Category: Medicine Hat News

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Irritable Bowel Syndrome

Some time ago I received a letter from one of the readers. It had multiple questions. So here are the questions and appropriate answers.

Q. Please describe irritable bowel syndrome (IBS). Is it constipation or diarrhea?

Irritable bowel syndrome is the most common chronic intestinal disorder. The symptoms are due to disturbance in the movement and sensation of the bowel. The person is otherwise well but presents with chronic or recurrent abdominal pain, change in bowel habit (constipation and/or diarrhea) and bloating.

Literature suggests at least 15 percent of the population has this condition. I feel that almost everybody has some element of irritable bowel syndrome.

It affects twice as many women as men and usually begins in early adult life. Although IBS can cause much distress, it does not lead to life-threatening illness. It is also called spastic colon.

Q. What can you do for it?

First, you have to see a doctor and get some basic investigations done to rule out any other illness like infection in the bowel, cancer, ulcerative colitis, Crohn’s disease, and celiac disease. Anemia, rectal bleeding and loss weight are not symptoms of IBS.

There is no cure for IBS. However, controlling the diet and emotional stress usually relieves the symptoms. Sometimes symptoms come and go. Some medicines may also help.

IBS is like arthritis of the gut. Just as in arthritis, your doctor may have to try more than one medication to control your symptoms.

Q. Early in spring, I had diarrhea for two weeks. Things settled down a lot since. I have a lot of gas and grumbling. Could this be due to stress?

That is quite possible. Stress plays a significant negative role in many of our illnesses. But before you blame everything on stress, you should talk to your doctor and let him decide the cause of your “back door trots”.

The subject of irritable bowel syndrome has been covered in these columns previously. These columns are available on my web site: www.nbharwani.com. Or you can pick up a copy of the relevant article from my office.

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Carpal Tunnel Syndrome

A young lady wants to know about carpal tunnel syndrome. What is it? Who gets it? How is it managed?

Carpal tunnel syndrome was first described in 1853. It is a common, painful disorder of the wrist and hand. It is caused by pressure on the median nerve in the wrist. The median nerve travels from the forearm into the hand through a “tunnel” in the wrist.

The cause of the pressure can be multifactorial. Some common causes and associated conditions are:
-repetitive and forceful grasping with the hands
-repetitive bending of the wrist
-broken or dislocated bones in the wrist which produce swelling
-arthritis, especially the rheumatoid type
-thyroid gland imbalance
-sugar diabetes
-hormonal changes associated with menopause
-pregnancy

Although any of the above may be present, most cases have no known cause.

It can occur at any age. The condition occurs most often in people 30 to 60 years old, and it is 5 times more common in women. It affects the dominant hand more frequently. It may affect both hands.

The symptoms start with pins and needles in three and half fingers (thumb, index finger, middle finger and half of ring finger) that are supplied by the sensory branch of the median nerve.

This may be followed by pain in the distribution of the median nerve, from the tip of the fingers to the neck. Symptoms may be worse at night and wake the patient from sleep. Relief is obtained by dangling the arm over the side of the bed.

Eventually, the median nerve supplying the small muscles of the hand may be affected. This produces wasting and weakness of the hand. There may be tendency to drop things.

A good history and physical examination is very important. Sometimes the condition may be confused with other problems affecting the shoulder and the neck. Therefore, nerve conduction study of the median nerve can provide more information.

The nerve conduction study helps localize the site of the entrapment and estimate the severity of damage. In less than 10 percent of the patients the test may be falsely negative. Clinical correlation is required to come to a final diagnosis.

Non-surgical treatment of carpal tunnel syndrome is: avoidance of the use of the wrist, placement of a wrist splint in a neutral position for day and night use, and anti-inflammatory medications.

Splinting can be combined with steroid injections. In one study, 80 percent had immediate relief of symptoms. But after one year only 20 percent were free of symptoms.

Ergonomic redesign of work stations is widely practiced for prevention and for relief of symptoms.

Surgical treatment involves a small incision on the palmar aspect of the wrist and the hand. The incision is deepened to divide the ligament to open the tunnel. Thus the pressure on the nerve is released.

The surgery requires no hospitalization and is done under local or regional anesthetic. No genera anesthetic is required. Studies have shown that surgical treatment relieves symptoms in 82 to 98 percent of the patients.

Relief of symptoms and return to normal level of physical activities may take few days to several months – depending on the damage to the nerve and the type of activity. Physiotherapy may become necessary.

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Trip to Jamaica! – Evidence Based Medicine

You see a doctor for a medical problem. He advises you to follow certain treatment. Do you ever ask him: Doctor, is there any scientific evidence to show that this treatment works?

