Say No to Alcohol !!!

    ,,First you take a drink, then the drink takes a drink, then the drink  takes you’’                

                                                  Scott Fitzgerald                          

                                                                                    

         Today is the national screening test for alcoholism in US and is a very good idea for us also, to raise awareness about this subject.

          I will make some references to the smoking subject in the sense that, the people who have problems with drinking, will surpass also some steps in order to recognize they have a problem and looking for help.

     When a patient is confronted with the idea that he is an alcoholic, the first reaction is denial. It is common sense for him. Even though the family is there and stresses the importance to get help,he will deny the fact, he has a drinking problem. The doctor with patience and diplomacy must to seed in the patient mind that it is a help available, in case he is interested in.

How can we know if the person has really a problem with drinking?

      A  CAGE questionnaire helps us know if the patient is addicted and the questions below are just the most important from the questionnaire.

►Did you feel the need to cut down drinking?   

►Did you feel annoyed when others people speak about your habit?

►Do you feel guilty about your drinking habit?

►Did you feel the need to drink first time in the morning after waking you up?

       Having the score for this type of questionnaire, we will know if the person has a problem of dependency, meaning alcoholism.  

      We can also know if the person consumes alcohol on a regularly basis, making some blood analysis, looking for liver tests or making an ultrasound and seeing an enlarged and very bright liver in hepatic steatosis or a granular liver and ascitis in cirrhosis.

There are many manifestations we can see on them:

      Red spots on the skin, a yellowish skin, itchy skin,  a tremor of the hands  called asterixis, we can see caput medusae on the abdominal skin, which means a dilatation of the portal  and umbilical vessels, a sensibility on abdominal palpation, breast growth in men and impotence, hemorrhoids and varix, bleeding tendencies, capillary fragility. Not to mention, unsteady gait with large base of support, confusion, agitation, sometimes amnesia and confabulation (lying because they don't remember facts). The risks are higher for the pregnant women, their children suffering by fetal alcoholic syndrome.

      In our society, there are a lot of occasions to drink; there are people who drink in order to dare speaking in public, to let the shyness or the panic behind, but also people who cannot stop this habit.

     We as individuals, we haven’t the same quantity of alcohol dehydrogenase in the bloodstream, an enzyme we are born with and which is necessary to metabolize the alcohol in the body. That’s why, we react differently to the same amount of alcohol. Some can tolerate well the alcohol, but some are not, because they don’t have enough enzyme to metabolize the alcohol. We must also have this particular aspect in mind, before judging or stigmatizing someone. If a person becomes drunk very rapidly, it is because of this enzyme, which is low in their bloodstream.

       Also the heredity is important, in the sense that, people with low enzyme will have offspring’s with the same problem.

     It is also a problem of education, meaning the example of the parents is important when a teenager became alcoholic. We say about an obese family, that they all eat on the same table but we can enlarge the definition, saying they drink also on the same table.

       It is like a vicious circle in the same family or in the same entourage, which must to be broken.

       At some point, the effects of alcohol will be present medically and also present in the social or professional life of our patients. They will look for help and then, the role of the family and the doctor and why not of the entourage will be a crucial one.

      We must to intervene before hepatic steatosis will become cirrhosis, the first one being reversible in nature instead of second one which necessitates a liver transplant.

     Treatment will be followed in clinics of rehab, with AAA meetings, passing 12 steps, taking treatment with Naltrexone and Antabuse, which modifies the behavior in front of alcohol, sedatives for a while to prevent seizures in withdrawal, peers group sessions, motivational sessions, psychologically aid, ergo therapy, sessions of relaxation, yoga classes, all that help people to relax and let behind this habit. Not to forget the medical and psychological follow-up, because some of them will recur.

The alcoholism it’s an illness and must to be treated in consequence!

  

Stigmatization and Anti-Stigmatization Trends

   This week was the antiracial movement week. I will not enter in this subject, but I will raise the awareness about a similar trend in the health system: The stigmatization or anti-stigmatization trend.

    In the health field it is something very frequent.We just know that we encounter a lot of people who bullies others human beings for any imperfection, for any visible handicap or for any mental or physical illness. This is not correct but it is still present in our society. Apparently we cannot intervene in situations like that, but we can raise the awareness on this issue.

