All About Positive Health

One day, I was consulted by a frightened patient and her relatives for bleeding from mouth. Her mouth was full of blood and hardly she could speak. Foul smelling odor was coming out of her mouth. No one could volunteer the cause of this bleeding. This is perhaps generic to India and particularly to Orissa; where doctor has to diagnose without much lead from the patient. Anyway, I thought it to be perhaps due to gingivitis, an inflammation of gum; which is much more common here. I examined the mouth with much difficulty as the patient could hardly open it; and saw a bleeding mass in the hard palate. The lady, as usual in rural Orissa is habituated to tobacco and on further inquiry she admitted that the lesion is of long duration. That was provisionally diagnosed to be a cancer of hard palate. Tobacco is the main culprit.

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Piles, medically called as hemorrhoid is a very common disease. It occurs more in female than male. It is probably the award to human race for adaption of erect posture, as quadrupeds do not suffer from this disease. Piles, as such occurs due to various local factors, mainly a cushion defect in the vascular bed of rectum and anal canal. But, there are some diseases which present as piles. Common amongst those are:

• Cancer Rectum and Colon
• Portal Hypertension

Cancer of rectum and colon: Many times the clinicians avoid digital rectal examination and presume that the bleeding from anus is from the simple piles. That is why, it is said that” If the clinician has not put his finger inside, he may put his foot in it”. This shows how much vexing it is, if not carried out. Many great surgeons have missed the diagnosis and operated as simple piles leaving the underlying disease intact. Rectal cancer may present as painless bleeding from anus. As the tumor grows there occurs some obstruction to the venous flow resulting in engorged anal veins, apart from it there may be direct bleeding from the tumor itself. Multiple polyposis is a predisposing cause among many others. Non-vegetarian diet, especially meat consumption is associated with colon cancer. Vegetarian diet, fiber in diet, aspirin, metformin and regular exercise may have some protective effect.
Portal Hypertension: This disease is rather a complication of cirrhosis of liver. Here, there is obstruction to free flow of blood from lower extremities through the liver; and alternative channels open up for the flow of blood to the heart. In that way an alternative channel opens up in the rectum and anal canal, in addition to other sites; the veins become engorged resulting in bleeding from the anus. Cirrhosis of liver may result from chronic hepatitis, commonly hepatitis B and C; amongst other causes alcoholic cirrhosis, biliary cirrhosis and aflatoxin poisoning are some of the common causes.

So, for any bleeding from anus a simple examination like digital examination should not be skipped.

In Indian mythology, there was a story related to the worship of Sun God. Samba, son of Lord Krishna was cursed to suffer from leprosy due to some evil act of his. He realized the mistake and sought the remedy. It was suggested to him that, only Sun God had the power to heal that disease, and he should make the god happy by prayers to get his blessings. He followed that and got cured. Whatever might be the behind story, it goes without saying that sun rays have much more implications in our lives, than originally thought of.

It is the sun rays, which helps in the synthesis of vitamin D from cholesterol in our body. This vitamin is not available in plenty in our day to day food. Vitamin D is converted to the active form in the kidney and help in calcium metabolism. In its deficiency, one may suffer from rickets to osteomalacia etc.. This was the traditional teaching about the utility of this vitamin.

Now more informations are pouring in regarding its role in human life. Researchers have found that this vitamin along with calcium maintain the integrity of cells of human body. The regulation of multiplication of cells, autonomy of cells and inhibition of unwanted growth like cancer are managed by vitamin D. Low level of it may be associated with cancer of breast, ovary, prostate and colon etc.. A higher level at about 40-60ngms/ml may actually prevent these cancers. This is very interesting development and further study will enlighten more about its role in cancer prevention.

That is why, now-a-days outdoor activity is encouraged in the school curriculum. Let us go outdoors to prevent these aggressive cancers for free.

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One of the most slow growing cancer is prostate cancer.The symptoms are indistinguishable from the benign prostate enlargement.The patient may have symptoms due to obstruction of the lower urinary tract and/or irritation of the same. The symptoms all together called prostatism.

