Arthroscopic Release of Frozen Shoulder Problems in Diabetics By Sweet Clinics..!!

Diabetics in India have an additional burden of joint problem in addition to their systemic problems of nerves, eyes, blood vessels, kidneys etc. Diabetics are prone to develop a condition of the shoulders called primary frozen shoulder. It can affect both shoulders in a small percentage of people. It usually resolves over a period of time but can leave behind a lasting deficit of certain movements.

Middle aged diabetics also develop tears of the rotator cuff and this can lead to a secondary frozen shoulder. Rotator cuff is group of tendons on top of the shoulder which help to stabilize the joint.

They can develop calcium deposition in the rotator cuff tendons.

They are prone to develop Gouty arthritis in their shoulders like in any other joints since Gout has an association with diabetes. Gout is a condition due to consumption of uric acid which is a by product of the digestion of red meat.

In this article I shall discuss frozen shoulder.

Definition-

Frozen shoulder (Adhesive capsulitis, periathritis) is a condition characterized by a loss all movements at the true shoulder joint. There is pain initially. Pain settles down and there remains stiffness which sets in over a short period of time. Clever people may recall a traumatic incident. In others it may come on slowly. Stiffness may be permanent. The movement that is maximally affected is external rotation (rotating the arm outwards away from the body). This results in inability to reach behind the head with the hand to tie the hair. When both shoulders are affected elderly women are in an embarrassing situation. Overhead activities are also affected as the degree of elevation of the arm is reduced.

Anatomy

The shoulder is the most mobile joint in the body. Its function is to position the arm in space to reach out to objects and deliver them to the mouth for eating and for other actions. The shoulder is a ball and socket joint formed by the upper end of the humerus (arm bone) and the socket formed by the glenoid of the shoulder blade. It is lined by a bag like capsule. The capacity of this joint is about 15- 20 cc. In frozen shoulder the capacity is reduced to 2- 3 cc. The movements at the shoulder joint occur synchronously with that at joint between the shoulder blade and the torso and are compensated to some extent by this.

History of frozen shoulder-

Only in the last few years has the ideal treatment been suggested. It is a relatively rare disorder of the shoulder and in a population of 20 shoulder patients there may be one or two with this condition.

However many doctors and orthopaedic surgeons label any painful condition as a frozen shoulder and advice physiotherapy. This can make the condition worse.

Recent advances

It has been recently discovered that the answer to frozen shoulder lies in the genes. These genes may also be associated with Diabetes mellitus. The alterations in these genes and chromosomes lead to a distorted response to wound healing and scar tissue formation. Exuberant scar tissue forms in response to trauma. The remodeling of scar tissue collagen is less. When more scar tissue forms in the capsule of the shoulder joint, the normally possible movements are grossly reduced. Diabetics also develop nodules in their palms and feet, another evidence of the exaggerated healing process.

Standard treatment-

This is a combination of physiotherapy and steroid injections when the condition is initially painful. Physio can be done at home. The standard Orthopaedic treatment has been a manipulation under anaesthesia. This carries a theoretical risk of fracture but has not been validated in practice.best diabetologist in navi mumbai

A manipulation is contraindicated when a x ray reveals that the bone is very osteoporotic. It is also contra indicated in diabetics as more exuberant scar tissue will form in response to the crude method.

Since I have pointed out that sometimes rotator cuff tears can coexist with a frozen shoulder, the ideal management for a frozen shoulder would be an arthroscopic release of the contracted structures within the joint. An arthroscope is an instrument used to look into joints through tiny key hole incisions. The benefits are less pain after surgery and faster rehabilitation. Since scar tissue formation is minimized, chances of recurrence are less and greater are the chance of retaining the full range of movement achieved during the procedure. The range of movement achieved after the release has to be maintained with physiotherapy. In case there is some tear of the rotator cuff, repair can be done at a later stage.

Diabetes and Heart Disease: What Is The Relationship Between Them...?

