Dataflow SCFHS (Saudi Arabia)

English: Saudi Arabia (Photo credit: Wikipedia)

Working in a healthcare industry in Saudi Arabia is quite tempting especially in the government-run facilities. The main thing is the tax-free salary. Besides, you will be provided with free accommodation and transportation.  Some are generous enough to give you food allowance. To sum up everything, there is a big chance for you to save if you spend your hard-earned money wisely. 

To realized everything I've mentioned above, you must fulfill the requirements mandated by law. Every individual, regardless of nationality, who wishes to practice their profession in Saudi Arabia are required to undergo registration process at the government regulatory body. Just like any other country, you are required to come in for an examination to check your competency and be able to practice your profession legally. I'll focus this topic to my fellow professionals in the healthcare industry,  particularly the physiotherapist. 






If you are living outside Saudi Arabia:

• Start the verification process with Dataflow.
• Click this website link>>> Dataflow SCFHS
• Click on the 'To initiate a new case' to register and to log in. Provide your email and password.
• Fill in all the required information (applicant) in the online application form.
• It should be written in English.
• Prepare all the documents in a scanned copy to be uploaded on the page where they are needed. Not a single upload.
• Documents to be submitted depend on the country where you from. Anyway, you will ask to what are these documents as you go along with your application.
• Applicants from the Philippines, prepare your College Credentials (TOR, Diploma), Government-issued IDs (Passport), Certificate of Employment(COE), and PRC Records. There is a note there mentioning nurses who doesn't have PRC will fall in the category of Nurse . I guess it applies to anyone who doesn't have PRC.
• Print, sign, scan, and upload the Letter of Authorization.
• Go over the pages and patiently review the information you provided before you proceed to the payment section.
• You cannot edit or make changes in your application once your payment is done.
• Anyway, they will inform you if there are changes to be made for clarification.
• Payment is SR500 thru credit card.
• If you don't  have the credit card, try to borrow from your friends or family and just pay them in cash.
• Once payment is done, you will receive an email from them to confirm your payment.
• Your will again receive an email if started working in your application as well as the anticipated date to finish.
• Keep all the email from them for future references.
• Check your SCFHS account to monitor the progress of your application.

Note:

Eligibility Number is provided to you after the verification (Dataflow). Use that Eligibility Number to register and schedule a Prometric Examination in the Philippines.

Useful Site:
http://www.dataflowgroup.com/applicant-gateway

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Obstetrics (Pregnancy and Exercise)

Muscles of the trunk (Photo credit: Wikipedia)

Exercise and Pregnancy

Regular exercise at the right intensity is an essential way of helping your body cope with the increased physical demands on your joints, muscles, heart and lungs during pregnancy. A recommended exercise, adequate diet, proper hydration, appropriate clothing, and optimal environment during exercise must be considered to obtain the best result.

I. Physiologic Changes during Pregnancy:

• Pregnancy weight gain
• Abdominal muscles are stretched and weakened
• Increased deep of respiration; hyperventilation and dyspnea during late pregnancy
• Increased tidal volume and increased minute ventilation
• Increased oxygen consumption per minute (15-20%)
• Ligamentous laxity secondary to hormonal changes  - hypermobile joints
• Frequent urination due to pressure in bladder
• Stress incontinence due to pelvic floor dysfunction
• Increased blood volume (40-50%); increased heart rate and cardiac output; decrease BP due to venous distensibility
• Increased basal metabolic rate and increased heat production
• Anemia may occur
• May develop hypotension in supine position during late pregnancy from pressure on the inferior vena cava.

II. Postural Changes during Pregnancy:

• Kyphosis with scapular protraction
• Increased cervical lordosis
• Forward head posture

III. Balance Changes during Pregnancy:

• Changes in center of gravity -shift forward and upward
• Wider base of support in standing

IV. Pathologies:

A. Diastasis Recti (Abdominal Separation)
A separation of the rectus abdominis muscles along the linea alba very common among pregnant women. Also common to newborn babies secondary to incomplete development and usually resolved without intervention. Men can possibly get it from weight cycling, doing wrong sit-ups or weightlifting, or from other causes.

Causes: 
Exact cause in unknown. Pregnant women may have the condition because of increased tension on the abdominal wall. Multiple births or many pregnancies have higher risk.

Symptoms:
It looks like a ridge running down the midline of the abdomen, anywhere from the xiphoid process to the umbilicus and more prominent with muscle  straining. Most easily seen when the baby tries to sit up. The top of the pregnant uterus is often seen bulging out of the abdominal wall in the late pregnancy. A trace of the unborn baby may be seen in some severe cases.






