Posts

Posted on

Islam

Depending on the moon’s visibility this week, 1.3 billion Muslims all over the world will be celebrating the end of the holy month of Ramadan. This celebration, “festival of breaking fast”, is called Id or Id al-Fitr.

Ramadan falls in the ninth month of the Muslim lunar year. All Muslims are expected to fast from dawn to dusk, refrain from drinking, smoking and sexual intercourse. Those who are sick, travelers, pregnant women, nursing mothers, and young children are exempted.

The aim of this self-discipline is to remind and reinforce among all Muslims their commitment to the legacy and teachings of prophet Mohamed. It also helps them understand and connect with their fellow human beings, and ultimately connect with God.

Islam, the religion of all Muslims, was revealed to Prophet Mohamed in Arabia in the 7th century AD. Islam is an Arabic word which means “surrender”. A Muslim accepts to surrender to the will of Allah – Arabic for God.

The will of God (Allah) was revealed to his messenger, Mohamed, and documented in the holy book called Quran (Koran). Ramadan marks the first time the Quran was revealed to prophet Mohamed. Mohamed was the last messenger and prophet of God after Adam, Noah, Jesus and others.

Historians consider the religion of Islam as one of the outstanding phenomenon of history. But Islam has no central authority (like Vatican) to guide its followers. And there are numerous divisions and subdivisions that interpret Quran in many different ways.

All Muslims observe the five pillars of religion. These are: recital of the Creed (There is no God but God, and Mohamed is the Prophet of God), prayer, fasting, almsgiving and pilgrimage to Mecca.

Prophet Mohamed had two sources of authority, one religious and other secular.

After the death of the prophet, two streams of thoughts split Muslims into Sunnis (the majority) and Shias (means a stream). Sunnis believe that Mohamed did not appoint a successor to take over the religious authority. So it was left to the Faithful to interpret the Quran.

The Shias believe that after the prophet’s death, Divine power was transferred to Hazrat Ali, prophet’s son-in-law, as the first Imam or spiritual chief of the devout. Shias followed the guidance of hereditary Imams. Some time they failed to agree who the rightful Imam was, resulting in further subdivisions.

In Islam, there are no priests or monks. There is no confession of sins except to God. Cleanliness and personal hygiene is important. Prayer is a daily necessity. Wars are condemned because Islam is a religion of peace.

If so, then why are Muslims constantly linked to violence and terrorism in the media and in the minds of some non-Muslims?

Is violence and terrorism a disease infecting a segment of the Islamic world or all of 1.3 billions of them? Or is it part of our culture – Muslim and non-Muslim?

If violence and terrorism is a disease then experts all over the world should listen to the symptoms, examine the signs, do investigations, come to a diagnosis and have a treatment plan. In medicine, if a cause is known then prevention and treatment is easy.

The Islamic world is in turmoil. The legacy of prophet Mohamed is being challenged by Muslims and non-Muslims. The various interpretations of the Quran are tearing the religion apart. Who is going to save Islam?

Happy Id and may peace be with you, Amen.

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

Posted on

Celiac Disease

A reader wants to know about celiac disease. Celiac disease is also known as celiac sprue.

Celiac means abdominal cavity. Celiac disease mainly affects the small intestine which is in the abdominal cavity. Very rarely it can affect stomach, colon or rectum.

Sprue is a chronic disorder that occurs in tropical and nontropical forms. It can affect children and adults. It is a condition in which nutrients are not absorbed. Symptoms of sprue include foul-smelling diarrhea and loss of weight.

Celiac sprue is due to gluten sensitivity of the small intestine. Gluten is a mixture of plant proteins occurring in cereal grains, chiefly corn and wheat, used as an adhesive and as a flour substitute. Gluten is a complex and variable mixture of glutin or gliadin, vegetable fibrin, vegetable casein, oily material, and others.

Gliadin is any of several simple proteins derived from rye or wheat gluten. It is capable of inducing a toxic response among individuals who lack the enzyme necessary for its digestion. Gliadin is vegetable glue or gelatin

Celiac sprue has been described since the first century A.D. But it was in 1940s, when a link to gluten was established by a Dutch pediatrician. He observed that children with celiac disease improved during the food shortages of the World War ll. But the symptoms recurred when the cereal supplies were restored, says an article in the New England Journal of Medicine (NEJM).

Symptoms of celiac sprue in children appear when cereal is introduced in their diet, anywhere between the ages of four to 24 months. They present with diarrhea, impaired growth and abdominal distension. Vomiting, anemia and swelling of the body tissues with fluid occur due to malnutrition.

Celiac sprue can develop in adults as new cases. The NEJM article says that 20 per cent of the patients may be diagnosed after the age of 60. Otherwise, most adults with celiac disease will have history of the disease going back to childhood.

NEJM article says that iron-deficiency anemia is now the most common clinical presentation in adults with celiac sprue. And approximately 50 per cent of adult patients do not have clinically significant diarrhea.

There are several immunological blood tests available to make a diagnosis of celiac disease. But the only confirmatory test is small bowel biopsy. Usually from second or third part of the duodenum during gastroscopy.

A person should not be prescribed gluten free diet until the biopsy has confirmed the diagnoses. Abnormality in small bowel disappears once the person strictly follows gluten free diet. So biopsy first is mandatory.

