Adapted from the Straits Times, May 27 2010

Gout - rich man's disease no more
Gout, known as the disease of kings or the rich man's disease, has had a long history - the Egyptians first wrote about gouty big toes in 2,600BC.

Today, however, the ailment is no longer confined to the nobility or rich.

Gout is a type of arthritis characterised by swollen, painful and red joints. While the base of the big toe is the most common spot, the feet, fingers, wrists, elbows, knees or ankles can also be affected. This happens when the body produces too much uric acid or cannot get rid of the excess acid, which comes from the breakdown of purine.

Purine is a nitrogenous substance that forms part of the body's cells and is usually found in high-protein food. If there is excessive purine in the blood due to too much purine-rich food, there will be excessive uric acid in the blood. This leads to the deposition of its crystals in the joints and tendons, causing gout, said Dr Low Chee Kwang, an orthopaedic surgeon from United Orthopaedic Specialists.

The condition can be so serious that multiple joints can become swollen. There is severe pain, making walking or going to work difficult, said consultant rheumatologist Wei Howe Koh, who runs the Arthritis and Rheumatism Medical Clinic. In some cases, patients can develop lumps of uric acid under the skin at the joints, known as tophi. These are generally painless, albeit unsightly.

The disease often recurs because many patients do not stick to their medication or diet, said Dr Wei.

More young people are getting it
Gout is usually hereditary, although it can be exacerbated by a rich diet. Hence, not everyone with high uric acid levels will necessarily get gout unless he consumes excessive levels of purine. For example, kidney patients, who tend to have high uric acid levels because their kidneys cannot handle its excretion, may not not show symptoms of gout, obeserved Dr Angeline Goh, a consultant at Singapore General Hospital's renal department.

The risk of getting gout increases when one is male, overweight and over the age of 40, or when one has certain blood disorders like leukemia or takes certain hypertensive medications. Women are less likely to get gout because of the protective effect of the female hormone Oestrogen. But the incidence of gout in women increases when they hit post-menopausal age, said Dr Wei. It can be a lifelong problem if not tackled and excessive uric acid can get deposited in the soft tissues of the ears, hands, and feet and the kidneys, leading to their blockage and renal failure.

Studies around the world suggest that more people are coming down with gout and that it is no longer a rich man's disease. Gout affects about 1.5 percent of people in Britain and 2 per cent in the United States. Statistics on the situation here are not available, although some doctors say there appears to be more young people seeking treatment for it.

They attribute this to increasing affluence, with more people having access to more food.

The availability of high-purine food such as sausages and fried chicken, as well as the fact that people are consuming more alcohol and ready-made sauces, are the main culprits, said Magdalin Cheong, the chief dietitian at Changi General Hospital's dietetic and food services. It is no wonder that gout seems to be hitting a younger crows as they turn to drinking and eating rich food and shun fresh fruit and vegetables.

Watch your diet
To keep gout at bay, drink plenty of water to dilute the uric acid and avoid alcohol and high-purine food loike animal organs and shellfish, advised Dr Low. A 2004 American study published in the journal Lancet found that men who drank two or more beers a day were 2.5 times more likely to develop gout than those who did not drink.

Another report published in the British Medical Journal in 2008 found that men who consumed two or more sweet soft drinks a day have an 85 per cent high risk of gout compared with those who drink less than one a month.

While controlling the diet is important, doctors may prescribe anti-inflammatory drugs and drugs to control uric acid deposition. There are also alternative treatments for gout, including taking cherries, coffee or more vitamin C. However, doctors say that those embarking on alternative treatments should do ample research, monitor the effects of such treatments and seek a qualified health professional's advice when in doubt.

Also, some other forms of arthritis can be mistaken for gout and vice versa. For example, in pseudogout - literally false gout - calcium pyrophosphate crystals are deposited instead of uric acid, leading to symptoms similar to gout, said Dr Wei. In this case, trying to lower purine or uric acid levels in the body, or taking uric acid-lowering drugs would not have worked.

Gout is usually diagnosed by a blood test to measure uric acid levels or an analysis of the joint fluids to detect uric acid crystals.

Hence, seeking proper medical help is always important.
____________________________________________________________
What is Gout?

Chronic gout can also lead to deposition of hard lumps of uric acid in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones.

Uric acid is a metabolite of purine, avoid food that is high in purines and high in proteins, or take them in moderation.

Doctors may prescribe allopurinol to control the uric acid levels in the body, together with colchicine to stop the inflammation. If the attacks are too severe, the doctor may have to draw the fluid from the joints with a needle.

Just to list a few high purines food
Animal organ like hearts, liver, kidney, and brains.
Mussels, sardines, tuna, scallops, and salmon.
Mutton, bacon, and turkey.
and many many more...

