User-agent: Google Allow: A Simple Guide to Medical Conditions: October 2011

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Sunday, October 30, 2011

A Family Doctor's Tale - VITAMIN B12 DEFICIENCY

DOC I HAVE VITAMIN B12 DEFICIENCY

Vitamin B12 (cyanocobalamin) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B12 as a result of inadequate dietary intake or impaired absorption.

Vitamin B12 is present in all living human tissues as an important  ingredient in the production of red blood cells.

Functions of Vitamin B12:
1.It is important in metabolism of labile methyl groups example biosynthesis of choline and methionine

2.It maintains glutathione in reduced state

3.It is important in the maturation of erythrocytes, neurologic function and growth.

Vitamin B12 is found primarily in
1.animal sources - red meat, liver, milk, egg yolks
2.vegetable sources: Vitamin B12 is found in fresh green and yellow vegetables, cereals

Optimal requirements of Vitamin B12 are:
1.adults and children above puberty: 1 mcg to 2 mcg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mcg to 1 mcg daily

Causes:
Vitamin B12 Deficiency occurs
1.when there is Vitamin B12 deficiencies due to
a.diet - starvation, vegetarians

b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis


c.intestinal parasites such as diphyllobothrium latum


d.pernicious anemia when the gastric mucosa  cannot produce the intrinsic factor necessary for vitamin B12 absorption

2.Severity of Vitamin B12 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B12 Deficiency is a silent disease in the early stages.
People with Vitamin B12 Deficiency often do not know that they have the condition.

2.Blood - anemia with pallor, shortness of breath and weakness


3.Brain -subacute combined degeneration of spinal cord and brain

  - numbness of hands and feet

                 -giddiness

                 -developmental delays and failure to thrive in children

4.Mental -depression, fatigue, mental confusion

Diagnosis:
1.Blood Vitamin B12 levels are low

Complications:

Serious complications of vitamin B12 deficiency include:

1.anemia

2.nerve damage

3.abnormalities in growth and development

4.brain dysfunction including depression and dementia

Treatment:
The goal of Vitamin B12 Deficiency treatment is the prevention of pernicious anemia and peripheral neuropathy.

Therefore, prevention of Vitamin B12 Deficiency is as important as treatment. Vitamin B12 Deficiency treatment and prevention measures are:

Medications:
Vitamin B12 supplements
1.Vitamin B12 is given at 100 mcg per day by injection which may be a life long treatment in cases when the body cannot absorb oral Vitamin B12


2.Oral Vitamin B12 tablets can be given in people who can absorb the vitamin in the stomach.

 It can also be given sublingually or through the nasal route.

3.treat the underlying causes such as gastric problems and gastrectomy, malabsorption, decreased intake in the case of vegetarians

Side effects of Vitamin B12 are:
1.Vitamin B12 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

Prognosis:
1.good response to treatment in Vitamin B12 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B12 Deficiency.

Prevention:
take more red meat, liver, egg yolks, cereals and fresh green vegetables.

Vegetarians should take Vitamin B12 supplements.

Friday, October 28, 2011

A Family Doctor's Tale - VITAMIN B6 DEFICIENCY

DOC I HAVE Vitamin B6 Deficiency

Vitamin B6(pyridoxine) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B6 as a result of inadequate dietary intake or impaired absorption.

Vitamin B6 is present in all living human tissues as an important  enzymes in amino acid metabolism

Functions of Vitamin B6:
1.It is converted to pyridoxal phosphate a co-enzyme of a seies of enzymes that atalyze tramination, decarboxylation and deamination of amin acids.

Vitamin B6 is found primarily in
1.animal sources - red meat, liver, milk, egg yolks
2.vegetable sources: Vitamin B6 is found in fresh green and yellow vegetables, cereals

It is rare as a isolated Vitamin B6 deficiency.

Optimal requirements of Vitamin B6 are:
1.adults and children above puberty: 1 mg to 2 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg to 1 mg daily

Causes:
Vitamin B6 Deficiency occurs
1.when there is Vitamin B6 deficiencies due to
a.diet - starvation,lactating mothers should take more Vitamin B6
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis
c.alcoholism
d.medications such as isoniazid, hydralazine, cycloserine and penicillamine

2.Severity of Vitamin B6 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B6 Deficiency is a silent disease in the early stages.
People with Vitamin B6 Deficiency often do not know that they have the condition.

2.Skin changes - seborrheic dermatitis of nose, mouth

3.Mucosal changes -oral erosions of the buccal lining

3.peripheral neuropathy

Diagnosis:
1.Blood Vitamin B6 levels are low

Treatment:
The goal of Vitamin B6 Deficiency treatment is the prevention of peripheral neuropathy and skin lesions.

