I was prompted to write about this when, in the last week or so, a couple of patients presented with upper back-pain in between the shoulder-blades and dismissed them off as ‘muscular aches’. In both cases, they turned out to be impending heart attacks. So what kind of symptoms are produced when the heart’s in trouble?
The reality is not all heart attacks happen suddenly and dramatically as in a TV drama where you clutch your chest in pain and fall to the ground. In many instances, the warning symptoms appear but are ignored because they appear in unusual parts of the body and may fade off after a while, only to reappear again especially when the heart is stressed.
The classical symptom is that of central chest-pain or pressure, not unlike someone standing on your chest. But sometimes, the pain can be in unusual locations include jaw or teeth pain, leading to a visit (wrongfully) to the dentist. An alert dental surgeon can recognise the differentiating features and refer the patient on to the cardiologist for urgent attention.
Another location for heart-attack pain can be the so-called interscapular area (the part between the shoulder-blades), even without chest-pain. Often, the pain can be excruciating with possible pain-free intervals, leading one to a false sense of security with disastrous consequences; because time is crucial in such circumstances : the well-known ‘golden hour‘, named because early treatment during an evolving heart attack can mean the difference between life and death.
Pain need not always be present as a heart attack develops. Especially in diabetics, breathlessness can be the only symptom. Of particular note is progressive deterioration of stamina, such as walking up a staircase.
Getting treatment within an hour of a heart attack cuts your risk of dying from it in half, so it is important to get to the nearest Emergency Department of a large hospital in double-quick time. Sometimes it may be better to rely on one’s own transport than to wait for an ambulance if that’s going to save time.
Are there any useful measures to do while waiting to receive medical attention? Anecdotally, several maneuvers have been promoted on the Internet, many without a proven basis. There’s certainly no place for home remedies! Sitting up and facilitating breathing (loosening tight clothing) and at the same time calming the patient does help as it is well-known that anxiety aggravates the heart. If aspirin is available (even the ones for headaches), putting a tablet under the tongue will help to thin out blood and prevent clots from developing.
Personally, I have encountered several instances where people hesitate to go to the hospital for fear of embarrassment in case it turns out to be a false alarm. Others deliberately neglect to call help, fearing the worst, but hoping their inner fears may be wrong. In any case, an important rule of thumb is that it is better to be proven wrong at the hospital than to miss a heart attack. No medical staff is going to chastise you, for sure, if you’re wrong.
- 20 Classic Heart Attack Signs Never To Ignore (positivelygood.net)
I wasn’t too surprised reading the other day that health-related matters take up 2% of all queries on internet search engines. In fact, I thought the figure would be higher, judging from day-to-day conversations with patients.
The big question of course is: how reliable are the facts dished out on the Internet? Obviously, its important that these websites are reliable and churn out accurate information. Even so, healthcare information is complicated by a few other factors not related to the reliability of these websites, as explained later.
How do you identify reliable websites? First of all, as a yardstick, websites sponsored by the governments, not-for-profit health or medical organizations, and university medical centers are the most reliable resources on the Internet. Sites supported by for-profit drug companies, for instance, who may be trying to sell you their products, are usually not your best option. Also note that medical info changes rapidly with time and a look at the dateline of the article is important. Here are a few such sites:
Medlineplus.gov - sponsored by the National Institutes of Health and managed by the U.S. National Library of Medicine, MedlinePlus provides information on more than 900 diseases and conditions in their “Health Topics” section, and links to other trusted resources.
WebMD provides a wealth of health information and tools for managing your health from an award-winning website, which is continuously reviewed for accuracy and timeliness.
MayoClinic.com – owned by the Mayo Foundation for Medical Education and Research, this site is produced by more than 3,300 physicians, scientists and researchers from Mayo Clinic, and provides in-depth, easy-to-understand information on hundreds of diseases and conditions, drugs and supplements, tests and procedures.
Sometimes,even with reliable trustworthy information, its rather difficult for the untrained public to give due weightage to the complex info that is being bombarded onto them. For instance, when reading the side-effects of a particular medication, it is difficult to appreciate that not all the listed side-effects will invariably occur when one consumes the drug.
This is why its better to consult a doctor to obtain clarification. It takes years of medical training to adequately decipher fully what’s found on web health-sites and to fully appreciate its implications.
In fact, the over-reliance of info on the internet has given rise to a new condition called cyberchondria (aka internet self-diagnosis) – this refers to the practice of leaping to dire conclusions while researching health matters online. If that severe headache haunting you in the morning led you to the Web search-engine and a search on ‘headaches’ led to ‘brain tumours’ or ‘meningitis’, people tend to look at the first few results in the search-engine which forms the basis for them to probe further till they are convinced that they have a brain tumour. The likely diagnosis is probably cyberchondria than anything else! The phenomenon has become so pervasive that Microsoft did its own study on the causes of cyberchondria way back in 2008.
