MULTIPLE SCLEROSIS

DOC I HAVE MULTIPLE SCLEROSIS

What is Multiple Sclerosis?

Multiple Sclerosis is a progressive degenerative disease of the central nervous system with recurrent episodes of neurologic

dysfunction disconnected in time and space and associated with evidence of demyelination of the central nervous system.

It affects the patient in different areas of the nervous system at various points in time.

What causes Multiple Sclerosis?

The cause is unknown but believed to be related to an auto immune disease resulting from a viral infection.

Multiple sclerosis results in destruction of the myelin surrounding the nerves of the CNS. The destruction is thought to be

caused by the body's immune system attacking the myelin sheath disrupting the transmission of information in the CNS and

lead to the symptoms seen in multiple sclerosis.


1.In Multiple Sclerosis, there is multiple scattered greying well defined lesions from few small mm size to few cm in size

present in the white matter and extending to the grey matter of the brain.

2.The lesions vary from partial to complete destruction of the myelin sheath with relative sparing of the axon , glia and

other structure.

Who is at risk of Multiple Sclerosis?

Multiple Sclerosis occurs between 20 to 50 years old.

It is more common in Northern Europeans.

Women are affected 2 times more than men.

Triggers that can cause the onset of MS are:
infections
trauma
surgery
emotional upset,
stress
pregnancy

What are the symptoms of Multiple Sclerosis?

The typical symptoms of Multiple Sclerosis are multiple and variable which explains its name.
There may be mild cases which may not need treatment or severe cases which need confinement to wheelchairs.

There is a typical course of exacerbations and remissions over a peroid of years and increased residual neurological deficit

1.impairment of vision is usually an early sign of MS
2.diplopia can occur with optic neuritis
3.unsteady gait due to the effect of the disease on the cerebellum which control balance and co-ordination
4.paresthesia or tingling sensation in the fingers and toes
5.weakness of the muscles leading to hemiplegia
6.facial paresis, vertigo and hearing loss
7.seizures when foci in the brain are over stimulated
8.Constipation and urinary incontinence may also occur as a result of the weakened muscles
9.one peculiar trait is that higher temperatures aggravate the symptoms in MS patients. Nerve conduction at higher

temperature such as a hot shower cause the slowing in the transmission of messages in nerves that have already lost myelin.

How is the diagnosis of Multiple Sclerosis made?

The diagnosis of  Multiple Sclerosis is difficult and involve
1.History of a multiple symptoms involving the nervous system
2.physical and neurological examinations for peripheral neurological deficit.
3.blood count and chemistry, urine analysis are all routine laboratory tests used to rule out other diagnoses
4.Cerebral spinal fluid evaluation may show mild mononuclear pleocytosis (less than 40 cells per cubic meter, protein normal

or increased and high gamma globulin IgG.
5.MRI can search for changes within the brain or spinal cord that are particular to multiple sclerosis.

What are the complications for Multiple Sclerosis ?

1.Weakness of the muscles leading to hemiplegia

2.spasticity of the muscles with rigidity and cramps

3.Poor co-ordination and imbalance

4.urinary and bladder problems

5.visual loss and pain suggesting optic neuritis , an inflammation of the eyeball

What is the treatment for Multiple Sclerosis?

Multiple Sclerosis cannot be cured but can be suppressed:

Supportive measures
1.Bed rest
2.Proper diet and nutrition to strengthen the muscles of the body
3.physiotherapy to strengthen muscles
4.occupational therapy to help stimulate the mind
5.Speech therapy for speech and awallowing
6.social support
7.Avoid triggers

Medications:
1.Glatiramer acetate is able to reduce the relapse rates of multiple sclerosis by about one-third and appears to reduce the

overall progression of multiple sclerosis

2.Natalizumab is a monoclonal antibody that binds to white blood cells which are thought to play a role in causing the

nervous system damage in multiple sclerosis. It also reduces the rates of relapses of MS by two thirds.

3.Fingolimod is a daily oral medication to treat MS by reducing the number of lymphocytes which is believe to cause

inflammation in MS.

4.Interferon which are anti-viral agents has found to reduce relapses of MS by one third.
What is the prognosis of Multiple Sclerosis?

5.Previous treatment used to be ACTH injections and corticosteroids. These are are seldom used.

What is the prognosis of Multiple Sclerosis?
MS is unfortunately still not curable at this time.
Most patients about 65 % with the relapsing and remitting form may improve to a stage where relapses are very much reduced.

Unfortunately they continue to have more disabling symptoms or secondary progressive multiple sclerosis.
15% become worse with progressive relapses.
10% has primary progressive MS with no remissions in between.
Death usually results from pneumonia and heart trouble.

HUNTINGTON'S CHOREA

DOC I HAVE HUNTINGTON'S CHOREA


What is Huntington's Chorea?

Huntington's Chorea is a progressive degenrative disease affecting basal ganglia characterized by choeiform movements (movements such as writhing, twisting, and turning in a constant, uncontrollable dancing motion) and mental deterioration.

What causes Huntington's Chorea?

The cause is believed to be genetic with autosomal dominance transmission from parent to offspring with full penetrance.

In Huntington's Chorea, there is widespread degeneration changes with cell loss and reactive gliosis mainly in the cerebral cortex (thinking and perception), basal ganglia (balance) and caudate nucleus (co-ordination).

There is the belief that the deficiency of gamma-aminobutyric acid (GABA) in the cells may have contribute to the impairment of the nerve cells.

Who is at risk of Huntington's Chorea?

Huntington's Chorea affects sexes in equal numbers.

