Make Chiangmai Mail | your Homepage | Bookmark

Chiangmai 's First English Language Newspaper

Pattaya Blatt | Pattaya Mail | Pattaya Mail TV

 
 

Doctor's Consultation  by Dr. Iain Corness

 

Update July 25, 2015

This time it’s for the menfolk

Women are wonderful creatures, with their own special problems and clinics just for the ladies, and heaven help any man who dares enter! In fact, if you are a man, have you felt ‘left out’ recently? With the current push for women’s health clinics and practitioners, it is easy for men to feel displaced. After all, you’ve no uterus to become cancerous, and although you do have vestigial breasts and it is 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 Willy the Wonder Wand and 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 organs, the kidneys!
To keep your kidneys in top shape does not require special kidney exercises. 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.
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!
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!
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 you should 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 (AKA Urologist)!


Update July 18, 2015

Is working under pressure important?

I had my annual medical the other day, and I was rushed for time. After the blood was taken I was presented with the small bottle to take to the toilet to collect the urine specimen. Managed that after five minutes of standing there whistling, turning on the tap until success. Rushed back to the nurse who said, “Now I will take your blood pressure.” Ignoring my please that I was too rushed, she took the pressure and it was something like 160/75. “Too high” she said, waiting for me to explode I think!
I left and after settling down, I popped into one of the Out Patients Clinics and got the nurse to take my BP. It was 147/75. Much better, but still marginally up. Was the first machine wrong?
No, the machine was not wrong, but what you have to understand is that BP is not a static measurement, but one that fluctuates for many reasons – rushing, coffee, anxiety, cigarettes and a whole host of others. This is why, if your doctor tells you that you have “hypertension” (high BP) on just one reading – don’t believe him (or her).
So how do you find out if your BP is too high? Quite simply by repeated measurements. Just as one swallow doesn’t make a summer, one elevated reading does not necessarily mean hypertension.
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.
So why is BP important? Because if you don’t you don’t have 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.
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.
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) / 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 (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 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 the doctor classify you as being “hypertensive” until repeated measurements confirm that your BP is too high.


Update July 11, 2015

Being prepared

I have it on good authority that unfortunately, the evidence would appear very strong, that we are all going to die. That’s you, Auntie Annie and even me.
OK, that 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.
What prompted this week’s column was the death of an old acquaintance of mine. Lovely bloke who took life seriously and would ask me all sorts of medical questions - but those questions 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 commonplace - 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 July 4, 2015

La Maladie des griffes du chat

Have you ever stopped to wonder why there are so many difficulties put in your way if you wish to import your pet cat? Well, one of the difficulties relates to “La Maladie des griffes du chat” known in English as Cat Scratch Disease.
Now most people know that dogs carry diseases, including the deadly rabies, but the other domestic pet, the cat, carries its fair share as well. However, almost every household has at least one cat, and often more. Cats are affectionate, warm pets that will sit on your lap for hours, purring away, while it licks your hands. During that time, it may even be giving you more than love. It may be giving you a little present called Bartonella henselae, AKA Cat Scratch Disease! Yes, your cat is a walking, purring receptacle of illness.
Tell me more, you say, while wondering if you should strangle the cat now or later! But first a little history. A little over 50 years ago, the clinical signs of Cat Scratch Disease were described, and despite 50 years in between, it is still in the feline population.
Cat Scratch Disease affects between 2-10 people per 100,000 head of population in America, so whilst it isn’t an everyday diagnosis, most doctors will come across a few cases in their medical lifetime.
The presenting symptom is a regional swelling of the lymph nodes, generally in a young person or a child, and the usual scenario involves a panicking parent who is sure the child has lymphatic cancer.
What actually happens is that the cat is carrying the organism known as Bartonella henselae, which is found all over the world, and which it inoculates into the human system. This bug in turn is trapped by the lymph glands, within which one almighty fight takes place, with the end result being that the glands swell dramatically and can even burst through the skin as a suppurating discharge. Other signs and symptoms include a fever, sore throat and headache.
Now there are many causes for swollen glands, fever, headache and sore throat, so how do we pick on the family pussy cat? Quite simply, there will be a history of having been bitten or scratched by the family moggy, and the inoculation site will drain into the affected lymph glands.
So just how does the cat give you a “shot” of bugs? Well, firstly somewhere between 20-40 percent of cats are carrying the organism, and it lives in the cat’s saliva as well as in its blood. While licking its claws, pussy cat leaves a collection of the organism there, which in turn becomes yours when the cat scratches you. Deliberately or accidentally.
Cat Scratch Disease, although generally localized can even end up infecting internal organs such as the liver, spleen, heart and brain, though this is very rare. For most people who contract the illness they quietly recover, though it can sometimes take some months. However, for people with compromised immune systems, spontaneous recovery is not the norm. Children get the disease more than adults, because children tend to spend more time with pets, and pull more than the occasional tail.
There is treatment, with one of the most appropriate antibiotics being Doxycycline, while the most usually available penicillins are fairly ineffective. There are tests which can be done in the laboratory to prove or disprove infection by Bartonella henselae, so what we call a “Definitive” diagnosis can be made. Again you can see the dangers in self medication. If you do indeed have Cat Scratch Disease from the cat bite, the penicillin you bought is useless!
So should we all go out and take our cats down to the vet and consign them to the great veterinary hospital in the sky? The simple answer is no, but the moral to this tale is that we should be on our guard. Cat scratches and bites should not be taken lightly. Immediately after any injuries you should wash the wounds with soap and water and after a thorough cleansing only then apply your favorite antiseptic, and at the first sign of problem, pop into the hospital and get it checked. But just leave the cat at home!


HEADLINES [click on headline to view story]

This time it’s for the menfolk

Is working under pressure important?

Being prepared

La Maladie des griffes du chat