Obesity Osteoarthritis Ovarian Cyst

Onychomycosis Osteoporosis

 

Obesity

 

Definition:

Body Mass Index (BMI) is commonly used to determine whether a person is overweight or obese. For most people, it is correlated with their amount of body fat. BMI is calculated as the following:

BMI (kg/m2)	=	Weight (kg)
		Height (m) X Height (m)

 

Here is the interpretation of BMI:

Source: WHO Western Pacific Region (2000)
Note: It is not applicable to people under 18 years old and over 65 years old, athletes and pregnant women

 

BMI does not measure body fat and its distribution directly. Methods to measure body fat and its distribution include skinfold thickness and waist circumference, waist-to-hip circumference ratios, ultrasound, magnetic resonance, etc.

Food provides us with energy as fuel for our work, exercise, growth and tissue repair. Excess energy is stored temporarily in the liver and permanently as fat. Obesity results when intake exceeds expenditure for a prolonged period.

 

Who is at risk?

• People who have high intake of energy (calories) and fat;
• People who have sedentary lifestyle;
• People who are genetically predisposed (We take after our parents in our body shape. Obesity can also be a feature of some hereditary diseases.) ;
• People who are on certain kinds of medication e.g. steroids and some antidepressants.

 

Symptoms:

• Increased weight.
• Obese patients are more prone to hypertension, coronary heart diseases, diabetes mellitus, certain cancers, gallbladder diseases and sudden death.

 

Treatment:

The goal of treatment is to reduce weight by 0.5 to 1kg per week. It is achieved by negative energy balance - increasing energy output and/or decreasing energy intake. The strategy may vary, depending on the ability, inclinations and degree of obesity of the patient.

In some cases, a combination of treatments may be needed. There include dietetics, physiotherapy, counseling, medication, and surgery and hospitalization in severe cases.

 

Prevention:

• Maintain a balanced diet.
• Avoid diet that is high in energy/calories and fat.
• Be physically active.
• Avoid excess alcohol consumption.
• Consult doctor before taking any medication.

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Onychomycosis

 

Definition:

Onychomycosis refers to the infection of a nail plate by a yeast or fungus. It can involve either the toenails or the fingernails and is difficult to cure.

 

Who is at risk?

Those who have poor hygiene standards, poor body defenses or need to have their nails exposed to water at work face higher risks. Onychomychosis is twice as frequent in men as in women. The aged are particularly prone. The risk of diabetic patients is increased three fold.

 

Symptoms:

The nail will become brittle and crack and may separate from its bed. The surrounding skin may be red, itchy or swollen. Depending on the type of fungus, the nail may turn yellow, gray, brown, or black.

 

Treatment:

The most common recommended treatment is oral medicine. The course of treatment used to last for years. With newer drugs such as terbinafine and itraconazole treatment can be shortened to months. External applications cannot penetrate the nail bed, but nail lacquer preparations* have been used recently with success. Nail surgery has been performed in the past but is no longer recommended except in resistant cases.

* Nail lacquer preparations - The anti-fungal drug is dissolved in a solution which is designed to dry and stick onto finger nails. The solution is painted onto affected finger nails after filing and cleansing. These preparations may effectively rid off the infection when used early and only one or two nails are affected. These are are available by prescription.

 

Prevention:

• Keep the nails dry and clean, and change socks often, especially in summer.
• Using an antifungal foot spray or powder can help.
• Avoid cutting or tearing the skin around the toenails, as this may provide an entry point for infection.

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Osteoarthritis

 

Definition:

• Osteoarthritis is the most common type of arthritis caused by degenerative changes in the joints.
• The disease affects primarily the cartilage that cushions the ends of bones within joints.
• Healthy cartilage allows bones to glide over one another and absorbs shock during movement. When the cartilage surface is affected by wear and tear, the bones rub against each other during movement. This causes soft tissue overgrowth and inflammation which may result in pain, swelling, and loss of joint mobility.
• Any joint can be affected. Involvement of the large weight bearing joints, such as the knees and the hips can be most debilitating.

 

Who is at risk?

• Elderly
• Previous joint injury
• Congenital abnormality in the limbs that result in abnormal posture or alignment
• Overweight
• Overuse, for example in menial workers and weight lifters

 

Symptoms:

Symptoms of osteoarthritis develop slowly. They include:

• Pain
• Stiffness
• Creaking or grinding sounds in the joint
• Swelling
• Decreased joint mobility

Stiffness is often worse in the morning. Pain may be worse at the end of the day or after exercise or overuse of the affected joint. Symptoms are often more noticeable with the change of weather

 

Treatment:

• Rest the joint if acutely painful.
• Doctors may recommend suitable pain reliever or anti-inflammatory drugs that work for you with the least side effects.
• Some orthopedic surgeons may recommend local injections of anti-inflammatory drugs into the joints. The doctor may also look inside the joint with a mini-telescope (arthroscopy) and perform minimal-invasive surgery to clean up debris in the joint.
• The most severely affected cases may need artificial joint replacement.

