Monday, August 30, 2010

When Your body Screams No!

When your immune system turn on itself, there is a war within the body. Stay safe and on the top of auto-immune disorders with this valuable users guide.

What if a police officer attacks you instead of protecting you? Or if, instead of getting the bad guys, he decides to put you behind bars?

This is exactly what happens when your body's immune system mistakenly turns on your own healthy organs and attacks them, resulting in autoimmune disorders. When the attack is on a single organ system such diseases are called 'organ-specific' autoimmune diseases (e.g., type 1 diabetes), whereas when the attack is more widespread and affects many organs the diseases are termed as 'systemic' autoimmune diseases (e.g. rheumatoid arthritis). Your immune system may also react to a foreign substance that it normally would ignore (akin to a cop arresting an infant) resulting in an immune reaction commonly termed as an 'allergy'. Here are some major autoimmune disorders and how to cope with them.

Diagnosing this disorder can be complicated as Systemic Lupus Erythematosus (SLE) symptoms tend to vary from patient to patient, are unpredictable, and follow an up and down course.

Lupus is a chronic inflammatory disease wherein your body's immune system attacks various organs including the joints, skin, kidneys, blood cells, heart and lungs, making it a potentially life-threatening illness. "While lupus is quite rare (affects 1 in 40,000 people), it is a dramatic disease," says Dr AN Malaviya, consultant rheumatologist, A&R Clinic and visiting senior consultant rheumatologist, Indian Spine Injuries Centre, New Delhi.

“Lupus affects young women between 13 and 40 years," says Dr BG Dharmanand, HOD, rheumatology at Manipal Hospital, Bengaluru. "Environmental factors, family history, exposure to oestrogen and smoking, and viral infections are other common risk factors.”

These include arthritis, kidney problems, low platelet and WBC counts, psychosis (manic episodes), rashes on face, especially after-sun exposure, mouth sores, and swelling of the lung and heart lining.

This is difficult to diagnose. Doctors will order blood tests to measure your blood cell count, ESR, kidney and liver functions, and the presence of anti-nuclear antibodies (indicative of an autoimmune disease) as well as urine tests to detect increased protein or red blood cells. A false-positive syphilis test may also be indicative of lupus.

“About 10 to 15 years ago, the 5-year mortality rates were 80% . But with improved treatment options, 90% of patients survive for 20 years," says Dharmanand. Treatment includes immunosuppresants and immunomodulating agents like steroids. "There are many side effects of steroid use, so it is a matter of balancing the side effects of the drug and the disease symptoms,” adds Dharmanand.

Although joint pain and inflammation are the most visible symptoms, this disorder affects every organ in the body; treating it early and aggressively is the best way to tackle the disease.

"The name is a misnomer," says Malaviya. Although classified as an autoimmune musculo-skeletal disorder with most visible symptoms like joint pain/inflammation, rheumatoid arthritis (RA) affects every organ in the body. 'We have outstanding medication to treat RA nowadays," says Malaviya, who pioneered the field of
rheumatology in India in 1968 and is credited with discovering the novel applicability of low-dose methotrexate (LDMTX). It is the 'central anchor drug' for the treatment of RA.

Although the cause is unknown, RA is more common in women. Among the confirmed risk factors are gum disease (periodonitis) and smoking.

Early diagnosis is very crucial, “says Dharmanand. "Symptoms to watch out for include: joint pain and swelling, long-lasting early morning stiffness, fever, weight loss and fatigue.”

Diagnosis is arrived at after clinical examination of the patients and blood tests to detect
presence of rheumatoid factor and anti-cyclic citrullinated peptide (anti- CCP) antibodies. A negative result for rheumatoid factor is not indicative of lack of the disease as this factor is detectable in only 75 to 80% patients.

There has been a “quiet revolution" in treating RA, states Malaviya. Besides LDMTX, other drugs prescribed may include non- steroidal anti-inflammatory drugs (NSAIDS), steroids, disease modifying anti-rheumatic drugs (DMARDS), and immunosuppresants.

“An exciting new discovery is that smoking is a trigger for autoimmune genes to become active” - Dr AN Malaviya

This condition is characterised by relapses (when new symptoms appear) and remissions (when symptoms improve on their own).

Multiple sclerosis (MS) is a disease in which your body's immune system destroys the protective covering on your nerves. This interferes with the communication between your brain and the rest of your body. This ultimately causes irreversible damage to the nerves themselves, which interferes with the functions that are controlled by the nervous system vision, speech, walking etc.

