nalam kaapohm souvenir

,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa

fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;

NUTRITIONAL SUPPORT FOR MALNOURISHEDPREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA

Project Implemented by:International Medical Health Organization (IMHO) - A USA based 501(3)(c) non-profi t organization

VenueAtlanta Hall, Toronto, Canada

April 5th 2008

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NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 3

PLATINUM SPONSORS

GOLD SPONSOR

SILVER SPONSORS

Akila Senthil, AMP, Invis Inc. Tel: 905-283-3318.

Wijay Senatahirajah(Gobu), Able Legal Services Inc., Tel: 416-293-2111.

Atlanta Party Hall, Tel: 416-298-5784.

Jay Jayanathan & Family, Florida, USA.

Sarangan & Rupa Gnanasambandhan Family.

Ratheeshan Sivapragasam, Coldwell Banker, Tel: 416-497-9794

Melani David, Barristers and Solicitors, Tel: 416-430-0044

Vincent Sinnadurai, Residential Mortgages, Tel: 416-438-1688x2000

Roopesh Parike, Pharmacist, Tel: 416-299-0399 or 647-290-4208

Rajah Mahendran, Homelife GTA, Real Estate, Tel: 416-315-9397

Jayanthi Sritharan, Homelife GTA, Real Estate, Tel: 416-918-5872

Ramanan Ramachandran HomeLife Today Realty Inc., Tel: 416-670-6467

Dilan Pharmacies Inc O/S Legacy Pharmacy, Tel: 416-299-0399

Analai Cultural Organization Of Canada

Old Students Association of Pungudutivu

Srikumar & Thanja Kanagaratnam Family

Surendra & Sakthi Santhirasekaram Family

Serendib Paints & Décor, Tel: 416-913-3396

Dr. Gerald Emanuel & Family

Krishna Vigneswaran, VMS Travels, Tel: 416-670-0573

Kesavan Law offi ce, Tel: 416-568-9843

Vanni Tamil Community & Cultural Center

Markandeyar Family

Rubini Grocery Store

Ninativu Development Society

The Law offi ce of Gary Anandasangaree, Tel: 905-321-1100.


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Federal Tax ID Number: 59-3779465 P.O. Box 901, Bel Air, MD 21014 – 0901, USA.

www.imhousa.org Email: [email protected]

Nutritional deficiency and anemia are common problems among pregnant mothers and children in Jaffna peninsula. The main reasons for malnutrition are poverty and unavailability of nutritious food. Fishing and farming communities have lost their livelihoods as their work places are held as high security zones. Recent collapse of ceasefire and closure of A9 highway (only land route to the Jaffna peninsula) has made the living conditions even worse. There are about 10,000 pregnant mothers in Jaffna District. Among them about 30%

(3,000 mothers) are severely malnourished with body mass index less than 18.5.

The Colombo prices of some supplementations in January 2008 are as follows (US$ 1 =

SLRs 110):

1. Calcivita – SLRs 250 2. Ovron - SLRs170 3. Nutritional food pack-healthy food for pregnant ladies 375gm – SLRs 540 4. Protinex -SLRs 490

Total = SLRs1,450 per month per mother Please calculate as above leaving a 10% margin for increase in prices. Typically, most pregnant mothers in Jaffna visit a health clinic during the end of their first trimester or beginning of the second trimester. Most mothers will need support during the last six months of their pregnancy. We believe the approximate cost for improving nutrition for pregnant mothers in Jaffna may come up to US$ 100 per pregnancy. For 3,000 pregnant mothers, the cost is US$ 300,000 per year. We hope to implement this project over the course of 2008. International Medical health Organization (IMHO) will take responsibility for purchasing the milk products and vitamins in Colombo, Sri Lanka, transporting them to Jaffna and distributing them to the identified pregnant mothers through our local partners in Sri Lanka. In addition, we will provide quarterly reports. International Medical health Organization (www.imhousa.org) was founded by a group of physicians in USA in 2003 to rebuild the broken health care infrastructure in the war-torn areas of the island.

Project Proposal


Greetings, Family and Friends! Since 2004, IMHO has undertaken many health and nutrition related projects in the island of Sri Lanka and in other parts of the world. As always, THANK YOU for your generous support. This letter is intended to update you on our current and future projects. As we are a volunteer organization, our administrative cost continues to be less than 2% of our budget. Even the funds spent on administrative side (for accounting and auditing) are raised by individual donors. Almost all your funds go towards the identified humanitarian project. Since we are a 501c3 registered organization, our accounts are transparent to the public and IRS. The IMHO Board accounts for every dollar that is spent. The decisions are made democratically by a diverse group of 11 board members. We take pride in our volunteer service to the organization and consider an honor to serve our people in need. For IMHO operations, 2007 has been a difficult year due to the breakdown of 2002 ceasefire agreement at the ground level and the closure of A9 highway. However, we continued with our projects. The credit goes to the dedicated staff and individuals in Sri Lanka. As a small charity in USA, we are blessed with strong grass root NGOs as our partners in Sri Lanka. Following are the projects, IMHO successfully implemented in 2007:

