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Diabetic Retinopathy

Diabetic Retinopathy-How to avoid it and have a better vision

 

Author of the articleWhat 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-Parts of eye

 

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-

Ocular diseases of eyes including Retinopathy of Diabetes

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”.

A book on Diabetes Mellitus to know about Retinopathy of DiabetesTo 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-

Table showing features of ocular diseases including Retinopathy of Diabetes

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-

  1. About one in 46 diabetic patients in India become visually impaired due to diabetes.
  2. Retinopathy of diabetes was prevalent in the diabetic population for up to 50 years.
  3. 16.9% suffered from DR. Out of these, 17% were males and 16.7%, females
  4. Age-wise, retinopathy of diabetes was present as follows-
  • 60-69 years-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-

  1. High blood pressure or hypertension
  2. High Cholesterol levels\
  3. Smoking
  4. Alcoholism

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 –

  1. Fasting BS-250mg/dl
  2. Post-prandial[after meals]- 450mg/dl.
  3. 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-

  1. 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.
  2. 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-

parts of a normal retina of eye

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-

 

Retinopathy of Diabetes-fundoscopy picture

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-

  1. Mild Non-proliferative Retinopathy[NPDR]
  2. Moderate Non-proliferative Retinopathy
  3. Severe Non-proliferative Retinopathy
  4. Very Severe Non-proliferative Retinopathy
  5. Proliferative Diabetic Retinopathy
  6. Diabetic Macular Edema[DME]

This slideshow will take you quickly through the different stages changes we see in the Retinopathy of Diabetes –

What happens in Retinopathy of Diabetes?

Let us first consider the function of 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 into electrical 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- Mild non- proliferative retinopathy of diabetes

This is the earliest stage of DR wherein there is a ballooning effect on the blood vessels of the retina. It is termed an aneurysm or 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- Moderate non- proliferative retinopathy of diabetes

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-

Severe non-proliferative retinopathy of diabetes

This stage is characterized by-

  1. Almost all the blood vessels of the retina get blocked leading to a lack of blood supply.
  2. 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-

  1. Microaeurysms or hemorrhages in all 4 quadrants of the retina.
  2. Venous beading in more than 2 quadrants
  3. 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-Very severe non-proliferative retinopathy of diabetes

This stage comprises of all the features of the above 3 stages plus –

  1. Increase in hemorrhages in all quadrants of the retina.
  2. New arteries and veins are formed that spread and cover most parts of the retina causing distortion of images formed on the retina.
  3. Swelling of the central most part of the retina- the Macula, causing more blurring of vision.

5. Proliferative DR-

Proliferative diabetic retinopathy

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-

  1. 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.
  2. The detachment of the retina due to traction.
  3. Hemorrhage into the Vitreous chamber leading to pain in the eyes and a sudden decrease in vision.

6.Macular Edema-Macular edema in retinopathy of diabetes

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 Diabetic Macular Edema or DME.

What are the symptoms at this stage?

The eye vision starts deteriorating. The symptoms observed are-

  1. Blurred vision;
  2. Impairment of color vision-the patient may not be able to distinguish different colors.
  3. On and off of vision i.e. fluctuating vision. There can be blacking out of vision.
  4. 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-

  1. Diminishing of vision
  2. Sudden-onset floaters: Black or red, moving on the movement of eyes, worse after waking up from sleep
  3. 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-

  1. Suggesting appropriate medicines;
  2. Investigating regularly, particularly HbA1C and cholesterol levels;
  3. By advising a change of habits like smoking and alcohol consumption;
  4. 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-

  1. Laser photocoagulation-to stop leaking microaneurysms and spread of diffuse retinal thickening.
  2. Subthreshold micropulse diode laser-to prevent retinal damage.
  3. Intravitreal anti-VEGF agents-to prevent macular edema.
  4. 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-

  1. Check your blood sugar and HbA1C regularly
  2. Do not skip any medicines prescribed by your doctor. If there is any problem, discuss it with your doctor.
  3. Make lifestyle changes-control your weight and cholesterol levels
  4. Avoid smoking and alcohol
  5. 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-

Read here to know more, click here-FYidoctors.com

And here-retinarisk.com

And here-msdmanuals.com

And here- harvard health publications

And here- Diabetic retinopathy 

Finally, I strongly recommend that you should visit this site for getting proper and more guidance for Diabetes Care-

irisvision.com

You can also visit this site for a video on an in-depth knowledge of eyes and related diseases.

A word of gratitude:-

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.

Man having chest pain of heart attack
CHEST PAIN-HOW TO KNOW IF YOU ARE HAVING A HEART ATTACK OR NOT

 

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

COSTICHONDRITIS
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

 Severe chest pain due to Fractured rib
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

  1. apply a compression bandage or a sleeve to reduce movement due to breathing. This will automatically reduce pain.
  2. 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.
  3. Calcium tablets to heal and breach the gap in the fractured bone ends.

 

3. Chest pain of the Pleuritis

Chest pain due to inflammation of the covering of lungs[pleura]
Inflammation of the covering of lungs[pleura] leading to chest pain
Inside 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-

  1. Antibiotics like a combination of Cefpodoxime+Calvulinic acid[Oxypod CV 200] to reduce infection.
  2. The anti-inflammatory combination as mentioned above to reduces pain and inflammation of pleura.

4.The Pneumothorax

Chest pain due to air trapped in the plueral cavity of the lungs
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 –

  1. Aspiration of air by needle and syringe
  2. 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-

    Intercstal catheter insertion for removal of air from the plueral cavity
    Intercostal catheter insertion for removal of air from the pleural cavity

5.The Pericarditis

Chest pain due to inflammation of the pericardium
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.

6. Chest pain due to Angina Pectoris

Chest pain can be a symptom of Angina Pectoris

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

Warning Signs of a 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.

For more on Heart attack, read here[link]

How can a patient with heart attack present-

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-

8.The Aortic Aneurysm/Dissection chest pain

Picture of Aortic Anuerysm
Aortic aneurysm picture

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

Chest pain due to clot formation in the lung artery
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 termed Deep 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

Chest pain due to inflammed lung airway.
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

Inflammed oesophagus due to acid reflux causing 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.

For more on chest pain  click this link

You may use my comments section to contact me if there are any queries.

 

 

Typhoid fever logo
TYPHOID FEVER

Typhoid Fever – How to Prevent it and Stay Healthy

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-

  1. Dengue[link]
  2. Malaria[link]
  3. Leptospirosis[link]

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]

A microscopic view of Typhoid fever causing bacteria

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-

  1. He or she may or may not have a fever.
  2. The patient may be asymptomatic.
  3. Secondly, he or she may not be maintaining good sanitary hygiene like washing hands with soap after attending nature’s call.
  4. These carriers are mostly cooks who work in hotels and restaurant or 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.

