Forgetting things has always been a matter of concern for most of the people. Most are concerned about the scare of Alzheimer’s as well. It has to be emphasized that our forefathers had been much better off during their days. Just as the body ages, the brain too ages and so also a decline in cognitive power can ensue. That is inevitable, but one can delay the onset and slow the progress of the decline with some efforts.
Now- a- days with the advent of improved technology, people are able to communicate better and faster and people from across the globe can be connected easily, but it has caused other problems as well. People are so busy peering into their mobile phones or electronic gadgets, they get frequent eye strain issues and dry eyes, neck and back pain due to the hunched posture, finger pain and wrist pain due to punching the buttons and have the lost of communication and eye contact. There are, however, a lot of people who use the mobile devices as an organizer which stores telephone numbers or helps schedule their appointments or remind them of things to be done. It has reached a point where people have almost stopped taxing their brain or mental capabilities to a point where they do not even recollect their families phone numbers !!! Strangely, many pharmaceutical companies have started capitalizing on this weakness and have brought about “magic cures” to help boost memory. Some medicines being taken for regular ailments have also been implicated in loss of memory !
Most of the time, the brain is not stretched to use its full potential causing it to be dull and lazy.
There are some good and harmless ways to get over this handicap before it gets out of control.
- Reading a book
- Learning a new language
- Play games
- Visiting a museum
There are good steps which can be done to help wake up the “sleeping brain”. There are the right handed and the left handed people. For the right handed people the right side of the brain is not used much and likewise for those who are left handed.
Neurobics is a type coined for the exercises which help the brain.
Playing Sudoku, chess, solving crosswords or the Rubiks cube are effective neurobics. Writing or drawing with the non dominant hand helps wake up and fire the sleeping side of the brain.
Trying to guess the dish by tasting it while blindfolded also helps to stretch ones imagination. You can add up fun by asking to guess the ingredients used in the cooking of the dish.
Playing exergames ( video games which involve exercise as in X box, play station, Kinect or Wii Fit ) helps creative skills and burns calories as well. These are particularly useful for those staying in places of extremes of climate, for the aged, for those shy to go outdoors and for those who do not have many friends. These also help the younger generation to bond well with the elders and people with joint problems can get moving as well. I do agree a walk in garden or beach side or a park will have its own benefits, but if unfavorable, this is a good alternative.
It goes without mentioning that adequate sleep, getting enough sunshine, exercise, having a good social support and a healthy diet all help in boosting brain power.
Try remembering phone numbers or appointments without the help of the mobile gadgets or the organizer.
Socialising and staying calm also help boost the brain functioning. Being stressed out does jolt your brain to standstill. When you are stressed, the brain refuses to think straight.
Though there are medicines which do claim improvement of brain ability, I am not competent enough to comment on those. I would rather you try boosting the mental power the natural way.
You must have been tired listening to doctors mentioning do some exercises …… but not many go into details of how to exercise, which exercises to do, how frequently one is to exercise or about the intensity. The important thing is to get started in case you have not. Any small step is better than no step at all.
Before embarking on a fitness program, especially if you have never done exercises regularly, get a medical checkup done by the doctor which will include an assessment of the heart as well. Though exercises are beneficial, they can cause problems for some with certain problems like eye, kidney, joint, nerve or heart problems.
If all is okay, assess how fit you are by these simple steps:
- Check pulse rate before and immediately after walking 1. 6 km or a mile. The pulse rate should not be racing away. The time taken for the heart rate to come back to normal level before you started walking is equally important.
- How long does it take you to walk a mile or run 2.41 km or 1.5 miles.
- Waist circumference
- Body mass index
Once you have assessed how fit you are, then design a plan:
- Define the need for the exercise plan- to don dresses that had been in the shelves for long, to look and feel good, for weight reduction, to do a marathon or to look good at a function.
- The activity must be of at least 150 minutes of moderate aerobic activity a week
- Include different activities so you do not get bored. You can walk, cycle, jog, do water exercises, skip the rope, do the hula hoop, aerobics, zumba dance and so forth.
- Remember to start slow and progress slowly.
- Stretching before exercises is very important.
- Allow time for recovery.
- You need not do all the activities at one go. You can conveniently space them out in intervals.
