All About Diabetes

Adding Romance to Physical Activities

admin — Mon, 01 Feb 2010 23:10:15 +0000

Every year, February brings that distinct aroma of love and romance that we anticipate so much, especially for couples. It’s a season that’s definitely filled with flowers, balloons, teddy bears, chocolates, and cakes. These are just some of the usual ways we show our love and affection to our partners. Yes, February is a time of mushiness and emotions but you can also make it the month to start living a fit and healthy lifestyle.

Here are some physical activities that you and your partner can try and experience this love month or in any other day of the year. Remember, some things are still best done together.

Jogging
Of course, you’ve done it before. Perhaps everybody has. You can see people jogging in parks, ovals, streets, gyms – virtually anywhere. But have you done it with your partner? People usually jog alone with their mp3 players for company. Instead of listening to the all-time favorite songs that you can play anytime, why not jog with your partner and share some quality time together?

Why jogging?
• It helps in blood circulation and strengthens the heart and respiratory system.
• It helps burn fat with about 100 to 200 calories in a half hour session. If you have poor appetite and are underweight, short jogging sessions improves your appetite and helps you gain those extra pounds.
• It strengthens the muscles of the legs, hips, and back without the worry of developing very big muscles.

What you need:
• Clothes. For warm weather, t-shirt or sando and shorts or jogging pants are ideal. For cold weather, use additional layers of clothes like sweaters. In general, clothes for jogging should be able to absorb moisture and sweat.
• Shoes. Running shoes should have soft inside areas but rigid soles to support impact and body weight. Also, the underside of soles should have friction to any surface to avoid slipping.
• Extras. Because jogging will make you sweat, you must drink a lot of water to re-hydrate. Energy drinks also help in boosting your running power. Hand towels help you dry up well-deserved sweat after your exercise.

Badminton

This sport continues to gain popularity here in the Philippines as badminton halls and courts are sprouting everywhere. Played by twos (singles) or by fours (doubles), a badminton session – not including warm-up time – may last for about half an hour to an hour, depending on you and your playmates’ skills. You
and your partner may try outplaying each other in a singles match or invite another couple to play with you in a doubles match. It will surely be double the fun!

Why badminton?
• Regular badminton play can reduce bad cholesterols (triglycerides, low-density lipoproteins) and increase good cholesterol (highdensity lipoprotein).
• It reduces blood pressure, strengthens heart muscle, and keeps blood vessels from clogging.
• It burns extra calories to help reduce weight and gain optimal weight for your height and age.
• Osteoporosis can be prevented as it helps the bone matrix absorb calcium better.

What you need:
• Clothes. T-shirt or sando and shorts, skirt, or sweat pants.
• Shoes. Rubber shoes are required, trainers or tennis shoes.
• Rackets and shuttlecocks. There are many brands of rackets to choose from depending on your taste and built. Rackets and shuttlecocks are often available in badminton halls.
• Extras. Water and energy drink allows you to replenish the body liquid that you lost during the game and towels should be around to wipe away the sweat.

Ice Skating
It doesn’t have to snow in the Philippines for you to experience ice skating. Some malls now have skating rinks for you and your partner to enjoy. Individual ice skating is fun in itself but having someone to lean on or catch you when you get off-balance definitely sounds better!

Why ice skating?
• It strengthens and tones the lower body – thighs, hips, and buttocks.
• It burns fat and strengthens the heart.
• It also allows you to improve your body’s balance and coordination.

What you need:
• Clothes. Since this activity is done on ice-you have to wear thick clothes or layers of clothes to fight-off the chill.
• Shoes. You’ll need a pair of ice skates. If you don’t have one, ice skates are for rent at the ice skating rink.
• Extras. For a total feel of the ice, you may also wear a bonnet or a pair of ear muffs.

Yoga

Yoga is a set of spiritual practices that originally came from India. Nowadays, yoga is not just a spiritual practice but more of a physical activity as well. Yoga may be perceived as mostly for women but it is actually for men, too! There are yoga poses that are especially designed for couples. Here is a
simple yoga exercise that you and your partner should try.

Couple’s Turtle Pose
• Begin seated on the floor, facing your partner. Keeping your back straight, extend your legs out to either side, attaining turtle position.
• Have your partner place his feet against your lower legs. Reach forward as your partner does the same, and grasp his upper arms as he grasps yours.
• Have him press gently upon your legs with his feet, maximizing your stretch. Have him then pull you slightly forward, again maximizing your stretch.
• Hold, and then release, relax, and repeat the exercise, with the partner’s positions reversed.
• The purpose of this exercise is not only to facilitate a gain in flexibility greater than you could achieve on your own, but also to build trust in each other. Allowing your body to be manipulated by your partner builds security in being able to depend on him or her.

Chuck the stick and save your heart

admin — Wed, 18 Nov 2009 12:18:00 +0000

Quit smoking now and prevent further health risks. Not news for most but a recent study confirms the direct link of smoking cessation to the recovery of damaged arteries due to cigarettes. Although it may take more than a decade for the arteries to heal, Dr. Noor A. Jatoi of the Trinity College in Dublin, Ireland pointed out that the adverse effects of smoking to the blood vessels are reversible. The findings supported studies showing that the risk of heart attack and stroke falls among smokers when they quit three to 20 years after, he said.

