Monthly Archives: May, 2009

Health Alert (8): Pain-Killers That Can Kill

Weeks after reading in the local papers about a 7 year-old boy that died after taking paracetamol (aka Panadol aka acetaminophen aka Tylenol) for fever at an adult dosage of 4000mg per day, my attention was directed to the coincidental release about this drug by the US Food & Drug  Administration. The FDA have now issued warning guidelines on the use of this popular pain-killer, generally regarded as one of the safest around and sold everywhere over-the-counter, without the need for a doctor’s prescription.

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The most popular brand of paracetamol worldwide

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..popular in the United States

The news release requires that the labeling must warn of the risks of stomach bleeding in alcohol-users and severe liver damage from overdosage. The latter has been blamed for many deaths arising from overuse of this drug.

The report also calls for limiting the maximum adult daily dose to no more than 3,250 milligrams (one paracetamol tablet is usually 500 milligrams, so that means the current recommended dosage of up to 4000 milligrams is already too high), but with a lower daily maximum for patients consuming three or more alcoholic drinks every day. For kids, all liquid forms (syrups) need to be in a single medium strength formulation with much lower dose recommendations.

My take on this is that every drug you take can have side-effects – its a question of balancing the pros and cons and,of course, taking it correctly!

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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.

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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.

Smartphones

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.
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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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Washing Your Hands Off This Matter..Don’t

With the flu epidemic extending its hold globally, health authorities are debating on the most effective strategy to contain it, but one thing remains unanimous…washing your hands is the most effective preventive measure. Because..

wash handsIn the healthcare setting, handwashing can prevent potentially fatal infections from spreading from patient to patient, and from patient to healthcare worker and vice-versa. The basic rule in a hospital is to wash your hands between seeing patients.

In the home, it can prevent infectious diseases such as diarrhea and hepatitis A from spreading between members of a family. The rule should be to wash hands before preparing food, after changing diapers, and after using the bathroom.

There are at least 4 ways diseases can be transmitted by hand:

  1. Hands to food: germs are transmitted from unclean hands to food, usually by an infected food preparer who didn’t handwash after using the toilet. Hepatitis A and shigella food-poisoning are examples.
  2. Infected infant to hands to other children: during diaper changing, germs are passed from an infant with diarrhea to the hands of a parent; if the parent doesn’t immediately wash his or her hands before handling another child, the germs that cause diarrhea are passed to the second child.
  3. Food to hands to food: germs are transmitted from raw, uncooked foods, such as chicken, to hands; the germs are then transferred to other foods, such as salad. Cooking the raw food kills the initial germs, but the salad remains contaminated. Bacterial food-poisoning results.
  4. Nose, mouth, or eyes to hands to others: germs that cause colds, eye infections, and other illnesses can spread to the hands by sneezing, coughing, or rubbing the eyes and then can be transferred to other family members or friends.The H1N1 flu spreads in this manner.

And there’s a proper way to wash those hands.. plenty of water and soap for at least 15 secs to cover all parts:

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And while we’re on this subject, can someone improve the thermal scanners at airports and devise one that will do this: 🙂

washinghands1

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When Medicines Were Simple & Effective..

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Bayer's heroin: Between 1890 and 1910 heroin was sold as a non-addictive substitute for morphine. It was also used to treat children with strong cough.

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Mariani wine (1875) was the most famous Coca wine of it's time. Pope Leo XIII used to carry one bottle with him

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For Inhaling IF You Have Asthma

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Cocaine tablets(1900) - All stage actors, singers, teachers, and preachers had to have them for a maximum performance

Ahh…thanks to medical research, we have better alternatives nowadays. But are all of today’s products free from side-effects?

(Thanks to Ron in Vancouver for the material)

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Sexual Recession – Get Free Viagra

If the  above headline looks like one of the many spam mails in your email box, I do apologise. But both sexual recession and free Viagra are indeed happening.

The present economic recession has created a lot of anxiety, depression and stress -these can wreck havoc on one’s libido and lead to deflation of impotence2the sexual kind, aka impotence aka erectile dysfunction(ED). By the way, just to set things right – many are confused between libido and impotence. Suffice to say that libido means sexual drive whilst impotence means failure in erection. Hence, ladies do not really get impotence because they do not need to stand to perform, but a couple’s sex life will all but disappear if the husband cannot rise to the occasion!

