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How to Treat Varicose Veins

Veins are blood vessels that restore blood from all the organs in the body towards the heart. The veins closer to the skin surface are called superficial veins. They handle less than ten per cent of the returned blood flow. But the veins that are deeper and closer to the centre of the body are called deep veins. Perforating veins connect the superficial veins to the deep veins.

When a few of these superficial veins become enlarged, dilated and raised over the skin’s surface, they are termed as varicose veins. They can develop anywhere in the body, but are more commonly observed in the legs.

About 25-30 per cent of the Indian population suffer with varicose veins, with the problem persisting more in females than in males. They can be painful and cosmologically a concern, but they are usually harmless. Another type of varicose veins are spider veins, which are non-palpable, small starburst clusters or spider web-like veins over the skin’s surface, These are often asymptomatic.

Symptoms of Varicose Veins

• Appearance of dark purple or blue coloured blood vessels on the thigh and the calf region.
• Heaviness, tenderness or soreness in the legs, accompanied with swelling in the feet or ankles precipitated by standing for a prolonged period of time.

In advanced stages of varicose veins, skin changes such as edema, inflammation, pigmentation (darkening of skin) and skin ulcers may be observed. These ulcers would heal initially, but when it reaches the final stage they convert into non-healing venous ulcers.

Diagnosis

Those suffering from the above signs and symptoms can undergo a simple ultrasound venous Doppler test, to confirm the disease. And like in the case of any other disease, the earlier the treatment of varicose veins, the better the results. A varicose vein is an irreversible and progressive disease. So, at any stage of disease, a patient can visit an interventional radiologist for treatment. However, the treatment will vary according to the stage of the disease.

Treatment

Traditional treatment consisted of open surgery ligation and the vein stripping procedure, resulting in sutures, scars and delayed healing. Due to the fear of surgery and a lack of awareness, patients avoid or delay the treatment for varicose veins.

Modern treatment option is endogenous laser/radio frequency ablation combined with foam sclerotherapy. With a single small IV line-like puncture, the laser is passed into the main superficial veins. And under the ultrasound guidance, the faulty veins are ablated.

Endovenous laser/radio ablation is a simple no cut, no suture, no scar, day care technique. Compared to the other procedures, it involves less pain and a person can return to routine normal life at a faster pace with similar cosmetic outcomes. It is performed with an aim to reduce the symptoms and the risk of complications, arising from various venous diseases including blood clots.

Foam sclerotherapy is another technique to treat varicose veins. But spider veins can be treated only with microsclerotherapy. However, the success of the treatment is dependent on the laser ablation of Incompetent perforators. This is done under proper image guidance. Also, these procedures are best carried out by interventional radiologists who are well versed with image guided procedures.

Like in the case of any other disease, the earlier the treatment, the better the results, as varicose veins are an irreversible and progressive disease

Complications Of The Procedure

Like every other procedure, this treatment too has some complications. However, when done by an expert, the complication rate is very minimal and self-limiting.

• Infection
• Pain over the vein
• Bleeding
• Bruising
• Nerve damage
• Redness or swelling (inflammation) of the vein
• Blood clots
• Changes in skin colour over the treated vein
• Burns

Factors Determining Which Procedure To Choose

You will have to keep several things in mind before making a decision as to which procedure is apt for you. Amongst them include the following:

• Age and overall health
• The degree and severity of your varicose veins
• Symptoms
• How certain procedures may affect your prognosis
• Your opinion about your physical appearance
• Doctor’s expectation about your condition in the future

Precautions

Though these simple steps to combat varicose veins, help delay the progression of the disease, it cannot arrest it completely.

• Wear class Il stockings all throughout the day
• Exercise daily (involving your legs). For example, walking cycling etc.
• Do not sit or stand for more than 30 minutes continuously: keep moving
• Elevate legs while sleeping (at a little higher level than your heart)
• Maintain a healthy weight

Here’s How Hypnosis is Boosting IVF Success Rates

Infertility is a complex and stressful experience and opting for IVF often causes more stress for women, because of the fear of not being able conceive. Widely popular and acceptable now, as more and more couples are considering it – in vitro fertilization or IVF is a technique used to treat infertility.

