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How not to have diabetic foot
Inadequate physical activity leads
to osteoporosis
Ayurveda & You
Health Notes
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How not to have diabetic foot A diabetic foot is an open wound that most commonly occurs on the bottom of the foot in approximately 15 per cent of patients with diabetes. Diabetes is the leading cause of non-traumatic lower extremity amputations, and approximately 14 to 24 per cent of patients with diabetes who develop a foot ulcer have an amputation. Anyone who has diabetes can develop a foot ulcer. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with excess weight, diabetes-related kidney, eye and heart disease. Causes: Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), trauma as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. Decreased blood flow can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk of an infection. Elevations in blood glucose can reduce the body’s ability to fight a potential infection and also retard healing. Treatment: The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less is the chance for an infection. Not all ulcers are infected. However, if an infection is diagnosed, a treatment programme of antibiotics, wound care and possibly hospitalisation will be necessary. There are several important factors to keep an ulcer from becoming infected by keeping blood glucose levels under tight control. The patient is advised to keep the ulcer clean and bandaged and not to walk barefoot. The science of wound care has advanced significantly over the past decade. Wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products such as growth factors, ulcer dressings and skin substitutes that have been shown to be highly effective in healing foot ulcers. The majority of non-infected foot ulcer cases are treated without surgery. However, when this fails, surgical management may be appropriate. Prevention: The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Wearing the appropriate shoes and socks will go a long way in reducing risks. Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day — especially between the toes and the sole — for cuts, cracks, blisters, redness, ulcers and any sign of abnormality. Any problems that are discovered should be reported to your doctor as soon as possible no matter how “simple” it may seem to you. Doctors treating diabetics should do a comprehensive foot examination at least annually to identify high risk factors such as the following:
The key to successful wound healing is regular care to ensure the “gold standard” of care, including lowering blood sugar, appropriate debridement of wounds, treating any infection, reducing friction and pressure and restoring adequate blood flow. The old saying, “an ounce of prevention is worth a pound of cure”, was never as true as it is when preventing a diabetic foot ulcer. The writer is Senior Consultant, Endocrinology, Fortis Hospital, Mohali. Email:
k.singh@fortishealthcare.com
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Inadequate physical activity leads to osteoporosis Osteoporosis is a condition characterised by low bone density/mass and increased bone fragility coupled with an enhanced risk of fractures. Bone comprises of proteins, calcium and collagen which lend strength. Osteoporosis causes bones to become porous, thereby rendering them compressible like a sponge. Fractures occur more frequently in the form of crack or collapse (vis-à-vis compression fracture of the vertebra of the spine). The bones more vulnerable to fracture are those of hips, spine, ribs and wrists. Bone mass density increases during childhood, reaching its peak around the age of 25. Crossing the age of 35, the density starts decreasing. Greater the bone density, stronger the bones. Men generally have bones with higher density as compared to women. Estrogen is the magic hormone which helps maintain bone density in premenopausal females. Due to the reduction of this hormone after menopause there is an increased incidence of osteoporosis in post-menopausal females.
Symptoms
Certain individuals experience no symptoms although could often complain of pain when the least pressure is applied on the bones. Vertebral fractures due to osteoporosis cause severe pain. Repeated fractures could lead to the collapse of the vertebra causing upper back hump as observed in elderly women. Hip fractures occur commonly in the elderly as a result of a fall.
Aggravating factors
Lack of exercise, taking a diet low in calcium, smoking, alcohol consumption, etc. Low estrogen levels in females. Low testosterone level in men. Certain medications — long-term consumption of steroids, phenobarbitone, etc. Bone density of an individual is compared with reference to the average peak bone density of young adults of the same sex and race. This score is designated as “T” score. Osteoporosis denotes bone density, “T” scores of - 2.5 or below. Osteopenia (between normal and osteoporosis score) denotes bone density “T” score between -1 and -2.5.
Treatment
The primary goal of treatment of osteoporosis is prevention in time so that the minimal bone loss occurs. Also there is need for initiating an exercise regimen in time so that bone density and strength can be maintained.
Calcium supplements — Dietary intake of calcium available in milk, cheese, yoghurt and dark green vegetables should be increased. Around 1000-1200 mg per day of calcium carbonate tablets should be taken in two doses with meals to avoid indigestion and constipation. Otherwise calcium citrate can be used. Daily intake of 400 to 800 IU of vitamin D is required. Vitamin D helps the absorption of dietary calcium from the intestines. Vitamin D comes from the dairy products, egg yolk and on exposure to sunlight. Exercises can slow down bone loss, help to maintain the posture and decrease the risk of falls because balance is improved and muscle strength is increased. Exercises that prevent the bone loss are resistance training exercises. These strengthen muscles, and strong muscles pulling on bones build denser, stronger bone. Brisk walking is the ideal weight-bearing exercise, which carries the minimum risk of injury. Stretch band is an excellent tool for strength training for the elderly since the risks of injury are minimised.
