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Alcohol, Drugs, Date Rape and Unwanted Pregnancy

“The contribution of alcohol and other drugs to sexual assault has been increasingly recognized during the last 15–20 years,” says an article in the Canadian Medical Association Journal (CMAJ March, 2009). The authors report that 20.9 per cent of victims of sexual assault met the criteria for drug-facilitated sexual assault, also known as date rape.

As we know, rape occurs when sexual intercourse is non-consensual. A person forces another person to have sex against his or her will. It is not uncommon to find that drugs and alcohol are involved in the rape. Rape includes intercourse in the vagina, anus, or mouth. Rape is among the most serious crimes a person can commit. Men as well as women and children can be raped.

The person who commits rape uses violence and fear to force the person to have sex. Victims of rape are physically and emotionally traumatized. Unwanted pregnancy and infection may be some of the unfortunate outcomes.

Date rape occurs when a substance is administered to a person which lowers his or her sexual inhibition and increases the occurrence of unwanted sexual intercourse. Usually, the victim and the person who commits the crime are known to each other and have been together socially in the past.

Rape is common with an estimated lifetime risk of up to one in four for women. About 25 per cent of the 1400 women who contact the Canadian Sexual Assault Centre each year report that drugs were a factor in a rape.

The drugs used in date rape usually have no colour, smell or taste and can easily be mixed with different kinds of drinks without the victim’s knowledge.

Drugs most commonly used in date rape are alcohol, marijuana, benzodiazepines, cocaine, heroin, amphetamines, GHB (gamma hydroxybutyric acid), Rohypnol (flunitrazepam), and Ketamine (ketamine hydrochloride). This list is extensive. Most of these drugs are often metabolized and excreted before the victim even perceives that a sexual assault may have occurred. Unfortunately, this contributes to the underreporting of drug-related sexual assault.

Alcohol is involved in most of the cases of date rape. Urine samples submitted by rape victims to treatment centers across the United States within 72 hours of a suspected drug-facilitated rape, alcohol was detected in 69 per cent of the samples, marijuana in 18 per cent and cocaine in 5 per cent.

The patient requires immediate attention regarding safety, management of injuries, forensic examination, emergency contraception, prophylaxis for sexually transmitted infections and psychosocial support.

Prevention is better than cure. If you are out drinking then vigilance is the key word. Drink your beverage slowly, keep an eye on your drink when mixed and obtain a fresh one after leaving the drink unattended. Do not accept drinks from strangers.

If you think that you have been drugged and raped then go to the police station or hospital right away. Get a urine test as soon as possible. Do not douche, bathe, or change clothes before getting help. You will destroy the evidence you need to find and convict the offender.

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Role of Calcium and Milk Products in Prostate Cancer

Dear Dr. B: We are in Arizona for the winter. My husband and I have always taken calcium and Vitamin D. There seems to be a lot of controversy here with several people who feel that calcium for men is putting them at high risk for prostate cancer.
Apparently this warning was on T.V. and in the newspapers. What is the truth, doctor?

Answer: Nobody knows exactly what causes prostate cancer. There are a variety of factors implicated in this process. There are some factors (diet and weight) you can change but others like age, ethnicity and family history cannot be changed.

As we know, prostate gland is present only in man. Any normal man can develop prostate cancer because normal men have male hormones (testosterone). Lack of testosterone due to any cause can reduce the risk of prostate cancer.

Age is an important factor. Prostate cancer is rare before the age of 45. As one gets older, the risk increases. Men of African or Caribbean ancestry have the highest risk.

What has race to do with prostate cancer? Scientists are not sure about that. There may be subtle genetic, dietary, environmental and hormonal differences. Another interesting fact is that dark skin absorbs less sunlight than light skin, which may contribute to the higher incidence of prostate cancer among men of African or Caribbean ancestry because of lack of vitamin D.

Family history is important. If your father or brother has had prostate cancer you are approximately two to two and half times more likely than the average man to be diagnosed with the disease during your lifetime. Having two first-degree relatives with prostate cancer increases your risk to about five to 10 times that of a man with no family history, and your risk soars to almost 100 per cent if three or more first-degree relatives have had prostate cancer.

Diet is linked to prostate cancer. A low fat diet may help prevent prostate cancer. Foods rich in saturated fats have been associated with increased risk of prostate cancer, possibly because they are metabolized into testosterone. Fish oils may protect against prostate cancer especially omega-3 fatty acids found in fatty fish like trout, anchovies, bluefish and white albacore tuna.

What about the role of milk, cheese and calcium? The American Cancer Society website article of 2001says, “Experts say excessive calcium intake may be unwise in light of recent studies showing that high amounts of the mineral may increase risk of prostate cancer.”

Here is a dilemma. There is a reasonable evidence to suggest that calcium may play an important role in the development of prostate cancer but evidence also shows calcium may lower the risk of colon cancer and age-related thinning of the bones.

The recommended daily allowance (RDA) of calcium is 1,000 mg per day for men and 1,500 mg for women. Important thing to remember is the words, “excessive calcium intake.” It is also critical to remember that this evidence is not conclusive. The word “may” is used quite often in this context.

You can have milk, cheese and other dairy products in moderation. An 8-ounce glass of milk contains about 300 mg of calcium, an ounce of cheese has about 200 mg, and a serving of yogurt has about 312 mg of calcium. Men should stay within 1000 mg of calcium per day. And don’t forget your vitamin D 1000 to 2000 IU per day especially in winter months. Vitamin D has an important role in preventing prostate cancer and other cancers.

A balanced diet, combined with regular exercise, is always a good idea.

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What to Use for Bowel Cleansing Prior to Colonoscopy?