It is an inherited condition. On average 50 per cent of children of the sufferers will be affected.

What are the symptoms of Huntington's Chorea?

The typical course of Huntington's Chorea usually appear between 30 to 45 years but may be earlier or later.

1.choreiform movements (movements such as writhing, twisting, and turning in a constant, uncontrollable dancing motion )

2.emotional disturbance with mental changes

3.cognitive impairment

4.mood swings with inertia followed by irritability

5.apathy

6.anger

7.depression

8.delusion and hallucinations

9.The speech can become  slurred and vital functions, such as eating, speaking, swallowing and especially walking, begin to decline.

10.All the above may occur to varying degree but rate of progression is  generally parallel.

How is the diagnosis of Huntington's Chorea made?

The diagnosis of  Huntington's Chorea involve:
1.Typical history of choreiform movements,emotional and mental impairment with family history.

2.physical and neurological examinations for brain neurological deficit.

3.CT scan or MRI may show selective atrophy of the caudate nucleus and putamen. In addition there are enlargement of fluid-filled cavities within the brain called ventricles. These tests do not completely differentiate Huntingson's Chorea from other conditions such as dementia but they will together with the choreiform movements,emotional and mental impairment point towards Huntingdon's chorea.

What are the complications for Huntington's Chorea ?

1.Progression of nerve involvement to whole body with paralysis

2.Dementia may gradually result from mental impairment

What is the treatment for Huntington's Chorea?

The is no cure for Huntington's Chorea but symptomatic control of choreiform movements and delusions with haliperidol or clonazepam may help.

Proper nutrition , fluids and exercise will help the patient to stay healthy and fit.

As the condition progress hospitalization or institutional care (such as nursing homes) is usually indicated.

Genetic counseling is important for treatment and prevention of  
Huntington's Chorea.

What is the prognosis of Huntington's Chorea?

Except for a few cases there is a relentless progression to death.
Death usually occurs in 10 to 15 years although the course may more acute or prolonged.

MOTOR NEURONE DISEASES

DOC I HAVE A MOTOR NEURONE DISEASE

What are Motor Neurone Diseases?

Motor Neurone Diseases is a group of progressive degenerative diseases affecting motor neurones with varying corticospinal involvement.

The diseases destroy cells that control important muscle activity such as speaking, walking, breathing, and swallowing. The damaged nerve cells are unable to send signals to the muscles to do their activity resulting in weakness, wasting and tremors of the muscles.

The Motor Neurone Diseases includes conditions such as Amyotrophic Lateral Sclerosis (ALS), progressive bulbar palsy, primary lateral sclerosis, and progressive muscular atrophy.

What causes Motor Neurone Diseases?

The cause is unknown but environmental, toxic, viral, or genetic factors have found to play a part in its formation.

1.In all Motor Neurone Diseases, there is loss of nerve cells in the anterior horn of spinal cord and motor nuclei of brain stem.

2.In Primary Lateral Sclerosis there is corticospinal tract degeneration most evident in the lower spinal cord but traceable to internal capsule and corona radiata.

Who is at risk of Motor Neurone Diseases?

Motor Neurone Diseases occurs in middle age 40-60 years old and are more common in males.

It occurs as endemic in Guam where there is high familial incidence in association with Parkinson dementia complex.

What are the symptoms of Motor Neurone Disease?

The typical course of Motor Neurone Diseases except for primary lateral sclerosis is 2 to 6 years resulting in death.

1.acute onset of asymmetrical muscle tremors, weakness and wasting in both lower limbs with ascending progression of the weakness upwards to the arms and face .

2.the lower cranial nerves can also be affected leading to bulbar weakness, (dysphagia or difficulty with swallowing), facial weakness and respiratory difficulties. If this happens , hospitalization is a must.

3.spasticity of the muscles

4.hyperreflexia

5.mental function is usually not affected

How is the diagnosis of Motor Neurone Disease made?

The diagnosis of  Motor Neurone Disease involve
1.History of a rapid onset and progression of motor weakness, wasting, tremors, hyperreflexia and the absence of fever.

2.physical and neurological examinations for peripheral neurological deficit.

What are the complications for Motor Neurone Disease ?

1.Progression of nerve involvement to whole body

2.Paralysis of respiratory muscles and swallowing can be life threatening

What is the treatment for Motor Neurone Disease?

Treatment for Motor Neurone Disease may be urgent especially in cases of respiratory distress:

1.Hospitalization and early intubation with a respirator on standby in case of difficulty in respiration

2.treatment of the condition is supportive only as there is no cure for the disease

a.physiotherapy to strengthen muscles

b.Speech therapy for speech and swallowing

3.The drug riluzole approved to treat ALS, prolongs life by 2-3 months but does not relieve symptoms. 

4.Symptoms such as spasticity  can be treated with muscle relaxants.

Anticonvulsants and pain killers can help to relieve pain.

5.A healthy and balanced diet is necessary to maintain strength in the muscles and mind

What is the prognosis of Motor Neurone Disease?

Most Motor Neurone Diseases except for primary lateral sclerosis (which is usually not fatal) are relentless diseases with  progression to death.

DUCHENNE MUSCULAR DYSTROPHY

DOC I HAVE DUCHENNE MUSCULAR DYSTROPHY

What is Duchenne muscular dystrophy?

Duchenne muscular dystrophy is a genetic disease which causes rapid weakness and wasting of muscles.

What is the cause of Duchenne muscular dystrophy?

Duchenne muscular dystrophy is believed to occur as a result of a defective gene for dystrophin (a protein in the muscles).

In Duchenne muscular dystrophy males are more likely to develop symptoms than are women.

