Sleeping with enemy

Sleep is integral part of ourliving . Sleep in appropiate way and time stimulates body to achieve a balance .
I saw a man sleeping in his shop and snoring . His brother consented he doesnot sleep at a stretch and all day also he will doze off every hour or so . Sleep apnoea syndrome . Poor man he was on psychiatric treatment for behaving in a vague way .
I could make a diagnosis of him . Because of constant loud snooring his soft palate used to collapse and cause obstruction to free flow of air .he would wake up to gasp for air and again sleep . The cycle repeats and the patient doesnot sleep at night and so also day . Day time somnolence. 

Such patients are prone for hypertension and heart diseases . If not diagnosed in time can manifest s in a amalgamation of diseases.

There is treatment available for this and doctor might recommend a cpap machine or surgery
.
Came across other dimension of sleep during my practice . Insomnia . The rich wealthy man came for cabg . On history he told he has not slept for 30 years and we should help him with sleep medications after surgery . He owned 36 mines around the area but no sleep . Could it be responsible for his heart disease  ?

Sleep praceful under the starry skies is a sign of royalty . So even if one doesnot own a car bike or say mobile of he is able to sleep peacefully them he is blessed . Modern man in his zest to achieve more wealth has lost his sleep and has to resort to drugs and pills .

A man who has sound sleep will seldom have hypertension.  Other diseases are a ping ball effect of the same and a time reaches exponential magnitude. 

So how much sleep is required ? On an average sleeping for 8 hours is good and this stimulate s body time for wear tear . This repair process is lost in insomnia . And many diseases come forth .

Constant worry of wealth ,

residency blues:surgeon dreams

incidences that have left a lasting impression on me .
railway accident young girl had lost both legs above knee . i was the houseman incharge and had to do her dressings everyday . it was painful ordeal for her and i had to struggle with her wound .
each day the trauma of dressing her wound was too much to bear .

3 years passed and i was returning from my seminar . a young lady welcoming me with smiles and walking towards me . i could not recognise varsha . she had got new prosthesis and a new life . all thanks . 

a dream come true for becoming a surgeon.

buzzing the maze

few heart patients experience changes in heart rhythm also known as palpitations .in medical terms it is called arrhythmia.  

to eliminate arrhythmia electric current is passed through the heart muscle , which sets the abnormal beats to normal . the procedure is maze . maze is but a drawing of few lines on the heart and blocking abnormal firing of extra nodal points . and synchronised beating of heart ensues .

more than 80 % success rate is achieved . those patients are put on simultaneous antiarrythmogic drugs such as amiodarone . 

patient selection is mandatory for planning MAZE procedure during a surgery . chronic atrial fibrillation more than 6 months duration , and left atrium large than 60 mm will not benefit from the procedure . in patients who have undergone MAZE extraprecaution need  to be employed in form of pacing wires are put in situ to be able to attach to pacemaker if need be . 

heart care in winter months

incidence of heart attack increases during winter months.
cold weather causes the blood vessels to constrict in response to cold there by aggravating the incidence of heart attack in the society.

care should be taken during cold weather to protect ones heart

1.layered clothing should be worn rather than single coat over body. the layers hold the heat in between and keep the person warm 


2.avoid unaccustomed strenuous activity during winter months.

unaccustomed activity coupled with cold weather increases the demand on heart causing it to work more.

3.take frequent breaks in activity.increase the number of breaks to sip in fluid or stretch out .winter months we feel less thirsty and over a period of time we could cause dehydration.

4 .avoid alcohol.alcohol gives a false hope of  warmth


5. winter days are shorter ,there by reducing the amount of sunlight we get in a day . additional vit d supplements and food need to be taken to increase the dietary intake of vit d

mitral valve regurgitation

one or more leaflets of the mitral valve may get elongated and become floppy.the chordae tendonae which are holding the mitral valve leaflets may get torn in the disease process and causing severe mitral regurgitaion.


such patients usually present with pulmonary edema and are breathless on rest.
repair of such dysfunctional valve may be carried out.

rheumatic heart disease

rheumatic heart disease starts in early childhood to make its presence felt in younger days. a lot of work days are lost ,some even remain uneducated because of frequent illness associated with rheumatic heart disease.
the disease process takes form of frequent sore throat infections followed by swelling of joints and limbs.if untreated the disease matures into a fulminant heart disease . it usually affects the mitral valve. in some cases the aortic valve is affected too.

the mitral valve disease is in form of mitral stenosis .in early stages the valve leaflets are not involved in the disease process.


the disease is restricted to the commissures only insuch a situation the mitral commissurotomy can be carried out.balloon mitral commissurotomy is the minimally invasive procedure carried out in the cath lab through femoral vein route.

at times the mitral valve leaflets are not pliable and during the process the mitral valve my get ruptured inadvertantly.then the open mitral valvotomy should be carried out in emergency .if not intervened in time the condition of patient deteriorates quickly.

the other valve affected in this disease process is the aortic valve too.

at times in chronic conditions the tricuspid valve is also involved though it is most of the time functional involvement and not physical .necessating the tricuspid valve repair in form of annuloplasty.

fever

fever is a common occurrence after the patient is operated for heart. patients are given anti pyretic tablets for the same. if the temperature lasts for more than 2 days ,the patients needs to be concerned and visit his operating surgeon for opinion. the surgeon can then change the anti biotics or prescribe new medications.usually we will wait for culture sensitivity report of the blood  and start the required anti biotics.
for fever lasting more than 5 days or sudden spurts of fever not responding to treatment,care needs to be taken to evaluate the cause of fever.there might be an element of infective endocarditis.