DEFINITION

Its a degenerative joint disease.It can be caused by aging,hereditary,injury,trauma,and another diseases.It is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints.It is the most common joint disease

CAUSES

PRIMARY OA

• With aging the water content of the cartilage increases and the protein makeup of the cartilage degenerates as a function of biologic processes
• Eventually cartilage begins to degenerate by faking or forming tiny crevasses
• In advanced osteoarthritis,there is a total loss of the cartilage cushion between the bones of the joint
• Repetitive use of the worn joints over the years can mechanically irritate and inflame the cartilage causing joint pain and swelling
• Loss of cartilage cushion causes friction between the bones leading to pain and limitation of joint mobility
• inflammation of the cartilage can also stimulate new bone outgrowth

SECONDARY OA

It is a form of OA that is caused by another disease or condition.It includes

• Obesity
• Repeated trauma or surgery to the structures
• Abnormal joints at birth
• Gout
• Diabetes
• Other hormone disorders

SYMPTOMS

• Pain and stiffness with loss of range of movement and function
• Swelling
• Warmth
• Creaking of the affected joints

INVESTIGATIONS

• No blood test for the diagnosis of OA
• X-ray of the affected joints can be used to diagnose OA

HOME REMEDIES

• Rest
• Exercise
• Diet control with weight loss
• Physical therapy
• mechanical support devices such as knee braces

TREATMENT

• Oral medications
• Topical treatments applied to the skin surface surrounding the joint affected by OA include anti inflammatory lotions
• Surgical treatments for knee include arthroscopy,cartilage repair,osteotomy and knee arthroplasty

For getting opinion from our network of hospitals visit mvtbooking.com or send a email to query@gtsmeditour.com

Prepared by: Dr Sajna Hamza

INTRODUCTION

Iron is most important among the minerals.it is the most common deficiency among females.Adult human body has about 3-4 gm,,in that 60-70% is present in blood and the remaining part in liver as storage

IMPORTANT FUNCTIONS

1. It is essential in formation of hemoglobin
2. It regulates the body temperature
3. Muscle activity is dependent on the status of iron
4. It helps in catacholamine metabolism
5. It boosts up immune system
6. It is a constituent of myoglobin,cytochromes, catalyses and certain enzymes
7. The most important point ,it helps in oxygen transport and cell respiration

SOURCES

Animal origin haem iron-Liver,meat,poultry and fish.They are readily absorbed due to absence of inhibitors

Plant origin no haem iron-Cereals,green leafy vegetables,legumes,nuts,jaggery. Absorption is hampered by inhibitors ie,phytates,oxalates,carbonates,phosphates and dietery fibers

FACTORS WHICH HELP IN IRON ABSORPTION

Ascorbic acid is a promoter ,which helps absorption of iron.Absorption is more when there is enhanced demand.

STORAGE 

Stored in

• Liver
• Spleen
• Bone marrow
• Kidney

MODES OF IRON LOSS

1. Hemorrhage-Physiological -menstruation,child birth-pathologically by hook worm ,malaria,hemorrhoids,peptic ulcer
2. Basal losses-urine,sweat,bile,IUCD

STAGES OF IRON DEFICIENCY

• 1st stage-decreased iron store
• 2nd stage-latent iron deficiency ie exhausted iron store
• 3rd stage-iron deficiency in blood ie Anemia

Anemia-mild 10-11.9 gm%

Moderate – 8-9.9 gm%

Severe – below 8 gm %

CLINICAL FEATURES

1. Malaise
2. Breathlessness
3. Weight loss
4. oedema
5. pallor
6. angular stomatitis
7. glossitis
8. brittle finger nails
9. bald tngue

DIAGNOSIS

Blood test

• Hb% Normal value 12-14 g%-females,14-16 g% in males
• serum iron concentration 0.8-1.8 mg/L normal
• serum ferritin value below 10 mcg/L indicate absence of stored iron
• serum transferin saturation -it should be above 16%,normal is 30%

 

Prepared by: Dr SAJNA HAMZA A

DEFINITION

Fasting is defined as “complete voluntary abstinence from taking any kind of food for particular time,in order to give rest to digestive system”.It helps to get rid of flesh tainted with toxic filth.It is one of the hygienic practices,which gives rest for digestive system and radical cure of diseases.It is one of the cheapest and important modes of treatment