- Be flexible. Do not punish your body.
Now that all is set, get the right footwear , get the right apparel, use a fitness app in your smartphone or use a fitness watch. The apps in the smartphone now-a-days gets one to be motivated to carry on.
Keep a diary to record the progress you made.
Reassess yourself every month.
Set new goals
Push outside your comfort zone as the body gets adjusted to the exercise quite soon and you will notice that the body needs to be pushed further to achieve more.
Do “listen” to your body. If weak or paining, do give a break and make sure all is okay. The injuries related to exercise too had been detailed in an earlier newsletter.
It is a welcome change in the climate after months of scorching heat in the middle East. This might last for a couple of months before the scorching heat picks up again. It is the time for outdoor partying, smell of inviting barbeques and probably increase in bad cholesterol levels !!!!! It is also the time for contracting viral fevers. Have you had your annual flu shot? The Flu Vaccine at least helps against many of the strains of virus which are getting more complex with each passing year.
Losing weight is something the doctor always stresses on. Interestingly, you might notice that the males are generally reluctant to address the obesity as well as their female counterparts. Moreover, weight loss is slower among those with diabetes due to the medicines they are on and also due to diabetic dysregulation. But , that cannot be used as an excuse for losing weight or even trying to.!!!! There is always a weight loss plateau that is to be expected and that should not deter yourself from continuing, but will need a self assessment as how to overcome the plateau.
Many now blame the cold weather and cold breeze and wish to remain cuddled under the blankets or remain indoors and try eating more to keep the body heat.
Impulsive eating can occur when stressed ( positive stress is during a vacation and negative stress during a personal tragedy) , when angry, when depressed or when worried about an upcoming event or even when stewing over a conflict at office or work. This often leads to impulsive eating followed by the guilt and again feeling low followed by eating again which gets you nowhere healthy !!!
Bed time snacking
People might keep on snacking to give them the so called energy while staying up awake while working late hours. There are certain occasions when you are allowed to snack especially when having an early light dinner and sleeping late. But, there are certain things to be known while snacking.
- Warm milk contains tryptophan and helps in sleep
- A bowl of cereal with milk or a glass of labaan( butter milk) , crackers or bread and cheese all can cause sleep due to the carbohydrate content.
- Sources of hidden caffeine and fatty food such as burgers can impair with sleep.
- Alcohol ( nightcap) might cause nightmares, frequent awakening, night sweats and headache for some which can impair with sleep. Drink plenty of water after the sleep.
- Protein rich and high fat food will cause problems in digestion which can impair sleep.
- Spicy food and smoking can impair with digestion.
So make healthy choices while snacking. Snack is just a small meal and not another meal.
The winter months are a cause for celebrations and family outings . The smell of barbeque fills the air after the sun sets. People might eat more of meat and prawns which might increase the cholesterol levels. You can however go a walk outside as the climate is much better than the hot humid summer climate.
Generally sugar levels and cholesterol levels rise with the increased food and alcohol consumption during the winter months.
You can safely exercise indoors if the weather outside is not to your liking. Tai Chi, Pilates, using the Hula Hoop, dancing to music, yoga, skipping rope or just spot jumping helps burn calories. Zumba or kick boxing are options that needs a trainer to help you out. For the fitness freaks who like to sweat it out in a gym, try something new at the gym or use resistance bands. You can swim or do any exercise in the pool as water is kind to the joints. Aqua aerobics is catching up in a big way as it is entertaining and kind on the joints as well. One can enjoy shopping by walking in the malls and doing window shopping !!!! Walking is still a good exercise. Take care of your footwear and use proper clothing if walking outdoors. Cover your head and neck if very chilly. The new form of play station using the X box helps you engage in interactive games and helps you combine entertainment with exercise and it can be enjoyable when performed with either family of friends.
For those who are interested in resistance training using small weights, remember to always warm up, stretch and do repetitions of ten to twelve in a smooth controlled motion. The muscles might ache at the beginning, Give a rest in a between and try these on alternate days to help the muscles to recover.
How to overcome barriers to exercise?
- Break the times of exercise to smaller periods if it not practical to spend 30 minutes a day for five days a week.