   In my opinion it is a problem of education, which apparently not everyone has.

A very good proverb says to not judge somebody, until you don’t walk a mile in their shoes. And how much truth it is in these words.

    In our society, we encounter blind people, deaf or mute people, people with neuromotory handicap, paralyzed people in their wheelchairs or using canes and people born with all sorts of handicaps which suffer physically and psychologically.

       Ideally, our society has to be a very accommodative one. And clearly on this point, the medicine has made a lot of progress in order to help these people. Politically speaking, we can also see progress, in the sense that we can encounter nowadays, a lot of organizations or foundations which fight for the well being of these people.

       But the problem still and will exist because a lot of ,,healthy” people continue to stigmatize these sick or unfortunate people.

In my childhood, I was very used to have people around me, with all sorts of problems but I was educated to consider them like everybody else and I can assure you, they really are.

     As a doctor, I have worked with children with all sorts of disabilities and it was an enriched and enlightened experience for me. I was always amaze, how these people have such a capacity to accept things which are not their fault, to move on with their lives, to develop new capacities or new abilities or to acquire new knowledges.

       A lot of people have the inferiority complex and they really fight against it. The most of them try so hard to surpass their temporary or permanent disability, giving us such a good example of survival , open-mindness and elevation of the spirit.

   In mental health, the stigmatization is more often, because people didn't acknowledged the fact, that these people are sick, some of them are born like that or some of them became mentally instable after different shocks in their life.

    The society nowadays became so senseless and intolerant, having no compassion for these kinds of people. In the same time, I can assure you, the sick people don’t look for compassion, but for the right to be seen and treated equally.

    We must to see the good and beautiful part in them, to see what they are capable of and using theirs capacities and capabilities to the fullest. We must to help them also being autonomous, helping them to become employed, to treat them equally, giving them the same rights in our society and why not, reaching the well being, things we also want for ourselves.

We must to treat the person near us exactly, how we want to be treated! No less, no more!

Assisted Reproduction

   We live in a world where the artificial means of procreation had found their places. We must to acknowledge that there are people in our society who have difficulties in order to procreate and who are using methods of assisted reproduction.

        I am not going to exemplify the possible causes of the infertility, which can be feminine or masculine, but I will try to create a necessary glossary in terms of IVF.

      What’s bothering me most is, when the patients pay for these procedures and they don’t really know for what are paying for.

       In my opinion, it is important that they know more about these procedures, especially seven of them which are the most used for every patient who struggles with infertility. The most frequent confusion is between in vitro fertilization and insemination.

        Insemination or IUI is a method which is applied for women which healthy tubes and uterus, but which encounter other difficulties on the level of their cervix or in cases of weak mobility of the semen. This method consists in directly introduction of the semen in the uterus in the day of ovulation and letting the ovum and the sperm to encounter each other as in the natural process. This is not an expensive method and it is not so invasive in comparison with other methods.

       In vitro Fertilization or IVF is the most complex and expensive method and it is applied to women with both tubes obstructed or in the situations of polycystic ovaries (PCOS) or problems with the semen. The both, the semen and the eggs are collected and they are put together in the dishes where they fertilize. The embryos, which result after the fertilization, are staying in the thermostat until the day of transfer. On the transfer’s day, the doctors put inside the womb as many embryos they consider fit with the age of the mother.

There are other techniques, which doctors use in order to facilitate a good implantation of embryos or a good fertilization of the egg.

       Intracytoplasmic Sperm Injection or ICSI is a method used when the semen has a bad mobility , that’s why in the lab conditions, the embryologist picks the best sperm cell and using a fine needle, introduces the sperm cell directly inside the ovum (the egg). This way,he's facilitating the fertilization of the egg.

       Assisting hatching or AH is a method in order to facilitate the bonding of the embryo to the womb. In this method, we just cut a little bit of the external membrane of the embryo, named zona pellucida because the region cut of the embryo has more affinity to stick to the womb’s wall.

Another two terms which are new discoveries in the assisted reproduction's field are:

       In vitro maturation of the eggs—which means the eggs are collected in immature state and they suffer a maturation process in the lab conditions.

      Testicular biopsy and sperm harvesting for IVF—this is a method use for males which are infertile or sterile, when after the testicular puncture, the embryologist can find immature sperm cells and they can help for maturation of these cells in the lab conditions. This is really a very helpful method for the couples with male infertility.

