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HEALTHLINE OCT-DEC 2015
A VOICE OF ASIA PUBLICATION
Empowering families
RHEUMATOID ARTHRITIS
Early Diagnosis and Treatment
CANCER SCREENING IN THE ELDERLY
KNEE OSTEOARTHRITIS SUPPORTIVE MEDICINE Providing hope Living with
HealthLine $2.00
When should we stop?
COMMON AILMENTS OF THE ELDERLY Oct - Dec 2015
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am gratified to report that the first two issues of our new endeavor, HealthLine Magazine, were a great success. Our community’s medical professionals as well as the public at large appreciated and welcomed the breadth and depth of the issues that were covered in our initial issues. The more that I become involved in the publication of HealthLine, the more I am convinced that this magazine is a “must” for community. HealthLine addresses the urgency within our community for the latest information pertaining to a myriad of health concerns facing most, if not, all of us. These health concerns range from the seemingly minor, to the more complex issues. Regardless of the nature of the health concerns, I realize now that HealthLine fills the information void for many in our community. The information void is such that we have been receiving feedback that HealthLine is a magazine that should be published and made available every month rather than quarterly. Slowly but steadily we will meet this need. I am always encouraged when we receive suggestions from our readers on the various topics and issues that they want to see addressed in HealthLine. Often, these topics and issues are those that they deal with daily in their lives. One of our goals at HealthLine magazine is to make people aware of the threefold approach to illness: Prevention, Treatment and Management of life threatening ailments. Our initial focus was on the challenges that our senior citizens face every day. This concern has not dissipated. Our upcoming issues will address some of the practical measures that our senior citizens need to implement even within the confines of their homes to make them safer. When parents were young they would worry about “child proofing” their homes. As our population ages, we now must concern ourselves with how to “senior proof” a home so that it is safer for aging parents and grandparents. It is true that in this information age, much advice is available online and through other sources. Our focus at HealthLine magazine is to assist our senior citizens in navigating their “golden years” by compiling information that is relevant to improving their lives on a day to day basis. The positive and affirming feedback that we receive from our readers encourages me that HealthLine is right on target. I welcome your suggestions, constructive criticism and your feedback. Please feel free to engage me at any time.
HealthLine Oct - Dec 2015
Contents
06 BREATHE EASY 21 PLANT-BASED PROTEINS Medicare to pay for lung cancer screening
For infectious diseases
04
08 CANCER SCREENING
22 EXPRESSING MEDICAL DECISIONS
SUPPORTIVE MEDICINE Providing support and hope to patients during serious illness
10
COMMON AILMENTS OF THE ELDERLY
The needs of a rapidly aging population must be dealt with
16
RHEUMATOID ARTHRITIS
Early diagnosis and treatment
27
AN EMERGING FACE OF THE ELDERLY: NEGLECT
30
WHEN UNCONSCIOUS
When should we stop?
12 IT’S FINALLY HERE The efficency tool every hospital needs
The healthcare documents you need today
24 THE DRY EYE EPIDEMIC 25 GENE
14 UTERINE POLYPS
EXPRESSION How genes help
In Perimenopausal and Postmenopausal women
PROVIDING 26 GOOD NUTRITION TO
15 SELF-DIAGNOSIS OUR CHILDREN 18 STROKE KNEE 28 OSTEOARTHRITIS Time is of the essence
20 SAHAJA YOGA MEDITATION AS A HEALTH BOOSTER
THE ABC’S OF 32 VIRAL HEPATITIS A health quiz
BREAST CANCER PREVENTION Risk factors and protective factors
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HEALTHLINE OCT - DEC 2015
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A VOICE OF ASIA PUBLICATION
Publisher Koshy Thomas Editor-in-Chief Shobana Muratee Marketing Manager Jacob David Marketing Susan Pothanikat Accounts Manager Priyan Mathew Administration AR Vadlamani Cover Design and Magazine Layout David Garvin Cover Photo Fotolia (All rights reserved) Printed at Richmond Printers LLC
OUR CONTRIBUTORS Abraham Thomas, MD Beverly J Gor, EdD, RD, LD Dipika S Ambani, MD, FACOG Hussain Ali, CEO, DSCE, DSDE, ISF-C, CCNA, OCP Julie Nangia, MD Kartik Payilla, BNYS Katya Rubia, PhD Nik Nikam, MD, MHA Radhika Hariharan, MD Rajagopal Appavu, MD Richard R. Andrews, MD, MPH Sandra P Gomez, MD, FAAHPM, MHMD Savitri Iyer, MD Sejal Patel, MD Sheri Dark, MD Sohail “Ali” Hasanali, Attorney At Law Thuy Hanh Trinh MD, MBA, FAAFP, FAAHPM, WCC
EDITORIAL Dear Reader, ur third and current issue weighs heavy on senior health articles covering some common aliments of that group. With a total of 76.4 million baby boomers in the United States (April 2014 - U.S. Census Bureau), the medical society is already shifting gears to cater to this group of aging adults. The multitude of information ranging from medical technology to medical documentation, coupled with ongoing researches, it’s sometimes too confusing even for those in the healthcare profession.
O
Everyone, at some point, would have surfed the internet for answers to their aliments but that information does not necessarily replace a proper visit to the doctor’s office. Similarly, the information provided in our publication by medical professionals only serves as an educational tool and helps make the right decisions about your health and that of your family. We are thankful to our contributors for their timely articles and we will continue to pursue them for the latest in their areas of specialization to keep our readers updated. Aging is not a welcoming milestone which is why many baby boomers are left stranded when it comes to health planning. Experts guide us through this phase by providing valuable information, like importance of timely screening, follow ups, dietary changes, health care options and even tell you how to prepare your Will and Last Testament. With each issue, we hope to bridge the gap between you and the healthcare professionals who are otherwise so busy and hard to reach. On the other hand, by reaching out to these physicians and health care professions we are conveying the real needs of the people as well. HealthLine magazine is a perfect match and all the hard work is worth it. Make it worthwhile for you as well. SHOBANA MURATEE EDITOR-IN-CHIEF
Victoria Ai Linh, PHARMD Vishalakshmi Batchu, MD Copyright Info & Disclaimer: All rights reserved. No Material herein or portion thereof may be published without the consent of the publisher. HealthLine assumes no liability resulting from action taken based on the information included herein. The opinions expressed are not necessarily those of the management. Healthline reserves the right to edit as necessary to correct errors of fact, punctuation, spelling and to comply with space constraints. HealthLine does not endorse the advertised product, service, or company, nor any of the claims made by the advertisement. Published quarterly by Free Press LLC, 8303 SW Freeway, Suite #325, Houston, TX 77074. Tel: 713-774-5140. Fax: 713-774-5143. Email for editorial submission:voiceasia@aol.com; Email for advertising inquiries and submission:ads@voiceofasiagroup.com. For reprint rights, please email; voiceasia@aol.com Subject line: Reprint rights.
HealthLine Oct - Dec 2015
by Sandra Gomez alliative Medicine (or Supportive Medicine as in Memorial Hermann Hospital System), is a medical specialty in which a highly trained medical team focuses on the symptoms and psychosocial distress a chronic or life limiting illness can cause. The mission of the Supportive Medicine team is to deliver care and support through a dynamic interdisciplinary care team for the emotional, physical and spiritual needs of the patient and family during times of serious illness. This interdisciplinary team is composed of Doctors, Nurse Practitioners, Registered Nurses, Social Workers, Chaplains and other counselors, who together give input on the care of the patient and provide support to the family and caregivers involved. They work together with the patient’s regular medical team to deliver high quality, coordinated, and effective symptom control.
P
Our goal This is called patient centered care - in which the focus is the patient and not the illness the patient has. People are complex, an illness does not define them, and one medical professional cannot be able to fully understand everything a patient goes through, it is a team effort.
