Hypotension can also cause complications

Hypotension can also cause complications

Lifestyle modifications and dietary changes can help in managing symptoms

New Delhi, 24 November 2017: Statistics indicate that the prevalence of hypotension or low blood pressure depends on age. It ranges from 5% in patients under 50 years of age to 30% in those over 70 years of age. In healthy people, low blood pressure without any symptoms means negligible health concerns. However, symptoms indicate inadequate blood flow to the heart, brain, and other vital organs, which needs to be treated as soon as possible.

Hypotension is a condition in which blood pressure in the arteries gets abnormally low. In some cases, the blood pressure becomes so low that it fails to reach all the body organs. The ideal reading level for blood pressure is more than 120 over 80 but less than 140 over 90 (120/80-140/90). When either number is below the ideal reading level, the blood pressure is considered lower than normal.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Our blood pressure varies throughout the day due to several factors. Some of them include body positions, the level of stress, physical condition, medications, eating and drinking habits. Blood pressure usually decreases when a person is asleep and rises when he/she wakes up. Some other causes include dehydration, some heart conditions, pregnancy, loss of blood, endocrine problems, infections, certain nutritional deficiencies, allergic reactions, and low salt intake. With age, the risk of low blood pressure normally increases. This is because the blood flow to the heart muscle and the brain declines with age, often due to a buildup of plaque in blood vessels.”

Some symptoms of hypotension include fainting in case of syncope, nausea, lack of concentration, fatigue, blurred vision, and dizziness or lightheadedness. In extreme cases, hypotension can also lead to rapid pulse rate, weakness, feeling of confusion, pale skin color, and rapid, shallow breathing.

Adding further, Dr Aggarwal, said, “Low blood pressure that either doesn't cause signs or symptoms or causes only mild symptoms rarely requires treatment. However, it is best to seek help in case of consistently low blood pressure readings. It also helps to keep a record of such signs and symptoms.”

The following preventive measures can be taken to manage chronic low blood pressure.

• Drink lots of fluids and avoid alcoholic beverages.
• Do not take over-the-counter medications.
• Indulge in regular physical activity to promote normal blood flow.
• Be careful when you get up from your sleep. For those who have consistent low blood pressure, it is imperative to be careful while standing up.
• To improve circulation, pump your feet and ankles a few times before standing up. Avoid heavy lifting.
• Increase your salt consumption in consultation with a doctor.
• Avoid prolonged exposure to hot water.
• To avoid problems with low blood pressure and lessen episodes of dizziness after meals, try eating smaller, more frequent meals.
• Cut back on carbohydrates and take some rest after eating. 

Eating disorders can lead to other complications later in life

Eating disorders can lead to other complications later in life

Parents should encourage a healthy and balanced eating pattern in kids

New Delhi, 23 November 2017: As per a recent study, eating disorders could lead to higher body weight, larger waist circumference and lower psychological wellbeing as well as a lower self-evaluation of general health in later life. Disordered eating is detrimental to the physical and mental health of young adults both in the short and long term. As per the IMA, it is imperative for parents must focus on a healthy balanced lifestyle for their children instead of on weight or dieting in order to prevent eating disorders.

Eating disorders are serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Eating disorders generally appear in the teen years or young adulthood. However, given the increasing peer pressure today, many younger children are also developing these conditions. Eating disorders affect both genders, although the incidence is higher in women than men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular. Eating disorders can also be contagious. Most youngsters try to copy the eating fads of one another. Some follow each other and attempt weight loss programmes even if they are not scientifically proven.”

Calorie-counting diets can deprive growing teenagers of the energy they need and lead to symptoms of anorexia nervosa, and other such disorders, which may even become life-threatening.

Adding further, Dr Aggarwal, said, “It is important that parents help their children develop a healthy body image by encouraging a balanced diet and exercise for fitness, not weight loss. One should also not tease teenagers about their weight. Such comments can also be detrimental to a teenager’s health and lead to the development of eating disorders in them. Dissatisfaction with one’s weight and body image is associated with lower levels of physical activity and vomiting, and use of laxatives and diuretics to control weight.”

Here are some tips that can prevent the development of eating disorders in young adults.

• Encourage healthy-eating habit This includes eating when hungry and a habit of eating together with the family.
• Encourage questions Let the children talk about and question what he or she has seen or heard, especially from websites or other sources.
• Promote a healthy body image Tell them about how healthy body shapes vary. Avoid making comments about another person based on his or her weight or body shape.
• Foster self-esteem Respect and support their accomplishments and goals. Look for positive qualities and assure them that your love and acceptance is unconditional.
• Educate them Tell them about the dangers of dieting and emotional eating. Educate them about the fact that eating or controlling diet is not a healthy way to cope with emotions. 

