Not Every Pain Needs a Pill

How we wish there were better ways to treat pain. But scientists are struggling to find them. The very nature of pain remains illusive too. Determining if pain is mild, moderate, or severe is a personal perception. Doctors and nurses ask patients to rate their pain from zero to ten. Whether the patient says 2 or 15, there’s more judgement than science in decisions about pain management. But one thing is certain, people managing pain at home are taking too many pills.

Pain, at best, is an annoyance. At worst, it is all consuming. It’s been said pain can collapse the universe and concentrate the soul until only the hurt is left. Elaine Scarry, a Harvard professor and author of “The Body in Pain”, wrote that pain and “injuring” are even tools of war.

In clinical settings, even when managed well, there are negative side effects with pain treatment. Acute pain can be reduced, for example, by opioids. But medical professionals need to be cautious with these drugs, because in addition to killing the pain, side effects can include euphoria and hallucinations, plus they are highly addictive.

Some researchers have been trying to develop drugs that ease pain without these side effects by attempting to turn on and turn off cellular and molecular receptors.  There is promise, but as yet no success.

Other problematic ways to beat pain include alcohol misuse, smoking, nutritionally devoid comfort foods, and default to a sedentary lifestyle. These are not good strategies. For people suffering from chronic pain, the key is to get professional help. A good doctor or pain management specialist will treat the pain and offer a plan to get off any drugs used in treatment. Run for help elsewhere if there is no such plan.

Numbing minor aches and pain with over-the counter pain medications has become a national pastime.

It’s foolish to hope people will change their ways. Einstein said the definition of insanity is doing the same thing over and over and expecting a different result. But we can only repeat the message that too many painkillers are worse than suffering a little pain. Paulo Coelho, the Brazilian novelist, said, “People never learn anything by being told, they have to find out for themselves.”

Sadly, some people find out the hard way, by paying the ultimate price. A report in the Canadian Medical Association Journal reports that a billion doses of acetaminophen are taken safely each year, but ten thousand people in Canada overdose on this over-the-counter medication annually. Of these, about 4,500 people are hospitalized and estimates suggest about one hundred people die.

How and why is this happening? Acetaminophen does not mix well with alcohol, yet people don’t read the warnings. In fact, the main cause of liver failure is an overdose of acetaminophen mixed with alcohol.

Tylenol is not the only pain reliever containing acetaminophen. People may consume more of the drug than they realize when they take multiple medications. Always read labels to make sure you’re not doubling or tripling the dose. When in doubt, talk with a doctor or pharmacist.

It’s not popular advice, but suffering a little bit is the right prescription for millions of people. Save the money spent on pain relievers and go home to get some rest instead. This goes for children too. It’s heart-wrenching to have a child experiencing even a little bit of pain. But in return for the hesitation to rush to medication, that child will gain a lifetime of fortitude and common sense to turn away from drugs when other options will ease the pain.

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Coughing Again? Could it be COPD?

Ask any singer what they detest the most and they will say, “People who cough at concerts.” So how do you tell if your annoying cough is due to getting older or being a little out of shape? Is it a common cold? Or could it be a life-threating condition, such as chronic obstructive pulmonary disease (COPD)?

It’s estimated that one in four people globally over the age of 35 will develop COPD. Worldwide, it’s the third leading cause of death.

It’s worrying that the National Heart, Lung, and Blood Institute reports that over 15 million Americans have been diagnosed with COPD and another 12 million don’t know they have the disease.

What causes COPD? It’s almost entirely due to smoking. Older women may experience more serious symptoms, even if smoking less than men. Other risk factors include exposure to second-hand smoke and airborne lung irritants such as toxic fumes and heavy dust.

People at a concert who can’t stop coughing may be suffering from emphysema or long-standing bronchitis, and often they will have both conditions.

However, the underlying pathology is quite different. In emphysema, the air sacks that transfer oxygenated air to and from the lungs have lost their elasticity, leading to chronic shortness of breath and lack of oxygen. Those suffering from chronic bronchitis have inflamed lungs clogged with mucus. This limits the intake of oxygen and builds up carbon-dioxide in the blood.

What is the answer to self-inflicted COPD? Shakespeare aptly wrote, “The fault, dear Brutus, is not in our stars, but in ourselves.” Some people, despite medical evidence that smoking causes COPD and most lung cancer, still play Russian roulette. They do not need a hard-working family doctor. They need a psychiatrist!

