Abdominal aortic aneurysm

Overview

Abdominal aortic aneurysm

Abdominal aortic aneurysm

An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from your heart through the center of your chest and abdomen.

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.

Depending on the size of the aneurysm and how fast it’s growing, treatment varies from watchful waiting to emergency surgery.

Symptoms

Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly.

If you have an enlarging abdominal aortic aneurysm, you might notice:

  • Deep, constant pain in your abdomen or on the side of your abdomen
  • Back pain
  • A pulse near your bellybutton

When to see a doctor

If you have pain, especially if pain is sudden and severe, seek immediate medical help.

Causes

Aneurysms can develop anywhere along the aorta, but most aortic aneurysms occur in the part of your aorta that’s in your abdomen. A number of factors can play a role in developing an aortic aneurysm, including:

  • Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel.
  • High blood pressure. High blood pressure can damage and weaken the aorta’s walls.
  • Blood vessel diseases. These are diseases that cause blood vessels to become inflamed.
  • Infection in the aorta. Rarely, a bacterial or fungal infection might cause an abdominal aortic aneurysms.
  • Trauma. For example, being in a car accident can cause an abdominal aortic aneurysms.

Risk factors

Abdominal aortic aneurysm risk factors include:

  • Tobacco use. Smoking is the strongest risk factor. It can weaken the aortic walls, increasing the risk not only of developing an aortic aneurysm, but of rupture. The longer and more you smoke or chew tobacco, the greater the chances of developing an aortic aneurysm.
  • Age. These aneurysms occur most often in people age 65 and older.
  • Being male. Men develop abdominal aortic aneurysms much more often than women do.
  • Being white. People who are white are at higher risk of abdominal aortic aneurysms.
  • Family history. Having a family history of abdominal aortic aneurysms increases your risk of having the condition.
  • Other aneurysms. Having an aneurysm in another large blood vessel, such as the artery behind the knee or the aorta in the chest, might increase your risk of an abdominal aortic aneurysm.

Complications

Tears in one or more of the layers of the wall of the aorta (aortic dissection) or a ruptured aneurysm are the main complications. A rupture can cause life-threatening internal bleeding. In general, the larger the aneurysm and the faster it grows, the greater the risk of rupture.

Signs and symptoms that your aortic aneurysm has ruptured can include:

  • Sudden, intense and persistent abdominal or back pain, which can be described as a tearing sensation
  • Low blood pressure
  • Fast pulse

Aortic aneurysms also put you at risk of developing blood clots in the area. If a blood clot breaks loose from the inside wall of an aneurysm and blocks a blood vessel elsewhere in your body, it can cause pain or block the blood flow to the legs, toes, kidneys or abdominal organs.

Prevention

To prevent an aortic aneurysm or keep an aortic aneurysm from worsening, do the following:

  • Don’t use tobacco products. Quit smoking or chewing tobacco and avoid secondhand smoke.
  • Eat a healthy diet. Focus on eating a variety of fruits and vegetables, whole grains, poultry, fish and low-fat dairy products. Avoid saturated fat, trans fats and limit salt.
  • Keep your blood pressure and cholesterol under control. If your doctor has prescribed medications, take them as instructed.
  • Get regular exercise. Try to get at least 150 minutes a week of moderate aerobic activity. If you haven’t been active, start slowly and build up. Talk to your doctor about what kinds of activities are right for you.

If you’re at risk of an aortic aneurysm, your doctor might recommend other measures, such as medications to lower your blood pressure and relieve stress on weakened arteries.

Source Credit: https://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/symptoms-causes/syc-20350688

Thyroid cancer

Overview

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Thyroid cancer occurs in the cells of the thyroid — a butterfly-shaped gland located at the base of your neck, just below your Adam’s apple. Your thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight.

Thyroid cancer might not cause any symptoms at first. But as it grows, it can cause pain and swelling in your neck.

Several types of thyroid cancer exist. Some grow very slowly and others can be very aggressive. Most cases of thyroid cancer can be cured with treatment.

Thyroid cancer rates seem to be increasing. Some doctors think this is because new technology is allowing them to find small thyroid cancers that may not have been found in the past.

Symptoms

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Thyroid cancer typically doesn’t cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:

  • A lump (nodule) that can be felt through the skin on your neck
  • Changes to your voice, including increasing hoarseness
  • Difficulty swallowing
  • Pain in your neck and throat
  • Swollen lymph nodes in your neck

When to see a doctor

If you experience any signs or symptoms that worry you, make an appointment with your doctor.

Causes

It’s not clear what causes thyroid cancer.

Thyroid cancer occurs when cells in your thyroid undergo genetic changes (mutations). The mutations allow the cells to grow and multiply rapidly. The cells also lose the ability to die, as normal cells would. The accumulating abnormal thyroid cells form a tumor. The abnormal cells can invade nearby tissue and can spread (metastasize) to other parts of the body.

Types of thyroid cancer

Thyroid cancer is classified into types based on the kinds of cells found in the tumor. Your type is determined when a sample of tissue from your cancer is examined under a microscope. The type of thyroid cancer is considered in determining your treatment and prognosis.

