cshapiro

I just have to comment on this.  One thing that has always seemed odd to me when I was in the UK.  The people there always think things are far.  British people will pack a lunch, plan a route, pour over maps and agonize for weeks about a trip from London to Oxford.  In Canada restaurants deliver (for free) that distance.  The notion of "far" in the UK  is just ridiculous.  People in Canada commute daily the equivalent distance of the length of Scotland.  It's time you realized, the UK, is a tiny (but lovely) island.

cshapiro

I don't want to belittle your nervousness over your drive.  Lots of people don't like driving in unfamiliar areas.  I have sympathy for your discomfort.  I'm just having a gentle poke at the UK sense of scale.  I guess we all are used to our own surroundings but in Canada and the US an hour or 2 in the car is an errand or regular commute in the UK it's an outing.

cshapiro

Sorry to hear about all the colds going around.  I hope you all recover real soon.  As for needing a day off to recover, that is the story of my life.  I end up going to work no matter how sick I am, which of course makes me end up taking longer to recover.  I just can't seem to avoid going in for at least part of the day.  Taking care of yourself is the best medicine.  I had pneumonia 3 years ago and it took me three months to fully recover because I never got enough rest to allow my lungs to fully heal.  Try to avoid making that mistake if you can.  I'm a big fan of folk remedies though.  My grandmother had a bunch of them and they all seemed to work.  At the very least you can't go wrong with a big bowl of chicken soup, the best cure there is.  Everyone should remember to get there flu shots now.  This is the beginning of flu season and now is the time to be immunised.

Feel better Barb and Shinny.

cshapiro

It is not true that only the elderly should get a flu shot.  There was a time that only people over 50 and people with other health issues were given a flu shot but now, it is recommended for everyone starting at 2 years old.  I am required by law to have one as someone in the health care field but it is a good idea for everybody.  In Canada it is free for everybody now.

cshapiro

You are correct.  The term "flu" is overused and misunderstood as is the flu shot.  Having the flu means being infected with one of the several hundred strains of the influenza virus and is a serious illness.  Influenza is categorized as either type A, B or C, A being the worst.  A severe epidemic of type A breaks out in 3-5 year cycles.  Flu is a disease of the respiratory  system and can lead to complicated bronchitis and pneumonia.  A case of flu usually lasts several weeks and in the US there are 20 000 deaths a year from flu.  This is why in Canada and the US flu shots are recommended for everyone.  There is no real risk from the shot and the few minor side effects outweigh the possible consequences of infection.  One common myth is that you can catch flu from the flu shot but this is not true.  There is no live virus in today's flu shots and no chance of catching flu from the shot.  I'm pretty sure doctors in the UK  recommend the shot as well, just the government doesn't want to foot the bill.  I would recommend it even if you have to pay out of pocket.  Of course there  is the famous man flu where some sniffling sends him to bed for a week.  A woman will go to work and go about her day with a knife in her back apologizing for the knife being in everyone's way.

cshapiro

The thing I think is overlooked by most people is, when there is a virulent outbreak of type A influenza, it can be serious for people with no other risk factors.  I work in a pediatrics hospital and last year 8 children, who were otherwise perfectly healthy, died from complications due to influenza.  In the US there are 20 000 deaths attributed to flu in an average year and that number as much as doubles in years with more serious outbreaks.  Of the total  number of deaths, about one quarter of them were people with no other risk factors.  Influenza is very contagious and is an airborne contagen, which makes it very easy to catch even with a perfectly normal immune system.  It is possible to catch the flu even after immunization but the illness is much less severe.  There are no reported fatalities in the low risk group of the population that has been immunized.

As for your story of being offered antibiotics for a viral infection, I am appalled.  I was under the impression that in Europe this was much less of a problem than in North America.  Here the issue is, patients often come to the doctor, and tell him/her what they want and lazy doctors don't want to spend the time arguing and more importantly, explaining, why they don't need the drugs.  Physicians have a responsibility to educate there patients, not patronize them.  Besides the problem of creating resistant bacteria,  there are some serious side effects, particularly for children, that arise from antibiotic treatment in the absence of a bacterial infection.  These include,  PERMANENT colitis, jaundice, severe hepatic dysfunction and even total liver failure, to name a few.  Antibiotics have enough adverse effects to deal with when they are necessary, but to take them when they aren't is crazy.  Every year in flu season, when the ER is packed, we announce to the people waiting that antibiotics will not  be given out for flu and half the people just get up and walk out.

