Dr. Swapnil A. Sonar - Consultant Physician

02/01/2020

https://www.freepressjournal.in/health/neurologic-bp-meds-may-reduce-breast-tumour-growth

Researchers have found that combining neurologic and blood pressure drugs may reduce breast tumour development

03/12/2019

WHY DOING 'ONLY ECG' IS A DANGEROUS PRACTICE.

- As a Physician I come across many patients mainly from young & middle aged population who approach us in the Hospital or Clinic just for an ECG. Some even WhatsApp their ECG and ask for a opinion whether ECG is normal or not. When enquired why he/she wants only ECG and not a proper consultation and checkup, usual answer from patient is - 'I had an episode of chest pain sweating and/or heaviness of breathing 4-5 days back in office or while jogging or while travelling. Now I am absolutely fine, don't have any chest pain as such and today is work-off so wanted to do the ECG and see. So just tell me doctor my ECG is normal or not!' Once told ECG is normal, he/she is relieved and resumes his/her routine without any further consultation, physical examination or any further communication. This is what I call the wrong and dangerous trend.
We have to understand that a routine resting ECG may show absolutely normal findings even if a person has significant blockages in his/her Coronaries ( Blood vessels Supplying Heart). So we may just get misguided and caught unaware because of that Normal ECG.
That episode of chest pain /sweating or heaviness of breath in the office / garden / station might have been a cardiac angina which might have resolved after rest. A thorough enquiry into symptoms and clinical history, detailed physical examination, certain blood tests, Radiodiagnostic modalities like 2DECHO, Cardiac Stress Test and CT/ Invasive Coronary Angiography and their proper correlation and interpretation is very important to diagnose a silent Heart attack, Angina and Coronary Blockage.
Many cases have been reported where young people have collapsed due to Heart attack and have had absolutely normal ECGs on previous 3-4 occasions. Sadly they never tried to go beyond Just ECG reporting! Unfortunately when we doctors try to tell and convince them to go for proper physical examination, few more tests and not to just rely upon a normal ECG, we are often looked down upon as some greedy persons skimming more money out of their pockets and not as Guardians of Health!

14/11/2019

Today is and also birthday of Sir Frederick Banting who discovered Insulin. Type 1 Diabetes was a death sentence until the discovery of Insulin by Banting and Best.Insulin came up as a Sanjeevani and has saved millions of lives of Diabetics world over. Let us all pledge to beat the Diabetes. Healthy Diet, Daily Exercise, Stress management, Medicines whenever required and regular screening tests is the mainstay to defeat the Diabetes.

01/11/2019

COMMON MYTHS ABOUT DIABETES

1. Diabetes stays permanent and medicines need to be taken for whole life.

- Not completely True.

Usually Diabetes is regarded as chronic metabolic disorder which stays for whole life requiring lifelong medicine intake. But in many patients diabetes can be reversed completely and patient can stay without medicines successfully. This path to reversal requires early diagnosis, strict diet control, losing abdominal fat and regular medicines for initial few years.

2. In Type 2 Diabetes, once Insulin is started we become Insulin dependent and then we have to take Insulin for whole life.

- completely false.

In diabetics, Insulin needs to be started in certain conditions like very High blood sugar levels, diabetic ketoacidosis, infection and Sepsis, before and during surgeries and pregnancy. Once these conditions are addressed and controlled , Insulin can be successfully stopped and patient can be switched on to oral medications.

3. Diabetes medicines damage kidneys. That is why doctors ask blood creatinine test and ultrasound of kidneys

- wrong.

Diabetes itself silently damages both kidneys along with many other organs over the years. So to understand extend of kidney damage doctors ask for those tests. As far as Anti-diabetic medicines are concerned, they are mainly excreted through kidneys, so if Kidneys are already damaged due to Diabetic nephropathy then these medicines can accumulate in blood and cause blood sugar to drop very low (Hypoglycemia). So We have to adjust and reduce the dose of medicines according to creatinine level to avoid hypoglycemia in such situations.

4. Antidiabetic medications cause weight gain

- Partly true.

Weight is gained mainly after sugar control due to buildup of lost weight during previous high sugar phase. Also some antidiabetic medicines can cause fluid retention and weight gain. Insulin is anabolic and can also cause 2-3 kg of weight gain. But the benefits of antidiabetic medications are much superior compared to this shortcoming.

5. Diabetics cannot eat fruits.

-Wrong.

