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Sep02
Diaphragmatic Pacing
Patients with chronic apnea, either due to cervical spine trauma or diseases, such as ALS, may benefit from Diaphragmatic Pacing.

Improvement in the quality of life has been demonstrated in these patients by delaying the need for mechanical ventilation and decreasing the incidence of pulmonary infections.

Phrenic nerve stimulation or direct diaphragmatic stimulation are preformed via implanted electrodes connected to a radiofrequency receiver which receives radio signals from an external transmitter.

Candidates for phrenic nerve stimulation must have intact phrenic nerve cell bodies, therefore patients with lower motor neuron diseases, such as ALS or damage to the cervical spine bellow C2, may be treated with direct diaphragmatic pacing only.

The electrodes are placed using minimally invasive surgical techniques. Phrenic nerve pacers are placed using cervical or thoracic approaches. Diaphragmatic pacers are placed laparascopically at diaphragmatic motor points, attachment points of the phrenic nerve on the diaphragm. These points are mapped using specialized computer software.

This procedure was developed at University Hospitals Case Western Medical Center. Patients include Christopher Reeves, who suffered a cervical spine injury following a riding accident leaving him quadriplegic and respirator dependent.

Reeves: "“The constant and high cost of care for ventilator-dependent patients not only exhausts most insurance policies but contributes to strain on families and caregivers. Once this procedure receives FDA approval, these patients and their caregivers should be able to achieve significant improvements in their quality of life.”

This procedure has been FDA approved since 2008 and is now gaining worldwide accreditation for its role in ICU patient rehabilitation.


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Feb17
Lung cancer
Lung cancer has emerged as no one cancer in men in metros. The major reason being smoking.The incidence and prevalence is going to be higher and higher.
mangement of lung cancer has become extremely important and involves lot of skill. early stage lung cancer is operable,but we see less than 5% operable cancers. so our major problem is advnanced or localy advanced cancer. The management of this disease involves extremely skilled choice of drugs .What is more important is navigation between different lines of treatment.Multiple group of drugs are available but unless they are used in appppropirate fashion we can get best out o fthem Important factors are histopathology, status of the patient. For example if is adenocarcinoma one can start with pemetrexed. But for non adenocarcinoma the drug of choice would be gemcitabine carboplatin.One can think of targeted drugs but again in select group.


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Aug22
Simultaneous involvement of larynx and middle ear in pulmonary tuberculosis
Case report "Simultaneous involvement of larynx and middle ear in pulmonary tuberculosis" By dr Khan, dr Parab & dr Ghaisas is published in international Journal The Laryngoscope. The link is :
http://onlinelibrary.wiley.com/doi/10.1002/lary.21029/abstract


http://onlinelibrary.wiley.com/doi/10.1002/lary.21029/abstract

Simultaneous involvement of larynx and middle ear in pulmonary tuberculosis - Parab - 2010 - The Lar
onlinelibrary.wiley.com
Parab, S. R., Khan, M. M. and Ghaisas, V. S. , Simultaneous involvement of larynx and middle ear in pulmonary tuberculosis. The Laryngoscope, n/a. doi: 10.1002/lary.21029