“Our study reinforces the message that smoking cessation is an important step smokers can take to enhance the quality and length of their lives,” Jatoi said. “The longer one stops smoking the better.” The study showed that smoking a single cigarette or exposure to “second-hand” smoke all lead to stiffer arteries, which eventually lead to high blood pressure. Jatoi’s research team found that the arterial stiffness parameters of ex-smokers showed some improvements after one to 10 years of cigarettes, but reached normal levels only after more than a decade.

Among the 150 current smokers, 136 ex-smokers and 268 nonsmokers in the study, current and ex-smokers of only one year had significantly narrowed arteries compared to nonsmokers, the team reported in the medical journal Hypertension. The ex-smokers were categorized as to how long they were off cigarettes-under 1 year, more than 1 but less than 10 years and more than 10 years, of smoking cessation, Jatoi explained.

Taming Anger

admin — Thu, 12 Nov 2009 06:23:54 +0000

Anger is a fact of life. Each of us, at some point experiences that feeling of irritation or rage for a certain individual or situation which harmed us or posed a threat to our well-being. If not managed well, anger may result in domestic abuse, road rage, workplace violence and addictions. Long term, it is linked to chronic headaches, sleep disorders, digestive problems, high blood pressure, and even heart attack. On the other hand, properly managed anger can lead to positive change.

Dr. Roanne Munoz Ramos shares with us some tips on anger management and on searching for healthy ways to express and resolve problems which ignite it.

By changing how we think with more rational thoughts, we change our perspective of the environment, and therefore change our emotional and behavioral reactions. For instance, instead of thinking, “What is happening to me is so terrible,” we replace it with, “What is happening is frustrating, and it is understandable that I feel this way, but getting angry will not solve anything.”

Getting angry also involves a physiological component, such as increased heart rate and blood pressure. With relaxation, clients are taught deep-breathing and positive imagery activities to calm them down. A common cause of anger for a number of individuals is getting frustrated over situations for which they cannot find solutions. Instead of mulling over what made you mad, find healthy ways to resolve conflicts.

Anger towards others can also be the result of faulty communication. Anger can cloud one’s judgment, making individuals come up with inaccurate conclusions. When a person finds himself or herself in a heated discussion, it is best not to respond with the first words that come to mind-rather; one should slow down and think through one’s responses. Listen carefully to what the other person is saying. By doing so, this avoids the impulsive, hurtful words hurled against another person, words one tends to regret later.

A technique which can work to our advantage, especially for us Filipinos, is the use of humor, which can lighten up tension. However, the use of sarcasm is riot advisable, since it can make a situation worse and hurt the feelings of others.

Dr Ramos adds that when anger becomes destructive and gets in the way of a healthy personal and professional life, it is advisable to get professional help. Through this, and anger management sessions held, destructive emotional reactions are reduced.

No related posts.

Diabetes Under the Knife

admin — Wed, 11 Nov 2009 06:12:17 +0000

Having diabetes alone can sometimes amp one’s stress and anxiety meter due to insulin shots here and there, often striking at any given time and place. Adding to the anxiety is the instance when one has to undergo a surgical procedure. To clear your blurry head of questions like “How long will it take for my wound to heal?” and “Will I be able to balance my blood sugar during operation?”, here are some pointers:

DO’s:
Talk to your doctor. Weeks prior to your scheduled operation, talk to your diabetes doctor or endocrinologist and formulate a plan on the best approach to lower the risk of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar) during your operation. You may ‘ need to adjust your medication doses and timing in relation to the operation.

Schedule operation in the morning. Since one is usually not allowed to eat 6 to 8 hours before surgery, if possible, schedule your surgery in the morning. Doing so will help spare you from high or low blood sugar reactions due to fasting or longer waiting time for operation.

Learn all you can about the surgery. Your surgeon is the next best person to talk to when you are about to undergo surgery. Since he will be operating on your body, he could tell you what to expect physically and emotionally before, during and after the operation. You can find out from him about recovery time, complications as well as food and activities that would or would not be allowed after the surgery. Your surgeon can also suggest the kinds of equipment or medical supplies you might need when you go home after the operation.

DON’Ts:

Don’t ignore your blood sugars. Blood sugars may shoot up or plummet fast when you are about to undergo surgery. Better blood sugar control ensures better outcomes after surgery, including better wound healing. Use your trusted blood sugar meter to help you keep your blood glucose within the target range specified by your doctor. Insulin may also be required if your blood sugars do soar out of control.

Don’t smoke. Any amount of smoking can impair wound healing. Smoking makes your blood vessels narrower thus reducing the amount of blood flow and nutrients to the wound. Smoking allows carbon monoxide, an oxygen-lowering poison, to enter the blood. Oxygen is crucial to wound healing. It takes 3 days of not smoking to rid your body of carbon monoxide and restore blood oxygen levels.

