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Arthritis – The Painful Crippling Problem

Dear Dr. B: Can you please write about arthritis? Are there different types of arthritis? Is there any treatment?

Answer: Recently, a friend was diagnosed with arthritis. My immediate query was, “What kind of arthritis?”

Like cancer, arthritis is not one disease. There are more than 100 conditions in which symptoms of arthritis are present. In fact, it is estimated that 46 million adults and 300,000 children suffer from arthritis in U.S. alone. It can be a painful and crippling disease although milder forms of arthritis are not uncommon in majority of the people.

Osteoarthritis (OA) is the most common form of arthritis. It is prevalent in people over the age of 60. But arthritis, in one form or the other, may affect people of any age group starting from infancy to old age. It affects more women than man (60 per cent to 40 per cent).

American Heritage Dictionary defines arthritis as inflammation of a joint, usually accompanied by pain, swelling and stiffness, resulting from infection, trauma, degenerative changes, metabolic disturbances or other causes. It occurs in various forms, such as bacterial arthritis (due to infection), osteoarthritis (wear and tear of cartilage), rheumatoid arthritis (overactive immune system) and gout (abnormal metabolism). These are just a few examples.

The joints are swollen and deformed from inflammation and destruction of the cartilage. Arthritis is a major cause of disability in the U.S. and Canada and it costs billions of dollars in medical costs, lost wages and production of goods.

Diagnosis of arthritis depends on your history, symptoms and physical findings. Your doctor will order blood tests and plain x-rays. If necessary, CAT scan and MRI will help in the diagnosis.

Is there a good treatment for arthritis?

Usually, there is no cure for arthritis. Treatment is aimed at relieving symptoms of pain and stiffness by reducing inflammation in the joints with the hope that it will slow down damage to the joints.

Most people with arthritis try over the counter medications like aspirin, acetaminophen, ibuprofen and variety of other NSAIDs (non-steroidal anti-inflammatory) available in the market. As the pain and stiffness deteriorates the patients require stronger medications like steroids. Some patients require combination of NSAIDs and steroids. Steroids can be injected into the joints as well. Certain types of arthritis require specific medical treatment.

Eventually surgery becomes an option to relieve pain or correct the deformity. Most commonly performed surgeries are total joint replacement (arthroplasty), tendon repair and removal of the joint lining (synovectomy). Surgery carries a risk of bleeding, infection and pain. You should carefully discuss and understand the benefits and risks of the procedure with your doctor.

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The Silent Killer – Hypertension on the Rise

“The number of adults with hypertension more than doubled from 1995 to 2005. The age- and sex-adjusted prevalence increased from 153.1 per 1000 adults in 1995 to 244.8 per 1000 in 2005, which was a relative increase of 60 per cent,” says an article in the Canadian Medical Association Journal (CMAJ).

The article was discussing public health strategies to prevent and manage hypertension and its consequences in Ontario, the most populous province in Canada. I think the problem of hypertension is no different in the rest of Canada and the U.S.

Articles in the CMAJ reported marked improvement in the diagnosis and treatment of high blood pressure. This may explain the increase in the prevalence of hypertension which may represent an increase in the detection of hypertension rather than a true increase in its incidence.

It is estimated that a middle-aged man with normal blood pressure has 90 per cent risk of becoming hypertensive. That is scary.

The consequences of high blood pressure are severe. 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.

For example, in U.S., studies show that only 37 per cent of hypertensive patients were treated and adequate control of blood pressure achieved. Comparative studies from Europe indicate that less than 25 per cent of people with hypertension receive adequate treatment. In Canada, 1985–1992 Canadian Heart Health Survey reported a treatment and control rate of only 13 per cent.

One of the most important findings reported in one of the studies from Ontario is the remarkable improvement in hypertension management. The study reported hypertension awareness rate of 87 per cent, treatment rate of 82 per cent and treatment and control rate of 66 per cent. These numbers are by far the highest from any population-based study, says one of the CMAJ article.

The study also revealed that South Asian and female black Canadians had a disproportionately high prevalence of hypertension. This means intervention programs should be targeted to such groups at community and individual levels. They also found that one in three adults with hypertension did not have blood pressure control.

Diabetic patients with hypertension have a high risk for cardiovascular disease. Unfortunately, two-thirds of these patients did not have blood pressure control and that over one-quarter had received no treatment. If these patients receive intensive treatment for high blood pressure then this actually saves the health care system money as well as prevents death and disability, says one of the articles.

As they say, prevention is better than cure. You can reduce the risk of hypertension by 50 per cent by maintaining healthy weight and exercising daily. Eating a healthy diet with lots of fruits and vegetables also helps. Have your blood pressure checked when you visit your doctor. Common symptoms of hypertension to look out for include recurring headaches, dizziness, confusion, unexplainable nosebleeds, and vision problems.

Bare your arm for blood pressure measurement next time you visit your doctor.

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How Safe Do You Feel As a Patient?

How safe do you feel as a patient?

