Dr Aravindhan

Last month, Kauvery celebrated World Elders day. In western countries, the majority of the population is aged above 60 years because of longevity and lower birth rate. With a vast improvement in the quality of life and medical care, Indians are also living longer. Nevertheless, old age inevitably brings with it issues like osteoporosis (weak bones) and osteoarthritis (wear and tear of joints). On Elders Day, we conducted programmes to create an awareness of such age related problems, as also strategies to cope with the same.

Kauvery Hospital, Chennai, was issued with form 17 (2) certificate by the IT Department. This certificate will enable employees of companies like IOCL, CPCL, ONGC and NLC to claim IT exemption for medical expenses. Henceforth, they can benefit from the specialized medical and surgical treatment available at Kauvery hospital.

Every year, Kauvery, in partnership with Rotary Club of Madras East, confers the Dr KVT award for excellence to prominent doctors. This year, the award was given to eminent cardiologist, Professor S Thanikachalam. In the award function on 14th of October, he spoke about lifestyle modification to prevent cardiac diseases.

As the year draws to a close, we hope to continue our efforts at taking healthcare to its core - human caring at its best and most humane.

Wish you all a healthy and cheerful November.

Best wishes

Dr Aravindan Selvaraj, MS Ortho, FRCS Ortho (UK & Ireland)
Executive Director & Chief Orthopaedic Surgeon, Kauvery Hospital

Live a Full Life, with Everyone, Like Everyone - in spite of Epilepsy!

Article by Dr. Prithika Chary, MD (Gen), DM (Neuro), MNAMS (Neurology), MCHN (Neuro Surgery)
Chief Neurologist, Kauvery Hospital

Epilepsy is a brain disorder characterized by recurrent fits, convulsions or seizures. This is due to abnormal electrical discharges from structurally or functionally disturbed areas of the brain.

The cause is unknown in most cases of patients. In young children it can be due to birth injuries, reduced blood or oxygen to the brain at birth, changes in chemicals in the blood, congenital malformations, and the consequent brain infections. In adults, especially the elderly, degenerative brain changes and problems of blood supply can lead to epilepsy.

Several daily life style habits can trigger seizures in people with epilepsy. Missing sleep or inadequate sleep is an important factor which often provokes seizures. Missing meals can lead to a drop in the blood sugar and induce seizures. Prolonged television viewing or onscreen work, high ambient temperature, fever, intercurrent infections, excitement, overexertion and emotional disturbances, can all provoke seizures. It is therefore necessary to have at least 6-8 hours of sleep every night, eat regular meals, avoid prolonged exposure to the sun, and get treated for infections and fever promptly in addition to taking the antiepileptic medications regularly.

Women with epilepsy face unique problems related to their hormonal cycles. The life of a woman consists of several challenges - childhood, adolescence and menarche (the first menstrual period), childbearing and contraception, fertility and pregnancy issues, and menopause or cessation of menstrual periods. The two main female hormones oestrogen and progesterone do influence epilepsy. Some women may have more seizures when their hormones undergo changes. This happens in 10-12% of women.

Some girls, on attaining puberty (menarche), may have seizures aggravated during menstruation. Seizures may be worse just before the start of the periods, or at the beginning of the period (when their progesterone levels drop), or during ovulation (when there is a lot of oestrogen in the body). Another type may occur during the last half of the cycle when an egg is not released (an anovulatory cycle). This type of epilepsy is called catamenial epilepsy and though it is uncommon, is a unique problem of the girl child with epilepsy.

During adolescence, boys and girls are acutely conscious of their body image. As mentioned above, the side effects of some of the antiepileptic drugs have to be avoided. The incidence of polycystic ovarian disease is a crucial problem that is more common in girls with epilepsy than in the general population, and particularly in those who are on a specific anticonvulsant called valproate. This can lead to a syndrome of obesity, hirsutism and irregular periods.

Hence, great care has to be taken in choosing the right drug for such patients.

