A Urinary Tract Infection (UTI) is an infection anywhere in the urinary tract (which includes the kidneys, ureters, bladder and the urethra). It is caused by bacteria, which get into the urinary tract through the opening of the urethra, (where urine leaves the body).  UTIs are very common; almost half of all women will experience at least one episode during their lifetime. Nearly 1 in 3 women will have had at least one occurrence of UTI by the age of 24 years. UTIs are more common in women because their urethrae are shorter, which allows for bacteria to reach the bladder more easily. The severity of UTI symptoms varies widely; some persons have very mild symptoms and can be treated at home, however others may become tremendously ill and have to be admitted to the hospital. A UTI that is not properly treated can lead to recurrent UTIs or to kidney damage. Below are more information on UTIs and a few easy tips to prevent them.
 
Tip#1:
 
SYMPTOMS
 
The most common symptoms of a UTI are:
 

1. Pain or a burning sensation when passing urine
2. Urinating more often than usual
3. Feeling the urge to urinate but not being able to
4. Urine that is cloudy, dark, bloody or has a smelly/bad odor
5. Fever.

 
These symptoms are common for infections of the bladder (Cystitis), however when the infection is in the kidneys (Pyelonephritis), symptoms may also include:
 

1. Back pain
2. Groin pain
3. Nausea  
4. Vomiting

 
 
Tip#2:
 
RISK FACTORS
 
The following are persons who are at increased risk for UTIs:
 

1. Persons with kidney stones
2. Postmenopausal women
3. Sexually active women
4. Spermicides
5. Pregnant women
6. Persons with a history of UTI in childhood
7. Persons with Diabetes
8. Persons with HIV/AIDS
9. Men with enlarged prostate
10. Persons with urinary catheters

 
 
Tip#3:
 
TREATMENT
 
If you think that you have a UTI, you MUST see a doctor. Your doctor may perform a urine test in the office or send a sample of your urine to a laboratory for further testing. You might be required to do other tests such as an ultrasound to rule out other conditions such as a kidney stone. The most effective cure for a UTI is antibiotic treatment. You may have to return to the doctor if your symptoms do not improve after completion of antibiotics. (You may need to be admitted to the hospital if you are extremely ill.)
 
 
PREVENTION
 
The following are tips to better prevent Urinary Tract Infections:
 
Tip#4:
 
Drinking lots of fluids, especially water, could decrease your risk of getting UTIs
 
Tip#5:
 
Do not hold your urine; empty the bladder regularly and completely.
 
Tip#6:
 
Women should urinate after sexual intercourse
 
Tip#7:
 
Women should wipe from front to back (not back to front) after bowel movements. This helps to prevent bacteria from the anus entering the urethra.
 
Tip#8:
 
Wearing loose fitting clothing including underwear may decrease your risk of getting a UTI.
 
Tip#19:
 
Postmenopausal women can use vaginal estrogen cream; this may prevent recurrent UTIs.
 
Tip#10:
 
It has been said that drinking cranberry juice can decrease the risk of UTIs, or be used as a method of treatment, however research does not support this claim.
 
 
 
I hope these tips on URINARY TRACT INFECTIONS were helpful, REMEMBER; YOUR HEALTH IS INVALUABLE.
 
By Dr. Lawarna Matthew

Arthritis is a condition that causes pain and inflammation in a joint. There are several types, but osteoarthritis is the most common. In Osteoarthritis the cartilage between the bones in the joint breaks down, causing the bones to rub together. Almost any joint in the body can be affected, but the most common joints are the knees, hips, spine and hands. The main symptoms of osteoarthritis are joint pain and stiffness, which are normally felt after prolonged use/activity. Some people also experience swelling, tenderness and a grating or crackling sound when moving the affected joints. (If you experience symptoms such as fever, pain, stiffness and swelling in the joints predominantly after waking in the mornings, you should see your doctor as you may have another kind of arthritis).
 
Osteoarthritis usually affects persons over 40 years but can affect younger persons as well, particularly if they have risk factors. Risk factors include obesity, family history of osteoarthritis, and previous traumatic injury to the joint. Joint deformities such as unequal leg length, bowlegs or knocked knees are also risk factors. There is no cure for osteoarthritis; the goal of treatment is to reduce pain and improve function of the affected joints. Below are some tips for the treatment of osteoarthritis of the knee.
 
