INFORMATION & IMPORTANCE OF BLOOD DONATION

INFORMATION & IMPORTANCE OF BLOOD DONATION

INFORMATION & IMPORTANCE OF BLOOD DONATION

The earliest documentation of blood transfusion is found in the religious text of many civilizations.

Karl Landsteener discovered the ABO blood grouping system in 1901, which is one of the most important landmark discoveries in the transfusion medicine. In the 1970s voluntary donors were accepted as blood donors. Blood transfusion lead to the discovery of Hepatitis B transmitted by donated blood. Since then testing for the hepatitis B antigen was implemented. Further studies since then have included tests for Malaria, Syphilis, AIDS, and Hepatitis C to make donated blood as safe as possible to the recipient.

Eligibility criteria for blood donors

  • Both men and women can donate blood.
  • Should be between 18-60 years of age with a weight of 50 kg or above with normal pulse rate, body temperature and blood pressure.
  • Donors with history of epilepsy, psychotic disorders, abnormal bleeding tendencies, severe asthma, cardiovascular disorders, and malignancy are permanently unfit for blood donation.
  • Donors suffering from disease like hepatitis, malaria, measles, mumps, and syphilis may donate blood after full recovery with 3-6 months gap.
  • People who have undergone surgery may safely donate blood after 6-12 months.
  • Women donors who are pregnant or lactating cannot donate as their iron reserves are already on the lower side.

How much blood can be taken during blood donation?

Our body has 5.5 litres of blood of which only 350 ml – 450 ml (one unit) of blood is taken depending upon weight of donor. Majority of healthy adults can tolerate withdrawal of one unit of blood. The withdrawn blood volume is restored within 24 hours and the hemoglobin and cell components are restored in 2 months. Therefore it is safe to donate blood every three months.

What is done with the blood collected?

The blood is collected in sterile, pyrogen free containers with anticoagulants like CPDA (an anticoagulant used in blood collection bags) or CPDA with SAGM (a solution that gives the red blood cells optimum viability). This prevents clotting and provides nutrition for the cells. This blood is stored at 2-6 C or -20 C depending on the component to be prepared. Donated blood undergoes various tests like blood grouping, antibody detection, testing of infections like hepatitis, AIDS, Malaria, syphilis and before it reaches the recipient it undergoes compatibility testing with the recipient blood.

One unit of whole blood is separated into components making it available to different patients according to their requirement. Thus one unit of blood is converted into packed cell volume, fresh frozen plasma, platelet concentrate, cryoprecipitate and granulocytes concentrate.

AAR BLOOD DONOR CLUB

Requirement of safe blood is increasing and regular voluntary blood donations are vital for blood transfusion services.  At AAR we have a blood donors club that was launched last year and has tremendously grown with over 200 registered members. From the clubs membership, we were able to save lives of two patients who critically needed blood.

Membership is free and open to all men and women between the ages of 18 to 60.  Once someone joins they will be grouped according to their blood type and will be issued with a membership card.  Incase of a request for a certain blood group, members with that blood type will be requested to go to the hospital the patient is admitted in and donate blood.

Blood transfusions save lives and this can only be possible if we all volunteer to donate blood. And as said by an unknown author, “Nobody can do everything, but everyone can do something” we should all endeavor to give blood.

Why isn’t my medication working???

Why isn't my medication working???

Why isn't my medication working???

One of the common problems patients, or people in general face nowadays is that they need to consult a doctor repeatedly for the same medical issues they may have…they present with the question that heads this article: “why isn’t my medication working???

I as a medical doctor would like to give a brief overview of the common reasons for this happening and hopefully in the process make most of you say to yourselves “Ahaa…that makes more sense now…”

Its always important to keep some very basic facts in mind when your body shows you any symptom. These include:

A symptoms is the bodies way of communicating with us about a problem that its facing

If you think about it, when you get hurt in your body, Imagine if you couldn’t feel exactly where…you would end up causing much more damage to that area before you can rest it  or treat it. The body needs to make you feel pain in order for you to know which part of you is being damaged. This blessing is sometimes missing in diabetics whose nerves have been effected. Ask any of them the importance of pain, and how it can be used to avoid the amputation of a limb!

Some conditions are not treatable, they’re just manageable

Doctors are not God, and there are quite a few conditions that we cannot treat. In such cases we offer advice and on how to manage the condition that you may have on a long term basis to prevent the severe symptoms that one may be experiencing. In other words we may have to give you tips on how to prevent things from getting worse…this is known as tertiary prevention. The concept is not so easily digested by most patients. There comes a time when our patient come to us and tell us “we stopped the medicines because we saw no improvement”. Ensure you confirm with the doctor if the medicines were meant to prevent worsening, as in osteoarthrtitis, before you decide they are not working!!

