Category: General

Weight gain is a common health problem. Most of weight gain can be attributed to genetic factors that govern your metabolism and environmental factors that cause an imbalance between calorie consumption and expenditure. Having low thyroid (hypothyroidism) can slow down metabolism and also lead on to accumulation of fluid in the body. This can cause weight gain.

Hyperthyroidism (increased activity of thyroid) can lead to weight loss. You may have tremors, palpitation, sweating and anxiety. High time to meet an endocrinologist and get your thyroid checked.

Dr. Deepa G

Getting diagnosed with any malignancy can be scary. But if you are diagnosed with a thyroid malignancy, you may have the highest chances of getting cured. Thyroid cancers may be of different types: papillary carcinoma, follicular carcinoma or medulllary carcinoma. Rarer varieties and mixed forms also do exist.

The doctor would first remove the entire thyroid gland (it is called total thyroidectomy). At times the diagnosis is confirmed only after a part of the gland is removed, in this case the doctor would decide if you require a “completion thyroidectomy”. The pathology may show a well demarcated tumour or otherwise with or without involvement of the lymph nodes. Once all these are known, your doctor would classify your “risk status”.

He will take a radioactive iodine whole body scan after 4 to 6 weeks to see if there is any residual tissue left in the neck or spread to any regions. Depending on your risk status, your doc will decide if you require Radioactive Iodine therapy, again a very benign mode of treatment. It doesn’t pain you nor make you feel like a patient. He will also check your blood for thyroglobulin, a marker of thyroid tissue in the blood.
Radioactive iodine therapy destroys any thyroid tissues which are left behind in your body (normal or abnormal). Following this, your doctor will start you on thyroxine to make sure that your TSH is kept on targets to prevent reactivation of the disease process.

Every 6 months, your doctor may ask you to come back for a review at which time the thyroxine is stopped and you may be subjected to a thyroglobulin blood test and a radioactive iodine whole body scan to decide your disease state. This method is gradually getting replaced with ultrasound scanning. This process may be followed for sometime till your doctor is sure that the disease is cured. At times you may be subjected to other imaging modalities like PET scans or CT scans.
Yes, it sounds a bit cumbersome. But you have very high likelihood of getting cured.

Dr. Mathew John

Congratulations on your decision. Your diabetologist and team can help you prepare for the same. Just a few things to note. If you are having diabetes for any duration, the first thing is to make sure that your diabetes is well controlled. This means that your fasting sugar is less than 100, the 2 hour post meal sugar is less than 140 mg/dl and your HbA1c ( glycosylated haemoglobin ) is less than 6.5 % (or 7 % ). And it would be preferable that you achieve the same with insulin. And you are on a self monitoring of blood glucose (SMPG) schedule.

Further, you need to get screened for diabetes complications. This means checking your kidney functions, your eye and your heart to make sure that they are in order. The blood pressures should be on target. You should also be on Folic Acid 5 mg daily at least 2-3 months before you plan to conceive. If you are overweight, you need to shed a bit of weight before you conceive.

Check list to complete before planning pregnancy with diabetes

1. Blood sugar on target (FBS< 100 mg/dl, PPBS < 140 mg/dl, HbA1c < 6.5 %) 2. On Folic acid 5 mg 3. Check kidney functions, heart and eyes 4. Blood pressure < 130/80 mm Hg 5. Weight management Dr. Deepa G

Providence Endocrine & Diabetes Speciality Centre Presents

CAMP 2014 : The Annual Get Together of Children with Type 1 Diabetes

A Report

The annual get together of children with type 1 diabetes was held on the 16th of November, at The Pattom Royal Hotel, Trivandrum. The families arrived by 8 AM,provided their samples for free testing of Glycosylated Haemoglobin at Providence and then moved on to the venue. Following registration, the children participated in the competitions; drawing for the younger children and painting for the older children.This was supervised by Asha Bobby.

Dr. Deepa welcomed the families on behalf of Providence and at 9 AM, Professor M Ramachandran inaugurated the Annual get together. He extended his welcome to the families as well and stressed on the theme: Learn, Share and Emerge! This was followed by the traditional lamp being lighted by the doctors, diabetes educators and senior persons with diabetes.

The first talk was experience sharing by Midhila and her mentor; Premlatha. It was about dealing with diabetes at school, amongst peers and about the times when families prepared for marriage.

