Dr. John’s Community Health Report September 2010
“ Personal Directives—–A New Approach”
Advance Directives or Living Wills have been available to Albertans for several years. Usually these documents have been drafted where an individual names a spouse, a family member or a close friend as their agent in case they become incapacitated by an accident or an illness. This document consists of a list of instructions that can be used by the agent to show health care workers what the writer of the living will or personal directive wants or does not want in terms of acceptable medical care.
The problem in the past has been that the health care workers often do not know that this particular document exists let alone what the directive wishes to take place, in terms of care.
Now, in Alberta legislation has been passed in which any Albertan can register the fact that a personal directive exists and the name of the agent who knows the wishes of the individual and the location of the agent where care givers can contact to find out the wishes in the personal directives. This registration can be done on the internet. This enables health care workers to contact the agent.
This process of registration is administered by the Office of the Public Guardian. It does not contain the details of the personal directives. It merely indicates that an individual has a personal directive, the date it was signed and provides contact information for the individual and the name and location of the agent who knows the details of the directives. The information simply brings the health care workers in touch with the person who knows the wishes of the person who wrote the personal directives. This would include details concerning treatments that were acceptable or not by the writer of the personal directives.
The whole process is done to respect the wishes of Albertans.
In our province a directive of this type can cover details such as short term and long term incapacitation. People can register their directives through a lawyer, or through the Public Guardian by phone or on line at www.seniors.gov.ab.ca/opg/registry/ I have tried the website and it is easy to use. The process assures good communication so that the wishes of people are going to be followed. It helps families such as mine where I am asking my daughter who is a nurse to act as my agent in health care matters and I will register her name so that she follows my personal directives that I will list for her.
Dr. John Morgan
80 Woodacres Dr. SW T2W4S6
403-251-5704
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Dr. John’s Community Health Report June 2010
“ The Colon and Health “
There is a long list of procedures and treatments that are purported to prevent toxic processes in the colon by health purveyors, such as naturopaths or other practitioners who promote their own medical treatments of the colon. They usually use vague terms such as relieving nerve pressures and clearing out toxins or the build up of other abnormal materials. This type of advice and treatment is offered as a matter of faith. Fortunately, the majority of patients that seek these types of treatments are not ill and seem to feel that these treatments are helpful.
One of the treatments that seems to have a patient following is cleansing treatments of the colon of what is thought to be removal of toxic material from the bowel.
The only time a regular physician studies the colon is when a gastroenterologist studies the colon and wishes to cleanse it first in order to see if there is any evidence of bowel infection or malignancy. There is no other scientific reason to cleanse the colon.
From a function point of view there is no practical reason to cleanse the colon. The colon is a long muscular tube with a thin lining and if extends from the lower part of the abdomen on the right extending upward near to the liver and then over to the left much like a picture frame extending then down on the left side of the abdomen to the rectum. The colon in function is a master eliminator. The muscular colon gradually moves the contents of the colon in one direction only which is toward the rectum. It is a one way street with only one function in mind along with the additional function of absorbing some fluid in the transit. Nature does the job. It does not need enemas or other sluicing procedures to get rid of the waste or the bowel bacteria.
Interference with the colon’s normal function with cleansing long term interferes with the normal functioning of the colon and it can even raise the possibility of creating a tear in the wall of the colon with a perforation that could be a surgical emergency.
Dr. John Morgan
80 Woodacres Dr. SW T2W4S6
403-251-5704
jcmorgan@shaw.ca
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“ Going To See Your Doctor “
Dr. John’s Community Health Report - May 2010
Looking back to my early years of practice I remember my first office nurse. Her name was Marion and she was a graduate of one of the old schools of nursing called the Edmonton General Hospital. Marion truly represented the old school as she came to work immaculately dressed in her full nursing outfit, including white stockings and her starched nursing cap. Starch was not spared. In appearance, Marion was definitely of the old school, where one of the rules of behaviour was a degree of formality. I was the doctor and Marion was the nurse. She was not above getting a patient ready for a physical examination and remarking to the patient with a zinger or two, such as “Patients coming for an examination should bathe”. She was delightful in all other respects, but she certainly set a high standard for people coming in to see her physician.