      Cryopreservation is a very well known method which helps to maintain our cells, eggs or semen and embryos on the low temperatures for a very long time with the help of liquid nitrogen. This is not just a method use in IVF, but help also people to preserve their cells in an effort to familial planning.

I consider you must to be inform about the techniques used in your case, the reasons for using these methods and to acknowledge what you are paying for, because the time spent in IVF clinics is not enough in my opinion to clarify all these matters. 

Quitting smoking-a big resolution for 2011

       
     Are you willing to try quitting smoking? This is one of the most common questions your doctor asks you  for. After this question, your physician will give you some pamphlets and probably he will start preaching you a lesson about how dangerous is to smoke. If you smoke, you must know how bad this habit is for you.

    From head to toes, you can develop cancer of  the mouth, lips, tongue, nose, pharynx,  cancer of the larynx, esophageal cancer, gastric cancer, pancreatic cancer, chronic bronchitis, emphysema, bronchiectasis, COPD, cancer of the lungs, urinary cancer, skin cancer. So many cancers in a phrase!
      Smoking is a risk factor which added to asbestos lead to mesothelioma more easily. Not to mention, the bad breath, discoloration of the skin, yellowing teeth, yellowing nails, bad circulation in the legs but also everywhere in the body, especially in your coronaries.

      From all of these, the most important and deadliest are lung and pancreatic cancers, because they have the shortest survival rates and also not to mention the fact that the medical possibilities are limited. Pregnant women, who smoke, have all the chances to give birth to children with very low weight, with a lot of health issues or to stillbirths.

        In order to continue or discontinue this habit, it is very important to know which are the risks involved. In general, the patients who are eager to renounce to this habit are those who are ill or frequently ill. But even when a doctor stresses the importance of losing this habit, some of the patients take it into consideration. They will pass in the second part of the process named reflexion. This is a period when, they will contemplate the idea, they inform themselves about it and subconsciously, they will choose to give it a try.

      The third part is when they do something about it and look for specialized help. This is where the doctor intervenes and besides the fact they enrolls you in some program similar with AAA meetings or detoxify programs, they work also with medication. You must know all those ads with Nicorette, which came out as chewing gums, tablets, patches to stick or inhalers. Your doctor will choose the right dose for you and this depends how addicted you are. The doses will decrease in time, depending how you react to the medication. The idea is to take the medication when you fell the strong or incontrollable desire to smoke. Another aspect is to announce your doctor if you take another drugs, because it can appears strong interactions.     

      Not take Nicorette if you are pregnant or breast-feeding, if you are allergic on nicotine, if you have circulatory problems, erectile dysfunctions, arrhythmias, angina or stroke. And try to avoid the areas with smoking people. Recently, on the market appear the electronic cigarette. Available in store in different countries, this can be a new solution in the fight against smoking.

Are you now ready to give it a try?

Be proactive! Get vaccinated!

      After a year, when we struggled from epidemic to pandemic swine flu, we are again in the good season to get vaccinated. Winter is here, and if you didn’t know the extreme fluctuation of the temperatures, put the flu virus in the position to multiply, replicate and to spread in the population, especially in the big cities where the population or the traffic are higher.

     Where can we catch the virus? Especially in every means of transportation as planes, metros, buses, in every places which reunite a large number of people , as airports, railway stations, metro stations, but also at festivities or cinema, theater, spectacles, in the workplace etc.  In all these places is enough a person with flu to sneeze or to cough and like this, the virus rapidly will spread from one to another.

The virus needs probably 24-48h to replicate in your body, before the symptoms can be seen. Symptoms like fever, chills, malaise, extreme fatigue, sneeze, cough, runny or stuffy nose, sore throat, headache, muscles pain can be expected.

     Who has more chances to catch the flu? There are some categories as the children less than 5 years old, the pregnant women, every adult after 65 years old, and people with different chronic diseases as: diabetes, chronic lung diseases, cardiac diseases, HIV positives, AIDS, with tuberculosis, cancers, blood diseases and people with a bad immunity.

A  person with a bad lifestyle,  who make a lot of excesses, who doesn’t exercise, who doesn’t eat healthy, doesn’t sleep well,  who has a lot of stress in life, is the most predisposed because his immunity will decrease.

