Fruits-13 must-have affordable ones with fantastic benefits for your good health( contd.)
Table of Contents
Part 2
Hello friends, welcome back to the second part of the fruits for health article. In my last article, I had discussed six such fruits out of the 13 which I want to talk about, and now we will try to learn about seven more such fruits.
As you all know, all fruits are packed with a lot of nutrients and chemicals – phytonutrients and antioxidants-that protect our organs and different parts of the body.
So let’s carry on- the next on the list is-
7. Sapota{Chikoo}-the gritty, sweet fruit
Sapota or chikoo[as it is popularly known in India] is a fruit that I usually recommend to my deficient patients in Calcium. They are generally available throughout the year in India and are quite affordable. One of my patients who has a chikoo farm near Mumbai brings me these fruits occasionally. Sometimes they are as large as a cricket ball.
Here are the nutritional facts about Chikoo-check it out. I am sure you will opt to purchase and eat more of this fruit whenever you visit your fruit market next time.
Chikoo fruit
In India, especially in Mumbai, we get delicious ice cream made from the chikoo pulp.
For more on the benefits of eating Chikoo, read this article on timesnownews.com.
8.Watermelon 🍉-the Summer Fruit
Watermelon starts appearing in the market in mid-February and remains throughout the summer. People who fast during Ramadan find it very useful as it –
Quenches thirst after a long day fast
Contains a lot of natural sugar, vitamins, and minerals.
For others, watermelon juice with some spices is a lovely alternative to artificially flavored cold drinks. Apart from that, did you know that watermelon and its seeds have many other benefits? The picture below will show you all the benefits of eating watermelon-
Now that you know what watermelon can give, you have your fill of the fruit and its juice. Having learned about the fruit, let’s try to understand what the seeds can provide us-see below-
9. Musk Melon 🍈-fruits with fantastic health benefit
Just like watermelons, musk melon is a summer fruit, albeit a bit costlier. They are also known as Cantaloupes. I have summarised the benefits of eating muskmelon below.
Source-Segerios.com
A fruit with so many benefits should be had as a dessert after meals as and when available.
10.Orange🍊and Lemons🍋- the tangy fruits
Oranges and lemons are considered winter fruits in India, and their availability ranges from October to mid-March. They are classified as a citrus group of fruits because they contain a lot of vitamin C. As you all know, due to the COVID-19 pandemic all over the world 🌎, doctors have recommended Vitamin C to boost immunity. In the picture below, I have provided the different benefits of eating these citrus fruits.
What better way to boost your immunity is there than eating an orange 🍊. There are many types of citrus fruits – you can click this link- thespruceeats.com -to know more about different oranges and lemons.
11. Pineapples 🍍the spiky fruit
Pineapples are very healthy and tasty fruits that have additional benefits of reducing your girth-i.e., the circumference of your tummy. It has an enzyme called Bromelain, which has the property to –
Digest proteins – so good to have it after a high protein content meal such as meat.
Reduce inflammation, particularly of joints( some anti-inflammatory drugs have them for, e.g., Tab. Zymogesic, the one I have discussed in the treatment of osteoarthritis)
Contain antioxidants that help in reducing problems of the heart and other organs in our body.
Pineapples 🍍are hardy, gritty fruits. You have to know how to peel them properly. Here is a short video that shows how you can do it-
12. Papaya
Papaya is one such fruit that has multiple benefits. I will explain how the nutrients present in papaya briefly- have a look at this picture first.
Nutrients in papaya fruit with values denoting the percentage of daily dietary requirement[ in 100 gm sliced fruit]
How the nutrients in papaya fruit help us-
Fibers-7%-these help relieve constipation.
Also, an enzyme-papain, helps in digestion by breaking down protein molecules in our food, mostly from meats. That’s why raw green papaya is used to tenderize or marinate meat while making curry and make them digestible.
Vitamin C and A levels are pretty high, which indicates that this fruit is good for our immunity and our vision and skin health.
13. Custard Apple
Custard apple- popularly known as Sitaphal in India
Sitaphal or custard apple is a fruit with blackish-brown seeds embedded in white or light yellow colored pulp. The pulp is the edible part, and each 100 gm is rich in-
Calcium-30 mg Potassium-382 mg
Magnesium -18 mg Phosphorus-21 mg
Iron-0.71 mg Sodium- 4 mg
Water-71.5 gm
Here are the full nutrifacts about Custard-apple-
Custard-apple pulp is used in making ice cream in India. It has exquisite taste, and I am sure you will not stop at one scoop of the ice cream.
For more details on Custard apple, click this Link- healthifyme.com.
CONCLUSION
There are many more fruits out there in the fruit market like Strawberry, Rasberry, Figs, Dates, Apricots, Peach, Dragon-fruit, etc. Each fruit is unique in structure and content. In the future, I will come out with another article regarding the nutritional facts about these fruits.
I hope you have enjoyed reading the nutritional facts about these 13 must-have affordable fruits that have benefits to boost your health.
If you would like to read such posts in the future, kindly click on the notification button to subscribe.
Here is one interesting quote by Linford Christie on the importance of eating fruits-
You can also share this post by clicking on this quote-
Fruits-13 must-have affordable ones with fantastic benefits for your good health
Table of Contents
Part 1
Do you know that eating fruits in the early part of life can give you tons of good health later in life? If you are still unaware of fruit-eating benefits, this article might be just for you.
Why should fruits form a part of your daily diet?
Fruits should form a part of everybody’s diet and here are 13 such fruits which are quite affordable that can keep you healthy, fit and fine. Nowadays, because of lack of time and a busy schedule, people are consuming processed and ready-made foods which cause more harm than good for one’s health.
Since my childhood and even today, I have been eating fruits regularly after my main meals. Every fruit contains measurable amounts of micro and macronutrients that are needed by our body. We will discuss the same in this article, and eventually, you will understand how eating fruits can ward off many ailments that affect us on a day-to-day basis.
Why am I writing this article on fruits?
In my past few articles, I have been writing mostly about diseases and ailments affecting us. Which, I feel, has been an overwhelming experience for most of you. This prompted me to write something more interesting, something delicious: something we eat regularly, i.e., fruits.
Ailments and diseases occur due to our own negligence. What if we can overcome this negligence and do something that can keep us healthy?So this time, I decided that I should share my knowledge on something that would prevent illnessand keep us healthy, i.e., by eating some delicious fruits as suggested by Harvard Health Education.
I have written this article keeping in mind some people who are skeptical about eating fruits and also dislike them. If these people read the beneficial effects of fruits, they might change their minds. To make it easier to absorb knowledge about different fruits in detail, I have split this article into 2 parts. In the first part, we will learn about 6 such fruits, and in the second part, the rest of the seven.
This article does not emphasize that you should eat only fruits throughout the day but advises you to add them to your daily diet if not already on it.
Why are fruits so important for us?
A lot has been written about the “good” and “bad” effects of consuming fruits. But if you were to ask me, I would say that there is nothing like fruits that can give us plenty of natural vitamins and minerals.
All fruits are a rich source of nutrients and antioxidants that are needed very much by our body to maintain good health. Now, what are antioxidants? To know more about antioxidants, read here on the Mayo clinic blog and have a look below to see how they work-
How I enjoyed eating fruits in my childhood-
During my childhood days, my father used to feed us fruits instead of chocolates🍫. As such, chocolates were a rare commodity those days, except for toffees or some plain candies. Present-day markets are flooded with these goodies. But these chocolates can cause future problems like-
Causing dental caries
Increasing our weight and abdominal girth
Leading to heart disease, diabetes, etc.
These ‘goodies’ also do not improve our health ( read here to know more). In this article, I have collected information from various sources and put them under one umbrella for you to easily understand why fruits should be an important part of our daily diet. Here is one more article that suggests you have 5 servings of fruits and vegetables a day- Eating five- a-day fruits…
Before I go on, let’s have a look at this short video-
So let’s shun the sweet goodies and look out for something healthy such as fruits, so let’s begin-
1.Apple 🍎-the Healthy fruit
‘A for apple’ is what we are being taught as we enter kindergarten in our school. So, you see, Apple is No.1 alphabet-wise, and it is also truly so.
You may also have heard the popular saying, “An apple a day keeps the Doctor Away!” How very true. You must have noticed that whenever someone falls sick, their friends and relatives who visit them to enquire about their health tend to bring along some apples. Why do they do so? Obviously because of its great health benefits.
What are the health benefits of eating Apples?
Apples are a great source of vitamins, minerals, and fibers. Here are some nutritional facts about apples-
So, you can see what all 1 apple weighing 100 gms can provide us. All the nutrients and micronutrients present in the apple help in the recovery of an ill person. The DV mentioned in the brackets stands for the average daily value percentage of that nutrient required by our body.
2.Banana🍌-the fruit for Super health
Bananas are packed with so many nutrients that they can be considered a Super Healthy food for all. Plus, it is the mostaffordable of all the fruits as well as available throughout the year in our country.
If you have noticed sports carefully like tennis, the player will eat at least 1 banana at every break. Why? Okay, just have a look again at the picture of the nutritional facts about this fruit. Other than carbohydrates and proteins in high amounts, it contains potassium and magnesium in large amounts. These minerals prevent muscle cramps in such an exhaustive sport, as the game can last for more than 3 hours sometimes, sapping out all the energy as well as the minerals mentioned above. Plus, you also get added benefits from the various vitamins, which are also present in good quantity.
So, I suggest that you should have at least one banana per day to help you remain healthy, fit, and fine. More on a banana- read here.
In my childhood days, we lived in a small beautiful town in the Pune district of Maharashtra. My father was in railways, and we had a sprawling bungalow with a front garden and a backyard. The best part was that there were a few guavas trees 🌳 which gave us plenty of guavas to eat. Every day, in the early part of the morning, parrots used to visit our garden to feast on the delicious guava.
We used to eat these fruits throughout the year, and there was no fixed season for it. Other than the fruit, the leaves and seeds of guava are also useful for our health. Here are a few benefits of eating guava-
Nutritional facts about Guava fruit. Source-Herbazest
If you have observed the above image, you can see that the vitamin C content is very high. Vitamin C is a powerful antioxidant and is being prescribed to boost immunity by doctors worldwide to fight the Covid-19 infection. So, eat this fruit as and when possible to get a tasty dose of your vitamin C rather than vitamin-C tablets from the chemist.
So you can see how these fruits gave me the health benefits which I am still enjoying at this stage of life. Have a look at the benefits of eating this ‘ poor man’s apple ‘ in this short video-
.
For more about the benefits of eating guava, read this article on this website- medlife.com.
4.Pear🍐
Pear is another fruit that I personally enjoy eating as and when it is available. The sweet, gritty taste appeals more to me than that of an apple. Plus, they are packed with some nutrients which are not available in other fruits.
Pears are like apples. They grow in colder climates and are therefore seasonal. In India, they are grown mostly in the northern states of Punjab, Haryana, Himachal Pradesh, and Kashmir. As compared to an apple, they are sweeter, i.e., they contain more sugar[see the table below in the nutritional facts about pear] – almost double that of apple-
A large amount of dietary fibers(6gm) helps our digestion and also relieves constipation like guava. Nowadays, pears are comparatively cheaper than apples. So, go ahead, eat some pears as and when available.
5.Mango🥭-the King of Fruits
Mangoes are seasonal fruits[except for some variety in south India which are available almost throughout the year]. In India, the season of mangoes lasts from February to June. There are many varieties of mangoes, each with a unique taste.
But almost all are very sweet to taste. This is because of the high content of sugar in it[ see below].
As you can see, in 100 gm of Mango fruit, you will get 15 gm sugar as carbohydrates which makes it very sweet. Apart from the vitamins and minerals, mango also contains some phytonutrients as shown in the figure to the right.
These phytonutrients help maintain-
Vision in our Eyes
The texture of our Skin
Strength of our Hair etc.
To know more about different varieties of mangoes, Click on this website- balconygardenweb.com. Raw or unripe mangoes are also used for making pickles and chutneys in India.
Now let us move to another fruit in our list, i.e., Grapes.
6.Grapes🍇- the tasty fruit
Black grapes on a vine
Grapes are my favorite among the many fruits I enjoy eating. These are seasonal, available mostly from January to mid-April in India. There are various grapes with different colors- green( the most common), black, red, purple, yellow, and magenta. Each type has a few common and unique properties. The colored ones have more phytonutrients and antioxidants that help our body ward off chronic diseases like diabetes, chronic kidney disease, hypertension, etc.
Taste-wise, they range from sour( used to make wine 🍷 and 🍾champagne )to very sweet. The health benefits of eating grapes are also quite vast and unique to the fruit. You can read this article here on healthline.com to know more.
I usually consume about 200 gm of the fruit after each main meal. 100 gm of grapes will provide you the following nutrients ( see table below)-
Table 1
Nutritional Facts of Grapes
PRINCIPLE
VALUE
IN 100 GM
CALORIES
70
FATS
0 GM
CARBOHYDRATES
14 GM
PROTEIN
1 GM
SUGAR
12 GM
SODIUM
2 MG
FIBER
1 GM
VITAMIN C
27%
RECOMMENDED DAILY INTAKE [RDI]
VITAMIN K
28%
RDI
VITAMIN B1-THIAMINE
7%
RDI
VITAMIN 6-RIBOFLAVINE
6%
RDI
POTASSIUM
8%
RDI
COPPER
10%
RDI
MANGANESE
5%
RDI
I have now come to the end of Part 1. I hope you have enjoyed reading this article. If you want more such articles to be notified to you, please click the notification button to subscribe so that you do not miss on my next post. And that will be about 7 more fruits which I will be posting 2 days from now.
As I wind up this article, I would like you to hear this article on how fruit can help us get good health you can read here on
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Learn how to prevent these diseases and treat them if you get it
After learning about acute common viral diseases, it’s time now to dig into some Acute Common Bacterial Diseases. In this article, we are going to learn how these diseases present with real-time examples of patients that I have come across in my Clinicand how I have treated them.
What are Acute Common Bacterial Diseases?
Let us briefly learn what we are going to discuss here.
Bacterias are living organisms that have a cell with a nucleus and a cell wall. A virus has a cell wall but no nucleus.
Instead, virus has what we call RNA( ribosome nucleic acid) or DNA( deoxyribose nucleic acid) strand. This they use to cause disease after entering a healthy cell.
Image showing different parts of a bacteria. Source- Wikimedia CommonsImage showing a Viral cell. Source- Wikimedia Commons
To know more about the structure of a bacteria, read this short article.
How do the viruses and bacterias grow in our body?
The above two pictures depicts the difference between a Bacterial cell and a viral cell. Both bacterias and viruses have a different way of multiplying in our body. Whereas the virus has the ability to replicate by releasing the RNA or DNA strands in the human cell, the bacterias multiply by a process called mitosis. In this the bacterias multiply by division of the cells.
I have explained how a viral disease is detected in the body in my recent article on COVID-19 infection.
Now let us proceed to learn about the Common Bacterial Diseases which may affect you.
The Acute Common Bacterial Diseases-
Broadly speaking, bacterial diseases affect almost all the important systems in our bodies. I have designed a table system-wise for your better understanding and learning.
