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The Act of Kindess

So many gods, so many creeds,
So many paths that wind and wind,
While just the art of being kind
Is all the sad world needs.

-Ella Wheeler Wilcox 1855-1919


The door bell rings. Its Saturday 8 a.m. It’s a Thanksgiving weekend. A gentleman stands at the door and hands over an item which we had lost recently. He finds it and wants to make sure we get it before the holiday weekend.

This gentleman, we shall call him Sean, was leaving town for the long weekend. But his thoughts and concerns were with our family. He wanted the item delivered to our house personally. We were very impressed and touched by Sean’s total selfless gesture.

Today, we want to express our gratitude to Sean for his kindness, thoughtfulness, and his generosity in stopping by at our house. He made our Thanksgiving weekend very special – it had a real meaning to it. I am sure Sean felt the same way.

This act of kindness also brought in me a sense of guilt and made me examine my own acts gone by. Have I been kind enough to make a difference in somebody’s life? Is there somebody out there who feels I have been unfair or unkind? In my own heart, is there a gap between perception and reality on what kindness means?

Nobody is perfect. So I must be guilty of some unkindness. We all have our share of mistakes, misjudgments and acts of stupidity. But in the end the question is – do we really care about others to make a difference in their lives?

Sir Rabindranath Tagore (1861-1941) said, “Men are cruel, but man is kind.” We just have to look at the world around us. On one hand there is death and destruction and on the other hand there is kindness and generosity. It is hard to believe men can be so cruel and still be so kind.

As a physician, the obligation of being kind is even more important. Canadian Medical Association’s Code of Ethics says that physician’s ethic of service is characterized by the values of:

-compassion,
-beneficence (quality of being kind, charitable, or beneficial),
-nonmaleficence (do no harm),
-respect for persons and
-justice.

Each day and during a physician’s lifetime of practice, he will see many patients and do numerous tests and procedures. By the law of averages, somebody is going to have complications and somebody is going to by unhappy. Somebody is going to feel that a physician is uncaring and unkind. It is impossible to satisfy everybody.

Does that mean we give up on being kind? No. An act of kindness does not always end in a win-win situation. But majority of the time it should and it does. Sean’s act of kindness is one example. And that is very encouraging. Just the art of being kind is all the sad world needs!

Thank you, Sean! Keep up the good work.

*****************************

Thought for the week:

“An ideal wife is any woman who has an ideal husband.” – Booth Tarkington (1869-1964).

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Migraine Headaches

Dear Dr. B: I was wondering if you could write your next column on the topic of migraine headaches. What causes them? How can you deal with them?

Migraine is a severe headache. It is often associated with severe pain on one or both sides of the head, nausea, vomiting and visual disturbance. It is the most common type of vascular headache.

Migraine headache affects 28 million Americans, 75 percent of whom are women. The first attack occurs between the ages of five and 35 years. It is rare to have first attack after the age of 40. The frequency of attacks varies a lot. But the frequency becomes less as the person gets older.

There are many types of migraine headaches. The two most common types are – the classic migraine and the common migraine.

The classic migraine is preceded by an aura – a person may see flashing lights, zigzag lines, or temporarily lose vision. There may be speech difficulty, weakness of an arm or leg, tingling of the face or hands, and confusion.

Common migraine is more common in general population. There is no preceding aura. There may be vague symptoms of mood changes and fatigue. There may be nausea, vomiting, diarrhea and increased urination.

What causes migraine headaches?

There is no known precise cause of migraine headaches. The theory is individuals have blood vessels that overreact to various triggers. This results in chemical changes in the blood and in the caliber of the blood vessels in the brain. First the blood vessels narrow and then after a while they rapidly widen and severe headache develops.

Stress and certain foods (like chocolates and cheese) can trigger an attack. Some people are affected by fatigue, glaring or flickering lights, and changes in the weather and at the time of menstruation. This list is by no means complete.

Although many sufferers have a family history of migraine, the exact hereditary nature of this condition is still unknown.


Do I need any tests?

Most of the time migraine headache can be diagnosed by your physician from your symptoms. A physical examination shows no detectable abnormalities during an acute migraine attack. Rarely CT scan or MRI of the brain is done to rule out serious causes like a brain tumor.


What is the treatment?

The object of the treatment will be:

-Drugs to reduce the duration of acute attacks
-Drugs to help treat symptoms
-Drugs to prevent future attacks

There are several drugs in each category. It will be futile to name them here. The best thing is to discuss with your family doctor. He will find an appropriate medication which suits your needs.


Can it be prevented?

You need to identify the factors which trigger your migraine. Keep a diary for few weeks to identify the triggers and then avoid them. Eat regularly and follow a regular sleep pattern. If life is stressful then learn to do some relaxation exercises. Laughter and meditation may help.

You can also visit Migraine Association of Canada’s website: www.migraine.ca (under construction but has some links) or contact them by e-mail: support@migraine.ca.


Thought for the week:

“What good is perfect eyesight when you are inwardly blind?” – From Images and Reflections by Dennis van Westerborg, a local artist and writer.

