Blood Transfusion

Dr. B, is blood transfusion safe?

Susan, blood can never be 100 percent safe. Therefore, it is important for health care professionals to develop strategies to avoid the need for blood.

But this not always possible. In Canada, approximately 600,000 people receive blood each year. It saves lives of critically ill patients. It also improves the quality of life of other patients who require blood transfusion.

So the need never stops!

Then, Dr. B., how safe is it to have a blood transfusion?

The safety level of blood transfusion in Canada has improved a lot. Recently, a not-for-profit, charitable organization called Canadian Blood Services (CBS) was given the task of collection and distribution of blood.

Susan, unlike Red Cross, blood is the sole focus for CBS. Safety, through research and development, is a priority for the Canada’s new blood agency, says Lynda Cranston, CEO of CBS in a recent article in Hospital Quarterly.

CBS spends $20 million annually for a new screening weapon that allows earlier detection of the viruses that cause hepatitis C and AIDS. Further $10 million is spent annually on leukoreduction – a process in which white blood cells are removed from the blood supply. This will further reduce the risk of transfusion reaction and infection.

Currently, the risk of viral infection to a recipient is too low to measure.

Dr. B, is it true that only 5 percent of the population donates blood, yet virtually all Canadians will need blood or blood products in their life time?

Yes Susan, that is correct. In the last 10 years, the amount of blood collected in Canada has dropped from 1.2 million units a year to just under 700,000 units. This is not good.

CBS needs donors. The bottom line is without donors there would be no Canadian Blood Services, says Gaylene Smith, Communications Coordinator of CBS in Calgary. She adds, “Medicine Hat is a terrific supporter of our mobile clinics.”

In the first five months of this year, Medicine Hat and Lethbridge have had 6 blood donor clinics each. The average attendance in Medicine Hat is 214 with average collection of 190 units of blood at each clinic. Figures for Lethbridge are: 211 and 186 respectively.

How much blood do we use in Medicine Hat?

In 1984, we used 80 units of packed red blood cells per month. In the last one year we have used 150 units per month, says Dr. Michael O’Connor, pathologist at Palliser Health Authority. He adds, “Like other places our need never stops either!”

“We certainly need more donors. Donors should remember that they are at no risk of contracting viral infection,” emphasizes Dr. O’Connor.

Dr B., can I be a donor?

Sure Susan, you can be a donor if you are between 17 and 61 years of age. You should weigh 50kg (110 lbs.) or more. Have a proper ID. You should not be on any medication, which will affect the recipient. You should wait at least 56 days between donations.

Thank you Dr. B. I better phone the toll free number (1-877-444-9284) and find out the date of next blood donor clinic in Medicine Hat.

Sounds like a good idea! Remember, a unit of blood saves more than one life! Good luck, Susan.

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!

Abdominal Gas (Flatulence)

“Doc, your column on constipation was interesting. What about bloating and flatulence? Don’t you think it is a major problem for many individuals!”

Dave, you are absolutely right. Call it what you want – flatulence, burp, belch, gaseous distention, wind, flatus, fart – excess intestinal gas can be a nuisance.

There is a social taboo associated with this topic. Unlike Eddie Murphy’s family dinner explosions in The Nutty Professor, most of us find a socially convenient place to “cut the cheese”.

From birth to death, the production of gastrointestinal gas continues unhindered. We are all familiar with our child’s difficulty with gas and colic. What about that burp? I bet that gave more sense of relief to the parent than the child.

There are 3 phenomenon of gas production: 1) Flatus is mainly due to production of gas by colonic (large intestine) bacteria, 2) Belching or burping is due to swallowed air, and 3) Bloating – the mechanism of which is not very clear.

A normal diet emits about one liter of gas in the intestine. Some gas is absorbed by the body. The rest, about 50 to 500 ml, is passed as flatus in small quantities several times a day. At night, minimal gas is produced, but we continue to release wind in our sleep. So, first thing in the morning, our abdomen is as flat as can be.

