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Freshly Pressed Ideas: (Not a manual for being freshly pressed).

1. Photography: Use the lens to capture the following.

A bicycle or its parts. Any other machine / machinery parts are also FP worthy. So take heed and give importance to the old parts lying in and around your dwelling. A favorite is a very old (read ancient) automobile. The likes of a T model and Volkswagen photographed at oblique angles with rust showing as decor are strongly recommended. Fungus growth is to be considered an added advantage, provided your shots highlight it.

A passage/ street/ residential block/ sea or riverside etc. and what grows out there like ground nuts and sweet potatoes (which are not seen on the ground hence the whole charm of photographing them).

A flower or its parts. Flower containers are somehow not popular.

A bridge or its parts (like what is it like under the bridge). Little bit of water can be included to increase the marks (if there are such in deciding a FP blog).

Try to capture the abstract like Wind, Breeze, Sounds etc.

Decorations on festive occasions.

2. Prose (remember poetry as such finds it very difficult to find place in the freshly pressed elite club).

Preparing a meal.

Thinking of preparing a meal.

Talk about a movie you don’t want to watch.

Talk about a set of movies you don’t want to watch.

Latest fight between husband and wife (read girlfriend / boyfriend if you don’t like the nomenclature).

How you avoided a fight with your girlfriend / boyfriend.

Teething problems of your dog.

Travel & / or visit to an exotic place (exotic means outside America). This account will encourage the Americans to have sympathy for those ‘poor’ people / their system of living & they would feel great. You get freshly pressed.

Wear an old dress and talk about it (want be sure of getting freshly pressed: get a corresponding photograph also).

Numbered account of your recent visit to your in-laws who gave you a very cold shoulder.

Lists: Like a list of activities which you never plan to do or a list of things which you actually did but the neighbors called the police.

Sketches are popular. You can be FP if you can draw like a 2nd grader. Cruder the sketches, more FP’able they become. Like you can sketch your cat’s maternity leave and see it getting popular in no time (or till the kittens become grand parents – who knows).

1. FP = Freshly Pressed.

2. … This list is not complete and cannot be completed. New ideas will keep on coming. So keep on waiting for them and add yours, please. Till then good luck with the dreams of getting freshly pressed.

3. No matter what your FP’ed blog contain, rest assured that there will be hundred of keen followers and like-ers who will shower you with even keen (read absurd) comments as it provides them with the only chance of getting noticed.

A step behind being freshly pressed. Image courtesy:eu.fotolia.com

How the time flies. How it stops when it’s a holiday.

I do not make ‘to do’ lists. They scare me as I know I would not be able to place tick marks on at least 90% of the listed items. Remaining 10% to me are never so important and therefore can be comfortably left alone. Without much (a)do.

I had a wonderful holiday time when ammi (Urdu for mom) was alive. She was my angel and she was a god when it came to taking care of me. On a holiday she would even ask the maids to stop talking loudly as I used to sleep till late. With late it means till it was lunch time or just before that. The normal utensil friction in the kitchen, the running tap water, the phish phish of insect killer spray, the grrrlp grrrlp of whirling washing machine – everything would come to a standstill because ammi would not allow any of this. She truly and magnanimously and selflessly loved me.

It was very early morning when all the tubes and lines attached to her stopped working all of a sudden and the monitors at her bedside showed a deep, silent, aggrieved, straight and lifeless line. My mornings and life had changed for ever. That also was very early in the morning, around 5 am and it was a Sunday.

Now I get up around 6 and head straight to kitchen to make a cup of tea. Somehow I believe it is rejuvenating and has the capacity to soothe my aching body and soul. Good thing about a holiday is there is no hurry to get to work. So I make that one cup and let the remaining water in the kettle so that to make another one and another one if my hunger or thirst for tea wasn’t quenched. My tiny study is usually clean as the maid gives some last-minute cleaning touches before leaving at night. The unwritten agreement is that on a Sunday I ‘ll not wake her up before 10 am. But by that time most of my ‘work’ is already finished.

Thankfully being fussy about eating is not a problem for me anymore. Frankly eating too much and being super choosy about what is for lunch/ diner is out of life (and believe me it makes life much easier). One realizes how much time and energy is spent daily basis on the selection of food items and mode of cooking /baking in an attempt to make sure that everyone leaves the dining table happy. Resorting to simple, basic foods is a blessing I have now. Though I shudder at how rudely choosy I was in this arena. For the past few years newspapers also have lost their ‘newness’ and charm, if you may call it. Rape, crime, war, terror, war on terror, killing of innocent people and calling it collateral damage, large ads of movies and gossip about movie stars is the stuff newspapers are made of. Sprinkle politics here and there and see your holiday morning destroyed and shredded.

Subtract breakfast and newspaper and you will suddenly realize how rich you are having so much of time. Problem with lot of time is humans want to spend it and on a holiday I am at a loss. I switch on the computer and avoid seeing the clock on the wall facing me. Then I get up and try to find a nail and hammer to place the clock behind me. One or two hours later I succeed in the first project of the morning and am ready for the 3rd cup of tea. And I am thinking of the remaining (almost) 20 hours of the holiday with clock now fixed at my back wall and nothing to do in sight. Should I be using to-do chits then? I wonder. There is silence to deal with when you don’t have anything else to do and it deepens into the crevices of soul.

On getting up in the morning with a severe headache.