Picture showing 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 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-

Thermometer showing high 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
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-

  1. the  enlargement of the liver[termed hepatomegaly]
  2. 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
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 antigen of 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 IgG antibodies 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 ratio of 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.

  1. Typbar TCV Vaccine;
  2. Biovac Typhoid 25mcg Injection;
  3. 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.

Further reading-
  1. Click here
  2. Click here
  3. Click here

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.

 

 

Complications of Diabetes

How to Avoid Complications of Diabetes and live a healthy life.

Introduction

Complications of Diabetes are those conditions in which diabetic patients suffer from the effects of high blood sugar levels on different parts or organs of the body.

In my previous blogs/articles on diabetes[Click these nos. above ¹ ² ³ ] 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.

Before we proceed ahead, I would like you all to listen to this short podcast-https://player.captivate.fm/episode/69757f35-ddf2-47e4-8415-e364cfe54521

What are these complications of diabetes?

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 severity of 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.Complication of Diabetes-Retinopathy

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
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  – Retinopathy of Diabetes. 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.

Prudent Diet-Fats- The Good, The Bad, And The Ugly

How Having Healthy Fats Helps Your Heart and Improve Quality of Life

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 bind structures 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 are fats useful for us
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 Clinic enquire 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
A combination of Rice Bran and sesame oils

Nutritional Info of Fortune Vivo cooking oil
Nutritional Info of Fortune Vivo cooking oil

 

  • Affects Heart functions- High B.P., blocked arteries due to cholesterol, etc.;Blockage of arteries caused by eating excessive amout of fats
  • 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 on Heart disease explaining the role of dietary fats in health
Book explaining the role of dietary fats( Click here to buy)

{ I have 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 a faulty diet. 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.

[Listen to this podcast for a while-

Before we proceed ahead, you can listen to this very interesting podcast by Kris Sollid, RD, senior director of nutrition communications at the IFIC Foundation, has to say on dietary fats-https://soundcloud.com/foodinsight/kris-sollid-fats-podcast-final]

How do we manage this high intake of fats?

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 fats in 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]

  1. The Good Fats
  2. Bad Fats and
  3. 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.

Nuts and seed conating Omega-9 Fatty acids
Nuts and seed containing Omega-9 Fatty acids

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 24 gm 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 oils we use and nuts. [Click here to know the nutrient value of different cooking oils]

Sesame oil-a source of Polyunsaturated[PUFA] fats
Sesame oil-a source of Polyunsaturated[PUFA] fats
You 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 acid that 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.

Canola oil -a good source of Omega 3 fatty acid
Canola oil -a good source of Omega 3 fatty acid
Omega-3 fatty acids are of 2 sub-types, namely-
    1. 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
Fish oil capsules containing Omega 3 fatty acids( Click here to buy)

2.ALA[alpha linoleic acid] is a plant-based Omega-3 fatty acid. It is present in vegetable oils like flaxseed and 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
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-

  1. Butter[eg. Amul, Britannia]
  2. Ghee[ eg. Amul, Patanjali]
  3. Coconut oil[eg. Parachute]
  4. 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-

Sources:-

  1. https://vikaspedia.in/health/nutrition/dietary-guidelines-1/moderate-use-of-edible-oils-and-animal-foods
  2. https://inbodyusa.com/blogs/inbodyblog/90571521-fat-doesnt-make-you-fat/
  3. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/#figure-2-7
  4. For those who want Hindi translation  – Click here

The topic for my next blog is an equally important one- Complications of Diabetes. This will be particularly helpful to those suffering from Diabetes.

If you have a Twitter account, kindly click on the Quote below so that this article reaches all your friends and followers.

Our Health depends on What we give to our Body-be it food, exercise, or proper rest. So Eat Right, Exercise daily, Sleep well and Stay Healthy, Fit And Fine! Click To Tweet
LEPTOSPIROSIS

Leptospirosis- Know How to Guard Against it and Stay Healthy

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 distribution of Leptospirosis
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:-
"<yoastmark
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.

  1. The acute phase is the one where the patient is sick but can be treated successfully.
  2. 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
Signs and symptoms of leptospirosis

A rash appears on the skin sometimes as shown below-

Skin rash in Leptospirosis
The skin rash in Leptospirosis

 

How many types of Leptospirosis are there?

There are 2 types of leptospirosis:-

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- Wells syndrome
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
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:-

Laboratory tests in LeptospirosisTreatment-

  1. Patients should have plenty of fluids, soups, etc. along with medicines prescribed by your doctor.
  2. Paracetamol- to reduce fever.
  3. Antibiotics:-Doxycycline 100 mg twice daily for a week to 10 days;
  4. Antiemetics[anti-vomiting]-like domperidone to prevent vomiting;
  5. Anti-inflammatory pain killers like diclofenac, ibuprofen,nimesulide
  6. Glucose powder- for severe fatigue.
  7. 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

  1. Avoiding barefoot walking in water flooded on roads in the rainy season,
  2. Use good rubber or all-season shoes,
  3. 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
Preventing leptospirosis

Let’s have a quick recap of what we have learned today-

Conclusion-

I hope I have explained all the details of this deadly disease. You can very well prevent leptospirosis if you follow all the precautions I have mentioned above.
Contaminated water in the rainy season is the main source of infection. Here again, wearing rubber gloves and shoes can go a long way in preventing the disease.
For more on Leptospirosis, Click Here.
Hope you have enjoyed reading this informative article.
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Prostate Problems

How to have a Healthy Prostate and Live a Good Life

Introduction-

The Prostate gland is a gland present in all men and its disease is very common as we grow old or simply put- when we age.

Many of the elderly men, especially those in their 50s and 60s, must have gone through prostate problems and may still be under treatment currently.

Why am I writing this article?

Exactly one and a half years ago, I had problems with urination. I am now 65 years old and the symptoms like frequent and scanty urination suggested to me that I may be going in for Prostate disease.

After ruling out urinary tract infection, I got my Ultrasonography Scan[USG] done, and lo!-it suggested I had Benign Prostatic Hyperplasia.

Case studies-

All the examples quoted in this article are true-life descriptions of the patients to whom I have attended in my clinic. [These examples will be included in each type of Prostate Disease which I will be discussing] However, the names of the patients in these case studies have not been revealed for the sake of privacy.

Moreover, I will be showing only the relevant part of the investigation reports so that you can focus on that part only if you are being investigated for prostate problems.

My suggestion is that you should read till the end because in the end, I have included some interesting podcasts which I believe you should listen to.

So, what did I do next?

As you all know, I am a General Medical Practitioner-I could have still treated myself- but I still consulted my Urologist colleague and started the treatment. With this treatment, I am doing fine to-date.

This experience and an ever-increasing number of patients visiting my Clinic gave me the idea that I should teach my patients about Prostate Problems.

Reading this article will give you sufficient knowledge of its disease so that you can discuss it with your Doctor while seeking treatment.

