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Spasms or muscle cramps

If you've ever had muscle spasms or muscle cramps, you know they can be extremely painful. In some cases, a muscle may spasm so forcefully that it results in a bruise on the skin. Most muscle spasms and cramps are involuntary contractions of a muscle. A serious muscle spasm doesn't release on its own and requires manual stretching to help relax and lengthen the shortened muscle. Spasms and cramps can be mild or extremely painful. While they can happen to any skeletal muscle, they are most common in the legs and feet and muscles that cross two joints (the calf muscle, for example). Cramps can involve part of a muscle or all the muscles in a group. The most commonly affected muscle groups are:

   Back of lower leg / calf (gastrocnemius).

   Back of thigh (hamstrings).

   Front of thigh (quadriceps).

   Feet, hands, arms, abdomen

Muscle cramps range in intensity from a slight twitch or tic to severe pain. A cramped muscle can feel rock-hard and last a few seconds to several minutes or longer. It is not uncommon for cramps to ease up and then return several times before they go away entirely.

What Causes Muscle Cramps

The exact cause of muscle cramps is still unknown, but the theories most commonly cited include:

   Altered neuromuscular control

   Dehydration

   Electrolyte depletion

   Poor conditioning

   Muscle fatigue

   Doing a new activity

Other factors that have been associated with muscle cramps include exercising in extreme heat. The belief is that muscle cramps are more common during exercise in the heat because sweat contains fluids as well as electrolyte (salt, potassium, magnesium and calcium). When these nutrients fall to certain levels, the incidence of muscle spasms increases. Because athletes are more likely to get cramps in the preseason, near the end of (or the night after) intense or prolonged exercise, some feel that a lack of conditioning results in cramps

Treating Muscle Cramps

Cramps usually go away on their own without treatment, but these tips appears to help speed the healing process:

   Stop the activity that caused the cramp.

   Gently stretch and massage the cramping muscle.

   Hold the joint in a stretched position until the cramp stops.

Preventing Muscle Cramps

Until we learn the exact cause of muscle cramps, it will be difficult to say with any confidence how to prevent them. However, these tips are most recommended by experts and athletes alike:

   Improve fitness and avoid muscle fatigue

   Stretch regularly after exercise

   Warm up before exercise

Stretch the calf muscle: In a standing lunge with both feet pointed forward, straighten the rear leg.

Stretch the hamstring muscle: Sit with one leg folded in and the other straight out, foot upright and toes and ankle relaxed. Lean forward slightly, touch foot of straightened leg. (Repeat with opposite leg.)

Stretch the quadriceps muscle: While standing, hold top of foot with opposite hand and gently pull heel toward buttocks. (Repeat with opposite leg.)

Most muscle cramps are not serious. If your muscle cramps are severe, frequent, constant or of concern, see your doctor.

Heart Diseases

Artherosclerosis

Hardening of arteries

   Tunica intima thickens with deposits of Cholesterol, Fibrous (scar) tissue, Dead muscle cells, Blood platelets        

      Arteries become less elastic and partially narrowed

        ↑BP which in turn accelerates atherosclerosis

         Leads to endothelium damage and weak walls

Mechanism

   Excess cholesterol leaks from lipoproteins (LDLs)

   Deposited on arterial walls

   Macrophages (white blood cells) are trapped within cholesterol

   Release free radicals which damage the arterial wall

   Activates blood platelets which stick to damaged areas releasing clotting factors (thromboxanes)

   Forms a plaque which may rupture to produce a thrombus

   Circulating thrombus is called an embolus

   Embolus may lodge elsewhere in the circulation (brain, heart arteries)

   NB: healthy arteries produce anti-clotting factors (prostaglandins) → don't form clots

Factors that aggravate atheroma formation / atherosclerosis:

   Hypertension (↑BP)

   Smoking (release of free radicals)

   High LDL and low HDL

   NB: they all cause endothelial damage

Aneurysm

   Weak arterial walls may burst leading to severe loss of blood (haemorrhaging)