Don’t think the solution is to quit at the first sign of trouble. These diseases are sneaky without major symptoms at first. By the time you notice you’re short of breath going up an easy flight of stairs, you may be too late in getting the message.

There are some things your doctor can do to help to reduce further damage to the lungs. Get a flu shot, the pneumonia vaccine, avoid fireplace smoke and other pollutants, and adhere to drugs prescribed by your doctor. If you have signs such as fever, more difficulty breathing, tightness in the chest and increased mucus, see your doctor.

Inhaled bronchodilators use drugs to relax the airway muscles making it easier to breath. Inhaled corticosteroids can be added to reduce inflammation in the lungs. Getting oxygen with a mask may be necessary.

There’s new evidence that long-term use of antibiotics such as azithromycin may decrease the number of recurrent COPD flare-ups after one year.

What about surgery? This is a last resort and only feasible for some cases. Diagnostic X-rays and CT scans may reveal a part of the lungs that is severely affected. Removing the most diseased lung tissue might enable the remaining healthier parts to work better. This may improve breathing ability, but it can also make the problem worse.

A lung transplant is another possibility, but new organs are a rare gift.

We hope in the years ahead there will be other ways to treat this debilitating disease. But let’s end with one last warning message. For now, COPD has no cure and will progress when smoking continues. COPD is a terrible price to pay when it means prematurely leaving loved ones needlessly. Doctors see this over and over.

What about doctors? Years ago, cocktail parties in the homes of doctors would be full of tobacco smoke. Not today. Most have heard the message.

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New Drugs for Type 2 Diabetes

Albert Einstein wrote, “Everything is a miracle.” Is it possible that a new class of drugs is finally providing a miracle in the fight against diabetes? Ozempic and Trulicity, produced by Novo Nordisk and Ely Lilly, are examples of the brand-name prescription drugs gaining attention for fighting type 2 diabetes and showing success. Type 2 diabetes is among the leading killers globally. But information about these drugs is running wild. The hoped-for miracle needs a measure of grounding.

Consider Ozempic, a prescription drug, injected weekly by pen. It’s approved in Canada and the U.S. to treat type 2 diabetes, a lifestyle disease linked with obesity and a major risk factor for heart attack, blindness, kidney failure, and gangrene of the legs with possible amputation.

But the active ingredients in this class of drugs, marketed under a variety of names, are also getting attention for effectiveness in reducing obesity. The respected journal, Lancet, predicts a revolution in the treatment of obesity.

How do these drugs work? Ozempic reduces blood sugar level while providing a feeling of fullness and satisfaction after eating, delaying emptying of the stomach, and curbing the appetite for further food. Managing food intake is essential in the fight against type 2 diabetes.

But weight loss is proving a beneficial side effect of Ozempic. People can expect to lose about 20 percent of their weight over a 72-week period. When Ozempic is stopped, however, weight tends to return. So, to the current trend is for people to maintain a regular routine of use.

What about complications? Ozempic users complain of the usual ones such as, nausea, vomiting, diarrhea, constipation, and stomach pain. In rats, tests show an increase in thyroid and pancreatic cancers. In humans, research to date suggests extremely low risk.

People may ask, why take the chance of developing thyroid or pancreatic cancer? But wait a minute. These are relatively rare forms of cancer driven by other risk factors.

Type 2 diabetes and obesity are far more significant hazards, triggering fatalities for millions. Weight reduction and management of type 2 diabetes are the smart investments. The better question is, could these drugs help millions who die annually from cardiovascular disease and heart failure? We could add renal disease, liver disease, and pneumonia, as well as additional but harder to count problems such as the surgical complications associated with diabetes and obesity.

Type 2 diabetes should be labelled “the great pandemic”. Why? Because the COVID-19 pandemic lasted just three devastating years. Many people died due to it. But nothing has been able to slow the progress of the globally mounting lifestyle disease of type 2 diabetes. We live at a time when there has never been greater medical communication. Yet there has been failure in convincing people that the key to good health and longevity is a sound lifestyle, started early in life and maintained.

