eople go to the doctor when they have pain somewhere in the body or some disability has manifested itself. However, often the disorders which are later indicated by outward symptoms start quite early in a painless fashion. For this reason, it is better to subject yourself to regular screening. For example, heart attacks, strokes or visual disturbances are only some of the catastrophic illnesses that start with certain risk factors but without pain, and only regular investigations can unravel these hidden snakes. It is thus very important to investigate yourself periodically. Diabetes, smoking, high lipid levels in the blood, as well as hypertension, are all major risk factors as well as indications for the development of atherosclerosis.
Atherosclerosis, or the hardening of blood vessels, affects all systems in the body and manifests itself with heart attacks, strokes and kidney diseases. The only way to curb the disastrous effects of atherosclerosis, is to subject yourself to periodic investigation. This type of screening is very important for those people who have a family history of this type of chronic disorder.
Further, no sooner than a person has been diagnosed with any chronic illness like hypertension and diabetes, it is very important for both patients and medical staff to study, record and maintain complete information about that particular patient’s disease. Chronic diseases need regular follow up in a hospital in order to detect complications at an early stage. Various interventions can only be undertaken in order to modify or alter the course of an illness, e.g. when proteinuria is detected at an early stage in a diabetic patient, medication like Angiotensin converting enzyme inhibitors can be given in order to retard the development of advanced renal disease in these patients. I is beyond the scope of this book to elaborate on the management of all chronic illnesses, however, I want to briefly write few lines about Diabetes mellitus, bearing in mind its increasing prevalence all over the globe.
Diabetes mellitus is increasing all over the world. It can present with classical symptoms of excessive thirst (polydipsia), excessive urination (polyuria) and excessive craving for food (polyphagia), or else it may present with complications like problems with vision (retinopathy) or kidney diseases (nephropathy) or problems with nerves (neuropathy).
Meticulous control of a patient’s blood sugar is mandatory in order to prevent long term complications. It is therefore necessary for diabetic patients to learn how to monitor their blood sugar themselves, and to be meticulous in attending their regular checkups. Who should get screened for diabetes mellitus? According to the American Diabetes Association, all patients should be screened for diabetes at three-year intervals, beginning at the age of 45, especially people who are overweight or obese. If multiple risk factors are present, screening should be done at an earlier age and more frequently. The U.S. preventive services Task Force recommends that adults with high blood pressure or high cholesterol should be regularly screened for type 2 diabetes (insulin resistant diabetes) in an effort to reduce the incidence of cardio vascular disease.
Various risk factors for the development of diabetes include
• People with a family history of diabetes (parents or siblings with diabetes)
• People who are overweight (with a body mass index equal to or greater than 25)
• Those who are habitually physically inactive
• Race/ethnicity (including African-Americans, Hispanic- Americans, Native Americans, Asian-Americans, and Pacific Islanders)
• History of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)
• High blood pressure (equal to or greater than 140/90 in adults)
• Abnormal lipid levels: HDL cholesterol equal to or less than 35 mg/dL and/or a triglyceride level equal to or greater than 250 mg/dL
• Patients with a history of gestational diabetes or having delivered a baby weighing more than nine pounds
• Patients with polycystic ovary syndrome
The diagnostic criteria outlined by the American Diabetes
Association (ADA) include the following:
• A fasting plasma glucose (FPG) level of 126 mg/dL or higher, or
• A 2-hour plasma glucose level of 200 mg/dL or higher during a 75-g oral glucose tolerance test (OGTT), or
• A random plasma glucose of 200 mg/dL or higher in a patient with classic symptoms of hyperglycemia or
If the screening test for diabetes is negative, patients should continue to have follow-up screening tests every three years or as recommended by their doctor. In addition, you can lower your chances of getting diabetes by losing weight, keeping your blood pressure and lipids at normal levels, and exercising regularly. A positive diagnosis for diabetes may feel shocking to you and your family at first, and one passes through various stages, Nip the Evil in the Bud! the stage of denial being the first stage when the person believes that the test is wrong or the doctor’s advice is incorrect. Millions of people are suffering from this disorder the world over but now, with the availability of better drugs, the complication rates have decreased. Insulin used only to be available for those diabetic patients who could afford it, but with modern technology it is now freely available. The best approach to this disease is to accept the diagnosis, and start educating yourself about it while regularly consulting your doctor, starting your medication, and according to the following guidelines:
a) Target your Hemoglobin A1C (HbA1C) below 7, gives an idea about blood sugar control over 3 months’ period.
b) Estimate lipids and consult your doctor in case your lipid profile results are unsatisfactory
c) Have an annual eye examination to rule out retinopathy and follow the advice of your doctor closely.
d) Have analysis of urinary proteins in a 24hr collection of urine at the time of diagnosis and yearly after. Consult your doctor if urinary protein levels are more than 30mg in 24hr collection. Doctor may prescribe some medication to retard the process of kidney disease.
e) Do not avoid fruit entirely. Diabetics should avoid those few fruits containing high levels of sugars like mangoes etc. but can still eat a variety of fruit in multiple servings.
f) Oil and rice must be taken in minimum possible amounts.
g) Regular exercise is crucial for diabetics. Exercise has an insulin sparing effect, as glucose enters exercising muscles without insulin. Before exercise it is necessary to ensure that a diabetic patient has taken adequate amounts of recommended food.
