Category: Medicine Hat News

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Research Shows Laughter and Music Good for Your Heart

A group of smiling women. (Goodshoot)
A group of smiling women. (Goodshoot)

In 2009, for the first time, research showed that there is some truth in the good old saying, “Laughter is the best medicine.” But anger and stress, hmm… not so good.

Laughter, along with an active sense of humour, may help protect you against a heart attack, according to the 2009 study by cardiologists at the University of Maryland Medical Center in Baltimore. The study found that people with heart disease were 40 percent less likely to laugh in a variety of situations compared to people of the same age without heart disease. They also displayed more anger and hostility.

The researchers could not explain how laughter protects the heart but they found that mental stress is associated with impairment of the lining of the blood vessels. The damage to the lining is followed by inflammatory reactions that lead to fat and cholesterol build-up in the coronary arteries and ultimately to a heart attack.

Now let us fast forward to 2011. Location: Paris, France. At a session entitled, “Don’t worry, be happy,” a series of research papers were presented at the European Society of Cardiology Congress highlighting the role of laughter, positive thinking (cognitive therapy), anger, and job stress on developing cardiovascular events.

The cardiologists from Baltimore presented their research related to the effects of humorous and stressful movies on the function of the lining of the blood vessels. They found that the blood vessels constricted by as much as 30 to 50 per cent when watching movies which were emotionally stressful. In contrast, blood vessels dilated when investigators measured vascular function in subjects watching the comedies.

Positive or negative effects on blood vessels can last for about an hour. Other researchers have seen the benefits of laughter on vascular function extended to 24 hours. The magnitude of change in the blood vessel is similar to the effects observed with statins and physical activity.

Other studies presented at the Paris conference dealt with the effect of anger, job stress, and depression. A study from University of Helsinki, Finland, observed that public-sector individuals who work more than three hours overtime per day were at an increased risk of coronary heart disease compared with those who worked no overtime.

A study from the Institute of Clinical Physiology in Pisa, Italy, recruited 228 patients with the diagnosis of myocardial infarction (heart attack), 200 of whom were men, and assessed the long-term effects of anger on recurrent cardiovascular outcomes. They found that over the course of 10 years, 78.5 per cent of patients without an angry-personality profile were free from a recurrent infarction compared with 57.4 per cent of patients with angry personalities. People with angry personalities tend to eat more and use alcohol too much to curb stress.

A study from Australia showed at four months, cognitive therapy reduced depression and reduced waist girth, increased good (HDL) cholesterol levels and increased physical activity. Patients were better at managing their anger, depression and anxiety.

A researcher from Germany, believes that classical music offers the ideal therapy for patients with hypertension and increased heart rates. He is now planning a prospective study called “Bach or beta blockers.”

Come to think of it, preventing heart attack is lot of fun. Laugh a lot, listen to music, have a positive attitude, meditate a bit, eat healthy, exercise regularly, have a glass of red wine, have a fulfilling relationship with your partner, go dancing and manage your anger. Easy.

Now, go and have some fun.

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A New Blood Thinner to Prevent Stroke

A doctor reviewing MRI films. (iStockphoto)
A doctor reviewing MRI films. (iStockphoto)

It was only a year ago, I wrote about a new blood thinner (dabigatran) to prevent stroke in patients with irregular heart rhythm. Now we have a second drug (rivaroxaban) for the same indication. This is good news for patients who are on blood thinners like warfarin – a rat poison.

About 350,000 Canadians suffer from irregular heart rhythm called atrial fibrillation (AF). In the U.S. there are approximately 2.3 million adults with AF. The commonest cause of AF is getting old. The lifetime risk of getting AF is one in four after the age of 45. Before that it is not that common. Occasionally, you do see patients in their 20s and 30s.

Most common causes of AF are: hypertension, valvular heart disease, alcohol excess, thyroid disease, obesity, sleep apnea, genetic predisposition and it can be idiopathic (cause unknown). What I call GOK – God only knows!

The most dangerous complication of AF is stroke. It accounts for up to 36 percent of all strokes in elderly people. The cost of looking after patients with stroke runs into millions of dollars.