Along with recent advancements in various procedures to help combat fertility and reproductive challenges, ‘hypnosis for fertility’ has also gained immense acceptance due to its effectiveness. The transfer of an embryo to a woman’s womb is considered a critical event in the in vitro fertilization IVF) procedure. It is likely that the success rate of the IVF might diminish, if a woman is continually stressed about the outcome and is apprehensive whether the transfer will be a painful aspect or not.

However, it is believed that ‘hypnosis’ can be considered instrumental in alleviating such stress, thereby helping a woman’s uterus to remain relaxed and facilitate the implantation of the embryo more easily. Experts are of the opinion that it is also possible that hypnosis brings about changes in the functioning of uterine hormones or the immune system and hence improves the interaction between the endometrium and the blastocyst, or the uterine lining.

Hypnosis can be considered instrumental in alleviating stress, thereby helping a woman’s uterus to remain relaxed and facilitate the implantation of the embryo more easily

Hypnosis: Making A Difference

Hypnosis or hypnotism is utilized when a person goes into a trance. Hypnosis is effective in establishing the sync between the mind and the body and can enhance natural conception and complement IVF. The reason why hypnosis makes such a dramatic difference is not completely known, but as the body is a more relaxed state, all the hormone systems work more effectively.

Battling Cancer and Pain

Fighting chronic pain which can be mild, moderate or severe on a daily basis, is part of the cancer struggle, which may be present for years to come

Due to the treatment, many cancer patients and survivors experience pain. This pain may be continuous, intermittent or breakthrough pain and often subsides when the treatment ends. It is called acute pain which is similar to the pain experienced after an operation.

Thus, the torment cancer patients face, doesn’t stop even after the treatment has been discontinued. Battling chronic pain which can be mild, moderate or severe on a daily basis is a part of their struggle, which may be present for years to come.

Pain After Surgery

Soon after the surgery, patients may experience mild, moderate or excruciating pain along the operative site depending on the site and kind of surgery. Hence, most cancer centres today have a specialized Pain Clinic or Acute Pain Service.

Treatment is planned and delivered orally or intravenously to treat the pain, minimize side effects and enhance the quality of recovery. Treatment may also be multimodal and can involve physical therapy, nerve blocks, epidural drugs, and nerve stimulation. Acute pain needs to be addressed aggressively and a quick look at some hypothetical case studies will provide a better insight into the plight of various cancer patients.

Hypothetical Case Studies

Ram Bahadur is 75 years old and has smoked for most of these years. He underwent a major surgery of the large intestine. The scar runs from his lower rib cage to below his navel. The Acute pain team placed an epidural catheter before surgery to target the expected pain.

When he woke up from the anesthetic he had no pain and could breathe deeply. If pain impairs the ability to breathe deeply, after an abdominal surgery, patients, especially elders can land up with pneumonias and a complicated and expensive ICU stay.

Sunita Arora was treated for breast cancer five years back. She had her breast removed (mastectomy) and underwent chemotherapy and radiotherapy after the surgery. She remembers mild discomfort for about three days after the surgery, in her chest and upper arm and armpit. But she has more vivid memories of the burning pain in the mouth and painful meals during chemotherapy.

For Sunita, the chemotherapy-related mouth pain (mucositis pain) was a bigger issue. It is imperative to treat this, because she couldn’t eat due to the painful mouth ulcers. This impacted her quality of life and poor nutrition also affects the ability to tolerate further chemotherapy.

An agonizing ‘pain’ that Sunita didn’t immediately complain about was the loss of self-esteem. She had an altered body image due the removal of the breast and perceived herself as unattractive and incomplete. Supportive care teams have multidisciplinary input and with the help of psychological support, group therapy, pain medications and a semi-solid diet she recovered her appetite, weight and her ‘whole’ self.

