Know Your Child’s Heart

Every year, at least 3 to 8 out of every 1000 babies are born worldwide with defective heart. In addition, a small proportion of children who are born with normal heart acquire heart conditions such as Rheumatic heart disease, Kawasaki disease, Myopathies etc.

Rheumatic heart disease usually follows a simple throat infection caused by the bacteria called beta-haemolytic streptococcus, which in some children damage the heart valves causing their malfunction.
Kawasaki disease starts as a fever, subsequently affecting the coronary arteries leading to complications such as heart attacks in children.

Myopathies are diseases of the heart muscle usually caused by some viral infections. The heart muscle weakens and becomes ineffective in its function as a pump, resulting in heart failure.

It is very important to suspect and diagnose these heart defects early. All these defects CAN be corrected with appropriate treatment. It IS possible for you to protect your children from these illnesses and help them live normal and full life.

Who is a paediatric cardiologist?
A Paediatric Cardiologist is a Children’s Heart Specialist who specializes in diagnosing heart diseases in children and offers solutions for normal life and growth.

When do parents need to take their children to a paediatric cardiologist?

• When either of the parents OR a previous child OR a close relative in the family has been diagnosed with a heart defect previously
• When the parents suspect that their child may have a heart problem

When should the parents suspect a heart problem in their child?
When the child shows any of the following symptoms:

As a baby: Breathing fast (tachypnoea), very slow interrupted feeding (suck-rest-suck cycle), sweating over the head while feeding (diaphoresis), poor weight gain (failure to thrive), going blue or dusky all over the body while crying (central cyanosis).

As an older child: Getting tired easily while playing (exertional fatigue), getting frequent chest infections (pneumonia), complaining of chest pain (palpitation), complaining of giddiness (syncope) and bluish discolouration (cyanosis).

How does the Paediatric Cardiologist check the baby’s heart?
The Paediatric Cardiologist checks the baby clinically for abnormal discolouration (cyanosis), abnormal pulse (rhythm disturbances and heart function) and abnormal heart sounds (murmurs). The common tests undertaken are Chest X-Ray (to see the position and size of the heart), ECG (to check the heart rhythm) and Echocardiography (to check for any structural problems in the heart and assess the heart function).

Can heart problems of babies be detected during pregnancy?
Yes, it can be done by using Foetal Echocardiography at 16-20 weeks of pregnancy. Elderly diabetic mothers, those with birth defects of the heart, and those who have previously given birth to babies with heart defects are advised foetal echocardiography.

What are the heart problems usually seen in children?
Heart problems in children may be CONGENITAL: these are defects at birth which are of two kinds – simple and complex.

Simple defects are those such as holes in the heart (ASD, VSD, PDA) and blocked valves (Aortic stenosis, Pulmonary stenosis, Coarctation of Aorta).

Examples of complex defects are blue baby conditions (TOF -Tetralogy of Fallot, TA -Truncus Arteriosus, TGA - Transposition of Great Arteries).

Heart problems in children may also be ACQUIRED: children have a normal heart at birth and then their heart becomes diseased (Cardiomyopathy, Rheumatic heart disease, Kawasaki disease).

Can these heart problems in children be cured?
About 95% of heart problems in children can be treated successfully. Majority of the simple problems can now be cured without operations by device closures and Angioplasty. Conditions cured without surgery are ASD, VSD, PDA, Coronary fistulas, Aortic stenosis, Pulmonary stenosis, Coarctation of Aorta. These procedures are carried out first by inserting small tubes called catheters into the heart through the blood vessels in the leg. Next with careful manoeuvres through the catheter, the holes in the heart are closed with devices; or the blockages in the heart are opened up with balloons and stents.

The advantages of these procedures are:

• complete cure of the heart without a visible scar on the body
• without blood transfusions
• without pain
• minimal hospitalisation period (usually 2-3 days)
• without a need for post-procedure resting period.

The complex blue baby conditions also have very good surgical solutions these days, providing the growing child with an excellent quality of life.

For more details on these procedures log on to www.hxplain.com

Article by Dr. R. Prem Sekar, Senior Consultant Interventional Paediatric Cardiologist, Kauvery Hospital, Chennai

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Importance of Immunizing a Child

Remember the old adage – “Prevention is better than Cure”? Well, immunizing your child is just that. There are certain diseases prevalent worldwide, especially in India, which can lead to dire consequences – even death. Diseases such as measles, diphtheria, mumps, polio, whooping cough, tetanus, rubella or German measles, Haemophilus influenza and rotavirus can all be prevented with vaccinations.

For instance, “Small Pox”, one of the most disfiguring diseases has been wiped off the face of our planet, thanks to the invention of an excellent vaccine. Immunizing your child helps not only protect your child effectively, but also prevent all the diseases named above.

