Category: Medicine Hat News

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Gambling

Sometime ago, video lottery terminals (VLT) were in the news. People in general expected VLTs and all types of gambling to disappear.

Did this happen? No.

In fact, Canada experienced a dramatic increase in legalized gambling in the 1990s, primarily because of governments’ need to increase revenue without additional taxation, says Dr. David Korn, health and addiction consultant at the University of Toronto. His article appears in the Canadian Medical Association Journal.

Gambling is as old as human history. Casinos have existed at least since the 17th century. In the 20th century, they became commonplace and assumed almost a uniform character throughout the world. In the late 20th century, the governments started to get involved, generating revenue for programs that we would otherwise not be able to afford.

Dr. Korn says that there are now more than 50 permanent casinos (in 7 provinces), 21,000 slot machines, 38,000 VLTs, 20,000 annual bingo events and 44 permanent horse race tracks in Canada.

By 1997, Canadians were wagering $6.8 billion annually on some form of government –run gambling activity, 2.5 times that amount in 1992, with casinos and video lottery terminal accounting for almost 60 percent of government revenue from gambling. In 1997, gambling accounted for at least three percent of total government revenue in all provinces.

Public health problems associated with gambling were brought to the forefront in 1972, when Dr. Robert Custer, a psychiatrist in Ohio, described a medical syndrome called “compulsive gambling”. In 1980, the American Psychiatric Association included “pathological gambling” in its Diagnostic and Statistical Manual of Mental Disorders, categorizing it as an impulse disorder.

A pathological gambler is one who disrupts his personal, family and work related pursuits. There is development of tolerance – need to gamble with increasing amounts of money to achieve the desired excitement – and withdrawal.

About 5.5 percent of general adult population has problems with pathological gambling. The impact of gambling is significant on our vulnerable population such as youth (13.3 percent), women, older adults and aboriginal people, says Dr. Korn. Lower income households spend proportionately more than higher income households on gambling.

Is there help for compulsive gamblers?

Yes. Locally we have Gamblers Anonymous. For help and more information call Lynn (526-7792) or Shirley (527-7673). Gamblers Anonymous runs a 12-step program that has helped many people. If you are or have a tendency to be a compulsive gambler then a phone call is worthwhile.

There is Calgary based Gambling Help Line (1-800-665-9626) which can find you help with Legal Aid, credit counselling, and refer you to one of the rehab centres. These centres run 21-day rehab programs. You can also try AADAC (Alberta Alcohol and Drug Abuse Commission) at 529-3582.

Gambling continues to increase in Alberta and Canada. Dr. Korn says, “ The cost to families in terms of dysfunctional relationships, violence and abuse, financial pressure, and disruption of growth and development of children can be great.”

If you think you or your loved one have gambling problem then help is only a phone call away. Ask for it!

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Religion and Illness

Should physicians prescribe religious activities to treat medical ailments – just like they prescribe antibiotics? Why not! In an era of complementary medicine and alternative therapies, why not add religious activities to a long list of non-traditional therapies?

But the answer is not simple. There are people who think this is not a good idea. A group of 7 chaplains, representing a wide range of religions, and two biomedical researchers, have written an article in the New England Journal of Medicine expressing their concerns.

Polls do suggest that the U.S. population is highly religious, that most people believe in heaven and hell, the healing power of prayer, and the capacity of faith to aid in the recovery from disease. About 77 percent of hospitalized patients want physicians to consider their spiritual needs in the management of their problems.

Surveys of family physicians in U.S. strongly support the notion that religious beliefs can promote healing. Nearly 30 U.S. medical schools now offer courses on religion, spirituality, and health. Some physicians believe that going to church promotes good health.

But the authors of the article are troubled by the uncritical enthusiasm shown by the general public, individual physicians, and American medical schools in promoting religious activities as part of medical treatment. The authors feel that there is very little scientific evidence to show religious activities promotes good health. Their argument is summarised here:

1. Is there evidence of a link between religion and health?

Yes. Some studies have shown that regular church attendance, listening to religious television programs, praying, and reading the bible may be associated with improved health. But the authors believe that the evidence is generally weak and unconvincing, since most studies are poorly conducted. A prospective double blind trial would be most difficult to conduct.

2. Should physicians recommend religious activity as a way of providing comfort?

The authors quote a study that says: “The primary task of the physician is to cure sometimes, to relieve often, and to comfort always.” We know that many people do get comfort from religious activities. But is it ethical for a physician to prescribe religious activities to a patient without infringing on patient’s freedom of choice?

The authors feel that religious practices can be disruptive as well as healing. That physicians are not trained to engage in in-depth conversations with their patients about their spiritual concerns. And the physician and the patient may not have the same religious beliefs. Therefore, it may not be a good idea for physicians to get into prescribing religious activities to their patients.

3. Do patients want religious matters to be incorporated into their medical care?

Studies have shown that 40 to 50 percent of patients want physicians to attend to their spiritual needs. But these numbers do not emphasise the views of 50 to 60 percent of the patients who think otherwise. Most of these surveys are on inpatients. This may not be relevant to office and outpatient work.

What do you think? Do you agree with the arguments? Would you like your doctor to prescribe religious activities to you as part of medical treatment? Write to me at: 821A – 5th Street SW, Medicine Hat, AB T1A 4H7 or use my e-mail address.

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Stuttering

Dear Dr. B: Can you please tell me about stuttering? Why do people stutter and can it be cured? Yours, Mr. H.

