Blogs

Gas Geysers are Dangerous & Potentially Life Threatening
CHILDREN WITH BONE CANCER
Cure right. Sleep tight. Good night
All about Knee arthroscopy
All about knee replacement surgery
WHEN SLEEP REFUSES TO SHAKE HANDS WITH YOU
GET TO KNOW YOUR ROTATOR CUFFS BETTER
BONE BANK HELPS WOMAN AVOID ARM AMPUTATION
TUNE IT UP: TIPS TO MAINTAIN A GOOD VOICE
Gas Geysers are Dangerous & Potentially Life Threatening

A 15 year old girl had gone to take a bath in the morning and as she was not coming out after half an hour, the mother went and found her daughter unconscious inside the bathroom and brought her to Prakriya Hospital Emergency Department. The Emergency department doctors immediately asked whether they were using gas geyser in the bathroom and upon confirmation of the same, carbon monoxide poisoning was suspected. Since it was moderate to severe poisoning clinically and as the child was extremely confused, had low blood pressure and not breathing properly and most probably had a seizure before coming to the hospital, she was mechanically ventilated and given 100% oxygen which is the main treatment. Carbon monoxide levels were sent which also confirmed the diagnosis. She was taken off the ventilator in 6 hours time and thankfully does not show any major acute changes of carbon monoxide poisoning and is well at present. However Dr Arun Thomas, the treating pediatric intensivist says that all is not well as the child might still have some delayed neurological sequlae which can present as memory loss, personality changes and cognitive decline till upto 1 year after exposure.


This is the fifth case of carbon monoxide poisoning that has been seen at Prakriya Hospitals in the past 2 and half months and Dr Merriyet MB, Consultant Pediatrician says that even more cases may come up because of the low temperature and widened use of gas geysers at home with improper ventilation.
Dr Mohan, the adult intensivist who has treated many such patients say that high index of suspicion and early diagnosis with prompt initiation of treatment has really helped in a positive outcome in all the 5 patients that have been treated and discharged from the hospital. With the late onset of winter and the rising use of gas geysers, people should make sure that the gas geysers should be switched off prior to taking a bath if the windows are all shut and there should be adequate ventilation in a bathroom or it may lead to serious health issues including death.
Carbon monoxide poisoning is a very dangerous and potentially life threatening condition if not diagnosed early. Carbon monoxide is a colorless, odorless, tasteless gas produced by burning gasoline, wood, charcoal or other fuel. Improperly ventilated appliances and engines, particularly in a tightly enclosed space, may allow carbon monoxide to accumulate to dangerous levels. While its more commonly seen in western countries where the temperature tends to be low and people use gas warmers, the use of gas geysers and improper ventilation has led to the rise of carbon monoxide poisoning here.


Signs and symptoms of carbon monoxide poisoning may include:

  • Dull headache
  • Weakness
  • Dizziness
  • Nausea or vomiting
  • Shortness of breath
  • Confusion
  • Blurred vision
  • Loss of consciousness
  • Carbon monoxide poisoning can be particularly dangerous for people who are sleeping or intoxicated. People may have irreversible brain damage or even die before anyone realizes there's a problem.


    Carbon monoxide poisoning can cause permanent brain damage, damage to your hear and in certain cases even death. In pregnant women, it can cause fetal death or miscarriage. The diagnosis is mainly clinical as only a high index of suspicion will lead to the right history and subsequently, a simple blood test will confirm the diagnosis. The treatment is initially reaching to the hospital as fast as possible and then breathing pure oxygen and breathing oxygen in a pressurized chamber.


    CHILDREN WITH BONE CANCER

    12 year old Sushma (Name Changed) started limping with pain which gradually increased. She is the only child for Prema. The mother noticed this and saw that there was a swelling in the upper part of thigh. They live in a village in Mandya district of Karnataka. They approached a nearby general practioner who prescribed medication. Even after taking the tablets the pain continued to increase. The child was taken to a hospital in Bangalore. Several investigations where done. The MRI revealed a growth in the thigh bone. The patient was immediately referred to Dr Srinivas Chirukuri, Orthopaedic Oncosurgeon a Prakriya Hospital, Bangalore. A needle biopsy was done and the diagnosis was confirmed to be Ewing’s Sarcoma of the bone (Bone Cancer).