Varicose veins is a highly ignored condition

Varicose veins is a highly ignored condition • Timely treatment is imperative to avoid complications • It is better to avoid tight clothes and high heels New Delhi, 11 August 2017: According to a recent study, varicose veins are a growing concern in Indians with about 7% of India's youth suffering from this condition. Women are four times more likely to suffer from this condition than men. As per the IMA, some of the major reasons for varicose veins include a sedentary lifestyle and wearing tight clothes and high heels. Varicose veins are formed when the valves of the superficial veins of the lower limbs get damaged. As a result, blood flow from the lower limbs to the heart is decreased resulting in retention of blood in the veins. It is most commonly found in legs and feet, particularly calves. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The legs contain multiple valves that help the blood to flow in the direction of the heart. Varicose ulcer can be found in both legs. Blood starts accumulating in the legs, when these valves get damaged, resulting in swelling, pain, fatigue, skin discoloration, itching, and varicosities. This a slow but progressing condition. Although the symptoms are mild in the beginning, people usually delay in getting themselves tested, which can lead to complications that become difficult to treat. It is imperative to treat this condition on time failing which it can develop a non-healing ulcer on the leg.” Some factors that influence the onset of varicose veins are age, sex, genetics, obesity, and the position of legs for longer periods. Ageing can also result in wear and tear of the veins. Pregnancy, pre-menstruation, and menopause are some factors influencing varicose veins in women. Adding further, Dr Aggarwal, said, “There is a lack of awareness in many people about this condition. What is alarming is that this is an under treated disease. Lack of timely treatment can lead to chronic venous insufficiency, venous ulcers, eczema, cosmetic disfigurement, and systemic hypertension. Provided the patient has no symptoms or discomfort, treatment should be accorded on time. Some patients may also undergo treatment for cosmetic reasons.” Certain self-help tips can help in preventing varicose veins. • Get moving Stimulate blood circulation in your legs by taking regular walks. • Control your weight and diet It is important to lose that excess weight to avoid pressure on the legs. Follow a low-salt diet to prevent swelling caused from water retention. • Wear comfortable clothes and footwear Low-heeled help exercise the calf muscles more and are hence, better for the veins. Avoid wearing clothes that are tight around the waist, legs, or groin. • Elevate your legs Take short breaks between work to elevate your legs above the level of your heart. You can lie down with your legs resting on three or four pillows. • Don’t sit or stand for a long time Change your position frequently to encourage blood flow.

Complications are bound to happen, what is important is how you tackle them

Complications are bound to happen, what is important is how you tackle them Medicine is an art, based on science, yet it is not an exact science. And it is the skills that the doctor picks up first during his education and then as part of his training, which help him to safely and effectively practice medicine. Years of clinical practice then further his knowledge and add to the skills. No two patients are alike; every patient is different and clinical decisions are tailored to individual patients. Therefore, probability and uncertainty are part of the practice of medicine where complications are bound to occur. But what is of the utmost importance here is to anticipate potential complications and manage them quickly. When any complication is anticipated, one is prepared accordingly to handle it. It is this ability to anticipate, recognize and the quickness shown in managing any complication that marks a distinguishing characteristic of a “good” doctor and sets him/her apart from others. To acquire these clinical and procedural skills, a doctor undergoes years of rigorous study and training. Only then, do they acquire adequate knowledge, discernment and develop skills to take the right decision for the patient and adapt to changing practices. But, today quacks are flourishing in our society. They are obviously untrained and lack the ability to diagnose or treat patients, in particular any emergency or complication. They cannot render timely first aid. Although it is their routine practice to refer patients to hospitals or higher centers, but precious time is lost. They can hardly be expected to be aware of the concepts of the “Golden hour” or the “Platinum 10 minutes”. And, the outcome often is patient succumbing to his illness. Quacks also prescribe antibiotics, which are Schedule H1 drugs. Misuse of antibiotics by quacks fails the very objective of Schedule H1, which is to control the rampant use of antibiotics and anti-TB drugs to check the epidemic of antibiotic resistance. Schedule H1 drugs, along with Schedule H and Schedule X drugs, are restricted drugs and cannot be sold to just anybody OTC. A valid prescription from a doctor of modern system of medicine is required before they can be dispensed to the patients. The Govt. is promoting AYUSH doctors to practice modern medicine. Scheduled drugs should only be allowed to be written by MBBS or BDS doctors. The prescription of Schedule H, H1 and X drugs by non-MBBS, non-BDS doctors can cause large-scale harm. Interpretation of a situation or judgment in the body is governed by chemical reactions and is controlled by the balance of autonomic balance system, which in turn is governed by the interaction of parasympathetic and sympathetic nervous systems. Sympathetic mode releases stress hormones and may trigger panic or nervousness, the “flight or fight” response. This prevents a person from taking the correct and decisive decision and increases the chances of mistakes, which in the case of a doctor may be costly. It may mean life or death for this patient. A parasympathetic state of mind, on the other hand, is quiet and composed enabling rational and Right conscious–based decisions and just the right frame of mind to tackle complications. Doctors should practice medicine in a parasympathetic mode. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

