Category: Medicine Hat News

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Religion and Peace

My first column appeared on August 13th, 1998. In that my imaginary friend Dave asks, “Doc, how can I stay healthy?”

This question is valid today as it was four years ago. Perhaps it has been valid for many hundred years. I guess our ancestors cared about their health as much as we do. And our struggle to stay healthy will continue. There are no short cuts and no magic pills. Its hard work!

Some people believe that physical health should go hand in hand with spiritual health. But is our spiritual health in any better shape than our physical health?

My December 30th, 1999 column was about “nirvana for the lifetime”! As somebody has said, “If a man thinks about his physical or moral state, he usually discovers that he is ill.” If we look at the philosophy and practices of all the great religions of the world we would not find any people in the world who do not believe in the existence and survival of human souls.

Unfortunately, we have people in our society who do not believe in this.

More than half the world’s population is made of Christians and Moslems. Like the Bible, the Qur’an is a book of divine revelation. The Bible and the Qur’an both reveal the word of God, says an article in The Newsweek. Both speak of prophets, redemption, heaven and hell.

Judaism, Hinduism and Buddhism make up most of the rest of the world who believe in God and the triumph of good over evil.

Historically, people have been fighting with each other since Adam and Eve. All the messengers of God have come and gone. They made many changes. But they did not abolish greed, conflicts, wars, hatred, revenge and thirst for blood.

Religion and education has made us smarter but we cannot get rid of our primitive instinct of hatred and revenge. Well meaning decent people try very hard to suppress those unhealthy feelings. And to most extent they succeed. But there are others who use their religion and education to produce more powerful and sophisticated weapons of mass destruction.

Nobody talks about the gentler kinder society anymore. Not even in the month of December. We are still talking about war, suicide bombings and revenge. All the talk is about attack. Is there a safe place in this world to hide, relax and meditate?

I was looking at my millennium edition column in The Medicine Hat News. It was about ELMOS (exercise, laughter, meditation, organic healthy food, stress relief). The message was and is to combine physical health with spiritual health. Exercise for the body, peace for the mind, prayers for the soul. That was two years ago!

In the last month or so, Hindus celebrated Divali, Muslims celebrated Ramadan and Eid, Jews celebrated Hanukkah, and now the Christians will celebrate Christmas. That means billions of people all over the world would have gone through prayers and celebration in one month. Is this going to change the bad and the ugly in our society?

May be it is time to clone a messenger with DNA from Jesus, Confucius, Moses, Mohamed, Krishna, Buddha, and call him – JECOMOMOKRIB. The question is – will he succeed where others have failed? Especially with a name like JECOMOMOKRIB? Sounds like Michael Jackson!

So how do you plan stay healthy in mind and body in 2003? Do you think Michael Jackson can heal the world or do we need JECOMOMOKRIB?

Greetings for the holiday season and Happy New Year. Let there be peace for all! Amen.

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Hysterectomy

Hysterectomy means surgical removal of the uterus. It is the most frequently performed major surgical procedure in gynecology. Hysterectomy came into widespread use about hundred years ago.

Last year, in Palliser Health Region, 159 hysterectomies were done, 50 vaginal and 109 abdominal.

In Canada, in 1998-99, 462 hysterectomies were done per 100,000 women over the age of 20. This rate varies per province from a low of 434 in British Columbia to a high of 750 in Newfoundland. Within each province, the rates fluctuate significantly by region as well, says Health Canada statistics.

The rates also fluctuate among different Western countries. For example, 37 per cent of women in the United States have had hysterectomy by the age of 60, compared to 20 per cent of women in the United Kingdom.

This raises several questions:
-Why are so many hysterectomies performed?
-Why do the rates vary so much?
-What are the outcomes, and do outcomes differ among different types of hysterectomy?

Answers to these questions are discussed in the October 24th editorial in the New England Journal of Medicine (NEJM).

In 1880, death rate due to abdominal hysterectomy was 70 per cent. In 1930, it was three per cent. Now it is less than 0.1 per cent. This has made it safer to operate on women with benign and malignant gynecological conditions. Thus more women benefit from the procedure.

