Posts

Posted on

Welcome to the Wonderful World of 2010

On January 1st, as I was heading home after a couple of weeks of Christmas holidays, I was humming 1968 Louis Armstrong song, What a Wonderful World.

If you look at the news then it is hard to believe we live in a wonderful world. Deaths of our brave soldiers and recent failed attempt to blow up a plane remind us once again why we need to protect and preserve this wonderful world of ours. It is disturbing to read that even the Pope is not safe.

We have 6.6 billion people on this earth. It is hard to guess what percentage of people believes in death and destruction of human lives and property. It has to be a very small number. The vast majority of people are law abiding descent citizens of the world. My faith in human kindness is reinforced every day at work and at home. But these are the things we take for granted. We fail to appreciate the kindness because we are so busy to stop and smell the roses.

My faith in human kindness is doubly reinforced when I travel. These days travelling is not very easy. But once you embark on your journey and meet the real people like yourself you find that this world is still safe to enjoy.

I find Christmas holidays are a good time to wind up the year, bond with my family and recharge my batteries for the following year. That is exactly what I did. In the process I met some wonderful people from all over the world.

A short golfing trip to a spring like weather in Las Vegas was a good treat from the snow and cold in Canada. The flights were cheap and the hotel with golf package (including full buffet
breakfast) was a bargain. We stayed at the JW Marriott Las Vegas Resort & Spa. The resort is surrounded by most prestigious collection of golf courses.

The package includes golf at TPC Las Vegas. It is located in southern Nevada desert, surrounded by lush greens of manicured turf and surrounded by the Red Rock Canyon. The resort is about 20
minutes from the strip. The hotel has free shuttles to take you to the golf course and to the strip to gamble and enjoy the night life.

During our trip to Hoover Dam, I met a man from Washington, DC. We had a good conversation about our families. Our stories, our dreams and aspirations were very similar. There was no discussion about politics or religion. Whether it was at the resort, the golf course or at different casinos and theatres, people were nice to each other. It was all about being happy and healthy.

Once we returned to Canada, the realities of winter hit hard. So I took the advice of Hagar the Horrible in his cartoon strip where he says, “Sure we live in a frigid climate…and sure, winters are long and cold! The secret to surviving a Scandinavian winter is to stop complaining and start taking advantage of it!”

So that is what we did. We headed to the Sunshine Mountain Lodge in Banff for three days of skiing and snowboarding. My skiing skills haven’t improved much. I am still stuck to the easy green runs. But the snow, the mountains, the beautiful sunrise at 7000 ft, the beautiful new wing at the lodge and the wonderful people we met made it all worthwhile. The lodge and the Sunshine Village Ski & Snowboard Resort are staffed by young, energetic people from Canada,
the U.K., Australia and New Zealand. It was fun having a conversation with them and listening to different accents.

So here we are, back to the realities of life. But it’s a new year. Full of new possibilities, new challenges, new opportunities and new experiences. That makes life exciting. Now you know why I was humming What a Wonderful World!

Have a great year.

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

Posted on

Fractures in Osteoporotic Men and Women

Osteoporosis is a condition in which there is a gradual softening of the bones which makes them fragile. It is caused by the loss of calcium. Our current understanding has been that osteoporosis occurs most often in women after the age of menopause. Men can suffer from osteoporosis as well when they experience low levels of testosterone.

Bone fracture is a common complication of osteoporosis. One in two women and one in five men over the age of 50 will have a fracture. A person may lose height if the vertebra collapses due to osteoporosis. One may develop a hump if several vertebrae collapse.

Other causes of osteoporosis for men and women are: long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, low body weight and medical conditions that affect absorption, such as celiac disease. Diagnosis of osteoporosis is made by measuring bone mineral density.

A recent article in the CMAJ says that our understanding of and approach to osteoporosis is in the middle of a revolution. Research now shows the bone loss begins before menopause and involves other hormones in addition to estrogen, and that measuring bone mineral density alone is an inefficient way of addressing the clinical burden of osteoporosis.

