Dr Ashwin Nanda, Author at GOQii

May 22, 2017 By Dr Ashwin Nanda 2 Comments

Tension or HYPERTENSION

I can’t count how many times in my 12 years of medical practice, a patient with just a headache has eventually been diagnosed with high blood pressure (hypertension). Whenever a patient complains of headache, I always make it a point to check his/her blood pressure (BP) as it is a very common symptom of fluctuating BP which presents usually around the temples but can also be on the back of the head (occipital region).

Do we know what’s blood pressure?

The pressure exerted by the column of blood flowing in the arteries once it has been pumped by the heart is called the systolic (higher value) blood pressure. Diastolic (lower value) BP is the resistance in the arteries which is always present due to the elastic tone of the arteries. A blood pressure of upto 120/80 is considered normal. Readings from 130/90 to 140/90 are the pre-hypertensive stage and above 140/90 is considered hypertension. If three readings on separate days are high, then the person is diagnosed with high BP.

If I have to look for, then the following symptoms should raise the suspicion of high blood pressure:

Headache
Feeling of tiredness.
Difficulty in breathing
Heaviness in the eyes / blurred vision.
Irritability
Irritability
In rare cases it may directly present as a complication of prolonged high BP like heart attack or hemorrhagic stroke.

High BP is a very common issue in adults over 50 years of age and is increasingly being diagnosed in younger age group due to bad lifestyle choices such as not getting adequate sleep on a regular basis, eating high salt content food, smoking, being overweight due to lack of exercise and eating junk food in excess. Extremely high stress levels arising from chaotic traffic in metros to financial strain and challenging deadlines set at workplace also contribute to high BP. Rarely, BP can be high due to secondary causes like thyroid disorders and narrowing of blood supply to the kidneys (Renal Artery Stenosis).

Why is it important to maintain your BP in the normal range?

Constantly high BP starts damaging the internal lining of blood vessels and gradually affects the brain, kidneys and eyes causing stroke, renal failure and hypertensive retinopathy respectively. All complications can be averted by controlling the BP.

How can one manage High BP?

Since lifestyle choices are the single most significant factor in controlling BP without medication, I will emphasize on them.

Sleeping regularly by 11 pm and waking up around 6 or 7 am is a habit, I can’t emphasize enough. Following the circadian rhythm (body clock) is an easy way to avoid raised BP.
Restrict salty foods such as chips, salted nuts, papad, pickles, processed sauces and dips.
Regular cardio exercise goes the longest way in keeping the heart healthy and preventing high BP. 45 minutes of brisk walking / 30 minutes of swimming or cycling or an aerobics session of 30 minutes suffice.
Weight reduction is essential for anyone with obesity and hypertension. The target should be 1 -2 kgs weight loss every month till BMI (body mass index) is 25.
Deep breathing /meditation helps negate mental stress. I strongly advise people to set realistic goals in personal and professional realms to avoid stress since unrealistic goals make life miserable.
Having a healthy social life is also necessary.

If the above non-pharmacological measures do not reduce BP at least in 6 months, one needs to consult a physician and explore the medication option. If the cause of hypertension is secondary (thyroid and renal artery stenosis) then treatment of the cause helps in correcting the raised BP.

Even the word hyperTENSION (high BP) has TENSION in it, so reduce Stress and start making your heart healthy today!

January 9, 2017 By Dr Ashwin Nanda 1 Comment

You are as ‘Old’ as your Prostate

Mr Rebello, sitting in front of me recalled his plight of waking up 2-3 times every night to void urine instead of only once as before. Initially, he assumed it was due to winter but, when the problem persisted in summer as well, he blamed it on his poorly controlled diabetes. He was 65 yrs of age when he began to experience this. He didn’t bother visiting his physician since he had made peace with his high blood sugars as he had no control over his eating habits.

How he wished he hadn’t assumed and instead consulted his physician. After 2 yrs he moved to another city and didn’t feel up to the task of finding a new physician to follow up with. Five years down the line, after his 70th birthday, he began experiencing lower back pain which he again concluded was due to ageing. Only when the pain became persistent and unbearable, he met an Orthopedic who after examination and X-rays diagnosed him with a collapsed vertebral fracture. He was crestfallen when the cause of his vertebral fracture was pinned down to ‘PROSTATE CANCER’.

Going back to the time when Mr Rebello was 65 yrs old, he overlooked the fact that the frequency of urination was normal during the day. Had high sugar been the cause, the issue would have bothered him during the day as well. Actually, this was the first symptom that his prostate gland was enlarged. Undiagnosed and untreated over 5 yrs the non-cancerous enlargement of the prostate had turned cancerous and spread to his backbone.

Let’s try to make sense about what the prostate gland is, its enlargement and when does it translate into cancer.

The Prostate Gland: Location in the body and function.

The image below shows the location of the prostate gland in the body which is present only in males. It is located below the urinary bladder. The prostate secretes the fluid that nourishes and protects sperms. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperms as semen. In the prostatic cells, the male sex hormone testosterone gets converted to dihydrotestosterone (DHT) which causes the cells to grow resulting in an increase in its size.