Severe headache getting up in the morning

Around 6 a.m. it is dark outside. The morning is crisp and clean with the breeze full of winter’s coolness. It is customary to give compliments to the morning otherwise there is nothing crisp about it as far as I am concerned. My son was up much before me as he has a term exam or whatever they call it in the university. The moment I tried to lift my head from the pillow I gave out a cry. “Idhar aao” (come here in Urdu). Hamza ran to me and held my head in his hands. He is now used to this exercise. When ever I have this headache, and it is always severe, he is the only one who consoles and cajoles me and tries to soothe me. Soothing helps sometimes. But the machinery inside the head continues to churn out pain in the form of … no, in every conceivable form. From large boulders of shattering pain to subtle needles of piercing agony. And there is no noise in the room. All this noise comes from within my head which by now is making me retch and vomit. “ulti kar lo” (please throw out) says Hamza while rubbing my nape and shoulders. He knows my headache get better if I vomit. But today morning it was different. There was an element of vertigo along with this excruciating pain and I was sick to the pit of my stomach. “Nahi ati tau kya karun” (if it doesn’t happen, what can I do), I shouted back. He kept quiet knowing too well that my temper takes a very deep plunge with the headache.

In the meantime Tahira comes downstairs. She is the maid who lives upstairs. Immediately she goes to the kitchen to make tea, following her morning ritual. That made me more furious. “STOP IT. STOP THIS NOISE. YOU WILL KILL ME”. I was trying to shout with authority but knew that my voice is trembling and she would be giggling behind the closed doors of kitchen. Even she is aware of my weaknesses during such pain and that is surely not a very pleasant thought for one who is suffering.

Tea came. My agony doubled. I wanted to take a few sips in the hope (and oh how I hoped this pain to get better) that it will soothe me but the clanking of utensils made it worse. Even when sugar was being mixed in the tea cup I almost shouted, ‘please leave it as such, I can live without this much sugar for one day’, it angered people around me (read my wife who does not need any valid situation to be angry), and it made me suffer more as I understood that none of them is trying to understand my agony. On top of that and on top of my head it seemed that many thousand animals with sharp claws are running in a stampede, literally crushing each and every nerve fiber in my brain and head. It was just like in the Disney movie, The lion king and hyenas are a perfect simile to the horde of animals making me suffer. As a doctor I learned that brain tissue is insensitive to pain. So this terrible pain (which has slowly taken the shape of added throbbing now) must be due to blood vessels and other tissues above the brain. Who wants to think of etiology when your head is being crushed at a hammering pace?

It gets worse with the help around

Finally, I took a sip of tea and glared at everyone in the room. My eyes must be very red and scary as the maid pointed out, ‘Bhai jan (elder brother) you must sleep a little, lack of sleep does this to you’. You know, when one is in pain, any advice is like a flesh or brain substance tearing weapon and I was struck with it with full force. ‘If I chose to sleep, who will go to work’ was my very (un)friendly mumbling back which I of course wished to sound like a real threat like command. There was silence inside the room but the headache was getting worst. My head was splitting and my temples throbbed as if there is some rattling steel furnace running at full speed inside my scalp.

Pounding headache with no relief in sight

After two or three sips of tea I objected to the degree of temperature and was told in a whisper that I don’t usually like lukewarm or cold tea. The poor gal who uttered those careful words never thought they will ignite me. At this point I was almost trembling with anger (more with pain but I would use anger to make me less guilty). ‘So I am not entitled to a less hot tea when I am dying with torture!’ was my calculated response. Though all calculations cease to exist in one’s mind when one of these headaches sound the war trumpet, knowing too well that they will win. Humans always lose this battle.

Two Aspirins and one Valium later I was slightly drowsy and Hamza hurriedly took advantage of the situation and started to press my shoulders and back. In a dreamy state I could feel the pain leaving me through my pores and I inhaled deeply. I am sure everyone saw it and took it as a sign to switch off all the lights and tip toe out of the room. Twenty five minutes later I suddenly got up with the residual pain like a stretching elastic band around my head but I could get up and go to office.

2. How do I know the Dengue fever has become dangerous? Dengue in Lahore: Serious symptoms.

Dengue fever can become very serious if the element of hemorrhage sets in. If the following symptoms are observed, take immediate steps.

SYMPTOMS:

1. Abdominal pain

2. Persistent vomitting

3. Weakness, increasing sleepiness

4. Cold sweats

5. Shortness of breath

6. Dark color urine

7. Lot of drinking fluids but very low urinary output.

If you or any body near you is found to have these symptoms, NEVER wait and IMMEDIATELY take the patient to the nearest emergency hospital. Any time spent at home will be wasted and can be fatal.

For more information a helpline by the government of Punjab has been set up. You can try this number: 0800-99000 (toll free).

What do I do if I have swelling in the neck: Mumps, Lymph nodes, Goiter, Thyroid enlargement.

A person with neck swelling has enlargement of the soft tissues that covers the neck. A neck swelling can also occur as accumulation of fluid, lymph, or inflammatory, or tumor cells in an area under the skin of the neck. Clinically speaking swellings in the region of neck are of great importance as they not only help in diagnosing some serious underlying disease but are also easy to treat if they are benign. Most of the times a simple surgical procedure is all we need.

Neck swelling may be caused by an injury, inflammation, infection, or a benign / malignant tumor. In mild cases of neck swelling, treatment may not be required. If the neck swelling is bothersome, over-the-counter medications such as anti-inflammatory drugs or pain medications or cold compresses may help reduce discomfort and swelling. In more serious cases, a visit to a medical professional may be necessary to determine the cause of neck swelling and appropriate treatment. Seek medical attention if your symptoms of neck swelling, or those of someone you are with, are accompanied by sudden swelling of the face, lips, or tongue, or breathing problems such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking. These symptoms may be signs of a severe allergic reaction.

