A Simple Guide to Obesity Part 2

A Simple Guide to Obesity Part 2
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What is the Treatment of Obesity?
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Motivation:
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Motivation is the key to weight control.

Knowing the dangers of obesity will help to motivate a person to lose weight.

Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.

Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.

Regular Exercise:
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Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.

Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.

Lead an active lifestyle.
Do not sit and watch TV all the time.

Diet Control:
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Choose a healthy diet with with reduced calories and which is nutritionally balanced

Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar

Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.

A combination of diet and exercise is more effective in reducing than either one alone.

Medication:
-----------------

Two main types of medications are available to help control weight:

1.Appetite suppressants:
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help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.

They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.

They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.

They should be used for short term (6-12 months) as there is also a danger of dependency.

2.Fat absorption suppressant:
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prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.

Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.

They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.

They can be taken for a longer peroid of 2 years.

Surgery:
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Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.

Surgery should be used only drug therapy, diet, exercise have failed.

Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.

Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.

Surgery has some complications such as infections.

How do you prevent recurrence of Obesity?
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Many studies showed that most people will regain weight within 5 years.

You can maintain your weight by
1.eating a low calorie diet, low in fats

2.maintaining a healthy exercise regime

3.maintaining motivation and self esteem

4.monitoring your weight food intake and exercise

A Simple Guide to Coronary Heart Disease Part 2

A Simple Guide to Coronary Heart Disease Part 2
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What is the treatment of Coronary Heart Disease?
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Any heart attack is an EMERGENCY!
Immediate treatment is urgent!

While waiting for the ambulance, lie the patient in a slightly inclined position.
Give nitroglycerin tablet under the tongue if available.
Admit to hospital as an emergency.

Severe cases are admitted to Cornary care unit(CCU) for constant monitoring of the heart, blood pressure and abnormal rhythm of heart rate.

Risk factors for Coronary heart disease like hypertension, high cholesterol, diabetes must be treated.

Medicine:
-----------

Anticoagulants such as warfarin, aspirin, Plavix,should be given to
prevent blood clots .

Vasodilators like isorbide are given to help dilate the artery to the heart

Any abnormal rhythm of the heart must also be treated with medications or pacemaker if severe as damage to heart may affect the conduction of the electrical impulse of the heart to the cardiac muscles.

Because of the psychological effect of a heart attack on the patient, sometimes antidepressant or tranquilliser may be necessary.

Interventional Procedures:
--------------------------

Once stable the patient may be requred to have a ballooning of the narrowed artery or a stent inserted in the narrowed artery.
This can be done during the cardiac catheterisation.

1.balloon angioplasty
balloon is inflated to compress fatty matter to the wall of narrowed artery and open the blood vessel

2.Stent:
balloon angioplasty is performed in combination with placement of a stent which is a small, metal mesh tube that provide support inside the coronary artery.

3.Drug eluting stents (DES):
Drug-eluting stents contain a medication that is actively released at the stent implantation site to prevent recurrence of narrowing of the artery

4.Rotablation
The Rotoblation special catheter, with an acorn-shaped, diamond-coated tip, spins around at a high speed and grinds away the heavily calcified plaque on the arterial walls.

5.cutting balloon
The cutting balloon catheter has a balloon tip with small blades which are activated when the ballon is inflated. The small blades remove the plaque and the balloon compresses the fatty matter into the arterial wall.

Surgery :
-------------

If the narrowing involved too many arteries, then a coronary artery bypass graft (CABG) surgery will have to be done.

Stay in Hospital and Rehabilation:
---------------------------------

Usually a heart attack patient stays in hospital for 2-4 weeks depending on the severity of his condition.

Mild exercise is started once his condition is stable.
Exercise is good for the patient because it helps the blood circulation.

However strenous exercise including sexual inercourse should start until at least 4-6 weeks later.

Most patients should be able to drive or fly after 2 months.

What can I do to prevent Coronary Heart Disease?
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Prevention of a heart attack is the same as prevention of a stroke as both involve the avoiding the blockage of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

3.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

4.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

5.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

What is the prognosis of Coronary Heart Disease?
---------------------------------------------------

The outlook following a coronary heart attack is generally good.
About 80% of patients are alive after 3 years and 70% after 6 years.

