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Doctor's Consultation  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 shape.

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 ago!”

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 age 44.

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 under control?

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 medical advice.

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 pumping pressure.

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-normal: 130–139/85–89

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!

Drug Addiction

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 the workload.

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.

HEADLINES [click on headline to view story]

G stands for Gluttony

Detecting the Silent Killer

The hewers of stone and drawers of water

Drug Addiction