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Dr Sudhir Kumar MD DM🇮🇳

@hyderabaddoctor

Dec 13

Sharing a few tips that could enrich doctor-patient relationship
1. I saw my first patient in 1994. During past three decades, I have learnt a lot from my patients while interacting with them. These tips could help younger doctors who have recently started this amazing journey.

2.Listen to patients: The clues to diagnosis often lie in patient’s history. Moreover, if patients are properly heard, they feel satisfied. Occasional chronic patients may have thick files; it is still worthwhile letting them narrate the story, especially if it is the first visit

3. If patient requests for a test, accept it, even if the chance of it being abnormal is low. Patients understand their body well, and you will be surprised to find an abnormality in the test they wanted and you felt it was not needed.
#MedTwitter #doctors

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Dr Sudhir Kumar MD DM🇮🇳

@hyderabaddoctor

Dec 12

When an old woman started speaking in a "foreign" accent all of a sudden
1. About a year back, a 70-year old woman was brought by her son to my OPD. As per him, she had started to speak Telugu in an "American" accent, since waking up that morning.
#MedTwitter #NeuroTwitter

2. She was illiterate, had no relatives or friends from USA and had never travelled to USA.
She had been confined to home for several months due to Covid lockdown and her son took her to a #psychiatrist, thinking she had developed this #Speech #abnormality due to stress.

3. Psychiatrist could not find any behavioral disorder and wanted a neurologist opinion.
Clinical examination revealed a problem with her speech. It was slow, and she had difficulty in clearly pronouncing words. It felt as if she was speaking Telugu in an American English accent

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Dr Sudhir Kumar MD DM🇮🇳

@hyderabaddoctor

Dec 10

How can one reduce the risk of knee #osteoarthritis?

1. Knee osteoarthritis (OA) causes knee pain. It limits mobility, hampers physical activity and contributes to sedentary lifestyle, which in turn, increases the risk of obesity, diabetes, hypertension, heart attack and stroke.

2. Who are at risk of developing knee OA?
*Non-modifiable risk factors:
Female gender and older age
*#obesity: Increases the risk of knee OA three-times. It also accelerates the progression of disease.
#MedTwitter #orthotwitter #orthopedics

3. Knee injury: Traumatic joint injury is a major risk factor for osteoarthritis, particularly at the #knee (i.e. meniscal damage, anterior cruciate ligament rupture, or direct articular cartilage injury). Ref: doi.org/10.1097%2FBOR.…

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Dr Sudhir Kumar MD DM🇮🇳

@hyderabaddoctor

Dec 9

T3 testing is not routinely needed in managing patients with primary #hypothyroidism

1. Primary hypothyroidism is a common hormonal disorder, which is treated with levo-thyroxine (T4) replacement.
#MedTwitter #endocrinology

2. In order to assess the adequacy of T4 dose, some clinicians routinely order #T3 along with #T4 and #TSH (thyroid stimulating hormone). Is routine T3 testing really needed in cases of primary hypothyroidism?

3. Clinician would be able to determine the adequacy or over-replacement of levo-thyroxine (T4) dose on the basis of T4 and TSH levels.
*In cases of over-replacement, T4 will be elevated and TSH suppressed.
*In cases of adequate dosing of T4, TSH and T4 levels would be normal.

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Dr Sudhir Kumar MD DM🇮🇳

@hyderabaddoctor

Dec 9

Learning case for #doctors
1. 76-year-old man;
8-month history of statis #dermatitis, weakness and painful dysesthesias in the hands and feet.
Sensory-motor type #polyneuropathy was evident in a stocking-and-glove distribution, confirmed by nerve conduction studies.
#MedTwitter

2. Extensive testing including brain magnetic resonance imaging, spinal magnetic resonance imaging, and cerebral spinal fluid examinations were nondiagnostic.
Subsequently, serum vitamin B6 (VB6) levels were found to be low at 3.5 ng/mL (normal values: 6.0-40.0 ng/mL for males).

3. Oral supplementation with 60 mg/d of pyridoxal phosphate hydrate (PPH) was initiated, and 1 week later, VB6 levels rose to 39.3 ng/mL, and drastic improvements of polyneuropathy and dermatitis were observed. Pain reduced to 3 from 8 (scale of 0-10) after one week and 0 at 5 wk

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Dr Sudhir Kumar MD DM🇮🇳

@hyderabaddoctor

Dec 8

Longer daily #sedentary time increases the risk of #Knee, #Hip and #back #pain

1. 20-25% of people aged 50 or more suffer from orthopedic problems such as knee joint pain, hip joint pain, back pain and knee stiffness. Sedentary lifestyle is a major risk factor for them.

2. In a recent study, men with sedentary time of 7.5 hours or more/day had 45% higher risk of orthopedic problems as compared to those with daily sedentary time of <7.5 hours.
#MedTwitter #ortho

3. A pink-collar job, physical inactivity during leisure time, and passive (e.g. riding in a car or train) versus active (e.g. walking or riding a bicycle) transportation- were more commonly associated with orthopedic problems in people with daily sedentary time >7.5 hours.

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