Until a few decades back, a family physician used to be the right answer for most healthcare situations, right from the toddler in the house to the octogenarians. Medical emergencies always have been an exception. The family physician could offer expert comprehensive medical care to people of all ages and genders, making them a preferred choice, a dear friend for the common needs of the entire family. He was a great support to all family members at almost all stages of their lives.
Unlike other medical specialists who focus on a specific medical condition, one part of the body or just an organ, a family physician has the expertise and knowledge to provide comprehensive healthcare as well as emotional support to patients of all ages. He was a health guide from infancy to late adulthood and in old age as well. That made him the go-to doctor at any point for the family.
A major role of the family physician was to educate the patients about disease prevention and health maintenance. It included focussing on both physical and emotional health, which may include stress relief, anger management, fertility counselling, weight management and nutritional counselling. For day-to-day common ailments like flu, ear infection, common allergy, draining small abscess, the family physician was the preferred go-to medical resource for the treatment.
The family doctor could help recognise potential red flags for any emerging conditions that may require prompt attention, such as diabetes, heart disease, or cancer – especially if there was a family history of the condition. If there was any need for specialist medical treatment, the family physician would refer to an appropriate specialist.
But now, with increasing medical commercialisation and consumerism, primary care is at the crossroads. The primary care delivery systems are becoming unsustainable and lack the resiliency to survive in new changing environments. In an era of specialisation, the primary care has to struggle to remain relevant and viable.
There has been an increasing inclination of patients to have opinions from specialist even for minor issues. In last few years, with greater smartphone ownership, internet connections – a bevy of apps, online medical service aggregators have started operating brazenly, advertised by superstars and celebrities, aggressively pushing for tests and surgeries – have made the ‘family doctor’ look like ‘Dr Minimalist’. There are a number of reasons why more doctors want to become specialists: competitive pressures, greater income potential, higher status among peers, greater prestige in society and patients’ demand. These factors drive the preference for specialisation. The final result is being lot of specialists, who treat an organ but too few “doctors” to treat the human body as a whole. The media insinuation against doctors has created an environment of mistrust against doctors in the community and rift in doctor-patient relationship.
In addition to basic medical services, the family physician used to act as health advisors, guiding anxious patients to the appropriate healthcare facility. In today times, one of the most effective healthcare interventions is to advise the person to “when to see a specialist doctor and when not to go”. But that friendly advice with in comfort of homely atmosphere is getting distant gradually.
The family doctor – a helping hand, a dear friend and an all-time support of is getting far away from patients in this era of medical consumerism.
If you’ve ever hiked up a mountain and felt yourself getting nauseous or lightheaded, you may have experienced altitude sickness, also called mountain sickness. This condition happens when you travel to a high altitude (elevation) too quickly.
It doesn’t happen only to hikers. Just visiting a high-altitude location can cause problems for some. Symptoms happen when your body tries to adjust to the lower air pressure and lower oxygen levels at high altitudes.
Altitude sickness symptoms can range from uncomfortable to life-threatening. But with some planning and precautions, you can avoid this condition. The best way to prevent it is to move at a slower pace and let your body adjust. If you notice symptoms at high elevation, don’t push yourself to go farther. Get back down to a lower elevation and let your body adjust before moving up, slowly and carefully.
Who is at risk for altitude sickness?
Anyone can get altitude sickness. Your age, sex and general health don’t seem to affect your risk. You may be at higher risk if you:
Have a lung or heart condition: Your healthcare provider may recommend avoiding high altitudes if possible.
Are pregnant: Talk to you provider before traveling to a high-altitude location.
Live at low elevation: Since your body isn’t used to higher altitudes, you have a greater risk for symptoms. If you’re planning a trip to a high-altitude location, be aware of the symptoms of altitude sickness and how to treat it.
Previously had altitude sickness: Talk to your provider about prevention and treatment before your next trip.
What is considered a “high elevation” in terms of getting altitude sickness?
Climbing to these elevations can bring on symptoms of altitude sickness:
High altitude: 8,000 to 12,000 feet above sea level.
Very high altitude: 12,000 to 18,000 feet.
Extremely high altitude: 18,000+ feet.
The summit of Mount Everest is over 29,000 feet.
How common is altitude sickness?
Altitude sickness may occur in up to half of people who climb to elevations above 8,000 feet.
What are the different forms of altitude sickness?
Most people who get altitude sickness get AMS, acute mountain sickness. Higher than 10,000 feet, 75% of people will get mild symptoms . There are three categories of AMS:
Mild AMS: Symptoms, such as mild headache and fatigue, don’t interfere with your normal activity. Symptoms improve after a few days as your body acclimates. You can likely stay at your current elevation as your body adjusts.
Moderate AMS: Symptoms start to interfere with your activities. You may experience severe headache, nausea and difficulty with coordination. You’ll need to descend to start to feel better.
Severe AMS: You may feel short of breath, even at rest. It can be difficult to walk. You need to descend immediately to a lower altitude and seek medical care.