After reading this article, kindly bookmark it for future reference.

What is the Prostate Gland?

Just have a look at the picture shown on your right to know how a prostate looks like and where it is placed in the body.

A detailed picture showing Prostate Gland and its relation to Male Urinary System
A detailed picture showing Prostate Gland and its relation to the Male Urinary System

It is a gland the size of walnut[looks like walnut too] below the bladder covering the part of the urethra[through which the urines flows out] adjoining the bladder.

What is Prostate Disease?

Any disease affecting the prostate gland is called prostate disease. There are 3 main diseases affecting the gland, namely:-

  1. Prostatitis
  2. Benign Prostate Hyperplasia
  3. Prostate Cancer

Now let us try to understand each disease one by one-

Prostatitis-

In this condition, there is an acute infection of the gland. This occurs mostly in a sexually active patient i.e. in the age range 20 to 50 years of age. I will explain the signs and symptoms of such a patient with an example-

Case study 1-

A 35-year-old patient visited my Clinic complaining of –

  • Frequency-that is repeated call for urination, especially at night.
  • Dysuria- that is a burning sensation while passing urine
  • Painful urination-especially at the end. The patient feels said his urination is not complete, so waits for some time till the last drop
  • Fever with chills-usually mild.
Investigations-

The patient was advised to do the following investigations-

  1. Complete Blood checkup[CBC}- This showed a rise in the neutrophil counts.
  2. Urine microscopic and routine- This showed the presence of pus cells, red blood cells[RBC], increased level of albumin[protein]

Treatment-

This patient was advised-

  1. Antibiotics- A combination of Norfloxacin and Metronidazole[Nor-metrogyl] was prescribed to reduce infection
  2. An anti-inflammatory drug combination of diclofenac sodium and serratiopeptidase[Emanzen-D] to reduce swelling of prostate and pain
  3. Tamasulin[Urimax]0.4mg-to reduce irritation of the bladder due to the prostate inflammation. This is short term therapy usually for 10 days.
  4. Paracetamol to reduce fever.

This patient recovered fully after 10 days of treatment.

Tips for prevention-

  1. Do not masturbate frequently, that is, say more than once a day.
  2. After intercourse, wash your genitals immediately, not the next day. Semen contains lots of sugar in it-this can invite unwanted infections that can lead to prostatitis.

Benign Prostatic Hyperplasia[BPH]-

Have a look at the illustration shown below-

Picture showing the comparison of the Normal and enlarged Prostate
Picture showing the comparison of the Normal and Enlarged Prostate

It shows a uniform enlargement of the gland compressing the urethra. This is a problem that occurs with-

  1. Aging -usually, the patients are in the range of 50 years and above.
  2. Reduced sexual desire
  3. Hyperactive sexual activity in some elderly patients
  4. The decrease in the hormone testosterone.

I will now explain the disease by an example.

 Case study 2-

A 55-year-old male patient visited my clinic with –

  1. Frequent urination, especially at night leading to disturbed sleep
  2. Pain below the navel-possibly due to distended bladder
  3. Burning sensation while passing urine-probably due to infection of urine.
  4. Slightly reddish urine-probably due to the passing of RBCs in the urine.
  5. Mild fever with chills and body ache.

[The last 2 symptoms will be reflected in the Urine lab test]

Investigations-

This patient was advised –

A] Urine routine and microscopic test[see the report below]

This report shows the presence of 25 to 30 pus cells indicating severe urine infection.Urine routine test for Prostate disease

B] Complete Blood Checkup-

This report shows an increase in WBC counts again indicating the cause of fever due to a possible infection of the prostate.

Complete blood checkup in prostate disease
Complete blood checkup in prostate disease

C] Ultrasonography-

The report show enlargement of the prostate gland[see below]

Ultrasonography scan report of enlarged prostate gland
Ultrasonography scan report of the enlarged prostate gland

 

Notice the size of the gland- it is 38ml. The normal range is 18 to 23 ml. This again suggests its enlargement -medically termed as Benign Prostatic Hyperplasia or simply BPH.

Other noticeable changes in the USG are enlargement of both kidneys and a cystic growth in the left kidney. These are not related to BPH.

D] Prostate-Specific Antigen[PSA] test-

This came out to be normal. The normal values range from 0-6. An increase in the value of PSA is indicative of Prostate Cancer. The normal range of PSA levels as per age is as given below-Normal PSA range as per age

You can also listen to this podcast to learn more about the PSA Test –http://prostatenet.com/DrIsaacPowell_200805.mp3

Treatment-

I treated this patient with the following medicines-

  1. Nitrofurantoin tablets[Niftas 100 mg] twice daily for 10 days. This is to clear the urinary infection.
  2. Urinary alkaliser[Cital UTI]- 10 ml in 1 glass water to reduce the acidity of the urine. This took care of the burning sensation while urinating.
  3. Tamsulosin 0.4 mg -once a day at night for at least 3 months. This was to reduce the size of the prostate gland[Prostatomegaly as seen in the USG report]. Treatment will be reviewed after fresh USG reports post 3 months.
  4. Combination of paracetamol and nimesulide[Sumo Plus]-to reduce fever and body-ache.

This patient has recovered almost fully and is free of symptoms at present.

This was my line of treatment for that particular patient. If you are facing this particular prostate problem, seek the advice of your family physician-he will be the right person to guide you.

Tips for Prevention-
  1. As this disease occurs during the 40s and 50s, there is a gradual decline of testosterone hormone and sexual desire. Having regular sex can help increase the level of this hormone and slow down prostate enlargement.
  2. Do not over-masturbate at these age levels.

Here are some tips to overcome BPH- Click here

Prostate Cancer-

This is the disease of people aged 60 years and above. In some of these patients, the prostate is so enlarged sometimes that one may not be able to operate it.

Types of Prostate Cancer-

There are many types of prostatic cancers. I may not be able to cover the details of all these cancers as it is beyond the scope of this article.

However, I will present a snippet of a few common ones-Click here to know more.

 

Now I will place the signs, symptoms, and investigation details of one of my patients in the following example.

Case study 3-

An 87-year-old male patient visited my clinic with the following complaints-

Signs and symptoms-

  1. Difficulty in urination and frequent visits to the washroom
  2. Passing of blood clots in urine
  3. Past history of being treated for prostate problems
Investigations-
  1. Urine routine and microscopic- This showed plenty of red blood cells and a few pus cells.
  2. Ultrasonography-This picture was presented by the USG Report-

    USG report of a Prostatic Cancer patient
    USG report of a Prostatic Cancer patient
  3. As you can see above, there is a gross prostatic enlargement. The normal weight of the prostate gland is around 22 to 23 grams. Here it is 105 grams-a whopping 500% increase.
  4. The PSA test-
    The PSA test report of a prostatic Cancer patient
    The PSA test report of a prostatic cancer patient

    The Prostate-specific antigen value has come 25 times more than normal suggesting advanced cancer of the gland.