Treatment Prognosis

Cancer and its treatment can occasionally also damage the nerves. Riyaz complains of a burning pain and a strange numbness in the soles of his feet and palms of his hands. This started two months after he received chemotherapy. The hands and feet feel heavy and cannot sense hot or cold. Appropriate nerve pain medications like anticonvulsants, antidepressants decreased the pain and improved the quality of sleep and the quality of life.

But, Riyaz will always need to protect his hands and feet from injury, not walk bare feet, avoid contact with hot water and avoid movements that require rapid motion for instance, rapidly chopping using a knife. This is difficult for him because he is a chef. However, he has gradually come to terms with this, because he is better oft than many other cancer patients – he is cured!

Pain Due To Relapse

Some patients may have chronic pain because the cancer has recurred or spread. So for ease of assessment, monitoring, and treatment, pain is measured in numbers usually on a scale from zero to ten. The good news is that relief from severe excruciating pain is possible for more than eighty per cent patients through oral inexpensive tablets called morphine.

A Tragic Scenario

But here’s the bad news. These strong painkillers (morphine) are available to less than four per cent of the people who need them in India. Government policies, legislation, lack of awareness and education have all contributed to this state of affairs. So the tragedy is that we grow it in our state and ‘make it in India’ but we sell it to the developed world. Also, very few doctors have the training to use morphine and only a tiny number of patients have access to it.

Ageing and Kidney Disease

Long-term studies show that after we cross the age of 30 years we lose 10per cent of our kidney function for every decade of life

It is a sad fact of life, but everyone gets old! Not only are we getting older, but more and more of us in the world are getting older. According to the WHO (World Health Organization), elderly are defined as individuals over the age of 65 years. Going by this definition, over 20 per cent of the world would be elderly. But due to greater medical advances, life expectancy is increasing.

According to global demographic projections, the number of elderly people is expected to triple by the year 2050 and they would make up 33 per cent of the world population. By then, the elderly will outnumber children. In India, in the 20th century, the total population increased three-fold but the population of the elderly increased seven-fold.

Having said that, a number of age-related diseases, kidney disease, being one amongst them, is also gaining more importance now. Geriatric medicine in the treatment of diseases in the elderly has also taken on much more relevance today and it is useful to know how the elderly are affected by kidney disease.

What Happens To Our Kidneys As We Age

Before we try to understand the unique characteristics of kidney disease in the elderly, it is useful to know what ageing does to our kidneys. Long-term studies show that after we cross the age of 30 years, we lose 10 per cent of our kidney function for every decade of life. Hence an 80-year-old would have lost half of his original kidney function due to ageing alone1 So, ageing interferes with both the structure as well as the functions of the kidney.

Structural Changes
As we grow older, the kidneys reduce in both size and weight from their normal length of nine to eleven centimetre and normal weight of 120 to 180 grams. The number of filtration units (called glomeruli) decrease in number. Usually, there are 1.3 million glomeruli in each kidney. Each of the remaining glomeruli also develops scars, which keep increasing with age.

The absorptive units (called tubules) get gradually atrophic and non-functional. The scaffolding units, where the glomeruli and tubules are embedded, get stiff and non-flexible. These scaffolding units form the backbone of the kidney and are called the interstitium. Finally, the blood vessels supplying the kidneys also get thickened and narrowed putting the kidneys on the brink of blood deprivation and failure due to lack of blood supply.

Functional Changes
As if these structural changes were not bad enough, the ageing kidney also undergoes changes that affect its functions as well. Its ability to filter the blood that flows through it, reduces leading to water retention, high blood pressure and toxin overload. It loses ability to retain sodium leading to frequent dehydration. Also, with ageing, the kidney does not excrete potassium properly causing heart blocks. There is decreased production of haemoglobin-producing hormones and vitamin D which leads to anaemia and bone disorders. Finally, ageing leads to the impairment of insulin clearance, causing high insulin levels and episodes of hypoglycaemia or dangerously low blood sugar levels.

