Medicine Hat News – Page 42 – Dr. Noorali Bharwani

June 28, 2016

Use and Abuse of Prescription Painkillers – Dentists, Drugs and Dependence

Happy Canada Day. (Dr. Noorali Bharwani)

NBC News called it “The Deadly Triangle: Dentists, Drugs and Dependence.”

In the U.S., about five million people each year have wisdom teeth removed. Many of them are prescribed Percocet, a commonly used painkiller for post-surgery discomfort. But most patients are never warned that Percocet has the potential to make patients dependent on the drug. It is very addictive.

Percocet is an opioid, a class of drugs that chemically follows the same nerve pathways as heroin, eliciting a sense of euphoria. Examples of weak opioids are – codeine and dihydrocodeine. Examples of strong opioids are – tramadol, buprenorphine, methadone, diamorphine, fentanyl, hydromorphone, morphine, oxycodone, and pethidine.

Recently, a Harvard research team reported in the Journal of the American Medical Association (JAMA) that dentists are among the leading prescribers of opioid analgesics, particularly for surgical tooth extractions. The most revealing aspect of the study was that the highest number of these opioid painkiller prescriptions were for teenagers, aged 14 to 17 years old, closely followed by young adults 18 to 24 years, says the NBC News.

Opioid abuse has sky rocketed.

Some patients and certain conditions do need strong painkillers. When used properly, prescription drugs can help. But, there are many dangerous and unpredictable side effects associated with abusing prescription drugs including addiction, overdose and death, say Government of Canada website on prescription drug abuse.

Besides opioids (used to treat pain) there are other prescription medications, which can be addictive. For example benzodiazepines (used to treat anxiety and sleep disorders), and stimulants (used to treat attention deficit disorder).

When an individual intentionally takes prescription drug for recreational purposes to get high or change mood then it is called drug abuse.

Prescription drug abuse is a growing public health and safety problem in Canada, particularly among youth. In the 2012 Canadian Alcohol and Drug Use Monitoring Survey, approximately 410,000 Canadians reported abusing prescription drugs like opioid pain relievers.

The abuse of prescription drugs has harmful effects on teens’ health. They are especially vulnerable because their bodies and minds are still developing. It can damage a teen for life.

Psychoactive drugs change brain function and results in alterations in perception, mood, or consciousness. These drugs are the third most commonly abused substances, after alcohol and marijuana, among Canadian youth. Last year, over 80,000 Canadian teenagers used prescription drugs to get high, even though it can be very dangerous.

In Alberta, since 1986, the College of Physicians and Surgeons (CPSA) started the Triplicate Prescription Program (TPP) – considered an important tool in reducing the misuse and abuse of prescription medications. TPP collects prescribing and dispensing data for listed drugs. When the data meet certain criteria, physicians and others involved in the care of the patient are alerted, provided with information and directed to resources to support them in providing safe care.

So the TPP program has been in force for 30 years. Has this put a dent in the use and abuse of narcotics and other drugs amongst vulnerable population of Alberta? I hope so but I don’t have the numbers.

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

June 14, 2016

Risk of Suicide After Head Injury is High

"To jump or not to jump?" (Dr. Noorali Bharwani)

Some years ago a car hit my cousin while he was crossing a street on pedestrian crossing. A driver ignored a clear sign to stop for pedestrians. Probably the driver was distracted by something he shouldn’t have been doing. My cousin had concussion and was in a hospital unconscious for several days. He recovered and went home. But he was never the same. Some years later he committed suicide.

In Medicine Hat, I think 13th Avenue is quite unsafe. It is one of the busiest streets with several businesses and seniors residencies all cramped together. Businesses like gas station, Co-op, car wash, banks, doctor’s office, dental office, golf course, Alberta Motor Association – just to name a few – are all busy with traffic going in and out of their parking lots. I think 13th Avenue is very unsafe.