1. With the closure of A9 highway, IMHO was able to purchase emergency and urgent medications in Colombo and transport to Jaffna and Kilinochchi with the help of Sri Lankan Red Cross and Consortium of Humanitarian Agencies (CHA). Partnered with Direct Relief International (DRI) in raising part of the funds. Budget: US$ 49,000

2. Continue to run mobile clinics with the help of Centre for Health Care (CHC) in rural areas and IDP camps. Both medical service and medications are provided free of charge. Similar projects were undertaken in the rural areas of the Jaffna peninsula with the help of consultants at the Jaffna Teaching Hospital.

These visits cost us US$1 per patient! Budget: US$ 22.800

3. With the Muttur and Vaharai displacements, we were able to work with CHA in funding a project providing clean water, sanitation, nutrition and basic health care to over 1,000 families. Budget: US$20,000

4. Funded a micro credit program for women-headed families through Eastern Self-reliant Community Organization (ESCO) based out of Batticaloa. Over 100 mothers and 350 children benefited from this program. Budget: US$30,000

5. IMHO strongly believes in capacity-building projects. Along this line, supported Jaffna medical students with

financial need, incentive allowances for doctors working in the islets and postgraduate training of doctors and nurses and further development of Institute of Health Sciences (IHS). Budget: US$29,100

6. Funded specific medical projects at the Psychiatric and Pediatric units at the Batticaloa Teaching Hospital. Budget: US$ 12,960

7. Supported health care and nutrition program at the Oncology unit at the Jaffna Teaching Hospital. Budget: US$ 6,200

8. Helped BRAC, a grass root NGO to help with their relief efforts to those affected by Cyclone Sidr in Bangladesh. Budget: US$ 5,000

IMHO’S 2007 Project Summary


Following projects are in progress:

1. Building and development of a Psychiatric unit in Vavuniya, first of its kind in the district. The project is being coordinated through Sri Lankan Red Cross. Budget: US$ 40,000

2. Construction and development of a Diabetic center at the Jaffna Teaching Hospital in conjunction with the Ministry of Health, Sri Lanka. Budget: US$ 70,000

3. Funding of a state-of-the-art medical laboratory at the Jaffna Teaching Hospital in conjunction with the Ministry of Health, Sri Lanka. Budget: US$ 52,600

4. Renovation of Psychiatric ward, Tellipalai hospital. Budget: US$ 30,000

5. Funding of Victory home (Vettri manai), an institution that cares for the mentally challenged women with multiple needs. This project is co-funded by Operation USA, a California based NGO.

Budget: US$ 10,000 6 .Funding of livelihood project for the resettled women headed families in Vaharai. Fifty families will benefit from this project; each will receive a cow for income generation. This project will be implemented by the Sarvodaya/Batticaloa and co-funded by Operation USA. Budget: US$ 12,000.

Our immediate future projects include:

1. Provide nutritional support for severely malnourished pregnant mothers in the Jaffna peninsula. This will cost US$10 per mother per month. Most mothers get medical attention only during their second trimester.

That is US$ 60 per pregnancy! 2. Initiate health care related projects in other impoverished areas of the island. 3. Continue to respond to emergency and urgent medical needs.

As always, IMHO is indebted to you for your moral and financial support. Happy holidays and a healthy New Year! With warmest winter wishes. Board of Directors IMHO


Pearls in

Cancer is one of the

leading causes of

death among

people of all ages.

Following are the top 3 causes of cancer deaths in men and women in the western world:

1. Lung cancer2. Breast or prostate cancer3. Colon cancer

Best way to treat cancer is to prevent! How to prevent cancer?

1. Stop smoking!2. Healthy life style: Good diet and exercise3. See your GP or family doctor regularly4. Follow-up with all cancer screening tests

What screening tools are available for early can-cer detection or prevention?

1. Lung cancer: None available as a screen-ing test but smoking cessation will lead to signifi cant risk reduction. Ninety percent of lung cancers are associated with smok-ing!

2. Breast cancer: There 3 components to this• Breast self examination: Should be

done monthly and ask your doctor on how to do it. Report any abnormalities to your physician promptly.

• First mammogram by 40 years of age or 10 years before the age at which your fi rst degree relative was diag-nosed of breast cancer

• Annual examination by your physician3. Prostate cancer: Digital rectal examina-

tion by your physician and a blood test called PSA (prostate specifi c antigen) by age 50 years. Most but not all prostate cancers are located peripherally and can be palpated on rectal examination. PSA testing is controversial.

4. Colon and rectal cancer: Digital rectal exam and occult blood testing by age 40 and colonoscopic evaluation by age 50.

