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| HEALTH & FITNESS |
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All uterine fibroids need not be operated upon Understanding osteoporosis Dangers of taking sleeping pills
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All uterine fibroids need not be operated upon The doctor reassured by saying, “All that you may need is good control of anaemia and medicines to reduce your menstrual bleeding for a year or two, surgery may not be essential. We have succeeded in preserving uterus in a large number of our patients who had fibroids and who were advised hysterectomy (removal of uterus) at other centres. Believe me, only a small percentage of cases require the radical surgery of uterus removal at your age”. ‘Can you save me without operation? Is it possible to cure this cancer with medicines?”, Neeta was not willing to believe it. The doctor added, “First of all, it is not a cancer. Secondly, you are nearing menopausal age when your hormonal levels will fall and the fibroid will also shrink as the menstruation stops.” Neeta was simply delighted.
What is fibroid?
What is hysterectomy?
What is uterine artery embolisation?
The procedure is performed by an interventional radiologist trained in the use of X-rays to guide minimally-invasive interventions within the arteries. During the procedure, the radiologist makes a small nick in the skin in the groin and inserts a catheter (a thin tube of the size of a strand, which can be seen with X-rays) into an artery. The catheter is guided to the arteries that bring blood to the uterus, and very small particles are injected through the catheter to block the blood supply to the fibroid tumour. This causes the tumours to shrink. The writer is a senior gynaecologist based in
Chandigarh. |
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Understanding osteoporosis Osteoporosis (porous bones) is a common disease characterised by low bone mass and micro-architectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Most of the patients suffering from osteoporosis are not symptomatic for it and bone fracture is the usual first manifestation. One out of two females and one out of four males suffer from osteoporosis-related fracture in their lifetime.
Reasons
Most common causes of osteoporosis are senile osteoporosis and postmenopausal osteoporosis. Basically, our bones undergo a constant process of remodelling which involves the formation of new bone tissue and removal of old bone tissue. In younger age, bone formation is more as compared to removal. So, by the age of about 30 years, there is progressive gain in bone mass, and peak bone mass is achieved. In older age and in the post-menopausal state reverse happens and there is a progressive bone lose. So, the development of osteoporosis depends mainly on two things —- how much peak bone mass was achieved during younger age and how much is being lost afterwards. Attaining the peak bone mass depends mainly on genetic factors, nutrition and lifestyle while estrogen deficiency and calcium and vitamin D deficiency are main factors for increased loss.
Risk factors
Most important risk factors for the development of osteoporosis are old age (women 65 years and men 70 years), estrogen deficiency such as postmenopausal state, Caucasians and Asian race, body mass index < 20kg/m2, family history of osteoporosis, current smoking, alcohol abuse, calcium and vitamin D deficiency, various medications like glucocorticoids, lack of regular physical exercise, malabsorption of essential nutrients from the intestine, chronic inflammatory disorders such as rheumatoid arthritis. Symptoms: Initially, osteoporosis may not cause any symptom but later on the person suffering from osteoporosis may complaint of back pain, forward stooped posture and low trauma fracture of the spine, hip and forearm. Spinal compression fractures may or may not cause pain. Spinal fractures can cause forward stooped posture and consequent decrease in the height of the person.
When and how to do screening for osteoporosis?
The best screening method for osteoporosis is dual energy x-ray absorptiometry (DXA). This test is very accurate, sensitive and easy to do. A study typically takes less than 10 minutes. This test assesses the bone mineral density of a person and hence detects that whether a person is having osteoporosis or not. The most important sites for the assessment of osteoporosis by DXA are lumbar spine, hip and forearm, as osteoporosis affects maximally at these sites. Routinely done X rays of the bones can also detect osteoporosis, but only when osteoporosis is very advanced. The person should undergo screening for osteoporosis if any of the underlying conditions is met: 1) Women aged 65 and older 2) Postmenopausal women under age 65 with risk factors for fracture. 3) Women during the menopausal transition with clinical risk factors for fracture, such as low body weight, prior fracture, or high-risk medication use. 4) Men aged 70 and older. 5) Men under age 70 with clinical risk factors for fracture. 6) Adults with a fragility fracture. 7) Adults with a disease or condition associated with low bone mass or bone loss. 8) Adults taking medications associated with low bone mass or bone loss. 9) Anyone being considered for pharmacologic therapy for osteoporosis. 10) Anyone undergoing treatment for osteoporosis to monitor treatment effect.
How to prevent and treat osteoporosis?
