DRINKING WATER FOR A HEALTHY LIVING- All you ever wanted to know

WATER INTAKE AND HEALTH

Water forms 60% of our body weight and is essential for life. It should be consumed in adequate amounts for proper functioning of various organs.

Normal water intake

1.     Men: 3.7 liters per day

2.     Women: 2.7 liters per day (Pregnant and breast-feeding women need more water).

20% of this comes from food (fruits, vegetables, beverages, etc) and the remaining should be consumed in the form of plain water.

When do we need more water?

1.     Exercise- Exercise leads to water loss in the form of sweating. So, we should consume water before, during and after exercise. Avoid drinking too much water as it can be harmful; it could dilute the body fluids leading to hyponatremia (low sodium).

2.     In hot climates- Water loss is more via perspiration and sweating, and hence, more water is needed.

3.     During illnesses such as fever, vomiting and diarrhea. All these conditions lead to water loss and this loss needs to be replenished.

When should the water intake be reduced (less than normal intake)?

In some diseases, water intake needs to be reduced (under the supervision of a doctor). These are:

1.     Chronic kidney disease,

2.     Heart failure,

3.     Chronic liver disease,

4.     Hyponatremia (low sodium)- some cases are treated by restricting fluid intake. 

How do we know whether our water intake is normal or not?

If you rarely feel thirsty and if the colour of your urine is light yellow (or colorless), your water intake is probably adequate.

What is the best way of getting our daily water requirement?

·      Plain water is the best (safe, inexpensive, easily available and has zero calories).

·      20% of water can also come from fruits, vegetables, juice, milk, tea/coffee, etc

·      Soft (carbonated drinks), sports drinks, energy drinks and alcohol should not be routinely relied upon to complete the daily quota of water. Sports drinks may be taken if one does rigorous exercise for one hour or more.

Can more water intake help in weight loss?

The answer is yes. This is because many times, thirst is confused with hunger. So, whenever you feel hungry, drink water first. People, who consume more water, end up consuming less salt, less sugar and less saturated fats (this leads to weight loss).

A bottle of water before main meals could aid in weight loss.

Replace soda with water, tea of coffee to fight diabetes

Yes, you heard it right. The habit of having a “soft drink” (carbonated beverage) to quench your thirst can increase your chances of getting diabetes, as it contains high amount of sugar. Replacing soda/soft drinks with water, tea or coffee (without sugar) leads to lesser chance of getting diabetes.

Is drinking water on empty stomach in mornings useful?

Yes, drinking water in morning on empty stomach is helpful. Most of us have not had water for about eight hours prior to getting up, leading to mild dehydration. So, one should consume 2-3 glasses (600-800 ml) of water in mornings. This helps in improving bowel movements & urination (leading to release of toxins). This would also reduce hunger, leading to lesser consumption of carbohydrates and fats (thus promoting weight loss).

Providing water dispensers in schools could also be a cheap method of reducing obesity in children.

Dr Sudhir Kumar MD DM (Neurology)

Consultant Neurologist

Apollo Hospitals, Jubilee Hills, Hyderabad

drsudhirkumar@yahoo.com

04023607777/60601066

https://www.facebook.com/bestneurologist/

TEST YOUR KNOWLEDGE ABOUT STROKE

TEST YOUR KNOWLEDGE ABOUT STROKE

1. STROKE is a disease that affects:

A. Heart
B. Brain
C. Kidney
D. Lungs

2. Common symptoms of stroke include:

A. severe chest pain
B. Fits or convulsions
C. Paralysis of face, arms, legs, slurred speech
D. Breathing difficulty

3. If someone suffers from stroke at 9 PM,

A. He can go to OPD the next day
B. He should rush to the nearest general physician
C. He should rush to a hospital with 24X7 CT scan and neurologist on call
D. He can try home remedies for the night.

4. Is there a treatment available for patients with stroke, which would minimise disability

A. Yes
B. No

5. Common risk factors for stroke include all the following EXCEPT

A. Diabetes mellitus
B. Hypertension
C. Running on treadmill
D. Smoking

6. Which of the following measures is NOT helpful in preventing a recurrence of stroke in a person who has suffered stroke?

A. Taking Aspirin
B. Controlling BP and sugars,
C. Quitting smoking,
D. Skipping breakfast, if overweight

7. Physiotherapy helps in better and faster recovery of stroke survivors.
A. True
B. False

8. Stroke affects only older people
A. True
B. False

9. Proportion of population that may suffer a stroke in their lifetime

A. 1 in 10
B. 1 in 8
C. 1 in 6
D. 1 in 4

10. Stroke is treated by
A. Neurologist
B. Cardiologist
C. Nephrologist
D. Chest physician

Please go through these questions and answer them. Answers are posted below

----------------------------------------------------------------------------------------------------

*****************************************************************************************************

Thank you for going through the questions. Here are the answers:

1. B
Stroke affects brain. It most commonly occurs due to blockage of blood supply to a part of the brain. In some cases, it can also occur due to rupture of a blood vessel.

