Dr. Noorali Bharwani

June 25, 2003

Power to Change

Never underestimate your power to change yourself;
never overestimate your power to change others.

-H. Jackson Brown Jr.

Its been six months since some of us made New Years resolutions. Most resolutions reflect our desire to be a better and healthier person. So, where do we stand at half way point?

Staying healthy is not easy. It is hard work which requires dedication and many sacrifices. When we talk about staying healthy, we think in terms of warding off cancer and heart disease. These are the two top killers. Death from accidents is the third one.

There are many other illnesses which take a toll on our lives. Recently, we have had few examples like SARS, West Nile virus, monkey pox, mad cow disease and others. But cancer, heart disease and accidents have been with us for decades and are not going to go away. So let us not forget about them while worrying about other illnesses.

June is heart month. The local media has done a good job to inform the public about heart disease and stroke. Darlene Neigum, from the Heart and Stroke Foundation and her band of dedicated volunteers do a great job fundraising and educating the public.

In North America, there is one death every 33 seconds due to heart disease or stroke. They account for more than 40 per cent of all deaths. More than half of all deaths due to cardiovascular disease each year occur among women. So it is not a disease affecting men only.

There are several risk factors which predispose a person to heart disease and stroke. But, unfortunately, one third of the people who have heart disease do not have the traditional risk factors.

The risk factors for heart disease and stroke are:

– High blood pressure
– High blood cholesterol
– Tobacco use
– Physical inactivity
– Poor nutrition
– Overweight
– Diabetes

Modifying risk factors over which we have control is critical both for preventing and for controlling cardiovascular disease. The risk factor over which we have no control is the family history of heart disease.

Have we made any advances in controlling this disease?

Yes, we have. In the last 30 years or so, the rate of death from stroke has been reduced by more than 50 per cent. The rate of death from cardiac causes has been reduced by more than 40 percent.

This success has been achieved because we can better manage the acute stage of heart attack and stroke by way of using clot busting drugs called thrombolytic therapy.

We have made advances in recognizing the risk factors and promoting awareness of healthy life style. And by using appropriate therapy for control of blood pressure, high cholesterol level, and control of diabetes. Use of aspirin and promoting physical activity and healthy eating has helped as well.

We may have reduced the death rates. But we have not changed the number of people who get heart attacks and stroke. And those who suffer the after effects of such illnesses. So lots more work needs to be done. By way of research and by way of changing our lifestyles.

So, is your health better off today than it was six months ago?

If yes, then be happy. And keep it up it keeps getting better.

If no, then sit down with somebody and reassess your strategy. Youre on the road to success when you realize that failure is merely a detour, says William G. Milnes, Jr.

Do not underestimate your power to change yourself. Too many of us too often worry about failure, and in so doing never really try for success (Secrets of Mind Power).

Good luck for the next six months! Then get ready for new resolutions.

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June 11, 2003

Restless Leg Syndrome

Dear Dr. B: My mother-in-law is 60 years old. She is quite healthy. But she is having cramps in her legs. From the toes to the side of her legs, inside and up to her hips. What can she do to relieve this pain?

A concerned daughter-in law sent me this question. It is not an uncommon complaint among women and some men. My own mother has had a similar complaint for many years.

So, I was quite interested in a recent issue of the New England Journal of Medicine (NEJM) which had a clinical practice article called Restless Legs Syndrome (RLS).

The article gives an example of a 45-year-old woman having had nightly insomnia for years. She reports having uncomfortable sensations in her legs when she lies down at night. She describes a feeling of needing to move her legs, which is relieved only by getting up and walking around.

This lady has RLS. It is also known as Ekbom’s syndrome. It is a neurological disorder. About three to 15 per cent of the population is affected. It is more common in women than men. The prevalence increases with age. There may be a family history of the condition.

The following features should be present to make a diagnosis of RLS:
-A distressing need or urge to move the legs, usually accompanied by an uncomfortable, deep-seated sensation in the legs that is brought on by rest (sitting or lying down), relieved with moving or walking, or worse at night or in the evening.
-Features frequently associated with the syndrome are: involuntary limb movements while patient is awake and/or periodic limb movements while patient is asleep.

The diagnosis of RLS is based on the clinical history. RLS may be a symptom of iron deficiency therefore the iron status should be assessed. No other laboratory tests are routinely indicated.

What about our readers mother-in-law?

She may have RLS but we do not know all her symptoms. There are many other conditions which cause leg pains and cramps especially at the end of the day or at night.