The ongoing Canadian Multicentre Osteoporosis Study also shows that both men and women experienced an additional phase of accelerated bone loss from age 70 onward. Hormone replacement therapy with estrogen in women does protect against bone loss over time.

The finding that bone loss began before menopause indicates that estrogen loss alone cannot account for the changes. Therefore, interest has focused on other hormones whose levels change in early menopause such as follicle-stimulating hormone and the activins and inhibins. The role of steroid produced in the body and the size of the body composition is being determined.

The current national guidelines recommend that the test for osteoporosis (measuring bone mineral density) should be done every 2-3 years. In one of the CMAJ articles, Berger and colleagues suggest that densitometry for most women can be repeated every five years rather than every 2–3 years because the average changes in bone density over 2–3 years is small and comparable to the measurement error in the scanning technique.

There is also a question whether women who are already receiving treatment for osteoporosis should have follow-up assessments of bone density at all, since changes in density as a result of therapy account for only a small component of the effectiveness of these medications, says the CMAJ article.

There are four key points in the CMAJ articles: bone loss in women begins before menopause and is accelerated in old age, medications which reduce the loss of calcium from the bone helps preserve bone density, the interval between bone density assessments can safely be increased to 5 years for many untreated women and finally, decisions about when to test and treat will increasingly focus on estimates of absolute fracture risk as indicated by the bone density test.

Osteoporosis is treated with calcium and vitamin D supplements, a variety of hormone treatments (hormone replacement therapy like estrogen) and Bisphosphonates, a group of drugs that prevent bone breakdown and can be very effective in osteoporosis. But prevention is better than cure. So, increase calcium and vitamin D in your diet, increase the amount of weight-bearing exercise you do, reduce your alcohol intake and quit smoking.

The reduction in risk was greatest among elderly individuals who were most adherent to therapy and among those who received at least 1200 mg of calcium and 800 IU of vitamin D daily.

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

Posted on

What Do You Know About Bone Marrow Transplant?

Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. When bone marrow transplant occurs, this spongy healthy tissue is used to replace unhealthy blood-forming cells.

The important thing to remember about bone marrow is that it contains stem cells, which are immature cells. These immature cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets help with blood clotting.

Bone marrow transplant is required if there is a problem with the bone marrow, if it is diseased with cancers like leukemia or lymphoma. You might need a transplant if a strong cancer treatment kills your healthy blood cells.

Bone marrow is usually collected from the hip bone (or pelvic bone) or less commonly from the breast bone (or sternum). The procedure is done under anaesthesia. Needles are inserted into the bone and marrow is withdrawn. The procedure takes about an hour. This process is called ‘harvesting’.

To prepare for the transplant, you may be given strong chemotherapy and/or radiation therapy. This treatment kills your unhealthy cells. Then healthy blood-forming cells are given to you in your vein. This is like a blood transfusion. The transplanted cells begin to grow and make the red blood cells, white blood cells and platelets your body needs. It typically takes three to four weeks for the cells to mature.

The cells used in transplants can come from three sources: bone marrow (as described earlier), peripheral (circulating) blood or blood collected from an umbilical cord after a baby is born. Umbilical cord blood is rich in blood-forming cells. The donated cord blood is tested, frozen and stored at a cord blood bank for future use. Your transplant doctor will choose the source of cells that is best for you.

You can use your own blood-forming cells or cells collected from someone else. This choice depends on your disease and other health factors. Your transplant doctor decides what kind of donor to use. In autologous transplant your own cells are used. The cells are collected from your bloodstream (or, less often, from your marrow) and stored for your transplant.

A transplant using cells from a family member, unrelated donor or cord blood unit is called an allogeneic transplant. A transplant using cells from an identical twin is called a syngeneic transplant. If your transplant donor is other than yourself then the tissue type has to match. So your best chance of finding a match is with a brother or sister. However, 70 per cent of patients do not have a suitable donor in their family.

