Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, May 24, 2017

Consumer Caution Advised in Energy Drinks

"The energy drink industry claims that their products are safe because they have no more caffeine than a premium coffee-house coffee."
"However, energy drinks also contain a proprietary 'energy blend', which typically consists of stimulants and other additives. Some of these ingredients [including taurine and guarana] have not been FDA-approved as safe in the food supply, and few studies have tested the effects of caffeine consumption together with these 'novelty' ingredients."
"On top of that, energy drinks are highly marketed to adolescent boys in ways that encourage risky behaviour, including rapid and excessive consumption. As a result, emergency room visits by young people in connection with energy drinks are rising."
Dr. Jennifer L. Harris, Rudd Center for Food Policy and Obesity, University of Connecticut
The multiple ingredients in different brands of energy drinks need more scrutiny, researchers say.
The multiple ingredients in different brands of energy drinks need more scrutiny, researchers say. (Canadian Press)


Over 500 energy drink products are now on the market; their popularity is manifest by the extent of their sales, and in lock-step with their popularity is the allied phenomenon of increasing visits to hospital emergency centres, and even deaths attributed to their consumption. A 32-ounce container of an energy drink is now being linked with potentially harmful blood pressure and heart function changes beyond alarming and owing not only to the caffeine in those drinks but other key ingredients present in them.

Consumers like energy drinks. And people who convince themselves that anything that is freely available on the market and that suits their lifestyle cannot be a threat to their health, simply will not believe that these drinks indeed can very well pose a threat best avoided. The manufacturers of the energy drinks, after all, attest to their perfect safety, in itself persuading consumers there is no threat to their health in their consumption. But the growing body of evidence appears to firmly point in the opposite direction.

Caffeine up to 400 mg, reflected in the consumption of up to five cups of coffee is considered to be a safe daily dose by the U.S. Food and Drug Administration. Energy drinks mostly contain caffeine, and plenty of it, but it is the other ingredients in those drinks about which the level of safety is largely unknown, concluded a study team whose results were published in the Journal of the American Heart Association.

A research team led by Sachin A. Shah of David Grant Medical Center on Travis Air Force Base along with the University of the Pacific in Stockton, California, set out to compare physical alterations resulting in a group of 18 healthy men and women after they had consumed an energy drink and after another drink with a similar dose of caffeine, lacking any other ingredients had alternately been consumed.

The energy drink given the test subjects contained four ounces of sugar, several B vitamins, and a proprietary 'energy blend' of taurine and other ingredients most often linked to drinks like Monster Energy, Red Bull, and 5-hour Energy. And that energy drink also contained the obligatory 320 mg of caffeine, analogous to what would be contained in four cups of coffee. Alternately another drink was given the participants which held only the 320 mg of caffeine, nothing additional.

The research team then measured the study participants' blood pressure along with measuring heart electrical activity for 24 hours following the consumption of the drinks. Using an electrocardiogram (EKG) for the heart measurement activity, it was discovered that a change identified as QTc prolongation, a condition associated with life-threatening irregularities in the heartbeat, was present post-energy drink consumption, but not after consuming the caffeine beverage.

Blood pressure was seen to increase by about five points after the energy drink was consumed, and in comparison less than a one point increase was noted after the test subjects drank the beverage containing caffeine only. In addition, blood pressure remained in that elevated state for the following six hours. The study points out that healthy individuals are not threatened by these changes, but people with particular heart conditions would do well to exercise caution with these energy drinks.

hi-energy-drinks-teen-852-c
Just as adolescents are taught to drink alcohol responsibly, they could receive a similar message about energy drinks, pediatricians say. (Jack Dempsey/Associated Press)

"The energy drink amount tested by the U.S. researchers in this study was equal to twice the amount that is permitted to be labelled in Canada for maximum recommended servings per day."
"Health Canada's recommended maximum amounts are based on all of the ingredients of energy drinks, not just the caffeine."
Canadian Beverage Association

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Tuesday, May 23, 2017

Preventing Cancer

"To see Sandra age and then quickly lose her cognitive ability, her speech, her memory, her ability to walk and care for herself ... It was all gone very quickly."
"To me, it's ass-backwards. You have all these millions of dollars of cancer treatment stuff, and then you have a dinky little cupboard [tiny, understaffed office], basically, for [cancer] prevention."
Alan Huggett, Prince George, British Columbia

