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In the Name of God بسم الله


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About Dr.Abdulkareem

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    ShiaChat.com Doctor
  1. salam brother Ali Thanks so much for the congratulation :) Thanks for everythig brother. May Allah bless you and reward you. I wish you a very happy and succesful life. inshallah you complete the other half of your religion as well, amin! I wish you a very happy Eid and Siyam maqbool inshallah, Eid Mubarak! your humble brother
  2. salam brothers & sisters Just to let my brothers & sisters know that I'll be travelling tomorrow to Syria in order to get married inshallah. I'll be away for about two months. I know I'll miss my shiachat clinic so much but what can I do? :) If you need any medical help or advice, my brothers Dr.Ali Asghar & Dr.Aale Mohammad will be more than happy to help you. Dr.Ali Asghar will be in charge of our clinic :) I'm sure he will answer all your questions and concerns. My thanks to brother Ali for building our clinic, and my thanks to Dr.Ali Asghar & Dr.Aale Mohammad for helping me & helping the others in our clinic. Till I see you again, i wish everyone a very happy Eid and a very healthy life inshallah. Dr.Abdulkareem's tip of the day: Marriage resolves 95% of psychological and physiological problems in any society. Early marriage is much better than late marriage! ma3a salama & Eid Mubarak :) your humble brother
  3. salam brothers & sisters Here's some useful information specific to women about seizure medications they might be taking. More than one million women and girls in the United States are living with seizure disorders. They face many unique challenges, from changes during the monthly cycle which may trigger seizures to concerns regarding pregnancy. Social factors leave them vulnerable to discrimination and abuse. Yet their plight and the manner in which they are affected has been largely ignored. As an important part of the Epilepsy Foundation's role in advocating for all people with epilepsy, we are committed to addressing the unique health concerns of women with epilepsy. Seizure medications may impact sexuality, reproductive health, birth control choices, pregnancy outcomes, and bone health in women with epilepsy. Choosing the appropriate seizure medication is very individual and women and their doctors must work together to find the best medication that is right for them. This information sheet explores such questions as: How do I know if I am taking the right medication for my seizures? Should I try the new medications? What does it mean when my doctor orders a "blood level" on my seizure medication? Will there be any problems with my seizure medication if I become pregnant? How do I know if I am taking the right medication for my seizures? The choice of antiepileptic medication is based on your seizure type, the pattern on your EEG, how well the medicine controls your seizures, and how you tolerate the medication. Some types of epilepsy respond better to certain medications than others. Seizure patterns can change and medication may need to be altered. Choosing the appropriate medication is very individual. An antiepileptic drug may work well for one person, and not for another. You and your doctor can work together to find the best medication for you. I've read about some new medications. Should I try one of those? That depends on how well your seizures are controlled and how you feel on your current medicine. If you want better seizure control than you now have, or feel you are having unpleasant side effects from the medication, talk to your physician about other options. Sometimes, there is no perfect solution and you will have to choose between some side effects and total seizure control, or no side effects and some seizures. Only you, with your doctor's advice, can decide what is the best choice for you. Some of the newer medications seem to control seizures well with minimal side effects. If you are not happy with your current situation, it makes sense to talk to your doctor about trying something else. However, any change in medication may put you at risk for break-through seizures and require some temporary limitations in lifestyle (not driving a car, for instance) until the effects of the medication are clear, Again, you will need to weigh the benefits versus possible risk and inconvenience. I tried three different medications before I found one that controlled my seizures. Why didn't my doctor try that one first? There is no magic way to know which medication will work for a specific person. Although it feels frustrating to be switched from one medication to another, it is a good medical decision to keep trying to find the antiepileptic drug that best controls seizures with the least side effects. Keep in close contact with your nurse and doctor to be sure they understand your response to medication. How do I know if I'm having side effects? That's a good question. All medications can cause side effects. However, most people tolerate their medications very well, The best way to tell if you are having side effects is to notice any symptoms you feel when you first take a medication or when the dose has changed. Some side effects of seizure medication are symptoms you feel, and are related to your dose of medication. If you are taking more medication than you can tolerate, you may feel groggy, or dizzy or sick to your stomach. You may have poor balance or see double at times. The dose at which these symptoms occur varies and some people can tolerate a much higher dose than others. In addition to side effects caused by the dose of medication, there may be symptoms that occur in some, but not all, people who take the drug. This is called an idiosyncratic side effect. Some people notice weight gain, unrelated to calories eaten, on certain seizure medications. Valproate (Depakote) may be the most common drug to have this side effect but it has been noted with carbamazepine (Tegretol) and gabapentin (Neurontin) as well. Felbamate (Felbatol) and topiramate (Topamax) can cause weight loss. Phenytoin,(Dilantin) may cause undesirable cosmetic side effects, such as excessive hair growth (including facial hair) and coarsening of the features. Again, this does not happen to everyone, and is more likely to occur after prolonged use. Mood changes seem to be more common with phenobarbitol (Luminal) or primidone (Mysoline), but any seizure medication can make some people feel depressed or irritable. Obviously, these symptoms may be caused by something other than epilepsy medicine, such as illness or stress. Give your doctor as much information as possible to help determine the underlying cause. There are some rare, dangerous side effects (including liver failure and blood disorders) that may initially show up only in a blood test. This is one reason that your doctor may order more frequent lab work when you first start a new medication. Most of these serious side effects show up in the first few months you take a medicine, are not dose-related and are unlikely to occur later. What does it mean when my doctor orders a "blood level" on my seizure medication? When you take a medication for epilepsy, only a portion of it enters your bloodstream and goes to the brain cells for seizure control. Some of it is metabolized in the liver to a substance that is not effective against seizures; some of it may be eliminated from the body by the kidneys or the intestine. The amount in the bloodstream, the "blood level," is measured by a laboratory test to determine how much medication is available to control seizures. This gives your doctor a practical range to make judgments about your medication dose. This information together with information you share about seizure control and possible side effects helps determine the dose of medicine you should be taking. I take birth control pills. Do they interact with my seizure medication? There may be complex interactions between the hormones in birth control pills and some of the medications used to control seizures. Some of these medications increase the breakdown of contraceptive hormones in the body, making them less effective in preventing pregnancy. It is very important that all your health care providers be aware of all the medicine you take. I am thinking of getting pregnant. Will there be any problems with my seizure medications? It's a good idea to think about these complex issues prior to getting pregnant. Vitamins with a folic acid supplement are an important factor in reducing the risk of certain kinds of birth defects, and you need to take folic acid before you become pregnant. Uncontrolled seizures can have risks for both you and your unborn child, and multiple seizure drugs at higher doses are statistically related to an increased risk for some types of birth defects. Whenever possible, a single anticonvulsant at the lowest dose that provides good seizure control should be used. But it's important to remember that your chances of having a normal, healthy child are excellent -- greater than 90%. Talk through any potential problems now with your neurologist and your gynecologist/obstetrician so you can make reasonable decisions about this important part of your life. Where can I get more information about seizure medications for women with epilepsy? Contact the Women and Epilepsy Initiative of the Epilepsy Foundation. It is dedicated to improving the care of women with seizures. Information about the Women and Epilepsy Initiative is available from the Foundation at 800-332-1000. Your local Epilepsy Foundation can give you more information as well. This information sheet was produced through an educational grant from Glaxo Wellcome, Inc. Dr.Abdulkareem's tip of the day: Prayers are more effective than millions of drugs.
