RA With Titre Test

Misarticulation - 
Different speech sounds are acquired at different stages of a child's speech development. Sounds such as /pa/, /tha/ are acquired earlier and sounds such as /sa/, /ra/ and /sk/ (as in school), /tr/ (as in tree) are acquired later. In some children only one or two sounds may be mispronounced whereas in others so many sounds may be mispronounced that the child's speech may be unintelligible. Even at 4 years of age if your child's speech is not easily understood by a stranger then it is best to get professional help. See faq for more information on misarticulation. 

Developmental dyspraxia- 

• These children have difficulty producing speech on command (i. E, requiring conscious effort), and find it easier to produce frequently used utterances (i. E, “hi”, “hello”, “bye”). Excessive effort is used to produce the simplest of sounds.
• Speech problems of children with repaired cleft lip and palate:
• These children have nasal voice and misarticulation of speech sounds. Early intervention will help improve the quality of their speech.

Rheumatoid arthritis is an autoimmune disorder in which the body recognizes the body's own system as foreign and produces an inflammatory reaction.  The synovium which is the space between the bones and the joints and contains a lubricating fluid which allows easy movement of the joints.

Inflammation of this space leads to painful, swollen joints that can also turn red and become stiff over a period of time.  The joint surfaces can gradually progresses to produce deformities (the swan-neck deformity of the hand for instance) and disability.

Because it is an autoimmune disorder, the exact etiology is not known but lifestyle, stress, cold weather are supposedly predisposing factors. That being the case, it is not surprising that Ayurveda has a variety of options, both in terms of do's and don't's to manage rheumatoid arthritis - both the severity of symptoms and further progression of the disease.

Do's:  A well-planned diet will help by supporting optimal functioning of the immune system and nourish the affected joints. 

1. People diagnosed with RA should follow a diet that is rich in fruits and vegetables.  Drumsticks, bitter gourd, carrot, papaya, green leafy vegetables, cabbage, etc., reduce inflammation and hyperactivity of the immune system.  The antioxidant properties in these neutralize the free radicals circulating in the body (responsible for increasing inflammation).  This helps control the longstanding inflammation of the joints
2. It is also advisable to eat them as whole fruits and not as juices.  The fiber in the whole fruits helps digestion
3. Sprinkle pepper powder over cooling food items like cucumber and radish
4. Include garlic which is an excellent remedy for RA,  can be mixed with buttermilk
5. Whole grains such as wheat, brown rice, millet, barley are beneficial for RA, their high fiber content helps in proper digestion and promotes regular bowel movements
6. Honey mixed with water
7. Drink boiled milk to which dry ginger powder is added; this can replace tea and coffee
8. Milk mixed with turmeric powder is also helpful in controlling inflammation
9. Work at reducing weight

Don'ts: In addition to adding the above to your diet, there are some things to avoid, which can worsen symptoms of inflammation. 

1. Avoid overall unhealthy and irregular diet habits which affects the immune system and aggravates symptoms
2. Avoid sleeping during daytime and staying awake at nights 
3. Avoid deep fried foods and fermented food items 
4. Given its autoimmune nature, it is better to avoid regular allergy-inducing foods like dairy products, soy, peanuts, processed foods, artificial additives, etc.  These could trigger an enhanced allergic reaction.
5. Avoid alcohol, tobacco 
6. Avoid tea and coffee and other caffeinated drinks 

With simple daily food habit and lifestyle changes, the severity of RA can be managed effectively. If you wish to discuss about any specific problem, you can consult an Ayurveda.

You may have reached a ripe age with all the worldly knowledge at your disposal to share with the world. You may have reached a stage where you no longer feel like a learner in important areas of life and could easily be someone who has the experiences and the expertise to help people out in times of their trouble.

However, you may also be at a juncture where your knees in particular may not be your best friends anymore. You may be facing a lot of joint issues and the knees may be a pair of joints that give you immense pain and discomfort when you climb stairs, walk some distance or even just stand or sit. It is very likely that you may be suffering from rheumatoid arthritis and may experience unbearable pain in a lot of joints of the body.

Though when you are afflicted with rheumatoid arthritis, you feel pain in more than one joints, but the knees are the worst affected areas in most cases and a lot of patients are advised to undergo a knee replacement surgery to be able to control the pain. There may be a lot of debates and doubts about whether a person suffering from RA should go under the knife to experience a new life after the surgery.

Some may not agree:
Just as all things have two sides to them, there are those who may be in favour of a knee replacement surgery and those who may not suggest taking the surgery. The reasons why a lot of experts may not favour the surgery include reasons such as the recovery period may take too long, though the surgery may be carried out for the knee joints, it may not be able to help in bringing down the pain in the other joints and arguments such as the replacement surgery may not be absolutely successful all the time.

