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Diabetes is no longer irreversible

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Diabetes is no longer irreversible

Diabetes

Diabetes: Reversing the irreversible

There is nothing new in acknowledging “diabetes” as a looming health crisis despite many recent advances in medicine and technology. Apart from being a pocket pincher, it has been identified as an incurable and progressive chronic disease, requiring medicines and insulin for the rest of life. It is looked upon as a life sentence once the diagnosis is made.

To give it a little sigh, a new section has been added in the 2016 WHO global report on “Diabetes Reversal”, a promising way to save the lives of many patients caught in this unprecedented epidemic.

Basics in diabetes, an old story yet relevant-

Known by “lifestyle disease” or simply “sugar” in common parlance, diabetes is a condition characterized by chronically elevated blood sugar levels. The mechanism behind high sugar varies depending on the type of diabetes. The major chunk of the disease is made by type 2 diabetes. The main driving force is “Insulin Resistance”, which means the body has normal insulin production but cells are resistant to its actions. All this has been linked to obesity, physical inactivity, and consumption of high-calorie foods.

What is diabetes reversal?

Means achieving glucose level below the diabetic range in the absence of active pharmacologic or surgical therapy. It’s more like inducing a drug-free period of remission in the already diagnosed patients.

Methods of reversal?

Bariatric surgery has a well-documented role in diabetes reversal. The basic idea in reversibility is to target the root cause that is insulin resistance. By achieving substantial weight loss, one can reduce the fat inside body cells and make it more sensitive to insulin action. This includes an intensive phase of strict calorie restriction and the burning of fats. Everyone knows that diet and exercise are the cornerstones for the treatment of all lifestyle diseases including diabetes. But unfortunately, many of the diabetics don’t aim for reversibility at any point of treatment. Reasons being unawareness and lack of self-motivation. Successful attempts of reversibility have been observed in type 2, obese patients, and even diabetes of 6 yrs duration.

Roadmap for reversibility

  • Aim for significant weight reduction
  • Cut down calories consumption to around 700-800/day
  • Indulge in at least moderate-intensity exercise (2-21/2 hrs /week)
  • Say NO to ALL sugar
  • Eliminate refined carbohydrates (flour, white rice, pasta) from your diet.
  • Stick to whole, natural, unprocessed foods
  • Include high-quality proteins and fats with each meal
  • Choose healthy, natural, omega3 fats –nuts, avocados, almonds, flaxseed, and whole eggs
  • Opt for intermittent fasting or time-restricted feeding i.e going empty stomach for a set amount of time in a day
  • Beware of illegally marketed formulations which claim to cure diabetes

It’s high time to stimulate interest in achieving remission as a treatment target at both provider and patient-level by addressing the root cause. A stern move by all of us can definitely revolutionize the way diabetes will be treated in the coming years.

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Medicare

Adult immunization – Vaccinations aren’t just for kids

Adult immunization

Vaccination is the safest and most effective way of disease prevention. It is the prime mode of making an individual immune and is the success story of the 21st century. Everyone is aware of childhood immunization, however, very few know about the need for immunization as an adult. In fact, adult vaccination coverage in our country is the most ignored part of health care services.

Why immunize an adult?

  • Immunity from some of the childhood vaccinations can wear off with time and thus might fail to protect us in adulthood. So, revaccination in the form of booster doses is required.
  • Better and safer vaccines keep on adding to the armamentarium, which may not have been available when we were children.
  • Vaccines and their recommendations keep changing with time according to the changing pattern of the different infections. So, we need to keep ourselves updated.
  • Just because we are adults doesn’t mean we aren’t at risk for certain diseases. Depending on the age and other factors, adults may be more  at risk than children.

Which vaccines do you need?

Vaccines are recommended for adults on the basis of age, prior vaccinations, co-existing health problems, lifestyle, occupation, and travel plans. Following is the list of few important vaccines which are recommended for all healthy, non-pregnant adults at different ages groups:

  • Influenza (seasonal flu) vaccine – for all adults over the age of 50 yrs annually.
  • Pneumococcal vaccine – for all adults age 65 years or older, as well as adults age 19 to 64 years who smoke or have diabetes or chronic heart, lung, liver, or kidney disorders.
  • Chickenpox vaccine – for all adults who have not had chickenpox or the vaccine previously.
  • Herpes zoster (shingles) vaccine – for adults age 60 years and older (whether or not they report a prior episode of shingles).
  • Tetanus vaccine – for all adults every 10 years, with at least one shot against whooping cough (Tdap) if not received during adolescence.
  • HPV (human papillomavirus) vaccine – for women age 26 or younger and men age 21 and younger (HPV virus can cause cervical, anal, oral, and throat cancers).
  • MMR – If you have not had an MMR vaccine and have never had measles,  mumps or rubella, you may need the vaccine.
  • The best way to decide exactly what you need and how to get fully immunized is to talk with your healthcare provider.