- Identify causes of waste of time such as watching the television, lying on the sofa. See if these can be overcome.
- Reframe the concept of exercise such as walking the dog or taking the kids for playing, playing ball on the beach or even dancing, walking in a mall, walking around a large airport terminal while waiting for the flight.
- Join a group who can motivate you.
- Watch the television or listen to music while exercising.
- Take stairs instead of the lift or escalators.
- When ill, do not exercise.
There are numerous apps which can be downloaded from the app store if you have a smartphone. These can monitor the progress and can even motivate you to get moving.
Ask yourself why you want to lose weight:
|Feel comfortable in clothes
|Improve self image and confidence
|Improve physical stamina
|Improve energy levels
|Be a role model for my family
|Improve the blood pressure, cholesterol and diabetes
|Reduce joint pain
|Improve life expectancy
You might want to add more…..such as want to look good at a function or don those clothes which you outsized and so on…..
Write down the challenges and obstacles you face towards achieving the goals. The more honest you are with yourself, both in recognizing the obstacles and coming up with realistic strategies, greater are your chances at succeeding. Let that be your New Year resolution.
Diabetes is on the rise the world over. Just about anybody can become a diabetic whether you are rich or poor or a male or female or whether your parents are diabetic or not. It is largely attributed to the disordered lifestyle habits and increased stress levels in day to day life that has caused this to blow out of proportion.
People turn to shortcuts such as the great number of diets available each one claiming superiority over the others, a great number of holistic medications or alternate medicines and of course, sugar free substitutes. It has taken the markets by storm and you have so many available in the market today which has been incorporated into carbonated soft drinks, chewing gums, baked goods, cakes, fruit juices, candies, ice cream and even yogurt.
There are natural sweeteners such as Agave nectar, date sugar, fruit juice concentrate, honey, maple syrup and molasses which are available in the market.
The artificial sweeteners are always artificial though some products such as those containing stevia are claiming themselves to be natural. But it has to be either refined or processed to be marketed. These are intensely sweet and are many times sweeter than natural sugar. All the sweeteners leave an aftertaste.
There are different types of sweeteners such as :
- Low calorie or no calorie sweeteners
- Non nutritive sweeteners
- Sugar substitutes
- Reduced calorie sweeteners
Some of the sweeteners can be used for either baking or cooking as well. These can come in different forms such as tablets, or sachets containing powder or in liquid forms.
Sugar alcohols do not contain alcohol and do not contain ethanol which is seen in alcoholic drinks. These are naturally seen in certain vegetables and fruits, but can also be manufactured. These help to increase the bulk and improve texture when added during cooking or baking. These are seen in toothpastes, mouthwashes, chewing gums, frozen desserts, fruit spreads and chocolate. It is labeled as Xylitol or sugar alcohol in the nutrition labels.
When consumed in large quantities the use of sugar alcohols can cause a bloated up feeling, loose stools and abdominal fullness
I have seen many people who had a craving for sweets after consumption of the artificial sweeteners which in turn, causes the sugar levels to fluctuate. This in turn, leads to an increase in either the doses of medicines or injectables with the hope to control sugar levels. Just being off the artificial sweeteners bring about so many changes and reduces the cravings as well.
Some of the common brands available in the market are:
- Sweet N low® contains sachharin
- Equal® contains aspartame
- Sweet one® contains Acesulfame potassium
- Splenda® contains Sucralose
- Fruit juice concentrates contain Neotame
How sweet are these artificial sweeteners?
Sachharin is 300 times sweeter than sugar, aspartame is 180 times sweeter, acesulfame is 200 times sweeter, sucarlose is 300 times sweeter and Neotame is 7000 times sweeter than sugar.
When artificial sweeteners are used there are some health concerns to be careful of- these can attribute to weight gain, tooth decay, probable increase in incidence of diabetes, cancer and troublesome numbness of the hands and feet, muscle spasms, giddiness and cramps. Generally people who are diabetic or those at risk to develop diabetes tend to rely more on ingestion of the so called sugar free containing food items. Besides having a lot of artificial sweeteners, the rest of the ingredients are the same which do add to the calories. Also it is worth bearing in mind that the taste has to be modified to enhance the flavor and also help it being sold off the racks at the supermarkets. The enhancement of flavor is done with the help of adding more hydrogenated oils or butter or fats which leave an excellent buttery taste and can help increase cholesterol levels !!!! People in this mad frenzy, tend to overeat their portions because of the false security given by the artificial sweeteners.
