New Year’s Resolution

Ring out the old, ring in the new,
Ring, happy bells, across the snow:
The year is going, let him go;
Ring out the false, ring in the true.

-Lord Alfred Tennyson (1809-1892)

Somebody asked me the other day, “Eh, doc, what is going to be your new year’s resolution?”

“Good question, I haven’t given it a thought yet!” I replied.

Then came an e-mail from a gentleman who wants to meet with me. He liked my column titled “Walking and my Grandma”. He wants me to take this subject one step further.

So, I met him last week. His name is Rob Gardner. He is a soft spoken, persuasive, enthusiastic, Community Education Coordinator for Canadian Diabetic Association (CDA). Currently, he is enrolling Medicine Hatters into CDA’s diabetes prevention program called “Keep Your Body in Check.”

“Rob”, I asked, “why do I need to enroll in this program? I don’t have diabetes.”

Gently, he put a small colorful flyer on my hands. He said, “Doc, this was mailed to everybody in Medicine Hat. Did you get one?” I could not recollect getting one. Have you looked at all the flyers which have come to your mail box this month? I haven’t!

Rob asked me to look at the question on the other side of the flyer. The question is: Are you at risk for type 2 diabetes?

The pamphlet says yes, I am at risk for type 2 diabetes if I am over 40, overweight (especially around my middle), or am of aboriginal, Hispanic, Asian, south Asian or African descent.

Yes, I am at risk if I have a parent or sibling with diabetes, if I have high cholesterol level, or I have high blood pressure or heart disease.

Yes, I am at high risk if I have given birth to a baby over four kilograms or had gestational diabetes.

I realized immediately that I had more than one risk factor for type 2 diabetes. I didn’t have to be a rocket scientist to know that. So, I enrolled in the diabetes prevention program.

Just like a good Santa, Rob gave me a box full of goodies – all free. Like an excited little boy, I opened the box. I was pleasantly surprised to see a pedometer (step counter), with a log book, a nice t-shirt, and a measuring tape to measure my waist. All free!

So, I knew what my New Year’s resolution was going to be – to keep my body in check and prevent type 2 diabetes. You can do the same, whether or not you have any risk factors. It is a good program to stay healthy. It is very easy to enroll and the gift box will arrive by mail. Use one of the following options to enroll:

-toll free number 1-866-533-7462 or
-the website www.keepincheck.ca or
-phone Rob Gardner at 403-529-4729 or
-e-mail him at rob.gardner@diabetes.ca

Mention that you read about this program in “What’s up doc?” column then Rob will give you an extra gift! Unfortunately, this program is only for people with Medicine Hat postal code. So, hurry up!

In case you missed my column, “Walking and my Grandma” then you can find it on my website: www.nbharwani.com and search under “Articles” or phone my office 527-0099 for a copy. In 2005, this column will run on Tuesdays.

Have a happy and wonderful 2005. And don’t forget Rob Gardner and keep your body in check!

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

Looking Back to 2004

If you believe the doctors, nothing is wholesome:
If you believe the theologians, nothing is innocent:
If you believe the soldiers, nothing is safe.
Lord Salisbury – (1830-1903).

It is time to look back to 2004.

Most of us are worried about our health. What did 2004 do for us? Did we make any significant gains to achieve good health? Did medical science make any progress in that direction?

Viox has gone off the shelves after initially being promoted as the magic drug. Looks like Celebrex and other painkillers will go the same way. These events remind us once again that medicine is an imperfect science, clouded with uncertainties

We have experts in all kinds of fields. But experience of life teaches us that we should be careful of what the experts have to say. An article in the British Medical Journal (BMJ) says, “Despite the exponential growth of medical information, the effects of healthcare interventions are often uncertain or controversial.”

I cannot recollect any major scientific breakthrough this year that changed medical practice in a positive way. Most headlines related to medical practice were of negative nature – withdrawal of Viox, outbreak of diarrhea in Calgary and Montreal, shortage of flu vaccine in US etc.

We continue to fight the old battles against obesity (including trans-fatty acids), smoking, cancer, heart disease and trauma. These are the big five causes of most diseases and disabilities in our society. This has not changed in 2004.

The editors of the journal Science have put out a list of top 10 scientific achievements of 2004. But the list does not contain any medical breakthrough to improve our health in the immediate future. For example, here are the top three scientific achievements of 2004:

The most important scientific achievement was the landing and discovery of water on Mars by NASA’s two rovers, Opportunity and Spirit.
The second was the discovery on the Indonesian island of Flores of fossils from a species of tiny humans. These humans were one meter tall with a brain less than one-third the size of modern humans. They lived about 18,000 years ago.

Third most important scientific achievement was the cloning of human embryos by South Korean researcher Woo San-hwang and his colleagues.

Why progress in medicine is so slow?

According to the BMJ article the major hidden barriers to better health care:

-uncertainty as a result of lack of convincing evidence because of delayed or obsolete data from clinical studies;

-uncertainty about applicability of evidence from research to the patient’s bedside;

-and uncertainty about interpretation of data.

Because of these uncertainties, there is overuse, misuse and sometimes underuse of medical technology with associated errors. Patients undergo excessive investigations and sometimes inappropriate treatment.

The BMJ article asks, “Can the fog that enshrouds the medical practice be lifted?”

Yes, the article says, if we can find evidence that is judged to be important for practicing doctors. Unfortunately, most existing evidence is irrelevant or unreliable.

Yes, if we can train doctors to make decisions under uncertainty.

