Thursday, January 8, 2015

Ideal Medical Therapeutic System

As per the article published on 6th june 2014 in nagpur today with the heading,

Homoeopathy docs wage wordy war on IMA for opposing Allopathy practice, bitter words

The proposed move by Maharashtra Government to allow Homoeopathy and Ayurvedic doctors practice Allopathy in the State of Maharashtra has triggered a war of words between the practitioners of medicine. The volcanic words used by Indian Medical Association (IMA) Maharashtra while condemning the move have left the Homoeopathy doctors baying for IMA’s blood. The words “Homeopathic doctors are half educated” have hit the alternate branch doctors where it hurts. Subsequently, letters of hard words have started flying with Homoeopathy doctors taking the IMA head on and trying to show their esteemed place in the medical field. 
While talking to Nagpur Today, Dr Arun Shukla, a Homoeopath, minced no words in criticizing the IMA which had sent a letter to Maharashtra Government protesting the move to allow Homoeopathy and Ayurvedic doctors practice Allopathy. Dr Shukla said, “While I respect and understand IMA’s legitimate right to protest against Maharashtra Government decision to allow homoeopathic practitioners to take a one year course in allopathic pharmacology, may I suggest some more effective ways of protest. 
Today IMA doctors may go and take charge of hundreds of PHCs across rural Maharashtra that have not seen a doctor for past many years. The people who are used to being treated by nurses and midwives will actually see the face of a real 24 carat Doctor and not a so called quack whom they routinely visit for their medical needs. The IMA is very fond of discussing various health indices and ratios and statistics inside AC conference halls in cities over 5-course lunch or dinner. But here you will get a real glimpse of malnutrition, infant mortality, maternal mortality, common easily treatable infectious diseases, tuberculosis, diarrhoea, the list is endless. All these are presently managed by the so called quacks. The Health Minister of Maharashtra had famously wept on the floor of the Assembly while saying very few MBBS doctors are willing to go to rural areas. IMA knows that there is a quota of 25 percent for BAMS doctors in PHCs and the rest are practically headless. But this is rural India a land alien to IMA,” said Dr Shukla with anger writ large on his face. 
Dr Arun Shukla further said, “Let us talk about urban scenario which is where IMA’s Allopathy doctors are concentrated. Even in our cities 50% poor and low middle class population depends upon the so called quacks as they cannot afford IMA’s fees and Government health facilities are not geared up to cater to all. There is a growing trend among MBBS graduates to go for specialization. Nothing wrong. But that does not bring family physicians into the system who are an important part of our health system for 100 years. And the Allopathy consultants are simply not affordable for urban masses for routine ailments. The last government medical college was started 23 years back and the state population has increased by 30 million since then. And all new colleges are private. We all know how affordable their fee structure is and on top of that the 20% management quota. Can IMA honestly aver that merit is not compromised here? The poor and middle class students who miss out narrowly in government medical colleges go on to qualify from alternative systems and the rich with no merit get into the private colleges,” asserted the Homoeopathy doctor. 
“But the IMA doctors do not protest these vagaries as it serves them to put their children into medicine with less merit and perpetuate the dynasty as we saw recently,” stated Dr Shukla sarcastically. 
Similarly, Dr Pradeep Bagal and Dr Raj Pandey, both Homoepaths, forwarded an identical letter to Nagpur Today which they have sent to IMA, too. The letter said, “It’s very pain giving experience to all homeopathic doctors in Maharashtra about news by IMA officials. They said that homeopathic doctors are half educated. We want to focus on few things as below: 
1) We have studied all subjects during our college except pharmacology (which is there in MBBS syllabus).
2) Govt is exactly giving us a course of one year of the same subject, which we haven’t studied so far. Course exam will be conducted by MUHS. Allopathy practice will be allowed only to the candidates, who will pass the exam, to a certain extent only.
3) We BHMS fellows have completed 5 1/2 year course, similar to MBBS.
4) Syllabus of BHMS includes following subjects: Anatomy, Physiology, Forensic Medicine and Toxicology, Preventive and Social Medicine, Parasitology, Biochemistry, Pathology, Microbiology, Medicine (only modern medicine subject Pharmacology is not under our syllabus). Passing limit for all subjects is 50% same as that of MBBS. 
The IMA can confirm above syllabus. Hope you will throw light upon Truth,” said Dr Bagal and Dr Pandey. 
However, a Homoeopathy doctor has toed the IMA line and strongly protested the Government move to allow Homoeopathy and Ayurvedic doctors practice Allopathy in the State of Maharashtra. Dr Anuprita Bhadage, while talking to Nagpur Today, said, “A bus driver cannot become an aircraft pilot just by sitting in cockpit. Maharashtra Government must direct Homoeopathy doctors to appear for Entrance Test for full Allopathy subjects like Anatomy, Physiology, Forensic Medicine and others. There should not be easy options. A course of one year of the same subject would do more harm. Half knowledge is more dangerous than no knowledge. It is a matter of life and death for patients. The Homoeopathy doctors may venture for surgery, anesthesia in future if Government move is accepted. Every expertise is for an expert. A matriculate cannot become a Collector, an IAS post. I would not allow an Allopathy doctor to practice Homoeopathy. Similarly, Homoeopaths should not be allowed to practice Allopathy,” said Dr Anuprita Bhadage. 
It may be recalled, the IMA had sent a protest letter to Maharashtra Government wherein it said, “Indian Medical Association, Maharashtra condemns the proposed move of Govt. of Maharashtra to allow Homoeopathy and Ayurvedic Doctors to practice Allopathy in the State of Maharashtra. We allopaths practicing modern medicine (Allopathy) respect all other branches of medicine namely Ayurvedic, Homoeopathy, Unani etc. We are of the opinion that the person who studies in a particular branch of medicine should practice that pathy only. We know many doctors with Homoeopathy and Ayurvedic qualifications practice using Allopathic medicines. This cross-pathy practice is illegal and many examples can be given to prove that patient badly suffered because of such malpractices. In short many long terms ill-effects has been noted like resistance developed to antibiotics because of irrational use, patient going in chronic renal failure because of long term use of some drugs etc. etc.” 
“We oppose the proposed decision to allow non allopathic doctors to practice Allopathy medicine after doing short course in Pharmacology. In spite of our representation to various concerned authorities with the respective judgments from various courts in India, Govt. has proposed this. This shall be promoting quackery and cause more harm to patients. Govt. of Maharashtra is on one side proposing CEA which promotes better and good healthcare for patients and on the other hand rather than taking effective action against the quackery, they are probably trying to legalize it.”
here i wonder, why there is such war in our medical therapeutic system??

