Flying On The Wings of Stress

The seven leading causes of stress, according to a University of Washington study are finances, work, family, personal concerns, personal health & safety, relationships and death. I’m going to take it they left out flying.. because they forgot to ask anyone who’s taken a trip by air. Many will agree that taking a flight is one of the major causes of stress in modern everyday living.

The amount of stress involved in flying starts way before the actual flight, right on the ground itself. First and foremost, the long trip to the airport itself is fraught with stresses, from lack of timely taxis to traffic jams to  making sure the kids are ready on time. Even if you decide to take to take to the road yourself, there’s the outrageous airport parking charges and the distance they are located from the terminal..

Having reached the terminal, there’s the queues, the far-from-easy electronic check-in terminals and the extra charges, ranging from that for overweight baggage to really unexpected surprises – Ryan Air insists you print your own boarding cards and if you misplace yours, they’ll print it for you..for a fee, 40 British pounds to be precise.

Then there’s the security screening..more stresses if you have shoes with bootlaces or laptops. By the way, the liquids ban mean you need clear plastic bags which are now sold at 1 pound each at some UK airports. Departure delays..these are a way of life nowadays with airlines cutting back on flights due to bad times.

Despite Attempts to Improve Economy Class, some Stressors Cannot be Eliminated

Once in the air, your problems are about to begin. If you turn left on entering the aircraft, well and good; but if you turn right, be prepared for cramped seating conditions (noticed the shrinking leg-room, especially on low-cost carriers?). If you can stomach the low-quality food, this may not stay down too long if the plane hits into turbulence – this has been cited as the top cause of stress while flying.

Once settled down, your mind may be jarred by a seemingly endless stream of in-flight announcements, in multiple languages, informing that you are 35,000 ft in the air (who really cares?). Add to this, the snoring passengers and crying babies and the soon-to-be-allowed mobile phone-calls and one can see why there’s so much stress.

Don’t forget polluted cabin air..a recent report in the London Telegraph confirms that the smell of jet-fuel in some cabins is far from imaginary.

TCP,from jet-fuel present in cabin air, causes drowsiness,nausea and headaches

33 million pieces of luggage were misplaced in 2008

Once landed at your destination and after surviving the long queues at Immigration, you might have to face the heart-sinking sensation of lost luggage (God forbid!) and the monumental paperwork that comes with it. And you thought London Oxford Airport would be at least near London.. be prepared for a 60-mile journey to the city!

And..long after reaching your final destination, there’s still the perennial fight with jet-lag! Numerous antidotes have been promulgated – but that’s another story..

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Curing Credit Card-itis

With unsolicited offers of credit cards coming ‘free-for-life’, its not surprising that many consumers will find that, with easy credit in hand amounting to a few extra thousand dollars, there’s a tendency to  treat it as extra spending money and over-indulge with bliss..till the end of the month, that is.

The real danger is when credit card usage passes the barrier of overspending and enters the realm of addiction. Yes, there are increasing numbers who will treat cards as extra spending money and go on a splurge , thereby  forgetting about the liabilities of spending beyond their means and ending up with huge balances at the end of the month, leading to, in extreme cases,  financial ruin.

Credit card addiction (I call it credit carditis) strikes when you least expect it. As with most addictions, the person with the problem is often the last one to realize that they have a problem.

How do you spot the warning signs of credit card addiction?

According to financial planner Julie Casserly, you’re there if you have 3 or more of the following features:

• You never have cash in your wallet
• When you do have cash, it burns a hole in your pocket.

• You buy things just because they’re on sale, or because they make you feel better if you’re upset.
• You have more than two “branded” or store credit cards.
• You and your spouse or partner argue over money.
• Credit cards balances are growing — and not being paid down — each month.
• Your cards are all maxed out. But instead of paying them off, you open new ones in order to have additional credit.
• You don’t know how much you owe on the cards you have.
• You own several things you’ve never worn, used, etc.
• You hide your credit card statements from your spouse.

How do you cure this addiction?