"It's why the cancer problem is as big today as it was when [President] Nixon declared the war on cancer."
"We haven't won that war because we have been fighting on the wrong front, or at least we haven't been fighting on the front where we could have a major impact."
"Curing cancer gets votes. There are no grateful people saying, 'Thank you for preventing my bladder cancer'."
Jack Siemiatycki, cancer epidemiologist, University of Montreal
Sandra Huggett
Sandra Huggett and her daughter Lia in 2014: Photo provided by Alan Huggett

Mr. Huggett of Prince George, B.C. is mourning his wife, stricken with lung cancer, diagnosed at stage-four at a point where the malignancy had already spread to her kidneys and bones. A year after her diagnosis the cancer had invaded her brain and she was in palliative care. She lingered for another few months and died before her 56th birthday, leaving behind her husband and their two young daughters. Sandra Huggett had never been a smoker.

After her shocking diagnosis a test for radon was conducted on their family house. That test revealed that she had been exposed to radon gas, a colourless, odourless gas found naturally throughout Canada. Her home was revealed to have three and a half times the level of radon considered to be safe. Radon, though considered to be the second greatest cause of lung cancer after tobacco, is not on most people's radar; most have never heard of it, have no idea what its exposure can cause.

And its presence and what it can cause is considered to be an avoidable source of cancer. Sandra Huggett's husband Alan and their daughters Lia and Kimberly still live in the family home in Prince George. But it no longer presents a dire health threat. The presence of radon has been for all practical purposes eliminated, and at a fairly modest cost. Retrofits that ensured the radon could no longer penetrate the house and affect the lungs of the remaining three of the Huggett family cost less than $1,500.

Research into cancer and treatments for cancer is a multi-billion dollar industry. Yet work hindering the disease from invading vulnerable humans to begin with appears to be treated as a casual afterthought, with barely five percent of the total expenditure on research and treatment going toward prevention.  According to a 2015 federal survey less than three percent of homes have been tested for the presence of the deadly gas.

As well, according to Dr. Siemiatycki, holder of the Guzzo Cancer Research Society chair in environment and cancer, Canadian scientists researching the causes of cancer have dwindled to half of their number involved in that work in 1985. Dr. Siemiatycki points out that the Canadian Institute for Health Research, the major federal medical-science body providing funding, is complacent over providing one to two percent of its cancer budget to prevention.

One day, he believes, scientists will have succeeded in identifying preventable risk factors for all cancers, once the tide turns and sufficient resources are allocated to ensure that outcome. Some experts feel that 40 to 50 percent of malignant cancers are now avoidable, as the result of lifestyle or environmental influence, ranging from sun exposure to obesity.
cancer cell
Dr. Siemiatycki feels that most cancers in all likelihood have both a non-preventable, genetic aspect along with an aspect relating to the individual's behaviour or environmental exposure. Tobacco, recognized as the most powerful carcinogen, relates to behaviour as well as exposure. Yet roughly ten percent of heavy smokers will end up with lung cancer, pointing to a hard-wired genetic propensity for acquiring cancer, working alongside the habit of exposure.

But science must repeatedly prove the theories that arise to convince doubters. In 2015 the journal Science published a paper written by Cristian Tomasetti and Bert Vogelstein, two Johns Hopkins University researchers who hypothesized that the lung is 11 times likelier than the brain to be affected by cancer, related to the frequency at which stem cells divide, leading to resulting DNA mutations. Their conclusion was that a random process is involved relating to the development of tumours adduced to stem-cell divisions.

Two thirds of cancer risks, according to these two researchers, can be attributed to "bad luck". Dr. Tomasetti, a bio-statistician, recommends a sharper focus on early detection to allow patients diagnosed with cancer an enhanced opportunity for survival. Inherited, environmental and random triggers represent the trifecta he and his research partner identified in their study. "This really is a paradigm shift and it has strong implications for research direction", he said.

The wholesale plummeting of smoking rates from the 1960s forward has saved 800,000 lives in the United States alone on an annual basis, accounting for most of the drop in  cancer mortality, according to a 2012 U.S. study. A new study involving 300,000 Canadians is currently underway where subjects are to be closely followed over time, with blood tests and questionnaires, in an effort to obtain data on why some people contract cancer and others don't.

