Osteoporosis- Weak Bones- Diagnosis, Symptoms, Treatment, Fall

$Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones). Osteoporosis is a “silent” disease because you typically do not have symptoms, and you may not even know you have the disease until you break a bone. Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist. However, you can take steps to help prevent the disease and fractures by: • Staying physically active by participating in weight-bearing exercises such as walking. • Drinking alcohol in moderation. • Quitting smoking, or not starting if you don’t smoke. • Taking your medications, if prescribed, which can help prevent fractures in people who have osteoporosis. • Eating a nutritious diet rich in calcium and vitamin D to help maintain good bone health. Who Gets Osteoporosis?$

Overview of Osteoporosis- Weak Bones

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).

Osteoporosis is a “silent” disease because you typically do not have symptoms, and you may not even know you have the disease until you break a bone. Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist.

However, you can take steps to help prevent the disease and fractures by:

Staying physically active by participating in weight-bearing exercises such as walking.
Drinking alcohol in moderation.
Quitting smoking, or not starting if you don’t smoke.
Taking your medications, if prescribed, which can help prevent fractures in people who have osteoporosis.
Eating a nutritious diet rich in calcium and vitamin D to help maintain good bone health.

Who Gets Osteoporosis?

Osteoporosis affects women and men of all races and ethnic groups. Osteoporosis can occur at any age, although the risk for developing the disease increases as you get older. For many women, the disease begins to develop a year or two before menopause. Other factors to consider include:

Osteoporosis is most common in non-Hispanic white women and Asian women.
African American and Hispanic women have a lower risk of developing osteoporosis, but they are still at significant risk.
Among men, osteoporosis is more common in non-Hispanic whites.

Certain medications, such as some cancer medications and glucocorticoid steroids, may increase the risk of developing osteoporosis.

Because more women get osteoporosis than men, many men think they are not at risk for the disease. However, both older men and women from all backgrounds are at risk for osteoporosis.

Some children and teens develop a rare form of idiopathic juvenile osteoporosis. Doctors do not know the cause; however, most children recover without treatment.

Symptoms of Osteoporosis

Symptoms of Osteoporosis

Osteoporosis is called a “silent” disease” because there are typically no symptoms until a bone is broken or one or more vertebrae collapse (fracture). Symptoms of vertebral fracture include severe back pain, loss of height, or spine malformations such as a stooped or hunched posture (kyphosis).

Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of:

Minor falls, such as a fall from standing height that would not normally cause a break in a healthy bone.
Normal stresses such as bending, lifting, or even coughing.

Causes of Osteoporosis

Osteoporosis occurs when too much bone mass is lost and changes occur in the structure of bone tissue. Certain risk factors may lead to the development of osteoporosis or can increase the likelihood that you will develop the disease.

Many people with osteoporosis have several risk factors, but others who develop osteoporosis may not have any specific risk factors. There are some risk factors that you cannot change, and others that you may be able to change. However, by understanding these factors, you may be able to prevent the disease and fractures.

Factors that may increase your risk for osteoporosis include:

Sex. Your chances of developing osteoporosis are greater if you are a woman. Women have lower peak bone mass and smaller bones than men. However, men are still at risk, especially after the age of 70.
Age. As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.
Body size. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men.
Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.
Family history. Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
Changes to hormones. Low levels of certain hormones can increase your chances of developing osteoporosis. For example:

Low estrogen levels in women after menopause.
Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.
Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis. However, the gradual decrease of testosterone with aging is probably not a major reason for loss of bone.
Diet. Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.

Other medical conditions. Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.
Medications. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:

Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.
Antiepileptic medicines, which treat seizures and other neurological disorders.
Cancer medications, which use hormones to treat breast and prostate cancer.
Proton pump inhibitors, which lower stomach acid.
Selective serotonin reuptake inhibitors, which treat depression and anxiety.
Thiazolidinediones, which treat type II diabetes.
Lifestyle. A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:

Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.
Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.
Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.

Diagnosis of Osteoporosis

Doctors usually diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for:

Women over age 65.
Women of any age who have factors that increase the chance of developing osteoporosis.

Due to a lack of available evidence, the Task Force did not make recommendations regarding osteoporosis screening in men.

During your visit with your doctor, remember to report:

Any previous fractures.
Your lifestyle habits, including diet, exercise, alcohol use, and smoking history.
Current or past medical conditions and medications that could contribute to low bone mass and increased fracture risk.
Your family history of osteoporosis and other diseases.
For women, your menstrual history.

The doctor may also perform a physical exam that includes checking for:

Loss of height and weight.
Changes in posture.
Balance and gait (the way you walk).
Muscle strength, such as your ability to stand from sitting without using your arms).

In addition, your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone, usually your spine and hip. BMD testing can be used to:

Diagnose osteoporosis.
Detect low bone density before osteoporosis develops.
Help predict your risk of future fractures.
Monitor the effectiveness of ongoing treatment for osteoporosis.

The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). It is a quick, painless, and noninvasive test. DXA uses low levels of x-rays as it passes a scanner over your body while you lie on a cushioned table. The test measures the BMD of your skeleton and at various sites that are prone to fracture, such as the hip and spine. Bone density measurement by DXA at the hip and spine is generally considered the most reliable way to diagnose osteoporosis and predict fracture risk.

Some people have a peripheral DXA, which measures bone density in the wrist and heel. This type of DXA is portable and may make it easier for screening. However, the results may not help doctors predict your risk for fractures in the future or monitor the effects of your medications on the disease.

Your doctor will compare your BMD test results to the average bone density of young, healthy people and to the average bone density of other people of your age, sex, and race. If your test results show that you have osteoporosis, or if your bone density is below a certain level and you have other risk factors for fractures, your doctor may recommend both lifestyle approaches to promote bone health and medications to lower your chance of breaking a bone.

Sometimes, your doctor may recommend a quantitative ultrasound (QUS) of the heel. This is a test that evaluates bone but does not measure BMD. If the QUS indicates that you have bone loss, you will still need a DXA test to diagnose bone loss and osteoporosis.

Treatment of Osteoporosis

The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your health care provider may recommend:

Proper nutrition.
Lifestyle changes.
Exercise.
Fall prevention to help prevent fractures.
Medications.

People who develop osteoporosis from another condition should work with their health care provider to identify and treat the underlying cause. For example, if you take a medication that causes bone loss, your doctor may lower the dose of that medication

or switch you to another medication. If you have a disease that requires long-term glucocorticoid therapy, such as rheumatoid arthritis or chronic lung disease, you can also take certain medications approved for the prevention or treatment of osteoporosis associated with aging or menopause.

Nutrition

An important part of treating osteoporosis is eating a healthy, balanced diet, which includes:

Plenty of fruits and vegetables.
An appropriate amount of calories for your age, height, and weight. Your health care provider or doctor can help you determine the amount of calories you need each day to maintain a healthy weight.
Foods and liquids that include calcium, vitamin D, and protein. These help minimize bone loss and maintain overall health. However, it’s important to eat a diet rich in all nutrients to help protect and maintain bone health.

Calcium and Vitamin D

Calcium and vitamin D are important nutrients for preventing osteoporosis and helping bones reach peak bone mass. If you do not take in enough calcium, the body takes it from the bones, which can lead to bone loss. This can make bones weak and thin, leading to osteoporosis.

Good sources of calcium include:

Low-fat dairy products.
Dark green leafy vegetables, such as bok choy, collards, and turnip greens.
Broccoli.
Sardines and salmon with bones.
Calcium-fortified foods such as soymilk, tofu, orange juice, cereals, and breads.

Vitamin D is necessary for the absorption of calcium from the intestine. It is made in the skin after exposure to sunlight. Some foods naturally contain enough vitamin D, including fatty fish, fish oils, egg yolks, and liver. Other foods that are fortified with vitamin D are a major source of the mineral, including milk and cereals.

The chart below shows how much calcium and vitamin D you need each day.

Recommended Calcium and Vitamin D Intakes
Life-stage group	Calcium mg/day	Vitamin D (IU/day)
Infants 0 to 6 months	200	400
Infants 6 to 12 months	260	400
1 to 3 years old	700	600
4 to 8 years old	1,000	600
9 to 13 years old	1,300	600
14 to 18 years old	1,300	600
19 to 30 years old	1,000	600
31 to 50 years old	1,000	600
51- to 70-year-old males	1,000	600
51- to 70-year-old females	1,200	600
>70 years old	1,200	800
14 to 18 years old, pregnant/lactating	1,300	600
19 to 50 years old, pregnant/lactating	1,000	600

Definitions: mg = milligrams; IU = International Units

Source: National Institutes of Health, Office of Dietary Supplements, November 2018

If you have trouble getting enough calcium and vitamin D in your diet, you may need to take supplements. Talk to your health care provider about the type and amount of calcium and vitamin D supplements you should take. Your doctor may check your blood levels of vitamin D and recommend a specific amount.

