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Merits of Having an Annual Physical Examination

Fishing – one way to relax and stay healthy. (Dr. Noorali Bharwani)
Fishing – one way to relax and stay healthy. (Dr. Noorali Bharwani)

Most health conscious adults get a yearly physical examination. Sometimes people wonder whether it is worth going through the process on a yearly basis – especially if you have no health issues.

An article in the Canadian Medical Association Journal (CMAJ November 4, 2014) discusses the pros and cons of such a yearly ritual (The periodic health examination in adults by David Ponka). The main purpose of this yearly ritual is for screening and preventive purposes.

This ritual dates back to at least the industrial revolution, when employers paid for annual check-ups to keep their labour forces healthy, says the CMAJ article. Now the practice has become one of the duties of a family doctor to keep the patients healthy. Interestingly enough, it is not an insured service in all provinces.

The question usually asked by the people who consider this an unnecessary expensive yearly ritual is, “Does it keep the adults healthy?”

The answer to this question is unclear, says the article. Some countries, such as the United Kingdom and Germany, encourage yearly physical examination for otherwise healthy adults aged 40–75 years. The reason being that this group has an increasing burden of lifestyle and chronic diseases that may be amenable to intervention. In Canada, the trend is toward reducing or eliminating the use of such yearly rituals in adults. One way is to disallow coverage by the health insurance plan.

There are some advantages to yearly physical examination for high-risk patients compared to low risk patients. The annual visit to a doctor provides opportunity to perform evidence-based preventive tests, to counsel patients on lifestyle issues, update vaccinations and, importantly, to identify risk factors and diagnoses through updating the patient history, says the article.

There is no scientific evidence to show that the annual physical examination reduces sickness and death in the community. On the contrary the annual ritual may lead to too many blood tests, chest x-rays and ECGs, exposing patients to the risks of investigation, such as false-positive results and over diagnosis.

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures. They have a very interesting website. You can Google it. It’s recommendations on periodic health examinations are:

-Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient.

-Don’t order screening chest x-rays and ECGs for individuals with no symptoms.

The article says that the value of a regular (not necessarily annual) physical examination may lie in other factors like:

-To assist marginalized groups who would otherwise not attend regularly

-It may also assist in efforts around management of chronic disease and over medication.

What do you think? If you are not sure whether you need an annual physical examination then discuss with your family doctor. Greetings for the holiday season. Be safe and eat less.

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Obesity is a Disease that Reduces Life Expectancy

People jogging. (Dr. Noorali Bharwani)
People jogging. (Dr. Noorali Bharwani)

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2). Ask your doctor where you stand.

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off. Habits that have been ingrained in your system since childhood.

Obesity is most commonly caused by a combination of excessive eating, lack of physical activity, and genetic susceptibility with hormonal or psychiatric disorders. Obesity increases the likelihood of various diseases, particularly heart disease, type-2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

What is the solution? Is there a way to stop this epidemic of obesity, which is a disease, a medical condition?

A political solution is needed, just like the laws against smoking, says an article in the Canadian Medical Association Journal (CMAJ November 18, 2014) titled, “A political prescription is needed to treat obesity” by Fletcher and Patrick.

Last year, World Health Organization (WHO) member states declared a target to stop the rise in obesity by 2025. A report from the Global Burden of Disease Study on global, regional and national trends in overweight and obesity has shown that obesity is still increasing worldwide, including in Canada, particularly among young people.

Governments must recognize that individual-level interventions, nutritional advice and activity guidance are not working, says the CMAJ editorial. Obesity will only be curbed by population-level measures supported by legislation. There is no disagreement among experts that physical activity is not enough to prevent or treat obesity, unless it is combined with some kind of dietary intervention.

The editorial says family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy.

Bariatric surgery (surgery for obesity) has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort.

Drugs to suppress your appetite may work to some extent, but may have nasty adverse effects.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level, says the editorial.

Experts agree there is no single solution to the problem of obesity. We should help people make better choices. People are addicted to sweet and high-fat foods that are inexpensive and easily available. We need to change our approach, says the article.

We should encourage school-based nutrition and activity, incentives for active commuting, restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products.

