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Money, Health, Happiness

“They’ve bought the BMW, and they have the $3 million Mill Valley house. And they still wake up in the morning and say, ‘I don’t feel good about myself’,” says Stephen Goldbart, psychologist and cofounder of the Money, Meaning and Choices Institute, highlighting the perils of Sudden Wealth Syndrome.

So, how about you? How do you feel each morning? Do you feel good about yourself?

“Plan for a better you in 2002” was the title given to my column on December 27, 2001. This was about New Year’s resolutions. Many of us promised to make changes in our lives so we can feel good about ourselves. Six months have gone by. What have we achieved? Are we better off today than six months ago?

There are many barriers to making a positive change in life. Some of these are:

-Failure on our part to accept that change is required.
-Failure on our part to have a strong will power to work toward that change.
-Failure on our part to find time to make the required change.

But if you have set certain goals in your mind then such barriers are only there to test your determination. Henry Ford says, “Obstacles are those frightful things you see when you take your eyes off your goal.”

The goal should be a reasonable one knowing your own strength and limitations. Rome was not built in a day. And you cannot make all the changes overnight. But six months is a good time to review the progress.

Review involves asking two questions:

-What is important in my life?
-What stops me from living my life on the basis of those important things?

“The aim of a life review is to step back and look at it as a whole, identify any problems, and consider what changes are needed to make it more fulfilling and pleasurable”, says an article in the New England Journal of Medicine (NEJM).

The article says that we play many roles in our lives. To balance these different roles is a real challenge. Lack of balance is one of the most frequent problems people face in their lives.

How can we find balance in life?

By simplifying life!

It’s all about choice and making sacrifices. We just have to learn to choose how we live our lives instead of letting life make all the choices for us. If we don’t, then we’ll have to face the grim reality – in trying to have everything all the time, it may just end up killing us!

So where do you stand with your New Year’s resolutions? Do you feel good about yourself each morning – with or without a BMW? Have you made the right choices? Have you found a right balance in your life? Have you begun to simplify your life? Is greed dominating your agenda?

A Chinese proverb says, “Love is blind and greed insatiable”. So make the right choices. Don’t worry and be happy! And if you want to know – that’s exactly what I plan to do – without a BMW!

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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My Father, Hussein

Next Sunday is Father’s Day. It’s a day to appreciate our fathers. A father is appreciated for many things. For his sacrifices. For teaching his children the right stuff. For preparing them to survive the constant danger they face everyday. And for being there when he is needed.

With close to 50 percent divorce rate, with wars, uprisings and terrorism, with famine and floods, through illness and accident, there are so many children in the world who have been deprived of their fathers. For them this day becomes even more special – to ask why life is unfair and what can we do to make this world a better place to live.

My father, Hussein, died on February 4th; 1991 in Calgary. He was 79 years old. He died the way he wanted to go – suddenly. He had a heart attack.

Hussein had a fair share of ups and downs in his life. Let me share with you Hussein’s journey through four continents in search of safety, security, prosperity and happiness for his family.

Hussein was born in Gujarat, India. He joined the work force at an early age of 13 when, in 1924, he came to Tanzania (then Tanganyika) from India with his older brother. His father’s business in India had failed, the local economy was bad, and the family needed financial help. So Hussein (after finishing grade four) embarked on a voyage of adventure to find work in Africa.

It took him almost a month by boat (across the Indian Ocean) and by rail (across East Africa) to arrive in Bukoba, on the shores of Lake Victoria, Tanzania. For eight years, Hussein and his brother ran a business in Bukoba and sent money to their father so he could support the rest of the family.

At the age of 21, Hussein went back to India to look for a bride. He married Sikina. Hussein stayed two years in Gujarat and their first child, Gulshan, was born. Sikina stayed back to look after Gulshan and the in-laws, and Hussein went back to Tanzania. This time he went to Musoma, another small town on the shores of Lake Victoria. He found a job, and Sikina and Gulshan joined him two years later when Hussein had saved enough money to get them over.

He was becoming restless again and wanted to start his own business. He did this in Kinesi, another small town across the river from Musoma. After five years in Kinesi, Hussein moved back to Musoma to continue expanding his business. Hussein’s family was growing in number (four girls and four boys). With the family manpower he had, at one time Hussein was running three shops in a fairly small town.

Life as a businessman was not always rosy. There were ups and downs. After 25 years in Musoma, he made another move to a bigger town (Mwanza) on Lake Victoria. Mwanza had a high school and it was good for his children. Perhaps Hussein’s best legacy was to encourage and support his children to seek more knowledge and strive for university education. For a man who had only grade four education, Hussein knew the value of higher learning – security.

Then came the era of Idi Amin and his terror in Uganda. In 1972, after 15 years in Mwanza, Hussein had to move again. First to England (three years) and then to Canada. Hussein and Sikina settled in Calgary.

As Hussein got older, he suffered from several health problems. He had heart disease for 20 years and was in pain with Rheumatoid arthritis. But he was a very strong, handsome, tall man. His appearance defied his internal sufferings.

He feared no one but God, and lived a very clean, sensible life. He believed in caring, loving and giving. He was a tower of strength to his family. He had no unfinished business left when he was summoned to his last journey on February 4th; 1991. He knew he had fulfilled all his obligations as a father. At the end he was a satisfied man. At peace with himself. A job well done!

May his soul rest in eternal peace! Amen!

