Rectal bleeding needs immediate attention

Rectal bleeding happens when one passes blood through the anus. Passage of blood during bowel movement usually means there is bleeding somewhere in the digestive tract. Sometimes the amount of blood that is passed with the stool is so less that it can only be detected by tests (which checks for hidden blood in the stool). Bleeding that usually happens higher up in the digestive tract makes the stool appear to be black and tarry. A person with blood in the stool may be unaware of bleeding and experience no symptoms. On the other hand, they may also have abdominal pain/cramping, vomiting, weakness, difficulty breathing, diarrhea, palpitations, fainting, and weight loss depending on the cause, location, length, and severity of the bleeding

Some common causes of Rectal Bleeding may be:

• Diverticular disease – Diverticula are small pouches that protrude from the colon. They usually do not cause any problems, but sometimes they can bleed and become infected. Treatment may include a special diet, antibiotics, or surgery.
• Anal fissure – A cut or a tear in the lining the anus similar to cracks that occur in chapped lips or a paper cut are referred to as Anal fissure. They are generally caused by passing a large, hard stool and are very painful.
• Colitis – Inflammation of the colon due to infections in the inner lining of the colon.
• Angiodysplasia – Bleeding which happens due to fragile, abnormal blood vessels
• Peptic ulcers. They are open sore in the inner lining of the or the duodenum, the upper end of the small intestine. They are infections caused by bacteria called Helicobacter pylori ( pylori). Such ulcers are generally caused by long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen.
• Polyps or cancer – Polyps are usually benign growths which can grow, bleed, and become cancerous. Colorectal cancer often causes bleeding that is not noticeable with the naked eye.
• Esophageal problems – Varicose veins of the esophagus or tears in the esophagus can also lead to severe blood loss.

Diagnosis

An accurate diagnosis of the location and the cause of rectal bleeding is very important for proper treatment, and to prevent further bleeding. Diagnosis can be done based on physical examination, anoscopy, flexible sigmoidoscopy, colonoscopy, radionuclide scans, angiograms, Video capsule and small intestine endoscopy and blood tests.

Can rectal bleeding or blood in the stool be prevented?

Most diseases that cause rectal bleeding may be prevented by following these steps:

• Hemorrhoids can be avoided with proper diet so that there is no constipation and straining to pass stool. Sometimes normal pregnancy increases the risk of hemorrhoid formation as does the acute diarrhoeal illness.

• Avoiding constipation is believed to decrease the risk of diverticulosis, protrusions in the lining of the colon, and the risk of a diverticular bleed.
• Alcohol abuse increases the risk of rectal bleeding in a variety of ways, from directly irritating the lining of the gastrointestinal (GI) tract, to decreasing clotting capabilities of blood.

What is GERD?

Sometimes on burping we feel an acidic taste in our mouth. What is it? It is a digestive disorder that occurs when acidic juices from the stomach, food and fluids flows back into the tube connecting our mouth and stomach. It can affect people of all ages whether infants or adults. GERD occurs when the sphincter at the bottom of the oesophagus becomes weak, or opens when it should not.  People with asthma are at higher risk of developing GERD. Asthma flare-ups can make the lower oesophageal sphincter relax, allowing stomach contents to flow back, or reflux, into the oesophagus. Acid reflux irritate the airways and lungs worsening asthma. This, in turn, can lead to progressively more serious asthma. GERD can be managed with lifestyle changes and medications. But many a time people with GERD may require stronger medications or surgery to ease the symptoms.

GERD occurs more commonly in people who are:

• overweight or obese because of the increased pressure on the abdomen
• pregnant
• taking certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants
• Smoking, and being exposed to second-hand smoke
• Drinking Alcohol or coffee
• Eating certain kinds of foods like fatty or fried foods may trigger it
• Suffering from Hiatal hernia. It is a condition where an opening in the diaphragm lets the top of the stomach move up into the chest. This lowers the pressure in the oesophageal sphincter and raises the risk of GERD

Symptoms

Common signs and symptoms of GERD include:

• A burning sensation in the chest/heartburn, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat
• Chronic sore throat
• Laryngitis or hoarseness
• Inflammation of the gums
• Cavities
• Bad breath

GERD if not treated on time and worsen. It can lead to complications like:

• Oesophagitis:Inflammation of the esophagus.
• Oesophageal stricture: The oesophagus becomes narrow, making it difficult to swallow
• Barrett’s oesophagus: The cells lining the oesophagus can change into cells similar to the lining of the intestine and can develop into cancer.
• Respiratory problems: Sometimes stomach acid can be breathed into the lungs, which can lead to chest congestion, hoarseness, asthma, laryngitis, and pneumonia.

