Sunday, May 27, 2012

Urine Trouble & Comments by Dr JB Lim

The blogger has received the following emailed information from a friend and circulated to other friends and e-buddies:

How the colour of your urine can be a warning of health problems.

Yellow

“Healthy urine goes from clear to pale yellow, dark yellow to amber,” says consultant urologist Tim Terry. This depends on hydration levels, but if you’re somewhere in the yellow team, you can breathe easy.

Green

“Some antiseptics and anaesthetics give urine a green tinge,” says Terry. This is thanks to methylene blue, a dye which kidneys sometimes struggle with. Nothing too much to worry about though.

Orange

“This is a sign of liver dysfunction,” warns Terry. If your urine is this colour and you notice that your stools are white, it could be obstructive jaundice. Put down that beer – it’s GP time.

Brown

Muddy-looking pee means kidney problems. “This can be a sign of serious renal disease, even a fistula,” says Terry. That’s when your bowel leaks into your bladder. Taxi to casualty now.

Red

This is really bad. Blood in your urine can mean a haemorrhage or cancer. “In anyone over 40 we assume it’s bladder cancer, unless proven otherwise,” says Terry. Get yourself to the doctor, quickly.
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Reference: http://www.menshealth.co.uk/healthy/symptoms-treatment/urine-colour-problems
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The blogger is pleased to append below comments from his most-learned e-buddy the Great Sifu Dr JB Lim on the above post:

Sunday, 27 May, 2012 10:29 PM
From: lim juboo

Thanks.

This is something we have been doing all the time by visual inspection, and chemically using dip sticks to detect for sugars, protein, acetone and other metabolites that cannot be seen using colours alone.

There are other also colours too not described here. For example, those who consume a lot of riboflavin (vitamin B 2) will have their urine turning bright orange-yellow. But that does not mean there is something wrong with their kidneys, just that the metabolites of riboflavin are being excreted out normally.

Those whose urine are frothy may indicate kidney disease, example: nephrotic syndrome as large amount of protein (proteinuria) are not retained, are thrown out. But there are other signs and symptoms too, example: fluid retention and swelling of the legs (oedema), weight loss, low blood pressure, easily free tired and unwell, etc.

So we cannot depend on color of urine alone to make a diagnosis.
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While the colour of urine can tell a lot about the renal (kidney) patho-physiology (in disease and health) in a very simple and cheap way through self examination, it should not be the only criterion in the assessment of renal health and its function. Symptoms the patient feels, and the signs the physician elicits and can see, touch, palpate, percuss (tap) or auscultate (listen) are all part of the assessment of renal diseases or any disease or in health (a small part of it).

In the colour of urine for instance, if a person drinks very little water in the last 24 hours, we can expect the urine to be concentrated, and it will be deep yellow or orange in color. This is caused by dehydration, which concentrates the urine to make it much deeper in color. The urine output is also scanty.

Depending on body weight and body surface area, environmental temperatures, humidity, metabolic rate, etc, the obligatory urine output is a minimum 800 ml a day whether or not a person drinks any fluid at all in the last 24 hours. This output volume is very crucial in our assessment on fluid nutrition and electrolyte balance.

That does not mean there is something wrong with his kidneys or bladder. If he drinks a lot of water, the urine will almost be colorless. There is nothing wrong with that.

Foods and drugs that colour:
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Then again some foods like beet root, fava beans, rhubarb, senna, and also some food dyes can also color the urine, making it red or pink. That does not mean blood is passed out unless in cancers of the urogenital system.

There are certain drugs such as phenazopyridine, sulfasalazine, and antibiotics like rifampin that also colour the urine. So are other medications like antimalarial drugs chloroquine and primaquine, and metronidazole, nitrofurantoin, and laxatives containing cascara or senna, and methocarbamol. All these color the urine. Other medications including amitriptyline, indomethacin (Indocin) and propofol (Diprivan) may cause urine to become blue, green, or other colours. It is just the color of the drug breakdown (metabolites) in the body.

Similarly, orange coloured urine can indicate disorders with the liver or bile duct, but this is usually accompanied by pale-colored stools.

While colour of urine gives a good and simple guide on kidney, liver and body health, that should not the only diagnostic criterion.

Urinary FEME:

One of the simplest lab tests using only a microscope is a urinary FEME (Full Examination, Microscopic Examination) also called a microscopic urinalysis. It involves the physical and/or chemical examination of the urine. This test looks for suspended sediment like crystals, casts, squamous cells, blood cells and other large objects under a low power of a microscope.
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Renal Profile Tests:
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More elaborate urinalysis consists of chemical and microscopic tests to screen for urinary tract infections, renal (kidney) disease, and diseases of other organs that result in the appearance of abnormal metabolites (break-down products) in the urine.
Urinalysis can reveal diseases that may have gone unnoticed because they do not produce striking signs or symptoms or colours of the urine. Examples include diabetes mellitus, various classes of glomerulonephritis, and chronic urinary tract infections.

