Fish Bile ‘Treatment’ Lands Woman in Hospital- Folly of Fringe Theories in medicine


    It has become a common practice to advertise health products or therapies that claim to be panacea for all ailments enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. Needless to say, the objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

    Companies have created huge fortunes based on circulation of such pedagogic narratives and social knowledge. But in real sense, these are actually chemical and have biological actions and reactions. Chemical derived from natural sources can have side effects and contain impurities.  Global neutral trials to validate effects and side effects remain an urgent need of the hour for all health products.

   Suffering for the common public is immense. Doctors’  sincere warning had no effect rather they were called as medicine mafia.   Unfortunately  false beliefs  like local religious figures can cure cancer and kidney diseases  cause they could communicate with invisible spirits  and gain knowledge. Unsurprisingly the cranks  have been  wrong and innocent patients suffer.   Doctors objecting to  elevation of  crank theories were painted as  western medicine agents,  or nattering nabobs of negativity.

 Here is an example of the folly of following fringe  theories.

Fish bile ‘treatment’ lands woman in hospital

Fish bile ‘treatment’ lands woman in hospital

 A 52-year-old homemaker from Dum Dum had to undergo a few rounds of dialysis and was put under intense critical care for a renal failure, triggered by ‘fish bile poisoning’. The patient had ingested raw fish bile for four consecutive days as a treatment to cure her diabetes prior to being rushed to Manipal Hospitals Kolkata with acute abdominal pain. Doctors at the Salt Lake hospital found the patient had low blood pressure and was in a state of shock. Initial reports showed a significant derangement of liver and kidney functions. It led doctors to treat common causes of liver and kidney injuries or drug induced organ damage. When further tests didn’t match with these diagnoses, the team started looking for a possible cause. The patient then revealed she had ingested bile of Rohu fish for four days to control her diabetes. “Consuming fish bile causes acute kidney and liver injury with the need to go for long term dialysis. This patient had to be put under dialysis within 72 hours of admission,” said internal medicine and critical care consultant. She was discharged from hospital after a month.

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Obesity & Overweight: Quality of Life, Causes, Diagnosis Treatment


Obesity is a complex disease involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty losing weight. Usually, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity.

Symptoms

Body mass index (BMI) is often used to diagnose obesity. To calculate BMI, multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms by height in meters squared.

BMIWeight status
Below 18.5Underweight
18.5-24.9Normal
25.0-29.9Overweight
30.0 and higherObesity

Asians with BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat.

Many doctors also measure a person’s waist circumference to help guide treatment decisions. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters) and in women with a waist measurement over 35 inches (89 centimeters).

Causes

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through normal daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people’s diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don’t tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping and drive-through banks.

Risk factors

Obesity usually results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.

Obesity tends to run in families. That’s not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

  • Unhealthy diet. A diet that’s high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
  • Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to significant weight gain.
  • Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is a sedentary activity. The number of hours spent in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medications can lead to weight gain if you don’t compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don’t have safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have access to healthier foods. In addition, the people you spend time with may influence your weight — you’re more likely to develop obesity if you have friends or relatives with obesity.

Age

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. Generally, lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.

Other factors

  • Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
  • Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. In the long run, however, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your doctor can help you prevent weight gain after quitting smoking.
  • Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
  • Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food when experiencing stressful situations.
  • Microbiome. Your gut bacteria are affected by what you eat and may contribute to weight gain or difficulty losing weight.

Even if you have one or more of these risk factors, it doesn’t mean that you’re destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

  • Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes.
  • Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
  • Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
  • Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
  • Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
  • Osteoarthritis. Obesity increases the stress placed on weight-bearing joints, in addition to promoting inflammation within the body. These factors may lead to complications such as osteoarthritis.
  • Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019 (COVID-19). People who have severe cases of COVID-19 may require treatment in intensive care units or even mechanical assistance to breathe.

Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

  • Depression
  • Disability
  • Shame and guilt
  • Social isolation
  • Lower work achievement

Diagnosis

To diagnose obesity, your doctor will typically perform a physical exam and recommend some tests.

These exams and tests generally include:

  • Taking your health history. Your doctor may review your weight history, weight-loss efforts, physical activity and exercise habits, eating patterns and appetite control, what other conditions you’ve had, medications, stress levels, and other issues about your health. Your doctor may also review your family’s health history to see if you may be predisposed to certain conditions.
  • A general physical exam. This includes measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
  • Calculating your BMI. Your doctor will check your body mass index (BMI). A BMI of 30 or higher is considered obesity. Numbers higher than 30 increase health risks even more. Your BMI should be checked at least once a year because it can help determine your overall health risks and what treatments may be appropriate.
  • Measuring your waist circumference. Fat stored around the waist, sometimes called visceral fat or abdominal fat, may further increase the risk of heart disease and diabetes. Women with a waist measurement (circumference) of more than 35 inches (89 centimeters) and men with a waist measurement of more than 40 inches (102 centimeters) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, waist circumference should be checked at least once a year.
  • Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure, high cholesterol, underactive thyroid, liver problems and diabetes.

Treatment

The goal of obesity treatment is to reach and stay at a healthy weight. This improves overall health and lowers the risk of developing complications related to obesity.

You may need to work with a team of health professionals — including a dietitian, behavioral counselor or an obesity specialist — to help you understand and make changes in your eating and activity habits.

The initial treatment goal is usually a modest weight loss — 5% to 10% of your total weight. That means that if you weigh 200 pounds (91 kilograms), you’d need to lose only about 10 to 20 pounds (4.5 to 9 kilograms) for your health to begin to improve. However, the more weight you lose, the greater the benefits.

All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your obesity severity, your overall health and your willingness to participate in your weight-loss plan.

Dietary changes

Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.