Labels: Gout

We see many new drugs on the market today, being just variants of old drugs. They are sometimes called purified drugs, yet the original drugs are certainly not impure. The new drugs' names are variations on the old drugs' names, often with a prefixes like, "lev," or "dextro" added (for example, cetirizine and levocetirizine; amphetamine and dextroamphetamine). What are their differences, and why are the new drugs viewed as better than their predecessors?

What is Cetirizine?
Cetirizine (Zyrtec®) is a second-generation antihistamine indicated for the treatment of seasonal allergic rhinitis, perennial allergic rhinitis and chronic idiopathic urticaria, in adults and children of 6 or more years. It is also used for the treatment of allergic rhinitis (relieves nasal congestion), causes little sedation and has no cardiac adverse effects unlike highly lipophilic antihistamines.

Cetirizine is a racemic mixture of levocetirizine (now available under the trademark Xyzal®) and dextrocetirizine. Xyzal and Zyrtec are both used in the treatment of nasal congestion and have anti-histaminic properties.

Let’s look into some biological properties of cetirizine and levocetirizine, namely enantioselectivity in pharmacological activity, the possibility of racemization, and the compared behavior of the two enantiomers. Recent data demonstrate that the antihistaminergic activity of the racemate is primarily due to levocetirizine. Levocetirizine is rapidly and extensively absorbed, poorly metabolized, and not subject to racemization.

Its pharmacological characteristics are comparable after administration alone or in the racemate (equal mixture). Levocetirizine has an apparent volume of distribution smaller than that of dextrocetirizine (0.41 L kg⁻¹ vs. 0.60 L kg⁻¹). Moreover, the non-renal (kidney), mostly hepatic (liver), clearance of levocetirizine is also notably slower than that of dextrocetirizine (11.8 mL min⁻¹ vs. 29.2 mL min⁻¹).

Levocetirizine inhibited histamine-induced healthy subjects response to the same degree as cetirizine, with a maximum result at 6 hr post-dose and a duration of action greater than 24 hr. In contrast, dextrocetirizine was much less powerful at the same dose. Levocetirizine (5 mg) and cetirizine (10 mg) also inhibited histamine-induced increases in nasal airway resistance while dextrocetirizine failed to demonstrate any significant antihistaminergic activity. Thus, the H₁-antagonist activity of cetirizine is primarily due to levocetirizine, which is considered to be the most active enantiomer (i.e. the eutomer), while dextrocetirizine is the least active enantiomer (the distomer).

Levocetirizine is considerably stable to racemization, and incubation of cetirizine enantiomers in buffer solutions of pH 7.4 at room temperature did not reveal the slightest occurrence of racemization even after days.

However, not all medications benefit from being enantiopure. For example, ibuprofen is a racemic drug, but the body has an enzyme that converts one enantiomer to the other, so there is no benefit to purifying one enantiomer.

Labels: Anti-histamine, Sensitive Nose

What is full blood count (FBC)
The full blood count (FBC) is one of the most commonly ordered tests and provides important information about the kinds and numbers of cells in the blood: red blood cells, white blood cells and platelets. Abnormalities in any of these types of cells can indicate the presence of important medical disorders.

Blood is composed of a variety of living cells that circulate through the heart, arteries and veins carrying nourishment, hormones, vitamins, antibodies, heat and oxygen to the body's tissues. Blood contains three main components — red blood cells, white blood cells, and platelets — suspended in fluid, called plasma.

Red blood cells contain haemoglobin, a protein that carries oxygen to all the tissues of the body.

White blood cells are responsible for protecting the body from invasion by foreign substances such as bacteria, fungi and viruses, and also control the immune process.

Platelets help the blood clotting process by plugging holes in broken blood vessels. Helps to stop wound bleeding.

What is Haemoglobin
Haemoglobin is an iron-containing protein attached to the red blood cells that carries oxygen from the lungs to the other parts of the body, exchanging for carbon dioxide at cellular level. Carbon dioxide is then transported back to the lungs, ready to be exhaled out of the body. Whether haemoglobin binds with oxygen or carbon dioxide depends on the relative concentration of each around the red blood cell. When it reaches the oxygen-rich lungs, it releases the less-abundant carbon dioxide to bind with oxygen; when it goes back out into the body where cells are producing carbon dioxide, it releases the oxygen and binds with carbon dioxide.

MCV, MCH, and MCHC values reflect the size and hemoglobin concentration of individual cells, and are useful in diagnosing different types of anemia.