  4. salam brothers & sisters Seizures are different from person to person. Some people have only slight shaking of a hand and do not lose consciousness. Other people may become unconscious and have violent shaking of the entire body. Shaking of the body, either mild or violent, does not always occur with seizures. Some people with seizures briefly lose touch with their surroundings and appear to stare into space. Although awake, the person does not respond normally. Afterwards, the person does not remember the episode. About 10% of people will have a single seizure during their life. The brain controls how the body moves by sending out small electrical signals through the nerves to the muscles. Seizures, or convulsions, occur when the normal signals from the brain are changed. Having one seizure does not always mean a serious health problem exists. However, a first-time seizure should be evaluated by a health professional. It is important to rule out a serious illness that may have caused the seizure. A seizure can be a symptom of many different health problems. A child with a rapidly increasing fever can have a seizure (febrile seizure). An extremely low blood sugar level can trigger a seizure in a person with diabetes. Nonepileptic seizure (NES), also called pseudoseizure, is a condition that can cause seizurelike activity. Withdrawal from alcohol, prescription medication, or street drugs can cause seizures. Many times a seizure is a symptom of an illness, such as meningitis or encephalitis. One cause of seizures that recur isepilepsy, or seizure disorder. Epilepsy is one of the most common nervous system problems. About 2.5 million Americans have epilepsy. It can develop at any age. There are several types of epilepsy. Epilepsy has many causes, including head injury, stroke, birth injury, and brain tumor. Experts disagree whether epilepsy is passed from parent to child (inherited). Some studies suggest that there is not an increased risk of developing epilepsy if a parent has epilepsy, while other studies suggest that a person is more likely to develop epilepsy if a parent has epilepsy. In most cases, the cause cannot be determined. I hope that helps inshallah
  5. The Endocrine and Metabolic Effects of Alcoholism By Dr. Shahid Athar, MD Indianapolis, IN Abstract This review outlines the endocrine and metabolic effects of acute and chronic alcohol abuse. Effects of alcohol on endocrine organs can be a direct toxic effect or an indirect effect through metabolism of hormones in associated liver and nutritional disorders, which are seen in chronic alcoholics. (1-2) It is hoped that more awareness of the effects of alcohol on endocrine organs will strengthen the belief in the Quranic prohibition. Keywords: Alcohol, endocrine effects, hypogonadism, pseudo-Cushing's, alcoholic hypoglycemia. Alcohol addiction is a major health and social problem in the United States. Close to 18 million Americans are habitual drinkers. Medical conditions, accidents, and loss of work account for $26 billion in health core costs. The effect of alcohol on major organs is well known. Practically, alcoholism damages all organs, the important ones being the liver, gastrointestinal tract, central nervous system, pancreas, and heart. However, the effect of alcohol on endocrine and metabolic systems (1-2) is neither well described nor appreciated by the general public. The endocrine effects of alcohol are acute or chronic, and can be contributed indirectly to be existing malnutritiontion and liver disease. At the pituitary level, one of the actions of alcohol is to decrease the release of vasopressin. Vasopressin is secreted from the hypothalamus, is stored in the posterior pituitary, and it is the hormone that controls urinary output. In chronic alcoholism, as a result of a lack of vasopressin, there is a diuretic state leading to further dehydration. (3-4) Alcoholics (1) serum calcium and magnesium levels are low because of malnutrition, malabsorption, diarrhea, and pancreatitis with increased urinary loss. Serum albumin is also low; therefore, the total calcium is falsely reduced further. Magnesium and calcium contribute to alcoholic tetany and cardiac arrhythmia. (5-6) Alcohol can increase serum triglycerides and VLDL associated with chronic fatty liver and acute pancreatitis, can cause exacerbation of the primary liver and acute pancreatitis, and can cause exacerbation of primary hypertriglyceridemia and diabetic hypertriglyceridemia. There is also a question of whether it will increase HDL. (7) There is sodium retention in alcoholics because of increased aldosterone and estrogen and abnormality of the prostaglandin and kallikrein/kinin system. There is also a decrease in the naturetic factor. The cortisol output from the adrenal cortex increases due to dual action of alcohol on the hypothalamus and pituitary. At the level of the hypothalamus, it causes an increase in CRF; at the level of the pituitary, it causes an increase in CRF; and at the level of the pituitary, it causes an increase in ACTH production. As a result, pseudo-Cushing's syndrome is not uncommon in alcoholics. The physical features are very similar to classical Cushing's syndrome, and it is confirmed with excess corticosteroids both in serum and urine. However, it suppresses normally on Dexamethasone, and there is a spontaneous resolution with abstinence. (8) Alcohol has many effects on carbohydrate metabolism, including glucose intolerance, alcoholic hypoglycemia, alcoholic ketoacidosis, and lactic acidosis. The mechanism of alcoholic hypoglycemia includes a decrease in glycogen storage and decreased production of glucose of decrease gluconeogenesis. One of the features of alcoholic hypoglycemia is that it is prolonged and does not respond to glucagon injections. Therefore, 50% or 10% Dextrose must be used to correct it until the effect of the alcohol has passed. Alcohol depresses LH and FSH secretion at the pituitary level, and there is also a possibility that it might affect LH-RH releasing hormone at the hypothalamus. The combination of this affects both testicular and ovarian functions. (9) As a result, the serum testosterone is decreased, not only because of a lack of gonadotropin acting on the testes, but also there is an increased clearance of testosterone and metabolites in the liver. Alcohol may also block LH receptors at the testes. Another factor in both decreased testosterone section and decreased spermatogenesis is malnutrition, which lowers FSH and LH hormones. As a result of decreased testosterone formation, there is a decreased libido, gynecomastia, atrophied testes, and impotence. Therefore, the myth of alcohol being an aphrodisiac is broken by actually causing more permanent damage on the gonadal system. Not only is there a decrease in testosterone level, but there is also an increased estradiol-testosterone ratio, increased LH and FSH due to decreased feedback and a decreased sperm count. In women, alcohol can cause oligomenorrhea, amenorrhea, and decreased fertility by acting directly on the ovaries or decreasing LH and FSH to the pituitary. Also, malnutrition in alcoholics affects LH-RH secretion in the hypothalamus, and LH-FSH section from the pituitary. (10) Some of the features of hypermetabolism are seen in alcoholics with proptosis of both eyes, plethora, tachycardia, warm and sweaty palms, and tremors. Thus, the question is, is there any thyroid dysfunction in alcoholism? Indeed, serum T4 is decreased in cirrhosis with a decrease in thyroid-binding globulin. However, there is an increase in the reverse T3 level in liver decreases and acute illness as a compensatory phenomenon. The firee T3 level actually may also increase, explaining some of these hypermetabolic features of alcoholism. (11) In summary, alcohol, in both acute form and in chronic cirrhosis, affects the endocrine and metabolic systems by acting directly or through malnutrition, affecting hormone releasing secretions. We hope that the above information will be understood and passed on to patients by the physicians so that they will practice abstinence or enter into a treatment program and not wait for end-stage liver disease, pancreatitis, or GI bleeding. -------------------------------------------------------------------------------- References 1. Van Thiel D, Gavaler J: The endocrine consequences of alcohol abuse. Alcohol and Alcoholism 1990;25:341-4. 2. Adler RA: Clinical review 33: Clinically important effects of alcohol on endocrine function. J Clin Endocrinol Metab 1992;74:957-60. 3. Loosen PT, Range AJ: Alcohol and anterior pituitary hormone secretion. Lancet 1975;11:985-6. 4. Linkola J, Fyhrquist F, and Forsander 0: Effects of ethanol on urinary AVP secretion. Acta Physiologica Scandinavia 1974; 10 1: 126-8. 5. Laitinen K, Lanberg-Allardt C, Tunninen R, et al.: Transient hypoparathyroidsim during acute alcohol intoxication. N Engl J Med 1991;324:721-7. 6. Lindholm J, Steiniche T, Rasmussen E, et al.: Bone disorders in men with chronic alcoholism: A revisable disease? J Clin Endocrinol Metab 1991;73:118-24. 7. Ben G, Gnudi L, Maran A, et al.: Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with Type II (non-insulin dependent) diabetes. Am J med 1991;90:70-6. 8. Kirkman S, Nelson DH: "Alcohol-induced Pseudo-Cushing's. Metabolism 1988;37:390-4. 9. VanThiel DH, Cobb CF, Herman GB, Perez L, Gavaler JS: Ethanol-induced testicular injury. Endocrinology 1981;109:2009-15. 10. Van Thiel DH: Alcohol-induced ovarian failure. J Clin Invest 1975;61:624-32. 11. Israel Y, Walfish PG, Orrego H: Thyroid hormone in alcoholic liver disease. Gastroenterology 1979;76:116- 22.Page 90 -------------------------------------------------------------------------------- Presented at the 27th annual convention of the Islamic Medical Association of North America, held in Oak Brook, Illinois, July 21, 1994. From the Departments of Medicine and Endocrinology Indiana University School of Medicine Indianapolis, Indiana
