Hi Friends, as u all know that I am a Doctor. I am qualified Practitioner of Homoeopathy. If you or anyone of your family, have some health problems and want Homeopathic treatment then you can tell me. I’ll be there for your help.
I will try to post here some information about the diseases or other problems, for your knowledge. I hope you will be like it.
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AN OVERVIEW OF CHOLESTEROL
What is Cholesterol?
Normal
Cholesterol is a type of fat (or lipid) present in certain foods and made by your liver. A certain amount is essential for the formation of cell membranes (the basic building blocks of life).
Abnormal
Too much "bad" (LDL = low density lipoprotein) cholesterol causes damage (atherosclerosis) to your artery walls. This build up of cholesterol results in narrowing of the arteries (which transport blood pumped from heart around the body). This process happens slowly over many years in most people in Western countries.
Lack of blood supply due to narrowed arteries can affect the heart (causing angina), the legs (causing claudication) and brain (causing transient ischaemic attacks, "TIAs"). If the artery blocks off completely it can cause a heart attack or stroke.
Some of the adverse affects of LDL cholesterol are reduced by "good" (HDL) cholesterol, which removes LDL cholesterol from the artery walls.
What are the causes?
There are genetic (inherited) causes of high cholesterol. However, cholesterol levels are also related to the type and amount of fat eaten, and your body weight.
Levels of good cholesterol are increased by exercise and low to moderate alcohol consumption.
What symptoms may I expect?
There are no symptoms directly related to high cholesterol levels. With time, the elevated cholesterol cause damage to your arteries that may result in angina, heart attack, TIA, stroke or claudication.
What will the doctor look for?
The doctor may examine the back of your ankle (Achilles tendon) and the skin just below your eyebrow, adjacent to your nose. These may be sites of cholesterol deposits in people with 'familial hypercholesterolamia (a genetic condition).'
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What investigations will the doctor consider?
Your doctor will order a blood test to measure your blood lipid levels. This will measure levels of total cholesterol, LDL cholesterol, HDL cholesterol and calculate the ratio of total to HDL cholesterol.
This test may need repeating to obtain a more accurate estimate, because there is natural variation in lipid levels from day to day.
What treatment options are available?
Natural history
Most people can reduce their cholesterol levels 10-20 percent by careful eating. However, this may not be enough in many cases to reduce risk and medication may be required. Increasingly, well conducted research is showing benefits from drug treatment in high risk groups.
Lifestyle
Dietary changes:
Reducing your cholesterol by 0.6 mmol/l long-term will reduce your risk of a heart attack by one third. This means reducing the amount of saturated fat eaten (mainly found in red meat and dairy products). Plant foods such as fruits, vegetables, grains, rice and potatoes contain no cholesterol or saturated fat, which leads to increased cholesterol levels.
The actual cholesterol in food is not as harmful as saturated fat in the diet. Most cholesterol in the body is made in your own liver using saturated fat from the diet.
Saturated fats are found mainly in animal foods such as meat and full fat dairy products. Two vegetable oils, coconut and palm oil are also high in saturated fat. They are used in commercially baked cakes and biscuits. Saturated fats are bad because they increase LDL cholesterol and lower HDL cholesterol.
Polyunsaturated fats are good because they lower LDL cholesterol (although they may also reduce HDL cholesterol). Polyunsaturated fats are in sunflower, safflower, corn, soybean, nuts and fish. Omega-3 polyunsaturated oils, found in some fish and building blocks are found in some foods (See Table). Omega-3's are particularly effective in preventing heart disease, even though they do not alter cholesterol levels much.
(moderate amounts found in Squid, Mussels & Oysters)
High in Omega-3 building block (alpha-linolenic acid)
Canola oil, Soya bean oil, Flaxseed or linseed, Walnuts, Wholemeal bread and cereals, Green vegetables and Legumes
Monounsaturated fats are found particularly in olive, canola, peanut and sunflower oils, avocados, olives, nuts and sesame seeds. Monounsaturated fats are good because they decrease LDL cholesterol without much effect on HDL cholesterol. Their consumption may be responsible for the lower incidence of heart disease in Mediterranean countries.
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A healthy diet includes lots of fruit, vegetables, whole grain bread, cereals, legumes (peas, beans and lentils). Eat fish at least twice weekly, especially those high in Omegat-3. Eat small amounts of only lean meat (fat removed), poultry without skin, and low-fat dairy products. Eat no more than three eggs each week. Use as little fat and oil as possible - grill, boil, steam, bake or microwave rather than fry. Use monounsaturated margarine or oil rather than butter for thin spreading and cooking. Avoid prepared foods - they contain too much fat.
Coffee that is unfiltered (i.e. espresso, plunger or boiled) will raise levels of bad LDL cholesterol. Therefore, it is best to choose filtered, percolated or instant coffee and limit intake to no more than five cups each day.
Recently, some compounds derived from plants ("plant sterols") have been found to lower the bad LDL cholesterol by a further 10-15 percent, over and above what can be achieved by regular dieting alone. These compounds have been incorporated into margarines which are now available in New Zealand as Flora Pro-Activ and Logicol.
A modest intake of alcohol may be healthy by increasing HDL cholesterol and reducing the risk of heart attacks. Alcohol intake should be limited to two standard drinks daily for women and three standard drinks daily for men (see table at bottom for standard drink definitions). Red wine contains antioxidants that may increase its beneficial effect
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BACK INJURIES
Overview
Back injuries are very common.
Most acute back injuries resolve rapidly.
It is best to remain active and at work if possible.
A few serious problems can occasionally result from back injuries.
What causes back injuries?
Usually the cause will be a single event, where the tissues at some vulnerable spot in the back are stretched beyond their usual tolerance for stress.
The back is a very complex structure, with a delicate spinal cord encased within angled bones at the rear of a column of bones arranged like building blocks. Between these blocks are discs, which have a tough outer casing and a jelly-like centre.
