COLDS & FLUS

Cough, running nose, sore throat, headache and fever are symptoms that we will experience from time to time. The challenge is these symptoms confuse people and they go to pharmacies where they are given an array of medication .The challenge is antibiotics are usually given and they may not be necessary. The reason for this is that a majority of upper respiratory tract infections are caused by viruses. That is the reason why antibiotics are never effective. Two common viral upper respiratory tract infections are the cold and the flu. Many a times the two are used interchangeably but they are totally different infections with different patterns of symptoms.

 CAUSE

Colds are caused by a group of viruses called Rhino viruses. There are almost 200 varieties of these viruses whereas the flu is caused by a group of influenza viruses.

SYMPTOMS

A cold is a much milder infection that the flu. The virus infects your nose, sinuses and throat. One to three days after the infection the symptoms of runny nose, sneezing, blocked nose, tearing eyes, headache and at times a sore throat. The sore throat can cause a dry cough. Throughout the infection the infected person can go about their daily tasks as they discomfort is minimal.

Unlike the cold, the flu viruses cause more serious signs and symptoms. In addition to the upper respiratory tract symptoms of running nose, sore throat and cough there are symptoms like fever, joint pains, fatigue, muscle aches which make a person feel very ill. The thing about the flu is that the symptoms develop much faster than a cold and you get ill very quickly.

In countries like Kenya the symptoms of the flu are often mistaken for malaria and this confusion makes it hard for people to seek adequate treatment.

 TREATMENT Image

Since they are caused by viruses it is very hard to treat them directly. Majority of the times we treat the symptoms to reduce discomfort e.g. antihistamines and decongestants can be used to relieve a stuffy nose while pain killers and cough syrups can help treat aches as well as coughs. However, cough syrups are not given to children as their adverse effects have not been well studied in children.

HOME REMEDIES

If you do not want to use medication, there are several well-known home remedies and actions that can help reduce the discomfort of colds and flus. These include:

  • Drinking plenty of fluids in form of water or freshly squeezed fruit juices. They help to boost the immunity of your airway. Can a shot of brandy in help clear your flu? Research states that you avoid alcohol when you have the flu as it dehydrates your body making recovery slower.
  • Rest is critical when you have flu. Rest boosts your immune system allowing for faster recovery.
  • If there is chest congestion chicken soup can help relieve this congestion and make your body feel better.
  • For coughs and sore throats a combination of honey and ginger will help relieve that.
  • To relieve congestion of the nose you can inhale steam.

PREVENTION

Prevention is always easier than treatment. Here are ways you can minimize your chances of getting these viral infections:

  • Proper hand washing using soap and water after blowing your nose, sneezing or coughing.
  • When sick with the flu it is best to stay away from places of work and school thus avoiding its spread.
  • Avoid close contact with people who are sick.
  • Cover your nose and mouth when coughing or sneezing. Preferably use tissue or a handkerchief. Make sure the tissue is well disposed and the handkerchief washed using hot water or disinfectant.
  • Ensure your immune system is strong by eating well, sleeping adequately, manage stress and exercise regularly.

WHEN TO GO TO HOSPITAL

Most times the symptoms of the cold and flu will subside with time. However, visit the hospital when you notice the following:

  • The fever is persisting.
  • Your symptoms are getting worse.
  • You have chest pain when breathing in and out.
  • You have a painful productive cough with yellow/green sputum that may be blood stained.
  • You are at risk of getting complications of the flu e.g. diabetic, HIV

Hypertension

Simply put, blood pressure is a result of the force of the blood in the blood vessels as it is pumped by the heart. The blood pressure is measured in two phases; systolic (when the heart pumps) and diastolic (when the heart relaxes). The blood pressure readings are therefore given as two figures, the systolic over the diastolic, all expressed in millimeters of mercury (mmHg). Blood pressure readings of more than 140mmHg systolic and 90mmHg diastolic are considered elevated, which is the definition of hypertension. Blood pressure is however classified depending on the specific figures as follows:Image

  • Normal blood pressure – systolic less than 120mmHg and diastolic less than 80mmHg
  • Pre-hypertension – systolic 120-139mmHg and diastolic 80-89mmHg.
  • Stage 1 hypertension – systolic 140-159mmHg and diastolic 90-99mmHg
  • Stage 2 hypertension – systolic 160 and above; diastolic 100 and above.