  6. Prayers and Healing by Shahid Athar, M.D., F.A.C.E. * We the Physicians have now come to accept a fact known to our patients for centuries, that healing is from God, and we are just an instrument of the Healer. We give the same medication to two different patients with the same type of medical problem or perform similar operations on two patients otherwise at the same risk and one will survive and the other one doesn't. It is more than LUCK. As Socrates put it -"I dress the wound and God heals it." This is also acknowledged by Prophet Abraham "and when I am ill, it is He who cures me" (Quran 26:80). God himself attests to it by saying "If God touches thee with an affliction, no one can remove it but He" (Quran 6:17). Healing from Quran Quran, the Muslim revealed scripture is not a text book of Medicine but in it are some guidance, that if followed, will promote good health and healing. Thus Quran calls itself a book of healing. "O mankind, there has come unto you a direction from your Lord and a healing for the heart and for those who believe in guidance and mercy" (Quran 10:57). "We have sent down in the Quran that which is healing and a mercy to those who believe" (Quran 17:82) Healing from Quran is of three types: a. Legislative effect: This includes Faith (Iman) in God as not only Creator but the Sustainer and the Protector. This also includes medical benefits of obligatory prayers, fasting, charity and pilgrimage, details of which is beyond the scope of this article. b. Health Guidelines: Health-promoting items from Quran and tradition of Prophet Mohammed include use of honey, olive, fruit, lean meat, avoiding excessive eating, and Prohibition of alcohol, pork, homosexuality, sexual promiscuity and sex during menstruation. c. Direct healing effect of Quran: Recitation of Quran by the sick person or for the sick person (ruqya) has shown to have a direct healing effect on the sick person. This most likely uses medical benefits of Echo. Echo of sound is such a powerful force that it has been used to blast off mountains. Now the miniaturized version of Echo is used in medicine to break Kidney Stones (lithotripsy), gallstones, and even vegetations in the subendothelial bacterial endocarditis (SBE). Listening to the recitation of Holy Quran, in a study conducted by Dr. Ahmed E. Kadi and Associates, has been shown to lower blood pressure, heart rate, and to cause smooth muscle relaxation in Muslim Arabs, non-Arab Muslims and even in non-Muslims. It is postulated that Echo Target of Alif Lam Meem is in heart and that of Ya-seen is in the pituitary gland of the brain. Thus Prophet Mohammad (P) always stressed reading Quran (Quran-recitation) loudly and not silently by saying "The comparison between a silent reader and a recitor (Qari) is like a bottle of perfume when it is closed and when it is opened." Use of Meditation (dhikr, Zikrallah) in Prayer and Healing Dhikr (Zikr meditation) are acts of remembrance and communications with God as ordained to us. 1. "When my servant asks you (O Muhammad) about me, (tell them) I am close to them: I listen to the prayer of each supplicant when he asks Me. Let them listen to My call and believe in Me, that they may walk in the right way" (Quran 2:186). 2. "Your Lord says: "Call on Me and I will answer your call" (Quran 40:60). 3. "Those who believe and whose hearts find rest in the remembrance of God, for in the remembrance of God do hearts find rest" (Quran 13:28). 4. "Remember Me, I will remember you; thank Me and reject Me not" (Quran 2:152). 5. "Remember thy Lord much and praise Him in the evening and morning" (Quran 3:41). 6. "Such as those who remember God standing, sitting and reclining" (Quran 3:191). 7. "and men who remember God much and women who remember God, God has prepared for them forgiveness and a vast reward" (Quran 33:35). 8. "O you believe! Remember God with much remembrance and glorify Him in the morning and evening" (Quran 33:41-42). Sayings of Prophet Muhammad (P) Prophet Muhammad, like all other prophets of God, was engaged in the remembrance (dhikr) of God most of the time. He is known to have said 1. "There is a polish for everything that removes the rust and the polish for the rust-of- heart is the dhikr (remembrance) of God." 2. He was asked which people are most virtuous and most highly esteemed by God on the Day of Judgement. The messenger of God (P) replied "Those who remember God often." 3. It is narrated in a hadith Qudsi (direct revelation to Prophet Muhammad) "God Most High says I am as my Servant - think I am. I am with him when he makes mention of Me. If he makes mention of Me by himself, I make mention of him to Myself. If he makes mention of Me in an assembly, I make mention of him in an assembly better than his. If he comes closer to Me a hand span, I come closer to him arms-length, if he comes to Me walking, I come to him running." Thus dhikr (meditation/remembrance) has been a practice of all Sufi sheikhs. In the words of Sheikh al-Mursi "dhikr pleases God, defeats and drives evil forces, increases livelihood, makes personality more prestigious, cleanses the heart, removes the faults and saves the tongue from lying, gossip, backbiting and hypocrisy while engaged in the remembrance of God." Seeking Help with Prayers According to Imam Ghazali (ra), illness increases faith and brings man closer to God. Knowing this nature, we are told in Quran - "O you who believe, seek help with patience and prayers, as God is with those who patiently persevere" (Quran 2:153). Prophet Muhammad (P) when he visited the sick, used to comfort him and say the following Prayer for the Sick - "O Allah remove the hardship, O Lord of mankind, grant cure for You are the Healer. There is no cure but from You, a cure which leaves no illness behind." Transliteration - "Allahumma Azhibil bas, Rabbannas, Ishfi wa anta Shafi, La Shifa illa Shafaok. Shifaal La Yoghadiro saqama." He used to make following prayer for his own health - "O Allah cure my body, cure my heart and cure my eyesight from any illness" (repeated 3 times). Transliteration - "Allahumma Afini fi badni, afini fi qalbi wa afini fi basari" (3 times). Do Prayers Work? Yes they do. Dr. Larry Dossey in his book "The Healing Words" has documented the healing effects of prayer. Citing one example from the research conducted by Dr. Byrd at San Francisco General Hospital in 1988, 393 critically ill heart patients admitted to the intensive care units over a 10-month period were divided in 2 groups. Group A were the patients who were prayed for by name till they left the hospital. Group B were not prayed for. The prayer makers were not told how to pray. The results were very interesting. Those who were prayed for left the hospital early, had less cardiac arrest, 2-1/2 times less incidence of congestive heart failure and needed 1/5th less antibiotics. They also observed that prayer combined with loving care worked even better. Men who had angina pectoris and a loving caring wife, reported 50% more reduction in angina than men who were single or divorced. Prayers work for us even while we are sleeping. Thus Prophet Muhammad (P) has advised us to say prayers from Quran (Surah Ikhlas, Al Falaq, Annas and/or last verse of Al Baqra (2:286) before going to sleep. My Own Practice I do dhikr in all my free time, especially while driving, and I pray for myself, my family, my friends and my patients by name, knowing that cure is only from God. One time I visited a critically ill patient who had an adrenal tumor (pheochromocytoma) and was in hypotensive shock. I asked her what could I do for her and she, out of desperation (doctors had told her she wouldn't make it) asked me to pray. So I placed my hand over the site of the tumor and made the Prophetic Prayer and left. The next day when I came, I was surprised to see her sitting up in bed smiling. She told me that evening the radiologist x-rayed her again and found no trace of the tumor. He could not explain it but thought the arteriogram may have "infarcted the tumor." The Sufi Practices In the treatment of diseases, Sufis use prayers and the knowledge of specific verse of Quran and names of Allah (Asmae husna). This is called the Science of Tawidh (Taweez). They use science of numerology associated with Arabic alphabets. Some sample tawidh is given for illustration. One must know the healing is not in a piece of paper, words or numbers, but only from Allah. In my humble opinion, Tawidh is only a way to become God-conscious and receive His mercy as a result. *Clinical Associate Professor of Medicine, Indiana University School of Medicine. Presented on March 7, 1997 at the 4th Annual Convention of International Association for Sufism, San Francisco, California. Dr. Athar is also the Chairman, Medical Ethics of Islamic Medical Association of North American and Member IAS. He is the author of "Health Concerns for Believers" and edited "Islamic Perspective in Medicine."