Types of thyroid cancer include:

  • Papillary thyroid cancer. The most common form of thyroid cancer, papillary thyroid cancer arises from follicular cells, which produce and store thyroid hormones. Papillary thyroid cancer can occur at any age, but most often it affects people ages 30 to 50. Doctors sometimes refer to papillary thyroid cancer and follicular thyroid cancer together as differentiated thyroid cancer.
  • Follicular thyroid cancer. Follicular thyroid cancer also arises from the follicular cells of the thyroid. It usually affects people older than age 50. Hurthle cell cancer is a rare and potentially more aggressive type of follicular thyroid cancer.
  • Anaplastic thyroid cancer. Anaplastic thyroid cancer is a rare type of thyroid cancer that begins in the follicular cells. It grows rapidly and is very difficult to treat. Anaplastic thyroid cancer typically occurs in adults age 60 and older.
  • Medullary thyroid cancer. Medullary thyroid cancer begins in thyroid cells called C cells, which produce the hormone calcitonin. Elevated levels of calcitonin in the blood can indicate medullary thyroid cancer at a very early stage. Certain genetic syndromes increase the risk of medullary thyroid cancer, although this genetic link is uncommon.
  • Other rare types. Other very rare types of cancer that start in the thyroid include thyroid lymphoma, which begins in the immune system cells of the thyroid, and thyroid sarcoma, which begins in the connective tissue cells of the thyroid.

Risk factors

Factors that may increase the risk of thyroid cancer include:

  • Female sex. Thyroid cancer occurs more often in women than in men.
  • Exposure to high levels of radiation. Radiation therapy treatments to the head and neck increase the risk of thyroid cancer.
  • Certain inherited genetic syndromes. Genetic syndromes that increase the risk of thyroid cancer include familial medullary thyroid cancer, multiple endocrine neoplasia, Cowden’s syndrome and familial adenomatous polyposis.

Complications

Thyroid cancer that comes back

Despite treatment, thyroid cancer can return, even if you’ve had your thyroid removed. This could happen if microscopic cancer cells spread beyond the thyroid before it’s removed.

Thyroid cancer may recur in:

  • Lymph nodes in the neck
  • Small pieces of thyroid tissue left behind during surgery
  • Other areas of the body, such as the lungs and bones

Thyroid cancer that recurs can be treated. Your doctor may recommend periodic blood tests or thyroid scans to check for signs of a thyroid cancer recurrence.

Prevention

Doctors aren’t sure what causes most cases of thyroid cancer, so there’s no way to prevent thyroid cancer in people who have an average risk of the disease.

Prevention for people with a high risk

Adults and children with an inherited gene mutation that increases the risk of medullary thyroid cancer may consider thyroid surgery to prevent cancer (prophylactic thyroidectomy). Discuss your options with a genetic counselor who can explain your risk of thyroid cancer and your treatment options.

Prevention for people near nuclear power plants

A medication that blocks the effects of radiation on the thyroid is sometimes provided to people living near nuclear power plants. The medication (potassium iodide) could be used in the unlikely event of a nuclear reactor accident. If you live within 10 miles of a nuclear power plant and are concerned about safety precautions, contact your state or local emergency management department for more information.

Source Credit: https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/symptoms-causes/syc-20354161

Dumping Syndrome

Dumping syndrome is common after gastric surgery. It is a group of symptoms that may result from having part of your stomach removed or from other surgery involving the stomach. The symptoms range from mild to severe and often subside with time. Although you may find dumping syndrome alarming at first, it is not life-threatening. You can control it by making changes in what and how you eat. By controlling dumping syndrome, you will also be avoiding the foods that tend to make you gain weight.

Causes of Dumping Syndrome

After gastric surgery, it can be more difficult to regulate movement of food, which dumps too quickly into the small intestine. Eating certain foods makes dumping syndrome more likely. For example, refined sugars rapidly absorb water from the body, causing symptoms. Symptoms may also happen after eating dairy products and certain fats or fried foods.

Dumping Syndrome: Symptoms of the Early Phase

An early dumping phase may happen about 30 to 60 minutes after you eat. Symptoms can last about an hour and may include:

  • A feeling of fullness, even after eating just a small amount
  • Abdominal cramping or pain
  • Nausea or vomiting
  • Severe diarrhea
  • Sweating, flushing, or light-headedness
  • Rapid heartbeat

Dumping Syndrome: Causes of the Early Phase

Symptoms of an early phase happen because food is rapidly “dumping” into the small intestine. This may be due to factors such as these:

  • The small intestine stretches.
  • Water pulled out of the bloodstream moves into the small intestine.
  • Hormones released from the small intestine into the bloodstream affect blood pressure.

Dumping Syndrome: Symptoms of the Late Phase

A late dumping phase may happen about 1 to 3 hours after eating. Symptoms may include:

Dumping Syndrome: Causes of the Late Phase

The symptoms of this late phase may happen due to a rapid rise and fall in blood sugar levels. The cause of this rapid swing in blood sugar may be worse when eating sweets or other simple carbohydrates.

If you have not already been diagnosed with the dumping syndrome, and you have confusion, dizziness, rapid heartbeat, or fainting, get immediate medical help. Call 911 right away.

Dumping Syndrome Treatment

Many people find that taking steps like these greatly reduces symptoms of dumping syndrome.

