Depression In Elderly

Depression-In-The-ElderlyDepression in elderly is very common but that does not mean that it is normal. It affects about 6 million Americans who are above the age of 65 years. Older patients are more at risk of suffering from depression due to a number of factors like retirement, isolation, death of loved ones and medical problems.

Depression- Definition: 

Anyone can feel sad or down but when these feelings of sadness are persistent causing trouble in daily routine activities then it becomes a disease. Depression is defined as a medical illness in which there is persistent feeling of sadness, often associated with discouragement and lack of self worth.

Clinical Features:

Identifying an elderly suffering from depression is necessary as it is frequently confused with the symptoms of other medical conditions the patient is already having and with the affect of multiple treatments the patient is receiving. It is important to remember that depression is a disease that affects both the body and the mind. The main signs and symptoms are as follows:

  • Sadness
  • Fatigue
  • Lost of interest in hobbies and things that used to give pleasure in the past
  • Decreased appetite
  • Sleep disturbances ( both either difficulty sleeping or excessive sleep )
  • Weight loss
  • Subtle signs of distress like irritable, agitated or difficulty sitting still.
  • Inability to concentrate.
  • Generalized body aches, headaches, digestive disturbance
  • Thoughts of suicide or a suicidal attempt.

Depression In elderly Is Different from Depression In Younger Patients:

  • Depression affects older people differently than in younger patients. Depression in the elderly often increases the risk of cardiac disease by two fold and thus increases the risk of death.
  • Depression reduces the elderly person’s ability to rehabilitate.
  • The chances of suicide  are more in elderly suffering from depression.
  • Its easy to miss the symptoms of depression in an older person due to isolation, lack of expression of feelings and avoiding to go for a regular medical checkup.
  • Many elderly patients do not recognize that their symptoms are due to depression and not a part of normal aging.

Cause of depression:

Causes and risk factors that contribute to depression in older patients and the elderly include:

  • Health problems like chronic pain, disability, damage to body image due to disease or surgery etc
  • Living alone and isolated
  • Death of close friends or loved ones.
  • Feeling of purposelessness following a retirement and lack of daily routine activity .
  • Fear of death
  • Anxiety and financial problems.
  • Con current medical illness like heart disease, stroke, Parkinson’s disease , diabetes etc.
  • Side effect of certain medications.
  • Lack of social supportive network

Continue reading “Depression In Elderly”

What Is Insulinoma- A Pancreatic Islet Cell tumor

InsulinomaIntroduction:

Insulinoma is a benign pancreatic islet cell tumor that produces excessive insulin and is derived from beta cells of the pancreas. The constant secretion of insulin from the tumor leads to hypoglycemia ( low blood sugar levels).

Incidence: 

Insulinomas are rare tumors and mostly occur as a single small non cancerous growth is adults. People with genetic disorder known as multiple endocrine neoplasia type I are more prone to have this type of tumor. Its incidence is only 3-4 per million people making it one of the very rare tumors.

Clinical features:

Patients usually present with:

  • Recurrent headache
  • Lethargy
  • Anxiety
  • Behavioral changes
  • Blurred vision
  • Seizures
  • Coma if severe hypoglycemia occurs.
  • Confusion
  • Hunger
  • Sweating
  • Tremors

Diagnosis:

The diagnosis of a patient having an insulinoma is made after some blood work and imaging studies. Blood glucose levels as well as insulin and C peptide are measured. A low blood glucose along with high insulin leads to the diagnoses of insulinoma. the C peptide is measured to differentiate the insulin synthesized in the body from the injected insulin. If insulin is injected there will be no C peptide. Later a CT scan or MRI of the abdomen may be done to look for the tumor in the pancreas.

Treatment:

The definitive treatment is the surgical removal of the tumor. Continue reading “What Is Insulinoma- A Pancreatic Islet Cell tumor”

Prophylactic Antibiotics In Surgery

Prophylactic Antibiotics In SurgeryWhenever surgeries are planned antibiotics are usually given to prevent the risk of wound infections which occurs in appx. 20% of GI surgeries. Prophylaxis is recommended for almost all clean or contaminated and dirty procedures.

Factors supporting the prophylaxis:

There are certain patient related or procedure related factors that support the giving of antibiotics in order to prevent infection associated with the surgical procedure. These factors may include:

  • Patients who have some valvular heart problem
  • Immunocompromised patients.
  • Too young or very old age.
  • Procedures involving mouth, GI tract, GU tract and respiratory tract.

Timings Of antibiotic Administration: 

It is important to give the antibiotic at a n appropriate time before the surgery in order to give the maximum benefit. The first dose is usually given before the surgery about 30 minutes before the incision. Re administration at one to two half live of the antibiotic is usually recommended.

