Medical | GOQii

September 14, 2017 By Dr Akshat Chadha 1 Comment

When was the last time you had a complete health check?

The week began on a sad note. Monday morning was a morning, I would like to erase out of my memory as soon as possible. I was sitting at the breakfast table with my wife when I got a call from my mom saying that one of my cousins-Raj had suffered a major heart attack and had passed away even before reaching the hospital. It was an untimely death. He was barely 40 years of age, young and happy with no major worries. Nobody, in the family, had seen this coming, not even his wife.

He displayed no signs of stress, worry or any kind of illness. He was not fat nor did he lead a sedentary lifestyle. Then what happened? This thought kept bothering me ever since I heard of what had happened. Being a Doctor, I was determined to delve deep to find the root cause of the problem. After probing some of the family members, I found that there was a family history of heart disease and diabetes. Despite this, he had not done a single blood check in the last 3 years. Whenever I would enquire about getting a health checkup, he would brush it aside and say, “I am healthy and I do not see a need to get pricked unnecessarily”.

What upsets me more is that we are a family of doctors and within my own family, I have people who think otherwise about health check-ups and feel it’s unnecessary to have one done regularly more so when you do not display any symptoms of illness. The importance of health checkups is highlighted only when you encounter health problems you really can’t predict. Isn’t it better to be safe than sorry later?

Let me be loud and clear here when I say there is a reason why blood tests have been invented and have a huge diagnostic value. But, unfortunately, getting a blood test today, is considered as a money making a source for the Doctor. I don’t want to talk about blood tests today, I just want to emphasize the importance of getting a whole body check-up done once a year especially if you are over 30 years old. Timely medical checkups could make all the difference between prevention and cure; especially when each decade comes with its own set of lifestyle ailments.

What is the harm I ask? What do you have to lose? If it’s the money, then maybe you can cut down on eating out one weekend or reduce your shopping one month and instead utilize that money to get to know about your health?

A lot changes in 30 days leave alone in 365 days. We go through several ups and downs and our body goes through a lot of wear and tear process be it physical or mental. Our internal organs such as the heart, liver, kidneys are designed to work non-stop and there is no harm in knowing the state of our organs and bones in real time so that the necessary lifestyle changes can be made if needed.

One does not have to necessarily pop pills, more often than not lifestyle changes can make a huge difference. If a machine works well with regular maintenance and check-ups then why do we leave the most important machine (our body) to chance?

You need to listen to your body, feel the pain when it happens, and address the breakdown in a way to avoid its re-occurrence. You need to give your body a good fighting chance by living a good healthy life which is supported by well-functioning internal organs.

Personally, a good comprehensive screening package including CBC ( Complete Blood Count), Lipids, Renal (Kidney) and Liver profile, Sugar tests, Thyroid and basic Vitamins like D and B12 is a must for every individual once a year even if he or she is absolutely healthy. Make sure you are working fine inside so that you can do everything you want outside.

Age is not a factor. Anybody at the age of 30 years and above should get their blood tests done once a year at least. This is an excellent comprehensive screening of your entire body including heart, liver, and kidney along with important vitamins. We are putting in a lot of effort taking care of our bodies but, if our organs don’t support it then we will always fall short of results.

The prerequisite for leading a healthy life is a comprehensive health check-up once a year.

September 9, 2017 By Dr Ashwin Nanda 2 Comments

Know all about Dengue and Chikungunya and how to prevent it

Chikungunya and Dengue have created havoc in the capital city of Delhi and certain other parts of the country. The death toll from the two vector-borne diseases has been climbing every day even as the number of affected people crossed 2,800. It has been reported that according to the National Vector Borne Disease Control Programme (NVBDCP), the number of chikungunya cases in Delhi had spiked to over 2000 till September 11 as fever clinics in the city continue to be swamped with patients.

The World Health Organisation has said that in recent years, globalisation of travel and trade, unplanned urbanisation and environmental challenges including climate change has had a “significant” impact on transmission of vector-borne diseases.

However, the key to averting such an adverse outcome is timely diagnosis and appropriate monitoring along with supportive care.