    Ewing’s sarcoma is a high grade bone cancer which usually affects the children. If detected late or untreated, the cancer cells will spread to other parts of the body and lead to death. In the last 3 decades chemotherapy drugs have helped in curing these patients. The cure rate ranges from 50% to 70 % if the cancer is detected early and treated adequately. The part which is affected needs to be treated either by surgery or Radiotherapy or both. Patients with this cancer are subjected to amputation of the limb which cripples the person. With modern reconstruction techniques, the limb can be preserved. If cancer can be detected early and treated completely the chance of cure is high.


    Sushma’s parents where counselled about the treatment options. As the cost of treatment was high, the parents struggled to arrange fund for treatment. But the mother was determined to save her child. With the help of the hospital, the treatment was initiated. She first received Chemotherapy followed by surgery. She underwent a unique 7 hours surgery where her cancer affected bone was removed, the bone was treated with high dose radiation and re-implanted into the body immediately. The bone thus implanted is a dead bone but with time the bone recovers to be a normal healthy bone. Sushma is undergoing further chemotherapy. The parents are looking forward for financial assistance from the Chief Ministers relief fund which is yet to be received.


    Ones she completes the treatment she is expected to go back to school. She needs to be on a regular follow-up with the doctor for few years.


    Cure Right. Sleep Tight. Good Night

    Do you wake up every night, thanks to your own loud snores?
    Do you feel tired throughout the day?
    Do you often fall asleep during an interesting lecture or meeting?
    Then my friend, you could be possibly be suffering from sleep apnoea.

    Snoring is a very common thing and occurs due to the vibration of the tissues at the back of the throat while sleeping. It usually does not indicate a serious problem. If it’s mild, then it doesn’t require treatment. However, some patients may have significant obstruction to airflow during sleep and this can indicate obstructive sleep apnoea. It requires detailed evaluation and treatment. Snoring and sleep apnoea usually affects middle aged to older men who are overweight. But this is not necessarily the case and can also affect women and children as well.
    Obstructive sleep apnoea can range in severity from mild to life threatening disease.


    During Sleep
    • The muscles of the tongue and the throat relax.
    • The lower jaw and the tongue fall backward towards the throat.
    • The airway becomes blocked due to the collapse of tissues in the throat.

    These result in stoppage of breathing and the silence ends abruptly with a loud cough or gasp. The patient then wakes up briefly and begins breathing again and then drifts back to sleep. Once the patient falls asleep, the muscles relax again, the airway gets blocked and the whole process repeats again. This can happen a few hundred times throughout the night.
    Though, the patient does not remember these multiple episodes of awakening at night, they significantly impact the quality of life of a patient. The patient often wakes up feeling drowsy and feels that he or she haven’t had sleep at all at night. This in turn leads to lack of concentration and irritability. Children with obstructive Sleep apnoea are often hyperactive during the daytime. Obstructive Sleep Apnoea is also associated with Heart disease, Diabetes and Hypertension.
    Obstructive Sleep apnoea is diagnosed after detailed history and evaluation which aims at determining the effect that lack of sleep has on your daily routine. The upper airways are evaluated for crowding of tissues. An Endoscopy is usually done either when awake or by stimulating sleep called Drug Induced Sleep Endoscopy. Sleep Study or Polysomnography is done during sleep at night either in a hospital setting or at home. The patient’s heart and lung function, breathing movements are then monitored to determine the severity of Sleep apnoea, which is assessed according to certain parameters.