Mrs. Premlatha described how she had revealed the news to her lover about her being diabetic and also how she took on the challenges of her pregnancy. Miss. Midhila spoke about her diet regimes for diabetes and hypoglycaemia. This was followed by audience interaction.

The second talk was again an experience sharing,this time about the insulin pump, by Abinandh, a medical professional who has been on pumping for over a year viagra pharmacie sans ordonnance. He listed his monitoring schedules, costs involved in using the pump and about the flexibility and control he experienced while on the pump. Dr. Mathew John, Senior Endocrinologist, pointed out that most people use less than 20 % of the features offered by the pump and how it could be optimised to get the most out of it.

The third talk was by Ms. Vani K B, a diabetes educator with experience in managing various subjects on Diabetes. She spoke about insulin technique, insulin storage, self monitoring and travelling with diabetes. This session was very interactive as well. Master Anson, a patient of ours, came up on stage asking why he is not controlled. His father spoke about his challenges in managing diabetes with limited resources.Mrs Rejitha Jagesh, senior Dietician, explained about the diet challenges faced by children with diabetes and their families. Questions from the audience were answered by the Providence team.

Dr Arun B Nair gave an exceptional talk on problems faced by kids with diabetes and various challenges in parenting;about peer pressure and the right guidance in choosing career by children.
Mr. Joji, spouse of Mrs. Richelle, detailed the challenges faced in marrying a lady with type 1 DM and raising a family with her. Joji’s confidence was infectious!

Mr. Saji, father of a child with type 1 diabetes explained about the need for patient support groups and his plan to form a support group at Providence. The parents exchanged phone numbers and promised each other to return with concrete steps for a support group.

After this,prizes were distributed to all the winners of the painting and drawing competitions. Prizes were distributed by the Real Heros – our senior Diabetes patients. Mrs. Annie Thomas, a lady who has lived with type 1 diabetes mellitus for more than 30 years and Mrs. Premlatha,again with more than 30 years of similar experience, were our heroes!

Mugs with the serenity prayer printed on them were distributed to all participants of CAMP 2014.This was followed by a sumptuous lunch.There were counters for checking out insulin pens and glucometers. Old Insulin pens were exchanged free of cost if they were found to be defective. Insulin pumps were demonstrated by Medtronic. Insulin bags, World Diabetes Day T shirts, caps and other goodies were also distributed.

Radioactive iodine is often chosen as a first line treatment for adults with hyperthyroidism. Sometimes we use it as treatment for relapses of hyperthyroidism. Either way, most of my patients have second thoughts. When you use RAI for hyperthyroidism, it accumulates in the thyroid gland and starts destroying the thyroid cells that over produce thyroid hormones. So eventually these cells die off and the thyroid hormone levels fall in the blood. Very few tissues other than thyroid absorb significant part of iodine and so it does not affect other cells.

It is given as pill and done as outpatient. 90 % of patients will require only one dose of radioactive iodine. Eventually patients taking radioactive iodine become hypothyroid (low levels of thyroid hormones). They will then require thyroxine replacement. It is recommended that women have a pregnancy test before using radioactive iodine. Radioactive iodine does not cause infertility but it is recommended that women refrain from conceiving for 1 year after the procedure.

Since these radioactive substances may be excreted by the body, some precautions may be recommended by your doctor. This may include

• Sleep alone for 5 nights after RAI.

• Close contact with children or pregnant women (hugging or kissing; for example), should be avoided for 7 days

• Drink plenty of water

• Stay at least 2 meter from others for the first 3 days after treatment.

• For 3 days, do not share items (utensils, bedding, towels, and personal items) with anyone else. Do your laundry and dish washing separately.

• Wipe the toilet seat after each use. Wash your hands often, and shower daily. Flush the toilet after every use.

Check your thyroid function 2 months after the dose and meet your doctor for expert advice. Radioactive iodine does not cause cancer.

These are some steps everyone can take to improve bone mass and prevent fractures. The skeleton contains 99 % of the body’s calcium stores. An adequate intake of calcium from the diet is required to maintain the body’s requirement for calcium. Calcium rich foods include low-fat dairy products, fruits and vegetables. If adequate calcium cannot be got from the diet, additional supplementation of calcium should be given.

It is recommended that men aged 50-70 consume 1,000 mg per day of calcium and that women age 51 and older and men age 71 and older consume 1,200 mg per day of calcium. Excess calcium can be associated with renal stones although the medical information in this area is not very clear.