       What to do? Get vaccinated. After the avian and swine flu, I know a lot of people refused to get vaccinated, because they were circumspects regarding the vaccines for these two.

I understand them completely, but they must to know that every year, the prepared vaccine is different, because the researchers have the ability to find the most probable virus which will spread every year and the vaccine is made for this most probable strain of virus.

This year beside the vaccine for H1N1 (swine flu), the most offered vaccine is for the H3N2 and the B-strain of the virus.

It is our choice if we get vaccinated or not, and we have the chance to choose this year between these vaccines. Because this year the chances to reappear the swine flu are so low, I recommend the other vaccine.

       It is in our power to do something, because even if we don’t get sick, we can be just transmitters of the virus and spreading it to your family or to other people.

Not to forget, avoid agglomeration in this period of time, sneeze or cough in your handkerchief, wash your hands regularly, eat healthy and avoid stress, hydrate yourself and finally take zinc and Echinacea supplements to boost your immunity.  
Update: It is confirmed that in Canada , this winter, the predominant strain of virus is H3N2, that's why you can avoid safely the swine flu vaccine, because the pandemia is gone. 
It is not late to get your vaccine!

Alopecia

  



 The popular name for this problem is the Hair Loss or the Baldness.

 Behind this  problem stay a lot of causes, but I will try to resume them as short as I can. They can be local, psychogenic or organic.

The hair pass through three stages.

The last one, named Telogen effluvium, is a normal period in the hair’s life , when the dead hair will fall. This is the most common  hair loss , and it’s seasonal , being observed mostly in the fall.

Firstly, alopecia can be hereditary, especially in middle age men, which means if the father was bald , the boys will be too. This kind of hair loss is influenced by an excess of testosterone.This can be treatable with anti androgen treatment and hair transplant. 

Secondly, could be after a chemotherapy or radiotherapy for a cancer. This hair loss is reversible.

Thirdly,could appear after a bad anemia,  a  crash diet , or in eating disorders . The excess of  vitamin  A  and zinc  could  gave us  a hair loss too. A diet and supplements reconsideration can solve the problem.

Not to mention the endocrine illnesses involving thyroid or adrenal glands or the locally  mycosis of the scalp which can generate the hair loss.
Women can lose hair diffusely related to all hormonal imbalances in or after the pregnancy, menopause, the estrogens levels having a role in that. The excess of testosterone in a woman gave the same reaction.

Losing hair could appear in trichotilomania, when the person pull her own hair and this is psychogenic.
We can identify also alopecia areata, when a patch of hair is missing in a specific area of the scalp, the cause being also psychogenic and can be reversible with local steroid treatment.

After a severe psychogenic distress we can lose the hair completely, phenomenon named calvition and in this case there is no treatment.

     It is very important to consult a dermatologist, to find out the cause of your problem and the appropriate treatment.

An analysis made from the root of the hair can be a good idea. A routine blood test, to find out the blood count  and also a hormone dosage can be  a good idea.  

   A life, avoiding and managing the stress, with a balance diet, taking supplements (selenium , zinc , vitamins B),a good exercise, a good hygiene of the scalp(medicinal shampoos), could prevent this problem, but when the case arrive, the treatment must to be related with the cause. 

Depression

   In the last two decades, the incidence of this illness is so  increasing that clearly deserves at least a  briefly approach. 

It is very important to be very attentive to ourselves, because we and our entourage are the first to observe the changes in our behaviour .

   In the most cases this illness is misdiagnosed or the patient doesn't consider to pay a visit to a doctor. Not to mention that some of us consider we just have a bad time,  this is temporary and don't look for any medical advice. 

  I will resume for you some of the most important changes in our mental health .

     Firstly, we will be sad for a long period of time , more than  2 weeks,without reason or being under the drugs influence.       
    Secondly, we will lose all interest for any pleasurable activities which we loved before . No one  from these will make you happy again. 

    Thirdly, we feel guilty all the time , with /without reason, but in general is a fabricated guilt. 