• Spend cash – this reduces the risk of impulse purchases.
• Hide the card – out of sight, out of mind.
• Set your short-term and long-term financial goals.
• If all else fails, seek counselling. There’s some websites worth looking  -Debtors Anonymous,
  Credit Cards.com

Some governments feel that by imposing an annual surcharge/fee for using each credit card, this  will help reduce the number of cards and help solve the addiction. As one can see from the experience of taxing cigarettes, this method is highly ineffective!

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Fasting Healthily

The term “fasting”  conjures up different meanings to different people. To some, it holds a spiritual significance whether they be Jews, Christians, Hindus or Muslims. To others, it is done on a purely physical level, the main benefit being that of healing, where the body is allowed to rest and rehabilitate, thereby flushing out toxic wastes which have been allowed to accumulate. In fact, fasting has often been called  the single greatest natural healing therapy. If you are doing it for both reasons, then the benefits are multiple..

In order to maximise the health benefits, below are some pointers for otherwise healthy folks. Bear in mind that, in the context of medical conditions like diabetes, kidney or heart failure, advice from your care-giver is important for the relevant dietary modifications.

The Do’s:

1. Before commencing the fast, consume slow digesting foods including fibre-containing foods, rather than fast-digesting foods. Slow digesting foods last up to 8 hours, while fast-digesting foods last for only 3 to 4 hours.Slow-digesting foods are foods that contain grains and seeds like barley, wheat, oats, millet, semolina, beans, lentils, wholemeal flour, unpolished rice, wholemeal bread,capati,naan,etc. (they are also called complex carbohydrates).
   

   Dates - ideal to replace the sugar,fibre,potassium and magnesium lost during fasting

2. When breaking the fast , dates are an excellent source of sugar, fibre, carbohydrates, potassium and magnesium to replace that lost during fasting.
3. Try to drink as much water or fruit juices as possible in the hours before commencing the fast so that your body may adjust fluid levels in time.This helps to prevent dizziness in the afternoon due to low blood pressure as a result of dehydration.

The Don’ts:

1. When about to start the fast, one should minimise fast-digesting foods, like those that contain sugar, white flour, etc (called refined carbohydrates). This may cause ‘rebound hypoglycemia’ and cause a feeling of hunger and giddiness a few hours after.
2. Avoid excessive fried and fatty foods which will create indigestion and ‘wind’.
3. Don’t take too much tea or coffee when commencing the fast. They make you pass more urine, taking with it valuable mineral salts (that your body would need during the day) in addition to causing dehydration.

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Living Statues

You’ve seen them in street corners, marketplaces, alleyways and anywhere where there’s passing traffic. These ’statues’ remain immobile and can fool even pigeons..only to give a wink at the drop of coins into the tips box.

Living statues..convincing enough even for the birds

The Silver Man...Fisherman's Wharf,San Francisco

A living statue refers to a mime artist who poses like a statue or mannequin, usually with realistic statue-like makeup, sometimes for hours at a time. It is an art that understandably requires a great deal of patience and physical stamina. And its a serious business..there are annual competitions in Arnhem, Holland, Pageant of the Masters in Laguna Beach, California, to name a few.

Some living statues really take the immobility aspect to extremes. One of them, Antonia Santos, aka Staticman, is the Guinness World Record Holder for standing still for 20 hours, 11 minutes and 38 seconds in 2003!  He has been a living statue since 1987, starting off performing at Las Ramblas in Barcelona but now to be found all over Europe.

FOP - muscles and soft tissues gradually are replaced by bone

Interestingly, there have been reports that some living statues suffer from rare medical conditions that enable them to immobilise longer. A case in point is ‘sleeping sickness‘, a type of encephalitis which was made famous in the movie “Awakenings” starring Robert de Niro & Robin Williams.

On a sadder note, sufferers of FOP (fibrodysplasia ossificans progressiva) causes bone to form in muscles, tendons and ligaments, creating a second skeleton that encases the body in a prison of bone. In a macabre manifestation, patients may eventually turn into living statues — standing, arms folded, sitting or even cruelly twisted. Incurable, sufferers don’t live beyond 45.

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The President, Professor & Policeman

It all began 2 weeks ago, when, following a police report from a neighbour in Cambridge,Mass. about an attempted burglary, Sgt James Crowley ended up arresting black Harvard professor Henry Gates,Jnr for disorderly conduct although the professor claimed he was actually entering his own home but had forgotten his keys.

