Problems with obesity

I know the topic isn't an easy target and many strong emotions rise when bringing it up. For those who feel offended I'm not in top shape myself and I've been bullied at school for this very same reason. But still it's worth writing for. Just to see a glimpse from doctor's point of view.

Currently I'm working at anesthesiology and to see heavily overweight patients makes me sigh because I know there's trouble ahead.

I'm writing this just to tell obese people view why physicians are so obsessed about their patient's weight. It's not about appearance, trust me. It makes our job extremely difficult in some cases and the cost of that just might be.. Well you know.

With obesity one is more likely to suffer from high blood pressure, lower limb osteoarthritis, sleep apnea etc. Making just about any diagnosis can be challenging. Listening to hear murmurs through a thick subcutaneous layer with your stethoscope, trying to locate a painful spot around the stomach, examining a chubby knee and realizing your muscles aren't big enough to lift it.

Then again we have all sorts of tests we can do, right? Lab results are rather reliable if one takes into account the size of the patient. In some cases the plasma is carrying too much lipids which can alter some results. X-rays are hard to read because the fat layer impairs the quality. Same goes for ultrasound. With CT or MRI scans the staff has to take into consideration whether or not the patient fits the cylinder.

Surgery and later physiotherapy repeat all these challenges from their own point of view.

So why does an over weight patient make my blood pressure rise? When putting patients to sleep for an operation you need to take care of their breathing. Usually this means intubation. Just because there isn't much space inside the throat this is difficult. Always. Then again there's extra weight above the lungs pulling them down. Ventilation machines are always fighting back when I make my adjustments. Heavy obesity also affects drug doses, blood pressure stabilizing, recovery and so on.

Westerns society is suffering from obesity. And the answer to the problem is not alone in the hands of medical doctors, but we do have our share. Information is one part of it.

For any overweight reader. I don't wish to overbear you. I'm sure obesity in your case is not a simple thing. I don't think it ever is. But you could be healthier and you could feel better. Sometimes the first step is like a baby step. How about turning to your physician? We don't know everything but we do know a lot. And we can help.

What ever happened to Delia?

Months prior to Christmas were busy busy busy. I truly did try to keep up that positive attitude towards the upcoming winter and appreciate the little things. Days were passing at work and while I wasn’t there I tried to focus on things that make me happy. Oh, and spicy food. (Thanks Jamie Oliver!) Cold, snow, slippery streets and dark mornings were there every single day. But then I faced one surprising turn after another.

I got one of those offers you can’t refuse. As my day job was anyway coming to an end and I had no plans for the future the decision was kinda easy. To put it short I’m in Africa! More specifically in Malawi, a beautiful tiny country south of Tanzania.

So instead of skiing and hibernating through the winter I’m enjoying sun, warm and wonderful people.

Next updates and number of pictures are purely dependent on Internet access.

Fingers crossed!

What is health?

Last night I gave a speech to colleagues about global health issues. Some were surprised as I tried to answer the question above.

Patients as well as the media often think that you have a better chance to stay healthy, if you have easy access to healthcare. True, but not the whole truth I dare say.

Nomenclature is a bit funny here. We talk about healthcare and at the same time mean two rather different things. Firstly the system is there to keep healthy people healthy. Secondly it is supposed to cure the sick or otherwise give them aid. From a doctor's point of view the latter is closer to our education. Quite frankly I'd give more responsibility of the previous for personal trainers, dietitians, nurses etc. If you're healthy, they can help you to stay that way a lot better than a doctor.

What are the factors that affect to the health of an individual? Apart from age, genes and sex the environment plays an important role. Environment with it's physical and social elements have major impact on our health. Questions like sanitation, pollution, water supply and climate change area easily big globally. In Mongolia's capital Ulan Bator winter time is hard on one's lungs. Smoke takes over and you can hardly see your neighbour's house. Nearly everyone I met there complained about pulmonary symptoms.

In social sense economics, gender, social status and education are all major players on the health of individuals just as nations. Take for instance Non-Communicable diseases, which are a major health challenge globally acknowledged also by World Health Organization. These often result after series of choices done in previous years. Smoking, alcohol consumption, seat belts, sports etc. Fast food is cheap. Healthier food is usually expensive and takes time to cook. Or obesity, why do you think it is rather common in women coming from Arabic countries.

