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My Mother, Sikina

Allow me to tell you a story of a very special, tough and courageous 84-year-old lady. Her name is Sikina. She recently spent five weeks in Foothills Hospital for removal of a 6-cm. benign brain tumour. The tumour had left her partially paralysed.

Sikina was born in India. At a very tender age of 15 she married a young handsome fellow named Hussein who was 21. At the age of 13, Hussein had gone to East Africa with his older brother to look for work. After eight years of work and making some money, he had returned to India to look for a bride. That is when he was introduced to Sikina and got married.

Hussein and Sikina lived in East Africa for many years. They had eight children. One day, in 1965, Sikina was travelling from Tanzania to Uganda when her car was involved in a head on collision with a drunk driver. She sustained life-threatening injuries to head, face, right thigh and both upper limbs. There were many broken bones.

Sikina never gave up. With Hussein at his bedside, she fought back and survived. She spent four months in a hospital in Kampala, Uganda. She came home to Tanzania walking with crutches. Another two months of physiotherapy and she was back taking care of her family.

With Idi Amin (does anybody remember him?) in Uganda, the political atmosphere in East Africa became very uncertain. So, 25 years ago, Hussein, Sikina and their children moved to Calgary.

Five years later, Sikina developed right-sided weakness. She was found to have a brain tumour close to a large blood vessel. Two neurosurgeons in Calgary felt that nothing should be done, as there was a significant risk of damaging the blood vessel during surgery.

Hussein wasn’t a man to give up easily. As Sikina’s condition worsened, Hussein insisted on another opinion. The third neurosurgeon, after considerable deliberation and consultation with his colleagues at the General Hospital, elected to do the surgery. This was in 1980. Sikina and her family were warned of the likely complications. But Sikina was ready for it, as she could not live the way she felt.

Sikina survived the six-hour surgery. She had a full recovery. Eighty percent of the tumour was removed. Luckily it was benign. Tumour close to the blood vessel was left behind.

After many years of good health, Sikina’s troubles started again. Her right leg was getting weaker. Then six weeks ago, she momentarily lost her speech and function on the right side of her body. She was thought to have a stroke and rushed to Foothills Hospital. Investigations revealed recurrence of a large tumour at the site of previous excision.

Within a week, she was back in the operating room undergoing another six hours of brain surgery. This time the recovery was slow. She was in the hospital for five weeks. But she did not give up!

Now she is home looking better and walking with a walker. Another courageous fight and a miraculous recovery! This time Hussein wasn’t there. He passed away nine years ago. But all her children and their families were there. So were the neurosurgeons, anaesthetist, geriatrician, nursing staff and physiotherapists. It was an excellent teamwork.

Sikina believes in God and miracles. But one thing stands out – Sikina’s courage. I am proud of her. She is a special lady. And she is my mother!

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Kidney Stones

Dear Dr. B: I have a granddaughter, 20 years old, who had kidney stones at age17and is still periodically in discomfort because of them. It would be helpful to know foods to avoid for possible prevention, writes Mrs. M.

Dear Mrs. M: Pain due to kidney stone is a very unpleasant experience. I have seen patients roll in pain on the floor of emergency department. The pain may last minutes or hours. After a pain killer or sometimes spontaneously the pain goes away and everything is back to normal. As if nothing had ever gone wrong!

One out of ten Canadians will have a kidney stone at some point in their life. It is more common in men than in women. It is not that common in teenagers. Usually it affects people in middle age.

The urinary system is made up of the kidneys, the ureters, the bladder, and urethra. The system’s main function is to eliminate waste products in the form of urine. The urine contains many chemicals. When the chemicals form crystals, they tend to stick together. These crystals can grow into a stone ranging in size from a grain to a golf ball. The stones cause pain when they get stuck or pass through the urinary system.

Most stones contain calcium oxalate crystals. Some are uric acid stones or cystine stones. Some people seem to be more prone to kidney stones than others. This is due to several reasons: recurrent urinary tract infections, drinking too little fluid, blockage of the urinary tract, confinement to chair or bed for prolonged periods, consuming diet rich in calcium oxalate or uric acid, too much of vitamin C or D, certain medications and metabolic illnesses.

