Rajen's Easytips: September 2019

DYSILIPIDEMIA OF THE HEART

Dyslipidemia is a condition wherein lipid levels in the blood stream go too high or too low.
Lipids comprise of HDL-‘good’ cholesterol, LDL-‘bad’ cholesterol, and triglycerides.
A Lipid Profile Check determines their levels in the blood.
Ideally, HDL should be at high levels, and LDL and triglycerides should be at low levels.

RISK FACTORS

High blood pressure
Excess body weight
Uncontrolled diabetes
Male above 40 years of age
A family history of cholesterol problem
Unhealthy lifestyle –

Irregular food habits
Smoking
Excessive alcohol
Little or no physical activity
Mental stress and strain

Chances are that you may have high levels of LDL and triglycerides, and low level of HDL, which increases your risk of heart attacks, reduced blood flow in the limbs, and stroke.

HEALTHY TIPS FOR HEART

Do’s

Eat more of fruit, vegetables, high-fibre, and low-cholesterol food.
Try to eat a new healthy recipe each week.
When traveling, carry heart-healthy snacks to avoid fast foods.
Drink plenty of water daily.
Exercise regularly and go for a brisk walk for 45 minutes to an hour, 3-4 times a week, to help increase your good cholesterol.
Take the stairs routinely.
Take the first available parking space and walk the extra distance to office or work.
Stop drinking alcohol, or limit it to a peg a day, twice a week.
Maintain a healthy body weight.
Control your blood glucose level.
If you are diabetic, get your lipid profile checked every 3 months.
Get a yearly checkup.
Sleep for 6-8 hours at a stretch.
Practice yoga to keep your lungs and heart healthy along with strengthening your back muscles.
Know the symptoms of a heart attack and get help right away.

Don’t’s

Don’t eat fried, junk, salty and oily food, and avoid red meat.
Don’t give diabetes a chance to increase your heart risk.
Don’t take stress for too long, by taking a ‘stress break’ of 15 minutes for relaxation, meditation or a walk.
Don’t feel depressed, with the help of a friend or relative.

Don’t start exercising without your doctor’s permission.
Don’t start late on good lifestyle practices such as walking, jogging, cycling or playing regularly with your children.
Quit smoking.
Don’t miss your regular appointments with the doctor.

TESTS FOR YOUR HEART

Checking your family history for causes of heart diseases.
Blood pressure levels (normal is 120 mmHg systolic / 80 mmHg diastolic)
Blood sugar level tests (fasting and post-meal).
Glucose tolerance test (GTT) and/ or a Glycosylated haemoglobin level test.
Lipid profile test (total cholesterol, HDL-good cholesterol, LDL-bad cholesterol, HDL: cholesterol ratio, and triglycerides)
ECG, 2D echo and a stress test.
Angiography.

CAROTID ARTERY DISEASE

1. ATHEROSCLEROSIS

Carotid arteries in the neck supply most of the blood to the brain.
These arteries can be affected by atherosclerosis that leads to progressive narrowing (stenosis), and in some cases, complete blockage (occlusion).
In occlusion, attempting to reopen the blocked artery isn’t beneficial, so treatment focuses on the arteries that are only partially blocked.
Atherosclerosis of the carotid arteries develops when fatty deposits or plaque clogs them.
The buildup blocks the blood supply to the brain and increases risk of stroke.
In its early stages, carotid artery disease has no symptoms.
As it progresses, it deprives the brain of blood and leads to a transient ischemic attack (TIA).
The symptoms of TIA include

sudden numbness or weakness on the face, arm or leg, typically on one side of the body
slurred, garbled speech or difficulty understanding others
sudden blindness in one eye.

Although a TIA produces symptoms similar to a stroke, it usually lasts a few minutes and causes no permanent damage, but is a warning of an impending stroke.

2. CAROTID ARTERY STENTING

In moderate cases, carotid artery disease improves with quitting smoking, losing weight, eating healthy food, and exercising regularly with medication.
But, in severe cases, where the carotid artery is blocked 70 percent, the blockage must be removed and the artery opened.
Carotid artery stenting is a safe, effective option.
A tiny balloon is threaded by catheter to the area where the artery is clogged.
The balloon is inflated to widen the artery and a small wire-mesh stent inserted to keep the artery from narrowing again.
This is low risk in most healthy people, prevents strokes and has lasting benefit.