As you can see, the list is quite big. So we proceed one system at a time, article by article.
In this article, we will discuss all the common Bacterial diseases affecting the uppermost part of our body i.e. the head. And in the head, we will learn about the face and in it, the most prominent part of the face-the NOSE.
Let us first try to know about the different bacterial infections of the different organs in the face. These are as shown below in the picture along with the terms used to describe them.
Table showing acute common bacterial diseases of the face
In this article and the subsequent ones, we will study common bacterial diseases concerned with-
Nose
Ears and
Eyes
To begin with, this article will deal with the Nasal System which includes the nasal cavities, the different sinuses connected to the nose, and as we go downwards, the throat or the pharynx.
Acute Common Bacterial Diseases of the Nasal System-
1. The Nasal system-
The nasal system comprises parts of the nose such as
nasal cavity,
the nasal septum,
paranasal sinuses [as shown below] and
the throat( pharynx).
The above picture shows the parts of the nasal system which are prone to Acute Bacterial Diseases. The common cold is one of them, which presents itself as Acute Rhinitis.
What are the acute common nasal diseases we come across?
They can be broadly categorized as-
Acute Rhinitis
Acute sinusitis
Acute Pharyngitis
We will discuss in detail the acute common bacterial diseases of these 3 conditions in this article.
Acute Common Bacterial diseases-Acute Rhinitis-Case study
Acute Rhinitis stands for inflammation of the nasal cavities, the nasal septum, and the turbinates[part of the nasal wall which cover the openings to the maxillary sinuses]. Let us study this ailment with an example-
Mr. MSK [name changed] visited my clinic with the following symptoms-
Runny nose with sneezing. If this is a thin watery fluid, then the likely cause is an allergy to either dust or pollen. This is mostly caused by viruses found in the common cold. This patient may have a history of allergy to dust.
The nasal discharge at the time of visit was a thick foul-smelling liquid. It is called phlegm, which can be greenish-yellow in color. This is mostly caused by bacteria. Click the link to know more about it from the Color of the Phlegm.
Pain in the nose. This was caused due to swelling of the turbinates[see the image showing a cross-section of the Nasal Cavity below⇓]. The turbinates are part of the nasal cavity which acts as a cover or a door to the openings of the maxillary sinuses, the bony chambers which form the part of the cheeks.
Acute Common Bacterial Disease of the Sinuses- Acute Sinusitis
After having a common cold, if the infection still lingers around, it can affect our nasal sinuses. There is inflammation of the sinuses which is called Sinusitis. The picture below shows how the nasal sinuses look on a cross-section of our face. Out of the 4 types of sinuses shown, the sinuses that are most affected by bacterial diseases are the frontal and maxillary sinuses.
Now let us study one more case who visited my clinic with cold and severe facial pain.
Mrs.SN reported to me with these symptoms-
Fever
Sneezing
Blocked nose due to nasal congestion
Facial pain, especially in the forehead( Frontal Sinusitis) and cheeks( Maxillary Sinusitis)
Signs-
On examination, she had
Moderate to high body temperature-(100 to 102.5° F, as per history given by the patient)
Tenderness( pain) on pressing the sinuses
Throat congestion
Nasal cavities appeared swollen and blocked by thick greenish-yellow phlegm
The two nasal cavities of our nose are separated by a cartilage called the septum. Sometimes, this septum gets deviated due to excessive growth. This deviated nasal septum, popularly referred to as DNS, blocks the fluid flowing from the upper or frontal sinuses causing Frontal Sinusitis.
Investigation-X-Ray of Paranasal Sinuses
I advised this patient an X-ray of the paranasal sinuses, popularly known as the Water’s View[see below]-
In this picture, you can see the swollen turbinates in the left nasal cavity. This has blocked the opening of the left maxillary sinus, causing fluid or pus to accumulate in that sinus. This was causing pain and headache in the patient.
Prevention-
It is not so easy to prevent sinusitis as it is a postlude to the common cold. Avoiding coming in contact with a person who is sneezing around is the best course. Other than that
wearing warm clothes in the winter season, especially a woolen cap
Woolen caps for preventing head cold. For more details, click here
having hot soups like tomato soup or chicken-stock soup will help overcome symptoms of acute sinusitis,
Steam inhalation if you are having a stuffy nose
Here is a short article that will help you prevent or treat sinusitis at home on this link-timesofindia.indiatimes.com
Treatment of Acute Rhinitis and Sinusitis
I have discussed the treatment of Acute Rhinitis in my previous article( kindly refer here).
The treatment of Acute Sinusitis includes all that for acute rhinitis plus these medications-
1.Nasal decongestant-
This includes nasal sprays like
oxymetazoline hydrochloride (Nasivion),
Saline nasal solution (Nasivion S).
These medicines when used as a spray or drops can relieve one from nasal congestion. This helps to breathe through the nose easier.
2. Anti-inflammatory drugs
Anti-inflammatory medicines help in reducing the congestion and swelling inside the sinuses. This reduces the pain and headaches experienced in acute sinusitis. The common medicines which I prescribe to my patients are-
Trypsin- Chymotrypsin ( Chymoral) plus either Diclofenac sodium ( Voveran, Diclogem) or ibuprofen( Brufen, Ibugesic)
3.Antibiotics-
There are many antibiotics 💊 that I prescribe depending upon the severity of sinusitis. These are-
Amoxycillin( Almox, Mox) of 250mg or 500mg strength depending upon the severity of infection
Doxycycline( Doxy-1L)
Azithromycin( Zithromax, Azee) of 250mg or 500mg strength depending upon the age of the patient.
4. Vapocaps-
Vapocaps are solutions used as a steam inhalation or by spray on a handkerchief that can help in relieving nasal congestion. A few names that I use are
Karvol plus,
Sinarest vapocaps
If the sinusitis is very severe, the patient is referred to an ENT surgeon for draining the accumulated fluid or pus in the sinus[as shown above in the X-Ray]. This is quite common in the maxillary sinuses.
Now let us proceed ahead with the next common bacterial disease of the nasal system-Acute Pharyngitis.
Acute Common Bacterial Infection-Pharyngitis
What is the pharynx? The pharynx is the part of the mouth that is behind the tongue. It forms the part of the ear-nose-throat triangle of the face. The picture below shows a cross-section of the head and face and the location of the pharynx in it-
The Pharynx is connected to the nose above and the ear by its side through the Eustachian tube. So, whenever there is an infection of the nose, there are equal chances of the pharynx getting swollen or inflamed. This is termed Pharyngitisor simply put, sore-throat.
It should be noted that the pharynx contains glands called the Tonsils. There is a circle of these tonsils that surround the nasal cavity from inside. Collectively, these are referred to as Adenoids. When these are also inflamed it is called Tonsillitis[see picture below].
Sometimes these tonsils block the tube extending from the pharynx to the middle ear, the Eustachian Tube. There may be inflammation here also which may give rise to pain in the ears and sometimes, discharge from the ears[will be covered in the next article].
Tonsillitis- Source- Researchgate
Now that we know what a pharynx looks like, let me discuss a case having the symptoms and signs of Acute Bacterial Pharyngitis and Tonsillitis.
Acute Bacterial Pharyngitis-a Case Study
Sixteen-year-old NK visited my clinic in September 2019 with the following signs and symptoms-
Fever off and on for last 3 days.
Stuffy nose.
Severe sore throat.
Hacking dry cough which gave him pain in the throat and both ears.
On physical examination-
His pulse rate was high(> than 100).
Throat was severely congested and showed a whitish patch on the tonsils.
Chest examination- normal breath sounds. No signs of lung infection.
Investigations of Acute Severe Pharyngitis-
CBC- This showed a high white cell count.
A throat swab was also taken- this revealed streptococcus bacteria on culture.
This bacteria was sensitive to these antibiotics-Amoxycillin, Doxycycline, Erythromycin, Gentamycin, and Amikacin.
X-ray paranasal sinuses showed signs of both Frontal and Maxillary Sinusitis.
Treatment of Acute Bacterial Pharyngitis-
Paracetamol ( Pacimol 500) for fever;
Diclofenac sodium + Serratiopeptidase( Emanzen-D)combination for throat pain and swelling;
povidone-iodine ( Betadine gargle) solution for gargling; cough suppressant ( Corex Dx) for the dry cough.
All these medicines were prescribed for 5 days. NK recovered fully. However, he was advised to continue gargling for 3 more days.
Prevention of Acute Bacterial Pharyngitis-
All the preventive measures taken for acute sinusitis and rhinitis along with regular gargling with warm salt water(at least once at bedtime) are advised for those having recurring pharyngitis.
Conclusion-
I hope this article has helped you understand almost everything about the acute common bacterial disease of the upper respiratory tract. In my next article, I will be discussing cases related to others parts of the head, namely the eyes and the ears.
Until then, wishing you all a healthy life free from any sort of disease. If you have found this article useful, be sure to share this knowledge with your friends and near and dear ones.
Kindly click on the quote below to share this article-
If you have any queries on the subject discussed in this article, kindly post them in the comments section at the end of this article.
Till then, Adios.
Disclaimer:-
The medicines mentioned in this article is for information purpose only and that which I prescribe to my patients on consultation. Drugs mentioned in this article should be consumed only after consulting your family physician or health care personal.
Acute Common Diseases- Know How to prevent or Manage Them
Table of Contents
Common Diseases that commonly affect us
What is this article all about?
In this article I am going to discuss about all the common diseases which causes illness for a short period of time. Sometimes these diseases can be serious enough to land you in a hospital.
The aim of this article is to make you understand these common diseases and help you prevent it or guide you for further action.
Here we will discuss
the causes,
the signs and symptoms,
methods to prevent and, if you do get it,
how to treat it.
So my suggestion will be, do read and re- read this article so that you know when you should visit your family physician.
What are these common diseases?
There are many common diseases out there in our environment. Many of us suffer from one disease or many diseases at the same time but may be totally unaware of what it might be. What if you know what it is and also know how to tackle it?
The different types of common diseases-
There are two types of common diseases, namely-
Acute common diseases
Chronic common diseases
You can refer to this short table to know what they are-
Knowing what disease{or diseases} you may have is the first step towards its prevention or management. There are many diseases that go unnoticed until you have some or the other complications, e.g., chronic kidney disease or CKD. My mother had it, and we did not know about it until one fine day she started vomiting, which would not stop with any anti-emetics ( medicines to stop vomiting). Later on, we found that her serum creatinine was far higher than the normal of 0.6 to 1.04gm/ dl when we investigated her.
In this article, I am going to outline some of the acute common diseases we come across. We are going to discuss all the signs and symptoms of all the mentioned diseases. Not only will I be discussing how they present but also some tips on recognizing it on time so as to avoid them.
This post will teach you how to prevent these diseases and some tips on treating them at home[ home remedies] before approaching your healthcare professional.
We will discuss first the Acute ones and then the Chronic ones. Read on….
Acute Common diseases
These common diseases are termed acute because they start suddenly and also disappear within few days. Most of these conditions are caused by either viruses or bacteria or maybe a combination of both, for, e.g., common cold followed by pneumonia.
Acute common diseases can present as-.
Viral Diseases
Bacterial diseases
Parasitic diseases
Fungal diseases
We will discuss the common Acute Viral diseases in this post and the rest in my subsequent posts.
Common Viral Diseases-
Acute viral diseases present in many ways. A few of them are-
The common cold
Influenza( including COVID-19)
Viral hepatitis
Viral pneumonia
We will discuss 2 of them, namely-
Common cold
Acute Viral Hepatitis
A) The Common Cold
One of the most common viral diseases is the common cold. It is winter over most parts of the world at present. It is very common to find people sneezing and blowing their noses during this season. The symptoms are-
Headache
Mild to moderately high fever( 100 to 102° F)
Generalized body ache
Sneezing
Sore throat
Coughing with or without phlegm or sputum.
A lady having a headache due to a cold.( Source-Photo by Anh Nguyen on Unsplash)
Recently we have been going through an acute viral disease all over the world- the COVID-19 pandemic or the SARS-Corona virus disease. We have discussed this disease’s signs and symptoms in my past articles-click here to know more and here.
Prevention-
Avoid going close to a person getting sneezes or having a cough. I always recommend having a hot soup like any vegetable soup( tomato soup is very good) for vegetarians and chicken- stock soup for non-vegetarians. They have a soothing effect on your throat if you are going in for a sore throat.
I also recommend gargling with warm salt water or povidone-iodine solution in half glass warm water at least 2 times a day.
Treatment of Common Cold-
In my regular practice, I prescribe these medicines for my patients-
Paracetamol ( Pacimol, Dolo) in the strength of 250 to 650 mg depending upon the age of the patient and severity of the fever.
Anti-cold tablets( Recofast plus, Sinarest)- 2 to 3 times a day
Antibiotics tablets or capsules (Almox 250, Doxy-1L) 2 to 3 times a day if the sputum is purulent( greenish-yellow in color)
A cough suppressant( Corex- Dx, Planokuf)
Something to give the energy to fight the disease like Vital- Z or Enerzest powder to be taken with water.
I also advise a proper diet and complete bed rest to the patient for at least 3 days. Nowadays, due to a hectic life, patients do not get complete rest, and that worsens the illness.
You can listen to this short podcast to know more about the common cold.
Common cold and Allergic Rhinitis
There is a thin line differentiating a common cold from the cold of allergy, popularly referred to as allergic rhinitis.
Here is an interesting article that will teach you how to differentiate both- link.
B) Viral Hepatitis
Hepatitis is a disease affecting your liver. There are many types of diseases causing inflammation in the liver, such as alcoholic hepatitis, non-alcoholic liver disease, amoebic hepatitis, and viral hepatitis.
Viral hepatitis is the most common causing severe illness. There are many types of viral hepatitis, namely, A, B, C, D, E.
Out of these, we will take up Viral hepatitis A or HVA in short. This is the most common and the most dangerous of the lot. The signs/symptoms (S/S) can range from mild to very serious or fulminant, causing death.
Cause of HVA-
The route of the hepatitis virus into our body is known as the fecal-oral route. Meaning that the virus is shed in our stools. And if the person or a carrier is not hygienic, this is transmitted to others through food handled by these people, mostly street food vendors.
Contaminated food( mostly street food)due to common houseflies and contaminated water in the rainy season are a few of the other common causes.
You can watch this video to know more about the different types of viral hepatitis.
Sign and symptoms
Viral hepatitis starts out as influenza, causing mild to moderate fever, cold, cough, etc. It then progresses to other S/S of liver disease, such as-.
Nausea and vomiting
Loss of appetite
Dark or yellow-colored urine
Pain in right flank due to an enlarged liver
Loose motions or sometimes, constipation
The feeling of tremendous weakness
Investigations of HVA
Your doctor may suggest you the following investigations-
CBC( complete blood checkup)- this may show a rise in white blood cells
Liver function test or LFT– these may show a rise in all liver enzymes such as SGOT, SGPT, ALT and a rise in bile pigments and bile salt such as bilirubin.
Urine routine and microscopic- this may show the presence of bile salts and pigments, as mentioned above.
HbsAg- this is a blood test showing a specific antigen(a surface protein on the virus-cell) of Viral Hepatitis B disease.
