World Alzheimer’s Day

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry simple everyday tasks. Alzheimer’s disease is the most common cause of dementia among older adults. The disease is named after Dr. Alois Alzheimer.

People suffering from Alzheimer’s might forget their loved ones. They might forget how to dress themselves, feed themselves, and use the toilet. The disease makes your brain tissue break down over time. It usually happens to people over age 65. A person can live with Alzheimer’s disease for just a few years or for a few decades.

Prevent Alzheimer’s

Here are a few things you can do to enhance your brain health and work to prevent Alzheimer’s:

1. Learn a second (or third, or fourth) language.

2. Eat raw fruits and vegetables.

3. Add a vitamin K supplement to your diet.

4. Reduce stress.

5. Commit to regular exercise.

6. Laugh more.

7. Limit sugar intake.

8. Make time for meditation.

9. Quit smoking.

10. Adopt a Mediterranean diet.

How to care for an Alzheimer’s patient:

Communication difficulties can be one of the most upsetting aspects of caring for someone with Alzheimer’s. It’s frustrating for those with the disease and for the caretaker. Familiarize yourself with some of the common situations that arise when someone has dementia, so that you can respond calmly and effectively. Here are few to tips to make note of:

• Scheduling. In order to keep your parents or loved ones safe, you have to establish a routine that will make your ordinary day more predictable, stable and less stressful.
• “Cues.” Explain regular, everyday things in detail. For example, if you name a drawer for what is inside, the patient will most likely put things in the correct place you suggested. This will ease things for both the caregiver and the patient.
• Remove danger. Remove things that could endanger patients like knives, car keys and matches.
• Use technology. Use technology at its best to monitor patient health, location as well as to keep a check on them while you are away from home.
• Create limitations. Limit your instructions to one step at a time. If you are having a conversation, limit surrounding distractions like the TV and radio. It will help your loved ones stay focused on the conversation.
• Professional help. If the patient’s health deteriorates ask for help. If required hire a professional caretaker or a nurse for full time or on a part time basis.

Facts About Alzheimer’s Disease

• More than 4 million Indians suffer from Alzheimer’s and other forms of dementia.
• Half of adults aged 85 and over have Alzheimer’s.
• More than half of the cases of Alzheimer’s remain undiagnosed.
• More women have Alzheimer’s than men.
• Globally India has the third highest number of cases of Alzheimer’s.
• India’s dementia and Alzheimer’s burden is forecast to reach almost 7.5 million by the end of 2030.

Alzheimer’s Symptoms

To receive a diagnosis of Alzheimer’s, the person must have experienced a decline in cognitive or behavioural function and performance compared with how they were previously. This decline interferes with their ability to function at work or in usual activities. The cognitive decline must be observed in at least two of the five symptom areas listed below:

1. Reduced ability to take in and remember new information, which includes:

• Getting lost on a familiar route.
• Repetitive questions or conversations.
• Misplacing personal belongings.
• Forgetting events or appointments.

2. Impairments related to reasoning, complex tasking, taking decisions, for example:

• Poor decision-making ability.
• Poor understanding of safety risks.
• Inability to manage finances.
• Inability to plan complex or sequential activities

3. Impaired visuospatial abilities like:

• Inability to recognize faces or common objects.
• Inability to use simple tools.

4. Impaired speaking, reading and writing, for example:

• Difficulty thinking of common words while speaking.
• Speech, spelling, and writing errors.

5. Changes in personality and behaviour, for example:

• Mood changes, including agitation, social withdrawal.
• Loss of empathy.
• Compulsive, obsessive, or socially unacceptable behaviour.

The number one symptom of Alzheimer’s still remains as memory loss especially in the area of learning and recalling new information. If you know someone showing these symptoms guide them to our Alzheimer’s Clinic. Please find below link of our website for further details:

https://www.kokilabenhospital.com/departments/clinicsatkh/alzheimersclinic.html

Spine care is an essential part of your health. The three main functions of the spine are to: 1. Protect the spinal cord, nerve roots and several of the body’s internal organs. 2. Provide structural support and balance to maintain an upright posture. 3. Enable flexible motion. Your spine allows your body to be in a stable and upright position. A strong spine and good posture are essential to healthy mobility, a painful spine can eliminate it.

Your spine is a part of the central nervous system, along with the brain, and relies on the peripheral nervous system: the millions of nerves that send messages to the brain that control the body’s functions. An unhealthy spine interferes with this entire system, causing a host of unwelcome health issues such as pain, numbness, and weakness in the arms and legs, digestion and impaired control of the bowel and bladder.

Spine disorders:

Here are a few common spine disorders that affect people:

• Degenerative disc disease is a normal part of aging that often occurs along with spinal stenosis. Over time, stressors and minor injuries cause the spinal discs to gradually degenerate, shrinking the space between discs and causing instability and nerve compression.
• Slip disc can occur as a result of injury, fall or repetitive motion or as a part of normal ageing process.
• Spondylolisthesis occurs when one vertebra slips forward on the vertebra below it. It causes immense back pain.
• Kyphosis is an abnormal forward curve in the upper part of the spine. It is typically found in older women but it may occur in any age. Severe Kyphosis may also cause fractures of the vertebrae.
• Osteoporosis typically occurs in post menopausal women and may contribute to vertebral fractures.
• Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine.
• Spinal Stenosis is the narrowing of the spinal canal that often accompanies degenerative disc disease and is typically seen in people over 60. It progresses slowly over time and causes back and leg pain during activity.
• Scoliosis is a sideways curvature of the spine that occurs during growth spurts before puberty or as a result of arthritis, spinal injury or other spinal disorders. Most cases are mild, but severe cases can be disabling too.

Strengthen your spine

Do you slouch?

Slouching is the reason why 80% people suffer from spinal problems.

Here are a few tips to help you take better care of your spine and back:

1. Good posture is essential

Maintaining an erect good posture is the key to a healthy spine and helps prevent many spine problems.

2. Deep belly breathing 

This can help improve your posture. Place your hands on your abdominal area and feel your belly move as you inhale and exhale. Do this as many times a day as possible to improve your posture and overall spinal health.

3. Exercise for good spine health

Just 10 minutes per day is all you need to perform some simple spine-strengthening exercises. Neck stretches, shoulder exercises, including bending and extension range-of-motion exercises can dramatically improve the health of the cervical spine.

4. Eat healthy for your spine

You may not think that your diet affects your spine, but it actually plays a key role. A healthy diet consisting mostly of lean proteins, healthy fats and lots of fresh fruits and vegetables is ideal for building a lean body and muscles that support the spine.

5. Get some sunlight

Sunlight contains vitamin D, which is required for strong bones, including the spinal column, and is manufactured in the body through sun exposure. Try to spend 10 to 20 minutes in sunlight daily.

6. Check your sleep pattern

Studies suggest that insufficient sleep is associated with increased neck and back problems. Sleep in a position that enables the spine to relax, the idal being on your side. Choose a suitable mattress as well as pillow for proper neck support.

7. Don’t hesitate to meditate

People who meditate tend to focus on their core, automatically straightening their spines in the process.

Stop these mistakes!

Here are a few mistakes that may ruin or worsen your spine problems:

• Ignoring your pain for too long – If back pain continues for a few days do not ignore. Do not just reply on self medication. Consult a spine expert for correct diagnosis and treatment.
• Choosing surgery too quickly – Do not take hasty decisions. It is recommended to try non-surgical treatments for at least several weeks or months before considering surgery.
• Poor sitting posture – Do you work for long hours at your desk in a poor posture? It is time to correct it with ergonomics.
• Excess mobile usage – Excessive texting or seeing your cell phone for long hours can cause repeated stress injury and pain in the neck. This is called text neck.
• Remaining inactive – If you are in pain, one or two days of doctor-recommended rest is fine. However, over time lack of activity will in fact lead to more pain. Consult a physiotherapist for a daily exercise routine that suits your spine.

Are you or a family member suffering from a spine injury or a chronic back ache? Get yourself checked, consult experts at our Centre for Bone and Joint for further help. Please find below link for more details:

https://www.kokilabenhospital.com/departments/centresofexcellence/centrefor_bonejoint.html

Do you follow a particular diet?

Are you conscious about your weight?

Do you take any special efforts to eat healthy?

Do you eat as per your body’s needs?

Good nutrition is one of the key to living a healthy life. You can improve your health by keeping a balanced diet. You must eat a variety of foods that contain vitamins and minerals. This includes fruits, vegetables, whole grains, dairy, and a source of protein. Your meal must be planned as per your age as well as your nature of work. Do not fall for fad or short-term diets that look tempting. They may promise to help you lose weight fast. However they may be unhealthy in the long run. A good and balanced diet improves the quality of life and helps prevent illnesses. Let us look at the various aspects of nutrition as we celebrate National Nutrition week from 1st to 7th September.

Benefits of good Nutrition:

Here are a few ways how a good diet affects your body positively:

1. Weight loss

Losing weight can help to reduce the risk of chronic conditions. Obesity highly increases your risk of developing several conditions, including heart disease, cancer, type 2 diabetes, osteoporosis.

2. Diabetes management

Eating a healthy diet can help a person with diabetes lose weight, manage blood sugar levels, manage blood pressure levels, prevent or delay the complications of diabetes.

3. Cardiac health and stroke prevention

A majority of premature heart disease and stroke cases can be prevented by making lifestyle changes, such as increasing levels of physical activity and eating healthfully. If a person eliminates trans fats from the diet, this will reduce their levels of low-density lipoprotein cholesterol. This type of cholesterol causes plaque to collect within the arteries, increasing the risk of heart attack and stroke.

4. Strong bones and teeth

A diet with adequate calcium and magnesium is necessary for strong bones and teeth. Keeping the bones healthy is vital in preventing osteoporosis and osteoarthritis later in life. Few sources of calcium rich foods are dairy, legumes, cauliflower, broccoli, bananas, etc.

5. Better mood

Research suggests that a diet with a high glycemic load may cause increased symptoms of depression and fatigue. Avoid foods made of refined carbohydrates like cakes, white bread, and biscuits which have a high glycemic index. Vegetables, whole fruit, and whole grains have a lower glycemic load.

6. Improved memory

A healthy diet may help prevent dementia and cognitive decline. Adequate intake of foods with vitamin D, C, E, omega 3 fatty acids, flavonoids and polyphenols helps boost your brain functions.

7. Improved digestive health

The colon is full of naturally occurring bacteria, which play important roles in metabolism and digestion and help fight harmful bacteria and viruses. A diet low in fiber and high in sugar and fat hampers this process. A diet rich in vegetables, fruits, legumes, and whole grains helps good bacteria to thrive in the colon.

Common Nutrition Myths:

• Carbohydrates make you fat.
  This depends on the quality of carbohydrates consumed that either leads to fat gain or fat loss. Simple carbohydrates like sugar, fruit juices, maida lead to fat gain, whereas complex carbohydrates like whole grains and cereals, whole fruits lead to sustained energy levels and fat loss.
• Too much protein causes hair fall.
  This is not true. Eating a protein-rich diet prevents deficiencies and reduces hair fall.
• Dal is a complete protein
  Protein required by our bodies for muscle and tissue repair is made of 22 amino acids. Animal-based proteins such as eggs and lean meat provide all these, whereas dal lacks in one of the amino acids and therefore must be combined with another cereal in order to make a complete protein.
• Diets don’t work!
  Diets work when they suit your metabolism and lifestyle. Poorly designed weight loss programs are ineffective. Tailor made nutritional plans created by qualified health professionals are effective.
• Too much protein can cause liver damage.
  No, metabolizing protein is a natural work of the liver. Only with a liver problem, one needs to restrict protein.
• Eliminating dairy products leads to weight loss.
  Excluding whole dairy products rich in saturated fats leads to fat loss. One can include low fat dairy products in a fat loss program. Excluding dairy completely is not recommended as it may lead to a calcium deficiency.
• Thirst is an indication to drink water!
  Thirst is an indicator of dehydration. Drink water regularly throughout the day. A dehydrated body compromises on performance and cannot burn fat nor build muscle.

Common nutrition myths for children:

• Frequent eating will make them healthy
  This is not true. Frequent eating will not advance your child’s growth and development. The fact is that healthy eating habits like fixed time of having meals, eating according to the appetite, healthy snacking and a balanced diet are the growth determinants. Frequent snacking and overeating can result in health issues like obesity, diabetes etc. later in life.
• Fruit Juice is healthy
  Always choose whole fruits over juices. Fibre is extremely important for a healthy body and fruit juice does not contain fibre, which a whole fruit does.
• Hide the vegetables
  Many parents secretly put veggies and other healthy ingredients in their child’s meal. While this may work in the short term, they are not developing the habit to eat a healthy diet. It is important to make them understand the concept of healthy eating and its significance in development.
• More sugar means high energy levels
  Consuming too much sugar is, in fact, bad for health. It can lead to ‘sugar addiction’ which can harm children both physically and psychologically. This addiction can generate mood swings, irritability, changes in activity levels etc. Hence, you should monitor their sugar intake levels regularly, and not encourage over-consumption of sugar.

How to eat Healthy

Make these smart changes in your diet:

• Swapping soft drinks for water and herbal tea.
• Avoiding processed foods.
• Eating whole fruits instead of juices.
• Limit your salt and sugar intake.
• Ensure fruits and vegetables make up 50% of your meal.
  • Instead of frying choose to bake or grill your meals.
  • Reduce any extra fat intake.
  • Read the nutrition labels on foods before you buy them.
  • Eat home-cooked meals as much as possible.

Are you struggling with your weight issues? Get your personalised diet plan with our dieticians. Consult our Department of Nutrition Therapy for more help.

Are you clothes fitting too tight?

Does your usual flight of steps feel tiring off late?

Do your knees, hips and back hurt all the time?

These are all signs of weight gain which may slowly lead to obesity. Obesity is a medical condition that occurs when a person carries excess weight or body fat that might affect their health.

Research conducted by the World Obesity Federation shows that the percentage of Indian adults living with obesity is set to jump to around 5% by 2025, from 3.7% in 2014. This is especially more applicable to urban Indians.

What is Obesity?

• Obesity means having excess body fat. Adults with a BMI greater than 30 are obese.
• Obesity is not just a cosmetic consideration. It is a chronic medical disease that can lead to diabetes, high blood pressure, obesity-associated cardiovascular diseases such as heart disease, gall stones,  and other chronic illnesses.
• Obesity is a risk factor for several cancers.
• No medicines can cure obesity. It requires a lifelong commitment to proper diet habits, increased physical activity, and regular exercise.

What causes obesity:

1. Wrong eating habits –  This is one of the major causes of obesity. Obesity never develops overnight; it progresses from a poor diet. And wrong eating habits from childhood also make people obese.

2. Less physical activity – Lack of physical activity aided by the technology boom is making us physically inactive and leading to people becoming obese. Make exercise a part of your daily routine.

3. Lack of awareness – A major section of the population still lacks basic knowledge about the right nutrition, which leads to obesity.

4. Genetics – Obesity has a strong genetic component. Children of obese parents are much more likely to become obese than children of lean parents. Some people appear to be genetically susceptible to weight gain and obesity.

5. Junk food diet – Heavily processed foods are often little more than refined ingredients mixed with preservatives and food colours. They lack nutritional value and are highly engineered to get people hooked. They also promote overeating.

6. Sugar Addiction – Sugar changes the hormones and biochemistry of your body when consumed in excess. This, in turn, contributes to weight gain. Added sugar in various foods, desserts, sweets, processed foods cause complex addictions and makes your brain crave for more. They are often compared to drugs cocaine, nicotine and cannabis.

7. Insulin – Insulin is a very important hormone that regulates energy storage. High insulin levels and insulin resistance are linked to the development of obesity. To lower insulin levels, reduce your intake of refined carbohydrates and eat more fiber.

How to assess your weight

• Body mass index (BMI): It’s a calculation that classifies your weight status from underweight to obese. It’s computed by dividing your weight in kilograms by your height in metres, and then dividing the sum by your height again. There are several apps and online calculators that can help you.
• Waist circumference: Start at the top of your hip bone, and keep your tape measure level with your belly button. Don’t hold your breath while measuring. A measure of 90cm (men) and 80cm (women) signals abdominal (central) obesity in Asians.

Obesity in India

Globally, over two billion children and adults suffer from health problems related to being overweight or obese, and an increasing percentage of people die from these health conditions. With childhood obesity on the rise—India has the second-highest number of obese children in the world after China. Over 5% of India’s population is now morbidly obese. It is important to eat healthy and maintain an active lifestyle.

Here are a few tips to follow to prevent obesity:

• Burn the calories you eat – The secret to not gaining excess weight is burning as many calories as you consume. Maintain a healthy balance between regular exercise and a healthy diet.
• Do your diet right – Diet is an essential part of your fight against obesity. Choose foods that are rich in fibre like dried beans and raw vegetables. They also help maintain a healthy gut system which, in turn, enhances the absorption of nutrients slowly throughout the day after meals.
• Maintain a food diary – A food diary is a useful way of keeping track of the intake of food and calories consumed. Consult with your nutritionist and work out what diet is the best for you. Use a food diary to follow this plan religiously.
• Track your BMI – Keep your weight in check and maintain it as per your height to keep the BMI within the ideal limit. This would go a long way in keeping obesity away.
• Pay attention to food labels – According to the Food Safety and Standards Authority of India(FSSAI), a food product with less than 40 calories per 100g of the food is termed low-calorie food. Make sure to read the labels on your food products and select low-fat, high-fibre and low-cal food.
• Say no to refined foods – Refined foods like maida, refined white sugar and refined white salt should be avoided. They are rich in simple carbohydrates that are easily absorbed by the body and stored as fat. Limiting the intake of refined foods will help in long-term weight management.

Are you suffering from extreme obesity? Is your excess weight causing joint problems and general discomfort in your daily life? Consult our expert Bariatric Surgeons to know if you are eligible for bariatric surgery.

Towards A New Beginning

What is kidney (renal) failure/injury?

Kidney Injury/Failure can be acute, which means that the kidneys have suddenly stopped working. Acute Kidney Failure is potentially reversible.

Chronic Kidney Failure is a slow progressive and irreversible loss of kidney function.

What is chronic kidney disease (CKD) and what are the common causes of CKD?

Chronic kidney disease is the presence of functional or structural abnormality in the kidney for three months or longer. eg. presence of screening “Maker” such as protein in urine or having a decreased kidney function for more than 3 months.

There are many causes of CKD. The kidneys are most commonly affected by diseases, such as diabetes and high blood pressure.

Some kidney conditions are inherited (run in families). Others are congenital, i.e., individuals may be born with an abnormality that can affect their kidneys.

What is end stage kidney disease (ESKD)?

ESKD is a stage at which practically the entire kidney function is lost. On ultrasound examination, the kidneys are usually small and shrunken. The kidneys can be considered to be dead for all practical purposes. Life long dialysis or transplantation becomes mandatory for survival. Each year approximately 350,000 – 400,000 people develop ESKD.

What are the signs and symptoms of kidney disease?

Kidney disease usually affects both kidneys. If the kidneys’ ability to filter the blood is seriously compromised by the disease, then wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

• Puffiness around eyes, swelling of hands and feet
• More frequent urination, particularly at night. Difficult or painful urination.
• Blood and/or protein in the urine
• High blood pressure
• A Creatinine & Blood Urea Nitrogen (BUN) blood test, above the normal range (BUN & creatinine are waste products that build up in the blood when the kidney function is reduced.)

What are the treatment options for ESKD?

There are only two options for End Stage Kidney Disease:

• Life Long Dialysis
• Kidney Transplantation

What is dialysis?

It is a process that removes the waste products and helps maintain the volume and composition of body water – the most important and indispensable function of the kidneys It does not help in blood formation and activation of vitamin D as is the case with normal kidneys. Hence supplementary therapy is required It does not improve the function of diseased kidneys

What are the types of dialysis?

There are two types of dialysis:

Haemodialysis, where the blood is cleaned outside the body via a machine Peritoneal dialysis, where the cleaning is done inside the body by the peritoneal membrane Occasionally, there may be medical reasons to prefer one dialysis over the other.

What is the best option for the treatment of ESKD?

Kidney (Renal) Transplantation is the best available treatment for ESKD because of the following reasons:

• Improved survival
• Better quality life
• Improved cost effective

Who is eligible for transplantation?

• All patients with ESKD should be assessed for suitability of kidney transplantation
• Patients having cancer or other active infections cannot go for transplantation

Special assessment is required for the following groups of patients:

• Old age
• Severe heart disease, lung disease or liver disease
• HIV positive patients
• Psychiatric Illness

Who can donate/give kidneys?

Living Donors

Indian Law permits near and dear ones to donate organs (kidney, liver, bone marrow). Parents, siblings, son, daughter, grandparents and spouse are treated as ‘near relatives’.

If a family member cannot donate a kidney because of difference in blood group and if there is another pair with a similar problem, the donors can be exchanged for the purpose of kidney transplantation. This is called a Swap Transplant.

Living donors are thoroughly investigated by the physician. The donors should be in good overall physical and mental health and free from uncontrolled high blood pressure, diabetes, cancer, HIV, hepatitis, and organ diseases (such as those related to the kidney, heart, liver, lung, intestine and pancreas). Living donors should be older than 18 years of age and compatible with the intended transplant candidate. The donors are screened from medical and psychosocial aspects.

Deceased Donor (Cadaver Donor)

A deceased donor is a person who is brain dead.

A person is dead when his heart stops beating permanently.

A person is dead even when the brain is dead but the heart is functioning. At this stage the heart can function for hours or days. During this period, if the family consents, various organs and tissues can be used for transplantation.

One can register for a cadaver organ with the ZTCC – Zonal Transplant Coordination Committee (city waiting list) through the Transplant Coordinator & the Nephrologist at the hospital.

What is the success rate of kidney transplantation?

• Overall, transplant success rates are very good
• Transplants from deceased donors have an 85 to 90% success rate for the first year. That means that after one year, 85 to 90 out of 100 transplanted kidneys are still functioning
• Live donor transplants have a 90 to 95% success rate. Long term success is good for people of all ages

What if my donor’s blood group does not match mine?

There are three options available for such patients:

• Blood group Incompatible transplantation ( ABOi)
• Living Donor Paired kidney exchange ( LDPE)
• Deceased donor ( cadaver) donor listing

What can my kidney donor expect?

The procedure for the person who is donating a kidney to you is exactly the same as for blood group compatible
donors. The special treatments are only necessary for you.

Is it expensive?

The cost of the kidney transplant surgery remains the same except that the cost of plasma exchange procedure is additionally to be calculated based on the amount of antibodies in your body.

Why Kokilaben Hospital?

The Nephrology and Urology departments boast of one of the largest dialysis units in the city and a sizeable renal transplant program, having performed both living and cadaveric transplants.

The stringent infection control practices, immunosuppressive protocols and proactive vigil for complications and their prompt management make the service comparable to the best. The Transplant Unit also integrates, analyses and addresses the health needs of the transplant patient and his or her family.

State-of-the-art procedures for kidney transplantation include:

• Cadaver Donor Kidney Transplantation
• Living Donor Kidney Transplants
• Paired Kidney Exchanges
• ABO-Incompatible Transplantation
• Laparoscopic Donor Nephrectomy

The Kokilaben Hospital Kidney Transplantation Team comprises of specialists in transplantation medicine and surgery. The team comprises of 2 nephrologists, 2 transplant coordinator and 3 transplant surgeons.