The editorial concludes by saying, “Our government needs to act to restrict the sale of high-calorie and nutrient-poor food products or reduce the incentive to buy them through increasing their prices via taxation.”

Can you think of a law that will make us exercise more, eat less and eat healthy? If yes, then a Nobel Prize may be waiting for 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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Walking is Good for Balance and Preventing Falls

A dog waiting to go for a walk. (Dr. Noorali Bharwani)
A dog waiting to go for a walk. (Dr. Noorali Bharwani)

November is senior’s falls prevention month. Studies have shown that walking is good for balance. A good balance does help prevent falls.

Walking is not always easy. Changing weather and flu season is a hindrance to establish consistent walking habit. Icy roads and sidewalks are dangerous. People find indoor areas like malls and indoor walking trails in places like YMCA very helpful.

We do have many good days in spring, summer and fall. The majority of the people should be able to walk to most of the places. But the problem is we are always in a hurry to get to our destination and then rush back home. We never seem to stop and ask, “Why am I rushing? Why cannot I take my time and enjoy the walk?”

You can walk leisurely 30 minutes a day for general health benefits. You can walk briskly to improve cardiovascular fitness by walking 30 minutes a day five days a week. If you are trying to lose weight then you need to walk briskly for 45 to 60 minutes a day five days a week. And make your dinner slimmer.

Get serious about your walking. Pedometers are the easiest way to keep track and log your daily activity. UWALK recommends the Piezo StepX pedometers, however any pedometer will work – see UWALK website. You can also track and log your daily activity using other activity monitors.

In the United Kingdom and Ireland, the term walking is used to describe both walking in a park and trekking in the Alps. However, in Canada and the United States the term for a long, vigorous walk is hiking, while the word walking covers shorter walks, especially in an urban setting, says UWALK website.

Scientific literature suggests that regular, brisk exercise of any kind can improve confidence, stamina, energy, weight control and life expectancy and reduce stress. It can also reduce the risk of coronary heart disease, strokes, diabetes, high blood pressure, osteoporosis and other health problems.

There is no doubt or any disagreement in scientific literature that sustained walking sessions for a minimum period of 30 to 60 minutes a day, five days a week, reduce health risks and have various overall health benefits – physical and mental. Walking is seriously encouraged because these days people walk less than they used to. If you are not a regular walker then it is time to start. For seniors it certainly helps prevent falls.

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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Is it Safe for Pregnant Women to Drive?

A lonely tree at Police Point Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)
A lonely tree at Police Point Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)

I found an interesting article in the Canadian Medical Association Journal (CMAJ July 8, 2014) regarding the above subject. Dr. Donald Redelmeier and his colleagues author the research paper titled, “Pregnancy and the risk of traffic crash.”

When a woman is pregnant there are a number of changes occurring in the body. These changes may contribute to increased driving error. The authors of the CMAJ article compared the risk of a serious motor vehicle crash during the second trimester to the baseline risk before pregnancy.

The authors analyzed women who gave birth in Ontario between April 1, 2006, and March 31, 2011. Certain groups of women were excluded from the study. The primary outcome was a motor vehicle crash resulting in a visit to an emergency department.

After analyzing all the data from the study, the conclusion was that pregnancy is associated with a substantial risk of a serious motor vehicle crash during the second trimester. The authors further suggested that this risk merits attention for prenatal care.

In a commentary associated with the article under the title, “High risk of traffic crashes in pregnancy: Are there any explanations?” Stephen J. McCall, and Sohinee Bhattacharya say that 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.

McCall and Bhattacharya make the following key points in their CMAJ commentary:
-Normal physiologic changes during pregnancy may increase sleep deprivation and stress, which may increase the likelihood of human error.
-Epidemiologic studies have shown an increased risk of motor vehicle crashes among women in their second trimester of pregnancy; these studies should be interpreted with caution because data on duration and frequency of driving, and on shared responsibility for crashes, were lacking.
-Further research into the biological mechanisms that may link pregnancy to car crashes is warranted.

So, like many things in medicine the jury is still out debating whether we should allow pregnant women to drive, especially during second trimester. Suffice to say whether you are male or female, pregnant or not, just drive carefully.

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