Monthly Archives: August, 2009

Healthcare Nowadays..(2)

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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).

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    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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MJ’s Death Explained

MJ

MJ - before and after cosmetic surgery

The Los Angeles County coroner has ruled Michael Jackson’s death a homicide, a law enforcement official told The Associated Press and MSNBC. The term homicide is rather confusing, especially to countries in the British Commonwealth. Briefly, homicide means  to take the life of someone or to kill a person, but does not necessarily mean a crime was committed.

Although this term is used widely in the US, it had its origin in ancient British law. There are several types of homicide which include non-criminal causes like self-defense, insanity or when a criminal is hanged by order of the court (capital punishment). In the case of MJ’s doctor, it was reported that he was to be charged with a type of homicide called manslaughter, which is criminal in intent but just falling short of murder.

I had highlighted in an earlier post soon after MJ’s death (“What Killed Michael Jackson?”) that a likely cause of his death would be a cocktail of sleeping pills, each given in the correct dose one after another when the desired sleep effect did not occur. This has been confirmed by the coroner’s report, which mentioned that he was first given a 10 milligram tablet of diazepam (Valium) at 1.30am, then an intravenous injection of 2 milligrams of lorazepam(Ativan) at 2am followed by 2 milligrams of midazolam (Dormicum) around 3 a.m., and repeats of each at 5 a.m. and 7:30 a.m. respectively.

Even this did not put MJ to sleep.

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Propofol -used commonly by anaesthetists to induce sleep.

The doctor told detectives that around 10:40 a.m. he gave in to Jackson’s “repeated demands/requests” for propofol, which the singer referred to as his “milk” but often referred to by doctors as the ” milk of amnesia“. He administered 25 milligrams of the white-colored liquid, — a relatively small dose — and finally, Jackson fell asleep. He left MJ for a few minutes but returned to find that he “had stopped breathing”.

The above facts lend credence, in my opinion, that the various cocktails of drugs, although each given in the proper doses, had caused additive effects leading to the breathing centre of the brain to stop functioning (these drugs are known to cause this) and consequently depriving the heart of the much-needed oxygen causing the heart to also stop functioning. “This is polypharmacy at its worse”, said a source familiar with the case.

Some of the lessons we need to learn here are that sleeping pills, if it has to be used, should be on short-term only and must not be mixed, not even with alcohol. It is common to find that those on long-term pills will eventually get addicted to them and require progressively higher doses to get the required effect.

See my other article Death of the Stars…Learning from Their Mistakes” to pick up other tips.

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Healthcare Nowadays..

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Know Your Masks, If You Must Mask

As the paranoia spreads with the increasing number of reported deaths worldwide, I couldn’t help noticing the plethora of mask types that are being worn. Is the right mask being worn? More important, are  people  wearing them for the correct reasons?

First a few facts:

  1. The H1N1 virus, like any flu virus, spreads in the air as droplets, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects (including hands) and then touching your nose or mouth.
  2. The flu virus is 0.08-0.12 microns in size (micron= one millionth of a metre). Small enough to pass through most masks!
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Facemasks galore..but only the N95 is truly effective, as worn by the male uniformed personnel above (courtesy of Sunday Mirror)

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The N95 Mask..so-called because 95% of airborne particles are filtered off

So, using an ordinary facemask, whether single-ply, 2 ply or 3 ply, is really to protect other people from you. Its designed to keep the germs in and should be worn by those having a influenza-like illness(ILI).(fever 37.8°C or greater) and a cough and/or a sore throat).

Otherwise, if you want to keep the germs out & protect yourself from getting the flu, then you need to use the N95 mask (also called respirator). It must be tight-fitting and is rather uncomfortable to wear over long periods as extra effort is sometimes needed to inhale.

Whichever mask you use, you need to practise social distancing (2 metres away), social etiquette (blocking off a sneeze and cough) and frequent handwashing.

Should the general public wear facemasks?

There is no evidence to suggest that this is a useful preventative measure. Unless of course, you have a flu-like illness (to prevent others from catching it) or you are in close contact with a probable, suspected or confirmed person. Confused with all these terms? The US Centre for Disease Control has made it somewhat easier by defining it:

A confirmed case of A (H1N1) virus infection is defined as a person with an influenza-like illness with laboratory confirmed novel influenza A (H1N1) virus infection by one or more of the following tests:

  1. real-time RT-PCR
  2. viral culture

A probable case of A (H1N1) virus infection is defined as a person with an influenza-like-illness who is

  • positive for influenza A, but negative for human H1 and H3 by influenza RT_PCR

A suspected case of  A (H1N1) virus infection is defined as a person who does not meet the confirmed or probable case definition, and is not novel H1N1 test negative, and is/has:

  • a previously healthy person < 65 years hospitalized for ILI

OR

  • ILI and resides in a state without confirmed cases, but has traveled to a state or country where there are one or more confirmed or probable cases

OR

  • ILI and has an epidemiologic link in the past 7 days to a confirmed case or probable case.

If you would like to know more about facemasks and who exactly should be wearing one, this CDC website is recommended.

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To Eat or Not To Eat

This being the weekend, most people’s thoughts would turn more towards food; so I thought I’d rehash two worthwhile quotes from previous blog postings which I hope would give some food for thought!

