What does it mean to be morbidly obese?

Excessive accumulation of body fat is called obesity. This is a common condition in the modern world. Prevalence of obesity has increased drastically due to sedentary life style and high fat diet. Accumulation of fat is a major cause of many non communicable diseases. Several types of measurements are used to identify people with high level of fat. BMI (Body Mass Index) is one such measurement. It is calculated by dividing the weight of the person by square of his or her height. According to WHO Body Mass Index (BMI) of obese people is above 30. BMI of morbidly obese persons is above 40. A person is also considered morbidly obese if he or she is 100 over his or her ideal body weight. People with a BMI more than 35 kg/m² along with obesity related health conditions are also considered as morbidly obese. As the name implies, these people are at a higher risk of getting diseases.

Morbid obesity  affects the person’s physical, psychological and social health. There are several physical illnesses that result from morbid obesity. They are type 2 diabetes mellitus, cardiac disorders, hypertension, hypercholesterolemia, osteoarthritis, gastro-esophageal reflux disease, gallstones, cancer and asthma. Some of theses diseases are collectively known as metabolic syndrome. It is also known as insulin resistant syndrome and syndrome X.  Apart form these serious health conditions, morbid obesity can affect the day to day activities of a person. Morbidly obese people find it difficult to move. They even find it hard to sleep because they develop sleep apnea.

Metabolic Syndrome

Metabolic syndrome  is a collection of conditions that increases the risk of diabetes mellitus, coronary artery disease and stroke. People with central obesity are more likely to get this syndrome. Fat tissues secrete several types of chemicals. Leptin and resistin  are two such chemicals that cause insulin resistant. These chemicals interfere with carbohydrate and fat metabolism in the body. These actions finally lead type 2 diabetes mellitus, hypercholesterolemia and atherosclerosis, coronary artery disease, hypertension and strokes.   

Osteoarthritis and other joint problems

Osteoarthritis is inflammation of the joints. It occurs as a result of wear and tear. When there is more stress on the joint, it gets damaged. When a person is morbidly obese, his or her weight is transmitted through the joint. Increased weight increases the resistance between two joints. This ultimately damages the joint and initiates an inflammatory process. The person starts to experience swelling, redness and impaired function of the joint. The increased weight on vertebral column causes the vertebral bodies to collapse. It also causes displacement of the intervertebral disks. It is called spondylolisthesis.

Sleep Apnea

 The excessive fat deposits in various places in human body. They can deposit in the tongue and neck. This leads to narrowing of the throat. So the person experiences difficulty in breathing. The effects are more when the person is sleeping. During sleep, especially when the person is sleeping on his or her back, the obese tongue falls back. This obstructs the respiratory passage. Sometimes it produces a noise. This is why many obese people snore when sleeping. These people accumulate carbon dioxide in their blood. It causes the dilatation of the vessels in the brain. When the blood vessels in the brain dilate, the intra-cranial pressure rises. Raised intracranial pressure causes nausea and drowsiness. That is why many morbidly obese people develop nausea and drowsiness in the morning.

Gastroesophageal Reflux Disease

Morbid obesity causes gastroesophageal reflux disease  due to several reasons. It causes esophageal motor disorders and decreases the lower esophageal sphincter pressure. There is also increased risk of development of hiatal hernia and intragastric pressure. All these effects finally lead to gastroesophageal reflux.

 

Infertility

Infertility  is a well known outcome of obesity. It is mainly seen in women. Polycystic ovarian syndrome is the commonest cause of infertility associated with obesity. It causes menstrual irregularities and chronic oligo-anovulation. Morbid obesity is a risk factor for miscarriages. Morbidly obese males have low testosterone levels, reduced spermatogenesis and erectile dysfunction. All these finally lead to infertility.

Depression

As mentioned earlier, morbid obesity affects not only the physical health but also the psychological and social health of a person. These people constantly face problems with their diet. They often feel uncomfortable among people due to their obesity. They often get offended with other peoples’ comments regarding their obesity. Above mentioned morbidities also put a great strain on them. All these things make them depressed.

Above mentioned are only several of morbidities associated with morbid obesity. Being morbidly obese is like living in a jungle of diseases. Morbid obesity is a huge burden to the person as well as to the country. Therefore, it is very important to prevent and treat obesity.   http://endo.endojournals.org/content/149/2/443.full 

Is Insulin The Last Resort To Treat Diabetes Mellitus?

Many people think that insulin therapy is started when there is nothing else to do. They also think that there is no hope. But, this is a wrong belief. Insulin is the best method of treatment for diabetes. It is started in young people instead of drugs to prevent tissue damage. Diabetic people lack insulin. Therefore, providing insulin from outside is almost equal to the normal body functions. On the other hand, diabetic drugs are artificial preparations. They exert various side effects in the human body. Insulin should never be regarded as the last resort.

According to the available research findings, injecting insulin has shown to reserve the function of the residual beta cells. So, insulin therapy is started for those who are diagnosed with diabetes mellitus type 2 as soon as possible. 

How Long will if Take to Cure Mononuritis and Mononuritis Multiplex in diabetes?

Mononuritis and mononuritis multiplex are neurological complications of diabetes mellitus. As the names imply single nerves are affected in these conditions. Both cranial and peripheral nerves can be damaged.  Commonest nerves affected are the occulomotor nerve, radial nerve, median nerve, ulnar nerve and common peroneal nerve.

When a diabetic person gets these diseases, the commonest mistake they do is thinking that only drugs can cure them, but this is not true. If the blood sugar levels are controlled for a certain period of time, the symptoms will spontaneously disappear over 3 to 6 months. Therefore, make sure you adhere to the diabetic diet. Engage in exercises at least for 20 minutes, 5 days a week. You will feel that you are getting better in no time.

Having Diabetes? Are You Having Acute Painful Neuropathy?

