Why Am I Allowed to Drink Clear Fluids Before Surgery, but Not Eat? (McGill OSS)

5 minute read

Surgeons often instruct patients to refrain from consuming food or drink before surgeries. However, even when patients aren’t allowed to eat, they can often drink “clear fluids”. Why aren’t clear fluids counted as consumption, and what purpose does fasting before surgery even serve?

Read the full article here: https://www.mcgill.ca/oss/article/health-general-science/why-am-i-allowed-drink-clear-fluids-surgery-not-eat

No Need to Shave the World: Why Your Beard Is Not a Problem in the Age of COVID

6 minute read
originally posted here: https://mcgill.ca/oss/article/health/no-need-shave-world-why-your-beard-not-problem-age-covid

In 1843 a letter to the editor entitled “The growth of the beard medically considered” published in the Boston Medical and Surgical Journalargued that beards were medicinally beneficial, and that “the practice of shaving the beard, and thus depriving the face, throat and chest of that efficient protection which nature has provided” was responsible for the “numerous diseases of the respiratory organs with which mankind are afflicted.”

Yet, by 1916 beards had lost their safeguarding status. Edwin F. Bowers (who would go on to invent the pseudoscience of reflexology) wrote in an article for McClure’s Magazine that “there is no way of computing the number of bacteria and noxious germs that may lurk in the Amazonian jungles of a well-whiskered face, but their number must be legion.”

It was only two years later that the 1918 Spanish Flu pandemic hit, and any possible disease vector, including beards, was targeted in bids to quell the number of sick individuals. Given that we’re currently in the midst of what the United Nations is calling “a global health crisis unlike any” it seems inevitable that beards once again fall under the literal microscope as potential germ gardens.

Luckily, given the scientific advances that have taken place since the last few hundred years, we don’t need to rely on racially contentious observations like this one from 1843: “those nations where the hair and beard are worn long, they are more hardy and robust and much less subject to diseases, particularly of a pulmonary character, than those who shave.”

Let’s see what science has to say about how pathogenic your facial hair might be.

Does facial hair collect more germs than a smooth face?

The real question of hair’s cleanliness isn’t whether or not it can harbour microbes. Unfortunately, just like any other surface, it most certainly can. What we really care about is whether a beard contains more germs than a clean-shaven face.

A 1967 study saw four volunteers’ beards or clean-shaven faces sprayed with a bacterial solution and swabs taken from their skin 30 minutes and six hours after, either with or without letting them wash their faces with soap. They found that while there were more bacteria on clean-shaven faces than on beards before washing, more bacteria were removed by washing a clean-shaven face compared to washing a beard. So even though the beards didn’t accumulate more bacteria than the face, they did retain it through the wash.

A 2014 study reinforced the finding that facial hair doesn’t accumulate more bacteria than non-hairy facial skin. Researchers took swabs from the cheeks and upper lips of 199 healthcare workers who had facial hair and 209 who didn’t. The results showed that clean-shaved healthcare workers were actually more likely to harbour certain types of bacteria than their fur-faced coworkers. Similarly, a 2015 study of 118 mustachioed and 123 non-mustachioed men found that “nasal S. aureus [a bacterium] carriage is similar in men with and without a mustache.”

So even though beards may retain bacteria through a wash (highlighting the importance of washing your beard well), there’s no evidence that they accumulate or harbour larger bacterial populations than smooth faces.

Does facial hair spread more germs than a smooth face? 

The other piece of this facial hair puzzle is whether or not people with beards spread more microbes than those without. This question has been at the forefront of a debate over whether or not doctors, nurses, surgeons and other healthcare workers should be allowed to have facial hair. Some people fear that their beards and mustaches could be contaminated and lead to infected patients. Others worry that strict facial hair rules unnecessarily limit a doctor’s personal choices.

Part of why this debate rages on is due to some conflicting study results. A study published in 2000 by McLure et al. compared the bacterial shedding of 10 bearded, 10 clean-shaven and 10 female subjects. The researchers had the volunteers wear a surgical mask either while talking and moving their faces such that the mask “wiggled” around or while still. They held agar plates just below their chins to collect any bacteria that fell off and then cultured these colonies and quantitated them. The results showed that with or without mask wiggling, bearded subjects shed more bacteria than clean-shaven ones.