It is normal to pass flatus. Usually, it consists of odorless gas – carbon dioxide and hydrogen – produced by bacterial action on carbohydrates and the proteins in the food we eat.

Hydrogen, carbon dioxide, methane and swallowed nitrogen comprise 90 percent of colon gas. The remaining one percent consists of trace gases that compensate for their small quantities by their strong odors. Smelly gases include hydrogen sulfide, ammonia, indole and volatile fatty acids.

Belching and burping occurs from the air ingested with breathing and swallowing. Anxiety, thumb sucking, gum chewing, drinking carbonated drinks, rapid eating and wearing poor dentures increase the amount of gas swallowed. Stomach gas has the same composition as the atmosphere.

Bloating occurs in 30 percent of adults. Individuals complaining of bloating and distention are convinced that they have excess gas. But this is not true.

In the morning the abdomen is nice and flat. As the day progresses, the abdominal girth increases by 3 to 4 cm. Plain x-rays and CT scan of the abdomen fail to show that this is due to gas. Passing flatus may temporarily relieve the symptom but the
phenomenon is not due to gas. By next morning the distention is gone.

“What influences the production of excess gas?” Dave asks.

Beans, broccoli, and cabbage have a high content of nondigestible polysaccharides. Other foods are cauliflower, corn, brussels sprouts, eggplant, nuts, onions, and prunes.

Most of the intestinal gas consists of swallowed air. Only about 10-30 percent of gas is produced in the intestine.

Furne and Levitt did a study looking at factors influencing frequency of flatus emission by healthy subjects. They concluded that some subjects consistently passed gas more often than did others. The individual differences depend on the ability of the bacteria to produce gas from the fermentable food residue.

Therefore, the management of “too much gas” should be directed toward reducing swallowed air and avoiding gas producing food. This is not always easy. But worth trying.

Finally, Dave, here is what Sir John Suckling (1609-1642) said about love and flatulence:
Love is the fart
Of every heart:
It pains a man when ‘tis kept close,
And others doth offend, when ‘tis let loose.

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!

Constipation

It is estimated that 50 percent of the healthy people have bowel problems. One of the most common complaints is constipation.

Constipation is hard to define. To some it means stool is too hard. To others it means stool is difficult to expel. Some have sense of fullness after defecation, some need to strain at stool frequently.

How often one should have a bowel movement?

Most people have between 3 movements per day and 3 movements per week. Some people consider that fewer than three movements a week without discomfort or dissatisfaction is normal.

Each day, one to two liters of semiliquid material passes from small intestine (ileum) to large intestine (colon). The material is composed of undigested food residue and intestinal secretions. There is nothing much left of nutritional value at this stage.

The liquid material is absorbed in the colon to convert the residue to solid feces. This advances to the rectum by the propulsive action of the colon, stimulated by the bulk of the stool.

The weight of stool in Western countries varies from 35 g. to 225 g. Water makes up 60 to 80 percent of the stool content.

What causes constipation?

Medications like narcotics and water pill can cause constipation. Dehydration, underfunctioning thyroid gland, increase in calcium level, spinal diseases, spastic bowel, bowel tumor, and narrowing due to various reasons may result in constipation.

Most cases of chronic constipation are due to habitual neglect of desire to go to the washroom because of sense of social impropriety, strange surroundings, poor toilet facilities, or illnesses which results in prolonged confinement to bed.

Constipation is a frequent problem in children under 6 years. The cause is not always clear. Most often, constipation is short-lived and of little consequence. In a British study, 5 percent of the children had constipation lasting for more than six months.

What’s wrong with constipation?

Constipation can create bloating and abdominal pain. Straining results in fissures and hemorrhoids. Increased pressure in the colon can result in pouches (diverticulosis).

Constipation is thought to increase the incidence of colon polyps and cancer. Since 1970, many studies have reported reduced risk of polyps and cancer with increased intake of fiber. But a recent study of 90,000 females followed for more than 16 years failed to confirm this.