Being a diabetic does not mean you should be off sugar in totality. Your body needs a balance of sugar, salt, fats, carbohydrates, proteins and fat to make a complete meal which can be taken as small frequent meals to prevent cravings later on. Combine this with adequate physical activity and all will be well.
The solution to sugar needs:
You can substitute the white sugar with brown sugar or cane sugar which is the unrefined version of sugar. It is extremely hygroscopic and hence absorbs water from the atmosphere once the cover if opened. Store this in air tight containers. Roughly 3 spoons of brown sugar equals one spoon of white sugar.
Remember that people of the previous generation did not rely on artificial sweeteners.
Checking the blood sugar is as common as checking ones blood pressure these days, but is not done as frequently though. There may be no symptoms at all related to high blood pressure or there maybe headache, giddiness or even shortness of breath. Some may present with severe headache or paralysis of one side of the body with a slurred speech or chest pain as part of a massive heart attack.
Having high blood pressure undetected and untreated over a long period of time, can put a strain on the important organs such as the heart, kidney, brain and eyes.
Blood pressure, diabetes mellitus and high cholesterol levels are like close friends. These all are affecting the blood vessels and having one can put you at risk for developing the other two.
Blood pressure is the pressure of the blood in the blood vessels which help propel the blood forward from the heart to different parts of the body carrying oxygen where needed and also carrying away the waste products from the kidneys and liver.
Blood pressure is recorded by a machine called sphygmomanometer in which a mercury expansion is measured. This is operated only by health care professionals as you have to hear the sounds to decide the blood pressure.
Now-a -days, digital blood pressure machines are available. The ones measuring the blood pressure by inflating the cuff around the arms is preferred. The ones measuring around the wrist is not reliable. The digital machines can be battery operated and or AC/DC operated. The batteries have to be removed after each check to prevent the leak of the batteries while kept inside for indefinite periods of time. There are two readings for the blood pressure, called systolic for the top reading and diastolic for the lower reading. So if the doctor tells your blood pressure is 130/80 mm it means, 130mm is the systolic and 80 mm is the diastolic reading.
The blood pressure can vary with the position, posture, soon after exercise, soon after driving, and even for some when they come to the hospital or clinic due to anxiety. It is wise to check the blood pressure after relaxing for some time. For those where anxiety visiting the hospital causes high readings, it is wise to have the blood pressure recorded at home with a machine and make a set of readings for a week and have the doctor analyse that. There is a devise which can be connected to the upper arm for 24 hours ( 24 Hour ambulatory Blood pressure monitoring) which will measure the blood pressure every 20 minutes even during sleep and activity and have the data downloaded. Keep the arms straight while the cuff is inflating to avoid errors in the machine reading. For some, the blood pressure is highest while at work, for some it is highest at night. Mental and physical stress plays a major role in fluctuations of blood pressure levels.
Pregnant women may get high blood pressure readings which are treated with some specific medicines as they will not cause harm to the growing baby. The blood pressure spike is usually associated with swelling of the feet and proteins in the urine. Some even get blurred vision.
Normally a doctor will not start medications for blood pressure based on one reading. An average of readings which show a persistent set of high levels will decide. The blood pressure can be high even for children in those having some diseases of the kidney. The cuff diameter is different while measuring the blood pressure for children and for those who are obese. The normal blood pressure readings are between 120-140 systolic and 70-90 diastolic. Generally the elasticity of the blood vessels is lost as one advance in age and so the blood pressure can be slightly high for the elderly and hence a level of 140/90 mm Hg is normal for the elderly.
What can be done from your side:
- Avoid stressful situations as much as possible. Learn relaxing techniques such as doing something you like or meditation or just relaxing on a rocking chair, or listening to songs or reading a book or enjoying a swim or watching a movie.
