by Dr. Iain Corness
G stands for Gluttony
Australians, if you
lump all the statistics together, tend to be obese. Read on and you will
see why. We had gone to a restaurant with some friends from Australia
who gave their son their extra French fries from their plates. It was
almost as if he had entered a competition to see how many fries he could
pick up with one hand, and then how many of those he could cram into his
mouth at one time. A prime example of gluttony.
In his case, gluttony might kill as
he could have choked to death. Not that he would have minded. Death by
French fry is probably more acceptable to a 12 year old mind than death
from gluttony at age 62.
Unfortunately, our diets are far
from healthy these days, and that includes both food and drink,
especially the kinds of drinks that come in dark green or brown bottles.
I am sure you know the types.
The problem here is the fact that
being overweight puts a strain on the cardiovascular system, which sends
the blood pressure up. That in turn affects all the organs and systems,
and everything goes pear-shaped from there on, as well as your body
In these situations, the combined
effects can be life threatening. We call it co-morbidity and is also
called ‘Syndrome X’ and is also possessed by around 40 percent of adults
over 40. Nice numbers you should remember. The combination of diabetes
and obesity, for example, can be a disaster waiting for somewhere to
happen. The combination of diabetes, smoking, obesity, hypertension and
high triglycerides (blood fats) is also cardiac dynamite. Your
conclusive heart attack is a matter of ‘when’ not ‘if’. The risk factors
stemming from all those conditions does not become a case of simple
addition, but should be multiplied together.
The problem from your point of view
is that most of these factors come on very slowly, and become part of
your daily living. You’ve smoked for years and never had a smoker’s
cough, so why stop now? Every time you get some trousers made the
waistband has to be that little larger. Your belt has been let out two
more holes over the past two years. Your doctor said you had a “Little
bit of blood pressure” three years ago, but you haven’t been back to
check, as you feel quite OK in yourself. Your ‘triglycerides’? “My
what?” Your blood sugar? “It was OK last time it was checked five years
The big problem is that the “Little
bit of blood pressure”, even say 150/100, can produce a very dangerous
situation when the person with that BP has elevated blood sugar as well.
Or smokes. It is the multiplication effect again. Whereas you can
(almost) ignore mild elevations like 140/90 if you have absolutely
nothing else wrong, ignoring it when there are other conditions
co-existing brings up that co-morbidity problem again and the
multiplication tables again. And the likelihood of a cardiac calamity at
Likewise, a “little bit of extra
weight” that we all excuse ourselves for carrying, may (just ‘may’) be
fine for someone with no other medical conditions, but represents an
enormous risk factor for someone with the Syndrome X.
For those who like figures with
their information, here are some chilling ones. Between 87-100 percent
of people with fatal coronary heart disease, or a non-fatal heart attack
had at least one of the following risk factors – smoking, diabetes,
increased blood fats and high blood pressure. Syndrome X is
characterized by having diabetes, increased blood pressure, and raised
blood fats. Can you now see the importance of doing something about
weight, blood fats and blood pressure? I for one would not like to be
sitting with a condition that gives me between 87-100 percent chance of
a cardiac problem.
So what is this week’s message?
Quite simply, if you have diabetes, do something about the other risk
factors. If you are overweight, do something about it. Stop smoking and
get your BP and blood fats checked. If you don’t even know what your
blood sugar level is, then get a check-up and find about all of it!
Gluttony can kill.
Detecting the Silent Killer
Do you know why the nurse takes your
blood pressure (BP) every time you come for a consultation? Simple reason –
because high blood pressure (Hypertension) can lead to many severe
illnesses, not just heart problems. So how do you keep your blood pressure
As part of the routine in most good hospitals and
clinics is the measurement of your blood pressure. You should get this done
at least twice a year. Rising or elevated readings do mean you should get
I get my own BP checked regularly and the other day I
was in the clinics and got the nurse to take my BP. It was 158/87. Too high.
However, about 30 minutes later I had my BP checked again. This time 147/76.
Much better, but still marginally up. How could this be? To complicate the
matters even more, I had my BP checked this week. Result 120/65. Now, were
all the machines wrong? Or were the nurses recording the pressure
incorrectly? Simple answer - Just as one swallow doesn’t make a summer, one
elevated reading does not necessarily mean hypertension.
So why is BP important? Because if you don’t you don’t
have any BP you are definitely dead! However, if your BP is too high, it can
mean you could be claiming early on your life insurance policy – or your
relatives will, on your behalf.
