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Living with a hole in your eye? Health Notes
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Kidney stones: Myths and facts a. Intake of tomatoes can cause stones Fact: It has been proven beyond doubt that tomatoes eaten in the usual quantities, bhindi and other seeded vegetables have no role to play in causing renal stones. On the other hand, all kinds of beans, foods like apples and apple juice, saag and leafy vegetables like spinach should be consumed in restricted quantities — there is nothing banned! b. Milk is prohibited in kidney stones Fact: Milk and calcium containing medicines have been shown to have no effect whatsoever on the formation of kidney stones. Excess of protein-rich foods like meat, chicken and fish should, however, be avoided. Myths about fluid intake c. One should take plenty of all kinds of fluids to get rid of stones Fact: The best fluid guaranteed to prevent and treat renal stones is plenty of water to which some lemon juice is added, without sugar or salt. Salt, in particular, is very harmful in stone disease. All other fluids like tea, coffee, sodas, soft drinks and juices, should be taken in moderation! All of these fluids do cause increased flow of urine but only by causing loss of the body’s own fluids! As a rough guide, each cup of tea causes the body to lose at least two glasses of water! If one likes to drink any of these dehydrating fluids, one must drink more water. d. Intake of beer is useful in kidney stone disease Fact: Beer causes kidney stones: In addition to causing a large-scale loss of precious body fluids, beer contains several chemicals which can cause kidney stones! e. If one stays in an airconditioned atmosphere all the time, one doesn’t need to drink more water Fact: One of the functions of airconditioning is to remove moisture from the environment. So, if one lives and works in an airconditioned atmosphere all day long, one must necessarily drink more water. People earning their livelihood through manual labour obviously need many times more. Myths about diagnosis of stone disease f. Ultrasound is always right in diagnosing kidney stones Fact: Ultrasound examination may diagnose stones where there are none, and conversely, miss stones when they are present. There is a portion of the ureter in which a stone can be missed quite easily. To make a firm diagnosis of renal stone, a urologist usually considers the patient’s history and then conducts a thorough clinical examination of the patient. Following this clinical examination, he may then advise several investigations, including urine microscopic exam, ultrasound and imaging studies of the urinary tract with intravenous urography and/or CT scan/Isotope scan. Using a combination of these techniques, he then advises appropriate treatment. He may also advise biochemical tests, including stone analysis, to guide the patient on how best to prevent stone recurrence. Myths about the treatment of renal stone a. Any doctor can treat stone disease Fact: Although every qualified MBBS doctor is supposed to have some working knowledge about various aspects of the kidney stone disease, many of them do not keep themselves updated, and so are unable to provide the correct advice. Non-MBBS doctors are obviously unqualified to prescribe allopathic treatment. b. Desi medicines can help get rid of stones Fact: There is no evidence that “desi” or indigenous medicines help in treating or preventing kidney stones. Many of these “desi” medicines, in fact, contain allopathic pain relieving medicines. The patient becomes free of pain and assumes that the stone has passed! After some time, the kidney becomes non-functional or “dead”. Ayurvedic/homoeopathic medicines may have some efficacy but do not have enough studies to support their use. c. Any surgeon can treat stone disease Fact: Many surgeons who are interested in the kidney stone disease and keep their knowledge updated can usually render appropriate advice regarding kidney stone management. The best consultant to manage a patient of kidney stones is a urologist. A urologist is a surgeon who has been trained in urology for two-three years after acquiring the degree of M.S.(Surgery). A urologist may hold the degree of M.Ch. or DNB in Urology. Unfortunately, there are only about 2000 qualified urologists in the whole of India, and most practise in larger cities. In Punjab, for example, this number may be less than 20. Thus, anybody and everybody helps in managing kidney stone disease. d. There is no medical treatment of kidney stone disease. Fact: There are specific guidelines for the management of every type of kidney stone disease, including medical management - most urologists are aware of these guidelines and follow them. As a general rule, if there are stones in both kidneys, at least one should be kept free of stone as soon as possible. Similarly, in case a stone is causing severe pain or fever or is likely to damage the kidney being affected, it usually needs urgent admission and management. Mere absence of pain does not mean that the kidney is safe. e. Absence of pain means the stone has disappeared. Fact: The fact that a stone which was earlier causing