Thavam Thambipillai M.D, Ohio

Cancer


Ragu Sinnarajah M.D, Maryland


Periodontal disease or advanced gum disease is one of the causes for tooth loss in adults. As one ages, there is an increasing likelihood that periodontal dis-ease may become evident. This disease is a result of invasion of bacteria deep into the gum and support-ing tissues of the teeth.

By maintaining good oral hygiene, regular preven-tive dental care, it is commonly successful in preserv-ing periodontal health. However, if this disease be-comes evident there are several treatment modalities available – scaling, root planning, periodontal surgery and in some cases antibiotics are utilized in therapy.

Much of the destruction of the periodontal (gum and adjoining) tissues results from patient’s infl am-

matory response to bacteria. Recent advances in research have translated into new methods to treat advanced gum disease. A lower dose of doxycycline (Periostat 20mg) given twice a day helps in modu-lating the patient’s response. I have been using this medication on several of my patients with chronic gum disease.

Periodontal disease causes separation of gum from teeth resulting in deep pocket formation. Delivering an antibacterial topical agent into the diseased site helps to eliminate the infection.

“Atridox” has been approved for use in Canada for this purpose by Health Canada. It is a controlled- re-lease doxycycline gel that is applied under the gum. This topical gel provides a valuable adjunct to peri-odontal treatment in cases requiring additional care.

Over the past 20 years, evidence has accumulated relating periodontal disease with diabetes, coronary heart disease and stroke. Another condition that is claimed to be associated with advanced gum disease is preterm low birth weight infants. The existing evi-dence indicates that this topic deserves further stud-ies.

Other major cause of early tooth loss is dental de-cay. It is a common condition seen in kids who do not brush their teeth properly. Harmful social and bio-logical risk factors (lower social class and education-al level of parents, higher sugar consumption, poor brushing and eating habits) accumulated early in life contribute to the development of high level of caries in childhood.

In trying to fi ght dental caries, in additional to pro-viding routine dental care, dentists need to identify patients who are more prone to the decay process. These kids can benefi t from active anticaries battery of treatment. The Cari Screen testing meter provides a test that measures the ATP in biofi lm. Cari Free Treatment Rinse elevates the local pH to kill the caries producing bacteria in the plaque biofi lm and thereby decreasing the dental decay.

Dental Decay & Gum DiseaseDr. Shanmugavadivel, Toronto


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gw; #j;ijAk; KuR tpahjpAk;Dr. Shanmugavadivel, Toronto


The Facts About Chronic Kidney Disease (CKD)

• Early detection can help prevent the progres-sion of kidney disease to kidney failure.

• Heart disease is the major cause of death for all people with CKD.

• Glomerular fi ltration rate (GFR) is the best esti-mate of kidney function.

• Hypertension causes CKD and CKD causes hypertension.

• Persistent proteinuria means CKD.• High risk groups include those with diabetes,

hypertension and family history of kidney dis-ease.

• Three simple tests can detect CKD: blood pres-sure, urine albumin and serum creatinine.

How do your kidneys help maintain health?

In addition to removing wastes and fl uid from your body, your kidneys perform these other important jobs:

• Regulate your body water and other chemi-cals in your blood such as sodium, potassium, phosphorus and calcium

• Remove drugs and toxins introduced into your body

• Release hormones into your blood to help your body:

1. regulate blood pressure 2. make red blood cells 3. promote strong bones.

Chronic Kidney Disease (CKD)Kandasamy Rajaram M.D, New Jersey


What is chronic kidney disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long pe-riod of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney dis-ease progresses, it may eventually lead to kidney fail-ure, which requires dialysis or a kidney transplant to maintain life.

What causes CKD?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are re-sponsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a lead-ing cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that aff ect the kidneys are:• Glomerulonephritis, a group of diseases that

cause infl ammation and damage to the kid-ney’s fi ltering units. These disorders are the third most common type of kidney disease.

• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the

kidneys and damage the surrounding tissue.• Malformations that occur as a baby develops

in its mother’s womb. For example, a narrow-ing may occur that prevents normal outfl ow of urine and causes urine to fl ow back up to the kidney. This causes infections and may damage the kidneys.

• Lupus and other diseases that aff ect the body’s immune system.

• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.

• Repeated urinary infections.

What are the symptoms of CKD?

Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:

• feel more tired and have less energy• have trouble concentrating• have a poor appetite• have trouble sleeping• have muscle cramping at night• have swollen feet and ankles• have puffi ness around your eyes, especially in

the morning• have dry, itchy skin• need to urinate more often, especially at night.

Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:

• have diabetes • have high blood pressure• have a family history of chronic kidney disease• are older• belong to a population group that has a high

rate of diabetes or high blood pressure


Incidence

Diabetes is the most common cause of kidney fail-ure, and the damage to the kidney (diabetic nephrop-athy) usually starts after 10 years. Statistics indicate that about 1 out of 170 people who have diabetes will develop kidney failure.

