Hello Doc,

As you must be knowing, Heart attack also called as Myocardial infarction is due to a coronary thrombus or a blood clot in lay man terms which does originate in few minutes obstructs the blood supply in any coronary artery to the myocardium. This whole scene can stretch for about 6 to 10 hours where the myocardium cries out for blood supply creating Angina. If the blood supply reaches the Myocardium in time, the cardiac muscle is saved, if not, the heart muscle is damaged leading to reduction in EF.

The risk factors involved in coronary thrombus initiation include smoking, diabetes mellitus, hypertension, hyperlipidemia, stress, and family history of atherosclerosis. A fissure in the atherosclerotic patch can lead to bleeding and thus form a thrombus.

As you know CABG and PTCA are revascularization therapies for Atherosclerosis and dont reduce even a single percent chance of future MI. Click this link to understand more from Harvard university What can Angioplasty do for you?

If you want to understand about What are the chances of Heart attack after Angioplasty…. Read COURAGE trial where 2 groups of 1000 patients each, were compared with each other. One group underwent only medical management and other underwent Angioplasty. At the end of 4.6 years, death rate due to MI was 18.5% in medical group and 19% in Angioplasty group.

Is Angioplasty better than Medical therapy? Click this link for COURAGE trial.

I hope this answers your question.

Hello Doc,

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

People who’ve had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Though Diabetes can be the major reason for it, frozen shoulder may be the result of many factors, including:

• Rotator cuff injury
• Broken arm
• Stroke
• Recovery from surgery
• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Tuberculosis
• Parkinson’s disease and many more unknown factors.

Now question arises, how to treat Frozen shoulder patients?

Active exercises related to the ligaments, muscles and capsule of the shoulder joint can be the best effective mode to treat Frozen shoulder. You can prescribe the 90 days Frozen shoulder care plan in the MIB Pulse application. Patient has to go to his Pulse application, pay online in the app itself and his exercise plan begins after 24 hours of payment. Everyday patient has to spend only 30 to 45 minutes on this Pulse app to perform exercise, watching the online exercise videos. Believe me, they are very effective.

I have prescribed it to several of my patients, its comfortable and convenient for the patients to perform exercises at their home for short duration everyday. Patients can experience improvement in his range of mobility of his shoulder joint from the 7th day itself. In a months time, the ROM of shoulder joint has been seen to improve drastically.

If required, additional medicines can be prescribed to reduce down the inflammation around the joint.

All the best!

Hello Doc,

Serum Insulin levels are to be advised to a patient in following scenarios

1. If you are in doubt whether the patient is in Type 1 or Type 2 DM
2. If the patient is NOT on injectable Insulin doses, in that case, C peptide can be an option
3. If the patient complains of Malaise and you suspect him to be in Pre diabetes
4. If the patient complains of excessive hunger without any history of Diabetes
5. PCOD, Obese patients also can be advised for serum Insulin. Reduction in serum insulin secretion can be a guiding star towards successful treatment in such patients.

These are major scenarios where it can be advised. Many more also can be mentioned if required.

I completely agree with Dr. Rahul about HRV being one of the leading cause for fasting BSL in a highly compliant patient.

Along with the above, the weight loss happening for the patient, if pathological, also can be a cause for the high BSL. Markers like LDH, CK can help you to identify the same.

Few medications like Steroids, anti depressants, oral contraceptive pills, Antifungals, antibiotics, Beta blockers, Thiazide diuretics, Statins also can lead to increase in BSL.

Following points to be implemented to prevent relapse of DM post tapering

1. Stop Wheat and wheat related products like maida and Suji for 90 days post reversal. Encourage the patient to consume complex carbs like Jowar, Bajra, Ragii, Besan and other relted products. Any complex carb atta he uses to make his roti, it should not be more than 30 gms in his one meal.
2. Prevent consumption of Milk and milk derived bakery products for 120 days minimum post reversal
3. Rice products to be kept on hold post 90 days of reversal
4. Keeping sugar, jaggery and sugar free products on hold, Even after Prameha diet kit, keep the patient on 800 calorie diet for next 90 days
5. If possible, ask the patient to consume only 2 meals a day for next 90 days post reversal.
6. Ask the patient to maintain a gap of minimum 8 to 10 hours in between these two meals.
7. 7 to 10 cups of salads to be consumed every day by the patient
8. If you plan to maintain the weight of the patient, keeping the sugar level in control, add required proportion of ghee to patients diet to match his calorie requirement.

I am sure, if you educate the patient for above points, you can surely prevent the relapse of disease post reversal.