cshapiro

Here in many ways it is worse.  In Canada and the US the drug companies buy data from the pharmacies that contains the information about how often the drugs are prescribed broken down by doctor.  So, if a doctor, lets say, stops prescribing a certain antibiotic that he always has used, he will "coincidentally" start to get more visits from that drug rep.  I have tried this several times and after three months they stop being subtle and come buy the office almost every day with lunch and pastries as well as some gifts for the wife and kids.  When I found out about this(I was still in Boston and they don't teach this in Med school, at least, not in the Glaxco lecture hall or the Abbott pharmaceuticals pathology lab)I started a policy that I maintain to this day.  I don't meet with drug reps, EVER.  It's not worth my time or the few lousy trinkets and it isn't in my patients best interest.  They still come by, and try.  They sit in my waiting room for hours.  They even sneak in and leave behind displays and other stuff which just go straight to the bin.  I have heard of  them posing as patients but since I only see kids it would be hard for them to pull that off with me.  
  You should know (as should your aunt's doctor) that the diagnostic imperative for determining high cholesterol is the ratio between LDL and HDL of less than 2.1 .  Total serum levels of less than 5.18 was on old guideline that is not as important as the ratio.

[ Last edited by cshapiro at 11-28-2008 14:05 ]

cshapiro

Cholesterol is the misunderstood molecule.  It is found in every cell in the body ans is necessary for all animal life.  Low density lipoprotein is used in cell construction and when we are building fat cells it ends up stuck to the walls of our arteries.  High density lipoprotein is used to transport fat from cells and deposit it in the liver for metabilisation and will remove LDL as well.  Inadequate amounts of cholesterol would lead to defects in the cells the body was trying to make.
Typically, a LDL of less than 3.36 is considered "good" an HDL of above .9 is also good and totals should be less than 5.18.  But it is more important to have a higher ratio  of LDL to HDL.  If someone had an LDL 4.0 and an HDL 2.0, they are better off than the person with the so called ideal numbers quoted above.  Even though they have a total lipid level of 6, which is high, they are at a much lower risk level.  The ratio should ideally be above .4 (ldl divided by hdl).  This number has proven to be a much greater indicator than total levels or even ldl levels.  Since I am a surgeon, I don't really prescribe a lot of drugs and I don't ever deal with statins.  Even more so because I only treat children but there is so much pressure by drug companies to expand use.  At the last pediatric seminar I was at there was talk of starting to prescribe statins to children as young as 8 years old.  A professor of mine is doing research which suggests that CIA drugs (Calcium intake antagonists, a widely prescribed heart drug that is supposed to prevent heart attacks) may be responsible for thousands of deaths.  When he published his journal article, he faced threats, ridicule and numerous attempts to discredit him personally.  As to the possibility that statins cause more damage than that which they cure, I don't know.  One thing is true, and that is that statins are more dangerous than they are made out to be.  Besides liver toxicity there is mounting evidence of pulmonary issues and long term muscle tone deterioration.  Statins are very dangerous when combined with a large number of drugs, some of them very common.  There have been many cases of death due to statin/erytheromycin interaction, so you had better hope that whoever is treating you is paying attention since it is such a commonly prescribed antibiotic.  High cholesterol can be very dangerous but I would say, having only slightly high numbers wouldn't be enough of a reason to treat with statins.  I would also urge you to consider other risk factors into the equation(previous heart attack, hypertension, arrhythmias, blocked arteries etc.  Of course it is never to early to treat with healthy eating habits and most importantly, exercise.

cshapiro

How cold is it over there?  I didn't think Ireland and the UK got that cold in the winter.  I suppose cold is relative but, right now, as I look at my outdoor thermometer it reads, -8 and very windy.  Tomorrow it is supposed to be another 10 degrees colder.  My whole life I have lived in places with harsh winters and Toronto is probably the mildest of the places I've lived, but I like winter and snow and wouldn't feel right if the winter was warm.  I grew up in Quebec and winter was much harsher and there was a lot more snow so, it doesn't seem so bad to me.  I guess it's what you're used to that defines what is considered warm and cold.

cshapiro

Sorry about the cold weather, I know it can be hard on people not used to it.  Today it's only -2 and I find it quite warm but my brother has lived in the Caribbean for the last 10 years and can't stand it here even in the spring anymore.  I hope you feel better soon.  In a couple of weeks I am actually going to Germany for about a week.  One of my closest friends from med school is getting married and I am going to the wedding.  I am pretty sure the weather is usually much milder than here but I have never been.  Anybody know of anything good to do in Munich or what it's like in December.  I am looking forward to the wedding but, I still have four other days to fill.  I am getting one day to spend with my friend which, I am really looking forward to.  He lives in Boston and we are both crazy busy and never see each other anymore.  This will be the first Christmas in 15 years that I won't be working and to get the time off I am now 36 hours into my first of three 48 hour shifts and I will have to work a 24 hour shift on New Years(6pm new years eve until 6 the next day).  It's one of my oldest and closest friends so it's all worth it though.

cshapiro

I wouldn't call it tropical and compared to Florida I'm sure you would find it cold but Munich only really goes down to around 0 at night at the coldest and is around 10 or so during the day.  Compared to Canadian winters it's quite nice.  Try to keep warm and have hot drinks to keep your immune system up.  You can crash after exams.

