Tag: travel

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Trip to Jamaica! – Evidence Based Medicine

You see a doctor for a medical problem. He advises you to follow certain treatment. Do you ever ask him: Doctor, is there any scientific evidence to show that this treatment works?

Most of us trust our doctor and are too polite to ask him such a question. Instead we rely on our neighbors, friends and families to give us a second and a third opinion.

Those who are computer literate surf the internet. But you know what happens there – there are thousands of references to search for an answer.

What do doctors do when they are looking for best evidence in their practice?

Doctors go back to their text books, read medical journals, talk to their colleagues, have case conferences in hospital or attend medical meetings at exotic places.

My surgical associate, Dr. Brzezinski and I just got back from Montego Bay, Jamaica where we attended a two day conference on Evidence Based Medicine in Gastroenterology.

It was a very interesting conference. The location was beautiful – an ideal environment to learn something! The warm ocean breeze, carrying important scientific knowledge, penetrates your brain without difficulty!

There were experts from Europe, Canada and Jamaica. Main discussion was on the problems of the esophagus and stomach.

As I have said many times here, medicine is an imperfect science. Quite often the practice of medicine is an art than science. And the discussion at the Jamaican conference again confirmed that.

Only about 10 to 20 percent of what we do in medicine is evidence based. That means it is scientifically proven. The rest is based on what each one of us think is correct, what we think is best for a particular patient, it is economical and safe.

The advantage of evidence based medicine is that it helps optimize patient care and minimize variation in best practice.

The problem is that in most cases there is not enough evidence available. The clinical decision making is a very complex process because no two patients respond to a treatment in exactly the same manner.

Therefore, evidence based medicine in clinical practice is quite often not relevant.

But in spite of imperfections in medical practice, we continue to treat hundreds and thousands of patients each day. Most of them do well and respond to treatment.

Some get better just by talking to a sympathetic doctor.

Some get better by taking an aspirin and going to bed.

Some get better by doing nothing – may be a shot of brandy. Or Jamaican style – don’t worry, be happy.

Some get better by following the principles of ELMOSS – exercise, laughter, meditation, organic/healthy food, stress relief, and by giving up smoking.

But eventually, most people do get better. Time is a good healer – unless you are suffering from an incurable disease.

So, medicine is not a rocket science. But you have to know the human anatomy, physiology, pharmacology, and pathology. Then you have to put all this knowledge together and pass few exams. Then you can call yourself a doctor of medicine and surgery!

Isn’t that easy? It just takes 10 to 15 years of your life. Then you start practice and find out that only 20 percent of what you practice is based on pure science! But you can say – I have been to Jamaica!

Seriously – next time you are sick………………well see your doctor first!

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Captivating Venezia (Venice)

I first read about Venice (Venezia), Italy when I was in high school in Tanzania. We were reading William Shakespeare’s Merchant of Venice. I never thought that one day I would get a chance to visit Venice, described by some to be the most beautiful and the most captivating city in the world.

It was last summer, we arrived at Venezia Santa Lucia train station on a Wednesday at 4.00 p.m. We had left Geneva at 9.05 a.m. So it was a long day. But traveling first class with prior reserved seats made the journey very comfortable.

As soon as we came out of the platform, we were approached by several “hotel agents”. We had booked our hotel which was supposed to be a walking distance from the railway station. But, in which direction? As we tried to make our way through these agents, a middle-aged man stopped us and said he was there to help us (i.e. tourists).

We gave the name of our hotel and he gave us the direction. The hotel was on the other side of the Grand Canal. As we came out, we could see the hotel from the railway station. But we had to carry our luggage and walk over a bridge which had lots of steps! I knew it would take more than five minutes to get there.

Venice is one of the most unusual places on earth. It is divided by a 1.8-mile-long waterway called the Grand Canal (Canal Grande). The canal is a magical highway – never fades. It divides the city in two and is crossed by three bridges.

Along the banks of the canal are the palazzi, or palaces, which were built by wealthy merchants and their families. Most of these were built between the 12th and 18th centuries. The owners decorated these palaces as a dazzling display of their power and wealth.