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Jul28
Helping asthma patients breathe easily with homoeopathy
If you or a family member has asthma, you know how frightening an asthma attack can be. Being diagnosed with asthma doesn’t mean an end to an active, healthy lifestyle. The truth is, although asthma is a serious and chronic illness, it’s also a very manageable one. “Asthma shouldn’t keep people from daily activities like taking the kids to the park, bringing the groceries up the stairs or walking at a shopping mall.” When you have asthma, the airways in your lungs, called bronchial tubes, become inflamed and swollen. These narrowed passageways cause coughing, wheezing, chest tightness and shortness of breath. Some people suffer only mild symptoms while others have such severe attacks, the results can be fatal. Unfortunately, adult asthma sometimes goes undiagnosed until an emergency arises. That’s because the symptoms of asthma can be easily confused with other illnesses, mainly respiratory infections, allergies and bronchitis. But any time you experience a cough that won’t go away, a cough that keeps you up at night, wheezing, tightness in the chest or shortness of breath, you should see a doctor. These are all possible symptoms of asthma. As far as what triggers an asthma episode or attack, the list of possibilities is long. Some of the most common asthma triggers are: colds and flu, cigarette smoke, air pollution, allergens (such as pollen, grasses, molds, dust), pet dander and saliva, changes in temperature or cold air, cockroach particles, exercise and physical activity, strong smells, such as fragrances, deodorizers, candles, paints, gas and propane. In orthodox system, there is no cure for asthma, but there are different types of medicines that will help to keep it under control and relieve symptoms, leaving aside lot of side effects. These are given in the form of various broncho – dilator medicines or in the form of anti – inflammatory steroids, which are only preventing medicines. Other type of medicine can be given in the form of tablets together with steroids. The very significance of the homoeopathy treatment is to ‘treat the patient as a whole’ or ‘patient as a person’ which is directed to heal the body – mind system from within. The constitutional treatment help the body’s own healing mechanism, enhances body’s self – recovery capacity hence leading to a long-term cure. Every patient of Asthma is evaluated as an individual case and treated as such. Therefore, APPLE CLINIC aims at not only relieving symptoms but at also re – integrating your life to normalcy.
Apple Clinic
S.C.O. 258,1ST FLOOR, SECTOR 44-C, CHANDIGARH
Ph.-0172-5049975,9915235141


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Jul06
BATTLE
Many clinical research groups have studied the possibility that cancer therapy can be selected on the basis of specific mutations suspected of driving cancer growth, but the new initiative, called BATTLE (Biomarker-integrated Approaches of Targeted Therapy for Lung cancer Elimination), is testing the hypothesis with a high degree of rigor. In BATTLE, molecular features of the tumor entirely drive the treatment selection.The basis is to stop looking at drugs and start looking at the individual tumors.The traditional way has been a retrospective analysis of tissue samples to stratify response rates by tumor characteristics.The new way is to base therapy on the tissue characteristic of the biopsy taken at diagnosis.It is a very important study which shows that it is possible to collect tissue and evaluate it for biomarkers in a time frame, that is acceptable for directing therapy.


