Health care

World Health Day – Second Innings

Prajakta Albuquerque

07/04/2018

2264

They say, “not all storms come to disrupt your life. Some come to clear your path.”

On the occasion of World Health Day, Indiavocal compiles one of the real-life incidences in the lives of doctors which will bring a ray of hope.

Name: Dr. Pramod Narkhede

Area of Expertise: Consultant Interventional Cardiologist

Hospitals: Jehangir Hospital; Ruby Hospital, Columbia Asia

Problem: Pulmonary Embolism

It is a blockage in one of the pulmonary arteries in the lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis). Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. Taking measures to prevent blood clots in your legs will help protect you against pulmonary thromboembolism.

Medication:

One of my patients, let’s just say, Mr. A, a 34-year-old, gentleman, otherwise healthy, developed sudden shortness of breath and left-sided chest pain with giddiness, lasting for few hours. Chest pain was so severe while inhaling (inspiration) and was feeling suffocated progressively. He was working in a financial company. He never had any addiction in life, nor was he taking junk food. No one from the family had any heart-related ailments. He considered it to be acidity and took over the counter medications for the same which didn’t give any relief to him. One night, he rang his neighbor up; my colleague shifted him to N.M. Wadia Institute of Cardiology. I found him in a collapsed state with pounding heartbeats, shortness of breath, borderline blood pressure. As he had de-saturation, he was given oxygen support and his initial blood investigation workup was done. His ECG revealed no significant change except a tachycardia (a heart rate that exceeds the normal resting rate). He was slightly overweight, history revealed, stressful life, prolong sitting hours with no regular exercise.

There were no signs of Deep Venous Thrombosis. Immediately echocardiography (sonogram of the heart) was done which showed dilated right-sided chambers with elevated pulmonary artery pressures which indicated Pulmonary Embolism. He was under proper medication, and he showed remarkable improvement in overnight ICU stay. Later, he was found to have high cholesterol, deficiency of anticoagulant proteins, which was addressed and discharged on the 5^th day. Next six months he was on regular follow up and sincerely followed doctor’s advice. This event changed his life in a positive way where he started taking care of himself. He started regular brisk walking (30-45 minutes daily), strict low cholesterol, low carbohydrate, high fiber diet, and meditation. Repeat CT chest was normal. He brought his weight to normal in 6 months. Less physical activity, sedentary lifestyle, faulty dietary habits threatened his life and he was lucky to get through it.

Doctor’s Note on World Health Day:

Considering the present stressful life, we are neglecting our health by having some excuse which makes us prone to such scenarios. One should not neglect any type of chest pain or shortness of breath as it can be lethal. Mr. A understood his risk factors, started regular exercise and modified diet which improved his life. We don’t know whether we will get a second chance. So start now.

Power your life by regularly moving out for exercise, eating healthy, coping up with the stress of life and making others aware of your healthy experiences.

Name: Ketaki Joglekar

Area of Expertise: Consultant Clinical Psychologist

Hospital: Sahyadri Hospital

Problem: Obsessive Compulsive Disorder

An obsessive Compulsive disorder is a neurotic disorder characterized by repetitive, intrusive thoughts images or impulse that are anxiety provoking and the person knows that these thoughts are illogical but cannot control them. These thoughts are often associated with some act which serves as an undoing act for these anxiety-provoking thoughts.

Medication:

As therapists, we empathize with the patient and validate their concerns. However, maladaptive patterns of behavior are not validated or reinforced. The client and therapist form a professional relationship, therapeutic alliance, to work towards the client’s mental health concerns.

I was visited by a client; let’s say, Mr. X, who had Obsessive Compulsive Disorder (OCD). He comes from a small town and works in a reputed organization in a dignified position. OCD is a neurotic disorder characterized by repetitive, intrusive thoughts images or impulses that are anxiety provoking and the client knows that these thoughts are illogical but cannot control them. These thoughts are often associated with some act which serves as an undoing act for these anxiety-provoking thoughts. The client gets the obsession, cannot control it, performs compulsion and the anxiety momentarily gets relieved. This cycle keeps happening to cause significant personal, social and occupational dysfunction.

So for Mr. X, he used to get the thought that he has harmed his colleague, who’s a female. He lived with the anxiety for 3 years and finally asked her if he has. The female colleague denied it and reassured that he hasn’t. However, he would not get reassured. So to get rid of this anxiety, he used to wash his hands, would repeat a sentence to himself once said. Unfortunately, he could not get any help and hence reached out to me. He was assessed to measure the severity which indicated moderate OCD. Also, assessment and interview revealed hopelessness which was the precursor of suicidal ideation in him

He was the first psycho educated about his condition with facts and available treatment options. With his consent, Cognitive Behavioral Therapy was initiated. He was asked to maintain a thought diary. His illogical thoughts were listed and were systematically disputed to get replaced by more adaptive thoughts. Exposure and Response Prevention was also used to manage his compulsive behavior.

It took 15 sessions, weekly one, for him to show significant improvement. The therapy was terminated when the client was reassessed and he was functioning at premorbid level.