Acute painful neuropathy is a microvascular complication of diabetes neuropathy. If your are experiencing burning or crawling pains in your feet, shins and anterior thighs, you may be having acute painful neuropathy. These symptoms usually get worse during the night. Even the touch of your bedsheets may cause severe pain making a good night sleep impossible. Muscle wasting is not a feature of acute painful neuropathy. 

What Should You Do If You Have Acute Painful Neuropathy?

As for every symptom and complication in diabetes, good blood sugar control is the key to relieve the symptoms. If you control your blood sugar levels well, the symptoms will disappear spontaneously within three to twelve months. 

There are pharmacological and non pharmacological methods to relieve pain. Medications given to treat acute painful neuropathy include tricyclics, gabapentin, pregabalin, duloxetine, mexilentine, valprovate and carbamazepine. Non pharmacological methods to relieve pain include acupuncture and transdermal nerve stimulation. 

Can Diabetes Cause Anemia?

Diabetes is a multi systemic disorder which affects almost every part of the body. Diabetes can also cause anemia. There are several ways that a diabetic patient can become anemic.

1. Due to nephropathy - Diabetic nephropathy is a microvascular complication of diabetes mellitus. Kidney secretes a chemical called erythropoetin which stimulates red blood cell production. Unfortunately, erythropoetin production is also reduced in diabetic nephropathy. As a result, less amount of red blood cells are produced making the person anemic. 
2. Due to autoimmune diabetes
3. Anemia in chronic disorder - Any chronic illness can cause anemia. Diabetes mellitus is also a chronic disorder.
4. As a side effect of diabetic medications - Unfortunately some of the medications given to treat diabetes cause anemia as a side effect. For example glitazone and metformmine cause anemia as a side effect.
5. As a result of autoimmune associated pernicious anemia - Some times diabetes results from an autoimmune disorder. In autoinnume disorders, antibodies are produced against the body's own cells. When these cells attack the beta cells of Islets of Lngarhan, diabetes develops. In such patients, the autoantibodies can also attack cells secreting intrinsic factor. Intrinsic factor is required to absorb Viatamin B 12 from the gut. Vitamin B 12 is required to produce red blood cells. Therefore, when there is reduced amount of intrinsic factor, the number of red blood cells produced gets reduced.

Above mentioned are the mechanism of anemia in diabetes mellitus. Anemia in diabetic patients should be identified and treated early. All preventive measured should also be taken because prevention is always better than cure.

How Obesity Causes Insulin Resistant

It is a well known fact that many people with obesity are at a high risk of developing insulin resistant. But, how does that happen. As you know obesity means excessive accumulation of fat. Fat tissues also act as an endocrine organ, so it secretes various types of chemicals. Leptin and resistin are two of such chemicals.These two chemicals have the ability to reduce the insulin sensitivity. Therefore, obese people become insulin resistant. When there is insulin resistance, the cells fail to uptake glucose from the circulation. As a result high blood glucose levels are seen in these people. Finally, they become diabetic.

Vitrectomy surgery procedure and recovery

Removal of vitreous fluid from the eye is called vitrectomy. It is done to treat several conditions such as retinal detachment, vitreous hemorrhage, endophthalmitis, macula hole, and intraocular foreign body. The decision to perform vitrectomy  is decided by an ophthalmologist after considering the symptoms, examination findings and investigation findings. The patient is counseled regarding the importance of performing the surgery. The doctor will also briefly explain the procedure and risks of the surgery. It is important to relieve anxiety.

Surgical Procedure

Briefly, the surgery involves cutting the vitreous gel, sucking it out and repairing the retina. At the end, a silicon oil or gas is injected to replace the vitreous gel. This might look very simple. But, it is not. Eye is a small and very sensitive organ. All measures should be taken to minimize damage to other parts of the eye. If the lens of the eye gets damaged during the procedure, cataract can develop. Therefore, performing vitrectomy requires good surgical skills and patience. 

The surgery is started by anesthetizing and positioning the patient. Propofol is given to sedate the patient. Then the patient is anesthetized by retrobulbar block . Therefore, the patient is conscious throughout the surgery. General anesthesia is used for children because they might not corporate during the surgery. The surgical area is cleaned thoroughly with 5% solution of povidone iodine. Then an eyelid speculum is placed to gain access to the eye. After these initial steps, vitrectomy is performed by creating sclerotomies. The sclera is incised and the instruments are inserted in to the eye. Some of these instruments illuminate the eye while some maintain the shape of the eye. The system used to perform vitrectomy could be either 20 gauge, 23 gauge or 25 gauge.  The procedure differs according to the system used. During the procedure, all the precautions are taken to prevent incarceration. After removing the vitreous the surgeon will take additional measures to treat the disease. These steps vary according to the type of the disease. Posterior vitreous detachments, removal of posterior hyaloids, shaving of the vitrous base are examples of such additional steps. Finally, the sclerotomies are closed by suturing. Measures are taken to make the closure water tight.

Recovery

Recovery is fast because it is done under local anesthesia. Some patients can develop post operative discomfort of the eye. The patient should be reassured because it is normal. Initially, the patient may not be able to see clearly. But, the vision will improve slowly and steadily over several months. After recovery, the commonest complications that the patient can develop are bleeding, infection and retinal detachment. So, the patient is monitored to detect these complications. Topical or subconjunctival antibiotics are given immediately after the surgery to prevent infections. 

On Discharge

The patient is discharged with instructions. The patient is advised to avoid exercises, watching television and reading. He should rest as much as possible. Every movement should be done slowly and steadily.  Patient should restrain from straining because it can increase intraocular pressure. He is advised to apply topical antibiotics for one week. Following these instructions is very important for fast recovery.

Post Operative Follow Up

The patient is followed up at the ophthalmology clinic. During the clinic visits the eye is examined for improvement. The ophthalmologist will also look for complications of the surgery such as cataract. Cataract is a common complication of vitrectomy surgery. The patient might have to undergo another surgery if cataract develops.

