Visual Impairment

Visual impairment is a term that is used in the medical industry to describe vision loss. There are over 5 million Canadians that live with an eye disease that either affects their vision or could lead to vision loss in the future – with nearly 65,000 of those individuals being right here in British Columbia, where Dr. Ali Ghahary works as a family physician. 

To be visually impaired means that your eyesight cannot be corrected to what would be deemed as a “normal” level by medical professionals. Vision loss can mean that you are partially sighted or blind, in addition to having a visual field that is narrowed, declined visual acuity, as well as other forms of visual impairment. Certain types of visual impairment are also considered a disability.

In Canada, the number one cause of visual impairment is a condition that is known as age-related macular degeneration, also known as AMD, which affects individuals aged 50 and older. It occurs as a result of damage to the macula – the area in the centre of your eye that is responsible for seeing objects that are straight ahead of you. In many cases, age-related macular degeneration advances very slowly and you will only notice symptoms as the condition progresses over time. When the macula is damaged, your vision becomes distorted. A few examples of distorted vision include blurriness or shadowy areas. You are at an increased risk of developing AMD if you are a smoker or if there is history of it in your family. You can help to reduce the risk of developing age-related macular degeneration by avoiding smoking (Dr. Ali Ghahary offers smoking cessation tips here), getting regular exercise, eating healthy and maintaining normal levels of cholesterol and blood pressure.

Glaucoma is another condition that can cause visual impairment. It is a condition that causes increased pressure/fluid build-up within the eye, causing damage to the optic nerve. The optic nerve is responsible for transferring visual information to the brain via electrical impulses. Similar to age-related macular degeneration, glaucoma usually does not become bothersome until later in life. If can be treated with eye drops, medication that you take orally, surgery, or a combination of all of these methods. If left untreated, however, glaucoma can lead to permanent loss of vision, so it is important to make an appointment with your physician or with your optometrist at the first sight of symptoms – which include blurred or distorted vision and eye pain.

There are also different types of blindness that an individual can be diagnosed with. These include colour blindness – where the individual is unable to tell the difference between certain colours, night blindness – which occurs in the evening or when in dimmer light and tends to make night-driving difficult, and complete blindness – where the individual has total vision loss.

If you develop sudden visual disturbances or sudden vision loss, this could be a medical emergency. Common medical causes of sudden vision loss include artery occlusion, vitreous hemorrhage, in addition to strokes or brain tumours. Dr. Ali Ghahary urges anyone who experiences sudden disturbances with their vision to seek immediate medical attention.

The Integumentary System

The integumentary system, compromised of the skin and its appendages such as hair, nails and exocrine glands, is responsible for acting as a barrier and protecting our bodies from any damage or disease, in addition to regulating body temperature. The skin consists of three layers: the top layer of skin known as the epidermis, the middle layer of skin known as the dermis, and the deepest layer of skin known as the hypodermis or subcutaneous tissue. 

In this article, Dr. Ali Ghahary will discuss the common disorders associated with the integumentary system, including the signs and symptoms to watch for.

Skin Cancer

Skin cancer is one of the leading types of cancers in the world today, affecting more than 80,000 Canadians each year. Skin cancer occurs when normal skin cells change and form a mass known as a tumor. 

There are three major types of skin cancer:

1. Basal Cell Carcinoma

This is the most common form of skin cancer, accounting for 80 to 90 percent of diagnoses. Basal Cell Carcinoma is usually a result of overexposure to the sun or ultraviolet (UV) radiation. With BCC, patients may first notice changes in their skin such as an odd growth, changes in appearance of moles, skin wounds that do not heal and/or skin irritation. Basal Cell Carcinoma commonly affects the nose but it can also affect other areas of the body including the back, beck, chest, shoulders and head.

2. Squamous Cell Carcinoma

Squamous Cell Carcinoma is the formation of a malignant tumour affecting the middle layer of skin, also known as the dermis. Similar to Basal Cell Carcinoma, you may notice changes to the skin including growths on the lips, mouth, tongue or genitals. Neglect of this condition can cause the cancer to spread. Treatment of Squamous Cell Carcinoma is depending on the size of the tumour…however, the cure rate is high if treated early.

3. Malignant Melanoma

This is a less common form of skin cancer – however, it is the most aggressive and can be fatal due to its high tendency to spread to various parts of the body. Malignant Melanoma occurs when cells called the melanocytes grow out of control and form tumours.

Other diseases and disorders of the skin include congenital skin conditions such as eczema, psoriasis and dermatitis, bacterial skin conditions such as rosacea and impetigo, viral skin conditions such as warts and herpes zoster (also known as shingles), and fungal conditions such as boils and folliculitis. For more information on skin conditions and diseases, visit the Canadian Skin Patient Alliance website at http://www.canadianskin.ca.

You can also follow Dr. Ali Ghahary on Twitter at @DrAliGhahary.

