Medical | GOQii

June 17, 2018 By Vaishali Khanna 1 Comment

Sleep Apnea, its symptoms and how you can prevent it?

Has anyone ever told you that you have a tendency to snore? Or maybe you don’t…but you have a partner or family member who does? Do you find that you tend to wake up throughout the night? Or maybe you think you get good sleep, but you consistently find yourself with a dry mouth in the morning?

These are all signs that could suggest that you (or…your beloved snoring family member) may have something called “Sleep Apnea.” Well, there are people who cannot sleep without a machine and that is because they suffer from a medical condition called ‘Sleep Apnea’.

Let’s actually break this down. What is Sleep Apnea?

The most common type of Sleep Apnea is ‘Obstructive Sleep Apnea’ (OSA). OSA is a potentially life-altering and life-threatening breathing disorder that occurs during sleep.

The upper airway repeatedly collapses, causing cessation of breathing (apnea) or inadequate breathing (hypopnea) and sleep fragmentation. The breathing stops during sleep for 10seconds to a minute or longer. Oxygen levels in the blood decrease.

One challenge with something like this is that you may not necessarily wake up entirely. So it’s not always easy to self-diagnose. BUT – Sleep fragmentation results in chronic daytime sleepiness (which you would expect if you’re constantly getting interrupted throughout the night).This disrupts healthy sleep and causes a number of short-term and long-lasting effects that threaten the health and well-being of those who suffer from the condition.

How many people have OSA? The prevalence of OSA in the general population is still unclear. Several epidemiological studies have attempted to examine this issue. Epidemiological data from Young, Palta, Dempsey, et. Al (1993) in a study paper titled:- Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options, estimated that in a group of 602 middle-aged individuals 2% of women and 4% of men meet the minimal diagnostic criteria for sleep apnea with excessive daytime sleepiness.

People most likely to have or develop OSA may have any of the following: Obesity, especially in the upper body

Small upper airway due to excess throat tissue or abdominal jaw structure

Nasal Obstruction

High Blood Pressure

Family History of OSA

Overweight Obese individuals

Obesity, particularly abdominal and upper body obesity is the most significant risk factor for obstructive sleep apnea. Excess body fat on the neck and chest constricts the air passageways and sometimes the lungs – thus setting the stage for interrupted breathing during the night. And according to the research…The more obese a person, the greater the risk of apnea.

The good news is that there are some general things that can make a big difference.

This includes:

Losing some weight, if you are overweight or obese (even as little as 5% of your body weight can make a change)

Avoid alcohol, sedatives, and hypnotics (as they can sedate the very muscles we need to breathe)

Sleeping on your side or in a semi propped position

If you have sleep apnea, do not take sleep medicines or sedatives. These chemicals will increase the relaxation in the tissues of the upper airway and make the obstruction worse. The specific treatment for obstructive sleep apnea is usually a mask worn at night to keep the airway open or using a sleep machine that can help you breathe and sleep properly.

If OSA is left untreated, it can increase the risk of developing:

Hypertension

Cardiac arrhythmias

Myocardial ischemia

Stroke Pre-diabetes

Decreased quality of life (because who wants to feel sleep deprived?)

Weight loss is frequently recommended to improve OSA among obese patients. Not only does sustained weight loss improve OSA,it also improves many other independently linked co- morbidities such as hypertension, high cholesterol, and diabetes. The greater the change in body weight or waist circumference, the greater is the improvement in OSA

June 7, 2018 By Luke Coutinho 1 Comment

Power Of Immunity – Part 2

In my last newsletter, I spoke about the importance of the lymphatic system and how a poorly operating system can cause major diseases like cancer.

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A poor lymphatic system can also be the reason one struggles to lose weight.

Allergies, sinus, and other immune related diseases, usually get treated with conventional medicine, I am not against this, if it works, use it. But, first make sure your lymphatic system is working well, as it’s this system which boosts immunity and prevents or heals the above related conditions.