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Mar05
SNOARING IN OBESITY: IS THERE ANY INVOLVEMENT OF CARDIA?
Here is a case review which will show the effects of obese individual who snores and wakes up in the night with history of so called sleep apnea. This is the case diagnosed and treated by us in our hospital, in fact the PFT and all could not be done due to untoward reasons, this was purely a clinical diagnosis.
CASE:
A sixty year old male came to ICCU with complains of generalized swelling and mild breathlessness since he has got generalized swelling, the duration of these complaints lasts from last 15 days, and retention of urine since one day.
Complete History:
15 days back patient was apparently alright when he noticed swelling of both the lower limbs to start with, gradual in onset and progressive in nature, of pitting type, this gradually progressed to involve the genitalia i.e. scrotal edema seen with difficulty in voiding urine since last one day, and also involved his abdomen i.e. he noticed distension of abdomen which was insidious and progressive and has progressed to the present sate in these 15 days, associated with this generalized edema all over the body patient is experiencing mild grade of breathlessness i.e. of NYHA classification Grade II, this complains of breathlessness patient had never in the past before, there are no aggravating and relieving factors for his breathlessness.
Patient gives history of cough since last one year, productive in nature, aggravating in supine position, and disturbing patient’s night sleep, producing scanty amount of sputum. Patient is a non smoker, non alcoholic, non tobacco chewer. Patient is living sedentary life style has no work, and has never worked in any industry or factories.
Patient had similar complaints of abdominal distension and pedal edema a year back for which he was consulted in some private hospital where he was diagnosed to be having cardiac problem but the details were not revealed before patient and his relatives.
Patient is not a known case of asthma, COPD, diabetes mellitus, hypertension, and no history was elicited in favor of tuberculosis in the past neither any history suggestive of any interstitial lung disease was elicited. Patient is not on any drugs like bronchodilators, antihypertensives etc.
No history was elicited in favor of any thyroid involvement in the past, and no history was elicited suggestive of IHD or CAD.
Retrospectively when history was elicited it was reviled that, patient was very obese in the past from a long time, and used to snore at night routinely, and always used to wake up at night due to shortness of breath atleast 2 or 3 times per night, and after sometime used to sleep again, this made his nights uncomfortable and sleepless, disturbing his sleep. Due to this patient used to be very lethargic, fatigued, and all the time in day used to sleep i.e. was suffering from day time somnolence. ( This history takes us away towards the syndrome called OBSTRUCTIVE SLEEP APNEA SYNDROME). From last couple of months patient has reduced his weight.
EXAMINATION:
General examination.
A sixty year old well built conscious oriented male patient.
Pallor. Present
Icterus. Absent
Cyanosis. Both central and peripheral cyanosis present.
Clubbing. Absent
Lymphnodes. Absent
Edema. Generalized edema noted with abdominal distension,edema of genitalia, and bilateral pitting type of edema.
Vitals.
Pulse: 60 beats per minute, regular, moderate volume pulse with normal character
Blood pressure: 96/70 on presentation and later after starting treatment maintained at 110-120/70- 80.
JVP: raised.
Peripheral pulses all felt with normal character and volume.
Saturation: 84% on presentation without oxygen. On starting oxygen therapy maintained on 94-96% .
Systemic Examination:
Cardiovascular examination:
Pulse: 60 beats per minute,regular,normal character, moderate volume.
JVP: Raised.
Periphral pulses all were normal in character and regular. No abnormality detected.
Blood pressure: 96/70 on presentation, improved with treatment and maintained on 110-120/70-80.
Apex beat was noted to be shifted laterally outwards in 6th intercostal space, which was confirmed by palpation.
No pulsations were noted on precordium.
Apex beat of ill sustained nature without any thrill.
A systolic thrill felt in tricuspid area.
Palpable P2 was noted.
Chest wall appeared to be thick.
No obliteration of superficial cardiac dullness, was felt in 3rd intercostals space.
Auscultation revealed,
Soft S1 in mitral area with no regurgitant or stenotic murmur.
Pansystolic mumur in tricuspid area,harsh in nature, conducting to all over the precordium, even to the carotids.
No split of heart sounds and no gallops.
Loud P2 in pulmonary area, with conducted PSM of tricuspid regurgitation, and another mumur of severe intensity was heard i.e. an Ejection Systolic Murmur (ESM).
Conducted murmur of tricuspid regurgitation noted in aortic area with conduction even to the carotids. No signs suggestive of Aortic regurgitation and aortic stenosis were noted.

Respiratory System:
Bilateral air entry was equally noted in all lung fields bilaterally.
The only positive finding noted here was bilateral basal rales, with central and peripheral cyanosis.

Per Abdomen:
Abdomen is grossly distended, firm in consistency through out, with engorged veins over the abdomen, and slight tenderness in the right hypochondriac area.
Hepatomagaly present but could not be felt accurately due to tense abdomen.
Hernial orfices intact, edema noted over scrotum with difficulty in voiding urine.

Central Nervous System:
Clinically no neurodeficit noted.
INVESTIGATIONS:
Routine blood parameters were in normal range.
Serum creatinine and Blood urea in normal range.
Chest X- Ray showed Cardiomegaly s/o biventricular hypertrophy with more of right ventricular hypertrophy. No findings s/o COPD in CXR were noted.
ECG: RVH with First degree heart block.
DIAGNOSIS:
With history given by the patient it made us to think in line of involvement of heart as principal organ, it made us to go inline with right ventricular failure, considering the history and signs, but the exact cause was not revealed so that the diagnosis would be confirmed. But when the retrospective history was taken into account of obesity,snoaring,sleep apnea, it made us to think in the direction of so called the OBSTRUCTIVE SLEEP APNEA SYNDROME. With this we came to a specific diagnosis with a specific cause though rare but one of the major cause, and the case was diagnosed to be,
OBSTRUCTIVE SLEEP APNEA SYNDROME COMPLICATING TO RIGHT SIDED HEART FAILURE WITH CORPULMONALE WITH PULMONARY ARTERY HYPERTENSION, WITH TRICUSPID REGURGITATION, WITH COMPONENT OF LEFT VENTRICULAR FAILURE.
PICK WICKIAN SYNDROME....



“NEVER TAKE SNOARING AS A FUNNY PART PF LIFE,IT MAY TAKE OF THE LIFE IF IS NOT CONTROLLED …….SNOARING AND HEART THUS ARE RELATED TO EACH OTHER BUT ONLY IN ASPECTS OF DELETERIOUS EFFECTS.”

