What Is Liver Cirrhosis ? Symptoms, Treatment & Causes

What Is Liver Cirrhosis ? Symptoms, Treatment & Causes

What is Liver Cirrhosis?

Cirrhosis is a type of chronic disease (slow processing) that’s relative to the liver. Cirrhosis is identified when the cells of the liver are getting replaced by fibrosis (i.e. fibrous thickening of tissue) or the replacement of normal tissue with scar tissue. Basically, cirrhosis leads to damage to our liver and their functions. The liver plays a significant role in metabolism, detoxifying harmful substances, purify the blood and also including bile production and excretion too. Mostly, cirrhosis caused in alcoholic person and also more chances in a patient of viral hepatitis (B and C).

By examing and performing various experiments the medical science finds out a way to limit the further effects of cirrhosis but still cannot be able to cure. The ultimate way to rescue from cirrhosis is liver transplantation.

Globally, At present, there are more than 1 million cases of liver cirrhosis are.

 

Symptoms of Liver Cirrhosis

  • Joint pain
  • Fever
  • Fatigue
  • Vomiting
  • Abnormal personality
  • Neurologically deprived
  • Hepatic encephalopathy
  • Peripheral neuropathy
  • Asterixis
  • Integumentary
  • Jaundice (icterus)
  • Spider angiomas
  • Palmar erythema
  • Purpura
  • Caput medusa
  • Itchy skin
  • Gastrointestinal
  • Dull abdomen pain
  • Dyspepsia
  • Fetor hepaticus
  • Flatulence
  • Varices
  • Gastritis
  • Gynecomastia’ testicular atrophy
  • Hematemesis
  • Feel like overeating
  • Hemorrhoidal varices
  • Digestion problem
  • Increase size of liver
  • Loss of appetite
  • Hematologic
  • Anemia
  • Thrombocytopenia
  • Leukopenia
  • Coagulation disorders
  • Splenomegaly
  • Metabolic
  • Hypokalemia
  • Hyponatremia
  • Hypoalbuminemia
  • Fluid retention
  • Peripheral edema
  • Ascites

 

Causes of Liver Cirrhosis

  • Hepatitis B
  • Hepatitis C
  • Biliary atresia
  • Wilson’s disease
  • Fat accumulated in the liver
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Infection (schistosomiasis, peritonitis)
  • Enlargement of the spleen (splenomegaly)
  • Portal hypertension
  • Esophageal varices
  • Malnutrition
  • Bone disease
  • Gallstones
  • Heart failure
  • Obstructed blood flow
  • Hormonal imbalance
  • Production of toxins
  • Prevent the functions of protein and drugs too
  • Non- alcoholic fatty liver disease (NAFLD)
  • Non- alcoholic steatohepatitis (NASH)
  • Greater chance of Liver cancer

 

Prevention of Liver Cirrhosis

  • Stop or reduce intake of alcohol
  • Focus on the balanced diet
  • Less intake of salt
  • Less intake of sugar too
  • Prevent from taking of non-veg and spices.

Tests to be Performed for Liver Cirrhosis

  • Blood test
  • Liver function test ( ALT, AST, ALP)
  • Creatinine
  • Hepatitis B And C
  • Imaging test (CT, MRI, ultrasound, MRE)
  • Biopsy
  • TREATMENT
  • Endoscopy
  • Medication
  • vaccination
  • Rehabilitation
  • Consume diet with low sodium content
  • Avoiding nonsteroidal anti-inflammatory drugs
  • Hemochromatosis (reduce the levels of iron)
  • By the excretion of copper in urine
  • Liver transplant

 

Conclusion

The liver is the most workable organ within our body, performs various functions relating to circulation too. The liver performs both functions like production and excretion too.

LIVER CIRRHOSIS is the most advanced form of liver disease that’s related to generally drinking alcohol and viral hepatitis B and C. Liver cirrhosis occurs when the liver cells are killed or injured, and after that when the inflammation occurs, the injured want to repair itself by forming scar tissue that consequences in forming new liver cells in clusters form that leads to regeneration of nodules of liver within the scar tissue.

The disease is a part of the progression. It may start with the fatty liver disease, then progress to alcoholic hepatitis, and then to liver cirrhosis.

Liver cirrhosis main identified by jaundice, loss of appetite and fatigue. There are various types of complications occur in liver cirrhosis including liver cancer.

Diagnosis of liver cirrhosis can be started firstly with examing patient history, family history also, the vital signs (physical examination), blood test, and we can also perform complete diagnosis by confirming liver cirrhosis by performing the liver biopsy.

Treatment of liver cirrhosis prevents further damage to the liver, liver cancer, other complications related to liver cirrhosis and other adjacent organs from any damage. By suppressing the immune system by prescribed medications like prednisone and azathioprine to prevent further inflammation related to the liver in such as autoimmune hepatitis.

We can’t cure liver cirrhosis, but we can provide treatment to the patient as medication and further types of test like endoscopy. The best recommendation for the liver cirrhosis patient is to liver transplant surgery, still, the medical science working on the curing of liver cirrhosis by medications and some other remedies.