In certain types of back injury, the casing of the disc can split and allow the centre contents to squeeze out. This is referred to as a "slipped disc".
If the disc presses on an adjacent nerve root, it can cause pain along the distribution of that nerve root, down the leg. This type of leg pain is called sciatica.
Other structures that can cause pain when injured include small joints at the rear of the spinal cord. These are called facet joints (between the vertebrae). In some athletes, e.g. fast bowlers in cricket, pain may arise from a stress injury to the bone.
Pain may also arise from irritated muscles which then go into spasm.
Other causes of back ache are much rarer and include infiltration of the bones of the spine with tumour deposits from spread of a cancer elsewhere in the body.
The exact identification of which structure is causing the pain is often difficult, and is not necessary in most cases.
What symptoms occur?
Back pain, generally at the level of the structure that is injured
Leg pain down the back of the leg if a nerve root is being irritated or pinched
Muscle weakness, if persistent squeezing of a nerve root occurs
Pins and needles in a particular part of the leg or foot if persistent squeezing of a nerve root exists
Rarely, disturbance of bowel or bladder function (e.g. inability to pass urine) may occur. This is serious and requires urgent evaluation in hospital
What treatment is recommended?
Firstly, it is important to see your doctor for a medical evaluation. Your doctor is aware of the serious symptoms that require urgent referral to a specialist (see below).
If these are not present, the following advice is recommended:
1. Avoid activities that provoke pain, at least in the first few days after injury. Bed rest is rarely needed, but if so, it should be limited to 2 days or less. Longer periods of bed rest can impair recovery.
2. If back or leg pain is significant, regular doses of analgesics (pain killers) are advisable in the first week or two. Paracetamol is purely a pain reliever, whilst aspirin and other anti-inflammatory drugs also relieve inflammation. If you have a pervious history of peptic ulcer, your doctor may recommend newer cox-2 anti-inflammatory drugs (e.g. celebrex) that do not upset the stomach.
3. Gradually increase physical activity over the first week or two as symptoms subside. In most cases, it is advisable to remain at work performing modified duties. Particular activities that may have contributed to the injury (e.g. heavy lifting, bending or twisting) should be reviewed and modified if possible.
4. Manual therapy can be very helpful in the first few weeks after a back injury. Physiotherapists, osteopaths, chiropractors and some doctors are trained to provide this treatment. The most important aspect is to find a person with hands-on therapy skills who has a good record of success. Avoid people who spend most of their time hooking you up to a machine while they treat someone else.
5. If you have persistent sciatica which has not responded to manual therapy after 2-3 weeks, you may be referred for an epidural steroid injection. This is an injection of cortisone via a very fine needle designed to shrink down the swelling around a disc which is pressing on a nerve root. It can be dramatically effective, but is only worth considering if sciatica is present.
What about x-rays and scans?
In most back injuries, x-rays and scans are not necessary. If there has been enough force to cause a fracture (e.g. fall from a significant height, high speed motor vehicle accident) then x-rays are worthwhile.
In older people with back injuries, x-rays may reveal disc space narrowing. However, these findings need to be interpreted cautiously, as there may not be much correlation between the person's condition and the appearance of their x-ray. We treat people, not their x-rays.
Other investigations (e.g. CT scans and MRI scans) are much more detailed and much more expensive. Their major role is when surgery is being considered.
What are the serious symptoms?
The following symptoms are considered "red flags". That is, they may be a pointer to an underlying serious problem such as rheumatic disease or an associated fracture. Your doctor is the person who is best placed to evaluate those symptoms in your particular case.
Disturbance of bowel or bladder function Bilateral sciatica - pain down both legs Significant trauma Weight loss History of cancer Fever Intravenous drug use Steroid use (e.g. prednisone tablets for asthma or arthritis) Patient aged over 50 years Severe, unremitting night pain Pain worse on lying down
What about surgery?
Surgery is not magic. It has a small but definite place in the treatment of some back problems. The most common indication for surgery in back disorders would be for a disc pressing on a nerve causing severe persistent leg pain, that is no better after an epidural steroid injection. Another less common indication would be for limiting slippage of one part of the spine on another part.
In summary
Most back problems resolve rapidly - within days to weeks. Pain relief and manual therapy can speed progress in the early stages. Leg pain (sciatica) may require an epidural steroid injection. There is a small role for surgery.
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GOUT
Overview
Gout is a painful inflammation of a joint, which comes on suddenly. It usually involves only one joint at a time.
It is due to a chemical called uric acid, which normally stays dissolved in the bloodstream.
If the level of uric acid in the blood goes too high it settles as crystals in a joint such as the big toe or the knee or in the kidney. This will cause great pain.
It is nine times more common for men than women, especially after the age of 40 and is more common for certain races such as Polynesians.
It is important for the gout sufferer to avoid situations that might bring on gout such as eating certain foods, drinking too much alcohol, and becoming overweight.
Drugs can help but you need to learn how to use the drugs prescribed. There are three types of drug treatment - those used to treat an acute painful gout attack, those used to block production of uric acid, and thirdly those that speed up uric acid excretion through the kidney.
Gout is not just a nuisance disease. It can lead to serious kidney damage and in association with obesity and high blood pressure can increase the risk of strokes and heart attacks.
What is gout?
"The disease of kings and the king of diseases," GOUT, is caused by an excess of URIC ACID floating in the blood.
Uric acid is a breakdown product of metabolism and at normal levels stays dissolved in the bloodstream as it travels to the kidney and passes out in the urine. However when the levels get too high it settles and forms crystals a bit like ordinary table salt.
The crystals tend to form around one joint such as the great toe joint or in the knee or elbow, or the crystals can form a hard stone within the kidney. They can cause lumps under the skin known as TOPHI. Uric acid crystals are very irritating to the body and set off a marked inflammation with pain, heat and redness.
The excess of uric acid is nine times more likely to happen in men than women especially as middle-age approaches and in people from certain races, e.g. Polynesians. Gout is more common in women after the menopause.