Red Blood Counts (varies with altitude):
Male: 4.7 to 6.1 million cells/mcL
Female: 4.2 to 5.4 million cells/mcL

White Blood Counts: 4,500 to 10,000 cells/mcL

Hematocrit (varies with altitude):
Male: 40.7 to 50.3 %
Female: 36.1 to 44.3 %

Hemoglobin (varies with altitude):
Male: 13.8 to 17.2 gm/dL
Female: 12.1 to 15.1 gm/dL

MCV: 80 to 95 femtoliter
MCH: 27 to 31 pg/cell
MCHC: 32 to 36 gm/dL

(cells/mcL = cells per microliter; gm/dL = grams per deciliter; pg/cell = picograms per cell)

A full blood count (FBC) characteristically reveals an abnormal decrease in white blood cells (leukopenia). Diagnosis of dengue infection is supported if there is thrombocytopaenia, commonly seen in dengue infection. Large increases in antibody levels of 4 times or greater help confirm the disease.

FBC costs only $15 per person, and for students, the doctor may charge you $10 for student-price.
:)

Labels: Dengue Fever, Medical Examination

3 Doctors are at a Convention talking Shop.

The first Doctor says: "I love doing surgery on Artists, they are so colorful: red Hearts, pink Stomachs, green Spleens."

The next Doctor says: "Me, I love doing surgery on Accountants, open them up and all their Parts are numbered, makes it very easy.”

The third Doctor says: "I love doing surgery on Lawyers, they have no Heart, they have no Guts and the Head and the Ass are interchangeable!"

(^_^)v

Labels: Medical Humour

Just a few weeks ago, I came across a very interesting question a patient had asked.

Patient: "Hi, do you have mediaxal?"
Me: "No, we don't carry that anymore."
Patient: "Oh why is it so? It's really good you know. Apparently all other clinics around this area also don't carry mediaxal anymore."
Me: "Really..? Hmm.. I don't know why."

This made me very curious why, did all other clinics stop carrying this medicine??! I did some research on the internet and this is what I have found.

What is mediaxal?
Mediaxal contains Benfluorex as its active ingredient, decreases the intestinal absorption of triglycerides (means a type of fats that bound to the bloodstream and fat tissue), the lipid synthesis (can cause high cholesterol) and facilitates the cellular penetration and utilization of glucose. Clinical studies have shown that it may improve glycemic control and decrease insulin resistance in people with poorly controlled type 2 diabetes.

In layman terms, mediaxal reduces the absorption of fats in your blood, and it can also be used in the management of diabetes and lowering of cholesterol levels.

As of 18 December 2009, the European Medicines Agency (EMEA) has urged the withdrawal of all medicines containing benfluorex in the European Union, because their risks, especially the risk of heart valve disease, have outweighed their benefits. Patients who had had taken benfluorex should consult a doctor to check for signs and symtoms of Heart Valve Disease, as it can developed years after treatment. Between its launch in 1976 and September 2009, a total of 45 cases of cardiac valve disease in patients exposed to benfluorex were reported to the French national pharmacovigilance system.

Therefore then, what is heart valve disease?

About Heart Valve Disease
Heart Valve Disease occurs when your heart valves do not work the way they should.
Our heart valves lie at the exits of each of the 4 heart chambers and control a 1-directional flow of blood through the heart. These valves make sure that the blood always flows freely in the forward direction and ensure that there is no backward leakage.

In our 4-chambered heart, 2 of the chambers are called ventricles, the other 2 are the atrium. The atrium receives blood as it returns to the heart to complete a circulating cycle, whereas the ventricle pumps blood out of the heart to start a new cycle. The left ventricle pumps blood into the systemic circulation through the aorta to the rest of the body, while the right ventricle pumps blood into the pulmonary circulation for the lungs. Blood flows from your right and left atria into your ventricles through the open mitral and tricuspid valves.

When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze). As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, the aorta, and the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap shut. These valves prevent blood from flowing back into the ventricles. This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and body.

There are several types of Heart Valve Disease.

Valvular stenosis
This occurs when a valve opening is smaller than normal due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see below). All four valves can be stenotic (hardened, restricting blood flow); the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis or aortic stenosis.

Valvular insufficiency
Also called regurgitation, incompetence or "leaky valve", this occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the conditioned is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation or aortic regurgitation.

Congenital valve disease
Most often affects the aortic or pulmonic valve. Valves may be the wrong size, have malformed leaflets, or have leaflets that are not attached to the annulus correctly.

Bicuspid aortic valve disease
A congenital valve disease that affects the aortic valve. Instead of the normal 3 leaflets or cusps, the bicuspid aortic valve has only 2. Without the third leaflet, the valve may be stiff (unable to open or close properly) or leaky (not able close tightly).

And many more other heart valve diseases.
The heart is such a vital organ.. please take good care of your heart :)

Labels: Heart Valve Disease, Obesity

What is High Blood Pressure?
Blood Pressure is the force that moves your blood around your body. The pumping action of your heart creates this force which helps the blood carry food and oxygen to all parts of your body.

Blood pressure is not a constant fixed value. It is different from one person to another. Even in the same person, blood pressure changes from minute to minute. Your blood pressure goes up when you are stressed, excited or exercising. It goes down when you are relaxed or asleep. These changes are normal.

