One thing that can put away talking to someone very interesting is bad breath. And it is not an uncommon problem. While most just try to use mouth wash and chewing gums to keep it away, it is important to note that bad breath can be a sign of underlying causes, both in the mouth and the body as a whole. 

Identifying the reason can help in early diagnosis and prompt treatment of the actual disease condition.


There could be oral and general causes for bad breath or halitosis as it is medically called. Food habits and other lifestyle habits including smoking can also lead to bad breath.


Oral causes


- presence of food debris in a moist environment (saliva) is ideal for the oral bacteria to act on the food particles and break them down. This causes a bad breath, when it leads to plaque formation and it then calcifies into a hardened substance called calculus. Plaque and calculus are the main ingredients for tooth decay and periodontal disease.
- severe tooth decay leads to bad breath as does periodontal infections. In severe cases, there could even be abscess formation in the root area of the tooth with pus formation 
- unclean dentures are another source of halitosis. There could be food lodged in between teeth or the undersurface of the denture, leading to bad breath.
- dry mouth or xerostomia - certain diseases and drugs can lead to dry mouth with reduced amounts of saliva. Saliva has a natural flushing effect on the bacteria, and in its absence, the bacteria thrive, leading to a bad odour.


General health: chronic diseases like gastroesophageal reflux disease, digestive disorders, liver disorders, cancer, and diabetes can lead to bad breath. 


Others:
- long-term smoking and/or chewing tobacco and alcohol are also reasons for bad breath.
- crash diets: people on low-carb diets can have a bad breath, owing to burning of the fat and producing ketones, which have a strong smell.
- medications: nitrates to reduce angina, chemotherapy agents for cancer, phenothiazines for anxiety can all lead to bad breath. They reduce saliva and/or release chemicals causing bad breath.


Management: the first step in managing halitosis is to nail the cause down, which makes it easier to treat.
- start with oral hygiene check, and if there is decay or gum disease, consider restorations and cleaning.
- mouth rinses can be used in the maintenance phase.
- cessation of tobacco use should be considered.
- general health conditions like gerd should be managed
- artificial saliva in cases of xerostomia
- alternative medications if they are causing the bad breath


Oral breath is definitely embarrassing but can be managed very easily.

Chronic Bad Breath - Causes and Management

It is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the oesophagus, stomach, or duodenum. Blood is often observed in vomit (hematemesis) or in the stool (melena). Upper gastrointestinal bleeding denotes a medical emergency and typically requires hospital care for primary diagnosis and treatment. The incidence of upper gastrointestinal bleeding is 50-150 individuals per 100,000 annually. Depending on its severity, it carries an estimated mortality risk of 11%.

The causes of upper gastrointestinal bleeding are as follows:

Oesophagal causes (gastrorrhagia):

Oesophagal varices
Esophagitis
Oesophagal cancer
Oesophagal ulcers
Mallory-Weiss tear
Gastric causes: 

Gastric ulcer
Gastric cancer
Gastritis
Gastric varices
Gastric antral vascular ectasia
Dieulafoy's lesions

Duodenal causes
Duodenal ulcer
Vascular malformation, including aorto-enteric fistulae
Hematobilia or bleeding from the biliary tree
Hemosuccus pancreaticus or bleeding from the pancreatic duct
Severe superior mesenteric artery syndrome
The signs and symptoms of upper gastrointestinal bleeding are as follows:

Hematemesis - Vomiting of blood
Melena - Blood in the stool
Hematochezia - Passage of fresh blood through the anus, usually in or with stools
Syncope - Loss of consciousness (fainting)
Presyncope - State of lightheadedness, muscular weakness, blurred vision, and feeling faint
Dyspepsia   IndigestionEpigastric painHeartburnDiffuse abdominal pain
Dysphagia - Difficulty in swallowing. Weight lossJaundice - Yellow discolouration of the skin, mucous membranes, and sclera
The diagnosis of upper gastrointestinal bleeding is made when hematemesis is present. In the absence of hematemesis, an upper source of GI bleeding is likely in the presence of at least two factors among - Black stool, age < 50 years or blood urea nitrogen/creatinine ratio 30 or more

If these findings are absent, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. Also, the following diagnostic tests are done:

Orthostatic blood pressure
Complete blood count with differential counts
Hemoglobin level
Type and crossmatch blood
Basic metabolic profile, BUN,
Coagulation profile
Serum calcium
Serum gastrin
Endoscopy
Chest radiography
Nasogastric lavageAngiography (if bleeding persists and endoscopy fails to identify a bleeding site)
Upper gastrointestinal bleeding can be managed in the following ways:

Airway management and fluid resuscitation using either intravenous fluids and or blood
Medications to stop the bleeding (Proton-pump inhibitors are often given in the emergency)
Surgical intervention
Treating the consequences (like anaemia) that the bleeding may have caused
Precautions are taken to prevent re-bleeding

What Are The Reasons Behind Ulcer?