3. ROTABLATION

Rotablation is a technological advancement which has immensely helped in improving the results of angioplasty.
Over time, plaque – a fatty substance made up of cholesterol, calcium and other materials, builds up in our arteries.
When a heart artery is completely blocked by a plaque, it can cause heart attack.
If a plaque is soft enough, angioplasty can be easily performed by opening the block with a balloon first and then placing a stent (kind of spring) across the block and opening the stent completely so as to keep the vessel fully open.
But, what if the plaque is too hard for angioplasty?
As calcium builds up in artery walls, plaque can become extremely rigid and hard or even too hard for an angioplasty balloon to stretch the artery open.
That is where rotablation, or rotational atherectomy, comes in.
A device called rotablator was invented, which is a tiny drill with a burr on the end that is coated in diamond dust.
The rotablator drills through calcific plaque breaking it up into tiny pieces and forming a smooth tunnel through the plaque.
These tiny pieces are small and safe enough to be picked up by the blood stream.
Because of the smooth tunnel formed by the rotablator through the block, it is easily possible to take the balloon and then the stent to the block, place the stent across the block after stretching open the block with the balloon and then easily open the balloon to its fullest – thus optimizing and perfecting the result of angioplasty.
It is because of the rotablator that it is possible to avoid bypass surgery in patients who have complicated open blockages.

4. CIRCLE OF WILLIS

But if a carotid artery is completely blocked, risk of stenting usually outweighs the benefit.
Fortunately, the brain can use alternative routes to provide blood to the area of the brain supplied by the blocked artery.
A network of blood vessels at the base of the brain, called the circle of Willis, can supply the necessary blood flow.
Many people function normally with one completely blocked carotid artery, provided they haven’t had a disabling stroke.
Medical treatment and carotid angioplasty is effective for preventing TIA and strokes in such cases.

DIABETIC RETINOPATHY

Diabetes affects many organs of the body, especially the eyes.
It causes early development and maturation of cataract.
Diabetics are more prone to develop glaucoma.
The most dreaded and vision threatening complication of diabetes is diabetic retinopathy.

It refers to retinal changes caused by damage to blood vessels of the retina.
New blood vessels get formed in the retina whose walls are thin and may leak spontaneously.
It causes retinal haemorrhage leading to significant loss of vision.

FACTORS

The duration of diabetes is the important factor in the development of this disease.
About 50% of diabetics develop diabetic retinopathy after 10 years, and almost all diabetics after 20 years.
Severity of this disease is not related to blood sugar levels.
Family history also makes a person more prone to it.
The risk of blindness is about 25 times greater in diabetics than non-diabetics.

SYMPTOMS

Blurring of vision, frequent change of refractive glasses, difficulty in reading and driving, and distorted vision are common symptoms of diabetic retinopathy.
Increased blood glucose level may sometimes cause oedema or swelling of the crystalline lens which leads to temporary myopia or near-sightedness, which blurs distant vision though the near vision remains intact.

DIAGNOSIS

An eye specialist examines the retina with the ophthalmoscope to make a diagnosis.
The other ways to diagnose this disease are fundus fluorescein angiography (FFA) and optical coherence tomography (OCT).
Photographs of the fundus or retina are taken to reveal the stage of development of diabetic retinopathy through FFA.

TREATMENT

Laser is very effective in treating diabetic retinopathy.
With the help of laser, new vessels can be destroyed and leaking vessels sealed.
Another option available is injecting the eyes with a special injection, which destroys new blood vessels which develop in diabetic retinopathy.

MANAGEMENT

If diabetes can be controlled in the initial stages, it can delay the development of this disease.
For this, it is vital to control blood sugar and blood pressure.
A diabetic can safeguard himself from the complication of this disease by consuming a fat-free diet, avoiding smoking and alcohol, exercising regularly and taking brisk walks.