If a vehicle hits you then the chances of sustaining head injury and broken bones is very high if you are lucky enough to survive. Studies have shown head injuries have been associated with subsequent suicide among military personnel.

A study from Ontario (CMAJ April 19, 2016) looked at the long-term risk of suicide after a weekend or weekday concussion. They identified 235,110 patients with a concussion. Their mean age was 41 years, 52 per cent were men, and most (86 per cent) lived in an urban location. A total of 667 subsequent suicides occurred over a median follow-up of 9.3 years, equivalent to 31 deaths per 100,000 patients annually or three times the population norm.

Weekend concussions were associated with a one-third further increased risk of suicide compared with weekday concussions. The paper concluded that adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends.

The authors of the article suggest greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented. More important and better option would be to prevent injuries to the head completely.

Last year, a movie, Concussion, a biographical sports drama thriller was released in the U.S. It is a true story based on the exposé “Game Brain” by Jeanne Marie Laskas, published in 2009 by GQ magazine. It is a true story.

Set in 2002, the film stars Will Smith as Dr. Bennet Omalu, a forensic pathologist of Nigerian origin with the Allegheny County, Pennsylvania Coroner’s Office. Omalu fights against efforts by the National Football League to suppress his research on chronic traumatic encephalopathy (CTE). A kind of brain degeneration suffered by professional football players from repeated injuries to the head.

Head injuries can be prevented. For example, heavy alcohol consumption contributes to one-third of motor vehicle collisions. Medical warnings by physicians to patients who are potentially unfit to drive are effective for preventing serious collisions. Let us make our roads safe, vehicles safe, sports safe. Let us prevent head injury, disability and death.

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

June 5, 2016

Chicago, the Windy City, has a Lot to Offer to Visitors

Cloud Gate, nicknamed The Bean, in Millenium Park, Chicago. (Dr. Noorali Bharwani)

If you haven’t been to Chicago then you are missing out on something. I was there to attend the American College of Surgeons meeting. Chicago is home to opera, jazz, museums, aquariums, parks, fountains, theatres, shopping malls, restaurants and extensive walking trails along the river.

Chicago was founded in 1833. It is the third most populous city in the United States. With over 2.7 million residents, it is the most populous city in the state of Illinois and the Midwest.

Chicago’s O’Hare International Airport is the busiest airport in the world when measured by aircraft traffic. The region also has the largest number of U.S. highways and railroad freight. Chicago has many nicknames, the best-known being the Windy City.

In Chicago, tourism is a serious business. In 2014, Chicago attracted 50 million domestic leisure travellers, 11 million domestic business travellers and 1.3 million overseas visitors. These visitors contributed more than US$13.7 billion to Chicago’s economy.

There are many ways to take sightseeing tours in Chicago. Ferries offer sightseeing tours along the Chicago River and Lake Michigan. You can take Hop-On Hop-Off tourist bus or you can walk. A 2011 study by Walk Score ranked Chicago the fourth most walkable of fifty largest cities in the United States.

Chicago’s Attractions

The Magnificent Mile
Chicago’s Magnificent Mile is the great Chicago shopping experience with an abundance and variety of boutiques and stores. It can satisfy all your shopping needs with towering shopping centers, chic designer studios, intimate specialty retail shops, iconic department stores, lavish luxury boutiques and trendy favorites all within an easy stroll.
The Millennium Park

In Millennium Park, there is the reflective Cloud Gate sculpture. Cloud Gate, a public sculpture by Indian-born British artist Anish Kapoor, is the centerpiece of the AT&T Plaza in Millennium Park. Also, an outdoor restaurant transforms into an ice rink in the winter season. Two tall glass sculptures make up the Crown Fountain. The fountain’s two towers display visual effects from LED images of Chicagoans’ faces, along with water spouting from their lips.
Chicago Riverwalk and River Cruise
Originally, the Chicago River flowed into Lake Michigan, which was the source of the city’s drinking water. To improve public heath by reducing water pollution, engineers completed the reversal of the flow of the river in 1900. Now the water flows into Mississippi River and this keeps Lake Michigan clean. Since 1970, the city reduced pollution and started to beatify riverbanks with dazzling views, landscaped riverwalks, parks and cafes. The river today is a constantly changing and improving.
Trump International Hotel and Tower (2009) – 1388 feet (423.1 meters)