Estimates by Cancer Research U.K. suggest that societal obesity reduction has the potential of preventing up to 187,000 cancer cases a year in Britain; that eating more fruit and vegetables would reduce cancer numbers by 15,000 annually; consuming less alcohol 13,000 fewer cancer cases; and more conscientious sun protection would result in 11,000 fewer cases yearly of skin cancers.

Cancer prevention

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Monday, May 22, 2017

Statistical Bias and Perceptions on Religious Devotion

"Caring for others versus personal fulfillment, those are two very different value constructs. And the relationship between them and religiosity is really significant."
"What this survey proves is that having a faith, being part of a faith community, seems to propel people in the direction of developing higher levels of compassion or caring."
"I find it noteworthy that we have significant divisions in this country on some moral issues, and those divisions seem to be heavily correlated with religious belief and membership in faith communities."
"We like to sometimes paint ourselves as this country where, unlike the United States, which has deep value differences, we are all sort of linked arm-to-arm on all issues. Actually, that's not true."
Angus Reid, founder/chairman, Angus Reid Institute

"On the one hand, in contrast to the prevalent public narrative that religion is private and it doesn't mater, it's quite clear that for the vast majority of Canadians, it does. Over half say, 'Religion is actually shaping my identity and my decisions'."
"On the other hand, that engagement is a relatively thin engagement."
Ray Pennings, executive vice-president, Christian think-tank Cardus
While some Canadians might not attend religious institutions like church regularly, many of them have religious views and personal faith.
While some Canadians might not attend religious institutions like church regularly, many of them have religious views and personal faith. (Chris Corday/CBC) 
 
On Mr. Reid's part, the recent survey his firm conducted allied with Faith in Canada 150, appears to validate for him a foregone conclusion -- that religious faith makes us better people, more aware of the needs of others, willing to inconvenience ourselves for the sake of aiding others, and being more receptive to the need to be charitable and generous and caring. On Mr. Penning's part, that validation has a bitter core; that not enough members of the broader public have committed to religious adherence and those that have do so in a tepid manner. Religion or not people who live fulfilled lives themselves tend to be more generous with others; it's called simple human decency.



This project took a year to gauge the beliefs of Canadians who took part in the poll to arrive at a consensus on their religious practices. People responding to the questions were divided into four distinct categories identifying them  as a) non-believers on to b) religiously committed devotees regularly attending places of worship. Responding to the choice of two alternatives representing their idea of "the best way to live life", 53 percent chose "achieving our own dreams and happiness" rather than "being concerned about helping others".

When religion was brought into the equation, it was found that 67 percent of those committed to religion chose helping others, while 65 percent of non-believers selected the personal pursuit of happiness. Something seems to be missing here, and that is the common-sense understanding that people who are happy and satisfied are more likely and able to extend themselves to helping others, while those who are miserable are usually so caught up in their situation they are  most often incapable of giving aid to others.

Across different regions of Canada the question elicited different responses, with the Province of Quebec scoring the highest proportion of people selecting for self-fulfillment at 65 percent, while Alberta was second at 54 percent and British Columbia came next at 43 percent. Elsewhere in Canada, a majority of respondents selected giving aid to others; Saskatchewan proving the most generous at 59 percent.

Oddly enough, Quebecers were traditionally the most bound to Catholicism before undergoing a sweeping change where the Catholic Church stepped back during the Quiet Revolution as formerly devout parishioners rebelled against the stranglehold on life of the Church. And Quebec is the province whose administration is the most broadly social-welfare inclined, so Quebecers are accustomed to having things done for them, not to doing for others. Religious devotion still plays a private, not a public role in the province, despite which Quebecers are parsimonious when it comes to funding charities.



A total of 2,006 Canadian adults took part in the survey and responded to a series of questions with clear moral overtones. Pollsters concluded that the two groups representing the religious spectrum, both privately faithful and religiously committed were likelier to agree that:
  • Canada should accept fewer immigrants and refugees;
  • They would be uncomfortable if a child planned to marry someone from a different cultural or religious background;
  • There should not be a greater social acceptance of people who are LGBTQ (lesbian, gay, bisexual, transgender, queer);
  • Preserving life is more important than people's freedom to choose on issues like abortion and doctor-assisted death;
Which hardly shines a socially g enerous light on religious adherents; rather their socially conservative attitude bespeaks issues of intolerance and a lack of openly generous impulse. Another question was where the poll led participants to select the statement they felt reflected their personal views:
  • People are fundamentally sinners and in need of salvation; or
  • People are essentially good and sin has been invented to control people.
The essential goodness of people was selected by two thirds of those pooled while the religiously committed, providing roughly one-fifth of the survey group, felt by 73 percent that people are fundamentally sinners. The concept of right and wrong in absolute terms or a vacillating conception was posed as well with a large majority of 68 percent finding that right or wrong "depends on the circumstances", while close to 66 percent outright rejected that moral questions' outcome differ for different cultures.