Inheritance is usually sex-linked and recessive. The sons of women who are carriers of the disease have a 50% chance of having the disease while the daughters have a 50% chance of being carriers.

Duchenne muscular dystrophy occurs in 0.3 per cent of male infants in the population.

What are the symptoms of Duchenne muscular dystrophy?

Symptoms may appear as early as infancy and include:

1.Fatigue
2.Muscle weakness which is worse in the legs

3.waddling gait

4.use of hands to raise self from floor
4.Difficulty in running, jumping
5.Frequent falling

6,climbing stairs difficult

7.Pseudohypertrophy of the infraspinatus, deltoids , triceps and calf muscles


8.Atrophy of muscles occurs with contractures and deformity

9.Progressive difficulty in walking with ability to walk lost by 12 years of age
10.Most patients at age 12 are confined to a wheelchair.

Signs :

A complete physical examination may show:

1.Abnormal heart muscle (cardiomyopathy)
2.Congestive heart failure
3.Deformities of the chest and back (scoliosis)
4.Enlarged calf muscles which are later replaced by fat and connective tissue (pseudohypertrophy)
5.Loss of muscle mass (wasting)
6.Muscle deformities in the heels and legs
7.Respiratory difficulty due to weakness of lung muscles

Investigations:

1.Electromyography (EMG)
2.Genetic tests
3.Muscle biopsy

What is the Treatment of Duchenne muscular dystrophy?

Treatment of Duchenne muscular dystrophy are usually symptomatic to improve the quality of life as there is no cure for the disease.

Gene therapy may be able to cure by removing the defective gene in the future.

1.Physical activity is helpful to maintain muscle strength and function.
Inactivity may worsen the muscle disease.

2.massage and electrical stimulation of muscles
2.Orthopedic appliances (such as braces and wheelchairs) may increase the ability for self help.

What is the prognosis of Duchenne muscular dystrophy?

Duchenne muscular dystrophy usually leads to rapidly worsening muscular condition.
Death can occurs by age 25 typically from respiratory conditions such as pneumonia.

What are the complications of Duchenne muscular dystrophy?

1.heart disease such as cardiopathy and heart failure
2.muscle deformities such as scoliosis
3.mental impairment which is rare
4.permanent, progressive disability
5.pneumonia or other respiratory infections
6.death from respiratory failure

What is the preventive measures of Duchenne muscular dystrophy?

Duchenne muscular dystrophy can be detected with about 95% accuracy by genetic studies performed during pregnancy.
Genetic couseling will therefore be a great help to prevent the disease.

PURPURA

DOC I HAVE PURPURA

Purpura is a physical sign of escape of red blood cells through the endometrial wall of the dermal capillaries resulting in purplish blotches under the skin.

What is the cause of Purpura?

It is usually due to vacular wall defect, low platelets, infections or injury:

Vascular wall defect may be caused by:
1.Scurvy or lack of vitamin C
2.Fragilty of vascular wall due to age(senile purpura, anemia, diabetes or steroid therapy
3.Autoimmune disease such as Henoch Schonlein purpura
4.Blood cancer such as multiple myeloma

Infections:
1.Dengue fever - cause low platelets
2.Subacute bacterial endocarditis - cause low platelets
3.Typhoid fever
4.Rocky mountain fever

Low Platelets:
1.Aplastic anemia - low production of red blood cells, white blood cells and platelets from marrow
2.Megaloblastic anemia
3.Leukemia
4.Exposure to toxic drugs (chemotherapy) or radiation
5.Splenomegaly
6.Idiopathic thrombocytopenic purpura
7.Lymphoma
8.Neonatal thromocytopenia
9.Drug induced thrombocytopenia

Others:
1.Injury
2.Trauma
3.Burns
4.Dialysis
5.Blood thinners such as aspirin, warfarin, plavix
3.alcohol

What are the symptoms of Purpura?

Symptoms:

1.typical purple blotches under the skin
2.fever with purpura is a medical emergency
3.fundoscopic bleeding
4.abdominal pain may be a recurring symptom
5.splenomegaly
6.low platelets
7.bleeding time prolonged

How do you made the diagnosis of Purpura?

Diagnosis of Purpura is often based on
1. history of Purpura
2. history of drug allergy
3. history of blood thinners
4. Full blood count
5. Bone marrow biopsy

What are the complications of Purpura?

The complications of Purpura are:

1. Anemia

2. damage to liver , spleen and nerves

What is the treatment of Purpura?

Treat the underlying cause:
1.Blood transfusion of platelets in severe cases

2.Antibiotics for infections

3.Avoid causative agents especially drugs, vitamin deficiency,renal disease,radiation

4.corticosteroids is useful in idiopathic thrombocytopenic purpura

5.Splenectomy may be helpful

What is the prognosis of Purpura?

Prognosis depends on the cause of Purpura.
Patients with blood cancer has a poorer prognosis compared to injury.

WEIGHT LOSS 3

DOC HOW DO I LOSE WEIGHT?

Control Diet

15.)Grocery store shop at outer aisles

There is one common thread in all grocery store designs: the healthy foods are on the perimeter aisles. Think about it, when you go into the grocery all of the healthy stuff, fruits, vegetables, meats, and dairy products are arranged around the stores walls whereas the center aisle areas in those few stores that stock butter and cheese in the center near the frozen foods. .

Train yourself to start on one end of the outer aisle and work your way around. You will be able to fill your basket with healthy items if you do so.

16.)Get good cook books

Get a good cookbook. Not all recipes in a cookbook are low-carbohydrate fare. However you will be surprised at the number of low-carbohydrate friendly recipes you can find in a standard Betty Crocker Cookbook.