Now for some advice for people that are coming in to see a doctor. I have found that informality now is the rule of the day. The doctor has someone at the desk in the waiting room as well as one or two assistants who call out your name and take you into an examination room. It is always a good idea to go up to the desk when you arrive so that they know that you have kept your appointment. The doctor’s assistant usually comes out and calls your name. She is dressed informally. They always ask why have you come in, and then they get you ready for an examination, as they get some data from you and insert your history into the keys of a computer. It is always best to prepare yourself in advance if a physical examination is going to be carried out. Bathing is not forbidden. Loose fitting clothes and avoiding tight undergarments such as pantyhose in women
It is best not to eat before coming to the doctor’s office—this particularly applies to avoiding large meals, drinking tea, coffee and caffeinated beverages for at least two hours before coming to the doctor’s office. Food drink and smoking can temporarily raise the heart rate and the blood pressure. The same stress can occur with a full bladder and it is best to tend to that problem before coming to the office.
If special male of female examinations are planned it is best to know this when booking the appointment in case any special preparation is necessary.
Generally it is best to try not rushing to get to the appointment. Be quiet and relaxed while waiting to come into the doctor’s examination room.
Be prepared to answer the questions from the doctor’s assistant. She may ask you about allergies and the medications that you have been taking. It is a good idea to bring your medications in case the assistant or the physician wants to review them. If you have any information from another physician or an emergency room visit you can tell your doctor about it.
Physicians like to concentrate on what single problem made you seek advice. Springing something new such as wanting a general examination or perhaps a specialist consultation is not too appropriate at the time of the visit.
Most of all thank everybody when you leave. They love patient patients.
Dr. John Morgan
80 Woodacres Dr. SW T2W4S6
403-251-5704
jcmorgan@shaw.ca
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“Vitamin D—–How Much is Enough?”
Dr. John’s Community Health Report - March 2010
Vitamin D is the only nutrient that the body can make for itself. Sun exposure with its ultraviolet B waves interact with a chemical in the skin changing it to an inactive form of vitamin D. An exposure to the sun for 10-15 minutes three times a week is considered adequate for an intake of Vitamin D. Because of the risk of skin cancer it is probably safer to get Vitamin D from food or drug supplements of Vitamin D than from sun exposure.
Food sources rich in Vitamin D are limited. Fatty fish, fish liver oils and egg yolks top the list along with vitamin D fortified foods such as milk.
How much vitamin D is enough to prevent deficiency problems?
Some of the following studies suggest the use of a vitamin D supplement particularly in the older age groups. Fracture prevention. Higher doses of vitamin D 400 Int. Units or more a day lowered the incidence of bone fractures in general by 20% in the spines of people over the age of 65 years. In cognitive studies, patients who had higher levels of vitamin D in the blood scored higher in executive functions. They were better able to plan, organize, tend to details and think abstractly. Another study of more than 1700 older adults found that those with the lowest vitamin D levels were more than twice as likely to have impaired thinking skills as were who had the highest vitamin D levels.
How much vitamin D supplement is enough? The current recommendation for patients of fifty years or older is 400 Int. Units a day. For patients with known osteoporosis the upper limits daily is no more than 2000 Int. Units.
Experts agree that an optimal vitamin D blood level is 30 nanograms per milliliter (Ng/ml)
In older ages vitamin supplements of 400 Int. Units a day are recommended, but you should follow the advice of your family physician in making this decision.
Dr. John Morgan
80 Woodacres Dr. SW T2W-4S6
403-251-5704
jcmorgan@shaw.ca
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“ How Much Medical Care is Enough ? “
Dr. John’s Community Health Report – February 2010
This past few months I have been involved with a group of young medical students at the University of Calgary discussing medical ethics in clinical care including end of life decision making by patients and their families.
