Category: Medicine Hat News

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Staying Healthy

“Doc, I am worried about 1999. I will be 41 and I want to stay healthy. How can I do it?”

Although Dave likes to plan ahead, he has difficulty remembering the five commandments of good health. He has been busy travelling and has no control over where he eats, what he eats, and how often he eats.

Dave has no time for regular exercise. His business lunches and dinners are not without good wine and alcohol. He forgets that alcohol is heavy in calories and devoid of nutrition

Dave has been working hard to quit smoking and get his weight under control. He finds this stressful. There are two other sources of stress in his life: dealing with difficult people and time management.

Dave feels trapped. He feels helpless. He wants to get control of his life.

“Doc, when I was growing up, my father used to say: son, your health comes first, your family comes second and your work comes third. Doc, in my case it is in reverse order!”

Dave cannot afford to give up his present job. The money is good. His wife, Susan, has a good salary as a legal secretary. They need two incomes to raise children, have a decent lifestyle and save money for holidays and retirement. Unfortunately, Dave’s lifestyle is anything but decent.

It is time to get tough. Dave, the first commandment of good health is to quit smoking. If you are unable to do so then get help. There are many programs to chose from. Pick one and stick to it.

Dave, the second commandment is to exercise daily. In your travels, pick hotels with swimming pool and health club. Get up early and start your day with 30 to 60 minutes of exercise. This will make you feel good, boost your morale and encourage you to follow healthy habits rest of the day. Regular exercise is the ultimate feel-good pill.

The third commandment is to control your weight by healthy eating. Eat diet with high fiber and low fat. Dave, do not forget that fruits and vegetables are good for you! Healthy eating, along with regular exercise, should make you a winner.

Dave smiles. I am serious. He should know, the pressure is on!

“Go on doc,” says Dave, looking little relaxed than when we started.

Dave, the fourth commandment is to have a regular physical checkup with your family doctor. Your doctor will recommend to you screening tests which may help detect conditions in early stage when it can be cured or controlled.

Finally, the fifth commandment is to control your alcohol intake. Besides being devoid of nutrition, it plays an adverse role in your weight control. Excessive alcohol intake leads to health and social problems which destroys your hard work and all your dreams.

“Doc, I promise you, next year things are going to be different. I know the odds are against me but I have to do it, for my family and me.”

Good luck, Dave. May peace be with you.

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

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New Year’s Resolutions

Are you one of the millions of people who is planning to go on a weight reducing diet soon after New Year’s eve party? Are you excessively infatuated with being thin?

Are you a retired, non-smoking, healthy man who is wondering: Am I going to live long enough to enjoy my retirement?

Read on to see who is saying what in the medical journals!

Losing Weight – An Ill-Fated New Year’s Resolution:

It is a well known fact that come January, within few days to few months, most people will give up on their New Year’s resolution to lose weight. Why? Because losing weight and sustaining the loss is a difficult task. This leads to guilt and self-hatred.

An Editorial, published in the New England Journal of Medicine on January 1st, 1998 estimates that at any given time, 15 to 35 per cent of Americans are trying to lose weight. They spend about $30 to $50 billion yearly on diet clubs, special foods and over-the-counter remedies. These remedies are not always harmless.

Why do people want to lose weight? First, there is enormous social pressure to look thin. Second, being overweight has some health risks: heart disease, high blood pressure, diabetes, and a variety of other problems.

Why is it that some people cannot lose weight? The old view is that if intake of calories is more than expenditure then the weight goes up. The new view is that there is a “fairly stable set point for a person’s weight that is resistant over short periods to either gain or loss, but that may move with age.”

This set point can be changed with extreme measures like diet and exercise. But when this measures are discontinued then the body weight returns to its original level. Heredity also plays a significant role.

So, what is the best approach to weight control and staying healthy?

Prevention!

“Encouraging lifelong, regular exercise in children may well have the greatest effect in terms of preventing obesity, as well as numerous other benefits,” say the authors. This should be combined with healthy eating habits.

What about those who are already overweight? In authors’ views, overweight people should be advised to lose weight if only it would be required to improve their health or if they ask for help.

Want to live longer after retirement?

A study published in the New England Journal of Medicine says that, “Encouraging elderly people to walk may benefit their health.”

Among the 707 men included in this study, the average distance walked was about 2.9 km (1.8 miles) per day. These men had 12 years of follow-up.

Results? Those who walked less than 1.6 km. (1 mile) per day, the death rate was 43.1 per 100 men. For those who walked more than 3.2 km (2 miles) per day the death rate was more than halved (21.5 per 100). Age had negligible effect on the out come. Time for another New Year’s resolution?

Wait a minute! Consult your doctor before you go wild!

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Ovarian and Uterine Cancer

“Dr. B, can we discuss early detection and prevention of cancers of the ovary and uterus?”

Sure, Susan. I will give you some information today and you discuss this further with your family doctor and/or gynecologist. Remember cancer of the uterus can be either in its body (endometrial) or in its opening (cervix).

In 1993, 606 Alberta women were diagnosed with invasive (beyond the superficial layer) cancers of the female genital organs: endometrial 256, ovary 203, cervix 122 and others 25. This does not include 1517 women who were diagnosed with in-situ (confined to the superficial layer) cancers of the cervix.