CLASSIFICATION

1. According to duration

• short duration-2-5 days mainly with water and fruits
• intermittent -1-2  days with satvika diet
• long duration-more than 10 days

2.Depending upon the purpose of fasting

• political
• religious
• therpeutic

3.Depending on the method of fasting

• dry fasting-without drinking water
• water fasting-for acute diseases
• juice fasting-acidic-in obesity and respiratory disease & alkaline – in kidney disorder diabetes
• fruit fasting-weak person
• mono diet fasting-only one type of diet in meal

4.Depending on condition

• fasting in healthy
• fasting in acutely ill
• fasting in chronically ill

PURPOSE OF FASTING

A man who treats his stomach unfairly,by injudicious eating,i.e eating without hunger,by over eating etc man becomes sick.He can be cured of his illness by fasting or eating in less quantity.Highest level of vital economy is achieved by fasting.

EFFECTS OF FASTING

According to Chandogya upanishad ,life is made of water ,so one can fast on water alone,but not too long a time.Sunlight ,air and ether help to sustain life during fast.Body gets rid of the flesh tainted with toxic filth.The person feels weak as the body is in the process of eliminating foreign mater.It is temporary weakness

FASTING IN ACUTE DISEASES

One should fast till the disease subsides and person has sense of lightness.One should break the fast in proper way and help to re establish the health

FASTING IN CHRONIC DISEASES

Long fasts  are contra indicated.Short fasts are recommended with proper interval.When patient is not fasting,positive foods will not deposit foreign matter in the body should be taken sufficiently.As the life force is weak due to unhygienic living,occasional short fasts will be ideal to remove the accumulated morbid matter.Latent disease will be alleviated by right dieting and occasional fasting.In case of chronic disease where there is no hunger ,person may fast from 3-5 days.If there is no return days of hunger,patient should take positive diet for few days and then again fast

METHOD OF FASTING

Fasting is considered not from the last meal,but after the meal has been digested.One should drink water when ever he feels hungry.Daily from sunrise the faster should be without food for 6 hours or more , until natural hunger is experienced and then take light meal with positive food.If one takes 2 meals per day,it is ideal.

Chronically ill patients are unfit for fasting.They can be provided with highly positive drink,not more than four times per day.Even fasting daily for few days in a month can also be indicated.One should drink water when ever he feels thirsty.

FASTING IN DESTRUCTIVE DISEASES

Fast every day for few hours,Take less food which is light and positive in nature,Fresh fruits,vegetables,raw and uncooked food are indicated.Avoid milk,flesh and other heavy foods

ACUTE EFFECTS OF FASTING ON THE BODY

1. Formation of gas-disintegration of old putrid matter leads to gas formation
2. Temperature increases in first few days
3. cotton mouth-combination of morbid elements takes place and filth is expelled through mouth ,leads to coating of tongue which is called as cotton mouth
4. By third and fourth day mucous membrane of intestine starts eliminating morbid matter ,indicated by fetid breath and coated tongue
5. bilious vomiting produced due to hepatomegaly
6. offensive perspiration  again due to expulsion of morbid matter
7. breaking down of tissues produce increased worne out cells and other morbid matter

PREPATION

It is safe to prepare system for the fast through low protein diet,rich in positive minerals or raw food diet.For prolonged fast supplement in the form of dilute acid,acid fruit juices which have neutralizing effect on toxins and elimination effect.They are splendid tonics ,antiseptics and life elements

BREAKING THE FAST

Small quantity of light food,which can be digested easily like dilute fruit juices,tender coconut water,vegetable soups and thin butter milk should be taken.Later when digestive power increases,heavy foods can be consumed.After recovery always consume positive food in the quantity

 

PREPARED BY:DR SAJNA HAMZA A

DEFINITION

Vitamins are organic compounds,required to the body in small amounts,so categorized under micro nutrients.Also classified under protective and regulatory food.They do not yield energy,but help the body to utilize other nutrients