2. C 
Common symptoms of stroke include sudden onset facial weakness, weakness of arm or leg, slurred speech, loss of vision on one side, imbalance while walking or severe headache.

3. C
Stroke is a medical emergency. The brain tissue can suffer irreversible damage, if not treated within the first four hours. Therefore, the patient should be rushed to a hospital with 24X7 CT scan facility. The treatment is administration of clot-buster therapy under the guidance of a neurologist.

4. A
Clot-buster therapy with tissue plasminogen activator or tenecteplase within the first four and a half hours after stroke onset can minimise disability.

5. C
Running on treadmill is a healthy exercise and protects from stroke.

6. C
Skipping breakfast is an unhealthy habit. Moreover, it does not help in reducing weight.

7. A
Physiotherapy is very helpful in faster recovery of stroke survivors. It should be started as early as possible.

8. B

Stroke predominantly affects older people, however, it can affect all ages, including children.

9. C

Stroke is a common cause of death and disability (along with heart attacks and cancer) in the world, and affects i in 6 people in their lifetime.

10. A
Stroke is a disease of brain and is treated by neurologist.

I hope you enjoyed this mini-quiz. I would love to hear your comments or any further queries.

Dr Sudhir Kumar MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
04023607777/60601066

https://www.facebook.com/bestneurologist/

"BRAIN" FOODS THAT HELP PREVENT NEUROLOGICAL DISEASES

"BRAIN" FOODS THAT HELP PREVENT NEUROLOGICAL DISEASES

Choice of foods is important, when it comes to prevention and treatment of certain neurological disorders. The article on this topic was published in November 2017 issue of B Positive magazine, a health and wellness magazine.

Dr Sudhir Kumar MD DM (Neurology)
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777/60601066
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/

STROKE: RISK FACTORS, SYMPTOMS, TREATMENT AND PREVENTION (Times of India article)

On the occasion of World Stroke Day (29th October), an article published in Times of India newspaper, to raise awareness about the diagnosis, treatment options and prevention of stroke. 

The article can be accessed in Times of India (Hyderabad edition), dated 29th October 2017 (Page 31), at the following link: http://epaperbeta.timesofindia.com/Article.aspx?eid=31809&articlexml=WORLD-STROKE-DAY-Avoid-a-brush-with-a-29102017105014

Dr Sudhir Kumar MD DM

Senior Consultant Neurologist

Apollo Hospitals, Hyderabad

04023607777/60601066
drsudhirkumar@yahoo.com

HOW TO MAKE YOUR MIND STRONG?

HOW TO MAKE YOUR MIND STRONG!

The mind is probably the strongest organ of the body. When the mind believes, anything is achievable, nothing is impossible! It is said, success or failure is more often decided in the mind, than the actual event itself. Thus, in the toughest sports tournaments, the players with stronger mind usually prevail.

Traits of a Strong Mind

A strong mind always looks at the positive aspect of things, because with regard to everything in life, there are both, positive and negative aspects.

·      Winners always focus on the positive aspect. Halfway in a marathon race, a person with a weak mind thinks, “half the distance is still yet to go and I may not be able to complete it well”. On the other hand, a person with a strong mind thinks, “I have finished half the race well, I can easily finish the second half equally well”. Needless to say, the runner with the stronger mind succeeds.

·      A person with a strong mind has a lot of self-belief. “When you do not believe in yourself, how can others believe in you?” So, you need to strongly inculcate the sense of self-belief in yourself at all times. This is considered as s stepping stone towards success.

·      Another feature of a person with strong mind is that he/she is always hopeful. They always hope for and expect a good outcome. Even when the whole world thinks otherwise, a person with strong mind always hopes for success. You would certainly agree to this one- how many times you have seen players winning a match from almost a losing position?! So, it is obvious that unwavering hope and self-belief are important for winning, even from “losing situations”.

·      A person with a strong mind looks at only the good qualities in another person and oversees the bad traits. Every individual has both good and bad qualities. It is always easy to focus on negative qualities of a person and criticize him. It takes a person with strong mind to focus on good qualities of others and appreciate them. This virtue makes them appear more congenial among masses. After all, no one likes a person who is always critical about him or her.