Diagnosis

To diagnose GERD several tests may be used including:

• X-ray of the upper digestive system
• Endoscopy (examines the inside of the esophagus)
• Ambulatory acid (pH) test (monitors the amount of acid in the oesophagus)
• Oesophageal impedance test (measures the movement of substances in the oesophagus)

Treatment & Management

If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.

Lifestyle changes to treat GERD include:

• Elevate the head of the bed 6-8 inches
• Lose weight
• Stop smoking
• Decrease alcohol intake
• Limit meal size, avoid heavy meals and eat slowly
• Do not lie down immediately after eating
• Avoid foods and drinks that trigger reflux like fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
• Avoid tight-fitting clothing

Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors may be effective in blocking acid production.

In severe and medication intolerant cases, surgery may be recommended. Surgical treatments for the prevention of GERD may include:

• Fundoplication: Here the surgeon sews the top of the stomach around the oesophagus which adds pressure to the lower end of the oesophagus to reduce reflux.
• Endoscopic procedures: To tighten the sphincter muscle stitches are used, and radiofrequency, which uses heat to produce small burns that help tighten the sphincter muscle.

Tuberculosis: Be Aware & Beware!

Poet John Keats, writer George Orwell, novelist Emily Bronte, actor Vivien Leigh, politician Simon Bolivar and poet Sukanta Bhattacharya…are all famous names who have one thing in common. We lost them all to the dreaded disease called Tuberculosis (or consumption as it was called). Today TB still remains a dreaded term even though medical science has found a cure to it. But lack of awareness and apathy has kept it almost on top of the list of diseases that cause the maximum number of deaths in the developing countries

What is Tuberculosis?

Tuberculosis is an infection, mostly striking the lungs, that kills more adults in India than any other infection. Each year, approximately 220,000 TB deaths are reported in our country and 2.2 million new cases are identifiedout of a global incidence of 9.6 million cases.6.7% of TB patients tested were found to be drug-resistant.However, TB is not an infection restricted to the lungs, it can occur in different parts of the body.
TB is curable with the correct treatment of full course of medications and stringent follow-up. Nelson Mandela, Graham Bell, Ringo Starr, Desmond Tutu andour own Amitabh Bachchanare among the famous names who have survived the dreaded disease and have led long and fruitful lives.

What Causes Tuberculosis

TB is an infecton caused by bacteria that spread from person to person through microscopic droplets released into the air by coughs, sneezes, spits, of the infected person.

Some key points about tuberculosis

• WHO estimates that around 9 million people get sick with TB per year, 3 million of these are “missed” by health systems
• TB is one among the top 3 causes of death among women aged 15 to 44
• TB symptoms (cough, fever, night sweats, weight loss, etc.) may be mild for many months, and peoplewith TB can infect up to 10-15 other people through close contact over the course of a year
• TB is an airborne pathogen, meaning that the bacteria that cause TB can spread through the air from person to person

Different kinds of TB infections:

Latent TB-the bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active

Active TB –the bacteria causes symptoms in the infected and can be transmitted to others

Drug-resistant TB – Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The bacteria which survive become resistant to that particular drug and other antibiotics as well. Sometimes, TB patients become drug-resistant because they discontinue taking medicines once they begin feeling better. On resuming the drugs, they often test resistant

It is said about one-fourth of the world’s population is believed to have latent TB and there is a 10 percent chance of this latent TB becoming active, but this risk is much higher in people who have a compromised immune systems, like those with HIV or suffering from malnutrition, people who smoke, drug users and health care workers who treat people with a high risk of TB.

TB bacteria most commonly grow in the lungs and can cause symptoms such as:

• A cough lastingfor 3 weeks or longer
• Pain in the chest region
• Coughing up blood or sputum

Other symptoms of TB.

