All Posts tagged elder adults

Exercising the brain

Exercising the brain

                                                                                    exergames-2brain-games-2

exergames-2Forgetting 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.

Sudoku

brain-games

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.

exergames

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.

 

 

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Using moisturizers

Using moisturizers

                                                                       moisturizer-2

The winter is coming and it is time for special care for your body. This is a time where one tends to have more parties and celebrations, will definitely eat and drink without guilt and sleep well due to the cold weather. But there are certain things to be careful of- the water intake might go less which can result in urinary infection or stones, indigestion due to excess spicy food, and dry skin especially on the exposed parts of the body. People might exercise less outdoors in view of the cold climate. You could still exercise indoors and can go outside dressing appropriately for the climate conditions outside.

Moisturizers help in treatment and prevention of dry skin. Besides this, it also protects sensitive skin and improves skin tone and texture. The moisturizers act by trapping water in the outermost layers of the skin and acts as a temporary barrier to water loss.

Moisturizers usually contain humectants and emollients which help retain moisture. They also claim to contain peels of fruits and fragrances to make it smell pleasing. But, for those with sensitive skin, these adulterants can cause irritation and allergy. The expensive moisturizer does not always mean it is the best.

For those with normal skin, apply water based creams which are non greasy ( non oily)

For those with dry skin, use one with a heavier oil base. Petrolatum based one s are ideal.

For those with oily acne prone skin, use lotions and must be noncomedogenic( not closing the pores which can worsen the acne). Most of the soaps and face washes can dehydrate the skin further. Use of foam free face wash is recommended.

For those with sensitive skin prone for rashes, allergy and irritation, look for ones with soothing ingredients such as aloe or chamomile. These are non perfumes usually.

Use moisturizers soon after bathing.

Heavy creams are used in areas where dry skin is there and hence the face is spared of heavier creams.

Some of the brands of moisturizers come with a sun protection as well.

If the skin dryness does not improve, please do consult a skin doctor.

Hydration and eating healthy are essential to retain the glow and moisture of the skin.

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Exercise tips in cold weather

Exercise tips in cold weather

 

Tai chi

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.

 


      image 3                                                    aqua aerobics 2

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:

Questions Yes No
Look better
Feel better
Feel comfortable in clothes
Improve self image and confidence
Improve physical stamina
Improve energy levels
Improve sleep
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.

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Artificial sweeteners – the facts

Artificial sweeteners – the facts

artificial sweeteners

 

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.

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Hypertension or high blood pressure

Hypertension or high blood pressure

blood pressure 4Checking 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 1

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.

blood pressure 2

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.

 

 

Treatment

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.

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Dry eyes

Dry eyes

dry eyes 2

 

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

 

Causes ::

  • 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.

 

Prevention::

  • 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

 

Treatment::

  • 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.
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Urinary problems among women

Urinary problems among women

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.

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Neuropathy and Diabetes

Neuropathy and Diabetes

numbness feet

 

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.

 

numbness feet 2

 

 

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.

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Let us walk to good health

Let us walk to good health

From time immemorial, man has been walking for traveling to reach one place, to hunt and gather food for self and family and also in search of a better place to live. Those were the days when there was no transport. God gave humans the legs so they could walk upright which is a feature not common among the animals by nature, though some animals can walk upright with training. Unfortunately, with the advent of modern transportation facilities as well as time pressures and deadlines to be met, people have literally forgotten to use their legs for the use they were meant to be used.

 

Benefits of walking
This is probably the safest form of exercise which can be done by anybody provided the eyesight is good and there is no neuropathy ( affection of the nerves which can cause lack of sensation on the feet making the person unaware of where the feet are planted on the ground).
The farther, faster and more frequently one walks can definitely improve the benefits by many folds. Walking also improves the balance and strengthens bones and muscles besides improving circulation.
Walking is proven to prevent the onset of diabetes, depression, cancer, joint problems, osteoporosis ( fragile bones) and heart ailments. This also helps the worsening of the above. The swinging action of the arms, the strides taken while walking, the fresh air , the sights to enjoy ( one does not get these benefits while walking the treadmill in the confines of either the gymnasium or home) and change in pace while walking navigating the turns all help in improving the muscle power and co-ordination.
Walking in groups with either your colleagues or with friends and family all could be entertaining as well you could even do long distances without being aware of the distance covered at all.

Walking at a speed of 6 km/hour , which amounts to a brisk walk, can burn up to 600 Kcals. But, may be not all can walk as fast. Some may be having either knee or back problems which needs a slower pace. But walking at any given speeds whether unaided or with the help of a walking stick is much better than not walking at all. Parking the car away from where you wish to go and just walking to your destination helps. You may still park close to your destination ( especially during the summer time when the heat maybe quite strong) and take a longer route rather than choosing the shortest route or just walking along the aisles in the malls are good options.
Walking with small children and pets is also a good option.

