Wednesday, August 10, 2011

voice conservation

Tips for a healthy voice.
Balance demand with rest. If you know you have to abuse your voice either by having to speak loud or long it makes sense to use it less or give it rest before and after the episode.
Humidify the envoirnment: dryness causes hoarseness and voice embaressment it makes sense to use humidifiers particularly at night since chances of mouth breathing is more. If you have a tendency chronic dryness then inhalation is a good idea.
Go slow on medication: over the counter medication like decongestions, anti-allergy medications tend to dry out body fluids, including the ones from the vocal folds. Always check with your physician about this and compensate with fluids. Oh! By the way caffeine and alcohol are also drying components.
Pamper laryngitis: if you are suffering from laryngitis particularly associated with the upper respiratory tract infection then it makes sense to rest your voice. If you have to use your voice use a soft breathy voice until the swelling resolves. Ideally don’t talk. You could harm your vocal folds if you over ride this.
Watch out for LPR (laryngopharyngeal reflux disease)  a rough voice in the morning with bad taste in the mouth and sensation of heart burn should ring bells you could be heading for LPR,there is irritation of the throat, excessive mucosal collection this requires a different kind of care.

voice breakdown

Break down of voice
Voice break down happens quite often let’s look at how exactly it can happen.
Sound process: generating air pressure
Brief description: breathe support Coordinated functions of diaphragm, abdominal muscles, chest muscles, lungs and chest cavity moves the air column upwards through the vocal folds.
Work distribution:  diaphragm abdominal and chest muscles move air into and out of the lungs. Lungs are the organs air; bronchi and trachea are passages for the air from the lungs.
Possible breakdown: that could affect the voice.
·         Lung disease
·         Airway obstruction like asthma, or hardening below the glottis(subglottic stenosis)
·         Paresis or paralysis of the muscles.
Possible symptoms:
·         Shortness of breathe
·         Weak voice.
Sound process—glottic closure of the vocal folds:
Brief description: vocal fold position critical. The vocal folds close during speech or singing and open during breathing. This is controlled by glottis.
Work distribution:
·         Laryngeal muscles contract to close vocal folds
·         Arytenoids cartilages pivot to move vocal folds towards midline
·         RLN and SLN bring nerve input to the muscle.
·         Vocal fold mass and edge contribute to the glottis closure.
Possible failure:
·         Nerve paralysis or paresis
·         Muscle weakness
·         Neurological disease
·         Arthritis of arytenoids cartilage.
·         Nodules, polyps, cysts at on the vocal folds
·         Atrophy of the vocal folds
·         Scaring of the vocal folds.
Possible symptoms:
·         Hoarseness
·         Breathlessness
·         Effortful phonation
·         Vocal fatigue
·         Diplophonia.
Sound process vocal fold vibration:
Brief description: wave like vibration from top to bottom repeated in cycles. With each cycle a puff of air escapes producing a buzzy voice sound. Singing voice produces a unique sound spectrum that is different from the spoken voice.
Work distribution: superficial lamina propria is the main vibrating layer in vocal fold mucosa. The integrity of the vocal fold surface allows the mucosal wave propagation. The vocal fold mass and edge contribute of the glottis closure.
Possible breakdown:
·         Vocal fold scar
·         Vocal fold lesions like cyst, nodules, polyps Papillion etc.
·         Grannuloma of the vocal folds
·         Swelling and infection
·         Paralysis
·         Haemorrhage, vascular ectasis.
Symptoms:
·         Hoarseness
·         Effort in phonation
·         Weak voice
·         Speaking voice is lower than usual
·         Voice fatigue.
Sound process—voice volume or loudness:
Brief description: amplitude of sound waves loudness is achieved by increasing pressure/flow. Or increasing vocal folds resistance.
Work distribution:  breathe support. Laryngeal muscles contract to adjust to the tension of the vocal folds. Vocal folds elasticity allows the fold to open wider and stay apart longer.
Breakdown
·         Scars on the vocal folds
·         Paralysis or paresis of the vocal folds
·         Lesions, cysts, nodules polyps, papilloma in the vocal folds
·         Swelling and inflammation.
Symptoms:
·         Unable to project voice
·         Weak voice
·         Voice breaks.
Sound process of voice pitch or highness or lowness.
Brief description: frequency of sound waves increases for high notes and tension decreases for low notes.
Work distribution: laryngeal muscles contract to adjust tension of the vocal folds. Specially for higher notes. The integrity of the vocal fold edges decides the elasticity or pliability of the vocal folds.
Possible breakdown:
·         Paresis or paralysis of the nerves
·         Scars of the vocal folds
·         Oedema of the vocal folds
·         Lesions on the vocal folds.
Symptoms:
·         Unable to hit high notes
·         Loss of glissando
·         Voice breaks.
This is rough sum up of what could be the cause and effect of the breakdown of the voice system and why it is necessary to see a doctor immediately.

