Month: October 2022

Blood clots are lifesavers when they seal a cut. They can be dangerous, even deadly, when they form inside an artery or vein. Deep vein thrombosis (sometimes called DVT) is the formation of a blood clot in a large leg vein. It can also occur in an arm vein. Deep vein thrombosis can lead to a pulmonary embolism, or sometimes a stroke.

Blood that circulates to the legs and feet must flow against gravity on its journey back to the heart. The trip is aided by the contraction of leg muscles during walking or fidgeting. The contractions squeeze veins, pushing blood through them. Small flaps, or valves, inside the veins keep blood flowing in the direction of the heart.

Anything that slows blood flow through the arms and legs can set the stage for a blood clot to form. This can range from having an arm or leg immobilized in a cast to prolonged sitting or being confined to bed. Things that make blood more likely to clot, such as genetic disorders and cancer, are other triggers for deep-vein thrombosis.

Symptoms of deep vein thrombosis and pulmonary embolism

Deep vein thrombosis can develop silently. It can also cause:

• pain or tenderness in a leg or arm that gets worse with time, not better
• swelling in one leg or arm
• a reddish or bluish tinge to the skin of one leg or arm
• a leg or arm that feels warm to the touch.

The symptoms of pulmonary embolism include:

• difficulty breathing
• chest pain or discomfort that worsens with a deep breath or cough
• coughing up blood
• a fast heart rate
• sudden lightheadedness or fainting

Diagnosing deep vein thrombosis and pulmonary embolism

To diagnose DVT, your doctor will examine your legs to check for swelling and tenderness. He or she will ask about your symptoms and risk factors.

Based on the findings, your doctor may order a D-Dimer blood test or an ultrasound of your legs.

The blood test measures the level of a chemical called D-Dimer. It is almost always abnormally high when blood clots are actively forming in the body.

An ultrasound of your legs is done to look for blood flow problems in your veins. This procedure is called a lower extremity non-invasive test, or LENI. If the LENI shows evidence of a blood clot, your doctor will diagnose DVT.

If the initial LENI is negative, it does not mean that there is no clot. It may be too early to see the full effect of the clot. Your doctor may ask that you return in three to four days for a repeat LENI.

If your doctor suspects you have a pulmonary embolism, he or she will first try to determine if you have DVT. If the LENI shows one or more blood clots in your leg veins, and you have symptoms of a pulmonary embolism, an embolism is the most likely diagnosis.

Or your doctor may order computed tomography (CT) of the chest. The test requires an IV injection of dye to look for blood clots in the pulmonary arteries. People that have impaired kidney function or an allergy to the dye might need a different type of lung scan called a V/Q scan to examine lung blood flow.

Treating deep vein thrombosis

The initial treatment for a DVT or pulmonary embolism is heparin or one of the newer oral anti-coagulant drugs. These medications act on certain blood proteins to prevent new blood clot formation and therefore help unwanted clots get smaller. They are commonly called “blood thinners.”

There are two main types of heparin. The oldest type of heparin is best administered by a constant intravenous infusion. Another type of heparin is called low-molecular-weight heparin. It is injected under the skin once or twice per day.

Two of the newer anti-coagulant drugs are approved for initial treatment of DVT and pulmonary embolism: rivaroxaban (Xarelto) and apixaban (Eliquis).

If you have a DVT without a pulmonary embolism, you may not need to be hospitalized. You could be treated at home with injections of a low-molecular-weight heparin or either rivaroxaban or apixaban.

Some people may need to start therapy in the hospital. In this case, the type of heparin used is determined by many factors. These include body weight, kidney function and other circumstances.

If you have a pulmonary embolism, you will probably be hospitalized. If so, you likely will be treated with either type of heparin initially. But oral rivaroxaban or apixaban could be an option instead of heparin if your pulmonary embolism is small.

If you are started on either IV heparin or low-molecular weight heparin shots under the skin, your doctor will transition you to an oral drug. Traditional oral therapy has been warfarin (Coumadin). For decades, it was the only oral drug to treat DVT and pulmonary embolism.

In addition to rivaroxaban and apixaban, two other oral anti-coagulant drugs can be used after heparin: dabigatran (Pradaxa) and edoxapan (Savaysa). More of these types of drugs will be approved soon.

Warfarin takes a few days to start working. Once a blood test shows that warfarin is effective, you will stop taking heparin. You will continue taking warfarin for several months or longer.