Consent Revisited: Inability to manage complications leads to violence

Consent Revisited: Inability to manage complications leads to violence Consent, as we know, is the authorization or grant of permission by the patient for treatment or any diagnostic, surgical or therapeutic procedure to be carried out by the doctor. A doctor has to take consent from the patient before proceeding with his treatment. It is ethical and in today’s scenario, a legal requirement. Any act done without permission is “battery” or physical assault and is liable for punishment. A valid consent has three components: Disclosure, Capacity and Voluntariness i.e. provision of relevant information by the doctor, capacity of the patient to understand the information given and take a decision based on the adequate information without force or coercion. This is informed consent. Any permission given under any unfair or undue pressure makes the consent invalid. The Hon’ble Supreme Court of India has defined ‘adequate information’ in the landmark case of Samira Kohli vs Dr Prabha Manchanda. This includes “(a) nature and procedure of the treatment and its purpose, benefits and effect (b) alternatives if any available (c) an outline of the substantial risks and (d) adverse consequences of refusing treatment.” No doctor practices medicine without taking informed consent. Yet we read and hear of incidents of violence against doctors from all parts of the country. So, are we going wrong somewhere? Are we doing something wrong somewhere? “Medicine is an art based on science”, said Dr. William Osler. Complications, adverse events or untoward incidents may occur at any time during the treatment. What is important here, how competent, we are, as doctors, or how competent is the hospital or the clinical establishment, in managing these complications or untoward incidents in a non-emergent situation. Not being able to manage complications leads to violence. The patient should be informed of every possible complication that may occur during this treatment, however rare they might be; even a complication rate as low as 0.1% might be 100% for that particular patient. No surgery can be called as a ‘minor’ surgery. Mistakes are made, but we believe that nothing will happen either to us or the patient. As I wrote few days back, it’s the case of "Kya pharak padta hai" to "bahut pharak padta hai". If nothing goes wrong, then "chalta hai". But, if something does go wrong or an unanticipated event occurs, then this becomes unacceptable “chalta nahi hai”. The key word here is ‘anticipation’. Anticipate what all can happen in the course of a treatment and be prepared to handle them or keep your patient informed. For example, you may need to shift the patient in an emergency to a higher care center and your establishment does not have an ambulance. Outsourcing an ambulance will delay patient transportation, and in an emergency situation, the longer the delay, more agitated are the patients or family members and may become violent. Let’s take another example. You might need the services of a specialist, say a urologist, neurosurgeon, or a nephrologist. If your hospital does not have these specialty doctors on its staff, then subsequent delays in procuring their services will increase risk of violence. Should you have these services and other such facilities as standby? Yes, everything must be on standby. The standby fee is 25%, while presence fee is 100%. This may increase the cost of treatment. The time has come when the patient must know that safety comes at a price in bigger hospitals. Inform the patient and the family members beforehand, let the patient choose and accordingly the consent should be taken. Safety of the patient is very important and should be our primary objective. A small set-up may not have all facilities as their bigger and better equipped counterparts. These smaller set-ups should keep the patient and/or family members informed about this lack of facilities and take consent. Good communication can reduce the rapidly increasing problem of violent attacks on doctors and healthcare establishments. ‘Adequate information’ for consent should include not only the competency of the doctor to treat the case, but also include the competency of the doctor and/or the hospital to manage any emergencies or untoward incident in a non-emergent situation. Any breach in this duty is negligence. This, I believe, is an area which we need to work on. It is the inability to manage complications that leads to violence. As doctors we SERVE our patients and the community and provide • Service which we have professionally trained for, which is • Excellent i.e. anticipated • Responsible, give our 100% to the patients and take responsibility • Value – Group; each member of the group knows the duties of another, so no gap in service may result • Enthusiasm: A positive happy atmosphere This is how we can avoid incidents of assault and violent attacks on doctors from happening. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)