after all, ultimately we all are having a same mission & that is to restore the sick to health, to cure, as it is termed.
isn't it??

If it is so, can't we make a single ideal medical therapeutic system, with sole aim of establishment of cure - IDEAL CURE ??

Master Hahnemann stated in,
§ 54 Sixth Edition

The allopathic method of treatment utilized many things against disease, but usually only improper ones (alloea) and ruled for ages in different forms called systems. Every one of these, following each other from time to time and differing greatly each from the other, honored itself with the name of Rational Medicine1.


Every builder of such a system cherished the haughty estimation of himself that he was able to penetrate into the inner nature of life of the healthy as well as of the sick and clearly to recognize it and accordingly gave the prescription which noxious matter2 should be banished from the sick man, and how to banish it in order to restore him to health, all this according to empty assumptions and arbitrary suppositions without honestly questioning nature and listening without prejudice to the voice of experience. Diseases were held to be conditions that reappeared pretty much in the same manner. Most systems gave, therefore, names to their imagined disease pictures and classified them, every system differently. To medicines were ascribed actions which were supposed to cure these abnormal conditions. (Hence the numerous text books on Materia Medica.3)


1 As if the establishment of a science, based only on observation of nature and pure experiment and experience idle speculation and scholastic vaporings could have a place.


2 Up to the most recent times what is curable in sickness was supposed to be material that had to be removed since no one could conceive of a dynamic effect (§ 11 note) of morbific agencies, such as medicines exercise upon the life of the animal organism.

3 To fill the measure of self infatuation to overflowing here were mixed (very learnedly) constantly more, indeed, many different medicines in so-called prescriptions to be administered in frequent and large doses and thereby the precious, easily-destroyed human life was endangered in the hands of these perverted ones. Especially so with seton, venesection, emetics, purgatives, plasters, fontanelles and cauterization.

