Category: Medicine Hat News

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Breast Self Examination

Dear Dr. B: I have been doing breast self-examination (BSE) for many years. But recent recommendation by the Canadian Task Force on Preventive Health Care has confused me. Can you please tell me whether I should continue to do BSE? And what is the Task Force’s exact recommendation? Yours, Ms. Confused.

Dear Ms. Confused: My recommendation would be to continue to do breast self-examination. If we are going to ask women to discontinue with BSE then we should ask the public to stop having rectal examination for detection of rectal and prostate cancer, we should stop doing PSA tests, we should stop checking moles, we should ask men not to examining their testicles for tumour – well I can go on and on.

Unfortunately, medicine is not a perfect science. That is why evidence based medicine is not popular with physicians who have to deal with sick and anxious patients face to face. Common sense and sense of responsibility dictates that we should continue to examine and check our bodies for any obvious abnormalities.

Of course, conducting unnecessary invasive tests without adequate clinical indication is not acceptable. But BSE is inexpensive and non-invasive test requiring no high tech machinery.

What did the Task Force recommend?

1. Women aged 40-69 years should not do BSE, as there is a fair evidence of harm and no evidence that it saves lives.

2. Women younger than 40 and older than 70 – no recommendation was made as there is lack of sufficient evidence to evaluate the effectiveness of BSE in this age group.

What are the recommendations based on?

The Task Force reviewed several large studies and failed to find any evidence that BSE prevents death from breast cancer. In fact, the studies show that women who do BSE visit doctors more often for evaluation of benign breast disease, and have higher rates of benign breast biopsy results. This inflicts anxiety and pain not only to patients but to their families as well.

Is this a big price to pay to rule out breast cancer?

Breast cancer is the most frequently diagnosed cancer among Canadian women. Breast cancer accounts for 30 percent of all new cancer cases diagnosed each year, says the Task Force article in the Canadian Medical Association Journal. Each year, 25 percent of women with diagnoses of breast cancer die.

Well, you be the judge. Each woman has to decide what is important for her. It is your body and you should have full control over it. If you are going to do regular BSE then make sure that you learn the right technique. Information pamphlets and videos are available at the Canadian Cancer Society office (Phone: 529-8015).

Early detection of breast cancer requires three tests: BSE, clinical examination of the breasts by a physician or a trained nurse, and mammography. None of these tests are hundred percent accurate in detecting early breast cancer. Therefore, many physicians, including myself will follow the dictum that a breast lump is malignant until proven otherwise. I would rather remove a benign lump then miss a breast cancer!

Ms. Concerned, I hope this answers your question. If you are going to continue to do BSE then make sure that your technique is correct.

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My Summer Holiday

Holidays are wonderful. They do wonders to our mental and physical health.

In the previous column, we talked about the advantages of taking a holiday. Holidays take us away from our daily chores and problems to a life of fun, freedom, happiness and family bonding. Holidays recharge our batteries and give us a different perspective to our daily life.

But sometimes we forget that even the best-laid plans can go wrong. Not because we did not do our homework, but the parties who promised to make our holiday a success fail to keep up to their end of the bargain. And if we are not careful then the experience can be very demoralizing. Allow me to share with you my recent experience.

Our recent holiday was planned to cover five cities (Ottawa, Quebec City, Montreal, Toronto and Niagara Falls) in two weeks, staying at four different hotels.

My wife had diligently planned the holiday with help from our travel agent. She booked our airlines tickets about three months ahead of time. At the same time the hotels were booked, confirmed and rooms guaranteed with credit cards. Special requests were made on the type of rooms we wanted. A rental van was also booked, and confirmation guaranteed with a credit card.

Since we like to have a trouble free holiday, a week before our departure, my wife phoned all the hotels we had booked with to reconfirm our bookings and requests for the types of rooms we wanted. July and August are busy months for the hotels.

