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FAITH IS THE FOUNDATION OF A DOCTOR-PATIENT RELATIONSHIP

FAITH IS THE FOUNDATION OF A DOCTOR-PATIENT RELATIONSHIP

 

“ There are two sorts of doctors: those who practice with their brains and those who practice with their tongues”

-William Osler

The big evolutionary step that is relevant to the mechanism of the doctor-patient relationship occurred when animals started grooming others rather than themselves. It represents an elementary form of medical care. It is the first example of social interaction. The doctor-patient relationship is considered to be the core element in the ethical principles of medicine. The people used to exhibit a lot of faith in doctors and at the same time, doctors exhibited high traditions of Hippocratic oath and morals enshrined in Vedas where the doctors’ aim was total dedication towards treating ailing living beings. Doctors were considered as demi-gods.

With the passage of time, setting up of corporate hospitals and commercial mottos the sacred doctor-patient relationship is spoiled. Thereby in today’s scenario, there is a deficit in the doctor-patient relationship which is leading to chaos. Continuity of care is something that is known to improve patient satisfaction and patient outcomes. You should be able to see the humanity on the other side of the white coat. It makes sense that if a patient trusts his doctor, the doctor will be in a better position to know the patient’s illness. This is a milestone in a doctor-patient relationship.

Various studies have shown that patients who went back to the same physician had a lower chance of dying, compared to patients who visited different doctors. The rationale for this is when you see the same physician you would talk more freely and give the doctor more information and build up a harmonious relationship with the doctor. This highlights the importance of relationships in the well being of an individual including in the medical care. A word of care and sympathy by a doctor to his sick patient can really restore a patient’s faith and confidence.

But today’s visual of deteriorating doctor-patient relationship was a manifestation system-wide malaise of decreasing respect for institutions, decrease in the value system and increasing violence and materialism. The lack of trust in a doctor-patient relationship is increasing the laws and regulations being imposed on the medical sector. In doctor-patient relationship, honesty is important from doctor’s point of view and a provider who listens, followed by one who is compassionate and one who can clearly explain what any medical problem is and how it will be treated is needed from patient’s point of view. Patient with a lower level of trust in their physician is more likely to report that requested or needed services are not provided. Understanding this relationship may lead to better ways of responding to patient requests that preserve or enhance patient trust, leading to better outcomes. A person may forget your name, but they will never forget how you made them feel. Every doctor should put in efforts to develop a good doctor-patient relationship to treat the patient who has the disease rather than treating the disease.

Therefore,

“The doctor-patient relationship is critical to the placebo effect”

Irwing Kirsch

PERCUTANEOUS BILIARY DRAINAGE

PERCUTANEOUS BILIARY DRAINAGE

 

Introductions:

Both ultrasound and computed tomography (CT) can be used to guide to percutaneous needle intervention. The choice of methods depends on multiple factors including lesion size, locations, equipment availability etc.

Ultrasound has several strengths as guiding percutaneous interventions. It is readily available, relatively inexpensive, and portable. It has no ionizing effects and can be used in almost all anatomical plane. The greatest advantage, however, is that it allows real-time visualization of needle tip as it passes through the tissue into the target. Ultrasound provides precise needle guidance to allow for needle aspiration

or catheter drainage of superficial and deep fluid collections throughout the body.

First, introduced in 1921 with direct puncture of the gallbladder. The technique was revolutionized in the 1960s with the introduction of fine-gauge (22- to 23-gauge) needles. It is an interventional radiology procedure undertaken for those with biliary obstruction. Biliary drainage relieves obstruction by providing an alternative pathway to exit the liver. If the bile duct becomes blocked, the bile cannot drain normally and backs up in the liver.

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Indications:

  • Biliary stones – within the gallbladder or within the bile ducts
  • Pancreatitis
  • sclerosing cholangitis
  • Tumors of the pancreas, gallbladder, bile duct, liver
  • Biliary Strictures
  • Malignancy: eg pancreas, Lymph nodes
  • Undiagnosed jaundice
  • Injury to the bile ducts during surgery

Contraindications:

  • Sepsis
  • bleeding disorders
  • contrast hypersensitivity

Patient preparations:

-The procedure and risk should be explained to the patient.

-The patient needs to empty stomach at least 4 hours.