A link between Heart Disease and Diabetes

Diabetes is a chronic disease that is marked by high blood glucose levels. Over a period of time, the elevated sugar in the blood leads to arterial damage that causes them to stiffen and harden. This is known as Atherosclerosis. High sugar levels also lead to plaque formation as those with diabetes also have high cholesterol levels. When the arteries get damaged due to plaque, the body sends platelets to try to repair the wall. Due to the narrowing of the arteries, this leads to a blockage which stops the oxygen from reaching the heart and the brain and ultimately results in a heart attack or a stroke. It is interesting to note that high cholesterol levels have already occurred before the elevation of sugar levels. Therefore, heart disease has already manifested before the onset of diabetes.Diabetologists in Vashi  .

Risk Factors of Diabetes and Heart Disease

There are several risk factors when it comes to diabetes and the heart. Here are some of them.

Family History

Those who have a family history of diabetes and heart disease are at a very high risk. They should be extra careful about their diet, medicines, and exercise. Those with Type 2 diabetes are at a risk of having a silent heart attack or a heart attack without any symptoms.

High Cholesterol Levels

The LDL levels (bad cholesterol) determine the timeline of the onset of heart disease. LDL has been considered one of the most important factors in determining vulnerability to cardiovascular problems.

Smoking

Smoking causes constriction and tightening of the blood vessels, thereby reducing blood flow to the heart and the brain. Those who smoke and are diabetics, increase their risks of developing heart problems exponentially.

High Blood Pressure

This is another significant risk factor for diabetes and heart disease. Chronically elevated blood pressure levels cause a majority of heart attacks.

Obesity

Obesity is linked to high blood pressure, high cholesterol levels, and diabetes. Even those who appear lean or thin but have a high amount of belly fat are at an increased risk of developing heart disease.

Sedentary Lifestyle

Those who are not active physically and have diabetes tend to develop heart problems at a much earlier age than their counterparts who are diabetics but who exercise.

Age

Those who develop diabetes earlier in life have an increased risk of developing cardiovascular problems. Also, as one gets older, the odds of suffering from heart disease increase.

Unhealthy Diet

A diet rich in fats, processed foods and with fewer quantities of fresh fruits and vegetables is bad for diabetes and for the heart. Following such a unhealthy diet will definitely cause diabetes and heart disease.

Stress

People with diabetes already respond negatively to stress as their sugar levels become high due to anxiety. Stress can indirectly increase the risk of developing heart problems as it makes one overeat or smoke or drink more.

Gender

More men develop heart problems under the age of 55 years. Women suffer more from cardiac issues once they cross 55 years of age.

Symptoms of a Heart Attack

Many people who have diabetes suffer from ‘silent heart attacks’ due to the nerve damage related to their high sugar levels. This is why regular screening is essential for all those who have diabetes. There are some symptoms to watch out for. If you suffer from any of the following, call the ambulance immediately.

Chest pain is one of the most common symptoms of a heart attack. It is also known as Angina. It feels like a pressure or painful squeezing of the chest. One might feel it in the arms, neck, back or the jaws.
Nausea and lightheadedness
Shortness of breath
Sweating
Fatigue
Indigestion
Loss of balance or dizziness
Trouble seeing things or having double vision
Confusion
Sudden severe headache
Prevention of Diabetes and Heart Disease
There are a lot of things you can do to manage your diabetes and stop or delay the onset of heart problems. The risks are reduced by introducing lifestyle changes, medicines, and increasing activity levels. Here are some tweaks that bring positive results.

Healthy Diet

Eating a variety of fresh fruits and vegetables, whole grains, low-fat food items, a high protein diet helps to combat heart problems.

Healthy Weight

Shedding off the excess weight and maintaining a healthy weight helps to keep away the cardiac issues for long. Instead of a tough weight loss plan, sit with your doctor and chalk out a reasonable weight loss strategy.

Quit Smoking

Smoking damages the blood vessels in the body and increases the risk of heart problems. Quit smoking to improve your health.

