Search for:
Instruments on Doctor's table
Common Diseases and their Management

Acute Common Diseases- Know How to prevent or Manage Them

 

Common Diseases that commonly affect us

What is this article all about?

In this article I am going to discuss about all the common diseases which causes illness for a short period of time. Sometimes these diseases can be serious enough to land you in a hospital.

The aim of this article is to make you understand these common diseases and help you prevent it or guide you for further action.

Here we will discuss

  • the causes,
  • the signs and symptoms,
  • methods to prevent and, if you do get it,
  • how to treat it.

So my suggestion will be, do read and re- read this article so that you know when you should visit your family physician.

What are these common diseases?

There are many common diseases out there in our environment. Many of us suffer from one disease or many diseases at the same time but may be totally unaware of what it might be. What if you know what it is and also know how to tackle it?

The different types of common diseases-

There are two types of common diseases, namely-

  1. Acute common diseases
  2. Chronic common diseases

You can refer to this short table to know what they are-

Types of Common Diseases

FEATURES
↕↕↕


ACUTE COMMON DISEASESCHRONIC COMMON DIDEASES
DURATIONSHORT-about one to two weeksLONG-more than 2 weeks to months
TYPES
1] VIRAL
2]BACTERIAL
3]PARASITIC
4]SEPTIC
1]BACTERIAL
2]PARASITIC
3] METABOLIC
4]INFLAMMATORY

Why should you know these diseases?

Knowing what disease{or diseases} you may have is the first step towards its prevention or management. There are many diseases that go unnoticed until you have some or the other complications, e.g., chronic kidney disease or CKD. My mother had it, and we did not know about it until one fine day she started vomiting, which would not stop with any anti-emetics ( medicines to stop vomiting). Later on, we found that her serum creatinine was far higher than the normal of 0.6 to 1.04gm/ dl when we investigated her.

In this article, I am going to outline some of the acute common diseases we come across. We are going to discuss all the signs and symptoms of all the mentioned diseases. Not only will I be discussing how they present but also some tips on recognizing it on time so as to avoid them.

This post will teach you how to prevent these diseases and some tips on treating them at home[ home remedies] before approaching your healthcare professional.

We will discuss first the Acute ones and then the Chronic ones. Read on….

Acute Common diseases

These common diseases are termed acute because they start suddenly and also disappear within few days. Most of these conditions are caused by either viruses or bacteria or maybe a combination of both, for, e.g., common cold followed by pneumonia.

Acute common diseases can present as-.

  •  Viral Diseases
  •  Bacterial diseases
  •  Parasitic diseases
  •  Fungal diseases

We will discuss the common Acute Viral diseases in this post and the rest in my subsequent posts.

Common Viral Diseases-

Acute viral diseases present in many ways. A few of them are-

  • The common cold
  • Influenza( including COVID-19)
  • Viral hepatitis
  • Viral pneumonia

We will discuss 2 of them, namely-

  • Common cold
  • Acute Viral Hepatitis

A) The Common Cold

One of the most common viral diseases is the common cold. It is winter over most parts of the world at present. It is very common to find people sneezing and blowing their noses during this season. The symptoms are-

  • Headache
  • Mild to moderately high fever( 100 to 102° F)
  • Generalized body ache
  • Sneezing
  • Sore throat
  • Coughing with or without phlegm or sputum.
Person suffering from head cold- one of the acute Common Diseases
A lady having a headache due to a cold.( Source-Photo by Anh Nguyen on Unsplash)

Recently we have been going through an acute viral disease all over the world- the COVID-19 pandemic or the SARS-Corona virus disease. We have discussed this disease’s signs and symptoms in my past articles-click here to know more and here.

Prevention-

Avoid going close to a person getting sneezes or having a cough. I  always recommend having a hot soup like any vegetable soup( tomato soup is very good) for vegetarians and chicken- stock soup for non-vegetarians. They have a soothing effect on your throat if you are going in for a sore throat.

I also recommend gargling with warm salt water or povidone-iodine solution in half glass warm water at least 2 times a day.

Treatment of Common Cold-

In my regular practice, I  prescribe these medicines for my patients-

  1. Paracetamol ( Pacimol, Dolo) in the strength of 250 to 650 mg depending upon the age of the patient and severity of the fever.
  2. Anti-cold tablets( Recofast plus, Sinarest)- 2 to 3 times a day
  3. Pain killer anti-inflammatory tablets ( Ibugesic, Combiflam, Nise)
  4. Antibiotics tablets or capsules (Almox 250, Doxy-1L) 2 to 3 times a day if the sputum is purulent( greenish-yellow in color)
  5. A cough suppressant( Corex- Dx, Planokuf)
  6. Something to give the energy to fight the disease like Vital- Z or Enerzest powder to be taken with water.

I also advise a proper diet and complete bed rest to the patient for at least 3 days. Nowadays, due to a hectic life, patients do not get complete rest, and that worsens the illness.

You can listen to this short podcast to know more about the common cold.

Common cold and Allergic Rhinitis

There is a thin line differentiating a common cold from the cold of allergy, popularly referred to as allergic rhinitis.

Here is an interesting article that will teach you how to differentiate both-  link.

B) Viral Hepatitis

A picture showing liver disease Liver Disease by Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Hepatitis is a disease affecting your liver. There are many types of diseases causing inflammation in the liver, such as alcoholic hepatitis, non-alcoholic liver disease, amoebic hepatitis, and viral hepatitis.

Viral hepatitis is the most common causing severe illness. There are many types of viral hepatitis, namely, A, B, C, D, E.

Out of these, we will take up Viral hepatitis A or HVA in short. This is the most common and the most dangerous of the lot. The signs/symptoms (S/S) can range from mild to very serious or fulminant, causing death.

Cause of HVA-

The route of the hepatitis virus into our body is known as the fecal-oral route. Meaning that the virus is shed in our stools. And if the person or a carrier is not hygienic, this is transmitted to others through food handled by these people, mostly street food vendors.

Contaminated food( mostly street food)due to common houseflies and contaminated water in the rainy season are a few of the other common causes.

You can watch this video to know more about the different types of viral hepatitis.

Sign and symptoms

Viral hepatitis starts out as influenza, causing mild to moderate fever, cold, cough, etc. It then progresses to other S/S of liver disease, such as-.

  1. Nausea and vomiting
  2. Loss of appetite
  3. Dark or yellow-colored urine
  4. Pain in right flank due to an enlarged liver
  5. Loose motions or sometimes, constipation
  6. The feeling of tremendous weakness

Investigations of HVA

Your doctor may suggest you the following investigations-

  1. CBC( complete blood checkup)- this may show a rise in white blood cells
  2. Liver function test or LFT– these may show a rise in all liver enzymes such as SGOT, SGPT, ALT and a rise in bile pigments and bile salt such as bilirubin.
  3. Urine routine and microscopic- this may show the presence of bile salts and pigments, as mentioned above.
  4. HbsAg- this is a blood test showing a specific antigen(a surface protein on the virus-cell) of Viral Hepatitis B disease.

Complications-

In fulminant HVA, the bile pigments can go and lodge in the brain, causing damage, known as hepatic encephalopathy. This usually causes coma and, ultimately, the death of the patient.

