Category: Medicine Hat News

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Four Factors that Determine Successful Aging

A windsurfer in Antigua. (Dr. Noorali Bharwani)
A windsurfer in Antigua. (Dr. Noorali Bharwani)

“Everyone wants to age successfully; however, the definition and criteria of successful aging remain vague,” says an article in Gerontologist (Feb 2015).

American Journal of Preventive Medicine (April 2005) looked at eight studies published between 1985 and 2003 that reported statistical associations between baseline determinants and healthy aging outcome.

Six behavioral determinants were found to make a positive difference in a person’s life. These were: smoking status, physical activity level, body mass index, diet, alcohol use, and health practices.

In an article published in the Canadian Medical Association Journal (CMAJ December 11, 2012) by Séverine Sabia and associates looked at the influence of individual and combined healthy behaviours on successful aging.

They concluded that although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. In fact they saw clear evidence of the importance of healthy behaviours for successful aging.

It is estimated by 2031, more than 20 per cent of Canadians will be senior citizens. These seniors will have chronic pain, serious age-related diseases and disability. This will cripple our health care system.

It is not too late to advise our patients to pursue healthy lifestyle. In the U.K. Sabia and colleagues carried out an observational study. Participants were 10,308 men and women aged 35 to 55 years.

Successful aging was defined as being alive at 60 years of age and beyond; having no history of coronary artery disease, cancer, stroke or diabetes. These individuals have good cognitive, physical, respiratory and cardiovascular function without disability, and good mental health.

Difficulty of doing a study like this is that there is no consensus definition for successful aging. Sabia and colleagues assessed whether engaging in four healthy behaviours during midlife influences a person’s ability to age successfully. These are:

  1. Regular physical activity
  2. Consuming fruits and vegetables daily
  3. Drinking alcohol moderately
  4. Never smoking

Moderate alcohol consumption and not smoking have well-known health benefits. But the apparent benefits of physical activity and healthy diets, which were not always evident in previous studies, were impressive, says the article.

There was a relatively large beneficial effect from physical activity (≥ 2.5 hours/week of moderate activity, or ≥ 1 hour/week of vigorous activity), which supports the notion that even small amounts of regular activity may have important health effects.

Similarly, although the number of fruits and vegetables to be eaten daily was not quantified, consumption of at least some amount each day appears to have an important association with successful aging. It would be interesting to know whether more servings of fruits and vegetables has a stronger effect and whether there is a dose–response relation, says the article.

To summarize: Sabia and colleagues found that four behaviours increase the odds of living in good health beyond 60 years of age: regular physical activity, eating fruits and vegetables daily, drinking alcohol moderately and never smoking.

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Pragmatic Approach to Treating Inflamed Nasal Passages and Sinuses

Alberta countryside. (Dr. Noorali Bharwani)
Alberta countryside. (Dr. Noorali Bharwani)

Sinusitis refers to inflammation of a sinus, while rhinitis is inflammation of the nasal passage. Anatomical closeness of the sinus cavities and the nasal passages lead to frequent simultaneous involvement of both structures. When both structures are involved the diagnosis is rhinosinusitis. The inflammation may be due to a virus or bacteria. The disease can be acute or chronic.

Rhinosinusitis is a frequently occurring disease. It has a big impact on the quality of life and health care spending. This also affects absenteeism and productivity. It is estimated that approximately six billion dollars is spent on 25 million individuals in the United States annually on therapy for rhinosinusitis. Rhinosinusitis probably affects more than 25 million Americans and 2.5 million Canadians.

As we know the quality of life of patients with chronic or recurrent sinusitis can be unpleasant. Antibiotics are prescribed for nearly all patients with sinusitis, but they are not always effective and increase the risk of antibiotic resistance.

A study published in the Canadian Medical Association Journal (CMAJ September 2, 2016) looks at the pragmatic approach to treating rhinosinusitis. The study involved adults age 18 to 65 years old with a history of chronic or recurrent sinusitis from 72 primary care practices in the United Kingdom. These individuals reported that the illness impacted their quality of life. They were randomly assigned to one of four strategies: usual care, daily nasal saline irrigation, daily steam inhalation, or combined treatment with both interventions. They were followed for three to six months.

The study concluded:

  1. Nasal irrigation: Nasal irrigation for chronic or recurrent symptoms was less effective than prior evidence suggested, but it resulted in reduced overall symptom burden, headache, use of over-the-counter medications and the perceived need to consult primary care physicians in future episodes.
  2. Steam inhalation: Steam inhalation had no consistent benefits. On a personal note – I have found steam inhalation done twice a day does provide temporary symptomatic relief by unblocking the nasal passages. You can try it. It may help but it will not hurt.

The common cold can lead to rhinosinusitis. Common cold is caused by a virus (rhinovirus), and in most cases the severity of symptoms peak by day three. However, the same virus can activate an inflammatory process leading to bronchitis, pharyngitis, and rhinosinusitis.

Rhinosinusitis caused by bacteria usually gets better in less than four weeks. Within this 4-week period, symptoms resolve either spontaneously or with appropriate treatment. There may be up to three episodes per year and full recovery in between episodes.

Harvard researchers found that sinusitis sufferers reported the highest levels of pain and the lowest levels of social functioning, as well as significant problems with work, energy, and mental health.

Mayo Clinic website says, “One of the simplest, cheapest, and most effective ways to prevent and treat sinus problems is nasal irrigation. Using a homemade solution, you can often relieve sinusitis symptoms, reduce reliance on nasal sprays and antibiotics, and improve your quality of life.”

