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Thyroid Disease

Dear Dr. B: I am requesting from you an article about thyroid disease whose purpose would be to educate the community on this life long illness. I have a thyroid problem. Sometimes I have been told that I am lazy, depressed, having panic attacks, jittery, weird looking etc. Is there anyway you can assist in educating the people who do not understand my problem? Yours, Ms. Frustrated

Dear Ms. Frustrated: Sure we can do something about this issue. Let me start by explaining where the thyroid gland is and what is its normal function. Then we will discuss the symptoms and signs of abnormal thyroid function.

The thyroid gland is shaped like a butterfly. It has two lobes, one on each side of the neck (resembling butterfly wings) weighing about 20g. The lobes are connected in front of the neck, below Adam’s apple, by a narrow band of tissue called isthmus (resembling body of a butterfly). When the gland is enlarged, it can be seen to move with swallowing.

What does the thyroid gland do?

The normal function of the thyroid gland is to secrete hormones which are two closely related chemical substances: T3 (triiodothyronine) and T4 (thyroxine). These hormones have multitude of functions and are vital to metabolism in adults and for normal growth and development of children. Deficiency of thyroid hormone in children leads to dwarfism and mental retardation.

Formation of normal quantities of thyroid hormone requires the availability of adequate quantities of iodine from outside sources. Given the fact that at least 1 billion individuals live in iodine-deficient areas of the world, it is not surprising that iodine-deficiency disorders (IDD), including endemic goitre and cretinism (stunted growth), are the most common thyroid-related human illnesses, indeed the most common endocrine disorders worldwide, says one textbook of endocrine diseases.

Normally iodine balance is maintained from dietary sources, i.e., food and water, but iodine may enter the body via medications, diagnostic agents, dietary supplements, and food additives, says the textbook.

The Thyroid Foundation of Canada estimates that thyroid disorders affect one in twenty Canadians and that most thyroid disorders are five to seven times more common in women.

Under-active thyroid (hypothyroidism) causes many symptoms: weight gain, lethargy, cold intolerance, menstrual irregularities, depression, constipation, dry skin etc. Overactive thyroid (hyperthyroidism) results in: palpitations, nervousness, tremor, heat intolerance, weight loss, muscular weakness and usually there is a presence of a goitre.

Diagnosis is made by history, physical signs and blood tests.

There are many causes of hypothyroidism. Anywhere from congenital development defect to acquired conditions like radiation therapy or autoimmune disease. But the cause of hyperthyroidism is not very clear.

Who is at increased risk for thyroid disease?

Women over 45, postpartum women, patients on lithium and amiodarone, patients with autoimmune diseases like type 1 diabetes, and patients with a strong family history of thyroid disease.

Ms. Frustrated, I hope this information will be of help. But as you may know, educating and changing people’s attitudes is not easy. Ignorant, prejudiced, shallow, self-centred people are hard to deal with. They get their strength by making life difficult for others. You will just have to ignore them. Try and get your strength from people who care about you. And I am sure they outnumber the shallow and the self-centred ones.

Good luck and good health!

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Doctors and Healthcare System

Dear Dr. B: Sometime ago you wrote about the shortage of doctors and other health care professionals. Is there any hope that things will improve in the near future since the Alberta Government has given doctors more money? Yours Mr. Concerned.

Dear Mr. Concerned: Unfortunately, no. To train a doctor and put him into practice takes ten to fifteen years. So it will be few years before we see some results.

The situation in Canada and Alberta continues to be critical. Here are some examples.

The Canadian Medical Association Journal (CMAJ) reports that last month was “match day” for Canada’s medical students. And the bad news is that the family residency programs in Canada for the year 2001 had 19 percent of its 476 openings unfilled.

The situation was worse for the specialized programs in family practice that are oriented towards practice in rural areas. One-third of these positions went unfilled. Recently, Alberta opened 20 new rural medicine slots. Fourteen of these 20 slots went unfilled in the first round! It seems Canada is not producing enough doctors who would be interested in family practice – once considered to be a very popular choice.

What about the specialists?

There will continue to be shortage of orthopaedic surgeons in the future. Eight of the 37 orthopaedic residency program slots remained unfilled on match day. This is the first time so many slots have gone unfilled!

Anaesthesia was the least popular program with the medical graduates five years ago. This year it has been different. There were 76 applicants for 58 spots! CMAJ says that obstetrics and gynaecology continues to be unpopular with medical graduates – twenty percent of slots remained unfilled. In psychiatry, nine of 79 slots went unfulfilled.

What are the medical graduates looking for? Perhaps a hospital-based salaried practice, more regular hours, no overhead expenses, no battles with hospitals for equipment, beds and funding, and better life-style choices.

One CMAJ headline says: Alberta investing $10 million to keep elite specialists. Who are these elite specialists?

There are about 70 specialists in Calgary and Edmonton who perform specialized procedures for province wide programs like organ transplants, neurosurgery, dialysis units etc. Over the next two years, Calgary and Edmonton health authorities will receive five million dollars each to stop these specialists going south of the border.

But what are we doing to keep specialists working in areas like Medicine Hat, Grand Prairie and Fort McMurray? Are the overworked specialists in these types of cities given incentives to have a better life-style so that they can continue to provide good service to the people of these areas?

Mr. Concerned, health care system is like a big puzzle. I doubt whether we will ever have all the pieces in place at the same time to have a perfect system. Most people in Alberta are satisfied with the care they get. Thanks to the dedication and sacrifices made by various people in the health care system.

So Mr. Concerned, this is a long answer to your short question!

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Colitis

Dear Dr. B: My doctor thinks I have “colitis”. What is colitis and how is it diagnosed and treated? Yours Miss C.