    The management options for Sleep Apnoea are
    • Lifestyle modification: losing weight, avoiding alcohol before bedtime, quitting cigarette smoking and avoiding sleeping on the back can help with reducing snoring and sleep apnea.
    • Continuous Positive Airway Pressure (CPAP): This is a machine that uses air under pressure to keep the airway open. This is usually offered as the first line of treatment.
    • Dental appliances: are used in to keep your jaw and tongue from falling backwards and keep the airway open.
    • Surgery: Surgical options are usually advised for patients with severe sleep apnea and include surgical options to reduce the tissues in the throat and back of the throat.

    So if you think you or your partner have snoring or sleep apnea, please consult a Doctor immediately. Your problem has a solution. Breathe easy. Sleep breezy

    TUNE IT UP: TIPS TO MAINTAIN A GOOD VOICE

    If you are a singer, a teacher or a professional voice user, you might have experienced several harrowing instances of sore throat, voice change and dry cough. Chronic and prolonged usage of voice can damage your vocal cords and you can end up with vocal nodules and other voice problems.

    Here are some tips to help you tune it up
    • Avoid Shouting or loud voice use: Loud voice and excessive shouting can cause damage to your vocal cords. So when you use your voice, use it at an optimal pitch and loudness.
    • Avoid whispering: Contrary to popular belief, whispering also has harmful effects on your voice.
    • Stay hydrated: Drink plenty of fluids and have multiple sips of water during long conversations to avoid excessive damage to your vocal cords.
    • Take frequent breaks: In scenarios where you are forced to use your voice for prolonged periods, take frequent breaks and sip water in between.
    • Quit smoking: Give up the harmful habit of smoking. Avoid passive smoking as well as it also affects the vocal cord.
    • Manage your allergies and acid reflux: This irritates your throat, causing the cough and post-nasal drip as well as hoarseness in the morning
    When to meet your doctor?

    In case you observe a change in your voice change that is not improving even after giving a short period to your vocal chords, please get yourself evaluated by an ENT specialist.

    All about Knee arthroscopy

    What is Arthroscopy? During an arthroscopy, a camera is inserted into the knee through two small puncture wounds. One for inserting the camera and the others for instruments. It allows us to look at the joint surfaces, cartilage and the main ligaments of the knee. The operation is usually carried out under a general anaesthetic. Once patient have recovered from the anaesthetic, they will be able to get up and a physiotherapist will explain some exercises. Why it is done? As well as allowing to see the problem, some procedures can be performed.

    • Repair or removal of torn cartilages. These are shock absorbers of the knee and are commonly damaged as a result of sports injury or simply ‘wearing out’.
    • Damage to the knee cap and the joint surfaces can be trimmed or shaved.
    • Small holes (micro-fractures) can be made in the bone to stimulate new cartilage growth.
    • Removal of loose bodies such as bone, cartilage or debris from the joint.
    • If inflammation is present, samples from the lining of the joint can be taken.

    What will be the recovery following surgery? The knee may ache and swell following surgery and patient might need to take some painkillers. Hospital stay will be 1-2 days. The majority of patients should be walking without too much pain and able to do normal daily activities and sedentary (office-type) work within one to two weeks. If job is more physical and involves climbing, squatting or lots of stairs, it will probably need two weeks off to recover. Driving is possible after five to seven days when knee is feeling comfortable. It is advisable to gradually increase the level of activity to see how knee copes.

    All about knee replacement surgery

    Do you need knee replacement? If your knee gives pain, stiffness, instability or loss of function that affects your daily life and activities, then you will benefit from surgery
    What are the advantages of Knee replacement? Freedom from pain and improved mobility and quality of life
    What are the possible disadvantages? Replacement joints wearing out over time (20 years) and difficulty with some movements (sitting cross legged or squatting not advisable)
    What are the alternatives to knee replacement? We recommend non operative treatment before considering surgery including weight loss, medication, knee brace and exercises
    What will be the recovery following surgery? Most people are able to start moving soon after the surgery which is good for lung function and the circulation. Physiotherapist will explain to you the exercises and help you walk. You will be discharged as soon as the wound is healing and you can safely manage to get about at home with help of walker. Most people leave the hospital between three and five days following surgery. When you are discharged, you will be given supporting therapy and follow up checks including for removal of stitches. Your knee will continue to improve for as much as a year after the operation

