Humza Khizer

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Glaucoma FAQs

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Saad Ullah Siddiqui

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Nuclear Stress Test FAQs

Introduction

With terms like &ldquo;nuclear&rdquo; + &ldquo;stress&rdquo;, the name itself may sound intimidating for a lot of you. However, it&rsquo;s just a common test that could help you determine whether every time you heave a bag upstairs is normal or a symptom of restricted blood flow and poor heart health<a href="#accordion">[3]</a>. 
&nbsp;

A nuclear stress test is an innovative diagnostic technique for heart problems. It may be necessary to:

<ul>
	<li>Identify heart diseases, such as<a href="https://merisehat.pk/disease/coronary-artery-disease"> coronary artery disease</a> and irregular heartbeat</li>
	<li>Verify the effectiveness of the treatment for specific heart issues</li>
	<li>Ensure the heart is capable of withstanding anesthesia before surgery&nbsp;</li>
	<li>Ensure that the fitness regimen your doctor recommends for you is safe 
	&nbsp;</li>
</ul>

Your doctor will observe how well your cardiovascular system works when you&rsquo;re at rest as well as when you&rsquo;re exercising. You will be given an IV infusion of a radioactive tracer before the procedure begins. The tracer will enable the nuclear camera to capture images of the heart muscle&#39;s blood flow during the entire process.&nbsp;

&nbsp;

Along with these pictures, the protocol entails that your heart&rsquo;s activity is also monitored through ECG and blood pressure. 
&nbsp;

Understanding FAQs About a Nuclear Stress Test

It may be conducted at a hospital or an outpatient clinic, i.e., under supervision of a technologist, nurse, and/or doctor.&nbsp;

&nbsp;

You&rsquo;ll be instructed to arrive for the test wearing comfortable shoes and clothes and to avoid applying any cream or oil to your skin on that day. As a precaution, the doctor may also have advised you to avoid some or all of your medications a few days before the test if they&rsquo;re likely to interfere with the test. And, likewise, they may ask you to not smoke, drink, and even fast for a couple of hours prior to the test.

&nbsp;

You may be allowed an inhaler if you&rsquo;re asthmatic&nbsp;as long as you&rsquo;ve informed the doctor and the medical team beforehand<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

During the procedure, your body will then be wired to an ECG machine, a blood-pressure cuff will be wrapped around your arm, and you may be asked to breathe through a tube.

&nbsp;

The test usually takes 2-4 hours, but some people are required to take the test over 2 days so you may want to confirm it with your doctor and plan accordingly. 
&nbsp;

If you do not exercise regularly, your doctor may opt for pharmacologic stress testing instead of the treadmilm<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

Again, there&rsquo;s no need to worry. It&rsquo;s a chemical stress procedure that mimics exercise by boosting blood flow to your heart. If your test result reveals that your heart is healthy at rest, but experiences a shortage of blood flow during stress (exertion), it means that the artery transporting oxygenated blood from the heart to the rest of your body is constricted. 
&nbsp;

Is There any Side Effect of Nuclear Stress Tests?

The radioactive tracer has no negative side effects. It has no effect on your kidneys since it doesn&#39;t include iodine<a href="#accordion">[4]</a>. 
&nbsp;

While it&rsquo;s a generally safe testing, you may experience the following complications<a href="#accordion">[2]</a>:

<ul>
	<li>Irregular cardiac rhythms, chest pain, and heart attacks affect 1 in 10,000 people&nbsp;</li>
	<li>IV insertion and the radioactive tracer injection may cause some discomfort&nbsp;</li>
	<li>An allergic response can triggered by the tracer or radioactive dye&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety</a>, trembling, nausea, dizziness, and chest discomfort are possible due to medications used in the test 
	&nbsp;</li>
</ul>

Depending on your particular medical condition and even your sex and age, there may be other risk factors involved, too. Make sure to inform your doctor of all your medical conditions so they can decide the level of radiation you&rsquo;ll be exposed to during the test. 
&nbsp;

The radioactive liquid will remain in your body for 24-36 hours after the examination<a href="#accordion">[5]</a>. Here&rsquo;s how you can take care of yourself and your loved ones: 
&nbsp;