Cookbooks often contain handy tips on purchasing cuts of meat and preparing meats, fruits and vegetables in new and exciting ways. New low-carbohydrate cookbooks are hitting the shelves all the time. Try to take advantage of these resources to eat something new, different and nutritious.

17.)Take a good multivitamin as supplement to your diet The most conscientious food combiner may miss some healthy vitamins, minerals and trace elements in their diets. To help supplement your diet, consider taking a good multivitamin. If you are an otherwise healthy individual, your body will do its part. Keep to the low-carbohydrate diet plan that is right for you with some variety to your meals to help you on the path to good health and weight loss goals.

18.) Reward Yourself

Once in a while reward yourself. You will be less likely to cheat on your new diet if you grant yourself small rewards. If you are a chocolate lover, treat yourself to a small square of chocolate  each evening.

BURN YOUR CALORIES

1.) Work Out with Weights

Beside the diet control the other way is to burn up the fat. One way is to add a weight exercise program and routine work out. Weight training will not only tone your muscles but will strengthen your body and improve your general health. Lifting weights will also help to burn calories and fat more quickly than ordinary exercise.It will also boost your blood circulation and metabolism.

2.) Avoid Marathon Work Outs

Some people feel that the best way to burn fat and lose weight is to have one long, extensive work out. That is not true because it will exhaust all your energy leaving less energy for the next exercise. Break up your work out plan into small manageable sessions throughout the day. For example take a brisk walk in the morning, enjoy a work out at lunch, and then exercise more in the evening. This will keep you active all day long and will better maintain your metabolism.

3.) Mix It Up

Being active in different quality exercises will keep your interest and help you to maintain your goal of burning fat. Changing exercises such as to swim laps one day, jog another, and riding a bicycle the next will not only allow you to experience a variety of physical activities, it will also allow you to better tone your body.

Finally a positive and cheerful optimism will help a long way to reduce your weight. If you can control your diet and burn your calories you will definitely lose weight! Do not doubt that!

WEIGHT LOSS 2

DOC HOW DO I LOSE WEIGHT?

Control Diet

7.)Avoid meal replacements

Every day new meal replacement shakes and bars are sold on the market.They may claim to be healthy, but almost all of them contain hydrogenated oil and sweeteners.

Low carbohydrate doughnuts and muffins can be found at your neighborhood grocery store . While low-carbohydrate pastries may be tempting to buy, unfortunately they still contain all of the usual carbohydrate suspects: sugar and flour.

They may be healthier than your typical muffin as an occasional treat but not for long term eating.

8.) Low Glycemic Index Diet

A low Glycemic Index(sugar index) diet is a good way of burning fat quickly. This diet allows people to take large amounts of foods with low rankings on the Glycemic Index. These foods have enough nutrition and will help your body to burn fats and calories faster. The diet includes many of your favorite fruits, vegetable, meats, dairy, and grain products.

9.)Get fresh fruits not squeezed

Fruit juice can be very tempting as a replacement for soda but most commercial fruit juice has very little actual fruit juice.

Instead you will find lots of sugar water and other ingredients. Skip the juice altogether and eat a fresh piece of fruit instead. Not only does fresh fruit contain less sugar than juice. Fresh fruit also has fiber which is good for you and will help you feel fuller longer.

10.)Cooking your own food:

Many food in restaurents claims to have low carbohydrate and calories but most of them are not ideal low-carbohydrate fare. There are many recipes for good nutritional and easily prepared meals that you can cook yourself at home.

If you cook your own foods, you will be able to know exactly the contents of the food and you will have better control for hidden sugar and otherwise processed foods.

The other benefit is the significant cost per meal as opposed to eating at restaurants and fast food establishments.

It is also easier to control your diet with your favorite fresh food selections available at your kitchen.

11.) Eat slowly and enjoy your food

You will feel full and more satisfied if you take the time eat slowly by chewing it and savouring your food. Do not eat while standing . Sit down and chew.

Eating slower will help you enjoy your food more, notice what it is you are actually eating and get a better knowledge of when you are actually full.

12.) Cut Calories Wisely

It is tempting to drastically cut your calorie intake when you start on a healthy lifestyle. By reducing calories too quickly, your body will be too rapidly burning all available calories, which will slow down your metabolism.
Instead use a step method when cutting your calorie intake to minimize risk.Furthermore, you are more likely to maintain your healthy lifestyle through this step method.

13.) Skip Happy Hour

Avoid alcohol. Alcohol is rich in sugars and carbohydrates, and therefore a high calorie substance. These calories can add up quickly and take away from essemtial nutrients that should be included in your daily diet. Besides this alcohol acts as an inhibitor for burning fat allowing your body to store the fat faster.

14.)Having your food storage containers

Using your food storage containers of various sizes will make it so much easier for you to plan your meals. You can buy and store nuts, fruits and vegetables in bulk for easy use later.

Fix your own lunch and snacks and bring them in containers with you to work.

WEIGHT LOSS 1

DOC HOW DO I LOSE WEIGHT?

A Simple Guide to your weight loss program involve 2 main components:
1.Control Diet
2.Burn up Calories

Control Diet
1.) Drink More Water

Drinking water 8 to 10 times each day to stay hydrated and healthy. Once you get started, you will begin to crave water.

Start with a glass of water first thing in the morning before you eat. If you really do not like the taste of water, try adding a few drops of lemon or lime to your water but no sugar or sweetener! Ice also helps.