There is an extraordinary opportunity at hand with drugs like Ozempic to address the awful consequences of this failure. But as was evident with COVID, social media has the upper hand over medical experts in the public discourse, especially among the young, and the information is not always to be trusted. But where do we expect people to turn when they are having such difficulties accessing a family doctor?

Beyond misinformation, the social media buzz has caused two other concerns: over-prescribing and drug shortages.

There is enormous power and wealth in the hands of the pharmaceutical companies producing these products. The ultimate question is, can they produce the miracle of motivating people to lead healthier lives?

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The Health Consequences of Cats

Dog lovers may want to skip this week’s commentary. For cat lovers too, this column may prove a disappointment. A health risk assessment of household cats might be all you need to recommit to a dog.

Cats are the darlings of the Internet. And that may be the safest way to enjoy them.

There can be no doubt that cats provide crucial companionship for many people.  Their entertainment powers rival dogs. But here are a few thoughts on the ways cats can have an impact on human health.

First, the killer instinct of cats has a startling effect on biodiversity.  About a decade ago, the journal Nature published a study that estimated domestic cats kill 1.3–4.0 billion birds and 6.3–22.3 billion mammals annually! More recently, in Australia, a study found that the hunting success of feral cats, especially in areas affected by wildfires, has contributed to the collapse in population of small mammal species.

While charming household cats may not be successful in killing larger prey, that doesn’t stop them from trying. It’s amazing to learn that nearly half of house cats have physically attacked their owners!

Most of these incidents are not serious. But when provoked, cats know to direct their sharp teeth and claws to the face of their victims. These are the injuries that result in emergency room visits.

What are some of the other perils of living with cats? Numerous diseases can be transmitted by cats, including bacterial infections. The cats usually become infected by eating contaminated raw meat. Humans touching these cats, their food, toys or bedding – and especially in handling cat poop – neglect to wash their hands. Salmonella can be caught this way.

Other bacterial infections can be caused by flea bites or fights with other infected cats. Cat scratch disease, for example, can be transmitted to humans by the lick of a cat. It’s normally not serious, but infection can lead to fever, eye infection, and more severe symptoms in children and people with weakened immune systems.

Hookworms are another concern. These tiny worms are found in cat feces and in the soil and sand used by infected cats. Humans walking barefoot in contaminated areas can pick up the worms. The larvae penetrate the skin causing red, raised tracks that are very itchy. Fortunately, the worms can’t survive in their human host, so the problem goes away without treatment within a few weeks most of the time.

Ringworm is an infection caused by fungus spread by touching an infected animal. Roundworm is a parasitic disease transmitted by swallowing the eggs, something children can easily do when playing in sandboxes and then not washing their hands.

Thanks to laws requiring vaccination, rabies in cats is rare. But watch out for feral cats that may have come in contact with infected wildlife.

Toxoplasmosis may be the greatest concern.  It’s caused by a parasite found in soil, water, meat, or poop from an infected cat. Most commonly, people become infected when they do not wash their hands after cleaning a cat’s litterbox. There can be serious health consequences for people with weakened immune systems, including neurological disease. Pregnant women need to stay away from the litterbox and any other areas exposed to cat poop due to the risk of birth defects associated with toxoplasmosis.

With such a disparaging commentary on cats, we are certain to receive a ton of reader mail reminding us about dog attacks, dog-borne diseases, and other dog drama. But long-time readers will know that for us, there is no contest.

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Little Relief and High Costs for Back Pain

Common Sense Health – W. Gifford-Jones MD and Diana Gifford-Jones

A humorous greeting card reads, “Technically I’m still young, but due to my back pain, I’m actually 90.” Whatever the age, including 99, back pain can be agonizing. It’s a surprisingly common problem. 

A new study published by the Lancet Rheumatology Journal reports that 619 million people suffer from low back pain globally. That’s nearly 10 percent of the world’s population!

Why so many people? With higher numbers of people living longer, in part it’s the mathematics. The older one gets, the greater the risk. By 99 years of age, the probability of living with back pain is high.

In addition to aging, what else causes the trouble? It is no surprise that researchers found obesity high on the list. Their finding that smoking is another cause of back pain is more curious. It’s thought that damaged arteries in the spinal column and joints cause the pain. Smoking also contributes to osteoporosis, the bone-thinning disease that can lead to a rounded spine and back pain.