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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Stomach Bacteria (H.pylori)

Helicobacter pylori (H pylori) is an organism found in stomach. It is estimated that more than half the world’s population is infected with this bacteria. That includes 20 to 40 percent of Canadians.

Usually, infected individuals have no symptoms and develop no problems as a result of this. Only 15 percent of infected individuals develop clinically significant H pylori related disease in their lifetime – stomach ulcers, gastritis and cancer.

Is this bacteria a normal inhabitant of stomach since so many people seem to carry it? Or people are infected from others? The answer is not very clear.

Since the bacteria have potential to cause illness, should we screen everybody for this bug?

Here is what a review article in the Canadian Journal of Gastroenterology says:

-Consensus conference of the Canadian Helicobacter Study Group does not recommend screening in asymptomatic individuals.

-Recommendation is to screen and treat all patients with gastric or duodenal ulcer whether they are symptomatic or asymptomatic.

-There is controversy as to whether patients with dyspepsia (indigestion) benefit from H pylori eradication. It seems that a small number (up to 15 percent) of such patients benefit from treatment.

How can we test for H pylori infection?

A blood test can tell us whether one has been exposed to the infection. If this test is negative then there is 90 percent chance that there is no infection. A positive blood test does not mean that you are currently infected. Under the age of 50, this test should be good enough depending on patient’s symptoms.

Urea breath test is superior to the blood test and is another simple way to check for infection. It has less than 10 percent false negative and false positive results. But in Medicine Hat, most patients end up getting the most expensive invasive test called gastroscopy. Why? Because the other two tests are not readily available.

What to do if infection with H pylori is detected?

The review article says that testing should not be performed to detect the presence of H pylori without an intention to treat if the test result is positive. Recently published guidelines recommend treatment of asymptomatic patients whose infection becomes known. In patients with peptic ulcer disease, eradication of H pylori infection is cost effective.

Treatment is with an acid suppressant (proton pump inhibitor) and two antibiotics for seven days. This is called triple therapy. It is almost always curative, and the infection almost never recurs in Canadian adults, but research says that eradicating the bacteria in the absence of peptic ulcer rarely fixes the problem of indigestion.

Are we smarter today than 17 years ago when the bacterium was first discovered?

In many ways, yes! Now we can cure peptic ulcer without surgery. But new studies suggest that treating this bacterium may increase the risk of esophageal ulcers and cancer. If you don’t treat it then there may be a risk of getting stomach cancer! Go figure!

Who said doctors know everything? In the last 20 years, this is one of the most important discoveries in medical science. But there are many unanswered questions.

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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Heart Burn

Heartburn is a common condition and people often ask me: Dr. B, why do I have heartburn? What can I do about it?

“Heartburn is a serious symptom that merits more attention from patients and physicians,” says an editorial in the New England Journal of Medicine (NEJM).

The editorial says that heartburn is the hallmark of reflux from stomach to esophagus, a disorder that may lead to esophagitis (inflammation of the gullet), progressing in some patients to cancer of the esophagus. The cancer is preceded by a condition called Barrett’s esophagus.

Heartburn (also known as GERD or gastro-esophageal reflux disease) is a condition in which an individual experiences a sensation of burning from the stomach to the throat. This is due to the reflux of acid, sometimes mixed with bile and food. This is accompanied by bitter taste in the throat and the mouth. Sometimes coughing spells follow the reflux as the acid spills over into the wind pipe. This may also result in pneumonia.

Normally, below the diaphragm and in the abdominal cavity, there is a functional valve at the junction of the esophagus and the stomach (gastro-esophageal junction). This valve allows saliva and food to travel one way from mouth and esophagus to stomach. When the valve becomes incompetent, stomach contents reflux into the esophagus – resulting in heartburn.

Heartburn is a very common condition. Four to nine percent adults have heartburn daily, and another 10 to 15 percent have heartburn at least once a week. That means about 20 percent of the adults have heartburn on a weekly basis.

Why does the valve become incompetent?

The valve loses its tone. The exact reason for this is not known. It may be associated with some medical condition, obesity or hiatus hernia – a condition in which gastro-esophageal junction slides between the chest and the abdomen through the opening in the diaphragm – a sliding hiatus hernia. Hiatus hernia may or may not be associated with reflux and vice versa.

How is it diagnosed?

Diagnosis is based on classical symptoms of heartburn. Difficulty swallowing food, liquids or even saliva signifies narrowing of the esophagus due to inflammation, scarring or cancer. Barium x-rays have a limited value in the assessment of esophagitis (inflammation of the esophagus) or Barrett’s esophagus. Endoscopy (gastroscopy) and biopsy is the best way to assess the lining of the esophagus for inflammation or pre-malignant Barrett’s changes.

Every person with heartburn does not require gastroscopy. The NEJM editorial says that there is no precise protocol to say when gastroscopy is warranted in patients with heartburn. The usual indication is when heartburn is severe enough to be the main symptom for which medical evaluation sought, and in patient who presents with difficult swallowing.

Heartburn can be prevented by change in life-style: lose weight, change eating habits, avoid bending or straining, sleep with head end of the bed elevated (maximum damage to the esophagus occurs at night), no smoking, no alcohol, and take appropriate medications to neutralize or reduce acid in the stomach. Surgery is also an option in patients with intractable problems or complications of reflux.

Remember, heartburn should not be ignored and must be given respect!

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