Testing:

• Patient in hook lying position.
• Place your fingers (palm facing you) just above your belly button.
• Lift your head and neck very slightly off the floor and press down with your fingertips.
• A gap felt greater than the width of two fingers indicates diastasis.
• A diastasis recti gap is measured in the width of fingers. 

Avoid :

• Be careful with crunches, sit-ups, oblique (twists) combined with crunches that will strain your abdominal muscles.
• Constipation and lifting heavy things.

Treatment: 

• No treatment is necessary for women while they are still pregnant.
• Education in the causes of diastasis recti and on the inappropriate abdominal exercises to avoid.
• Postpartum abdominal binding may be helpful in some cases because can help with awareness of the abs and for lower back support.
• Perform deep abdominal exercises  targeted to help narrow the separation between the muscles.
• Observe body mechanics
• Postural Awareness
• Maternity Belly Band

B. Pelvic Floor Weakness

Pelvic floor muscles are muscular bottom part of the abdomen which are attached and span to the bottom of the pelvis. These muscles function to support pelvic floor organs, aid in sexual performance (orgasm), gives us control over the bladder and bowel, stabilize connecting joints, and act as a venous and lymphatic pump for the pelvis.They come under great strain in pregnancy and childbirth. Being pregnant and giving birth, these muscles of your pelvic can become overstretched and weak as early as 12 weeks into your pregnancy.

Effects of Weak Muscles:

As a result of weak pelvic floor muscles, the internal organs are not fully supported leading to difficulty controlling the release of urine, feces, or flatus (wind). It is quite common that you may accidentally leak a little urine when you coughing, sneeze, or exercise (stress incontinence) and it can continue after pregnancy. Constipation is common in pregnancy and adds more strain on your pelvic floor. Another thing, weak vaginal muscles may put your uterus, bowel or bladder to slip forward or down against the walls of your vagina (prolapse) making sex less satisfying, and feel less sensitivity in your vagina.

Pelvic Floor Exercise:

Strengthen the muscles of the pelvic floor helps to reduce or avoid stress incontinence even if you’re young and not experiencing from stress incontinence.A few daily pelvic floor exercises will help to treat bladder weakness or prolapse symptoms. Encourage strengthening of the muscle after each baby as muscles tend to weaken with age and will help to prevent problems later on.  Keep your pelvic floor strong for the rest of your life since hormonal changes after the menopause worsen incontinence.

Kegels Exercise

• Start with an empty bladder before you begin.
• The way to check if you are doing it right is by inserting a clean finger into your vagina and try to squeeze the muscles surrounding it. If you feel pressure around your finger, then that's it.
• Begin by contracting these muscles for 5-10 seconds, then relax, repeating 10-20 times. Do this at least three times a day.
• It is perform without pulling in your tummy, squeezing your legs together, tightening your buttocks, or holding your breath.

V. Benefits of Exercise during Pregnancy

• Support the extra weight of pregnancy.
• Promote healing in incision area due to increase blood circulation 
• A more satisfying sex life
• It can help reduce back pain, improve or maintain muscle tone, reduce leg cramps, swelling and constipation, and improve sleep patterns 
• often feel better about themselves and their changing body during pregnancy.
• less likely to experience fatigue due to improved sleep pattern, are less anxious and experience reduced pain perception and neuromuscular tension.

VI. Postural Education during Pregnancy

• Stand tall, with your abdominal muscles gently drawn in and your shoulders back, and gently drop your chin. 
• Watch and maintain a correct posture regularly during the day.

VII. Ideal exercises or activities during pregnancy (No complications)

• Light stretching
• Walking
• Golfing
• Low impact aerobics
• Water aerobics
• Pregnancy exercise classes
• Stationary cycling
• Swimming (freestyle not breaststroke)
• Light weight training 

VIII. Exercises activities to avoid during pregnancy

• Skiing/Water skiing
• Lifting heavy weights
• High impact or jerky movements
• Contact sports
• Scuba diving
• Excessive twisting and turning activities - Skating
• Prolonged bouncing activities - Horseback riding
• Any activities or exercises that cause pain or numbness, stop it immediately or advise the instructor if you are in a class.
• Exercises that require you to hold your breath or shortness of breath.
• Prolonged standing static exercises.
• Exercises that involving sudden changes in direction.
• Activities or exercise involving sudden changes in intensity.
• Exercises that increase the curve in your lower back.
• Avoid exercise in the supine position after the first trimester.
• Stop exercising when fatigued and not exercise to exhaustion.

IX. Contraindications:

• Pregnancy induced hypertension
• Preterm rupture of membrane/leaking of amniotic fluid
• Preterm labor during the prior or current pregnancy
• Incompetent cervix
• Persistent second to third trimester bleeding
• Intrauterine growth retardation
• Reduced movements of your baby
• Dizziness, faintness, headaches, blurred vision, nausea or vomiting

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Blood Pressure

BLOOD PRESSURE:

The blood pressure is the pressure of the blood within the arteries. It is produced primarily by the contraction of the heart muscle. Measurement is recorded by two numbers. 

