Tuesday, 27 September 2011

Hypertension-myths and realities

Well one of the second largest killer  coming under the preview of non contagious disease.The World Health Organization (WHO) reports NCDs to be by far the leading cause of mortality in the world, representing over 60% of all deaths. 
 In US alone one in three has hypertension(HTn) where global index no better.
One of other disease coming under the head of non contagious disease ,also known as silent killer,you must have noticed people saying 'Oh he/she was alright till yesterday,had no symptoms with no major disease died of sudden stroke,MI or had a paralytic attack!!!!!!
     1.Don't feel any symptom.
  • That is the reason it is called silent killer disease.
  • Persistent hypertension creates risk for strokes,heart attacks/heart failure and still is one of the leading causes for kidney failure.
  • HTn has a cascading effect on most vital organs as they are deprived of adequate blood supply and oxygen.
  • Here comes the need of half yearly /annual health checkup so as to screen even what some call as pre hypertension condition.
     2.HTn means check BP every day.
  • Initially yes,when one is prescribed with a new regime of treatment/change of drug or dose,but there after twice/thrice a week generally suffice but preferably at the same time  .
  • Harmful effects occur over a period of long time i.e.years and not days/month
  • Keep a record of average BP over month and show the pattern to your healthcare professional.  
   3.Normal range is 110/70 to 120/80 mm Hg.
  • No,normal BP has now a slightly wider range depending upon ethnic groups,demographic locations and conditions,age gender,etc.
  • Health bulletin released by WHO for country specific can be seen for that.
  • But for US below 120/80 is normal.
    4.Manage either systolic or diastolic.
  • No,a serious myth,both are equally important
  5.Blood pressure is controlled,so i can stop taking pills.
  • Unfortunately like many other NCDs ,HTn cannot be cured ,once diagnosed,it can only be controlled/managed .
  • The moment treatment is withdrawn there are high possibilities HTn bounce back.
     6. My BP is controlled by Pills meaning I can continue my old life style of smoking,alcohol     consumption etc.
  • No,all these are excessive risk factors with continues excessive smoking,high alcohol consumption pills become less effective as arteries become harder & narrow with formation of plaque etc.
     7.All HTn pills have side effect and nothing can be done for that.
  • Gone are the days when HTn pills had major side effects and nothing could be done but now scenario has changed,now doctors prescribe pills which are practically without side effects.
  • But yes exceptions are there a pill which suits one might have some side effect for other,like ACE inhibitors might induce dry cough in some,but these effects are of mild nature ,do inform about even any slight change you notice.
    8.Old age means HTn.
  • Age has no specific relation to HTn.
  • There are many factors which cause hypertension-genetic,stress,lifestyle,kidney impairment,etc
  • Collecting in simple words,HTn is caused when due to some reasons heart has to work harder to pump blood to different parts of body.
   9.High cholesterol levels means definitive HTn.
  • Poor eating habits with sedentary life style may increase may increase both but not necessarily that high cholesterol means also high BP.
   10.Diabetic on insulin will become Hypertensive.
  • There was a thought years back when insulin therapy was initiated,but with improvised insulin and techniques now we know that there is no substantial base to it.
   11.I am hypertensive suffers from severe headache means stroke is about to happen.
  • No,severe headache can occur due to various reasons,though mild heaviness or mild headache can be associated with HTn.,but prolonged very high values might trigger severe headache or worse impending stroke,but then this is not always the case,individual body responds differently.
  • Remember headache is not a disease ,it  is a symptom for some underline disease.
   12.Diet has no or minimal role in managing BP.
  • DASH -Dietary approach to stop hypertension.system is now used worldwide to control blood pressure with minimal support of hypertensive pills.
  • Further information can be seen at DASH