<ul>
	<li>Drink plenty of liquids: This is to help you flush the radioactive fluids out of the body. Ask your doctor which fluids are best for you and how much you need to consume daily.</li>
	<li>Wash your hands with soap and water: Your body releases the radioactive liquid throughout your stool and urine movements. Make sure you wash your hands after you have a bowel movement or you urinate. Anybody who comes in contact with your feces or pee should wash their hands as well.</li>
	<li>Breastfeed as directed: Ideally, though, you should avoid it for a day at least after your test.</li>
	<li>Restrict cuddling: This is especially true if there are children under<a href="#accordion">[3]</a>. Hug them briefly or wait for at least 18 hours after the test to hold them close. 
	&nbsp;</li>
</ul>

If your test results are abnormal, you might require cardiac catheterization or further testing. The medical terminology in a stress test result can be perplexing, therefore, it's crucial to schedule a consultation with your doctor to understand the results of your stress test.&nbsp;

Conclusion

A heart stress test is a very safe way to measure how your heart responds to an increased workload. It can diagnose many heart problems, including heart artery blockages and arrhythmias. It can also show if your heart is strong enough to handle anesthesia for surgery or to start a new exercise program. If your stress test is abnormal, it could mean that you need more testing on your heart. <o:p></o:p>

[1] Iskandrian AS, Verani MS, Heo J. Pharmacologic stress testing: mechanism of action, hemodynamic responses, and results in detection of coronary artery disease. J Nucl Cardiol. 1994;1(1):94–111.

[2] Vilcant V, Zeltser R. Treadmill stress testing. In: StatPearls [Internet]. StatPearls Publishing; 2022.

[3] Nuclear stress test: Benefits and side effects. Medical News Today..

[4] What to expect: Nuclear stress testing. Heart House.

[5] Nuclear stress test (discharge care). Drugs.com.

[6] Nuclear stress test. Mayo Clinic.

Neelam Asad

Iqra Mazhar

Edema FAQs

<a href="https://merisehat.pk/disease/edema">Edema</a> is a palpable swelling produced by an accumulation of fluid in the intercellular tissue resulting from an abnormal expansion in interstitial fluid volume. 
&nbsp;

Understanding Frequently Asked Questions about Edema

While swelling can occur in any part of the body, it is most common in the feet, ankles, and legs. 
&nbsp;

Other symptoms of edema include:

<ul>
	<li>Warmth, discoloration, and changes in the texture of the affected area</li>
	<li>Pain and tenderness in the affected area</li>
	<li>The affected area appears bigger than it was a day ago</li>
	<li>The skin covering the swollen area appears to be taut and smooth</li>
	<li>Difficulty walking if the swelling is in the legs, ankles, or feet</li>
	<li>Coughing or having trouble breathing</li>
	<li>A sensation of fullness or tightness in the affected area of the body 
	&nbsp;</li>
</ul>

Edema can occur in various parts of the body. Based on the location and causes, it can be classified into the following types. 
&nbsp;

<ul>
	<li>Peripheral Edema - Generally, the legs, feet, and ankles are affected. However, it can also occur in the arms. This indicates issues with the circulatory system, lymph nodes, or kidneys. 
	&nbsp;</li>
</ul>

<ul>
	<li>Pedal Edema - It affects the feet and lower legs. It&rsquo;s more common in older or pregnant individuals. 
	&nbsp;</li>
	<li>Lymphedema - Swelling in the arms and legs occurs when the lymph nodes are damaged, usually due to cancer treatments. Cancer itself also blocks lymph nodes, resulting in a build-up of fluid. 
	&nbsp;</li>
	<li>Pulmonary Edema - Fluid accumulation in the air sacs in the lungs makes it hard for the individual to breathe. The condition worsens when the person is lying down. They may have a fast heartbeat, feel suffocated, and cough up a foamy spittle, sometimes with blood. Pulmonary edema is a life-threatening condition that requires immediate treatment. 
	&nbsp;</li>
	<li>Cerebral Edema - Hydrocephalus is a serious medical condition caused by an excessive accumulation of fluid in the brain. A head injury, blockage or rupture of blood vessels, tumors, or allergic reactions can all cause cerebral edema. 
	&nbsp;</li>
	<li>Macular Edema - Macular edema occurs when fluid accumulates in the macula, a crucial part of the retina located in the center of the eye, due to fluid leakage from impaired blood vessels in the retina. 
	&nbsp;</li>
</ul>