Protect yourself and your loved ones

Some people in our family or community e.g. Infants, elderly, people with weakened immune systems (undergoing cancer treatment) are especially vulnerable to infections, at the same time vaccines are contraindicated for them due to their age or health condition. Thus they rely on our immunity to help prevent the spread of disease to them.

Make sure you are vaccinated for the best protection!

Adult vaccination must become part of routine immunization because these vaccines alone can save millions of lives and reduce the economic burden on the world’s healthcare systems.

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Medicare

Fatty Liver: A modern day life style disease

Fatty Liver

What is fatty liver disease?

The liver is the second largest, the multifunctional organ inside our body which helps in digestion, energy storage, and detoxification. A healthy liver contains little or no fat. Fatty liver is a condition in which fat builds up in the liver. There are two main types:

  • Alcoholic fatty liver disease: related to the consumption of large amounts of alcohol.
  • Nonalcoholic fatty liver disease (NAFLD): related to a wide range of conditions other than alcohol. In fact, routinely used terminology fatty liver is shorthand for NAFLD.

How common is Fatty Liver disease?

It is also projected as one of the leading indications of liver transplantation in the present decade. The increasing incidence of NAFLD is tied to the growing obesity epidemic but not every obese develops fatty liver, and vice versa. Owing to rising childhood obesity, fatty liver is expected to become the leading cause of liver disease and failure, and indication for liver transplantation even in children and adolescents, within the next 10 years.

What are the risk factors for fatty liver?

  • Obesity
  • Diabetes
  • High blood cholesterol
  • High blood pressure
  • Family history
  • Drugs (steroids, anticancer drugs)
  • Rapid weight loss/ poor eating habits
  • Certain infections (hepatitis C)

What are the stages of fatty liver?

The spectrum of Fatty liver disease can be divided into 4 stages:

Stage 1 (simple fatty liver or steatosis): when fat accounts for more than 5 to 10 % of the liver’s weight without any inflammation or liver cell damage. It is one of the most common forms of reversible, harmless liver disease, with an estimated 30-40% prevalence in India. There are usually no symptoms and diagnosed incidentally.

Stage 2 (Non-alcoholic steatohepatitis, NASH): This means when the liver gets inflamed along with fat accumulation. Around 5-8% of the Indian population has NASH. NASH is a more aggressive form. A person may have a dull or aching pain in the top right of the abdomen or fatigue.

Stage 3 (Fibrosis): When the healthy liver tissue is replaced by fibrous scar tissue.

Stage 4 (cirrhosis or chronic liver disease): the most severe irreversible stage, bands of scar tissue develop, liver shrinks, becomes hard, functions less and leads to liver failure.

Apart from these, fatty liver can lead to liver cancer in a few circumstances.

How can Fatty Liver be diagnosed?

Fatty liver is often diagnosed incidentally when ultrasonography picks excessive fat content in the liver or routine blood tests show raised liver enzymes (ALT/AST) signifying ongoing inflammation in the liver. At-risk persons should get liver function tests and ultrasonography of the upper abdomen regularly.

Once the fatty liver is diagnosed, a newer technique called fibroscan/ transient elastography, which measures the liver’s stiffness, can help in the staging of fatty liver disease. Greater stiffness suggests greater scarring. A liver biopsy may be recommended if tests are inconclusive.

What are the treatment options for non-alcoholic fatty liver disease?

Diet, Exercise, and Healthy Lifestyle are the first and foremost treatment options.

  • Gradual weight reduction (>10% of baseline) can remove some fat from the liver
  • Eat a healthy diet with lots of fruits, vegetables, and whole grains, limiting salt and sugar.
  • Do daily moderate-intensity exercise such as walking or cycling, at least 150 minutes a week. All types of exercise can help improve NAFLD, even if you don’t lose weight.
  • Use cautiously dietary supplements, vitamins, or herbal remedies as these can damage the liver.

According to the latest American and European Liver society guidelines, no specific drug therapy can be firmly recommended for NAFLD at present.

What is the long-term prognosis of fatty liver?

The progression rate of simple fatty liver to advanced disease is low, and it may go away with simple lifestyle modification. But that doesn’t mean it’s not a serious condition as few people can eventually develop stage 2 disease.

In patients diagnosed with stage 2 fatty liver disease i.e. NASH, there are about 25% chances of developing cirrhosis within a decade and of this, about 50% will develop liver failure with the survival rate of no more than two years. So here is the importance of lifestyle changes at early stages to prevent the disease from getting worse.

To summarize, fatty liver is plaguing our modern society in parallel with other common lifestyle diseases. It is not a single entity rather a sequential spectrum of stages, out of which simple fatty liver is the most common earliest reversible phase which can be taken care of by lifestyle modification and weight loss; else it can progress to liver cell damage in 10- 25 % from where there is no turning back. Hence ‘ an ounce of prevention is worth a pound of cure’ holds true for fatty liver.