 

Prevention:

• Exercise regularly but not excessively
• Watch your weight
• Use assisting device to help relieve work load of the affected joints, such as a walking cane for a painful knee
• Maintain good posture. Poor posture would distribute weight bearing unevenly.

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Osteoporosis

 

Definition:

Osteoporosis is a disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

 

Who is at risk?

• Aged;
• Women: Women have less bone tissue and lose bone density more rapidly than men because of the changes involved in menopause;
• People with family history and past history of fractures;
• Race: Caucasian and Asian women;
• Thin individuals with small bony framework;
• Women during and after menopause;
• Smokers and alcoholics with sedentary lifestyle;
• People taking medications to treat disorders such as rheumatoid arthritis, hypothyroid disease or endometriosis: Examples are steroid, thyroxine, methotrexate, cyclosporine and gonadotropin releasing hormones (GnRH).

 

Symptoms:

• Early in the course of the disease there are no symptoms.
• Later in the course of the disease: Dull pain in the bones or muscles, particularly low back pain or neck pain and sharp pains may come on suddenly. It may be made worse by activities that put weight on the area. Pain may linger more than 3 months.
• Spinal compression fractures may result in loss of height with a stooped posture (called a dowager's hump).
• Fractures at other sites, commonly the hip or bones of the wrist, usually result from a fall.

 

Treatment:

Types of therapy

1. Anti-resorptive drugs: Slow the progressive thinning of bone.
   • Alendronate (Fosamax): Bisphosphonate group.
   • Raloxifene: A selective estrogen receptor modulator (SERMS).
   • Tibolone: A synthetic analog of the gonadal steroid.
   • Intranasal or injectable calcitonin.
   • Hormone Replacement Therapy (HRT).
2. Bone-building agents: Help to rebuild the skeleton.
   • Parathyroid Hormone (Teriparatide).
   • Strontium Ranelate.
3. Non-pharmacological interventions:
   • Calcium, Vitamin D, and protein: Shown to reduce the risk of hip fracture in elderly women living in nursing homes. Sufficient protein intake is mandatory to help maintain muscle function and bone mass.
   • Exercise: Shown to help maintain and build up bone mass. Special care must be taken when exercising to reduce the risk of fracture due to impact or falls.
   • Psychological and practical support: Important especially at the rehabilitation period. Self help groups also play an important role.

 

Prevention:

• Bones are living tissue, and the skeleton grows continually from birth to the end of the teen years, reaching a maximum strength and size (peak bone mass) at age 35, followed by about 1% of bone mass lost each year.
• Children and adolescents should ensure an adequate calcium intake and avoid undernourishment and protein malnutrition.
• Both children and adults should have adequate calcium and Vitamin D intake via food or supplements, weight-bearing exercise and avoid heavy smoking and alcohol.
• Prevention of falling especially in the elderly by identifying and modifying their risk of falls.
• People with risk factors for diagnosis should consider taking a bone mineral density (BMD) test (e.g. Dexa scan). This quick, non-invasive and painless test measures bone mass and helps determine if a person has osteoporosis and/or is at risk for bone fracture.
• Discuss with family physicians to avoid any medication that might render osteoporosis.

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Ovarian Cyst

 

Definition:

An ovarian cyst is a sac filled with fluid present in the ovary. Eggs of a normal woman are developed in sacs filled with fluids. Sometimes they may become large enough to be seen in ultrasounds, and are called "functional cysts". Functional cysts would shrink in size within 1 to 3 months. "Chocolate cysts" are ovarian cysts with bloody fluid contents. They are often caused by endometriosis, a condition where tissue lining the uterus grows onto surfaces of other internal organs. Tumors growing within the ovary may also appear like a cyst. Tumors may be benign or malignant, so an ovarian cyst may be the early symptom of ovarian cancer.

 

Who is at risk?

Functional ovarian cysts are more common in women during the childbearing years, but can be present even in young girls. Benign tumors of the ovary presenting as ovarian cysts can also occur in females of all ages, and some of them are congenital. Ovarian cysts detected in older women need to be taken care of more seriously, because the chance of ovarian cancer is higher.

 

Symptoms:

Most ovarian cysts do not cause symptoms, and are only found during a routine pelvic examination or ultrasound scanning. A large ovarian cyst may present with symptoms such as:

• Pain of fullness in the abdomen
• Pain during sexual intercourse
• Problems when passing urine
• Painful menstrual periods and abnormal bleeding

 

Treatment:

Functional cysts do not require specific treatment. Though, it is best to have ultrasound check repeatedly within a few months time to ensure that it goes away. If a cyst looks unusual on the ultrasound, or that it does not resolve spontaneously, the doctor may prefer to remove it surgically, especially in older women. This can be achieved by "key-hole surgery" performed through a lighted tube called a laparoscope. For large cysts, or when the chance of ovarian cancer is high, conventional open surgery should be a safer option.

 

Prevention:

Functional ovarian cysts are normal and cannot be prevented. Ovarian cancer is rare, but the risk is higher in women 50 to 70 years of age. Routine pelvic and ultrasound examination can detect abnormal ovarian cysts early in women with high risk. Women who are diagnosed early do much better than those who are diagnosed late.

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