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Update May 2017

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Update by Natrakorn Paewsoongnern

Doctor's Consultation  by Dr. Iain Corness


Update May 20, 2017

Professor Hickey’s Wayside Inn of Ill Repute

The good book states that the term ‘diverticular disease’ comes from the Latin word ‘diverticulum’ which means a “small diversion from the normal path”. However, the late Max Hickey, my old Professor of Anatomy, claimed it was Latin for a “Wayside Inn of Ill Repute”. His definition was much more memorable.

However, a diverticulum as it refers to you and me, is a small bleb or ‘pouch’ that pops through from the inside to the outside of the colon, and usually seen in the descending colon which leads down to the rectum and anus.

When you have a few of these diverticulae (plural of diverticulum – Latin) we say you have the condition called ‘diverticulosis’. This condition, on its own, does not produce any symptoms, so you do not know if you have it. A bit like early stages of hypertension or even diabetes.

When diverticulosis causes symptoms, it can do so in one of two ways: first the pouches can rupture into the abdominal cavity, causing localized irritation and inflammation or produce an abscess. This inflamed diverticulosis is now called ‘acute ‘diverticulitis’ (remember when we put “-itis” on the end of a word it means inflammation). Patients who have diverticulitis often will usually present with a sudden onset of pain located in the lower left part of the abdomen over the sigmoid colon. It is frequently exquisitely tender and is associated with fever and a high white blood cell count.

Secondly, the diverticulae can begin to bleed to produce significant amounts of rectal bleeding. This can also be painless, just to confuse your gastroenterologist!

So who gets it? If you are Caucasian and you are over 65, then you have a 50 percent chance of having it already. The reason given for this is the lack of bulk present in the diet of industrialized countries allowing muscle contractions to create localized areas of high pressure allowing diverticulae to form. Some pundits say that the pressure created by muscle contractions of the left side (sigmoid) of the colon are considerably greater than those of the right side (ascending colon). This could explain why diverticulae are more common on the left than right side of the colon. However, this does not explain why Asians get diverticulae on the right side. (Ah, the mysterious East! Or perhaps the theory is wrong!)

Acute diverticulitis is usually diagnosed by the typical history and a physical examination demonstrating tenderness over the sigmoid colon (left lower part of the Caucasian abdomen). Fever and a high white blood cell count generally confirms the diagnosis. A CT scan or ultrasound of the lower abdomen can be very helpful in showing an inflammatory mass over the sigmoid colon.

If the presenting symptom is rectal bleeding, this can be a bit more difficult to diagnose and is frequently a “diagnosis of exclusion” by which we can find no other cause for the bleeding. Fortunately this is not common, and less than five percent of people with diverticular disease of the colon will bleed.

Acute diverticulitis is treated with antibiotics for 7-10 days. These antibiotics frequently have to be given intravenously. Diet is often severely limited during the first few days of treatment. Most patients will recover completely, but occasionally surgery is necessary in order to drain all the infected material and completely empty an abscess cavity.

So can you do something to stop your diverticulosis becoming diverticulitis? It hinges on eating more fiber. High-fiber foods, such as fresh fruits and vegetables and whole grains, soften waste and help it pass more quickly through your colon. This reduces pressure inside your digestive tract. Aim for 25 to 30 gm of fiber each day. Fiber works by absorbing water and increasing the soft, bulky waste in your colon, but if you do not drink enough liquid to replace what is absorbed, fiber can be constipating.

Respond to bowel urges. Do not delay. Delaying bowel movements leads to harder stools that require more force to pass and increased pressure within your colon.

Finally, exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes on most days. At least try!

Update May 13, 2017

Are you ready?

I have it on good authority and the evidence would appear very strong, that unfortunately, we are all going to die. That’s you, Auntie Annie and even me (and I used to be 10 foot tall and bulletproof).

OK, the dying thing is something we all consign to sometime in the future, and anyway, I’m not ready to die yet. I jokingly proclaim that if you can’t take it with you, then I’m not going! But that is just a good throw-away joke line.

This week’s column reminded me of the death of an old acquaintance. Lovely bloke who took life seriously and would ask me all sorts of medical questions – but were all related to ‘living’. We never discussed ‘dying’.

He had an accident that resulted in a brain injury that rendered him unconscious – a condition he never recovered from and eventually he died, leaving a grieving wife.

Unfortunately, these scenarios do tend to be common place – we are all going to die, and since, in general, we are older than our Thai wives, we can expect to rock up to the pearly gates first to be fitted up with a harp and a comfy cloud.

Unfortunately, whilst it may be ethereal up there, you may have left bedlam down here. As well as grieving wives and family you may have left a financial mess.

Answer this question: when you die, how does your wife get the money necessary for daily living? Was this something you paid her each month, like a salary? But now you’re not there to pay that salary.

Where does your money come from? A pension or superannuation that is paid regularly directly into your account? And does your wife/partner have any access to that account?

Even if your “exit fees” are covered by an insurance policy, does she know where that policy is kept? Or even the name of the company?

