What to do if you are choking and there’s no one around to help

Most people more or less understand what they have to do to if they see someone choking. But what’s the solution when we ourselves suddenly find our breathing is obstructed, and no one’s around to help?

Here we publish the instructions for how to respond in this situation. It’s definitely worth reading them – one day they may just save your life. 

Jeff Rehman, a fire medic with 22 years of experience, came up with an effective way to save yourself in such difficult situations.

Here are the key points:

  1. Don’t panic. Remain calm as much as you possibly can.
  2. Kneel on the ground, with your body held vertically over the ground by your arms.
  3. Sharply pull away your arms and fall onto the ground hard with your torso. The hard blow to your chest will force out a large amount of air from your lungs, and at the same time expel whatever’s obstructing your air flow.

Here’s a video with Jeff’s instructions:

Source: https://brightside.me/article/what-to-do-if-you-are-choking-and-theres-no-one-around-to-help-13705/

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Difference between heart attack and cardiac arrest

People often think that a heart attack is the same thing as a cardiac arrest. This, however, is not true. In order to understand the difference between a heart attack and a cardiac arrest, it is first necessary to understand what happens in both of these processes.

What is a heart attack?

The heart is a muscle, and like all muscles it requires an oxygen-rich blood supply. This is provided to the heart by coronary arteries. A heart attack occurs when there is a blockage of the coronary arteries. This is often caused by a blood clot. Such a blockage, if not quickly resolved, can cause parts of heart muscle to begin to die. 

What is a cardiac arrest?

A cardiac arrest is different to a heart attack. In a cardiac arrest the heart actually stops beating; whereas in a heart attack the heart normally continues to beat even though the blood supply to the heart is disrupted. 

Symptoms of a heart attack and of cardiac arrest

In addition to the physiological mechanism being different, the symptoms of a heart attack and a cardiac arrest also vary.

Symptoms of a heart attack include:

  • Chest pain – this is often a feeling of tightness in the center of the chest which may last for several minutes and will not decrease upon resting (although the most common symptom of a heart attack, not all patients having a heart attack will experience chest pain)
  • Spreading of chest pain to other areas, most commonly to the arms, jaw, neck, back and abdomen
  • Shortness of breath
  • Coughing
  • Wheezing
  • Feeling or being sick
  • Anxiety
  • Light-headedness or dizziness
  • Sweating
  • Weakness
  • Palpitations (noticeable heartbeats)

Symptoms of a cardiac arrest include:

  • Sudden loss of consciousness/responsiveness
  • No breathing
  • No pulse 

The lack of pulse is caused by the heart actually stopping during a cardiac arrest. As a consequence of this, the organs of the body are deprived of blood – this can lead to death. 

The following warning signs may also occur in the period before a cardiac arrest:

  • Chest pain
  • Shortness of breath
  • Weakness
  • Dizziness
  • Palpitations
  • Nausea 

Causes of heart attacks and cardiac arrests

Cardiac arrests have several potential causes. These include:

  • Ventricular fibrillation – an abnormal heart rhythm (arrhythmia) where the lower chambers of the heart (the ventricles) beat irregularly
  • Ventricular tachycardia
  • Coronary heart disease
  • Changes of the heart structure
  • Pacemaker failure
  • Respiratory arrest
  • Choking
  • Drowning
  • Electrocution
  • Hypothermia
  • Dramatic drop in blood pressure
  • Drug abuse
  • Excessive alcohol consumption
  • An unknown reason

A cardiac arrest can also be caused by a heart attack. In fact, according to the British Heart Foundation, the majority of cardiac arrests in the UK are caused by heart attacks. 

A heart attack itself involves a cut off in the blood supply to part of the heart muscle. If a large enough portion of the heart is affected, then the heart may stop beating, i.e. a cardiac arrest may occur.

But what about heart attacks themselves? What causes them? Well, in contrast to cardiac arrests, heart attacks are generally caused by one main factor – coronary heart disease (CHD).  CHD is a condition that is generally caused by fatty deposits building up in the coronary arteries, which provide oxygenated blood to the heart. This is also known as atherosclerosis.  Those most at risk of CHD include:

  • Smokers
  • Those who eat an unhealthy diet – one that is high in saturated fat
  • Those with high blood pressure
  • Those with diabetes
  • Overweight or obese people
  • People who do not exercise frequently
  • Older people, in particularly older men
  • Those with a family history of heart disease
  • People who have been exposed to air pollution, particularly traffic pollution

People with CHD may experience a heart attack if a plaque, (a raised patch on the artery wall) splits and causes a blood clot which in turn blocks the coronary artery. 
Source: http://www.news-medical.net/health/Heart-attack-and-cardiac-arrest-difference.aspx

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Suicide prevention

Magnitude of the problem

Suicide is among the top 20 leading causes of death globally for all ages. Every year, nearly one million people die from suicide.

Risk factors

Mental illness, primarily depression and alcohol use disorders, abuse, violence, loss, cultural and social background, represent major risk factors for suicide.


Restriction of access to means of suicide, such as toxic substances and firearms, identification and management of persons suffering from mental and substance use disorders, improved access to health and social services, and responsible reporting of suicide by the media are effective strategies for the prevention of suicide. 

Here are some common myths and facts about mental health.

Myth: There’s no hope for people with mental illnesses.

Fact: There are more treatments, strategies, and community supports than ever before, and even more are on the horizon. People with mental illnesses lead active, productive lives.

Myth: I can’t do anything for someone with mental health needs.

Fact: You can do a lot, starting with the way you act and how you speak. You can nurture an environment that builds on people’s strengths and promotes good mental health. For example: 

  • Avoid labelling people with words like “crazy”, “mad”.
  • Learn the facts about mental health and share them with others, especially if you hear something that is untrue.
  • Treat people with mental illnesses with respect and dignity, as you would anybody else.
  • Respect the rights of people with mental illnesses and don’t discriminate against them when it comes to housing, employment, or education. Like other people with disabilities, people with mental health needs are protected under mental health rights. 

Myth: People with mental illnesses are violent and unpredictable.