Vaccines contain antigens that help the body produce antibodies to fight the disease causing germ. True, a vaccine contains in part the viruses or bacteria that cause the disease, but the immune system fights and destroys or weakens the viruses/bacteria, so that your children do not become sick. Children develop immunity through vaccinations and thus we, as parents, can help protect our children from contracting the actual disease.

Here are a few more facts why immunization is important.

1. A newborn baby is immune to many diseases as the baby has got the necessary antibodies from mother. The immunity, however, is effective only for the duration of the first year of life.
2. Prior to the advent of vaccinations, many children died from diseases such as measles, polio, and whooping cough. An unvaccinated child exposed to any of these diseases is not usually strong enough to fight the disease. Immunization with proper and timely vaccinations gives the baby better protection and a better fighting chance against these harmful diseases.
3. Diseases caused by failure to administer vaccinations lead to frequent visits to the doctor, hospitalization, loss of time, dislocation of work, avoidable medical bills and in some cases premature death.
4. Immunization of every child assures a healthy and wealthy future of the nation, as health is the real wealth.

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Stay Safe from Dengue Mosquitoes

Stagnant waters of any type are favorite breeding grounds for all types of mosquitoes. With the recent downpour and flooding of Chennai City and many districts in Tamil Nadu, there are pools of undrained stagnant water in many places.

Rainwater by itself is harmless, though it does carry many pathogenic material, such as bacteria, pollutants, algae, plant parts, soil, mold, fungi, amoeba, pesticides, dust, protozoa, lead, arsenic and insect parts. This kind of contamination can be expected in a large city. Pools of stagnant water or slow draining water provide ideal breeding grounds for many insects, including mosquitoes. Add poor and inadequate sanitation facilities to the mix, and an epidemic is waiting to happen.

Lay to rest the thought that Dengue mosquitoes only breed in clean water. Research has clarified that these mosquitoes may breed in clean waters sprinkled with dust or in muddy waters that have been stagnant for 6 days and more.

Dengue flourishes in Chennai, in the months of July, October, November and peaks in January. July generally is the month when the Monsoons from the west coast of India, drop a few showers in Tamil Nadu, but October and November are generally the months when the East Coast Monsoons inundate the state.

For the year 2014-2015 dengue cases and deaths are reported to be 2357 cases from January to Mid-September, which includes 5 deaths. Of the 2357 cases, 80 cases were from Chennai City. There has been a rise in the number of dengue fever cases, as against 1146 cases reported in the previous year.

The following districts in Tamil Nadu have been earmarked as high risk districts for cases of dengue fever.

1. Dharmapuri
2. Krishnagiri
3. Salem
4. Theni
5. Tirupur
6. Trichy

Symptoms

Children and teenagers may not exhibit signs or symptoms in mild cases of infection. The symptoms normally surface 4 – 10 days after the person has been bitten. Signs and symptoms to watch out for:

1. High Fever (106F or 41C)
2. Pain behind the eyes
3. Headaches
4. Bone, Muscle, and joint pain
5. Rash all over the body
6. Minor bleeding from gums or nose
7. Vomiting and nausea

Recovery is generally within a week, but in cases where the infection is severe, the following symptoms will be prevalent, as the blood clotting ability of the body drops:

1. Bleeding from the nose and mouth
2. Bleeding under the skin, which could look as if there are bruises
3. Severe abdominal pain
4. Lungs, liver and the heart show signs of distress
5. Persistent vomiting

Causes

There are 4 types of dengue viruses spread by mosquitoes that flourish around human dwellings. After a mosquito bites a human being having dengue virus, it in turns becomes the vector. When this mosquito vector bites the next person, that person gets infected with the dengue virus. If a person has had dengue fever once, though they do develop an immunity to that particular strain, they, however are now at high risk to being infected by the other three strains. Besides, such people are in the high risk category to develop dengue hemorrhagic fever.

Prevention

Dengue fever vaccines are still in the nascent stage of development. Therefore, it behooves that precautionary measures be taken to stay safe.

• Live or stay in air-conditioned housing or dwellings where there are mosquito screens on windows / mosquito protective gear
• Ensure good lighting. Contrary to some understanding, that these mosquitos bite in the dawn, dusk and evening hours, it has been proved by research, that dengue causing mosquitos like to feed (bite) in the dark
• Wear long sleeved protective clothing, long pants, socks and shoes when in mosquito infested areas
• Use mosquito repellents, coils and chemicals
• Ensure you do not create mosquito breeding habitats such as old automobile tires

If you have been unfortunate to have been affected by Dengue Fever, please contact a doctor immediately and get treated. 

