Whew! Thats one question anyone would like to know!
'Heart attack' as most people perceive it ranges from various degrees of chest pain, accompanied or unaccompanied by sweating, nausea, a 'fear of death' which could put a person in immediate peril.
Like all horrible things, 'heart attack' also usually comes with fore-warning (diabetics may not have this advantage as their nerves may not recognize the pain). The fore-warning is in the form of 'chest pain' which initially comes on and off, is provoked by physical exertion usually after meals or in cold and also by anger or other excitement. This will usually settle with rest. The pain may not always be in the left side of the chest contrary to popular belief. It can be below the sternal bone (so it is often mistaken for the common gastritis), can radiate to the left arm or even the left lower jaw! It is frequently a crushing kind of pain. Some deviant varieties can present with pain on lying down, pain in the night (caused by vivid dreams in sleep), pain that occurs without provocation (even at rest) and a special type that can occur in women with positive stress test but no findings in an angiogram.
If the pain is not investigated and treated, the effects can be disastrous as we all know. The pain may progress and not be relieved even at rest or may suddenly throw up an excruciating painful episode with sweating, nausea or vomiting and a terrifying fear.
This indicates the 'warning pain' or 'angina' has progressed to a full-blown heart attack! A heart attack needs immediate treatment. The sooner the patient is in a hospital, the better.
We must remember that diabetics often do not have the luxury of a fore-warning pain like this. They tend to not feel the pain, as their nerves have become insensitive; so they are in danger of 'Silent MI' which can be fatal.
If someone gets angina, what do you do next?
Rest. Once the heart slows down with rest, there is more time for the coronary arteries to fill with precious oxygenated blood to deliver to the oxygen-deprived heart muscle. Besides, as the heart slows, its work becomes lesser, making it's need for oxygen also lesser. So it can survive on lower levels for some time.
Get to a doctor as soon as you can and find the cause of the pain, the extent of the disease and the options for treatment.
These are done as simple OP procedures in the form of a physical check up by a doctor (including recording your blood pressure, pulse rate and rhythm, looking for swelling in your feet, etc), complete blood profile for cholesterol, blood sugars, haemogram, an ECG, an ECHO cardiogram, followed by a Treadmill stress test (remember to do the stress test only after confirming your heart can stand it by earlier ECG and ECHO). If these show an indication for angiography, then an angiography is done.
During an angiography, if blocks are found, some are relieved by inserting stents during the angiography itself (this depends on the number of blocks, the extent of block and the site of the block). Others may require surgery.
There are many options now available, so we can be of good cheer! People are even trying stem cell implants to revive portions of the heart that have got 'infarcted' or sort-of 'died' in an earlier heart-attack, in heart-attack survivors!
Prevention though, is always the best though not all factors that cause a heart attack are preventable. We can try to modify what we can to decrease the risk we face:
1. If you are a smoker, QUIT SMOKING! That's like tying a noose around a suffocating man's head! Medicines can't help you beyond an extent if you don't! Besides, after you do stop, it takes 12 to 23 months for the risk level to begin to fall and a much longer time for the risk to fall to baseline levels of non-smokers!
2. Eat sensibly. Don't overdose on fatty stuff especially those fried food and fast food. Happily go overboard on salads and fish (Salmon, Sardines, Mackeral, Albacore tuna, Herring, Sword fish and Lake trout are recomended with an intake of at least two portions per week totalling of 120gms).
3. Try to get some exercise (other than walking around the house).
4. Get yearly health check especially if you have a family member who has had a similar problem (even if you are only 35 or even if you are a woman).
5. Cholesterol gets deposited in the arteries as yearly as 2 years on! So keep the kids also off unhealthy diet (once in a while a stop at the pizza joint or burger stall should be ok!).
If you have any questions, feel free to ask! We have a cardiac team on our panel!
Wednesday, January 16, 2008
Stem Cells
Today's headlines carry the exciting news how 'a dead heart beats again'! Amazing, yes. Researchers from the University of Minnesota namely Prof. Doris Taylor and her team, acheived the feat by a unique method: The stripped the heart of a dead rat of all cells, leaving the extra-cellular matrix and hence the 'backbone' of the structure alone intact. They repopulated this 'skeleton' with immature cells. Four days later contractions were observed. Eight days later, the world's first 'bio-artificial' heart was pumping, though at an efficiency of 2% compared to the adult heart!
