Category: Medicine Hat News

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There is something about feet and the toenails that fungi just love.

Sunset boating in Chicago. (Dr. Noorali Bharwani)
Sunset boating in Chicago. (Dr. Noorali Bharwani)

“There are about 80 types of fungi residing on a typical person’s heel, along with 60 between the toes and 40 on the toenails,” says an article in the Globe and Mail (Social Studies May 24, 2013).

It goes on to say that the feet are home to more than 100 types of fungus, more than any other area of the human body, quoting a study published in the journal Nature.

Many of the fungi on our skin are good for us in that they prevent bad fungi adhering to our skin. They protect us from getting athlete’s foot, plantar warts and stubborn toenail problems.

Most problems are not life threatening. Here are some examples:

Plantar warts: These are also known as common warts. They grow on the soles of the feet. They grow into the skin because we walk on them. They can be painful on walking. The virus causing the wart is picked up from walking bear foot in locker rooms and swimming pools.

Treatment: They may spontaneously disappear if you wait long enough – months to years. They can be managed by freezing, scrapping or burning. They can recur.

Callus and corns: These are thickened areas on the hands or feet caused by pressure or friction. This is usually related to work or sporting activities. Uneven pressure of body weight during walking or ill-fitting shoes can cause calluses and corns on the feet.

Treatment: Wear proper fitting shoes and use corn pads to relieve pressure on the corns. Thick calluses can be sliced down to normal skin over a period of time. If the source of friction and pressure is removed then corns and calluses should not recur.

Toenail problems: Mainly involves the big toe. It may be ingrown or overgrown. Ingrown toenails are commonly due to ill-fitting shoes pressing on an incorrectly cut nail. Poor foot hygiene encourages infection.

The problem occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Treatment: In an acute stage antibiotic, painkillers and bathing the foot in warm salt water are necessary. Surgery is required in most cases. The problem can be prevented from recurring by keeping the feet clean and wear correctly fitting shoes. Cut the nail straight.

Fungus infection of the nails: Usually affects toenails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Treatment: Anti-fungal therapy is required – orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

Our feet are subjected to more wear and tear and hence they get more problems than our hands. Our natural tendency is to take care of our hands more than our feet. Many of these problems are preventable.

In my view, walking bear feet is the worst thing you can do for your feet. Wash your feet at least once a day (twice if your feet sweat a lot) with soap and water. Dry them well with a soft towel. Apply some skin lotion or powder. Wear good quality clean socks and proper fitting comfortable shoes.

Have a wonderful Christmas and Holiday Season.

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Making sense of celiac disease, gluten allergy and non-celiac gluten sensitivity.

Crown Fountain in Millennium Park, Chicago, Illinois. (Dr. Noorali Bharwani)
Crown Fountain in Millennium Park, Chicago, Illinois. (Dr. Noorali Bharwani)

Celiac disease is a lifelong autoimmune intestinal disorder that runs in families.

The symptoms of celiac disease are triggered by gluten (a protein found in wheat, rye, barley and triticale) in people who are genetically susceptible. Triticale is a hybrid of wheat and rye first bred in laboratories during the late 19th century and can be associated with other immune diseases.

What is non-celiac gluten allergy?

It is a condition with symptoms of celiac disease but the diagnosis cannot be confirmed.

It has taken only 13 years or so to move celiac disease from obscurity into the popular spotlight worldwide. What is more interesting is the spectrum of illnesses associated with ingestion of gluten. Such as allergy to wheat, autoimmune celiac disease, and immune-mediated gluten sensitivity. Sounds complicated? Well, you are not alone.

Research estimates that 18 million Americans have non-celiac gluten sensitivity. That’s six times the amount of Americans who have celiac disease. Researchers are just beginning to explore non-celiac gluten sensitivity.

These individuals seem to be sensitive to gluten often also experience headaches, rashes and fatigue. It is possible that it may in fact be other proteins or sugar in wheat (other than gluten) that may be triggering the reaction. There is no inflammation or damage to the intestinal lining as in celiac disease. More research is needed to understand this problem.

Things to remember about celiac disease are:

A first-degree relative with celiac disease has a 10-fold increased risk of acquiring the condition. It affects one in 133 North Americans.

The risk is increased among people with autoimmune thyroid disease (three to five per cent), type one diabetes mellitus (five to 10 per cent) and Down syndrome (5.5 per cent).

The disease can develop at any age.

Symptoms can be abdominal pain, diarrhea, weight loss and malnutrition.

The most widely available test is the tissue transglutaminase IgA antibody test, which has an estimated 95 per cent accuracy rate. If antibody testing is negative and celiac disease is suspected, the IgA level should be measured.

All adults with an abnormal screening result should undergo a small-bowel biopsy to confirm the diagnosis of celiac disease.

Celiac disease should be considered as a diagnostic possibility in any patient with unexplained iron deficiency anemia, especially if there has been a poor response to oral iron supplementation.

Treatment is lifelong adherence to a gluten-free diet. Examples of gluten-free naturally occurring grains are – oats, buckwheat, millet, rice and quinoa. Gluten-free diet reduces the risk of complications such as osteoporosis and intestinal lymphoma.

Remember, celiac disease is a condition that is fully treatable with dietary modification alone. There are few diseases in medicine that can make this claim.