Some conditions are self limiting, the medications given just help temporarily alleviate the symptoms while the infection takes its course

The common cold is appropriately named, as the cases are really too common. An important thing to note is that it is one of the conditions that we don’t cure. Our bodies’ immune systems is what we rely on to fight this, we only assist the symptoms that may be quite severe with our medication and allow the disease to take its course. So if the medication is not causing a lasting effect, or if the condition is persistent because of habits like exposing ones self to cold or playing in the rain, don’t think its the medication that is ineffective

As much of a nuisance some symptoms may seem, it may be playing a very important role in limiting the disease that you have… so sometimes its good to bear some of the symptoms rather than get rid of all of them!

It has been proven that the high temperatures during a fever also limit the growth of bacteria causing the infection, and the cough that one may develop in a cold is a very effective way of getting rid of the trapped pathogens in our mucus membranes…so stopping the cough or maintaining a low temperature of 36 degrees Celsius may not necessarily be a good thing all the time

When you feel better because of medication, that doesn’t mean you can resume all the stressful and difficult activities… your body mostly will require some time for recuperation

Out of site, out of mind!!! when people don’t feel their sickness any more they immediately resume their stressful and difficult activities. It’s important to remember that the result of such actions is a slow recovery and a high chance of recurrence of the problem.

The body needs rest so it can focus on rebuilding itself, and combating the remnants of the infection or disease that one has.

If you don’t help you’re body, it will not help you!

As long as you don’t understand the cause of the disease, you will never be able to stop it from recurring

When we fall sick it’s imperative to understand the source of the infection or cause of the illness. It’s not enough to just feel happy that the symptoms have gone after taking medication. Recurrent amoebic dysentery, because some patients take medicines then go back to drink the same contaminated water, has been found in many cases. The medicines may be working after all, but the disease keeps being brought back into your system before you can enjoy the medicines positive effects!!!

With the above tips, it should be clear that treatment consists of more than just taking of pills prescribed by a doctor at the appropriate dose…it’s about understanding what illness you have and how your body works to get rid of it.

I wish all the patients best of luck with their conditions as we pray for their recovery, but I advise them, and everyone in the general population to adopt the informed approach to illnesses and other medical conditions so that they may know what to expect.

Heard about yips?

Heard about yips?

Heard about yips?

Just about everyone has had moments when we get nervous breakdowns especially when we need to rise up to the occasion. School students sometimes exhibit this kind of tension during exams; actors get stage fright before an audience and sportsmen may get the yips when competition is high.

The yips refer to unintentional muscle movements especially when sportsmen need to perform maneuvers that require precision. These involuntary muscle motions occur in little muscles and are known as muscle spasms usually. It impacts players of varied sports like cricket, darts and golf and is grounds that sportsmen eliminate their professional careers sometimes.

In golf, yips are seen as a muscle twitches or spasms when golfers are trying to putt. Due to the distraction due to the shaking in the hands and wrist, this inevitably necessitates even more strokes than are necessary for the average 18 hole rating. That is common when playing big tournaments or playing against extremely competitive or seemingly best players in the overall game. Research has demonstrated that nearly 50 % of golfers have observed the yips. A few of the elements that may boost the possibility of a golfer obtaining the yips are:

  • Excessive utilization of certain muscles: it’s understandable that golfers with an increase of experience are even more at risk than people that have less experience
  • Players with a lesser handicap
  • The elderly: This can be as a result of biochemical adjustments in the brain as you grows older

Although the specific reason behind yips is not ascertained, the etiology is graded to be possibly neurological or psychological:

Read moreHeard about yips?

Osteoarthritis

https://upload.wikimedia.org/wikipedia/commons/9/9c/Heberden-Arthrose.JPG

https://upload.wikimedia.org/wikipedia/commons/9/9c/Heberden-Arthrose.JPG

Osteoarthritis

Osteoarthritis is a degenerative joint disease that involves cartilage destruction.

It usually presents with joint pain, joint swelling due to effusion, limitation on the range of movement and joint deformity.

It increases with age, worsened by weight gain and overuse of certain joints like in athletes.

History of bone fractures across a joint predisposes one to osteoarthritis.

Treatment is both pharmacological and non pharmacological.

Patients must realize that a cure and symptom-free state may not be achievable while physicians must understand the 3 Cs’ i.e. compliance, control and communication.

  • Compliance- patients must take the medicines as prescribed, use assistive devices as advised and exercise
  • Control is better when patients actively participate in the management of their condition and
  • Communication; People remember
    • 10% of what they read
    • 20% of what they hear
    • 50% of what they see and hear
    • 70% of what they articulate
    • 90% of what they articulate, do, or demonstrate

Physical therapy includes weight loss, aerobic exercise and use of assistive devices such as canes.