CLASSIFICATION

• Fat soluble – Vitamin A,D,E &K
• water soluble – Vitamin B & C

VITAMIN A

• It acts as a regulator of cell and tissue growth and differentiation
• it is a group of unsaturated nutritional organic compounds that includes retinol,retinal and several pro vitamin A carotenoids
• it is important for growth and development for the maintenance of the immune system
• for good vision
• immunity-susceptibility to infection and lowered immune response is found in  deficiency of vitamin A
• Vitamin A is needed by the retina of the eye in the form of retinal ,which combines with protein opsin to form rhodopsin,the light-absorbing molecule necessary for both low light and color vision
• it also functions in a very different role as retinoic acid,which is an important hormone like growth factor for epithelial and other cells
• Vitamin A covers both vitamin and pro vitamins
• Vitamin A retinol is from animal source
• Pro vitamin of vitamin A is beta-carotene.It is converted into retinol by intestinal mucosa

SOURCES

• Animal origin- Liver,eggs,butter,cheese,whole milk,fish and meat
• Plant origin – green leafy vegetables,spinach,yellow fruits,papaya,mango,pumpkin,roots like carrot
• Artificially fortified foods-milk, vanaspathi,margarine

STORAGE

Stored in the liver in the form of retinol palmitate.The store is sufficient to meet the needs for 6-9 months

DEFICIENCY

Predominantly ocular manifestations,less commonly extra ocular manifestations also found

XEROPHTHALMIA

it includes all ocular manifestations of Vitamin A deficiency from night blindness to keratomalacia

1. Night blindness
2. Conjunctival xerosis
3. Bitots spots
4. Corneal xerosis
5. keratomalacia

Night blindness:

It is beginning stage of Vitamin A deficiency with inability to see in the dim light

Conjuctival xerosis:

First clinical sign of Vitamin A deficiency ,conjunctiva is dry and non wettable. Instead of smooth and shining conjunctiva appears muddy and wrinkled

Bitots spots:

Triangular pearly white or yellowish foamy spots on bulbar conjunctiva on either side of cornea ,usually bilateral is known as bitots spot

Corneal xerosis:

Serious condition,cornea appears dull,dry,non wettable and eventually opaque.Severe deficiency leads to corneal ulceration.It may heal with scars which are opaque

Keratomlacia:

Liquefaction of cornea takes place ,cornea may become soft & may burst open.The process is rapid ,eye collapses and vision is lost

EXTRA OCULAR MANIFESTATIONS

They consist of follicular hyperkeratosis, anorexia and growth retardation

MEASURES FOR PREVENTION

1. Improvement of diet ,regular and sufficient intake of vitamin  rich food
2. By preventing contributory factors Ex.PEM,respiratory infection,diarrhea,measles
3. Prophylactic dose of vitamins A-single massive dose of retinol palmitate orally,to all preschool children(1-6 yrs)once in 6 months is advocated, 1-6 yr -2,00,000 IU of retinol  palmitte, 6 months -1 yrs -1,00,000 IU of retinol palmitate

For getting opinion from our network of hospitals visit mvtbooking.com or sent a email to query@gtsmeditour.com

DEFINITION

The sciatic nerve is the largest nerve in the human body and sciatic is pain which occurs due to irritation of the sciatic nerve

The pain which might feel like a bad leg cramp or can be a shooting pain that makes standing or sitting nearly impossible,is typically felt from the lower back to behind the thigh and radiates down below the knee

CAUSES

• Herniated or slipped disc:this will cause pressure on the nerve and as a result pain occurs along path of the nerve
• Piriformis syndrome:which occurs when the small piriformis muscle,which lies deep in the buttocks,becomes tight and spasms,thus putting pressure on and irritating sciatic nerve
• Spinal stenosis: this results from narrowing of the spinal canal which puts pressure on the nerve
• Spondylolisthesis: that occurs when one vertebrae slips,so that it is out of line with one above it,narrowing the opening through which sciatic nerve exist

RISK FACTORS

• Changes in the spine due to advancing age,such as herniated disks and bone spurs
• being obese which stresses the spine
• sitting for prolonged period
• leading a sedentary life style
• diabetes
• jobs which require to carry heavy loads,drive for long periods,repeatedly twist your back

SYMPTOMS

• Lower back pain
• pain in the rear or leg which worse when sitting
• hip pain
• burning or tingling in the leg
• weakness
• numbness
• difficulty in moving the leg or foot
• shooting pain making difficulty in stand up

COMPLICATIONS

• Permanent nerve damage
• loss of feeling in the affected leg
• weakness of leg
• loss of bowel or bladder control

INVESTIGATIONS

• X ray
• CT
• MRI

TREATMENT

• Medications
• physical therapy:your Doctor may recommend to perform a few back exercises and streches