One of the best weight loss secrets is to avoid the sweet drinks and the sodas which are all calorie laden. Instead grab a refreshing glass of water.

Besides flushing toxins and waste material out of your system, drinking water encourages you to build muscle.

Drinking a glass of water after very meaal will help you get in your 8 to 10 glasses of water each day but it can also have other benefits.If you feel hungry after a smaller meal, try drinking water after the meal. The water will help you feel full and prevent further eating.

2.) Eat More Small Meals

Do not skip breakfast each morning even if you will have to go bed earlier 20 mins each night to wake up for a proper breaskfast! Breakfast is the most important meal of the day and will contribute to your good health and to weight control.

Eating breakfast is not only good for overall weight loss, it will help you control your diet the rest of the day. You will less likely to eat something sweet and in the bread group if you skip breakfast.

Keep a couple of hard-boiled eggs in the fridge or some high-fiber, low starch fruit around to take for breakfast. Breakfast is the best time to take fruits.

You will feel better and lose weight quicker if you eat a large breakfast and eat a smaller dinner. Try and eat the majority of your carbohydrates earlier in the day, leaving a salad and lean meat protein for dinner.

By eating larger meals during the part of the day when you are most active will help you to feel less hungry throughout the day and stop cravings for unhealthy snacks.

Traditional three-large-meals-a-day plan will not help your body to burn up large meals and any excess will be turned into fat. Many nutritionist believe you should eat six small meals a day. You should cut back on your food consumption at each meal, or else you will be doubling your intake of calories!

Just like eating breakfast will increase your metabolism, so will eating small meals more often. This will also help you reduce the total carbohydrate intake by making sure that your meals are planned and occur regularly throughout the day.

3.) Consider eating a salmon or fish during breakfast

This is one way to work in Omega-3 fatty acids that are good for you and add some variety to your daily diet. After a time you may tire of eating eggs and bacon for breakfast. Eating a salmon or fish will give you the protein and healthy fish oils you need.

4.)Avoid White Foods

Anything which is made from sugar, flour, potatoes, rice or corn - just avoid. Always look for colorful fruits and veggies to substitute for the white foods. Buy broccoli, lettuce, bell peppers, green beans and peas, brown rice in moderation, leafy greens like kale and spinach, apples, melons, oranges and grapes.

Fruits and vegetables are not only colorful but they are also high in fiber, nutrients and important antioxidants. Eating colorful fruits and vegetables will give your diet variety as well as healthy benefits with their fresh vitamins, minerals and fiber. Most people will find some vegetables that they enjoy eating. Vegetarians have food that looks and taste as good as meat .They are actually made out of soya bean and flour.

5.) Choose Protein

Choose protein-laden foods for boosting your metabolism and enabling your body to burn fat rapidly. In addition to burning fat, consuming a protein-enriched diet will help you rebuild muscle after work outs and maintain leanness of that muscle. Wisely choose proteins for your diet. Take great care to pick proteins low in fat so you do not consume extra calories.

6.)Eat more protein at every meal

Eating protein helps you burn more calories. This iss because protein is made up mainly of amino acids, which are harder to breakdown in your body so you burn more calories getting rid of them.

Eating a protein rich snack can help you to lose weight.

Eating protein will also help you feel full so that you have less craving for unhealthy snacks.

BRISTOL STOOL SCALE

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DOC HOW DO I KNOW WHETHER MY STOOL IS NORMAL

Actually many people do not know the definition of diarrhea.

They define the word diarrhea as watery stools where in fact the word diarrhea means any stools which are softer or more frequent than normal.

The researchers at the Bristol University have come out with a scale which is called the Bristol Stool Scale.

According to the Bristol Stool Scale, the seven types of stools
are:
1.Type 1: Separate hard lumps like nuts
2.Type 2: Sausage shaped but lumpy
3.Type 3: like a Sausage but with cracks on its surface
4.Type 4: like a Sausage or snake, smooth and soft
5.Type 5: soft blobs with clear cut edges
6.Type 6: Fluffy pieces with ragged edges, a mushy stool
7.Type 7: Watery, no solid pieces. Entirely liquid.

Type 1 and 2 indicate constipation while type 5-7 indicate diarrhea. Type 3 and 4 are considered ideal stools because they are the easiest to pass.

Avoidance of constipation include:

1. Increase in daily fiber intake to at least 15gm (eg. 1 bowl of bran cereal for breakfast),
fruits and vegetables).
Fibre increases the bulk of the stool allowing easy passage of stools through the large
intestine.

2. Drink at least 8 glasses of water a day (2 liters). Water reduces the hardness of stools.

3. Regular exercises at least 2-3 times a day especially after meals. Exercise will enhance
intestinal movement.

4. Allow a distraction free period of 15 min a day for bowel movement. The strongest
intestinal movement occurs after breakfast.

5. Do not ignore or suppress the urge to pass bowel movement. This may impair the
sensation to detect initiation of bowel movement leading to constipation.

Avoidance of  diarrhea include:

1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers

2.washing your hands thoroughly for 20 seconds before eating

3.disinfecting contaminated surfaces such as counter tops and baby changing stations

4.Avoid eating or drinking foods or liquids that might be contaminated

5.Avoid rapid intestinal movement from stress, irritable bowel syndrome

Please read my blogs on constipation and diarrhea

BIRD FLU

DOC I HAVE BIRD FLU

Bird Flu or more correctly, avian flu is new strain of influenza virus H5N1 which can infect humans.

It has been around for 1987 and was expected to be the next big pandemic to hit the world.

Millions of birds and poultry has been culled all these countries especially in Thailand and China.