Pharmacological therapy involves use of drugs such as pain killers and steroid injections.

Typhoid fever

Typhoid fever

Typhoid fever

Introduction

Many times in Medical practice we come across patients who often complain of “Typhoid fever”. These patients have also been on treatment previously at peripheral centres for this diagnosis, commonly by unqualified personnel, or on a basis of non specific laboratory tests and often on clinical suspicion. This kind of practice has led to Overtreatment and irrational use, and thus potentially abuse, of antibiotic medications.

Other names

Enteric fever,Typhoid.

But what exactly is Typhoid fever?

Typhoid is a bacterial infection that is characterized by fever and abdominal pain and caused by dissemination of Salmonella Typhi or Salmonella Paratyphi types of bacteria. It is a clinically distinct diagnosis, though clinical features may resemble those of many other tropical diseases such as Malaria, Amoebiasis, Dengue fever, hepatitis, bacterial enteritis, Ricketsial infection, and Acute HIV infection among others.

It is thus important for you to note that there are many clinical scenarios similar to typhoid, thus it’s the duty of trained medical personnel to differentiate which one it is.

How is typhoid transmitted?

Salmonella that cause typhoid reside only on Humans, no Known Animal reservoir.
Infection is acquired by direct contact with an infected individual or indirectly via contaminated food or water. There is a story of “typhoid Mary” the cook in early 20th century NewYork who infected approximately 50 people, with 3 persons reported to have died,  highlights the person to person spread of this infection and role of asymptomatic carriers maintaining the cycle of infection.

Factors predisposing to infection include:

  1. Conditions increasing the PH of the stomach like
    • Increased use of Antacids
    • Low levels of hydrochloric acid in the stomach (Achlohydria)
    • Age of <1 year
  2. Inflammatory conditions such as Inflammatory bowel disease,
  3. Previous gastric surgery,
  4. Altered intestinal Normal Flora due to antibiotic usage.

What are the symptoms of Typhoid fever?

Following infection with Salmonella, there is an Incubation period of between 3 to 21 days, with average 10-14 days. There are no signs of disease at this time.

The length of this duration reflects the inoculum size and a person’s health and immune status. Infection leads to an onset of fever with other non specific symptoms. There non specific symptoms that often precede fever such as chills, headache, anorexia, cough, weakness, sore throat, dizziness, and muscle pains.

The Classic presentation of Typhoid in untreated person is divided into weeks is as follows:

First week of illness

Nonspecific symptoms including:

  • Persistent headaches
  • Malaise,
  • Rising remittent fevers also called the Step ladder fever. This is fever that rises exponentially over a tie period without remittion
  • Constipation
  • Mild nonproductive cough.

Second week

  • The patient looks toxic and apathetic
  • There is a sustained high temperature.
  • The abdomen slightly distended
  • There is an enlarged spleen (Splenomegally)

Third week

  • The patient becomes more toxic and ill.
  • There are persistently high fever episodes.
  • There may be intestinal bleeding and perforation, resulting in peritoneal infection (peritonitis).
  • There is abdominal distension that on auscultation, there are pronounced  scanty bowel sounds.
  • Diarrhoea common with liquid, foul smelling green-yellow stools.
  • The patient becomes delirious and a confusional state sets in (typhoid state)

Fourth week

  • Patients who survive have considerable weight loss.
  • Fever, mental state, and abdominal distension slowly improve.
  • Convalescence is slow.

How is Typhoid Fever Diagnosed?

Other than a positive culture, no specific laboratory test is diagnostic for enteric fever.
Cultures can be done on the following specimen:

  • Blood
  • Stool
  • Urine
  • Rose spots
  • Gastric or intestinal secretions
  • Bone Marrow; these remains positive in more than 90% of cases even after 5 days of good antibiotics.

Other tests that may give clues to the diagnosis of typhoid fever include a Complete Blod Count, Liver Function tests, Kidney function tests all which may change in various other disease states.

How about the Widal test?

The classic Widal test is widely available however, it has high rates of false positive and false negative, and thus this test is not clinically useful.

How is Typhoid fever treated?

Several Antibiotics are available for treatment of Typhoid fever, and since they are prescription only medicines, it’s wise to present to the doctor whenever you suspect Typhoid fever.