Some readers of this blog asked what they can do to prevent a stroke from hitting them. Plenty!
A very recent research study just released in the British Medical Journal by 4 authors, one of whom is a Malaysian classmate who now works in the UK, reveals 4 things that people can do to reduce the chances of getting a stroke by half.
The study, conducted in England involving 20,000 people over 11 years, showed that they could reduce the chances of getting stroke by 50% if they did all the following life-style measures:
- not smoking
- being physically active
- limiting their alcohol intake to not more than 14 units a week
- fruit and vegetable intake of at least five servings a day.
Apart from the above, it is well-known that the presence of the following risk-factors also predispose to stroke: high blood pressure, diabetes, high cholesterol, atrial fibrillation (irregular heart-beats), heart disease and certain blood diseases which cause clotting.
One does need to realise, however, that some risk-factors cannot be changed or eliminated. Try changing your age (the chance of having a stroke approximately doubles for each decade of life after age 55), sex (more common in men), your relatives( your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke) or the fact that you have had a previous stroke or transient ischemic attack (TIA, or warning strokes)!
The whole idea of getting away from stroke is to eliminate as many of the above risk-factors as possible and to lead a healthy lifestyle.
See my related article “Mending A Stroke In Time”.
Last month, it was reported that an American, Michael Boatwright was discovered unconscious in a Motel 6 room in California , but when he awoke could not remember anything about himself, recognize even his own reflection, nor how to speak English.
Even though his driver’s license says he was born in Florida and served in the U.S. Navy from 1971 to 1973, Boatwright has no memory of his life to date and now answers only to Johan and converses in Swedish to doctors with the help of an interpreter.
This brings to mind several similar cases in the past where apparently normal strangers have been seen to be aimlessly walking around in total amnesia, with no recollection at all on their name or background.
As in this case, the cause has been attributable to a medical condition called transient global amnesia - a sudden, temporary episode of short-term memory loss that cannot be attributed to conditions like epilepsy or stroke (which are known causes of temporary amnesia).
What causes this condition? Basically, any sudden stress to the brain, whether in the form of sudden immersion in cold water, physical strain, mental stress, head injury or even sexual intercourse. They tend to occur in those over 50 and who suffer from migraine. It is thought that in all of the above conditions, there is a temporary constriction of the blood vessels going to the brain, causing temporary brain malfunction.
The good news is that the condition is temporary and usually resolves within 24 hours. No treatment is required and the condition seldom recurs.
Back to Michael Boatwright. It turns out that the American had lived in Sweden in the 1980s where he learnt to speak good Swedish and was known as Johan Ek. He was identified by members of the Swedish branch of the Society for Creative Anachronism, where he was a keen participant of the group’s jousting team. So, mystery solved..
Its all very well for big pharmaceutical companies (pharmas) to release a new medication with a big bang , what with the enormous money invested in its research, development and production . However, not often enough, such new launches become unstuck when unexpected side-effects appear after a few months on the market, despite the most strenuous prelaunch testing and extensive marketing as a blockbuster-to-be.
Unexpected side-effects aside, what’s potentially more serious is when clinical trials (designed to prove a drug’s efficacy before its official launch) are falsified, thereby giving end-users erroneous data proclaiming (falsely) the drug’s efficacy. Such appears to be the case with regards to the Kyoto Heart Study.
What was the significance of this study? This study by Japanese scientists was greeted with great fanfare in 2009 and centres around the ability of a medication ,already extensively used for the treatment of high blood pressure, to reduce the possibility of getting stroke by 50% when used in high-risk patients. This was a milestone in drug treatment for hypertension and enabled the maker, Novartis , to make it one of the best-selling drugs in the world.
The drug itself, valsartan, which is marketed as Diovan has been on the market since around 2001 for the treatment of hypertension and belongs to the new group of ARBs (angiotensin-receptor blockers). In fact, its patent expired in 2012, thereby enabling any pharma to produce its own version, so-called generic drug.
And now the bombshell: Last Friday, Japan’s minister of health, Norihisa Tamura, as well as university officials at Kyoto Prefectural University announced that the Kyoto Heart Study data were “very likely” fabricated, Apparently, incomplete data was used and some of the scientific investigators were in fact employees of Novartis.
The reaction to this has been deafening. the respected European Heart Journal retracted the study from its 2009 issue. There has been widespread condemnation among medical circles, resulting in the resignation of the principal Japanese investigator from the Kyoto University, Dr Matsubara.
This episode puts into perspective the over-reliance of the efficacy of new medications on so-called landmark scientific studies, whose integrity may be subject to the temptations of big bucks and commercialism. Often, the losers are the consumers themselves.