There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

  • Cutting calories. The key to weight loss is reducing how many calories you take in. The first step is to review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
  • Feeling full on less. Some foods — such as desserts, candies, fats and processed foods — contain a lot of calories for a small portion. In contrast, fruits and vegetables provide a larger portion size with fewer calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.
  • Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains. Also emphasize lean sources of protein — such as beans, lentils and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils.
  • Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans are effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended. Limiting these drinks or eliminating them altogether is a good place to start cutting calories.
  • Meal replacements. These plans suggest replacing one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that’s low in fat and calories. In the short term, this type of diet can help you lose weight. But these diets likely won’t teach you how to change your overall lifestyle. So you may have to stay on the diet if you want to keep your weight off.

Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don’t appear to be any better than other diets.

Similarly, you may lose weight on a crash diet, but you’re likely to regain it when you stop the diet. To lose weight — and keep it off — you must adopt healthy-eating habits that you can maintain over time.

Exercise and activity

Increased physical activity or exercise is an essential part of obesity treatment:

  • Exercise. People with obesity need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve.
  • Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Park farther from store entrances and take the stairs instead of the elevator. A pedometer can track how many steps you take over the course of a day. Many people try to reach 10,000 steps every day. Gradually increase the number of steps you take daily to reach that goal.

Behavior changes

A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity.

  • Counseling. Talking with a mental health professional can help address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Counseling can be one-on-one or in a group.
  • Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area.

Weight-loss medication

Weight-loss medications are meant to be used along with diet, exercise and behavior changes, not instead of them. Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects.

The most commonly used medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of obesity include:

  • Bupropion-naltrexone (Contrave)
  • Liraglutide (Saxenda)
  • Orlistat (Alli, Xenical)
  • Phentermine-topiramate (Qsymia)

Weight-loss medications may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost.

Endoscopic procedures for weight loss

These types of procedures don’t require any incisions in the skin. After you are under anesthesia, flexible tubes and tools are inserted through the mouth and down the throat into the stomach. Common procedures include:

  • Endoscopic sleeve gastroplasty. This procedure involves placing stitches in the stomach to reduce the amount of food and liquid the stomach can hold at one time. Over time, eating and drinking less helps the typical person lose weight.
  • Intragastric balloon for weight loss. In this procedure, doctors place a small balloon into the stomach. The balloon is then filled with water to reduce the amount of space in the stomach, so you’ll feel full eating less food.

Weight-loss surgery

Also known as bariatric surgery, weight-loss surgery limits the amount of food you’re able to comfortably eat or decreases the absorption of food and calories. However, this can also result in nutritional and vitamin deficiencies.

Common weight-loss surgeries include:

  • Adjustable gastric banding. In this procedure, an inflatable band separates the stomach into two pouches. The surgeon pulls the band tight, like a belt, to create a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.
  • Gastric bypass surgery. In gastric bypass (Roux-en-Y), the surgeon creates a small pouch at the top of the stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of the stomach.
  • Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It’s a less complicated surgery than gastric bypass.

Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

Mayo Clinic

Other treatments

Other treatments for obesity include:

  • Hydrogels. Available by prescription, these edible capsules contain tiny particles that absorb water and enlarge in the stomach, to help you feel full. The capsules are taken before meals and are passed through the intestines as stool.
  • Vagal nerve blockade. This involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full.
  • Gastric aspirate. In this procedure, a tube is placed through the abdomen into the stomach. A portion of the stomach contents are drained out after each meal.

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Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Online Health Service Aggregators- New Commission Agents in Medical Business: Increase Cost


 

India features a mixed-market health system where chronically low investment in public health systems has led to the proliferation of private care providers.  In last few years, a bevy of apps and service aggregators have starting operating brazenly in the country, pushing aggressively for tests and surgeries and delivering drugs, often advertised by Superstars and Celebrities. Patient often zigzags between health providers with unclear referral pathways, and ends up receiving questionable quality of care that may typically neither be safe nor affordable.   

       Online health aggregators are nothing more than sophisticated commission agents. The medical business model thrives on advertisement and commission. Government rules prevent doctors from advertising or soliciting for surgeries, but these companies live on advertising. Any doctor or hospital can get advertised through these companies. In lieu of some money, anyone can be declared as the best and hence misguidance to the patients cannot be ruled out. The flow of patients to a health care facility can be enhanced by financing the advertisements and not by actual quality work and results in increasing medical business manifold.  They do not contribute to much needed medical infrastructure and merely redirect patients to existing facilities. They may at the best be able to  become facilitators of the process that attract patients by advertisements and  result in skyrocketing cost to patients. Any of the Hospitals and doctors can be projected as the best, who tie up with these online aggregators in lieu of some money. Therefore the misguidance as well as increased costs is the two main drawbacks of such a lucrative arrangement of this new medical business.  They charge hospitals and doctors for advertisements ( sending more patients) and patients for channelizing them. In the resulting Zig-Zag path, patients are treated more on the basis of advertisements that are many times aired by our ‘Filmy Superstars’.

The health service aggregators have no skin in the game. Neither do they invest in hospitals nor do they have the responsibility of running a hospital, but they want the money which a patient will spend on their health in a hospital. They have conveniently created online apps and are ranked top on search websites. This whole process is against the values and ethics, which healthcare delivery is supposed to be.

Unregulated operations by unscrupulous online health service aggregators pose grave risk to public health.

   

Unregulated operations by unscrupulous online health service aggregators pose grave risk to public health.

  The damage caused by the unchecked presence of health service aggregators online is snowballing into a major healthcare crisis which the Union and state governments can ill afford to ignore. Instead of becoming a part of the solution, they have added to the problem by pushing aggressively for tests, surgeries and healthcare services without any medical requirement or prescription.

  There are plenty of  such apps which advertise about doctor consultations, quick surgeries and direct-to-consumer laboratory tests.

       This is where the trouble begins.

In one  case, the  healthcare aggregator suggested surgery for constipation. The mention of surgery scared the patient, who then approached a hospital where they advised him to improve his diet.

For a kidney stone issue, a healthcare aggregator suggested a laser surgery  to a patient without consulting a urologist. The laser surgery was done and the stones got stuck in his pelvi-uretery junction of the kidney-uretery track. He  became aware of it two weeks later when he had severe pain in his flank, because of which he walked in to a hospital after the app refused to acknowledge his concerns.