Hand washing techniques (The beginning of infection control)

Hand washing techniques (The beginning of infection control)

Hand washing techniques (The beginning of infection control)

Introduction

There are hundreds of thousands of bacteria that live on our hands. We keep on adding and removing them with our hand washing methods. We keep adding some from the things we handle, the greetings we get and many more. Most bacteria are harmless but gain entry to the body after a small weakness in our defence systems. If you imagine all the places you visited today, from your office to the washroom, you must have handled many things. By frequently washing your hands the right way you will wash away germs, i.e. bacteria and viruses. Improper hand washing techniques is one of the many ways we breach our immune defence systems. The skin is one of the body’s defence organs against such germs, by washing your hands; you are performing one of the single most important-infection prevention procedures.

What is hand washing?

Hand washing is the removal of dirt, germs or micro-organisms and other organic materials that may be present on the hands by using water.

Why do we wash hands?

By performing this procedure, we are able to remove about 99% of micro-organisms with simple soap, water and friction. This helps to reduce the rate of infection from person to person or patient to patient, patient to health worker. By reducing the rates of transmission of these organisms, we are able to directly influence the rates of infections and complications that arise.

When should we wash hands?

Basically your hands should be washed after you have performed every act or procedure, whether domestic or at the place of work. The most important times are after:

  • After blowing your nose or coughing/sneezing
  • After using toilet
  • Before handling food
  • After handling food
  • Before and after handling patients
  • After handling pets and other animals
  • Before and after procedures
  • Before changing a diaper
  • Before touching newborns (neonates) as their immunity is not well developed.
  • When physically dirty

What to use when washing hands

The three most important things you need are:

  • Water
  • Soap
  • Antiseptic solution

Water is responsible for removing and rinsing all dirt from the hands. Soap helps dissolve some of the particles and materials that cannot dissolve in water and the antiseptic soaps hep I killing the germs.

How to wash hands

The most important thing to remember is never to touch the tap with dirty hands, wash the hands than return to the tap with clean hands to close it. Basically you end up having done nothing. In most health institutions, the types of taps used are different from the taps at home for the purpose of minimizing the risk of transfer of infections. You may use a paper towel to open the tap and let it flow especially if your hands are completely dirty. After doing this;

  1. Wet hands with running water
  2. Apply soap and distribute it over the hands.
  3. Away from running water rub the palm, back of hands, between fingers, back of  fingers, thumbs, finger tips and wrist and remove debris from under the finger  nails if any.
  4. Do this for at least 20 seconds.
  5. Thoroughly rinse and dry your hands using disposable towels or hand dryer
  6. Close the tap to save on water.

The use of antibacterial / antiseptic soaps

What is an antibacterial soap?

Antibacterial soaps are agents used to clean with the aim of removing or killing bacteria that are logged in the skin, nails and hair. The soaps contain the following antibacterial agents:

  • Triclosan
  • polyhexamethylene biguanide
  • benzethonium chloride
  • farnesol

Any benefits antibacterial soaps?

Most antibacterial soaps come with ingredients in combination or as triclosan alone. There may be other kinds of antibacterial agents. Research done in the department of Surgery, Columbia College of Physicians and Surgeons, Columbia University, New York, New York showed that the combination of Triclosan, polyhexamethylene biguanide, and benzethonium chloride-TPB or farnesol polyhexamethylene biguanide, and benzethonium chloride-PB showed superior rapid and broad-spectrum reduction of risk of organisms developing resistance than do soaps containing triclosan alone. Hand washing with TPB and FPB soaps by healthcare workers and the general population may reduce the transmission of germs, with a lower risk of promoting the emergence of resistant organisms.

When are the antibacterial soaps effective?

A study was done in the Dial Corporation, Microbiology Department, in Scottsdale Rd., Scottsdale,  USA ( link Janice.Fuls@us.henkel.com ) and found that the antibacterial soaps effectiveness depend on the following

  • The compliance of the person using them. If used on an on and off basis, the effectiveness is reduced and the chance of bacterial resistance increased. This is because the bacteria get clever and develop mechanisms of resistance or eliminating the antibacterial agents from inside their cells
  • The soap volume. The higher the amount of soap volume the better. Less amounts are more or less ineffective in destroying the bacteria altogether
  • How much time do you spend washing? It has been studied and found that the more time spend (minimum of 15 seconds) significantly reduced the bacteria transmission.

Unacceptable hand washing methods

About the antibacterial soaps

Much has been written about the potential hazards versus benefits of antibacterial (biocide)-containing soaps. A study be the department of epidemiology university of Michigan, Ann Arbor concluded that soaps containing triclosan within the range of concentrations commonly used in the community setting (0.1%-0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. Several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria.