Common Types of Skin Rashes

Skin rashes are a common condition that can affect both adults and children. Psoriasis, Eczema and Rosacea are the most common, recurrent skin conditions that are found in adults; Chicken Pox, Measles, Heat Rash, Hives, and Hand, Foot and Mouth Disease are the most common skin conditions that affect children.

A skin rash can also be the result of an allergic reaction – usually the result of a food or medication – with the rash typically appearing within 30 to 40 minutes of consumption or contact with the allergen.

For specific information on food allergies, visit https://alighahary.wordpress.com.

Psoriasis

While the exact cause of psoriasis is unknown, it is thought to have genetic predispositions as well as environmental factors. Stress has also been said to play a significant role in the flare-ups of psoriasis. Psoriasis can cause small patches of red, scaly, flaky and crusty skin that can be itchy and/or sore. It commonly occurs on the knees, elbows, scalp or lower back, but can appear almost anywhere on the body.

Psoriasis

Eczema

Similar to Psoriasis, Eczema can also cause itchy, scaly skin. It affects anywhere from 10 to 20 percent of infants and 3 to 5 percent of adults. The cause of Eczema is also unknown but it has been linked to an overactive response by the body’s immune system, usually to an irritant.

Eczema

Rosacea

Unlike Psoriasis and Eczema, Rosacea does not typically cause itching. Instead, the main symptom of Rosacea is inflammation causing burning, redness and/or flushing of the cheeks, nose, chin and forehead. It can also cause soreness or burning of the eyes. Rosacea can worsen over time if left untreated, so it is important to see your physician if you suspect you have Rosacea to get appropriate treatment.

Rosacea

With many of these skin conditions, Dr. Ali Ghahary will prescribe lotions or creams to reduce the symptoms. The most commonly prescribed lotion is hydrocortisone, which works by reducing inflammation of the skin.

Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis

Affecting up to as many as 200,000 Canadians each year, Deep Vein Thrombosis (commonly referred to as DVT) is a condition that occurs when blood clots form in the veins located in your body – typically affecting the thigh or lower leg. However, it is not unlikely for them to also develop in other areas of the body.

DVT usually occurs most commonly in Canadian adults aged 50 or older, and can be the result of many risk factors and health conditions that change how blood moves throughout your veins, such as injury to the veins, obesity, smoking, birth control pills, hormonal therapy, smoking, and staying seated for long periods of time. Certain forms of cancer, inflammatory bowel disease and heart failure have also been found to be linked to Deep Vein Thrombosis, and it can also occur as a result of pregnancy due to an increase in hormone levels and slower blood flow as the uterus expands. The increased risk of developing DVT can last as many as 6 weeks after giving birth. Certain surgical procedures can also lead to the development of DVT, so it is important to talk to your physician about the risks and benefits of surgery.

Dr. Ali Ghahary, a physician in Vancouver, treats patients with DVT based on the symptoms they present with. However, not all individuals with Deep Vein Thrombosis are even aware that they have this condition, as symptoms usually only occur in approximately half of individuals with DVT. The most common symptoms of DVT include swelling in extremities such as the ankles, legs, or feet, cramping or severe and unexplained pain, skin that feels warm to the touch or an area of skin turning blue or reddish in colour. One complication of DVT is known as a Pulmonary Embolism, a life-threatening condition that results in arteries in the lungs being blocked. Signs and symptoms of a Pulmonary Embolism include dizziness, sweating, chest pain, fast breathing, rapid heart rate and coughing up blood. If you experience any of these symptoms it is recommended that you seek medical attention immediately.

As mentioned, Deep Vein Thrombosis is usually diagnosed in combination with the symptoms patients present with. Dr. Ali Ghahary and other Vancouver physicians may order tests such as an ultrasound study, venogram, MRI, and a blood test known as a d-dimer. If you are diagnosed with DVT, medications such as Heparin or Warfarin may be prescribed. These medications help to thin the blood, thus making it difficult for the blood to clot and decrease the risk of developing blood clots in the future. If blood thinners are not successful, you may be given medication known as a Thrombolytic drug via intravenous. Thrombolytic therapy works to break up blood clots. 

To prevent DVT, it is important to make certain lifestyle changes. These changes include smoking cessation, weight loss, and physical activity. 

Psoriasis Exacerbated by Cooler Weather

As summer comes to a close in just over two weeks, cooler temperatures and a change in the weather will soon follow suit – and the colder the season, the drier, itchier and inflamed the skin can become.

Psoriasis, a common autoimmune disorder that affects as many as 1 million Canadians and 125 million individuals, manifests itself as a skin problem. With Psoriasis, skin may feel itchy and/or sore and appear scaly and/or red. While the exact cause of Psoriasis is unknown, a combination of genetics and certain triggers (such as stress) are likely to play a part in the disorder; and while family physicians like Dr. Ali Ghahary may need to prescribe medication to individuals with Psoriasis, there are also some steps you can first try in order to help sooth the skin as well as prevent flare-ups of the disorder. The following steps are also beneficial to anyone who might be suffering from dry skin.

