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Scoliosis

Dear Dr. B: My mother is 83 years old. She has osteoporosis and lumbar scoliosis. She has back pain. For several years she has been advised to lie on plywood without a mattress. Is this the right treatment for her scoliosis and back pain?

Answer: Spine has natural curves. There is a natural curve round our shoulders (kyphosis) and there is one in the lower back (lordosis). Theses curves are required to maintain appropriate trunk balance over the pelvis. In scoliosis, some people have abnormal curvature of the spine to the left or right.

Scoliosis is more common in females and may run in families.

What are the causes of scoliosis?

Eighty per cent of the cases of scoliosis have no definite cause (idiopathic). In some cases it may be congenital and present at birth. Some rare causes are: muscle weakness around the spine, cerebral palsy, poliomyelitis, unequal leg length, and spinal injury.

What are the symptoms?

In most cases the symptoms of spinal scoliosis develop gradually as a child grows. There is a visible curvature of the spine on one side; there is back pain and difficulty walking. The rib cage may be deformed in severe cases of upper spinal scoliosis and this may compromise the function of the heart and lungs.

How is it treated?

Mild cases of idiopathic scoliosis do not require treatment. They are carefully monitored to see if the curvature is getting worse. If there is an obvious cause then the treatment is geared to correct that problem.

If the scoliosis is severe and progressive then spinal brace is used to limit further progression. In some instances surgery (spinal fusion or metal rods and wires) is used to control the condition.

Scoliosis Research Society’s website (http://www.srs.org/patients/) says that there is no scientifically documented role for exercises, manipulation or electrical stimulation in the management of scoliosis. And I did not find any reference to lying on plywood as a remedy for backache due to scoliosis.

Is there a relationship between scoliosis and osteoporosis?

Osteoporosis is a very common condition amongst women. In one study, 48 per cent of the women with osteoporosis had scoliosis. Osteoporosis and scoliosis frequently occur together. Scoliosis of the lumbar area was more commonly seen. Elderly women with scoliosis are at a high risk of getting fractures of the vertebral bodies.

Recommended treatment for elderly women with osteoporosis includes pain killers, exercise, and certain types of braces to support the spine. Patient should be advised to increase intake of calcium and vitamin D.

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Insomnia

Dear Dr. B: What is insomnia and how much sleep do I need to stay healthy?

Answer: Insomnia is defined as chronic inability to fall asleep or remain asleep for an adequate length of time.

It is estimated that 10 to 40 per cent of people suffer from some sort of insomnia. This is only an estimate as nobody has yet defined what constitutes normal sleep.

Most adults sleep seven to eight hours a night. Newborns and children may sleep up to 16 hours a day. Older people may sleep only six hours a night. There is no magic number. If you are tired the next day or are yawning all the time then you need more sleep.

The quality of sleep you get is also important. The quality and quantity of sleep depend on many factors like your health, your lifestyle and your environment.

In a survey done in the United States, it was found that many patients with insomnia have other medical problems. Thirty per cent of the patients have depression, 20 per cent have other mental disorders, and 19 per cent have other illnesses. But 31 per cent of the patients have primary insomnia (i.e. they have no medical condition contributing to insomnia).

Sometimes insomnia may be the first symptom of depression.

“The prevalence of insomnia has also been reported to be higher in women, women in minority groups, people who are unemployed or separated, lower socioeconomic groups and in those with medical or psychiatric (particularly substance abuse) disorders,” says an article in the Canadian Medical Association Journal.

Workaholics spend many sleepless nights to accomplish their tasks. They ask, “Why do we need to sleep?”

I have experienced this first hand when I used to be surgeon-on-call, sometimes several nights in row. I never thought I needed more than four to five hours of sleep. My ego was driven by the amount of work I did. I did not have insomnia. But I thought I did not need too much sleep. My adrenaline level was pretty high.

Now I realize sleep is important. Not only the quantity but the quality of sleep is important. Experts say we need sleep to rest. Sleep allows the brain and the body to recover and restore itself. So we can be fresh for the next task.

It is very important that you consult your doctor if you have trouble falling asleep or cannot remain asleep for an adequate length of time. The cause of your insomnia could be stress, depression, anxiety, panic attacks, spastic bladder, arthritis, hyperthyroidism, congestive heart failure, obstructive sleep apnea, or lung disease. You may be overindulging in caffeine or alcohol. Or there may some other cause.

Your physician can help you sort some of these problems by recommending regular daytime exercise, avoiding large meals at night, avoiding caffeine, tobacco and alcohol; reducing evening fluid intake; maintaining a consistent wake-up time; avoiding or limiting daytime napping and avoiding bright lights (including television), noise and temperature extremes. In some circumstances he may recommend medications.