Exercise:in Sciatica exercises usually the focus on stregthening and streching the spinal column and muscles and tendons

• Surgery:Micro discectomy is a common surgical approach used to treat sciatica that is caused by a lumbar disc herniation.in this surgery,a small part of the disc material under the nerve root is taken out.while technically an open surgery,a microdiscectomy uses minimal invasive techniques and can be done with relatively small incision and minimal damage

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DEFINITION

It refers to a degenerative process affecting the vertebral disc and facet joints that gradually develops with age.The condition can narrow the spinal canal that results in the compression of spinal cord and nerve roots

Usually the conditions associated with cervical spondylosis arise from the regular wear and tear of the bones and cartilages located in the neck region

CAUSES

Bone spur: The overgrowth of the bones in the neck or spine area could be due to body trying to grow some extra bone for making the spine stronger.However the growth of extra bones could start pressing on delicate ares of the spine including spinal cord ,nerves and surrounding muscles leading to pain and discomfort

Herniated Discs: This happens due to the development of cracks in the spinal discs.these cracks allow the leakage of the internal material required for cushioning.The material could press on the nerve and spinal coed and would thus,result in symptoms

Dehydrated spinal discs: The presence of the gel like material between the discs of spine bones could dry out with passage of time.this would lead to rub the spinal vertebrae against each other that could result in immense pain

Injury: Injury in neck during some accident or fall

RISK FACTORS

• Age over 60
• accident
• excessive work resulting in wear and tear

SYMPTOMS

• Pain around shoulder blade
• pain along entire arm and finger
• stiffness in the neck muscles
• constant headaches that usually occur towards the back of head
• numbness or tingling affecting the arms and shoulder

DIAGNOSIS

While making the diagnosis of cervical spondylosis ,it is essential for the doctor to rule out the possibility of having fibromyalgia

INVESTIGATIONS

• X-ray
• CT
• MRI Scan
• EMG

COMPLICATIONS

• Spinal nerve injury
• Neck Injury
• Paralysis

TREATMENT

• Physical therapy
• Medication
• Surgery-When the condition becomes severe,then surgery of the affected area remains only option to get relief from pain

ANTERIOR CERVICAL DISKECTOMY AND FUSION

In this the problematic disk and additional bone spur are removed and stabilize the spine through spinal fusion .Typically a plate with screws is added to the front of the spine for added stability

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A cancer that forms in the cells of the breast.common between age 40-50.

1. 

PRECIPITATING FACTORS

1. Unmarried women
2. nulliparous women
3. women with bad obstrectic history
4. high in oral contraceptives

SYMPTOMS

1. lumb in the breast
2. bloody discharge from breast
3. changes in shape or texture of the nipple or breast

 

CLASSIFICATION

a) intra dochal -within the ducts

b) extra dochal-outside the ducts

CLINICAL TYPES

1.Invasive duct carcinoma-common form ,lumb is very broad &irregular causes drowning of the nipple .

2. Medullary carcinoma-primary tumors is soft and circumscribed and may attain a large size

3. Colloid CA/Tubular CA – Appear as well defined masses common in elderly

4.Inflammatory CA – Seen usually during pregnancy and lactation.Breast is often painful

5. Technical Types

Mastitis Carcinoma:i.e carcinoma + inflammation ;retracted nipple;skin is red ,warm and painful

MANCHESTERS STAGING OF THE BREAST  CANCER

Stage 1 – Growth confined to breast;An area of adherence to the skin smaller than the periphery of the tumor does not affect staging.Even ulceration of the skin in the area defined does not alter it

Stage 2 – same as stage 1 but palpable,mobile,lymph node gathering of growth to the pectoral muscle

Stage 3 – skin involvement larger than tumor. Tumor fixed to pectoral muscle.if the nodes are palpable they must be mobile

Stage 4 –

• Skin involvement as stage 3
• Tumor fixed to chest wall
• Axillary nodes are not mobile
• Palpable nodes in supra clavicular fossa
• Secondary deposits in skin
• Secondary deposits in the opposite breast
• Distant metastasis

The physician or surgeon can easily notice certain peculiar features in the breast in the conditions of any breast cancer