  5. CT Scan- this report below shows a picture of large growth or tumor in the prostate gland intruding into the urinary bladder. This was the main cause of the passing of blood clots in the urine.
The CT scan report of a Prostate Cancer patient
The CT scan report of a Prostate Cancer patient

Shown below is the actual MDCT scan picture of the same patient-

Prostatic Cancer picture
Prostatic Cancer picture

I referred this case to a Urologist for further treatment. here is what he suggested-

  1. Bone Scan- to rule out metastasis[spread] of cancer to the bone.
  2. Transurethral biopsy of the prostate
  3. ECG and Echocardiography.
  4. chest X-ray- to rule out the spread of cancer to the lungs.

The patient is currently undergoing investigations and treatment for his symptoms. Depending upon the results of the biopsy of the prostate, further treatment like removal of the cancerous growth will be considered.

The Biopsy report-

The biopsy report came out to be adenocarcinoma of the prostate gland. As a part of the treatment, to slow down the progress of cancer, his testicles were removed. According to the operating surgeon, this type of cancer spreads fast due to excess testosterone hormone released by the testicle.

For more about preventing prostate cancer or what one should do about it, listen to this podcast

Conclusion

Dear friends, I get inspiration to write articles by reading articles written by other authors, reading health-related books on Kindle for Amazon, and watching good health serials on Amazon Prime Video. At present, I am watching The Good Doctor on Amazon Prime Video. If you are interested, you can get it all here-

 

Amazon prime subscription picture
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I hope this article will help you make an informed decision when it comes when confronted with prostate problems any time in the future.

I would appreciate it if I could know how useful this article has been to you by placing a comment or suggestion in the comments section below.

Share this Article

I would also appreciate even more it if you could spread this knowledge you have acquired by sharing it on social media like Twitter, Quora, Mix, Linkedin, Whatsapp.

Alternately, you can click on the quote given below-

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Image showing Plasmodium falciparum- Malaria Fever causing parasites
MALARIA

MALARIA FEVER

Introduction

Malaria fever is only next to Dengue and chikungunya spread by mosquitos. In this disease, a female anopheles mosquito[shown below] is a culprit. They feed in the night on human blood and breed during the daytime.

Malaria spreader Female Anopheles mosquito
Malaria spreading female Anopheles mosquito

These mosquitoes transmit the malaria parasite from person to person by their bites.

Why I am writing this article?

As you all know, I am a General Medical practicing in Navi Mumbai, India. Every monsoon after a few days of heavy rains, water stagnates at many places serving as breeding places for Dengue and Malaria causing mosquitos. Many patients with fever attend my clinic. They are either suffering from Malaria or dengue.

Children and the elderly are more susceptible to a severe form of malaria. To make this aware to all my readers, I decided to write a comprehensive article describing everything you may want to know about the disease.

My motto has always been-Prevention is Better than Cure!  That is the sole purpose of this a,rticle.

I request all my readers to read the article until the end to understand it fully. If possible, bookmark this on your browser so that you can refer to it anytime in the future.

What is Malaria and what causes it?

It is a form of fever that can make you very sick. Dengue fever discussed in my previous article[click here to read] was caused by a virus.

Malaria is caused by a protozoan parasite called Plasmodium and is transmitted/spread by the bite of mosquitos.

 A Brief History of Malaria-

Many centuries ago, malaria existed in the gorillas in the African subcontinent. They were transmitted to human beings by Anopheles mosquitoes.

Transmission pattern of malaia worldwide
The transmission pattern of the malaria distribution worldwide

From Africa, the disease spread all over the world and is still causing havoc in South America, India, China, and other countries. This picture map shows how Malaria is ruling in different countries-

 

  Transmission of Malaria parasite – The Pathophysiology of Malaria-

One should know how one gets Malaria. The picture shown below shows how exactly the malarial parasite is transmitted and spread by the female anopheles mosquito.

Malaria parasite being transmitted by mosquito
Spread of Malaria parasite by Anopheles mosquito

As the parasite enters the human body, it undergoes various stages. This goes on until it is picked up again by another mosquito. So, less or no exposure to mosquito bites should be your first concern.

Types of Species of Malaria parasites-

There are 4 types of malaria parasites-called Plasmodium[P.]– depending on which part of the world they are found-

1. Plasmodium Falciparum-

Found almost all over the world. This the most dangerous of the four varieties. India is also a host to this parasite. It can cause a severe form of malaria affecting the brain[Cerebral Malaria] and the kidney[Black water fever].

Fever occurs every day with rigors[shivering] and can reach up to 107° Fahrenheit.

2. P.Vivax –

This is also found worldwide, is less dangerous but can cause severe illness. Found in India. The disease caused by this variety is milder but can sometimes mimic P.Falciparum.

Fever can occur on alternate days or every 4th day.

3.Plasmodium Ovale- 

Such type of malaria is found in Latin America and many Southeast Asian countries including India[rare]. This has a very low presence and is not that dangerous.

4.P.Malariae-

Found mostly in the Far East countries like Malaysia, Thailand, Vietnam. and China. Incidence is the same as that of P.Ovale.

Signs and symptoms of Malaria-

All the symptoms are related to the phases of the development of the malarial parasite in the body and circulating blood[see the pathophysiology picture above]. The fever usually occurs in the schizont and merozoite stage, that is when the parasite enters the bloodstream from the liver[merozoite stage] to enter the red blood cell.

Next is when it breaks from the RBCs [ schizont stage]

The major symptoms of this disease are-

A] Fever-

Pyrexia or fever can range anywhere from 100°F to 107°F. The fever is intermittent. Depending on the type of malaria they are further classified as follows-

  1. Tertian fever- This occurs every 48 hours in P.Falciparum, P.Vivax, and P.Ovale.
  2. Quartan Fever- this occurs in P.Malariae
  3. Malignant fever- This is a feature of severe P.Falciparum malaria. It can lead to multi-organ failure[more on this in complications] and ultimately death if not treated in time. These patients need to be admitted to an ICU unit.

B] Rigors or Shivering-

Just before the fever begins, the patient starts shivering vigorously with the chattering of teeth. This called rigor. This is also called the Cold Stage.

C] Severe headache and body ache-

Fever and shivering are followed by severe headache, body ache, and pain in the eyes.

D] Vomiting, diarrhea, cough-

A few patients have severe bouts of vomiting and some, diarrhea [Seen in Intestinal malaria- a rare occurrence]. This can lead to the patient getting dehydrated and lethargic.

E] The Signs-

As the disease progresses, there is an enlargement of the liver and another organ called the spleen due to which there is a pain in these organs.

The liver gets enlarged because the parasites are multiplying there[ hepatic schizont stage].

