Category: Medicine Hat News

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Influenza (Flu)

Flu and pneumonia can be serious illnesses.

“Influenza (flu) is a highly contagious acute respiratory disease of global importance,” says an editorial in the New England Journal of Medicine.

The editorial says that vaccination is currently the most effective measure to reduce the impact of influenza. But it is not easy to formulate a vaccine for a constantly changing virus. For the last 50 years, World Health Organization has monitored the appearance and spread of new variants of the virus worldwide that may cause the next epidemic. This usually results in producing well-matched vaccines.

How does the vaccination work?

It works by exposing an individual to modified form of influenza virus in order to generate an immune response.

For many years, attempt has been made to prevent and control influenza by vaccinating people over 65, those with chronic medical conditions (heart disease, lung problems, diabetes, kidney disease etc.), medical care providers and others who might transmit the virus to those at risk.

This effort has considerably reduced deaths from this disease. The flu epidemic of 1918 killed 21 million people worldwide. The epidemics come every two years but we have better tools now to save lives.

There is also some comfort in the news that research has produced new ways of dealing with this challenging problem – by way of producing oral antiviral agents. There are few in the market and the newest one – Relenza – has been approved by Health Canada and should be in the drug stores soon.

This takes us to another related disease – pneumonia.

“Invasive pneumococcal disease can be deadly,” says Dr. Ross Pennie, Professor in the Faculty of Health Sciences at McMaster University in Hamilton, Ontario. In an editorial in the Canadian Family Physician, Dr. Pennie says that fewer than 5 percent of the population at increased risk of pneumonia has received the pneumococcal vaccine.

Alberta Health says that the pneumococcal vaccine is now available – free of charge – to all Albertans over the age of 65 through community health clinics and physicians’ offices. The vaccine can prevent serious infections caused by the bacteria Streptococcus pneumoniae.

The organism can cause pneumonia, meningitis, and sinusitis. About 400 people die each year in Alberta from pneumococcal infection.

Among those at greatest risk for the disease are seniors, people living in a nursing home or other long term care facility, or those over two years of age who have medical conditions that may affect their body’s ability to fight diseases, says Alberta Health.

These conditions are: people who have had their spleen removed, who have diabetes, lymphoma, chronic diseases of the heart, lungs, liver, and kidneys. The current vaccine is ineffective for children younger than 2 years.

“In most cases, one pneumococcal vaccination is all a person will ever need,” says Dr. Karen Grimsrud, deputy provincial health officer.

Over the years, flu and pneumonia has taken many lives in nursing homes and seniors living at home. Remember, help is here. It is free. So, if you are not sure whether you need to take these vaccines then speak to your doctor or a public health nurse. Do it soon.

Have a healthy winter!

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Breast Pain

Fear of cancer makes Susan seek help when she discovers a lump in her breast.

“Fear is not an unknown emotion to us,” says Neil Armstrong, the first man to walk on the moon.

“Just as courage imperils life, fear protects it,” says Leonardo da Vinci.

It is this protection women look for when they visit their physician with a breast lump.
The scenario of fear and protection leads to frequent office visits, multiple negative needle and surgical biopsies, and sometimes-more anxiety and more fear.

In fact, only 10 to 20 percent of biopsies of breast lumps show cancer. But this is necessary if we are to treat every breast lump as malignant until proven otherwise.

In the last column, we discussed about fibrocystic changes in the breast and the pain associated with this condition. Susan wants to know how this condition is treated.

Painful breasts can be cyclic (associated with menstruation) or non- cyclic. Two thirds of the women have cyclic pain and one- third experience non-cyclic pain.

First step in the management of this problem is to rule out cancer. This is done by history, physical examination, needle biopsy and if indicated, by mammography. If there is a persistent lump after all this then surgical removal becomes necessary. A pathologist’s report will give a definitive answer.

This process will help reassure 85 percent of the women. Their pain is not significant enough to require more than regular painkillers or anti-inflammatory medications. The remaining 15 percent will continue to have severe pain, which will affect their lifestyle and warrant more than regular painkillers.

This is where we are long on drug choices but short on effective uncomplicated therapy.

Here is a list of substances tried: birth control pills, progesterone, bromocriptine, danazol, thyroid hormones, tamoxifen, vitamins A, B-complex, and E, diuretics (water pills), prostaglandin inhibitors, iodine, primrose oil, restriction of methylxanthine (coffee, chocolate), and the list goes on.

In young women in their 20s, the birth control pill may be helpful as it provides a stable amount of hormones each month.

Bromocriptine (a prolactin hormone antagonist), and danazol (a synthetic anti-estrogen) have been found to be helpful to large number of women but these drugs have significant side effects. Side effects of bromocriptine are – nausea, headaches, and dizziness. Side effects of danazol are – loss of menstruation, weight gain, acne, hirsutism, and voice change.

Other popular remedies advocated are the use of primrose oil, iodine, and restriction of chocolates, and caffeine containing substances. Whether the benefits obtained are real or psychological is debatable. But the use of or restriction of these substances have no side effects and in fact may be beneficial for other reasons!