The excess of uric acid can be caused by the following:
An increase in manufacture by the body
The kidneys not passing enough uric acid in the urine
Increased intake of foods containing PURINES which are changed to uric acid inside the body. Sweetbreads, brains, shellfish, dried peas, and beans are particularly high in purines.
Too much alcohol leading to dehydration i.e. reduced water in the bloodstream. Water is needed to keep uric acid dissolved in the blood to stop it settling out as crystals. So for gout sufferers it is a good idea to "mix water with wine".
Certain drugs which cause an increase in uric acid e.g. thiazide diuretics used for treating high blood pressure or low dose aspirin used for heart attack prevention.
An injury to a joint. This can be a minor injury such as stubbing a toe.
Other causes of dehydration such as a surgical operation.
Certain diseases which can result in raised uric acid e.g. leukemia or lymphoma.
Gout often occurs in people with obesity, high blood pressure, high cholesterol in the blood and diabetes, which makes for a higher risk of heart attacks and strokes.
Sometimes there is no obvious cause for a gout attack.
Quite frequently people are found to have a high uric acid level in the blood but never get attacks of gout. The reason for this is unknown. This condition is called HYPERURICAEMIA.
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What are the symptoms?
1. A sudden attack of gout (acute gout) shows up as:
sudden, severe joint pain
joint swelling
shiny red skin around the joint
extreme tenderness in the joint area
When gout first appears, long gaps may occur between attacks. An attack may last a week or so and everything seems to go back to normal. However, without treatment, attacks may happen more often and last longer and may lead to damage to the affected joints. If a joint is damaged after an attack it may feel stiff with reduced movement.
2. Kidney stones may appear as severe cramping pain in either the right or left side of the abdomen towards the back. Sometimes the pain radiates around towards the groin on the same side. This pain can come on quite suddenly causing the sufferer to roll around in pain and even vomit with pain. Kidney stones can occur in people with high uric acid who have never had an attack of acute gout and kidney damage can occur without ever having a painful kidney stone.
3. People with high uric acid can develop TOPHI. After several years, the uric acid crystals can build up around joints and surrounding tissues. They form lumps under the skin called TOPHI. These are often found in or near joints previously attacked by gout and also on the elbow, over the fingers and toes, and in the outer edge of the ear. They can damage joints.
Diagnosis:
If you are a middle-aged man or a woman past menopause and have a family history of gout it is worth having a blood test to see if you have hyperuricaemia - high blood uric acid without gout. This would allow you to take precautions to prevent gout and kidney stones.
If you have sudden onset of a single painful red swollen joint such as a great toe or knee, your doctor may suspect gout and arrange some tests. Unfortunately measuring the blood uric acid level during an attack of gout may not help. Often the uric acid level is normal or low. Presumably this is because the excess uric acid has settled out of the blood into the joint as crystals.
The best immediate test to diagnose gout is for your doctor to instill local anaesthetic into the skin over the painful joint and to suck out fluid for examination for uric acid crystals under a special microscope. This is easy in the knee but harder in smaller joints. Other diseases can imitate gout, for example pseudo gout or a joint infection. Your doctor may arrange blood and urine tests after the gout attack has settled. These may well be done after an overnight fast test. The tests will be to find out information such as:
Are you a high uric acid producer or do your kidneys hold back uric acid instead of excreting it?
Do you have signs of kidney damage?
Do you have abnormal blood lipids? This is the term for cholesterol and other fats floating in the blood. This test is carried out because of an increased risk of heart attacks and strokes for people with high uric acid, high lipids, high blood pressure and obesity and is best carried out after an overnight fast test.
Do you have signs of diabetes? This is also best determined after an overnight test.
Do you have normal liver function tests? One of the drugs used to control gout long-term can upset liver function tests.
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AUTISM
Autism is a developmental disorder
Autistic children will have problems communicating and delayed language skills
The condition is normally noticed before the age of 3
It affects about 1 in 1000 people
Severely autistic children may appear mentally retarded
The condition is believed to be caused by genetic and environmental factors
There is no cure but some sufferers will improve as they mature
Early intervention offers the best hope of treatment
What is it?
Autism is a developmental disorder which can vary from mild to severe.
Children with autism have three main types of characteristics: impaired social skills, communication problems, and unusual or limited interests.
These children rarely understand the world they live in, to them it is a frightening place.
Severe autism is marked by aggressive behaviour towards themselves and others, chronic repetitive and unusual behaviour. Some sufferers will be severely retarded.
Mild forms involve a personality disorder and learning difficulties.
Autism affects approximately 1 in 1000 people, and boys are four times more likely to be autistic than girls.
The exact cause of autism is unknown.
It is believed that a combination of genetic and environmental factors can cause the condition.
Researchers have found abnormalities in several regions of the brain in autism sufferers, suggesting problems with early fetal development.
A genetic link has been discovered in some people in autism. Couples with one autistic child have a 5 percent risk of having another one - a much greater risk than the general population.
What are the signs?
The symptoms of autism can vary according to the degree of severity. The condition may not be recognised for several years in those with mild autism, or those with other mental and physical disabilities.
Symptoms normally appear within the first 3 years of life, and may begin with poor maternal bonding.
Children with the condition may avoid social interaction, they may ignore their own name being called, avoid looking at other people and are unaware of other people's feelings.
Repetitive movements are common such as rocking back and forth, head-banging and teeth-grinding. They may also repeat what someone else has said over and over again.
Some practise ritualistic behaviours with their routines, and can become hysterical if they are disrupted or something is out of place.
They may resist physical contact like being hugged and develop strong attachments to unusual things like paper or other worthless objects.
Some children do not appear to feel pain after a bad fall, and much less painful sensations could upset them such as walking on the grass or hearing a loud noise.
Most children with autism score poorly on IQ tests. A small percentage may have exceptional ability in certain areas.