The stone, when passed or removed, should be sent for chemical analyses. This will help in planning diet and preventive measures. About 20 percent of patients have no definite cause for stones and the best treatment for them appears to be high fluid intake. The majority of patients with kidney stones have treatable metabolic disorder that can be detected by blood and urine tests.

Certain medications can help dissolve kidney stones except the ones with calcium. Unfortunately these are the commonest type. Small ones pass spontaneously. The ones that do not pass are blasted by high energy shock waves (Lithotripsy). Stones larger than 2 cm require surgery.

How can we prevent kidney stones?

Kidney stones recur in about 50 percent of cases. Therefore it is important to take preventive measures to avoid some very painful moments and prevent permanent damage to the kidneys.

Drink plenty of water during the day and at night. Drink plenty after meals and exercise. Patients with calcium oxalate stones should avoid large amount of dairy products and foods high in oxalate content (tea or chocolate). Avoid large doses of vitamin C (4 grams or more daily) and avoid heavy use of antacids.

If you have uric acid stones then cut down on the amount of red meat you eat.

This is just an over view of preventive measures. You should see a urologist for definitive answers to a specific problem.

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Bad Breath

Dr. B, my husband had his gall bladder out in November 1999. Before and since surgery, he has had the most foul smelling breath about two to three hours after he eats. I thought once he had the surgery, this smell to his breath would disappear. He does have caps on his teeth. He has regular check-ups with his dentist and gets his teeth cleaned on a regular basis, but this smell to his breath persists. He does not seem to notice it himself, but I find it hard to talk with him at close range without getting a sniff of his foul odour. I have encouraged him to brush often, but this does not seem to dispel the odour for very long.

I would like to know what is causing this unusual odour and I would like to know what, if anything can be done to eliminate it or at least diminish it, asks a distressed Mrs. X.

Dear Mrs X: Removal of a gall bladder does not get rid of chronic bad breath. The commonest indication for removal of gall bladder (cholecystectomy) is for pain in the right upper quadrant of the abdomen due to gallstones not for bad breath.

Bad breath (halitosis) can be due to several causes. Infection in the mouth (stomatitis), gums (gingivitis), or extensive caries can give bad breath. Infection in the windpipe and the lungs, fishy odour of the breath due to liver failure, urinary odour in kidney failure, and sweet, fruity odour is typical of diabetic crisis. Infection and tumours of the oesophagus can give bad breath as well.

Occasionally, otherwise normal persons will have halitosis without obvious cause. Some who smoke heavily have halitosis. Common but harmless cause of bad breath is what we eat – garlic, onions, and high protein diet.

Most bad breath comes from something in the mouth. Food sticks between our teeth, around the gums and on our tongue. This food rots and allows bacteria to grow and thrive creating volatile sulphur compounds. The sulphur compounds give bad breath.

How can we prevent bad breath?

Brushing and flossing are two of the most crucial elements for attacking bad breath. Learn proper technique to floss and brush. Most of us spend less than one minute to brush. That is not good. We should spend atleast five minutes. Flossing is also very important in removing rotten food particles in the spaces between our teeth. As somebody has said – brushing without flossing is like washing only 70 percent of your body.

Keep your tongue clean. Scrap it with a tongue cleaner.

Avoid food and beverages that give bad breath: onions, garlic, and alcohol. Avoid tobacco products.

Avoid dry mouth by drinking water, chewing sugar-free gum and sucking on sugar-free mint. Remember alcohol, tobacco products and certain medications can make your mouth dry and result in bad breath.

Keep your dentures and removable braces clean. Have regular dental check-ups.

If you still have bad breath then see your family doctor to check for other causes.

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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Holiday in Alaska – Boats, trains and helicopters.

There’s more than one way to see beautiful Alaska – and you don’t have to stick to just one.

I had been dreaming of an Alaskan cruise for a long time. Now that our children are a little older – Alia is 10 years old and Hussein is 12 – my wife Sabiya and I felt this was the best time to make this once in a lifetime trip.

I knew I wouldn’t be the first to travel to Alaska, of course – in 1725, a Russian explorer, Vitus Bering, became the first European to set foot on Alaskan soil. Since then much has changed.

In 1867, U.S. Secretary of State William Seward purchased Alaska from Russia for two cents an acre! Critics laughed and called it foolish. But soon Alaska surprised the world with its wealth of natural resources (gold, oil, tourism, fishing and lumber).

