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)
Some patients asked recently whether coffee was good for one’s health. They had apparently noticed that there has been the shift in marketing strategy by coffee-makers in promoting it as a rich source of anti-oxidants, and therefore beneficial to health.
YES, coffee is a rich source of anti-oxidants, like chlorogenic acid and melanoidins, the latter being the most important component of roasted coffee. Some of the other beneficial effect of drinking coffee include:
- Reducing the incidence of Parkinson’s Disease and Alzheimer’s. Read “A Cup of Coffee a Day will Keep Alzheimer’s Away”.
- Protecting against diabetes. Moderate consumption may lower the risk of type 2 diabetes in younger and middle aged women.
- Preventing liver disease and the formation of liver and kidney stones.
- The beneficial effects of caffeine in coffee on alertness, attentiveness, and wakefulness.
NO, among other things:
- Unfiltered coffee (as in Turkish coffee and kahawa) raises blood cholesterol. Filtered coffee, as in instant coffee, does not do so as diterpenes, responsible for raising cholesterol, are removed by filtration.
- Coffee consumption is also associated with an increase of plasma homocysteine, a risk factor for coronary heart disease.
- Caffeine in coffee can increase the risk of elevated blood pressure and hardening of the arteries, as well as palpitations.
- 4 cups or more will hasten osteoporosis, especially in those with low calcium intake in the diet.
- Coffee increases heartburn, aka gastro-eosophageal reflux disease (GERD).
What about heart disease? The verdict’s not in just yet..on one hand, diterpenes cause a rise in cholesterol and homocysteine but this seems balanced by the beneficial anti-oxidant properties. As of now, there is no convincing evidence that coffee leads to heart disease, period.
I ought to clarify here that we are talking about coffee, just plain coffee. The pendulum swings the other way when we consume coffee with additives, like milk and sugar. The latte at the local Starbucks will add on quite a substantial amount of fats, sugars and calories (260 to be precise, see here). Compare that to the ZERO calories of plain black coffee!
It doesn’t happen often, but when you’re one of the top restaurants in the world and your customers end up with food poisoning, that becomes a tsunami in the culinary world.
Given two stars by the Michelin Guide and voted byThe S Pellegrino and Acqua Panna World’s 50 Best Restaurants as the best restaurant in the world for three years running, the Noma restaurant in Denmark has been serving exotic dishes that include foraged Nordic ants, fermented grasshoppers, live shrimp and locally sourced carrots in malt soil at around 5,000 Danish krone (£580) for a 12-course set menu for two including appetisers, treats to finish, wine pairing and a tour of the kitchen to meet some of the 50 chefs.
Established in 2004,the name is a blend of the two Danish words “nordisk” (Nordic) and “mad” (food) and can only seat 40 diners on one sitting. Rumour has it that the wait-list is several months long.
The first sign of trouble started between 12 and 16 February when 63 customers who ate there developed fever, vomiting and diarrhoea. Danish health authorities have since traced the cause to a Norovirus infection, spread by an infected kitchen staff. They criticised the restaurant for not having running warm water for staff to wash their hands.
The Norovirus, which causes stomach flu and viral gastroenteritis, is spread by several ways:
- Consuming contaminated food or drinks.
- Touching surfaces or objects contaminated with norovirus and then putting hands or fingers into your mouth.
- Having direct contact with another person who is infected e.g. sharing food or eating from the same utensils as someone who is ill.
- Aerosol spread (when vomiting disperses virus particles into the air).
The virus has been responsible for several outbreaks in the last few months, as in the UK during last winter and on several cruise ships, the last one being yesterday (see here).
Such outbreaks in restaurants are nothing new. 3 years ago, I wrote about a similar Norovirus outbreak at the famed Fat Duck restaurant in the UK, where 240 people fell sick and survived the ordeal.
So will the world’s best restaurant be forced to close its doors? Highly unlikely, as the Fat Duck has showed, as it still enjoys booming business. But will it retain its title for this year when results are announced next month? We shall see..
Its the holiday season again, and many will be embarking to distant lands.. and with it comes the risk of exposure to new bugs (currently, the Norovirus virus outbreak is the vogue. Read more here.) Seasoned business travelers know that to reduce their chances of getting sick, its best to maximize the use of soap, water and hand sanitizer and minimize the number of times they touch their face.
