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Pain Management Clinic

Pain is defined by International Association for study of Pain as an unpleasant sensory and emotional experience with actual or potential tissue damage.

Conquering pain has been a major limitation for the more evolved human race. Pain imposes a burden on those who suffer from it and impairs quality of life. Most often, it is the common symptom that brings the patient to see a Physician. Pain most commonly presents as a warning sign for any pathological process in the body nevertheless may also cause agony without a specific purpose. The most common forms of pain encountered in daily medical practice are musculoskeletal pain 30-40 %, neck and back pain 30%, headaches less than 10%, and cancer pain 1-2 %.

            Pain Clinic at International Modern HospitalPain may be classified into different types based on the origin, duration, periodicity and nature of pain. Accordingly, Pain management can broadly be classified as acute and chronic pain management. While acute pain deals with perioperative pain, pain in labour, trauma, burns etc., and the latter includes a diverse group of patients in the outpatient setting. The management of acute pain is primarily therapeutic. Chronic pain management requires various pharmacological and non pharmacological approaches to tackle the multidimensional components of pain. At International Modern Hospital we take a holistic approach so as to not only treat the underlying cause but also provide psychological support and rehabilitation to ailing patient.

Pain Clinic at International Modern HospitalPain management largely comprises of pharmacological and non-pharmacological modalities, commonly being medication, counselling, relaxation techniques, electrical stimulation and local anaesthetics. Few Prescribed medications include anti-depressants and systemic local anaesthetics.

Pain Clinic at International Modern HospitalAt International Modern Hospital we undertake Interventional modalities which include diagnostic and therapeutic nerve blocks, facet blocks, epidural steroids, intra articular injections, trigger point injections for myofacial syndromesetc. Therapeutic adjuvants include Psychiatric counselling, physiotherapy and electrical stimulation. Unrelieved and inadequate relief of pain is continuing to be a global health problem and serious efforts have to be taken to provide pain treatment as it is definitely a basic human right.

Varicose Vein

19705Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They usually appear in the legs, but can occur in other parts of the body.

Causes

Normally, one-way valves in your leg veins keep blood moving up toward the heart. When the valves do not work properly, they allow blood to back up into the vein. The vein swells from the blood that collects there, which causes varicose veins. Smaller varicose veins that you can see on the surface of the skin are called spider veins.
Varicose veins are common, and affect more women than men. They don’t cause problems for most people. However, in some people, they can lead to serious conditions, such as leg swelling and pain, blood clots, and skin changes.
Risk factors include:
• Older age
• Being female (hormonal changes from puberty, pregnancy, and menopause can lead to varicose veins, and taking birth control pills or hormone replacement can increase your risk)
• Being born with defective valves
• Obesity
• Pregnancy
• History of blood clots in your legs
• Standing or sitting for long periods of time
• Family history of varicose veins

Symptoms

• Fullness, heaviness, aching, and sometimes pain in the legs
• Visible, swollen veins
• Mild swelling of feet or ankles
• Itching
Severe symptoms include:
• Leg swelling
• Leg or calf pain after sitting or standing for long periods
• Skin color changes of the legs or ankles
• Dry, irritated, scaly skin that can crack easily
• Skin sores (ulcers) that don’t heal easily
• Thickening and hardening of the skin in the legs and ankles
• Bleeding from ruptured veins

Diagnosis

Your doctor will examine your legs to look for swelling, changes in skin color, or sores. Your doctor also may:
• Check blood flow in the veins
• Rule out other problems with the legs (such as a blood clot)
• Do a colour scan for the leg veins