Please note the following

  • Triclosan is used in higher concentrations in hospitals and other clinical settings, and may be more effective at reducing illness and bacteria than the home setting
  • There are other soap ingredients that help fight bacteria such as savlon, peroxide hydrogen, povidone iodine or Betadine.
  • A combination of several drug ingredients is far much better than a single ingredient since it leads to faster bacterial resistance.
  • When using the soaps, allow at least 15 seconds or more wash time to be sure of the effectiveness
  • Most soaps contain only one type of ingredient ( always read the insert) and this becomes a problem when trying to reduce hand or skin bacteria
  • Not all that is seen in an advert may be true concerning eh effectiveness of some products. A lot of consumer knowledge and follow up is important

Based on the above details and research findings one should always ask him/herself; how long do I take to wash hands? Most of the time is after the dirt is gone or when the water that comes out of the hands is clear. These are practices that are not effective in removing bacteria and other organisms from the hands:

  • Not washing hands after every procedure
  • Irregular use of antibacterial soaps
  • Washing hands for less that accepted time. It is advised that you wash for at least 20 seconds
  • Using soaps that have not been medically tested and or registered as antiseptics
  • Using soaps that do not contains enough antibacterial ingredients
  • Reusing the water that is already contaminated
  • Using towels that are dirty and not frequently cleaned
  • Using wet towels to dry hands. Wet towels tend to adsorb dirt and accumulated more germs
  • Using the same towels for more than one purpose e.g. one towel for the washrooms being used in the kitchen

Everyday Tips To Keep The Dr Away:

Everyday Tips To Keep The Dr Away:

Everyday Tips To Keep The Dr Away:

My son was unwell for several days and for the first time I felt like a mechanic who couldn’t fix his own car. Every time I thought ah! I have this figured out something else came up. Until I met a Doctor friend who said sometimes kids get bugs that are unexplained. During this period I learnt a few things I’d like to share.

  • Regardless of child’s age all his/her utensils should be properly sterilized. Studies have shown that Rota virus infection in older children is worse than the younger ones.
  • Cold drinks e.g. water, soft drinks do affect the child because they act as a media for infections viral or bacterial especially upper and lower respiratory tract.
  • Immediately you remove your baby’s pamper especially one with stool wash your hands thoroughly before fitting him/her with new pamper.
  • Be prepared when you come to the doctor. If your child is having vomiting or diarrhea carry the stool and urine sample. These can be brought to the lab at most ONE hour after collection.
  • Make sure your child is warmly dressed especially at night since the child keeps tossing and turning chances of staying under covers are minimal. Please don’t judge by the way you feel children are more sensitive to lower temperatures than adults.
  • An important sign that your child could be feeling cold is if they start to have running nose, sneezing or coughing. Dress him/her up give warm fluids and you will see the change.
  • Reassure the child and be honest with them on exactly what is going on regardless of age. Let then know everything is being done to make them feel better but don’t over do it. It’s not the time to buy that toy or game or sweets just make it look like part of life.
  • Oh! Don’t scare the child about doctors. Many a time I’ve heard parents tell kids to ‘behave or the doctor will inject you!!’ This just makes it harder for the child to cooperate with the doctor/health profession. Also chances that your child may not say when he/she is ill are high for fear of injections. As for dentist visits, well even I, am still afraid.
  • Don’t panic regardless of what your child is going through. This just makes them worry too.
  • Do not be afraid to ask for or accept help from partner/spouse or whoever is available. You need rest and fresh mind to handle whatever comes tomorrow.

A Devastating Monster

HIV, A Devastating Monster

HIV, A Devastating Monster

Many diseases are caused by germs (microorganisms) which invade the body and alter the normal body functioning. These germs differ from one another and are thus grouped as viruses, bacteria or fungi. The most devastating and difficult diseases to treat are those caused by viruses, due to their uniqueness from other microorganisms. Viruses are very small in size (minute) and have no cellular structure, little wonder, they are called infectious particles.

The most outstanding feature of viruses is their inability to grow (replicate) outside living cells and because of this, fewer drugs are available to treat viral infections. More confounding in their ability to cause diseases is a group of viruses called retroviruses and in particular, Human Immunodeficiency Virus (HIV).

So what makes HIV more confounding than other viruses?

A clearer understanding of the uniqueness of HIV can be achieved by understanding how viruses cause diseases. Viruses can only grow inside a living cell outside of which they are inactive (metabolically inert), and this is why unlike other microorganisms which invade tissue surfaces, viruses invade the cells. Following entry into a cell, a virus shuts down all the activities of the host cell, then it directs the cell to produce the materials (proteins and nucleic components) required to make new viruses (virions) during its growth.

The new (daughter) viruses then grow and mature inside the host cell and are eventually released through rupture of the cell membrane(unenveloped viruses) or by budding(enveloped viruses).Either way, both processes of release lead to the death of  the host cell whereas the new viruses infect more cells and the process continues. This process is devastating considering that most drugs cannot act against germs within the cells (intracellular pathogens). The viruses can therefore hide causing more and more infections without being destroyed and the high number of cell death eventually lead to the death of the whole organism.