Prevention of Hepatitis-

We can easily prevent viral hepatitis by following these simple steps-

  1. Wash hands with a germicidal soap thoroughly before eating and after you attend nature’s call.
  2. Avoiding street food, mostly in the rainy season.
  3. Eat vegetables, fruits, etc., washed thoroughly, preferably by filtered water 💧 if it is known that there is hepatitis going around in your city or town.
  4. By vaccination- vaccines to prevent hepatitis are easily available and can be prescribed by your doctor. This article will help you know more about the different vaccines available to prevent viral hepatitis.

Treatment-

According to an article in ucsfhealth.org, the treatment of different types of viral hepatitis varies according to severity.

There is no specific treatment for viral Hepatitis A. For Hepatitis B and C, there are a few anti-viral drugs available, namely-

  • Lamivudine[ available as Lamivir HBV Tablet]
  • Adefovir[available as Adesera 10 mg tablet]

*These drugs or medicines are prescription medicines and are to be taken only if your doctor prescribes it.

Alternatively, Hepatitis B can be cured by taking injections (💉 ) of a drug called pegylated interferon-alpha. This is given to those who progress to Chronic Hepatitis B. It is given weekly for 6 months.

Treatment for Hepatitis A

In the case of HPA, other than prevention ( which is the best method), treatment consists of-

  • Complete bed rest at home 🏡
  • Avoid fatty and oily foods for a period of 1 to 2 months.
  • High carbohydrate diet
  • Proper hygiene, especially sanitation of hands after attending nature’s call to prevent spread among other family members.

In case the patient is having consistent vomiting and getting dehydrated, the best course is to admit him/ her to the hospital for taking intravenous fluids like 5% Dextrose or Dextrose Saline or Ringer Lactate.

I hope you have understood these two acute viral diseases. I will introduce you to a few Acute Bacterial diseases in my next article.

If you have liked this article, do spread the knowledge by clicking on the quote given below-

Good health is not something we can buy. However, it can be an extremely valuable savings account. Anne Wilson Schaef Click To Tweet

Disclaimer:-

The medicines mentioned in this article is for information purpose only and that which I prescribe to my patients on consultation. Drugs mentioned in this article should be consumed only after consulting your family physician or health care personal. 

 

 

 

 

 

 

 

.

 

 

 

 

 

PICTURE SHOWING COVID-19 INFECTION OF LUNGS
The Covid19 pandemic

Living with COVID-19 pandemic- How to Reshape our Lives Now and Lead a Happy Healthy Life

The COVID-19 PANDEMIC-

Would you like to lead a healthy, fit, and useful life in this COVID-19 pandemic? That’s a question everyone wants an answer to because the pandemic never seems to be letting up.

For the last 12 months, we all have been bombarded with the same word-COVID-19- over and over again on all the media channels. Today, we are all really ‘Sick’  of-

  • Hearing about COVID-19
  • Listening to the loss of our near and dear ones, including friends, due to the disease
  • The fear with which we are living our day-to-day life

Is it ever going to end, or are we being compelled to being living with COVID-19 forever?  These questions linger in the minds of almost all the patients that I see daily in my clinic.

What has been the situation so far due to the COVID-19 pandemic in the city where I am living?

I live in Navi Mumbai, a place named Vashi. In the early days of the COVID-19 pandemic, there were a few cases and much fewer deaths. In the past 6 months, the situation changed drastically- the number of positive cases just shot up. And the number of deaths also shot up.

What has been my experience so far?

As the days progressed from January 2020, the number of cases all over India started spurting to unprecedented levels. Initially, in the early days of COVID-19, I had written 2 articles{ read here-1, 2 }.

Those were early days, and I had assumed that this disease would peter out like its other cousins- SARS-1 and MERS. But I [and the whole world, for that matter] was wrong. The disease, instead of declining, started climbing with unprecedented speed causing immense damage to the economy as well as the lives of the family who had patients amongst them. You can also say that this is the worst ever pandemic of the century, after the Great Spanish Flu of 1918, where millions had lost their lives.

Here, in this article, I am going to share my experience with one of my patients. This will help you to understand what happens when you suffer from a Covid-19 infection.

Case study of COVID-19:-

Mrs.SS, a 56-year-old lady, visited my Clinic in the first week of September 2020. At that time, it was raining very heavily in Navi Mumbai.

This lady had-

  • High temperature-102.5°F
  • Cold
  • Sore throat
  • Cough
  • Pulse Oximetry reading-SpO2-98%

At this stage, her chest examination was found to be normal. With 2 days of treatment with paracetamol, anti-cold medicines, and an antibiotic, her temperature was back to normal. But, on the third day, she started complaining of-

  • Severe weakness
  • Breathlessness
  • Pulse Oximetry reading -SpO2-had dropped to 85%
  • Dry hacking cough which was making her feel very sick

I ordered the following investigations-

A] Fever Panel-

This investigation consists of the following tests-

  • Complete Blood Checkup-this showed a high total white blood cell count with reduced lymphocytes. 
  • C- reactive protein[ a marker of inflammation] very high- it was 45( normal range 0 to 6). This suggested a severe infection in the body.
  • Increased levels of liver enzymes- Again, signs of severe infection, mostly of the liver.
  • Widal test – negative for typhoid
  • Malaria parasites- absent in the smear.

B] RT- PCR test

This the test which determines whether one is infected with the Coronavirus. The full form of RT-PCR is the Reverse Transcriptase Polymer Chain Reaction test. You can watch this short video to know more about the test- click here

In this patient, it was negative.

C] Pulse Oximetry-[discussed below]

The oxygen level- SpO2- of this patient when she visited for the first time was 98%. Gradually, by the 3rd day, her SpO2 level came down to 85% and appeared as if she was gasping for oxygen.

D] Chest  X-ray

This showed changes of pneumonia.

E] HRCT of Chest

This test is a high-resolution CT- scan of the lungs and the chest. It showed the presence of round glass pneumonia [similar to the image shown below]HRCT image of lungs in COVID-19 pnuemonia

After proper assessment,  this patient was referred to a COVID-19 Center, where she was admitted for approximately 14 days and treated with medication 💊 for Coronavirus.

F]The  After- effect of treatment –

This patient was admitted to the hospital, and she received treatment and attention for about 14 days. There she was treated for ‘cytokine storm'( discussed below). She was administered these medications-

  1. Antiviral injection Remedesvir by intravenous route- 1 dose per day for 6 days.
  2. Injection Sepsivac- an immunomodulator to neutralise the excess antibodies in the body and tackle the cytokine storm. This was given subcutaneous( underneath the skin) at 3 places for 3 consecutive days.
  3. Steroid injections – to reduce swelling inside the lungs.
  4. Antibiotics
  5. Cough syrup.

The side-effects-

Now, these medicines have their own side- effects. This patient developed-

  1. High blood pressure – the blood pressure had shot to 200/ 120 mm of Hg when she visited my clinic again after discharge from the hospital.
  2. Hyperglycemia- her random blood sugar was 245 mg/ dl.
  3. She had developed a moon face due to steroids used to treat her.

However, after a few days of medications, she was back to normal.

What about the present COVID-19 situation in India?