Vitrectomy surgery is a common surgery performed by ophthalmologist everyday. The techniques and instruments used for the surgery are also advancing with time. Therefore, the outcome of the surgery is also improving.    

Most effective medication for the treatment of vaginal thrush

Vaginal thrush, medically known as vulvovaginal candidiasis, is caused by yeast. Yeast is a fungus belonging to the genus Candida. There are several species of fungi belonging to the genus Candida. Out of them, Candida albicans is the commonest species that cause vaginal thrush. Candida albicans is an opportunistic organism. Opportunistic organisms normally live in human body in harmony. At normal conditions, they don’t cause harm. But, these organisms start to proliferate and invade the human body when the immunity reduces. So, vaginal thrush also occurs as a result of changes in the host immunity. The normal vaginal environment is acidic. The excessive growth of Candida is inhibited by this acidity. But, when the acidity reduces, Candida gets the opportunity to proliferate rapidly.  

According to Center of Disease Control and Prevention,  75% of women experience at least one episode of vaginal thrush at some point in their life. Therefore, it is a very common illness among women that requires effective treatment. Various types of treatment methods have been used to treat this condition. Antifungal medications are the main method of treatment.

Antifungal Medications

There are several types of antifungal medications. They are available as local preparations, oral drugs and intravenous preparations. The type of medication should be carefully chosen according to the severity of infection the woman has. For example, if the woman comes with a mild disease with no previous history of similar illness, she can benefit from simple local therapy. Local antifungal medications are available in the forms of creams and suppositories. They are usually prescribed for up to one week. Most infections relieve within several days.

Sometimes, a single dose of oral antifungal is given to treat mild to moderate infections. There are several types of antifungal medications. Azoles and fluconoazole are two of such antifungal medications that are widely being used. Examples for commonly used Azoles are Imidazole, Miconazole, Clotrimazole and Fluconazole. The above mentioned treatment options may not be effective for a woman who has a history of recurrent vaginal thrush.  She might be having a resistant infection. In such instances, the choice of treatment must be individualized by considering the effectiveness, convenience, potential side effects and cost.

Place of Ozone Therapy in Vaginal Thrush

Ozone therapy  has also been used to treat vaginal thrush but, its effectiveness is yet to be clarified. Vaginal insufflation is done by inserting a clean olive oil lubricated vaginal catheter. Ozone is delivered to the vagina through this catheter. The woman might sense the heat produced by oxidation. The procedure is repeated for several days.

As described above, vaginal thrush is an infection with very effective treatments. The effectiveness of the treatment depends on the correct choice of therapy. To have the maximum effectiveness, the patient should adhere to the physician’s instructions.

Duties of a physician's assistant

Physician’s assistant, as the name implies, is a person who works under the supervision of a physician. A physician’s job is to treat patients. A physician requires help of various people to fulfill this task. This is where the role of physician’s assistant comes in to play. So, a physician’s assistant’s duties are also related to patients and their treatments. Medicine is a field of work that involves diseases of humans. If you are not the kind of a person who can deal with diseases, may be this is not the field of work you belong. On the other hand, jobs in the field of Medicine are some of the most satisfying jobs in the world. The pleasure you get when you save someone’s life is immeasurable. It is important that you understand the duties of a physician’s assistant before you apply for one. The salary is the most important thing that everyone wants to know before entering a job. According to the Bureau of Labor Statistics , the median pay of a physician’s assistant is $ 86,410 per year and $ 41.54 per hour.

The main duty of a physician’s assistant is to practice medicine under the direction and supervision of a physician. This involves talking to patients, examining them and diagnosing certain injuries and diseases and providing treatment. A physician’s assistant talks to the patient when he or she comes with a problem. He takes a proper history that is essential for the diagnosis and further management of the patient. Then he examines the patient in order to find the cause for the illness, to make the diagnosis and to decide on the management plan. Sometimes, the physician’s assistant can order certain investigations such as X-rays. The assistant analyses the gathered information and finally comes to a diagnosis. After making the diagnosis, he can treat it if it is a minor injury or an illness. They can do minor procedures such as suturing, splinting, casting etc. The duty of the physician’s assistant does not end with treating the illness. It is his responsibility to advice the patient regarding prevention of the disease before they get discharged. Sometimes, the physician’s assistant is appointed to patient education camps. In such camps, he delivers knowledge regarding health issues to the general public. The physician’s daily work also includes doing rounds in the hospital or the nursing home.

Now you can see that the work of a physician’s assistant is quiet similar to that of a physician. The only difference is that they only treat minor conditions. You can gather more information regarding physician’s assistants from the American Academy of Physician Assistants.  

Best ways to sleep when you have back pain

Everybody experience back pain at some point in their lives. It becomes more prevalent with increasing age. Understanding the mechanism of back pain will help you to understand the postures that minimize the pain. Some of the causes of back pain  are spondylosis, quada equine syndrome, spinal disc degeneration and radiculopathy. These are diseases of the vertebral column. Degenerative changes of the inter-vertebral discs  are responsible for most of the back pains. The discs are composed of two components. They are the nucleus pulposes and the annulus fibrosus which surrounds the nucleus pulposus. With aging, the discs get dehydrated. As a result, they get compressed. This reduces the disc space and the annulus fibrosus bulges out. These changed initially causes ischemia to the spinal cord creating ischemic pain. The bulged disk can compress the nerve roots. As a result, the nerves get irritated and pain arises. These changes mainly occur in the lower back because it holds most of the body weight.

As described above, the causes for the back pain accelerate when more weight is put on to them. Therefore, you should sleep in a way that minimizes the weight on the vertebral column. Sleeping on your side is one of the ways to minimize strain on your back. Turn to our back with hips and knees slightly flexed. You should not let your upper leg fall off because, it can twist your vertebral column and causes more pain. You can prevent it from falling off by keeping a pillow between the knees and thighs. There are specially designed pillow that you can buy to fulfill this purpose. Sometimes, people who are used to sleep in their back tend to change their posture back in to the supine position when in sleep. You can place another pillow behind your back to prevent this from happening. If you want to sleep on your back , you should make sure that you maintain the normal curves of the back. To achieve this, you can place a pillow under your knees. In addition, you can also place a small rolled towel under your lower back. Always place a pillow under your neck.