So, if you have insomnia, do not panic. Talk to your doctor.

Jokes for the week:

Why did the University of Calgary researcher stay awake every night?
He was trying to find a cure for insomnia!

Doctor, Doctor, with all the excitement of spring I can not sleep.
Try lying on the edge of your bed…you’ll soon drop off!

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Date Rape

Dear Dr. B: What is a date rape? What are the drugs involved in date rape? How can one avoid date rape?

Answer: Date rape is a drug-facilitated rape or sexual assault. This occurs when a substance is administered to a person which lowers his or her sexual inhibition and increases the occurrence of unwanted sexual intercourse.

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.

Most of the drugs used for this purpose have no color, 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).

Alcohol is involved in most of the cases of date rape.

According to an article in the Canadian Medical Association Journal, of 2003 urine samples submitted by rape treatment centers across the United States within 72 hours of a suspected drug-facilitated rape, GHB was detected in three per cent of the samples and flunitrazepam in less than one per cent; alcohol was detected in 69 per cent of the samples, marijuana in 18 per cent and cocaine in 5 per cent.

GHB (also known as liquid ecstasy, grievous bodily harm, and scoop) comes in a liquid form with no odor or color. It also comes as a white powder and as a pill. Rohypnol (similar to valium but very potent is also known as love drug, Roofies, ruffies, roche, R-2, rib, rope) is a pill and dissolves in liquids. Ketamine is a white powder.

What are the consequences of date rape?

Rape inflicts serious consequences on the victim. These include psychological problems, infection, and unwanted pregnancy. People who have been raped may present, immediately or later, to a family physician or to an emergency department.

The patient requires immediate attention regarding safety, management of injuries, forensic examination, and emergency contraception. And there is a risk of sexually transmitted infections like gonorrhea, chlamydial infection, HIV, and herpes.

How can I protect myself from being a victim of date rape?

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. Don’t accept drinks from other people, except trusted friends. Do not share drinks.

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. The drugs can leave your system quickly. So do not urinate before getting help. 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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Yoga and The Centre of Consciousness

Do you know what a Centre of Consciousness is? Have you ever thought of finding one? Once you find it, what do you do with it? What has yoga and meditation to do with the Centre of Consciousness?

Answers to these and many other questions can be found in a book titled Sutras of the Inner Teacher – The Yoga of the Centre of Consciousness. It is written by Drs. Martin and Marian Jerry, physician-scientist and clinical psychologist respectively.
Jerrys are now retired and live in Canmore.

During the Family Day long week-end, I decided to visit Canmore. I wanted to ski with my friends and to pay my respects to my mentor – the man who gave me a start in Canada.

That mentor happens to be Dr. Martin Jerry. I also had a selfish reason to visit him and his lovely wife. I wanted to discuss and get advice on a couple of projects I am working on.

I first met Martin Jerry when I came to visit my parents in Calgary in the summer of 1979. I had finished my surgical training in Britain and was looking for a research fellowship in Canada.

Jerry was then Professor of Medicine at the University of Calgary and Director of the Oncology Research Group of what later was to become Tom Baker Cancer Centre.

Jerry told me that he was looking for a research fellow in cancer immunology and the funding from the National Cancer Institute of Canada (NCIC) was already in place. After an interview and after completing other formalities he offered me the position that carried NCIC fellowship stipend of $1000.00 (one thousand dollars) per month.

I was single. I lived with my parents like a student, made some sacrifices and survived. I spent two years with Jerry’s group. I remember Jerry as an outstanding teacher, clinician, researcher and mentor who took good care of me and all those who worked under his stewardship. I also had the pleasure of knowing his wonderful wife Marian and their two sons, Paul and Mark.

In fact Paul Jerry is a chartered psychologist in Medicine Hat. What a coincidence.

Over the years I have been in touch with the Jerrys. I keep them informed on the progress I make in life. I feel the man who gave me a start in Canada should know how I am doing. I am also fascinated with their book. I would like to find my Centre of Consciousness, find spiritual enlightenment and take care of my fears and phobias. Is yoga and meditation the answer?

I believe so. Only time will tell whether I have the discipline to achieve that spiritual enlightenment. Jerrys’ book says, “No one can carry you to the mountain top. You can be guided, but eventually you must climb to the peak yourself to achieve complete mastery.”

The book is a good guide. And the visit to Canmore was very enriching. We talked about the past, the present and the future. I got the advice I needed to keep my projects on the right track and learnt again that there are kind and caring people in this world who do make a difference in a very private and quite way. For that I am thankful. I pray for their good health and happy retirement.

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