“Women are 1.5 to 2 times more likely to get the disease," says Dr BS Singhal, professor and head, Department of Neurology, Bombay Hospital, Institute of Medical Sciences, "and it manifests itself in younger people between 20 and 30 years of age.” Adds
Dr Apoorva Pauranik, professor of neurology, MGM Medical College, Indore, "Asian people are less at risk; it typically affects North Europeans." Genetics, infections, and the presence of other autoimmune conditions are also risk factors.

These include loss of vision in one eye, weakness/paralysis of legs, arms, head and neck muscles weakness, tremors, fatigue, and difficulty in swallowing or speaking.

The availability of the MRI has revolutionised diagnosis and treatment. "You can spot lesions in the brain very early in the disease," says Singhal. Other tests include electrical tests that document the velocity of impulses from various parts of the body to the brain and a spinal tap.

In many cases, minor symptoms resolve themselves without any treatment. Treatments to control symptoms include immuno-modulating drugs like interferon and glatiramer which slow down the appearance of symptoms and steroids and mitoxantrone to suppress the immune system. However, interferons are very expensive (Rs 25,000 to 30,000 a month) and therefore not accessible to many. Currently, many drugs are in trial and the outlook is optimistic.

Although most common in children, this form of diabetes (also known as juvenile onset diabetes) is not easily recognised.

Type 1 diabetes is a condition where your pancreas produces very little or no insulin, the hormone needed to process sugar to produce energy.

Risk factors include family history, genetics, geographical location, exposure to certain viruses, as well as dietary factors like low Vitamin D levels. This disorder is commonly seen in young children (peak age of onset is 12 or 13 years) and in women.
“Onset is more dramatic, and if not diagnosed, this condition can potentially be fatal,” says Dr Sanjay Reddy, medical director and consultant, Bangalore Diabetes Centre. "In a lot of cases, the diagnosis is made when the child presents acute complications." Stay vigilant for symptoms like weight loss, excessive urination, hunger, blurred vision, fatigue, etc.
Diagnosis is primarily done based on patient history and age. Abnormal blood sugar levels show up in a random blood sugar test and a glycated haemoglobin (A1C) test. Specific blood tests to confirm diagnosis include checking for the presence of GAD antibody, islet cell antibody, and insulin auto-antibodies.

Life-long treatment with insulin is the only option available currently. Patients are also advised to eat right, exercise, and diligently monitor their blood glucose levels.

This autoimmune disorder is characterised by chronic inflammation of the thyroid gland leading to either hypothyroidism or hyperthyroidism.

Thyroiditis is a condition wherein the immune cells attack the thyroid gland causing inflammation. This chronic inflammation leads to thyroid cell damage. Depending on the rapidity of the damage, a patient can develop hypothyroidism or hyperthyroidism.

Various factors including heredity, gender (women are more susceptible), age (middleaged women), and viral infections playa role. "There is a 50% concurrence in
identical twins indicating that the trigger is 50% genetic and 50% environmental," states Dharmanand.

Generalised symptoms may include fever, weight loss, puffiness and joint pain. Typical hypothyroidism symptoms include constipation, weight gain, lethargy and dry skin. Typical hyperthyroidism symptoms include cardiac problems, weight loss, diarrhoea and tremors.

Thyroid function tests and blood tests are normally done.

Hypothyroidism is treated with synthetic thyroid hormones. Treatment for hyperthyroidism includes drugs to reduce the effect of excessive thyroid hormones. For example, beta blockers may be prescribed to reduce the impact on the heart. Surgery or radiotherapy to destroy the thyroid gland is also an option.

What are allergies?
Allergies are another form of immune system error which occur when your immune system reacts to a foreign substance (allergen) such as pollen, dust, food, or any other allergen that it would otherwise typically ignore. The resulting symptoms can range from minor irritation to a potentially life-threateninq emergency.

Common allergens
• Dust, pollen, mould
• Penicllin-based antibiotics
• Insect bites (bees, wasps)
• Eggs, nuts, dairy products, wheat

• Skin test
• Blood tests

Avoid the allergen
Take steroids, antihistamines, decongestants to relieve symptoms
Purified allergen shots
Epinephrine shots in emergencies

Wednesday, August 25, 2010

Juvenile diabetes

Juvenile diabetes is one of the most common chronic conditions to affect children all over the world and each day, over 200 children are diagnosed with type 1 diabetes. Although Diabetes is a metabolic disorder, it can have psychosocial effect, if not handled in the right manner. As a long term condition that affects day-to-day living, diabetes can be particularly stressful on the child and parents. Newly detected Diabetes impacts all aspects of a child's life and its management requires the parents to tackle challenges at multiple levels physical, psychological, social and educational. If not effectively addressed, a spectrum of psychological issues ranging from lack of confidence to severe depression may result. However with proper training, learning about diabetes and making small changes in life style as a family, you can live a fairly normal life.

