Hearing loss is a very common finding as devotees get older and is becoming an increasingly recognized problem among older devotees, lets review what it is and how we can best protect ourselves against it.
A. What causes hearing loss?
old age and chronic exposure to recreational noises are the two biggest risk factors for hearing loss.
• Old age, 1/3 of all people between age 65-75
• ½ of all people over 75
• Chronic exposure to loud noises
B. What are the symptoms of hearing loss, what should I watch out for?
• Muffled speech
• Difficulty understanding against background noise
• Frequently asking others to speak slowly, more clearly, and loudly
• Tinnitus(buzzing noise in the background)
• Withdrawal from conversations
• Avoidance of certain social settings
C. How is sound measured?
Sound is measures in decibels(DB). For every 10 DB increase in sound level, we perceive the sound to be twice as loud.
D. What is the safe range and risk range for hearing?
Whisper is 30 decibels and normal conversations happen between 50-70 decibels and are considered safe for hearing. Washing machines and household appliances produce about 70 decibels.
Sounds above 80 decibels are considered in the risk range meaning chronic exposure to noises above 80 DB can produce progressive hearing loss over a number of years. If you are regularly exposed to sounds above 80 DB, it is recommended that one wears some kind of protective hearing device(ear plugs etc). Below are the maximum noise exposure allowed by law in USA(protective devices recommended)
||15 minutes or less
Kirtan with microphone perfomed in a enclosed room reaches 80-85 DB and if instruments like whompers or bigger kartals or multiple mridangas are used, sound level easily crosses above 95 DB. Poor acoustics can also account for increased sound levels. In the beginning, people who are exposed to loud noises suffer from high frequency hearing loss and then later on develop low frequency hearing loss progressing to deafness.
E. Are children at risk?
Children less than 6 years old are at increased risk for developing hearing loss when exposed to sounds above 80 DB.
F. What are the complications of hearing loss?
• False sense that others are angry with you
G. Can hearing loss be prevented?
Yes, it can be prevented by taking the following measures
• Avoid noise above 85 DB
• Wear earplugs or hearing protective devices
• Protect ears of children
• Be alert to Hazardous noise
H. What we can do collectively to protect the ears of devotees and our children?
Be extremely mindful of using bigger kartals/whompers/multiple mridangas in closed room settings.
Avoid sounds which are distracting and take away from the meditation of sweet kirtan
Educate devotees about hearing loss
Make policies at local levels
Build temple rooms with proper acoustics, and equip them with proper speakers, microphones etc.
Wear protective devices (ear plugs) if other devotees are not considerate
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Many devotees have asked me about the use of vitamins in daily use and their efficacy in disease conditions, so here is a little review from the medical literature about the vitamins: These guidelines are conclusions from all medical studies done until now about the use of vitamins
Vitamins are chemically unrelated organic compounds, or families of organic compounds, that are essential in small amounts for normal metabolism. Because vitamins (with the exception of vitamin D) cannot be synthesized by humans, they need to be ingested in the diet to prevent disorders of metabolism. They should be distinguished from minerals (such as calcium and iron), some of which are also essential micronutrients. "Food supplements" is a general term for vitamins, minerals, herbs, and other natural compounds claimed to improve health when taken in small amounts as alternatives or supplements to drugs
RECOMMENDATIONS — Key points:
1. The second United States Preventive Services Task Force (USPSTF) recommends a folic acid supplement of 400 micrograms/day for all women in the childbearing years .
2. There is insufficient evidence to recommend for or against the use of supplements of vitamins A, C, E, multivitamins with folate, or antioxidant combinations for the prevention of cancer or cardiovascular disease.
3. There is no indication for use of beta carotene to prevent cancer and heart disease.
4. In general, simple multivitamins are not beneficial for most adults who eat a balanced diet and get regular sun exposure or drink vitamin D-fortified dairy products. Because multivitamins may be harmful in some people, vitamin recommendations should be tailored to individual patients: * A diet with five to nine servings of vegetables and fruits per day supplants multivitamin use in most patients. This diet promotes health not only by providing known vitamins, but also because it contains fiber and other less well-defined nutrients and replaces meat and animal fat.
* Women of childbearing potential should take a vitamin supplement containing at least 400 micrograms of folic acid per day. In addition to a varied diet, women who are trying to conceive should take a daily supplement of 400 to 800 micrograms folic acid or a prescription prenatal vitamin.
* People with diets high in vitamin A, pregnant women, and those who are at increased risk for fractures or osteopenia should avoid supplements that contain vitamin A, including multivitamin supplements.
