Good Old Aspirin for Cardiac Emergency

Heart attacks are common above 40, often coming at odd times, without warning, and are the commonest killer of our modern times. The best chances of reducing the severity of an acute attack and improving the chances of survival are by chewing aspirin at the very start and reaching a hospital within 2 hours.
A doctor colleague of mine, Dr Anil Behl, has started a unique form of social service, of putting 4 aspirin tablets in a plastic pouch and keeping it available at all times with the security check-post of his housing colony. He has backed up this simple act by informing all residents of his colony by email and posters, that should anyone have early symptom of heart attack, they should immediately procure the pills from the security room and chew them while waiting for further help to arrive.
During a heart attack, blood clot forms in the arteries of the heart blocking the flow of oxygen-rich blood to heart muscles. Clot formation begins with clumping of small blood particles called platelets. What aspirin does is that it prevents stickiness and clumping of platelets,. When taken during a heart attack it therefore slows clotting and decreases the size of the clot.
Most cardiologists swear by aspirin for several reasons.
For those who have had a previous heart attack, long-term use of aspirin reduces the chances of having a second one.
It is useful for those who have never had a heart disease before but are at increased risk of having one. This group includes people above 40 who have diabetes, high blood pressure, increased blood levels of cholesterol and smokers. Those with a strong family history of heart disease also come in the “risky” category.
A daily dose of low-dose aspirin has been shown to reduce the risk of a first heart attack in this group. Cardiologists also recommend aspirin to all those who have had a cardiac artery bypass surgery or angioplasty. The reasons are much the same. It prevents platelets to clump thus reducing the chances of clot formation in the arteries of the heart.
Heart attack presents as heaviness or pain in the center of the chest, often radiating to the neck or left arm or back, sometimes associated with sweating and uneasiness. It is often felt as “gas” and vomiting by some.
Aspirin is of course the first step that can be taken at home or on the way to a hospital. An angiography, and opening up of the blocked arteries by angioplasty, performed within the first 6 hours, reduces damage and death of heart muscles, and the best chances of long-term survival.
It makes sense to keep aspirin handy at all times, not just for you, but others around you who might need it in an emergency.

Microbial Garden in Your Gut

The paradox that scientists are trying to come to terms with is that our “healthy” human body is loaded with germs, and that these germs might be conferring positive health to our bodies. To be specific, we carry over a trillion (1014) bacteria in our guts. And they belong to as many as 400 different species. If we could scoop them all out and place them on a weighing scale they would weigh as much as 1.5 to 3 Kg, even more than the clothes we wear!

The presence of this huge bustling wild-life sanctuary of little animals or microbial garden in our guts has puzzled scientists for decades. There was a time when “germs” were those terrible little things that caused nasty infections and often took lives. In fact, when some of these germs migrate from the gut to “abnormal” places such as the urinary tract, they produce illnesses such as urine infections.

The logical approach that scientists therefore took in the last two centuries was to rid the body of all germs, in an attempt to “sterilise” it. They soon realised that removing the “good” germs often cleared the field for disease-producing bacteria to invade the body and cause diseases.

It has now become clear that just as good germs need our warm moist slushy guts to survive, breed and colonize, we need them just as much to act as guards preventing invading germs from coming in and causing diseases.

The most dramatic example in current times is a condition called “antibiotic associated diarrhea (AAD)” or the upset tummy that many of us experience when we take antibiotics for infections such as those of the chest, urine, skin or bones.
The gripes and ‘loosies’ we get are best managed by consuming “good” germs, called probiotics, either in the form of curd or yogurt, or as preparations that come as capsules or liquids. A particular variety of healthy germs called Saccharomyces boulardi has been shown to work best for this condition.

Scientists have now gone even a step further. Why not take germs from a person with a healthy gut and “transplant” or put them into people with weak guts? Stool transplant or Faecal Microbiota Transplant (FMT), as it is called, involves taking stools from healthy donors, running it through labs to ensure absence of harmful ones, and instilling them into the intestines of patients through a tube passed from either end of the gastrointestinal tract.

There are 25 medical centres in the USA that have started doing FMT, as have some in India. In conditions such as C difficile toxin disease, the results with this procedure are thrice as good as any other form of treatment.

While these are still early days and one has to study and observe more to recommend it in wider indications, the initial results are very promising.

The Chinese seemed to have known all this from as far back as the 4th century BC. They had a practice of young mothers feeding a small bit of their stools to their new borns to make their guts strong.

And we seem to have come a full circle now with faecal transplantation to regain our health!