The worst position  for back pain is sleeping on your stomach. It puts a lot of strain on your back and thereby aggravates the back pain. Therefore, you should take all the precautions to not to sleep on your stomach. There are commercially available mattresses and pillows  that are designed to make you sleep comfortably. 

Types of alcohol addiction treatment

Alcohol addiction is a major health care problem nowadays. It affects the person as well as the society in a negative way. An alcohol addicted person continues to take alcohol despite of obvious evidence of danger to his or her health. They neglect all other pleasurable activities they were doing in the past. These people experience withdrawal symptoms when they are not taking alcohol. Alcohol addiction is also responsible for some of the crimes that occur in the society too. Therefore, it is important to identify alcohol addicted persons and guide them to take treatment. 

There are several types of alcohol addiction treatment  methods. These types can be broadly divided into two groups. They are psychological methods and pharmacological methods.  The available psychological methods include motivational enhancement therapy, couples therapy and brief interventions. Motivational enhancement therapy is done to make the person understand the adverse outcomes of alcohol addiction. The physician also discusses with him about the available treatment methods too. This is considered as the most cost effective treatment option.

In couple’s therapy , the addicted person is accompanied by the non addicted spouse. This method has increased the patient participating rates.  The program has also allowed the couples to work on their marital problems. Final outcome of the therapy is promising and long lasting than the other methods. Brief incidents are when the addicted persons meet a primary care physician or a nurse. At these brief incidents, the person is advised briefly regarding the negative health outcomes of alcohol addiction. They are also informed about the specialized programs that are available to achieve complete abstinence. Most of the nicotine addicted people are also addicted to alcohol. They have found out that treating both conditions together can give better outcome.

When a person gets addicted to alcohol, his or her brain is adjusted to the continuously high levels of alcohol in their blood. The brain set points are changed accordingly. These set points do not come back to their normal levels as soon as the person stops drinking. That is why addicted people experience withdrawal symptoms when they stop drinking. So, these withdrawal symptoms should be controlled when treating alcohol addiction. This is where pharmacological therapy comes in to play. Naltrexone, acomproste, odonsetron and sertraline are some of the drugs that are being used to treat alcoholism. Combination therapy with non pharmacological and pharmacological methods has shown more promising results. 

Causes, symptoms and treatment for a swollen eyelid

Eye lids are designed to protect the eyes. They also help to keep the eye wet. There are special structures in the eye lids to achieve these targets. The eye lids get swollen when any of these structures gets inflamed. Eye lid is composed of a fibrous plate called tarsus, muscles (orbicularis oculi, levator palpabrae superioris), meibomian glands, skin and eye lashes. Swelling of the eye is very common. The cause for the swelling can vary from person to person. Their symptoms and treatments also vary according to the cause.

There are over 70 causes for swollen eye lid. But, only few of them are common. Some of the commonest causes for swollen eye lid are conjunctivitis, styes, allergic reactions, blepharitis and chalazion. Out of these, styes and chalazion appears alike but, an experienced physician can differentiate the two by examining the eye lid. Eye lids can become swollen if you are allergic to chemicals such as hair spray, make up etc. Allergies to plants and animal can also cause swollen eye lids. In allergic reactions, the eye becomes itchy. Allergic reactions  are associated with release of histamine which starts an inflammatory process which, finally give rise to swollen eye lids. Washing eyes with clean water can always help but, make sure you do not rub your eyes. This condition can easily be treated with eye drops that can reduce the inflammation. These eye drops usually contain an antihistamine, mast cell stabilizer or a corticosteroid.

Infection can also cause eye lid swelling. The eyes can get infected with both bacteria and viruses. Bacterial conjunctivitis  causes sever symptoms such as reddening, itching and swelling of the eyes. The symptoms of viral conjunctivitis are usually not as severe as bacterial conjunctivitis. Conjunctivitis is usually treated with antibiotics such as chloramphenicol and fusidic acid.

Styes are inflamed sebaceous glands. These glands are situated at the base of the eye lashes. The commonest causative agent for styes is Staphylococcal bacteria. You should never try to squeeze the stye. It can contaminate your hands with bacteria. This can promote the spreading of the infection. Styes are treated with warm compression and pain killers. Your doctor will drain the pus collected inside the stye by making a very small cut.

Chalazion  develops as a result of blockage of meibomian glands. This condition is initially treated with wet and warm compresseion and antibiotics. If these do not work, you will have to undergo surgery to remove it.

A common mistake that most of the people do when they see that their eye lid is swollen, is trying to handle it. Some even squeeze hard. These practices should be strictly prohibited because they can only bring more harm to the eye. Eye is one of the precious organs in human body. You must take all precautions to avoid harming it. 

What cholesterol levels mean

Hypercholesterolemia is a non communicable disease that is becoming more prevalent due to sedentary life style and high fat diet. Your doctor will order to do a cholesterol profile to see if you are having the disease. Normally, a cholesterol profile gives the levels of total cholesterol, triglycerides, LDL, HDL and VDRL. It also provides the ratio between LDL and HDL.  The American heart Association  has provided normal, desirable and abnormal values for each of these cholesterol types. So, what does each of this cholesterol level mean? To understand this, you should know the cholesterol metabolism  within your body.

Fat is one of the major nutrients that the human body requires. It is recommended that you take 30% of your energy as fat. In the gut, the fats are broken down in to triglycerides and fatty acids. Then they are absorbed in to the gut mucosa. Then these lipids are carried to the liver. Fat cannot be dissolved in the blood. Therefore, certain protein molecules (apolipoproteins) help to carry them to the liver. This fat and protein complexes (lipoproteins) are called VDRL. VDRL stands for Very Low Density Lipoprotein. You will be advised to stay fasting for 10 hours prior to doing the cholesterol test. If you do not stay fasting, the VDRL levels will be higher than the normal level. On the other hand, it will be low if you fast too long.