Stem cells are certainly the way to fairy-lore in medicine. The problem yet to be overcome appears to me to be how to make these cells learn to fuction physiologically like the cells they successfully anatomically replicate. Stem cells become myocardiac cells, but they need to learn to function like the myocardium. Let us hope this break-through comes up sooner than later, for the benefit of the thousands who need them!
In the meanwhile, if anyone has news on any more/other break-throughs in on-going stem cell research in India or elsewhere to treat cardiac failure, peripheral vascular disease, paraplegia, chronic renal failure, cirrhosis or diabetes mellitus, do share your information in the 'comments' section.
Hopefully, this site can serve to link patients and physicians in such crucial areas on the cutting edge of medicine.
Stem cells are certainly the way to fairy-lore in medicine. The problem yet to be overcome appears to me to be how to make these cells learn to fuction physiologically like the cells they successfully anatomically replicate. Stem cells become myocardiac cells, but they need to learn to function like the myocardium. Let us hope this break-through comes up sooner than later, for the benefit of the thousands who need them!
In the meanwhile, if anyone has news on any more/other break-throughs in on-going stem cell research in India or elsewhere to treat cardiac failure, peripheral vascular disease, paraplegia, chronic renal failure, cirrhosis or diabetes mellitus, do share your information in the 'comments' section.
Hopefully, this site can serve to link patients and physicians in such crucial areas on the cutting edge of medicine.
To be or not to be: Medical/Surgical Termination of Pregnancy
Medical / Surgical Termination of Pregnancy might well be one of the most and hotly debated questions in history. Personally I think this should be classified in two categories: the unmarried young woman and the married mother.
The unmarried young woman presents the more heart-wrenching subject. I respect life. I did not and cannot create life and so I do not have authority to destroy it. I believe life is created the time the sperm and ova unite and form the unicellular zygote. This single cell comes with the blue print of life for the future individual. This one cell holds the key of life, or better still, is life.
Yet when a young woman walks into your OP pregnant, says she cannot be married for some reason, what do you do? If you don't do it, she is going to get it done anyway. She may go to a qualified practitioner (hopefully) of she may end up on a quack's table which may turn out catastrophic for the life of the young girl.
One bright morning, a girl of about 14 walked into my OP accompanied by a middle-aged man who introduced himself as her 'uncle'. She complained of 'abdominal pain'. On examining, she was obviously with child, the fundus about 20 to 24 weeks. I could hear the fetal heart. The child refused to open her mouth except to say she had 'abdodminal pain', refused to even accept there was a baby within her! The 'uncle' was in top hurry to get rid of the unwanted baggage. Much as I wept within for this little girl who was in no way prepared to be a mother, I could not bring myself to do an MTP. So finally I sent them away.
I know my hand would simply not have been able to insert that tablet of misoprost into her vagina. Even if she had come in the first trimester, I know I couldn't have done it, but I just cannot forget the girl or the blank look on her face. I do not know what became of her...
There were numerous married ladies who came in seeking MTP since either their career was peaking or they just could not afford one more, etc, etc. These I strived to convince. I drew pictures, showed posters and carefully preserved abortus specimen from naturally terminated pregnancies. Happily, a good many of them carried to term and went in for a good method of contraceptive after the delivery.
According to the NEJM: 30 March 2000 Volume 342:946-956, 'an estimated 26 million pregnancies are terminated legally each year throughout the world, and 20 million are terminated illegally, with more than 78,000 deaths.'
I hope that raw 14 year old was not one of them. I know I can still not go ahead with an MTP except if its medically indicated. I don't know which is the harder burden to carry in my soul: the life of the young mother or that of her unborn child.
The unmarried young woman presents the more heart-wrenching subject. I respect life. I did not and cannot create life and so I do not have authority to destroy it. I believe life is created the time the sperm and ova unite and form the unicellular zygote. This single cell comes with the blue print of life for the future individual. This one cell holds the key of life, or better still, is life.