Most of us trust our doctor and are too polite to ask him such a question. Instead we rely on our neighbors, friends and families to give us a second and a third opinion.

Those who are computer literate surf the internet. But you know what happens there – there are thousands of references to search for an answer.

What do doctors do when they are looking for best evidence in their practice?

Doctors go back to their text books, read medical journals, talk to their colleagues, have case conferences in hospital or attend medical meetings at exotic places.

My surgical associate, Dr. Brzezinski and I just got back from Montego Bay, Jamaica where we attended a two day conference on Evidence Based Medicine in Gastroenterology.

It was a very interesting conference. The location was beautiful – an ideal environment to learn something! The warm ocean breeze, carrying important scientific knowledge, penetrates your brain without difficulty!

There were experts from Europe, Canada and Jamaica. Main discussion was on the problems of the esophagus and stomach.

As I have said many times here, medicine is an imperfect science. Quite often the practice of medicine is an art than science. And the discussion at the Jamaican conference again confirmed that.

Only about 10 to 20 percent of what we do in medicine is evidence based. That means it is scientifically proven. The rest is based on what each one of us think is correct, what we think is best for a particular patient, it is economical and safe.

The advantage of evidence based medicine is that it helps optimize patient care and minimize variation in best practice.

The problem is that in most cases there is not enough evidence available. The clinical decision making is a very complex process because no two patients respond to a treatment in exactly the same manner.

Therefore, evidence based medicine in clinical practice is quite often not relevant.

But in spite of imperfections in medical practice, we continue to treat hundreds and thousands of patients each day. Most of them do well and respond to treatment.

Some get better just by talking to a sympathetic doctor.

Some get better by taking an aspirin and going to bed.

Some get better by doing nothing – may be a shot of brandy. Or Jamaican style – don’t worry, be happy.

Some get better by following the principles of ELMOSS – exercise, laughter, meditation, organic/healthy food, stress relief, and by giving up smoking.

But eventually, most people do get better. Time is a good healer – unless you are suffering from an incurable disease.

So, medicine is not a rocket science. But you have to know the human anatomy, physiology, pharmacology, and pathology. Then you have to put all this knowledge together and pass few exams. Then you can call yourself a doctor of medicine and surgery!

Isn’t that easy? It just takes 10 to 15 years of your life. Then you start practice and find out that only 20 percent of what you practice is based on pure science! But you can say – I have been to Jamaica!

Seriously – next time you are sick………………well see your doctor first!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Breast Feeding

Human milk is the ultimate form of early nutrition for children, and the search for the ideal substitution infant formula will never be concluded satisfactorily.

Dr.Yap-Seng Chong, BMJ September 20, 2003

The year 2003 marks the 12th annual World Breastfeeding Week. It is celebrated on the 40th week of the year (October 1-7) because from conception to birth, breast feeding is initiated on the 40th week.

One would think that breast feeding would be a natural sequential process after pregnancy and birth. Body’s hormonal system is designed in such a way that the breasts are ready with milk when the baby arrives.

Then why have World Breastfeeding Week?

A report shows that in Canada, the overall rate of breast feeding initiation was 75 percent in 1991 and 1992. Fifty-four percent of women were still breast feeding at three months and 30 percent at six months of age.

In 1995, 60 percent of women in the United States were breastfeeding either exclusively or in combination with formula feeding at the time of hospital discharge; only 22 percent of mothers were nursing at six months, and many of these were supplementing with formula, says another report.

The target is to have more than 75 percent of mothers breastfeed their babies in the early postpartum period and to have at least 50 percent to continue breastfeeding until their babies are six months old

What are the obstacles to the initiation and continuation of breastfeeding?

There are many. These include physician apathy and misinformation, insufficient prenatal breastfeeding education, disruptive hospital policies, inappropriate interruption of breastfeeding, early hospital discharge, lack of timely routine follow-up care and postpartum home health visits.

Other obstacles are: mother’s place of employment (especially in the absence of workplace facilities and support for breastfeeding), lack of broad societal support, media portrayal of bottle-feeding as normative, and commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and television and general magazine advertising.

These obstacles will have to be removed to encourage young mothers to provide the best possible care for their infants.

Extensive research has shown compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.

Both the American Academy of Pediatrics and the Canadian Pediatric Society have recommended breast feeding as the preferred mode of infant feeding.

The World Health Organization and UNICEF have developed explicit guidelines to encourage breast feeding around the world.

More information can be obtained by visiting the websites of these organizations. Locally, you can phone Community Health Services (403-502-8200) and get more information and help.

All communities worldwide need to protect, promote and support breastfeeding. And to remove barriers which inhibit young mothers to feed their infants on demand. We should encourage mothers to continue breastfeeding for at least six months.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!