Diabetics can surely eat fruits having low glycemic index. Fruits are rich source of Antioxidants and Multivitamins and are essential components of balanced diet.

6. Diabetes runs in families.

- Partly true.

Diabetes is Polygenic in inheritance. That means multiple genes are responsible for development. But the studies have clearly shown that the individuals whose one or both parents have diabetes are more prone to develop diabetes as compared to other individuals who don't have any family history of diabetes.

7. Sugar-free foods are good and allowed for diabetics.

- Wrong.

Many sugar-free foods contain same amount of carbohydrates which ultimately get converted into glucose and calories inside the body. So it's always advisable to read the nutrition content chart on the packet and confirm with your doctor.

8. It is okay to have HBA1C of 8.

- No.It is not okay.

Diabetes in Indians is very aggressive causing multi organ complications including kidney failure, blindness, neuropathy, vascular blockages and many more. So for Indians ideal HBA1C Target is 6 to 6.5. In old aged people this target can be higher up to 7-8 depending upon in individual case.

9. I have no symptoms means I can't have diabetes.

- Completely wrong.

Diabetes, Hypertension, Hypercholesterolemia are in fact called silent killers because they do not cause any symptoms for years and directly lead to complications. Regular screening before the appearance of symptoms helps in early detection and prevention.

10. Gestational Diabetes (Diabetes that develops only during pregnancy) means you will have diabetes permanently.

- Wrong.

On most occasions, Gestational Diabetes cures completely after delivery. But the risk of developing diabetes later in life is increased in such females. They need more regular screening tests to detect and treat it early stage.

01/09/2019

In fight against × Disease and Sufferings, Patient and Doctor have to be on same side...!! Then only we can win against the disease or atleast blunt it ...When Patient and Doctor fight each other then it's the Disease which wins...So let's Have Faith, let's Communicate and Talk to each other and try to Conquer the Disease and try to eliminate the sufferings..

30/08/2019

Government of India has launched in right direction and at right time. Prime Minister Modi in yesterday's speech, specifically mentioned about the growing Diabetes and Hypertension Epidemic, their ill-effects on health and need to counter them on urgent basis. This menace of Diabetes-Hypertension-Insulin Resistance - Obesity - Metabolic Syndrome is silently gripping and crippling the most efficient, hardworking and talented young population group in India and worldover. These modern day Metabolic disorders can cause frequent illness, absenteeism, increase financial burden and and adversely affect mental health in turn. The measures to counter them need to be taken on multiple fronts.
Right from
- healthy and organic farming,
- fixed working hours in all jobs in all fields,
- 40 mins of physical exercise and 6-7 hours of daily sleep
- availability of public grounds and jogging parks,
-continuous supply of standard quality medicines at cheaper rates,
-control on use of plastics chemicals in food and diary products.
is a long way but definitely achievable.Our policymakers now should continue the focus on it.

07/01/2019

Well many of my diabetic patients in OPD have been asking me about revised HBA1C target in treatment of type 2 diabetes. The new guidelines from American College of physicians (ACP) have recently recommended that for strict control of blood sugar levels, achieving moderate HBA1C level of 7- 8 is acceptable as compared to previously advised stricter and lower HBA1C target of 6.5 - 7. But majority of Indian Physicians have advised to be cautious about these revised targets and infact still adhere to lower HBA1C targets of 6.5-7 mainly in young type 2 diabetics.So this has confused many patients. Many media articles without even hearing our side have quickly labelled Indian doctors as greedy and called this as Doctor-Pharma nexus to keep medicines sell on. Well it is not the case. As a matter of fact Diabetes in young Indians has been very agressive. Within 15-20 years of diagnosis it eventually leads to many serious and dreadfull complications like Both Kidney failure and Dialysis dependence, blindness, Stroke , Heart attacks , Peripheral vascular diseases , amputations of extremities and Painful neuropathies. May be Indian diabetes is new in overall world diabetes chronology and also genetics playing it's role, it has to be treated aggressively in young adults to save all these vital organs and functions. A diabetic patient with poorly controlled sugars in his /her 50s and 60s having both kidney failed and going on permanent dialysis and ultimately for renal transplant is a common scenario in clincial practice. Over the years our Neuroendocrine system may produce new Guardian molecules making diabetes relatively slow and blunt and less agreessive. But right now diabetes in young Indians needs to treated aggressively.