Ensure the following before walking:
• Check the blood sugar before walking.
• Ask your health care provider if it is safe to embark on a regime.
• Go at a pace comfortable. Walking should not leave one gasping for breath.
• It is okay to rest in between.
• It is okay to take sips of water in between the walk and before the walk.
• If you experience feeling of nausea, chest discomfort, pain in the arms, jaw or back while walking, please seek medical help immediately.

Stretching before any exercise program:
Proper stretching before any exercise or even walking can help tone up the body and prevent joint problems.
Some of the commonly done stretches:

 

Calf stretches- calf stretch

 

Stand at an arms length distance from the wall. Keep one leg forward with knees slightly bent. The other leg with knee straight and heel down. Keeping back straight, move hips towards the wall and feel the stretch. Hold for 30 seconds, relax and repeat with other leg.

 

Quadriceps stretch- quadriceps stretch

 

While supporting a fixed structure, grasp the ankle with one hand and pull the heel up and down till one feels the stretch in the front of the thighs. Hold for 30 seconds, relax and then repeat with other side.

 

Hamstrings stretch-

hamstrings

 

Sit on one chair, and keep the other leg on another chair in front. Keeping the back straight, bend the pelvis forward till a stretch is felt in the back of the thighs.

 

Low back stretch- lying on the back with the feet kept flat and knees bent, bend the knees ( both together or separately) towards the chest using both hands. If one has knee problems, one can hold hands behind the thighs instead.

 

Chest stretches- chest stretches

Clasp hands behind the head. Pull elbows gently by pinching the shoulder blades together.

How to walk?

The ideal way of walking involves walking upright, head held up eyes looking forward, chest pulled out, shoulders thrown back, landing the feet on the heel and taking the stride on their toes. Swing the arms freely slightly bent at the elbows. Walking with small weights held in the hands further enhance the calories burned.
The neck, shoulder and back must be relaxed and not stiff. While walking the treadmill one usually does not maintain these as people have to be holding onto the side railings and the back is usually arched back and stiff to prevent slipping.
Please make sure the footwear is of a good quality and have the insoles and heels checked for wear and tear. View the shoes from behind. If the shoe is tilted to one side, it is time to change the shoes. Change the shoes after it has done 400-600 km.

walking to good health 17
One should dress appropriately in attire that suits the climate, a comfortable and well padded pair of shoes, a scarf or hat as the case may be and some music if needed to be played and listened with an ear phone if needed. Generally the pavements are safe, but it still pays to look ahead and down as well.
150 minutes of any exercise a week is recommended. You can do 30 minutes 5 days a week or split that every day in some form like three sessions of ten minutes each or two sessions of fifteen minutes each.
The long term goal is to make 10000 steps a day. This is ideal for maintaining good health.
One needs to walk at least 30 minutes a day to maintain his or her weight and at least 45 minutes a day to have some weight reduction.
A pedometer is a small device which can be clipped on to the belt or kept in your pocket close to your body. This will count the steps one takes during the course of your daily chores such as walking, climbing stairs, jogging and even adventure sports. But, pedometers vary in their function.

clipped on pedometer

pedometer

 

Get to know your pedometer

 

Ease of use: Some of the pedometers just have to be clipped and it starts. These will be needed to be reset to zero the next day so you could count the number of steps taken.

All pedometers have a battery which needs to be replaced depending on the life.
Some pedometers need to have the data fed in such as date and time, the weight of the person, the length on ones stride which will be calculated and input fed in.
The extra benefits: Some just give the number of steps taken during the day till one resets it back to zero. Other pedometers count the calories burned during the activity, the distance walked and some even upload the data to a remote computer which will maintain a log book of the progress.
Accuracy: generally all pedometers are accurate. However change of strides such as a sudden increase in pace ( or decrease) , jogging in between or even climbing stairs in between the walk may not be counted by the machine( after all it is a machine) and so the calories counted may not be very accurate in that way.
Get a pedometer that has good back lighting so it could be easy to use both indoors and outdoors and also during either the day or night.
Some pedometers are small, others are big. Go for a size that suits you.
The pedometer must have a sturdy clip to help attach on the waistband or have a strap.
Price is also of major concern.
The recent smartphones have an app which could be downloaded for performing the same function as that of a pedometer.
Before you use the pedometer regularly the following are to be noted:

 

  • Please attach the pedometer on yourself for three days in succession whenever you are awake. The total number of steps covered in 3 days divided by three will give the average steps in a day. This is called the baseline steps. ( This will also give you an idea how many steps you had taken in a day which might be embarrassing)
  • Once you know the baseline steps, set up short term goals such as adding a thousand steps a day, for example, to your baseline number which you do target for a week.
  • Once you have achieved this short term goal, you could set yourself another goal. You could reward yourself and make this interesting.