If there is no donor in the family then you need to find a donor who can match your tissue type. For this your doctor goes to Be The Match Registry , operated by the National Marrow Donor Program (NMDP), which provides access to more than 12 million volunteer donors on the global donor listing. This includes more than 7 million volunteer donors and nearly 90,000 cord blood units.

Unfortunately, not everyone finds a suitable match. In that case your doctor will look at other treatment options. These options might include using a partly matched family member (haploidentical donor).

The procedure is associated some risk of complications like infection, bleeding, pain and others. How well you do after transplant depends on many factors such as: what type of bone marrow transplant you had, how well your donor’s cells match yours, your age and overall health and many other factors. If the transplant works, you can go back to most of your normal activities.

If you want to be a donor then visit National Marrow Donor Program (www.marrow.org).

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

Posted on

Anal Itch Can Drive you Embarrassingly Crazy

Anal itch or some people may call it rectal itch is also known as pruritus ani (proo-rí-tus a-ní). It is a fairly common condition. Most people think that the reason they cannot stop scratching their butt is because of hemorrhoids. But hold your breath or your gas (so to speak), there is more to itchy butt than you think.

There are several benign conditions which can cause anal itch. Conditions to keep in mind are hemorrhoids, fecal incontinence of varying magnitude and severity, anal fistulae and condyloma (anal warts). Anal fissures are very painful but may be a cause of anal itch in chronic cases.

Other benign conditions which can cause anal itch are contact dermatitis, fungal infections, diabetes, pinworm infections, psoriasis and seborrhea (dermatitis of the oil glands).

A common cause of anal itch is excessive moisture in the area. Moisture may be due to perspiration or a small amount of residual stool around the anus. Itching can be made worse by scratching, vigorous cleansing of the area or overuse of topical treatments. Use of dry rough toilet paper can be another source of itch. You might as well use sand paper (just kidding!).

In some individuals, itching can be caused by eating certain foods, smoking and drinking alcoholic beverages, especially beer and wine. Examples of food items associated with anal itch are coffee, tea, carbonated beverages, milk products, tomatoes and tomato products such as Ketchup, cheese, chocolate and nuts. That is hell of a list. If you are over indulging in any of these items then you may know where the problem lies.

Cleanliness is next to godliness, so once a person develops the itch there is a tendency to wash the area vigorously and frequently with soap and a washcloth. This almost always makes the problem worse by damaging the skin and washing away protective natural oils. God will not be happy with that.

What about cancer? Yes, we have to keep that condition in mind. You may recall, Farrah Fawcett, one of the Charlie’s Angels, was diagnosed with anal cancer in 2006. She died in June of this year.

Be aware of the condition but do not panic. Anal cancer is fairly uncommon. It accounts for about one to two per cent of gastrointestinal cancers. About 4,000 new cases of anal cancer are diagnosed each year in the U.S.A., about half in women.  Approximately 600 people will die of the disease each year.

Anal cancer is commonly associated with the human papilloma virus (HPV). This virus causes warts in and around the anus and on the cervix in women.  It is associated with an increased risk of cervical cancer in women.

If you have anal itch, then talk to your doctor and get the area thoroughly checked. This includes a good history and a physical. Visual inspection of the anal area, a digital rectal examination and a scope test should be part of the examination. A biopsy of the area and stool test may be necessary. Once this is complete then the doctor (or a specialist) should be able to give you a diagnosis of the problem.

Treatment depends on the cause of the problem. Besides that there are things you can do. Try dietary modifications. Avoid moisture in the anal area by using cotton balls, gauze or corn starch powder. Avoid further injury to the area by avoiding soap of any kind and do not scrub the area. For hygiene, it is best to rinse with warm water and pat the area dry. Use wet toilet paper, baby wipes or a wet washcloth to blot the area clean. Never rub.

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