During the first few weeks that you take warfarin, you will continue to need frequent blood tests to make sure you are taking the right amount. Once your blood test results consistently show that you are taking the right amount of medication, blood can be drawn every two to four weeks.

Some foods—especially green, leafy vegetables that contain large amounts of vitamin K—can alter the blood-thinning action of warfarin. Ask your doctor or pharmacist for a list of these foods. You can continue to eat these foods as long as you eat approximately the same amount of them each day. That way, the effect on your medication will be consistent.

Other medications can also affect how warfarin works in your body. Tell any doctor who is prescribing medications for you that you are taking warfarin.

The new novel oral anti-coagulants don’t require regular blood testing. They are given in a fixed dose. The other advantage is not worrying about eating food with too much vitamin K.

A normal, healthy spleen is up to 12 cm long and 70 g in weight. An enlarged spleen may be up to 20 cm long and can weigh more than 1,000 g. Several things can cause your spleen to enlarge, including inflammation, fat storage, pooled blood, benign or malignant growths and overproduction of cells. Some causes are temporary and others may indicate a chronic or progressive condition.

Symptoms

An enlarged spleen typically causes no signs or symptoms, but sometimes it causes:

• Pain or fullness in the left upper belly that can spread to the left shoulder
• A feeling of fullness without eating or after eating a small amount because the spleen is pressing on your stomach
• Low red blood cells (anemia)
• Frequent infections
• Bleeding easily

When to see a doctor

See your doctor promptly if you have pain in your left upper belly, especially if it’s severe or the pain gets worse when you take a deep breath.

Causes

A number of infections and diseases can cause an enlarged spleen. The enlargement might be temporary, depending on treatment. Contributing factors include:

• Viral infections, such as mononucleosis
• Bacterial infections, such as syphilis or an infection of your heart’s inner lining (endocarditis)
• Parasitic infections, such as malaria
• Cirrhosis and other diseases affecting the liver
• Various types of hemolytic anemia — a condition characterized by early destruction of red blood cells
• Blood cancers, such as leukemia and myeloproliferative neoplasms, and lymphomas, such as Hodgkin’s disease
• Metabolic disorders, such as Gaucher disease and Niemann-Pick disease
• Pressure on the veins in the spleen or liver or a blood clot in these veins
• Autoimmune conditions, such as lupus or sarcoidosis

How the spleen works

Your spleen is tucked below your rib cage next to your stomach on the left side of your belly. Its size generally relates to your height, weight and sex.

This soft, spongy organ performs several critical jobs, such as:

• Filtering out and destroying old, damaged blood cells
• Preventing infection by producing white blood cells (lymphocytes) and acting as a first line of defense against disease-causing organisms
• Storing red blood cells and platelets, which help your blood clot

An enlarged spleen affects each of these jobs. When it’s enlarged, your spleen may not function as usual.

Risk factors

Anyone can develop an enlarged spleen at any age, but certain groups are at higher risk, including:

• Children and young adults with infections, such as mononucleosis
• People who have Gaucher disease, Niemann-Pick disease, and several other inherited metabolic disorders affecting the liver and spleen
• People who live in or travel to areas where malaria is common

Complications

Potential complications of an enlarged spleen are:

• Infection. An enlarged spleen can reduce the number of healthy red blood cells, platelets and white cells in your bloodstream, leading to more frequent infections. Anemia and increased bleeding also are possible.
• Ruptured spleen. Even healthy spleens are soft and easily damaged, especially in car crashes. The possibility of rupture is much greater when your spleen is enlarged. A ruptured spleen can cause life-threatening bleeding in your belly.

Diagnosis

An enlarged spleen is usually detected during a physical exam. Your doctor can often feel it by gently examining your left upper belly. However, in some people — especially those who are slender — a healthy, normal-sized spleen can sometimes be felt during an exam.

Your doctor might order these tests to confirm the diagnosis of an enlarged spleen:

• Blood tests, such as a complete blood count to check the number of red blood cells, white blood cells and platelets in your system and liver function
• Ultrasound or CT scan to help determine the size of your spleen and whether it’s crowding other organs
• MRI to trace blood flow through the spleen

Finding the cause

Sometimes more testing is needed to find the cause of an enlarged spleen, including a bone marrow biopsy exam.