Foods to avoid. Avoid eating sugar and other sweets such as:

  • Candy
  • Sweet drinks
  • Cakes
  • Cookies
  • Pastries
  • Sweetened breads

Also avoid dairy products and alcohol. And avoid eating solids and drinking liquids during the same meal. In fact, don’t drink 30 minutes before and 30 minutes after meals.

Foods to eat. To help with symptoms, also try these tips:

  • Use fiber supplements, such as psyllium (Metamucil or Konsyl), methylcellulose (Citrucel), or guar gum (Benefiber).
  • Use sugar replacements, such as Splenda, Equal, or Sweet’N Low, instead of sugar.
  • Go for complex carbohydrates, such as vegetables and whole-wheat bread, instead of simple carbohydrates, such as sweet rolls and ice cream.
  • To prevent dehydration, drink more than 4 cups of water or other sugar-free, decaffeinated, noncarbonated beverages throughout the day.

How to eat. Here are some other ways to lessen symptoms of dumping syndrome:

  • Eat five or six small meals or snacks a day.
  • Keep portions small, such as 1 ounce of meat or 1/4 cup of vegetables.
  • Cut food into very small pieces. Chew well before swallowing.
  • Combine proteins or fats along with fruits or starches. (For example, combine fruit with cottage cheese.)
  • Stop eating when you first begin to feel full.
  • Drink liquids 30 to 45 minutes after meals.
  • Reclining after eating may help prevent light-headedness.

When to Call the Doctor About Dumping Syndrome

It is important to manage dumping syndrome so you stay well-nourished and don’t lose too much weight. Talk to your health care provider about any symptoms you have and what else you can do. In some cases, medication or surgery may be needed to help correct the symptoms of dumping syndrome.

Source Credit: https://www.webmd.com/digestive-disorders/dumping-syndrome-causes-foods-treatments#2

How do you stop snoring?

Snoring occurs when a person’s upper airway tissue vibrates, making them breathe noisily as they sleep. It is a common issue that affects most people at some time during their lives.

Snoring is often not thought to be a serious health concern, and home remedies may reduce it. If these do not work, medical treatment may be available.

Sometimes snoring indicates a more serious health problem. If it becomes disruptive or a person has other symptoms, it is best to see a doctor.

Causes

During waking hours, the tissues in the throat and upper airway are open, and air enters the lungs easily for most people.

During sleep, the soft tissues and tongue relax. This can partially block the airway. If the air coming in and out of the airway meets resistance, vibration can occur, causing snoring.

Factors that can lead to snoring include:

  • smoking
  • drinking alcohol
  • using depressants or other muscle relaxants
  • sleeping on your back
  • congestion from a cold or allergy
  • deviated septum or other structural features
  • being middle-aged
  • being male
  • pregnancy
  • genetic characteristics that affect the structure of the mouth and throat

According to the American Academy of Sleep Medicine, around 40% of adult males and 24% of adult females snore regularly.

Snoring is more common during middle age, while males aged over 70 years are less likely to snore than younger males.

Research also suggests that people who snore are more likely to have:

These factors all increase the risk of cardiovascular disease. However, experts do not know what exact role snoring plays in these conditions or whether they are a cause or an effect.

Learn here about sleeping positions for good health.

Sleep apnea

Snoring is a symptom of sleep apnea. A person who experiences this condition may appear to stop breathing for a while as they sleep, then make choking or gasping sounds.

There are two types:

  • Obstructive sleep apnea involves a structural blockage. This type of sleep apnea often has links with snoring.
  • Central sleep apnea is due to a problem with the central nervous system that controls breathing. This type of sleep apnea is not associated with snoring.

Apart from loud snoring, a person with sleep apnea may also experience:

Sleep apnea has links with other conditions, such as hypertension, congestive heart failurehypothyroidism, or problems relating to the nervous system.

Some research suggests that approximately 50% of people with hypertension may have sleep apnea. Experts also believe that sleep apnea contributes to high blood pressure.

Home remedies

Several home remedies may help with snoring.

Avoiding alcohol and sedating medications

Drugs that act as depressants or sedatives aim to relax muscles, which can lead to snoring. Alcohol also acts as a depressant.

People should only use prescription or over-the-counter sleep aids under the guidance of a doctor.

Relieving nasal obstruction

Nasal congestion is often due to inflammation. Medicines and other techniques can help reduce congestion and inflammation.

They include:

  • nasal strips
  • corticosteroid and moisturizing nasal sprays
  • antihistamines
  • a room humidifier

Changing sleep positions

Sleeping position may affect snoring. A person who sleeps on their back can cause their tongue to relax and block the airway.

Alternative sleeping positions and methods to try include:

  • sleeping on your side
  • raising the head of the bed by a few inches
  • using an anti-snore pillow to improve neck position

Another tip is to sew a tennis ball or other soft object in the back of a person’s sleep shirt. This might help prevent rolling over to the back sleeping position. There are also positional sleepers available online to help a person avoid sleeping on their back.

Weight management

In a person with obesity, fat tissue can surround and narrow the airway, obstructing the airflow, which can lead to snoring.

Maintaining a moderate weight may reduce the risk of snoring.