Today is 3rd January 2021, 3 days after I started writing this article. So far, as per the daily news about COVID-19 Infection spread in India, it is –

  1. Total No. of active COVID-19 cases as of today-2.5 lakhs
  2. No. of deaths due to COVID-19 reported so far-1.5 lakhs
  3. Recovered cases from COVID-19 as of today-9.9 lakhs

But the cases are not declining. The recovery rate is quite slow, and the number of deaths is increasing by the day, even though it is just 1.5% of the total. It remains to be seen how we will fare in the coming days. In the past 11 months since the first case was detected in India, the total no of cases are as follows-

  1. 10.3 million
  2. 9.98 million recovered
  3. 1.49 lakh dead

You can have a look at the real-time statistics of the COVID-19 situation in India by clicking this link.

What should we do in such a situation?

What is heartening news is that the percentage of recovered cases of COVID-19 is quite satisfactory. Now imagine a situation where you yourself or your near and dear one gets affected by the Coronavirus. In most cases, people first rush to their family physician [if he/she is available, as most of them are not].

What are the likely questions that you may be asking your family physician about COVID-19 infection?

My experience in the past 10 months of the ongoing pandemic is that patients who visit my Clinic are very anxious and more and more worried about getting infected by the COVID-19 virus.

To allay the fear of all concerned, I am going to put up some frequently asked questions by my patients and the answers I give-

Q1. What is this COVID-19 infection? And How do we get it?

Answer:- COVID-19 infection is a viral infection just like the seasonal flu; the only catch is it is more severe and dangerous. You can get it in several ways-

  • Through a person who has already been exposed to the virus. This virus has been imported to our country by people who had traveled to places like China, where it was reported first.
  • By inhalation of air that has been contaminated by droplets containing the virus by a patient who has a cough, cold, or sneezing.
  • Touching things like metals[ copper, steel of door handles], wooden surfaces like that of tables, chairs, etc.
  •  Direct contact with an asymptomatic person[one who does not show any signs/symptoms] like kissing, hugging, etc.

2] What is the course of progressing disease in a Covid-19 pandemic?

Answer:- To begin with, the COVID-19 infection presents as a common cold with –

  • Sneezing
  • Runny nose
  • Sore throat
  • Cough
  • Fever which may be as high as 102° F.
  • Loss of sense of smell and taste( read this article to know more about these symptoms)

As the disease progresses, the cold and fever may disappear with the patient feeling better. Then suddenly, after 2 to 3 days, the patient presents with-

  • Mild to severe breathlessness
  • His or her oxygen level drops. This can be seen by using a Pulse Oximeter-
    Pulse Oximeter
    Pulse Oximeter-Click here to purchase

    The normal oxygen level, read as SpO2 on the Pulse Oximeter, ranges from 95 to 100%. This drops down below 90 and may range anywhere between 65 to 85%.

  • X-ray chest shows changes of typical pneumonia called Ground glass pneumonia.
  • HRCT[ discussed above] also shows changes in Ground glass pneumonia.

3] What is Cytokine storm

This is a condition that occurs a few days or even months after the initial Coronavirus infection. When we suffer from the disease, our body produces antibodies to fight the infection. If these antibodies are in excess, they attack parts of our own body such as the lungs[most common], the brain, the eyes, the joints causing post-COVID complications. This collective complication is called the “Cytokine Storm.”

To know more about Cytokine storm, click on this link- link

4] Will I recover fully if I get affected by the COVID-19 pandemic?

This is a tricky question. Most cases that do not have any other comorbid conditions like old age diabetes, hypertension, heart disease, arthritis recover fully. Provided proper treatment is given.

For those having the above-mentioned comorbid conditions, there is a chance they might not survive. For instance, consider this case which came to me for cold, cough, and fever- a lady who was

  • 68 years old,
  • had hypertension
  • as well as diabetes.

She got infected by the disease and was admitted to the hospital with severe breathlessness, where she was diagnosed as RT-PCR positive, and her HRCT showed signs of a Cytokine Storm. This lady underwent the treatment as per COVID-19 protocol but could not survive due to her other co-morbid conditions.

Recently, an anti-inflammatory drug called piroxicam has been shown to reverse the Cytokine storm. Here is a interesting short video by Meyer Organics, the manufacturer of Ugesic, a sublingual anti-inflammatory  medicine piroxicam,  that can reverse the cytokine storm- click this link  Cytokine storm reversal medicine- piroxicam .

I hope I have explained most of the queries regarding the Covid-19 pandemic. In case anyone has any doubts regarding the COVID-19 infection, you can put up a query in the comments section. I will surely answer them to the best of my knowledge. All said and done ✔, we have to take care of ourselves whether we are in a pandemic or not. Here is one article which can help you to do so- read here.

For more details on COVID-19, I recommend you to read this article- link.

This is the latest take on the news of the new variant of COVID-19 which is prevalent in the United Kingdom- link

 

 

 

A person with dementia
Dementia Prevention and treatment

Dementia Prevention and treatment Best Ways for Prevention of Dementia and its Treatment

-For Living a Better Cognitive Life

Taking off from where we left earlier- Memory loss Part 1  and Part 2 – we now move on to the prevention and treatment of memory loss or Dementia. Treatment of dementia with full recovery is difficult, but prevention is very much possible.

I recommend that you read this article till the end. To know if you are at risk for getting dementia, assess your risk by using this article

As we proceed, I will come to this risk assessment in detail.

Before we do that, let’s see what the numbers say about Dementia worldwide and that in India specifically.

What is the state of affairs regarding Dementia/ Alzheimer’s disease in India?

According to the World Health Organization, worldwide 🌐 , the number of patients scenario of dementia is as follows:-

  • Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.
  • Out of the total, about 60 to 70% are that of Alzheimer’s disease.

In India, research shows that 5 to 6% of the older adults aged 65 to 70 years suffer from memory loss and progress to Alzheimer’s disease.

Alzheimer’s Disease is the most common type of Dementia and about 5-6% of people in the age group of 65-70 years in India suffer from this problem.

That is why it is very much important to study more about Dementia, even as the whole world is grappling with the scourge of the COVID-19 pandemic. 

Click this link here to know more.

How to know whether you are going in for Dementia?

Are there any early signs/ symptoms of dementia?  Yes, definitely, a few tell-tale signs which indicate that you or your loved one is going in for Dementia. These are as follows:-

  1. Failing to remember appointments;
  2. Forgetting where you have kept your things like important documents,  keys, etc.;
  3. Can’t remember having taken his or her meals- this may occur a few minutes of just having one’s meal;
  4. Disturbed sleep- a person may get up in the middle of the night and feel as if he has overslept;

As a General Physician, I  usually use the GPCOG test method to decide the Risk of Dementia in a patient. Click here to more about GPCOG

Click this link  here to know more about the cause of dementia in India.

The good physician treats the disease; the great physician treats the patient who has the disease -William Osler Click To Tweet

Prevention of Dementia-

Can we prevent or delay the onset of dementia? Yes, certainly we can. Before we proceed, I would like you to read this beautiful story about caring for your parents if they have dementia.

Now, back to preventing dementia- read on-Infography to showing 6 ways to prevent Dementia

1.Eating right- The Diet

Dementia Prevention and treatment- Diet to prevent Dementia
Diet for Dementia-Infographics source-Dreamstime.

The food that we eat has its effect on almost all parts of the body. E.g., –

  • Eating foods rich in saturated fats or trans fats are not good for the heart(link) and can increase cholesterol levels ( link)
  • A high protein diet is detrimental to chronic kidney disease( kidney failure) and gouty arthritis.
  • Alcohol binging can lead to liver cirrhosis and the loss of memory(Wernicke- Korsakoff disease).