Fact: In reality, the vast majority of people who have mental health needs are no more violent than anyone else. You probably know someone with a mental illness and don’t even realize it. 

Myth: Mental illnesses cannot affect me.

Fact: Mental illnesses are surprisingly common; they affect almost every family in America. Mental illnesses do not discriminate-they can affect anyone. 

Myth: Mental illness is the same as mental retardation.

Fact: The two are distinct disorders. A mental retardation diagnosis is characterized by limitations in intellectual functioning and difficulties with certain daily living skills. In contrast, people with mental illnesses-health conditions that cause changes in a person’s thinking, mood, and behavior-have varied intellectual functioning, just like the general population. 

Myth: Mental illnesses are brought on by a weakness of character.

Fact: Mental illnesses are a product of the interaction of biological, psychological, and social factors. Research has shown genetic and biological factors are associated with schizophrenia, depression, and alcoholism. Social influences, such as loss of a loved one or a job, can also contribute to the development of various disorders.

Myth: People with mental illnesses cannot tolerate the stress of holding down a job.

Fact: In essence, all jobs are stressful to some extent. Productivity is maximized when there is a good match between the employee’s needs and working conditions, whether or not the individual has mental health needs.

Myth: People with mental health needs, even those who have received effective treatment and have recovered, tend to be second-rate workers on the job.

Fact: Employers who have hired people with mental illnesses report good attendance and punctuality, as well as motivation, quality of work, and job tenure on par with or greater than other employees. Studies by the National Institute of Mental Health (NIMH) and the National Alliance for the Mentally Ill (NAMI) show that there are no differences in productivity when people with mental illnesses are compared to other employees.

Myth: Once people develop mental illnesses, they will never recover.

Fact: Studies show that most people with mental illnesses get better, and many recover completely. Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life. For others, recovery implies the reduction or complete remission of symptoms. Science has shown that having hope plays an integral role in an individual’s recovery. 

Myth: Therapy and self-help are wastes of time. Why bother when you can just take one of those pills you hear about on TV? 

Fact: Treatment varies depending on the individual. A lot of people work with therapists, counselors, their peers, psychologists, psychiatrists, nurses, and social workers in their recovery process. They also use self-help strategies and community supports. Often these methods are combined with some of the most advanced medications available. 

Myth: Children do not experience mental illnesses. Their actions are just products of bad parenting.

Fact: A report from the Mental Health  research showed that in any given year 5-9 percent of children experience serious emotional disturbances. Just like adult mental illnesses, these are clinically diagnosable health conditions that are a product of the interaction of biological, psychological, social, and sometimes even genetic factors.

Myth: Children misbehave or fail in school just to get attention.

Fact: Behavior problems can be symptoms of emotional, behavioral, or mental disorders, rather than merely attention-seeking devices. These children can succeed in school with appropriate understanding, attention, and mental health services. 

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World Mental Health Day

World Mental Health Day raises public awareness about mental health issues. The day promotes open discussion of mental disorders, and investments in prevention, promotion and treatment services. This year the theme for the day is “Depression: A Global Crisis”.

Depression affects more than 350 million people of all ages, in all communities, and is a significant contributor to the global burden of disease. Although there are known effective treatments for depression, access to treatment is a problem in most countries and in some countries fewer than 10% of those who need it receive such treatment.

Mental Health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the WHO is definition of health: “A state of complete physical, mental and social well-being, and not merely the absence of disease”. It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders

What Is Mental Illness?

Mental illnesses include such disorders as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, attention deficit/hyperactivity disorder, borderline personality disorder, and other severe and persistent mental illnesses that affect the brain. 

These disorders can profoundly disrupt a person’s thinking, feeling, moods, ability to relate to others and capacity for coping with the  demands of life.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.

Mental illnesses are treatable. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery.

Here are some important facts about mental illness and recovery:

  • Mental illnesses are biologically based brain disorders.  They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence. 
  • Mental disorders fall along a continuum of severity. The most serious and disabling conditions affect five to ten million adults (2.6 – 5.4%) and three to five million children ages five to seventeen (5 – 9%) in the United States.  
  • Mental disorders are the leading cause of disability (lost years of productive life) in the North America, Europe and, increasingly, in the world. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.   
  • Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable. 
  • Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States. 
  • The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports; 
  • Early identification and treatment is of vital importance; By getting people the treatment they need early, recovery is accelerated and the brain is protected from further harm related to the course of illness. 
  • Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.


Depression can affect anyone and it is one of the most widespread illnesses, often co-existing with other serious illnesses.

According to the World Health Organization, unipolar depressive disorders were ranked as the third leading cause of the global burden of disease in 2004 and will move into the first place by 2030.

Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. 

Depression can be long-lasting or recurrent, substantially impairing an individual’s ability to function at work or school or cope with daily life. At its most severe, depression can lead to suicide. When mild, people can be treated without medicines but when depression is moderate or severe they may need medication and professional talking treatments.

Depression is a disorder that can be reliably diagnosed and treated by non-specialists as part of primary health care. Specialist care is needed for a small proportion of individuals with complicated depression or those who do not respond to first-line treatments. 

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Life After Kidney Transplant

The Technological advances in transplantation have enabled thousands of procedures that benefit organ and tissue recipients worldwide. Transplantation benefits patients who need solid organs, tissues and cells by means of the development and improvement of surgical techniques, inputs, equipment and immunosuppressive drugs needed to this therapy. The number of kidney transplant performed has increased significantly.

In most situations these procedures are presumed as the only resource for sustaining life. However, this treatment option is not always available for those who are waiting for organ transplantation because it requires a donation.

Kidney transplantation requires compatibility between tissues obtained for the Human Leukocytes Antigen typing (HLA).While waiting for a donor, the chronic renal disease patients have other forms of Renal Replacement Therapy (RRT) which allow the maintenance of their life and also justify the increasing number of patients registered on the waiting list for kidney transplantation.

Renal Insufficiency and the complications associated with its treatment constitute a serious public health problem worldwide, with social and financial burden resulting from increasing rates of young patients with renal function failure.