The matter mushroomed when President Obama declared on prime-time TV that the police had acted stupidly. Although he later expressed regret, things did not subside much; so the President did what he thought was best: invite all parties to the Rose Garden patio at the White House for some beer. “I have always believed that what brings us together is stronger than what pulls us apart”, said Obama.

Sitting under the magnolia tree - Biden, Gates, Crowley and Obama

After the 40-minute chat under the canopy of a magnolia tree, there was no apology from all three but everyone agreed to disagree and meet again in the future.

There are several lessons about this tale – never speak out when you don’t have the facts before you (and this applies to Presidents as well). Another is – get to know who your neighbours are! Yet another – damage control and conflict resolution can often be settled over a cup of tea – in this case, beer.

For the record of beer-lovers, Obama had his usual Bud Light, the professor Adams Light and the policeman the wheat beer Blue Moon. Not to be outdone, when teetotaller Vice-president Joe Biden arrived later, he had the nonalcoholic beer Buckler.

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What Killed Michael Jackson?

Now that the initial autopsy had ruled out trauma and assault as possible causes, toxicology testing will need to be carried out to determine the existence and levels of foreign substances (read drugs) in the singer’s bloodstream. Not surprisingly, this is going to take “6-4 weeks”, according to the Coroner’s Office; as , even in the best centres, such an analysis is a laborious process.

Photo taken by "Entertainment Tonight" shows Jackson leaving his residence in ambulance. Note the Umbo bag attached to the endotracheal tube, indicating he was being manually assisted to breathe. The pair of hands on the chest means chest compression was taking place, part of the cardiopulmonary resuscitation (CPR) process.

According to various media reports, the singer had “cardiac arrest” at home and that his personal physician (a cardiologist) was in attendance at that point in time. You can hear the actual recording of the 911 call here.

Several news reports have said that Michael Jackson had been addicted to OxyContin for several years, among other drugs. This is collaborated by his children’s nanny who testified she had to perform stomach washouts several times to remove a cocktail of drugs, as reported by the Times of London. OxyContin is a effective pain-reliever but is a member of the narcotic class of analgesics, meaning it is in the same category as morphine and therefore habit-forming and can lead to addiction.

The other big problem with this class of drugs is that it is associated with several side-effects, notably its ability to suppress breathing. Hence, it is not used in patients who have breathing diseases like asthma and sleep apnoea.

Notoriously, OxyContin which is given as tablets, cannot be combined with other narcotic pain-killers, tranquillizers, sedatives and even alcohol as this potentiates the side-effects (all of them are depressants on the brain) and can cause confusion, breathing difficulties, coma and death.

In Michael’s case, this takes on added significance, as it has been reported that an hour before he collapsed, he had been given a shot of another narcotic pain-killer Demerol (aka Meperidine aka Pethidine). Eye-witnesses reported that they noticed his breathing was becoming shallower and shallower, which is consistent with respiratory depression( suppression of the brain’s breathing efforts) due to additive effects of the two narcotic drugs. The toxicology tests will bear out this possibility eventually but two questions remain:

1. Wasn’t the attending doctor aware that MJ had been on other narcotic pain-killers?

2. There is an effective antidote, Naloxone, which if given by injection immediately, can reverse the side-effects of the overdose. Was this given?

Australian actor Heath Ledger died in Dec 2008 of an overdose of 6 different prescription drugs

If the final autopsy results confirm drug interaction and overdose as the cause of death, MJ will join a long line of celebrities including Jimi Hendrix, Elvis Presley and most recently, Heath Ledger. In the latter’s case, the autopsy revealed that he had taken 6 different drugs: OxyContin, hydrocodone, diazepam (Valium), temazepam (Normison, for sleep), alprezolam (Xanax,for anti-anxiety) and doxylamine (available over-the-counter as Somnil for aiding sleep).

The message to take home obviously is that every medication has side-effects, and its use must be balanced by the benefits vs harmful effects.

Update (25 Aug 2009): see “MJ’s Death Explained“

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New Drugs In The News – Searching For the Truth

In the last week alone, the media featured  reports about 2 new ways for treating prostate cancer, the most common cancer for men in the UK. One of them added more concrete evidence with regards to the already many health benefits from drinking green tea – that the polyphenols in the tea can prevent prostate cancer progressing (see here).