* In patients with known osteoporosis or previous fracture, we suggest an additional supplement of 800 International Units of vitamin D with calcium, particularly if dietary intake is inadequate and sun exposure on the skin is poor. For all adults over age 70, the RDA is otherwise 600 International Units per day. The value of vitamin D supplementation is marginal in younger adults but is better established in the elderly
* Since the best available evidence, suggests that high-dose vitamin E increases all-cause mortality, patients without special indications should not take supplements containing high doses of vitamin E for preventive health care. Additionally, patients on blood thinning medications should be particularly discouraged from using very high doses of vitamin E supplementation, which might cause bleeding complications.
* Patients with clinical reasons for vitamin deficiency, such as those with alcoholism, malabsorption, vegan diet, a history of gastric bypass surgery, or some inborn errors of metabolism, as well as those being treated with hemodialysis or parenteral nutrition, should receive multivitamin supplements whether or not blood tests suggest deficiency.
* Blood tests for vitamin deficiency are useful in some patients with clinical indications. Marginal blood levels should not be over interpreted as abnormal. Patients with clear-cut deficiencies should be treated with additional vitamins as indicated.
* Patients should not use large doses of individual vitamins. While they may take multivitamins tailored to age, sex, or specific medical conditions, with the exception of pregnancy this is not supported by strong evidence and may be harmful.
One important point for devotees to consider is use of vitamin D. Vitamin D has been linked with high energy levels, promoting sense of well being, and low levels of vitamin D has been linked with cancer, heart disease and other medical conditions. For devotees who do not receive adequate sun exposure and are not medically healthy, they might want to contact their physician to get a blood test called 25 hydroxy vitamin D. It will give them an accurate assessment of their vitamin D status.
For any more questions, regarding vitamin supplementation, please do not hesitate to contact me.
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The ABC's of a Hernia
October 29, 2010
Hernias are areas of weakness of the body wall through which intracavity structures pass. They are among the oldest recorded afflictions of man, and inguinal hernia repair is the most common general surgical procedure. Surgery is the only effective treatment.
What are the main types of hernia?
There are 3 main types of hernia which we will discuss here, rest are uncommon and beyond the scope of this discussion:
1. Inguinal hernia: It is the most common type of hernia in which a portion of our intestine herniates down due to a defect in the inguinal canal. This most commonly occurs in construction workers, weight lifters, people who commonly smoke and have chronic cough.
2. Adominal wall hernia: Most common type of abdominal hernia are Incisional hernias and by definition develop at sites where an incision has been made for some prior abdominal procedure. Hernias are due to failure of tissues to heal and close following surgery. Any condition which inhibits natural wound healing will make a patient susceptible to the development of an incisional hernia. Such conditions include: infection, obesity, smoking, medications such as immunosuppressives, excessive wound tension, malnutrition, fractured sutures, poor technique. Emergency surgery increases the risk of incisional hernia formation.
3. Hiatal hernia: Sliding of part of the upper stomach into the esophagus through the diaphragm leading to acid reflux disease and in some cases difficulty in swallowing.
What symtoms will I expect?
You will notice a frank mass or a soft tissue swelling protruding out in your groin area. You might also experience pain, swelling, discomfort. If untreated, you may experience constipation and urinary difficulty. Worst case scenario is that if left untreated an hernia may proceed to strangulation or incarceration of intestine leading to extreme pain and need for emergency surgery.
How does the doctor make diagnosis?
Diagnosis is made clinically by physical exam and history, is some cases a surgeon might get an ultrasound to accurately determine the extent of hernia. Hiatal hernias are diagnosed by upper GI endoscopy.
What is the treatment?
The only effective treatment is surgery. Now a days, mesh repair is the surgical procedure of choice where a surgeon reduces the hernia and puts a strong mesh to fill the defect which prevents hernia from reoccurring. It can be done laparascopically or open repair and will be decided by the surgeon. It is a very safe procedure and you can expect to go home the next day.
Is surgery needed in all cases?
NO, absolutely not. Surgery is only needed if symptoms of pain and discomfort and not manageable and are interfering with daily activities of life. It might also be needed in large hernias. Othewise, your surgeon can monitor the progress of hernia without any operative intervention.
Will my hernia reoccur?
In 10% of cases, hernia can reoccur if the conditions which caused the hernia at the first place are not removed.
I hope this primer is helpful, please set up a consultation with a general surgeon if you ever experience hernia symptoms and follow his advice.
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Deep Venous Thrombosis
August 17, 2010
By: Dr. Piyush Gupta (Premvilas Das)
This month I received a question concerning Deep Venous Thrombosis (DVT henceforth) or blood clots in the legs. So let’s look at this issue closely:
1. What is DVT?
As the name suggests, it refers to having abnormal clotting of blood leading to formation of blood clots or thrombus in the deep veins of the legs.