Two severe forms of altitude illness occur less frequently but are more serious. Both can be life-threatening. You need to descend immediately and receive medical treatment for:
HAPE (High-altitude pulmonary edema): HAPE produces excess fluid on the lungs, causing breathlessness, even when resting. You feel very fatigued and weak and may feel like you’re suffocating.
HACE (High-altitude cerebral edema): HACE involves excess fluid on the brain, causing brain swelling. You may experience confusion, lack of coordination and possibly violent behaviour
SYMPTOMS AND CAUSES
What causes altitude sickness?
Altitude sickness results from a rapid change in air pressure and air oxygen levels at higher elevations. You may have symptoms if you travel to a high elevation without giving your body time to adjust to less oxygen. Even if you’re physically fit, you can still experience altitude sickness.
In addition, high altitude and lower air pressure can lead to fluid leaking from blood vessels. Researchers don’t understand exactly why this happens. This leakage causes fluid to build up in your lungs and brain. Ignoring moderate or severe symptoms can lead to a life-threatening situation. What are the symptoms of altitude
Symptoms of altitude sickness?
You’ll likely feel nauseous and lightheaded. You may vomit and have a headache. Different levels of altitude sickness have different symptoms:
Symptoms of mild, short-term altitude sickness usually begin 12 to 24 hours after arriving at high altitude. They lessen in a day or two as your body adjusts. These symptoms include:
Dizziness.
Fatigue and loss of energy.
Shortness of breath.
Loss of appetite.
Sleep problems.
Symptoms of moderate altitude sickness are more intense and worsen instead of improve over time:
Worsening fatigue, weakness and shortness of breath.
Coordination problems and difficulty walking.
Severe headache, nausea and vomiting.
Chest tightness or congestion.
Difficulty doing regular activities, though you may still be able to walk independently.
Severe altitude sickness is an emergency. The symptoms are similar to moderate AMS, but more severe and intense. If you start experiencing these symptoms, you must be taken to a lower altitude immediately for medical care:
Shortness of breath, even when resting.
Inability to walk.
Confusion.
Fluid buildup in the lungs or brain.
HAPE, when fluid builds up in the lungs, prevents oxygen from moving around your body. You need medical treatment for HAPE. Symptoms include:
Cyanosis, when your skin, nails or whites of your eyes start to turn blue.
Confusion and irrational behavior.
Shortness of breath even when resting.
Tightness in the chest.
Extreme fatigue and weakness.
Feeling like you’re suffocating at night.
Persistent cough, bringing up white, watery fluid.
HACE happens when the brain tissue starts to swell from the leaking fluid. You need medical treatment for HACE. Symptoms include:
Headache
Loss of coordination.
Weakness.
Disorientation, memory loss, hallucinations.
Psychotic behavior.
Coma.
DIAGNOSIS AND TESTS
How is altitude sickness diagnosed?
If you get a headache and at least one other symptom with 24 to 48 hours of moving to a higher elevation, it’s most likely altitude sickness. If you’re climbing, a more experienced climber may recognize symptoms of altitude sickness and guide you to get help.
If you have severe altitude sickness, a healthcare provider will ask about your symptoms, activities and location. The provider may perform a physical exam, including listening to your chest.
Will I need tests to diagnose altitude sickness?
You may need a chest X-ray to see if there is any fluid in your chest. In severe cases, your healthcare provider may order a brain MRI or CT scan to check for fluid in the brain.
MANAGEMENT AND TREATMENT
How is altitude sickness treated?
The main treatment for altitude sickness is to move to a lower elevation as quickly
and safely as possible. At the very least, do not go higher. If symptoms are mild, staying at your current elevation for a few days might be enough to improve the symptoms.
Other treatments depend on how severe the symptoms are:
Mild altitude sickness: Over-the-counter medicines can relieve headaches. Other symptoms will improve once your body adjusts or you move to a lower altitude.
Moderate altitude sickness: Symptoms should improve within 24 hours once you are 1,000 to 2,000 feet lower than you were. Within three days, you should feel completely better.
Severe altitude sickness, HACE and HAPE: If you have severe symptoms, you must be taken immediately to an elevation that’s no higher than 4,000 feet. Get to a healthcare provider as soon as possible. You may need hospitalization.
For fluid in the brain (HACE), you may need dexamethasone, a steroid that helps reduce swelling in the brain. Dexamethasone is sometimes prescribed as a preventive medication.
For fluid in the lungs (HAPE), you may need oxygen, medication, a lung inhaler or, in severe cases, a respirator.
If you need more oxygen, a provider might prescribe acetazolamide, which increases your breathing rate, so you take in more oxygen. The medicine helps your body adjust faster to the higher elevation and reduces symptoms of altitude sickness.
The best way to prevent altitude sickness is to go slow — called acclimatization. This process allows your body time to adjust to the change in oxygen levels. Take your time when traveling up. For instance, spend a day at a point midway up before continuing to ascend.
You can also talk to your healthcare provider about taking acetazolamide before your trip. Taking it 24 hours before traveling to a high altitude and continuing for five days can help prevent altitude sickness. Dexamethasone can also be used preventively, but it can have serious side effects. Talk to your provider before your trip.