In all of these cases, the apps charged almost double the existing rates for surgeries. For a piles operation, in a general ward, a hospital charges between Rs 50,000-70,000, inclusive of medicines in a patient without co-morbidities. The apps charged between 1.25 lakh to 1.5 lakh, while the national public health insurance scheme Ayushman Bharat rates for such surgeries begin at Rs 10,000.

Ads are being run by online health service aggregators in newspapers and all  kind of  media.

For removal of kidney stones, hospitals charge Rs 50,000, while the apps charge upwards of Rs 1 lakh, while on the government’s Ayushman Bharat scheme, it is Rs 33,000.

Circumcision is priced at Rs 60,000 by the healthcare aggregators, when hospitals charge Rs 10,000 for a surgery such as this and it is Rs 3,000 for those availing it using Ayushman Bharat.

Their modus operandi? The healthcare aggregators have tie-ups with certain departments in certain hospitals, where after the app does the diagnosis, a doctor on their payroll is sent to the hospital to perform the surgery. After the surgery, the doctor walks away without any care and the patient is left at the hospital until he gains consciousness. At which point, if there is any immediate post-operative care, the nurse concerned does it based on the instructions of the doctor who left. Then the patient checks out.

    A fee is paid by these healthcare aggregators to these hospitals for use of the premises for the surgery. In most cases, they approach smaller hospitals where either the top administration turns a blind eye towards these activities.    Sometimes, the  doctor who performed the surgery may not be  on their rolls, but that from a healthcare aggregator.

 “The health service aggregators  have no skin in the game. Neither do they invest in hospitals nor do they have the responsibility of running a hospital, but they want the money which a patient will spend on their health in a hospital. They have conveniently created online apps and are ranked top on search websites. This whole process is against what healthcare delivery is supposed to be,” said Dr Jagadish Hiremath, CEO of ACE Suhas Hospital in Bengaluru.

Government rules prevent hospitals from advertising or soliciting for surgeries, pointed out Hiremath, but these companies live on advertising.

Such health care aggregators are feeding off hospitals and they need to be regulated. “If you remove the advertisements, these companies don’t exist. They have no physical presence except for a few labs or clinics,” he added.

“The problem is getting compounded by these discounts and offers for unnecessary medically and unwarranted testing in the name of wellness/immunity packages. It is a price war to offer maximum number of tests at lowest prices which is totally meaningless,” highlighted Malini Aisola, co-convenor of All India Drug Action Network (AIDAN)

These online health service aggregators have added to issue of illegal pathology laboratories mushrooming all over, pointed out Dr Jagadish Keskar of the Maharashtra Association of Pathologists and Microbiologists

  Almost all of them have roped in big names as brand ambassadors – actor Hrithik Roshan, Amitabh Bachchan, singer Guru Randhawa, Rahul Dravid, actor Sonu Sood, actor Rajat Kapoor,  Neha Dhupia, Yuvraj Singh and Randeep Hooda to talk about specific health issues and MS Dhoni.

   “They have all these famous names as brand ambassadors as if they will perform the surgeries or look at your blood in a lab. This confuses the public, who are already bombarded with too much information,” quipped Hiremath.

     Consumer Drug Advocacy group All India Drug Action Network (AIDAN) argued that the direct-to-consumer advertising has to stop completely. “It is too dangerous in healthcare. Aggregators are inducing demand when people are at their most vulnerable due to the pandemic. They are pushing promotions and offers on tests and surgeries and healthcare services without medical assessment or prescription,” said Aisola.

There is a danger particularly with surgeries, contended Aisola, because this could lead to bypassing medical opinions and identifying alternative treatments. When doctors, hospitals and labs associate themselves with the aggregators, there are ethical issues too, she pointed out.

The practice of doctors associating themselves with these healthcare aggregators have alarmed several doctors’ associations. Association of Minimal Access Surgeons of India (AMASI) wrote to its members stating that any member who has made such a contract with healthcare aggregators should disengage immediately failing which a member found to be in contract thereafter may be liable for disciplinary action by regulatory authorities.

They warned that any litigation arising from such practices will not be defended by the association during legal process by way of expert opinion or otherwise.

“It jeopardizes adequate clinical judgment by a trained person regarding need for surgery and decision as to the type of surgery that would be optimum for the particular patient. The apps are made for the sole purpose of making money,” said the AMASI notification.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

CJI Ramana’s Concern about Violence against Doctors: too Mild a Remedy, Need Concrete Action


            

            While violence against doctors should be a concern to everyone, more so for the public, but sadly everyone in society has preferred to take advantage and reap benefit of the situation at the cost of doctors. Government has remained more or less indifferent, whereas people don’t have minimum basic health amenities and doctors have become punching bags for inept health system.  Law industry has been enormously benefited financially due to medico-legal cases against doctors. Media and celebrities have sold their shows and 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.  Local goons have blackmailed doctors over genuine complications and the natural deaths occurring in hospitals.  There is a little token action by police after routine incident of violence against doctors. Consequently medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.  Actually public needs to be concerned as the society itself is going to suffer in the long run,  not realizing  that people themselves are responsible for their health problems and not the doctors. 

     At this stage, Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them.  The show of concern is nice gesture, as problem is clearly evident to all, but merely  expressing a concern at this stage is too mild a remedy.  When cancer is in late stages and  needs a radical surgery,  applying an ointment will not work.

Rising violence against doctors saddening, they deserve better: CJI Ramana            

Rising violence against doctors saddening, they deserve better: CJI Ramana

Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them. The CJI said that he would also like to pay his tribute to the unending spirit of doctors, who work tirelessly round the clock for their patients. Doctors are mentors, guides, friends and counsellors. They should always remain active members of society, and solve problems faced by the people,” he said. The CJI said, “I am extremely saddened to witness rising violence against doctors. Several false cases are being lodged against upright and hardworking doctors. They need a better, and more secure, working environment.  This is where professional medical associations assume great significance. They have to be proactive in highlighting the demands of doctors.”  The CJI also expressed concern about the healthcare system in India and said that more than 70 per cent of the population resides in rural areas where people don’t have minimum basic amenities, forget about the comfort of corporate hospitals.

