A Simple Guide to Obesity Part 2

A Simple Guide to Obesity Part 2
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What is the Treatment of Obesity?
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Motivation:
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Motivation is the key to weight control.

Knowing the dangers of obesity will help to motivate a person to lose weight.

Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.

Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.

Regular Exercise:
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Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.

Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.

Lead an active lifestyle.
Do not sit and watch TV all the time.

Diet Control:
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Choose a healthy diet with with reduced calories and which is nutritionally balanced

Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar

Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.

A combination of diet and exercise is more effective in reducing than either one alone.

Medication:
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Two main types of medications are available to help control weight:

1.Appetite suppressants:
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help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.

They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.

They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.

They should be used for short term (6-12 months) as there is also a danger of dependency.

2.Fat absorption suppressant:
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prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.

Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.

They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.

They can be taken for a longer peroid of 2 years.

Surgery:
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Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.

Surgery should be used only drug therapy, diet, exercise have failed.

Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.

Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.

Surgery has some complications such as infections.

How do you prevent recurrence of Obesity?
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Many studies showed that most people will regain weight within 5 years.

You can maintain your weight by
1.eating a low calorie diet, low in fats

2.maintaining a healthy exercise regime

3.maintaining motivation and self esteem

4.monitoring your weight food intake and exercise

A Simple Guide to Coronary Heart Disease Part 2

A Simple Guide to Coronary Heart Disease Part 2
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What is the treatment of Coronary Heart Disease?
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Any heart attack is an EMERGENCY!
Immediate treatment is urgent!

While waiting for the ambulance, lie the patient in a slightly inclined position.
Give nitroglycerin tablet under the tongue if available.
Admit to hospital as an emergency.

Severe cases are admitted to Cornary care unit(CCU) for constant monitoring of the heart, blood pressure and abnormal rhythm of heart rate.

Risk factors for Coronary heart disease like hypertension, high cholesterol, diabetes must be treated.

Medicine:
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Anticoagulants such as warfarin, aspirin, Plavix,should be given to
prevent blood clots .

Vasodilators like isorbide are given to help dilate the artery to the heart

Any abnormal rhythm of the heart must also be treated with medications or pacemaker if severe as damage to heart may affect the conduction of the electrical impulse of the heart to the cardiac muscles.

Because of the psychological effect of a heart attack on the patient, sometimes antidepressant or tranquilliser may be necessary.

Interventional Procedures:
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Once stable the patient may be requred to have a ballooning of the narrowed artery or a stent inserted in the narrowed artery.
This can be done during the cardiac catheterisation.

1.balloon angioplasty
balloon is inflated to compress fatty matter to the wall of narrowed artery and open the blood vessel

2.Stent:
balloon angioplasty is performed in combination with placement of a stent which is a small, metal mesh tube that provide support inside the coronary artery.

3.Drug eluting stents (DES):
Drug-eluting stents contain a medication that is actively released at the stent implantation site to prevent recurrence of narrowing of the artery

4.Rotablation
The Rotoblation special catheter, with an acorn-shaped, diamond-coated tip, spins around at a high speed and grinds away the heavily calcified plaque on the arterial walls.

5.cutting balloon
The cutting balloon catheter has a balloon tip with small blades which are activated when the ballon is inflated. The small blades remove the plaque and the balloon compresses the fatty matter into the arterial wall.

Surgery :
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If the narrowing involved too many arteries, then a coronary artery bypass graft (CABG) surgery will have to be done.

Stay in Hospital and Rehabilation:
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Usually a heart attack patient stays in hospital for 2-4 weeks depending on the severity of his condition.

Mild exercise is started once his condition is stable.
Exercise is good for the patient because it helps the blood circulation.

However strenous exercise including sexual inercourse should start until at least 4-6 weeks later.

Most patients should be able to drive or fly after 2 months.

What can I do to prevent Coronary Heart Disease?
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Prevention of a heart attack is the same as prevention of a stroke as both involve the avoiding the blockage of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

3.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

4.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

5.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

What is the prognosis of Coronary Heart Disease?
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The outlook following a coronary heart attack is generally good.
About 80% of patients are alive after 3 years and 70% after 6 years.

The outlook varies depending on the age of the patient and severity of the heart attack.

However with new treatment and a healthy lifestyle, the prognosis has improved tremendously.

Medication such as Aspirin or warfarin may have to be taken permanently to prevent a recurrent attack.

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
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Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
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A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
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1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
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1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
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Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

A Simple Guide to Nasopharyngeal Cancer

A Simple Guide to Nasopharyngeal Cancer
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What is Nasopharyngeal Cancer ?
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Nasopharyngeal cancer, commonly referred to as NPC, occurs when the cells lining the nasopharynx(area behind the nose and above the back of the throat) become abnormal and proliferates giving rise to cancer cells.
It affects more men than women.

What are the causes of Nasopharyngeal Cancer?
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Various causes may be involved:
1.Genes. -males between the ages of 20-50 from southern China and Southeast Asia are at higher risk.

2.Diet. such as preserved foods ( salted fish, vegetables and meat) can cause a higher risk of NPC. Cooking of such food releases toxic substances called nitrosamines into the fumes that we breathe.
Many NPC patients consumed much less fresh fruit and vegetables.

3.Virus. There is evidence that NPC patients have higher levels of the Epstein-Barr virus in their blood. The Epstein-Barr virus activating substances have been detected in a number of these preserved foods.