Most of the time, your blood pressure stays within a normal range when you are at rest. Usually the younger you are, the lower your blood pressure should be. If your blood pressure goes up and stays high most of the time, even at rest, then you have high blood pressure or also known as hypertension.

What makes Blood Pressure go up?
Your blood pressure will go up if:
-your blood volume is increased by too much salt which retains more water in the blood
-your blood vessels become more rigid due to atherosclerosis (a process where fatty substances are deposited in blood vessel walls)
-your heart pumps too hard and too fast because of substances like alcohol and chemicals found in cigarettes.



Do I have High Blood Pressure?
Take the opportunity to get your blood pressure checked whenever you visit the doctor. If you are 40 years or older, you should have your blood pressure checked at least once a year.

The systolic reading is the blood pressure when your heart is pumping. It is high than the diastolic pressure. The diastolic reading is the blood pressure when your heart is relaxing between the pumps. Blood pressure is given as systolic/diastolic, eg. 120/80 mmHg.

You have high blood pressure if your systolic reading is 140mmHg or more and/or your diastolic reading is 90mmHg or more. However, a single raised blood pressure value does not necessarily mean that you have high blood pressure. Your doctor will usually check your blood pressure at a second visit to see if it is still high.

What causes High Blood Pressure?
Older people and men are more likely to develop high blood pressure. High blood pressure also seems to run in families. Although you may inherit the tendency to get high blood pressure, other lifestyle factors may determine if you actually get the disease:

Overweight & sedentary lifestyle. If you are not active and do not get enough exercise, you are likely to become overweight. When you are overweight, you heart has to pump harder to move blood around your larger body. People who are overweight are more likely to have high blood pressure.

Eating unhealthily. Taking too much fatty food like fatty meat, sausage, butter and deep-fried food makes you overweight. Together with high cholesterol food which includes egg-yolk and organ meat, it also increases the blood cholesterol level. Too much cholesterol in the blood makes the artery walls thick and hard. This can increase blood pressure.

Taking too much salt. Salt contains sodium which draws water into the blood. This increases the blood volume and pressure.
Drinking too much alcohol. People who drink large amounts of alcohol regularly are more likely to develop high blood pressure. Alcoholic drinks also contain many calories and can make a person overweight.

Diabetes mellitus. Diabetes mellitus accelerates atherosclerosis, which normally occurs with ageing. This can result in blindness, kidney disease and high blood pressure.
Too much stress. When you are angry, excited, frightened or under stress, you blood pressure goes up temporarily. If you remained stressed for a long time or are unable to cope effectively with stress in daily life, you may develop high blood pressure.

Smoking. The chemicals in cigarette smoke raise the smoker's blood pressure while he smokes. They also speed up atherosclerosis and increase his risk of heart disease.

And many other factors........... so do exercise regularly to have a healthy lifestyle. :)

Labels: High Blood Pressure

I wish... I could help others and make a difference. If I could choose what I want to do in life again, I would like to go into nursing. Being a clinic assistant is the closest I can get, and I am thankful to be able to get this close.


I will pen my somewhat-limited-medical-knowledge in this blog, and the interesting things that I have come across my life. This blog serves as a way for me to learn and discover, and if there is any information presented here that is not accurate, please kindly give your opinion and correct me.

I hope that someday, I may be able to pursue a part-time degree in nursing......!

about me

• ♥Missy Cai
• an ex-clinic assistant who shares her views and her little medical knowledge.

recent records

• Mania (psychological term) - another mental illnes...
• Logorrhea, is this a mental illness? (Part I)
• Parkinson's Disease
• SGH warns against evangelising
• Floaters in the eye
• HSA recalls Po Chai Pills
• Steps for performing CPR
• Preventing strokes and heart attacks
• Use of diabetes drug curbed
• Rheumatoid Arthritis

I say

• In life, you can never have everything you want. But you can make the best out of what you have.

patients' messages

• Blogwalkers are sick.

past medical history

• September 2012
• October 2011
• September 2011
• April 2011
• January 2011
• November 2010
• September 2010
• August 2010
• May 2010

health topics and diagnosis

• Anti-histamine
• Constipation
• CPR - Cardiopulmonary Resuscitation
• Dengue Fever
• Diabetes
• Eye
• Gout
• Heart Attack
• Heart Valve Disease
• High Blood Pressure
• Logorrhea
• Mania
• Medical Examination
• Mental Illness
• Miscelleneous News
• Obesity
• Parkinson's Disease
• Rheumatoid Arthritis
• Sensitive Nose
• Stroke
• URTI - Upper Respiratory Tract Infection
• Wound Dressing
• Medical Humour

disclaimer

• This blog is intended for my own learning and reference only and does not serve as professional medical advice. It's always best to consult your doctor prior to initiating any form of medical regimen and treatment.