“I saw few die of hunger; of eating, a hundred thousand.”

Benjamin FranklinBenjamin Franklin

(from my posting “On Eating” July 13,2008)

The second quote, from the posting of August 13,2008, is one of my favorites; with apologies to my colleagues!

Found on a Hieroglyph, from an ancient Egyptian tomb

“One quarter of what you eat keeps you alive.  The other three-quarters keeps your doctor alive”.

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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.

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Living statues..convincing enough even for the birds

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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

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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Swine Flu, Social Distancing & School Closures

It takes a challenging virus like the H1N1 to make health authorities worldwide scupper for renewed definitions and amended health protocols.

Take the phrase social distancing used in public health practice to mean  encouraging people to keep their physical distance from each other social distancingduring disease outbreaks in order to slow the spread of infection. This term should not to be confused with that well-worn phrase in sociology, social distance. Social distancing has recently come into vogue  as an effective weapon to curb the rapid spread of swine flu.

Examples of social distancing include cancellation of public events like sports,plays and concerts and closure of schools. These are touted to be “feasible community containment measures”, according to WHO, in a pandemic. All of these measures  have significant impact on the community and workforce, however, and careful consideration would be focused on their potential effectiveness.

When the outbreak was first reported, many local authorities were quick to close an entire school for a week upon the detection of a student with the H1N1 virus.The contacts and immediate family members were placed in quarantine for a similar period.

Now that most countries have moved from the containment phase to the mitigation phase (in short, public health officials raising their hands up to concede that the H1N1 virus cannot be fenced in anymore), local health authorities have stopped counting the number of cases and concentrating their resources to treating those badly afflicted with the disease.

Why, the US Centre for Disease Control (CDC) is now recommending that schools should not be closed unless the majority of students were having another medical condition which would make them extra-vulnerable. Even more significant, those who are sick can return to school or work if they were fever-free for more than 24 hours, instead of the previous advice of 7 days.

Why the change of heart? Because the virus does not typically cause life-threatening illness, says the CDC. Less than 3% of those who get H1N1 die. Instead, schools should weigh the “definite harm” of lost learning, lost wages if a parent has to stay home to care for the child, or the risks of having an unsupervised child at home

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Going For Surgery? Remember This..

My doctor colleagues were quite puzzled recently when a patient, after undergoing routine surgery, took a longer time than usual to wake up after GA was completed and stopped. The patient required an overnight stay in the ICU before finally waking up 24 hours later! It was subsequently discovered that the patient had been taking supplements, in this case, St John’s Wort.

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This popular supplement,EPO, needs to be stopped 2 weeks prior to surgery (see text)

Before undergoing surgery, one important info which must be disclosed to your doctor is whether you are taking herbal supplements. This is often left out by patients when doctors enquire on what medications they are taking, as often many people do not equate medicines with supplements.

Many intensive care physicians including anaesthesiologists will tell you of their experience with patients who take a long time to wake up after surgery; develop fits upon recovery or bleed excessively after surgery; all due to the taking of herbals.

Incidents like the above used to mystify many doctors previously but evidence is now clear that several over-the- counter supplements can interfere with the various actions of medications used during surgery.

Take a look below at some common examples:

Herbal supplement Possible complications
Aloe vera May cause increased intestinal muscle movement to digest food (peristalsis), may decrease effectiveness of water pills (diuretics) given after surgery
Bromelain May cause bleeding or interact with antibiotics such as amoxicillin or tetracyclines
Danshen May cause bleeding
Dong quai May cause bleeding
Echinacea May interfere with immune functioning, may alter effectiveness of immunosuppressant drugs given after transplant surgery
Ephedra May cause abnormal heartbeat, may cause extreme high blood pressure and coma if combined with certain antidepressants and anesthesia
Feverfew May cause bleeding
Garlic May cause bleeding, may interfere with normal blood clotting
Ginger May cause bleeding
Ginkgo May cause bleeding
Ginseng May cause bleeding, may cause rapid heartbeat, may cause high blood pressure
Goldenseal May cause or worsen swelling and high blood pressure
Kava May enhance sedative effects of anesthesia
Licorice (not including licorice candy) May increase blood pressure
Omega-3 fatty acids May cause bleeding if taken in doses greater than 3 grams a day
Senna May cause electrolyte imbalance
St. John’s wort May increase or decrease the effects of some drugs used during and after surgery
Valerian May prolong the effects of anesthesia
The above list is not exhaustive. As more cases are encountered, the list gets longer!
Evening Primrose Oil (EPO) is now implicated in the cause of fits or seizures following general anaesthesia.
Some points to note if you are undergoing planned surgery:
  1. Remember that the list of medications that you need to reveal to your doctor includes all supplements, whether as pills or as a drink.
  2. Some of these herbals may have to be stopped more than 2 weeks prior to planned surgery.
  3. In emergency surgery, remember to reveal to your doctor and next-of-kin what you are taking so that some preventive measures may be undertaken beforehand by the doctors.
  4. Some people believe if something is natural, it is safe. That is not necessarily true. If in doubt, show your care-giver the original container of the supplement.


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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.

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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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