“Even Primary Health Centres (PHC) are also not properly equipped, if there is a PHC there are no doctors and if there is a doctor, there is no PHC. If both are there, there is no infrastructure. This is the situation in this country and in this scenario this type of affordable technique of detecting cancer through ultrasound at the preliminary stage is very helpful,” the CJI said.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

About ‘Shigella’- Bacteria killed a girl after she ate Shawarma in Kerala


 

 Diarrhoea –loose motions  has many causes. Bacterial, protozoal or viruses all can cause diarrhoea. Infections like cholera caused by bactweria Vibrio cholera can be life threatening. Similarly Shigella, another bacteria can be fatal occasionally, if treatment is delayed.  Shigellosis is not a very common infection, and it can be treated easily, doctors say. But a delay in getting to a doctor can complicate the effects of the food poisoning. Young children and those with weakened immune systems are more vulnerable.

The Kerala health department on Tuesday (May 3) identified Shigella bacteria as the cause for the food poisoning incident in Kasaragod, which claimed the life of a 16-year-old girl and led to 30-odd others being admitted to hospital.

The presence of the bacteria was confirmed in the blood and faeces of people undergoing treatment after they consumed chicken shawarma from an eatery at Cheruvathur in Kasaragod last week. Police have arrested the owner and staff of the eatery.

While food poisoning is fairly common and can occur in a range of situations, how common is Shigella infection, what are its symptoms, and when should you consult a doctor?

First, what is Shigella?

Shigella is a bacterium that belongs to the Enterobacter family — a group of bacteria that reside in the intestine, not all of which cause disease in humans. It mainly affects the intestine and results in diarrhoea, sometimes bloody, stomach pain, and fever.

The infection spreads easily as it takes only “a small number of bacteria to make someone ill”, says the US Centres for Disease Control and Prevention (CDC). It is a food- and water-borne infection, and can happen when someone consumes contaminated food — like in the case from Kerala — unwashed fruit or vegetables.

The disease is easily spread by direct or indirect contact with the excrement of the patient. You can get the infection if you swim or take a bath in contaminated water.

How widespread is Shigella infection?

Shigella outbreaks appear to be exacerbated during pregnancy and in children under five years of age, and in those with weakened immune systems.

There are four types of Shigella bacteria that affect humans — Shigella sonnei, Shigella flexneri, Shigella boydii, and Shigella dysenteriae. The fourth type causes the most severe disease because of the toxin it produces.

But is it common for people to die of the infection?

It is not. Doctors say that the infection does not generally kill, unless the patient has a weak immune system or the pathogen is resistant to the antibiotics that are prescribed. It is a very treatable condition; if a patient reaches hospital on time they can effectively be treated using IV antibiotics.

He said that doctors usually send samples of patients with severe diarrhoea for culture to see what pathogen is causing the symptoms, in order to decide which antibiotics were likely to work the best. In the meanwhile, doctors prescribe antibiotics for the most common infections that cause diarrhoea, and they will generally work for Shigella as well.

The problem though, occurs when the antibiotics do not work because the bacteria are resistant to it.

The problem with Shigella is that it produces a lot of toxins that can affect all other organs. So, if the bacteria continue to proliferate in the body even after giving the antibiotics, it will continue to produce toxins, which can then affect the kidney, cause seizures, lead to multi-organ failure, and shock, and even turn fatal. This, however, does not happen in most cases, the mortality of the infection is less than 1%.

So if you have abdominal discomfort or an upset stomach, at which point should you start worrying?

There is no need to rush to a doctor or a hospital every time you have loose motions.  However, if you have loose motions accompanied with high fever, blood in the stool, or constant vomiting such that you cannot keep any fluids down, you must get yourself to a doctor.

     A person who has severe diarrhoea — which means 20 or more bowel movements in a day — must see a doctor within a day; a patient with mild diarrhoea may wait for three to four days before going to a doctor.

This is true of any diarrhoea, whether it is because of Shigella or any other reason. It is possible that the student from Kerala who died after eating the shawarma did not get medical treatment in time, he said.

What precautions should you take?

The measures to prevent a Shigella infection are the same as that of any other food- and water-borne infection. Wash your hands thoroughly before and after a meal. Wash your hands properly after a bowel movement. Ensure the water that you drink is clean and the fruits and vegetables are fresh.

“Products such as milk, chicken, and fish can get infected easily and must be kept at a proper temperature. They must also be properly cooked.

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   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

A comparison of imparting Justice Vs Health: Grave injustice to medical professionals


        Justice is needed for satisfaction of soul and peaceful mind, is of same importance what is to the health of body. Justice delayed gives a sense of hurt and pain to soul. Pendency in courts simply reflects the grave injustice people are living with.

 Pendency in courts casts a ‘pall of gloom’, presents a hopeless situation: AG

          Justice and Health- Both are crucial for happiness of the living beings as well as society as a whole.  Hospitals are full of patients and so are courts with litigants. None of the people go to hospital and courts happily and everyone invariably wants early relief.

   Compare the situation in courts with a hospital.  Once a patient visits hospital, he will be treated almost instantaneously; irrespective how many patients’ doctors might have to examine in a day or night. There is almost nil pendency in hospitals, be it day or night, emergency or routine cases.

     Now can we expect similar treatment at courts? Do the people visiting courts are imparted justice in real sense.  Doctors get few minutes to decide. Most of the time, for the investigations and the treatment few visits are required. But there is no pendency. In Government hospitals, even appointments are not given. A doctor sitting in outdoor will see hundreds of patients. On emergencies night duties, doctor will not be able to count how many he/she has stabilized or numbers treated.