 

ROADS LESS TRAVELLED

ROADS LESS TRAVELLED

One fine morning as I was going on my routine rounds, my eyes were particularly fixated on an old man. It was onco-surgery ward. A ward so infamous, so notorious for all the gloom it possesses. And among all that dejection and despair filling up the atmosphere of the room, this patient was smiling brightly. I went through each of the patient writing up their notes, plans for the day and as I reached the patient in consideration, he was still smiling. I politely asked him, “Sir, how are you feeling this fine sunny morning?” He replied cheerfully that he was feeling great and more so as he was being discharged that day. I opened up his file and saw that he was a case of oesophageal carcinoma. His oesophagus had been resected but only too late. The cancer had metastasized everywhere and he was admitted with the sole purpose of attempting to prolong his life. I asked the patient again, “Sir do you know why you have been admitted here for these past days?” The patient confidently replied he was suffering from some minor ailment that caused him sore throat and vomiting of blood and now that those symptoms had been less frequent, he had healed and was ready to return to his village. So it was only natural when I asked him who had told him about the discharge and his medical condition. Of course, it was his son. And his son on being questioned why he simply replied that he wanted to see his father happy and he couldn’t gather enough courage to break the news and deal with the breakdown it ensues. So I turned back to the patient again, smiled and immediately regretted for asking that if he had any plans after returning to his village. So unaware of the certain death that lurks him, so hopeful of the future, so full of plans and so full of optimism. I too didn’t have the courage to break his heart right away. I walked out silently with a heavy heart not knowing at that very moment what it was that I should have done.

On another instance, it was this woman in her fifties. She was being wheeled into the operation theatre for a major surgery. The patient party had already given their informed consent after being explained about the whole procedure, its risks, benefits and complications. So during the course of the conversation, the attending anesthesiologist asked her how she was feeling and if she was anxious at all. The woman promptly replied that she isn’t scared at all and she thought that all those preparation and precautions were an overkill for a small injection. She casually said the injection could have been given outside as well and they didn’t need to bed her and drag her into some special place. The anesthesiologist sprung up with rage on hearing it. The operation was delayed and the patient party and the attending surgeon were summoned and inquired about the matter. The surgeon mentioned that the patient party had requested him multiple times to let them be the ones to break the news to their patient. On other hand, the patient party replied feebly that they thought all she was going to remember was an injection of anesthesia before she passed out. In their words, they didn’t want to burden her with such grave news and they couldn’t bring them self to let her know about the dangers she is facing.

These are just two instances which I experienced personally. Most of us might have been through it ourselves too. In a country like ours where a significant portion of the population is still illiterate and yet more unaware about health and medical conditions and even a huge portion of people gullible to what others say, it can very easily be projected that the huge chunk of patients do not know what afflicts them even after a correct diagnosis has been made. Of course it is the duty of the attending physician/surgeon to make a diagnosis and explain it to the patient in an understandable language but when the patient hails from a downtrodden table of society with little or no educational background (which is fairly common in our setting) often the final and the only message that gets delivered across to him is “You are DYING”.

So after a patient comes to know he is dying, a different set of dynamics comes into play. It is a gray area really. Not black, nor white. But a plain shade of frustrating, depressing, discouraging and demoralizing gray.

How do you explain hope and define optimism to someone who has never believed once that life has been fair to them and it will ever be…

OR

How do you lie or let the relatives lie to someone who might have important things as managing his family, properties, making his last will and testaments or fulfilling his final desire and wishes? But with all the researches published that have found out optimism in a patient certainly does prolong the life and bring about favorable outcomes in the patient, you certainly tend to think twice.

So what is it that we really should do???

To go against the wishes of the patient party who suggest you to not disclose the news or to do what is ethically right and let the patient know and decide how they want to deal with the disease. In the present context, in our setting not complying by the wishes of the patient party might invite a whole new set of problems with risk of physical, social and psychological trauma for you. But even after you reveal the despairing news to the patient they might opt to abstain from any forms of treatment to save money and not become a burden for his family. They might give up all hope on life which might adversely affect at any chance of having a better prognosis. But this issue can be very much be ameliorated by a slight change in our approach to one aspect of medicine we rather choose to ignore, “counseling”. From what has been extensively researched and from what is being practiced by our counterparts on the other face of the world, counseling itself is a major factor that determines the entire outcome of the treatment.

With suitable and effective counseling, the view of the patient towards the disease and treatment process can be exceptionally altered. It is better if you let the patients know that they are not alone suffering from the disease and share the experiences of how others coped with the situation. You could always suggest picking up yoga, meditation or any other means to calm the mind. How they should utilize the time they have tying up any loose knots. And if needs be how you are always there to support him with any palliative care they may need. With a proper counseling, the compliance and adherence of patient to treatment increases, optimism in patients rise to new heights and the overall prognosis and outcomes have favorably fluctuated.

The disease the patients are suffering from is a truth, its prognosis/outcome also a truth, right to information of a human being and your responsibility to respect his sovereignty also a truth and what I firmly believe is only the revelation of this truth and a competent counseling and treatment course will be in the best interests of the patient and the treating physician/surgeon himself. And only then can we rise from the ranks of common people and truly be what the people expect us to be…

“An ethically and morally impeccable human being”.

A Doctor’s View on Doctor – Patient Relationship

A Doctor’s View on Doctor – Patient Relationship

MBBS (Bachelor of medicine and bachelor of surgery ) the most inspiring and attractive word for me throughout my whole childhood. But it becomes toughest on 5th June 2015 when the first time I was successfully failed to get an eligible rank in my West Bengal joint entrance examination for medical. Though the word inspiring was existing in my life for MBBS. I desperately accumulate all my courage and restart my preparation to crack the same examination for the next year.  And that time I successfully able to get the entry in my childhood wish. I was started my journey as an MBBS student at the BURDWAN MEDICAL COLLEGE, WEST BENGAL and from the beginning of that, I was an active part of the world medical association.

‘Doctor Babu ‘when I heard the word indicating to me for the first time it was such a pleasure to feel that astounding feeling. In the first year one day I went to visit the hospital for the first time with my white apron. Then a short height, an unhygienic man came towards me and ask for ECG room. But at that time I was not able to help that man because I also didn’t know this. As a doctor, my duty was to help that man.