Lifestyle

In addition to a healthy diet, a healthy lifestyle is important for optimizing bone health. You should:

Avoid secondhand smoke, and if you smoke, quit.
Drink alcohol in moderation, no more than one drink a day for women and no more than two drinks a day for men.
Visit your doctor for regular checkups and ask about any factors that may affect your bone health or increase your chance of falling, such as medications or other medical conditions.

Exercise

Exercise is an important part of an osteoporosis treatment program. Research shows that the best physical activities for bone health include strength training or resistance training. Because bone is living tissue, during childhood and adulthood, exercise can make bones stronger. However, for older adults, exercise no longer increases bone mass. Instead, regular exercise can help older adults:

Build muscle mass and strength and improve coordination and balance. This can help lower your chance of falling.
Improve daily function and delay loss of independence.

Although exercise is beneficial for people with osteoporosis, it should not put any sudden or excessive strain on your bones. If you have osteoporosis, you should avoid high-impact exercise. To help prevent injury and fractures, a physical therapist or rehabilitation medicine specialist can:

Recommend specific exercises to strengthen and support your back.
Teach you safe ways of moving and carrying out daily activities.
Recommend an exercise program that is tailored to your circumstances.

Exercise specialists, such as exercise physiologists, may also help you develop a safe and effective exercise program.

Medications

Your doctor may prescribe medications for osteoporosis. The U.S. Food and Drug Administration (FDA) has approved the following medications for the prevention or treatment of osteoporosis:

Your health care provider will discuss the best option for you, taking into consideration your age, sex, general health, and the amount of bone you have lost. No matter which medications you take for osteoporosis, it is still important that you get the recommended amounts of calcium and vitamin D. Also, exercising and maintaining other aspects of a healthy lifestyle are important.

Medications can cause side effects. If you have questions about your medications, talk to your doctor or pharmacist.

Bisphosphonates. Several bisphosphonates are approved to help preserve bone density and strength and to treat osteoporosis. This type of drug works by slowing down bone loss, which can lower the chance of fractures.
Calcitonin. This medication is made from a hormone from the thyroid gland and is approved for the treatment of osteoporosis in postmenopausal women who cannot take or tolerate other medications for osteoporosis.
Estrogen agonist/antagonist. An estrogen agonist/antagonist, also known as a selective estrogen receptor modulator (SERM), and tissue-selective estrogen complex (TSEC), are both approved to treat and prevent osteoporosis in postmenopausal women. They are not estrogen, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues. This action helps improve bone density, lowering the risk for some fractures.

Estrogen and hormone therapy. Estrogen and combined estrogen and progestin (hormone therapy) are approved to prevent osteoporosis and fractures in postmenopausal women. Because of potential side effects, researchers recommend that women use hormone therapy at the lowest dose, and for the shortest time, and if ot

other medications are not helping. It is important to carefully consider the risks and benefits of estrogen and hormone therapy for the treatment of osteoporosis.
Parathyroid hormone (PTH) analog and parathyroid hormone related-protein (PTHrP) analog. PTH is a form of human parathyroid hormone that increases bone mass and is approved for postmenopausal women and men with osteoporosis who are at high risk for fracture. PTHrP is a medication that is also a form of parathyroid hormone. It is an injection and is usually prescribed for postmenopausal women who have a history of fractures.
RANK ligand (RANKL) inhibitor. This is an inhibitor that helps slow down bone loss and is approved to treat osteoporosis in:

Postmenopausal women or men with osteoporosis who are at high risk for fracture.
Men who have bone loss and are being treated for prostate cancer with medications that cause bone loss.
Women who have bone loss and are being treated for breast cancer with medications that cause bone loss.
Men and women who do not respond to other types of osteoporosis treatment.
Sclerostin inhibitor. This is a medication that treats osteoporosis by blocking the effect of a protein, and helps the body increase new bone formation as well as slows down bone loss.

Who Treats Osteoporosis?

Health care providers who treat osteoporosis include:

Endocrinologists, who treat problems related to the glands and hormones.
Geriatricians, who specialize in caring for all aspects of health in older people.
Gynecologists, who specialize in diagnosing and treating conditions of the reproductive system of women.
Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
Physiatrists (doctors specializing in physical medicine and rehabilitation).
Physical therapists, who help to improve joint function.
Primary care providers, such as a family physician or internal medicine specialist.
Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.

Living With Osteoporosis

In addition to the treatments your doctor recommends, the following tips can help you manage and live with osteoporosis, prevent fractures, and prevent falls.

Preventing fractures is important when you have osteoporosis because fractures can cause other medical problems and take away your independence. Exercise can help prevent fractures that occur as a result of falling and improve bone strength, when your health care provider tailors a program to your individual need. If you have osteoporosis or bone loss, it is important to talk to your doctor or physical therapist before beginning any exercise program.

In addition, preventing falls helps prevent fractures. Falls increase your likelihood of fracturing a bone in the hip, wrist, spine, or other part of the skeleton. Taking steps to prevent falls both inside and outside of the house can help prevent fractures.

Some factors that may contribute to falls include:

Loss of muscle mass.
Illnesses that impair your mental or physical functioning, such as low blood pressure or dementia.
Use of four or more prescription medications.
Poor vision.
Poor balance.
Certain diseases that affect how you walk.
Alcohol use.
Side effects of some medications, such as:

Sedatives or tranquilizers.
Sleeping pills.
Antidepressants.
Anticonvulsants.
Muscle relaxants.
Heart medicines.
Blood pressure pills.
Diuretics.

If you have osteoporosis, it is important to be aware of any physical changes you may experience that affect your balance or gait and to discuss these changes with your doctor or other health care provider. It is also important to have regular checkups and tell your doctor if you have had problems with falling.

Falls can also be caused by factors around you that create unsafe conditions. Here are some tips to help prevent falls outdoors and when you are away from home:

Use a cane or walker for added stability.
Wear shoes that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
Walk on grass when sidewalks are slippery; in winter, put salt or kitty litter on icy sidewalks.
Stop at curbs and check their height before stepping up or down.

Some ways to help prevent falls indoors are:

Keep rooms free of clutter, especially on floors. Avoid running electrical cords across walking areas.
Use plastic or carpet runners on slippery floors.
Wear shoes, even when indoors, that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
If you have a pet, be mindful of where they are to avoid tripping over them.
Do not walk in socks, stockings, or slippers.
Be careful on highly polished floors that are slick and dangerous, especially when wet, and walk on plastic or carpet runners when possible.
Be sure carpets and area rugs have skid-proof backing or are tacked to the floor. Use double-stick tape to keep rugs from slipping.
Be sure stairs are well lit and have rails on both sides.
Install grab bars on bathroom walls near the tub, shower, and toilet.
Use a rubber bathmat or slip-proof seat in the shower or tub.
Improve lighting in your home. Use nightlights or keep a flashlight next to your bed in case you need to get up at night. Install ceiling fixtures or lamps that can be turned on by a switch near the room’s entrance.
Use a sturdy stepstool with a handrail and wide steps.
Add more lights in rooms.
Keep a cordless phone or cell phone with you so that you don’t have to rush to the phone when it rings. In addition, if you fall, you can call for help.
Consider having a personal emergency-response system; you can use it to call for help if you fall.

Other tips that can help you manage your osteoporosis include:

Talking with other people who have osteoporosis.
Reaching out to family and friends for support.
Learning about the disorder and treatments to help you make decisions about your care.

he above article is for information purposes only and is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.

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June 8, 2022 0

Obeisance for Dr Archana Sharma: Bigger Role for Doctors’ Associations

The painful incident of Dr Archana Sharma’s Suicide unmasks the everyday struggle of the doctors in the present era. Her supreme sacrifice depicts the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death is the result of the apathy of fair justice that eludes medical community. Sadly, the society is unable to realize its loss. Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.

Dr Archana Sharma Suicide

It was an incident that was enough to jolt doctors’ and medical associations out of their deep slumber against the everyday sufferings of their members. Protecting and supporting the suffering members against physical and legal assaults should be the need of the hour. But sadly, it was not enough to wake them up. After few days of token protests, everything came back to routine. Unfortunately Doctors’ associations have limited their role merely to social gatherings with some token academics. They have not risen to the real life problems of doctors like goonism, blackmail, physical and legal assaults. Doctors as individuals remain vulnerable to these issues and always remain at receiving end of the stick. In this era, doctors’ associations need to play a bigger role especially in cases of medico-legal suits against doctors; to support the sufferers. As cases of medical negligence may be circumstantial incidents and not real mistakes, courts may not be able to deliver justice to doctors many times. A concern is that in case of poor outcome and case goes to courts, there is an indirect perverse incentive to deliver a guilty verdict against the doctor as a person, who is responsible for life and death.