Many sex therapists have coined the term sexual recession to account for this phenomenon. One such therapist warns here that it is important for couples to talk it out before false accusations of infidelity arise because one partner is ‘disinterested’ in sex.

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Viagra - among the 40 Drugs to be distributed free to the unemployed in the US

Meanwhile, the world’s biggest drug-maker Pfizer announced May 14th that it will provide 70 of its most widely prescribed drugs — including the wonder-drug Viagra — for 1 year free to people who have lost their jobs and health insurance during the recession. In a move seen to be a public relations exercise as well as an attempt to prevent patients switching to cheaper generic versions, this gesture of goodwill may backfire.

Already, criticisms are coming hard and fast.. ranging from accusations of encouraging the unemployed to have more babies and worsening their financial status, to being sexist as the drug is not seen to benefit women!

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Stress & Burnout…Even Doctors Get It Too

Met a colleague the other day in the hospital corridor who appeared uncharacteristically aloof and disinterested when we were discussing about a mutual patient we were managing. Taking into account his body language, it didn’t take too long to realise that he was exhibiting symptoms of burnout. A recent issue of the Archives of Surgery highlighted that as many as 38% of surgeons get burnout. It lists 10 reasons why doctors get burnout:

  • Length of training and delayed “gratification”

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    Burnout...A Common Condition Among Doctors Too

  • Long working hours and enormous workloads
  • Imbalance between career and family
  • Feeling isolated / not enough time to connect with colleagues
  • Financial issues (salary, budgets, insurance issues)
  • Grief and guilt about patient death or unsatisfactory outcome
  • Insufficient protected research time and funding
  • Sex- and age-related issues
  • Inefficient and/or hostile work environment
  • Setting unrealistic goals or having them imposed on oneself

I can add one more…the increasing threat of medical litigation!

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Stress or Burnout? There Are Vital Differences Between The Two

So what is burnout?

Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation in your work, leading to loss in productivity and  leaving you feeling increasingly helpless, hopeless, cynical, and resentful.

The negative effects of burnout spill over into every area of life – including your domestic and social life. Burnout can also cause long-term changes to your body that make you vulnerable to illnesses like colds and flu.

Its also important to differentiate between being stressed and burnout…those under stress are aware that if everything is put under control, things would be better; whereas those who are burntout often don’t realise they are there already and often don’t see any hope of positive change in their situation.

On the road to burnout?

You could very well be if you agree with the following statements:

  • Every day is a bad day.
  • Caring about your work seems like a total waste of energy.
  • You’re just plain tired all the time.
  • The majority of your day is spent unproductively on tasks you find dull or overwhelming.
  • Nothing you do makes a difference or is appreciated.

Take this quiz to see if you are suffering from job burnout here.

This Thing Called Meningitis

Amidst the H1N1 flu outbreak, my attention was diverted to news reports about a meningitis outbreak  in a training academy in Malacca, Malaysia just 2 days ago. The suspected bacterial meningitis outbreak was detected on May 7 when nine trainees were referred to the hospital there after they complained of fever, cough, headaches and joint pains. Earlier,a 24 year-old trainee had succumbed to the infection while being rushed to the hospital here.

Meningitis is caused by the presence of germs (usually viruses, bacteria or fungi) within the coverings of the brain and spinal cord. While the dreaded swine and avian flus are due to viruses, meningitis caused by viruses are relatively mild and sufferers can often be treated at home.

meninges-of-the-brain

Its when they are caused by bacteria that it becomes a real source of worry, as the infection can run a rapid and fatal course over a few hours and days, sometimes even when antibiotics have been given. Of the three types of bacteria that are the usual culprits, the one caused by Neisseria meningitidis (aka meningococcus) is the most notorious as it is highly infectious and may cause local epidemics in college dormitories, boarding schools and on military bases.

In all likelihood, this bacteria (meningococcus) is the likely culprit in this outbreak, although it will take 3-4 days for actual confirmation as the specimens taken from the victims containing this bacteria need that amount of time to grow in the lab and be conclusively identified.