The story of Emmie We once cared for a young woman named Emmie, she was young and vibrant, had two young children: two and four Sandra P. Gomez, MD, FAAHPM System Director Supportive Medicine, Memorial Hermann Hospital System
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Supportive Medicine
Providing Support and Hope to Patients During Serious Illness
The focus is on the whole patient and the whole situation
and was diagnosed with uterine cancer. She was referred to us by her oncologist for evaluation of the pain her cancer was causing her. During our time with her we heard her story and found how brave she was and how much she needed more than just pain control. She couldn’t walk comfortably due to swelling in her legs; she couldn’t sleep due to
The focus includes the effect the illness may have on the family and their ability to care and support the patient. her shortness of breath, and couldn’t understand why this was happening to her. There was so much more to Emmie than just her physical pain. Our team was able to find the right combination of pain medications that kept her comfortable but yet not overly sleepy so she could chase after two toddlers. We discussed
her shortness of breath and leg swelling with her oncologists and made a plan to address those problems too. Our social worker was able to help her find some disability benefits through her employer which helped her with her bills and gave her books on parenting while coping with cancer. Our home visiting nurse was able to make home visits on days she wasn’t able to come to clinic due to her weakness and fatigue.
Our Team The home team coordinated IV fluids in her home so Emmie wouldn’t have to be hospitalized due to her severe nausea and vomiting caused by chemotherapy and miss time with her family. The chaplain was able to hear her emotional and spiritual distress on days she couldn’t understand why such a terrible thing could happen to a woman who was “a good person who never hurt anyone”. I was able to sit with her husband and hear him ask “what do I do when I feel I can’t help her?” I coached him on a plan to deal with symptoms that could occur with her treatment and we made a plan of what to do when her oncologist’s office was closed so he wouldn’t panic and have to call 911. I offered to have him call our Supportive Medicine nurse practitioner or doctor on call if he had any worries that would keep him from getting a good night’s rest due to endless worry. He never called after 5 PM, I believe it was because he was at peace knowing we were there just a phone call away.
Dr. Gomez speaking at the IACAN outreach event on June 7, 2015.
The IACAN aims to provide educational programs on cancer, ways of early detection and prevention. IACAN has presented outreach programs on integrated medicine, alternative and complimentary therapies such as Yoga, Meditation and other resources available in our community. One such program was on Symptom Management, Pain and Sleep Management presented by Dr. Gomez. For more information about IACAN, email iacannetwork@gmail.com or visit www.iacanetwork.org
The focus is on the whole patient and the whole situation and includes the effect the illness may have on the family and their ability to care and support the patient. They worry it is just Hospice and that we will discontinue lifesaving treatments or therapies and offer only comfort care. They don’t realize that we can help patients of any age, with any chronic or life limiting illness, and at any stage of their illness. Some of our patients are still getting chemotherapy, blood transfusion, surgeries, and medications to help them treat their disease. Yes, some of our patients may at some point need hospice, but Supportive Medicine is just that - Support and Hope during times of serious illness.
Dr. Gomez, was one of the speakers at the Indian American Cancer Network (IACAN ) outreach event on Sunday June 7th, 2015 at the India House and she gave an informative talk about Palliative Medicine. Dr. Gomez’s article sheds more light into this new field of medicine.
HealthLine Oct - Dec 2015
Oct - Dec 2015 HealthLine
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Breathe Easy
Medicare to Pay for Lung Cancer Screening
W
e are experiencing a historic moment in the battle against lung cancer – currently America’s number-one cancer killer – as people at high risk now have no-cost coverage for effective screening. This annual low-dose CT screening is
by Victoria Ai Linh Bryant smoked 30-pack years (one pack a day for 30 years, two packs a day for fifteen years, and so on) and are at least 55 years old. If you are on Medicare the coverage is through age 77 and for private insurance it is through age 80. With access to screening, more people will be diagnosed at an earlier stage when it is most treatable. If half of everyone at high risk was screened, it is estimated that we could save over 13,000 lives each year. It is important to discuss with your doctor the benefits and risks of screening. Remember, screening is not a substitute for quitting smoking and it is never too late to quit.
© Fotolia
Screening and early detection can change the narrative about lung cancer from America’s number-one cancer killer, to a treatable disease. recommended for people who are at high risk for lung cancer, and studies show that it can reduce the number of deaths from lung cancer in both current and former heavy smokers between ages 55 to 80 by up to 14%.
On February 5, 2015, Medicare announced it would bring the benefit of screening to approximately five million American seniors.
Access to screening is a game changer for the highrisk population. But we know that more investment in research is needed to find better ways to diagnose, treat and cure lung cancer.
That’s why the American Lung Association has launched the LUNG FORCE initiative, raising awareness about lung cancer as the #1 cancer killer of both women and Victoria Ai Linh Bryant men, and PHARMD also raising funds to Critical Care Together with an earlier decision that requires most invest in Pharmacist, private insurance plans to cover screening for high-risk research. Michael E. individuals, now is the time to talk to your physician DeBakey Learn more about about getting screened. Veterans Affair how you can get Medical Center involved at www. The high-risk population includes current smokers LUNGFORCE.org and those that quit within the past 15 years who have
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HERE’S TO OUR UNSUNG HEROES Every day, thousands of Texans perform a great labor of love: caring for older parents, spouses, and other loved ones so they can live independently at home. These family caregivers are often on duty 24/7 and sometimes they can’t even take a break. But, they wouldn’t have it any other way. Help us recognize these unsung heroes. Visit aarp.org/iheartcaregivers. facebook.com/AARPTexas @AARPTX aarp.org/TX Paid for by AARP
Internal Medicine Associates of Houston, P.A. Dr. Vishalakshmi Batchu, M.D. Internal Medicine Associates of Houston, P.A. 10970 Shadow Creek Pkwy, Suite: 120 Pearland, Texas 77584 Tel: (713) 436-4566
Fax: (713) 436-4866
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Cancer screening is meant to detect cancer at very early stages when the cancer can be easily cured before one develops symptoms. Many cancers are more common in the elderly so it is important to screen for cancer in the elderly who are healthy and expected to live for many years. Cancers that are detected by screening in the elderly that have multiple other medical problems and are not expected to live more than 5-10 years often would never have caused any symptoms and these are the cancers that are being over-diagnosed & over-treated. Most guidelines for cancer screening are recommend once someone is 75 years old to discuss with their physician if they should continue cancer screening. In my opinion, as long as an elderly patient is healthy with a life expectancy of 5-10 years it is reasonable to continue cancer screening per general population
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Cancer Screening in the Elderly When Should We Stop? by Julie Nangia
Most guidelines for cancer screening are recommended once someone is 75 years old © Fotolia
C
ancer is the second most common cause of death among the elderly (next to heart disease). Caring for the elderly is an art and when it comes to screening for cancer this is a decision that should be made between the patient and their physician. As we all know, not all elderly are the same: some are very healthy and will live for many years while others have multiple medical problems and are frequently hospitalized with a life expectancy of just a few years. A man who lives to age 65 is expected to live an average of 18 more years and a women is expected to live 20 more years.
guidelines. This includes: • Breast Cancer: screening for women annual mammogram and clinical breast
with Juliean Nangia, MD exam
• Cervical Cancer: it is not recommended to continue Director, screening with pap smears after age 65 in women Breast Cancer who have had prior adequate testing and are not Prevention & High at a high risk Risk Clinic, Lester & Sue Smith • Colon Cancer: screening with either Breast Center at checking for blood in the stool annually or Baylor College of Medicine colonoscopies every 10 years • Prostate Cancer: screening for men with an annual digital rectal exam and PSA blood test • Lung Cancer: consideration for screening with a low dose CT annually in individuals who are/were heavy smokers (30 years) • Skin Cancer: annual skin exam especially if the individual is fair or has a personal history of severe sunburns.
Cancer screening can save lives, but in the elderly who are ill with multiple medical problems it can lead to unnecessary tests that result in the over-diagnosis and over-treatment of cancer. Once an individual is 75 years old the risks and benefits of continuing cancer screening should be discussed with your doctor.
