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Had Your Butt Checked Out Lately?

There are more jokes and humorous videos on the internet about colonoscopy than about mammography or cervical cancer screening. The reason is quite obvious. Most people do not like the idea of people inserting long tubes and cameras in the rear end of our anatomy. That is where the problem lies. Out of fear and embarrassment, we ignore that area and by the time we pick up cancer it is too late.

Alberta Cancer Board, Canadian Cancer Society and Alberta Health Services have been very aggressive in promoting the Alberta Colorectal Cancer Screening Program. You must have read about it in the newspapers, heard about it on the radio and seen the news on TV. The question is: what have you done about it? Are you ready for it?

The program aims to save lives by improving the prevention and early detection of colorectal cancer in Albertans between the ages of 50 and 74. The sad part is only 10 to 20 per cent of Canadians come forward to have some kind of screening test done for their colon. More women would go for mammography and cervical cancer screening than colorectal screening. And men are worse when it comes to screening for colorectal and prostate cancer.

Men and women are almost equally at risk of getting colorectal cancer. There is a less than three minutes video on YouTube (http://www.youtube.com/realmenscreen) titled: “Had your butt checked out lately? – The Canadian Cancer Society asked men this question.” It is humorous and educational. Check it out!

Colorectal cancer is the fourth most common cancer. The average lifetime risk of developing colorectal cancer is six per cent. It is the second leading cause of cancer death in Canada. It is expected that colorectal cancer screening will decrease both, incidence and mortality.

Most people are scared as soon as they hear the word colonoscopy. It is important to remember that colonoscopy is not the only test for screening although it is the best test and is considered as gold standard against which other screening tests are compared. In certain circumstances (high risk patients) you do not have a choice but go through a colonoscopy for diagnosis, prevention and treatment of certain conditions.

You are at a high risk of getting colorectal cancer if you have a family history of colorectal cancer or polyps, have a personal history of ulcerative colitis or Crohn’s colitis
and have had polyps or previous history of colorectal cancer.

If you have symptoms like rectal bleeding then you don’t have a choice – you need a test. Depending on your age, the test may be a flexible sigmoidoscopy in the office or colonoscopy at the hospital. For example, six per cent of the patients who say they are bleeding from hemorrhoids have colon or rectal cancer.

Every individual is at risk of developing colorectal cancer. If you have no symptoms, have no family history of colorectal cancer and you are 50 years or older then you do not have to go through colonoscopy. You have a choice of doing stool tests for occult blood yearly or bi-annually, flexible sigmoidoscopy in an office every five years or combine stool test and flexible sigmoidoscopy every five years.

Every test for screening has advantages and disadvantages. None of them are full proof. And they vary from very invasive (colonoscopy) to least invasive (stool test). If you fall into high risk category then colonoscopy is the way to go. If you are asymptomatic person with an average risk then you have a choice of tests mentioned earlier.

So don’t be scared, talk to your doctor and have your butt checked out!

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

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Why some scars do not look pretty?

As part of a nomal healing process, the body forms a scar after an invasive medical or surgical procedure, after tattoos and piercings and after ordinary events, such as insect bites and trauma from scratching. When the body fails to heal properly, there is an abnormal proliferation of scar tissue. This results in a raised formation of fibrous scar caused by excessive tissue repair. The resultant abnormal scar is called a keloid.

Keloid is a common presenting complaint in a medical practice. Managing and preventing keloids is a formidable challenge because of incomplete understanding of how keloids are formed. There is no good way to prevent or treat them as they seem to recur in certain percentage of the population. This leaves patients and physicians quite frustrated.

Keloids have been recognized since antiquity. The term keloid was chosen based on the Greek word for crab claw (“cheloid”). Main complaints from patients vary from unsightly look to itching and pain at the site of the keloid. The most common anatomical sites for keloids include the chest, shoulders, earlobes, upper arms, and cheeks.