Edema usually occurs in the skin, particularly in the arms, hands, legs, ankles, and feet. However, it can also affect the muscles, lungs, bowel, eyes, and brain. 
&nbsp;

Edema develops in two steps:

<ol>
	<li>The capillary hydrostatic pressure gradient and the oncotic pressure gradient across the capillary regulate the fluid between the interstitial and intravascular space. When local or systemic conditions change this equilibrium, it leads to greater plasma volume, capillary hydrostatic pressure, and capillary permeability while reducing plasma oncotic pressure.</li>
	<li>The kidneys respond to these changes by retaining sodium and water. 
	&nbsp;</li>
</ol>

The following are the causes of edema:&nbsp;

<ul>
	<li>Low Albumin: Also known as hypoalbuminemia, the lack of albumin (a type of protein in the blood) can lead to edema. This is because albumin acts like sponges to retain the fluid in the blood vessels. 
	&nbsp;</li>
	<li>Allergic Reactions: Allergic reactions also cause edema. Blood vessels release fluid into the affected region when the skin is exposed to an allergen. This results in swelling. 
	&nbsp;</li>
	<li>Obstruction Of Flow: Fluid can accumulate if fluid drainage from any body part is obstructed. Blood clots or tumors obstruct the normal flow of blood or lymph and cause edema in the affected area. 
	&nbsp;</li>
	<li>Critical Illness: A condition, like severe burns or severe infection, can result in fluid leakage into tissues throughout the body, leading to generalized edema. 
	&nbsp;</li>
	<li>Congestive Heart Failure: When the heart weakens and pumps blood less effectively, it causes fluid to build up slowly in the legs. If the buildup is rapid, fluid can accumulate in the lungs. In the case of right-sided heart failure, it can cause fluid buildup in the abdomen. 
	&nbsp;</li>
	<li>Liver Disease: Severe liver disease, such as cirrhosis, causes fluid retention. It also decreases the albumin level and other proteins in the blood. The accumulation of fluid in the abdomen leads to edema in the legs. 
	&nbsp;</li>
	<li>Kidney Disease: Nephrotic syndrome, a medical condition affecting the kidneys, can cause pronounced edema in the legs and, in severe cases, generalized edema throughout the body. 
	&nbsp;</li>
	<li>Pregnancy: Mild leg edema is common during pregnancy. Severe conditions like deep vein thrombosis and preeclampsia during pregnancy can also cause edema. 
	&nbsp;</li>
	<li>Head Trauma: Cerebral edema can be caused by several factors, such as low blood sodium levels (hyponatremia), exposure to high altitudes, the presence of brain tumors, and obstruction in the drainage of fluid from the brain (hydrocephalus). It can lead to headaches, confusion, unconsciousness, and coma. 
	&nbsp;</li>
</ul>

Medications, Including:

<ul>
	<li>High blood pressure medications such as calcium channel blockers</li>
	<li>Pain drugs such as NSAIDs, pregabalin, and gabapentin</li>
	<li>Diabetes medications such as pioglitazone</li>
	<li>Inflammation medications such as steroids 
	&nbsp;</li>
</ul>

Twisted ankles, a bee sting, or a skin infection can also cause edema. In some cases, like an infection, edema can be helpful because it increases the number of white blood cells in the affected area that fight off infections<a href="#accordion">[4]</a>. 
&nbsp;

Edema can showcase in multiple forms, including unilateral (one-sided), bilateral (both sides of the body), localized (specific region of the body), or generalized (throughout the body) edema.

The doctor will begin by taking note of the patient&#39;s history, including the timing of the edema, changes of edema with position, and medication usage.

They may perform a physical exam to diagnose edema. They will examine the affected areas for swelling, especially where the skin looks shiny or stretched, employing volume measurements (with a water volumeter), girth measurements (with a tape measure, including the circumferential method and the figure-of-eight method), and pitting edema assessment (based on the depth and duration of the indentation).

