Category Archives: health

Diet For Gout Patients

What is gout?

Gout is a type of arthritis. It is caused by having too much of the chemical, uric acid, in your bloodstream.

Uric acid is the waste product created when the body breaks down purines (a type of
protein found in many foods and all of your cells).

Increased levels of uric acid in your blood may occur if, for example, your kidneys cannot efficiently remove it, you have a rare genetic abnormality, or because your diet and lifestyle increase the amount of uric acid that you produce.

If levels of uric acid are high for prolonged periods, needle-like crystals can start to form in your tissues, resulting in swollen, painful joints.
Your diet plays an important role in both causing gout and reducing the likelihood of suffering further painful attacks of gout.

If you already suffer from gout, eating a diet that is rich in purines can
result in a five-fold increase in gout attacks.

Are other illnesses associated with the development of gout?

Elevated uric acid is seen in many other conditions, and people who have gout may also have raised cholesterol, raised triglycerides (a type of fat in your blood), high blood pressure and poor glucose tolerance.
This may make it more likely that you have (or will develop) type 2 diabetes, metabolic syndrome and kidney disease.
In addition, approximately half of all gout sufferers are overweight.
Central obesity (carrying weight around your middle) also increases certain inflammatory substances in your blood. This can further exacerbate gout attacks, as well as putting you at risk of developing heart disease, diabetes and metabolic syndrome.

 Can losing weight help my gout?

Losing weight alone can reduce blood uric acid levels, and the number of acute attacks suffered.
Weight-loss will also help to reduce the stress on weight–bearing joints e.g. hips, knees, ankles and feet.
However, it is important to avoid any type of crash dieting, as going without food for
long periods and rapid loss of weight can increase uric acid levels and trigger painful gout attacks.
A combination of balanced healthy eating and regular physical activity is the best way to lose weight safely and maintain a healthy weight

Which foods should be avoided?

As uric acid is made in the body from the breakdown of purines that
come from your diet, it is advisable to reduce the amounts of foods
that you eat that are high purines.

High purine foods include: (avoid)

•Offal – liver and kidneys, heart and sweetbreads

•Oily fish -anchovies, herring, mackerel, sardines, sprats, whitebait

Seafood – especially mussels, crab, shrimps and other shellfish, fish roe, caviar

Moderate purine foods (eat in moderation)

•Meat- beef, lamb chicken, pork
•Poultry- chicken and duck
•Dried peas, beans and legumes- baked beans, kidney beans, soya beans and peas etc.
•Mushrooms
•Some vegetables- asparagus, cauliflower, spinach
•Wholegrains- bran, oatbran,wholemeal bread

Low purine foods

•Dairy- milk, cheese, yoghurt, butter
•Eggs
•Bread and cereals- (except wholegrain)
•Pasta and noodles
•Fruit and vegetables

 

How much protein do you need?

Generally you need about 1g of protein per kg of body weight (70kg man only requires 70g of protein daily), unless you on a protein restricted diet e.g., some people with kidney disease may need to restrict their intake.

Are there any foods that are good for gout?

Studies have shown that men whose diet is higher in vitamin C are less likely to develop gout.
Also, taking additional vitamin C as a dietary supplement (500 to 1500mg/day) can reduce blood uric acid levels.This is achieved by helping to remove uric acid from the
body via the kidneys.
If you’re considering supplementing your diet, always discuss this with your doctor as vitamin C can (rarely) interact with prescribed medications.
High doses of vitamin C can also cause loose stools in some people.

Eating healthily is key

Eating a balanced diet is important for everyone. A healthy diethelps to control weight and provides all the necessary nutrients needed for maintaining good health.
A variety of foods from the four main food groups should be eaten every day, this means:
•Plenty of fruit and vegetables
– it’s very important to achieve at least 5-a-day, as fruit and vegetables provide fibre, vitamins, minerals and phyto nutrients essential for good health
Plenty of bread, other cereals and potatoes
– try to eat some whole grains, and use the skin on potatoes to ensure you get the vitamins, mineral and fibre you need
Moderate amounts of meat, fish and alternatives
– avoid eating large portions – beware restaurants often serve 8oz of meat
for a main
Moderate amounts of dairy products
– the recommended amount is three portions of dairy products daily e.g. 200 ml glass of milk, a pot of yoghurt and a 30 mg (matchbox-sized) piece of hard cheese
Reduce or eliminate highly processed foods and drinks

Should I drink lots of water?

Yes, drinking fluids reduces the likelihood of crystals forming in the kidneys. As a general rule, drinking 8 large glasses of fluids a day (1.5 litres) is recommended. All drinks, except alcohol, count towards your fluid intake, including caffeine-containing drinks such as tea and coffee. Caffeine can act as a mild diuretic, which means it causes you
to pass urine more often.

Can I drink alcohol?