Complications-
In fulminant HVA, the bile pigments can go and lodge in the brain, causing damage, known as hepaticencephalopathy. This usually causes coma and, ultimately, the death of the patient.
Prevention of Hepatitis-
We can easily prevent viral hepatitis by following these simple steps-
Wash hands with a germicidal soap thoroughly before eating and after you attend nature’s call.
Avoiding street food, mostly in the rainy season.
Eat vegetables, fruits, etc., washed thoroughly, preferably by filtered water 💧 if it is known that there is hepatitis going around in your city or town.
By vaccination- vaccines to prevent hepatitis are easily available and can be prescribed by your doctor. This article will help you know more about the different vaccines available to prevent viral hepatitis.
Treatment-
According to an article in ucsfhealth.org, the treatment of different types of viral hepatitis varies according to severity.
There is no specific treatment for viral Hepatitis A. For Hepatitis B and C, there are a few anti-viral drugs available, namely-
Lamivudine[ available as Lamivir HBV Tablet]
Adefovir[available as Adesera 10 mg tablet]
*These drugs or medicines are prescription medicines and are to be taken only if your doctor prescribes it.
Alternatively, Hepatitis B can be cured by taking injections (💉 ) of a drug called pegylated interferon-alpha. This is given to those who progress to Chronic Hepatitis B. It is given weekly for 6 months.
Treatment for Hepatitis A
In the case of HPA, other than prevention ( which is the best method), treatment consists of-
Complete bed rest at home 🏡
Avoid fatty and oily foods for a period of 1 to 2 months.
High carbohydrate diet
Proper hygiene, especially sanitation of hands after attending nature’s call to prevent spread among other family members.
In case the patient is having consistent vomiting and getting dehydrated, the best course is to admit him/ her to the hospital for taking intravenous fluids like 5% Dextrose or Dextrose Saline or Ringer Lactate.
I hope you have understood these two acute viral diseases. I will introduce you to a few Acute Bacterial diseases in my next article.
If you have liked this article, do spread the knowledge by clicking on the quote given below-
The medicines mentioned in this article is for information purpose only and that which I prescribe to my patients on consultation. Drugs mentioned in this article should be consumed only after consulting your family physician or health care personal.
Living with COVID-19 pandemic- How to Reshape our Lives Now and Lead a Happy Healthy Life
Table of Contents
The COVID-19 PANDEMIC-
Would you like to lead a healthy, fit, and useful life in this COVID-19 pandemic? That’s a question everyone wants an answer to because the pandemic never seems to be letting up.
For the last 12 months, we all have been bombarded with the same word-COVID-19- over and over again on all the media channels. Today, we are all really ‘Sick’ of-
Hearing about COVID-19
Listening to the loss of our near and dear ones, including friends, due to the disease
The fear with which we are living our day-to-day life
Is it ever going to end, or are we being compelled to being living with COVID-19 forever? These questions linger in the minds of almost all the patients that I see daily in my clinic.
What has been the situation so far due to the COVID-19 pandemic in the city where I am living?
I live in Navi Mumbai, a place named Vashi. In the early days of the COVID-19 pandemic, there were a few cases and much fewer deaths. In the past 6 months, the situation changed drastically- the number of positive cases just shot up. And the number of deaths also shot up.
What has been my experience so far?
As the days progressed from January 2020, the number of cases all over India started spurting to unprecedented levels. Initially, in the early days of COVID-19, I had written 2 articles{ read here-1, 2 }.
Those were early days, and I had assumed that this disease would peter out like its other cousins- SARS-1 and MERS. But I [and the whole world, for that matter] was wrong. The disease, instead of declining, started climbing with unprecedented speed causing immense damage to the economy as well as the lives of the family who had patients amongst them. You can also say that this is the worst ever pandemic of the century, after the Great Spanish Flu of 1918, where millions had lost their lives.
Here, in this article, I am going to share my experience with one of my patients. This will help you to understand what happens when you suffer from a Covid-19 infection.
Case study of COVID-19:-
Mrs.SS, a 56-year-old lady, visited my Clinic in the first week of September 2020. At that time, it was raining very heavily in Navi Mumbai.
This lady had-
High temperature-102.5°F
Cold
Sore throat
Cough
Pulse Oximetry reading-SpO2-98%
At this stage, her chest examination was found to be normal. With 2 days of treatment with paracetamol, anti-cold medicines, and an antibiotic, her temperature was back to normal. But, on the third day, she started complaining of-
Severe weakness
Breathlessness
Pulse Oximetry reading -SpO2-had dropped to 85%
Dry hacking cough which was making her feel very sick
I ordered the following investigations-
A] Fever Panel-
This investigation consists of the following tests-
Complete Blood Checkup-this showed a high total white blood cell count with reduced lymphocytes.
C- reactive protein[ a marker of inflammation] very high- it was 45( normal range 0 to 6). This suggested a severe infection in the body.
Increased levels of liver enzymes- Again, signs of severe infection, mostly of the liver.
Widal test – negative for typhoid
Malaria parasites- absent in the smear.
B] RT- PCR test
This the test which determines whether one is infected with the Coronavirus. The full form of RT-PCR is the Reverse Transcriptase Polymer Chain Reaction test. You can watch this short video to know more about the test- click here
In this patient, it was negative.
C] Pulse Oximetry-[discussed below]
The oxygen level- SpO2- of this patient when she visited for the first time was 98%. Gradually, by the 3rd day, her SpO2 level came down to 85% and appeared as if she was gasping for oxygen.
D] Chest X-ray
This showed changes of pneumonia.
E] HRCT of Chest
This test is a high-resolution CT- scan of the lungs and the chest. It showed the presence of round glass pneumonia [similar to the image shown below]
After proper assessment, this patient was referred to a COVID-19 Center, where she was admitted for approximately 14 days and treated with medication 💊 for Coronavirus.
F]The After- effect of treatment –
This patient was admitted to the hospital, and she received treatment and attention for about 14 days. There she was treated for ‘cytokine storm'( discussed below). She was administered these medications-
Antiviral injection Remedesvir by intravenous route- 1 dose per day for 6 days.
Injection Sepsivac- an immunomodulator to neutralise the excess antibodies in the body and tackle the cytokine storm. This was given subcutaneous( underneath the skin) at 3 places for 3 consecutive days.
Steroid injections – to reduce swelling inside the lungs.
Antibiotics
Cough syrup.
The side-effects-
Now, these medicines have their own side- effects. This patient developed-
High blood pressure – the blood pressure had shot to 200/ 120 mm of Hg when she visited my clinic again after discharge from the hospital.
Hyperglycemia- her random blood sugar was 245 mg/ dl.
She had developed a moon face due to steroids used to treat her.
However, after a few days of medications, she was back to normal.
What about the present COVID-19 situation in India?
Today is 3rd January 2021, 3 days after I started writing this article. So far, as per the daily news about COVID-19 Infection spread in India, it is –
Total No. of active COVID-19 cases as of today-2.5 lakhs
No. of deaths due to COVID-19 reported so far-1.5 lakhs
Recovered cases from COVID-19 as of today-9.9lakhs
But the cases are not declining. The recovery rate is quite slow, and the number of deaths is increasing by the day, even though it is just 1.5%of the total. It remains to be seen how we will fare in the coming days. In the past 11 months since the first case was detected in India, the total no of cases are as follows-
10.3 million
9.98 million recovered
1.49 lakh dead
You can have a look at the real-time statistics of the COVID-19 situation in India by clicking this link.
What should we do in such a situation?
What is heartening news is that the percentage of recovered casesof COVID-19 is quite satisfactory. Now imagine a situation where you yourself or your near and dear one gets affected by the Coronavirus. In most cases, people first rush to their family physician [if he/she is available, as most of them are not].
What are the likely questions that you may be asking your family physician about COVID-19 infection?
My experience in the past 10 months of the ongoing pandemic is that patients who visit my Clinic are very anxious and more and more worried about getting infected by the COVID-19 virus.
To allay the fear of all concerned, I am going to put up some frequently asked questions by my patients and the answers I give-
Q1. What is this COVID-19 infection? And How do we get it?
Answer:- COVID-19 infection is a viral infection just like the seasonal flu; the only catch is it is more severe and dangerous. You can get it in several ways-
Through a person who has already been exposed to the virus. This virus has been imported to our country by people who had traveled to places like China, where it was reported first.
By inhalation of air that has been contaminated by droplets containing the virus by a patient who has a cough, cold, or sneezing.
Touching things like metals[ copper, steel of door handles], wooden surfaces like that of tables, chairs, etc.
Direct contact with an asymptomatic person[one who does not show any signs/symptoms] like kissing, hugging, etc.
2] What is the course of progressing disease in a Covid-19 pandemic?
Answer:- To begin with, the COVID-19 infection presents as a common cold with –
Sneezing
Runny nose
Sore throat
Cough
Fever which may be as high as 102° F.
Loss of sense of smell and taste( read this article to know more about these symptoms)
As the disease progresses, the cold and fever may disappear with the patient feeling better. Then suddenly, after 2 to 3 days, the patient presents with-
Mild to severe breathlessness
His or her oxygen level drops. This can be seen by using a Pulse Oximeter-
Pulse Oximeter-Click here to purchase
The normal oxygen level, read as SpO2 on the Pulse Oximeter, ranges from 95 to 100%. This drops down below 90 and may range anywhere between 65 to 85%.
X-ray chest shows changes of typical pneumonia called Ground glass pneumonia.
HRCT[ discussed above] also shows changes in Ground glass pneumonia.
3] What is Cytokine storm
This is a condition that occurs a few days or even months after the initial Coronavirus infection. When we suffer from the disease, our body produces antibodies to fight the infection. If these antibodies are in excess, they attack parts of our own body such as the lungs[most common], the brain, the eyes, the joints causing post-COVID complications. This collective complication is called the “Cytokine Storm.”
To know more about Cytokine storm, click on this link- link
4] Will I recover fully if I get affected by the COVID-19 pandemic?
This is a tricky question. Most cases that do not have any other comorbid conditions like old age diabetes, hypertension, heart disease, arthritis recover fully. Provided proper treatment is given.
For those having the above-mentioned comorbid conditions, there is a chance they might not survive. For instance, consider this case which came to me for cold, cough, and fever- a lady who was
68 years old,
had hypertension
as well as diabetes.
She got infected by the disease and was admitted to the hospital with severe breathlessness, where she was diagnosed as RT-PCR positive, and her HRCT showed signs of a Cytokine Storm. This lady underwent the treatment as per COVID-19 protocol but could not survive due to her other co-morbid conditions.
Recently, an anti-inflammatory drug called piroxicam has been shown to reverse the Cytokine storm. Here is a interesting short video by Meyer Organics, the manufacturer of Ugesic, a sublingual anti-inflammatory medicine piroxicam, that can reverse the cytokine storm- click this link Cytokine storm reversal medicine- piroxicam .
I hope I have explained most of the queries regarding the Covid-19 pandemic. In case anyone has any doubts regarding the COVID-19 infection, you can put up a query in the comments section. I will surely answer them to the best of my knowledge. All said and done ✔, we have to take care of ourselves whether we are in a pandemic or not. Here is one article which can help you to do so- read here.
For more details on COVID-19, I recommend you to read this article- link.
This is the latest take on the news of the new variant of COVID-19 which is prevalent in the United Kingdom- link
Dementia Prevention and treatment Best Ways for Prevention of Dementia and its Treatment
Table of Contents
-For Living a Better Cognitive Life
Taking off from where we left earlier- Memory loss Part 1 and Part 2 – we now move on to the prevention and treatment of memory loss or Dementia. Treatment of dementia with full recovery is difficult, but prevention is very much possible.
I recommend that you read this article till the end. To know if you are at risk for getting dementia, assess your risk by using this article
As we proceed, I will come to this risk assessment in detail.
Before we do that, let’s see what the numbers say about Dementia worldwide and that in India specifically.
What is the state of affairs regarding Dementia/ Alzheimer’s disease in India?
According to the World Health Organization, worldwide 🌐 , the number of patients scenario of dementia is as follows:-
Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.
Out of the total, about 60 to 70% are that of Alzheimer’s disease.
In India, research shows that 5 to 6% of the older adults aged 65 to 70 years suffer from memory loss and progress to Alzheimer’s disease.
Alzheimer’s Disease is the most common type of Dementia and about 5-6% of people in the age group of 65-70 years in India suffer from this problem.
That is why it is very much important to study more about Dementia, even as the whole world is grappling with the scourge of the COVID-19 pandemic.
How to know whether you are going in for Dementia?
Are there any early signs/ symptoms of dementia? Yes, definitely, a few tell-tale signs which indicate that you or your loved one is going in for Dementia. These are as follows:-
Failing to remember appointments;
Forgetting where you have kept your things like important documents, keys, etc.;
Can’t remember having taken his or her meals- this may occur a few minutes of just having one’s meal;
Disturbed sleep- a person may get up in the middle of the night and feel as if he has overslept;
As a General Physician, I usually use the GPCOG test method to decide the Risk of Dementia in a patient. Click here to more about GPCOG
Click this link here to know more about the cause of dementia in India.
Can we prevent or delay the onset of dementia? Yes, certainly we can. Before we proceed, I would like you to read this beautiful story about caring for your parents if they have dementia.
The food that we eat has its effect on almost all parts of the body. E.g., –
Eating foods rich in saturated fats or trans fats are not good for the heart(link) and can increase cholesterol levels ( link)
A high protein diet is detrimental to chronic kidney disease( kidney failure) and gouty arthritis.
Alcohol binging can lead to liver cirrhosis and the loss of memory(Wernicke- Korsakoff disease).
All the above eating habits can also speed up memory loss. The picture below shows what to avoid and what to eat 🤔 to prevent Dementia.
Avoid these foods to prevent Dementia
Eat these foods to prevent Dementia
Daily consumption of nitrate-rich vegetables such as spinach and swiss chard may prove invaluable in the prevention of neurodegenerative diseases such as dementia and Alzheimers-(Source-Medium.com). There is evidence that foods rich in a chemical called flavanols( that which gives color to fruits and vegetables) can improve your memory- (read here for more).
2. Control blood pressure well if you are under treatment for dementia
Hypertension( link) is a primary cause of Silent Stroke in many people ( we will discuss this in a separate article). If you are undergoing treatment for high BP, be regular to avoid silent stroke s it can also lead to loss of memory.
3. Control your blood sugar if you are a diabetic if you have dementia
Long-term Diabetes causes many complications if not controlled well. One of them is a Stroke. A stroke can damage the memory center in the brain. Those who control their blood sugar well can avoid this complication and memory loss.
4. Regular exercise can help you prevent dementia
Exercise is something which keeps one fit in life from all angles, namely-
It helps burn fats, thereby reducing blood cholesterol, which may be causing narrowing of arteries in the brain
Keep your heart ticking
Improve joint health, especially the knees, and keep you running
Maintain your body weight
All these points above also help improve the overall health of the brain- the seat of memory.