Religiously committed were the most likely to claim universal rights apply to the entire human race, at 74 percent. And they represented people stating their faith to be of primary importance to their personal identity at 54 percent, and to their day-to-day lives at 55 percent. Of course religion, as does culture and heritage, shapes an individual's values and colours the way others are viewed; human beings are programmed by nature to cleave to those who share like commitments and values. Which should not deter them from viewing those outside their groups as worthy, but that too reflects basic human nature.




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Sunday, May 21, 2017

Living With Cancer

"If you're surrounded by people who are telling you, 'you've got to fight', you think, 'How about I rest today and fight tomorrow? How about, 'I'm scared and I don't want to battle'?"
"And some people talk about just feeling ready to let go. They've battled it for too long. But that's unacceptable. That's seen as failure. That's seen as losing."
"I always get these looks, deep in my eyes -- 'how are  you doing'?"
"It's the people who get kind of stuck there, and I find that difficult. ...I'm not there any more, and I guess that's part of the chronic thing. People who have had cancer for a long time, I'm sure they don't want to live as if their identity is, 'I'm a cancer person'."
United Church Minister David Giuliano, 20-year cancer patient

"Who wants to go to war with themselves? How is it ever helpful to think of oneself as a victim who was randomly attacked and now you're trying to kill your assailant in order to survive?"
"Some cancer patients may perceive themselves as a soldier going to war. But surely not all do."
Radiation oncologist Edward Halperin, New York Medical College

"Battle language is everywhere in my profession. [The message conveyed is] that there's a choice to fight or give up."
Dr. Seema Marwaha, internal medicine specialist, Toronto

"But cancer isn't an enemy -- it doesn't have an ideology, it doesn't have a political agenda."
"It comes from within us; it's part of the history of humanity. We rarely cure cancer unless we can cut it out. But things like long-term remission and disease control -- these are the goals."
"We're getting better at controlling cancer for longer periods of time."
Dr. James Downar, critical care and palliative care physician, University Health Network, Toronto 

"There are periods where the cancer needs treatment and periods where no treatment is given."
"Part of the challenge also is doing enough, doing sufficient visits and scans so that you have a good handle on what's happening so that you can adjust and adapt and intervene, but not overburden somebody with scans."
"This is all quite new, this whole notion of kind of being in-between [treatments]. It's a bit of a limbo state, sometimes."
Dr. Jonathan Sussman, radiation oncologist, McMaster University
cancer cell
At the present time, an estimated 800,000 cancer "survivors" exist in Canada, some living with cancers which never quite recede on a permanent basis, like lymphomas of a certain type, leukemia, and sometimes invasive beast cancers. This is cancer hovering, always in the background, seeming to recede, then returning years later. Low-grade lymphomas, for example, cancers of the lymphatic system, are among those which arrive, depart, return.

At one time melanomas were always lethal when they spread, having an average survival rate of a year, two years. At the present time, immunotherapies succeed in placing a robust proportion of patients with metastatic melanoma in a state that is controlled "where the thing is quiet, it's not really advancing", explained Dr. Sussman. But cancer is not an invited and a valued guest, and when it does decide to invade, the psychological burden is a heavy one when people are plagued by fears of a returning or progressing cancer.

The language of cancer, the nomenclature used, is an understandable one; after all this dread disease has decided to invade someone's body, threatening anguish, pain and death. And when people are constantly encouraged to put a positive spin on their fears  of what that cancer is doing to them, by 'fighting' it, an insidious state of mind can creep into the situation, where patients accede to brutal treatments or "maximum tolerated doses" of chemotherapy, despite the hope of survival being so dim.

If patients become so committed to 'fighting' when it's long past time to struggle with the disease, that they refuse palliative care to ease symptoms and alleviate the mind which in and of itself is capable of slightly prolonging life, the demand for aggressive treatment among others whose type of cancer would in all probability never threaten their existence, but leaves them subjected to pain and trauma represents two polarized states and outcomes, both linked to 'fighting' and 'defeating' cancer.