Therefore, prevention of Vitamin B6 Deficiency is as important as treatment. Vitamin B6 Deficiency treatment and prevention measures are:

Medications:
Vitamin B6 supplements
1.Vitamin B6 is given at 5 mg per day orally until the response is adequate.

2.prevention of Vitamin B6 deficiency in people taking isoniazid, hydralazine, cycloserine and penicillinamine

3.Patients with homocystinuria
Side effects are:
1.Vitamin B6 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

2.It should not be given in patients taking levodopa because it antagonizes the effects of the drug.
Prognosis:
1.good response to treatment in Vitamin B6 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B6 Deficiency.

Prevention:
take more red meat, liver, egg yolks, cereals and fresh green vegetables.

Wednesday, October 26, 2011

A Family Doctor's Tale - VITAMIN B2 DEFICIENCY

DOC I HAVE Vitamin B2 Deficiency

Vitamin B2(riboflavin) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B2 as a result of inadequate dietary intake or impaired absorption.

Vitamin B2 is present in all living human tissues as an important anti-oxidant and enzymes in food metabolism

Functions of Vitamin B2:
1.It is necessary for normal growth and development of the fetus

2.It has a role to play in the release of ACTH from the pituitary gland.

3.It share the function with Vitamin A in visual processes.

Vitamin B2 is found primarily in
1.animal sources - liver, milk, egg yolks
2.vegetable sources: Vitamin B2 is found in fresh green and yellow vegetables, cereals

It is rare as a isolated Vitamin B2 deficiency.

Optimal requirements of Vitamin B2 are:
1.adults and children above puberty: 1 mg to 3 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg to 1 mg daily

Causes:
Vitamin B2 Deficiency occurs
1.when there is Vitamin B2 deficiencies due to
a.diet - starvation,lactating mothers should take more Vitamin B2
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin B2 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B2 Deficiency is a silent disease in the early stages.
People with Vitamin B2 Deficiency often do not know that they have the condition.

2.angular stomatitis

3.glossitis

4.cheilosis

5.seborrheic dermatitis

6.corneal lesions

7.In pregnant women, deficiciency of Vitamin B2 can lead to fetal deformities such as shortened bones and deformed growth.

Diagnosis:
1.Blood Vitamin B2 levels are low

Treatment:
The goal of Vitamin B2 Deficiency treatment is the prevention of peripheral neuropathy and heart failure.

Therefore, prevention of Vitamin B2 Deficiency is as important as treatment. Vitamin B2 Deficiency treatment and prevention measures are:

Medications:
Vitamin B2 supplements
1.Vitamin B2 is given at 5 mg per day orally until the response is adequate.

Side effects are:
1.Vitamin B2 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

Prognosis:
1.good response to treatment in Vitamin B2 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B2 Deficiency.

Prevention:
take more liver, egg yolks, cereals and fresh green vegetables.

Monday, October 24, 2011

A Family Doctor's Tale - VITAMIN B1 DEFICIENCY

DOC I HAVE Vitamin B1 Deficiency

Vitamin B1(thiamine) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B1 as a result of inadequate dietary intake or impaired absorption.

Vitamin B1 is present in all living human tissues as an important enzyme in the metabolism of carbohydrates.

Functions of Vitamin B1:
1.It is also required for metabolism of alpha-ketoacids and pyruvates in its carbohydrate form,

2.It is also a co-enzyme of pyruvate dehydrogenase and alpha-ketoglutarate both essential in carbohydrate metabolism.

3.It is also essential in production of acetylcholine.

4.It also play a part in energy metabolism for neurons and cardiac muscles.

Vitamin B1 is found primarily in
1.animal sources - liver. egg yolks
2.vegetable sources: Vitamin B1 is found in fresh green and yellow vegetables, cereals, whole grains and potatoes.

Unfortunately most of the active ingredients of Vitamin B1 is lost in cooking.

Optimal requirements of Vitamin B1 are:
1.adults and children above puberty: 1 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg daily

Causes:
Vitamin B1 Deficiency occurs
1.when there is Vitamin B1 deficiencies due to
a.diet - starvation,lactating mothers should take more Vitamin B1
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin B1 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B1 Deficiency is a silent disease in the early stages.
People with Vitamin B1 Deficiency often do not know that they have the condition.

2.Vitamin B1 deficiency can result in 2 major illnesses:
A.Beri Beri
1.peripheral neuropathy affective all the peripheral nerves
2.muscle weakness
3.anorexia
4.heart failure
5.aphonia and absent tendon reflexes in infants

B.Wernicke's Syndrome
1.Occurs in severe Vitamin B1 deficiency
2.brain hemorrhage
3.mental confusion
3.aphonia
4.weakness of sixth nerve
5.total opthalomoplegia (blindness)
6.coma and death

Diagnosis:
1.Blood Vitamin B1 levels are low

Treatment:
The goal of Vitamin B1 Deficiency treatment is the prevention of peripheral neuropathy and heart failure.

