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Leelawati Clinic & Day-care Centre, 201, Second Floor, Niramay Medical Hub, B/h HP Petrol Pump, Near Gh-3 Circle, Sector 6, Gandhinagar (2025)

02/11/2023

How to attain optimum health – 151

As per his daily routine, Surya sat down to his daily cup of tea with the daily newspaper. His eyes immediately noticed the news regarding sudden (cardiac?) death of a young adult male. He realized that he too was leading a sedentary (though mentally taxing) life leaving no room for exercise and that he could meet the same fate.

He decided to join a gym from that day itself. The very next day he read a news clipping of how a famous influencer (and a gym freak) died a sudden cardiac death while exercising.

So, he abandoned the plan (as well as the annual charge he had paid) of going to the gym and decided to go on a walk from the next day. A few days later he read a news article of how a person who was on his regular walk and suddenly collapsed and died. Now, he was in a fix. What should he do to ensure his good health and life?

We all have lived this scenario that Surya did and have asked ourselves the same questions.

The answer is: Neither too much of gym, nor a regular walk (while having an otherwise unhealthy lifestyle), nor yoga daily, nor some form of exercise is sufficient to ensure that you shall live a healthy and a long life.

Health, by definition, is a state of complete physical, mental and social well-being and not merely an absence of disease.

This means that you have to strike a balance between your physical, mental and social well-being. Apart from a regular walk (or yoga or exercise or whatever works for you); you also need peace of mind, regular sleep, regular rest and break from work (including from exercise). Yes, a weekly off from exercise is also needed.

You have to nurture and nourish your mental and social well being too. This means indulging in hobbies, travel, healthy food habits, avoiding addictions like smoking, alcohol, to***co; ensuring you breath clean air and involve yourself in positive social life.

Apart from this, regular preventive health check-ups go a long way in early detection of ailments and a cure.

Despite all this, you may still suffer from some health issue between your last and next preventive health check-up. Don’t ignore that health issue and immediately consult your doctor.

Discard the mentality that getting back normal reports is a waste of time and money and that investigations or health check-ups are only needed when you are ill. Just as you take your vehicles for an annual service and oil change even when they are working fine; you too need an annual health check up and addressing of the health issues that are detected.

A slim waist, six pack abs and big biceps alone don’t mean health. They may be concealing many underlying unaddressed health issues. In fact, lifestyle compromises to attain such film-star or influencer looks may push you towards grave medical issues.

Surya ultimately settled for going to bed at an early hour followed by waking up early, going for early walks, quitting addictions of alcohol and social media; spending an hour daily in his hobby of gardening; resetting his ambitions of corporate life so as to give him a relaxed schedule and fewer responsibilities and spending quality time with his family. He doesn’t have a six pack or huge biceps but he feels fresh, healthy; does not become breathless on exertion and having given up social media, now feels no pressure to live up to the society’s standards of success and health.

Takeaway: Spare time daily for exercise, healthy food, socializing, rest, sleep, hobbies and creativity apart from your job/profession. Do not lead a life where you might end up first spending your health for money and then all that money to regain your health resulting in a sum zero equation.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

20/10/2023

150 – When not to pursue treatments

“Do no Harm” is the first diktat that is given to medical students when they join medical school.

What is not taught, however, is that among the various medical managements; death too is an outcome. It is also not taught that patients and their near and dear ones should be made aware of this truth. It is in such scenarios that doctors end up harming more by pursuing treatment than just telling the patient to go home and live out the rest of her/his days.

Many times when a person suffers from a terminal disease such as cancer, multi organ failure or major trauma whose prognosis is bleak; it is important to discuss or consider if treatment is actually going to benefit the patient in terms of quality of life? Shall the patient recover enough to regain control of her/his life so that they can sustain it without support? Are the potential benefits following planned management sufficient to justify the costs and potential complications of the therapy (medicines, procedures or surgery)?