On Canada Day, we (my family) drove from Medicine Hat to Calgary and then took a flight to Ottawa. After about twelve hours, we arrived in Ottawa at midnight. We went to the car rental agency to pick the van we had booked.

“Sorry Sir, we don’t have the van which you had booked. But we can give you an upgrade at no extra charge!” said the desk clerk. At midnight, after 12 hours of journey, with two tired children, was I supposed to be overjoyed that I was getting a free upgrade? I was not pleased. There was a special reason why we booked a van and not any other vehicle. I was too tired to do argue and settled for the free upgrade.

We drove to our hotel and got there at about one in the morning. The lady at the check in counter says to my wife, “Sorry, we don’t have any rooms for you for tonight. We will put you up at another hotel for one night at our cost!” So what was the purpose of our booking three months ahead of time and guaranteeing with a credit card? This is a four star hotel!

We checked in at the other hotel. It was two in the morning. Next day we got the rooms we had asked for at our original hotel but not before we made a big fuss with the Manager. We lost one day of our holiday by moving back and forth and talking to the front desk several times.

The rest of the holiday at the hotel and Ottawa was wonderful. Ottawa is full of Canadian history. A must for all Canadians to visit, specially school children. At the Canadian Museum of Civilization there is a display of Medalta Potteries and old photographs of the Medalta buildings.

Our next stop was Quebec City. We checked in at our four star hotel. Again they did not have the rooms we had asked for. Next day we talked to the desk Manager and he found the rooms we wanted. Why wouldn’t they give it to us when we checked in?

Quebec City is one of my favourite cities. Very beautiful and clean. They wash their streets everyday in the morning. They plant thousands of trees every year. Every new building has to have a piece of art or sculpture in front. We found the people very friendly. And every body we talked could communicate in English. It was a very enjoyable stay.

Our next stop was Montreal. Crowded and dirty. What a contrast from Quebec City! Culturally, Montreal is a very exciting place. They have hundreds of festivals each year. When we were there, they had just finished the Jazz Festival and were getting ready for Just for Laughs festival. We kept our stay brief and went to the next stop – Toronto.

Toronto is another busy and dirty city. There is lot to see, including the CN Tower. We had an interesting visit including a day of shopping! We spent a day at Niagara Falls. About an hour and half drive from Toronto. Niagara Falls is one of my favourite places.

The exciting Maid of the Mist boat tour takes visitors to the base of the American Falls and then on to the basin of the Canadian Horseshoe Falls. “It’s a half hour thrill of a lifetime,” says a tourist brochure. And I agree. It is also a photographer’s paradise. So many views and angles!

Finally, it was time to go home. Ready to work and pay the bills and plan for the next holiday! Inspite of the few glitches, we kept a positive attitude and paced ourselves. And returned home satisfied that we did everything we wanted to do.

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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Having a Healthy Holiday

By the time you read this, you and your children will be ready for a holiday. But, again, you may think you are too busy to take time off. You think the world will come to an end if you are not around. Well, you are not the only one who thinks like this. About five million Canadians think the same way.

As somebody has said: Work is a mysterious thing; many of us claim to hate it, but it takes a grip on us that is so fierce that it captures emotions and loyalties we never knew were there.

So, if you are not listening to your mind, your body or your children then see if you like what Leonardo da Vinci (1452-1519) has to say. This is what he said about 500 years ago:

Every now and then go away,
Have little relaxation,
For when you come back to your work
Your judgement will be surer;
Since to remain constantly at work
Will cause you to lose power of judgement…
Go some distance away
Because the work appears smaller
And more of it can be taken in at a glance,
And lack of harmony or proportion
Is more readily seen.

If that was true then surely it is true now. As the Eddy Bauer ad says: Never confuse having a career with having a life.

If you have already planned to take a holiday then make sure it is safe and healthy. Food and water is what we consume the most on our holidays. You should make sure that drinking water is safe. Otherwise look for bottled water.