              The first (systolic pressure) is measured after the heart contracts and is highest.
              The second (diastolic pressure) is measured before the heart contracts and is lowest.

A blood pressure cuff is used to measure the pressure placed in your upper arm. Elevation of blood pressure is called HYPERTENSION.

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/Ab
outHighBloodPressure/Understanding-Blood-Pressure-
Readings_UCM_301764_Article.jsp


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Crutches

English: Using underarm crutches. Español: Caminando con dos muletas de aluminio. Polski: Osoba z dwiema kulami pachowymi. Svenska: Kryckor av aluminium. (Photo credit: Wikipedia

It is one of the many ambulatory aid used to help people who have suffered an injury and/or disability to one of their feet, knees, ankles, or legs by transferring weight from the legs to the upper body for reasons ranging from short-term injuries to life-long disabilities. Crutches are made in all sizes, for adults and children. Some devices are adjustable to accommodate differences in height or it can be custom made to fit a particular individual. It is normally recommended by a doctor or a physical therapist to use temporarily to protect the injured area from further damage or it can be use by an individual with permanent disabilities for functional ambulation. Another thing to consider which is equally important are the crutch muscles. Promote strengthening exercise to the upper extremities to better prepare the patient with crutch ambulation.

                                             







Types of Crutches:

Lofstrand (Forearm) Crutch

• This crutch promotes ease of movement but provide slightly less stability. Require highest level of coordination. The hands are free for use without dropping the crutch as secured by forearm cuff. It is used by placing the arm into a cuff and grasping the grip. The cuff should cover the proximal third of the forearm, about 1 to 1.5 inches below the elbow (below olecranon process) so it does not interfere with elbow flexion.

Axillary (Underarm) Crutch 

• This is the most common type. Easily adjusted  according to your overall height and hand height. Require higher coordination to properly use. Provide increased trunk support compared to forearm crutch. Has difficulty moving around in small areas. Avoid prolong leaning on the axillary bar to keep away from axillary artery and/or radial nerve damage.

Platform (Triceps) Crutch

• These are less common and used by those with poor hand grip due to arthritis, cerebral palsy, or other conditions. The arm rests on a horizontal platform and is strapped in place. The hand rests on a grip which, if properly designed, can be angled appropriately depending on the user's disability. Offer support for people who cannot bear weight in their wrists.

Strutter (Underarm) Crutch

• This crutch is a type of underarm crutch is designed with a large base pad with a slip resistant sole. Come with a padded handgrips and a padded, u-shaped axilla support. This allows for improved weight distribution and more even walking gait.

Leg Support Crutches

• These non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. The affected leg is strapped into a support frame on wheels. Leg support crutches are particularly useful for below the knee injuries or postoperatively after below-the-knee surgery that affect one leg only. It has the advantage of not using the hands or arms while walking.

Crutch Measurement:

There are several basic types of crutches and all should be custom fitted properly to help reduce movement problems.

Axillary crutch: 

• In the standing position , the top of the crutch should extend 2 inches (about two finger widths) below the armpit (axilla) to a point on the floor 6 inches in front of your foot and 2 inches lateral to the foot. The handgrip should allow you to flex your elbow about 30°, enough to fully extend your elbow when you take a step.
• In the supine position(unable to stand), simply subtract 16 inches from your height or from the axilla  to a point 6-8 inches lateral to the heel.

Forearm crutch: 

• Proper fit should allow you to flex your elbow 20°-30° while holding the handgrip. The crutch is positioned 6 inches in front and 2 inches lateral of your foot. The arm cuff should sit 1 inch to 1.5 inches below the olecranon process.

Platform crutch:

• This crutch is measured 2 inches below the skin-fold of the armpit. The lower cuff is 0.5 in-1.5 inches below the back of the elbow to avoid bony contact on the arm.

                             
Gait Patterns

Two-Point Gait

• It uses two crutches or canes.
• Each step is one-point and a complete cycle is two-points.
• Slightly faster than a 4-point gait but requires more balance.
• Allows natural arm and leg motion normal gait, good support , and stability (closely resembles normal walking).
• Pattern: Right crutch and left leg; left crutch and right leg.

Three-Point Gait

• It can be seen with walkers or crutches.
• Indicated with involvement of one lower extremity to decrease weight-bearing.
• Fairly rapid but requires arm strength to support significant body weight and maintain balance.
• Pattern: Both crutches and the affected leg move forward simultaneously; then the stronger extremity is moved forward while placing most of the body weight on the arms.