A number of diseases are capable of destroying renal function in all age groups. The most common causes for renal disease leading to kidney transplantation are the following:

Diabetes -31%

Chronic glomerulo nephritis -28%

Polycystic kidney disease -12%

Nephrosclerosis ( Hypertensive)-9%

Systemic lupus Erythematosus (SLE)-3%

Interstitial nephritis -3%

Thus, measurement of the patient’s quality of life after kidney transplantation is a relevant topic for many individuals who are on dialysis and receive care in a dialysis center.

Renal transplantation is the best therapeutic option for patients with chronic kidney disease. The surgical procedure is relatively simple, and post transplantation certain actions are necessary such as the use of immunosuppressive drugs and the outpatient follow-up. Therefore for these patients, the clinical management, the evaluation of treatment results and impacts on quality of life are important issues.

Health –related quality of life contains multiple aspects of health related issues from the patient’s perspective including physical, psychological and social functioning and overall well being. Numerous clinical trials have established the importance of health related quality of life in various diseases and it is increasingly popular to evaluate disease specific health related quality of life as a measure of patient’s subjective state of health.

Kidney transplantation is the treatment of choice for end stage renal disease (ESRD). Advances in renal transplant procedures and immunosuppressive therapies have increased dramatically the survival over the last decades, one year allograft survival rates are currently over 90%.

The major goal of transplantation is the achievement of maximal quality and quantity of life while minimizing the effects of disease.

In renal transplantation the costs are not only limited to the transplant procedure but also to the evolving costs to treat adverse events, some of them caused by the immunosuppressive therapy.

Since the first successful kidney transplantation as early as the early 1950s, immunosuppressive therapies improved considerably, the most revolutionary development being the introduction of cyclosporine in the early 1980s. The introduction of new immunosuppressive agents has further increased the therapeutic options for immunosuppressive combination therapies in transplanted patients.

In parallel to better patient care and new immunosuppressive regimens the median survival of renal allograft improved continuously. Hand in hand with these achievements, greater attention has been given to long term quality of life. It is generally accepted however, that patients with a functioning renal allograft have a improved health-related quality of life as compared to patients on dialysis.

Summary Points:

·         The global burden of End Stage Renal Disease is increasing.

·         Renal transplantation increases patient survival and quality of life and reduces the cost of care for patients with End stage renal disease.

Longer life with a transplant

On the other hand, patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years and a deceased donor kidney from 8 to 12 years.

·         Most donor kidneys come from ‘brain death’ or ‘cardiac death’ donors, but donations from living donors are increasing.

·         Pre-emptive transplantation from a living donor is the best treatment choice for patients with end stage renal diseases and has been associated with improved allograft and patient survival. ***

·         Long term outcomes in kidney transplantation are improving

·         Better Quality of life

Even though kidney transplant is major surgery with a phased recovery period, it can, in comparison to dialysis, offer you the opportunity for a longer, more satisfying life. Most patients who have been on dialysis and then had a transplant report having more energy, a less restricted diet and fewer complications with a transplant than if they had stayed on dialysis. Transplant patients are also more likely to return to work after their transplant than dialysis patients.

*** Data from the Organ Procurement and Transplantation Network for transplants performed in 2002-2004 show that the 1-year survival rate for grafts from living donors is approximately 95% and the rate for deceased donor grafts is approximately 89%. The half life for grafts from living donors increased steadily from 12.7 to 21.6 years.

Preemptive transplantation refers to kidney transplantation before a patient needs to start dialysis therapy. Patients who get a preemptive transplant receive their kidney when their health is generally good, which can improve new kidney function and enhance overall health and life expectancy.

                                Epidemiological data from the past decade suggest that the global burden of the patients with renal failure who receive renal replacement therapy exceeds 1.4 million and that this figure is growing by 8% a year.

Transplantation is the renal replacement modality of choice for patients with diabetic nephropathy and pediatric patients.


Candidates for renal transplantation undergo and extensive evaluation to identify factors that may have an adverse effect on outcome.

Mostly, all transplant centers have a committee that meets regularly to discuss the results of evaluation in a patient and select medically suitable candidates only to place on the waiting list.

In addition to a thorough medical evaluation the committee also evaluates the social background of the patient to determine conditions that may interfere with the outcome of transplantation, such as financial and travel restraints or a pattern of noncompliance.

Laboratory Studies in transplant candidatesInfectious profile in transplant candidates
Blood ChemistriesHepatitis B And C serology’s
Liver function testsEpstein –Barr Virus, serology (IgM and IgG)
Complete Blood Count (CBC)Cytomegalovirus (CMV) serology’s (IgM and IgG)
Coagulation  ProfileVaricella –zoster virus, serology’s (IgM and IgG)
 Rapid plasma reagin (RPR) test for syphilis
 Purified protein derivative (PPD)- tuberculosis skin test

Urine analysis, Urine culture and cytospin should be ordered when indicated.

A complete cardiac workup and immunologic evaluation (ABO blood group determination, Human Leukocyte Antigen (HLA) typing, serum screening for antibody to HLA phenotypes, cross matching) are also done.


In addition to the surgical transplantation procedure itself, management includes the following:

·         Organ procurement

·         Provision of immunosuppressive therapy to the recipient

·         Short and long term follow-up to look for indications of renal allograft dysfunction and other complications

Organ Procurement

·         Identification of potential donors

·         Assessment of donor suitability

·         Determination of donor brain death

Immunosuppressive therapy after transplant

All kidney transplant recipients require life-long immuno suppression to prevent a T-cell alloimmune rejection response. The goals are as follows:

·         Prevent acute to chronic rejection

·         Minimize drug toxicity and rates of infection and malignancy

·         Achieve the highest possible rates of patient and graft survival

The critical considerations in medical follow up are as follows:

·         Rejection

·         Nephrotoxicity of calcineurin inhibitors (i.e. cyclosporine, tacrolimus)

·         Recurrence of native kidney disease

Transplant recipients tend to be highly experienced patients. Many dealt with their chronic illness for years have been treated and examined by innumerable doctors, have undergone dialysis and its attendant intrusions on their lifestyle, have managed a complicated regimen of medications and have (in many cases) developed a certain expertise related to their own care.

