- Bed Sores
Bed sore are pressure point ulcers develop in the bed ridden patients. Many patients unable to move and even change the sides become the victim of pressure sores. Unconscious, paralytic, old ages, fracture of hip or neurological deficit patients remaining bed ridden are prone to it. These bed sores refuse to heal and go worse from day to day. Best way is to prevent it than to treat it.
Some points are to be kept in mind while managing bed ridden patients;
- Bed should be soft and without any folds.
- A water bed is always better if can be affordable.
- Bed sheets should not be of rough type and there should not be any creases.
- Change of sides of patient at frequent intervals.
- The bed should not be soiled with water, urine or feces
- The patients should be cleaned daily and body sprayed with talc powder. Surgical spirit can be applied all over body; especially over the pressure points like; hip, gluteal region, shoulder blades, heels and back etc. two to three times a week.
All of the above will prevent development of bed sore.
But if develops, all of the above steps must be followed rigorously. A dressing is to be applied over the wound after cleaning with a mild antiseptic lotion. Diabetic status is to be checked and if present will be controlled. Oral protein supplementation should be continued if otherwise not contraindicated e.g. patients suffering from hepatic coma; but can be given through intravenous route. A short course of antibiotic coverage keeping an eye on anaerobic bacteria coverage is to be given; but a culture and sensitivity test to choose an antibiotic is better than empirical choice. Vitamin B can be given to assist in healing. Sometimes blood and blood fractions may be required if there is anemia.
The gold standard is “Prevention is better than cure”.
Saying no is a difficult affair for some and they suffer for it. People say yes, even to illegal works in order to be popular; sometimes to keep friendship and sometimes with hope of getting illegal gratification. These are the people with vested interest and they thrive well in their illegial sphere and go on expanding the network. But, sometimes may be cought red handed. Good people do say yes under some compulsion and 
keep grumbling, being unable to avoid it all together. And, these people atfer induldging in the activity,when refuse to oblige later on due to some or other cause, breed enimity to the severest extent. So, it is better to learn to say a big “No” when somebody does not approve the “Yes” from the inner corner of the heart. It may be unpleasant for time being, but there is no future problem associated with it. Again he will not be approached to gratify the illegal request. That keeps stress and strain out from the person. But, it requires a lot of courage to say “NO”. It is rather difficult but not impossible an act.
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Some years back, one of my friends asked me that a person known to him is having pain in the left arm while walking, compelling him to take a break; and gets back the pain sometimes after resuming his walk. I suggested an electrocardiogram (ECG), and as expected by me a coronary artery disease was diagnosed. This symptom is somewhat a tale tell story of angina pain of heart. In my childhood, I have seen dancing of some superficial arteries of old aged persons and surprised over it; now, I am clear about its cause i.e. it is due to thickening of wall of peripheral arteries from atherosclerosis. In atherosclerosis; there occurs deposit of cholesterol, calcium, some blood cells and some other components in the inner layer of blood vessels called intima. This is equally seen larger as well as smaller blood vessels in the body. Smoking is an important cause of atherosclerosis.
Recently, researchers have found out the role of immune cells in the formation of atheroma after triggering an inflammation in the intima of blood vessels. Drugs targeting these cells also cause harm to useful effects of these cells. So, now they are targeting research, how to destroy the bad effect of cells leaving ahead the good effects. They also found out one molecule that switches on the harmful effect of these immune cells. The new research will be focusing more on blocking the action of the molecule.
Pot bellied persons due excess abdominal fat; the apples are prone to develop atherosclerosis than the pears; persons having fat deposit around hip, researchers say. Smoking, alcohol, sedentary life style and more saturated fat consumption are some of the contributing factors for atherosclerosis. Measurements of waist circumference (WC), waist to hip ratio (WHR) and Body mass index (BMI) are some of predictors of risk of heart attack. Waist circumference >32 inches in female and >37 inches in male have the risk of heart attack. Persons having WHR > 0.7 and BMI >30 are at the risk of developing atherosclerosis.
- Basmati Rice
Rice is the staple diet of more than 50% of population of world. In India, most of the people depend on rice as food. India is one of the most important countries in production of varieties of paddy. It is a good source of carbohydrate and contains about 8-9% of good quality protein. It also contain some B vitamins.
Rice is extracted from paddy after milling. Too much milling or polishing removes most of nutritional value. Washing with a lot of water; cooking in more than required amount of water and draining the water removes much of vitamins from it. Thiamine is a important B vitamin, it contains. In it’s deficiency, people suffer from beriberi. Beriberi is marked by soreness in tongue, anemia, swelling of body due to involvement of circulatory system; and blunting of sensory and motor nervous system etc. Rice consists of three parts namely; germ,endosperm and the outer layer called pericap. The endosperm contains most of carbohydrate where as germ and pericap contain most of vitamins.
Parboiling is an age old established process of preserving the nutritional value of rice in India. This is done in tree steps; 1) soaking paddy in water heated upto about 65 degrees Celsius temperature for 4-5 hours and draining the water; 2) steaming as such; and 3) drying under sun. This process hardens the outer layer of rice making it resistant to insects; the vitamins and nutrients percolate into the deeper layer making those relatively non removable to milling and making it easily digestible by gelatining the starch. Thus, parboiling helps it in many ways in preserving the nutritional value. Rice should not be washed in copious amount of water for many times making the water soluble vitamins vulnerable to be washed away. It also should not be cooked in a large amount of water, and water be drained;which will take away nutrients with it.
So, parboiling and cooking in just the amount of water will protect the nutritional value.
There is pain of varying degree in the anus during passing of motions, compelling the patient to hold stool. The pain lasts for sometimes after the act. Most of the sufferers are ladies. It may follow after passing of hard stool in the recent past.
It is called Fissure-in-Ano. Non-vegetarian food of animal origin is responsible for it as that causes constipation. A life style change with more protein intake has increased it many fold. Some patients have an inherent problem of high sphincter tone. Fissure is a linear ulcer seen in the external anal region. It may occupy either front or back side of anal canal, or sometimes both the sides. In female, it is usally seen in the anterior (front) side whereas in male in the posterior side (back). Usually always, covered by a skin fold in the out side. As the skin fold guards the fissure like a sentry, called sentinel pile, is always painful to touch. The fissure sometimes bleeds and blood comes as a streak attached to the stool.
Fiber in diet prevents it. Most commonly treated in a conservative manner keeping in view to make the stool soft. So, stool softeners paly a major role. Liguid paraffin containing liquids are avoided, as they delay healing. To get ride of pain anesthetic gels are prescribed. A warm bath to anus, called sitz bath is advised after defaecation. An antibacterial gel is also advised. A smooth muscle relaxant gel is also prescribed. If conservative treatment fails a sphincter cutting surgery is contemplated. But, such surgery has the problem of anal incontenence. Most of my patients get relief from dietary modification and conservative treatment.
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