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St. Maarten – A Healthy Place for R & R

Photograph shows Noorali savoring the beauty of St. Maarten sea side resort (obviously not a nudist colony).

First, we should get the name right. Is it St. Maarten or St. Martin?

Both names are correct. The northern part of this Caribbean island is French with 21 square miles (54 km2) of land. The southern part of the island is Dutch with 16 square miles (41 km2) of land. The French call their part of the island St. Martin and Dutch call their part of the island St. Maarten. Collectively, the two territories are known as “St. Martin/St. Maarten”

This tropical island is the smallest inhabited island in that area with a population of the entire island of approximately 72,000 people. Both parts of the island live in harmony. You can go from one end of the island to the other without restrictions. No questions are asked. But culturally the two areas are different.

On the French side, they speak French or English with a distinct French accent. They use Euro as their main currency and the main town, Marigot, has a distinct European flavour. The clothing stores have mostly European style apparels. About 35,000 people live on this part of the island. The French side is known more for its nude beaches, clothes, shopping (including outdoor markets), and rich French and Indian Caribbean cuisine.

On the Dutch side, English is more widely used although Dutch is the primary language. Netherlands Antillean guilder is their main currency although American dollar is accepted on both sides of the island. The main town, Philipsburg, looks and feels like a typical Caribbean island town. About 37,000 people live on the Dutch side. This part of the island is known for its festive nightlife, beaches, jewelry, exotic drinks made with native rum-based liquors and plentiful casinos.

The island is also known as a shopper’s paradise as it offers high quality duty-free goods in numerous boutiques. Popular goods include local crafts and arts, exotic foods, jewelry, liquor, tobacco, leather goods as well as most designer goods.

Salt and sugar cane industries are dead. The main economy is tourism and many Caribbean cruises include a stop over in Philipsburg. Phillipsburg has twelve gambling casinos and four duty-free streets full of shops and restaurants along the harbour. Also there is a beach and a board-walk just where the ship docks. One million tourists visit the island each year.

In summary, if you are looking for a quite, healthy, relaxing holiday then St. Martin/St. Maarten is a bargain. The relaxing island provides plenty of time to enjoy the diverse cultures, beaches, water sports, shopping, casinos and excellent food on both sides of the island.

If you are an ardent environmentalist and a naturalist and are looking for a nudist colony then keep French side in mind. They don’t believe in wearing designer clothings on nude beaches. Now I know where I forgot my Speedo. Is that a good reason for a second trip?

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A Weakness for Alcohol can be Dangerous

Alcohol has been used and abused for generations. Previous attempts to make alcohol drinking illegal have failed miserably. There is a constant desire to use alcohol by humans who drink it for various reasons.

Most of us are well aware that alcohol can cause momentary lapse of judgment which can result in acts of irresponsibility. Sometimes this results in loss of limb or life.

Small amount of alcohol (one to two drinks) intake per day is known to reduce sickness and death from coronary artery disease. It makes the blood thinner and reduces the incidence of Alzheimer’s disease and dementia.

Excessive abuse of alcohol causes cirrhosis of liver, liver failure and pancreatitis. These are very serious conditions. It can cause gastritis and bleeding which can be life threatening if not brought under control immediately. On a long term basis it causes cancer of the esophagus, breast and other cancers.

Alcohol is very heavy in useless calories. Alcohol abuse during pregnancy causes fetal alcohol syndrome in the new born.

Alcoholism is considered a disease. It is a compulsive addictive behavior. About 10 per cent of the population is addicted to it. Alcohol is a drug with complex behavioral effects. It causes traffic or work related accidents. It is a major cause of death and disability. It destroys a person’s personal life, family life and capacity to earn a decent living.

Unfortunately, the good side of alcohol is sometimes abused by individuals who get addicted to it. Therefore physicians are reluctant to encourage or promote alcohol as a panacea for major health problems.

Critics of alcohol use say that much of the protective effect gained from alcohol use in coronary artery disease can be achieved by other means – exercise, diet, avoiding smoking and control of cholesterol level.

We can maintain a happy and healthy life style without the use of alcohol. And finally, there are many economic advantages in not using alcohol. So save money, avoid useless calories and remain sane by not drinking alcohol.

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A Bulge in the Groin Could be a Hernia

Dear Dr. B: I have bulge in the groin. Is it a hernia?

