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Wednesday, August 13, 2014

Homeopathy for Geriatric Disease ( old age problems )



GERIATRIC DISEASES
                                                                            1 . DEMENTIA
Dementia is defined as a decline in cognitive, intellectual and memory function due to disease process affecting the Cerebra Nervous System. It is detected by using criteria of DSM IV.
                                                                   Causes of Dementia
Dementia can be caused by a variety of diseases mentioned below –
1.Vascular – This includes diffuse small vessel disease (commonest), amyloidal  antipathy multiple emboli & cerebral vacuities.
2. Neoplastic – This includes some primary cerebral tumor , & secondary deposits
3. Inflammatory – This includes diseases like sarcoidosis & multiple sclerosis & multiple sclerosis
4. Traumatic – This includes chronic subdural haematoma. post head injury ( commonest) & punch drunk syndrome.
5. Hydrocephalous, toxic & infective cause
                                                           Symptoms of dementia
1.Disturbances in personality or memory dysfunctiuon
2. Forgetfulness- usually has a slow onset
3. Loss of interest in surroundings
4. Impairment in social skills and personality
5. Depression – usually in early stages
6. Disorientation in time & space which is followed by language impairment, aphasia, apraxia fits & paralysis.
                                                             Investigations
In order to find out the exact cause of the disease imaging of the brain is important and so either CT Scan / MRI of head is done. other investigations include-
. Blood test – This includes full blood count, ESR , urea electrolytes, glucose, calcium, liver function test, thyroid function test, Vit  B 12, VDRL test , ANA & anti- ds DNA.
.Chest X-Ray
 . EEG
. And in some selected patients following tests are also done –Lumbar puncture, HIV Serology & brain biopsy can be performed.
                                                                     2. URINARY INCONTINENCE
It is defined as the involuntary passage of urine through urethral orifice. It is common in females.
Urinary incontinence may occur with a normal urinary tract for example with poor cognition or poor mobility or during hospitalization or acute illness in older people.
Some of the urodynamic abnormalities found in patients with urinary incontinence are mentioned below-
1. Stress incontinence- in this condition as such the patient remains normal but during the act of coughing, sneezing urine leaks as there is passive increase in the vesical pressure & which is more than the urethral pressure. This is most commonly found in females after childbirth and rarely in males.
2. Urge incontinence- Sometimes during filling the detrusor muscle contracts which leads to increased vesical pressure and if this vesical pressure is greater than the urethral pressure, leaking occurs . The incidence of the condition increases with age.
3. Overflow incontinence – In this case the bladder is full and there is no contraction of detrusor muscle but a minimum quantity of abdomen & vesical pressure result in urine leakage.
4. Prostatic obstruction – In this condition the storage phase is normal but there is a problem in voiding phase. During the act of voiding of urine detrusor muscle contracts which results in increased vesical pressure but besides this increased vesical pressure there is a poor/ wavy flow of urine because of obstruction in the prostatic urethra also.
                                                                           Cause of Urinary Incontinence
Causes of urinary incontinence van be classified as follows-
1. Established – This includes various diseases such as cerebral or spinal cord lesion , stroke, dementia, bladder diseases, parkinsonism & myelopathy.
2. Transient – This included the following diseases dementia , UTI, atrophic senile vaginitis, pharmaceutical or drug induced, incrased urine output, restricted mobility, stool impaction.
                                                                      Investigations
Urinary incontinence is evaluated by taking history and conducting physical examination including neurological, rectal & gynaecological examination.
Some of the specific tests are mentioned below-
. Cystoscopy
. Urodynamic studies
.Cystometry
.Sphincter electromyography
                                                              3. BENIGN HYPERTROPHY OF PROSTATE
Prostate enlargement occur from the periurethral (transitional) zone & involves both glandular and stromal tissue. Prostate increases in volume by 2.4 cm3 / yr on an average after 40 yrs.
                                                                             SYMPTOMS
Symptoms associated with BHP are seen after 60 yrs & over 80 yrs of age, men face symptoms as mentioned below-
. Due to prostate obstructing urethra- Hesitancy, poor prolonged flow & sensation of incomplete emptying.
. In cases of chronic urinary retention , bladder slowly distends due to inadequate emptying over a long period of time. The following symptoms include- hydroureter, hydronephrosis and renal failure.
                                                                          Investigations
Symptoms relating to the disease can help in assessing the urinary problems & following investigations can be done-
1. Flow meter can help in measuring the flow rate
2. Prostate volume can be measured- Rectal examination or TRUS (transrectal ultrasound scan)
3.Objective assessment of obstruction is done by urodynamics.
                                                                    4.  OSTEOPOROSIS
Osteoporosis is defined as a group of bone disorders in which the absolute bone mass is less than normal & which result into decrease in micro – architecture leading to increased bone fragility & risk. The mineral- matrix ratio is reduced. It usually remains silent or asymptomatic until a fracture occurs. In India around 35% post-menopausal women are at risk of developing osteoporosis.
                                                              Types Of Osteoporosis
Primary osteoporosis this can be classified into the following
. Post-menopausal (type-I),senile ( type-II)
.Idiopathic which is further divided into juvenile & in adults (premenopausal)
Secondary Osteoporosis- This can be classified into-
Genetic – This basically includes heritable disorders of connective tissue & includes ontogenesis imperfect, marfan’s  syndrome, otomocystinuria.
Nutritional
. Calcium deficiency
. Protein deficiency
. Scurvy
. Malabsorption , malnutrition
Endocrine
. Hypogonadism
. Cushing’s syndrome
. Thyrotoxicosis
.Hyerparathyroidism
.Acromegaly
. Diabetes mellitus
Iatrogenic
. Steroids
. Heparin
. Anti-convulsant
Regional osteoporosis
. Immobilization
. Post- traumatic
. Transient
. Migratory
As the eole grow both the sexes tend to lose on the bone mass but the bone mass loss is accelerated in females during their menopausal time and this is known as age-related osteoporosis or involutional osteoporosis. This can be divided into following types-