Four-Point Gait

• Very similar to two-point; The difference is that the leg is not moved simultaneous with the crutch/cane instead it waits and moves only after the crutch/canes has advance.
• Prescribed to patient with impaired coordination, balance, or significant strength deficit.
• Pattern: Right crutch, left leg; left crutch, right leg.

Swing-To Gait

• Ideal to patient with bilateral trunk and/or lower extremity weakness
• This type of gait requires considerable arm and upper body strength to support the entire body weight.
• Pattern: Bear weight on unaffected leg (or legs); advance both crutches forward simultaneously, lean forward while swinging the body to a position even with the crutches.

Swing-Through Gait

• The fastest of all crutch gaits but not as safe as swing-to gait.
• It is different from swing-to gait only in that the body lands beyond the crutches with every step.
• Used for patient with bilateral lower extremity involvement and with trunk instability
• Pattern: Advance both crutches forward; lift legs off the ground and swing forward beyond the crutches; bring crutches forward rapidly.

Proper Use and Instructions for Crutches

Standing

• The top of your crutches should be about 2 inches below your armpits.Your weight should rest on your hands(not on the underarm) to avoid damage to the nerves and blood vessels under your armpit.
• Place the tip of the crutches 8 inches to 10 inches in front of you.
• The handgrips of the crutches should be even with the top of your hip line.
• Elbows slightly flexed bent holding the handgrips.

Walking

• Do not try to move too quickly or to cover too long a distance with each step. Keep the crutches close to your body.
• Always look forward, not down at your feet.
• Turn by pivoting on your strong leg, not your weak leg.
• Chose the gait pattern to use.

Stairs

• Ask assistance
• Going down stairs, place the crutches on the next step below, then step down with the good leg.
• Going up stairs, lead with your good foot, keeping your injured foot raised behind you, then bring the crutches up.

Sitting

• Use a chair with armrests to make sitting and standing easier.
• To sit to a chair, bed, or toilet. Put your injured foot in front of you and hold both crutches in one hand.
• Using your free hand, grab the armrest, the seat of the chair, or the bed or toilet.
• Slowly lower yourself into the chair.
• When you are seated, lean your crutches in a nearby spot.
• Rest your crutches upside down when you are not using them so that they do not fall down.

To stand up

• Push yourself forward of the chair as well as your weak leg.
• Hold both crutches in the hand on your uninjured side.
• Push yourself up and stand on your good leg.
• Balance on your strong leg while you place a crutch in each hand.

Safety Tips:

• Avoid slick conditions, such as wet floors; snowy, icy, or rainy conditions.
• Be especially careful on curbs and steps.
• Wear well-fitting, low-heel shoes or slippers with rubber or non-skid soles. Do NOT wear shoes with heels or leather soles.
• Don’t use crutches if you feel dizzy or drowsy.
• Do make sure your crutches have rubber tips.
• Carry things hands-free by using a backpack, or an apron with pockets.
• Simple home modifications for safety and convenience.
• Walk only in well-lit rooms
• Don’t put any weight on the affected foot if your doctor has so advised
• Keep stairs and floor clear of clutter.

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Arterial Insufficiency Ulcers

English: A 71-year-old diabetic male smoker with severe peripheral arterial disease presented with a dorsal foot ulceration (2.5 cm X 2.4cm) that had been chronically open for nearly 2 years. (Photo credit: Wikipedia)

Arterial Insufficiency Ulcers 
(Ischemic ulcers or Ischemic wounds)

Arterial ulcers occurs secondary to inadequate supply of oxygenated blood, which is almost always caused by atherosclerosis, or fatty plaque build-up in the arteries.

Characteristics:

• Etiology: Associated with chronic arterial insufficiency;arteriosclerosis obliterans; artheroembolism;history of minor non-healing trauma.
• Pain: Often severe, intermittent claudication,progressing to pain at rest;may complain of pain nocturnally; pain can be relieved by lowering the leg below heart level (i.e. dangling leg over the edge of the bed).
• Pulses: Decreased or absent.
• Appearance: Round or punched out with sharply demarcated borders, yellow base, or necrosis; irregular,smooth edges; min to no granulation;Minimal to no hair;periwound skin pale; tend to be deep.
• Location: Located mainly on the lateral malleolus, ant. tibial area,on the distal lower leg (toes, feet)
• Temperature: Lower extremities cool to touch.
• Color: Skin is pale on elevation, shiny, taut, and thin; dusky rubor on dependency.
• Drainage: Minimal to no drainage.
• Gangrene: May be present
• Edema: Normal
• Others: Presence of femoral bruit and prolonged venous filling time.