Monday, August 8, 2011

the voice box

Our voice is created by the voice box.  When the voice comes up from the lungs the vocal cords to vibrate and continue up through to the mouth.
The voice box is within the larynx.
Phonation is production of sound by the voice box.
Larynx essentially has three functions
·         Sound production
·         Air passage for breathing
·         Protecting the air passage during swallowing.
Vocal cords are the soft tissues mainly responsible for the vibratory component of the voice.
Glottis is the opening between two vocal folds and closes during the swallowing and sound production.
The spoken words are recreated by three components
·         Voice sound and basic sound produced by the voice folds. This sound is often described as buzzy.
·         Resonance of sound and amplification is modified  by sound retraction.
·         Articulation produces recognizable sound this is created by voice articulators like soft palate, tongue and lips.
Voice mechanism is created by three subsystems each with specific roles.

Subsystem
Organs involved
Role.
Air pressure system
Diaphragm
Chest muscles
Ribs
Abdominal muscles
Lungs
Provides air pressure to bring about vibration in the folds.
Vibratory system
Larynx (voice box)
Vocal fold
Vocal folds vibrate change air pressure sound waves often described as buzzy .
Varies the  pitch of sound.
Resonating system.
Vocal tract (pharynx)
Oral cavity
Nasal passage
Change buzzy sound to recognizable voice of a person.


Functions of the voice box
·         Breathing opening of the glottis
·         Cough reflex close glottis and open it.
·         Swallowing closing of glottis
·         Voice creation close the glottis and adjust the vocal tension
The process of voice involves three steps.
air is moved out from lungs and towards the vocal cords due to the co-ordinated action of diaphragm, abdominal muscles, chest muscles  rib cage and vocal cord vibrations. Voice folds use muscles, nerves and cartilage to create sound.
Vibratory cycle occurs repeatedly and each cycle is as follows.
·         Column of air pressure opens at the bottom of the vocal folds.
·         Column of air continues to move upwards towards the top of the vocal folds and opens at the upper most.
·         Bernoulli’s effect is created by the low pressure caused by the upward moving column causing the bottom folds to close followed by the top one.
·         Closure of the air column releases a pulse of air.
The cycle repeats.
Rapid air pulses created by repeated vibratory cycles produced a sound that is just buzz.
This gets amplified and modified voice tracts resonators producing voice as we recognize it.
·         Loudness increases in air flow blows vocal folds wider apart which stay apart longer during a vibratory cycle
·         Pitch increases in frequency or vocal fold vibration raises pitch
Voice can break down
·         Air pressure system gets hampered. Air flow is inefficient .e.g. asthma, emphysema.
·         Vibratory system gets compromises causing hoarseness and voice symptoms eg.cold.

Monday, August 1, 2011

Iceland's tobacco legislature

The government of Iceland is conserving a physician sponsored legislative tat provides a new approach to tobacco control.


If this law gets passed then tobacco, cigarettes would be sold only in pharmacies to adults over 20yrs and they would need a permit for it.

Since tobacco/nicotine addiction is best handled by primary prevention once addiction sets in it deserves therapy.

But still does not address answer what happens to secondary smoking or tertiary smoking.

It could also give rise to illegal sales, and the other issues.

The doctors bill

Watching Hindi movies about corrupt doctors, or organ stealers hurt.


I have grown up being a doctor’s daughter and a general practitioner’s grand-daughter. Heard stories about my great grandfather’s healing skills. This meant, we were prepared that at a family evening out my father would be called for an emergency. Many times my father was away during our annual school concerts and never around when we received our awards.