      Even in such chaotic systems, doctor can be punished, dragged to courts or assaulted for unintentional mistakes, that are  almost always secondary to load of patients or inept infrastructure.

     The work at hospital continues day and night, 24 hours and 365 days, despite almost always lesser number of doctors and required manpower. Systems in hospitals  are designed and maintained meticulously   to have no pendency what-so-ever situation is.   Larger number of patients go back home treated well and very few unfortunate patients are unable to recover, but still whatever is required- is done invariably.

Pendency in courts casts a ‘pall of gloom’ , presents a hopeless situation: AG

NEW DELHI: India’s top law officer K K Venugopal on Friday said litigants’ fundamental right to speedy justice lay in tatters and implored country’s top judges to take drastic measures to arrest their waning confidence in justice delivery system caused by monstrous pendency of 4.8 crores cases, many for decades. When we look at the pendency, a pall of gloom settles. We find that we are in a hopeless situation,” Venugopal said, “How has the justice delivery system deteriorated to this extent? If you look at the pendency over the years, we realise that over a lakh of cases are pending for more than 30 years at trial court level and 10-15 years in HCs. How do you believe that so far as litigants are concerned they would have confidence in the justice delivery system?” “But against whom the poor litigant can complain, or an under trial who is incarcerated for a number of years which he would have undergone had he been convicted and punished? Do they file a case for enforcement of their fundamental right? But against whom?

44 million pending court cases: How did we get here?

       There are about 73,000 cases pending before the Supreme Court and about 44 million in all the courts of India, up 19% since last year.

According to a 2018 Niti Aayog strategy paper, at the then-prevailing rate of disposal of cases in our courts, it would take more than 324 years to clear the backlog.

Grave injustice for medical professions:

  1.  A doctor making wrong diagnosis (gets few minutes to decide) can be prosecuted, but courts giving wrong verdicts (get years to decide) are immune?

     2. Compare the remuneration of lawyers to doctors. Doctors gets few hundreds to save a life (often with abuses) and lawyers can get paid in millions (happily).

      3. Doctors treat the body and larger is still not fully known about mechanisms. Still doctors can be blamed for unanticipated events. Whereas  law is a completely known and written subject.

   4. If health is citizen’s right so should be a timely justice.

         Despite doing so much for patients, still people’s behaviour to doctors and hospitals is not respectful. Doctors are punished for slight delays and people and courts remain intolerant to unintentional mistakes. But people can’t behave in the same manner to courts and legal system and keep on tolerating the blatant injustice for years. 

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

   

Myocardial ischemia-Complications-Prevention-Treatment 


Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart’s arteries (coronary arteries).

Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle’s ability to pump blood. A sudden, severe blockage of one of the heart’s artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms.

Treatment for myocardial ischemia involves improving blood flow to the heart muscle. Treatment may include medications, a procedure to open blocked arteries (angioplasty) or bypass surgery.

Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.

Symptoms

Some people who have myocardial ischemia don’t have any signs or symptoms (silent ischemia).

When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include:

  • Neck or jaw pain
  • Shoulder or arm pain
  • A fast heartbeat
  • Shortness of breath when you are physically active
  • Nausea and vomiting
  • Sweating
  • Fatigue

When to see a doctor

Get emergency help if you have severe chest pain or chest pain that doesn’t go away.

Causes

Myocardial ischemia occurs when the blood flow through one or more of your coronary arteries is decreased. The low blood flow decreases the amount of oxygen your heart muscle receives. Myocardial ischemia can develop slowly as arteries become blocked over time. Or it can occur quickly when an artery becomes blocked suddenly. Conditions that can cause myocardial ischemia include:

Coronary artery disease (atherosclerosis). Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is the most common cause of myocardial ischemia.

Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body.

Coronary artery spasm. This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to part of the heart muscle. Coronary artery spasm is an uncommon cause of myocardial ischemia. Chest pain associated with myocardial ischemia can be triggered by: Physical exertionEmotional stressCold temperaturesCocaine useEating a heavy or large mealSexual intercourse Risk factors Factors that can increase your risk of developing myocardial ischemia include: Tobacco. Smoking and long-term exposure to secondhand smoke can damage the inside walls of arteries. The damage can allow deposits of cholesterol and other substances to collect and slow blood flow in the coronary arteries. Smoking causes the coronary arteries to spasm and may also increase the risk of blood clots.

Diabetes. Type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.

High blood pressure. Over time, high blood pressure can accelerate atherosclerosis, resulting in damage to the coronary arteries.

High blood cholesterol level. Cholesterol is a major part of the deposits that can narrow your coronary arteries. A high level of “bad” (low-density lipoprotein, or LDL) cholesterol in your blood may be due to an inherited condition or a diet high in saturated fats and cholesterol.

High blood triglyceride level. Triglycerides, another type of blood fat, also may contribute to atherosclerosis.

Obesity. Obesity is associated with diabetes, high blood pressure and high blood cholesterol levels.

Waist circumference. A waist measurement of more than 35 inches (89 centimeters) for women and 40 inches (102 cm) in men increases the risk of high blood pressure, diabetes, and heart disease.

Lack of physical activity. Not getting enough exercise contributes to obesity and is linked to higher cholesterol and triglyceride levels. People who get regular aerobic exercise have better heart health, which is associated with a lower risk of myocardial ischemia and heart attack. Exercise also reduces blood pressure.

Complications

Myocardial ischemia can lead to serious complications, including:

Heart attack. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal.

Irregular heart rhythm (arrhythmia). An abnormal heart rhythm can weaken your heart and may be life-threatening.

Heart failure. Over time, repeated episodes of ischemia may lead to heart failure. Prevention The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.

Diagnosis

Your doctor will start by asking questions about your medical history and with a physical exam. After that, your doctor might recommend:

Electrocardiogram (ECG). Electrodes attached to your skin record the electrical activity of your heart. Certain changes in your heart’s electrical activity may be a sign of heart damage.

Stress test. Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise.

Echocardiogram. Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.

Stress echocardiogram. A stress echocardiogram is similar to a regular echocardiogram, except the test is done after you exercise in the doctor’s office on a treadmill or stationary bike.