However, a 2016 study by Parry et al. using the same methods found no difference in the amounts of bacteria shed by bearded versus clean-shaven subjects regardless of whether they wore a surgical mask, a surgical mask plus a hood (shown below), or nothing.

Image source: http://www.healio.com/doiresolver?doi=10.3928/01477447-20160301-01

Unfortunately, this leaves us at the familiar scientific dead-end: more research is needed. Without another study, preferably one with a much larger sample size than the 30 and 20 of these trials, it’s difficult to know which results to trust. Both researchers present reasonable explanations for their results. McLure et al. suggest that beards “may act as a reservoir for bacteria and dead organic material which can be easily dislodged with movement of the face mask,” whereas the daily act of shaving helps to remove the “superficial layer of skin containing bacteria” and thus give clean-shaven men fewer microbes to shed.

On the other hand, Parry et al. suggest that daily shaving can cause micro-cuts on the face that can serve as hiding places for bacteria. They also pondered if their results could be due to beard lengths. They showed that longer beards shed less than shorter beards when the subjects wore masks and hoods, which they hypothesize is due to longer beard hair being less abrasive and therefore leading to fewer shed bacteria. Unfortunately, since McLure did not report their participants’ beard lengths, it’s not possible to know for sure.

But wait, what about viruses?

To throw another wrench in the interpretation of these results, allow me to point out that all these studies measured the amounts of bacteria on participants’ faces or beards. However, the current COVID-19 pandemic is being caused by a virus, not a bacterium. While this distinction may not seem important, there are a lot of differences between these two types of microbes: in particular, size! As you can see below, the size range for bacteria is roughly 500-5000 nanometres, but for viruses is only roughly 100-800 nanometres, making them quite a bit smaller. The SARS-CoV-2 virus (at the time known as 2019-nCoV) has been reported to be 60-140 nm in diameter, making it a particularly small virus, as viruses go.

Image source: https://www.researchgate.net/figure/Relative-sizes-of-major-host-cells-and-their-components-versus-those-of-bacteria-and_fig4_325937574

In the end, there’s no compelling evidence that beards foster bacteria, but we cannot really say if they do lead to increased bacterial shedding. And as far as viruses are concerned, we have no evidence at all.

The good news is, that if you’re practicing proper social distancing, washing your hands often and not exposing yourself to others unnecessarily, you and your beard are unlikely to encounter the SARS-CoV-2 virus at all. So, if you’re doing your part to flatten the curve by staying home, keeping your beard should be fine. However, healthcare workers should consider the role that their facial hair may play in transmitting microbes and take care to wash it very thoroughly whenever possible. However, I do expect that, given that many facial hairstyles can interfere with special masks called respirators, many have already done a spring shave.

Image source: https://www.cdc.gov/niosh/npptl/pdfs/FacialHairWmask11282017-508.pdf

Getting More Bhang for Your Buck: Cannabis in India

3 minute read
Originally posted here: https://mcgill.ca/oss/article/health/getting-more-bhang-your-buck-cannabis-india

As of October 18th, 2019, edible (and drinkable) cannabis became legal in Canada. And yet, almost 5 months later, legal cannabis stores have remarkably little selection. The SQDC (Quebec’s cannabis retailer) only started stocking cannabis beverages one week ago and only offers three types of tea and one type of seltzer. All things considered, it doesn’t seem like drinkable cannabis will be replacing Canadian’s joints, oils, pills or vapes any time soon.

If we look elsewhere however, the story of cannabis drinks couldn’t be more different.

According to the 2017 World Drug Report from the United Nations Office on Drugs and Crime, two of the top 10 cities that consume the most cannabis in the world are in India: New Delhi and Mumbai. The trick here is that much of the cannabis consumed isn’t smoked, but rather drunk in a drink called “bhang”.