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Medicare

Interpretation of Complete Blood Count

Interpretation of cbc

We all undergo a blood test sometime or another in our life. While most of us have basic knowledge about hemoglobin, hematocrit, and white blood cells (WBC), there are a number of other components of a CBC report that we do not understand. If they appear in the report, they must hold some significance.

What are the different blood components?

The two main components are plasma and cells. The cells flow freely in a liquid-like substance which is known as plasma. The cells are of different types and include erythrocytes (red blood cells or RBC), leukocytes (white blood cells or WBC), and the thrombocytes, also known as platelets.

What is analyzed in a CBC test?

CBC test measures the number of RBCs, hemoglobin, hematocrit, reticulocytes, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration in the blood. Additionally, platelets are also calculated in a CBC test.

Red blood cells

Commonly known as RBC, the measurement of the blood cells shows the number of erythrocytes in 1 cubic mm of whole blood. In the case of iron deficiency, blood loss, hemolysis, and bone marrow suppression the number of RBC decreases.

Hemoglobin

Hemoglobin is a pigment available in RBCs and is responsible for carrying oxygen to the different parts of the body. 14-18 g/dl and 12-16 g/dl is the normal level of Haemoglobin in males and females respectively.

Haematocrit

This the measurement of cell volume as a percentage of the plasma and cell volume in the blood. Normally, the Haematocrit percentage is 3 times more than the hemoglobin count.

Reticulocyte

The new cells released by the bone marrow are known as Reticulocyte.

Indices

Indices are the measure of the average characteristics of the erythrocyte. This includes mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), the mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW).

Platelets

They are also known as thrombocytes. Platelets are also formed in the bone marrow. They can be defined as the fragments of the megakaryocyte cytoplasm and are responsible for stopping the bleeding. An individual dealing with thrombocytopenia will have a low platelet count.

White blood cells

White blood cells are smaller in size than red cells. They are also known as leukocytes. They are responsible for the response to any type of inflammatory condition or injury.

Miscellaneous content of CBC

  • Bands: Also known as stabs. Their presence indicates that the inflammatory process is occurring.
  • Eosinophils: The number of Eosinophils increases in case of allergic and inflammatory reactions and parasite infections
  • Basophils: They contain heparin and histamine and are active in case of allergic and stress situations.
  • Monocytes: They are responsible for removing injured and dead cells, microorganisms and other particles from an injured site.
  • Lymphocytes: These are of two types – B cells and T cells and fight virus infections.

Hope this helps you read your CBC report efficiently the next time.

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Medicare

First in Ludhiana to get NABH Safe-I Certificate

First in LudhianaRG Stone has become the first hospital in Ludhiana to get Safe-I certificate from National Accreditation Board for Hospitals & Healthcare Providers (NABH). Safe-I is the most comprehensive certification program that enables healthcare organizations in upgrading their infection control practices thereby ensuring quality care for their patients. It is increasingly being recognized by healthcare fraternity that a vibrant and functional infection control program is the cornerstone of ensuring safety and quality.

It will help us to get recognized as a hospital that follows the mandated quality protocols and has a vibrant infection control program that enables safety for the patients, ensures safety for the healthcare workers, and has processes that ensure that it does not generate waste that is dangerous to the community.

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Medicare

RG Stone now in Bathinda

We proudly announce the opening of our satellite clinic cum information centre in Bathinda. Every Saturday our urologists from RG Stone, Ludhiana will be attending the OPD from 10:00 am to 2:00 pm

Patients from Bathinda and adjoining regions can call us at 0164-5012222 or on our 24 hrs helpline 98769-10000.

RG Stone Bathinda

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Medicare

Rare distinction for RG ORTHOPAEDICS’ surgeon

RG Orthopaedics & Joint Replacement Centre is a well-known name around the world for its orthopaedic related specialized treatments. The department is headed by Dr. Bikram Singh Rajpal from the last 3 years. He is one of the fewest surgeons in Punjab who has received Mch degree in the field of orthopaedics from the University of Seychelles, American Institute of Medicine (USAIM). He has done numerous reconstructive & joint replacement surgeries at RG Stone And Super Speciality Hospital, Ludhiana.

RG Stone And Super Speciality Hospital, Ludhiana is the premier institute in Punjab which is providing all types of orthopaedic related treatment facilities under one roof. RG Joint Replacement Centre at Ludhiana offers special features that are absolutely essential for joint replacement. The operation theatre at RG is a modular theatre and has a vertical laminar flow / HEPA filter.

RG Joint Replacement Centre has a quality operation theatre having an advanced design to minimize the infection along with very high hygiene standards, clean air, flexibility, better work efficiency & cost-effectiveness. These OT’s comply with international standards. The ceiling of the RG Modular OT consists of a plenum box supplied with conditioned air from the central system via “S”’ class HEPA filters mounted on the top which gives a filtration level of 0.3 microns and also filter 99.99% of particles. The operation theater contains a wide variety of equipment & services in a relatively small area.

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