In cases of cancer, if doctors suggest the removal of lymph nodes, I strongly suggest second and third opinions. Removing lymph nodes if not necessary, can cause more serious problems in the future. Sometimes cancer cells may have already passed through those nodes to other parts of the body, so removal may not be necessary.

Our body has different parts that contain lymph nodes responsible for removing and cleansing deadly toxins.

It’s a common practice to have one’s tonsils removed during a severe bout of flu and cold. Try never to do that if it can be avoided. Your tonsils have an extremely important role to play in your lymphatic system, so goes the same for an enlarged spleen. Many say these parts of the body don’t have roles to play, but they do.

The lymphatic system, a system of lymph fluid and lymph nodes, is vital for

Elimination of toxins. The lymphatic system can be aptly described as the garbage disposal of the body and is responsible for filtering and eliminating toxins.
The immune system. The lymph nodes house a high concentration of white blood cells that increase when the body is fighting off illness or infection.
Weight loss and weight management. Toxicity is a huge part of the weight loss puzzle. If you don’t support your lymph system, you will have even more trouble losing weight and gaining muscle tone.

The most important thing to remember about the lymphatic system is that it relies on our movement. Unlike the cardiovascular system with the heart automatically pumping fluid, the lymph system relies on our body movements as a pump.

This means that exercise, even a simple walk, can stimulate your system to work well and drain toxins out from the body.

The older we get, or even if we are sick or bed ridden, we must make attempts to walk or move so we can help the lymphatic system work.

While all movement engages the lymphatic system, walking is an accessible exercise that everyone can fit into their daily routine. If you don’t have the opportunity to walk around outside, take occasional breaks to simply walk in place.

Deep breathing

You know how I emphasize on ‘ Vitamin O ‘ being the most important vitamin we need. Well the lymphatic system needs it too. The more you breath, the deeper you breathe, try breathing from your diaphragm, all this helps you stimulate this amazing system.

Yoga

In the deeply restorative practice of Yin Yoga, poses are held for at least 3 minutes, and up to 10 minutes. The pressure of your own body in these prolonged holds can help release areas of lymphatic congestion. Additionally, many of the poses reverse the flow of gravity and twist the body, aiding in lymphatic flow. You can also focus on poses that stretch the hips, since the groin area contains a concentration of lymph nodes.

Legs Up Against The Wall

In this pretty self-explanatory yoga pose, lymphatic circulation in the lower body is maximized. By reversing the flow of gravity in your legs, you circulate the lymphatic fluid and encourage the elimination of toxins.

Dry Brushing

the lymphatic system is pretty close to the surface of the skin. It doesn’t’t take deep pressure to help release lymphatic congestion, which is why dry brushing your skin is so helpful. This process requires just a few minutes before your shower and stimulates lymphatic flow. You simply brush your body with a stiff, dry brush and this activates the lymphatic system.

Sitting

Have you heard of the modern epidemic called “Sitting Disease?” Studies show that prolonged periods of sitting correlate to an increase in degenerative disease. Research shows that exercise doesn’t reduce the risk of sitting… the only way to reduce the risk is to not sit as much.

Perhaps one factor influencing the correlation between sitting and disease is lymphatic function. Movement engages lymphatic flow, but sitting creates stagnation of lymphatic fluid. Remember, the lymphatic system doesn’t’t have a pump so you have to be the pump!

Hot And Cold Showers

Alternating between hot and cold showers stimulate the system to work better.

Lymphatic massage

These are professional massages that are done to help cleanse the system.

Important: Major lymph nodes are situated under the arms, where the breast connects to the armpits and the inner groin areas along the thighs. We need to keep these nodes open for breathing and release of toxins through sweat.

Don’t use anti perspirants, that block these nodes to prevent one from sweating.

Avoid wearing under wire bras for a long time as these block the nodes.

Avoid tight underwear for long periods of time.

Select apparel like cotton that allows the skin to breathe and the body to naturally let go of toxins through sweat.