OUTLOOK / PROGNOSIS
What’s the outlook for someone with altitude sickness?
Most people who get altitude sickness get the mild form. Once you return to a lower elevation (or stay at your current elevation without climbing higher), symptoms improve.
Are there long-term effects of altitude sickness?
If you take care and move to a lower elevation when you feel symptoms, altitude sickness has no long-term negative effects. You’ll recover within a few days. Once you feel better, you can continue to travel to higher elevations, as long as you do so slowly and carefully.
Can altitude sickness be fatal?
In rare cases, altitude sickness can be life-threatening. If you develop HAPE or HACE, you are at risk for complications such as coma or even death. Get treatment as soon as possible to reduce your risk.
Can altitude sickness be cured?
Altitude sickness is temporary. Once you return to a lower altitude, you’ll feel better. When you begin your ascent again (or on your next climb), make sure to travel slowly to let your body acclimate.
If I’m planning a hike to a very high elevation, how can I hike safely without getting altitude sickness?
These steps can help your body acclimate:
Walk up: Start below 10,000 feet and walk to a high altitude instead of driving or flying. If you drive or fly to an elevation higher than 10,000 feet, stay at your first stop for at least 24 hours before going higher.
Go slow: Once above 10,000 feet, don’t increase your altitude more than 1,000 feet a day.
Rest: Build a rest day into your schedule for every 3,000 feet you climb.
“Climb high and sleep low”: If you climb more than 1,000 feet in a day, come down to sleep at a lower altitude.
Know your body: Recognize the signs and symptoms of altitude sickness. Move to a lower altitude (or avoid climbing higher) if you notice any symptoms.
Stay hydrated: Drink 3-4 quarts of water per day.
Avoid alcohol: Alcohol can dehydrate your body. It also has stronger effects at higher elevations, which can impair judgment.
Eat carbs: Eat a diet that’s more than 70% carbohydrates.
Know the “don’ts”: Avoid tobacco and depressant drugs, such as sleeping pills and tranquilizers.
My second book has been released on Amazon worldwide. The book ‘A Midnight Adieu during Indo-Pak Partition 1947’ is a story of Dr Paras Ram family. Today story is about the book, so it is little different from usual medical topics of this blog.
The Massive Betrayal- No One to Blame
In this book, Narain has narrated the true incidents of his life during Indo-Pak partition in 1947. His story depicts the tragedy of millions during riots amidst celebrations for independence by others. Innocent Hindus and Sikhs, who had nothing to do with politics, went through a nightmare and the worst phase of their life because of weak statesmanship and poor capabilities of their leaders. It was highly impractical to assume that Muslims in Pakistan would remain neutral to Hindu minority, who were left behind.
The painful truth that his father, Dr Paras Ram was killed by Baloch’s own army and not by rioters still burns Narain inside. How human greed intertwined with religious fanaticism and communalism changed life of millions of families overnight, still haunts him. With no serious policing, coupled with Government indifference, the partition turned out to be unthinkable nightmare for the masses.
The book is a kaleidoscope of Narain’s pained soul where he only has one unanswered question for his countryman far and near; were these atrocities borne by minorities worth their unanimous dark lives. Why masses as humans refuse to take lessons from such inhumane religious conflicts and never take refuge in any recourse for alleviating inhuman act and conflicts for our generations to grow with.
For the victims, neither religion nor Government was helpful. The differences over faith and religion had put people through beastly times. If this was all in the name of religion, one would say it is better not to have religion at all.
CBI has arrested Joint Drugs Controller for allegedly taking a ₹4 lakh bribe to clear injections made by Biocon Biologics .The CBI has arrested Joint Drugs Controller S Eswara Reddy for allegedly receiving a Rs 4 lakh bribe from a conduit to waive the Phase 3 clinical trial of the ‘Insulin Aspart’ injection, an under development Biocon Biologics product to manage Type 1 and Type 2 diabetes, officials said on Tuesday.
The incident may be just a tip of the iceberg, to indicate collusion between administrators and various industries. It is the time to regulate all important components of health industry including health administrators as doctors are regulated – to achieve real cost effective health care.
In last few decades, as doctor-patient relationship has been getting more complex and medical industry has controlled the financial interaction, the medical costs have become expensive. Hence the health insurance industry is gradually becoming indispensable. As doctors are at the front and remain the visible component, they are blamed for the expensive medical treatments. The tremendous rise in health care expenses is usually borne by the government, taxpayer, insurance or patient himself. Therefore there has been an increasing dependence on investors in health care, along the lines of an industry to ensure its financial viability. 25 factors- why health care is expensive
Complex interplay of various industries like pharmaceutical, consumable industry and other businesses associated with health care remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain unregulated. There is large number of administrators involved in such processes. Although doctors are strictly regulated and kind of over-regulated but such administrators and financial controllers who play important part in medicine, cost, sale and purchase, remain largely unregulated. Because of such undeserved criticism, doctors have actually been alienated from financial aspect but still they are often perceived as culprits for cost escalation.