If the risk benefit ratio is considered, do the benefits of the management far outweigh the (physical, emotional, social, and financial) risks?

It is the doctor in charge who is best placed to answer these questions. A doctor who has sufficient experience of managing such cases would know the potential outcomes (of course, they can vary case to case but in broad terms she/he would know) and whether the potential benefits in terms of length of life and quality of life would outweigh the potential risks & complications.

It is important that patients and their relatives are given the information in such terms so they may make an informed choice to pursue the treatment or not.

Just because a treatment exists doesn’t mean it shall benefit the patient in her/his stage of the ailment. Having a management protocol on paper and its ex*****on in real life on a living and breathing patient almost always have different and sometimes wholly unexpected outcomes.

The patients and their relatives too need to understand that even death is an outcome; in fact it is the only inevitable outcome that can be predicted at the start of any management plan.

Takeaway: Make a choice of whether to pursue a treatment or not keeping in mind that the treatment should not create more pain and damage to the patient. One should not be led on a treatment plan where a patient may cry out, “Please take away your treatment and give me my ailment back.”

It should also be remembered, that once such a choice is made, it is not always possible to reverse the decision and again opt for treatment. One should then be prepared to accept the final outcome too.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

14/10/2023

FATIGUE – 149

We often hear people (young and old alike) complaining that they feel tired, unmotivated to work or move and they lack enthusiasm.

A state of lingering tiredness that is constant and limiting; where there is persistent, unexplained and relapsing exhaustion; that is a state of fatigue.

Frequently fatigue is waved off by calling it laziness or having a too pampered growth; many times people complaining of fatigue are called out as being entitled and are asked to chin up and to get back to work.

However, there are many medical conditions that present as fatigue and unless these are ruled out, the person’s complaints should not be taken lightly.

The common conditions that we see in clinical practice that present as fatigue are (not in chronological or in order of frequency):

Hypothyroidism, Diabetes (or Pre-Diabetes), Hypertension, Obesity, Vitamin deficiency (most often B12 and D3), anemia, depression, subclinical viral infections, chronic kidney or liver ailments, depression, electrolyte imbalances (frequently – low sodium, especially in the senior citizens); side effects of medications like anti-depressants, sedatives, anti-histaminics (which frequently cause sedation); over exerting oneself for social or professional commitments.

A proper examination by your family doctor followed by the appropriate investigations (as deemed fit by the doctor) would lead to a proper diagnosis and appropriate treatment. An early diagnosis accompanied by proper treatment and lifestyle changes can go a long way in prevention or treatment of ailments (if any discovered) leading to a better quality of a longer life.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

09/10/2023

IMPORTANT POINTS TO REMEMBER IN TREATMENT OF DENGUE/VIRAL INFECTION - 148

Viral infections like influenza and Dengue tend to present with very high grade and persistent fever. Sometimes, the fever does not come down for many days and is noted in the range of 103-105 ^F.

In such a situation the family (understandably) becomes very agitated and they tend to keep giving antipyretics (like Paracetamol) and often analgesics (like Ibuprofen and Nimesulide) in an attempt to break the fever.

However, they end up doing more harm than good.

Please remember the following advise:

Paracetamol may be given upto a maximum of 6 times (4 hourly) in a day. The maximum adult dose is 650 mg 4 hourly (3900 mg in a day). In a child the maximum dosage in 24 hours is 75 mg/kg given in a minimum interval of 4 hours or more between two doses. Dosage in excess may cause gastric and hepatic complications.

In the event that the patient still has fever despite this dosage, you may apply cold compresses to the forehead and be sure to maintain adequate hydration.

Often people also administer Ibuprofen or Nimesulide. While these medicines do reduce the temperature; they also have an effect on the platelets and reduce blood coagulation. In viral fevers, especially dengue, patients are already at a risk of bleeding disorders owing to reducing platelet counts. This is also one reason why such patients suffer from intraabdominal or intracranial bleeding and sometimes even succumb to it.
Hence, DO NOT ADMINISTER IBUPROFEN OR NIMESULIDE TO A PERSON WHO IS EVEN SUSPECTED OF HAVING A VIRAL INFECTION.