Answer: A bulge in the groin could be a hernia, an enlarged lymph gland, an enlarged vein, an aneurysm of femoral artery, a lump of fat or a swollen skin gland. Let us presume it is a hernia.

There are two types of hernia in the groin: inguinal and femoral. Inguinal hernia is by far the commonest hernia. Inguinal hernia can appear at any age – from birth (congenital) to old age (weak muscles).

The hernia appears through a potentially weak spot in the abdominal wall. The hernial sac may contain an organ, most often the bowel but sometimes the bladder or an ovary.

The hernia can be a source of discomfort or pain or can be totally asymptomatic.

A groin hernia presents as a bulge during straining, coughing, micturating or doing heavy lifting. The bulge will appear whenever there is increase in the intra-abdominal pressure. The bulge will usually disappear on lying down or after gentle manual reduction.

If the bulge cannot be reduced then it becomes a potentially life-threatening problem. The hernial contents trapped in the hernial sac may lose its blood supply and become gangrenous.

Treatment of hernia is surgery. If the hernia is causing no symptoms then one can elect not to have surgery. Hernia does not go away without surgical treatment. If surgical treatment is not undertaken then the hernia may remain the same, get bigger or there is a small risk of strangulation and gangrene.

If the hernia is symptomatic then surgery is the best answer. There are two surgical approaches to repair of inguinal hernia: open method (a groin incision with tension free mesh repair) and laparoscopic repair (done through small holes in the abdominal wall).

People commonly ask: Which method is superior? Answer to this question is controversial. Commonly four outcome measurements are used to measure the success of each technique: return to work, operative time, postoperative pain, and recurrence rate.

Studies have shown that patients return to work after a minimum of nine days, regardless of the type of repair. Return to work is more a function of employment status; self-employed workers go back to work earlier than patients on workers’ compensation.

Operative time depends on individual surgeons. Overall operative times are not significantly different between the two repairs although some studies have shown that laparoscopic repair takes little longer.

Some reports have suggested that post-operative pain is less for laparoscopic repair, but these studies have not adequately compared the patients who had open tension-free repair. What about the recurrence rate? Laparoscopic repair appears to have lower recurrence rate than open method but there were very few tension-free repairs in that study to make appropriate comparison.

Overall, the two repairs appear to have similar complication rates. The procedure is done as a day surgery under local, spinal or general anaesthetic. The type of anaesthetic used depends on the surgical technique used and the general condition of the patient.

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Lactose Intolerance is Usually Permenant in Some Adults

Lactose intolerance commonly develops after adolescence. It is estimated that between 30 and 50 million Americans are lactose intolerant.

Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African Americans and American Indians and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Lactose is a natural sugar found in milk and dairy products. Lactose intolerance means inability to digest lactose. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine.

Function of lactase is to break down milk sugar into simpler forms that can then be absorbed into the bloodstream. Lactose is broken down in the intestine by lactase to glucose and galactose. These simple sugars are easily absorbed through the intestinal wall and enter the blood stream to be transported to the liver. Galactose is further broken down in the liver into glucose.

At birth large amount of lactase may be present in the intestine. But as the child grows the level of lactase may fall and by adolescence the level may be low enough that the milk can no longer be digested.

Lactase deficiency may be congenital. Or the deficiency may be acquired. It may occur temporarily after a bout of gastroenteritis. Certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. But for most people, lactase deficiency is a condition that develops naturally over time.

Absence of lactase will make lactose ferment in the intestine and cause symptoms.
Common symptoms include nausea, cramps, bloating, gas, and diarrhea. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.

Most individuals will be diagnosed by the typical symptoms they experience. You may be asked to keep a diary for few days of what you eat and the symptoms you get. You may be advised to completely quit dairy products and see if the symptoms disappear. Then you will be asked to go back on the dairy products. If the symptoms reappear then the diagnosis is confirmed.

The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance test, the hydrogen breath test, and the stool acidity test.

Lactose intolerance is usually permanent in adults. The symptoms can be completely relieved by eliminating lactose from the diet by avoiding milk and milk products. Others can use lactase liquid or tablets to help digest the lactose. Other option would be to drink lactose-reduced milk available at supermarkets. This milk contains all the nutrients found in regular milk.

Milk is an important source of calcium in our diet. We need calcium for growth and repair of bones. If milk and milk products are avoided then consult your dietitian or physician to suggest other sources of calcium for your body.

Although lactose intolerance is widespread, it does not pose serious threat to our health.

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