This is followed by further diagnostic tests aimed at determining the root cause. This includes liver tests, complete blood count, blood urea nitrogen, serum electrolytes, serum protein, creatinine, and urinalysis.

The doctor may also order a chest X-ray, EKG, D-dimer (for suspected pulmonary embolism), and brain natriuretic peptide (for suspected heart failure). 
&nbsp;

A medical professional will perform a pitting test to check for edema. They apply gentle pressure with their finger to the swollen part for 5-15 seconds. After the pressure is released, a dimple or pit will form in the skin if there is fluid buildup in the tissues.

<ul>
	<li>Grade 0: No clinical edema</li>
	<li>Grade 1: 2 mm pit that rebounds immediately</li>
	<li>Grade 2: 4 mm pit with no readily detectable distortion that rebounds in fewer than 15 seconds</li>
	<li>Grade 3: 6 mm pit that rebounds in less than 30 seconds</li>
	<li>Grade 4: 8 mm pit that takes more than 30 seconds to rebound 
	&nbsp;</li>
</ul>

Mild edema usually goes away naturally with some lifestyle modifications. In case of more severe edema, the doctor may prescribe medications, such as diuretics. Diuretics or water pills help increase urine formation to excrete surplus fluid. However, diuretics may not be effective when edema arises due to medication. 
&nbsp;

Several self-care techniques can help reduce the risk of edema or provide relief from its symptoms<a href="#accordion">[3][7]</a>: 
&nbsp;

<ul>
	<li>Avoid tobacco and alcohol.</li>
	<li>Wear compression (support) stockings, sleeves, or gloves, usually after the swelling has gone down, to prevent the recurrence of the condition. These garments keep pressure on the limbs to prevent fluid from building up. For pregnant women, support stockings worn during air travel can be beneficial.</li>
	<li>Avoid packaged and processed foods with a high salt content. Salt can increase fluid buildup and worsen edema.</li>
	<li>Elevate the affected body part above the heart level, especially while lying, as it helps improve circulation.</li>
	<li>Maintain a healthy weight.</li>
	<li>Engage in physical activity and move the muscles of the affected area, particularly the legs. It is imperative to avoid remaining in a static position for long periods and instead take breaks to move around. Even while traveling, it&#39;s recommended to stand up and walk periodically.</li>
	<li>Massage the affected area using firm, non-painful pressure in a direction toward the heart. This technique can facilitate the movement of fluid out of the region.</li>
	<li>Always wear socks or shoes on the feet if that&#39;s where the swelling usually is. Protect the swollen region from harm by ensuring it is clean and injury-free. Applying lotion or cream can help avoid dry and cracked skin, which otherwise increases the risk of cuts, scrapes, and infections. 
	&nbsp;</li>
</ul>

Diuretics are frequently used to treat edema. They help remove excess fluid by increasing urine production. Furosemide (Lasix) is the most commonly used diuretic.

Note: Medications should only be used as per the doctor&rsquo;s instructions. Do not adjust the dosage or abruptly stop any medication without the doctor&rsquo;s advice. 
&nbsp;

If not treated completely, edema may cause several complications, including:

<ul>
	<li>Increased swelling</li>
	<li>Decreased mobility</li>
	<li>Overly-stretched, itchy skin</li>
	<li>Decreased blood circulation to the area 
	&nbsp;</li>
</ul>

If you develop any of the following signs and symptoms, contact a healthcare professional immediately:

<ul>
	<li>Shortness of breath, especially when lying down.</li>
	<li>Chest pain.</li>
	<li>Fast or irregular heart rate.</li>
	<li>Coughing up pink, foamy sputum. 
	&nbsp;</li>
</ul>

The following factors can increase the risk of edema:

<ul>
	<li>A poor diet, especially a diet that contains too much salt, can cause mild edema. A poor diet combined with other conditions can also make edema worse.</li>
	<li>Malnutrition with a low-protein intake can also lead to hypoalbuminemia, which in turn can lead to edema.</li>
	<li>Prolonged sitting and standing can also cause edema, especially in hot weather and long-duration travel.</li>
	<li>Obesity</li>
	<li>Pregnancy 
	&nbsp;</li>
</ul>

The healthcare provider may suggest regular physical activity and minimizing sodium intake to prevent edema.

