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Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)

“Dr. B, what is the difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)?” asks Susan.

Irritable bowel syndrome is a condition where the symptoms are due to disturbance in the movement and sensation of the bowel. The person is otherwise well but presents with chronic or recurrent abdominal pain, change in bowel habit (constipation and/or diarrhea) and bloating.

Inflammatory bowel disease is a condition where symptoms are due to inflammation (redness, swelling, ulcers) of the lining of the bowel. This result in abdominal pain, bloody diarrhea, and loss of weight and feeling unwell.

The exact cause of either condition is not known. Sometimes the symptoms are such that it is difficult to differentiate between the two conditions.

“Dr. B, can you tell me more about irritable bowel syndrome (IBS)?”

IBS affects about 15 percent of the population. Only 30 percent of the people affected by the condition seek help from their family physicians.

Usually a diagnosis is made after extensive and uncomfortable investigations to rule out other conditions like inflammatory bowel disease and cancer. This is called diagnosis by exclusion!

Couple of years ago, internationally recognized experts in IBS held a consensus conference to develop recommendations on diagnosis, patient education, psychosocial management, dietary advice and treatment. This is to help physicians understand and manage the condition better.

For diagnosis without investigations, the most reliable symptoms criteria used are 1. Abdominal pain 2. Pain relieved by defecation 3. Pain relieved with looser stools 4. Pain associated with more frequent stools.

Bloating is more common in women.

Using these symptom criteria, the chances are that the physician’s diagnosis of IBS is correct in 60 to 80 percent of cases. Physical examination is usually normal. In some cases there may be some abdominal tenderness or palpable colon.

Investigations are required in patients who have weight loss, rectal bleeding, anemia, family history of inflammatory bowel disease or bowel cancer, new symptoms in patients over 50 or the physician is uncertain of diagnosis of IBS.

These patients should have complete blood count and colonoscopy (a day surgery procedure under sedation in a hospital). Instead of colonoscopy, one can have air-contrast barium enema and flexible sigmoidoscopy (a 60-cm version of a colonoscope done without sedation in a doctor’s office).

Management of this condition is not always easy. Patient needs education and reassurance. It is a chronic, relapsing but benign condition although in some it can cause significant psychosocial problems.

Advice on balanced diet, exercise, and “toilet training” is important.

Most patients do not need drug therapy. No single medication has been shown to be beneficial for IBS. Symptomatic treatment of constipation, diarrhea, abdominal pain, and bloating is required.

Associated conditions like depression and anxiety should be recognized and treated.

As you can see, lot more research is required to unlock the mystery and frustration of this condition. In the meantime, we have to deal with the problem with patience and perseverance.

Physicians and patients have to understand each other’s limitations and difficulties and work together to relieve pain, anxiety and discomfort.

“Thank you Dr. B., this will certainly help me understand my problem!” says Susan as she gets ready to leave.

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!

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Alaska Holiday 2

“One of the symptoms of approaching nervous breakdown is the belief that one’s work is terribly important, and that to take a holiday would bring all kinds of disaster,” says The Conquest of Happiness.

With this in mind, Dave and family go on an ambitious Alaska cruise. Last week’s column describes Dave’s experience of a “stress free” holiday, mixed with food, fun and laughter.

Today, Dave tells us about the beauty of Alaska and the activities he enjoyed with his family during the short time he was there.

Let us start with a brief history.

In 1867, United States’ Secretary of State William Seward purchases Alaska from Russia for two cents an acre! Critics laugh. They call it foolish. But soon Alaska surprises 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.

The cruise ship’s first stop is Juneau, the capital city with a population of 26,800. It is inaccessible by land. 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, trail hiking, rain forest nature walk, glacier trekking by helicopter, wildlife cruise, salmon bake, pan for gold or sportfishing.

Our children decide that we go glacier trekking by helicopter! Well, dad has the plastic card! The helicopter soars over Juneau’s wild backcountry and spectacular glaciers. The tour covers 65 miles of Alaskan wilderness and makes a brief glacier landing within the massive Juneau Icefield. The view is spectacular and breathtaking.