In this article, we examine the need for counseling and the various counseling options that a parent has to help a child and themselves deal with such issues.

Counseling the diabetic child
A child diagnosed with diabetes is suddenly thrust into the unenviable position of dealing ith a chronic condition. Starting from dietary restrictions to insulin injections, the child has to come to terms with the all-pervasive impact of this condition. As a result, the child ay suffer from stress. Resentment, fear of being mocked at by peers, a fear of being branded as a 'sick' or 'ill' person, and anger at parental control on diet and activities are ome of the feelings that a child may experience. If allowed to build up, such feelings can have a debilitating effect on the child's mental and physiological health.

Parents can do a lot towards helping the child cope with diabetes. In fact, the attitude of parents plays a great role in forming the child's response to the condition. Paying enough attention to the psychological needs of the child can be as important as providing medication. By following these simple do's and don'ts, parents can empower the child as he/she work on responding to the condition.

Do not be over-protective. Many parents confuse precaution with apprehension and cross the fine line between being protective and over-protective. Understand that diabetes need not stop your child from leading a healthy, active life. Do not deter the child from participating in active sports and games in the mistaken belief that your child has to be protected.
2. Do listen and watch out for cues to your child's state of mind. Loss of appetite, sudden loss of interest in studies, reluctance to go to school, a listless attitude are some signs that your child needs help in coping with the condition.
3. Do not refer to the condition as a disease.It only helps to firm up an opinion that diabetes is to be feared and dreaded.
4. Do discuss the condition, its causes, treatment and precautions to be followed. An understanding about the physiological conditions and changes associated with diabetes will alleviate your child's fears about this condition and will equip him/her with the requisite knowledge to tackle it.
5. Do not express worries about the child's future, especially within earshot of the child.
6. Do not treat the child differently from his/ her siblings. This will only make your child more conscious about his/her condition.
7. Do take every opportunity to stress that diabetes is treatable.
8. Do focus on success stories of fellow diabetics from your child's area of interest - for example, successful cricketers, or athletes who are diabetics. Your child will profit from such role models.
9. Letting some one know about the fact that your child is diabetic should occur as naturally as divulging any other personal fact about yourself. If someone were to notice your child taking a shot and wondered what it was or why it was so, that would be a reason to explain! Don't express being diabetic as a negative thing or something that defines a person. Let it come naturally but definitely don't hide it. Be short, precise and positive while telling about it.
10. Be realistic in the goals set of your child.
11. Do set a personal example. Follow a healthy regimen of diet and exercise yourself to make it easy for your child to adhere to his.
12. Be understanding during the instance that your child deviates from the prescribed routine – your child is still a child and there may be occasions when he she feels the need to bypass the routine.

Counseling partners and caretakers
Juvenile diabetes impacts the entire family, not just the affected child. The parents of a diabetic child are also subject to stress, although for different reasons. In the case of parents, possible stressors are a fear of societal ridicule, apprehension about a girl child's marital prospects, worry about the child's longevity and future and sometimes guilt on not being able to protect the child from this condition. Counselling of parents and caretakers can go a long way in helping them tackle the emotional impact of this condition. While child counselling sessions help to assure the child, reinstate confidence and also infuse the belief that diabetes is a manageable condition, parental counseling seeks to allay the parents' fear regarding their child's future.

External sources of counselling
Depending on the extent of the psychological impact, counselling of the child is therefore not just desirable but even required. Although parents may be able to provide suchadvice, external help and counseling can effectively supplement the efforts of parents.

There are various counseling options available.
These are :
Family physician: The family physician is often the first line of support. The family physician will have an intimate knowledge of the child, his/her interests, and temperament. Further, the family physician enjoys the trust of the parents and the child alike. A talk with the family physician may be a timely confidence-booster.

Friends and family: Advice from friends and family, especially fellow-patients can also be very effective. A family member or friend who is successful and happy, despite such a diagnosis can be a very effective role model.

Online and offline support groups: Online support groups for both children and parents alike, provide a global network of support and also resources that the parents and child can tap into. Online support groups overcome the barriers of distance and allow parents to communicate, share and get answers to mutual concerns on bringing up a diabetic child.
Professional counseling: Where the emotional impact is deeper, professional counseling is not just desirable but required. Where thepsychological impact has resulted in mild or severe Depression,advice from a psychiatric professional is mandatory.