  7. Medical Ethics Questions From the Audience During the Medical Ethics Symposium at ISNA Convention, 1997 and answers by *Dr. Hassan Hathout and compiled by ** Dr. Shahid Athar Medical Ethics is not an exercise between all black or all white, or absolute right or all wrong but, in gray areas, when it is not clear, in Medical Ethics we try to find a better answer over the worse one. The difference between what can be done and what should be done is the reason for Medical Ethics. The objectives of Islamic Shariah (Laws) is for the protection of individual life, religion, mind, property and family. In difficult cases, the rules are: a) take the lessor of the two evils, B) necessity overrides the prohibition. Q.1. Is CPR (Cardio Pulmonary Resuscitation) part of the mandate to maintain life. What is the status of DNR and code "C"? A. When the treatment becomes - scientifically - futile (i.e. hopeless), it is no more mandatory, and DNR would be acceptable. Q.2. Is it OK to withdraw the life support system for example: ( A Ventilator for a patient who has no cerebral function and is in a vegetative state)? A. Same answer as questions 1. If there is no hope of treatment, you may withdraw the life support equipment. In an attempt to prolong life without quality, one must not prolong the misery at a high cost. Q.3. When a terminally ill patient and their families reject medical treatment saying that "it is God's will", what should a physician do? In the same context, if the physician suggests DNR, then what should the families do? A. a.) Rejecting treatment; Tell them that treatment is also God's will , that Jesus said, "I cure the sick with the leave of God"; That Mohammed said "your body has right on you, and said: seek treatment, servants of God, for every illness God created, he created a treatment for=2E (B.) The family should comply because the physician is one who knows best. But the decision is theirs. Q. 4. What is the definition of "dead" when do you say it is OK to turn the machine off when the patient is dead? Is brain death and brain stem death the same thing? A. Bra in death is no synonymous with brain stem death and does not mean death. Brain death including brain stem death, means death. The brain stem contains the centers for breathing and the heart. Thus brain stem death fulfills the requirements of Cardio-pulmonary death. Q. 5. If a person is in a vegetative state on artificial life support but he is not brain dead but his survival chances are minimal, are physicians' allowed to turn off the machine at this point? A. If "minimal" means hopeless upon scientific assessment, one may turn off and withdraw life support. Q.6. Should cancer patients' requiring heavy pain medication take the medication or be in pain patiently and remember God. A. They must be given pain medication, remember God, and be patient about residual inevitable pain that cannot be relieved medically. A heavy dose of is permitted if necessary, provided the intention (niyyah) is not to kill the patient. Q.7. Should a Muslim patient with terminal cancer or parents of a newborn with a congenital defect with a poor chance to survive seek the most invasive and most expensive treatment and do whatever that can be done to save lives or submit to God's will and accept death? A. Heroic treatment with poor prognosis is not an Islamic requirement, if scientifically it has no promise of cure. Q.8. Is organ donation permitted in Islam? A. Certainly with the juridical safeguards. "An whoever saves a soul it would be as if he had saved all mankind". It should be given as a gift. The sale of an organ is prohibited. (Quran 5:32) Q.9. Is receiving organs for transplantation from an animal source permitted and especially if the animal is a pig? A. Certainly permitted. Necessity overrules prohibitions in the juridical rule. Q.10. Is it necessary to have the permission from the donor or a relative to receive the organ? A. Definitely yes. Q.11. What is the Islamic position on fetal tissue transplant? A. As long as the procurement of the fetal tissue is legitimate, it is alright. It is not permissible to conceive or to induce abortion of a fetus for the sole purpose of taking its tissues for therapeutic use. Q.12. What type of contraceptions are allowed in Islam? A. As long as they are not harmful; they are not abortifacient; or they do not cause sterility. Q.13. How come contraception is allowed and abortion is not? A. Contraception is a prevention of pregnancy; abortion extinguishes an existing human life. Q.14. If the fetus is diagnosed with a genetic disease such as Down's Syndrome, can the mother have an abortion? A. Islamically not but, also Islamically society should support the life of the child if the parents cannot. Q.15. Would you allow an abortion for pregnancy resulting from rape? A. No. Why ki ll an innocent life? But the baby should be the responsibility of society if the mother cannot support it. Coverage, care and sympathy are amongst her rights. I acknowledge a different position taken by other notable jurists. Why commit one crime because of another crime. Q.16. Is giving medication like RU 486 "the morning after pill" which prevents the formation of zygote equal to causing an abortion? A. No; unless the pregnancy has already formed or implanted. Q.17. Is the conception without implantation an abortion? A. I tend to take it as a different form of abortion. Q.18. If a mother is fertile but cannot carry the child for medical reasons, is surrogacy allowed? A. Not in Islam. Procreation emanates from a marriage contract, and a marriage contract accommodates two persons; husband and wife. Thus, assisted reproduction is allowed only between husband and wife while they are married. Q.19. When a woman is not able to have a baby, the man has the option of marrying another woman. What happens if the man is sterile, does the woman have any options. A. She has the legitimate option of procuring a divorce and marrying another man. Q.20. What is your view about permanent sterilization? A. Only for permanent medical indication or for the parous woman approaching her menopause. Q.21. When does life begin? At inception or at 120 days "when the spirit is blown"? A. Life and spirit are not synonymous. Life begins at the inception, fusion of sperm and egg. Abortion in both stages is a crime however, it is a more severe crime in the second stage. Q.22. Is cloning permissible or not? A. A short answer is no. A cell from a sterile husband to be cloned and incubated in his wife's uterus requires independent consideration but, the "sliding slope" factor should be taken very seriously. However, genetic engineering deletion of a gene to cure a disease is acceptable. Q.23. Is homosexuality genetic or inborn? A. Please clarify the difference between genetic and inborn. Whatever its cause, its practice is prohibited. In Islam, the key is not "Be what you are" but "Be what you should be", irrespective of moods and inclinations. Sometimes inborn conditions can have a genetic expression later on. Q.24. Are Muslims allowed to consume medications which contain alcohol or pig by-products? A. Only if it is a life saving necessity, when non-alcoholic and non-pork medicines ate not available. = Q.25. If a Muslin doctor who is apposed to abortion and euthanasia is asked by his non-Muslim patient to perform such procedures which is also acceptable in the States, should he refuse because of his personal convictions? A. Yes. There is room for the conscientious objector in our system. Q.26. I am a medical student and I would like to know if it is OK for a female doctor to examine male patients private areas, or is it OK for a male doctor to be a Gynecologist? A. It is alright, early jurists allowed it. Medical Figh Conference in Kuwait in the 80's allowed it for the purposes of diagnosis, treatment and medical education. The Niyyah, (intention) however, is of crucial importance in the individual case. Patients' preferences should be respected. Q.27. Do Medical Ethics slow down medical research and progress? A. It should not. Safeguards and regulations are necessary if medicine is to remain medicine. -------------------------------------------------------------------------------- **Shahid Athar, M.D., F.A.C.E., F.A.C.P. is Clinical Associate Professor of Medicine at the Indiana University School of Medicine. He is also the Chair of Medical Ethics. Committee of the Islamic Medical Association. *Hassan Hathout, M.D., Ph.D., F.R.C.O.G. is a retired Professor of OB/GYN and now devoted full time for Islamic D'awa. He is the author of Reading the Muslim Mind (ATP)
  8. Contemporary Issues in the Practice of Islamic Medicine Dr. Shahid Athar, MD Indianapolis, Indiana -------------------------------------------------------------------------------- Abstract Today's Muslim physicians must come out of the glory of the past and revive the concepts of Islamic medicine as it applies to today's patient care, health care, research, and education. They are obligated not only to find cures for diseases not now curable, but also emphasize preventive aspects in all illnesses, physical, mental, and spiritual. They should be able to provide Islamic perspectives in health issues, such as medical ethics, and come up with scientific explanations for Islamic principles and prohibitions. In order to achieve this, they need to excel not only in contemporary knowledge and skill but also be able to comprehend the philosophy of Islam and Islamic medicine. Key words: Muslim physician, medical ethics, health care program. Each Muslim physician should ask himself the following questions: 1. In his medical school curriculum, was he taught about contributions of Muslim physicians of the past and Islamic philosophy of medicine and ethics? 