 Risk factors:

• Vascular insufficiency
• Uncontrolled Diabetes Mellitus 
• Limited joint mobility
• Poor footwear that inadequately protects against high pressure and shear
• Obesity
• Structural foot deformity(Charcot foot) and callus formation resulting in focal areas of high pressure   
• Retinopathy (poor eye sight)
• Renal disease
• History of cardiac or cerebrovascular disease; leg claudication, impotence, pain in distal foot
• Increased age/ Elderly patients
• Absence of protective sensation due to peripheral neuropathy

Complications:

It may lead to serious complications (including tissue necrosis, infection and amputation) if left untreated.







Diagnosis:

• Topical Wound Oxygen (two2™)
• Ankle brachial index
• Buerger's test
• Arterial Doppler studies and pulse volume recordings
• Antiplatelet and other rheologic agents
• Address risk factors

Management:

Intervention is focused on increasing the arterial circulation.The affected region can sometimes be revascularized via vascular bypass or angioplasty. Amputation and rehabilitation in extreme cases.

Intervention and Recommendation:

• Cleaning the ulcers -wash and dry feet thoroughly; debridement to remove dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.   
• Rest -if the wound is on the plantar area(walking surface of foot), patient is advised to give rest to foot to avoid enlargement of the ulcer.
• Reducing risk factors - Smoking should be avoided to aid wound healing.
• Limb protection - wear appropriately sized shoes with clean,seamless socks  
• Proper glycemic control in diabetics is important
• Avoid unnecessary leg elevation
• Avoid using heating pads or soaking feet in hot water.
• Inspect legs and feet everyday
• Avoid unnecessary pressure

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Osteoarthritis (Degenerative Joint Disease)

Česky: Artróza - deformity kloubů na prstech (Heberdenovy uzly) Deutsch: aktivierte Heberden-Arthrose des Zeigefingers rechts (Photo credit: Wikipedia)

(Degenerative Joint Disease, OA, Osteoarthrosis)

The most common form of arthritis, affecting millions of people worldwide.Rheumatoid arthritis - the second most common form of arthritis - affects other parts of the body besides the joints.A joint disease that mostly affects cartilage,the slippery tissue that covers the ends of bones in a joint that breaks down and wears away over time.In a normal joints,a healthy cartilage is a firm,slippery tissue provides a smooth, gliding surface for joint motion and acts as a cushion. 
In OA, the cartilage breaks down, causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.It can damage any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe.Occurs in people of all ages, osteoarthritis is most common in people older than 65(usually begins later in life). Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.Osteoarthritis often gradually worsens, and no known cure .Progression can be slow down by maintaining a healthy weight and other treatments.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time.

Pain  

• Tends to be worse when you move your joint or at the end of the day.May feel pain more often in severe cases.Example is hip pain felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.

Tenderness  

• May feel tender when you apply light pressure to it.Pain and tenderness is felt in the large joint at the base of the big toe. There may be swelling in ankles or toes.

Stiffness  

• Most noticeable particularly first thing in the morning or after a period of inactivity.Joints may feel stiff after rest, but this usually wears off as you get moving.    

Swelling  

• Affected joints may get swollen, especially after extended activity.The swelling may be hard (caused by osteophytes) or soft (caused by synovial thickening and extra fluid), and the muscles around your joint may look thin or wasted.

Grating sensation  

• May hear or feel a grating sensation when you use the joint.A grinding sensation (crepitus). A “grating” or “scraping” sensation occurs when moving the knee.

Loss of flexibility  

• May not be able to move your joint through its full range of motion.

Bone spurs  

• Extra bits of bone, which feel like hard lumps, may form around the affected joint.Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb.

Risk Factors: Who may get this?

1. Older age 

• Occurs most often in older people but younger people sometimes get osteoarthritis primarily from joint injuries, usually starts from the late 40s onwards.
• Not fully understand why it’s more common in older people, but it might be due to your muscles weakening and your body being less able to heal itself, or your joint slowly wearing out over time. 

2. Gender

• Women are more likely to develop osteoarthritis, though it isn't clear why.
• For most joints, especially the knees and hands, osteoarthritis is more common and more severe in women.

3.Obesity   

• Many years of carrying extra pounds can cause the cartilage that cushions joints to break down faster.
• It added stress on weight-bearing joints, such as your hips and knees.

4.Genetics  

• Various genetic traits can make a person more likely to develop OA. 
• One possibility is a rare defect in the body’s production of collagen, the protein that makes up cartilage.

5.Joint injuries and overuse(trauma)   

• Repetitive movements or injuries to joints (such as a fracture, surgery or ligament tears) can lead to osteoarthritis. 
• Some athletes, for example, repeatedly damage joints, tendons and ligaments, which can speed up cartilage breakdown. 
• Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.