For a long time cholesterol in totality was seen as a bad thing for your body although the truth was a little more complicated than that. Cholesterol primarily is divided into two types, one of which can be categorized as bad cholesterol and the other as good cholesterol. Let's have an in-depth look at both the categories.

LDL or Low Density Lipoprotein aka bad cholesterol: Cholesterol is a wax like chemical, which is found all over the body and it has important functions to perform. Cholesterol is carried all over the body by Lipoproteins. The low density lipoproteins are denoted as bad cholesterol as they can accumulate on the walls of the blood vessels and cause blockages resulting in many ailments. LDL levels of 190 and above are considered dangerous. 

Some of the risks associated with it are:
1. Heart disease
2. Stroke
3. Atherosclerosis
4. peripheral artery disease among many others

HDL or High Density Lipoprotein aka good cholesterol: This is a form of cholesterol which is usually desired in higher quantities as it removes LDL from the system by dislodging it from the arteries and then carrying it through the blood stream into the liver. The liver then breaks it down and removes it from the body. Thus, higher number of HDL cholesterol is always desirable. 

Some of the ideal numbers for HDL cholesterol within the body are:

Women - Ideal: 60 mg/dl, dangerous: 50 mg/dl or lower
Men - Ideal: 60 mg/dl, dangerous: 50 mg/dl lower

The role of triglycerides
Good and bad cholesterol levels also depend on the levels of triglycerides within the body and not just LDL or HDL cholesterol. Triglycerides are another type of fat which are used to store energy within the body but can also affect your health. It is most associated with atherosclerosis when the levels of triglycerides are high within the body. 

Some habits that contribute to high levels of it are:
a. Lack of physical activity
b. Obesity or being overweight
c. Excesses in alcohol consumption
d. Smoking
e. Bad diet and others

Thus the good cholesterol versus bad cholesterol war also includes other factors, most of which can be easily changed by making subtle changes in lifestyle and incorporating healthier habits. This will increase the good cholesterol and the other relevant elements and reduce the bad.

Good Cholesterol Vs Bad Cholesterol and Factor involved in It

The chronic disorder that causes recurrent and unprovoked seizures is referred to as Epilepsy. A seizure is an impulsive and unexpected rush of activity in the brain. The reasons for the cause of epilepsy include head trauma, high fever, low blood sugar, and alcohol withdrawal. It is a neurological disorder and more than 3 million people in the United States have been affected by epilepsy. The chronic disorder is common not only in adults but even in young children and it has been observed that it occurs more in males. The disorder can merely be controlled by the use of various strategies as there is no cure for it till date.

Causes of epilepsy
Any illness that disturbs the usual form of neuron activity can lead to seizures. There are many possible causes of epilepsy. The 2 main types of seizures include partial/focal seizure and generalized seizure. The partial seizure would affect only one part of the brain. It is difficult to identify mild seizures. Further, stronger seizures are known to cause uncontrollable muscle twitches and spasms. At the time of a strong seizure, a patient can lose his consciousness. On the other hand, generalized seizures affect both parts (cerebral hemispheres) of the brain so their onset is not easily identifiable. Types of generalized seizures include tonic-clonic, absence or atonic etc. The other important fact is that epilepsy progresses because of imbalance of neurotransmitters which are nerve-signaling chemicals and also due to an abnormality in the brain wiring.

Drugs used to treat epileptic seizures
Anticonvulsant drugs are mainly used to treat epileptic seizures. The type of treatment provided to patients mainly depends on factors like severity and frequency of the seizures. The other factors that are also taken into consideration for the type of treatment provided include medical history, overall health and the age of a person. A patient can feel better with a seizure medication, an implant that works on the nerves, a special diet, and surgery.
To control epileptic seizures medications are the best option and to treat the brain disorder the right medication needs to be used. There are nearly 20 drugs available that are used for treating different types of epileptic seizures. The doctors provide medication only after proper review of the patient s medical history and their lifestyle. Some of the medications that are made include the use of antiepileptic drugs and anti-seizure drugs. The faulty signaling of the brain is suppressed with these medications.

Important precautions you must take

It is very important that the medication is taken as directed by the doctor. The main reason behind the use of these drugs is that they reduce the number of seizures and there are no side-effects. 
Care should be taken that the drugs provided to the children to treat epilepsy are FDA approved and are safe for use by children. 
The epilepsy drugs that can be taken for partial seizures include carbamazepine, phenytoin, valproic acid, valproate, and brivaracetam.
Natural treatments can also be made use of for epilepsy as at times medications do not work well on some patients. Acupuncture, use of natural herbs and vitamins can also be used for treating the brain disorder.

Epilepsy - Things You Must Take Care Of!

A common headache can have a number of reasons behind it, such as defective vision, hetrophoria or convergence deficiency, etc. Now, the question arises as to how they can cause headache. Read on to know more...

Q. Why should defective vision cause headache?

To attain a perfect vision, eyes with defective vision have to make sustained extra efforts, which results in headache. Even if the refractive error is very small, it can be the cause of headache. More prolonged the working and smaller the print, higher the incidence of headache.