1. Peu-d-orange

2. Oedema of the arm

3. Browny arm

4. Development of carcinomatous nodules on the affected side of the chest wall .

SPREAD OF CANCER

1.Local spread – From mammary gland to skin muscles and chest wall

2. Lymphatic Spread – Leading to inflammatory of internal mammary lymph nodes,supraclavicular node,axillary lymph nodes etc…

3. Spread  by Blood Stream – To ribs ,lumbar vertebra, femur,thoracic vertebrae, to the skull,may lead to pathological fractures

4. Spread to liver – May lead to jaundice

5. Transcoelomic spread

INVESTIGATIONS

a) Needle biopsy/FNAC

b)Trephine biopsy

c)Open biopsy

d)Frozen section biopsy

e)Mammography

f)Ductography

g)Thermography

 

TREATMENTS

1. hormonal
2. endocrine manipulations
3. radio therapy
4. oestrogen blockers
5. immuno therapy
6. chemo therapy

At present ,radical mastectomy or extended radical mastectomy offers the prospect of long survival provided the neoplasm categorized as belonging to stage 1 and stage 2 .when stages  3 and 4 are reached,the interests of the patient are best served by simple mastectomy and radiotherapy provided the tumor is hormone stimulated ,with endocrine therapy.

RADICAL MASTECTOMY (halsted)

The breast and associated structures are dissected enblock, and the excised mass is composed of

1. The whole breast
2. A large portion of skin ,the centre of which overlies the tumor ,but always included the nipple,where there is much skin involvement more skin must be sacrificed
3. The  fat and fascia from the tumor border of the clavicle to,including the upper quater of the sheath of the rectus abdominis and from the sternum to the anterior border of the latismus dorsi
4. pectoralis major,and its fascial sheath
5. pectoralis minor and sheath
6. the costo-coracoid membrane
7. all the fat,fascia and lymph nodes of the axilla
8. the fascia over and a few fibres of the external oblique,serratus anterior subscapularis ,the latismus dorsi and the upper part of the rectus abdominis

2)Extended radical mastectomy

In this ,the radical mstectomy along with removal of internal mammory lymph glands and second inter costal muscle

For getting opinion from our network hospitals visit mvtbooking.com or send a email to query.gtsmeditour.com

 

 

 

 

 

 

 

 

DEFINITION
It is a non progressive neurological disorder of movement ,posture and tone due to a non progressive pathological process in the brain caused by an insult to the developing brain

 

Depending on the site and extent of involvement ,it may be associated with

• visual disturbances
• seizures
• mental retardation

Etiology

Both prenatal and perinatal factors are considered.

1. prematurity

2. kernicterus

3. structurally abnormal brain

4. birth asphyxia

5.encephalitis

6.meningitis

Classification

1. spastic CP
2. Extra pyramidal CP
3. Cerebellar or ataxic CP
4. Mixed CP

Spastic C P

Again classified into

1. Diplegic C P
2. Hemiplegic C P
3. Quadriplegic C P

Diplegic C P

commonest form of C P in preterm

symptoms

1. spastic lower limbs with increased tendon jerks and extensor plantar  response
2. scissoring of legs
3. visual disturbances

Hemiplegic C P

There is paresis of one side of body with upper motor neuron type of spasticity increased reflexes and extensor plantar response

Quadriplegic C P

1. spasticity in all the four limbs with pseudo bulbar palsy
2. severe mental retardation
3. epilepsy

Extra pyramidal C P

Distonia and choreoathetosis in various propotions

1. Defective coordination of movements
2. defective regulation of muscle tone,resulting in the inability to execute the intended movements

Ataxic C P

Manifest only in second year of life,before that the child may remain floppy without other cerebellar signs

 

Investigations

1. CT
2. MRI
3. TORCH screening for associated symptoms

Treatments

Treatment of associated defects and optimum utilization of available motor functions become important

Treatment of associated deficits

• seizures can be controlled with anticonvulsants
• early stimulation aimed at functional development of various modalities is a must
• physiotherapy
• prevention of contractures -splinting  may prevent this
• avoid\make use of abnormally persisting reflexes
• reflex stimulation
• training in motor activities
• education
• Orthopedic & neurosurgical measures