Don’t stress out. Minimize your stress levels as both physical and emotional stress can raise the blood sugar. Learn about relaxation techniques such as deep breathing exercises, meditation, positive visual imagery and the like. People around you may say a thing or two to calm your nerves before your operation. However, if they say something that does not really make sense to you, it would be wise to talk to your diabetes doctor regarding any concerns.

POPTFN: Advocating a Healthy Lifestyle to Raise Healthy Kids

admin — Tue, 10 Nov 2009 02:33:45 +0000

Filipino children today live in an age where things are going instant and processed, at the same time, digital and virtual. Today’s commercialism has influenced kids to rather stay indoors, take fast-food meals, junk food and sodas while watching their favorite show on TV or play computer games.

Countless kids now lead sedentary lifestyles, which, if continued for a long time, can result in, obesity and other lifestyle diseases including hypertension and diabetes. And although parents play a significant role in watching over their kids’ health, schools and health organizations play an equally important role in educating children to develop proper nutrition and healthy lifestyle practices to prevent the development of these diseases.

The American Association of Clinical Endocrinologists Philippine Chapter (AACE-PC) launched the POPTFN (Power of Prevention Through Fitness and Nutrition) program in 2007. It was subsequently integrated into the curriculum of a number of schools in the country. Dr. Florence Amorado-Santos, chair of the Committee on Social Projects of the AACE-PC shares with us the nature of the POPTFN program.

How it works
The POPTFN program shares five modules on proper nutrition and physical activity, which where incorporated in the curriculum of sixth grade Science or Physical Education classes of participating schools. The modules include an orientation on the significance of good nutrition, knowledge about the different body systems, the vitamins which our bodies need, proper serving or meal sizes, what comprise a healthy meal, and the value of physical activity.

As of this year, six schools have participated and successfully integrated the program in their curricula. These include the De La Salle Santiago Zobel School and the PAREF Woodrose School in Alabang, St. Scholastica’s College and St. Peter the Apostle School in Manila, St. Bridget College in Batangas City, and St. Joseph College in Olongapo.

Prior to the POPTFN launch, the AACE-PC, specifically, the Obesity and Nutrition Task Force in charge of the program, conducted a small workshop entitled “Train-the-Trainors”, which aptly trained the teachers of the program the latest information on proper nutrition and lifestyle, and how to impart it to the students. The teachers also served as the AACE-PC’s coordinators for the program.

The program is built into the curriculum according to the timeline of the school, and at the end of it, students who finish the modules are given the POPTFN certificate and the official AACE-PC pedometer. The POPTFN program is one of the advocacies of the mother society of the AACE. It was started in the United States in 2002, and was launched here in the country on November 1], 2007, as part of the project of the Obesity and Nutrition Task Force of the AACE-Philippine Chapter.

Another component of the project is the SEAALA (Senator Edgardo Angara Active Lifestyle Award) or the medal of excellence for health-conscious students.

The nature of the SEAALA

At the end of the POPTFN program, each school chooses its candidate for the SEAALA. In the process, two students per class are chosen, and they are met by the AACE-PC representative for briefings regarding the criteria for selecting the awardees. The students are given an activity and food diary which are to be filled up for thirty days. For the first fifteen days, they will log the different kinds of food they have eaten, whether healthy or unhealthy. The last fifteen days will be a log of all their activities. Afterwards, the candidates undergo a final exam prepared by the POPTFN committee.

However, these are not the only criteria in choosing the awardees. It also includes the pre- and post-test scores conducted during the modules, and most importantly, their performance for the duration of the program.

Its future goals
Since the program is still quite new, having been in the curriculum of a limited number of schools in the country, it hopes to be developed further. The POPTFN Committee plans to increase the number of private schools which will participate in the said program, and once streamlined, it envisions to be incorporated in the curriculum of public schools in the country.

She, the Teacher

In The Arms of Miracles

admin — Sun, 08 Nov 2009 12:12:52 +0000

What is a miracle? How do you define it? Would you know one when you see one? Orestes Ignacio, 61, came face-to-face with one of the biggest miracles during his 58th year of existence. This is his story.

Before his life turned about, Orestes was the typical loving father and an industrious Casino Manager at PAGCOR living his life one day at a time. But, without his full knowledge, the diabetes that he inherited from his diabetic mother had already begun to take its toll. He noticed that his complexion became all the more yellowish. He also experienced difficulty in breathing, a feeling that was most alien to him since he used to jog, play basketball and lift weights for maintenance.

Little did he know that, at a snail’s pace, diabetes was stealthily creeping through his body. “I didn’t have any idea about my diabetes until I was operated on during my executive check up in 2006. All those times, I ignored it,” recalled Orestes. “I was running on the treadmill during the check-up when the doctor saw that I was skipping a beat. He immediately called my wife and was advise to go home after that.