There are superficial veins in the legs which do not have the potential for developing clots. They are thinner and more superficial and can get inflamed or infected, but very infrequently form blood clots.
There are deeper veins in the legs which are thicker and are responsible for bringing the blood back from the lower extremities to the heart and are prone to developing clots under certain conditions (discussed separately). Remember, it is the deep veins in the legs which have the potential to form blood clots and not the arteries.
Arterial blood clots in legs are extremely rare and it is a limb- or life- threatening emergency. It happens under such rare circumstances that to discuss it is beyond the scope of this topic.
2. Why will anyone develop DVT?
Yes, that’s a good question. Normally deep veins in the legs serve as conduits for returning blood from the legs to the heart for circulation and in normal conditions these deep veins do their jobs very efficiently and effectively. However, certain conditions can impair the ability of these veins to do their job and some conditions predispose the blood to becoming excessively thick, increasing its viscosity and making it prone to develop clots.
Let’s review these conditions:
1. Morbid Obesity and sedentary life style:
Sitting in one position for a long time, as in the case of long distance flights, for example. For normal venous circulation, the deep veins of the legs need help from the calf muscles to push the blood upwards. People who are sedentary have a higher risk of developing clots. Also, it is advisable to periodically stretch, move your lower extremities and walk in long distance car and plane rides.
2. Post-surgery period, especially knee or hip surgeries:
Any surgery increases the risk for thrombus, especially lower extremity surgeries. Your surgeon will use a blood thinner in the perioperative period to ensure that clots don’t develop. It is also important that you undergo rehab and physical therapy as soon as possible in the post-surgery period.
3. There are certain genetic conditions which can predispose one to blood clots, especially Factor 5 mutation and absence of certain anticoagulants (blood clotting inhibitors) in the blood. . There are blood tests which can detect these. Your physician can order blood tests.
4. Lower extremity trauma: Any orthopedic injury to the lower extremity predisposes one to blood clots in the legs. Again, prompt return to mobilization and physical therapy is the key.
5. Malignancy: Cancer of any kind predisposes one to having blood clots. Ovarian, colon and pancreatic cancers are the worst offenders in this regard. Any cancers involving the pelvis, groin and lower extremities will invariably lead to blood clots in the legs.
6. Use of oral contraceptives or hormone replacement therapy: Both of these medications are a very common source of blood clots in the legs. Most physicians prescribe the lowest possible dose of these medications. People who use these drugs should refrain from smoking as smoking multiplies the risk.
7. Pregnancy or postpartum status
8. Stroke: Stroke leading to weakness or paralysis of the limbs is an independent risk factor in developing venous thrombosis.
What are the symptoms of DVT and how can one know when to seek medical attention?
Most common symptoms are immediate onset of pain, swelling or discoloration of the leg or any combination of these three. It is important to remember there are many other conditions which can cause symptoms like DVT.
- Calf injury during running or sports
- Muscle strain, tear, or twisting injury to the leg
- Cellulitis — Superficial infection of the skin of lower extremities
- Gout: A condition causing deposition of uric acid in joints of lower extremities
- Varicose veins or venous insufficiency
- Knee abnormality
- Previous lower extremity surgery
- Side effects of BP medications like Norvasc.
Please Note: Not everyone with swelling in the legs should be alarmed that they have DVT. If you are experiencing sudden onset of swelling and pain in your lower leg, you should immediately go to the nearest emergency room or consult your family physician.
How can my doctor diagnose my condition?
The gold standard is a Doppler ultrasound of legs which can be performed non-invasively and efficiently in any emergency room and you will know in half hour or so whether you have actual thrombosis or something else.
Non-compressibility of lower extremity veins on an ultrasound will alert your physician about DVT.
How can I be treated?
If you indeed have DVT, your doctor will take a comprehensive history, order a battery of blood tests, and do further investigations to rule out the
possibility of cancer. He will start you on a medication called warfarin, or Coumadin, and adjust your these medication levels to goal by drawing your blood periodically.
If this is your first episode and no cause could be ascertained, then you will be on warfarin for 6 months, but if it happens again, you might have to be on this medication for the rest of your life and get regular blood work done. Your physician might also discuss the use of a filter in your large veins to prevent the clot from traveling upstream.
What if I don’t treat it?
The thrombus in the leg can potentially travel to your lungs causing a blood clot in the lungs. This causes chest pain and shortness of breath and can be life threatening! It can also extend in the leg causing significant discomfort, pain and swelling.
Do my family members have the risk of developing blood clots if I have the blood clot?