To make matters worse, the standard tests to estimate kidney function are erroneous and misleading in the elderly. This makes treatment even more difficult and complicated. Thus, kidney disease in the elderly is getting more and more important and relevant, especially with the Lycoming of age’ of more people due to greater life expectancy, this presents as a ‘growing’ challenge for all concerned.

Kidney Disorders

Cardio Renal Syndrome
Any kind of heart disease can cause kidney disease. In fact, heart diseases are invariably followed by kidney disease and vice versa. It is a well-known fact that heart disease affects the elderly mainly and thus cardiorenal disease is more common amongst them.

Reno Vascular Disease
In the elderly, blood vessels all over the body get narrowed or blocked. This includes the blood vessels of the heart, brain, limbs and intestines. And the kidneys are no exception and damage to their blood supply is called Reno Vascular Disease, which leads to high blood pressure and kidney failure.

Drug-Induced Kidney Disease
The elderly are usually taking a multitude of drugs for various age-related illnesses. Thus, they could be taking painkillers for arthritis, blood pressure medications for high blood pressure, anti-diabetic medicines for diabetes and cardiac drugs for heart disease and so on. This kind of Lpolypharmacyl predisposes them to drug-induced kidney damage.

Prostate Enlargement
With ageing, the prostate gland enlarges in size. Since it lies right at the junction of the urinary bladder and the urethra, enlargement leads to obstruction of urinary flow. This causes retention of urine and subsequent urinary infections and backpressure kidney damage.

Ageing and Kidney Disease
These are the commonest causes of kidney damage globally and are typically ‘old age’ diseases.

Beware of Hepatitis B Infection

Recognized as a global health problem, hepatitis B is a viral infection of the liver that can lead to both acute and chronic disease. It is estimated that around two million people worldwide have been infected with the hepatitis B virus (HBV) with around 350 million chronically infected and around 50 million cases diagnosed annually. HBV also remains the leading cause of liver diseases such as cirrhosis (destruction of the liver) and hepatocellular carcinoma (HCC).

Symptoms And Progression

Usually a person at the acute stage, does not exhibit any symptoms. However, in some people having acute illness, symptoms may include yellowing of the skin and eyes, dark coloured urine, extreme fatigue, nausea, and abdominal pain.

In severe cases, the person can become comatosed but this is not very common. In chronic hepatitis B infected people, liver-related complications like vomiting of blood (hematemesis), black tarry stools (melena), loss of consciousness (hepatic encephalopathy), fever [because of low immunity], distension of abdomen (ascites) and swelling of the legs (pedal edema) is observed.

On an average, it takes about six months for the virus to clear on its own. If the infection still persists, the person is said to be affected with chronic hepatitis. The infection can be exacerbated if the individual consumes alcohol or has a coinfection of HIV.

There are routine blood tests available that can be done in any reputed laboratory

Modes Of Transmission

• In areas of tow prevalence of HBV infection, the transmission is more commonly via unprotected sexual intercourse, IV drug abusers or occupational exposure to blood or blood products like in the case of paramedical workers.
• In underdeveloped countries, reuse of medical instruments, contamination of multiple dosing vials and reuse of disposable needles also contribute to the risk of infection.
• Contamination of dialysis equipment is also a source of transmission, it isolation of Infected patients and strict adherence to infection control measures are not practiced.
• Percutaneous routes of exposure include transmission of blood or blood products, contaminated health related paraphernalia or needle sticks and IV drug users.

Treatment

Treatment for Hepatitis B infection depends on the stages of the infection. If one is at an acute stage, the doctor may suggest adequate rest and good nutrition to help the patient recover better. However, il one is at a chronic stage, treatment options that lessen the chances of a liver disease and prevent the infection from spreading may have to be sought. These include antiviral medications, interferon alla – 2b (Intron A) and liver transplant.