What happens to the kidneys in diabetes?

The human body has two kidneys, and each kid-ney has about 1 million units. These units fi lter the blood, separate the waste, and send it down with salt and water in the form of urine. In diabetes these units start leaking protein into the urine and eventu-ally end in kidney failure which causes accumulation of the waste, salt, and fl uid.

What are the symptoms of kidney failure?

• The symptoms vary but may include:• Fluid and salt retention causing swelling of the

face and legs and also shortness of breath.• Tired feeling from anemia (decrease of produc-

tion of erythropoietin from the kidneys).• Loss of appetite, nausea, and vomiting.• Headache which may be associated with hy-

pertension.• There may be no symptoms in the early stages

of kidney failure.

How do you diagnose diabetic nephropathy?

Check the following:• Urine for protein.• Blood for a rise in creatinine and urea to assess

the degree of damage to the kidneys and ab-

normalities in electrolytes, calcium, potassium, and hemoglobin.

• Blood pressure for hypertension (high blood pressure).

• Ultrasound of the kidneys to rule out other causes including obstruction of the urinary tract.

• Kidney biopsy to confi rm diagnosis if neces-sary.

How do you treat?

There is no cure for diabetic nephropathy, but one can slow the deterioration of kidney function by:

• Controlling blood pressure and keeping the reading below 130/80.

• Controlling blood sugar.• Using medications such as ACE inhibitors and

ARBs to decrease proteinuria, slow the worsen-ing of kidney function, and also control blood pressure.

• Proper diet including low protein to decrease the workload on the kidneys. Later stages need a decrease in sodium and potassium in the diet.

• Avoiding medicines which can hurt the kidney function such as NSAIDs (arthritis medicines like Aleve and ibuprofen), contrast dye injec-tion for x-rays, etc.; and adjusting medication doses for decreased kidney function.

• Treating urinary tract infections.• Treating anemia with erythropoietin injections.• Stopping smoking.• Getting proper exercise.• Controlling cholesterol.• If the kidneys do fail, one can consider the op-

tions of dialysis and/or kidney transplant.

The care of patients with diabetic nephropathy should be a team eff ort to include the primary care physician, kidney specialist (nephrologist), and dieti-tian.

Diabetes And Kidney DiseaseKanagasabai Devacaanthan M.D, Florida


“Pulsing,” “pounding,” “throbbing.” To anyone who has ever suff ered from headache, these descriptions are all too familiar. Nearly everyone experiences some form of head pain at one time or another. In fact, it is estimated that each year, 70% of the popu-lation will have at least one headache and over 5% of the population will seek medical attention for their headaches.

Fortunately, most headaches are not associ-ated with serious underlying conditions and can be treated with nonprescription medications. However, some severe headaches need a doctor’s attention and may require prescription drugs. There are several types of headache and, depending on their severity and frequency, they may require diff erent treatments. Sometimes, it can be diffi cult to distinguish one type of headache from another. So, it is important to “know your symptoms” in order to help your doctor identify the type (or types) of headache you have and recom-mend or prescribe the best available treatment.

One key to headache management is good com-

munication between patient and doctor. Your doctor

will need to obtain a careful history and description

of your headache symptoms.

The following is a basic overview of some of the

major headache types; it may help you to understand

your headache and describe its symptoms accurately

to your doctor. This should not be used for “self-diag-

nosis” -- that is your doctor’s job. This overview should

serve, instead, as a guide to help you understand the

major headache types as you work with your doctor

to fi nd a treatment tailored to your needs. It should

also be pointed out that many patients may suff er

from more than one type of headache or from a sub-

type of one of the major headaches.

Migraine Headache: Migraine is the best known

and most researched type of headache, although its

exact mechanism is not fully understood. It aff ects

almost three times as many women as men. Migraine

usually occurs on one side of the temple, but can af-

fect both sides of the head at the front or back. A

typical migraine attack usually lasts anywhere from

four hours to more than a day, if not appropriately

treated.

HeadacheK.N. Sena, M.D.


It may be preceded by an “aura,” which consists of

symptoms or sensations ranging from visual distur-

bances (such as fl ashes of light or geometric patterns)

to muscle weakness or diffi culty speaking. The aura is

followed by head pain, which builds quickly to a peak

intensity and then slowly tapers off . The pain peak

is usually more severe than with tension headache.

Symptoms associated with migraine include nausea,

vomiting, and extreme sensitivity to light and sound.

During an attack, migraine suff erers may be unable

to engage in activities that require any type of exer-

tion (i.e. stair climbing). There are several subtypes of

migraine, which the treating doctor will need to con-

sider when evaluating a migraine patient.

Tension-Type Headache: This type of headache is

the most common. It usually consists of a dull pain

that spreads across the head, typically on both sides.

Many patients suff ering from this type of headache

describe it as the sensation of a “band tightening

around the skull.” Other eff ects of this headache may include mild sensitivity to light or sound, lighthead-edness, blurred vision, and a general feeling of inabil-ity to function normally. There is some overlapping of symptoms between this type of headache and mi-graine.