LDL (low Density Lipoprotein) cholesterol is the lipoproteins which transport lipids away from the liver to peripheral tissues. VDRL and LDL cholesterol are elevated in hypercholesterolemia. Therefore, they are called ‘bad cholesterol’. This LDL cholesterol circulates in the blood stream. LDL cholesterol deposits in the blood vessel walls when they exist in high levels. This is the first step of development of atherosclerosis, which initiates a cascade events that leads to many of the arterial diseases such as ischemic heart disease, stroke etc. According to American Heart Association, LDL level less than 100 mg/dl is optimum, 100 to 129 mg/dl is above optimum, 130 to 159 mg/dl is borderline high, 160 to 189 mg/dl is high and more than 190 mg/dl is very high.   

HDL cholesterol is the ones that collect lipids from the peripheral tissues. They bring these lipids back to the liver, so the liver can excrete them through bile. Therefore, HDL cholesterol reduces the peripheral levels of lipids. This action of HDL cholesterol reduces the chance of developing atherosclerosis. Therefore, they are regarded as ‘good cholesterol’. So, higher the HDL levels better. Higher levels of HDL protect you from heart diseases and strokes. You should have more than 60 mg/dl of HDL level to get protected from atherosclerotic disease. HDL level less than 40 mg/dl for men and less than 50 mg/dl for women are considered as risk factors for development of heat disease.

Total cholesterol level is the other value which a cholesterol report provides. It is calculated by using the following formula. 

Total cholesterol = HDL + LDL + Triglycerides/5

The desirable total cholesterol level is less than 200 mg/dl. If your total cholesterol level is lower than 200 mg/dl, you are at low risk of developing heart disease and strokes. Levels between 200 and 239 mg/dl are considered as borderline high. If the cholesterol levels are higher than 240 mg/dl, it is considered as high blood cholesterol. If your total cholesterol level is higher than 240 mg/dl, you are at a higher risk. Therefore, you should get immediate medical advice.

Triglyceride levels are also given in cholesterol profile. Normal triglyceride value is less than 150 mg/dl.  Triglyceride levels between 150 to 199 mg/dl is borderline high, 200 to 499 mg /dl is high and levels more than 500 mg/dl is considered to be very high. Triglycerides are the lipids that get elevated as a result of obesity, cigarette smoking, high fat diet, excessive alcohol consumption and sedentary life style. But, some genetic disorders can also cause hypertriglyceridemia.

Now you can go through your own cholesterol levels and see whether you are at risk of developing heart disease or stroke. Your doctor will give you advice regarding the actions you should take according to the level of risk. 

What is Asterixis of Liver Disease

Asterixis of liver disease is a type of negative myoclonus. This is elicited by physicians by asking the patient to keep the wrist extended. The posture is irregularly interrupted by producing a flapping movements. This is also called flapping tremor. This is commonly seen in liver failure.

Flapping tremor

Tetracycline side effects

Tetracycline is an antibiotic effective against many micro-organisms, including gram positive bacteria and gram negative bacteria. Therefore, it is regarded as a broad spectrum antibiotic . Tetracycline can have several side effects, but everyone taking tetracycline  may not experience all of them. Most of these side effects are minor ones. So, you should take medical advice only if you experience them persistently. It is also important that you understand that some of these side effects are unavoidable. You should never stop taking the drug just because some minor side effects. If they are really disturbing, do not stop the drug with out medical advice. In such instances, meet you doctor and seek help. If you stop taking antibiotics half way through, drug resistance can develop.

If you are having chronic kidney disease or dehydration, your doctor might prescribe you tetracycline with caution because, it can cause azotemia, hypophosphotemia (reduced phosphate levels), and acidosis. It can also cause BUN and Fanconi’s syndrome. Gastrointestinal disturbances are well identified side effects  of tetracycline. You might feel bulky loose stools, diarrhea, nausea, indigestion and abdominal pain when taking tetracycline. Tetracycline is known to cause discoloration of the developing teeth. This occurs as a result of tetracycline deposition within developing teeth.  It also causes hypoplasia of the enamel. Therefore it is not given to pregnant ladies and children under 12 years of age. Tetracycline can have effects on the skin in several ways. It can give rise to maculopapular and erythematous rashes, exfoliative dermatitis and onycholysis.

Benign intracranial hypertension is another side effect of tetracycline. It has found to occur among women who were given tetracycline to treat acne. The pressure within the skull was found to be increased in these patients. The symptoms of benign intracranial hypertension are headache, blurring of vision and nausea. Fortunately, the symptoms reduce with stoppage of treatment.

Liver is another organ affected by tetracycline. It can cause liver failure, and can increase liver enzyme levels. Tetracycline also causes reduction of blood cells. It reduces the number of red blood cells, platelets, neutrophils and eosinophils. Hypersensitivity reactions are important side effects that everybody taking tetracycline should know about. It can even cause anaphylaxis which is life threatening. Therefore if you develop symptoms of hypersensitivity reaction, you should take immediately stop the drug and seek medical attention.

 Every drug has its own side effect profile. But, their benefits are far better than the side effects. Therefore, one should never stop a drug due to a minor side effect, because it might cause more harm than good. If you develop disturbing side effects, take immediate medical advice. Never try to stop or adjust doses by yourself.

The pros and cons of taking the emergency pill

Emergency pill, also called morning after pill is a hormonal method of preventing pregnancy. It is used by women who are not in a long term contraceptive method. It is also used in instances where the other methods of contraception fail, such breaking of a condom, missing pill etc. As with any contraceptive method, emergency pill also has its own pros and cons . It is important that you know them before you use it.