However all routine urinalysis must begin with a simple physical examination of the urine sample such as colour, appearance and frothiness. The urine is then examined for urine sediments by urinary FEME. Examination of urinary sediments gives the physician an idea of urinary tract morphology in order to get better diagnosis and prognosis later.

These are simple tests before more elaborate renal function tests need to be done to look for concentrations of the waste substances like creatinine and urea as well as electrolytes. These measures are adequate to determine whether a patient is suffering from kidney disease.

Renal function tests:

In renal profile tests that can only be done in a clinical biochemistry lab, blood urea nitrogen (BUN) and creatinine are determined. This is normally not be elevated above the normal range until the kidneys have lost about 60% of its function. A better assessment for renal function is to determine the glomerular filtration rate and creatinine clearance.

Another prognostic marker for kidney disease is a raised level of protein in the urine. The most sensitive marker of proteinuria (protein in the urine) is to detect urine albumin. Its presence of more than 30 mg albumin per gram creatinine in the urine over a 24 hour period is diagnostic of chronic kidney disease.

Microalbumin:

The presence of microalbuminuria in the range of 30–299 mg/g may be indicative of renal damage - an end organ target of high blood pressure (example). A concentration of albumin in the urine is not detected by usual urine dipstick method. A good biochemical lab is needed for this.

Neither can micro albumin be detected by any colour in the urine except perhaps the presence of large amounts of blood in the urine. Small amounts of blood may easily be seen under a microscope for the presence of erythrocytes or red blood corpuscles (RBC).

Ultrasonography:

Of course the morphology of the kidneys and bladder for shape, size and other deformity cannot be detected biochemically. Special contrast x-rays, ultrasound and other imaging techniques are needed. But that is another story, and we shall not discuss this here.

Comments by:
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jb lim

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Friday, May 25, 2012

Where To Live When You Retire?

No NURSING HOME FOR me!!!

We'll be checking into a Holiday Inn!

With the average cost for a nursing home care costing $188.00 per day, there is a better way when we get old and too feeble.

I've already checked on reservations at the Holiday Inn.

For a combined long term stay discount and senior discount, it's $59.23 per night.

Breakfast is included, and some have happy hours in the afternoon.

That leaves $128.77 a day for lunch and dinner in any restaurant we want, or room service, laundry, gratuities and special TV movies.

Plus, they provide a spa, swimming pool, a workout room, a lounge and washer-dryer, etc.

Most have free toothpaste and razors, and all have free shampoo and soap.

$5 worth of tips a day you'll have the entire staff scrambling to help you.

They treat you like a customer, not a patient.

There's a city bus stop out front, and seniors ride free.

The handicap bus will also pick you up (if you fake a decent limp).

To meet other nice people, call a church bus on Sundays.

For a change of scenery, take the airport shuttle bus and eat at one of the nice restaurants there.

While you're at the airport, fly somewhere. Otherwise, the cash keeps building up.

It takes months to get into decent nursing homes. Holiday Inn will take your reservation today.

And you're not stuck in one place forever -- you can move from Inn to Inn, or even from city to city.

Want to see Hawaii? They have Holiday Inn there too.

TV broken? Light bulbs need changing? Need a mattress replaced? No problem.. They fix everything, and apologize for the inconvenience.

The Inn has a night security person and daily room service. The maid checks to see if you are ok. If not, they'll call an ambulance or the undertaker.

If you fall and break a hip, Medicare will pay for the hip, and Holiday Inn will upgrade you to a suite for the rest of your life.

And no worries about visits from family. They will always be glad to find you, and probably check in for a few days mini-vacation.

The grandkids can use the pool.

What more could I ask for?

So, when I reach that golden age, I'll face it with a grin.




Thursday, May 24, 2012

God Has Such a Sense of Humour

A woman was at work when she received a phone call that her small daughter was very sick with a fever. She left work and stopped by the pharmacy to get some medication.

She got back to her car and found that she had locked her keys in the car. She didn't know what to do.

She called home and told the baby sitter what had happened.

The baby sitter told her that the fever was getting worse. She said: "You might find a coat hanger and use that to open the door."

The woman looked around and found an old rusty coat hanger that had been left on the ground, possibly by someone else who at some time had locked their keys in their car.

She looked at the hanger and said: "I don't know how to use this."

She bowed her head and asked God to send her HELP.

Within five minutes a beat up old motorcycle pulled up. A bearded man who was wearing an old biker skull rag on his head. The woman thought: "This is what you sent to help me?" However, she was desperate. She was also very thankful!

The man got off of his cycle and asked if he could help. She said: "Yes, my daughter is very sick. I stopped to get her some medication and I’ve locked my keys in my car. I must get home to her. Please, can you use this hanger to unlock my car?"

He said: "Sure." He walked over to the car, and in less than a minute the car was opened.

She hugged the man and through her tears she said: "Thank You SO Much! You are a very nice man."

The man replied: "Lady, I am NOT a nice man. I just got out of PRISON yesterday, I was in prison for car theft.”