Hepatitis B virus infection is a potent killer, but the right in formation and right steps towards prevention can keep this deadly virus at bay.

Preventing Common Infectious Diseases

Key interventions to prevent common infectious diseases involve improved sanitation, e use of drinking water and an absolute stress on personal hygiene

Though a robust system for disease surveillance and better fortification of health infrastructure is mandatory, a better portion of prevention depends on us to ward off diseases. Much is known about common water related diseases that prevail during the monsoon and this may come as no surprise, that most of these diseases are aggravated due to faults in our lifestyle and failing personal hygiene.

However, if we choose to be more precautionary in our approach, some common water-related diseases can certainly be curtailed. So, here’s some insight into some of these diseases.

Common Water-Related Diseases

Diarrhoeal Disease
Diarrhoea is an infection of the gastrointestinal tract that is mainly caused by microbes such as bacteria, viruses and parasitic organisms spread by contaminated water, either from sewage or human excreta. Depending on the type of infection, the diarrhoea may be watery (for example in cholera) or passed with blood (in dysentery).

Poor personal hygiene and unhygienic food handlers are another source of infection. Key interventions involve improved sanitation, the use of boiled drinking water and of course the absolute stress on personal hygiene and handling food in a clean way.

Ascariasis (Roundworm Disease)
Ascariasis is the most common form of roundworm infection that is caused by ingestion of food or water contaminated with the eggs of a roundworm. The first sign may be the passage of a live worm, usually in the faeces. In severe infection, intestinal obstruction may occur, especially in children, Other symptoms may include low-grade fever, breathlessness, wheezing and abdominal pain.

Improved sanitation and hygiene reduces the risk of this disease. Preventive treatment with deworming medications may be advised in endemic areas and key interventions involve thoroughly washing, peeling and cooking all raw vegetables and fruits. Also, personal hygiene before handling food cannot be ove rstressed.

Hepatitis A and E
Hepatitis A and E are liver diseases caused by the hepatitis A and E virus, respectively. The virus is mainly transmitted through the taecal-oral route due to f aecal contamination of drinking water and foodborne transmission from ingestion of products derived from infected animals. Symptoms include fever, abdominal pain and jaundice.

Key interventions include good hygiene practices such as thoroughly washing and peeling the fruits and vegetables before consumption and avoiding all raw or undercooked foods including meat and fish.

Also, drinking only boiled water and avoiding consumption of outside beverages is essential. Thus, it is better to opt for freshly prepared homemade soups, juices or milkshakes. It is also vital to ensure washing of the hands thoroughly after using a washroom or changing a baby’s diaper and before preparation of a meal or eating.

Typhoid And Paratyphoid Infection
These infections are caused by the bacteria Salmonella typhi and Salmonella paratyphi respectively. The blood, human excreta and urine of the infected person mainly contains these microorganisms. Hence, a person may develop the infection by ingesting contaminated food or water by sewage or food prepared by the person infected with the bacteria.

A person is also likely to suffer from this infection, if he or she has come in indirect contact with the diseased person, for example by touching the surfaces such as bathroom taps, flush buttons, etc. Interventions include safe and healthy hygiene practices.

Why Hygiene Is Of Paramount Importance

One should certainly realize the necessity of personal hygiene and proper food handling to prevent these diseases, because more than being monsoon-related, most of these diseases are obtained in our own home& Thus, kitchen related practices, food handlers at home and outside, should be more stringent with hygiene.

Also, as difficult as it may sound, avoiding outside food is the hallmark of the preventive intervention of these water-related diseases. In addition, it would also be helpful to pay attention to the points mentioned below to stay protected from monsoon-related ailments.