Therefore, prevention of Vitamin B1 Deficiency is as important as treatment. Vitamin B1 Deficiency treatment and prevention measures are:

Medications:
Vitamin B1 supplements
1.Vitamin B1 is given at 5 mg to 30 mg per day orally until the response is adequate.

Side effects are:
1.Vitamin B1 may cause anaphylactic reactions when given intravenously.

Prognosis:
1.good response to treatment in Vitamin B1 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B1 Deficiency.

3.Heart failure in beri beri may not respond to digoxin

4.Cardiac beri beri and Wernicke's disease may be fatal if left untreated.

Prevention:
take more liver, egg yolks, cereals and fresh green vegetables.

Saturday, October 22, 2011

A Family Doctor's Tale - FOLIC ACID DEFICIENCY

DOC I HAVE FOLIC ACID DEFICIENCY


Folic acid Deficiency is a medical condition caused by the deficiency of the human body of Folic acid as a result of inadequate dietary intake or impaired absorption.

Every one needs Folic acid which is essential to build the red blood cells of the human body.

Folic acid which is also a B Vitamin is found primarily in
1.animal sources - liver , kidneys, egg yolks


2.vegetable and fruit sources: dark green leafy vegetables such as spinach,asparagus, brocolli ,fresh and dried beans,

fruits such as papaya, oranges , cantaloupe

and yeast

Optimal requirements of Folic acid are:
1.adults and children above puberty: 100mg daily
Pregnant mothers requires more folic acid (400-500mg per day)
2.Infants and children before puberty: 5omg daily

Functions of Folic acid:
1.Folic acid is essential for production of red blood cells together with Vitamin B12, iron, minerals, Vitamin C and protein.

2.Folic acid is also needed for growth and reproduction

3.Folic acid is needed for stimulating the brain cell function and has been used to prevent dementia.

Causes of Folic acid Deficiency:
Folic acid Deficiency occurs
1.when there is Folic acid deficiencies due to
a.diet - folic acid is just sufficient in normal western diet


b.malabsorption as in celiac syndrome, sprue or hepatic cirrhosis


c.malignancy affects the absorption of folic acid


d.oral contraceptive may affect the absorption of folic acid

2.Severity of Folic acid deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Folic acid deficiency:
1.Folic acid Deficiency is a silent disease.
People with Folic acid Deficiency often do not know that they have the condition.

2.macrocytic anemia - low hemogloblin, enlarged red blood cells, pallor


3.Mucosa - mucosal membrane lesions such as aphthous ulcers .

4.Growth-growth retardation and anemia is common in children with Folic acid deficiency

5.diarrhea - may occurs as a result of mucosal lesions in the intestinal walls


6.Mental-Brain dysfunction may occur in children and elderly with Folic acid deficiency.

Diagnosis of Folic acid deficiency:
1.Blood Folic acid levels are low

Treatment of Folic acid deficiency:
The goal of Folic acid Deficiency treatment is the prevention of anemia and mucosal lesions

Therefore, prevention of Folic acid Deficiency is as important as treatment.

Folic acid Deficiency treatment and prevention measures are:

Medications:
Folic acid supplements
Folic acid is given at 250 to 5000 mg per day orally until the response is adequate.

Side effects are negligible

Prognosis of Folic acid deficiency:
1.good response to treatment in folic acid deficiency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Folic acid Deficiency.

Thursday, October 20, 2011

A Family Doctor's Tale - VITAMIN C DEFICIENCY

DOC I HAVE VITAMIN C DEFICIENCY

Vitamin C Deficiency is a medical condition caused by the deficiency of the human body of Vitamin C as a result of inadequate dietary intake or impaired absorption.

Vitamin C or ascorbic acid is present in all living human tissues as an important antioxidant compound of cell metabolism.

It is unfortunately rapidly destroyed by heating in the presence of air.

Vitamin C is found primarily in
1.animal sources - animal organs such as liver and adrenals.


2.vegetable and fruit sources: Vitamin C is found in fresh green and yellow vegetables and fruits such as tomatoes, papaya, oranges, blackberries etc.

Optimal requirements of Vitamin C are:
1.adults and children above puberty: 70 mg daily
2.Infants and children before puberty: 30 mg  daily

Functions of Vitamin C:
1.Vitamin C together is essential for the formation and maintenance of intercellular substances such as connective tissue, bones and cartilage.

2.Vitamin C is involved in the hydroxylation of proline to hydroxyproline which helps in wound healing.

3.Vitamin C stimulates defenses of the body to form antibodies and activates reticuloendothelial system.(walls of the blood vessels)

It is therefore useful in the prevention of people with low immunity to illnesses.

