Doctor’s blog

Diabetes is a disorder of carbohydrate metabolism. Two types of diabetes is generally recognized (although there are a few more uncommon types of diabetes), type I diabetes or insulin dependence diabetes mellitus (IDDM) and type II diabetes or non-insulin dependence diabetes mellitus (NIDDM). Dietary advice for both the types of diabetes is essentially the same. Diet has a very important role in treatment of diabetes and it can be used alone for management of mild cases of diabetes or diet can be used along with medications (insulin or oral hypoglycemic agents).

The objectives of diabetic diet:

• To maintain adequate nutrition and optimal health for diabetics.
• To maintain blood sugar level within normal limits.
• To bring body weight to normal (if obese) and maintain it.
• To prevent, delay or minimize the onset of chronic systemic complications of diabetes, which ultimately cause the death of the diabetic patient.

Foods to be avoided by diabetics:

Ideally a diabetic patient should avoid glucose, sugar, all types of sweets, candies, chocolates etc.

Foods to be restricted by diabetics:

Potatoes, sweet potatoes, yam, bananas, alcoholic drinks (especially in excess than 2 drinks per day), grapes, mangoes, fried foods (especially deep fried foods), cakes, pastries, dry fruits etc. should be taken in limited quantities.

Foods to be consumed liberally by diabetics:

Foods to be taken in large quantities by diabetics are green leafy vegetables, cucumber, radish, tomatoes, bitter gourd, buttermilk, tea and coffee (without sugar), different types of vegetables etc.

Important points to remember:

• It is very important for a diabetic to remember that he/she should control the quantity of food and time of food intake (ideally small quantity of food more frequently).
• Meals should not be missed as well as large meals should be avoided.
• Substitute craving for sweet by some fruits (preferably low carbohydrate fruits).
• Select foods of your liking and within the acceptable list of foods for diabetics.

While surfing the net I came across a good (better to say excellent) health website “Online Health” (nethealthsite.com). The great health website has number of great topics and has details of information on several diseases, many of which are common and some are uncommon but very important.

One of the best things about the health website is that, you can reach any page (content of the website) with only a few clicks (no content is far away from “homepage” of the website). To reach any page of the health website you need maximum 4 clicks, which can save you valuable time (unlike many websites which may take more than 10 clicks to reach the content you want to view) while visiting the website for any topic discussed in the website.

To make finding a topic easy, the health website has sections and each section has several categories for easier viewing of the health website. The health website is user-friendly for the viewers and not made for the search engines.

Sections such as “important and current health articles” provide latest and important health information on important health topics and current global health problems, section “diseases A to Z” gives all the information about diseases with the name starting from A (such as atopic dermatitis) to Z (such as Zollinger-Elison syndrome) and very frequently the admin is adding information about new diseases (which you can find out by visiting the health website a few times for a month or so).

The section “All About Diabetes” gives all the information one may require to know or learn about diabetes mellitus, such as the different types of diabetes, diagnosis of diabetes the latest management/treatment of diabetes, how to prevent/delay development of diabetes.

The author will keep adding the new topics and provide information about all the diseases in the health website.

Gout is a metabolic disorder which cause increased uric acid level in blood and deposition of uric acid crystals (monosodium urate or MSU) in various joints of the body. As the main reason of gout is increased uric acid level in blood and uric acid is produced from purine rich diet, the role of diet in causation of gout as well as in management of gout is extremely important.

Historically gout was known as the “disease of Kings” or “rich man’s disease” as it was more common among affluent class of the society. But these days it is not uncommon to see patients of gout from poor and lower middleclass also. Gout is no more a disease of rich men and it can be seen among all the classes of the society.

As gout is due to increased uric acid level in blood and uric acid is produced from diet which contains high purine, it is only prudent to avoid purine rich diet completely or if it can not be avoided completely, the amount of intake of purine rich diet should be reduced as much as possible.

To avoid or reduce intake of purine rich diet it is important to have knowledge about the foods which contain high purine and food items with low purine content. The idea is to reduce purine rich food intake and increase low purine food intake which will hopefully reduce uric acid level in blood in combination with medication for gout.