Dealing with diabetes is not just about taking medication, it is about dealing with its invisible and intangible effects. Counselling is one of themost potent tools that parents have to successflly manage the psychological consequences of this condition.
For stories on successful role models for children and more tips to young people on self management, coping and living with diabetes please visit

Tuesday, August 24, 2010

High levels of blood sugar

High levels of blood sugar, especially over long periods of time, can result in complications of other body functions. Uncontrolled diabetes can also lead to long term complications such as heart disease, skin problems, digestive problems, erectile dysfunction, kidney, eye complications and teeth and gum problems. This does not mean that the prognosis is dire for people with diabetes - by fallowing a few simple guidelines and taking necessary precautions, these complications can be successfully prevented.

Typical complications and their prevention
The following are some of the most likely complications from an untreated or neglected diabetic condition and tips for their prevention.

Heart disease and stroke:
Diabetes contributes to a thickening of the blood vessels and consequently, problems with blood circulation leading to a higher risk of cardiac problems and stroke.

1. Aggressively control blood sugar.
2. Proactively monitor and control modifiable risk factors for heart disease such as blood pressure and high cholesterol.
3. Quit smoking.
4. Consult your doctor on whether a daily dose of aspirin and statins will help you.

Diabetic nephropathy:
Diabetic nephropathy is a progressive kidney disease caused by damage to renal tissue due to high blood sugar.

Undergo the blood and urine tests recommended by your doctor. Doctors usually ask for Micro albumin urea at the first step to assess if there is damage to the kidneys. Other than this Creatinine blood tests, which assess kidney function and urine tests to check for the presence of protein in the urine are also asked.
Control your blood pressure.
Restrict protein intake if advised by your doctor. Aggressively control blood sugar.

Eye problems:
Diabetic retinopathy (Damage to the retina -the lining of the interior of the eye), cataract and glaucoma (Increased pressure in the eyes) are some of the eye problems that a person with diabetes may develop.

1. Have a comprehensive check of your vision every year.
2. Rigorously control blood sugar and blood pressure.
3. If you are pregnant it is very important to have an eye exam during your first 3 months of pregnancy.

Peripheral neuropathy:
Peripheral neuropathy affects sensations especially in the legs and feet. Since a person
with diabetes has a decreased ability to perceive pain many injuries can go unnoticed. Similarly, because of difficulty in perceiving changes in position, you may have difficulty in bearing weight properly and are at risk for developing calluses and ulcers on your feet.

Prevention :
This is one of the most easily preventable complications of diabetes. Ensure that you diligently check your feet everyday for ulcers cuts or sores.
See your doctor in case of any foot injury or ulcer. Do not try to treat them yourself.
Use footwear that cover your feet - do not walk barefoot or use open toed shoes or slippers.
Aggressively control blood sugar.

Skin problems:
Some of the skin problems that may be associated with diabetes are candidiasis, diabetic
dermopathy or skin spots, digital sclerosis, rashes and blisters, and fungal infections.

Do not ignore spots, rashes or blisters-get them checked by your doctor.
Follow high standards of personal hygiene to prevent fungal infections.
Aggressively control blood sugar.

Other complications:
In addition to the above people with uncontrolled diabetes are also at higher risk for disorders such as gastro paresis, sexual dysfunction and depression.

While some of the complications associated with diabetes are life-threatening, there is no need for undue alarm. On the other hand, the possibility of such complications is one more reason for timely diagnosis and treatment. To summarize, follow these simple guidelines to lower the risks of developing such complications.

1. Stay committed : Stay committed to your diabetic care regimen. Regularly monitor your blood sugar and take medication as advised by your doctor.
2. Exercise regularly : Regular exercise goes a long way in staying off heart disease and stroke. Start and then adhere to an exercise program of your choice.
3. Maintain your blood pressure and cholesterol within acceptable limits. Ensure that the blood pressure and cholesterol levels are within the range acceptable for your age.
4. Have a comprehensive health and eye checkup every year : Do not skip your annual physical examination. Early detection is the key to the prevention of many of the diabetes - related complications.
5. Check your feet : People with diabetes need to examine their feet everyday for sores, blisters and cuts. If untreated, even a small cut can develop into serious complications.
6. Drink responsibly : If you do drink then keep it to a minimum and never drink alcohol on an empty stomach as this could lead to hypoglycemia.
7. Quit smoking: Smoking increases the risk of various diabetes complications, especially heart disease and stroke.
8. Ensure personal and dental hygiene : People with diabetes are at higher risk for gum and skin infections.

It is vitally important that one is not just aware of the complications of uncontrolled diabetes but also take the first steps towards its management. The risk of diabetes-related complications can be effectively mitigated by following the simple steps outlined above. More importantly have a positive attitude and remember that leading a healthy life is in your hands. Take charge now for a healthier tomorrow.