He finally went an angiogram, a procedure which Orestes refused a year earlier because he said he wasn’t ready. It was found out that there are 4 clogged arteries in his heart. However, when he was finally operated on, the surgeons found another clog that wasn’t show in the angiogram, something that is more complicated.

“I was ordered to eat soft foods such as noodles, soup, and porridge but the swallowing part was really tough” With this, he became gaunt and weak. A sight which his loving wife, Tess, a nurse, got awfully worried about. But, with his rockhard determination combined with his wife’s non-ceasing love and concern, they fought this eating ordeal which resulted in his gradual recovery.

“To heal faster and maintain my blood sugar, I religiously follow my diet; no to too much sugar, mango or any food that has high sugar,” said Orestes. “I perpetually take the medicines that my doctor gave me. Also, I do jogging as it improves my blood circulation, although not regularly because of my work shift.”

In the absence of time for jogging, this family man spends his time in his lush backyard. Simple planting, watering and pruning plants give Orestes utmost delight and new-found zeal in life. “This is to entertain me, eventually forget my illness and enjoy life,” he said.

For some, inspiration is more elusive when they most need it, but for Orestes, inspiration is a mere step away as it comes in the form of his family, most especially his special child, Tammy, and his wife.

“My wife keeps me on my toes as she helps me with my daily regimen and diet,” he said. “I also get inspiration from my special daughter who loves to kiss and hug me every time she gets the chance.”

His wife, a beaming bag of sunshine who effortlessly assisted this writer during the interview, became the key to this story’s theme-family’s love. With her knack for entertaining guests, this writer couldn’t help but be inspired by the cheery Mrs. Ignacio who treated , guests like a relative who just came from abroad.

Not all husbands are blessed with a wife so caring, loving and infectiously cheerful; the kind who would endure all things with their partners until the end. Not all are endowed with a family like that of the Ignacios that feels your every hurt and shares your every anguish.

“God is my number one inspiration, then my wife and my children. I pray to God and thank Him for my family. They push me to strive harder to improve my health,” said Orestes. “My son who’s abroad now constantly reminds me not to overwork and force myself too much. He also tells me to take good care of myself and sleep early whenever we get the chance to talk.”

In this life, no amount of love and care can be measured up against that one given by your family. Yes, your best friend will be there, even your trusted colleague may do, but they can only do so much.

A family’s love is like a constant flowing river: boundless and unconditional.

Under the Knife

admin — Sat, 07 Nov 2009 08:35:05 +0000

When a diabetic undergoes surgery. People with diabetes may undergo surgery due to complications such as cardiovascular problems and infection that may develop in their bodies or due to other conditions unrelated to their diabetes. During these times, people with diabetes must adhere to certain special requirements and considerations to help ensure surgical success.

According to Dr. Florence Amorado-Santos of the American Association of Clinical Endocrinologists-Philippine Chapter, (AACE-PC) “A diabetic person undergoes almost the same types of surgery that a non-diabetic person does. However there are specific procedures that are commonly done in diabetic patients which are usually due to infection such as ray, below or above the knee amputation, debridement of non-healing wounds and gangrene.”

During these times, it is important to closely monitor metabolic processes, maintain the necessary amount of fluid and caloric repletion, and availability and judicious use of insulin. These processes are taken into consideration not only during the procedure itself but even before and after it.

Pre operative assessments indicate the preparations and processes to monitor before the surgery takes place. First and foremost, it is significant to know whether the patient has poorly controlled diabetes or not. Secondly, the physician or endocrinologist should check whether there is a presence of any other co-morbid condition that would need treatment and would warrant pre-admission to the hospital.

According to Dr. Santos, such evidence of ischemic heart disease, cerebrovascular disease, and kidney dysfunction should be sought. It is also important to note the anti-diabetic regimen that the patient has. “If the patient is receiving oral hypoglycemic agents, they may be continued until the evening prior to the surgery, remembering that these drugs may produce hypoglycemia several hours after their administration in the absence of food intake. Those having insulin regimen may also need adjustments for their insulin doses prior to the procedure,” says Dr. Santos.

Part of the preoperative assessment is to assess the kind and amount of anesthesia that will be used for the operation, and the extent to which the patient’s body can handle it. The reason behind this is that anesthesia during surgery of diabetics can result in metabolic stress responses that can lead to insulin resistance, gluconeogenesis, and high blood sugar.

Also, it can lead to the release of catabolic hormones such as epinephrine, norepinephrine, cortisol, glucagons, and growth hormones. It has even been observed that epidural anesthesia, spinal blocks, and splanchnic nerve blocks ameliorate the endocrine and metabolic response.

Dr. Santos emphasizes that epidural and low spinal anesthesia can preserve glucose tolerance, presumably due to the inhibition of the counter regulatory hormone epinephrine as a response to surgery.

From the study of Dronge et al (2006), good preoperative glycemic control with an HbA1c level of less than 7% is associated with lower risk of postoperative infections (such as pneumonia, wound infection, urinary tract infection, and sepsis) when adjusted for other factors that are known to influence this outcome.