Some of food items with high purine content and should be avoided:

• Meat (any type of meat, red or white meat), fish, poultry, sea foods especially shellfish such as crab, oyster, scallop, shrimp, lobster, and crayfish etc.
• Liver, kidney, brain, meat extracts, meat gravies etc.
• Fast growing vegetables such as asparagus, spinach, mushrooms, cauliflower, pulses (such as lentils, peas etc.).

Some low purine foods and to be taken liberally:

• Cheese and other dairy products, tart cherries, celery extracts (including celery seeds) etc.
• Fresh fruits and vegetables are low in purine content.
• Dietary supplements and carbonated beverages.

Some food items may not have high purine but can aggravate gout and may increase uric acid level indirectly also should be avoided such as alcoholic beverages.

Moderate intake of fruits and vegetables with high purine content is not associated with increased risk of gout nor they precipitate gout and can be consumed safely. There is no data suggests moderate intake of high purine fruits and vegetables is harmful in gout.

Varicose veins in rectum are called hemorrhoids. When a vein becomes elongated and tortuous it is said to have become varicose. The common anatomical sites where veins can become varicose are rectum, leg, abdomen, esophagus, scrotum and many other sites of the body. If you are suffering from hemorrhoids, it may become embarrassing at times and also troublesome, especially in long standing hemorrhoids.

Symptoms of hemorrhoids include bleeding (fresh) per anum, pain, itching, in severe and late cases prolapse of the varicose veins. Due to regular bleeding anemia may become evident, especially on long standing cases and if other cofactors for anemia exist, such as worm infestation, other bleeding sites in the gastrointestinal tract, poor dietary intake of iron etc.

Hemorrhoids should be treated promptly and appropriately upon diagnosis. It is difficult so say which the best hemorrhoid treatment method is. Generally the mode of treatment depends on many factors such as the type of treatment a patient wants, the age of the patient, treatment facilities available locally, the affordability of the patient, expertise of the treating physician etc.

Many patients choose to get hemorrhoids home treatment, at the comfort of home, especially if the hemorrhoids is not giving much trouble and at the initial stage of disease when it can be managed medically or at least it is possible to prevent further progression of the hemorrhoids. There are several methods which can help relieve symptoms and also prevent further progression of hemorrhoids, such as establishing normal and healthy bowel habits, use of non prescription pain relievers and other NSAIDs (non steroidal anti inflammatory drugs such as ibuprofen), application of ice locally several times a day etc. Normal and healthy bowel habit can be established by taking plenty of fiber rich foods such as fresh fruits and vegetables and whole cereals instead of taking refined and fast food.

If you are a user of contact lens, it is utmost important to take proper care of you contact lenses, otherwise your contact lens may give you more trouble than benefits. This article is not to train you how to take care of your contact lenses, but to inform you that taking care of your contact lens is of vital importance and to inform you how you can do it. You can use this information for taking care of contact lens.

The most important aspect of care for contact lens is to keep it safe, so that the lenses do not break or get damaged easily. For storage of contact lenses, always use lens cover which you get while purchasing contact lenses. Storing of contact lenses in lens cover will prevent the lenses from breakage or damage. So always store your contact lenses in lens cover which manufacturer recommend.

Next important aspect in care of contact lens is to keep contact lenses clean and sterile. Keep contact lens clean and sterile by use of a cleaning solution. There are several different cleaning solutions available in the market. Follow the advice of the contact lens manufacturer or consult your doctor, preferably eye surgeon for advice. Never hesitate to consult your eye surgeon if you have any doubt, because eyes are very precious. Regular cleaning of contact lenses is very important to prevent infection, which may be due to bacteria, fungus, ameba, etc. which form a thin layer over contact lens known as biofilm. Clean the contact lenses as per advice of your eye surgeon or the manufacturer of the contact lens.

If you are not comfortable or do not want to clean your contact lenses daily, you can go for disposable contact lenses. Disposable contact lenses are costlier than reusable contact lenses, but the chance of infection is also minimized by use of disposable contact lens.

If you have chosen to use contact lens instead of glasses or if you eye surgeon advised you to use contact lens it is vital to take precaution and take proper care of the eyes as well as contact lenses. You have to take care of your eyes and of course you have to take care of your contact lenses too. You should always ask your doctor about how to take care of the contact lenses and also what precautions you should take while using contact lens. If you have any doubt, you should clarify the doubt immediately from your doctor or health care provider.