Failure of Doctors’ and Medical associations to rise to the occasion even in such a case of blatant cruelty will be a real injustice to DR Archana Sharma.

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Thyroid gland- Hyperthyroidism & Hypothyroidism, Symptoms, Treatment

Thyroid gland creates and produces hormones that play a role in many different systems throughout your body. When your thyroid makes either too much or too little of these important hormones, it’s called a thyroid disease. There are several different types of thyroid disease, including hyperthyroidism, hypothyroidism, thyroiditis and Hashimoto’s thyroiditis.

What is the thyroid?

The thyroid gland is a small organ that’s located in the front of the neck, wrapped around the windpipe (trachea). It’s shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body.

When your thyroid doesn’t work properly, it can impact your entire body. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, it’s called hypothyroidism. Both conditions are serious and need to be treated by your healthcare provider.

What does the thyroid do? Cleveland clinic

Your thyroid has an important job to do within your body — releasing and controlling thyroid hormones that control metabolism. Metabolism is a process where the food you take into your body is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly. Think of your metabolism as a generator. It takes in raw energy and uses it to power something bigger.

The thyroid controls your metabolism with a few specific hormones — T4 (thyroxine, contains four iodide atoms) and T3 (triiodothyronine, contains three iodide atoms). These two hormones are created by the thyroid and they tell the body’s cells how much energy to use. When your thyroid works properly, it will maintain the right amount of hormones to keep your metabolism working at the right rate. As the hormones are used, the thyroid creates replacements.

This is all supervised by something called the pituitary gland. Located in the center of the skull, below your brain, the pituitary gland monitors and controls the amount of thyroid hormones in your bloodstream. When the pituitary gland senses a lack of thyroid hormones or a high level of hormones in your body, it will adjust the amounts with its own hormone. This hormone is called thyroid stimulating hormone (TSH). The TSH will be sent to the thyroid and it will tell the thyroid what needs to be done to get the body back to normal.

What is thyroid disease?

Thyroid disease is a general term for a medical condition that keeps your thyroid from making the right amount of hormones. Your thyroid typically makes hormones that keep your body functioning normally. When the thyroid makes too much thyroid hormone, your body uses energy too quickly. This is called hyperthyroidism. Using energy too quickly will do more than make you tired — it can make your heart beat faster, cause you to lose weight without trying and even make you feel nervous. On the flip-side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.

These two main disorders can be caused by a variety of conditions. They can also be passed down through families (inherited).

Who is affected by thyroid disease?

Thyroid disease can affect anyone — men, women, infants, teenagers and the elderly. It can be present at birth (typically hypothyroidism) and it can develop as you age (often after menopause in women).

Thyroid disease is very common, with an estimated 20 million people in the Unites States having some type of thyroid disorder. A woman is about five to eight times more likely to be diagnosed with a thyroid condition than a man.

You may be at a higher risk of developing a thyroid disease if you:

Have a family history of thyroid disease.
Have a medical condition (these can include pernicious anemia, type 1 diabetes, primary adrenal insufficiency, lupus, rheumatoid arthritis, Sjögren’s syndrome and Turner syndrome).
Take a medication that’s high in iodine (amiodarone).
Are older than 60, especially in women.
Have had treatment for a past thyroid condition or cancer (thyroidectomy or radiation).

SYMPTOMS AND CAUSES

What causes thyroid disease?

The two main types of thyroid disease are hypothyroidism and hyperthyroidism. Both conditions can be caused by other diseases that impact the way the thyroid gland works.

Conditions that can cause hypothyroidism include:

Thyroiditis: This condition is an inflammation (swelling) of the thyroid gland. Thyroiditis can lower the amount of hormones your thyroid produces.
Hashimoto’s thyroiditis: A painless disease, Hashimoto’s thyroiditis is an autoimmune condition where the body’s cells attack and damage the thyroid. This is an inherited condition.
Postpartum thyroiditis: This condition occurs in 5% to 9% of women after childbirth. It’s usually a temporary condition.
Iodine deficiency: Iodine is used by the thyroid to produce hormones. An iodine deficiency is an issue that affects several million people around the world..
A non-functioning thyroid gland: Sometimes, the thyroid gland doesn’t work correctly from birth. This affects about 1 in 4,000 newborns. If left untreated, the child could have both physical and mental issues in the future. All newborns are given a screening blood test in the hospital to check their thyroid function.

Conditions that can cause hyperthyroidism include:

Graves’ disease: In this condition the entire thyroid gland might be overactive and produce too much hormone. This problem is also called diffuse toxic goiter (enlarged thyroid gland).
Nodules: Hyperthyroidism can be caused by nodules that are overactive within the thyroid. A single nodule is called toxic autonomously functioning thyroid nodule, while a gland with several nodules is called a toxic multi-nodular goiter.
Thyroiditis: This disorder can be either painful or not felt at all. In thyroiditis, the thyroid releases hormones that were stored there. This can last for a few weeks or months.
Excessive iodine: When you have too much iodine (the mineral that is used to make thyroid hormones) in your body, the thyroid makes more thyroid hormones than it needs. Excessive iodine can be found in some medications (amiodarone, a heart medication) and cough syrups.

Is there a higher risk of developing thyroid disease if I have diabetes?

If you have diabetes, you’re at a higher risk of developing a thyroid disease than people without diabetes. Type 1 diabetes is an autoimmune disorder. If you already have one autoimmune disorder, you are more likely to develop another one.

For people with type 2 diabetes, the risk is lower, but still there. If you have type 2 diabetes, you’re more likely to develop a thyroid disease later in life.

Regular testing is recommended to check for thyroid issues. Those with type 1 diabetes may be tested more often — immediately after diagnosis and then every year or so — than people with type 2 diabetes. There isn’t a regular schedule for testing if you have type 2 diabetes, however your healthcare provider may suggest a schedule for testing over time.

If you have diabetes and get a positive thyroid test, there are a few things to you can do to help feel the best possible. These tips include:

Getting enough sleep.
Exercising regularly.
Watching your diet.
Taking all of your medications as directed.
Getting tested regularly as directed by your healthcare provider.

What common symptoms can happen with thyroid disease?

There are a variety of symptoms you could experience if you have a thyroid disease. Unfortunately, symptoms of a thyroid condition are often very similar to the signs of other medical conditions and stages of life. This can make it difficult to know if your symptoms are related to a thyroid issue or something else entirely.

For the most part, the symptoms of thyroid disease can be divided into two groups — those related to having too much thyroid hormone (hyperthyroidism) and those related to having too little thyroid hormone (hypothyroidism).

Symptoms of an overactive thyroid (hyperthyroidism) can include:

Experiencing anxiety, irritability and nervousness.
Having trouble sleeping.
Losing weight.
Having an enlarged thyroid gland or a goiter.
Having muscle weakness and tremors.
Experiencing irregular menstrual periods or having your menstrual cycle stop.
Feeling sensitive to heat.
Having vision problems or eye irritation.

Symptoms of an underactive thyroid (hypothyroidism) can include:

Feeling tired (fatigue).
Gaining weight.
Experiencing forgetfulness.
Having frequent and heavy menstrual periods.
Having dry and coarse hair.
Having a hoarse voice.
Experiencing an intolerance to cold temperatures.

Can thyroid issues make me lose my hair?

Hair loss is a symptom of thyroid disease, particularly hypothyroidism. If you start to experience hair loss and are concerned about it, talk to your healthcare provider.

Can thyroid issues cause seizures?

In most cases, thyroid issues don’t cause seizures. However, if you have a very severe cases of hypothyroidism that hasn’t been diagnosed or treated, your risk of developing low serum sodium goes up. This could lead to seizures.

DIAGNOSIS AND TESTS

How to do a self-exam of your thyroid.

How is thyroid disease diagnosed?

Sometimes, thyroid disease can be difficult to diagnose because the symptoms are easily confused with those of other conditions. You may experience similar symptoms when you are pregnant or aging and you would when developing a thyroid disease. Fortunately, there are tests that can help determine if your symptoms are being caused by a thyroid issue. These tests include:

Blood tests.
Imaging tests.
Physical exams.

Blood tests

One of the most definitive ways to diagnose a thyroid problem is through blood tests. Thyroid blood tests are used to tell if your thyroid gland is functioning properly by measuring the amount of thyroid hormones in your blood. These tests are done by taking blood from a vein in your arm. Thyroid blood tests are used to see if you have:

Hyperthyroidism.
Hypothyroidism.

Thyroid blood tests are used to diagnose thyroid disorders associated with hyper- or hypothyroidism. These include:

Thyroiditis.
Graves’ disease.
Hashimoto’s disease.
Goiter.
Thyroid nodule.
Thyroid cancer.