No cars, taxis, motorcycles or trucks are permitted within the city of Venice. If you arrive in a wheeled vehicle to Venice then you have to leave your vehicle in a parking lot on the outskirts of the city. From there you enter Venice by boat or on foot.

Venetians use boats instead of cars to travel through the town, because there are more waterways than walkways. There are water taxis and water buses. Instead of streets, there are 120 canals. There are traffic lights as well. And there is water police, enforcing law and order and traffic control. Docks and bridges connect the canals to the land.

Water bus, water taxi or gondola drops you off to the landing point nearest your destination then you have to walk. There is lot of walking to do.

To build houses and office buildings is not easy. First, you have to drive wooden poles, called pilings, deep into the firm clay of the lagoon. Then timbers are attached to the pilings and buildings are constructed over them.

What did we do?

Out of our three weeks in Europe, we had kept two nights for Venice. That came down to one evening and one full day. We knew that would not be enough. But we wanted to have a glimpse of the city and see what it is all about – how do people travel and work and live in this unusual city.

After we checked-in in our hotel, we decided to explore the surrounding areas by foot. The canal is like a busy highway during the day time. As the darkness arrives, the city gives an aura of romance as reflected lights twinkle on the water. There are multitudes of shops and restaurants catering to the tourists who flock this place like birds. Of course, nothing is cheap. Even pizza is expensive!

Next day, after breakfast, we were offered free water taxi (compliments of Murano Gallery) to visit the island of Murano and the Murano glass factory. We took up the offer and spent couple of hours at the gallery. Glass is a true Venetian specialty, made for centuries (since 1291) on the island of Murano. The furnaces were moved away from the city as a fire precaution.

There were eye popping, breathtaking colorful glass pieces from very small to giant size glasses, stemware, bowls, vases, chandeliers and other artifacts. No photographs were allowed inside the gallery. Nothing there was within my prize range! The sales person, who gave us a guided tour, was very persuasive. But we resisted the temptation.

From Murano, we took a water taxi to San Marco square. It was full of tourists. It is a beautiful open space. We took a stroll around the square and saw many monuments which have played important role in the development of Venice. The important monuments are: a 15th century Torre dell’Orologio (Clock Tower) and its zodiac clock, the beautiful Libreria Sansoviniana (Sansoviniana Library) and two columns near the waterfront, topped by the lion of St. Mark and St. Theodore with his crocodile emblem.

We took a day pass for the water bus and did some more site seeing of our own. There are many guided water-taxis and walking tours available. For example, Casanova and the Age of Decadance focus on the life and times of Casanova. A time of illegal gambling parlors, of masked courtesans and spies, of corruption and political intrigue.

Other tours show you the Jewish Ghetto and life of Marco Polo. Rialto and Merchant of Venice and Venice Ghost Walk, where the ghosts of the past and present day will keep you company as your guide will tell the stories as you walk along the dimly lit deserted streets of Venice – as your shadows get longer, you can hear the foot steps coming behind you!

We managed to cover a lot of Venice walking and using the water bus pass – very economical way to do it if you go with your family. It was a hot day. After a brief afternoon rest at the hotel we took a Grand Canal Boat Tour at 5.30 pm (there is another one at night at 9 pm). That was great fun – maximum of eight people in a luxurious motor boat lasting 70 minutes. It takes you through the Grand Canal and some lesser known canals.

As the darkness fell, we went on our walk along the canal near the railway station. They are open till late in the evening.

After a good night’s sleep, it was time to pack and walk to the railway station. Our next stop was Florence. We felt we needed more time to enjoy this beautiful and unusual city. A day and a half was worth it but not enough! One day, we hope to go back.

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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Leaning Tower of Pisa

Damn cheap architects!

In July/August, I went to Europe with my family. We visited London, Oxford, Paris, Geneva, Venice, Florence, Pisa, Rome and Vatican City.

It was interesting to visit the Leaning Tower of Pisa. Its construction began in August of 1173. It took about 200 years to build with couple of long interruptions. Towers inclination started when the third floor was built – it has eight floors. In the last couple of years, steps have been taken to reduce the inclination. It is again open to public. The tour guide told us that it is now good for another 300 years.