5. Avoid head injury to avoid getting dementia
Head injuries are known to cause loss of memory by-
Direct injury to the brain causing sometimes irreparable damage
The pooling of blood below the skull and compressing the brain
Most of the head injuries occur in vehicular accidents, more so in two-wheeler accidents. Sometimes a fall on the head while climbing or getting down the stairs, mostly in older people, can cause similar effects in a vehicular accident.
6. Taking medicines-
Patients suspected to be going in for memory loss will have to take medicines that can slow down or halt the progress of dementia. These are discussed in detail in the section below. The patient’s family members have to be very regular and prompt while giving medications to ensure that the progress of dementia is arrested.
7. Stop taking Narcotic drugs-
Drugs like cannabis, LSD, etc., can cause dementia. If any family member or your relatives or friends are on to drugs, do your best to wean them off by counseling them or admitting them to a De-addiction center.
To know more about the prevention of dementia, read here- link.
Here is another good article by Dr. Michael Hunter on how you can prevent Dementia- link
Now that we know how to prevent Dementia let’s move on to the treatment part. Read on-
Before we proceed to treatment with medicines, let us briefly recollect about the sites in the brain which is concerned for memory storage and/or memory loss- the seat of memory>>this picture-
We should now concentrate on the Temporal part of the brain, which gets affected by dementia and Alzheimer’s disease.
Parts of the brain showing the seat of memory[Source-Pinterest-Click for a Better view]
In the temporal region, we have a part called the Limbic System, which contains these areas-
Some medicines work on the limbic system, particularly the hippocampus. Now we can proceed with knowing what medicines are effective and when.
There are 2 major types of memory loss-have a look at this diagram-
The treatment is based on which type of memory loss a person has.
There are a variety of medicines 💊 for Dementia that can –
Halt the progress
Control signs and symptoms
Improve memory 📝
In this article, I will only highlight ✨ some of the medicines briefly as these medicines cannot be purchased over-the-counter. These medicines are to be taken strictly under the guidance of a Neuro physician or a Neuropsychiatrist.
Treatment of Dementia-Medicines 💊 to halt the progress
Dementia typically progresses from Mild Cognitive Impairment to full-fledged Alzheimer’s disease. There is no particular drug to prevent or halt this progress. However, there are few medicines to slow down cognitive impairment, and they are as follows:-
Donepezil[ Donep]
Galantamine[ Galamer]
Rivastigmine[ Rivamer]
Memantine[ Admenta]
These medicines are available in different strengths and combinations depending on the stages or severity of the disease. However, one should not self-prescribe these drugs and be taken strictly under a neuropsychiatrist’s supervision.
Treatment of Dementia-Medicines 💊 to Control the Signs and symptoms
Treatment of Dementia also includes some medicines to treat underlying conditions such as Depression, Irritability, Anxiety, Restlessness, Sleeplessness, Tremors of hands, etc. These are some of the medicines-
Finally, if you have someone at home who has dementia and needs help, you can consider moving that person to a place where they care for people with dementia like this place- Carefordementia
Before we wind up, I would recommend you all to-
Read this handy blog on caregiving in Dementia- link
You can also read this article for a To Do List For Dementia to improve Memory and mental health.
Memory loss due to Silent Stroke
To know memory loss due to Silent Stroke, we should understand what happens in a stroke. This will be discussed in a separate article in the coming days.
In the meantime, you can learn to calculate your riskof getting a stroke by clicking on the link given below.
What are the Investigations in Memory loss and how to get it done
Introduction-
Welcome back to Part 2 of the series on Loss of Memory. In my last article[Click here in case you have not read it], we discussed the brain’s different parts and their function. Taking off from there, we proceed ahead to learn about the causes and the investigations of Memory Loss.
What are the common causes of Loss of Memory?
I can’t remember a damn thing!
Before we take up the investigations, let’s see what the common and uncommon causes of loss of memory are-
Old Age-very common. As with other organs of the body, our brain also changes from aging. The brain is known to shrink in size.
High blood pressure- hypertension ( read here to know how)
Head Injury-Most of the head injuries, either due to a fall on the head or due to some vehicular accident, can lead to brain compression due to blood accumulation in a particular area of the brain. In this case, there is a temporary loss of memory.[I will explain this with an example below]
Infection of the brain like Encephalitis.
Drinking Excessive Alcohol – According to research, excessive alcohol causes brain damage, termed Alcohol-Related Brain Damage{ABRD}. Alcohol🍸 affects the area of the brain 🧠 called the Wernicke’s area, where there are nerve cells that help in the comprehension of speech.
–A person with ARBD may experience all of these types of damage. The different types of damage are linked to different types of ARBD. For example, Wernicke–Korsakoff syndrome is most closely linked with low levels of thiamine [vitamin B1]-Source- Alzeimhers.org.uk
The lack of or absence of blood supply to the part marked Broca’s area and Temporal lobe of the brain.
Parts of the brain and their functions- Source-Pinterest
This mostly causes a condition called stroke resulting in loss of memory and paralysis of some body parts. Sometimes there is a minor cut-off of blood supply leading to temporary memory loss. This is termed Silent Stroke, wherein the patient may complain of weakness of some parts of the body like one hand or leg. He or she may not be able to recall what he/she said a few moments ago.
What’s the difference between Memory loss due to Dementia and a Silent Stroke?
In this article, I will discuss everything about Dementia, which usually occurs as we age.
Read on-
Memory loss due to Dementia/Alzheimers disease-
You must have noticed the changes occurring in our body as we age, namely-
The appearance of wrinkles on the face;
Greying of hair;
Shortening of our height-due to loss of calcium from the vertebral bones;
Changes in our vision- due to cataract of the lens of our eyes, thinning of the retina;
Slowing down of our ability to walk, etc., etc.
As with other parts of the body, the all-important learning center and the center for recollecting and memory-The Brain- also ages accordingly. The ability to grasp what is being said, understand what is being said, and recollect most of the things that have been said also declines. This is the condition which we call Dementia-leading to Memory loss.
What happens in our brain that leads to Dementia?
Our brain is something like a modern computer where data is stored in a place called the Hard-Disk. Similarly, there are parts in the brain, such as the hippocampus, which is the seat of our memory.
Like the computer, which has a memory chip present in the hard-disk and is connected to different parts of the computer by parts called software, our brain has millions of nerve cells called neurons. These are connected by extensions called dendrites.
The dendrites are connected by ends called synapses. These synapses can get disrupted, causing malfunction of brain activity due to to-.
Lack of oxygen
Reduced supply of energy-giving glucose
Some infection in the brain
A Case Study
These conditions mentioned above are the more common ones you come across day-to-day. But there are some conditions like sudden grief[read here] or a head injury that can also lead to temporary memory loss. Like, for instance, this patient who I came across while I was in the second year of my MBBS course-
A 45-year-old male patient was brought to the General Hospital, Solapur, in an unconscious condition. He was badly beaten up with severe injuries to his head. He was being treated by the Civil Surgeon, Dr.Hoshang, at that time.
Dr.Hoshang explained to our group of students, as part of the surgical posting, all the intricacies of head injury that had led this person to this present condition- he was in Coma. The reason for him being in a coma[a state of deep unconsciousness] was a large clot of blood that had formed due to internal bleeding. It was compressing the cortex of the brain.
Dr. Hoshang removed the clot surgically and slowly, over the days, the brain expanded to its normal size. The patient started recovering and was soon out of the coma and regained consciousness. But, as a side effect of the brain’s compression, he had lost his memory and was unable to remember anything. He could not recollect –
His name;
Where was he from;
What happened to him that landed him in the hospital.
Over a period of two weeks, he regained his memory completely and was able to recollect everything. This condition is called Temporary Amnesia.
What is Alzheimer’s disease?
Alzheimer’s disease is one type of dementia and also the most common one to occur. In this type of dementia, there is a loss of memory causing-
Difficulty in retaining recent information. For example, if he has been told to repeat, say the names of a few people he may know, he may not do so.
Inability to recall recent events like conversations, songs which he has just heard, etc.
Trouble in tracking upcoming events like attending an invitation to a party, marriage, etc.
To make repetitive comments ( like the case mentioned above)
You can take a small break here and listen to this short podcast to know more about Dementia and Alzheimer’s disease–
Are there any tests or investigations to detect Memory Loss?
Yes, there are two tests, namely-
A] The Montreal Cognitive Assessment(MoCA)-
This test is to be carried out by a person trained in this test, such as Neuro physicians or Neuropsychiatrists. The figure shown below is an example of how this test is done.
The Montreal Cognitive Assessment test for assessing Memory loss[Source:-Click here for a better view-Pinterest].Here the patient’s mental status is evaluated by making them answer a set of questionnaires presented to them as shown above. The level of dementia or memory loss is then calculated as per the points shown on the right-hand side. There is a set of 30 questions that the patient is made to answer.
A score of 26 and above is considered Normal.
A score of 21 to 26 goes in favor of mild memory loss.
A score between 16 to 20 confirms Alzheimer’s disease.
B] The Mini-Mental State Examination test-
This a similar test to MoCA. It is also carried out to judge the mental status of a person suspected of memory loss. This is how it looks like-
Mini-Mental State Examination test for Memory loss[Source:- Click this link for better view-Pinterest]
You can Download both these tests and evaluate if you are going in for dementia or memory loss. That way, we can take further steps to prevent it[more in Part 3 of this series]
Are there any blood tests /any other tests to detect impending Dementia or Alzheimer’s disease?
Research shows that there are certain proteins responsible for changes in the way we remember and forget. These proteins are-
The tau proteins-p-tau217
Amyloid proteins
These proteins can be detected in the blood by using tests known as Bio-markers – namely-
The levels of these protein components are high in the blood in patients with dementia or those going in for Memory Loss. You can get these tests done herein India.
Another way to find is by doing a brain scan called the PET scan. This scan shows the p-tau and amyloid plaques formed tangles in the brain, causing the cells to store the memory to die. For PET scan in India, Click Here.
Watch the video at the end of this article to know how exactly this happens.
What happens in Dementia or Alzheimer’s causing Loss of Memory? The high levels of these proteins in the brain cause plaques and tangles in the brain’s nerve tissues. Watch this very short video- a GIF- showing the involvement of the above-mentioned proteins in causing changes or disruptions in the nerve tissues in the brain leading to the tangles and plaques –
A short video showing what happens in the brain causing Loss of Memory
Here is another video that will explain to you in detail exactly how these proteins affect our brain leading to loss of memory- link
I have covered almost all the essential tests to rule out memory loss/dementia/Alzheimer’s disease. Before we leave, kindly listen to this podcast on investigations in Memory loss.
We stop here today. But before we go, did you know that the food we eat influences our brain 🧠 health? Here is a very good article that I came across that tells us how eating highly nutritive food cannot only help us keep our general health in good shape as well as our brain health- Procerahealth.com
In my next blog, which will be published shortly, we will discuss the prevention and treatment of memory loss/dementia/Alzheimer’s disease.
How to Prevent Loss of Memory and live a Healthy Cognitive Life
Introduction
As the elderly population increases due to improving lifestyle, doctors are confronted with many cases of Memory loss. If you look at the picture just above the introduction, you can see what I mean- as we get older, this can be a situation. You will be downright happy to retain your memory and be proud of it, too! Nobody in his or her right mind would like to end up losing his or her memory. Just imagine, if one of your loved ones were to lose their memory, how would you feel about it.
Flashback-
Stressful life is another trigger for Memory Loss. I experienced this first hand when I visited my grandmother 25 years back. My grandmother- my mom’s mom- lived at our native place called Kumbla, a small town on the Kerala- Karnataka border in India. ” Mowma, kashi asa?” I asked her in Konkani, our mother tongue meaning’ how are you.’ Mowma is grandma in Konkani.
She just stared at me and replied ” Kon re tu? Kasa katir Ayla? Amtlya khampu kayi na.” Meaning ‘Who are you? Why you have come here? We do not have anything to be stolen for’.
My ‘ mowma’ had lost her memory. She was excellent till my uncle got married and left her. My uncle was the only son among six daughters of my grandparents. And he was her heart and soul.
After he left, she went into depression, which ultimately culminated in a total loss of memory. And this devastated all of those who considered her near and dear.
I was her favorite grandson. She did not recognize me. Imagine how I must have felt when she looked at me and asked me those questions!
Apart from memory loss, she had also lost her her spatial orientation- she had forgotten to use the toilet for her daily routine. She used to urinate and defecate whenever and wherever she was placed at that moment without any inhibitions!
This condition is called Alzheimer’s disease- a type of Dementia or memory loss.
What does it mean to Age Well?
In the past, we have heard people saying, ” The Older, the Wiser.” But, the present-day situation has changed- not every adult older adult is wise. In fact, in many cases, it’s just the opposite- old age has brought with it changes in forgetfulness in some older people. So much so that these people have been put up in Old Age Homes for caretaking.
To age well and keep our memory intact, we have to take care of our brain from as early as our adolescence. How to do it is the purpose of writing this article.
This article is very exhaustive, as we have to understand exactly how, why, and what about losing our memory. So, I have decided to break up this article into 3 parts to for you understand it better–
Part 1-where we will discuss all things about the brain and the part responsible for our memory-The Seat Of Memory:
Part 2-where we will discuss tests and investigations for Memory Loss;
Part 3– where we will discuss how to prevent/treat memory loss.
For whom is this article can be useful?
This article has been written not only with older people in mind but also for the younger generations. Why the younger generation? Because the process of memory loss starts much before we reach old age.
Preventive measures are best taken from a young age. After a particular age, say in the 30s and 40s, changes start occurring in the brain, which may not be reversible. I will come to the prevention part as we go ahead.
Where do we stand now?
As the days go by, and as the longevity of many of us increases, we may have many more and more cases of Memory loss. Possibly surpassing almost other causes of old age diseases such as hypertension and diabetes.
Changes in cognition occur as we age. As we age, so does our brain. Just like in heart disease, changes start taking place in the brain naturally due to to-.
Lack of blood supply due to the formation of plaques in the arteries[similar to that in the heart vessels];
Rupture of blood vessels leading to what is commonly known as Stroke or BrainHemorrhage.
Our brain is a complex structure. It is full of nerve cells and nerve fibers that connect with connectors called synapses. There are parts in the brain responsible for our memory- I will try to simplify it for better understanding.
{This article here will help you understand the science behind Memory Loss in a better way- link( inside the brain) }
Which part/ parts of the brain are involved in Memory loss?
Before we proceed ahead, let’s see how the brain looks, its different areas, and what function they carry out. Observe- your brain appears like a walnut kernel with the skull bones protecting it just like the outer shell of a walnut[see the picture below]-
The resemblance of walnut and human brain[ Source-Pikrepo]
Let’s now have a look at these two pictures in detail to understand the different parts of the brain and the seat of memory-
Fig.1
The seat of Memory in the brain-Click on the link to expand-Source-Pinterest
Parts of the brain with their function[Source-Click here to expand> Pinterest]Here we are concerned mostly with areas marked Temporal Lobe and Frontal Lobe in the second picture.These two areas represent our mental abilities- the ability to remember, carry out intelligent tasks, etc. Injury to these areas like a head injury or hemorrhage will affect these areas causing loss of memory.
Are all the parts of the brain interconnected with each other?