Anatomy of the neck

Benign skin conditions can cause small areas of the neck to appear swollen. Swelling of the lymph nodes in the neck is a common symptom of many different types of viral and bacterial infections as well as many benign and malignant disorders. Lymph nodes are small organs distributed in the body which collect fluid. They get swollen if inflammatory fluid deposits in them. They are also swollen if cancer cells from an organ reach them in case they are said to have metastasized. In the neck they are present in distinct groups and are almost always show as medium to small size swelling mostly on the sides of the neck and / or under the jaw. Have a look at this illustration, it shows different groups of nodes in and around the neck.

you can see different sets of these lymph nodes like sub-mandibular, and occipital. So their enlargement is either benign or malignant. These nodes are also swollen in cases of TUBERCULOSIS (TB). TB is a treatable disease which affects millions of people all over the world. A biopsy result of the neck swelling, from a pathology laboratory is all you need.

If the swelling is on one or both sides of

Lymph nodes in the neck

the neck just below the ear lobe, it may be MUMPS. In that case immediately consult your doctor. Mumps is a viral infection and can have serious side effects long after the swellings have disappeared. This viral attack  can lead to swelling and pain in the salivary glands (Parotid glands), along with fever, loss of appetite, and fatigue. It mostly occurs in children but can affect us in later life. Remember there is a vaccine against Mumps which protects us from this viral infection.

MUMPS: A viral illness which causes swelling of Parotid glands.

There are some skin causes of neck swelling:

Neck swelling may be caused by a variety of skin conditions including:

• Acne
•  Boils
• Cyst (a benign collection of fluid)
• Lipoma (collection of fatty tissue under the skin; a benign condition)
• Skin infections

Other causes of neck swelling

Neck swelling can also be caused by a variety of other conditions including:

• General infection leading to swollen lymph nodes in the neck region
• Goiter (an enlarged thyroid gland)
• Mumps (viral infection of the salivary glands in the neck)
• Recent neck injury or trauma
• Recent neck surgery

Other causes of lymph node swelling in the neck are the blood cancers like Leukemia, Lymphoma and Hodgkin disease.

In some cases, neck swelling may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

• Anaphylaxis (severe allergic reaction)
• Angioedema (a severe swelling beneath the skin that can cause breathing difficulty)
• Cancer of the throat, thyroid gland or other structures in the neck

LUMP IN THE NECK WHICH IS DUE TO THYROID ENLARGEMENT (GOITER):

A goiter is an enlarged thyroid gland. Some people with a goiter (but not all) have an under-active or overactive thyroid.  A goiter can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid.
The thyroid gland is in the lower part of the front of the neck. It lies just in front of the trachea (windpipe). It has a right and left lobe which are connected together by a narrower band of thyroid tissue. (It is roughly the shape of a butterfly.) You cannot usually see or feel a normal thyroid gland. If the thyroid enlarges it causes a swelling in the neck which you can see – a goiter. There are various causes of goiter and treatment depends on the cause. As such the thyroid swellings can also be classified as benign or malignant. The benign swellings do not cause spread of the disease and are mostly fluid collection in some part of the gland. Hemorrhage in the gland is another example where a neck swelling is observed. Thyroid swellings are prominent and are always situated in front of the neck (see illustration). They may be mobile (moving with swallowing) or fixed. If the swelling is benign   and is mobile, there are chances that it is not dangerous at all and a simple surgical procedure will correct it.

In case of more than one swelling (lumps) in front of the neck which are due to thyroid enlargement, they are called as Multinodular goiter while a single swelling (lump) is termed as simple nodular goiter.

CAUSES OF SIMPLE OR NODULAR GOITER:

Always remember that a thyroid swelling does not mean there is an element of dysfunction also (please see previous blogs about hypothyroidism and hyperthyroidism).

Simple diffuse goiter

They may be there due to IODINE DEFICIENCY in which case they are termed as IODINE DEFICIENCY GOITER. In most of the cases they are diffuse (no nodularity is seen). When there is no nodule palpable in the neck and there is diffuse swelling, it is SIMPLE GOITER. It can also occur at puberty in young girls and is called PUBERTY GOITER.

Diffuse/Simple goiter:

This means that the entire thyroid gland is larger than normal. The thyroid feels smooth but large. There are a number of causes. For example:

• Grave’s disease – an auto-immune disease which causes the thyroid to swell and make too much thyroxine.
• Thyroiditis (inflammation of the thyroid)
• Iodine deficiency. The thyroid gland needs iodine to make thyroxine(T4) and T3. If you lack iodine in your diet the thyroid swells as it tries to make enough of its hormones which are so vital for our bodily functions like metabolism and control our heart rate and many other functions
• Some medicines can cause the thyroid to swell as a side-effect. For example, lithium and treatment of Hepatitis C
• Hereditary factors – some people inherit a tendency for a thyroid to swell. In particular, it may swell at times of life when you may make more thyroxine and T3. For example, when you are pregnant, or during puberty.

Nodular goiter

A thyroid nodule is a small lump which develops in the thyroid gland, in front of the neck. There are two types:

• A multinodular goiter. This means the thyroid gland has developed many lumps or ‘nodules’. The thyroid gland feels generally lumpy.
• A single nodule. Causes include:
  • a cyst (swelling with fluid in it)
  • an adenoma (a solid lesion in the gland composed of glandular cells)
    

    large multinodular goiter

  • a benign or malignant tumor

IF I HAVE GOITER DOES IT MEAN MY THYROID GLAND IS MALFUNCTIONING?

