Gastroesophageal Reflux Disease: Dos and Donts

GERD gastroesophageal reflux disease, this disease is fairly common in the population particularly in obese people. This disease usually occurs when the lower esophageal sphincter tone is decreased leading to reflux of acid from stomach to esophagus. Few symptoms of this disease are heartburn, belching, asthma, acid reflux in mouth, bad teeth. I am not going to discuss about the whole disease here i am going to give a few lifestyle modification advices which will help you to reduce the symptoms.

Dos:-

• Elevate the head end of your bed to around 20-30 degrees. This helps to keep the food in the stomach due to gravity during sleeping.
• Divide your meals in several small parts during the whole day rather than taking one large meal. E.g. youcan divide your lunch into four separate meals 2hrs apart.

Donts:-

• Dont go to bed immdiately after a meal.
• Dont eat a heavy meal as it will not allow the lower esophageal shincter to close properly.
• Dont drink tea, coffee or eat chocolates too much as these affect the normal physiology of lower esophageal sphincter and reduce its force of contraction.
• Dont drink lots of water just after the meal. You should wait for atleast 45 mins to drink water after meals.
• Do not smoke or atleast try to quit as nicotine also decreases lower esophageal shincter tone.

Hope this information helps you keep yourself  heathy . Do read some other articles on the blog.

Dos and Donts in Kidney Stones

While many patients suffer from kidney stones in the world and are prescribed for medications no dietary advices are given to these patients like which food will increase the process of stone formation and will lead to recurrence of kidney stones after their removal and which diet leads to decreased stone formation even spontaneous dissolution of the stones. So here is an advice on dietary modifications in kidney stones.

Dos:-

• Drink plenty of water around 8-10 glasses per day
• Eat fruits and vegetables rich in citrate (vit C) as they lead to decrease precipitation of calcium oxalate like orange juice and coconut water rich in potassium and other electrolytes
• Drink Cranberry Juice as it decreases the chances of urinary infections due to stones which can be disastrous
• Eat fruits rich in vit B6 like banannas

Donts:-

• Avoid soyabeans and nuts
• Avoid vegetables like cauliflower, brinjal, tomatoes, beatroots, dark leafy vegetables
• Avoid nonvegetarian food like red meat, fish
• Avoid dairy products
•  Avoid carbonated drinks like coca cola, pepsi etc as they are rich in oxalates leading to stone formation

This dietery modification usually helps to reduce kidney stone formation i  patients who are prone recurrent stone formation. Also after the removal of kidney stones the contents of stones are analyzed and dietary modifications are adviced according to that.

WHAT ARE THYROGLOSSAL CYSTS

Thyroglossal cysts are fibrous cysts that forms due to a persistent thyroglossal duct. The thyroid gland usually develops in the oropharynx and then it descends to its final position through tongue, hyoid bone and neck muscles making a thyroglossal duct which usually closes before birth. If it remains open it is called persistent thyroglossal duct which can lead to a thyroglosssal cyst formation.

Symptoms:

Usually patients present with palpable lump in the midline of neck between thyroid and hyoid bone which moves swallowing and upward with protrusion of neck. Usually the patients are asymptomatic but a few of them might complain of dysphagia i.e. difficulty in swallowing or he can present with difficulty in breathing. Sometimes cysts can get infected.

Treatment:

Surgical removal is the mainstay. Sistrunk operation is performed in which hyoid bone is also removed to ensure the complete thyroglossal tract removal to prevent recurrence.

TUNING FORK TESTS

These tests are use for assessment of hearing in an individual, hearing loss. We can also differentiate between conductive hearing loss and sensory hearing loss using these tests.

Hearing Pathway: The sound first reaches the tympanic membrane via external auditory canal then via auditory ossicles (Malleus, Incus, Stapes) reaches the cochlea from where VIIIth nerve takes the impulse and take to brain in the temporal lobe. The pathway till cochlea is the conductive pathway.

So now for the test we need tuning fork, 512hz frequency is ideal as lesser frequencies produce more vibration on the bone and the tone of higher frequencies decay faster.

Air Conduction: It the conduction via normal pathway as described above. It is usually better than bone conduction.

Bone Conduction: When we put the base of tuning fork on the mastoid, or middle of forehead the sound waves travel directly via cranial bones to the cochlea bypassing the normal pathway. This is called bone conduction.

Below is a video showing how to do a Rinne Test.

Now there are usually three tests that we use in Tuning Fork Test

1. Rinne Test: It is done using a 512hz tuning fork. 1st we check the bone conduction by ringing the tuning fork and then placing the base of the tuning for on mastoid process. Ask the patient whether he can hear a sound or not and if he can hear the sound then ask him to raise his hand or simply tell you when the ringing stops. Note that time. Then again hit the tuning fork and place it near his ears and repeat the same procedure.

• Rinnes test is positive in normal people as Air Conduction > Bone conduction. 
• Rinnes Test is negetive In conductive hearing loss the BC>AC as there is problem in conductive pathway leading to decreased conduction but when we bypass the pathway via bone conduction the soun is percieved normally as cochlea is healthy. 
• Rinnes is positive in sensory neural hearing loss i.e. AC>BC but the duration of the ringing is reduced for both AC and BC, as cochleae is damaged so there is no bypass pathway left to carry sound energy to brain.

   2.   Webers Test: It is done by placing the tuning fork in the middle of the forehead of the patient. Then ask the patient on which side he can hear the sond better. In conductive hearing loss the sound lateralises to bad ear while in sensory neaural hearing loss sound goes to better ear

WHAT IS PARONYCHIA

Paronychia is a bacterial or fungal infection of hand where nail meets the skin. It could start suddenly called acute paronychia or it gradually called chronic paronychia.. It is usually common in diabetics. Acute paronychia usually occurs in bacterial infection whereas fungal infection causes chronic paronychia.

Symptoms: Usually the first symptom is painful, red swelling around the nail, often at the cuticle or at the site of hangnail or other injuries. Pus filled blisters can also be found specially in bacterial infection.

Treatment: Paronychia can effectively be treated with antibiotics like cephalexin or dicloxacillin. Topical antibiotics can also be used. When there is pus in loculi we need to drain it. Sometimes partial nail is also removed.

                    Fungal infection tends to heal slowly taking a period of around 4-6 weeks.

Prevention: 

• Care for nail and and skin around the nail properly.
• Do not bite or pich the nai
• Protect nails from damage
• Bring your manicure tools.
• Avoid gatting damage to flaps.