   Brain aneurysm is called a stroke

Deep Vein Thrombosis

   Clots are formed by

   Endothelial damage (see atherosclerosis)

   Altered blood components (dehydration, too many platelets)

   Altered blood flow (stasis of veins) → this is what causes DVT

      Prolonged immobility

      Such as paralysis, long-distance flights, lying down for weeks after surgery

   Thrombus often originates in calf veins

   Inflammation of vein walls → destroys vein valves

   Causes leg pain, swelling, and redness

   Elastic support stockings required for life

   Prevented by taking aspirin or warfarin which inhibit blood clotting

Coronary Heart Disease

   Atherosclerosis causes arteries to become narrowed

      More force required to move blood through narrowed vessels

      Blood pressure increases

   Stable angina

      ↑exercise leads to ↑oxygen requirements by heart

      Narrowed arteries prevent more blood to pass through

      Shortage of blood to heart muscle causes chest pain

      Cells do not die as some blood can still pass through

      Pain only occurs during activity but not at rest

Myocardial infarction (MI)

   Coronary artery is totally blocked by a thrombus/embolus

   No blood supply to heart muscle and cells die

   Irreversible if not treated within 90min

Heart failure

   Prolonged blockage of artery causes damage to heart muscle

   ↓contractions / ↓cardiac output / ↓pressure generated / less blood leaves heart

   More blood is stored:

       on the right side of the heart → enlarged heart

       in veins → swollen legs and enlarged liver

Lifestyle

Cholesterol

  Needed for

     Vitamin D production in skin

     Sex hormone production in gonads and adrenal glands

     Making cell membranes

     Produce bile acid (salts)

  Has properties similar to fats → soft, waxy, and insoluble (difficult to remove if deposits form)

  Transported in blood from liver to tissues

  Safe transport is needed due to its insolubility

  Achieved by lipoproteins, which are soluble fatty proteins

  These are wrapped around cholesterol

  Normally, only small amounts of free cholesterol escape

LDL

   Low density lipoproteins

  Carries cholesterol from liver to tissues

  Normally, some cholesterol 'leaks' from the lipoprotein and is absorbed to build cell membranes

   Excess LDL/cholesterol → too much cholesterol leaks out and causes atherosclerosis

HDL

   High density lipoprotein

   Picks up cholesterol from arterial walls and carries it away from tissues

   Travels to liver where cholesterol is removed with bile

Smoking

↓antitoxidants (vitamins), more damage due to release of free radicals by phagocytes

Nicotine constricts arteries causing platelets to stick together → vasoconstriction → heart must work harder to force blood through → increases BP

↑BP causes damage to blood vessel lining / endothelium / collagen

Leads to rise on blood platelets and makes them more sticky / form a plug / adhere to collagen fibres

Release of thromboplastin/thrombokinase

Fibrinogen converted to insoluble fibrin

Platelet plug trapped by fibrin mesh

Raises conc. of fibrinogen (in blood) → increased risk of clotting

↑LDL causes more cholesterol to leak out in blood

Carbon monoxide reduces the efficiency of the blood in terms of carrying oxygen

Haemoglobin combines with CO more readily than with oxygen → forms carboxyheamoglobin

Associated with plaque formation

Principle CHD = heart muscle receives inadequate amount of blood or oxygen/(coronary) blood supply reduced

Treatment

Medication

Beta blockers reduce heart rate and reduce oxygen required by heart

Aspirin prevents blood clotting and thrombosis formation

ACE inhibitors stabilize plaques → prevent thrombus to break off

Statins reduce LDL and increase HDL

Angioplasty

Deflated balloon-like device is passed up to the heart via the aorta

Guided into damaged coronary artery and inflated to stretch the artery

Heart by-pass graft

Leg veins and arteries from chest are used to by-pass the blocked region of the coronary artery

Involves open heart surgery

Reperfusion therapy after a myocardial infarction

Angioplasty done within 90 minutes of onset of chest pain

May prevent irreversible damage to the heart muscle

Prevention 

1. Screen population for

   High BP

   High cholesterol

   Uncontrolled diabetes

   Smoking? Unhealthy diet? No exercises?