-Patient need to get IV antibiotic before the procedures start

-We routinely require platelets and PT for the drainage procedure

-IV access is obtained to the patients for administration of medications and emergency access for complications

Technique and stenting

-The patient will lie on supine position

-Educate the patients about the whole procedure

-Skin will be cleaned with an antiseptic solution, and most of the rest of your body will be covered with a sterile towel

-The radiologist will use an ultrasound machine to decide on the most suitable point for inserting the fine plastic tube (the drainage catheter)

-Normally inserted between two of your lower ribs, on the right side

-Apply local anesthesia lidocaine 1% solution. The usual maximum adult dose for local anesthesia is 4.5 mg/Kg

-A small incision was made.

– Catheter insertion can be performed using the Seldinger technique; the choice usually depends on operator preference.

-When the radiologist is sure that the needle is in a satisfactory position in one of the bile ducts, a guide wire will be placed through the needle into the bile duct; this enables the plastic drainage catheter to be positioned correctly. The procedure may end at this stage, with the catheter being fixed to the skin surface, and attached to a drainage bag.

-Repeat ultrasound is done to look for drainage site and any complications.

-In some cases, a permanent metal tube, called a stent, may be placed across the obstruction to relieve the blockage. Even if this is done, a temporary external catheter may be left in place, attached to a drainage bag.

Percutaneous biliary drainage is considered a very safe procedure, designed to save you having a larger operation. Sometimes the bile may leak around the catheter and form a collection in the abdomen that can cause pain and may require drainage.

It usually takes 30 to 40 minute.

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Biliary Drain

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Biliary stenting

Post Procedure:

-The patient will send to ward

-Monitor vitals 8 hourly

-Take care of drainage bag so that catheter doesn’t get pulled out.

-All drains must be irrigated regularly. Injection and aspiration of 10 mL of isotonic sterile saline three or four times daily is usually sufficient

-Empty the drainage bag 8 hourly and record the output.

-If the patient goes home, educate the patient about catheter care and drainage output

Catheter Removal: Three criteria for catheter removal are as follow:

1. Negligible drainage over 24 hours

2. Afebrile patient

3. Minimal residual cavity

The catheter should be removed gradually over a few days, which promotes healing by secondary intentions.

Advantages of biliary drainage:

If a patient is suffering from symptoms of a blocked bile duct, such as skin discoloration, itching, rashes, nausea and tiredness, a biliary drainage may relieve some of these symptoms over time (it often takes a number of days after the procedure for these benefits to become apparent). If the bile in the blocked bile ducts is infected, biliary drainage is an important part of the treatment. Hepatic functions may be improved after biliary drainage.

NIPAH VIRUS (NiV) INFECTION- A NEWLY EMERGING ZOONOSIS CAUSING DANGER TO HUMAN

NIPAH VIRUS (NiV) INFECTION- A NEWLY EMERGING ZOONOSIS CAUSING DANGER TO HUMAN

  • Introduction: Nipah Virus is a newly emerging zoonosis that causes a severe disease in both Animals and Humans.
  • This may worsen into a state of a coma over a day or two.
  • Complication can include Encephalitis and Seizures.
  • This is a highly contagious and deadly virus.
  • What is Nipah Virus: The virus, a member of the family Paramyxoviridae (genus Henipavirus) is named after the Malaysian Village of Sungai Nipah, where many Pig farmers became ill.

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  • Epidemiology: Nipah Virus was first isolated & identified about 2 decades ago in 1998-99 When Malaysian & Singaporean Pig farmers & others in close contact with the animals suffered from respiratory illness.

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  • Outbreaks: Nipah Virus outbreaks have been reported in Malaysia, Singapore, Bangladesh, and India.
  • The Highest Mortality Rate has been reported about 2 decades ago in Bangladesh in 1999, where about 300 human cases of Nipah Virus were reported, including 100 deaths.

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  • At that time, more than one million pigs were euthanized to contain the outbreaks.
  • In 2001, NiV was again identified and isolated as the causative agent in an outbreak of human disease occurring in Bangladesh.
  • Recent Outbreaks In India: Recently, Nipah Virus came into the limelight when there is 17 people have died due to this fatal contagious viral disease in the Indian State of Kerala, According to the Health Ministry Official.