If edema is due to underlying health conditions, like congestive heart failure, liver disease, or kidney disease, the swelling can only be controlled and managed rather than completely cured. Treating any underlying disease or condition helps prevent it from worsening. 
&nbsp;

Key Takeaways

<ul>
	<li>Edema is swelling caused by too much fluid trapped in the tissues.</li>
	<li>Edema can be due to an underlying disease, certain medicines, or pregnancy.</li>
	<li>Lifestyle changes, such as reducing salt intake and wearing compression garments, can help relieve edema. However, any underlying disease needs to be treated as well.</li>
</ul>

[1] Lent-Schochet D, Jialal I. Physiology, Edema. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

[2] Edema: Types, causes, symptoms, and treatment. WebMD.

[3] Causes, symptoms, treatments, and prevention of edema (swelling). Novus Spine & Pain Center.

[4] Heitz D. What you should know about edema. Healthline.

[5] Besharat, S., Grol-Prokopczyk, H., Gao, S., Feng, C., Akwaa, F., & Gewandter, J. S. (2021). Peripheral edema: A common and persistent health problem for older Americans. PloS one, 16(12), e0260742.

[6] Edema: Causes, symptoms & treatment. Cleveland Clinic.

[7] Edema. Mayo Clinic.

[8] Deshmukh KP, Rahmani Dabbagh S, Jiang N, Tasoglu S, Yetisen AK. Recent technological developments in the diagnosis and treatment of cerebral edema. Advanced NanoBiomed Research. 2021;1(11):2100001. doi:10.1002/anbr.202100001.

[9] Physiopedia - Oedema assessment.

Arbaz Ansari

Glaucoma is frequently referred to as the &quot;sneak thief of sight&quot; because it typically does not show any signs until significant peripheral vision loss becomes evident in the last phases of the illness.

Most forms of glaucoma, in contrast to the majority of eye conditions, are chronic. That is, they can be managed through lifestyle changes but not cured. 
&nbsp;

Understanding FAQs about Glaucoma

<h5 style="text-align:justify">Can Vision Loss Due To Glaucoma Be Restored?</h5>

As of now, the answer is no. The optic nerve and the neurons in the eye do not develop back after they are gone. 
&nbsp;

<h5>Can Surgery Cure Glaucoma?</h5>

There is no surgery available that can cure glaucoma or vision loss. However, surgical intervention can help protect vision and prevent it from getting worse. For example, trabeculectomy is done to lower the pressure inside the eye. 
&nbsp;

<h5>Can Laser Cure Glaucoma?</h5>

Laser techniques can help manage symptoms of glaucoma, but no treatment options are available right now to cure the disease. Laser surgeries can help drain the fluid from the eye, thereby helping maintain normal eye pressure and reducing the risk of more damage to the optic nerve. 
&nbsp;

<h5>What Is The Rarest Type Of Glaucoma?</h5>

Irido Corneal Endothelial Syndrome (ICE)&nbsp;

Childhood glaucoma, including primary congenital glaucoma and secondary glaucoma, is one of the rarest types of glaucoma. Only 5 in 100,000 babies and children are either born with glaucoma or develop it during their early years as a result of another condition<a href="#accordion">[2]</a>.&nbsp;The term &#39;infantile glaucoma&#39; refers to the diagnosis before the age of 3. In most cases, glaucoma is diagnosed before the child turns 1. 
&nbsp;

The following symptoms present themselves in babies who have this condition:

<ul>
	<li>They are sensitive to light</li>
	<li>They have eyes that are larger than normal</li>
	<li>They have cloudy eyes</li>
	<li>They make extra tears 
	&nbsp;</li>
</ul>

<h5>What Foods Should I Avoid If I Have Glaucoma?</h5>

<ul>
	<li>Replace pasta and white bread in the diet with whole-grain versions.</li>
	<li>Switch sugary drinks to water.</li>
	<li>Avoid caffeine, processed foods, and fried foods.</li>
	<li>Reduce the intake of fish and shellfish. 
	&nbsp;</li>
</ul>