Let me begin with the basics about dengue and chikungunya…….the culprit for both is the Aedes aegypti mosquito and hence a person can be infected with both diseases simultaneously by its bite. Viruses are the cause of both problems, which enter the mosquito when it bites a human suffering from dengue or chikungunya.

The most likely time for this mosquito to bite is 2 hrs after sunrise and 2 hrs before sunset but, probability of a bite occurring is anytime during daylight hours. So it’s active during the time when most of us are also likely to be outdoors.

Chikungunya begins with sudden onset of high fever, ranging from 101 to 105 degree Fahrenheit accompanied by severe pain in joints. Other symptoms like chills, headache, fatigue, abdominal pain, nausea, vomiting, diarrhea, reduced appetite and conjunctivitis can also be seen. Rash occurs typically on day 2 or 3 when the fever has subsided along with itching.

The Complete Blood Count (CBC) may show reduction in the total White cell count and platelet count, though neither are severe nor life threatening. IgM (Immunoglobulin M) antibody against Chikungunya can be detected in blood after 5 days till months after onset of symptoms. Joint pains and stiffness can last for weeks or months and can be distressing.

Treatment involves paracetamol to control fever, although NSAIDS (Non-Steroidal Anti Inflammatory Drugs like Brufen and diclofenac) may be needed to reduce fever and joint pains as paracetamol may not suffice. Ice compress on the joints can reduce pain. Ensuring water intake of at least 3 liters/day for adults is a must to counter the dehydration resulting from high fever. Antihistamines reduce the rash and itching. Extreme joint pains get relieved by oral steroids.

Dengue is equally dangerous and spreading. According to New Johns Hopkins Bloomberg School of Public Health’s research finds that the Dengue virus is the most rapidly spreading virus transmitted by mosquitoes and is a major source of illness in the tropics and subtropics, infecting as many as 400 million people annually.

Dengue symptoms are no different from Chikungunya. Both have similar onset with high grade fever (102 to 105 degree fahrenheit), headaches especially behind the eyes, back pain, muscle & joint pains, weakness. Rash can also occur. Cold and cough, vomiting and diarrhoea may accompany other symptoms. The diagnosis can be done through blood tests like Dengue NS1 which comes positive during first 3 days of fever & Dengue IgM which is detected from 5^th to 7^th day from onset of fever.

Treatment of uncomplicated dengue is same as chikungunya. Hospitalization is a must in worsened abdominal pain & vomiting, significant fall in blood pressure, breathlessness and platelet count going lower than 30,000. Platelet transfusions may be needed along with fluid infusion.

There are no antiviral medicines yet for dengue and chikungunya. Prevention of mosquito bites is the easiest way of avoiding these diseases, wearing full length shirts & trousers helps, applying mosquito repellent & using mosquito nets goes a long way in avoiding bites.

The Aedes aegypti mosquito breeds in stagnant fresh water which is avoidable by disposing used plastic bottles & discarded tyres properly. Pooling in plant trays and coolers also needs to be prevented. Also one should cover water containers that can be mosquito breeding grounds.

August 16, 2017 By Trishala Chopra 1 Comment

Effect of different medications on exercise!

statins (1) (2)

Either you or somebody you know might be on some kind of long term medications! I am not talking about somebody who takes an aspirin or a paracetamol or some antipyretic. When I say long term medications-I am talking about cholesterol, blood pressure and blood sugar lowering drugs. When a patient usually gets on any of these drugs there are high chances that they are on them forever!

Each one of these medications has a tremendous impact on the body which comes as a blow if you an exercise person!

Every medication has a different set of action, here are some points for you to keep in mind!

(1) Cholesterol medications

statins

Most commonly used cholesterol medication is statin.
The generic names of these drugs mostly available are Rosuvastatin, Atorvastatin, Fluvastatin, Lovastatin, Pravastatin, Simvastatin, Pitavastatin.

(To check which statin is your medication- check behind the tablet. Salt name is always mentioned. If in case it is not mentioned, check it on company’s site)

Statins deplete CoEnzyme Q10 in the body which is very important for muscles to make energy. This will affect your strength training routine. Post strength training recovery will be slow.
It might also lead to rhabdomyolysis which means muscle death is definitely not good!