The virus is more frequent in Bangladesh & India, where exposure to Nipah Virus has been associated with eating raw date palm sap with contact with infected Bats Or Human.

  • Transmission: Transmission of Nipah Virus to human may occur when one comes in direct contact with infected bats, infected pigs or infected people.

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  • The recent outbreak of Nipah Virus in Kerala (May 2018), occurred when people consumed fruits bit by infected fruit bats, When bats carrying the virus bites into fruits, the virus enters the fruits and then infects the humans who consume it.

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  • Bats shed the virus in their excrement and secretions which can infect humans, as well as animals such as pigs, dogs, cows, etc who come into contact with the droppings.
  • The “Hospital-Acquired Infections” – are a major path of human to human transmission.
  • The Nipah Virus is also suspected to get transmitted through coughing. This infection can also easily affect people who come in direct contact with contaminated bodies.
  • Incubation Period: The symptoms may take from 4 to 14 days to appear after a person gets infected.
  • Risks of Exposure: Consumption of raw date palm & contact with bats. Human to Human transmission has been documented & exposure to other Nipah infected individuals is also a risk factor is reported in India & Bangladesh.
  • Signs & Symptoms: NiV infection can progress silently in humans without showing any symptoms. However, people infected with this deadly virus may display Influenza-like symptoms.
  • The Sign & Symptoms of Nipah Virus include:
  • Acute Respiratory Infection, which can be mild to severe and cause interference in breathing.
  • Fever, Muscle Pain, Headaches, Nausea, Vomiting, Sore Throat.
  • Dizziness, Drowsiness, Mental Confusion & Disorientation, Atypical Pneumonia.
  • Brain Swelling or fatal encephalitis. Gradual progression to Coma within 24 to 48 hours.
  • People who survive the infection may suffer from long-term side effects such as Convulsion and Personality Changes.
  • Mortality Rates: The virus can kill between 40% to 100% of those infected by it. Surprisingly, more than 60% of this infection in humans comes from animals.
  • How is Nipah Virus Infection Is Diagnosed:

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  1. Throat & Nasal Swabs.
  2. Blood Tests.
  3. Virus Isolation & Detection.
  4. CSF Analysis, Urine Tests.
  5. ELISA (IgG- IgM).
  6. Real-Time Polymerase Chain Reaction (RT-PCR).
  7. In Fatal Cases, immunohistochemistry on tissues collected during Autopsy may be the only way to confirm it.
  • What is the treatment for Nipah Virus Infection:

Currently, there is no vaccine or treatments available for Nipah Virus, Supportive Care and Prevention is the key to stop the spread and remain safe from this virus.

The drug Ribavirin has been shown to be effective against the virus in vitro, but the usefulness of Ribavirin remains uncertain.

  • How We Can Prevent The Nipah Virus Infection:
  1. People Should prevent the animals from eating fruits contaminated by Bats since the Fruits Bats are the Primary cause of Nipah Virus Infection.
  2. Stay away from consuming date palm for some time.
  3. Avoiding direct contact with Pigs, Bats, Human in Endemic.
  4. Health-Care Professionals to such patients should take precautionary measures such as Wearing Masks, Gloves etc.
  5. To avoid Hospital-Acquired Infections raise awareness about signs & symptoms & transmission to avoid human to human infection in such settings.

 

 

 

 

 

 

 

 

” SISTER, BP CUFF! SISTER, GRABS! SISTER ROUNDS! “

” SISTER, BP CUFF! SISTER, GRABS! SISTER ROUNDS! “

Med school! Hospital!!
Everyone in chaos. Sisters, interns, residents, consultants. Everybody in a constant race. Each one of them has their own story.
“sister, bp cuff!  Sister, grabs! sister rounds!
Gosh! Sister, why the hell isn’t this monitor working?? Sister, this! Sister,  that! Omg!! The sisters are a way too clumsy man,” utters the intern.
And here the sisters are in hustle always. Continous running, loading medicines, withdrawing samples, dressing, preparing for dispatch, doing everything in the permitted time. Too much of rush.