Antibiotic Regimens: It depends upon personal and local preference but the usual recommendation is as follows:

  • Biliary surgery: Cefuroxime 1.5 g for 1 dose IV + Metronidazole
  • Appendectomy: If uncomplicated , a single dose of cefuroxime 1.5 g is effective
  • Colorectal Surgery: Cefuroxime 1.5 g every 8 hrs + metronidazole 500 mg 8 hrly given for 1 – 3 doses IV
  • Vascular surgery: Co-amoxiclav 1.2 g IV on induction, if penicillin allergic, give Cefuroxime 1.5 IV or IM + metronidazole 500 mg IV.

Continue reading “Prophylactic Antibiotics In Surgery”

Managing Vitamin D Deficiency

manging vitamin D deficiencyDeficiency of Vitamin D can affect people of all ages and is usually manifested as bone and muscle pain and weakness. The goal of treatment is to bring the levels to normal, prevent bone fractures and relieve the symptoms. Recent research and evidence shows that vitamin D deficiency is very common in general population. Average daily Vitamin D intake in the diet is usually inadequate to maintain normal blood levels.

Diagnosis Of Vitamin D Deficiency:

A low level of Vitamin D can be diagnosed with a blood test that checks the levels of 25 hydroxyvitamin D:

  • A normal level is defined as a concentration greater than 30 ng/ml
  • Insufficiency is defined as levels b/w 20-30 ng/ml
  • Deficiency is defined as levels less than 20 ng/ml

Management:

The amount of vitamin D that is needed to correct the deficiency depends upon the severity of the deficiency.

Rule of thumb: for every 1 ng/ml increase in your blood level you need an additional 100 IU vitamin D per day.

There are many different strengths and preparations of vitamin D supplements available to treat and prevent the deficiency.

  • In patients with levels less than 20 ng/ml treatment consists of 50,000 IU of Vitamin D taken by mouth once or more every week for 6 to 8 weeks.
  • In patients with levels b/w 20-30 ng/ml treatment consists of giving 800-1000 IU of vitamin D by mouth daily usually for a period of 3 months.
  • Once a normal level is achieved 800 IU of vitamin D taken by mouth once daily is recommended.
  • In infants and children with a deficiency and a level less than 20 ng/ml treatment is 1000-5000 IU vitamin D daily for 2 to 3 months.
  • Patients who are obese, have a malabsorption syndrome or are taking medicines that can impair vitamin D absorption are recommended to take two to three times higher dose.

For optimal absorption it is recommended to take vitamin D with a meal that has high fat content as fat promotes absorption of vitamin D

Prevention:

The major source of Vitamin d comes from sun exposure. It is suggested that 10-15 minutes of sun exposure at least two times per week to the face, hands, arms, or back without Continue reading “Managing Vitamin D Deficiency”

Introduction To Vitamin D Deficiency

vitamin D defeciencyVitamin D also commonly known as Sunshine vitamin is a fat soluble vitamin and essential to normal body growth and development. It is produced in the body in response to skin being exposed to sunlight. The deficiency of vitamin d may occur due to either inadequate nutritional intake or inadequate sunlight exposure.

Sources Of Vitamin D:

There are two forms of Vitamin D known as D2 and D3.

  • Vitamin D2 also known as Ergocalciferol basically comes from fortified foods, plant foods and supplements.
  • VitaminD3 also known as Cholecalciferol comes from fortified foods, Animal sources like fish, eggs and liver as well as can be synthesized in the body when the skin is exposed to ultraviolet rays from the sun.

Symptoms Of Vitamin D Deficiency:

Mild deficiency of Vitamin D is usually not associated with any symptoms. The main symptoms are bone pain and muscle weakness. The deficiency of Vitamin D is associated with a number of different health disorders like:

  • Rickets in children characterized by impaired growth and deformity of long bones.
  • Osteomalacia in adults characterized by muscle weakness and bone fragility
  • Osteoporosis a condition with reduced bone mineral density and increased risk of fractures.
  • Increased risk of death from cardiovascular disease.
  • Cognitive impairment in older adults
  • Muscle twitching or fasciculations .
  • Severe asthma in children
  • Increased risk of cancer.
  • Increased chanced of being diagnosed with Schizophrenia

Causes of Vitamin D Deficiency:

There are a number of reasons an individual may have a deficiency of Vitamin D. These include:

1. Lack of consumption of Vitamin D in the diet mostly because of following a strict vegetarian diet. Continue reading “Introduction To Vitamin D Deficiency”