Desires Practicalities And Cosmetic Surgery

“A plastic surgeon starts off with whatever exists as the patients’ features and therefore cannot be expected to change a person’s nose, mouth or lips to make it look totally different”

One often hears of incidents that include people being so obsessed with their idols (Elvis Presley and Michael Jackson to name the most popular ones) that they even go ahead and have their faces changed to resemble them! However, one must remember that icons invariably rely on several props which make them look the way they do. Point in example, Elvis’ sideburns and MJ’s iconic sequined glove. It only requires another person to adorn these to get halfway there already. A plastic surgeon starts oft with whatever exists as the patients’ features – be it the nose, mouth or lips. He/she cannot be expected to change it to look totally different, just as ¡t is impossible to make tea out of coffee powder.

Ladies And Cosmetic Surgeries
Women too try and change their appearance to please their unrealistic husbands. Unfortunately and quite often, it is to try and hold on to a philandering partner. Needless to say, these ladies need to be discouraged from surgery as the two issues have no bearing on each other, whatsoever. Cosmetic surgery is not known to have changed people’s characters.

A Personal Desire
As people begin to live longer and healthier lives, they also wish to restore their appearance to a younger, more youthful look. ‘If I feel like a 50-year-old. why should I look 65?’ Now, this s a better reason to effect the changes in one’s appearance – a personal desire to deal with a ‘problem’ that is bothering one on a daily basis. Of course, one assumes that the patient is otherwise medically fit, to undergo the surgery that ¡t entails. Because surgery it is, with its associated discomfort, downtime, expenditure, scars and complications too. So, it’s up to the surgeon to explain all of the above with integrity and honesty before agreeing to take up a patient for surgery.

The Practicalities
People at large have become more readily accepting of cosmetic surgery and this acceptance exists across all socio-economic borders. Patients from all quarters of life approach a plastic surgeon to find out about cosmetic surgery. With an improvement in financial well-being, comes the desire to spend some of that money on one’s looks. As long as the demand is a realistic one and the surgeon feels confident of having understood what the patient is asking for, plus the knowledge that the request is surgically achievable, it should be known that there is absolutely no harm in undergoing this surgery.

Nip Communicable Diseases In The Bud

Better access to immunization and treatment, improved living standards and an increasing awareness of hygiene and sanitation has led to the decrease in the overall incidence of communicable disease. Yet, communicable diseases still rank high in the list of causes of morbidity and deaths. Broadly speaking, communicable diseases refer to infectious diseases which are transmitted by various routes. Some of the common ways of spreading these infections include:

Airborne Spread
Through direct respiratory droplets inhaled from infected patients or through fomites (infected droplets on objects which are subsequently transferred to the patient). Common infections transmitted through this route include measles, rubella, tuberculosis, chicken pox, and influenza. A large number of viruses affecting a person cause respiratory infections.

Faecal-Oral Transmission
These include diseases which spread through faecal contamination of food or water. Some of the common diseases that spread through this route is typhoid and paratyphoid fevers, hepatitis A and E infections, cholera, bacterial and amoebic dysentery, E.coli infections and viral diarrheal diseases.

Contact Transmission
Person to person spread which occurs through exposure of skin or mucus membrane contact as with scabies, skin infections with streptococci, staphylococcal wound infections, certain STDs etc.

• Blood or blood products like HIV, hepatitis B, C infections.
• Soil transmission through spores found in soil resulting in tetanus.

Zoonosis
Spread from infected animals to humans. Diseases like rabies, salmonellosis, brucellosis, tapeworm infections and leptospirosis are usually transmitted from infected animals to humans.

Parasite And Arthropod Borne Infections
Transmitted through bites of mosquitoes, ticks and mites. Common diseases include malaria, dengue. rickettsial dise ases etc.

Most of these infections are familiar to us. So, depending on their mode of transmission, various preventive measures are recommended:

Preventing Airborne Spread

• Most respiratory diseases can be contained by good hand hygiene. Frequent washing of hands or use of sanitizers prevents infected particles from being transferred by patients themselves or by care givers.
• Isolation of patients suffering from diseases with high communicability like measles, chicken pox, open cases of pulmonary tuberculosis etc. help reduce droplets related transmission in the community.
• Wearing masks or covering the nose and mouth with a cloth while sneezing or coughing is a basic requirement.
• Infected persons should avoid crowded places till recovery.
• Avoid exposure to very small children. those seeking cancer treatment or people who are on immunosuppressive medications.
• Affected individuals should seek prompt treatment and complete medication courses. Taking plenty of warm fluids, avoiding exposure to dust and irritants or extreme cold environments will accelerate recovery.

