Medical Strangulation

Gunja, a 31 years old pretty vivacious woman who works as a medical administrator in a corporate hospital and stays alone in an apartment, is perpetually frightened ever since she survived a near death experience from suffocation a year ago.


Over the last two years, every now and then she suddenly breaks out into angry itchy hives all over her body, along with a feeling of choking that makes her gasp for breath.

She recounts in horror when she had a particularly bad attack one early morning while she was alone at home. Soon after the skin hives started appearing, she experienced a feeling as though someone was tightening a noose around her throat. She gradually turned blue and lost consciousness.

Luckily, she had been able to pick up her cellphone and make a call to her doctor-friend who, sensing something seriously wrong had rushed to her home and injected her with adrenaline, which had saved her in the nick of time.

Subsequent tests showed that she suffered from a rare condition called angio-edema, in which an individual is prone to develop swelling (or edema) of the soft tissues and mucous membranes of the body on provocation by certain foods, medicines, bee stings, wasp bites or minor trauma. When the swelling occurs in the neck, especially around the wind-pipe, it obstructs the air passages, sometimes causing death from suffocation.

Angio-edema is rare, but many probably die due to lack of recognition and timely action. Gunja has been fortunate in that she works in a hospital, and her caring medical colleagues have been able to put

her through the requisite tests and prove that she indeed has a deficiency of a C1 q esterase enzyme that is the hallmark of this condition.

Medical suffocation, be it from angio-edema, or anaphylaxis a severe form of allergy, requires prompt recognition and action. Though intravenous injections of anti-allergics and corticosteroids often work, the specific therapy to turn things around is a subcutaneous injection of adrenaline.

A special pre-loaded adrenaline pen, or epipen as it is called, looks quite like an insulin pen, and is easy to self-use. It is helped save many lives. One just needs to jab it on one’s thigh and inject it.

That delay can cost lives was realised when a 14 year old Irish girl, Emma Sloan died of peanut allergy in a restaurant a few years ago. Seeing her daughter get breathless in a restaurant, her mother had rushed to the nearby chemist’s shop to procure an epipen. The Irish chemist refused to dispense the injection without a valid medical prescription. The young girl had collapsed and died minutes later.

Saving lives is sometimes all about timing and promptness. In the words of JFK, “The difference between salad and garbage is in the timing”.

My naughty mind often wonders what would be the fate of such patients if our courts were to decide on their treatment?

Try Fasting to Get in Shape

While loosing weight can indeed be a formidable challenge for those suffering from obesity, my experience suggests that most do not really try hard enough to get back to shape! They go through the customary dietary consults and sermons on regular exercise, give the appearance of being convinced and motivated, but turn up after a couple of months without having shed any weight.
Sometimes, their weight paradoxically go up after they start going to the gym. Many manage to get off fats, but increase their consumption of starch and sugars. It is true that one gram of butter or oil provides 9 Kcal while sugars and starch provide only 4 Kcal, but snacking on potato chips or drinking fruit juices can add more to your belly than a thin smear of butter on a brown toast.

On trying to unravel the mystery of why some gain weight after starting workouts instead of losing it, many admit to increasing their food intake in response to hunger that exercise drives up.
What seems to lie at the root of the weight problem is how to cut down on the calories we consume.

Fasting, within limits, may not be a bad thing to try. The health effects of periodic fasting are generally positive and has been promoted by most religions. It helps loose weight by shedding excess body fat, improves diabetes and high BP, and has been shown to reduce cancer risk. Studies have shown that periodic fasters have lower risk of heart disease and tend to live longer.

Glucose is the body's primary fuel source and is essential for the brain’s functioning. When denied glucose for more than 4–8 hours, the body turns to the liver for glycogen, a storage form of glucose, to be used for fuel. At this point, the body also uses small amounts of protein to supplement this fuel. This fuel will last for up to 12 hours before the body needs to turn to glycogen stored in muscles, lasting for a few more days. If glucose is still denied at this point, muscle wasting is prevented by temporarily switching to fat as the fuel source, meaning fat is converted into ketones. Ketones, while not sugars, can be used by the brain as a fuel source as long as glucose is denied.

The body continues to use fat for as long as there is fat to consume. It will generally indicate to the faster when fat levels are running extremely low (less than 7% and 10% of body weight for males and females, respectively) with an increased urge for food.

If you are serious about losing weight, there is hardly any hope if you do not restrict calories. Periodic fasting may be worth a try as long as you do not binge after the fast is broken.?

Uberification of Health Care

The imaginative concept of matching transportation demands of people with cab facilities using a smartphone platform that Uber is credited to having created is now beginning to be applied to health care as well.

At the outset, let me share with you what I understand of Uber. It is an on-line transportation company that develops, markets and operates the Uber mobile app, which allows consumers with smartphones to connect with Uber drivers through a software platform for taxi service. Uber itself does not own any assets such as cars, or hire the drivers.

Uber was founded by Tavis Kalanick and Garrett Camp as recently as 2009 in San Francisco, but the impact and success of this “start up” has reverberated across the world, being now valued at US $ 62.5 billion.

Fresh successful ideas in one domain often tickle the minds of entrepreneurs in other fields. Healthcare experts are now trying to explore if they can bring about a revolution in their sector as well.

The proposition seems to be as follows: there are several people who need medical help, just as there are several doctors who can deliver them, but connecting them quickly is the real challenge. Our traditional rigid system of “going to a hospital” that is located at a distance, is rigid, and has multiple layers of hurdles is not easy for someone in urgent need.

This was sought to be short-circuited with the development of telemedicine services, by which a patient could get medical advice through an internet based software service or telephone. This format however works only for simple ailments, as there is not much scope for to-and-fro discussion, physical examining the patient, or getting prescription medicines.

The next major step, which enabled a patient to see the doctor and discuss his problems, came with skype based consultations. One could see the doctor on the screen and a to-and-fro discussion was possible. The only shortcoming Skype consults however is the lack of physical feel that is sometime important in clinical medicine. For follow ups, say for instance to tweak insulin doses in a diabetic, physical examination may not always be necessary, and Skype consult can be very convenient for patients.

The new concept of Uberification goes a step further. Can there be smart phone based app that helps patients in emergencies, such as an outbreak of allergy or high blood pressure or acute diarrhea, to get quick medical help from a nearby doctor who is available to visit his home?

This new strategy could be important for several reasons. Ailments which require the physical presence of a doctor would be possible, home care could get its long needed boost, and medical emergencies needing prompt responses would be easy to deliver.

“Unlike cabs, the main challenge in India would be to ensure a uniform and high quality of care by different doctors”, says Dr Dilpreet Brar. Upper class citizen have already started signing up on MediCube that she has launched in Indian metro-cities recently.

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.