All parts of the brain are directly connected. How? You may ask by nerve cells called Neurons that have branches called dendrites. Let’s say you have –
Lost the smell-This sensation comes under the olfactory area- an area marked as the Parietal lobe in Fig 1. For example, if you close your eyes and are made to smell a crushed garlic pod, and you cannot tell what it is, then the memory stored in this area may have been lost. This can be a short term memory loss. This is exactly what happened to many of the COVID-19 patients-the Coronavirus had affected those parts of the brain-area no.2 and 8.
Can’t remember how one person appears or looks– This can occur if an Occipital lobe area has been affected.
Could this Memory loss be a case of what we doctors call Senile Dementia, or could it be a Silent Stroke?
An old age picture
Many of us are familiar with words like Dementia, Alzheimer’s disease(AD), Parkinson’s disease (PD), etc. You may have also heard someone saying, ” He is demented- don’t listen to him.” Now, in this sentence, the word demented means foolish. But, in medical terms, Dementia means loss of Memory or Cognition. When it occurs in the elderly, we call it Senile Dementia.
As we age, the brain’s blood supply can get disrupted ( as mentioned above)in a small way. This can lead to the death of a few brain cells causing what we call a Silent Stroke. Here again, there can be changes in one’s memory, and the person may not remember recent events.
Now, What does this ‘Cognition’ mean?
In simple words, Cognition is the ability to remember and reproduce what we remember. A decline in cognition is called MemoryLoss.
We shall stop here as I have come to the end of Part 1 of the Memory Loss Series. Hope you have understood the basic anatomy of the brain and its function. Kindly read and re-read this article because I shall be using many of the words used herein in my next article-especially the link I have provided on Inside the Brain.
How to Control Blood Sugar With or Without Medicines
A patient who has been controlling his blood sugar very well with medicines recently asked me this question-“Doctor, can we control blood sugar without taking medicines?”
My answer-“Yes. But it depends on the stage of your diabetes.” “Meaning? How?” he asked again. I then went to explain to him ‘How’.
Now let me elaborate on this ‘How’. For explaining this ‘How’, I will tell you my experiences with some of my patients.
Table of Contents
For whom I have written this article-
Any patient having difficulty controlling his/ her blood sugar should read this article. The examples of patients narrated are real life patients undergoing treatment in my clinic.
Now, let’s begin-
Case Study no.1:-The patient with Very High Blood Sugar
About 2 years ago, a 62 years old father of a priest in our community temple visited me at 12.30 p.m. with the following symptoms-
Feeling very tired and fatigued.
A sudden increase in the frequency of urination-about 7 to 8 times in the night for more than a week.
Dry mouth and intense thirst.
Sudden loss of weight– about 10 kg in a span of 15 days.
He later went on to say that he was traveling to his native place Mangalore and he had already reserved a seat on the train. The train was to depart at 3.45 p.m. I was in a fix now, because I had an inkling of what has happened to him.
On an impulse, I told him that I am getting his blood sugar done. I keep a Glucometer in my clinic, just for times like this.
Upon checking his blood sugar, the glucometer gave this report- Not Recordable. I was shell shocked. Now what? I asked him-” Since when are you suffering like this?” “One week”, he replied. “Then why the hell did you wait for so long?” I asked him in an annoyed tone.
What did I do next?
I immediately referred him to a pathology lab to get his random blood sugar and urine done urgently. After half an hour, my Pathologist colleague rang me up and he reported these results-
Random blood sugar-725mg/dl
Urine Sugar- 4+
Ketones in urine-+ve
HbA1c-11.8%
Now, look at the HbA1c value- it is way above the normal range of 5 to 6%. For your ready reference, I am including a table below which shows how much the mean blood sugar value should be for every 1 percentage rise in HbA1c-
Table-
What did I advise this patient?
Firstly, I advised the patient to cancel his journey and get admitted to the hospital. I also told him that he was suffering from severe diabetes with a condition called Diabetic Ketoacidosis. And, that if he chose to travel, he may not reach his destination alive.
This patient was admitted to the hospital for about a week where he was treated with intravenous[IV] Insulin to bring his sugar before other complications set in. Later on, after his blood sugar reached normal levels, he was put on Oral Anti-Diabetic Drugs which maintained his blood sugar very well.
He was also advised to go for regular walks and have a properly balanced diet sans sweets and starchy food. I also advised him a high protein diet to build up his muscle mass as he had lost plenty of it during his ordeal.
Take-home point-
This patient will need medicines to keep his diabetes in check throughout his life. Along with medication, I also advised him to have a proper 3 meal diet containing all the essential nutrients with lots of fibers in it.
Now, let’s jump to the next patient-
Case Study no.2:-A patient with Pre-Diabetes having a marginally raised blood sugar-
A young male person aged 26 years visited my clinic with complaints of-
As usual, I checked his random blood sugar. It was 166 mg/dl. This made me suspect pre-diabetes in this patient. I suggested the following investigations for this patient-
Blood sugar[BS] fasting and post-lunch[PP]
Urine sugar
HbA1C%
His reports came in as follows-
BS- Fasting-118, Post-lunch[PP]- 175;
Urine Sugar- Fasting-Negative, Post-lunch-1+
HbA1C-6.8%
If you have noticed the above reports, they are slightly above the normal values. This condition is called Impaired glucose tolerance (IGT) or Pre-diabetes.
These patients can be successfully treated without medicines. Here is a good article on Pre-diabetes that i suggest you should read-link
What did I advise this patient?
This patient was advised-
Regular exercise- preferably walking or jogging. This helped him reduce his BMI to acceptable values- about 24kg/ sq.mtrs- in 6 months time
Eat a low carbohydrate diet- avoid sweets, rice and potatoes as far as possible.
Add more fibers to the diet in the form of fruits and vegetables. This helped him overcome the urge for sweets as well as bringing down his weight by 10 kg.
This patient was advised to keep up this routine throughout life to maintain his sugar levels and avoid becoming a diabetic.
Case Study no.3:-A patient with poorly controlled Diabetes
A middle-aged man visited my clinic with complaints of a painful urination. On examination of his genitals, I came across this picture-
The foreskin of his penis was swollen-he could not retract it. It appeared like this-
Candidial balanitis due to high blood sugar. Source-DermNet NZ
There was whitish discharge around the foreskin-this a candidial[yeast] infection in diabetes.
The urination was very painful suggesting urethritis .
Blood sugar random came out to be 215gm/ dl.
I suggested him the following investigations-
Urine routine and microscopic- there were lot of bacteria, yeast as well as pus cells in his urine.
Blood and urine sugar- both fasting and post-lunch. Both were very high- BS( F)-175, BS(PL)-255; Urine Sugar- Fasting +2, Post Lunch- +4
HbA1c-8%
This patient was already on these medications-
Glycomet GP1- a combination of metformin in and glimepride-two times a day.
Dichrome( Chromium picolinate)- once a day. It helps insulin to work properly.
What this patient was not doing-
No exercise- he was sedentary and rarely went for walk or did any physical work. During this visit his weight was 82 kg for a height of 162 cms- way above the ideal body weight requirement of 61kg. His BMI was-31.25kg/ sq.mtrs.- way above requirements of 18- 25.
Not following the diet regimen I had suggested- he was binging on sweets. He liked sweets.
Skipping medications off and on.
My updated suggestions-
1.Added 2 more medicine- 💊-
Tenegylptin(Zilenta) 20 mg 1 before lunch
Voglibose 0.2 mg(Vogli) 1 before lunch and 1 before dinner.
Tab. Flucanozole 150 mg once daily for 5 days to control the candidial ( yeast) infection.
Anti- inflammatory drugs to control swelling and pain in the urethra
Candid cream( clotrimazole) to apply locally on the infection.
2. Strict diet control- no sugar or starchy food ( rice, potatoes).
3. Regular walks and exercise to bring down his weight to acceptable levels of 61 to 65 kg.
After 3 months-
The following changes were observed as the patient followed my instructions strictly-
Weight reduced to 75kg. BMI down to 28.58 kg/ sq.mtrs.
As you can see, I have narrated 3 different instances of varied signs and symptoms of diabetes with increased blood sugar and its management.
I hope you have understood the implications of having a high blood sugar level. And I also hope this article helps you managing your diabetes very well, if you are under treatment for same.
To know more about how you can manage blood sugar withoutmedicine, you can read this Article>Link
Diabetic Retinopathy-How to avoid it and have a better vision
What is Diabetic Retinopathy?
In simple words, Diabetic Retinopathy refers to the eye complication of diabetes caused due to poor blood sugar control. It is the major cause of blindness in advanced Type 2 and in Type 1 diabetes. It is also called the “blurry vision of diabetes type 2”.
Before we proceed ahead with how one gets to this condition, let’s make ourselves familiar with the structure of the eyeball.
Anatomy of the Eyeball-
Have a good look at this picture of the eyeball-
The reason behind showing this anatomical picture of the eye is that almost all structures shown can get affected by a high blood glucose level in Diabetes. The collective conditions of eye diseases in diabetes are termed Ocular Eye diseases. Now have a look at the same picture showing the affected parts of the eye- it reveals[in red color] some of the commonly encountered Ocular diseases-
The disease affecting the screen of the eye- the Retina- is called Retinopathy and in the diabetic patient, it occurs early.
According to the authors of the book A Practical Guide to Diabetes Mellitus[shown below], “diabetic patients are 25 times more likely to suffer blindness other than nondiabetic patients matched for age and gender”.
To know more about the eye problems, I have designed a table showing different Ocular diseases[ as shown in the picture above] that occur in general and diabetes in particular.
Table of Ocular Diseases-
Out of all the Ocular Diseases, retinopathy of diabetes stands out as quite important because it is the major cause of various visual impairments, including blindness.
Why am I writing this article on Diabetic Retinopathy[DR]?
All the above conditions shown in the table above occur in diabetes. All the parts of the eyeball are necessary for having a good vision. Whereas some of the conditions such as refractory changes are correctable with the use of spectacles, and some with medications, retinopathy requires special attention.
According to a survey in October 2019, Diabetic retinopathy affected almost 16% of diabetics annually in India. It affects about 80% of those having Diabetes. Moreover, the longer a person suffers from diabetes, the more his/her chances of developing DR.
According to the Survey-
About one in 46diabetic patients in India become visually impaired due to diabetes.
Retinopathy of diabetes was prevalent in the diabetic population for up to 50 years.
16.9% suffered from DR. Out of these, 17% were males and 16.7%, females
Age-wise, retinopathy of diabetes was present as follows-
60-69years-18.6%
70-79 years-18.3%
80 years and above-18.4%
The incidence of blindness among all diabetic patients was found to be 2.1% and visual impairment, 13.7%. This shows that out of 100 people suffering from diabetes, about 2.1% will suffer from blindness and about 13.7% will have some eyesight problems like blurred vision, double vision, cataract, etc.
These findings prompted me to write this article as our eye is one such organ that is very delicate and its disease will cost one dearly.
You should definitely read this 》》 [ click here] to know how serious the condition can be among diabetics in India.
What are the risk factors for getting Retinopathy of Diabetes?
Diabetic retinopathy, as the name suggests, is due to poor control of blood sugar. However, this is enhanced by-
All these conditions have a profound effect on the blood supply of the retina. They are known to narrow/block the arteries supplying the retina.
Case Study-
In my clinical practice also, I have come across a few cases with Diabetic Retinopathy. Here is one such example of findings in a case of diabetic retinopathy. About 20 years back, Mr. AM[real name hidden for privacy sake], was suffering from Type 2 diabetes and hypertension.
He was an alcoholic and did not bother about his health. One day he calls me up from his native place-New Delhi. He complained of a total loss of vision in the right eye and partially in the left eye. I enquired about his blood sugar[BS] level.
It was as follows –
Fasting BS-250mg/dl
Post-prandial[after meals]- 450mg/dl.
HbA1c- above 11
I then suggested him to see an eye specialist[ophthalmologist] in Delhi and send me his reports and treatment suggested. By evening he reported the following findings-
The right eye showed the detachment of retina because of which he had lost his vision. There was no hope of saving vision in this eye.
The left eye showed inflammation of the retina with leakage of blood in the eye. He was going in for a condition called Diabetic Macular Edema[DME]. This was the cause of partial loss and blurring of vision in that eye.
I suggested that he come back to Mumbai which he did. After reviewing his case, I suggested the total abstinence of alcohol. With proper treatment, his blood sugar was brought under control.
Later, he was referred to a prominent retina surgeon in Mumbai. The Surgeon managed to salvage most parts of his left eye retina and saved him from total blindness.
Are there any Stages of Diabetic Retinopathy?
Let us first study how the Retina looks like and what are its parts. If the retina is normal, this picture will be seen by your eye specialist when you visit him to rule out DR. Have a look at this picture-
Picture 1-
All the different parts of the retina- the optic disc, the fovea, the macula, the blood vessels[the central retinal artery, retinal venules, retinal arterioles, central retinal vein]supplying the retina, etc., can get affected due to rising blood sugar levels.
Now, look at the picture below showing the changes in the retina of the eye as seen in the fundoscopy examination by your eye specialist-
Picture 2-
All these changes seen in retinopathy do not occur at the same time. There are various stages[discussed below] of retinopathy. The changes shown above occur gradually depending upon your blood sugar levels.
Uncontrolled diabetes or poor management of blood sugar levels causes changes in almost all parts of the eyes. These changes are slow to appear and the patient does not realize it initially. As shown in the picture above, changes start in the blood vessels of the eyes defining the different stages of Diabetic Retinopathy. Your ophthalmologist may suggest that you may have either of these stages-
Mild Non-proliferative Retinopathy[NPDR]
Moderate Non-proliferative Retinopathy
Severe Non-proliferative Retinopathy
Very Severe Non-proliferative Retinopathy
Proliferative Diabetic Retinopathy
Diabetic Macular Edema[DME]
This slideshow will take you quickly through the different stages changes we see in the Retinopathy of Diabetes –
Let us first consider the functionof the retina. The retina is a thin lining at the back of the eye. It contains blood vessels[arteries and veins] and nerves. These nerves contain light-sensitive tissues that-
Detects light.
And interprets this light intoelectrical impulses.
These electrical impulses are then transmitted to the brain through the optic nerve [see the anatomy of eyeball shown above] to form an image or picture.
The high blood sugar in diabetes causes changes in the retina-
By damaging the tiny blood vessels supplying the retina-
Leading to leakage of blood and fluid in the retina-
Causing distortion of the image formed on the retina and this leads to a condition called Diabetic Retinopathy.
To know what happens in DR, let us go thru the sign, symptoms, and implication of the different stages mentioned above-
1.Mild Non-proliferative DR-
This is the earliest stage of DR wherein there is a ballooning effect on the blood vessels of the retina. It is termed an aneurysmor more correctly-microaneurysm[ as seen in Picture 2]. Fluid like blood and plasma then leak through these microaneurysms and cause blurring of vision.
Sometimes these changes in the retina will not be felt by the patient. A proper blood sugar control at this stage will help in slowing the progress of the retinopathy to its next stage. And possibly reverse the eyesight to its original state.