Interns,  the beginners, super fresh in their carrier are not much in less haste. Within a week of joining,  get completely used to the new world. The day starts in a haste to reach the rounds without a time for breakfast. After finally finishing writing progress and collecting reports and even before feeling a bit glad to have skipped breakfast for their service, it’s a time to get a complaint about not being responsible towards patients. “Omg! Interns like these kill the patients, says your consultant. When I was on your phase, I solely looked after the ward and opds too”, adds the resident. Interns are under the constant pressure from almost every one,  starting from sisters to consultants. Sometimes more of a paperwork make them forget their profession. Running the entire day, they wanna get through every procedure. But their hard work and sleepless nights are always overruled by the silly mistakes, immaturity and the little ignorance which is definitely not acceptable in our beautiful world of healing. Neither the Residents are free of this vicious cycle. Well,  they are at the top to have the uncountable number of mishappenings and acquaintances at the end of residency. PG’s, the fastest runners of the medical marathon, responsible for every misshapenness and aberrations in their respective wards, from the cleanliness of ward,  infrastructures, patient progress and many more. Never too prepared for the rounds,  always sort of knowledge which seems and is definitely very basic to the consultants. In spite of daily learning,  insistent practice, hard work, they are still miles away from getting pro. On their attempt of getting more serious,  they often land up in misunderstandings with residents of other departments. Their best decisions for their patient are most of the times mistaken irrelevant and inessential investigations or consultation or expert opinion to the counter residents and vice versa.

And again,  cutting off some of them with an intention of helping out your copartners would again label you a negligent one. You are always in a hit to be so incompetent to the duty. They complete the entire residency in chaos and even at the end,  they are labeled as not very compatible.
Completing postgraduate doesn’t even ease you out or relieves you of pressure. Rather you ought to be more responsible and handle your juniors. Entire hospital is in your hand and you can’t afford a slight carelessness towards the patient. What you call little creates a huge difference in the treatment protocol.
Finally,  its all about life. Its all about healing and curing. You do your level best,  keep running and yelling and complaining and blaming to finally be a better healer,  better soother. You shout at others cause you to feel your way of healing is better and vice versa. All of us are on a single journey with one single motive but with different roads. It’s not easy to know others journey without walking on their shoe. Let’s complain less, be more kind and only a little more understanding. Afterall, all of us have a single aim. Better healing and curing!!!
LIFE OF A DOCTOR AS AN ANATOMIST

LIFE OF A DOCTOR AS AN ANATOMIST

 

What is life if full of care!!
We have no time to stand and stare!!

These are my favorite lines. I feel those lines invariably especially after choosing
to be in the medical profession.
I had been totally unwary all throughout my medical journey which ended up being
an Anatomist. Repeating for getting into the medical profession and then for post-graduation
!! And then still the life is yet to settle!! But, I am always keeping the
hope to get a good opportunity. This reminds lines from the stalwart M. S.
Dhoni, “Kharagpur ki Government naukri mei phas gaya toh aghe kuch nahi ho
payega. Sirf 9 to 5 ki duty karte rehna padega.” (Meaning that,”If I join the
Government as a permanent employee as a ticket collector in the railways at
Kharagpur, then I will have to remain satisfied doing the 9 am to 5 pm duty. I will
be unable to satisfy my inner voice, be unable to fulfill the dream I cherish as a
cricketor.”)
And now we are not even able to get that. No satisfactory job nor salary!! Post PG
long wait; no result! MPSC was hope, but it was as if wanting to taste poisonous
honey!! It being preclinical subject is given last priority. Later on only to realize
that all preclinical vacancies are being directed to clinical subjects. I really fail to
understand why preclinical subjects are being looked down so much. To add on to
the existing struggle, MCI has reduced the requirement of staff members to be
recruited. Most of the time, pan India vacancies are available, but not where one
stays!! Ab kya pura India ghume? No family life.
But being a teacher, I encourage students. So how do I lose hope? Where there is
a will, there has to be a way. So, just need to keep patience and wait for the right
time to come.
And then by the grace of God a ray of hope is seen.
Job in a private college!! Everyone knows how it is!! Actually, it’s an open secret. But
sometimes to achieve something in life, some risks and compromises have to be
made. One needs to come out of the comfort zone as my husband puts it. It was slightly skirmished
for me. Not used to the local train travels, those fight to get
seats and phone calls to railway helpline numbers and many more. But, then I made
great lifetime friends in due course of time as well. Also, I got to learn a lot from
them. How everyone is struggling and yet so happy!!
I learned a lot as an Anatomist. I have my own innovative and unique style of
teaching. But at the same time, I am eager to learn from students as well. Although
it’s really funny to listen to their answers (entertainment time), it teaches lots
of lessons as well. For example, most of the time students are confused between
the lungs and liver. So, one can stress on this mistake. Thus, in future students can
avoid these errors. Also, if students are aware of the system wise different trays
kept in the examination, they can avoid mixture of two topics. In addition, one must be
aware that for dental students, knowledge on HNF is to be imbibed more.
Exercise science, Occupational therapy and Physiotherapy students, limb study is
to be focused. For MBBS students, mnemonics and stories help a lot to catch
their attention.
Ultimately, one has to choose a profession of our liking or like the one in which he
or she is into. I would like to reiterate on the winning statements of our beloved
MISS INDIA WORLD MANUSHI CHILLER, “Profession is not just about being
paid. It’s the respect and love one gets by doing whatever one has focused on.
Mothers’ life is full of sacrifice and doesn’t expect anything in return. And so that
is the highest paid profession.” And yes, of course, I could better understand
these words as I am because of the sacrifices and struggles of my mother and my
elder brother. Had they not been selfless, can’t even imagine my fate.
In the meantime, one has to be vigilant and look out for the opportunity. It does come
and in a special way unfolds the divine plan of God. Of course our efforts and hard
work matters!! And that opportunity did come thanks to the Modi government. Pan
India Central government is opening new medical colleges.
So, I am feeling positive and hopeful for the future. As Bob Hope rightly says, “I’ve
always been in the right place and time. Of course, I steered myself there.”

