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Everything you want can be found in New Orleans.

China Lights at New Orleans City Park Botanical Gardens (Dr. Noorali Bharwani)
China Lights at New Orleans City Park Botanical Gardens (Dr. Noorali Bharwani)

It has been more than 30 years since we were last in New Orleans. It was time to revisit the city that has to offer everything you ever wanted for fun and food.

“New Orleans is one of the world’s most fascinating cities – it’s home to a truly unique melting pot of culture, food and music,” says New Orleans Official Guide. Everything the guide says is true. We were there in early April and the city was full of tourists.

New Orleans is a major United States port on Mississippi River and the largest metropolitan area in the state of Louisiana. The population of the city is about 400,000. The city is named after the Duke of Orleans. It is well known for its distinct French and Spanish Creole architecture, as well as its cross-cultural and multilingual heritage. It is also famous for Mardi Gras, dating to French colonial times.

Here are few items of interest to note:

China Lights at New Orleans City Park Botanical Gardens

China Lights at New Orleans City Park Botanical Gardens

This incredible exhibit from China is open for a limited time from February 23 to May 1, 2016. Best time to visit is at night as display of over 30 extraordinary structures light up. There is food and music and things to see in the Botanical Garden. The exhibits will travel the world and may come to a city near you.

New Orleans Cemeteries (Cities of the Dead)

New Orleans Cemeteries (Cities of the Dead)

Normally, a public cemetery would not be a tourist attraction. But in New Orleans it is different. New Orleans is built on a swamp. The deceased have to be buried above ground. Each unit belongs to a family to accommodate multiple bodies. Over time the cemeteries, with elaborate sculptures and other decorative artwork, resemble small villages.

Entertainment

Street Jazz players in New Orleans, LA.

New Orleans business signs.

New Orleans, birthplace of jazz, offers all kinds of music. Whether you like jazz, rock, hip-hop, pop, funk, indie, blues, there is live entertainment for everyone. There are street musicians and there are world famous performers come and perform at Jazz Fest.

The nightlife goes on all night. You can drink anywhere you want. You can play music and dance. Nobody stops you as long as you are having fun. Spending a night or two (or more) walking and drinking on the Bourbon Street is a must. It is a famous historic street dating from the time of French Louisiana, along the French Quarter. Bourbon Street is steeped in history, folklore and beauty that date back to the early 18th century.

Riverside Walk

Riverside Walk in New Orleans, LA.

A walk along the Mississippi River in New Orleans, you get to experience riverfront area adjacent to the French Quarter. You get to experience public art, family activities including food outlets offer delicious food. There is also an air-conditioned mall.

Looking for alligators

Alligator in New Orleans, LA.

Airboat tour in New Orleans, LA.

We used the services of Airboat Tours by Arthur Matherne, Inc. to look for alligators and swamp wild life. This is a high speed adventure that is part tour and part ride.

The adventure takes you through swamp, marsh and lake. You may see anything from a Bald Eagle to a Pelican to Osprey to an Owl and alligators. It is very exciting.

Well, there is a lot to see and do in New Orleans – more than what I can write here.

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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Early Detection of Stroke Improves Outcome

Lincoln Memorial in Washington, D.C. (Dr. Noorali Bharwani)
Lincoln Memorial in Washington, D.C. (Dr. Noorali Bharwani)

“Advances in the management of stroke promise to significantly improve outcomes for patients,” says an article in the CMPA Perspective in their September 2015 newsletter. CMPA (Canadian Medical Protective Association) advises physicians on medico-legal issues.

The most important thing is prompt recognition of signs and symptoms of stroke. Often the benefits of these advances are best realized if stroke is promptly recognized and treated. The efficacy of thrombolysis (clot busting drug) is up to 4.5 hours from the onset of symptoms and studies have confirmed the importance of the time to treatment for positive outcome.

Ischemic stroke (stroke due to a blood clot) is a medical emergency. It requires fast and effective collaboration between a neurologist and radiologist.

Stroke is the second leading cause of death. Stroke affects people of all ages. The lifetime risk of overt stroke is estimated at one in four by age 80 years.

There are two types of stroke, either ischemic (in 85 per cent of cases) or hemorrhagic (in 15 per cent of cases). Hemorrhagic strokes are divided equally into intracerebral hemorrhage (bleeding in the brain) and atraumatic subarachnoid hemorrhage (bleeding in the lining of the brain).

The public can be taught to recognize and act upon stroke using the acronym FAST, for facial droop, arm drop, speech disturbance and time. There may be other symptoms too.

A review article in the Canadian Medical Association Journal (CMAJ September 8, 2015) says, “The most important historical feature of stroke is the suddenness of its onset. Identification of a stroke syndrome is relatively easy: sudden onset of acute neurologic symptoms, peaking within a few minutes, is deemed a stroke until proven otherwise.”

In a review of cases, CMPA found that the biggest issue was the difficulty of early diagnosis. Most patients first present in a hospital emergency. Some went to their family physicians or a walk-in clinic.

More than a quarter of the patients died. Another 40 per cent were left with permanent disability. That means about 70 per cent of the patients who have a stroke either died or became permanently disabled. That is not a very good outcome.

Research suggests that about 10 per cent of the cases are not diagnosed initially because the patient presents with atypical symptoms. In the cases reviewed by CMPA, the most common symptoms were headache, dizziness, nausea and vomiting.

A full clinical exam is important and patient should be observed. If symptoms deteriorate then further evaluation should be done. Special attention should be given to patients who have risk factors like smoking, obesity and hypertension.