Hypertension may be primary or secondary. Secondary hypertension is caused by other medical conditions and accounts for less than 10% of the hypertension cases. The concern is primary hypertension which accounts for up to 90% of the cases, and is associated with risk factors that can be prevented.

Hypertension is often referred to as the ‘silent killer’ due to the fact that it may be present but without any symptoms. It causes deaths as a result of the complications associated, which may be discovered once they have already developed. These life-threatening complications include:

  • Heart disease including enlargement of the heart, heart attacks and heart failure
  • Kidney failure
  • Stroke
  • Aneurysms – swelling of the blood vessel wall which can rupture with heavy bleeding.

Other complications include visual impairment and blindness.

Hypertension has been increasing as the lifestyle patterns have been changing; initially it was mainly a disease of the developed world but it is now increasing in developing countries. The prevalence in Kenya in 2008 was estimated at 37% (WHO, 2010), a figure that has continued to rise.  And yet hypertension is a lifestyle disease whose risk factors are amenable to lifestyle changes as follows:

  • Body weight – achievement and maintenance of ideal body weight reduces the risk of hypertension. For patients who are overweight, a reduction in the body weight of about 10kgs reduces the systolic blood pressure by 5 to 20 points.
  •  Diet:
    •  A diet low in fats, sugars and salt helps reduce blood pressure.
    • Increase intake of vegetables to the recommended 4 to 6 servings per day.  These include green vegetables, broccoli, carrots and tomatoes.
    • Intake of 4 to 6 servings of fruits per day. These are rich in fiber, magnesium, potassium and other vitamins which have been associated with a reduction in blood pressure.
    • Reduce intake of dairy products and change to low-fat dairy products. It is recommended to have 2-3 servings of low-fat dairy products such as milk, yoghurt, cheese which are rich in calcium and are a source of protein. Calcium intake is associated with lower blood pressure.
    • Reduce intake of red meat and eat more fish, poultry and nuts as source of protein.
    • Intake of whole grains – at least 6 to 8 servings of foods such as pasta, cereal and bread.
    • 4 to 5 servings of nuts and legumes such as peanuts, peas, lentils, beans etc. are a source of magnesium and potassium, which reduce blood pressure.
  • Reduce the amount of alcohol to one standard drink per day, which is approximately half a pint of beer, a tot of spirits or a small glass of wine.
  • Stop smoking.
  • Engage in some form exercise lasting 30 minutes at least 5 days per week. This coupled with the dietary measures above should help control body weight.

These lifestyle changes do not only apply to the prevention of hypertension, but are also the first line in the treatment of hypertension. Some cases of hypertension can be controlled purely by these lifestyle interventions but in many cases, medication is necessary. Treatment will also include screening for other conditions that commonly occur with hypertension and that may affect its control. This includes conditions like diabetes and elevated cholesterol. As we have seen, the risk factors for these lifestyle diseases tend to be similar, and thus it is not uncommon to find these diseases occurring together. The presence of more than one compounds the risk of complications. Screening and treatment for other lifestyle diseases is therefore part of the treatment of one.

Lifestyle diseases are associated with life-threatening complications, which can be avoided since these diseases are largely preventable. The lifestyle changes need to be instituted as early as childhood if we are to curb the increase in these diseases.

Diabetes

Diabetes is a chronic illness which occurs when there is inadequate insulin produced by the pancreas or the body is unable to utilize the insulin that is produced. Insulin is the hormone responsible for regulation and uptake of glucose (sugar) by various organs and tissues in the body. Without insulin, blood sugar from the diet is not absorbed by the target organs and tissues, resulting in an increase in the blood sugar level (hyperglycemia), and inadequate sugar levels in these organs which affects their functioning. The high blood sugar level over time causes damage to blood vessels and nerves, resulting in the complications associated with diabetes.

There are mainly 2 types of diabetes;Image

  • Type 1 diabetes – this occurs due to lack of insulin production. This type of diabetes is often diagnosed in childhood, and requires daily use of insulin.
  • Type 2 diabetes – this occurs when the body is not able to use the insulin that is produced. This type of diabetes is classified as a lifestyle disease since it is caused by overweight and obesity, and lack of physical exercise.

There are risk factors that increase the likelihood f developing type 2 diabetes. These include:

  • Age – previously, type 2 diabetes occurred mainly in adults over the age of 45 years. However, it is now increasingly occurring in younger people.
  • Family history of diabetes in the immediate family such as a parent or a sibling.
  • Excessive body weight
  • High blood pressure
  • Elevated levels of blood cholesterol
  • History of impaired blood glucose level in the past, including diabetes in pregnancy.

