Hypertension: The Silent Killer

Systemic hypertension, more often known as High Blood Pressure or simply BP, is one of the commonest diseases related to life style. According to a 2014 research report that was published in the Journal of Hypertension, an alarming 29.8% of the entire Indian population is suffering from hypertension In other words, one in three Indians is a victim of this disease.

It is called the 'Silent Killer', because it gives no warning and many people do not know they have hypertension. Over time they become exposed to serious risks of heart disease, stroke and kidney failure. Increasing stress levels, obesity, sedentary life style, smoking and changing dietary habits are all responsible for this illness.

What is blood pressure?

When your heart pumps blood, the force of oxygenated blood pushes against the walls of the thick muscular tubes called arteries. Blood flows with this force through these tubes to various parts of your body. This force of blood is called blood pressure. When it happens to be too high, it becomes an illness known as high blood pressure. With the help of the BP equipment, your doctor actually reads two aspects of your blood pressure:

1. Systolic Pressure: Pressure of blood when your heart beats while pumping blood.

2. Diastolic Pressure: Pressure of blood when your heart is at rest between beats.

A blood pressure less than 120/80 mmHg (read out as 120 over 80 millimetres of mercury) for an adult is considered normal. The first number 120 indicates systolic pressure, and the second number 80 indicates diastolic pressure. You are called 'Pre hypertensive', if your systolic blood pressure is between 120-139 and diastolic pressure between 80-89. Blood pressure reading greater than 140/90 indicates hypertension.

Essential hypertension

There are no underlying identifiable causes for this illness in about 85-90% of the reported cases: this type of hypertension is called 'Essential hypertension'; but it has been linked to risk factors such as increased salt sensitivity,family history, age and race.

Secondary Hypertension

The remaining 10-15% of the patients with hypertension have identifiable underlying reasons for their increased blood pressure; examples include kidney diseases and a few endocrine diseases related to thyroid, adrenals, and narrowing of the main vessel in the arterial network (coarctation). This type of hypertension is called 'Secondary Hypertension'.

How to identify secondary hypertension?

Indications of secondary hypertension include sudden onset of hypertension before 25 or after 55 years of age, hypertension that is difficult to control, hypertension that needs multiple antihypertensive drugs, hypertension associated with swelling of the legs, or protein leakage in the urine, low hemoglobin and kidney failure. But every hypertensive patient should not be suspected to be a case of secondary hypertension.

What to do when your blood pressure is high?

The first step is to exclude secondary hypertension. The basic steps to follow would be early CHANGES IN LIFE STYLE: this includes 30 minutes of brisk walking or any moderate exercise, reduction of dietary salt by 50 % and reduction of 5 kg of body weight. By following these steps, mild increase in blood pressure can be controlled, without the need for medications.

If pressure remains high in spite of these measures or if the initial blood pressure itself is high, then you need medications.

What are the measures to be taken if your blood pressure is high?

Continue life style modification. Take blood pressure medications regularly. Monitor your blood pressure regularly. Monitor annually the well-being of the heart, kidneys and brain.

Why should you control blood pressure?

Uncontrolled blood pressure can lead to acute and long term complications. The commonest acute complication is heart failure, when the pressures are too high. Long term uncontrolled blood pressure leads on to increased risks of heart attack, heart failure, and stroke and kidney failure.

The good news is that well-controlled blood pressure decreases the risks of these life-threatening complications.

What else should you do to ensure good blood pressure control?

Home blood pressure monitoring: Like blood sugar monitoring, this is ideal to track the level of your blood pressure control.

24-hour blood pressure monitoring: Also known as Ambulatory Blood Pressure Monitoring, this will make available your blood pressure pattern over a 24-hour day-night period. It is useful in identifying the following two most important variables, which are necessary to study the quality of your sleep and general health in relation to your hypertension and risks of diseases:

1. 'Blood pressure dipping pattern': Normally your blood pressure is expected to fall by 10 to 20% when you sleep; if it happens so, you are called a dipper, and the pattern of fall, BP dipping pattern. In about one-fifth of the population, blood pressure may not dip and such patients are non-dippers. In certain other patients there may even be an alarming increase: those patients are reverse dippers. They run an increased risk of heart attack and stroke.

2. 'Early morning surge in blood pressure': A few patients who have night-time dipping of blood pressure may register an abrupt increase in the early morning. Win over the silent killer, and live a long, peaceful, healthy and happy life.

