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Cardiologists Find the Reason for Deterioration of Heart Muscle in Patients With Diabetes
by Savitha C. Muppala on March 04, 2012 at 7:52 AM Cardiologists have discovered the reason for the deterioration of heart muscle in patients with diabetes. The new research, available online and published in the March 1 issue of the Journal of Clinical Investigation, was carried out in the laboratory of Dr. Joseph Hill, director of the Harry S. Moss Heart Center at UT Southwestern. "If we can protect the heart of diabetic patients, it would be a significant breakthrough," said Dr. Hill, the study's senior author who also serves as chief of cardiology at the medical center. "These are fundamental research findings that can be applied to a patient's bedside." Cardiovascular disease is the leading cause of illness and death in patients with diabetes, which affects more than 180 million people around the world, according to the American Heart Association. Diabetes puts additional stress on the heart above and beyond that provoked by risk factors such as high blood pressure or coronary artery disease, Dr. Hill said. "Elevated glucose and the insulin-resistant diabetic state are both toxic to the heart," he said. Dr. Hill and his colleagues in this study were able to maintain heart function in mice exposed to a high fat diet by inactivating a protein called FoxO1. Previous investigations from Dr. Hill's laboratory demonstrated that FoxO proteins, a class of proteins that govern gene expression and regulate cell size, viability and metabolism, are tightly linked to the development of heart disease in mice with type 2 diabetes. "If you eliminate FoxO1, the heart is protected from the stress of diabetes and continues to function normally," Dr. Hill said. "If we can prevent FoxO1 from being overactive, then there is a chance that we can protect the hearts of patients with diabetes." Source-Eurekalert

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REACTION
Diabetes Mellitus has always been known as a type of disease which causes viscosity to the blood due to the excessive amount of glucose present in it. Due to this viscosity, it can affect the systemic circulation of the blood all throughout the body. Thus complications will eventually exist due to increased viscosity of the blood such as deterioration of the heart muscles. Its really good to know that recently, scientists have come up with a reason as to why persons with Diabetes Mellitus eventually have deterioration of heart muscles. According to them, the deterioration is due to elevated glucose and insulin resistant diabetes which is actually toxic to the heart. By inhibiting a certain protein called FoxO1 on an experimental mice exposed unto high fat diet, deterioration of the heart is more likely be prevented. According also to the article, previous investigations from a doctor named Joseph Hill were wherein in his laboratory there demonstrated that FoxO proteins, a class of proteins that govern gene expression and regulate cell size, viability and metabolism, are tightly linked to the development of heart disease in mice with type 2 diabetes mellitus. There is actually a great chance that persons with diabetes can prevent eventual heart muscle deterioration with the help of this new discovery. If this certain protein wont be overactive, then there is a greater chance in protecting the heart of diabetic patients. We definitely approve of this development that has recently occurred and it is definitely essential for the prevention of further complications such as your deterioration of the heart muscles.

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Exercise for Below-Knee Leg Amputation

May 26, 2011 | By Carrie Cronkite

Exercising after a below-the-knee amputation adds flexibility and strength, allowing for better coordination and balance when ambulating with prosthesis. Exercise also benefits your cardiovascular system, and prevents your hips and knees from acquiring a fixed bent or flexed position. In addition, strengthening your muscles can make it easier to perform activities of daily living. Hip Flexor Stretch To tone and stretch your hamstring muscles at the back of your thighs, lie on your back, grasp the thigh of your non-amputated leg with your hands and raise your knee to your chest. Do this while pushing your opposite leg down on the bed or floor. Hold this position for 20 seconds, relax and lower your leg. Repeat with your amputated limb. Do two sets of five repetitions with each limb. Alternative Stretch This exercise tones and stretches the back muscles of your amputated limb. Lie on your stomach for 20 minutes with a pillow under your amputated limb, feeling the stretch in the back of your limb. Slowly progress to a larger pillow to raise your limb higher and increase the intensity of the stretch. Adductor Stretch This exercise stretches your adductor muscles. While sitting against a wall or with your back to the head of your bed, extend your amputated limb out to the side while slightly bending your other leg. Push on the thigh of your amputated limb so that you feel the stretch in your inner thigh. Keep both sides of your buttocks on the floor or bed during this exercise, without lifting it up in the air. Relax and repeat five times. Side Hip Extension The side hip extension exercise strengthens your hip muscles. While lying on your side, extend your amputated limb straight back behind you. Hold for 20 seconds and return to starting position. Do two sets of five repetitions. Sitting Quadriceps and Hamstring Exercise While sitting in a chair that allows you to freely move your stump backwards, keep your thigh anchored on the seat of the chair. Grasp the sides of the chair for support, completely extend your amputated limb out and hold for five seconds. Relax and bend your knee back as far as possible, and hold for five seconds. Return to starting position and do two sets of five repetitions.

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Reaction
For us, this article is very helpful especially for postop patient under BKA. Exercising after any other procedure not only for BKA but also for other operations is really of great help strengthening the muscles which can help in easier performance of the daily living and promotes faster recovery. There are many different exercises mentioned in the article. These are Hip flexor stretch which helps in toning the hamstring muscles at the back of the thighs, the adductor stretch which stretches the adductor muscle. Side hip extension which strengthens the hip muscle, this is very essential to strengthen the hip muscle especially in postop BKA patient in order for the patient to develop independence sooner or later in the course of his/her treatment with. And finally the Sitting Quadriceps and Hamstring Exercise which help to develop the quadriceps and hamstring muscles.

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Bibliography
Book Sources: Black, J. and Hawks, J.H. (2008). Medical-surgical nursing: Clinical management for positive outcomes. 8th ed. Singapore: Elsevier, Inc. Brunner, S.C & Bare, B.G. (2004). Medical-surgical nursing. 10th ed. USA: Lipincott Williams & Wilkins Lemone, P. & Burke, K. (2008). Medical-surgical nursing: Critical thinking in clients care.4th ed. Upper Saddle, New Jersey: Pearson Education Inc.

Internet Sources: Cronkite, C. (2011). Exercise for Below-Knee Leg Amputation. http://www.livestrong.com/article/388408-exercise-for-below-knee-leg-amputation/. Retrieved on March 11, 2012

Muppala, S.C (2012). Cardiologists Find the Reason for Deterioration of Heart Muscle in Patients With Diabetes. http://www.medindia.net/news/cardiologists-find-the-reason-fordeterioration-of-heart-muscle-in-patients-with-diabetes-98327-1.htm. Retrieved on March 12, 2012 Quinn, E. (2006). Lower Leg Anatomy. http://sportsmedicine.about.com/cs/leg_injuries/a/leg1.htm. Retrieved on March 3, 2012

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