In order to prevent stroke, patients with AF are converted to regular (sinus) rhythm by applying direct-current electrical shock (cardioversion), by medications or by ablation therapy. If it is difficult to sustain regular rhythm, then the patients receive blood thinners (like warfarin) on a regular basis to reduce the risk of stroke by 70 percent.

The main advantages of warfarin are that it is cheap and is covered by provincial drug plan. Major disadvantages are that you need frequent blood tests to make sure that the blood concentration of the drug is at a safe level to keep the blood thin. But not dangerous enough to make you bleed in the brain or some other place. It is quite difficult to achieve the safe level and maintain it.

Over the years, there has been great amount of research to find a drug to replace warfarin. Last year, dabigatran (Pradax) was introduced. This year we have rivaroxaban (Xarelto) in the market. These new blood thinners do not require regular blood tests.

Rivaroxaban is an oral blood thinner invented and manufactured by Bayer as Xarelto. Rivaroxaban is well absorbed from the gut and maximum inhibition of factor Xa occurs four hours after a dose. The effects last eight to 12 hours, but factor Xa activity does not return to normal within 24 hours so once-daily dosing is possible. Compared to dabigatran which is to be taken twice a day. The daily dose for rivaroxaban is usually 20 mg once a day.

The newer oral blood thinners have been found to be better in preventing stroke than warfarin and the risk of side-effects like bleeding is less than warfarin. And remember – no blood tests.

There are two significant disadvantages to taking the newer drugs. One, there is no antidote to convert your blood to normal if you have a significant bleed after trauma or bleeding due to another cause. The mortality rate can be high. Second, the pills are expensive. So, you have to check with your insurance company if the cost of the pills will be covered. Xarelto is slightly cheaper than Dabigatran because of once a day dosage.

Now, only if we can permanently prevent atrial fibrillation, warts, common cold and hemorrhoids (just to mention a few) then life will be good. You won’t have to choose between the devil and the deep sea. But some of us will be out of business.

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Did You Get The Right Toilet Training?

A kid learning to sit on a toilet. (Comstock/Thinkstock)
A kid learning to sit on a toilet. (Comstock/Thinkstock)

When I hear about toilet training, I wonder if I got the “right” toilet training when I was growing up in a small town in Tanzania. My parents did not have the books which modern mothers have to guide them. We did not have the public health care system to help young mothers at home.

By the time I was born, my mother already had five children. So I am sure she knew what to do. My role in toilet training my children was to listen to my wife and follow her advice. “Mother knows best” is my mantra when I don’t know what to do. When I have to rush to work or to golf course then, of course, “mother knows best” works quite well. Sometimes it can back fire.

Ok, let us not digress. My eyes lit up the other day when I looked at the recent issue of the Canadian Medical Association Journal (CMAJ March 20, 2012). There is commentary titled, “Toilet training children: when to start and how to train.” It is written by Dr. Darcie A. Kiddoo, who is with the Divisions of Pediatric Surgery and Urology, Department of Surgery, University of Alberta, Edmonton, Alta.

So I said to myself, here is something scientific to tell me how to toilet train my grandchildren.

Dr. Kiddoo says, “Toilet training is felt to be a natural process that occurs with development, yet very little scientific information is available for the physicians who care for children. In reality, toilet training is a complex process that can be affected by anatomic, physiologic and behavioural conditions.”

Over the last 100 years, there have been many ways of toilet training our children. This varies from passive and lacking in structure, to coercive and regimented, to child-oriented and semistructured, says the article.

In 1962 Brazelton developed a “child readiness” approach, which was child-focused and unregimented. The children started training at 18 months of age, and, daytime continence was achieved by a mean age of 28.5 months.

Spock discussed toilet training in Baby and Child Care, published in 1968. His approach was similar to Brazelton’s. He was opposed to absolute rules that could result in behavioural problems.

Since then many methods have been described. These are: structured and parent-oriented, the very early approach of assisted toilet training in infants when the infant is two to three weeks of age, then there are other approaches which involve both positive and negative reinforcements.

Many studies have been published but none providing any definitive answer to the question – What is the best way to toilet train your child?

