Cardiomyopathy

The muscles of the heart have the most important function in the body. They help the heart to pump blood, throughout the body. When these muscles become abnormal, they affect the functioning of the heart and its ability to pump blood, to maintain its regular rhythm. 

Any condition that affects the functioning of the muscles of the heart is known as Cardiomyopathy. There are different types of cardiomyopathy disorders:

• Hypertrophic
• Dilated
• Restrictive or Idiopathic
• Arrhythmogenic right ventricular dysplasia
• Unclassified Cardiomyopathy
• Stress induced Cardiomyopathy or Broken Heart Syndrome or Takotsubo cardiomyopathy (tako tsubo refers to the pot-like shape of the heart that resembles octopus traps)

In a Cardiomyopathy patient, progressively, the heart muscles enlarge, become thicker or rigid. In very rare cases, scar tissue replaces the muscle tissue of the heart.

The end result of Cardiomyopathy is that it can lead to heart failure.

Symptoms of Cardiomyopathy

The signs and symptoms of Cardiomyopathy may not be visible in the initial phase, but once the disorder has reached a more advanced stage, they will appear. A cardiomyopathy patient will exhibit the following signs and symptoms:

• Edema in legs, feet and ankles, lungs and abdomen (swelling due to fluid buildup)
• Unable to lie down due to continuous coughing. The patient will have to sit up and sleep (45 degree angle), instead of being able to lie down flat, to stop the coughing fit. Coughing can occur due to any strain within the body (like eating too quickly, exertion of any sort)
• Breathlessness when walking or when exerting, and sometimes when at rest
• Bloating of the abdomen (due to build-up of fluid)
• Fatigue
• Palpitations – a fluttery feeling, rapid heartbeats, pounding / irregular heartbeat
• Occasional lightheadedness, dizziness / vertigo and a feeling of fainting
• Inability to maintain balance, occasionally
• Chest pain
• Regardless of the type of cardiomyopathy a person has, the symptoms related above are common to all types of cardiomyopathy. This disease may progress very quickly in some and in some it could be over a period of years.

This disorder can be treated but the type of treatment depends on the type of cardiomyopathy a patient has and how serious it is. Types of treatment available are:

• Medical (prescription of medications)
• Surgical implants / implantation of devices
• Transplantation (in very severe cases)

In many cases, especially those where the disease makes its appearance at a very later stage, doctors are unable to pinpoint the cause, but have been able to identify some of the contributing causes, which include:

• Defect at birth due to genetic / hereditary factors
• Disorders such as diabetes, thyroid disease or obesity
• Heart Valve problems
• Continuous condition of long term high blood pressure
• Complications during pregnancy
• Deficiencies of vital vitamins or minerals (thiamin B-1)
• Consumption of too much alcohol over several years
• Constant and continuously rapid heart beats
• Infections of a certain type that injure the heart and cause cardiomyopathy
• Hemochromatosis - buildup of Iron content in the heart muscle
• Sarcoidosis – this is a disorder that causes lumps of cells to grow in the heart and other organs in the body
• Amyloidosis – this causes abnormal buildup of proteins
• CTD or Connective Tissue Disorders

Types of Cardiomyopathy
Hypertrophic Cardiomyopathy

• Abnormal thickening of heart muscles particularly affecting the muscles of the left ventricle
• Can develop at any age, but tends to be severe when it is apparent in childhood
• In general, patients with this type of cardiomyopathy, have a family history of this disease
• Genetic mutations have been associated with this type of cardiomyopathy

Dilated Cardiomyopathy

• Most common type of cardiomyopathy
• Generally affects men
• Occurs mostly in middle-aged people
• Affects the pumping ability of the heart – the left ventricle becomes less forceful. The left ventricle becomes dilated (enlarged) and cannot effectively pump blood out of the heart