Drinking alcohol can increase your risk of developing gout and can bring on a sudden attack if you are already a gout sufferer. Alcohol can raise the level of uric acid in the blood in a number of ways and so trigger a gout attack. Many beers contain large quantities of purines from the fermenting process and alcohol stimulates the production of uric acid by the liver. More importantly, however, alcohol is converted in the body to lactic acid which interferes with the removal of uric acid from the body by the kidneys.

While it is certainly possible for people with gout to remain well without becoming teetotal, reduction in alcohol consumption is very important particularly if you are drinking more than the recommended healthy limit of 21 units per week for men or 14
units per week for women.(Recommended by UK society for Gout)
1 unit of alcohol is provided by:
•½ pint of standard strength (3-4% alcohol by volume) beer, lager or
cider
•125ml glass of wine (11%, 100ml glass of stronger wine)
•Single measure of spirits (25ml)
•Single measure of sherry or fortified wine (50ml)
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Filed under Disease, Gout, health, Patient Information, Uncategorized

Anesthesia Vs. Anaesthesia: Does It Really Matter?

Ashish Khanna, 1998 batch

Connections-May 2013 (Volume 10, Issue 2) 

The Oxford dictionary definition of Anaesthesia is “insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations”. The Merriam-Webster dictionary defines Anesthesia as “loss of sensation and usually of consciousness without loss of vital functions artificially produced by the administration of one or more agents that block the passage of pain impulses along nerve pathways to the brain” Synonymous: yes?

Anyone would agree that the difference between Anaesthesia (British English) versus Anesthesia  (American English) is above and beyond the addition of a single alphabet of the English language. I started my journey as an anesthesia resident in a country where Anaesthesia was the correctly spelt version of the branch of medicine that dealt with this specialty. Today, three years after re-training the art and re-learning Anaesthesia to be spelt as Anesthesia in the United States, it is time to look back and ponder on the finer points.
The decision to leave your own country after finishing a residency always comes with a pinch of salt. As you look to expand your clinical and academic training beyond the horizon, you are faced with the uncertainty of the unexpected. The challenge is a system of medicine distinctly different from your home country and a culture to healthcare that demands considerable understanding. A question that I am very often faced with when I make my frequent trips back home is “What is different about Anesthesia practice in the United States?” It might come as a surprise to a lot of people if I say “nothing at all” in reply. Well, what is different is not Anesthesia or Anaesthesia, only the fine print!! The other very frequent question that is thrown at me is the almost rhetorical “Is it better there?” Let me step back today and say let’s keep all this better – worse talk aside. It never was and it will never be fair to compare two vastly different systems of medicine. As I direct this piece of writing to those friends of mine who are faced with doubts and internal struggles before they leave the comfort of their own homes I would like to emphasize one singular fact: forget about quality of medicine or quality of life and remember the biggest challenge is the ability to train to re-train or put
in more simple words another residency program after a prior residency in your home country. Starting a residency program in Anesthesia under the Accreditation Council for Graduate Medical Education (ACGME) at the Cleveland Clinic Foundation, I realized early on that the essence of getting the most out of this education is to wipe my slate clean and restart again. Tell the world that you are trained in your specialty in your own country and you are capable of doing your thing does provide you with the much-needed independence of clinical work at times, but can be your worst
enemy if you want to acquire new knowledge. It is important to understand that there will be days where the attending will hold your hand when you are doing a procedure that you have done so many times before or might tell you that “this is the way it is done here”. Days, when you need to keep you’re your ego at home. Days when you will feel your neurons are struggling to cope with erasing old skills and acquiring new skills for the same procedures again. But, hey did you want to  do things the way you were doing them in your own country? That said, what is the reason you
made this trip across 4000+ miles half way across the planet? The answer to these questions will help you understand that unless you let your guard down in a foreign land and show that you are an open book you will never learn anything new and in essence never grow as a clinician. Medicine is repetitive science; it is very easy to be lulled into a false sense of satisfaction practicing the same
things over and over again, the same very way every day. The only way to appropriately imbibe your area of expertise and to mature as a clinician is to step out and see what else can be done differently and is being done differently. My message here is not to train in the United States after training in India, but to train at different places and in that process acquire a new set of skills all the time.
Going further, another area of distress for the physician from India as he or she steps onto alien soil is the cultural aspect of medicine. The interaction between peer groups as resident doctors and patient physicians as healthcare providers is different to say the least. As you move away from the “yes sir/ma’am” policy to “yes Dr. XYZ” even when that Dr. XYZ might be your department chair, you will quickly realize that you have to prove your worth as a resident by the sheer quality of your work and not the weight of your courtesy and multiple salutations directed to your staff. Decision making for the betterment of your patient is another area where the young resident here is thrown into the deep end every single day. An ICU attending will ask you for your plan, and so will your anesthesia attending in the operating room. And yes, your plan will be plan that will be executed as long as you can justify it. And that holds true for every provider from the lowest level of an intern to upwards.
Protecting patient privacy and respecting that the patient is the true owner of his or her healthcare information is another moot point here. Not to discuss patients with names or anything that could identify them, not to talk about them in the hospital corridors or the escalators is a habit that is difficult to get rid of. The tendency to try to force your decision as a clinician on the patient or the patient’s family is also something that we live by all the time in India. The patient is the master of his/her own destiny here and whether it be morbid obesity, chronic smoking in a vasculopath or narcotic abuse in a chronic pain patient, your job will be to ask them whether they feel they can change theirlifestyleand not to enforce that change on them. Difficult times will also revolve around “End-of-Life” decisions in the ICU and DNR (Do Not Resuscitate) statuses. The ability of families here to think very practically for their dying loved ones and to let go of them when there is point of futility, is commonplace. Another challenge that is
beyond the understanding of anesthesia and different from back home, and is something that you
have to deal with on a regular basis.
How can I forget to include in my set of challenges also, the change from using pharmaceuticals as brand names versus names of salts back home. Or the different abbreviations that come inherent with another healthcare system. Yes, I gave my senior resident a quizzical look when he said “Did you tube your patient” ( a.k.a intubation) or “Can you do the A-line first?” ( a.k.a arterial line) or “ Is he off the vent ?” (weaning from the ventilator) or “When is your ICU patient going to the sniff?” (a.k.a skilled nursing facility). There are numerous more such which define the distinct cultural differences in healthcare here in the United States.
As I look back today, I know that things have evolved for me as a clinician but also more importantly as a human being. I look at medicine differently; I look and understand a patient’s emotions differently. That to me is the pivotal change. For all those fellow friends who are getting ready to step out on this often-treaded path of training in another country after training as a specialist in India, I hope this writing will give a better idea of what to expect. All said and done, the
difference is not in quality of healthcare or the quality of life that you can expect to live, but in what you can assimilate from the new system of medicine.