4.Vitamin C also strengthen the walls of the capillaries and blood vessels preventing bleeding.

5.Vitamin C transport iron from transfer into ferritin a precursor of hemoglobin.

6.Vitamin C also interacts with folic acid, iron, Vitamin B12 and protein and other minerals to form the red blood cells.

Causes of Vitamin C Deficiency :
Vitamin C Deficiency occurs
1.when there is Vitamin C deficiencies due to
a.diet - lactating mothers should take more Vitamin C
b.malabsorption as in celiac syndrome, sprue or hepatic cirrhosis
c.rapid loss of Vitamin C from the body

2.Severity of Vitamin C deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin C Deficiency :
1.Vitamin C Deficiency is a silent disease.
People with Vitamin C Deficiency often do not know that they have the condition.

2.Mucous membrane-swelling and bleeding of gums a condition called scurvy.

3.Skin- hyperkeratosis and metaplasia of skin and mucous membrane may occur and lead to increased susceptibility to infection.

4.Body function-weakness and fatigue

5.Mental-Brain dysfunction may occur in children with Vitamin C deficiency.

Diagnosis of Vitamin C Deficiency :
1.Blood Vitamin C levels are low

Treatment of Vitamin C Deficiency :
The goal of Vitamin C Deficiency treatment is the prevention of bleeding mucosa,gum and skin problems, and general immunity to illnesses.

Therefore, prevention of Vitamin C Deficiency is as important as treatment. Vitamin C Deficiency treatment and prevention measures are:

Medications:
Vitamin C supplements
Vitamin C is given at 50 mg to 100 mg per day orally until the response is adequate.

In fact the Chemistry nobel laureate Linus Pauling has advocated the daily dosage of Vitamin C of 1000mg to 5000mg daily as a prevention to colds and influenza.
However such high dosage treatment has been known to have strong side effects and is still controversial.

Side effects are:
1.Vitamin C is only excreted in the urine and such high dosage of Vitamin C being acidic can damage the kidneys.

2.Precipitation of uric acid stones can also occur

3.Gastric problem may occur as Vitamin C is a strong acid

Prognosis of Vitamin C Deficiency :
1.good response to treatment in vitamin C deficiency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin C Deficiency.

Prevention of Vitamin C Deficiency :
take more fresh fruits and vegetables.

Tuesday, October 18, 2011

VITAMIN E DEFICIENCY

DOC I HAVE VITAMIN E DEFICIENCY

Vitamin E Deficiency is a medical condition caused by the deficiency of the human body of Vitamin E as a result of inadequate dietary intake or impaired absorption.

Vitamin E is present in all living human tissues as an important fat soluble antioxidant compound of cell metabolism.

It also help to control membrane premeabilty and stability.

It may have a role in the normal differentiation of fetal tissues.

In laboratories it has been found to increase fertilty in mice.

Vitamin E is found primarily in
1.animal sources - eggs, butter and milk.
2.vegetable sources: Vitamin E is found in fresh green and yellow vegetables and cereals.

Optimal requirements of Vitamin E are:
1.adults and children above puberty: 30 mg to 60 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg per kgm daily
Infants can get sufficient Vitamin E in breast milk

Functions of Vitamin E:
1.Vitamin E together is essential for the formation and maintenance of intercellular substances such as connective tissue, bones and cartilage.

2.Vitamin E is involved in the skin wound healing

3.Vitamin E improves the blood circulation in the human body

It is therefore useful in the prevention of people with low immunity to illnesses.

4.Vitamin E also interacts with Vitamin C, folic acid, iron, Vitamin B12 and protein and other minerals to form the red blood cells.

Causes of Vitamin E Deficiency:
Vitamin E Deficiency occurs
1.when there is Vitamin E deficiencies due to
a.diet - lactating mothers should take more Vitamin E
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin E deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin E Deficiency:
1.Vitamin E Deficiency is a silent disease.
People with Vitamin E Deficiency often do not know that they have the condition.

2.Mucous membrane-mucosa of the internal organs is affected by deficiency of Vitamin E

3.Skin- hyperkeratosis and metaplasia of skin  may occur and lead to increased susceptibilty to infection.

4.Body function-weakness and fatique

Diagnosis of Vitamin E Deficiency:
1.Blood Vitamin E levels are low

Treatment of Vitamin E Deficiency:
The goal of Vitamin E Deficiency treatment is the prevention of increased fragility of red blood cells and low Vitamin E.

Therefore, prevention of Vitamin E Deficiency is as important as treatment. Vitamin E Deficiency treatment and prevention measures are:

Medications:
Vitamin E supplements
Vitamin E is given at 37.5 mg to 45 mg per day orally until the response is adequate.

There is no proof that Vitamin E is useful to prevent heart disease or help in fertilty.