Apart from that, what about other risks? Dehydration poses a greater risk, drying out the body’s natural defenses against germs. Avoid coffee and alcohol (no, its not a devious plan by airlines to reduce their beverage costs), which act as diuretics, and try to drink a cup of water an hour. Saline solutions can keep your nose and eyes moist, providing a barrier against germs. Dehydration makes the body’s defence mechanisms perform less efficiently and thus make the entry of germs easier.
While going around, preventing dehydration remains important, particularly in hot arid climates, where body water loss is not too obvious due to the absence of sweating.To avoid drinking contaminated water, watch out for recycled tap-water impersonating as bottled mineral water (look for a sealed cap). For that matter, possibly contaminated water could also be present in ice, uncooked salads and fruits that are eaten without peeling. These methods of reducing the odds of getting sick are important, as contaminated foods (due to agents causing infectious diseases) remain the number one killer of humans on earth.It is said that 80% of all infectious diseases are transmitted by direct or indirect human contact
Many air travellers claim they caught an infection from other passengers but, with the efficient air filtering systems of modern aircraft, where air is circulated 15-20 times per hour through efficient biofilters, chances of this happening is low unless the offending party is coughing and sneezing repeatedly within two rows of oneself.
At the hotel, I do recommend laying the bedspread aside, because it is washed rarely, and making sure the sheets are crisp and clean; if they are not, request another room. Check the mattress for bed bugs. Wipe down the telephone, night stand, remote control and bathroom with disinfectant. Disinfect the handle on the minibar fridge, and relax.
Indeed, various gadgets are available to make travelling safe – personal hand-sanitizers, personal air purifiers, UV scanners that destroy contaminants and the Silky Dreamsack, which “puts a layer between you and suspect bedding.”
All very exotic, but I would really recommend that the only cost-effective device that you will ever need is a bottle of hand-sanitiser..and refraining from touching your eyes,face or mouth. Not forgetting the ubiquitous mineral water bottle!
Its been speculated for some time..that eating red meat leads to an increased incidence of heart disease and cancer. And an analysis, published in Archives of Internal Medicine, using data from two studies that involved 121,342 men and women, further confirms the fact that consuming red meat is associated with a sharply increased risk of death from cancer and heart disease; and the more of it you eat, the greater the risk.
People who ate more red meat were less physically active and more likely to smoke and had a higher body mass index, researchers found. Still, after controlling for those and other variables, they found that each daily increase of three ounces of red meat was associated with a 12 percent greater risk of dying over all, including a 16 percent greater risk of cardiovascular death and a 10 percent greater risk of cancer death.
The increased risks linked to processed meat, like bacon, were even greater: 20 percent over all, 21 percent for cardiovascular disease and 16 percent for cancer.
You might say that you had suspected this all along, but the new results suggest a surprisingly strong link and further reinforce this conclusion.
The modus operandi for red meats and heart disease is quite clear-cut: the high saturated fats content leads to cholesterol deposition in the walls of the arteries. In the case of cancer, the mode of action is less clear-cut. Some postulated causes include:
- the presence of conjugated linoleic acid (CLA) in grass-fed meat which has anti-cancer properties.
- the mode of cooking, with preference to ‘low and slow’ and doneness.
- chemicals (nitro compounds) used in preservation of processed meats.
- breakdown of blood components like haem to harmful cancer-causing chemicals (read more here).
This probably why meat-eating countries like Argentina do not report high incidences of gut cancer..
Some friends asked me how can they know when someone has a stroke and what they should do about it. Its summarised quite well on this chart.
A few words about the last point – stroke is a medical emergency. If given through the veins within three hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke, by dissolving the clot that caused the blockage. In some cases, the stroke may be completely cured. As this drug can only be given in hospital, its important to transport a person suspected of a stroke to the Emergency Department as soon as possible.
- Earlier Treatment with Clot-Busters Boosts Survival in Stroke (everydayhealth.com)
- Emergency Medicine: Recognize the Signs of Stroke (omtimes.com)
- Stroke Treatment – Why Every Second Counts (everydayhealth.com)
The recent revelation of an American football coach sexually assaulting 10 boys who were placed under his charge (see here) must have placed many parents under some distress. How did the culprit get away with it undetected for so many years? Why did not the victims raise the alarm?
Like many sexual predators, Jerry Sandusky developed strong relationships of love and trust with his victims before molesting them. Quite often, such pedophiles position themselves into positions of respect and trust, such as being football coaches, physiotherapists and boy scout leaders. This is not to say, of course, that everyone in this position are sexual predators.