Yet when a young woman walks into your OP pregnant, says she cannot be married for some reason, what do you do? If you don't do it, she is going to get it done anyway. She may go to a qualified practitioner (hopefully) of she may end up on a quack's table which may turn out catastrophic for the life of the young girl.
One bright morning, a girl of about 14 walked into my OP accompanied by a middle-aged man who introduced himself as her 'uncle'. She complained of 'abdominal pain'. On examining, she was obviously with child, the fundus about 20 to 24 weeks. I could hear the fetal heart. The child refused to open her mouth except to say she had 'abdodminal pain', refused to even accept there was a baby within her! The 'uncle' was in top hurry to get rid of the unwanted baggage. Much as I wept within for this little girl who was in no way prepared to be a mother, I could not bring myself to do an MTP. So finally I sent them away.
I know my hand would simply not have been able to insert that tablet of misoprost into her vagina. Even if she had come in the first trimester, I know I couldn't have done it, but I just cannot forget the girl or the blank look on her face. I do not know what became of her...
There were numerous married ladies who came in seeking MTP since either their career was peaking or they just could not afford one more, etc, etc. These I strived to convince. I drew pictures, showed posters and carefully preserved abortus specimen from naturally terminated pregnancies. Happily, a good many of them carried to term and went in for a good method of contraceptive after the delivery.
According to the NEJM: 30 March 2000 Volume 342:946-956, 'an estimated 26 million pregnancies are terminated legally each year throughout the world, and 20 million are terminated illegally, with more than 78,000 deaths.'
I hope that raw 14 year old was not one of them. I know I can still not go ahead with an MTP except if its medically indicated. I don't know which is the harder burden to carry in my soul: the life of the young mother or that of her unborn child.
Doctors' Diary
Rural life and rural people have their own innocent charm. Years ago, while working in a mission hospital in Mussorie, there was a young couple who walked into OP one morning. She was into her 5th month and came with pains. This was her 3rd or 4th pregnancy; all earlier ones had terminated with onset of pains about this time. Examination showed an incompetent cervix. We put a McDonald's stitch, admitted her and put her on bed rest till the pains could subside.
After couple of weeks, the pains had come down and the couple wanted to return; they had to care for their fields. We were aghast; returning meant a bumpy ride on a rickety jeep for hours through steep roads. Even if she did reach home safely, she was going to continue hard manual labor in all likelihood. If she did get pains, there was no other hospital nearby to go to for help. We were the closest and of course, all this distance away. Yet they insisted and we had to let her go. We explained all the risks of early pains with a McDonald's stitch and pleaded for her to come back when she started on her 8th month at the latest.
There wasn't a day in that time when my mind wouldn't have strayed to her, imagining her walking her fields, carrying bundles on her head, all with a McDonald's stitch!
Finally one morning, both husband and wife re-appeared in the hospital's portals. She was starting on her 8th month, was getting along fine and had come in for re-admission! We were overjoyed and greatly relieved! After a few weeks of bed rest, the McDonald's stitch was out and she progressed into labor and delivered a beautiful boy baby normally!
As I walked back home late that evening after conducting her delivery, with the dark sky and chill winds for company, I heard the sound of footfall behind. I hurried, not knowing who was out on a cold and lonely night like this (unless they had to deliver or conduct a delivery!). The footfall also increased pace with me. When I was almost at my door, I heard a voice call, "Doctorji, doctorji!"
I stopped and turned around. It was the young woman's husband, holding out a box of sweets!
"Doctorji, thank you! We are so happy! Please accept this!"
"Oh! I am so happy for you too! But I think you should give the sweets in the office, they will give all the staff. We don't take from patients..."
The young man refused to give up. "Doctorji, I have already given the staff. They told me this is what you would say, that is why I came here to give you. Please take this... Its from our family to yours."
He refused to budge. I could not bring myself to be blatantly rude and still say no. Reluctantly, I took the box of sweets going against years of die-hard training in our good old alma matter!
By the time I left Mussoorie, a few more corn cobs and garlic cloves were added to my list! To this day I savor the memories and the wonderful people, my patients, who made them for me...