 
PHYSICAL METHODS
 
Tip#1:
 
Exercise
 
Exercise has been proven to reduce pain and improve function of the knee in persons with knee osteoarthritis. Exercises can include water-based exercises, aerobic activity and strength/resistance training. Physiotherapy may also be helpful in relieving symptoms.
 
Tip#2:
 
Balneotherapy/Spa therapy
 
Balneotherapy refers to bathing in natural mineral or thermal waters (e.g. mineral baths, sulphur baths, Dead Sea baths). This has been proven to help reduce pain for persons with osteoarthritis, especially for persons whose disease affects multiple joints (knee, hip, spine and hand). It is also good for persons with other chronic illnesses or comorbidities (including diabetes, hypertension, cardiovascular disease, renal failure, Gastrointestinal bleeding, depression, and obesity).
 
Tip#3:
 
Weight Loss
 
Studies have found that weight loss of about 5% over a 20 week period, can significantly reduce pain and physical disability in persons who are overweight. (There are also many other health benefits of weight loss).
 
Tip#4:
 
Biomechanical Interventions
 
Biomechanical interventions such as knee braces, knee sleeves and foot orthoses can considerably reduce pain and joint stiffness in persons with knee osteoarthritis.
 
For persons with severe arthritis, a cane or walking stick can be used to decrease pain and improve mobility.
 
 
DRUG THERAPY
 
Tip#5:
 
NSAIDs
 
NSAIDs are common pain killer medications that are very effective at reducing pain from osteoarthritis. Many are affordable and easily accessible and include Advil, Aleve and Voltaren. (One side effect of long-term use of NSAIDs is the formation of stomach ulcers. You may need to see a doctor to be prescribed something for stomach protection if you take NSAIDs very regularly.)
 
Acetaminophen
 
Acetaminophen/paracetamol/panadol are also painkillers used for osteoarthritis pain. However, they are better for short-term use, as longer-term usage can lead to serious side effects.
 
Duloxetine
 
Duloxetine (Cymbalta) is another drug that is very effective at relieving pain from osteoarthritis. It is more appropriate for persons with comorbidities and with osteoarthritis of multiple joints. If you have severe osteoarthritis pain, ask your doctor if you may benefit from Cymbalta.
 
Tip#6:
 
Capsaicin cream
 
Capsaicin cream is made from the pepper plant (capsicum) and is effective at relieving knee pain caused by osteoarthritis. You should apply it three times daily for it to be effective. It is only available by prescription. (There may be a warming effect after using capsaicin that eventually wears off after a few days. The pain-relieving effect starts after several days of regular use.)
 
Tip#7:
 
Intra-articular corticosteroids
 
Injection of corticosteroids into the joint can decrease inflammation and is very effective at reducing pain. Some persons claim to have pain relief for months using this method. If you have severe pain from osteoarthritis, ask your doctor if this may be a treatment option for you.
 
Tip#8:
 
Surgery
 
For persons who fail medical treatment or who have serious joint damage, surgery may be the best treatment option. Surgery may involve arthroscopy (repair of the joint done through small incisions/ cuts). However, if the joint damage cannot be repaired, you may need a total joint/knee replacement.
 
 
I hope these tips on KNEE OSTEOARTHRITIS were helpful; REMEMBER, YOUR HEALTH IS INVALUABLE.
 
By Dr. Lawarna Matthew

Asthma is a long-term disease that leads to inflammation and narrowing of the airways in the lungs. During an asthma flare (exacerbation or attack), the lung airways become so inflamed and narrow that it becomes difficult to move air in and out of the lungs. As a result persons experience symptoms of shortness of breath, chest tightness, cough and wheezing. Wheezing is a whistling sound heard when breathing and chest tightness may feel like something is pressing down on the chest. The shortness of breath feels like it is difficult to exhale or breath air out of the lungs and the coughing usually occurs at nights or early mornings. Your doctor will diagnose asthma based on your medical history, a physical exam, and “Lung Function” test results.
 
