Heavy Snoring Can Be A Danger Sign

Mount Kidd, Kananaskis Golf Course (Dr. Noorali Bharwani)
Mount Kidd, Kananaskis Golf Course (Dr. Noorali Bharwani)

Do you have sleep problem that leaves you chronically fatigued, sleepy and irritable?

If yes then you may have disorders like narcolepsy, snoring or sleep apnea.

Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day.

Snoring is rough rattling noise made on breathing in during sleep by vibration of the soft palate and the uvula.

Snoring is believed to occur in 30 per cent of women and over 40 per cent of men. It can be potentially serious health hazard. Many people may not think of snoring as a sign of something potentially serious, and not everyone who snores has obstructive sleep apnea.

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep.

Obstructive sleep apnea is more common form that occurs when throat muscles relax and block your airway during sleep and cause snoring. The other two are central sleep apnea and complex sleep apnea syndrome.

Obstructive sleep apnea can seriously affect your health. High blood pressure, heart attack, heart failure and stroke top the list. It can affect your heart rhythms. It can lower your blood pressure, lower your oxygen level and lead to heart attack and death.

If you are a chronic snorer and your partner observes that you make a snorting, choking or gasping sound then you have a problem.

It is time to discuss your symptoms with your doctor and get a referral to a sleep specialist. You will undergo tests to confirm the diagnosis. The tests involve overnight monitoring of your breathing and other body functions during sleep. The test is called nocturnal polysomnography.

If you have obstructive sleep apnea, your doctor may refer you to an ear, nose and throat specialist to rule out any blockage in your nose or throat. An evaluation by a cardiologist may be necessary.

How to manage obstructive sleep apnea?

Guidelines (2014) from the American College of Physicians (ACP) emphasize lifestyle modifications – especially weight loss. Though the guidelines do not offer any radical treatment updates, they do reinforce the effectiveness of tried and true therapies.

Breathing devices are still best for treating obstructive sleep apnea. Continuous positive airway pressure (CPAP) works well. It is the first line of treatment. It has to be used during sleep. It relieves symptoms but does not cure the problem.

Oral appliances are useful. They are worn only during sleep. Research shows that oral appliance therapy is an effective treatment option. But does not cure the problem.

Surgery is the last option to be used if all else fails. There are many different types of surgery for sleep apnea and snoring. Surgery will not fix everything. You may need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea.

Remember, surgery can have side effects and surgery alone will not fix all your problems. Discuss your options, long-term outcome and side effects of treatment with your specialist before going for surgery.

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Good Samaritan: Is there a doctor on board?

Sand art on a beach in Albufeira, Algarve, Portugal. (Dr. Noorali Bharwani)
Sand art on a beach in Albufeira, Algarve, Portugal. (Dr. Noorali Bharwani)

“The parable of the Good Samaritan is a parable told by Jesus and is mentioned in only one of the gospels of the New Testament”, says an article in Wikipedia.

Good Samaritan acts are defined as when doctors and other healthcare professionals who aren’t on duty offer help in an emergency.

The concept of a Good Samaritan is not new. But in the present era of litigation some people are reluctant to help a stranger in an emergency situation.

“When an individual suddenly becomes ill or injured, doctors instinctively stop in the midst of their vacation, their business trip, or their work and offer assistance as good Samaritans, often under trying conditions”, says an article in the Canadian Medical Protective Association Bulletin (CMPA eBulletin MARCH 2018). CMPA provides legal assistance to doctors.

What are the physician’s ethical obligations and legal risks?

The article says legal obligations and risks can be more difficult to determine because emergencies can occur anywhere at any time. Besides physicians may find themselves being asked to provide emergency care in a variety of legal jurisdictions.

In Canada, most jurisdictions do not impose a legal duty or obligation on physicians to provide emergency medical services. Quebec is the only province in Canada that imposes a legal duty on physicians to come to the aid of a person in a life-threatening emergency. Quebec’s Civil Code protects physicians from liability for that care.

All jurisdictions, however, have legislation that protects physicians who voluntarily provide emergency assistance at the scene of an accident or in any emergency.

CMPA does not think courts anywhere would criticize the conduct of a physician who in good faith treated a person in need of urgent medical care.

CMPA says when its members provide care in an emergency as Good Samaritans they are generally eligible for CMPA assistance regardless of where the emergency care was delivered – anywhere in the world. Former CMPA members who act as Good Samaritans are also eligible for CMPA assistance.

With that in mind, the CMPA encourages its members to consider assisting when confronted with urgent or emergent circumstances.

As soon as possible after the emergency, physicians should document the encounter in their own records. The documentation provides a record of the medical reasoning and the steps taken, may facilitate any further investigations and treatments, and provides a valuable resource if afterwards there are questions about the care. One survey showed in spite of the risks involved most doctors are willing Samaritans.

Helping people and saving lives is what doctors do.

In a British study of doctors who acted as Good Samaritans, in the majority of cases doctors received no recognition for the help they provided, although many pointed out they did not want or expect anything. Others received thank you cards, and in a few cases the doctor was rewarded with a gift ranging from a free meal to an airline upgrade.

Most of the time you don’t need to be a doctor to provide basic life saving support. Remember what you learnt in your first aid course on CPR (cardio pulmonary resuscitation). The most popular acronym you learn for CPR is “ABC”. The “A” stands for airway, “B” stands for breathing, and “C” stands either for circulation or compression of a bleeder. If you can do this until further help arrives then you are doing well. You are a Good Samaritan.