Oral appliances

A custom-fitted oral appliance, similar to a retainer or mouth guard, may help keep the airway open by moving the tongue and jaw slightly forward.

A specially trained dentist can design this device for a person.

Throat exercises

Research suggests that throat exercises may help strengthen throat muscles and prevent them from collapsing during sleep in some people. However, the study results are mild and inconsistent, while practitioners cannot agree on what these standardized exercises should be.

Here are examples of exercises that some experts recommend:

  • Repeating each vowel (“a, e, i, o, u”) out loud several times a day for 3 minutes.
  • Closing your mouth and pursing your lips, and holding this for 30 seconds.
  • Opening your mouth and tightening the muscle at the back of the throat for 30 seconds. Repeat several times.
  • Making a vowel sound intermittently and then continuously for 3 minutes each day.
  • Putting the tip of the tongue behind the top front teeth, and then sliding the tongue backward. Do this for 3 minutes every day.
  • Pushing the tongue against the roof of the mouth for 3 minutes each day.
  • Pressing the tongue into the bottom of the mouth while keeping the tip against the front teeth for 3 minutes a day.
  • Opening the mouth and moving the jaw to one side. Hold for 30 seconds, then repeat on the other side.

A person will need to practice these exercises consistently and regularly to see results.

Quitting smoking

Tobacco smoke is an irritant that can result in tissue inflammation. The upper airway is a narrow passage, so even small amounts of inflammation can restrict airflow.

Quitting smoking can help reduce this risk and lower the likelihood of other diseases and conditions.

Following good sleep hygiene practices

Develop a good sleep hygiene program by getting consistent sleep on a comfortable bed, in a dark, cool room. Experts link inadequate sleep with weight gain, which can lead to snoring.

Where possible, follow these tips for getting a good night’s sleep:

  • ensuring the bed is comfortable
  • making sure the room is cool and quiet
  • using blinds or heavy curtains to restrict outside light
  • sticking to a regular sleeping and waking schedule, even on weekends
  • avoiding screen time before sleeping
  • avoiding eating large meals and drinking fluids close to bedtime
  • taking part in exercise, but not within 2–3 hours of bedtime
  • avoiding caffeine and nicotine
  • keeping smartphones and other devices outside the room

Medical treatments

If a person’s snoring or sleep apnea is severe, a doctor may suggest treatment alongside lifestyle measures.

Continuous positive airway pressure (CPAP)

This is the first-line treatment for people with obstructive sleep apnea. A person wears a specialized mask during sleep that delivers pressurized air.

Surgery

In some cases, surgery may help resolve severe snoring. Several options are available for people with snoring or sleep apnea, but results are often difficult to predict and less robust than CPAP.

They include:

  • Palatal implants, which involve inserting small fiber rods into the soft palate to stiffen loose tissue.
  • Septoplasty can help straighten a deviated nasal septum.
  • Uvulopalatopharyngoplasty removes excess tissue from the soft palate and uvula.
  • Radiofrequency stiffens loose tissue in and around the throat and tongue.
  • Genioglossus advancement involves moving the tongue attachment forward to allow for more breathing space.

There are risks with all types of surgery, so it should be a last resort.

When to speak with a doctor

Heavy snoring and sleep apnea can disrupt sleep, leading to fatigue and difficulty concentrating. A lack of sleep can also increase the risk of some mental health issues.

If a person experiences severe snoring, especially with other symptoms, they may wish to seek medical advice.

A medical professional or dental specialist can help determine any underlying causes, and they may suggest ways of stopping or reducing snoring.

Summary

Snoring occurs due to the airway tissues vibrating during sleep. It can occur for various reasons.

Snoring may indicate a medical condition. It can also lead to embarrassment and can disrupt the sleep of the person and other nearby partners or people.

A doctor may advise a person on how to reduce their snoring.

Source Credit: https://www.medicalnewstoday.com/articles/303834

Everything You Want to Know About Comorbidities and COVID-19

Probably the biggest fear to come out of the COVID-19 pandemic is the fear of the unknown. This is understandable since we are dealing with a virus that is largely alien to humans.

But as the virus has spread around the globe, so scientists have started finding answers to their questions, one of which has become an absolute certainty:

If you have a chronic or underlying disease that has compromised your immune system, you are at a higher risk of developing severe symptoms or complications if you become infected with COVID-19.

In this article we address the questions people often ask about the link between chronic diseases (comorbidities) and COVID-19. We focus on the most common comorbidities that people need to be aware of. But the principles apply to any person who is living with a chronic disease, whether it is a rare or common one. Similarly, all elderly people are more vulnerable, because typically the immune system does not function as well when you grow old.

1. What is a comorbidity?

Comorbidity is the presence of one or more additional medical conditions often co-occurring or co-existing with a primary condition. In the context of COVID-19 it refers to existing chronic diseases that could put people at a higher risk of developing complications if they are infected with the Coronavirus.

People across all ages with existing comorbidities like diabetes and hypertension – which seem to be the most prevalent – are more at risk of becoming severely ill if they get COVID-19. This is why the Health Department is urging all South Africans to play their part in protecting the more vulnerable members of society – people with comorbidities at any age and people aged 59 and older with or without comorbidities – from becoming infected with the virus.