2. Since graduation: a. How many research articles has he written or contributed to? b. Which clinical or research journals does he subscribe to or read daily or weekly? c. Which professional organizations does he belong to, and does he attend their meetings? What are his CME hours per year? d. Does he understand the changing government regulations, i.e., IPO, PPO, HMO, DRG, capitation, etc.? e. Can he make ethical decisions for a Muslim patient? In our last survey, 11% could not. f. Do most of his patients and colleagues know he is a Muslim? The exact number of Muslim physicians in the world is not known; however, there are about 100 medical schools in Muslim countries. If each of them produced even 200 physicians a year, the estimated number would be at least 20,000 Muslim physicians yearly. The number of Muslim physicians in the United States is estimated to be 15,000. Nearly all Muslim medical schools have a Western medical education curriculum in which there is emphasis on the technology of the science of medicine. The emphasis is on how to give the students knowledge of physiology, anatomy, pharmacology and biochemistry, and then applied sciences of medicine, surgery, gynecology, ophthalmology, etc., so that students will graduate in 4-5 years and go into the business of practicing medicine. In their practice they will be involved in making a diagnosis depending on the signs, symptoms, and laboratory testing of a particular case, and then either prescribing medicine or surgery according to what they have been told to do in the book and by their teachers. This is not enough because they will not be taught the business aspects of medicine and insurance and government regulations; they will have to learn practice management on their own after a few years of being in practice. The art of practicing Western medicine will come even later. Their eyes and ears will be closed to the spiritual aspects of medicine. Their decisions will be test- and procedure-oriented, and they will fail to make a connection between a disease of the body and that of the soul. Very few of them will realize that the physical disease may sometimes be just a manifestation of an abnormal lifestyle or a spiritual problem. Many of these medical graduates will end up becoming specialists in the disease of an area of one organ only. They will not be able to practice holistic medicine. A few of these medical graduates in the early years of their practice will even think of medical ethics as a real entity and leave those decisions to either ethnicity or religious scholars. Thus, most physicians trained in Western secular education are nothing but technicians and scientists rather than the Hukania or A'tibbd' that Islam had produced in the past in the form of ibn Sina, al-Razi, and others. We have to introduce Islam in the curriculum of medical education so that not only these physicians will have the technical knowledge of functions of the body organs and low they become ill, but also will be aware of all other influences on health. They must excel in the contemporary knowledge of medicine and skill, but also to some degree, in the philosophy of Islam so that they can combine the two. Traditional medicine of the past with contemporary medicine of today can be merged because the physician can practice both at the same time for a given patient. In order to achieve this, we need to rewrite the textbooks of medical branches or specialties with an Islamic perspective. For example, if I have to write a chapter on heart diseases, I must start with the place of the heart in Islamic philosophy and knowledge as Sufis have described. From there I must give a history of Muslim physicians of the past, like ibn Nafis and al-Razi, who have worked to develop the knowledge of cardiology. Then I will come to the contemporary knowledge of anatomy and physiology of the heart, and then the diseases that may affect it. When it comes to the treatment aspects after describing the modern treatment of medicine's electro physiology, bypass surgery, I must conclude with the spiritual care of the heart with a clean life, meditation, and "Dhikr" (remembrance of Allah). The same format can apply to other areas of diseases like diabetes. A physician coming out of such a program will have a total picture of the problem and will be able to give a contemporary knowledge and a solution from the Islamic perspective. The second issue in the practice of Islamic medicine, as it applies to Muslim physicians, is the area of continued research. Prophet Muhammad [PBUH] said, "God has not created any disease without a cure." This obligates all Muslim physicians to search for a cure. We also need to search for the cause. Therefore, the concept of research in both basic sciences and applied medicine is a must for the curricula of all medical schools. Medical schools should be encouraged to do so in the very beginning rather than wait for the students to finish their training and begin research fellowships. For each medical school and hospital in Muslim countries, part of the budget must be allocated for only research of a retrospective and prospective nature with well planned trials. Journals should be encouraged to publish reports of successes as well as failures. Failures are important in the sense that people do the same research again, only to find out that this was done many years ago and was found to have negative results but was not published. No health care program is effective unless it has aspects of preventive medicine that include hygiene, nutrition, and mental illness. Therefore, cleanliness, for example, should be a prerequisite for all health care programs, not only for government and health officials but also individuals who should be compulsive about keeping everything clean, as it has been said by our prophet [PBUH] that "cleanliness is half of the faith." However, personal cleanliness is not seen in most Muslim countries, why? The third area of concern in the contemporary issues of the practice of medicine is presenting Islamic perspectives in health care and medical ethics issues that include termination of life, artificial respiration, surrogate parenting, abortion, euthanasia, and care of homosexuals and AIDS patients. There should be a clear consensus on such issues so that the cost of care is optimized and guidelines are available for everyone to see and use. A team of researchers qualified both in medicine and Islam would be able to give some perspectives with scientific explanation for Islamic injunctions and prohibitions. It is hoped that the combination of the two reasons will increase the belief in a given individual with regard to staying away from such things for the betterment of society. I am proposing that each medical school curriculum should also be looked at by Islamic scholars, preferably including a Muslim physician, to see if this curriculum will produce a Muslim physician or any physician, if there is a difference. In terms of pharmacology, there is no reason as to why we cannot incorporate some of the Yunani (Greek) practices in medicine, along with necessary Western medicine; there is no reason as to why we cannot include prayer, meditation, and dhikr, along with psychotropic medicine for psychological illnesses. I am happy to know that the Hamdard University is going in this direction, and we hope to start a similar university in this country and produce Muslim physicians practicing Islamic medicine. Finally, on an individual level, a Muslim physician must try to accomplish all those questions that were mentioned earlier. Yes, there can be Muslim physicians of tomorrow practicing Islamic medicine if we believe in the concept and work toward the goal. -------------------------------------------------------------------------------- From the Department of medicine and Endocrinology St. Vincent Hospital and Indiana University School of Medicine Indianapolis, Indiana
  9. "Effects Of Prohibited Foods, Intoxicants, And Ingredients On Human Hormones And Behavior" Dr. Shahid Athar, M.D. Quranic Prohibitions: FOOD: 2: 173 " He has forbidden you dead meat, and blood, and flesh of swine , and on which any other name has been invoked besides that of Allah. But if one is forced by necessity without willful disobedience, nor transgressing, due limits.... than he is not guilty, for Allah is forgiving, merciful." 5:4 " Forbidden to you are: Dead meat, blood, the flesh of swine and that on which has been invoked a name other than Allah's, and that killed by strangling, or by a violent blow, or by a headlong fall, or by being gored to death: That which has been eaten by a wild animal: Unless you are able to slaughter it, that which has been sacrificed on stone: (forbidden) also is the divination of arrows: that is impiety. 6:145 "Say: I find not in the Message received by me by inspiration any meat forbidden to be eaten by one who wishes to eat of it, unless it be dead meat, or blood poured forth, or the flesh of swine, for it is an abomination, - or what is impious, (meat) on which a name has been invoked, other than God's. But even so, if a person is forced by necessity without wilful disobedience, nor transgressing due limits, - Your Lord is Oft-Forgiving , Most Merciful." 16:115 "He has-only forbidden you dead meat, and blood; and the flesh of swine, and any (food) over which the name of other than God has been invoked. But if one is forced by necessity without wilful disobedience, nor transgressing due limits, - Your Lord is Oft-Forgiving , Most Merciful." INTOXICANTS: 2:219 "They ask you concerning wine and gambling. Say: "In them there is great sin, and some profit, for men, but sin is greater than the profit." 4:43 "O you who believe! Approach not prayers, with a mind befogged, until you can understand all that you say." 5:90 "O you who believe! Intoxicants and gambling, (dedication of) stones, and (divination by) arrows, are an abomination of Satan's handiwork. Avoid such (abomination) that you may prosper." 5:91 "Satan's plan is to sow enmity and hatred among you with intoxicants and gambling, and to hinder you from the remembrance of Allah and from prayer. Will you not then give up." PROPHET MOHAMMED (PBUH)ON THE SUBJECT OF LAWFUL AND PROHIBITED. I. "That which is lawful is plain and that which is unlawful is plain and between the two of them are doubtful matters about which many people do not know. Thus he who avoids doubtful matters clears himself in regards to his religion and his honour, but he who falls into doubtful matters falls into that which is unlawful." (narrated by Abu Abdullah An Numan Bin Bashar-R.A. Reported in Bukhari and Muslim.) 2. "Allah the Almighty has laid down religious duties, so do not neglect them; He has set boundaries, so do not cross them; He has prohibited some things, so do not violate them; about some things. He was silent out of compassion for you, not due to forgetfulness-, so do not seek after them." (narrated by Abu Tbalaba Al Khushani Jurtum Bin Nashir-R.A.reported in Ad-Daraqutni.) 