Article by Dr. R Balasubramaniam, Senior Consultant Nephrologist, Kauvery Hospital

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Hip Replacement [Part – 1]

Hip replacement surgery is a common procedure to treat severe cases of osteoarthritis and injuries (fractures) that affect the hip joint, resulting in pain and reduced mobility. The procedure involves removing the affected hip joint and replacing it with one made of metal, plastic or ceramic components. The surgery is usually performed when other treatment options have proven to be ineffective and once completed the patient can usually look forward to the disappearance of the pain and the regaining of mobility with the new joint.

The Procedure

There are two ways of performing the surgery – the traditional one where the incision on the side of the hip is 8 to 10 inches long and what is called the minimally invasive technique where the incision is usually 2 to 5 inches long. The minimally invasive technique is thought by many surgeons to reduce blood loss during surgery, reduce post-operative pain, shorten the hospital stay and minimize the scarring. The decision on what type of procedure to use will depend on patient related specifics.

In general the process is the same in both cases. 

• The patient is given either general or spinal anesthesia to put him or her to sleep and prevent any sensation of pain during the surgery.
• An incision is made along the side of the hip though which the muscles connected at the top of the thigh bone are moved aside to provide access to the hip joint.
• The ball section of the joint is then removed by cutting the bone with a special surgical saw.
• The artificial joint is then put into place and attached to the thighbone using either special cement of some other material that will allow the new material to attach to the bone.
• The surface of the hip bone is then cleaned of any damaged cartilage and the replacement socket is attached.
• The ball is then inserted into the socket.
• A temporary drain may be put in place to drain any fluid that collects over the next few days.
• The muscles are then reattached and the incision closed.

The Recovery

A typical recovery will be as follows:

• The post-operative hospital stay is normally between 5 to 7 days.
• While in bed a cushion or other object is usually taped between the legs to ensure the new joint remains in place.
• A drainage tube will be placed in the bladder to allow for urination.
• A drip of glucose and / or any other substances or medications or pain relievers the doctor advises will be put in place.
• Physical therapy will normally begin the day after the surgery.
• Walking with the use of a walker or crutches may begin after 2 or 3 days.
• Physical therapy and exercise will continue for some months after the surgery until the muscles return to normal and the hip movement is free and without pain.

On Returning Home

The amount of rest and relaxation at home will depend on the health of the individual. It is important to not over do things and follow the doctor’s instructions. In general:

• Avoid climbing stairs until approved by the doctor.
• Sit in a chair with an upright back. Avoid the use of recliners.
• Remove all carpets and rugs from the floor to reduce the chances of tripping while walking.
• Avoid excessive bending that will place stress on the new joint. Use an elevated toilet seat to prevent bending the hip too much.
• Be careful in the presence of small children and pets who may jump on you and cause a fall.
• Get adequate rest and nutrition.

The next stage of the recovery process will be covered in the second part of this blog.

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The Ignored Ache

No textbook of Psychiatry could have taught me better to decode and to comprehend the sufferings of the unrest mind as patients do.

This patient walked me through the agonies of his mind which was fast sinking through unfathomable depths and a mind which kept trying hard with utmost rationality to decipher the reasons behind the struggle. I have never understood Depression better.

"I am no longer what I am doctor..." and thus he started his narration and his ordeal with his mind. It started with nagging headaches and near constant aches that refused to wash away with cups of caffeine or pain killers. Gradually unending episodes of fatigue & exhaustion started sapping me up and I realised that it was not just physical any more. My mind refused to lighten up. The smiles of my children were no longer contagious, music and television appealed to me no more. I stopped reading and talking to my friends..the world no longer mattered to me..The most minuscule acts of daily life like showering or dressing seemed totally overwhelming. I remember the dreadful long hours I looked at the comb with an absolutely shocking lack of will and drive to groom myself. Darkness loomed large and my mind kept rapidly filling up with irritatingly repetitive thoughts of doom, dread and catastrophe. I wished to sleep it all off but I realised that darkness was even more agonising. Sleeplessness haunted me..My wishes to end it all kept growing by the day. I feared the day when my death instincts would overpower my reasons to live. Panic and uncertainty kept ripping through me..I kept cuddling up near my child just like an infant wanting to be nursed. I wanted to be embraced, wanted something or someone to get rid of my soul shattering pain. I failed to find a reason try as I might. I am no longer a father, a husband, a boss ..I am no longer what I am doctor"

The sufferings of a depressed mind cannot be explained better. Depression is a medical disorder. It is one of the biggest public health challenges because of its high incidence. Research globally as well as in India suggests that at least one in 5 women and one in 10 men suffer from major depressive disorder at sometime in their lifetime. Medical science has given neurobiological underpinnings to the disorder. Genes, faulty neural circuits, abnormal levels of chemical messengers in the brain can all be important causal variables. Psychosocial factors like recent losses, relationship failures, and stressful environment intertwine with biological vulnerability leading to this illness. It is time to clear common misperceptions of the illness.