§ 55 Sixth Edition
Soon, however, the public became convinced that the sufferings of the sick increased and heightened with the introduction of every one of these systems and methods of cure if followed exactly. Long ago these allopathic physicians would have been left had it not been for the palliative relief obtained at times from empirically discovered remedies whose almost instantaneous flattering action is apparent to the patient and this to some extent served to keep up their credit.

§ 56 Sixth Edition

By means of this palliative (antipathic, enantiopathic) method, introduced according to Galen's teaching Contraria contrariis for seventeen centuries, the physicians hitherto could hope to win confidence while they deluded with almost instantaneous amelioration. But how fundamentally unhelpful and hurtful this method of treatment is (in diseases not running a rapid course) we shall see in what follows. It is certainly the only one of the modes of treatment adopted by the allopaths that had any manifest relation to a portion of the sufferings caused by the natural disease; but what kind of relation? Of a truth the very one (the exact contrary of the right one) that ought carefully to be avoided if we would not delude and make a mockery of the patient affected with a chronic disease1.


1 A third mode of employing medicines in diseases has been attempted to be created by means of Isopathy, as it is called - that is to say, a method of curing a given disease by the same contagious principle that produces it. But even granting this could be done, yet, after all, seeing that the virus is given to the patient highly potentized, and consequently, in an altered condition, the cure is effected only by opposing a simillimum to a simillimum.

To attempt to cure by means of the very same morbific potency (per Idem) contradicts all normal human understanding and hence all experience. Those who first brought Isopathy to notice, probably thought of the benefit which mankind received from cowpox vaccination by which the vaccinated individual is protected against future cowpox infection and as it were cured in advance. But both, cowpox and smallpox are only similar, in no way the same disease. In many respects they differ, namely in the more rapid course and mildness of cowpox and especially in this, that is never contagious to man by more nearness. Universal vaccination put an end to all epidemics of that deadly fearful smallpox to such an extent that the present generation does no longer possess a clear conception of the former frightful smallpox plague.

Moreover, in this way, undoubtedly, certain diseases peculiar to animals may give us remedies and thus happily enlarge our stock of homoeopathic remedies.
But to use a human morbific matter (a Psorin taken from the itch in man) as a remedy for the same itch or for evils arisen therefrom is - ?
Nothing can result from this but trouble and aggravation of the disease.


In order to carry into practice this antipathic method, the ordinary physician gives, for a single troublesome symptom from among the many other symptoms of the disease which he passes by unheeded, a medicine concerning which it is known that it produces the exact opposite of the morbid symptom sought to be subdued, from which, agreeably to the fifteen - centuries - old traditional rule of the antiquated medical school (contraria contrariis) he can expect the speediest (palliative) relief. He gives large doses of opium for pains of all sorts, because this drug soon benumbs the sensibility, and administers the same remedy for diarrhoeas, because it speedily puts a stop to the peristaltic motion of the intestinal canal and makes it insensible; and also for sleeplessness, because opium rapidly produces a stupefied, comatose sleep; he gives purgatives when the patient has suffered long from constipation and costiveness; he causes the burnt hand to be plunged into cold water, which, from its low degree of temperature, seems instantaneously to remove the burning pain, as if by magic; he puts the patient who complains of chilliness and deficiency of vital heat into warm baths, which warm him immediately; he makes him who is suffering from prolonged debility drink wine, whereby he is instantly enlivened and refreshed; and in like manner he employs other opposite (antipathic) remedial means, but he has very few besides those just mentioned, as it is only of very few substances that some peculiar (primary) action is known to the ordinary medical school.