6.Certain occupations 

• Stresses on the joints from certain jobs and playing sports play a part in OA.
• Certain careers that require standing for long period of time, repetitive bending, heavy lifting or other movements can also make cartilage wear away more quickly. 
• An imbalance or weakness of the muscles supporting a joint can also lead to altered movement and eventual cartilage breakdown in joints.

7.Bone deformities/Joint abnormalities  

• Anyone born with abnormalities or with malformed joints or defective cartilage, increases the risk of osteoarthritis.
• Perthes’ disease of the hips is an example.

8.Other diseases 

• Having diabetes or other rheumatic diseases such as gout and rheumatoid arthritis can increase your risk of osteoarthritis.
• Certain metabolic disorders such as hemochromatosis, which causes the body to absorb too much iron, or acromegaly, which causes the body to make too much growth hormone

Complications

1.Gout 

• A common type of inflammatory arthritis, which is caused by high levels of urate that lead to sodium urate crystals forming in and around your joints. 
• The changes that osteoarthritis causes in cartilage can encourage crystals to form within your joint. 
• If you have both osteoarthritis and a high level of urate in your blood, you’re at an increased risk of developing gout.
• The base of the big toe is a very common site for a painful attack of gout, and this is partly because this joint is the most common joint in the foot to be affected by osteoarthritis.

2.Chondrocalcinosis  

• A calcium pyrophosphate crystals formed in your cartilage.
• OA tends to become more severe more quickly when calcium crystals are present.

3.Diabetes and Heart Disease  

• Knee or hip pain may lead to a sedentary lifestyle that promotes weight gain and possible obesity. 
• Being overweight or obese can lead to the development of diabetes, heart disease and high blood pressure.

4.Falls  

• Anyone with osteoarthritis experience as much as 30 percent more falls and have a 20 percent greater risk of facture than those without OA. 
• People with OA have risk factors such as decreased function, muscle weakness and impaired balance that make them more likely to fall. 
• Side effects from medications used for pain relief can also contribute to falls. 
• Narcotic pain relievers can cause people to feel dizzy and unbalanced.

Diagnosis

No single test can diagnose osteoarthritis. Most doctors use several methods, including medical history, a physical exam, x-rays, or lab tests.A doctor will collect information on personal and family medical history, perform a physical examination and order diagnostic tests.

1. Patient Health History and Symptoms

• Detailed description of the symptoms.
• When did your joint pain or other symptoms begin?Is the pain continuous, or does it come and go
• Information about medical problems you've had.Have you ever injured this joint?
• Location of the pain, stiffness or other symptoms. Visual inspection.
• How the symptoms affect daily activities or any particular activities make the pain better or worse?
• Information about the medical problems of your parents or siblings.
• All the prescription and over-the-counter medications and dietary supplements you take and the dosages
• List of current medications.

2. Physical Examination

• Examination of the joints - look for joint damage,tenderness, pain, or swelling; body mechanics.
• X-ray - cam show damage and other changes related to osteoarthritis. Cartilage loss is revealed by a narrowing of the space between the bones in your joint.
• Blood test -  are usually not helpful in a diagnosis. May help rule out other causes of joint pain, such as rheumatoid arthritis.
• Joint aspiration -  involves withdrawing (aspirating) a sample of fluid from a joint using a needle and syringe either relieve swelling or to obtain fluid for analysis to diagnose a joint disorder and/or problem.
• Magnetic resonance imaging (MRI)  - isn't commonly needed to diagnose osteoarthritis but may help provide more information in complex cases. Produce detailed images of bone and soft tissues, including cartilage.

Treatment Goals and Intervention

1. Managing symptoms, such as pain, stiffness and swelling 

• Transcutaneous electrical nerve stimulation (TENS) can help to ease pain. 
• Heat and cold therapies.

2. Improving joint mobility and flexibility  

• Range-of-motion exercise helps maintain and improve joint flexibility and reduce stiffness. Slow, gentle stretching of joints may improve flexibility, lessen stiffness and reduce pain. 
• Yoga and tai chi are great ways to manage stiffness.

3. Maintaining a healthy weight - 

• Excess weight adds additional stress to weight-bearing joints, such as the hips, knees, feet and back. 
• Appropriate diet with increased physical activity will effectively loss weight. One of the most beneficial ways to manage OA is to get moving.

4. Getting enough of exercise -

• The U.S. Department of Health and Human Services recommends that everyone, including those with arthritis, get 150 minutes of moderate exercise per week. 
• Strengthening exercises to muscles around the affected joints.

5. Physical Activity  

• Aerobic exercise helps to improve stamina and energy levels and also help to reduce excess weight. 
• Walking, gardening, briskly pushing a baby stroller, climbing the stairs, playing soccer, or dancing the night away are all good examples of being active.

