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Erectile Dysfunction May Be An Early Sign Of Heart Disease

Erectile dysfunction (impotence) may be an early sign of heart disease.

Greek researchers evaluated the incidence of asymptomatic coronary artery disease in 26 men with erectile dysfunction and found 23 per cent had coronary artery disease confirmed by angiography (x-rays of the coronary vessels).

Italian researchers studied 162 patients and found the prevalence of erectile dysfunction was high (66 per cent) among those with chronic angina and multivessel disease and low (18 per cent) among those who had had an acute myocardial infarction with only one vessel affected.

Patients with erectile dysfunction, with no obvious cardiac problems, are at a risk of a heart attack within two to three years. In these kinds of patients, erectile dysfunction is considered to be a warning sign of heart attack to come. For this reason, it is being suggested that patients with erectile dysfunction, with no obvious cardiac symptoms, should be evaluated for cardiovascular disease.

There are several reasons why patients with heart disease will have erectile dysfunction. Atherosclerosis (clogging and hardening of the blood vessels) narrows the blood vessels and reduces blood flow to your heart, brain, extremities and the penis. Reduced blood supply to the penis causes erectile dysfunction.

Certain medications taken for heart disease can cause erectile dysfunction (high blood pressure pills and diuretics). It is also important to remember medications taken for impotence may not be safe when combined with certain heart medications (for example nitrates). There is a connection between depression, heart disease and erectile dysfunction. Feeling anxious can also lead to erectile dysfunction. Fear of having a heart attack while having sex can lead to impotence.

Usually, this is an unfounded fear. After a heart attack, you can resume your sexual activity as soon as your doctor says ok. Sexual intercourse seldom causes heart attacks. Having sex with your usual partner in a familiar setting doesn’t lead to a particularly high blood pressure level or heart rate. Even if you’re at high risk of having a heart attack, weekly sexual activity only slightly raises the risk. In fact, regular sexual activity leads to a happy and satisfactory relationship and is good for your heart.

There are a number of risk factors that can contribute to both heart disease and erectile dysfunction. These factors are well known: diabetes, obesity, high cholesterol level, smoking and high blood pressure fall into this category. So, erectile dysfunction may have multifactorial cause and will require investigations and long term planning to get the situation under control.

Let us go back to the real life scenario – you have erectile dysfunction but have no other obvious health problem. What should you do?

First, you have to look at your personal scenario. Is your relationship with your partner stressful or unpleasant? Are you living or working in an environment which is depressing? Such factors will affect your performance in bed.

Your next step is to talk to your doctor. After evaluating your history and physical examination, your doctor will decide on what kind of investigations to undertake. Your doctor may decide to refer you to a urologist, a cardiologist or to a psychiatrist.

So, don’t be shy. If you are having problems maintaining an erection during sexual intercourse then see your doctor. It may save your life and your sex life.

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Traveler’s Diarrhea Can Cause Irritable Bowel Syndrome

Have you already planned a winter holiday? Besides getting your passport and appropriate currency, you need to think of getting your vaccinations updated and take actions to prevent traveler’s diarrhea (TD).

TD hits your system when you consume contaminated food and water. It occurs during or shortly after travel, most commonly affecting persons traveling from an area of more highly developed hygiene and sanitation to a less developed one. Food and water may be contaminated with bacteria, parasites or viruses. A similar but less common syndrome is toxic gastroenteritis, caused by ingestion of pre-formed toxins.

Studies have shown bacteria are responsible for approximately 85 per cent of TD, parasites about 10 per cent, and viruses five per cent. On average, 30-50 per cent of travelers to high-risk areas will develop TD during a one to two-week stay.

TD is generally self-limited and lasts 3-4 days even without treatment, but persistent symptoms may occur in a small percentage of travelers. Any diarrhea associated with fever and blood in the toilet requires medical attention.