Thorough clinical evaluation is important. You cannot solely rely on CT scan. In ischemic stroke CT scan is quite often normal in the first 24 hours. In case of subarachnoid hemorrhage the CT scan will be positive in the first six hours but this number drops to 85 per cent if the CT is done after six hours.

Rapid clinical diagnosis, urgent CT scan and urgent use of clot busting drug within 4.5 hours is critical in achieving positive outcome in ischemic stroke.

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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Sibling Rivalry can be a Source of Anxiety for Parents

There is strength in unity. Boating in North Glenmore Park, Calgary. (Dr. Noorali Bharwani)
There is strength in unity. Boating in North Glenmore Park, Calgary. (Dr. Noorali Bharwani)

“Siblings that say they never fight are most definitely hiding something,” says novelist Lemony Snicket.

If you look at it in a positive way, sibling rivalry is a type of competition. It can be a healthy rivalry. If it goes in a negative way then rivalry creates animosity and nightmare for parents.

There are several factors involved in how the siblings bond. Siblings generally spend more time together during childhood than they do with parents. As they grow the relationship is often complicated and is influenced by factors such as parental treatment, birth order, personality, and people and experiences outside the family.

If the children are very close in age and of the same gender and/or where one or both children are intellectually gifted then the relationship can be complicated.

Listening to your children fight with each other can be frustrating. As parents what can you do to create harmony? Problem comes when parents start taking sides. Things become more difficult if you have more than two children.

So I did some reading to see what the experts have to say. Here is the summary:

  1. Accept the fact that if you have more than one child there is going to be sibling rivalry. If the rivalry is healthy then it creates healthy, smart, happy family.
  2. Parents should learn to know when and how to intervene when siblings have a conflict. Taking sides is totally unnecessary and can be counter productive. You cannot have one favourite child out of two or more children you have.
  3. Parents should remember sibling rivalry typically develops as siblings compete for their parents’ love and respect. That is natural part of growing up. Rivalry also depends on children’s age, sex and personality, the size of the family, whether it’s a blended family, and each child’s position in it.
  4. As children grow parents find out that each child has unique habits and needs although they have genes from the same parents. Learn to respect each child’s unique needs.
  5. Parents have a tendency to compare their children’s achievements and disappointments. Avoid comparisons. Comparing your children’s abilities can make them feel hurt and insecure. Each child is born with unique gifts. Parents should learn to understand this and nurture them.
  6. Parents should learn to listen to their children. They should encourage their children to talk to each other and learn to understand and appreciate each other’s successes and failures. Family dinners also provide opportunities for talking and listening.
  7. Never forget to compliment your children when they behave well, have success in their endeavors, are playing well together or working as a team. Encourage good behavior.
  8. Show your love. Spend time alone with each of your children. Do special activities with each child that reflects his or her interests. Remind your children that you are there for them and they can talk about anything with you.

I am sure there is more to parenting than just eight points mentioned here. I feel the most important point is to give each child unconditional love. They will never forget that. I am sure they will pass that unconditional love to their children.

Long live good parenting.

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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Pregnancy and the Risk of Traffic Collision

Washington Monument at the National Mall in Washington, D.C. (Dr. Noorali Bharwani)
Washington Monument at the National Mall in Washington, D.C. (Dr. Noorali Bharwani)

The Canadian Medical Association Journal (CMAJ March 1, 2016) has awarded its top research honour to the authors of a study that showed women face an increased risk of serious car accidents during pregnancy.

Dr. Donald Redelmeier and his colleagues are the recipients of the Bruce Squires Award for their article “Pregnancy and the risk of a traffic crash,” which showed that pregnant drivers were 42 per cent more likely to have a serious collision that resulted in an emergency department visit. It generated the most public interest of any CMAJ research paper in 2015, says the CMAJ article.

Redelmeier’s team analyzed the health records of 507 262 Ontario women who gave birth between April 1, 2006 and March 31, 2011. The researchers found that the risk of a serious crash peaked in the fourth month of pregnancy, and was higher in the afternoon and in complicated traffic. It affected pregnant women regardless of their background, whether they had been pregnant before, or whether they were carrying a boy or a girl, says CMAJ article.

The authors concluded that pregnancy is associated with a substantial risk of a serious motor vehicle crash during the second trimester.

The World Health Organization classifies maternal deaths due to traffic crashes as coincidental and not related to the state of pregnancy. Others have argued that pregnancy is the root cause of such deaths, because pregnant women are more susceptible to crashes.

In 2014, CMAJ published a commentary (July 8, 2014) on Redelmeier’s research. The title of the commentary was “High risk of traffic crashes in pregnancy: Are there any explanations?” The commentary touched on several likely explanations. Here is the summary:

  1. Driving requires a high level of concentration and cognitive ability to maintain and complete a number of complex tasks. If there is any impairment in the driver’s cognitive ability, there may be an increased risk of a crash.
  2. The physiologic changes of pregnancy have been shown to increase fatigue and sleep deprivation in pregnant women.
  3. Prospective study using self-reported questionnaires showed that sleep length began to decrease during the second trimester and quality of sleep worsened during pregnancy.
  4. Maternal stress is also a common feature of pregnancy.
  5. Drivers who experience sleep deprivation, stress or fatigue will have an increased risk of a car crash.
  6. If busy urban areas are harder to navigate and require greater concentration in driving, then fatigue, tiredness and stress are likely to have a greater impact on the risk of a crash in urban areas.

There is no doubt studies have shown an increased risk of motor vehicle crashes among women in their second trimester of pregnancy.

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