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HealthLine Oct - Dec 2015
Oct - Dec 2015 HealthLine
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Common Ailments of the Elderly
The health needs and demands of a rapidly aging population has spurred the growth of Geriatric medicine. Geriatrics is the physician discipline that focusses on improving health, functioning and well-being of the elderly and when this
Radhika Hariharan, MD Section of Geriatrics, Baylor College of Medicine
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HealthLine Oct - Dec 2015
by Radhika Hariharan
is not possible, providing palliative care. In addition, geriatricians are often involved in selecting and supervising long-term-care services both at home and at institutions. With reduced physio-logical reserve, the elderly suffer from a host of illnesses including cognitive decline, falls, incontinence, and visual and hearing loss that constitute definitive Geriatric Syndromes. Asian immigrant elderly, in addition, suffer the additional social consequences of isolation and financial dependence. A comprehensive geriatric assessment is often the first to pick up important signs of both medical and social issues. Cognitive changes are common in the elderly and range from a spectrum of mild age-related impairments to dementia. While a cure for dementia is still awaited, considerable strides have been made in evaluating the types of dementia and the approaches to supportive care. Drug therapy may improve quality of life, function and delay nursing home placement. Medical screening is often the first indication of decline. © Fotolia
W
e live in an era of unprecedented longevity. Improved public health, control of infectious diseases and preventive care have resulted in a substantial increase in life expectancy. One of the greatest challenges in caring for this population is providing optimal care for individuals with multiple chronic conditions or “multi morbidity”. Over 50% of the elderly have three or more chronic conditions with complications that significantly affect functioning.
About 30% of persons over the age of 65 fall yearly, and the incidence increases with age. Falls are associated with increased risk for functional decline, ambulation issues and nursing home placement. Risk factors include general weakness, visual impairment, dizziness, cognitive impairment, medications, arthritis, and neurological problems such as stroke and Parkinson’s disease. Medical and preventive interventions significantly reduce fall rate. Incontinence is widely prevalent in the aging population and can significantly affect quality of life. Medical therapy in addition to behavioral and lifestyle modifications are the cornerstone of management. Disease detection, especially in the frail elderly, is often fraught with difficulty as presentations are atypical; resulting in delayed diagnoses. For instance, cardiac issues may present with fatigue and dizziness rather than chest pain and shortness of breath. Poor compensatory mechanisms result in prolonged course of illness and slow recovery. A simple upper respiratory illness may result in significant functional decline. Hospitalization, in particular is fraught with serious risks of complications especially confusion and increased mortality.
End of life and advance care planning in older individuals are crucial and often neglected in Asian communities. Considerations include choosing a surrogate decision maker, having a will and clear communication of values and preferences especially in regard to critical care at the end of life. It is notable that with regular screening, preventive care and medical interventions, older individuals can now enjoy an unparalleled quality of life and independence in their sunset years.
HealthLine Oct - Dec 2015
Oct - Dec 2015 HealthLine
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It’s Finally Here: The Efficiency Tool Every Hospital Needs
by Hussain Ali
ealthcare culture is fast-paced and patient-oriented, but those two adjectives do not necessarily go hand in hand. In an environment where caregivers are making choices that affect the lives of patients every day, organization and timely information updates are both key ingredients to smart decision-making.
H
With technology in place to increase efficiency where it currently lacks, the healthcare industry would see a change that reflects the sense of urgency and productivity that should remain constant in any well-run facility.
idea behind it is to quickly communicate accurate information to those who need it. As nurses enter patient rooms for rounding purposes their badges are detected, and entry and exit into the rooms are recorded electronically. Paper signs on doorways indicating special circumstances would be replaced by electronic signs. Rules can be applied to the signage and customized to reflect different patient conditions, all while remaining consistent and accurate throughout all workstations.
The bonus: The nurses in charge have minute-to-minute updates constantly at the tips of their fingers as the system gathers real-time data for analysis, reporting and decision-making.
Paper, phone calls and magic markers are still the default communication method among nurse stations. However, whiteboards are not constantly updated, nurse names are not always modified as shifts change, and patient status is not always accurately posted, causing apparent confusion among nurses. To patients and visitors, this inaccuracy can become uncomfortable and worrisome. These issues can be rendered nonexistent by implementing a new team response management technology. That technology is here and ready to be utilized. It’s a rule-based solution made for gathering and sharing information controllable by management but flexible enough for different departments. The
Hussain Ali DSCE,DSDE,ISF-C, CCNA,OCP Houston Dynamic Displays, Houston, TX @HD2Tx
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HealthLine Oct - Dec 2015
Hospitals already implementing this technology have reported an increase in patient, visitor and nurse satisfaction, as well as a
high increase in HCAHPS satisfaction survey scores.
HealthLine Magazine urges you to
Get It Checked!
Physical Exam
Every 3 years 20-39 Every 2 years 40-49 Every year 50+
Blood pressure
Every year
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TB Skin Test
Every 5 years
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Blood Tests and Urinalysis
Every 3 years 20-39 Every 2 years 40-49 Every year 50+
Bone Test
Discuss with a physician ~ 60 Baseline 30 Every 2 years 40-49 Every year 50+
EKG
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HealthLine Oct - Dec 2015
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13
Uterine Polyps
by Dipika S. Ambani
in Perimenopausal and Postmenopausal Women
I
The exact reason why polyps develop is unknown, but swings in hormone levels may be a factor.
Uterine polyps are more likely to develop in women between 40 and 65 years of age.
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Chances of developing uterine polyps may increase in women who are overweight, have high blood pressure or who take tamoxifen, a drug that is used to treat breast cancer. The doctor uses a soft plastic instrument to collect tissue from the inner walls of the uterus (Endometrial biopsy) and the sample is sent to the laboratory for testing to determine the cause of the abnormal bleeding. In addition an ultrasound may be done to visualize the number and size of the polyps. Š Fotolia
rregular or unpredictable menstrual periods, prolonged or excessive menstrual bleeding (menorrhagia), bleeding between periods, and bleeding after menopause or sexual intercourse can be very worrisome and can be caused by various gynecological conditions such as excessive growth of the cells that make up the lining of the uterus, medications such as tamoxifen, cancer of the uterus, cervix or vagina, uterine fibroids or polyps. In about 25% of these women these problems are caused by uterine polyps. Uterine (endometrial) polyps are growths that occur in the endometrium, the inner lining of the uterus. They are attached to the endometrium and may be round or oval, and range in size from a few millimeters to a few centimeters, the size of golf ball. There may be one or several polyps present. Uterine polyps are usually benign (noncancerous) and very rarely turn cancerous.
Hysteroscopy is a simple in-office procedure done to visualize and remove the polyps. There is no way to prevent uterine polyps. It’s important to have regular gynecological checkups and to see the doctor Dipika S. Ambani, for any MD, FACOG abnormal bleeding Obstetrics and since most Gynecology, of the conditions Memorial are Hermann treatable if Southwest corrected Hospital early.
I
by Nik Nikam
Not the Same as a Selfie!
n this Internet and smart phone era, the first thing we do when we hear a crick in our back or feel pain in the belly is to rush to the Internet on the laptop or a smart phone to self diagnose the problem and find a remedy that we can conjure with the assistance of our non-healthcare partner in crime. If you think texting and driving is a bad idea, then think twice before you self-diagnose a problem based on the uncensored information on the net.
How prevalent is this problem? As the adage goes; ‘Half-knowledge is more dangerous”, you may endup being a hypochondriac and add an additional disease to your list. The information on the Internet is like a misguided missile riddled with erroneous messages, sales pitches, and down-right scams. Yes there are sites such as Mayo clinic, Cleveland Clinic, the American Heart Association, etc., which provide prudent information on specific conditions. However, they can’t teach you how to navigate through differential diagnoses and eliminate the lesser possible alternatives and arrive at a definitive diagnosis. It is the job of experts in the medical profession.
According to Women’s Health Magazine, 80% of women surf the Internet for health related issues and 60% are geared toward finding an answer to specific symptoms.