One may have

• Frequency of urination especially at night called nocturia making him almost awake throughout the night.
• Slow start of urination i.e.patient has to patiently wait for the urine stream to start, called hesitancy.
• Patient may not be able to postpone an urge for urination called urgency.
• Precipitancy is fall of a few drops of urine before the person finds a suitable place to pass urine.
• A narrow stream of urine.
• Longer time taken to pass urine.
• A sense of incomplete evacuation of bladder.
• At a later stage may come with acute retention of urine.

• Burning urination may occur.

If these symptoms are seen one has to undergo examination for prostate disease. A simple per rectal digital examination will reveal many information. An enlarged, hard,painless and irregular prostate indicates towards cancer. There are a battery of investigations to confirm cancer.They are

• An ultrasonogram.
• CT scanning.
• Plain x-rays of hip and vertebra.
• Plain x-rays of chest.

Blood tests particularly for prostate cancer are

• Prostate specific antigen
• Acid phosphatase
• Alkaline phosphatase

important apart from routine blood tests.

Tissue diagnosis is an important aspect of confirming cancer of prostate.It is done by

• Fine needle aspiration cytology.

A tissue sampling for heat shock protein-27 is under research to predict the aggressive nature of the disease.It is because some prostate cancer are so slow growing that the patient may pass away from an unrelated condition rather than from prostate cancer.

Many treatment options are available.They are

• Surgery.
• Hormonal manipulation.
• Chemotherapy.
• Radiotherapy in case of bone metastasis.

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The tags attached to the disease are fat,fertile,fifty and female are not absolute.It is said for gall stone disease.This disease gives rise to pain in the upper mid-abdomen.Other tags attached to it are flatulent dyspepsia .Some other diseases may be associated with it namely a hiatus hernia , diverticulosis of colon or pancreatitis.

Typically pain comes after a fatty meal.Other symptoms are vomiting ,loss of appetite,jaundice and fever .If associated with other diseases their symptoms also manifest.Gall stones form in a diseased gall bladder,supersaturated bile and infected biliary system .It is prevalent in a areas prone for malaria  and haemolytic diseases such as sickle cell disease.It is said that “Every   gall tone is a tomb stone erected to the memory of bacteria living or dead within it”.

The stones  are of a few types namely a cholesterol stone,a pigment stone or a mixed stone.The inflammation of gall bladder is called cholecystitis.It may occur with a gall stone when it is called a cholelithiasis with cholecystitis . when cholecystitis occurs without a gall stone is called an acalculus chilecystitis.Complications do follow a long  standing cholecystitis.They are gangrene of gall  bladder,pancreatitis,perforation of gall bladder,stone migration  to common bile duct and it’s obstruction, stone obstruction of intestine and  pus in gall bladder to name  few.It  may become associated with a cancer of gall bladder  also.

Medical treatment for small cholesterol stone may become effective.Nevertheless surgery is indicated for it’s cure.A laparoscopic approach is the gold standard treatment now-a-days.

Patient  comes with a swelling on his body to a doctor which has been there for along period.Many swellings are seen on the body surface which have to be differentiated  from each other .A lipoma  is a swelling on the body surface.This is painless,no pain on pressure,can be pushed in different directions to a little  extent and soft to firm. And some amount of fluctuation as observed in fluid containing cavities can be elicited. This is not an actual fluctuation,  called a pseudo-fluctuation .It grows in size over the years without much problem except a disfigurement. It can grow in any site but commonly in the neck region ,forehead and abdomen are affected.It also can be seen in the body cavities and near vital areas can to cause problem  due to pressure.

It is a benign tumor of fat cells .Can be diagnosed basing the on the above findings.A fine needle aspiration  cytology will clinch the diagnosis. An ultrasonogram is also helpful.Lipoma very rarely may turn to malignancy called a Liposarcoma.One important feature of this tumor is that it burrows into the surrounding tissue if not capsulated.But many times it is capsulated.

Surgical removal is the answer under local,regional or general  anaesthesia.Recovery is uneventful and recurrence is usually not seen.If tumor tissue incompletely removed from holed up locations fear of recurrence remain.