- Incorporate a healthy lifestyle which includes at least 150 minutes of physical activity a week and a diet in which salt consumption is reduced. Sausages, sauces, tinned vegetables , olives soaked in brine, potato fries all come with salt. Use of rock salt is better or low sodium salt is another option. One can use lemon or vinegar to add a salty taste without actually adding salt. Among the exercises, Tai Chi, Yoga, swimming, skipping rope, aerobics, walking, cycling, golf, playing shuttle badminton or tennis if it is okay , are good options. Enjoy the exercises sessions.
- Avoiding spicy and oily food helps.
- Take plenty of vegetables, fruits depending on diabetes levels, non roasted and non salted nuts, fish and chicken and lean meats.
- Avoid too much of caffeine
- Maintaining a normal weight is equally important.
- Limit alcohol consumption- for males 21 units a week and for women 14 units a week ( one unit is half a pint of beer, a glass of wine or a single measure of spirits)
- Cigarette smoking is another thing to be careful of. Smoking can make the blood cells stick together which can help form blocks and also increase the chances for a block in the blood vessels. There are ways to stop smoking by using various nicotine replacement techniques such as nicotine chewing gum, lozenges or patches.
- Be regular in your visits to the doctor.
- If there is a history of high blood pressure running in the close family ( parents or uncle and aunt), have the blood pressure monitored. If your parents have had either a stroke ( paralysis of one side of the body) or a heart attack at an earlier age ( below the age of 50) you have to be careful.
- If you are overweight or obese ( having a body mass index of more than 25) or having diabetes, you have to check the blood pressure.
This involves the basic essentials such as reducing stress levels, stop smoking and alcohol consumption, reducing excess salt intake, maintaining a healthy diet, exercising regularly and having a check up on time.
When the above measures do not work or if you develop some complications such as problems with the kidneys, heart or brain, medicines are prescribed.
The eye doctor looks into the eye and checks for early changes in the blood vessels on the retina which needs you to be starting treatment soon to prevent further damage to the eyes.
There are certain basic tests which are necessary such as checking the haemoglobin, sugar, cholesterol, kidney, liver, urine for leak of proteins, ECG and ECHO for the heart, an eye check up and further tests if anything is amiss and needs further evaluation. Some need a scan of the brain if there has been a stroke.
Some people need one medicine and some need more than one medicine. There are different medicines coming in different strengths. The number of mg of each tablet does not reflect upon the severity of the blood pressure. The doctors decide which medicine based upon the kind of protection needed. Some need to have additional protection to the heart and kidney, some need to have their heart rates reduced, some need to have their feet swelling reduced, some need to have the pressure in their kidney reduced and so forth. The aim is to bring down the blood pressure to normal without causing further damage.
As with all tablets, there are some side effects with the medicines for blood pressure. Some may cause slow heart rate, some cause swelling of the feet, some cause coughing and throat irritation, some cause electrolyte disturbances and some medicines are not tolerated well. The dose of medicines has to be adjusted based on individual needs. Generally, once you are on medicines it must be continued for life. But, having a metabolic surgery ( bariatric surgery) can help avoid the need for a medication. This will help control the diabetes, blood pressure as well as your weight. If the blood pressure is solely due to increased stress levels, change of job or relocation will help cure the blood pressure as well.
Many people delay the initiation of treatment despite the medical advice. This is putting your life in danger as changes once they occur, in important organs, are difficult to reverse. It is much better to control the blood pressure than having a massive heart attack or a stroke and put your family or yourself at risk.
Treadmill is the commonest equipment bought for the home gym and is also one of the commonest equipment used if one frequents the gym. It is often believed that the cardio exercises such as running, jogging or cycling help lose weight and also to keep one fit. But, it is worthwhile to note that the low intensity exercises help the body to adapt over a period of time thereby losing its efficiency at reducing the calories burned per minute.
Most of the people buy the treadmill and it soon becomes a dread mill- some use it as a storage space for books and other commodities. Some use the treadmill as a stand for hanging clothes.
There are, however, some points to ponder before buying one.
The advantages of a treadmill:
- Can exercise indoors despite adverse climate
- The smooth cushioned belt is kinder to the joints than when running on hard surfaces outside.
- Those who have no baby sitter or those who cannot leave home can benefit having this at home.
- This can be folded and kept aside if space is being compromised.
- Can listen to audio or see videos while on the treadmill.