Preventing Faecal-Oral Spread

• Food hygiene safety measures must be constantly practiced.
• Drink lots of water from a known. clean or purified source.
• Avoid fresh juices unless prepared at home or in a hygienic environment. Water or ice are usually the sources of infections like diarrhoea.
• Avoid semi-cooked or non-cooked foods that are prepared on the roadside, unless the surroundings are hygienic.
• Avoid foods that may not be thoroughly washed or which is left uncovered for a long time. This includes salads that are commonly served at eating joints.
• Hand hygiene of food handlers matters too, especially when food is prepared on a large scale or on the roadside.

Preventing Contact Transmission

• Avoid direct contact with infected wounds or sores unless protected by gloves.
• Wash small wounds or abrasions under running water to clean any infected soil particles which may transmit tetanus spores.

Preventing Animal To Human Spread

• Some of these diseases can be prevented by thorough cooking of meat and poultry, including eggs. Avoid eating raw meat.
• Milk should always be pasteurized. Avoid cheese made from unpasteurized milk.
• Avoid exposure to rabid animals. All animal lovers must immunize their pets.
• Prevent arthropod or parasitic borne infections.
• Use mosquito nets especially in mosquito infested areas. And use mosquito repellents at all times.
• Avoid breeding of mosquitoes by keeping the environment dean without stagnant water.

Immunization Can Set You Free

Child and adult immunizations help in preventing major communicable diseases. The eradication of small pox and the tremendous efforts to eradicate poliomyelitis are all remarkable successes of immunization.

Childhood immunization against measles, mumps, rubella, chicken pox, tuberculosis, poliomyelitis and hepatitis is highly effective in preventing them. Efforts to develop vaccines against malaria, dengue, and even I-11V is going on and once they are ready a majority of communicable diseases will be prevented.

Chemoprophylaxis (Medication)

The prevention of malaria in travelers going to endemic diseased areas by using medications is highly recommended. Another example of chemoprophylaxis (which was successful) was the use of tamiflu (oseltamivir) which was used to prevent H1N1 infection during the initial outbreak a few years ago.

In conclusion, communicable diseases continue to pose a big challenge to mankind but constant efforts from the community and the medical fraternity are needed and are being carried out for effective measures to prevent communicable diseases and to stop their incidence.

How To Stop Nosebleeds

Bleeding from the front of the nose is quite a common occurrence and is easy to control either by simple home measures or by a general practitioner. It is a common ENT emergency which can be scary and frightening. Luckily, most often it is not serious and usually can be managed, although sometimes, medical intervention may become necessary.

While bleeding from the front of the nose is called anterior epistaxis, the other form of nose bleeding is from the back and deeper end of the nose. called posterior epistaxis, which is less common and tends to occur ¡n the elderly. This ¡s more complicated and usually needs admission into a hospital and should be managed by an ENT specialist.

Causes

The commonest cause for nose bleeding is trauma to the nose either external, such as a blow to the tace, or internal, due to nose picking. However, in most cases there is no easily identifiable cause. Some other local conditions that can cause epistaxis includes prolonged exposure to warm and dry air, sino-nasal infections, allergies, foreign body inside the nose. blowing the nose hard, nasal surgeries and septal deviation or perforation, to name a few.

Some of the less common causes of nose bleeding include drugs or medications such as anti-platelets that prolong blood clotting, which include aspirin, ecospirin. clopidogrel, NSAI Ds (non-steroidal anti-inflammatory drugs). Sometimes nasal bleeding may also be caused by topical nasal medications like antihistamines and corticosteroids.

Chronic liver or kidney disease, long standing alcohol abuse, platelet disorders and inherited bleeding disorders can interfere with blood clotting and influence nasal bleeding. Vascular malformations inside the nose and certain tumours of the nose are some rare causes of epistaxis Uncontrolled hypertension can also cause nose bleeds, but often it is the anxiety associated with nose bleeding that leads to an increase in the BP.

Nose bleeding in the paediatric age group or children between two to twelve years is common and is at most times, harmless and self-limiting. It can also normally be managed at home. And unlike adults, bleeding in children occurs from the front of the nose. It is a spontaneous occurrence, even though some children may experience it more frequently.

The most common causes of nose bleeding in children are minor trauma due to nose picking and exposure to warm, dry air leading to crusting. especially during the summer.

The commonest causes for nose bleeding is trauma to the nose, either external such as a blow to the face, or internal, due to nose picking

Dealing With Nosebleeds Not a lot needs to be done when there is only a small amount of bleeding from the nose. For example, if a person with sinusitis or a cold blows his/her nose forcefully and notices blood on the tissue, they should avoid vigorous nose sneezing, blowing the nose and nose picking. This ¡s enough to keep the bleeding from getting worse.

