Category: Medicine Hat News

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What would make the liver quit working?

A cirrhotic liver. (iStockphoto/Thinkstock)
A cirrhotic liver. (iStockphoto/Thinkstock)

Dear Dr. B: What would make the liver quit working? This person did not use alcohol. Could West Nile virus, hepatitis or E. coli possibly affect your liver?

Two most common causes of liver failure in North America are alcohol and acetaminophen use. Acetaminophen is present in over-the-counter pain and cold medications like Tylenol. We will come to this later. Let me first answer your question.

As far as I know, West Nile virus does not cause liver failure. Usually. West Nile fever resolves spontaneously and completely. In a worst case scenario, fatigue, headache, weakness, movement disorders can persist for weeks or months. Severe disease involving the nervous system can result in death or permanent disability. Death is from swelling of the brain and respiratory failure.

Hepatitis does cause liver failure. Hepatitis is a generic term used for inflammation and damage to the liver cells. The liver cells can be damaged by drugs, any kind of toxins, alcohol, inherited diseases, certain metabolic diseases and viruses. Generally speaking, when we say hepatitis, it refers to viral hepatitis A, B, and C. Hepatitis C is the commonest reason for liver transplant in the U.S.

E. coli infection is very common. But it is not a common cause of liver failure. E. coli can cause infection of the urinary tract, gallbladder, bile ducts and the infection, in rare cases, travel to the the liver, brain (meningitis) or lungs (pneumonia). The majority of infected individuals make a full recovery within a week. About six per cent of patients end up having kidney failure (hemolytic uremic syndrome). Of these, between three to five per cent of patients will die.

Alcohol is a poison. Any amount of alcohol can produce damage to the the liver. The liver is very sensitive to alcohol. If you have had previous problems with the liver then the best thing is to avoid alcohol and acetaminophen.

The most common agent causing liver damage is acetaminophen. However, It is considered the safest medication for fevers, aches and pains, but only if taken in small recommended amounts. In large amounts, greater than those recommended, can result in the liver damage or failure. Acetaminophen overdose is a common reason for considering a transplant.

We have five vital organs – the liver, the brain, the heart, the lungs and the kidneys. The liver plays a vital role in the metabolism of fat and carbohydrates, synthesis of proteins, detoxification of poisons and storage of good nutrients. When the the liver fails, either acutely or chronically, these important functions do not occur. Thus, the person faces severe ill health. There are numerous other reasons why the liver can fail. It is impossible to discuss them all here. However, you get the idea. It is easy to damage your liver if you are not careful.

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There are Many Options to Alleviate Jet Lag

A tired traveler. (iStockphoto/Thinkstock)
A tired traveler. (iStockphoto/Thinkstock)

People travel for business or pleasure. But there is always a price to pay in terms inconvenience before, during and after the trip. Disruption of your body’s circadian rhythm is one of those inconveniences if you are travelling across time-zones (east-west or west-east).

What is circadian rhythm? It is your body’s 24-hour biological clock. Circadian rhythms are physical, mental and behavioural changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in your environment. The rhythm is disrupted because your internal clock is unable to adapt to a rapid change in the light-dark cycle. This causes disruption in sleeping and eating patterns, also known as jet lag.

The inconvenience of jet lag may last several days and some experts have suggested the recovery rate of one day per time zone crossed. During the days of propeller flights, jet lag was not a problem as the flights were slower and of more limited distance. Crossing one or two time zones does not typically cause jet lag nor does north-south travel. So it all depends on the number of time zones you cross.

There are no serious health consequences to jet lag. It does make you tired, moody, and may cause diarrhea or constipation. Airline pilots and in-flight cabin crew members are monitored for jet lag for safety reasons. You don’t want your plane crash or have hot coffee spilled on your lap.

There is no easy solution to prevention or management of jet lag. But the options are many. Before travel, try to go to bed a little earlier each night. That does not happen as we are busy trying to finish all we need to do before the trip. Some people try homeopathic tablets. Recently, I read about a new innovation Valkee Brain Stimulation Headset, which helps to alleviate jet lag by channeling bright light into the brain through the ear canal. Do your homework before you use pills or the headset.

An article in the New York Times (August 15, 2012) discusses “the latest (and perhaps most effective) jet-lag solutions” being developed by the fatigue management team at NASA Johnson Space Centre in Houston to help astronauts overcome jet lag two to three times faster than other travellers.

First, understand that the direction you are travelling makes a difference. Most people have an internal body clock that makes it harder for them to travel east. If you’re travelling east and want to adapt to the new time, you will have to wake up earlier and go to bed earlier than you normally would. This is known as advancing your body clock.

If you’re travelling west, you’ll have to adapt to the new time by waking up later than usual and going to bed later than usual, delaying your body clock. You can do that by wearing sunglasses even if you are in the plane. The idea is to ease yourself into the new time zone by consciously manipulating your exposure to light. So keep those sunglasses on.

Some people use synthetic melatonin to induce sleep. It is not a regulated medication so discuss with your doctor first. Light-therapy lamp is another option. It can speed up the process up to one hour per time zone if used correctly. You can try fasting to change the circadian rhythm to adapt to new eating time. Viagra has been tried in hamsters and the recovery from jet lag is faster by 50 per cent. It has not been tested in humans.