HealthLine Oct - Dec 2015
tiredness on the Internet would be absurd and risky. It could be due to anemia, low thyroid, diabetes, low sugar, low blood pressure, malignancy, lack of nutrition, stress, just to name a few. Don’t lose valuable time in vain searching for the answers on the internet.
Don’t lose valuable time in vain searching for the answers on the internet.
The vaguer the symptoms, the more likely it is that you are not going to find the right answers. Medical professionals spend tens of thousands of dollar in tests and procedures and sometimes still can’t get answers to many problems, so hoping to find the perfect solution to your weakness, exhaustion, or
Here is another example where stomach symptoms may mimic heart symptoms and heat symptoms may mimic stomach symptoms. People with gallbladder disease and heart attack may present with similar symptoms.
Moreover, the Internet does not provide an objective evaluation of your symptoms in the context of your pre-existing health issues, surroundings, family history, and abnormal physical findings. Better yet, talk to a pharmacist, a nurse, or a knowledgeable medical professional. Best, just make an appointment with your primary care physician.
Nik Nikam, MD Cardiologist, Sugar Land Heart Center
Oct - Dec 2015 HealthLine
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© Fotolia
SelfDiagnosis of Symptoms:
Early Diagnosis and Treatment of Rheumatoid Arthritis Š Fotolia
by Thuy Hanh Trinh
R
heumatoid arthritis (RA) is an autoimmune disease, which means the body’s immune system is attacking its own cells. It affects women more than men. Tobacco use or a family history of having rheumatoid arthritis increases the risk of having the disease. It can start at any age, with a typical onset at age 30 to 50, and it progresses as a person gets older. Patients can present with pain and morning stiffness in multiple joints, often in the joints of the hands and wrists, lasting more than an hour. Boggy swelling of the joints, called synovitis, can be on one or both sides of the body. Moderate to severe RA can involve rheumatoid nodules, cartilage destruction, and erosions of the bones along the joints. These can be seen on radiography. Other symptoms include fever, weight loss, and fatigue.
Rheumatoid arthritis contributes to disability and can severely affect quality of life 16
HealthLine Oct - Dec 2015
Blood tests are required to diagnose RA. Rheumatoid factor can be found in patients with rheumatoid arthritis, but it is also found in patients with hepatitis C and other diseases. Anticitrullinated protein antibody is a more specific test for patients who have RA. A positive antinuclear antibody test, high levels of erythrocyte sedimentation rate and high levels of C reactive protein are also common in patients with RA. Early and aggressive treatment for RA is recommended. The first-line treatment for RA is methotrexate, which is a disease-modifying antirheumatic drug (DMARD). Methotrexate targets immune cells to slow the progression of RA. Since the immune cells are responsible for keeping us free of infections, it is important to monitor for infections, as well as other effects DMARDS can have on organs. Blood tests can include complete blood counts and tests for liver and kidney function. Other DMARDs include gold, minocycline (Minocin), sulfasalazine (Azulfadine), leflunomide
It can start at any age, with a typical onset at age 30 to 50
(Arava), tofacitinib (Xeljanz) and hydrochloroquine (Plaquenil). Combinations of DMARDs increases effectiveness, but the side effects increase. Biologic response modifiers target the immune system by affecting the part that causes inflammation and joint damage. Some biologic response modifiers include abalimumab (Humira), abatacept (Orencia), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade), rituxamab (Rituxan), golimumab (Simponi), certolizamab pegol (Cimzia), and tocilizumab (Actemra). Treatment for RA may include corticosteroids and non-steroidal anti-inflammatory medications, like ibuprofen and naproxen, for management of pain and swelling; however, these are typically recommended for short-term use, since these can contribute to stomach upset and gastrointestinal bleeding.
Physical exercise can improve strength and range of motion in patients with RA
With early diagnosis and treatment of RA, patients can improve pain and swelling, slow the joint erosion, prevent disability, and improve their quality of life. Complete knee replacement surgery is also available as a last resort.
“If you have arthritis, it’s important that you keep moving. That’s the upshot of a new study that found exercise can lift the mood of people suffering from pain and fatigue associated with arthritis. The study discovered that on the days when patients were physically active, their mood was much more positive.” (9/9/2015 - Newsmax.com)
Joint replacement, commonly the hip or knee, may be necessary for patients who have symptoms not improved with medications, and who have severe disability from joint erosion.
Exercise may also release endorphins to improve the patient’s emotional state. Family and community support is often essential since the disability and disfigurement caused by RA may contribute to social isolation. HealthLine Oct - Dec 2015
Thuy Hanh Trinh, MD, MBA, FAAFP, FAAHPM, WCCC Associate Medical Director, Houston Hospice, Houston
Oct - Dec 2015 HealthLine
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IT’S A DISEASE THAT
KILLS HUMAN BEINGS,
MAIMS HUMAN BEINGS,
DESTROYS HUMAN LIFESTYLES
CAN POTENTIALLY REVERSE STROKE
W
ITH NEW DRUGS AND TECHNOLOGY THERE IS HOPE
STROKE:T1me 1s the Essence by Abraham Thomas
S
troke is caused by a blockage or rupture of a blood vessel in the brain. Described more than 2400 years ago, strokes has made strides in terms of treatment, only in the last two decades. Globally, stroke is the second leading cause of death and third leading cause of disability worldwide. The term “stroke” may also be called “cerebral accident”, “cerebrovascular accident” or “brain attack”.
and disability (in years) attributed to stroke increased by 19%. However, the more troublesome news is that the incidence more than doubled in low-income or middle-income countries compared to high-income countries. Likely secondary to rise in hypertension and unhealthy lifestyles (physical inactivity, unhealthy diet, obesity, alcohol abuse, and tobacco abuse). Surprisingly, most of the global burden of stroke is due to the hemorrhagic (bleeding) type of stroke rather than being due to the ischemic (lack of blood flow) type of stroke. The opposite is true in the United States of America, where ischemic strokes contribute to approximately 80% of the new incident strokes.
When one is suffering from a stroke, do not take Aspirin immediately
Over the past twenty years, the number of people with incident strokes has increased significantly by 37% for ischemic and 47% for hemorrhagic strokes. Most of the burden of ischemic and hemorrhagic strokes are in people aged 75 years old or higher. However, an age-standardized reduction in incidence of ischemic and hemorrhagic strokes, as well as mortality rates is noted secondary to improved education, prevention, diagnosis, treatment, and rehabilitation of stroke. From 1990 to 2010, stroke-related deaths increased by 26%
Abraham Thomas, MD Vascular Neurologist, Eddy Scurlock Stroke Center Associate Director, Neurology Residency Elected Deputy Chair, Neurology Dept. Medical Director, TTI Home Health Care
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In the United States, stroke is the leading cause of disability each year and it is the fifth leading cause of mortality. Approximately, 795,000 new cases of stroke are diagnosed per year, of which 55,000 more women than men are diagnosed with a stroke per year.
To put things in perspective, on average, every 40 seconds, someone in the United States has a stroke and, every 4 minutes, someone in the United States would have died from a stroke.
The more common risk factors for stroke include:
• • • • • • • • • •
Age >/= 55 Gender (Male) Family history of stroke Hypertension Diabetes Mellitus Dyslipidemia Cardiac Arrhythmia Hypercoaguable Disorders Connective Tissue Disorders Previous Transient Ischemic Attack (TIA) /Stroke • Carotid artery disease • Hyperhomocysteinemia • Cerebral Amyloidosis
terms of numbers, 1.9 million brain cells die every minute during an ischemic stroke. Hence, the urgency to save brain cells by immediately reporting to the closest stroke-certified hospital. Time is of the essence.
Stroke Onset When one is suffering from a stroke, do not take Aspirin immediately. Strokes are divided into two categories, hemorrhagic (bleeding) and ischemic (nonbleeding) strokes. Therefore, if one is suffering from a hemorrhagic stroke, taking an Aspirin will only increase the risk of further bleeding to occur. A CT scan of the brain is the best way to assess the type of stroke in progress. If an ischemic (nonbleeding) type of stroke is identified (and if no other contraindications exist), a medication known as IV-tPA or Activase (Alteplase) may be given to break up the blood clot that is blocking the blood vessel which is responsible for the stroke in progress.