 

” THE GOOD PHYSICIAN TREATS THE DISEASE , THE GREAT PHYSICIAN TREATS THE PATIENT WHO HAS THE DISEASE”

” THE GOOD PHYSICIAN TREATS THE DISEASE , THE GREAT PHYSICIAN TREATS THE PATIENT WHO HAS THE DISEASE”

 

The doctor-patient relationship has been and remains a keystone of healthcare in community. In ancient era people would seek medical remedies from ‘vaidya’ and had faith in him. He was family physician for the people. The guidance ,co-operation and to lesser degree mutual participation were distinguishing patterns of doctor-patient relationship.

For medical profession , Hippocratic oath established a code of ethics for doctor ,it also provided ’Bill of Rights’ for patients. The code emphasized the doctor’s attitude towards patient, “The regimen I adopt shall be for the benefit of my patients according to my ability and judgement ,and not for their hurt or for wrong…Whatsoever house I enter ,there will I go for the benefit of the

Sick ,refraining from all wrongdoing or corruption and especially from any seduction,of male or female ,of bond free. Whatsoever things I see or hear concerning the life of men,in my attendance on the sick or even apart there from,which ought not be noised abroad ,I will keep silence thereon ,counting such things to be as sacred secrets”.

Previously doctor would be called as GOD and his word was final for the patients.Patients never used to doubt doctor’s skill and approach towards patient.

Becoming a doctor was considered to be a noble profession but scenario has changed for last two decades. The doctor who was treated respectfully by society is now beaten by that society.People don’t think of sacrifices which he/she made for becoming a doctor.

“Stethoscope is the costliest jewellery to wear in the world ,it costs your whole youth”

Currently the scenario changed from GOD to people thinking of him now selfish person. Still many doctors are praised for their service but very little section of society holds this attitude. Doctor used to treat patients on the basis of his clinical knowledge which he acquired through years of practice and hard work and this created good rapport between doctor and patient. Now a days ,due to advances in diagnostic technology ,doctors are relying on tests and advising investigations added to financial burden on patient and this is one of the reason creating bitterness in doctor-patient relationship. After implementation of Consumer Protection Act, doctors included under provisions of act also widened gap in doctor-patient relationship. Communication gap is widening between doctor and patient as less time given to patient’s complete history taking and discussion to create good rapport. Inspite of all efforts if something untoward happens, the relatives hold doctor responsible. People should realise that under certain critical conditions of patients, every patient can’t be saved even by greatest doctor. Sometimes there might be negligence from doctor side but such incidences are very few.

