DrugsRead – Read about Health

Diabetes is a multifactorial disease with genetic and environmental factors contributing to its clinical expression. The prevalence of diabetes is increasing worldwide and has become a major health problem. Relatives of diabetes patients or laymen commonly ask about the symptoms of diabetes. In view of this, I will try to highlight the various modes of presentation and detection of diabetes – the first symptom for which the patient goes to the doctor or the circumstances in which diabetes is detected. These various modes of detection of diabetes is based on our clinical records (OPD and Indoor) and clinical experience.It is important to realize that early diagnosis of diabetes can preventor postpone various complications of diabetes. Introduction : Diabetes can appear with or without symptoms. The disease can remain undetected when without symptoms, such cases when detected might have already developed the complications. This emphasizes the need for early detection of diabetes.When diabetes mellitus appears in childhood, it is known as Type -1 or Juvenile diabetes or Insulin Dependent Diabetes Mellitus (IDDM). When diabetes is detected in adult life, it is known as Maturity Onset or Type -2 or Non-Insulin Dependant Diabetes Mellitus (NIDDM).

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The emergence of new disease organisms from human enclaves was once a great danger that often materialized into great devastation. Plague carried off one third of the European population in the fourteenth century. Yellow fever created more sporadic havoc, biting out sizable chunks of cities such as Memphis and Philadelphia in the seventeenth and eighteenth centuries. Falciparum malaria was present in ancient Egypt and probably hitched rides throughout the Mediterranean as humans crisscrossed this ancient marine thoroughfare. The list could go on. From ancient Egypt to nineteenth-century London, new diseases were rolling, riding, sailing, and steaming their way into populations around the world.     But the time when these concerns were most warranted is over. The last big hurrah of world exploration by human pathogens corresponded to the period of human exploration and colonization. If Christopher Columbus had had a high-tech surveillance system at his disposal, the mind-set of a public health expert, and the ability to influence public policy, he would have been in a position to do some major disease prevention. This last great expansion of infectious diseases gets less airplay than the current threat of emerging diseases because humans are self-centered beasts, being more attentive to the minor dangers that threaten us today than to the devastating problems we imposed on others in the past. The most devastating new diseases in recorded history were those transmitted from rather than to Europeans. American Indians, Polynesians, and aboriginal Australians did not write our history article. There were not many of them who were in a position to do so, partly because there were not that many of them. Most had been destroyed by European diseases such as smallpox and measles.     The history of the twentieth century indicates that the greatest threat to Europe and North America from African and Asian diseases has already come and gone. What nasty new epidemics spread to Europe and North America from Africa and Asia during the twentieth century? Only AIDS. Even the most notorious pandemic of influenza, which has given some notoriety to east Asia as a virological melting pot, cannot be attributed to Asia. As I noted in the first chapter, the best reconstruction of evidence traces the origins of the exceptionally virulent 1918 viruses not to Asia but to the western front of Europe, where the conditions of trench warfare and the transport of severely ill patients apparently favored evolutionary increases in the virulence of the influenza viruses that were circulating there.     The greatest threat to humans from pathogens is from pathogens that are already widespread in humans. True, some pathogens can cross into humans from other species in faraway places, but we now have a good sense of which ones can generate a grave threat. We have tracked this drama with yellow fever and influenza repeatedly. Long before the AIDS pandemic, most of the dangerous pathogens from African jungles or Asian multitudes had amply demonstrated their particular horrors.     Certainly, imported diseases have recently caused problems for small numbers of people in wealthy countries. Increased travel between rich and poor countries exposes travelers to the unsolved problems of the poorer countries. The blood of visitors to sub-Saharan Africa has a good chance of acquiring the malaria parasites that annually kill a million people in poor countries. The intestinal tracts of travelers to almost any poor country have a good chance of becoming hosts to the waterborne viruses, bacteria, and protozoa that annually kill millions of people by causing diarrhea.     Every day, travelers bring these pathogens into JFK and Los Angeles International Airport, fresh from the poorer countries. These infected travelers may serve as the source for a few additional infections that arise within our borders, but by and large these chains of infection peter out, largely because the infrastructure of rich countries inhibits their spread.