According to the study, back pain occurs more in women than men. The reasons range from the effects of pregnancy and hormone changes to higher rates of osteoporosis. By the demographic numbers, with substantially more older women than men in the world, there are more female sufferers.

What’s the economic effect? Back pain among the working age population means higher absenteeism from work, lower productivity among those at work, and early exits from employment, often with costly disability payments.

In the U.S., a 2016 study by the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine assessed the costs associated with 154 conditions. The Institute reported “low back and neck pain generated the highest expenditures at $134.5 billion. When combined with all other musculoskeletal disorders, such as joint and limb pain, osteoarthritis, and rheumatoid arthritis, the total exceeds $380 billion.” Think about that.

What about the other chronic conditions that get prominent headlines? According to the study, “other health conditions with substantial spending in 2016 were diabetes ($111.2 billion), ischemic heart disease ($89.3 billion), and falls ($87.4 billion).” What’s the key message? Back pain is a gargantuan financial problem for healthcare systems, public or private.

And watch out. With aging populations in most countries, fewer numbers of young people are being more heavily saddled to pay these costs.

It’s discouraging that after so much study, there are few signs of new treatments that relieve the pain or cure the problem. The long standard prescription for acute pain is bedrest, heat treatments, and painkillers. With time, the pain goes away. But for chronic pain, it’s not so easy.

X-Rays or MRI can help pinpoint the source of pain. Some people try acupuncture and get relief. Others have success with chiropractors.

Another option is a fluoroscopy procedure on the facet joints of the spine. It does not require a general anesthetic. A needle injection numbs the joint and during a fast 30-minute procedure a small instrument destroys targeted spinal nerves. It works for some, not for others.

When there’s no help to relieve the pain, what do you do? You search for your own ways to make life more comfortable.

People who know the challenges of living with chronic back pain don’t need an autopsy to find out why gravity is so brutal. What’s needed is a solution to the knowledge that this pain will be with them to their dying day.

A word to the young, from Socrates, the greatest thinker of ancient Greece, who said, “If you would seek health, look first to the spine.”Sign-up at to receive our weekly e-newsletter. For comments, Follow us on Instagram @docgiff and @diana_gifford_jones

Early Hormone Therapy Has Benefits

It was surprising news in the Canadian Medical Association Journal. There’s another about-turn among scientists studying hormone therapy (HT) as a treatment for symptoms of menopause. This time, researchers have produced findings that suggest benefits to healthy women who start HT early in the transition to menopause.

Women have long been perplexed by conflicting advice on hormone replacement, and this new study doesn’t offer universal guidance. The bottom line remains, HT is a complicated business, requiring patients and doctors to weigh many factors in deciding for or against.

Dr. Iliana Lega of the Women’s College Hospital and the University of Toronto has this to say, “Menopausal hormone therapy is the first line treatment of symptoms in the absence of contraindications.” That clarity may be overly simplified, and she adds that patients and doctors need to consider symptoms before and during menopause and to discuss treatments based on personal preferences and potential risk factors.

Those risk factors have been well publicized. Many studies have suggested leaning away from HT due to associated increased risk of breast cancer, stroke, and cardiovascular disease. But new findings offer important insights for younger women.

Previous studies have shown an increased risk of breast cancer in women taking HT. However, this new study reports the risk is much lower in people aged 50-59 years and in those who start HRT in the first 10 years of menopause.

Increased risk of ischemic stroke (blood clot) has been a concern for women older than 60 years who start HT 10 years after the start of menopause. But new findings suggest the risk is reduced for those younger than sixty.

Furthermore, data from the Women’s Health Initiative trial show a possible reduction in coronary artery disease with HT among younger menopausal patients, specifically those who start HT before 60 years of age or within 10 years of the start of menopause.

Be sure to discuss the issues with your surgeon if you are scheduled for a hysterectomy. Leaving ovaries in place can preserve natural estrogen function for a time. But removal of ovaries and use of HT eliminates any future risk of ovarian cancer. Of course, most saved ovaries do not develop a malignancy. So, sparing one or both ovaries in younger patients should be a matter for discussion.