Be careful about fast food. Food sold by street vendors and restaurants, which do not look clean, should be avoided. Do not forget your daily dose of fruits and vegetables to keep your bowels regular.

If you have a medical condition then make sure you have enough medications with you to last through your holiday. If you are planning to go abroad then make sure your medication containers are labelled appropriately so the customs officers do not bother you.

Don’t forget to take your running or walking shoes. Thirty minutes of daily exercise will keep your body tuned up. If you are flying or driving then exercise your ankles and calf muscles to avoid forming a clot in the deep veins of your legs. Do not drive if you are tired. Take a break and have power nap. Or let somebody else drive for few hours while you rest.

Jet lag and time difference is another problem. You are not only sleep deprived but also your digestive and other systems take a beating. There is no easy solution to this problem. Just have to catch up with your sleep and adjust slowly over few days.

These are just a few ideas on making your holiday safe and healthy. If you are one of the five million Canadians trying to win the rat race then remember what Lily Tomlin said, “Even if you win the rat race, you are still a rat!”

Well, who wants to be a rat? I want to be a happy camper, and one way to do that is to listen to what Leonardo da Vinci has said. “Every now and then go away, have a little relaxation….”

And have a safe, happy and healthy summer holiday.

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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Laughter is Good Medicine

“Only three things in life are real: God, human stupidity, and laughter. But the first two pass our comprehension; we must do what we can with the third,” says Aubrey Menen in The Ramayana.

We must do what we can but are we doing enough?

We are lucky. We are blessed with the greatest gift of all – capacity to laugh. But quite often we are trapped in the cycle of fear, depression, and panic. We forget our best weapon against pain and misery is laughter.

Mark Twain said: “The human race has only one really effective weapon and that is laughter.” But the weapons we use against our fellow humans are weapons of terror, destruction, greed, treachery, and hypocrisy.

But, of course, there are exceptions. In his bestseller, Anatomy of an Illness, Norman Cousins writes about his battle against painful condition of joints and muscles. He says, “I made the joyous discovery that ten minutes of genuine belly laughter had an anaesthetic effect and would give me at least two hours of pain free sleep.”

Laughter has been known to be therapeutic for many centuries. But laughter is becoming a rare event in most of our lives as the world becomes faster, smaller, and complicated. We live in a world of instant gratification and band-aid solutions. This does not allow us any time to explore the beauty of the gift of laughter.

Ashley Montagu, who has written about laughter, says that only those animals capable of speech are capable of laughter and the humans being the only animal that speaks, is the only animal that laughs.

So, why do humans laugh? We laugh for many reasons. And for centuries biologists, philosophers, psychologists, and medical doctors have sought a definitive explanation of laughter.

Like anything else, there are positive and negative aspects of laughter. In a negative way, people use laughter to intimidate others, and gain stature over them by humiliating them. We laugh when we compare ourselves with others and find ourselves superior and in fact we laugh at the infirmities of others.

In a positive way, we laugh in order not to cry, we use laughter as a remedy for painful experiences, and we laugh to show our happiness.

The average six years old laughs 300 times a day, the average adult laughs about 170 times a day. Can adults do better?

Sure, we can do better if we have the determination do something about it. First, we need to have a strong desire to live a pain free, stress free, happy, and healthy life. Then we need to assign certain amount of time everyday or every other day to be creative so that laughter is fun rather than a chore to be accomplished.

Here are some helpful hints from www.laughter.com:

-Think funny – find humour in different situations
-Personalize material – adapt humour to personal situations
-Be the target – poke fun at yourself
-Share your humour with others
-Play with children
-Watch comedy shows and movies
-Read funny books, comics, cartoons
-Sing and dance to music
-Seek company of people who are happy and funny

Let me end by telling you couple of doctor jokes taken from laughter.com:

How many psychiatrists does it take to change a bulb?
One, but the light bulb has to want to change!

“Doctor, I can’t stop behaving like a dog.”
“How long have you been acting this way?”
“Since I was a puppy!”

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