Despite the lack of evidence, the American Academy of Pediatrics and the Canadian Paediatric Society recommend a child-oriented approach based on expert opinion. They advise starting when the child is 18 months of age and suggest that the child must be interested in the process, says the CMAJ article.

If you toilet train your child later (more than 18 months of age) then there is a higher incidence of incontinence and urinary tract infections. Some experts have concluded that toilet training at a younger age (18 to 26 months) was associated with a longer training interval but no adverse events. But have no fear or sense of guilt, because there isn’t a final word written on this subject.

Three things to remember:
-Toilet training should be started when both the child and parent are willing and able to participate.
-A positive, consistent approach to toilet training is unlikely to cause long-term harm.
-Mother knows best.

Well, I wish your children happy “pooping.”

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Female Hysteria and Invention of a First Electric Vibrator

“Did you know the vibrator was the fifth domestic appliance to be electrified, after the sewing machine, fan, tea kettle and toaster? It also was invented about a decade before the vacuum cleaner and electric iron. Interesting right?” asks Brad Brevet in the online review of 2011 movie Hysteria. It was posted on his website: RopeofSilicon.com.

Now you know, an electric vibrator is a domestic appliance. Next time you buy a house, check if it is included in the price.

Seriously speaking, the movie, Hysteria, is about how female hysteria led to the invention of the vibrator. It is also a tale of a Victorian doctor who co-patents – in the name of medical science – the first electro-mechanical vibrator. It is also a story of sexual repression and woman’s liberation during the Victorian time.

Then there is a play called In the Next Room (Or The Vibrator Play). The story centers around a young male doctor at the turn of the century who innocently uses a new electric vibrator to cure a female patient of her hysteria and his wife’s discoveries about the device.

A review in the Globe and Mail says, “The film and the play are the latest incarnations to cast a bemused glance back at “hysteria,” the catch-all Victorian malady that pathologized female desire and had doctors masturbating patients, first with their hands and later with rudimentary vibrators, in hopes of treating a wide variety of symptoms, from anxiety, depression and insomnia to nymphomania and frigidity – not to mention the much frowned-upon practice of reading novels.”

Hysteria was considered a “womb disease.” It was a loosely defined condition which emerged in Hippocrates’ days (c. 460 BC – c. 370 BC) and involved “anything that made the woman troublesome to those around her.”

Generally speaking, the word hysteria describes unmanageable emotional excesses. People who are “hysterical” often lose self-control due to an overwhelming fear that may be caused by multiple events in one’s past that involved some sort of severe conflict. Until the seventeenth century, hysteria referred to a medical condition thought to be particular to women and caused by disturbances of the uterus.

Symptoms of female hysteria are various. One Victorian physician cataloged 75 pages of possible symptoms of hysteria and called the list incomplete.

The treatment of female hysteria varied. One recommendation was pregnancy to cure the symptoms, ostensibly because intercourse will “moisten” the womb and facilitate blood circulation within the body. The condition was also thought to be a sexual dysfunction. Typical treatment was massage of the patient’s genitalia by the physician and, later, by vibrators or water sprays to cause orgasm.

Manual massage by physician became a standard medical treatment in Europe at least by the 5th century AD, running through about 1900. In 1883, a British doctor, Joseph Mortimer Granville, inadvertently invents the first vibrator, known as the “Granville’s Hammer.” It was intended as a muscular massage for men.

The appearance of the mechanical vibrator relieved doctors of the drudgery of performing the massage. Some manual sessions would span close to an hour and the vibrator reduced this to mere minutes.

In Hysteria, the well-to-do women visiting Dr. Mortimer Granville’s medical clinic complain of distracting thoughts and hating their husbands. His “medical treatment” – first digital and later aided by a crude vibrator when his hands go numb – sends the women into paroxysms of pleasure and pain. People did not know much about the word “orgasm” those days.

Since then the science of Psychiatry has moved on to diagnose patients better and treat them without using a mechanical vibrator. But there is a continued fascination with the antiquated diagnosis of “female hysteria.” One explanation is that people are still uncomfortable talking about sex and sexuality. It is about failure to communicate one’s desires out of embarrassment, awkwardness or because of social issues.

To be sexually empowered is to understand your own sexuality and be comfortable with it.

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