Treatment

Your doctor may suggest that you take the following self-care steps to help manage varicose veins:
• Wear compression stockings to decrease swelling. These stockings gently squeeze your legs to move blood up towards your heart.
• Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
• Raise your legs above your heart three or four times a day for 15 minutes at a time.
• Care for wounds in you have any open sores or infections. Your health care provider can show you how.
• Lose weight if you are overweight.
• Get more exercise. This can help you keep off weight and help move blood up your legs. Walking or swimming are good options.
• If you have dry or cracked skin on your legs, moisturizing may help. However, some skin care treatments can make the problem worse. Talk to your health care provider before using any lotions, creams, or antibiotic ointments. Your provider can recommend lotions that can help.
If your condition is severe, your doctor may recommend the following treatments:
• Laser therapy. Strong bursts of light are projected on smaller varicose veins, making them disappear.
• Sclerotherapy. Salt water or a chemical solution is injected into the vein. The vein hardens and disappears.
• Ablation. Heat is used to close off and destroy the vein. The vein disappears over time.
• Microphlebectomy. Small surgical cuts are made in the leg near the damaged vein. The vein is removed through one of the cuts.
• Bypass. Surgery reroutes blood flow around the blocked vein. A tube or blood vessel taken from your body is used to make a detour around, or bypass the damaged vein.
• Angioplasty and stenting. A procedure opens a narrowed or blocked vein. Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh tube called a stent is then placed inside the vein to prevent it from narrowing again.
Varicose veins tend to get worse over time. Taking self-care steps can help relieve achiness and pain, keep varicose veins from getting worse, and prevent more serious problems.

When to Contact a Medical Professional

Call your health care provider if:
• Varicose veins are painful
• They get worse or do not improve with self-care, such as by wearing compression stockings or avoiding standing or sitting for too long
• You have a sudden increase in pain or swelling, fever, redness of the leg, or leg sores
• You develop leg sores that do not heal

ANAESTHESIA – AWARENESS ABOUT “NO AWARENESS”

anaesthetist

A visit to the doctor confirms your worst fear: SURGERY. Suddenly you cease to think about the disease that is plaguing your body and it all becomes about the upcoming and seriously daunting surgery. You get anxious and scared and seek people who can answer some questions that are running through your mind. Will I be seeing the surgery? Will I wake up of the Anaesthesia? When will I wake up? What if I wake up in the middle of the surgery? Will there be pain? If yes, how much pain? What can be done to have no pain during and after surgery? What will happen if the said surgery doesn’t go well, or as predicted? Will I come out of the surgery alive? But often these questions are not directed to the right person who can give us the right information. Have you ever consulted an Anaesthetist before you go to the operation theatre for the surgery and have your queries been addressed to? After practicing Anaesthesia for close to a decade now, I have realized that most patients go into surgery scared and with many of these questions still unanswered. Let me try to solve this mystery for you by answering some of the frequent questions that plague a person’s mind before surgery:

