Posts

Posted on

SARS

What can I write about SARS (Severe Acute Respiratory Syndrome) that has not been reported already in the media?

From my research, I found that SARS has been reported to WHO since 1999 – but it did not make big headlines until earlier this year when several countries were affected.

WHO website says that on February 13th, 1999 an outbreak of an unidentified disease was reported to have occurred in Darwaz, Badakhshan, Afghanistan.

The outbreak began after two young men returned from the village of Waram, both suffering from an acute respiratory infection. Over the next two days, approximately 40 persons living in the same household became ill.

The disease then spread through the whole village, affecting 70-80 per cent of households. The village has a population of 5400. The deaths occurred among both males and females and involved primarily infants and the elderly.

The disease was described to be flu-like and is characterized by abrupt onset of fever, headaches and muscle pain, followed by chest pain and cough. Living and sanitary conditions were crowded, and the water supply was unprotected. Nutrition was of poor quality.

WHO website does not mention any SARS cases in 2000 and 2001. Between April and December of 2002, SARS was reported from Greece, Madagascar, and the Democratic Republic of Congo.

On February 11th, 2003 WHO announced that it had received reports from the Chinese Ministry of Health of an outbreak of acute respiratory syndrome with 300 cases and 5 deaths in Guangdong Province.

On March 12th, 2003 WHO issued a global alert about cases of atypical pneumonia. The announcement said that since mid-February, WHO had been actively working to confirm reports of outbreaks of a severe form of pneumonia in Viet Nam, Hong Kong, and Guangdong province in China.

On March 15th, 2003 WHO issued emergency travel advisory. It went on to say, “During the past week, WHO has received reports of more than 150 new suspected cases of SARS, an atypical pneumonia for which cause has not yet been determined. Reports to date have been received from Canada, China, Hong Kong, Indonesia, Philippines, Singapore, Thailand, and Viet Nam.”

On March 26th, 2003 WHO stated that 1323 cases of SARS had been reported from 12 countries and that 49 people had died.

As of Tuesday, April 29th, 2003 a cumulative total of 5462 probable cases of SARS with 353 deaths have been reported from 27 countries. Except for China, most countries have been able to control the spread of this deadly disease. By the time you read this column, we hope there will be even better news.

But we should continue to be vigilant. Things to remember about SARS:

1. If you have flu like symptoms, with fever of more than 38 degrees Celsius, then report to your doctor. Currently, there is no laboratory test to confirm the diagnoses.

2. The cause of SARS is not certain, there is a strong indication that it is linked to the coronavirus, with the possibility that other factors also contribute.

3. The primary way that SARS appears to spread is by close person-to-person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS.

4. The incubation period for SARS is typically two to seven days; however, isolated reports have suggested an incubation period as long as 10 days. . The first cases of SARS identified in Canada are people who had traveled to Hong Kong. Subsequent cases have been in their close contacts and travelers to Asia.

5. Practicing good personal hygiene is a key to stopping the spread of this disease. Thorough hand-washing with a disinfectant or using hot, soapy water and lathering for at least 20 seconds. This is because disease-causing micro-organisms can frequently be found on the hands.

6. Masks are not recommended for use by the general public. The only exception would be a person having come into close contact with a SARS-affected individual.

7. Where can you find up-to-date information on SARS?
Health Canada Web site: http://www.sars.gc.ca and World Health Organization’s web site for current figures: http://www.who.int/csr/don/en/. Information for the public: 1-800-454-8302.

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

Posted on

Aspirin

Recently, I saw a 36 year old man in my office with bowel problems. His first question was: Doc, should I take an aspirin a day to prevent colon cancer?

First, let us look back in history.

Hippocrates and the Indians of North America have known the pain killing properties of willow bark, which contains salicylates (aspirin is acetylsalicylic acid), for many hundred years.

Besides it being a painkiller, it also reduces inflammation and fever. Commercially, aspirin became available in 1899 as a result of a search by Felix Hoffman at Bayer Industries to help his father who suffered from rheumatoid arthritis.

By the 1960s, aspirin became the most widely used pharmaceutical product in the world. For example, in U. S. alone, the annual production of aspirin is over 15,000 tons (13,600 metric tons).