    WHEN SLEEP REFUSES TO SHAKE HANDS WITH YOU

    Insomnia is a common sleep disorder that makes it difficult for people to fall asleep, stay asleep, causes them to wake up too early and tough to get back to sleep. As a result, one doesn’t feel fresh when they wake up.
    Though, the hours of sleep one needs varies from person to person, most adults need seven to eight hours of sleep every night. While, Insomnia may be the primary problem for sleepless nights, it may also be associated with other medical conditions or medications.
    The symptoms that indicate that a person is suffering from insomnia are:

    • Difficulty in falling asleep at night
    • Waking up during the night
    • Waking up too early
    • Not feeling fresh and rested after a night's sleep
    • Daytime tiredness or sleepiness
    • Difficulty paying attention, focusing on tasks or remembering
    • On-going worries about sleep
    • Irritability, depression or anxiety

    Insomnia is often associated with other medical conditions.
    Chronic insomnia is usually a result of stress, life events or habits that tends to disrupt sleep. Treating the underlying cause can resolve insomnia, but sometimes it can last for years. The common causes of chronic insomnia are:

    • Stress
    • Travel or work schedule like jet lag from traveling across multiple time zones or working in shifts
    • Poor sleep habits

    The other medical conditions that cause sleeplessness are:

    • Mental health disorders: Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening well ahead of your routine time can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
    • Medications: Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications like pain medications, allergy and cold medications, and weight-loss products contain caffeine and other stimulants that can disrupt sleep.
    • Medical conditions: Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), hyperthyroidism, Parkinson's disease and Alzheimer's disease.
    • Sleep-related disorders: Sleep apnea causes you to stop breathing periodically throughout the night, thus interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
    • Caffeine, nicotine and alcohol: Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.

    Insomnia becomes more common with ageing. However, children and teens also find it difficult to get sleep or resist a regular bedtime as they want to go to bed later and sleep later in the morning.
    Sleep is an important ingredient of life just like a healthy diet and regular physical activity. Whatever your reason for sleep loss may be, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.
    By following these simple steps regularly one can prevent insomnia.

    1. Waking up at the same time everyday
    2. Limiting daily in-bed time to the usual amount present before the sleep disturbance
    3. Discontinuing central nervous system (CNS)-acting drugs (caffeine, nicotine, alcohol, stimulants)
    4. Avoiding daytime naps
    5. Establish physical fitness by means of a regular exercise early in the day
    6. Avoid evening stimulation; substitute television with radio or relaxed reading
    7. Try very hot, 20-minute, body-temperature-raising bath soaks near bedtime
    8. Eat at regular times daily; avoid large meals near bedtime
    9. Practice evening relaxation routines like meditation
    10. Maintain comfortable sleeping conditions

    If insomnia persists for more than weeks and makes it hard for you to function during the day, it is important that one should opt for medical aid.

    GET TO KNOW YOUR ROTATOR CUFFS BETTER

    Rotator cuff is a group of four muscles, which surround the shoulder joint. They come together as tendons to form a covering around the head of the upper arm and helps keep the shoulder in socket

    However, sometimes the tendon or the tendons get damaged or torn due to “wear and tear” or because of an injury.

    Symptoms

    The symptoms that indicate that you have suffered a rotator cuff tear are:

    • Pain while resting at night, particularly if you are lying on the affected shoulder
    • Pain when lifting and lowering arm
    • Weakness when lifting arm

    If you have a rotator cuff tear and yet you continue to use the affected arm despite a chronic pain, you might end up causing further damage. The tear can get larger over time.

