When it comes to elderly patients, we just need to listen to all their problems patiently, health related and also their circumstances/other reasons for stress/anxiety. We may not be able to solve any of those .. but listening amd empathising makes them feel better. #Geriatrics Image
I have an elderly couple. The wife suffers from Dementia and he himself has undergone surgery and radiation for prostate cancer. He takes care of her with help from a caretaker. I tell them to do video consult. But he says he feels good to come and talk to me for few minutes.
Most of them are very patient. If you're busy they'll wait for you so that they get those few precious minutes extra to discuss everything from their financial issues to death of some friend or relative. They almost always ask the doctor about his/her family and how they're doing
It's not easy dealing with some of these pts. They can be very blunt and negative. And very stubborn too. Name dropping and stretching converstions too long beyond a point is very common. But we need to try hard and maintain our patience somehow and you learn with experience.
Many of the elderly patients come with a list written down about their health issues. A good habit, because when in front of the doctor possibility of forgetting to tell something important is common. I prefer this over verbal. #Clarity Image

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More from @DrDeepakKrishn1

Aug 31
Hindu deities are seldom depicted without their particular ‘vahana’ (vehicles) on which they travel. These vahanas are either animals or birds and symbolises the various forces they ride. #Ganesha Image
While Lord Ganesha’s vahana is a mouse which symbolises crushing useless thoughts. Have you ever wondered why the elephant god rides on a tiny mouse? Well, there’s a story behind it. Read on to know. Image
According to Ganesha Purana, there was a celestial musician-god named Krauncha. He accidentally stepped on the foot of Muni Vamadeva who cursed him to become a mouse. However, after he recovered his temper he promised Krauncha that one day the gods themselves would bow before him Image
Read 7 tweets
Aug 26
A close friend kept saying you should check my heart someday and midnight she landed up at ER with a heart attack. Could quickly perform an emergency angioplasty and re establish blood flow. We had a hearty laugh after it though it was a deeply emotional moment. #PropheticWords
She had messaged around evening saying she has neck pain. I advised some medication and told to see me tomorrow. Later after 2 hours she said she is not able to walk and is getting uneasiness in throat and jaw and said she'll come to hospital. ECG and echo confirmed heart attack
Women are more likely to have atypical symptoms compared to men. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as: Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort. Shortness of breath. Pain in one or both arms.
Read 6 tweets
Aug 26
48y guy presented with breathing difficulty. BP 240/140. Acute pulmonary edema (fluid in lungs). Echo - Severe left ventricular dysfunction, EF 20%. S.creat 3.5. Stopped BP medicine 4y ago after listening to a BMHegde YouTube video saying BP medicine is not necessary #MedTwitter
It's high time the health ministry and NMC take strict action on people propagating wrong health advice on social media. Videos need to be pulled down from websites. Some of these people like BMHegde and few others have spoilt health of more people than someone can imagine.
I've personally seen hundreds of patients like this who have landed in severe complications after listening to BMH videos. Being a medical doctor who occupied such high positions of reputed institutions, he's a disgrace to our profession. Shameful.
Read 5 tweets
Aug 24
Good to see some gyms doing a clinical assessment and asking for #cardiacfitness before enrolling people. 28y guy with a family history of premature Coronary artery disease. Detected to have high BP. Overweight by 12-15kg. A basic clinical check can reveal so much information! Image
In such a patient assessing overall cardiac risk and controlling blood pressure before allowing him to exercise is crucial. In the absence of a pre-enrollment check if any cardiac event like heart attack happens, people will be quick to blame #exercise as the culprit!
Most people who develop a heart attack or cardiac arrest while exercising have a pre existing cardiac condition which has not been diagnosed. So it is critical to screen people before letting them join the gym. Also depends on how intense the training will be. Image
Read 5 tweets
Aug 24
The atherosclerotic plaque is formed by deposits of cholesterol and calcium and inflammatory cells into the endothelial lining inside the artery. It can slowly narrow down the artery causing Stable angina or suddenly rupture leading to clot formation and #heartattack ImageImageImage
This explains why some people experience chest pain going on for months or stable angina and some people suddenly present with heart attack as the first symptom. Stable angina is due to gradual narrowing of lumen while heart attack is due to sudden occlusion.
A 50% narrowing plaque can rupture leading to a heart attack. But unless the narrowing is more than 70% it won't cause any chest pain. Hence many patients with heart attack haven't had any symptoms before that. A vulnerable plaque is at risk of rupture irrespective of narrowing Image
Read 7 tweets

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