In 1985, researchers first established that aspirin can prevent heart attacks. If you have chest pain and are suffering a heart attack, then taking an aspirin will reduce your chance of dying from heart attack by 25 per cent. It also reduces the risk of a second heart attack by 50 per cent. For patients who have suffered a stroke, it offers protection from a second one.

So, what about cancer prevention?

For the last 25 years, researchers have been saying that aspirin, ibuprofen and other anti-inflammatory drugs may play a role in preventing cancer. Studies have found that it could reduce the risk of both colorectal cancer and mouth and throat cancers by two-thirds.

In one recent study, women who took a single ibuprofen tablet at least three days a week for 10years or more saw their risk of breast cancer fall by 49 per cent.

Women who regularly took aspirin saw their risk of breast cancer drop by only 28 per cent.

There is also some evidence that ibuprofen may offer more protection from Alzheimer’s disease. Canadian researchers have shown that ibuprofen may reduce the risk of getting Alzheimer’s by up to 30 per cent.

If this is all true then why physicians do not promote the use of aspirin and ibuprofen as a prophylactic for cancer prevention?

The above findings are from retrospective studies – they look back at men or women who were taking these products for other illnesses and see if they suffered from specific cancers compared to those who did not take aspirins or ibuprofens.

There are no prospective randomized double blind trials to prove that aspirin or ibuprofen is what prevents cancer. There may be other variables which may influence the outcome. Prospective randomized double blind trials eliminate those variables.

Many doctors are cautious about the idea of healthy people taking aspirin or ibuprofen in the hope of preventing disease. More studies are needed to confirm that the benefits outweigh the risks. They don’t know what dose is appropriate, or how many years the drugs must be taken before they offer protection.

These drugs are not always harmless. Internal bleeding is a serious risk. The painkillers can also interact dangerously with other drugs.

Recently, the Globe and Mail wrote, “Randall Harris, a respected professor of epidemiology at Ohio State University, didn’t follow the cautious approach when he announced the results of the breast-cancer study. Instead of recommending waiting until more studies are done, he urged women over the age of 40 to talk to their doctors about taking a standard dose of ibuprofen (200 milligrams) or aspirin (325 mg) daily.”

But there are other reports which say that taking ibuprofen may undo the protective effect of aspirin.

Are you confused? So are the doctors! But my answer to the young man is – there are many other ways of preventing cancer (remember ELMOSS?) – rather than looking for a miracle drug.

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

Posted on

Sugar, the Sweet Poison

I call sugar a sweet slow poison, a weapon of mass destruction. The difference is, we use it on our friends and families, not on our enemies.

It is reported that the North American diet contains about 20 per cent sugar. This is equivalent to 30 teaspoons a day! Most of it is hidden in pop, processed food and baked goods.

Like alcohol, sugar has no nutritional value. It has no vitamins, minerals or fiber.

North American children’s consumption of sugar per day is reported to be between 25 to 35 per cent of total calories. Is this too much? Yes. The World Health Organization recommends daily dietary sugar intake of no more than 10 per cent of total calories.

According to Encyclopedia Britannica, sugar is any of numerous sweet, colorless, water-soluble compounds present in the sap of seed plants and the milk of mammals and making up the simplest group of carbohydrates. The most common sugar is sucrose, a crystalline tabletop and industrial sweetener used in foods and beverages.

Sucrose is found in almost all plants, but it occurs at concentrations high enough for economic recovery only in sugarcane (Saccharum officinarum) and sugar beets (Beta vulgaris).

Sugarcane ranges from seven to 18 percent sugar by weight, while sugar beets are from eight to 22 percent sugar by weight.

Sugarcane, once harvested, cannot be stored because of sucrose decomposition. For this reason, cane sugar is generally produced in two stages, manufacture of raw sugar taking place in the cane-growing areas and refining into food products occurring in the sugar-consuming countries. Sugar beets, on the other hand, can be stored and are therefore generally processed in one stage into white sugar.

The Encyclopedia says that different methods of crystallization of sugar containing syrup are used to produce variety of sugars and at least six or seven stages of boiling are necessary before the molasses is exhausted.

The first three or four strikes are blended to make commercial white sugar. Special large-grain sugar (for bakery and confectionery) is boiled separately. Fine grains (sanding or fruit sugars) are usually made by sieving products of mixed grain size.

Powdered icing sugar, or confectioners’ sugar, results when white granulated sugar is finely ground, sieved, and mixed with small quantities of starch or calcium phosphate to keep it dry.