Cluster Headache: As the name implies, these types of headaches occur in bunches or “clusters” followed by pain-free periods. They are less common than mi-graine, aff ecting less than 1% of the population, and typically occur fi ve times more often in men than in women. Patients who suff er from cluster headaches usually describe a very severe, localized pain behind and around one eye; they often say, “it feels like a nail being driven into the eye.” Symptoms associated with cluster headache occur on the same side of the head as the pain. They include tearing from the eye or dis-charge from the nostril.

Each cluster consists of regularly occurring head-

Headache type Symptoms/description

Migraine May be preceded by aura, usually one-sided, pain tends to be moderate to severe, pulsating, and aggravated by physical activity, associated with nausea, vomiting and sensitivity to light and sound; affects more women than men

Tension-type headache

Dull, squeezing, non-pulsating pain, usually on both sides of the head, tends to be less severe than migraine, mild sensitivity to light and sound, no nausea.

Cluster headache

Headaches occur in clusters with pain-free periods in between; pain is very severe, localized and stabbing; attacks briefer than migraines; facial symptoms occur on same side as headache; affects more men than women.

Local head or neck pain

Pain does not fit other headache categories; usually steady, dull and localized in head, temple, or cheekbones; usually caused by an injury or overuse of joints or muscles.

Table 1: Summary of Major Headache Types and Symptoms


aches that may last for months. The headaches usu-ally occur relatively close together and possibly at the same time of the day or night. They are typically briefer than migraine attacks; each headache may last from a half-hour to several hours. When a cluster of headaches ends, it may be several years before an-other occurs.

Local Head or Neck Pain: This is a general term used to describe pain that does not fall into one of the ma-jor headache categories, but is problematic enough to bring the patient in for a medical evaluation. It is commonly caused by muscle injury or surrounding tissue irritation, but may also be caused by irritation of a joint or the spine of the neck. The pain usually occurs in a localized area, such as the back or side of the head, the temple, or the cheekbones. It can be described as steady and dull rather than throbbing and sharp. As the pain is generally caused by an ac-cident or overuse of the muscle/joint, the problem is usually resolved with rest, physical therapy, biofeed-back and/or medications.

If you have migraine headaches, you may have recognized that some things you do -- or don’t do -- may provoke an attack. These are called migraine “triggers”. When you seek medical help for your head-ache, it is not enough to discuss your symptoms with your doctor. It is also important to identify the spe-cifi c triggers of your headaches. By doing so, you may improve your condition by simply learning to avoid your specifi c headache triggers.

A trigger can be either an external factor or an in-ternal factor that may lead to headache onset. What-ever it may be, the trigger is not the cause of the head-ache. Examples of external triggers include changes in weather, bright lights, or certain foods. Triggers that occur internally include exhaustion, hunger or the relaxation period following stress.

Avoiding your triggers is not always easy and sus-

ceptibility to triggers will vary from person to per-son. Factors such as age and sex can also infl uence how a trigger will aff ect each individual. For instance, younger people may have a higher tolerance of cer-tain triggers and women may be aff ected more often by weather changes or certain odors than men. With women, susceptibility to triggers often increases dur-ing the pre- or postmenopausal period and decreases after menopause.

Table 2 contains many, but not all, of the triggers that may bring on migraines in some susceptible people:

Doctors often ask headache patients to keep a diary in which they record the time their headaches began, how long they lasted, what may have trig-gered them, where the pain was located, and what the character of the pain was. Several triggers may be involved in the onset of your headaches so it is important to identify as many as possible. Keeping a headache diary can be helpful for both you and your doctor. Not only does it provide valuable information that can help your doctor determine which treatment is appropriate, but it can help give you direction amid the confusion of recurring pain.

What is the analgesic rebound headache?

Many people who experience chronic head pain at-tempt to medicate themselves by taking a daily regi-men of analgesics, or pain medications. These are the “rescue” drugs we all keep in our medicine cabinets -- such as aspirin, acetaminophen or combination pain medications. These drugs may be eff ective for many patients. However, we now know that overuse of these drugs may actually cause daily headaches rather than relieve them. This phenomenon is known as analgesic rebound headache.

The principle behind analgesic rebound headache is drug dependency. The body becomes accustomed to having a certain level of pain medication in the


bloodstream; when blood levels fall, the headache

recurs, or “rebounds.” Over time, the recurring head-

aches may become transformed into a “chronic daily

headache” which can be very diffi cult to treat.

Overuse of prescription and nonprescription pain

medications can undermine a doctors eff orts to con-

trol headache. A patient who takes an excessive

amount of pain medications is not likely to benefi t

from a preventative medication until the pain medi-

cations are withdrawn. The pain medications com-

pete with the preventative medication for binding

sites in the brain known as receptors. By occupying

the same binding sites as the preventative medica-

tion, the analgesics may “crowd out” the preventative

medication, aff ecting its ability to function properly.