We will lose the energy to do things and have an easy fatigability on minor activities. We lose our concentration, we cannot focus on things, we cannot learn, read, we can see that very easily when the patient is an academic. We lose the attention, which means we will be easily distracted. We can have an phsychomotor instability,being in general very agitated, sweating all the time. Sleeping is very disturbed, we cannot sleep or if we sleep, we wake up in the middle of the night and cannot fall asleep again. Irritability will be just a side effect of this involuntary sleep deprivation. Eating also is a problem, eating to much or less, losing or gaining weight as in the eating disorders.  

Some patients will contemplate suicide , some of them will make a plan, and others just contemplate the idea , but this will be in general in the major depression.

   The most important triad in depression is Worthlessness-Hopelessness-Helplessness, which make the patient think he is not worth to live, he is not useful to the society, he has no hope , he is desperate, a lost cause and he cannot be helped by other peers. Not to forget, this is a treatable illness in which you can see changes in minimum 2 weeks after you begin the treatment. The compliance to the treatment is mandatory. 

Did you remark these symptoms on you for a period longer than 2 weeks? Is it anything which can relieve these symptoms?

    Maybe is the time to pay a visit to your doctor, if you remark at least five from all these symptoms and for a period longer than 2 weeks.
 Definitely, depression should not be a life sentence.

Hepatitis B and C between STD?

    The both hepatitis can be transmitted by infected needles, by infected blood, by infected organs or bone marrow, and by sexual contact, sometimes by tattoos, and when you share the same syringe and needle with an infected person. Hepatitis B can be transmitted vertically from mother to child through pregnancy.

      Hepatitis B virus is more infectious, this is why,it can be transmitted by sexual contact.

      Hepatitis C virus can be also transmitted by sexual contact, but because C virus is not so infectious, is very rare when a hepatitis C is transmitted this way. That’s why, we must to consider hepatitis B and C between sexually transmitted diseases (STD).

      Both hepatitis can become severe, and share the same complications. The only thing is, the hepatitis B has 85 % chances to be cured with a good treatment and 15 % develop complications.

    Hepatitis C evolves in a chronic pattern in a large percentage of cases. Complications are: chronic hepatitis, cirrhosis of the liver, hepatic cancer and liver insufficiency.

    These complications can appear in both hepatitis B and C. The most severe is hepatitis C, because a large percentage of people develop chronic hepatitis, develop liver failure, cirrhosis and cancer.

In conclusion, we have the chance to be cured by B Hepatitis, but Hepatitis C become chronic almost all the time.

   Another aspect is, when you have or had hepatitis B and/or C, you cannot be a blood, bone marrow or organ donor. In the same time, if you develop liver insufficiency, you will need a transplant.

Think twice, when you have an unprotected intercourse.The condom use will be always a good idea , preventing a large number of infectious and deadly diseases .
It is always more easy to prevent than to be cured.

Generics or Brand Name drugs?

       The brand name drugs are the original drugs, the first drugs discovered, tested and put on the market. They have benefits and side effects.

      The original drugs are put on the market, and they are sold for approximately 20 years. In this time, the companies make profits, but also it is a period of time, when the treatments with these drugs are observed. If in time, problems with the drug occur, they can either stop the production and/or resolve these problems. After 20 years, the company will sell the patent kind of way, meaning some companies will produce the drug, in a similar form, but with a new name. These are the generics.

     The generic drugs, contain the same chemical substance but other ingredients can be different, in general these ingredients giving the shape, color, and consistency of the drug. Some of these ingredients can be allergenic for some people, but also are the ingredients from the brands name drugs.

     There are studies who said, there are no significant differences between the generic and brand name drugs. This is not entirely true. There are cases when the original has proved to be the best and also rare cases, when the generic are not so effective.

     It is well known the generics are cheaper than the brand name drugs, that’s why the generics help us to decrease, the amount of money spent in our Healthcare.

Are they the same with the original? Not in every aspect.

Are they effective as the original? In majority of cases, yes.

    I know doctors who prescribe the original drug, but this is when they have a lot of experience with that drug, and in their opinion, nothing is better than the original. But I can assure you; this is not a common practice, because we try to spend the healthcare money more efficiently. Sometimes the insurance company decides for you if, you receive the original or the generic. In some situations, I will choose the original, even if I must to pay the difference, but in majority of cases the generics are always a good solution.

Exercise –induced amenorrhea

        Did you know, if you become a fitness freak female, you can stop menstruate?