Here is why you should get it:
Though the patients may have to go through pain in getting a set of new knee joints, there are a lot of reasons that help the patients in taking up the resolve to get the surgery done. Here are a few reasons why it may be the thing to do:

1. The surgery help you get back in time when you were able to lead a life free of pain in the knees. While the other joints may experience pain when you suffer from RA, the pain in the knees comes across as the most painful and when that is tackled, more than half the battle is won.
2. While it may be easy to tackle the pain in the other joints through simple physio exercises, it is difficult to manage the knee joint pain and a surgery may be the ultimate relief for the problem.
3. When a major pain region such as the knee is tackled, it becomes simpler to handle the other joints and the problem of RA may be resolved entirely.

With such advantages from the surgery, it may make sense to a lot of people to get over with the procedure and experience a better quality of life.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Researchers believe that not much can be done for providing you relief to a great extent, in case you are suffering from rheumatoid arthritis. But, they also say that a lot can be controlled by changing your diet. There are certain foods, which are known to add on to the problem of arthritis. These foods increase the pain of arthritis. However, there are also certain foods, which are known to cause relief to the patients by reducing the pain and getting rid of the factors causing it.

It has been a common practice that people suffering from rheumatoid arthritis (RA) are constantly trying to ease its symptoms with food and by taking dietary supplements. There are several studies that indicate a connection between certain types of foods and the inflammation. This inflammation characterises the autoimmune condition. But, it is always advisable that you must consult your doctor before embarking on a new diet chart or taking supplements. Therefore, the best approach towards curing this disease with the help of foods is to take a well-balanced diet.

Foods that can help fight Rheumatoid Arthritis

1. Omega-3 fatty acids: It is important that your diet includes cold-water fish as herring, mackerel, trout, salmon and tuna. These fish have omega-3 fatty acids. This is known to have anti-inflammatory effect on the patient. Fish oil can provide relief in joint pain and help in easing morning stiffness. You may also consult your doctor to know whether you can or should take fish oil supplements. The doctor will prescribe you the dosages, depending upon your joint pain. But you should also remember, higher doses of the supplements can have negative effect. They tend to react with other drugs and increase blood pressure.
2. Fibres, Whole grain: You must increase the amount of fibre in your diet. So, don’t forget to eat a lot of fresh fruits and vegetables and whole grains. This will help in reducing the inflammation. Fibre is known to lower the levels of C-reactive protein in the patient’s blood stream. It is an indicator for inflammation in the body.
3. Extra virgin olive oil: This will reduce inflammation. It works in the similar fashion as non steroidal anti-inflammatory drugs such as ibuprofen works. Researchers believe that virgin olive oil contains a compound called oleocanthal. This compound blocks the enzymes that is known to cause inflammation.
4. Vitamin D: You must have foods rich in vitamin D that is usually linked to calcium and provides protection against osteoporosis. Talk to your doctor, if you are needed to have vitamin D supplements.

Foods That Can Cause Inflammation
There are certain foods that can increase the inflammation and the pain. The inflammation is increased by meats, protein-rich foods, like pulses, etc. Also, omega-6 fatty acids containing foods such s corn, soyabean, etc. can make things worse.

Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.

What causes cirrhosis?

1. Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
2. Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
3. Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
4. Drugs causing liver injury.
5. Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.

What are the symptoms of cirrhosis?

1. Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
2. Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.

What are the complication of cirrhosis?

Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

1. Increase risk of infection because of immune system dysfunction.
2. Development of liver cancer (Hepatocellular carcinoma)
3. Easy brusibility or bleeding following light trauma.
4. Gall bladder stone formation
5. Metabolic bone disease

What are the stages of cirrhosis?

1. Compensated cirrhosis: Liver damage is damaged but no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
2. Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

How cirrhosis is diagnosed?

1. Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.

2. Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).

How to prevent cirrhosis?

Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:

1. Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
2. Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
3. Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
   1. Practice safe protected sex
   2. Alcohol
4. Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
5. Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
6. Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titre. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).

Prevent others from getting infected from you if you harbor virus causing liver damage.

How to treat cirrhosis?

Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development

1. Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson's disease, etc.
2. Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
3. Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
4. Low salt high protein diet
5. Stop alcohol intake even if you have other cause of cirrhosis.
6. Stop smoking
7. Avoid over the counter drugs (especially pain killers)
8. Vaccinate if not done already or infected

   If you wish to discuss about any specific problem, you can consult a gastroenterologist.