In the case of HIV, what distinguishes it from other viruses and makes it a monster of sorts is the type of human body cells it invades and the subsequent weakening of the body’s immune system leading to AIDS. Within the body of an infected individual, HIV is mainly present in semen, vaginal/cervical secretions and blood. It may also be present in saliva, tears, urine, breastmilk, cerebralspinal fluid and infected discharges. The virus can be transmitted from infected person to uninfected person through sexual intercourse, from mother to child during birth, blood transfusion and use of contaminated syringes and needles.

Once inside the body, HIV infects the very cells which are meant to defend the body against germs that cause diseases. Worst of all, the virus readily infects the type of cells (CD4 T-cells) which control and regulate almost the entire body’s defense system in addition to infecting other cellular components involved in the body’s defences.As was described earlier, this state of affairs leads to massive destruction of immune cells hence leaving the body vulnerable to all kinds of disease – causing organisms which in essence would not have caused any disease had the immune cells not been depleted. The depletion of the body defences continues over a long period of time and the resulting immunosuppression paves way for opportunistic infections such as pneumonia, tuberculosis, typhoid, dysentery and meningitis. These diseases further weaken the body’s immune system resulting into immunodeficiency which eventually leads to full blown AIDS.

Indeed, the devastation caused by HIV may be compared to a nation whose armed forces have been killed and so its citizens are attacked from all sides by foreign aggressors eventually leading to the demise of that nation.

Who is a good doctor

Who is a good doctor

Who is a good doctor

The definition of a good athlete, a good prosecutor, or a good artiste is fairly easy. It’s the one who scores most goals, the one who puts most criminals behind bars, and the one who sells millions of albums. The best soccer team is the one that takes home the most trophies. Having said that however, I must point out that arsenal in my opinion still remains the better team albeit it’s poor goal record.

On the other hand, what makes a good doctor is more difficult to define. Using specific parameters to measure how good a doctor is, is one of the biggest challenges for health managers. The best doctor is not the one who heals most patients, because in many specialties, cure is not the goal of patient management. In fact some of the best doctors I know are in specialties that take care of patients with terminal illnesses.

It’s not the one whose patients live the longest, because in many situations we need to add life to our patients’ days rather than adding days to their lives. In fact in some circumstances prolonging/sustaining life may be considered undesirable by the patient and his/her loved ones.
It’s not the cleverest or most knowledgeable one since there’s still so much we don’t know in medicine, that if that were the only parameter we’d all fall short.

Not the one with the best people skills, because that’s not enough in the craft of medicine. It’s definitely not the one who rakes in the most money for their practice. In my opinion however these are parameters we can’t trash wholesome when we attempt to define the attributes of a good doctor. Enough of what a good doctor is not.

To different people a good doctor means different things but there are some key attributes that most people agree on.

  • A good doctor is humane, a good person. He is a friend, compulsively compassionate, respectful, patient, a good listener and available. He takes interest in the patient as a person and not as a constellation of symptoms.
  • A good doctor appreciates and admits their limitation.
  • A good doctor has a high tolerance for ‘not knowing’ and knows when to consult. I’ve seen a many professors learn from junior students. One of the most elusive diagnoses I’ve seen made, was by a fourth year student. The professor leading the team was humble enough to pursue that possibility. Because it’s all about what’s best for the patient and not polishing our personal egos.
  • A good doctor must be knowledgeable, scholarly and in touch with current trends in medical practice. He or she must demonstrate respect for the body of science, must use evidence as a tool to optimize patient care but not merely to justify a certain course of action.
  • A good doctor must also be a critical thinker, always questioning every decision he/she makes. He/she makes decisions that add value to the task at hand. Costly investigations that confirm only what history and physical examination have discovered have no place and neither have investigations that would not change patient management.
  • A good doctor is gentle yet firm. He educates, counsels and informs the patient’s decision making. He recognizes that the ultimate responsibility for health decisions is the patient’s.

That’s the summary of who I want my doctor to be. What’s yours?

Are fish oils the cure for mental health?

Are fish oils the cure for mental health?

Are fish oils the cure for mental health?

This month in our Health promotion calendar we are focusing on mental health.

WHO definition of Health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

With this in mind then it is clear that mental health is a priority for healthcare providers and should be a concern of all adults just as much, if not more than the concern and care that goes into preserving their physical health.

The rationale here is: if one is willing to wake up at 6 am and jog for 1 hour or sweat it out in the gym, choose carefully what they eat and dedicate time to living a healthy lifestyle then some effort should be spared towards promoting mental health. Here is some information on how to achieve the same with your mental health.