Side effects are:
1.Vitamin E may enhance anticoagulant activity and cause hemorrhage in bleeding prone patients.

2.nausea

3.headache

4.poor vision

5.fatique

Prognosis of Vitamin E Deficiency:
1.good response to treatment in Vitamin E deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin E Deficiency.

Prevention of Vitamin E Deficiency:
take more diary products,cereals and vegetables.

Sunday, October 16, 2011

VITAMIN A DEFICIENCY

DOC I HAVE VITAMIN A DEFICIENCY

Vitamin A Deficiency is a medical condition caused by the deficiency of the human body of Vitamin A as a result of inadequate dietary intake or impaired absorption.

Vitamin A (retinol) is found primarily in
1.animal sources - fish liver oil, liver , dairy products and meat.
2.vegetable sources: Vitamin A precursor (carotene) is found in green and yellow vegetables and fruits such as tomatoes, carrots. papaya, etc.
However only one third of the carotene is converted to Vitamin A.

Optimal requirements of Vitamin A are:
1.adults and children above puberty: 5000IU daily
2.Infants and children before puberty: 1500-2500 IU daily

Functions of Vitamin A:
1.Vitamin A together with protein opsin form the light-sensitive
pigments in the cones and rods of the retina and is thus important for clear vision.

2.Vitamin A also acts to maintain the integrity of epithelial tissues and mucous membranes by preventing metaplasia of the squamous type. It is therefore important for good skin function.

3.Vitamin A is also peripheral antagonist to estrogen.
It is therefore useful in the treatment of people with overly high
estrogens.

Causes of Vitamin A Deficiency:
Vitamin A Deficiency occurs
1.when there is vitamin A deficiencies due to
a.diet - insufficienct vitamin C in diet
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis
c.Failure to convert carotene to Vitamin A
d.rapid loss of Vitamin A from the body

2.Severity of Vitamin A deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin A Deficiency:
1.Vitamin A Deficiency is a silent disease.
People with Vitamin A Deficiency often do not know that they have the condition.

2.Vision-Initial manifestation of inadequate Vitamin A may be night blindness with progression to xeropthalmia and keratomalacia.
Corneal perforation may occur followed by blindness.

Bitot's spots which are superficial patches exposed bulbar conjunctiva are a pathognomic changes of Vitamin A deficiciency in the eye.

3.Skin- hyperkeratosis and metaplasia of mucous membrane may occur and lead to increased susceptibilty to infection.

Reversal of corticosteroid induced impairment of wound healing has been reported after topical application of Vitamin A.

4.Growth-growth retardation, loss of appetite and anemia is common in cildren with Vitamin A deficiciency

5.Mental-Brain dysfunction may occur in children with Vitamin A deficiciency.

Diagnosis of Vitamin A Deficiency:
1.Blood Vitamin A levels are low

Treatment of Vitamin A Deficiency:
The goal of Vitamin A Deficiency treatment is the prevention of vision defects and skin problems.

Therefore, prevention of Vitamin A Deficiency is as important as treatment. Vitamin A Deficiency treatment and prevention measures are:

Medications:
Vitamin A supplements
Vitamin A is given at 25.000 to 50,000 IU per day orally until the response is adequate.

Side effects are:
1.painful and tender swellings of the bones

2.dry rough skin

3.headache

4.weakness

5.liver and spleen enlargement

6.Massive overdosage of Vitamin A may lead cerebral edema, liver failure, convulsions and death

Prognosis of Vitamin A Deficiency:
1.good response to treatment in vitamin A deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin A Deficiency.

3.eye damage may not be reversible

4.Overdosage symptoms usually disappear within 1-4 weeks after stopping high vitamin A dosage.

Friday, October 14, 2011

A Family Doctor's Tale - OSTEOMALACIA

DOC I HAVE OSTEOMALACIA

Osteomalacia is a metabolic bone condition in adults characterized by the lack of nineralization of the bone or osteoid matrix although the osteoid is otherwise normal and the osteoid bone is unaltered.

Causes:
Osteomalacia occurs
1.when there is vitamin D deficiencies due to
a.diet
b.malabsorption

2.Vitamin D deficiecy is common in the elderly especially people who have dark skin and are not exposed to the sun

3.Malabsorption of Vitamin D may occur in gluten enreropathy or post gastectomy

4.Renal disease and anticonvulsant drugs may reduce the formation of active metabolites of vitamin D

5.Certain medications can cause Osteomalacia. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

6.Rarely calcium deficiecy is a cause of osteomalacia

Symptoms:
1.Osteomalacia is a silent disease.
People with Osteomalacia often do not know that they have the condition.

2.Fractures from Osteomalacia commonly occur in the wrist, spine and hip.
Persons with fractures may complain of pain and deformities as a result of the fractures.

