Does technology helps or damage our health?

Now a days wherever you see, you will see people engaged in cellphone or tablet. Using smart technology to reduce work.

Pros:
- Get updated with world news
- Stay in touch with distant friends and family
- keeps your mind busy
- less physical work

Cons:

1. More cases of headache, neck pain, back pain and knee pain

Text Neck : Due to constant bending of neck while using phone, it can cause permanat damage to cervical spine and can cause pain, numbness or weakness in arm or fingers.


Headache: 
Meta-analysis Studies by Wang J.(1)  showed that mobile phone/ digital item use is significantly associated with headache.

Back Pain: 
In this digital world everyone work with computer more or less, People who sit constantly in front of computer, or sitting  job with non proper back positioning can damage lower back spine and cause back pain and nerve root shooting pain in limbs (2).

Knee pain: 
Sitting with crossed leg and lack of exercise causes damage to knee joint article which cause knee pain.

2. Increased in Sedentary lifestyle

Digitization has caused person to use of computers and laptops more and more at work, working on that has made life style more sedentary without exercise in routine work.  It led to the problems such as Diabetes, Obesity and cardiovascular problems  (2)

3. Depression/ Person feel lonely without it

Cell phone and internet excessive use causes addiction of it. It has increased a distant between family members. In absence of phone, person feels lonely and depress. Its more common with youth and kids. Cases of depression are increasing with increase internet/ smartphone usage. (3)

Solutions:

1. Be smart and aware: Limit use of cell phones and digital devices.
2. Exercise: Walking, household work, gardening, cooking, cleaning are good ways of exercise and use of time
3. Talk: Talk to people in your family, friends, meet in person, go to social gatherings.
4. Breaks: Give yourself frequent breaks on work, to drink water, take a small walk, take stairs , so you can get up and move around rather sitting in one place at job.
5. Proper positing while sitting: Here is the link from Harvard health for good positioning and posture
https://www.health.harvard.edu/pain/4-ways-to-turn-good-posture-into-less-back-pain



Reference:

1. Wang J, Su H, Xie W, Yu S. Mobile Phone Use and The Risk of Headache: A Systematic Review and Meta-analysis of Cross-sectional Studies. Sci Rep. 2017;7(1):12595. Published 2017 Oct 3. doi:10.1038/s41598-017-12802-9

2. Anna Citko at el, .Sedentary Lifestyle and Nonspecific Low Back Pain in Medical Personnel in North-East Poland.BioMed Research International ,Volume 2018, Article ID 1965807, 8 pages https://doi.org/10.1155/2018/1965807

3. Alhassan AA, Alqadhib EM, Taha NW, Alahmari RA, Salam M, Almutairi AF. The relationship between addiction to smartphone usage and depression among adults: a cross sectional study. BMC Psychiatry. 2018;18(1):148. Published 2018 May 25. doi:10.1186/s12888-018-1745-4

High Blood Pressure / Hypertension

What is Blood Pressure: 

There are two numbers in blood pressure:  one is systolic and another is diastolic blood pressure. 

Systolic blood pressure:

Pressure required by heart to squeeze blood from heart to various blood vessels to supply oxygen to organs. Normal systolic blood pressure is under 120 mmHg.

Diastolic Blood pressure:

Resting pressure in artery between two heart beats / when heart is resting. Normal diastolic blood pressure is under 80 mmHg.

As per previous guidelines, normal blood pressure was under 140/90 but as per new guidelines it is 120/80.

Complication of uncontrolled high blood pressure:

Brain damage / Stroke (paralysis)
Heart failure
Retinal damage (vision problems)
Renal/Kidney damage

Practical approach: 

When the medicine is needed to control blood pressure?

Examples:

1. My mom is having hypertension from past 20 years and she is on 3 blood pressure control medicines. Her medicine dose was increased 3 months ago as her pressure was staying in range of 170-180 systolic. She is in India, I am in US but I am still her primary physician. Yesterday she called me that she is getting tired a lot even if she does small work from past 1 week. I know we might think may be she is getting symptoms of heart failure but I knew her and all her history so, I knew her heart has mild hypertrophy but its function is fine. There were no leg swellings/pedal edema. I ask her to measure her blood pressure. To her surprised it was 116/ 64 , at two different times. I stopped one out of 3 of her medicines. After two days her blood pressure was 130/80. She was feeling great and was back to her routine. 

Tight blood pressure control is not needed but it should be below 140/90 in chronic hypertensive patients. As guideline changed from 140 to 120 as normal systolic pressure, but patients whose heart was accustomed to 140 may not tolerate lower pressure. On the other end, in young newly diagnostic hypertensive patient tight control of blood pressure with diet, exercise and medicine is recommended.