Takeaway: Be mindful of the maximum permissible dosage of Paracetamol and Do not administer any other medications (especially ibuprofen and Nimesulide) in an attempt to control fever in dengue or viral fevers.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

08/10/2023

BETA THALASSEMIA MINOR – 147

Mr. X presented to the general OPD with symptoms of fever and general malaise. When his blood reports (given for diagnosis of fever) came in, I noticed that his Hemoglobin was 10.2 gm% (normal Hb in males is at least 13.5 gm%).

Upon casual query, he revealed that his Hemoglobin has always been in this range and repeated courses of iron and vitamin supplements have given no tangible results. I advised Hb Electrophoresis and iron studies.

As expected, he had high levels of serum iron and was actually suffering from Beta Thalassemia minor.

Thalassemia is an inherited blood disorder of hemoglobin production in which there is a partial or complete failure to synthesize a specific type of globin chains.

Hemoglobin molecules are made up of chains called alpha and beta chains that can be affected by mutations. Depending on which chains are affected by the mutations and type of mutations; a person may have alpha or beta thalassemia which may be mild or severe.

Here we shall talk about Beta Thalassemia Minor.

When a person is heterozygous for the mutation causing impaired production of beta chains, he is said to have Beta Thalassemia Minor.

In such individuals, Hemoglobin levels are low and when it results in mild hemolytic anemia, the affected person may have symptoms of fatigue, frequent headaches, difficulty in concentration, being more weak or tired than usual.

While such patients do not require any treatment for anemia (in fact, since there is iron overload, iron supplements are contraindicated); prevention of further transmission in the family is important.

If a person with Beta Thalassemia trait (Beta Thalassemia minor) marries an individual carrying the same trait – their children have 25% chances of being Homozygous for the disease i.e., 25% chances of being born with Beta Thalassemia Major (Cooley anemia); 50% chances of being born with the trait; and 25% chances of being born as normal (neither trait nor disease).

Hence, it is important that both partners should undergo testing for Thalassemia prior to marriage.

Takeaway: Beta Thalassemia Minor is an inherited condition present from birth. A person having persistent anemia despite iron supplements should be tested for Thalassemia trait. No active treatment is required for anemia resulting from the trait.
Such an individual should not marry without confirming that his/her partner is not having Beta Thalassemia trait.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

05/10/2023

DIABETIC NEUROPATHY – 146

It is commonly known that Diabetic patients suffer from complaints of tingling and numbness, burning sensations, weakness and often pain in hands and feet; sometimes even loss of sensation. Other common complaints are not being aware of hypoglycemia, sudden bouts of giddiness and/or fall, gastric fullness, visual defects.

All of these and more are a result of the damage to nerves that occurs in diabetics. This damage to nerve due to diabetes is called Diabetic neuropathy and it may affect the sensory or motor or both types of nerves.

The risk factors are long standing Diabetes (more the duration of disease, higher the risk); uncontrolled Diabetes; obesity, smoking and kidney damage (presence of more toxins for a longer time following kidney damage).

The commonest type of Diabetic neuropathy (DN) is Peripheral Diabetic Neuropathy (PDN) in which typically the glove and stocking type of symptoms are seen – that is symptoms like tingling, burning, numbness, pain, loss of sensation, sometimes extreme sensitivity to touch, weakness and pain are felt in the feet and hands.

Autonomic neuropathy involves the autonomic nervous system that supplies to the heart and blood vessels, gastrointestinal tract, sexual organs, eyes, bladder and the sweat glands. The symptoms are fall blood pressure on change in posture, unawareness of hypoglycemia, gastroparesis (food does not clear easily from the stomach), erectile dysfunction, vaginal dryness, dry skin, loss of control of bladder function and visual impairment.

