Category: Medicine Hat News

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Sibling Rivalry can be a Source of Anxiety for Parents

There is strength in unity. Boating in North Glenmore Park, Calgary. (Dr. Noorali Bharwani)
There is strength in unity. Boating in North Glenmore Park, Calgary. (Dr. Noorali Bharwani)

“Siblings that say they never fight are most definitely hiding something,” says novelist Lemony Snicket.

If you look at it in a positive way, sibling rivalry is a type of competition. It can be a healthy rivalry. If it goes in a negative way then rivalry creates animosity and nightmare for parents.

There are several factors involved in how the siblings bond. Siblings generally spend more time together during childhood than they do with parents. As they grow the relationship is often complicated and is influenced by factors such as parental treatment, birth order, personality, and people and experiences outside the family.

If the children are very close in age and of the same gender and/or where one or both children are intellectually gifted then the relationship can be complicated.

Listening to your children fight with each other can be frustrating. As parents what can you do to create harmony? Problem comes when parents start taking sides. Things become more difficult if you have more than two children.

So I did some reading to see what the experts have to say. Here is the summary:

  1. Accept the fact that if you have more than one child there is going to be sibling rivalry. If the rivalry is healthy then it creates healthy, smart, happy family.
  2. Parents should learn to know when and how to intervene when siblings have a conflict. Taking sides is totally unnecessary and can be counter productive. You cannot have one favourite child out of two or more children you have.
  3. Parents should remember sibling rivalry typically develops as siblings compete for their parents’ love and respect. That is natural part of growing up. Rivalry also depends on children’s age, sex and personality, the size of the family, whether it’s a blended family, and each child’s position in it.
  4. As children grow parents find out that each child has unique habits and needs although they have genes from the same parents. Learn to respect each child’s unique needs.
  5. Parents have a tendency to compare their children’s achievements and disappointments. Avoid comparisons. Comparing your children’s abilities can make them feel hurt and insecure. Each child is born with unique gifts. Parents should learn to understand this and nurture them.
  6. Parents should learn to listen to their children. They should encourage their children to talk to each other and learn to understand and appreciate each other’s successes and failures. Family dinners also provide opportunities for talking and listening.
  7. Never forget to compliment your children when they behave well, have success in their endeavors, are playing well together or working as a team. Encourage good behavior.
  8. Show your love. Spend time alone with each of your children. Do special activities with each child that reflects his or her interests. Remind your children that you are there for them and they can talk about anything with you.

I am sure there is more to parenting than just eight points mentioned here. I feel the most important point is to give each child unconditional love. They will never forget that. I am sure they will pass that unconditional love to their children.

Long live good parenting.

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Pregnancy and the Risk of Traffic Collision

Washington Monument at the National Mall in Washington, D.C. (Dr. Noorali Bharwani)
Washington Monument at the National Mall in Washington, D.C. (Dr. Noorali Bharwani)

The Canadian Medical Association Journal (CMAJ March 1, 2016) has awarded its top research honour to the authors of a study that showed women face an increased risk of serious car accidents during pregnancy.

Dr. Donald Redelmeier and his colleagues are the recipients of the Bruce Squires Award for their article “Pregnancy and the risk of a traffic crash,” which showed that pregnant drivers were 42 per cent more likely to have a serious collision that resulted in an emergency department visit. It generated the most public interest of any CMAJ research paper in 2015, says the CMAJ article.

Redelmeier’s team analyzed the health records of 507 262 Ontario women who gave birth between April 1, 2006 and March 31, 2011. The researchers found that the risk of a serious crash peaked in the fourth month of pregnancy, and was higher in the afternoon and in complicated traffic. It affected pregnant women regardless of their background, whether they had been pregnant before, or whether they were carrying a boy or a girl, says CMAJ article.

The authors concluded that pregnancy is associated with a substantial risk of a serious motor vehicle crash during the second trimester.

The World Health Organization classifies maternal deaths due to traffic crashes as coincidental and not related to the state of pregnancy. Others have argued that pregnancy is the root cause of such deaths, because pregnant women are more susceptible to crashes.

In 2014, CMAJ published a commentary (July 8, 2014) on Redelmeier’s research. The title of the commentary was “High risk of traffic crashes in pregnancy: Are there any explanations?” The commentary touched on several likely explanations. Here is the summary:

  1. Driving requires a high level of concentration and cognitive ability to maintain and complete a number of complex tasks. If there is any impairment in the driver’s cognitive ability, there may be an increased risk of a crash.
  2. The physiologic changes of pregnancy have been shown to increase fatigue and sleep deprivation in pregnant women.
  3. Prospective study using self-reported questionnaires showed that sleep length began to decrease during the second trimester and quality of sleep worsened during pregnancy.
  4. Maternal stress is also a common feature of pregnancy.
  5. Drivers who experience sleep deprivation, stress or fatigue will have an increased risk of a car crash.
  6. If busy urban areas are harder to navigate and require greater concentration in driving, then fatigue, tiredness and stress are likely to have a greater impact on the risk of a crash in urban areas.

There is no doubt studies have shown an increased risk of motor vehicle crashes among women in their second trimester of pregnancy.

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Are we doing too many colonoscopies? The new guidelines are here.

Dr. Noorali Bharwani demonstrating flexible sigmoidoscopy.
Dr. Noorali Bharwani demonstrating flexible sigmoidoscopy.