• In many people with a goiter it does not affect the amount of thyroxine T4 or T3 that they make. You are then Euthyroid which means you make the correct amount of these hormones.
• In some people, the goiter is associated with an abnormality of thyroid function. You may make too much thyroxine or T3 (hyperthyroidism) or too little thyroxine or T3 (hypothyroidism) For details please see related posts in this blog.

WHAT STEPS ARE TAKEN TO ASSESS / DIAGNOSE A GOITER:

1. Blood samples are taken to evaluate the amount of circulating thyroid hormones in the body. Normal T4, T3, and TSH means you are Euthyroid while over active and under active thyroid gland is also established and then the treatment starts according to the condition.

2. An ultrasound scan of the thyroid is done. This may be done if you have a single nodule. An ultrasound scan is a safe and painless procedure which uses sound waves to create images of organs and structures inside your body. It can tell if a nodule is a cyst or a solid lump.

3. A radioactive iodine scan. This scan is done (details given in the next post) to establish the uniformity or nodularity of the gland and whether some part of it is HOT or COLD. The hot spots on a radionuclide scan mean this portion of the gland is making more hormones (T4 and T3) than the surrounding gland and a COLD nodule means this area of the gland is not properly functioning. If on scan results there is a COLD NODULE, it is usually suggestive of malignancy (Thyroid cancer) and appropriate medical opinion must be sought immediately.

4. Biopsy: A small piece of tissue (a biopsy) may be taken from a nodule to look at it under the microscope. The biopsy is done by inserting a fine needle into the nodule. (It is like taking a blood sample but the needle is smaller.) It is a simple and safe procedure.

TREATMENT OF GOITER:

• If you have a small goiter, and your thyroid is making the correct amount of thyroxine and T3, then you may not need any treatment. It happens in patients who has simple diffuse goiter
• You will need treatment if you make too much or too little thyroxine T4 or T3
• An operation to remove some or all of the thyroid may be an option in some cases
• Radioactive iodine treatment may be an option for a goitre causing an overactive thyroid. This involves taking a drink, or swallowing a capsule, which contains radioactive iodine (I-131). The radioactive iodine builds up in the thyroid gland. As the radioactivity is concentrated in the thyroid gland, it destroys some thyroid tissue mainly by it beta emissions. If too much of thyroid is destroyed, there is replacement therapy in the form of thyroxine tablets. Their use and the fact that radioactive Iodine treatment is not particularly harmful (it is not given in pregnant or lactating mothers or prospective mothers), this form of treatment for Grave’s disease (toxic goiter) is very useful.
• If you have cancer of the thyroid, you will probably need an operation to remove the cancer and some of the thyroid gland. The strategy to deal with this cancer will be outlined by an Oncologist with the aid of a surgeon.
• Iodine replacement, if the goiter is due to lack of iodine in the diet.

NOTE: If you have any questions, you can always ask the author who is a thyroid diseases consultant.

How do I know I have Hypothyroidism: (Myxedema).

Hypothyroidism is a condition in which the thyroid gland is under-active (it is producing an insufficient amount of thyroid hormones).

Hypothyroidism is the most common thyroid disorder. Severe hypothyroidism can lead to a condition called myxedema, characterized by dry, thickened skin and coarse facial features. So Myxedema is also hypothyroidism but in its extreme form.

Hyper- and Hypo- thyroid states: comparison of symptoms.

WHO IS AT RISK:

As there is very insufficient amounts of circulating thyroid hormones in the body, and since the main purpose of thyroid hormone is to “run the body’s metabolism,” it is understandable that people with this condition will have symptoms associated with a slow metabolism. The estimates vary, but approximately 10 million Americans have this common medical condition. In fact, as many as 10% of women may have some degree of thyroid hormone deficiency. Hypothyroidism is more common than you would believe, and millions of people are currently hypothyroid and don’t know it. It is estimated to affect 3-5% of the adult population. It is more common in women than in men, and the risk of developing hypothyroidism increases with advancing age.

WHAT CAUSES HYPOTHYROIDISM:

Hypothyroidism is most commonly a result of an autoimmune condition known as Hashimoto’s thyroiditis, in which the body’s own immune cells attack and destroy the thyroid gland. Since the activity of the thyroid gland is controlled by other hormones from the pituitary gland and the hypothalamus of the brain, defects in these areas can also cause under-activity of the thyroid gland (such as brain tumors). Previous surgeries on the thyroid or a history of irradiation to the neck are other causes of hypothyroidism. A condition like this can also occur when Hyperthyroidism (Grave’s disease or Toxic goiter) is treated with Radioactive Iodine (I-131) and as a result the thyroid tissue is destroyed resulting in less than normal production of thyroid hormones.

CAN IODINE DEFICIENCY LEAD TO HYPOTHYROIDISM?:

Yes. In areas of the world where there is Iodine deficiency in the diet, severe hypothyroidism can be seen in 5% to 15% of the population. Examples of these areas include Zaire, Ecuador, India, Pakistan, and Chile. Severe iodine deficiency is also seen in remote mountain areas such as the Andes and the Himalayas. Since the addition of iodine to table salt and to bread, iodine deficiency is rarely seen in the United States.