Some years ago, experts estimated that in U.S. up to 98,000 people die each year from medical errors that could have been avoided. Many others may have been less seriously injured. In Canada and other developed countries the figures are proportionally no different.

There is no doubt that health care professionals work hard to provide safe and high quality medical care. But errors occur and there are many reasons for that. We cannot cover them all here but we can discuss few in terms of how you, as a patient, can stay safe.

Your safety, first of all, depends on your identification. Make sure your name and current address is correctly spelled and written, your date of birth is correct and your health insurance plan number on the card is correctly copied.

If you Google your name on the Internet you will find there are many people in the world who bear the same name as yours. In our office we have several patients with identical names. We have to be very careful that we do not mix their reports or give them wrong treatment. We feel checking the name, address, date of birth and health care insurance card number is very important. In the hospital, make sure your wrist band has correct information.

One thing which bothers me a lot is how dates are written by various people, organizations, departments, hospitals and doctors’ offices. The way I like to write is month in alphabets followed by day and year in numerical (June 10/08). This creates no confusion. Can you imagine people writing the same date in various different ways: 6/10/08 or 10/6/08 or 08/10/6? I think it is ridiculous and dangerous that we allow so many different ways to write dates.

Medication errors are not uncommon. There are many medications which have similar sounding names. You should always carry in your purse or wallet a list of medications you take. When you visit a doctor (who is not your regular doctor) you should take all your medications with you. Each year, during your annual physical, take with you all your pills and review with your doctor the necessity of continuing to take them. Also make sure your allergies are recorded properly.

You run the risk of picking up infection in every health care setting. To minimize the risk take necessary precautions. Wash your hands before and after your visit to a health facility. Just like washing your hands before and after you eat. Shower and wear clean clothes before your visit. With snow and rain, we tend to carry lot of dirt on our shoes. Most health care facilities request patients to remove wet and dirty shoes before they go in the examination rooms. Some facilities provide shoe covers. There is no guaranteed way to prevent infection. But each person, including health care providers, has responsibility to minimize the risk of infection.

What about complications from surgical procedures and invasive investigations? All procedures carry risks. Risks vary from minor to major like death. Before going through a procedure, you should discuss with your health care provider your expectation of the outcome. In return, the health care provider will explain to you the procedure and its likely complications. Make sure the site of surgery is marked with indelible ink so you do not end up getting a wrong foot amputated or a wrong side hernia repaired or a healthy knee replaced. In your follow-up visit make sure you get the results of all your tests and procedures.

Finally, carry a copy of your health history. It should contain your personal and medical information as discussed earlier including your family history. Being safe is being healthy.

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Lives Lived: Sikina Bharwani

Sikina Bharwani
Sikina Bharwani

Wife, mother, grandmother, great-grandmother, great-great-grandmother, matriarch. Born Dec. 1, 1920, in Jamjodhpur, Gujarat, India. Died April 19 in Calgary of metastatic gynecologic cancer, aged 87.

At the tender age of 15, Sikina married a handsome man named Hussein, who was 21. He had worked in Tanzania for eight years and had returned to India to look for a bride. He and Sikina married and lived in Tanzania for more than 35 years. They had eight children.

Sikina faced many challenges in her life. One of them was a motor vehicle collision in 1965. She was a passenger in a cab that was taking her to Masaka, Uganda, when the cab was hit head-on by a drunk driver. Sikina sustained multiple life-threatening injuries with many broken bones. She spent four months in a hospital in Kampala, Uganda. But she fought back and survived.

With Idi Amin’s brutal regime in Uganda terrorizing Asians, Hussein and Sikina decided to leave Tanzania. They moved to England and then to Canada, arriving in Calgary in 1975.

Five years later, Sikina was found to have a brain tumour close to a large blood vessel. Two neurosurgeons in Calgary felt surgery would be too risky. Hussein insisted on a third opinion. The third neurosurgeon, after considerable deliberations, elected to do the surgery. We were warned of the likely complications and the possibility of death. But Sikina was ready for it; she could not live the way she felt.

Sikina survived the six-hour surgery and had a full recovery. After many years of good health, in April, 2000, she momentarily lost speech and function on the right side of her body. A large tumour had recurred at the site of the previous excision.

Within a week, Sikina was back in the operating room undergoing another six hours of brain surgery. This time the recovery was slow. She was in the hospital for five weeks. But she did not give up. She was home again looking better and walking with a walker.
This time Hussein wasn’t there – he had passed away in 1991. But all her children and their families were around.

Sikina also had numerous friends. She was known to be always smiling and never complaining. Out of all things, her courage stands out. She had experienced three life-threatening events, moved through four continents and courageously faced many of life’s ups and downs and survived. She had a Grade 4 level education and spoke very little English, yet she managed to live alone for 17 years in a one-bedroom condo. She was one tough lady.

Sikina believed in God and miracles. She was the matriarch of the family, survived by five children, 18 grandchildren, 10 great-grandchildren and one great-great-grandchild. She is missed by all who knew her. Long live Sikina and her legacy of love, courage and optimism.

Noorali Bharwani is Sikina’s son.

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