Diabetes Mellitus

By: Dr. George I. Traitses

Diabetes is a severe health condition that can cause life-altering and even life-threatening problems, such as slow wound healing and nerve disorders. It can also complicate problems in muscles, bones, and joints.

Diabetes results from an excessive buildup of glucose in your bloodstream. Glucose, or blood sugar, which the body gets from food and also manufactures in the liver and muscles, is a substance the body uses for energy and nutrition.

To control glucose levels in your blood, the body uses insulin, a substance produced by the pancreas. An imbalance in this system can cause pre-diabetes or diabetes. In most people, normal blood glucose levels are usually less than 6.1. The levels vary depending on the time of day and how long it has been since you’ve eaten. Levels can go as high as 7.8 within 2 hours after a meal.

Pre-diabetes is excess blood glucose that is not severe enough to be called diabetes. The mild-to-moderate abnormal blood glucose levels of prediabetes can make you more likely to develop type 2 diabetes, stroke, and heart disease.

Types of Diabetes

There are two main types of the disease.

Type 1 diabetes, formerly called juvenile or insulin-dependent diabetes, usually begins in childhood to early adulthood. It results from destruction of insulin-producing cells in the pancreas. When the body destroys these cells, insulin levels in the blood become too low to properly manage blood sugar.

Type 2 diabetes is also called adultonset diabetes or non-insulin-dependent diabetes. This condition results from insulin resistance—the inability of body tissues to properly utilize insulin produced by the pancreas. The pancreas compensates by producing more insulin, but eventually it cannot keep up with the demand, especially after meals. Obesity, poor diet, and lack of exercise predispose you to developing type 2 diabetes.

A less common form of the disease is called gestational diabetes. It occurs, secondary to hormonal changes, in pregnant women during the late stages of pregnancy and usually resolves after the birth of the baby. It is important to remember, however, that gestational diabetes makes a woman more likely to develop type 2 diabetes later in life.

Managing Glucose Levels

With diabetes, uncontrolled glucose levels can lead to serious problems with vision, kidney function, nerve dysfunction, and blood vessels, including heart attack and stroke. In fact, people with diabetes have approximately twice the risk of stroke and heart attack faced by the general public.

In a nutshell, to manage glucose levels, you should exercise regularly, eat a healthful balanced diet, and maintain a healthy body weight. Physical activity helps control blood glucose levels in both healthy adults and in diabetics. Aerobic exercise, such as walking, swimming, dancing, and riding a bicycle, appears to be most beneficial.

What that does is raise your heart rate, helping to not only control blood glucose but also prevent heart attack and stroke. You can get some exercise by house cleaning or doing yard work, such as gardening. Physical activity helps diabetic patients maintain a healthy body weight, helps insulin lower the blood glucose levels, and gives patients more energy. Before you start an exercise program, consult with your doctor to make sure that the exercise program is tailored to fit your specific needs.

It’s also important to eat foods that are generally low in fat—and when fats are eaten, aim for “good” ones, such as those found in olive oil, fish, and other products.

Signs and Symptoms

The most common signs and symptoms of

diabetes are:

• excess thirst

• excess urination

• excess hunger

• fatigue

• losing weight without trying

• sores that heal slowly

• dry, itchy skin

• loss of feeling or tingling in your hands and/or feet

• blurry eyesight

If you experience any of these symptoms, you should seek treatment as soon as possible. Early diagnosis can play an important role in managing the disease and preventing multiple problems. Not all of these signs and symptoms need to be present in patients with diabetes. In fact, it is not uncommon to have diabetes with no apparent signs or symptoms.

Youth Connection : Preventing “text neck”

Cellphone and Health Concerns .

Preventing “text neck” By: Dr. George I. Traitses 

In the last issue of the Caribbean Xpress we gave you an article on Blackberry Thumb.

Too much texting caused some people to come down with painful Blackberry Thumb. Now today’s technology is being blamed for another malady: text neck. 

Canadians sent 110 billion text messages this past year.

According to the Canadian Wireless Telecommunications Association, 56.4 billion texts were sent in Canada in 2010, up 60 per cent from the 35.3 billion sent the previous year.

As technology advances, allowing us to do more tasks on smaller equipment, our bodies often pay the price.

