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Carbon monoxide in your home is a silent killer.

Olympic Flame from the 1988 Winter Games at the University of Calgary. (Dr. Noorali Bharwani)
Olympic Flame from the 1988 Winter Games at the University of Calgary. (Dr. Noorali Bharwani)

A 12-year-old boy has died after high levels of carbon monoxide were detected at an Airdrie, Alberta apartment complex earlier this month.

Sometime ago provincial politicians in Ontario passed a bill named after a family of four who died in 2008 from carbon monoxide (CO) poisoning in their Woodstock, Ontario home.

These are just two examples.

According to Statistics Canada, there were 380 accidental deaths caused by CO in Canada between 2000 and 2009. Approximately 600 accidental deaths due to CO poisoning are reported annually in the United States. Intentional carbon monoxide-related deaths is five to 10 times higher.

CO has no smell, no taste and no colour, but its effects can be deadly if it goes undetected through your house.

CO is produced when fuels such as natural gas, gasoline, oil, propane, wood or coal are burned. The situation gets worse when that combustion is not properly ventilated, or when the CO can not get out of the house because of a blocked or dirty chimney.

It is dangerous to use appliances indoor that are meant to be used outdoors. CO can build up to dangerous levels when fuel-burning generators, space heaters, barbecues, grills or other appliances are used indoors in the garage.

CO is invisible. There are no obvious signs it may be building up around you. When you inhale CO it gets into your body and competes with oxygen. Oxygen is very essential for our survival. The brain is extremely vulnerable to oxygen deprivation. Without oxygen, body tissue and cells cannot function. CO deprives you of oxygen and literally suffocates you.

It is essential to have CO detectors in your vicinity. The most important place to install a CO alarm is in hallways, outside of sleeping areas.

At low levels of CO exposure, Health Canada says, you might have a headache, feel tired or short of breath, or find your motor functions impaired.

At higher levels of exposure, or at lower levels for a long time, symptoms might include chest pain, feeling tired or dizzy, and having trouble thinking.

Convulsions, coma and death are possible with high levels of exposure.

If the levels are very high, death can occur within minutes.

Prevention is better than cure. Fire and public safety officials recommend having CO detectors in the house, ideally located outside every sleeping area. Make sure your appliances are well maintained.

Fuel-burning appliances such as furnaces, water heaters, fireplaces and wood stoves should also have regular maintenance, and ventilation should be checked, ensuring it is not blocked by snow or leaves.

Treatment of CO exposure consists of removing the person from the site, administrating 100 per cent oxygen and transporting to the nearest hospital for further management.

Finally, make sure your house has CO detectors and smoke alarms. Smoke alarms alert you to fires. Install a CO alarm certified by a certification body that is accredited by the Standards Council of Canada.

Test your CO alarms regularly. Replace batteries and the alarm itself as recommended by the manufacturer.

Contact your municipal or provincial government office for more information on the use and installation of carbon monoxide alarms. Your local fire department may also be able to assist you.

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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Follow This Simple Principal for a Long and Healthy Life

Whats up, deer? (Dr. Noorali Bharwani)
Whats up, deer? (Dr. Noorali Bharwani)

“Diet-related risks combined with physical inactivity are estimated to cause nearly one in five deaths worldwide,” says an article in the Canadian Medical Association Journal (CMAJ December 13, 2017 – New ammunition in the fight to label unhealthy foods).

Since 20 per cent of the deaths are related to what we eat, there is an urgent need to put warning labels on the packages containing foods high in sugar, salt and fat.

Unhealthy eating causes chronic diseases. This impacts on mortality and morbidity. It also has a large bearing on the economy in terms of direct health care costs and indirect costs, such as those related to loss of productivity.

When you think about eating sugar, salt and fat you should think about chronic non-communicable diseases, such as obesity, type 2 diabetes, heart disease, and cancer.

The incidence of type 2 diabetes continues to rise and heart disease is one of the leading causes of death in Canada. With high rates of obesity and hypertension, as well as an aging Canadian population, the impact of chronic diseases is likely to continue to increase unless action is taken to reduce modifiable risk factors.

Consuming poor unhealthy diet costs taxpayers $26.7 billion annually. That is lot of money. We can use that kind of money to improve the quality of our health and other social needs of the population.

If you are obese then eat healthy and try to lose one pound a week or a month. As they say slow and steady wins the race. If you lose your weight slowly then you can maintain the loss.

There are hundreds of diet plans in the market. You just have to find one and stick to it. I looked at the Mayo Clinic diet. That makes sense to me. The Mayo Clinic Diet is the official diet developed by the Mayo Clinic in Minnesota. It focuses not just on what you eat and how much you weigh but also on your overall health and lifestyle.

If you follow Mayo Clinic diet then you can drop one to two pounds a week until you reach your goal. Then you follow a program to maintain your weight.

The Mayo Clinic diet gives you lots of food choices within six food groups:

  1. Fruits
  2. Vegetables
  3. Whole grains
  4. Lean proteins such as beans and fish
  5. Unsaturated fats such as olive oil and nuts
  6. Sweets, in small amounts

The global plan is to begin work on global standards for front-of-package nutrition labeling, with new guidelines expected in the next three to five years. The labels on the package will warn consumers about unhealthy foods and ingredients.

The global talks come at a crucial time for Canada, which is poised to announce draft-warning labels for foods that contain more than 15 per cent of the daily value for sugar, sodium or saturated fat.

Do warning labels work? Surveys show that the warnings influenced more than 91 per cent of consumers, and food companies reformulated 18 per cent of products to avoid the labels.