A healthy doctor patients relationship is the most important part of treatment. Healthy means professional. Some foremost characters should have to be developed to become a successful doctor. At first, a doctor must have to be helpful towards his patients but obvious within his professional limit. Secondly, justice with patients, equality among patients, and equal division of limited resources only and only based on priority need and next one is fidelity means the ability to truths about our each and every action because mistakes are forgiven but lies are strongly punishable. We must have to be understood that patients are not help-seeking rather we are the help provider.

Doctor patients relationships are of different types. One may be doctor-centric in which doctors are superior and patient must have to follow doctors advice and another one is patients centric in this doctors are flexible in their point of views and they give opportunities to his patients to choose their options.

A doctor can play different roles in appearance to influence his patients. We must have to be flexible in our behavior and it will be the strongest ladder to achieve effective care. The term ‘placebo’ is a substantial term conjoin with the medical profession. Sometimes we have to use strongly directive approach to make better treatment. Some pessimistic patients are not aware of their health so they ignore the treatment process. It is our duty to strongly put our advice and make the better health of the patient. But as besides this, it is also important to remember that the right to refuse is the personal choice of the patient. We can’t pressurize them in any aspect rather we can motivate them. As a good doctor, we have to use tremendous politeness and respect during the treatment of geriatric patients and it is an appropriate doctor-patient relationship.  Another one is protectively paternalistic approach and this is maximally used in pediatric treatment. A doctor can advise his patients by gathering kindness, protection, strength, and patience. Because pain is the fearest foe of a child and as a doctor, our responsibility is not to destroy the fear but to achieve the power to fight against it so that he can tolerate it in his upcoming life. Some other aspect is the supportively directive approach. In this type, doctors believe in patient’s choice along with providing reassurance and guidance. Another example of the perfect doctor-patient relationship is the relationship between doctor and female patients. Most of the female patients always choose female gynecologists for their treatment but as a male doctor also our duty is to provide equal safety and security to them so they can trust us . A doctor can play an active role in the treatment of terminally ill patients. As a doctor, our responsibility not only in cure purpose but also provide the hand in care. In the case of terminally ill patients, we can’t stop our treatment by accepting upcoming death but it is our duty to provide a peaceful death to our patients.

Relationship means the mutual connection between two peoples. So both sides effort is necessary to make a relationship healthy. Patients also have to believe in the doctor to make the relationship more trustworthy. Some people told that feel your patients as your family members but I think rather it is important to feel our family members as our patients when they suffer from disease because a professional relationship can handle effective treatment rather than a coherent relationship. As besides the importance of establishing relationships, it is also important to perfectly terminate our relationship with our patients because we can’t expose us as available and as sympathetic so that we become emotional during termination.

As a future doctor, I will definitely maintain these in my working phase and I wish my other co-workers who are reading this may also influence through my words.

 

 

Five Years of My MBBS Life

Five Years of My MBBS Life

I had joined the medical college with all the excitement that is humanly possible. Getting merit-based scholarship and not having to pay a single penny as a donation to college, I had made my parents proud. Not that I had always wanted to be a doctor. Being a doctor is the epitome of success academically in our society. The toppers of the country would choose to be a doctor. More than me, my parents were happy that I was studying Medicine. What more could I do than to make my parents proud. Not that I was forced to study medicine. Personally, I was indifferent. I wanted to go through the tough road that elites chose. Deep down inside, I still wanted to explore passion in life. But I was far too lucky (and thinking now maybe unlucky) that I got my name in the successful candidate name list in the MBBS entrance examination.

First year: Crushed euphoria

I was so happy to sign in the admission forms and submit all my certificates. More than that I was happy to see my dad’s smile while I was signing. Getting my hostel room key and filling a small sheet of paper for college identity card filled me with utmost pride.

As classes started, the happiness curve went down. All my expectation of med school became upside down with the reality. As happy I was to get the key to my hostel room, I was more disappointed to open the room of the hostel that was located 3 kilometers away from the hospital right next to the public bus park. Unlike the photos are shown on the website of the college, the hostel was a temporary rented hotel, with zero facilities. The hostel corridor had a leaking terrace and in the monsoon flooded our room if we opened our door for long. The soaked carpet smell mixed with our own sweat smell during the power cuts was in the air. Love definitely wasn’t in the air.

Second year: Exams

Literally, the second year was nothing but the exams. We had monthly big exams, and countless small posting examination. The syllabus was vast and time very limited. On top of that, we would hear about the terror of HODs of departments during practical Viva examinations. Our only aim was to pass every internal examination so that we would not be barred from giving board examination.

Third year: Honeymoon year

We were posted in the hospital. We had our first share of exposure to the patients. Only two subjects whose exam would be there. Taking history and learning physical examination. It was far different kind of learning compared to learning from the cadavers of first-year anatomy class. For the least, all we had to do was to maintain our attendance to 80 percent.

Fourth Year: Minors

We had already spent a year in the hospital wards and OPDs. The place felt familiar and we had been quite familiar with the history taking and physical examination. Watching POP casts and slabs in the Orthopedics OPD was exciting. Learning to use an Otoscope and be able to visualize the perforated eardrum gave all of us some happiness of sorts.

Final Year: The real exams

We were the same as the third year and our posting was the same. But the way our teachers treated was entirely different and that increased the fear. They would constantly remind of us being the ‘exam giving batch’ and that we had to cover each and every topic. Everyone was seriously studying except for the legends who still got time to flaunt the new bike they had bought.

Time passed in a blink of an eye. There was so much to study and so less of time. Nothing except the syllabus mattered. The frequency of mom and dad calling to ask about my whereabouts decreased. Going out for parties were almost nil. Birthday parties got postponed.