Nuclear stress test. Small amounts of radioactive material are injected into your bloodstream. While you exercise, your doctor can watch as it flows through your heart and lungs — allowing blood-flow problems to be identified.

Coronary angiography. A dye is injected into the blood vessels of your heart. Then a series of X-ray images (angiograms) are taken, showing the dye’s path. This test gives your doctor a detailed look at the inside of your blood vessels.

Cardiac CT scan. This test can determine if you have a buildup of calcium in your coronary arteries — a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).

Treatment

The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle. Depending on the severity of your condition, your doctor may recommend medications, surgery or both. Medications Medications to treat myocardial ischemia include:

Aspirin. A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent blockage of your coronary arteries. Ask your doctor before starting to take aspirin because it might not be appropriate if you have a bleeding disorder or if you’re already taking another blood thinner.

Nitrates. These medications widen arteries, improving blood flow to and from your heart. Better blood flow means your heart doesn’t have to work as hard.

Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure so blood can flow to your heart more easily.

Calcium channel blockers. These medications relax and widen blood vessels, increasing blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.

Cholesterol-lowering medications. These medications decrease the primary material that deposits on the coronary arteries.

Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels and lower blood pressure. Your doctor might recommend an ACE inhibitor if you have high blood pressure or diabetes in addition to myocardial ischemia. ACE inhibitors may also be used if you have heart failure or if your heart doesn’t pump blood effectively.

Ranolazine (Ranexa). This medication helps relax your coronary arteries to ease angina. Ranolazine may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitrates.

Procedures to improve blood flow

Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include:

Angioplasty and stenting. A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a tiny balloon is threaded into the narrowed area and inflated to widen the artery. A small wire mesh coil (stent) is usually inserted to keep the artery open.

Coronary artery bypass surgery. A surgeon uses a vessel from another part of your body to create a graft that allows blood to flow around the blocked or narrowed coronary artery. This type of open-heart surgery is usually used only for people who have several narrowed coronary arteries.

Enhanced external counterpulsation. This noninvasive outpatient treatment might be recommended if other treatments haven’t worked. Cuffs that have been wrapped around your legs are gently inflated with air then deflated. The resulting pressure on your blood vessels can improve blood flow to the heart. Lifestyle and home remedies

Lifestyle changes are an important part of treatment. To follow a heart-healthy lifestyle:

Quit smoking. Talk to your doctor about smoking cessation strategies. Also try to avoid secondhand smoke.

Manage underlying health conditions. Treat diseases or conditions that can increase your risk of myocardial ischemia, such as diabetes, high blood pressure and high blood cholesterol.

Eat a healthy diet. Limit saturated fat and eat lots of whole grains, fruits and vegetables. Know your cholesterol numbers and ask your doctor if you’ve reduced them to the recommended level.

Exercise. Talk to your doctor about starting a safe exercise plan to improve blood flow to your heart.

Maintain a healthy weight. If you’re overweight, talk to your doctor about weight-loss options.

Decrease stress. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. It’s important to have regular medical checkups. Some of the main risk factors for myocardial ischemia — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.  

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Hyperlipidemia- Bad cholesterol (LDL) and plaque in an artery


Hyperlipidemia

Hyperlipidemia (high cholesterol) means your blood has too many lipids (fats) in it. These can add up and lead to blockages in your blood vessels. This is why high cholesterol can put you at risk for a stroke or heart attack. But you can make lifestyle changes like eating healthier and exercising to lower your cholesterol. Medicine can help, too.

  Hyperlipidemia, or high cholesterol, can let plaque collect inside your blood vessels and put you at risk of a heart attack or stroke. The good news is that you have the power to reduce your risk of heart attack and stroke. Exercising more and eating healthier are just two of the ways you can improve your cholesterol numbers. Taking medicine your provider orders makes a difference, too.

OVERVIEW

Bad cholesterol (LDL) and plaque in an artery

What is hyperlipidemia?

Hyperlipidemia, also known as dyslipidemia or high cholesterol, means you have too many lipids (fats) in your blood. Your liver creates cholesterol to help you digest food and make things like hormones. But you also eat cholesterol in foods from the meat and dairy aisles. Since your liver can make as much cholesterol as you need, the cholesterol in foods you eat is extra.

Too much cholesterol (200 to 239 mg/dL is borderline high and 240 mg/dL is high) is not healthy because it can create roadblocks in your artery highways where blood travels around to your body. This damages your organs. Bad cholesterol (LDL) is the most dangerous type because it causes hardened cholesterol deposits (plaque) to collect inside of your blood vessels. This makes it harder for your blood to get through, which puts you at risk for a stroke or heart attack.

Think of cholesterol, a kind of fat, as traveling in lipoprotein cars through your blood.

  • Low-density lipoprotein (LDL) is known as bad cholesterol because it can clog your arteries like a large truck that broke down and is blocking a traffic lane. (Borderline high number: 130 to 159 mg/dL. High: 160 to 189 mg/dL.) 
  • Very low density lipoprotein (VLDL) is also called bad because it carries triglycerides that add to artery plaque. This is another type of traffic blocker.
  • High-density lipoprotein (HDL) is known as good cholesterol because it brings cholesterol to your liver, which gets rid of it. This is like the tow truck that removes the broken down vehicles from the traffic lanes so vehicles can move. In this case, it’s clearing the way for your blood to get through your blood vessels. For your HDL, you don’t want to have a number lower than 40 mg/dL.

It’s important to know that providers consider other factors in addition to your cholesterol numbers when they make treatment decisions.

Is hyperlipidemia the same as high cholesterol?

Yes, hyperlipidemia is another name for high cholesterol, and so is hypercholesterolemia.

What is dyslipidemia vs. hyperlipidemia?

They are mostly interchangeable terms for abnormalities in cholesterol. Your cholesterol can be “dysfunctional” (cholesterol particles that are very inflammatory or an abnormal balance between bad and good cholesterol levels) without being high. Both a high level of cholesterol and increased inflammation in “normal” cholesterol levels put you at increased risk for heart disease.