6. Assistive devices 

• Braces or shoe inserts can help reduce pain when you stand or walk. 
• It can immobilize or support your joint to help take pressure off it as well as help with function and mobility. 
• These include items, such as like scooters, canes, walkers, splints, shoe orthotics or helpful tools, such as jar openers, long-handled shoe horns or steering wheel grips.

Pain and Anti-inflammatory Medications

Medicines for osteoarthritis are available as pills, syrups, creams or lotions, or they are injected into a joint. They include:
1. Analgesics. 

• These are pain relievers and include acetaminophen, opioids (narcotics) and an atypical opioid called tramadol. 
• They are available over-the-counter or by prescription. Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce inflammation. 
• It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. 
• Liver damage if taken more than the recommended dosage.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 

• These are the most commonly used drugs to reduce inflammation and relieve pain. 
• They are available over-the-counter(ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others) or by prescription(stronger NSAID). Side effects include stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. 
• Oral NSAIDs has more side effects compared to topical NSAIDs. Oral NSAIDs usually not recommended to older people over 65 years of age and those with stomach bleeding.

3. Corticosteroids. 

• These are powerful anti-inflammatory medicines taken by mouth or injected directly into a joint. 
• It can start to work within a day or so and may improve pain for several weeks or even months. 
• Steroid injections are mainly used for very painful osteoarthritis. 

Complementary and Alternative Medicine

These include nutritional supplements, acupuncture or acupressure, massage, relaxation techniques and hydrotherapy, among others.

Surgery

Joint surgery can repair or replace severely damaged joints, especially hips or knees performed by an orthopaedic surgeon.Surgery can be recommended if pain is very severe or you have mobility problems or if conservative treatments don't help. Some surgical procedure may include osteotomy and arthroplasty.

Helpful site:

Common aches and pain
See more at: http://www.arthritisresearchuk.org/arthritis-information/common-pain.aspx

Exercises to manage pain
See more at: http://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain.aspx

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Diabetes Mellitus

Česky: Aplikace "rychlého" inzulínu inzulinovým perem (Photo credit: Wikipedia)

I. Definition:

More commonly referred to as "diabetes" or sometimes called "sugar diabetes", is a condition that occurs when the body can't normally use glucose(a type of sugar).Glucose is vital to your health because it's an important source of energy for the cells of your muscles and tissues.It's also your brain's main source of fuel.The level of glucose in the blood are controlled by a hormone called Insulin, which is made by the pancreas. Insulin helps glucose enter the cells.

II. Target Blood Sugar Level:

Source: The American Diabetic Association(ADA) and American Academy of Pediatrics(AAP)

Children of any age with type II diabetes and most adults with type I or II diabetes(non-pregnant).

•      A1c: less than 7.0%
•      Before meals: 70 to 130 mg/dL
•      1 or 2 hours after meals: 100 to 129 mg/dL

Women with type I or type II diabetes who become pregnant.

•     A1c: less than 6.0%
•     Before meals, bedtime, and overnight

Women with type I or type II diabetes who become pregnant

•     A1c: less than 6.0%
•     Before meals, bedtime, and overnight: 60 to 99 mg/dL
•     1 to 2 hours after meals: 100 to 129 mg/dL or lower

Women who have gestational diabetes

•     Before meals: 95 mg/dL or less
•     1 to 2 hours after meals: 120 to 140 mg/dL or lower

Adolescents and young adults with type I diabetes(13 to 19 years old)

•     A1c: less than 7.5%
•     Before meals: 90 to 130 mg/dL
•     Bedtime and overnight: 90 to 150 mg/dL

School-age children with type I diabetes( 6 to 12 years old)

•    A1c: less than 8.0%
•    Before meals: 90 to 180 mg/dL
•    Bedtime and overnight: 100 to 180 mg/dL

Toodlers and preschoolers with type I diabetes(under 6 years old)

•    A1c: less than 8.5%
•    Before meals: 100 to 180 mg/dL
•    Bedtime and overnight: 110 to 200 mg/dL

III. Classification:

A. Type I diabetes

• Also known as juvenile diabetes because it begins most commonly in childhood or adolescence (usually less than 25 years of age) or was also called insulin-dependent diabetes because this type need to have daily injection of insulin.
• A metabolic disease caused by destruction of islets of Langerhans cells secondary to possible autoimmune or viral causative factor.
• It has abrupt onset; accounts for 5-10% of cases
• Insulin production is very little to none

Brittle diabetes 

• Frequent and rapid swing of blood sugar level between hyperglycemia and   hypoglycemia.
• Requires several injection of different types of insulin during the day.

