Category: Medicine Hat News

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Measles is a Highly Contagious Viral Infection of the Respiratory Tract

Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)
Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)

Measles is making bad news. It seems to have started in Disneyland. A place where kids go for fun. How ironic and sad. And it has spread to several states in the U.S.

According to Centers for Disease Control and Prevention (CDC) website, 50 people from six states were reported to have had measles in the first two weeks of this month. Most of these cases are part of a large, ongoing outbreak linked to Disneyland in California.

According to CBS news (January 22, 2015), at least 75 people have now been infected with measles virus. The California public health officials are urging those who haven’t been vaccinated against the disease, including children too young to be immunized, to avoid Disney theme parks.

Age of people infected ranges from seven months to 70 years old, including five Disneyland workers.

Measles spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Alberta had a measles outbreak last year. On April 29, 2014, Alberta Health Services declared a measles outbreak in the Calgary, Central and Edmonton Zones of Alberta Health Services (AHS). By July, AHS declared the outbreak to be over.

The best way to prevent measles is to have Measles-Mumps-Rubella (MMR) Vaccine. All health care workers should be vaccinated with two doses of the vaccine. Health care workers are at greater risk of measles infection than the general population because they provide care for ill individuals. A recent review concluded that health care workers were 13 to 19 times more likely to develop measles than other adults.

MMR vaccine is highly effective at preventing measles. One dose is 85-95 per cent effective and the effectiveness of two doses approaches 100 per cent. Two doses provide long-lasting immunity. The vaccines are very safe.

Measles was eradicated by year 2000 because of vaccination. But the virus has made a comeback in recent years, in part because of people obtaining “personal belief exemptions” from rules that say children must get their shots to enroll in school. Others still believe in now-discredited research linking the measles vaccine to autism.

Who started the current outbreak? Should we blame people who refuse to get vaccinated because they believe it is harmful to their children? Apparently, a small number of those stricken had been fully vaccinated. It is also reported the outbreak was triggered by a measles-stricken visitor to one of the Disney parks who brought the virus from abroad last month.

Coughing and sneezing spreads the highly contagious virus. Deaths are caused by complications associated with the disease. Complications are more common in children under the age of five or adults over the age of 20.

There is no specific antiviral treatment. Mostly symptomatic treatment is provided for symptoms and complications. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one U.S. dollar to immunize a child against measles. And it saves lives.

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Exposure to Asbestos Leads to Many Health Problems

A beautiful view of the Canadian Rockies. (Dr. Noorali Bharwani)
A beautiful view of the Canadian Rockies. (Dr. Noorali Bharwani)

This is my 600th column and 19th year of writing What’s up doc? How time flies when you are having fun. So, here we are in 2015. Let me wish you a Happy New Year. It is never too late to wish happiness to anybody at any time of the year.

We will start the year discussing a condition that is not so common now. But there are people who are suffering and if we are not careful then more people will be affected. People who are working in old buildings and construction sites.

I am talking about the risks of exposure to asbestos. Exposure to asbestos leads to many health problems including cancer called mesothelioma. Mesothelioma (also called malignant mesothelioma) is cancer that affects the protective lining that covers many of the internal organs of the body.

Most people who develop mesothelioma have worked in jobs such as miners where they inhaled or ingested asbestos fibers, or were exposed to airborne asbestos dust and fibers in other ways.

Asbestos fibres are strong, durable and non-combustible. They were widely used by industry, mainly in construction and friction materials.

How much asbestos is in a product does not indicate its health risk. If the asbestos fibres are enclosed or tightly bound in a compound, there is no significant health risk. Asbestos poses health risks only when fibres are present in the air that people breathe.

One of the main problems with asbestos came from easily broken up asbestos used in buildings until the 1970s. People working in construction, maintenance or in the renovation of older buildings should be particularly careful.

Mesothelioma commonly affects the outer lining of the lungs and internal chest wall, but it can also arise in the lining of the abdominal cavity, the sac that surrounds the heart, or the sac that surrounds the testis.

The symptoms of asbestos exposer or mesothelioma are shortness of breath due to fluid between the lung and the chest wall, chest wall pain and unexplained weight loss.

The diagnosis may be suspected based on chest X-ray and CT scan findings, but must be confirmed either by chest fluid examination and biopsy. Mesothelioma carries a poor prognosis. Treatment with chemotherapy, radiation therapy or surgery is not very effective.

Health Canada has encouraged provincial occupational health authorities to adopt stringent workplace exposure limits for asbestos. Use of asbestos is strictly regulated under the Hazardous Products Act.