Idiopathic or Restrictive Cardiomyopathy

• The Heart muscles become rigid and less elastic
• Prevents the heart from expanding and fills the heart with blood between heartbeats
• Can occur at any age, generally affects people who are older
• Is the least common type of cardiomyopathy and can occur for no reason
• Can be caused due to diseases in other parts of the body (diseases such as buildup of Iron content in the heart muscle or buildup of abnormal amount of proteins, diseases that cause inflammations, or disorders of the blood causing blood cell damage to the heart – eosinophilic heart disease

Arrhythmogenic right ventricular dysplasia

• Rare type of cardiomyopathy
• Muscles in the lower right ventricle gets replaced by scar tissue
• Causes heart rhythm problems
• Caused by genetic mutations
• Unclassified Cardiomyopathy
• Types of cardiomyopathy that do not fit into any of the other types
• Stress induced Cardiomyopathy
• Also known as Broken Heart Syndrome or Takotsubo cardiomyopathy (tako tsubo refers

Management of Cardiomyopathy

Leading a healthy lifestyle, regular follow up with your doctor, taking medications as prescribed. 

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Osteoarthritis - Age Related Disorder

Types of Arthritis

There are more than 100 known types of arthritis of which the following top three types of arthritis most commonly affect people. 

1. Osteoarthritis
2. Rheumatoid Arthritis
3. Psoriatic Arthritis

Osteoarthritis

This debilitating disease affects areas of the musculoskeletal system where there are joints present. Cartilages are slippery tissue that provide a protective covering to the ends of the bones at joints like the elbow joint, should joint, knee joint. The cartilage protecting these joints, with age undergo “wear and tear”, in short wear away with use. These cartilages could also be damaged due to sports or other injuries. Without the cartilage to cushion the bones, the bones rub against each other causing pain, swelling and loss of motion, in the affected joint. Over a period of time, the rubbing eventually wears the bones away, changing the normal shape of the bones. Sometimes spurs may form on the edges of the joint. The rubbing of the raw edged bones can even chip the bone edges, leaving bits of bone floating around in the joint space, which causes even more pain and damage. 

Osteoarthritis affects only the joints in the hand, wrist, neck, back, spine and hip, all regions that bear weight.

Risk Factors that Cause Osteoarthritis

1. Age is one of the causes of Osteoarthritis, as with age, the cartilage at the joints wear out due to years of use

2. Obesity adds to the development of Osteoarthritis, as obesity puts on an added stress on the joints that have to carry the weight of the body. Joints like the hip and knees get affected. Additionally because of being obese the fat tissue produces proteins that may be the cause of inflammation around the joints

3. Occupations where a certain joint is constantly in use can also cause deterioration in the cartilage cushioning the joints, leading to osteoarthritis

4. Researchers have identified that women are more prone to develop osteoarthritis than men 

5. Joint injuries acquired due to accidents or while playing sports increase the risk of osteoarthritis developing

6. Heredity in some people causes development of osteoarthritis
  7. Bone deformities such as birth defects of the cartilage or bone malformation are also prone to develop osteoarthritis
 
8. People with other diseases such as diabetes, rheumatoid diseases (rheumatoid arthritis and gout) are at an increased risk of developing osteoarthritis

Symptoms

Osteoarthritis develops slowly and worsens with time. Symptoms that indicate that you may have osteoarthritis are:

1. Pain in the affected joints either when moving or at rest

2. The tender joint will not be able to withstand even light pressure, when applied

3. Most noticeable symptom is the stiffness in the joint especially when waking up in the mornings or after a period of inactivity 

4. When using the joint, either a grating sensation may be felt or heard

5. Formation of bone spurs will feel like hard lumps in the joint

Diagnosis and Treatment of Osteoarthritis

Several methods to diagnose the disease are used, which include:

1. Conducting a physical exam
2. Taking an x-ray of the affected areas
3. Checking the medical / genetic history of the patient
4. Blood tests and fluid in the joints examinations

Treatment Options

There are several options available to treat Osteoarthritis:

1. Through medications
2. Controlling weight
3. Exercises / Physiotherapy
4. Through rest and joint care
5. Surgery

The Goals 

While treating Osteoarthritis, the doctors / physicians / surgeons aim to achieve these results:

1. To control pain
2. Maintain healthy body weight
3. Improve the functionality of the joint
4. Maintain a healthy lifestyle

Management of Osteoarthritis

It is important for the patient also to participate in their treatment plan, to achieve the end results that their physician is working towards. People affected by Osteoarthritis have found that self-management programs have helped them lead a better quality of life. People with a healthy attitude and a determination to manage the pain and disability, after making lifestyle changes, can eventually lead a better quality of life. 