1.    arthrodesis of the wrist,ankle etc may be considered if it adds to the functional recovery
2. in established contracture , muscle lengthening to decrease the adduction of hip,flexion of knee etc..
3. surgical transfer of tendons to the muscles of desired function and release of tendo achilles contracture
4. peripheral nerve section (obturator nerve) may help to reduce adductor spasm
5. a more advanced surgery is selective motor fasiculotomy where selected fasicule of a nerve that causes undesirable hyper tones is cut off after identifying them by stimulation studies
6. surgical implants of electrodes in   selected areas over the dura of spinal cord can be used for spinal stimultaion

 

For getting opinion from our network of hospitals visit mvtbooking.com or send a email to query@gtsmeditour.com

 

 

 

Bipolar Disorder

Bipolar disorder is a serious mental health condition in which some individuals experience alternating periods of high energy levels and extremely low mood. People with bipolar disorder may find the COVID-19 pandemic and resulting lockdown to be particularly challenging to manage.

Do you feel very happy and outgoing—or very irritable—on some days, but unusually sad or anxious on other days? Do the “up” periods go along with increased energy or activity? Do the “downs” go along with low energy, hopelessness, or inability to enjoy what you usually like to do, and sometimes suicidal thoughts? Do these mood swings make it hard to sleep, stay focused, or get things done? Some people with these symptoms have a lifelong but treatable mental disorder called bipolar disorder.

What is bipolar disorder?

Bipolar disorder is a chronic or episodic (which means occurring occasionally and at irregular intervals) mental disorder. It can cause unusual, often extreme and fluctuating changes in mood, energy, activity, and concentration or focus. Bipolar disorder sometimes is called manic-depressive disorder or manic depression, which are older terms.

Everyone goes through normal ups and downs, but bipolar disorder is different. The range of mood changes can be extreme. In manic episodes, someone might feel very happy, irritable, or “up,” and there is a marked increase in activity level. In depressive episodes, someone might feel sad, indifferent, or hopeless, in combination with a very low activity level. Some people have hypomanic episodes, which are like manic episodes, but less severe and troublesome.

Most of the time, bipolar disorder develops or starts during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Although the symptoms come and go, bipolar disorder usually requires lifetime treatment and does not go away on its own. Bipolar disorder can be an important factor in suicide, job loss, and family discord, but proper treatment leads to better outcomes.

Symptoms of bipolar disorder?

The symptoms of bipolar disorder can vary. An individual with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. There are different types of bipolar disorder, which differ in their symptoms and severity.

The main symptoms of bipolar disorder is alternating episodes of high and low mood

Symptoms of a Manic Episode

Feeling very up, high, elated, or extremely irritable or touchy

Feeling jumpy or wired, more active than usual

Decreased need for sleep

Racing thoughts

Thinking you can do a lot of things at once without getting tired

Excessive appetite for food, drinking, sex, or other pleasurable activities

Feeling like you are unusually important, talented, or powerful

Symptoms of a Depressive Episode

Feeling slowed down or restless

Trouble concentrating or making decisions

Feeling very down or sad, or anxious

Unable to do even simple things

Talking very slowly, feeling like you have nothing to say, or forgetting a lot

Feeling hopeless or worthless, or thinking about death or suicide

Most people experience mood changes at some time, but those related to bipolar disorder are more intense than regular mood changes, and other symptoms can occur. Some people experience psychosis, which can include delusions, hallucinations, and paranoia.Anxiety disorders and ADHD often are diagnosed in people with bipolar disorder.People with bipolar disorder are more prone to misusing drugs or alcohol,also eating disorder, such as binge eating or bulimia.

Between episodes, the person’s mood may be stable for months or years, especially if they are following a treatment plan.

Causes

The exact cause of bipolar disorder is unknown. However,Men and women are equally likely to get it. research suggests that there is no single cause. Instead, a combination of factors may contribute to bipolar disorder.For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.

Bipolar Disorder Types

There are a few types of bipolar disorder, including:

Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks.

Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.

Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.

With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues.

Diagnosis

A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms, lifetime course, and experiences of the individual. Some people have bipolar disorder for years before it is diagnosed.

Diagnosing bipolar disorder is all about the person’s symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?

The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.

Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.

Treatment

Treatment aims to stabilize the person’s mood and reduce the severity of symptoms. The goal is to help the person function effectively in daily life.Bipolar disorder is generally a chronic condition, meaning that there is no cure. However, it is possible to manage the condition and lead a full and productive life. The key is to find the right combination of treatments and remedies, including medications and healthful lifestyle measures, and to stick with them. It may take some time to accomplish this, so friends and family should be patient and remain supportive.