·      The most important quality in a person with strong mind is their ability to control emotions. Emotions and sensitivity are important for good social interactions; however, exaggerated emotional responses may interfere with daily life. A person with a weak mind may suffer from sadness and depression after a failure. On the other hand, a person with strong mind treats failure as a medium to work on flaws and successfully outgrows them. If one remains pre-occupied with negative emotions after a failure, there is no time and energy left to sharpen the skills to excel later. However, the person with a strong mind puts the failure behind and works harder in order to succeed at the next available opportunity.

·      Anger is a negative emotion, which a person with strong mind lacks. Strong-minded people are able to smile at all instances and events and strongly believe in letting bygones be bygones, because they know that anger does not solve a problem; on the contrary, it may aggravate it. Everyone likes a smile and appreciation- who likes getting reprimanded?! There is no wonder, then that people who often smile have a large number of admirers as compared to those who get angry with small issues.

The Making of a Strong Mind

From the above discussion, it is quite evident that a strong mind is vital for a fulfilling and successful life. So, is the “strong mind” inherited from one’s ancestors or can one do something to make the minds stronger? Well, here’s how you can build a strong mind. Just follow these methods:

1.     Regular exercises not only help you making physically fit, but also impacts your memory and thinking skills. There is a release of good chemicals such as endorphins and dopamine post-exercise, which elevate our mood and keeps depression away. So, stay active!

2.     Good nutrition is important to keep the brain strong. Timely balanced meals are the key. So, dig into foods that are good for the brain. These foods include fish, eggs, broccoli, asparagus, spinach, blueberries, dry fruits like almonds and walnuts, etc.

3.     Ensure adequate sleep of seven to eight hours at night, as it relaxes the body and mind. The mind gets re-energized after a restful sleep and is ready to take on the everyday challenges of life.

4.     The brain gets bored and inactive with a monotonous schedule and activities, and the risk of cognitive impairment increases with this schedule. On the other hand, challenging the brain with newer activities, such as learning a new language or playing a musical instrument, would make the brain sharper and stronger. This also boosts the self-confidence in a person.

5.     Avoiding smoking and alcohol as both these vices  have a negative influence on brain and mind functions, making them weaker and prone to mental illnesses.

6.     Socialize whenever you can! Isolation and loneliness are detrimental to brain and mind and make them weaker. On the other hand, greater social interactions, especially spending quality time with family and friends are healthy for brain and makes it stronger.

(

(This article was first published in the September 2017 issue of B POSITIVE, a health and wellness magazine)

Dr Sudhir Kumar MD DM (Neurology)

Apollo Hospitals, Hyderabad

04023607777/60601066

drsudhirkumar@yahoo.com

FLUOROQUINOLONE ANTIBIOTICS CAN INCREASE THE RISK OF BENIGN INTRACRANIAL HYPERTENSION

FLUOROQUINOLONES CAN INCREASE THE RISK OF BIH

Antibiotics are commonly prescribed for treating infections. Although they are generally safe, sometimes, rare and serious adverse effects can occur.

In a recent research study, fluoroquinolones and tetracycline group of antibiotics were found to increase the risk of developing benign intracranial hypertension (BIH). Fluoroquinolones include some commonly used antibiotics such as ciprofloxacin, levofloxacin, norfloxacin, ofloxacin and moxifloxacin.

The adverse event of BIH was noted within 15 day and 30 day period of starting fluroquinolones. The risk of developing BIH was about five times more than non-users. 

Patients with BIH present with headache, double vision and tinnitus (ringing sound in ears). If left untreated, there is a risk of vision loss.

Fluoroquinolones can also increase the risk of seizures and confusion, especially in older people.

The research study was published in the August 22, 2017 issue of Neurology Journal and can be accessed at the following link:

http://www.neurology.org/content/89/8/792.full

Conclusions

1. Fluoroquinolones can increase the risk of BIH, and hence caution is needed while prescribing them.

2. Patients who are taking fluoroquinolone antibiotics, and develop headache, double vision or tinnitus, should consult a neurologist.

3. Patients who have suffered from BIH in the past should avoid using fluoroquinolones, as much as possible.

DR SUDHIR KUMAR MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
04023607777/04060601066

EDARAVONE- A NEW HOPE FOR PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS

EDARAVONE- A NEW HOPE FOR PATIENTS SUFFERING FROM AMYOTROPHIC LATERAL SCLEROSIS (ALS)

Amyotrophic lateral sclerosis (ALS) is an uncommon degenerative disease of nervous system, mainly affecting the motor nerves. The common symptoms of ALS include weakness of arms and legs, difficulty in swallowing & speaking and breathing problem. The symptoms of ALS continue to get worse over time and most people die within 3-5 years after diagnosis, often due to respiratory failure.

