Health Wikipedia

Pain in the knees is particularly a serious problem faced by the older people. Sometimes it becomes so severe that it incapacitates people in bed.

Age related wear and tear of the knee — known as Osteoarthritis (OA) is mainly responsible for this. Although common, many people are not aware of the solutions that are currently available. Proper medication, physiotherapy, lifestyle modification and sometimes surgery can help stop or lessen the pain.

In Bangladesh, approximately 10 million people are suffering from Osteoarthritis. Women suffer more — 2 out of 3 women over the age of 65 have osteoarthritis. More than half of all men over the age of 65 have osteoarthritis.

With the increasing longevity of life, the problem will multiply itself within a very short time. Osteo-arthritis occurs when the knee undergoes age-related wear and tear around its joint. Almost every one is affected by it to some extent, as they grow older.

Osteoarthritis can also occur in weight bearing joints mainly hips and ankles. This form of arthritis slowly and gradually breaks down the overlying bony ends which forms the joint.

With osteoarthritis, the smooth surface of bones becomes rough and pitted. In advanced stage it may wear away completely. Without the normal gliding surface the bones, eroded bones grind against one another causing pain, swelling, restricted knee motion, crispy sound inside the joint and sometimes bowing of the knees.

In addition to age related wear and tear, athletes, labourer and highly physically active persons often stress their knee joints that lead to prolong wear and tear, which places them at increase risk of developing arthritis.

Arthritis has been linked with joint injuries and damaging events like fractures and infections that can harm the internal tissues of the joints. Individuals who experience repeated knee injuries are much more likely to develop osteo-arthritis as they get older.

Lack of exercise can weaken the thigh muscles that support the knee joints, eventually making the under-used joint stiff, painful and dysfunctional. Lastly, heavy individuals are at increased risk of developing osteoarthritis, because their knees become strained by excessive weight. Research indicates that people who are overweight as young adults are likely to develop osteoarthritis of the knees as they age.

“When and how would I understand that I have osteoarthritis?” is a common question I face in my clinical practice. People start limping and the knee may become swollen with fluid. There may be a reduction in the range of motion of the affected knee — the knee bends less than normal and may lose the ability to completely straighten out. Finally, as the condition becomes worse, the pain persists all the time and may even keep you awake at night.

Repeated knee pain is the main symptom. It tends to be worse after activity. Knee stiffness occurs after rest, the joint feels stiff and it hurts to get going after sitting for any length of time. In time, the joint gets stiffer and you are unable to fully straighten or bend the joint. Knee swelling is also common especially after excessive activity. Knee bowing is seen if osteoarthritis is severe, your joint may become deformed what we call bowlegged.

Most people suffering from osteoarthritis can be treated by non-surgical means which include pain killer, physiotherapy, life style modification and injection in to the knees. Unfortunately if the medical measures are not successful in relieving pain, surgery may be considered. Among the surgical options, arthroscopic washout of the knees is relatively new method in Bangladesh used to relieve pain for sometimes.

When medical measures and arthroscopic washout fail; knees become progressively worsened both in pain and deformity, total knee joint replacement are the better option which is now being done in state-of-the-art hospitals under skilled care of experienced Knee Consultants.

Dr M Ali

Breast lump or swelling in the breast is a complaint frequently encountered by general surgeons. It is a common reason for the female patients to seek surgical consultation.

In my surgical practice the most common question that I face from the patient — “Is it cancer?” Breast lump has become synonymous with breast cancer. The fact is only 20 percent of breast tumours turn out to be malignant or cancerous!

Commonest benign (non-cancerous) breast lump is called fibroadenoma which is typically found in young women. It is generally smooth, spherical, painless and very mobile without any attachment to skin or surrounding breast tissue. More than one lump may be present. It gradually increases in size and may eventually fill the whole. During pregnancy fibroadenoma may increase in size, but returns to the original size after delivery of the baby.

Fibroadenoma is usually treated by surgical removal. It is a minor operation commonly done under short general anaesthesia. It is possible to plan the cut in the breast skin in such a way that there is almost no post-operative scar marks. In case of unavoidable large cuts, it is placed in such a way that the scar is hidden under the clothing.

The other common breast lump is due to an abnormality in female hormone level. In this condition, multiple lumps of various sizes are found in the breast. Typically both breasts are involved, although patients may complain about one breast only. Lump size maybe somewhere between a size of grain to 3-4 cm. The breasts are painful and tender. The pain may become intense at or near the time of menstruation. The pain may radiate to the arm or back, and may be so severe to interfere normal life.

In most patients it is the pain that brings them to a surgeon and not the lump. There may be nipple discharge in the form of clear sticky fluid.

The disease called Fibroadenosis is a disease of the reproductive age. It may be self-limiting, usually disappearing after the first pregnancy. In most patients the disease is of mild form and simple painkiller with adequate explanation usually brings about a relief.

