Colds and flu – a quick insight

Around the world billions are affected by colds a year. People experience  lot of sleepless nights, sick days, chapped noses, crumpled tissues, and general misery. Most people begin to feed better within week or two. However, some symptoms, including a cough, can sometimes last up to three weeks

Not much can be done to kill the virus  and there’s very little you can do to fight the common cold.

When we get a cold, all we can really do is make ourselves a little more comfortable.

Home remedies may help ease symptoms while your body heals itself. These tips won’t cure the common cold. But they might make you or a loved one feel just a little better while you recover.

Prevention

Tips trust help prevent getting a cold or flu 

1. Wash hands often, use alcohol based hand gel to kill Germs

2. Try avoid touching your face often when you are out.

3. Cough or sneeze on your elbow, bend your hand and do so. This avoids spreading of the germs.

4. Eat healthy

5. Exercise regularly

6. Manage the stress levels

7. Get plenty of rest

8. Get a yearly flu shot to protect against flu

9. Vitamin C – Making sure to include plenty of foods rich in Vitamin C in your diet will increase the body’s production of white blood cells and antibodies needed to defend the body against invading viral infections

10. Tulsi/ basil tea – helps alleviate congestion and common cold

A flu shot is safe and effective in preventing the flu. It will not give you flu has very low rate of side effects, those who have Allergies to eggs should consult about it with the physician.

Asthmatic patients, diabetics, heart patients, People older than 50 yrs of age,and pregnant women should be careful because the complications of flu and cold may be severe on them.

Home remedies that help ease symptoms are as follows:

For general relief

1. Extra rest

2. Fluid intake should be increased.

3. Herbal tea, warm water, chicken soup, soups in general are good for congestion and runny stuffy nose.

4. Take acetaminophen, Advil, Ibuprofen for body aches. ( ask pharmacist if you are not familiar with these over the counter medications)

5. Quit smoking.

6. Avoid second hand smoking

For runny or stuffy nose

1. Keep inside of the nose moist with salt water solution like saline nose drops or nasal sprays

2. Breath warm, moist air from a steamy shower, hot bath or sink / vessel filled with hot water.

3. Use decongestant nose sprays don’t overuse ask the doctor for prescription if needed.

4. Take decongestant like sudafed, sinarest. Consult with doctor if you have high blood pressure.

5. Apply warm moist towel or gel pack to your face three or four times a day for 5- 10 minutes each time.

For cough

1. Use cough drops to soothe throat irritation

2. Drink plenty of warm fluids.

3. Use cough suppressants With dextromethorphan.

For sour throat 

1. Gargle with warm salt water frequently. 1 tsp salt in 1 cup of warm water.

2. Drink extra fluids

3. Take mediations like acetaminophen or Advil or over the counter lozenges to soothe soreness

4. Use a humidifier to add moisture to the bed room.

Pregnant women and precautions 

Prolonged fever should’ve addressed as it is harmful to the baby.so rapid onset of symptoms, cough, fever , tired and archly feeling should be taken care of

Consult a doctor to bring down the fever, do not use aspirin or Advil during pregnancy

Antibiotics won’t help

Virus and bacteria are the cause for these cold, found chest cold. Antibiotics  kill bacteria alone.

Colored mucus doesn’t mean one needs antibiotics as it is not bacterial infection, it is common occurrence.

Antibiotics causes side effects, like upset stomach, diarrhea, vaginal infection,rashes, allergic reactions.

Go back to doctor when

1. When symptoms come back

2. Trouble breathing, wheezing, tightness in chest

3. A deep cough with lots of mucus or a cough that lasts more than 3 weeks.

4. A very sore throat, a sudden hearing loss, or discharge from ear.

5. A fever of 100.4F or higher for three days or more with a stiff neck,a severe headache or a rash.

Uvulopalatopharyngoplasty – what to expect

Uvulopalatopharyngoplasty – preoperative and post operative care.

 

Obstructive Sleep Apnea (OSA) is the disruption of the breathing during sleep that is caused by the complete or partial obstruction of the upper airways.  Narrowing of the air passages along with muscle tone relaxation during sleep leads to apnea, cessation of sleep more than 10 seconds and hypopnea, that causes 30 – 50% reduction in airflow, which usually occurs when the tongue and soft palate fall back and block the airflow.  The patient has decreased blood oxygen saturation (hypoxemia) and increased partial pressure of C02 (hypercapnia). The patient is at risk of cardiac arrythmias, hypertension, right-sided heart failure from pulmonary hpertension and suffers from irritability, headaches, impaired memory and inability to focus and reduced sex-drive.   Deviated septum, narrow nasal passage, nasal polyps, disproportionate jaws, large neck size and tongue, obesity and enlarged tonsils leads to OSA.  Research confirms decreased concentration of gray matter in the OSA patients.   OSA is a main cardiovascular risk factor.