What are the risk factors for hyperlipidemia? 

Several things can put you at a higher risk of hyperlipidemia, including:

  • Having a family history of high cholesterol.
  • Having hypothyroidism.
  • Having obesity.
  • Not eating a nutritious diet.
  • Drinking too much alcohol.
  • Having diabetes.
  • Smoking.

How common is hyperlipidemia?

Hyperlipidemia is very common. Ninety-three million American adults (age 20 and older) have a total cholesterol count above the recommended limit of 200 mg/dL.

How serious is hyperlipidemia?

Hyperlipidemia can be very serious if it’s not controlled. As long as high cholesterol is untreated, you’re letting plaque accumulate inside your blood vessels. This can lead to a heart attack or stroke because your blood has a hard time getting through your blood vessels. This deprives your brain and heart of the nutrients and oxygen they need to function. Cardiovascular disease is the leading cause of death in Americans.

How does hyperlipidemia affect my body?

Hyperlipidemia (high cholesterol) that’s not treated can allow plaque to collect inside your body’s blood vessels (atherosclerosis). This can bring on hyperlipidemia complications that include:

  • Heart attack.
  • Stroke.
  • Coronary heart disease.
  • Carotid artery disease.
  • Sudden cardiac arrest.
  • Peripheral artery disease.
  • Microvascular disease.

SYMPTOMS AND CAUSES

What are the symptoms of hyperlipidemia?

Most people don’t have symptoms when their cholesterol is high. People who have a genetic problem with cholesterol clearance that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on the skin) or corneal arcus (cholesterol rings around the iris of the eye). 

What causes hyperlipidemia?

Various hyperlipidemia causes include:

  • Smoking.
  • Drinking a lot of alcohol.
  • Eating foods that have a lot of saturated fats or trans fats. 
  • Sitting too much instead of being active.
  • Being stressed.
  • Inheriting genes that make your cholesterol levels unhealthy.
  • Being overweight.

Medications that are helpful for some problems can make your cholesterol levels fluctuate, such as:

  • Beta blockers.
  • Diuretics.
  • Hormonal birth control.
  • Steroids.
  • Antiretrovirals for HIV.

Medical problems can also affect how much cholesterol you have. These include:

  • Multiple myeloma.
  • Polycystic ovary syndrome (PCOS).
  • Hypothyroidism.
  • Primary biliary cirrhosis.
  • Chronic kidney disease.
  • Diabetes.
  • Lupus.
  • Sleep apnea.
  • HIV.

DIAGNOSIS AND TESTS

How is hyperlipidemia diagnosed?

Your provider will want:

  • A physical exam.
  • Your medical history.
  • Your family’s medical history.
  • To calculate your 10 year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score.

A blood test called a lipid panel will tell you these numbers:

Type of cholesterolBest number to have
Total cholesterolLess than 200 mg/dL
Bad (LDL) cholesterolLess than 100 mg/dL
Good (HDL) cholesterolAt least 60 mg/dL
TriglyceridesLess than 150 mg/dL

What tests will be done to diagnose hyperlipidemia?

Your provider may also do these tests:

  • High sensitivity C-reactive protein (hs-CRP).
  • Lipoprotein (a).
  • Apolipoprotein B.
  • Coronary calcium scan.

MANAGEMENT AND TREATMENT

How is hyperlipidemia treated?

Changing their lifestyles may be all some people need to do to improve their cholesterol numbers. For other people, that’s not enough and they need medication.

Things you can do include:

  • Exercising.
  • Quitting smoking.
  • Sleeping at least seven hours each night.
  • Keeping your stress level under control.
  • Eating healthier foods.
  • Limiting how much alcohol you drink.
  • Losing a few pounds to reach a healthy weight.

What medications are used for hyperlipidemia?

People who need medicine to treat their high cholesterol usually take statins. Your provider may order a different type of medicine if:

  • You can’t take a statin.
  • You need another medicine in addition to a statin.
  • You have familial hypercholesterolemia, a genetic problem that makes your bad (LDL) cholesterol number extremely high.

Are there side effects of hyperlipidemia treatment?

Any medication can have side effects, but the benefits of statins far outweigh the risks of minor side effects. Let your provider know if you aren’t doing well on your medicine so they can develop a plan to manage your symptoms.

How soon will the hyperlipidemia treatment start working?

Your provider will order another blood test about two or three months after you start taking hyperlipidemia medication. The test results will show if your cholesterol levels have improved, which means the medicine and/or lifestyle changes are working.

PREVENTION

How can I reduce my risk of hyperlipidemia?

Even children can get their blood checked for high cholesterol, especially if someone in the child’s family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.

Once you reach middle age, you should have your cholesterol checked every year or two. Your healthcare provider can help you decide how often you should have a hyperlipidemia screening.

How can I prevent hyperlipidemia?

Changes you make in your life can keep you from getting hyperlipidemia. Things you can do include:

  • Stop smoking.
  • Stay active instead of sitting too much.
  • Keep your stress level down.
  • Get the right amount of sleep.
  • Eat healthy foods.
  • Cut back on eating fatty meats.
  • Don’t buy snacks that have “trans fat” on the label.
  • Stay at a healthy weight.

OUTLOOK / PROGNOSIS

What can I expect if I have hyperlipidemia?

If you have hyperlipidemia, you’ll need to keep using healthy lifestyle habits for years to come. You’ll also need to keep follow-up appointments with your provider and continue to take your medicine.

How long will you have hyperlipidemia?

Hyperlipidemia is a condition you’ll need to manage for the rest of your life.

What is the outlook for hyperlipidemia? 

Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself by living a healthier lifestyle and taking medicine if needed.

LIVING WITH

How do I take care of myself with hyperlipidemia? 

Be sure to follow your provider’s instructions for making your lifestyle healthier.