The following are Factors that may trigger or worsen asthma symptoms (especially when asthma is uncontrolled):
 

• Viral infections (cold or flu)
• Allergens (e.g. dust mite, pollen, cockroach)
• Tobacco smoke
• Smoke, chemical fumes or strong odors
• Exercise
• Laughter
• Stress
• Some drugs can trigger asthma in some persons, e.g. aspirin or other NSAIDs.

 
The cause of asthma is still unknown, and there is no cure. It affects roughly 300 million persons worldwide (according to WHO). It affects persons of all ages, but most often starts during childhood. Asthma flares can be fatal, so it is very important to follow your “ asthma action plan”. Below are some tips to help reduce asthma flares and help keep the disease under control.
 
CONTROL

Tip#1:
 
The goal of asthma treatment is to control the disease, which will prevent asthma attacks, help you maintain good lung function and let you maintain your normal activity and sleep at nights.
 
MEDICATION
 
Tip#2:
 
Asthma medicines are usually taken using a device called an inhaler, which allows the medicine to go directly to the lungs. (Some medicines for asthma are taken in tablet form as well.)
 
Tip#3:
 
Quick Relief Inhalers
 
Every person with asthma should have a quick relief inhaler. Use these whenever you feel symptoms (chest tightness, wheeze, shortness of breath, cough). The medicines in these inhalers are short acting beta2 agonists e.g. salbutamol/albuterol/Ventolin. They are bronchodilators, which relax the tight muscles around the airways in the lungs; this allows the airways to open up to allow better airflow. Your Reliever Inhaler should be taken with you everywhere you go in case you do begin to feel symptoms.
 
Tip#4:
 
Controller (Prevent-er) Inhalers
 
Most persons with asthma have to use a controller inhaler. These inhalers contain medicines called Inhaled Corticosteroids, which offer long-term control of asthma. Some examples include beclometasone, budesonide and fluticasone. These work by reducing the inflammation of the airways in the lung. They prevent symptoms from starting, but DO NOT OFFER QUICK RELIEF OF SYMPTOMS. These inhalers should be used daily and can reduce the severity of symptoms and how often they occur.
 
Inhaled corticosteroids usually are safe, but can have side effects, the most common being oral thrush (a mouth infection). Rinsing your mouth with water after using your controller inhaler can lower your chance of getting thrush. Another option is to use a SPACER to prevent the medicine from landing in your mouth or throat (see below).
 
Tip#5:
 
For persons with severe asthma, other types of medicines may be used to help control symptoms. These include long acting beta2 agonists with inhaled corticosteroids (inhaler), leukotriene modifiers, theophylline and oral corticosteroids that are all in pill form. 
 
Tip#6:
 
How to use a Metered-dose Inhaler (MDI)
 
A metered-dose inhaler is a device that sprays a pre-set amount of medicine through the mouth to the lungs. It is important to use it as prescribed by your doctor. The steps below indicate how to use your inhaler correctly.
 
1st- Take off the cap of the inhaler and shake it about 10 times.
2nd- Take a deep breath in and then blow out the air completely.
3rd- Hold the inhaler upright and place it in your mouth, make a tight seal.
4th- Press down firmly on the canister once to release 1 puff, while taking a slow breath.
5th- Hold your breath for about 5 to 10 seconds, then exhale slowly.
6th- Wait for about 30 seconds before taking another puff.
 
 
Tip#7:
 
How to use an inhaler with a Spacer
 
SPACERS are large tubes, usually plastic, that are used with inhalers to deliver medicine to the lungs. They are easy to use, and deliver more medicine to the lungs than inhalers alone. One end has an opening to attach the inhaler and the other end has an opening for the mouth (a face mask can also be attached here). Children benefit more from spacers with face mask.
 
1st- Take off the cap of the inhaler and shake it about 10 times.
 
2nd- Attach it to the spacer in an upright position.
 
3rd- Put the other end of the spacer in your mouth, (or attach a face mask and put it over the mouth and nose). Ensure a tight seal.
 
4th- Press down firmly on the canister once to release 1 puff, while taking a slow breath.
 
5th- Hold your breath for about 5 to 10 seconds, then exhale slowly.
 
6th- Wait for about 30 seconds before taking another puff.
 