Modern society is a “Death Denying” people who have great faith in the medical profession in their ability to sustain and to prolong life when they offer great technical achievements to try and reverse the inevitable.
Death is always in the news. Large scale disasters such as the Katrina flooding in New Orleans and the possibility of H1N1 or other viral epidemic with fatal consequences, is great fare in our newspapers and television outlets.
The expectation of the public is to do everything possible to prevent death. While this is a natural wish, we know that there is a gradual deterioration of ill patients in hospitals and in long term care facilities where decisions as to appropriate or inappropriate care has to be made, and even decisions not to resuscitate a very ill patient should be made. Living wills or advance directives, where we recognize the autonomy of people when they are lucid or by the knowledge of close family members who clearly want the wishes of a loved one to be followed, help the care givers while demands for care that serves no useful purpose are voiced by some distraught relatives.
Physicians are helped when there is a clear transfer of autonomy, either by the advanced directive or the patient or agents in the family that know the long standing wishes of the patient.
Having families that demand ineffective or inappropriate care in emergency rooms or acute care facilities of a hospital, can usually be settled by a family conference with the caregivers.
In my medical career I found the social service department in the hospital to be a great help. They were dressed like the family, and often met with the family and shared their thoughts with the family. This type of shared companionship with family members allowed for better communication with the physicians and the nurses.
In health care we must understand that “wanting does not always mean getting” when it comes to making decisions in critical situations.
Dr. John Morgan
80 Woodacres Dr. SW T2W-4S6
403-251-5704
jcmorgan@shaw.ca
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Dr. John’s Community Health Report – December 2009
“Obesity and the Snake Oil Treatment”
An editorial in the Canadian Medical Association Journal back last February made the following observations about weight-loss programs and what we should do about the sellers of snake oil treatments for this major problem.
“The $50 billion North American weight-loss industry comprises a morass of fantastical claims of products and programs promising quick, easy, and long-lasting results. Given this wealth of magical weight-loss aids, why is obesity still a problem? Perhaps because magic exists solely within consumer hopes and dreams, which many commercial weight-loss providers happily exploit.”
“Recognizing the substantial morbidity and mortality associated with obesity, physicians, public health campaigns and nongovernmental organizations fuel the fire of the public’s weight-loss desires by promoting awareness of obesity’s risks. However, by not explicitly recommending evidence-based treatments, these well-intentioned messages drive consumers to blindly navigate in an unregulated wilderness. This has, at times, had fatal consequences, as with the administration of ephedra and with medically unsupervised very-low-calorie diets.”
“Physicians, governments and public health departments all share medical and moral obligations to protect consumers from shady weight-loss practices. Since weight loss addresses a medical concern for which treatment guidelines exist weight-loss products and services must be regulated to protect consumer health. Currently, hospitals and other health care facilities, both private and public, are subject to mandatory accreditation.”
“Before we can truly address the devastating obesity epidemic, we must first stem the centuries-old flow of snake oil. We call on governments to require formal accreditation of weight-loss providers to ensure quality and to protect consumers with an easily recognizable means of identifying evidence-based services. Simultaneously governments must pass legislation to subject weight-loss products to regulatory approval before they can be marketed.”
“Neither public health agencies nor the medical community are doing enough to solve the problems of obesity. Those suffering with obesity are often desperate for solutions and hence prone to exploitation. It’s time to put an end to this nonsense.”
Dr. John Morgan
80 Woodacres Dr. SW T2W-4S6
403-251-5704
jcmorgan@shaw.ca
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Dr. Morgan’s Community Health Report – November 2009
“Practicing Medicine in Pioneer Alberta”
As a change of pace for my readers, I am going to quote some passages written by my great uncle who practiced medicine in High River Alberta back in 1901. His name was Dr. G.D. Stanley and he recounted some of these stories in his book “Fun in the Foothills” that I am going to quote from.
“I assume that my readers are anxious to know what initial surgical operations or medical cures were, that established my professional reputation on a sufficiently sure and sound basis, that I have been able to carry on with a fair degree of success ever since. I should say that my first two cases did the trick.”