High BP is otherwise known as the “silent killer” as
there are very few symptoms of the increase in blood pressure, until a
vessel bursts somewhere, generally catastrophically! The good thing is you
are dead within minutes, so you won’t linger.
Why is it important? Blood is needed to keep all the
organs of the body supplied with oxygen. This is done by the red blood cells
which carry the oxygen, with the pump to drive the system being the heart.
The tubes from the heart heading outbound are the arteries, and those
returning the blood to the heart are the veins.
This heart-arteries-veins-heart system is a “closed”
circuit. In other words, no leaks, otherwise you would be continually losing
the life-preserving blood, but to make it go around, there has to be a
The heart squeezes the blood inside itself and pumps it
out into the arteries. This squeezing pressure is called the Systolic, and
is the upper number quoted when we measure your blood pressure. For example
systolic 120 over 70.
After the squeeze, the heart relaxes to allow the blood
to fill the chamber, ready for the next squeeze. The pressure does not
return to zero, because there has to be some pressure to refill the chamber.
This resting or ambient pressure is the lower number quoted and is called
the Diastolic. BP is then typically quoted as 120/70, being 120 (systolic)
over 70 (diastolic). The actual pressure number is measured in a millimeters
of mercury scale.
So what is the correct BP? The following table shows
the categories of BP measurements.
Optimal: less than 120/80
Normal: less than 130/80
High blood pressure (true hypertension):
Stage 1: 140–159/90–99
Stage 2: 160–179/100–109
Stage 3: 180 or higher/110 or higher
The problem with running at high pressure is that the
heart is having to work harder, and therefore may be subject to premature
heart failure. The arteries are also subjected to higher pressures than they
were designed to cope with and can burst, making the risk of stroke so much
higher. Other organs don’t like working at the high pressures either, and
kidneys in particular, can go into failure mode.
No, if you really have hypertension, get it treated –
but remember to have repeated measurements done, and don’t let a doctor
classify you as being “hypertensive” on one BP reading, until repeated
measurements confirm the high level to show that your BP is too high.
There is a good reason for this as well as the straight
out medical one. If your BP is (consistently) too high, your friendly
insurance man will decline insuring you because you are “hypertensive”.
Don’t let them do that on one reading outside their “limits”.
The hewers of stone
and drawers of water
With the current
push for women’s health clinics and practitioners, it is easy for men to
feel left out. After all, you’ve no uterus to become cancerous, and
although you do have vestigial breasts and it is theoretically possible
to get breast cancer, I don’t suggest you go looking for breast lumps
every month after your non-existent periods.
However, there are some specific
male areas, and these centralize around the genito-urinary systems. In
the medical business, Urologists are sometimes called the hewers of
stone and drawers of water, because much of their work deals with kidney
stones and assisting men to be able to pass water adequately. We men do
suffer at times, it’s not only the ladies who have ‘specific’ problems!
Your urinary system is a remarkable
collection of organs, beginning with the kidney, the “super filter”. The
kidney filters the blood and allows the important stuff like blood cells
and nutrients to continue waltzing around your circulation, but taking
out the nasties, and at the same time helping balance the
acidity/alkalinity of the body. Clever little organs, the kidneys!
To keep your kidneys in top shape
does not require special kidney exercises, you will be pleased to know.
In fact, there is nothing you can do ‘physically’ to make the kidneys
perform, but fortunately there are some things you can do to keep them
in top condition.
The first is to drink plenty of
water every day. And by ‘water’, I mean the plain and simple H2O style
water, not the stuff that has been mixed with hops, distilled with grain
or left to age in oak casks. Making the kidneys exercise, to filter and
regulate the circulating blood volume, is simply carried out by drinking
several liters of water every day. Yes, it is that easy. On your desk at
work keep a glass of cold water beside you and empty it every 30
minutes. Into your gut, not the sink.
The advantages you get from this
are enormous. First off, you have immediately lowered the chances of
forming kidney stones, a potentially dangerous (and always painful)
condition. Being a card carrying coward, I have always preferred the
drinking water option to the lying in bed groaning with pain
alternative. In fact, around 15 percent of people will experience stones
in their lifetime (especially in the hot climates) and men outnumber
women between two to three times. We also know that if you do not change
your lifestyle, you are very likely to develop another stone within two
years after the first episode. We men do suffer at times, it’s not only
the ladies who have ‘specific’ problems!