Diagnosis
Diagnosis must be made by specialists with expertise in working with children with autism. Several sets of diagnostic criteria are used for autism, these include:
Limited imaginative and social play Limited ability to start or have a conversation with others Problems making friends In severe cases they may not be aware of others Repetitive or unusual use of language Preoccupation with certain objects and parts Obsessive focus on some interests Strict adherence to routines or rituals
The following conditions are often described as autism spectrum disorders:
Asperger's syndrome where children have mild symptoms of autism but well-developed language skills.
Childhood disintegrative disorder in which children regress after appearing normal for several years.
Girls with Rett's syndrome which causes neurological disturbances may also show some forms of autistic behaviour.
What can be done to help?
There is no cure for autism and children will have it throughout their lives. However, many show some improvement as they mature, and some with mild forms go on to lead normal lives.
Behavioural management programmes can be specifically tailored to children to help control problem behaviours in children with the disorder.
Early behavioural programmes to develop children's language and social skills currently offer the best hope of treating the condition.
The accepted model involves educating the child in as normal environment as possible. Children may be placed in the same class as normal children and given special education as needed.
However, some experts advocate controlled education environments for autistic children with little sound and visual stimulation. Learning is broken down into very small segments which must be grasped before progressing to the next activity. There continues to be controversy over the effectiveness of this treatment.
Counselling is helpful for families to come to terms with a child with autism. Living with an autistic child can be extremely stressful and some families can become isolated.
Adolescence can cause more marked behavioural problems in some children who can become aggressive and difficult to control. Some children may develop epilepsy.
A range of medication can be prescribed to help reduce aggressive and violent behaviour.
Future trends
Researchers are continuing to study the condition and develop new programmes to help reduce some of the problems associated with the condition.
Initial findings from some studies have shows people with autism have abnormal signaling molecules in the brain, including serotonin, but more research is necessary on this.
Scientists also hope to identify the genes that may increase the risk of autism.
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CHICKENPOX -
Chickenpox is highly contagious and 90 percent of children will get it
It is usually a mild illness in children but can be severe in adults
The illness is spread by direct contact or coughing and sneezing
The incubation period is between 10 to 21 days
A person will be contagious two days before the itchy sores appear
The sores look like pimples at first but then blister and eventually crust over and heal
Chickenpox is contagious until the blisters have scabbed about a week later
A vaccine is available for children to prevent the illness
Chickenpox will lie dormant in the body after recovery and cause shingles later in life
What is it?
Chickenpox is caused by a virus (same family as herpes) and almost everyone gets the illness before they become adults.
It is highly contagious but is usually a mild illness. However, it can be severe in babies, adults and those with weak immune systems.
The virus is spread by direct contact, or coughing and sneezing from an infected person.
Chickenpox epidemics usually occur in late winter or early spring. Millions of people catch chickenpox each year, and 90 percent of sufferers will be under 15 years.
The incubation period is 10 to 21 days after contact with a carrier. A person is contagious two days before the chickenpox rash appears.
After recovery from chickenpox the virus remains dormant in nerve cells and can be reactivated during adulthood, causing a painful illness called shingles or herpes zoster.
Babies born to women who got chickenpox within five days before and 48 hours after delivery could develop complications from the infection, however, this is rare.
What are the symptoms?
A chickenpox rash is generally the first sign of illness. The rash is characterised by itchy round or oval sores which at first look like pimples but will later blister and then crust over and heal.
The sores are normally found on the back, chest, stomach and face, but can cover the whole body.
The illness may cause a fever, particularly in adults who are more likely to feel a lot sicker than children.
Other symptoms include tiredness and loss of appetite.
The illness lasts for about a week to 10 days and patients are contagious for about one week after the rash breaks out. Sufferers will need to be isolated during that period.
Possible complications include bacterial skin infections, scarring, pneumonia and in rare cases meningitis and brain inflammation (encephalitis).
Seek medical advice if the patient runs a high fever, experiences dizziness, a rapid heart beat, breathlessness, tremors, vomiting or a stiff neck.
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BUTTOCK PAIN IN ATHLETES
Dr Ruth Highet - Sports Physician
What is buttock pain?
At least half a dozen times a week, an athlete will walk into the clinic complaining of a "pain in the butt". Usually they are a runner, a cyclist, or an athlete in a kicking or sprinting team sport.
Diagnosis of the specific cause of buttock pain can be difficult as pain can arise from local structures in the buttock or be referred from the lumbar spine or sacroiliac joints. These are the joints at the bottom end of the low back where the hipbones (ilia), connect to the sacrum (the low end of your low back).
What causes the condition?
The most common causes of buttock pain are referred pain from the lumbar spine and sacroiliac joints and problems involving the hamstring attachments on the ischial tuberosities (these are the hard bony parts of your bum that take your weight when you sit down!).
Injuries commonly seen in this area include a tendonitis at the origin of the hamstring muscle, a partial tear of the hamstring muscle, or a bursitis at the hamstring attachment (ischial bursitis). Tight and inflamed ligaments that pass from the ischial tuberosities back to the sacrum (sacrotuberous ligaments) can also cause very acute and localised pain in this area. The bursa inflammation (bursitis), may give rise to pain when sitting, and is a frequent complaint of cyclists who take most of their weight on their "bum bones" - ischial tuberosities is better "table-talk".
Buttock pain that refers down the back of the thigh will usually suggest that its origin is in the low back but this can also be caused by tight external hip rotator muscles. This is important to recognise to avoid sometimes unnecessary back surgery for presumed sciatica from a damaged disc. The reason why these can be confused is that the sciatic nerve sometimes passes through the pyriformis muscle (deep inside the buttock), which can get very tight in athletes. Compression of the nerve by the tight muscle may mimic the "true" sciatica caused by a swollen or damaged disc or narrowed joint compressing the nerve where it exits the spine. The pyriformis tightness problem is much more easily remedied with appropriate stretching of the muscle groups, work on muscle balance of the hip and low back muscles, and regular massage.