Such patients are invariably grateful for any recognition or acknowledgment of their ordeal. Thus, it is advisable that they are educated about and encouraged to participate actively in their disease management to the fullest possible extent. That said, these patients problems are often complex and decisions regarding their care should be made after consulting the appropriate transplant team.

It is worthwhile to mention-

·         Till date, more than 250,000 kidney transplants have been performed in United States alone.

·         In 2007,6037 kidney transplants were performed from living donors and 10,082 from deceased donors.

·         Currently more than 100,000 people in the United States are living with the functioning kidney transplant.

This number represents 27% of the nearly 350,000 persons enrolled in the US ESRD program.

In1973, congress enacted Medical entitlement for ESRD treatment to provide equal access to dialysis and transplantation for all patients with ESRD in the Social security system by removing the financial barrier to care.

Currently, the main obstacle is donor organ shortage. An increasing rise in ESRD coupled with a lack of donor organs has resulted in an average waiting time of more than 4 years for a deceased donor renal transplant.

The social factors and the perception of the complications of donation by the donor, family members or even the recipient can affect the act of voluntary donation. In India, the Human Organ Transplantation Act of 1994 and its amendments discourages unrelated transplant due to ethical reasons and to avoid exploitation of the financially disadvantaged people.

The latest statistics says that the donors volunteer themselves for transplant evaluation in 28% of the cases and in the rest, it is either requested by the recipient or suggested by the recipient’s physician.

Of all the donors who come for evaluation, 46 (22%) report at least one instance of an attempt to discourage donation and donor’s spouse is the commonest (47.8%) identified cause. Similarly the commonest cause for some of the possible donors declining to even come forward for donor evaluation is again the spouse refusing to give consent.

This emphasizes the fact that the donor’s spouse is always a part of decision making along with the donor to alley some of the fears associated with donation.

It takes courage to ask others for help- and there’s no bigger ask than asking for a kidney and it is always good to help others and there is no greater help than donating an organ and giving a new lease of life to someone.

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Total Knee and Total Hip replacements are highly successful operations that can dramatically improve the quality of life of a person riddled with end- stage arthritis. An increasing number of people are having these now as the technology and expertise has become easily available across our country. At the same time, the rapid expansion of the Healthcare industry in India has led to mushrooming of several facilities, all of which market their wares quite aggressively. In this scenario, it is possible that the opinion seeking patient is offered the solution that is available within the premises of the particular healthcare facility rather than the treatment which might be best suited for that patient’s specific needs. It is therefore important that one is aware of the options available when at the receptive end of this gamble.

First of all, replacement surgery works for severe arthritis that has caused significant pain and disability. If there are symptoms from early or mild arthritis, there are a variety of non- surgical treatments like exercise, medications and injections which must be explored. A thorough consultation with a specialist helps decide which option is the best suited for a particular individual. Similarly, Total Joint Replacement works well in people over the age of 60 years. At younger ages with severe arthritis, surgical options like bone re-alignment and Partial Joint Replacement exist.

Joint Replacement is an elective procedure and must never be decided upon in a hurry. It must never be forced upon an individual or the success and satisfaction will be less, as any operation involves going through pain and risk. At the same time, new developments have enabled many of the previous myths associated with such procedures to wane.

For patients wanting to undergo such surgery, there are good services available in most Indian cities. There are an increasing number of dedicated firms doing exclusive work, where the standards are bound to be better. At the same time, I would discourage people from travelling too far to have these procedures undertaken at the more famous centres, as travelling back home soon after such surgeries is not without risk. Similarly, one must be in a position to manage stairs within three to four days of surgery too, unless one has not been doing stairs at all before. Only with a reasonable amount of independence, usually achieved within four to five days of surgery is a patient deemed fit to leave hospital, as we cannot guarantee good rehabilitation with the currently available infrastructure of home care services. The cost of surgery varies a lot with the city and set up. However, it does not mean that increased cost would guarantee important things like theatre standards (having a separate theatre for clean planned cases), water impervious drapes, etc. What materials are being used should be transparent and patients must demand for records of what is implanted into their bodies.

Patients in our country are given a choice of “Indian” or “Imported” prostheses. There is however a large armamentarium of prostheses available from across the world. We have some very good quality prostheses manufactured in India now. Similarly, there are ones manufactured abroad with less sound engineering. Every joint replacement surgeon should ideally be comfortable using a range of prostheses. The question to tackle is the disability experienced by the individual person leading to joint replacement. Design of prosthesis should be selected as per that very need. Differently manufactured prostheses are based on different engineering. The pattern of movement allowed by each prosthesis is thereby slightly different. Different designs of prostheses can hence be chosen to suit the individual patients’ specific needs and to match their pattern of arthritis. The price often depends on an individual companies marketing strategies. Expensive pricing certainly does not equate with better design always.

Even though an operation of this nature is a large attack on the body, there is worldwide evidence that shows better results when patients are made to get up and walk right from the day of surgery. With the patient visiting the toilet on the day, urinary catheterisation can be avoided. Patients even manage stairs in a couple of days. Hospital stay and complications like infection thereby are much reduced. Modern techniques of pre- operative medication and anaesthesia combined with sound surgical measures make this ‘Enhanced Recovery’ possible. As these procedures are planned, we have the opportunity to optimise the patient’s status before the surgery.

The technique of making a patient walk early has been used in reputed centres worldwide for the last three to five years with documented success and decreased complication rates as compared to the conventional technique. At the same time, marketing sometimes go over the top and advertise Joint Replacement as ‘day surgery.’ A technique is good and viable when it can be reproduced easily for most patients undergoing Joint Replacement, not for a select few younger and fitter ones. Even in a smaller setup in Mangalore, we have employed this over the last six months, and 100% of our patients of ages between 62 and 79 have stood up and taken a few steps on the day of surgery.