People with these risk factors should be on the lookout for the symptoms of diabetes which include excessive thirst, excessive passing of urine, excessive hunger, weight loss and fatigue. Though the symptoms of diabetes are the same for type 1 and type 2 diabetes, they are less marked in type 2 diabetes. This can lead to delay in the diagnosis since people may not recognize these symptoms immediately. In many cases, diabetes may be diagnosed at the time when a complication occurs. The complications of diabetes are mainly seen in the blood vessels, the nerves, the heart and the kidneys. The main complications are:

  • Heart disease due to the effect on the blood vessels to the heart.
  • Stroke.
  • Diabetic foot ulcers which increase likelihood of infection and amputation.
  • Blindness due the damage to the blood vessels in the retina.
  • Kidney failure, increasing the need for dialysis and/or kidney transplant.

To avoid these complications, early diagnosis and treatment is crucial. Diagnosis is made based on the clinical symptoms and the blood sugar levels. In addition, screening for complications is also done to diagnose these early and implement the control measures to avoid progression or development if none exist at the time of diagnosis.

Treatment of diagnosis begins with changes in the lifestyle that can improve the utilization of insulin in the body. Excess body weight should be controlled by increasing physical activity and adopting healthy diets. Weight loss increases the sensitivity of body tissues to insulin, which reduces the level of blood sugar. A reduction in body weight of between 5% and 10% is associated with a reduction in the risk of developing complications associated with diabetes. Smoking is another risk factor for the complications of diabetes and therefore cessation is advised. In some cases, these lifestyle and dietary changes are adequate to control the blood sugar. However, where these alone do not achieve blood sugar control, then the use of oral medications is warranted. In some cases, insulin may be required to control the blood sugar. In addition, it is important to screen and treat of any accompanying risk factors such as high blood pressure and high blood cholesterol.

The key message is that type 2 diabetes can be prevented by implementing simple lifestyle habits such as:

  • Control body weight within the ideal range for ones height (BMI between 18.5 and 24.9 is considered ideal).
  • Exercise regularly, with a minimum of 30mins of exercise atleast 5 days a week. To make this sustainable, include more physical activity in your daily routine such as walking.
  • Eat a healthy diet, with five servings of fruits and vegetables daily and reduced intake of foods high in sugar and fats.
  • Avoid or stop smoking.

“Smokers Cough”

Chronic obstructive pulmonary disease (commonly referred to as COPD) is a lung disease that affects the flow of air from the lungs. COPD comprises two conditions; chronic bronchitis and emphysema. However, the two conditions have increasingly been diagnosed just as COPD. The limitation in the low of air is due to the narrowing of airways and collection of mucus (chronic bronchitis) and/or the loss of the elasticity of the airways, which affects the narrowing and widening of the airways during exhalation and inhalation. This disease has been colloquially referred to as ‘smokers cough’ due to its relation to smoking, which remains its commonest cause. COPD is not curable, but it is preventable. Image

The incidence of COPD has been increasing over the years, and unlike the past when the disease manly affected men, it now affects both men and women alike. This has been linked to the higher number of women who smoke. As at 2008, it was estimated that up to 18% and 0.7% of men and women respectively in Kenya smoke (WHO, 2010). Undoubtedly, this number has increased. Though tobacco smoke remains the primary risk factor, there are other risk factors such as air pollution such as seen with wood smoke when cooking or heating, some type of industrial dusts and chemicals.

COPD symptoms include a chronic cough with production of sputum which is usually worse in the morning, breathlessness and wheezing in some cases. This difficulty breathing gets worse with time and with exertion such as climbing stairs. COPD progresses gradually over time, getting worse as one grows older. Therefore most cases are diagnosed in people over 40 years. The diagnosis is based on determining the flow of air in and out of the lungs, which is done through a test called spirometry. The less the amount of air exhaled after inspiration, the more severe the disease. Other tests may then be conducted such as chest x-ray, arterial blood gas, chest CT scan etc.

Once the diagnosis of COPD is made, the most important step in treatment is to STOP SMOKING. This, together with other treatment options slows the progression of the disease. As mentioned above, COPD is not curable, but there are medications that can ease the symptoms. The most common medications used help dilate the airways to allow for improved movement of air in and out of the lungs, and may be taken orally or in the form of an inhaler. In severe cases, the use of steroids and oxygen may be necessary.  COPD tends to have periods of acute episodes, where symptoms worsen for a short period commonly due to infections. When this occurs, patients need to seek medical attention immediately. Due to this susceptibility to frequent infections, most COPD patients are advised to routinely receive the influenza vaccine.