The CBI has arrested Joint Drugs Controller S Eswara Reddy for allegedly receiving a ₹4 lakh bribe to waive the phase three clinical trial of the Insulin Aspart injection, a product of Biocon Biologics under development to manage Type 1 and Type 2 diabetes, officials said on Tuesday.
Biocon Biologics is a subsidiary of the Biocon. The company has denied allegations.The agency has also arrested director at Synergy Network India Private Limited, who was allegedly giving Reddy a bribe, they said.
After completing the necessary paperwork, the CBI has arrested Reddy and Dua, nabbed during a trap operation on Monday while the alleged bribe exchange was going on, the officials said.
The CBI has also booked Associate Vice President and Head-National Regulatory Affairs (NRA), Biocon Biologics Limited, Bangalore, L Praveen Kumar, as well as Director, Bioinnovat Research Services Private Limited, Delhi, Guljit Sethi in the case under IPC sections of criminal conspiracy and corruption.
Quality of medical education is a deciding factor for the kind of doctors and hence the character of the treatment that patients are going to get. Transparency about the infrastructure and faculty of medical college are important and the deciding factors about the credibility of the institute. But the new opaqueness (by National Medical council- NMC) in the system displaying the critical details about medical colleges can have deleterious effects on medical education. The medical students are blind about the claims made by a medical college during inspection for recognition and permission to admit students, which may be not true. There have been many instances and several complaints of ghost faculty in private colleges and mass transfer of faculty during inspection from one government medical college to another. Not only medical students pay millions to have a seat in private medical colleges, they invest their prime life time in studying medicine. Such opaqueness has a potential to ruin their careers. Medical students will have to work harder to get true information and more careful, about the institute they are getting into.
The National Medical Commission (NMC) does not post college infrastructure assessment reports on its website and has also removed all previous assessment reports posted by the erstwhile Medical Council of India (MCI). So, students or members of the public cannot know what claims were made by a medical college during inspection for recognition and permission to admit students. Why are these assessment reports important? The reports reveal the date of inspection, the names and designation of the inspectors, usually experienced medical faculty from government medical colleges, along with their comments and findings. They reveal what kind of infrastructure existed or was claimed, including inpatient and outpatient load, number of beds and facilities in the teaching hospital and in the college. They reveal the number of faculty shown as employed by the college department-wise. With about 50 new medical colleges opening in 2021, a record for a single year, and especially unusual since it was the peak pandemic year, there were several complaints of ghost faculty in private colleges and mass transfer of faculty during inspection from one government medical college to another. “Not uploading assessment reports shields such substandard colleges with inadequate faculty and infrastructure. They just want to claim more colleges have been opened and that more MBBS seats have been created. It is a numbers game, quality be damned. In the case of private colleges, getting approval without adequate infrastructure or faculty is a windfall as they charge exorbitant fees from students. Usually, approval is given for 100-150 seats. Even at Rs 15 lakh per annum as tuition fees, the college gets to collect Rs 15 crore to Rs 22.5 crore from the first batch,” said a retired professor of a government medical college. “The MCI, which was labelled corrupt and non-functional, used to post the reports of assessments of infrastructure and faculty done according to minimum standard requirements each year,” said Dr Mohammed Khader Meeran, an RTI activist. In response to Dr Meeran’s RTI application seeking college assessment reports of academic years 2020-21 and 2021-22, the NMC said that “the information sought is very voluminous and scattered in various files” and that “it would disproportionately divert the resource of MARB (Medical Assessment & Rating Board) of NMC”.
Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses’ union announces it will join work slowdown
Violence against doctors has become a serious issue across the globe. The underlying basic reason for the omnipresent malaise is the altered doctor-patient equation globally and growing mistrust in the saviours. The mistrust is propagated by opportunist medical industry, media and law industry for their selfish motives as doctors are shown as front men for the failures. Poor outcomes are projected because of medical errors and mistakes. Every death is thought to be because of negligence rather than a natural complication of the disease. Because of the instigation and poor law enforcement in favour of doctors, the response of lay public to these unfortunate incidents has become extremely erratic and out of proportion. As Governments remain more or less indifferent, and doctors have become punching bags for inept health systems. Law industry has been enormously benefitted financially due to medico-legal cases against doctors. Media has sold their news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations. An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors. There is a little token action by police after routine incident of violence against doctors.
Consequently violence (legal, verbal or physical) against doctor has acquired an epidemic proportion, omnipresent world-wide. As a result, medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.
But in Israel, doctors, nurses and health care workers seem to be united against this menace and their associations are actively pursuing the issue. More-over the Government also seem to be sensitive to the issue in Israel.
Health Ministry Director-General Nachman Ash on Wednesday sharply criticized the ongoing violence against healthcare providers, a day after a doctor was badly beaten by a patient at a community clinic.“It’s a general atmosphere that permits the blood[shed] of healthcare providers and for no reason,” Ash told the Ynet news site. “A doctor was busy and couldn’t see a patient so he broke into a room with an iron bar and hit her on repeatedly on the head and other parts of her body.