The outlook varies depending on the age of the patient and severity of the heart attack.

However with new treatment and a healthy lifestyle, the prognosis has improved tremendously.

Medication such as Aspirin or warfarin may have to be taken permanently to prevent a recurrent attack.

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
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Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
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A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
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1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
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1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
----------------------

Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

A Simple Guide to Scoliosis

A Simple Guide to Scoliosis
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What is Scoliosis?
----------------------

Scoliosis literally means a crooked spine, a lateral curve or angular deviation of one or more of the vertebral segments.
3% of the population have some form of scoliosis.
For many people it's not much of a problem.
For a small number of people, the curve gets worse as they grow.

What is the cause of Scoliosis?
-----------------------------------

1.The most common type of scoliosis is called idiopathic(or unknown cause.) scoliosis.
2.Scoliosis can run in families, that is , it may be hereditary.

Who is affected by Scoliosis?
---------------------------------

Scoliosis usually begins at the age of 9-18 years when the bone starts growing during puberty. After this age, the curve usually become permanent as the bone stopped growing.
Scoliosis is more common in girls than boys.

How Do You check for Scoliosis?
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Scoliosis may be easily noticeable.
A curved spine can cause someone's body to tilt to the left or right.
Many children with scoliosis have one shoulder blade that's higher than the other or an uneven waist with a tendency to lean to one side.

During a doctor visit in school, cases of scoliosis are easily detected during examination.
It's an easy test called the forward-bending test.
It involves bending over, with straight knees, and reaching your fingertips toward your feet or the floor. Then the doctor will look at your back to see if your spine curves.

Someone with scoliosis may have a back that curves like an "S" or a "C."
This type of curve may be noticeable to others and can be uncomfortable.

How to decide whether your Scoliosis require Treatment?

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If you have confirmed scoliosis, then the doctor will decide whether treatment is necessary. He may order X-rays of your spine. This will determine the angle of curvature and the severity.
If the curve is mild, you may not need much treatment except for exercises to straighten your back and consistent monitoring of your spine.

If the curve is severe ,an orthopedic surgeon will check on how severe your spine's curve is.

He will looks at your X-rays and measures the spine's curve in degrees.

Someone who has a mild curve may just need regular checkups to make sure the curve isn't getting worse.

Someone with a more severe curve may need to wear a brace or have an operation.

What is the treatment of Scoliosis?
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There are 3 main methods of treatments:

1.Exercises for back and monitoring:
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For mild cases, you may need to do some exercises to help straighten the back such as doing pull ups.

2.Treating With Braces
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The brace for scoliosis is meant to hold the spine in place so the curve doesn't get any worse.
Some braces are made to be worn only at night.
Others are designed to be worn for much of the day.
Most children need to wear their braces at least 20 hours a day, so that means wearing them to school.
As he or she gets older and the spine curvature improve, braces are worn for a shorter peroid daily.

Braces now are lighter, more comfortable, and easier to wear.
There are many different types of braces.
Where the scoliosis is in the lower part of the back, the child often wear a brace called a thoracolumbosacral orthosis or TLSO for short.
This kind of brace comes up under the arms and is more comfortable than the bigger braces.
The two most popular TLSOs are the Boston brace and the Wilmington brace.

3.Treating With Surgery
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Braces often are able to control the curvature.
Some children who have scoliosis eventually need an operation because of the increasing severity of the scoliosis or if a severe scoliosis is detected late.

During the operation, the orthopedic surgeon fuses the bones in the spine together to correct the curve using metal rods, hooks, screws, and wires to hold everything in line until the bones heal.

The operation takes several hours, depending on how big the curve is and how many bones need to be fused.
After the operation,the child can usually go back to school about a month later.
He or she need not wear a brace and can return to some activities in 3 or 4 months, and most normal activities after a year.
Each patient's surgery and recovery might be different, depending on the type of surgery and the patient's age.

With improved treatment, more children with scoliosis can live normal lives.

A Simple Guide to Osteoporosis

A Simple Guide to Osteoporosis
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What is Osteoporosis?
---------------------------

Osteoporosis, which literally means porous bones, is a condition in which the bones become weak and brittle, resulting in a greater likelihood of breaking after minor trauma.
Bone is constantly being removed and replaced in our body.
Osteoporosis occurs when bone is lost faster than it can be replaced.