2. What comorbidities put people at a higher risk of contracting severe symptoms of COVID-19?

According to the Centre for Disease Control and Prevention (CDC), the top five comorbidities are hypertensionobesitychronic lung conditions like TB, COPD (chronic obstructive pulmonary disease), asthma and cystic fibrosis,  diabetes, and cardiovascular conditions like coronary heart disease, congenital heart disease and heart failure.

Other individuals at risk are older adults, aged 59 and over, people with autoimmune illnesses as well as compromised or suppressed immune systems due to cancer treatments or steroids. Pregnant women are also at a slightly higher risk.

COVID-19 severe symptoms mean your oxygen levels are below 93% and you require hospitalisation. If you are a person at higher risk, don’t panic because it also depends on how your comorbidities are being managed, the strength of your immune system and how much of a viral load you get exposed to, which will affect the risk factor even more. In other words, it is usually a combination of issues which lead to you getting severe symptoms.

3. If I have a comorbidity like hypertension, diabetes, asthma or heart disease but my immunity is usually very strong at fighting regular illnesses like colds and flu, does this put me at high risk of contracting COVID-19?

The presence of comorbidities does not necessarily put you at higher risk for contracting COVID-19, as everyone is equally at risk of becoming infected. Which is why we must all take precautions to prevent infection, including practicing social distancing and good hygiene (hand washing, sanitising and wearing a mask).

However, should you get infected and also have a comorbidity, you have a higher risk of getting it more severely. The severity of your symptoms will depend on how well you are taking care of yourself and managing your pre-existing condition.

4. If I have comorbidity, how can I give myself the best chance of recovery, in the event of contracting COVID-19?

The most important ways to protect yourself against the severity of the disease are :

  • Boost your immune system with the supplements Vitamin C, Vitamin D and Zinc
  • Maintain a healthy lifestyle and eating habits and exercise regularly
  • Continue with your usual treatment – make sure you never miss out on even a day of medication
  • Monitor and control your blood pressure if you suffer from hypertension
  • Monitor and control your glucose levels if you have diabetes
  • If you suffer from obesity, make every effort to lose weight
  • Make sure you have an adequate supply of medicine
  • Reduce exposure to tobacco smoke
  • Get seven to eight hours of sleep
  • Keep well hydrated, preferably by drinking water
  • Take care of your mental health by remaining calm and positive – try not get caught up in a cycle of stress

5. If you are younger than 59 with a comorbidity are you still at a high risk?

Certain underlying medical conditions may increase risk of serious COVID-19 disease for individuals OF ANY AGE. These include, but are not limited to, cancers, chronic lung disease including asthma, chronic bronchitis or emphysema, diabetes, chronic kidney, lung or heart disease. You must take steps to lower your risk of getting infected in the first place. In addition, do your best to keep your chronic conditions well controlled

6. One of the members in my household is being treated for cancer; how do we keep her safe from getting COVID-19?

Cancer patients on treatment are immunosuppressed and at a higher risk of developing severe symptoms if they become infected. The first course of action is to minimise their risk of potential infection.

Here are some good prevention tips for cancer patients:

  • Stay at home
  • Follow strict social distancing rules when out in public
  • Never shake hands or hug
  • Practice diligent hand washing with soap and water or apply sanitiser to hands after contact with surfaces inside and outside your home
  • Wear a face mask in public, crowded or small and enclosed places
  • Eat well and get plenty of sleep, which helps keep your immune system healthy

7. Why are people with rheumatologic (autoimmune) disease at a high risk?

Rheumatologic or autoimmune disease is characterised by inflammation that affects the connecting or supporting structures of the body – most commonly the joints but also, tendons, ligaments, bones and muscle. Some rheumatic diseases can affect the organs of the body.

People with rheumatic diseases are at increased risk of developing severe symptoms should they become infected with COVID-19.  This is due both to the disease itself and to the immunosuppressant medication used to treat these diseases. This vulnerability can affect people living with rheumatic conditions such as lupus, myositis, rheumatoid arthritis, scleroderma and many others.

8. Why are people with diabetes at high risk?

People with diabetes are at increased risk of developing severe symptoms and related complications from COVID-19. Diabetes patients have impaired immune response to infection. Poor glycaemic control impairs several aspects of the immune response to viral infection and also to potential secondary bacterial infection in the lungs.

Many patients with type-2 diabetes are obese, and obesity is also a risk factor for severe infection. Diabetes complications such as kidney disease and cardiac disease increases the severity of COVID-19 infection.

People with type-1 diabetes who have their blood sugar well controlled are at less risk of infection and getting severe COVID-19.

9. Why are people with hypertension at a high risk?

Hypertension, or high blood pressure, is the most common comorbidity globally. For older South Africans this poses a concern because it is quite common for people over the age of 60 to develop higher than normal blood pressure (according to StatsSA).

In fact, hypertension frequently co-exists with other underlying conditions such as diabetes, obesity and cardiovascular complications.

In patients with COVID-19, untreated hypertension is associated with approximately twofold increase in mortality, compared with treated hypertension. Doctors are therefore cautioning patients with high blood pressure to keep taking their medication and individuals older than 59 should have their blood pressure checked.

