Osteoarthritis: Painful Joints in Old age- Symptoms, Diagnosis, Treatment


This serious, painful condition is the most common form of arthritis and can affect any joint.

Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis, affecting more than 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention.

Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility.

OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it.

There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile.

Causes

Causes

Factors that may contribute to the development of OA include 

  • Age. The risk of developing OA increases with age and symptoms generally, but not always, appear in people over 50. 
  • Joint injury. A bone fracture or cartilage or ligament tear can lead to OA, sometimes more quickly than in cases where there is not an obvious injury.
  • Overuse. Using the same joints over and over in a job or sport can result in OA.. Excess weight adds stress and pressure on a joint, plus fats cells promote inflammation.
  • Musculoskeletal abnormalities. Misalignment of bone or joint structures can contribute to faster development of OA.
  • Obesity
  • Weak muscles. If muscles don’t provide adequate joint support, poor alignment can result, which can lead to OA.
  • Genetics. People with family members who have OA are more likely to develop it.
  • Gender. Women are more likely to develop OA than men.
  • Environmental Factors. Modifiable environmental risk factors include things like someone’s occupation, level of physical activity, quadriceps strength, presence or absence of prior joint injury, obesity, diet, sex hormones, and bone density.

Symptoms

Symptoms tend to build over time rather than show up suddenly. They include

  • Pain or aching in a joint during activity, after long activity or at the end of the day.
  • Joint stiffness usually occurs first thing in the morning or after resting.
  • Limited range of motion that may go away after movement.
  • Clicking or popping sound when a joint bends.
  • Swelling around a joint.
  • Muscle weakness around the joint.
  • Joint instability or buckling (as when a knee gives out).

OA may affect different parts of the body in different ways.

  • Hips. Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh.
  • Knees. A “grating” or “scraping” feeling when moving the knee. 
  • Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb.
  • Feet. Pain and tenderness in the big toe, with possible swelling in the ankles or toes.

Potential Consequences

Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to health complications that are not caused by the disease itself.

Obesity, Diabetes and Heart Disease

Painful joints, especially in the feet, ankles, knees, hip or back, make it harder to exercise. But physical activity is not only key to managing OA symptoms; it also can help prevent weight gain, which can lead to obesity. Being overweight or obese can lead to the development of high cholesterol, type 2 diabetes, heart disease and high blood pressure. 

Falls

Research indicates people with OA experience more fall and risk of fracture than those without OA. Although study results vary, some research shows they may have up to 30% more falls and have a 20% greater risk of fracture. Having OA can decrease function, weaken muscles, affect overall balance, and make falls more likely, especially among those with OA in knees or hips. Side effects from pain medications, such as dizziness, can also contribute to falls.

Diagnosis

Medical history, a physical examination and lab test help to make up the OA diagnosis. 

A primary care doctor may be the first person you talk to about joint pain. The doctor will review your medical history, symptoms, how the pain affects activities, as well as your medical problems and medication use. He or she will also look at and move your joints, and may order imaging. These tests help to make the diagnosis:

  • Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis.
  • X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis.
  • MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.

Treatment

There is no cure for OA, but medication, assistive devices and other therapies that don’t involve drugs can help to ease pain. As a last resort, a damaged joint may be surgically fused or replaced with one made of a combination of metal, plastic and/or ceramic. 

Medications

Pain and anti-inflammatorymedicines for osteoarthritis are available as pills, syrups, patches, gels, creams or injectable. They include:  

  • Analgesics. These are pain relievers and include acetaminophen and opioids. Acetaminophen is available over the counter (OTC); opioids must be prescribed by a doctor.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirin, ibuprofen, naproxen and celecoxib, available either OTC or by prescription. The OTC versions help with pain but not inflammation.
  • Counterirritants. These OTC products contain ingredients like capsaicin, menthol, lidocaine that irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain. 
  • Corticosteroids. These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.
  • Platelet-rich plasma (PRP). Available from a doctor by injection, this product is intended to help ease pain and inflammation. This is not approved by the Food & Drug Administration and evidence is still emerging, so discuss it with your doctor before trying it.
  • Other drugs. The antidepressant duloxetine (Cymbalta) and the anti-seizure pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain.

