An estimated of 10 percent or more children snore for more than 1 night. Snoring results from the obstruction of breath when the air makes its way through the mouth. The air passage of the throat through which the air goes in and out causes the tissue to vibrate causing snore. The sound of the snore totally depends on the amount of air passing through the mouth and the frequency at which the throat is vibrating. Children above the age of three years tend to snore when they are deep in sleep.

Primary and secondary snoring:
Children who are otherwise healthy should not have a snoring problem unless there is some health disorder. However, if loud snoring is observed in otherwise a perfectly healthy kid, seeking medical help is a wise thing to do. In general, primary snoring is defined as a condition which is not associated with other sleep-related disorders such as lung disorder, OASS, inability to sleep for a longer duration etc.

Other possibilities:
It is estimated that close to three percent of the children suffers from breathing problem while sleeping. OSAS is a condition which is characterised by pauses in breathing and gasps along with loud snores. There could be instances where a kids  muscle relaxes way too much obstructing the air to pass through. The body and the brain are both alerted at this stage. As soon as the brain sends a signal, the body wakes up. Thus, most kids suffering from this disorder are not able to sleep well and tend to feel tired throughout the day.

Common causes of sleep apnea:
Sleep apena is a major cause of snoring. It can be caused because of allergies, obesity, GERD etc. In children sleep, apnea can also be caused by tonsil. Since the tonsil size of children less than 7 years of age tends to be bigger than adult individuals, it causes snoring related problem. Swollen tonsils not only obstruct air but creates other health related problems as well.

Symptoms of sleep apnea during the day and night:

Loud snore
Snorts, gasps, pauses during sleep
Heavy sweat during sleep
Social and behavioural problems
Failure to get up in the morning
A nasal voice
Easily irritated, cranky and aggressive
Relief measure:
The first thing a that a doctor does is a physical exam followed by observing the symptoms of a kid. Primary snorting can be addressed by physical exercise, counselling and breathing exercise. Problems related to apnea are addressed through medicine, counselling, and exercise. Certain dietary restrictions also needed to be followed during this time. However, apena is completely treatable within a certain time frame.

Mouth Breathing - What Can Cause It?

Dysentery is the inflammation of the intestine that causes appearance of blood and mucous in stool. It is caused by bacteria or parasites. In this condition, the patient passes semi liquid stool many times in a day. It is a contagious disease and is transmitted via the faecal oral route. Thus, a group of people like a family living together or students in a hostel are more prone to picking up the infection. This infection is also transmitted via anal sex. 

Ayurveda is a herbal medicinal treatment, originated in India. It is known to have cure for various health problems. Usually Diarrhoea cures itself through diet change, but in case of dysentery, medication is required to combat bacteria and parasites. Some ways to treat Dysentery with Ayurvedic remedies are as follows:

Isabbael for Chronic Amoebiasis: Isabbael is a formulation that treats dysentery caused due to Amoebiasis. When the stool contains mucus and the infected patient feels a cramp before passing stool, it is considered an Amoebiasis infection. Isabbael is very good for bacillary dysentery as well. It is advised to consume 1 teaspoonful twice daily with water for 5 to 7 days for best results. 
Ambimap for dysentery: Ambimap herbal formulation possesses a multi-purpose approach to control and cure dysentery (Pravahika). It is known to treat and cure all types of parasitic infection and provides immediate relief. For best results, 1 or 2 tablets should be taken 2 to 3 times a day with water.
Churna for dysentery: Churna is a polyherbal Ayurvedic medicine in powdered form and is high beneficial in treating dysentery.
You can also opt for Ayurvedic remedies that can be formulated at home. They are as follows:

Combine powdered dry ginger root, amla powder, long and black pepper in equal proportions. It is advisable to store this dry mixture in a glass container. For best results, consume one teaspoon of this mixture with lukewarm water two times a day. 
Another great way to combat dysentery is to drink buttermilk. Just add a bit of rock salt as well as powdered roasted cumin seeds. Drink this mixture two times a day preferably with breakfast and at lunchtime. 

Dysentery - 3 Ayurvedic Home Remedies to Help Treat it 

How To Take Care Of Nail Health 

Nails significantly reveal about your overall health.When well taken care of, nails not only look good but they also help you stay healthy.
Follow these tips for a shining nails.
1. Moisturize - Use a Hand-Nail cream regularly to avoid ragged cuticles and flakey skin. Moisture keeps your nails in a good shape.

2. Mild Soaps - Use specially formulated hand foams to wash your hands. Certain anti-bacterial soaps can strip away layers of essential oils from your skin, thus leaving your palms dry and even itchy.

3. Massage - Massage your cuticles regularly. This will help improve blood circulation to the tips as well as stimulate the entire nervous system promoting the growth of strong and healthy nails.