- The programmable workout can be done to make the treadmill more interesting
- Can be monotonous
- The force of impact while stamping on the belt can cause injuries or pain to the knee, ankle or hip joints for some.
- While running or walking outside, the muscles make small adjustments to improve the co-ordination and balance which is not there while on the treadmill.
- While walking or running outside, the hamstring muscles ( muscles of the back of thigh and calf) help to propel the body forward. This does not take place while on the treadmill as the machine pulls the body forward.
- There is no wind resistance which can be encountered while exercising outdoors.
- There is nothing to match the downhill running on treadmill. While running downhill, there has to be a good co-ordination between the muscles of the front of thighs and lower leg muscles.
- Can fall off the treadmill with injuries if not concentrating while on the treadmill
- Adequate footwear is essential as the footwear can wear and tear easily due to the friction.
- Cannot enjoy the sights outside, no fresh air and also change in pace is not possible.
Points to ponder while buying one:
- There are two types- manual and motorized type. The manual needs one to use force to start it moving and some need even an inclination, but once it gets moving, the inclination cannot be adjusted unless you come off the machine. The manual one costs lesser than the motorized one.
- Stand on the belt and see if there is any jerky movement or instability of the base of the machine
- Look for a continuous duty rating of > 1.5 HP
- The belt size must be at least 48” long and 16” wide.
- The control panel must be easily accessible
- There must be an emergency stop button which can be used if there is a mishap.
- Look for the programmable versions available where the pace and inclination can be adjusted.
- Addition of audio and video plug ins cost more
- Water bottle holders are another option.
- Look for the warranty period
- If any other person besides you are planning on using the machine, please buy the high end machine. Those who are heavily built need a better machine.
- Regular servicing or maintenance is needed.
Before using the treadmill, do the following:
- Proper attire including good shoes
- Make sure you are fit to undergo the exercise. If a first timer, make sure the doctor clears you of any heart, eye, kidney or nerve problems. If having back pain, ask the doctor before starting the treadmill.
- Make sure the sugar levels are not too high or too low. Correct the sugar levels before the exercise.
- Carry with you an ID card mentioning you are diabetic. Have fast acting carbs with you. Carry either orange juice or water which can be had midway between a heavy work out if the duration lasts more than an hour. If you feel dizzy or complain of difficulty breathing, do consult a doctor before continuing.
- Adequate warm up is essential, start slow and then build up the pace or inclination and also stop slowly. Do not suddenly stop unless it is an emergency.
- Leave a space behind while on the belt, it is safer you have some space behind in case you slip.
- Hold on to the side railings while using an inclination or losing balance.
- Swing arms if possible as in natural walking.
- The short bursts of fast pace followed by slow pace improve the fitness levels as well do not exhaust the body.
- Keep back straight and not slouched over.
Dry eyes occur when the tears are not able to lubricate the eyes properly. This is quite a common symptom in today`s world, but poorly understood among the public.
Tears are a mix comprising of mucous, water and fatty oils which help in lubricating the eyes as well as protecting the eyes from infection.
The common symptoms::
- Eyes may sting or burn
- Scratching sensation
- Redness of the eyes
- Difficulty in wearing contact lenses
- Blurred vision
- Watering of the eyes
- Ageing. Those who are above the age of 50 have reduced tears production.
- Some diseases such as diabetes, rheumatoid arthritis, thyroid disorders, deficiency of vitamin A can be associated with dry eyes.
- Some medicines such as antihistaminics, some medicines for blood pressure control, anti depressants, hormone tablets can cause dryness of the eyes
- Inflammation or radiation can damage the tear glands
- Diseases of the eye lids where it is turned inwards or outwards can increase tear evaporation.
- Those exposed to smoke, hot air or heavy winds can have increased evaporation of tears.
- Reduced blinking of the eye lids as in those reading a lot or driving a lot or those using the computers for long hours can have dryness of the eyes.
- Those who consume a diet deficient in omega 3 or vitamin A can have dry eyes.
- Those using contact lenses are prone to dry eyes.
- Avoiding air blowing directly to the eyes from the air conditioners as in cars, hair dryers or fans.
- Humidified air will help
- Donning protective eye wear
- Giving the eyes breaks of rest while reading or computing for long hours at a stretch.