More resistant cases are treated with hormone therapy. Surgery is reserved for extreme cases. A particularly painful cyst or lump is removed under general anaesthesia. As in fibroadenoma, it is possible to plan the skin cut to provide best cosmetic results. The most important point to remember from the patient’s point of view is the possibility of recurrence, and more than one operation may be required.

A breast lump is particularly a concern in women with risk factors. Risk factors include age, family history, early onset of menstruation, late menopause, late first pregnancy, obesity, hormone replacement therapy etc. More than 66 percent of women with breast cancer are above the age of 50 years and 80 percent are at least 40 years old. The chances of developing cancer are two to three times higher in case of women with a close female relative (mother, sister) who had breast cancer.

Early diagnosis is the key to effective treatment for breast cancer. Most breast cancers are detected by the patient herself. This is why, self-examination by the patient is important.

Health is not just absence of disease but it is a state of wellness in which a person enjoys physical, mental, social and spiritual health. Health is connected to the total well being of an individual. Apart form environmental and social factors, there are subtle factors that affect the health of a person. A clean and pure mind is a prerequisite for healthy life. A pure mind enables the use of time, energy and resources in the best way. Stress or negative thinking has been identified as a leading cause of quite a number of major illnesses.

Holistic health encompasses total health of a human being in all four aspects of life — physical health, mental health, social health and spiritual health. Meditation promotes health in all these areas of life. Meditation regulates the physical responses of the body by eliminating stress and stimulating healthy hormones. It creates self-control thus enabling a person to remain free from negative influences and give the best in every role and situation. It empowers a person to deal with challenges in equanimity and positivity. Meditation alters the physiological and psychological response of the body remarkably. Reduction in heart and respiratory rate, and a drop in blood pressure suggest reduction in the level of sympathetic activity. Meditation aids the secretion of ‘healthy’ hormones such as endorphins and encephalon’s, which help, in detaching oneself from various kinds of pains. Meditation helps sustain deep relaxation even during active states of mind. Brain wave recordings of Rajyogis have shown alpha and theta waves even while they performed various mental and intellectual tasks.

The benefits of meditation go beyond relaxation response. A number of studies have critically investigated meditation for effective treatment of hypertension, diabetes, headache, anxiety, depression and heart disease. Meditation reduces the requirement of medication for pain and sleep etc. It is reported to be effective in de-addiction from drugs; alcohol, tobacco and can increase decision-making skills, overcome irrational fears, phobias and expand spiritual life.

One of the most subtle but critical factors that affect health is quality of our actions. The law of action is infallible — you reap what you sow. If we use our body to perform good and right actions then we will enjoy good health. Body is the temple in which the divine self resides. If we treat our body well then it will perform well. The seed of good actions is pure feelings and thoughts; hence, we have to make a conscious choice to nurture only pure thoughts. Everything that we suffer through our body is a debt of bad action that the soul is paying off. To enjoy good health we have to accumulate a stock of good karma by sharing the qualities of peace, love and joy in every thought, word and action.

Memory is the mental registration, retention and recollection of past experiences, sensation or thought. Sometimes we cannot retrieve important information that we stored in our brain. Many people forget things easily. Memory impairment is embarrassing too. With some of the following exercise we can memorise things better.

Brain exercises
Memory is like muscular strength. The more we work out our brain, the better we will be able to process and remember information. Regularly exercising the brain keeps it growing and spurs the development of new nerve connections that can help improve memory.

Mnemonic to improve memory
Mnemonics are clues of any kind that help us remember something, usually by causing us to associate the information we want to remember with a visual image, a sentence, or a word. Common types of mnemonic devices include visual images, sentences, word, acronyms, rhymes and alliteration, joke etc.

Regular exercise
Regular exercise increases oxygen to our brain and reduces the risk for disorders that lead to memory loss, such as diabetes and cardiovascular disease. Some study found that it might enhance the effects of helpful brain chemicals and protect brain cells.

Managing stress
Stress cause release of hormone cortisol that can damage the hippocampus (important memory area of brain). Further, stress makes it difficult to concentrate.

Good sleep habits
Sleep is necessary for memory consolidation. Sleep disorders like insomnia and sleep apnea leave you tired and unable to concentrate during the day.

Not smoking
Smoking heightens the risk of vascular disorders causing stroke and constrict arteries that deliver oxygen to the brain. Indirectly it impairs brain function.

Nutrition
It is found that diet based on fruits, vegetables, whole grains, and healthy fats found in fish will provide lots of health benefits along with improving memory. Vitamins B, especially B6, B12, and folic acid protect neurons by breaking down homocysteine, an amino acid that is toxic to nerve cells. They are also involved in making red blood cells, which carry oxygen. Spinach and other dark leafy greens, broccoli, asparagus, strawberries, melons, black beans and other legumes, citrus fruits, soybeans rich in those vitamins.

Antioxidants found in berries, sweet potatoes, red tomatoes, spinach, broccoli, green tea, nuts, seeds, citrus fruits, liver destroy free radicals are highly reactive and can damage brain cells.