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Removal of Gallbladder by Laparoscopy

The Gallbladder is a small organ located under the liver. Its purpose is to store the extra bile produced by the liver, and secrete it to the small intestines, where the bile aids in the digestive process. The bile is a fluid and is composed of:

• Cholesterol
• Bile Salts
• Bilirubin (an orange-yellow pigment in the bile formed as a breakdown product of haemoglobin)

The bile thus helps digest the fat in the food that is consumed.

Gallstones that are formed in the gallbladder can happen due to several reasons, such as genetics, reduced motility in the gallbladder, diet and body weight. There are two types of gallstones:

• Cholesterol stones: In 80% of the cases, the gallstones are of this type. They are greenish yellow in colour. The cholesterol stones form when there is too much cholesterol in the bile. Another reason for cholesterol stone formation is attributed to the inability of the gallbladder to empty itself quickly.
• Pigment stones: Made of bilirubin, these stones are smaller in size and darker in colour. These stones are more common in people with certain medical conditions like cirrhosis of the liver, and blood disorders such as sickle cells or anaemia.

Risk factors for developing gallstones

• Hereditary factor: Anybody with a family history of gallstones is at risk.
• Uncontrolled weight/obesity: Being one of the biggest risk factors, obesity can cause rise in the cholesterol levels in the bile, which prevents the gallbladder from emptying itself.
• Estrogens: High levels of estrogens too can reduce motility in the gallbladder. Pregnant women and those who have undergone hormone replacement therapy are at greater risk.
• Gender and age: Women and elderly people are more prone to develop gallstones.
• Cholesterol Medications: A few types of cholesterol-lowering medications can increase the amount of cholesterol in the bile, thus increasing the possibility of developing gallstones.
• Weight Loss and Fasting: Losing weight rapidly causes increased levels of cholesterol formation in the bile, which in turn causes the development of gallstones. Fasting causes the gallbladder to contract less, thereby increasing the chances of gallstones formation.
• Diabetes: Diabetic people tend to have a higher level of triglycerides in their blood. This is a big risk factor for formation of gallstones.

The Procedure
Laparoscopic gallbladder removal surgery or cholecystectomy is a very safe and effective procedure. There are very low risks involved in this surgery.

The surgeon makes four small (keyhole size) openings in the abdomen. A laparoscope with a lighted scope attached to a camera is inserted into the incision closest to the belly button. The surgeon uses a video monitoring screen for guidance while inserting the surgical instruments through the remaining incisions, to remove the gallbladder. Prior to removing the gallbladder, a special X-ray procedure called intraoperative cholangiography may be performed to view the anatomy of the bile ducts.

Anaesthesia
General anaesthesia is administrated prior to the procedure.

Post Laparoscopic Surgery

• The recovery time is very quick. You may be required to stay in hospital for 3-4 days.
• The bile will flow directly from the liver to the small intestine and will not affect the digestive process.
• Some discomfort maybe there for a week, but 10 days (normally), after the procedure, you will be able to resume all normal activities.
• No special diet is required.

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The 5 Stages of Parkinson’s disease

On August 11, 2014, the world woke up to the shocking news that the famous comedian and actor Robin Williams of Mrs. Doubtfire fame (the movie that inspired the making of Avvai Shanmugi) had passed away. Robin Williams had been afflicted with Parkinson’s disease, a degenerative disease that affects the nervous system. Apart from restrictive mobility, depression is one of the hallmarks of this disease.

The signs and symptoms commonly exhibited by someone afflicted with Parkinson’s are discernible as follows:

• Lack of coordinated movement
• Uncontrolled shaking or tremors exhibited by parts of the body (head, hands, etc)
• Stiffness of the limbs
• Slow movement
• Standing up and balancing
• Difficulty in speaking lucidly

These signs may differ from person to person, but as this brain disorder progresses, it only worsens through the stages. The progression of Parkinson’s has been mapped into 5 stages, which are:

Stage I: A person in this stage may show some mild symptoms, which are not alarming, and which do not prevent them from carrying out their daily tasks, nor does it affect their lifestyle. The tremors and difficulty in movement are very minimal and are usually restricted to one side of the body. These signs are so minimal that they can often be missed. When diagnosed and treated at this stage with medications, it does work to minimize the symptoms.

Stage II: This is considered the moderate stage and the symptoms become noticeable. Changes in facial expressions may begin to occur, and the trembling, tremors and stiffness in the muscles will be very perceptible. There is no impairment of balance, but stiffness in the muscles does elongate the time taken to complete tasks. Also at this stage, Parkinson’s affects both sides of the body and may cause speech difficulty. Progression from stage I to II can happen in months or may take years, and depends on each individual.

Stage III: This is still considered the mild stage and the symptoms are still the same as were in Stage II, but with the added symptoms of loss of balance and decreased reflexes. The chances of falling frequently are greater at this stage. Moreover, the patient will now find it more difficult to complete their daily tasks. Medication and occupational therapy can help decrease the symptoms now.