Only if you have one of the genetic disorders. Your physician will advise you about this and your family members might have to be tested.
What advise will you give me to prevent blood clots?
Best advise is to lose weight (yeah right), exercise regularly and be as physically active as you can. Avoid smoking, and speak to your physician before any surgical procedure about post-operative rehabilitation and physical therapy. If you know anyone with cancer, be doubly sure to discuss this with them and their oncologist.
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Gastro Esophageal Reflux Disease (GERD)
Hare Krishna Devotees,
Please accept my humble obeisances. All glories to Srila Prabhupada.
I thought of writing about a very common medical problem called gastro esophageal reflux disease or GERD. Many devotees suffer from it and this can become quite a problem if not treated properly and prevented by appropriate means. So, let’s start:
What is GERD?
GERD also called acid reflux or acid regurgitation is a medical condition in which the contents of the stomach along with the acid in the stomach regurgitate into the esophagus. Esophagus is a tube which connects your mouth with the stomach. There is a sphincter or a valve called the lower esophageal sphincter (LES) which prevents the food to come up from the stomach into the esophagus. GERD happens when the LES opens spontaneously or fails to close completely causing the acidic contents of stomach to regurgitate back into the esophagus. People of all ages can have GERD.
What are the symptoms of GERD?
The main symptom is frequent heartburn or a burning sensation in your chest, behind your breast or in your stomach. This happens when the refluxed acidic food touches the lining of esophagus. You might get frequent belching or an acidic taste in your mouth. Sometimes it’s called water brash. Acid in the esophagus can also cause spasm of the bronchus causing cough or asthma-like symptoms, wheezing etc. Patients who have asthma frequently report that there asthma symptoms get worse with GERD. Sometimes you may get a persistent cough at night because of GERD.
So what causes GERD?
Research has shown that in patients with GERD, LES relaxes while the food is being digested in the stomach or the esophagus is contracting. Also, some patients can have a hiatal hernia. Hiatal hernia happens when the upper part of the stomach and the LES move upward and above the diaphragm, the muscle wall that separates the chest from the stomach. Normally, the diaphragm assists the LES in keeping the food down but if the LES and upper part of the stomach moves upward, food can reflux more easily. You may have a hiatal hernia without any symptoms. Other factors which predispose one for GERD are:
But the most important cause of GERD is dietary: There are certain foods which worsen acid reflux by causing the LES to relax:
- Citrus fruits like lemons, oranges
- Spicy foods
- Foods rich in butter, like cakes, cookies etc, also all fried and fatty foods
- Tomato containing foods like pizza, spaghetti, pasta sauce, chili, salsa
- Drinks with caffeine and alcohol
- Mint or chewing gum
In addition to this, heavy meals, meals late at night or lying down after eating predispose one to acid reflux.
So, how do we treat GERD or acid reflux?
- If you smoke, stop. Generally this is not a issue with devotees.
- Avoid foods which worsen reflux especially fatty, fried foods and spicy foods. Avoid all soda pop and carbonated beverages.
- Loose weight (yeah right!!!!)
- Wear loose fitting clothes
- Avoid lying down for 3 hours after a meal
- Raise the head of the bed, just using extra pillows will not help, you might have to put wooden blocks under the head end of the bed to give a 15-20 degree elevation.
- Eat small balanced meals.
Medications for GERD are divided into three categories:
Antacids: like Maalox, Mylanta, Rolaids, TUMS or Alka Stelzer, they provide immediate relief and are effective, but they can have side effects like constipation or diarrhea.
H2 blockers like Pepsi, Zantac. They are available in over-the-counter (OTC) and prescription formulations. They are effective in about half the cases of acid reflux
Proton pump inhibitors: They are the strongest and most effective medications for acid reflux and work by reducing the amount of acid production in the stomach. They are very effective for healing ulcers in the stomach or esophagus and are taken for 6 weeks to heal symptoms from reflux. They are called Prilosec, which is available over the counter in America, Prevacid or Nexium and are very heavily advertised due to there high cost.
What if medications fail to relieve my symptoms?
Then I suggest that you consult with your doctor about a possible endoscopy where they look down into your esophagus or stomach with a camera and take biopsies. He might also suggest a special kind of x-ray called as barium swallow or refer you for surgery if you have a large hiatal hernia.
What are the long term complications of GERD?
Most dreadful is the possibility of esophageal cancer, but the common ones are narrowing of the esophagus secondary to chronic reflux and inflammation of the esophagus leading to pain. Please consult with your doctor if you have chronic acid reflux.
Hope this meets you all well.
Please write to me if you have any questions at firstname.lastname@example.org
Your doctor servant,
(Piyush Gupta, MD)
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