Texting is an easy to get away with in certain situations. Kids text right under the noses of their teachers during school hours. Most of these kids are so good with their keyboards that they don’t even have to look at the device while composing and sending a message. Text messaging has become so much a part of teenagers’ lives that 87 percent of those who text said that they sleep with – or next to – their phones.

With a growing potential for injuries from technologies that we rely on, it’s important to minimize the risks. One problem that is becoming more prevalent is neck strain from the over-use of mobile devices, or “text neck.” What Causes Text Neck? Text neck is caused by poor posture when using a mobile device. It’s all too common to become hunched over with your head drooping forward and your shoulders rounded as you become engrossed in your messaging or games.

How to Avoid Text Neck
. • Sit up straight with your chest out and your shoulders back.
• Bring your arms up in front of your eyes so that you don’t need to look down to see the screen.
• Tuck your chin into your chest to look down rather than dropping your head forward.
• If you must use your mobile device for lengthy typing, invest in an external keyboard.
• Rest your forearms on a pillow while typing to help minimize neck tension.
• Avoid using mobile devices while in bright sun light. Straining to see the screen leads to jutting the chin forward, shifting work from the spine to the muscles that hold up the head. The best way to avoid text neck is to limit the use of your mobile device. If you need to send a longer e-mail, wait until you have access to a computer or consider calling the person rather than texting.

Stretches for Frequent Texters
• Hand stretch. Start with your hands in a fist and stretch your fingers out as wide as they’ll go and then return to a first. Shoot for about 10 stretches with each hand. For added resistance you can stretch a rubber band around your fingers.
• Squeeze a stress ball. Do this for approximately 30 seconds for each hand.
• Chest stretch. To counteract the hunched posture of texting, stand up straight with your arms down at your sides. Turn your forearms until your thumbs are pointing at the wall behind you.

Are more doctors instituting annual patient fees?

An increasing number of primary-care physicians are hitting their patients with a new charge: an annual “administrative fee” of $100 to $300 to help them defray the costs of running their practice.

It’s not not clear how many doctors are charging extra fees, but the number seems to growing -- as are the
fees, say health critics.

And some practioners do seem to be taking things to extremes. A Toronto doctor will face a disciplinary hearing for charging patients a $1,000 a year to receive care. And there are those collection agencies.

There are now at least four companies specializing in helping doctors collect annual fees from patients, according to the Canadian Medical Association Journal.

According to official guidelines, legitimate fees generally cover the amount of time doctors or their assistants spend giving medical advice over the phone, e-mailing patients, providing sick notes, maintaining medical records, renewing prescriptions and tallying missed appointments.

Sounds fair, after all no one works for free, and you could end up paying less than you would in an ad hoc arrangement, say doctors.

But, “in some cases, it’s going far beyond the ostensible reason doctors need to charge fees and it’s about a separate income,” says Natalie Mehra, director of the Ontario Health Coalition.

Patients feel compelled to pay annual fees to ensure that they continue to have the services of a doctor, Mehra adds. “Patients think: ‘If I don’t pay this, am I going to lose my family doctor?’ Or: ‘Am I going to be dropped to the bottom of the list’?”

Is that how you feel? Are you paying annual fee? What happens to this money at the end of year if you don’t need these services?

YOUTH CONNECTION : “BlackBerry Thumb”

Like many young people today, I own a BlackBerry and can say (from experience) that it is harder than you think to put down or to not use it for a long period of time.

It has the convenience of everything being in one place: BlackBerry Messenger, Facebook, Twitter, the  Internet, Maps, and hundreds of apps.

Even though it is one of the most popular devices today it does, like everything else, lead to health problems.

I found some information that was very enlightening that may help your “BlackBerry addiction.”

BlackBerry thumb is a neologism  that posits a form of repetitive strain injury caused by the frequent use of
the thumbs to press buttons on PDAs, smart phones, or other mobile devices. The name of the condition  comes from the BlackBerry, a popular brand of smartphones that debuted in 1999.

Part of the rationale is that the thumb does not have the dexterity that the other four fingers have, and that it is especially common in those who use these devices for such activities at high speeds comparable to that of touch typing.