10. Why are people with cardiovascular diseases at a high risk?

Cardiovascular disease, involving disorders of the heart and blood vessels, is the third-biggest killer in South Africa after TB and diabetes. It is often linked to obesity, uncontrolled high blood pressure, smoking, diabetes and high cholesterol.

When blockages stop the blood flow from the arteries to the heart or brain, you can have a heart attack or stroke. Severe COVID-19 can damage your lungs which then causes your blood oxygen level to drop. It can also bring about inflammation which is more likely to make blood clots as well as cause your blood pressure to drop. When this happens, your heart has to pump faster and harder to circulate oxygen, and can strain a weak heart.

11. Why are people with obesity at high risk?

Did you know that at least 70% of South African women and something like a third of the country’s men are unhealthily overweight or obese? This means that more than eight million people live with obesity. This figure is higher than the number of South Africans living with HIV. One of the biggest reasons so many people suffer from obesity is a poor diet high in sugar.

People living with obesity are at higher risk of experiencing severe symptoms if they contract COVID-19. Obesity can also cause a chronic inflammatory state which affects immunity, which means that people who are overweight are more likely to get infections.

Multiple comorbidities are also common with obesity, such as type 2 diabetes and asthma, which affect the severity of the disease.

12. If my young child has asthma or diabetes, does this put him or her in the high-risk category?

Most children experience mild symptoms of COVID-19 if they become infected. They may even remain asymptomatic, but they can still be carriers and spread the virus.

However, children with certain underlying medical disorders may experience severe symptoms if they become infected. The types of disorders are asthma, diabetes and chronic kidney, lung, liver or heart disease.

Your child should continue to take his or her chronic medication to lower the risk of getting severely ill with COVID-19. Oral steroids and aerosol measures to control asthma should be continued to reduce the risk of complications.

13. Are there any medications for comorbidities that may put you at higher risk of experiencing severe COVID-19 symptoms?

Medications that suppress your immune system, like chemotherapy, may increase your chances of becoming severely ill if you are infected by COVID-19. However, it has not been proven that certain chronic medications, such as those used for hypertension and anti-inflammatories for pain and arthritis, might put you at greater risk.

How you respond to infection depends on many factors, medication being only one of them. It would be best to consult with your doctor first before changing your medication or stopping it altogether because this could make your underlying condition worse.

Medication compliance is essential in all chronic conditions and should only change if your doctor says so. Except for oral steroids (such as Prednisolone, Dexamethasone or Hydrocortisone) using prescribed medication should continue as normal during the COVID-19 pandemic. Do not take experimental and hypothetical drugs which you hear about without consulting with a specialist first.

14. I am taking my treatment for TB; what do you suggest I do if I become infected with COVID 19?

If you are experiencing mild symptoms, which may or may not be COVID-19 related, it is important to carry on taking your TB treatment to completely cure your TB. Also, inform your TB treatment provider and find out how to access COVID-19 diagnostic services it if you need to. There is no evidence currently that TB medications increase your risk of developing severe COVID-19 symptoms.

If you are diagnosed with COVID-19, let the healthcare provider know that you are on TB treatment. If you have been started on any treatment for COVID-19, your care provider can make sure there are no drug-to-drug interactions with other medications. This is particularly important if you are on treatment for drug-resistant TB as you are on more medications and you may be at more risk of drug-to-drug interactions.

As the impact of COVID-19 on people with TB and on treatment is unknown, you should, if possible, practice strict social distancing, wear a mask at all times around people and control infections to minimise your risk of getting infected.

15. Since the symptoms for TB are quite similar to COVID-19, what should a person look out for to know whether they have one or the other illness?

The symptoms of COVID-19 can be similar to those of TB, such as fever, cough and shortness of breath, but there is usually a difference in the speed that the symptoms start. COVID-19 symptoms are likely to come on much more quickly.

If you come into contact with someone known to have either TB or COVID-19, that increases your chance of contracting these diseases. If you are unwell and are showing the above symptoms and have been in contact with someone with either TB or COVID-19, it is important that you are tested for both. When you visit the healthcare facility, let them know your symptoms and any risk factors you may have for either TB or COVID-19 so they can ensure the appropriate infection prevention and control measures can be implemented while you wait for your diagnosis.

16. I have recovered from TB, does this still make me vulnerable to getting severe COVID-19 disease or becoming infected at all?

As COVID-19 is so new, there are no data currently on whether those who have TB or who have a previous history of TB are more at risk of worse outcomes. However, COVID-19 affects the lungs and, as we know, there is usually some left-over damage in the lungs following TB disease, which may put you at increased risk of developing more severe COVID-19 symptoms.

People who have had TB, particularly those who have had lung surgery or were diagnosed with post-TB lung disease, should consider avoiding exposure to high risk situations.

In addition to the advice regarding regular handwashing, regular cleaning of surfaces, wearing of masks in public, and practicing social distancing measures, some of the ways to protect yourself include keeping in good general health and not smoking.

Source Credit: lenmed

Stroke Signs and Symptoms

During a stroke, every minute counts! Fast treatment can lessen the brain damage that stroke can cause.

By knowing the signs and symptoms of stroke, you can take quick action and perhaps save a life—maybe even your own.

Signs of Stroke in Men and Women

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking, or difficulty understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
  • Sudden severe headache with no known cause.