When To Seek Medical Intervention

• If bleeding persists after pinching the nose for 10 to 20 minutes.
• If nosebleeds occur frequently over a short time or if a large amount of blood is lost.
• If feeling dizzy or lightheaded
• Heart beat is fast or there is trouble with breathing.
• If vomiting blood
• Have a rash or high fever

Treatment

Most of the anterior bleeding is controlled by day care office procedures such as chemical cauterization (sealing the blood vessel). In severe cases it may be necessary to pack the nose with medicated gauze, balloon nasal packs and synthetic sponge packs that expand when moistened.

The decision on the best course of treatment is made by the ENT specialist. The packing is left in place for 48 to 72 hours. If this does not control bleeding, then arterial embolization or certain surgical procedures may be required.

Prevention

• Avoid nose picking and forceful blowing of the nose.
• Trim children’s nails
• Use saline drops or moisturizers during summer.
• Take blood thinners only under medical supervision
• Keep blood pressure under control

FirstAid

• Don’t get anxious and panicky
• Sit straight with the head raised. Leaning your head forward while tilting your head back will only make you swallow blood.
• Pinch the nostrils together and apply direct pressure with the thumb and index finger for 10 minutes.
• Apply ice packs tightly over the nose on both sides.
• Spit out any blood in the mouth. Swallowing blood may make one feel nauseous.

How Deep Is Your Pain?

pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. or described in terms of such damage. Pain helps us to withdraw from the actual injury and is usually a protective measure. It also helps us seek appropriate action and prevent potential harm that we might do to ourselves. But sometimes, the pain continues to bother people even after the actual stimulus has been taken care of, continuing to impact an individual’s life.

Debilitating Pain Syndromes

• Complex Regional Pain Syndrome (CRPS)
• Phantom Pain
• Fibromyalgia

Here is an example of a case where a patient with severe pain was treated:
A 49-year-old male was involved in a motor bike accident and sustained a trimalleolar fracture. He underwent an operation and the recovery was as expected and he went home, but he was walking with crutches when discharged. He continued to suffer from pain though the wound had healed and had to be readmitted to the hospital again to remove the surgical plates placed in his ankle. There was some improvement in the pain but it started again after six months.

The pain increased in intensity and started affecting his day-to-day life. So, he avoided meeting his friends and family and became quite withdrawn. He even quit his job as a carpenter and always stayed at home due to the pain. Finally, an orthopaedic team met him and even a number of tests could not detect the cause of the pain. He was then referred to a neurologist to manage the pain. He reported throbbing pain in his right ankle ranging in intensity between seven to nine out of 10 on a pain scoring system. He also reported of a freezing sensation over his foot as well as a change of colour in his toot and ankle with it turning pink/ mottled and swelling during a flare up.

A neurologist reviewed his case and noted that he has less hair on his right leg. has smooth skin with mottled appearance, dystrophic nails, cold to touch and sweaty on comparison to the normal side. The man was diagnosed with CRPS and referred to chronic pain service. He was put on multiple medications with limited benefits. He was also given some low dose antidepressants, which made no significant difference.

He then had to undergo intensive therapy under the rehabilitation department and inputs from the pain team at the same time. He was started on peripheral nerve block with a local anaesthetic and was seen by a rehabilitation physician, physiotherapist, occupational therapist, psychologist and a social worker for a multidisciplinary approach.

Budapest Diagnostic Criteria For CRPS

The man had temperature changes. colour changes, swelling, sensitivity changes, shiny skin and dystrophic nails.

The Budapest Criteria

Sensory
Allodynia (aka pain normally not painful situations such as touch, temperature, or movement), Hyperalgesia (heightened pain intensity)

Vasomotor
Differences in skin temperature (greater than 1°C)

Differences in skin colouration between different sides of the body

Sudomotor/oedema
Changes or asymmetry in swelling

Changes or asymmetry in sweating

Motor/trophic Decreased movement
Motor symptoms (weakness, tremors etc)

Changes in hair/skinfriails

Left/Right Discrimination

The man was challenged with various approaches and his responses and accuracies were timed. Research shows that people with debilitating pain lose left/right discrimination and retraining, helps them to progress to the next stages of GMI.

He then underwent motor imagery where he had to imagine doing some movements and initially he had pain issues just by imagining the movements, but he made progress with time. His third step in GMI (Graded Motor Imagery) was mirror therapy.

Invented by Dr Vilayanur S Ramachandran, mirror therapy was initially designed for relieving phantom pain and is now being used for other conditions like complex pain syndromes and stroke recovery as well.