DIABETIC GASTROPARESIS

Diabetic gastroparesis, or delayed gastric emptying, is a medical condition caused by partial paralysis of the stomach muscles.
It leads to food remaining in the stomach for much longer than normal, and can occur in both type 1 and type 2 diabetes.
It is more common in type 1 diabetics, particularly those with poor glycemic control.
Normally, strong muscular contractions squeeze the food down from the stomach into the small intestine in peristaltic waves for further digestion.
Gastroparesis occurs when the vagus nerve, which controls these contractions, is damaged, affecting the contraction of the gastrointestinal muscles, and preventing the stomach from emptying its content at a normal pace.
Diabetes can damage the vagus nerve if blood glucose levels remain high over a prolonged period.

SIGNS AND SYMPTOMS

Nausea
Vomiting of undigested food
Early satiety and lack of appetite
Heartburn
Abdominal bloating
Pain in the upper abdomen due to spasms of the stomach wall
Erratic blood glucose levels
Weight loss
Consumption of high-fibre, oily and spicy foods and carbonated drinks increase these symptoms.

COMPLICATIONS

General malnutrition, chronic fatigue and weight loss because of poor calorie intake.
Bacterial infection from the fermentation of undigested food.
Intestinal obstruction due to solid masses of undigested food.
Fluctuations in blood glucose levels because of delayed and unpredictable gastric emptying.

DIAGNOSIS AND MANAGEMENT

Evaluate any gastrointestinal symptoms in diabetics to rule out gastroparesis.
Adequate glycemic control remains the primary goal of treatment.
Appropriate dosage and intake of diabetic medications, monitoring of food intake and blood glucose levels are of utmost importance.
The mainstay of medical treatment includes anti-emetic and pro-kinetic therapy.
Therapeutic endoscopy may be beneficial in some cases.
For patients not responding to medical therapy, there are other medical interventions possible.

SUGGESTIONS FOR DIETARY MODIFICATIONS

Eat smaller, but more frequent meals.
Include low-fibre diet.
Avoid tea, coffee, alcohol, tobacco and chewing gum.
Avoid late evening snacks.

CERVICAL (UTERUS) CANCER

It is the cancer of the mouth of the uterus or cervix.
It is the most common cancer in India and all sexually active women are at a risk of contracting this disease.

Human papillomavirus (HPV) infection is the main and necessary virus for this cancer.
It is a sexually transmitted virus passed through genital contact.

DEVELOPMENT

Early marriage
Use of oral contraceptives
Smoking and consumption of tobacco
Immuno-suppression
Infection through other sexually transmitted diseases
Poor nutrition

SYMPTOMS

Pelvic pain and pain during intercourse
Bleeding between periods and post-menstrual bleeding
Vaginal discharge.

TREATMENT

The first and second stage of cervical cancer is operable.
Patients are operated through keyhole surgery.
It is less painful and less time is spent in the hospital.
Patients can return to their normal life quite soon.

PREVENTIVE MEASURES

Delaying sexual intercourse
Limiting one’s sexual partners
Using barrier protection like condoms
Annual screening after 30 years of age through pap-smear test.
HPV vaccination

STOMACH (GASTRIC) CANCER

Helicobactor Pylori (H Pylori), a spiral-shaped stomach bacterium, is the cause for chronic gastritis, peptic ulcers and gastric cancer.
It is a dormant bacterium since 80% of the population in most developing countries is infected, but only 20% have symptoms.
The bacteria can be passed from person to person through contact with saliva, vomit or faecal matter.
The infection can be picked up in childhood and can persist lifelong if left untreated.
Good hygiene, healthy eating habits and proper treatment can protect you against it.

GASTRIC CANCER

H Pylori is a risk factor for two types of stomach cancer:

Gastric adenocarcinoma and
MALT lymphoma

People with H Pylori infection have a 6-times higher risk of developing gastric cancer than the uninfected.
Symptoms of cancer include persistent upper abdominal pain, vomiting with blood in the vomit, blood in the stool, loss of appetite, fatigue and significant weight loss.

DIAGNOSIS AND TREATMENT OF H PYLORI

H Pylori can be diagnosed with a simple breath, stool, serological or endoscopic test.
A 2-week antibiotic course is enough to eradicate the bacteria.
Eradication of H Pylori with antibiotics reduces cancer risk.
It may become drug-resistant following inadequate treatment.

RISK FACTORS

Low socio-economic status
Lack of education
Poor general and dental hygiene
Crowded living space
Unhealthy eating habits