Contraception is another issue in the adolescent girl with epilepsy, which needs to be addressed. Oral contraceptives interfere with and modify the blood levels of several antiepileptic drugs, and hence there can be an increase or decrease in the efficacy of the drug. Also some antiepileptic drugs interfere with the metabolism of the oral contraceptive, and can lead to contraceptive failure.

Pregnancy is a period of joy as well as anxiety for all women. Women with epilepsy, however, are often justifiably fearful of the effects on the foetus of both their epilepsy and the antiepileptic drugs they take. Co-ordinated care of both an obstetrician and a neurologist is needed for such women throughout the period of their pregnancy. Avoiding seizures during pregnancy is critical for the safety of both mother and baby. This is done by ensuring the use of appropriate drugs in appropriate doses with adjustments being made as and when necessary throughout the term. Delivery should be planned at a hospital capable of handling high risk pregnancies with adequate facilities for good neonatal care. A majority of women with epilepsy have uneventful pregnancies with good outcome to mother and foetus. Issues of breast feeding and postpartum adjustment of antiepileptic drugs should be discussed.


Women with epilepsy on reaching menopause may observe a reduction, but rarely an increase in their seizures. They have a two- to sixfold increase in fractures as well. The critical issue for these women is bone health, which deteriorates due to aging and loss of female hormones, and culminates in the thinning of bones (osteoporosis), long-term consumption of anticonvulsants being the culprit. Usually antiepileptic drugs have to be modified by supplementation with Vitamin D and Calcium; also regular physical exercise is advised to protect bone health.

Dr. Prithika Chary, Chief neurologist at Kauvery hospital has specialized in the care of patients with epilepsy. She has transformed, over the years, anxious lives of hundreds of epileptic women into stress-free study, work, marriage and safe pregnancy. All of them with a sense of joy and fulfilment now “Live a full life, with everyone, like everyone in spite of epilepsy”.

Dr. Prithika Chary runs the EPICENTTRE at Kauvery Hospital.

Dengue Awareness

This is a season of fevers. So there may be fever in your family, neighbourhood, and town and everywhere in the country. The fevers of patients, which we examine in our out-patient (OP) Department, are due to tropical infections, like for example, the dengue fever. Dengue is a threat not only carefully diagnosed these days in the OP, but also in the Emergency Department. Normal symptoms of dengue will include fever, body pain, headache, backache, and in quite severe cases bleeding too.

Dr. Ashwin Subramaniam, Consultant, Internal Medicine and Diabetology at Kauvery Hospital, talks about Dengue fever, its symptoms and treatment.

Watch his video talk on YouTube.

The 5 Stages of Parkinson’s disease

On August 11, 2014, the world woke up to the shocking news that the famous comedian and actor Robin Williams of Mrs. Doubtfire fame (the movie that inspired the making of Avvai Shanmugi) had passed away. Robin Williams had been afflicted with Parkinson’s disease, a degenerative disease that affects the nervous system. Apart from restrictive mobility, depression is one of the hallmarks of this disease.

The signs and symptoms commonly exhibited by someone afflicted with Parkinson’s are discernible as follows:

  • Lack of coordinated movement
  • Uncontrolled shaking or tremors exhibited by parts of the body (head, hands, etc)
  • Stiffness of the limbs
  • Slow movement
  • Standing up and balancing
  • Difficulty in speaking lucidly

These signs may differ from person to person, but as this brain disorder progresses, it only worsens through the stages. The progression of Parkinson’s has been mapped into 5 stages, which are:

  • Stage I: A person in this stage may show some mild symptoms, which are not alarming, and which do not prevent them from carrying out their daily tasks, nor does it affect their lifestyle. The tremors and difficulty in movement are very minimal and are usually restricted to one side of the body. These signs are so minimal that they can often be missed. When diagnosed and treated at this stage with medications, it does work to minimize the symptoms.
  • Stage II: This is considered the moderate stage and the symptoms become noticeable. Changes in facial expressions may begin to occur, and the trembling, tremors and stiffness in the muscles will be very perceptible. There is no impairment of balance, but stiffness in the muscles does elongate the time taken to complete tasks. Also at this stage, Parkinson’s affects both sides of the body and may cause speech difficulty. Progression from stage I to II can happen in months or may take years, and depends on each individual.
  • Stage III: This is still considered the mild stage and the symptoms are still the same as were in Stage II, but with the added symptoms of loss of balance and decreased reflexes. The chances of falling frequently are greater at this stage. Moreover, the patient will now find it more difficult to complete their daily tasks. Medication and occupational therapy can help decrease the symptoms now.
  • Stage IV: Dependency on others increases at this stage, as movement becomes very difficult indeed. The patient may be able to stand up without aid, but may require an assistive aid such as a walker to move. Performing daily tasks also becomes even more difficult, and the patient can no longer live alone.
  • Stage V: This is the final and most advanced debilitating stage in Parkinson’s disease. The stiffness is in an advanced stage, and upon standing, sometimes causes freezing of the muscles. The patient will require being in a wheelchair and may often be unable to stand without falling.

Therefore, the patient will require round-the-clock assistance. Furthermore, the patient will experience hallucinations and be occasionally delusional. The side-effects of medications at this stage counterbalance the benefits.

Age groups prone to Parkinson’s disease

The early stages of Parkinson’s set in usually around 62 years of age. Parkinson’s is also known to occur in people of younger age groups - 50 and below. Being affected by Parkinson’s below the age of 50 years is known as ‘young-onset Parkinson’s disease’.

Ask The Doctor

Doctor, I am getting old and am afraid of falling and suffering a fracture. Is there any way by which falls could be prevented?

Yes, falls can be prevented. These are some simple ideas for you to guard yourself against falling.

  • Talk to Your Doctor freely expressing all your worries.
  • Ask your doctor to evaluate your risk for falling, and get to learn from them specific steps you can easily follow.
  • Ask your doctor to review your medicines to check if any of them might make you dizzy or sleepy. This should include prescription medicines and over-the counter medicines.
  • Ask your doctor’s advice on taking vitamin D supplements with calcium.
  • Do strength and balance exercises that can make your legs stronger and your balance better. Tai Chi is a good example of this kind of exercise.
  • Have your eyes checked by an eye doctor at least once a year. Take care to change your eyeglasses for vision correction, if needed. You may want to get a pair of distance vision glasses just for your outdoor activities, such as walking, if you use at home bifocal or progressive lenses. Sometimes these types of lenses can make things seem closer or farther away than they really are.
  • Make your home safer:
    •  Get rid of things you could trip over.
    •  Add grab bars inside and outside your tub or shower and next to the toilet.
    •  Put railings on both sides of stairs.
    •  Add more powerful or greater number of electrical lights to make sure your home is brighter.
Doctor, what is COPD?

Prolonged exposure to cigarette smoke (both active and passive inhalation of cigarette smoke), or other types of air pollutants like irritating gases causes COPD, an abbreviation for Chronic Obstructive Pulmonary Disease. COPD causes obstruction to airflow, to and from the lungs and the patient experiences breathing difficulty, coughing fits, production of sputum, and tightness in the chest and wheezing. The major risk of people suffering from COPD is that they can develop heart diseases, lung cancer and other types of ailments.

Chronic Obstructive Pulmonary Disease is of two types - Chronic Bronchitis and Emphysema. These two disorders are the most common of conditions in patients with COPD.

Chronic bronchitis causes the lining of the bronchial tubes to inflame. The bronchial tubes are responsible for the passage of air to and from the alveoli (air sacs) in the lungs.

Emphysema, on the other hand, destroys the alveoli that are located at the end of the tiny bronchioles (air passages/tubular pathways) of the lungs. This happens when the patient is exposed over a period to the damaging fumes of cigarette smoke or other pollutants.

To diagnose whether you have COPD or not, there is a simple test called Spirometry that needs to be performed. This test uses a machine called the spirometer which will measure how much air you inhale and exhale, and how quickly your lungs exhale air. The spirometer comprises a tube into which you will have to breathe air.

COPD can be managed, though there is no treatment available to restore the damaged alveoli affected by emphysema, or the bronchi affected by bronchitis. Medications prescribed for COPD help widen the air passage to the lungs, reduce inflammation and treat any lung infections found.