కశ్మీర్‌లో ఉగ్రవాదులు, వేర్పాటు వాదులే లక్ష్యంగా ఆర్మీ ఉక్కుపాదం మోపుతోంది. 70 మంది ఉగ్రవాదులు, వేర్పాటు వాదులను ఐఏఎఫ్‌ విమానంలో ఆగ్రాకు తరలించినట్లు తెలుస్తోంది. మిషన్‌ కాశ్మీర్‌ ఆపరేషన్‌ చేపట్టిన ఆర్మీ… జమ్మూకశ్మీర్‌లో ఎలాంటి అల్లర్లు చెలరేగకుండా చర్యలు చేపట్టింది.

Knockout Knee Pain

The dip in temperature during the winters, can be troublesome for some and most especially for those suffering from joint pain, inflammatory conditions, and arthritis. It is believed that joint pains increase in winters because the air pressure decreases during cold weather. It is because of this, that the inflamed parts of the body like the knees, shoulders. elbows etc. swell up and pain increases. This pain can nevertheless be managed by following some simple tips.

Pain Management

Eat Healthy
Eating healthy food that includes a lot of vegetables. diary, fruits, cereals and pulses is good for the joints. Consuming food rich in vitamins C and K is good for cartilage production and absorption of calcium which will in turn strengthen the bones. Drinking water, taking vitamin D supplements and staying away from coffee, tea, alcohol and sugary drinks is great for the joints. Drink juices or just plain water instead of unhealthy drinks.

Exercise
Working out regularly not only aids weight loss but also makes the body flexible and strengthens the muscles, supporting the joints. Exercises like cycling and walking are good for the knees.

Soak Up Some Sun
The best source of vitamin D is the sun and it is very important for bone strength. Standing in the sun early morning or just before sunset is good for bodily functions and is the best way to warm up on chilly mornings as well as to soak up important nutrients but avoid the afternoon sun.

Keep Warm
To ease joint pain, soak them in warm water. Taking a hot bath or swimming in a hot pool can also help. But do not let it last for more than 20 minutes. Wrapping joints in a warm cloth or wrap also helps.

Joint pain, stiffness and inflammation can be quite debilitating for a person as almost every activity they were previously used to, like walking or even sitting can prove painful. In winters, the pain can be terrible during the nights making a person feel fatigued and requiring painkillers to ease the discomfort. In such cases, it is important to visit a doctor in the early stages of the pain so that it doesn’t get aggravated.

If a doctor suggests surgery after consultation, necessary research and even a second opinion needs to be taken before opting for it. There has been a lot of technological advancements in hip and knee surgeries, so getting a knee replacement surgery done is not a problem.

Latest technology has helped create long-lasting implants that also perform very well like Oxinium, which has been tested extensively in labs before being used on patients. It is the most commonly recommended prosthesis on patients and is responsible for them leading more active and happy lives.

Addressing Fertility Problem In Men

Infertility, especially in India, is still considered to be a female problem, while in reality, sometimes the infertility problems could lie with the man. People know it exists, but it is one of those things that no one wants to address. Male infertility happens to 50 per cent men who visit clinics and the problem can be due to low sperm motility, abnormal sperm, and even low sperm count.

Male infertility could also be due to genital infections, hormonal problems and ejaculatory dysfunction. It is therefore important for men to get fertility tests done along with their partners. The semen of the man is analysed to check its quantity and quality. Any defects like oligospermia (few sperms produced), azoospermia (zero sperm count) no sperm movement and sperm motility problems can be detected with sonography and analysis.

Thanks to advances in technology, the causes of male infertility is easy to detect. A DNA fragmentation is used to check for damages in the DNA. a sperm aneuploidy test (SAT) and a diagnostic test can be done to study chromosomal abnormalities to determine the cause of infertility. In some cases, when the veins get too enlarged in the scrotum, like in varicocele, surgical therapy can prove helpful.

It is always easy to choose the right treatment once the cause of infertility is determined. The various treatment options include hormonal treatments, intra-uterine insemination, intracytoplasmic sperm injection (ICSI) and assisted reproductive techniques. The ICSI is a new procedure whereby the egg and sperm of the couple are taken and then a single sperm is injected into an egg which is then implanted into the uterus of the woman. It ¡s just like having a test tube baby.

Another successful process is the testicular sperm exaction in which sperm is taken from the testicles if there is no sperm in the semen due to a blockage in the testes. Some of the most common lifestyle causes of male infertility is, leading a sedentary lifestyle, smoking, and stress. According to research, these causes amount to 25-50 per cent of male infertility.

Helpful Suggestions

• Do not delay having a baby. Men, like women, also have a biological clock so the older a man gets, the harder it becomes to impregnate a woman.
• Do not get too stressed out. Do some yoga or some form of exercise to feel good.
• Avoid taking steroids
• Give up smoking as it affects fertility, reduces sperm production and also damages the DNA.
• Visit a fertility specialist if you have not been able to conceive for a year.