Yes it’s entirely true. And it is not good at all for your health, even if you believe the sport is generally healthy.

Why is that?

      First, every woman has sexual hormones (estrogens and progesterone) and a small percentage of testosterone, produced in ovaries and adrenal glands. All these hormones have a different chemical structure, but all of them share the same molecule at start, the cholesterol molecule.

      It is no news that cholesterol in our body exist in two forms: circulating in blood, and in fat deposits everywhere in the body. This is the reason why, we go to gym, to burn that stored fat, as soon as possible.

      When we begin our workout, generally, we will increase every day the level of our effort, the time we spend at the gym, and when we enter in routine, we try other machines, maybe other sports. We can say the beginnings are hard on every sport; everything will become possible in the middle and sometimes become obsessive in the end, especially if your workout had no results as far.

     All efforts you do in order to slim, you will lose some fat on the beginning, you will have a period when your weight will stagnate, and after that if you perseverate, you will slim enough to be happy about it.

     In the slimming process, we do a lot of sport and paradoxically we don’t eat so much. This way, we will develop a big imbalance in our body between demand and offer. Because of this imbalance, our metabolic rate will increase and that’s how we lose weight.

      Everything seems to be alright until the fat stored in our body, decrease under 16%.

    Under 16 % fat in our body, there is not enough fat to produce sexual hormones, that’s why in the absence of these hormones, women stop menstruate. Our body prefer to keep the remaining fat to produce energy for the body,    producing heat.

It is like the body, stop the functions which are not important, keeping active the surviving functions. And how relieved we feel, when we see our body is really set for survival.

    By contrary, when a female body stops menstruating, a lot of problems appear.

One of them is, they can suffer a lot of fractures, because in the absence of sex hormones, the bone density decreases and the bones become very fragile at minimum impact. Other facts are: women cannot procreate in this period of time and others become anorexic, could develop hot flushes and some become emotionally unstable.

    In conclusion, it’s very important , to continue to eat a healthy diet, not to decrease under 1200 calories/day ,  having a very realistic workout not exceeding  1 hour and 20 minutes /day and not to forget the multivitamins and multimineral supplements .

New trends in Mamography

Every society which has a lot of respect for the people, invest a lot of money in healthcare and also in prevention. In the last 30 years, all women had a mammogram at 40 years old  in order to prevent breast cancer. A lot of women discovered in early stages their breast cancer. This was very good for some of the women. Mammography was and continues to be a good preventative measure. But the American studies and statistics had shown, even if the US healthcare invested a lot of money in a lot of preventative measures, like mammograms, the numbers of breast cancer discovered didn't justify the money spent. 

They consider that breast cancer has a large probability to appear after 50 years, and they reconsider the use of mammograms for women beginning with 50 years old.

All women who have breast cancer in 1st and 2nd degree relatives, is it highly recommended to have their mammograms at 40 years, because they are at risk. Why 40 years and not sooner? Because mammograms can irradiate the body, and the eggs from ovaries. We consider that at 40 years old, the women had their children, and can do a mammogram after this age. Not to forget about men who can develop also breast cancer in a small percentage, but in general is more aggressive. For all people at risk, the first mammogram age will remain 40 years old .It is always better to prevent.

Because Canada tries hard to be in trends with US in terms of health, technology and prevention, right now in Canada, all women will have a mammogram at 50 years old. 
This is a new guideline and I consider it is better to be informed.

Introducing myself

      My name is Diana C, and I graduated Medicine University in 1997.

    I have chosen Family Medicine residency, and I became a family doctor specialist, after 4 years of stages in hospitals. I worked with children with disabilities but also with adult patients. 

      Later,I became also interested in domains as occupational medicine and also general ultrasound and I studied for my competencies certificates in order to work in these domains. Currently I study for my Master Degree in Mental Health,because in the last couples of years, these mental diseases continue to increase. 

     I create this blog, in order to be helpful to all of you, the patients, searching for answers in different medical situations. I will try to respond to you as soon as possible and  I will try to respond in my area of expertise , even if sometimes I will cross the boundaries of my specialty .

    I really enjoy this opportunity to be near you , talking about your medical issues and I expect your questions on this blog. I hope all of you are in a good health, but when the case arrives, I will be here to advice you. 

Diana C MD