Dear Dr. B: I have been booked for a colonoscopy. I know I have to have my bowel cleaned out for this test to be successful. I am worried about using Fleet Phospho-soda (oral sodium phosphate product) bowel cleansing laxative because of the recent negative media reports. What should I do, doctor?

Answer: US Food and Drug Administration (FDA) issued an alert in December, 2008 which said, “FDA has become aware of reports of acute phosphate nephropathy, a type of acute kidney injury, associated with the use of oral sodium phosphate products (OSP) for bowel cleansing prior to colonoscopy or other procedures.”

FDA also says that in some cases when OSP is used for bowel cleansing, kidney failure has occurred in patients without identifiable factors that would put them at risk for developing acute kidney injury.

FDA recommends, in light of the risk of acute phosphate kidney injury, over-the-counter laxative OSPs should not be used for bowel cleansing. Consumers should only use OSPs for bowel cleansing pursuant to a prescription from a healthcare professional.
Fleet Phospho-soda has been used for many years, on millions of people, in many countries. It has been popular because of low cost and small volume of fluid to drink. The incidence of side effects is minimal in healthy individuals. There are three dangers associated with OSP in venerable patients who have heart failure or kidney disease – dehydration, electrolyte imbalance and phosphate injury to kidneys.

OSP is popular amongst physicians because it has been found to be a better bowel cleansing preparation than many other similar products.

FDA’s warning regarding kidney injury with OSP is of real concern to physicians and patients. A study published in the American Journal of Gastroenterology (103(11):2707-16, 2008 Nov.) concluded that in patients with preexisting kidney disease, OSP use was associated with an increased risk of kidney dysfunction. Their suggestion was to measure the kidney function before OSP administration in order to avoid its use in patients with renal disease.

Is bowel preparation before colonoscopy a risky business for the kidneys? This is the title of an article in Nature Clinical Practice Nephrology (4(11):606-14, 2008 Nov.). It says that in 2004, five cases of irreversible renal failure after bowel preparation with OSP were reported.

The authors say that more recently, several retrospective studies have shown that the incidence of acute kidney injury after OSP use is in the range of one to four per cent, similar to the incidence of contrast kidney disease in patients who undergo special x-rays where contrast dye is used.

During bowel preparation physicians should watch for and correct any fluid and electrolyte imbalance. Patients should be checked for kidney function and serum phosphorus level after colonoscopy. Other option would be to use alternative bowel cleansing agents.

What should you do if you are going for a colonoscopy? If your doctor wants you to use Fleet Phospho-soda to cleanse your bowel then your kidney function should be normal and you should have no cardiac problems like heart failure. The risk of kidney damage in healthy individuals is about one to four per cent. There are other bowel cleansing agents in the market. You can discuss with your physician what are your best options for a good clean out.

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Role of Flouride in Preventing Dental Caries

Dear Dr. B: Last evening I listened to a radio program regarding fluoride. The doctor who hosted the show had nothing good to say about fluoride and was quite adamant that it should not be in toothpaste or in our water. He said that just bathing in water with fluoride in it is causing too much absorption and is harming our bones amongst other things. I am especially interested because I have a hygienist appointment coming up and the procedure is always finished by applying fluoride in your favorite flavor.

Answer: Health Canada website is a good source of information on this subject. The information is summarized here.

There is enough evidence to show that the use of fluoride decreases dental caries. The introduction of fluoride to drinking water in 1958 resulted in a dramatic reduction of dental caries. It is also clear that the ingestion of too much fluoride can result in varying degrees of fluorosis.

Fluorosis is an abnormal condition caused by excessive intake of fluorides, characterized in children by discoloration and pitting of the teeth and in adults by abnormal bone changes. Thus, to prevent fluorosis, the administration of fluoride should strike a right balance.

Fluoride prevents caries mainly by its local effect. Dental caries result when plaque, a sticky film of bacteria on the surface of the tooth, feeds on sugar and food residue to produce acid, which dissolves the surface of the tooth (demineralization). Bathing the surface of the tooth with fluoride causes a dramatic decrease in enamel solubility. Ingested fluoride, on the other hand, has little effect on caries, but contributes significantly to the development of fluorosis.

Fluorosis of our skeleton is a progressive but not life-threatening disease in which bones become more brittle. In mild cases, the symptoms may include pain and stiff joints. In more severe cases, the symptoms may include difficulty in moving, deformed bones and a greater risk of bone fractures.

The Health Canada website has a statement from Dr. Peter Cooney, Canada’s Chief Dental Officer which says, “In light of recent news features, Canadians may be wondering if fluoride is, in fact, safe for use in our water supply and dental hygiene products such as toothpaste.

An expert panel, commissioned by Health Canada to review the scientific studies available on fluoride and its possible effects on health, made a number of recommendations to Health Canada, including:
-to decrease slightly the amount of fluoride that can be added to municipal drinking water,
-to encourage the availability and use of low-fluoride toothpaste by children, and
-to suggest to makers of infant formula to reduce levels of fluoride in their products.”

Community water fluoridation has been identified by U.S. Centers for Disease Control as one of 10 great public health achievements of the 20th century. Canadian and international studies agree that water that was fluoridated at optimum levels does not cause adverse health effects. About 40 percent of Canadians receive fluoridated water.

Experts say there are several steps you can take to maintain your fluoride intake within the optimal range for attaining the dental benefits. Never give fluoridated mouthwash or mouth rinses to children under six years of age, as they may swallow it. Health Canada does not recommend the use of fluoride supplements (drops or tablets).

Make sure that your children use no more than a pea-sized amount of toothpaste on their toothbrush, and teach them not to swallow toothpaste. Children under six years of age should be supervised while brushing and children under the age of three should have their teeth brushed by an adult without using any toothpaste.

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