New Drugs -It Costs Up To USD 200 million To Develop One and the Pitfalls are Plenty

The other remedy, about using a new drug, ipilimumab, may have raised many present cancer sufferers’ hopes, but the truth is that this new treatment is only in Phase 1 trial stage (there are 4 stages to go through before a drug is released for general public use). This means at the earliest, this drug will only be available in 2012; and this too,  assuming it passes all the 4 Phases. Another new drug for prostate cancer which first made headlines in 2008,  abiraterone, is now in Phase 3 and will be general use only in 2011. So, these ‘premature’ announcements in the lay press at best give an insight of probable cures to come, but are of little use to present-day sufferers.

In the best scenario, a new drug will appear after a few years and it will be costly(you bet!); and in the worse-case scenario, it will be consigned to the waste-basket due to the presence of terrible side-effects which hitherto had not yet been detected.

So why does the media appear to overplay new drug discoveries?

Put it simply, such items are big news..and news sells! Not forgetting, of course, the commercial benefits the company producing the drugs receive, or the publicity it attracts to the researchers concerned!

Here are  some tips on how to evaluate news items that you may come across..

• It is a fact that competition is intense among medical journals, research bodies and medical journals to attract media attention. Media themselves compete with each other to come out with the latest. Try to read the same news from several sources. Obviously, if the item is reported in just one obscure source, it should carry less weight.
• Look for key-words like suggestive or may (as opposed to will) as this does not always indicate a cause and effect meaning. Many people make hard-core assumptions based on such words.
• It is the nature of scientific studies that, for a given topic, several would say one thing and a few would say the complete opposite. It is for the trained professional and their peer-groups to make an informed decision to advise consumers. Bear in mind that space is a premium with the mass media and such reports usually omit vital details which will affect accuracy.
• Separate the wheat from the chaff..make sure the website you’re looking at is a reliable one!
• Personally, I feel reports originating from researchers and pharma companies should not appear in the mass media without vetting by an appropriate professional body so as to convey the proper perspective to the audience at large. So if a news report originates from a known professional body, that should carry a lot of weight; as opposed to a solitary item in a health magazine.

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Red Wine – Pros & Cons

‘Alcohol provokes the desire, but takes away the performance.’

(Shakespeare (1564-1616), Macbeth; Act II, Scene 3)

Even the Bard knew the ill-effects of too much alcohol..but really, when is it enough and when is it excessive?

Unless you’re the Malaysian Tree Shrew, the world’s heaviest drinker (featured in my earlier post here), how do you know whether you’re drinking too much? Get pen and paper ready and take this quick quiz here, courtesy of MSN.

White,Rose or Red? Choose Red for Resveratrol

The benefits of red wine on health are quite well-known, thanks largely to the French Paradox: – the low incidence of heart diseases among  the French despite ingesting foods high in saturated fats; this attributable to taking regular red wine.

So what is it in red (but not white) wine that confers the beneficial effects? This is attributable to the high content of polyphenols which originate from the skins, seeds, and vine stems of red grapes. This anti-oxidant comes in two main forms: flavonoids and nonflavonoids, the latter being the one well-known for resveratrol, the substance known to be the found in the skin of the red grape (or for that matter, any of the colored berries, like raspberry,cranberry,blueberry,etc).

One of most well-documented benefits of red wine is the heart protective effect. Moderate consumption of red wine on a regular basis may be a preventative against coronary heart disease, as well as increasing the levels of the good HDL-cholesterol. It is believed the polyphenols as anti-oxidants also prevent plaque formation and clogging of the arteries in the heart, besides having an anti-clotting effect that causes ‘thinning’ of the blood.

And what’s moderate consumption? 2 glasses (1 glass=5 oz=150 cc) for men and 1 glass for women daily.

And what about the bad? Apart from migraine and dehydration (the thirst the morning after), the alcohol in the wine interacts with a lot of medications - special warning to those taking tranquillizers and sedatives because alcohol is a downer which adds on to the effects of these pills to cause, in extreme cases, inability to breathe, coma and death. Impairment of attention and skills, including delayed reaction times is a well-known danger for drivers, a fact well-known in causing serious accidents on the road.