Spleen is known as the graveyard of RBCs. After the release of the parasite from RBCs, the RBCs are scavenged by the spleen, enlarging it as the disease progresses.

F] Recovery phase-

The above symptoms last for a good 2-3 hours. After this, the recovery begins with the patient feeling very tired and wanting to sleep.

What are the laboratory investigations?

Blood tests commonly recommended are

a] Complete blood checkup[CBC]- this will, in almost all cases, show-

  1. Anemia i.e. low hemoglobin levels
  2. Reduced RBC count
  3. Decreased Platelet count[ normal range 1.5 to 4.5 lakhs]

b] Smear for malaria parasite[MP] to confirm the diagnosis and show

  1. Type of malaria parasite
  2. The percentage of affected RBCs-more than 2% can lead to severe complications and death.
  3. Stage of development of the parasite, for eg., Schizont, or trophozoites or merozoite stage.

c] You can also have an immunological card test to confirm the type of malaria.

Having understood the Signs and symptoms, we now move to the treatment part.

Treatment Of Malaria:-

Drugs used commonly in the treatment are:-

  1. Chloroquine- This the most prescribed drug[ eg. Lariago, Nivaquin]. This is a 3-day course.
  2. Primaquine-Given after Choroquine dose is over. Should be taken for 14 consecutive days. I usually prescribe folic acid tablets[Folvite] with primaquine, as there is always acute folate deficiency in malaria.
  3. Mefloquine-rarely given nowadays;
  4. Quinine-Dosage depends upon body weight.
  5. Artesunate-Given in severe malaria. The dosage depends upon the severity of malaria.
  6. Artemether- Same as Artesunate

etc. to name a few.

Let your family physician decide the dosage and the type of medicine to be prescribed to you.

Kindly do not attempt to self-treat yourself as these medicines have severe side-effects. Better to leave it to your Family physician to take care of you.

Along with the antimalarial drugs you will also be prescribed-

  1. Paracetamol[ Crocin, Calpol, Pacimol] for fever;
  2. Domperidone[Domstal DT, Domperon] for nausea and vomiting;
  3. Chlorpheneramine[Avil] to prevent shivering and itching:
  4. Diclofenac/Ibuprofen[ Voveron, Diclogem, Ibugesic].
  5. Intravenous[IV] fluids if patients are vomiting continuously, with 5% glucose or ringer lactate. This can prevent severe dehydration.

A word of Caution-

If you have G-6PD deficiency or anyone in your family has this, kindly let your doctor know about it. This can prevent severe complications of malaria treatment.

G-6PD deficiency causes a condition called Hemolysis, wherein the RBCs in the blood are destroyed. Some antimalarials, especially Chloroquine and Primaquine, can cause severe hemolysis leading to jaundice and death in G-6PD deficient patients.

Non-medical treatment-

This consists of-

  1. Plenty of fluids, preferably with glucose or some powder like Vital-Z, Enerzal;
  2. Proper diet;
  3. Fruits
  4. Adequate bed-rest until full recovery. Avoid doing any form of exercise during the treatment period.

Complications of malaria-

Two types —P.vivax, and P.falciparum— are very common in India. Out of these two, P.vivax is less dangerous than P.falciparum.

The later one can cause multi-organ failures like-

  1. Kidney failure-wherein you may pass coffee-colored urine[so-called black-water fever],
  2. Brain fever -also called cerebral malaria, where the patient can go into a coma
  3. Blindness -due to choking of eye blood vessels, etc.

These patients need urgent admission in the hospital because they are very sick and need intravenous fluids like glucose-saline etc. and also to prevent complications of malaria, like coma, dehydration, congestive cardiac failure, etc.

Is there any immunity to the disease?

There is a small group of people having what we call the Sickle Cell Trait who are immune to malaria. People with Sickle cell trait are found immune to malaria. The reason is the parasite requires a lot of oxygen to survive. This is less in Sickle cell trait as the RBCs of these people are deformed i.e. shaped like a sickle.

These traits are found in tribals and poor people who lack money to get treated. These people over the years develop natural immunity in the form of deformed RBCs from trying to fight the disease.

Can you Prevent Malaria?

Yes, definitely. I would like to add a few words on the prevention of malaria because prevention is far better than cure. Kindly follow the following steps:-

Malaria Prevention
Malaria Prevention

 

I preferably advise chemoprophylaxis if at least one member from the family has suffered from malaria.

What is Chemoprophylaxis? Is there a vaccine?

So far, no vaccine has been found for preventing malaria. Therefore, prevention or prophylaxis with drugs is the only way out.

Chemoprophylaxis is basically a medicine given to prevent disease. In Malaria, chloroquine is prescribed 2 tablets a week to all the family members who had a member suffering from the disease.

Other than that, a tablet combination of Pyrimethamine and Sulfadoxin[Reziz] is given on a monthly basis.

Some personal observations which can be useful to all-
  1. Use full-sleeved hosiery material shirts and pants-the the mosquitos find it difficult to pierce through these types of clothes.
  2. Never wear dark or black colored clothes-it camouflages the mosquitos[you can see them hiding in dark places or on furniture that is dark-colored].
  3. If you see a large mosquito parking on the ceiling, it is mostly a female anopheles one. Aedes Aegypti mosquitoes are small and will hide under furniture.
What else should you do to prevent malaria?

I personally use mosquito repellents such as mosquito repellent coils, patches, fabric roll-ons, window nets etc. These are easily available online. See below –

Mosquito mesh for windows used for keeping out mosquitos causing malaria malaria
Mosquito mesh for windows[Click here to buy]

Mosquito repellant fabric patches for babies and infants to repel malaria causing mosquitos
Mosquito repellant fabric patches for babies and infants[Click here to buy]

Mosquito repellant Fabric roll-on to repel malaria causing mosquitos
Mosquito repellant Fabric roll-on[Click here to buy]

Mosquito repellant coil to repel malaria causing mosquitos
Mosquito repellant coil[Click here to buy]

 

 

 

 

To know more about malaria you can click here.

What can you as readers do to make the world a better place to live in-

Friends, as you all know the whole world is up against the Covid-19 pandemic. During this period, Malaria can overlap with the COVID-19 pandemic.

There is a saying “Sharing is Caring”. I have done my bit by getting this article to you. Now, you can contribute, without spending a penny by sharing this information with all those you love and care for.

Do this now by clicking on the Social Media icons in this article with a small note” Read this article”.

Alternately, if you have a Twitter account, you can just click on the quote below-

Stay Informed, Stay Healthy- Let us together Fight Covid-19 and Malaria Click To Tweet

As usual, I would like to add-if you have any queries, you can leave a message in the comments section. I will be glad to help and guide you.

 

 

DENGUE FEVER

Dengue Fever- Signs, Symptoms, and Treatment

Introduction

Monsoons have arrived in India bringing with it much needed relief from the summer heat, but along with rains the common diseases like the Dengue Fever.