Do all of this to improve your own immunity without the dependency on heavy medication and drugs. Your body is designed to heal itself, it has the powerful inbuilt mechanism to do so. Start your own healing, and the sicker you may be, the more requirement for helping your lymphatic system and immunity.

From a nutritional aspect, waking up to a glass of warm water with freshly squeezed lemon does wonders for your lymphati

June 6, 2018 By Luke Coutinho Leave a Comment

Power of Your Immunity-Part 1

Over the years my work has led me to believe that we need a fundamentally different way of looking at health care. We need a system that works beyond simply just looking at the symptoms that brings people into the clinics and instead is actually able to look and improve health where it begins. Health does not begin in the 4 walls of a doctors’ office or a hospital, but where we live, we work, we eat, sleep, learn and play.

Are you struggling with disease, pain, taking more medicines and spending more time with the doctors? Are you still sick?

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Are you scared of the onset of disease, of flu’s, of cancers ?

We may be living in a polluted world, with pesticide laden foods, water that we think is clean and pure, but may not be, breathing in oxygen that consists or several deadly carcinogens, using cosmetics and hair colours laden with chemicals, microwaves, eating toxic junk food… the list goes on..

And we keep running around, like headless chickens, searching for the next best healthiest option, getting sucked into fads, diet programs, dangerous exercise programs, believing in the media, in what our social circles say, in what Bollywood and Hollywood blinds us with..

Eminent Doctors/Nutritionists across the U.S have T.V. shows that inspire the masses with their latest take on weight loss pills that work… first there was green bean coffee extract, then there was raspberry ketones, then Garcinai Cambogia. If these worked, there would be no one struggling with weight issues…

Stop all of this, step back and really slow down.

Yes it’s a crazy world, and people are going to get sicker by the day, and there are going to be more antibiotics, cancer, diabetes, thyroid drugs that pharmas will continue to flood our communities with. But, guess what, it’s all of this that is not allowing us to get healthier.

Your body is designed to heal itself, if you give it a chance. I’m not saying stop medication. If it works, do it. But, aim to understand what got you on that medication, what’s the trigger and then sort that out so you don’t have to stay on medicines. Don’t get reliant on the medication and continue to live without making changes in your lifestyle.

The answer to disease prevention and cure is ‘IMMUNITY. It is your body’s first and last line of defense against all diseases .

We all know that Nutrition, Exercise, Stress and Sleep are the aspects that work together to contribute towards a strong immunity….

Over and above this my first recommendation would be for everyone to understand their ‘lymphatic system, and how it works in each of our body’s.

Having a lymphatic system that works well, is the first step towards a super strong immune system.

The lymphatic system is closely related to the cardiovascular system and is sometimes referred to as the body’s secondary circulatory system. Its major function is that of a defense mechanism and it is a key to the body’s immune defenses. The lymphatic system includes the lymph vessels (four times more than blood vessels), lymph nodes, tonsils, spleen and thymus gland. Lymph is the colorless fluid containing white blood cells that bathes the tissues and drains through the lymphatic system.

The lymphatic system:

– Distributes fluid and nutrients throughout the body,

– Assists in draining off excess fluids and protein left behind by capillary circulation activity, preventing tissues from swelling,

– Removes toxins,

Furthermore, when toxins are produced within the body faster than the body can process and release them, the body suspends those toxins in fat and interstitial spaces in an attempt to protect the organs. This toxic buildup results in soft and connective tissue inflammation and excessive buildup of lymph fluid which contributes to fibromyalgia, chronic fatigue, cancer and a multitude of immune system disorders.

To be continued …………

May 9, 2018 By Disti Shah Leave a Comment

Regular exercise can control Diabetes

The facts and myths about diabetes are plenty especially on the kind of foods one should have or not have, whether one should exercise to control diabetes etc etc. But, it’s when I saw my dad exercising one day and a thought struck me is it not important to test a diabetic before exercise? Is diet all that one needs to focus on?