So, what can be done?

The first thing which you should always try is getting off statins as soon as possible with some changes in your diet and exercise routine. You can ask your coach to help you with this! (Let your doctor change your medicines and coach can guide the path to that!)
While you are on a statin, you should always try a gradual progress. Do not rush into any kind of exercise routine. Give your body enough time to get adapted.
Take longer recovery time. Instead of having a 1-day gap between your strength training schedules you can take 2 days gap which will give your muscles more time to recover! You can do light workouts on the day when you don’t plan to do strength training.

(2) Beta blockers

beta blocker

This is a group of medications used for lowering down the high blood pressure.
Most commonly used beta blockers are atenolol, bisoprolol, propranolol, metroporolol.

(To check which beta blocker is your medication- check behind the tablet. Salt name is always mentioned. If in case it is not mentioned, check it on company’s site)

People who are on beta blockers see that their heart rate is always less no matter what form of exercise they do. Maintaining a proper heart rate during different activities is very important for having a good cardiac health.
People taking beta blockers witness that their heart rate after a sprint and after a moderate jogging is exactly the same. In fact, this shouldn’t be the case. It has to be more while sprinting than jogging.

So, what can be done?

Instead of checking your heart rate for your exercise progress, start checking your exertion timing.
If you start panting very soon, note that time. Work on your stamina and then go ahead. Beta blockers will always keep your heart rate low.

(3) ACE inhibitors

pharmacology-of-ace-inhibitors

These are another set of medications which are used in the treatment of lowering your high blood pressure!
Most commonly used ACE inhibitors are fosinopril, lisinopril, quinapril.

(To check which ACE inhibitor is your medication- check behind the tablet. The salt name is always mentioned. If in case it is not mentioned, check it on company’s site)

There are 2 types of people- One who has high blood pressure and is not taking any medication and another one who has high blood pressure and is on either beta blocker or ace inhibitor. If the person without the medication exercises, his blood pressure will come down automatically post exercise. This is called as post exercise hypotension.
This even happens with someone who is a blood pressure medication, but then it can go really very low! That’s the reason people feel dizzy, shaky, nauseous, blurred vision post exercise. Sometimes the person can faint as well.

So, what can be done?

For obvious reasons, you cannot skip the medications and neither can you skip your workout but you can definitely manage it.
For people on BP medications, you should cool down a bit longer than an average person. Instead of a 5-minute cooldown, do a 10-minute cooldown.
Your heart beat tracker can help you in this!
For example, if your heart rate is 140 beats per minute- Post workout it can drop to 110 which is ok. After another minute it might go further low to 90. Hold on. Breathe it. Stretch yourself. Your targeted heart beat should be only 10% more than your RHR (Resting heart rate) which is around 60-70 beats per minute.

(4) Blood sugar lowering medications

lower blood sugar

There are different blood sugar lowering medications which affect the body in different ways.
Either they increase the insulin function, or removes excess sugar out through urine or decreases the amount of carbohydrate absorption in the body
For a non-diabetic person, while exercising there are different hormonal fluctuation which happens. Adrenaline is released followed by a surge in the cortisol levels and these hormones rise the blood sugar levels. To bring this down, pancreas secretes another hormone called as insulin which brings the elevated sugars down. So, the fluctuation is not seen whereas this is not the case in people with diabetes.
Some medications can cause hypoglycemia (Blood sugars below 70) in diabetics.

So, what can be done?

Well, in this case, nothing much can be done apart from monitoring.
Check your blood sugar levels before exercising, middle of the exercise and after the workout gets over.
Keep half glass of fruit juice or 1 glass of milk always with you and if the sugar drops please consume either of this.
Do strength training, reduce your carbohydrates, add enough proteins to your routine and ask your doctor to reduce your medications!

Questions for me? Please drop in the comments below!