With the Covid-19 pandemic raging all over the world-India being no exception- there are chances that Dengue Fever may overlap with the Covid-19 cases.

This can cause more anxiety in an already existing panicky situation.

Cause of Dengue fever-

With the rise in population in most of the developing countries and lack of hygiene and cleanliness, there has been a rise in the mosquito population as well. Dengue is caused by a daytime biting mosquito called Aedes Aegypti [as shown below]. They carry the dreaded flavivirus called the dengue virus and there are four varieties that can cause the disease in varying severity.

Shown below is a nice graphic presentation By Dr. Eva Harris a Professor in Public Health that explains how the Dengue virus is transmitted and how it affects the human body.

Transmission and life cycle of Dengue Fever Virus
Transmission and life cycle of Dengue Virus
PICTURE SHOWING HOW DENGUE VIRUS IS TRANSMITTED
TRANSMISSION OF DENGUE VIRUS FROM MOSQUITO TO HUMANS

 

 

SIGNS AND SYMPTOMS OF DENGUE FEVER
Signs and symptoms of Dengue Fever

Having viewed the visuals above, you will have a fair idea as to what to expect in dengue. Patients of dengue complain of

  1. severe body-ache[so called breakbone fever]  along with
  2. abdominal cramps,
  3. vomiting,
  4. sometimes rash all over the body[due to leakage of fluids],
  5. diarrhea, etc.

Here are 2 Case studies of patients that visited me  to help you understand Dengue Fever better [Read Here]

Tests to be carried out are:-

  1.  CBC;
  2. Urine routine and microscopic;
  3. NS1 antigen test[mostly positive from the 2nd day of fever]. NS1 antigen is a protein released by the dengue virus which is the main cause of destruction and damage caused to the cells of our body. This is one quick test to determine if the patient is suffering from dengue.

Now let us analyze each test one by one to know what to expect in Dengue Fever-

CBC(Complete blood checkup)-

CBC may show a

  1. A rise in hemoglobin level and red blood cell count [also called hemoconcentration],
  2.  Lowering of platelets-
  3. Lowering of platelets may cause-a]internal bleeding, b] leading through the nose leading to a condition called Dengue hemorrhagic shock and if not treated properly, ultimately leading to death.
  4. Lowering of white blood cell count-called leucopenia can cause a lowering of immunity to any disease.
  5. There is seepage of plasma, that is, leakage of fluid from the tissue cells into the space surrounding the cells leading to severe dehydration.

Urine analysis

This may show a rise excretion of body proteins-an indication of impending acute kidney failure.

Treatment

As with any other viral disease,  for eg like the Covid-19 disease, there is no specific treatment to treat Dengue Fever.

There are also no vaccines so far to prevent it. We, doctors, treat the symptoms like fever, headache body ache, vomiting, dehydration.

We also monitor the progress on a day-to-day basis and if symptoms are not improving, the patient is referred for the hospital admission.

If you are suspecting dengue fever or are living in an area infested with Aedes Aegypti Mosquitoes, you should visit your family physician/healthcare personnel for treatment.

Never try to treat Dengue fever on your own- you may land up with fatal complications[elaborated below in the complication section].

Treatment is primarily to correct dehydration by having oral fluids and/or I.V. fluids like glucose, saline, electrolytes, etc. if there is vomiting. Antiemetics are given to reduce/stop vomiting. Paracetamol is given to control the temperature.

The patient is encouraged to have a regular diet, as there is a loss of appetite due to fever, vomiting, and the disease itself.

In case of severely lowered platelets[normal range 1.5 t0 4.5 lakhs per decilitre of blood], your attending physician may consider transfusion of platelets[ if it goes below 15000/decilitre of blood].

Complications of Dengue Fever-

Dengue Haemorrhagic Fever[DHF]-

This is a very severe form of Dengue fever. This appears after a lull of 5 to 7 days wherein the patient feels well. Suddenly after the lull, the patient becomes very ill and prostrated. He goes into delirium and may go into a comaunconscious state).

Laboratory Tests-

All the tests mentioned above have to be carried out along with some additional tests as shown below –

Liver function test

  1. The liver enzymes like SGPT, SGOT, etc are very high, suggesting liver damage.
  2. Serum bilirubin and bilinogen( popularly known as bile salts and bile pigments) are very high, giving rise to jaundice.

Chest X-ray-

This can show the accumulation of fluids in the lungs and pleural cavities ( pleural effusion) which can hamper patients breathing ability.

Ultrasonography of Abdomen(USG)-

USG is a test that can reveal-

  1. Hepatomegaly- that is, enlarged liver
  2. Splenomegaly- that is enlarged spleen[the spleen is popularly known as the graveyard of blood cells. With a lot of RBCs getting destroyed, spleen works overtime to scavenge these dead cells thereby increasing its size].
  3. Ascites- accumulation of fluid in the abdominal cavity due seeping out of fluids from the blood vessels.
  4. Acute Kidney failure- there is damage to the kidneys due to dengue infection.

Treatment-

The condition of the patient suffering from Dengue Haemorrhagic fever is serious. There is a severe loss of blood platelets due to the dengue virus.

This causes bleeding in various parts of the body like-

  1.  The eyes( the sclera- white part of the eye- is blood-tinged)
  2. Stomach – showing fresh blood in vomitus
  3. Kidneys- urine shows RBCs.
  4. Lungs- causing blood to be coughed out.

This causes multi-organ failure and eventually, the death of the patient.

Taking into consideration all these features, the DHF patient has to be shifted to a hospital with an Intensive Care Unit(ICU) and has to remain there until full recovery.

Can we prevent dengue-

Yes, we can—both malaria and dengue mosquitoes breed in water ponds which are unattended. So, see that there are no water collections near your home.

Conclusion-

One thing to remember:- malaria mosquitoes bite in the night and dengue mosquitoes in the day-time.

Here are are a few items that you should consider keeping in your home during the monsoon season –

1.Mosquito Repellant- I use this at my home. It is very effective to keep mosquitoes away.

Herbal repellant to prevent mosquito bites and Dengue fever
Herbal repellant to prevent mosquito bites and Dengue fever[ Click here to purchase]
Mosquito net to prevent mosquito bite and Dengue fever
Mosquito net to prevent mosquito bite and Dengue fever.[Click here to purchase]
 2. A mosquito net-  those who are allergic to the smell of mosquito repellants can use a net to cover the bed as shown here-

3. A mosquito repellant vaporizer with liquid as shown below-

 

Mosquito repellant liquid with vaporizer
A repellant liquid with vaporizing machine to drive away Dengue causing mosquitoes. Click Here to purchase.

I use the above gadget and the vaporizing liquid in my house to keep the mosquito away and have peaceful sleep at night.