The specific blood tests that will be done to test your thyroid can include:

Thyroid-stimulating hormone (TSH) is produced in the pituitary gland and regulates the balance of thyroid hormones — including T4 and T3 — in the bloodstream. This is usually the first test your provider will do to check for thyroid hormone imbalance. Most of the time, thyroid hormone deficiency (hypothyroidism) is associated with an elevated TSH level, while thyroid hormone excess (hyperthyroidism) is associated with a low TSH level. If TSH is abnormal, measurement of thyroid hormones directly, including thyroxine (T4) and triiodothyronine (T3) may be done to further evaluate the problem. Normal TSH range for an adult: 0.40 – 4.50 mIU/mL (milli-international units per liter of blood).
T4: Thyroxine tests for hypothyroidism and hyperthyroidism, and used to monitor treatment of thyroid disorders. Low T4 is seen with hypothyroidism, whereas high T4 levels may indicate hyperthyroidism. Normal T4 range for an adult: 5.0 – 11.0 ug/dL (micrograms per deciliter of blood).
FT4: Free T4 or free thyroxine is a method of measuring T4 that eliminates the effect of proteins that naturally bind T4 and may prevent accurate measurement. Normal FT4 range for an adult: 0.9 – 1.7 ng/dL (nanograms per deciliter of blood)
T3: Triiodothyronine tests help diagnose hyperthyroidism or to show the severity of hyperthyroidism. Low T3 levels can be observed in hypothyroidism, but more often this test is useful in the diagnosis and management of hyperthyroidism, where T3 levels are elevated. Normal T3 range: 100 – 200 ng/dL (nanograms per deciliter of blood).
FT3: Free T3 or free triiodothyronine is a method of measuring T3 that eliminates the effect of proteins that naturally bind T3 and may prevent accurate measurement. Normal FT3 range: 2.3 – 4.1 pg/mL (picograms per milliliter of blood)

These tests alone aren’t meant to diagnose any illness but may prompt your healthcare provider to do additional testing to evaluate for a possible thyroid disorder.

Additional blood tests might include:

Thyroid antibodies: These tests help identify different types of autoimmune thyroid conditions. Common thyroid antibody tests include microsomal antibodies (also known as thyroid peroxidase antibodies or TPO antibodies), thyroglobulin antibodies (also known as TG antibodies), and thyroid receptor antibodies (includes thyroid stimulating immunoglobulins [TSI] and thyroid blocking immunoglobulins [TBI]).
Calcitonin: This test is used to diagnose C-cell hyperplasia and medullary thyroid cancer, both of which are rare thyroid disorders.
Thyroglobulin: This test is used to diagnose thyroiditis (thyroid inflammation) and to monitor treatment of thyroid cancer.

Talk to your healthcare provider about the ranges for these thyroid blood tests. Your ranges might not be the same as someone else’s. That’s often alright. If you have any concerns or worries about your blood test results, talk to your provider.

Imaging tests

In many cases, taking a look at the thyroid itself can answer a lot of questions. Your healthcare provider might do an imaging test called a thyroid scan. This allows your provider to look at your thyroid to check for an increased size, shape or growths (nodules).

Your provider could also use an imaging test called an ultrasound. This is a diagnostic procedure that transmits high-frequency sound waves, inaudible to the human ear, through body tissues. The echoes are recorded and transformed into video or photographic images. You may think of ultrasounds related to pregnancy, but they are used to diagnose many different issues within your body. Unlike X-rays, ultrasounds do not use radiation.

There’s typically little or no preparation before your ultrasound. You don’t need to change your diet beforehand or fast. During the test, you’ll lie flat on a padded examining table with your head positioned on a pillow so that your head is tilted back. A warm, water-soluble gel is applied to the skin over the area that’s being examined. This gel won’t hurt your skin or stain your clothes. Your healthcare provider will then apply a probe to your neck and gently move it around to see all parts of the thyroid.

An ultrasound typically takes about 20 to 30 minutes.

Physical exam

Another way to quickly check the thyroid is with a physical exam in your healthcare provider’s office. This is a very simple and painless test where your provider feels your neck for any growths or enlargement of the thyroid.

MANAGEMENT AND TREATMENT

How is thyroid disease treated?

Your healthcare provider’s goal is to return your thyroid hormone levels to normal. This can be done in a variety of ways and each specific treatment will depend on the cause of your thyroid condition.

If you have high levels of thyroid hormones (hyperthyroidism), treatment options can include:

Anti-thyroid drugs (methimazole and propylthioracil): These are medications that stop your thyroid from making hormones.
Radioactive iodine: This treatment damages the cells of your thyroid, preventing it from making high levels of thyroid hormones.
Beta blockers: These medications don’t change the amount of hormones in your body, but they help control your symptoms.
Surgery: A more permanent form of treatment, your healthcare provider may surgically remove your thyroid (thyroidectomy). This will stop it from creating hormones. However, you will need to take thyroid replacement hormones for the rest of your life.

If you have low levels of thyroid hormones (hypothyroidism), the main treatment option is:

Thyroid replacement medication: This drug is a synthetic (man-made) way to add thyroid hormones back into your body. One drug that’s commonly used is called levothyroxine. By using a medication, you can control thyroid disease and live a normal life.

Are there different types of thyroid removal surgery?

If your healthcare provider determines that your thyroid needs to be removed, there are a couple of ways that can be done. Your thyroid may need to be completely removed or just partially. This will depend on the severity of your condition. Also, if your thyroid is very big (enlarged) or has a lot of growths on it, that could prevent you from being eligible for some types of surgery.

The surgery to remove your thyroid is called a thyroidectomy. There are two main ways this surgery can be done:

With an incision on the front of your neck.
With an incision in your armpit.

The incision on the front of your neck is more of the traditional version of a thyroidectomy. It allows your surgeon to go straight in and remove the thyroid. In many cases, this might be your best option. You may need this approach if your thyroid is particularly big or has a lot of larger nodules.

Alternatively, there is a version of the thyroid removal surgery where your surgeon makes an incision in your armpit and then creates a tunnel to your thyroid. This tunnel is made with a special tool called an elevated retractor. It creates an opening that connects the incision in your armpit with your neck. The surgeon will use a robotic arm that will move through the tunnel to get to the thyroid. Once there, it can remove the thyroid back through the tunnel and out of the incision in your armpit.

This procedure is often called scarless because the incision is under your armpit and out of sight. However, it’s more complicated for the surgeon and the tunnel is more invasive for you. You may not be a candidate for this type of thyroid removal if you:

Are not at a healthy body weight.
Have large thyroid nodules.
Have a condition like thyroiditis or Graves’s disease.

Talk to your doctor about all of your treatment options and the best type of surgery for you.

How long does it take to recover from thyroid surgery (thyroidectomy)?

It will take your body a few weeks to recover after your thyroid is surgically removed (thyroidectomy). During this time you should avoid a few things, including:

Submerging your incision under water.
Lifting an object that’s heavier than 15 pounds.
Doing more than light exercise.

This generally lasts for about two weeks. After that, you can return to your normal activities.

OUTLOOK / PROGNOSIS

How long after my thyroid is removed will my tiredness go away?

Typically, you will be given medication to help with your symptoms right after surgery. Your body actually has thyroid hormone still circulating throughout it, even after the thyroid has been removed. The hormones can still be in your body for two to three weeks. Medication will reintroduce new hormones into your body after the thyroid has been removed. If you are still feeling tired after surgery, remember that this can be a normal part of recovering from any type of surgery. It takes time for your body to heal. Talk to your healthcare provider if you are still experiencing fatigue and other symptoms of thyroid disease after surgery.

If part of my thyroid is surgically removed, will the other part be able to make enough thyroid hormones to keep me off of medication?

Sometimes, your surgeon may be able to remove part of your thyroid and leave the other part so that it can continue to create and release thyroid hormones. This is most likely in situations where you have a nodule that’s causing your thyroid problem. About 75% of people who have only one side of the thyroid removed are able to make enough thyroid hormone after surgery without hormone replacement therapy.

Should I exercise if I have a thyroid disease?

Regular exercise is an important part of a healthy lifestyle. You do not need to change your exercise routine if you have a thyroid disease. Exercise does not drain your body’s thyroid hormones and it shouldn’t hurt you to exercise. It is important to talk to your healthcare provider before you start a new exercise routine to make sure that it’s a good fit for you.

Can I live a normal life with a thyroid disease?

A thyroid disease is often a life-long medical condition that you will need to manage constantly. This often involves a daily medication. Your healthcare provider will monitor your treatments and make adjustments over time. However, you can usually live a normal life with a thyroid disease. It may take some time to find the right treatment option for you and control your hormone levels, but then people with these types of conditions can usually live life without many restrictions.

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June 5, 2022 0

Burnout at Workplace: How to Recognize and What to do

Burnout, as it is defined, is not a medical condition — it’s “a manifestation of chronic unmitigated stress.” The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy.