pain is not painful anymore does not necessarily indicate that it has been passed out. In fact, many times, pain disappears merely because the kidney has stopped to function! Even the absence of stone on ultrasound may not confirm that it has passed out. Passage of stone in the urine is the only proof, positive of stone passage, unless additional tests confirm it. f. Intravenous fluids can help get rid of stones. Fact: Intravenous fluids are used only to manage an episode of severe pain, not to “get rid of” stones. Pain caused by stones may be so severe as to require intravenous medication for pain relief. In addition, there may be vomiting and abdominal distension during severe pain which may limit the intake of oral fluids by the patient, and this is why an intravenous drip may become necessary. g. “Flushing”/”Lasix Therapy” or “Forced Diuresis” can get rid of kidney stones. Fact: There is NO medical evidence that Lasix therapy/forced diuresis helps to get rid of stones. However, despite this fact, this form of “treatment” continues to be the most commonly abused. If the stone is in the kidney, the increasing urine flow will never affect it. If the stone is in the ureter or obstructing the system, “flushing” can be so dangerous that it can actually kill the patient! All urologists have seen patients brought in as an emergency in severe septicaemia because some doctor tried this ridiculous means of treatment. h. Open stone surgery is the only sure method to get rid of all the stones. Fact: Open surgery for stone disease has been given up as a method of choice for more than 98 per cent of kidney stones treated all over the world. The reasons are very obvious: Endoscopic surgery requires very tiny or no incision compared to open surgery which requires very large and muscle-damaging incisions. There is hardly any pain during and after endoscopic surgery. No rest is required after endoscopic surgery, which can be repeated if and when the stone occurs again (recurrence). Open stone operation, on the other hand, becomes more and more difficult with every repeated attempt, and may even lead to the removal of the kidney finally. Apart from the trauma and pain, open surgical incisions for kidney surgery are very prone to form hernias. However, endoscopic surgery for stone disease is rather expensive in terms of proper equipment and adequate training of urologists. So, open surgery is quite common in India and the developing world. i. Surgical removal of stones is useless because stones may form again. Fact: Surgical removal can never be a cause for new stone formation! Urologists usually give detailed dietary and medical advice to ensure that stones do not form again. It then becomes the duty of both the patient and the doctor to ensure that the advice is followed religiously. j. Endoscopic surgery can cause recurrence (re-occurrence) of stones. Fact: Endoscopic surgery can never be a cause for stone recurrence. What can happen is that stones or stone fragments are left behind during surgery and they grow later. This may happen in patients who have multiple kidney stones. For this very reason, most urologists make sure that patients leave the hospital free of stones after endoscopic surgery. Several techniques, including X-rays, are used to ensure that the patient is absolutely stone-free after the operative procedure. This is something which is almost never done after open surgery! The writer, based in Amritsar, is one of the senior urologists in Punjab. |
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Living with a hole in your eye? When Bhagat, 65, visited the eye centre for an eye examination with the complaints of flashes of light and floaters in the right eye and some loss of vision on the left side, he was taking it to be a routine visit for a change of glasses. However, when the doctor covered his right eye he found ‘marked blurry and distorted vision in the left eye’ that scared him. The doctor dilated his pupils in both eyes with drops for a better examination and pronounced, “Dear, you have holes in both eyes; on the left it is a macular hole — in the centre of the retina and on the right it is at the periphery of the retina. If it is not sealed with laser/surgery immediately, you can develop retinal detachment and blindness. Unfortunately, a hole in the retina is not an uncommon condition. You are also developing cataract, which will require surgery in due course, but this will make our task difficult in doing laser for retinal holes.” Bhagat got a shock of his life as it appeared to him the beginning of a long dark tunnel ahead.
Macular holes
The macula, where holes sometimes develop, is a very small spot in the centre of the back of the eye /retina. Light focuses at the macula, which is the only area of the eye that sees crystal clear, colour vision. When a macular hole develops, most people notice a sudden decrease in vision in one eye. Left untreated, a macular hole can worsen over time. Macular holes occur in three stages: Foveal detachments — about 50 per cent worsen without treatment. Partial-thickness holes — about 70 per cent worsen without treatment. Full-thickness holes — most worsen without treatment.
Why macular holes?
