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. Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.
It was an incident that was enough to jolt doctors’ and medical associations out of their deep slumber against the everyday sufferings of their members. Protecting and supporting the suffering members against physical and legal assaults should be the need of the hour. But sadly, it was not enough to wake them up. After few days of token protests, everything came back to routine. Unfortunately Doctors’ associations have limited their role merely to social gatherings with some token academics. They have not risen to the real life problems of doctors like goonism, blackmail, physical and legal assaults. Doctors as individuals remain vulnerable to these issues and always remain at receiving end of the stick. In this era, doctors’ associations need to play a bigger role especially in cases of medico-legal suits against doctors; to support the sufferers. As cases of medical negligence may be circumstantial incidents and not real mistakes, courts may not be able to deliver justice to doctors many times. A concern is that in case of poor outcome and case goes to courts, there is an indirect perverse incentive to deliver a guilty verdict against the doctor as a person, who is responsible for life and death.
Failure of Doctors’ and Medical associations to rise to the occasion even in such a case of blatant cruelty will be a real injustice to DR Archana Sharma.
Burnout, as it is defined, is not a medical condition — it’s “a manifestation of chronic unmitigated stress.” The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy.
Dr. Jessi Gold, a psychiatrist at Washington University in St. Louis, knows she’s edging toward burnout when she wakes up, feels instantly angry at her email inbox and doesn’t want to get out of bed. It’s perhaps not surprising that a mental health professional who is trying to stem the rising tide of burnout could burn out sometimes, too. After all, the phenomenon has practically become ubiquitous in our culture.
In a 2021 survey of 1,500 U.S. workers, more than half said they were feeling burned out as a result of their job demands, and a whopping 4.3 million Americans quit their jobs in December in what has come to be known as the “Great Resignation.” When people think of burnout, mental and emotional symptoms such as feelings of helplessness and cynicism often come to mind. But burnout can lead to physical symptoms as well, and experts say it can be wise to look out for the signs and take steps when you notice them.
Burnout, as it is defined, is not a medical condition — it’s “a manifestation of chronic unmitigated stress,” explained Dr. Lotte Dyrbye, a physician scientist who studies burnout at the Mayo Clinic. The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy.
“You start not functioning as well, you’re missing deadlines, you’re frustrated, you’re maybe irritable with your colleagues,” said Jeanette Bennett, a researcher who studies the effects of stress on health at the University of North Carolina, Charlotte.
But stress can have wear and tear effects on the body, especially when it doesn’t ease up after a while — so it makes sense that it can incite physical symptoms, too, Bennett said. When people are under stress, their bodies undergo changes that include making higher than normal levels of stress hormones such as cortisol, adrenaline, epinephrine and norepinephrine. These changes are helpful in the short term — they give us the energy to power through difficult situations — but over time, they start harming the body.
Our bodies were “not designed for the kinds of stressors that we face today,” said Christina Maslach, a social psychologist at the University of California, Berkeley, who has spent her career studying burnout.
Here’s how to recognize burnout in your body and what to do about it.
Insomnia- One common burnout symptom is insomnia, Dyrbye said. When researchers in Italy surveyed front-line health care workers with burnout during the first peak of the pandemic, they found that 55% reported having difficulty falling asleep, while nearly 40% had nightmares.
Research suggests that chronic stress interferes with the complicated neurological and hormonal system that regulates sleep. It’s a vicious cycle, because not sleeping throws this system even more out of whack. If you’ve noticed that you’re unable to sleep at night, that could be a sign that you’re experiencing burnout, Dyrbye said — and your sleeplessness could exacerbate the problem.
Physical exhaustion is another common sign. Gold said that one of her key symptoms of burnout was fatigue. “I realized I was sleeping every day after work — and I was like, ‘What is wrong with me?’ but it was actually burnout,” she said.
Changes in eating habits — either eating more or less than usual — can also be a sign of burnout: In the study of Italian health care workers, 56% reported changes in food habits. People might eat less because they’re too busy or distracted, or they might find themselves craving “those comfort foods that we all like to go to when we need something to make us feel better,” Bennett said. Research suggests, too, that stress hormones can affect appetite, making people feel less hungry than usual when they’re under a lot of stress, and more hungry than usual when that stress alleviates.
Headaches and stomachaches can also be incited by burnout, Gold said. One study of people in Sweden suffering from exhaustion disorder — a medical condition similar to burnout — found that 67% reported experiencing nausea, gas or indigestion, and that 65% had headaches. It’s also important to note that burnout can develop alongside depression or anxiety, both of which can cause physical symptoms. Depression can cause muscle aches, stomachaches, sleep issues and appetite changes. Anxiety is linked to headaches, nausea and shortness of breath.