Stage IV: Dependency on others increases at this stage, as movement becomes very difficult indeed. The patient may be able to stand up without aid, but may require an assistive aid such as a walker to move. Performing daily tasks also becomes even more difficult, and the patient can no longer live alone.

Stage V: This is the final and most advanced debilitating stage in Parkinson’s disease. The stiffness is in an advanced stage, and upon standing, sometimes causes freezing of the muscles. The patient will require being in a wheelchair and may often be unable to stand without falling.

Therefore, the patient will require round-the-clock assistance. Furthermore, the patient will experience hallucinations and be occasionally delusional. The side-effects of medications at this stage counterbalance the benefits.
Age groups prone to Parkinson’s disease

The early stages of Parkinson’s set in usually around 62 years of age. Parkinson’s is also known to occur in people of younger age groups - 50 and below. Being affected by Parkinson’s below the age of 50 years is known as ‘young-onset Parkinson’s disease’.

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Stroke in the Elderly

Stroke, as per statistics, is the leading cause of impairment and the third leading cause of death among the elderly, in India. Stroke is also the cause of disability and pre-mature death in the rural, semi-urban and urban regions of India. To a large extent, the poor who have been exposed to the risk factors, basically have no knowledge of how to act in the event a loved one has an attack of stroke, nor do they have the means to meet the high cost for stroke care. 

The primary non-modifiable risk factor for an attack of stroke is age. The risk factor of a stroke attack for elders in the age group of 74-84 have been determined to be 60% and for those 85 years of age and beyond, the risk factor has been determined to be around 80%. The gender of the elder also plays a significant part in the outcomes, treatment and epidemiology of geriatric stroke. It is important to recognize gender differences to enable better outcomes and treatment. Though the entire aged population are at a risk of a stroke, the incidence of stroke is higher in men in the age group 65 to 84 years (men 52%, women 48%) but greater in women at 85 years and above (men 37%, women 63%). 

Some of the common disorders among the elderly include:

• Silent Strokes
• Other unrecognized brain abnormalities
• Aneurysms
• Benign Brain Tumors

Generally, the tendency of many people is to ignore the small stokes or in some cases, may be ignorant of the signs that are associated with a stroke. However, a stroke does give prior warnings of an impending attack. Therefore being aware of what those signs or symptoms are is important. A sudden attack of any of these symptoms is an indication of an impending attack of stroke.

• Weakness, numbness or paralysis occurring in the facial region, arms or legs
• Inability to speak properly, may feel confused or have trouble understanding
• Temporary loss of vision in either eye, rarely in both
• May feel dizzy, have trouble walking, maintaining balance or coordination
• Severe headaches for no apparent reason

Strokes of any type are categorized under two major categories – Ischemic and Hemorrhagic. 

Ischemic Stroke

The term Ischemia refers to the condition where there is insufficient supply of blood to a particular region. Hence, blockages of blood supply to the heart, brain, etc are called an Ischemic attack. The more common of the two types of strokes, is Ischemic stroke. During an Ischemic stroke, blood clots or formation of plaque, block the blood supply to the blood vessels in the brain. The blood clot(s) forms along the walls of the blood vessel or in some cases fat deposits narrow the passage in the blood vessel, thus causing a thrombotic stroke. Many times, due to high blood pressure levels, the blood vessel may also be damaged. A blood clot or an embolus occurring in another part of the body, can travel to the brain region and block the blood vessel (s) there, causing an embolic stroke or cerebral embolism. An embolic stroke, more commonly occurs when the blood clot travels from the heart, after a heart attack or when atrial fibrillation (irregular heartbeats) occur. 

Hemorrhagic Stroke

When a blood vessel in the brain bursts or there is leakage of blood into the brain, a hemorrhagic stroke occurs. Hemorrhagic stokes do not occur as commonly as the Ischemic stroke. They are categorized into two types – Intracerebral and Subarachnoid hemorrhages.  

Leakage of blood from a broken blood vessel in the brain, damages the brain cells and also cells beyond the area of the broken blood vessels, which die due to lack of blood supply. This condition is referred to as intracerebral hemorrhagic stroke. 

In a Subarachnoid hemorrhagic stroke, a blood vessel that is close to the surface of the brain breaks, and the blood collects between the surface of the brain and the skull, causing irritation to the lining of the brain. This is also a very painful condition. 

Act on a TIA

Be aware of the mini stroke or Transient Ischemic Stroke (TIA), which is a temporary forewarning of an impending stroke. It may last for a few minutes or for an hour or two, as the block that occurs, quickly clears up by itself. However, this is definitely a sign / symptom of a full blown Ischemic stroke, which could occur anytime soon, even the same day. Consequently, an immediate medical evaluation will help stave off dire consequences.

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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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