Symptoms/Signs of a Stroke Education is the first domino in the string of protocols needed to ensure rapid reversal and treatment of stroke. If a patient does not recognize that he or she is suffering from a stroke, the alert or the phone call to ‘911’ is not achieved. So, even if a multi-million dollar stroke certified hospital is only five minutes away, if the individual does not recognize the stroke, the treatment will never occur. The symptoms or signs of a stroke may include weakness of the face, arm, and/or leg, along with slurred speech, difficulty with understanding language or producing language, acute dizziness or imbalance that persists for more than a few seconds, an acute change in vision, hearing, or taste, acute numbness or tingling (electric or burning) of the face or extremities, or suffering from a sudden and severe headache (“worst headache” [of your life]). Once a stroke is recognized, dial your local emergency number (in the USA, dial ‘911’) in order to obtain transport to the nearest stroke certified hospital. In the USA, there are three such stroke designated hospitals: the ‘Stroke Center Ready’, ‘Primary Stroke Center’, and ‘Comprehensive Stroke Center’ designations.
Time is Brain For every 15 minutes that passes after the onset of stroke, an additional month of disability is added. In
HealthLine Oct - Dec 2015
© Fotolia
Global Treatment Population-based mass strategies to reduce consumption of salt, calories, alcohol, and tobacco, by improving education and the environment. Blood pressure control appears to be the most important variable. Treatment and control of the modifiable risk factors such as hypertension, diabetes, high cholesterol, along with a healthy diet and exercise regimen are key to winning the global war on stroke.
Oct - Dec 2015 HealthLine
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Sahaja Yoga Meditation as a Health Booster
by Katya Rubia
Sahaja Yoga Meditation, developed by Shri Mataji Nirmala Devi, is a Yoga technique that goes back to the original concept of Meditation as a practice that leads to the state of thoughtless awareness on a regular basis. This state is perceived as a state of deep relaxation and is associated with positive emotions such as feelings of joy. Studies have shown that long-term meditators of Sahaja Yoga Meditation have better general and mental health than the average population Furthermore, the benefits are associated with the frequency with which they achieve this state of thoughtless awareness. This suggests that it is the state of thoughtless awareness or mental silence that is responsible for the health benefits. There have been many scientific studies on the effects of Sahaja Yoga Meditation on the body and the brain. In the body, Sahaja Yoga Meditation activates the parasympathetic
20
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nervous system that is responsible for restoring bodily functions, manifested by a reduction of breathing, heart and pulse rate, blood pressure, oxygen metabolism and other physiological stress parameters.
Meditation has been shown to have a positive clinical effect on blood pressure, asthma, and menopause. Brain imaging studies have shown that Sahaja Yoga Meditation activates attention regions in the brain and the limbic system that mediates positive affect. Socalled “happy chemicals” in the brain such as betaendorphines are released, presumably causing the feelings of joy. A recent study showed that the normal aging process of progressively diminished volumes of these attention and emotional centers with increasing age is delayed in people who meditate for over 10 years, suggesting that it makes your brain younger. In conclusion, Meditation that leads to the state of mental silence has significant positive effects on the body and brain and this may be underlying its positive clinical effects on a series of mental and physical disorders.
Katya Rubia, PhD Professor of Cognitive Neuroscience, King’s College London, UK
© Fotolia
S
cientific evidence has shown that meditation is not merely relaxing but has positive health effects on body and mind. Sahaja Yoga Meditation, in particular, has been demonstrated to have substantial positive effects in both the prevention and treatment of physical and mental disorders.
American Scientists “Design” Plant Protein-Based Vaccine for Multiple Infectious Diseases A team of scientists, led by an Indian, at the University of Texas developed a plant protein-based vaccine for treatment of all infectious diseases, including Malaria, AIDs and Ebola. The vaccine, which is still under clinical trial, could eventually be ‘a single vaccine adjuvant shot to treat multiple infectious diseases.’
by Rajagopal Appavu
© Fotolia
“We are developing peptide-based vaccine adjuvants that boost the immune system against infectious diseases,” Dr. Rajagopal Appavu, a scientist at the Department of Pharmacology & Toxicology, UT Medical Branch and the lead author of the paper ‘Enhancing the Magnitude of Antibody Responses through Biomaterial Stereochemistry’ told Indian Science Journal.
Many vaccines under development are chemically heterogeneous mixtures of plant or pathogen-derived products, formulations of mineral salts or emulsions, which have associated toxicity. “All the peptides reported have toxicity under the acceptable limit.” D-peptides or D-proteins are present in plant cells and therefore, have no adverse effect on human physiology. The source of D-peptides are Pasture Grass (Phalaris tuberosa), Sunflower (Helianthus Annuus), Beechnuts, Wheat (Triticum Asetivum) and Lentil (Ervum Lens). Vaccines currently licensed (FDA approved) for human use are aluminum-based salts, or alum or alum-MPL (alum in combination with monophosphoryl lipid A). (ISJ). HealthLine Oct - Dec 2015
On the other hand, the current experiments by the team would pave the way for D-peptide-based natural nano-fibre vaccine adjuvants that can be taken orally and is effective for a longer period of time. “To the best of our knowledge, we are the first to design D-peptide vaccine adjuvants for infectious diseases,” said Dr. Rajagopal Appavu, who is currently with the MD Anderson Cancer Center, Houston. “Self-assembling peptides composed of D-amino acids are strong immune adjuvants and can be used as a design tool to program adaptive immune responses for vaccine development. These vaccines can be antibodies to identify and neutralize pathogens such as bacteria and virus, that causes infectious diseases, AIDs and Ebola”.
Oct - Dec 2015 HealthLine
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Expressing Medical Decisions When Unconscious s the average person lives longer, families and individuals have been forced to consider a whole new range of healthcare choices and issues.
A
Legal end-of-life considerations are no longer just about having a Will & Last Testament. Individuals and their families must consider other scenarios regarding endof-life decisions before death. Clients usually approach me for consultations regarding their “Will”. The Will is important, and I advise individuals who are married and/or have children to consider having one made as soon as feasible. However, the Will addresses only one scenario. “What happens when or after I die?” Today, there are additional scenarios that an individual needs to consider. “What happens if I can’t take care of myself?”
Sohail “Ali” Hasanali Attorney, Fort Bend and Harris Counties, T.V. Watson Law PLLC
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HealthLine Oct - Dec 2015
To address the latter question a Will is ineffective, because a Will comes into effect only after the person is deceased. It does not address what happens if someone is alive, but no longer able to make decisions for themselves. These scenarios occur all the time. A parent who has Alzheimer’s, a patient who is under anesthetic, a sibling who is unconscious, or a relative that has a terminal illness.
desires.
So what other documents do I need?
The Healthcare Power of Attorney:
For healthcare matters, I recommend also having a Healthcare Power of Attorney and a Healthcare Directive. Additionally, I encourage a Durable or Financial Power of Attorney.
The HPoA designates an agent and alternate agent to be able to make healthcare decisions on your behalf if you are legally unable to make the decision. Reasons for this can be due to dementia, unconsciousness, and/or a number of other reasons where you are mentally unable to make a decision.
What’s the Difference between a Healthcare Power of Attorney and a Healthcare Directive? The difference is the audience of the document. A Healthcare Power of Attorney (“HPoA”) authorizes someone like a family member to be able to make healthcare decisions on your behalf while a Healthcare Directive (“Directive”) is a document that directly tells a physician your healthcare
The reasons for whom someone designates as their agent can vary. Some reasons I’ve heard include, a parent selecting which child lives closest or which child has taken care of them most in recent years, a step-father choosing their step-child that they never legally adopted, and a person choosing a close friend whom they trust more than any current relative. The importance of this is that the individual can name who speaks
© Fotolia
by Sohail “Ali” Hasanali
for them (and an alternate) when they cannot make a decision for themselves. It allows the individual to talk to the physician about the individual without going through the default rules and red tape, and can ultimately help clarify the individual’s desires when interested relatives desire different healthcare decisions for the individual.