Internship: Three Ds

Dressing. Discharge. Daru (alcohol). The dressing of wounds and especially of the burn patients was really difficult and time-consuming. Making discharge sheets of patients who were admitted for delivery of babies was hectic as hell as the number many a time crossed half-century. And a chilled beer once in a while was the answer for releasing the frustration of doing ‘clerk-type’ work every day.

Right now, I am almost halfway through my internship. The days are so varied. Some days, we get all the time in the world to talk about all the things that are shitty in this country. Other days, we are so tired we fall asleep right as we close our eyes. The way we are treated also varies greatly. Some patients treat as if we are magicians wearing white gloves applying elixirs in their wounds and heal them. Other patients treat as if we don’t even exist there.

Final Note:

With all the free ‘no-need-to-read-compulsorily’ time that I have got in the internship, I get plenty of time to introspect. I think about the situation in the country. I talk with the residents and learn about the things I could do during my internship days to make the future a little bit easier when I would be working in a hospital far from cities. And some nights when I am alone in my room and it is raining outside, I wonder with one question on my mind:

Would I be a good doctor?

EXPERIENCE AS AN INTERN

EXPERIENCE AS AN INTERN

 

 

Being a child, I was always afraid of doctors. They always seemed like a demon with a sword ready to pierce me through. But the reality would be just a simple man, wearing a bright white coat and standing right in front of me with a 2cc syringe. I never thought of them as a demon because of their deeds but the fact that they had a needle in their handmade my imagination go crazy. After all, I was just a normal kid waiting in the queue to get my routine vaccines and also watching every kid come out of the doctor’s cabin crying their lungs out, made my heart skip a beat. Those were the days when I had sworn to never get close to a doctor and here I am today, standing in a bright white coat, with a Littmann around my neck, entering my OPD for the very first time as an INTERN!

 

Every senior doctor will tell you that these twelve months of your life will help you decide your future course and with no surprise, it did help me understand what I really wanted in life.

 

So I started my internship with the department of community medicine. Little did I know that this would be the time when I would learn the most. Yes, it was this period of two months that taught me the most valuable lesson of my life – humanity. I can still remember my first day and my very first patient. She was a 70years old granny, a known diabetic as well as a hypertensive for the past 20years, came for her routine checkup. Her name was Mrs. Lakshmi. I clearly remember her peculiar voice and her interest in her medicines. She was an active woman with all the knowledge about her drugs as well as her doctors. She very well knew about the system of our department. She was aware that every two months the PHC would have a new batch of doctors, which is why she made sure her new doctor thoroughly went through her history and did n’t mess up with her medicines. This was something rare for an uneducated lady to do and also the reason why I remembered her so well. She made me nervous, as I was a beginner. I did not want to fail in any circumstances. Later, after reading her records, I handed her the prescription with my name and initials signed on it. She smiled with gratitude, with a blessing in return. That was the moment which made me realize that my journey had now begun. I spent two months traveling to various villages, set out camps, provided health education, distributed free drugs to those who need it. And that’s when I learnt that there are endless people who need medical help and also people who are unaware of their illnesses needed  education and our duty is not just to sit within four walls and sign off prescriptions, our duty includes to stretch a hand of humanity towards those who are suffering and bring them to a better world and at least try to give them a better life to live . I learned, we doctors, are the ray of hope they were in search of.

 

After completing a posting filled with mixed emotions, I entered the world of surgeons. General surgery was my next department, where I saw myself turning into the imaginary demon I was once afraid of as a kid. Every procedure I did, every step I took, involved my patient under a scalpel. My hands were shaking as I assisted my professor for my first surgery. I was all decked up and a tad bit excited to read my name on the surgeon’s walls for the scheduled surgery. But, the first time I had to bury my gloved hands into someone’s wound made me obnoxious. I felt miserable for the patient. Had just one question throughout my surgery, “God, why must a human suffer so much ?” I could barely concentrate on what was going on. I had a sigh of relief once we closed up. Happy for the patient who had made it, but still a thought in the back of my mind – what if he wouldn’t have?

 

As days passed, my hands stopped shaking and my thoughts started diminishing. I started emphasizing learning how to save a life. There were no options apart from reading those huge books which would weigh more than a sack of rice and to practice the art of butchering. While I was a student, I would often hear doctors being referred to as a butcher. I used to get offended. But today, while I stand wrapped in my gown, with my patient completely sedated, lying down with his fate in my hands, I don’t feel less like a butcher. The only difference is we save lives.

 

Weeks after weeks, I started feeling strong and confident in what I did. The feeling of helping people cure their illnesses started growing on me. It was a magical land where drugs would do the magic and a surgery would cut the illness totally where and when required. I shifted from general surgery to orthopedics, and then kept moving to other departments as in the routine, and I could feel the magic of a scalpel until I entered the department of obstetrics and gynecology. Being in gynecology didn’t make me feel any different from being in any other surgical department. But what changed my complete mindset was the department of obstetrics.

 

My first few hours in obstetrics gave me a panic attack. I was in shock to see patients screaming in pain. I took a minute to see all around the department and realized this is something beyond the magic of a scalpel. I can’t help the ones crying for help. I just can not sedate them and cut them open to cure them. I felt very helpless. All I could do was console each and every mother and wait with them for the birth of their precious ones. I could see them struggling for hours together. And their struggle taught me to tranquilize my temper and be patient. After all, it was I, who could cheer them up and regain their confidence in the process they were going through. I could not wait to deliver a baby, but at the same time, I could not rush at any given cost.