• Weakness or fatigue
• Weight loss
• No appetite
• Chills
• Fever
• Night Sweats

There some very common myths associated with TB which often lead to misconceptions and also incorrect treatment at times

Tuberculosis: Facts and Myths

• Myth: TB runs in the family; it is a genetic / hereditary ailment

Fact: Heredity or genes have simply no role

• Myth: There is no cure for TB or having it means death

Fact: TB is curable and effective anti-T.B. medicines are available today

• Myth: TB occurs only in the lungs

Fact: TB can occur in different organs like the Lymph nodes, Bones, Kidney, etc

• Myth: It is highly contagious and exposure to any TB patient can lead to the disease

Fact: Only Lung TB is infectious but TB in organs and childhood TB are non-infectious

• Myth: Coughing out blood with sputum means sure shot TB

Fact: Bleeding gums, sore throat, ulcers in mouth, nose bleed, pneumonia, peptic ulcer, bleeding disorders and cancer could lead to cough with blood and is not the only criteria to confirm TB

• Myth: It is a disease of the lower socio-economic class

Fact: TB can affect anyone irrespective of their socio-economic background and living conditions

• Myth: Treatment of TB is very expensive

Fact: Govt. of India provides drugs and tests for TB absolutely free of cost to Indians if they are registered with Revised National Tuberculosis Control Programme (RNTCP)

Complications

Without treatment, active tuberculosis can be fatal. Apart from the lungs, it can spread to other parts of the body through the bloodstream. Some complications of TB include:

• Spinal pain- Back ache and stiffness
• Joint damage-TB may also affect the hips and knees
• Swelling of the membranes that cover your brain (meningitis) – Tuberculosis can cause swelling in the brain membraneswhich can lead to lasting or intermittent headaches
• Liver or kidney problems –Functions of Liver and Kidney get impaired by tuberculosis
• Heart disorders –Sometimes tuberculosis can infect the tissues that surround the heart, causing inflammation and fluid collections effecting the heart’s ability to pump effectively

Testing

There are mainly two kinds of tests which are used to detect the TB bacteria in the body:

• TB skin test (TST)or the Mantoux tuberculin skin test
• Blood tests

A positive result means the person is infected with TB bacteria, butit does not classify whether he/she has latent TB infection (LTBI) or it has progressed to TB disease. Other tests, such as a Chest X-ray and a sample of sputum, are required to know whether the person has TB disease or not

Treatment

TB medications if started immediately will gradually control and finally cure the disease if the correct protocols are followed. However, the medications take a while to start acting. If you have been diagnosed with TB, then follow some simple tips to keep your friends and family from getting infected:

• Stay home – Do not go to work or school or sleep in a room with other people during the first few weeks of treatment to prevent active tuberculosis from spreading
• Proper Ventilation – TB germs spread more easily in small spaces where air doesn’t move thus good ventilation is a must to prevent it from spreading
• Cover your mouth –Cover your mouth with a tissue or a cloth anytime you laugh, sneeze or cough and throw it away when not required
• Wear a mask – Wearing a mask during the first few weeks of treatment, may help to cut down the risk of transmissionof the disease to others
• Finish your course of Medication –This is the most important step you can take to protect yourself and others from tuberculosis. Stopping or skipping treatment gives the TB bacteria chance to mutate which allow them to survive the most potent TB drugs. Drug-resistant strains are much more deadly and difficult to treat.
• Vaccination – In countries where tuberculosis is more common, infants are vaccinated with Bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children.

Medicine

For Latent TB one may have to take medications for 9months/4months or 3months depending on the extent of the infection. For Active TB you will need to take a number of antibiotics for 6 to 9 months. But for the Drug Resistant TB you may need to see a specialist as soon as possible and may need to take the medications for around 20 to 30 months.

Living with COPD

Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a group of progressive lung diseases including emphysema, chronic bronchitis, nonreversible asthma, and some forms of bronchiectasis. COPD is a common condition that mainly affects middle-aged or older adults who are exposed to smoke. Most people don’t even realise they have the disease. The breathing problems tend to get gradually worse over time and can limit your normal activities, although proper treatment can help keep the condition under control. According to the World Health Organization report, the prevalence of COPD ranges between 4% and 20% in Indian adults. Exposure to biomass combustion fuels inside the home, lead to hazardous indoor air effluents which are associated with an increase of COPD. This is worse in the rural areas where houses are poorly ventilated. Added to this, the non-conventional forms of tobacco products such as bidi, hookah, which deliver relatively greater amounts of combustion by-products, are excessively consumed in the rural areas. This disease is mainly characterized by increasing breathlessness, generally caused by damage to the lungs over a long period due to smoking, chemical fumes, dust, air pollution, etc.