Many patients with analgesic rebound headaches re-quire hospitalization to wean them from their drug dependence.

The message here is a very important one: over-use of pain medications can actually be a cause of constant or recurring headaches. That is why doctors ask headache patients to report exactly what medi-cations they take, how often they take them, and in what amounts. Only when these medications are withdrawn can headaches be successfully treated. Your physician needs this information to determine the correct course of treatment.

The Migraine Foundation

365 Bloor Street East, Suite 1912Toronto, Ontario, Canada M4W 315

Foods and beverages Environmental Factors

Alcoholic beverages (especially red wine) Aged cheese Smoked or pickled fish Sour cream or yogurt Chocolate Nuts or beans Caffeine Nitrites, MSG, artificial sweeteners

Bright or flickering lights Weather changes Perfume Strong odors Second-hand cigarette smoke Polluted air Chemical fumes

Medications Lifestyle changes

Diuretics Blood pressure medications Asthma medications Nitroglycerin

Change in sleep pattern Irregular eating habits Relaxation period following stress

Hormonal factors Physical factors

Menstruation Pregnancy and delivery (pregnancy relieves migraine in many women) Oral contraceptives Estrogen therapy

Blow to the head Physical exertion Sexual activity Neck injury

Table 2: Common Migraine Triggers


Introduction

What does it mean when someone is said to have dementia? For some people, the word conjures up scary images of “crazy” behavior and loss of con-trol. In fact, the word dementia describes a group of symptoms that includes short-term memory loss, confusion, the inability to problem-solve, the inability to complete multi-step activities such as preparing a meal, balancing a checkbook or even looking up a phone number and dialing the number, and some-times personality changes or unusual behavior.

Saying that someone has dementia does not off er information about why that person has these symp-toms. Compare it to someone who has a fever: the person is ill from the fever, but the high temperature does not explain the cause or why the person is ill, such as having pneumonia or a bladder infection.

Does any loss of memory signify dementia? Is not memory loss a normal part of aging? When some-one is old, memory problems can be just natural and are to be expected. But those memory problems are mild, and given time the individual is able to recollect the memory and there is no functional impairment. Serious memory loss is when an individual’s function-al capacity to be gainfully employed, maintain self-care or live in a society is impaired and should not be ignored.

Not all memory loss is due to Alzheimer’s disease, though it is the most common or well known enti-ty. There are other conditions which can also cause memory and cognitive problems severe enough to in-terfere with daily activities. The conditions can aff ect younger as well as older people and some of them are reversible. Thus, a clear diagnosis is important.

The causes of reversible dementias include medi-cation interactions, depression, vitamin defi ciencies and thyroid abnormalities.

The causes of irreversible dementias are com-monly called degenerative dementias and the dis-eases include Alzheimer’s disease, ischemic vascular dementias, dementia with Lewy Body disease, fron-totemporal dementia, Parkinson’s dementia, normal pressure hydrocephalus and mixed dementias.

Importance of Obtaining a Diagnosis

The diagnosis of dementia requires a complete medical evaluation and may also require neuropsy-chological testing.

A medical evaluation for dementia usually includes the following:

• Review of the history as to what the problem is, how the problem started, in what order the problem evolved, how it is aff ecting the per-son’s ability to function in daily life.

• A medical history and medications are impor-tant, including the presence of hypertension, diabetes, history of head injuries, seizures and also the medications that the individual is tak-ing.

• Neurological examination helps to identify symptoms and signs that may be present in particular kinds of dementia and other condi-tions such as stroke, Parkinson’s disease or hydrocephalus.

• Laboratory tests to rule out vitamin defi cien-cies or metabolic conditions such as thyroid imbalance or Vitamin B12 defi ciency.

• A scan of the brain, such as a CT scan or MRI scan would be helpful in looking for evidence of hydrocephalus, brain tumor, subdural hema-toma and strokes, which can produce demen-tias.

• Lastly, neuropsychological testing, either done at the bedside or formal testing might be ap-propriate when there is doubt as to whether the noted memory diffi culty is due to a brain

DementiaRagu Sinnarajah M.D, Maryland


problem or due to severe depression, which can mimic dementias.

Reversible Dementias

• Emotional distress, depression or major life changes such as retirement, divorce or loss of a loved one can aff ect one’s physical and men-tal health. Sometimes under severe distress, memory function can be aff ected and clinically present as disturbances of memory function. This is quite reversible.

• Adverse reaction to medications, especially when multiple medications are taken together, can lead to memory diffi culties. All medica-tions, including over-the-counter medications have to be carefully looked into. It is also possible to obtain blood levels for some of the medications to see whether there is too much of the medication in one’s system, producing memory diffi culties.

• Endocrine abnormalities such as abnormal-ity in thyroid function or adrenal function can produce reversible dementia.