Alas, it was time to conduct my first delivery. It was something I had to do without a scalpel. My hands had to be steady but tender. This time I was not about to cut an odious part of her body, but bring out the little one who has been growing in her womb for the past 9 months. This journey of mine continued for days together. I shared a very strong bond with each and every mother I came across. Each one was special. The joy of bringing another life into this world was incomparable to any other feeling I had ever felt. But as we all know, life is not a bed of roses. They always have thorns in it. And this time I was pricked by a thorn when I was informed I have to hold a scalpel in my hand once again. It was time for my first cesarean. Something I knew I would come across, but hoped I would never have to. Because unlike other surgeries, this one had another life struggling between my patient and my scalpel. I had to help protect a life unseen. As we painted and draped the patient, we prayed for the betterment of the little one who is yet to see the world. As we cut open in search of the juvenile soul, I could once again feel the pressure and fear which I had felt on the day of my very first surgery. This time the pressure had turned more intense and I had a sudden adrenaline rush to see the angel face safe. This was not something which was growing on me. Unlike my previous postings, this time I was not getting stronger with time, but I was definitely getting better with my skill. The task to get the mother and child safe from the surgery had become easier, but the worry I had before each every incision never reduced. I still pray before I start operating on a mother. I still feel the responsibility of keeping the mother and her offspring safe. There were sleepless nights, which I never regretted. Continuous duties which never stopped me. My journey in this department was like a roller coaster ride, where I  had numerous state of excitement which always encouraged me to move forward. I just wanted to stay back in the department, because for the very first time I felt like this is where I belonged.

 

It was my last day in the department as well as my last day as an intern. I had no emotions to express as I was going through my last few hours. That day we all sat together, recalled memories of our entire internship. All I could think of was how badly would I miss this department. As my seniors always used to say, this is when I would realize what my future holds for me, I agree with them, because  I have realized what I want my future to be.

 

Twelve months of the internship was nothing less than those twelve years of school life. We gradually learn as we grow. And that’s exactly what happened with me. It was the most difficult ‘goodbye’ of my life. Tears rolled then as they roll now while I conclude sharing my EXPERIENCE AS AN INTERN.

 

 

EXPERIENCE OF A DOCTOR

EXPERIENCE OF A DOCTOR

The hustle bustle, the chaos of the daily life, splattered blood on the floor and big blobs of Potassium Permanganate scattered all around –Yes this is the Emergency Room or fondly called the ER. The daily commotion of the ER and its speed of treating patients is what makes it the most critical yet exciting area of the hospital. It must sound preposterous to some, to call a Department or award with critically ill patients as ‘exciting’, but a Doctor’s point of view says much different. The thrill of cut and the joy of recovery – both are felt by the doctor at the same time, Blissful as I may call it. In the ER, you must work then and there –provide the patient with the first and foremost help required and as said by the book of Love and Bailey – ‘The Golden Period decides the quintessential treatment required by the patient  ’.  But is it really all that rosy and sparkly as it seems?  Every cloud might have a silver lining- but every cloud has a time when it bursts too. Same could be said with a doctor – A little delay of the seconds, a little inappropriately the body reacts and whoop- the case becomes critical than ever. How the doctor deals with the patient at that time, how he puts his extreme hard work of medical studies into actual treatment and how he manages to save the patients life is the real ball game. Unconscious, yet aware subconsciously how much pain the patient is going through – the doctors know it all. They might not be emotionally involved with everyone but yet the patient’s pain is their pain and the patient’s anguish is their anguish. And theoretically, everything is laid down on the books – which Medicine is first, which injection is second, when to push your chest for CPR and when to call time of death. And amongst all these battles with life – only one thing remains out of control of the patient –a deterration from the normal and even the abnormal. What if a patient reacts a way not mentioned in any Medicine books? What if the patient shows a symptom or sign never seen before –then what? Do we blatantly blame the doctor or feed our superstitious belief that God has planned so. Patients maybe mum at the time of crisis but the ones who love him/her are the real sufferers here. They want to do so much- and yet are helpless there. And there at that moment all their hopes, dreams, wishes lie on the doctor- and he is wilfully made the God. But also with that, lies the blame, the resentment, and the accusations – and if nature takes a call where the Doctor is unable to do anything even though he tried everything to his best of abilities –he is made a demon.
The ER has a million stories every day, millions of hopes and hues and cries of hurting people. It shows how the doctor rushes to the patients help, it shows what medicines are given during emergencies, it should how a person who has ingested poison can be saved – what it doesn’t show is the Pressure of the doctor,what it doesn’t show is the extreme burden of putting his treatment to use in a way that it shows results,the burden of handling a living human life in hand and most of all,the burden of letting down the patient and  above all –himself.
A doctor isn’t merely a white coat human with a stethoscope. A doctors experience is way more than words can explain. He wakes up early in the morning or possibly after only 2 hours of sleep after a night shift, then gets ready and on his toes for the next 10-12 hours. Crying, mourning and pain is what he sees every day. He doesn’t have a sunlight showing him joyous things all day long.  He doesn’t have flowers and butterflies and wall pictures. What he has is a solution- to heal people’s wounds. To make the best of his potential and treat that ulcer, and cure that chest pain. He works and works till the removes the word PAIN from patients’ dictionaries. He doesn’t mean harm – he only means well and truth. And the truth lies in the very basic fact that – LIFE AND DEATH ARE CONTROLLED BY SOME EXTERNAL FORCE THAT CANT BE ELUCIDATED and a doctor can trade his own life for the life of his patient but that’s all he can do. He can work and work and work harder to heal the pain, the sufferings the torture and turmoil born by the patient and his family – what he can’t do is compete against the undeciphered External Force of Nature and have a victory over it.
Lastly would like to quote – “The highest form of knowledge is empathy, for it requires us to suspend our egos and live in another world. It requires profound purpose, larger than the self-kind of understanding.”
-Bill Bullard.
MY EXPERIENCE AS A DOCTOR

