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Doctor's Consultation  by Dr. Iain Corness


Hooray for Uncle Harry!

I can assure you that every practicing doctor in the world has heard about your Uncle Harry who smoked three packs of cigarettes a day, drank two bottles of whisky by lunchtime and lived to be 104 and was shot by a jealous husband after being found ‘in flagrante delicto’. The story of Uncle Harry is trotted out to stymie any thoughts of stopping smoking, or that too much alcohol is really too much of a good thing.

Unfortunately, your unstoppable Uncle Harry means absolutely nothing when we look at health risks from an overall point of view. Just as one swallow doesn’t make a summer, one Uncle Harry does not prove that smoking isn’t dangerous, or that too many bottles of whisky won’t cause cirrhosis. That kind of “proof” only comes after looking at large numbers of Uncle Harry’s, and that is done by a special group of people called epidemiologists.

Now the World Health Organization (WHO) has teams of epidemiologists and other health watchers, looking at the spread of disease in the world. Not just Uncle Harry. They have a good idea where we’re headed, but much of that depends upon where we (you) are.

The WHO has data to show the major influences and risks to health, with the number 1 global health risk appearing to be Underweight. Here is the influence of the African continent, with malnutrition and outright starvation influencing statistics. Again, it is the African continent that has dominated the second major health risk - Unsafe sex. The HIV/AIDS epidemic in that region, influencing the global statistics. After those two comes High Blood Pressure and Tobacco and then Alcohol at number five, and so much for Uncle Harry.

However, if you split the statistics up and examine the situation in developing countries, such as much of Asia, the picture is different. Number 1 health risk is Alcohol, followed by High BP, Tobacco and being underweight.

A close look at the risks for the developed societies (that covers the Europeans, Brits, Americans, Australians) gives yet another differing list with top spot Tobacco, followed by High BP, Alcohol, Cholesterol and being Overweight.

So, depending upon the society, the things that are waiting to get you are quite different. A WHO report states, “As a country develops and more people buy processed food rather than growing and buying raw ingredients, an increasing proportion of calories tends to be drawn from sugars added to manufactured food and from relatively cheap oils. Alongside the change in diet, changes in food production and the technology of work and leisure lead to decreases in physical exercise.

The consequent epidemic of diet-related non-communicable diseases (obesity, diabetes, hypertension and cardiovascular disease) is projected to increase rapidly. For example, in India and China, a shift in diet towards higher fat and lower carbohydrate is resulting in rapid increases in overweight - among all adults in China and mainly among urban residents and high income rural residents in India.” And have you noticed how many overweight Thais there are these days?

An interesting fact comes out of some developing nations, however, where countries have taken it upon themselves to promote a healthier way of life, despite the advent of the high living “western” style economy. Again, quoting WHO, “The Republic of Korea is an example of a country that has experienced rapid economic growth and the introduction of Western culture since the 1970s. There were large increases in the consumption of animal food products, and a fall in total cereal intake. Despite this, national efforts to retain elements of the traditional diet - very high in carbohydrates and vegetables - seem to have maintained low fat consumption and a low prevalence of obesity.

“The Republic of Korea has strong campaigns to promote local foods, emphasizing their higher quality and the need to support local farmers. A unique training program is offered by the Rural Development Administration. Since the 1980s, the Rural Living Science Institute has trained thousands of extension workers to provide monthly demonstrations of cooking methods for traditional Korean foods such as rice, kimchi (pickled and fermented Chinese cabbage) and fermented soybean food.”
It’s not too late to look at your diet either! And put that cigarette out.

Poisoning your children

Did you know that the incidence of poisoning of children has risen in the past few years? This is not deliberate poisoning by someone with evil intent, but “accidental” poisoning where small children (toddlers especially) are poisoned by taking something dangerous they have found in the home.

The concept of ‘child-proof tops’ has been about for many years, but I am sure you have found that the majority of medications still have simple closures. And where do the majority of these medications reside in your household? Probably in the bathroom cabinet or in the fridge. Yes, your bathroom cabinet!

To show just how unfinished medicines can accumulate in your household (even though you are supposed to take the complete course), one of the patients brought me a present a couple of years ago. A very large package which weighed 1.44 kg. If this had been just before Xmas, it could have been all sorts of goodies. (Miss Hillary in this section would have thought all her Xmases had come at once! Chocolates at least!)

In fact it did contain all sorts of goodies. There were capsules, tablets and lozenges and in all kinds of wonderful colors. These would have been a toddler’s delight. And all potentially lethal.

The package was the result of the patient’s cleaning out of his bathroom cupboard of outdated, or no longer needed, or even ‘unknown’ medicines. The man was not a hoarder, but knew that medications should be kept out of the reach of children, which he had been doing - for quite some time! However, when he started running out of room, a problem presented itself. How was he going to get rid of them?

He was savvy enough to know that if he just ditched them in the local rubbish bin, the recyclers would definitely consider them treasure trove, and he could foresee some untrained person attempting to differentiate the various pills and tablets and sell them somewhere. Paracetamol tablets do generally look the same after all, white round ones, but so also do many other medications, which are not as relatively safe to be taken indiscriminately.

