Health news blog

Signs and symptoms

Tenderness without swelling at the edges of the kneecap usually indicates that the cartilage on the underside of the kneecap has been bruised and softened (chondromalacia). Swelling of the knee joint-fullness on both sides of the kneecap- indicates inflammation in the joint or an internal injury. Diagnosing the cause of knee pain depends upon the patient’s history, the presence or absence of symptoms, and upon the location of pain.

Home care

Treatment depends upon the problem, but usually – as in Osgood-Schlatter’s disease – it involves limiting your child’s activities. For two to four weeks, or until the swelling and tenderness are gone, the knee must not be bent; if the knee is not bent, it follows that it cannot be forcefully extended. From the child’s point of view, this rules out two-legged stair climbing, bicycling, running, and jumping. An elastic knee support can be a helpful reminder that the knee needs rest during this period of healing. Treatment of chondromalacia involves the temporary limitation of strenuous activities like track, trampoline, football, and soccer.

Precautions

• Swelling of the knee joint may be serious; it requires a doctor’s attention.

• If one knee cannot be straightened to match the opposite knee, fluid (blood or the serum that remains after blood has formed a clot), or pus has probably accumulated at the joint; the knee should be seen by a doctor.

• The child should not put weight on a swollen knee until it has been seen by a doctor.

• Remember that knee pain may be a sign of a hip problem.

Medical treatment

The doctor will make a thorough, detailed examination of each part of the knee and leg and check the range of normal and abnormal movement. The doctor may order X rays of knees and hips. Sometimes, an arthrogram, which is an X ray taken after a special opaque fluid has been injected into the area, will be necessary. The opaque fluid, which can be seen on the X ray, outlines the interior of the joint. Swelling, accumulation of fluid, and distortion or injury of parts of the joint can then be seen. The doctor may also require tests of fluid drawn from the joint. Depending upon the diagnosis, treatment of knee pain may include bed rest, antibiotics, a cast, crutches, or surgery.

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What is it?

An allergic condition affecting one person in ten in which the sufferer overreacts to pollens, moulds or spores in the air.

Hay fever-a seasonal form of allergic rhinitis-is really an inflammation of the nasal passages. The sufferer complains of sneezing, an itchy, blocked or runny nose, itchy eyes (which may also be red, watery and sensitive to light) and an itchy throat.

The condition can easily be confused with perennial allergic rhinitis which occurs year-round and is caused by an allergy to house-dust mites which live in carpets and bedding. Some people who appear to have allergic rhinitis are in fact sensitive to the weather, a deodorant spray or indeed one or more of many other things. This is not a true allergy but simply oversensitivity.

Most people who have hay fever start having trouble before the age of 15 and some grow out of it. Hay fever, like all allergies, tends to run in families. You don’t need to live in the country to be troubled with hay fever but if you live at the seaside you will be protected to some extent by winds that are pollen-free coming off the sea.

What causes it?

• An oversensitivity to pollens, moulds or spores. Tree pollens are most plentiful in April and May; grass pollens in June and July; and moulds and spores in August and September.

• Allergies run in families. We can’t choose our parents but a couple one or both of whom has a family history of allergy can take certain steps to reduce the chances of their children suffering from allergies.

Prevention

• Do all you can to avoid producing allergic children.

• Take preventive medications prescribed by your doctor or have a series of desensitizing injections. Discuss these with your doctor.

• Try an ‘alternative’ therapy. Homoeopathy, acupuncture and hypnotherapy all claim to prevent hay fever.

• Buy a car that has a ventilation system that can filter out pollens.

Only one European car does this (Saab). Sneezing when driving can be very dangerous because if your eyes are shut for half a second, say at 60 mph, you will travel ‘blind’ for 44 ft.

• If you have to drive start early in the day or late at night when pollens are not so plentiful in the cool air. Keep your car windows shut and the ventilators closed.

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Fibrates

Fibrates, such as gemfibrozil (Lopid) and clofibrate (Atromid-S), do not substantially lower LDL and are used more often to lower triglycerides. Clofibrate is used less today because it was associated with considerably increased general mortality in the World Health Organization Cooperative Trial even though it reduced coronary events by 25 percent. Although the Helsinki Heart Study showed a significant reduction in coronary heart disease with gemfibrozil, it may increase the number of deaths due to cancer. Gemfibrozil is associated with gallstones, hepatitis, and myositis (painful, inflamed muscle tissue). Combined with lovastatin or pravastatin (see the following section), gemfibrozil can cause life-threatening muscle destruction and subsequent kidney damage.