<h5>What Foods Should I Consume If I Have Glaucoma?</h5>

<ul>
	<li>Plenty of fruits rich in vitamin C</li>
	<li>All green leafy vegetables and vegetables rich in Vitamin A</li>
	<li>Foods rich in Omega-3 fatty acids (e.g., salmon, chia seeds)</li>
	<li>Foods rich in vitamin B3 (e.g., turkey, tuna, mushrooms, peanuts, chicken, liver)<a href="#accordion">[4]</a> 
	&nbsp;</li>
</ul>

<h5>Is Glaucoma More Common In Diabetics?</h5>

<a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a> increases the risk of glaucoma. 
&nbsp;

<h5>Can A Glaucoma Patient Drive?</h5>

No, they can&rsquo;t. Glaucoma impairs driving skills. 
&nbsp;

<h5>Does Pigmentary Glaucoma Only Affect Males?</h5>

No, it affects a person irrespective of their sex. However, pigmentary glaucoma is more common in males as compared to females. 
&nbsp;

<h5>Can Glaucoma Cause Headaches?</h5>

The chronic types of glaucoma do not cause headaches. But, the acute types can trigger headaches and eye pain whenever eye pressure increases quickly. 
&nbsp;

<h5>Is Glaucoma More Common In Women?</h5>

Some types of glaucoma are more common in women. E.g., angle closure glaucoma and normal pressure glaucoma. 
&nbsp;

<h5>What Is The Most Dangerous Type Of Glaucoma?</h5>

Angle-closure glaucoma is a medical emergency. It is characterized by intense eye pain, blurry vision, and red eyes. The iris does not allow fluid to drain out of the front of the eye as a result of which eye pressure increases suddenly. Without treatment, this can result in blindness within days. 
&nbsp;

<h5>Is Open-Angle Glaucoma An Emergency?</h5>

Open-angle glaucoma is&nbsp;the most common type of glaucoma and even though it too leads to a buildup of pressure in the eye that eventually damages the optic nerve, it is not regarded as a medical emergency. 
&nbsp;

<h5>Does Family History Matter In Glaucoma?</h5>

It has been suggested through genetic studies that more than 50% of glaucoma is familial[1]. The rate of glaucoma is 10 times more in individuals with a sibling who has glaucoma. 
&nbsp;

<h5>What Is Tunnel Vision In Glaucoma?</h5>

If glaucoma is not effectively controlled and managed at an early stage, the disease can progress into severe peripheral vision loss. The condition is known as tunnel vision because the person can only see what&rsquo;s directly in front of them. 
&nbsp;

<h5>Do Eye Drops Help In Treating Glaucoma?</h5>

The treatment for glaucoma often begins with these eye drops. There are different types of drops available, including prostaglandin analogs, beta blockers, alpha-adrenergic agonists, carbonic anhydrase inhibitors, and cholinergic agents. The aim is to lower the eye pressure and, thereby, protect the optic nerve. It&rsquo;s important to use them as directed by the doctor. 
&nbsp;

While glaucoma cannot be avoided, early detection is crucial to prevent eye damage. Since most types of glaucoma develop gradually and exhibit no symptoms, everyone,&nbsp;especially those who are at high risk, should have regular eye checkups to monitor their health. For adults over 40 with a low risk of eye disease, it&rsquo;s recommended to get a comprehensive eye exam every 2-4 years. Diabetics, in particular, should get their eyes checked annually irrespective of their age.

[1] Lee DA, Higginbotham EJ. Glaucoma and its treatment: a review. American journal of health-system pharmacy. 2005 Apr 1;62(7):691-9.

[2] Glaucoma in babies and children | Congenital glaucoma | Glaucoma UK.

[3]Wolfs RC, Klaver CC, Ramrattan RS, van Duijn CM, Hofman A, de Jong PT. Genetic risk of primary open-angle glaucoma: population-based familial aggregation study. Archives of ophthalmology. 1998 Dec 1;116(12):1640-5.