The kidneys drain to the bladder by
two tubes called Ureters. These do not do much, other than connect the
kidney to the collecting vessel (bladder). However, if a piece of stone
gets stuck, you will soon know about it. Renal colic sorts out the men
from the boys! Ultimate pain! Down on your knees type pain.
From the bladder, the urine gets
introduced to the outside world by another tube called the Urethra. This
is short in ladies and is the reason that women get Cystitis (bladder
infections). It is longer in the men folk, allowing us to stand up to
pee and become obsessed with how long or short it really is. After the
age of 40 give up the ‘Who can pee the highest’ competitions.
However, we chaps have another
problem in that region, as far as getting the urine from the bladder to
the far wall of the urinal. This is called the Prostate, and it
encircles the Urethra and when enlarged, closes down the internal
diameter of the pee tube. This makes it difficult to pass water and you
dribble on your shoes. The prostate can also become cancerous, an even
less pleasant state of affairs. We men do suffer at times, it’s not only
the ladies who have ‘specific’ problems!
Yes, you can have a check-up for
this area too. Just ask to see the hewers of stone and drawers of water!
When I was a young
doctor, I had a somewhat morbid fascination with the reasons why my
colleagues would be ‘struck off’. Each month, in the back of the British
Medical Journal there would be the list of disciplinary hearings and their
findings and penalties, including de-registration, otherwise known as being
‘struck off’. And the majority was for illegal drug use.
This I found simply flabbergasting. How
could my senior colleagues (in those days just about everyone was senior to
me), get the drug habit, when we had all been taught that it was something
we had to treat very vigorously? And it was something that was very
difficult to treat as well.
All of the above remained in my
subconscious until one fateful day, many years later, that I was to come
face to face with Pethidine, one of the drugs of addiction. Not that I
hadn’t met, or prescribed Pethidine before that, but this was a very
different set of circumstances.
It was mid-afternoon in my small, but
very busy suburban clinic. I was a solo GP, and the staff consisted of my
practice nurse and myself. The waiting room had spaces for eight patients,
and the waiting list by 3 p.m. had the queue going out the door and on to
the footpath outside. It had been a long day and it was going to be a longer
one to come.
It was then that a 10 year old boy was
brought in, having fallen off his bicycle outside. He was in great pain and
I didn’t need an X-Ray to tell that his forearm was broken. Well, either
that or he had two elbows on one arm. My practice nurse rang for an
ambulance, while I began treatment. The lad was in so much pain, I took out
an ampoule of Pethidine. This was 100 mg, but with the injured being only a
youngster, I drew up half the ampoule and only injected 50 mg to ease the
pain while I stabilized the fracture and we waited for the ambulance. The
half an ampoule I left on the shelf above the sink. The ambulance came
quickly, and the lad was driven away to the nearest hospital, while I
returned to the overflowing waiting room and began trying to catch up with
One hour later, and I still had a full
waiting room. There just seemed to be no end to the line of patients, and
none of them were simple ‘slap on a plaster’ cases. I could feel myself
becoming more and more frazzled.
It was then, while washing my hands
after the previous patient, I looked up and saw the 50 mg of Pethidine
looking down at me. “This stuff is supposed to give you a lift,” said a
little voice in the back of my head. The temptation was almost overwhelming.
The ampoule was literally dancing in front of my eyes, and it was then that
I realized just how my colleagues could be caught out. Taking 50 mg today
while under extreme stress, would be another 50 mg the next time I was
overloaded, and then it would become 50 mg at the start of the clinical
sessions, in case I became overloaded.
You can see the dizzy downward spiral.
From 50 mg it becomes 100 mg and you are hooked. After running out of the
emergency supply of Pethidine given to us by the government, it would be
writing prescriptions for fictitious patients. All very sad, but at that
instant I could feel nothing but compassion for former colleagues who had
succumbed and been struck off.
I broke the ampoule and poured the
contents down the sink, and returned to my list of patients. Nobody knew
just what strain I had been under. Nobody knew how close, in my own mind, I
had come to the brink of the abyss.
Drug addiction is a problem for medical
practitioners. The workload, the lifestyle, the irregular hours are things
that you are not taught how to handle in medical school. That so many of us
actually manage to get through it all, is amazing. I consider myself to be
lucky that I recognized it.