WHAT ARE THE SYMPTOMS OF HYPOTHYROIDISM:

An under-active thyroid gland affects all organs and functions within the body, leading to both physical and emotional symptoms. Symptoms of hypothyroidism are usually very subtle and gradual and may be mistaken for symptoms of depression. The following are the most common symptoms of hypothyroidism. However, each individual may experience symptoms differently.

* dull facial expressions, lack of drive, low mood
* hoarse voice
* slow speech
* droopy eyelids
* puffy and swollen face
* weight gain, lethargy, body aches and pains
* constipation
* coarse and dry hair
* coarse, dry, and thickened skin
* slow pulse or bradycardia.
* muscle cramps
* confusion, memory loss, loss of libido (decreased sex drive)
* increased menstrual flow in women (menorrhagia)

* One reason of clinical depression is severe hypothyroidism so if you have depression, it is mandatory to get thyroid hormones evaluated from a good, reliable laboratory. As one of the reasons for hypothyroidism is raised TSH (Thyroid stimulating hormone) due to pituitary disturbances / diseases, it should be kept in mind that there are numerous cases of infertility in women which is due to hypothyroidism.

DIAGNOSIS AND TREATMENT:

Since hypothyroidism is caused by too little thyroid hormone secreted by the thyroid, the diagnosis of hypothyroidism is based almost exclusively upon measuring the amount of thyroid hormone in the blood. There are normal ranges for all thyroid hormones which have been calculated by computers which measure these hormones in tens of thousands of people. If your thyroid hormone levels fall below the normal range, that is consistent with hypothyroidism. These tests are very accurate and reliable and are so routine that they are available to everybody. Diagnosis is made by a doctor working in the field of endocrinology or an endocrinologist. The hormones are evaluated in a laboratory and methods like RIA (radioimmunoassay) give very accurate results of circulating hormones. In most cases the TSH (thyroid stimulating hormone) levels are found very high.

Treatment of hypothyroidism:

The goal of treatment is to restore the thyroid gland to its normal function, creating normal levels of thyroid hormones in the circulating blood. Specific treatment for hypothyroidism will be determined by your physician based on:

* your age, overall health, and medical history
* extent of the disease
* expectations for the course of the disease

Treatment may include prescription of thyroid hormones (Thyroxine, Levothyroxine, Eltroxin) to replace the deficient hormones. Dosage of thyroid hormone may need to be increased over the years. Yearly or biyearly checkups are usually required to ensure that the proper dosage of thyroid hormones is taken. A patient usually takes thyroid hormones for the rest of his/her life. Remember you should not be shy in discussing with your doctor your blood hormone test results, symptoms, how you feel, and the type of medicine you are taking. The goal is to make you feel better, make your body last longer, slow the risk of heart disease and osteoporosis, in addition to making your blood levels normal. Sometimes that’s easy, when its not, you need a physician who is willing to spend time with you that you deserve while you explore different dosages and other types of medications (or alternative diagnoses).

How do I know I have Hyperthyroidism: (Grave’s disease or Toxic goiter)?

The Thyroid gland

INTRODUCTION TO THE THYROID GLAND:

All of us have a small gland in our necks called the Thyroid gland. Normally it is not visible and we cannot feel its presence inside us. It sits comfortably in its bed and does a lot of good to us through its excretions (hormone) which are synthesized by Iodine. These hormones are essential for the function of every cell in the body. They help regulate growth and the rate of chemical reactions (metabolism), and are involved in the circadian rhythms that govern sleep, among other essential functions. Optimum human health is not possible without adequate supply of Thyroid hormones. So this small gland which is not seen by others and is not felt by ourselves is critical to our health. That is why the over production of these hormones causes a disease called Hyperthyroidism which is our topic in this blog.

IODINE AND THYROID HORMONES:

The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3), and Thyroid stimulating hormone (TSH), which is produced by the pituitary gland in the brain. The thyroid also makes the hormone Calcitonin, which is involved in calcium metabolization and stimulating bone cells to add calcium to bone. It is the same Iodine which is presentin Sea weed, Fish (Cod, Shrimp and Tuna etc), milk, Corn, Prunes, Banana, Cheese, Cereal, Apple juice, and some vegetables. If the level of Iodine drops in our blood and remains low for prolonged period of time we can have enlargement of thyroid gland (also called as Goiter) or a disease Hypothyroidism (we will talk about it in another blog). Remember it is the lack of Iodine in the diet which causes the Thyroid gland to swell.

Goiter or swollen Thyroid gland.

The Goiter shown in this picture is pretty large and usually represents very long standing Iodine deficiency. But sizes even greater than this are a pretty common site in some areas of the world where the Iodine content of the water is below normal. Use of table salt containing Iodine is therefore advised in such areas. Please remember that some young females have what is called as Physiological Goiter. That is small, diffuse enlargement of thyroid gland in menstruation and pregnancy. This condition is mostly self limiting and is mainly due to hormonal changes in the body.You can have hyperthyroidism with or without thyroid gland swelling.

RISK FACTORS IN THE PRODUCTION OF HYPERTHYROIDISM:

The risk factors for development of hyperthyroidism or Graves’ disease include personal or family history of thyroid or autoimmune disease, recent pregnancy, and exposure to Iodine, among other factors. Women are affected by this illness 8 times more than men.