What are the symptoms of Osteoporosis?
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Osteoporosis is a silent disease. People with osteoporosis often do not know that they have the condition. Fractures from osteoporosis commonly occur in the wrist, spine and hip.
Persons with hip fractures suffers considerable loss of function and becomes dependent on others.

What are the risk factors of developing Osteoporosis?
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Factors that will increase the risk of developing osteoporosis are:
Female gender;
Caucasian or Asian race;
Thin and small body frames;
Family history of osteoporosis ;
Personal history of fracture as an adult;
Cigarette smoking ;
Excessive alcohol consumption;
Lack of exercise;
Diet low in calcium;
Poor nutrition and poor general health;
Malabsorption syndromes(nutrients poorly absorbed from the gastrointestinal system)
Low estrogen levels (such as occur in menopause or early surgical removal of both ovaries); Chemotherapy can cause early menopause due to its toxic effects on the ovaries;
Amenorrhea (loss of menstrual period) in young women causes low estrogen and osteoporosis;
Chronic inflammation, due to diseases (such as rheumatoid arthritis,chronic liver diseases);
Immobility, such as after a stroke, or from any condition that interferes with walking;
Hyperthyroidism, a condition with too much thyroid hormone ;
Hyperparathyroidism, a disease with excessive parathyroid hormone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis;
Vitamin D deficiency. When vitamin D is lacking, the body cannot absorb adequate amounts of calcium to prevent osteoporosis.
Certain medications can cause osteoporosis. 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).

How do you Screen for Osteoporosis?
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Bone Mineral Density:
Routine X-rays cannot detect osteoporosis until it is quite advanced and there is a lot of bone loss.
The best way to detect osteoporosis is to carry out a Bone Mineral Density (BMD) test to measure density (solidness) at various sites (e.g. hip, spine).
It will help to assess your risk of having a fracture.
BMD is frequently measured by dual energy X-ray absorptiometry (DXA).
It is a painless procedure.

How is osteoporosis diagnosed?
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A routine x-ray can reveal osteoporosis of the bone, which appears much thinner and lighter than normal bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30% of the bone has already been lost.
DXA measures bone density in the hip and the spine. The test takes only 5 to 15 minutes to perform, uses very little radiation and is quite precise.

Who should have bone density testing?
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All postmenopausal women below age 65 who have risk factors for osteoporosis;
All women aged 65 and older;

What are the consequences of Osteoporosis?
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Osteoporosis bone fractures are responsible for considerable pain, decreased quality of life, lost workdays, and disability.
Elderly patients can further develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after a hip fracture.
Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture.

How is osteoporosis treated and prevented?
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The purpose of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength.
Early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture.
There is no complete cure for osteoporosis .
There is no way to completely rebuild bone that has been weakened by osteoporosis.
Therefore, prevention of osteoporosis is as important as treatment.

Osteoporosis treatment and prevention measures are:
Lifestyle Changes:
1.Exercise has a wide variety of beneficial health effects especially weight-bearing exercise, such as walking.
However, exercise does not bring about substantial increases in bone density.
The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased.
It is important to avoid exercises that can injure already weakened bones.
In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure , exercise should be monitored.
Cessation of Smoking :Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause.
Decrease regular consumption of alcohol and caffeine on osteoporosis is not as clear as with exercise and cigarette.