Who Gets BlackBerry Thumb?
Together with several other repetitive stress injuries that are showing up in this fast-paced, technology-focused era is a malady known as BlackBerry thumb. Actually, we can overuse any personal digital assistant (PDA), resulting in tenderness or pain in the thumb, the base of the thumb, and wrist.

Red flags that signal a need to change how we use PDAs, and possibly a need to consult with a qualified health care professional, are occasional aches in any or all of those areas. Left untreated, BlackBerry thumb
can develop into severe pain, weakness, and even disability.

What Causes It?
BlackBerry thumb is the result of asking the thumb joints to repeatedly perform the same action too often. Excessive tapping, flicking, and clicking do thumbs no favors. Some sports enthusiasts make themselves “work through the pain.” They believe that by pushing the body beyond its current limits, it will gradually become accustomed to new demands placed on it. That approach does not work with joints. And since BlackBerry thumb is a joint problem, forcing thumbs to go above and beyond will only lead to further trouble.

What Are Some Typical Treatments?
Treatment typically consists of resting or splinting the thumb. Medical doctors may suggest anti-inflammatory
medicines, cortisone injections, and, as a last resort, surgery.

What Might a Doctor of Chiropractic Suggest?

Doctors of chiropractic are educated to use a variety of non-drug, non-surgical approaches to BlackBerry thumb. Giving your thumbs a chance to start the healing process may include a program of rest, thumb strapping, and gentle stretches or targeted massage. A DC may decide to use Instrument-Assisted Soft-Tissue Mobilization (IASTM) to help alleviate the problem. One of the better-known such techniques
is Graston Technique®, which utilizes stainless steel instruments in the hands of practitioners skilled at
treating damaged soft tissues. Certain nutritional supplements can help in the inflammation and swelling.
 
How Is It Diagnosed?
X-ray and exam findings can determine if a patient has BlackBerry thumb.

What Can I Do To Help Myself?
Whatever we might wish them to do, doctors cannot simply make BlackBerry thumb “go away” without the cooperation of the patient. Moderation and flexibility in how we use PDAs are key. When it comes to BlackBerry thumb, the following tips can make our PDAs do what they were designed to do: serve us, not hurt us:

- Avoid typing for more than three minutes without a break.
- Hold the PDA comfortably and close to the body.
- Insert it into a holder and set it on a desk or a briefcase.
- Turn the device off on weekends or  at least on Sundays.
- Decide that you will check emails and text messages just four times a day.
- Cut back on the number of keystrokes and keep messages short and simple.
- Abbreviate.
- Consider using the AutoText feature.
- If a message must be longer, use your computer keyboard, not your PDA.
- Practice using other fingers for typing especially when thumbs hurt.
- If thumbs are in pain, use a thumb or wrist support.
- Pay attention to your grip. Keep wrists upright and straight.
- Don’t slouch while texting. Slouchers often develop neck pain, in addition to thumb pain.

7 year old Sarah’s last dance

Sarah Ohid

Little Sarah Ohid seemed energetic and exuberant as she sang her favourite song and danced at her home last week, while already afflicted with the  dengue virus that would kill her days later.

Mourners at her funeral service yesterday at the family home at Crissy Street, Block Five, Palmiste, San Fernando, were shown a 30-second video of the girl, captured by relative Mark Ohid.

Those 30 seconds were the only time that tears were replaced by chuckles of laughter at the funeral service.

During his remarks, Ohid paid special tribute to Sarah, playing her favourite song “Who says” by Selena Gomez, with the words of the chorus, “I’m no beauty queen, I’m just beautiful me”.

Sarah, who was born on Christmas Day, 2003, died early morning on Saturday September 17 after falling ill last Monday with fever, diarrhoea and vomiting.

The Standard Two pupil of the San Fernando TML Primary School stayed home from school that day and her parents sought medical attention at a private doctor, who had ruled out dengue haemorrhagic fever.

She returned to school on Tuesday September 13 and Wednesday September 14, but by Thursday her condition deteriorated.

her mother, Sherry Ann, took her for treatment at a nursing home, and when a test confirmed she had dengue, she was transferred to the San Fernando General Hospital.

She arrived at the San Fernando General Hospital in shock, and doctors said they fought to save her life. However, she passed away after six hours.

