Paan and coffee bad for your bones, say doctors

Rheumatoid arthritis is the most common but Karachi has only 20 experts in the area.

KARACHI:

The effects of paan and coffee on bone health and the difficulties in diagnosing the actual type of arthritis were discussed at the 22nd Biennial International Convention of Pakistan Islamic Medical Association (PIMA) on Saturday.

Dr Mansoor Ali Khan, associate professor at Indus Hospital, gave a presentation on the diagnosis and treatment options for osteoporosis. He refuted the notion that the disease is most common in menopausal women and said that different factors lead to the disease in both men and women. “It is a pediatric disease with a geriatric outcome.”

According to a report, 3.2 million is the projected number of osteoporosis patients in Asia by 2050. Here, calcium and vitamin D are essential. “Vitamin D is not just a vitamin, it’s a steroid,” he said. Milk in Europe and other parts of the world is vitamin D fortified, but not in Pakistan. In fact, paan or betel leaf and chaaliya or betel nut has enzymes which break down vitamin D in the body. The good news is that a fair amount of exposure to the sun can help make up for the deficiency. However, there is no consensus on the appropriate intake of vitamin D and thus it is should be monitored.

It is thus also important to eat dairy products (milk, cheese) and be careful of ‘calcium robbers’ such as coffee and carbonated drinks.

Arthritis

Around 0.25 million people in Karachi have arthritis, said Prof. Dr Syed Mahfooz Alam whose presentation focused on the importance of identifying the symptoms to confirm the type of arthritis, since there are more than 100 forms. Rheumatoid arthritis is one of the most common but unknown types in the country.

“There are maybe 20 rheumatologists in the city which is not nearly enough,” said Alam. Rheumatoid arthritis is an inflammatory type of arthritis while osteoarthritis, the other common type is the “wear and tear” arthritis. The professor criticised doctors who order expensive tests to confirm the diagnosis. According to him, the best diagnosis for such diseases is clinical and a test or x-ray only provide limited assistance.

Such a disease cannot be cured but it can be treated to reduce pain, maintain function and improve the quality of life, said Alam. “Early and aggressive therapy leads to positive outcomes.”

Surgical relief 

Prof. Syed Shahid Noor of the Liaquat National Hospital agreed with the previous speaker and said a thorough clinical diagnosis is most crucial. He also spoke against reducing a patient’s physical activities unless it is the only option.

According to Noor, 95 per cent of the bone and joint diseases are non-operative. They can be treated by weight reduction, physiotherapy, exercise, hydrotherapy and other medical treatments. If surgery is imperative, then procedures such as arthroscopy and knee replacement can be looked into. The level of the surgery depends on the patient’s history and how early the disease was diagnosed.

He brought up patient counseling and said that pre-op assessments should not be taken lightly. Apart from the patient’s medical condition, their mental and physical state should also be taken into account. There are certain preconceived ideas in connection to surgical procedures which should be cleared up. Some patients are cautious of this treatment, thinking that it will make them bedridden for too long. On the other hand, other patients opt for surgery because they think it will be an ‘absolute’ cure.

“Patients try every other treatment, such as homeopathy and ‘maalish’, before they visit the doctor for a proper diagnosis.”

Published in The Express Tribune, March 4^th, 2012.