3. "Allah the Almighty is pure and accepts only that which is pure. Allah has asked the believers to do that He asked the messengers, and the Almighty has said: (23:5 1) " 0 you messengers! Eat of the pure things and do right." And Allah the Almighty has said: (2:172) "O you who believe! Eat of the pure things that we have provided you." Then the Prophet (pbuh) gave example of a man tired and dusty after a long journey, raises his hands to the sky and says: "O Lord! 0 Lord!".. while his food is unlawful, Ns drink is unlawful, his clothing is unlawful, and he is nourished unlawfully, so how can his prayers be answered?" (Narrated by Abu Huraira-R.A. reported in Muslim.) INTRODUCTION: It is not required of the believer to always find a scientific justification for the divine prohibitions.However, if they look and find it, they must share the information, that will increase their faith. To the contrary, lack of confirmation should not question the authenticity of the Quran. We believe that all Quranic statements are true, and if science has not confirmed some of them yet, it will do so in the future, may be it needs to examine its data more deeply or repeat the experiment. For the benefits of non-medical readers, before I describe the topic in question i.e. hormonal and behavioral effect of prohibited food, intoxicants and ingredients, I must define some medical terms and inter-relationships: HORMONES: These are the powerful secretions of Endocfine (internal) glands. They control the functions of all organs, and even individual cells. They are made from proteins (peptides) or sterols in nature. The endocrine glands are hypothalmus which secretes various releasing hormones for pituitary, and pituitary which secretes hormones for target endocrine glands. Both of them are inside the brain. Target endocrine glands are thyroid hormones. Thyroid hormones control our metabolism, energy level, and temperature tolerance. Behind them are para-thyroid gland which control our calcium metabolism. In the abdomen are adrenal glands above the kidneys which secrete cortisone, the life saving essential hormone, and catecholamines and aldosterone which control our blood pressure and heart-rate. steroids and catecholamines are derived from cholesterol. Also in the abdomen is the pancreas which secretes insulin which lowers blood sugar, and glycogen which raises a low blood sugar. Lower down in the pelvis are gonads, ovaries in women, and testes in men, which secrete estrogen, progesterone and testosterone respectively. All these hormones have internal control, and influence each other. They control our growth, muscle mass, bone development, temperature tolerance, blood pressure, energy, fertility, sex desire, thirst, and well being in general. HOW DO HORMONES AFFECT BEHAVIOR: The site of secretion of releasing hormone, and of neurotransmitter in the brain are the same in the hypothalmic area. Most of the psychotropic drugs either act by increasing or decreasing the neurotransmitter levels i.e epinephrine, norepinephrine, serotonin, dopamine or endorphrin level in the hypothalmic area. Similarly, peurotransmitters influence hormone secretion. Clinically we see various behavioral manifestations in endocrine disorders. Hypoglycemic patients (low blood sugar) suffer from depression and poor mental concentration and patients with low thyroid have impotency and depression, while patients with high thyroid have agitation, irritability, and lack of sleep. Patients with low cortisone (Addison Disease) have severe depression while with high cortisone have hallucination and psychosis. Patients with high testosterone have been claimed to have criminal tendencies (i.e. rapists) while low testosterone have behavioral problems in adjustment. Patients with calcium changes. Physiologically, boys and girls are different in playing behavior i.e. aggressive versus passive (playing with mechanical toys and guns versus dolls) due to difference in their sex hormone even in pre-pubertal age. This becomes more obvious after full sex differentiation takes place. In fact, by changing the sex hormone level of a given sex one can change not only the sexual behavior but the aggressiveness of a particular sex. Homosexual males have been noted to have less male sex hormones, and on the other hand, repeated sex offending males can be "cured" by castration or by the injection of the female hormone progesterone. In one experiment, female rats whose mothers were treated with testosterone while pregnant showed male behavior pattern of threatening peer, rough play, and increased sexual activity as compared to a control rat. This shows that testosterone not only affects the individual, but the offspring as well. Girls with congenital adrenal hyperplasia (excessive testosterone secretion) when in post puberty age show tomboy attitude with liking rough sports, preferring boys as playmates, and low interest in dolls and baby care. Sexual behavior is not only affected by testosterone, but also by the pineal gland which is turned off and on by light and darkness. Hormones, not directly but indirectly by controlling\sugar, calcium, sodium balance,affect behavior in general to include anger, love, anxiety, panic attacks, and agitation. The hyperactivity in children could be due to low blood sugar or due to many food preservatives and coloring agent like nitrites, and Dye No. 5. After this much introduction of hormones, and behavior, I turn to the main theme. HORMONAL AND BEHAVIORAL EEFFECT OF PORK MEAT AND FAT INGESTION: Pork meat and fat are not only prohibited to Muslims, but were also prohibited to Jews and Christians as well because "Swine were designed to be scavengers, to eat up filth." In old testament Leviticus Chapter 7-8, it is mentioned about swine " Though he divides the hoof and be cloven footed, yet he cheweth not the cud, he is unclean to you. Of their flesh shall you not eat." There is no mention in the Bible that Jesus ever ate pork in his life. It was Paul who declared all food and drink permissible saying, "To the pure, everything is pure." THE LIFE OF THE SWINE: To get a first hand idea, I interviewed farmers of Fisher, Indiana, who breed swine. According to them "Swine is cheaper to breed, since it does not require pasture, it can live on manure and other such items including dead meat. In fact, it can even eat its own feces. Their sexual habits are also different from other animals like cow, sheep and goat. Swine have very little shame i.e. engage in sex acts anytime anyplace. The female hog is very aggressive in sexual activities when she is in "heat" she does not care about anything (i.e. food or privacy) until she has the sex. They i.e. swine, also lick the genitals of their partners after sex like dogs, but not other mammals like cow, sheep or goat." WHY IS PORK FAT DIFFERENT FROM OTHER ANIMAL FAT: Fats are lipids which are a source of energy. They can be of vegetable source or of animal source. Triglycerides are neutral fats with 1 molecule of glycerol and three fatty acids. The fatty acids can be saturated or unsaturated.The more unsaturated fats have high melting points. The iodine value of fat gives the degree of un saturation. The iodine value of lard is 65, beef 45, and mutton 32. After ingestion, emulsification of fat takes place in the stomach by gastric lipase. By pancreatic lipase hydrolysis of triglyceride into glycerol and fatty acids takes place. The fatty acids and glycerol are used by various tissues like muscle, heart, kidney, and liver for an energy source. Herbivorous (plant eating) animals have unsaturated fatty acid on the position 2 of the triglyceride (tg) molecule, while the carnivorous (meat eating )animals have saturated fatty acid at the position 2. Pancreatic lipase (pl) can not hydrolyze TG molecule if saturated fatty acid at position 2. Fat of dogs, rats, cats, and pork, have saturated fatty acids on positions 2. If a person eats fat of herbivomus animal, the fat will be hydrolyzed, absorbed, and then re synthesized and stored as human fat, while that of carnivorous animals and pork fat will not be hydrolyzed and therefore has to be deposited in humans as pork fat in the adipose tissue. WHAT HAS DEPOSITION OF PORK FAT TO DO WITH HORMONE AND BEHAVIOR IN HUMANS: Circulating hormones are in bound form and free form. The free form has to be attached to receptor in fat tissue before becoming active. Obesity decreases the number of receptors therefore the hormones cannot be utilized. Therefore, if the hormone is insulin, it leads to diabetes (type 2); and if it is testosterone, it leads to sub fertility and amenorrhea. The amount of fat also controls hormone release. Therefore we see menarche is delayed in athletic girls with less fat, and occurs early in sedentary overweight girls. It can be postulated that in humans who have pork fat deposit there is derangement in the binding of hormones, therefore they have a higher level of circulating active hormone. It is possible that the sexual promiscuity and deviant sexual practices of pork eating society is due to what they eat ! After all, it has been said by nutritionists, "Yor are what you eat." Since this is a paper on hormones and behavior, the time does not permit discussing the effect of pork on cholesterol, sodium and the relationship to heart disease. EFFECTS OF DEAD MEAT AND BLOOD INGESTION: Dead meat is the meat of animal which died before slaughtering and blood could not flow out, and blood ingestion is not only the drinking of blood as it was prevalent in the Jahiliya of Arabia or even now in Africa (and in France) but also the blood which is retained inside the meat by improper killing of the animal. All hormones, and antibodies are retained in the blood, and all infective organisms including virus flourish in the blood media, therefore ingestion of such will be dangerous midecally. It may also induce animal instincts as seen in carnivorous animals like dogs, cats, and lions. HORMONAL EFFECTS OF ALCOHOL: Both in acute and chronic alcoholism, endocrine glands are affected. Hypoglycemia is a manifestation of acute alcoholism which may be severe, and can lead to coma. This should be recognized and treated with dextrose intravenously since it mat not respond to glycogen. Low magnesium with resultant low calcium is another effect resulting in poor concentration, muscle twitching and even seizure. Increase in urine flow is due to depression of antidiuretic hormone. Chronic alcoholism leads to pancreatitis with failure of pancreatic endocrine system (sometimes Diabetes) and exocrine gland (malnutrition). This leads to protein deficiency leading to reduced production of testosterone, which may lead to impotency, gynecomastia in men and amenorrhea in women. Alcoholics can also have a pseudo (false) cushing syndrome. Alcohol related liver disease causes increased clearance of testosterone with testicular atrophy leading to true hypogonadism. Sperm formation is also affected leading to infertility. Infants born to an alcoholic mother can also have undercended testes and labial hypoplasia. In addition, the cortisol levels are increased during withdrawal, while LH and LH-RH levels are suppressed during chronic alcoholism. BEHAVIORAL EFFECTS OF ALCOHOL: Alcohol, being a central nervous system depressant, depresses both facilitatory and inhibitory pathways. It is the suppression of the latter that abolishes the shame and removes control. Therefore, what a normal person will be prevented from doing i.e. abusive language, undressing in public, etc. will not be prevented under the influence of alcohol. There are more serious behavioral disorders described to include brain disjunction in 50- 70%, memory loss, depression both acute and chronic, high suicide rate, mood fluctuation, delirium tremorous (DTS) in withdrawal state, and blackout spells during drinking. One-third of all auto accidents are due to alcoholism. Under the influence of alcohol are mental judgement and motor skills, which are both affected. Sometimes the level of consciousness is also affected. Alcohol had been found to be at the root of family violence, sexual violence, rape, assault, and child abuse. Alcohol is not an aphrodisiac, as it is claimed. Not only does it depress the central nervous system's effect on the libido, but actually lowers the penile blood flow and tumescence (swelling) thereby decreasing the performance. EFFECTS OF NARCOTICS (COCAINE & MARIJUANA) ON HORMONES AND BEHAVIOR: