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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