A sample of solid bone marrow may be removed in a procedure called a bone marrow biopsy. Or you might have a bone marrow aspiration, which removes the liquid portion of your marrow. Both procedures might be done at the same time.

Liquid and solid bone marrow samples are usually taken from the pelvis. A needle is inserted into the bone through an incision. You’ll receive either a general or a local anesthetic before the test to ease discomfort.

A needle biopsy of the spleen is rare because of the risk of bleeding.

Your doctor might recommend surgery to remove your spleen (splenectomy) for diagnostic purposes when there’s no identifiable cause for the enlargement. More often, the spleen is removed as treatment. After surgery to remove it, the spleen is examined under a microscope to check for possible lymphoma of the spleen.

Treatment

Treatment for an enlarged spleen focuses on the what’s causing it. For example, if you have a bacterial infection, treatment will include antibiotics.

Watchful waiting

If you have an enlarged spleen but don’t have symptoms and the cause can’t be found, your doctor might suggest watchful waiting. You see your doctor for reevaluation in 6 to 12 months or sooner if you develop symptoms.

Spleen removal surgery

If an enlarged spleen causes serious complications or the cause can’t be identified or treated, surgery to remove your spleen (splenectomy) might be an option. In chronic or critical cases, surgery might offer the best hope for recovery.

Elective spleen removal requires careful consideration. You can live an active life without a spleen, but you’re more likely to get serious or even life-threatening infections after spleen removal.

Reducing infection risk after surgery

After spleen removal, certain steps can help reduce your risk of infection, including:

• A series of vaccinations before and after the splenectomy. These include the pneumococcal (Pneumovax 23), meningococcal and haemophilus influenzae type b (Hib) vaccines, which protect against pneumonia, meningitis and infections of the blood, bones and joints. You’ll also need the pneumococcal vaccine every five years after surgery.
• Taking penicillin or other antibiotics after your surgery and anytime you or your doctor suspects the possibility of an infection.
• Calling your doctor at the first sign of a fever, which could indicate an infection.
• Avoiding travel to parts of the world where certain diseases, such as malaria, are common.

A note from Bhavishya Clinic

An enlarged spleen is a symptom that healthcare providers need to investigate. Whether or not it’s causing you discomfort, it indicates an underlying condition that may need treatment. When it’s temporary, an enlarged spleen won’t harm your overall health. But chronic swelling could damage and endanger your spleen. Your healthcare provider will treat it by treating the underlying cause.

What is Down Syndrome?

Down syndrome is a disorder caused by a problem with the chromosomes — the pieces of DNA that have the blueprint for the human body. Normally a person has two copies of each chromosome, but a person with Down syndrome has three copies of chromosome 21. The condition also is called trisomy 21.  

In a few cases, the extra copy is part of another chromosome (translocation), or found in only some of the person’s cells (mosaicism). 

The extra DNA makes the physical and mental characteristics, which include a small head that is flattened in the back; slanted eyes; extra skin folds at the corners of the eyes; small ears, nose and mouth; big-looking tongue; short stature; small hands and feet; and some degree of mental disability.  

Down syndrome affects an estimated 1 in 800 births. It’s the most common chromosome problem seen in live births. 

Symptoms

In addition to the characteristic physical features and decreased mental abilities, other health problems frequently are seen. These include: 

• Hearing deficits 
• Heart problems 
• Intestinal abnormalities 
• Eye problems 
• Low levels of thyroid hormone 
• Skeletal problems such as joint instability 
• Poor weight gain in infants 
• Kidney and urinary tract anomalies 

People may develop leukemia more often than those without the disorder, and they are more likely to develop infections, problems with the immune system, skin disorders and seizures. 

Infants usually develop more slowly than other children of the same age, although a wide variation is seen. Language development is typically much slower, as is motor development. Their body strength may seem a little weak. For example, most toddlers walk between 12 and 14 months of age, but toddlers walk between 15 and 36 months. 

Diagnosis

Down syndrome frequently is suspected at birth based on physical appearance. The diagnosis usually is confirmed by a blood test to examine the chromosomes. Additional testing may be done, including chest X-rays, echocardiography and an electrocardiogram, to check for heart problems. Sometimes X-ray studies of the gastrointestinal tract are done as well. 