So it can be said that this is predominantly a disease of women. The riskiest age for developing Graves’ disease and hyperthyroidism is between 20 and 40. Pregnancy and the year after childbirth are both times of greater risk for this disease. There is an increased risk of Graves’ disease in smokers. Smokers with this disease tend to have more severe symptoms like thyroid Opthalmopathy feature (the prominent eye problems or the protrusion of eye balls) that are more resistant to treatment. Some treatments and medications can trigger Graves’ disease and/or thyrotoxicosis in some people, including: Interferon Beta-1b and Interleukin-4, immunosuppressant therapy for Hepatitis, antiretroviral treatment for AIDS, and lithium, widely used to treat Depression and Manic Depressive illness. There are two particular treatments that are known triggers hyperthyroidism: a third of patients receiving monoclonal antibody (Campath-1H) therapy for multiple sclerosis (MS) develop Graves’ disease within six months, and receiving a donated organ or bone marrow transplant from someone with Graves’ disease can also cause the disease in the recipient. Talking of risk factors in the production of hyperthyroidism it may be kept in mind that Stress is a factor that appears to trigger the onset of Graves’ disease in some patients. There is a definite connection between major life stressors – i.e., death of a spouse or close family relative/ friend, divorce or separation, loss of a job, major accident/personal injury, moving, marriage – and the onset of this disease.

SYMPTOMS OF HYPERTHYROIDISM and its treatment (What you should be experiencing if you are suffering from it):

As the thyroid gland acts upon our body through its hormones in numerous number of ways, it is often difficult for the doctor to correctly diagnose this condition on the symptoms alone. Most of the symptoms are vague and are present in so many other conditions also. At such times the laboratory comes to the help and decides the onset of this disease as the levels of hormones are disturbed. Most frequent symptoms are:

* Sudden weight loss, even when your appetite and diet remain normal or even increase,
* Rapid heartbeat — commonly more than 100 beats a minute; irregular heartbeat (arrhythmia) or pounding of your heart (palpitations),
* Nervousness, and anxiety,
* Tremor — usually a fine trembling in your hands and fingers,
* Excessive sweating,
* Changes in menstruation patterns,
* Increased sensitivity to heat, or heat intolerance,
* Changes in bowel patterns, especially more frequent bowel movements, or loose motions,
* An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck,
* Fatigue, muscle weakness, feeling of not being well,
* Difficulty in falling sleep.
* Staring eyes (Hyperthyroid Opthalmopathy).

Staring eyes in Hyperthyroidism

Older adults are more likely to have either no signs or symptoms or some very subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired easily. Medications called beta blockers, which are used to treat high blood pressure and other conditions, can mask many of the signs of hyperthyroidism. So never use any medication unless your doctor has prescribed it after careful evaluation of your symptoms and with the help of available laboratory tests.
Prompt diagnosis and treatment of hyperthyroidism can lead to a good prognosis or a cure in some cases. With regular medical care and compliance with treatment plans, most of the people with the disease live active, normal lives. It may be emphasized that patients with hyperthyroidism may need Radio active Iodine treatment (also called as medical thyroidectomy), surgery (removal of the whole or part of the thyroid gland), and various drugs to be taken for considerable periods of time. At the end of which, you should be sure, that even if it is not completely cured, your life will be as near normal as possible and you will enjoy all the activities of a normal healthy being.

CAN IT BE SERIOUS:

Hyperthyroidism can lead to serious, potentially life-threatening symptoms and complications, such as cardiac arrhythmias and heart failure. Seek immediate medical care if you, or someone you are with, have symptoms such as unexplained weight loss, hair loss, frequent bowel movements, excessive sweating, weakness, joint and body pains and aches, tachycardia (palpitations), heat intolerance, irritability, anxiety, irregular periods / excessive bleeding (in women only), loss of hair, loss of sleep, chest pain, or shortness of breath.

If you have any suggestions / questions please feel free to ask here.

What happened at OJHRI CAMP in Rawalpindi in 1988.

“Ojhri” is the beef stomach which is cooked in the form of a very spicy and delicious curry in Pakistan and India. The prepared dish looks like this. However this ‘Ojhri’ camp we are talking about was an ammunition depot in Pakistan.

Ojhri Camp was a large ammunition depot of Pakistan army located in Rawalpindi / Islamabad, Pakistan. It was used as an ammunition depot for Afghan Mujahedeen fighting against Soviet forces in Afghanistan. Those were the days when CIA and America loved Islamic Jihad and Mujahideen as they gave their lives in the battle fields of Afghanistan. Soviet Russia‘s last strong hold was crumbling fast due to the impact of these Mujahedeens., and bulk of them were recruited, trained and dispatched by the famous ISI and Pakistan army. American paid them handsomely and supplied them with the latest arsenal which was distributed to them by ISI. The army officer incharge of all this was General Akhtar Abdul Rehman who got killed in the plane crash along with Zia ul Haq.
The camp exploded on April 10, 1988, killing more than 4,000 people in Rawalpindi and Islamabad.There was speculation that the explosion was done by Pakistani agents to cover up a pilferage of the weapons stocks, including Stinger missiles. But as usual the matter was swept under the carpet by the then president, General Zia ul Haq; as fingers were being pointed at their money making operations through illicit arms deals. Zia himself and his cronies amassed millions of dollars which are still being used by their families. Recently a veteran politician, Kalsoom Saifullah has written a book in which she has told the Pakistani people that it was none other than Zia ul Haq himself who ordered the explosion to be carried out so that the threat of American checking of stinger missiles could be averted. This book is published in September 2011 in Pakistan.