Our pilot/guide unveils the beauty and the mystery of the area. Walks us through some interesting spots (require special boots) and help us explore its surface.

Juneau icefield is North America’s fifth largest icefield. It covers more than 1,500 square miles of land. It is estimated that icefield’s snow and ice depth to be from 800 to over 4,500 feet deep. Annual snowfall on the Juneau Icefield exceeds 100 feet.

During the flight, we see mountain goats. The goats favor the high ridges surrounding the icefield during the summer months. We see deep icefield crevasses, hanging icefalls and jagged spires.

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

Each place has its own history and beauty. But there is something special about Skagway – the White Pass and Yukon Route railroad tour in search of gold!

Well, the Klondike Gold Rush was 100 years ago! But there is still high adventure and scenic drama. A ride along the shoulders of granite mountains.

The train (some train cars straight out of the 1890s), leaves Skagway (elevation: 0) on a narrow gauged railroad (built 1898), climbs through the Coast Mountains in Tongass National Forest, through mountain tunnels to the White Pass Summit (elevation: 2,865 ft). Takes you through unforgettable spectacular scenery.

Well Dave, what’s left?

The Glacier Bay! Naturalist and adventurer John Muir is credited with discovering the bay in 1879 but continues to remain isolated and undeveloped. Enter Glacier Bay and you cruise along shorelines completely covered by ice. As water undermines some ice fronts great blocks of ice break loose and crash in to the water. A beautiful sight to cherish.

Well, it is time to cruise back to Vancouver and to the real world. But you cannot disembark until you have cleared your bills, tipped all the kind people who made your trip a delight and cleared the customs!

Dave jumps in the cab, looks at the ship and says, “Alaska, we will be back!”

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!

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Alaska Holiday 1

“Alaska, here I come!” says Dave as he embarks on a week’s cruise with his family.

This, ones in a lifetime cruise, is one way Dave and Susan can escape from the stress of modern day life.

We need holidays to take a break from the daily rituals, have quality time with our family, recharge our batteries, reorganize our thoughts and priorities, and bring new vigor to our outlook.

On his return, Dave is overjoyed with what he saw and the way he felt. He sat down to tell me all about it.

In 1725, a Russian explorer, Vitus Bering, is the first European to set foot on Alaskan soil. In 1867, the Government of United States purchases Alaska from Russia for $7.2million (two cents per acre!).

Initially thought to be a foolish deal, Alaska surprises the world with its wealth of natural resources – gold and oil. While oil continues to dominate Alaskan economy, tourism leads fishing and lumbering as the state’s second major industry.

Dave and family board the 50,000-ton ship on a Monday evening in Vancouver. There is nothing very spectacular about the departure. As the ship cruises at an average speed of 20-knots/23 mph, Dave takes pictures of the breathtaking view of Vancouver sun set.

Well, I am getting impatient to know more about the cruise! About food and entertainment. About the beauty of Alaska – glaciers, whales, and the wilderness.

Is there anything healthy to do on board the ship?

There is lots of food! Food services start at 6 am and end with midnight buffet. There is everything, including pizza and ice cream. There are plenty of fresh fruits and vegetables. Enough for 2000 passengers and 625 crewmembers to last for more than a week.

The best thing about the cruise is that you don’t have to work. The phone does not ring. There are no deadlines. No meetings to attend. No complaints to listen to.

The cabins are cleaned twice a day. The towels are changed twice a day! You can order room service if you like. It’s a big, mobile, floating hotel and a small city put together.

All food served is not “unhealthy”. Besides fresh fruits and vegetables, there are sugarless deserts and low calorie items on the menu. One thing they do not provide is will power to resist “unhealthy” food!

For the fitness buffs, there is fully equipped gym with massage therapists. Variety of fitness classes offered that range from beginners to advanced levels. There is sauna, spa, aerobics, yoga – you name it and they have it.

There is basketball area, small driving range (lousy clubs – not like your own), table tennis, two small swimming pools, two hot tubs, and walking and jogging areas.