Keloids are more common in dark-skinned persons. It is estimated to be between four to 16 per cent among blacks and Hispanics. Keloids occur with equal frequency in men and women. Younger patients are affected more often, with an age range of 10 to 30 years. A genetic predisposition to keloids has been described.

There is no good treatment available to take care of keloids. There are multiple treatment options but they can be expensive and recurrence rates are high. Therefore, prevention is important. Patients with a family history of keloids should avoid ear piercing, and those with a personal history should avoid elective surgical procedures unless absolutely necessary.

Injection of steroids is the most effective and widely used treatment for keloids. In one study there was a symptomatic improvement in 72 per cent of patients and complete flattening of the keloid in 64 per cent. However, the long-term cure rates remain uncertain. Recurrence rate can be 50 per cent or more.

Surgical removal of keloids generally results in recurrence of lesions, with rates ranging from 40 per cent to 100 per cent. In fact the regrowth of keloid may be larger.

Radiation therapy has been shown to effectively reduce the recurrence rate of keloids. Recurrence rates were substantially reduced to 14 per cent. But there are side effects to radiation therapy. This includes redness of the skin, inflammation, swelling and ulceration. Radiation therapy is not easily available.

Silicone gel has been approved by the U.S. Food and Drug Administration as an effective addition to keloid removal and as prophylaxis to prevent abnormal scarring following surgical incisions. Silicone gel can be applied to the scar after the incision has healed. The entire scar should be covered for 12 to 24 hours a day to get good results. If used correctly, silicone gel has been shown to induce more rapid healing.

Some researchers have reported pressure therapy following removal of the keloid to be effective. Laser therapy has not been found to be effective and its cost is prohibitive. There is a long list of therapies which have been tried without great success.

The bottom line is there is no ideal therapy for treating keloids. This is because we do not understand the mechanism behind abnormal healing of tissues in some. Combination therapy helps. For example, silicon gel to be applied to the scar after the keloid has been surgically removed.

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

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Addiction to Sugar Continues to Adversely Affect our Health

It is reported that the North American diet contains about 20 per cent sugar. This is equivalent to 30 teaspoons a day! Most of it is hidden in pop, processed food and baked goods. Like alcohol, sugar has no nutritional value. It has no vitamins, minerals or fiber.

North American children’s consumption of sugar per day is reported to be between 25 to 35 per cent of total calories. Is this too much? Yes. The World Health Organization recommends daily dietary sugar intake of no more than 10 per cent of total calories.

What is sugar? Sugar is any of numerous sweet, colorless, water-soluble compounds present in the sap of seed plants and the milk of mammals and making up the simplest group of carbohydrates. The most common sugar is sucrose, a crystalline tabletop and industrial sweetener used in foods and beverages.

Sucrose is found in almost all plants, but it occurs at concentrations high enough for economic recovery only in sugarcane and sugar beets. Sugarcane ranges from seven to 18 percent sugar by weight, while sugar beets are from eight to 22 percent sugar by weight.

Sugarcane, once harvested, cannot be stored because of sucrose decomposition. For this reason, cane sugar is generally produced in two stages, manufacture of raw sugar taking place in the cane-growing areas and refining into food products occurring in the sugar-consuming countries. Sugar beets, on the other hand, can be stored and are therefore generally processed in one stage into white sugar.

Different methods of crystallization of sugar containing syrup are used to produce variety of sugars and at least six or seven stages of boiling are necessary before the molasses is exhausted.

The first three or four strikes are blended to make commercial white sugar. Special large-grain sugar (for bakery and confectionery) is boiled separately. Fine grains (sanding or fruit sugars) are usually made by sieving products of mixed grain size.

Powdered icing sugar, or confectioners’ sugar, results when white granulated sugar is finely ground, sieved, and mixed with small quantities of starch or calcium phosphate to keep it dry.

