Degenerative Diseases

My hands are trembling…is it normal that when my arms are at rest they are shaking or its something else. Learn more about “Degenerative Disease” and how can it affect you…

Degenerative Diseases

Parkinson's  Disease

Parkinson's Disease

Tremors

Parkinson's Disease

Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD.  Therefore the diagnosis is based on medical history and a neurological examination.  The disease can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.

Treatment

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.  Usually, patients are given levodopa combined with carbidopa.  Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain.  Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply.  Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.  Anticholinergics may help control tremor and rigidity.  Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.  An antiviral drug, amantadine, also appears to reduce symptoms.  In May 2006, the FDA approved rasagiline to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD. 

In some cases, surgery may be appropriate if the disease doesn't respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.

Prognosis of the Disease

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.  Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and other symptoms are more troublesome.  No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person.

Tuberculosis

Overall, one-third of the world's population is currently infected with the Tuberculosis. Know more about this disease and how can you protect yourself. 

 

                                    

Young Child with Tuberculosis

Tuberculosis

An infectious disease caused by Mycobacterium Tuberculosis having propensity to infect lungs, bone, gastrointestinal tract, meninges and urinary tract. In fact tuberculosis is believed to be one of the most infectious and resistant bacteria known.

Infection and Transmission

Skin Test

Mantoux test/ Tine test is the most common method used to know the exposure of a person with tuberculosis.

After the skin test, the result will be 72 hours or 3 days

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.

Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater.

Ø      Someone in the world is newly infected with TB bacilli every second.

Ø      Overall, one-third of the world's population is currently infected with the TB bacillus.

Ø      5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.

Drug-resistant TB

Common Drugs for Tuberculosis

Rifampicin-

Isoniazid

Pyrezinamide

Ethambutol

Streptomycin

Until 50 years ago, there were no medicines to cure TB. Now, strains that are resistant to a single drug have been documented in every country surveyed; what is more, strains of TB resistant to all major anti-TB drugs have emerged. Drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period because they start to feel better, because doctors and health workers prescribe the wrong treatment regimens, or because the drug supply is unreliable. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease caused by TB bacilli resistant to at least isoniazid and Rifampicin, the two most powerful anti-TB drugs. Rates of MDR-TB are high in some countries, especially in the former Soviet Union, and threaten TB control efforts.

While drug-resistant TB is generally treatable, it requires extensive chemotherapy (up to two years of treatment) with second-line anti-TB drugs which are more costly than first-line drugs, and which produce adverse drug reactions that are more severe, though manageable. Quality assured second-line anti-TB drugs are available at reduced prices for projects approved by the Green Light Committee.

The emergence of extensively drug-resistant (XDR) TB, particularly in settings where many TB patients are also infected with HIV, poses a serious threat to TB control, and confirms the urgent need to strengthen basic TB control and to apply the new WHO guidelines for the programmatic management of drug-resistant TB.

Importance of Multidrug Therapy

Compliance is one of the major problems in dealing with patients with Tb. Due to the long term use of the drugs some or most of the patient intend not to finish the program (minimum of six months) in dealing with the disease. Proper knowledge is the key in this problem. If the patient is given enough information of the reason about why the drug therapy would take months. It would make a big difference about how the patient will comply.

If  a patient was not able to finish the program assigned, there is a big chance that the tuberculie

 bacilli will be resistant to the drugs used. Further more the nest time the patient will undergo treatment it will be more aggressive than the previous one.

Global and regional incidence

WHO estimates that the largest number of new TB cases in 2008 occurred in the South-East Asia Region, which accounted for 34% of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the South-East Asia Region with over 350 cases per 100 000 population.

An estimated 1.3 million people died from TB in 2008. The highest number of deaths was in the South-East Asia Region, while the highest mortality per capita was in the Africa Region.

In 2008, the estimated per capita TB incidence was stable or falling in all six WHO regions. However, the slow decline in incidence rates per capita is offset by population growth. Consequently, the number of new cases arising each year is still increasing globally in the WHO regions of Africa, the Eastern Mediterranean and South-East Asia.

HIV and TB

HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the immune system. Someone who is HIV-positive and infected with TB bacilli is many times more likely to become sick with TB than someone infected with TB bacilli who is HIV-negative. TB is a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor contributing to the increase in the incidence of TB since 1990.

WHO and its international partners have formed the TB/HIV Working Group, which develops global policy on the control of HIV-related TB and advises on how those fighting against TB and HIV can work together to tackle this lethal combination. The interim policy on collaborative TB/HIV activities describes steps to create mechanisms of collaboration between TB and HIV/AIDS programmes, to reduce the burden of TB among people and reducing the burden of HIV among TB patients.