Each evening there is lot of laughter and fun. There are outstanding Broadway shows, stand up comedians, and singers. Audience participation programs are very funny.

They have baby-sitting arrangements, children’s programs and teen activities.

For gamblers, there is daily lotto, bingo, and casino.

There are two formal evenings when you can dress up in your best clothes. There is beauty saloon to get you ready if you need their services. You can even rent a tuxedo!

There are gift shops with Alaska souvenirs that are made in Canada for which you pay American dollars!

There are several ship photographers who take innumerable pictures for you to buy. Who is not tempted to buy his own picture – although it may never make it to the cover of Rolling Stones magazine!

There is plenty of open seas, fresh air, sunshine (if it does not rain), and blue skies. You can watch sunrise and sun set. You can sit on the deck and watch the stars and the moon. You can watch beautifully lighted cruise ships sail by. Evenings are beautiful, calm and relaxing.

In the next column, I will tell you what Dave and his family saw in Alaska.

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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Substance Abuse

“Substance abuse is an enormous problem in Canada,” says Dr. John S. Millar, MD, in an editorial in the Canadian Medical Association Journal. Dr. Millar is Provincial Health Officer for British Columbia.

The exact cost –monetary and nonmonetary- of disease, disability and death due to substance abuse is difficult to estimate. But it is thought to be in billions of dollars.

Three commonly abused substances are tobacco, alcohol, and drugs.

Tobacco use continues to be the leading lifestyle-related cause of death in Canada – 45,000 each year. About 30 percent of adult Canadians over 15 smoke regularly. Teenage girls are more likely to smoke (39 percent) than teenage boys (22 percent).

Alcohol use takes its toll. About 10 percent of adult Canadians have a drinking problem. Impaired driving is a major cause of death. About 45 percent of the dead drivers have some alcohol in their blood and 38 percent are over the legal limit of .08 percent blood alcohol concentration.

Use of drugs like cannabis, cocaine and heroin amongst Canadians has been increasing. In 1994, the daily use of cannabis in Canada was estimated at 7.4 percent of the population, cocaine at 0.7 percent, and LSD, speed or heroin at 1.1 percent.

In Alberta, the most popular illicit drug is cannabis (marijuana and hashish).

In 1994, 32.8 percent of Albertans (aged 15+) reported using cannabis at some time in their lives, while 8.4 percent said they had used this drug in the 12 months preceding the survey.

What about Medicine Hat? I asked Paul Jerry, a Chartered Psychologist and Instructor at Medicine Hat College in the Addictions Counseling Program.

“Compared to other places in Alberta, Medicine Hat is doing well,” says Jerry. Out of 26 AADAC service areas, Medicine Hat ranks 14th for rate of cannabis and other drug possession charges; 24th for sexual and physical assault charges; and 19th for total rate of alcohol-related primary and secondary diagnosis admission to hospital.
According to AADAC’s breakdown of client demographics, 60 percent of these clients are adult males, 23 percent adult females, 10 percent collaterals and 6 percent teens, says Jerry.

Why are some people prone to substance abuse?

According to Dr. Millar, there is a biological or genetic propensity for substance abuse. This is similar to chronic diseases such as diabetes, hypertension and asthma.

It has also been shown that people who have been abused or neglected in childhood or children from low socio-economic background (poverty, homelessness) have high incidence of substance abuse.

It is also common among people with mental illness.

Dr. Millar says that it is important to understand the underlying cause for substance abuse for any intervention program to succeed. We should stop treating addicts and substance abusers as criminals and begin treating them as patients who deserve respectful, effective care.

I asked Paul Jerry, who has 10 years’ experience in the field of mental health and addictions, about the Addictions Counseling Program at Medicine Hat College.

“Our program is unique in that we hold the view (different from AADAC) that eating disorders and sexual compulsivity can be framed in an addictions perspective. So we apply the addiction model to alcohol, drugs, gambling, food and sex. We train counselors to intervene with these issues in individuals, couples, families, groups, and communities.”

Finally, Carl Jung (1875-1961) has the last word: Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism.

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