People who are encouraged to 'fight' and to remain 'positive' are likelier to succumb to emotional distress while putting on that proverbial brave face. Over one thousand Canadian women with breast cancer, part of a research program out of the University of Manitoba, revealed that those who considered their disease in 'enemy' terms and 'punishment' suffered higher levels of depression and anxiety three years later.

According to some experts the future holds out the promise that it may be possible to conceptualize a time when cancer, Ike controlled diabetes or HIV, becomes a chronic, manageable disease. Some medical scientists feel that if total destruction of cancer remains elusive, an alternative arises where tumour cells are contained, when it becomes possible to "box-in tumour cells with a discrete-focused strategy of containment."

Meanwhile, the drive to destroy cancer cells unremittingly leads, according to those experts, to survival of the fittest in the sense that the "moderate" cells, sensitive to chemotherapy are destroyed at the same time that the "extremist" cells are left intact, preparing to morph into even more deadly tumours. Whereas a middle ground between "appeasement and Armagedden is containment".

Survival of at least five years after diagnosis represents the reality for about 60 percent of cancer patients overall. That, in comparison to the 1950s, when fewer than 25 percent of cancer patients would survive their bout with cancer. As for most women going through breast cancer diagnosis and treatment, "the breast cancer is not going to be their length-of-life-defining illness", Dr. Sussman emphasizes.

Cancer

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Friday, May 19, 2017

A Living Surgical Nightmare

"Someone was inside me, ripping ripping me apart."
"It was excruciating. It was burning and burning and burning."
Lynn Hillis, 54, Cancer patient, Toronto

"She described trying to move, open her eyes and scream but being unable to get the attention of the doctors."
Judge Kendra Coats, Toronto

"The impact was just profound. It started with the nightmares."
"It's been nine years [since her own 'awakening' during surgery] and I still have nightmares. I still wake up screaming."
Donna Penner, Winnipeg, former surgical patient
In the first ruling of its kind in Canada, a judge says an anesthetist was at fault for a Toronto woman's nightmare experience of waking up in the midst of surgery.
SunMedia    In the first ruling of its kind in Canada, a judge says an anesthetist was at fault for a Toronto woman's nightmare experience of waking up in the midst of surgery
 
Surgeons and anesthesiologists are increasingly aware that on occasion a patient under sedation in preparation for surgery can 'awaken' and be entirely aware of what is happening as an operation proceeds. Because of anesthetic immobilizing them physically and breathing tubes inserted through their mouths since the autonomic breathing is interfered with when anesthetic is infused into a human body, the newly-awakened patient, while aware of what is transpiring and feeling horrible pain, cannot communicate with the surgeons. It is only after the surgery that the surgical patients can describe the horrors they experienced.
 
New research appears to have concluded that this 'awakening' phenomenon almost exclusively impacts on morbidly obese patients resulting from the difficulties anesthesiologists experience in calculating how much anesthetic to administer; just enough to keep them sedated; not too much so that there is danger blood flow may be restricted to the heart and brain. Most anesthesiologists end up calculating the amount of anesthetic required by body weight, and with obese patients those calculations tend to discount body fat, just weight minus the fat out of concern of administering too much.
 
In Lynn Hillis's experience the accidental surgical 'awareness' left her vulnerable to physical helplessness, and being forced to be aware of everything taking place during her surgery, including the incalculable pain she experienced. Suddenly, halfway through her operation resulting from her diagnosis of endometrial cancer where laparoscopic surgery to remove her uterus, ovaries and fallopian tubes was taking place at Toronto General Hospital, she awoke.
 
What she experienced during that 2008 operation forever changed her life; she was diagnosed with severe trauma; post-traumatic stress disorder. Her experience of being frozen by paralytic drugs leaving her unable to communicate with the surgeons focusing on her surgery was the stuff of nightmares. And it is calculated that roughly one thousand patients annually in Canada undergo some version of being 'awake' during surgery when anesthetic fails; sometimes fleetingly, sometimes throughout the surgery.