Type I (postmenopausal) –This occurs in the age group of 51-70 yrs with a female: male as 5:2
Mainly there is an accelerated bone loss from the trabecular region & vertebrae (crush) & distal radius are the fractured sites are. There is a decrease in calcium absorption , parathyroid function & renal conversion of 25 (OH) D to 1,25 (OH)2D. The main cause of this type of osteoporosis arew the factors related  to menopause.
                                                               Symptoms Of Osteoporosis
Mostly the patients remain asymptomatic until they develop a complicating fracture which can be caused by slightest trauma. Most common sites for fracture are hip, humerus, ribs & wrists.
Symptoms include- PPain in the back , deformity of the spine (Kyphosis) & loss of height, pain usually results from collapse of the vertebral bodies, especially in lower dorsal and upper lumbar region.
                                                                            Diagnosis
In earlier days the diagnosis was made after the manifestation of fracture in old age. But now the diagnosis can be made easily by-
Bone densitometry which includes
. Dual energy X-Ray  absorptiometry
 . Quantitative computed tomography
. Quantitative ultrasound
. Radiographic absorptiometry
.Single energy X-Ray absorptiometry
Interpretation of result is done in terms of T- score or Z-score. T-score represent bone mass of patient compared to mean peak bone mass & Z-sore compares the patient bone mineral density (BMD) with the mean BMD of the person of same age.
According to the WHO osteoporosis is diagnosed using T-score as-
1. BMD within 1.0 SD –Normal
2. BMD between 1.0 SD or more – Osteopaenia
3. BMD below 2.5 SD or more – Osteoporosis
4. BMD beyond 2.5 SD with one or more fragility fracture- severe osteoporosis.
X-RAY is useful when 30-50% bone mass is lost. The radiological changes are more market in bones of the axial skeleton & consist of loss of bone density, decrease in number & size of the trabeculae  and thinning of the cortex.
Risk  factors
1. Age- Mostly found at the age group of 50 yrs or more
2. Sex- Most commonly found in females
3. Race-Mostly found in caucasian or oriental ethnic origin
4. Menopause
 5. Diet-Excess of caffeine, alcohol  and reduced calcium, protein & phosphate can cause osteoporosis.
6. Sedentary life style
7. Multiparity
8. Medications such as – steroids, anti-epileptics, anti-coagulants
9. Cigarette smoking
                                                               PREVENTION
Osteoporosis can be prevented or early treatment can be opted in order to prevent the disease by using following measures-
. Calcium intake 1.0-1.5 g/ day
. Moderate phosphorous intake
. Moderate Vit. D intake
. Appropriate exercise programmed
Avoidance of alcohol & cigarette
.Periodic assessment of skeletal status
                                                OTHER TYPES OF OSTEOPOROSIS
Idiopathic osteoporosis
This is found in children, younger men or premenopausal women. Juvenile osteoporosis, rare condition is found in age group between 8-14 yrs. Onset is usually abrupt with appearance of bone pains and fracture after minimal trauma .Investigation reveal malabsorption of calcium and/or increased urinary calcium loss.
Steroid induced osteoporosis
Sometimes osteoporosis is seen with some other disease such as Cushing’s syndrome etc. Glucocorticoid excess can result in increased rate of bone desorption and decreased rate of bone formation.
                                                                          5. MENOPAUSE
Menopause occurs in both males (Andropause) & females (Menopause)
Andropause
Andropause occurs in males due to decline of androgenic hormone with ageing It is not universal and but is a gradual rocess which is not associated with any other complaint as in females. There is a decrease in testosterone and serum inhibin with an increase in sex hormone binding globulin (SHBG).Some of symptoms which usually seen are fatigue, depression, loss if energy and increased risk of cardiovascular problems and osteoporosis.
Menopause
Menopause is defined as the tie of cassation of ovarian function resulting in permanent amenorrhea. Menopause usually occurs between the age group of 45 and50 yrs.
Menopause after the age of 50 indicates the good health and nutrition of the female but late menopause is also found in females with uterine fibroids and who have a risk of endometrial cancer. If the menopause occurs before the age of 40 then it is known as premature menopause.
Risk factors for menopause
There are certain factors which can become risk factors for menopause related diseases are mentioned below-
. Early menopause
. Surgical menopause or radiation
. Chemotherapy especially alkalytic agents
.Smoking , caffeine , alcohol
.Family history of menopausal diseases
Drugs related like heparin , corticosteroids and clomiphene etc. If given for a prolonged period then can lead to estragon deficiency.
Symptoms of menopause
Menstrual flow can cases in the following three ways-
. Sudden cassation
. Gradual diminution in the amount of blood loss with each regular period until menstruation stops
.Gradual increase in the spacing of the periods until they cease for at least a period of one year.
symptoms relating to the menopause are mentioned below-
. Hot flushes – They are the waves of vasodilatation which effect the face and neck for 2-5 minutes and occur at several times in a day . Hot flushes lead to sweating . These flushes are also preceded by headaches.
. Palpitation
. Mild depression due to disturbed sleep
. Irritability
.Lack of concentration
Various other symptoms include-
. Neurological – Vasomotor symptoms , par aesthesia which causes a sensation of pins and needles in various parts.
. Urinary symptoms – Urethral carbuncle dysuria with or without infection, urge and stress incontinence like symptoms are seen because of the estrogen deficiency.
Various sort of urinary symptoms are clubbed together and are known as urethral syndrome.
. Genital- Atrophic vagina reduces the vaginal secretion which leads to dryness of vagina and cause dyspareunia.
Menopausal women because of the estrogen deficiency can also develop various disease as mentioned below-
.Arthritis, osteoporosis and fracture
. Cardio vascular accidents such as ischemic heart disease, myocardial infarction and atherosclerosis
.Stroke
.Skin changes – There is a decrease in collagen content which leads to wrinkling of the skin
. Alzheimer disease
. Ano- colonic cancer
.Tooth decay
Investigations
Investigations which can be done in order to find out the cause of the symptoms are mentioned as-
.History of various symptoms
.General examination which includes blood ppressure recording, palpation of the breast, weight, hirsuitism.
.Pelvic examination
.Blood sugar , lipid profile
.Mammograhy, pelvic ultrasound
.Bone density study
. Estrogen level , FSH to decide on the need of hormone replacement therapy.