In the end, it is not Anesthesia versus Anaesthesia, and it really does not matter!

Dr.Khanna

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Filed under Anesthesia, attitude, GMCH, health, humor, life, Residency, USMLE

The President’s Visit

VIP duties for the medical persons usually means moving around them amid their tight securityFor I have done quite a number of them in the past few years; the craze and excitment I used to feel initially seems to have been washed away.

But this month when I got a letter from the hospital  administration regarding my deputation for honorable president of India’s visit on 15 march,I was super excited .

First of all it is an honor to be a part of medical  team of India’s first man.

Secondly I always have had this cherished dream of seeing the president ‘s security arrangements as it involves huge number of cars and men .Most of traffic on the roads is stopped when his team passes and as a common man I had watched it from outside but always wondered how it must feel to move along those fast cars traveling at high speeds .I wondered as if they had brakes in those cars !!!

Thirdly I have seen our honorable president Mr.Mukherjee enough number of times on T.V. and wanted to see him in live.

On the day of his visit , we asked to to join the duty at 6:30 am in the morning and we went to receive his excellency at the airport.It was jam packed with who-who’s of the region .I remember seeing probably every high up right from the governor to defense chiefs of the region along with seasoned politicians and bureaucrats.The whole atmosphere was filled with thrill of his arrival and on corner of the road you could see high security.

On his arrival he was given a customary march past along with dignitaries greetings .He had come with his wife and staff and then we went to the air force station.The Air force people had put up a splendid show but the best part was paratroopers jumping from the planes in Indian Flags colored parachutes and reaching the ground on a designated spot.It was really amazing and drew a lot applaud from the audience.

And  then we went along with Mr.President  to the governor house.All the roads on the way were empty due to high security and our caravan of nearly 100 cars zoomed past the city roads with police men all around the city .

I was wondering if Mr.President had even known the meaning of the word traffic jam !!!

After the lunch we went to PGI where convocation function was presided by his excellency.And there he was joined by the chief ministers of Punjab and Haryana.

Afterwards we went back to the airport along with the caravan which this  time around had about 150 cars.At the airport I got an opportunity to see all these high profile dignitaries form a very close distance .Actually I wanted to get photographed but the protocol did not allow that.But high point was watching the first citizen of the country amid his security and high profile dignitaries .

The driver of our ambulance had rightly remarked on the way:

           “Dr .Saab eh ta raje ne raje ,te asi ennadi praja,

        raje di shaan ta vakhri hi hundi hai

mai pichle janam rath chalanda si te es janam car”

Meaning : Doctor  they(President) are the modern day  kings and we are his people .

                   Kings magnificence is above all .

                    I was a chariot driver in last birth and a car driver in this birth !!!!!

president visit

Mr .President

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Medico Legal opinions……

Opinions

Opinions in medico legal cases are like time as per wrist watches.