Most common indication for hysterectomy is to improve a woman’s quality of life rather than cure life-threatening conditions, says the NEJM editorial.

The majority (85-90 per cent) of hysterectomies are done for fibroids, endometriosis or uterine prolapse. And their symptoms are:
-Heavy or irregular uterine bleeding
-Pelvic pain
-Pelvic pressure

There are several reasons why rates of hysterectomies vary from country to country, province to province and from region to region. For example, application of drug therapy and minimally invasive surgical techniques are available to treat the conditions for which hysterectomy may be performed, says the editorial.

However, the success of such methods of treatment are not always uniform and without side-effects. Some women are desirous of keeping the uterus and others want relief from hysterectomy. And a treating physician’s preference becomes an important factor in deciding whether hysterectomy should be done or not. All these factors make rates of hysterectomy variable.

The editorial says that there is no universal agreement with respect to strict criteria for hysterectomy, and treatment is currently tailored to individual patients. Studies have shown that 96 per cent of women who had hysterectomy for severe pelvic pain had complete resolution of their symptoms.

Currently there are three ways of doing hysterectomy: vaginal, abdominal and laparoscopic. This may be total (including the cervix), or subtotal (cervix is preserved), and with or without ovaries.

In Canada, in 1999-2000, 32 per cent of hysterectomies were vaginal, the rest were abdominal and laparoscopic.

In U.S., between 1990-97, 65 per cent of hysterectomies were total abdominal, 23 per cent total vaginal, 10 per cent total laparoscopic, and two per cent subtotal abdominal or laparoscopic. The NEJM editorial says that it is not clear whether all types of hysterectomy result in similar outcomes.

However, hysterectomy, whether total or subtotal, has beneficial effects on urinary tract symptoms like stress incontinence, urgency, frequency, and voiding at night. And it does not cause deterioration in sexual function.

Over the last 100 years, hysterectomy has helped many women improve their life style. It will continue to do so until other treatments are developed that provide similar results, says the editorial.

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Islam

Depending on the moon’s visibility this week, 1.3 billion Muslims all over the world will be celebrating the end of the holy month of Ramadan. This celebration, “festival of breaking fast”, is called Id or Id al-Fitr.

Ramadan falls in the ninth month of the Muslim lunar year. All Muslims are expected to fast from dawn to dusk, refrain from drinking, smoking and sexual intercourse. Those who are sick, travelers, pregnant women, nursing mothers, and young children are exempted.

The aim of this self-discipline is to remind and reinforce among all Muslims their commitment to the legacy and teachings of prophet Mohamed. It also helps them understand and connect with their fellow human beings, and ultimately connect with God.

Islam, the religion of all Muslims, was revealed to Prophet Mohamed in Arabia in the 7th century AD. Islam is an Arabic word which means “surrender”. A Muslim accepts to surrender to the will of Allah – Arabic for God.

The will of God (Allah) was revealed to his messenger, Mohamed, and documented in the holy book called Quran (Koran). Ramadan marks the first time the Quran was revealed to prophet Mohamed. Mohamed was the last messenger and prophet of God after Adam, Noah, Jesus and others.

Historians consider the religion of Islam as one of the outstanding phenomenon of history. But Islam has no central authority (like Vatican) to guide its followers. And there are numerous divisions and subdivisions that interpret Quran in many different ways.

All Muslims observe the five pillars of religion. These are: recital of the Creed (There is no God but God, and Mohamed is the Prophet of God), prayer, fasting, almsgiving and pilgrimage to Mecca.

Prophet Mohamed had two sources of authority, one religious and other secular.

After the death of the prophet, two streams of thoughts split Muslims into Sunnis (the majority) and Shias (means a stream). Sunnis believe that Mohamed did not appoint a successor to take over the religious authority. So it was left to the Faithful to interpret the Quran.

The Shias believe that after the prophet’s death, Divine power was transferred to Hazrat Ali, prophet’s son-in-law, as the first Imam or spiritual chief of the devout. Shias followed the guidance of hereditary Imams. Some time they failed to agree who the rightful Imam was, resulting in further subdivisions.