Dr. Santos explains that according to the American Diabetes Association, observational studies among surgical patients whose blood glucose levels are not within target (>220 mg/dL), have higher rates of infection. Longer hospital stay and frequent ICU admissions were also noted for these patients. Surgical patients with fasting glucose of. less than 126 mg/dl and all random glucose levels of less than 200 mg/dL have better outcomes.

The intraoperative period begins when the patient is transferred to the operating room bed and ends when the patient is transferred to the post-anesthesia care unit. During this period, the patient is monitored, anesthesized, prepped, and draped, and the operation is performed.

Intravenous infusion of fluid such as insulin, potassium, and glucose is necessary during the surgery of a type 1 diabetic, or a special case type 2 diabetic. These are administered in order to maintain volume in the blood vessels. The surgical process in type 2 diabetic patients involves two main determinants. First, there is the magnitude of the intended surgical procedure (if it is a major or a minor surgery), and second, there is the metabolic state of the patient on the day of surgery.

Rifkin, et al states that the patient who is well-controlled on diet alone, or diet plus oral agents does not require any specific therapy for minor surgery. There is more argument as to how the poorly controlled type 2 diabetic patient should be treated . for minor surgery. Some still advocate no specific therapy, but on occasion an insulin infusion regimen would seem appropriate. Many different regimens have been suggested for metabolic control during major surgery in type 2 diabetics.

The authors also maintain that it is logical and simple to use the same regimen as for type 1 diabetics, as this gives similar results in terms of glycemic regulation. Close monitoring of the blood glucose and maintaining its level is necessary all throughout the procedure to avoid further problems such as high blood sugar, very low blood pressure, electrolyte imbalance, and diabetic ketoacidosis (DKA).

Aside from the constant monitoring and maintenance of the blood glucose level in patients, it is highly important for them to comply with the medications, whether oral hypoglycemics, insulin, antibiotics, and cardiac drugs. Adjustment of medications for diabetes after surgery is common. These are done to have good glucose control vital to wound healing. According to Dr. Santos, some patients may need to be shifted to insulin regimen during their recovery period.

Aside from that, she also maintains that any note of signs and symptoms of post-operation complications such as non-healing incisions, pus draining from surgical wounds, fever and chills should be brought to the immediate attention of the attending physician.

Post Operative Infections and Diabetes

admin — Fri, 06 Nov 2009 12:23:04 +0000

A significant cause of complications in patients undergoing surgical procedures is post-operative wound infection. The occurrence of post-operative infections depends on the complex interaction of several factors. These include 1) patient-related factors, such as the person’s immunity, nutritional status, and the presence or absence of diabetes, 2) procedure-related factors, such as placement of foreign bodies/prosthesis and severity of trauma to the patient, 3) microbial factors that contribute to the aggressiveness or invasiveness of the bacteria, and 4) the use of antibiotics before and after surgery.

Patient and procedure-related factors contribute to a higher risk for developing post-operative wound infections. Patient-related factors include extremes of age-the very young and the elderly, presence of diabetes or inadequate glucose control before and after surgery, long-time smokers, presence of ongoing or active infection, obesity, malnourishment, low albumin levels, chronic steroid use and prolonged surgical procedure.

Procedure-related factors include inadequate cleaning prior to surgery, shaving of the surgical site before surgery, improper use of antibiotics before and after surgery, inadequate operating room ventilation, increase in operating room traffic contributing to a crowded operating room during surgery, a break in the sterile technique during the procedure, poor surgical technique (i.e. inexperienced surgeon) and inadequate cleaning of the instruments used during surgery.

Why the higher risk?
Several studies have noted that patients with diabetes have a higher risk of getting postoperative wound infections compared to healthy individuals. Diabetics usually have diminished vascularization or blood supply to a particular area, leading to poor blood circulation.

People with diabetes also have abnormalities in the immune system, which lessens the ability of the body to fight infections. There is usually a dysfunction in cell-mediated immunity and phagocytic function associated with the increase in blood sugar levels. This weakens the ability of the body to attack and destroy infected cells.

High blood sugar also aids in the colonization and growth of a variety of organisms, thus making diabetic patient more susceptible to infections. Due to the above reasons, adequate blood sugar control after surgery is important for all patients who will undergo surgical procedures. This will promote good wound healing and prevent bacterial colonization of the surgical wound.

There are several steps that can help prevent the development of post-operative wound infection. The first line of defense involves steps to decrease introduction of bacteria into the wound site. These include hygienic practices such as applying antiseptics to the skin of the patient, washing and sterile gloving of the surgeon’s hand, using sterile drapes, ensuring adequate airflow inside the operating room and using gowns, caps and masks by the operating personnel.

To reduce the acquisition of resistant bacteria from the hospital environment prior to surgery, the pre-operative stay should be as short as possible. The use of antibiotics prior to surgery should also be avoided whenever possible. The impact of hair removal may also play a factor in the development of surgical site infection. Shaving using a razor may leave microabrasions around the site that may lead to colonization of bacteria. To prevent causing microabrasions, hair removal can be done by using clippers or depilatories.

