COMPARISON OF COST OF MEDICAL TREATMENT IN NEUROLOGICAL ILLNESSES (INDIA versus USA)

COMPARISON OF COST OF MEDICAL TREATMENT IN NEUROLOGICAL ILLNESSES (INDIA versus USA) (in US dollars; 1 USD=70 INR)

	INDIA	USA
Neurologist consultation fees	10-20	500-600
CT scan charges	30-60	1,000-1,600
MRI scan charges	150	2,600
EEG (routine)	30-60	500-600
Long term EEG recording	150	3,000
NCS/EMG	50-150	1,000-5,000
Botox (One vial cost)	300	525
Hospitalization for acute STROKE treatment	1,500-7,000	14,000-30,000

The costs in India are that of private hospitals and diagnostic centers. Also, the discussion pertains to Neurology treatments in urban areas and metros of India.

Costs are exorbitantly high in USA

It is obvious that the treatment costs are several times higher in USA, as compared to India. I agree that insurance companies cover most of the cost in USA, but individuals still need to pay at least 10-20% of the bills. You can imagine the fate of those who do not have medical insurance (about 12% of Americans do not have insurance). In 2007, 62% of filers for bankruptcy in US claimed high medical expenses. US spends about 10,000 dollars per year per person on healthcare. About 20% of GDP is spent on healthcare. The medical treatment costs in the US are the highest in the world. 

                                          (Source: Washington Post)

Waiting periods to see specialists/get procedures are long

In USA, there are long waiting periods to see a Neurologist, as well as, to get the procedures (EMG, EEG, Botox, MRI, etc) done. In India, one can see a neurologist, get the MRI done and get it reported by a Radiologist in a few hours! On the other hand, the average wait time to see a Neurologist in USA is 30-35 days. Getting the MRI done and its report would take several more days. The situation in UK and Canada are worse, where one may have to wait for 2-3 months to see a specialist and get an MRI done. 

The charges are higher in several other countries too, including Singapore, Australia and Thailand.

Indian Neurologists are well trained and experienced

Regarding the expertise of Neurologists, training in premier Indian Institutes such as AIIMS, PGI Chandigarh, NIMHANS, CMC Vellore, Sree Chitra, Tiruvannathpuram, JIPMER Puducherry, etc are at par with the best in USA. The clinical experience of treating neurological illnesses is several times more among Indian Neurologists, simply because they see more number of patients. There are about 2000 neurologists to cater to 1.25 billion people (one Neurologist for every 6,25,000 people). In comparison, US have about 18,000 neurologists for a population of 320 million (one Neurologist every 18,000 people). On an average, Indian neurologists see 3-4 times more number of patients as compared to American or British Neurologists.

In summary, Neurological treatment costs are much lower in India as compared to US and many other countries. The access to Neurology care is easy, and has little or no waiting times. Neurologists in India are well trained in the subject and have a vast clinical experience. 

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)

Senior Consultant neurologist

Apollo Hospitals, Jubilee Hills, Hyderabad

Phone: 0091-40-23607777/60601066
Online Consultation:  http://bit.ly/Dr-Sudhir-kumar
Email: drsudhirkumar@yahoo.com

TIPS FOR GOOD AND RELAXING SLEEP (on WORLD SLEEP DAY)

TIPS FOR GOOD AND RELAXING SLEEP

Today is World Sleep Day (celebrated on Friday of second full week in March).  You must be wondering why should we celebrate World sleep day. This is because about 45% of population suffers from one form of sleep disorder or other or are sleep deprived. Sleep problems are not only associated with un-refreshed feeling, but are also associated with major health hazards. So, the World sleep day is aimed at raising awareness about benefits of good sleep and ways to ensuring a good sleep. This year’s slogan for World sleep day is “Good sleep is a reachable dream”.

Normal Sleep

     1. Normal sleep duration is 7-9 hours in adults (10-11 hours in 6-12 year olds; 9 hours in teenagers)
     2. Natural sleep occurs at nights, as melatonin (sleep hormone) is released during nights (when there is no light)
     3. Adults need to sleep only once (at nights). This is called monophasic sleep. People older than 60 may have biphasic sleep (in addition to nights, they may sleep in afternoons too). Newborn babies and infants may have polyphasic sleep (they sleep and get up multiple times).
     4. The best time to go to bed is between 9 PM to 11 PM and the best time to get up is between 5 AM to 7 AM. It should be made a habit to go to sleep and awaken at the same time everyday to avoid sleep problems.
     5. People who work until late evenings may benefit from a short post-noon sleep, called as siesta or power nap. Typically, it should not last more than 15-20 minutes. Siesta energizes the individual improving their work efficiency.

Functions of Normal Sleep
1. Sleep is restorative in nature and makes us fresh and energised to do the day’s work,
2. Growth hormone (GH) is released at nights during sleep. GH secretion may get affected in nights shift workers (and day sleepers). (Prolactin and testosterone are also maximally secreted at nights)
3. Consolidation of memory occurs during sleep. So, it is a better habit to have a good nights’ sleep for better memory, rather than burning midnight oil! The best long term memory is achieved when learning is followed by sleep within three hours.