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Warning Symptoms of Meningitis - Quite Similar to Flu. When In Doubt, See Your Doctor.

Where does the bacteria come from? Don’t get paranoid, but they live in 1 out of every 10 people’s throats! Natural body resistance keeps it at bay as long as the lining of the throat remains intact.They are passed from person to person through prolonged close contact: coughing, sneezing, breathing each other’s breath or by kissing someone who is carrying the germ!

Unlike what was reported in the local press, they are not contagious and therefore cannot be passed on via cutlery or clothing.

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Tackling Rising Healthcare Costs…the Chinese Way

The current H1N1Virus epidemic illustrates how expensive healthcare can become. Apart from the increased manpower costs in conducting tamiflusurveillance checks globally, the individual senses some of the impact as well – take the cost of a course of Tamiflu, one of two antiviral drugs that can mitigate influenza in general.  At nearly US$6 a capsule, the complete course of 10 is going to create quite a dent in your pocket if you’re uninsured.

China has now come up with an affirmative program to reduce healthcare costs – the use of traditional medicines, which in general costs much less than Western medicine.

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Chinese Herbs - a popular form of Traditional Medicine

The State Council, the country’s Cabinet, pledged in a circular Thursday to enable every community and village health service center, at the lowest level of the program, to provide traditional medicine service for citizens.It ordered local governments at county level or higher to include traditional medicine hospitals in their health service networks. County hospitals were also encouraged to set up traditional medicine departments.

Traditional Chinese medicine has its unique theories and practices in areas such as herbal medicines, acupuncture, massage and dietary therapy, which is independent from Western medicine.

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Acupuncture - widely accepted in Western medicine nowadays

For some time, traditional Chinese medicine was sidelined as many of its theories could not be explained by modern medicine but it recently became popular among Chinese as an alternative way to keep fit. Indeed, acupuncture has found acceptability in many Western medicine circles nowadays. Costs for acupuncture treatment for chronic back-ache is now reimbursible by most private insurance companies in the US.

One important problem that may create difficulty in promulgating traditional medicine is the fact that a lot of valuable knowledge was not passed from the older generation to the younger due to lack of documentation and some important therapies have been lost.According to the circular, the government plans to register ancient medical books, develop a catalog and set up a digital data base for them. It will also support research and publishing of these books.

Its about time more countries sit up, take notice and develop their own initiatives to develop alternative and complementary medicine strategies – the cost-savings can be tremendous.

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H1N1 Virus..Where There’s A Threat, There’s Opportunity

The Chinese character for ‘crisis’ is a hybrid for ‘danger’ and ‘opportunity’. This applies as well for the current H1N1 influenza near-pandemic, formerly known as Swine Flu.

crisischinesecharacter

Crisis=Danger+Opportunity

Already, websites and emails are sprouting extolling the virtues of products that claim to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus. These fraudulent sites have escalated in intensity recently,   enough for the US Food and Drug Administration FDA to issue a warning on fraudulent influenza products here.

Here’s a quick rundown on on some myths about the current H1N1 flu infection:

1. There are currently no flu vaccinations that can prevent an attack by the H1N1 virus. The current stockpile was derived from the flu epidemic a few years ago caused by the H3N1 and related viruses, so they will not be effective here.

2. The two antiviral drugs approved by the FDA for treatment and prophylaxis of the 2009 H1N1 influenza virus are Tamiflu (oseltamivir phosphate) and Relenza (zanamivir). However, health experts caution against using them routinely for several reasons: the emergence of resistant strains when used in mild flu infections, its ineffectiveness when given more than 48 hours after the onset of flu, the presence of side-effects (in particular,psychiatric disturbances, heart and lung disorders and deaths in children).

3. Should masks be used? Certainly not the ordinary ones as they do not filter small particles that carry the culprit viruses. You need to get the N95 respirators which block off 95% (hence the name) of small particles which carry the viruses. These are expensive and are for single-use only.

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The N95 Mask is Effective..but Must be Tight-Fitting and Not For Hairy Faces!

Said the Federal Trade Commissioner, Jon Liebowitz, “The last thing any consumer needs right now is to be conned by someone selling fraudulent flu remedies”.

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