Vitamin D is important for absorption of calcium, muscle strength an balance and reduces the risk of falling. It is recommended that 800 to 1,000 international units ( IU ) of vitamin D per day are consumed by adults older than 50 years. In subjects with Vitamin D deficiency, Vitamin D levels should be measured and supplemented to keep Vitamin D levels above 30 ng/ml.

Exercises are important to strengthen the bones. Weight bearing exercises and muscle strengthening exercises are important in osteoporosis. Weight bearing exercises include walking, jogging, stair climbing, dancing and tennis. Muscle strengthening exercises include weight training, yoga and Pilates. Ongoing exercises are important. Fall prevention is one of the most important steps you can take to reduce the risk of fractures.

Information courtesy to IOF

Osteoporosis is a disease that can be potentially treated. Unlike the treatment options for diabetes, the awareness of treatment options for osteoporosis is very low among general public. The options for treatment include

1.Hormone Replacement therapy: this includes estrogens for women and testosterone for men. Hormones are given to subjects who are deficient in them, men with testosterone deficiency due to disorders of the testes and women with ovarian failure.

2. Bisphosphonates: these are agents that prevent bone resorption. These are given orally in empty stomach as one weekly (Alendronate and Risedronate) or as once monthly (Ibandronate). They can be given once every 1 year as intravenous Zoledronate also. They can improve bone density and prevent fractures.

3. Teriparatide: this is recombinant PTH which can be given as daily injections. These can build bones and reduce fracture risk.

4. Denosunab: It is given as an injection every 6 months. It prevents destruction of bones.
Other less commonly used agents include Calcitonin and Raloxifene.These medications are extremely useful for patients with osteoporosis. But they have to be taken only under the guidance of a healthcare professional.

Identifying osteoporosis gives an opportunity to preventing fractures. Identifying osteopenia (reduced bone mass) helps individuals take corrective steps to prevent progression. The best method to identify osteoporosis is to take a DXA scan. It is an X ray based procedure which measures the bone density at the hip, wrist and spine. It reports the bone mass of individuals in comparison to bone mass of healthy individuals. It is not painful and takes less than 30 minutes to complete. Once a diagnosis of osteoporosis is made, we need to look for reasons why it has happened. For this your endocrinologist will go through your history, clinical examination and relevant investigations. Treatment will be considered only after knowing the reason for osteoporosis.

Most people have an inherent fear of diabetes and cancer. People fear that one day they may get diabetes and take steps to prevent it. But seldom does anyone think that they will get an osteoporotic fracture. For a lady, the lifetime risk of a fracture is more than the risk of diabetes or breast carcinoma. And we need to prevent it.

Fractures like wrist and hip are obvious. They cause severe pain and deformity with limitation of movement. But vertebral fractures may not cause enough symptoms to seek medical help. It may be a small back ache or a loss of height that most people may not notice. Eventually it becomes and deformity. But remember that even the first fracture can be prevented!

Fractures may be a sign of hidden disease

Fractures may be due to osteoporosis. But osteoporosis can be due to uncommon but serious underlying disease. Vitamin D deficiency, poor calcium intake, thyroid and parathyroid diseases may cause osteoporosis. Steroid use and increased internal production of steroids may cause osteoporosis. Poor absorption of calcium due to intestinal diseases or just plain immobilisation can cause weak bones. Rare malignancies like multiple myeloma can cause osteoporosis. Common diseases like Rheumatoid Arthritis can make you prone to developing osteoporosis. If you have osteoporosis, it is important to investigate it with an endocrinologist.

It is common to mention things like “his nose resembles Dad’s “and “Her cheeks mirrors her mother’s “. It applies to height also. One of the major determinants of the child’s final height is the parental height. Taller parents tend to have tall children. Nutrition plays an important role in helping children reach their genetic height potential.

Children have a growth spurt around the age of puberty with the pubertal height gain contributing significantly to the final height. In children with delayed puberty, the usual pubertal spurt is delayed. In a normal variant of growth called “constitutional delay in growth and puberty”, children especially tend to have delay in both growth and puberty. These children seem to have a delayed growth around the time their peers show the growth spurt, but soon bloom to reach their height potential. They are the “late bloomers”. It may run in families.

Consider a check up if you think that your child is not in keeping with his or her genetic height potential.