The more I looked at the Tower the more it reminded me of our health care system. It has been in crisis since I joined the system 17 years ago. Like the Tower, the health care system is expected to collapse anytime but continues to survive with lot of band-aid solutions and Royal Commissions. I would not be surprised if it outlasts most of the present generation of doctors.

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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My Summer Holiday

Holidays are wonderful. They do wonders to our mental and physical health.

In the previous column, we talked about the advantages of taking a holiday. Holidays take us away from our daily chores and problems to a life of fun, freedom, happiness and family bonding. Holidays recharge our batteries and give us a different perspective to our daily life.

But sometimes we forget that even the best-laid plans can go wrong. Not because we did not do our homework, but the parties who promised to make our holiday a success fail to keep up to their end of the bargain. And if we are not careful then the experience can be very demoralizing. Allow me to share with you my recent experience.

Our recent holiday was planned to cover five cities (Ottawa, Quebec City, Montreal, Toronto and Niagara Falls) in two weeks, staying at four different hotels.

My wife had diligently planned the holiday with help from our travel agent. She booked our airlines tickets about three months ahead of time. At the same time the hotels were booked, confirmed and rooms guaranteed with credit cards. Special requests were made on the type of rooms we wanted. A rental van was also booked, and confirmation guaranteed with a credit card.

Since we like to have a trouble free holiday, a week before our departure, my wife phoned all the hotels we had booked with to reconfirm our bookings and requests for the types of rooms we wanted. July and August are busy months for the hotels.

On Canada Day, we (my family) drove from Medicine Hat to Calgary and then took a flight to Ottawa. After about twelve hours, we arrived in Ottawa at midnight. We went to the car rental agency to pick the van we had booked.

“Sorry Sir, we don’t have the van which you had booked. But we can give you an upgrade at no extra charge!” said the desk clerk. At midnight, after 12 hours of journey, with two tired children, was I supposed to be overjoyed that I was getting a free upgrade? I was not pleased. There was a special reason why we booked a van and not any other vehicle. I was too tired to do argue and settled for the free upgrade.

We drove to our hotel and got there at about one in the morning. The lady at the check in counter says to my wife, “Sorry, we don’t have any rooms for you for tonight. We will put you up at another hotel for one night at our cost!” So what was the purpose of our booking three months ahead of time and guaranteeing with a credit card? This is a four star hotel!

We checked in at the other hotel. It was two in the morning. Next day we got the rooms we had asked for at our original hotel but not before we made a big fuss with the Manager. We lost one day of our holiday by moving back and forth and talking to the front desk several times.

The rest of the holiday at the hotel and Ottawa was wonderful. Ottawa is full of Canadian history. A must for all Canadians to visit, specially school children. At the Canadian Museum of Civilization there is a display of Medalta Potteries and old photographs of the Medalta buildings.

Our next stop was Quebec City. We checked in at our four star hotel. Again they did not have the rooms we had asked for. Next day we talked to the desk Manager and he found the rooms we wanted. Why wouldn’t they give it to us when we checked in?

Quebec City is one of my favourite cities. Very beautiful and clean. They wash their streets everyday in the morning. They plant thousands of trees every year. Every new building has to have a piece of art or sculpture in front. We found the people very friendly. And every body we talked could communicate in English. It was a very enjoyable stay.

Our next stop was Montreal. Crowded and dirty. What a contrast from Quebec City! Culturally, Montreal is a very exciting place. They have hundreds of festivals each year. When we were there, they had just finished the Jazz Festival and were getting ready for Just for Laughs festival. We kept our stay brief and went to the next stop – Toronto.

Toronto is another busy and dirty city. There is lot to see, including the CN Tower. We had an interesting visit including a day of shopping! We spent a day at Niagara Falls. About an hour and half drive from Toronto. Niagara Falls is one of my favourite places.

The exciting Maid of the Mist boat tour takes visitors to the base of the American Falls and then on to the basin of the Canadian Horseshoe Falls. “It’s a half hour thrill of a lifetime,” says a tourist brochure. And I agree. It is also a photographer’s paradise. So many views and angles!

Finally, it was time to go home. Ready to work and pay the bills and plan for the next holiday! Inspite of the few glitches, we kept a positive attitude and paced ourselves. And returned home satisfied that we did everything we wanted to do.

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