3.Muscle weakness may occur when serum calcium is very low

Diagnosis:
1.Blood calcium and organic phiosphates are low or low normal

2.Blood alkaline phosphatase is increased

3.Blood Vitamin D levels are low

4.X-rays showed typical fractures (Looser zones) in pelvis, long bones, metacarpals and metatarsals

Treatment:
The goal of Osteomalacia treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength.

Therefore, prevention of Osteomalacia is as important as treatment. Osteomalacia treatment and prevention measures are:

A.Lifestyle Changes:
Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density.

B.Medications:
1.Vitamin D
An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength.
Vitamin D is important in several respects:

Vitamin D helps the absorption of calcium from the intestines.
A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.
Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.
Vitamin D comes from the diet and the skin.
Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions can produce most of the vitamin D they need from their skin.

2.Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes.
Calcium supplements are safe and generally well tolerated. Side effects are indigestion and constipation.

3.Medications that stop bone loss and increase bone strength, such as
alendronate (Fosamax),
risedronate (Actonel),
raloxifene (Evista),
ibandronate (Boniva),
calcitonin (Calcimar);

Prognosis:
1.good response to treatment in vitamin D deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of osteomalacia.

Wednesday, October 12, 2011

A Family Doctor's Tale - ROTATOR CUFF INJURIES

DOC I HAVE A ROTATOR CUFF INJURY


Rotator Cuff Injuries is a common disorder of the shoulder characterized by the injury and damage to the rotator cuff muscles or tendon resulting in pain and restriction of movement.

The rotator cuff muscles consists of 4 muscles that are used to stabilize the shoulder and move the shoulder.

It is more common in people above the age of 40.

The risk of injury increases with age.

The causes of Rotator Cuff Injuries are:
Several conditions has been blamed:
1.Repetitive movements of the shoulder- Swimmers, rowers and tennis players who use repetitive movements are at higher risk of rotator cuff injuries.

2.Heavy lifting or pulling:lifting and pulling an object that is too heavy or lifting in the wrong way can cause a strain or tear to the rotator cuff muscle or tendon.

Household tasks such as carrying a heavy load, lifting things overhead or hanging the clothes out may also cause rotator cuff injury.

3.Normal wear and tear- with age the blood supply to the tendons of the rotator cuff muscles is reduced resulting in degeneration of the cuff muscles and tendons.
This degeneration can be aggravated if there is repetitive shoulder movements resulting in a tear in the tendons or muscles.

4.trauma - injury to the rotator muscles such as a fall or direct hit to the shoulder muscles may cause a tear in the muscles resulting in tightening of the injured muscles around the shoulder joint.

5.Poor posture. Sloughing forward of the head and neck cause the rotator muscles to be strained leading to inflammation and tears.

Symptoms:
1.Pain in the shoulder when lifting the arm

2.Pain can occur when trying to comb the hair

3.Certain movements makes the pain worse

4.weakness and tenderness of the the shoulder with pain when sleeping on the affected arm

5.complaints of stiffness of the shoulder and loss of range of movement of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:
1.apprehensive patient who holds the arm protectively

2.Generalized tenderness of rotator cuff

3.Limited shoulder movement

4..Range of muscle movement is reduced in all directions

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the shoulder

2.Ultrasound and MRI will show if there a tear is present as it can identify all rotator tears from degeneration to partial or complete tears

The Treatment of Rotator Cuff Injuries are:
Conservative treatment:
1.rest of the shoulder

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

5.Physiotherapy such as traction, shortwave diathermy help to increase shoulder strength and improve flexibility

6.gradual mobilization and exercises to loosen the tight muscles surrounding the shoulder

Surgery is usually indicated in Rotator Cuff Injuries if the condition does not improve with conservative treatment.

A keyhole or arthroscopic repair is done to remove the torn edges of the cuff muscles and retach them to the bone using absorbable or metal anchors.

After surgery patients are put in a sling or brace.

Physiotherapy starts the day after surgery.

Prognosis depends on the underlying cause.

In most cases Rotator Cuff Injuries may resolve itself with conservative treatment

Monday, October 10, 2011

A Family Doctor's Tale - SEPTIC ARTHRITIS

DOC I HAVE SEPTIC ARTHRITIS

Septic Arthritis is an infection of the joint by pyogenic bacteria.

The most common causes of Septic Arthritis is

1.Staphylococcus aureus bacteria(80%).

Other bacteria involved are:

2.Streptococci Group A & B

3.Enterobacter species

4.Haemophilus influenzae

5.Pneumococci

6.Pseudomonas

Anerobic infections may also cause Septic Arthritis.

Predisposing conditions of Septic Arthritis are:
1.injury to the joint is the most common cause.

The joint injury is exposed to local infection in the skin or environment.

Staphylococcus aureus is the most common bacteria in Septic Arthritis resulting from bone injury and infection.