Medications:
1.Medications that stop bone loss and increase bone strength, such as
alendronate (Fosamax),
risedronate (Actonel),
raloxifene (Evista),
ibandronate (Boniva),
calcitonin (Calcimar);
2.Medications that increase bone formation such as teriparatide (Forteo).
3..Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes.
800 mg/day for children ages 1 to 10
1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen
1200 mg/day for teenagers and young adults ages 11 to 24
1500 mg/day for post menopausal women not taking estrogen 1200mg to 1500 mg/day for pregnant and nursing mothers
The total daily intake of calcium should not exceed 2000 mg
Daily calcium intake can be calculated by the following method:
Excluding dairy products, the average diet contains approximately 250 mg of calcium;
There is approximately 300 mg of calcium in an 8-ounce glass of milk;
There is approximately 450 mg of calcium in 8 ounces of plain yogurt;
There is approximately 1300 mg of calcium in 1 cup of cottage cheese;
There is approximately 200 mg of calcium in 1 ounce of cheddar cheese;
There is approximately 90 mg of calcium in ½ cup of vanilla ice cream;
There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.
Additional calcium can be obtained by drinking more milk and eating more yogurt or cottage cheese, or by taking calcium supplement tablets as well from calcium-fortified foods.
Calcium supplements are safe and generally well tolerated.
Side effects are indigestion and constipation.
4.Vitamin D:
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. Daily Vitamin D intake are:
200 IU daily for men and women 19 to 50 years old,
400 IU daily for men and women 51 to 70 years old, and
600 IU daily for men and women 71 years and older.
But if a person already has osteoporosis, it is advisable to ensure 400 IU twice per day as usual daily intake, most commonly as a supplement alongside prescription osteoporosis medication.
5.Hormone therapy (menopausal hormone therapy)
Menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) has been shown to prevent bone loss, increase bone density, and prevent bone fractures. It is useful in preventing osteoporosis in postmenopausal women.
Medications that prevent bone loss and breakdown

How do you monitor Osteoporosis?
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Repeat bone density testing (DXA scans) is NOT indicated in monitoring osteoporosis treatment or prevention on a routine basis.
Bone density changes so slowly with treatment that the changes are smaller than the measurement error of the machine.
The real purpose of osteoporosis treatment is to decrease future bone fractures.
There is no good correlation between increases in bone density with decreases in fracture risks with treatment.
In the future, however, if ongoing research brings new technology or new therapies, testing decisions will clearly change.


Added 4th October 2008
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Osteoporosis
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One way of determining the risk of Osteoporosis:
substract the weight in kg from the age in years.

If the number is less than 0 the risk is low

If the number is between 0-20 the risk is moderate

If the number is above 20 the risk is high and you should see the doctor.

A Simple Guide to Parkinson's Disease

A Simple Guide to Parkinson's Disease
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What is Parkinson's Disease?
----------------------------------
Parkinson's Disease is a disorder of old age characterised by slow movement , rest tremors , rigidity and poor coordination.

Who gets Parkinson's Disease?
------------------------------------

Parkinson's Disease usually after the age of 50 years.
Incidence is about 0.2% of population.
It is one of the most common neurologic disorders of the elderly.
It affects both men and women equally.

What causes Parkinson's Disease?
---------------------------------------

Parkinson's Disease results when the nerve cells in the part of the brain that controls muscle movement (substantia nigra) are gradually destroyed.
Nerve cells use a brain chemical called dopamine to help send signals back and forth.
Damage in the area of the brain that controls muscle movement causes a decrease in dopamine production.
Low dopamine affects the balance between nerve-signalling substances (transmitters).
As a result, the nerve cells cannot properly send messages.
This results in the loss of muscle function.

What are the symptoms of Parkinson's Disease?
--------------------------------------------------------

Early symptoms may be nonspecific and may include numbness, painful and tender muscles, stiffness and weakness of limbs, fatigue and unexplained weight loss.

As the disease progresses, the classical features of Parkinson's Disease appear:
1. Bradykinesia(slowness of movement)
2. leadpipe rigidity
3. rest tremors
4. Postural instability

How is Parkinson's Disease diagnosed?
----------------------------------------------

Parkinson's Disease is diagnosed when there are at least 2 of the four classical features are present. To improve diagnostic accuracy, bradykinesia must be present.

1. Bradykinesia usually presents with lack of voluntary and automatic movement such as monotonous speech,
lack of facial expression,
Slow movements
Difficulty initiating any voluntary movement
Difficulty beginning to walk
Difficulty getting up from a chair
shuffling of feet movement

One way to demonstrate this is to have the patient tap his index finger on his thumb.
The movement is slow and lack momentum.

2. Rigidity of Parkinson's Disease is leadpipe in nature.
This rigidity contribute to the
mask like facial appearance,
Muscle rigidity
stiffness of posterior neck muscles,
diminished arm swing,
cogwheel rigidity of the wrists,
Difficulty bending arms or legs

3.Rest tremor is classical of Parkinson's Disease.
There is this resting or pill rolling tremors of the hand which is worsened by anxiety and fatigue and disappears when the hand is in use. Tremor is usually unilateral.