MY EXPERIENCE AS A DOCTOR

 

I’ve dealt my experiences and knowledge with WHO’s this year theme Health for all

Let`s define Health for all-“Attainment of a level of health that will enable every individual to lead a socially and economically productive life”

When wealth is lost nothing is lost

When health is lost something is lost

When a character is lost everything is lost

Last year WHO stressed on the character aspect that too in individual level through the topic, ”Depression-Let’s talk”. This year we are dealing with the health aspect in community level and the wealth which is needed to establish the health system

“WHO was founded in 1948 to make health a human right and not as a privilege. We’ve crossed 70 years and still the conviction is as strong as ever”, these are the words of WHO director Dr.Tedros

As a third-year medical student, PSM is the subject which gave me the most joy as it dealt with health in community level. Health is something which is to be learned at a community level for the overall health promotion. Health is the only thing which is needed by the richest and also the poorest in the country without any compromise. It would be ruthless and barbaric to put an option like health or food/education/basic needs among the poor. That’s why this year WHO insisted on Health for all everyone everywhere

Now I’ll tell you my real life impact on community health during my 3rd-year ward posting. 8 year old female named Dhivya came to the pediatric OPD with chief complaints of respiratory distress. She is a known case of spastic cerebral palsy who had lost her mother during labor and father to an accident. She is now under the care of her grandmother. On head to foot examination, we found severe pediculosis affecting her scalp and eyebrows. We asked her caretaker to maintain proper hygiene by providing her regular bath and prescribed her ketoconazole shampoo to be bought outside (as it was not available in the hospital pharmacy). But she didn’t take the prescription and wept about her poor socioeconomic status to buy the shampoo which costs Rs.180. This patients history raised me questions in my mind. Why should the innocent girl suffer this? Is this any incurable medical condition like malignancy or AIDS? NO INDEED. Then there is no point in her suffering. The entire humanity should feel ashamed for her suffering as we are spending millions in finding and drug and testing it by clinical trials. Yet this Rs.180 made pushed the therapy to an unreachable altitude.

Sometimes I get inspired by watching medical series like HOUSE MD and got inspired by the American health care system. But after doing research regarding that I came to know that the health insurance companies only cover those people who are in good jobs. What about the homeless old man wandering in their streets? Does their insurance companies think that is a life not worthy of a medical care? We need a policy from our leaders which establishes equity among people. This year is the time to ask our leaders our basic right, OUR HEALTH.

For a good health care facility, we need people, services, products, finances and information and everything is needed especially in times of an outbreak. A good example of our health care system can be explained by the Nipah virus outbreak in Kerala. This is a deadly virus an too difficult to establish a diagnosis in index and primary cases. But our health care facility was able to tackle the situation and saved millions in spite of losing a few.

Here we are providing health care free of cost and health insurance also free of cost. As a medico from a government institution, I came across a lot of people from low socioeconomic class (as per modified Kuppusamy scale) seeking medical attention and they were given excellent care under free of cost. Few cost expensive services like MRI are covered under their insurance scheme. But still, we are not providing some advanced services like bone marrow transplantation, gene therapy, etc. which are provided by corporate hospitals. This is one milestone we need to achieve.

When we went to field trips to PHC, ICDS, Health sub-centre during field visits, I can see that at least essential health care is accessible to all individuals and families in an acceptable and affordable way with their full participation. We have launched a sustaining primary health care by formulating national policies, strategies, and plans of action as per Alma-Ata-conference. In spite of inequality among education, social status, economic status, etc, Healthcare is the only this we`ve tried to establish some equality and equity among people.

Regarding the inspiring 2018 theme of WHO I came to know that half of the world`s population don’t have access to a proper healthcare facility. Millions are pushed to poverty due to money spent on food. WHO insisted the need that No one should have to choose between health and food/education/shelter. Then what is the solution? The answer is to establish affordable health services for EVERYWHERE, EVERYONE. This universal health coverage can be achieved if and only if the political will is strong. WHO is calling leaders this year to make universal health coverage a reality for everyone, everywhere.

The very special 2 things in 2018 universal health coverage concept:

  • First, this stresses the importance of nurses and midwives in the health care system. Generally, they are underrated. They are the pillars of our health care system. I’ve seen a Nurses strike in my college. The whole hospital was stranded. They have the number and knowledge for our health infrastructure.
  • Second, universal health coverage stresses the importance of healthcare for older people. It considers their health issues in a novel approach. WHO does not want them to seek a doctor for their diabetes another doctor for arthritis and another doctor for hypertension. It wants them to have a health coverage in such a way that they can whatever the services they need in a single institution with their health-related data and treatment history being synchronized among different specialties.

Countries with universal health care include

Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Malta, Moldova, the Netherlands, Norway, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine and the United Kingdom.

There is a very peculiar thing about this list of countries. Have you noticed any South East Asian county on the list? The answer is a big NO. In South East Asia over 800 million people don’t have full coverage of essential health services. 65 million people are pushed to poverty because of the health costs. We cannot accept or afford a world like this. Especially as a South Asian Country, India cannot accept this atrocious state of us and our neighborhood. That’s why we should make health services universal so that these people do not suffer from financial hardship. By tracking who is not getting health care and who is being improvised by health care, we can make policy to establish this system. This would pave a way for a fairer and healthier world.