Some common causes are: muscle fatigue, strain, injury, or depletion of certain minerals such as potassium, calcium, sodium, and magnesium (particularly when taking diuretics). Trouble with the veins and arteries; arthritis or gout; neuropathy (nerve damage) or Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back. There may be other causes as well. Medications like steroids can induce leg pain.

The article says that despite the distinctive clinical features of RLS, there remains substantial variability in responses to treatment and in clinical progression and outcome.

It seems all patients with RLS do not present with classical symptoms. Therefore, my impression is, many patients with leg pain go undiagnosed or inadequately treated.

Is there good treatment for the condition?

For RLS, there are few medications in the market. But the NEJM article says that there is currently inadequate information on the efficacy of medications other than the group of drugs known as dopaminergic drugs. The management of RLS in patients who are pregnant or undergoing dialysis is not clear.

For unexplained leg pain, rest as much as possible. Elevate the leg and take pain medications which you are familiar with. Gentle massage may improve comfort. Heat or cool soaks may help. If pain persists or swelling develops, see your family physician.

For leg pain caused by varicose veins, leg elevation and compression with elastic bandages or support hose can help. Walking is the best way to keep the blood flowing back to the heart from the legs.

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

June 4, 2003

Skin Cancer

This column is about skin cancer about prevention and about early detection.

I am bold (and bald) enough to tell you that I have not picked this subject because my shiny scalp is devoid of bicolored locks, hence increased risk of exposure to the suns damaging ultraviolet rays, but I think skin cancer is an important subject as we get into hot weather.

For my head shave, we were able to raise over $2200 for the Canadian Cancer Society a big thank you to generous contributors who made the event satisfying and worthwhile.

Now, for $10,000 to the cancer society, I may be (I repeat, may be) tempted to get an ear ring, a nose ring and a tattoo on my scalp! A little advisory here statement like this is not to be taken seriously and there is no need to call a psychiatrist. My head is bald but it is not out of place!

Anyway, we wont discuss this any further. Lets get back to our discussion on skin cancer.

There are two important things to remember about prevention of skin cancer: cover up and stay out of the sun, says an editorial in the British Medical Journal (BMJ).

Skin cancers can be divided into two types: melanoma and non-melanoma. Non-melanoma skin cancers are: basal cell cancer and squamous cell cancer.

Experts believe that 90 per cent of non-melanoma skin cancers and two thirds of melanomas may be attributed to excessive exposure to the sun, says the BMJ.

According to Alberta Cancer Board publication (Cancer in Alberta, A Regional Picture January 2003) non-melanoma skin cancers account for approximately 30 per cent of malignant cancer cases diagnosed each year among Albertans. It says that although these tumors are malignant, they are not typically life threatening and are usually successfully treated in doctors offices.

Melanoma accounted for four percent of new invasive cancers in Alberta in year 2000. In 1993, Alberta Cancer Registry adopted a new coding system to monitor incidence of melanoma. Since 1995, melanoma rates in Alberta have remained pretty much stable. In 1999, 194 new melanoma cases were diagnosed in Alberta.

In the Palliser Health Region, on an average 13 cases of melanoma are diagnosed each year.

For Canadian males, the incidence rate for melanoma has tripled since the late 1960s. For Canadian females, the rates have varied over the years but still shows a gradual increase.

In the United Kingdom and the United States the incidence of melanoma has doubled in past 20 years.

Melanoma is by far the most serious form of skin cancer, the survival rate is very high when detected and treated early, says the Alberta Cancer Board document.

To prevent deaths from skin cancer, particularly melanoma, the public has to be educated on two strategies: advice on early recognition and advice on prevention. Australia has done well in this regard. The incidence of melanoma has been falling in that country.

Can we achieve the same results in Canada?

By way of prevention: we need to keep reminding ourselves that skin tanned by ultraviolet radiation is damaged skin which predisposes to cancer. There is a potential risk of using sunbeds. We need to avoid sunburn and generally reduce exposure to ultraviolet radiation by staying out of the midday sun, wearing protective clothing, seeking shade, and applying sunscreen.

By way of early recognition: we should have moles or sun burnt skin surgically removed if they show signs of change or non-healing. Bleeding, chronic irritation, change in color or size should warn us to have these moles removed.

The BMJ article says that despite having a good understanding of the relation between overexposure to the sun and skin cancer, 81per cent of Americans still think they look good after being in the sun. Do you feel the same way? A good tan may shorten your life.

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