Varicose Veins

Article by Prof. Dr. N. Sekar, MS, MNA, MS, MCH, FICS, DSC, FRCS
Vascular Surgeon, Kauvery Hospital

Veins carry deoxygenated blood from the tissues back to the heart. The flow in the veins is one-way, maintained by a series of valves which allow flow only towards the heart. When the valves get damaged, blood gets trapped in the vein leading to varicose veins.

The varicose veins get dilated, become long and coiled like a snake. It is commonly found in policemen, waiters, salesmen and teachers who stand for long hours on duty. It is more common in women and usually starts during pregnancy. In many cases the varicosities regress after delivery, but with recurrent pregnancies the vein remains permanently dilated.

Symptoms

  • Heaviness in the legs, more on standing
  • Swelling in the leg that is reduced when the leg is kept elevated
  • Cramps and spasms giving pain, more at night
  • Pigmentation around the ankle and lower leg
  • Itching, ulceration and eczema
  • Spontaneous bleeding from the veins
  • Rare clotting or Deep vein thrombosis
  • Many women have tiny veins in the skin - spider veins - which are due to hormone disturbances, and do not require any treatment except for cosmetic purposes

Investigations

Clinical Examination

Color Doppler study helps to determine which system of veins is affected. It helps to decide on the mode of treatment.

Treatment

Stagnation of blood can be prevented by:

1. Medical management: Graded compression stockings or Elastocrepe bandage. This should be worn from mid foot up to knee or mid thigh and should be worn during the day.

2. Elevation of the leg from time to time helps empty the vein. You must lie down and elevate the leg to facilitate blood flow in the veins by gravity.

3. Wound care, if there is ulcer or eczema.

A majority of the patients will get good relief with these measures. All these steps can only prevent complication, but cannot correct the varicose veins which require some form of intervention.

Injection Sclerotherapy

Some varicose veins can be managed by injecting an irritant solution into the vein to block them. Sclerotherapy is best for small varicosities, recurrent varicosities after surgery and for spider veins.

Surgical Treatment

  • Open Surgery
  • Laser Ablation
  • Radiofrequency Ablation

Surgical treatment is needed when non-operative measures fail to control the condition, or if there are complications. In open surgery, the damaged saphenous vein in the thigh is removed using a stripper through small incisions in the groin and upper leg (Stripping).Varicose bunches in the leg are removed by tiny stab incisions (Stab Phlebectomy)

Less invasive procedures like Laser and RF ablation have become more popular recently, and have shown good results. In cases of laser and RF Ablation no cuts are made. The laser or RF fibre is passed into the vein through a tiny needle hole, and the saphenous vein is burnt by the heat generated. Varicosities below the knee are treated by sclerotherapy or phlebectomy.

Even after surgery, patients must wear compression stockings for 4-5 months to get maximum benefit.

How to prevent?

  • Wearing stockings during pregnancy and after delivery
  • Weight reduction
  • Elevation of the leg from time to time
  • Adequate exercises like pedalling movement of the ankle - it works the calf muscle and helps to empty the veins.

How to manage bleeding

Patients must lie down immediately and elevate the affected leg. This empties the vein and the bleeding gets reduced immediately. Pressure must be applied over the bleeding site till the bleeding stops. After this, a compression bandage or stockings must be used.

Events of the past month

Department of Geriatrics, Kauvery Hospital, celebrates Elders’ Day

Kauvery Hospital’s Department of Geriatrics celebrated Elders’ Day (the UN’s International Day of Older Persons) on Sunday, October 11th. The occasion also served the purpose of releasing Vithaikul Oru Virutcham (A Tree inside a seed), a Biography of Padmashri Prof Dr. V.S. Natarajan, the Father of Geriatrics. Mrs. Bharathi Baskar released the first copy, presenting it to Dr. Aravindan Selvaraj, Executive Director, Kauvery Hospital.

Geriatrics is the medical discipline concerning diseases of the elderly. The department focuses on geriatric diseases prevention and improving the quality of life of seniors.