OMEGA 3 FATTY ACIDS:

What are they?

The Omega 3’s are a group of essential fatty acid nutrients derived from marine or plant sources. The two principle types of Omega-3 are EPA and DHA – both found in fish oil. Omega 3 fatty acids have been shown to have mood stabilizing effects, and fish oil has become a very popular choice among those with bipolar disorder and depressive illnesses seeking natural treatment for their symptoms.

Fish, particularly fatty ocean fish, is an excellent source of omega-3 fatty acids. At least three clinical trials have observed a marked improvement in depressed patients given relatively high doses of fish oils. This has spurred other scientists to look closer at the potential benefits of fish oil supplementation. At the moment there are at least 10 clinical trials underway evaluating fish oils in the treatment of depression, attention deficit disorder, and schizophrenia

Fish oils: A cure for depression?

According to a BBC report, on a worldwide basis more working days are lost to depression than to any other illness. The incidence of depression is growing with people born within the last 50 years being twice as likely to suffer from it as were their parents.

Dr. Joseph Hibbeln of the National Institutes of Health believes that the reason for the increase in depression can be directly attributed to a major shift in dietary patterns, specifically fat intake. He points out that the vast increase in the use of soy, corn, palm and cotton seed oils in the last 100 years has totally changed the traditional ratio of omega-6 to omega-3 fatty acids in the diet. Soy oil consumption in the US, for example, has increased thousand-fold in the last 100 years helping to skew the omega-6 to omega-3 ratio from about 1:1 to today’s 16:1.

The brain consists pretty well entirely of fat so clearly one’s fat intake could affect one’s brain composition, particularly the ion channels which channel signals in and out of the brain. There is also evidence that low levels of omega-3 fatty acids are associated with low levels of the mood hormone serotonin.

Dr. Hibbeln’s hypothesis is supported by the fact that the incidence of depression is considerably lower in countries with high fish consumption.

HEALTH EFFECTS OF FATS:

BENEFITS:

Omega 3 fatty acids have been linked to various clinical and behavioral conditions involving mental function. These include depression, bipolar disorder, schizophrenia, violence, aggression, and attention deficit hyperactivity disorder.

These fatty acids are also associated with certain neurodegenerative diseases such as Alzheimer’s and Parkinson’s diseases. A common feature of these disorders is low levels of the marine or fish oil omega-3s, EPA and DHA and arachidonic acid.

Low levels of omega-3s have not been shown to cause any of these disorders, but they appear to significantly increase the chance of developing them. Other factors are often involved, such as family history and environmental influences. All the same, there is a plausible basis and growing evidence for the involvement of marine omega-3s in brain function in these conditions.

Depression: This is the most common form of mental affliction. The National Institute of Mental Health in the U.S. estimates that about 4% of adolescents also get seriously depressed. More than just feeling «down,» depression affects a person’s ability to work, sleep, eat, and experience pleasure; it can be disabling. It is more common in women than men, particularly after childbirth.

Depression is least common in countries where people eat the most fish, such as Japan, Iceland, and Korea, while countries with low fish consumption have the highest rates. They include the U.S., Canada, and West Germany.

People with depression often have low levels of EPA and DHA in their tissues compared with healthy people, but it is not clear what this means.

Several studies have reported positive outcomes in depressed patients who took EPA along with their usual medication.

Schizophrenia: Less common than depression, schizophrenia is a crippling mental illness that affects about 1% of the US population. There are several neurological and biochemical alterations in this condition, including reduced cell membrane levels of arachidonic acid and DHA. Occurrence of schizophrenia in different countries does not appear to be linked to seafood consumption. Nearly all patients are treated with medications, so studies of supplementation with omega-3s include drug treatment too. Some medications may reduce cell fatty acids, so it is difficult to distinguish the effects of more than one treatment.

Studies have confirmed that people in this country and in many other countries around the world are not eating enough of the right kinds of fish and are therefore not getting enough of the right type of fatty acids. This not only leads to depression but can have horrible effects on physical health as well. The only documented side effects of the Omega 3 fatty acids seem to be nausea, diarrhea, and a fishy aftertaste.

Editor’s comment: Daily supplementation with 1-3 grams of high quality fish oil is entirely safe and may not only improve your mood, but help protect you from heart disease, stroke and arthritis as well!
I don’t know about you but I’m off to purchase some omega 3 as soon as possible.

On that note, here are some locally available preparations:

  • Seven seas: caps and suspension
  • Omega 3 caps.

Sources:
Small, Meredith F.  The happy fat. New Scientist, August 24, 2002, pp. 34-37.
www.fatsoflife.com
BBC.