The woman hugged the man again and with sobbing tears cried out loud:

"Oh, thank you God! You even sent me a Professional !!"

(Courtesy of forwarded mail from David Chen)

Things to Know

In the 1400's a law was set forth in England that a man was allowed to beat his wife with a stick no thicker than his thumb.
Hence we have 'the rule of thumb'.
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Many years ago in Scotland, a new game was invented.
It was ruled 'Gentlemen Only....Ladies Forbidden'.
And thus, the word GOLF entered into the English language.
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The first couple to be shown in bed together on prime time TV was Fred and Wilma Flintstone.
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Each king in a deck of playing cards represents
A great king from history:
Spades - King David
Hearts - Charlemagne
Clubs -Alexander, the Great
Diamonds - Julius Caesar
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111,111,111 x
111,111,111 = 12,345,678,987, 654,321
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If a statue in the park of a person on a horse has both front legs in the air, the person died in battle.
If the horse has one front leg in the air, the person died because of wounds received in battle.
If the horse has all four legs on the ground, the person died
Of natural causes.
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Q. If you were to spell out numbers, how far would you have to go until you would find the letter 'A'?
A. One thousand
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Q. What do bulletproof vests, fire escapes, windshield wipers and laser printers have in common?
A. All were invented by women.
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Q. What is the only food that doesn't spoil?
A. Honey
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In Shakespeare's time, mattresses were secured on bed frames by ropes.
When you pulled on the ropes, the mattress tightened,
Making the bed firmer to sleep on.
Hence the phrase...'Goodnight, sleep tight'.
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It was the accepted practice in Babylon 4,000 years ago that for a month after the wedding, the bride's father would supply his son-in-law with all the mead he could drink. Mead is a honey beer and because their calendar was lunar based, this period was called the honey month, which we know today as the honeymoon.
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In English pubs, ale is ordered by pints and quarts....
So in old England, when customers got unruly, the bartender would yell at them: 'Mind your pints and quarts, and settle down. It's where we get the phrase: 'mind your P's and Q's'.
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Many years ago in England, pub frequenters had a whistle baked into the rim, or handle, of their ceramic cups. When they needed a refill, they used the whistle to get some service.
'Wet your whistle’ is the phrase inspired by this practice.
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(Courtesy of forwarded mail from Chan Chun Mun)

婚前婚後的差別

以前提到結婚,想到「天長地久」;現在提到結婚,想到「能撐多久」。
當初會結婚,說是「看上眼」;後來會離婚,說是「看走眼」。
婚前,愛情是神話;婚後,愛情是笑話。
男人花錢,是為了讓女人高興;女人花錢,是因為男人讓她不高興。
嫁入「豪門」,要懂得理財; 嫁入「寒門」,要懂得生財。
以前的人,視婚姻生活為「一輩子」;現代的人,視婚姻生活為「一陣子」。
婚前,男人在餐廳等女人; 婚後,女人在客廳等男人。
婚前,男人經常找女人「討論」; 婚後,男人只告訴女人「結論」。
婚前,男人對她悄悄講話; 婚後,男人對她大聲講話。
戀愛時,情話綿綿; 結婚後,謊話連連。
戀愛時的男人,喜歡「毛手毛腳」;結婚後的男人,變成「沒手沒腳」。
婚前,情侶做什麼都是「浪漫」;婚後,夫妻做什麼都是「浪費」。
想結婚,是自己已能獨立; 想離婚,是子女已獨立。
婚前的男人,大都很幽默;婚後的男人,大都很沉默。
女人的記性,吵架時最好; 男人的耐性,結婚後最差。
戀愛時,一見面就「親嘴」; 結婚後,一見面就「鬥嘴」。
婚前,男人常給女人「空白支票」;婚後,男人常給女人「空頭支票」。
戀愛時,生活「妙不可言」; 結婚後,日子「苦不堪言」。
婚前,男人天天盯著女人; 婚後,女人天天盯著男人。
熱戀時,總相許下輩子再結良緣;結婚後,懷疑上輩子造作孽緣。
大男人,會「作威作福」; 好男人,會「作牛作馬」。
婚前,「謊話」都是「情話」; 婚後,「情話」都是「廢話」。
婚前,靠近一點;婚後,閃開一點。
婚前,沒話找話說; 婚後,有話也不說。
「成功」?對男人的定義是指能賺很多的錢, 對女人的定義是指能花很多的錢。
男人有錢就變壞,女人變壞就有錢。
男人沒有女人,耳根清淨; 女人沒有男人,居家乾淨。
男人「入錯行」,上班會很痛苦;女人「嫁錯郎」,下班會很痛苦。
好女人,養壞男人的胃口; 壞女人,吊足男人的胃口。
婚前,男人像傳令兵;婚後,男人像指揮官。
失戀不見得是世界末日: 你的心也許會「泣血」,你的荷包卻可以不再「失血」。
(Courtesy of Facebook posting by Chin Mee Poon)

Wednesday, May 23, 2012

Office Environment

(Courtesy of forwarded mail from CK Cheong)

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