He then thought about flushing them all down the toilet, but decided that 1.44 kg of strange tablets might just block the precarious plumbing that pervades in Thailand. When the locals are afraid of putting soluble toilet tissue down the loo, what would strange foaming tablets do? Let alone capsules and lozenges.

The next resort was to borrow a mortar and pestle from the local ‘som tum’ roadside kitchen and having ground them all to a paste then spread the resulting pulverized mass over the garden as a somewhat powerful weedicide. At least the grass would be germ-free! However, this was not really practical either, as the som tum lady couldn’t wait the several hours that was going to be necessary.

So I then became the last option, and with a smile he presented me with the aforesaid 1.44 kg bag, with wishes for a very happy Khao Pansa.
Abandoning my initial thoughts of hurling them from the top of the 15 storey hospital building and watching people scrabble for free tablets, I saw the senior pharmacist in charge of the Pharmacy at the Bangkok Hospital Pattaya who assured me that yes, they could dispose of the 1.44 kg bag and contents, as there was a service to allow total destruction of medications such as these, under very secure circumstances, run by the Thai government, and he would be happy to forward the 1.44 kg bag of goodies.

So there you are. It is probably a good idea as part of your New Year’s resolutions, to clean out your bathroom cabinet of old, half used, undated, expired and unknown medications, tablets, lozenges and mixtures. If the quantity is too great for flushing down the loo (and 1.44 kg is too great), then bring them to the closest hospital and ask that they supervise the destruction.

Of course, as mentioned above, when you are prescribed a course of medication (antibiotics in particular) you should keep taking them until the course is finished. We don’t prescribe ‘extras’ just to fill up the bag!

Seven Deadly Sins!

Were you aware that heart disease is still one of the greatest killers of mankind, ranking a strong second after the Thailand motorcycle riders road toll - OK, I exaggerated that a little, but the road toll in this country is a blight on the face of the community.

Interestingly, if you look at the major causes of death by development of the countries, in the high income countries death toll comes from heart disease, stroke and lung cancer, middle income countries have stroke, heart disease and lung disease and for the low income countries it is heart disease, respiratory infections and then HIV/AIDS.
There are many reasons for the differences, including dietary, socio-economic, educational, development of health services and tobacco and alcohol abuse. However, this week I am only going to address heart disease, and the seven deadly ‘sins’ that can predict your likelihood of getting (and suffering from) heart disease.

1. High Blood Pressure: 20 percent of elderly people suffer from this condition. Imagine trying to blow through a long tube. If the tube becomes constricted for any reason, you will have to blow harder, increasing the pressure. Blood pressure is the same - if the arteries are constricted or less pliable, it takes a greater pressure to force the blood around. The heart has to work harder to produce the increased pressure, and eventually the heart gets tired and fails.

2. High cholesterol: High cholesterol foods such as egg yolk, offal, animal brain, animal fats, dairy products, seafood, oyster, squid, etc, leave deposits in the blood vessel walls. As a result, the fat “plaque” on the vessel walls obstructs the blood flow and this will eventually cause heart disease, as per the first deadly sin above.

3. Smoking: Smoking is a primary factor in the causation of coronary artery disease. Smokers are at a much higher risk, even two times more than non-smokers. Smoking increases adrenaline, which causes an increased heart rate, increased blood pressure and lowers the amount of oxygen carried by the blood.

4. Diabetes: Diabetic people have twice the risk of congestive heart failure than people with normal blood sugar levels, due to their increased weight (see number 5) and high cholesterol levels produced in the blood.

5. Obesity: People who are fatter than average have to face a 30-40 percent increase in risk of heart disease compared to thin people. In just carting around the extra weight, the heart has to work harder (and the knee and hip joints wear out). Try walking around with 10 kg extra on your back and tell me how you feel at the end of a week. Tired? Of course. And your heart is tired too.

6. Stress: Stress is not totally bad for us, as it keeps you going, and in an appropriate level actually stimulates our curiosity and motivation; however, by getting over-stressed, adrenaline levels are increased and this may lead to abnormal heart function. Though stress is not the main cause of heart disease, it can make the artery walls less flexible, which is the beginning of heart disease.

7. Lack of exercise: Exercise is the best way to increase high density lipoprotein (HDL) - “good” cholesterol that prevents the arteries becoming abnormal. By exercising, blood pressure, body weight, and the possibility of thrombosis will be reduced.

So you can see just how these seven risk factors all are inter-related. Keep the arteries clean, watch the diet and ensure you have a reasonable level of exercise. Check the Blood Pressure and stop smoking.

Remember too, that as you get older, the chances (and risks) of heart disease are higher. (Young males are more likely to die from clumsy motorcycle parking.) Statistically, men aged over 40 years as well as the postmenopausal women have a higher risk than adolescents.

Despite our knowledge, we still cannot predict exactly when the demise will come, but looking at the big picture, we do know that smoking, overweight, unfit diabetics with high blood pressure and high cholesterol do not live as long as non-smoking, fit, lean people with normal blood pressure, and normal blood sugar and cholesterol levels.
Do you know your levels? A brief medical check-up will tell you.

HEADLINES [click on headline to view story]

Hooray for Uncle Harry!

Poisoning your children

Seven Deadly Sins!