In Islam, there are no priests or monks. There is no confession of sins except to God. Cleanliness and personal hygiene is important. Prayer is a daily necessity. Wars are condemned because Islam is a religion of peace.

If so, then why are Muslims constantly linked to violence and terrorism in the media and in the minds of some non-Muslims?

Is violence and terrorism a disease infecting a segment of the Islamic world or all of 1.3 billions of them? Or is it part of our culture – Muslim and non-Muslim?

If violence and terrorism is a disease then experts all over the world should listen to the symptoms, examine the signs, do investigations, come to a diagnosis and have a treatment plan. In medicine, if a cause is known then prevention and treatment is easy.

The Islamic world is in turmoil. The legacy of prophet Mohamed is being challenged by Muslims and non-Muslims. The various interpretations of the Quran are tearing the religion apart. Who is going to save Islam?

Happy Id and may peace be with you, Amen.

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Celiac Disease

A reader wants to know about celiac disease. Celiac disease is also known as celiac sprue.

Celiac means abdominal cavity. Celiac disease mainly affects the small intestine which is in the abdominal cavity. Very rarely it can affect stomach, colon or rectum.

Sprue is a chronic disorder that occurs in tropical and nontropical forms. It can affect children and adults. It is a condition in which nutrients are not absorbed. Symptoms of sprue include foul-smelling diarrhea and loss of weight.

Celiac sprue is due to gluten sensitivity of the small intestine. Gluten is a mixture of plant proteins occurring in cereal grains, chiefly corn and wheat, used as an adhesive and as a flour substitute. Gluten is a complex and variable mixture of glutin or gliadin, vegetable fibrin, vegetable casein, oily material, and others.

Gliadin is any of several simple proteins derived from rye or wheat gluten. It is capable of inducing a toxic response among individuals who lack the enzyme necessary for its digestion. Gliadin is vegetable glue or gelatin

Celiac sprue has been described since the first century A.D. But it was in 1940s, when a link to gluten was established by a Dutch pediatrician. He observed that children with celiac disease improved during the food shortages of the World War ll. But the symptoms recurred when the cereal supplies were restored, says an article in the New England Journal of Medicine (NEJM).

Symptoms of celiac sprue in children appear when cereal is introduced in their diet, anywhere between the ages of four to 24 months. They present with diarrhea, impaired growth and abdominal distension. Vomiting, anemia and swelling of the body tissues with fluid occur due to malnutrition.

Celiac sprue can develop in adults as new cases. The NEJM article says that 20 per cent of the patients may be diagnosed after the age of 60. Otherwise, most adults with celiac disease will have history of the disease going back to childhood.

NEJM article says that iron-deficiency anemia is now the most common clinical presentation in adults with celiac sprue. And approximately 50 per cent of adult patients do not have clinically significant diarrhea.

There are several immunological blood tests available to make a diagnosis of celiac disease. But the only confirmatory test is small bowel biopsy. Usually from second or third part of the duodenum during gastroscopy.

A person should not be prescribed gluten free diet until the biopsy has confirmed the diagnoses. Abnormality in small bowel disappears once the person strictly follows gluten free diet. So biopsy first is mandatory.

What are the dietary guidelines for patients with celiac disease? The NEJM article advises as follows:

1. Avoid all foods containing wheat, rye, and barley gluten.
2. Avoid all foods containing oats and lactose (at least initially).
3. Use only rice, corn, maize, buckwheat, potato, soybean, or tapioca flours, meals or starches.
4. Look for foods that have the gluten-free symbol.
5. Try foods containing wheat starch from which gluten has been removed.
6. Read all labels and study the ingredients of processed foods.
7. Beware of gluten in medications, food additives, emulsifiers, and stabilizers.
8. Avoid all beers, lager, ales, and stouts.
9. Wine, liqueurs, most ciders, and other spirits, including whiskey and brandy, are allowed.
10. Take essential medications through other routes than mouth if malabsorption is severe.

Once celiac is diagnosed, it is prudent to stay on a life-long gluten-free diet. It is not easy but the alternatives are worse – development of cancer of the small bowel and other complications related malnutrition.

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