Yes, if our leaders and the public understand the inherent limitations of medical knowledge and the role of research in reducing uncertainty.

Unfortunately, uncertainty influences virtually all of medical decision making. And this has not changed in 2004. So, we just have to keep fighting the old battles!

Thought for the week:
To like and dislike the same things, that is indeed true friendship.
-Sallust 86-34 BC

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

Looking Ahead To 2004

The best years of your life are the ones in which you
decide your problems are your own.
You do not blame them on your mother,
the ecology or the president.
You realize that you control your own destiny.
– Albert Ellis

Well, 2004 is here. And it is going to be here for the next 365 days. So, what are you going to do to stay healthy and happy and perhaps control your own destiny in areas of mental and physical health?

It’s a simple question. Can we find a good and a simple answer for you? Let us give it a try!

First, you need to take stock of your current situation. Then you need to have some idea of what you expect to achieve in the next 363 days (two days have already gone by!).

Do you have any risk factors – genetic, environmental, or lifestyle habits – which make you prone to mental and physical ill health? If yes, then you need to take actions to reduce these risks factors and if possible to eliminate them.

If you do not have any risk factors then you need to take actions which will keep you healthy and happy for many years to come.

As we know, our health is determined by many things. Our genes play an important role. So do our environment and the lifestyle we choose to pursue.

About hundred years ago, many lives were lost in infancy and childhood or before the age of 50. This was due to malnutrition and infection.

Since then we have made progress. Now a child born in Canada can expect to live to about 80 years. Many factors have contributed to our longevity – improvement in nutrition, public hygiene, discovery of antibiotics, introduction of immunization programs, newer and better methods of understanding, diagnosing and treating many illnesses.

Now we seem to take life for granted – especially in the industrialized and affluent countries we live in. Very few people die of infection or malnutrition. Instead we have an epidemic of obesity – which leads to diabetes, heart disease and other illnesses and disabilities.

The prevalence of diabetes in Canada is increasing. The proportion of Canadians with diabetes rose from 3.4 percent in 1994/95 to an estimated 4.5 percent in 2000/01.

Heart disease, stroke, cancer and lung diseases (most of them related to smoking) take its own toll. Use and abuse of alcohol costs our health care system billions of dollars. A British government sponsored report found that “average drinkers” today are consuming 150 percent more alcohol than their counterparts did 50 years ago.

Motor vehicle accidents and other types of accidents kill and disable many of our young people.

So, is this how life is going to be? Or can we change it? Or can we be selfish enough to keep ourselves and our families out of trouble?

We cannot change our genes. But we can make a contribution to improve our environment. We can try and reduce stress and make better lifestyle choices. Yes, lifestyle choices! Healthy lifestyle choices.

Here are few suggestions – eat right, exercise regularly, get enough sleep, quit smoking, wear a seatbelt, drive carefully, and watch your alcohol intake. Make time for laughter, meditation and family.

Making changes is not always easy. But one has to make a commitment and go for it. You may have to make some sacrifices but in the long run it will be a good investment.

It is estimated that if you live up to 80, then the last 10 years of your life will be spent fighting some sort of disease or disability. This burden may be reduced if we take care of our health during our better days.

So, 2004 is here. And you have to make some choices – yes, choices. Make sure they are healthy ones!

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

New Year’s Resolutions

Are you one of the millions of people who is planning to go on a weight reducing diet soon after New Year’s eve party? Are you excessively infatuated with being thin?

Are you a retired, non-smoking, healthy man who is wondering: Am I going to live long enough to enjoy my retirement?

Read on to see who is saying what in the medical journals!

Losing Weight – An Ill-Fated New Year’s Resolution:

It is a well known fact that come January, within few days to few months, most people will give up on their New Year’s resolution to lose weight. Why? Because losing weight and sustaining the loss is a difficult task. This leads to guilt and self-hatred.

An Editorial, published in the New England Journal of Medicine on January 1st, 1998 estimates that at any given time, 15 to 35 per cent of Americans are trying to lose weight. They spend about $30 to $50 billion yearly on diet clubs, special foods and over-the-counter remedies. These remedies are not always harmless.

Why do people want to lose weight? First, there is enormous social pressure to look thin. Second, being overweight has some health risks: heart disease, high blood pressure, diabetes, and a variety of other problems.

Why is it that some people cannot lose weight? The old view is that if intake of calories is more than expenditure then the weight goes up. The new view is that there is a “fairly stable set point for a person’s weight that is resistant over short periods to either gain or loss, but that may move with age.”

This set point can be changed with extreme measures like diet and exercise. But when this measures are discontinued then the body weight returns to its original level. Heredity also plays a significant role.

So, what is the best approach to weight control and staying healthy?

Prevention!

“Encouraging lifelong, regular exercise in children may well have the greatest effect in terms of preventing obesity, as well as numerous other benefits,” say the authors. This should be combined with healthy eating habits.

What about those who are already overweight? In authors’ views, overweight people should be advised to lose weight if only it would be required to improve their health or if they ask for help.

Want to live longer after retirement?

A study published in the New England Journal of Medicine says that, “Encouraging elderly people to walk may benefit their health.”

Among the 707 men included in this study, the average distance walked was about 2.9 km (1.8 miles) per day. These men had 12 years of follow-up.

Results? Those who walked less than 1.6 km. (1 mile) per day, the death rate was 43.1 per 100 men. For those who walked more than 3.2 km (2 miles) per day the death rate was more than halved (21.5 per 100). Age had negligible effect on the out come. Time for another New Year’s resolution?

Wait a minute! Consult your doctor before you go wild!

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