Call 9-1-1 right away if you or someone else has any of these symptoms.

Acting F.A.S.T. Is Key for Stroke

Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:

F—Face: Ask the person to smile. Does one side of the face droop?

A—Arms: Ask the person to raise both arms. Does one arm drift downward?

S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?

T—Time: If you see any of these signs, call 9-1-1 right away.

Note the time when any symptoms first appear. This information helps health care providers determine the best treatment for each person. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Treating a Transient Ischemic Attack

If your symptoms go away after a few minutes, you may have had a transient ischemic attack (TIA). Although brief, a TIA is a sign of a serious condition that will not go away without medical help.

Unfortunately, because TIAs clear up, many people ignore them. But paying attention to a TIA can save your life. Tell your health care team about your symptoms right away.

Polycystic Ovarian Syndrome (PCOS) and Obesity

This month we take a look at the link between PCOS and obesity in women.

Image Credit: Alena Menshikova/Shutterstock.com

Polycystic Ovarian Syndrome is often a sensitive topic. Most individuals are familiar with the common health risks linked to obesity, including type 2 diabetes, sleep apnea, coronary artery disease (CAD), high blood pressure and cancer; however, fewer know that women affected by obesity are also more likely to face reproductive problems like polycystic ovarian syndrome (PCOS).

What is PCOS?

PCOS is one of the most common hormonal disorders in women of reproductive age, affecting 5 to 10 percent. Women with PCOS have irregular menstrual bleeding and often have difficulty getting pregnant. The syndrome occurs when levels of hormones are abnormal. The name “polycystic ovarian syndrome” refers to the appearance of small cysts along the outer edge of the enlarged ovaries of women with this condition.

What Causes PCOS?

The exact cause of PCOS is unknown, but experts believe it is related to the production of an excess amount of androgens, a group of male sex hormones. Although all women produce some androgens, too much of this type of hormone prevents ovulation. Excess androgens also disrupt the normal menstrual cycle. They may cause infertility, acne and abnormal hair growth, such as excess facial hair or male pattern baldness. But, what causes a woman to produce excess androgens?

Many factors may play a role in the production of androgens, and thus the development of PCOS. For instance, excess insulin (the hormone that allows cells to use sugar) may be a factor in developing PCOS. Excess insulin leads to insulin resistance, which in turn decreases your ability to use insulin effectively. When the body cannot use insulin properly, it secretes more insulin to make glucose available to cells. The resulting excess insulin is thought to additionally boost androgen production by the ovaries.

Low-grade inflammation is another potential factor leading to PCOS. Research has shown that women with this condition often have low-grade inflammation. Heredity is also a factor. If your mother or sister has PCOS, you may have a greater chance of having PCOS.

Finally, even conditions before birth in the mother’s womb can be a factor contributing to PCOS. Excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working normally. These androgens can promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Because many factors can lead to the development of excess androgens, which is related to the development of PCOS, it is impossible to name a single, exact cause of this condition.

Does being Overweight Cause PCOS or Does PCOS Result in Obesity?

Both are possible. The link between PCOS and obesity is complicated. Signs and symptoms of polycystic ovarian syndrome begin for some females soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not work as it should. The inability of insulin to function normally is one reason why women with PCOS tend to gain weight or have a hard time losing weight. For others, PCOS develops later on, following substantial weight gain. What is clear is that women affected by obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity.

What are the Symptoms of PCOS?

Although the symptoms vary from individual to individual, a diagnosis is usually made after two of the three following symptoms are found: menstrual irregularity, excess androgen and polycystic ovaries. Since there is no definitive test for PCOS, a doctor diagnoses this condition by ruling out other possible disorders. The physician’s diagnosis is based on findings from your medical history, physical and pelvic exam and pelvic ultrasound. Women diagnosed for PCOS also undergo blood tests that measure levels of several hormones in order to exclude potential causes of menstrual abnormalities or androgen excess.

Addressing Your Overall Health as Part of the Treatment for PCOS

Quitting smoking is generally the most positive action you can take to improve your health, and related to PCOS, it may lower the higher levels of androgens. Birth control pills and androgen reducing therapies can address the symptoms of PCOS, such as menstrual cycle problems, male-type hair loss and hair growth and acne. For women who wish to get pregnant, fertility drug treatment may also help start ovulation. For some women, a doctor might also prescribe the anti-diabetic drug metformin, or the fertility drug gonadotropins, to address insulin resistance.

And importantly, even modest weight-loss of 5 to 7 percent of body weight throughout six months can lower your insulin and androgen levels. Such a reduction, according to Dr. Huang and associates in the 2007 edition of Berek and Novak’s Gynecology, restores ovulation and fertility in more than 75 percent of women with PCOS.

Why is Early Diagnosis and Treatment of PCOS Important?

As with any chronic disease, finding it early helps a lot. That’s because PCOS makes a number of other diseases more likely. These include high blood pressure, type 2 diabetes, sleep apnea, abnormal uterine bleeding, cholesterol abnormalities, metabolic syndrome, heart disease, cancer of the uterus and complicated pregnancies. With early diagnosis and treatment of PCOS, doctors can reduce risk of these long-term complications.

What Treatments Can Help with PCOS?