Just in December 2011 there has been a few cases found in Hong Kong where culling of poultry has been done .

The number of cases of avian flu in humans in the current outbreak is very small, and almost all have come about by direct contact with infected or dead birds or poultry.

The first outbreak of bird flu occurred in 1987 . Since then the bird flu have claimed at least 306 human lives in Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Laos, Nigeria, Pakistan, Thailand, Turkey, and Vietnam.

Just as recent as December 2011 one woman in Shenzhen which is in southern China died of bird flu(H5N1).

On January 7th 2012 another person also died of Bird flu in Indonesia.

Central to the problem of dealing with bird flu is diagnosis.
A number of upper respiratory infections have similar symptoms—at least at the onset of the illness, including the common cold, seasonal influenza, and bird flu.

Seasonal flu and bird flu have almost identical symptoms:
1.fever,
2.cough,
3.malaise (feeling unwell),
4.nausea,
5.vomiting,
6.diarrhea.

The Multiplexed Respiratory Test, discriminates influenza A from influenza B and identifies the H5-subtype of influenza A (bird flu is “H5N1”) from all other H subtypes.
In addition, it can identify almost all the other common—and some uncommon—viruses that cause influenza-like illnesses.

Preparation to treat a bird flu epidemic:
1. The single most important thing for an epidemic such as avian bird flu is to have well-prepared local health care systems.

2. Regular hand washing, and other beneficial cleanliness custom may save more lives than all other medicines combined.

3. The proper recognition and prizes should be given to those who have come up with effective vaccines for the avian bird flu disease. On the same note, vaccine makers should be given the freedom to make use of state materials needed for the vaccines.

4. Relevant drugs and vaccines for the avian bird flu disease should be bought and sold at fair prices.

5. Make preparations to ensure the continuity of food and power supplies.

6. It is therefore appropriate to have local health authorities ready to be used when the situation calls for it.

7. Encourage the formation of prediction markets about the avian bird flu epidemic.

8. There should be useful information about the progress of avian flu.

This will be especially useful in some Asian countries where the avian bird flu epidemic is expected to be rampant.

9. The World Health Organization should be prepared for such a bird flu epidemic.

During an avian bird flu epidemic, there are also things that should not be done:
1. Tamiflu and vaccine stockpiling have their useful roles.

In addition to the medical limitations of these investments(Tamiflu is losing its effect on most influenza because of their frequent use especially in Hong Kong), other institutional factors, such as transportation, will restrict the ability to allocate these supplies promptly to the persons needing them(healthcare and emergency staff)

2. Quarantines and mass isolations are useless in a bird flu epidemic.

3. In an avian bird flu epidemic  the health authorities must be in full control of the situation

4. It is pointless to block off or isolate the pandemic in its country of origin.It may have spread abroad already. Besides birds are migratory.

5.Public places such as schools and marketplaces should be closed immediately to be on the safe side.

5. People should not obsess over avian bird flu at the expense of other medical issues.

BED BUGS

DOC I HAVE BEEN BITTEN BY BED BUGS

What are Bed Bugs?

A Bed Bug is an insect called Cimex lectularius which is a small living insect that one can hardly see with the naked eye.

Bed bugs can be found in schools, hotels, apartments and houses. They can usually crawl and hide themselves in clothes, quilts, bed covers, pillow, furniture, cracks and crevices in the home.

Bed bugs are usually active at night. They mostly bite at exposed skin area such as face, neck, arms, hands feet etc. leaving swelling and redness at those bitten areas.

Their bites are characterized by itchiness and secondary skin infections.

Bed bugs are very flexible and tough insects because after they eat once in their life  they can spend their whole life span on that single meal.

The Life span of bed bugs is only one year.

Bedbugs can survive as long as up to one year without sucking blood.

The female bug can lay lay eggs three times in their life. and 300 eggs at one time. The eggs hatch in 6-10 days into adult bed bugs.

What are the Symptoms of Bed Bugs?

1.itching which is worse at night

2.rashes and abrasions on the skin due to scratching and secondary infections.

Rashes typically are present on legs and arms, sometimes on the body , seldom on the face. Rarely it may be present on the scalp.

Bedbug bites can not be felt immediately because of a sedative present in the saliva of the bedbug that keeps the blood from clotting and immunes the body for some time.

The process of sucking blood of a host lasts for 4-5 minutes.

The only good thing about these bugs is that they don not carry germs or bacteria that may cause harmful diseases to human body.

How do you confirm the diagnosis of Bed Bugs?

Skin scrapings can be examined microscopically for the Bed Bugs bites.

What is the Treatment of Bed Bugs?

Wash the infected area with an antibacterial liquid and apply calamine lotion afterward.

Pesticides (chemicals to treat Bed Bugs) actually contain mild insecticide :

Benzyl benzoate lotion

Malathion lotion

Gamma benzene hexachloride cream

Permethrin cream

Bathing is followed by application of the insecticide to the whole body from the neck to soles, left for 24 hours.

Treatment of contacts may be required if there is obvious signs of Bed Bugs.

While the Bed Bugs cannot live off the human skin for longer than 24 hours, each treatment with pesticide should be accompanied by washing, in hot water, of bedsheets, pillow cases and any clothes worn over the previous week.

Most people improve within a few days of treatment but it may take 4-6 weeks for the itch and rash of Bed Bugs to go away completely.

Prevention:
Keep your house clean and spray an effective pest control formula to eradicate these bugs completely.


 

AEROBICS

DOC WHAT IS AEROBICS?