Get Moving

Exercising for just 30 minutes five times a week brings down the risks of developing heart problems in diabetics. If you cannot exercise in one go, divide the activity into batches of ten minutes. It also helps to control the high glucose levels in the blood.

Stress Management

Learn to meditate and not stress over things in life. Anger, jealousy, spite are negative emotions that affect the body negatively.

Medications

If you already have heart disease, take your medicines on time to prevent more complicated issues.

Control the Parameters

To prevent an early onset of heart problems, keep your blood sugar levels and your blood pressure levels under control. Avoid too many fluctuations to prevent organ damage.

Takeaway

There are several treatment options to keep heart disease and diabetes under control. With proper lifestyle changes, effective weight management and efficient control over blood sugar levels, those who suffer from diabetes can live healthy, quality lives.

A for apple pie, B for burger… D for diabetes..!! – Dr.Vinod Methil (Sweet Clinics Diabetes Clinic)

With school canteens serving a variety of colas and junk food, children are falling prey to lifestyle diseases like diabetes and obesity at an early age. DNA talks to parents and experts to find whether a possible solution exists.

In two years’ time, from kindergarten to Std II, seven-year-old Vignesh Mohile’s association with the alphabet has undergone a drastic change. Even before the chubby little boy has learnt to communicate in English, his vocabulary already consists of words like enchilada, spaghetti, alfredo, tiramisu —- which his parents often fail to pronounce and that sound like Greek to his grandmother.

Vignesh’s mother finds it difficult to convince Vignesh to carry a home-cooked meal of simple chapati-bhaji in his school tiffin. “I’ve tried options like sprouted bhel or sandwiches on alternate days. But the aroma of Italian and Mexican food which his friends bring in their dabbas, coupled with items like pav bhaji and samosas sold in their school canteen appears far more attractive,” says an exasperated Sucheta.

She says that all her efforts to convince Vignesh to eat healthy falls flat the moment the recess bell rings. “Vignesh and his friends sit in a group and have lunch. It’s but natural that he gets tempted to eat what his friends are eating.”
 


A similar yet slightly different case is that of Mohan and Lalita Kumar, parents of 14-year-old Nishita. The Std IX student eats in her canteen everyday, despite carrying two dabbas. Mohan, who works as a manager in a bank in Girgaon, says that Nishita’s school canteen is flooded with every chips and cola brand available in India.

Her mother, Lalita, says that though Nishita takes roti-sabzi in one dabba and fruits or biscuits in the other, she complains that two dabbas are insufficient, and unfailingly ends up eating a burger or a plate of noodles. “She doesn’t want to carry a third dabba as it will increase the weight of her bag. If this eating out was not enough, there is hardly any outdoor activity that she can indulge in, especially now that she will go to class X,” says Lalita, explaining that all Nishita does after coming from school is either study or chat on the computer.

 just 70 to 80 minutes of PT in an entire week is insufficient for growing children. “The result of all this is weight gain. Over the past year and half, she has put on so much weight that we fear it may lead to obesity,” says Lalita.

Like many other mothers, Sucheta and Lalita believe that it’s pure addiction to junk food that is harming their children. Eating fast food once in a while is fine, say the mothers. “But children often don’t have the capacity to limit intake,” says Lalita.

 once children are familiar with the taste of junk, they tend to eat it regularly and slowly get addicted, to the extent that they can’t do without it even for a day. “Addiction is what I’m worried about.”

 several schools in Mumbai give food coupons and serve vadas and samosas. “After eating junk, the child feels hungry very soon and starts feeling restless and distracted.”

Dr.Vinod Methil, consultant diabetologist at Sweet clinics, says that type II diabetes, which was till lately seen in adults, is now increasingly seen in children because of lifestyle factors.Diabetologists in Vashi

“The main cause of type II diabetes is central obesity — big stomach and insulin resistance. This develops from unhealthy eating,” says Dr Methil, explaining that she has seen children as young at 6-7 years developing type II diabetes.