Screening for Cancer Checking for cancer (or for conditions that may become cancer) in people who have no symptoms is called screening. Screening can help doctors find and treat several types of cancer early. Early detection is important because when abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread and it becomes an uphill task for the patient, relations and the treating physician. Several screening tests have been shown to detect cancer early and to reduce the chance of dying from that cancer.
The results of screening have been found dramatic. In a report published by the National Cancer Institute in the USA, the estimates of the premature deaths that could have been avoided through screening vary from 3% to 35%, depending on a variety of assumptions. Beyond the potential for avoiding death, screening may reduce cancer morbidity since treatment for earlier-stage cancers is often less aggressive than that for more advanced-stage cancers. There are seven warning signs of cancer described in the literature, based on published reports and various studies.
1. Changes in bowel or bladder habits
2. A sore that doesn’t heal
3. Unusual bleeding or discharge
4. Lumps or thickened areas in the breast, testicles, or elsewhere
5. Indigestion or difficulty swallowing
6. A change in the size, color, shape, or thickness of a wart, mole, or mouth sore
7. Cough or hoarseness that doesn’t go away
The following symptoms may also signal some types of cancer:
• Persistent headaches
• Unexplained loss of weight or loss of appetite
• Chronic pain in bones or any other areas of the body
• Persistent fatigue, nausea or vomiting.
• Persistent low-grade fever, either constant or intermittent
• Repeated infection
Always consult your doctor in the event that the above symptoms are present and follow their advice. The doctor may advise you certain tests depending upon his clinical suspicion and the test may vary as follows
a) Direct or assisted visual observation is the most widely available examination for the detection of cancer. It is useful in identifying suspicious lesions in the skin, retina, lip, mouth, larynx, external genitalia, and cervix.
b) The second most available detection procedure is palpation to detect lumps, nodules, or tumors in the breast, mouth, salivary glands, thyroid, subcutaneous tissues, anus, rectum, prostate, testes, ovaries, and uterus and enlarged lymph nodes in the neck, axilla, or groin.
c) Internal cancers require procedures and tests such as endoscopy, x-rays, MRI, or ultrasound. Laboratory tests, such as the Pap smear or the Fecal occult blood test have been employed for detection of specific cancers.
Studies have shown that some people have a higher risk of cancer development and they need to be extra cautious. One of these indications is when the patient has a strong family history of cancer (in two or more first-degree relatives); increasingly, as genetic mutations and polymorphisms are found to be associated with specific cancers, high-risk individuals can be identified through genetic testing. Amongst common cancers, colon cancer screening has been found to be a very important factor in affecting the prognosis and survival. A joint guideline developed by the American Cancer Society and the American College of Radiology recommends that screening for colorectal cancer and adenomatous polyps should start at the age of 50 in asymptomatic men and women. In addition, individuals with any of the following colorectal cancer risk factors should
undergo colonoscopy at an earlier age, and more frequently han average risk individuals:
1. Those with a family history of colorectal cancer or polyps
2. Those with a family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)
3. Those with a personal history of chronic inflammatory bowel disease (ulcerative colitis or Crohn disease). The patients with ulcerative colitis are prone develop malignancy and it depends upon the extent and duration of the disease. The patient must have regular colonoscopy for the early detection of these cancers.
Vaccination has prevented lot of communicable diseases in children, and then, of course, the adults they grow up to be. Consult your doctor about which vaccinations they should have and keep them up to date. However, we must make sure that we have our children vaccinated in places where there are proper facilities for vaccine storage. Vaccines lose their potency unless they are stored at a constant temperature. Vaccination against Hepatitis B prevents the development of chronic liver disease and subsequent liver cancer. (In addition to this, of course, it is necessary to avoid unnecessary exposure to drugs, injections, or unsafe sexual practices in order to avoid liver damage.)
“The difference between a successful person and others is not
lack of strength not a lack of knowledge but rather a lack of will.”
– Vince Lombardi
Link to purchase book https://sites.google.com/view/bumpy-roads/home
Author is a MD. DM (Gastroenterology) FACP, FACG Consultant Gastroenterologist & Associate Professor at Yenepoya University, Mangalore. He can be reached at email@example.com