Care for the elderly is an issue that requires more attention across the world. Globally the percentage of people over the age of sixty is increasing rapidly, and will reach thirty percent by 2050. In India, about 7% of the population is over the age of 60, and the number of senior citizens is expected to increase rapidly in the years to come.

Dr. N. Lakshmipathy Ramesh, Senior Consultant Geriatrician, Kauvery Hospital shed light on the prevailing scenario: “In the traditional joint family system, elders held a place of prominence and they were well cared for. Unfortunately, the current trend of nuclear families has resulted in a large number of senior citizens being neglected. Many of them live alone, including those with serious health problems.

They require a shoulder to lean on in this difficult stage of life. With the right Geriatric care and a dedicated Geriatrician, even senior citizens with multiple medical problems can lead a healthy life. At Kauvery Hospital, we follow certain methods to provide the best Geriatric Care. Our staff members are trained to be patient and make elders feel safe and comfortable”

The grand finale of the day was the staging of Shri. Kathadi Ramamurthy’s humorous Tamil play “Pillayaar Pidikka...”


Dr. K. V. Thiruvengadam Award for Health Care

The "Dr. K. V. Thiruvengadam Award for Health Care" was instituted by the Rotary Club of Madras East in 2006. This award for the year 2015 was presented to Dr. Thanikachalam at a grand gathering of Rotarians of RCME @ Crowne Plaza on October 15, 2015 organised by Kauvery Hospital, Alwarpet.


Ayudha Puja Celebrations

Whatever is impossible in the eyes of man is colossally and divinely possible for God, the Almighty. Invoking the divine blessings on the occasion of Ayudha Puja at Kauvery Hospital, Chennai.


Launch of New Operation Theatre

Kauvery Hospital inaugurates yet another Operation Theatre, the fifth one on the Third Floor.

Upcoming Events

General Medical Camp at Vellore
Kauvery Hospital will conduct a general medical camp on Orthopaedics, Vascular Surgery and Cardiology at Vellore on 08/11/2015.
Time: TBA

Paediatric Cardiology Camp at Mettupalayam
Kauvery Hospital will conduct a Paediatric Cardiology camp for the general public at Mettupalayam on 14/11/2015.
Time: 10.00 am
Doctor: Dr.Prem Sekar, Senior Interventional Cardiologist, Kauvery Hospital

CME at Kauvery Hospital
CME on epilepsy in women by Dr. Prithika Chary, Chief Neurologist and Neuro Surgeon, Kauvery Hospital at 7th floor Kauvery Hospital for doctors on 17/11/2015.
Time: TBA

Paediatric Cardiology Camp at Thirunelveli
Kauvery Hospital will conduct a Paediatric Cardiology camp for the general public at Thirunelveli on 21/11/2015.
Time: 10.00 am
Doctor: Dr.Prem Sekar, Senior Interventional Cardiologist, Kauvery Hospital

Gastro and Spinal Camp at Manapakkam
Kauvery Hospital will conduct a Gastro and Spinal camp for employees of L & T at Manapakkam during the 3rd week of November, 2015.
Time: 2:00 pm

Patient Experience

"Services to the patient are very good. We never expected services like this."
- K.M

"Overall very efficient; quick diagnosis and speedy action taken; highly appreciated. Both Dr. Bhuvaneshwari and Dr. Balamurali patiently answered all our questions. Excellent service from them."
- P.D

"Hospitality is very good. Doctors, ICU Staff, Nurses, Housekeeping Staff and Security Staff were outstanding in their services. We are happy and lucky to have had such a team."
- K.M

"We have many times visited various hospitals in Chennai, all famous hospitals. We have never seen such good service rendered anywhere else. No words to express my feelings about Kauvery Hospital. Excellent! keep it up!"
- A.K

"Overall, good service. Very impressed with the service of the nurses and support staff."
- A.M

"Feeling very good with overall experience at Kauvery and discharging with patients happy and with high spirit. Special mention about Dr. Aravindan and 5th floor support staff - Pauline."
- S.H

"D.Shanthi, a room service woman was very perfect in work and maintenance. Doctor facility and service, very nice. Thanks to Dr.Senthil Kumar."
- K.G.B

"Nursing team at private ward B were very helpful and made the whole process very smooth."
- A.N

"Overall treatment, Doctors’ involvement and nurses’ services were excellent. The doctors and nurses team are very prompt, efficient and courteous."
- D.S

"Well taken care and good hospitality. It feels like being at home. Friendly behaviour of staff was good."
- D.D

May Millions of Lamps Illuminate Your Life with Endless Joy, Prosperity and Health forever!