The Healthcare Directive: The Directive is most often commonly referred to as the “Living Will”, mainly because it is a document that expresses an individual’s desires about themselves and is effective while the person is alive, unlike a regular Will. The Directive is the individual’s express desires to the physician. If valid, the Directive even
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trumps a family member or healthcare agent’s desires. The Directive mainly addresses two scenarios: 1) Do you want to be on life-sustaining devices, if the only way you can survive is being on life-sustaining devices? (Think the Terry Schiavo Case or if someone is in a vegetative state); and 2) If you are terminally-ill and expected to die within 6-months, do you want to continue to receive life-sustaining treatment or just be made comfortable? (Think terminal cancer, and you want to stop Chemo Treatments).
under law, but can go ignored if not stated clearly ahead of time.
Other things that you can include in a Directive is procedures opposed/favored for religious or spiritual reasons, organ donation, and/or any other specific medical request. Faith-based limitations are important and largely accepted
Although it’s impossible to know exactly what will happen in the future, it is always prudent to be prepared.
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In summary, the two health-care documents mentioned above are important for giving an individual peace of mind. Like the Last Will and Testament, the Healthcare Power of Attorney and Healthcare Directive allows an individual to make contingency plans in the case something happens.
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23
The Dry Eye Epidemic
D
by Sejal Patel
© Fotolia
ry eye is a very common condition in which there is an insufficient supply of tears to nourish the surface of the eye. This can be due to a low production of tears, a lack of quality tear composition, or inflammation of the eye. Common symptoms of dry eyes are: lack of clear vision, red eyes, burning eyes, excess tearing, having a sandy, gritty sensation in the eye or feeling like something is in your eye
TREATMENT Common causes of dry eye • Increasing age • Females have an increased change of having dry eye due to hormone fluctuations and menopause • Long periods of staring at the computer • Weather such as dryness and wind • Irritants such as smoke or air conditioning • LASIK eye surgery • Medical issues such as Thyroid disease, Diabetes, and Rheumatoid Disease • Medications such as antidepressants, antihistamines, decongestants, acne meds, birth control, and high blood pressure meds. 24
HealthLine Oct - Dec 2015
There are various channels of treatment of dry eye. The first and easiest mode is supplementing the eye with over-the-counter artificial tear drops and ointments. These can be used for mild to moderate dry eye. An added step to artificial tear drops is a surgical procedure to block the tear ducts in the eyes with a silicone punctal plug. This will keep the tears on the surface of the eyes longer rather than the tears being drained into the tear ducts. If the dry eye is due to inflammation of the eye or the lids, hot comSejal Patel, MD presses, lid masOptometrist sage, and Owner, and lid Custom Eyes, scrubs (to Pearland, Texas remove flakey skin) can help.
by Kartik Payilla
A
gene is a small piece of genetic material written in a code and called DNA. Each gene has within it a set of instructions for making molecules that organisms need to survive. Gene expression is the process by which the information contained within a gene becomes a useful product and this information is used in the synthesis of functional gene product. Genes are present at sub cellular levels: changes at these levels external as well as internal expressions.
A CASE FOR DIABETES People’s general perception is that, a disease like diabetes has no permanent cure. Diabetes in simple terms is: 1. Defect in insulin production 2. Lack of insulin receptors This happens at thesub cellular levels and the cure for this is also available at these levels through process of gene expression.
ROLE OF TELOMERE Telomere is at the end of chromosome and protects it from deterioration. It length determines its stability. Telomere plays important role in gene expression; telomere is a region of repetitive nucleotide sequences at each end of chromatin, the sub cellular level. Due to aging, the length of telomere decreases which leads to decrease in the process of the gene replication. This drastically affects the functioning system of the body like hormone production, immune cells production and enzymes production depending upon where it is located. For example,
HealthLine Oct - Dec 2015
if its length reduces in the replication cells of bone marrow, the production of myeloid and lymphoid cells in marrow cells decreases. This is the one of the reasons for the various health problems in at every age. There are several other factors along with the length of telomere which are to be maintained through natural means. This is a precondition for gene expression through which cure for any disease at any age is highly certain.
TIME PERIOD The time period for gene expression depends upon several factors: Age, Strength of immune system, Lifestyle, Food habits, Type of environment we live in, and Intake of drugs, chemicals and pesticides. For various lifestyle disorders like diabetes, hypertension, autoimmune disorders, cancers, the conventional Allopathic medicines are generally preferred which leads to various side effects. So gene expression through natural means is best cure for any disease. For example, for a person within age group of 10-25 where conditioning, learning, food habits, molding are positive, the time period for expression of gene is influenced by these factors i.e it takes less time to cure.
GENE EXPRESSION THROUGH NATURE CURE AND YOGA THERAPY Existence of human body different planes physical, mental, pranic and spiritual levels. Through changes in life style by natural means and yoga therapy gene expression is highly possible without any side effects. Nature cure includes: Organic diet Detoxification Yoga pranayama / Meditation Mud therapy Massage therapy Chromo therapy Music therapy Hydrotherapy For various lifestyle disorders like diabetes, hypertension, autoimmune disorders, cancers, the conventional Allopathic medicines are generally preferred which leads to various side effects. So gene expression through natural means is best cure for any disease.
Dr. Kartik Payilla BNYS Director SLNS Nature Cure Hospital, India Oct - Dec 2015 HealthLine
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Š Fotolia
How Genes Help In Gene Expression
Providing Good Nutrition To Our Children by Beverly J. Gor
arents are always thinking about providing the best nutrition for their school going children. According to the US Centers for Disease Control, about 18% of American schoolchildren aged 3-19 are obese. On the other hand, the number of food insecure children increased by 18,630 in SE Texas. The Houston Food Bank reports that the percentage of food insecure children increased from 24.7% to 26% in 2015. In 2010, Congress passed the Healthy, Hunger-Free Kids Act, which directed the U.S. Department of Agriculture to update school meal standards based on the current science to improve the diet of every child receiving in school meals.
School meals are now mandated to provide more nutritious fruits and vegetables and whole grains and contain less sugar, sodium and fat. However, this legislation has not been without controversy and some legislators and community members want to roll back those changes. When the changes were first implemented, some students even produced a youtube video that went viral in which high schoolers expressed their disdain for the changes. In 2012, in response to public criticism, the USDA decided to allow more protein in the form of meat and additional grains in school lunches. In fact, a survey conducted in 2015 by the W.K. Kellogg Foundation showed the majority of Americans now support current efforts to keep school meals healthy. So what should parents do to make sure their children have a healthful diet and not develop obesity and the chronic diseases associated with excessive weight? • Probably the greatest influence on a child’s diet is their
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P
parents’ example. Get kids interested in eating healthy food by spending time with them preparing healthy meals, shopping for nutritious ingredients at a grocery store or farmers market, or grow your own vegetables and fruits • Exercise is also important. Make sure kids get in the recommended 60 minutes of physical activity every day. This may mean some sacrifice on the parent’s part if they work all day and then come home and have to fit in some family fitness time. At least every other day, take a walk or bike ride before dinner while you talk about the day, or consider walking to school with your kids if you can. Limit “screen time” (time in front of computers or television). • If your child brings lunch from home, make sure it includes some high quality protein like lean meat or fish, a boiled egg, low fat cheese, fresh or canned fruit and/or vegetables, whole grain bread or crackers. Make sure they eat a good breakfast before going to Beverly J. Gor school, too. • Get involved in the school’s wellness council. Observe the meals at school and advocate for healthy foods if they are not being offered. Make sure students get sufficient physical activity and recess time.
EdD, RD, LD Dietitian and Staff Analyst, Houston Department of Health and Human Services
An Emerging Face Of The Elderly:
Neglect
tories of an elderly person falling, breaking a hip and being unable to get help is becoming all too common among our elderly. It is called the new, emerging face of the elderly - Neglect.