As the name implies, emergency pill is designed to use in an emergency. If you are not on a long term contraceptive method, emergency pill is one of the methods that can minimize the chances of getting pregnant after having unprotected sexual intercourse. Therefore, it prevents unwanted pregnancies. This is the biggest advantage of the emergency pill. The pill is freely available and cost effective. Anyone over 17 years of age can buy the emergency pill without a prescription from a doctor. So you do not have to go to a doctor. High effectiveness  is another major advantage of the emergency pill. It is said that seven women who would have gotten pregnant will not get pregnant after using the emergency pill. This takes a huge burden off a woman’s life. It does not cause miscarriage. It does not cause any abnormalities in the fetus if pregnancy has already occurred. It does not affect the fertility of the women. It is a very safe method of contraception because it does not have any long term effect on the body. It is effective up to 5 days of having unprotected sex. Many women like this method due to these reasons.

The emergency pill is highly effective and a safe method of contraception. But, it also has its own set of disadvantages. It is only effective up to five days of having unprotected sex. It has to be taken as soon as possible. That is why it is called the morning after pill. Therefore, its efficacy reduces with time. It is a hormonal method of contraception. Therefore, it does not provide protection against sexually transmitted diseases. The pill has a high concentration of levonorgestrel. This hormone also has many other effects on the body other than preventing pregnancy. Nausea is one such disturbing side effect most of the women experience after taking the emergency pill. Vomiting is not as common as nausea. But, if vomiting occurs within 2 hours of ingestion of the pill, you might have to take another pill.  It can also cause abdominal pain and diarrhea. Fatigue, headache, dizziness and breast tenderness are other well known side effects. Some women may not have any of these effects.

As mentioned above, the emergency pill contains high concentration of levonorgestrel. It is a type progesterone hormone. If the pill is taking before ovulation, you may experience progesterone withdrawal bleeding within 7 days of taking the pill. If it is taken after ovulation, it can lengthen the luteal phase of the menstrual cycle. This results in delaying of menstruation. Ovulation usually occurs on the mid day of the cycle if, you are having 28 day cycles. If not, you can calculate the day of ovulation by subtracting 14 days from the next expected day of menstruation. The emergency pill can have serious health effects on women with diabetes, heart disease, migraine, deep vein thrombosis, liver disease and breast cancer. Therefore, these people are advised to not take the emergency pill. According to them, its widespread availability has increased the incidence of sexual promiscuity, sexual violence and sexually transmitted diseases. Emergency pill should not be used as a long term method of contraception. If you are using the emergency pill very often, you are in need of a long term contraceptive method. You should take medical advice before taking the emergency pill if you are diagnosed to have medical illnesses such as diabetes, deep vein thrombosis, migraine, breast cancer etc. 

Dangers of not eating enough protein

Protein is one of the major nutritional ingredients. It is Proteins are major constituents of the human body. They are essential components of muscles, bones, immune system, blood, skin appendages, enzymes and many more. In simple words, proteins are involved in development of almost every part of the body. Therefore, proper functioning of the body requires adequate protein intake. Some people restrain from eating proteins. Vegetarians and people on diet control are the people who are most affected. Animal foods are the major source of proteins for humans. Vegetarians should eat a lot of protein containing vegetables to get required amount of proteins.

Protein energy malnutrition  is the well known outcome of reduced protein intake. There are two types of protein energy malnutrition. They are kwashiorkor and marasmus. These two diseases are very rare in developed countries. These are well known conditions mainly affecting children who are given foods which, do no contain enough protein. Children are more prone to get these conditions during the weaning period (when the children are introduced to the adult diet). These conditions are more common in poorly developed countries. Kwashiorkor is characterized by edema, muscle wasting, growth retardation and psychomotor retardation. These children usually have moon faces, brittle hair and pigmented skin.  They also develop helpatomegalya (enlargement of the liver) and other vitamin deficiencies. These children are unable to produce proteins that are required to deliver fat away form liver. Therefore, fat accumulate within the liver, causing it to enlarge.

The appearance of children with marasmus  is different from that of children with kwashiorkor. Marasmus is a result of starvation. It is common in children under one year of age. It occurs when breast feeding is inadequate. Feeding of diluted animal milk also leads to marasmus. They do not develop edema as in kwashiorkor. These children are deprived of both protein and calories.  

Nowadays, some people put themselves in danger because they voluntarily restrain from eating protein. There are many dangers of not taking enough protein. One such danger is deprivation of essential amino acids. Proteins are made up of amino acids.  The proteins you take are broken down in to amino acids before they get absorbed. There are about 20 amino acids. The human body can produce some of the amino acids by using others. But, there are some amino acids which the body can not produce. They are called essential amino acids. Essential amino acids should be taken from outside. If you do not take enough proteins, you are in the risk of depravation of essential amino acids.

Humans do not have additional protein stores. The human body always requires a certain amount of proteins. The only place the body can get proteins when you do not eat enough protein is the muscles. This leads to reduction of muscle bulk. This leads to weight loss. Severe weight loss makes your body vulnerable to many illnesses. According to livestrong.com http://www.livestrong.com/article/523735-does-not-getting-enough-protein-affect-the-immune-system/ , not taking enough protein makes your immune system weak. Immunoglobulins are major components of the immune system. They are made up of amino acids. When there is reduced intake of proteins, the immunoglobulin production also reduces. This makes you vulnerable to infections.

Now it is vivid that reduced intake of protein can have adverse effects on your body. If you are on diet control to reduce weight, make sure you take the required amount of protein. If you are a vegetarian, make sure you eat enough vegetables which supplies the protein requirement. 

How the drug Viagra works

Viagra, medically know as sildenafil citrate, is a drug widely used to treat erectile dysfunction. You need to know the physiology of erection  to understand the way it works in people with erectile dysfunction. Penis is made of smooth muscles, arteries and veins. These three components play major roles in erection of the penis. In flaccid phase, the smooth muscle cells situated within the walls of the blood vessels are in a contracted state. This causes constriction of the vessels. Constricted vessels only allows small amount of blood to the penis.  When the male gets sexually stimulated, the brain sends down the impulses which cause the release of neurotransmitters. These neurotransmitters cause relaxation of the smooth muscles. 