The six components of the Stop TB Strategy are:

1. Pursue high-quality DOTS expansion and enhancement. Making high-quality services widely available and accessible to all those who need them, including the poorest and most vulnerable, requires DOTS expansion to even the remotest areas.
2. Addressing TB/HIV, MDR-TB and the needs of poor and vulnerable populations.Addressing TB/HIV, MDR-TB and the needs of poor and vulnerable populations requires much greater action and input than DOTS implementation and is essential to achieving the targets set for 2015, including the United Nations Millennium Development Goal relating to TB (Goal 6; Target 8).
3. Contribute to health system strengthening based on primary health care. National TB control programmes must contribute to overall strategies to advance financing, planning, management, information and supply systems and innovative service delivery scale-up.
4. Engage all care providers. TB patients seek care from a wide array of public, private, corporate and voluntary health-care providers. To be able to reach all patients and ensure that they receive high-quality care, all types of health-care providers need to be engaged.
5. Empower people with TB, and communities through partnership. Community TB care projects have shown how people and communities can undertake some essential TB control tasks. These networks can mobilize civil societies and also ensure political support and long-term sustainability for TB control programmes.
6. Enable and promote research. While current tools can control TB, improved practices and elimination will depend on new diagnostics, drugs and vaccines.

The strategy is being implemented as described in The Global Plan to Stop TB, 2006-2015. The Global Plan is a comprehensive assessment of the action and resources needed to implement the Stop TB Strategy and to achieve the following targets:

• Millennium Development Goal (MDG) 6, Target 8: Halt and begin to reverse the incidence of TB by 2015;
• Targets linked to the MDGs and endorsed by the Stop TB Partnership:
• by 2005: detect at least 70% of new sputum smear-positive TB cases and cure at least 85% of these cases;
• by 2015: reduce TB prevalence and death rates by 50% relative to 1990;
• by 2050: eliminate TB as a public health problem (1 case per million population).

Progress towards targets

In 2008, an estimated 62% of new smear-positive cases were treated under DOTS – just short of the 70% target.

The treatment success in the 2007 DOTS campaign was 86% overall, surpassing the 85% target for the first time. The treatment success target was met by 13 of the 22 high-burden countries. However, the regional average cure rates in the African, American and European regions were below 85%.

It is estimated that the global TB incidence rate peaked in 2004. Therefore, the world as a whole is on track to achieve the MDG target of reversing the incidence of TB. The major exception to this is the epidemiological sub region of African countries with low HIV prevalence. Six epidemiological sub-regions (Central Europe, Eastern Europe, Eastern Mediterranean, high-income countries, Latin America and the Western Pacific) have already achieved the target of halving the 1990 prevalence rate. Four epidemiological sub-regions (Central Europe, high-income countries, Latin America and the Western Pacific) have already achieved the target of halving the 1990 mortality rate.

Anorexia Nervosa

Anorexia vs. Bulimia NERVOSA

Eating disorders with not only young women may suffer.

                                                                                              

Purging does Not Prevent Weight Gain

Purging isn’t effective at getting rid of calories, which is why most people suffering with bulimia end up gaining over time. Vomiting immediately after eating will only eliminate 50% of the calories consumed at best-and usually much less. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective. Laxative gets rid of only 10% of the calories eaten, and diuretics do nothing at all. You may weigh less after taking them, but that lower on the scale is due to water loss, not true weight loss.

Bulimia Nervosa

            Bulimia Nervosa is bouts of over eating followed by vomiting in young girls. Bulimia Nervosa is an eating disorder which a person desires to loose weight but can’t overcome their desire to eat, after eating she encourage herself to vomit of what she had eaten. Normally they vomit within two hours after eating.   

This vicious cycle of binging and purging takes a toll on the body, and it’s even harder on emotional well-being. But the cycle can be broken. Effective bulimia treatment and support can help you develop a healthier relationship with food and overcome feelings of anxiety, guilt, and shame.

Three Features of Bulimia

Regular episodes of out-of-control binge eating

Inappropriate behavior to prevent weight gain

Self-worth excessively influenced by weight and physical appearance

 

 

 

 

 

 

 

 

Signs and Symptoms of Purging
Going to the bathroom after meals:	Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
Using laxatives, diuretics, or enemas after eating.	May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
Smell of vomit:	The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.

Binge and Purge Eating

Dieting triggers bulimia’s destructive cycle of binging and purging. The irony is that the more strict and rigid the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition.

 

Unfortunately, purging only reinforces binge eating. Though you may tell yourself, as you launch into a new diet, that this is the last time, in the back of your mind there’s a voice telling you that you can always throw up or use laxatives if you lose control again. What you may not realize is that purging doesn’t come close to wiping the slate clean after a binge.

 

 

 

 

 

 

 

Binge Eating Signs and Symptoms

Lack of control over eating: Inability to stop eating. Eating until the point of physical discomfort and pain. Secrecy surrounding eating: Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy. Eating unusually large amounts of food with no obvious change in weight. Disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food. Alternating between overeating and fasting: Rarely eats normal meals. It’s all-or-nothing when it comes to food. Excessive exercising: Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners.

