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DIET KIT
In the case of Renal patients ( CKD/ Mono kidney/ post-transplant patients) the decision for diet has to be taken in accordance with Renal profile specifically eGFR and Electrolytes. All of our diets are primarily antioxidant and reduce tissue damage, thus they are going to be helpful for Kidneys.Read more
In the case of Renal patients ( CKD/ Mono kidney/ post-transplant patients) the decision for diet has to be taken in accordance with Renal profile specifically eGFR and Electrolytes. All of our diets are primarily antioxidant and reduce tissue damage, thus they are going to be helpful for Kidneys. Also, they help reduce Hyperglycemia, and Hypertension induced injuries too in the co morbid patients. So yes you can definitely advise our diet kits to this patient.
Care to be taken – eGfr severely impaired patient might require modification in fruit/salad selection advised along with our diet kit. Also, night requires adjustment in protein portion ( i.e daal and soya-based breakfast option). And most importantly in eGfr imparied patients electrolyte has to be monitored closely. As these patients have a tendency of suffering from Hyperkalemia in this cases we tend to avoid Pottasium rich diet kits namely GoBipi and Reverse diet kits. So perferably swasthyam and prameha are used frequently in this cases.
My personal experience I prefer using Prameha Kit and add Sneha( ghrit) to the diet as many renal patients suffer from vaat prakopak symptoms too.
See lessHeart
As any dr in Madhavabaug can tell none are the best option for our patients, but considering a world where we have to choose a lesser evil between these two procedures, I'm sharing conclusion of few Meta Analysis comparing Outcomes of PTCA vs CABG in patients with multiple vessel disease, have alsoRead more
As any dr in Madhavabaug can tell none are the best option for our patients, but considering a world where we have to choose a lesser evil between these two procedures, I’m sharing conclusion of few Meta Analysis comparing Outcomes of PTCA vs CABG in patients with multiple vessel disease, have also given link below for reference.
At one year, there was no significant difference between the two groups in terms of the rates of death, stroke, or myocardial infarction. Among patients who survived without a stroke or a myocardial infarction, 16.8 percent of those in the stenting group underwent a second revascularization, as compared with 3.5 percent of those in the surgery group. The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery (P<0.001 by the log-rank test). The costs for the initial procedure were $4,212 less for patients assigned to stenting than for those assigned to bypass surgery, but this difference was reduced during follow-up because of the increased need for repeated revascularization; after one year, the net difference in favor of stenting was estimated to be $2,973 per patient.
As measured one year after the procedure, coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death, stroke, and myocardial infarction. However, stenting is associated with a greater need for repeated revascularization.
https://www.nejm.org/doi/full/10.1056/nejm200104123441502
Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555581/
In patients with multivessel coronary disease, compared with PCI, CABG leads to an unequivocal reduction in long-term mortality and myocardial infarctions and to reductions in repeat revascularizations, regardless of whether patients are diabetic or not. These findings have implications for management of such patients.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1783046
my conclusions from above
PTCA ( Multiple stenting )
CABG
there isn’t a clear choice here so the suggestion from cardiologists mostly stems from their personal preference.
See lessCatheter angiography
There are multiple ways and points you can use to communicate why CT coronary is preferable for your patients as compared to Traditional CAG. CT CAG is non-invasive so minimal risk during the procedure CT CAG is more accurate and especially with volumetric it gives you a deeper understanding of PlaqRead more
There are multiple ways and points you can use to communicate why CT coronary is preferable for your patients as compared to Traditional CAG.
- CT CAG is non-invasive so minimal risk during the procedure
- CT CAG is more accurate and especially with volumetric it gives you a deeper understanding of Plaque structure ( calcium capsule, lipid core, etc) thus understanding the real risk if any posed by it.
- but the most important point of argument is the one you have mentioned in the question itself cardiologists prefer traditional angioplasty as they can use the situation to their benefit in convincing ( scaring) the patient and relative to go for immediate plasty. whereas in CT CAG patient gets time to evaluate the need for surgery. So I think this is also the strongest argument for us that we don’t need to that in CT CAG there are minimal chances of manipulation and push for Surgical intervention.
- In cases where a patient who has agreed to your treatment the aim is to have a report which can be objective so as to be comparable pre and post. The traditional CAG which is reported subjectively by the performing cardiologist is not at all useful for the same.
See lessDiabetes
Yes, we can definitely use it for excellent glycemic control and medicine tapering. Many of our senior doctors have used it with great success to reduce sugar levels and taper medicines or insulin in such cases. But definitely due diligence has to be taken. In cases with active weight loss, I wouldRead more
Yes, we can definitely use it for excellent glycemic control and medicine tapering. Many of our senior doctors have used it with great success to reduce sugar levels and taper medicines or insulin in such cases. But definitely due diligence has to be taken. In cases with active weight loss, I would definitely suggest considering alternatives. In other cases, we can start diet kit with added portions of sneha ( ghrit) and balya protein. The target is to provide low carbs while making sure no muscle loss happens, also to avoid vaat prakop. Also in these cases patients exercise has to be strictly controlled. Avoid too much cardio or walking and focus has to be on strength training, yoga, and meditation. Additionally, external snehan with tanupusthi oil/til oil at home is advised in these cases. Senior doctors who have handled such cases should share one or two case experiences for better clarity.