Brown sugars (light to dark) are either crystallized from a mixture of brown and yellow syrups (with caramel added for darkest color) or made by coating white crystals with brown-sugar syrup. Nutritional value of brown sugar per 100 gm is 380 kcalories compared to granulated sugar which is 390 kcalories.

Beet sugar factories generally produce only white sugar from sugar beets. Brown sugars are made with the use of cane molasses as a mother liquor component or as a crystal coating.

Sugar is dangerous because it causes obesity, diabetes, hypertension and heart disease leading to sickness and death. Sugar is very tempting and addictive because it tastes good and is very satisfying to our palate.

Men who drink sugary drinks have 46 per cent increased risk of stroke, possibly because of sugar’s blood-thickening osmotic effect or its known ability to raise cholesterol levels
Reports suggests diets high in refined sugar increase the risk of developing Crohn’s disease and colorectal and pancreatic cancer

Smokers keep smoking although they know smoking is dangerous. Similarly, sugar consumers will continue to eat sweet stuff as long as it tastes good and give you a temporary sugar buzz. It is a dangerous addiction and a slow poison.

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

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Male Menopause is Treatable

Yes, males do go through menopausal changes. As the joke goes, male menopause is a lot more fun than female menopause. With female menopause you gain weight and get hot flashes. With male menopause you get to buy a sports car, date young girls and drive motorcycles.

The correct name for male menopause is “andropause”. “Andro” stands for androgen – a male sex hormone, such as testosterone, that controls the development and maintenance of masculine characteristics. The onset of andropause is unpredictable. Its clinical manifestations are subtle and variable.

The symptoms of andropause include fatigue, depression, hot flushes, sweats, decreased libido, erectile dysfunction, changes in cognition (like poor concentration and memory) and mood. Since these symptoms are more subjective than objective, some experts have trouble accepting andropause as a clinical condition.

Physical examination of an aging male patient with andropause may be quite normal. There may be presence of gynaecomastia (enlargement of male breast) and/or soft small testicles. Low testosterone level does not produce any specific organ changes.

Diagnosis of andropause is made by symptoms, physical signs and early morning non-fasting specimen of blood for testosterone level. Testosterone level is highest in early morning and can decrease by 35 percent in the mid-afternoon and evening.

Early morning testosterone level less that 7 nmol/l indicates that a man has poor testicular function. Testosterone level found to be critical for sexual function in men is around 10.4 nmol/l. There can be some variation between individuals.

Normally men experience a continuous slow (an average of one to two percent a year) decline in serum testosterone level after about age 30 years. This is due to decrease in testosterone production. There are many other reasons why testicular function may fail – injury, infection, tumours, surgery and effect of other hormonal problems.

The goals of treatment for poor testicular function are to improve erectile function, restore libido, and improve psychological well-being and mood. It is important to remember that in men over 50, cause for erectile dysfunction may be other than low testosterone level. So testosterone replacement therapy will improve libido and psychological well-being in this age group but may occasionally improve erectile dysfunction. Testosterone replacement therapy improves bone mass, coronary artery disease, reduces total cholesterol and LDL (bad cholesterol) levels.

Testosterone should not be given to individuals with prostate or breast cancer. Sleep apnea has been shown to contribute to low serum testosterone levels and testosterone therapy has been reported to make sleep apnea worse. Testosterone therapy may make blood thick (polycythemia), promote benign and malignant changes in the prostate, and can cause tenderness and enlargement of breasts.

Testosterone is available for clinical use in many forms: injectable, oral pill, skin patch, gel and implantable formulations. Each one has advantages and disadvantages. Your physician will advice you the best formulation for you. The physician should monitor the treatment to check for any side-effects and for any long term complications like prostate cancer.

So there is hope for aging men. Besides sports cars and motor bikes, there is Viagra and testosterone. You will be laughing and driving your motor bike all the way to a nursing home when you are 90 or 100. But talk to your doctor first before you put your life’s savings in a sports car.

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