The care for your eye starts with not wearing contact lens 24 hours a day. Wearing contact lens continuously may cause irritation to the cornea and also it may reduce oxygen supply to the cornea and cause problem. You should always remove contact lenses during sleeping (which may be night time sleep or day time nap). Wearing of contact lens, especially hard type of contact lens during sleep may cause injury to the eye. Use of soft type of contact lens may reduce the chance of injury due to wrong handling of the contact lenses.

Before you touch contact lenses (for wearing them) you should wash and rinse your hands thoroughly with soap and clean tape water. The soap should not contain any fragrance, or any allergen. The soap should not contain any antibacterial substance as it may destroy the normal bacterial flora of the eye due to improper washing or cleaning/rinsing of hands. The normal bacterial flora of the eye does not allow the pathogenic bacteria to colonize the eye. You should also wash your face (eyes) thoroughly with the same soap used for washing and rinsing your hands.

The technique of inserting/wearing contact lens should be learned and practiced properly as improper technique can cause injury to the eye, especially cornea. You should learn the technique from your health care provider and practice it before actually using contact lens. The technique of wearing hard type and soft type of contact lenses are slightly different.

Many smokers want to quit smoking, but unable to do so and are frustrated due to inability to quit smoking. Most of us (non smokers as well as smokers) are aware of the ill effects of cigarettes oh our health, but despite knowing the health disaster cigarettes can cause, many smokers are unable to quit smoking. Studies have revealed that quitting smoking is more difficult than quitting drinking alcohol, because smoking becomes part of behavior, every smoker has his/her own style of smoking and the style become part of his/her life and quitting smoking becomes a real challenge where many smoker fail to meet the challenge.

21^st century is an era of science and scientific development and science has come up with a solution to overcome smoking habit. Electronic cigarettes or e-cigarettes are the solution for quitting smoking easily and avoid the health hazards that traditional tobacco cigarettes cause. With electronic cigarettes the smoker gets the satisfaction of smoking without getting the harmful nicotine and several other harmful chemical which can cause serious health hazards like cancer.

Some positive aspects in favor of e-cigarettes in compare to traditional tobacco cigarettes are absence of several (as many as 400 harmful chemicals are said to be present in traditional tobacco cigarettes) harmful chemicals which are responsible for ill effects of traditional tobacco cigarettes on health, there is also no tar, smoke, carbon monoxide and other carcinogens in e-cigarettes.

Other than health benefits electronic cigarettes also have several other general advantages over traditional tobacco cigarettes like freedom of smoking electronic cigarettes in public places (whereas you can not smoke traditional tobacco cigarettes in public places), more convenient and have no bad odor of traditional tobacco cigarettes in electronic cigarettes. You may get complete satisfaction of smoking with electronic cigarettes without getting the health hazards, not to mention the lower cost of e-cigarettes in compare to traditional tobacco cigarettes.

Getting good night’s sleep is a problem for many of us these days of stressful, fast, modern and cosmopolitan life. Every people face some short duration of insomnia, which lasts for few days and generally is due to some precipitating factor like change of bed or sleeping environment, due to some ill health, jet lag or some other definable cause. If the precipitating factor is removed the problem of insomnia also disappears by itself as it has appeared.

But many people are not aware that many a times insomnia can be solved by non pharmacological (without use of any medication) measures like maintaining good sleep hygiene. Sleep hygiene is the environmental and behavioral factors that precede our sleep and by good sleep hygiene it means that these environmental and behavioral factors are so modified that these factors become conducive to good sleep.

What should be done for improving sleep hygiene?

For improving sleep hygiene and for good sleep the factors that can cause disturbance and less conducive for good sleep should be avoided or eliminated if possible. Avoid hot shower or beverages like tea before going to bed. Avoid drugs at night (if you are taking for some medical condition) that stimulate central nervous system. Avoid stressful work or heavy meal at night. If noise disturbs your sleep try to reduce or eliminate the source of noise. Do not bring office works to your home and try to finish them in office. If you can not sleep well in bright light, make it dim. Take warm shower in the evening, several hours before sleep and change to fresh cloths before sleep, which will help in getting good sleep.

