Medical Archives

November 6, 2019 By Dr. Viral Thakkar Leave a Comment

Stroke: A Few Untouched Aspects

Stroke is the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is lost by blockage or rupture of an artery to the brain. According to the WHO, it is the second leading cause of death and the third leading cause of disability. Stroke is also a leading cause of dementia and depression. For commonly known causes of stroke, please refer to the article “Stroke: Straight Dive or Pavilion” published earlier. While you might have read a number of reasons which lead to stroke, this article focuses on the importance of emotional health to prevent stroke.

There Are 2 Main Types of Stroke

Hemorrhagic Stroke: is caused by bleeding in the brain due to a weak spot in the wall of the vessel, which can cause an aneurysm (bulging of the vessel wall). The vessels can also be weakened by chronic or very high blood pressure and break from force. When the vessel breaks, blood leaks into surrounding tissue, and the brain doesn’t get the oxygen and nutrients it needs.
Ischemic Stroke: results from blocked arteries, which often occur from cholesterol build-up, called plaque. Plaques on the inside of the vessel can be fragile when blood flows past, causing the plaque to lift. But in the blood vessel, when a plaque lifts-up and the body tries to heal it, like it would scab on your arm, it makes a clot where that plaque lifted up, which blocks blood flow and can lead to ischemic stroke.

The human body is magical. When the mind perceives a threat or stress, the body releases cortisol and adrenaline to cope with it. These hormones impact the homeostasis of the body; the other parameters get deranged and affect the healing processes of the body. Now, if your personality is to take constant stress, cortisol and level of other stress hormones will be high to ensure the body deals with stress. This could cause retention of salt which might increase blood pressure. Stress also causes an increase in blood sugar, which means the vessels can’t dilate or contract to better control blood flow. Increased cortisol is also known to disrupt sleep cycles leading to fatigue.

Anyone Can Be At Risk…

…for many reasons, not just stress. Sometimes, it just how your body responds.

While there is no concrete reason to state that positive emotions, a stress-free life or a balanced psychological state will not lead to stroke. However, there are numerous research studies to indicate that there might be a relationship between negative emotions, stress & stroke. In my practice, I have usually seen stressed people holding negative emotions fall prey to issues like stress, heart ailments, etc. A University of Michigan study found that men who were more physiologically reactive to stress were 72% more likely to suffer a stroke.

Regardless of how your life or your job is, if you feel you are stressed, you most probably are.

If you’re still unsure, ask yourself these questions:

Does your significant other tell you, you seem stressed?
You tend to pick up fights and arguments with your family and co-workers more than normal?
You resort to alcohol, drugs, smoking to alleviate stress?
Do you find less joy in things that normally make you happy?
Do you find it difficult to fall or stay asleep compared to normal?
You don’t like to get up in the morning, especially on days you know you will come across stress causing situations

If the answer to the above is yes, then it’s time for you to work on yourself. Contemplate on the reason, give attention to the little things in life… It is the little things which lead to bigger changes! Some attitude changes like acceptance and forgiveness make a lot of difference!

Quick tip: Whenever you feel stress, start taking deep breaths. Mentally count till 5 & inhale, count another 5 and exhale. Make it as slow and steady as possible. Taking in more oxygen allows more oxygen to be available to the brain tissues. Some research suggests that deep breathing helps to rehabilitate the brain after a stroke. This style of breathing also helps to relax and calm the mind and whole being.

While everyone faces issues in life, it is the ability to cope with it, be in sync with one’s body which determines health!

#BeTheForce

October 29, 2019 By Dr. Viral Thakkar Leave a Comment

Stroke: Straight Drive or Pavilion

“Doctor please help! Half of my body does not move anymore” came a slurry cry from a helpless Vinod Agrawal, a businessman. His wife stood next to him in the emergency department weeping profusely and their 16 year old son watched his parents helplessly.

When examined thoroughly, Agrawal was diagnosed with STROKE. Thanks to the lifestyles that most people lead these days, this is a common site in hospitals.

A stroke strikes when the blood supply to the brain is affected either due to blockage leading to ischemia or rupturing of vessels. Due to this the brain does not receive enough oxygen and nutrition causing cell death, which is the ideal condition for stroke.

How Does a Stroke Happen?

Ischemia: Occurs due to narrowing or blockage of blood vessels due to blood clots formed either in arteries connecting brains or other vessels or due to dislodgment of fatty deposits called plaques (atherosclerosis).
Haemorrhagic: Bursting or leaking of blood vessels which compresses the brain cells. This leakage of blood puts pressure on brain cells which is accumulated in brain due to trauma, hypertension or some blood thinning medication.
TIA- Transient Ischemic Attack (Mini Stoke): Brief episodes of stroke which is self-limiting. Blood flow is briefly interrupted and these are the warning signs of future stroke. It is like an alarm from the body.

Common Presentation of Stroke

Weakness or tingling in half or full body depending on the involved artery
Deviation of face with difficulty in speech and closure of one eye
Mental Confusion, severe headache, loss of power in the limbs

When any of the above symptoms are seen, the patient must be rushed to the hospital.