See videos in the link below that demonstrate proper techniques on using inhalers and spacers. https://www.cdc.gov/asthma/inhaler_video/default.htm
 
 
 
Tip#8:
 
AVOIDING TRIGGERS
 
One of the important methods to control asthma is to avoid its triggers. Avoiding some allergens such as dust and smoke may be easy, and keeping the home clean may be possible. However other triggers such as stress and viral infections may not be as simple. It is important to stop smoking, as this could significantly improve symptoms. One trigger that must not be avoided is EXERCISE because of the overall health benefits that it provides. Talk with your doctor about how to manage exercise-induced asthma.
 
Tip#9:
 
EXERCISE-INDUCED ASTHMA
 
Some persons’ asthma is triggered by increased physical activity. If you have exercise-induced asthma, you may benefit from using a controller medicine or using a reliever inhaler before exercising. Some types of exercises are less likely to induce symptoms than others; these include walking, hiking, biking and swimming. Sports such as football, basketball and long distance running require longer activity and are more like to provoke asthma symptoms.
 
Tip#10:
 
Asthma Diary
 
Keeping an asthma diary can help your doctor identify how controlled your symptoms have been since you were last reviewed. Note the date you had symptoms and what kind of symptoms they were and how severe. Also note when you used your reliever inhaler.. If you know how to take your own peak flow readings, you can record them as well. An asthma diary is beneficial to persons who have symptoms often (several times a year).
 
Tip#11:
 
ASTHMA ACTION PLAN
 
An action plan is written up by your doctor/nurse. There are 3 main sections: green, yellow and red, which correspond to ‘doing well’, ‘warning symptoms’ and ‘emergency’.
 
Each zone describes the symptoms you are experiencing and tells you what and how much medication you should take, and whether or not you should go to a doctor/hospital. Your action plan may change slightly depending on how controlled your symptoms are. Persons that follow their action plan are 4 times less likely to end up in the hospital.  
 
Tip#12:
 
Emergency!!
 
The following are signs/symptoms of an asthma attack that requires that you or anyone with these signs/symptoms be taken to the emergency department.
 

• Gasping for breath
• Relief Inhalers are not helping
• Cannot do usual activities
• Symptoms still persist or get worse after 24 hours
• Peak flow reading less than 50% of best
• Trouble talking and walking because of shortness of breath
• Cannot speak properly because of shortness of breath
• Cannot lay down because of shortness of breath
• Lips or finger nails turn gray or blue
• Confused or exhausted
• Person blacks out or becomes unconscious

 
If you/anyone having an asthma attack experience any of these symptoms and have/ has a RELIEVER INHALER, take 4 puffs every 4 minutes until symptoms subside or until you/they have arrived to the hospital or an ambulance has arrived.
 
 
I hope the tips on ASTHMA were helpful, REMEMBER, YOUR HEALTH IS INVALUABLE.
 
By Dr. Lawarna Matthew

Hemorrhoids are swelling of veins in the anus. They may present as a single swelling or multiple, and sometimes protrude out of the anus. Although they appear in various sizes, shapes and colors (pink, red, blue and purple), a small, round, flesh colored lump at the anus is most common. Hemorrhoids may bleed with the passage of stool and may be painful.
 
While hemorrhoids may be very manageable to some, they may be a nuisance and a terrible inconvenience to others. Usually they are caused by anything that increases pressure in the abdomen such as a chronic cough, prolonged straining/ heavy lifting, constipation and pregnancy.
 
Hemorrhoids may be classified into four types according to their degree of prolapse.
Grade 1: these may bleed, but do not protrude from the anus.
Grade 2: these protrude with defecation, but go back into the anus afterward.
Grade 3: these protrude, but can be pushed back inside the anus by hand.
Grade 4: these protrude from the anus permanently.
It is important to know what grade of hemorrhoids you have as this affects what kind of treatment options may be best for you. Below are a few tips on the best treatments available for hemorrhoids.
 
 
Tip#1:

Diagnosis
 
Other serious disorders may present similar to hemorrhoids. Diseases such as anal cancer, colon cancer, anal fissures, perianal abscesses and inflammatory bowel disease may present with bleeding in the stool and/or a lump at the anus. If you have been experiencing a sudden change in bowel habit, weight loss, fever, severe pain around the anus, tearing pain when passing stool, or if you have a family history of colon cancer, you may have a more serious condition. Your doctor may want you to do other tests such as a colonoscopy in order to rule out other illnesses.
 