Treatment involves a combination of therapies, including:

• medication
• counseling
• physical intervention
• lifestyle remedies

It can take time to get a correct diagnosis and find a suitable treatment, as individuals react differently, and symptoms vary widely.

Takeaway

Bipolar disorder is a serious mental health condition in which some individuals experience alternating periods of high energy levels and extremely low mood. People with bipolar disorder may find the COVID-19 pandemic and resulting lockdown to be particularly challenging to manage. Above tips and precautions may help them to cope with the same.

Charley Horse is another name for  muscle spasm – when a muscle suddenly tightens up on its own resulting severe pain.They’re common in your legs, often occurs during exercise and at night. It commonly affects the calf muscle at the back of the lower leg, but it can also occur in the foot and, occasionally, in the thigh.The sudden and uncontrollable spasm can often be brief, but it can last for several minutes or up to 10 minutes.

Causes:

Doctors do not know exactly why muscle cramps happen when a person is exercising or when they have no other medical conditions.

Things that can trigger a charley horse include:

• Poor blood flow
• Working your muscles too much
• Not stretching enough
• Being active in high temperatures
• Dehydration
• A lack of magnesium and/or potassium in your diet
• A problem such as a spinal cord injury or a pinched nerve in your neck or back
• Kidney disease
• Muscle cramps are also a side effect of some drugs – diuretics, raloxifene (Evista), or statin drugs

Risk factors for charley horses

Muscle spasms can happen to anyone, at any age. And a charley horse can occur at any time of the day or night.

Charley horses do tend to occur more often among people in the following groups:

• athletes
• infants
• older adults
• people who are obese
• people taking certain medications like diuretics, raloxifene (Evista), or statin drugs
• people who smoke

People who are obese are more likely to experience charley horses because of poor circulation in their legs. Athletes often experience charley horses because of muscle fatigue or overuse.

Charley Horse Diagnosis

The occasional charley horse doesn’t require an official medical diagnosis. However, your doctor should investigate frequent, recurrent muscle spasms. This would apply if a charley horse occurs more than once a week without an adequate explanation.

Your doctor can usually make a diagnosis based on your medical history and a physical examination.

The doctor will more than likely ask about their symptoms, including:

• what the cramping is like and where it occurs
• when the cramps happen and for how long
• how severe or regularly the cramps occur
• whether they have started recently

A doctor is likely to ask about the person’s exercise habits, diet, and any other symptoms, medical problems, or current medications, as well.

Treatment

There is little evidence that medical intervention can help cure or reduce muscle cramping.

However, when a muscle is cramping, and a person experiences a charley horse, the following action may help them find some relief:

• If you get a charley horse in your calf or in the back of your thigh (hamstring), put your weight on the affected leg and bend your knee slightly. Or sit or lie down with your leg out straight and pull the top of your foot toward your head.
• For a cramp in the front of your thigh (quadriceps), hold on to a chair and bend the knee of the affected leg. Pull your foot up toward your buttock.

  Massage, a bath with Epsom salts, or a heating pad can relax the muscle. To fight pain, use an ice pack or take an over-the-counter medication like ibuprofen or naproxen.

  In most cases, the charley horse will stop within a few minutes. But if you get them often and for no clear reason, consult your doctor

• In severe cases, your doctor may prescribe antispasmodic medication. Also, physical therapy can help you cope with muscle spasms and prevent further complications.
• In extreme cases, you doctor may recommend surgery. If other treatments fail, surgery can enlarge the space around a nerve to relieve pressure. This may help if nerve compression causes your spasms.

Preventing charley horses

Once you identify the cause of the occasional charley horse, symptoms are generally easy to prevent. Take these steps to help avoid future muscle spasms:

• Stretch before and after exercise.
• Avoid exercising the same muscles on consecutive days.
• Weight loss for people with excess weight
• Changing to different more comfortable footwear
• Do not exercise in severe weather.
• Drink water throughout the day.
• Drink beverages that contain electrolytes, such as Gatorade.
• Stretch before going to bed
• Don’t smoke.
• Limit Alcohol intake

Takeaway

Charley horses are common and can occur in any muscle at any time. They’re usually treatable and can sometimes be prevented.

Any pain caused by a spasm won’t typically last more than a day. However, if you experience charley horses frequently, talk with your doctor about treatments.