Second-line measures are targeted toward improving the ability of the person to contain infection or limit its spread and the immediate elimination of bacteria that have passed through the first line of defense and have colonized the surgical wound. Most studies have emphasized that good surgical technique is the single, most important factor in preventing surgical wound infection. Gentle handling of wound tissues and prevention of blood build-up and devitalized tissues during surgery are important in maintaining an infection-free wound.

Avoidance of gaps in the wound and careful approximation of tissue planes during surgical closure also contribute in the prevention of post-surgical infection. Adequate blood sugar control and proper nourishment, particularly after surgery, also appear to decrease the incidence of wound infection.

Patients, whether diabetic or not, who will undergo surgical procedures should follow the above measures to reduce the risk of post-surgical wound infections. In diabetic patients, good blood sugar control should be strictly employed to promote good wound healing and prevent overgrowth of bacteria in the surgical wound, thereby contributing to the prevention of the development of wound infection.

Treatment of Pain After Operation

admin — Thu, 05 Nov 2009 23:43:50 +0000

Mr. Reyes is a 41-year old father of three who has had diabetes since 10 years ago. He is scheduled for a cholecystectomy, an operation to remove his gallbladder. He is feeling very nervous about the upcoming operation. In particular, he says that: “I am afraid that I will be in a lot of pain after I wake up from the operation.” After talking with Mr. Reyes, his doctor notes that he has a lot of questions and worries.
• What is pain? Does it help me in any way?
• What can be done to control my pain after my operation?
• How will my doctor know how much pain I have?
• What can I do to make sure that I will not have pain after my operation?

These are very typical concerns for someone who is about to get an operation. Let us try to answer some of Mr. Reyes’ questions.

What is pain? Does it help me in any way?

The ancient Egyptians believed that pain was a sensation felt from the heart that arose from wounds and internal afflictions. Aristotle, the philosopher (384322 B.C.) considered pain to originate from the heart and described it as a quality of the soul which is the opposite of pleasure. The Roman physician Galen (131-200 A.D.) viewed pain as a sensation originating from the brain. Traditional Chinese medicine considered pain as a result of imbalance in the two opposing life forces in the body, the Yin and the Yang. They believed that restoring the balance would eliminate the pain.

The word pain arose from the Latin “poena” meaning punishment. This concept closely linked pain to sin committed by the sufferer. In this view, pain may possibly be relieved by prayer or some type of offering. Most of us may be familiar with the close ties between pain, sin, and punishment in the writings, artworks, and cultural beliefs that have been preserved throughout the centuries.

In the simplest definition, “pain is what hurts,” or “pain is what the sufferer says it is.” We have to understand that pain is a very personal experience. No two persons can ever feel the same pain. The statement, “I feel your pain,” is nice to hear, but is not true. Pain was defined in 1986 by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with tissue damage. Pain usually drises from tissue damage. There are two types of pain based on the length of time it persists. Acute pain is hurt of recent onset and probable limited duration (e.g. pain from a needle puncture), chronic pain is hurt which remains even when the damaged tissue has healed.

Pain is carried through nerves known as C-fibers, A-deltafibers, and A-beta-fibers. These nerves also carry the sensation for temperature changes. These nerves send impulses from the skin, muscles, bones, and other parts of the body centrally to the brain. The brain processes the impulses it receives and tells us that the sensation is painful. We must understand that acute pain does have a purpose. It is an alarm that tells us something is wrong with our body. It tells us that we may be injured or sick. We can then do the needed things to take care of ourselves before we become even more sick or injured. Pain acts as a warning of potential damage.

What can be done to control my pain after my operation?

In the context of modern medicine and surgery, acute pain only has benefits for a short time, after which it causes more harm than good. Scientific studies have shown that the proper relief of acute pain in patients decreases the hospital stay, medical costs, complications, and deaths. In addition, unrelieved pain has been shown to decrease levels of insulin in the body and cause high blood sugar. This may result in difficulty in managing your diabetes after an operation if the pain is not well-controlled.

There are a lot of ways of treating pain after an operation. Among these are the following:
• Epidural pain medications (usually up to 2 days)
• Injectable (or intravenous or IV pain medications (usually up to 4 days)
• Oral pain medications (usually up to 1 week)
• Patient controlled analgesia (or PICA) medications (usually up to 4 days)

Epidural pain medications are given through a tiny tube called an epidural catheter which will be placed in your back by the anesthesiologist while you are in the operating room. Medications such as local anesthetics or opioids are given through this epidural catheter to control your pain. This is a very good way to control pain after an operation. It is painlessly removed after 2-3 days. However it is only effective after operations which are from the chest area down to the feet area and is rarely used for pain control of other types of operations.

Injectable pain medications are given through the intravenous (IV or “dextrose”) line. Medications such as opioids or NSAIDs (non-steroidal anti-inflammatory drugs, similar to the pain relievers we buy over the counter) are given through the IV line. This is a very flexible type of pain control and can be used after any operation as long as you have an IV line. Another advantage of IV pain medications is that these already take effect within a few minutes of injection.