Here are things you can do yourself:

  • Exercise.
  • Stop smoking.
  • Sleep at least seven hours each night.
  • Control your stress level.
  • Eat healthier foods.
  • Limit how much alcohol you drink.
  • Stay at a healthy weight.

Other things you can do:

  • If your provider ordered medicine for you, be sure to keep taking it as the label tells you to do. 
  • Keep your follow-up appointments.

When should I see my healthcare provider?

You should see your provider if you have:

  • High blood sugar.
  • High blood pressure.
  • High cholesterol.

What questions should I ask my doctor?

  • Do I need to make lifestyle changes, take medication or both?
  • If I do what you tell me to do, how quickly can my numbers improve?
  • How often do I need to check in with you? 

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Why buying a medical college seat & paying millions may be a blunder?


    The painful incident of Dr Archana Sharma’s Suicide unmasks the everyday struggle of the doctors in the present era. Her supreme sacrifice depicts the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death is the result of the apathy of fair justice that eludes medical community. Sadly, the society is unable to realize its loss.

    Negligent police, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  It may not be a good idea to opt for a medical career any more. In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some people are naïve enough to spend millions on securing an expensive medical college seat.  Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.

Disadvantages of being a doctor, Drawbacks of Medical profession: 

Choosing medical career  or being a medical professional  a disadvantage to doctor in comparison to other professions?

  1. Medical courses are comparatively lengthy and expansive study course and difficult training with slave like duties. “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

  • Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
  • The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
  • Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
  • Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
  • Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
  • Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
  • Retrospective analysis of doctor’s every action continues all the life: It could be by patients and relatives every day in the form of “Why this was not done before?” Every day irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

The decision taken in split seconds will be questioned, which  in retrospect  may not turn out to be the best one. But later retrospective analysis along with wisdom of hindsight with luxury of time  (in courts) may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with patients makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

  1. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
  2. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
  3. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession:  It is heart-breaking to watch  zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.
  4. Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic Oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, which use pressure tactics to get their own way.

       It may be a  naïve idea  or just a blunder to pay millions to be a doctor.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

‘Doctor- Save Yourself’: Court Convicts Doctors For Operating Woman Without Ventilator


A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other lifesaving equipment.  This was despite the fact that  the committee constituted by the District Surgeon to verify the allegation of medical negligence in its final report has said there is no negligence on the part of the accused during the performance of the LAVH surgery and also shows  *how the accused have tried to save the deceased.”*

What is worrying for the doctors is that every death during medical treatment can be a blame against the doctors. If the courts were to impose criminal liability on the hospital and doctors for everything that goes wrong, the doctors now should be more worried about their own safety than giving all the best treatment to their patients.     Both Government and Private  small hospitals carry out  thousands of routine surgeries every day. Occasionally complications may arise  in simplest looking procedures – for example even in   normal deliveries; what to say about routine surgeries.         How many hospitals (Government and private) in districts, town in peripheries are equipped with a ventilatory support system?  Perhaps  they are too less, although an honest count would  be some  interesting data.  Still, surgeries of the type mentioned are conducted  routinely  in almost all of these small centres.

So based on one incident of this kind, the thousands of surgeries done in such areas are going to be affected. In other words, doctors will not dare to conduct surgeries in peripheries.       As per the verdict of the court, many of the surgical speciality’s doctors in periphery are indulging in blameworthy activities every day in their routine work. Why should they risk their lives and profession in such circumstances?   That raises  another question , as many  Government  Hospitals are also without ventilators in the periphery. Should Govt doctors also  refuse surgeries without an ICU setup?  Any Surgery or even normal delivery in rare circumstances can get complicated and  the patient may require ventilator. Usually anaesthetist use Ambu-bag for an emergency situation and transport the  patient to other facility. So absence of a  ventilator is not life threatening in a real sense.     In peripheries, a large number of  deliveries are conducted  by ANMs, and nurses, and complications may arise occasionally.  So what are the facilities expected and available at a sub-centre? In reality   almost nothing is available.      Merely having a ventilator  does not solve the problem and  is not enough . The hospital  requires much more  arrangements to keep a patient  on ventilator.  Do all Govt hospitals where surgeries are  being done have ventilator and trained doctors  and support staff to operate those ventilators? It needs round the clock trained  doctors  and nurses, ABG  machine, portable X-ray , bed side Echo dialysis etc. Doctors in ill-equipped Govt   centres  are forced to conduct deliveries.  What should be the SOP in such circumstances? A real and honest data would be an eye opener and interesting.

Doctor need to  ponder over the issue of saving themselves before they save the patient.

 

 

Medical Negligence: Karnataka Court Convicts Three Doctors For Death Of Woman Operated Without Ventilator Facility & Other Life Saving Equipment* “A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other life saving equipment. BIDAR: Four people, including three doctors, have been handed jail terms and slapped with fines by a local court for a botched surgery which claimed the life of a woman.The II Civil (senior) and JMFC Court judge Abdul Khadar sentenced well-known medical practitioners Dr Rajshree Biradar and Dr Vaijinath Biradar, and Saibanna, to two years imprisonment and fined them Rs 10,000 each. If they fail to pay the fine, they will have to serve an additional six months in prison. Dr Rajshekar Patil was sentenced to six months imprisonment and fined Rs 5,000. He will have to serve additional imprisonment of one month if he fails to pay the fine.The case dates back to October 12, 2014, when Sampavati, wife of Ghaleppa Auradakar, got herself admitted to Sushrut Nursing Home in the city for a hysterectomy procedure. But after a five-hour surgery, she died due to alleged medical negligence.However, without disclosing her condition to the family, she was shifted to Dr Rajshekhar Patil’s Shree Hospital in an ambulance. Dr Patil continued the treatment without disclosing her condition, it was alleged in the chargesheet.

Nursing home was negligent in not having ventilator: Court

Later, it was revealed that Sampavati had died at Sushrut Nursing Home itself due to the lack of ventilator facility. The court, while convicting the accused, observed that the nursing home authorities were negligent in not having a ventilator facility for such a risky procedure.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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