Brandon Sun (Newspaper) - June 26, 2002, Brandon, Manitoba
Sleep deprivation good, eheap way to fight depression
MONTREAL — You’re depressed but don’t like the idea of taking antidepressants?
Try going with only four hours of sleep for one night.
Sounds bizarre, but for many people sleep-deprivation therapy really works.
Indeed, it’s used quite a lot in Europe, delegates at a conference heard this week.
Lights out at 9 p.m. and set your alarm clock for I a.m. Then don’t go to sleep again until your regular bedtime that night.
Studies have shown that in about 80 per cent of cases, depression is reduced by at least 50 per cent in less than two days, said Dr. Barbara Parry, head of psychiatry at the University of California in San Diego.
That is faster than for anti-depressants, which can take three or four weeks to start showing effects.
Parry presented the findings of her studies on “wake therapy” at an international congress on neuro-psychopharmacology in Montreal.
The beneficial effects of wake therapy will usually last for at least six weeks, with as many as 20 per cent of patients continuing to feel good after six months, Parry said. That’s at least as good a response rate as for anti-depressants and probably slightly better, she added.
Once the effects of the wake therapy wear off, you can repeat the exercise. She said the therapy works best when the patient sleeps from 9 p.m. to I a.m. as opposed to, say, 3 a.m. to 7 a.m.
However, she cautioned against the therapy for manic depression.
— Canadian Press
Sun gazing dangerous
Sun gazing can literally bum a hole in the retina if you gaze at the sun for longer than a minute.
In the early stages, the retinal tissue swells and the retinal pigment is destroyed. Several months after the sun exposure, damage to the photo receptors develops. After the exposure, a small gray lesion will appear in the centre of the macula.
After several weeks, the lesion fades and is replaced by a tiny hole. Since the
_ very centre of the
macula, the fovea, is responsible for sharp vision, acuity WW®. may drop to 20/200 following sun gazing.
Symptoms develop a few hours after exposure. An aching feeling develops over the eyes and there may be a vision defect in the central field. The individual may also experience wavy vision and colour vision defects.
Sun gazing can inflict serious damage to sensitive retinal tissues resulting rn a severe loss of vision. There is always an increase in this problem following an eclipse.
Be careful! It is important that proper glasses be used and that you never stare directly at the sun.
DR. GERALD DRESSLER
Eye to Eye
Gerald Dressier is a Brandon optometrist.
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Practice makes perfect with major surgery
Who is the safest surgeon for a coronary bypass operation? Which is the preferred hospital for the procedure? The answers to these questions may determine whether you end up in the graveyard or return home to recuperate.
I’ve often said to patients, “This is the best surgeon and hospital for the operation.” Some have replied, “But if I go there my family will have to travel many miles to visit me.” I feel like replying, “That’s right, but if you die your family would wish they had been given the chance to travel those extra miles.”
There’s an old saying that “practice makes perfect” and it’s true whether you’re a plumber or a cardiac surgeon. A report from the
Canadian Institute for _
Health Information (OHI) adds more weight to this adage.
The report reveals that during one year, 22,500 bypass operations were performed in Canada in 33 hospitals. The number done in each hospital varied from 200 to 2,000.
This difference in numbers had a surprising effect on outcome. For instance, patients who had bypass surgery in hospitals that performed fewer that 500 cases a year were 39 per cent more likely to die!
Why should there be such a difference? It’s due to a combination of factors. Like Wayne Gretzky in hockey, some surgeons are more technically adept than others and the more cases they do obviously benefits patients. It also means a speedier operation and
The Doctor Game
less anesthesia, important factors during bypass surgery.
Another important ingredient is the operating room team. The greater the number of operations performed, the greater the team’s speed and efficiency. Watching a superb operating team is like watching a great symphony orchestra.
And last, but not least, the nurses and doctors doing post-operative care.
So what is your risk of having surgery in a low volume hospital? The CIHI report says that only four per cent of Ontario patients had bypass operations in hospitals performing less than 500 a year. This compares to 16 per cent in British Columbia, 23 per cent in Atlantic provinces, 33 per cent in Prairie provinces and 47 per cent in Quebec.
The concept that hospitals and surgeons must attain what’s called “critical mass” for good results is not new. And it’s true whether doctors are doing bypass operations, angioplasties or radical cancer surgery.
Several years ago, Dr. James Hollis, Professor of Medicine at Duke University in Durham, N. C., stressed this point at a meeting of the American Heart Association.
Patients, he said, are more likely to die or require emergency bypass surgery at the time of angioplasty when treated by those performing the procedure in low volume hospitals.
During angioplasty, doctors try to open a coronary artery that is partially blocked by an atherosclerotic
lesion. One method is to insert a balloon into the artery, which pushes the lesion against the wall. Another involves inserting a “stent” device that holds arterial walls open.
But if the coronary artery is perforated, an emergency bypass operation is needed.
Dr. Hollis reported that more than half the hospitals performing angioplasty failed to do sufficient cases to acquire expertise. And you don’t have to be a rocket scientist to know that this spells trouble.
In 1998, in order to avoid needless complications and death, U.S. doctors were issued guidelines. Individual doctors were instructed not to perform angioplasty unless they were doing 50 a year.
And hospitals were advised they must do at least 200 a year or none at all.
So what happened? Many doctors and hospitals simply ignored the guidelines. The results were predictable.
A subsequent survey showed that
for doctors performing fewer than 25 angioplasties a year, 6.1 per cent of patients required either follow-up bypass surgery or died in hospital. For doctors doing more than 50 cases a year, 4.7 per cent required bypass or died.
Critical mass is vital in everything. I wouldn’t want my hair cut or gallbladder removed by someone who has only done it three times.
Yet there are cases of surgeons tackling complicated cancer operations having performed only a few cases every year. And the risk to their patients is four times greater. These surgeons must believe they’re related to Wayne Gretzky, Michael Jordan or the Almighty.
Ideally, complicated surgery such as coronary bypass should be done in university hospitals where volume is high. Even with gallbladder, hernia and less complicated operations, the importance of critical mass is imperative.
It’s the best insurance policy to prevent complications and death.
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Dr. Jay T. Winbum Dr. Jeffrey Bales
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