2. Moderate Non-proliferative DR-
If the patient has not felt the changes of the first stage, and his blood sugar control still remains to be poor, the retinopathy progresses to the second stage.
At this stage, there is swelling and distortion of the blood vessels which nourish the retina. There is leakage of blood products or blot hemorrhages in the retina.
These are termed soft exudates[cotton wool spots]. If you divide the retina into 4 quadrants, these cotton wool spots will be visible in at least in one of the quadrants.
There are changes in the veins also making them appear as a string of beads. This is called Venous beading.
3. Severe NPDR-
This stage is characterized by-
Almost all the blood vessels of the retina get blocked leading to a lack of blood supply.
Growth of newer blood vessels which we call collaterals. This happens due to the release of a growth factor called Vascular Endothelial Growth Factor[VEGF].
In this stage, you will see all the changes seen in Mild and Moderate NPDR along with-
Microaeurysms or hemorrhages in all 4 quadrants of the retina.
Venous beading in more than 2 quadrants
All other symptoms of Stage 1 and Stage 2 DR
There is an increasing incidence of blindness. More than one part of the eye may get affected leading to loss of eyesight.
4. Very Severe NPDR-
This stage comprises of all the features of the above 3 stages plus –
Increase in hemorrhages in all quadrants of the retina.
New arteries and veins are formed that spread and cover most parts of the retina causing distortion of images formed on the retina.
Swelling of the central most part of the retina- the Macula, causing more blurring of vision.
5. Proliferative DR-
This stage is characterized by an abnormal growth of blood vessels in the part of the retina called the optic disc[see Picture 1-Parts of Retina].
This is called the Proliferation of the vessels which spread and cover most parts of the retina.
This stage is common in Type 1 Diabetes and Type 2 patients on insulin.
If these new vessels grow into the Vitreous Chamber[ a jelly-like fluid in the eye-see Parts of Eyeball], they can-
Cause an increase in eyeball pressure which results in Glaucoma leading to a sudden decrease in vision preceded by red floaters. Glaucoma can be detected by checking eyeball pressure by an instrument called tonometer.
The detachment of the retina due to traction.
Hemorrhage into the Vitreous chamber leading to pain in the eyes and a sudden decrease in vision.
6.Macular Edema-
This leads to changes in the Macula – the main part of the retina through which the blood vessels and nerves enter and leave the retina. These collective changes in the retina are termed DiabeticMacular Edema or DME.
What are the symptoms at this stage?
The eye vision starts deteriorating. The symptoms observed are-
Blurred vision;
Impairment of color vision-the patient may not be able to distinguish different colors.
On and off of vision i.e. fluctuating vision. There can be blacking out of vision.
Floaters in the vision i.e different shapes floating in front of the eyes while watching something. These appear as dark spots in the field of vision.
What are the symptoms to watch out for?
What we have discussed above are the signs that will be seen by your ophthalmologist. Most of the symptoms I have covered while discussing the stages of retinopathy.
However, if a diabetic patient is going in for retinopathy, he/she should look out for-
Diminishing of vision
Sudden-onset floaters: Black or red, moving on the movement of eyes, worse after waking up from sleep
Painful red eye.
Let us now move on to the treatment of these stages of retinopathy.
Treatment of Diabetic Retinopathy-
Let us divide this into 2 parts–
1.By your family physician-
It is your doctor’s responsibility to control your diabetes by-
Suggesting appropriate medicines;
Investigating regularly, particularly HbA1C and cholesterol levels;
By advising a change of habits like smoking and alcohol consumption;
Random blood sugar checks while you visit his/her clinic
2. By your ophthalmologist-
A detailed discussion of this is beyond the scope of this article as these procedures are difficult to understand. However, I will touch briefly upon some of the main components of what your eye surgeon may advise.
Depending on the stage of retinopathy, your ophthalmologist may suggest-
Laser photocoagulation-to stop leaking microaneurysms and spread of diffuse retinal thickening.
Pars plana vitrectomy-again to prevent macular edema and retinal detachment.
Let us now move on to something which we can really do-prevention of Diabetic Retinopathy.
How to prevent retinopathy or reduce risk of retinopathy-
If a diabetic patient sincerely follows these steps, there is a good chance of not getting Retinopathy of Diabetes-
Check your blood sugar and HbA1C regularly
Do not skip any medicines prescribed by your doctor. If there is any problem, discuss it with your doctor.
Make lifestyle changes-control your weight and cholesterol levels
Avoid smoking and alcohol
If you notice any changes in your vision, promptly discuss it with your family physician and your ophthalmologist.
Conclusion-
As I come to the end of this blog/article, I would like to add that the Diabetic Retinopathy is such a condition that is very much preventable. Just follow the advice I have suggested above. If any of your loved ones are suffering from diabetes, you can help them from getting blind by reading out this article to them.
Finally, you should also read some more articles which I am suggesting below-
Friends, the knowledge that I have just shared with you is a collective effort by me to put the best available information available in books and the internet, albeit in a very simple format. The book ” A Practical Guide to Diabetes Mellitus” by the authors N Thomas, N Kapoor, J Velavan, and KS Vasan has been of great help in the writing of this article. I offer my sincere thanks to these authors.
Chest pain-how to know if you are having a heart attack
Introduction
Chest pain is something which we all must have experienced some time or the other. Sometimes it can be the beginning of something sinister, like for example, the first signs of an impending Heart Attack.
In my 35 years of Medical Practice, I have come across many patients who complained of chest pain and were quite worried about it. Most of them were not very serious to cause panic, but some were serious enough to warrant hospitalization.
Many of us have had chest pain one time or the other and I am sure that most of you and your loved ones must have been scared to death that it must be a heart attack. Yes, it may be or maybe not. In this article, I am going to guide you to decipher that chest pain, and if it is one of those things that you have, here’s what to do. Read on:
1.Chest pain caused by Costo-chondritis
COSTOCHONDRITIS
One patient visited my Clinic with a complaint of chest pain in the left half of the chest which aggravated on movement, bending forward and stretching the arms. I examined the patient. His pulse and heart sounds were normal, there was no sweating, BP was also normal and all other chest sounds like breath sounds were also normal. One putting pressure on the just left of the center of the chest, the patient cringed with pain.
What was this? Well, this is a condition caused due to the swelling of the joint of ribs with the central chest bone called the sternum and is called Costo-chondritis. On inquiry, the patient gave a history of lifting a heavy object 1 week back. This is what led to swelling of one of the costochondral joints and subsequently the pain after about 1 week. This is a fairly common condition causing chest pain and can be treated by hot fomentation and anti-inflammatory tablets.
2.The Rib fracture chest pain
Rib fracture causing severe chest pain.
A patient came to my clinic one day with a complaint of swelling and chest pain on the left side, aggravated by breathing. On examination, I could see a purple swelling at the site of pain. He had an accident the day before while driving a two-wheeler. X-ray chest was advised which showed fractured ribs. He was referred to the orthopedic surgeon for further treatment.
Treatment-
The ortho surgeon may
apply a compression bandage or a sleeve to reduce movement due to breathing. This will automatically reduce pain.
Other than that an antiinflammatory pain killer like a combination of Diclofenac sodium +Serratiopeptidase[Emanzen-D] or diclofenac+Trypsin-chymotrypsin+rutoside[Inflachek-D] may help in healing.
Calcium tablets to heal and breach the gap in the fractured bone ends.
3. Chest pain of the Pleuritis
Inflammation of the covering of lungs[pleura] leading to chest painInside our chest, we have 2 major organs- the lungs and the heart. The lungs are enclosed by 2 layers covering called pleura. In between inner[visceral] and outer[parietal] pleura, there is the pleural space that contains a fluid that helps lubrication when the lungs expand and contract while breathing. Sometimes due to some infections of the lungs, there is inflammation of the pleura, which has sensory nerves, which causes pain in breathing. This inflammation is called pleuritis. The picture shown above shows how the pleura looks after getting inflamed. Treatment is with antibiotics and anti-inflammatory drugs under supervision at the hospital.
Treatment-
Your doctor may suggest-
Antibiotics like a combination of Cefpodoxime+Calvulinic acid[Oxypod CV 200] to reduce infection.
The anti-inflammatory combination as mentioned above to reduces pain and inflammation of pleura.
4.The Pneumothorax
Trapped air in the Pleural Cavity of the lungs causing chest pain
Just as in pleuritis, there is a condition where the air gets trapped in between the pleura. This occurs suddenly with severe pain. The lungs on that side collapse and the patient become breathless. This patient needs urgent admission to the hospital for the removal of the trapped air.
Treatment-
Your attending physician on admission to the hospital may –
Aspiration of air by needle and syringe
Tube drainage-wherein one end of a tube or an intercostal catheter is inserted into the pleural cavity and the end inserted into a bottle containing water to remove the trapped air, as shown below-
Intercostal catheter insertion for removal of air from the pleural cavity
5.The Pericarditis
Inflammation of the pericardium causing chest pain
The human heart has a protective cover called the pericardium. It has 2 layers. When there is inflammation of the pericardium due to infection or in a heart attack, it is called Pericarditis. As the heart is pumping blood non- stop, there is rubbing of the 2 layers of the pericardium leading to a pain similar to a heart attack. There will be ECG changes also.
Treatment-
Thi is done by getting admitted to a hospital under a cardiologist.
Angina Pectoris chest painThis is the most common chest pain of the heart which is a precursor to the heart attack. This pain occurs due to the insufficiency of blood supply to the heart muscle due to a block developing in the coronary [heart] arteries, which supply oxygen to the heart muscle. The pain occurs mostly on exertion and reduces on resting. Accordingly, there are two types of angina pains, viz., A] Stable angina; B] Unstable angina.
In Stable angina, the chest pain disappears on resting but in Unstable angina, the pain persists even at rest. Your doctor might give you a nitroglycerine tablet to be kept under the tongue, which dilates the arteries and improves blood supply to the heart muscle.
7.The Heart Attack
Early signs of a Heart Attack
This is by far the most terrifying pain in the chest. The patient complains of severe crushing pain in the center of the chest just behind the breast bone, followed by excessive sweating, nausea/ vomiting, and passing of stools without knowing it. Here he/ she may also complain of giddiness. His or her BP my be high or low. The treatment is the same as for pericarditis i.e. admission in a hospital where the Intensive Cardiac Care Unit is available.
Years ago, I had the experience of a patient with a Heart Attack. Unfortunately, he did not survive. Read about that experience in this article-[ link]
You can also listen to this interesting podcast on heart disease here-
Aorta is a major blood vessel in the chest which supplies blood to all parts of the body through various branches. Diseases like tertiary syphilis[ a type of sexually acquired disease] can cause infection in the wall of the Thoracic aorta[part of aorta present in the chest], which, due to continuous pumping activity of the heart becomes thin and forms a balloon-like defect in the aorta, as shown below. If it goes unnoticed, it can burst which causes severe pain and death in most of the cases. If it is somehow detected accidentally on an investigation like echocardiography, surgery can prevent further events and save the life of the patient.
9.The Pulmonary embolism
A blood clot in the lung artery causing chest pain.
This is a condition that occurs in a patient who has got a clot in the veins of the lower or upper limbs [also termedDeep Vein Thrombosis or DVT] and which got released in the venous circulation and got carried to the pulmonary ( lung) circulation. This is called embolism and leads to severe chest pain and lung infarction, that is, the death of that part of the lung. DVT of the lower limbs is common in hospitalized patients and in pregnancy. Again, this is an emergency and needs admission to the hospital for further treatment.
10.The Pneumonitis
Inflammation of the Lung airway causing chest pain
Just before someone gets affected by pneumonia, there occurs swelling of the lungs parenchyma( lung tissue) and it appears like a haze in the x-ray. There is swelling of the airways leading to chest pain at this stage and later on, it leads to pneumonia. The above picture shows the changes in airways due to pneumonitis. This can happen as an allergy to inhaled chemicals, smoke, dust, etc. Your doctor will help you to get relief from pain and further progression of the disease.
11.The Oesophagitis chest pain
Inflammation of Oesophagus due to acid reflux causing heartburn- a type of chest pain
The food we eat passes to the stomach through a food pipe called the esophagus. When there is reflux of acid from the stomach into the esophagus[also known as GASTROESOPHAGEAL REFLUX DISEASE OR GERD], the inner lining of the food pipe gets inflamed.
This gives rise to a burning sensation and pain in the chest. The picture shown above explains how GERD occurs. This sort of pain is also called heartburn because it mimics a heart attack. Treatment consists of ruling out a heart attack and taking antacids advised by the attending physician.
These are a few common but important causes of chest pain. There are many more causes such as cervical spondylitis, TB of the thoracic spine, herpes infection[shingles], etc. These causes are too vast to discuss presently and will be dealt with separately in future blogs.
Kindly do not try treatment such as taking antacids. Contact your health provider or family physician and he/she will guide you properly.
Typhoid Fever – How to Prevent it and Stay Healthy
Table of Contents
Introduction-
Typhoid Fever is a disease caused by a bacteria called Salmonella typhi and Paratyphi, through the fecal-oral route.
Why I am writing this article on Typhoid fever?
As monsoon has commenced in almost all parts of India, so has different diseases and illnesses that occur due to rains. There are many patients visiting my clinic at this time of year who have a high fever. My previous 3 articles were on fever during monsoon, namely-
Why I am writing this article on a dreaded disease called Typhoid Fever is because it is occurs mostly during the monsoon.
Now, what exactly is Typhoid Fever?
Typhoid fever, as mentioned in the introduction, is a fever caused by bacteria called Salmonella Typhi[see the image given below]
These organisms are transmitted through the food we eat, especially street food.
They are found mostly in drains carrying sewage water. It is also called the‘ food handler’s’ disease. The food handler is termed the carrier. Carriers have the following features-
He or she may or may not have a fever.
The patient may be asymptomatic.
Secondly, he or she may not be maintaining good sanitary hygiene like washing hands with soap after attending nature’s call.
These carriers are mostly cooks who work in hotels and restaurantor maybe a waiter or waitress who deliver drinking water. Avoid drinking water from hotels if you see the waiter dipping his hands in the glasses which he serves[this is common in rural India].
Typhoid Mary
There is a famous story about the discovery of typhoid which led to a lady cook called Mary Mallon in America, who was later called Typhoid Mary.
She, as a carrier, seems to have infected at least 51 people out of which 3 people died due to typhoid. You can read all about Typhoid Mary on Wikipedia or Google.
You can also read a novel written by Mary Beth Keane called FEVER. It describes in detail how typhoid spread in America during the early 1900s.
How is typhoid related to monsoon?
During monsoon, a lot of common houseflies are seen which, after scavenging through sewage dumps, carry the bacteria on their legs and transmit it to the food we eat by settling on it while we eat. So, here the common housefly is the carrier. These flies are seen mostly hovering in hoards around the street food vendors and mostly settle on uncovered cooked food.
Common housefly feeding on garbage -carriers of Typhoid fever bacteria
Common signs and symptoms of the disease: –
Typhoid fever is a disease of the intestinal tract. After ingesting contaminated food, the bacteria makes its way through the stomach and reaches the small intestine. Then it lodges there and grows in the lymphatic tissue of the intestines called the Peyer’s patches.