Both LSD and cocaine cause decreases in plasma testosterone and LH. The aphrodisiac effect is due to local anesthesia causing prolonged erection and central stimulation causing general well being. Also by inhibiting the inhibitions, they encourage engagement in unusual sex acts like sodomy or oral genital sex. Psychologically they cause mood elation and a false sense of euphoria followed by depression, anxiety and agitation Panic attacks, suicidal tendencies, and violent behaviors are not uncommon. Chronic usage may lead to schizophrenia, paranoia, and a variety of psychiatric disorders, even infants born to cocaine addicted mothers show signs of withdrawal. EFFECTS OF INGREDIENTS ON HORMONES AND BEHAVIOR: If ingredients are of prohibited nature, i.e. pork, lard, alcohol, cocaine etc., the effect will be as described earlier, though because of the small quantity, the effect will be slow and may be cumulative. More serious are items like sugar which causes reactive hypoglycemia; sodium which may lead to hypertension; DES (Diethylstillbestrol, a female hormone given to cattle and chickens to increase fat and muscle content) linked to vaginal and cervical cancer in women; and artificial sweeteners like saccharine related to bladder cancer in rats, and aspartame related to brain damage. CONCLUSION: More research is needed on all of the above areas, especially those affecting the life style of Muslims. Though usage of prohibited items are not commonly found in Muslims, the dangers also may come to their health and spirits by the effects of non-prohibited items like western rock music, dress (i.e. tight jeans affecting testicular temperature) and sexual practices, and cigarette smoking. -------------------------------------------------------------------------------- SELECTED REFERENCES: 1. -Qur'an;2:173,5:4,6:145,16:115,2:219,4:43,5:98,5:91 . 2. - Yusaf Al Qardawi; The Lawful and Prohibited in Islam: 39-61. 3. - Hussaini, M.M. and A.H. Sakr. 1983, Islamic Dietary Laws and Practices, Published by the Islamic Food and Nutiition Council of America, Chicago, Illinois U.S.A. 4. -William,R.H.;Test Book of Endocrinolocy. 6th edition:chapter on Psychoendocrinology. 5. - Felig & Baxter; Endocrinology and Metabolism. 6. - Goodart & Shils; Modern Nutrition in Health And Disease: 6th edition. 7. -Badri,M.B.; Islam and Alcoholism: ATP Publication, lndianapolis. 8. - Saud, M.A.; Sex Roles in Muslim Families in U.S.A.; Published in Al-ittihad. 9. - Drucker, WM.; Endocrinc Abnormalities caused by Alcobolism; Medical Aspect of Human Sexuality-Vol. 16, No. 12, Dec. 1982. 10. - Eckardt et a]; Health Hazard Associated with Alcohol Consumption: JAMA 1981. 11. - Washton and Stone; Human Cost of Cocaine Use; Medical Aspects of Human Sexuality-Vol. 18, No. II, Nov. 1984. PRESENTED ON: September 20, 1986 at the Fourth Annual Convention of the Islamic Food and Nutrition Council of America, held at the Muslim Community Center, Chicago.
  10. Medical Ethics Questions Asked by Muslims in the USA Received via E-mail and Their Short Answers by Dr. Shahid Athar, MD, FACP, FACE -------------------------------------------------------------------------------- Q. Can Muslim patients take medicines which may contain alcohol or pig by- products? A. No, Muslims should not take these medicines unless they are life saving drugs and no substitute is available. Q. I am 3 months pregnant and doing fine. Can I fast during Ramadan? A. It is preferable that you utilize God's granted exemption and do not fast. Your baby is dependent on you for his or her nutrition and hydration. Why do you want him or her to fast with you? Q. Is use of placebos in clinical trial endorsed by Muslim Ethicists? A. Yes, but make sure that the protocol is fully explained to the patient and by delaying the treatment, no worsening of his medical condition takes place nor his life is endangered. Q. While fasting can a Muslim patient have a blood test (venous draw) or check his glucose with a finger stick? A. Yes, if it is a medical necessity. Q. While fasting can a Muslim patient take tablets, injections, inhalers or patches? A. The general rules are: (1) Sick patients are exempt from fasting. (2) Any medicine of nutritional value or taken with water will break the fast. (3) Patches and inhalers can be used. Q. On Separation of conjoined twins, one dependent on the other, which one to save? A. It is a difficult situation. The emphasis should be to save both lives and one cannot be sacrificed over the other. However, if one has to do so, the twin who cannot function on its own and acts as a vestigial organ of the other, may have to be sacrificed during the process of separation. Q. Should a female patient only seek a female Gynecologist? A. If available, same sex health care providers are encouraged but, if not available and in life saving situations, "necessity overrides the prohibition" - a rule of Islamic Sariah. Q. Can a female Physician do genital/rectal examination of male patients? A. Yes, but in the presence of a male nurse or male relative of the patient. The answer to the previous question also applies here. Q. Should Muslim Physicians care for AIDS patients? Is this endorsing homosexuality? A. We do not discriminate other patients because of their lifestyle (smokers, alcoholics, over eaters etc) nor should we do so for AIDS patients. We should care for them as we care for any patient, taking all the necessary precautions to protect ourselves. By the way, not all AIDS cases are due to homoxexuality. Q. Should Muslim OB/GYN Physicians perform abortion, vasectomy or tubal ligation? A. Such procedures are prohibited in Islam except to save the life of the mother. Thus, like Catholic Physicians, Muslim Physicians also may not perform them. Q. We are getting married and can not afford to have children, as both of us are still students. What contraception measures are allowed? A. All co ntraception measures between married couples for a valid reason and with consent of both are permitted if they are not irreversible (sterilization/tubal ligation), abortifacient ( RU 486, IUD ) or harmful ( oral contraceptives). That leaves only abstinence, condoms and the withdrawal method. Q. My wife can not conceive. Can she use her ovum and my sperm to be fertilized in her sister's uterus? A. No. Surrogacy is not permitted in Islam. Q. We got married 3 months ago. My husband is in a coma after an auto accident and is expected to die soon. I love him very much. Can I save his sperm to have his baby after his death? A. No. After his death, his sperm can not be used. All methods of assisted reproduction are allowed between husband and wife only during the intact span of marriage. Q. I am pregnant and expecting delivery soon. Should I request my husband be present but no other male attendant during labor? A. Yes. You can make such a request. Q. My friend is in the hospital. He is to have a major operation and will require blood. Is blood transfusion allowed and should we select the donor? A. Yes. Blood transfusion is allowed. Blood is routinely screened for HIV and other diseases. It would be nice if you could find a relative of your friend to match and donate his or her blood. Q. At what stage of pregnancy does the termination become abortion, after 120 days or before? A. According to Imam Ghazali School of Thought, to which I belong, life begins at conception, but other Islamic Jurists may have different opinions. Q. Is post-mortem (autopsy) of a dead body allowed? A. Yes, but only as a medical or legal necessity to ascertain the cause of death. Q. What should be done to the products of miscarriage? Should they be destroyed or buried? A. Preferably they should be handled with the same respect as another death and be buried if possible. Q. After a massive brain hemorrhage, my mother is in a coma and is on artificial life support. Her Physician says there is no hope of her surviving and wants to pull the plug. We love her very much. What should we do? A. Islam does not encourage prolonging misery in a vegetative state and patients should be allowed to die naturally when nothing more can be done. You should agree with the medical decision , maybe seek second opinion, but insist that hydration and nutrition be maintained. Q. Question from a medical student: "As a Physician, when I find out that my patient has a terminal illness and will die very soon, should I tell the truth to my patient and his family as soon as I know it myself? A. You should always tell the truth but do not be dogmatic about it. You can explain the diagnosis and natural history of the disease process but do not give a time limit as you do not know for sure when the patient will die. Q. My grandfather never took care of his diabetes. Now he has developed gangrene in his foot. Doctors recommend amputation to save the rest of his leg. He refuses. What should we do? A. You should talk to him again and again that God entrusted him with care of his body and if he does not do what Doctors recommend, his condition may worsen and he will be questioned about it on the day of judgement in addition to having additional suffering in this life. Q. My sister, who is pregnant, found out the baby has the congenital defect, Down's syndrome. Should she abort the fetus or carry it to term and spend her life caring for a disabled child? A. Carry to term. There is extra reward in going through this test from God in caring for such a child. Q. For a patient who has cancer with bone metastasis and is in constant pain, is it better that he takes strong pain killers all the time or be in pain and remember God? A. He should take pain killers as God does not want him to suffer. In severe pain he may not have the strength to remember God. Q. I am on a heart transplant waiting list. Should I accept a heart from a criminal or an atheist? A. Yes, and pray that God changes your new heart to adopt it to your pious body. Q. Should the pregnancy resulting from rape be continued to term or aborted? A. Carried to term unless the life of the mother is in danger. Why commit another crime? Q. Is patient's autonomy (i.e. right to not seek treatment) equal to planned suicide? If so, should it be allowed? A. Patient's autonomy involves a sound mind while suicide decision is made in severe depression. One can refuse treatment because of side effects, but to kill yourself is against the will of God. Q. I am a Muslim female medical student who does hijab (head cover). How can I scrub before surgery without removing my head cover and pulling up sleeves? A. You should do Masah (wadu) over the head cover, or remove in the presence of a female co-worker only. Q. Is gene therapy and genetic manipulation to cure diseases allowed? Can we use embryonic stem cells for this? A. To seek cure for a disease is mandatory. Thus, gene therapy is allowed and stem cells from spontaneously miscarried embryos can be used. However, it is wrong to conceive or create an embryo just to harvest cells and then destroy it. Presented at the 34th Annual and 5th International Convention of IMANA at Tehran, Iran on July 29, 2001.