                                          Stephen Hawkings (suffering from ALS)      AFP

There is no cure available for ALS. There is only one medication, RILUZOLE, which was approved for treating ALS in 1995. Riluzole can be used to slow down the deterioration in muscle strength. However, it has limited benefit in most patients. (In India, riluzole is offered free of cost to patients with ALS by Sun Pharmaceuticals). 

Now, there is a new hope for patients with ALS. A new medicine, EDARAVONE INJECTION, has been approved by US FDA to treat patients with ALS.

What is basis of Edaravone efficacy?

A research was conducted in Japan on more than 100 patients suffering from ALS. Edaravone injections were given for a period of six months. After six months, patients who received edaravone had better functional status and better quality of life (as compared to those who did not receive edaravone). 

Which patients with ALS would benefit from Edaravone injections?

Patients with ALS of less than two years duration, with mild disease severity, would benefit from edaravone. In addition, they should not suffer from any respiratory failure. 

What is the treatment regimen?

Patients are given edaravone injection 60 mg per day as intravenous infusion (given over 60 minutes) for 14 days. Then there is a gap of 14 days. Edaravone injection is supplied as 30 mg/20 ml vials (in India). In US, it is usually supplied as 30 mg in 100 ml. So, two vials would be needed per day. 

In second month, the injection is given on 10 out of 14 days. There is a gap of 14 days. This is continued for five months. 

So, in total, patient receives 64 doses of edaravone injections (60 mg each time) over a period of six months.

How long is the treatment continued?

As of now, there is efficacy and safety data for six months, so, it should be continued for total of six months, as per the schedule mentioned above. 

Is Edaravone treatment safe?

Yes, there are no serious adverse effects with edaravone. Minor side effects are similar to placebo. 

Do we need to reduce the dose of Edaravone in patients with kidney or liver disease?

There is no need to reduce the dose in patients with renal or liver function impairment. 

What is the cost of edaravone injections?

Each 30 mg vial costs about INR 400 (in India). So, the per day cost is about INR 800. The total cost of 64 days course of edaravone would be INR 51,200 (approximately 800 USD). Additional room rent, nursing charges, doctors fees, etc may be incurred. 

How about Riluzole?

Riluzole tablets should be continued together with edaravone injections. 

So, in summary, now we have a new drug for ALS, which is the first drug approved in 22 years for ALS after Riluzole. 

DR SUDHIR KUMAR MD DM

Consultant Neurologist

Apollo Hospitals, Hyderabad

drsudhirkumar@yahoo.com

www.facebook.com/bestneurologist/

04023607777/60601066

TELEMEDICINE CONSULTATION IS AS GOOD AS TRADITIONAL CONSULTATION FOR NONACUTE HEADACHES

TELEMEDICINE CONSULTATION IS AS GOOD AS TRADITIONAL CONSULTATION FOR NONACUTE HEADACHES

The traditional method of consultation involves a patient visiting a doctor's clinic. The doctor takes history, performs clinical examination, orders investigations (as necessary) and prescribes medicines. This is the "gold standard" when it comes to accurate diagnosis and correct treatment.

However, there are a number of limitations for the traditional method of consultation: 

1. Lack of time on the patient's side due to his/her work/family assignments; 

2. Lack of a specialist in his native place; 

3. Limited number of choices of specialists in his native place; 

4. Higher costs (travel costs, need to skip work, etc).

In this digital era, telemedicine consultations are feasible. This could include email chatting, audio or video consultation. By this method, a patient can choose a doctor in any part of the world, timing of consultation can be flexible and the costs are lower.

However, the major concern is the accuracy of telemedicine consultation. This issue was addressed in a recent research in patients with nonacute headaches. About 200 patients were treated on the basis of telemedicine consultation and another 200 patients with traditional method of consultation. At the end of one year, there was no difference in the outcomes in either group.

There is a fear of missing secondary causes of headache such as brain tumor, bleeding in brain, infection of brain, etc. One would need to provide 20,200 consultations by telemedicine to miss one such case. That is an extremely low risk.

In conclusion, telemedicine consultation seems to be an ideal alternative to traditional consultation for patients with nonacute headaches.

This study was published in recent issue of Neurology Journal (July 14, 2017 issue) and can be accessed at the below link:

http://www.neurology.org/content/89/2/153.short

DR SUDHIR KUMAR MD DM
CONSULTANT NEUROLOGIST,
APOLLO HOSPITALS, HYDERABAD
drsudhirkumar@yahoo.com
04023607777/60601066