Health is a human right. No one should get sick and die just because they are poor or because they cannot access the health services they need. 97 million deaths can be prevented worldwide when the global community makes the right investments in the right health care system. This is quite a big number. The SDG or Sustainable Development Goals insists on making the right investment in the next 15 years to prevent this death. The SDG price tag in 67 countries which has 75% of the world`s population is 3.9 trillion dollars for the 15 years. These countries don’t have the economic source to pay the price tag (India is not one of those countries we have enough resources). But most other countries have the fund to make an investment in these countries. By giving economic assistance is theoretically proven that SDG can be established worldwide. This could add 535 million extra years of healthy living to the world’s population.

People-centered care:

Recently a lot of money invested in health has been wasted due to unnecessary investigations etc. To avoid this year WHO insists on people-centered care. People-centered care means health services are ensured to people’s needs and provided in partnership with them rather than simply given to them. It means the care where people, community, and families were respected informed engaged and treated with dignity and compassion. This improves the trust, experience, and outcome from people and gives confidence and job satisfaction among professionals. This would also improve the quality and efficiency of the healthcare system

Let’s take a look at these facts by WHO:

  • 5 million people don’t receive treatment for TB
  • 17 million people do not receive treatment for HIV
  • 20 million infants are not vaccinated against DPT
  • 204 million women do not receive adequate family planning
  • 1.1 billion people are living with uncontrolled hypertension
  • 2.3 billion people lack basic sanitation

What do we infer from these points? All the above-mentioned care is available now that’s what we are thinking, isn’t it? What is the whole point in developing a care that is not reaching millions and billions of people? We have the good knowledge I accept but we need to make this knowledge useful to the community. Otherwise, all these knowledge are vain.

Social media and mass media: Boon or ban for HEALTH FOR ALL:

Everyone will think that social media and mass media will be useful in spreading knowledge and improving the concept of health for all. But my point is they are better in collapsing the health care system rather than promoting it.

A good example is the MMR vaccination program last year. It was a great program to prevent 3 deadly childhood diseases Mumps, Measles, and Rubella. But it was a failed program. Because of fake what’s app message telling about researches in which they’ve proven that this MMR has lots of ADR?

My cousin refused to vaccinate her child with MMR.

I’ve shown her the researches about the vaccine in PubMed and yet she insisted on that wapp message and ignored me. In the history, there were a lot of failure programs due to mass media also.

. Universal health coverage is more than just health insurance, more than just health care. It means people can get quality health services where and when they need them without suffering financial hardship. Half of the population have no access to healthcare and millions are pushed to poverty due to health expenses. Universal health coverage is the solution to all this problem. Evidence and experience show that all countries at all income levels can make progress with the resources they have also show us that there is no single path to Universal health coverage. All countries must find their own way in their own political social and economic circumstances. Let`s take Ghana and Rwanda as examples,

In Ghana, a remote household receives support from community healthcare workers. They help people to receive relevant health care. I’ve read an interesting story about a 16-year-old boy, Shaibu, who was found to have a deadly skin disease and was spotted during such visits. He was referred to hospital to get specialized quality care. Ghana`s National Health Insurance provides free health services for children under 18. Since 2003, this health insurance covered over 6000 patients.

In Rwanda, Dr.Olushayo Olu WHO representative in Rwanda really wanted to create a community where everybody has a good access to health care, basic services like water and sanitation. He developed a system in which financial barriers are removed. The main problem is lots of their people were working in the informal sector. Generally, health insurance schemes focus on people who are working. So the government decided to create different categories called “UBUDEHE”. This classified people according to socioeconomic status and to know who needs assistance and what level of assistance they need. And the Community based health insurance scheme was rolled out. Now they have a coverage of over 80% which by African standards and by any standards represent a great number and they are now progressing towards 100%.

In India, states like our Tamil Nadu have the glory of having a state government implemented a government insurance scheme. Now the central government also made an initiative, Ayshman Bharat which could be the world’s largest health insurance program.

Conclusion:

Universal health coverage not only improves health. It reduces poverty, creates jobs, spares inclusive economic growth and increases gender equality. Strong healthcare systems based on the foundation of primary care are also the best defense against outbreaks and other health emergencies. Universal health coverage and health security are truly two sides of the same coin. Now it is the time for all countries to invest in universal health coverage.

It`s time to talk about the best ways to get health services to all.

Time to remind the world leaders “Health is a human right”

It’s time to have the Right care in Right time in the Right place.

JOURNEY OF MY M.B.B.S

JOURNEY OF MY M.B.B.S

For starters, I want to share my experience with students who want to go on this route and with people who are just curious about what it’s all about – Becoming a doctor.
 I still remember the first day of landing to medical college; the cheerfulness, happy moment, excitement and dream that everybody carries to become a doctor.
Well, my journey was both sweet and sour. The first phase is one of the important years I believe, That is when students have to acclimatize to the new environment. Nevertheless, it’s the year when everyone is ready to get kick started to become a doctor. Everyone is usually more focused during the first phase and eventually, some people start drifting away from their goals. I can’t say that’s the worse thing in the world since that’s how most of us learn the major life lessons. However, I would say getting a good grip on the first phase subjects anatomy, pathology and physiology go a long way. They make the foundation for a smooth journey ahead. I must add, I am not saying that biochemistry isn’t important. Each and every subject carries its own importance. What I see, in the medical field seniors are the motivators, guides and helpers.there are so many books and every writer had their own opinion regarding the books. and they help us in choosing the finest book to read and pass an exam. I love to read ROBBINS PATHOLOGY and GUYTON’S physiology.these book changed the way what I saw in the entire medical field, Guyton telling the all the normal physiology that happens in our body where Robbins explained the detail possible cause where physiology goes wrong to cause disease. studying these books throughout the first phase of my basic science tells me the start from normal physiological cell to the concept of a necrosed cell.
The first year is very fast but at the same time its sort of slow. It might be because its hard to forget the memories made especially during this year. The big transition from school to college is difficult to forget for the most of us. Then comes the second year, which is 1 years long on TU. Well, my biggest mistake was to think “Oh no biggie, I have a lot of time to hit the books.” I was wrong. this year we have to study all system remaining after the first year. Pathology and Anatomy is a major subject of the second year and its best to get a head start rather than waiting until the end. In my opinion, the best case scenario will be a student who not only focuses on the second year subjects but also adds medicine to pathology. Worse case scenario would be waiting until the end to open books!! Well, this is also the year when students start planning trips and enjoying college life. Have fun but don’t overindulge to a point that you can’t come back.
The third year is the easiest year I think. But also because I studied decently throughout the year and it’s very feasible. The holy grail of M.b.b.s is the fourth and final year. Its the hardest I believe. Mostly because practicals weigh just as much as theory, and I was always terrified of vivas. So focus on both theory and practicals. Attend the clinical postings from the third year onwards and be well equipped with the history taking skills.
The internship is one year long. That’s when most of the students learn the basic procedures and get a good taste of the hospital life specifically being on call or night duties.
Moreover, I believe that my medical journey was both sweet and sour.W e are not alone in the journey there is a lot in the world who are with us on the journey. I want to share  a great word by ARISTOTLE
  -“NO GREAT MIND EVER EXISTED WITHOUT A TOUCH OF MADNESS”
DOCTOR-PATIENT RELATIONSHIP- THE CURRENT SCENARIO