What are the dietary guidelines for patients with celiac disease? The NEJM article advises as follows:

1. Avoid all foods containing wheat, rye, and barley gluten.
2. Avoid all foods containing oats and lactose (at least initially).
3. Use only rice, corn, maize, buckwheat, potato, soybean, or tapioca flours, meals or starches.
4. Look for foods that have the gluten-free symbol.
5. Try foods containing wheat starch from which gluten has been removed.
6. Read all labels and study the ingredients of processed foods.
7. Beware of gluten in medications, food additives, emulsifiers, and stabilizers.
8. Avoid all beers, lager, ales, and stouts.
9. Wine, liqueurs, most ciders, and other spirits, including whiskey and brandy, are allowed.
10. Take essential medications through other routes than mouth if malabsorption is severe.

Once celiac is diagnosed, it is prudent to stay on a life-long gluten-free diet. It is not easy but the alternatives are worse – development of cancer of the small bowel and other complications related malnutrition.

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

Posted on

Quick Q & A with The Medical Post

The Medical Post November 19, 2002

Quick Q & A with Dr. Noorali Bharwani – a general surgeon in Medicine Hat, Alta.

What is your least favourite medical procedure that you regularly perform?
Not a medical procedure but part of it: filling insurance forms.

What book are you reading?
Jacalyn Duffin’s History of Medicine: A Scandalously Short Introduction.

What illness do you most fear getting?
Hepatitis or AIDS.

What do you think is the most exciting field of science at the moment?
Medical genetics.

What is the least enjoyable job you’ve ever had?
Working as a stock boy at a supermarket in London, England, while waiting for my General Medical Council registration.

What do you do when you need to clear your mind?
Watch a comedy show, go on a treadmill or meditate.

What is the best piece of advice you’ve ever been given?
“Be an optimist but have plan B ready.”

What is your greatest fear?
To die before my children enter university.

What vice do you have that you hide from patients?
My short fuse – if that is a vice!

What is your biggest extravagance?
My office building.

What talent do you envy in others?
Singing.

What is your favourite meal?
My wife’s vegetable soup.

What do you say to someone who says “doctors have it made”?
Try going through a medical school and residency program, then come and talk to me.

What do you think is the greatest political danger to the medical profession?
Politicians do not understand that medicine is an imperfect science with many promises and expectations which cannot be satisfactorily delivered without adequate funding, manpower, equipment and infrastructure.

What’s your junk-food weakness?
Chocolate chip peanut butter cookies from Tim Hortons! Our hospital Tim Hortons is out of bounds for me, so I am going through withdrawal symptoms.

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

Posted on

Nipple Discharge

“The secretion of fluid from the nipple of a newborn baby or any mature woman is not unusual, nor is it a sign of breast pathology,” says a textbook, Breast Diseases.

Nipple discharge is not an uncommon complaint. At one breast clinic, using a special suction device, researchers were able to demonstrate nipple secretion in 83 per cent of the consecutive breasts examined.

Statistically, only five percent of the patients with breast problems present with nipple discharge. But it is the third most common complaint after breast lumps and pain. Breast lumps – with or without pain – account for 70 to 80 per cent of complaints.

What information a physician wants when a patient presents with nipple discharge?

1. Is it spontaneous or elicited? If it is elicited then probably it is benign. To be significant, nipple discharge should be true, spontaneous, persistent and non-lactational.

2. Is it from one nipple or both nipples? If it is from both nipples then the chances of serious pathology is small.

3. Is it from one duct or multiple ducts? Discharge from one duct is of more concern than from multiple ducts.

4. What is the color and consistency of the discharge? If it is milky (galactorrhea), multicolored and sticky, or pus then it is probably benign. Pus needs to be drained and infection taken care of. Galactorrhea should be investigated for a pituitary tumor. A multicolored and sticky secretion is usually due to dilated ducts (duct ectasia) near the nipple.

5. Is the discharge surgically significant? Yes, if it is clear (watery), serous (yellowish), pink (blood stained) or bloody. It may indicate presence of a polyp in a duct, fibrocystic changes, pre-cancerous changes or cancer.

What about investigations?

A smear from the discharge can be sent for microscopic examination to see if there are any cancer cells. But it is not a very reliable test in this type of situation. A mammogram may or may not pick up a lump. Special x-ray of the nipple with dye in the duct (ductogram) can be helpful if it picks up a lump.

So, how do we know if the discharge is due to cancer? Quite often one can never be sure. But certain signs and symptoms may suggest presence of cancer in the breast if:
-the discharge is watery, serous, pink, or bloody
-it is accompanied by a lump
-it is from one nipple
-it is from one duct
-if mammogram is abnormal
-and if a woman is over 50 years of age.

In one series of 249 patients with nipple discharge, only four per cent of the patients had cancer of the breast. Nipple discharge due to cancer is not that common – but one can never know until appropriate investigations, including surgical biopsy, says there is no cancer.

What is the surgical management?

Most surgeons will recommend breast biopsy for all women with persistent spontaneous single duct nipple discharge, whether it is serous or bloody. However there are exceptions, in pregnant women and women on birth control pill usually secretion is not pathological.

Spontaneous multiple duct nipple discharge may occur in several benign conditions. Surgery is usually recommended to relieve profuse discharge.

Although nipple discharge is often due to benign conditions, it should not be ignored. Appropriate consultation and investigation should be undertaken to make sure a serious pathology is not missed.

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