• Metabolic disturbances such as electrolyte imbalance, low blood sugar, high or low cal-cium, and diseases of the liver or pancreas can produce problems with memory function and many are correctable.

• Infections, (especially in senior citizens, when there is some memory diffi culty, but not enough to interfere with their lifestyle) such as a bladder infection or infection underneath the skin, even in a remote part of the body, can aff ect the memory function and present as dementia. Certainly, syphilis and tuberculosis of the covering of the brain have to be consid-ered as they are treatable to a great extent.

• Nutritional defi ciencies, especially the B group of vitamins, such as Vitamin B12, folic acid or thiamine, can produce impairment of memory function.

• Hydrocephalus. Hydrocephalus is a condition where cavities inside the brain start enlarg-

ing and manifest as memory diffi culties, dif-fi culty with gait and diffi culty in controlling the bladder. This is a totally reversible condition if diagnosed early, shunting of the ventricle and releasing the fl uid inside the brain to another body cavity can completely cure the memory diffi culty.

• Chronic Subdural Hematoma. Sometimes blood clots can form, especially in the elderly, particularly if they are taking blood thinners such as aspirin or Coumadin for other medi-cal reasons. Blood clots can form slowly over weeks and months between the brain and skull bone, and can present as dementia with or without headache. A scan of the head can diagnose this condition easily and if diagnosed and treated early, memory dysfunction can be corrected.

Irreversible Dementias

These are degenerative conditions of the brain. The cause of this is not clearly understood. There may be a genetic component, but mostly it is due to the reason that we are living longer and longer. With the passage of time, a person living up to 80 years of age has as high as a 20% chance of developing degenera-tive dementia.

The common degenerative dementias include:• Alzheimer’s Disease. This is the most common

cause of dementia in people over 65, although the disease can occur in younger people. Symptoms diff er from person to person, but there is a decline in memory, thinking and abil-ity to function which gradually progresses over a period of years with the patient developing behavior changes and personality changes, eventually with demise occurring in about 10 to 15 years time after the disease has been di-agnosed. There is no specifi c treatment avail-able at this time, though there are medications that can slow down the deterioration of this condition, called cholinesterase inhibitors and


Namenda.• Ischemic Vascular Dementia, or hardening of

the arteries of the brain, or cerebral atheroscle-rosis. This is the second most common demen-tia, characterized by an abrupt loss of function or general slowing of cognitive abilities. Some-times this is associated with weakness, numb-ness or incoordination on one or the other side of the body and these patients have the risk factors for cerebrovascular disease such as high blood pressure, diabetes, smoking and coronary artery disease.

• Dementia with Lewy Bodies. This is a progres-sive degenerative disease and have symptoms common to Alzheimer’s disease and Parkin-son’s disease. Behavior changes occur early in the course of the illness.

• Frontotemporal Dementia. This is a degenera-tive condition of the anterior part of the brain. Patients who have this condition have diffi -culty with reasoning, personality, social graces, and behavior changes. This can be easily misdiagnosed as psychological or an emotion-ally based problem and tend to happens at an earlier age than 65 years.

• Parkinson’s Disease. People with Parkinson’s disease, which is the second most common neurodegenerative disorder, in addition to the motor diffi culties such as diffi culty moving, shaking and falling, also eventually develop dementias.

Medical Treatment

There is no cure for the irreversible or degenera-tive dementias. Treatment focuses on maximizing the individual’s cognitive and functional abnormali-ties. Cholinesterase inhibitors and Namenda may be used in Alzheimer’s Disease and Lewy Body Disease and to a lesser extent in frontotemporal dementias. In vascular dementia, controlling the risk factors for cerebrovascular disease such as high blood pressure, diabetes, high cholesterol, and stopping smoking as well as regular exercises may be helpful.

Lastly, medications to control the symptoms such

as controlling mood, if there is a mood disorder, with

antidepressants, and controlling behavior, such as ir-

ritability or agitation, with medications is possible.

Prevention of Alzheimer’s Disease

Up-to-date research does not have any clear guide-

lines as to how one could prevent Alzheimer’s disease

from developing. One may be able to postpone the

development of Alzheimer’s disease by “good living”.

This involves regular exercise to the body and brain.

The former includes ideal weight, walking briskly two

miles a day and the latter includes learning new activ-

ities, reading magazines or papers and writing a short

version of it, playing cards, checkers and doing cross-

word puzzles. One should certainly avoid items that

could hurt the brain which includes smoking, alcohol,

head injury, and treat hypertension, diabetes mellitus

and elevated cholesterol. Daily vitamin supplements

are appropriate as well.

Recommended Reading:

• The Forgetting, Alzheimer’s: Portrait of an

Epidemic, David Shenk, 2001, Random House,

New York, NY.