Symptoms of COPD

Some of the common symptoms of COPD are:

• Increased breathlessness
• Frequent and long lasting cough
• Wheezing
• Tightness in the chest

Who are prone to COPD

• People who smoke
• People who are exposed to lung irritants more often
• People who are exposed to a lot of second hand smoke
• People who have a family history of COPD
• People who have Asthma or history of respiratory problems

How can COPD be diagnosed?

To diagnose if you have COPD or not your doctor will:

• Do a physical examination and listen to your lungs
• Enquire about your smoking habits or your exposure to lung irritants
• Carry out breathing tests like spirometry
• Do other tests like Chest XRay and others to rule out other problems

Ways to minimize chances of flare up of symptoms

• Avoid smoking or being around second hand smoke, fume or irritants
• Use an air filter in your home
• Use mask while you are out to prevent pollutants from triggering COPD
• Keep in touch with your doctor and always have medicine at hand
• Get your flu shot, pneumococcal vaccine, and a tetanus booster that provides protection from pertussis and whooping cough
• Keep a portable oxygen unit ready for use when required

Treatments for COPD

The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition. Treatment includes:

• Quit smoking – if you have COPD and you smoke, this is the most important thing you can do
• Inhalers and medications – to help make breathing easier
• Pulmonary rehabilitation – a specialized programme of exercise and education
• Surgery or a lung transplant –this is only an option for a very small number of people

Thus, it is important to know the signs and symptoms of COPD so as to get the treatment soon. Treatment in time will help avoid future complications and distress.

Air Pollution

Air pollution has been a serious environmental problem and a major concern for public health worldwide. It continues to be a major environmental health risk, particularly in developing countries where the motor vehicle traffic and industrialization increase quickly. The respiratory system (tract and lung) is vulnerable to air pollutants, including ozone, carbon monoxide, nitrogen dioxide, sulphur dioxide and particulate matters.

There are four main types of air pollution sources:

• mobile sources – such as cars, buses, planes, trucks and trains
• stationary sources – such as power plants, oil refineries, industrial facilities and factories
• area sources – such as agricultural areas, cities and wood burning fireplaces
• natural sources – such as wind-blown dust, wildfires and volcanoes

Air pollution is highest during the heat of the day, so plan your outdoor activities for early morning or late evening. Avoid walking or biking on busy streets. If you’re sitting in traffic, use the recycled air setting on your air conditioner to help cut down on fumes.

If you’re in a location where you can’t escape the pollution, try putting a handkerchief over your mouth and nose to help filter gas and smoke.

Antioxidant-rich foods like fruits and vegetables can also help shield your body from the damaging effects of free radicals created by air pollution.

Finally, don’t forget that indoor spaces can be polluted, too. To limit pollution at home, don’t forget to:

• Consider purchasing an indoor air purifier
• Avoid air fresheners and candles
• Keep filters on air conditioners and heaters clean
• Vacuum often
• Wash sheets and stuffed toys to get rid of dust mites
• Open the windows to circulate the air on days when the air quality is good

Sudden Cardiac Arrest

World pair figure skating champion Sergie Grinkov already had four world champion, and two Olympic trophies under his belt by the time he was 28. Pairing with his wife Gordeeva, he won his first World Champion trophy when he was just 18 and the pair became known for their quiet glide over ice, making no noise as they glided. A darling of the crowds wherever he performed, the Russian ice skater was just 28 on 20th November 1995, when he suddenly collapsed while practicing at Lake Placid in New York, for the upcoming ‘Stars on Ice’ tour, and died of a massive heart attack. Doctors found he had severely clogged arteries. He also had a genetic risk factor (PLA-2 variant) linked with premature heart attacks. The risk factor is now also known as the ‘Grinkov risk factor’.