Dr Methil adds, “When a child complains of excessive thirst, tends to eat more, etc. an examination shows that his sugar levels are high. It is shocking to see such young children having diabetes and obesity.”

Exercise a must for people with diabetes...?

Are you aware that India is the leading country for diabetes in the world? Currently over 60 million Indians suffer from diabetes with a projection of 109 million individuals with diabetes by 2035 as per the Indian Heart Association. That is a lot! Seeing as this condition affects over 7% of India’s adult population it is likely that you know someone with this disease.

Talk to them about their routine or steps they’re talking to manage their condition and they’ll surely tell you an earful. Dietary changes and their meal plans, the medicines they’re taking, how often they’re getting their tests done to check sugar levels and a whole lot more. But ask them about exercising and you’re sure hear something like ‘Oh no, it causes my blood sugar to drop low, or ‘I get too tired to exercise’ or ‘Where is the time’ or even ‘I don’t think I’m strong enough’. While some just don’t understand the importance of an exercise regime with diabetes, some are actually concerned that it may harm their health.

So what’s the verdict? Is exercise a must for diabetics?

The answer is a loud resounding YES!!Exercise actually helps manage your diabetes better by keeping your blood sugar levels in the normal range. Basically, in diabetes, the body has trouble processing insulin. Physical activity promotes insulin absorption in the cells thus avoiding excess insulin levels in the blood.

Another important benefit of exercising is weight control. Obesity is a major factor for diabetes as excess weight leads to increase production of insulin in the body. A regular exercise regime can help keep excess weight off which in turn helps keep diabetes in check.

People with diabetes are also at a higher risk for heart problems and high cholesterol levels. A regular exercise routine helps keep your heart healthy and increases good cholesterol in your body, keeping your levels in check.

Care tips and precautions before starting a new regime

Though exercise helps you lower your blood sugar but exercising when sugars are above 250mg/dl can make your blood glucose levels go higher.

Before you put on your shoes and decide to blast the excess fat away, it is advised to talk to your doctor. He may suggest certain suitable exercises, or change your medication timings to avoid low blood sugar levels or determine when to exercise in the day. He may also suggest certain foods before or after your activity. So be sure to plan your routine and discuss the same with your healthcare provider. In case you are worried about low blood sugar levels, ask for foods to keep with you at all times, especially during a workout.

Also be sure to maintain a journal monitoring your blood glucose levels before your regime and regularly once you start it this will help you and your doctor determine if you are on the right track or need to modify any exercises or medications.

If you are insulin dependent avoid physical activity when you have ketones in the blood or urine.

Which exercises should I do?

Note: Be sure to first discuss this with your doctor. People with additional complications caused due to diabetes may be advised against certain types of exercises.

Depending on your age, exercise history and other factors you can draw up a plan. If you are a beginner, take it slow. You don’t need to compete with your neighbour who looks like he was born lifting weights. Start with some light exercises instead like walking, stretching, climbing stairs, light dancing, yoga etc. and build up your stamina to include more.Doctors for Diabetes in Navi Mumbai

In case you have a history of exercising, maybe do something a little more intensive like aerobics, cardio, strength training for improving muscle tension and brisk walking. While it’s always good to push yourself, be careful not to push too far. You can’t go from doing nothing to everything overnight. So take your time and be consistent for healthy blood sugar levels.

Also, increase your activity levels throughout the day in simple ways:

Just get up from your couch and take a walk
Spend some time playing with your kids in the neighbourhood park
Take your pet for a jog in the evenings
Ditch the elevators and use the stairs
Make it a rule to stand and walk for a minute after every 30 minutes of sitting
Walk to your neighbourhood grocery store
So whether you have just been diagnosed with diabetes or have been living with it for a long time, exercise is a must. Even if you haven’t done it till now – talk to your doctor and start today! Not only will it help you look younger and healthier but feel better too. And at the same time, help control your insulin levels.