All the above eating habits can also speed up memory loss. The picture below shows what to avoid and what to eat 🤔 to prevent Dementia.

 

Avoid these foods to prevent Dementia
Avoid these foods to prevent Dementia

 

 

 

Foods to eat to prevent Dementia
Eat these foods to prevent Dementia

 

 

 

 

 

 

 

 

Daily consumption of nitrate-rich vegetables such as spinach and swiss chard may prove invaluable in the prevention of neurodegenerative diseases such as dementia and Alzheimers-(Source-Medium.com). There is evidence that foods rich in a chemical called flavanols( that which gives color to fruits and vegetables) can improve your memory- (read here for more).

2. Control blood pressure well if you are under treatment for dementia

Hypertension( link) is a primary cause of Silent Stroke in many people ( we will discuss this in a separate article). If you are undergoing treatment for high BP, be regular to avoid silent stroke s it can also lead to loss of memory.

3. Control your blood sugar if you are a diabetic if you have dementia

Long-term Diabetes causes many complications if not controlled well. One of them is a Stroke. A stroke can damage the memory center in the brain. Those who control their blood sugar well can avoid this complication and memory loss.

4. Regular exercise can help you prevent dementia

Exercise is something which keeps one fit in life from all angles, namely-

  • It helps burn fats, thereby reducing blood cholesterol, which may be causing narrowing of arteries in the brain
  • Keep your heart ticking
  • Improve joint health, especially the knees, and keep you running
  • Maintain your body weight

All these points above also help improve the overall health of the brain- the seat of memory.

5. Avoid head injury to avoid getting dementia

Head injuries are known to cause loss of memory by-

  • Direct injury to the brain causing sometimes irreparable damage
  • The pooling of blood below the skull and compressing the brain

Most of the head injuries occur in vehicular accidents, more so in two-wheeler accidents. Sometimes a fall on the head while climbing or getting down the stairs, mostly in older people, can cause similar effects in a vehicular accident.

6. Taking medicines-

Patients suspected to be going in for memory loss will have to take medicines that can slow down or halt the progress of dementia. These are discussed in detail in the section below. The patient’s family members have to be very regular and prompt while giving medications to ensure that the progress of dementia is arrested.

7. Stop taking Narcotic drugs-

Drugs like cannabis, LSD, etc., can cause dementia.  If any family member or your relatives or friends are on to drugs, do your best to wean them off by counseling them or admitting them to a De-addiction center.

To know more about the prevention of dementia, read here- link.

Here is another good article by Dr. Michael Hunter on how you can prevent Dementia- link

Now that we know how to prevent Dementia let’s move on to the treatment part. Read on-

Treatment of Dementia- Medications

Know different parts of the brain to prevent Dementia
Different parts of the brain.[Source- Pinterest -click for a better view]

Before we proceed to treatment with medicines, let us briefly recollect about the sites in the brain which is concerned for memory storage and/or memory loss- the seat of memory>>this picture-

We should now concentrate on the Temporal part of the brain, which gets affected by dementia and Alzheimer’s disease.

Parts of the brain that store memory and prevent Dementia
Parts of the brain showing the seat of memory[Source-Pinterest-Click for a Better view]

 

 

 

 

 

 

In the temporal region, we have a part called the Limbic System, which contains these areas-

Some medicines work on the limbic system, particularly the hippocampus. Now we can proceed with knowing what medicines are effective and when.

There are 2 major types of memory loss-have a look at this diagram-Different types of Memory loss leading to Dementia

The treatment is based on which type of memory loss a person has.

There are a variety of medicines 💊 for Dementia that can –

  • Halt the progress
  • Control signs and symptoms
  • Improve  memory  📝

In this article, I will only highlight ✨ some of the medicines briefly as these medicines cannot be purchased over-the-counter. These medicines are to be taken strictly under the guidance of a Neuro physician or a Neuropsychiatrist.

Treatment of Dementia-Medicines 💊 to halt the progress

Dementia typically progresses from Mild Cognitive Impairment to full-fledged Alzheimer’s disease. There is no particular drug to prevent or halt this progress. However, there are few medicines to slow down cognitive impairment, and they are as follows:-

  1. Donepezil[ Donep]
  2. Galantamine[ Galamer]
  3. Rivastigmine[ Rivamer]
  4. Memantine[ Admenta]

These medicines are available in different strengths and combinations depending on the stages or severity of the disease. However, one should not self-prescribe these drugs and be taken strictly under a neuropsychiatrist’s supervision.

Treatment of Dementia-Medicines 💊 to Control the Signs and symptoms

Treatment of Dementia also includes some medicines to treat underlying conditions such as Depression, Irritability, Anxiety, Restlessness, Sleeplessness, Tremors of hands, etc. These are some of the medicines-

  1. Alprazolam[ Restyl,Trika,Alprax]-for sleep disturbance
  2. Levodopa[Syndopa]-for tremulousness
  3. Anti-depressant and ani-anxiolytics like-Mirtaz, Pexep, Prodep, Nexito, etc.

Again, these medications are to be taken strictly under the supervision of a Neuropsychiatrist.

Treatment of Dementia-Medicines 💊 to improve Memory

Your Family Physician can prescribe these medications. They are namely-

  1. Ginkgo Biloba[Gingkocer Plus]
  2. Piracetam[ Cognix]
  3. Ayurvedic medicine like Brahmi and Shankhapushpi( Memorin capsules).

The above medicines are useful in Mild Cognitive Impairment. They can improve memory by halting or partially reversing the progress of dementia.

In India, we are blessed with a low rate of Dementia. Read here to know why India has the lowest rate of dementia.

Here are some useful links for the care and the treatment of dementia of the elderly in India:-

1.Link:- Alzheimer’s Association

2.Link:- Evexius Healthcare

3.Link:- Samarth Eldercare

4. Link:- Padirac Innovation 

Finally, if you have someone at home who has dementia and needs help, you can consider moving that person to a place where they care for people with dementia like this place- Carefordementia

Before we wind up, I would recommend you all to-

  • Read this handy blog on caregiving in Dementia- link
  • Listen to this podcast

You can also read this article for a To Do List For Dementia to improve Memory and mental health.

Memory loss due to Silent Stroke

To know memory loss due to Silent Stroke, we should understand what happens in a stroke. This will be discussed in a separate article in the coming days.

In the meantime, you can learn to calculate your risk of getting a stroke by clicking on the link given below.

Stroke Risk Calculator

Check,Change,Control- link

 

 

 

Dementia-Part 2

Loss of Memory Part 2-

What are the Investigations in Memory loss and how to get it done

A Meme on Memory Loss

Introduction-

Welcome back to Part 2 of the series on Loss of Memory. In my last article[Click here in case you have not read it], we discussed the brain’s different parts and their function. Taking off from there, we proceed ahead to learn about the causes and the investigations of Memory Loss.

What are the common causes of Loss of Memory?

Loss of Memory icon
I can’t remember a damn thing!