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An injured meniscus will typically result in tenderness and swelling at the joint line. However, in the case of an acute injury, an observant patient can further help clarify the diagnosis. To the trained ear, there is a big difference between a patient who reports, “I was playing tennis and then suddenly I was in so much pain that they had to carry me off the court and my knee swelled up like a balloon,” and a patient who says, “I was playing tennis last night, and my knee hurt a little but I continued playing, but by morning, my knee was really swollen.” The degree of pain and the timing of swelling can provide important diagnostic clues as to the location and severity of the injury. Here’s why. The blood supply to the meniscus, which comes from the capsule, flows from the outer part of the meniscus to the middle. As a result, there is a very good supply of blood to the peripheral or outer part of the meniscus, called the red zone. However, as you move from the periphery to the middle of the meniscus, the blood supply becomes scarce—the so-called white zone. Nerve endings tend to follow the blood vessels. Pain is a reflection of the synovial reaction or inflammation throughout the joint. If there is a peripheral tear, blood will immediately spill into the joint. If no blood vessels are disrupted, the synovium will secrete fluid, a delayed response, which results in a collection of fluid several hours later.The timing of swelling can also help to pinpoint the location of the injury. Immediate swelling means that blood vessels have been ruptured, a sign that the injury occurred in the red zone or is more typical of a ligament injury. Delayed swelling, swelling that begins 6 to 12 hours after an injury, is a sign that the joint has filled up with fluid as a result of inflammation, the so-called synovial response.