After couple of weeks, the pains had come down and the couple wanted to return; they had to care for their fields. We were aghast; returning meant a bumpy ride on a rickety jeep for hours through steep roads. Even if she did reach home safely, she was going to continue hard manual labor in all likelihood. If she did get pains, there was no other hospital nearby to go to for help. We were the closest and of course, all this distance away. Yet they insisted and we had to let her go. We explained all the risks of early pains with a McDonald's stitch and pleaded for her to come back when she started on her 8th month at the latest.
There wasn't a day in that time when my mind wouldn't have strayed to her, imagining her walking her fields, carrying bundles on her head, all with a McDonald's stitch!
Finally one morning, both husband and wife re-appeared in the hospital's portals. She was starting on her 8th month, was getting along fine and had come in for re-admission! We were overjoyed and greatly relieved! After a few weeks of bed rest, the McDonald's stitch was out and she progressed into labor and delivered a beautiful boy baby normally!
As I walked back home late that evening after conducting her delivery, with the dark sky and chill winds for company, I heard the sound of footfall behind. I hurried, not knowing who was out on a cold and lonely night like this (unless they had to deliver or conduct a delivery!). The footfall also increased pace with me. When I was almost at my door, I heard a voice call, "Doctorji, doctorji!"
I stopped and turned around. It was the young woman's husband, holding out a box of sweets!
"Doctorji, thank you! We are so happy! Please accept this!"
"Oh! I am so happy for you too! But I think you should give the sweets in the office, they will give all the staff. We don't take from patients..."
The young man refused to give up. "Doctorji, I have already given the staff. They told me this is what you would say, that is why I came here to give you. Please take this... Its from our family to yours."
He refused to budge. I could not bring myself to be blatantly rude and still say no. Reluctantly, I took the box of sweets going against years of die-hard training in our good old alma matter!
By the time I left Mussoorie, a few more corn cobs and garlic cloves were added to my list! To this day I savor the memories and the wonderful people, my patients, who made them for me...
Home
I sit at home as I write this. What is home? Your nest, the place you come back to every night, the place you refresh and start your day from every morning... Isn't it always nice when you come home to a welcome? To warm hearts waiting for you? Of course!
That brings us to the whole topic of latchkey kids. Would it be better for a child to come home to the warm embrace of a loving parent or to take out a key from the pocket, open a cold house, switch on the lights, throw the bags down, pick a snack from the fridge, flick on the telly, flop down the sofa and ...
Most families are forced to have both parents working, so what do we do? Maybe one takes it easy till the li'l birdies fly away... Or switch off those cell phones and set apart some hours in the evenings and weekends just for the kids ... Perhaps a grandparent staying with the family might fill the gap. Different families come up with different solutions. Yet we cannot escape the reality that children need stability, identity, a feeling of being wanted, a feeling of not only being loved but cherished... these help build a strong, secure person with sincerity and integrity... What is the point in spending your whole life earning for your child and finally realizing when he or she is twenty the sweet child you once knew is now a slave to a bottle, a syringe or someone totally askew... Would you rather have not earned little less and see your child be stable and blessed?
Time once spent cannot be earned back. So plan your family time just as you plan your family money, spend it well and wisely and you will reap your dividends richly!
That brings us to the whole topic of latchkey kids. Would it be better for a child to come home to the warm embrace of a loving parent or to take out a key from the pocket, open a cold house, switch on the lights, throw the bags down, pick a snack from the fridge, flick on the telly, flop down the sofa and ...
Most families are forced to have both parents working, so what do we do? Maybe one takes it easy till the li'l birdies fly away... Or switch off those cell phones and set apart some hours in the evenings and weekends just for the kids ... Perhaps a grandparent staying with the family might fill the gap. Different families come up with different solutions. Yet we cannot escape the reality that children need stability, identity, a feeling of being wanted, a feeling of not only being loved but cherished... these help build a strong, secure person with sincerity and integrity... What is the point in spending your whole life earning for your child and finally realizing when he or she is twenty the sweet child you once knew is now a slave to a bottle, a syringe or someone totally askew... Would you rather have not earned little less and see your child be stable and blessed?
Time once spent cannot be earned back. So plan your family time just as you plan your family money, spend it well and wisely and you will reap your dividends richly!
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