Rheumatoid arthritis.

What is Rheumatoid athritis?
It is a generalized disease of the whole body which is mostly known for the pain and deformity it causes. It one of the diseases in which the body's immune system is mistakenly targeting itself. "Friendly fire".
It affects joints on both sides of the body at once most times and attacks more of small joints like finger, toe and wrist joints. The symptoms are worse in the morning with pain and stiffness and usually will last more than one hour. In other conditions that resemble rheumatoid arthritis the  morning pain  will last less than one hour. The pain of rheumatoid arthritis will gt better as the day gets on. But prolonged use of affected joints will worsen the pain. It weakens bones both around affected joints and other bones remote from the joint affected. It does so through a some substances that are part of the disease process and because of dis-use or reduced use of the joint, this therefore also affects muscle.

Organs affected  include:  

• the heart and/or blood vessels
• the skin
• the spinal cord
• the nerves
• the lungs.
• the blood
• the eyes
• joints and bones

How does rheumatoid arthritis come about?

It has been suspected that an infection sets it off. A germ that has a molecule on it resembling one that a person  has infects the person. Large foreign molecules 'provoke a fight' when they enter the body. So the persons immune system takes a sample of this foreign molecule and carries it through a process that results in protective molecules called anti bodies being made. These are always made to specification to recognize that one particular molecule and neutralize it. Unfortunately the body is not aware it has it's own molecule that looks very much like the stranger, so it also ends up attacking itself even after the stranger is no more and most times will continue to do so for life. 

It is not certain that this is exactly what happens but these are  certain:

1. RA can start at any time in an individuals life, though is usually does not start below age 15.

2. It is three times more common in women than men.

3. If a family member is a sufferer the odds for suffering it doubles for every other member of the family. So there is a genetic component. One in every one hundred persons have it.  In affected families two out every one hundred have it.

Joints and Bones

The tissue that is attacked in the joint is called the synovial membrane. A thin tissue-lining for the joint that produces the fluid that lubricates it. It becomes thickened and painful  and excessive  fluid is produced. The joint swells. If not stopped  the process will spread to the slippery covering that allows bone to move on bone in joints, called cartilage, and to the bones themselves. Eventually cords that attach bones to the muscles that move them, called tendons, may be affected too. Hence there is joint destruction and disability.

The skin may be affected in many ways but commonly is the formation of nodules.

How is RA treated.

Drugs: 

1. Pain killers. These are two groups of pain killers used to address pain in RA. Aspirin-like pain killers and steroids. They both can cause s stomach ulcers especially as they are used for extended periods. The steroids can cause multiple other problems including being prone to infections, poor wound-healing, abnormal weight-gain and distribution, weakened bones, poor blood pressure control and poor blood sugar control. 

2. Biologics. Some of the worst problems in RA are the effects of substances the body produces. The biologics are used to block the actions of specific substances.

3.Disease modulating agents. These delay the development of damaging features like cartilage damage and bone deformity.

Non-drug treatments

1. Surgery: This may be used to remove the diseased synovial membrane to prevent other tissues getting affected or to replace a joint (altogether) with an artificial joint.

2. Exercise. Moderate exercise can reduce pain, stiffness and increase strength.

3.Physiotherapy and occupational therapy can be useful.

Drug treatment should follow proper medical assessment so to prevent abuse drugs are not mentioned by name here.

How good is your sperm?

The man is resposible 40 to 50 per cent of the time a couple cannot get pregnant. The major cause is low semen quality.
Semen  like blood is a fluid organ. It comes from the seminal vesicles, the prostate, the bulbourethral glands and the testes.  These make and contribute diffferent components of semen which contains sperm(atozoa), sugars(fructose and galactose), enzymes, basic compounds to counter the vagina's acidity, hormones and other substances.

What makes good semen?

1. Volume:There should be more than 2 milliliters per ejaculate.

2 The sperm count: This is the concentration of sperm cells. The number of sperm  in one milliliter of ejaculate. It should be at least 15 million per ml.