Child safety expert Irene van der Zande says that pedophiles know how to find and manipulate vulnerable kids – and how to put on a great show for everyone else, even members of their family. Quite often, these kids do not speak up because the person abusing them is someone they love and trust.
Van der Zande, child safety expert and the author of The Kidpower Book For Caring Adults, offers the following tips to protect children from child abusers:
1. Accept the reality that many child molesters may seem like wonderful people. Don’t be fooled by outside appearances. Pay attention to what someone is actually doing with your kids. If someone who is responsible for the care of many kids starts to single your child out for special attention, be careful. Don’t assume that someone is safe just because this person is generous, beloved, charming, and kind.
- Know the Signs of Child Sexual Abuse (aarp.org)
There’s a joke making the rounds that the number of Alzheimer’s disease sufferers will soon outstrip older male patients with erectile dysfunction ..so much so, elderly people will be taking Viagra and not remembering what to do with the erection afterwards!
But jokes aside, WHO, in its recent news release (11 April 2012) revealed that dementia cases are set to triple by 2050 worldwide and that the problem is still largely ignored. There are 35 million people in the world with dementia and this number is set to double by 2030 and triple by 2050.
Dementia is a syndrome, usually of a chronic or progressive nature, caused by a variety of brain illnesses that affect memory, thinking, behaviour and ability to perform everyday activities. The most common form of dementia is Alzheimer’s disease, which afflicts people of any socio-economic status. Celebrities afflicted with this condition include Ronald Reagan, Rita Hayworth and Perry Como.
Treating and caring for people with dementia currently costs the world more than US$ 604 billion per year. This includes the cost of providing health and social care as well the reduction or loss of income of people with dementia and their caregivers. The important role of caregivers cannot be over-estimated because AD cannot be cured and is degenerative, so the sufferer increasingly relies on others for assistance. The role of the main caregiver is often taken by the spouse or a close relative, and is well-known to place a great burden on the care-givers.
Some facts about dementia:
- Although dementia mainly affects older people, it is not a normal part of ageing.
- 60% of people with dementia live in middle or low income countries.
- Early diagnosis improves the quality of life of people with dementia and their caregivers.
- Dementia is a public health priority which has long been ignored.
The WHO report points to a general lack of information and understanding about dementia. This fuels stigma, which in turn contributes to the social isolation of both the person with dementia and their caregivers, and can lead to delays in seeking diagnosis, health assistance and social support. It also recommends involving existing caregivers in designing programmes to provide better support for people with dementia and those looking after them.
Public health authorities worldwide would do well to place more emphasis on undertaking programmes to raise the level of awareness of this disease as well as implementing programmes to strengthen care and support.
In South Africa, its HIV/AIDS; but the commonest ailment in China is diabetes. According to the BBC, China faces a diabetes epidemic, what with almost one in 10 adults having the disease, while more cases remain undiagnosed.
Given China’s huge population, this means that there are some 90 million diabetics; more than anywhere else in this planet. Even the US, with a similar prevalence of 1 in 10 plays second fiddle in terms of numbers simply because of China’s sheer size.
This represents a major public health problem for the authorities in Beijing as diabetes is a major factor in illnesses such as heart disease, stroke and kidney disease. Add to this the fact that this disease does not have many symptoms during the early stages and we have a potential gigantic health problem in the next few decades.
The reason for this upsurge in diabetes is the rapid economic development in China where a combination of urbanisation, lack of exercise, changing eating habits and higher stress have all resulted in obesity and sedentary lifestyle. Prosperity has resulted in the average Chinese going from a situation where he has not enough food and has to resort to manual labour to eke out a living, to a situation of having enough (or too much) food and doing less exercise.
As if not to make matters worse, diabetes is a disease which is difficult to diagnose in the early stages, largely because it is silent and wreaks serious damage before symptoms appear. It basically affects every blood vessel in the body and therefore will damage practically every organ in the body. Read more here.
Given the difficulty in diagnosing diabetes early, an extremely simple test to see whether you have diabetes is by measuring the amount of glucose in the blood. This is easily done by doing an instant finger-prick test at the pharmacy. If the result is suspicious, further blood tests will have to be done at the doctor’s office to confirm.
- Diagnosing Crucial Diabetes Signs (slideshare.net)