Buttock pain which is worse in the mornings, and improves with light exercise, is more suggestive of pain arising from inflamed sacroiliac joints. This cause of buttock pain will be usually be associated with pronounced low back stiffness in the mornings, which can take 30 minutes to several hours to ease. Inflammation in these joints is often associated with inflammation in other tendons, joints and tissues in the body (e.g. plantar fasciitis, Achilles tendonitis), and may be part of medical conditions such as ankylosing spondylitis. This cause of buttock pain will usually be significantly relieved with nonsteroidal anti-inflammatories since it is true "inflammation" causing the symptoms.
What can be done to help?
Treatment for the various causes of buttock pain will obviously be very dependent on the actual diagnosis. It may involve therapy to try and mobilise the low back and sacroiliac joints, stretch tight pelvic ligaments, strengthen back supporting muscles, exercises to improve the strength and flexibility of the hamstring muscles, and deep tissue massage to the muscles attaching around the pelvis and the connective tissues enveloping them - the "myofascia".
Inflammation of the bursa, overlying the "bum bone", will not usually get better with frictional massage, ultrasound or other mechanical physio modalities, and may require an anti-inflammatory injection to dampen it down. If the sciatic nerve is very tight due to scarring and adhesions around it, this may also cause sciatica symptoms. In this case, the physios will do a lot of "neural stretching" and give the athlete neural stretches to do as part of their home rehab programme. These need to be carried out cautiously to avoid aggravating symptoms.
Hamstring injuries often occur because of "relative overuse" of the hamstring muscles. We see many runners who have forgotten how to use their buttock muscles (gluteals), but have extremely strong hamstring muscles. They have often had years of hamstring pain thinking that the answer to their problems is further hamstring strengthening. Very specific exercises to make them start using their "glutes" again and so reduce the load on the hamstrings often results in a dramatic improvement in their symptoms.
Conclusion
As in all areas of sports medicine successful treatment requires a specific diagnosis being made and then an appropriate rehabilitation programme for that diagnosis. Anti-inflammatory pills and rest may well reduce symptoms but if the primary cause is not treated, the same symptoms will usually recur on return to activity, cessation of pills or after surgery is completed.
In many cases of buttock pain, an important lesson to give patients is to "work their glutes" and stop overusing their hamstrings! "Pretend you've got a $100 note in the buttock crease and keep it there all day - in the supermarket queue, going uphill or stairs, standing around talking to people or talking on the phone. The possibilities are "endless" or should I say "bottomless"?
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A FEW TIPS FOR LOWERING CHOLESTEROL
What is cholesterol?
A white waxy substance normally found in all healthy cell membranes and necessary for the production of a variety of hormones. Most of the cholesterol in our body is produced by the liver, and the level in the blood is affected by certain types of food we eat.
What causes high blood cholesterol?
A diet too high in saturated fats found mostly in animal products e.g. meat, chicken, eggs, dairy
A genetic tendency to high blood cholesterol (runs in families)
Inefficient liver function due to a variety of reasons - stress, caffeine, lack of exercise, smoking, alcohol, overweight
Hormonal problems e.g. underactive thyroid gland
What problems can cholesterol cause?
Excessive amounts of cholesterol in the body may build up in the artery walls over time, narrowing and hardening them until the blood flow is reduced. This increases the risk of heart disease (angina and heart attacks), and stroke.
What are the different types of cholesterol?
There are two main types of cholesterol; one of which can protect against heart disease, the other can cause it. All cholesterol is carried in the blood by proteins - together they are called lipoproteins.
High density lipoproteins (HDL) are termed 'good' because they remove cholesterol from artery walls. A higher level of HDL is actually protective against heart disease.
Low density lipoproteins (LDL) are termed 'bad' because they deposit on the artery walls. It is very important to try lower the level of LDL to reduce the risk of heart problems.
Which foods contain cholesterol?
Most cholesterol in the body is made in the liver from saturated fat in the diet, thus the important thing is to reduce your saturated fat intake as much as possible.
Fatty meats and full-fat dairy products are particularly high in saturated fat.
Some foods e.g. prawns are high in cholesterol, but low in saturated fat. Cholesterol intake per se should not be excessive, but it plays a much lesser role than saturated fat in determining your blood cholesterol level.
Most plant foods such as fruits, vegetables and cereal grains contain no fat or cholesterol.
What foods should you avoid?
Cream, butter, cheeses, icecream, milk Vegetable fats such as palm oil or vegetable shortenings, some margarines Takeaways and fried or roasted foods that have had fat or oils added to them Meat pies, pastry, croissants, cheese-coated bread Sausage, luncheon sausage, salami Cakes, biscuits, puddings Chocolate and snack bars high in fat Roasted, salted nuts, crisps, crackers Alcohol - reduce to two evenings per week or drink low alcohol versions of wine and beer Eggs - no more than three per week
Foods to enjoy
High fibre foods help to produce HDL cholesterol. Include daily: Wholegrain breads, cereals, brown rice, wholegrain pasta Leave skins on vegetables and eat them e.g. potatoes, kumara, taro Use wholegrain rolled oats for porridge or muesli, or add oat bran to breakfast cereals Avoid sugar and white flour in cooking and baked goods Fresh fruits and vegetables contain antioxidants and vitamin C which protect the artery walls. Include daily:
Three servings of fruit - raw, cooked, or tinned without sugar Two to five servings of vegetables - either raw as salads or lightly cooked. Include both green and red/yellow/orange vegetables Choose lean meats, skinned poultry, or fish to reduce LDL cholesterol
Use lean meats, cut all visible fat off, buy low-fat mince Do not eat the skin on poultry Eat up to three fish meals a week. Fish helps to reduce LDL levels Do not roast or fry foods. Instead, grill, bake, boil, or steam Take care with dairy foods
Use low-fat yoghurts, cottage cheeses, ricotta, quark and reduced-fat yellow cheeses Keep milk intake down and low in fat Keep cheeses such as cheddar, fancy cheeses, and fetta cheeses to a minimum Try soy milk for a change and use soy beans, tofu, and soy icecream Avoid icecream - use low fat and low sugar versions or fruit-based jellies and sorbets Coconut cream and milk are high in saturated fat which produces LDL cholesterol Go vegetarian
Eat dishes containing beans, lentils, chickpeas, soybeans, tofu and tempeh - these do not contain cholesterol and they are high in fibre Eat pastry-less quiches, and lasagne dishes made with ricotta, cottage, or quark cheeses Use the good oils
Use monounsaturated oils and margarines e.g. olive and canola, these raise HDL cholesterol levels Avoid using butter, a saturated fat, or only use small amounts of unsalted butter Polyunsaturated oils such as sunflower, safflower, corn, soy, and nut oils will lower LDL cholesterol, but may also reduce the level of HDL cholesterol Choose takeaway foods that have minimal frying such as stir-fried Asian dishes Choose low-fat mayonnaises, soups, sauces, and salad dressings Further tips for lowering cholesterol Exercise daily for a minimum of half an hour Reduce stress where possible Drink less tea, coffee, chocolate drinks and colas Stop smoking (smoking reduces the good HDL cholesterol) Aim for a healthy body weight More information can be obtained from the National Heart Foundation of New Zealand and your local registered dietitian.