Nondrug Therapies

Exercise

Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal, according to the U.S. Department of Health and Human Services. A good exercise program to fight OA pain and stiffness has four parts:

  • Strengthening exercises build muscles around painful joints and helps to ease the stress on them. 
  • Range-of-motion exercise or stretching helps to reduce stiffness and keep joints moving.
  • Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.
  • Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.

Talk to a doctor or physical therapist before starting a new exercise program.

Weight Loss

Excess weight puts additional force and stress on weight-bearing joints, including the hips, knees, ankles, feet and back, and fat cells promote inflammation.  Losing extra weight helps reduce pain and slow joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.

Physical therapy and Assistive therapy
Physical therapists, occupational therapists and chiropractors can provide:

  • Specific exercises to help stabilize your joints and ease pain.
  • Information about natural treatments and products that can ease pain.
  • Instruction to make movement easier and to protect joints. 
  • Braces, shoe inserts or other assistive devices.

Surgery

Joint surgery can improve pain and function. Joint replacement surgery replaces damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopedic surgeon can determine the best procedure based on how badly damaged the joint is.

Self-Care

Practicing these habits can slow down OA, keep you healthier overall and delay surgery as long as possible. It is important to pursue a number of different self-care approaches simultaneously. They are listed below.

Maintain a Healthy Weight

Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

Control Blood Sugar

Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

Maintain Range of Motion

Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help. But listen to your body and never push too hard.

Protect Joints

Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.  

Relax

Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.

Choose a Healthy Lifestyle

Eating healthy food, balanced nutrition, not smoking, drinking in moderation and getting good sleep will help you to feel your best.

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Rheumatoid Arthritis: Painful Joints in Young- Causes, Symptoms, Treatment


Rheumatoid arthritis (RA) causes joint inflammation and pain. It happens when the immune system doesn’t work properly and attacks the lining of the joints, called the synovium. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body, such as both hands or both knees. But sometimes RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or the lungs.

For unknown reasons, more women than men get RA, and it usually develops in middle age. Having a family member with RA increases the odds of developing RA.

Causes

In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack those cells.  RA, it attacks the synovium, the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender and look red and swollen, and moving the joint may be difficult.

Researchers aren’t sure why people develop RA. They believe these individuals may have certain genes that are activated by a trigger in the environment, such as a virus or bacteria, physical or emotional stress or some other external factor.

Symptoms

Symptoms

In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain.
These symptoms are clues to RA:

  • joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
  • Morning stiffness that lasts for 30 minutes or longer.
  • More than one joint is affected.
  • Small joints (wrists, certain joints in the hands and feet) are typically affected first.
  • The same joints on both sides of the body are affected.

Many people with RA get very tired (fatigue) and some may have a low-grade fever. RA symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months. 
 

Health Effects

  • Eyes. Dryness, pain, inflammation, redness, sensitivity to light and trouble seeing properly.
  • Mouth. Dryness and gum inflammation, irritation or infection. 
  • Skin. Rheumatoid nodules — small lumps under the skin over bony areas. 
  • Lungs. Inflammation and scarring that can lead to shortness of breath and lung disease.
  • Blood vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs.
  • Blood. A lower than normal number of red blood cells. 
  • Heart. Inflammation can damage the heart muscle and the surrounding areas.
  • Painful joints also make it hard to exercise, leading to weight gain. Being overweight may make people with RA more likely to develop high cholesterol, diabetes, heart disease and high blood pressure.

Diagnosis

Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. A doctor with specialized training in treating arthritis (called a rheumatologist) is the best person to make a correct diagnosis, using medical history, a physical examination and lab tests.

Medical history. The doctor will ask about joint symptoms (pain, tenderness, stiffness, difficulty moving), when they started, if they come and go, how severe they are, what actions make them better or worse and whether family members have RA or another autoimmune disease. 
Physical examination.  The doctor will look for joint tenderness, swelling, warmth and painful or limited movement, bumps under the skin or a low-grade fever. 
Blood tests- The blood tests look for inflammation and blood proteins (antibodies) that are linked to RA:

  • Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) levels are markers for inflammation. A high ESR or CRP combined with other clues to RA helps make the diagnosis. 
  • Rheumatoid factor (RF) is an antibody found (eventually) in about 80 percent of people with RA. Antibodies to cyclic citrullinated peptide (CCP) are found in 60 to 70 percent of people with RA. However, they are also found in people without RA. 