Diabetic proximal neuropathy affects predominantly the area of the buttocks, thighs, chest and abdomen and manifests as difficulty in getting up from sitting position.

Since Diabetes is a disease of the small and medium blood vessels, when the blood vessels supplying the nerves are damaged (read occluded), they cause damage to the nerves and hence Diabetic neuropathy.

Prevention is in form of healthy lifestyle where in proper control of body weight and blood sugar are maintained. Regular exercise, healthy diet, healthy sleep pattern and not indulging in addictions like alcohol and smoking go a long way in preventing or controlling Diabetic neuropathy.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

03/10/2023

HICCUPS – 145

While hiccups are referred to in jest as someone seems to be remembering you; not all hiccups are so innocent.

Hiccups are repeated spasms or sudden movements of the diaphragm that one can’t control. Diaphragm is a muscle that separates the abdominal cavity from the chest cavity. A spasm in the diaphragm causes the vocal cords to close suddenly, producing a “hic” sound; and hence – hiccups.

While hiccups are mostly caused by consumption of carbonated beverages, alcoholic drinks or a large meal; swallowing air like when chewing gum or smoking; or even when a person gets excited suddenly. However, in such cases the hiccups resolve mostly in a few minutes or hours.

If the hiccups last for > 48 hours, there is a possibility of an underlying cause.

Such causes may be damage or irritation to the phrenic or vagus nerves. The causes for this may be irritation of the eardrum due to hair or foreign body; tumor cyst or growth on the thyroid gland; gastro-esophageal reflux (GERD); sore throat or laryngitis.

Central nervous system disorders like encephalitis, meningitis, stroke, serious brain injury or tumors may cause hiccups.

Metabolic issues like Diabetes, low or high potassium or sodium or kidney diseases may cause hiccups.

Use of drugs like sedatives, anesthetic medicines, steroids and alcohol use disorder may also cause hiccups.

Takeaway: While hiccups are mostly innocent, in the event that they last for longer than 48 hours or have appeared in patients who have any of the above comorbidities, then immediate medical attention should be sought.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

01/10/2023

HYPOTHERMIA – 144

While people tend to ask a lot of questions and seek to understand fever (high temperature) and how to deal with it prior to seeking medical attention; hardly anyone is curious about hypothermia (low core temperature) and how to identify and deal with it.

Hypothermia occurs when body loses heat faster than it can produce heat. When body temperature drops; heart, nervous system and other organs can’t function normally. Left untreated, hypothermia can lead to complete failure of the heart and respiratory system and eventually may lead to death.

Normal body temperature is 98.6^F (37.0^C). Temperature below 95^F (35^C) is considered to be Hypothermia. It is more difficult to identify it in its early stages since there isn’t much awareness about it (especially as we live in a nation that is mostly exposed to moderate temperatures).

Those who are at risk of developing hypothermia are the elderly; the very young; alcoholics; those exposed to cold temperature without adequate clothing for a long duration; those who have become wet and haven’t (or haven’t been able to) changed clothes; those living in homes that are either at chilly locations (hills, woods) or where the air conditioners are continuously on at low temperatures; those who are taking anti-depressants and anti-psychotics; people with mental illness, dementia; hypothyroidism, poor nutrition, stroke, severe arthritis, Diabetes, Parkinson’s disease and spinal cord injuries.

The symptoms of hypothermia are shivering, irregular pulse rate, drowsiness, fatigue, weakness, confusion, slurred speech or mumbling, memory loss. When the temperature falls below 26^C (78.8^F) the patient loses consciousness and may develop general oedema.

Emergency management of Hypothermia includes certain DON’TS: Don’t shift the person into a tub of warm water; Don’t give them alcoholic beverages; Don’t try to heat them with radiating heat (fire, electric heaters); Don’t rub the body parts to try to make them warm.
The DO’S are: First, shift them to a warm area; remove all wet clothing; cover them with dry and warm clothes and blankets; serve them warm (non-alcoholic) beverages. Care should be taken that ideally the speed of warming them should be 0.5-1.0^C per hour. Shifting them should be done slowly as jarring movements may trigger arrhythmias.