“I talked to the doctor and I understand that it was very fortunate that it ended the way it did [and wasn’t worse],” he said.
“It’s just shocking, and this violent discourse and behavior must be stopped.”
Ash also linked repeated incidents of violence against healthcare providers to anti-vaccine discourse that became prevalent during the coronavirus pandemic. “The connection exists because any discourse that encourages violence ultimately also leads to violence. These are two things that until now we did not want to link,” Ash said. “The violence toward [officials] is one matter and this violence toward healthcare providers is a second issue. But everything is connected.”
A number of top officials and doctors have faced verbal abuse and threats from anti-vaccine activists. Most notably, Dr. Sharon Alroy-Preis, the Health Ministry’s head of public services and a top COVID adviser to the government, has been repeatedly threatened by anti-vaccine activists and conspiracy theorists who view her as the public face of the health system’s inoculation effort. Ash noted that while there were newly announced plans to station police at hospitals, community clinics were more of an issue.
“It really is a much bigger challenge. I want to say that having police in hospitals will not solve everything either. It is impossible to put a police officer in every clinic — that is clear. I believe that punishment is the key, to create deterrence,” AAsh’s comments came as the suspect in Tuesday’s attack on a doctor in the central city of Be’er Yaakov appeared in court on Wednesday for a remand hearing. Police were seeking to charge him with attempted murder.
According to the Kan public broadcaster, the court was told that the suspect is alleged to have attacked the doctor with a meat tenderizer.According to police, the suspect, a resident of the town in his 30s, went to the clinic for medical treatment. While at the clinic he began to behave wildly. He refused to leave when asked by the doctor to do so, and instead grabbed a weapon and hit her on the head.
The doctor was moderately wounded and taken to a nearby hospital for further treatment. The man was apprehended by police shortly afterwards.Tuesday’s attack was the latest in a string of acts of violence in hospitals and clinics in recent months. In the wake of the latest attack, the doctor’s union announced staff at public hospitals and clinics will go on a two-day strike to protest violence against medics, by operating on a weekend schedule with reduced services for all of Thursday and Friday.
“We have made it clear over the past year unequivocally that any case of violence will encounter zero tolerance on our part,” the chairman of the Israel Medical Association, Prof. Zion Hagay, said on Tuesday.
“The most recent strike has led to an important government decision to place police in emergency rooms and allocate the necessary manpower, but we must look solely at how things are implemented on the ground. As long as we do not see real action in the immediate term, we will intensify our actions until someone here wakes up and understands that violence in the health system is a real epidemic,” he said. The nurses union said Wednesday that it will be joining the strike.
The upcoming strike is the second initiated by the doctors’ union in recent weeks. A labor action was called last month after family members of a patient who died at a Jerusalem hospital attacked medical staff and caused significant damage to an intensive care unit after they were informed of his death.
This serious, painful condition is the most common form of arthritis and can affect any joint.
Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis, affecting more than 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention.
Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility.
OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it.
There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile.
Factors that may contribute to the development of OA include
Age. The risk of developing OA increases with age and symptoms generally, but not always, appear in people over 50.
Joint injury. A bone fracture or cartilage or ligament tear can lead to OA, sometimes more quickly than in cases where there is not an obvious injury.
Overuse. Using the same joints over and over in a job or sport can result in OA..Excess weight adds stress and pressure on a joint, plus fats cells promote inflammation.
Musculoskeletal abnormalities. Misalignment of bone or joint structures can contribute to faster development of OA.
Obesity
Weak muscles. If muscles don’t provide adequate joint support, poor alignment can result, which can lead to OA.
Genetics. People with family members who have OA are more likely to develop it.
Gender. Women are more likely to develop OA than men.
Environmental Factors. Modifiable environmental risk factors include things like someone’s occupation, level of physical activity, quadriceps strength, presence or absence of prior joint injury, obesity, diet, sex hormones, and bone density.
Symptoms
Symptoms tend to build over time rather than show up suddenly. They include
Pain or aching in a joint during activity, after long activity or at the end of the day.
Joint stiffness usually occurs first thing in the morning or after resting.
Limited range of motion that may go away after movement.
Clicking or popping sound when a joint bends.
Swelling around a joint.
Muscle weakness around the joint.
Joint instability or buckling (as when a knee gives out).
OA may affect different parts of the body in different ways.
Hips. Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh.
Knees. A “grating” or “scraping” feeling when moving the knee.
Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb.
Feet. Pain and tenderness in the big toe, with possible swelling in the ankles or toes.
Potential Consequences
Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to health complications that are not caused by the disease itself.
Obesity, Diabetes and Heart Disease
Painful joints, especially in the feet, ankles, knees, hip or back, make it harder to exercise. But physical activity is not only key to managing OA symptoms; it also can help prevent weight gain, which can lead to obesity. Being overweight or obese can lead to the development of high cholesterol, type 2 diabetes, heart disease and high blood pressure.
Falls
Research indicates people with OA experience more fall and risk of fracture than those without OA. Although study results vary, some research shows they may have up to 30% more falls and have a 20% greater risk of fracture. Having OA can decrease function, weaken muscles, affect overall balance, and make falls more likely, especially among those with OA in knees or hips. Side effects from pain medications, such as dizziness, can also contribute to falls.