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Help with financing health care is offered by both state and federal governments. One kind of help, called Medicaid, is available to those who are indigent; that is, people who are unable to support themselves. The other kind of help with finances is called Medicare. Medicare is an
add-on to Social Security benefits. Therefore, if you are over sixty-five years old, or are disabled by Social Security standards, and if you are eligible for Social Security benefits, you should qualify for Medicare.
Veterans Administration (VA)-About thirty million Americans are veterans and are potentially eligible for care through the Veterans Administration, or VA. The VA hospital system is the largest health care system in the United States: it has 171 acute care hospitals, 133 of which are affiliated with medical schools.
Eligibility for the services of a VA hospital includes having spent time in the armed services, plus having a disability connected with that service or an income below the poverty level—for the VA, poverty level is around $18,000 for a couple.
The VA provides a comprehensive program of services, including hospital care, outpatient care, and medications. The VA does not require any co-pay.
The budget for the VA has not kept pace with the rising costs of medical care, so the VA has made a rigorous effort to reduce costs. The result is a corresponding reduction in services. The best quality of care is provided in the VA hospitals affiliated with medical schools, though most of this care is supervised by medical residents.
Some VA hospitals have comprehensive programs for people with HIV infection. Like most health care, the availability of resources and expertise varies in different locations.
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Albert, in his 70s, had been undergoing thyroid treatment for years, and came to me for back pain and stiffness, complaining he could no longer play golf. I ordered x-rays to evaluate his postural problems and found his bones to be “see-through”—not an uncommon finding for someone taking synthetic thyroid hormone for so long. For the bone loss to be clear on an x-ray, I knew it was severe, and a bone density scan revealed that, indeed, his bone density was 15 percent below normal for his age at the hip. (Fifteen percent may not sound alarming, but the average for a man in his 70s is already very low.)
Albert had seen doctors a couple of times a year for decades prior to these x-rays, but he had never been advised to take preventive steps to protect his bone density. His primary care physician had asked an endocrinologist well known for treating osteoporosis to consult on the thyroid treatment, but neither doctor had looked for early signs of osteoporosis or explained precautionary measures like diet, exercise, or testing that could have made all the difference in the world. Too many doctors are still operating under the false assumption that osteoporosis is something only women get.
Albert’s back pain cleared up after a few visits to my office for osteopathic manipulation, and for continuing treatment of his osteoporosis he went back to his usual doctor for prescription medication to stop his bone loss as quickly as possible. There are a lot of good options available to him now, but simply knowing about the proactive measures as soon as he started thyroid treatment could have kept him out of my office indefinitely. I’m always pleased to lose a patient that way.
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Katie was two-and-a-half and severely handicapped. She functioned like a one-year-old. She was not able to walk or talk. Fortunately, her local school system had a superb program for handicapped children. This program had occupational therapists, physical therapists, and speech therapists. Katie was an ideal candidate—except for her seizures. The school claimed that they had no one who could cope with her frequent generalized tonic-clonic seizures. What would happen if a seizure was prolonged? What were they to do? Katie would require far more time than the other children, and if a seizure occurred, they had no one with the special training needed. Katie’s mother had no problem coping with her child’s seizures, although she had had no special training. To put it frankly, the school was afraid of accepting the responsibility. Katie was deprived of her right to an optimal program. The school’s solution was a home teaching program with visits several times a week. Clearly this was not optimal. Finally we helped Katie’s mother to achieve a compromise. She agreed to go to school to handle the seizures while the teachers taught. Over several weeks the school came to realize that Katie’s seizures did not pose a major problem, and no longer required that her mother be present.
The end of Katie’s story was that she was found to be a candidate for surgery, her damaged hemisphere was removed, and she no longer has seizures.
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Greg is a fifteen-year-old boy whose seizures began in early childhood. Although his development was delayed, seizures came under control with medication and the family was able to adjust to their mildly retarded son. At age five, the seizures recurred and Greg appeared more severely delayed. The family again went through grieving, anger, and frustration while the physicians tried new medications. Eventually the seizures were again controlled and the family readjusted to their new circumstances. At age nine, atonic seizures began and Greg made frequent trips to the emergency room for stitches. During the brief periods of time when these seizures were brought under control, Greg could function in the moderately retarded range. But the frequency of seizures or the side effects of medication continued to handicap him. An abnormality on the MRI scan led us to hope that surgery might control his seizures. Surgery was successful even though his minimal hemiparesis increased. Greg only had rare seizures in his sleep. He wasn’t falling, and his language and function had improved. Both his family and Greg were delighted. This honeymoon lasted for six months until the seizures recurred.
In Greg’s case we and the family have a dilemma. We know of no other combination of medicines likely to control his seizures. We are considering further surgery to section the corpus callosum. Will further surgery be of benefit? Are the risks of new surgery worth taking? What are the chances of success? The answers are unclear.
There are many lessons in Greg’s story. One lesson is that even if parents do develop a realistic acceptance of their child’s limitations, that acceptance may be challenged when the situation changes. Adjustment for those families whose children have multiple handicaps may be a roller coaster. A second lesson is that often other approaches might succeed in controlling intractable seizures. Deciding whether or not to take the risks of these new approaches when you don’t know their benefits in advance can be difficult for both the family and the concerned physiciin. There may be a time when you and your physician must accept the status quo, but the question will be, when has that time
Come?
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Removal of the testes can produce remissions of prostate and breast cancer. This operation can result in decreased growth of facial hair, a higher voice, loss of interest in sex and loss of the ability to get an erection (impotence).
If you have prostate cancer, your main alternative is oestrogen treatment.
If you have breast cancer, you have more alternatives. Read other relevant sections to help you to decide which is best for
Removal of the adrenal glands can produce remissions of any cancer that is stimulated by either male or female hormones (breast cancer and prostate cancer). The adrenal glands are situated at the back of your abdominal cavity, just above each kidney. The idea of removing them is to remove an important source of male and female hormones but it is a very drastic way of doing this. Ask about all other alternatives before agreeing to it.
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Mixtures of drugs, or drugs and alcohol, are fairly common among addicts. This may mean you are not sure how to stop. The rule of thumb is simple. If you are habitually using alcohol, barbiturates, or benzodiazepine tranquillisers with any of the other drugs listed here, you must take measures to avoid withdrawal fits by withdrawing only under medical supervision.
Psychological withdrawal symptoms-All addicts will get psychological symptoms when they stop using drugs. These are painful but not dangerous.
1. Cravings for the drug. These may be constant throughout the day or they may hit you at odd moments. They may feel overwhelming, but they are not. Think of them as a kind of trick the drug is playing on you. It wants you back as a user! Rule number one about coming off
drugs – do not act on the cravings.
2. Emotional confusion. Mood swings are common in the first few days of withdrawal. You may swing from elation to suicidal depression, or from happiness to fury. All kinds of unpleasant feelings emerge as the drug leaves your system. Fear and anxiety are common. These emotions are painful, but in themselves they cannot hurt you. Keep reminding yourself that they will not last for ever.
3. Minor aches and pains. These have normally been blotted out by your drug-using; now they hit you with a surprising force. Addicts are not used to this kind of physical pain, because they generally blot it out with drugs. But pains like this are a sign that you are at last in touch with your own body.
4. Agitation, restlessness, and extreme fatigue. The mind seems unable to concentrate, and the body unable to relax. Yet, paradoxically, you may feel absolutely exhausted. Thinking is unclear. You may be unable to settle to anything.
5. Fear. Many addicts have feelings of fear that almost overwhelm them. They are terrified that they will not be able to stay off the drug. They are frantic at the thought that they may not be able to resist it and, on the other hand, they fear a life without drugs. That is why it is a good idea to spend as much time as possible at Narcotics Anonymous or Alcoholics Anonymous meetings. Stay in the company of recovering addicts as much as you can – or with friends or family who will support you and understand what you are going through.
6. Insomnia. Several nights of sleeplessness are common when you first come off drugs. You may find that you cannot get to sleep at all, and that you stay awake throughout the night. This is extremely unpleasant, but fundamentally it does not harm you. Nobody dies from lack of sleep. Sometimes the recovering addict is hit by nightmares or complex, disturbing dreams. This is often the brain catching up on dreaming (which it needs to do to stay healthy) because drugs have suppressed dreams for some time.

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