Statins

Statins block the liver enzyme for cholesterol synthesis, HMG-CoA reductase. LDL levels fall be 20 to 45 percent, depending on the dose, and triglyceride levels are slightly decreased, while HDL levels may increase slightly.

Lovastatin (Mevacor) was the first, then simvastatin (Zocor) and pravastatin (Pravachol) were introduced. Despite occasional gastrointestinal side effects, they are considered well-tolerated drugs. You may want to take them at night, the peak period of cholesterol synthesis.

People using these drugs are warned about possible liver inflammation, and their liver enzymes are measured periodically. If you take gemfibrozil along with a statin, your chances of severe myositis and muscle and kidney damage may be increased beyond any benefit of lowered cholesterol.

Marine triglycerides

Researchers speculate that a diet rich in omega-3 fatty acids can prevent or delay atherosclerosis and thrombosis. Saltwater fish such as mackerel, herring, sardines, trout, and salmon contain these omega-3 fatty acids. The Inuit people, whose dietary protein is supplied from marine animals and fish, have a very low heart attack rate.

While doctors regard increased consumption of these fish as pru¬dent, they fear the administration of high-dose supplements may in¬crease gastrointestinal side effects, allow unwanted bleeding, and reduce inflammatory or immune responses. The use of omega-3 fatty acids to prevent restenosis (when the new artery closes off) in patients having angioplasty remains controversial because clinical trials have generated conflicting results.

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Dr. Gareth Beevers, of Dudley Road Hospital, Birmingham, England, is highly respected internationally for his work on high blood pressure. His review of thousands of people with high blood pressure showed a very strong link between alcohol consumption and high blood pressure. The more people drank, the higher their blood pressures were.

This finding flew in the face of the accepted wisdom on alcohol. After all, a substance that opened up blood vessels would be expected to lower pressure, not raise it. Dr. Beevers showed that the pressure-raising effect was due to a direct action of alcohol on the heart muscle itself, even when it was taken in moderate amounts. Many moderate drinkers had enlarged hearts, high blood pressure, and a poor heart reserve in times of illness.

Dr. Beevers’s conclusion was that if you have angina, alcohol will always make that worse rather than better. It is safer for people with angina, he concluded, to abstain completely than to drink even a moderate amount.

So how much alcohol can a person drink without harming health? The King’s College rules still apply to men and women who have no sign of liver, brain, or heart disease. If you have angina, and especially if you have high blood pressure too, then the twenty a week total for men and the twelve a week total for women may be too much. Each case is different. My advice, if you have angina, is to discuss your drinking habits fully and honestly with your cardiologist, who will guide you on what is best for you.

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If you have angina, advice to exercise more probably seems ludicrous. After all, doesn’t exercise do precisely what you wish to avoid—bring on the pain? And isn’t rest important for your heart? Look what happened to James Fixx!

As you saw in chapter 1, James Fixx was actually a success story. He probably gave himself an extra twenty years of life before he succumbed to heart disease, and he might well have lived even longer if he had heeded his warning signs and sought medical help.

The fact is that the news about exercise for heart patients is all good. Exercise is good for you, even if your heart has been damaged by a previous heart attack. This will surprise many older people, who remember the days when heart patients were advised to rest all the time, and became chair-bound or bedridden on the advice of their doctors. When I was a medical student in the early 1960s, victims of heart attacks were kept in bed for between six and twelve weeks.

The idea was that if you rested the heart until the scar of the attack healed, the scar would be stronger and smaller, and the eventual recovery would be better. From then on, though, the patient was expected to lead a quiet life.

This “advice was left over from the Victorian age, when it was fashionable to “take to your bed.” From the mid-1850s right up to the 1960s, people recovering from illnesses and operations were sent to convalescent homes where they rested and lazed around until they were better. It sometimes took a very long time. Charles Darwin and Florence Nightingale spent many years languishing in bed during the daytime, suffering from “neurasthenia” or “nervous exhaustion.”

This attitude to rest, and advice against exercise, turned many people into “cardiac cripples.” They were told they were delicate, and must not overexert themselves. All sorts of activities were forbidden to them, including walking up stairs, running, and lovemaking.

None of this advice was based on fact. Some eminent physician had once decreed that this was the way to behave if you were a heart patient, and everyone believed the advice and followed it.