Diagnosis
Medical history, a physical examination and lab test help to make up the OA diagnosis.
A primary care doctor may be the first person you talk to about joint pain. The doctor will review your medical history, symptoms, how the pain affects activities, as well as your medical problems and medication use. He or she will also look at and move your joints, and may order imaging. These tests help to make the diagnosis:
Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis.
X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis.
MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.
Treatment
There is no cure for OA, but medication, assistive devices and other therapies that don’t involve drugs can help to ease pain. As a last resort, a damaged joint may be surgically fused or replaced with one made of a combination of metal, plastic and/or ceramic.
Medications
Pain and anti-inflammatorymedicines for osteoarthritis are available as pills, syrups, patches, gels, creams or injectable. They include:
Analgesics. These are pain relievers and include acetaminophen and opioids. Acetaminophen is available over the counter (OTC); opioids must be prescribed by a doctor.
Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirin, ibuprofen, naproxen and celecoxib, available either OTC or by prescription. The OTC versions help with pain but not inflammation.
Counterirritants. These OTC products contain ingredients like capsaicin, menthol, lidocaine that irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain.
Corticosteroids. These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.
Platelet-rich plasma (PRP). Available from a doctor by injection, this product is intended to help ease pain and inflammation. This is not approved by the Food & Drug Administration and evidence is still emerging, so discuss it with your doctor before trying it.
Other drugs. The antidepressant duloxetine (Cymbalta) and the anti-seizure pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain.
Nondrug Therapies
Exercise
Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal, according to the U.S. Department of Health and Human Services. A good exercise program to fight OA pain and stiffness has four parts:
Strengthening exercises build muscles around painful joints and helps to ease the stress on them.
Range-of-motion exercise or stretching helps toreduce stiffness and keep joints moving.
Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.
Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.
Talk to a doctor or physical therapist before starting a new exercise program.
Weight Loss
Excess weight puts additional force and stress on weight-bearing joints, including the hips, knees, ankles, feet and back, and fat cells promote inflammation. Losing extra weight helps reduce pain and slow joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.
Physical therapy and Assistive therapy Physical therapists, occupational therapists and chiropractors can provide:
Specific exercises to help stabilize your joints and ease pain.
Information about natural treatments and products that can ease pain.
Instruction to make movement easier and to protect joints.
Braces, shoe inserts or other assistive devices.
Surgery
Joint surgery can improve pain and function. Joint replacement surgery replaces damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopedic surgeon can determine the best procedure based on how badly damaged the joint is.
Self-Care
Practicing these habits can slow down OA, keep you healthier overall and delay surgery as long as possible. It is important to pursue a number of different self-care approaches simultaneously. They are listed below.
Maintain a Healthy Weight
Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.
Control Blood Sugar
Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.
Maintain Range of Motion
Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help. But listen to your body and never push too hard.
Protect Joints
Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.
Relax
Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.
Choose a Healthy Lifestyle
Eating healthy food, balanced nutrition, not smoking, drinking in moderation and getting good sleep will help you to feel your best.
An overstressed hospital system unable to bear the rising patient load is an important factor for the frequent fire incidents. Overstressed ICUs, ACs, lot of oxygen flowing, other combustible chemicals, gases, and electrical equipment all around make hospitals a dangerous place for the incidents of fire.
Last year Hospitals increased beds, equipment and staff to admit more Covid patients, but it is not possible to immediately expand the electrical wiring system. Medical equipment or wires carrying current beyond their capacity can overheat. That is what is happening in many hospitals. Besides looking at fire
audit, an electrical audit is also needed.
Fire prevention and safety is a matter of vital importance concerning everyone in the hospital industry. After another incident in Delhi, have further raised the concerns about safety of patients in hospitals. Unawareness of safety measures especially among staff of hospital can increase death toll among patients as well as health care workers. Such incidents happening frequently have become an eye opener for government, health administrators as well as health care providers. NABH and Fire Safety For fire prevention and safety in hospital, certain modifications in building design are required to deal with various potential emergency situations to avoid further incident and damage. The main objective of fire safety design of buildings should be assurance of life safety, property protection and continuity of operations or functioning.