Normally, the prostate gland is approximately the size of a walnut. As the size increases with age (which can start as early as 40 yrs) it starts to obstruct the urine outflow as shown in the image.

Symptoms of Prostatic enlargement:

A weak or slow urinary stream.
A feeling of incomplete bladder emptying.
Difficulty starting urination.
Frequent urination.
The urgency to urinate.
Getting up frequently at night to urinate.
A urinary stream that starts and stops.
Straining to urinate.

Medically enlarged prostate which is not cancerous is called Benign Prostatic Hyperplasia (BPH).

As the gland keeps getting enlarged, there are mutations in the DNA of its cells causing it to grow uncontrolled and abnormally resulting in cancer.

The saving grace in this entire process is that prostatic enlargement can be diagnosed early and controlled thereby preventing cancer.

DIAGNOSTIC MODALITIES:

Sonography of the prostate gland is advised once a man turns 50 yrs to establish if enlargement has started. If there is a family history of prostate cancer then it should be done as early as 40 yrs.
A blood test called Prostate Specific Antigen(PSA) should be done. Very high values are suggestive of cancer whereas in the enlargement phase the values remain < 4 units.

If you are facing any of the above symptoms, you must visit a Urologist who will diagnose and prescribe medication for the same. Incase medicines are not effective, one might have to opt for surgery.

In Mr Rebello’s case, since cancer had already developed, radiotherapy was first given to shrink the size of the prostate, post which surgery was performed to remove the cancerous gland. Cancer which had spread to his backbone was controlled by a combination of chemo and hormonal therapy.

Risk Factors for prostatic enlargement and cancer:

Age – prevalence increases markedly with age. The gland grows at a rate of 2 – 2.5 % annually in older men.

Genetics – 50% men undergoing surgery for BPH < 60 yrs of age have inheritable form of the disease.

PREVENTION:

Apart from timely diagnosis and treatment, being physically active, controlling Diabetes and weight are known to reduce enlargement of the gland. Diet rich in antioxidants and vitamins is also beneficial in prevention along with avoiding red meat.

Image credit – prostate.net

November 14, 2016 By Dr Ashwin Nanda 2 Comments

DECODING DIABETES

Last month, I had 2 patients on the same day diagnosed with Diabetes- one an overweight 34 year old IT professional and the other a 6-year-old girl. The reason, why this incident comes to my mind today is because they were both diabetics but, had different diabetes and even their course of treatments was different.

But, the first question I was asked in both the cases was whether they will need to be put on insulin injections immediately. Well, this is a common question asked by patients. To understand this condition better, let me try and explain a bit about the different types of diabetes on the basis of which the required treatment is normally recommended.

Diabetes is a group of metabolic disorders in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin or both. Common symptoms of either diabetes are unexplained weight loss, excess hunger, and excess thirst and delayed wound healing.

Today, I would like to take you through specifically 3 major types of diabetes namely, Type 1, Type 2 and gestational Diabetes.

Let’s talk about

Type 1 Diabetes: is caused by a loss or malfunction of the insulin-producing cells in the pancreas, called beta cells. Damage to beta cells results in absence or insufficient production of insulin. Most cases of Type 1 Diabetes have an autoimmune basis in which immune system mistakenly attacks and destroys its own beta cells. These cases are detected either in childhood or teenage years. There are many theories about what causes type 1 diabetes like autoimmune disease, viral infection, genetic predisposition and environmental factors may also play a role.

Whatever be the cause, this missing insulin has to be replaced as insulin is necessary to sustain life. It is responsible for entry of glucose into the body cells from where the glucose is further utilized for energy and other activities. This glucose which is not entering the cells is circulating in the blood which gets detected as high blood sugar. The replacement insulin is administered by injection using a syringe or an insulin pump. Thanks to the invention of Insulin clubbed with a healthy lifestyle, a Type 1 diabetic is able to lead a happy good quality life.

Coming to Type 2 diabetes most often than not your tissues will be resistant to insulin, so the insulin is being produced but unfortunately not being utilized properly. It is the most common form of diabetes worldwide and accounts for 90-95% of the cases.

Insulin resistance in type 2 diabetes means the signal insulin gives to a cell is weakened. This results in less glucose uptake by muscle and fat cells and a reduction in insulin mediated activities inside cells.

Risk factors for Type 2 Diabetes include an Unhealthy Lifestyle (being physically inactive or less active, erratic food and sleep habits, stress), being overweight or obese and importantly family history of diabetes in close relatives.

We have ample medicine combinations for type 2 diabetes like tablets which keep the blood sugar under control. But if sufficient sugar control is not achieved in spite of oral medications and a healthy lifestyle, then insulin might be required for further management.

Another type of Diabetes I would like to talk about is Gestational diabetes which basically refers to diabetes diagnosed during pregnancy.

