Diabetes Denial
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This document discusses the challenges of managing chronic diseases like diabetes and outlines different types of patient segments based on their attitudes and approaches to treatment. It identifies those who are knowledgeable and disciplined in managing their condition positively, as well as those who are scared, have negative attitudes, low awareness, a short-sighted approach, or overconfidence in their knowledge. Managing chronic illnesses requires patients to balance treatment with daily life while preventing problems through ongoing vigilance and self-management.
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This document discusses various medical conditions that can cause changes in pigmentation and other physical features. Excess pigmentation may be caused by Cushing syndrome due to high steroid levels or an overactive thyroid. Other conditions mentioned include vitiligo, thyroid eye disease, a pituitary tumor, low testosterone in men causing small testes, breast enlargement in boys, excess facial hair in girls often due to polycystic ovarian disease, and symptoms of polycystic ovarian disease like irregular periods, excess hair growth, and obesity.
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This document discusses attention deficit hyperactivity disorder (ADHD), including its definition, diagnostic criteria, treatment options, cultural perceptions, and abuse of ADHD medications. It notes that ADHD is a neuropsychiatric disorder affecting cognitive, academic, behavioral and other functions. Stimulant medications are the first-line treatment but also discusses non-stimulant options and monitoring medication side effects. The document also addresses myths about ADHD and risks of co-occurring substance use disorders.
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The document discusses Justine's personal experience with bulimia and how it affected her life and career. It provides information about eating disorders, including definitions and statistics. It offers suggestions for how companies can help employees who may be struggling with an eating disorder, such as addressing performance issues confidentially with HR, providing information on treatment resources and medical leave policies, and ensuring a supportive work environment that prioritizes mental health.
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This document discusses depression, including its symptoms, criteria for diagnosis, prevalence, and treatment approaches. Depression exists on a continuum from normal mood fluctuations to more severe abnormal mood lowering with functional impairment. It is a persistent and pervasive condition with a wide range of psychological and physical symptoms. Treatment involves both antidepressant medication and talking therapies, with the goals of explaining depression, setting a treatment plan and review schedule, and preventing future episodes.
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The document discusses maintaining good health and longevity. It states that with the right lifestyle choices, people can live up to 120 years without disease or sickness. However, most people on average only live 65-70 years due to actions like poor diet, lack of exercise, smoking, etc. that inadvertently cause health issues before their full lifespan. It emphasizes that health is largely in one's own hands, and with eating nutritious foods, maintaining a healthy weight, getting regular physical activity, limiting screen time, and not smoking, one can prevent diseases like diabetes, high blood pressure, and cancer to live a long and joyful life past 100 years.
Depression in Primary Care
This document provides guidance on assessing and managing depression in primary care. It outlines how to screen for depression using the Whooley questions, assess severity using tools like the PHQ-9, and conduct a biopsychosocial evaluation. A stepwise treatment approach is recommended starting with active monitoring or low-intensity therapies for mild cases, and introducing antidepressants and high-intensity therapies for more severe or treatment-resistant depression. Guidance is given on choosing, starting, monitoring, and stopping antidepressants safely. Local support services and resources are also reviewed.
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The document discusses coping strategies for illness. It notes that when faced with illness, individuals will develop coping strategies to try to return to a state of healthy normality. Some key coping strategies mentioned include accepting the reality of the illness, focusing on strengths rather than limitations, exercising appropriately, eating a balanced diet, reducing stress, praying or worshipping, and surrounding oneself with supportive people. The document emphasizes coping with illness in a positive way rather than feeling sorry for oneself.
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Somatic symptom disorder, previously known as hypochondriasis, is characterized by at least six months of preoccupation with fears of having a serious illness based on misinterpreted bodily symptoms. This preoccupation causes significant distress and impairment. While prevalence is 4-6% in medical clinics and up to 15%, diagnosis is more common in blacks than whites and transient in medical students. Etiology may involve focusing on and misinterpreting bodily sensations due to faulty cognitive schemas or using illness as an "escape" from problems. Treatment involves psychotherapy and reassurance through medical exams, while avoiding unnecessary tests or treatments. Prognosis is better with social support, treatment of related disorders, and absence of personality disorders.
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This document discusses mental health and illness. It defines mental health and lists some of its effects. Mental illness is caused by abnormal brain functioning and can cause thinking, emotional, and sleep problems. Common mental disorders mentioned include depression, schizophrenia, bipolar disorder, and anxiety disorders. The document also summarizes a study conducted on mental health status of university students in India which found high rates of mood changes, anger, and substance abuse among hostel residents. It concludes by emphasizing that those with mental illness should have their rights and contributions to society respected.