That’s when I decided I would go for dentistry instead of general medicine. I have a home practise, my patients think its their royal right to barge into the clinic be it after 9pm or even a Sunday, since I am at home, and they save their leave.

These are the very same patients who crib about the doctors fee. But do doctors get concessions when it comes to grocery bills or school fees? If a corporate worker can bill overtime, isn’t the doctor’s family entitled to his time?

Is a doctor not entitled to a family life, and if he does give up that time should he not be compensated?

This is not just the Indian scenario I am sharing an article about family doctors in the states

http://www.kevinmd.com/blog/2011/04/society-frown-doctors-earning-reasonable-living.html



Monday, July 25, 2011

dignity of risk

With life expectancy increasing we are grappling with chronic disabilities and atrophies. The needs for hospital care and home care givers have re-invented themselves.


The society is constantly being brainwashed to accept its own incompetency to handle either the young or the old. Our role as care givers is being shaken. Look at the parenting classes and magazines that mushroom.

The same is applied to the senior citizens. There is a lack of faith in the senior citizens to take care of themselves. I have come across many of my peers who assume judgemental errors from their parents, despite parents being perfectly capable of handling themselves. There is an increasing tendency to segregate them into old people’s homes or senior citizen’s settlement.

When it comes to senior citizens there is a need to let them take the dignity of risk and decide if they need to leave their familiar surrounding and relocate, from things they value particularly into institutes. Just as our parents had to prioritize and make choices while bringing us up we need to give the choice as long as the choice is possible.

The risks are enormous and sometimes in retrospect we might feel guilty of leaving them in a less conducive atmosphere, but the choice as far as possible should be left to them.

Medico-legal provisions have been made to define the extent of live saving procedures the decision to live in a home environment is more difficult.

We need to allow the elders in our life to live their remaining life as independently and as freely as they want. We will have to make time to listen to the scraping of knees sometimes even more serious things, but they will be living and not just waiting to die.

Friday, July 22, 2011

health care what exactly we mean

During the hospital stay there were some interesting things to observe and learn.


Morning rounds, rushing residents, some of them seem to think they were like the Cabots who only spoke to Gods.

Dr.Viraj Kandolkar was resident that every patient used to look forward, brusque yet the patients would look forward to him being in the ward. The answer was simple he took the trouble talking to the patient. He made the patient feel he cared.

When we now talk of health care we seem to be talking of two mutually elusive goals, one health which is techno driven, ensure the patients health no compromise on it. Yet the vital factor is missing which is the second goal.—CARE

• Careful attention or careful heed

• To take charge of, look after, provide for

• To feel concern about or interested in.

That is the actual reaching out, to the patient.

This could be a direct fall out of us taking on more patients than we can really handle, or it could be our increased trust in technology and reluctance to talk to people.

Easier to deliver health than healthcare.

But it is time to get our act right.

Monday, July 18, 2011

healthcare in transition

Health care transportation is a systemic process by which patients, critical materials like specimens pharmaceutical supplies and medical records are transported through multiple touch point within a healthcare organization or between healthcare organisations. In which health care during the transition plays a major role.


Healthcare in transition is the movement of patient between the healthcare settings. This particularly in the elderly becomes exacting.

When we talk of health care in transit we are addressing three different areas here.

• The care of a patient when being transported from one destination to other

• Patient information being handed from within organization and from the primary care centre to the health care centre.

• Transportation of specimens or health care products from research or production site to destination.

The increase in life expectancy increases chronic disease and the burden of care giving also proportionately increases. As extensive hospitalization would mean emotional disturbance to the patient and uptake of hospital resources to more acute cases the need to reduce the number of hospitalization days has come about.

Decreased days of hospitalization does not mean decreased healthcare cost. For this has given rise to the need for post hospitalization physician, professional caretakers, physiotherapists, after care and rehabilitation institutes.

Germany is one country which has tackled this by creating a chain of healthcare centres appropriately equipped, and covered with health care insurance. The government has made provisions for long-term professional homecare and assignments are made depending on the severity of need.