Helpful Preventive Tips

• Make use of separate hand towels to minimize the chances of contracting infections.
• Cover your mouth with a handkerchief while coughing or sneezing.
• Make use of nets and mosquito repellants at home to keep the dengue and malaria transmitting mosquitoes at bay.
• Restrict crowded places.
• Keep a hand sanitizer always.

Note:
The list of such diseases is quite exhaustive, with malaria, dengue, and leptospirosis being amongst the other monsoon diseases, which have fortunately received enough attention and awareness.

Overcome Gloom and Doom

We get fidgety during a quiet moment or experience stress when alone, thereby latching on to a fidget spinner! Our waking time seems occupied by constant engagement in an activity, technological distractions and habits. And boredom, the other side of restlessness, is a new age ailment. We rest to de-stress, but then that too makes us restless and stressed. This is because we prioritise the external world over our inner world and emotions.

There is an eternal expectation of being happy and occupied, or both, Thus, emotions, especially melancholy, have become one of the most difficult feelings to handle. Also, those who have experienced clinical depression earlier, expect to have a stable and happy mood all the time. Besides, these Individuals unnecessarily suffer anticipatory fears of reoccurrence of another episode and associate any circumstantial upset feeling with relapse and these feelings of gloom can trigger a profound sense of doom.

Difference Between Depressed Mood And Depression

Feeling depressed, melancholic and sad is part of being human. Perhaps these feelings are necessary to gain deeper insight into our emotions and the ways one relates to the world. Grieving is a natural reaction to loss or separation from a loved one or thing. While everyone feels down or sad, these moods pass usually, with little (if any) long-term consequences. One continues to function normally during this time and knows he/she can bounce back in time.

The boundary between this depressed mood and clinical depression is imprecise, but the latter is associated with stronger symptoms which lasts longer, has a profound impact on functioning and is much more likely to require treatment. However, clinical depression Is a common medical condition or a more severe form of a depressed mood that goes beyond life’s ordinary ups and downs.

Symptoms Of Clinical Depression

• Excess fatigue and loss of energy
• Significant sleep disturbance with early waking
• Loss of appetite with weight loss
• Indecisiveness, trouble thinking or poor concentration
• Hopelessness and worthlessness or excessive and inappropriate guilt
• A recurrent thought of death or suicide, or a suicide attempt

Causes Of Clinical Depression

Clinical depression is a result of various biological, psychological and social factors. Unlike a depressed mood which can be a reaction to minor life experiences, clinical depression is more likely to be caused by conflicting life events. Depression can make matters worse ¡t left intact, depending on how the lite situation proceeds. Also, genetic and family history of problems related to mental health can raise the risk of emotional or psychological problems.

Clinical depression is a common medical condition or a more severe form of a depressed mood that goes beyond life’s ordinary ups and downs

How To Get Help For Clinical Depression

If you are experiencing clinical depression and it is affecting your functioning (work, relationships and activity), then it’s time to seek help to overcome it, because life is greater than all its problems put together.

So, when the sense of doom begins to prevail, it’s better to put in efforts to remedy those feelings rather than act impulsively and ¡n a negative or harmful manner. Your family doctor or physician may be a good place to start, as your doctor can screen you for depression.

You can also seek help from a psychiatrist or qualified mental health practitioner to help you understand, manage and treat your symptoms. Early intervention reduces unnecessary suffering and aids faster recovery. Also, remember that all forms of depression can be cured with support and treatment.

How To Proceed With Treatment

It is a myth that people with clinical depression can simply pull themselves together and get better. Such views have contributed to the stigma of problems related to mental health and delay in seeking help.

Talking to a mental health practitioner can be of enormous help as understanding your feelings and emotions and its underlying context, can itself be very therapeutic.

Sometimes, counselling and psychotherapy needs to be complemented with medicine such as antidepressants for added effectiveness. Research has also established that a combination of medication and psychotherapy is more effective than intervention alone.

Health Tip

Acknowledging the fact that you may be suftering from depression and talking about it, can be the first step to recovery. Also, remember that a fresh start is always possible!