One of the most difficult challenges that COPD patients face is how to quit smoking. As most smokers will confess, this is easier said than done. Nicotine which is found in cigarettes is the addictive ingredient which causes withdrawal symptoms once one stops smoking. These withdrawal symptoms include anxiety, irritability, fatigue, lack of concentration, lack of sleep or drowsiness. These symptoms can be very unpleasant, leading to the frequent relapses. There are various tools that smokers can use to help quit smoking. These include:

  • Setting a quit date – this is a crucial first step in the efforts to stop smoking. It helps one prepare psychologically to stop, and to deal with the after effects. The involvement of the doctor in setting this date is important since the period prior to stopping includes education of the patient on what to expect.
  • Support both personal from friends and family, and professional through individual or group counseling.
  • Nicotine replacement to reduce the withdrawal symptoms have been used successfully in those highly addicted to nicotine. Nicotine replacement is often through nicotine chewing gum and nicotine patches, which are readily available in the market.
  • Antidepressant – in some cases, a specific antidepressant may be prescribed.

COPD is a life threatening incurable lifestyle disease, and can be largely prevented by smoking cessation, and the earlier this is done, the better.

Ideal Weight!

Overweight and obesity are fast becoming a crisis in many countries, and yet it is preventable. Overweight and obesity is defined as the accumulation of excessive body fat to the point where it may affect the health of the individual. Overweight and obesity are classified based on the Body Mass Index (BMI), which calculates the weight-for-height. The BMI is calculated by dividing the body weight in kilograms by the height in meters squared. The figure one arrives at is the BMI, which is then classified as follows:

Image

  • BMI less than 18.5 is underweight
  • BMI between 18.5 and 24.9 is ideal weight
  • BMI of 25.0 and above is overweight
    • BMI of 25.0 to 29.9 is pre-obese
    • BMI of 30 and above is obese

Worldwide, the rates of obesity have doubled over the last 3 decades. It is the fifth leading cause of death among adults. In Kenya alone, by the year 2008, 13% of males and 24% of females were overweight, while 2% of males and 6% of females were obese (WHO, 2011).

As mentioned earlier, the increase in overweight and obesity has been due to a reduction in the level of physical exercise and an increase in intake of unhealthy foods. Physical inactivity has increased as more people drive to work, where they tend to sit most of the day, and have less time and/or desire for exercise. This is an increasing concern especially with children who have replaced traditional play which was physically exerting, with the more sedentary hobbies such as video games and watching TV. In 2008, it was estimated the approximately 15.4% of Kenyans were physically inactive (WHO, 2010). This sedentary lifestyle has been compounded by the change in dietary habits. The increase in intake of sugary foods and foods high in fat has significantly contributed to the rising rates of overweight and obesity.

So what is the exact health risk posed by overweight and obesity?

Overweight and obesity increases the risk of several diseases including:

  • Cardiovascular diseases – the fatty deposits in the lining of the blood vessels (arteriosclerosis) increases the risk of stroke and ischemic heart disease.
  • Diabetes mellitus
  • High blood pressure
  • Musculoskeletal diseases – overweight and obesity increases the wear and tear of the joints with earlier onset of osteoarthritis.
  • Some forms of cancer such as breast and colon cancer.

Prevention of obesity

Overweight and obesity are largely preventable, which greatly reduces the risk of developing the associated non-communicable diseases listed above. The reduction of obesity however requires not just the individual effort, but also societal as well as policy changes that will encourage physical activity and healthy eating.

Individuals should reduce the amount of sugar and fat intake, and increase the intake of fruits and vegetables. In addition, it is recommended to engage in 45 mins of exercise atleast 3 times a week. Physical exercise does not have to be going to the gym. Physical activity should be as regular as possible, and is more sustainable if worked into the normal daily routine e.g. walking to nearby destinations instead of driving, taking the stairs instead of the elevator and so on. These activities need to be supported by policies affecting the agricultural and food industry (e.g. reducing amount of sugars and fat in foods), roads and transport (e.g. making pedestrian walkways to encourage and make walking safer), education and labor (e.g. creating awareness of risk of obesity in schools and increasing physical activity in schools and in workplaces).