Miscellaneous Health Topics

Some items of interest from the world of medicine:

1. Infant Homicide:

Infanticide (killing of a child in the first year of life) is the subject of a special article in a recent issue of The New England Journal of Medicine. The timing of the deaths, potential risk factors and prevention are discussed.

In Europe, in the early 1800s, up to a third of live-born infants were killed or abandoned by their parents. In the U.S., between 1983 and 1991, 2776 cases of infanticides are identified by the authors. The problem has not disappeared.

Studies have shown that homicide during the first week of life is usually committed by the mother. After that age, the culprit is usually a male, often the father or stepfather of the victim. In children three years and older, the perpetrator is usually unrelated to the victim.

On Friday, Nov 20th, The Medicine Hat News reported that three people in Salt Lake City are accused of murdering a three year old child-one of the accused being the child’s mother from Alberta.

So, what are the risk factors? Usually, the mother is young, has been pregnant before, has low level of education and gets late prenatal care. The infant has low birth weight, usually is a male who arrives earlier than due date.

How can we prevent infanticide? The authors of the special article feel that “…the identification of risk factors and interventions must take place during pregnancy, at the time of delivery, and in the immediate postpartum period.”

Studies have shown that child abuse can be reduced by home visits from trained nurses during pregnancy and in the first two years of life of a first-born child of an unmarried mother with low socio-economic status.

2. Do Rich People Live Longer?:

A U.S. study, on the above subject, is discussed in an editorial in one of the recent issues of the Annals of the Royal College of Physicians and Surgeons of Canada.

The study confirms the long held belief that the rich do live longer than the poor. But, this has nothing to do with the life style of the affluent. In fact, in U.S., the authors of the study found that the major factor for high death rate amongst the poor is due to inadequate access to timely and high quality health care.

3. What women don’t know could kill them:

This is the title of an article in a recent issue of The Canadian Medical Association Journal.

Most of us know that heart and blood vessel diseases are number one killer. Women make up 40 percent of these deaths. But, a recent Heart and Stroke Foundation survey shows that only 17 percent of the Canadian women are aware of this.

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Pancreatic Cancer

“Doc, few days ago, my neighbor’s wife, Yazmin, died of pancreatic cancer at the age of 59. Her husband, Yusuf, is devastated. He feels guilty. He thinks he could have done more to save her.”

Dave looks upset. I know when something is bothering him because normally he would say: What’s up doc? Busy today?

“Dave, here is some information which may help.”

Pancreatic cancer is the fifth leading cause of cancer death in North America. In 1992, 214 Albertans died of the disease (males 114, females 100). In 1993, 216 new cases were diagnosed in this province (males 98, females 118).

The prognosis is dismal. The overall 5 year survival rate is less than 2 percent, the worst of any cancer. Only 20 percent of the patients will be diagnosed at stage where surgery may offer hope.

The surgery is extensive with significant complications. Even those who survive the ordeal, the 5 year prognosis may not be better than 25 percent.

“Doc, why is it difficult to make an early diagnoses?”

Two main reasons: first, the pancreas is a long, narrow, transverse, deep seated organ behind the stomach in the upper abdomen; second, the initial symptoms are none or very vague. By the time ultrasound or CAT scan picks it up, it is too late.

Dave is surprised to hear that. He tells me about the difficulties Yusuf and Yazmin have overcome over the past 25 years. They had arrived penniless as refugees from Uganda with six children: the youngest, triplets, were about a year old.

Yusuf is a good watch repairer. After moving from few unsatisfactory jobs, he opened his own business: a jewelry shop. Yazmin did the “salesmanship” and Yusuf repaired watches. They were happy.

As parents, they had their share of problems raising children. Their oldest daughter has multiple sclerosis. Now, Yusuf has to deal with the tragedy of losing his wife.

Dave was almost in tears. “Doc, what causes pancreatic cancer?”

The precise cause is unknown. Smoking and chronic inflammation are suspected in the causation of the disease. An estimated 5-10 percent of pancreatic cancers are inherited and additional 10-20 percent may have other significant genetic influence (Current Oncology-July 1998).

“Doc, thanks for listening. I will go and see Yusuf. See if I can help him with the information I have.”

Good luck, Dave.

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)

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Miscellaneous Health Topics

Some items of interest from the world of medicine:

1. Screening: what does it mean?

Physicians’ opinions differ on the meaning of the word “screening”. One definition used in the Canadian Medical Association Journal (Oct, 20 1998) is: “Screening for disease control can be defined as the examination of asymptomatic people in order to classify them likely, or unlikely, to have the disease that is the object of screening.”

Screening is recommended for variety of diseases-malignant and non-malignant. This is based on the premise that benefit will follow if an asymptomatic person undergoes a particular test.

2. Violence against health care workers:

There is a growing trend toward violence in society at large, says Barbara Sibbald, in an article in the Canadian Medical Association Journal (Oct, 20 1998). She is an Associate Editor of the Journal.