More information can be obtained from various sources like Wikipedia, Canadian Centre for Occupational Health and Safety, Health Canada and mesothelioma.net. The mesothelioma.net support group provides patients with free resources, support, education, and referrals to experienced mesothelioma doctors. For more information contact: sharon@mesotheliomahope.net

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Do We Have to Make a New Year’s Resolution?

Peace and tranquility for the New Year. (Dr. Noorali Bharwani)
Peace and tranquility for the New Year. (Dr. Noorali Bharwani)

The other day a friend said to me, “Every year I make a resolution to change myself. This year I am making a resolution to be myself.” Sounds pretty sensible to me.

Anyway, who started this idea of making a New Year’s resolution?

“A New Year’s resolution is a secular tradition, most common in the Western Hemisphere but also found in the Eastern Hemisphere, in which a person makes a promise to do an act of self-improvement, …” says an article in Wikipedia.

The ancient Babylonians and the Romans began each year by making promises to the gods. Similarly, there are many stories in the literature about other religious groups doing something significant in the New Year. The main goal is to reflect upon self-improvement on a yearly basis.

“At the end of the Great Depression, about a quarter of American adults formed New Year’s resolutions. At the start of the 21st century, about 40 per cent did,” says Wikipedia.

New Year’s Eve has always been a time for looking back to the past, and more importantly, forward to the coming year. It’s a time to reflect on the changes we want to make and resolve to follow through on those changes.

Some of the common resolutions are: spend more time with family and friends, join a fitness club, lose weight, quit smoking, enjoy life more, quit drinking, get out of debt, learn something new, help others and get organized. Hmm…! How successful are you with resolutions?

A 2007 study from the University of Bristol involving 3,000 people showed that 88 per cent of those who set New Year resolutions fail. Men achieved their goal 22 per cent more often when they engaged in goal setting, something more specific than saying “lose weight.” Women succeeded 10 per cent more when they made their goals public and got support from their friends.

One way to succeed in achieving your goal is to join a group with similar goals or have a friendly competition with a colleague or a family member.

Do we have to make a New Year’s resolution? Not really. Life goes on. Just be a nice person and keep smiling.

Have a wonderful happy New Year.

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Merits of Having an Annual Physical Examination

Fishing – one way to relax and stay healthy. (Dr. Noorali Bharwani)
Fishing – one way to relax and stay healthy. (Dr. Noorali Bharwani)

Most health conscious adults get a yearly physical examination. Sometimes people wonder whether it is worth going through the process on a yearly basis – especially if you have no health issues.

An article in the Canadian Medical Association Journal (CMAJ November 4, 2014) discusses the pros and cons of such a yearly ritual (The periodic health examination in adults by David Ponka). The main purpose of this yearly ritual is for screening and preventive purposes.

This ritual dates back to at least the industrial revolution, when employers paid for annual check-ups to keep their labour forces healthy, says the CMAJ article. Now the practice has become one of the duties of a family doctor to keep the patients healthy. Interestingly enough, it is not an insured service in all provinces.

The question usually asked by the people who consider this an unnecessary expensive yearly ritual is, “Does it keep the adults healthy?”

The answer to this question is unclear, says the article. Some countries, such as the United Kingdom and Germany, encourage yearly physical examination for otherwise healthy adults aged 40–75 years. The reason being that this group has an increasing burden of lifestyle and chronic diseases that may be amenable to intervention. In Canada, the trend is toward reducing or eliminating the use of such yearly rituals in adults. One way is to disallow coverage by the health insurance plan.

There are some advantages to yearly physical examination for high-risk patients compared to low risk patients. The annual visit to a doctor provides opportunity to perform evidence-based preventive tests, to counsel patients on lifestyle issues, update vaccinations and, importantly, to identify risk factors and diagnoses through updating the patient history, says the article.

There is no scientific evidence to show that the annual physical examination reduces sickness and death in the community. On the contrary the annual ritual may lead to too many blood tests, chest x-rays and ECGs, exposing patients to the risks of investigation, such as false-positive results and over diagnosis.

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures. They have a very interesting website. You can Google it. It’s recommendations on periodic health examinations are:

-Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient.

-Don’t order screening chest x-rays and ECGs for individuals with no symptoms.

The article says that the value of a regular (not necessarily annual) physical examination may lie in other factors like:

-To assist marginalized groups who would otherwise not attend regularly

-It may also assist in efforts around management of chronic disease and over medication.

What do you think? If you are not sure whether you need an annual physical examination then discuss with your family doctor. Greetings for the holiday season. Be safe and eat less.

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