Oral pain medications are taken by mouth. These medications may include opioids or NSAIDs or even a combination of these two drugs. The advantage of taking oral pain medications is that it does not need an epidural catheter or an IV line. Therefore, these medications may be taken even when you have already gone home from the hospital.

Patient-controlled analgesia or PCA is a special way of giving injectable pain medications (analgesia means pain relief). With a PCA pump, you can press a button each time you have pain and the pump will automatically give you a previously programmed amount of medication. You can control how much medication you get depending on the amount you need. With PCA,’you need not call the medical personnel each time you have pain, and you need not be afraid of overdose. Your doctor will set a maximum limit of drug which is safe for you. Above this limit, you will not receive medication even if you continue to press the PCA button. The medications used in PCA are usually injectable opioids.

These medications and techniques may be given in combination (called multi-modal analgesia). This has the advantage of needing a lower dose of each medication and having lower risks of side effects.

How will my doctor know how much pain I have?

This is a very appropriate question. One of the foremost leaders in pain management in our country, Dr. Merle dela Cruz-Odi, once said: “In order to treat pain, one must first see it.” Your pain doctor can use different scoring tools with which you can report the pain you have. Some of the most commonly used are the numeric pain score and the visual analog scale (VAS). With the numeric pain score you will be asked to score the severity of your pain from 0 (no pain) to 10 (worst pain you’ve ever felt) with 5 being moderate pain. With the VAS you will be shown a 10 cm long horizontal line with the left-most point marked no pain and the rightmost point marked worst pain; you will then point which part of the line corresponds to the severity of your pain. That point is measured from the left-most point and is noted as the VAS score (in centimeters or in millimeters).

What can I do to make sure that I will not have pain after my operation?

We cannot be completely sure of zero pain all the time after an operation. But by observing your pain scores and using the choices above for pain treatment, we can properly manage our pain after operation. The usual goal for pain control is a numerical score of less than 3 or a VAS score of less than 3 cm. When you have pain more severe than these scores which is not going away, or is recurring frequently, DO NOT BEAR THE PAIN! Be sure to tell the medical personnel, they will give you something for it. Your role is to be a partner together with your doctor on deciding the best technique for managing your pain. You can ask so that your anxieties and fears will be put to rest. A more relaxed attitude usually results in better pain control and faster recovery. The accurate reporting of your pain score will also be crucial in your pain management. Remember that your medical personnel are not mind readers! They do not know how much pain you are in unless you tell them.

Weight Loss Surgery: A Cure for Diabetes?

admin — Wed, 04 Nov 2009 23:23:04 +0000

Obesity often occurs with Type 2 diabetes mellitus. At least 8 out of 10 people with Type 2 diabetes are overweight or frankly obese. In fact, the rising number of people with diabetes in the last 20-30 years has been attributed to the rising number of people who are overweight or obese. This is observed worldwide, alerting health experts to the continuing twin epidemics of diabetes and obesity.

Occurring together, diabetes and obesity share common grounds going back to how they start, how they develop and how they cause health problems. With this close association, it is easy to see the possibility that treating one will help treat the other. Clearly, effective diabetes treatment targets good to normal blood sugar readings, normal blood pressure levels, normal cholesterol values and of course, healthy weight. On the other hand, healthy weight loss can help treat diabetes and even prevent diabetes. Thus, managing diabetes and obesity together is really a must.

Lifestyle intervention through healthy eating and adequate physical activity can effectively help treat diabetes and can lead to significant weight loss. Since lifestyle changes require behavioral changes, the results are often limited by problems of patient compliance and commitment on a long term basis. Losing weight and keeping it down for good are difficult, just ask anyone who has battled weight problems. Drugs to treat obesity, with the few ones available, have some limited effectiveness and have known potential side effects. Lifestyle intervention and drug therapy both only result in modest weight loss, average of as little as 3 to 5% and up to 5 to 10% of initial body weight.

Weight loss surgery then comes into the picture as part of effective options for treating obesity. The commonly used surgical procedures today for weight loss started in the 1960s and have been called bariatric surgery. The earlier focus of these procedures is to bypass the person’s stomach so that food taken in is delivered to the distal or lower parts of the small intestines. Delaying food emptying from the stomach to the small intestines is also part of these procedures. As such, the absorption of food will then be minimized, contributing to weight loss due to less food absorbed by the body. Thus, these bypass procedures are also called malabsorptive.

Newer surgical procedures,focus on limiting the capacity of the stomach to take in food. These are thus called restrictive procedures because they effectively limit the available stomach area for food intake. They may be in the form of cutting part of the stomach (gastric resection or gastrectomy) or by narrowing the passage to the stomach (gastric inlet, gastric banding). More recently, gastric banding procedures done laparoscopically, meaning with guidance from endoscopic machines and with minimal and small incisions in the abdomen, have become popular with surgeons and patients alike because of their minimally invasive nature, ease in doing the procedure, less complications and shorter hospital stay. Combination effects of malaborption/bypass and restriction are also seen in the commonly done bypass procedure called Roux-en-Y gastric bypass.

