by W. Gifford-Jones, M.D. and Diana Gifford-Jones
Common sense health advice

A 57-year-old woman, receiving physiotherapy for an injured ankle, suddenly suffered a seizure, became unconscious, and was rushed to Emergency. The obvious diagnosis, a sudden stroke.

But as Sir Arthur Conan Doyle, the English doctor and writer who created the fictional private detective, Sherlock Holmes, wrote, “There is nothing more deceptive than an obvious fact.”

A report in the Canadian Medical Association Journal shows that Doyle was right. Doctors must sometimes think like Sherlock Holmes. The ultimate diagnosis was not a stroke. Rather, a complication from the triple A disease, abdominal aortic aneurysm (AAA).

It’s a problem that doesn’t receive much press. But it killed Albert Einstein, the famous scientist, Lucille Ball, the TV star, and the actor George C Scott. Unless diagnosed early, before it ruptures, AAA is an efficient assassin.

The aorta is the main artery that delivers blood from the heart to the entire body. It’s about the size of a garden hose and after leaving the heart it extends to the neck a short distance, then down the back of the abdomen.

During the last 60 years the risk of AAA has tripled. This is in part due to improved diagnostic methods and an aging population. It’s also more common in males than females, and about five percent of men over age 65 have some degree of aortic aneurysm.

Increased blood pressure is a major risk factor for AAA. It’s also more likely to develop in smokers and those suffering from chronic lung disease. But AAA can result from atherosclerosis (hardening of arteries) that gradually weakens the arterial wall and is a major cause of heart attack which ends the lives of so many North Americans.

An aortic aneurysm may be without symptoms until rupture occurs in which case the hemorrhage is so sudden and severe that death is speedy. But today many aneurysms are diagnosed during other diagnostic abdominal procedures.

This provides significant time to decide how these herniations are best treated, particularly since the majority of aneurysms expand at a very slow rate.

Since major surgery is involved to remove an aneurysm, it’s prudent to monitor them every six to twelve months by abdominal ultrasound, CT scans, and MRIs to detect changes in dimensions.

In the final analysis, the decision depends on the size of the aneurysm. Surgery is normally advised when the aneurysm measures 5 to 5.5 centimeters as this is when they’re more likely to rupture. In some cases, a surgical stent is placed inside the aneurysm to decrease the risk of rupturing.

Rather than using an abdominal incision, the stent is inserted through the femoral artery in the groin and then guided up and into the weakened aortic wall.

This operation is more serious than having an appendix removal so surgical expertise is vital. It’s the old story that practice makes perfect, whether a plumber or a surgeon.

For instance, in one study for aneurysms repaired by a vascular surgeon in a university hospital, the mortality rate was 2.2%.

But in hospitals where surgeons were performing fewer cases and were less experienced, the mortality rate was 5.5%.

Remember the common Gifford-Jones recommendation. If you are told surgeon X is the best for the operation and that surgeon has the personality of Dracula, don’t look elsewhere. It’s the hands that do the surgery, not the personality.

The story of the patient with the injured ankle had a happy ending. She was discharged in nine days. It reminds doctors that 30% of AAA have neurological signs, not pain or other symptoms. Like Sherlock Holmes, doctors need to be good detectives.

by Dr. Gifford Jones

What is a ketogenic diet? How does it differ and is it more effective than other diets? Apart from the hype surrounding this diet, what are the medical concerns about it?

Recent marketing of the ketogenic diet suggests it’s a new one. But a report from the University of California says it’s been used for years to treat medical problems such as epilepsy in children.

But what is it about the ketogenic diet that causes weight loss? A major factor is that it’s low in carbohydrates and high in fats.
Blood sugar (glucose) is normally the body’s main source of energy. But when blood sugar is diminished by eating less carbohydrates, the body is unable to maintain needed levels. To compensate, the body must start burning fat for energy. It also obtains more energy by converting some amino acids from protein in foods. And if this does not suffice, it gets energy from muscles.

The breakdown of fat, and to a lesser extent, protein, creates a condition called “ketosis” which is also used for energy. Hopefully none of us will ever be in a situation where we’re starving. But if that happens, we develop ketosis. It also occurs in uncontrolled diabetes.

Ketosis starts within a few days after carbohydrates are decreased to between 20 and 50 grams a day. This is not much carbohydrate, as two one-ounce slices of bread contain 28 grams of carbs!

How does a ketogenic diet compare with a normal diet? The average North American gets 50-55% of energy from carbohydrates, 30-35% from fats, and 15-20% from protein. The ketogenic diet obtains 5-10% from carbohydrates, 70-75% from fats, and 20% from protein.

A ketogenic diet contains full-fat dairy, eggs, fish, poultry, meat, nuts, non-starchy vegetables and butter. You are allowed to eat as many of these foods until you are full. It eliminates starchy vegetables, most fruits, grains, and sweets.

The British Journal of Nutrition analyzed 13 diet studies and reported that most, but not all, found that patients on a ketogenic diet lost more weight than those on other diets. They also ended up with lower blood pressure and blood triglycerides. And it helped those with type 2 diabetes. The negative of this diet is that it also increases bad cholesterol because of its high content of saturated fat.

Another negative is that the low carbohydrate content makes it hard for people to stick to it. Also, by eliminating most fruits, many vegetables, whole grains, and fiber, constipation is more likely to be a problem. Moreover, it removes ingredients essential for good health. No one should start a ketogenic diet without the help of your trusted family doctor.

It’s unfortunate that most diets wouldn’t be needed if people would follow a sound lifestyle. The first error is not having a bathroom scale that you step on every day. Scales tell it the way it is. Focus on losing any gained weight the same day the scale reports an increase.

This means saying no to high calorie desserts, eating smaller portions on smaller plates, and declining any offered second portions. Healthy weight loss also means an increase in daily exercise. Loss of excess weight and common-sense healthy living significantly reduces the risks associated with the epidemics of obesity, heart disease, and Type 2 diabetes. A sustained commitment can add years of longevity.

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