If, in estimating the value of this mode of employing medicines, we should even pass over the circumstance that it is an extremely faulty symptomatic treatment (v. note to § 7), wherein the practitioner devotes his attention in a merely one-sided manner to a single symptom, consequently to only a small part of the whole, whereby relief for the totality of the disease, which is what the patient desires, cannot evidently be expected, - we must, on the other hand, demand of experience if, in one single case where such antipathic employment of medicine was made use of in a chronic or persisting affection, after the transient amelioration there did not ensue an increased aggravation of the symptom which was subdued at first in a palliative manner, an aggravation, indeed, of the whole disease? And every attentive observer will agree that, after such short antipathic amelioration, aggravation follows in every case without exception, although the ordinary physician is in the habit of giving his patient another explanation of this subsequent aggravation, and ascribes it to malignancy of the original disease, now for the first time showing itself, or to the occurrence of quite a new disease1.
1 Little as physicians have hitherto been in the habit of observing accurately, the aggravation that so certainly follows such palliative treatment could not altogether escape their notice. A striking example of this is to be found in J. H. Schulze's Diss. qua corporis humani momentanearum alterationum specimina quoedam expenduntur, Hale, 1741, § 28. Willis bears testimony to something similar (Pharm. rat., § 7, cap. I, p.298): Opiata dolores atroscissimos plerumque sedant atque indolentiam - procurant, camque - aliquamdiu et pro stato quodam tempore continuant, quo spatio elapso dolores mox recrusescunt et brevi ad sol itam ferociam augentur. And also at page 295: Exactis opii viribus illico redeunt tormina, nec atrocitatem suam remittunt, nisi dum ab eodem pharmaco rursus incantuntur. In like manner J. Hunter (On the Venereal Disease, p.13) says that wine and cordials given to the weak increase the action without giving real strength, and the powers of the body are afterwards sunk proportionally as they have been raised, by which nothing can be gained, but a great deal may be lost.

§ 53 Sixth Edition

The true mild cures take place only according to the homoeopathic method, which, as we have found (§§ 7-25) by experience and deduction, is unquestionably the proper one by which through art the quickest, most certain and most permanent cures are obtained since this healing art rests upon an eternal infallible law of nature.
The pure homoeopathic healing art is the only correct method, the one possible to human art, the straightest way to cure, as certain as that there is but one straight line between two given points.

Take Care Of Your Body,

It's The Only Place You Have To Live In.

With Best Regards, Karnav Thakkar :) :)

Thursday, January 1, 2015

Cardiovascular Examination

Introduction :-

The Cardiovascular examination is a portion of the physical examination that involves evaluation of the cardiovascular system.
  • Some portions of the examination may be best performed while sitting up (such as a neck bruit), while other portions may be best performed while lying back at a 30- or 45-degree angle (such as hepatojugular reflux.) Some portions (such as the heart sounds) may be evaluated in both positions, while others (such as the carotid artery auscultation) may be done in either.
  • Certain conditions can be identified upon inspection.

Phrases in the write-up can include:
More detailed notes may mention heaves and bruits. Peripheral pulses may be included in a cardiovascular system or in a "Extremities" section.

Heart Rate :-



Heart Sounds :-


Murmurs, Rubs & gallops :-


Point of maximal Impulse :-


Take Care Of Your Body,

It's The Only Place You Have To Live In.

With Best Regards, Karnav Thakkar :) :)

Thursday, December 25, 2014

Respiratory Examination




Introduction :-

In medicine, the respiratory examination is performed as part of a physical examination, or when a patient presents with a respiratory problem (dyspnea (shortness of breath), cough, chest pain) or a history that suggests a pathology of the lungs. It is very rarely performed in its entirety or in isolation, most commonly it's merged with the cardiac examination.


The respiratory exam has conventionally been split into different stages:
  • Position of the patient and the environment.
  • Inspection of the patient and respiratory effort.
  • Palpation of the patient's anterior and posterior chest.
  • Percussion of the patient's anterior and posterior chest walls.
  • Auscultation of the patient's anterior and posterior chest walls.
One method to remember the steps of the examination is through the mnemonic PIPPA.
When accompanying other physicians or students, medical staff typically report as they examine a patient. Examples of a normal examination may include:
  • adjustment of environment
  • "on inspection, effort is normal"
  • "no tenderness to palpation", "fremitus WNL"
  • "clear to percussion bilaterally" or "CTP B"
  • "clear to auscultation bilaterally" or "CTA B"; "no R/R/W" or "no rhonchi, rales or wheezes"

Positioning and Environment :-
  • In the respiratory examination, the patient is asked to sit upright on an examination table, with arms at the side. Adequate lighting is ensured, and the patient is asked to expose the chest. Later in the examination, when the back is examined, the patient is usually asked to move the arms forward so that the scapulae are not in the way of examining the upper lung fields. These fields are intended to correlate with the lung lobes, and are thus tested on the anterior and posterior chest walls (the front and back of the patient's thorax).
Inspection:-