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The importance of getting screened for common cancers.

An owl in the Dubai desert. (Dr. Noorali Bharwani)
An owl in the Dubai desert. (Dr. Noorali Bharwani)

“Facts do not cease to exist because they are ignored,” says Aldous Huxley.
Aldous Leonard Huxley was an English writer. By the end of his life, Huxley was widely acknowledged as one of the pre-eminent intellectuals of his time.

Generally speaking, many people ignore going through screening tests. They believe “no news is good news.” That is not good.

The fact remains early detection of cancer increases the chances for successful treatment and improves cure rate and prognosis. With this in mind the Government of Alberta has set up Alberta Cancer Screening Programs called Screeningforlife.

The Alberta program offers cancer screening to people who have no symptoms to get checked for breast, cervical and colorectal cancer.

Breast Cancer Screening

Just because no one in your family has had breast cancer does not mean you are not at risk. In fact, 80 per cent of women who develop breast cancer have no family history at all.

Having routine mammograms is the best way to find breast cancer early.

If you are between the ages of 50 and 74, you are at an age when it is important to consider having mammograms regularly. This is because the risk of breast cancer increases, as women get older.

Women who are under the age of 50 and over the age of 74 may need a screening mammogram on a regular basis if there are strong indications such as family history of breast cancer. These women should discuss their individual situation with their family doctor.

Cervical Cancer Screening

Screening is recommended for all average-risk females 25 to 69 years.

It is important to know cervical cancer can almost always be avoided with screening and vaccination. In fact, 90 per cent of cervical cancer can be prevented with regular Pap tests (the main screening test for cervical cancer) and following up on any abnormal results.

Georgios Nikolaou Papanikolaou (1883 – 1962) was a Greek pioneer in cytopathology and early cancer detection, and inventor of the “Pap smear”.

The single most important reason to have regular Pap tests is that they can save your life. About 75 per cent of sexually active Albertans will get HPV(human papillomavirus) in their lifetime. It is the main cause of cervical cancer. Good news is nine in 10 cases of cervical cancer can be prevented with regular Pap tests.

Colon and Rectal Cancer Screening

It is possible you may have colon cancer but have no symptoms. Speak to your doctor about colorectal cancer screening after you turn 50. Commonly used tests are:

Fecal Immunochemical Test (FIT) – This is a home stool test for people who have no symptoms and no family history of colon and rectal cancer.It is safe, easy to do and can be done right at home. Should be done once a year.

Colonoscopy – If your FIT is positive then you need a colonoscopy.A colonoscopy can also be recommended as your screening test instead of a FIT if you have any history that puts you at an increased risk.

Do not ignore the facts. Get yourself screened. If Albertans follow these guidelines then we can reduce the risk of cancer in Alberta by about 50 per cent. That would be wonderful!

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STROKE – New Stroke Management Guidelines can Benefit More Patients

Sunset in Hawaii. (Dr. Noorali Bharwani)
Sunset in Hawaii. (Dr. Noorali Bharwani)

Every nine minutes someone in Canada has a stroke. In the U.S., it happens once every minute. Usually the prognosis is not good.

But the odds of survival are getting better because of a new emergency intervention being offered at many hospitals across Canada and USA.

While the majority of strokes strike people over the age of 65, 10 to 15 per cent affect individuals 45 and younger. What is alarming is this number is on the rise.

Stroke is the second-leading cause of death in the world and a leading cause of adult disability.

According to the Heart and Stroke Foundation’s 2014 annual report, strokes in people in their 50s have increased 24 per cent over the last decade.

That is the bad news. The good news is Heart and Stroke Foundation is making changes in its stroke treatment guidelines, extending the window for endovascular thrombectomy from six hours to 24 hours.

Endovascular thrombectomy is the emergency procedure to remove the damaging blood clots from the blood vessel that is blocking the blood flow to the vital parts of the brain.

The change in the management of acute stroke comes after both the Heart and Stroke Foundation and the American Heart Association reviewed research suggesting it’s possible for some patients to benefit from the procedure even after many hours have passed since their first symptoms of stroke.

All patients may not be eligible for treatment if they are seen after six hours. But it is expected some patients may be eligible for treatment within six to 24-hour window.

Patients living in remote areas or who suffer a stroke in their sleep expected to benefit most from the new 24-hour guidelines.

Removing blood clots:

Mechanical thrombectomy (endovascular thrombectomy) is a procedure where doctors remove blood clots using a device passed through a blood vessel. New research shows some carefully selected patients may benefit having this procedure even after the six-hour window has passed (up to 24-hours). Up to 20 per cent of all ischemic stroke patients are currently eligible for clot removal. This number is expected to increase.

Dissolving blood clots:

In the second method doctors use clot-dissolving intravenous medication called alteplase (tPA). Alteplase was approved to treat ischemic stroke about 20 years ago and remains the only medication approved by the FDA to dissolve clots. It has been proven to decrease disability when given promptly (within six hours of onset of symptoms).

These two procedures can only be used for ischemic strokes (strokes caused by a blood clot), as opposed to those caused by a bleed in the brain.

Recognizing signs of stroke:

Studies have shown one in seven young patients were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems – and sent home without proper treatment.

Age of the patient does not matter. If they have the FAST signs, whether they resolved or not, it was probably a stroke. Call 911 right away. Remember the acronym FAST:

Face: Is it drooping?

Arms: Can they raise both?

Speech: Is it slurred or jumbled?

Time: To call 911 right away.

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