Before we take up the investigations, let’s see what the common and uncommon causes of loss of memory are-

  1. Old Age-very common. As with other organs of the body, our brain also changes from aging. The brain is known to shrink in size.
  2. High blood pressure- hypertension ( read here to know how)
  3. Head Injury-Most of the head injuries, either due to a fall on the head or due to some vehicular accident, can lead to brain compression due to blood accumulation in a particular area of the brain. In this case, there is a temporary loss of memory.[I will explain this with an example below]
  4. Infection of the brain like Encephalitis.
  5. Drinking Excessive Alcohol – According to research, excessive alcohol causes brain damage, termed Alcohol-Related Brain Damage{ABRD}. Alcohol🍸 affects the area of the brain 🧠 called the Wernicke’s area, where there are nerve cells that help in the comprehension of speech.  

    A person with ARBD may experience all of these types of damage. The
    different types of damage are linked to different types of ARBD. For
    example, Wernicke–Korsakoff syndrome is most closely linked with low
    levels of thiamine [vitamin B1]-Source- Alzeimhers.org.uk

  6. The lack of or absence of blood supply to the part marked Broca’s area and Temporal lobe of the brain.
    Parts of Brain and their functions
    Parts of the brain and their functions- Source-Pinterest

    This mostly causes a condition called stroke resulting in loss of memory and paralysis of some body parts. Sometimes there is a minor cut-off of blood supply leading to temporary memory loss. This is termed Silent Stroke, wherein the patient may complain of weakness of some parts of the body like one hand or leg. He or she may not be able to recall what he/she said a few moments ago.

What’s the difference between Memory loss due to Dementia and a Silent Stroke?

In this article, I will discuss everything about Dementia, which usually occurs as we age.

Read on-

Memory loss due to Dementia/Alzheimers disease-

You must have noticed the changes occurring in our body as we age, namely-

  1. The appearance of wrinkles on the face;
  2. Greying of hair;
  3. Shortening of our height-due to loss of calcium from the vertebral bones;
  4. Changes in our vision- due to cataract of the lens of our eyes, thinning of the retina;
  5. Slowing down of our ability to walk, etc., etc.

As with other parts of the body, the all-important learning center and the center for recollecting and memory-The Brain- also ages accordingly. The ability to grasp what is being said, understand what is being said, and recollect most of the things that have been said also declines. This is the condition which we call Dementia-leading to Memory loss.

What happens in our brain that leads to Dementia?

Our brain is something like a modern computer where data is stored in a place called the Hard-Disk. Similarly, there are parts in the brain, such as the hippocampus, which is the seat of our memory.

Like the computer, which has a memory chip present in the hard-disk and is connected to different parts of the computer by parts called software, our brain has millions of nerve cells called neurons. These are connected by extensions called dendrites.

The dendrites are connected by ends called synapses. These synapses can get disrupted, causing malfunction of brain activity due to to-.

  • Lack of oxygen
  • Reduced supply of energy-giving glucose
  • Some infection in the brain

A Case Study

These conditions mentioned above are the more common ones you come across day-to-day. But there are some conditions like sudden grief[read here] or a head injury that can also lead to temporary memory loss. Like, for instance, this patient who I came across while I was in the second year of my MBBS course-

A 45-year-old male patient was brought to the General Hospital, Solapur, in an unconscious condition. He was badly beaten up with severe injuries to his head. He was being treated by the Civil Surgeon, Dr.Hoshang, at that time.

Dr.Hoshang explained to our group of students, as part of the surgical posting, all the intricacies of head injury that had led this person to this present condition- he was in Coma. The reason for him being in a coma[a state of deep unconsciousness] was a large clot of blood that had formed due to internal bleeding. It was compressing the cortex of the brain.

Dr. Hoshang removed the clot surgically and slowly, over the days, the brain expanded to its normal size. The patient started recovering and was soon out of the coma and regained consciousness. But, as a side effect of the brain’s compression, he had lost his memory and was unable to remember anything. He could not recollect –

  1. His name;
  2. Where was he from;
  3. What happened to him that landed him in the hospital.

Over a period of two weeks, he regained his memory completely and was able to recollect everything. This condition is called Temporary Amnesia.

What is Alzheimer’s disease?

Alzheimer’s disease is one type of dementia and also the most common one to occur. In this type of dementia, there is a loss of memory causing-

  1. Difficulty in retaining recent information. For example, if he has been told to repeat, say the names of a few people he may know, he may not do so.
  2. Inability to recall recent events like conversations, songs which he has just heard, etc.
  3. Trouble in tracking upcoming events like attending an invitation to a party, marriage, etc.
  4. To make repetitive comments ( like the case mentioned above)

You can take a small break here and listen to this short podcast to know more about Dementia and Alzheimer’s disease

 

Are there any tests or investigations to detect Memory Loss?

Yes, there are two tests, namely-

A] The Montreal Cognitive Assessment(MoCA)-

This test is to be carried out by a person trained in this test, such as Neuro physicians or Neuropsychiatrists. The figure shown below is an example of how this test is done.

Montreal Cognitive Assessment test for assessing Memory loss
The Montreal Cognitive Assessment test for assessing Memory loss[Source:-Click here for a better view-Pinterest].
Here the patient’s mental status is evaluated by making them answer a set of questionnaires presented to them as shown above. The level of dementia or memory loss is then calculated as per the points shown on the right-hand side. There is a set of 30 questions that the patient is made to answer.

  • A score of 26 and above is considered Normal.
  • A score of 21 to 26 goes in favor of mild memory loss.
  • A score between 16 to 20 confirms Alzheimer’s disease.

B] The Mini-Mental State Examination test-

This a similar test to MoCA. It is also carried out to judge the mental status of a person suspected of memory loss. This is how it looks like-

Mini Mental State Examination test for Memory loss
Mini-Mental State Examination test for Memory loss[Source:- Click this link for better view-Pinterest]

 

 

You can Download both these tests and evaluate if you are going in for dementia or memory loss. That way, we can take further steps to prevent it[more in Part 3 of this series]

Are there any blood tests /any other tests to detect impending Dementia or Alzheimer’s disease?

Research shows that there are certain proteins responsible for changes in the way we remember and forget. These proteins are-

  1. The tau proteins-p-tau217
  2. Amyloid proteins

These proteins can be detected in the blood by using tests known as Bio-markers – namely-

  1. Certain proteins called Amyloid-beta peptides floating in the blood
  2. A fat-binding protein called apolipoprotein E.

The levels of these protein components are high in the blood in patients with dementia or those going in for Memory Loss. You can get these tests done here in India.

Another way to find is by doing a brain scan called the PET scan. This scan shows the p-tau and amyloid plaques formed tangles in the brain, causing the cells to store the memory to die. For PET scan in India, Click Here.

Watch the video at the end of this article to know how exactly this happens.

What happens in Dementia or Alzheimer’s causing Loss of Memory? The high levels of these proteins in the brain cause plaques and tangles in the brain’s nerve tissues. Watch this very short video- a GIF- showing the involvement of the above-mentioned proteins in causing changes or disruptions in the nerve tissues in the brain leading to the tangles and plaques –

A short video showing what happens in the brain causing Loss of Memory
A short video showing what happens in the brain causing Loss of Memory

Here is another video that will explain to you in detail exactly how these proteins affect our brain leading to loss of memory- link

I have covered almost all the essential tests to rule out memory loss/dementia/Alzheimer’s disease. Before we leave, kindly listen to this podcast on investigations in Memory loss.