Imaging tests- RA can cause the ends of the bones within a joint to wear down (erosions). An X-ray, ultrasound, or MRI (magnetic resonance imaging) scan can look for erosions. But if they don’t show up on the first tests that could mean RA is in an early stage and hasn’t damaged bone yet. Imaging results can also show how well treatment is working.
 

Treatment

The goals of RA treatment are to:

  • Stop inflammation or reduce it to the lowest possible level (put disease in remission).
  • Relieve symptoms.
  • Prevent joint and organ damage.
  • Improve function and overall well-being.
  • Reduce long-term complications.

To meet these goals, the doctor will follow these strategies:

  • Early, aggressive treatment to reduce or stop inflammation as quickly as possible.
  • Targeting remission or another goal (called “treat-to-target”) to work toward few or no signs or symptoms of active inflammation. 
  • Tight control to keep inflammation at the lowest level possible.

Working with your doctor to ensure you get appropriate medical treatment is essential, but you can also take measures on your own to manage your RA and ease pain and fatigue. Diet, exercise, smoking cessation and mental health are all key to good health overall and controlling RA.

Healthy Eating. A balanced, nutritious diet consisting of the recommended amounts of all the food groups helps promote wellness and makes it easier to maintain a healthy weight. 

Daily movement. Even when you don’t have time to exercise, try to make movement part of your everyday routine. Use the stairs instead of taking the elevator. Park in a spot that makes you walk a bit to enter a building. Take the longer way to a meeting in your office. 

Balancing activity with rest. It’s important to try to stay physically active even during a flare, but rest is also especially important when RA is active and joints feel painful, swollen or stiff. Rest helps reduce inflammation and fatigue that can come with a flare. Taking breaks throughout the day protects joints and preserves energy.

Hot and cold treatments. Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain and swollen joints. It can numb painful areas and reduce inflammation. 

Topical products. These creams, gels or stick-on patches can ease the pain in a joint or muscle. Some contain the medicine that you can get in a pill, and others use ingredients that irritate your nerves to distract from pain.

Stress Reduction and Complementary Therapies. There are different ways to relax and stop focusing on pain. They include meditation, deep breathing, and thinking about images in your mind that make you feel happy. Massage can help reduce pain, relax sore muscles and ease stress or anxiety. Acupuncture involves inserting fine needles into the body along special points to relieve pain. If you don’t like needles, acupressure uses firm pressure instead. 

Supplements. Studies show that curcumin/turmeric and omega-3 fish oil supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and how it may affect other medicines you are taking.

Positive Attitude and Support System. Cultivate a network of friends, family members and co-workers who can help provide emotional support. Take time to do things that you enjoy to lift your mood, which can help relieve pain.

Disclaimer-The 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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How to Prevent Fall in Elderly


In a young person, usually there are specific ailments for example heart and and nervous system that can cause some one to fall down. But the older age can predispose people to fall for many factors.

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.

How to prevent Falls in elderly

How to prevent Falls in elderly

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.

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


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 groupCalcium mg/dayVitamin D (IU/day)
Infants 0 to 6 months200400
Infants 6 to 12 months260400
1 to 3 years old700600
4 to 8 years old1,000600
9 to 13 years old1,300600
14 to 18 years old1,300600
19 to 30 years old1,000600
31 to 50 years old1,000600
51- to 70-year-old males1,000600
51- to 70-year-old females1,200600
>70 years old1,200800
14 to 18 years old, pregnant/lactating1,300600
19 to 50 years old, pregnant/lactating1,000600

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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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:

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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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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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

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


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.

BMIWeight status
Below 18.5Underweight
18.5-24.9Normal
25.0-29.9Overweight
30.0 and higherObesity

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.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Why buying a medical college seat & paying millions may be a blunder?


    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.

    Negligent police, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  It may not be a good idea to opt for a medical career any more. In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some people are naïve enough to spend millions on securing an expensive medical college seat.  Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.

Disadvantages of being a doctor, Drawbacks of Medical profession: 

Choosing medical career  or being a medical professional  a disadvantage to doctor in comparison to other professions?