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MOUTH ULCERS -
What is a mouth ulcer?
A mouth ulcer is a breach or break in the mucous membrane which lines the inside of the mouth. It usually looks like a depression in the mucous membrane and usually has a yellow or white colour. The size may vary from a millimetre or less in diameter to several centimetres. It is often painful.
What are the most common types of mouth ulcers?
There are many different types of mouth ulcers. The two most common types are
1) ulcers caused by minor injuries and
2) aphthous ulcers.
1. Ulcers caused by minor injuries:
If a person has a sharp edge on a tooth (for example, because the tooth is chipped), or poorly fitting dentures, the mucosal lining of the mouth may be injured and this may result in an ulcer. These ulcers usually heal rapidly if the source of the injury is removed (for example, if poorly fitting dentures are removed or replaced).
2. Aphthous ulcers:
Most people probably get aphthous mouth ulcers at some time in their life. Usually the first attack occurs in adolescence or young adulthood. These ulcers are usually small (less than 5 mm in diameter) and painful. There may be just one or two at a time, or there may be very numerous ulcers in the mouth. People with this condition usually feel fairly well apart from the pain in their mouth. The ulcers usually heal in 1 to 2 weeks but they tend to recur at intervals over the course of many years. In some cases recurrences can be so frequent that mouth ulcers may be constantly present for prolonged periods.
Occasionally, aphthous ulcers can be much larger (more than a centimetre in diameter), and then they can take months to heal. These large ulcers are called 'major aphthous ulcers'.
People may feel pain or tingling in the mouth for a day or two before aphthous ulcers break out. It's best to start treatment at this time if possible.
The exact cause of aphthous ulcers is unknown but it is thought that they may result from the body's own immune system attacking the mucosal lining of the mouth. They may occur after minor injury to the inside of the mouth. Aphthous ulcers are more likely to occur at times of stress. They may occasionally occur after eating certain foods. They may be more common when certain hormones circulate; they tend to be more common round about the time of a menstrual period but less common during pregnancy. Sometimes aphthous ulcers can be caused by deficiency in vitamin B12, folic acid or iron. In rare instances, aphthous ulcers may be caused by coeliac disease (coeliac disease is a condition caused by an inability to tolerate gluten in the diet). A blood test can be used to test for coeliac disease.
Viral infections causing mouth ulcers:
Several different types of viral infections can result in ulcers forming in the mouth and throat.
The herpes simplex virus can cause an illness known as primary herpetic gingivostomatitis. This illness is most common in children. Numerous small painful ulcers occur on the lips, in the mouth and in the throat. There is usually a fever and the glands in the neck are enlarged. The child is usually miserable and may have difficulty eating and drinking because of the pain.
Another viral infection called hand, foot and mouth disease is most common in preschool children. Small ulcers occur in the mouth and little blisters also occur on the hands and feet of the child.
Healthy people with normal immunity recover rapidly from most viral infections in the mouth and throat; people suffering from the viral illnesses described above usually recover completely after a week or two.
Mouth cancer:
Most mouth ulcers are caused by relatively harmless conditions. However, an ulcer in the mouth may sometimes be the first sign of a mouth cancer. Any sore or ulcer in the mouth which is unexplained and not healing should be checked carefully by a general practitioner or specialist in case it might be a cancer. This is particularly important for older people and smokers, because mouth cancer is more common in these groups.
What are the other causes of mouth ulcers?
There are a great many other conditions which can cause mouth ulcers. These can include infections; abnormalities of the blood; adverse reactions to medications; and skin conditions in which rashes or ulcers may occur on other parts of the body too, not only in the mouth. People who suffer from intestinal conditions such as ulcerative colitis or Crohn's disease may also get mouth ulcers.
Ulcers can sometimes occur after radiotherapy to the head and neck region.
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JAUNDICE
What is it?
Jaundice is not actually a disease itself. Rather, it is a manifestation of an underlying problem.
The word jaundice is derived from the French word for yellow: "jaune" and refers to a yellowish colour of the skin and eyes. It is caused by a build-up of bilirubin in the body tissues. Bilirubin is a pigment which is formed as a natural process when haemoglobin (the oxygen-carrying component of blood) is metabolised. Any disease affecting the liver, the bile ducts or the breakdown of red blood cells, can cause an accumulation of bilirubin and lead to jaundice.
What are the causes?
There is a multitude of possible causes of jaundice. In all cases, a person with jaundice should be seen by a doctor who will need to take a history of the illness, examine the patient and request some tests in order to make an accurate diagnosis.
Some of the more common and more important causes of jaundice are described below:
1. Neonatal Jaundice
Jaundice in newborn babies is very common and is mostly a normal event. It can occur for two reasons:
Newborn babies have too many red blood cells which contain haemoglobin. It is normal for the baby's body to break down these excess red blood cells and thus form a large amount of bilirubin.