Diet – For prevention and treatment of osteoporosis, a balanced diet with adequate proteins, calcium and vitamin D is a must. Milk and other dairy products are the most important dietary sources for calcium. One litre of milk provides about 1 gram of calcium. Daily requirement of calcium for an adult is about 1000 – 1200 mg. Calcium supplements should be taken if diet is inadequate in calcium. For adequate absorption of dietary calcium, vitamin D is required. Vitamin D is formed in human skin on sun exposure. Routinely diet contains almost negligible vitamin D, as it is available only in certain food such as fatty fish. Despite plenty of sunshine, vitamin D deficiency is very common in Indians. This is mainly due to poor sunshine exposure, dress code and pigmentation of the skin. Most persons in India would require vitamin D supplementation to ensure adequate vitamin D levels in the body. Exercise – Regular physical exercise is very important in prevention and treatment of osteoporosis. But it should be well guided by the treating doctor. Exercises, especially those of weight bearing type, help in maintaining the density and strength of the bone by putting load on the bones. It also increases muscle strength and body balance; so the tendency to fall decreases and hence the risk of fracture decreases. Smoking cessation – Smoking is as dangerous for bones as for heart and lungs. Females who smoke tend to attain menopause at an early age and hence tend to develop estrogen deficiency early. Smoking also decreases the absorption of calcium from food. The writer is DM, Endocrinology,
AIIMS, New Delhi. |
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Dangers of taking sleeping pills
London: The safety of commonly prescribed sleeping pills is under scrutiny again after new research linked the drugs, used by millions of people worldwide, to a fourfold increased risk of dying. Occasional insomniacs who took fewer than 18 pills per year were three times more likely to die than those prescribed no sedatives, according to the study published in British Medical Journal Open. The risk of dying increased in relation to the dose, so the more pills a person took, the greater the risk. And those taking high doses, an average of nine pills per week, were 35 per cent more likely to develop cancer. Sleeping pills, or hypnotics, are commonly prescribed by GPs despite growing evidence that non-addictive, psychological therapies are safer and more effective in the long-term. Nearly 13 million prescriptions were dispensed by UK pharmacists in 2010, explained by the fact that one in four Britons is dissatisfied with their sleep and one in 10 suffers from a sleep disorder. Observational studies like this one do not prove cause and effect, but randomised control trials cannot be carried out for ethical reasons. This research is the 19th study to show a statistically significant increased risk of death among people taking sleeping pills. — The Independent
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Overeating may lead to memory loss Washington: Excessive eating may greatly increase the risk of memory loss for elderly people, a new study has suggested.In 2006 the Mayo Clinic chose a random sample of 1,233 people in Olmsted County, Minn., ages 70 to 89 years (none previously diagnosed with dementia), and asked them to fill out a questionnaire describing their diets over the previous year. Participants then returned the surveys to the clinic in Rochester, Minn., after which the researchers grouped the study participants into three categories: those whose daily caloric consumption was between 600 and 1,526 calories; between 1,526 and 2,143; and between 2,143 and 6,000. Each participant then underwent a series of MRI brain scans and cognitive tests. Correlating caloric consumption with test performance, researchers concluded the odds of having MCI more than doubled for those in the highest calorie-consuming group compared with those in the lowest calorie group. There are several caveats to these findings, however. For instance, the report did not take into account the types of food and beverages consumed nor did it examine the rate at which food was eaten throughout a day. Study author Yonas Geda acknowledged that the research to better understand the link between mild cognitive impairment (MCI) — the stage between normal age-related memory loss and early Alzheimer’s disease — and eating in the elderly is still preliminary, but he noted that it does create a foundation for more extensive cause-and-effect research, which he and his colleagues are currently pursuing. —
ANI Statins may help cut depression risk in heart patients Washington: Taking cholesterol-lowering statins may reduce the risk of developing depression in patients with heart disease, researchers suggest. Mary Whooley, a physician at the San Francisco VA Medical Center and a professor of medicine at the University of California, San Francisco, and her research team evaluated 965 heart disease patients for depression, and found that the patients who were on statins were significantly less likely to be clinically depressed than those who were not. They then followed the 776 patients who were not depressed — 520 who were using statins and 256 who were not — for an additional six years. Of those taking statins, 18.5 per cent developed depression, compared with 28 per cent of those not on the drugs. Put another way, the patients who took statins were 38 per cent less likely to develop depression than patients who did not.As the study went on, said Whooley, the difference between the two groups became more pronounced, with the patients on statins becoming less likely to develop depression and the patients not on statins becoming more likely to become depressed over time. “This would suggest that statins may have some kind of long-term protective effect against depression, perhaps by helping to prevent atherosclerosis in the brain, which can contribute to depressive symptoms,” Whooley noted. She also noted that statins have positive effects on the endothelium — the inner lining of the blood vessels — keeping blood vessels less rigid and therefore better able to adapt to the body’s changing needs.—ANI Targeted drug extends survival of leukemia patients Washington: Patients with chronic myeloid leukemia (CML) who have not responded to interferon treatments, experience long-term benefits when they switch to the targeted drug imatinib, according to a new study. The finding indicates that imatinib is the treatment of choice for these patients. Imatinib, a drug that blocks the protein made by a particular cancer-causing gene, has revolutionised the treatment and prognosis of patients with CML. Now up to 93 per cent of patients who take the drug as initial therapy for CML survive at least eight years, whereas prior to imatinib, patients survived an average of only three to six years. While imatinib is now the standard drug given after a diagnosis of CML, approximately 15,000 to 20,000 patients in the United States may have started taking imatinib after failing to respond to the previous standard drug for CML, interferon.
—ANI
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Neeta, 46, reported to her gynaecologist for surgery with a fibroid in her uterus. She is in a hurry to get operated upon but is scared of knife. “I have undergone several investigations, including serial MRI; my tumour is growing and excessive monthly bleeding is sapping my energy. Will I survive the surgery? Doctor, can you help me?”