3.The total number of sperm in one ejaculate should be at least 39 million.

4.The liquefaction time: Semen is sticky. It is thought to help retain it in the vagina. But liquefies as time passes. It is thought to enable it swim on towards the egg.
This should happen within  sixty minutes of collection of the semen sample.  Prolongation of this time may be caused by an infection.

5. Motility: At least 60 percent of the s;perm cells should be motile


6. Morphology: At least 70% normal in shape. Sperm have a head, neck and tail. Abnormal shape includes two heads, two tails, round heads, and short tail.  Abnormally shaped sperm may not be able to fertilize the egg.

7.The acidity/Alkalinity: The normal pH  ranges from 7.2 to 8. Slightly basic to counter the acidity of the vagina.

8.White blood cells: none should be present.

9. Red blood cells: none should be present.

The semen sample is collected after total abstinence of at least three days and preferably by masturbation as against interrupted sex. However special collection condoms yield better samples. The analysis is repeated as semen quality is variable for the same man. First samples are usually the poorest.

Other tests of male fertility include hormone assays for luteinizing hormone(LH), follicle stimulating hormone ( FSH), prolactin and dihydrotestosterone.

Causes of low quality sperm include: varices in the scrotum(varicocoele), mumps, radiation exposure to  the testes and and the male mixed -sex condition Klinefelter's syndrome.

Keeping your Risk Low- cardiovascular risk factors.

The chances that a person will suffer a vascular event ( blood vessel) is a portfolio anyone can manage. It is the risk that a pipe conveying blood in your body will burst or block. This blocking event in the heart is called heart attack(myocardial infarction). It is the leading cause of death in the Western hemisphere. In the brain it can be both ways and is called a stroke( cerebrovascular accident). It can happen in the intestines, the limbs, kidney, the lungs, the eye... any tissue or organ. So how do you make sure a pipe in your body does not break or block.  The integrity of the pipework in peoples bodies is what determines how long people live in the Western world.

Know the risk factors and play the game of your life.
1. Some of the factors are already set and there is nothing you can do about it. These are being male, being black and getting old.
2. Hypertension. This makes the pipes less flexible and more rigid thus easier to break. A flaky material gathers along the wall of the blood vessels(pipes) like sludge in hot water pipes reducing the bore of the blood  vessels. This is progressive if it is not stopped . The track for blood to pass gets narrower and narrower. Soon pain starts downstream  at the organ being starved of blood.  Just like you feel pain in the buttocks on a very long journey seated in a car or train when muscles in your buttocks are starved of blood because you are seating on them; your weight compressing the arteries that supply them. This is exactly what happens when the yellow sludge called atheroma blocks enough of a blood vessel  and the organ or tissue being supplied has no way to derive the shortfall (like from alternative supply called collaterals).  So this is not a bad word after-all.  The pain is saying there is tissue damage going on, do something. On the journey you will adjust how you seat and shift your weight but eventually this will not suffice. So with the organ being starved of blood. usually resting will relieve the chest pain or leg pain then as the blockage gets worse resting does not bring relief. Hypertension blocks your vessels and make them rigid .  It can cause a blocked vessel anywhere: heart, guts,brain( or a burst vessel)  leg,or even arteries supplying the pregnant womb to damage the placenta.

Action: Check your blood pressure every six months if you are forty or above. If hypertensive you need life-long treatment to prevent tissue damage or halt tissue damage if it has already begun.

3.Smoking: Smoking alone is a risk and can burst or block vessels apart from other risks it bears; cancer, respiratory problems , social etc. It will add to any preexisting risk like hypertension, diabetes mellitus,, abnormal blood vessels, clotting disorders, abnormal heart rhythm, prosthetics used to repair blood vessels,  and contraceptives.  Stopping smoking at any point, even after twenty years of chain smoking, will result in some reduction of risk.

Action.
Stop smoking..