Accordingly, aerobics is defined as “a method of physical exercise for producing beneficial changes in the respiratory and circulatory systems by activities which require meeting a modest increase of oxygen intake and so can be maintained."

Because of today’s many new illnesses (hypertension, type 2 diabetes, and other cardiovascular conditions) brought about by modern man’s generally inactive physical lifestyle, experts strongly recommend aerobics for everyone.

Aerobic exercise

The common definition of aerobics is simply the activity that consists of low-intensity repetitive motions of mostly the large muscles of the arms and legs for a period of time. This activity increases breathing and heart rate.

Most low-intensity activities you do during the day also fall under this category. It includes such regular activities as walking, jogging, swimming, and cycling.

For individuals who are beginners in exercise programs, or maybe have histories of health conditions, light exercise routines are recommended at first on most days of the week.

Cardiovascular benefits

Experts advise that these aerobic exercises have to be performed at moderate intensity. This level of activity is safe for almost everyone, and it still provides the desired health benefits.

Recent research brings in additional good news. It is revealed that aerobics performers can still have cardiovascular benefits even if the exercise routine (usually 30 minutes total) is broken into three or four 8-10 minute segments, as long as they are of the same intensity.

Intensity

Doctors, however, discourage infrequent bouts of high-intensity aerobics routines. It is found that this approach is not very healthy.

In the first place, reduction in risks of hypertension, high cholesterol, type 2 diabetes and other conditions depends on the total volume of the exercise done, rather than on intensity.

Higher intensity exercise activities raise your chances for muscle or joint injury. Worse, it may trigger fatal consequences because of heart rhythm disturbances.

Aerobics instructors always begin their sessions with light stretching and low-intensity movements for about 5 to 10 minutes. This warm-up routine is important to avoid injury. At the end of the routine, a similar cooling-down period for about 5 to 10 minutes is also done.

Benefits

As had been proven these years, people who engaged in regular aerobics have been known to benefit by way of lower blood cholesterol counts, lower blood pressure, toned body because of fat reduction and beneficial weight loss.

They have been known to have developed muscular and overall body endurance, have a happier disposition and moods, and a medically-certified general lower risk to cardiovascular diseases.

Common activities

The best part is the easy way on how to do your aerobics, even without going to the gym and participating in gym routines.

Doctors recommend a simple walk that totals around 10,000 steps a day. Start with something lower, and add the number of steps slowly everyday until you reach your goal.

Done on a regular basis, brisk walking is guaranteed to erase your common health risks. Your need for aerobics is not be that hard to fill up.

HYPNOTHERAPY

DOC WHAT IS HYPNOTHERAPY?

Hypnotherapy is the use of hypnosis to treat patients who are in pain or who are having problems within their minds.

The word Hypnotherapy is based off the word "Hypnos," and this was the name of the Greek god of sleep.

Those who use hypnotherapy believe that patients who enter a trance are much more likely to listen to suggestions which are given to them.

Some conditions which are treated by hypnotherapy are
1.pain,
2.stress,
3.obesity,
4.smoking,  
5.amnesia.
6.hysteria

While many of these conditions are related to the mind, some functional ailments can be treated as well.

Hypnotherapy is a practice that was started by the Ancient Egyptians and Indians. Here the practice would often have a religious tone, and both music and dance was included in the practice.

It wasn't until the 19th century that a number of healers begin developing the methods that would come to be known as hypnosis. Franz Anton Mesmer developed a theory which has come to be known as animal magnetism.

He did extensive research on hysteria, and his studies indicated that advanced cases were similar to what is called a post-traumatic stress disorder.

The work of Sigmund Freud also played an important role in the development of hypnotherapy.

A number of criticisms have been made against the practice:

1.Some believe that the connection between the patient and the therapist may cause problems.

2.The patient may want to please the therapist, or they may worry that the therapist doesn't like them.

However, many of these claims are inconsistent because clinical hypnotherapy will generally take place in a medical facility.

There are a number of common techniques that are used in this practice.
1.Regression method-One of the primary techniques is age regression. The hypnotist will attempt to mentally return the patient to a previous state, and this will often be done to help the patient gain something that they have lost.

2.Revivification -the second technique that is commonly used in hypnotherapy is called revivification. In this technique, the hypnotist will help the patient remember previous experiences they've had. As an example, the hypnotist may ask a patient if they have ever been fishing, and if they have been, they will begin recalling the time that they went fishing, and there will be no need for the hynotist to create a new state.

3.Guided Imagery -another common method that is used in hypnotherapy is called a guided imagery. With this technique, the hypnotist will guide the patient through a pleasant experience.

4.Repetition method-The hypnotist may often repeat certain ideas or concepts in order to get the patient to accept them, and this is called repetition.

In general, people are more relaxed when they are in a dream state. When a person is able to visualize something they desire, research has shown that it is much more likely that they will obtain it.

In this situation, the goal of the hypnotist is to help the patient achieve a desired goal.

This technique has primarily been used to help people on a mental level since the 19th century.

MAJOR COSMETIC SURGERY

DOC WHAT ARE THE MORE MAJOR COSMETIC SURGERIES AND PROCEDURES

Major Cosmetic Surgeries which has some risks:
1.Facelifts for patients with wrinkles, excess folds of skin over jaw and neck.
During a facelift operation the wrinkles and excess skin  are eliminated by by tightening of the skin pulling it upwards and backwards.The purpose of the surgery is to give the patient a natural face tension and smooth skin without excess skin under the jaws and neck.Complications to this surgery include bleeding and infection, damage to the facial nerve .Incisions are hidden within the hairline and in front of the ear.
A normal facelift can last for 5 to 10 years.However not all wrinkles can be eliminated.