We stop here today. But before we go, did you know that the food we eat influences our brain 🧠 health? Here is a very good article that I came across that tells us how eating highly nutritive food cannot only help us keep our general health in good shape as well as our brain health-  Procerahealth.com

In my next blog, which will be published shortly, we will discuss the prevention and treatment of memory loss/dementia/Alzheimer’s disease.

Those with dementia are still people and they still have stories and they still have character and they're all individuals and they're all unique. And they just need to be interacted with on a human level. Carey Mulligan Click To Tweet
Picture reflecting loss of Memory
Dementia- Part1

Memory Loss-Part 1

How to Prevent Loss of Memory and live a Healthy Cognitive Life

Memory Meme

Introduction

As the elderly population increases due to improving lifestyle, doctors are confronted with many cases of Memory loss. If you look at the picture just above the introduction, you can see what I  mean- as we get older, this can be a situation. You will be downright happy to retain your memory and be proud of it, too! Nobody in his or her right mind would like to end up losing his or her memory. Just imagine, if one of your loved ones were to lose their memory, how would you feel about it.

Flashback-

Stressful life is another trigger for Memory Loss. I experienced this first hand when I visited my grandmother 25 years back. My grandmother- my mom’s mom- lived at our native place called Kumbla, a small town on the Kerala- Karnataka border in India. ” Mowma, kashi asa?” I  asked her in Konkani, our mother tongue meaning’ how are you.’ Mowma is grandma in Konkani.

She just stared at me and replied ” Kon re tu? Kasa katir Ayla? Amtlya khampu kayi na.” Meaning ‘Who are you? Why you have come here? We do not have anything to be stolen for’.

My ‘ mowma’ had lost her memory. She was excellent till my uncle got married and left her. My uncle was the only son among six daughters of my grandparents. And he was her heart and soul.

After he left, she went into depression, which ultimately culminated in a total loss of memory. And this devastated all of those who considered her near and dear.

I was her favorite grandson. She did not recognize me. Imagine how I must have felt when she looked at me and asked me those questions!

Apart from memory loss, she had also lost  her her spatial orientation- she had forgotten to use the toilet for her daily routine. She used to urinate and defecate whenever and wherever she was placed at that moment without any inhibitions!

This condition is called Alzheimer’s disease- a type of Dementia or memory loss.

What does it mean to Age Well?

In the past, we have heard people saying, ” The Older, the Wiser.” But, the present-day situation has changed- not every adult older adult is wise. In fact, in many cases, it’s just the opposite- old age has brought with it changes in forgetfulness in some older people. So much so that these people have been put up in Old Age Homes for caretaking.

To age well and keep our memory intact, we have to take care of our brain from as early as our adolescence. How to do it is the purpose of writing this article.

This article is very exhaustive, as we have to understand exactly how, why, and what about losing our memory. So, I have decided to break up this article into 3 parts to for you understand it better

  1. Part 1-where we will discuss all things about the brain and the part responsible for our memory-The Seat Of Memory:
  2. Part 2-where we will discuss tests and investigations for Memory Loss;
  3. Part 3– where we will discuss how to prevent/treat memory loss.

For whom is this article can be useful?

This article has been written not only with older people in mind but also for the younger generations. Why the younger generation? Because the process of memory loss starts much before we reach old age.

Preventive measures are best taken from a young age. After a particular age, say in the 30s and 40s, changes start occurring in the brain, which may not be reversible. I will come to the prevention part as we go ahead.

Where do we stand now?

As the days go by, and as the longevity of many of us increases, we may have many more and more cases of Memory loss. Possibly surpassing almost other causes of old age diseases such as hypertension and diabetes.

Changes in cognition occur as we age. As we age, so does our brain. Just like in heart disease, changes start taking place in the brain naturally due to to-.

  1. Lack of blood supply due to the formation of  plaques in the arteries[similar to that in the heart vessels];
  2. Rupture of blood vessels leading to what is commonly known as Stroke or Brain Hemorrhage.

Our brain is a complex structure. It is full of nerve cells and nerve fibers that connect with connectors called synapses. There are parts in the brain responsible for our memory- I will try to simplify it for better understanding.

{This article here will help you understand the science behind Memory Loss in a better way- link( inside the brain) }

Which part/ parts of the brain are involved in Memory loss?

Before we proceed ahead, let’s see how the brain looks, its different areas, and what function they carry out. Observe- your brain appears like a walnut kernel with the skull bones protecting it just like the outer shell of a walnut[see the picture below]-

Resemblance of wlnut and human brain
The resemblance of walnut and human brain[ Source-Pikrepo]

Let’s now have a look at these two pictures in detail to understand the different parts of the brain and the seat of memory-

Fig.1

The seat Of Memory in the brain
The seat of Memory in the brain-Click on the link to expand-Source-Pinterest

Parts of the brain with their function
Parts of the brain with their function[Source-Click here to expand> Pinterest]
Here we are concerned mostly with areas marked Temporal Lobe and Frontal Lobe in the second picture. These two areas represent our mental abilities- the ability to remember, carry out intelligent tasks, etc. Injury to these areas like a head injury or hemorrhage will affect these areas causing loss of memory.

Are all the parts of the brain interconnected with each other?

All parts of the brain are directly connected. How? You may ask by nerve cells called Neurons that have branches called dendrites. Let’s say you have –

  1. Lost the smell-This sensation comes under the olfactory area- an area marked as the Parietal lobe in Fig 1. For example, if you close your eyes and are made to smell a crushed garlic pod, and you cannot tell what it is, then the memory stored in this area may have been lost. This can be a short term memory loss. This is exactly what happened to many of the COVID-19 patients-the Coronavirus had affected those parts of the brain-area no.2 and 8.
  2. Can’t remember how one person appears or looks– This can occur if an Occipital lobe area has been affected.

Could this Memory loss be a case of what we doctors call Senile Dementia, or could it be a Silent Stroke?

Elderly woman
An old age picture

Many of us are familiar with words like Dementia, Alzheimer’s disease(AD), Parkinson’s disease (PD), etc. You may have also heard someone saying, ” He is demented- don’t listen to him.” Now, in this sentence,  the word demented means foolish. But, in medical terms, Dementia means loss of Memory or Cognition. When it occurs in the elderly, we call it Senile Dementia.

As we age, the brain’s blood supply can get disrupted ( as mentioned above)in a small way. This can lead to the death of a few brain cells causing what we call a Silent Stroke. Here again,  there can be changes in one’s memory, and the person may not remember recent events.

Now, What does this ‘Cognition’ mean?

In simple words, Cognition is the ability to remember and reproduce what we remember. A decline in cognition is called Memory Loss.

We shall stop here as I have come to the end of Part 1 of the Memory Loss Series. Hope you have understood the basic anatomy of the brain and its function. Kindly read and re-read this article because I shall be using many of the words used herein in my next article-especially the link I have provided on Inside the Brain.

You may also listen to this Podcast-Understanding The Brain to know more about the brain.

In my next part, which will be published shortly, we will discuss-

  1. The causes of Memory loss
  2. Dementia and Alzheimer’s disease
  3. Tests and investigations for the above-mentioned illnesses.
Brain Health is as Important as Physical Health-Learn how to Keep It Healthy Click To Tweet
Photo by Mykenzie Johnson on Unsplash
HOW TO CONTROL BLOOD SUGAR WITH OR WITHOUT MEDICINES

How to Control Blood Sugar With or Without Medicines

A patient who has been controlling his blood sugar very well with medicines recently asked me this question-“Doctor, can we control blood sugar without taking medicines?”

