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Does Hand Washing Prevent the Spread of Infection

Cleanliness is next to godliness. My guess is, your mother said this to you many times when you were growing up. Now you say that to your children. What does that really mean? What it means is that except for worshipping God, the most important thing in life is to be clean. I guess you knew that.

According to the American Heritage Dictionary of Idioms, this phrase was first recorded in a sermon by John Wesley in 1778, but the idea is ancient, found in Babylonian and Hebrew religious tracts. It is still invoked, often as an admonition to wash or clean up. Being clean is a sign of spiritual purity or goodness.

When it comes to our health, hand hygiene, household cleaning and food safety constitute the main focus where emphasis is put to keep our homes and the community healthy. Hand washing is considered the most important and least expensive measure to prevent transmission of infections.

Several studies have shown that the compliance rate for hand washing is poor. In the past physicians, nurses and other health care providers were under attack for not washing their hands before or after seeing a patient. Now the general public is being admonished for not doing enough hand washing.

According to an article in the Canadian Medical Association Journal (CMAJ), consistent recommendations are to clean hands often by washing with soap and warm water or to use alcohol-based gel sanitizers if running water is not accessible. Hands should be washed before eating, before preparing food, after using the toilet, changing diapers or other similar exposure, and after playing with or feeding pets. Hand hygiene after contact with potentially infected objects or infected people is also appropriate.

Quite often, in the restaurants, I see the servers use the same wet cloth over and over again to clean tables. I don’t see them go and wash their hands after that. It makes me cringe. I am sure there are servers and kitchen hands that are very meticulous with their hand hygiene. Just like the health care providers and others who serve and take care of other people.

Does hand washing prevent the spread of influenza? There’s no evidence that good hand hygiene practices prevent influenza transmission, according to a Council of Canadian Academies report commissioned by the Public Health Agency of Canada (PHAC).

This statement rattled the medical community. Hand hygiene is being promoted as one of the several measures to be taken to prevent the spread of H1N1 virus. Despite those 2007 findings, PHAC still recommends hand washing as the primary preventive measure against flu transmission, says CMAJ.

PHAC also said that there is substantial evidence to support hand hygiene as a basic premise of infection prevention and control measures. The agency also indicated that its hand hygiene recommendations are based on a combination of expert opinion and evidence, as reviewed in the British Medical Journal (BMJ 2009;339:b3675). So, there you have it. Science at its best – imperfect and contradictory.

But, do not give up on hand washing. It is a simple thing to do for yourself, your family and for people around you. And if you believe in God then you know you are up there in godliness (religious, saintly, holy, righteous, good.). If you do not believe in God then you are still a winner, by preventing the spread of germs. That is righteous and good. You like that? Go wash your hands now.

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Vitamin Supplements Are Recommended For Healthy Individuals

Medical teaching says that a healthy individual, who eats a good diet, does not require vitamin supplements. He should be able to meet his vitamin needs from his healthy diet. But the public interest in vitamin supplements is enormous – sometimes due to misguided reasons. Almost 30 percent of our population takes vitamin supplements. And there is no control over it.

On the other hand, there is a consensus among experts that taking certain vitamin supplements on a daily basis does more good than harm to healthy individuals. This was well written in an article in the New England Journal of Medicine (NEJM 20 Dec, 2001) titled What Vitamins Should I Be Taking, Doctor? Here is some information of vitamins you should consider taking on a daily basis.

Folic acid (400 ug/day) reduces the risk of birth defects during pregnancy. There is some evidence that B vitamins, including folic acid, B6 and B12, may help lower blood levels of a substance called homocysteine. A good deal of research has implicated high homocysteine levels in heart disease and stroke. Significantly fewer deaths, nonfatal heart attacks or repeat angioplasties occurred among patients given folic acid, vitamin B12 and vitamin B6 compared with those who got a placebo (Harvard Health Publications website).

Recommended daily dose of vitamin B6 is 2 mg/day and vitamin B12 is 6 ug/day. One multivitamin tablet a day plus a tablet of folic acid will ensure an adequate intake of these vitamins.

Vitamin D (400 IU/day) minimizes risk of osteoporosis and fractures and certain types of cancer. Recently, much has been written about the advantages of taking 1000 to 2000 IU/day of vitamin D.