There are many more ways to improve sleep hygiene, which can help in sleeping well. These can vary from person to person and every individual should try to improve sleep hygiene it his/her own way.

Nonscarring alopecias are Telogen effluvium, Alopecia areata, Traumatic alopecia, Tinea capitis, Androgenetic alopecia etc. The treatment of different types of alopecia is essentially different as the cause of alopecia is different.

Telogen effluvium:

This type of alopecia is generally reversible if the offending factor (high fever, severe infection) is removed. Initially patient is kept under observation and the offending agent identified. If it is due to drug, it should be stopped. If alopecia is due to underlying metabolic disease like hypothyroidism, hyperthyroidism etc. the disease should be appropriately treated.

Alopecia areata:

This type of alopecia is treated with topical anthralin, if it is not successful than glucocorticoids can be given intralesionally.

Traumatic alopecia:

This type of alopecia is generally due to use of curlers, rubber bands, braiding and exposure of hairs to heat or chemicals etc. For treatment of traumatic alopecia, the offending hairstyle should be discontinued. If the cause of alopecia is trichotillomania or pulling of hair, than psychotherapy may be required.

Tinea capitis:

This is due to fungal infection (Trichophyton tonsurans is the commonest fungus involved in this type of alopecia) and should be treated with appropriate antifungal antibiotics like griseofulvin or terbinafine along with 2.5% selenium sulfide or ketoconazole shampoo. Ideally other family members also should be examined for fungal infection.

Androgenetic alopecia:

This type of alopecia is male pattern of female pattern of alopecia. If no excess androgen can be demonstrated this type of alopecia (Androgenetic alopecia) is generally treated with minoxidil, finasteride or hair transplantation.

There are causes alopecia like drugs, genetical cause, systemic disease, primary cutaneous disorders etc. Some of the different causes and their descriptions are elaborated here. The most common causes of alopecia are telogen effluvium, androgenetic alopecia, alopecia areata, tinea capitis, and traumatic alopecia.

Telogen effluvium:

In telogen effluvium generally there is diffuse shedding of normal hairs, which generally follows major stressful situations like high fever, severe systemic infection or a change in hormones as seen in post partum. Generally no treatment is required as this condition is reversible and discontinuation of offending drug if it is due to drug will cause reversal of the alopecia. Underlying metabolic disorders like hypothyroidism, hyperthyroidism etc. should be excluded. The pathogenesis of telogen effluvium is synchronization of growth cycles of individual hairs due to stress (high fever, severe infection), which are normally asynchronous, which leads to large numbers of growing hairs (anagen phase) simultaneously entering dying or telogen phase.

Alopecia areata:

There are well-circumscribed, circular areas of hair loss, 2 to 5 cm in diameter. In severe cases there is merging of two or more such areas and/or hairless spots in other hair-bearing surfaces of the body. Pitting of nails can also be seen. Treatment of alopecia areata is by topical anthralin or glucocorticoids directly into the lesion, or topical contact sensitizers.

Androgenetic alopecia:

Androgenetic alopecia may be male pattern or female pattern. There is recession of the anterior scalp line in men (rarely in some women). There is miniaturization of hairs along the midline of the scalp. Treatment of androgenetic alopecia if no hyperandrogen state is found is with topical minoxidil, finasterid or hair transplant. Pathogenesis is due to increased sensitivity to the effects of testosterone in the affected hairs.

Tinea capitis:

Tinea capitis a fungal infection (commonly dermatophytes Trichophyton tonsurans is involved) of scalp can also cause alopecia. Clinical manifestation can vary from scaling with minimal hair loss to discrete patches with broken hairs to boggy plaque. The treatment is by oral griseofulvin or terbinafine plus 2.5% selenium sulfide or ketoconazole shampoo. Other members of the family should be examined and treated the same way if fond infected.

Traumatic alopecia:

The causes of traumatic alopecia are traction with curlers, rubber bands, braiding, trichotillomania (mechanical pulling), heat or chemical exposure as used for hair straighteners. The treatment is discontinuation of hairstyle, avoidance of heat or chemicals (if used) etc. Trichotillomania may require psychotherapy after confirming diagnosis with biopsy or hair clipping and observation of shaved hairs.