The transportation of patients involves transformation of information which is understandable to the healthcare expert who takes over. This not only becomes complex but there is also a need for standardization. Standardization would mean

• Information between the healthcare practioner and hospital should be precise and should mean the same thing to both.

• Checklist from the healthcare practioner,before handing the patient to the hospital

• Checklist for hospital discharge.

• Standard transition form

• Short but precise, standard discharge summary that is legible.

Many practioners tend to use their own check lists or short forms causing miscommunication. Standardization helps to overcome this.

A discharge interview is important so that both the patient and the caregiver are aware of the level of care giving needed.

In geriatric cases in addition to hospital and care centre maintenance of the patient’s independence also is an issue. Helping the patient retain his/her independence would mean helping him/her maintain his/her dignity. Curb to curb transport facility, home to destination care becomes important.

WHO has adopted towns worldwide as senior citizen friendly towns, these are designed to let senior citizens walk by placing open spaces with sitting felicities. A chain of emergency healthcare felicity is also provided with the citizen being assigned the nearest centre.

To be continued…



Tuesday, July 5, 2011

the family physician

Family physician.


Twenty year old Swati had problem, if she took anything before 9 am she would bring it out. For three years she went various specialists and alternate therapists nothing seemed to work. When she went to her hometown of Halsnaad, she went visiting Dr.Halsnaad a senior doctor who treated her family since the days of her great grandfather.

He told her a simple remedy, gargle with warm water first thing in the morning drink a glass of warm water after an hour you’ll be fine. Following his Swati has been rid of her symptoms five years now, her life is normal. Dr.Halsnaad says he could give the exact treatment as he knew the family history of nocturnal nasal drip resulting in fluid accumulation this would get dislodged and irritated when she took milk, coffee or tea, the gargling and warm water flushed out the secretion relieving her off the symptoms.

This is the need for a family physician many of you born post 1980 may not even the know the existing of this extinct tribe. They came home on calls, they knew your family and environment usually they belonged to the town where they practised. A kind of demi-god.

A family physician is a general practioner or doctor consulted by the family regularly.

The family medicine is re-invention of the family physician, though how much of sense it makes with the floating and migrating population one does not know.

Family medicine deals with the comprehensive health care of individuals of all age, and sex while placing particular emphasis on family.

Their basic aim is to provide persona, comprehensive and continuing care for individuals in the context of family and community.

Family medicine practioners are trained in all aspects of medicine.

They tend to know their patients on a personal level and are also are aware of their emotional and physiological state, they are also aware of the environment that the patient comes from. The practioner would refer a patient to a specialist only if the need arises, and with his knowledge he would guide the patient to the right specialist.

The tradition is the referring doctor sends the history to the specialist bringing down the consultation time.

Having a family physician and regular health check up would definitely keep your health care bills down.

When choosing your family physician it makes sense to keep in mind

• Location of the doctor

• Your comfort levels with doctor.

• Office hours

• Other doctors associated with the practise.

• Does he listen to you, and then explain options to your satisfaction

It is always a good idea to put down what actually bothers you health wise when you visit your doctor. It is also perfectly alright to ask your doctor questions.

You definitely need to check these with your doctor

• What is exactly wrong with you?

• What caused it?

• How serious is it?

• Will it require long term treatment and does it have other complications?

• Can I prevent it from recurring?

• What do the prescribed medicine do?

• How long should I take the medication?

• What are the side effects of the medications?

• When do I see you for a follow up?

Ultimately it’s our health we are talking about it makes more sense to talk to the person who knows it from prologue to epilogue than someone who reads it mid chapter.

Incidently this vaccum is being filled by the Ayurvedic and Homeopathy doctors in many places.










Monday, May 23, 2011

bifocals

1700 AD this day i.e. May 23rd Benjamin Franklin discovered the bifocal lenses.


Bifocals are eyeglasses or contact lenses having two portions one for near reading and one for far vision. This is used to treat Presbyopia.

Presbyopia means “age of sight” when there is a gradual loss of accommodation. It can start as early as 36yrs or as late 50yrs. But usually becomes noticeable in mid forties.

It becomes recognizable as difficulty in reading fine prints begins.

It takes about 1 to 2yrs before treatment is required for before that adjusting illumination or distance helps.