Adult ADHD

Adult ADHD

Adult ADHD

Have you ever had trouble concentrating, found it hard to sit still, interrupted others
during a conversation or acted impulsively without thinking things through? Can you
recall times when you daydreamed or had difficulty focusing on the task at hand?

Most of us can picture acting this way from time to time. But for some people, these and
other exasperating behaviors are uncontrollable, persistently plaguing their day-to-day
existence and interfering with their ability to form lasting friendships or succeed in
school, at home and with a career.

Experts used to believe children would grow out of ADHD by the time they were adults.
In recent years, it’s been recognized that ADHD can continue on into adulthood. This
relatively recent acceptance of adult ADHD means that many adults remain
undiagnosed and aren’t aware their symptoms and behaviours are actually part of an
identifiable condition.

Unlike other mental disorders such as depression, ADHD does not start in adulthood.
Adult ADHD is a continuation of ADHD from childhood. The main difference is in the type
of difficulties and symptoms experienced. Adults are less likely to have intense
hyperactivity.

Rather than problems at school, its work lives and relationships that prove troublesome.
Instead of hyperactivity, one is likely to feel restless, fidget a lot, have difficulty relaxing
and feel on edge a lot of the time.

A typical ADHD adult may have gone through life being constantly misunderstood:
One’s behavior and actions may have caused difficulties with teachers, friends and work
colleagues. One may have been called clumsy, hyper, rude, abrupt, lazy, insensitive and
irresponsible. Smoking, drinking alcohol and, in some cases, drug taking are also more
common among ADHD adults.

What are the symptoms of adult ADHD?

Like childhood ADHD, adults share the symptoms of inattention, impulsiveness and
hyperactivity. For some adults, the hyperactivity part of things calms down and is more
controllable as they get older.

Adults can experience ADHD in different ways, but some of the common symptoms
include:

  • Concentration problems
  • Forgetfulness and poor short-term memory
  • Lack of organization
  • Problems with creating and maintaining routines
  • Lack of self-discipline
  • Impulsive behaviour
  • Depression
  • Low self-esteem
  • Restless mind
  • Restlessness
  • Poor time management
  • Impatience and frustration
  • Poor social skills and making inappropriate remarks
  • Feelings of underachievement.

Diagnosis difficulties with adult ADHD

As an adult, getting a diagnosis of ADHD is not straightforward. ADHD adults will have
experienced their symptoms for most of their life and, despite frustration, are likely to
have reluctantly accepted them as part of their unique make-up. Some will have learnt to
develop their own coping strategies and may remain unaware they have a recognisable
condition. In most instances it’s friends, family or work colleagues who instigate a visit to
a doctor.

What treatment is available?

Although there’s no complete cure for ADHD, a number of treatments can significantly
help with the management and control of symptoms. The most appropriate treatment
regime varies according to individual needs and set of symptoms. The best treatment
should accommodate all areas of need.

Treatment focuses on helping behaviour, emotional problems and social difficulties
caused by ADHD. The main treatments for adult ADHD are:

Behavioural therapy

It helps one learn about the disorder and ways to manage it effectively. For example,
manage and maintain daily schedules better through making lists, cope with large
projects at work by breaking them down into smaller chunks.

Psychotherapy

Psychotherapy helps treat the emotional disturbances of people with ADHD. Sessions
can take place:

  • on a one-to-one basis with a professional
  • in a group
  • in conjunction with a partner if relationship difficulties are the main problem.

Psychotherapy can help remove or modify troublesome emotional symptoms and help
you cope with the daily challenges of living with ADHD.

Medication

Is usually used alongside other therapies; The most common medication for adults is
stimulants, but some people benefit from taking antidepressants – particularly if they
have co-existing symptoms such as anxiety and mood swings.

It is important to note that a treatment plan is developed according to the
individual needs of each person.

Diabetes: Are you scared of it?

Diabetes: Are you scared of it?

Diabetes: Are you scared of it?

What exactly is diabetes? What types do we know and what can we do about it –this is what this article is all about

WHAT IS DIABETES?

Diabetes is essentially all about blood sugar control.
Normally our blood sugar levels are all within a certain range between 3.5 mmol/L and 8 mmol/L depending on whether we are fasting or have just eaten. We have a delicate balance of blood sugar, controlled by a number of different hormones, the most important of which is Insulin.

We speak about Diabetes when the blood sugar goes above the normal reference ranges on a continuous basis.
What happens when the blood sugar is higher then normal?
It tends to stick to certain proteins in the body and leads to the symptoms & signs of diabetes, and eventually to complications if not managed adequately.

Read moreDiabetes: Are you scared of it?