2.Eyelid surgery such as double eyelids, removal of bags under the eye and drooping eyelids:
Double eyelids operations are done by incision(cut) under local anesthesia of the skin of eyelid, excess fat is removed and the upper eyelid muscle(levator palpebae superior) is attached to the upper eyelid skin to simulate a natural fold. The result is an eye that look brighter and more awake.
Drooping eyelids are due to stretching of upper eyelid skin as a result of aging.
Removal of the excess skin and any excess fat tissue through an incision of the upper eyelid under local anesthesia will tighten the upper eyelid and prevent drooping.
Bags under the eyes is due mainly to aging with congestion of blood, water and fat under the eye as well as looseness of the lower eyelid. They make a person look tired, sad and old. Excess fat, skin is removed through an incision very close to the margin of the lower eye under local anesthesia.
Recurrence of all 3 conditions can occur after a few years.

3.Nose operation includes reduction of large nose or augmenting a flat nose.
Reduction Rhinoplasty: here the nose is too large,so the operation require dissection of the nasal bone with fine saws and reduction of cartilage under general anesthesia to give the desired shape.
Augmentation Rhinoplasty:The nose is too small, the bridge is too low or the tip is too short .The best way to reshape the nose is with a silicone implant tto alter the shape of the nose aand lift the bridge and tip of nose.This is done under local anesthesia through incision through the nostril so there is no obvious scar.

4.Reduction of bat ears which are sticking out can be done by reshaping the abnormal  ear cartilage and the ear folded backwards until it is parallel to the side of the face. This is done under local anesthesia and usually done for children before going to school.

5.Chin and neck problem can be either protruding too much forward or too far backwards.  Where there is no problem with teeth alignment, treatment is easier with reshaping of the front of the jaw bone.
In cases where the jaw is too short, the shape of the jaw can be corrected with a silicone implant through a small incision inside the mouth.
Where there is problem with teeh alignment, the jaw may be required to be shortened and the teeth realigned. This usually requred the services of a specialist dental surgeon.
Double chin patients usually have too much fat and skin under the neck. The fat and can be removed through a small incision in the neck under local anesthesia and the excess skin can also be removed easily by surgery.

6.The breasts can be either too small or too big.
Augmentation surgery usually involve the insertion of a silicone or saline prosthesis into the space between the breast and the chest wall through an incision under the breast.
Reduction of large breast is done under general anesthesia in hospital with removal of excess breast tissue and transplant of the nipple higher to a normal position.

7.Spare tyre may be in the form of excess fatty tissue and loose skin.
The commonest area is in the bulging abdomen especially in the elderly and in women with several pregnancies. The commonest way to remove excess fat is by liposuction which is done under general anesthesia to suck out most of the fat tissues in the abdominal area, thighs, hips or buttocks.The fat is often softened with saline or liquefying agent.
In cases where there is excessive loosness of the skin some surgery may be needed to remove the excess skin and tighten the muscles of the abdomen.

8.Collagen and botox injections: Collagen injections are used to fill up the depression of scar tissue or deep wrinkles. They are also used to tighten the sphincter of urinary tracts or anus in incontinence cases.
Botox injections are used to numb the nerves of the skin so that the muscles of the skin do not tighten to cause wrinkles.

HEALTH EDUCATION

THE IMPORTANCE OF HEALTH EDUCATION AS AN INTEGRAL PART OF PRIMARY HEALTH CARE

by Kenneth Kee 1993

A Dissertation Presented in Partial Fulfilment of the Requirements for the Degree of Doctorate of Philosophy with a Major in Health Care Administration and approved in 1993

ABSTRACT OF DISSERTATION:

This paper examines how health education and promotion forms an integral part of the Primary Health Care System.

It also shows how the concept of health has changed from its original definition by the World Health Organization as a state of complete physical, mental and social well being and not merely the absence of of disease and infirmity to something more realistic, dynamic and measurable.

The original definition has been described as an ideal state which is rarely attainable in real life.

The definition of of health care has also changed from a hospital based curative medicine to one of Primary Health Care and Preventive Medicine.

Primary Health Care is emphasized as the cornerstone of all good health care systems.

The escalating cost of health care associated with high technology and hospital based medicine in the treatment and rehabilitation of chronic diseases has led to the realization among many health care providers that many of the risk factors in the chronic diseases can be prevented at the Primary health care level.

A more rational approach to the current health may require more of a preventable rather than a curative approach in medical treatment.

To this end health education and promotion has proved its importance in the fight against disease and form an integral part of the health care system.

This paper also examines some well known models of health education and promotion such as the Tanahill's model of identifying key groups and their roles in health education and the Green's Proceed-Precede planning framework which identifies various behavioral and environmental factors affecting health.

It recommends various strategies for the [promotion of health such as formulation of definite goals, intersectional collaboration in health education and community participation in health education and community participation.

This dissertation about health education has brought me more knowledge about health issues than 20 years of practice in the field of primary health care.

It has focused my mind on the very important field of preventive medicine and health education.

It has made me more determined than ever to continue my work as a health educator as well as a medical practitioner

It has made me even more aware of the need of continuous medical education to keep abreast of the latest advances in medicine.

Unless I continuously update my medical knowledge I will not be able to explain the latest medical advance to my patient.

Lastly I must always remember that it is the patient who will benefit from my knowledge and that knowledge is not to be kept but to be imparted.

In the words of Professor Rosalind Miller:

"it is a society with myopic vision that foster episodic medical care than health care that includes Primary prevention particularly for those at greatest risk and where social welfare and health problems are indispensable"