4. Cholesterol: this is the yellow substance that accumulates on the wall of the blood vessels. The more there is in blood the more it will stick to the wall.. Some  people have a problem handling cholesterol so they have a risk of their blood vessels bursting or blocking. Some accumulate a lot of it in their body by taking too much. . They exceed their bodies' capacity. Cholesterol has a bad name but it so essential that absolute lack of it equals death. The hormones that make men men, women women, control the amount of salt and water in the body including blood volume and enable people withstand stress are all made from cholesterol. Lab results show LDL and HDL as well as other lipids in the profile. It is useful for persons to know that we want  HDL to be high and LDL low. HDL is the "good" cholesterol and "LDL" the bad cholesterol.
People who have  defects in both genes that control the level of cholesterol in the blood do not live beyond their third decade.  They suffer a blood vessel event.   So high cholesterol on its own or in tandem with another factor(s) can cause a blood vessel to burst or block.


Action: Dietary limitation  and drugs if cholesterol is high. Eggs and red beef are high in cholesterol. It is good to check the nutritional labeling of food products. Especially when there are health issues.
 increase the chances of blood lots forming in  leg veins..They can be transported to the lungs where they cause a potentially fatal problem.

Birth Control pills: This can increase the propensity of blood to clot.
Action: Ensure you are well assessed before starting birth control pills and injectables.

Clotting Disorders: Some health conditions and diseases increase the likelihood of blood to clot. These include: after  major injury and major surgery, after child birth, being still for a long time (air travel) or bed ridden. There are inherited conditions characterized by blood having a greater propensity to clot, they are called thrombophilias. Also acquired conditions like lupus can be associated with a clotting disorder. A clot will form wherever the innermost layer/lining of the pipe is scratched. It starts small and grows. There is a possibility of the clot being dislodged. If this happens it may cause blockage downstream as the blood vessels divide and become progressively smaller .After a heart attack the innermost layer is damaged in the heart and a clot may well form. So a patient who survives a heart attack is at serious risk of a brain attack( a stroke) or a second heart attack The clot may be  trapped in a vessel suffering from atherosclerosis( yellow sludge) blocking it completely. This risk can operate on it's own or jointly with others.


Action: Always take sometime to move if you are on a long flight: you can move your feet up and down repeatedly from time to time, it prevents blood pooling in your legs.Medical personnel take care of the risk that follows giving birth, surgery and injury. There are standard measures for the thrombophilias which a doctor will put in place.


Abnormal blood vessels: Some persons are born with defective blood vessel that are prone to bursting.  If such a vessel bursts  in their brains they have a stroke.  There is not much action that can be taken against this.

Abnormal heart rhythms: When blood is not flowing smooth it tends to clot. Like when a section of the wall of the heart is " beating an egg out of it"


Action:   Treat all heart conditions promptly and fully.

Diabetes mellitus: This is a major risk factor. It  causes the deposition of cholesterol on the walls of arteries on its own. Can cause hypertension through damage to the kidneys.  It is severe on its own but can work jointly with others risk factors.

Action: Screen for diabetes mellitus every six months if forty and above. Start at 30 years if it is in your family. Control of blood sugar is essential here.

These are the risks. It may not be exhaustive but check yourself  against the factors discussed here and take action if you need to. Educate someone, refer them to this blog. You may save a life.

HYPERTENSION.

What is hypertension?

Think of the tap at your wash-basin. You could turn the pressure up or down. Hypertension is when the pressure with which blood is flowing in your blood vessels(specifically arteries) is too high. It is too high because it is causing damage to your  tissues. The values at which this starts is 140/90 mmHg. I40 mmHg is the pressure when the heart is pumping with greatest force, this is called the systolic blood pressure. It lasts for one-third of the pump-cycle( heart cycle). The 90 mmHg is the pressure when the heart is fully relaxed and filling up for the next 'stroke action'. This lasts for two-third of the pump(heart) cycle. So the blood vessels are exposed for twice as long to the lower value(diastolic) than the higher value(systolic).  This means that while both values are important  the lower value is very important.