The chemical they release is nitric . Nitric oxide is a potent vasodilator. It has the ability to stimulate the enzyme guanylate sulfate. This enzyme produces another chemical called cGMP. Finally, cGMP is the chemical responsible for the smooth muscle relaxation. As a result, the diameter of the blood vessels increases. So, more blood can come to penis with minimum resistant. The blood accumulates within the sinusoids of the penis. Meanwhile, the venous outflow also gets blocked.  This leads to erection of . Then the ischiocavernosus muscle contracts. This phase is called rigid erection phase. Men develop erectile dysfunction when these steps don’t occur properly. cGMP is removed from the system by the action of another chemical called phosphodiesterase 5.

As described above, smooth muscle cells are the ones which determine erection. If the smooth muscle cells fail to relax, the person finds it difficult to have an erection. As described earlier, cGMP should be there to cause erection. People with erectile dysfunction lack this chemical. Viagra has the ability to cause smooth muscle cell relaxation when the person is sexually aroused.  Its does this by inhibiting the enzyme phosphodiesterase which is responsible for the degradation of cGMP. As a result, more cGMP accumulates and more erection is achieved. The effect of Viagra is limited to penis. This is because the penis is the only place where there is phosphodiesterase 5.

Like in any drug, Viagra also has its own side effect profile. Commonest side effects men complain are alteration of the green and blue color perception, headache, long lasting painful erection and dependency. It can also have very serious side effects such as heart attacks. That is why Viagra is not an over the counter drug. Viagra is not given to people taking nitroglycerine for angina. Nitroglycerine also causes vasodilatation by increasing the amount of nitric oxide. The effects get exaggerated if you take both of them together.

Viagra (Sildenafil) is also used to treat pulmonary hypertension . This is a new development in the field of Medicine. Viagra is marketed as Revatio for the treatment of pulmonary hypertension. Its action is also used to relieve mountain sickness, Raynaud’s phenomenon and heart disease.

How to define abnormal grieving

Grieving is common to everyone in the world. Everybody faces several episodes of grieving within their lifetime. Therefore, grieving is not always abnormal. But, it can become abnormal in some instances. Before defining abnormal grieving, one should know what normal grieving is. Grieving occurs is four steps . They are shock and denial, intense concern, despair and depression and recovery. Everybody goes through all these steps. Finally the person understands the loss, accepts it and moves on. There are specific time durations for each of these steps.

People grieve when they loose something very dear to them. For example, death of a loved one is an inevitable grieving event a person faces during his or her lifetime. When a person gets to know about a loss of a loved one, he or she does not immediately accept the fact. They know that the person they loved won’t come back. But, they continue to pretend as if it is not. This is the first stage of grieving, named as shock. This step can normally last 2-3 months. Intense concern is next step of the grieving process. During this period the person’s day to day activities are significantly disturbed by the thoughts of the loved one. They keep having flash backs of the incidents. This period can last from 6 months to 1 year. Despair and depression is the most painful part of the grief reaction. The person can even get depressed during this period. Even though it is very painful, it is the most important step of the grieving process in which the person finally understands the loss. The final step of grief reaction is recovery. At this step, the person understands that he or she has to go on with life. The pain caused by the loss is significantly reduced. The incident becomes only a part of their life. 

The grieving process becomes abnormal  any of these steps takes more time than usual. It is also abnormal for a person to have suicidal ideas, or psychotic symptoms during grieving. It is normal to have brief moments of abnormal behavior during the process of grieving. But, it becomes abnormal when the person continues to have these abnormal behaviors. For example normally, one can complain that he or she is seeing the lost person. These are very brief episodes. It is abnormal if the person continues to behave and talk to the lost person as if they are with them all the time.

Depressio n, suicidal thoughts and suicidal attempts are also symptoms of abnormal grief. A depressed person usually has a low mood, loss of interest in pleasurable activities and he or she might also experience weakness. They can also have low self esteem, poor concentration, poor sleep, pessimistic ideas, abnormal appetite and guilty feelings. If a person expresses suicidal thoughts, he or she should be immediately referred to a psychiatrist because they can act on their thoughts at any time. 

Causes and symptoms of dehydration in the elderly

A person is considered as elderly when he or she passes 65 years of age. The elderly population is slowly increasing in most of the developed countries. This is mainly due increased life expectancy of people as a result of development of the modern medicine and health care facilities. Elderly care  is becoming more important topic with the increase of the elderly population. People face various diseases and abnormalities with aging. Their physiological, psychological and social functions are slowly deteriorating. These deteriorating functions exert many health effects on an elderly person. Dehydration is one such health effect that requires the attention of the care givers.

Elders become dehydrated due to several reasons.  Reduced intake of water is one of the commonest causes. With aging, many people find it difficult to walk and move frequently due to illnesses such as arthritis. Some elders have developed illnesses such as stroke which has made it impossible for them to move. Therefore, most of them are confined to a single place. This prevents them from taking water when they need. They prefer staying in the same place rather than moving to get water. Some elders suffer from illnesses like dementia which cause them to forget. In such instances, they loose track of their day to day activities. These people also forget to drink water even if they feel thirsty.

Most of the elders are on various kinds of medication for various kinds of diseases. Some of these drugs can also cause dehydration . Diuretics are examples of such drugs. Diuretics are given to people with some medical illnesses such as kidney disease, heart disease, liver disease etc. They increase urine out put. Therefore, they loose more water from their body. They become dehydrated, if they do not take enough water. Constipation is another common illness in the elderly. People are given laxatives to relieve constipation. One of the side effects of laxatives is dehydration. Senior citizens are also vulnerable to gastrointestinal disturbances such as vomiting and diarrhea. This is mostly due to their impaired ability to tolerate some of the foods. There immune system is also weak. This also makes them more vulnerable to gastrointestinal infections. Diarrhea and vomiting cause loss of large amount of fluid from the body making the person severely dehydrated.