 

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Love your feet !!

Love your feet !!

Feet are, strangely, the most neglected of all the body parts. There are many who pamper their feet, more ladies than men. The feet are an important part to be checked for while being a diabetic. Generally the problems with the feet can occur whether one has either type 1 or 2 diabetes, whether young or old and in any part of the feet though generally the under surface are affected more than any other part of the feet.
Feet are the parts of the body that keep one mobile, that maintain the balance and stance of a person, help drive us around, help us to swim, pedal a cycle, go on hikes or trekking, the list is endless.
Causes of foot problems while having diabetes mellitus:

foot ulcers

 

Trauma to the foot due to poor or ill fitting footwear, not wearing a footwear,
Foot deformities such as an in growing toe nail caused by improper nail clipping, having flat foot when the arches of foot collapse, having claw toes, having over ridden toes.
Poor blood flow to the feet due to small blocks in the blood vessels
Neuropathy due to diabetes which leads to poor sensation- impaired sensation to temperature changes or pain or touch.
Lack of proper access to proper education.
Living alone.
Poor socioeconomic conditions
Poor control over blood sugar, blood pressure and cholesterol.
Smoking
Previous amputation or ulcer foot
Poor eye sight

 

What can be done to prevent foot problems?

foot ulcer

DFU- Diabetic foot ulcer

 
Maintain good blood sugar and blood pressure control
Maintain normal lipid levels
Stop smoking
• Regular exercise
Check the feet regularly- check for cracks or fissures on the heels. Check between the toes for any fungal infection.
• While clipping the nails make sure it is cut straight taking care not to take the corners. The corners can be filed.
Do not cut callosities which are thickened pads of skin. Have either a trained podiatrist( who specializes in foot care and pedicure) manage it. You also use a pumice stone after bathing to rub down the thickened skin.
Apply moisturizing creams on the feet and under surface before retiring at night. Take care not to apply moisturizing creams between the toes as they will retain moisture and favor fungal infection. Use the ones containing Aloe Vera or vitamin E.
Use a hand held mirror to check the under surface of the feet.
Use cotton based socks without tight bands. Some socks now come with silicone impregnated gel pads as well.
Use shoes that are one size bigger. Buy the shoes towards the end of the day when the feet will be swollen slightly. There should be enough room for the toes to wriggle comfortably. Wear and also the sole of the footwear for any nails or sharp objects. Pointed shoes are not advisable.
Check the inside of the footwear with the hands for any irregularity or wearing off.
Have the feet checked at least once by a health care provider.

ingrowing toe nail 1

Ingrowing toe nail due to improper cutting of nails

ingrown-toenail 2

 

 

Look at the difference in the left foot

Charcots foot

 

This is a foot disorder that can happen to almost anybody with diabetes. The loss of deep sensation leads to destruction, degeneration and disorganization of the bones and joints of the foot. The foot can be swollen, warm to touch and be red. But, the pulses of the feet will be normal on examination. Once suspected of this, you will be referred to either a foot care team or the orthopedic doctor. Normally, the foot will be immobilized in a cast. This will be removed after a period of time as suggested by the team and protective custom made footwear will be given.

For those who are used to wearing high heel footwear, the pressure while walking is shifted to the forefoot and there will be strain on the Achilles tendon at the back of the foot ( the thickened cord felt behind the ankle)

Regular check up of the feet:
The feet will be checked for color, any cracks, any infection between the toes, any deformities, any callosities, and non healing wounds, any color changes, the skin of the feet, the hair growth and the nails.
Blisters are water filled collections ,corns are thickened skin due to repeated friction, calluses occur usually on the bottom of the feet which are due to thickened pads of skin, and bunions are those out projections seen from the joint of the big toe which is a structural deformity.

Clawing of toes

bunion 2
The feet will be checked for local warmth, the sensation will be checked with a monofilament, the sensation to appreciate hot and cold sensations, vibration sense will be checked. The pulse will be checked for on the feet. The ankle brachial index ( comparing the pressure of the ankle and arm BP are compared to assess blood flow) are checked in high risk feet.

A podoscan can be used to measure the pressure while walking or stepping.

Customized foot wear is often required when there is a problem to the feet which have to be designed by cobblers specialized for this.

There are tests to measure the amount of blood flow to the legs such as an ultrasound Doppler test ( which is non invasive) or an angiogram which is invasive. If blood flow is compromised ,depending on the severity, either medicines or stents or surgery are advised.
Ulcers ( breach of the skin) may heal with medicines or may remain active or in some people may progress rapidly to cause infection. In some cases, an amputation is performed to save the limb or even life. There are many comfortable prostheses available in the market to get over the handicap.

 

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