Some political persons or media person also make doctor ,a soft target to get publicity by creating negative picture of medical profession in society. Political or some public comments like doctors are charging at higher rates ,doing unnecessary surgeries, writing expensive drugs widens gap in doctor –patient relationship. Political persons instead of directly talking in public,they should discuss issues with medical committees or governing bodies so that further bitter consequences can be avoided.

Another contemporary effect on doctor-patient relationship has been the exponential increase in the use of internet by patients. Better patient education has obvious advantages for mutual relationship ,there are concerns that information on the internet might not always be accurate and reliable. This poses a new challenge for the medical professional-that of revising any misinformation the patient has found him or herself.

For a community to get good healthcare services, doctor-patient relationship needs to be in harmony .Increasing communication between two sides is an important step to improve relationship. Keeping patient and relatives aware of critical conditions that might occur during disease course will help to avoid unnecessary misunderstanding .Media should project positive and good aspects of medical profession also. If any patient or relatives have complaint of doctor ,then they should approach appropriate authority or governing bodies instead of taking law in hand .There is provision of legal action for misbehaving with medical professionals but it has not created much impact in society. The law should be strictly implemented to safeguard medical profession.

By dispensing information in a manner that maximizes understanding is a prerequisite for more equal participation. Shared decision making between the doctor and patient will determine the most appropriate and best course of action for an individual patient.

Doctor is human being and needs to be treated as human ,not required to be a GOD. Good doctor-patient relationship is need of hour for healthy society.

WHY DO BABIES RARELY BLINK?

WHY DO BABIES RARELY BLINK?

When you will see into a baby’s eyes, and you might notice sometime Babies rarely blink. As we know adults, blink about 15 times a minute, on average. But newborns and infants blink rarely — only a handful of times every minute, with some babies blinking as infrequently as once a minute. The average is two or three blinks That’s because blinking is regulated by the brain’s dopamine, one of the neurotransmitters that allow brain cells to communicate. So, blinking in babies could help us better understand how this important neurotransmitter operates in infants. We know the link between dopamine and blinking, as conditions or drugs that affect dopamine also change blinking rates. People with schizophrenia, which may be caused, in part, by too much dopamine, blink more frequently. As in Parkinson’s disease, which is caused by the death of dopamine-producing neurons, blinking is markedly decreased. Taking medicine to raise dopamine levels brings blinking rate back up. But dopamine also underlies a diverse set of other functions, from the control of movements and hormonal levels to learning and motivation. So, babies’ blinking rates may reveal something about the development of the dopamine system and perhaps even reflects individual differences in some aspects of babies’ nervous systems, there will potentially spontaneous blink What does this all mean for babies? Because one function of blinking is to keep the eyes lubricated, researchers have proposed that babies blink less than we do because their small eyes don’t need as much lubrication.. the reduced blinking rate in newborns is due to an underdeveloped dopamine system.
YOUR HEART KNOWS THINGS THAT YOUR MIND CAN’T EXPLAIN

YOUR HEART KNOWS THINGS THAT YOUR MIND CAN’T EXPLAIN

 

 

     Days passed by hearing the sudden death news of Celebrities like Michael Jackson, Sri Devi, Sema Lagoo, Om Puri due to Heart Disease. Heart disease can occur in 2 ways:  One by birth, family history, diabetes mellitus type 1. Second by cholesterol, lack of exercise, overweight, smoking, diabetes mellitus type 2.  Nowadays a heart attack by diabetes mellitus is getting worse. If we think twice or thrice, the common effect for this disease can be the mistakes and discipline of our daily life activities.

Recently, ‘diabetic heart disease’ is the highly ranked disease crawling among the adults with an age of 45 to 55. Sadly, this evil that will be been weaving around us at the youthful age. As laziness and unhealthy diet take a major place in your life, the art of heart disease gives birth in your body.

Every profession got its own way of stress, tension, sleepless tasks in simpler word ‘difficulties’ as an employee pressurized by the boss, as a boss stressed in maintaining company statistics, as a student tensed about career and future, a doctor diagnosing patients’ diseases we cannot blame anyone for this. But by these effects of stress, tensions, staying in a stationary position for extended periods of time, our body will be prone to chronic disease like diabetes. Diabetes mellitus type 2 is the most entertained disease in our body. How about the stress of the work which damages your nervous system, increases your blood pressure, constricts your blood vessels? Have you ever thought that not only the junk in your body but even the stress, fear, tension taken up during the work affects your body in a soothing way?