   Men over 55 and women over 65 are at highest risk

2. Monitor the behaviour of the heart during exercise

   Difficult but encouraging the population to adopt a more healthy lifestyle from an early age is important

   Often leads to changes in diet and weight management

3. Giving up smoking and reducing alcohol intake

    Reduces blood pressure

    Coronary heart disease is a long-term degenerative disease, starts at birth

Jaundice

Jaundice refers to the yellow colour of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells.

Normally, bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body. Reasons for this include:

  Newborns make more bilirubin than adults do since they have more turnover of red blood cells.

  A newborn baby's still-developing liver may not yet be able to remove adequate bilirubin from the blood.

  Too large an amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool.

High levels of bilirubin — usually above 25 mg — can cause deafness, cerebral palsy, or other forms of brain damage in some babies. In less common cases, jaundice may indicate the presence of another condition, such as an infection or a thyroid problem. The American Academy of Pediatrics (AAP) recommends that all infants should be examined for jaundice within a few days of birth.

Types of Jaundice

The most common types of jaundice are:

Physiological (normal) jaundice: occurring in most newborns, this mild jaundice is due to the immaturity of the baby's liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age.

Jaundice of prematurity: occurs frequently in premature babies since they are even less ready to excrete bilirubin effectively. Jaundice in premature babies needs to be treated at a lower bilirubin level than in full term babies in order to avoid complications.

Breastfeeding jaundice: jaundice can occur when a breastfeeding baby is not getting enough breast milk because of difficulty with breastfeeding or because the mother's milk isn’t in yet. This is not caused by a problem with the breast milk itself, but by the baby not getting enough to drink.

Breast milk jaundice: in 1% to 2% of breastfed babies, jaundice may be caused by substances produced in their mother's breast milk that can cause the bilirubin level to rise. These can prevent the excretion of bilirubin through the intestines. It starts after the first 3 to 5 days and slowly improves over 3 to 12 weeks.

Treatments

In mild or moderate levels of jaundice, by 1 to 2 weeks of age the baby will take care of the excess bilirubin on its own. For high levels of jaundice, phototherapy — treatment with a special light that helps rid the body of the bilirubin by altering it or making it easier for your baby's liver to get rid of it — may be used.

More frequent feedings of breast milk or supplementing with formula to help infants pass the bilirubin in their stools may also be recommended. In rare cases, a blood exchange may be required to give a baby fresh blood and remove the bilirubin.

If your baby develops jaundice that seems to be from breast milk, your doctor may ask you to temporarily stop breastfeeding. During this time, you can pump your breasts so you can keep producing breast milk and you can start nursing again once the condition has cleared.

If the amount of bilirubin is high, your baby may be readmitted to the hospital for treatment. Once the bilirubin level drops and the treatment is stopped, it is unlikely that treatment for jaundice will need to be restarted.

Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood. Incompatibility jaundice can begin as early as the first day of life. Rh problems once caused the most severe form of jaundice, but now can be prevented with an injection of Rh immune globulin to the mother within 72 hours after delivery, which prevents her from forming antibodies that might endanger any subsequent babies.

Symptoms and Diagnosis

Jaundice usually appears around the second or third day of life. It begins at the head and progresses downward. A jaundiced baby's skin will usually appear yellow first on the face, followed by the chest and stomach, and finally, the legs. It can also cause the whites of an infant's eyes to appear yellow.

Since many babies are now released from the hospital at 1 or 2 days of life, it is best for the baby to be seen by a doctor within 1 to 2 days of leaving the hospital to check for jaundice. Parents should also keep an eye on their infants to detect jaundice.

If you notice your baby’s skin or eyes looking yellow you should contact your child's doctor to see if significant jaundice is present.

At the doctor's office, a small sample of your infant's blood can be tested to measure the bilirubin level. Some offices use a light meter to get an approximate measurement, and then if it is high, check a blood sample. The seriousness of the jaundice will vary based on how many hours old your child is and the presence of other medical conditions.