Vitreous shrinkage and/or separation is a common cause. Because the vitreous is attached to the retina with tiny strands of cells, it can pull on the retina as it shrinks. Sometimes, this shrinkage can tear off a small piece of the retina, causing a hole. Fluid develops where the vitreous shrinks to fill the space. This fluid can seep into a macular hole, causing blurred and distorted vision. Other causes are: diabetic eye disease, high myopia, macular pucker, a detached retina, eye injury, etc. A vitrectomy is the most common treatment for macular holes. In this surgery, a retina specialist removes the vitreous gel to stop it from pulling on the retina. Then the specialist inserts a mixture of air and gas into the space once occupied by the vitreous. This bubble of air and gas puts pressure on the edges of the macular hole, allowing it to heal. While the bubble is doing its job, the patient must lie with the face down so that the bubble stays in the right place in the eye, sometimes for as long as two to three weeks! Although it can be very boring to stay still for long, this approach is absolutely necessary for treatment.
Retinal holes in the periphery
The shrinkage of the vitreous body sometimes causes traction on the peripheral retina in areas where the vitreous body is “struck”. This traction may cause a tear in the retina. Other types of breaks seem to be related to changes due to aging which occur in both the retina and the vitreous body. A direct blow to the eye may cause the retina to tear away from its attachment. Most of the holes are in the retinal periphery causing no symptoms. However, its formation may be associated with sudden flashes of light, floaters and smokes and cobwebs. The presence of these symptoms calls for an immediate eye check-up.
What to do?
Retinal breaks, if left unsealed, may lead to retinal detachment. If your doctor feels he may seal the hole by laser; tiny burns are put around the break for welding it. A patient won’t even know if it has been done. Even after the treatment a new break may occur, so a regular check-up or emergency check-up should be done if symptoms of floaters or flashes develop. One can’t do anything to prevent new holes from developing later, other than just get dilated every year and try to catch them early. The writer is a Chandigarh-based eye specialist. |
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Fruit and veggies can help protect against cancer risk
London: Millions of people do not eat enough fruit and vegetables putting themselves at risk of cancer, a new survey has revealed. Only one in five people in Britain consume the recommended five portions a day, according to the research carried out for the World cancer research Fund. “A diet based on plant foods, such as wholegrains and pulses as well as fruit and vegetables, can reduce cancer risk as research shows they protect against a range of cancers. Recent research has confirmed that foods containing fibre reduce the risk of bowel cancer,” the Daily Express quoted Kate Mendoza of the fund as saying. The YouGov survey of 2,128 adults was commissioned by the charity to coincide with Cancer Prevention Week. — ANI
Women twice likely to suffer post-traumatic stress after ICU
Washington: Women are more likely to suffer post-traumatic stress than men after leaving an intensive care unit (ICU), according to a new study. However, psychological and physical ‘follow-up’ can reduce both this and post-ICU depression. Patients in the ICU often suffer post-traumatic stress, anxiety or depression due not only to the illness or trauma that put them there, but also to the very nature of the ICU and life-saving treatment. As a result, follow-up schemes have been put into place to help alleviate these psychological problems. Researchers from the Karolinska University Hospital Solna and the Karolinska Institutet compared patients’ recovery since 2006, before a follow-up scheme was started, with that of patients in 2007 and 2008.
— ANI
Statins can ‘halve risk of
bowel cancer’
London: Statins, the pills taken by millions of people to combat high cholesterol, could more than halve the risk of bowel cancer, say researchers. In a recent study, a team of doctors at Norfolk and Norwich University Hospital found that the cholesterol-busting pills, which cost as little as 40p a day, slashed the chances of the disease developing by an average of 57 per cent. And in patients taking higher doses of the cholesterol-busting drugs, or those who were on them for at least five years, the risk fell by more than 80 per cent. The researchers stressed the numbers involved in their study were small but the findings could be important in terms of preventing an often fatal illness.
— ANI
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Fruit and veggies can help
protect against cancer risk
The kidney stone disease is very common in this part of the country. It constitutes a part of the “stone belt” of the world. Every other person either suffers from kidney stones or has a relative who does. Unfortunately, there are so many myths and commonly held misbeliefs about kidney stones. The common man easily gets misled into a confusion of different kinds of advice he gets from friends, relatives, quacks and even qualified doctors.