Signs and Symptoms of bulimia

If you’ve been living with bulimia for a while, you’ve probably “done it all” to conceal your binging and purging habits. It’s only human to feel ashamed about having a hard time controlling yourself with food, so you most likely binge alone. If you eat a box of doughnuts, then you’ll replace them so your friends or family won’t notice. When buying food for a binge, you might shop at four separate markets so the checker won’t guess. But despite your secret life, those closest to you probably have a sense that something is not right.

 

Physical Signs and symptoms of bulimia
Signs and Symptoms	Due to
Calluses or scars on the knuckles or hands	from sticking fingers down the throat to induce vomiting.
Puffy “chipmunk” cheeks	caused by repeated vomiting
Discolored teeth	from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
Not underweight:	Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
Frequent fluctuations in weight:	Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging.

Effects of bulimia

When you are living with bulimia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure

Complications and Adverse effects of Bulimia include

Weight gain Abdominal pain, bloating Swelling of the hands and feet Chronic sore throat, hoarseness Broken blood vessels in the eyes Swollen cheeks and salivary glands Weakness and dizziness Tooth decay and mouth sores Acid reflux or ulcers Ruptured stomach or esophagus Loss of menstrual periods Chronic constipation from laxative abuse

The dangers of ipecac syrup

If you use ipecac syrup, a medicine used to induce vomiting, after a binge, take caution. Regular use of ipecac syrup can be deadly. Ipecac builds up in the body over time. Eventually it can lead to heart damage and sudden cardiac arrest, as it did in the case of singer Karen Carpenter.

 Bulimia causes and risk factors

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing causes. In most cases, people suffering with bulimia—and eating disorders in general—have trouble managing emotions in a healthy way. Eating can be an emotional release so it’s not surprising that people binge and purge when feeling angry, depressed, stressed, or anxious.

Major causes and risk factors for bulimia include:

Poor body image: Our culture’s emphasis on thinness and beauty can lead to body dissatisfaction, particularly in young women bombarded with media images of an unrealistic physical ideal.

Low self-esteem: People who think of themselves as useless, worthless, and unattractive are at risk for bulimia. Things that can contribute to low self-esteem include depression, perfectionism, childhood abuse, and a critical home environment.

History of trauma or abuse. Women with bulimia appear to have a higher incidence of sexual abuse. People with bulimia are also more likely than average to have parents with a substance abuse problem or psychological disorder.

Major life changes: Bulimia is often triggered by stressful changes or transitions, such as the physical changes of puberty, going away to college, or the breakup of a relationship. Binging and purging may be a negative way to cope with the stress.

Appearance-oriented professions or activities: People who face tremendous image pressure are vulnerable to developing bulimia. Those at risk include ballet dancers, models, gymnasts, wrestlers, runners, and actors.

Therapy

Poor body image and low self-esteem are at the core of bulimia, therefore, psychotherapy is an important part of recovery. Here’s what to expect in bulimia therapy:

Therapy for Bulimia
Breaking the binge-and-purge cycle	Changing unhealthy thoughts and patterns	Solving emotional issues
– The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge.	– The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight.	– The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder in the first place. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness.

 

Helping a person with bulimia

It’s painful to know your child or someone you love may be binging and

purging. You can’t force a person with an eating disorder to change and you can’t do the work of recovery for your loved one. But you can help by offering your compassion, encouragement, and support throughout the treatment process. Here are a few ideas for what you can do today to help make a difference for tomorrow.

Do:

Don’t:

Be a cool customer. No matter how worried you are, approaching your loved one with alarm is not the best approach. Stash away the eating disorder articles for now. Find a neutral place to chat and: (1) calmly say what you’ve noticed, and (2) explain why you’re worried. Talk and listen. Let compassion be your guide. Make sure they know you intend to listen. Keep in mind they might feel defensive or angry. It’s embarrassing to talk about binging and purging. But if they do come to you for a listening ear, show no judgment, even if they sound unstable. Take “solve” out of your vocabulary. As a parent or friend, there isn’t a lot you can do to “fix” your loved one’s bulimia. They must decide on their own when they are ready to move forward. Set an example of healthy eating, exercising, and body image. Never make negative comments about your own body or anyone else’s. Be good to yourself. Know when to seek advice for yourself from a counselor or health professional. Keep your friends and relatives involved in the support network.

Be the food police. A person with bulimia needs kindness, not nutritional advice. Use insults, fear, guilt, or embarrassment. Since bulimia is often a caused by a form of stress and self-hate, negativity will only make it worse. Let kindness, compassion, support and empathy be your guide. Support from friends and family is always helpful for recovery.