2.Diabetes mellitus in adults.

3.rheumatoid arthritis

4.steroid therapy

5.Joint infection in adults are usually due to their lower resistance from
a.debilitation,


b.intravenous drug abuse,


c.infectious root-canaled teeth,


d.other disease or drugs (e.g. immunosuppressive therapy).

Symptoms of Septic Arthritis:
1.pain and swelling of the joint  

Joint is hot, swollen with effusion, very tender and limited mobility

2.fever and chills

3.systemic signs of infection

Signs of Septic Arthritis:
1.Hot tender joints

2.Throbbing pain of bones in joints

3.Abscess and swelling

Diagnosis of Septic Arthritis is often based on

1.Blood ESR is raised and high polymorph leucocytes

2.Blood and joint fluid cultures are normally required to identify the specific pathogen

3.X-rays are normal at first but later show osteoporotic changes

The complications of Septic Arthritis are:

1.damage of the bones in the joint,

2.osteomyelitis

3.sepsis

Treatment of Septic Arthritis:
1.antibiotic therapy  - must be started immediately even before culture results are back and continued usually as prolonged treatment lasting a matter of weeks or months until the infection is clear.

2.Splinting or immobilization of the affected joint to prevent movement

3.Aspirations of the infected joint fluids

4.Hyperbaric oxygen therapy has helped in the treatment of refractory Septic Arthritis.

5..Septic Arthritis may also need open surgical debridement to remove pus and damaged bone tissues if infection do not respond to antibiotics.

6.Physiotherapy may be required to restore joint range and muscles once the infection has cleared up.

6.Severe cases may lead to the loss of a limb.

Prognosis of Septic Arthritis depends on the rapidity of onset of treatment.

The faster the treatment the faster the cure.

Otherwise the condition may become a chronic illness requiring multiple surgical procedures.

Prevention of Septic Arthritis is to avoid infection of the skin near the joints or injury to the joints.

Treatment of underlying conditions such as diabetes is important.

Saturday, October 8, 2011

A Family Doctor's Tale - GANGLION

DOC I HAVE A GANGLION

GANGLION or ganglion cyst is a cyst found next to tendon sheath or joint.

It may occur at any part of the body but is most common on the dorsum of the hand or foot.

The cause of the ganglion is unknown but the cyst contains a mucinous material like from a tendon sheath or joint.

It has a stalk that can be traced to a tendon sheath or joint.

Ganglion cysts are seen in children but frequently disappear spontaneously in this age group in 2 to 3 years.

Symptoms of the ganglion cyst:
1.The onset is usually related to a history of trauma.

2.local pain and swelling at the dorsum of affected hand or foot

3..feeling of weakness of the affected hand or foot

4.swelling usually increase in size in relation to activity of patient.

Physical examination of the ganglion cyst:
1.hard swelling on the dorsum of hand or foot often described as a small bony swelling

2.the ganglion is freely movable on the affected hand or foot

3.the ganglion is most obvious when the hand or foot is flexed.

Treatment of the ganglion cyst:
1.Aspiration of the ganglion cyst under local anesthesia.

2.Punctuate the ganglion with a large sterile needle in many areas in the hope that the mucinous fluid may be forced out through the many needle holes

3.injection of the ganglion cyst can be done with a steroid compound

4.After the above procedures, a compression dressing is applied for 48 to 72 hours.

5.Some alternative medical advocates even suggest hitting the ganglion cyst with a wooden hammer to burst the cyst and allow the fluid to flow out under the skin.

Surgery:
1.Surgery is done only as a last resort or if symptoms persist.
Excision of the ganglion is done under local anesthesia however occasional damage to the nerve or tendon may complicate the surgery.

Prognosis:
generally good but recurrence are not uncommon.

Thursday, October 6, 2011

A Family Doctor's Tale - ARTICULAR CARTILAGE INJURY

DOC I HAVE ARTICULAR CARTILAGE INJURY

Articular Cartilage Injury is a common disorder of the knee caused by damage of the surface of the cartilage covering of the knee.

It can also occur from wear and tear through repeated friction of the cartilage resulting in chronic wear and tear or direcr trauma.

The carticular cartilage acts to allow frictionless movement of the bone against another and performs also as a shock absorber during weight bearing activities.

The causes of Articular Cartilage Injury are:
Several conditions has been blamed:
1.Repetitive movements of the knee-soccer players who use repetitive movements are at higher risk of Articular Cartilage Injury as well as meniscus tears.

2.Chronic wear and tear- with age the blood supply to the knee is reduced resulting in degeneration of the the articular cartilage of the knee.