2. I know a physician whose blood pressure ranged between 140-160 on medicines. He used to say it was normal for him. After 5-7 years he got a stroke and half body weakness, at the time of stroke BP was 180 systolic. Learning point: BP  should be tightly controlled to be less than 140 mmHg systolic in chronic hypertensive patients. 

3. 24 year old man complaining of headache, BP=140/90. This is not normal. All other tests were normal, no secondary causes identified which raises blood pressure. I started him on low salt diet and exercise. But he was symptomatic due to headache. So, I have to start him on medicine. I started him on low dose of B blocker. After 6 months, his BP was normal.  Then I tapered his medicine. And now he free without hypertension, not on any medicine from past 7 years. BP should be controlled to be 120/80 in young or any symptomatic patient.

Prophylactic Aspirin in Hypertensive patients?

Low dose of aspirin is recommended in many patients to prevent stroke and heart attack who have hypertension, or mild blockage. Aspirin is a two age sword. It can protect us from stroke ( in which lack of blood supply damage brain tissue)  or it can worsen the stroke( bleeding in brain from rupture of artery due to high pressure). 

In patient taking aspirin tight blood pressure control below 140 systolic is needed to prevent intracranial bleeding.

Do I need to take medicine if my blood pressure is normal on medicine?

Yes. If your BP is controlled after starting you on the medicine, you should keep taking it regularly. If it goes down then you can start adjusting its dose/ tapering it off under physician's guidance.

Learning points:

Walking, losing 10% of body weight and staying stress free helps control the blood pressure.

Reference:

https://www.health.harvard.edu/blog/new-high-blood-pressure-guidelines-2017111712756

Knee joint osteoarthritis

What is osteoarthritis of knee?

Knee joint is a hinge type of joint which get lubricated with synovial fluid secreted from cartilage covering the bone that make this joint. Over the time the joint space decreases which cause two bones to rub against each other damaging cartilage.

Causes/ Predisposing factors:

1. Old Age: >45 year . Due to wear and tear of joint.
2. Weight: It increases pressure on joint
3. Repetitive injury / stress on knee joint: Squatting, kneeling, lifting heavy weight, sittng crossed legs for longer time
4. Heredity/genetic

Symptoms:

Pain in knee while walking
Knee swelling
Feeling stiffness in knee joint, Difficulty standing up from sitting

Diagnosis:

- X ray knee joint: Decrease in joint space with or without cartilage damage
- MRI

Prevention and Treatment:

Avoiding risk factors:

1. Reduce body weight 
2. Avoid heavy weight lifting
3. Avoid sitting with crossed legs
4. Do regular exercise: Walking is a good exercise. It increase joint fluid section which help to lubricate joint.

Symptomatic Treatment:

1. NSAIDS/ pain medicine: Ibuprofen , Naproxane can help but long time use (>7 days) of these medicine should be avoided

2. Physical Therapy: It can help to improve joint function and reduce pain

3. Steroid or hualuronic acid ( joint lubricant) injection in to the joint: It can help to relieve pain  in the early stage of the disease

4. ACS:  Also known as serum treatment: It has mixed results(3). As per one study it's better than fluid/ lubricant injection but, after 2 years its not sure. One study says it helps on mild disease only. Another study says its not effective. I would say it might help to prolong the disease but ultimately after couple years you will be on same page.

Definitive Treatment:

Knee joint replacement is recommended in stage 3 or 4 of the disease.



Reference:

1. https://www.webmd.com/osteoarthritis/ostearthritis-of-the-knee-degenerative-arthritis-of-the-knee#1

2. https://www.medicalnewstoday.com/kc/stages-osteoarthritis-knee-310579

3.Antonio Frizziero, Erika Giannotti, Francesco Oliva, Stefano Masiero, Nicola Maffulli, Autologous conditioned serum for the treatment of osteoarthritis and other possible applications in musculoskeletal disorders, British Medical Bulletin, Volume 105, Issue 1, March 2013, Pages 169–184, https://doi.org/10.1093/bmb/lds016

Stress - the biggest enemy of our health?

What is Stress?

In a simple words, when your mind thinks a lot over any situation in life, you feel heaviness in head. You lose happy and calm nature of yourself. It is called stress or tension.

Continuous stress is the biggest enemy of health.