“The first case was one of quinsy (ed. note–a throat infection). My young patient was unable to swallow at all, and was having considerable difficulty breathing. I attempted to palpate the abscess in his throat but in my clumsy nervousness I poked it with the end of my finger—and presto the abscess discharged, and the cure was effected. The magic outcome was a winner for the new doctor, and the entire community soon heard all about it.”
“The second case was that of a well known character, a stock detective Jackson, who presented himself to have a couple of molar teeth extracted. I want them both out he said pointing to the two lower molars on one side of his mouth. I had only one pair of upper molar forceps but used it to tackle the job. I fastened the forceps to one of the back molars and began to extract it. The tips of the forceps slipped its hold, lodged between the two teeth and out came the two molars as clean as a whistle. The new doctor was not only expert to pull a single tooth but he knew how to get them out two at a time.”
“Another outstanding success became widely known. This was a medical case from the United States brought up by her brother because of a long and continuous illness. Three minutes convinced me that she was a psychoneurotic to a high degree, but I took three days, off and on, to complete a most detailed physical checkup and discussed the findings with her. My prescription for her consisted of only Aqua distilata, Aqua purifacta and Aqua colorata. The dose was exactly ten drops of this mixture in a glass of water before meals along with the warning that if she had any doubt to the accuracy of the count to throw the dose away and recount the drops in a new dose. The treatment worked like a charm, and for many years the High River druggist repeated the prescription for many addresses in the United States over many years. (ed. note–prescription of distilled, pure and coloured waters).”
Ed. Note–Dr. Stanley came to Alberta just before it became a province. He practiced in High River and later in Calgary where he was one of the founders of the Calgary Associate Clinic. He became one of my mentors, and encouraged me to come to Calgary to practice medicine, which I did in the mid 1950’s.
Dr. John Morgan
80 Woodacres Dr. SW T2W-4S6
403-251-5704
jcmorgan@shaw.ca
Dr. John’s Community Health Report – October 2009
“Acute Infections, Vaccinations, and the Prevention of Heart Disease”
In my September Community Health Report I commented on immunization guidelines for adults. One of the areas that I explored was the use of pneumococcal vaccines to prevent pneumonia in smokers, asthmatics and in all older people. Thinking about this, I want to explore how important it is to prevent heart disease in older people by the use of vaccines against pulmonary infections.
I would like the reader to understand where I am coming from in this matter. Now that I have retired from active medical practice, I have tried to follow my own advice. Ten years ago, I began having flu shots every fall and as I was then getting into my mid 60’s, I also had a single vaccine shot against pneumonia. Ten years have gone by, and my good record against pulmonary infections has been broken by episodes of pulmonary infections in the last three winters. With this change, I am now thinking about having a repeat vaccine injection against pneumonias. I checked the medical literature, and found that this was a recommendation made by researchers in this field. A physician should not try to treat himself so I am going to ask my own doctor about it.
I possibly have what medical research people call a “Healthy User” bias, as a receipt of a pneumococcal vaccine may be an indication of better access to health care, a healthier attitude towards a good life style, and with my better control of risk factors. I plead guilty to all of these counts, as I have decided that I am going to look after myself, as it is my problem, and not the problem of the Calgary Health Region.
In reviewing the medical literature on pulmonary infections triggering episodes of heat disease I found one researcher who reviewed 170 patients that came into hospital over five years with pneumonia, and he found in this group that 7% of them had heart attacks while they were in the hospital. In another study a researcher found that in the two weeks before coming into hospital with a heart attack that 28% of the patients had pulmonary tract infections. These were not well controlled studies, but they were suggestive enough to consider the use of pneumococcal vaccine in all older patients with a possible booster dose of the vaccine about ten years later.
Join me then in being a “Healthy User” of our health system. Prevent the problems don’t enjoy them.
Dr. John Morgan
80 Woodacres Dr. SW T2W-4S6
403-251-5704
jcmorgan@shaw.ca