One patient came to me in great distress with hiccup,pain in the abdomen and inability to stand. Apart from this ,patients present to a doctor with complains of vomiting of stale food some hours or  days of  taking food.There is loss of appetite ,weakness,malnutrition,hiccup and desire to induce vomiting to get relief from pain.

These are the cardinal symptoms of obstruction to passage of food from stomach called Pyloric obstruction/Duodenal stenosis.Causes are varied.Important common cause are development of stenosis after a benign duodenal or pyloric ulcer,a cancer obstructing the passage from stomach and a foreign body such as leaves or hair ball(eaten) seen in psychotics.After invent of stomach acid suppressing drugs these cases are seldom seen.But the patient in question was a road side vendor with irregular and bad eating habit.The patient said that he is in empty stomach .So to find out the cause in hope of some interesting findings the endoscope was put. Read the rest of this entry »

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The advertisements given in the media are often very attractive and surpass the scenes from the cinema.In India various type of such advertisements are seen .The TV and Newspaprs take the lead.The adds range from cancer cure to  a quick weight loss and many more.The desperate persons especially with medical problems fall victim to it.Consequently they are exploited.I do not know the status in foreign counties.But I hope there might be a system in place to assess the credibility of the facts to be advertised.Sometimes the media  shifts the responsibility with a foot note that they do not endorse the credibility of the matter advertised and advice the watchers to verify the same.

But is it possible for a common man in India to ascertain the truth in it ? A lot of frauds are also  seen in financial and education sector.Will it not be possible to set up a mechanism to verify the correctness of the facts before they are advertised ?

Food grains such as groundnuts,maizes and parboiled rice may get infested with fungus.This, if occurs because of Aspergillus Flavus poses a health risk.One toxin called Aflatoxin is produced by it.Aflatoxin B1 is linked to serious diseases and deaths in India .Ingesting these contaminated grains may cause serious liver disease i.e. hepatoma, a cancer of liver or cirrhosis of liver.
Increased moisture and humidity facilitates fungus growth.The food grains must be stored dried and moisture content be below 10%.If contamination is noticed the food should be discarded.

A molecule of aflatoxin.

Aflatoxin B1

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          After creation of the universe , the God of Destruction “Lord Shiva” ordered His godly carrier a bull “Nandi” to go to Earth and convey the inhabitants that they will take food one time in seven days.Nandi went uttering and remembering the order loudly in the fear of forgetting it.But the worst happened , he reached the earth only to announce that Lord Shiva has ordered the inhabitants to take food seven times a day.And that was totally reverse.Then he returned to heaven to convey Lord that His orders has been communicated.Knowing the totally reverse communication God became angry and said that as the bull has done the mistake he will  do  the cultivation of land  for human to produce  the huge quantity of  food that will be required .And since then the bull is doing the hard work for mankind.
      Whatever may be the folk tale the fact is that human has got a good appetite for food.It may be lost in various occasions starting from a trivial fever to more dreaded  cancer.

          Loss of appetite is different from anorexia many times used as synonym.Loss of appetite means there is no feeling of hunger and anorexia means there is hunger but no desire to take food.One feels hungry by the site , smell or at the usual time of taking food.So it is essentially centrally controlled .There is a center for appetite and satiety in the brain which regulate intake of food.

       Apart from minor and temporary causes of loss of appetite ,there are more important causes for loss of appetite and anorexia.One condition called Anorexia Nervosa  seen in young and adolescent  ladies where there is anorexia probably due to hormonal imbalance.Here the patient does not take food and becomes bony thin.This gets cured by hormonal support and assurance .

Image by *jen via Flickr

     Next important cause is old age ,here the taste buds of tongue gets destroyed , there is no taste of food and consequently the person does not want to take food.Vitamin supplementation relieves it to some extent.
     Gall bladder disease,liver disease and disease of pancreas can cause loss of appetite.

   Loss of appetite with new found anaemia in old people points to cancer of stomach.Any cancer can be a cause  loss of  appetite.
  There area host of other causes.

                   Diagnosis and treatment depends on the cause.