B. Type II diabetes

• Previously referred to as "non insulin-dependent diabetes mellitus"(NIDDM) or sometimes called as age-onset or adult-onset diabetes.
• The most common form of diabetes
• Etiology: resistance at insulin receptor sites usually secondary to obesity; ethnic prevalence.
• Significantly link to a person's lifestyle, weight, and age.
• Sometimes developing over the course of several years(slow or gradual onset); usually older than  40 years of age.
• Accounts for 90-95% of cases: Ketoacidosis rarely occur(ketosis-resistant diabetes; Insulin production is variable.
• Can be controlled by: Weight loss, Exercise, Diet, and Oral insulin.

Gestational diabetes 

• Develop during pregnancy (2nd or 3rd trimester) and generally resolves after delivery.
• Etiology: believed due to hormonal changes, metabolic demands, and genetic and environmental factors.
• Born prematurely, hypoglycemic, or severe jaundice at birth.

Risk Factor of Type II diabetes

• Usually older than 40 years of age
• Have a relative with diabetes mellitus (parent or siblings)
• Overweight or obese(more than 20% above their ideal body weight)
• Physical inactivity
• History of gestational diabetes or have delivered a baby more than 9 lbs(4 Kg)
• A high blood pressure(140/90 or above)
• Polycystic ovary syndrome (PCOS)
• Impared glucose tolerance or impaired fasting glucose on previous testing
• History of CVD
• A high-density lipoprotein(HDL) below 35 mg/dL; triglyceride level above 250 mg/dL
• Predieteacosis nigricans - a dark,velvety rash around the neck or armpit.

IV. Sign and Symptoms:

4 Classic symptoms:    Weight loss in spite of increased eating(unexplained weight loss
                                         Increased urination(polyuria)
                                         Increased thirst(polydipsia)
                                         Feeling very hungry(polyphagia)

• Blurred vision
• Dehydration
• Irritability
• Slow healing sores
• Frequent infections (gums or skin infections and vaginal infections)
• Ketones in urine

V. Complications:

• Hypoglycemia and hyperglycemia
• Nephropathy
• Retinopathy
• Impotence
• Cardiovascular and peripheral vascular disease
• Diabetic ketoacidosis
• Increased risk of infections
• Acceleration of atherosclerosis
• Leading cause of lower limb amputation and end-stage disease
• Major cause of blindness(adults)

VI. Diagnosis:

A. Fasting Plasma Glucose Test:

• Patient has not eaten at least 8 hours,usually in the morning before breakfast.
• A plasma level of 200mg/dL(7.8 mmol/L) or higher indicate diabetes.

B. Postpradial Glucose Test:

• Test is done right after the patient has eaten a meal

C. Oral glucose Tolerance Test:

• Test is done before and after a patient drinks a thick, sweet syrup of glucose and other sugars.
• Plasma level of 11.1 mmol/L(200mg/dL) or higher at two hours after drinking indicates diabetes .

D. Urine Analysis - detects ketones and protein in the urine



VII. Interventions:

Type I diabetes

• Exogenous insulin injection per physican orders
• Subcutaneous insulin infusion pump for continuous admistration of insulin (surgical transplantation)
• Intraperitoneal dialysis for patient with renal failure

Type II diabetes

•     Usually given with oral hypoglycemic agents 

Exercise Therapy

*Benefits

•  Assists in weight reduction
•  Improves blood glucose control and circulation
•  Delays disease onset
•  Reduced cardiovascular risk
•  Improves strength and reduces stress

 *Take caution for exercise-induced hypoglycemia
 *Exercise testing is done prior to exercise  

• 50-60% of their predicted HR unless directed by physician

*Precription 

• Daily aerobic exercise; duration and intensity may be decreased.
• Include: cardio machines, aerobic classes, dancing, running, swimming, walking, or hiking
• Home exercise program: General exercise and strengthening, stretching and self monitoring of cardiac status.

*Diet - control of carbohydrates, protein fat, and caloric intake.
*Acupuncture - can help relieve the pain associated with diabetic neuropathy.
*Herbal remedies - may be helpful in managing diabetes - NO herbal substitute for insulin.

Exercise Precautions:

• Monitor glucose prior to and following exercise; readily carbohydrates snacks.
• Do not inject insulin in exercising muscles or sites close to it. 
• No exercise without eating at least 2 hours before exercise.
• No exercise for poorly controlled blood glucose level or at high level(at or near 250 mg/dL).
• No exercise if  urine test indicates presence of ketones.
• No exercise without adequate hydration.
• No exercise in extreme enviroment temperature(very cold or very hot).
• No exercise poorly controlled complications( as mentioned above).
• No exercise alone; need close supervision.  

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