Takeaway: Elderly and very young children are often unaware of their bodies becoming cold. Care should be taken that they are covered up well (more warm clothing than an average adult needs). Those having Diabetes, Hypothyroidism have greater risk of developing Hypothermia; similarly, those having suffered trauma or who are in an accident where their bodies are exposed to cold air or have become wet; care should be taken to immediately move them to warm environments.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

30/09/2023

PILONIDAL CYST AND PILONIDAL SINUS – 143

Occasionally a person may suffer from pain and difficulty in sitting owing to a small swelling near the upper cleft between the buttocks. This crease/cleft between the upper end of the buttocks is called the natal or intergluteal cleft.

This swelling, which presents with complaints of pain, swelling, and occasionally pus discharge is called a Pilonidal Cyst. Pilonidal is Latin for a nest of hair and this cyst contains hair and skin debris. It usually occurs near the tailbone at the upper end of buttocks.

It occurs in those who have to sit for long durations (and hence is also called jeep driver’s disease), those who have hairy back and buttocks; those who are obese.

It occurs when a hair pe*****tes the skin and gets embedded inside the skin. Slowly more hair may pe*****te and the debris accumulates resulting in a cyst that contains fluid, hair and skin debris. It may become infected resulting in an abscess and pus discharge. A rare complication is squamous cell carcinoma.

Treatment consists of draining the cyst when in early stage, but mostly it would require surgical excision and dressings. Sometimes it may become chronic and require repeated medications and surgeries.

Preventive measures include losing weight, avoiding sitting for long durations and shaving the hair around the buttocks once a week and maintaining proper hygiene in the area.

Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

29/09/2023

HIDRADENITIS SUPPURUTIVA – 142

Quite often a person suffers from a skin condition (mostly in the armpits) where there is an appearance of a cluster of painful bumps under the skin that seem to persist and not respond to treatment. They grow, may discharge pus or blood, are painful, irritating and despite treatment, they seem to persist and recur.

This condition is Hidradenitis Suppurutiva (HS) and it commonly occurs where skin rubs against skin – armpits, groin, buttocks and the undersurface of breasts. However, it may occur at other areas also.

The primary reason is clogging of the opening of the hair follicles that results in appearance of the bumps under the skin that then become inflamed, infected, and painful and then discharge pus and/or blood.

It usually begins after puberty and most cases appear between puberty to 40 years of age. It is three times more common in females. Obesity, smoking, diabetes, metabolic syndrome are risk factors to develop HS.

While the primary symptoms are appearance of bumps under the skin; over time they become painful, discharge pus and may even develop tunnels under the skin connecting individual lumps.

The inflammation and swelling may lead to scars and skin changes (pitted skin); restricted movement especially if it affects the armpits or groin; swelling the arms, legs or ge****ls if the scar tissue affects the lymph drainage system; anxiety or depression owing to embarrassment due to location, odor; lifelong pain and in rare cases may even lead to squamous cell carcinoma (skin cancer) especially if it involves the perianal area.

Cessation of smoking, regular exercise to keep weight in control, proper control of blood sugar, maintaining hygiene in the armpits and groin, wearing loose fitting clothes are the steps one may take to prevent occurrence of HS.

Treatment is in form of anti-inflammatory and antibiotic medication, local antiseptic ointments, dressings (if needed) and sometimes surgery.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

28/09/2023

MICTURITION SYNCOPE – 141

Fainting resulting from stressful triggers that results in sudden drop in blood pressure and heart rate is called syncope. When it occurs during after micturition (passing urine), it is called micturition syncope.

Each of us has heard at least once in a lifetime that some friend/relative’s parent went to the bathroom at night and had a fall. While the focus shifts to fall (and to the resultant fractures); very few of us pause and think why a fall in the bathroom at night is so common.