Wishing You and Your Family a Very "HAPPY DIWALI",

- From Everyone of Us at Kauvery Hospital

Tips to Enjoy a Safe Diwali

DO's

  • Always set off crackers in an open area. Make sure there are no inflammatory things nearby.
  • Keep small children away from the place where crackers are set off.
  • Keep handy a bucket full of water and a first aid box.
  • In case of major burns, the victim should be taken to a burn specialist at the earliest.
  • In case of eye burns, wash the area with tap water for 10 minutes, and then take the victim to the Hospital.

DON'Ts

  • Don't wear nylon clothes as they catch fire quickly.
  • Never give crackers to small children.
  • Don't keep your face close to crackers and fireworks while lighting the fuse.
  • Never leave a matchstick, lighter or candle near unused crackers and fireworks.
  • Never set off crackers near electric poles and live wires.
  • Don't throw crackers on people.

Recipe Corner

Sautéed Paneer Masala Dosa

Preparation time: 20 minutes
Cooking time: 20 minutes
Caloric Value: 200

Nutritional Value in this Recipe: Fat - 8.9 g - 14%; Cholesterol 7 mg - 2%; Sodium 358 mg - 15%; Carbohydrates 13 g - 5%; Potassium 290 mg - 8%; Dietary Fiber 2.4 g - 10%; Protein 14.2 g; Vitamin A - 39%; Vitamin C - 136%; Calcium- 6%; Iron - 2%.

A tasty, healthy, filling and easy-to-make snack that children and adults will love. This quick preparation is a great tea-time snack. It can be served in various ways. It can be served by itself or as a topping for salads or as a stuffing in Parathas, Chappathis or Dosas. This receipe gives the method for stuffing in a dosa.

Ingredients:

  • Paneer or Cottage Cheese - 350 g
  • Sweet Red Peppers - 2, diced into tiny pieces
  • Onion - 2, medium sized; finely diced
  • Oil - 2 ½ tbsp. (refined, olive or oil of choice)
  • Fresh Coriander Leaves - finely diced
  • Salt to taste
  • Turmeric Powder - ¼ teaspoon
  • MTR Pulao Mix - ½ teaspoon
  • Grand Sweets readymade green Chutney - ½ teaspoon per dosa
  • Dosa Batter to make dosa

Preparation:

1. Slice the Paneer into tiny pieces.

2. Set a kadai and wok on a low flame. Add 2 tablespoons of oil.

3. Add the finely diced onions and sauté until the onions are translucent.

4. Add the red peppers and sauté until desired level of crunchiness is obtained.

5. Add salt, turmeric powder and MTR pulao masala and sauté for 5 minutes.

6. Add the paneer and mix the masala well, sauté for another 5-10 minutes.

7. Add finely diced coriander leaves, before removing the sautéed paneer masala off the stove.

8. Remove from fire and serve in little bowls or set aside as filling for dosa.

9. Next on a non-stick tawa, pour a ladle of dosa batter on to the tawa and spread.

10. Spoon ½ teaspoon of oil around the dosa. Turn and cook for 3 minutes and turn over again.

11. Ladle out a teaspoon of the green chutney on to the dosa and spread. (Instead of green chutney, coconut chutney, Maggi Hot and Sweet Sauce or Ketchup may be used, to suit taste).

12. Next ladle out a tablespoon of the paneer mix, on top of the dosa and line it in the center.

13. Fold the dosa ends from either side and serve hot either with coconut chutney or by itself.

This dish can also be prepared for parties and served as small eats/appetizers. After rolling up the dosa ends, cut into small bite size pieces, use a toothpick or clove to keep the ends together, and serve on a platter.