Soltalk December 2019 | Page 42

HealthTalk
Doctor’s notes
Dr Rik Heymans is a general practitioner in Nerja and writes
on developments in the world of medicine
Constipation
bowel obstruction and, in extreme cases, colonic perforation.
These complications contribute to patient pain, morbidity, and
mortality, and can lengthen hospital stays and would increase
healthcare costs.
Constipation due to the use of Opioid derivatives (used for
pain management) is an increasing problem due to the
common use of opioids for pain worldwide. Inadequate
treatment of this is a barrier to the management of chronic
pain and leads to a poorer quality of life. It is the most
common and persistent side effect experienced by patients
with chronic moderate to severe pain; although estimates of its
prevalence vary, rates as high as 81% have been reported.
Variance in prevalence rates is due in part to differences in
patient self-report of symptoms and physician perception - in
one study of 520 patients receiving long-term opioid analgesia,
the prevalence was 67% by patient self-report and 86%
according to clinician opinion. Unlike most opioid side effects,
OIC does not diminish over time, and so it remains a chronic
problem for most patients who develop it.
It is however very important that other causes of constipation
(eg, inactivity, metabolic derangements, and medications that
can cause constipation as well) should be considered.
Lean muscle mass
Higher levels of lean muscle mass in middle age may be linked
to lower 10-year cardiovascular disease (CVD) risk, regardless
of traditional risk factors such as diet, income, smoking,
obesity, diabetes, high blood pressure, and abnormal
cholesterol levels, a study found. The present study reports an
inverse association between skeletal muscle mass [SMM] and
the ten year CVD incidence in a large sample of CVD-free
adults 45+ years old. Lean muscle mass accounts for
approximately half of body mass and plays an important role
in metabolism and control of blood sugar levels. Starting at
around age 30 years, lean muscle mass starts to decrease, and
this decline may continue at a rate of approximately 3% per
decade. Decreased lean muscle mass has been linked to a
number of health problems, including disability, poor mental
health, diabetes, CVD, and premature death; therefore,
interventions that target the decline in lean muscle mass may
have further reaching implications for cardiovascular and
overall health. The authors suggest that health campaigns
aimed at improving nutrition and protein intake, as well as
exercise with resistance training, may prevent age-related
deterioration in muscle mass., and thus reduce the other risk
factors for illnesses.
Aspects of this constipation include pain, bloating, and other
symptoms that can significantly reduce patient quality of life,
disturb daily activities, and compromise work productivity.
Some patients consequently reduce or omit opioid doses to
reduce constipation, compromising their pain relief. This can,
in addition, reduce absorption of oral drugs and may lead to
Pollution effects
Airborne chemical contamination is a major environmental
risk factor worldwide and contributes significantly to many
diseases, even neurologic diseases. Environmental pollution is
considered the third greatest contributor to “disability-adjusted
life years “(DALYs), mainly due to stroke, as supported by
observations of seasonal, diurnal, and geographic variations in
stroke incidence. Strokes relate very closely with increases in
levels of carbon monoxide, sulphur dioxide, nitrogen dioxide,
and fine particulate matter.
The World Health Organization (WHO) has estimated that 90%
(!) of the world’s population breathes air that exceeds WHO
contamination limits. The Global Burden of Diseases study
2015 estimated that 898,100 cerebrovascular disease deaths and
19.2 million DALYs were attributable to ambient air pollution.
Air pollution accounts for nearly 30% of global stroke burden,
with the greatest effects in low- and middle-income countries.
In these countries, much of the pollution is within households
as a result of combustion of fuels for cooking and heating, with
improper ventilation and/or extraction mechanisms. So,
perhaps the, mainly Asian, travellers one sees with a face mask
are not wrong at all…
© Dr RIK HEYMANS
c/ Angustias 24, Nerja
Tel: [phone]
40