What causes hypertension?
There are two types of hypertension: A type where the cause is not known and a type where the cause is known. 9 out of 10 people suffer from the first type, where the cause is not known. These things are known about it:
1. If a kidney is taken from a person who has this type of hypertension and transplanted to a person who does not  the recipient will  develop hypertension.
3. It is more common as people get older.
4. Reducing salt intake or removing salt from the body reduces the pressure.
Exercise and anxiety can cause the blood pressure to rise. If you are not hypertensive when you rest, like when asleep, the pressure will  become normal. If you are hypertensive your blood pressure is high even when you are asleep or awake, anxious or relaxed, at rest or active.

How does hypertension happen?
Just like you adjust the pressure of the tap in your wash-basin by narrowing or widening the channel through which flows so does the body. The arteries branch successively into smaller branches. The penultimate branch, just before the smallest branch called capillaries, are used to control blood pressure by narrowing or widening them. They are called arterrioles. This can be done within seconds.
The volume of blood pumped with each stroke of the heart is the second factor determining the pressure with which blood flows in arteries. This too can be adjusted very quickly.
A slower way in which hypertension bulids up is by the body retaining salt. With more salt retained the body retains water. This increases the volume contained in the pipes: the circulation, the heart fills more since it is part of this system that is completely sealed(closed) and  pumps more blood with each stroke causing the pressure to increase.

What will you feel when you have hypertension?
Maybe something, maybe nothing. Hypertension has been called a silent killer. You could feel headaches, you may feel tense or not sleeping as well as you used to. Or you may feel the effects of it having damaged tissues or being in the process of damaging tissues when it is extremely high.

What are the damages done to tissues and how do they show?
1, The brain: Strokes, dementia by causing several small strokes so that in all a large amount of brain  tissue is damaged. Very high pressure can cause the person to be confused and talk irrationally or even go into coma.

2.The Heart: Blocked heart arteries. Angina. Manifesting as chest pain usually going up the left side of the neck and the left arm.  Brought on by exercise and relieved by  rest. It may not be relieved by rest-unstable angina. The blockage could be so bad that it causes heart muscle to die. This is the heart attack or myocardial infarction.

3.The Kidneys. Hypertension damages the kidneys. First the patient just leaks protein in urine. Eventually the kidney is severely damaged shrinking in size. The  capacity greatly reduced and inadequate. This is kidney failure, the long running type. If the pressure is extremely high the kidneys can be damaged very rapidly  to produce a rapidly developing kidney failure.

4. The Arteries. The high pressures make their walls to thicken and become flaky and easy to burst. Fatty substance is deposited in the interior. Thus  the vessel may become too narrow. In the leg this may cause pain  when walking that is relieved by rest. It is called intermittent claudication..
5.The Eyes. The hypertension causes deposits on the sensitive layer of the eye.
6.  Pregnancy: Hypertension makes a pregnant woman more likely to develop a condition called pre-eclampsia were there is hypertension, abnormal kidney function and brain affectation. The woman is prone to convulsion if not handled properly and may die.  The placenta may be damaged by the high pressure, suffering small strokes and  reducing the weight gain of the baby.

The Tests:
1. Blood pressure measurement. Serially.
2 Kidney function tests.
3. Serum Cholesterol.
4. Complete blood count.
5.Chest X-ray.
6.Electrocardiogram.

The Treatment.
1. Diet: Reduce salt intake.
2. Exercise. May be limited by the presence of complications: Angina, claudication heart failure. kidney failure.
3. Calm. Avoidance of emotional extremes.
4. Drugs.
Hypertension is not curable so it is chronic illness. The care for it requires periodical hospital visits where progress is assessed, including the patient's report of the state of her well being where she recounts any new complaints or side-effects of drugs. Her blood pressure will be taken and her treatment plan reviewed. watching out for complications is a continuous element of the follow up.

The other Ten Per Cent.
The curable causes of hypertension include renal artery stenosis, coactation of the aorta,  a tumor that produces -adrenaline-like substances called phaeochromocytoma,  Cushings syndrome, polycystic ovarian disease, and hyperthyroidism.