Not today, though. It is now known that the more you use an organ, the more effective it becomes, and the heart is no exception even when it is affected by atheroma. It needs to be stimulated to keep strong. If the heart works at resting pace all the time, then it makes it difficult to step up a gear when that is needed.

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This has been determined internationally by authorities such as the United States National Heart, Lung, and Blood Institute, the Study Group of the European Atherosclerosis Society, and the World Health Organization MONICA Project (MONitoring trends In Cardiovascular disease)- Via a simple blood test, cholesterol levels are measured in milligrams per deciliter (mg/dl).

The experts have agreed that cholesterol levels are becoming moderately high when they are above 200mg/dl, and need definite attention when they rise above 250mg/dl. People are defined as hyper-lipidaemic (a serious high blood-fat level needing medical treatment) if their blood cholesterol is above 300mg/ dl. Doctors try to keep patients in a range between 155 to 200mg/dl.

That sounds fairly simple, but the reality is different. To begin with, even average levels of cholesterol in developed countries are well above 200mg/dl. In 1989, Dr. Hugh Tunstall-Pedoe and his colleagues in Dundee measured blood cholesterol levels in more than ten thousand men and women between the ages of twenty-five and sixty-four. Three-quarters of them had cholesterol levels above 200, a third had levels over 250, and in one-tenth they were above 300! Dr. Tunstall-Pedoe drew two main conclusions from his study: The first was that it confirmed why we Scots are so unhealthy, and have such a high rate of angina and heart attack. He added, however, that the figures are not so different from anywhere else in Europe. The second was that so many people have high blood cholesterol levels that advice on how to lower them could be given to everyone, without the need to spend time and money testing for it.

This view was contested for a while, when reports appeared that too low a cholesterol level might be just as harmful as an excess. Dr. Christopher Isles, studying cholesterol levels in fifteen thousand men and women in Renfrew and Paisley, towns just west of Glasgow, Scotland, found that the people with the lowest cholesterol levels (below 155 mg/dl) were more likely than the others to die from cancer. In his study, the people with the lowest death rates over all had cholesterol levels of around 215mg/dl.

These figures suggested that it would be wrong to advise the whole population to lower their cholesterol level. However, follow-up research since then has shown that the cancer occurring in patients with a very low level of cholesterol may in fact have predated the measurement of their cholesterol. The cancer may have exhausted the body’s cholesterol-forming mechanism, and the fall in their cholesterol levels may have been due to their illness and not vice versa. It is now accepted that lowering cholesterol from around 230mg/dl to around 155mg/dl (the aim of most dietary regimens) does not increase the risk of any illness, but substantially reduces angina and heart attack rates.

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Hardly anyone in a developed society escapes atherosclerosis completely. Doctors examining the bodies of young U.S. soldiers killed in the Korean War were amazed by the extent of the process already visible in the soldiers’ arteries. The first signs of this are of fatty streaks in the arteries’ inner surfaces, the surfaces that come into contact with the blood. Almost all of the young soldiers possessed such streaks.

As you age, the fatty streaks become plaques—plate-like thickened areas that roughen the inside surfaces of the arteries. Plaques start forming in childhood from the streaks, and grow very slowly over many years into thickened masses that protrude into the bloodstream. Their numbers and size depend almost entirely on one thing—the levels of cholesterol in the blood.

The world over, the higher the blood cholesterol level, the more extensive the atheroma. In communities existing almost entirely on fish and vegetables, such as in rural Japan, blood cholesterol levels are low, there is very little atherosclerosis, and angina is virtually unknown. Yet Japanese people who have emigrated to the United States and have taken on American lifestyles have higher cholesterol levels, and are just as prone to angina as their American neighbors.

Why should plaques be so important? We can now study the flow of blood through the coronary arteries in living people, using coronary angiography, a technique that will be explained in more detail later in the book. A dye that is opaque to X rays highlights nar-rowings (stenoses) in the coronary arteries that correlate with plaque sites. Beyond the stenoses, the blood flow can be considerably reduced.

The reduction may not be much when the owner of the arteries is at rest, but the big difference comes with exercise. An artery narrowed and “hardened” by atherosclerosis cannot expand to accommodate the big increase in blood flow needed when the heart is beating faster and with greater force—as in exercise or emotional stress. It may not be able to supply enough oxygen and glucose to the heart muscle that it serves, and the process leading to angina begins. The muscle must switch to anaerobic activity, lactic acid builds up, and the pain starts. The only way to return things to normal is to reduce the heart’s demand for oxygen, and the fastest way to do that is to rest.

