Archive for April, 2014

Vitamin D and its Deficiency

Posted on: April 30th, 2014 by admin No Comments


What is Vitamin D?

Vitamin D is a vitamin important for good overall health and strong & healthy bones. Vitamin D is also known as Sunshine Vitamin. It is produced by our body in response to sunlight.

Why is Vitamin D so Important?

Vitamin D is essential for strong bones because it helps body use calcium from the diet. Vitamin D is effective for preventing & treating many conditions like

• Osteomalacia

• Low levels of Phosphate in blood

• Psoriasis

• Low blood calcium levels

• Helping prevent low calcium & bone loss

• Rickets

• Vitamin D deficiency

Sources of Vitamin D:

The main source of Vitamin D is Sunlight. Other sources include

1) Oily Fish ( Herring, trout, tuna, salmon)

2) Fortified foods (Margarine, some Cereals)

3) Cod liver oil

4) Egg yolk, Liver & wild mushrooms

Causes of Vitamin D Deficiency:

a) Inadequate exposure to sunlight

b) Vitamin D Malabsorption syndrome

c) Inadequate consumption of recommended levels of vitamin

d) Dark skin

e) Obesity

f) Kidneys not converting Vitamin D to its active form

Symptoms of Vitamin D deficiency:

• Fatigue

• General muscle pain & weakness

• Muscle cramps

• Joint pain

• Chronic pain

• Weight gain

• High BP

• Restless sleep

• Poor concentration

• Headaches

• Bladder problems

• Constipation/Diarrhea

How do we Diagnose Vitamin D deficiency?

– Initial diagnosis is from medical history, symptoms or life style

– Simple blood test for Vitamin D level

– Blood test for calcium & phosphate levels & liver function


– Sun Exposure- Sensible sun exposure for 10-15 minutes between 10AM and 3.00PM produce Vitamin D in skin that may last twice as long in the blood

– Diet- Consume foods rich in Vitamin D

– Vitamin D supplements

Vitamin D deficiency is a part of General Orthopedics which should not be ignored.


Posted on: April 30th, 2014 by admin No Comments

Gout is a type of arthritis in which crystal of sodium urate produced by the body can form inside the joint. Sometimes referred to as “DISEASE OF KINGS”. Gout causes attacks of painful inflammation in one or more joints, common being “the base of big toe”. Nowadays the presentation is quite uncommon. It being presented in “Heel, Knees, Wrist & Fingers”. We can define Gout as follows: “A disorder resulting from Tissue Deposition of Monosodium Urate Crystals in Joints, Bursae, bone & certain other soft tissues such as Ligaments, Tendons & occasionally Skin”


Gout occurs when excess uric acid builds up in the blood & needle like urate crystals deposit in joints. Uric acid is a waste product made in body everyday & excreted mainly via Kidneys. Gout may happen because either Uric acid production increases or more often, the kidneys cannot remove uric acid from the body well enough.

Risk Factors:

• Shell Fish & red meat

• Alcohol in excess

• Sugary drinks & food rich in fructose

• Vitamin C deficiency

• Some medications

• Low dose Aspirin

• Certain Diuretics

• Immunosuppressant

• Male gender

• Obesity

• High BP

• Kidney damage

• Diabetes mellitus

• Lipid Disorders

• Vascular disease

• Enzyme defects such as Hypoxanthine guanine Phosphoribosyltranferase (HGPRT) deficiency & G-6PD deficiency


The natural course of classic gout passes 3 stages:

a) Asymptomatic Hyperuricemia:

– Serum Urate concentration is above the solubility level, but no symptoms or signs of Gout or Kidney stones occurs.

b) Acute / Intermittent Gout:

– Abrupt onset of severe joint inflammation (warmth, swelling, erythema & pain) often at night. Pain increases over 8-12 hours period

– Lower extremity joints affected first

– Low grade fever, chills, and malaise may occur

– Leukocytosis & elevation of ESR may occur

– Usually monoarticular involvement

– Early morning attacks of acute pain over joints

c) Advanced Gout:

– Joints persistently uncomfortable, stiff, swollen

– intensity of pain less than acute Gout

– Polyarticular involvement may develop

– Upper extremities may involve

– Palpable & visual nodules over areas of pressure/trauma


– Typical Gout symptoms

– Raised blood level of uric acid

– Fluid aspiration from affected joint & microscopic examination for urate crystals

– X-ray may show joint damage in Gout of long duration

– Ultrasound &Dual energy CT


Treatment focuses on relieving pain during acute attacks, preventing future Gout attacks & reducing risk of developing Tophi & permanent joint damage.

a) General Measures:

– Ice the affected area to reduce swelling

– Elevate the affected area above level of heart

– Rest the affected area

b) Acute attack of pain management:

– Non- Steroidal Anti-inflammatory Drugs

Each & every patient is different & unique. So patient requires complete evaluation before prescription of medicines.


7 lifestyle suggestions to prevent Gout attacks:

1) Try to lose some Weight

2) Avoid foods rich in Purines. Eg. Foods rich in proteins, red meat etc

3) Reduce amount of alcohol you are drinking

4) Avoid certain medicines which may cause Gout

5) Have your BP checked atleast once a year

6) Avoid lack of fluid in the body (Dehydration)

7) Reduce or cut the amount of sugar sweetened soft drinks.