The examiner then observes the patient's respiratory rate, which is typically conducted under the pretext of some other exam, so that patient does not subconsciously increase their baseline respiratory rate. Signs of respiratory distress may include:
  • Cyanosis, a bluish tinge of the extremities (peripheral cyanosis), or of tongue (central cyanosis).
  • Pursed-lip breathing
  • Accessory muscle use,including the scalene and intercostal muscles.
  • Diaphragmatic breathing, paradoxical movement of the diaphragm outwards during inspiration.
  • Intercostal indrawing.
  • Decreased chest-chest movement on the affected side.
  • An increased Jugular venous pressure, indicating possible right heart failure
Chest wall abnormalities are also examined, and may include:
  • Kyphosis, abnormal anterior-posterior curvature of the spine
  • Scoliosis, abnormal lateral curvature of the spine
  • Barrel chest, - chest wall increased anterior-posterior; normal in children; typical of hyperinflation seen in COPD
  • Pectus excavatum - sternum sunken into the chest
  • Pectus carinatum - sternum protruding from the chest
As well as the patient's respiratory rate, the pattern of breathing is also noted:
  • An acidotic patient will have more rapid breathing to compensate, known as Kussmaul breathing.
  • Cheyne–Stokes respiration, which is alternating breathing in high frequency and low frequency from brain stem injury. It can be seen in newborn babies which is sometimes physiological (normal). Also observe for retractions seen in asthmatics. Retractions can be supra-sternal, where the accessory muscles of respirations of the neck are contracting to aid inspiration. Retractions can also be intercostal, in which there is visible contraction of the intercostal muscles (between the ribs) to aid in respiration. These are signs of respiratory distress.
The physician then typically inspects the fingers for cyanosis and clubbing.
Tracheal deviation is also examined.

Palpation:-

The physician then places both palms on the posterior lung fields, asking the patient to count 1 to 10. The physician aims to feel for vibrations and compare the right/left lung fields. If the patient has a consolidation, (for example caused by pneumonia), the vibration will be louder at that part of the lung. This is because sound travels faster through denser material than air.
If a patient has pneumonia, palpation may reveal increased vibration and dullness on percussion. If there is pleural effusion, palpation should reveal decreased vibration and there will be 'stony dullness' on percussion.
The examiner then tests for
  • Tracheal deviation, whether trachea is in centred or not, indicating enlargement or collapse of a lung field.
  • Tactile fremitus, with the patient asked to say boy-O-boy or ninety-nine, and the physician using the ulnar aspect of their hand to feel changes in sound conduction.
  • Respiratory expansion, indicating whether lung expansion is equal.
  • the position of the apex beat to check if there has been deviation of the heart.

Percussion:-

The physician attempts to examine changes in density of the lung fields by examining its resonance.
Specifically, percussion is performed with the middle finger striking the middle phalanx of the other middle finger of the other hand. The sides of the chest are compared. This is performed symmetrically on all lung fields, on the anterior and posterior chest walls.
Examples of alterations in density may include pleural effusion and pneumothorax. The sound is described as tympanic if there is a pneumothorax because air will stretch the pleural membranes. Conversely, if there is fluid between the pleural membranes, the percussion will be dampened and sound muffled.

Auscultation:-

 The physician then auscultates the respiratory sounds over the lung fields, listening to the fields through a stethoscope. This is conducted while the patient is breathing, noting normal breath sounds and any abnormalities including:
  • Wheezes, describing a continuous musical sound on expiration or inspiration. A wheeze is the result of narrowed airways. Common causes include asthma and emphysema
  • Rhonchi (an increasingly obsolete term) characterised by low pitched, musical bubbly sounds heard on inspiration and expiration. Rhonchi are the result of viscous fluid in the airways.
  • Crackles or rales. Intermittent, non-musical and brief sounds heard during inspiration only. They may be described as fine(soft, high-pitched) or coarse (louder, low-pitched). These are the result of alveoli opening due to increased air pressure during inspiration. Common causes include congestive heart failure.
  • Stridor a high-pitched musical breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is not to be confused with stertor. Causes are typically obstructive, including foreign bodies, croup, epiglottitis, tumours, infection and anaphylaxis.
  • Appropriate ratio of inspiration to expiration time (expiration time increased in COPD)
  • Bronchial or vesicular breath sounds.
Lastly an assessment of transmitted voice sounds is performed.