Dr. Jessi Gold, a psychiatrist at Washington University in St. Louis, knows she’s edging toward burnout when she wakes up, feels instantly angry at her email inbox and doesn’t want to get out of bed. It’s perhaps not surprising that a mental health professional who is trying to stem the rising tide of burnout could burn out sometimes, too. After all, the phenomenon has practically become ubiquitous in our culture.

In a 2021 survey of 1,500 U.S. workers, more than half said they were feeling burned out as a result of their job demands, and a whopping 4.3 million Americans quit their jobs in December in what has come to be known as the “Great Resignation.” When people think of burnout, mental and emotional symptoms such as feelings of helplessness and cynicism often come to mind. But burnout can lead to physical symptoms as well, and experts say it can be wise to look out for the signs and take steps when you notice them.

Burnout, as it is defined, is not a medical condition — it’s “a manifestation of chronic unmitigated stress,” explained Dr. Lotte Dyrbye, a physician scientist who studies burnout at the Mayo Clinic. The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy.

“You start not functioning as well, you’re missing deadlines, you’re frustrated, you’re maybe irritable with your colleagues,” said Jeanette Bennett, a researcher who studies the effects of stress on health at the University of North Carolina, Charlotte.

But stress can have wear and tear effects on the body, especially when it doesn’t ease up after a while — so it makes sense that it can incite physical symptoms, too, Bennett said. When people are under stress, their bodies undergo changes that include making higher than normal levels of stress hormones such as cortisol, adrenaline, epinephrine and norepinephrine. These changes are helpful in the short term — they give us the energy to power through difficult situations — but over time, they start harming the body.

Our bodies were “not designed for the kinds of stressors that we face today,” said Christina Maslach, a social psychologist at the University of California, Berkeley, who has spent her career studying burnout.

Here’s how to recognize burnout in your body and what to do about it.

What to look out for

Insomnia- One common burnout symptom is insomnia, Dyrbye said. When researchers in Italy surveyed front-line health care workers with burnout during the first peak of the pandemic, they found that 55% reported having difficulty falling asleep, while nearly 40% had nightmares.

Research suggests that chronic stress interferes with the complicated neurological and hormonal system that regulates sleep. It’s a vicious cycle, because not sleeping throws this system even more out of whack. If you’ve noticed that you’re unable to sleep at night, that could be a sign that you’re experiencing burnout, Dyrbye said — and your sleeplessness could exacerbate the problem.

Physical exhaustion is another common sign. Gold said that one of her key symptoms of burnout was fatigue. “I realized I was sleeping every day after work — and I was like, ‘What is wrong with me?’ but it was actually burnout,” she said.

Changes in eating habits — either eating more or less than usual — can also be a sign of burnout: In the study of Italian health care workers, 56% reported changes in food habits. People might eat less because they’re too busy or distracted, or they might find themselves craving “those comfort foods that we all like to go to when we need something to make us feel better,” Bennett said. Research suggests, too, that stress hormones can affect appetite, making people feel less hungry than usual when they’re under a lot of stress, and more hungry than usual when that stress alleviates.

Headaches and stomachaches can also be incited by burnout, Gold said. One study of people in Sweden suffering from exhaustion disorder — a medical condition similar to burnout — found that 67% reported experiencing nausea, gas or indigestion, and that 65% had headaches. It’s also important to note that burnout can develop alongside depression or anxiety, both of which can cause physical symptoms. Depression can cause muscle aches, stomachaches, sleep issues and appetite changes. Anxiety is linked to headaches, nausea and shortness of breath.

What to do

If you’re experiencing physical symptoms that could be indicative of burnout, consider seeing your primary care doctor or a mental health professional to determine whether they are driven by stress or rooted in other physical conditions, Dyrbye said. Don’t just ignore the symptoms and assume they don’t matter.

“It’s really easy to blow off your own symptoms, especially in our culture, where we’re taught to work hard,” Gold said.

If it is burnout, then the best solution is to address the root of the problem. Burnout is typically recognized when it is job-driven, but chronic stress can have a variety of causes — financial problems, relationship woes and caregiving burdens, among other things. Think about “the pebbles in your shoe all the time that you have to deal with,” Maslach said, and brainstorm ways to remove some of them, at least some of the time. Perhaps you can ask your partner to help more with your toddler’s bedtime routine, or get takeout when you’re especially busy so you don’t have to plan dinner, too.

Despite popular culture coverage of the issue, burnout can’t be “fixed” with better self care, Maslach said — in fact, this implication only worsens the problem, because it lays the blame and responsibility on those with burnout and implies that they should do more to feel better, which is not the case, she said. However, some lifestyle choices can make burnout less likely. Social support, for instance, can help, Gold said. This could include talking to a therapist or meeting with friends (even if over Zoom). It may also help to take advantage of mental health or exercise benefits offered by your employer. Sleeping more can help too — so if you’re suffering from insomnia, talk to a doctor about possible treatments, Bennett suggested.

Finally, while you may not want to add more to your plate, try to make a bit of time each day for something you love, Dyrbye said. Her work has found that surgeons who make time for hobbies and recreation — even just 15 to 20 minutes a day — are less likely to experience burnout than surgeons who don’t.

“You have to have something outside of work that helps you de-stress, that helps you focus and helps you relax,” she said.

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June 3, 2022 0

#Doctors-‘Earn Hundreds & Pay Back Millions’ #USG-Lab-Nagpur to Pay 1. 25 Cr Compensation

Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist. With court compensations going into crores, many times patient’s relatives try to use the opportunity. Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also need to be careful about how courts may interpret the medical processes. What doctors think is a correct medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight, which everyone is flushed with as an after event.

Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.

Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.

Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.

Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also need to be careful about how courts may interpret the medical processes. What doctors think is a correct medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight, which everyone is flushed with as an after event.

Large compensations against medical profession are the single important factor can increase the cost of healthcare and demoralize medical profession. Doctors are always on the receiving end in case of an adverse outcome. Medical problems are very complex and sometimes it is difficult to judge the future course of disease as well as court interpretation of medical science, especially with retrospective wisdom by courts. Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.

Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of lawyers. Law industry has been benefitted enormously because of consumer protection act at the cost of doctors.

Strangely doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.

New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies.
Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint.
The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for the treatment and purchase of limb prostheses.
The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses.
As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”.
But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist.
He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.

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June 2, 2022 0

A Central Law Needed for Violence against Doctors: IMA to NMC

Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being.

Unfortunately, abusive and violent behaviour by patients or relatives or those accompanying patients has become one of the attendant risks of the medical profession. It is no surprise then that the medical fraternity has once again called upon the government to enact stringent laws and their proper implementation to curtail this kind of behaviour with the National Medical Commission (NMC) proposing that registered medical practitioners (RMPs) refuse to take on such cases.

The NMC (which replaced the Medical Council of India) is a body that regulates medical education and professionals.

The NMC’s Ethics and Medical Registration Board has issued draft regulations inviting comments from the public, experts, stakeholders and organisations on “National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations 2022”.

Comments and suggestions on the draft proposal can be sent by June 22.

A Central Law Needed for violence against doctors: IMA to NMC

“In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behaviour and refuse to treat the patient. Such patients should be referred for further treatment elsewhere,” the draft proposal says.

“If a change of RMP is needed (for example, the patient needs a procedure done by another RMP), consent should be obtained from the patient himself or the guardian. The RMP who attends to the patient will be fully accountable for his actions and entitled to the appropriate fees,” it added.

Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being. Sahajanand Prasad Singh, president, Indian Medical Association (IMA, a panel that represents doctors and their interests), said a doctor would be ethically wrong if he or she refuses treatment to someone in need. So the need of the hour is to have a central law to check such untoward incidents, said Dr Singh.

“The government passed an Epidemic Diseases (Amendment) Act in 2020 which provided acts of violence against healthcare personnel during any situation akin to current pandemic to be cognizable and nonbailable offences. This law should remain in force forever. If the NMC wants the welfare of doctors, they should work in that direction,” he added.

“The commission or abetment of such acts of violence shall be punished with imprisonment for a term of three months to five years, and with fine of Rs 50,000 to Rs 2,00,000,” says the Epidemic Diseases (Amendment) Act, 2020.

Former IMA president Rajan Sharma, who led a nationwide protest condemning violence against doctors in India, said without a Union home ministry law against attacks on doctors, these proposals would do very little to prevent incidents against healthcare workers.

“There has to be strong laws to deal with the rising cases of violence. The regulations made by NMC should be in tandem with the stringent laws from the Union home ministry,” Dr Sharma said.

On his part, IMA general secretary Jayesh Lele, “It’s only a draft regulation, we are going to submit our important observations to the NMC.”

Anuj Aggarwal, general secretary, Federation of Resident Doctors Association of India, said the RMP Professional Conduct Guidelines offers some breather for resident doctors but has some way to go.