Elective surgery is an entirely different ball game as compared to emergency or traditional fracture related orthopaedic operations. It is a matter of changing the quality of somebody’s day- to- day life. Seemingly small alterations in technique can hence make a large difference in rehabilitation of a patient into their desired life activity following joint replacement procedures. With the increasing scale of these operations across our country, it is imperative that dedicated units offering such services incorporate the best standards of care and rehabilitation.

The author Dr. Yogeesh D. Kamat is a Consultant Hip & Knee Specialist Orthopaedic Surgeon. He practises exclusively in Joint Replacement, Arthroscopy and Sports Injury related to the lower limb joints and is available at KMC Hospital

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Arthritis is not an unknown entity and has been around since prehistoric times. It’s incidence has however certainly seen a dramatic rise in the last few decades. There are various types of arthritis that may not be entirely preventable. Osteo- arthritis is one of the commonest types and occurs entirely due to mechanical reasons. This article provides a short overview of the problems caused and possible solutions.

Due to the structure of our health system, we do not have a mechanism and culture to facilitate referrals to the appropriate specialist doctor. This is largely due to random distribution of speciality practitioners as well as incomplete knowledge about their expertise amongst the people. As people directly approach specialists, they might not always see the exact person suited to their problems. Similarly, it is too easy to get a variety of medicines and splints directly from the stores or even ‘online’ nowadays, that a lot of potentially harmful self- medication is rampant.

Movement is among the very most basic functions, which gets affected in severe arthritis. At present we do not have quantitative statistic measures to evaluate the disability caused in the general population due to arthritis. We accept heart disease as a common killer; heart attack being a sudden unforgettable event. However the total quantity of problems caused with sever arthritis is much higher. It presents gradually and in different forms:

  1. Immobile & elderly people get more prone to fractures as bones become weaker with decreased mobility.
  2. Severe arthritis can cause giving way of joints and falls on it’s own accord. Such fractures can get difficult to treat and often work as a beginning towards a slow and painful end.
  3. Various drugs – both prescribed and self- medicated can cause harmful side effects that lead to kidney failure, etc.
  4. Decreased mobility brings about decreased self- esteem and confidence, less productivity and mental health issues.
  5. Untreated osteoarthritis itself is self- propagating: by avoiding mechanical pressure on an affected joint, one strains the neighbouring joints and the other side, overall increasing the risks and making for further complexities in treatment.

Early detection and appropriately instituted treatment can go a long way in preserving quality of life. Similarly, the risks of various treatments need to be evaluated before resorting to operative or non- operative means of treatment in cases of severe end stage arthritis.

There is a lot of knee osteo-arthritis at younger ages in India owing to: (i) widely unrecognised and improperly treated knee injuries and (ii) common activities like squatting, sitting cross legged and praying in our cultures place high demands on the knees. The important preventive measure hence lie in getting appropriate attention if a seemingly simple knee injury does not recover in a couple of weeks. Various non- operative methods exist and are mainly effective in earlier stages of osteo- arthritis: medications, exercises, injections and the like. Treatment needs to be customised to the individual needs of the patient. Medications need to be titrated and monitored to avoid dangerous long- term side effects.

Surgery – What needs to be understood about surgery is that early and rightly directed Arthroscopic surgery can actually prevent arthritis from developing, after one has sustained certain cartilage or ligament injuries. This type of surgery can mostly be performed as a day procedure without admission and often doesn’t even entail stitches. People return to their work within days. This should hence not be viewed as a major event as compared to a fracture or general hospital admission for most other reasons.

Joint Replacement is proving to dramatically change the quality of life for patients riddled with severe end- stage arthritis. It is high time that myths regarding risks associated with such surgery are dispelled, as modern techniques have consistently enabled return to walking right from the day of surgery. This is planned surgery and hence the potential for proper organisation and enhanced recovery as opposed to fracture or emergency operations. For patients wanting to undergo such surgery, there are good services available in most Indian cities. There are an increasing number of dedicated units doing exclusive work, where the standards are bound to be better. At the same time, I would discourage people from travelling too far (more than 5- 6 hours or any flight) to have these procedures undertaken, as travelling back home soon after such surgeries is not without risk. Similarly, one must be in a position to manage stairs within three to four days of surgery too, unless one has not been doing stairs at all before. Only with a reasonable amount of independence, usually achieved within four to five days of surgery is a patient deemed fit to leave hospital, as we cannot guarantee good rehabilitation with the currently available infrastructure of home care services. The cost of surgery varies a lot with the city and set up. However, it does not mean that increased cost would guarantee important things like theatre standards and materials used. There are various standard prosthetic materials from various manufacturers that have shown to provide good results. Success depends on the technique of surgery than whether the implanted prosthetic is of local or foreign make.

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Vaidyo Narayano Bhava’ is a well quoted Sanskrit phase which places a doctor at a similar pedestal as God himself. This is indeed the only profession in which someone’s body is entrusted to the practitioner. The evolution of science and technology however has brought about a steady decline in the divinity of the doctor- patient relationship. There is no doubt that malpractices in the medical profession are equally to blame. Information technology makes it easy to attain knowledge about any disease at the click of a button today. However, the reliability of such data depends on the source which has uploaded or published it. Most information sources are good but some could be biased. To add to the problems come in the pharmaceuticals and the modern health industry with their marketing tactics that has increasingly become very commercial in India.

Due to the structure of our health system, we do not have a mechanism and culture to facilitate referrals to the appropriate specialist doctor. This is largely due to random distribution of speciality practitioners as well as incomplete knowledge about their expertise amongst the people. As people directly approach specialists, they might not always see the exact person suited to their problems. Similarly, it is too easy to get a variety of medicines and splints directly from the stores or even ‘online’ nowadays, that a lot of potentially harmful self- medication is rampant. I have listed a few of such practices relevant to disorders of the knee below:

Pain Medications

These are the most commonly used medications worldwide. They are easily available over the counter and are also the most prescribed. These are the first line treatment given after injuries as well as in arthritis. To make matters worse, patients often move from doctor to doctor without carrying the prescription of one to another. The doctors might end up prescribing different preparations of the same or similar medications resulting in long term use. Side effects are well known and they are the leading cause of kidney failure. There are various newer preparations available, but long term safety of most of these is not established.