Alaska is the largest state in the U.S. It is 2.5 times the size of Texas, with a population of only 609,300.

Our cruise on the Norwegian Wind began on a Monday evening in Vancouver.

We boarded the 50,000-ton ship with significantly less fanfare than was seen during the departure scene in the movie Titanic. From the deck, we took pictures of a breathtaking Vancouver sunset as we headed out of the harbour.

Next it was time to explore the ship, which is really more of a floating city. It had everything we’d ever want in a week!

The cabins were cleaned twice a day (including changing of towels) and there was plenty of food – certainly enough for the 2,000 passengers and 625 crew members to last for more than a week. Food services started at 6 a.m. and ended with the midnight buffet.

Nor were all of the snacks necessarily “unhealthy.” Besides fresh fruits and vegetables, there are sugarless desserts and low-calorie items on the menu.

One thing they don¼t provide is the willpower to say „no¾ to unhealthy foods!

For fitness buffs, there was a fully-equipped gym with massage therapists. Many varieties of fitness classes were offered that range from beginners to advanced levels. Sauna, spa, aerobics, yogaãyou name it and they had it. There was a basketball area, a small driving range (with lousy clubs), table tennis, two small swimming pools, two hot tubs and walking and jogging areas.

Evening was a time for laughter and fun. There were outstanding Broadway-style shows, stand-up comedians and singers. The audience participation events were especially fun.

The ship offered babysitting arrangements, children’s programs and teen activities.

For gamblers, there was daily lotto, bingo and a casino.

There were two formal evenings when we dressed up in our best clothes. There was a beauty salon, and we could even have rented a tuxedo!

But of course, the strongest draw of cruising the Inside Passage is to be on deck, enjoying the open sea, fresh air, sunshine and blue skies (if it does not rain – this is, of course, the West Coast). Evenings on deck are majestic, calm and relaxing as one watches other beautifully lit cruise ships periodically sailing by.

The ship’s first stop was Juneau, Alaska’s capital city with a population of 26,800 which is inaccessible by road. Mountains, islands, saltwater bays, forested valleys and flatlands surround it.

With the few hours we had in Juneau, we had to decide whether we should go sea kayaking, canoeing, hiking, flying over a glacier by helicopter, panning for gold, sportfishing or to a salmon bake.

Our children decided we’d go glacier trekking by helicopter. Luckily, I had my plastic card as some of the on-shore options have a separate fee. The helicopter soared over Juneau’s wild backcountry and spectacular glaciers, covering 65 miles of Alaskan wilderness and making a brief glacier landing within the massive Juneau ice field. The view was spectacular.

Our pilot/guide showed us a bit of the beauty and mystery of the area by walking us through some interesting spots which require special boots. Juneau ice field is North America’s fifth largest ice field. It covers more than 1,500 square miles of land. The ice field¼s snow and ice depth are estimated to be from 800 to more than 4,500 feet deep. Annual snowfall on the Juneau ice field exceeds 100 feet.

During the flight, we caught tantalizing glimpses of mountain goats. The goats favour the high ridges surrounding the ice field during the summer months.

Then, too quickly, it was time to board the ship again. In the next couple of days, we disembark at Skagway (population 700), Haines (population 1,200), and Ketchikan (population 8,300).

Each has its own history and beauty. But there is something special about Skagway and its 100-year-old connection to the Klondike Gold Rush.

In Skagway, for our off-ship adventure, we took a trip on the White Pass Scenic Railway and saw some of the most spectacular scenery we’d ever hope to see. The train (some train cars are straight out of the 1890s) leaves Skagway (elevation: 0) on a narrow-gauge railroad (built 1898), climbs through the coast mountains in Tongass National Forest and through mountain tunnels to the White Pass Summit (elevation: 2,865 ft).

The last of the spectacular scenery before heading back to Canada was Glacier Bay. Naturalist and adventurer John Muir is credited with discovering the bay in 1879 but it continues to remain isolated and undeveloped. We entered Glacier Bay and cruised along shorelines covered by ice. As water undermines some ice fronts, great blocks of ice break loose and crash into the water. It was a beautiful sight to cherish.

Then it was time to cruise back to Vancouver and the real world. In the end, it was an unforgettable experience.

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