To know more about Dengue fever, you can visit these sites-

  1. MedLife
  2. Zana.com
  3. Yoganama

I hope you have enjoyed this article which tells you what to look for and how you should treat or prevent Dengue fever. I would be very happy if you could bookmark this article on y.our browser, so that you can visit it any time you need to read it.

This article will be followed by a series of monsoon related diseases like-

  1.  Malaria,
  2. Leptospirosis,
  3. Chikungunya, and
  4. Typhoid fever.
Stay Healthy, Stay Safe- Prevent Dengue Fever Click To Tweet

As usual, I choose to close this article by reminding my readers to post your opinion and reviews in the Comments Section of this article.

Be sure to leave your email Id so that you can be the first to receive informative articles like this as soon as it is published.

Most Effective Ways To Treat Osteoarthritis[OA]-Stagewise

Most Effective  Ways To Osteoarthritis[OA] – Medications

In my last article on Osteoarthritis, I had written about the preventive aspect of the disease- in this article, I will be discussing the medication aspect.

How to treat Osteoarthritis with Medicines-

Before we jump on to the treatment part of osteoarthritis, let’s have a brief look at the picture shown below-

Picture showing changes observed in Osteoarthritis

Now let us see how these changes appear in an X-ray picture of an Osteoarthritis joint-

 

Right knee joint xray showing osteoarthritis changes
X-ray picture of osteoarthritis in right knee joint

The 4 stages of OA-

Before we go on with the medication for osteoarthritis, let us quickly recall the various stages of OA as shown below-

  • Normal Knee joint parts

Why is the staging of OA so important?

Different stages of OA have slightly different modes of treatment. In this article, I intend to inform you on both non-medical and medical line of treatment of all stages except the 4th stage. Stage 4 osteoarthritis mostly requires surgery, especially in the knees,

The stage-wise treatment is as given below:-

A] Stage 1-

In this stage, the treatment is mostly non-medical. Meaning that very few medications are prescribed and they are mostly nutraceuticals. I mostly stress on exercises to relieve the stiffness in OA.

What do I advise my patients?

Medications are bare minimal at this stage. This is what I advise my patients:-

a] Exercises-

  1. Brisk walking for at least 30 to 45 minutes for knee OA.
  2. For early OA of hands, an exercise in a bowl of warm water is very effective[see below]
    • Exercise for Hand OA in warm water
  3. Hip OA pains in the early stages are quite disturbing and exercise can help relieve pain gradually by strengthening the muscles and other structures supporting the hips. Here are 10 exercises which can help relieve pain as well as strengthen the muscles-watch this short video-
  4. For early OA of the spine, popularly known as spondylitis/spondylosis[Cervical{neck} and Lumbar{ lower back}], some of the exercises shown above work very well.
  5. Neck OA or cervical spondylitis pain can be relieved by these exercises as shown below-
    • Neck Exercise No.1
      Neck Exercise No.1
  6. For OA of the lower back, I suggest this simple exercise-
    Exercise For OA of Back
    A simple exercise for OA of Back

    Here is one more short video that shows that exercise helps in a lot in Osteoarthritis –

Are there any items to reduce/ease the pain?

Apart from exercises, I have used these items to relieve pain and stiffness in my knee joint-Kneecap for Osteoarthritis

A good pair of Knee caps for Knee Osteoarthritis
A good pair of Knee Caps for Osteoarthritis [Click Here for details]

A pair of self-heating Knee straps for Osteoarthritis
A pair of Self-heating Knee Straps for Osteoarthritis[Topurchase Click Here]
Both these items help in relieving pain and stiffness in osteoarthritis of the knees. They can be worn while walking. The self-heating knee straps can be removed after getting sufficient heat-it should not be worn while sleeping. These straps contain a substance called tourmaline which heats up when in contact with our skin. The magnets in the strap help in healing the damaged cartilage.

  1. For Stage1 OA of the neck spine or Cervical spondylitis, I usually prescribe a Cervical collar to prevent  excessive movement [as shown below ]     
    Cervical collar for neck spondylitis
    Cervical collar for neck spondylitis[Click here to buy]
  2. Similarly, for pain or back spasm, I have prescribed a lumbosacral [LS] belt and a heating pad to some of my patients.  They give very good relief from stiffness and pain. Have a look-
    Heating pad for backache
    Heating pad for chronic backache due to OA of the lumbar spine.[Click Here to purchase]

b] Medications-

Pain in joints[hands, hips, knees, or the back] is the sole reason why patients visit me for treatment at my Clinic.

Medicines are prescribed mostly to relieve pain, stiffness, and swelling if any. However, they should be taken only under the supervision of your healthcare provider. These are some of the medicines which I regularly prescribe-

1] Non-steroidal Anti-inflammatory Drugs[NSAID]-

Drugs like diclofenac sodium [Voveran], naproxen[Naprosyn], ibuprofen[Brufen], nimesulide[Nise/Nimulid] etotodolac[Proxym ER 300] etc., come under NSAIDs[pronounced N-seds].

These medicines have got the ability to reduce pain as well as inflammation of the joints in Osteoarthritis. They should always be consumed after food, preferably with a little milk because they have the tendency to cause acidity and gastritis.

2] Proteolytic Enzymes-

A very good class of drugs-they have the ability to reduce swelling by breaking down the proteins which cause inflammation in OA. Examples of proteolytic enzymes are-

  • Serratiopeptidase[ Emanzen, Cipzen]
  • Trypsin  Chymotrypsin[Chymoral, Enzoflam CT]
  • Bromelain, Rutoside[these two can be used with trypsin chymotrypsin for better effect]. These are enzymes derived from the plants with excellent anti-inflammatory and antioxidant activities.

All of the above medicines, when combined with NSAIDs, have a very good pain-relieving and anti-inflammatory effect in Osteoarthritis.

3] Nutraceuticals-

Nutraceuticals[word derived from nutrition and pharmaceuticals] are substances that are derived from food that we eat, albeit in a concentrated form. They have been combined together in a tablet form for consumption. These are some of the nutraceuticals that I recommend regularly to my patients with Stage 1 OA-

a]Glucosamine Sulfate, Chondroitin Sulfate, and MSM[Methyl-Sulofonyl-Methane] -a boon for Osteoarthritis treatment-

All the above-mentioned substances are present naturally in the cartilages[read about it here] in most of our joints. They are a group of substances called Proteoglycans and they help in building and constantly repairing damaged cartilage. Thus consuming them becomes a part of Osteoarthritis treatment.

b] Curcumin, Omega 3 fatty acids –

Curcumin is easily available in our food as turmeric. Omega 3 fatty acids are available in fish oils as well as flaxseed oil and soybean oil.

These nutrients have both anti-inflammatories as well as painkilling properties. These are available in purified powdered form and are used for fortifying glucosamine and chondroitin tablets.

c] Collagen-

This is a protein that is found in skin, nails, tendons, bone, etc. Out of this, that found in the cartilage is called Undenatured Type II collagen. This collagen helps by relieving pain and stiffness, and improving mobility of the joints. They are used in conjunction with the above 2 mentioned nutraceuticals.