Everyone’s watch shows different time from other.

But all think that time ,as per their watch ,is accurate.

Source:Department of Forensic Medicine, GMCH,Chandigarh

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Incredible India……

Over the past few months since  i have joined the Community medicine there have been a few incidents which have made me think as to how the  life varies from person to person

Even the basic perspective ,the way of thinking,mental make up all change in the circumstances one lives.

How a small gesture of yours can make someone real happy and how more than half of our population lives  in Rural India. There happens to be considerable difference in views of urban and rural population and gap seems widening with rising population ,growing inflation,and due to lack of basic health facilities.

There have been instances where I have felt how some one could be so ignorant at times or how basic health services have still a lot to cover to reach the common man.

Well one of the instances which really surprised me was a woman of less than 35 years with her grandson in Opd !!!!!!!

While taking history of patient i just noticed she called him(the patient) her grandson and likewise i was amazed.

I asked her to confirm as if he was her real grandson and her age

and she told me the story about her life as how she was married at early age of 14 and her first son at born at 16 and he was married at 15.

As i was just coming to terms with her story she further pointed how the kids mother had left their family and went to Nepal (her native place)never to return again

and kids father spent whole day playing cricket;and being the eldest in family she has just responsibility of bringing up the kid.

Well comparing this perspective with the one with the people in  professional  background where most people tie knot in late twenties or early thirties, and  spend quite a time in finding suitable match is really amazing

How much education is needed at the grass root level is really noticeable,considering the fact that above story was of person living in Chandigarh ,which boasts of  good primary education and good health services in the government sector

and condition in really backward states is not hard to imagine………

Mughal Emperor Bahadur Shah has summed up life quite well:

Umr-E-Daraaz Mang Kar Laye The Chaar Din
Do Aarzoo Mein Kat Gaye Do Intezaar Mein

Keh Do In Hasraton Se Kahin Aur Ja Basein
Itni Jageh Kahan Hai Dil-E-Daagdar Mein

{For passing life, we brought four days, but two of them passed in desire and two in the waiting (for the fulfillment of the desire)}

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Polythene banned in Chandigarh ?

bag

NECESSITY IS THE MOTHER OF ALL INVENTIONS

Source : photo taken in sector 26 grain market few days back

This years Gandhi jayanti brought a new gift to Chandigarh

With administration poised to clean the environment and retain the beauty of Chandigarh a ban has been put on polythene use in the city

usage invites a fine upto one lac and imprisonment of one year and imprisonment of one year!!!!!!!!  

If u have lived in the city for many years you would have realized it is losing its glory all the time

it has become overpopulated and this has affected its environment great deal

Well this a welcome step from administration in a way it plans to clean the environment,

nature lovers are exited at thought of this

What I wonder or fail to understand is while the rules are being framed who happens to be focus of government

On one hand we have a large battalion of green demanding environmentalists whose rich lobby would not mind buying expensive paper bags

and on other we have kids like these who work as laborers and don’t have money to buy even a glass for water

While we as a developing nation lack the right infrastructure we tend to get carried away by the European standards

we should work by Indian standards and try to make them at par with European rather than blindly following west

we need to understand that basic needs of person are above any other needs of society

Well many laws have been passed in India in past tending to protect environment but to me most ended as failures because lack of mass participation

and this will come only when we divert funds to education ,health ,and related sectors

and  people will feel why they are important rather than government imposing  on them

also we need to provide ample alternatives to it….……..

But with polythene gone I would really miss those heavy rainy days when I would get caught in drizzle and put my books in polybag borrowed from any shop on way and could enjoy rains without being worried about books

Well I absolutely adore rain bath but from now on will have to be more careful I guess………

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Toilet Dairies……

Reserved????

Reserved????

There always used to be a demarcation between staff and non staff toilets but this has now extended to a further level!!!!!

As shown in pic concerned dept has put up a placard at toilets entrance where toilets has been exclusively marked for its staff

Well the gesture may be benevolent to its staff it still doesn’t seem to strike a chord with others

Considering that a security device (lock) has been placed at the entrance and if u want to have admission to it u need to take the keys from thestaffassociate

So too much for a obligation for ANSWERING NATURE ‘S CALL but believe me this wont be big when u really want to do it and cant consider anywhere else in hospital

Now is this a effect of reservation policy of Central Government????

Where by everything seems to becoming reserved these days

So what if they put up banners saying reserved for particular class and division thereof ????

What if MANDAL COMMISION report is applied to all such places ????

I just pray it doesnot happen

And how will then the inside of these rooms meant for answering nature’s call divided is unimaginable

Well u never know ANYTHING and EVERYTHING can happen in INDIA

 Just requires some worthy politician to take a note of it

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Filed under ART, health, imagination, reserved, WORK