A newborn's liver is underdeveloped or immature and therefore cannot process the bilirubin as quickly as an adult.
In most cases, an infant's jaundice will resolve within a few days, often without the need for any treatment.
Occasionally, jaundice in an infant is caused by blood group incompatibility (ABO or Rhesus Incompatibility) which causes a very fast breakdown of red blood cells. If it is not the mother's first pregnancy, the possibility of this problem is usually picked up in the antenatal period.
A rare cause of neonatal jaundice is a physical defect in the liver or bile duct system.
Treatment of jaundice in a newborn may be required if the blood level of bilirubin is very high. This will usually entail placing the infant under fluorescent lights for a few days, which speeds up the metabolism of the excess bilirubin.
2. Viral Hepatitis
Hepatitis means inflammation of the liver and is often associated with jaundice. Hepatitis can be caused by several viruses, but the most common ones are: hepatitis A, hepatitis B and hepatitis C. More recently, other viruses causing hepatitis have been discovered, but less is known about them.
Symptoms
The severity of symptoms of viral hepatitis varies widely, but the symptoms in each of the different viruses are similar. Apart from jaundice, viral hepatitis can cause flu-like symptoms: fever, headache, aching limbs, tiredness, loss of appetite, nausea and vomiting. Skin rashes and joint pains can also occur in hepatitis B. A tender and enlarged liver is also commonly present.
Hepatitis A is transmitted through contaminated food or water. The virus is excreted in the faeces of an infected person and can survive for 3-4 hours outside of the body. Transmission of the virus is thus enhanced in conditions of poor hygiene and overcrowding. Generally, hepatitis A is a self-limiting illness and does not persist in the bloodstream nor in the stools after the illness has resolved. A vaccine against hep A is available and will prevent 90% of people from getting the disease.
Hepatitis B and C are transmitted in blood and other body fluids (e.g. semen, breast milk). Hepatitis B is particularly infectious and is frequently spread by sexual contact. It can also be transmitted by hep B positive mothers to their infants at the time of delivery, in which case the risk of chronic hepatitis in the baby is as high as 90%. Other groups at high risk of getting hepatitis B include intravenous drug abusers, homosexuals and health care workers.
Most people who get hepatitis B will become ill and their immune system will fight off the infection. However, 5-10% of people will go on to develop chronic hepatitis. Another 5-10% will become carriers, in which case they will be asymptomatic but able to infect others.
The hep B vaccine consists of 3 separate injections over a period of 7 months and is also 90% effective.
Hepatitis C is less likely to be transmitted by sexual contact or from mother-to-neonate, and is more likely to be transmitted in blood (e.g. intravenous drug use or blood transfusion). Both hepatitis B and C are now screened for in blood donors and the risk of getting these viruses from blood transfusions is nowadays negligible.
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3. Gallstones
Gallstones are a common problem in adults. Although they more commonly cause intermittent abdominal pain, they can sometimes cause jaundice. This occurs when gallstones get stuck in gallbladder or bile duct system, blocking bilirubin from being excreted via the intestine. Usually, the acute problem will resolve spontaneously and the gallbladder can be taken out non-urgently. However, sometimes, gallstones can lead to infection of the gallbladder or bile duct and/or septicaemia, which also may be associated with jaundice. This can be a serious condition and requires urgent treatment with appropriate antibiotics.
4. Alcoholic Hepatitis
Alcoholic hepatitis can be an acute or chronic illness that occurs as a result of liver cell damage caused by excessive alcohol. It is usually a reversible disease, but can go on to cause cirrhosis.
It usually occurs after a recent binge of heavy drinking. The symptoms can include jaundice, nausea, loss of appetite, abdominal pain, an enlarged tender liver, fever and mental confusion. It can be a mild illness which resolves after stopping alcohol, or it can lead to serious complications, causing critical illness and even death.
5. Malignancy
Cancer is a possible cause of jaundice, particularly in older people and in cases where there are few other symptoms besides the jaundice.
In these cases the jaundice is usually caused by a blockage in the excretion of bilirubin. A tumour causing the blockage may be in the liver, in the bile duct system or in the pancreas and pressing on the bile duct.
In cases where the jaundice is caused by excessive breakdown of red blood cells, there might be a malignancy of the blood, or involving the spleen. (The spleen is largely responsible for the breakdown of 'old' blood cells).
6. Medications
Several medications can cause hepatitis as a possible side effect. This may or may not result in a visible jaundice and sometimes it only causes a blood test abnormality. The jaundice is usually mild and the illness nearly always resolves once the drug has been stopped.
7. Pregnancy
A rare cause of jaundice is pregnancy. Sometimes, this is associated with excessive 'morning sickness' (hyperemesis gravidarum). The reason why some women get jaundice with pregnancy and the mechanism behind it are unclear, but it is usually a mild illness with an excellent prognosis.
What tests might the doctor order to diagnose the cause of jaundice?
1. Blood tests
Blood tests are very useful in a case of jaundice. These will usually show raised 'liver enzymes' as well as a high bilirubin level. Depending on exactly which enzymes are raised, further tests may be necessary to make an accurate diagnosis.
A 'full blood count" is also useful to look for infection or any blood cell abnormality.
2. Imaging
A doctor may request an ultrasound scan or a CT scan of the abdomen to check for gallstones or other structural abnormalities of the liver, gallbladder or bile ducts.
3. ERCP
ERCP (endoscopic retrograde cholangiopancreatography) is an invasive test requiring sedation or anaesthetic. It involves passing a 'scope' into the bile and pancreatic ducts via the small intestine and can be useful to demonstrate a site of blockage or to perform delicate surgery, including gallstone removal.
4. Liver Biopsy
Sometimes, a sample of liver tissue is required to make a definitive diagnosis. Liver biopsy is usually done under local anaesthetic and involves a long biopsy needle being passed through the skin to get a small sample of liver. Sometimes, it is done under ultrasound or CT guidance.