After thoroughly understanding the history and general examination, few specific tests and examination like CT scan are done to find out the cause of the stroke. The treatment is very complicated and management is done in ICU and Neurophyscican may be required.

As there are two major causes of stroke- ischemia and haemorrhage-both have different management. If ischemic– the focus is to restore adequate blood flow-clot is broken or dissolved.

If haemorrhagic -stop bleeding or leakage of blood, to reduce the pressure of brain cells. Surgical intervention may be required if there is any arterial malformation or rupture of vessels.

Rehabilitation activities like physiotherapy, speech therapy, etc help to restore the physical activities gradually.

Prevent It!

All the above symptoms and complications can be prevented if a healthy lifestyle is followed. Eat a healthy- diet which includes fresh fruits, vegetables, avoiding processed meat and avoid junk food.

Yoga, especially Pranayama, as this ensures that every cell of the body receives adequate oxygen for appropriate functioning. Pranayama rejuvenates the body cells which ensures the ideal functioning of the body.

Stress kills! Accept what life offers happily and keep working towards your goal without killing yourself.

Remember Smoking Kills — all advertisements shown are true. STOP smoking. Avoid alcohol, if you do consume it, make it minimal.

If you are hypertensive keep absolute check on blood pressure and follow all dietary and physical discipline so the blood pressure is controlled.

If one is diabetic, regular check of sugar is important.

Listen to your body. It always warns you before the disease sets in.

Stroke is an acute emergency but the root cause lies in chronic habits and patterns of life. Every moment, even at this moment of reading the blog, we can choose health or disease. Either you choose to pick up alarming signals of body and take necessary prevention to live a healthy life or be undisciplined and get hospitalized. THE CHOICE IS YOURS!

October 23, 2019 By Vickel Dubey Leave a Comment

Understanding Patient Behaviour Towards Digital Therapeutics

Are we, as patients ready to pay for an app which is intended for Therapeutic Purpose & Helping us manage our lifestyle better?

What a Patient Thinks

Ideation of this whole article took a shape while having a discussion with my father who is a Type 2 Diabetes patient. I was actually insisting him to install an app to better manage his lifestyle specifically the dietary recommendation (Since he is a banker by profession and also manages family business, day to day life is a complete mess) given by his doctor. Initially he was in agreement but when he asked me if there is any cost associated, I nodded yes. His decision changed immediately. According to him, he knows what to eat, what not to eat and on top of it, he is taking his medication (which he often forgets) so there is no need of a digital intervention. I tried to explain to him multiple times thereafter but all in vain. According to him, it’s just a waste of money.

Patient Compliance Behaviour: Medication vs Lifestyle Recommendation

This is the story of most Chronic Disease patients for whom managing their lifestyle is a crucial need. But it’s really sad to see the poor grades when it comes to be compliant of various lifestyle aspects. According to a study conducted among Indian diabetes patients, only 24.1% were aware and have been following self-blood glucose monitoring appropriately. Similarly, only 37% of the patients are adhered to the dietary prescription made by their physicians and only 35% follow up the physical exercise recommendations.

Why is it important to talk about “Patient’s Compliance Behaviour” before getting into the “Patient’s Commercial Behaviour”? The reason is that patients need a push specifically in case of chronic diseases because it’s all about care, whether it’s done by the patient himself or by a caregiver. In case of medication, the weightage is higher since it’s coming from doctors (with serious words) while in case of lifestyle, it comes as a recommendation rather than a prescription which defines the seriousness.

So, if a patient is serious enough about his disease condition and strictly follows the testing, medication and lifestyle modification, he/she doesn’t need any intervention, traditional or digital to manage his/her lifestyle but the statistics don’t reflect the same. Hence, it becomes important for patients who are not serious or moderately serious to keep engaged and motivated to adhere with the doctor’s recommendation via a push. Digital gives that push.

Now comes the commercial behaviour. There are hundreds of apps available in the market to manage your disease conditions. Some are freely available; some are coming complementary with the devices/treatment and for some, you have to lighten your pockets. Definitely the skewness is higher towards the free ones. Most of us preferred the free apps and uninstall any paid app when it asks for a payment after the trial period. But free apps have their own limitation and for better services/attributes or features, you have to pay. Same goes with the apps which are offering lifestyle management solutions for patients.

A Preliminary Investigation

To get a deeper understanding of patient’s behaviour, I conducted a small survey among diabetes patients. The survey designed on SurveyMonkey consists of 10 questions (5 open ended, 5 close ended) and shared on a few social media & chatting platforms such as Facebook, WhatsApp etc. The key questions are:

Patient’s Name
Age
Is he a diabetic patient?
If yes, is he using any online application to manage his Lifestyle?
Name of the app he is currently using
Is it a paid app?
Approximate cost of the app.
Will he pay for an app which promises to better manage lifestyle (in case the answer of Q6 is no)?
If yes, what is the approximate cost he will pay?
If no, why?