On April 10, 1988 Pakistan was in the iron fist of a military dictator, General Zia ul Haq who came to power after sacking the elected prime minister, Zulfiqar Ali Bhutto. He later hanged him through a very dubious court proceedings and it has since been termed as the ‘judicial murder’ of Z. A. Bhutto. This was another dark period of military rule in Pakistan. A time when the military rulers danced to American tunes. This was not the era of ‘Enlightened Moderation’, but that of militant jihad-ism acceptable to the Americans. This was the era of General Zia’s Raj. This was a time when Pakistan was once again a ‘Front Line state’ and the West, particularly America and its allies were supporting the Mujahidin groups, and when of course Osama Bin Laden America’s most favourite freedom fighter was leading the Western inspired Jihad against the Soviets. Hundreds of millions of dollars were given to the Pakistani military to manage the Jihad in Afghanistan, and hundreds of millions of dollars was also spent on providing weapons and logistical support for the Mujahid groups through Pakistan. Who then were of course the sacred, adored, ‘freedom fighters’ and NOT the terrorists (as they are hatefully called today by America).

The weapons stored at OJHRI camp were sent mainly by Americana, but also, by other allies of the US, including Britain. They were shipped to Karachi and from there taken towards North of Pakistan where vicinity of Afghan border was the biggest consideration in storing them. One of the biggest central dumps was Ojhri. This dump was directly controlled by the ISI. It was an open secret that the ISI was not even answerable to the GHQ in Rawalpindi, but directly to General Zia himself.

Ziaul Haq who ordered the explosion at Ojhri camp, Rawalpindi.

Martyred daughter of a martyred leader: Benazir Bhutto shaheed whom shaheed Zulfiqar Ali Bhutto loved and mentored.

One of the most important political fall out of this incidence was sacking of the then prime minister Mohammad Khan Junejo, a handpicked, docile politician from Sindh; by General Zia himself. The government of prime minister Muhammad Khan Junejo, installed by General Zia, was dismissed shortly after the Ojhri camp blasts and the newspapers said that an inquiry report by Junejo’s government was the reason for the dismissal.

On April 10, 1988, over one million citizens of the twin cities of Rawalpindi and Islamabad stared death in the eye. A blast in the ammunition depot of Ojhri camp wrecked havoc as shells and rockets of various shapes and sizes started raining over a radius of ten miles.Thousands perished and many more were wounded. There has been no accepted statistical data available to date but a careful account put the figure of deaths close to 4000.

The first reaction of many citizens was that India had attacked. This was during the height of the Afghan conflict, with Pakistan about to sign the Geneva accords four days later. Others argued that the Soviets had attacked Pakistan to teach her a lesson. Two committees were formed by the government to look into the affair. The first was the military committee headed by a serving General. This committee’s findings and recommendations were ignored since it called for the removal of General Zia’s right hand man, General Akhtar Abdul Rehman, along with other senior military officials. Its report, presented within one week of the incident, was rejected. Another more interesting committee was the one set up by prime minister Muhammad Khan Junejo.This was a political committee headed by a Cabinet minister and comprised of four federal ministers. Controversy surrounded the findings of this committee. The members could not reach a consensus on who was responsible for the Ojhri tragedy. In his remarks, the head of the committee, Aslam Khattak concluded, “No one was responsible. It was an act of Allah.’

Dengue Fever in Lahore. What we should know and do about it. How do I know I have Dengue fever.

Punjab and in particular Lahore is being crippled by increasing number of Dengue fever patients. We all know it is an illness caused by a virus. This virus is spread by Dengue mosquito. Without going into details of types and kinds of the mosquito, viruses and irrelevant data, I will endeavor to present here some basic facts so that if you or anyone near and dear to you has a fever these days, you should know what to do.

SYMPTOMS OF DENGUE FEVER: How can you diagnose Dengue fever.

Dengue virus infections cause a spectrum of illness ranging from asymptomatic, mild undifferentiated fever to classical dengue fever (DF), and dengue fever with haemorrhagic manifestations, or dengue haemorrhagic fever (DHF) and the dengue shock syndrome (DSS). Keep the following in mind when dealing with Dengue fever.

The symptoms generally are:

1. High continuous fever of 3 days or more

2. Abdominal pain

3. Small hemorrhages under the skin.

4. Rash. The skin rash of Dengue fever is mostly itchy and mostly occurs on the back.

5. Abdominal pain due to enlargement of Liver.

6. Fall in platelet count that precedes or occurs simultaneously with a rise in haematocrit

7. Normal WBC or leucopaenia with increase in Lymphocyte count.

8. Normal ESR (< 20mm per hour) It tends to increase in fevers caused by most of the infections in our region.

Some less common but very significant symptoms are:

• Acute abdominal pains, diarrhoea, severe gastrointestinal haemorrhage

• Severe headache,

• Inflammation of brain (Encephalitic) signs associated with or without intra-cranial hemorrhage

• Irregular pulse and heart rate

• Respiratory distress / difficulty in breathing.

PLATELETS:

In a normal person the platelet count in a blood sample is 150,000 to 250,000 / cu.mm. Platelets are the small particles which help in coagulation. If the platelet count is BELOW 100,000/ cmm, it should be considered an emergency and patient should be hospitalized. Remember the duration of fever is 5 – 7 days after which there is afebrile (fever less) phase which lasts for 2 to 5 days but is of high importance as most of the complications (including bleeding) occur in this period of time. So absence of fever in diagnosed case of Dengue does not mean that the patient should be allowed to move about.