Joint Reparative Medications

These do not have bad side effects as the pain medications. However one must be cautious taking various combinations of such medications that are increasingly available over the counter too. Long term side effects of various such combinants are not yet conclusively established.

One must similarly beware of medications made from plant extracts that are claimed as ‘natural’. These have been found in certain cases to contain steroids that cause osteoporosis and increase risk of bone fractures in the long run. Similarly it might be quite deleterious to combine medications from different systems of medicine and patients must be cautioned against taking medicines from different practitioners simultaneously.

Knee Caps & Braces

Various such contraptions are available commercially and often bought off the counter. They are mostly OK for short term use. However habitual use is often recommended by non- specialist practitioners. This makes matters worse as continuous use of braces causes muscle wastage. This in turn makes arthritis worse.

With modern techniques of specialty surgery, the need for braces following planned operations is very rare. It is not uncommon however to find these being used. Even though they seem protective, they often delay optimal rehabilitation.

Exercises & Physiotherapy

The importance of developing the right muscles by exercise is rarely stressed upon in our setup. Even though the basic principles of exercise are age-old and find mention in older systems of medicine like Ayurveda, focus has somehow shifted to medications alone. Many Physiotherapy practitioners too encourage use of modalities for pain relief and patients are less motivated to learn techniques of muscle strengthening, which are themselves the key to solving early arthritis related symptoms and also important in making recovery after surgeries.

Blood testing, Xrays & Scans

Health screening packages have become fads in recent times. Going through routine ‘complete health packages’ does not give any insurance against the diseases screened for any future period. Similarly, the availability of investigations has driven us doctors away from clinical medical examination and spending time talking to the patient. Many a time, a number of tests are unnecessarily ordered and might lead to wrong conclusions about diseases like Gout and Rheumatoid Arthritis, resulting in over- treatment and side effects. Excess radiation can also cause cancers.

In this scenario, every educated person seeking a solution to a medical problem can at least check before hand that the specialist they are approaching is the right one for that respective need. Family doctors or general practitioners can play a very good role here, as they have the advantage of knowing the individual patient more entirely. Many of us however no longer have regular contacts with family physicians. Similarly there also exist alliances between different practitioners that can influence the pattern of referral to particular specialists. The onus thus falls on the patient. Despite all the above discussed disparities, we have a large number of great practitioners who have dedicated themselves to the best care of their patients. Our health system gives us the power to decide who will treat us, unlike the case in many developed countries with evolved health systems.

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We are surrounded by fast- growing technology all around and often find it difficult to keep pace. Twenty five years ago, talking to another person involved booking a trunk call and waiting endlessly. Todayone can share pictures with an entire group of people while on the move. Development has revolutionised every aspect of life and healthcare is no different. Howeverit is not that keeping in contact over mobile phones betters relationships between people. Nothing can replace a one to one meeting and a face to face conversation. Similarly as regards a medical problem, even though vast knowledge could be available on the Internet by uploading reports, thorough clinical examination by a good doctor is irreplaceable and invaluable.

Surgeries on joints have improved the quality of life of millions of patients worldwide and are now rated among the best of all types of planned surgery. Like some people accept technology more easily than others, there are many who would rather suffer a lot of disability than go through surgery for fear of becoming worse. At the same time, there is a plethora of sites advertising different treatments claiming success, which would definitely confuse people. There is often no mechanism of getting the correct scientific and evidence based information.In this scenario, I have tried to address certain issues below on aspects related to surgery. As surgical techniques have evolved, concrete proof on each of these aspects has emerged, that too not in relation to a small group of patients but in various different environments all around the world.

To have or not to have surgery

There are few causes for which surgery is absolutely and urgently necessary on knees e.g. Fractures when the blood vessels are injured as well. Recommendation for surgery should be made only after discussing the merits and demerits of the procedure, and that too after clinical examination, not on the basis of reports. Commercialisation of healthcare has brought about practises where patients are coerced into immediate/ early surgery. There is evidence that most cases of ligament injury will not do well with immediate unplanned surgery, even Arthroscopy. If done immediately after knee injuries, they cause more stiffness and pain. In knee injuries where there are none or minor fractures, early rehabilitation by return to movement of the knee is the key. The majority of ligament injuries heal on their own. Splints, plasters or knee caps are grossly overused. They are known to weaken the muscles over time and would cause further predisposition to injury or worsen arthritis in the case of the young or older patient respectively. Correct rehabilitation after an injury should make the knee feel 70-80% better. One must pay attention to symptoms if present about a month or later after injury and consult the right specialist at that stage. If seemingly minor problems are neglected, they can progress to irreversible joint damage over time. Many people get arthritis very early in this country as mechanisms for recognition of early damage are not in place.

In the case of arthritis, we see various remedies- both operative and non- operative being advertised. Before going for any of these, one must question the scientific proof and explore side effects. Any knee pain is described as arthritis. In my practice most 40 to 60 year olds presenting with knee pain are due to muscular problems or moderate arthritis at the most, which can be very well managed without surgery. In such cases exercises have a better role than medications. Traditional systems of medicine can work very well if implemented in pure holistic form, without mixing treatments.

Surgery – joint replacementon the other hand, is not for any joint pain. It works very well for pain and disability associated with severe end stage arthritis I.e. Bone surfaces badly destroyed, not otherwise. There is a lot of research on unsuccessful joint replacement surgery and specialists practising exclusively in this field could reasonably predict after careful discussion and examination whether a patient might benefit or not.The commonest reason for unsatisfied patients is improper selection of patient for surgery. When the arthritis is severe, it is pointless to roam around looking for ‘magic’ cures, as different medicines (allopathic or traditional medicine) all have a side effect profile. Arthroscopy (keyhole surgery) is something with almost no risk, but works well for ligament and cartilage injuries, not for arthritis. If advised at age of 40 or less, there is little to think against it as there is no risk or downside to it. In fact, it can be done as a day case with no overnight hospital stay. Rehabilitation in such case should be quick and the person can even get back to work within a week– seems like hardly any surgery at all. On the other hand, keyhole surgery after the age of 40 may not always be so advantageous, as the presence of arthritis might make it’s success limited.