 
Conservative Treatment

Tip#2:
 
Maintain soft bulky stools that can be passed without straining. Keep a diet that has adequate amount of fluid and fiber. Studies show that fiber supplementation with psyllium or sterculia (e.g. Metamucil), or unprocessed bran/whole grain foods decreases bleeding, pain, prolapse, and itching from hemorrhoids.
 
Tip#3:
 
Over the counter topical preparations that contain steroids, anesthetics, astringents, and/or antiseptics can be used for hemorrhoids. Although studies done are unsure of their value in the treatment of hemorrhoids, many persons claim that they do relieve symptoms.
 
Tip#4:
 
Avoid using topical preparations that contain steroids for prolonged periods because they may cause thinning of the skin around the anus.
 
Tip#5:
 
Many persons also claim to find relief from sitz baths. You can prepare a sitz bath by placing warm water in a container, and then sitting in it for a few minutes several times per day. It is important not to make the make the water too hot that it burns the skin. You may consider this method as a form of treatment as it is simple and cost nothing, however studies are unsure if there are any real benefits to this.

 
Office Procedures
 
Several minor surgical procedures can be done at the doctor’s office to remove/ treat grades 1 to 3 type of hemorrhoids. These procedures are simple and are usually well tolerated by patients; however, there is a high possibility that hemorrhoids can return with these treatments. The three main office procedures include Banding, Sclerotherapy and Infrared coagulation. Persons who are on blood thinners should inform their doctors before considering one of these procedures, because there is a risk for significant bleeding.
 
Tip#6:
 
Rubber Band Ligation
 
Rubber band ligation, also called Banding is a very popular and effective method to treat hemorrhoids. The doctor inserts an anoscope (or and instrument with a short tube and a light at the end) into the anus so that the hemorrhoid(s) can be visualized easily. Afterward another instrument is used to put a very small rubber band at the base of the hemorrhoid. The band is left on for about 5 to 7 days, and the blood supply to the hemorrhoid is gradually interrupted. The hemorrhoid eventually falls off when passing stool without you noticing it. The method is generally painless and there is usually no need for anesthesia.  Banding has a lower need for repeated treatment when compared with sclerotherapy and infrared coagulation but the chances of complications (such as bleeding and abscesses) are higher, and there may be pain after the procedure.
 
TIP#7:
 
Sclerotherapy
 
Sclerotherapy involves the injection of a sclerosant into the hemorrhoid. The procedure is also very simple; an anoscope is passed into the anus and a liquid containing drugs is injected into the area around the hemorrhoid. The aim of this procedure is to shrink the hemorrhoids by damaging their blood vessels. It usually needs to be carried out several times in order to treat all of the enlarged hemorrhoids. The injections are typically given every few weeks. Recurrence is frequent and complications are similar to banding. Sclerotherapy is not commonly done.
 
Tip#8:
 
Infrared Coagulation
 
Infrared coagulation involves the application of light/radiation from a specific type of lamp to the base of the hemorrhoid, using a probe tip. The heat/radiation reduces blood flow to the hemorrhoid and creates an ulcer that eventually heals. The procedure is well tolerated, but success rates are lower than those with banding. Infrared coagulation may be considered for persons who are on blood thinners.
 
 
SURGERY
 
Tip#9:
 
Surgery is very effective for grades 3 and 4 hemorrhoids. It is a very efficient technique for removal and it is the most successful method that reduces recurrence of hemorrhoids. Unlike office procedures, surgery may result in greater postoperative pain and could require a longer time for recovery and return to work and regular activities. Complications are not very common but include: bleeding after the operation, wound infections, abscesses, narrowing of the anus and anal leakage. Nevertheless, surgery is a great option for persons who have not had success using other treatment methods.
 
Tip#10:
 
Postoperative Care
 
There may be significant pain after surgery, and medication will be helpful. Additionally, your doctor may prescribe some topical preparations to apply around the anus to prevent pain. It is important not to strain when passing stool after surgery; using stool softeners and bulking agents can prevent this. Sitz baths and warm water sprays can also be used to keep the site clean.
 
I hope these tips on HEMORRHOIDS were useful; REMEMBER, YOUR HEALTH IS INVALUABLE.
 
By Dr. Lawarna Matthew