Infectious diarrhea can have a long term effect on our system resulting in arthritis, Guillain-Barré syndrome (a reversible condition that affects the nerves in the body), and irritable bowel syndrome (IBS). IBS may occur in up to 30 per cent of persons who contracted travelers’ diarrhea or infectious diarrhea. Research is going on to determine if post-infectious IBS can lead to inflammatory bowel disease.

IBS is a complex disorder clinically characterized by abdominal pain and altered bowel habit. Its causative mechanisms are still incompletely known. It could be a person’s genes, psychosocial factors, changes in gastrointestinal motility and hypersensitivity of certain organs in the body.

TD can be self-limiting benign condition or may result in serious sequalae. So it is no rocket science to conclude that we should try and prevent TD by taking necessary preventive measures. Travelers should remember to wash their hands with soap and water prior to eating or meal preparation.

Eat foods that are freshly cooked and served piping hot and you should avoid water and beverages diluted with non-potable water. Foods like salads are washed in non-potable water. You should avoid that. Raw or undercooked meat and seafood and raw fruits and vegetables should be avoided. Safe beverages include those that are bottled and sealed or carbonated. Consumption of food or beverages from street vendors poses a particularly high risk.

What kind of medications can you use as prophylaxis against TD?

Studies from Mexico have shown Pepto-Bismol (taken on arrival at the destination as either two oz. of liquid or two chewable tablets four times per day) reduces the incidence of TD from 40 to 14 per cent, says one research paper. You should make sure that Pepto-Bismol is compatible with other medications you take. There is no conclusive evidence that use of probiotics is helpful.

E. coli is the most common type of bacteria which causes TD. Use of oral Dukoral vaccine (two weeks and one week before travel) provides protection against E. coli diarrhea for three months.

Use of prophylactic antibiotics has been demonstrated to be quite effective in the prevention of TD. Studies have shown that attacks of diarrhea are reduced from 40 per cent to 4 per cent by the use of antibiotics. But it is becoming difficult to decide which antibiotic to use as bacteria tend to develop resistance to antibiotics. For this and other reasons, prophylactic antibiotics should not be recommended for most travelers.

Three months before you travel, you should visit your family doctor and local public health nurse and discuss your travel plans. They will provide you with the most advanced information on how to have a healthy and happy holiday.

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Anal Fistula Can Be Difficult To Treat

This model illustrates various pathology of the rectum. (iStockphoto/Thinkstock)
This model illustrates various pathology of the rectum. (iStockphoto/Thinkstock)

Last week, I was in San Francisco, California to attend the Clinical Congress (convention) organized by the American College of Surgeons. It is one of the largest surgical conventions in the world. The convention lasts five days (Sunday to Thursday). By Wednesday afternoon, total registration for the convention was 14,397: 8916 were physicians and the rest were exhibitors, guests, spouses and convention personnel.

Not everybody is in one auditorium or room at the same time. Each room has its own list of speakers and topics for discussion. So you head yourself to a room which offers discussion on a topic which interests you the most. The conference was held at the Moscone Convention Center. It is the largest convention and exhibition complex in

San Francisco. It comprises three main halls with total of 84,000 square meters of space (900,000 square feet).

One of the symposiums I attended was on surgical problems of anus and rectum: cancer, fistula, fissure and hemorrhoids. Today, I will review the subject of anal fistula (fistula-in-ano).

What is a fistula? A fistula is an abnormal tunnel connecting two body cavities (such as the rectum and the vagina) or a body cavity to the skin (like the rectum to the outside of the body). Fistulas are usually the result of infection, injury or surgery. With an anal fistula there is a tunnel between the anus (and/or rectum) to the skin. A peri-anal abscess has a 50 per cent risk of turning into a fistula.

Anal fistulas do not generally harm the body. They are mainly a nuisance with some pain or discomfort and irritating intermittent discharge of blood, pus or stool. They can form recurrent abscesses which may require drainage under local anaesthetic.

Most of the time the diagnosis of fistula is made on the basis of classical clinical history and physical findings. Examination of the rectum may show an opening of the fistula onto the skin, the area may be painful on examination, there may be redness, a discharge may be seen or it may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula.