S
According to Psychology Today, neglect occurs when a caregiver does not provide for an elder’s safety, or for his or her physical and/or psychological needs. Some examples of physical neglect are consistent with: inadequate or absence of necessary medication, physical therapy, proper hygiene, sanitary and safe living environments. Examples of psychological neglect include, but are not limited to, leaving an elderly person alone for extended periods of time, as well as, failure to provide social contact, activities, or information. In addition, Nursing magazine reports that approximately 50% of elder abuse cases are the result of neglect. As people are living longer, with elders described as age 65 or older, neglect can potentially affect 700,000 to 1.2 million people in the United States alone. This means that there are approximately 450,000 new cases annually. Unfortunately, most neglect can occur intentionally or unintentionally by caregivers who are adult children, other family members such as grandchildren, or spouses. Neglect can also
HealthLine Oct - Dec 2015
occur in institutional settings as well by non-family members. Many caregivers, especially family members are overwhelmed, receiving minimal to no support from other family members, or are ignorant, underestimating the amount of care an elderly person will need. Most caregivers, however, are in denial to the needs of aging family members, as they are busy working and caring for their own families and may not even be aware of the signs of neglect.
Some of the signs of neglect of elderly persons are: • Unusual weight loss, malnutrition, dehydration • Untreated physical problems, such as bed sores • Unsanitary living conditions: dirt, bugs, soiled bedding and clothes • Being left dirty or unbathed • Unsuitable clothing or covering for the weather • Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards) • Desertion of the elder at a public place
by Sheri Dark
With awareness of the definition and signs of neglect, what can be done to prevent elder neglect? You may check on elders in your neighborhood on a regular basis and become a trusted confidante. You may also give a caregiver a break by staying with a elderly person at certain intervals, as well as be supportive. Should you suspect actual neglect of an elderly person, you may contact your county Adult Protective Services. The worst thing that you can do to an elderly person who is being neglected is to ignore the signs. Remember, that this aged woman or aged man, is someone’s parent, grandparent or friend who has contributed to our communities and nation, one person at a time. Sometimes, that person has been you ... and sometimes that person has been me. So, as they have cared for us, let us not forget that it is now our time, and our privilege to care for them. Sources: Psychology Today, Nursing, HelpGuide.org, ‘Elder Abuse and Neglect’
Sheri Dark, MD Board certified Family Practice Physician Oct - Dec 2015 HealthLine
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K NEE O STEOARTHRITIS
Arthritis is a joint disorder (inflammation of the joints). There are several types of arthritis: Degenerative (Osteoarthritis), Autoimmune (Rheumatoid, Psoriatic, Lupus etc‌), Infectious, and Crystal Deposits (Gout etc...)
O
steoarthritis is the most common joint disability. It is considered to be a normal process of ageing. It is common among the older age groups but in the recent years there has been a trend towards the middle age groups, and in the coming years this trend could be moving towards the younger age groups specifically due to lifestyles. My attempt is to explain this process to a common man in the simplest way possible. My emphasis is on disease process and prevention. First let’s look at the physiology inside a normal knee joint to better understand the disease process. Knee joint primarily comprises of: Femur (thigh bone), Tibia (shin bone), Fibula (calf bone), Patella (knee cap), Cartilage & Meniscus (thin fibrous cartilage), Ligaments, Joint capsule, Synovial membrane, and Synovial fluid
by Vishalakshmi Batchu
Middle stages
- Gaps in the cartilage widen - Gradual thinning of the cartilage creates more stress on the ends of the bone causing tiny bony projections called Osteophytes - Pieces of cartilage break causing crepitus (grating, popping sound) while walking. - Synovial fluid seeps through cracks in the cartilage, eventually the body produces more synovial fluid as a natural defense mechanism in an attempt to maintain the gap between the bones, which ultimately causes swelling of the joint. - The cartilage is completely damaged, causing the bones to grind against each other (bone to bone stage) - Due to friction bones get deformed. The intensity of pain depends on the degree of damage done to the joint. Patients become functionally impaired eventually, causing an increase in overall morbidity and mortality.
Knee Cartilage
Is mainly composed of tough connective tissue (supporting tissue) and water. Allows bones to slide easily and provides cushion within the joint spaces. It acts as a shock absorber. It has no blood supply, so an injured cartilage takes a long time to heal and a damaged (lost) cartilage never gets regenerated naturally.
Synovial Fluid
Synovial fluid is a yolk like fluid that is produced by the synovial membrane that surrounds the inner linings of the joint. Less than 3.5 ml of synovial fluid is needed for the cartilage to slide freely inside the joint between the bones. Synovial fluid production is directly dependent on the usage of the joint. It is composed of hyaluronic acid which is a dense (viscous) substance that helps with the lubrication of the joint.
Normal knee joint
PATHOPHYSIOLOGY:
There is no universal staging system for osteoarthritis, I am going to break this down into various stages for easier understanding.
Early stages
- As a normal physiologic process of ageing, synovial fluid production decreases. - Thinning of the cartilage occurs, cracks form on the cartilage surface due to decreased lubrication.
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HealthLine Oct - Dec 2015
Osteo arthritis - middle stage
FINAL STAGE: Prevention
The degeneration can be slowed down in asymptomatic and minimally symptomatic people (early stages of the disease). Here are some preventive measures I suggest:
1. Fluid Intake
As mentioned earlier, the cartilage is made of water. So optimal fluid intake is essential for optimal cartilage functionality. At least 2 to 3 liters of water a day is advised (Patients with chronic kidney and heart diseases must consult with their physicians about fluid intake)
2. Exercise
Regular physical activity is needed for optimal synovial fluid production and lubrication of the joint. Lack of exercise, decreases the synovial fluid production and causes stiffness in the joint.
3. Sodium intake (salt)
Excess sodium intake causes stiffness of the joints accelerating the disease process. Sodium intake is dependent on individual’s metabolism and co existing chronic medical conditions.
4. Obesity
Accelerates the disease process as the entire weight falls on the knee causing damage to the joint.
5. Vitamin D and Calcium
Vitamin D and calcium is needed for proper bone growth function. Correcting vitamin D deficiency and optimal calcium intake helps to prevent progression of disease process. Sunlight is the best source of Vitamin D, however, supplementation may be necessary in case of deficiency There is no permanent solution to slow down the progression of the disease process but leading a wellbalanced lifestyle helps. It is never too late to start and the human body is capable of doing wonders provided we start doing things the right way.
“Daily exercise is essential ” • Exercise improves the body metabolism, boosts up
the immune system by improving the blood supply to all parts of the body. Recommended exercises in osteoarthritis are swimming, moderate cycling and walking and tai chi. • Sugary drinks, sodas, artificial drinks must be replaced by water. Drink water throughout the day. Water lubricates the joints and contributes to cartilage health. Water helps excrete excess salts. • Increase – water intake, activity, sunlight exposure, nutritious food • Decrease – sedentary lifestyle, excessive salt, processed food and drinks
Treatment Osteo arthritis - stage 1
Resting the joint for a few days is the only option during acute episodes.Options include both medical and surgical. - Pain medication (analgesics) during episodes of flareups and as needed for the pain - Steroid injections into the joint space - Glucosamine, Chondroitin supplements (not proven to be very effective) Complete knee replacement surgery is also available as a last resort.
Vishalakshmi Batchu, MD
Osteo arthritis HealthLine Oct - Dec 2015
Board Certified, Internal Medicine Associates of Houston, PA, Pearland, Texas
Oct - Dec 2015 HealthLine
29
BREAST CANCER PREVENTION by Savitri Iyer reast cancer is the most common type of non-skin cancer in women. Breast cancer prevention is the action taken to lower the chance of getting cancer. Recognition of the risk factors that increase and protective factors that decrease the chance of developing breast cancer will be useful. It is to be noted that avoiding risk factors and increasing protective factors may lower the risk and prevent the development of breast cancer but it does not mean that the chances of developing breast cancer is entirely eliminated. The following are the currently established risk factors and protective factors for the development of breast cancer.