So far, the story is clear. If you keep your cholesterol levels low, you can avoid angina. But what can you do if your coronary arteries are already affected by atherosclerosis to the extent that you have angina? Can you reverse the process, and restore your coronary circulation to normal?

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Researchers at the Ohio State University report that recent findings indicate that estrogen replacement therapy (ERT) used as a treatment for menopausal symptoms and in the prevention of osteoporosis, may double the risk of breast cancer in lean women.

In the study, lean women were described as those in the lowest one-third of body mass— a ratio of weight to height. Researchers studied over 600 women who had been diagnosed recently with breast cancer and 520 women who had similar characteristics but no history of breast cancer. While there did not appear to be a link between estrogen replacement therapy and breast cancer in general, researchers say that among lean women the overall difference was significant.

47 percent of the lean patients with breast cancer used estrogen, compared with 31 percent of women who did not use estrogen. Researchers say that this obvious difference is worth investigating and that doctors should be more cautious about prescribing estrogen replacement therapy, especially for lean women who have a family history of breast cancer.

The researchers point out that the results of their new study should not be considered as an indictment of ERT as being a cause of breast cancer development. They suggest, however, continued studies into the potential effects of ERT among post-menopausal women, and in particular, “among lean women”.

Many experts feel that the overall proven benefits of estrogen far outweigh the potential risks. These proponents of ERT cite the fact that it is beneficial in preventing heart disease and osteoporosis, while the risk of breast cancer has never been strongly confirmed. None-the-less, there is general agreement among experts that women taking estrogen should be monitored regularly and carefully with mammograms and other tests.

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1) Irritable Bowel Syndrome— a chronic gastrointestinal disorder which is made worse by emotional stress, some foods, and infections or condition is twice as common in women as it is in men. The symptom diarrhea, often alternating with constipation; abdominal pain; bloating; nausea; and mucus in stools.

Doctors may miss a correct diagnosis for this problem because provide no clear cut possibility. In some cases the same symptoms normal reaction to a single episode of stress in many people which irritable bowel syndrome. Usually, doctors diagnose irritable bowel eliminating all other reasonable possibilities.

2) Subacute Bacterial Endocarditis— this is a bacterial infections of the heart, often the result of an upper respiratory tract infection or d symptoms include weakness; fatigue; intermittent, low- grade fever; chills; aches; and weight loss.

This condition is more commonly found among AIDS patients i users. Doctors who are inexperienced in such cases may have difficult the condition.

3) Early Onset Emphysema— Lung specialists say that about thousand people have alpha-antitrypsin deficiency, also known as early emphysema. The deficiency is often misdiagnosed because it is not well-recognized by many physicians. According to experts, if physicians are not lung sp might not even know about the deficiency. In many cases it is confused misdiagnosed as asthma or bronchitis.

The deficiency is caused by an inherited lack of the protective protein, alpha-antitrypsin and can be detected through a simple blood test. Experts everyone who has the deficiency develops emphysema, and while the c no cure, researchers are having some success in developing a potentic slow the progress of the disease. The treatment which is currently involves giving patients back the missing protein intravenously through called prolastin. The substance is derived from human plasma and researchers, has no significant side effects. Researchers need to conduct with the new treatment before they can say for certain that it will slow the disease.

Early diagnosis is essential, otherwise the deficiency can develop asthma and lead to death. (Researchers say that smokers will die 20 than non-smokers who have the deficiency).

People who have a family history of emphysema or with symptoms including shortness of breath, excessive coughing, difficulty exhaling, wheezing, and a decreased ability to exercise, should be tested by a physician.

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A reevaluation of the cholesterol content in regular eggs suggests that there is no “significant difference” between those eggs and the relatively new low- cholesterol eggs. According to the Nutrition Composition Laboratory of the United States Department of Agriculture, there’s really not much difference between low-cholesterol eggs and regular eggs. The cholesterol content of a regular egg is about 213 miligrams—considerably less than the 274 milligrams previously attributed to regular eggs— while low-cholesterol eggs contain about 180 milligrams of cholesterol. The 30 milligrams of cholesterol difference between low-cholesterol and regular eggs is not large enough to be significant. And, low-cholesterol eggs are more expensive than regular eggs.

The cholesterol count of regular eggs was revised from the previous 274 milligrams because of better testing methods and egg industry breeding practices. The revision motivated the American Heart Association to raise its recommended weekly limit of egg yolks—both regular and low-cholesterol—from three to four. The recommendation does not apply to persons on a cholesterol- restricted diet.

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