  1. Medical courses are comparatively lengthy and expansive study course and difficult training with slave like duties. “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

  • Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
  • The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
  • Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
  • Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
  • Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
  • Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
  • Retrospective analysis of doctor’s every action continues all the life: It could be by patients and relatives every day in the form of “Why this was not done before?” Every day irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

The decision taken in split seconds will be questioned, which  in retrospect  may not turn out to be the best one. But later retrospective analysis along with wisdom of hindsight with luxury of time  (in courts) may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with patients makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

  1. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
  2. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
  3. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession:  It is heart-breaking to watch  zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.
  4. Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic Oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, which use pressure tactics to get their own way.

       It may be a  naïve idea  or just a blunder to pay millions to be a doctor.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

 Sow Muskmelon-Deserve/Expect Apple? #NEET-Medical-seats filled  with rock-bottom scores


Doctors are just as offshoots of a tree called as society. They essentially are the same as rest of the society. It is a specialized branch of tree which helps other offshoots of tree to save others. As part of same tree, they resemble the parent society, of which they are part. Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people.

      Apple tree will have apples and musk melons plant will grow muskmelons only. One should not expect apples to grow on muskmelon stem. If society has failed to demand for a good and robust system, failed to save them, it should not rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety.

Therefore the quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.

        Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who   secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college.  Even   an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 15-20 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats? Answer to that is simple.  To select and find only those students from millions, who can pay millions to become doctors?  

   If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way  forward.  So children have to be careful while choosing medical careers from the beginning.

NEET Tail-Enders Jump Queue, Grab Medical Seats

    NEET Tail-enders Jump Queue, Grab Medical Seats

MUMBAI: MBBS aspirants who missed out in the initial rounds of seat allotment and pinned their hopes on vacant NRI quota seats have been bested by students at the tail end of the NEET qualifying list helped by NRI sponsors. Overnight, close to 152 aspirants, many of them with ranks in six digits, have submitted documents, including a certificate from the consulate concerned, to prove that their education will be sponsored by an Indian based abroad. Aspirants with much higher scores, who were banking on the addition of vacant NRI seats to the relatively cheaper management quota — the fee differential can be as much as Rs 25 lakh-35 lakh — have been done in by a minor clause in the fingerprint. A medical college in Maharashtra has, in fact, already allotted a seat to a NEET qualifier placed 267th from the bottom in a list stretching into several lakhs. When registration for the all-India mop-up round began on March 10, several Indian candidates had applied to convert to NRI status. The medical counselling committee gave such students time from noon on March 11 to 6pm the next day to change their nationality from Indian to NRI. However, candidates wrote to the NMC asking for their nationality to be converted in the last leg of the admission process, presumably after all other options to secure a seat had been exhausted. “The NMC was forced to open that window. According to a 2017 Supreme Court judgment, a candidate can change his or her nationality at any point,” said Dr Pravin Shingare, former head of the Directorate of Medical Education and Research.  NRI seats, which cost Rs 40 lakh-60 lakh per year — 4-5 times more than those in the management quota — and had no takers until last week, were now suddenly in demand and filled by candidates with rock-bottom scores. At Pravara Institute of Medical Sciences, Loni (Maharashtra), the last management seat was filled by rank 83,817 while the last NRI seat went to rank 8,72,911. At Sri Devaraj Urs Medical College, Kolar, the last management seat was allotted to rank 86,416 and its last NRI seat to rank 8,76,357. This scenario has played out in medical institutes across the country. Rank holder 71,474 had named MGM College as his first choice in the mop-up round. He didn’t get a seat, but a candidate more than 8 lakh ranks below at 8,73,286 has got lucky, thanks to the clause which allows a student to abruptly change his/her nationality in the midst of the admission process. Hence, of the 19 vacant NRI seats at MGM that should have been converted to the general category, according to the NMC notification, not a single one eventually remained vacant.

           Our society fails to develops a robust system of choosing and nurturing good doctors and therefore itself responsible for decline in standards of medical profession. A famous axiom “as you sow so shall you reap” has an application to health system, Government and Public as well in this scenario, so people should not rue scarcity of good doctors.  

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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