 How do these nutraceuticals work in Osteoarthritis?

All these nutraceuticals are derived from cartilages of animals like cows, pigs, etc. They can also be manufactured artificially.

Most of these have similar properties and they help to-

  • Reduce pain and inflammation
  • Build new cartilage
  • Repair the damaged cartilage

These medicines are available as Jointace C2+, Durajoint in the medical stores, and can be purchased without a prescription. However, I would advise you to consult your family physician regarding dosage which can vary from person to person.

Do I recommend Nutraceuticals for OA?

Yes, I do, and that too strongly.

There are many contrasting views regarding the use of these substances in the treatment of OA. But my experience is that they are very good. In my previous article on preventive management of OA, I had mentioned that I was diagnosed with knee OA Stage 2 in December 2016 after which I was advised to undergo TKR[total knee replacement] surgery after 2 years. I was practically limping while walking at that time.

What else do I recommend?
  1. Oils and liniments or rubefacients- Massaging at the site of joint pains with liniments and oils give relief in the form of providing warmth to the joint. Many such herbal oils are available in the market place and they provide excellent relief. I have personally used liniments like Arnopen[Phytopharma], Pain Relief[20 Microns], and ointments like Arthrella[Charak]. That brings me to the next medication-
  2. Ayurvedic preparations- The above-mentioned companies producing liniments also produce tablets and capsules which they claim to be effective. They contain ingredients like Boswellia Serrata, Curcumin, etc., which help in reducing pain and inflammation, albeit gradually. I recommend them to patients who are afraid to consume allopathic pain killers because of their side effects.

Here is a very good article that will help you overcome pain of Arthritis.

Finally, I would recommend you to listen to this interesting 🤔 podcast- link

How did I  treat my knee Osteoarthritis?

I followed this method to reduce pain and stiffness and I advise my patients to do the same.

  1. Exercise to reduce my weight-I was 15% above my ideal body weight of 72 kg. I realized that this was putting tremendous stress on my knees.[For every extra Kg of body weight, the stress on knees increases by four folds]. Brisk walking for 45 to 6o minutes daily for 5 to 6 days a week helped me reduce this excess weight by 50%.   I started noticing the effect it had on my knee pain-it had almost disappeared.
  2.  Proxym ER 300 once a day and Zymogesic DS twice a day were taken to relieve pain and swelling. One month later the pain improved substantially.

What more did I do for my Knee Osteoarthritis?

With the above two regimens, I added a nutraceutical-Jointace C2+- which I am having to date. My pains, as well as limp, have gone and I still walk briskly daily.

This how I beat OA of my knees. I have pushed my TKR till further date i.e. as and when my OA pops up again or becomes unbearable.

There are a host of companies providing nutraceuticals for Osteoarthritis with different combinations. Here are some of the commercially available nutraceuticals for OA- Click Here.

To know more about these nutraceuticals click here

B] Stage 2 OA-

This stage usually occurs in the 30s and 40s. Treatment of this stage is the same as that of Stage 1 with an increased period of anti-inflammatory and proteolytic medication.

During this stage, I advise my patients a few more things to do-

  1. Avoid squatting. Squatting causes more wear and tear of an already degenerating knee and hip joint.
  2. Carry out quadriceps muscles strenghtening exercise- it helps reduce pain as well as increase mobility [ read here]
  3. Replace the Indian style commode by a western style one- this has the same effect as avoiding squatting.

I also prescribe a Calcium and Vitamin D supplement as I have observed changes of Osteoporosis[brittle bones] in these patients.

C] Stage 3 OA-

As we age, the metabolic process in our body slows down. This stage mostly occurs in the early 40s and 50s. The pain starts becoming unbearable. The disability increases.

The joint gets deformed due to fraying of cartilage[shown below]-

Bowed legs in osteoarthritis of Right Knee
Osteoarthritis -Right Knee showing bowing of legs

 

At this stage, I recommend all the medications in Stage I & II OA along with-

  1. Calcium supplements- to increase the density of bones around the joint
  2. Wearing of braces to correct the bowing of joints and use of a cane for support while walking[as shown below]-

These are very helpful to maintain balance in Stage 3 OA as patients tend to lose balance and can easily fall causing injury in the form of bone fracture as at this stage there is an increase of porosity of bones due to calcium deficiency. This is especially more so in women of post-menopausal age.

Braces to prevent splaying in knee Osteoatrhritis
Braces to prevent splaying of the knee joint in Osteoarthritis 
Walking stick for OA of knees
Walking stick to help relieve pain in Osteoarthritis of knee

D] Stage 4 OA-

In this stage, the cartilage is almost absent[as shown in the X-ray picture at the beginning of the article]. The pain is more severe and patients have sleep disturbance.

There is no point in continuing the nutraceuticals. So along with anti-inflammatory pain killers, I recommend additional narcotic pain killers like Tramadol[Tramazac], Tapentadol[Tapnex ER 50], and liniments and oils.

These medications help in improving the quality of sleep as well as relieving pain substantially.

At this stage, I usually recommend that patients should go for TKR  i.e. Total Knee replacement.

What is TKR?

TKR means replacing the damaged knee joint or hip joint by cutting the bones[ femur and tibia] at the joint level and replaced with artificial parts or prosthesis. By undergoing this operation, the patient gets tremendous relief from pain. The effectiveness of the operation depends on many factors such as-

  • Age of the patient-the more aged the patient, less effective is the replacement
  • Weight of the patient-obesity and overweightedness causes failure of TKR in most cases
  • Bone density of femur and tibia- Very important as the strength of the new joint depends on the strength of bones holding it.
What’s the latest news in the treatment of OA?

Research is on for a pain killer for Stage 3 and 4 OA. One such drug which is doing the rounds is Tanezumab- an injection that is administered subcutaneously[below the skin] in a dosage of 5mg/week.

Another interesting piece of news is that research is going on for using stem cells to regenerate the degenerated joint tissue of Osteoarthritis. For details, Click Here to read.

This medication though showing great promise, is still under clinical trials. If approved, it can be a boon to those who could not be operated.

With this, I come to the end of my series of articles on Osteoarthritis. If you have any questions or queries, you can join me by discussing the topic in the comment section of the blog.

Be sure to provide your e-mail address so that I can contact you personally to help you sort out your OA problems.

For more on Osteoarthritis, you can Read Here

And for all things to do about pain management Read here.

To learn about other people’s experiences Click here.

I take a multivitamin, I take extra C, I take chondroitin and glucosamine for my joints, I take calcium for my bones. And by the way, weight-bearing exercises can help ward off osteoporosis and yoga helps ward off arthritis. Raquel Welch Click To Tweet

 

 

 

 

Dr. K. P. V. Rao's Health Blogs
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