A report published in the Journal of the American Geriatrics Society says vitamin D, taken in a high dose, may help prevent falls in the elderly. Another report appeared in the journal Nutrition Reviews suggests that adults should daily take 2,000 IU of vitamin D to help prevent colon and breast cancer .

A third report came out in the Archives of Internal Medicine. This review paper analyzed the results of 18 vitamin D studies says that taking vitamin D supplements may help people live longer. The Canadian Cancer Society is now recommended taking 1,000 IU of vitamin D daily as a cancer prevention step.

Regular use of vitamin E and C remains controversial. The authors feel that vitamin E supplements are reasonable for most middle-aged and older individuals who are at increased risk for coronary artery disease. But this should be reviewed annually as more information becomes available.

To the list of vitamins you can add omega-3 fatty acids. These are a family of unsaturated fatty acids to be taken everyday (1000 mg/day or eat fish three times a week). Omega-3 has many benefits including the risk of sudden heart attack is reduced by 50 to 80 per cent. It can help ward off the serious heart rhythm disturbances associated with sudden cardiac death. It also appears to reduce the risk of strokes, mental decline in old age and prostate cancer.

In summary, a healthy individual (after consultation with your doctor) should consider taking one multivitamin tablet, one folic acid 5 mg. tablet (under certain conditions), vitamin D 1000 IU, omeg-3 fatty acids 1000 mg (or eat fish three times a week) and vitamin E if your doctor thinks it may benefit you.

You should understand that excessive use of vitamins or omeg-3 fatty acids may be detrimental to your health. Vitamin pills do not compensate for the massive risks associated with unhealthy lifestyle with smoking, obesity or inactivity. Healthy nutritious diet and regular exercise is the basic foundation of good health. Vitamin supplement is just an icing on the cake – so to speak. A healthy layer of icing on a healthy cake.

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There Are Good Ways to Treat Hemorrhoids

The earliest writings on the subject of symptomatic hemorrhoids occurred in 400 BC by Hippocrates. Red-hot iron was used to cauterize the hemorrhoids. In 1815, at the Battle of Waterloo, Napoleon was defeated by the British because he was too busy treating his hemorrhoids with leeches. The treatment of hemorrhoids has come a long way since.

Hemorrhoids, also known as piles, are swollen veins around the anus or lower rectum. They are either inside the anus (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). We all have hemorrhoids. We are born with them. They are in the form of small veins. Hemorrhoidal veins get bigger from straining to have a bowel movement, during pregnancy and aging, as aging process makes the supporting tissues in that area lax. Usually, people with chronic constipation or diarrhoea are affected.

Internal hemorrhoidal veins are at three locations: at three, seven and 11 o’clock. When these veins get large and stretch out (like varicose veins in the legs) we call them hemorrhoids. External hemorrhoids are in the form of redundant skin usually at the same three locations. Some internal hemorrhoids can be quite big and prolapse through the anus that they need to be pushed back. Some people have extensive circumferential hemorrhoids and redundant skin in the anal area.

It is important to remember that hemorrhoids are not always symptomatic and all problems in the rectal area are not due to hemorrhoids. It is difficult to estimate the true incidence of symptomatic hemorrhoids.

Troublesome hemorrhoids present with symptoms like bleeding, prolapse, feeling of incomplete evacuation, soiling, irritation and/or itching. Severe pain in the rectal area is usually due to thrombosed hemorrhoid, fissure, infection (abscess) or cancer.

The diagnosis of symptomatic hemorrhoids is usually made with digital rectal examination and direct visualization with an instrument. If a patient presents with rectal bleeding then other causes of bleeding should be ruled out by a scope test. All patients with symptomatic hemorrhoids do not require leeches, iron rod, Captain Hook (just kidding) or surgery. I find that about 80 per cent of my patients with symptomatic hemorrhoids can be managed by medical treatment only.

Medical treatment includes careful examination and diagnosis, detailed explanation of the problem, careful review of treatment options and monitoring progress to see if the medical treatment has worked. Detailed advice consists of high fiber diet, fiber supplement, use of hemorrhoidal ointment, hot baths and explanation on how to take meticulous care of the anal are – just like flossing and brushing your teeth!