August 8, 2017 By Dr Darshana Salve 2 Comments

Snooze off fatigue!

fatigue

The alarm is set for 6 am to go for a morning walk, filled with determination to start on a routine walk from the next morning, she went to sleep early. But, like any other day, the alarm went off but, as usual, she couldn’t get out of bed. With each passing day, it got difficult even to get up for work. This happened almost for 2-3 months when Ananya realized this was not just laziness but something beyond and decided to see the doctor.

Ananya described that she had no energy to wake up in the morning and felt tired and exhausted by the end of the day. Sounds familiar??!! Yes, this happens to many around us or even to us. This Syndrome is called fatigue.

Fatigue is generally defined as a feeling of lack of energy and motivation that can be physical, mental or both. Fatigue is very common. Fatigue can be caused by Physical (around 60%) as well as Mental causes (40%). Unfortunately, it can also occur in normal individuals that experience intense physical or mental activity (or both).

However, in contrast to fatigue that occurs with some diseases and syndromes, normal fatigue in healthy individuals is quickly relieved in few hours to about a day when the physical or mental activity is reduced and adequate rest is taken.

So what are the most common causes of fatigue??

fatigue 1

Sleep Problems-Sleep Apnea, insomnia working in shifts or work shift changes, pregnancy, extra night hours at “work”, gadget time. For such problems, including foods like nuts or milk that are rich in tryptophan (sleep inducing hormone) can help get better sleep.
Dysglycemia – Skipping Breakfast, long gaps between meals is known to cause irregular fluctuations in sugar levels. To avoid such irregularities one must have a healthy breakfast every day preferably within one hour of waking up. Always plan for a mid-meal snack especially when the gap exceeds 5 hours.
Nutritional deficiency – Eating a healthy, balanced diet (proteins, carbohydrates, fats and fibre) is an important part of maintaining good health, and can help you feel your best. Include fruits, whole grains, and protein rich foods and avoid junk food, processed/packaged food.
Gut disturbances – An acidic body doesn’t allow oxygen to be absorbed and in turn causes fatigue. Gastric issues like bloating, constipation, food sensitivity/allergy, leaky gut (gastric reflux) all create havoc in our body resulting in physical and mental fatigue. Including adequate quantity of fibre, probiotics like curd and a good intake of water keep your gut happy and healthy.
Caffeine overload – Limit tea/coffee/green tea to 2 cups/day. Avoid having it post sunset and near bed time.
Dehydration – When dehydrated, the fluid loss causes a drop in blood volume, which makes the heart work harder to push oxygen and nutrients through the bloodstream to the brain, skin, and muscles. Maintaining a water intake to 2.5-3 litre is adequate for the majority of the population.
Metabolic/endocrine causes – Vitamin D deficiency, Hypothyroidism, Diabetes, Electrolyte abnormalities, kidney disease, Liver disease can all cause varying degrees of fatigue.
Anemia (Iron deficiency, Vitamin B12 deficiency) – It is one of the most common reasons of fatigue or tiredness in India and especially common amongst the women.
Infectious diseases -Viral infections, Hepatitis, Tuberculosis, cytomegalovirus (CMV), HIV infection, Influenza (flu), Malaria and many other infectious diseases.
Medications –It might come as a surprise to you but many drugs like antidepressants, anti-anxiety medications, sedatives, antihistamines, steroids and even some blood pressure medications can cause fatigue.
Mental Health (psychiatric) –Stress, Depression, Anxiety, Drug abuse, Alcohol abuse, eating disorders, (for example bulimia/anorexia), Grief and Bereavement are all few of the most ignored causes of fatigue. Awareness and proactive management of mental disorders is a must for living healthy.

Depending on the above reasons, the right treatment must be decided as it is important that the root cause of fatigue be treated and not just the symptom.

fatigue 3

In the case of Ananya, on taking a proper history and some blood tests, she was found to have nutritional and Vitamin D deficiency. Once these were corrected she felt strong and active enough to start with her healthy regime.

Fatigue is a natural part of all our lives, because of which we tend to ignore it and instead learn to live with it which in the long run causes more trouble. We must look out for tell-tale signs of things we could do earlier but can’t do anymore, unrelated aches and pains or headaches and if found positive we must seek the right help. Don’t let feeling tired today ruin your attempt to feel healthy tomorrow!