QUEEN VICTORIA
Age: 124
7819 days old here
Total Posts: 26285
Points: 0
Location:
Lahore, Pakistan
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.
QUEEN VICTORIA
Age: 124
7819 days old here
Total Posts: 26285
Points: 0
Location:
Lahore, Pakistan
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.
QUEEN VICTORIA
Age: 124
7819 days old here
Total Posts: 26285
Points: 0
Location:
Lahore, Pakistan
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.
Heat sugar and water in a saucepan stirring occasionally until the sugar dissolves. Boil for 10 minutes without stirring. Remove it from the heat and allow to cool slightly. Mix the cooled syrup with the coconut milk and pour into a container. Cover and freeze for about 3 hours or until semi-frozen around the edges and mushy in the centre.
Transfer the mixture to a bowl and cut up with a knife. Then place half the quantity at a time in a food processor and process until smooth, or whisk thoroughly by hand. Turn the mixture into a bowl. Whip the cream until soft peaks form and fold into the ice-cream, then stir in the desiccated coconut. Return the mixture to the container and freeze again until solid.
Boil the milk well. when it cools down mix the custard powder in a little milk and keep aside. Separate egg white and egg yolk. Boil the bananas in some milk. When it is done smash the bananas well after removing the seeds. Keep the remaining milk in a small flame and when it begins to boil stir in sugar and custard powder kept aside. Add the beaten egg yolk and the smashed bananas to it. Keep stirring while adding all the ingredients. Remove from the fire. When it cools down add the essence and beat well in a mixer. Keep it in a freezer to set. When it is half set take it out and add the egg white and beat it well. Again freeze it until solid.
Pour the boiling water into a bowl, stir in a cardamom seeds and leave for 15 minutes to infuse.
Meanwhile, put the condensed milk into a blender together with cold water, pistachio nuts, almonds and almond essence. Process the mixture until very finely mixed. Add the cooled and strained cardamom water and pour into a bowl. Whip the cream until soft peaks form. Whisk into the mixture. Pour into a container and freeze until semi-frozen around the edges and mushy in the centre.
Transfer the mixture to a bowl and mash well with a fork. Divide the mixture evenly between 6-8 small moulds and freeze for at least 4 hours or overnight until firm. To serve, dip the base of each mould quickly into hot water and run a knife around the top edge. Turn out on to serving plate.
Method 2
Ingredients :
Milk - 6cups Corn flour or arrowroot - 8tbs Mawa - 11/2cup Castor Sugar - 13/4cup Cream - 1cup Keora Essence Badam, Pista, Cardamom - few pieces
Method of Preparation :
Preparing Mawa : Boil 1 litre milk and add a pinch of soda, stirring continuously. When it thickens to mawa consistency remove from heat and cool.
Put corn flour and sufficient amount of mil to make thick paste. Grind it for few seconds. Add rest of milk and grind once again. Pour it into a vessel and boil until it thickens. Add mawa to it and remove immediately from heat. Grate badam, pista and cardamom. Add sugar and cream to it. Add this to the prepared paste. Pour a few drops of keora essence. Fill the paste in a