Surgery, if and when advised, should be planned with a clear understanding of what is wrong and what one aims to achieve. The practice of admitting a patient in hospital first, deciding on joint surgery and undertaking it with no clear idea of timelines must be condemned, as results are far poorer in scientific literature across the world. The best results are when a patient has had enough opportunity to contemplate what they are undergoing, had discussions with close family and friends who will contribute towards their support and rehabilitation after surgery.
There is enough proof to show that knee surgery is not as successful when a patient is not themselves ready to undergo it. Hence no one should be forced unless they make the choice on their own accord.Most timings can be planned as per family logistics over a few months’ time.

Investigations and MRI
Development has brought about endless tests which are easily available even in smaller cities. Blood tests and MRI of knees are recommended at a very early and often unnecessary stage. These often do not contribute anything towards the patients’ treatment and reportscommonly have errors when the MRIs are low resolution poor quality images. There is also a known limit of diagnostic accuracy with these and errors in imaging could be 20% or higher. I would like to strongly stress that any blood test report or image in the world has relevance only in the clinical context I.e. if it can be correlated with a problem following discussion with and examination of the patient.
If and when the same patient presents for surgery, MRI done many months in advance might be irrelevant if the clinical picture has changed by then. Hence I would strongly advise patients to know from their specialist doctor why a specific test or MRI is being requested and whether it is likely to result in surgery, with the urgency thereof. If the patient has logistic constraints or is keen to try non- surgical treatment, there is often no need to undertake MRI. It could be postponed to a time when situations change.

Worsening the situation
There’s no doubt that overt advertisement of healthcare commodities confuse patients when they have to make a choice for their treatment. The easy way found by most is to take various opinions from multiple places and compare costs. There is nothing wrong in seeking opinions from practitioners of different principles too. However patient compliance with all the treatmentsin such cases is often very low. One must therefore follow advice given by the doctor for the recommended period before deciding whether it works or not.
The onus is on the patient to approach a particular practitioner. Instead of roaming randomly from pillar to postand taking a mixture of treatments from different places, often resulting in greater side effects than benefit. A literate person could check whether the doctor being approached is the best suited for their specific problem in terms of speciality practice. When comparing prices, the patient must ensure that they are comparing like and like. There is no point in compromising on certain theatre standards purely to decrease the cost and also cut corners by undertaking certain surgeries in theatres not correctly equipped. Bigger setups could cost more but would certainly be safe. Technical details are difficult to explain to patients. It will help patients to frankly discuss above matters with their respective specialist and understand nuances rather than run around with half baked knowledge. There are different ways of decreasing costs which can be discussed as per the individual’s problem.

Cost of Surgeryand Implants
Many patients are convinced that they want ‘imported’ implants, but would like compromise on other aspects in hospital to reduce the cost. This notion is incorrectly founded, as there are now some good quality implants being manufactured indigenously. There are similarly a number of implants manufactured abroad that do not have much scientific research backing.
In my practice, it is not expense, but clinical need that determines what implant a patient should have. There are various implant designs registered successful in the long term on international joint registries. It is best to select one of these or an indigenous one based on similar engineering design principles, which every joint surgeon must be well versed with. Within these, there are cheaper and more expensive options.
There are packages available in most specialist centres where costs can be cut. It is not worth further compromising on these in smaller setups as risks of complications then increase drastically.There are schemes available through which the State pays a major chunk of the cost, even when the patient is not previously medically insured.

Recovery after Surgery, Blood transfusion and ICU stay
Best practice techniques internationally have enabled ‘Enhanced Recovery’ in planned joint surgeries I.e. Patients walk the same day of surgery and achieve a level of activity that they can manage independently at home following discharge. This technique has shown immense cost benefit by reduction of hospital stay and the requirement for additional rehabilitation measures at home after release from hospital.
Similarly, with modern techniques, we have seen that requirement for blood transfusion after surgery in our practice is less than 5%. ICU stay is ‘0’ for straight primary operations. There are guidelines established in specialty centres around the world for joint surgeries so as to minimise complications.These methods have revolutionised such apparently ‘major’ surgery. It is not worth doing such surgeries if these standards are not adhered to. Every patient undergoing joint surgery can have access to world best practice standards.

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Physical and Psychological sufferings of patients dealing with a condition like Cancer has made a deep impact and galvanized our Cancer research efforts .In our quest to address these issues, we at Muniyal Ayurveda have designed and developed an innovative line of treatment for Cancer called Mahoshadha Kalpa

It is known that abnormal cell division is the genesis of cancer. But the exact cause for such a rapid and uncoordinated growth is not explained by modern medical science.

Our research leads us to believe that Disturbed Cellular Intelligence leads to abnormal cell division causing cancer. This disturbance can be attributed to vitiation of food, environment and consciousness. To correct this disturbance and awaken cellular intelligence an Integrated and Holistic approach is necessary which improves the overall health and brings about a strong sense of well-being in patients. This will bring about positive reinforcement both in the mind and body of the patient.

Mahoshada Kalpa
Kalpas are unique lines of treatment developed by Muniyal Ayurveda for treating chronic disorders. It is a combination of several Ayurvedic procedures, proprietary and classical ayurvedic medicines manufactured by Muniyal Ayurveda.
The treatment principle is developed on 3 pillars:

Curative: To Correct and control the abnormal cell division that leads to cancer. To control cancer growth progression and prevent metastasis.

Preventive: To detoxify the body by chelating heavy metals and scavenging free radicals. To achieve Bio-purification of the body

Rejuvenative: To Rejuvenate and Revitalize the patient both physically and mentally. This will immensely benefit the patient, who has been undergoing intense cancer treatment and interventions from a long duration. The rejuvenating treatment and therapies will help the patient start a fresh new life.

Lifestyle / supplementary care:

  • Prevention of food-related (Aahara) diseases by adopting clinical diet
  • Adoption of Dinacharya (daily regimen) and Rutucharya (seasonal regimen) to counter the environmental ill effects.
  • Practice of Samata and Maitri Dhyana, Yoga and Pranayama for Chitta Shuddhi and Vipassana Dhyana to control the cancer growth progression.
  • Rejuvenation of body cells by Pyramid therapy.