- Close eyes in between to reduce evaporation as when flying in aeroplanes, traveling through deserts or in high altitude areas.
- Position the computer below eye level
- Stopping smoking or avoiding being in a smoke filled room.
- Using artificial tears
- Meet the eye Dr who might advise antibiotics if inflammation is the cause or advise surgery if there are problems with the eye lids or tear ducts. The treatment depends on the severity.
- Special contact lenses, if applicable.
- Eye drops ( artificial tears) can be those with preservatives to increase shelf life or those without preservatives. The ones with the preservatives might be a cause of irritation.
- Eye ointments are oily and will last longer, but can cause clouding of vision and hence advised to be sued at night time before bedtime.
Urinary problems can happen to all people at some time of their lives. Most of the time, the women tend to ignore this till it becomes very advanced. The presentation: The urinary problems may present as a delay in passing urine, it may be as recurrent urinary infection, it may present as a sudden urge to pass urine and if not voiding, it may spill ( urge incontinence) or can leak when coughing, laughing or sneezing( stress incontinence) This may occur with advancing age when the muscles controlling the sphincters are not strong enough to hold the urine. This can happen for some following operations on the uterus. Most of the women tend to hold back urine till they feel the toilet is clean and hygienic. During the menstrual cycle when the blood flow in the pelvis is more than normal, urine flow may increase. There are many factors that can be the cause for the problems. Urinary problems also can occur among those women who have had many deliveries during the child bearing age. Prolapse of the uterus ( uterus coming down) is another cause for urinary problems among women. When sugar levels are high, urinary output will increase. Infection of the terminal part of the urinary system,the urethra, may also cause urinary frequency. Other causes:
- Too much of fluids over a short period of time can cause urgency. However, too little fluid intake also will cause the urine to get concentrated when the urine gets dark and this can irritate the bladder causing urgency.
- Acidic fruits such as grapefruit, orange, lemon, intake of spicy food, tomato based products, corn syrup, carbonated drinks, caffeinated drinks, alcohol, use of artificial sweeteners, chocolate, and cranberry juice can increase urine output.
- Certain medicines can upset the bladder function. Drugs used to control blood pressure, those acting on the heart, those acting as diuretics, muscle relaxants, some sedatives, some anti depressants and some anti histaminics are known to disturb normal bladder habits.
The solution: Exercises: Improving pelvic floor muscles by doing Kegels exercises can help in a major way. Squeezing the pelvic floor muscles as if trying to stop urination can help improving the strength of the muscles. There are some people who place a weighted cone into the vagina and contracting the pelvic muscles to prevent it from falling also helps. Personal hygiene: The manner in which some women wash their private parts with a full jet of warm or hot water as a hand shower jet is to be condemned. The actual manner of using a tissue paper is to wipe from top to bottom and not from bottom to top as it may cause contamination from the anus to irritate the urinary system. Water intake: Spread out the water intake during the day and early half of the night. Normally the cold weather can trigger urination. Leading a healthy lifestyle with dietary changes and adequate exercises can go a long way in improving this condition. Cessation of smoking among those who smoke and minimizing constipation are also important.
This is a novel step in the management of diabetes. Many people, even today, fail to understand the indications for transplantation. Many assume this can be done for almost anybody with diabetes. Incidentally, as early as 1890 in England, the first transplant involving fragments of sheep pancreas was first tried on a young boy with uncontrolled diabetes. Improved surgical techniques, better immunosuppressive medicines and healthier recipients have helped improve the outcomes.
What is pancreas transplantation?
This is a surgical procedure involving transfer of a healthy pancreas from a deceased donor to a person whose pancreas no longer functions at all.
This is reserved only for those with type 1 diabetes , but does not form part of standard treatment.
- When standard insulin treatment cannot control diabetes type 1
- Poor sugar levels
- Kidney damage in those with diabetes type 1
- Frequent insulin reactions
- Pancreas only transplant
- Simultaneous pancreas- kidney transplant
- Pancreas transplant after kidney transplant
Normally the endocrinologist or the diabetologist refers the patient to the nephrologist, the specialist in kidney diseases, who will run some tests to assess extent of kidney function. Once the possibility of transplant is considered, the transplant team is consulted. The team comprises a medical transplant doctor, a transplant surgeon, diabetes educator, a social worker, a psychologist and a financial advisor.