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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Canada’s Healthcare System

Canadians say that proper funding and management of our health care system should be our number one priority. And elections in Canada are won or lost on what the politicians say about our health care system.

According to the Health Canada website, the Canada Health Act contains nine requirements that the provinces and territories must meet in order to qualify for the full federal cash contributions. Out of these nine criteria, five are program criteria about which we hear a lot. These five criteria require that our health care:
-should be publicly administered on a non-profit basis
-should be comprehensive and must insure all insured health services
-should be universal, all insured residents of a province or territory must be entitled to the insured health services
-should be portable, residents moving from one province or territory to another must continue to be covered for insured health care services
-should be accessible, so that the residents have reasonable access to insured services

How much does it cost to run this huge enterprise?

Total health expenditures in 2000-2001 amounted to $3,174 per capita. Currently, I believe, it costs $120 billion a year to run this big enterprise.

For $120 billion a year we should have a perfect system. But we don’t. It is one of the best in the world but it is not perfect. Is it ever going to be perfect? Definitely not. Nothing is perfect.

So, what ails our health care system? Why it cannot be perfect?

Waiting times are too long – but what does it mean? Nobody has defined this issue yet! Drugs are too expensive – but is there a reasonable plan to curtail the cost? Emergency departments are too crowded. So, how can we fix this? Do we need more ER doctors or nurses or more ER departments? Nobody has figured it out yet.

There is shortage of doctors and nurses and other health care providers but no plans to immediately provide a remedy. There are 4000 international medical graduates who are looking for work. They are allowed to come into this country but there are no plans to absorb them into our system. We cannot use their skills and education. They serve this country by delivering pizzas and driving taxis – not to mention doing other non-medical jobs.

There are inadequate Home Care services. There is shortage of medical equipment. There is shortage of acute and long term care beds.

When Paul Martin became Prime Minister, he promised to fix the health care system for a generation. He called the First Ministers conference and offered them some money – $41.3 billion in new federal funding over 10 years.

Is this going to fix the problems for a generation?

Of course not. Nothing is ever fixed permanently. You have to keep working at it. Our health care system is like a big jigsaw puzzle – you have to have all the pieces in place for the system to work properly. Unfortunately, some pieces are bigger than others so all the pieces will never be in place at the same time.

What do the Canadians think? They are torn between reality and perception. “They say the system is crumbling but are largely happy with their experiences when they use it,” says an editorial in the Medical Post.

Finally, the health care system will never be a perfect system as long as the provinces and the federal government play politics with it.

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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Vioxx Withdrawal

Vioxx is off the shelves and off the medicine cabinets. In five years, Vioxx took a dive from being a super drug for arthritis and acute pain to the dust bin.

It was a made in Canada drug. Last year, 3.4 million prescriptions were filled by Canadians, and 84 million people swallowed the pill around the world. Worldwide sales of Vioxx in 2003 were $2.5 billion.

Soon after the withdrawal of Vioxx, the stock price of Merck and Co., a U.S.-based pharmaceutical giant, the world’s second-largest drug maker, fell $12.07, or 26.8 per cent, to close at an eight-year low of $33 in New York.

The company’s legal problems continue to grow as it was hit with class-action lawsuits in Canada and USA.

So, why all the fuss about Vioxx?

It is simple. It is a good drug for arthritis and acute pain but it is not good for the heart. And here is how they found out.

A study was designed to evaluate the efficacy of Vioxx 25 mg. in preventing recurrence of colon and rectal polyps in patients with a history of colon and rectal adenomas (pre-malignant polyps).

The study, involving 2,600 patients between the ages of 40 and 96, was to have lasted three years. But last week, just 18 months into the research, the company learned the risk of heart attack and stroke was double in patients taking Vioxx and halted the trial.

This information was not new to the company. Previous studies had created a suspicion that Vioxx might be bad for the heart. The question is: Why did it take so long for the company to come to grips with the situation? Is there something wrong with the regulations, the way new drugs are brought into market?

Two weeks ago, we discussed in this column, the side-effects and dangers of using non-steroidal anti-inflammatory medications (NSAIDS). The column can be read again on my website: www.nbharwani.com. These drugs are used to treat arthritis but do increase the risk of ulcers or bleeding in the stomach in the long term. Vioxx comparatively had fewer gastrointestinal complications.

The drug had become very popular. Some doctors have even prescribed Vioxx to young girls to treat menstrual cramps although it is not approved for use in children.

Why does Vioxx increase the risk of heart problems?

The answer is not clear. It probably raises the blood pressure. Now the tables have turned. At this time, I presume, the blood pressure of the CEO of Merck and Co. must be fairly high.

What happens now?

Arthritis affects millions of Canadians and they are all looking for pain relief. Nobody likes pain. Especially, if it is painful to move and walk. There are many drugs in the market for arthritis. Your physician will have to carefully evaluate your situation and advise you accordingly. Do not make any drastic or sudden changes in your medications until you have discussed the situation with your doctor.

Thought for the week:
“I joined a health club last year, spent about 400 bucks. Haven’t lost a pound yet. Apparently, you have to go there.”

E-mail from a friend.

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