Dear Mr. H: According to Webster’s dictionary, to stutter means to speak or utter with spasmodic repetition as a result of excitement or impediment.

Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for the person’s age. The speech disruptions may be accompanied by rapid eye blinks, tremors of the lips and/or jaw or other struggle behaviours of the face or upper body that a person who stutters may use in an attempt to speak. Stutters can predict 95 percent of the words over which they will stutter.

An article in the Canadian Medical Association Journal (CMAJ) quotes a study involving 1879 university students showing prevalence of self-reported stuttering of 2 percent. Information picked up from Encyclopaedia Britannica suggests that over three million Americans stutter.

Stuttering affects individuals of all ages but occurs most frequently in young children between the ages of 2 and 6 who are developing language. Boys are three times more likely to stutter than girls. Most children, however, outgrow their stuttering, and it is estimated that less than 1 percent of adults stutter.

Some successful famous stutters are: Winston Churchill, actress Marilyn Monroe, actors James Earl Jones, Bruce Willis and Jimmy Stewart. But in some, stuttering can interfere with academic and professional development and social communication and interaction.

What causes stuttering?

There are varieties of possible causes of stuttering but the precise mechanisms causing stuttering are not understood. Stuttering can be developmental or acquired.

Developmental stuttering is by far the commonest and may or may not be associated with psychiatric illness. Developmental stuttering occurs in children who are in the process of developing speech and language. Acquired stuttering in previously fluent individuals may be as a result of brain damage due to variety of causes including head injury and stroke.

Some stuttering may be hereditary but no gene or genes for stuttering has yet been found.

Speech-language pathologist, a professional who is specially trained to test and treat individuals with voice, speech and language disorders, makes a diagnosis of stuttering. If you suspect your child to have speech problems then the best thing is to consult your family doctor or your paediatrician and get a referral to a speech-language pathologist.

What is the treatment for stuttering?

In Roman times, stutteres were thought to be possessed by evil spirits that had to be exorcised. In the Middle Ages the tongue, thought to be the source of the problem, was tortured with hot irons and spices, says the article in Encyclopaedia Britannica.

The CMAJ article says that between 50 and 80 percent of children with developmental stuttering will recover with or without professional treatment, generally before puberty.

To prevent developmental stuttering from becoming a life-long problem, speech evaluation is recommended for children who stutter for longer than six months or for those whose stuttering is accompanied by struggle behaviours. Developmental stuttering is often treated by educating parents about restructuring the child’s speaking environment to reduce the episodes of stuttering.

Stuttering is something people do not want to talk about. I knew very little about the subject myself! So, thank you Mr. H for asking the question. And you can obtain more information from the National Institute on Deafness and Other Communication Disorders (National Institutes of Health) web site (www.nih.gov/nidcd).

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Summer Heat

The heat is on! The air conditioners are going crazy! And the people are asking: Hot enough for you?

Many of us have been waiting for this kind of weather. But is it healthy? Is it safe?

Some of you may remember the heat wave of Chicago in 1995. Many people died. About 20 years ago, heat also claimed the lives of 88 people in Memphis, Tenn. Most of these deaths are due to heat stroke. Heat stoke is dangerous and deadly but fortunately, preventable.

The vast majority of people affected by the immense heat are the elderly with medical problems such as mental illness, lung diseases, or heart disease. Social isolation is another factor. People who live alone and /or are confined to bed are at higher risk compared to those who have access to transportation, nurse visitors or social services, Having an air conditioner helps. But not many elderly people can afford it.

Memphis has adopted a protocol to prevent death from dehydration and heat stroke amongst the sick and elderly and the public in general. At the beginning of summer, officials organize surveillance of emergency departments in the area to see if heat-related visits have increased.

Once temperature starts to rise, media print or broadcast general public advice to increase fluid intake, to reduce physical activity, and to seek medical help for heat related problems.

Visiting nurses, Meals on Wheels workers, and letter carriers help out in finding people who live in isolation and are at increased risk of heat stroke.

Our temperatures may not rise to a level of heat waves seen in Chicago or Memphis but the danger is still there for people of any age group who do not maintain adequate fluid intake during summer months. Especially people with medical conditions.

Effective treatment for heat stroke depends on rapid diagnoses and rapid cooling. Otherwise, a chain of events will lead to irreversible injury and death.

The blistering sun is also damaging to our skin if it is exposed to the sun for prolonged periods of time on a regular basis. The damage is cumulative, starting with sunburn and progressing over a period of time to skin cancer.

There are three types of skin cancers: Basal Cell Cancer, Squamous Cell Cancer and Melanoma. First two are very common and can invade local tissues but are not fatal. Melanoma is not that common but can be fatal if not detected early and excised.

Can we prevent skin cancer? Yes! The Canadian Cancer Society recommends the following preventive measures:

1. Avoid prolonged exposure to the sun especially between 11 a.m. and 4 p.m.
2. Wear protective clothings, such as long-sleeved shirts, and wide brimmed hats.
3. Use a sunscreen with a SPF of 15 or higher to absorb ultraviolet rays.
4. Seek prompt treatment of any skin abnormality.

Summer is time for out door activities and fun. Children are out of school. Many adults take holidays during this time to enjoy family life. When we are having fun, it is hard to remember the dos and the don’ts. So let us make it simple by remembering two facts:

1. Skin is the largest organ of our body and has many important functions to protect us from environment.
2. About 60 percent of our body is water. Water and salt is vital to the survival of our cells and tissues.

So let us treat our skin with respect and keep our systems well lubricated with water and have fun!

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