It will be assessed if you are a healthy candidate to tolerate the procedure, if there is anything in your records to hinder the success of the procedure or if you are compliant with the advice given by the team. It is an emotional, mental, physical and financial burden on the family and the patient.
Not to be forgotten are the legal issues associated with the transplantation ( still considered a taboo in many parts of the world), availability of donor, blood group and the severity of the kidney damage. Most of the centers have a waiting period which varies. The donor must be aged between 4 and 55 years and free from diabetes and must not be obese. There are areas in the world where organ donation is a business and various trade rackets have been busted.
Do your homework well….
Find out about the transplant center- the number and type of transplants done there, survival rates, the support given, the recovery phase stay and travel arrangements. The cost of the procedure is also of importance and how much the insurance will cover.
After the transplant you can expect the following:
The surgery can last for 4 to 6hours generally.
Stay in the intensive unit for the first few days- this is for frequent monitoring and to cut back on visitors during the crucial first few days. There will be frequent blood checks. The attendants will be asked to wear a face mask and those with common cold, fever or cough should be refrained from attending on the patient. Frequent hand washing with a hand sanitizer is needed.
Insulin is no longer needed as the new pancreas starts functioning. That will be the striking change the patient notices. However, one should also bear in mind the possibility of a rejection, possibility of a bacterial, viral or fungal infection as immunity is compromised by the medicines taken to prevent the rejection.
Failure of the pancreas to function can also occur for some unfortunate people.
The side effects of the medicines to prevent rejection include:
- Weak and thin bones
- High blood pressure
- High cholesterol levels
- Puffiness of the face
- Diarrhea or constipation
- Gums can be swollen, mouth ulcers can occur
- Acne on the face
These depend on a lot of factors. Based on data from around the world, 72% of the simultaneous pancreas- kidney transplant survive after 5 years, 59% of the pancreas after kidney transplant survive after 5 years and 52% of pancreas only transplants survive after 5 years.
Neuropathy is a complication that is bothersome and not very often addressed or treated properly. This complication gradually develops over a period of time and is not always due to diabetes mellitus. This can be due to smoking or excessive alcohol intake as well. However, longer the duration of diabetes, chances of developing a neuropathy are higher. Neuropathy can be aggravated by insulin and some medicines. Rapid control of sugar is known to cause neuropathy for some people. Classically the neuropathy first affects the feet and toes and may gradually ascend.
There are four major types of neuropathy
- Peripheral neuropathy- this is the commonest form which affects the feet and hands. This can present in many forms. There may be numbness of the digits and reduced ability to feel changes in temperature or pain. Patients may complain of tingling or burning, feeling of insects crawling on the body, sharp pains at night, and some may experience extreme sensitivity to even the lightest of touches. Some may experience difficulty in walking or can have ulcers or deformity of the feet.
- Autonomic neuropathy: This part of the nervous system controls the functioning of the eyes, heart, lungs, stomach,intestines and sex organs. Thus, a dysfunction of this part of the nervous system may cause either of the following: urinary bladder problems ( too much urine or lack of control in holding the urine), constipation or diarrhoea, slow emptying of the stomach leading to fullness, difficulty swallowing, dryness of vagina, erectile dysfunction in males, reduced sweating, problems regulating body temperature, difficulty in eyes adjusting to a dark room when coming from a bright room. Some people have variations in blood pressure while getting up from lying down posture leading to imbalance.
- Radiculoplexus neuropathy- affects bigger nerves and hence the numbness can affect the thighs, buttocks, hip and legs. Characterestically patients complain of difficulty getting from sitting position. Some may complain of abdominal swelling and weak muscles.
- Mononeuropathy- this is the type of neuropathy affecting one single nerve. This may disappear over a period of time. No long term complications associated with this type. There maybe difficulty in focusing of the eyes, paralysis of one side of the face with deviation of angle of mouth, carpal tunnel syndrome where there is numbness of one part of the palm with weakness of muscles or loss of sensation. This can be corrected by a small surgery.
For details on how to test for neuropathy, please refer to the blog on feet.