When person awakes from a deep sleep at night to pass urine, the sequence of events is usually like this. It is usually an adult male, senior citizen, who likely has an enlarged prostate owing to which he has to get up at night to pass urine. The person is semi-conscious and usually wakes up due to the strong urge to pass urine. They, hence, don’t sit for a while after waking but immediately stand up from a lying posture, go the washroom and strain to pass urine.

Due to the activity of sudden standing posture from a deep sleep one, Valsalva manoeuvre of straining to pass the urine and the sudden drop in stretch of the urinary bladder muscles due to rapid emptying of the bladder – one or a combination of these activities results in a sudden fall in the blood pressure due to dilatation of the blood vessels.

The results in cerebral hypoperfusion and results in syncope and a fall. N.B. even a hypoperfusion of 3-5 seconds is sufficient to induce a fall.

This may be aggravated by factors like alcohol intake, dehydration, taking alpha receptor antagonists for benign prostate enlargement, elder age and fatigue.

A person who has sustained such a fall should first be evaluated for any injuries due to the fall and any co-existing ailments (cardiac, vascular, neurological, hypoglycaemia). A diagnosis of micturition syncope is usually a diagnosis by exclusion of any other possible causes.

While there is no specific treatment for micturition syncope itself, a few measures may be taken to avoid such an occurrence.

Alcohol should be avoided; if there is an urge to pass urine at night, the person should first sit in the bed for a few seconds till they gain complete consciousness and awareness; urine should be passed in the sitting posture; complete and rapid emptying of the bladder should not be done – rather, start and stop of micturition should be adopted to ensure slow emptying of the bladder. Even after complete evacuation of the bladder, they should sit further for a few more seconds till they feel in complete control of their faculties.

A further step may be taken – if practically possible - to inform their partner (if any) that they are going to the washroom; this is because it sometimes happens that a person collapses in the bathroom from micturition syncope, suffers serious injuries and they are not discovered till after quite some time elapses. This delay in getting prompt medical attention may result in serious morbidity or even mortality.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

26/09/2023

SUBCONJUNCTIVAL HEMORRHAGE – 140

Infrequently a person notices that either they themselves, or someone they are conversing with, have a red eye that appears like blood.

It is quite understandable that such a scenario – seeing blood in ones or someone’s own eyes – is quite alarming.

This is subconjunctival hemorrhage (bleeding beneath the conjunctiva).

Conjunctiva is the clear lining that covers the eyeball and the undersurface of the eyelids. Bleeding beneath it is called subconjunctival hemorrhage. It is caused by rupture of some very tiny vessel below the conjunctiva.

This may be caused by sudden rise in pressure inside those vessels by coughing, sneezing, lifting heavy weights, trauma or a sudden spike of blood pressure. Patients on anti-coagulant therapy may also develop subconjunctival hemorrhage with minimal increase in pressure.

It does not affect the vision. However, it is important to determine the borders of the hemorrhage, since if the posterior border is not visualized, it may actually be caused by intracranial hemorrhage (which is serious and needs immediate medical attention).

Subconjunctival hemorrhage is self-resolving and needs no medical intervention. If a person is on anti-coagulants, they may need to be stopped for a few days. Blood pressure should be monitored and if raised, appropriate management should be done.

- Dr Preeyank Vora (M.B.B.S.)

Amedicalfactaday.wordpress.com

Leelawati Clinic & Day-care Centre

02/11/2023

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14/10/2023

09/10/2023

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05/10/2023

03/10/2023

01/10/2023

30/09/2023

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26/09/2023

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Monday	8:30am - 8:30pm
Tuesday	8:30am - 8:30pm
Wednesday	8:30am - 8:30pm
Thursday	8:30am - 8:30pm
Friday	8:30am - 8:30pm
Saturday	8:30am - 8:30pm