                     HOMEOPATHY  MEDICINES IN CASES OF GERIATRIC DISEASES
                           LIQUID DILUTIONS
                              INDICATIONS
ALTHEAS CYNAPIUM
Sudden redness in the face with a wild look, especially and during menopause.
ALUMINA
Prostatic discharge. Flowing of prostate fluid during difficult stools. There is fullness and enlargement of the prostate gland & various disturbances of the prostate, with sensation of fullness in the perineum.
  • FEMALE GENITALIA/SEX – MENOPAUSE
  • GENERALS- OLD AGE- old people ;in
AMYLENUM NITROSUM
For nervous , sensitive , plethoric women, during or after the menopause.
ANACARDIUM ORIENTALE
Senile dementia. Dementia of old people, with rapid loss of memory & mental vigor; mental fatigue & brain-fag from overexertion; syphilitic mental debility.
  • Sensation of being possessed of two opposing wills; is inclined to laugh when he ought to be serious, & does not incline to laugh when tempted by what is ludicrous; action stupid & childish; rapid loss of self reliance, memory & mental vigor; incipient dementia.
APIS MELLIFICA
Incontinence  of urine, with great irritation of the parts; can scarcely retain the urine a moment, & when passed scalds severely; frequent, painful, scanty, bloody.
ARNICA MONTANA
Retention or incontinence of urine after labor(op.)
ARSENICUM ALBUM
Incontinence of urine , which escapes almost involuntarily, even at night, in bed .

