Category Archives: Infographics

Heart Health: When You Should Take Daily Aspirin

When should you take daily aspirin?

If you’ve had a heart attack or stroke: Taking a low-dose aspirin a day is an important part of your treatment. It can help you prevent another heart attack or stroke.

If you haven’t had a heart attack or stroke: Taking an aspirin a day may prevent heart attack or stroke, but it can also cause bleeding. Talk with your health care team about the risks and benefits of aspirin for you. In general, don’t take a daily aspirin if you are 60 or older and don’t have heart disease.

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Conditions: How Chronic Kidney Disease, Diabetes & Heart Disease Are Linked

The body is complicated! While organs in your body each have a specific job to do to keep you healthy, they still rely on each other to function well. When one organ isn’t working the way it should, it can put stress on other organs, causing them to stop working properly as well.

The relationship between chronic kidney disease (CKD), diabetes, and heart disease is one example of the ways our organs are connected.

The body uses a hormone called insulin to get blood sugar into the body’s cells to be used as energy. If someone has diabetes, their pancreas either doesn’t make enough insulin or can’t use the insulin it makes as well as it should.

If someone has CKD, their kidneys are not able to filter out toxins and waste from their blood as well as they should.

Heart disease refers to several types of heart conditions. The most common condition, coronary artery disease, leads to changes in blood flow to the heart, which can cause a heart attack.

Make the Connection

So how are these three conditions connected? Risk factors for each condition are similar and include high blood sugar, high blood pressure, family history, obesity, unhealthy diet, and physical inactivity.

High blood sugar can slowly damage the kidneys, and, over time, they can stop filtering blood as well as they should, leading to CKD. Approximately 1 in 3 adults with diabetes has CKD.

When the kidneys don’t work well, more stress is put on the heart. When someone has CKD, their heart needs to pump harder to get blood to the kidneys. This can lead to heart disease, the leading cause of death in the United States. Change in blood pressure is also a CKD complication that can lead to heart disease.

Luckily, preventing or managing one condition can help you prevent and manage the others and lower the risk for more complications.

The Two Types Of Stroke: Ischemic & Hemorrhagic

There are two types of stroke:

transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different from the major types of stroke, because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.1

Ischemic stroke

Most strokes are ischemic strokes.2 An ischemic stroke occurs when blood clots or other particles block the blood vessels to the brain.

Fatty deposits called plaque can also cause blockages by building up in the blood vessels.

Hemorrhagic stroke

A hemorrhagic stroke happens when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.

High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke.

Transient ischemic attack (TIA or “mini-stroke”)

For Blanche Teal-Cruise, a smoker for 40 years who also had high blood pressure, the transient ischemic attack (sometimes called a mini-stroke) she had on the way to work was a wake-up call. Read Blanche’s story.

TIAs are sometimes known as “warning strokes.” It is important to know that

  • A TIA is a warning sign of a future stroke.
  • A TIA is a medical emergency, just like a major stroke.
  • Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel signs of a stroke or see symptoms in someone around you.
  • There is no way to know in the beginning whether symptoms are from a TIA or from a major type of stroke.
  • Like ischemic strokes, blood clots often cause TIAs.
  • More than a third of people who have a TIA and don’t get treatment have a major stroke within 1 year. As many as 10% to 15% of people will have a major stroke within 3 months of a TIA.1

Recognizing and treating TIAs can lower the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

Diagnosis: Gastro – Oesophageal Reflux

Gastro-oesophageal reflux disease (GERD) is a common disorder in adults and children. The global prevalence of GERD is high and increasing. Non-erosive reflux disease is the most common phenotype of GERD. Heartburn and regurgitation are considered classic symptoms but GERD may present with various atypical and extra-oesophageal manifestations. The pathophysiology of GERD is multifactorial and different mechanisms may result in GERD symptoms, including gastric composition and motility, anti-reflux barrier, refluxate characteristics, clearance mechanisms, mucosal integrity and symptom perception.

In clinical practice, the diagnosis of GERD is commonly established on the basis of response to anti-reflux treatment; however, a more accurate diagnosis requires testing that includes upper gastrointestinal tract endoscopy and reflux monitoring. New techniques and new reflux testing parameters help to better phenotype the condition. In children, the diagnosis of GERD is primarily based on history and physical examination and treatment vary with age.

Treatment in adults includes a combination of lifestyle modifications with pharmacological, endoscopic or surgical intervention. In refractory GERD, optimization of proton-pump inhibitor treatment should be attempted before a series of diagnostic tests to assess the patient’s phenotype.

Medicine: Adult-Onset Autoimmune Diabetes

  • Adult-onset autoimmune diabetes encompasses a wide spectrum of heterogeneous genotypes and phenotypes, ranging from classic adult-onset type 1 diabetes mellitus to latent autoimmune diabetes in adults (LADA)
  • The heterogeneity of LADA arises from its definition as being present in any adult with diabetes who does not require insulin and who is positive for any islet autoantibody, regardless of titre, number or epitope specificity
  • The heterogeneity of LADA manifests in different clinical phenotypes, ranging from prevalent insulin resistance to prevalent insulin deficiency, each of which might be associated with different autoimmune and metabolic markers
  • Although patients with LADA are leaner and have healthier lipid and blood pressure profiles, evidence shows that there is no difference in cardiovascular outcomes between these patients and those with type 2 diabetes mellitus

Dr. C’s Journal: What Is Achilles Tendinitis?

The Achilles tendon, or “heel cord”, connects your calf muscle to the heel. Overuse can inflame the tendon, or even tear or rupture it, causing a lot of pain.

Sudden increases in intensity of exercise can be a cause. It is more common in men, and as you get older. Running a lot in the soft sand of the beach has caused problems in many of my friends. Achilles tendinitis can be caused by certain antibiotics, such as fluoroquinolones.