There are other benefits of hormone therapy in the treatment of menopausal symptoms. Reducing the severity of hot flashes is the main one. Another is reduced fragility, with one large study involving over 25,000 women aged 50-79 showing that HT reduced the risk of any fracture by 28 percent, a major osteoporotic fracture by 40 percent, and a hip fracture by 34 percent. HT can also offer relief from mood swings, vaginal dryness, and joint pain.

The cognitive effects of HT are debated. Past research questioned the impact on risk for dementia. Other research found benefits including reduced “brain fog” and reduced risk of Alzheimer’s.

Dr. Pauline Maki is a specialist in menopause and cognition in the department of Psychiatry and Psychology at the University of Illinois at Chicago.  She notes, “Women who initiate hormone therapy before their final menstrual period show increased blood flow to the hippocampus and better verbal memory compared to nonusers.”

The message is that “timing is everything” in decisions around hormone therapy.

That’s not easy to action given menopause may begin up to 10 years before the last menstrual period and can last more than 10 years. For some women, the symptoms are intense. Others never know the menopause has come and gone.

So get informed guidance from your doctor and start the discussion early.

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Total Family Doctor Prevents Needless Surgery

How important is what I like to call the “Total Family Doctor” (TFD)? For years, I’ve praised the hardworking family doctor for the role he or she plays in medical care. Now, many North Americans say it’s impossible to find a family doctor.  What has happened to them?

Prior to becoming a surgeon, I had the good fortune to spend time as a family doctor. And I nearly decided to follow this path. Why? Because I also watched Specialists performing the same task every day. It could become boring, I thought. So, surgery finally won. But I’ve never forgotten the challenges of being a family physician. I even experienced the roles of hotel doctor and ship’s surgeon during medical training.

I believe that people who are fortunate enough to have a family doctor have a better chance of living longer. Why? Because seeing a doctor regularly for checkups means they’re not playing Russian Roulette with their health. We all hope that nothing is going to go wrong with the only body we will have in this life. But when your family doctor finds you have hypertension, you can start to cut down on salt. Or when the doctor recommends you should avoid obesity, you can improve the diet and decrease health risks.

Getting a head start on problems cannot be overemphasized. Consider the woman whose breast malignancy is diagnosed early. Or the man who believes rectal bleeding is due to hemorrhoids. The “total family doctor” thinks otherwise and orders a colonoscopy which detects early cancer of the bowel. Or someone who believes a chronic cough is due to allergy. But an x-ray ordered by the family doctor finds early cancer of the lungs.

 So give thanks to the Almighty if you have a “total family doctor” looking after you. Kudos if yours steers you away from the disease I call “Pillitis”, causing people to rush for painkillers at the first sign of a headache, ignoring the serious side effects of these drugs. Why not a cold towel on the brow? Or a quiet room to relax? And why the need to rush to the pharmacy after overindulgence in food? The family doctor may suggest just a change in eating habits as the right prescription.

It is also a plus to have a total family doctor who warns about the possible excess of radiation. He or she knows X-rays saves lives, but many patients are heedless of the damage of overuse. Patients should be hesitant to demand X-rays of the reluctant doctor.

Herewith relevant stories. Family doctors, because they know their patients well, are astute diagnosticians.  I’ve known many direct, decisive and empathetic TFDs. Patients appreciate these traits.

I witnessed a telling incident. Three specialists gathered around a patient were worried about his laboured breathing following gallbladder removal. They had decided the obstructed breathing was so serious it required an immediate tracheotomy to put a tube in his throat.

As they were about to wheel the patient into surgery, the family doctor arrived and listened to his long-time patient’s breathing. Promptly he said, “I’ve known Tom for 40 years and he always breathes that way!”  The operation was immediately cancelled. Three embarrassed specialists departed.  This illustrates why continuity of care is so vital.

There’s another way family doctors can be of tremendous help, when the problem is beyond the TFD’s range of expertise. A fast referral to the right specialist is something people without a family doctor rarely achieve.

Let’s train more TFD’s, the backbone of medical practice! In another life, I’d be one of them without hesitation.

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Make a stink for better public washrooms

When asked how to become a famous comedian, Steve Martin replied, “Be so good they can’t ignore you.” It’s true, bad performers can usually be ignored. But there’s no ignoring bad public washrooms.

Public washrooms have a reputation for abysmal filth, as evidenced by dirty toilets, overflowing trash, empty or broken soap dispensers, sloppy countertops, and door handles not to be touched.