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How long can you safely keep leftovers in the refrigerator?

Leftovers can be kept for three to four days in the refrigerator. Be sure to eat them within that time. After that, the risk of food poisoning increases. If you don't think you'll be able to eat leftovers within four days, freeze them immediately.

Food poisoning — also called foodborne illness — is caused by harmful organisms, such as bacteria in contaminated food. Because bacteria typically don't change the taste, smell or look of food, you can't tell whether a food is dangerous to eat. So if you're in doubt about a food's safety, it's best to throw it out.

Fortunately, most cases of food poisoning can be prevented with proper food handling. To practice food safety, quickly refrigerate perishable foods, such as meat, poultry, fish, dairy and eggs — don't let them sit more than two hours at typical room temperature or more than one hour at temperatures above 90 F (32 C).

Uncooked foods, such as cold salads or sandwiches, also should be eaten or refrigerated promptly. Your goal is to minimize the time a food is in the "danger zone" — between 40 and 140 F (4 and 60 C) — when bacteria can quickly multiply.

When you're ready to eat leftovers, reheat them on the stove, in the oven or in the microwave until the internal temperature reaches 165 F (74 C). Because they may not get hot enough, slow cookers and chafing dishes aren't recommended for reheating leftovers.

Courtesy - http://www.mayoclinic.org/

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What to Expect from Knee Replacement?

Knee arthroplasty or knee replacement surgery is for those whose knee joint has been badly destroyed which in turn causes chronic pain and impairment of functions. Knee arthroplasty is considered when all other treatments have produced no results. Generally patients suffering from osteoarthritis, in the age group beyond 50 years, are deemed to be prime candidates for a knee replacement surgery.

The Procedure

This is a surgical procedure where the diseased knee is either totally or partially replaced with an artificial (metal or plastic) joint. With advanced medical technology, it is now possible to perform keyhole surgeries or minimally invasive surgeries. The steps involved are:

1. Either general or spinal / epidural anesthesia is administrated to the patient.

2. While the patient is under, a 3-5 inch incision is made in the anterior / frontal part of the knee.

3. The knee part abutting the end of the femur or thigh bone is replaced with a metal component and the end abutting the top of the tibia (leg bone), is replaced with a furrowed plastic piece with a metal stem.

4. A plastic button maybe placed under the knee cap, depending on the condition of the kneecap.

5. The artificial parts or prosthesis function with the help of the surrounding muscles and ligaments.

In a knee replacement surgery, there is one other tissue called the posterior cruciate ligament that could be partially or totally replaced with a “polythene post”. The function of the posterior cruciate ligament is to support the hind leg from buckling backwards when the leg is in motion.

Benefits of Knee Arthroplasty

1. The incision made is very small in comparison to the traditional surgery.

2. There is lesser damage to the surrounding tissues, when an Orthopedic Surgeon is making the incision.

3. Instead of cutting through the tendons (traditional method), the Orthopedic Surgeon, operates between the fibers of the quadriceps muscles.

4. Healing time is quicker and extent of pain is considerably reduced.

5. Better motion due to less scar tissue formation.

Post Knee Arthroplasty

1. Hospital stay will be between 3-5 days.

2. A month or so later, the patient will observe a dramatic change in the movement of their knee joint.

3. There will be relief from the debilitating pain.

4. Post-surgery, the patient will be able to stand or move the joint. Generally, this can be done the very next day after the surgery.

5. To begin with the patient will walk with the help of parallel bars and later on with a walking devices like the walking stick, walker or crutches.