How Diabetes Mellitus type 2 starts?

You get to work and end up the day with an entire body filled with tiredness. All this time the brain helped in thinking, calculating, decision making; digestive system extracted some enzymes from food which helps the other organs to work in a proper way and energy distributed all over so that you may not faint in the middle of your work, but stress disturbed them. As tension and stress make your heart beats fast soon blood pumps fast and your blood vessels constrict by pressure, as the blood moves fast in your body the organs of your body attempts to work fast. This means the body is working more than needed. Eventually, the pituitary gland (master gland of the body) secretes hormones in large amount which means hyperfunction takes places in the organ. As concerned to the pancreas, sometimes it cannot be capable of secreting insulin and the glucose cannot be converted into glycogen that brings changes to the blood sugar level. By this, you will be affected by diabetes mellitus type 2.

Symptoms of Diabetes Mellitus type 2:

If you have diabetes mellitus type 2 you will have an Increased thirst and frequent urination (Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues), Increased hunger, Weight loss (Calories are lost as excess glucose is released into the urine), Fatigue, blurred vision (If blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus), Slow-healing sores or frequent infections, Areas of darkened skin (patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance). These symptoms of diabetes mellitus type 2 can affect your heart.

 

How Diabetes Mellitus type 2 affects your Heart?

By regular fast pumping of the heart, it can become weak and irregularity of heartbeat takes place, which may lead to arrhythmia (irregularity of heartbeat) or dilated cardiomyopathy (heart chambers become dilated because of heart muscle weakness and cannot pump blood properly) sometimes heart failure(insufficient supply of oxygen).

As a foodie, a chicken burger with extra cheese in right hand and a cola in the left hand or trying out new fast food seems to be a magic ‘mantra’ for after work stress-relief. You may enjoy that plate of delicious food and get back to sleep. What about the fat summed up in your body?  There is no way for the calories to burn up!

First, calories pile up and there will be no scope to run out of the body. These tiny calories turn and convert into a thick creamy unwanted layer of fat in the body. The unwanted fat slowly turns into cholesterol and lead to obesity. Some of the diluted fats go around the body and stays at a place like heart, bundles up into cholesterol, mostly in a coronary artery, one of the main arteries of the heart. This leads to improper pumping of the blood leading to coronary heart disease. Sometimes, myocardial infarction (heart attack) caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms occur.

 

Symptoms of Heart Disease:

You should be aware of what is happening in your body.

When you feel an unbearable pain that travels through the body (for example from the chest to the arms, neck, back, abdomen, or jaw) light-headedness and dizzy sensationsprofuse sweating nausea, and vomiting clearly shows that your heart is in trouble. It is not getting enough oxygen to pump up the blood. Immediately run to the hospital.

 

Medications for Heart Disease:

The main medications in use are statins (for lowering cholesterol), aspirin, clopidogrel, and warfarin, (for preventing blood clots), beta-blockers (for treating heart attack, heart failure, and high blood pressure), angiotensin-converting enzyme (ACE) inhibitors (for heart failure and high blood pressure). The doctor will work to find a medication that is safe and effective. They will also use medications to treat underlying conditions that can affect the heart, such as diabetes before they become problematic.

 

‘Prevention is better than cure’

The only way to get rid of the disease is proper diet and regular exercise. When you wake up a 5-minute meditation or yoga will give fresh start and calmness to your mind which controls your anxiety, stress, tension for the entire day, regular breakfast, minimum 30-minutes exercise per day, power naps, healthy diet, avoid smoking, avoiding or reducing junk food and soda will be helpful to get a good health. By this, you will be healthy and have a great immunity in your body.

IS BASIC SCIENCE TOO BASIC??

IS BASIC SCIENCE TOO BASIC??

 

Finishing two years of basic sciences and really looking forward to the clinical years now I am thinking as many a time I did in the past, whether the basic sciences course taught us in Nepal are not updated as per the need of now.

What I am saying is that the information we learn now should be learned either to make a base for learning and understanding the clinical medicine or knowledge that can be utilized in the clinical side.