Brown sugars (light to dark) are either crystallized from a mixture of brown and yellow syrups (with caramel added for darkest color) or made by coating white crystals with brown-sugar syrup.

Beet sugar factories generally produce only white sugar from sugar beets. Brown sugars are made with the use of cane molasses as a mother liquor component or as a crystal coating.

Sugar is dangerous because it causes obesity, diabetes, hypertension and heart disease leading to sickness and death. In the last few months, couple of articles in the Medical Post summarizes the dangers of sugar:

-people have to eat more of sugar containing food to feel satisfied (thus promoting obesity and diabetes) compared to those eating food with artificial sweetener

-sugar contributes to development of high blood pressure

-men who drink sugary drinks have 46 per cent increased risk of stroke, possibly because of sugar’s blood-thickening osmotic effect or its known ability to raise cholesterol levels

-diets high in refined sugar increase the risk of developing Crohn’s disease and colorectal and pancreatic cancer

-eating sugar increases body fat rather than lean body mass. It promotes obesity without any effect on muscle mass, i.e. there is no gain in useful tissue.

Sugar tastes nice and sweet but it is a killer. Sugar in the diet should be kept to a minimum, and if drinks and snacks are consumed, they should be sweetened with artificial sweetener or should be unsweetened.

Sugar is one temptation we should do without!

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

Posted on

Hearing Loss

A reader writes: “I am a 62 year old male. I was recently diagnosed with a condition I had never heard before – sudden idiopathic sensorineural hearing loss – in my left ear involving the facial nerve that goes through the middle ear and to the brain.

It started with a ringing in the ear and then I went deaf and the right ear is super sensitive to sound. There is roaring and buzzing in the left ear. Would you be able to provide me with some information on this subject?”

I don’t have much knowledge about this condition. So, I asked our local expert, Dr. Neil Harris, a specialist in ear, nose and throat surgery to enlighten me with some details. Following is the summary of the information he sent me.

Sudden idiopathic sensorineural hearing loss is a condition which may surprise you as the name says – suddenly – like waking up one morning with a hearing loss. Or one may notice hearing loss over a few days

Fortunately, the vast majority of cases of sudden hearing loss affect only one ear, and the prognosis for some recovery of hearing is good.

There are mainly four reasons for sudden hearing loss. It may be due to viral infection in the inner ear, or loss of blood supply to that area, or rupture of cochlear membrane in the inner ear, or due to problems in the immune system.

Many cases, however, fit into the idiopathic category where the cause is not known. That is very frustrating situation when it comes to management.

In the U.S., it is estimated that five to 20 cases are reported per 100,000 persons. Many cases likely go unreported, and the incidence may be higher. A sudden hearing loss may resolve before the patient can be evaluated medically, making it unlikely for that individual to seek help.

Distribution of the condition is equal amongst males and females. Left ear is affected as frequently as the right. Sudden hearing loss in both ears occurs in approximately one to two percent of cases.

All age groups are affected by sudden hearing loss, but fewer cases are reported in children and the elderly. Young adults have incidence rates similar to those of middle-aged adults. The median age at presentation ranges from 40-54 years. The occurrence of sudden hearing loss across all age groups is an indication of the multifactorial nature of this clinical problem.

Sudden sensorineural hearing loss has been considered an emergency situation. Patient evaluation should proceed promptly and expeditiously. Early presentation to a physician and early institution of treatment improves the prognosis for hearing recovery. The immediate goal is to discover a treatable or defined cause of the sudden hearing loss.

There is no preferred treatment regimen for the condition. One textbook says that treatment can be based upon a rational approach – depending on the history, physical examination, and laboratory results. Should no definitive or treatable cause be found, the treatment regimen should be dictated by the most likely factors involved.

It is reported that 47 to 63 percent of patients recover their hearing spontaneously. These figures vary according to different studies utilizing different criteria for degrees of recovery. The true spontaneous recovery rate is unknown.

Unfortunately, existing studies have not provided answers to questions regarding the best method of treatment, prognostic factors in recovery, and the exact cause of sudden hearing loss. These are questions that require a lot of research.

In the meantime it is important that if you experience sudden hearing loss then report the situation immediately to your doctor. Let him decide how to manage the problem.

I hope this helps.

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