“The guidelines give rightful exceptions to patients with life-threatening conditions, which is justified. However, it is important to consider that most of the events in which a patient’s attendants turn violent are when the patient is very critically ill. So this proposal has no role to play in the majority of such scenarios,” he said.

Dr Aggarwal said that while it is a welcome step to curb the issue of rising violence against doctors, a central law would be a better and more effective deterrent.

The government did propose a central protection act and a draft was put in the public domain in 2019 for feedback but it was put on the back burner.

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May 30, 2022 0

Dr Manjula Case NHS-UK: Semantics-Regulator’s own Fitness to Practice Doubtful? #GMC-UK

Regulation of the medical profession has become a tool to oppress doctors.

Dr Manjula Arora case (NHS-UK) unmasks the everyday struggle of the doctors in present era. Being undervalued and demonized, forced to work as sub-servant to administrators and regulators are considered new normal and has become an accepted form of harassment. Fatigue and burnout are thought to be routine side effects of being a doctor or nurse. The unhindered over-regulation has left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession. Single stray or a trivial incident is projected as an example to portray poor image of medical profession as generalization and as a token of the ‘excellent’ work done by administrators and regulators. Doctors have become soft targets because of their nature of work as they deal with life and death. Any trivial issues such as semantics used by Dr Manjula Arora (in this case) were blown out of proportion and GMC finds this as an opportunity to send a strict message to the whole profession. Such incidence show that regulators and administrators can use the nature of doctors’ work to be used against medical profession to make saviours as an easy prey for punishments on the pretext of dishonesty, negligence or semantics being used as legal weapons by law-enforcers, even in case of a perceived bias. In the process of such ‘tokenism’ administrators prove their relevance to the system.

Regulation of the medical profession has become a tool to oppress doctors. Driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes- causing patient harm.

Dr Manjula Arora’s case

Dr Arora has been a doctor since 1988 and is of good character. She asked her employer for a laptop. For context, most employees would reasonably expect their employer to provide work-related IT equipment. She was told that none were available, but her interest would be noted for the next roll-out. Many people would interpret this positive response to mean that they would get a laptop in due course. Clearly if her employer did not intend for her to have a laptop, they could simply have said so. Dr Arora spoke to her IT department about getting a laptop and said she had been ‘promised’ one.

And that’s it. That is the entire extent of her ‘misconduct’.

One could regard her statement as a minor exaggeration, or loose terminology, or careless language or verbal shorthand over a trivial subject. But no one should consider it to amount to ‘dishonesty’ unless interpret it in biased manner.

The tribunal took a different view. They concluded that ordinary, decent people would consider her use of the single word ‘promised’ as dishonest. The tribunal further decided that this so-called dishonesty amounted to misconduct.

They also considered that the misconduct was serious.

They decided her fitness to practice was impaired, and that it was necessary to suspend her to send a message to the profession.The regulator has a difficult task. Good regulation protects patients. Poor regulation harms patients, because doctors will run away from a toxic regulatory environment.

Manjula Arora case: the GMC stumbles again? -BMJ

The case of Manjula Arora, a GP in Manchester, who has been suspended for a month for supposed “dishonesty” about a laptop, was picked up by a few colleagues, and social media did its work of ensuring the pick-up rate increased exponentially. One always worries about the latest “MedTwitter” controversy. But this one has come on back of seething annoyance among many doctors about our regulator—the General Medical Council (GMC)—and its perceived bias, with cases such as those of Hadiza Bawa-Garba and Omer Karim still fresh in our memories.

Couple this with the recent Medical Workforce Race Equality Standard (MWRES) data confirming a clear association of increased referrals and convictions on the basis of racial background—or indeed country of origin as regards training—and this case lit the touch paper.

If one considers the publicly available details of the whole trial, you have to scratch your head and wonder how it got to this stage? Would this happen if the name of the individual was, for example, Michael Andrews?

The relevance of this case stood on two things—any harm to the patient population, which, to me, should be the primary aim of the GMC, and then dishonesty and disrepute brought upon the medical community.

This ruling makes it clear that there is no risk of harm to the public: “The Tribunal considered that no issues in relation to patient safety had been identified in this case. Dr Arora is a competent clinician, and there is no necessity to protect the public.” That should have ended the issue. But the complications started when interpretation about honesty came into the picture.

“The Tribunal attached significant weight to the fact that Dr Arora’s misconduct was a single incident in relation to the use of a single word, with no evidence of any other similar episodes of dishonesty before or after the event.” If you go into the details of the case, it becomes even more murky, as it’s the interpretation of a word—subjective at best— against the background of someone for whom English is not their first language. But it was deemed enough to warrant a month’s suspension according to the tribunal: “this period would send an appropriate message to the medical profession and to the wider public that Dr Arora’s misconduct, albeit relating to a single fleeting moment of dishonesty and not a planned deception.”

This raises a multitude of questions. Firstly, there is the principle that one fleeting moment of dishonesty could result in suspension. If that’s the standard, then the profession is indeed in trouble, with the GMC now making subjective judgements and being an arbiter of what is deemed to be honest or not. Where does the line get drawn? Discussions about patients or conversations about whether Santa exists or not?

Secondly, and more importantly, there is the suspicion of bias in how that law is being applied. Daniel Sokol has written a recent column which discusses the notion of doctors as the “saintly being”; the epitome of perfection at all times. Yet, within all of us exist the same prejudices and flaws as for the rest of the population. Sokol suggests that doctors have to be “scrupulously honest—in and out of work—unless the situation obviously allows for ethical dishonesty.” Yet he makes no mention of the fact that the GMC seems to apply that principle unevenly across the board. I accept that it can be difficult to see the “problem” others are complaining about, but I can assure you there are very few international medical graduates who have read about Arora’s case and not thought “I know why this has happened.”

There is professionalism, but there is humanity too, and I would propose that driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. What is honesty? Saying to patients that they need to wait for another 16 hours to get a bed, or holding the hand of the elderly frail lady, comforting her and saying “I am sure something will come up shortly”? It brings back the concept that being a doctor is a vocation. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes—causing patient harm.

Finally, if the role of the GMC is to protect the public from “single moments of untruth,” as this destroys the view among the public that doctors are saints (although I am pretty sure the public don’t see doctors like that in modern life), then there needs to be a discussion of that concept, of the overreach into personal lives, and of where the line is drawn as regards the GMC’s intrusion and inordinate application of that principle. I would suggest the role of the regulator should be for the rare circumstances when there is an interest in behaviour not being repeated or where it cannot be dealt with effectively by an employer.

I work with the GMC closely these days, and I find it immensely frustrating to see such cases as they undermine some significant hard work that is being done by individuals who are determined to change the narrative that the GMC is biased. I would encourage all concerned to look into this case, review it, learn from it, and offer support to Arora. There is a lot of work in hand to repair the damage from the Bawa Garba case, and this case could reinforce those sentiments, which we must avoid.

The intention may once have been for doctors to be Superman, but modern times and the foibles of individuals only permit a Batman. It’s worth remembering neither of them work to harm the public.

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May 29, 2022 1

Fish Bile ‘Treatment’ Lands Woman in Hospital- Folly of Fringe Theories in medicine

Fish bile ‘treatment’ lands woman in hospital A 52-year-old homemaker from Dum Dum had to undergo a few rounds of dialysis and was put under intense critical care for a renal failure, triggered by ‘fish bile poisoning’. The

It has become a common practice to advertise health products or therapies that claim to be panacea for all ailments enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. Needless to say, the objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

Companies have created huge fortunes based on circulation of such pedagogic narratives and social knowledge. But in real sense, these are actually chemical and have biological actions and reactions. Chemical derived from natural sources can have side effects and contain impurities. Global neutral trials to validate effects and side effects remain an urgent need of the hour for all health products.

Suffering for the common public is immense. Doctors’ sincere warning had no effect rather they were called as medicine mafia. Unfortunately false beliefs like local religious figures can cure cancer and kidney diseases cause they could communicate with invisible spirits and gain knowledge. Unsurprisingly the cranks have been wrong and innocent patients suffer. Doctors objecting to elevation of crank theories were painted as western medicine agents, or nattering nabobs of negativity.

Here is an example of the folly of following fringe theories.

Fish bile ‘treatment’ lands woman in hospital

A 52-year-old homemaker from Dum Dum had to undergo a few rounds of dialysis and was put under intense critical care for a renal failure, triggered by ‘fish bile poisoning’. The patient had ingested raw fish bile for four consecutive days as a treatment to cure her diabetes prior to being rushed to Manipal Hospitals Kolkata with acute abdominal pain. Doctors at the Salt Lake hospital found the patient had low blood pressure and was in a state of shock. Initial reports showed a significant derangement of liver and kidney functions. It led doctors to treat common causes of liver and kidney injuries or drug induced organ damage. When further tests didn’t match with these diagnoses, the team started looking for a possible cause. The patient then revealed she had ingested bile of Rohu fish for four days to control her diabetes. “Consuming fish bile causes acute kidney and liver injury with the need to go for long term dialysis. This patient had to be put under dialysis within 72 hours of admission,” said internal medicine and critical care consultant. She was discharged from hospital after a month.