PICTURES OF THE 2DECHO AND COLOR DOPPLER OF THE SAME PATIENT SHOWING PULMONARY HYPERTENSION WITH RVH AND RA DILATATION WITH VERY MILD TR CAN BE SEEN IN MY PHOTO ALBUM AS I COULD NOT PUT THEM HERE.


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Jan23
Spirometry for obstructive & restrictive lung disease
Respiratory system performs functions of ventilation (V), perfusion (Q), and diffusion (DL). All respiratory function tests are based on the measurement of these functions. Spirometry measures the echanical function of the lung, chest wall, and respiratory muscles by assessing the total
volume of air exhaled from a full lung (total lung capacity [TLC]) to an empty lung (residual volume). This volume, the forced vital capacity (FVC) and the forced expiratory volume in the first second of the forceful exhalation (FEV1), should be reproducible to within 0.15 L upon
repeat efforts unless the largest value for either parameter is less than 1 L. Flow-volume loop recording is one of the dynamic ventilatory function tests. This is a safe, simple and reproducible. It is performed routinely in general practice. The shape of the flow-volume loop can differentiate between normal or abnormal lung function. Abnormalities like obstructive or restrictive lung conditions can be differentiated. Although these tests cannot give a pathological
diagnosis and assesses the mechanical functional impairment of various respiratory conditions, but they support other respiratory function tests. Moreover, they are important prognostic indicators of disease process and are commonly used to monitor drug therapy. This review explains the interpretation of flow volume curves in health and disease which will provide an
easy guide for both clinicians and physiologists.
Keywords: Spirometry, FEV1, FVC, Obstructive lung disease, Restrictive lung disease


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May20
Management of Bronchial Asthma
Shwas (Bronchial Asthma)



Introduction


The word Shwas means “difficulty in breathing”. Normally shwas word represents to Tamak shwas described in Ayurvedic texts. The feature of this disease is very similar to the disease ‘Bronchial Asthma’ mentioned in allopathic books. It is characterized by difficulty in breathing, increased breathing rate, cough with thick sputum.

Hetu (causes) – the common causes includes


Kulaj-: family history of Tamak shwas.

Food-: excess of food items like curd, milk products, and uncooked food; drinking very cold water, cold beverages etc.

Exposure to dust, smokes, breeze, air condition.
Injury to vital organs.

Anemia, respiratory tract infections.


Classification / Types

It is divided into five types; these are Mahan, Urdhva, Chinna, Tamaka & Kshudra.

Purvaroopa (prodormal symptoms)

Cough (with or without expectoration), flatulence, constipation, discomfort in chest, are some common prodromal symtoms.



Rupa (clinical Features):

Dysnoea (aggravated in lying position and relived in sitting position), momentary comfort after expectoration


Cough with cracking sound /with or without expectoration; running nose,
Loss of taste, appetite
Perspiration on forehead, dry mouth, desire for hot comforts, darkness in front of eyes.
Fever, generalised fatigue, delusion
The condition gets worsened in rainy season, windy and cloudy atmosphere. On the contrary the patients feel fresh on bright sunny day.


Sadhya - Asadhyatva (Prognosis)

Acute attacks of tamak swasa need urgent management. Otherwise it can prove life threatening also. It is considered as Yapya (incurable but manageable, persists for a long time). The chronic disease in a thin and weak person carries a bad prognosis. The disease with latest onset and no family history can show excellent prognosis by Ayurvedic medications.



Chikitsa - treatment

Shodhan-:


Snehapan-: in this mode certain medicated ghee/ oils are advised for ingestion. Usually ghee like vasa ghrita, kantkari ghrita, bharngyadi ghrita, yashtimadhu ghrita etc are used for shodhan purpose. These are administered in an increasing dosage schedule for not more than 7 days.



Swedan-: in acute stage, lukewarm mahanarayan taila mixed with saindhav salt is used for gentle chest massage, which is followed by fomentation by vapours of dashmoola decoction. It is a very effective remedy for reliving bronchospasm. Swedan by means of dry valuka pottali, hot water bag is also useful in acute cases.