Benefits of Mahoshada Kalpa

  • Early restoration of health – prolongs life span.
  • No ill effects like hair fall, organ damage, etc.
  • Early treatment provides better efficacy and benefits.
  • Helps prevent Metastasis
  • Treatment is economical, compared to prevailing lines of treatment.
  • Can be used along with chemotherapy and radiation.
  • Proper spiritual guidance and counseling improves will power to face the disease, and wards-off fear of death.

More than 350 cancer patients have received the Mahoshadha Kalpa treatment. On evaluation, the results of this treatment have been highly encouraging. Results have been detailed in the case study reports.

We have successfully helped patients diagnosed with different types of cancer and under different stages of treatment as listed below

  • Recently diagnosed and not administered any form of conventional treatment,
  • Administered conventional treatments like chemotherapy and radiotherapy,
  • Discontinued chemo/radiotherapy.
  • Post-surgical procedures

Mahoshadha Kalpa treatment has provided complete cure in several cases of thyroid cancer, ovarian cancer, cervical cancer, lung cancer and lymphomas. In most cases we could help the patient in various aspects i.e.; improving the quality of life, prolonging life span and life expectancy, development of positive attitude, minimizing the adverse effects of chemotherapy and radiation.

This positive result has further encouraged us to work towards making this holistic line of treatment available to maximum number of people suffering from cancer.

Few Short case studies suggesting the effectiveness of Mahoshadha Kalpa

A 27 year old female patient approached Muniyal Ayurvedic Hospital and Research Centre with the complaint of a swelling in the anterior aspect of neck since two months. There was no apparent constitutional symptoms. She had consulted a surgeon with the presentation of “multi-nodular goiter”.
On examination, the swelling was firm, nodular and moving up during deglutition. No lymph nodes involved.
Blood Pressure : 150/100 mmHg.
Thyroid profile: T3 : 112 ng/dL(normal range: 60 – 200)
T4 : 2.6 µg/dL(normal range: 4.5 – 12.0)
TSH : 97.48 µIU/mL(normal range: 0.30 – 5.5)
Treatment: I. Oral medication: Muneks tablets, Kanchanara guggulu, Munipyrin tablets
II. Pyramid therapy
III. Meditation
After 45 days of above treatment, the swelling is markedly reduced
Blood Pressure: 140/86 mmHg.
Thyroid profile: T3 : 101 ng/dL(normal range: 60 – 200),
T4 : 6.3 µg/dL(normal range: 4.5 – 12.0)
TSH : 20.34 µIU/mL (normal range: 0.30 – 5.5)
She continued the treatment for six months, her TSH level came to 5.2 µIU/mL
with no clinical features.


A 61 years old lady with carcinoma of sigmoid colon, post-operative, post chemotherapy with the metastasis at Liver and Lungs approached our hospital with the complaint of loss of appetite, gaseous distension of abdomen and mild cough. She was treated under Mahoshadha Kalpa. She is on regular follow up since 12 months with substantial improvement in her condition.

Her SGOT and SGPT levels which was elevated have significantly come down with increase in appetite and reduction in gaseous distension of abdomen.


A diagnosed case of papillary carcinoma of thyroid, with a swelling in the anterior part of neck was treated under Mahoshadha Kalpa. He took the treatment for about 4 years with regular follow up.

He is also a diagnosed case of Left Ventricular Hypertrophy and renal failure. He had complaints of general debility, loss of appetite, pedal oedema and exertional dyspnea. He is showing improvement in all these symptoms, swelling of neck has reduced .Blood urea has reduced from 87.00 mg to 49.00 mg, serum creatinine from 2.1 to 1.8. Thyroid Stimulating hormone reduced from 46.5 to 14.53(normal: 0.3 – 5.5) within 45 days which eventually got normalised by the end of three months (4.8IU/ml). This patient eventually showed no symptoms of thyroid cancer and his swelling in the neck was completely relieved.


A female patient aged about 40 years with infiltrating ductal carcinoma of right breast, post-operative but without any chemotherapy or radiation is under the treatment of Mahoshadha Kalpa since last 1 1/2 years.

She has showed good improvement in general condition like weight, appetite and haemoglobin and has shown no signs of metastasis.


A 60 year old male patient with bronchogenic carcinoma of the upper lobe of left lung approached Muniyal Ayurvedic Hospital and Research Centre two years back with the complaint of severe cough and breathlessness. He has not received any conventional cancer treatment.

After 2 months of treatment his cough reduced significantly and there no signs of metastasis. Treatment was continued for a period of two years with no serious episodes of symptoms but with dramatic remission in respiratory symptoms. CT scan done indicated no signs of bronchogenic carcinoma.


A 30 year old lady with carcinoma of lung was on chemotherapy with severe adverse reactions like weakness, vomiting, and oral ulcers. Her lesion was found to be chemo resistant. She is under Mahoshadha Kalpa treatment since one year.

Her symptoms like cough and breathlessness have considerably reduced; adverse effects of chemotherapy has subsided. There are no signs of metastasis.


A60 year old male patient, a diagnosed case of bronchogenic carcinoma (post-operative and chemo resistant) approached with the complaints of cough with haemoptysis, dyspnea and general debility.

He is also a known case of Type II Diabetes mellitus. His complaints like haemoptysis, cough and dyspnea drastically reduced in a month’s treatment.

He became almost asymptomatic after the treatment for about 12 months. CT scan of lungs indicated no signs of carcinoma. He is continuing the treatment since 7 years.


A diagnosed case of carcinoma of oesophagus and hard palate approached for treatment under Mahoshadha Kalpa. He had the complaints of dysphagia, loss of appetite, loss of taste, general debility, and cough with whitish sputum.

During the course of treatment his cough was substantially reduced, appetite improved and taste sensation is slightly better. USG of abdomen did not show any signs of metastasis.

Follow up endoscopy indicated no signs of carcinoma.

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