Statistics Canada data indicate that the number of violent crimes committed annually per 100 000 Canadians increased from 865 to 1037 between 1988 and 1994.

The figures from BC Workers’ Compensation claims resulting from workplace violence indicates that BC nurses now face the same risk of workplace violence as police officers – nearly 4 times the incidence of any other profession.

Health care workers in psychiatry and emergency medicine are more exposed to violence in a hospital setting. Danger can follow physicians outside the institutions they work in. Some of the reasons given are: cutbacks in the health system, political differences and/or ideological motivation.

3.Death from recreational activities:

Drowning is the leading cause of death related to recreational activities in Canada and is exceeded only by motor vehicle crashes and drug overdose as the cause of death among young adult men, says the Canadian Medical Association Journal (Aug, 11 1998).

Nearly 40 percent of all drowning result from boating accidents, and most of these involve motorized boats used for fishing and power-boating. High use of alcohol and low use of personal flotation device is the 2 main reasons for the boating related deaths.

4. A pill for every ill?

A recent Statistics Canada survey found that 10 percent of seniors had taken 5 or more drugs during the 2 days immediately before they were surveyed (Canadian Medical Association Journal, Aug, 11 1998).

That numbers rose to 13 percent among respondents aged seventy five or older. A full 10 percent higher than for the population as a whole.

The 1994-95 National Population Health Survey found that pain relievers, high blood pressure and heart pills, water pills (diuretics), stomach remedies and laxatives were the most common prescription and nonprescription medications taken by seniors.

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Rectal Bleeding and Hemorrhoids

“Hello doctor, I am Maggie, Susan’s mother. I have been passing blood in my stool. Do you think it is hemorrhoids? Dave and Susan think it could be cancer.”

Maggie is sixty seven. She has been bleeding rectally for the last two years. Over-the-counter medications for local application have not helped. Has she got colon or rectal (colorectal) cancer?

Colorectal cancer affects men and women equally. It is the fourth most common cancer site. It is the second leading cause of cancer deaths in men and women combined ( A Snapshot of Cancer in Alberta-1996).

Do we know what causes colorectal cancer? No. If we did then prevention and cure would be easy. But we do know the risk factors.

Like breast cancer, age is a significant factor. Before the age of forty, the incidence is pretty low. But by the age of fifty, the risk begins to increase dramatically.

What about lifestyle and nutrition?

Studies have shown that death from colorectal cancer can decrease with increased intake of fiber, fruits, and vegetables. Decrease in fat intake also helps.

Increased physical activity, aspirin and avoiding cigarette smoking may be beneficial.

Heredity and genetics is now recognized as a risk factor for this disease. Studies have shown that if there is a family history of colorectal cancer in a parent or a sibling , then a person’s lifetime risk of colorectal cancer jumps from 1.8 fold to 8.0 fold.

Previous history of colorectal cancer or polyps, inflammatory bowel disease and exposure to radiation are other significant risk factors.

With this information in the back of my mind, I take a full history from Maggie and do a thorough physical examination.

The physical examination is normal. A digital rectal examination reveals no suspicious lumps. A proctosigmoidoscopy ( a hollow tube with a light at one end to examine the rectum) shows internal hemorrhoids but no lumps to suggest a new growth of tissue.

Although Maggie has internal hemorrhoids, there are about fifty percent chances that the blood could be coming from higher up in the colon. This may or may not be due to cancer. But she requires further investigation like colonoscopy.

Examination of the entire colon by colonoscopy (a thin, flexible tube made of fibers that transmit light) is the most important test for looking, taking biopsies and when possible, removing growths. Maggie agrees to have the test done as soon as possible.

Maggie has to take laxatives to clean the colon completely of waste products the day before the procedure. The test is done at the hospital as day surgery and under sedation.

A polyp (new growth of tissue) is discovered and removed during colonoscopy. This is sent to the lab for testing to see if it is benign or malignant. In the meantime, she makes an appointment to see me in the office for the results.

Susan accompanies Maggie to make sure her Mom understands the results and its implications. Susan also wants to know how the findings will affect her (Susan’s) health in the future.

“Maggie, I have good news for you. The polyp is benign in nature but it’s a type which can come back and turn into cancer if not picked up early and removed.”

“Dr. B, thank you for the good news. Now I have the same old question for you. How can my mom and I stay one step ahead of the game?” Susan asks with a sense of relief.

Eat less fat. Eat more fiber-containing foods. Have a digital rectal examination and annual stool test for hidden blood and colonoscopy every 3 to 5 years. Report to your doctor earlier if there is any change in bowel habit.

Maggie and Susan are happy that this is all over. As they leave the examination room, I overheard Maggie say to Susan, “I hope now you will listen to your mother and start eating bran flakes cereal in the morning!”

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)

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