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How good is Soy The most recent "health trend" involves the wonderful world of Soy protein. Can Soy really live up to its new found reputation? more...
Good Garlic
Go heavy on garlic. Garlic has been found to fight cancer and growth of abnormal cells in your body. But make sure you are not cooking the benefits right out of this powerful herb. A recent study at Penn State University demonstrated that if you cook garlic cloves whole, you won't get the preventive effect. Heating a whole clove destroys the enzyme needed to produce allyl sulphur compounds, which are cancer fighters. So, next time you are adding garlic to your dishes, make sure you slice, chop or crush it, then let stand for 10 minutes before adding. Cutting into the cell membrane releases the enzyme that creates the active compounds.
Stop Aging with phytochemicals
Phytochemicals are the new buzzword in health food. These chemicals are not really essential nutrients that your body needs but they can help slow down the aging process of the cells in your body and lower the risk of cancer.
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CHILDHOOD FOOD ALLERGIES
What is a food allergy?
Food allergy is the result of an immune reaction by the body to normally harmless substances in foods. These substances are called antigens or allergens. For a variety of reasons some children's immune systems release antibodies and histamines in response to these allergens.
Reactions may occur within minutes of eating the allergen (Type 1 hypersensitivity), or be delayed up to 48 hours after consuming the food (Type 4 hypersensitivity).
The release of histamines in the body may cause a variety of symptoms:
Type l - occurs within 60 minutes of exposure. Reactions include:
Type 4 - occurs within hours or days of exposure and may be dependent on the amount of allergen consumed. Reactions include:
Eczema, dermatitis Asthma, hay fever, sinusitis, persistent cough, runny nose, ear infections Constipation Sweating Poor appetite, feeding difficulties Behaviour and mood changes, rocking, hyperactivity, poor attention Sleep problems Why do allergies occur? Typically a reaction occurs because a foreign protein (antigen or allergen) is absorbed from the digestive system into the blood. The production of antibodies and histamines are the body's protective mechanism against these.
Children may inherit tendencies towards allergies. The stronger the family history of allergies e.g. asthma, eczema, hay fever - the earlier the child is likely to develop these.
Sensitivity may also develop when the digestive system of the child is immature and comes into contact with new foods and substances.
Allergy prevention
Where there is a known family history the mother should avoid suspected foods throughout her pregnancy and breastfeeding. To avoid the possibility of nutrient deficiencies she should consult a registered dietitian for dietary guidance.
Breastfeeding exclusively up to the age of six months helps to reduce the possibility of allergies developing for any child. For infants requiring bottle feeding before the age of six months, look for hypoallergenic (low allergy) formulas.
Care must be taken with all infants at the introduction of solids. Because the digestive system is very immature it may allow the absorption of foreign proteins which would normally not be allowed to pass into the blood system.
Do not be in a hurry to start feeding different foods. Introduce one new food per week. All foods should be cooked. The least allergenic foods to start with are rice, pears, yellow and root vegetables.
By the age of 8 to 9 months start to introduce:
Oats Green vegetables Unprocessed meat and chicken
From 9 to 12 months:
Wheat Soy Dairy e.g. plain yoghurt, cottage cheese, goats milk products Beans, lentils, chickpeas Tomatoes Citrus and other fruits
From 18 to 24 months:
Eggs Berry fruits
From age 3:
Peanuts, nuts Fish and shellfish
Avoid processed meats e.g. ham and bacon, also chocolate, spices, colourings, artificial flavourings, fruit drinks and juices. Be cautious with cow's milk and cheese, pork, beef, citrus fruits, and all gluten containing grains (e.g. wheat and rye; rice and millet are gluten free).
Suspect a food allergy? Here's what to do:
Your health practitioner can arrange for various skin and other food sensitivity tests. These are not considered to be completely reliable however and may return false negative and false positive results in some cases. Do not depend on them completely to alter your child's diet.
Careful elimination of the suspected foods give the best results and allow for less reduction of important nutrient containing foods. The advice of a registered dietitian is important to prevent any nutrient deficiencies developing.
Suspected foods should be removed from the diet for four to six weeks then reintroduced while carefully noting any recurrence of symptoms. Introduce suspected foods one week apart to allow for delayed reactions.
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Introduction
As we all grow older, changes occur in our organ systems including our eyes. Most ocular changes associated with age are not a reflection of disease processes but can have a significant effect on vision.
Failing near vision (presbyopia)
The ability of the lens inside an eye to focus gradually decreases with age. This results in many people over the age of 40 years requiring reading glasses to see clearly for near vision. These reading glasses overcome the requirement of the lens in the eye to change its focal length. They need to be gradually increased in power as the eye loses its focussing ability, but the use of reading glasses does not accelerate or retard this process.
Macular degeneration
In the over 60-year-old age group, reduction in central vision can occur as a consequence of degenerative changes in that part of the retina which we call the macula. The macula is the central part of the retina which is used for reading and other fine visual tasks. The cause of macular degeneration is poorly understood but is believed to be related to exposure of high levels of light over a prolonged period.
The use of sunglasses may decrease the incidence of macular degeneration but most forms of this condition are slowly progressive.
If you are known to have macular degeneration and experience a sudden change in your vision with distortion, reduced near vision or blurred central vision, you should see your ophthalmologist without delay.
Cataracts
Opacification of the lens within an eye is called a cataract.
The incidence of cataracts increases with age and some cataracts may progress to require surgery. Many people over the age of 60 have cataracts but not all require surgery as this is usually only advised when the vision has become blurred to the extent that normal visual tasks are not able to be performed well.
Glaucoma
Glaucoma is an ocular condition in which the pressure inside the eye is too high and is causing loss of vision.
Glaucoma can run in families and is seen more commonly in the over 50 age group but most patients are unaware that they have the disease until it is in an advanced state.
It is important to have regular eye examinations and be screened for glaucoma, especially if there is a family history.
In most cases the condition can be successfully treated with pressure lowering drops.