“What symptoms would I have if I had cancer of the ovary or uterus?”

Susan, unfortunately the early symptoms are none or very vague. Early diagnosis of ovarian cancer is more a matter of chance. Irregular vaginal bleeding may be the only early sign of uterine cancer. Hence, most of the gynecological cancers are picked up at a late stage. Of course, the Pap smear has completely changed the outcome of cervical cancers.

“Doctor, are there any risk factors which I should be aware of?”

Susan, for ovarian cancer, the risk factors are age (steady rise up to age 80) and family history. For endometrial cancer – age, obesity and estrogen therapy are major risk factors. For cervical cancer, the risk factors are well recognized. These are: some types of sexually transmitted disease(s), early age at first intercourse, and having multiple sexual partners.

“Doctor, what about screening tests?”

Susan, for ovarian and endometrial cancers, there are no recommendation for screening. But for cervical cancer, Pap smear is highly recommended. In U.S., this has reduced the incidence and death rate by 70 percent in the last 40 years.

Invasive cervical cancer is usually diagnosed between the ages of 45 and 50. But the average age of women with carcinoma in-situ is between 25 and 30 with evidence of increase in younger women. This could be related to risky health practices, such as experimenting with new ideas, relationships and activities during adolescence which may have long term adverse consequences.

“Dr. B, final question! How often should a woman get a Pap smear?”

Susan, for those who are not at high risk, first Pap smear should be done soon after the age of 18 or once the woman is sexually active. If this is normal and the one after a year is also normal then repeat after every three years until age 70.

It is very important for every woman to discuss her risk factors with her family doctor and/or gynecologist. Recommendations may vary. Any unexpected vaginal bleeding should be reported to your doctor to see if further investigation is required.

“Thank you, doctor,” Susan said as she got ready to leave my office. She continues to strive for good health for herself and her family. I admire her dedication.

(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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Do we really need disgruntled doctors?

Published on the editorial page of The Medicine Hat News, Wednesday, December 2, 1998, Page B6. At that time Dr. Bharwani was Regional Chief of Staff, Palliser Health Region, Medicine Hat, Alberta.

People keep asking me how the Palliser Health Authority got dragged into a situation which should be a Provincial issue?

It is a good question, but I do not have a good answer. What I know is that we have three very unhappy, angry Obstetricians – Obstetricians who have served this Region well for several years. They have kept our obstetrical care at the highest level in the Province, and they are fine family people who want to be appreciated and remunerated appropriately for what they do.

We are seeing a very sad situation. Angry, unhappy Obstetricians with a Health Authority strapped for money and pushed against the wall. “Give us the on call money or we quit” say the Obstetricians. But the Regional Health Authorities are not funded to pay for services provided by physicians.

The Obstetricians’ anger is only the tip of the iceberg. Physicians, in general, are angry and frustrated. They say, compare our hourly take home pay and lifestyle with those of dentists, lawyers, accountants, realtors, stockbrokers, bankers, etc.

This year the Canadian Medical Association conducted a survey on doctors’ attitudes and activities. This revealed that almost two-thirds of Canada’s physicians (62 percent) feel they are over worked, and more than half (55 percent) say that their family and personal life has suffered because they chose medicine as a profession.

Physicians feel that their income is declining even though their hours of work have increased. With the explosion of medical information on the Internet, the patient’s expectations have risen dramatically. In the era of cut backs, the physicians feel great pressure to satisfy their patients’ needs.

In a 1997 national survey of doctors, done by The Medical Post, the young doctors nationwide expressed extreme unhappiness with the health care system.

In Defense of the Obstetricians, From Where I Sit – 2

In the U.S.A, the situation is no different. In an editorial in The New England Journal of Medicine, Dr. Jerome Kassirier wonders if a health care system functions effectively if a sizable fraction of physicians are disgruntled. He asks, “Are patients well served by unhappy physicians?”

Physicians in the United States working in managed care organizations get financial incentives, which depend on limiting referrals, and care which would compromise their work. Physicians feel that incentives, which reward quality of care and provide patient satisfaction would offer better job satisfaction.

In his book “Paging Doctors”, David Woods, a medical journalist says, “The doctor’s dilemma, as George Bernard Shaw defined it in his play of that name, was the moral one imposed by getting paid for operating and not getting paid for not operating.” Bernard Shaw also raised some broader questions about the relative worth of people and objects. How do you define worth?

Finally, sixteen years ago, Modern Medicine of Canada wrote, “Doctors surely are stressed. The strain comes mainly from the profession that bears the most direct responsibility for other peoples quality of life and the nature and timing of their deaths. In fact, there is hardly a single human being living in a developed society who has not been treated by a physician several times in his life. But no matter how strenuously a doctor has toiled or how miraculous the results, it is all taken for granted and in this day and age, gratitude is minimal”.

So where do we go from here? The Palliser Health Authority would love to have happy doctors providing excellent quality service in an environment, which would recognize and reward their special skills. How can we do this?

I will leave you with these questions which were asked earlier: Can a health care system function effectively when a sizable fraction of the physicians are disgruntled? Are patients well served by unhappy physicians? Think about this, and tell me how we can keep our doctors happy and satisfied.

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