What if he exercises vigorously and his sugar levels drop down, at what sugar levels should we allow or not allow a person to exercise? What should be the intensity and frequency of exercise? What type of exercise should a Diabetic do?

These questions obviously led me to explore and research more about diabetes and exercise. I would like to share some information about what Diabetes is, what are its types and how regular exercise can control your Diabetes.

What is Diabetes?

Diabetes is a chronic disease wherein there exist high levels of sugar in the blood either due to less of insulin sensitivity or because of low insulin secretion or no insulin levels in the body.

There are three major types of diabetes. The causes and risk factors are different for each type:

Type 1 diabetes -can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown.
Type 2 diabetes makes up for most of the diabetes cases. It most often occurs in adulthood, but teens and young adults are now being diagnosed because of high obesity rates. In such cases either the body becomes less sensitive to insulin or insulin secretion decreases.
Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes. And disappears once the pregnancy is over.

Diagnosis

Blood tests:

Fasting blood glucose level – 70-100mg/dl
Post Prandial – Less than 140mg/dl
Haemoglobin A1c test -Normal: Less than 6%

After understanding the different types of diabetes and ways to diagnose them let’s get to the core area of exercise.

We all know that exercise has multiple benefits for a healthy human being but, did we know the benefits of exercise on a diabetic? So let’s understand the benefits of exercise for a diabetic in brief first.

How does Exercise Help in Diabetes?

Lowers blood sugar levels.
Helps you feel better.
Help maintain proper body weight.
Help keep the heart rate and blood pressure lower.
Help keep blood fats levels normal.
Improves insulin sensitivity.
Help maintain normal blood circulation in the feet.

Now that we know seven of the many reasons why exercise is important for a person with diabetes, let’s know which exercise benefit diabetics.

Which kinds of Exercise are Best?

Expert agree you need either

30 minutes of “moderate intensity” aerobic activity – 5 days a week.
“Vigorous intense” aerobic activity 20 minutes or more a day – 3-5 days a week.

In addition, you should add flexibility and strength training to your routine.

Flexibility activities 5-7 days a week.
Strength training 8-10 exercise, 10-15 repetitions of each exercise, 2-3 days a week.

Calories Per hour and the types of moderate and vigorous exercises

Moderate physical activity for one hour	Calorie burnt per hour
Hiking	370
Light gardening / Yard work	330
Dancing	330
Golf(walking and carrying clubs)	330
Bicycling (<10mph)	290
Walking (3.5mph)	280
Weight lifting (light workout)	220
Stretching	180

Vigorous physical activity for one hour
Running / Jogging (5mph)	590
Bicycling (>10mph)	590
Swimming (Slow freestyle laps)	510
Aerobics	480
Walking (4-5 mph)	460
Heavy Yard work (chopping wood)	440
Weight lifting (vigorous effort)	440
Basket ball (vigorous)	440

Source – Dietary Guidelines for Americans – 2005 *(These values are not specifically for Indians as they are taken from American journals)

When should we Exercise?

The best time to exercise will vary with our schedule. Preferably we should pick up the same time for exercise each day so that if on insulin the adjustment of insulin dosage is manageable.

Morning exercise may cause your blood glucose to drop less than if you exercised later.
If you are on insulin or taking pills that work by making more insulin, evening exercise may result in low blood glucose while you sleep.

Remember -Your Diabetes Management can be adjusted to suit your lifestyle. Your lifestyle does not have to be adjusted to fit your diabetes.

After knowing what kind of exercise and at what time we should do them, let’s see what precautions should be taken while doing them.

Safety Tips for Active Diabetics

Get your doctor’s okay before you start exercising.

This is especially important if you are older than age 35, have had diabetes for more than 10 years, have any complications of diabetes, have not exercised in a long time, or have heart disease.

Exercise has the same effect on blood glucose as insulin. It lowers blood glucose, making you more sensitive to insulin. This is a benefit of exercise that can also pose a problem if it lowers your blood glucose too much.

