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Christmas Means Happy Times Are Here

So this is Christmas
And what have you done
Another year over
And a new one just begun
And so this is Christmas
I hope you have fun

Most of you will recognize the above lyrics are from John Lennon and Yoko Ono’s Happy Christmas (War Is Over).

Christmas is here. That means it is end of the year. It is time to take stock of things. It is time to ask some questions and time to plan for the next year. Christmas is also time for friends and family to rejoice and renew their love for each other.

Each year is interesting in its own way. There are many things one can look back on and be grateful about. Equally, there are many things we can look back on and be unhappy about. Sometimes the glass is half full and sometimes it is half empty. And sometimes the glass isn’t there.

But the spirit of Christmas is always there. I find that so wonderful. So many people put in so much effort to make the occasion a happy one. There is something for everyone. Especially for people who are disadvantaged and marginalized in our affluent society. Christmas brings cheers for them as well.

There are about 1.8 billion Christians in a total world population of 5.5 billion, making it the largest religion worldwide. Most historians peg the first celebration of Christmas to Rome in 336 A.D. Christmas was largely a non-event in America until the 1860s. No one was really in the habit of exchanging elaborate gifts until late in the 1800s.

There are so many traditions associated with Christmas. I wonder how many people really know their origin. For example, mistletoe has apparently been used as a decoration in houses for thousands of years and is also associated with many pagan rituals. Mistletoe was banned in churches throughout the Middle Ages. Hanging of mistletoe over the front door is a Scandinavian tradition for goddess of love (Frigga).

But does it really matter what traditions you follow. I don’t think so. What matters is the spirit of love, happiness and peace as the city grinds down to a slow pace for Christmas and New Year.

The hospital will be empty accept for the very sick. Most doctors and health professionals (except those who are on-call) will get some time to spend with their families.

As Boxing Day comes, emergency department gets busy – thanks to too much food and alcohol. There will be patients with tummy ache, diarrhea, and vomiting – probably due to food poisoning. Some will have bowel blockage, some will have stomach and intestinal bleeding, some will have gall stone attacks, and some will have pancreatitis (due to gall stones or alcohol abuse).

Some will come with chest pain and heart attack. Some will be in heart failure. Some may get asthmatic attacks, some may get migraine. Unfortunately, some will get involved in motor vehicle collisions, and some will get involved in fights.

Those who survive all this will soon recover to get ready for the New Year’s Eve bash. There will be more food and more alcohol. And then there will be a hangover and 2008 will be history!

Don’t drink and drive. Make sure you are safe and have fun. Merry Christmas and Happy New Year!

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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Controlling Hypertension Means Preventing Stroke

When was the last time you had your blood pressure checked?

Last week, I wrote in my column that we should learn to recognize early signs of stroke because if you receive clot busting medications within three to 4.5 hours then your chance of survival and living without disability is considerably improved.

So, what can you do to prevent stroke?

There are many things you can do to prevent stroke. One of the most import things you can do is to keep your blood pressure under control. Especially, in the current worsening economic situation.

We know that anxiety does not cause permanent high blood pressure but it can cause dramatic temporary spikes of high blood pressure which can cause damage to our blood vessels and vital organs like heart and kidneys. It can damage the brain and retina. Persistent or recurrent anxiety can make us prone to picking up bad habits like smoking, drinking or eating too much unhealthy food. Combination of these factors can increase our risk of high blood pressure.

Nearly two-thirds of all cases of stroke and one-half of all cases of coronary heart disease are directly related to hypertension. What is scarier is that most cases of hypertension either go undiagnosed or untreated. That is why it is called a silent killer. You may have high blood pressure but may not have any symptoms.

World Health Organization says that hypertension causes seven million premature deaths worldwide each year. Hypertension affects 22 percent of Canadians. It is estimated that 25 percent of the 42 million people with high blood pressure in the United States are unaware that they have hypertension. It is a ticking but silent time bomb ready to explode any time.

The incidence of hypertension increases with age. Most elderly Canadians have high blood pressure – probably due to thickening of blood vessels. No cause is identified in 80 to 95 percent of people with hypertension. This is known as idiopathic or essential hypertension. Others have hypertension due to primary disease of kidneys or due to certain hormonal disorders.

We eat too much and we do not exercise enough. Our blood vessels become harder and less compliant with age. When the blood is pumped out of the heart into less compliant blood vessels, the blood pressure goes up. So the heart has to work harder – and eventually it becomes tired, weak and fails. It silently causes damage to our vital organs and eventually results in heart attack, congestive heart failure, stroke, kidney failure and blindness.

Normally, systolic blood pressure should be less than 140 mm Hg (mercury) and diastolic pressure of less than 90 mm Hg. Blood pressure is lowest in the early morning, rises as the day progresses, and then dips down during the night and earliest hours of the morning.

Hypertension can be prevented and treated with lifestyle changes – with or without medication. Eat a healthy diet, lose weight if you are overweight, do not smoke, limit alcohol intake, eat a low salt diet, minimize sugar intake, do regular exercise, relax and learn to manage stress with laughter and meditation.

If your doctor wants you take pills to control your blood pressure then make sure you take it regularly. Research has shown that 50 per cent of the patients with high blood pressure discontinue their antihypertensive medications by the first year. This is no good.