AURUM MURIATICUM
Hemorrhaging at menopause. Female- BLEEDING, uterus, metrorrhagia- menopausal period, during. Diseases- PROSTATE, benign enlargement
BENZOICUM ACIDUM
Enuresis nocturna of delicate children; dribbling urine of old men with enlarged prostate; strong characteristic odor; excesses of uric acid.
  •  Sensibility of bladder with muck- purulent discharge
CALCAREA ARSENICOSA
Complaints of fleshy women when approaching the menopause.
CALCAREA CARBONICA
Curvature of bones, especially spine and long bones; extremities crooked , deformed; bones irregularly developed.
CALCAREA PHOSPHORICA
Spine weak, disposed to curvatures , especially to the left; unable to support body ; neck weak, unable to support head
  •  It is especially indicated in tardy dentition and troubles incident to that period, bone disease non-union of fractured bones, and the anemia’s after acute diseases and chronic wasting diseases.
CIMICIFUGA RACEMOSA
Uneasy, restless feeling in limbs.
  •  Aching in limbs and muscular soreness.
  • Rheumatism affecting the belly of muscles, especially large muscles.
CAPSICUM ANNUUM
Uterine hemorrhage near the menopause, with nausea. PROSTATE GLAND- COMPLAINTS of prostate
CONIUM MACULATUM
Great difficulty in voiding urine; flow intermits, then flow again; prostatic or uterine affections. Discharge of prostatic fluid . It is a well indicated medicine for urinary complaints arising from enlarged prostate and uterine affections.
CROTALUS HORRIDUS
Menopause; intense flushing & drenching perspiration ; faintness & sinking at stomach; prolonged metrorrhagia dark, fluid, offensive; profound anemia.
·         Flushing and sinking of menopause.
DULCAMARA
Urine, difficulty in passing;  incontinence of.
HELONIAS DIOICA
Debility attending the menopause.
HYOSCYAMUS NIGER
Paralysis of bladder: after labor, with retention or incontinence of urine; no desire to urinate in lying- in women (Arn., op.)
KRESOTUM
Incontinence of urine; can only urinate when lying; copious , pale; urging, cannot get out of bed quick enough (Apis, Petros.); during first sleep (sep)
LACHESIS MUTUS
Climacteric ailments: hemorrhoids, hemorrhages; hot flushes and hot perspiration ; burning vertex headache , especially at or after the menopause
LYCOPODIUM

PULSATILLA
Frequently called for in acute symptoms of the bladder and urethra, with enlarged prostate, the faces are flattened. Menopausal and post- natal hormonal changes can also upset pulsatilla’s delicate emotional balance. She is listed in Kent’s repertory under the rubrics ‘Insanity-puerperal’ ,and  ‘Insanity- puerperal’ , but I am sure that emotional liability at these times is far more common than insanity in pulsatilla women . Affections of the bladder and prostate gland
SECALE CORNUTUM
Enuresis: of old people ; urine pale , watery, or bloody; urine suppressed.
SEPIA OFFICINALIS
Hot flashes at menopause with weakness and perspiration.
SILICA TERRA
Sciatica , pains through hips , legs and feet.
  • Cramp in calves and soles.
  • Loss of Power in legs.
  • Tremulous hands when using them.
  • Paralytic weakness of forearm
  • Pain in bones, especially shin bones; not worse by pressure.
  • Pain in shoulder and arm at night, relived by warm wrappings.
  • Limbs and feet very tired and as if paralysed.


                                                                                                                      
                                                                                                           



                                                                    Bibliography
1. API Textbook of medicine , 9th edition, Yash Pal Munjal.
2. A Concise textbook of surgery, S. Das
3. Davidson’s, principles- practice of medicine, 21st edition, Nicki Ra .Colladge, Brian R Walker, Stuart H. Ralston.
4. Shaw’s textbook of Gynecology
                                                                                                  Compiled by:
                                                                                                                   Dr. Nidhi Navin Sharma for Homeobuzz

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