4. Postural instability usually occurs late in the illness.
It is seen in the
Unstable, stooped, or slumped-over posture
freezing gait,
retropulsion,
loss of balance and
frequent falls

Turning in bed, rising from the chair and turning when walking is difficult because of poor body and limbs coordination.

What are the other symptoms associated with Parkinson's Disease?
-----------------------------------------------------------------------------

Additional symptoms that may be associated with this disease:
Depression
Confusion
Dementia
Seborrhea (oily skin)
Loss of muscle function or feeling
Muscle atrophy
Memory loss
Drooling
Anxiety, stress, and tension

What are the Complications of Parkinson's Disease?
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Untreated Parkinson's Disease progresses to total disability, often accompanied by general deterioration of all brain functions, and may lead to an early death.

Treated, the disorder impairs people in varying ways.
Most people respond to some extent to medications.
The side effects of medications may be severe:
Varying degrees of disability
Difficulty swallowing or eating
Difficulty performing daily activities
Injuries from falls
A variety of gastrointestinal symptoms, mainly constipation
Daily activities such as bathing,dressing, walking and even writing may be difficult.

How is Parkinson's Disease treated?
------------------------------------------

Parkinson's Disease is not curable and the purpose of treatment is to:
1. improve functions and
2. treat symptoms

Treatment of Parkinson's Disease can be broadly classified into:
1. Non-drug therapy:

Good general nutrition and health are important.
Exercises that improve strength, agility and flexibility are useful to minimise the disability of Parkinson's Disease.
A range of motion exercises is useful to keep the joints supple and mobile.
Patients are encouraged to exercise according to their ability.
Good exercises include walking,swimming, stretching and riding stationary bicycles.

Patients are taught sitting balance,walking techniques and the use of handrails. Activities of daily living is made more manageable with aids like:
Buttoning -replace buttons with Velcros
Eating -use utensils with large handles
Getting out of bed -install an overhead grab bar
Prevents falling -install hand bars in bedroom and bathroom. use nonslip mats.
Getting out of chair - use high seat chair
Railings or banisters placed in commonly used areas of the house may be of great benefit to the person experiencing difficulties with daily living activities.
Special eating utensils may also be helpful.

2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions.
depression
insomnia
constipation,
dysphagia,
urinary frequency

2. disease modifying drugs such as:
Levodopa may be used to increase the body's supply of dopamine, which may improve movement and balance.
Artane -is particularly good for reducing tremors
Jumex- is used in early Parkinson's Disease and helps reduce bradykinesia
Bromocriptine - enhance the effect of levadopa Deprenyl may provide some improvement to mildly affected patients.
Amantadine or anticholinergic medications may be used to reduce early or mild tremors. Carbidopa reduces the side effects of levodopa and makes levodopa work better.
Entacapone is used to prevent the breakdown of levodopa.
Pramipexole and ropinirole are used before or together with levodopa.
Rasagiline is approved for patients with early Parkinson's disease. Rasagiline helps block the breakdown of dopamine.
Neupro is a new skin patch that contains the drug rotigotine. This medicine helps dopamine receptors in the brain work better. The patch is replaced every 24 hours.

Additional medications to help reduce symptoms or control side effects of primary treatment medications include antihistamines, antidepressants, monoamine oxidase inhibitors (MAOIs), and others.
It is important that the disease should be controlled before irreversible brain damage occurs.

3. Surgery:
In some cases surgery can help to alleviate symptoms especially when all other medications and measures failed.
Surgery to implant stimulators or destroy tremor-causing tissues may reduce symptoms in some people.
Transplantation of adrenal gland tissue and stem cells to the brain has been attempted, with variable results.


Added 4th October 2008:
---------------------------------

Parkinson Disease:
----------------------
Less than 5% of Parkinson's Disease patients gets the disease through genetic reasons.

A mutation of a gene (LRRK2) called G20135 has been found to increase the risk of Parkinson's disease in some families.

People with the mutated gene gets the illness at a younger age than the normal which is 60 and above.

The cause of Parkinson's disease is still unknown.

The prevailing theory is that environmental factors such as exposure to high levels of pesticides is the cause of the disease.