Adding to the list is of course access to healthcare services. But the above listing tells the secret why in so many countries grass root health work has done wonders. Barangai workers in the Philippines or community health workers in Nepal are doing the same work for the best of their country. I think in the West we are waisting our resources when trying to provide good health to our people. We've forgot what it takes to have good health.

Seasonal affective disorder

Sounds horrid doesn't it? Back here we mean Winter Blues. Why? Cause it gets so blimey dark.

Mental problems are not a very popular topic, but this one is an exception. Everyone's talking about it around this time of the year. At coffee breaks, with the family, in shops and among colleagues. We have to talk about it cause it affects nearly the whole nation.

Sounds crazy? Well imagine yourself driving to work in the morning and it's dark. The same happens in the afternoon while driving back. If you work indoors, you won't catch any sunlight during the week. If you're lucky, it might peek down on weekends. Before snowfall darkness feels really dark and that's not due in weeks. Meantime sun rises later and later every morning and sets earlier every afternoon.

How do we cope? We fight back!

A funny article made me realize how easily our way to face this time of year makes us feel even worse. A sigh comes out every time we look out the window. We give in to tiredness and slowly begin neglecting our own wellbeing. That's why I've come up with my own survival list.

1. Darkness is a good excuse to burn candles. Some people enjoy this time of the year, so I might give it a try and stop waiting for it all to be over.
2. Bright colors are allowed even though it's not summer. I'm investing on juicy colored nail polishes.
3. Friends are essential, just like laughter and good stories.
4. My girl Florence



I know it's dog days. But my singalong goes dark days.
5. Sports. My goodness how gyms, pilates groups, swimming pools and the lot are packed when we turn to November. And boy when the snow finally comes you can't go more hard core than skiing.
6. Spicy food. When it gets cold and dark outside get some fire in your mouth.. and belly.
7. Smiling is hard if you don't feel like it. But sometimes little bit of forcing is good for ya. At work I've realized that it spreads. Someone just has to lead the way.
8. Focusing on good things in your life. I should be a lot more grateful than I remember to be.
9. Light therapy. Philips I thank thee for building my loyal bright light lamp.

The New York Times on Light Therapy

Here's the answer, but what was your question again?

Where there is Christian mission there are also medical doctors. For centuries these colleagues have packed their belongings and shipped themselves to the other end of the world to do a noble and most of the time not so easy a job. Along with other things they've taken with them their western medicine and social thinking. It can't be beaten for sure.

Medical aid promotes Christian faith and little by little locals want to know more. Motivation for this can be caused by a number of things. Churches are established and they grow by number. One day that congregation might be sending a missionary of their own to a far away land. This is the big picture.

I was surprised to discover how little research has been done of the role of medical work in the field of mission. These days our work and education is all about evidence based methods. But that does not seem to apply for the ones in the jungle.

I managed to get a hold of few articles criticizing western medicine and the inability for priests and medical doctors to work alongside. The publication used a particular African tribe as an example, but I think this can be applied to nearly anywhere.

As a representative of western medicine I listen and examine a patient usually with only one thought. What is the right diagnosis and then, how should I treat this. Sometimes I decide to see the patient later on again, but for most that one appointment is it. If I manage to answer those two questions in a way that pleases both the patient and myself, I'm usually content and forget the whole case. This is pretty much the method used by the doctors described in the article.

However for the locals, which this article describes, getting sick and cured was much more than that. They wanted to know the cause and understand it. They wanted to be cured in a holistic way and moreover the same should be prevented from happening later on. This way of approaching diseases was provided by the traditional healers and their methods pleased their customers. Needless to say the end results weren't always successful and the treatments sometimes cost a fortune.

With the arrival of foreign medical doctors the statistics got better. But a healthy patient was not always a pleased one. Western medicine felt so superb it kinda forgot there ever was any other sort. Or the possibility of learning from others.