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The document discusses health and wellness from multiple dimensions. It defines health as a state of physical, mental, and spiritual well-being that is influenced by one's community and environment. Five dimensions of health are identified: physical, social, spiritual, intellectual, and emotional. A wellness line is presented showing levels of health from death to optimal wellness. Characteristics of physically, socially, and emotionally well people are provided. The impact of choices on wellness and life expectancy is discussed. Tips for making positive behavior changes include considering the value, timing, costs, and probability of rewards versus consequences. Motivation and commitment to change are also addressed.
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I chose my …… as my subject. She is a 68-year-old woman, who is still working full-time as the Vice President of a bank in the small community that she lives in. She is still married to my Dad, with whom she just celebrated her 47th wedding anniversary and, in my opinion, is quite healthy. She has a solid group of friends that regularly eat lunch together as well as take trips together a couple of times a year. She does not take any medications, nor has been diagnosed with any chronic health issues. Although, exercise has never been something she has indulged in, she is still leisurely active around the house and likes to take walks with her dog. Mom loves wine, but has never smoked cigarettes. She agreed to be the subject of my gerontological assessment. Since my subject is not frail but rather very robust for her age, I focused my assessments by using tools that were meant to help gain a better understanding of my subject’s health status and where improvements can be made for optimal health management and disease prevention. In combination with a comprehensive questionnaire, I utilized the Tinetti Balance Assessment Tool to assess gait, and the Katz Index to assess how well subject does with ADLs.
Subject questionnaire
It seems that my subject is very healthy in contrast to other people her age. She feels strong mentally and physically, and has a great attitude towards the way one should live life. She should concentrate on weight management, exercising more regularly, and preventing osteoporosis by including enough calcium in her diet. She should also be sure to have regular, annual checkups such as vision and hearing checks, in addition to her normal blood work.
Subject is not happy with the way she thinks the older generation is treated by younger people or doctors even.
It would seem that the subject’s family has been predisposed to living longer lives, with the exception of her father, who was a heavy, lifelong smoker that died of cancer. So far, subject’s genetics are working in her favor. See Appendix A.
Tinetti Balance Assessment Tool
The Tinetti Gait and Balance Instrument is designed to determine an elders risk for falls within the next year. The higher the score, the better the performance. In performing the balance and gait assessment for my subject, it was found that subject scored as high in points as possible and therefore, has no issues with either balance or gait and is a low risk for falls.
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The document outlines the diagnostic criteria for diabetes mellitus, including symptoms of excess urination and thirst plus random venous plasma glucose over 200 mg/dl or fasting venous plasma glucose over 126 mg/dl. It also describes a glucose tolerance test procedure involving a fasting blood sample, drinking 75g of glucose, and a 2-hour post-drink blood sample to diagnose diabetes if over 200 mg/dl. Reasons for delayed diabetes diagnosis include lack of awareness, negligence, economic factors, and access to medical services.
Diabetes And Eye
Diabetes can cause several eye problems by damaging the retina such as diabetic retinopathy and diabetic macular edema. Around 25% of diabetics have some form of diabetic retinopathy, which increases to 60% for those with type 2 diabetes after 20 years, so annual eye exams are important for early detection and treatment. Laser treatment can be used to treat more severe cases of retinopathy and prevent vision loss, but screening and management of blood sugar levels are crucial to reduce the risk of eye damage from diabetes.
Diabetes And Heart
Diabetes increases the risk of atherosclerosis and heart disease through metabolic abnormalities like high blood sugar and insulin resistance. These alterations affect the function of endothelial cells, platelets, and smooth muscle cells in the arteries, leading to atherosclerosis and destruction of the arteries. A typical type 2 diabetic patient has equal risk of future heart attack as a past heart attack survivor without any other heart problems. Over 75% of people with diabetes die from coronary atherosclerosis and managing diabetes involves following a healthy diet, regular exercise, medication adherence, and regular blood glucose testing.
Osteoporosis
Osteoporosis is a major health problem in India, affecting over 43 million women. Some key facts are that over 61 million Indians have osteoporosis, with 80% being women. Indians also have the highest rates of osteopenia globally. Osteoporotic fractures occur earlier in Indians compared to other populations and are more common in Indian men. Poor calcium intake, lack of exercise, vitamin D deficiency, and low bone mineral density contribute to higher osteoporosis rates in India. Osteoporosis poses a serious burden through increased fracture risk and reduced quality of life.
Diabetes And Kidney
This document discusses diabetic kidney disease and nephropathy. Diabetic nephropathy is the leading cause of renal failure, with 50% of dialysis patients having diabetes. Risk factors include poor blood glucose control, long diabetes duration, hypertension, and family history. Symptoms include protein in urine, high blood pressure, and declining renal function. Screening for microalbuminuria is important. Strict glycemic control and keeping blood pressure below 130/80 can prevent or slow progression. Treatment involves diet, medication, fluid management, and potentially renal replacement therapies like hemodialysis if kidney function declines severely.
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Diabetes Denial
- 10. Patient segments Positive attitude to treatment Scared Negative attitude to treatment Knowledgeable Low levels of awareness Myopic I Know it all Casual High levels of awareness