Controlling jet lag is fundamentally about controlling light and darkness. It is not always easy to do that. So, forget about jet lag, pack your suitcase and fly away – with or without Viagra.

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There are Many Reasons for Insomnia

A woman suffering from insomnia. (iStockphoto/Thinkstock)
A woman suffering from insomnia. (iStockphoto/Thinkstock)

Insomnia is defined as chronic inability to fall asleep or remain asleep for an adequate length of time. It is estimated 10 to 40 per cent of people suffer from some sort of insomnia. This is only an estimate as nobody has yet defined what constitutes normal sleep.

Most adults sleep seven to eight hours a night. Newborns and children may sleep up to 16 hours a day. Older people may sleep only six hours a night. There is no magic number. If you are tired the next day or are yawning all the time then you need more sleep.

The quality of sleep you get is also important. The quality and quantity of sleep depend on many factors like your health, your lifestyle and your environment.

In a survey done in the United States, it was found that many patients with insomnia have other medical problems. Thirty per cent of the patients have depression, 20 per cent have other mental disorders, and 19 per cent have other illnesses. But 31 per cent of the patients have primary insomnia – no medical condition contributing to insomnia. Sometimes insomnia may be the first symptom of depression.

“The prevalence of insomnia has also been reported to be higher in women, women in minority groups, people who are unemployed or separated, lower socioeconomic groups and in those with medical or psychiatric – particularly substance abuse – disorders,” says an article in the Canadian Medical Association Journal.

It is very important you consult your doctor if you have trouble falling asleep or cannot remain asleep for an adequate length of time. The cause of your insomnia could be stress, depression, anxiety, panic attacks, spastic bladder, arthritis, hyperthyroidism, congestive heart failure, obstructive sleep apnea, or lung disease. You may be overindulging in caffeine or alcohol. Or there may some other cause.

Your physician can help you sort some of these problems by recommending regular daytime exercise, avoiding large meals at night, avoiding caffeine, tobacco and alcohol; reducing evening fluid intake; maintaining a consistent wake-up time; avoiding or limiting daytime napping and avoiding bright lights – including television, noise and temperature extremes. In some circumstances he may recommend medications.

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E. coli Infection from Contaminated Food can be Very Serious

Your hamburger may be a bio-hazard! (iStockphoto/Thinkstock)
Your hamburger may be a bio-hazard! (iStockphoto/Thinkstock)

Last week’s news: Health officials in Alberta say they are investigating five cases of E. coli infections in people, but they are not linking them to an extensive recall of ground beef from major Canadian grocery stores.

It seems the problem is sporadic rather than widespread. However, the person infected with E.coli can suffer from mild to severe and sometimes life threatening symptoms. It has been reported four of the infections are in Edmonton and one in Calgary. Apparently, one such case involves a four-year-old Calgary girl whose kidneys have failed and she has had two blood transfusions.

The Canadian Food Inspection Agency first warned last week that ground beef from Edmonton-based XL Foods may contain E. coli. Investigations are going on but it is not always easy to pin down the source of infection since there are many potential sources of exposure.

E. coli is one of the many organisms which colonise intestinal tract of humans and animals. E. coli and related bacteria constitute about 0.1 per cent of gut flora. E. coli colonizes an infant’s gut within 40 hours of birth with food or water or with the individuals handling the child. They remain harmless in the gut until they become virulent and cause all kinds of troubles.

Virulent strains of E. coli can cause gastroenteritis, urinary tract infections, and neonatal meningitis. In rarer cases, they can cause hemolytic-uremic syndrome (toxic substances destroy red blood cells causing kidney injury), peritonitis, mastitis, septicemia (bacteria in the blood cause chills, high fever, rapid breathing and rapid heart rate), and pneumonia.

Food, water and dirty hands are contaminated with animal or human faecal matter containing E. coli and then we ingest it. Other sources of E. coli are undercooked ground beef, unpasteurized milk or cider, salami, alfalfa sprouts and lettuce. Person-to-person transmission is common.

Clinical presentation is from mild nonbloody diarrhea to serious bloody diarrhea with severe abdominal cramping, septicemia and kidney failure. The incubation period averages about four days, but ranges from one to 10 days. Adults typically shed the bacteria for about a week after infection, young children, for up to three weeks. Diagnosis is made by stool cultures.

Treatment is, for the most part, supportive with maintenance of fluid and electrolyte balance and blood transfusion if necessary. Preventing this infection is difficult because E. coli is present almost everywhere. Attention should be paid to food safety, personal hygiene and the rapid identification of active cases. Always remember to wash your hands as often as possible. Servers and kitchen staff at restaurants and fast food joints, staff at nursing homes and hospitals and industries where food is extensively handled by different individuals have to pay extra attention to personal and environmental hygiene.

It is important to report to the local medical officer of health all suspected and confirmed cases of E. coli infection. These infected individuals should refrain from interacting with the vulnerable populations – elderly, children and the sick. If they handle food then they should refrain from these occupational activities until two stool samples have tested negative for E. coli.

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