I often find myself in a situation where the patient is somehow dissatisfied without either one of us being able to point a finger at a particular problem. It is likely that non-medical answers are expected from us and a wake up call could do good for the whole system of health care. Here the traditional method could be of aid. Maybe there's plenty to be found in the toolbox of the traditional healer as well as in his style of approach.

Lucky Girl

Today back at work. What went through my office? Tears were shed and I laughed with some patients. I met nervous parents and carefree elderly. I had to listen to bitter complaints and I spotted an old friend at the waiting room.

I've wanted to be a doctor since I was ten. Don't know why. My parents aren't. But the idea of helping others was so intriguing it guided me all the way to med school. And now I'm living my dream.

Sometimes I need a reminder of how cool this profession is. How unbelievable it still feels to realize I made it.

These pics are from Nepal and the Philippines. What I learned back there was that high quality medicine is not dependent of fancy buildup, but qualified professionals.

GLS Wisdom

Lately I've worked too much and paid too little attention to myself. This of course is solely my own fault. With this profession you have a never ending to-do-list no matter how hard you try. I just really like a clean table at the end of the day.

I've pushed myself too hard and last week I realized the result on that. I was not fun to be with, work with or seek aid from. This got me thinking of buckets.

Couple of years ago in Global Leadership Summit (GLS)  Bill Hybels gave a very simple advice on how to manage through rough and not so rough times. Imagine a bucket full of water. When it's full it's usefull. When the water has run out and the bucket nearly empty there's no point with the bucket either. If you imagine a bucket filled with your resources and a level that tells how full the bucket is you get a picture of how you're doing. One thing is to be aware of the bucket another is to come up with things that prevent it from falling too low.

The idea is simple. Simple enough for me. It has worked before. My bucket is full after sports, spending time with my nieces and wondering through art galleries. And the fun part is there are many more. I just need to find them and take better care of my bucket.

Flustered

Euthanasia, abortion and killing new born babies. You know what. This was not in mind when I dreamt of becoming a doctor as a kid.

Personally I am not a fan of ethical arguing. Mainly cause it never leads anywhere. "On the other hand" is a phrase you can always use and on the conversation goes. Those who don't deal with these things in their own life are often most enthusiastic about them. With my profession ethics does not stay in a theoretical level. It is there always present and the most difficult questions come without warning. It is not a theory, it is the life of a true person right in front of you. And you have a chance to totally screw up.

The talk is active again thanks to a paper published in Journal of Medical Ethics. A potential person is not the same as a person thus the killing of new borns is ok? The road to these conclusions is long I bet. What moral, ethical or ideoogical backround such clames must have. Is this the kind of world we want to live in? In the end, if you think all of this is only a coinsidence and life has no meaning what so ever, it must be hard to define right and wrong. If there is no God, everything is permitted.
  
Somehow medical personel is expected to do wonders these days. People think they're clients when in fact they're actually patients. The kind of sick consumerism entered our hospitals and clinics ages ago. But now since someone's moral standards have reached a new level, does that imply it should be put to action. The reason why medical doctors have raised their voices against this is that in time, if this would become legal it would be naturally their job to play the part of the executioner. Anyone can be a killer, not everyone can be a doctor.

On Call – How I survive it

Some tips to start with

1. Comfortable shoes. It's no time to be fancy pancy. Personally I prefer Crocs. They're light. You can run or sneak in wearing them and no matter how slippery the floor you won't take a fall. Plus a bright colour can cheer one up.

2. Drink. It's easy to forget food, but with all the running and talking you need water to avoid dehydration.

3. Stay cool. Anyone or anything can anoy you, but the work has to be done.

4. Go easy on caffeine. It's hard to focus if your heart is beating like mad. Also heps with numer 3.

5. Make return home feel like a prize. Food, fresh linen, flowers you name it. Take a breather. Yes it's morning, but you need it.

6. Sleep. Anytime it's possible take a rest. Even few minutes can do wonders. Some things can be done in the morning in stead of 3 a.m.

7. Forget life outside the hospital. There is none. At least not until the shift is over.

8. Remember to smile. Colleagues and the rest of the staff have rough time too. Appreciation and kindness always come back to you.

9. Don't be too hard on yourself. It'll be easier next time.

10. Enjoy. In the end its' a great job.