    Causes

    Rotator cuff injury may be the result various reasons:

    • Repetitive stress: Repetition of the same shoulder motions in sports like cricket, tennis, badminton, rowing, and weightlifting and a few overhead activities for a prolonged period of time may irritate or damage the tendon.
    • Lack of blood supply: As one ages, the blood circulation to our rotator cuff tendons decreases. As a result, the body's natural ability to repair tendon damage is impaired, which in turn causes damage to the tendon.
    • Bone overgrowth: Sometimes, when the shoulder bone overgrows, it rubs against the rotator cuff especially when we are lifting our arms. This is called shoulder impingement. With time this bone overgrowth weakens the tendon and might cause it to tear.
    Diagnosis and Treatment

    A rotator cuff tear can be detected with the help of an MRI or Ultrasound. It also helps in detecting where the tear is located within the tendon and the size of the tear.

    The treatment for the tear varies depending on the age, activity level, general health & the type of tear. The treatment involves

    • Resting by using a sling to help protect shoulder.
    • Avoiding activities that cause shoulder pain
    • Doing exercises and stretches to improve flexibility and range of motion.
    • Strengthening the muscles that support shoulder can relieve pain and prevent further injury
    • If resting, medications & exercises fail to relieve pain, an injection of a local anaesthetic & steroid may be helpful
    • A surgery may be required in cases of acute tear. It involves re-attaching the tendon to the head of humerus (upper arm bone) by keyhole surgery or as an open procedure.
    BONE BANK HELPS WOMAN AVOID ARM AMPUTATION

    Living with a bone borrowed from a dead person is indeed something uncommon. But this rarity will soon change as Bengaluru has got a bone bank about eight months ago. In fact, it has already helped doctors to save a homemaker's elbow from being amputated. The patient, a 39-year-old Kalamma from Mandya, had been suffering from immense pain in her right elbow for the past three years. Doctors in Mysore diagnosed the problem as bone cancer. The tumour was surgically removed. But when it resurfaced, doctors advised her to amputate her arm. Desperate to save her arm, Kalamma approached a few other hospitals, before consultant orthopedic oncosurgeon Dr. Srinivas CH gave her an alternative solution. “Kalamma had undergone several surgeries but the tumour was recurring. Everyone she consulted, recommended her to undergo an amputation. We suggested that a cadaver bone grafting could save her elbow,” said Dr. Srinivas. Surgeons then contacted the bone bank. When they came across a suitable match, they began a unique limb-saving surgery. They first completely removed the tumour before reconstructing the elbow joint with Allogenic Bone Graft (large bone graft). “Bone from cadaver was cut to the desired shape using a medical saw and fixed with cement and screws. For prosthetics that followed bone grafting, we had ordered a special titanium joint. During the process, the patient lost some skin. It necessitated plastic surgery to cover the elbow and implants,” explained Dr. Srinivas. The plastic surgery was carried out by Dr. Madhusudan. Approximately 10 cm of bone that was affected by the tumour was removed and replaced in a seven-hour surgery. Dr. Srinivas has said that this kind of surgery, involving cadaver bone and prosthesis, had never been carried out on an elbow in India before. Six months has passed by since the surgery and Kalamma has undergone several sessions of physiotherapy as part of the follow-up process. Today, she is free of cancer and goes about with her household chores with a smile on her face. “I do not know whose bone I am living with, but I will always pray for the donor’s family. In death, the person gave me a fresh lease of life,” Kalamma said. The bone bank which began operations recently is indeed a blessing. It is one of its kind in the country and is especially helpful in cases of massive allograft or large bone grafting. Dr Sundresh, orthopedic specialist and head of bone bank says, “Cadaver bone is a boon for bone cancer patients. Earlier, bones had to be imported. With increasing awareness, many citizens are coming forward to donate their organs after their death.” To add on this blessing, bone transplant also has a few other advantages as compared to other organs. According to Dr Srinivas the chances of rejection by the recipient’s body—like in the case of liver or kidney transplant—are less.