First, let us face the facts. Colorectal cancer is the third most commonly diagnosed cancer in Canada. It is the second leading cause of cancer death in men and the third in women. The lifetime probabilities of dying from colorectal cancer among men and women are three to four per cent.

What’s the best way to prevent colon and rectal cancer?

We have been doing colonoscopies just over 50 years. The technology is changing almost every year. The service is now available almost everywhere. There are more doctors doing colonoscopy. And people are getting the procedure done more often. The indications of doing the procedure are increasing everyday. The saying goes, “If you haven’t had a colonoscopy then you need one. If have had one then you need another one!” Is that the way to go?

Last time the guidelines for colonoscopy were updated was 2001. Now, in 2016, we have new guidelines from the Canadian Task Force on Preventive Health Care. The new guidelines state there is not enough evidence to justify colonoscopies as routine screening for colorectal cancer. Instead, patients should undergo fecal occult blood testing every two years, or flexible sigmoidoscopy every 10 years. Flexible sigmoidoscopy is a procedure in which a scope is inserted in the lower portion of the colon and rectum rather than the entire tract. I used to provide that service in my office.

It is sad to note that currently no provincial screening program includes flexible sigmoidoscopy.

It is important to remember that the guidelines apply to adults aged 50 to 74, who are asymptomatic and at low risk for colorectal cancer, meaning they have no prior history of the disease, no family history, no symptoms such as blood in the stool, or genetic predisposition. If they have any of these risk factors then they need a colonoscopy – full examination of the colon and rectum.

The task force hopes that ultimately, most Canadians will likely be screened using fecal occult blood tests, which look for microscopic specks of blood in the stool that could be a sign of cancer. If that is positive then a colonoscopy is indicated. If a flexible sigmoidoscopy (a 60-cm scope which examines the rectum and left colon) is positive for any abnormal findings then the person needs a colonoscopy.

To spread this message, we have to educate the public about the risk of the disease and the safety and importance of screening. Adults 75 and over should not be ignored. If they are in good health then they should discuss with their doctor and get into the screening program.

Colonoscopy is a great test but because waiting lists are long and the potential for side effects such as bleeding or intestinal perforation are greater than they are for other tests, the guidelines recommend against using colonoscopies as a routine screening tool in asymptomatic low-risk adult.

The old guidelines (2001) recommended annual or biennial faecal occult blood test (FOBT) and flexible sigmoidoscopy every five years in asymptomatic people older than 50 years. The guideline did not recommend whether these screening modalities should be used alone or in combination or whether to include or exclude colonoscopy as an initial screening test for colorectal cancer. And provincial screening programs do not include flexible sigmoidoscopy as one of their screening options. This should change.

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Grapefruit in Your Diet may Interfere with Certain Medications

The Statue of Liberty on Liberty Island in New York Harbor. (Dr. Noorali Bharwani)
The Statue of Liberty on Liberty Island in New York Harbor. (Dr. Noorali Bharwani)

“Our research group discovered the interaction between grapefruit and certain medications more than 20 years ago,” says an article in the Canadian Medical Association Journal (CMAJ March 5, 2013) written by Dr. David Bailey, Ph.D and his colleagues from Ottawa.

Certain other citrus fruits and products can interfere with several kinds of prescription pills. You are advised to check with your pharmacist and/or doctor before consuming any citrus products, including grapefruit, if you take prescription medications. Taking your medication and grapefruit product at different times does not stop the interaction.

Chemicals in the fruit can interfere with the enzymes that break down the medication in the digestive system. As a result, the medication may stay in your body for too short or too long a time. A medication that’s broken down too quickly won’t have time to work. On the other hand, a medication that stays in the body too long may build up to potentially dangerous levels.

There is a long list of medications that is affected by grapefruit and other citrus food. Here are some examples:

Antibiotics: erythromycin

Cholesterol reducing pills: atorvastatin (Lipitor), lovastatin (Altoprev), others

High blood pressure pills: felodipine, carvedilol (Coreg), others

Pills for heart problems: amiodarone (Coradarone, Pacerone)

Antidepressants: diazepam (Valium, Diastat), fluvoxamine, others

Pills to prevent organ rejection in transplant recipients: cyclosporine (Sandimmune and others)

Play it safe with prescription drugs. Always ask your doctor or pharmacist when you get a new prescription if it interacts with any foods or other medicines.

Many of the drugs that interact with grapefruit are highly prescribed and are essential for the treatment of important or common medical conditions. Currently, more than 85 drugs have the possibility of interacting with grapefruit; of these drugs, 43 have interactions that can result in serious adverse effects.

The chemicals in grapefruit involved in this interaction are the furanocoumarins.

One whole grapefruit or 200 mL of grapefruit juice is sufficient to cause clinically relevant increased systemic drug concentration and subsequent adverse effect. Seville oranges, often used in marmalades, limes and pomelo also produce this interaction.

In spite of the scientific evidence from reliable sources regarding adverse effects as discussed earlier, in routine clinical practice physicians do not see too many complications. One reason could be that multiple factors likely need to combine to achieve a marked increase in systemic drug concentration. It is reasonable to assume that just exposure to any interacting combination would not be sufficient to cause a clinically important change in drug response in all, if not most, cases.

Having said that, the fact remains you have to be vigilant. Pharmacists are the best source of information when it comes medications.

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