 1. What is Anaesthesia? Anaesthesia literally means insensitivity to pain temporarily induced by drugs. It is a speciality of medicine which deals with temporary induced state with one or more of the following: Analgesia (relief from or prevention of pain), Amnesia (loss of memory), Paralysis (extreme muscle relaxation) and/or Unconsciousness. It is a temporary state where you are completely unaware of the surroundings controlled by various drugs given to you by a qualified Anaesthetist, who also take care of your vitals (heart beat, blood pressure, oxygen concentration, temperature, respiration or breathing and status of other organs like kidney, liver, etc.) while you are unaware of these experiences. Anaesthesia is science being researched and developed by medical science and is an important aspect of a successful surgery today.
2. Who is an Anaesthetist or Anaesthesiologist? An Anaesthetist (or Anaesthesiologist) is a highly trained specialist in the subject, (who has done specialisation/post graduation in Anaesthesia for 3 years, after 5 and half years of graduation i.e. M.B.B.S.), who makes all the decisions during surgery. She/he is responsible for the administration of anaesthesia and patients well being while under anesthesia and also the immediate post-operative care. Anaesthetists play a vital role in various areas of healthcare and hospitals these days. They are your perioperative physicians who take care of your illnesses prior to the surgery and also after the surgery. Anaesthetists are a vital team member of the Intensive care units or the critical care units. Some Anaesthetists also run pain clinics to take care of your long standing pain. Anaesthetists also take up the role of emergency physicians in trauma care and acute pain management. Anaesthetists are also key member of the hospital administration and management who can connect all the departments with ease.
3. What are the side effects of the anaesthesia that will be given to me? The medications given to you during anaesthesia are chosen as per your physical condition, and your pre-existing ailments. These medications are used in combination and the dosages are well calculated before administration and are associated with very minimal or negligible side effects. However, in some patients may experience reactions to the medications given, in the event of which the Anaesthetist will address to it immediately.
4. Does the Anaesthetist makes patients sleep during surgery and leaves the theatre? An Anaesthetist makes you sleep, takes care of your vitals throughout the surgery, awakens you, accompanies you to the recovery ward and takes care of you in the immediate postoperative period. She/he is mandatorily required to be present with the patient from the time the patient enters the operating room till the time the patient reaches the recovery room.
5. I am afraid of being in the operation theatre. Can you make me sleep before going in to the operation theatre? All patients are anaesthetised only after attachment of the standard monitoring and after securing an intravenous access. But for patients who are over anxious of the theatre they may be given some sedative or anti-anxiety medication in the preoperative ward, before going into the theatre. Usually your anaesthetist prescribes you some medications to be given in the ward which also helps you relieve anxiety and when you come to the theatre you might be in a light sleep.
6. I fear the needles. Is there any other way of making me sleep? Usually the anaesthetic medications are given to you through an intravenous cannula, secured in a vein in one of your hands which needs just one needle prick. It is mandatory for administration of anaesthesia. In children, they are either sedated with gases or an intramuscular injection and then intravenous access is secured. Same can be done for adults who have severe phobia for needle prick, as a special case.
7. Will I be seeing the surgery? Usually you will be completely unaware of the surgery; that means you will be under anaesthesia. In some cases where only part of your body is anaesthetised, either your lower half of the body or your any of your limbs, you may opt to see the surgery. Certain centres also record the surgeries to be seen later.
8. Will I wake up of the Anaesthesia? When will I wake up? Will I come out alive after the surgery? With the advancement of this medical speciality there are various medications whose combination is used for administration of safe anaesthesia and patients can be awakened within minutes of completion of the surgery. You will awaken, and very much alive, immediately after the surgery.
9. What if I wake up in the middle of the surgery? The Anaesthetised patient is closely monitored by the Anaesthetist who makes sure you don’t awaken in between surgery. The depth of anaesthesia can be well maintained safely with the advanced drugs available these days. Despite all the efforts, in certain cases where due to some genetic illnesses some patients awaken in between there is a very low chance of them knowing or remembering the said instance.
10. Will there be pain? If yes, how much pain? The patient undergoing anaesthesia is given Analgesia (pain killer) prior to the surgery and maintained throughout the surgery. You might wake up with a little burning sensation in the operated site but usually there is no pain or very minimal pain of the surgery for which your Anaesthetist will give you pain medication in the recovery ward. . Along with that, there are various techniques to block the pain mechanism of the surgery site which are done. This technique is also called Regional Anaesthesia. These injections are usually given while you are still asleep and when you awaken you are pain free.
11. What will happen if the said surgery doesn’t go well, or as predicted? Anaesthetists take all precautions for conduct of safe surgery. Despite all the efforts some patients might have complications during or after the surgery. All patients are monitored for such scenarios. Any patient who encounters such complication is taken to the intensive care units (I.C.U.) or critical care units for observation and further management.
12. What are the various Anaesthetic options I have? Anesthesia is broadly divided into General anaesthesia and Regional Anaesthesia. General anaesthesia is the one where you are completely unconscious and unaware of the surgery. Regional anaesthesia is again divided in various forms where a part of your body is anaesthetised during the surgery and can be combined with some sedation or even general anaesthesia. Spinal or epidural anaesthesia is one where lower half of your body is anaesthetised. Local anaesthesia is done in superficial surgeries where only the surgical part in anaesthetised. Nerve blocks are done, where the nerves supplying the surgical area are selectively anaesthetised and you feel no pain during the surgery and these can also be used for postoperative pain management. These are also combined in a surgery for better comfort and outcome.
13. I have heard from my relatives that Spinal anaesthesia causes backache. Is it true? Backache is predominant in mankind as a punishment for our standing posture. In pregnancy because of poor back care patients experience backache. Rather these days various types of epidural medications and treatment are given for various types of backache. In pregnancy the back pain is due to inadequate exercise, and back care. The spinal anaesthesia is safer option for you and your baby during a caesarean section (unless contraindicated for some coexisting illness). These days epidural Anaesthesia is being given for painless normal deliveries, which are also safe for you and your baby.
14. Minor surgery involves no risk. Is it true? The severity of surgery is not the only factor that determines the risk involved. Your coexisting diseases also play a major factor in risk assessment. For example – a patient with severe cardiac problem is very high risk for surgery even for a small biopsy.
15. The risk involved is due to Anaesthesia. Is this true? Some patients think that the risk involved in a surgery is only due to Anaesthesia, which is not true. The anaesthetists are well trained to administer you anaesthesia with your coexisting diseases safely, it is rather the stress of surgery (especially without anaesthesia) that is more risky than undergoing surgery under anaesthesia. The anaesthetists just want to correct the coexisting problems as much as possible and then take you for surgery so that the surgery is done more safely, medically optimise your health condition prior to surgery.