My answer-“Yes. But it depends on the stage of your diabetes.” “Meaning? How?” he asked again. I then went to explain to him ‘How’.

Now let me elaborate on this ‘How’. For explaining this ‘How’, I will tell you my experiences with some of my patients.

For whom I have written this article-

Any patient having difficulty controlling his/ her blood sugar should read this article. The examples of patients narrated are real life patients undergoing treatment in my clinic.

Now, let’s begin-

Case Study no.1:-The patient with Very High Blood Sugar

About 2 years ago, a 62 years old father of a priest in our community temple visited me at 12.30 p.m. with the following symptoms-

  1. Feeling very tired and fatigued.
  2. A sudden increase in the frequency of urination-about 7 to 8 times in the night for more than a week.
  3. Dry mouth and intense thirst.
  4. Sudden loss of weight– about 10 kg in a span of 15 days.

He later went on to say that he was traveling to his native place Mangalore and he had already reserved a seat on the train. The train was to depart at 3.45 p.m. I was in a fix now, because I had an inkling of what has happened to him.

On an impulse, I told him that I am getting his blood sugar done. I keep a Glucometer in my clinic, just for times like this.

Glucometer for checking Blood Sugar
Photo by Kate on Unsplash

Upon checking his blood sugar, the glucometer gave this report- Not Recordable. I was shell shocked. Now what? I asked him-” Since when are you suffering like this?” “One week”, he replied. “Then why the hell did you wait for so long?” I asked him in an annoyed tone.

What did I do next?

I immediately referred him to a pathology lab to get his random blood sugar and urine done urgently. After half an hour, my Pathologist colleague rang me up and he reported these results-

  1. Random blood sugar-725mg/dl
  2. Urine Sugar- 4+
  3. Ketones in urine-+ve
  4. HbA1c-11.8%

Now, look at the HbA1c value- it is way above the normal range of 5 to 6%. For your ready reference, I am including a table below which shows how much the mean blood sugar value should be for every 1 percentage rise in HbA1c-

Table-HbA1c levels and the corresponding blood sugar levels

What did I advise this patient?

Firstly, I advised the patient to cancel his journey and get admitted to the hospital. I also told him that he was suffering from severe diabetes with a condition called Diabetic Ketoacidosis. And, that if he chose to travel, he may not reach his destination alive.

This patient was admitted to the hospital for about a week where he was treated with intravenous[IV] Insulin to bring his sugar before other complications set in. Later on, after his blood sugar reached normal levels, he was put on Oral Anti-Diabetic Drugs which maintained his blood sugar very well.

He was also advised to go for regular walks and have a properly balanced diet sans sweets and starchy food. I also advised him a high protein diet to build up his muscle mass as he had lost plenty of it during his ordeal.

Take-home point-

This patient will need medicines to keep his diabetes in check throughout his life. Along with medication, I also advised him to have a proper 3 meal diet containing all the essential nutrients with lots of fibers in it.

Now, let’s jump to the next patient-

Case Study no.2:-A patient with Pre-Diabetes having a marginally raised blood sugar-

A young male person aged 26 years visited my clinic with complaints of-

  • Repeated urination
  • Increased weight- his BMI was 28kg/sq.mtr.
  • Excessive thirst
  • Increased hunger

As usual, I checked his random blood sugar. It was 166 mg/dl. This made me suspect pre-diabetes in this patient. I suggested the following investigations for this patient-

  1. Blood sugar[BS] fasting and post-lunch[PP]
  2. Urine sugar
  3. HbA1C%

His reports came in as follows-

  • BS- Fasting-118, Post-lunch[PP]- 175;
  • Urine Sugar- Fasting-Negative, Post-lunch-1+
  • HbA1C-6.8%

If you have noticed the above reports, they are slightly above the normal values. This condition is called Impaired glucose tolerance (IGT) or Pre-diabetes.

These patients can be successfully treated without medicines. Here is a good article on Pre-diabetes that i suggest you should read-link

What did I advise this patient?

This patient was advised-

  1. Regular exercise- preferably walking or jogging. This helped him reduce his BMI to acceptable values- about 24kg/ sq.mtrs- in 6 months time
  2. Eat a low carbohydrate diet- avoid sweets, rice and potatoes as far as possible.
  3. Add more fibers to the diet in the form of fruits and vegetables. This helped him overcome the urge for sweets as well as bringing down his weight by 10 kg.

This patient was advised to keep up this routine throughout life to maintain his sugar levels and avoid becoming a diabetic.

Case Study no.3:-A patient with poorly controlled Diabetes

A middle-aged man visited my clinic with complaints of a painful urination. On examination of his genitals, I came across this picture-

  1. The foreskin of his penis was swollen-he could not retract it. It appeared like this-

    Candidial balanitis due to high blood sugar
    Candidial balanitis due to high blood sugar. Source-DermNet NZ
  2. There was whitish discharge around the foreskin-this a candidial[yeast] infection in diabetes.
  3. The urination was very painful suggesting urethritis .
  4. Blood sugar random came out to be 215gm/ dl.

I suggested him the following investigations-

  1. Urine routine and microscopic- there were lot of bacteria, yeast as well as pus cells in his urine.
  2. Blood and urine sugar- both fasting and post-lunch. Both were very high- BS( F)-175, BS(PL)-255; Urine Sugar- Fasting +2, Post Lunch- +4
  3. HbA1c-8%

This patient was already on these medications-

  • Glycomet GP1- a combination of metformin in and glimepride-two times a day.
  • Dichrome( Chromium picolinate)- once a day. It helps insulin to work properly.

What this patient was not doing-

  1. No exercise- he was sedentary and rarely went for walk or did any physical work. During this visit his weight was 82 kg for a height of 162 cms- way above the ideal body weight requirement of 61kg. His BMI was-31.25kg/ sq.mtrs.- way above requirements of 18- 25.
  2. Not following the diet regimen I had suggested- he was binging on sweets. He liked sweets.
  3. Skipping medications off and on.

My updated suggestions-

1.Added 2 more medicine- 💊-

  • Tenegylptin(Zilenta) 20 mg 1 before lunch
  • Voglibose 0.2 mg(Vogli) 1 before lunch and 1 before dinner.
  • Tab. Flucanozole 150 mg once daily for 5 days to control the candidial ( yeast) infection.
  • Anti- inflammatory drugs to control swelling and pain in the urethra
  • Candid cream( clotrimazole) to apply locally on the infection.

2. Strict diet control- no sugar or starchy food ( rice, potatoes).

3. Regular walks and exercise to bring down his weight to acceptable levels of 61 to 65 kg.

After 3 months-

The following changes were observed as the patient followed my instructions strictly-

  1. Weight reduced to 75kg. BMI down to 28.58 kg/ sq.mtrs.
  2. Blood sugar – Fasting-118; Post-lunch- 156; HbA1c-6.5%.

Conclusion-

As  you can see, I have narrated 3 different instances of varied signs and symptoms of diabetes with increased blood sugar and its management.

I hope you have understood the implications of having a high blood sugar level. And I also hope this article helps  you managing your diabetes very well, if you are under treatment for same.

To know more about how you can manage blood sugar without medicine, you can read this Article>Link

 

 

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.