• Alzheimer’s Disease: Unraveling the Mystery,

Anne Brown Rodgers, 2003, ADEAR (Alzheim-

er’s Disease Education Referral Center, a ser-

vice of the National Institute on Aging), Silver

Spring, MD.

• Caregiving at Home, William Leahy, M.D., 2005,

Hartman Publishing Inc., and William Leahy,

M.D., 8529 Indian School Road, NE, Albuquer-

que, NM 87112, (505) 291-1274.


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kdr;Nrhu;itf; Fzkhf;Ftjw;F kUe;Jfs; xU

Kjd;ikahd KiwahFk;. Nehahspfspd; Fzq;

FwpfSf;Fk; Njitf;Fk; Vw;g itj;jpau; kUe;ijj;

Nju;e;njLg;ghu;. gytifahd> kpfg;ghJfhg;ghd>

jpwd;kpf;f kUe;Jfs; jw;NghJ cs;sd. cjhuzk;:

Prozac (Fluoxeting)> Paxil (Paroxitine)> Zoloft (sertraline)>

Lexapro (esitalopram)> Wellbutrin (Bupropoine)> Effexor

(venelofaxine) Cymbalta.

xU kUe;J Ntiy nra;ahtpl;lhy; my;yJ mjd;

ghjfkhd gf;ftpisTfs; (negative side effects) $Lj

yhf ,Ug;gpd; ,d;ndhU kUe;ijj; Nju;e;njLf;fyhk;.

rpy rkak; kUe;jpd; Muk;g tpisitf; fhz 1-6

fpoikfs; nry;yyhk;. vdNt ek;gpf;ifiaj; jsu

tplhky; itj;jpaupd; mwpTiuapd; gb kUe;ijj;

njhlu;e;J vLf;f Ntz;Lk;. Nehapd; Fzk; njup

aj; njhlq;fpa ehspy; ,Ue;J 6 khjj;jpw;fhtJ

rpfpr;iria njhlu Ntz;Lk;. kUe;ij epWj;Jk;

NghJk; itj;jpaUld; fye;jhNyhrpj;J> rpwpJ rpwp

jhf Fiwj;J epWj;j Ntz;Lk;.

2) cstsr;rpfpr;ir (Psychotherapy / Counseling):

,JTk; xU Kf;fpa rpfpr;ir KiwahFk;. vq;f spd;

vz;zq;fisAk;> vjpu;ghu;g;Gf;fisAk;> nray;fis

Ak; khw;Wtjhy; kd czu;TfisAk; khw;wyhk;.

cstsr;rpfpr;ir vq;fs; gpur;rpidfis xU MNuhf;

fpakhd fz;Nzhl;lj;Jld; ghu;f;f cjTtJld;

jplkhd> cWjpahd> fbdq;fisr; rkhspf;ff;$ba

kNdhghtj;ijAk; cUthf;f cjTk;.

3) kpd;typg;Gr; rpfpr;ir (Electroconvulsive therapy):

,r;rpfpr;ir Kiw cldbahd tpisTfisf;

nfhLf;Fk;. ,J fLk; kdr;Nrhu;T nfhz;ltu;fSf;Fk;

cldbahd gyd; Njitg;gLgtu;fSf;Fk; mj;Jld;

NtW rpy tpNrl re;ju;g;gq;fspYk; toq;fg;gLk;.

cjhuzkhf kUe;J xj;Jtuhj my;yJ kUe;J

Ntiy nra;ahj xUtUf;F my;yJ rpfpr;ir

Njitg;gLk; 4-6 khj fu;g;gpzpg; ngz;fSf;F ,J xU

jFe;j rpfpr;ir KiwahFk;.

cyf Rfhjhu epWtdj;jpdhy; kdr;Nrhu;T Nehah

dJ kf;fspd; nraw;gLk; jpwikiaf; Fiwf;Fk;

Kjd;ikahd Nehahf milahsk; fhzg;gl;Ls;sJ.

Mz;fspy; 10 tpfpjkhNdhiuAk; ngz;fspy; 25 tpfpj

khNdhiuAk; ghjpf;Fk; ,e;Neha; Vio> gzf;fhud;>

gbj;jtd;> gbfhjtd; vd;w NtWggby;yhky; vtUf;

Fk; tuyhk;. vdpDk; kpfTk; ghJfhg;ghd> jpwikahd>

njupTnra;ag;gl;l itj;jpa Kiwfs; jw;NghJ fz;L

gpbf;fg;gl;Ls;sd.

Neha;f;fhd mwpFwpfs; Muk;gpj;j clNdNa

rpfpr;iria Muk;gpj;jYk; G+uz FzkilAk; tiu

rpfpr;iria ePbj;jYk; NehapypUe;J kPo;tjw;fhd

rhj;jpaf;$Wfis mjpfupg;gJ kl;Lky;yhky; xU

MNuhf;fpkhdJk; nraw;jpwd; kpf;fJkhd tho;f;

ifia tho;tjw;F cjTk;.

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