If you’re experiencing physical symptoms that could be indicative of burnout, consider seeing your primary care doctor or a mental health professional to determine whether they are driven by stress or rooted in other physical conditions, Dyrbye said. Don’t just ignore the symptoms and assume they don’t matter.
“It’s really easy to blow off your own symptoms, especially in our culture, where we’re taught to work hard,” Gold said.
If it is burnout, then the best solution is to address the root of the problem. Burnout is typically recognized when it is job-driven, but chronic stress can have a variety of causes — financial problems, relationship woes and caregiving burdens, among other things. Think about “the pebbles in your shoe all the time that you have to deal with,” Maslach said, and brainstorm ways to remove some of them, at least some of the time. Perhaps you can ask your partner to help more with your toddler’s bedtime routine, or get takeout when you’re especially busy so you don’t have to plan dinner, too.
Despite popular culture coverage of the issue, burnout can’t be “fixed” with better self care, Maslach said — in fact, this implication only worsens the problem, because it lays the blame and responsibility on those with burnout and implies that they should do more to feel better, which is not the case, she said. However, some lifestyle choices can make burnout less likely. Social support, for instance, can help, Gold said. This could include talking to a therapist or meeting with friends (even if over Zoom). It may also help to take advantage of mental health or exercise benefits offered by your employer. Sleeping more can help too — so if you’re suffering from insomnia, talk to a doctor about possible treatments, Bennett suggested.
Finally, while you may not want to add more to your plate, try to make a bit of time each day for something you love, Dyrbye said. Her work has found that surgeons who make time for hobbies and recreation — even just 15 to 20 minutes a day — are less likely to experience burnout than surgeons who don’t.
“You have to have something outside of work that helps you de-stress, that helps you focus and helps you relax,” she said.
Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being.
Unfortunately, abusive and violent behaviour by patients or relatives or those accompanying patients has become one of the attendant risks of the medical profession. It is no surprise then that the medical fraternity has once again called upon the government to enact stringent laws and their proper implementation to curtail this kind of behaviour with the National Medical Commission (NMC) proposing that registered medical practitioners (RMPs) refuse to take on such cases.
The NMC (which replaced the Medical Council of India) is a body that regulates medical education and professionals.
The NMC’s Ethics and Medical Registration Board has issued draft regulations inviting comments from the public, experts, stakeholders and organisations on “National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations 2022”.
Comments and suggestions on the draft proposal can be sent by June 22.
“In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behaviour and refuse to treat the patient. Such patients should be referred for further treatment elsewhere,” the draft proposal says.
“If a change of RMP is needed (for example, the patient needs a procedure done by another RMP), consent should be obtained from the patient himself or the guardian. The RMP who attends to the patient will be fully accountable for his actions and entitled to the appropriate fees,” it added.
Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being. Sahajanand Prasad Singh, president, Indian Medical Association (IMA, a panel that represents doctors and their interests), said a doctor would be ethically wrong if he or she refuses treatment to someone in need. So the need of the hour is to have a central law to check such untoward incidents, said Dr Singh.
“The commission or abetment of such acts of violence shall be punished with imprisonment for a term of three months to five years, and with fine of Rs 50,000 to Rs 2,00,000,” says the Epidemic Diseases (Amendment) Act, 2020.
Former IMA president Rajan Sharma, who led a nationwide protest condemning violence against doctors in India, said without a Union home ministry law against attacks on doctors, these proposals would do very little to prevent incidents against healthcare workers.
“There has to be strong laws to deal with the rising cases of violence. The regulations made by NMC should be in tandem with the stringent laws from the Union home ministry,” Dr Sharma said.
On his part, IMA general secretary Jayesh Lele, “It’s only a draft regulation, we are going to submit our important observations to the NMC.”
Anuj Aggarwal, general secretary, Federation of Resident Doctors Association of India, said the RMP Professional Conduct Guidelines offers some breather for resident doctors but has some way to go.
“The guidelines give rightful exceptions to patients with life-threatening conditions, which is justified. However, it is important to consider that most of the events in which a patient’s attendants turn violent are when the patient is very critically ill. So this proposal has no role to play in the majority of such scenarios,” he said.
Dr Aggarwal said that while it is a welcome step to curb the issue of rising violence against doctors, a central law would be a better and more effective deterrent.
The government did propose a central protection act and a draft was put in the public domain in 2019 for feedback but it was put on the back burner.
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.
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.
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.
BMI
Weight status
Below 18.5
Underweight
18.5-24.9
Normal
25.0-29.9
Overweight
30.0 and higher
Obesity
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).
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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?
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:
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.
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.
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.
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.
Evolution of Medical profession-Extinction of good doctors 