In the past, these weight loss surgical procedures were performed on patients considered morbidly obese, with body mass index (BMI) of 40 and above or those patients, not as heavy-BMI of 35 and above but with significant weight-related health problems (diabetes, heart disease, sleep disorder and others). The classification of overweight and obesity used internationally is based on the BMI, a measure of an individual’s body weight in kilograms divided by his height in meters squared. Table 1 summarizes the criteria for each degree of overweight or obesity and the attendant health risk. A different classification is recommended for Asians because it has been noted that Asians have more weight-related health problem at lower BMI levels (lower weight/lesser degree of obesity) compared to Caucasians.

Results of weight loss surgery are quite dramatic, causing weight loss of more than 20 to 50 kilograms. This degree of weight loss (30-50% of initial weight) can be maintained for many years as seen in many long term studies lasting more than 10 years. Again, the earlier data were on patients who have more severe degree of obesity.

More recently, convincing data have shown that weight loss surgery has many beneficial effects, aside from the significant weight loss. Normalization of blood sugars, blood pressure and cholesterol levels have been observed in many of these patients who underwent these procedures. In at least half (50%) and maybe more (up to 80% and higher) of these patients had resolution of diabetes, hypertension, hypercfiolesterolemia and obstructive sleep apnea. Risk of death has also been shown to be cut by 30% in patients who had the gastric bypass compared to those who did not. Clearly, effective weight management leads to important disease resolution as well as disease prevention.

Solid evidence now points out that weight loss surgery can not only treat but also cure diabetes. The long term follow up of many patients post bariatric surgery in several medical centers in the US, Sweden, Brazil and other countries have shown that the weight loss surgery can prevent the development of diabetes in patients who are at high risk of developing diabetes (93%, compared to 25% with lifestyle changes and 19% with weight loss drugs). Moreover, among patients already with diabetes and who had weight loss surgery, normalization of blood sugars and discontinuation of antidiabetes medications have been noted in up to 80% of them. These positive effects were maintained up to a period of more than 10 years in many of these patients. It was also observed that even before the significant weight loss has occurred, normalization of blood sugars already started to occur. Many mechanisms, aside from weight loss, appear to contribute to this remarkable resolution of diabetes. Truly, weight loss surgery, does treat and cure diabetes.

Weight loss surgery leads not only to weight loss and diabetes remission but also to important metabolic and cardiovascular benefits that range from normalization of blood pressure and cholesterol levels, resolution of sleep apnea to reduction in death rates. Because many of these changes may also benefit those who are less obese (BMI of less than 35 or even 30), not a few experts in the field of weight loss surgery have proposed lowering the threshold for performing weight loss surgery. They have even started calling these procedures metabolic surgery, instead of bariatric or weight loss surgery. These experts strongly believe that beyond causing weight loss, metabolic surgery can treat and prevent many diseases, foremost among them is diabetes.

Efficacy of weight loss surgery is clearly well-demonstrated and the next important question is its safety. As a surgical procedure, weight loss surgery carries a very low risk of 0.2% mortality from the procedure itself. Mechanical problems from banding procedures and dumping problem due to the rapid transit of food from the stomach to the intestines can be seen in some patients. The improvement in surgical techniques and the use of laparoscopic procedures have contributed to the better outcomes.

However, since weight loss surgery involves restructuring the normal anatomy of the stomach and intestines, there are known potential problems. Nutritional deficiencies are common because of the resultant malabsorption as well as low intake of nutrients. This can lead to vitamin deficiencies, anemia, increased risk of gallstones, some kidney stones and osteoporosis. Behavioral problems, particularly depression, may be seen even though significant improvement in psychosocial functioning is usually noted. Long-term multidisciplinary management before and after the procedure will help address these potential problems. Metabolic monitoring, nutritional supplementation and psychological counseling are part of the total management plan. The other drawbacks include the costs of the procedure. The procedures are already being done in several centers in the Philippines and costs can run up to PhP 300,000 to 500,000.

Clearly, weight loss surgery is a welcome addition to our options for the comprehensive treatment not only of obesity but also of diabetes. Selection of the right patient who will benefit most from the procedure is crucial. Heavier and older patients, with significant associated conditions and without psychiatric history nor eating disorder or substance abuse problem may be the best candidates but several factors, such as unrealistic expectations, socioeconomic status and health care access, can be limiting. Being well informed, motivated and committed to lifelong lifestyle changes and good family support are likewise prerequisites to the ideal potential candidate for weight loss programs.

Special considerations for the young patients, women in the child bearing age, elderly patients and super obese individuals (BMI above 60) must also be emphasized in the selection of potential candidates for the procedure. Multidisciplinary team approach to the twin problem of diabetes and obesity will ensure the best outcome of whatever treatment plan, medical versus surgical, is chosen for the patients with diabetes. Finally, it can not be overemphasized that the best treatment for many diseases, including diabetes, is PREVENTION. Your doctor can help you do it!