Category: Medicine Hat News

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Saying the Last Good-Bye to an Inspiring Friend I Never Met

Candles - Peace for Joyce. (Dr. Noorali Bharwani)
Candles - Peace for Joyce. (Dr. Noorali Bharwani)

I have been writing articles on a random basis since my school days. But my serious writing started in Medicine Hat. I also started taking a writing course inspired by a friend I never met, Joyce. Joyce is a successful writer.

Due to various reasons, I never finished the writing course but Joyce received my columns on a regular basis. From time to time she would write to me encouraging and inspiring letters. She lived in British Columbia. Once I was there on a holiday with my family. I arranged to meet with Joyce. The meeting was cancelled at the last minute, as I was running late in my other commitment. Now I feel so bad that I never got to meet Joyce.

In the last few months, Joyce has been sharing with me her health issues, which are not very good. I think about her and pray for her health and comfort. You wonder sometimes why such good people have to suffer so much at the end of the their wonderful and satisfying life. I saw my mother suffer from the consequences of cancer in her dying days. As a physician I know what Joyce is going through.

Her last email to me arrived few weeks ago. I will share that with the readers of my column because many will empathise with what Joyce has to say. Her email reads as follows:

Hello Doctor,

I’m shutting down my computer in a few days, so I wanted to bring you up-to-date.  I think I told you I have lymphoma.  They radiated the tumour and I went into remission.

About three months ago, I came up with a tumour in the colon, unrelated to the lymphoma. Last week they sent me for a scope and couldn’t even get it in the colon.  As far as they can tell, my large colon is almost solid with cancer.  It is fast growing and metastasizing. I’ve decided not to do anything.

I’m almost 80, have had 39 surgeries, 2 heart attacks, been hit by lightning twice, Don is gone and I’ve had over 40 years of pain. It all started when I got that heart virus.  To be honest, I’m tired and can’t fight anymore.  My kidney function is approaching dialysis so it’s unlikely I’d survive removing my entire large bowel.

The oncologist said I’m not going to feel much worse until the bowel completely closes and perforates.  From then it’s right to hospice and it will go quickly.  He said they’d likely put me in a coma the first day or two. Until then, it’s life, as we know it.

I’ve done everything I’ve wanted to, have made all my amends and have left a legacy of which I’m proud.  It’s been difficult for my family and some of my friends, but everyone is starting to settle down.  I have no fear and am actually anxious to start the next adventure.

I’m very proud of you and what you’ve done with your talent.  It’s been fun for me to watch you grow and to read your columns.  Thanks for taking the time to send them to me.  I wish you all the luck as you go forward with your writing.  The blessing is, it is something you can do no matter where life takes you.  You’ve been an inspiration in my life.  Thank you!

Joyce

Well, what can I say Joyce. You have inspired me and many of your students. So good-bye Joyce, may you find peace and comfort where ever you go in the world beyond this planet. May your soul rest in eternal peace… Amen.

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Screening with Pap Test Should Not be Ignored

Barbuda - time to relax on a beach. (Dr. Noorali Bharwani)
Barbuda - time to relax on a beach. (Dr. Noorali Bharwani)

“The rate of death from cervical cancer is reduced by more than 80 per cent among women who have regular Papanicolaou (Pap) screening,” says an article in the Canadian Medical Association Journal (CMAJ December 9, 2014).

Every woman knows or should know the importance of regular Pap smear test. Since World War II, the test has been the most widely used and successful cancer screening technique in history. It is named after the Greek doctor who invented it – Dr. George Nicholas Papanicolaou.

Since the Pap smear was introduced in 1940s, deaths from invasive cervical cancer occur mostly among women who do not undergo regular screening. It is sad to note that women of lower socioeconomic status and those who are older, First Nations or immigrants are less likely to be screened regularly.

The article notes that screening intervals shorter than three years increase the risk of finding and investigating abnormalities that mostly resolve spontaneously. So it is unnecessary to do Pap smear more often than every three years. The drawback is that longer intervals require organized screening and recall programs to maintain high participation rates. This is not always easy.

At what age should we start doing Pap smear? This varies by jurisdiction, but most guidelines agree that harm from false-positive results outweighs potential benefits of Pap screening in young women. Women who have had a total hysterectomy for a benign disorder and women over 70 years of age who have had three normal test results within 10 years do not require Pap screening, says the article.