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May 24, 2022 0

All about Monkeypox & its Relation to Smallpox

How monkeypox relates to smallpox

The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which has been eradicated. Smallpox was more easily transmitted and more often fatal as about 30% of patients died. The last case of naturally acquired smallpox occurred in 1977, and in 1980 smallpox was declared to have been eradicated worldwide after a global campaign of vaccination and containment. It has been 40 or more years since all countries ceased routine smallpox vaccination with vaccinia-based vaccines. As vaccination also protected against monkeypox in West and Central Africa, unvaccinated populations are now also more susceptible to monkeypox virus infection.

Whereas smallpox no longer occurs naturally, the global health sector remains vigilant in the event it could reappear through natural mechanisms, laboratory accident or deliberate release. To ensure global preparedness in the event of reemergence of smallpox, newer vaccines, diagnostics and antiviral agents are being developed. These may also now prove useful for prevention and control of monkeypox.

Key facts

Monkeypox is caused by monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.
Monkeypox is a viral zoonotic disease that occurs primarily in tropical rainforest areas of Central and West Africa and is occasionally exported to other regions.
Monkeypox typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications.
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur. In recent times, the case fatality ratio has been around 3-6%.
Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.
Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.
The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980. Monkeypox is less contagious than smallpox and causes less severe illness.
Vaccines used during the smallpox eradication programme also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of monkeypox
An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox.

WHO- Monkeypox

Introduction

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health. Monkeypox primarily occurs in Central and West Africa, often in proximity to tropical rainforests and has been increasingly appearing in urban areas. Animal hosts include a range of rodents and non-human primates.

The pathogen

Monkeypox virus is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. There are two distinct genetic clades of the monkeypox virus – the Central African (Congo Basin) clade and the West African clade. The Congo Basin clade has historically caused more severe disease and was thought to be more transmissible. The geographical division between the two clades has so far been in Cameroon – the only country where both virus clades have been found.

Natural host of monkeypox virus

Various animal species have been identified as susceptible to monkeypox virus.. This includes rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other species. Uncertainty remains on the natural history of monkeypox virus and further studies are needed to identify the exact reservoir(s) and how virus circulation is maintained in nature.

Outbreaks

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-year-old boy in a region where smallpox had been eliminated in 1968. Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo and human cases have increasingly been reported from across Central and West Africa.

Since 1970, human cases of monkeypox have been reported in 11 African countries – Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. The true burden of monkeypox is not known. For example, in 1996–97, an outbreak was reported in the Democratic Republic of the Congo with a lower case fatality ratio and a higher attack rate than usual. A concurrent outbreak of chickenpox (caused by the varicella virus, which is not an orthopoxvirus) and monkeypox was found which could explain real or apparent changes in transmission dynamics in this case. Since 2017, Nigeria has experienced a large outbreak, with over 500 suspected cases and over 200 confirmed cases and a case fatality ratio of approximately 3%. Cases continue to be reported until today.

Monkeypox is a disease of global public health importance as it not only affects countries in West and Central Africa, but the rest of the world. In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana. This outbreak led to over 70 cases of monkeypox in the U.S. Monkeypox has also been reported in travelers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, to Singapore in May 2019, and to the United States of America in July and November 2021. In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns.

Transmission

Animal-to-human (zoonotic) transmission can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa, evidence of monkeypox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others. The natural reservoir of monkeypox has not yet been identified, though rodents are the most likely. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor. People living in or near forested areas may have indirect or low-level exposure to infected animals.

Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers, household members and other close contacts of active cases at greater risk. However, the longest documented chain of transmission in a community has risen in recent years from six to nine successive person-to-person infections. This may reflect declining immunity in all communities due to cessation of smallpox vaccination. Transmission can also occur via the placenta from mother to fetus (which can lead to congenital monkeypox) or during close contact during and after birth. While close physical contact is a well-known risk factor for transmission, it is unclear at this time if monkeypox can be transmitted specifically through sexual transmission routes. Studies are needed to better understand this risk.

Signs and symptoms

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

The infection can be divided into two periods:

the invasion period (lasts between 0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) and intense asthenia (lack of energy). Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox)
the skin eruption usually begins within 1-3 days of appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases). Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea. The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of lesions varies from a few to several thousand. In severe cases, lesions can coalesce until large sections of skin slough off.

Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications. Underlying immune deficiencies may lead to worse outcomes. Although vaccination against smallpox was protective in the past, today persons younger than 40 to 50 years of age (depending on the country) may be more susceptible to monkeypox due to cessation of smallpox vaccination campaigns globally after eradication of the disease. Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The extent to which asymptomatic infection may occur is unknown.

The case fatality ratio of monkeypox has historically ranged from 0 to 11 % in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3-6%.

Diagnosis

The clinical differential diagnosis that must be considered includes other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish monkeypox from chickenpox or smallpox.

If monkeypox is suspected, health workers should collect an appropriate sample and have it transported safely to a laboratory with appropriate capability. Confirmation of monkeypox depends on the type and quality of the specimen and the type of laboratory test. Thus, specimens should be packaged and shipped in accordance with national and international requirements. Polymerase chain reaction (PCR) is the preferred laboratory test given its accuracy and sensitivity. For this, optimal diagnostic samples for monkeypox are from skin lesions – the roof or fluid from vesicles and pustules, and dry crusts. Where feasible, biopsy is an option. Lesion samples must be stored in a dry, sterile tube (no viral transport media) and kept cold. PCR blood tests are usually inconclusive because of the short duration of viremia relative to the timing of specimen collection after symptoms begin and should not be routinely collected from patients.

As orthopoxviruses are serologically cross-reactive, antigen and antibody detection methods do not provide monkeypox-specific confirmation. Serology and antigen detection methods are therefore not recommended for diagnosis or case investigation where resources are limited. Additionally, recent or remote vaccination with a vaccinia-based vaccine (e.g. anyone vaccinated before smallpox eradication, or more recently vaccinated due to higher risk such as orthopoxvirus laboratory personnel) might lead to false positive results.

In order to interpret test results, it is critical that patient information be provided with the specimens including: a) date of onset of fever, b) date of onset of rash, c) date of specimen collection, d) current status of the individual (stage of rash), and e) age.

Therapeutics

Clinical care for monkeypox should be fully optimized to alleviate symptoms, manage complications and prevent long-term sequelae. Patients should be offered fluids and food to maintain adequate nutritional status. Secondary bacterial infections should be treated as indicated. An antiviral agent known as tecovirimat that was developed for smallpox was licensed by the European Medical Association (EMA) for monkeypox in 2022 based on data in animal and human studies. It is not yet widely available.

If used for patient care, tecovirimat should ideally be monitored in a clinical research context with prospective data collection.

Vaccination

Vaccination against smallpox was demonstrated through several observational studies to be about 85% effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness. Evidence of prior vaccination against smallpox can usually be found as a scar on the upper arm. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public. Some laboratory personnel or health workers may have received a more recent smallpox vaccine to protect them in the event of exposure to orthopoxviruses in the workplace. A still newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved for the prevention of monkeypox in 2019. This is a two-dose vaccine for which availability remains limited. Smallpox and monkeypox vaccines are developed in formulations based on the vaccinia virus due to cross-protection afforded for the immune response to orthopoxviruses.

Prevention

Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus is the main prevention strategy for monkeypox. Scientific studies are now underway to assess the feasibility and appropriateness of vaccination for the prevention and control of monkeypox. Some countries have, or are developing, policies to offer vaccine to persons who may be at risk such as laboratory personnel, rapid response teams and health workers.

Reducing the risk of human-to-human transmission

Surveillance and rapid identification of new cases is critical for outbreak containment. During human monkeypox outbreaks, close contact with infected persons is the most significant risk factor for monkeypox virus infection. Health workers and household members are at a greater risk of infection. Health workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions. If possible, persons previously vaccinated against smallpox should be selected to care for the patient.

Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories. Patient specimens must be safely prepared for transport with triple packaging in accordance with WHO guidance for transport of infectious substances.

The identification in May 2022 of clusters of monkeypox cases in several non-endemic countries with no direct travel links to an endemic area is atypical. Further investigations are underway to determine the likely source of infection and limit further onward spread. As the source of this outbreak is being investigated, it is important to look at all possible modes of transmission in order to safeguard public health. Further information on this outbreak can be found here

Reducing the risk of zoonotic transmission

Over time, most human infections have resulted from a primary, animal-to-human transmission. Unprotected contact with wild animals, especially those that are sick or dead, including their meat, blood and other parts must be avoided. Additionally, all foods containing animal meat or parts must be thoroughly cooked before eating.