While waking during surgery is not common, professor of anesthesiology Dr. Eric Jacobsohn says it needs to be taken seriously.
While waking during surgery is not common, professor of anesthesiology Dr. Eric Jacobsohn says it needs to be taken seriously. (Jean-Sebastien EvrardAFP/Getty Images)

Ms. Hills decided to sue the two anesthetists who took part in her surgery; one a staff doctor who handed over her care halfway through the surgery to a "fellow"; an advanced trainee, present for the entire surgical procedure. Ms. Hillis was able to recount the entire proceedings of the surgery, including what the surgeons transmitted to one another as they spoke and how the surgery proceeded. And while the doctors' lawyers insisted that anesthetic was properly administered, the judge hearing the case concluded that Dr. Reza Ghaffai had erred in failing to increase the intravenous Propofol sufficiently.

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Thursday, May 18, 2017

Goldilocks: Not Too Much, Not Too Little: Just Right

"Using the lean body weight formula [in sedating a patient for surgery through the application of anesthetic] probably isn't the best method to dose your propofol in the morbidly obese patient, because it results in under-dosing."
Dr. Jean Wong, anesthesiologist, Toronto Western Hospital

"I have been practising for over 25 years -- so over 25,000 anesthetics -- and so far have not had one patient mention awareness as a problem."
"Having said that, obesity is becoming more common and more severe all the time. No one really knows how to adjust the doses of drugs for large patients."
"The problem affects all drugs. Are bacterial infections adequately treated if obese patients are given too little antibiotic? Do obese people die of heart attacks if they are given too much or too little of various medications?"
"No one knows."
Dr. John Friesen, anesthesiologist, University of Manitoba
The rue dose of propofol required is certainly higher than the lean body weight but a littler lower than total body weight
The right dose of propofol required is certainly higher than the lean body weight but a littler lower than total body weight: Carl de Souza/AFP/Getty Images  

Now, it seems, the obese have yet another health impact to worry about: during surgery, the application of anesthetic insufficient to take into account their morbid body weight having the potential to lean toward their 'waking up' at a most inconvenient time throughout the surgical process when in theory and in practise, they are imagined to be fully sedated, unaware of what is happening to them.

One woman's experience was narrated as part of a large audit of "accidental awareness during general anesthesia" published in a British review that discovered a disproportionate number of people had reported their unfortunate experience with the terrifying phenomenon -- all of whom were obese patients. And now, a new Canadian study published in the Canadian Journal of Anesthesia for which Toronto Western Hospital's Dr. Wong was the senior author, has identified a failing in the standard formula calculating the amount of anesthetic required to induce unconsciousness in surgical patients.

Even while there is an ever-growing demographic of people with morbid obesity, defined as a BMI of 40 or more, anesthesiologists base induction doses of the most commonly used anesthetic, propofol on lean body weigh represented by an obese individual's body weight, subtracting the fat quotient. There is a reason for that; caution. Due to the fear that by using total body weight to calculate the amount of propofol needed could lead to overdosing the extremely obese. Serious complications can ensue with such an overdose; a rapid drop in blood pressure, decreased blood flow to the heart and brain.

Dr. Wong's study found that the use of lean body weight for calculating doses in the morbidly obese results in an "insufficient" depth of anesthesia in 60 percent of the cases studied. That lack of depth leads to accidental awareness because of the failure to deliver enough anesthetic to the body. Researchers randomly assigned sixty patients undergoing bariatric (stomach-shrinking surgery) to one of two groups.

The first group had doctors dosing propofol using the lean body weight calculation. For the second group doctors used a unique device known as a bispectral index monitor (BIS) to measure brain activity which determines how the anesthetic has succeeded in sedating the patient. The monitor uses he information to translate to a number from 100 (person is wide-awake) to zero (no brain electrical activity). Once the number dropped to 50, the propofol infusion  was stopped.


Eighteen out of thirty people remained "responsive" after the initial propofol dose, requiring additional infusion before a sufficient level of sedation was achieved. In the group monitored by the bispectral index monitor of the brain on the other hand only one patient remained "responsive" when the target of BIS 50 was reached. Propofol is highly fat soluble making it more difficult to reach sufficient levels in specific target receptors in the brain to properly sedate people entering surgery.

Numerous reports of obese patients reporting "falling asleep", then waking while a breathing tube was being inserted, or alternately at the beginning of the surgery, were documented in the largest prospective study on accidental awareness by Dr. Jaideep Pandit, consultant anesthetist at Oxford University Hospitals. Dr. Pandit felt the results of this new study demonstrates "that the true dose of propofol required is certainly higher than LBW (lean body weight) but a little lower than TBW (total body weight)."