Hope this information helps. Flu season is coming. Do not forget your flu shot!

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Detecting Breast Cancer in Women with Dense Breasts Made Easier

Valley of the Kings, located on the west bank of the Nile, Egypt. (Dr. Noorali Bharwani)
Valley of the Kings, located on the west bank of the Nile, Egypt. (Dr. Noorali Bharwani)

The Canadian Cancer Society recommends that all women 50 to 69 years of age be screened for breast cancer every two years, using mammography. But mammography is less useful in identifying cancerous tissue in women with dense breasts; that is, women whose breasts have less fatty tissue but have more fibrous tissue.

In Canada, more than one million women (that is 50 per cent of women) who are 50 to 69 years old have dense breasts. Mammography is not a good test for picking up breast cancer in women with dense breasts. These women are being offered an additional test in the U.S. at a cost of about U.S. $2000 (two thousand). This test is called molecular breast imaging (MBI). This is not the first line of investigation for breast lumps. All women who are eligible for breast screening first undergo mammography and if necessary ultrasound to see if a lump is solid or cystic. Women with dense breasts then can be offered MBI if the mammogram is negative.

In a study from Mayo Clinic, 2600 women with dense breasts underwent mammogram and then MBI. Thirty two per cent of women were found to have breast cancer. Of these only eight breast cancers were picked-up by mammogram alone but 29 breast cancers were picked up by mammography plus MBI. This test is four times better than mammogram alone, is less painful and gives better pictures. However, this is not the final answer. More research is in progress to see how the results can be improved.

MBI is not going to replace mammography. Mammograms will remain the gold standard in breast cancer screening and will continue to be the standard first step in breast cancer detection. Use of MBI, MRI (magnetic resonance imaging) and ultrasound will continue to serve special populations of patients who need tests beyond a mammography.

Breast MRI is not recommended as a screening tool for women who are at average risk of developing breast cancer. It is better than mammogram but a major disadvantage is that breast MRI screening results in more false positives. In other words, the test finds something that initially looks suspicious but turns out not to be cancer. To avoid unnecessary biopsies MRI screening is reserved for high-risk women only. MRI is also more expensive and not widely available.

In conclusion, mammograms are probably the most important tool doctors have, not only to screen for breast cancer, but also to diagnose, evaluate, and follow people who’ve had breast cancer. It is safe and reasonably accurate. The technique has been in use for more than 50 years. MBI is still being tested, but it appears to hold promise for detecting breast cancer in women who are at higher-than-average risk for the disease and have dense breasts. Ultrasound and MRI is used for special cases.

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Increased E-cigarette Use in High Schools

South Saskatchewan River in Medicine Hat, Alberta. (Dr. Noorali Bharwani)
South Saskatchewan River in Medicine Hat, Alberta. (Dr. Noorali Bharwani)

Cigarette smoking is dangerously addictive and lethal. Now there are new concerns with the introduction of electronic cigarettes or e-cigarettes.

E-cigarettes are cigarette-shaped canisters used to simulate the action of cigarette smoking.
The e-cigarettes are fluid-filled cartridges that contain varying concentrations of flavouring agents, propylene glycol, glycerine, water and other chemicals. The batteries within the canisters heat up contents of the e-cigarette.

Some e-cigarettes contain nicotine. The cartridge content varies widely according to the manufacturer and distributor. The act of smoking an e-cigarette is called “vaping,” because the user inhales vapour, not smoke.

A new study by Khoury and colleagues published in the Canadian Medical Association Journal (CMAJ August 9, 2016) reports that 10 per cent of a representative sample of grade 9 students in Ontario had tried electronic cigarettes (e-cigarettes).

An editorial in the CMAJ says this finding is likely an underestimate of rates across Canada. For example rates in Quebec are double those in Ontario.

Usually smokers start using e-cigarettes to kick the smoking habit. But Khoury and colleagues found that most smokers were motivated to try e-cigarettes by their novelty and “coolness” – rarely did youth use e-cigarettes to quit smoking.

The study found e-cigarette use was highest among the most vulnerable youth who are in poor health, high stress or low socioeconomic status. The study also confirmed that most were not substituting e-cigarettes for cigarettes: instead, the odds of e-cigarette use were 12-fold higher in youth who also smoked cigarettes (i.e. “dual users”).

Evidence shows increasing use of e-cigarettes in Canada and U.S. A recent study in the US involving youth found that those who did not smoke from grades 11 to 12 and used e-cigarettes, had six fold higher odds of becoming cigarette smokers a year and a half later when they reached the legal age to purchase tobacco. The typical fruit and candy flavourings of e-cigarette liquids are the number one reason they appeal to youth.

What is the government doing about this?

In Canada, governments have begun to take action to protect our youth from e-cigarettes. Ontario and seven other provinces have now passed or tabled legislation that treats e-cigarettes similarly to tobacco products – including a prohibition on selling or supplying them to minors, says the CMAJ editorial.

There is no good reason for youth – or any non-smokers – to be using e-cigarettes. Nothing good can come of providing vulnerable individuals with a more appealing way to become addicted to nicotine, says the editorial.

Some of the things the government can do are: prohibit flavourings in e-cigarettes and introduce advertising restrictions currently in place for tobacco products.

Parents and teachers have an important role to play in engaging our youth in a conversation about the harms of e-cigarettes, lest we lose the progress against tobacco that we have worked so hard for decades to achieve, says the editorial.

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