There were 43 responses received in total out of which 32 were diabetics. The outcome of the survey are as follows:

~80% of the total respondents are within the age group of 30 to 60 years
Out of total diabetes patients, only 36% are using one or another app to manage their lifestyle
Majority of the patients are using MySugar (45%) followed by Apollo Sugar (27%), GOQii (18%) and Wellthy (9%).
Only 2 out of the total patients with diabetes who are using an app have paid some amount
The approximate cost which they have paid is ~INR 2500
77% of the patients who are using an app (and answered no for Q6) are not ready to pay even if it provides a better solution, while only 23% are ready to pay.
The approximate cost which most of the patients feel comfortable to pay is INR 100-200 per month.
Free availability, YouTube videos, Advice by friends and family, waste of money etc. are some of the major reasons why people don’t want to pay for an app.

So, if we look closely, patients are quite ignorant when it comes to pay for an app. Reason, they consider it as a waste of money. This outlook needs to be changed. This perception needs to be changed. And it can only be changed when it comes as a prescription and not just a simple recommendation.

Conclusion

If a patient can spend ~INR 9,000 (from an analysis conducted by Lady Hardinge Medical College) annually for his diabetes treatment, he can definitely spend few hundred bucks to manage his lifestyle for better outcomes. But the patient also needs support from other industry stakeholders such as Pharma, Devices and payers so that the cost can be shared and patient will have to bear minimum cost burden.

January 26, 2019 By Dr Ashwin Nanda 2 Comments

Organ Donation – Gift of Life

A decade ago as a medical student, I had come across a blind man selling torches in the local trains. I asked him just out of curiosity the reason for his blindness to which he replied that he lost his sight in childhood after an accident which permanently damaged the blood supply to the retinas. He then went on to ask why I brought up the question and when I told him I was studying to be a doctor, he smiled and said, “I have a question for you”? I anticipated, he would want to know about recent advances in medicine that could probably restore his sight. But, I was wrong, instead, his question was different. His question was whether he could still donate his eyes. I was absolutely overwhelmed when he asked this. That is the day when I realized one can lose his eyesight but, still have a vision. With a sense of respect for him, I explained to him that his corneas could indeed be donated after his demise.

Organ transplantation is a marvelous procedure of modern medicine which helps the recipient gets a new lease of life. The only issue is, untimely demise of a loved one plunges the family and friends in so much grief that donating the deceased person’s organ doesn’t come to mind most times. It takes a mighty heart to brush aside the sorrow and take the step of organ donation, to give the gift of life to someone when you have lost a loved one.

Organ donation is permitted by law after a person is declared brain dead.A brain dead person has no chance of revival as all his brain activity has stopped permanently and completely. The medical fraternity follows very strict standards laid down by the Transplantation of Human Organs Act, 1994 to determine if someone is brain dead or not.

In India, it takes 4 well qualified doctors to declare brain death before a person’s organs can be harvested. The biggest hesitation in organ donation is that the body will be disfigured. The surgeon makes a single neat incision from top of the chest to the navel and after organ harvesting, it is stitched professionally and the body is handed back in the most dignified state. The organ/organs are stored in cooled containers with special preservative fluid.

Organ donation from brain dead individuals in India is very less compared to Europe and US. Live donor numbers are increasing steadily since it is possible for a relative to survive on a single kidney and even the left lobe of liver can be donated by a live donor as the liver regenerates.

2 lakh corneas are needed annually in India but only 50,000 donations happen. 5 lakh people die annually waiting for a lifesaving organ. Presumed consent for organ donation is used to increase the pool of potential donors in countries such as Austria, Belgium, Czech Republic, Finland, France, Greece, Hungary, Israel, Italy, Luxembourg, Norway, Poland, Slovenia, Spain, Sweden, Singapore and Turkey. After the death of the individuals the state becomes the custodian of the dead body, who take out the organs for transplant. Spain has the highest rate of organ donation at 36 / million. India is at 0.26/million only.

Who, What and How Can you donate?

1) Kidneys, Heart, Lungs, Liver, Small Bowel and Pancreas can be donated for transplant. Tissues that can be donated include eyes, heart valves, bone, skin, veins and tendons.

2) Every healthy person can donate. Old age is not a deterrent to donation. Person’s physical condition, not age, which is the deciding factor. Organs and tissue from people in their 70s and 80s have also been transplanted successfully.

3) Specialist health care professionals decide in each case which tissue and organs are suitable.

4) Your near and dear ones should be aware of your will to donate your organs. In case of your untimely demise they can inform concerned authorities to harvest your viable organs.

5) Kidneys, liver, heart need to be harvested within 6 hours of death whereas corneas within 12 hrs.

“Green corridor” is the term used when a lane from the airport to the hospital where the organ recipient is waiting is kept totally vacant for speedy transport of the organ by the doctor who has retrieved it from a donor in another city. The city traffic police officers go all out to ensure a smooth transit with zero stoppage. The nobleness of organ donation is highlighted by the efforts put in by them to help the cause.

Organ donation is easier said than done. This article is an attempt to increase awareness about this cause so that we all can create the mindset to be willing to donate organs. All religions promote this practice since extending life is considered an act of God.

So let’s pledge our organs and live even after we are gone.

Here are a few websites through which you can register and pledge your organs

www.mohanfoundation.org/

http://www.transplantindia.com/

donatelifeindia.org/

http://www.organindia.org/