1. It is important to understand that Depression need not have a psycho social cause all the time. In several cases it occurs out of the blue. It is then called an endogenous or melancholic depression which endorses the biological nature of the problem.

2. Having a Depressive Disorder does not equate with 'weakness of mind'. In fact the strongest willed are sometimes more susceptible to it.

3. Depressive Disorder can be treated. Pharmacotherapy, psychotherapy or a combination of both works. What works for whom is decided by the mental health professional on the basis of the severity of the illness, symptom profile and cause.

4. Anti depressants work by helping regulate the disordered brain chemistry and are not sedatives as widely believed.

5. The usual course of treatment is between 6-9 months and not life long as widely misconceived. Being in good health includes being in good mental health.

Let's fight and help fight those with the ache in the psyche. Let's fight depression! Only then you can be truly who you are!

Article by Dr. Yamini Kannappan, Psychiatrist, Kauvery Hospital

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Flooding and Communicable Diseases

Chennai, Kancheepuram and Tiruvallur Districts of Tamil Nadu experienced unprecedented amounts of rain, followed by devastating floods in the first week of December, 2015. The immediate need of the hour in these areas is to take precautionary measures to prevent post-flood epidemic outbreak of communicable diseases. Against the backdrop of typical tropical climate, these three districts are at an increased risk of the outbreak of the following communicable diseases.

•     Waterborne diseases such as Typhoid, Leptospirosis, Hepatitis A and Cholera
•     Diseases such as Dengue Fever, Malaria, Yellow fever and Hemorrhagic Fever  
      spread mainly by mosquitoes

When there is a significant displacement of population and when post-flood water sources become contaminated, the potential of an epidemic of such diseases is rather high. Of the diseases named, Cholera is one dreaded disease to be doubly guarded against.

Causes, Symptoms and Treatment of Cholera

The bacteria Vibrio Cholerae that cause this dangerous disease can contaminate easily the following common sources of food and drink.

•     Food and drinks sold by street vendors
•     Ice made from municipal corporation water
•     Municipal water supplies
•     Raw or undercooked fish/seafood caught in polluter waters, especially if contaminated by sewage

When food prepared with contaminated water is eaten, or contaminated water is drunk, the bacteria release a toxin that produces severe diarrhea.

Symptoms

The symptoms of cholera can be noticed as soon as a few hours, or in about 5 days after the infection has occurred. Symptoms are often mild, but sometimes they can be very serious too. One in 20 may have severe watery diarrhea together with vomiting.

Diarrhea accompanied by vomiting can lead to dehydration. Even people only mildly affected are potential carriers of the infection; if they are not identified and treated immediately, the illness can spread quickly from them, causing an epidemic.

Dehydration will lead to:

•     Low blood pressure
•     Rapid heart beat
•     Loss of skin elasticity
•     Increased thirst
•     Dry mucous membrane in the nose, as well as the mouth, eyelids and throat
•     Muscle cramps

When dehydration is left untreated, it can lead to shock and consequently certain death, in a matter of hours.

Treatment

Though a vaccine is available to prevent cholera, its effects last only a few months and it may not save one in two who receive it; taking other precautionary measures, therefore, for prevention of the infection is a much better solution.

The mainstay of treatment for cholera is to stay hydrated. Depending on the severity of the diarrhea, the treatment will comprise oral medications or intravenous solutions, to compensate the loss of fluids from the body. In mild cases, antibiotics may be prescribed but not as part of emergency care treatment.

Protective Measures

Ensure that you use only boiled, chemically treated, disinfected or bottled water for the following purposes:

•     Drinking
•     Preparation of food or beverages
•     Washing vegetables, fruits and other edible products that require to be washed
•     Making ice
•     Washing hands and face
•     Brushing teeth
•     Washing utensils and dishes used to prepare food or to serve

To ensure that you have clean water, boil water for a minute, filter, and add a commercial chemical to disinfect.

Furthermore, avoid eating raw foods, including:

•     Raw and under-cooked meat or seafood
•     Unpeeled fruits and vegetables
•     Fish caught in waters which could be contaminated
•     Unpasteurized milk or milk products

In the event of developing watery and severe diarrhea self or any other, please notify and seek immediate medical help. Cholera is treatable if reported promptly, but the ensuing dehydration can cause serious complications, and therefore it is important to seek treatment immediately.

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