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Surgeon General of the U.S. Promotes Healthy Walking

A beach in Albufeira, Portugal. Stay active, stay healthy! (Dr. Noorai Bharwani)
A beach in Albufeira, Portugal. Stay active, stay healthy! (Dr. Noorai Bharwani)

Regular walking has physical and mental benefits.

“If you seek creative ideas go walking. Angels whisper to a man when he goes for a walk,” says writer Raymond I. Myers.

If you want to be healthy and stay healthy then take a walk, says U.S. Surgeon General Dr. Vivek Murthy. Vice Admiral Vivek Murthy is an American physician, a vice admiral in the Public Health Service Commissioned Corps, and the 19th Surgeon General of the United States. He knows what he is talking about.

Only half of adults and just over a quarter of high school students get the amount of physical activity recommended for good health. That is not good.

How much activity do we need to stay healthy?

It is recommended that adults get at least two and half-hours a week of moderately intense physical activity. Children should be active at least 60 minutes every day.

Why do we need to be physically active?

The reasons are pretty simple but very important. Regular physical activity reduces the risk of heart disease, diabetes, obesity and a list of other health problems – and can ease symptoms and improve quality of life for people already living with chronic diseases.

Murthy says your walking should be brisk enough that you can still talk but not sing. Walking should be brisk enough to get your heart rate up. To encourage walking we need to make our neighborhoods easier and safer for foot traffic. Walking is simple and affordable. Murthy encourages communities to create walkable neighborhoods. Make sidewalks safer for seniors.

November is senior’s falls prevention month. Studies have shown that walking is good for balance. A good balance does help prevent falls.

Walking is not always easy. Changing weather and flu season is a hindrance to establish consistent walking habit. Icy roads and sidewalks are dangerous. People find indoor areas like malls and indoor walking trails in places like YMCA very helpful.

You can walk leisurely 30 minutes a day for general health benefits. You can walk briskly to improve cardiovascular fitness by walking 30 minutes a day five days a week. If you are trying to lose weight then you need to walk briskly for 45 to 60 minutes a day five days a week. And make your dinner slimmer.

Scientific literature suggests that regular, brisk exercise of any kind can improve confidence, stamina, energy, weight control and life expectancy and reduce stress. It can also reduce the risk of coronary heart disease, strokes, diabetes, high blood pressure, osteoporosis and other health problems. And Friedrich Nietzsche, author of Twilight of the Idols says, “All truly great thoughts are conceived while walking.” What more can you ask for?

Now lets get cracking!

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High Blood Pressure is a Silent Killer

Fishing - one way to relax. (Dr. Noorali Bharwani)
Fishing - one way to relax. (Dr. Noorali Bharwani)

A new study shows that lowering blood pressure more with a target of 120 instead of 140 mm Hg systolic can cut deaths by 25 per cent. A third of U.S. and Canadian adults have high blood pressure. So millions could be affected by the new findings. But U.S. government-funded researchers who ran the study say it’s too soon for anyone to change what they are doing just yet.

“This is huge – I mean, 25 per cent less deaths and a third – 33 percent – less heart attacks, strokes and heart failure – that’s huge,” says Dr. Julia Lewis, a kidney specialist at Vanderbilt University who took part in the new study.

Normally, systolic blood pressure should be less than 140 mm Hg (mercury) and diastolic pressure of less than 90 mm Hg. It is written as – systolic over diastolic (for example 120/80 mm Hg). Blood pressure is lowest in the early morning, rises as the day progresses, and then dips down during the night and earliest hours of the morning. Blood pressure can fluctuate under different circumstances.

World Health Organization says that hypertension (high blood pressure) causes seven million premature deaths worldwide each year. Hypertension affects 22 percent of Canadians. It is estimated that 25 percent of the 42 million people with high blood pressure in the United States are unaware that they have hypertension. These patients probably have no symptoms. That is dangerous. That is why it is called a silent killer.

The incidence of hypertension increases with age. Most elderly Canadians have high blood pressure – probably due to thickening of blood vessels. No cause is identified in 80 to 95 percent of people with hypertension. This is known as idiopathic or essential hypertension. Others have hypertension due to primary disease of kidneys or due to certain hormonal disorders.

Blood pressure also varies from minute to minute, depending on levels of stress and physical activity. “White-coat hypertension” means a person’s blood pressure is up in the doctor’s office but not elsewhere.

Hypertension can be prevented and treated with lifestyle changes – with or without medication. Eat a healthy diet, lose weight if you are overweight, do not smoke, limit alcohol intake, eat a low salt diet, minimize sugar intake, do regular exercise, relax and learn to manage stress with laughter and meditation.

If your doctor wants you to take pills to control your blood pressure then make sure you take it regularly. Research has shown that 50 per cent of the patients with high blood pressure discontinue their antihypertensive medications by the first year. This is not good.

The U.S.-funded study is not quite finished but the effects on the heart were strong and clear. Getting blood pressure to 120 or lower reduced rates of cardiovascular events, such as heart attack, stroke and heart failure by a third. It reduced the deaths from any cause by 25 percent.

The research team is still studying the effects of lower blood pressure on dementia, memory loss and kidney function. Other studies have suggested lower blood pressure can help reduce or delay dementia symptoms and boost kidney function.

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