Bhang looks somewhat like a shamrock shake or a green smoothie, but tastes (I’m told) of spices and herbs like saffron, fennel, garam masala and more. Strictly speaking, the term bhang refers to a paste made by steeping finely ground cannabis leaves (not buds) in hot milk. This paste can then be eaten on its own or used to create drinks or snacks like pakoras. However, the most popular preparation by far involves adding more milk, rosewater, sugar, nuts and other ingredients to the paste to create a refreshingly cool drink. This drink is often referred to as bhang but is more correctly named according to what ingredients are used, as a bhang thandaibhang lassi or other.

Bhang is especially common during Hindu festivals, in particular Holi, the two-day Festival of Spring, which turns the streets into a sea of colour with coloured paint and water pistols. Cannabis has a rich history in sacred Hindu texts and is named as one of the five sacred plants in the Atharva Veda. The Hindu god Shiva has long been associated with cannabis, and is said to have used bhang for meditative and healing purposes, and is even known as the Lord of Bhang. Cannabis has been used in Ayurvedic medicine to treat conditions ranging from skin disorders to anxiety.

Despite India’s rich cannabis-history, marijuana is actually illegal in the country. Bhang manages to maintain its huge consumption rates due to a legal loophole. It is against Indian law to possess hashish and ganja, but not the leaves of the cannabis plant, which is what bhang is made from. Incidentally, despite its illegality, hashish (made from the resin of the cannabis plant and commonly mixed with tobacco before smoking) is much more popular in India than in North America, while marijuana (the dried buds of the cannabis plant) is much less popular.

Interestingly, cannabis of all preparations was legal in India until 1961, when the Single Convention on Narcotic Drugs moved cannabis to the hard drug category. Prior to this, cannabis consumption had been seen as an inherent part of the religious and social customs of India. Even the colonial British rulers concluded, after commissioning the Indian Hemp Drugs Commission Report of 1894, that “to forbid or even seriously to restrict the use of so gracious an herb as cannabis would cause widespread suffering and annoyance.”

Today any flowering top (called ganja) and separated resin (called charas) from the cannabis plant remains illegal in India, although that is clearly not limiting citizen’s ability to imbibe in THC and CBD. So long as only the leaves of the cannabis plant are consumed, Indians are within their legal rights. As to what happens to the flowering buds once the leaves are removed, well, perhaps I’ll save that for the Indian government to worry about.

Should I pop my blister?

2 minute read
Originally posted here: https://mcgill.ca/oss/article/health-you-asked/should-i-pop-my-blister

If you’re someone who likes to hike, bike, garden, run or do pretty much any physical activity, you’re likely quite familiar with getting blisters.

These fluid-filled skin bubbles can hypothetically form anywhere on your body but tend to form in places with a thick stratum corneum (the outermost layer of your skin) like the palms of the hands or soles of the feet. They are the result of an object (like a boot or a shovel handle) applying a force on our outer layer of skin, causing it to shear or split from the inner layers.

The space created by this skin split is then filled with fluid due to hydrostatic pressure. The fluid is usually clear and similar to blood plasma (although contains less protein) but if the skin split goes through several layers, the blister can fill with blood instead.

Moist skin is more likely to generate blisters than wet or dry skin, thanks to the forces of friction. When skin is wet, the water can act as a lubricating agent between an object and your skin. Similarly, when skin is dry, repeated rubbing against dry skin causes exfoliation and the buildup of a thin layer of dead skin cells that serve as a lubricant. But when skin is moist the dead cells are stuck to the skin and are unable to act as lubricants.

What should you do when you get a blister? Ideally, nothing. Blisters take roughly 7-10 days to heal and usually leave no scar. However, they can become infected if exposed to bacteria. If you don’t pop a blister, it remains a sterile environment, virtually eliminating any risks of infection.

But, if a blister is somewhere it cannot avoid being popped, or if it’s painful, draining it (carefully!) is an option. Preferably, have a medical expert drain it for you, but either way, make sure not to tear off the top of the blister! It serves as a biologic dressing over the wound and helps to keep it bacteria-free.