Wednesday, 14 September 2011

Diabetes-myths and realities

 I will not go into teaching what diabetes is,lot of research is being done by people who are diagnosed by diabetes,the word these days has fetch the name of being a silent killer,one of the worst disease et al.One of the largest killer disease coming under the head of Non Contagious diseases,Hypertension , Cerebellar stroke Asthma being the other few.
Numerous myths,misconceptions are being attached ,circulated via different means and ways,moreover when despite medication and other modes,abnormal blood sugar levels and other associated complications are seen patient really tries to believe many improper notions.
I have tried to collect few most common misconceptions out of my clinical experience.
      1.Diabetes is not a serious disease.
             Lot of recently diagnosed patients say "Sir we don,t think that diabetes is a serious disease"reason    being they don't feel any pain,etc or any symptom which is not the case.
    • It causes more deaths in a year then AIDS,TUBERCLOSIS AND BREAST CANCER taken together.
    • Two out of three diabetics die of Myocardial infarction and stroke.
    • Every 6-7 minutes a limb is being amputated .
    • Millions are spent by Fedral .and other govt.worldwide on medication and on complications.
     2.Eating lot of sugar related items causes diabetes.
      No,not at all,Dessert lovers,chocoholics,sweet lovers,etc. aren't destined to develop diabetes.
  • It is actually a amalgam of too many factors,genetic(hereditary),life style,stress,obesity to name a few.
  • A diabetic family profile from any side be it paternal or maternal should be a alarm bell for you.
  • Follow the basic principle 'prevention is better then cure'-sweat a lot,exercise a lot,eat cautiously,check obesity,things will fall in line.
     3. Just cannot eat anything sugary.
       Avoiding isn't a compulsion but limiting the quantity is.
  • Sweet/confectioneries have ready carbohydrates which increase glucose levels almost instantly and considerably,but then a piece of cake,part of dessert or few cookies won't harm if taken as a part of healthy diet combined with medication,exercise,etc.
  • Follow the rule"Anything in excess is harmful".
    4.A diabetic child will not carry disease in adulthood.
  • Childhood diabetes or Type1 diabetes or  juvenile diabetes or Insulin dependent diabetes  is caused by malfunction of insulin producing cells i.e. Beta cells of pancreas,which are destroyed by body itself .
  • Hence a child will carry the disease till adulthood.
  • Till date only treatment/management is possible no definitive cure is there,though trials are going on artificial pancreas,once a month insulin shots,nothing is affirmative yet..
    5. pregnant diabetic females have numerous complications..
    • Years back this was not a myth, diabetic mothers with poorly controlled blood sugar levels were   unable to carry full term pregnancy due to self spontaneous abortion(miscarriage) or malformation in early pregnancy ,hypertension and premature babies in later pregnancy,also uncontrolled diabetes leads to high birth weight leading to unwanted severe complications for both mother and newborn,
    •  Now with modern understanding and treatment of diabetes leading to tight control of diabetes and its complications ,any diabetic can give even normal delivery like any other  female.
    • Gestational diabetes is a term used for females who develop diabetes during pregnancy which generally gets cure on its own after pregnancy but might carry on even after pregnancy.
         6.Diabetics are more prone to any illness..
      • Again a myth,controlled diabetics lead normal life any other human being falling like any other,but yes some US guide lines say about the need of Flu shot,this is still controversial,as any illness makes diabetes a nightmare to control.
      • Uncontrolled diabetes may lead to severe life threatening complications even in minor surgeries..
           7.Diabetics should not play outdoor sports activities.
      • Moderate physical activities,exercise,brisk walk,etc are integral part of treatment and prevention of diabetes but diabetics with complications should first seek medical advice before initiating any new exercise in their regime.
      • Diabetics with numbness/weakness in lower limbs should restrict jogging/brisk walking without special diabetics footwear,due to fear of unwanted foot injuries or foot ulcers,etc.
      • Over enthusiastic or uncontrolled exercise regime can damage heart muscle permanently,in diabetics.
           8.Diabetics on pills/insulin can eat what ever they like by increasing dose.
      • No,diabetics need to be utterly cautious about their food intake,all these pills try to regulate by bringing sugar levels near to normal by putting extra pressure on already fatigued out pancreas,so they can ill afford any extra glucose load cause by unregulated,unhealthy diet.
      • Though insulin doses are adjusted according to sugar levels,overeating causes weight gain, cholesterol increase leading to other complications. 
           9.Diabetics should not drink alcohol.
      • Moderate amount of alcoholic beverages with food does not cause much adverse effect on sugar levels but alcohol taken empty stomach may cause severe dip in sugar levels.
      • Reports in insulin-dependent diabetics and even in healthy subjects have shown that acute alcohol consumption impairs the body response to hypoglycemia.
      • Chronic or excessive drinking ,in contrast ,has been associated with hyperglycemia .Chronic alcohol abuse can reduce the body's responsiveness to insulin and cause glucose intolerance in both healthy individuals and alcoholics with liver cirrhosis.
      • Any short spell of hypoglycemia can cause severe brain damage as brain CANNOT store glucose  and it relies exclusively on body glucose levels to cater its energy needs.
          10.Let diabetics enjoy life without medication eventually he/she has to die.
      • Well this question is asked by few often,my reply is,u need to take diabetes like any other disease but with more caution,any disease left untreated will give unwanted complications,etc.

      Thursday, 1 September 2011

      The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.  ~Plato