An American survey found that 21 percent of respondents used a public washroom at least six times a week, sometimes over 15 times! The reason was not always obvious.

Youth tend to visit washrooms to use their phones, change their clothes, or “get away”.  In fact, 21 percent of youth acknowledge the use of public washrooms to take a mental health break, to avoid someone, and on occasion to cry.

Older people, in addition to using the facilities, also visit public washrooms to check their appearance.

Whatever the reason to visit, how important is it to take precautions? The good news is that some of the germs found in public washrooms are no different than the germs found in many other places, including the bathroom at home.

Take Staphylococcus aureus for example. It will be found in dirty public washrooms. But it is also commonly carried around by 20-30 percent of people on their skin or in the respiratory system. It is an opportunistic pathogen, meaning it starts to cause trouble not when commonly encountered in the washroom but when the immune system is weakened or when the natural balance of bacteria in the gut is altered.

Authorities disagree on how long certain other nasty germs survive or how readily they cause infection. But many bathroom studies have shown remarkable staying power – up to 8 days for E. coli. According to the Centers for Disease Control and Prevention, the flu can survive on some surfaces for 48 hours.

Washing hands after using public facilities is a no brainer. Yet a study published in Antimicrobial Resistance & Infection Control found that handwashing and hand-drying equipment in public washrooms are facilitating infections due to contaminated sink handles and paper towel dispensers. Plus people don’t wash their hands with soapy water for 20 seconds or more.

Even with the best of efforts, some researchers have noted that “adequate hand hygiene may not always be achievable when using public washrooms.” That’s because the door handle used to leave the washroom is covered in germs.

Opting out of using a public bathroom and resorting to “holding behaviour” is not advisable. “Always go to the bathroom when you have a chance,” goes the sage advice of King George V. Royalty have their own reasons. But among common folk, holding urine in the bladder can invite bacteria in the urine to multiply and cause the development of urinary track infections.

When you’ve got to go, you’ve got to go.

But there’s worse news to report. A study published in 2020 in Physics of Fluids described a phenomenon known as “toilet turbulence.” It’s an alarming and repulsive discovery to learn that flushing a toilet can send small droplets of water and aerosols containing fecal germs three feet into the air above the seat!

One public health message advises users to turn away from the toilet when flushing. Good lord! There’s a reason for a toilet seat lid. Put it down before you flush.

Making a stink about public washrooms that are poorly designed and infrequently cleaned is probably the best course of action. Afterall, what restaurant or community venue wants to be associated with disgusting washrooms?

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Are Canadians Better at Preventing Lyme Disease?

It’s tick season and the little pests are out with a vengeance. Tiny as they are, ticks are a huge nuisance and a hazardous vector of disease. Their ability to latch onto unsuspecting hosts has made them one of the most successful blood-sucking parasites on the planet.

Ticks are the primary carriers of Lyme disease, infecting people with their bite. But do ticks or people account for the sizable difference in the number of reported cases in the US and Canada? Every year, in the United States, about half a million people are diagnosed with Lyme disease. Based on population, all other things equal, one would expect about 50,000 cases annually in Canada. Other things, however, must not be equal. Because according to the Public Health Agency of Canada, only 3,147 cases were reported in Canada in 2021, up from 144 in 2009.

Is geography behind this huge difference? Ticks that transmit Lyme are found in most parts of the US and have expanded into the areas of Canada where most people live over the past two decades.

Challenges with diagnosis of Lyme disease might help explain the gap. When diagnosed early, a course of antibiotics is an effective treatment. If untreated, the bacteria causing infection can linger in the body for months or years before presenting symptoms ranging, for example, from short-term fevers, rashes, and fatigue to more devastating conditions.

An attack on the central nervous system could be one manifestation. This can cause numbness, pain, stiff neck, headache, and many other symptoms, including psychiatric problems.

Another concern is the cardiovascular system, where Lyme disease can disrupt electrical signals that coordinate heart beats.

Painful swelling of joints is a common feature.

Celebrities have shared their experience with long lists of problems. Among them are musicians Avril Lavigne, Shania Twain, and Darryl Hall, actors Alec Baldwin and Ben Stiller, writer Amy Tan, and even President George W. Bush.

How can these stars, and even a president, fall victim? Ticks are stealthy. They can bite people and feed for a day or more before dropping off undetected.