Whether you pop it or not, you can cover your blisters with a bandage to help cushion it, but topical antibiotics aren’t necessary. You could, however, always try an unconventional approach like covering your blisters with cyanoacrylate, or super glue! At least one study has found it more effective at reducing pain from blisters in soldiers and praised its ability to stay on for many days at a time

Is hard water dangerous to drink?

3 minute read
Originally posted here: https://mcgill.ca/oss/article/health-you-asked/you-asked-hard-water-dangerous-drink

What is Hard Water?

Hard water is water containing high concentrations of dissolved minerals, usually calcium or magnesium carbonates (CaCO­or MgCO3), chlorides (CaCl2or MgCl2) or sulphates (CaSO4or MgSO4). The hardness of water depends on its source. Groundwater that has been in contact with porous rocks containing deposits of minerals like limestone or dolomite will be very hard, while water from glaciers or flowing through igneous rocks is much softer.

The hardness of water is determined by the milligrams of calcium carbonateper litre and is reported it in parts-per-million (ppm). In general, water with less than 60 ppm can be considered soft, water with 60-120 ppm moderately hard, and water with greater than 120 ppm hard. For reference, Montreal’s water is typically around 116 ppm, or moderately hard, and sea water’s hardness is approximately 6,630 ppm since it contains many dissolved salts (depending on the sea, of course).

Hard water can interfere with the action of soaps and detergents and can result in deposits of calcium carbonate, calcium sulphate and magnesium hydroxide (Mg(OH)2) inside pipes and boilers, causing lower water flows and making for less efficient heating. The ions in hard water can also corrode metal pipes through galvanic corrosion. Water softening filters can circumvent these problems through the use of ion-exchange resins that replace calcium and magnesium ions with sodium and potassium ions. But if one consumes water with higher-than-average concentrations of calcium and magnesium. Is that OK?

The Health Effects of Hard Water

Studies have generally found hard water to have positive effects on the health of its drinkers. Several studies have reported that calcium and magnesium in drinking water have a dose-dependent protective effect when it comes to cardiovascular disease. There is also some evidence that calcium and magnesium in drinking water may help protect against gastric, colon, rectal cancer, and pancreatic cancer, and that magnesium may help protect against esophageal and ovarian cancer. Hard water may also serve a protective role against atherosclerosis in children and teens.

Some studies have shown a relationship between the mineral content of water and eczema or dermatitis in children. However, a 2011 study from the University of Nottingham involving 336 children aged 6 months to 16 years with eczema put that relationship to the test. The researchers installed water softening units in half of the participants’ homes and monitored the children’s eczema over a period of 3 months. Using a standard scoring system, the group that received softened water showed a 20% improvement, while the group that continued with hard water showed a 22% improvement, making it unlikely that hard water is contributing to worsening eczema symptoms.

Likewise, while some studies have shown correlations between water hardness and kidney stone formation, the majority of studies have found no such relationship.

It is estimated that individuals living in hard water areas who drink 2 litres of water a day ingest about 52 mg of magnesium from their water. Considering the daily recommended intake of magnesium is 420 mg, water can account for about 12% of that.

Individuals with type 2 diabetes often experience hypomagnesemia (low magnesium) as insulin regulation requires magnesium to function. In these people, the extra intake of magnesium through drinking water could be beneficial. The heightened magnesium concentration in hard water can also benefit people experiencing chronic constipation, as magnesium salts act as laxatives. One study noted that vegetables cooked in hard water often show an increase in their calcium concentration, as opposed to the decrease seen when they’re cooked in soft water.

It is fairly difficult for humans with healthy kidneys to experience hypercalcemia (too much calcium), as any excess calcium is excreted through the kidneys. Similarly, hypermagnesemia is fairly rare, and usually just results in short episodes of diarrhea.

The Physical Effects of Hard Water

There are, however, some non-medical reasons hard water isn’t always preferable. Hard water can appear cloudy if the solubility of mineral salts is exceeded. Furthermore, if the calcium concentration surpasses 100 ppm, the water will taste “funny.” Neither of these presents a risk, but consumers prefer a “clean” appearance and taste.

Basically, while hard water can be hard on appliances and pipes, it is not hard on the body, and can actually give the daily intake of calcium and magnesium a nice little boost.