6. Six week later, the patient will be able to walk with minimum aid.

7. With the help of physiotherapy, the muscles are restored and the patient can then undertake any activity other than jumping or running.

Joint replacements initially were thought to last only 10 years but with advancing research it has been established that joint implants can last as long as 20 years, especially with advancing medical technology and avant-garde surgical techniques. 

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True beauty lies in motherhood!!

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Geriatric Depression: Causes, Symptoms and Treatment

Depression whether it occurs in the young adult or in the elderly is not normal. Generally, the tendency is to be dismissive of the condition, when it occurs in somebody 65 years old and beyond, attributing it to the normal aging process. On the contrary, it should be taken seriously and treated.

Depression in Senior Citizens is a mental and emotional disorder, and can have a negative and debilitating effect on the individual’s quality of life. However, the occasional “blue mood” or feelings of sadness are very normal.   

A significant percentage of the elderly suffer from subsyndromal depressions and if left untreated, it could evolve into a major depression disorder.

Some of the common symptoms associated with subsnydromal depression are:

-  Insomnia

-  Constantly feeling tired

-  Frequent thoughts of death

-  Trouble concentrating

-  Significant weight gain

-  Decelerated thinking

-  Hypersomnia

Causes

The causes of depression in the elderly cannot be isolated to any single factor but generally it is an amalgamation of biological, social and psychological factors. Reports from researchers suggest that the following could be the contributors to geriatric depression:

-  A family history of depression

-  Traumatic life events such as loss of a loved one or abuse

-  Low levels of crucial neurotransmitter chemicals in the brain

-  Limited mobility due to biological complications

-  Isolation

-  Fear of death

-  Prolonged substance abuse

-  Change of location or financial status due to retirement, difficulty in making the transition

-  Deaths of peers, friends, loved ones, widowhood or divorce

-  Chronic medical conditions

Signs and Symptoms of Geriatric Depression

Regardless of the age group, the signs and symptoms of depression are the same and these include:

-  Apathy

-  Crying spells

-  Changes in appetite

-  Fatigue

-  Feelings of worthlessness

-  Irritability

-  Lack of concentration

-  Physical aches and pains – more often than not, these physical aches and pains are not related to any other medical condition and are because of depression

-  Restlessness

-  Sadness

-  Sleeping problems

-  Thoughts of suicide

-  Withdrawal

Diagnosis

Detecting geriatric depression in an elderly person is quite difficult, so also diagnosing and treating it. A psychiatrist, who is a trained professional in both mental and emotional illnesses, can help diagnose symptoms of geriatric depression by checking the mood, behavior, everyday activities and family health history of the patient. There are also many tools available to help diagnose the type of depression (minor, major and Dysthymic disorders), a patient may have. The Geriatric Depression Scale or GDS is the most widely used scale to measure the level of depression in the elderly. A person is determined to have depression if the symptoms displayed are present, for no lesser than 2 weeks.

Treatment of Geriatric Depression

In the aforesaid paragraphs it has been discussed that geriatric depression cannot be attributed to any one cause. Likewise, there are multiple treatment options, each tailored to the needs of each patient. Discovering the right treatment may take time. Typically, any treatment devised will involve a mix of medication, therapy and lifestyle changes.

Several therapies are available, such as talk therapy, art therapy, cognitive behavior therapy and more. Lifestyle changes like increasing physical activities, having regular visits with family and friends, eating a well-balanced diet, finding a hobby or activity of interest, getting sufficient sleep, are used to treat depression in the elderly. There are a variety of medications that are used in the treatment of geriatric depression.

Living with and Managing Geriatric Depression

Aging certainly compounds the difficulties correlated to geriatric depression and can be difficult to diagnose. However, once diagnosed, with proper care and treatment, living and managing geriatric depression in an elderly loved one, is possible. The right treatment and care will vastly improve the quality of life of the elderly person, especially when family and friends participate, offering their support and help.

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Frozen Shoulder: Factors, Stages, Treatments

Stiffness around the shoulder joint, debilitating pain and limited range of movement in the shoulder are all symptoms of “Frozen Shoulder” or “Adhesive Capsulitis”. The onset of this disorder is very slow and to regain the use of the shoulder, free of pain is also a slow process.