It is important to note that Salmonella typhi is resistant to acid present in the stomach unlike other bacterial species.
So those of you who are on medicine to control acidity like omeprazole, pantoprazole, etc. are more prone or at risk to get typhoid than others. The other common cause in developing countries is the consumption of shellfish which acts as a carrier. Because shellfish are mostly found in water that is contaminated by sewage water.
The incubation period i.e. the time interval between getting infected to having signs and symptoms of typhoid fever is about 10 to 14 days.
Signs and Symptoms of Typhoid Fever-
People suffering from typhoid present with the following signs and symptoms:-
1] Fever-
The high temperature in Typhoid fever
–
The fever keeps on rising steadily till it reaches a plateau. After this phase, the fever remains steady above 38° Celsius[C]. This fever starts subsiding 48 hours after starting the typhoid medication. In some cases, it can reach even above 40°C.
2]Headache
Mild to severe headache is very common and can be very disturbing.
3] Constipation or diarrhea-
These patients have loose motions, often called“ pea-soup” diarrhea along with abdominal pain;
4] Bloating-
There is a fullness of stomach with loss of appetite and feeling of nausea sometimes leading to vomiting.
5] Severe Debility-
The patient may have extreme weakness and prostration with an apathetic-lethargic state[the so-called tuphos by the ancient Greeks].
6] Rash over Chest/Abdomen-
Pink colored or Rose spots rash appear in fair-skinned patients, often seen on the chest, abdomen, arms, and legs in up to 25% of the patients late in the first week of fever, as shown below. You can zoom out for seeing how the rash appears.
Pinkish colored rash of Typhoid Fever
7] Pain in abdomen-
There is the tenderness of the abdomen i.e. pain on feeling the abdomen by hands. It may be due to-
the enlargement of the liver[termed hepatomegaly]
an organ called spleen [felt by palpation with hands by a physician] also termed hepatosplenomegaly.
8]Delirium-
Some patients may present with very high fever and delirium or psychosis. Delirium is a condition where the patient is semi-conscious and incoherent in his speech. Psychosis in typhoid is a condition where the patient becomes violent because of the effect of high fever on the brain. These patients have serious problems and the have to be hospitalized.
9] Oral cavity-
Coated tongue [as shown below] with loss of taste and appetite is very common.
Coated Tongue
9]Bradycardia-
Bradycardia is a presence low pulse rate compared to high pulse rate found mostly in other high fever states. This is also called relative bradycardia.
10] Melena
Black colored stools- also called melena– occurs in patients if there is an intestinal perforation, which is a serious complication of typhoid fever.
What are the investigations which your family physician may order if he is suspecting typhoid fever?
Your family physician or healthcare provider may suggest you some or all of these tests for arriving at a proper diagnosis.
A] Complete blood check up[CBC]-
There is a lowering of total white blood cell count[WBC], with a gross reduction of lymphocytes. This is termed relative lymphopenia. The overall WBC reduction is called Leucopenia. The normal WBC range is 4000-10000/dl of blood. In typhoid fever, it may go as low as 1500.
B] Blood culture and Sensitivity test–
This is the most important and sensitive test to diagnose Typhoid fever.
A blood sample of the patient is taken and spread in a glass dish called Petri dish. This contains appropriate media with antibiotic patches, which can grow bacteria.
If the blood contains Salmonella bacteria, then it will form colonies around these antibiotic patches. The antibiotic patch around which the growth of bacteria is least is then chosen to administer to the patient. It is the most effective one which will inhibit or kill the bacteria.
C] Stool culture:-
This test is similar to blood culture, the only difference being that stool is used in place of blood. As the disease is primarily of the intestines, the bacteria if present, will be excreted in huge quantities through stools. This can be grown in culture media as shown above for blood.
D] Widal test–
This was a test to detect the H and O antigenof Salmonella bacteria which is present in the blood. It is being carried out in some hospitals but has become outdated as of today. Of late, it has been replaced by more specific tests like the antigen-antibody tests like the ELISA[enzyme-linked immunosorbent assay] to detect the IgM and IgGantibodies to the Salmonella cell wall components. The values of both these antibodies are high in a patient of typhoid.
E] Liver function test [LFT] –
Two tests, namely serum alanine aminotransferase [ALT] and lactic dehydrogenase[LDH] are elevated in typhoid as the severity of infection increases. The ratioof the two i.e. ALT: LDH, if it is more than 9:1 indicates Viral Hepatitis.
If it is less than 9:1 it indicates Typhoid Fever Hepatitis.
F] Other tests
Sometimes, other sophisticated tests like a polymer chain reaction test [PCR] is rarely used if the cause of fever is not known by using the above 5 tests.
Treatment of Typhoid Fever-
We now come to the treatment part of the disease. If the illness is uncomplicated, it can be treated on an outpatient basis and if complicated, the patient should be hospitalized. Having said this, what are the precautions one should take if you are having typhoid?
Precautions
They are:-
1] Wash your hands thoroughly after defecation using a good disinfectant soap like Dettol.
2] The patient should not cook food for others.
3] Have plenty of fluids, especially boiled and cooled water.
4] Eat soft digestible non-spicy food which does not cause distension or bloating of the abdomen.
5] Total bed rest with least exertion is advised till full recovery, which is almost 2 weeks from being diagnosed as typhoid positive.
Medications:–
1] Paracetamol[ Crocin, Calpol, Pacimol] to control the temperature.
2] Antibiotics like
chloromycetin- these was the only medicine available when typhoid was first detected many years ago. Of late, the use of this medicine has been curtailed.
ampicillin+trimethoprim-sulphamethoxazole combination [typhoid bacteria has been found resistant to these medicines nowadays],
ceftriaxone+ ciprofloxacin combination.
newer medicines combination like cefpodoxime and ofloxacin are showing encouraging results.
3] Probiotics like lactobacillus, Saccharomyces Boulardi is also prescribed along with vitamins as the beneficial bacterias also perish while treating typhoid fever.
These medicines are to be taken for 10 to 14 days, depending upon the severity of typhoid fever.
A word of caution-
As far as treatment with antibiotics is concerned, one should not self-medicate and leave it to your respective health care provider/physician.
Is there a vaccine for Typhoid fever?
Yes, there is. These vaccines provide passive immunity and protect one from getting infected. I will mention a few names here.
Typbar TCV Vaccine;
Biovac Typhoid 25mcg Injection;
Typhivax 0.25 mcg Injection
To have these vaccines, kindly consult your family physician or doctor.
Conclusion
In conclusion, I would like to advise everybody
to take maximum precautions during the rainy season;
and to avoid eating food from street vendors who do not cover cooked food.
Thankfully or fortunately, because of the COVID 19 pandemic lockdown, the street vendors have disappeared[for fear of COVID 19 infection]. The hotels are not operating fully- only home delivery of food is allowed. So we are partially protected.
But, but- there is no lockdown for the vermins like the house fly and those in contaminated water.
If you have found this article useful, I request you share it among your friends and groups on social media so that that one remains hale and hearty in the rainy season.
How to Avoid Complications of Diabetes and live a healthy life.
Table of Contents
Introduction
Complications of Diabetes are those conditions in which diabetic patients suffer from the effects of high blood sugarlevels on different parts or organs of the body.
In my previous blogs/articles on diabetes[Click these nos. above ¹²³ ] I had discussed in detail about signs/symptoms, investigations, and treatment of diabetes.
Having understood what diabetes is, its investigations, and treatment, we now move on to know what can happen if the patient neglects the advice of his healthcare physician.
For whom is this article about complications of diabetes important and why?
This article is meant basically for those patients who are already undergoing treatment for diabetes. Slight negligence of advice on the part of the patient can lead to serious health issues. So, as per the headline of this article, the idea behind it is to help patients avoid complications of diabetes and to live a healthy life.
The purpose behind writing this article is to spread awareness regarding complications of diabetes and not to scare the patient but help him/her to prevent it.
As far as different complications of diabetes and their treatments are concerned, the subject is quite vast. Hence, I have decided to break up the article into many small parts for a better understanding of each complication.
The Minor Complications[mentioned below] have been covered in previous articles and so will not be discussed here.
In this article, I will discuss in brief about the various major complications. As we go ahead, each complication will be taken up individually. They will be discussed in detail so that you can take timely and preventive action.
Coming to the complications, they can present as-
A] Minor Complications of Diabetes-
Hypoglycemia- a side-effect of overmedication or undernutrition i.e. not eating food on time as prescribed by his/her physician[Read here to know more]
Hyperglycemia- exactly the opposite of hypoglycemia. Here the patient is non-compliant as far as medication is concerned and does not have control over his diet.
B] Major Complications of Diabetes-
1]Infections–
Infections of different tissues in our body is a very common complication of diabetes.
We are all prone to some infection or the other in our lifetime. What stands out in the case of a diabetic patient is the severityof any infection that the patient suffers from. These patients mostly have uncontrolled blood sugar levels. Most common infection the patient faces are-
A]Respiratory tract infections-
Both upper and lower respiratory tract infections occur as complications of diabetes.
B]Urinary tract infection-
this includes the kidney, ureter, bladder, and the urethra.
C]Skin Infections-
Occurs mostly due to dryness of the skin making the patient prone to bacterial and fungal infections
D]Gastrointestinal infections-
such as cholecystitis[gallbladder infection] and enteritis[intestinal]
2]Retinopathy–
a condition where our eye gets affected due to poor blood sugar control causing poor blood supply. The optic nerve supplying the screen of the eye-Retina-gets affected leading to blindness.
3]Angiopathies–
a condition where our blood vessels are affected leading to a lack of blood supply to different parts of the body. They are again classified as-
Macroangiopathy, and
Microangiopathy.
Most of the other conditions mentioned in this article are directly or indirectly related to angiopathy. The above picture of the eye shows microangiopathy.
4]Diabetic Polyneuropathy[DPN]–
As the name suggests DPN is related to our nervous system. It is the most common complication of diabetes. It can affect up to 50% of diabetic patients during their lifetime.
A Complication of Diabetes-Peripheral neuropathy
5]Diabetic Foot disease–
This complication of diabetes is a combination of both antipathy[Macro- as well as Micro-] and Peripheral Neuropathy. Foot ulcers occur due to loss of sensation and loss of blood supply to the foot tissues. The patient does not feel pain leading to abuse of foot creating ulcers that are difficult to treat ultimately leading to gangrene[rotting of tissues] and amputation.
6]Diabetic Ketoacidosis-
This is by far the most dangerous of all the complications of diabetes. In this condition, the tissues in our body cannot take up glucose due to absolute or relative deficiency of insulin. This is common in Type1 diabetes. It also occurs sometimes in Type2 DM where the patient has not adhered to his treatment regimen and/or is suffering from some infection. I will discuss this in detail when we come to this complication later.
7]Diabetic Nephropathy –
Uncontrolled or poorly controlled blood-sugar levels lead to malfunctioning of kidneys. It does this by affecting the filtration units of the kidneys-the glomerulus. This is called Glomerulosclerosis and it causes kidney failure or chronic kidney disease in the long run.
8] Pregnancy-
A female diabetic patient can get complications during the course of pregnancy such as abortion, or antenatal [in-pregnancy] uterine bleeding which can retard fetal growth. Poorly controlled diabetes can also lead to the baby being born large for its age.
I will now discuss these complications in detail in the forthcoming articles as we go along. Before going on to the next level I would like to share some information which is quite important-
Can you imagine how many people are living with Complications of Diabetes worldwide and how many in India?
As per the latest statistics on the total number of diabetes patients, China led the number with 116.4 million and India coming second with 77 million patients. The cases in India are increasing rapidly. According to the International Diabetes Federation, it was 40.9 million in 2015 and is set to cross 69.4 million by 2025. This includes pre-diabetes, diabetes without complications, and those with complications.
That said, it will be now up to us to bring this number to manageable levels so that diabetic patients do not develop complications. How to do it, we will discuss in my future articles as we go ahead.
To know more about Complications of Diabetes you can read here on the site of IDF- Click here.
In my next article, I will be focussing on a major complication – RetinopathyofDiabetes. This is an important topic as many of the diabetics with poor control land up having impaired vision and blindness. I will also be discussing its management.
For those who love the information in Hindi, Click here
Here is a short video that you can watch to know more about complications of Diabetes- linkhttps://youtu.be/HdR4CTm4Ptg
To know how diabetes can be controlled naturally, click here- Link
Do post your comments and if you have any suggestions to add, kindly do so.
How Having HealthyFats Helps YourHeart andImprove Quality of Life
Table of Contents
Introduction to Dietary Fats-
After writing articles on Carbohydrates and Proteins we now discuss Dietary fats, which is nothing but the Fats we use in our Diet.
Hi, this is Dr. K.P.V.Rao, your mentor and guide in the world of Healthcare.
In this article, you are going to learn today all the facts about the Fats we put in our food to make it palatable and tasty.
Did you know-
that there are-
Good fats- the saturated ones like the MUFA and PUFA[discussed in detail below].
Saturated fats- the not so good fat.
And the Trans fat- the most unhealthy and the dangerous of the lot.
This article will give you good insight regarding these fats and help you choose the best.
How do fats shape our health?
Consuming healthy fats can be good for your heart. In some cases even help reverse the levels of your cholesterol reports from bad to good.
Staying healthy and fit is all about eating healthy food. Out of all the macro items in our diet, eating of fats, its quantity, and quality matter most.
As a part of patients seeking advice on their heart health, I consider counseling on different food items as quite important. So, I take pleasure in talking on their diet and suggest some modifications. Like, for eg., the oils they use for cooking, their benefits or pitfalls, etc., etc.
One has to decide which type of fats to have as we reach adulthood so as not to cause Obesity, Heart disease, or Diabetes. The purpose of writing this article is to guide you to eat healthy fats. That will help you live a healthy and fit life as you reach old age.
Why am I writing this article on fats?
In my day to day practice, I come across different types of chronic patients. These patients usually have diet-related problems such as consuming unhealthy types of fats. They do not know that these fats they consume like for eg. in fried food in oils that are used over and over again are very harmful.
Repeated heating of the same oil makes them highly oxidized. These oxidized oils used in food items like samosa, potato chips, potato vada raise our bad cholesterol. This can lead to the formation of plaques[blocks] in our heart arteries.
So I decided to share my knowledge of these Dietary fats with you so that you can have a healthy heart and a better quality of life.
What’s next?
Even though this article is quite vast and lengthy, I request you read it till the end. I will be adding some interesting podcasts in between for you to listen to if reading appears overwhelming to you.
Now let’s jump on to the main topic-
What are Dietary Fats and what do they do?
Fats belong to a group of chemicals called lipids. They are present in our food in the form of vegetable oils, animal foods like milk, butter, ghee, and in foods like egg, meat, etc.
Whereas carbohydrates give us energy, proteins build our body, fats in our diet bindstructures in our body. They do it with the help of a tissue called Adipose tissue.
How Are Dietary Fats Useful to our Body?
This illustration shown below shows how dietary fats play a role in our health-
How fats in our diet help our body
The implication of excess fats-
Excessive fats in our diet can cause health problems. It can cause obesity[accumulation of fats in the abdomen], surround organs [Visceral fats], builds plaques in the arteries of our heart, etc., etc.