Omega-3 fatty acids are concentrated in the brain and are associated with cognitive function. They count as healthy fats, as opposed to saturated fats and trans fats, protecting against inflammation and high cholesterol. Cold-water fish such as salmon, herring, tuna, halibut, mackerel, walnuts and walnut oil rich in omega -3 fatty acids. Iron is also important for staying mentally sharp. It helps create hemoglobin, an iron containing protein in red blood cells, which transport oxygen to the brain. Oxygen in the brain is vital, since it helps to metabolise glucose.

If a child does not receive enough iron, it can impair brain development and lead to deficits in speech, math and reading.

Laser hair removal is a technique that uses beams of highly concentrated light to penetrate the hair follicles. The light is absorbed by pigment in the hair follicles and destroys the hair within the follicle. Removing unwanted hair thus leaves you with bumps, burns, or the hassles of repeated shaving, tweezing, or waxing. Hence, laser hair removal may be an option worth considering.

Although Lasers are useful for removing unwanted hair from different parts of the body, you must consider the following things before undergoing this procedure.

* Prior to having laser hair removal, you should thoroughly check the credentials of the doctor performing the procedure and the hospital where you are planning to avail the service.

* Once you have planned laser hair removal, you should limit plucking, waxing and electrolysis for six weeks before treatment. That is because the laser targets the hairs’ roots, which are temporarily removed by waxing or plucking.

* You should also avoid sun exposure for six weeks before and after treatment. Sun exposure decreases the effectiveness of laser hair removal and increases the risk of complications following treatment.

* Laser hair removal works better on some people than others. No one knows for sure what the regrowth rates are. Some people notice regrowth after several months or years, while others find they never have to shave again.

* Costs of Laser hair removal vary widely depending on a number of factors like size of the area being treated and time required for treatment and number of sessions required. Because each person’s pattern of hair growth is unique, it is difficult to predict exactly how many treatments will be needed to completely get rid of unwanted hair or the exact cost of doing so. For a better idea of the cost for your particular hair problem, you should schedule a consultation with a doctor, who must be an expert dermatologist with skill and experience in laser skin treatment.

World Kidney day was observed on 11 March in more than 100 countries of the world. The slogan of World Kidney Day this year was “Protect your kidneys, control Diabetes”. World Kidney Days aims to raise awareness about the heavy burden of chronic kidney disease (CKD) on human lives.

The mission of World Kidney Day is to raise awareness of the importance of our kidneys to overall health and to reduce the frequency and impact of kidney diseases and its associated health problems worldwide. The objectives of the World Kidney Day 2010 were the followings:

* Raise awareness about our “amazing kidneys”

* Highlight that diabetes and high blood pressure are key risk factors for chronic kidney disease (CKD)

* Encourage systematic screening of all patients with diabetes and hypertension for CKD

* Encourage preventive behaviours

* Educate medical professionals about their key role in detecting and reducing the risk of CKD, particularly in high risk population

* Stress the important role of local and national health authorities in controlling CKD epidemics. Health authorities worldwide will have to deal with high and escalating costs if no action is taken to treat the growing number of people with CKD. On World Kidney Day all governments are encouraged to take action and invest in further kidney screening

* If detected early, CKD can be treated by reducing other complications and dramatically reduced the growing burden of deaths and cardiovascular disease worldwide

Kidney diseases are silent killers which largely affect the quality of life. There are, however, several easy ways to reduce the risk of developing this kidney disease.

Seven golden rules:
i) Keep fit and active
ii) Keep regular control of your blood sugar level
iii) Monitor your blood pressure
iv) Eat healthy and keep your weight in check
v) Do not smoke
vi) Do not take over the counter pills on regular basis
vii) Check your kidney function if you have one or more of the high risk factors

Diagnosis of CKD with Diabetes:
People with diabetes should be screened regularly for kidney diseases. The two key markers of kidney diseases are eGFR and urine albumin. Kidney diseases are present when eGFR is less than 60 ml/min.

The Americal Diabetic Association (ADA) and National Institute of Health (NIH) recommend that eGFR can be calculated from serum creatinine at least once a year in all people with diabetes.

Urine albumin is measured by comparing amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amount of creatinine but almost no albumin. Even small increase in ratio of albumin to creatinine is a sign of kidney diseases. Kidney diseases is present when urine contain more than 30 mg of albumin per gram of creatinine, with or without decrease eGFR. The ADA and NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have type 1 diabetes for 5 years or more.

Good care makes a differencePeople with diabetes should:
* Measure their HbA1C level at least twice a year which should be kept less than 7%

* Regular insulin injection, intake of other medicines, meal planning, physical activity and blood sugar monitoring

* Blood pressure should be checked several times a year which should be kept <130/80 mmHg

* Regular intake ACEI or ARB medicine for controlling high blood pressure

* To measure effective eGFR yearly

* To estimate urine albumin atleast once a year to check kidney damage

* To take reduce amount of protein in the died at to seek health from the dietitian regarding meal planning

In conclusion early detection and treatment of kidney diseases are the best way to prevent CKD in order to reduced substantial burden of health budget.