And then, there is this: most frequently people of "normal" weight exclusively take part in drug trials.

Oxygen mask
Thinkstock

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Wednesday, May 17, 2017

Coping With The Financial Fallout of Cancer

"It's a huge issue [loss of income and costs related to cancer care]. For middle-class Canadians and working-class Canadians a cancer diagnosis is like standing on thin ice, and you only hope you can get back to work and cover your bills before you go under."
"Those [government] benefits just expire too soon for a lot of people."
Gabriel Miller, Canadian Cancer Society

"It's something I'm not proud of [filing for personal bankruptcy], something I never thought I'd do. I've always been a proud, stand-up individual. But I had no alternative ..."
"You're not bringing in income, bills are mounting, [creditors] are not compassionate and understanding. They want their money."
Lawrence, (last name withheld),Toronto real estate agent, 56

"The thing that keeps me up at night is, if I do need a drug or some treatment of some sort, will we have the funds to cover it?"
"And if we have to sell our house, is that even a reasonable thing to do? Probably, I would just go quietly."
Deb Maskens, advanced kidney cancer patient, Guelph, Ontario

"People will deal with different stresses, they will have financial stress or problems with health."
"When you throw everything together all at once, there comes a point where you say 'I just can't do it any more'."
"You need to be able to breathe."
Monica Pope, 51, breast cancer patient
cancer cell
In Canada, a growing body of research, along with interviews with patients, point to the fact that despite universal health care coverage for everyone, a diagnosis of cancer has an enormous drag on anyone's future. Going beyond the dread diagnosis and the accompanying psychological stress and physical pain of surgery and treatment, there is the looming threat of financial insolvency caused by the inevitable prolonged income loss and costs related to cancer treatment.

Drugs required on an ongoing basis, not administered in a hospital, are paid for by the patient. If there are expenses related to travel on top of the drug costs the end result is a devastating financial burden at the very time when fear rules while the cancer is being treated and the final outcome remains unknown. An estimated one in six bankruptcies are caused by the fall-out of health problems, and many of them relate to cancer.

If there are economic options that come into play they are the draining of savings for retirement for example, the re-mortgaging of homes, and the base alternative of going on welfare. Undergoing cancer drug treatment at home, not in hospital, means it is patients who personally must pay the cost of expensive medications in some provinces. Once the fear of a dramatically shortened lifespan reflected reality, now however, patients live longer post-treatment and federal and provincial income support programs prove inadequate.

Some people have disability insurance that they rely upon to help them with their growing health-related expenses while there is a hiatus from their work, yet some insurance companies if they can prove a pre-existing condition is involved, refuse to honour the policy. Even though in Canada oncology treatment comes without a personal charge under the universal health care system, all other costs associated with treatment are at the patient's expense.

According to a 2002 survey by the Canadian Partnership Against Cancer, two of every five people diagnosed with cancer go off their work schedules for a minimum of six months while receiving treatment. The diagnosis of  cancer and its after-effects impact on caregivers, some 60 percent of whom must cut work hours or leave their employment, according to a Lung Cancer Canada Survey. Canadian patients' families experience incomes plummeting by 26 percent according to a 2010 McMaster University study.

While some employees in Canada have access to workplace disability benefits, an estimated seven million Canadians have none. Those who qualify can count on Employment Insurance kicking in, but sickness benefits last for fifteen weeks at most, providing 55% of normal salary. As for the Canada Pension Plan, cancer patients run into problems qualifying for disability benefits to people under 65 under CPP which kicks in at a rate of $1,300 monthly. And welfare provides less than that figure, as an alternative.

According to Ilene Shiller, a manager at Wellspring, a Toronto-based cancer charity, some people are so "shocked" at the prospect of their income falling so dramatically they delay treatment so they can remain at work longer. Quebec, Alberta and British Columbia pay for all cancer medications, Ontario and the Atlantic provinces provide less coverage for home medications typically costing thousands monthly. Ontario does have a catastrophic drug coverage program for patients under 65 with no workplace drug plan but patients are required to contribute four percent of their income yearly.

The nightmare for people facing a cancer diagnosis and attempting to balance all their needs as a patient with a drug protocol will continue to become an acute social problem as cancer drugs by 2020 taken at home are expected to impact 60 percent of patients. And while the Canada Health Act requires hospital-administered drugs to be covered by medicare, provinces are not expected to fund those medications self-administered in the home.

cancer bankruptcy

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