Some have raised concerns about the government’s narrow focus on sugar, sodium and saturated fat. Four times as many nutrition-related deaths are linked to diets low in fruits, vegetables, whole grains and other ingredients, says the CMAJ article.

Just follow a simple principal – eat right and eat less.

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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Five Things to Know About Take-Home Naloxone

Antigua (Dr. Noorali Bharwani)
Antigua (Dr. Noorali Bharwani)

“Nothing is impossible; the word itself says, ‘I’m possible!'” -Audrey Hepburn

Naloxone is a life saving medication when used after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription.

There are three kinds of opioid drugs. These are synthetic opioids (example fentanyl), semi-synthetic opioids (oxycodone, heroin), and natural opioids (opium, morphine, codeine). Natural opioids are from a natural source – opium poppy.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anaesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illness like cancer.

Fentanyl is a powerful drug. It is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been responsible in the number of overdose deaths in recent years. It plays a role in the deaths of more than four people on average every day in B.C. and Alberta alone.

Fentanyl poisoning results in respiratory depression, miosis (excessive constriction of the pupils) and altered level of consciousness. These three features should alert physicians to the possibility of fentanyl poisoning.

An article in the Canadian Medical Association Journal (CMAJ September 18, 2017) titled “Five things you should know about take-home naloxone” emphasis the following points:

1. Naloxone is available without prescription in Canada

In 2016, naloxone was removed from the federal Prescription Drug List. Now pharmacists can dispense it without prescription. It is available in commercial formulations, including intranasal preparations, as well as in locally prepared take-home naloxone kits, available from some pharmacies, clinics, emergency departments and community health centres.

2. Most take-home naloxone kits contain similar equipment

Most take-home naloxone kits will contain two ampules of naloxone (0.4 mg per vial), two safety-engineered syringes, two ampule-opening devices, alcohol swabs, nonlatex gloves and a rescue-breathing barrier. The average cost for a take-home naloxone kit is $35. However, many sites offer them free of charge.

3. Multiple doses of naloxone may be required for overdoses related to high-potency opioids

In overdoses related to fentanyl and other synthetic opioids, multiple doses may be required to restore breathing. Most take-home naloxone kits include two doses, and additional doses can safely be administered every two to five minutes if there is no response. Naloxone should be used in conjunction with basic life support principles, such as rescue breathing, cardiopulmonary resuscitation and calling 911.

4. Take-home naloxone kits may reduce overdose-related mortality

Observational studies in North America, Europe and Australia, has found that take-home naloxone programs led to improved survival rates among program participants.

5. Take-home naloxone kits are not only for patients with current opioid abuse

The kit can be used for other at-risk populations include individuals who are on methadone or on high doses of prescription opioids, or who frequently use recreational drugs.

Naloxone can be delivered to the patients in different forms: intravenously, intramuscularly, subcutaneously, through the trachea and nose. The drug is effective in one to eight minutes after administration.

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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Understanding Factors that Determine Our Health

A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)
A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)

“The perception that health comes from the health care system is widespread. Yet the health care system accounts only for a small – albeit important – part of the overall health of the population, mainly through treatment. It’s really an illness care system,” says Dr. Trevor Hancock in the Canadian Medical Association Journal (CMAJ December 18, 2017). The title of the article – “Beyond health care: the other determinants of health.”

Hancock is an internationally recognized public health physician. The Canadian Public Health Association recently recognized his outstanding contributions in the broad field of public health with the R.D. Defries Award.

Our health care system is geared towards providing acute care. Most major determinants of health lie outside the acute care system. Health care system should provide major care towards factors that really make us sick, says Hancock.

Hancock says a 2014 policy brief found the health care system to be responsible for just 10 to 20 per cent of broadly defined health outcomes. It does not take into account other factors that affect our health. For example: our behaviour, our social circumstances, physical environment that includes pollution, and genetic factors.

This is hardly a new understanding. The Canadian government’s 1974 landmark Lalonde Report suggested four health fields:

  1. Human biology
  2. Lifestyle
  3. Environment
  4. Health care

Public health care service should attempt to reduce the overall burden of disease, ensuring clean water and air, clean and reliable energy, and quality early child development experiences.

Clearly most of these factors do not lie within the jurisdiction of the Minister of Health or the health authorities, says Hancock.

We need to broaden our concept of health policy and ask ourselves, in what way is current food, housing, transport, or economic policy bad for health, and, conversely, what would a healthy housing and transport policy look like, asks Hancock.

In another article, (CMAJ November 20, 2017) titled “No quality health care without strong public health,” Hancock says public health is in the same business as the rest of the health care system: saving lives and reducing suffering. But it does so by intervening before – rather than after – the onset of disease or injury.

Hancock says the objectives of public health are three:

  1. To focus on improving health in the population as a whole rather than through one-on-one care. It has been found that local and national public health interventions were highly cost-saving.
  2. To improve the patient’s experience of care. Prevention should be seen as the first step in disease management and a key marker for quality health care.
  3. The final aim is to reduce the per-capita cost of health care. This can be approached in four main ways: reduce the burden of disease, improve self-care so fewer people seek care, improve the efficiency and effectiveness of care services, or reduce services.

We have to strike a better balance between prevention and treatment. Let us intervene before the onset of disease or injury. That will save lives and reduce suffering. I will finish with the following words of wisdom:

“Nothing that has value, real value, has no cost. Not freedom, not food, not shelter, not healthcare,” says Dean Kamen, an American inventor and businessman.

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