Face-masks come in many shapes and sizes. One normally associates them with surgical masks, which is meant to prevent germs from the wearer contaminating the environment. However, the haze which is affecting Southeast Asia is another story..
The Southeast Asian haze event is caused by continued uncontrolled burning from “slash and burn” cultivation in Indonesia, and affects several countries in the Southeast Asian region because the prevailing southwesterly winds carry the pollutants across the water – see below.
What are haze particles composed of? Haze particles are predominantly made up of fine particles that are 2.5 micrometers or smaller. This means using an ordinary facemask, whether single-ply, 2 ply or 3 ply, hardly protects the wearer effectively from the haze particles Its designed to keep the germs in and should be worn by those having viral illnesses like flu. Nevertheless, ordinary surgical masks will reduce the inhalation of haze particles but NOT eliminate them completely.
To eliminate haze particles completely, one needs to wear a N95 mask (so-called because these masks eliminate 95% of particles as small as 0.1 micrometers (or microns). It must be tight-fitting and is rather uncomfortable to wear over long periods as extra effort is sometimes needed to inhale.
For this reason, the N95 mask is a must for those with lung problems, those with reduced immunity and those who have to be in the open for prolonged periods (like traffic cops).
For those who are otherwise healthy and stay indoors most of the time, ordinary surgical masks may be adequate. In all cases, adequate hydration is important mainly to facilitate the removal of the haze particles which have lodged in the lungs.
- Singapore’s Great Haze exposes limits of e-commerce (sgentrepreneurs.com)
If the latest manual in psychiatry is anything to shout about, ladies and gentlemen, we have quite a number of new mental illnesses to worry about. And maybe throw out a couple of outdated ones out of the window..
The Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, lists these changes. The American Psychiatric Association released its revised fifth edition of the manual recently, which serves as the official authority on mental health diagnoses (and related insurance claims).
Among the new entries are:
Compulsive Hoarding- a pattern of behavior that is characterized by the excessive acquisition of and inability or unwillingness to discard large quantities of objects that cover the living areas of the home. Read more here.
Excoriation (Skin-Picking) Disorder- Under the group of obsessive-compulsive disorders, this condition is characterized by chronic picking and scratching of the skin that can cause wounds and scabs. The condition can be associated with other disorders involving compulsive eating, buying and stealing. The problem is often treated with antidepressants, anti-anxiety drugs or other medications.
Caffeine Withdrawal- People who are grumpy before they’ve had their morning coffee may welcome caffeine withdrawal to the manual as a legitimate mental affliction. A controversial addition, the new diagnosis directly reflects our increasing dependence on caffeine, from the proliferation of Starbucks outlets to the growing array of non-coffee energy drinks and caffeine-injected alcoholic beverages.
Social (Pragmatic) Communication Disorder- With this addition to the manual, psychiatrists can now more precisely diagnose speech and written language problems that are unrelated to autism. Indeed, while symptoms of this disorder, which must date back to childhood, include “inappropriate responses in conversation” and difficulty communicating, the diagnosis can only be made after autism spectrum disorders have been ruled out. These problems often hamper people’s social lives, academic careers and job performance.
A few entries in previous editions have been taken out. “Sexual aversion disorder,” for example, has been retracted from legitimate diagnoses because of “rare use and lack of supporting research,” according to the APA. By the way, as an illustration of changing times and how time changes society’s values, until the 1970s, the manual listed homosexuality as a disorder.
2000 calories..that’s what an average-sized man requires in one day. I found this interesting video and it helps explain why there is so much obesity around.
The effects of the current outbreak of the H7N9 avian influenza in China has been as varied as causing the sales of KFC to drop and causing the stock-prices of rubber-glove manufacturers to be on the uptrend..but there’s no mistaking the fact that to date, there has been 9 deaths and 28 confirmed cases (see here).
But a mystery is brewing..the first known human case was in eastern China on Feb. 19, but this was not announced to the public until March 31, some 6 weeks later. This delay in announcement is even being questioned by the heavily censored news media, such as the Communist Youth Daily, the official newspaper of the Communist Youth League.
Was there deliberate concealment by the health authorities? The answer may not be that straightforward. Possible reasons for the delay may include that the new virus strain shows unusual properties and that Chinese laboratories might have been doing tests to detect the previous H5N1 strain instead. To recap, the H5N1 outbreak struck in 2003 where a total of 247 people died. Measures instituted at that time included the controversial administration of several million vaccines to the chicken population at a significant economic cost. This could also be a reason why the news has been suppressed.
Avian influenza (also called avian flu, bird flu) is a flu virus that infects poultry but can be transmitted to man by direct or indirect exposure to infected live or dead poultry or contaminated environments. It is generally classified of low virulence (it does not spread to man easily). There is no evidence that the disease can be spread to people through properly cooked food. You can get more info from the WHO Fact Sheet here.