Brazilian footballer Christiano Sebastiao de Lima Junior was known for his sublime skills as the forward for India soccer club Dempo (Goa). Earlier, he had formed an elite strike partnership with India’s ace footballer Baichung Bhutia, with the pair leading Kolkata Club East Bengal to victory in the league championship games. Playing for Dempo in Federation Cup finals against Mohun Bagan on 5th December 2004, Christiano Junior collided with the opposition team goalkeeper and collapsed. Attempts to revive him on field were unsuccessful and he was rushed to a nearby hospital, where he was pronounced brought dead. Autopsy revealed he had died of cardiac arrest. He was only 25.

Sudden Cardiac Arrest in young athletes is not an uncommon phenomenon.

Young athletes aged between 25 and 35, with no previously known symptoms, have been known to collapse while playing and die due to cardiac arrest. Argentinian footballer Christian Gomez, professional basketball player Gilbert D Bulawan from Phillipines, swimmer Alexander Dale Oen, wrestler Eddie Guerrero, Marathon runner Ryan Shay to name just a few, are all victims of ‘sudden cardiac death’.
It has been seen that the sudden cardiac arrest syndrome affects men more than women. The arrest occurs without warning and is usually triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). With its pumping action disrupted, the heart is unable to pump blood to the brain, lungs and other organs, and within seconds the person loses consciousness and has no pulse. If the victim does not receive treatment immediately, death occurs within minutes of the attack.
Signs of sudden cardiac arrest include

• Unconsciousness
• Irregular or no breathing
• Chest pain
• Discomfort in one or both arms or in the back, neck, or jaw
• Unexplained shortness of breath

With each passing minute after a sudden cardiac arrest, the survival chances of a person diminish by 10 percent. Unless revived immediately by CPR or with defibrillator, the person will go into coma leadng to eventual death.  Fortunately, star basketball player Mike Papale survived because of the quick reaction of an EMT, who immediately initiated CPR and the chain of survival

Are Heart Attack and Cardiac Arrest the same?

No, Sudden Cardiac Arrest is not a Heart Attack (myocardial infarction). A heart attack occurs when blood flow to the heart is blocked, and sudden cardiac arrest occurs when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem whereas a sudden cardiac arrest is an “electrical” problem. Sudden Cardiac Arrest, however, may occur post a heart attack.

Conditions that can trigger Sudden Cardiac Arrest include:

• Coronary artery disease -This is the most common cause of sudden cardiac arrest in people with age above 35
• Cardiomyopathy – When you have this condition, your heart muscle becomes enlarged/thick and weakened
• Long QT syndrome and Brugada syndrome –It is a disorder of the heart’s electrical system which leads to abnormal heart rhythms
• Marfan syndrome – it is an inherited disorder which causes parts of the heart to stretch and become weak
• Heart birth defects – Risk could be due to unidentified congenital defect, however, even if a person has had surgery to correct a heart defect at birth, he or she is still at risk of sudden cardiac arrest

Know the risk factors

• Generically, men are more at risk that women
• The risk increases with age in both men and women, however, this does not hold true for people who have already been diagnosed with heart disease and are under treatment
• A previous episode of cardiac arrest or heart attack
• A family history of cardiac arrest or heart disease
• Hypertension, obesity, smoking habit, elevated sugar and cholesterol levels increases the risk

Treatment & Prevention

As in most cases sudden cardiac arrest occurs without any previously identified symptoms, prevention is difficult. However, in people with known family history of heart disease or with any other risk factor, it is advisable to go per regular consultations and check-ups.

Sudden Cardiac Arrest requires emergency treatment, which includes CPR (Cardio Pulmonary Resuscitation) and/or Defibrillation (electric shock to the heart) for reviving the victim. Post revival the patient needs to be transferred to an emergency cardiac care unit and may need medical (with drugs), interventional (angioplasty) or surgical (Bypass) treatment.

At Medica, we have the most effective emergency transport service for cardiac emergencies, fully equipped emergency room, skilled cardiologist and surgeons available round the clock, along with latest generation Cathlabs to handle all Heart related emergencies. We have one of the most advanced ICU/CCU in Eastern India for best care of critical patients. Medica’s Chest Pain Responder service is equipped to provide the best possible cardiac support during transport of heart attack or cardiac arrest patients.