3.trauma - injury to the articular cartilage such as a fall or direct hit to the knee

4.Obesity cause more weight bearing effect on the articular cartilage

The symptoms and signs of Articular Cartilage Injury are:
Symptoms:
1.Recurrent Pain in the knee

2.Swelling of the knee

3.Difficulty in bending or straightening the knee

4.audible clicks on knee movement

5.difficulty in walking because of the pain

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee

2.MRI will show if there is articular cartilage damage

The Treatment of Articular Cartilage Injury is:
Conservative treatment:
1.rest,elevation and ice compress treatment of the knee upon injury

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain relief and reducing inflammation

3.Muscle relaxant to relax muscles

4.crutches can reduce the weight off the affected limb

5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee

Surgery is usually indicated in Articular Cartilage Injury if the condition does not improve with conservative treatment.
1.A keyhole or arthroscopic microfracture repair is done to fill the defect in the cartilage with stem cells

2.Osteochondral graft transfer techniques where plugs of cartilage together with the bone foundation are taken from a less critical of the knee and transplanted to cover the defect in the cartilage.

3.Autologous cartilage implantation techniques where cartilage cells harvested from the knee , grown and multiplied in the laboratory are tranfered back into the joint to cover the defect.

Physiotherapy starts the day after surgery.

Prognosis depends on the severity of the cartilage injury

In most cases Articular Cartilage Injury may recover with conservative methods.
Some cases however may require surgical treatment

Prognosis is good after surgical treatment.

Prevention is to avoid weight bearing, reduce obesity and muscle strengthening exercises.

Tuesday, October 4, 2011

A Family Doctor's Tale - FLAT FOOT

DOC I HAVE FLAT FOOT

Flat Foot is a common disorder of the foot characterized by the depression or loss of the medial longitudinal arch of the foot.

It is usually associated with valgus of the foot or eversion of the heel and abduction of the forefoot.

It is also associated with a tight Achilles tendon.
 
The cause of Flat Foot is :
1.hereditary and associated with hypermobilty of the other joints

2.a rupture of the posterior tibial tendon

Symptoms:
1.Pain in the foot especially when standing for a prolonged period

2.easy fatigabilty of the foot.
 
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

Signs:

1.absence of the medial arch is present

2.hypermobility of the foot is apparent

3.mild genu valgum (knock knee) or internal tibial torsion is also present.

4.Xrays of the foot usually show a loss of the normal arch and plantar flexion of the talus.

Complications:
1.mild deformity of the foot

2.strain on the back (lumbar spine) with prolonged standing

3.heel cord contractures

Conservative treatment:
1.no treatment is usually necessary if mild

2.shoe correction may help temporarily

3.Exercises to stretch and loosen tigh heel cords

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles especially the back

Surgery:

Surgery is usually not indicated in Flat Foot.
Rarely surgery is to tighten the muscles supporting the medial arch of the foot only for severe cases with symptoms of pain and to prevent complcations.

Prognosis:
There is no cure for flat foot but surgery may help in severe cases to prevent complcations.

Prevention:
avoid prolonged standing

use shoes with medial arch correction pads

Sunday, October 2, 2011

A Family Doctor's Tale - ACHILLES TENDINITIS

DOC I HAVE ACHILLES TENDINITIS

Achilles Tendinitis is the inflammation and swelling of the Achilles tendon .

The cause of Achilles Tendinitis is due:

1.Injury or trauma to the Achilles tendon-minor tears in the tendon of these muscles are always present in injury

2.Repetitive over usage of Achilles tendon especially in a runner

The symptoms and signs of Achilles Tendinitis are:

Onset is usually gradual unless due to injury

Symptoms:
--------------

1.Pain on movement of the Achilles tendon

2.Swelling of the Achilles tendon affected at the lower leg and heel
 
3.Stiffness of the Achilles tendon  - inability to stretch

4.Pain often radiates into the foot

Signs:

1.swelling of the affected Achilles tendon

2.pain and local tenderness of the affected Achilles tendon

3.dry crepitus on movement of the Achilles tendon is present
 
4. X-rays are usually normal although an ultrasound may show minor tears in the tendon.

The complications of Achilles Tendinitis are:

Fibrosis and rupture of the inflammed Achilles tendon of the heel area may occur leading to loss of function of the tendon in lifting the foot resulting in a drop foot.
The Treatment of Achilles Tendinitis is:

Conservative treatment:
1.rest of the tendon

2.hot compress may help reduce inflammation

3.Splints or bandaging of the tendon and heel area and ankle to rest the tendons

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.local injection of local anesthetic and long acting steroid should be avoided because of danger of rupture of tendon.

7.Avoid overusage of the Achilles tendon

Surgery :

Surgical reattachment of Achilles tendon may be necessary if torn .
The prognosis of Achilles Tendinitis is:

Prognosis is usually good although recurrence may occur.

The prevention of Achilles Tendinitis is by:

1. Avoiding any strenuous exercises

 

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