Dehydration can have serious effects on the health of a person. Severe dehydration can even cause death. Therefore, it is very important that care givers of elderly persons know about the signs and symptoms of dehydration. A dehydrated person may complain of thirst, dry mouth, and dry tongue. They can also complain of cramping of arms or legs. They can sometimes complain of reduced urinary out put and dysuria (painful urination). Dehydration is the commonest cause for urinary tract infection. If they complain of painful urination, reduced urine out put, increased frequency of urination with or without fever, they may be having a urinary tract infection. In such instances, you should check the hydration status. Dehydration of the brain causes abnormalities of the brain activities. In such cases, the person may look confused, sleepy, dizzy and irritable.

A dehydrated person can be identified by several signs. Some of them are reduced skin elasticity, dry skin, shrunken eyes, cold extremities, increased capillary refill time, rapid thready pulse, low blood pressure and increased breathing. A severely dehydrated person can also present with convulsions. If you suspect dehydration in an elderly person, check for the above mentioned signs and symptoms. If they present, take immediate medical advice. 

Physical Therapy for Shoulder Tendinitis

Shoulder pain is a common complain among adults. This condition occurs due to inflammation of the muscles around the shoulder joint. Therefore, it is called shoulder tendinitis. Shoulder  is the place where your upper arm is connected to the axial skeletal through the shoulder girdle. This joint is composed of three bones, namely the humerus, scapula, and the clavicle. The head of the humerus is inserted in to the shoulder socket (glenoid fossa). This socket is not very deep because it is designed to allow a wide range of motion to the upper limb. Therefore, there are a lot of muscles around this joint to make it more stable. These muscles include the rotator cuff muscles. There are bursae (lubricating sacs) between these rotator cuff tendons and the bones. Their main function is to prevent friction between the tendons and the bones.

Shoulder tendinitis  occurs when these rotator cuff tendons get inflamed. Shoulder tendinitis can occur in both athletes and in normal people. In normal people, it occurs when they engage in activities that involves sudden overhead movement of the arm. The incidence is more when the person’s age is 40 years or more. In athletes, the condition occurs mainly due to repetitive use of the tendons.   

There are several treatment methods  available for this condition. But, you should keep in mind that prevention is always better than treatment. So, learn the correct postures during exercising and during engaging in sports. Physical therapy is a known treatment method for shoulder tendinitis. It restores the range of movements and helps to relieve the pain and weakness it causes.

Before starting physical therapy, the inflammation must be settled. When the tendons get inflamed, they show the cardinal features of inflammation. These features are edema, rising of temperature, vasodilatation, pain and loss of function. These effects can be relieved by getting enough rest, keeping ice and by using anti-inflammatory drugs. Physical therapy, which is performed under the guidance of a physical therapists starts once the acute phase of the illness is relieved. Physical therapists are capable of identifying the tendons that are involves and assign exercises that are specific to those particular tendons.

Physical therapy for shoulder tendinitis is given in a stepwise manner. First the range of motion is restored. This is followed by stretching, stabilizing and strengthening the shoulder joint. The therapist performs the movements manually to acquire the required range of motion with minimum amount of pain.  The next step is stretching. The trapezius and the pectoralis major and minor are the muscles which are usually tight and therefore require stretching to loosen them up. These muscles are not always tight, so they need to be evaluated before starting the exercises. Stabilizing exercises are designed to improve endurance of the shoulder joint muscles. The success of these exercises depends on the use of proper technique. Strengthening exercises are begun only if all the above steps are completed successfully. Strengthening exercises should be done by using the proper technique. If not the tendons can get damaged again. 

The Origin of the Word 'Cancer"'

Cancer is a word that brings fear to anyone’s mind. It has many meanings. In medicine cancer is referred to an invasive growth arising from body tissue. In astronomy, cancer is a zodiac sign with the symbol of a crab. The word cancer is also used to describe something destructive and fast growing.

 The word cancer was first introduced to medicine by Hippocrates, the father of Medicine. He has used the words carcinos and carcinoma to describe cellular growths. Carcinos, carcinoma, Karkinos were Greek words meaning ‘crab’. He decided to call these growths as crab, because they appeared like one. Most of the cancers that Hippocrates came in to contact were end stage cancers. Fortunately, nowadays end stage cancers are rare due to screening programs and due to high early detection rates.

When examining a lump, a physician looks for several features. They are the site, size, shape, surface, surroundings, consistency and the margins.  Hippocrates has also done the same thing. There, he noted several special features of an invasive tumor. He has analyzed those features and decided to give it the name ‘karkinos’ (crab) because the tumors had many features similar to a crab. The surface of most of the malignant tumors is hard. The shell of crab is also hard. There is another argument saying that Hippocrates named malignant tumors as ‘Karkinos’ by considering the pain it causes. The pain caused by cancer is similar to the pain caused by crab’s claw.   

The word cancer was used by physicians and other philosophers since then. According to npr.org, in about 47 A.D the Greco-Roman philosopher Celsus named his encyclopedia of Medicine Cancer. Later on, another physician called Galen noticed that the tumor tissues spread away from the main mass of the tumor. This resembled the appearance of the legs of a crab. These findings supported the persistence of the term cancer in the field of Medicine. 

The term cancer has always been considered as a mean and dangerous word. Ancient people thought that cancer is a punishment given from the god to those who have done bad things. Until recently people referred to cancer as the C word. In early days, there was no treatment for cancer. Hippocrates used to advise his cancer patients to go home and stay with their loved once until they die. With the development of modern health care knowledge, services and facilities the prognosis of cancer has become less frightening. Therefore, now people use the word cancer more often than early days.