Exercises
Sitting knee extension: This exercise strengthens thigh muscles i.e. quadriceps. Sit with your back straight. Tie the band around the ankle. Slowly straighten one knee while lifting your heel a few inches from the floor. Repeat eight to 10 times for three sets. Calf:
Loop the band around the upper part of your foot and hold the ends in both hands separately. Pull the upper part of the foot and feel the stretch at the calf muscle. Repeat it five times. Foot:
Place a small wet towel on the floor and curl it towards you with toes. Repeat this exercise five times. Fingers:
Wrap a rubber band around fingers and thumb. Spread fingers and thumb apart. Hold and return to the starting position till one gets tired. Wrist and forearm:
Forearm rests on the tabletop with the hand over the end of a table. Hold the band with your palm facing upwards. Move the wrist up and down 8-10 times for two sets. Now hold the band with palm facing downwards and move the wrist up and down. Biceps:
While sitting, loop the band under the foot and holding it in one hand. Lift the band up with a bend elbow and feel a stretch at the bicep muscle. Repeat 10 times.
Exercise for lower back
Lying on the back with the knees bent, tighten the abdomen muscles and push the pelvis down to the floor. Hold for five seconds and return back. Repeat it five times. To prevent osteoporosis it is imperative to integrate the strengthening exercise regimen in the daily routine along with the intake of an adequate amount of calcium. The writer runs a pain management clinic in
Chandigarh. E-mail: chadha_r2003@yahoo.co.in
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Ayurveda & You After the cessation of the menstrual periods, the reproductive phase in women’s life comes to an end. This is the time when, as part of the natural aging process, the ovaries begin to produce fewer hormones and most of the women at this stage experience a number of physical and psychological changes. Though many of these symptoms like hot flashes, general body fatigue and mood swings are encountered for a short period, many others like weight gain, joint pains and osteoporosis have a lasting effect on a woman’s life, and need better management. Of the numerous menopausal treatments talked about, a majority of them emphasise to reset the hormonal balance. But a practical and simpler approach to deal with the menopausal syndrome is to evolve a diet plan which should help reduce in a natural way many of the discomforts and allay the long-term problems associated with this phase. The ayurvedic masters have provided ample guidance to manage menopause on the basis of “doshic” predominance in the case of each woman. As a rule, a healthy diet for the menopause phase should include eatables having a good amount of essential nutrients, vitamins and minerals. This is not the time to be obsessed with the calorie value of food. On the other hand, care should also be taken to choose the diet that is easily digestible and doesn’t cause any digestive upsets. Variety and moderation are important milestones of a diet plan for the menopausal phase which has to continue for a couple of years. The “vata” type of menopause is marked by nervousness, anxiety, palpitation, insomnia, vaginal dryness, skin tone loss, joint pain and reduction in the body’s calcium. These women should eat at regular intervals and their diet should include plenty of fruits, milk, fish, wholegrain cereals and pulses. Decreasing the intake of stimulants like alcohol, tea and coffee and avoiding eatables with a too cold effect are recommended. And a food that is stale, refined and is of junk in nature is not good for them. Shatavar, ashwagandha and arjuna are the best herbs for this group. Hot flashes and night sweats, feeling of irritability and anger, acidity, recurrent urinary tract infections, acne and intermittent heavy menstrual bleeding are the symptoms of “pitta”-dominated menopause. In such cases, women should take plenty of liquids, coconut water, green vegetables and skimmed milk. They are advised to avoid late-night dinners and control eating hot, spicy, deep fried and non-vegetarian food. Amla, coriander, cardamom, sandal and aloe vera are the herbs which control aggravated “pitta”. The “kapha”-dominated menopause is marked by weight gain, sluggishness and fluid retention, and can be accompanied by low moods and depression. These women are advised to eat light and warm food having very little of oil. With an early dinner, they should prefer boiled vegetables, salad, wholegrain cereals, legumes and tea and coffee in moderation. Meat, bakery items and dessert are harmful for them. They should use black pepper, asafetida, garlic, turmeric and ginger regularly in their meals. The writer is a Ludhiana-based senior ayurvedic consultant. E-mail: yourhealth @rediffmail.com
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Health Notes WASHINGTON: Shedding just over half a stone could be enough to beat heart disease, concludes a new study. According to the study done at the Washington University School of Medicine in St. Louis, obese patients who lost a moderate amount of weight by eating less and exercising more improved their cardiovascular health. Published in the Dec 15, 2009, issue of the Journal of the American College of Cardiology, the finding showed that weight loss led to improvement in certain key measures of heart and vascular health.
— ANI
Exercise ‘doesn't alleviate period pain’
LONDON: Exercise is of no use when it comes to period pain, say researchers. Birmingham University researchers, who studied more than 650 university students, said they found no link with the amount of exercise the participants did. The study reported in BJOG found 28 per cent had moderate-to-severe period pain, reports the BBC. According to study boffins, beliefs about exercise being an effective treatment for bad period pain had persisted for years.
— ANI
Extend youthfulness to keep Alzheimer's at bay
WASHINGTON: Taking steps to remain healthy and young may help delay the onset of Alzheimer's disease, according to a new study. The researchers conducted a study on mice to reach the conclusion. Andrew Dillin of The Salk Institute for Biological Studies, said: "There's something about being youthful that protects us from Alzheimer's disease. "People say that if you live long enough, you get Alzheimer's. But if that were true, mice that live longer should get the disease at the same rate. That's not what we found."
— ANI
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