Vaman-: vaman reduces the recurrence rates of asthmatic attacks



Virechan-: it is also useful mode of purification for increasing the immunity of an individual towards allergies.



Basti-: various preparations like mahanarayan taila, yashtimadhu taila etc are administered through anal route. This helps in reducing the severity of attacks.



Shaman Chikitsa -: commonly used drugs



Churna-:

Yashtimadhu + tankan
Pushkarmoola churna
Shringyadi churna
Shatayadi Churna




Aasav-:

Kanakasav Somasav
Dashmoolarishta


Bhasma -:

Abhrak bhasma
Raupya bhasma
Shrung bhasma
Suvarna bhasma
Moti Bhasma


Raskalpa-:

Brihat Vata Chintamani Rasa
Shwas-kasa chintamani rasa
Suvarna malini vasant
Shwas kuthar rasa
Nag guti


Avaleha-:


Chyavanprashavleha
Kantkari avaleha
Vasa Avaleha
Agastiprasha
Chitrak haritaki avaleha


Miscellaneous-:


Vardhaman Pimpali
Chaushati pimpli


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May18
A COMPREHENSIVE STUDY OF KAAS (Respiratory diseases) & ITS MANAGEMENT
Introduction

Respiratory Disease will afflict every human being at some time in their life. Whether it’s a cough associated with the common cold or respiratory distress associated with allergies and asthma, respiratory challenges are a constant source of irritation and misery for the afflicted.

Classical Ayurvedic Medicine categorizes respiratory challenges into two main categories. These are Kasa (cough) and Swasa ( dyspnea or difficulty breathing). From an understanding of ayurvedic knowledge, common conditions such as the common cold, asthma and bronchitis can be understood and managed. This article address the condition of kasa (cough).

Kasa (Cough)

In the Allopathic medicine, Cough are understood to be the result of either infection or irritation of the bronchial tissue and are known as bronchitis. Infectious bronchitis commonly accompanies the common cold but may occur separately and may or may not be associated with fever. Cough may be dry or productive. Irritative bronchitis is usually the result of pollutants, smoke, or chemicals and may have an allergic component.

Samprapti (Pathology)

Kasa occurs when apana vayu is obstructed resulting in an increase in upward motion. Vitiation of udana vayu propels the air upward and out of the body. Vata may however lodge in the chest, back, or head resulting in pain and repeated coughing.

All disease has its physicial origins in the digestive system. This is the site of accumulation and aggrevation of the doshas. Kasa begins with vitiation of apana vayu in the purishavaha srota (large intestine). Vata eventually overflows into circulation (raktavaha srota) and relocates to the pranavaha srota (respiratory system.) Additional doshas may mix with vata or become dominant in the pathology.

Purvarupa (Prodomal symptoms)

Cough are often preceeded by symptoms of the common cold such as a sore throat, and a decrease in appetite. Proper early management of the prodromal symptoms can prevent the onset of bronchitis.


Types of Kasa

Kasa (cough) is of five types; vata, pitta, kapha, ksataja and ksaya. Those of a vata, pitta and kapha nature represent different doshic manifestations of a cough. Ksataja type are due to chest injuries while ksaya type is due to disease that results in wasting of the bodily tissues such as tuberculosis.


Rupa (symptoms)

Cough due to vitiation of vata are called “vataja kasa”. They present as a dry cough with little mucous production. While small amounts of hard mucous may occasionally accompany a cough, the condition is for the most part dry. Examination of the mucous reveals it to be gray in color and ununctuous (not very sticky). The cough may be accompanied by a loss of voice and severe chest pain. The frequency of the cough is episodic and may occur in fits.

Cough due to pitta vitiation are called “pittaja kasa”. They present with a greater amount of mucous. Examination of the mucous reveals a yellow color and possible blood within the mucous giving it a “rusty” appearance. This latter appearance indicates that the infection has penetrated deeper in the respiratory system as is seen in pneumonia. Pittaja kasa is accompanied by fever. The cough is more continuous than that of vata type.

Cough due to kapha vitiation are called “kaphaja kasa.” They present with the greatest amount of mucous. Examination of the mucous reveals a cloudy, white color and the mucous is thick and sticky. The condition is often accompanied by a runny nose, nausea, and vomiting. Actual pain in the chest and head is mild. Kaphaja kasa is not associated with fever. Coughing is continuous.