Pregnancy hormones can interfere with the way insulin works in the mother’s body which can lead to elevated blood glucose levels during pregnancy. Women are typically screened for gestational diabetes at 24-28 weeks of pregnancy, however, women who have risk factors may be screened earlier.

Risk factors for developing gestational diabetes include having a family history of diabetes, being overweight, or over 28 years old. Blood glucose control during pregnancy is critical as elevated maternal glucose levels can lead to pregnancy complications and pose risks to the health of the baby. Gestational diabetes is likely to recur during subsequent pregnancies.

Gestational diabetes requires specialized treatment for the rest of the pregnancy. After the pregnancy is over, most women will have normal blood sugars again; however, up to 20-50 % can develop type 2 diabetes within 10 years. Regular screening is recommended.

A study conducted on people at risk of type 2 diabetes, it was seen that those who lost just 7% of their weight and exercised about 30 minutes a day cut their risk of diabetes by nearly 60%. In a nutshell, irrespective of the type of diabetes the best prevention or diabetes management strategy is to eat healthy, stay active and keep a check on your weight.

Reference: University of California, San Francisco – Diabetes online Education website.

October 10, 2016 By Dr Ashwin Nanda 1 Comment

SHEDDING LIGHT ON DEPRESSION

Last year, when the famous Bollywood actress Deepika Padukone opened the lid on her struggle with anxiety and depression and admitted to the world that she was on medication for the same, it became the talk of the town. Everyone started discussing mental health, there were articles in Newspapers, TV channels interviewing the actress and asking her to tell her story. Padukone became an example for many to come out and discuss their issue without fear. Why so? Because depression and mental illness isn’t usually talked about. There is shame and stigma attached to talking about depression. Today, on world health day, I would like to share some insights into depression and what needs to be done when in that situation.

My first experience in dealing with depression was when I was still in Medical school. My very close friend from medical school went through depression. It was then I realized that one needs a lot of empathy and patience to understand what someone is going through in depression. The extreme low mood during depression is such a bad feeling that no one chooses to be depressed by choice …it’s either circumstances or medical conditions that push an individual into depression.

My friend had slipped into depression due to a heart break. The impact was so huge that he withdrew himself from studies, friends and family. He slept longer than usual 8 hours, ate less and experienced terrible mood swings. He refused to talk to anyone and eventually turned suicidal. It is at this point that we had to rush him to the psychiatry department of our college hospital.

The psychiatrist talked to my friend privately for 15 minutes and then to his parents and me privately for another 10 minutes. Then, called us all in and sat us down and explained to us that my friend was suffering from an episode of major depression and medication was a must.

None of us were comfortable that he needed medication to recover from depression but, as counseled by the doctor, avoiding medicines wasn’t an option as he was feeling suicidal. Fifteen days later he started feeling better by 10% and the counselor started weekly sessions with him on the recommendation of the Psychiatrist to expedite recovery. Thankfully my friend recovered completely to his normal self in 6 months’ time and medicines and counseling were discontinued.

It is said that one in every four people suffer from anxiety and depression. According to WHO (World Health Organization) 350 million people worldwide suffer from depression in a year. By the year 2020, it will be the second most common disorder after heart disease. The chemical changes occurring in the brain during depression is a reduction in the level of Serotonin, dopamine and nor adrenaline – these are neurotransmitters (Chemicals which are produced by brain cells).

SOME COMMON SYMPTOMS OF DEPRESSION:

Loss of interest / pleasure in activities which were previously enjoyable.
Decreased energy.
Feelings of guilt and low self – worth.
Disturbed sleep and appetite.
Poor concentration.
Substantial impairment in the person’s ability to handle his/her daily responsibilities.
At its worst it can make the person suicidal.

All symptoms are mild in the beginning and gradually increase in intensity over time.

RISK FACTORS:

Genetics – If you have an immediate family member who has experienced major depression, there is a likelihood that you will also have an episode in your lifetime.
Financial hardships and low education levels.
Female Gender – depression is two to three times more likely in women as compared to men. Depression setting in after delivery of child occurs in some cases.
Chronic illnesses like diabetes, tuberculosis, arthritis.
Exposure to violence / Abuse especially in childhood.
Being separated / divorced especially for men.

MANAGING DEPRESSION:

It is important to recognize depression and take it seriously. Going to a psychiatrist is a must

Mild cases can improve with counseling and psychological therapy (depending on the cause of depression, the person is taught coping mechanisms). Severe cases need anti-depressants along with psychological therapy. Self help is equally essential.

Some self help tips:

Create a daily routine and try to stick to it.
Exercise releases endorphins in the brain which give a feeling of happiness, hence daily exercise is a must to recover and prevent depression.
Try to eat a healthy and balanced diet daily.
Openly communicate with family members and loved ones about what you are experiencing to foster relationships and get support.
Avoid alcohol and recreational drugs as they worsen depression.
Be patient with yourself. For someone with depression even the smallest tasks can seem impossible.

Depression is treatable and plenty of help is available to assist a person cope with it and get back to leading a normal and enjoyable life.