No simple cure for PCOS exists. Fortunately, it can be controlled, decreasing the risk of long-term complications. Engaging in regular exercise, keeping a healthy diet, losing excess weight, quitting smoking and using medications to control hormones are all important parts of treatment for PCOS.

Daily exercise improves the body’s use of insulin, and many of the symptoms of PCOS may improve with at least 30 minutes of exercise a day. Furthermore, it is important to fuel your body with a healthy diet – one that includes many complex carbohydrates and is low in animal fats. The more fiber in a food, the slower it is digested, which has the advantage of causing your blood sugar levels to rise slower. Examples of high-fiber complex carbohydrates include whole-grain breads and cereals, whole-wheat pasta, brown rice, barley and beans.

Conclusion

PCOS is a common hormonal disorder that affects women of reproductive age. PCOS challenges the quality of life of the women who suffer from it. Yet with proper treatment, PCOS can be managed and symptoms can be relieved. In addition, early diagnosis and treatment of PCOS can help reduce the risk of long-term complications such as type 2 diabetes, heart disease and stroke. For more information on PCOS, visit the Polysystic Ovarian Support Association at www.pcosupport.org.

Source Credit: https://www.obesityaction.org/community/article-library/polycystic-ovarian-syndrome-pcos-and-obesity/

further references for reading: https://www.news-medical.net/news/20200720/Developing-a-Better-Understanding-of-Polycystic-Ovary-Syndrome-(PCOS).aspx

Covid 19 and the current situation with surgery

With the reported increase in the number of COVID-19 cases in South Africa at the moment, elective surgery may have to take a backseat for a second time this year since a nationwide lock-down was introduced in March 2020.

The following is an extract from The Federation of Surgeons of South Africa consensus document detailing the various surgical categories and their classification in terms of treatment under lock-down regulations:

With the requirement for our profession to provide critical care services and the possibility
that our operating theatres may be converted into Intensive Care Units, it becomes our
collective responsibility to take appropriate steps to support measures that will “flatten the
curve”. This is a dynamic document with it’s recommendation being effective at the time of
issue and may be updated or changed at any time.


At this stage we do not propose a list of surgical procedures, but rather categories into which
we encourage surgical/ procedural teams classify their patients into. For the purposes of this
document we define elective and other surgery/procedures as follows:


Discretionary elective and Essential surgery is surgery that is scheduled in advance and
where postponement of the surgery/ procedure will not result in the patient’s outcome or
quality of life being significantly altered with a 3 month delay.


Essential surgery is a surgery that is scheduled in advance and where postponement of the
surgery will result in the patient’s outcome or quality of life being significantly altered if
extended past 2 weeks to 3 months.


Urgent, essential surgery is surgery that must be performed in order to preserve the patient’s
life or limb or prevent longer term systemic morbidity, but does not need to be performed
immediately and should be generally performed within 2 weeks.


Emergency surgery is one that must be performed without delay or until the patient is
medically stable; the patient has no choice other than to undergo immediate surgery if
permanent disability or death is to be avoided.


It is impossible to define the medical urgency of a case solely on whether a case is on an
elective surgery schedule. While some cases may be postponed indefinitely, the majority of
cases performed are associated with progressive diseases which by their nature will continue
to progress at variable, disease specific rates. Hence the judgement as to whether or not a
surgical intervention should take place can only be decided once numerous considerations
have been observed.

Given the uncertainties regarding the impact of COVID –19, delaying
some cases risks having them reappear as emergencies at a time when they will be less easy
to manage. FOSAS strongly urges communication and collaboration between hospital
clinicians and their administrative staff to consider the following recommendations:

  1. Hospitals and surgical teams should consider both their patient’s medical needs and
    their logistical capacity to meet those needs in an appropriate time frame.
  2. The medical need for a given procedure should be established by a surgeon with
    direct expertise in the relevant surgical speciality to determine which medical risks
    will be incurred by a delay.
  3. Logistical feasibility for a specific procedure should be determined by management
    personnel with an understanding of hospital and community limitations. This includes
    facility resources (eg. beds, staff, equipment etc.) as well as the safety and well-being
    of care providers and local community.
  4. Case conduct should be determined based on knowledge of national, regional and
    local evolving conditions, recognizing that marked regional variation may lead to
    significant differences in regional decision making.
  5. The risk to the patient should include an aggregate assessment of the real risk of
    proceeding and the real risk of delay, including the expectation that a delay of
    several weeks (or months) may be required to emerge from to an environment where
    COVID – 19 is less prevalent.
    In general, a day by day, evidence driven assessment of the changing risk-benefit
    analysis will need to influence clinical care decisions and delivery for the foreseeable
    future. Plans for case triage should avoid blanket policies and instead rely on data and
    expert opinion from qualified (and well informed) clinicians and management teams
    understanding all COVID–19 issues in play. Although COVID–19 is a clear risk to all,
    it is but one of many competing risks for patients requiring surgical care. Thus, surgical
    procedures should be considered not based solely on COVID–19 associated risks, but
    rather on an assimilation of all available medical and logistical information.

Source Credit: http://www.surgeon.co.za/wp-content/uploads/2020/05/FOSAS-Consensus-Document-on-Resumption-of-Elective-Surgery.pdf