Comparative Rupa (symptomatology) of Vataja, Pittaja and Kaphaja Kasa
Vataja Pittaja Kaphaja
Minimal mucous, hard mucous, grey in color Moderate mucous, sticky, yellow in color Large amounts of mucous, sticky, cloudy and white in color


Cough due to trauma, called “ksataja kasa” reveal a combination of symptoms related to vata and pitta types. Sputum may be red, yellow or black indicating infection and bleeding. While the mucous is abundant, it is ununctuous. Fever is probable and there may be joint pains as well. Due to trauma, blood may simulatanously appear in the urine. Cough due to trauma are described as resembling the cooing of a pigeon.

Cough due to ksaya occur with wasting disease such as tuberculosis. Tuberculosis is called “rajayaksmadi” literally the “kind of diseases” in the Ayurvedic literature. The condition results in a drying up and loss of tissue (ksaya). While vata dosha plays the most important role in this condition, the condition is sannipattika in nature (due to the vitiation of all three doshas).


Chikitsa: Treatment and Management

The management of kasa (cough) requires an understanding of the state of the patients agni, ama, and ojas as well as an appreciation of the doshic pathology present. In addition to treatment at the site of relocation in the pranavaha srota (respiratory system), treatment should also be directed toward the mahavaha srota (digestive system) as this is the physical root of the condition and the raktavaha srota (circulatory system) as the pathway of overflow.


Management of Vataja Kasa

The management of vataja kasa, at the site of relocation focuses on the application of oils and heat to the pranavaha srota (respiratory system). Sesame oil massaged into the chest followed by fomentation is recommended. Fomentation may be performed simply using hot water bottles, a heating pad or locally applied steam as in nadi svedana. Popular cough relieving herbs from India include kantakari (solanum xanthocarpum; VK-P+) and vamsa rochana (bamboo manna; VP-K+) . These are commonly used and may be prepared as ghrita (medicated ghee). Popular herbs used in the West include licorice (glycyrrhiza glabra; VP-K+) and wild cherry bark (prunis virginiana, prunia serotina; VP-K+).
Care of the digestive system requires dietary modification and the use of anuvasana basti (oil enema) or niruha basti (decoction enema). The diet, though nourishing should be taken in small quantities at first until the agni becomes strong. Nourishing soups are most beneficial. Patients should receive plenty of rest.

For both vataja and pittaja kasa, the classical formulation, Sitopaladi churna is commonly used. It may also be prepared in warm water or with honey. Sitopaladi churna is a combination of many herbs and spices with vamsa rochana as the chief herb in the formulation.


Management of Pittaja Kasa

The management of pittaja kasa, at the site of relocation focuses on herbal therapies. Oil and heat are not recommended. Medicated ghrita (ghee) may be prepared with cough relieving, expectorant herbs such as vamsa rochana (bamboo manna; VP-K+) and vasa (adhatoda vasica; PK- V+). Western herbal alternatives include licorice (VP-K+), mullein (verbascum thapus; PK-V+) and wild cherry bark (prunis virginiana, prunia serotina; VP-

K+). The classical Indian formulation, sitopaladi churna may also be used.
Virechana performed early in the condition is most beneficial to allieviate pitta at its root. The diet should emphasize a greater amount of the bitter taste as the bitter taste is cooling and purifies the rasa and rakta dhatu helping to destroy the infection. The diet should be light and and consist of easy to digest foods until improvement is noted. Stronger antimicrobial bitter herbs may be given to accompany the cooling, cough reducing herbs. These include kutki (Gentiana kuroo; PK- V+) and neem (Azadirachta indica; PK-V+) as well as well as Western alternatives such as goldenseal (Hydrastis Canadensis; PK-V+) and echinecea (Echinecea augustifolia, echinecea purpura; PK-V+). Patients should receive plenty of rest.