Let me give you an example:

Why do we have to learn “all” the names of enzymes and memorize the steps of a biochemical pathway? I am saying “all” because some steps are there where the pathology lies(deficiency or overactivation) or the site for drug action and these are crucial to understanding to learn about the disease and the treatment but some steps are there without any significance in clinical application( they may have importance in research but we are learning medicine not researching about everything) . And our syllabus expects us to remember those rather than concepts that are vital.

It may sound like a cry of a lazy student but I say lets put the same time and effort to learn other concepts and applicable things. I am not undermining the importance of the basic science subjects or the curriculum but I feel that if the students are taught from the very beginning to be clinically oriented they will retain the information better and be a better doctor.

If students know that they need to learn the path of this tract in CNS because it signifies the appearance of clinical signs and symptoms according to the site of damage then they will want to know and will understand it better then just learning the path.

Best of all will be integrating the basic science subjects’ concept to give their clinical application. For example, knowing about the location of the pancreas(anatomy) gives me the idea that carcinoma of the head of the pancreas(pathology) can block the hepato-pancreatic duct thus obstructing the bile flow. Knowing about the formation and function of bile(biochemistry and physiology) I can know what will happen in the obstruction vs infection(microbiology). I admit all the times the subjects can’t be integrated but I feel more integration is needed.

Latest approach by Kathmandu University to introduce more clinical insight to the basic sciences is done by the inclusion of a subject named Introduction to Clinical Medicine(ICM) and it is very appreciable and fruitful for the students. It integrates the knowledge of the basic sciences to explain signs and symptoms and management. But one subject is not enough.

I hope that in the next revision of the curriculum the integration and clinical use will be given more importance than just facts and numbers that won’t be clinically applicable.

 

THE IMPACT OF CURRENT HEALTH CARE SITUATION ON MEDICAL STUDENTS AND YOUNG DOCTORS OF NEPAL

THE IMPACT OF CURRENT HEALTH CARE SITUATION ON MEDICAL STUDENTS AND YOUNG DOCTORS OF NEPAL

 

The current situation of doctors in Nepal is one of the major factors that is causing the doctors of our generation to practice medicine in a foreign country. At least we won’t have a fear to be beaten up by an angry mob when the patient dies (even after the doctors did all they could).

This type of situation is highly demotivating and will have an impact on the health sector of Nepal for a long time. Lack of Professional security, unfair wages are some of the few reasons that implant the dream of USMLE(USA), GMC(UK), AMC(AUS) in the mind of the young medical students and doctors who don’t see or don’t want a future here.

And when all the competent Doctors leave the country for a place with better job security, job satisfaction, paygrade, respect then the country will be left with lack of manpower and will go through a medical crisis with lack of manpower.

People may argue “Doctors should not work for money, they should do good to the society,” I ask WHY? Does anyone tell an engineer to build houses/roads for “betterment of the society”? OR ask the banks to give away money for the same cause. No!

Then why should we do that? Is it wrong that I would want luxuries of modern society after doing my job to the best I can? If I paid a large sum of money for my education is it wrong that I would like to earn a lot more?

So someone who spends their better part of their life and a large sum of money to be a doctor, why would he/she like to remain in a place with minimal pay, lack of freedom to practice their skills and fear. of getting beaten! And they know they have way better alternatives abroad.

I don’t believe Doctors are next to God, I don’t want to be called that either. The medical profession is like just another profession and we are just like other people. We have our own set of skills and limitations just like any other professionals and people seem to forget this.

I am not denying the fact that there is no medical negligence and some doctors are responsible for the wrong outcomes and they are at fault. But it’s not the angry mob or the saddened family of the patient who decides who was at fault.

We have proper laws and the government and Nepal Medical Council(NMC) to investigate it and decide whose fault was there if any. And one can even be banned to practice medicine for life if any major negligence is found. But No! Here, the mob decides that ALWAYS the doctor is at fault. It’s like saying that if some students fail in exams/do bad then the teachers are ALWAYS at fault! If the student doesn’t study properly then whatever the teachers do that student will fail and it won’t be the fault of the teachers. The same analogy applies in case of a doctor and a patient.

If the situation continues like this we will see a decline in the competent people wanting to join medicine in the first place let alone practice here and the quality of the services will degrade causing more mishappenings and the vicious cycle will continue.

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