Very often patients coming to my Clinicenquire about fat-related issues. These patients mostly have-
What’s the relation of Dietary Fats we eat and our health?
Most of these patients have a direct relation to the fats they use in their diet. They are worried whether they are eating the right type of fats.
Depending on what type of fats they are consuming, changes are observed in-
Body structure like Central Obesity;
Lipid profile aberrations like High/Low Total cholesterol, High Triglycerides, etc. Let me explain this with an example. Just have a look at the picture of a typical lipid profile test shown below-
The picture shown below is that of my lipid profile values as of 24/4/2016.
This is my latest[shown below] lipid profile report as of June 2019. It clearly shows how the values of my different cholesterol have changed over a period of 3 years[2016 to 2019]
These changes in the lipid profile values have been achieved without using any cholesterol-lowering drugs like statins. A mere change of cooking oil and regular brisk walks have brought about these changes. I simply switched to a combination of Rice Bran Oil and Sesame oil[shown below-just click on the image to know more]-
A combination of Rice Bran and sesame oils
Nutritional Info of Fortune Vivo cooking oil
Affects Heart functions- High B.P., blocked arteries due to cholesterol, etc.;
This leads to High Triglyceride levels due to the consumption of some fats that can lead to Diabetes and vice versa.
My Source-
A lot of research goes into each of the articles I bring to you. I came across a very good book on Heart Disease we Indians are exposed to[See Below].
Dr. Enas A. Enas in his book ‘HOW TO BEAT THE HEART DISEASE EPIDEMIC AMONG SOUTH ASIANS ‘ mentions that ” Consumption of excess fat[above 65 grams a day] has been shown to double the risk of heart attack and stroke “.
Book explaining the role of dietary fats( Click here to buy)
{ Ihave a copy of this book in my personal library. I refer to it frequently; it has helped me to guide hundreds of my patients who have afaultydiet. This has helped me avert life-threatening conditions in such patients}.
According to him, we need 30-35% of fats of the total calorie requirement in our diet. So if your calorie requirements are 2200 calories( Read here), the calories purely from fats would be around 660 calories. One gram of fats provides 9 calories. So in this case, it translates to around 73.33 gm of fats, which is very high.
So, how do we control this high intake of fats? Let us first try to understand the different types of fats we consume. We can then figure out ways to use them as per their benefits they add to our overall health.
This brings up one question-What are the different types of fatsin our food?
Types of Dietary Fats-
Based on the importance of the fats, I have classified the fats on whether they are beneficial, partially beneficial, or totally bad type. Hence, I have named them[as in the English film-the Good, the Bad, and the Ugly]–
The Good Fats
Bad Fats and
The Ugly Fats.
I have made a simple table for you to know and understand these different varieties of dietary fats. This should help you make an informed decision while using them in your food or diet.
Table
1. The Good Fats-
Let us now begin with the Good variety of fats in our diet. These are”Good” in the sense that they help to maintain the health of our hearts. These are the fats that have a great impact on our Cholesterol levels. As you all know, a bad cholesterol report is a sign of having plaques or blocks in our coronary[heart] arteries.
Good fats are the Monounsaturated[MUFA] and Polyunsaturated fats[PUFA]. These fats contain what we call the healthy or essential Fatty Acids. There are different types of fatty acids with varied health benefits. Let us discuss them one by one.
What are these Fatty Acids and how do they help us?
By reading the above question, you must be wondering-are we consuming some form of acids? Well, to answer that question -no, not at all.
Let us go back to the table shown above and analyze it step by step-
The Essential Fatty Acids
Well, fatty acids are those components of the fats that are essential in maintaining our organs like the heart, brain, and kidneys.
Surprisingly, most of these essential fatty acids are not produced by our bodies. They have to be out-sourced from different types of food items.
Very often you may have heard people talking about Omega 3 or Omega 6 or Omega 9 supplements they are taking. They have probably been prescribed these supplements either-
As a part of treatment to reduce cholesterol levels[eg. in heart disease]
For treating arthritic conditions
Hair growth problems
Skin diseases.
These fatty acids serve as components of various functions of fats in the body.
Types of Essential fatty Acids-
These Fatty acids are present in the Good type of fats, namely Polyunsaturated and Monounsaturated, as shown in the table above. They are essential in the sense that they help in bringing about changes in different aspects of our body.
Let us discuss their features and benefits one by one-
Omega 9 Fatty Acid-
These fatty acids are a part of Monounsaturated fats.
These are the healthiest of the lot. They help in-
lowering your LDL[bad cholesterol]
increasing your HDL cholesterol.
Omega 9 fatty acids also reduce Serum Triglycerides[TGL].
This can be a great help to we Indians as TGL is high in most of us.[ To learn more about cholesterols-Read here]. Nuts, Olive oil, Canola oil, etc., are the source of these very important monounsaturated fats.
The more you have foods containing Omega-9 fatty acids the better. The recommended daily requirement is 20% of our total calories and is roughly 24gm in a person whose needs are 2000 cals/day. So, having a handful of nuts a day can keep your heart problems away! [Click here to know more]
Omega-6 Fatty Acid-
The omega-6 fatty acid is present in Polyunsaturated fats. They are present in most of the cooking oilswe use and nuts. [Click here to know the nutrient value of different cooking oils]
Sesame oil-a source of Polyunsaturated[PUFA] fatsYou must observe that in the Nutritional Value of the oil, as shown above, you will notice that it contains both MUFA and PUFA. The MUFA is more than PUFA, indicating that this oil is very good for our heart health.
The recommended daily requirement is 10% of your total daily calories. The properties of this fatty acid are-
helps to lower LDL cholesterol
But also decrease HDL at the same time
They are moderately healthy.
Omega -3 Fatty Acid-
This is another very healthy fatty acidthat I recommend to my patients regularly. They are also present in Polyunsaturated fats.
Omega-3 fatty acids are present in vegetable oils [eg. Canola oil] and nuts. They help lower LDL and increase HDL.
DHA[docosahexaenoic acid] and EPA[eicosapentaenoic acid]-the names are a bit overwhelming. Never mind, we’ll remember them as DHA and EPA. Both are present in fish oils, particularly in fishes lake trouts[1.6 gm],salmon[1.4 gm], sardines[3.3 gm], and mackerel[2.5 gm], where the total weight of fish is 100 gm. Consuming these fishes in a curry form[ & not fried] 2-3times a week will provide you with plenty amount of DHA and EPA. Alternately, you can purchase Fish oil capsules as shown below, and have it 2 times daily
Fish oil capsules containing Omega 3 fatty acids( Click here to buy)
2.ALA[alpha linoleic acid] is a plant-basedOmega-3 fatty acid. It is present in vegetable oils like flaxseedand canola oil[shown above].
Where can we get these Omega 3 Fatty acids?
Omega-3 fatty acids have the ability to lower your triglycerides as well as LDL. Lowering triglycerides is especially helpful for patients having a risk of developing diabetes.
Some oils that are rich in ALA Omega 3 fats are-
Flaxseed oil[50%]
Canola oil [10%]
Soya bean oil[7%]
Other sources are –
Nuts[Almonds, Walnuts, Peanuts]
Tofu, soya beans, pinto beans, flax seeds.
Here I have covered almost everything you want to know about the GOOD FATS. Now we move on to the next in line- the BAD FATS.
2. The Bad Fats-
Coming to the table on fats, the second one in line is the Bad fat. They are also known as Saturated fats. Let’s start with an example here. Look at this picture shown below-
Picture showing Saturated fat value in a food Item
This the back page information on the packet of potato chips of a reputed company. Note the total absence of the Good Fats and a whopping 34% total bad fats in a 35 gm packet, i.e., about 11.9 gm.
Imagine you are eating about 100 gm of this chips every day. The total amount of fats consumed will be 34 gm, way above the recommended value of 6% or 6 gm. This is known to increase the risk of having a heart attack by 10 folds.
Now that you know the risk, I would like to point out that we Indians are even more prone to heart disease, Why? you may ask.
Because we consume lots of these fats. They are present in-
Butter[eg. Amul, Britannia]
Ghee[ eg. Amul, Patanjali]
Coconut oil[eg. Parachute]
Palm oil[ the above-shown chips have been fried in this oil] such as Palmoline.
Now that you know the consequences, I recommend that these Bad Fats should be consumed in moderation. Just once in a way, that too say, 35 gm of potato chips. I believe that we should sometimes pamper our taste buds!
Now lets on to the next in line- The Ugly Fats.
3.The Ugly Fats-
This is the most dangerous of the lot. They are also called Trans Fats. These are vegetable oils in solid forms, popularly called hydrogenated or partially hydrogenated oils. Here the oils are subjected to a chemical process called hydrogenation which has the ability to –
Increase the shelf life of these fats.
Make the cooked items tastier.
it is cheaper and is used in making tasty bakery products like biscuits, cookies, cakes, etc.
Another form of trans fat is the oil which has been used for frying items such as samosa. bhajia, potato vada, etc. In this instance, the vendors overuse these oils. As mentioned earlier, these fats undergo a process called oxidation.
Some countries like Japan and Finland do not use these Trans fats. Hence the rate of heart disease in these countries is very low.
In our country, it is the opposite. Compared to Good Fats like olive oil, canola oil, avocado oil, these Trans Fats oils are very cheap. And the economic condition of our overpopulated country forces us to use these trans-fat oils. Hence the number of heart disease cases is high in our country.
Conclusion-
The topic of Dietary fats and their use is very exhaustive. However, I have done my best to help you to choose the right type of fats. Here is a link that might help you choose the right type of food for a healthy life- link
Hope you have enjoyed reading this article. If you have any doubts or queries, do leave a comment in the comments section. I will be glad to help you out.
Finally, as I come to the end of this article, I would like you to listen to this podcast by Marni and Jesse-
Leptospirosis- Know How to Guard Against it and Stay Healthy
Table of Contents
Introduction-
Leptospirosis is a water-borne disease that occurs in the rainy season.
It is caused by an organism called Leptospira, which is shed by rats, dogs, cattle, etc., through their urine. These animals are the carriers of this organism and they harbor it in their urinary system without getting affected.
When their urine gets diluted in the water puddles during the rains, they can infect human beings by direct entry through the intact skin.
Leptospirosis is prevalent worldwide with India, some African and South American countries leading with a large number of cases yearly.
Shown below is the distribution map the disease worldwide-
World map showing the distribution of Leptospirosis
What is leptospirosis?
In my last two blogs on Infectious disease, I had discussed Malaria and Dengue.
Both are transmitted by mosquitoes. Whereas Malaria is caused by a parasite called Plasmodium, Dengue by the Dengue virus, Leptospirosis is caused by a spiral bacteria called the Leptospira.
As per the WHO definition, it is:-
I will now show some pictures below which will explain the disease in detail with signs, symptoms, and complications.
What is Leptospira look like?
This is a spiral bacteria called Leptospira interrogans.
It is found mostly in the urine of rats, dogs, and cattle.
How is this disease spread?
The figure below shows the different ways on how we get leptospirosis:-
Having known its transmission, you can see how it can be prevented by taking a few precautions in the rainy season[discussed at the end]
What are its Signs and Symptoms of Leptospirosis?
Signs and symptoms vary in different people. The picture below shows the symptoms mostly found in patients suffering from leptospirosis.
It shows that the disease as 2 phases, namely the Acute phase and the Immune phase.
The acute phase is the one where the patient is sick but can be treated successfully.
The immune phase is the one where complications as shown in the picture occur and mostly lead to complications which requires hospitalization.
Signs and symptoms of leptospirosis
A rash appears on the skin sometimes as shown below-
The skin rash in Leptospirosis
How many types of Leptospirosis are there?
There are 2 types of leptospirosis:-
Types of leptospirosis
In the first type, there is no jaundice. That is why it is termed Anicteric. They may have all other symptoms like headache, body ache, skin rash, and other features as shown in the picture of signs and symptoms above.
In the Icteric type, the patient has severe jaundice and other parts of the body get involved. There is internal hemorrhage[bleeding] within organs like stomach, eyes, kidney, etc. This ultimately leads to multi-organ failure and death.
Weil’s Disease-
Weil’s disease is a major and fatal complication of leptospirosis and is as described below-
Complications of leptospirosis- Weil’s syndrome
If you are having any of the above symptoms, you should contact your family physician.
Shown below is a picture of the effect of a severe form of leptospirosis wherein the platelet count of the patient low and internal bleeding occurs.
The eyes show seepage of blood in the sclera[white part of the eye] and is called conjunctival suffusion.
Conjunctival suffusion
What laboratory investigations your doctor may advise?
If your doctor is suspecting that you are suffering from leptospirosis, he/she may order the following tests:-
Treatment-
Patients should have plenty of fluids, soups, etc. along with medicines prescribed by your doctor.
Paracetamol- to reduce fever.
Antibiotics:-Doxycycline 100 mg twice daily for a week to 10 days;
Antiemetics[anti-vomiting]-like domperidone to prevent vomiting;
Anti-inflammatory pain killers like diclofenac, ibuprofen,nimesulide
Glucose powder- for severe fatigue.
Intravenous Dextrose saline to correct dehydration.
You may also be suggested by your family physician regarding the prevention of the disease in other family members by prescribing some medicine like doxycycline once a day for 2 weeks. Kindly do not treat yourself – this disease can be fatal. Weil`s disease is a serious condition that needs hospitalization.
Prevention Of Leptospirosis-
Having said all this, you can prevent this disease by
Avoiding barefoot walking in water flooded on roads in the rainy season,
Use good rubber or all-season shoes,
Try to avoid wetting your feet in the muddy waters during the rainy season.
Some precautionary measures for the prevention of leptospirosis as suggested by the WHO is as shown below:-
Preventing leptospirosis
Let’s have a quick recap of what we have learned today-
Sapota or chikoo[as it is popularly known in India] is a fruit that I usually recommend to my deficient patients in Calcium. They are generally available throughout the year in India and are quite affordable. One of my patients who has a chikoo farm near Mumbai brings me these fruits occasionally. Sometimes they are as large as a cricket ball.
To know more about the eye problems, I have designed a table showing different Ocular diseases[ as shown in the picture above] that occur in general and diabetes in particular.
Introduction
![Chest pain due to inflammation of the covering of lungs[pleura]](https://i1.wp.com/raodoctor.com/wp-content/uploads/2019/08/Pleurisy.jpg?ssl=1 "ePainAssist.com")
![Sesame oil-a source of Polyunsaturated[PUFA] fats](https://i1.wp.com/raodoctor.com/wp-content/uploads/2020/07/sesame-oil-1.jpg?resize=300%2C300&ssl=1 "raodoctor.com")
we’ll remember them as DHA and EPA. Both are present in fish oils, particularly in fishes lake trouts[1.6 gm], salmon[1.4 gm], sardines[3.3 gm], and mackerel[2.5 gm], where the total weight of fish is 100 gm. Consuming these fishes in a curry form[ & not fried] 2-3times a week will provide you with plenty amount of DHA and EPA. Alternately, you can purchase Fish oil capsules as shown below, and have it 2 times daily
Treatment-