Do we need to investigate cases of constipation?

Yes. If there is a recent history of change in bowel habit. If constipation is associated with rectal bleeding. If there is loss of weight, anemia, or suggestion of bowel blockage.

How can we manage constipation?

If investigations reveal no abnormalities, then careful education relieves lot of anxiety and discomfort. Do not ignore urge to defecate. Establish a routine at a given time each day. Physical exercise and increase in fluid intake helps.

Increase fiber intake with fruits, green vegetables, and cereal grains. Bulk laxatives, such as hemicellulose, psyllium extract, and all bran provides additional bulk.

Older individuals with poor muscle tone, minimal physical activity and other medical problems need more than bulk in the colon. Stool softeners, enemas and stimulant laxatives are required until a regular pattern is established.

So, next time you are constipated, make sure you get some relief with fluid and fiber. That is better than having an enema!

An after thought advisory: do not read this column before a sumptuous meal. It may result in nausea, vomiting and constipation!

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Stress

“Doc, I feel stressed out. Is this hurting my health?”

Dave works hard. Like most of us, he performs best when he is under certain amount of stress. Dave strives for excellence in everything he does. This certainly creates stress.

Work is not the only source of stress for most people. The pressures of modern day life keep everybody under stress. It has become part of our daily life.

Stress is an individual reaction to threats –either real or perceived.

Acute stress is in the nature of “fight or flight” or stress of major life events. Chronic stress is day-to-day stress which builds up over a period of time. Both can have long term consequences, writes Dr Bruce McEwen, Ph.D., in the New England Journal of Medicine.

Individuals who are chronically stressed exhibit fatigue, lack of energy, irritability, demoralization, and hostility. It is estimated that 60 percent of patients seen by family physicians have stress related health problems.

Sometimes stress is good. It energizes you. It can supply that zest for living.

“Doc, how does my body respond to stress?”

Dr. Bruce McEwen describes our body’s normal response to stress as ALLOSTASIS – the ability to achieve stability through change. This is critical to our survival.

The body provides this stability by activating four systems – nervous, cardiovascular, metabolic, and immune systems.

Our capacity to respond to stress depends on two things: 1) how we perceive a particular situation, 2) general state of our physical health.

Whether one perceives a situation as a threat, either psychological or physical, is crucial in determining the behavioral and the physiologic response, writes Dr. McEwen. The ability to adjust to repeated stress is also determined by the way one perceives a situation.

Physical condition of our body is important to combat adverse effects of stress. Rich diet, use of tobacco, alcohol, and lack of exercise can exacerbate chronic stress.

Body responds to stress by turning on an adaptive response and then shutting off this response when the threat is gone. If the system is inefficient in shutting off the response then the body is overexposed to stress hormones. This is not good.

Stress hormones cause anxiety, increase the heart rate (palpitation), increase blood pressure (hypertension), and increase blood sugar level. Repeated exposure to stress hormones may lead to heart disease, obesity, and diabetes.

Repeated stress also affects brain function (memory loss), and suppresses immune system (compared to acute stress where immune system is enhanced).

Dr. McEwen says that in laboratory animals, inefficient response to stress is due to the aging process. But this has not been proven in humans. It is possible that the ALLOSTATIC system wears out or becomes exhausted over a lifetime due to repeated exposure to stress.

“Doc, what can I do to combat stress?” asks Dave.

One has to learn coping skills, recognize one’s own limitations, take time off and relax. Eat a low fat diet, quit smoking and exercise regularly.

Dr. Peter Hanson, author of “The Joy of Stress” writes: Strive to maximize success by investing your energy and time in all four quadrants of your life – financial sufficiency, personal happiness, sound health, and respect on the job. Earn the respect of your peers, the loyalty of your friends, and the love of your children and spouse. Be spontaneous. Be funny.

It’s all mind over matter; if you don’t mind, it don’t matter. So don’t worry, be happy! Dave smiles and leaves the room humming…don’t worry….be happy…….

(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!