4. Manicure - Treating your hands once a month to a relaxing manicure is an excellent idea. Not only do your nails end up looking fabulous but the additional TLC will go a long way in ensuring that your hands don’t look twice their age. Scrubbing off the dead cells, applying a ‘hand mask’ and then some relaxing massage as you close your eyes to some soothing music, is just what ‘nail therapy’ is all about.

5. Maintain - It’s a common knowledge that the skin on our hands tends to age quicker as it is often left exposed to the elements such as the harsh sun or extreme winters. To maintain your manicured nails, use a sunscreen regularly and wear gloves in the winters and even while going about household chores such as doing the dishes or mopping the floor.

If you would like to consult with me privately, please click on 'Consult'.

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 Are Your Nails Telling Others About Your Health?

How to diagnose asthma in children

Asthma in children under the age of 5 is a matter of concern. It is not a rare disease and early diagnosis is important. Common signs of asthma in children are:

1. Recurring bronchitis
2. Wheezing
3. Discomfort in the chest
4. Coughing
5. Trouble breathing

While some children have persistent yet mild symptoms, some children have severe attacks at times. Seasonal allergies and smoke make the symptoms worse.

What to notice?
While feeding an infant, if you notice that your child is facing shortness of breath, it might be a symptom of asthma. In a toddler, if your notice a decreased desire to run and play, or easy fatigue, then this could be a symptom of asthma. Asthma attacks for many children under the age of 5 are worsened when they catch cold or have any other respiratory infections. All these, if noticed should not be ignored and your child's pediatrician should be consulted.

The above mentioned symptoms were mild. Some children have it worse and the attacks can be life-threatening, needing immediate treatment. If your child is under the age of 5 and you see them doing one of the following, contact emergency services immediately:

1. Trouble in speaking because they have restricted breathing
2. When they are breathing in, the effort is so much that the abdomen is getting sucked in
3. Gasping for air.

Diagnosing asthma in a child can be tricky as symptoms like coughing, wheezing, etc can be for other conditions also. Once a child is a little older and if the symptoms persist, breathing and lung function tests are taken to gauge the situation. 

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How To Diagnose Asthma In Children, Before It Attacks?

Hepatitis C is a Viral Infection That is Little Talked About, But Can Be As Dangerous As Hepatitis B

Most people have head or what became in the 1980s and '90s the dreaded AIDS virus. With time and the availability of medicines, it ceased to be a killer. However, the knowledge of it helped stem its spread. Most people, unfortunately, don't realize that hepatitis C is also a killer, simply because not much has been said about it. In fact, it is also a virus, but is 10 times more infectious than HIV.

Hepatitis C is transmitted through the blood, and is usually passed on to women through infected needles and sex. At-home glucometers are often shared, or sometimes a woman's own lifestyle or her partner's lifestyle before marriage may put her at risk, because the virus can stay in the blood for years. It is also transmitted through blood products, like in the case of a transfusion, though in the case of pregnant women, this is not so common.

The dangers
The virus affects 1 in every 100 people in India, while globally 180 million are infected with it. Sometimes, it may just pass through the body, like many other viruses do, but sometimes, it can remain. If detected quickly, within six months or so, cure rates are high. the problem is that it is often not easy to detect, as symptoms resemble those of a regular seasonal viral infection: fatigue, nausea, loss of appetite. If it remains in the body, becoming chronic, then it may progress to liver disease. But the hepatitis C virus (HCV) doesn't have to be a killer. You can conquer it with these moves. 

What you should do before
A number of couples who come to me have planned pregnancies-they opt for a baby, rather than the baby just 'happening' to them. This not only helps family planning, but it also helps us rule out infections or treat them if present. Usually, in the first trimester, your gynecologist will ask you to do a simple blood test for HIV, hepatitis B and C. In the case of a planned pregnancy, visit your doctor beforehand and ask if you need to take these tests before you conceive. However, there is no vaccine for HCV yet.

What you should do after
If a woman find out in the first trimester that she is hepatitis C positive, there's nothing much that can be done, as anti-viral medications cause birth defects, so a mother can only be put on them after delivery. She is advised to continue the pregnancy. A baby's chance of acquiring the infection in utero is between 5 and 7%. While this is not high, parents may like to avoid the risk. However, co-infection with HIV (if the mother is HIV positive) pushes the risk up to 19.4%. The pregnancy itself will not be hampered by the HCV infection. Nor does the risk of transmission to the child have anything to do with the mode of delivery-either vaginal or C-section. In India, there is little data on HCV transmission from mother to child. However, once the baby is born, the pediatrician may not do an immediate test to check for the virus, as it generally clears out from the baby's system in a year or so. Testing may only be done at 18 months.

Hepatitis C: Can Be as Dangerous as Hepatitis B

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

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