There is no effective uncomplicated therapy applicable to all women with painful lumpy breasts. There is lack of research on breast pain. But it is important to remember that pain is usually not an indicator of cancer in the breast. And a breast lump is considered malignant until proven otherwise.

Well, Susan, are you better informed now? She smiles and says: Thank you for now, Dr. B!

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

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 Pain

Breast pain is a common complain among women of menstruating age.

Susan is no exception. Besides pain, she has lumps in both breasts. Her symptoms are cyclic – associated with menstruation.

Since October is Breast Month, Susan wants her breasts examined. She is worried about cancer.

Susan’s physical examination reveals diffuse lumpy areas in both breasts with one discreet lump (about 3 cm in size) in the right breast. A fine needle aspiration of the lump confirms the presence of clear fluid and the lump disappears.

Susan’s mammogram reveals no suspicious lesions to suggest cancer. She is aware that 15 percent of mammograms fail to detect cancer (false negative).

Therefore, the conclusion is that Susan has fibrocystic changes in her breasts. The old term “Fibrocystic Disease” has now been replaced with fibrocystic changes. It cannot be a disease if the condition is very common, responds to physiological hormonal changes, and disappears later in life.

Women with fibrocystic changes not only suffer from pain but also have significant anxiety about cancer. One can easily miss a malignant lump among the multitude of benign appearing lumps.

Physicians and patients have to be vigilant at all times. The principle of management should be that a breast lump is malignant until proven otherwise.

Dr. B, can you tell me more about the fibrocystic changes of the breasts?

Susan, this condition is known by many different names and encompasses many benign conditions of the breast.

One textbook says that it is virtually impossible to estimate the incidence of benign breast disorders. But it is believed that 50 percent of women experience symptoms of fibrocystic changes at some point in their lifetime.

Usually the symptoms occur in women of menstruating age, with a mean age of 39years and a range of 18 to 67 years.

Solid benign lumps (fibroadenomas) occur in younger women, but cysts occur few years before and after menopause (35 to 60 years).

This condition is associated with a history of premenstrual breast discomfort, irregular menses, and spontaneous abortions; a family history of both benign and malignant breast disease; lack of use of oral contraceptives; a low incidence of obesity; small breasts, and late natural menopause (Breast Diseases by Harris and others).

The cause is unknown. It is likely due to imbalance of the female sex hormones as the condition occurs after the onset of menstruation and rarely appears after menopause.

Dr. B, do fibrocystic changes cause cancer of the breast?

Susan, there is inadequate evidence to suggest that fibrocystic changes lead to cancer of the breasts. Usually the fear is that cancer may be missed in women who have “lumpy” breasts. These women do and get regular breast checkups.

The management of this condition is not easy. We will discuss this next week. In the meantime remember: A breast lump is malignant until proven otherwise.

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

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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Health and Happiness

Happier we are, the healthier we feel.

The key words are happy, healthy, and feel. It is easy to get these words in one sentence. But is it easy to get them together in life?

Each one of us looks at and feels about life in different ways.

According to E. M. Forster, it is not that the Englishman can’t feel – it is that he is afraid to feel.

Charles Lamb, on the death of his mother said, “I have something more to do than feel.”

But most of us would agree with George Ridding that “I feel a feeling which I feel you all feel”.

Let us look at some examples of healthy and unhealthy feelings.

Some time ago, on a Friday, there was a column in this newspaper titled “Washerwoman’s legacy helps poor students” by Margaret Wente. This is a very inspiring story of a 91 year old lady, who never went past Grade 6, never married, and never owned any book but her Bible. She made her living by washing other people’s clothes.

Dime by dime and dollar by dollar she saved her washerwoman’s money. Then in 1995, she donates $150,000 (US) to fund scholarships for poor students. Wente describes how this 91-year-old is energized to discover what her donation has done for the students.

That must be a great feeling!

Then on a Tuesday, there is Paul Sullivan’s column: More people I meet – more I like my dog. His message is clear – People do suck especially the big ones.

He was discussing the case of Nadia Hama and her daughter with Down’s syndrome, Kaya, who miraculously survived the fall off the Suspension Bridge in Vancouver. Sullivan also explores the methods used by RCMP to investigate this case.

The whole scenario does not inspire healthy feelings.

Compare this to the letter to the editor in Friday’s paper: Heartfelt thanks to a real-life superhero. Leslie Beckman writes: The fact that this man (real-life superhero) could care for a complete stranger, in such an amazing way, is absolutely unbelievable and beyond appreciation.

This superhero is one of the three men who helped a young man survive a near disastrous accident.

So there are people who do things that make us and themselves feel good. Although nobody is perfect.

But life is not about perfection. Life is about what you do with what you have been given, says Globe and Mail in a recent editorial on the new Governor General.

Let us put it this way: Good health is not about perfection. Good health is about what we do with what we have been given and feel good about it!

If that makes us happy then we should feel healthy.

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