Causes of stress:

1. Dissatisfaction:  either with work, or position.
2. Not letting go nature: Think constantly about why someone said this or that to me
3. Holding on to things: Rigid in the way things should be
4. Lack of guts to take responsibility: blaming other people for any unwanted situation
5. Finding goal /making decisions: difficulty deciding what you want to do.
6. Unexpected problems: loss of job, or family, sickness


Complications:

Health Issues :

1. Hypertension
2. Heart problems
3. Stroke
4. Depression
5. Anxiety
6. Headache
7. Hair fall/ Gray hairs

Social issues/ personality change

1. Family problems
2. Change in behavior/ Angry nature
3. Feeling Lack of happiness
4. Loss of peace


Solutions:

Stress is the status of mind. You need to take mind out of that state. Divert the thought, or even better way is to convert the thought.

1. Convert Dissatisfaction at work to self satisfaction:
ex.You are working more than your coworker without getting recognized.
Here there are two problems:
A. Comparison: Don't compare, instead recognize your good points and use it for everyone's benefit.
B. Need for appreciation: Believe in yourself. If your work is good enough, you will get recognized eventually. Take a break/ vacation.

2. Let things go: 
If someone said something to you that you didn't like, stop for a moment. Think about it. Are you really that kind of person, if yes then take it as granted and try to improve. If that was false blame, you can reply back or let it go. Let stuff you don't like go out of your mind. Divert mind to your hobby or things you like.

3. Be flexible:
Flexibility helps reliving stress. Don't be to rigid on thing should be this way or that way.Or other should follow your ways.
Ex. you don't like wet towel to be thrown on bed after bath and you want your husband to hang it in a proper place to dry. Rather than getting angry or saying you never put things in proper place, you place it in right place as soon as he/she throws towel on bed. Do this couple of days, later you can say it would be nice it you help me by hanging this towel to dry.
-Help is a good word to use than saying or forcing someone to do things in your way.
Remember if you like keeping thing certain way, its is your problem, not others.

4. Take Responsibility:
Don't blame others all the time. Remember the saying, when we point one finger at other, the other 4 fingers points at us. Best thing is to look at other's positive points.

5. Decision making:
In time when you have to make important decision about life and you feel stressed;
Take advice from friends and family, write down all positive and negative points about new situation and in the end follow your heart/gut feeling.

6. Unexpected problems:
Believe in God. Give some time for meditation, and spirituality. It makes you calm and focused. Spiritual people are more tolerable to unexpected loss/ problems.

Constipation

1. Constipation In Children

Hard stool, infrequent bowel movement in Children are very common

Symptoms:

Hard Stool
Bowel movement every 2nd or 3rd day
Bloating/Gas
Abdominal Pain while passing stool

Causes:

- Fear of passing stool
- Less fibers in Diet 
- Drinking less or infrequent water
- Milk allergy
- Certain pain medicines or antidepressant medicines
- Rarely low thyroid hormone 

Treatment/Solution:

1. Make sure child is not afraid of passing stool.
These happen while starting toilet training or when child starts school. Child avoid going to toilet and hold stool, which cause stool to get dry and hard.
- Make a habit to make child sit on toilet for 10 minutes in the morning and evening. Once they stat passing stool at a regular time fear will go away.

2. Add more fibers in diet / Make child Eat at least two fruits and vegetables in a day
These include banana, apples, green vegetables, whole grains like roti and bread. Taking 2 prunes a day really helps.

3. Ask child to drink more water
Keep eye on how much water your child drink. 5 year old should drink atleast 5 glass of water a day.

4. Try changing milk or stopping milk for couple of days and see if that helps

5. Make sure child is active and doing enough exercise
Activity helps to relieve constipation. Play with child such as hide and sick, or tag or dancing. Now a days when outdoor games are becoming less and less and TV has made life sedentary, exercise is needed in form of free play.

5. If child is taking medicines which can cause constipation, stop medicines if not needed or try taking fiber tablets to avoid constipation

6. If constipation is associated with obesity and concentration problem, check child's thyroid hormone level with your physician.

More information can be found on following link by mayo clinic on constipation in children.

https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242


2. Costipation in Adults

Two type of constipation in adult. Acute which can be due to bowel obstruction and chronic. Here we will discuss only on chronic constipation. 