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
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
Click here to get this subscription

 

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-

Knowledge Shared is like Knowledge Earned-Come Let's Fight the Prostate disease with this knowledge Click To Tweet
Prudent Diet-Proteins

Eat more Proteins and Live a Happy Healthy Life

Introduction

Proteins form an important part of the diet in a diabetic patient. Research has found that they are an alternative to energy production after carbohydrates and fats in conditions leading to starvation. You must have noticed that in a starving person, the patient loses weight as he loses body fats. Here the fatty tissues convert to carbohydrates to provide energy and after that reserve is depleted, the proteins in the body start breaking up to provide energy. This leads to further emancipation, further weight loss, and eventually death if not treated on time.

The picture below shows the effect of starvation and protein loss-

Starved Girl picture
Emancipation due to starvation

In my last post, I had stressed the importance of Carbohydrates in our diet and how it affects the blood sugar levels in a diabetic. In this present article, I am going to highlight the second most important part of our diet-The Proteins.

The diet in diabetes should contain the proper amount of proteins for the wellbeing and good health of the patient.

What are proteins?

Proteins are the basic building blocks of the cells of the human body. They are made up of units called amino acids. There are about 20 Amino Acids which help in structuring a protein molecule. The picture below will show these amino acids that go into making a protein molecule-

Amino acids that make up protein molecule
Essential and nonessential amino acids that help in forming a protein molecule

Why are the Amino acids that important?

These amino acids are used by different body cells for making up the structure of parts of the body like muscles, blood, skin, hair, nails, and internal organs. Out of the above, the Essential Amino Acids, form a part of  Class 1 proteins[see below]. 

What role do dietary proteins play?

Protein is a crucial component of every cell in our bodies. It helps to build and repair tissues like-

  • skeletal muscle,
  • bone,
  • hair,
  • fingernails,
  • cartilage,
  • skin,
  • blood

They also help to synthesize enzymes[digestive enzymes such as the lipase, pepsin, amylase, etc.,], and hormones[insulin, testosterone, thyroid hormone.etc.,]. These enzymes and hormones help regulate metabolism, growth, and many other functions in the body.

Types of proteins-

In my last post on Diet In Diabetes Part 2A – I had briefly touched upon types of proteins. This picture shown below will give you a brief idea of some of the different proteins we consume.

Types of proteins
Types of proteins

As you can see above, proteins are classified as Class 1 or Class 2. Alternately, we can classify them as –

  1. Animal source proteins-mostly Class 1
  2. Plant source proteins- Mostly class 2

Animal source proteins contain all the essential amino acids whereas plant source does not contain all the essential amino acids with the exception of a few like the Soy protein.

So we have to combine 2 or more plant sources to get all the amino acids, for eg. Rice+lentil, Bread +lentil. They can also be combined with animal source proteins to complete the picture.

Just like carbs and fat, excess protein gets converted to fats and is stored in the adipose tissue for future use as a source of energy.

How many grams of protein per kilogram of body weight is appropriate for you-

  • Use the low end of the range if you are in good health and are sedentary: 0.8g per kg.
  • A higher number (between 1.2 and 1.4g/kg) is advised if you are under stress such as pregnancy, recovering from an illness, or if you are involved in a consistent exercise like aerobics, Zumba, etc.
  • For endurance training[tennis, marathon athletes] and gym-goers, where you would like to build up muscles, 1.4 to 2.0 g/kg is recommended.

The Recommended Dietary Allowance (RDA) for protein is a modest 0.8 grams of protein per kilogram of body weight in a normal person having a semi-sedentary life.

Whenever we consume food, we should consider how much proteins come with all we eat, along with fats, carbohydrates, vitamins, minerals, etc., so that we consume a complete food package.

Care should also be taken to see that these food packages are low in saturated fats and processed carbs like refined flour and refined sugar.

Good sources of protein-

Many of the dietary products we eat have a good source of proteins as well as a poor source of good proteins[proteins that are not complete]. Shown below are some of the common sources of food that contain Class 1 proteins-

Food Protein (in grams) per serving-

  1. 1 cup of milk-8gm
  2. ½ cup cooked beans-8gm
  3. 1 egg- 6gm
  4. ½ cup cottage cheese[paneer]-14gm
  5. 1 cup cooked pasta-8gm
  6. ¼ cup or 28 gm of nuts (all types)-7gm
  7. 100gm tuna, salmon, haddock, or trout-26gm
  8. 6 ounces of plain yogurt[curd]-17gm
  9. 100gm ounces cooked turkey or chicken-24gm
  10. 1 bowl of quinoa[100gm] -4.4gm
  11. 100gm tofu[soy]-4gm

These are a few protein sources I have mentioned for your daily use and more so in a diabetic patient. For some recipes containing proteins, you can refer to my previous article- Prudent Diet for Good Health.

As per the latest report in Harvard Mens Health Watch, plant proteins are found to be better than animal proteins. Those who ate plant proteins like tofu, nuts, lentils, beans etc., had a 13 to 24 % lower risk from death due to any cause.

What are protein supplements and are they useful?

In my clinical practice, I get many patients who are keen on-

  • Building muscle mass
  • Having a beautifully structured body
  • Those who attend gyms and have been advised to have protein supplements
  • Patients who have suffered from a prolonged illness like hepatitis, tuberculosis.

Most of them ask to be recommended a protein powder or supplement. I have always recommended natural plant or animal proteins as they are more nutrient-dense. For those who are adamant, I recommend these-

Protein powder made from milk whey
Whey protein powder

Protein powder derived from plants with natural herbs
Plant-based protein powder

Why is protein so important in diabetes?

In a diabetic patient, as the age advances, they are faced with some complications such as Diabetic Nephropathy which leads to Chronic Kidney Disease. [I will touch upon this in my future article on complications in diabetes]. Protein consumption is highly restricted in such patients because a high amount of protein in the diet leads to a condition called Glomerulosclerosis-a disease in which the filtration capacity of the kidneys gets reduced substantially.

Some of these patients also lose muscle mass due to age-related wasting of muscles. In such patients, I do recommend extra proteins to regain their muscle mass. Sometimes I prescribe a  protein powder which is either a plant-based one like soy powder or milk-based like casein. In either case, my advice to them is to have natural proteins that are available in food, because when we eat the food we also get benefits of other nutrients like carbohydrates, fats, vitamins, and minerals.

Hence, if a person is a diabetic, and feeling that he or she is losing muscle mass, it becomes mandatory for him or her to check his blood sugar levels as well as HbA1C [click here]levels as well as Serum Proteins regularly to avoid complications like Diabetic Nephropathy.

How else does protein help?

Other than building muscle mass or causing kidney disease in diabetes, proteins help in improving our immunity by producing antibodies to diseases. These are available as serum proteins, mostly a protein called globulin. A high level of globulins is indicative of good immunity against many bacterial diseases.

For more knowledge on proteins for diabetes, you can refer to these sites-

  1. Diabetes.co.uk
  2. Verywell Health
  3. Harvard- T.H. Chan School of Public Health

In my next article, I will be writing on Fats in the diet for diabetes-the Good, the Bad and the Ugly ones.

If you have any queries regarding Diabetes in general and proteins in particular, you may mail me at the e-mail address – drrao@raodoctor.com.

 

Dr. K. P. V. Rao's Health Blogs
%d bloggers like this: