Tuesday, May 19, 2015

Are We being Overtested,Overdiagnosed and Overtreated?

Go to any hospital,nursing home,diagnostic centre or chemist shop;chances are,you will find a jostling crowd there.Is it population explosion or disease explosion?Point to ponder.

In the years decades gone by,people used to ignore minor hiccups in their body systems.If the problem persisted they would first try home remedies and then go to a doctor.The doctor also relied on clinical diagnosis rather than ordering a battery of tests.

Today everything has changed--the patients as well as the doctors.The average person today is better informed about various diseases and their outcomes.An ever-active media has ensured this.There is a kind of disease phobia in many of us.We rush to the doctor at the first hint of a cold because we are afraid it might be Swine Flu, which has already claimed many lives.This fear even spurs us to request the doctor to carry out some tests even if he did not find it necessary to do so in the first place.

We all have a fear of disease but in some it is so pronounced that they exaggerate their complaints significantly while consulting a doctor.As a result they are saddled with stronger and more medicines than they need.They also end up getting more investigations done on their bodies.

Some,who have health insurance,voluntarily ask for excessive healthcare.This gives only marginal benefits and can even be harmful.

Advanced diagnostic tools like CT scans,MRIs and ultrasounds have made it easy for the doctor to nail down the cause of the patient's distress but excessive use of these tests can be harmful.CT scans expose patients to radiation which is a known cause of cancer.More testing also means more false positives,more unnecessary invasive procedure,more patient stress and higher costs. 

Indeed,according to  Medical Daily :--  

 Unnecessary tests and treatments, while they may appear helpful, are often nothing but money-makers for the hospital and increase a patient’s anxiety (after which anxiety is treated with more pills — a vicious cycle).

Obviously,medical malpractice can generate paranoia about a disease and cause untold harm to a family's emotional and financial status.A news report in The Times of India revealed an alarming trend in private hospitals--that of giving false adverse reports in the hope of getting "more business like further tests,procedures,or even surgeries and prolonged treatment."According to this news item an officer was advised angioplasty following a treadmill test at a private hospital.He went to the A.I.I.M.S for a second opinion and there he was told that there was no need for angioplasty,nor any cause for worry.

I certainly don't mean to imply that the whole fraternity is manipulative or dishonest but since such things are happening,it is up to us to be vigilant and avoid being taken for a ride.
  • Firstly learn to ignore petty problems.The Body Knows How To Heal Itself.
  • Adopt a healthy lifestyle incorporating exercise,nourishing diet and a good work-life balance.
  • If any ailment like headache,back pain,spondylitis,joint pain, allergy,dyspepsia or I,B,S,presents itself off and on;determine what sets it off and avoid it in future.For example many pains can be cured by simply correcting the posture or exercising, and a delicate digestive system can stabilize with proper diet.
  • Don't dramatize your symptoms when you consult a doctor.
  • Take a check list along with you when you visit a doctor so that you can better explain your condition.
  • Do not hesitate to ask the doctor about the adverse effects of any medicine or procedure he may have prescribed.
  • Keep yourself informed about your disease.
  • It is better to start a new medicine in the morning so that ready help is available in case of an adverse reaction.
  • When in doubt,or if advised an expensive/invasive investigation;go for a second opinion.
Just as I was winding up this piece I read a heartening news in The Times of India,Jaipur edition dated May 18.It says that the Society for Less Investigative Medicine (SLIM ) will prepare a list of the investigations which ought not to be done in normal circumstances.This is a very good start,hope it goes far.


Tuesday, May 12, 2015

A simple fight-back against #Depression

Depression creeps up upon a person and catches him unawares.The changes are subtle and they deepen slowly.The symptoms are not as obvious or tangible as of a physical ailment.The patient is so taken up with his problems that he fails to recognize them as precursors of depression.There is also the stigma of consulting a Mental Health Practitioner.As a result a depressive mood can dig deep roots if counteractive measures are not taken in time.

There are innumerable self-help books,therapies and medicines which can help a person fight depression.One simple,basic strategy which I have found useful is,to keep up a regular routine.As depression spreads it's tentacles we slowly give up many of our essential and non-essential activities.The result is that we have much less to do in each day.This makes us lazy and dull.The body and brain both slow down.

But the mind does not.The less we have to do,the more time we have to think,and the thoughts in such a condition are not at all cheering.They intensify our depression because anything which we do repeatedly becomes a habit.Our woeful thoughts form definite pathways in our brain and then we automatically begin to think in that very manner.In neuroscience it is known as experience-dependent-neuroplsticity.But :--

Through concentrated and intentional repetition, you can change your brain. The technical word for this concept, as coined by Jeffrey Schwarz at UCLA, is self-directed neuroplasticity, and recent studies bolster the theory. The ability to rewire our brain holds enormous potential for positive therapeutic change — especially for those who suffer from depression.

It is evident that in order to beat depression we need to desist from thinking doleful thoughts.This is not possible if we are sitting idle,doing nothing.Agreed, that when depressed,we have very little energy or motivation to tackle heavy,challenging tasks.But we can start by sticking to our usual routine as far as possible.Here are some suggestions :--

As soon as you open your eyes in the morning,get up, turn around and make your bed.Go to the wash-room,freshen up and do your hair.Open the doors and windows.Make the cup which cheers you,pick up the newspaper and sit down to enjoy it.Isn't this a lot better than if you had continued to lie down in your bed?

There are many things which we do when we are fine;but tend to neglect when we are depressed.Like taking a bath,wearing fresh,ironed clothes,reading stuff we like,watching our favorite shows on T.V,conversing with family,putting away yesterday's newspaper,putting dirty clothes in the washing machine,taking out garbage,watering the plants and generally tidying up the rooms.Some of these activities are avoidable but they keep us busy,give us something to do and introduce order in our life.

These activities open new avenues for the next level of tasks which further keep us occupied.For example,when you keep yesterday's newspaper in the cupboard you may see that it is already chock-full.You decide to go to the market and dispose them off.Over there,you might meet an old friend,chat with him and come home refreshed.Or you may be tempted to buy a delicacy which you used to enjoy earlier but have been without for pretty long.Someone might accost you and ask why you have not been around for some time.Going out,meeting others,takes our mind off our travails.

As we move around in or outside our home,the blood circulation picks up,digestive system works better and the joints are exercised.Our limbs remain supple and the muscles do not slacken because of disuse.Thankfully,depression does not impose any ambulatory restrictions.The only obstacle is a psychological disinclination to do anything.It is this which has to be fought because it obstructs recovery.

Most importantly,maintaining the routine which we had before depression ensnared us, saves us from slipping into a shabby lifestyle.That in itself,is no mean achievement.At a time when we feel we are on the brink of disintegration,following the old,familiar routine gives a lot of comfort.We feel that we are in charge of our life.

Going out,finishing pending jobs gives a sense of achievement.There is a palpable surge in our confidence level.When we exit our home,narrow confines open up to wider avenues.Our ordeals are no longer the main subject of our thoughts.Imperceptibly,we have joined the mainstream.

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Tuesday, May 5, 2015

Illness Anxiety Disorder or Hypochondriasis

Have you ever met anyone who is generally bogged down by a deep concern over his health?He suspects he is suffering from a terrible--or not so terrible--disease.There is a grim look on his face as he goes around from one doctor to another and undergoes various investigations.Even when the results declare him to be totally fit,or at least not seriously ill,he is not satisfied;and the cycle is repeated again and again.

This tendency is known as Hypochondriasis.It is estimated that around 10% of all those who consult a general practitioner suffer from it.Drugs.com has defined it thus:-- 
 Hypochondriasis is a persistent fear of having a serious medical illness. A person with this disorder tends to interpret normal sensations, bodily functions and mild symptoms as a sign of an illness with a grim outcome. For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be a sign of a serious disease.
A hypochondriac lives in constant fear of deteriorating health.Doctors' assurances and negative test results may give temporary relief but before long he is again overcome by worries about his health.He consults many doctors and undergoes various investigations.He may even hunt for a doctor who will confirm his suspicion that he suffers from a  serious disease.There is a tendency to check his body for signs of disease like lesions,lumps or eruptions;and repeatedly check his B.P,pulse and blood sugar.He talks,only about his disease, symptoms and discomfort.The symptoms are vague and keep shifting,because there is no underlying disease.But he is not a malingerer.The discomfort he feels is very real.
This constant foreboding of suffering from a life threatening disease often causes mental disorders like Anxiety,Depression or O.C.D;which in turn,produce physical symptoms like headache,dizziness,nausea,insomnia,stomach discomfort,muscle tensions,rapid heart beat,palpitations and numbness or pain in various parts of the body.The worst part is,that these symptoms are misconstrued as rumblings of a serious disease.Naturally this accentuates his illness anxiety,which again causes further physical symptoms.It is a vicious cycle.

It is easy to see why Hypochondria is difficult to shake off.If these conditions last for six months and negatively impact a person's personal,social or occupational life then he can be said to be suffering from Hypochondria. 
The causes of hypochondria are hard to pinpoint.

1--Caregivers who are excessively concerned about minor ailments or bodily harm of a child could be sowing the seeds of this disorder.

2--A serious illness in childhood can also predispose a person to Hypochondria.

3--Serious disease or premature death of a loved one can also cause this disease.

4--Sometimes media is also responsible for triggering this disease in vulnerable individuals.Discussions about serious diseases on TV or print media,or the news of the outbreak of an epidemic also have an adverse effect upon such persons.

5--Cyberchondria-a new offshoot of this disease affects those who conduct extensive research about diseases on the Internet.

6--General Anxiety Disorder can also result in hypochondria.

7--Negligent / abusive parents.
Psychotherapy and medications are two options for treating this disorder.Both can run side by side.In fact they are both complementary because a person weighed down by misgivings about his health requires the assurance that the medicines prescribed by a doctor will cure him.

A strong will power and family support can hasten his recovery.It is essential to make determined efforts to maintain the pre-hypochondriac life style as far as possible.Paying undue attention to the symptoms worsens the condition.

The patient should recognize the triggers which worsen his condition and learn to counter-act them.
1--A hypochondriac should stick to one doctor--which he usually does not do.Consulting various doctors can expose him to unnecessary,repetitive tests and risky,invasive or painful procedures which will only inflict damage.
2--There is also the danger of over-medication which could precipitate adverse reactions.Constant fear and anxiety can make the person forgetful,with the result that he may take double doses of his medicines or miss them completely.

3--A pervasive feeling of impending doom can generate anxiety,depression,anger and frustration,leading to thoughts of suicide.

4--Some persons may latch on to substance abuse to generate a feeling of well-being.

5--Bogus or fraudulent healers should be avoided.They will not hesitate to pounce upon susceptible targets.

6--Repeated consultations with doctors can inflate the patient's bills sky-high.

7--A prolonged history of negative test results-coupled with the patient's tendency to magnify his ailments can result in him not being taken seriously when he actually does catch a disease.This ought to be guarded against.
Recovery from Hypochondria is slow.This is a long term condition.Approximately 30% of hypochondria patients may improve significantly.Recovery is better in well to do persons whose anxiety responds well to treatment and who do not have any personality disorder.Tackling the patient's anxiety should be the first concern.If that is removed then the battle is won.