Symptoms;

- Straining while passing stool,
- difficulty in passing stool
- irregular/infrequent bowel movement.

long term non-treated constipation can cause following side effect

-Piles/ hemorrhoids - due to straining
-Anal Fissure- as hard stool rub and damage anal mucosa


Causes:

- Sedentary Life style
- Drinking less water
- Less fibers in Diet
- Obesity
- Drinking coffee and soda
- Pregnancy
- low thyroid hormone
- Antidepressant, codeine or opioid pain medicines

Solution:

1. Avoid coffee/ excessive black tea and sodas
2. Try changing or stopping milk
2. Drink plenty of water - 8 to 10 glass a day
3. Eat more fibers in Diet: fruits, vegetables, prune and prune juice helps
4. Exercise regularly- walk 20- 30 minutes a day
6. Use Castor oil coated rice, wheat and lentils rather than dry lentils
7. Reduce weight, check thyroid hormone and get treatment if you have hypothyroidism
8. Use fiber tablets and stool softner in case you also have anal fissure or piles

Beware of Pain medicines?

NSAIDS/ AntiInflammatory or Pain relieving medicines

Ibuprofen
Naproxan
Diclofenac

These are easily available medicines for pain without doctor's prescription.But, It has serious side effects.

Most common side effects:

1. Heartburn/Acidity
It can cause blockage of protective enzyme receptor and increase acid in the stomach. It can cause ulcers and bleeding in stomach. Watch for black stool while taking these medicines on long term.

2. Liver failure
High dose and long term use can cause damage to liver cells and liver failure specially in people with fatty liver.

3. Kidney(Renal) failure
High dose and long term use can damage kidney cells and can cause slow renal dysfunction. Specially in patient with mild renal problem or diabetes caution is needed.

These medicine can be used safely if for short time/few days, but long term >1week use should be avoided. 


Opioids/ Narcotics

Morphine
Hydrocodone
Tramadol

These medicines will not be available without doctor's prescription.

Side effects;

1. Constipation
Most common side effect. 

2. Tolerance
Meaning you no longer respond to drug the same way you responded earlier. Overtime you will need higher doses to get same pain relieving effects

3. Dependence
High chance of becoming mentally addicted and or physically dependent. You get unpleasant symptoms while trying to get rid of that medicine after a longterm use.

4. Respiratory depression 
At higher dose it can cause respiratory depression and death.

These medicine are only for severe pain, its controlled medicines, and should be taken under strict guidance of physician. 

It should be taken only for sort time/3-4 days to avoid dependence. 

• Other remedies for pain:

Supportive / alternatives to pain medicines:

- Use hot and cold compression
- Bed rest when needed (ex. Disc problems). Avoid more than 3 days of complete bed rest.
- Avoid certain posture ( Ex. For knee pain avoid sitting on the floor, for back pain avoid carrying heavy weight)
- 'Get up and go'. Try to keep mind busy by activities and productive work. 
- Avoid Stress.
- Swimming and Walking are good exercise
- Ginger, Turmeric and Capsaicin, Lavender oil and Eucalyptus oil are natural remedies which might help.

Stroke

What is Stroke?

  

Signs and symptoms that are experienced due to lack of blood supply to certain part of brain. It can be due to blockage of one of the artery supplying brain or due to bleeding in the brain due to tear or rupture of the artery supplying the brain.

It's an emergency. Time is very crucial in it. Each passing minute after stroke without treatment, increases the chances of permanent disability.

Symptoms

-Sudden slurring of speech
-Facial paralysis / One side of face droops down when attempting to smile
-Sudden inability to move one sided upper and or lower limb
-Sudden balance problem with inability to stand steady
-Nausea, vomiting associated with Severe Headache

Sort form to remember is FAST that is developed by American stroke association.
1. Facial droop
2. Arm weakness
3. Speech difficulty
4. Time to call 911 in USA or 108 in India
https://www.stroke.org/understand-stroke/recognizing-stroke/act-fast/

Causes

Uncontrolled High blood pressure
Blood clot usually traveled from heart 
Aneurysm/ abnormal dilatation of blood vessels supplying brain

Treatment

Its based on weather its due to a block or bleeding.  CT scan of brain is needed to find it out. Treatment is like a two way sword in a stroke.

1. Block in vessel due to clot

Thrombolytic agents should be ideally given within 1 hour of last well known time but can be given up to 4 hours. NOT after it. Higher chances of full recovery if given in first hour but it also have risk of bleeding.

Also, thrombectomy, a surgical procedure to remove clot, can be done in first 24 hours in eligible patients. But only few doctors are trained to do it at very few hospitals.

After 24 hours of stroke, any treatment given is a supportive care to prevent another stroke. Intense physical therapy might help with recovery rate.

2. Bleeding 

Any agents like aspirin or any blood thinner increase further chance of bleeding. Immediately stop it. They usually put a drain in the brain called EVD to decrease intracranial pressure. Also some supportive treatment like controlling blood pressure is highly important.