And there’s of course temporary amnesia if you’ve drunk too much!.. as in UB40’s Red Red Wine (watch it here!):

Red, red wine
Goes to my head
Makes me forget that I
Still need you so

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A New Tool In The Doctor’s Bag

They say the Internet has revolutionised the way the world is doing business and undergoing education. That’s true in medicine as well – gone are the days that medical students cut up human cadavers and lug around Gray’s Anatomy. The use of virtual 3D models and optical discs has made studying medicine a bit more bearable; but even these technologies will fall by the wayside in the future.

Smartphones..the most important tool after the stethoscope

A recent study Taking The Pulse v9.0 issued by Manhattan Research found that 64% of doctors, more than double the number eight years ago, are using smartphones — iPhones, BlackBerrys, Treos and other hand-held devices.

How can smartphones help? Some examples:

• A doctor seeing a patient for the first time can be astounded by the variety of pills given by previous doctors. By feeding in the shape, colour and probable use of the pill into a software called Epocrates, one is able to obtain a list of medications and images that match those criteria, allowing the doctor to identify the pill.
• While dining in a restaurant, a doctor can receive an attachment by email showing an ECG done by a colleague of a patient about to get a heart attack. Previously, he would have had to stay at home and wait by the fax machine.
• By the bedside, a doctor can check immediately the dosages of medicines, drug interactions and even show images to help the patient understand better.

My favourite - the Blackberry Bold - largely because many medical programs are Windows-based

Such is the popularity of these devices that some medical schools, like Georgetown University in Washington DC  already require their students to each use a smartphone. This is a trend catching on fast and it looks like a matter of time before they are used in all med schools.

But with any new technology, there are reservations. Take privacy concerns, for example..all this patient stuff in a smartphone can fall into the wrong hands and create confidentiality issues. There are concerns too by some patients that it would be quite annoying talking to a doctor who’s busy peering into the small screen and apparently not paying attention to what is being said!

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G-20 Man’s Death: 2nd Postmortem Raises More Questions

The earlier revelation that 47 year-old Ian Tomlinson had died of a heart attack at the G-20 meeting in London following assault by a policeman caused quite a ripple when this evidence surfaced in the form of a video taken by a New York fund manager who happened to be at the scene. I had commented then (April 8th) that it would not be surprising that a second postmortem would be ordered.

A Police paramedic attends to Ian Tomlison within minutes of him collapsing (photo courtesy of Daily Mirror,UK)

Well, the second postmortem was indeed performed at the behest of the IPCC and the family of the deceased and the results released yesterday(April 17th). The second postmortem was conducted by Dr Nat Cary, who was able to scrutinise video evidence before conducting his examination. In a statement last night, City of London coroners court said Dr Cary had provisionally concluded that internal bleeding (intra-abdominal hemorrhage) was the cause of Tomlinson’s death, not a heart attack.

This finding has raised several questions:

1. How did the first pathologist(Dr Freddy Patel) who conducted the initial postmortem come to the conclusion that it was a heart attack that killed the victim? It was discovered that Dr Patel had previously been reprimanded by the General Medical Council, the watchdog body for doctors in the UK, over 2 other cases. See here.

2.The second postmortem did not state so far the cause of the internal bleeding. The assault, as seen on the video, appears to be mainly from a baton hit on the victim’s left thigh and not on the torso.

A CT scan of the abdomen, showing a swollen aorta(in white) - an aortic aneurysm - a common cause of bleeding as it tends to leak eventually

Abdominal bleeding is usually due to bursting of the blood vessels of any of the organs within the abdomen, such as the liver, spleen, intestines or even the aorta (the largest artery in the body). The commonest cause for these blood vessels to burst is any kind of trauma, such as road accident injuries, severe falls or assault. It would be fair to say that massive abdominal bleeding arising out of a simple fall is very unusual.

We await further developments in this case. Meanwhile,the Metropolitan police officer suspected of the assault has  been suspended from duty has now been interviewed under caution on suspicion of manslaughter.

See my earlier posting “G-20 Man’s Death Diagnosis Disputed”