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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Plan Ahead for a Dignified Death

Last week, my friend Evelyn sent me a red rose in memory of my mother. Evelyn also had a question, “Why an elderly lady in a nursing home was denied treatment because her nursing care status was DNR 3?” Let me give you some personal examples to answer the question.

Yesterday (December 1) was my mother’s 88th birthday. But she wasn’t here to celebrate. So the red rose was timely. The red rose and the letters DNR brought back memories of my parent’s last few hours or few days in this world.

In my dad’s case, he had a severe heart attack at home. The paramedics revived him, put him on a breathing machine and transported him to Foothills hospital.

As I was about to leave for Calgary, my dad’s cardiologist phoned me to say that my dad’s chances of recovery were minimal and needed directions regarding resuscitation and how long to prolong his life on a breathing machine. He wanted me to discus the situation with the rest of the family since my dad had not left any written direction regarding such matters. We chose DNR 3.

In my mom’s case the situation was little different. She was diagnosed with terminal cancer. She was given a choice between receiving chemotherapy, with its unpleasantness and no chance of cure vs. tender loving care with no active treatment to avoid unnecessary prolongation of sufferings. My mom was mentally alert and was able to make an informed decision after a family discussion to let nature take its course. That means she elected to be DNR 3.

DNR stands for “do not resuscitate”. DNR provides guidelines for resuscitation levels depending on patient’s condition. Resuscitation care decisions are made by the attending physician in consultation with the patient, if the patient is mentally capable of making that decision. Otherwise the physician has to discuss the situation with the patient’s family members or a legal guardian. If there is no next of kin or a legal guardian then a second physician is consulted.

DNR has three levels: DNR 1, DNR 2 and DNR 3.

Patients on DNR 1 receive total supportive treatment including CPR (cardio-pulmonary resuscitation). The patients receive all aggressive medical, nursing and paramedical intervention including mechanical breathing machine and defibrillation. This status is given to all new patients in acute care unless they have a personal directive which gives clear instructions otherwise.

Patients on DNR 2 have to be deemed to have a poor likelihood of returning to a stable condition after CPR. Patients under this status do not get CPR or mechanical breathing. They receive all other supportive treatment.

Patients on DNR 3 receive comfort measures only as they are deemed to have an illness or condition which does not have a cure or provide a good quality of life. Therefore these patients receive only tender loving care.

The whole purpose of DNR policy is to allow people to die with dignity. That is why it is important to have a personal directive. A personal directive is a legal document you write in case you cannot make your own personal decisions in the future. The document lets you choose another person, an agent, to act on your behalf and make decisions for you when you cannot make them yourself.

You can have a personal directive if you are 18 years or over. Personal Directives Act (December 1, 1997) requires that for a personal directive to be valid, it should be signed, dated and witnessed. For more information you should visit Alberta Seniors and Community Supports (Office of the Public Guardian) website at www.seniors.gov.ab.ca. Their phone numbers: Edmonton office 780-422-1868, Lethbridge office 403-381-5648.

If you do not have a personal directive then you should get one today.

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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There Are New Guidelines For Stroke Management

“During a BBQ, a friend stumbled and took a little fall – she assured everyone that she was fine (they offered to call paramedics) … she said she had just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food. While she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening.
Ingrid’s husband called later telling everyone that his wife had been taken to the hospital. Ingrid passed away at 6:00 pm. She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don’t die … they end up in a helpless, hopeless condition instead.

A neurologist says that if he can get to a stroke victim within three hours he can totally reverse the effects of a stroke … totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.”

Above two paragraphs are taken from an email sent to me by a friend in Calgary. It is not an uncommon story. Most people know somebody who has been paralyzed or killed by stroke. The good news is there is lot of research going on to prevent stroke. “Research in stroke care is generating new information at a rate that challenges our ability to effect health-system change in a timely manner,” says an article in the Canadian Medical Association Journal (CMAJ).

What is new now is the time window for delivery of thrombolytic therapy (clot buster) for acute ischemic stoke has been extended, from three to 4.5 hours after the onset of stroke symptoms. The CMAJ article says that for a person with stroke, “time is brain,” and earlier treatment is associated with better outcomes. Even if a patient presents later than the 3-hour window, he or she should still be considered for clot busting therapy.

For a better outcome, acute stroke teams and emergency departments must continue to give priority to all suspected stroke patients and follow agreed-upon protocols. Rapid transportation, diagnosis and treatment go hand-in-hand in improving prognosis. Patients with suspected transient ischemic attack (sort of a temporary stroke) or minor stroke, if treated early, can minimize the risk of disability significantly to less than five per cent.

How can you recognize stroke early? If you are a victim of a stroke or you see somebody complaining of some strange symptoms then you can make a rapid diagnosis by following the following check-list:

S: Ask the individual to smile (there should be no drooping on one side)

T: Ask the person to talk (coherently) and stick tongue out to see if it deviates on one side.

R: Ask the person to raise both arms (there should be no weakness on either side).

If he or she has trouble with any one of these tasks, call 911 immediately and describe the symptoms to the dispatcher. Don’t worry if you are wrong. There is no penalty for that. But if you are right then you will save somebody’s life or prevent lifelong disability.

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