Take home message: With any of above mention symptom of stroke, immediately call 911 in USA or 108 in India, and go to the hospital where CT scan facility is available.

Prevention: 

Controlling blood pressure and healthy life style are keys to prevent stroke.


More information about the stroke can be found on the following website by American Heart Association/ American Stroke Association.
https://www.stroke.org/understand-stroke/

Allergy

What allergy means in simple words?

Allergy simply means reaction to a thing(allergen) that our body don't like or reject. That reaction occurs by our immune system cells which tries hard to get rid of that stuff.


What are the symptoms:


Mild symptoms:


Hives/Rashes: looks similar to what we see when an ant or mosquito bites us, but this will be multiple either all over body or locally. It is mostly associated with itching.



Diarrhea, vomiting


Severe Symptoms:

Mouth swelling, difficulty to breath due to laryngeal edema, Dizziness, skin pilling or blisters- Immediately go to Hospital if any of this severe symptoms appears.




Treatment:

Only one: Find out what substance you are allergic to and avoid it.
Once you get in contact with allergen, after you get rid of it, it will take couple of days until body stop reacting to that allergen.
For Symptomatic Care: Use antiallergen or antihistaminics
Example:
1. Syrup. Benadryl 5ml for children >5year age, and 10ml for adults for two to three times a day for 2-3 days
or
2. Tablet Cetrizine10mg - one tablet once a day for adult and half tablet once a day for children more than 5 year of age, for 2-3 days.
3. Calamine lotion : It will help with itching and burning
4. For Difficulty in breathing/asthma: Use albuterol inhaler if available immediately until you reach to physician


How to find out what is causing allergy?

It usually take 1-2 days to develop allergic symptoms first time but it will take just few minutes to a hour for second time exposure.  Think what new thing you used or try in past couple of days.
Think of followings:
New food?
Most common are:
Nuts (peanut can cause severe allergy),
Milk (Lactose allergy can cause bloating and diarrhea),
Chocolate/Candy,
Wheat( diarrhea, rashes),
Fatty food (foul smelling stool),
Oil,
eggs/ meat/fish
New weather?
New weather like sudden cold weather or sudden rainy wet weather can cause reaction in airway which can cause difficulty in breathing
New body soap/ Detergents?
Can cause small rashes all over body
New cloths?
Can causes rashes on contact area
New Medicine?
Any including multivitamins can cause mild to severe allergic reactions
Mold in house/ backyard?
It mainly causes breathing problems/ asthma
Animal contact/ Animal dropping/hair contact?
Animal contact or contact with their dropping or hair can causes rashes and itching
Dust allergy?
It usually causes breathing problems, such as asthma, nasal congestion,and coughing.
Keep the house clean specially sleeping area. Get rid of carpets as it hold dust, plus in a day today life we don't clean carpets everyday. Wooden floor or tile floor is much better than carpet as you can see dust on it.



If symptoms remain persistent and you are unable to find out what causing allergy, then take appointment with allergy/immunology specialist to get various allergen testing done.

CPR

When I visited India last time about 6 months ago, my father in law passed away with sudden death. He did not get any CPR (Cardio Pulmonary Resuscitation) at that time and we were not near them at that moment. For increasing chances of survival for anyone who suddenly become unresponsive CPR can be given by anyone nearby until medical ambulance or care is available. 

There are the simple steps of CPR that everyone should know.

https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr-steps

1. Tap person hardly and ask Are you ok, If no answer then

2. Call for help. 911 at USA or 108 in India for assistance

3. Open the mouth,  with the person lying on his or her back, tilt the head back  

4. Check for breathing. Check putting hand near nose or look for chest movement. If  no breathing begin CPR.

Steps of CPR: 

x

1. Chest Compression: 100 compression per minute

Place your hands, one on top of the other like making a bird sign with hand. Put it in the middle of the chest just above the abdomen. Keep the elbow straight. So, your body weight can help you do deep compressions that are at least 5 cms deep. Do atleast 100 compressions per minute. Push hard, push fast. 

2. Breething: 2 blows per minutes

Tilt person's head back, pinch nose, open his mouth and blow in to his/her mouth so the person's chest can raise. Blow two times and then continue with chest compression. 

Continue CPR steps. Keep doing chest compressions and breathing at a ratio of 100:2 until the person starts breathing or ambulance or doctor arrives. 

Ready for your questions?

I will try to answer your question regarding heath and will provide you information and suggestion to the best of my knowledge and with article search.

Jay Shree Krishna