Risks and Hazards of Sleeping Less
1. Attention and concentration are impaired the day after less sleep. This could result in driving errors, poor efficiency at school or work, as the case may be,
2. Some people complain of general tiredness or heaviness of head/headache after sleeping less,
3. Memory impairment may occur in people sleeping less,
4. Increased irritability and behavioral problems are seen in sleep deprived people,
5. Less sleep may make you fat and lead to obesity,
6. Increased incidence of diabetes mellitus, hypertension, cancer, stroke and coronary artery disease is seen in people sleeping less,
7. Lack of sleep kills sex drive,
8. Less sleep may lead to depression and anxiety; also, people with depression and anxiety sleep less,
9. Lack of sleep leads to skin ageing, and makes it lackluster. Dark circles may form under the eyes.
10. There is also an association between less sleep and higher death rates. Reducing sleep duration from 7 to 5 hours on a regular basis may double the risk of death, mostly from cardiovascular causes.

Tips for Ensuring Good and Sound Sleep
1. Have a light dinner and avoid heavy meals at nights. Eat at least two to three hours before sleeping time. A full stomach may cause sleep disturbance. Late dinners may cause acid reflux in the stomach,
2. Avoid tea, coffee other stimulant drinks at nights, as it may cause less sleep,
3. Avoid smoking at all times, especially at nights,
4. Maintain a good sleep hygiene (try to sleep and wake up at the same time every day)
5. Avoid night shift duties and doing duties in changing shifts (occasional night duty is alright),
6. Avoid frequent travels to places with different time zones (this can lead to jet lag and impaired sleep),
7. Avoid arguments and heated discussions just before sleep,
8. Avoid watching negative news on TV about various crimes, etc at nights. Instead it may be better to listen to some soothing music or read a relaxing novel.
9. Exercise in the evenings improve night’s sleep quality,
10. A glass of milk would also improve sleep,
11. The bedroom should be used only for sleep (and sex) and office work should not be brought to bedroom.
12. It is better to keep the phones and other gadgets away during sleep, and keep them in silent mode
13. Sleep is better in dark, so, ensuring that would improve sleep quality.
14. Also, maintain a good ambient room temperature. Too hot or too much cold temperature may hamper good sleep.
15. Avoid taking sleeping pills, as they can lead to addiction or dependence on them. After that, you would not get sleep without them and over a period of time, much higher doses of sleeping pills would be needed.

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Hyderabad

Phone- 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online consultation:  http://bit.ly/Dr-Sudhir-kumar

How Different is a Woman’s Brain from a Man’s?

How Different is a Woman’s Brain from a Man’s?

A woman is a lot different from a man in terms of physical appearance and behavior. The differences are part of the natural evolution of human beings; as males and females got adapted for different roles played by them. The differences are also due to the effects of hormones as well as sociocultural factors. The current article focuses on the differences between the brains of men and women, both in terms of structure as well as functions.

Men have a larger brain volume as compared to women. Even after taking into consideration the fact that males are taller and larger, their brains are about 10% larger than that of women. Higher brain volume in men does not translate to the fact that men are smarter or more intelligent than women. IQ tests across large number of women and men have not shown any statistically significant differences between the two sexes.

The main difference between a man and woman’s brains is regarding their language areas. In men, the language area is predominantly located in the left hemisphere of the brain; whereas in women, language areas are located in both left and right hemispheres of brain. In a research detecting blood flow to brain while people listened to a novel, only the left hemisphere was activated in men. On the other hand, both hemispheres were activated in women. The language areas on right frontal and temporal lobes are larger in women than in men. Also, the language areas in girls mature about six years earlier than in boys.

These observations explain the better proficiency of women when comes to language skills. Females use language more when they compete. They gossip, manipulate information as per David Geary, professor of psychological sciences at the University of Missouri. If there are more areas dedicated to a set of skills, it follows that the skills will be more refined. Women also use language to build relationships. Women pause more, allow the other friend to speak more, offer facilitative gestures.

Certain disorders such as learning disability or dyslexia and attention deficit hyperactivity disorder (ADHD) are more common in boys than in girls.

It is not that women have all the advantage! Boys fare much better when it comes to mathematics and geometry. The areas of brain involved in math and geometry mature four years earlier in boys than in girls. Males tend to have much larger inferior parietal lobules, the area of brain thought to influence mathematical ability. Interestingly, this is the same area of Einstein’s brain, which was discovered to be significantly large. However, many researchers believe that the mathematical ability does not differ between the sexes. The apparent differences are because of sociocultural factors, such as less encouragement for girls regarding mathematics, lesser coaching/training and math anxiety among girls.

Women are generally more emotional and are able to express their feelings better. This is mainly because of their larger deep limbic system. Women are able to connect better and they serve as better caregiver for children. The downside to this larger deep limbic system is that women are also more prone to depression, especially during times of hormonal shifts such as after childbirth or during menstrual periods. Women are also more prone to develop anxiety.

