[Note: Sandip Shah is fully identified to us. --Paul]

Dear Mr.Paul,

Hello.How are you ? I hope you are fine as usual.
One of my very close friend's wife has a problem of
Rhumetism ( RA +ve )for last one and half years. Her
history is as per under.

Name : Mrs.Chhaya Shah
Age : 48 Years
Weight : 85 Kgs.
Height : 153 Cm.
Blood Pressure : Sometimes it goes to systolic 90 and
distolic 60 level.

Treatment : She is taking one Calcium tablet daily and
takes pain killer only when the pain
becomes unbearable.
Problem : Acute pain in all the joints in the
morning hours which subsides as the day
progresses.Little pain in all the time
in all the joints.She is confined to home
and does not go out.

I request you to suggest her better treatment please.

Looking forward to hear from you soon.

Thanks & Best Regards

Sandip Shah

[The most important factor in the information that you have given is that this
woman has a BMI (body-mass index) of 36.3 and is thus, well into the obese range
(which begins at a BMI of 30). All her extra fat tissue is producing
inflammatory cytokines and her weight is huge stresses on her supporting joints.
The first and most important therapy for her is weight loss and without it any
other therapy is not likely to be effective in helping her.

With respect to her blood pressure, I find it amazing that her readings go as
low as 90/60 at her level of obesity. Normally this would not be a level which
should be of concern. For example, 90/60 is the standard blood pressure reading
for both me and Kitty when sitting relaxed. However, for an obese person such a
low blood pressure may be indicative of a hypothyroid condition. (Does she
exhibit considerable weakness and fatigue? You also have not mentioned her pulse
rate.)

If she has not done so, she should have a comprehensive set of blood tests
including all major hormone axes. There may be early signs of diabetes and other
deteriorating conditions that are seen with obesity.

For details on Obesity and accomplishing weight reduction see:

http://www.lef.org/protocols/prtcl-083.shtml

for details on Arthritis see:

http://www.lef.org/protocols/prtcl-013.shtml

and for details of Thyroid Deficiency see:

http://www.lef.org/protocols/prtcl-104.shtml

--Paul]