Failure of medical treatment and patients with no external hemorrhoidal components will benefit from rubber band ligation of internal hemorrhoids in the office – a less than five-minute procedure. Patients do not require any anaesthetic for this.

Symptomatic patients with big hemorrhoids with external components require surgical excision. Duration of this procedure and post-operative recovery time depends on the extent of surgery required to fix the problem.

If you think you have hemorrhoidal problems then do not be afraid to have your butt checked out. Believe it or not, there are gentler and kinder ways to take care of the area. And you might even get a candy or a sucker after the procedure! You may even say “thank you” before you leave the office.

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Ten Reasons Why I Had H1N1 Vaccination

H1N1 influenza virus treatment collage. (iStockphoto/Thinkstock)
H1N1 influenza virus treatment collage. (iStockphoto/Thinkstock)

Recently, President Barack Obama declared swine flu a U.S. national emergency. His daughters, Malia (age 10) with Sasha (age 8) received their H1N1 vaccinations last week. The President and the First Lady will wait their turn as they do not meet the priority criteria. That did surprise me. I thought the world’s most powerful man would be protected first. But that is another story.

In Canada, our Prime Minister, first sounded hesitant, then changed his mind and said he plans to get the vaccine. About half of the Canadians are not sure if they would get the vaccine to prevent H1N1. What are they afraid of, side effects from the vaccine?

Except for taxes and death, there are no guarantees in life. If you are afraid of complications or dying from receiving the vaccine then look at the daily risks you take when you cross a street, drive a vehicle, fly in a plane, smoke like a chimney, drink alcohol, take any kind of medications (they all have some side effects), undergo surgery and I can go on and on.

So, here are 10 reasons why my family, my office staff and I had H1N1 vaccination (information provided here has been gathered from various very reliable sources):

1.To start with, the vaccine costs about $8 a dose. We, the tax payers, through the Federal and Provincial governments, are spending more than $400-million for the product plus the costs of administration.

2.Without vaccine and antiviral medication, between 25 and 35 per cent of the Canadian population could become ill over a period of a few months. Of the people who get the H1N1 virus, about one in 1,000 will become gravely ill and have to be hospitalized. Out of those, one in five will die.

3.H1N1 is more serious disease than common cold or seasonal flu. It is unusual for common cold or seasonal flu to infect the lungs. It is usually confined to the nose and throat and may be the upper airway. H1N1 virus also infects the airway, but in some individuals, it continues to move down and infect the lungs. The H1N1 virus causes lung infection much more often and more completely, that is why some people have ended up in intensive care units or even died from complications of the virus.

4.I believe Health Canada when it says the vaccine is safe. There are no credible reports to the contrary. Health Canada says there have been no shortcuts taken in the approval process. We have been giving flu shots for decades and this is just another flu shot. Data from Europe says that this vaccine is safe and effective.

5.Adjuvant vs. non-adjuvant. The adjuvant vaccine is made up of two natural fats: vitamin E and squalene which is a molecule your body makes (the squalene in the vaccine comes from fish oil). The adjuvanted vaccine gives a better and faster immune response than the non-adjuvanted vaccine.

6.Is squalene a problem? Reports I have read says that our liver makes squalene all the time. It is a natural compound. It has never been scientifically linked to Gulf War syndrome, an illness reported by combat veterans of the 1991 Persian Gulf War – fibromyalgia, chronic fatigue syndrome, eczema, and dyspepsia.

7.The preservative in the vaccine is thimerosol. Thimerosol has never been credibly linked to any health problems, including autism.

8.Nobody has died because of the vaccine. It takes about 10-14 days to develop immunity post vaccine. Influenza vaccines are not 100 per cent effective. It is possible to get H1N1 after the vaccination. However, chances are the symptoms will be milder. Getting the H1N1 vaccine does not mean you will not get sick this winter; there are other strains of flu and numerous other viruses and bacteria that circulate.

9.Pregnant women, whose immune systems are suppressed, are at high risk of complications from the flu. The World Health Organization says pregnant women should get non-adjuvanted vaccine where possible, but that an adjuvanted vaccine could be used if necessary. There are no studies to suggest that adjuvanted vaccine is harmful to pregnant women.

10.Benefits outweigh the risks of vaccination. So I did this to protect myself and the people around me.

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