Differential Diagnosis Of Respiratory Diseases :-









Take Care Of Your Body,

It's The Only Place You Have To Live In.

With Best Regards, Karnav Thakkar :) :)

Thursday, December 18, 2014

Abdominal Examination

Introduction :-
The abdominal exam, in medicine, is performed as part of a physical examination, or when a patient presents with abdominal pain or a history that suggests an abdominal pathology.
The abdominal exam has conventionally been split into different stages:
  • Positioning of the patient and their environment.
  • Inspection of the patient and their anterior and posterior abdomen.
  • Auscultation of the abdomen with a stethoscope.
  • Palpation of the patient's abdomen and its organs.
  • Percussion of the patient's abdomen.
  • Special tests inspecting for signs of various liver diseases.
When accompanying other physicians or students, medical staff typically report as they examine a patient. An example normal examination may include:
  • adjustment of environment
  • "on inspection, the abdomen is non-distended and there are no signs of liver disease"
  • "bowel sounds are present"
  • "the abdomen is soft and non-tender, with no organomegaly"
  • "no rebound tenderness"
Positioning and Environment :-
  • Position is patient should be supine and the bed or examination table should be flat. The patient's hands should remain at his/her sides with his/her head resting on a pillow. If the neck is flexed, the abdominal musculature becomes tensed and the examination made more difficult. Allowing the patient to bend his/her knees so that the soles of their feet rest on the table will also relax the abdomen.
  • Lighting is adjusted so that it is ideal.
  • Draping is patient should be exposed from the pubic symphysis below to the costal margin above - in women to just below the breasts. Some surgeons would describe an abdominal examination being from nipples to knees.
  • Although physicians have had concern that giving patients pain medications during acute abdominal pain may hinder diagnosis and treatment.

Inspection:-

The abdominal exam typically begins with the examiner inspecting the patient, paying particular attention to any signs of liver disease. These signs (stigmata) may include
The patient is also examined for:

Auscultation:-

  • Auscultation refers to the use of a stethoscope by the examiner to listen to the abdomen.
  • Auscultation is performed prior to palpation of the abdomen as it is least likely to elicit pain.
  • The doctor warms the diaphragm of the stethoscope, and listens to the bowel sounds. Some controversy exists as to the length of time required to confirm or exclude bowel sounds, with suggested durations up to five minutes. Bowel obstruction may present with grumbling bowel sounds or high-pitched noises. Absence of sounds may be caused by peritonitis.
  • The examiner also typically listens to the two renal arteries for bruits by listening in each upper quadrant, adjacent to and above the umbilicus. Bruits heard in the epigastrium that are confined to systole are considered normal.

Percussion:-

 

Percussion is performed by knocking the middle finger against the phalanx of the middle finger of the opposing hand, which rests against the surface of the abdomen in each of the nine areas tested. Percussion can elicit a painful response in the patient, and may also reveal whether there is abnormal levels of fluid in the abdomen. Organomegaly may also be noted, including gross splenomegaly (enlargement of the spleen), hepatomegaly (enlargement of the liver), and urinary retention.
The examiner, when percussing for organomegaly, percusses in a particular manner:
  • percuss the liver from the right iliac region to right hypochondrium
  • percuss for the spleen from the right iliac region to the right hypochondrium and the left iliac to the left hypochondrium.
Examination of the spleen

Palpation:-

The examiner typically palpates all nine areas of the patient's abdomen. This is typically performed twice, lightly and then deeply.
On light palpation, the examiner tests for any palpable mass, rigidity, or pain.
On deep palpation, the examiner is testing for and organomegaly, including enlargement of the liver and spleen.
Reactions that may indicate pathology include:
  • guarding, describing muscle contraction as pressure is applied.
  • rigidity, indicating peritoneal inflammation.
  • rebound, pain on release
  • hernial orifices if positive cough impulses.

Other & Special Maneuvers:-


  • Examination of pelvic lymph nodes
  • Digital rectal exam - Abdominal examination is not complete without a digital rectal exam.
  • Pelvic examination only if clinically indicated.
Special manevures may also be performed, to elicit signs of specific diseases. These include





Take Care Of Your Body,

It's The Only Place You Have To Live In.

With Best Regards, Karnav Thakkar :) :)