The physician orders for a sleep study to evaluate OSA.  The patient’s chest, abdominal and limb movements, oral and nasal airflow, snoring sound, pulse rate, blood oxygen saturation, eye movement, heart rate and rhythm are monitored.  OSA is confirmed by more than five episodes of apnea/hypopnea events/hr with a 3%-4% decrease in SP02 .  A Uvulopalatopharyngoplasty (UPPP) is ordered by the physician. Modification of the uvula, removal of redundant pharyngeal and palatal tissue, and primary closure of the posterior and anterior pillars to enlarge the retropalatal airway, removes obstruction at the oropharyngeal level.  The proposed changes aimed at enlarging the pharynx and reducing the redundancy and collapsibility of hypopharyngeal tissues .   The tonsil is removed, a horizontal incision is made along the soft palate mucosa just anterior to the uvula, the redundant soft palate and lateral pharyngeal mucosa is resected.  Destroying tissues stops blood vessels from bleeding resulting in hemostasis. Both oropharyngeal and nasopharyngeal mucosa are sutured together.

Preoperative care involves high quality and client foccused care, open and dynamic interaction with the patient, surgeon, anesthesiologist and the nurse.  Communication and documentation of the information is vital to the continuity of the care. Establishing a baseline data for the continuation of care during the intra-op and post-op  stages, decision to proceed with the surgical intervention and preparatory education are the main goals. A preoperative interview is conducted by the nurse to gather information about patient’s health prior history of surgeries and how they reacted to anesthesia, and assess the patient’s emotional stage.  Nurse explains the procedure, answers questions, and begin the paperwork.  Preoperative assessment some times reveal  abnomalities like fever that might postpone a surgery itself, hence it is important to assess the patient carefully. The surgeon orders diagnostic tests to screen preexisting abnormalities.  Identifying patient’s at risk prior to surgery as well as determining how to best monitor patients at risk for postoperative cardiorespiratory events are major concerns.  Prescription medications, over the counter drugs, any herbal supplements are documented.

The lab results CBC, Hematocrit and hemoglobin values, INR, PT, GLU, K levels, electrocardiogram, allergies to any medication, and all preoperative diagnostic tests are documented in the patient’s record.  The surgical site is identified and documented. Patient’s emotional status, anxiety, conflicts, potential stressors and fear about surgery is addressed.  Nurse determines if patient’s consent for surgery is signed and witnessed.   Any history of congestive heart failure is documented and interventions done.  Smoking habits,  alcohol and illegal drugs can cause adverse reactions to anesthesia, hence documented in patient’s record.  Any impaired airway pattern is notified to the healthcare providers as certain anesthesia can cause laryngeal muscle spasms.  Heart and vascular system is assessed and cap refill is noted.  Neurological assessment to find if the client is alert and oriented is done for all patients receiving anesthesia.

Education and  preparatory information help the patient to know what to expect. Explanation and demonstration of the breathing exercises like deep breathing, turning , coughing is done.  Use of Incentive Spirometry, TED hose, sequential compression device is explained and demonstrated. Both client and patient are told what to expect in the post-op phase. The patient is taught how to use Patient controlled analgesic (PAC) and the expected pain.  Patient is advised to have 8hr fast before surgery to prevent aspiration. Serum electrolytes is determined to give proper IV fluids and electrolyte additives and an IV line is started. Surgeon orders antibiotics to reduce risk of surgical wound infection.  Proper skin preparation reduces risk of post-op wound infection.

Diverticulitis – a digestive disease, pathophysiology

Diverticulitis is a disease caused by the colon rupture that causes the inflammation of the tissues around the colon. The colon is a long tube that aids in storage and elimination of the waste products. In few cases, example in old age the wall of the colon develops many pockets called the diverticula that projects outside, especially the sigmoid colon. Diverticulosis caused no symptoms or pains but when it ruptures and infection sets in it is called diverticulitis.

 

The causes of diverticulitis:

  • The muscular wall of the colon grows thicker with age whose cause is unclear. It may reflect the increasing pressures required by the colon to eliminate feces.
  • The lower fiber diet is considered a cause for diverticulitis. The low fiber diet causes the colon to work extra hard.
  • Over time, high pressures in the colon compartment is not able to dissipate to the rest of the colon and push the inner intestinal lining outward (herniation) through weak areas in the muscular walls. These pouches or sacs that develop are called diverticula. During constipation, the stool is trapped in the pouch/ diverticula. This causes infection or inflammation of the diverticula.