If there is no bleeding and the platelet count is not going below 100,000 /cmm, majority of treatment consists of correcting the fluid balance, giving antipyretic medication (NEVER USE ASPIRIN as it can further complicate bleeding disorder), rest, good protein diet and antibiotics (if needed) to reduce the chance of secondary infection. As such antibiotics (Tarivid, Ofloxacin, Leflox, Ofloxin, Cephradine, Septran, Vibramycin, etc.) have no role in the treatment of Dengue fever. They are only used for any secondary infection in the body and in its absence should NOT be used.

TREATMENT OF DENGUE FEVER:

Look for these symptoms and decide:

• Restlessness or lethargy

• Cold extremities

• Bleeding in any form

• Oliguria (low urinary output), reluctance to drink fluids

• Rapid and weak pulse

• Haematocrit of 40, or rising haematocrit

• Platelet count of less than 100,000/mm3

• Acute abdominal pain

Most of the times such patients MUST be hospitalized and further treatment is done there.

If the patient REFUSES TO GO TO HOSPITAL, Do these:

1. Encourage the patient to drink fluids

2. Observe for coldness / blueness of extremities

3. Administer Paracetamol(Panodol, Calpol) for fever 10-15mg/kg/dose 4-6 hourly (limit to 5 doses in 24 hours)

4. Cold sponging as necessary, especially if the fever is above 102 F

5. Avoid aspirin and non-steroidal anti-inflammatory drugs (Bruffen, Feldene, Naproxyn, Synflex, Dicloran etc.)

HOW DO WE KNOW THAT THE PATIENT IS NOW OK AND DOES NOT NEED ANY MORE HOSPITAL STAY:

If these six (6) conditions are fulfilled, the patient should be discharged from the hospital:

1. Absence of fever for 24 hours without the use of antipyretics, and a return of appetite

2. Visible improvement in clinical picture

3. Stable haematocrit (laboratory finding on blood test)

4. Three days after recovery from shock

5. Platelet count greater than 50,000/mm3 and rising

6. No respiratory distress

PLEASE FOLLOW the instructions on media/ press about how to prevent Dengue fever and stay away from mosquito. Remember, this mosquito bites early in the morning and in the evenings, so avoid being outside at these times. Also this mosquito breeds in fresh water. So be careful of any such collection (leaking pipes, the drainage of air-conditioner and fridge, old/new tires, store room stuff which is not cleaned / dried daily, flower and other pots, water tanks (over head or at the ground level), kitchen and bathroom fittings where fresh water can pool and if allowed to stand for sometime will be a breeding ground for the Dengue mosquito. USE mosquito repellent when going out. AVOID going out to the public places during the time the infection is rampant. THIS INFECTION IS NOT TRANSMITTED THROUGH ANOTHER HUMAN BEING so there is no need to keep the patient in solitary rooms/ areas but as the mosquito can bite any of us after biting a patient with fever, it is advisable to avoid contact with large number of people.

If you or anyone around you have fever for more than 2 days with vomiting, headache, pain in the eyes and abdominal pain, DO NOT WASTE TIME but go to the nearest doctor/ hospital.

All dengue patients must be carefully observed for

complications for at least 2 days after recovery from fever. This is

because life threatening complications often occur during this phase.

Patients and households should be informed that severe

abdominal pain, passage of black stools, bleeding into the skin or

from the nose or gums, sweating, and cold skin are danger signs.

If any of these signs is noticed, the patient should be taken to the

hospital.

In case of emergency you can contact me also:

Tel: (+92) 0333 4307227.

PS: If you are outside Pakistan and plan to visit (particularly Lahore), this is NOT one of the best times to come back. If it is important pleases make sure you take all precautions to keep the mosquitoes away from you. That includes using mosquito repellents and avoiding going out doors. Also instead of PARACETAMOL we can use TYLENOL / ACETAMINOPHEN/ WILGESIC/ DIAGESIC. Last but not the least have faith in God. He will protect you.

WHERE CAN I GET TREATMENT FOR DENGUE FEVER AND GET MY TESTS DONE:

These hospitals in Lahore are catering for the needs of patients with Dengue Fever infection. They are mostly offering their services free of charges. Even the laboratory tests are charged at minimal rates. There are a number of private clinics/ hospitals which also take care of such patients but charge large amounts of money as their fees / lab charges.

1. Mayo hospital, Lahore.

2. Sir Ganga Ram Hospital, Queens road.

3. Sheikh Zayed hospital.

4. Ittefaq hospital.

5. Services hospital, Shadman, Jail road.

6. Jinnah hospital, near Canal bank.

7. Mian Munshi hospital. Band road.

Other, expensive labs are Chughtai lab, Shokat Khanum lab, Agha Khan hospital lab, Labex, Zeenat clinic, Karachi Lab, Raceview lab, Mehran lab, and hundreds of others in virtually every area of the city.

The Punjab government has announced that 8 of its social security clinics in the city are being equipped to deal with cases of Dengue Fever. Information about these clinics can be had from the following toll-free number:
(+92)42 0800 73774. (This is not an on-line advisory service. Only for  inquiries about social security clinics).

USEFULNESS OF PAPAYA LEAVES IN RAISING PLATELET COUNT:

There is no cure as such for Dengue fever as discussed. There have been reports that Papaya (scientific name Circa Papaya) leave extract works miraculously in raising the platelet count if that goes down. Doctors working in the field of infectious diseases have confirmed this fact.

METHOD OF PREPARATION:

Papaya plant

Take two fresh papaya leaves (use only the leafy part, remove the stalks), wash, clean, pound and squeeze out the juice into a blender. That should yield approximately 2 tablespoons of bitter juice to be taken as it is. Do not boil or dilute with water. One serving per day is recommended.