Mel, you are more charitable than my wife about substitute teachers.  She finds that they don't follow her instructions and lesson plans and they end up being so far behind.  It's frustrating for her since she is so conscientious.  I see her spend an hour or two working on detailed lesson plans for the sub while having 102 fever and being really sick, only to have them ignored.  It drives her mad!  I'm sure you're happy to be back in the class again.  Not to knock the subs, but if you want anything done right, you need to do it yourself!  Try to stay as well rested as possible to allow yourself to fully recover(I know, easier said than done but I said TRY).

cshapiro

I will be arriving on the 23rd of December.  Any advice about what to do there would be appreciated.
Thanks.

I'm off to bed.  I finished a 48 hour shift this morning at 8am and have been up all day.  It's around 11pm here now and I have to be in by 6am tomorrow morning.

cshapiro

Thank you very much for letting me know about the Christmas market in Munich, I will definitely check it out.  I am also happy to be done with my week.  I just finished my second 48 hour shift and rounded up my 108 hour work week.  I am getting too old for this stuff.  All this for 6 days off.

  I agree with you completely that being together with family is the best part of the holidays.  It is the people you have around that makes it a true holiday.  One reason I'm so looking forward to this trip to Munich is, all the people we know from Boston are going to be there.  When we lived in Boston we didn't have any real family and this group of people became our family and that's how we think of them as, our "Boston family".  All of us being together again is like a family reunion and my wife and kids are so looking forward to seeing everyone again.  Being reunited with our Boston family is a holiday in itself for us.

cshapiro

Hello Penny.  I wanted to give this a separate posting.  I was glad to here you are well, it is lovely to here from you as always.  Take care and we all hope to see you around the forums more often again.

cshapiro

Wish me luck!

I'm at Pearson(Toronto) airport right now awaiting my flight to Munich.  I'm here with the whole family and my kids are watching shows on VIP on my laptop so at least they are occupied.  They are showing the flight as delayed by an hour but they say we should get out then and we won't be canceled.  I'm told the weather is quite nice in Munich right now.

cshapiro

I was only delayed about an hour which isn't too bad.  Thanks for your kind wishes.  I haven't been able to fall asleep and since it's like 4am and everyone is sleeping, I thought I would check in  here.  The weather here is nice (relatively) and we are all having a great time.  Munich is beautiful and has a very different atmosphere on Christmas eve from Ontario.  The whole family made it, kids and all and it is amazing to see everyone together again.

cshapiro

Thank you very much for recommending the Munich Christmas market.  We went yesterday morning and we all had a great time, particularly the kids.

cshapiro

I got back from Munich on Tuesday night and worked a 24 hour shift on Wednesday for New Years.  Munich was awesome.  The wedding was great and our whole "Boston Family" was there, kids and all.  We got to be together again just like "the old days".  It was over too quick.  There were lots of tears at the airport when we all came home and had to part ways again.  I hope everyone is feeling better from their laryngitis and migraines.  I have to comment on the whole "chivalry" and helping out others topic but it will have to wait until tomorrow.

cshapiro

Thank you for your kind well wishes about my vacation and for your interest.  I have been a mod now since August or there about and you may be a bit out of it but you have always been one of the best mods here.  I know you have a very full plate with school and everything else but don't let it bury you.  I can sympathize, our twins were born just after my surgical internship began.  I don't really remember anything from that year but, we did survive.

cshapiro

I know this is an old topic but I think it needs further comment.  The world needs more courtesy and kindness.  People need to be raised to help people in need and have proper manners.  I think it is important to hold the door for people and say thank you and please.  When it snows my kids are always out helping people shovel because that is what you do when you see someone that needs help.  As for it creating expectations, well, if an elderly, ill person ends up with some expectations of some help it isn't wrong.   That's the point.  It should be expected to help people in need.  
Bala, I don't want to pick on you but you speak about wanting a girlfriend and being sensitive to the needs of others is what a relationship is all about.  If you want to have a relationship your mindset has to change to "what I can do for you".  The most important thing to have in any relationship is respect.  You need to treat any partner with total respect.  I have been married 20 years now and I am always looking for ways to make my wife's life easier and for things to make her happy.  Sometimes I'm not at home a lot so I have to find ways to show her that I want to be with her even when I can't.  Every time I travel alone for work, I send a letter(not email) from wherever I go, to show I miss her.  Usually I get home before the letter but it doesn't matter.  The best gifts are the ones that have no special reason because they show how much you care.

[ Last edited by cshapiro at 1-6-2009 03:19 ]