In some cases, Down syndrome is suspected during pregnancy from the results of a fetal ultrasound and blood test that measures the levels of three chemicals (a “triple-screen” test) in a pregnant woman’s blood. If these results are abnormal, further tests can be done to help diagnose it.

Expected Duration

Down syndrome continues throughout life.

Prevention

There is no way to prevent it. However, the chance of having a child with Down syndrome increases as the age of the mother increases. 

Treatment

There is no treatment to reverse the genetic abnormality that causes Down syndrome. However, many of the associated medical and developmental conditions can be treated to: 

• enhance the person’s quality of life 
• improve the child’s development, and  
• increase his or her life expectancy. 

Many health care professionals may be involved in assessing and planning the course of treatment for a child with Down syndrome. Surgery may be required for cardiac or gastrointestinal problems. 

Physical therapy and integrated special education services help children with Down syndrome to make the most of their abilities and reach their potential. Children with Down syndrome usually respond very well to sensory stimulation, exercises to help their muscle control, and activities to help their mental development. School helps children with Down syndrome to learn social, academic and physical skills that may allow them to attain a very high level of functioning and independence.

When To Call a Professional

Most cases of Down syndrome are detected early in life. Call your doctor if you suspect that your child has Down syndrome that has not been diagnosed or if you have questions about your risk of having a child with Down syndrome.

Prognosis

The outlook for a person with Down syndrome varies with the accompanying medical and developmental conditions. The outlook continues to improve, as educators and health care professionals recognize the importance of early interventions to promote both health and development. Advances in medical treatments have greatly improved the life expectancy for people with Down syndrome, with the majority living past age 55.

Theme of International Day of Older Persons: Resilience of Older Persons in a Changing World

The overall umbrella theme for the United Nations International Day of Older Persons in 2022 is “Resilience of Older Persons in a Changing World.” This theme will be celebrated by the NGO Committees on Ageing in New York, Geneva and Vienna – each with a unique and complementary approach to the overall theme.

Objectives

• To highlight the resilience of older women in the face of environmental, social, economic and lifelong inequalities
• To raise awareness of the importance of improved world-wide data collection, disaggregated by age and gender
• To call on member states, UN entities, UN Women, and civil society to include older women in the center of all policies, ensuring gender equality as described in the Secretary-General’s report, Our Common Agenda

Common health conditions associated with ageing

Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia. As people age, they are more likely to experience several conditions at the same time.

Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.

Background

On 14 December 1990, the United Nations General Assembly designated October 1 as the International Day of Older Persons (resolution 45/106). This was preceded by initiatives such as the Vienna International Plan of Action on Ageing, which was adopted by the 1982 World Assembly on Ageing and endorsed later that year by the UN General Assembly.

In 1991, the General Assembly adopted the United Nations Principles for Older Persons resolution 46/91. In 2002, the Second World Assembly on Ageing adopted the Madrid International Plan of Action on Ageing, to respond to the opportunities and challenges of population ageing in the 21st century and to promote the development of a society for all ages.

The composition of the world population has changed dramatically in recent decades. Between 1950 and 2010, life expectancy worldwide rose from 46 to 68 years. Globally, there were 703 million persons aged 65 or over in 2019. The region of Eastern and South-Eastern Asia was home to the largest number of older persons (261 million), followed by Europe and Northern America (over 200 million).

Over the next three decades, the number of older persons worldwide is projected to more than double, reaching more than 1.5 billion persons in 2050. All regions will see an increase in the size of the older population between 2019 and 2050. The largest increase (312 million) is projected to occur in Eastern and South-Eastern Asia, growing from 261 million in 2019 to 573 million in 2050.

The fastest increase in the number of older persons is expected in Northern Africa and Western Asia, rising from 29 million in 2019 to 96 million in 2050 (an increase of 226 per cent). The second fastest increase is projected for sub-Saharan Africa, where the population aged 65 or over could grow from 32 million in 2019 to 101 million in 2050 (218 per cent). By contrast, the increase is expected to be relatively small in Australia and New Zealand (84 per cent) and in Europe and Northern America (48%), regions where the population is already significantly older than in other parts of the world.

Among development groups, less developed countries excluding the least developed countries will be home to more than two-thirds of the world’s older population (1.1 billion) in 2050. Yet the fastest increase is projected to take place in the least developed countries, where the number of persons aged 65 or over could rise from 37 million in 2019 to 120 million in 2050 (225%).

Change the Way You Think About Age!