120 patients died due to hospital fires since April 2020 Even the roads inside big hospitals, which should be 6 metres wide, are blocked with parked vehicles. If a fire breaks out, the fire tenders cannot even enter. Therefore norms & codes for building design & fire safety should be followed not only for high rise hospital buildings but also for small set up or nursing homes properly. Fire Codes process is a complex process which integrates many skills, products and techniques into its system. Hospital engineering service provision for Fire Protection according to NABH:
1. Fire fighting installation approval must be obtained 2. Location of control room should be easily accessible. 3. Control panel & manned, PA equipment should be connected with detection system or fire alarm system. 4. Pumps and pump room 5. 2 separate pumps i. e .Electric and diesel pump should be available 6. Provision of Forced ventilation should be there. 7. Arrangement of filling Fire tenders 8. 4 way fire inlet must be present in case of emergency 9. Proper access for Fire tender to fire tanks 10. Fire Drill should be performed 11. Yard Hydrants should be available 12. Ring main and yard hydrants should be as per strategic locations. 13. 2 way fire heads to charge the ring main 14. Landing Hydrant & Hose reels 15. Wet riser system must be installed 16. First aid Fire fighting appliances must be in working conditions 17. First aid equipment cabinets 18. Provision of Escape routes – escape stairs 19. Sprinklers system – basement & bldg. above 15 M in height 20. Automatic Smoke detectors / heat detectors 21. Provision of Fire Alarm System & Fire extinguishers
1. All high-rise buildings need to get NOC as per the zoning regulations of their jurisdiction concerned. 2. A road which abuts a high rise should be more than 12 metres wide, to facilitate free movement of Fire Services vehicles, especially the Hydraulic Platform and Turn Table Ladder. 3.Entrance width and clearance should not be less than 6 metres or 5 metres, respectively. 4. At least 40 per cent of the occupants should be trained in conducting proper evacuation, operation of systems and equipment and other fire safety provisions in the building, apart from having a designated fire officer at the helm. 5. The buildings should have open spaces, as per the Zonal Regulations. 6. Minimum of two staircases with one of them on the external walls of the building. They should be enclosed with smoke-stop-swing-doors of two-hour fire resistance on the exit to the lobby.
General Recommendations:
1. Hospitals of high rise buildings are found to be utilising the cellars for generators and transformers, which is strictly prohibited. 2. Canteens, OP blocks, dormitories and pathological labs are not allowed in cellars. 3. Regular refresher training courses for the fire brigade personnel. 4. Recommendation for creating Rural Fire Services in areas which are not at present under any full time Fire Service cover. 5. Augmentation of Municipal Hydrant System. 6. Adoption of best practices from other city codes like Mumbai Delhi and Hyderabad by State Government for fire safety. 7. Clarifying position of CFO and Fire Protection Consultant in approval procedures. 8. Recommendation for establishment of Disaster Control Room for cities. 9. A passing reference to NBC rules like provision of fire doors, fire separating walls, fire exit & fire lifts should not be overlooked.
Fire safety Measures have 4 Parameters namely means of access through approach roads, open spaces, means of escapes like external Staircases & Fire fighting equipment. Thus provision of all these is necessary from safety point of view within hospital premises. An effective fire program calls for an understanding of the hospital fire plan & the active participation of every employee at all times. Also at least 1 well trained fire officer should be elected at every hospital. There is no better protection against fire than constant vigil to detect fire hazards, prompt action to eliminate in safe conditions & a high degree of preparedness to fight fire.
Everyone should remember that every big fire starts from small one therefore nothing should be considered insignificant within hospital premises. Some hospitals lack trained staff to handle such emergencies therefore frequent mock as well as evacuation drills must be taken. Panic & confusion are the greatest hazards of fire & they can be countered only by sufficient preparedness which should be avoided by means of hospital staff in case of fire emergency.
Rheumatoid arthritis (RA) causes joint inflammation and pain. It happens when the immune system doesn’t work properly and attacks the lining of the joints, called the synovium. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body, such as both hands or both knees. But sometimes RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or the lungs.
For unknown reasons, more women than men get RA, and it usually develops in middle age. Having a family member with RA increases the odds of developing RA.
Causes
In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack those cells. RA, it attacks the synovium, the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender and look red and swollen, and moving the joint may be difficult.
Researchers aren’t sure why people develop RA. They believe these individuals may have certain genes that are activated by a trigger in the environment, such as a virus or bacteria, physical or emotional stress or some other external factor.
In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain. These symptoms are clues to RA:
joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
Morning stiffness that lasts for 30 minutes or longer.
More than one joint is affected.
Small joints (wrists, certain joints in the hands and feet) are typically affected first.
The same joints on both sides of the body are affected.
Many people with RA get very tired (fatigue) and some may have a low-grade fever. RA symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months.
Health Effects
Eyes. Dryness, pain, inflammation, redness, sensitivity to light and trouble seeing properly.
Mouth. Dryness and gum inflammation, irritation or infection.
Skin. Rheumatoid nodules — small lumps under the skin over bony areas.
Lungs. Inflammation and scarring that can lead to shortness of breath and lung disease.
Blood vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs.
Blood. A lower than normal number of red blood cells.
Heart. Inflammation can damage the heart muscle and the surrounding areas.
Painful joints also make it hard to exercise, leading to weight gain. Being overweight may make people with RA more likely to develop high cholesterol, diabetes, heart disease and high blood pressure.
Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. A doctor with specialized training in treating arthritis (called a rheumatologist) is the best person to make a correct diagnosis, using medical history, a physical examination and lab tests.
Medical history. The doctor will ask about joint symptoms (pain, tenderness, stiffness, difficulty moving), when they started, if they come and go, how severe they are, what actions make them better or worse and whether family members have RA or another autoimmune disease. Physical examination. The doctor will look for joint tenderness, swelling, warmth and painful or limited movement, bumps under the skin or a low-grade fever. Blood tests- The blood tests look for inflammation and blood proteins (antibodies) that are linked to RA:
Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) levels are markers for inflammation. A high ESR or CRP combined with other clues to RA helps make the diagnosis.