Reading glasses are an option for correcting presbyopia; this is great for people who do not require distance vision correction. Reading glasses are also bought able over the counter without tests thought this is not advisable.

Bifocals requires practise to be used, for the person needs to get used seeing through the proper part of the glass.

From 1700’s ground glass bifocals to today’s seamless ones the bifocals have travelled a long distance.



Tuesday, April 26, 2011

garlic

Garlic or Allium Sativum as it is scientifically known belongs to the plant.


The plant is erect, and belongs to the same family as onions i.e. it is an annual herb. Entire plant that is the bulb, leaves, flowers are all edible though the cloves of the bulb are most popularly used. These are used either raw or roasted.

Early documents speak of garlic implying that it was grown in England, despite this it is not found in English cuisine.

It is medicinal ayurveda uses this extensively. Cherokee Indians use garlic as an expectorant. It is a potent antibacterial, antimicrobial and antifungal.

Medical use:

• In treating common colds, asthma and bronchitis. A study conducted in 2001 where 146 volunteers for 12 weeks 24 of the garlic users showed reduced attacks of common cold as compared to the 64 in the placebo group.

• Arthrosclerosis,

• It reduces cholesterol level as per the study conducted in 2009 comparing it with placebo.

• A possible reduction in cancer on regular intake of garlic was demonstrated by 19 studies in 2001

• Can cause vasodilatation

• Decreases platelet aggregation

• Regulates blood sugar level on regular use as in lowers homocystiens. This also helps in reducing the complication of diabetes mellitus.

Adverse effects being Halitosis, irritable bowel diahorrea, oral ulcers, anaphylaxis, thin’s blood particularly during pregnancy. It can also interfere with some drugs.

Storing garlic: has to be stored in a dry open container. If at all it has been stored in vegetable oil then refrigerating is a must to avoid Botticelli formation.

Cooking garlic: the thumb rule when cooking garlic is the finer it is cut the stronger is its aroma and flavour.

Raw garlic has maximum smell

When cooked whole the flavour mellows to a sweet, nutty flavour.

While sautéing beware for it turns bitter on slightest of over frying.

Growing garlic:

Garlic grows well with other plants and flowers. For symbolic or practical reasons it is sowed on the shortest day of the year. It needs plenty of sunlight, and should not be very damp.

Cloves should be planted 4” apart from each other, and rows should be 18” apart.

Tolerates a pH range between 5.5 acidic to 8.5 alkaline.

It is not commonly troubled by pests, though if the root turns pink then the growth is stunted.

Kingdom Plant

Angiosperm

Monocot

Order Aspargates

Family Alliacea

Subfamily Alliodeae

Tribe Alliene

Genus Allium









Thursday, February 3, 2011

congo fever


Congo fever,

 Or Crimean-Congo hemorrhagic fever Is a rather rare diseases. 
This is a zoonosis transmitted through ticks of the Hyalomma species. The larvae and nymphs feed on small mammals, like rabbits, and ground frequenting birds like hen, crane etc. while the adult ones prefer larger animals.  This would mean humans are bitten by the immature ticks, but by the adult ones. Even the adult ticks are not so fond of humans. This is why the cases are rare.
Then how do the humans get infected? It is either occasionally by the tick bite or from contact of infected blood/tissue through broken skin either from other infected humans or animals. Farm dwellers and stockmen are more prone to get infected, humans working in the slaughter house or abattoirs are other susceptible people.
Typically it has an incubation period of 1-3 days. Flu like symptoms appears which resolves in a week, in few cases however hemorrhagic signs appear between 3-5 days. There is mood instability, agitation, mental confusion, throat petechiae, nose bleed, bloody urine, vomiting, and black stools. The liver wells and becomes painful. As the disease progresses kidney failure, shock and sometimes acute respiratory distress syndrome follows.
Recovery begins 9 to 10 days after the onset of symptoms though 30% tends to get fatal
Treatment is symptomatic and supportive  invitro Ribavirin is effective but there is no trial evidence found.
Prevention focuses on agricultural regulations like de-ticking the farm animals before slaughter. Use of adequate clothing and footwear, use of insect repellent would be personal avoidance measures.
Infected patients should isolated particularly when evidence of bleeding is seen.