  11. salam sis Zuljenah I really appreciate your honesty & franakness :) I was not refering to you though, I was refering to someone else. Sure ! We all need each other's help . You may need my help today and I may need your help tomorrow. May Allah help us to help each other!
  12. Males and females brains differ There are differences in the mental function of men and women according to the latest discovered evidence - thanks to an array of new imaging machines that have revolutionized neuroscience. Researchers are begining to glimpse the difference in how men's and women's brains function. With the new technologies, like: functional magnetic reasonance imaging (FMRI) and positron emission tomography (PET), researchers catch the brains in the very act cogitating, feeling or remembring. Reseachers say that men and women use different clumps of neurons when they rake a first step towards reading and when their brains are idling. Reports say that women engage more of their brains than men do when the think sad thoughts, but perhaps less of their brains when they solve math problems. Professor Richard Haier, of pediatrics and neurology at the university of California, Irvic, says, "Now that we actually have functional brain data, we are getting lots of new insights. Even at this early point we have data to support the idea that men and women in general have brains that work differently.". To compare male's and female's brain at work, volunteers got an injection of radiocative glucose and were told to think of nothing. For 30 minutes a volunter lay in a quiet dimly lit room wih eyes open and head in a tunnel with detectors embedded in the walls. Each volunteer was told to relax without exerting mental efforts.. While PET read his/her mind. When told to think of nothing, men fixate on sex and football, while women weave together strings of words. However, in men the pilot light is always on in neurons that control aggression and action. It may explain why they are more violence prone than women. The brain - imaging studies are the latest and the highest-tech, periscope into sex differences in brains, The researches serve as ammiunition in society's endless gender wars. When a talk was given to M.D. and PhD students in Illinios about sex differences in brains, a group of women asked the lecturer to stop publicizing the work. They were afraid women would lose 20 years of gains if word got out that: sexes are not the same! They have good reason to worry Passages in recent pop-science books say:" Male brains are not so easily distracted by superfluous inforrnation and: Women may be less able to Separate emotion from reason," and "the male brain is a tider affair". Even before scientists caught images of the brain thinking or emoting, there were hints that men's brains and women's differed. As long as 1880,English surgeon Jeames Crichton Browne reported slight differences in the brain anatomy of men and women: a slightly larger gaggle of neurons here in one sex and there in the other. But by far the most frequent finding through the years has been that the bundle of nerve cells through which the left side of the brain talks and listens to the right, is larger in women than in men. In 1991 a neuroendocrinologists examind 146 brains from cadavers and found that the back part of women's callosum (left part that talks and listens to the right) is up to 23% bigger than men's. The neuroscieniusts found it fitting their cherished idea that in male brains the right and the left side barely know what the other is doing; while in women there is practically nonstop left-right neural chitchat. Women's language ability better survivies a left-brain stroke perhaps because they tap language capacity of the right brain, the emotional right brain enriches their left brain vocabulary. Women have better intuition because they are in touch with the left brain's rationality and the right's emotions simultaneously. In November 1994, at the annual meeting of the society for Neuroscience, Sandra Witelson of Memaster University in Ontario, reported result from a study of MEN WOMEN nine outopsied brains. Women despite having smaller brains than men because their whole bodies are smaller have more neurons. The 11 % are all crammed in two layers of the cerebral cortex whose job is to understand language and rocognize melodies and tone of voice. The force, that prunes and stimulates, kills and nourishes the brain gaggles of neurons is the sex hormones. Before birth a fetus's brain is bathed in sex hormones different ones, different amounts depending on whether the fetus is male or female. Psychologist Doreem Kinura oF the University of Western Ontario wrote in 1992, "Hormonal effects appear to extend to all known behaviours in which males and females differ". Biology And Free will Aren't at Odds Each new finding leaves the impression that nature is winning out over nurture - that biology is destiny and free will is an illusion. But the nature - narture dichotomy is itself an illusion. Many scholars now are realizing that everything we associete with: nature, is at some level a product of our biology, and every aspect of our biology, from brain development to food preference, has been shaped by an environment.. To ask whether nature or nurture is more important is same as to ask whether length or width is a better gauge of size. In 1954, anthropologist Ashely Montagu declared that: .. Mankind has no instincts because everything... acquired from one's culture.".The distinction between innate and acquired, seems razor used to slice life. Development of the Brain While gestating in the womb, a child develops some 50 trillion neurons. But those cells become functional only as they respond to outside stimuli. During the first year of life the most frequently stimulated neurons form elabrate networks for proscessing information, while the others wither and die. One can say that brains determine the stucture of one's experience, or the experience determines the strucutre of one's brain. Social behavior follows the same principle. From the old nature - verses -nurture perspective, a tendency is that: Culture rather than nature, affects one's behavior. Biology does not determine exactly what one will do in life, but it determines how different environments will affect one. Biology itself is a record of the environments our ancestans encountered. Arciheological finding suggests that men hunted and women foraged, throughout vast stretches of evolutionary time. Psycholgists note:"......tracking and killing animals entail different kinds of spatial problems than does foraging for edible plants...." Violent crime, like overating and drunkness, has clear biological roots, but that does not mean it is inherent in any one's nature.As a social critic Robert Wirght noted, in a recent New Yorker article, that: "Low serotonion may leave people more prone to violence, but poor social conditions seem to lower serotonion levels. "Perhaps the best way to counter the biological cause of urban crimes ' It concludes, is to create better schools and higher paying jobs, to turn the inner cities to places where the young have non-violent routes to social status." Biology shapes our impulses and aptitudes, but it does not act alone Social factors interact throughout life process.
  13. salam brothers & sisters I think we need female doctors for this forum to answer the female-related questions. Male doctors can't answer & discuss all the questions related to women. The following reasons state why: 1) I think it's Haram (or leads to Haram) for both the man & the woman to discuss private matters unless otherwise they're married . 2) It's sometimes embarrassing for both the man & the woman. 3) We're not doctors yet, we're still students; therefore, the doctor-client privalage doesn't exit here. 4) Some women might get upset or offended when you be very frank with them about their case! 5) Some women might interpret the medical advice to something else. For these reasons we're looking for a female doctor for our shia chat public clinic :) Nurses , medical assistants & students are accepted. :D Your humble brother
  14. Happy Birthday brother/doctor Ali Asghar. P.S. I see most of shiachat members are becoming doctors now, is it contagious or what ? :) I suggest we open a clinic or public hospital here to treat our patients for free (volunteers ). We need nurses, medical assistants, pharmacy & ambulance for emergency cases. lol
  15. salam bro sag_IMAM-REZA (shiachat secret agent [FBI] :) Do you mean fake doctors or fake lawyers? Well, in my disclaimer i already said I am neither a doctor nor a lawyer. Your doctor & lawyer :)
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