Dear Miss C: “Colitis” is a very loose term used by many people to indicate some sort of irregularity of bowel movements – especially diarrhoea. If you have diarrhoea or irregular bowel movements then you don’t have “colitis” until proven by biopsy of the lining of the colon or by some other investigation. Literally, colitis means inflammation of the colon.

There are many causes for the inflammation of the colon. One may get colitis from viral infection, bacterial infection, parasitic infection, or fungal infection. Radiation colitis occurs when the colon is “burnt” during radiation therapy to the prostate, cervix or other abdominal organs.

Certain medications can cause colitis. Use of antibiotics can kill good bugs in the colon and allow the bad bugs to thrive causing bloody diarrhoea. This is known as antibiotic associated colitis or pseudomembranous colitis.

Then there is microscopic colitis. Here there is no change in the bowel wall as seen through the naked eye but the changes are visible only microscopically. These patients have chronic diarrhoea without any blood in the stool.

Irritable bowel syndrome (IBS) is quite often called mucous colitis or spastic colitis. But there is no true inflammation of the bowel. It is basically a motility problem.

The term “colitis” is most frequently used for inflammatory bowel disease (IBD). IBD comprises of two conditions: ulcerative colitis and Crohn’s disease. Crohn’s disease can affect any part of the gastro-intestinal tract – from mouth to anus. But most common site is the small intestine where it joins the colon. Colon is the second most common site and it is called Crohn’s colitis. Crohn’s can be at more than one site.

Ulcerative colitis is disease of the colon only and does not affect the rest of the gastro-intestinal tract. It is associated with bloody diarrhoea. Crohn’s and ulcerative colitis can have systemic effects and can affect the joints (arthritis), eyes, skin, bile ducts etc. Ulcerative colitis is a pre-malignant condition. That means that it may turn into cancer. If ulcerative colitis is present for eight years then the risk of cancer increases and the colon needs to be checked on regular basis. If there is evidence to suggest that colitis is turning into cancer then the colon needs to be removed.

On the other hand, Crohn’s does not require same sort of surveillance but the incidence of cancer of the gastro-intestinal tract is increased in patients with Crohn’s. IBD can run in the families. In Crohn’s, there is diarrhoea, which may or may not be bloody. There may be lump in the abdomen. Abdominal pain is more severe than in ulcerative colitis. Sometimes it is difficult to differentiate from irritable bowel syndrome.

Diagnosis of “colitis” is based on history and physical findings. Stools are cultured for growth of bacteria or parasites. Colon is checked by way of barium enema and flexible sigmoidoscopy (a 60 cm. flexible instrument to check the distal colon and rectum), an office procedure or colonoscopy (a longer flexible instrument) under sedation in the hospital.

Treatment depends on the type of “colitis”. As far as IBD is concerned, the medical treatment for ulcerative colitis and Crohn’s disease is the same. But the surgical management varies. And there are many variables when it comes to surgical management of Crohn’s disease.

So we have to be careful before we use the term “colitis”. It is better to give it a proper name. Miss C, you should talk to your doctor and he will give you more details. I hope the information provided here will be of some help.

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Simplifying Life

Dear Dr. B: I feel trapped. I belong to the “sandwich generation”. I am worried about my parents’ health and my own health. I am worried about my business, my colleagues, my partners and my customers. I am trying to make enough money to give my family and myself a decent lifestyle but I don’t have enough time to spend with my young family. I am stressed, anxious and sometimes depressed. How can I deal with the situation? Yours Mr. SAD

Dear Mr. SAD: I presume SAD stands for stressed, anxious, and depressed. The concerns you share with us are not uncommon. These days it is difficult to have a decent lifestyle without all the members of the family chipping in. Therefore, what you are going through is a normal “cycle of life”. Most people in their forties and fifties are going through the same scenario.

But there is something you can do about it without ending up in the emergency room of your nearest hospital.

Let us put a positive spin to your problems. For example, parents can provide lot of wisdom and strength in difficult situations. I am sure once in awhile you do spend some time with them and talk about your problems. You will be surprised how they can make you feel better. They probably went through the same sort of problems in their own lifetime. But if they are not in good health and are unable help emotionally then that is understandable.

In any case, your current struggle is to find balance and equilibrium in life. You can achieve that as long as you are mentally strong and are ready to make sacrifices. Most of us complain about difficulties of life but have no will power or strong desire to do anything about it. And remember to make changes gradually. Do not shock your yourself or your environment with hasty decisions.

There are numerous books written on this subject. But the simplest and the best article I have read on the subject was printed in the Stratford Beacon Herald and reprinted on the editorial page of The Medicine Hat News on Wednesday, February 9th. 2000. It is simple and makes lot of sense. My prescription is to find this article and read it twice a day and follow its advice.

Here are few paragraphs from the article:

“How do we beat stress and keep its deadly side effects at bay? Probably one of the first (and maybe only) things we should do is to begin to simplify our lives.

It’s all about choice. We can choose never to say “no” to our bosses when asked to work late or take on extra projects. We can choose to work at jobs that keep us away from our families, but pay us well enough to afford the house with the three-car garage, the sports utility vehicle and designer clothes for the kids.

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 Mr. SAD, making changes in life is not simple! If you are determined to make changes and take care of your family and yourself then make a list of things that are important to you. Sit down with your family and some trusted friends and see how you can achieve your goal.

So simplify life and make some choices. Ask yourself: can I live happily without doing some of the things I enjoy? Remember, everybody’s life will go on with or without you. But what about your own life? Will you be there when your family needs you?

Good luck, happy choices and happy times!

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