B
which is responsible for female sex characteristics for a long time may increase risk of breast cancer. - Early menstruation: Starting periods at age 11 years or earlier. - Late menopause (stopping of periods): The longer a woman has periods the higher is the exposure of the breasts to estrogen - Late pregnancy: Woman who became pregnant for the first time after 35 years or woman who never became pregnant. • Women taking combination hormone replacement therapy/hormone therapy containing estrogen and progestin given to replace estrogen no longer made by ovaries in postmenopausal women or in those where the ovaries are removed will increase the risk. • Exposure to radiation: Radiation therapy to chest for treatment of cancer can increase the risk of developing breast cancer starting 10 years after treatment. The risk is dependent on the dose of radiation and age of treatment. The risk is highest if treatment is given during puberty. • Obesity increases the risk of developing breast cancer especially in postmenopausal women who have not used hormone replacement therapy. • Alcohol drinking increases the risk of breast cancer proportionate to the amount of alcohol consumption.
October is Breast Cancer Awareness Month RISK FACTORS FOR DEVELOPMENT OF BREAST CANCER • Being female and older age are important risk factors for developing breast cancer. A women’s risk for developing breast cancer is 100 times that of a man’s risk. A 70 year old woman has 10 times more risk than a 30 year old woman. • Personal history or family history of breast cancer or benign (not cancer) breast disease. - Personal history of cancer. - Personal history of breast disease that is not cancer. - Breast cancer in a first degree relative (mother, sister, daughter) • Women who have inherited changes in BRACA1 and BRACA2 genes have a higher risk for developing breast, ovarian and colon cancer. Men with inherited changes in BRCA2 genes have increased risk for developing cancers of breast, prostate, pancreas and lymphoma. • Dense breast: Women with dense breast have increased risk for developing breast cancer. Increased breast density can be inherited but can occur in women who have not had children, first pregnancy late in life, take postmenopausal hormone replacement therapy or drink alcohol. • Exposure to Estrogen, a hormone made in the body
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HealthLine Oct - Dec 2015
PROTECTIVE FACTORS FOR PREVENTION OF BREAST CANCER • Decreasing the length of time a women’s breast tissue is exposed to estrogen may protect against breast cancer. Exposure to estrogen is reduced in the following ways : - Early pregnancy : Women who had first full-term pregnancy before 20 years compared to women who never had any children or who gave birth to their first child after 35 years - Breast feeding. Women who have breast fed have a lower risk of breast cancer compared to women who never breast-fed. - Removing one or both ovaries can decrease the amount of estrogen made in the body - Late menstruation: Beginning periods after 14 years of age. - Early menopause: The fewer years a woman menstruates (has periods) the lower is the
production of estrogen by the ovaries and lower is the exposure of breasts to estrogen.
Women who exercise 4 or more hours a week, particularly premenopausal women of normal or low body weight have a lower risk for developing breast cancer. • Estrogen only hormone therapy after hysterectomy (surgical removal of uterus) can decrease the risk for developing breast cancer but increase the risk for stroke, heart and blood vessel disease in postmenopausal women. • Selective estrogen receptor modulators (SERMs): Drugs such as Tamoxifen and Raloxifene are agents that act like estrogen in some tissues and block the effect of estrogen in other tissues. These agents can decrease the risk of breast cancer in postmenopausal women and high risk premenopausal women. Tamoxifen can cause hot flashes, endometrial cancer, stroke, cataracts, blood clots in lungs and legs. Raloxifene lowers the risk of breast cancer in women with decreased bone density and high or low risk of breast cancer. Raloxifene increases the risk of developing blood clots in lungs and legs but does not increase the risk for developing endometrial cancer. • Aromatase inhibitors and inactivators: The enzyme aromatase makes estrogen in tissues such as brain, fat, and skin. Aromatase inhibitors such as anastrozole, Letrozole and aromatase inactivators such as exemestane can lower the risk of breast cancer in women with a history of breast cancer and postmenopausal women with high risk. These agents can cause muscle, joint pains, decrease bone density, hot flashes.
HealthLine Oct - Dec 2015
• Prophylactic mastectomy (Removal of both breasts when there is no sign of cancer). Women with a high risk for developing breast cancer can choose to have both breasts removed. It is important to have cancer risk assessment and counseling about the different ways to prevent breast cancer before making the decision. • Prophylactic oophorectomy (Removal of one or both ovaries with no sign of cancer): Premenopausal women who have a high risk for developing breast cancer due to changes in BRCA1 and BRCA2 genes may choose to have their ovaries removed to decrease the risk of breast cancer. • Bisphosphonates: These are drugs that are used to treat osteoporosis and hypercalcemia to prevent bone fractures in cancer patients. When taken for more than one year they may decrease the risk for developing breast cancer.
FACTORS WHOSE ROLE FOR DEVELOPING BREAST CANCER IS NOT CLEAR • Oral contraceptives: Taking oral contraceptives can increase the risk of breast cancer slightly in current users but the risk decreases over time. Progestin only oral contraceptives do not increase the risk. • Environment: The role of exposure to substances in environment such as chemicals is not clear.
FACTORS THAT DO NOT INCREASE THE RISK FOR DEVELOPING BREAST CANCER • Having an abortion (loss of pregnancy) • Taking cholesterol lowering drugs • Diet low in fat and high in vegetables and fruits. • Taking vitamins • Cigarette smoking • Using deodorants Consult your doctor to evaluate your risk for developing breast cancer and for adoption of of protective factors to decrease your risk for developing breast cancer.
Savitri Iyer, MD Professor, Department of Pathalogy, MD Anderson, ViceChair, Institutional Preview Board Oct - Dec 2015 HealthLine
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The ABC’s of Viral Hepatitis by Richard R. Andrews
H
epatitis means liver inflammation. Hepatitis A, B and C are all caused by viruses. Hepatitis A is often caused by contaminated food or water, but does NOT cause cirrhosis or cancer. Hepatitis B and C can both cause cirrhosis and liver cancer, they are NOT caught from food or water, and
they both can be caught from your mother around the time of birth. Hepatitis B is often spread by sex, but hepatitis C usually is NOT. There are vaccines for Hepatitis A and B, but not for hepatitis C. There are good medicines for hepatitis B and hepatitis C. Get all 3 hepatitis B tests, and 1 for hepatitis C.
TRUE OR FALSE: (Learn more about Hepatitis) 1. You can catch all kinds of hepatitis from contaminated food or water 2. You can catch some kinds of hepatitis from a blood transfusion 3. You can catch some kinds of hepatitis from giving (donating) blood 4. You can catch some kinds of hepatitis from sex 5. You can catch some kinds of hepatitis from your mother when you are born 6. Hepatitis A, B and C can all lead to liver cancer 7. Hepatitis A, B and C can all lead to liver cirrhosis (scarring) & liver failure 8. There is no medicine yet to cure any form of hepatitis 9. Since I’ve had all my hepatitis shots, I don’t need any blood tests from now on to see if I’m okay
� TRUE � TRUE � TRUE � TRUE
� FALSE � FALSE � FALSE � FALSE
� TRUE � TRUE � TRUE � TRUE � TRUE
� FALSE � FALSE � FALSE � FALSE � FALSE
ADVERTISERS INDEX A1 Bombay Grill - 9 AARP Texas - 7 Harry Patel, Advocate - 13 Houston Dynamic Displays - 32 Hilton Garden Inn, Pearland - 13 Houston Hospice - 13 Immigration - Sharlene S. Richards Law Firm - 13 Internal Medicine Associates of Houston, PA - 7 Madhu Sekharan, Attorney at Law - 13 Minuteman Press / Signarama - 9 Santhigram Wellness - Ayurveda - 7 Sherly Thomas - Philip, Attorney at Law - 11 St. Luke’s Medical Group, Sugar Land - 9 The College of Health Care Professionals - 7
Richard R. Andrews MD, MPH
Proof
Board certified Family Practice Physician
Answers to Quiz: 1) F, 2) T, 3) F, 4) T, 5) T, 6) T, 7) F, 8) F, 9) F
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