Emergency Medical Kit

he regular depiction in TV serials of a doctor arriving home almost instantaneously when summoned on telephone to attend to an emergency, could not be farther from reality. Most good doctors do not attend home calls, and the chances of getting one in the middle of the night when you are down with an attack of incessant vomiting or an allergy could be well neigh impossible.
It makes perfect sense to keep some medicines at home or carry on travel. Here are some tips on how to make your own emergency medicine kit:
1. Keep medicines that you are familiar with, and preferably, have taken before, so that it is not a first timer during an emergency and that too in a new place.  If you take a new antibiotic while on travel, and come down with hives, things can get rather complicated.
2. If you are not good with tongue twisting drug names, put them in labelled envelopes according to indications. For example, you could have paracetamol tablets in an envelope labelled “Fever, Body pains”, loperamide in one labelled “Loose motions” or Avomine in one labelled “Motion sickness”.
3. Keep them in your hand baggage, in a separate pouch or flap. The best of medicines kept in the checked-in-luggage will be of no use to you should you need it in an emergency.
4. Know your special needs: For example an asthmatic should ensure he travels with his bronchodilators, those with heart disease must have their nitrates, those with diabetes should carry not just the blood sugar lowering drugs but also some sweets or sugars, in case their head spins due to a drop in blood sugar.
A practical step would be to try making your medical kit to deal with:
1. Allergy, hives, itching, running nose, watery eyes, brochospasm: Allegra/ Alspan/ Cetriz/Avil
2. Loose motions (watery) : loperamide (Imodium)
3. Acidity/ heartburn: Digene or Gelusil tablets/ Ranitidine or Omeprazole
4. Nausea or vomiting : Domperidone or ondansetron
5. Motion sickness : Avomine
6. Infections: Tummy or urine infections, fever: Ciprofloxacin or ofloxacin/ cephalosporins Throat or chest infections: cephaloporins or amoxycillin or Septran
7. Fever, body aches, sprains, injury: Paracetamol/Brufen
8. Crampy pain in abdomen or painful periods: Spasmindon, Cyclopam/ Meftal spas are some antispasmodics
9. Band-aids and antiseptic creams for abraisions and hurts.
10. Laxatives ( Isabgula husk, lactitol or PEG pouches)
Laxatives are particularly important for people with chronic constipation who travel overseas. One tends to unknowingly suppress bowel evacuation during long journeys, especially flights. Further, the diet in most western countries tend to constipate as they are low on fibre and often contain cocoa.
It is not uncommon therefore for stools to harden, causing anal fissures and piles.
It is indeed paradoxical that despite mushrooming of hospitals and clinics, getting a good doctor when in need is a matter of rare luck.
(I have avoided commercial names of medicines, which your pharmacist will help you with)

Are we prepared for ZIKA?

I had honestly not heard of ZIKA virus till recently, when this hitherto unheard virus shot into international fame for allegedly damaging the brains of babies growing in their mother’s wombs, and having them being born in vegetative states with mental retardation. 

It is true, that ZIKA, which spreads through mosquito bites, does not seem to be dangerously fatal to the humans it stings, but the suspected havoc it causes to expecting mothers, who go on to deliver deformed mentally retarded babies, and the effect of this trauma on their families is often perceived by many to be worse than death.

Although ZIKA virus epidemic is raging in distant countries like Brazil, Mexico, Africa and other South American nations, it would be silly to adopt an “ Abhi Dilli Door Hai” stance. The same strain of mosquito that spreads ZIKA, called Aedes aegypti, is rampant in most ‘nukkars’ and ‘galis’ of India. At the moment it is fervently engaged in spreading other viruses such as Dengue and Chikungunya here. 

But when ZIKA arrives here after getting past the Indian immigration, it will find the Aedes mosquitoes eagerly waiting to carry it to a huge number of human Indian hosts living in populated towns and cities, many of who would be pregnant mothers. If swarms of Aedes mosquitoes could carry the Dengue and Chikungunya viruses, bringing governments to their knees, why would they not carry ZIKA?

Most people who catch the ZIKA infection do not show symptoms. Few (around 20%) develop fever, body aches, rash and congestion of the eyes that pass off in a few days. Hardly anyone dies. But some adults develop neurologic problems such as paralysis of muscles.

But the problem is, that unlike Dengue, there is no easy test to detect the infection. How then would an expectant mother know if she suffered the ZIKA infection during pregnancy? Or worse, how would she know that the baby growing in her womb has not been unknowingly harmed by the infection that she did not get to know about? 

This is what is making young mothers and couples in ZIKA affected areas go crazy, some even committing suicide after giving birth to deformed babies with small heads (microcephaly).

The World Health Organisation has sounded an international alarm, and the Indian government has echoed it. But in the absence of specific diagnostic tests, specific drugs to kill the virus or a vaccine to prevent the infection, how do people and nations that have swarms of mosquitoes breeding passionately face this dangerous threat?

The solution could lie beyond the virus, in its transmitter, the mosquito that carry it. And making settlements free of mosquitoes could solve the problem not just of ZIKA, but that of Dengue, Chikungunya, malaria and many more.

Civic bodies seem better positioned to solve this health problem than medical people. And we could play our little individual roles to check the mosquito-menace near our homes, schools and offices.