Symptoms:

  • Sudden and severe pain on the left lower side of the abdomen
  • Many have excessive thickening of the muscular wall of the colon where the diverticula form
  • It includes abdominal pain that may be milder in the beginning becomes worse over several days and lasts longer.
  • Abdominal bloating, gas formation, abdominal tenderness, abdominal cramps and change in bowel habits.
  • Nausea and Vomiting
  • Diarrhea
  • Bleeding from the rectum is less common

Complications:

  • On rare occasions the inflamed diverticula erode into the urinary bladder causing bladder infection and passing intestinal gases.
  • Inflammation of the colon can lead to colonic bowel obstruction.
  • Sometimes the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity that can cause an inflammation of the lining of abdominal cavity (peritoneum). Peritonitis is a medical emergency and requires immediate care.
  • Abscess can form due to collection of pus in the diverticula.
  • An abnormal passageway occurs between different parts of your intestine, between intestine and bladder or vagina, or between intestine and abdominal wall called fistula results.
  • Diverticulitis can make rectal cancer or colon cancer difficult to be diagnosed.

Rhabdomylosis – the breakdown of muscle fibers pathophysiology

Rhabdomylosis is the breakdown of muscle fibers that result in the release of the myoglobin, the fiber contents into the bloodstream and the extra cellular fluids. This can cause complications to the renal system, as the kidney is unable to excrete the concentrated urine. In rare cases it can even lead to death. The amount of myoglobin and an enzyme called creatine kinase in the muscle cells in the blood is a measurement of the degree of muscle injury caused by rhabdomylosis.

The causes and pathophysiology of rhabdomylosis are:

  • Muscle trauma or crush injuries like fall, accident and muscle collapse
  • Severe Burns, electric shock injury and lightning strike
  • Endocrine diseases- Ketoacidosis a metabolic disorder, hypothyroidism, thyroid storm, Hyperaldosteronism
  • Diseases of the muscle like congenital muscle enzyme deficiency (Mitochondrial enzyme deficiencies), muscle dystrophy
  • Flu, HIV, or herpes simplex virus- viral infections
  • Bacterial infections cause sepsis and accumulation of toxins in the muscles
  • Prolonged coma, long lasting muscle compression caused by lying unconscious for a long time due to illness, alcoholism, medications, drugs like cocaine, amphetamines overdose cause muscle damage
  • Severe muscle contractions due to seizures, tetanus over exertion due to long running, delirium tremens and chills cause excessive muscle activities that lead to muscle injury.
  • Electrolyte imbalances of calcium, magnesium, sodium and phosphates cause perturbation of sodium-potassium pumps, and generation of oxidative free radicals and release of proteolytic enzymes – caused by increased calcium. This is mainly due to ATP depletion, the presence needed for cellular transport and electrolyte balance.
  • Autoimmune diseases  – the inflammatory muscle disorders like polymyositis and dermatomyositis.
  • Action of phospholipases in insect and snake venom may cause hemolysis, muscle damage, endothelial necrosis and rhabdomyolysis, which in turn cause acute kidney damage.
  • The release of protease and the proteolytic enzymes degrade the muscle filaments and injure the phospholipid layer of cell membrane and releases the intracellular contents into the plasma, like calcium, phosphates, urates and myoglobin. Excess myoglobin may thus cause renal tubular obstruction, direct nephrotoxicity (ischemia and tubular injury), intracranial vasoconstriction, and acute kidney injury.
  • Occlusion of the vessels like thromboembolism causes ischemia or necrosis of the muscles.  The gastro ischemia is common in patients with fluid and electrolyte imbalances that lead to endotoxin absorption, cytokine production, and perpetuation of the systemic inflammatory response.

Pancreatitis – Inflammation of the pancreas

Pancreas is a gland found behind the stomach, which produces hormones, the insulin and glucagon that are involved in the blood glucose metabolism and also digestive enzymes that help digest carbs, proteins and fats. Pancreatitis is the inflammation of the pancreas. When the inflammation occurs the enzymes auto digest the pancreas itself.

 

Types of pancreatitis:

Acute that suddenly occurs and lasts for few days
Chronic, which can happen over a long period of time like years, in the person.

 


The cause of pancreatitis:

It is caused by many reasons-

Alcohol abuse and gallstones are responsible for 80-90% of the disease. Drinking can be acute even the first time they see the doctor.
Gallstones block the pancreatic duct trapping the digestive juices inside the pancreas, which in turn destroys the organ. This is common in women over 50.
10-20% of the disease is caused by factors like-

  • Abdominal surgery
  • Certain medications
  • Smoking
  • Hereditary
  • Cystic fibrosis
  • Endoscopic retrograde cholangiopancreatography (ERCP), when used to treat gallstones,
  • Hypercalcemia – Increased calcium
  • Hyperthyroidism- Increased thyroid hormone
  • Hyperglyceridemia – Increased triglycerides
  • Infections
  • Abdominal injuries
  • Pancreatic cancer.