Treatment of the fistula depends on the presentation of the problem. If there is active infection or abscess then it needs to be treated with drainage of the pus and antibiotics. Once the infection is cleared the fistula can be treated surgically. If it is difficult to get rid of the infection then long term drainage can be established by inserting a seton – a length of suture material or thin rubber tubing is looped through the fistula which keeps it open and allows pus to drain out.

The treatment aim should be to prevent recurrence of fistula. Treatment depends on where the fistula lies, and which parts of the anal sphincter it crosses.

There are several options. Doing nothing – a drainage seton can be left in place long-term to prevent problems. But this does not cure the fistula. Fistula can be layed open under anaesthetic. Once the fistula has been layed open it will be packed on a daily basis for a short period of time to ensure that the wound heals from the inside out. Depending on the depth of the fistula, this option may affect continence if the fistula involves sphincter muscles. Most fistulas are superficial and can be layed open under local anaesthetic without much problem with continence.

Other methods of treating fistula are: using fibrin glue injection, using fistula plug, creating a flap to cover the internal fistula opening and using a seton to cut through the deep fistulous tract. Each method has advantages and disadvantages.

Some fistulas are very difficult to treat if they are caused by inflammatory bowel disease like Crohn’s disease. Any patient with recurrent fistula should be investigated for inflammatory bowel disease. Otherwise, most fistulas can be cured with patience and perseverance.

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Shortage Of Doctors – A 10-Point Plan To Fix The Problem

Almost every Canadian is aware that we need more doctors. Ipsos-Reid poll done for the Canadian Medical Association indicates that MD shortages rank second only to the economy in a list of election issues (CMAJ July 1, 2008).

According to Statscan, more than four million Canadians do not have a family doctor. Currently, Canada produces 2,300 new doctors a year but we need about 3,200 doctors a year (The Medical Post, June 3, 2008). How can we find 900 more doctors each year?

According to Draft 2005 Alberta’s Physician Resources Planning Committee Report Data, Alberta, one of the richest Canadian provinces, will be short of 1,541 doctors by 2010. Dr. Dale Dauphinee, executive director of the Medical Council of Canada, coauthored a report in 1999 that calculated that Canada needs to recruit 2,500 new doctors a year. This would cover both physicians retiring or leaving the country and population growth. Our own graduates can’t fill the void.

That was in 1999, which is almost 10 years ago. Has anything changed since? Looks like things are worse now.

Over the years, so much has been said and written about finding a solution to the problem that one would think that the problem would have been solved by now.

Reports indicate there are numerous factors contributing to Canada’s shortage of physicians. Some of these factors are: migration of doctors to the United States, reluctance of medical students to choose specialties and locations where they are most needed, and new practice patterns (lifestyle goals and use of the health care system) and there are fewer doctors now partly because of a 10 per cent reduction in medical school enrolment that was imposed across the country in 1993.

What Canada has failed to do is to utilize the resources already available in our country and in overseas medical schools. We know thousands of international medical graduates are in Canada who are unable to practice because they are unable to get a license. According to CMAJ (April 10, 2007), Association of International Physicians and Surgeons of Ontario has a membership of 1800. So, how many international physicians and surgeons are in Canada who are delivering pizza or driving a taxi?

We also know there are thousands of Canadian citizens who are studying abroad because they could not wait to apply to a Canadian medical school. Generally speaking, a Canadian applicant to a medical school in Canada has roughly six per cent chance of admittance (CMAJ April 10, 2007).

There are Canadians studying in Ireland, the U.K., Europe, Australia, in several medical schools in Caribbean islands, South America, Cuba and the U.S.A. I have been to the island of Antigua twice in the last eight months and visited the American University of Antigua College of Medical School (www.auamed.org) in St. John where my son is a student. I have met and spoken to some of the people who run this place.