DOCTOR-PATIENT RELATIONSHIP- THE CURRENT SCENARIO

DOCTOR-PATIENT relationship!!!!

The above word relationship is “Highlighted” reason is simple… Things that are falling, failing are always highlighted!!!!!!

What’s the reason behind that?

What in this whole world where a doctor was(is???) considered God is now beaten like anything??

Why patient is not trusting doctor??

Are doctors only the reason behind that???

What’s the reason????

Let’s begin with a simple story of a boy. He decides to become a doctor at an age of 12 or 13 just by watching a doctor treating a patient and the healing of the patient, THE SMILE of the person making the day of that doctor!!! The boy decided he will be a doctor and will never disappoint a patient!!! FRIENDS NEVER DISAPPOINT A PATIENT MEANS HE WILL NEVER DISAPPOINT HIMSELF!!!! Then the boy studied hard and cracked the entrance… He got admission in the medical college… An ordinary boy now learns to be a person who will be SUPPOSED to be GOD after his completion!!! The boy gets graduation and joins post graduation coarse by cracking the entrance, the boy is still supposed become a god after his Post graduation!! He becomes a surgeon, one day due to some reason the patient died but wasn’t his fault (was it?) the fault of his was only that he was SUPPOSED TO BE GOD!!

The patients’ relatives got mad and took the life of that doctor!!!

Only a few could understand this, coz doctors are not to be treated like this!! They are here to treat you!!

Believe me, I don’t say it is one-sided fault… There might be few doctors about whom you would have a bad experience but they are never the same!! There are reasons for every advice of a doctor!!!

Doctors give 200% to save a life! If he fails written above he disappoints himself, I don’t say there is no problem yes there is a communication gap… If doctors are not communicating then misunderstanding might be produced!!!

In medicine, there is no place for misunderstanding!!!

If we treat the patient like a god he will definitely regard us with the honor of GOD!!!

And THE PATIENT AND RELATIVES MUST NEVER FORGET DOCTORS ARE HUMANS!!!

 

FIGHT OF A MEDICO AGAINST TUBERCULOSIS

FIGHT OF A MEDICO AGAINST TUBERCULOSIS

This is not only an article but my own story.  I am a 2nd-year student at Vardhman Mahavir medical college and Safdarjung hospital.

Last year around my professional examination I was getting ill very frequently it’s was like almost every evening suddenly fever was coming. I didn’t have a cough but sputum was present. I went to doctors many times but still have to take a PCM almost every night. Finally, one doctor asked me to get an x-ray done. seeing the x-ray he was not sure but I don’t know I had a gut feeling that it may be tuberculosis. After that, I panicked and I didn’t get the sputum test done there and went to a home in Ambala. There I gave my sputum sample and it was 4+ve  at that time I didn’t new 4+ve is what but in the 2nd year of my MBBS I got to know that. My treatment was started with my professional just a month away none of my friends knew at that time I went back to college tell the whole situation to the faculty. They told me I will be sputum -ve in a month and that till that time I can be at home. It turns out that my medicines ( Rifampicin ethambutol pyrazinamide isoniazid) work out great for me.
            My exam started I went to the hostel but I had to get a separate room for me because of the stigma of the disease. All my friends were very very supportive I couldn’t have fought that situation without them. As professional examination are very difficult it was really difficult for me to take my medicines on time and very frequently there was few hours delay. I use to go to the library and in the morning I have to get back in the hostel so as to take my medicines and plus gave to maintain a good diet,  keep a check on my weight and I feared that these drugs have side effects and also about the ease with it can change to XDR or MDR  .
When only one month of my course was remaining and I was doing just fine. I got hepatitis many students in my hostel were suffering from that even my roommate my medicine was modified now instead of rifampicin I had to take ethambutol. But in the end, everything went well. I passed my examination my x-ray became clear and I am doing just fine right now.
 But what I did realize that the biggest problem with this disease is social stigma. I was a fortunate event to have a supportive friend. This disease also has a psychological symptom I guess I think so because my friends after my condition got improved used to tell me that I started to behave weirdly when I was getting frequently ill.
    It is very important for every Medical student or practitioner to be careful as this disease does not see a class or economic level of the person but it can happen to anyone.
Today our nation is facing an outburst of TB. It is the need of an hour to solve this problem and stop it from destroying our lives.
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