Men and women perceive pain differently. Women require higher doses of painkillers for pain relief. They are also more likely than men to complain about pain and seek treatments for pain relief. The area of brain that gets activated in pain is amygdala. In women, the left amygdala is activated, whereas in men, the right amygdala is activated during pain. The left amygdala has more intense connections with other parts of brain that modulate pain.

Men and women respond differently to stressful situations. Men tend to have “fight or flight” type of response. They are either aggressive or run away. Women on the other hand approach the stressful situations with “tend and befriend” strategy. When faced with stressful situations, women first take care of themselves and their children (tending) and form strong group bonds (befriending). This difference is because of hormone called oxytocin. Oxytocin is released during stress in both men and women. Estrogen (female hormone) enhances oxytocin resulting in calming and nurturing feelings, whereas testosterone (male hormone produced in high levels during stress) reduces the effect of oxytocin.

There are also certain differences with regards to memory functions between men and women. Women are better in recognition of emotional expressions, especially negative emotions such as fear or sadness.

Short term or working memory is also better in women than men. This is partly because women are better in attending to more than one task at a time (multitasking). On the other hand, certain types of short-term memory such as visuo-spatial information are better in men. If a couple gets lost in a deep forest, it is the man who is more likely to find the correct route to safety!

Women are better than men in remembering specific dates or events, which explains why men forget the most important birthdays and anniversaries.

When it comes to disorders of memory loss, men are more likely to suffer from age-related memory impairment. On the other hand, Alzheimer’s disease, the most common cause of dementia, is more common in women than men.

In summary, a woman’s brain is different from a man’s brain in many ways. These differences have been the result of millions of years of evolution and help women and men adapt to the different roles they need to play in family as well as society.

(This article was slightly modified and published in March 2016 issue of B Positive magazine)

Dr SUDHIR KUMAR MD DM

Senior Consultant Neurologist

Apollo Health City, Hyderabad

Ph- 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online consultation:  http://bit.ly/Dr-Sudhir-kumar 

SLEEPING PILLS AND HEALTH HAZARDS

SLEEPING PILLS: Pills for Blissful Sleep or Early Deaths?

Sleeping pills (sedatives and hypnotics) are commonly used (and abused) by the general population. About 6-10% of adults use prescription sleeping pills. The usage of sleeping pills is higher among women and overweight people. Usage also increases with increasing age and in those with pain or depressive illness.

Insomnia (an inability to get normal sleep) is cited as the commonest reason to use sleeping pills. A normal adult requires 7-9 hours of sleep per night. Sleeping pills help increase the number of sleeping hours providing bliss to people with insomnia. But is this bliss coming at a cost? Are there any health hazards associated with sleeping pill usage? The current article is aimed at finding out the risks and hazards of sleeping pill usage.

Do sleeping pills lead to more deaths?

Several studies have shown that use of sleeping pills is associated with higher death rates. In a large study published in British medical Journal in 2012, more than 10,000 people who used sleeping pills were compared to about 24,000 people who did not use sleeping pills. They were followed up for 2.5 years. The hazard of death was three times more in people prescribed as little as 1-18 sleeping pill tablets per year. The hazard for death increased with higher number of prescriptions per year, and it was five times more for those using greater than 132 doses of sleeping pills per year. This increased risk of death was seen with older benzodiazepines (such as alprazolam, lorazepam, diazepam) as well as newer agents (such as zolpidem and eszopiclone). The comparison was done after accounting for smoking, obesity and other risk factors that could contribute to more deaths.

In another study from UK, about 35,000 patients who were prescribed sleeping pills were compared to about 70,000 people who were not prescribed sleeping pills (control group). They were followed up for a mean duration of 7.6 years and death rates were compared between the two groups. In the first year, twice as many deaths occurred in the “sleeping pills” group as compared to the “control” group. After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription.

Sleeping pills and cancer

In a large study, the risk of cancer increased by 35% in people who were prescribed sleeping pills, as compared to those without sleeping pills. This puts “use of sleeping pills” as risky as “smoking cigarettes” said, study leader Daniel F. Kripke.

Sleeping pills adversely affect work output

Sleeping pills cause drowsiness and hang over and affect the performance in work the next day too. Concentration is impaired and memory loss may be seen.

Sleeping pills and falls

Sleeping pill use is linked to falls in elderly, which is an important cause of fractures in them.

Sleeping pills increase the risk of road traffic accidents

Use of sleeping pills lead to increased road traffic accidents. This is because it hampers the attention and concentration ability.

Above hazards prove that sleeping pills are unhealthy and dangerous. Long-term use of sleeping pills has never been studied in people and should be discouraged. If sleeping pills are used at all, it should be for a short period of a few days and with extreme caution.

Dr Sudhir Kumar MD DM

Consultant Neurologist

Apollo Health City, Hyderabad
Email: drsudhirkumar@yahoo.com
Ph: 0091-40-23607777/60601066