Management of Kaphaja Kasa

In the management of kaphaja kasa, treatment focuses on strong purification and may include vamana, virechana and niruha basti. Nasya is also recommended to purify the nasal passages and sinuses. An important herb from India is kantakari (solanum xanthocarpum; VK-P+). Kantakari alleviates cough and is a bronchodilator. Kantakari is one of the herbs in the famous ten roots formulation, dashmoola. Along with kantakari, additional herbs may be added to formulations such as vidanaga (embelia ribes; KV-P+) and chitrak (plumbago zeylancia; K-VP+). Dry, expectorant herbs may also be added to formulation or prepared for inhalation. Clove (caryophyllus aromatica) and bayberry (myrica nagi, myrica sapida, myrica cerifera) are commonly prepared in cigarette form or simply burned and inhaled. Western herbs that are beneficial include elecampane (inula helinum), eucalyptus (eucalyptus globulis) and black pepper (piper nigrum).

The diet of patients with kaphaja kasa should be very light and patients may fast for several days according to their strength. The diet emphasizes the pungent taste to support drying the lung tissues. Patients who are not experiencing great fatigue should remain active but should not overly exert themselves.



Managing Cough due to trauma requires referral to a medical specialist as the lung may be punctured. Until medical care can be administered, patients should take hemostatic herbs such as the Indian herbs manjishta and praval pisthi . Patients should also stay well hydrated.

Cough associated with wasting disease are difficult to treat and careful management is required. Weak patients usually require tonification to combat weight loss and increase strength. Medicated ghees with demulcent herbs such as bala rejuvenate the body and support repair of respiratory tissues. The dosage of the herbs is dependent upon the state of the patient’s agni. Anuvasana basti should also be administered to improve strength and can be prepared with nourishing herbs such as bala and ashwaganda in a sesame oil base. The diet should be nourishing. Meat and bone soups may be required to prevent continued weight loss.

Vegetarian patients may object, however they are strongly recommended if the patients life is in danger. The quantity of food taken should be proportional to the bodies abililty to digest it. Hence, dipanas to strengthen agni are required.


Sadhyasadhyata (Prognosis)

Doshic disturbances resulting in kasa are relatively easy to treat with vataja considered the easiest and kaphaja the most difficult. Those of mixed dosha pathology such as ksataja type are more difficult. Ksaya kasa is the most difficult of all. Ayurvedic texts state that kasa of any kind, if not treated properly can progress to ksaya type.


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May10
THORACOSCOPIC SYMPATHECTOMY FOR SWEATY PALMS
1. When is surgery needed for sweaty palms?
Excessively sweaty palms are usually no more than a nuisance. Occasionally, however, they may cause social embarrassment or interference with sports or occupation. Medical treatment with dermatological agents and iontophoresis sometimes work and this should be attempted. Those who fail conservative treatment and are incapacitated with the problem may consider surgery for a permanent cure.
2. What operation can be done?
A procedure called Thoracoscopic Sympathectomy can be done. The main principle of the operation is to divide the sympathetic nerves which control sweating in the palms. The nerves are found in the thoracic cavity running along the neck of the ribs. A complete division of the nerves from the second to the fourth rib is usually recommended. Those patients with excessive sweating in the armpits may require a modification of the levels divided.
The entire operation can be performed with the keyhole technique called Thoracoscopy. A 5 mm telescope is used to visualization. Two 3 mm instruments are used to locate, dissect and divide the sympathetic nerves.
3. What can I expect before and after surgery?
Some surgeons do this procedure on one side first and delay the procedure on the other side till a few weeks later. We prefer to do both sides at the same time if the patient is young and fit. This obviates the need for two separate operations.
The operation is done under General Anaesthesia. Patients are usually admitted to hospital on the day of surgery and stay overnight for observation. A small chest tube is sometimes left inside the rib cage for a few hours after the surgery is completed. This can be removed once the lung is fully re-expanded.
Recovery is usually rapid as only small keyhole incisions are used. Occasionally, however, you may feel some pain for the first few weeks. This can sometimes be intermittently severe. There may also be a feeling of heaviness in the chest and pain in the arms for a few days. Temporary recurrence of the sweaty palms, lasting for a few hours, may happen especially between the second and fifth day after surgery.
Most patients are completely satisfied with the results of surgery. They can, however, have compensatory excessive sweating in the trunk due to a rebound phenomenon. This is usually of little concern but do remember that it can happen and it cannot be prevented. Surgery is also irreversible once it is done so do reconsider whether you want to have the operation if you feel that this side effect is going to bother you.


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