According to Mr. Vito Barbiera, Director of Marketing for the American University of Antigua College of Medicine (commonly known as AUA), AUA has 1200 medical students. Of these 20 per cent are Canadians, 70 per cent are Americans and the rest are from Antigua and different parts of the world.

According to the Canadian Medical Association Journal (April 10, 2007), more than 300 Canadians are now studying at four Irish medical schools, and 60 to 70 new ones join them annually. Who knows how many Canadians are all over the world striving to get a medical degree.

According to Mr. Dick Woodward, AUA’s Vice President for Enrollment Management,
AUA College of Medicine provides medical education equal to the highest U.S. medical education standards. The purpose of the training at AUA is to prepare students to pass the U.S. Medical Licensing Examination (USMLE), for U.S. medical licensure, and to provide the foundation for postgraduate specialty training in the U.S.

Woodward says, “The AUA School of Medicine is fully recognized and approved by the government of Antigua to confer the degree of Doctor of Medicine upon students who fulfill the School’s admission requirements and complete the prescribed curriculum.”

Barbiera proudly reiterates what they say on their website that AUA is the first medical school in the Caribbean with a U.S. model medical education to be hospital-integrated. AUA’s program of medical education has been approved by the State of New York and pursuant to its approval, one of the few international schools that can place its students in New York Hospitals for 2 years of clinical training.

Woodward says that AUA had a first graduating class of eight in 2007. Last year AUA produced 21 doctors and this year they expect to graduate 50 doctors. He said all AUA’s graduates have been matched in the U.S. residency programs. If these graduates are absorbed in the U.S. medical system, the question is: why cannot we engage the services of these doctors in Canada?

AUA has very ambitious plan for the future. On June 15, 2007 AUA broke ground on its new $60 million, 17-acre campus. The plan is to create an educational institution on Antigua that would provide a comprehensive state-of-the-art learning facility for students who aspire to become highly skilled compassionate physicians and plan to practice medicine throughout Canada, the United States and the Caribbean region, says AUA website.

Antigua is just one example of how U.S. is taking full advantage of recruiting and absorbing international and American physicians who pass their licensing examination by giving them opportunities of doing clinical rotations and residency program.

I propose a 10 point mini-Marshall plan to be implemented on a national level to utilize the services of international graduates in Canada who have no license to practice and Canadians studying abroad:

1. A national medical manpower czar should be appointed by the federal government. He should have sufficient budget and manpower to undertake the enormous task of making Canada self-sufficient in medical manpower.
2. The czar should create a registry of all international medical graduates who are in Canada but have no license to practice medicine. This can be done by announcements in the media.
3. The czar should conduct a survey of these graduates to find out what each one of them requires to be fully licensed to practice medicine.
4. From the responses received the czar should create conditions and provide financial help (in conjunction with teaching institutions, hospitals, licensing bodies and provincial governments) to help these graduates to be fully licensed in one year.
5. Those who fail to get a license should get one more try. If they fail again then they should be told to pursue other careers.
6. Those who accept the government help should promise to work in an underserviced area for two years before they move to another city.
7. The czar should also create a registry of Canadian medical students in all overseas countries. This can be done by announcing in the media for the parents of these students to register their children with the czar’s office.
8. The czar should take survey of these students to find out how many of them want to return to Canada to do residency program and practice here.
9. The czar should constantly stay in touch with these students and encourage them to pass LMCC (Canadian licensing examination) when they prepare for the USMLE (American licensing examination). To make it easier, the Canadian licensing bodies should accept USMLE to be equivalent to LMCC.
10. The czar should offer them financial incentives to come back to Canada by offering them signing bonuses. This can be done in conjunction with hospitals and provincial governments.

The international medical graduates and the Canadians who study abroad did not cost the Canadian tax payers a single penny. What is wrong with investing some money on them and absorb them into our system? That is better than spending thousands of dollars on Canadians who obtain their M.D. in Canada and then move to U.S. Here is a free supply of precious commodity. Canada, open your arms and take it.

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