And where is your money kept, once you’ve popped your clogs, so to speak? Banks can get very pernickety about people trying to withdraw money from a deceased person’s account, no matter how long they had lived together.

Then there’s wills. If you die without making a will (intestate) then everyone hops in for a slice of the action, right the way through to the gardener and the soi dog. Sorting that lot out takes months (sometimes years), and money is not dispersed until all claims have been verified. (You can relax a bit here – the soi dog won’t get anything.)

But there’s another important will here – your Living Will. You are ensconced in the ICU, unconscious and unable to function on any level. Who has the authority to tell them to pull the plug? If you don’t nominate somebody in your Living Will then nobody has the authority. And while your body is lying there, the taxi meter is ticking away.

However, there is confusion in the minds of many people, as to what a “Living Will” actually is and what it covers. Borrowing from the Mayo Clinic in the US, it states on their website “This written, legal document spells out the types of medical treatments and life-sustaining measures you do and don’t want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation.” The important words to note are “life sustaining” and “resuscitation”. Neither of these concepts imply medically assisted suicide, or euthanasia.

Remember that we are talking about terminal situations here. Not situations from which it would be reasonably expected that you will recover and still have a good quality of life. A fractured hip when you are 90 is a serious situation, but provided you are healthy otherwise, then it would be expected that you would recover. You might need a stick for a while, but you would still be able to have a beer with your mates or play Scrabble or whatever your pursuits were before the incident. In other words, the expectancy of a reasonable quality of life is there.

However, if you are in the terminal phase of metastatic cancer, which has progressed despite treatment, the future quality of life is not there. Artificially prolonging life under that situation is then covered by the Living Will.

Update May 6, 2017

Exercise for Health. Does that include sexercise?

Probably the commonest advice a doctor gives is to lose weight and get some exercise. Does that ring a bell in your memory? Was that part of the advice after your annual physical check-up?

Unfortunately, there seems to be very little real understanding of what exercise should consist of, how often, what type, how long and what about sex? For example, I was reading an article on exercise the other day and it said authoritatively that one should wear comfortable clothing and socks with the correct size of non-slippery, shock-absorbing shoes. If this includes sexercise, there are some strange shoe fetishes out there that I haven’t heard of yet!

However, getting a little serious, exercise will be good for you, provided that you pick a form of exercise that is not harmful for you! Now I know that looks as if I have put my money on both horses in the race, but take that sentence at its face value. Enough research has been done to show that regular exercise is beneficial for everybody, in both the physical and psychological aspects, but, and it is a big ‘but’, all forms of exercise have relative bodily risks, and this has to be taken into account before you buy a pair of expensive jogging shoes and tackle a 10 km trot in the middle of the day. True stories – a medical colleague in Australia took up playing squash when he turned 50 and dropped dead on the court of a heart attack, and another acquaintance of mine turned 40, decided he wasn’t fit, bought a bicycle to ride to work each day and was run over by a bus.

The same article that advised non-slippery shoes, did have some wise words, however. These included to choose appropriate exercise according to your ability. Never exceed your limit. Remember that it is not the harder the better. If you have acute medical problems (such as fever, or pain), stop exercising. If you have chronic medical conditions (such as hypertension, diabetes, ischemic heart disease and arthritis), seek advice from your doctor or physiotherapist beforehand. All of these I agree with. If you are happy to take your body to your medical advisor when it is sick, take it back to your doctor for advice on how to tone it up as well.

The other words of wisdom suggested that for prolonged exercise such as hiking, continually drink water to supplement the loss of body fluid due to sweating. Do not wait until you are thirsty. Take appropriate breaks during exercise. Do not over-exert yourself. Forget about “powering through the pain barrier”. Leave that for Olympic cyclists.

As well as the form of exercise, there is the frequency. At least three times per week, 20-30 minutes (or more) is necessary each time, to derive the maximum benefit. And always remember, if there is dizziness, fainting, shortness of breath, chest pain, vomiting, nausea or severe pain during exercise, stop exercising immediately and seek medical advice as soon as possible.

I am a great believer in taking the animal kingdom as a bit of a guide for us human animals, and the lion pride is a good one to follow. The Alpha male is not seen dashing around the plains. He leaves that to the younger males, while he himself exercises at a slower pace. Regular light exercise is much better than severe exercise once a week.

Now I did mention at the start of this week’s article, the word “sexercise”, and some of you have been impatiently reading, while nervously fiddling with your expensive packet of Viagra, Kanagra, Cialis and other lead-in-your-pencil medications (I draw the line at tiger willy). OK, what about sex? The problems with this form of exercise when you have some chronic complaint (such as hypertension, diabetes, ischemic heart disease, etc.), should be part of the advice you get from your doctor beforehand. The danger of over the counter willy stiffeners is that you don’t get advice with them. The blue diamonds are only for use by males who have a reasonable level of fitness.

Finally, the learned article did say “Exercise with friends. Company provides enjoyment, mutual encouragement and support.” That goes for sexercise too!

HEADLINES [click on headline to view story]

Professor Hickey’s Wayside Inn of Ill Repute

Are you ready?

Exercise for Health. Does that include sexercise?



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