Rheumatoid factor (RF) is an antibody found (eventually) in about 80 percent of people with RA. Antibodies to cyclic citrullinated peptide (CCP) are found in 60 to 70 percent of people with RA. However, they are also found in people without RA.
Imaging tests- RA can cause the ends of the bones within a joint to wear down (erosions). An X-ray, ultrasound, or MRI (magnetic resonance imaging) scan can look for erosions. But if they don’t show up on the first tests that could mean RA is in an early stage and hasn’t damaged bone yet. Imaging results can also show how well treatment is working.
Stop inflammation or reduce it to the lowest possible level (put disease in remission).
Relieve symptoms.
Prevent joint and organ damage.
Improve function and overall well-being.
Reduce long-term complications.
To meet these goals, the doctor will follow these strategies:
Early, aggressive treatment to reduce or stop inflammation as quickly as possible.
Targeting remission or another goal (called “treat-to-target”) to work toward few or no signs or symptoms of active inflammation.
Tight control to keep inflammation at the lowest level possible.
Working with your doctor to ensure you get appropriate medical treatment is essential, but you can also take measures on your own to manage your RA and ease pain and fatigue. Diet, exercise, smoking cessation and mental health are all key to good health overall and controlling RA.
Healthy Eating. A balanced, nutritious diet consisting of the recommended amounts of all the food groups helps promote wellness and makes it easier to maintain a healthy weight.
Daily movement. Even when you don’t have time to exercise, try to make movement part of your everyday routine. Use the stairs instead of taking the elevator. Park in a spot that makes you walk a bit to enter a building. Take the longer way to a meeting in your office.
Balancing activity with rest. It’s important to try to stay physically active even during a flare, but rest is also especially important when RA is active and joints feel painful, swollen or stiff. Rest helps reduce inflammation and fatigue that can come with a flare. Taking breaks throughout the day protects joints and preserves energy.
Hot and cold treatments. Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain and swollen joints. It can numb painful areas and reduce inflammation.
Topical products. These creams, gels or stick-on patches can ease the pain in a joint or muscle. Some contain the medicine that you can get in a pill, and others use ingredients that irritate your nerves to distract from pain.
Stress Reduction and Complementary Therapies. There are different ways to relax and stop focusing on pain. They include meditation, deep breathing, and thinking about images in your mind that make you feel happy. Massage can help reduce pain, relax sore muscles and ease stress or anxiety. Acupuncture involves inserting fine needles into the body along special points to relieve pain. If you don’t like needles, acupressure uses firm pressure instead.
Supplements. Studies show that curcumin/turmeric and omega-3 fish oil supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and how it may affect other medicines you are taking.
Positive Attitude and Support System. Cultivate a network of friends, family members and co-workers who can help provide emotional support. Take time to do things that you enjoy to lift your mood, which can help relieve pain.
Disclaimer-The above article is for information purposes only and is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.
In a young person, usually there are specific ailments for example heart and and nervous system that can cause some one to fall down. But the older age can predispose people to fall for many factors.
Some factors that may contribute to falls include:
Loss of muscle mass.
Illnesses that impair your mental or physical functioning, such as low blood pressure or dementia.
Falls can also be caused by factors around you that create unsafe conditions. Here are some tips to help prevent falls outdoors and when you are away from home:
Use a cane or walker for added stability.
Wear shoes that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
Walk on grass when sidewalks are slippery; in winter, put salt or kitty litter on icy sidewalks.
Stop at curbs and check their height before stepping up or down.
Some ways to help prevent falls indoors are:
Keep rooms free of clutter, especially on floors. Avoid running electrical cords across walking areas.
Use plastic or carpet runners on slippery floors.
Wear shoes, even when indoors, that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
If you have a pet, be mindful of where they are to avoid tripping over them.
Do not walk in socks, stockings, or slippers.
Be careful on highly polished floors that are slick and dangerous, especially when wet, and walk on plastic or carpet runners when possible.
Be sure carpets and area rugs have skid-proof backing or are tacked to the floor. Use double-stick tape to keep rugs from slipping.
Be sure stairs are well lit and have rails on both sides.
Install grab bars on bathroom walls near the tub, shower, and toilet.
Use a rubber bathmat or slip-proof seat in the shower or tub.
Improve lighting in your home. Use nightlights or keep a flashlight next to your bed in case you need to get up at night. Install ceiling fixtures or lamps that can be turned on by a switch near the room’s entrance.
Use a sturdy stepstool with a handrail and wide steps.
Add more lights in rooms.
Keep a cordless phone or cell phone with you so that you don’t have to rush to the phone when it rings. In addition, if you fall, you can call for help.
Consider having a personal emergency-response system; you can use it to call for help if you fall.
The above article is for information purposes only and is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.
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Evolution of Medical profession-Extinction of good doctors 