Choosing Wisely Canada recommendations on Pap screening are as follows:
1. Don’t use the Pap test for screening in women who are under 21 or more than 69 years of age (Screening should stop at age 70 if the results of three previous tests were normal).
2. Don’t do Pap screening annually in women with previously normal results.
3. Don’t do Pap tests in women who have had a full hysterectomy for a benign disorder.

How can we prevent cervical cancer by testing for human papillomavirus (HPV) infection? The answer to this question is not clear yet. It is work in progress. It is important to remember that HPV is a cancer-causing virus. We know infection with specific strains of HPV is a necessary precursor to cervical cancer. HPV types 16 and 18 are present in about 70 per cent of cervical cancers worldwide and are targeted in HPV vaccines. Some of the viruses cause genital warts – another sexually transmitted infection.

Who is susceptible to HPV infection? A woman who is sexually active, she has multiple partners or she has sexually transmitted infection. Then there would be an indication to do HPV test. The reason HPV test is not recommended for all women is because there is not yet sufficient data on its effect on mortality and incidence of invasive cervical cancer.

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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CT Scan versus MRI Scan – Which is Better?

A boat waiting to sail off the coast of Antigua. (Dr. Noorali Bharwani)
A boat waiting to sail off the coast of Antigua. (Dr. Noorali Bharwani)

It is hard to think that there is any adult who hasn’t had either magnetic resonance imaging (MRI) or computed tomography (CT) or both. They are complementary imaging technologies and each has advantages and limitations for particular indications.

CT is more widely used than MRI in some countries. That raises concern about the potential for CT to contribute to radiation-induced cancer. In 2007, it was estimated that 0.4 per cent of current cancers in the United States were due to CTs performed in the past. It is also estimated that in the future this figure may rise to two per cent based on historical rates of CT usage.

CT scans have many benefits that outweigh this small potential risk. Newer, faster machines and techniques require less radiation than was previously used. Still, CT is contraindicated in pregnancy.

Compare that to MRI. An advantage of MRI is that no ionizing radiation is used. MRI is recommended over CT when either approach could yield the same diagnostic information. Unfortunately, there are not many common imaging scenarios in which MRI can simply replace CT.

Although MRI can detect health problems or confirm a diagnosis, it is interesting to note that medical societies often recommend that MRI not be the first procedure for diagnosis and treatment.

CT images provide more detailed information. A CT scan combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues inside a body.

A CT is well suited to quickly examine people who may have internal injuries from car accidents or other types of trauma. A CT scan can be used to visualize nearly all parts of the body and is used to diagnose disease or injury as well as to plan medical, surgical or radiation treatment.

MRI scanners use magnetic fields and radio waves to form images of the body. The technique is widely used in hospitals for medical diagnosis, staging of disease and for follow-up without exposure to ionizing radiation. In certain cases MRI is not preferred as it can be more expensive, time-consuming, and claustrophobic.

To summarize, indications of doing CT scan and MRI scan are pretty similar. There is a small radiation exposure in CT compared to none in MRI. CT is slightly cheaper to do. It takes less time than MRI, especially beneficial for claustrophobic patients and time utilization in the radiology department. If you are claustrophobic then ask for a mild sedation and enjoy the ride.

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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The Secret to Losing Weight – Eat Right and Eat Less

Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)
Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty five per cent of your effort should be spent on physical exercise. If you made a New Year’s resolution on losing weight then this is a good time to take stock of your achievement. We are into April. Have you lost at least four pounds?

If yes, then keep it up. Slow and steady wins the race. If you haven’t then you should know that there are 37,000 books in the market on how to eat right and lose weight. According to the Canadian Medical Association Journal (CMAJ March 17, 2015), dieting programs and books are a $66-billion industry. Now you know where all your money goes.

We all have different ideas on what is right and what is wrong. When it comes to eating, it will be hard to find two people following the same dietary regimen to lose weight. If you want to be a permanent loser (I mean losing weight) then eat less.

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2).

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level. There is no simple solution. It is determination and hard work.

So the secret is out – to lose weight you have to eat smart and eat less for life.

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