4.Smoking. People who smokes have a higher risk

What are the signs and symptoms of Nasopharyngeal Cancer?
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The following are symptoms of nasopharyngeal cancer:

1.A painless lump in the neck-usually a lymph node infiltrated by cancer cells

2.Nosebleed or blood stained sputum

3.Blocking of one or both nostrils

4.Loss of hearing, or ringing in the ear

5.Discharge from the ear

6.Blurred or double vision

7.Difficulty in breathing or speaking

8.Persistant Sore throat

9.Paralysis of one side of the face

10.Headaches

How can Nasopharyngeal Cancer be detected?
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Examination of the upper part of the nose for swelling or lumps.
An endoscope is inserted into the nose. The ENT specialist may extract tissue(biopsy) which can be sent for testing, to confirm if there is a cancerous growth.

If a tumour is found, magnetic resonance imaging (MRI) can be used to assess its size.

Patients may also be tested for the presence of the Epstein-Barr virus in their systems. This is used to indicate the likelihood of contracting NPC.

How can NPC be prevented?
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No one can be fully protected from NPC.
However, you can modify your lifestyle practices to reduce your chances of contracting NPC.
Avoid preserved foods at an early age.
Eat fresh fruit and vegetables. Studies ave found that citrus fruits (rich in Vitamin C) and orange-coloured vegetables (eg, carrots and sweet potatoes), tomatoes, and dark green vegetables (all rich in carotenoids) also help lower the chances of contracting NPC.
Don't smoke. Smoking increases the risk of NPC by two to four times. Those who smoke, can still lower their risk by cutting down on the number of cigarettes smoked a day. Better still, quit smoking.

How can Nasopharyngeal Cancer be treated?
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Radiotherapy.
This is the most common treatment. This involves the use of radiation to attack cancer cells, stopping them from growing or multiplying.

Chemotherapy.
This involves the use of anti-cancer medication to treat the cancer.
For both methods, the patient may experience side-effects such as tiredness and nausea.

Surgery
Surgery is seldom used because of the danger of cutting tissues too close to the brain.

Early treatment is recommended as it increases the patient's chances of survival.
Delayed action could result in the cancer spreading to other parts of the body, making it more difficult to treat.

A Simple Guide to Irritable Bowel Syndrome

A Simple Guide to Irritable Bowel Syndrome
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What is Irritable Bowel Syndrome?
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Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal system. It is characterised by abdominal pain/cramps, bloating or gas, diarrhoea and/or constipation. It is also known as spastic colon.

Who is affected by Irritable Bowel Syndrome?
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It occurs in one in five persons and usually between the ages of 20-50.
Women outnumber men by two or three to one.
It can become a chronic condition causing much discomfort and inconvenience to the patient. However, it does not progress to cancer.

What is the Cause of Irritable Bowel Syndrome?
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The exact cause of IBS is not known.

The muscles of the walls of the intestines in the normal person contract and relax in a co-ordinated rhythm known as peristalsis. This action helps to move food along the intestines during which time absorption takes place.
The nerves and muscles in the bowel appear to be extra sensitive in people with IBS. The contractions are stronger and last longer.
Food is pushed along the intestines at a faster rate, giving rise to abdominal pain, gas and diarrhoea. Sometimes, the opposite occurs. The contractions are weaker causing the passage of food to slow down and constipation results.

Other factors that have been shown to play a part are stress, diet and hormones. These are called triggers.

1.Stress
which may be psychological or physical.
Psychological stresses such as family misunderstanding; bereavement; anxiety; meeting deadlines etc.
Physical stresses such as illnesses, infections, exhaustion etc.

2.Diet
certain foods have been known to cause the onset of symptoms. They include fried or oily food; gas-forming foods e.g.broccoli, beans, cabbage; chocolates; coffee.

3.Hormonal changes
some women experience attacks during or around their menstrual periods.

What are the Symptoms of Irritable Bowel Syndrome?
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The main symptoms of IBS are:
1.Abdominal pain or cramps-usually over the left side or over the lower abdomen
2.Bloating and/or gas
3.Diarrhoea, constipation or alternating diarrhoea and constipation.
4.whitish mucus in the stool

The symptoms can range from mild to severe.
In many cases the symptoms are bearable and go off after a bowel movement.
Women with IBS often have more symptoms during their menstrual periods.

How do you make the Diagnosis of Irritable Bowel Syndrome?
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Because the cause is unknown and there is a lack of specific physical signs, diagnosis is arrived at through a process of elimination .

A colonoscopy is usually done to rule out colon cancer, diverticulosis, polyps.

What is the Treatment of Irritable Bowel Syndrome?
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There is no real cure for Irritable Bowel Syndrome.
Treatment is mainly symptomatic i.e. it is directed towards the relief of symptoms.

Mild symptoms usually go off on their own.
If symptoms are severe, the doctor may prescribe the following:

Anti-spasmodics for the abdominal pain and cramps,
Anti-flatulents to get rid of gas and relief the bloating,
Anti-diarrhoeals to stop diarrhoea,
Antidepressants, even in lower doses than are used for treating depression, can help people with IBS.
Laxatives to relief constipation.

Foods and drinks that may cause or worsen symptoms include:

fatty foods, like french fries
milk products, like cheese or ice cream
chocolate
alcohol
caffeinated drinks, like coffee
carbonated drinks, like soda

Some foods make IBS better.

Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass.
However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables.
Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.

Eat small meals for example eating four or five small meals a day.
Large meals can cause cramping and diarrhea in people with IBS.

Stress doesn’t cause IBS, but it can make your symptoms worse.
Learning to reduce stress can help with IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.
Meditation, exercise, hypnosis, and counseling may help.

What can be done to prevent Irritable Bowel Syndrome?
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Prevention is an important part in the total management of this condition.
They consist of stress management and life-style changes.
Stress management
Avoid unnecessary stress
Learn to relax
Exercise regularly

Dietary changes
Avoid oily, spicy food
Avoid gas-forming foods e.g. cabbage, broccoli, beans
Avoid coffee, chocolates, and alcohol
Avoid large meals
Take more fibre