Avoid low blood sugars

Low blood sugars are when the glucose levels dip below <70mg/dl.

Common symptoms include shakiness, weakness, abnormal sweating, and anxiety, tingling of mouth and hunger, headache, visual disturbance, confusion, seizures, coma. Blood glucose monitoring before and following exercise, especially when beginning or modifying the exercise program is prudent.

Always keep a 15g of fast-acting carbohydrate (powdered sugar / Glucose tablets 3-4) with you to treat Hypoglycemia.

Check your blood glucose levels pre and post workout

If you blood glucose is below 70 –

Take 5g of carbohydrate right away
Wait for 15 minutes
Check again – if still below 70 have another 15grams.

It should work now.

If the blood glucose is high – Fasting is>250 and ketosis is present.

Or >300 with or without ketosis.

Avoid exercise with such high blood sugar levels.

Eat before heavy exercise

If you’re going to exercise around mealtime you should eat the meal first. When possible, allow half an hour for digestion. Solid foods, such as whole grains vegetables etc are digested slowly then liquids and provide protection for at least 2-3 hours.

When it is possible to choose the exercise time, try to begin the exercise 30-60 minutes after a meal or snack.

Remember – Nothing works better than experience and frequent blood glucose testing.

Diabetic complications

Retinopathy – Patients with retinopathy are at risk for retinal detachment and vitreous haemorrhage associated with vigorous-intensity exercise.

Thus for those with retinopathy, vigorous aerobic and resistance, weight-bearing exercises should be avoided.

Nephropathy: Should not indulge in vigorous-intensity exercise as protein excretion increases post-exercise.
Peripheral Neuropathy – Should take proper care of feet to prevent foot ulcers.

Feet should be kept dry.

Avoid the wrong type of socks and shoes. Avoid tight elastic bands and ill-fitted shoes (they reduce circulation). Should not wear thick or bulky socks (they can fit poorly and irritate the skin). Rather wear light coloured cotton socks that dissipate heat faster.

Moisturize your feet – but not between your toes- that could encourage a fungal infection.

Use a moisturizer daily to keep dry skin from itching or cracking.

Consider non-weight bearing activities as they may be better tolerated and aid healing.

Stay hydrated

Proper hydration is essential during exercise. Exercising during hot weather requires special attention. Drinking extra fluids should begin an hour or two before starting to exercise. A general rule is to drink 8ounces of fluid for every 30 minutes of vigorous activity.

Check your pulse rate

It’s important to check the pulse periodically to see if you are exercising within your target zone. Right after you exercises take your pulse – count your pulse for 10 secs and multiply the no by 6.

Compare the numbers on the right grouping in the table below.

Age	Target Heart range zone
20 years	100-150 beats/min
25 years	98-146 beats/min
30 years	95-142 beats / min
35 years	93-138 beats/ min
40 years	90-135 beats/min
45 years	88-131 beats/min
50 years	85-127 beats/ min
55 years	83-123 beats/min
60 years	80-120 beats/min
65 years	78-116 beats/ min
70 years	75-113 beats / min

Source: Exercise and Your Heart, NationalHeart, Lung, and Blood Institute/American Heart Association, NIH Publication No. 93-1677.

Therefore the good news is that if someone regularly exercises these benefits can be permanent, and for someone with diabetes it can mean reducing medication. If younger members of families with a predisposition to diabetes exercise regularly they could avoid diabetes altogether.

A single bout of exercise can benefit the body’s sensitivity to insulin for 16-18 hours and therefore have effects on blood glucose control (glucose absorption) for 24-48hours.

But these effects wear off by 60-72 hours. Therefore keeping active most of the time is the best.

I just want to convey that Diabetes cannot take your hope, faith, attitude, courage, happiness, and happy life away from you. We are author of our own health and disease. Let’s overcome it, no matter what type or what level of disease it is. Let’s help others and ourselves to be active most of the time. Exercise can permanently remove or reduce medication.