Plasma therapy for Baldness to Joint Diseases

Excessive hair loss, or alopecia as it is medically called, now has a promising new therapy. Doctors are using platelets from the patient’s own blood to stimulate hair growth.

Platelets are small little particles present in blood that play an important role in plugging leaking arteries and in clotting. They also contain a large number of “stimulating factors” that stimulate degenerating tissues to grow again.

There are several of them such as platelet derived growth factor (PDGF), growth stimulating factor (GSF), epidermal growth factor (EGF), vascular epidermal growth factor (VEGF) and mediators like Interleukin 8 which stimulate growth of hair follicles and cells of several tissues such as nerve cells, bones, cartilage and muscles. This newly discovered property has suddenly catapulted plasma into centre stage.

Plasma rich platelet (PRP) therapy as it is called, involves drawing a sample of autologous (patient’s own) blood, mixing it with an anti-coagulant that prevents it from clotting, spinning it in a test-tube, and taking out the platelet rich portion of the plasma. It is then injected into the scalp or other tissues with a very fine needle, like the insulin needle. Typically 2 to 4 mL are injected in each session, that are then repeated 2 weekly 4 to 6 times.

Several studies have shown this therapy to work in reducing hair loss and improving hair growth, either alone or in combination with other treatments such as minoxidil or hair transplantation. Safety issues around transmitting infections are hardly any as it is the patient’s own blood that is used. It is also cheap and simple.

There is however still some concern about how effective it really is. Some trials have shown impressive success while others have not. Experts believe this difference could be due to the variation in skill and expertise for separating and concentrating platelets.

PRP therapy now has a wide range of evolving applications: plastic surgeons are using it to treat scars and skin grafts while orthopaedic surgeons are treating degenerative joint disorders like osteoarthritis with it. It has become particularly popular in sports-medicine for treatment of injuries of tendons, ligaments and joints. Even neurologists are using it to stimulate regeneration of nerves.

Interestingly, the first use of PRP was in 1997 in Italy for treatment of dead and degenerating heart muscles. Perhaps the fascination of cardiologists with stem cells for the same purpose, made PRP recede to the background over the last 2 decades.

If it delivers on its present promise and proves to be effective, PRP could be a much simpler, safer and cheaper therapy to help stimulate growth of a variety of degenerating tissues, from sleeping hair follicles in balding scalps to the tired muscles of broken hearts.

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)