Tick saliva is amazing stuff, containing antimicrobials, analgesics, blood thinners, and immune suppressors in cocktails that change according to the situation. It’s this saliva that enables ticks to bite and feast without notice. What’s more, unlike female ticks which become engorged, male ticks don’t eat such a big meal, making them very hard to notice.

Take a walk outdoors when good weather beckons but know how to avoid trouble. Ticks can’t jump to catch a ride. They “quest” by perching on the tips of grasses, leaves, and branches, then use their forward legs to grab hold when a host brushes up. So stay out of long grasses in areas home to deer, rabbits and field mice. Be wary of other places where ticks might catch a human host. For instance, ticks are commonly found in grasses, bushes and treed areas of golf courses. Any pet dog stepping into long grass or jumping in and out of ditches could pick up ticks, then bring them in the home where close contact with owners can easily occur.

Why do Canadians record so few cases of Lyme disease as compared to Americans? Lack of awareness of the disease among healthcare providers and low sensitivity of diagnostic tests are part of the answer. Additionally, one study found that Canadians tend to seek medical care less frequently for tick bites and are less likely to be tested for Lyme disease, leading to a 40% lower detection rate.

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Fish Oil: Superhero of Supplements

You may be forgiven if you are unfamiliar with Aquaman, a superhero who breathes underwater, communicates with sea creatures, and possesses superhuman strength and agility. But revisit past columns if you haven’t learned that fish are the real superheroes. Why? Because when mere mortals consume fish, their bodies gain extraordinary powers to fight the arch-nemesis of illness.

Studies have repeatedly shown that the omega-3 fatty acids found in fish oil have remarkable health benefits, including reducing the risk of heart disease, improving cognitive function, and reducing inflammation throughout the body.

To gain these benefits, eating enough fatty fish, like salmon and mackerel, isn’t easy, especially with high food prices. For a fraction of the cost, fish oil supplements are a no-brainer.

What’s preventing some people from taking this superhero of supplements?

Some people suffer from “fish burps”. It’s what happens when your digestive system lets out a little aquatic airfare, and a pungent reminder of your fish oil supplement.

The prevalence of burping or other gastrointestinal side effects when taking omega-3 fish oil supplements can vary depending on the individual. Some studies report that 30% of individuals may experience gastrointestinal symptoms such as burping, heartburn, or diarrhea. Most people experience no effects at all.

Why do people burp from fish oil? The main reason is that fish oil is a rich source of omega-3 fatty acids, which can be difficult for the body to digest, leading to the release of gas, which causes burping.

For those who are affected by burping, taking fish oil supplements can be a real problem. Not only is the burping unpleasant and embarrassing, but it can dissuade people from taking fish oil altogether, leaving them without the health benefits.

The likelihood of experiencing burping or other gastrointestinal side effects may also depend on the dose and formulation of the supplement being used.

And that’s where there is a good solution to the burping problem. Look for a fish oil supplement that offers a form more readily accepted by the stomach. One example to be found at health food stores is Certified Naturals Omega3X fish oil containing MaxSimil, which is pre-digested with enzymes, leading to better absorption and making it much less likely to cause burps.

To explain, omega-3 fatty acids are a type of polyunsaturated fat that are often found in the form of triglycerides. Triglycerides are the main form of fat in the human body and in the food we eat. They consist of a glycerol molecule and three fatty acids. In consuming omega-3 fatty acids, the role of the digestive system is to capture them for use as energy.

But our bodies contain a lot of water, and these oily triglycerides therefore can pass right through the body’s digestive system and out the other end, all benefits missed. The purpose of using enzymes is to convert the fats from a triglyceride to a monoglyceride. Monoglycerides are the form of fat that our body must convert fish oils into, so having it pre-digested into a monoglyceride makes it easier for our system to absorb, and thus less burping.  

In another approach to reduce burping, some supplements involve gelcaps that are enteric-coated for delayed release, but these can contain undesirable plasticizers.

For some, no matter how good the supplement, burping can remain a problem. Try refrigerating the capsules and taking them with food. Remember, accepting a little burp is better than forgoing the benefits.

If persistent or severe burping persists, talk to your healthcare provider, as these symptoms may indicate an underlying health condition or allergy.

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