At over 90 stories, Trump Tower, with a hotel at the base and residential units above, was designed by Skidmore, Owings and Merrill, the firm responsible for Burj Khalifa, Dubai the world’s current tallest building.
The Chicago Loop
The Chicago Loop is the central business district. The best way to go through the Loop is by taking Hop-On Hop-Off sight seeing bus.

With an estimated completion date of 2020, the Barack Obama Presidential Center will be housed at the University of Chicago in Hyde Park and include both the Obama presidential library and offices of the Obama Foundation.

If you plan to visit Chicago then make sure you plan well. Enjoy!

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

May 31, 2016

Medical Management of Heartburn can be Challenging

An American Robin at Echo Dale Regional Park in Medicine Hat, Alberta. (Dr. Noorali Bharwani)

More than one-third of the population has symptoms of heartburn secondary to gastro-esophageal reflux disease (GERD), with about one-tenth afflicted daily. Infrequent heartburn is usually without serious consequences, but chronic or frequent heartburn (recurring more than twice per week) can have severe consequences.

Here are some points to remember to prevent complications secondary to reflux:

Lifestyle modifications may or may not help. But it is worth trying. That means try and avoid stressful situations and learn to sleep well.
Weight loss has been shown to be beneficial for individuals with recent weight gain or those with a BMI over 25.
Elevation of the head of the bed and avoidance of late evening meals, particularly with high fat content, has shown to be beneficial for individuals with nocturnal symptoms or sleep disturbance.
Avoid food that trigger heartburn such as chocolate, caffeine, citrus foods, spicy foods, carbonated beverages, etc., has been shown to be beneficial only if an individual can identify a specific trigger.

If a person has classical symptoms of GERD not relieved by conservative measures then it is worth trying a trial of medications called proton pump inhibitors (PPIs). There are several medications in this group and they all have very similar effect in terms of symptom relief or healing of erosive esophagitis (inflamed esophagus).

Some examples of PPI are: omeprazole (Losec), lansoprazole (Prevacid), pantoprazole (Tecta), esomeprazole (Nexium).

The PPI should be taken once a day, usually 30-60 minutes before the first meal of the day. The pills should be tried for a month or two to see if there is any relief of symptoms before ordering invasive investigations. If there is symptom relief then the patient can be put on maintenance therapy using the lowest effective dose, which could include on-demand therapy.

Some patients may have side effects from these medications such as headache, rash, diarrhea or constipation, nausea or abdominal pain. Dose reduction or change of pill may help.

If the PPI agents do not help then further investigation should be undertaken to make a diagnosis and check for complications such as acute inflammation or malignancy.

PPI has long-term side effects such as vitamin B12 deficiency, increased risk of infection, such as colitis with Clostridium difficile, warns Health Canada advisory issued in February 2012. They also warn that the high rate of seniors on PPIs raises worries about C. difficile outbreaks in hospitals and nursing homes.

C. difficile is a bacteria capable of causing life-threatening cases of diarrhea (10 bowel movements a day) and conditions like colitis.

By lowering stomach acid levels, PPIs might affect the body’s absorption of calcium, which in turn could lead to osteoporosis and fractures. Researchers found a link between long-term use of PPIs and hip fractures. Their results also suggested that the risk increased the longer people were taking PPIs.

If you suffer from GERD then try conservative measures such as: lifestyle changes, weight loss and eat smart by avoiding foods that bother your stomach. If you need to use PPI then try lower dose and short duration of treatment.

Finally, my British teacher used to advise his patients to avoid hurry, worry and curry!

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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