Preventing monkeypox through restrictions on animal trade

Some countries have put in place regulations restricting importation of rodents and non-human primates. Captive animals that are potentially infected with monkeypox should be isolated from other animals and placed into immediate quarantine. Any animals that might have come into contact with an infected animal should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.

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May 21, 2022 0

Obesity & Overweight: Quality of Life, Causes, Diagnosis Treatment

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity. Symptoms Body mass index (BMI) is often used to diagnose obesity. To calculate BMI, multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms

Obesity is a complex disease involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty losing weight. Usually, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity.

Symptoms

Body mass index (BMI) is often used to diagnose obesity. To calculate BMI, multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms by height in meters squared.

BMI	Weight status
Below 18.5	Underweight
18.5-24.9	Normal
25.0-29.9	Overweight
30.0 and higher	Obesity

Asians with BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat.

Many doctors also measure a person’s waist circumference to help guide treatment decisions. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters) and in women with a waist measurement over 35 inches (89 centimeters).

Causes

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through normal daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people’s diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don’t tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping and drive-through banks.

Risk factors

Obesity usually results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.

Obesity tends to run in families. That’s not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

Unhealthy diet. A diet that’s high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to significant weight gain.
Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is a sedentary activity. The number of hours spent in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medications can lead to weight gain if you don’t compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don’t have safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have access to healthier foods. In addition, the people you spend time with may influence your weight — you’re more likely to develop obesity if you have friends or relatives with obesity.

Age

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. Generally, lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.

Other factors

Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. In the long run, however, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your doctor can help you prevent weight gain after quitting smoking.
Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food when experiencing stressful situations.
Microbiome. Your gut bacteria are affected by what you eat and may contribute to weight gain or difficulty losing weight.

Even if you have one or more of these risk factors, it doesn’t mean that you’re destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes.
Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
Osteoarthritis. Obesity increases the stress placed on weight-bearing joints, in addition to promoting inflammation within the body. These factors may lead to complications such as osteoarthritis.
Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019 (COVID-19). People who have severe cases of COVID-19 may require treatment in intensive care units or even mechanical assistance to breathe.

Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

Depression
Disability
Shame and guilt
Social isolation
Lower work achievement

Diagnosis

To diagnose obesity, your doctor will typically perform a physical exam and recommend some tests.

These exams and tests generally include:

Taking your health history. Your doctor may review your weight history, weight-loss efforts, physical activity and exercise habits, eating patterns and appetite control, what other conditions you’ve had, medications, stress levels, and other issues about your health. Your doctor may also review your family’s health history to see if you may be predisposed to certain conditions.
A general physical exam. This includes measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
Calculating your BMI. Your doctor will check your body mass index (BMI). A BMI of 30 or higher is considered obesity. Numbers higher than 30 increase health risks even more. Your BMI should be checked at least once a year because it can help determine your overall health risks and what treatments may be appropriate.
Measuring your waist circumference. Fat stored around the waist, sometimes called visceral fat or abdominal fat, may further increase the risk of heart disease and diabetes. Women with a waist measurement (circumference) of more than 35 inches (89 centimeters) and men with a waist measurement of more than 40 inches (102 centimeters) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, waist circumference should be checked at least once a year.
Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure, high cholesterol, underactive thyroid, liver problems and diabetes.

Treatment

The goal of obesity treatment is to reach and stay at a healthy weight. This improves overall health and lowers the risk of developing complications related to obesity.

You may need to work with a team of health professionals — including a dietitian, behavioral counselor or an obesity specialist — to help you understand and make changes in your eating and activity habits.

The initial treatment goal is usually a modest weight loss — 5% to 10% of your total weight. That means that if you weigh 200 pounds (91 kilograms), you’d need to lose only about 10 to 20 pounds (4.5 to 9 kilograms) for your health to begin to improve. However, the more weight you lose, the greater the benefits.

All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your obesity severity, your overall health and your willingness to participate in your weight-loss plan.

Dietary changes

Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.

There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

Cutting calories. The key to weight loss is reducing how many calories you take in. The first step is to review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
Feeling full on less. Some foods — such as desserts, candies, fats and processed foods — contain a lot of calories for a small portion. In contrast, fruits and vegetables provide a larger portion size with fewer calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils.
Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans are effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended. Limiting these drinks or eliminating them altogether is a good place to start cutting calories.
Meal replacements. These plans suggest replacing one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that’s low in fat and calories. In the short term, this type of diet can help you lose weight. But these diets likely won’t teach you how to change your overall lifestyle. So you may have to stay on the diet if you want to keep your weight off.

Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don’t appear to be any better than other diets.

Similarly, you may lose weight on a crash diet, but you’re likely to regain it when you stop the diet. To lose weight — and keep it off — you must adopt healthy-eating habits that you can maintain over time.

Exercise and activity

Increased physical activity or exercise is an essential part of obesity treatment:

Exercise. People with obesity need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve.
Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Park farther from store entrances and take the stairs instead of the elevator. A pedometer can track how many steps you take over the course of a day. Many people try to reach 10,000 steps every day. Gradually increase the number of steps you take daily to reach that goal.

Behavior changes

A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity.

Counseling. Talking with a mental health professional can help address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Counseling can be one-on-one or in a group.
Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area.

Weight-loss medication

Weight-loss medications are meant to be used along with diet, exercise and behavior changes, not instead of them. Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects.

The most commonly used medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of obesity include:

Bupropion-naltrexone (Contrave)
Liraglutide (Saxenda)
Orlistat (Alli, Xenical)
Phentermine-topiramate (Qsymia)

Weight-loss medications may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.

Endoscopic procedures for weight loss

These types of procedures don’t require any incisions in the skin. After you are under anesthesia, flexible tubes and tools are inserted through the mouth and down the throat into the stomach. Common procedures include:

Endoscopic sleeve gastroplasty. This procedure involves placing stitches in the stomach to reduce the amount of food and liquid the stomach can hold at one time. Over time, eating and drinking less helps the typical person lose weight.
Intragastric balloon for weight loss. In this procedure, doctors place a small balloon into the stomach. The balloon is then filled with water to reduce the amount of space in the stomach, so you’ll feel full eating less food.

Weight-loss surgery

Also known as bariatric surgery, weight-loss surgery limits the amount of food you’re able to comfortably eat or decreases the absorption of food and calories. However, this can also result in nutritional and vitamin deficiencies.

Common weight-loss surgeries include:

Adjustable gastric banding. In this procedure, an inflatable band separates the stomach into two pouches. The surgeon pulls the band tight, like a belt, to create a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.
Gastric bypass surgery. In gastric bypass (Roux-en-Y), the surgeon creates a small pouch at the top of the stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of the stomach.
Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It’s a less complicated surgery than gastric bypass.

Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

Mayo Clinic

Other treatments

Other treatments for obesity include:

Hydrogels. Available by prescription, these edible capsules contain tiny particles that absorb water and enlarge in the stomach, to help you feel full. The capsules are taken before meals and are passed through the intestines as stool.
Vagal nerve blockade. This involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full.
Gastric aspirate. In this procedure, a tube is placed through the abdomen into the stomach. A portion of the stomach contents are drained out after each meal.

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Who Gets Osteoporosis?

Causes of Osteoporosis

Treatment of Osteoporosis

Nutrition

Calcium and Vitamin D

Lifestyle

Exercise

Medications

Who Treats Osteoporosis?

Living With Osteoporosis

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What is thyroid disease?

Who is affected by thyroid disease?

SYMPTOMS AND CAUSES

What causes thyroid disease?

Is there a higher risk of developing thyroid disease if I have diabetes?

Can thyroid issues make me lose my hair?

Can thyroid issues cause seizures?

How is thyroid disease diagnosed?

How is thyroid disease treated?

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OUTLOOK / PROGNOSIS

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If part of my thyroid is surgically removed, will the other part be able to make enough thyroid hormones to keep me off of medication?

Should I exercise if I have a thyroid disease?

Can I live a normal life with a thyroid disease?

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Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being.

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How monkeypox relates to smallpox

Key facts

Introduction

The pathogen

Natural host of monkeypox virus

Outbreaks

Transmission

Signs and symptoms

Diagnosis

Therapeutics

Vaccination

Prevention

Reducing the risk of human-to-human transmission

Reducing the risk of zoonotic transmission

Preventing monkeypox through restrictions on animal trade

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Symptoms

Risk factors

Family inheritance and influences

Lifestyle choices

Certain diseases and medications

Social and economic issues

Age

Other factors

Complications

Quality of life

Diagnosis

Treatment

Dietary changes

Exercise and activity

Behavior changes

Weight-loss medication

Weight-loss surgery

Other treatments

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