Composition of the Shoulder

The shoulder comprises of a ball and socket joint. Three bones conjoin to form this joint –

1. The shoulder blade or scapula

2. The collarbone or clavicle

3. The upper arm or humerus

The head of the humerus fits into the shallow socket of the shoulder joint, and the connective tissue also known as the shoulder capsule, envelops the joint. Synovial fluid present in the shoulder capsule, lubricates the shoulder capsule and the joint and thereby enables the shoulder to move more easily. 

When the connective tissue in the shoulder capsule becomes rigid due to the formation of tight bands of tissue or adhesions, with a simultaneous decrease in the level of synovial fluid, it causes stiffness and limits the range of motion, of the shoulder. This condition is referred to as “Frozen Shoulder”.

Stages of Adhesive Capsulitis

• First stage or Freezing Stage – it is a slow process and with time the pain increases and becomes worse, consequently leading to loss of motion in the shoulder joint. It takes anywhere from 6 weeks to 9 months for the onset of a freezing shoulder
• In stage two (4 months to 6 months), or the Frozen state, the stiffness in the joint continues, however, the pain may subside slightly. During this stage, daily activities involving the movement of the shoulder will be very difficult
• In the Thawing or third stage, the motion in the shoulder begins to improve, but to regain complete or near to normal motion in the shoulder, it may be anywhere from 6 months to 3 years

Factors

• Affects people in the age group between 40 – 70 years
• People with chronic ailments like diabetes or suffering from stroke, hypothyroidism, hyperthyroidism, Cardiac and Parkinson’s diseases
• Can be caused by surgery, such as mastectomy, or due to a fracture or any other injury

Diagnoses

The doctor will either conduct a physical examination or will request for an x-ray or MRI to rule out other causes or injuries. The Orthopedic Surgeon may also request an Ultrasound if suspecting a thickening of the broad ligament (coracohumeral ligament), which helps strengthen the capsule in the shoulder joint. Thickening of the coracohumeral ligament or CHL is another suggestive factor of adhesive capsulitis or frozen shoulder.

Treatments

The minimum time taken for a frozen shoulder to regain its normal range of motion or near normalcy, could be 3 years, if left untreated.   

The aim of treating a frozen shoulder is to curb the pain and to improve the range of motion in the shoulder and to strengthen the shoulder.

Non-Surgical Treatments

Include:

• Prescription of anti-inflammatory, non-steroidal drugs such as analgesics or ibuprofen
• Injecting Cortisone, a steroidal medication, directly into the shoulder joint
• Physiotherapy and heat treatment – In some cases heat treatment may be employed to loosen the shoulder joint, before performing the stretching and range of motion exercises, which are performed under the supervision of a physiotherapist 

Surgical Treatment

When a patient diagnosed with frozen shoulder disorder, fails to respond to any of the non-surgical treatments, listed above, then surgery will be considered. 

The aim of performing surgery is to remove the stiffness from the joint and to stretch the connective tissue. This is done either by manipulation under anesthesia (MUA) or through shoulder arthroscopy. 

MUA – This procedure is performed by the Orthopedic Surgeon. Anesthesia is administrated and while the patient is under, the Orthopedic Surgeon will manipulate the shoulder joint to move, causing the capsule and scar tissue to either tear or stretch, consequently releasing the stiffness and increasing the range of motion.

Surgical Capsular Release or Shoulder Arthroscopy – After anesthesia has been administrated, the Orthopedic Surgeon will make 2 or 3 tiny, keyhole incisions into the afflicted shoulder. An arthroscope (camera measuring 3 and half millimeter) is inserted into one of the incisions. The images from the camera are projected onto a computer screen. Through the other two incisions, microsurgical instruments are inserted to surgically release the frozen shoulder.

Sometimes, the orthopedic surgeon may use both the manipulation and arthroscopy procedures simultaneously, to get the maximum outcomes. 

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