Her father, Kelly, a project engineer, said that before the illness she was a healthy child.

Also attending the service were members of the Cub Scouts from her school, of which she was a member. They placed pink and white roses in her casket and her cub scout leader placed an honorary scarf on her body.

Two pictures of Sarah were placed near her casket, with brightly coloured flowers and wreaths next to them.

A neighbour, Keith Ramdass, said Sarah had told him she wanted to be a housewife, and was passionate about cooking. “She was very polished,” Ramdass said. “She had the quality to be a statesman. She was very graceful. She was charismatic. Even if you didn’t know her, you would have found it in your heart to love her”.

Pastor Clyde Ramlochan, in delivering the sermon, told mourners that although she was a child, she had impacted on the lives of many persons, not just her parents.

Ramlochan said: “Remember parents, children are an inheritance from the Lord. Sarah was an inheritance and a reward from God. Those who see them as a distraction and a nuisance should see them as the future”. He appealed to parents to “introduce our children to God, to Jesus. Let us bring them to where they can find God so that there will be a change in Trinidad and Tobago”.

Sarah was buried at the Cap-de-Ville cemetery, near Point Fortin.

Fuad: “I did no wrong”

Dr. Fuad Khan

Health Minister Dr Fuad Khan yesterday declared he has not broken any law or compromised his responsibilities by continuing to function in his private capacity as a urologist.

Khan made this statement yesterday as Opposition Leader Dr Keith Rowley criticised his actions and Local Government Minister Chandresh Sharma defended him.

In a statement, Khan said he was called to serve in the Cabinet at short notice.

“This request came at a time when the health sector was in crisis and it was my belief that given my experience as a medical doctor, my knowledge of the system, my proficiency in management, coupled with my background in mediation, I possessed the requisite skills to make a positive impact on the system, to enforce change to bring about a vastly improved public health care for the benefit of all citizens,” Khan said. “It was on this basis that I accepted the call to serve.”

Khan said he informed his patients he would be suspending his medical practice because of his ministerial responsibilities. He also advised his patients to seek other urologists for assistance but was already overwhelmed with requests to conduct surgeries which he had already committed himself to.

In light of this, Khan said he felt it was appropriate for him to continue to clear the backlog of patients who were already scheduled for surgery under his care.

He proceeded to conduct surgeries on Saturdays and saw patients after  4 pm on Tuesdays. Stating neither of these activities compromised his ability to function as Health Minister, Khan said he has been advised by his lawyers he was not in breach of the Integrity in Public Life Act.

“One cannot expect me as a medical practitioner to abandon my patients at the stroke of a pen and while some have expressed some ethical concerns in this matter, I can assure the public that my responsibilities as minister have not been compromised in any way,” Khan stated.

Rowley said it was unacceptable for Khan to continue his private practice following his appointment as Health Minister on June 26. Referring to a media report which quotes Khan as saying he did not inform Persad-Bissessar he was continuing his medical practice at the St Augustine Private Hospital, Rowley recalled he had warned the country that this could happen when questions were raised about whether it was appropriate for Jack Warner to simultaneously serve as a Cabinet minister and FIFA vicepresident.

Rowley said under the PNM, no health minister was allowed to undertake any action outside of their remit at private or public hospitals.

Sharma said he did not see any issue where Khan was concerned.

Sharma said his understanding was Khan was in the process of transferring his patients to other doctors.

Foreign Affairs Minister Dr Suruj Rambachan did not offer any opinion on Khan’s case but observed traditions outlining how government ministers conduct themselves have been long established and those traditions must always be practiced.

Finance Minister Winston Dookeran and Housing Minister Dr Roodal Moonilal declined to comment on the matter.

Persad-Bissessar said she had told Khan, a urologist, that not only was such behaviour inappropriate, but “it was untenable”.

In a release, Khan, the MP for San Juan/Barataria, stated his decision to cease his private medical practice.

Following is the statement:
“I have decided in essence to put my country first! We are in crucial times and each and every one of us must take responsibility for the direction in which we want our nation to develop. I love my country, and if this is the best  way I can serve, I stand ready, willing and able to answer that call. I now urge every citizen to work with me as we transform the public health sector.”