First and foremost, individuals suffering from dry skin should moisturize daily. Moisturizer will not only leave your skin feeling smoother and softer, but also help to prevent irritation. The thicker the moisturizer, the better, as it well help to lock water into the skin, leaving it moist. If you have sensitive skin then you should make sure you use products that are perfume and lanolin-free. Cleansing skin is also important, but make sure you do not overdo it as you may actually wind up stripping the skin of its natural moisturizing factors. 15-minute oatmeal or Epsom salt baths will also help to sooth dry, irritated skin.

Protecting exposed areas of the skin while out in cold, windy weather is another important factor as Psoriasis can oftentimes be exacerbated by the cooler elements. When outdoors you should always wear soft, warm layers of clothing, as well as hats, gloves and scarves.

If you find that following these steps do not improve the skin’s appearance, you should talk with your doctor so that an effective treatment plan can be put into place.

Cases of Melanoma Growing Rapidly in Canada

On average, an estimated 500 Canadians are diagnosed with cancer each day. Out of each type of cancer that exists, Melanoma is one of the fastest rising cancers in the country. As many as 6,800 Canadians will be diagnosed with Melanoma; 3,700 of those diagnosed are men, while 3,100 are women.

Melanoma occurs when the skin has been exposed to too much ultraviolet radiation – either from natural sunlight or other forms of UV radiation such as tanning beds – which causes a change in the skin cells. As a result, a malignant tumour or tumours will form in the melanocytes. The melanocytes are cells that produce melanin, which is responsible for the pigmentation of your skin and eyes. Keeping the skin protected at all times is important. The skin is the body’s largest organ and is culpable in protecting the skin from injury, infection and sunlight. The skin is also plays an essential role in keeping your body temperature under control by ridding itself of bodily waste via the sweat glands. Malignant tumours can also oftentimes metastasize to different parts of the body, and it is not limited to just the skin. Albeit rare, Melanoma can be found anywhere in the body that melanocytes are present, including the mucosal tissue (Mucosal Lentiginous Melanoma), internal organs, and the eyes (Intraocular Melanoma.)

The most common and earliest symptoms that an individual with Melanoma may present with is changes to otherwise normal-looking skin or moles. While it is not uncommon to have moles (the average person has as little as 10 moles and as many as 40), they should not change in size, shape or colour, be more than 6mm in length, or feel itchy or painful. Late signs of Melanoma include enlarged lymph nodes in the neck or under the arms, feeling out of breath, chest pain, headaches, nausea, fatigue, loss of appetite and weight loss.

While Melanoma is one of the deadliest forms of skin cancer, taking some straightforward protective measures against ultraviolet radiation can also help to prevent it. If spending a protracted amount time outdoors, you should always ensure that you have the proper protection against the sun’s harmful UV rays. Wearing sunglasses and other protective articles of clothing, applying sunscreen and staying in the shade are all crucial factors in avoiding Melanoma. For more information on how you can avoid other heat-related illnesses, read Dr. Ali Ghahary's article on summer health and safety tips.

Chronic Fatigue

We all know what feeling tired is like – it can happen after a long day at work or strenuous physical activity. Tiredness is the body’s natural reaction to any kind of exertion. As a result, we must allow our bodies time to rest in order to allow it the capability to function as normal and perform new duties. However, if you are feeling tired after very little activity, if it is constant, and is not relieved by rest, you may suffer from something called Chronic Fatigue.

Chronic fatigue, a diagnosis that was once dubious amongst those in the medial field, is now being accepted as a true medical disorder, with just under 400,000 Canadians having been diagnosed. It typically affects individuals over the age of 40, with the majority of chronic fatigue sufferers being women. Certain viral infections such as the Epstein-Barr virus, hypotension (low blood pressure), a weakened immune system and hormonal imbalances have all been suspected to play a part in the diagnosis of chronic fatigue, but there has been no direct link between them. With no current cure for chronic fatigue, treatment is focused solely on the symptoms that are presented by the patient. 

Below are some common symptoms of chronic fatigue:

• Excessive tiredness (lasting longer than 24 hours)

• Mental exhaustion

• Inability to focus/concentrate

• Memory loss

• Headaches

• Muscle pain

It is also important to rule out any other potential causes of your tiredness, as there are other conditions with symptoms that mimic those of chronic fatigue such as Lyme disease, lupus, mononucleosis, hypothyroidism, fibromyalgia and even depression.

Perhaps the most important thing one can do to relieve symptoms associated to chronic fatigue is by making lifestyle changes, something Dr. Ali Ghahary already recommends to his patients under many different circumstances and for certain health conditions. These lifestyle changes include making dietary changes, and limiting or all together eliminating intake of caffeinated beverages such as coffee and sodas (doing so well help you get a better night’s rest.) You should also limit your use of nicotine and alcohol, and ensure that you are not overexerting yourself during the day, especially when involved in any physical activity. It may also be a good idea to work with a trainer or physical therapist to help you with an easy exercise routine. Alternative medicine such as acupuncture, yoga and massage therapy have also been found to be constructive for chronic fatigue sufferers, but you should always check with your physician beforehand.