Q. Can this occur at all ages?

Yes, it can occur at all ages. However, with age, the resistance decreases and hence elderly people are more prone to get headache. More the use of computer, mobiles, TV or prolonged studies precipitates headache

Q What is Hetrophoria?

Normally, both eyes always remain parallel, but in some cases, eyes have slight tendency to develop minor squint, may be convergent or divergent. This is called Hetrophoria or Latent squint. Such patients have to take extra strain to keep the eyes straight

Q. What is convergence deficiency?

For reading, both eyes have to converge and if there is weakness of convergence, extra strain has to be put on the eyes, which cause headache.

Q. What is the ideal method of refraction in young patients, I,e below 40 years?

Ideal method is to dilate the pupil with Tropicasyl plus drops. This has the advantage that the doctor can see the retina and Optic Disc. This is important to exclude any involvement of brain as the cause of headache. It also relaxes accommodation and hence provides correct refraction. In cases of Hypermetropia, it is extremely essential to dilate the pupil.

Q. What is the role of Autorefractmeter (a computer) in refraction?

It is a very important instrument to provide correct refraction, but it cannot be totally relied upon. Some opticians rely on it and give wrong numbers.

Q. What is acceptance Test?

You have refracted the eyes with Autorefractmeter or Streak Retinoscope but exact power is what a patient accepts. This is very important.

Q. What is astigmatism?

There is a difference in refraction in different meridians and it is important that a cylinder number is prescribed in correct axis. This is a difficult task and needs lot of experience.

Q. Is it important to correct astigmatism?

To relieve headache and strain on the eyes, it is very important that exact cylinder is prescribed.

Q. What is the role of exact centring of Optical Lenses?

You may give correct number, but if the centre of the Optical lenses and cornea do not coincide, satisfactory results are not obtained. To dispense correct lenses is a big art and the Optician must be qualified and well experienced.

Q. Does the quality of lens affect the visual comfort?

Yes, it is important that quality of lenses should be good, preferable fibre lenses which are Ant reflect coated. Crizal coating with capability to block the UV rays are very popular.

Conclusion: Refractive errors are important cause of headache and needs proper examination of the eyes, preferably after dilating the pupil. Astigmatic error even if too small may be the cause of headache. Spectacle dispensing is an art and a patient must select proper optician. Spectacles if advised for constant use must be used constantly to get full relief.

Defective Vision - Can it be a Cause of Your Headache?

The largest internal organ in the body, the liver, is also one of the silent heroes, which performs close to 500 functions. It produces energy, fights infections, gets rid of wastes, and is a metabolic factory.

There are four major types of liver diseases out of which alcoholic liver disease accounts for about 40% of them. Other types include non-alcoholic liver disease, viral hepatitis and autoimmune (chronic) hepatitis.

Risk factors: The severity of drinking habit is directly proportional to the chances of developing alcoholic liver disease. People who consume more amount of alcohol are more likely to develop the disease. However, it is also not necessary that every person who consumes alcohol develops liver disease.

Following are obvious risk factors for developing alcoholic liver disease.

1. Alcohol dependency: While enjoying a drink is not barred, getting the body dependent on alcohol for regular functioning is definitely a no-no. The rate of developing the disease in people dependent on alcohol is as high as 70%.

2. Females: The way alcohol is metabolized in females could have an effect on the higher risk they face in developing alcoholic liver disease.

3. Obesity: Excessive weight puts additional stress on the metabolic effects of the liver and therefore has a higher tendency to develop alcoholic liver disease.

4. Family history: Strong familial history increases the risk of developing alcoholic liver disease.

Symptoms: The difficulty in diagnosing the disease lies in the fact that there are no clear-cut symptoms that can indicate the diagnosis. Initial general symptoms include fatigue, poor appetite, abdominal pain, nausea, weight loss, loss of energy, and red spider nevi (spider-like blood vessels) on the skin.

As the liver function continues to worsen, there are additional symptoms like swelling of the legs due to fluid accumulation, swelling of the abdomen, jaundice (yellow mucous membranes and skin), redness of palms, impotence, breast swelling, easy bruising, cognitive problems and clay-colored stools. This stage will see liver scarring and subsequent cirrhosis. The second set of symptoms is more diagnostic. An experienced practitioner will be able to suspect and diagnose the alcoholic disease with a detailed history and some liver function tests.

Treatment: If identified early and alcohol habits are reversed, the damages of the liver can be completely reversed. In addition, the following lifestyle changes are suggested:

1. Low-salt diet

2. Hepatitis vaccines (A and B)

3. Medications to manage fluid retention, spontaneous bleeding and infections as the case may be

4. Excessive fluid accumulation in the abdomen may require removal

5. Shunt in the liver to repair blood flow

6. If cirrhosis stage is reached, a liver transplant may be required

While there are many ways to manage alcoholic liver disease, prevention is the best way. Limiting alcohol consumption can definitely help in the prevention of the disease.

All About Alcoholic Liver Disease

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