anaesthesia

Safe and successful surgery is a result of many factors involved in surgery including a good and responsible anaesthetist. It is very important to meet your Anaesthetist before any surgery, as your Anaesthetist evaluates your health status, your coexisting illness or diseases, status of your vital organs like the heart, kidneys, liver, etc and co-relates with the surgery involved and accordingly decides the Anaesthesia best for your surgery in your own health condition. This is also the best time to ask the questions you want to ask your Anaesthetist about the unawareness and postoperative care.

Don’t Procrastinate with Pelvic Pain

If you have recurring pain in your pelvis or bladder, you probably don’t think “interstitial cystitis.” It’s a long name for a condition that can be difficult to diagnose because it can have multiple, interrelated causes.

Interstitial cystitis, or “IC,” is a chronic health issue in which patients feel pain or pressure in the bladder area. An estimated 4 million people in the U.S. suffer from IC, approximately 80 percent of them female.

Pelvic Pain Women

Several different conditions – or combinations of conditions – can cause IC. That’s why it’s important to consult with your physician if you’re experiencing pelvic pain. A proper diagnosis may require time and you don’t want to suffer any longer than necessary.

To further complicate the diagnosis, symptoms range from mild to severe and vary from person to person. Any of the following could indicate IC:

  • Pain ranging from ‘nagging’ to ‘intense’ in the bladder and surrounding pelvic region
  • A sense of urgency and/or increased frequency of urination
  • Pain that worsens during menstruation
  • Painful sexual intercourse for women
  • Pain or discomfort in the scrotum or penis
Pelvic Pain Man

For many, IC feels like a bladder infection, though antibiotics make no impact because there’s no infection to treat. The exact cause of pain with IC is actually not clear, but several theories exist. These range from an allergic response to autoimmune reaction to an excessive inflammatory response to even the slightest stimulus which would not generally be perceived as painful in a patient who does not have IC.

IC can frustrate patients because besides a challenging diagnosis, not everyone responds the same way to the same treatment. In addition, IC treatments can take several weeks to several months to provide relief.

If you suffer from pelvic pain, begin with an open discussion with your physician. Whether or not you are diagnosed with IC, you can start to work toward solutions to your condition. Treatment options, such as pharmaceuticals, nerve stimulations or surgery can be evaluated and your doctor can help you decide on the appropriate approach for you.

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