Varying your type of exercise, or cross training, distributes the strain you put on your body and decreases the likelihood of Achilles tendinitis. Swimming comes to mind with any disturbance of your lower extremities. The pool in which I swim three days a week is disparagingly called the “injured reserve pool” in my community  Stretching before exercising is always a good idea. Pick a routine and stick with it, particularly as you get older. If you have flat feet, getting a slight lift for the heel may help to take tension off the Heel cord, and orthotics may help. Getting expert advice is always advisable.

Prevention is always far better than treatment.

If a short period of rest doesn’t get rid of the pain, check with your Doctor, who might examine the tendon, take x-rays, or order ultrasounds to check the extent of the difficulty.

—Dr. C.

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Medicine: Graves’ Disease Autoimmune Disorder

Graves’ disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves’ disease is a common cause.

Thyroid hormones affect many body systems, so signs and symptoms of Graves’ disease can be wide ranging. Although Graves’ disease may affect anyone, it’s more common among women and in people younger than age 40.

The primary treatment goals are to reduce the amount of thyroid hormones that the body produces and lessen the severity of symptoms.

Medical Conditions: Signs And Treatment Of Sepsis

Sepsis occurs when the body’s response to an infection damages its own tissues. When these infection-fighting processes turn on the body, they cause organs to function poorly and abnormally.

As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis may cause abnormal blood clotting that results in small clots or burst blood vessels that damage or destroy tissues. If sepsis progresses to septic shock, blood pressure drops dramatically, which can lead to death.

Nearly 270,000 people in the U.S. die each year as a result of sepsis, and one-third of people who die in a hospital have sepsis, according to the Centers for Disease Control and Prevention.

Signs of sepsis

To be diagnosed with sepsis, you must have a probable or confirmed infection, and all of these signs:

  • Change in mental status.
  • Systolic blood pressure — the top number in a blood pressure reading — less than or equal to 100 millimeters of mercury, or mm Hg.
  • Respiratory rate higher than or equal to 22 breaths per minute.

Signs of progression to septic shock include:

  • The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
  • High levels of lactic acid in your blood, which means that your cells aren’t using oxygen properly.

Treatment

Early, aggressive treatment increases the likelihood of recovery.

A number of medications are used to treat sepsis and septic shock, including antibiotics, corticosteroids, painkillers and sedatives. Supportive care, including oxygen and dialysis, and surgery to remove the source of the infection, also may be needed.

People who have sepsis require close monitoring and treatment in a hospital ICU. Lifesaving measures may be needed to stabilize breathing and heart function.

Read more at Mayo Clinic

COMMENTS:

The hospital is a dangerous places to be, and the most common cause of death there is sepsis. Sepsis is an underappreciated killer, and it’s getting more common because people are aging, devices are more commonly implanted into the body, immunosuppressive treatment is being used more commonly, and hospital acquired infections are increasingly resistant to treatment.

Sepsis can be caused by an overwhelming infection with bacteria, but can also be caused by viruses, fungi, and severe trauma. Low blood pressure is a common  problem, and is associated with change in mental status, and increased breathing rate in raising a red flag for sepsis. Endotoxins play an important, if confusing, role. Endotoxins derive from Gram negative bacteria, but the most common bacterium causing sepsis is the gram positive staphylococcus aureus. With sepsis, though,the gastrointestinal tract may become more leaky, and Gram negative organisms may thereby gain  access to the blood stream.

A ccmmon test to detect sepsis is the serum lactate, which becomes elevated if oxygen utilization is diminished, such as in sepsis. There is also a direct test for endotoxin in the bloodstream, performed by using LAL, or Limulus amebocyte lysate. This substance, derived from the cells of the blood of the horseshoe crab, is very sensitive to endotoxins, and coagulates in its presence. This test is also used to detect endotoxins in Biological products and devices, making horseshoe crab is quite valuable.

Maintaining general health, keeping up on your immunizations, wishing your hands, keeping cuts and burns free from infection, ovoid smoking, controlling diabetes and avoiding hospitals whenever possible are useful preventative techniques.

—Dr. C.

Dr. C’s Journal: Flat Feet And Overpronation

Flat feet will exempt you from the draft, but that is where are their benefit stops. This condition can be inherited, but the arch can also fail to develop during puberty.

The entire bottom of the foot will contact the ground when walking if you have flat feet.

Overpronation happens when the way you walk causes the arches of the feet to flatten even more, putting a strain on the muscles, tendons, and ligaments that support your arches. Overweight and running a lot on hard surfaces accentuates this problem, and pain in the ligaments in the arch of the foot is the result.

Overpronation may be indicated by excessive wear on the inside of the heels and soles of your shoes, and can cause all kinds of problems such as Achilles tendinitis, iliotibial band syndrome, plantar fasciitis, shin splints, and even knee, hip, or back pain. these things may  develop in compensation to overpronation while walking.

As an older person, I have pretty much given up tennis and running, and walk rapidly for long (for me) distances in order to get sufficient exercise. Without noticeably increasing my walking, I have recently developed tenderness in the arch of my left foot that made walking painful. Curling my toes, and walking on the outside of my feet seemed to alleviate the pain. This is an exercise that I remember from my childhood, and may have been shown me because of my moderately flat feet.

Swimming for Exercise, and decreasing the amount of walking seems to have corrected the condition at least temporarily, but I have also ordered some orthotic inserts for my shoes as an arch support, in case I need them going forward. I have been told that if this is insufficient I can go to a specialty store and order some special shoes that might help. I have not mentioned painkillers such as NSAIDs, because I try to avoid them

Please check with the accompanying references for more information about flat feet and over pronation.

—Dr. C.

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