A Simple guide to Hemorrhoids

A Simple guide to Hemorrhoids
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What are hemorrhoids?
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Hemorrhoids or piles are distended veins inside the anus which are swollen and inflamed. Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

What is the cause of hemorrhoids?
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Hemorrhoids usually result from straining to pass the stool out of anus. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea.

What are the symptoms of hemorrhoids?
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The most common symptom of internal hemorrhoids is bleeding from the anus.Bright red blood may be seen covering the stool, on toilet paper, or dripping from the anus into the toilet bowl.
There may be pain too especially if the stool is hard. This could be due to the hard stools pressing on the swollen piles or due to a tear in the inner lining of the anus.

A painful swelling or a hard lump around the anus may occur when a blood clot forms. This condition is known as a thrombosed hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching.

How common are hemorrhoids?
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Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50.
Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. For most women, however, hemorrhoids caused by pregnancy are temporary.

When are hemorrhoids diagnosed?
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A thorough examination and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and the entire colon with colonoscopy.
Colonoscopy is a diagnostic procedure that also involve the use of lighted, flexible tube inserted through the rectum.

What is the treatment?
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a.Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include:

1.tub baths several times a day in plain, warm water for about 10 minutes
2.application of a hemorroidal cream or suppository to the affected area.
3. medicines such as daflon to shrink the swollen blood vessel.

b. Surgical treatment:A number of methods may be used to remove or reduce the size of internal hemorrhoids.
These techniques include
1.Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
2.Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
3.Laser coagulation. A special device is used to burn hemorrhoidal tissue.
4.Hemorrhoidectomy. Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.
5.A new method is the Longo technique. It involve using a circular stapling device which removes a ring of tissue in the lower anus pulling the enlarged piles up within the anus. The staples also interrupt the blood supply to the piles

How do you prevent hemorrhoids?
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The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs.

Drink lots of water at least eight glasses a day.

Eating the right amount of fiber result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Good sources of fiber are fruits, vegetables, bran bread, and whole grains.

Avoid food which cause local irritation of anus (spicy food,alcohol) or bowel excitation (coffee,tea)

Exercise, including walking, swimming, help reduce constipation and straining by producing stools that are softer and easier to pass.
Avoid certain sports such as cycling and horse -riding because of the pressure exerted on the anal region.

Avoid sitting in hot places for too long.

Use the toilet at a fixed time eg. after drinking a big glass of water, when you wake up.

A Simple Guide to Constipation

What is Constipation?
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Constipation by definition is a condition which is characterised by fewer than normal bowel movement than usual.
It is accompanied by straining, incomplete evacuation and passage of hard stools.

Who gets Constipation?
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It is particularly common among the elderly and younger children.


How do you get Constipation?
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There are a few causes of constipation:

1. Insufficient fibre(fruits,vegetables) to form bulk in the stools.

2. Insufficient fluid in the diet(at least 8 glasses of water).

3. Insufficient time to go to toilet when there is the urge to pass motion.

4. Insufficient exercise to help the intestine to move especially after meals, common in
sedentary jobs and older people

5. Stress cause the constriction of the anal sphincter preventing the stools from passing.

6. Depression on the other hand depress the movement of the intestines.

7. Drugs like cough mixture containing codeine,antispasmodic, antacids may also reduce the
motility of the intestine.

8. Pregnancy in the later stage cause the womb to press against the intestine.

9. People with low thyroid hormone slows down the movement of the intestines.

10.People with piles or pelvic space occupying swelling which may press against the
intestine or rectum.

How to avoid Constipation?
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Avoidance of constipation include:

1. Increase in daily fibre 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 litres). 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.

How to treat Constipation?
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1.Follow the advice above.

2.Consult your family doctor to exclude any abdominal swelling which may be blocking the
passage of stools.
A colonoscopy may be needed to check the large intestines for tumours or early cancer.
Your piles may be removed during the colonoscopy if found to be obstructing passage of
stools.

3.Try Yogurt or fermented milk with lactobacillus as a method to stimulate more
production of bulk in stools.

4.Try not to take laxatives unless it is deemed necessary by your doctor.
Most doctors preferred not to use medicine in combating constipation.

5. Learn to relax the anal sphincter by doing some pelvic exercises