See lesswhat would be treatment for raise creatinine? sr. creat is 7
As stated by Dr Rohit sir in absence of clear guidelines and research backed results it is best to not promise much in this case. But in general I would like to share my basic concept of CKD management which we can use for our patients. In CKD the severity or prognosis of disease is measured by checRead more
As stated by Dr Rohit sir in absence of clear guidelines and research backed results it is best to not promise much in this case. But in general I would like to share my basic concept of CKD management which we can use for our patients.
In CKD the severity or prognosis of disease is measured by checking Sr creat and GFR of the patient. Oversimplifying the subject, creat ( by product of muscle damage/wear and tear) is something that has to be filtered out through kidneys and excreted by urine. When that doesn’t happen it usually indicates failing kidney function and shows up in form of Raised creat. In Ayurveda mutra is responsible for Kleda (vikrut/again related to mansa and meda dhatu) vahan , so if mutra utpatti is hindered Kleda sanchiti will occur.. even though Kleda and creat cannot be one and the same. I have treated patient on same principle. So Kledapachak and Kleda sodhak medicines should be used. In traditional formulations Arogyavardhini, Chandraprabha and Punarnava mandoor help. In Madhavbaug we can definetly use our medicines like Sothagni , punura in combination with Pachanvati or goodilax for good improvment. Keeping in mind most of Severe CKD paitent exhibit vaat prakop lakshna (karshya, karshnya etc) too, using Siddha ghrit is also advised in those cases.. more so because Vrukka is referred to be medo moola.
Lastly USG grading of Kidney disease is also very important in prognistic prediction. A case with very poor corticomedulary diffentiation will show poor/slow response to any treatment.
See lessMedicine
Hello doctor, As rightly said by Omkar sir Balya Kalpa is among the first choice of drug for managing asymptomatic HIV +ve Patient. Many studies point to positive impact of ayurvedic herbs like ashwagandha, shatavari but also of Amla, Guduchi. So consider adding Madhavprash and goodilax as boRead more
Hello doctor,
As rightly said by Omkar sir Balya Kalpa is among the first choice of drug for managing asymptomatic HIV +ve Patient. Many studies point to positive impact of ayurvedic herbs like ashwagandha, shatavari but also of Amla, Guduchi. So consider adding Madhavprash and goodilax as both Rasayan and immunomodulator. Even a combo of Amalaki ,Haridra and Guduchi should be beneficial which is available in Endogaurd.
See lessCabbage in salad should not be allowed in Swathyam diet box, for TMP pts
Hello doc, In relation of effect of Cruciferous Vegatables and Funtioning of thyroid Glands here are some transcripts form various studies which should help us plan our approach.. 1. Very high intakes of cruciferous vegetables, such as cabbage and turnips, have been found to cause hypothyroidism (inRead more
Hello doc,
In relation of effect of Cruciferous Vegatables and Funtioning of thyroid Glands here are some transcripts form various studies which should help us plan our approach..
1. Very high intakes of cruciferous vegetables, such as cabbage and turnips, have been found to cause hypothyroidism (insufficient production of thyroid hormones) in animals (54).
-Two mechanisms can potentially explain this effect. The hydrolysis of progoitrin, found in cruciferous vegetables , may yield a compound known as goitrin, which may interfere with thyroid hormone synthesis. The hydrolysis of another class of glucosinolates, known as indole glucosinolates, results in the release of thiocyanate ions that can compete with iodine for uptake by the thyroid gland (55).
2. However, increased exposure to thiocyanate ions from cruciferous vegetable consumption does not appear to increase the riskof hypothyroidism unless accompanied by iodine deficiency. One study in humans found that the consumption of 150 g/day (5 oz/day) of cooked Brussels sprouts (another cruciferous )for four weeks had no adverse effects on thyroid function (56).
In conclusion eating cruciferous vegetables should not impact your patients thyroid functions until unless they are also suffering from Iodine deficiency or are eating very large quantities of Uncooked Criciferous vegetables. As Rahul sir shared cooking the Cruciferous veggies in this case further alleviates the risk.
why should we add cricuferous to our patients diet,
well apart from the obvious benefit of calories vs satiety, high fiber content here are some other points to consider..
few observational Studies have specifically examined the potential benefits of cruciferous vegetable consumption. In the Shanghai Health Study (mean follow-up, 10.2 years) which included a total of 134,796 Chinese adults, participants in the highest versus low level of cruciferous vegetable intakes had a 22% reduced risk of all cause-mortality and a 31% reduced risk of CVD-related mortality (26). A case-control study conducted in 2,042 subjects (ages, <75 years) who survived a first acute myocardial infarction (MI), and matched healthy controls with no CVD history found that the individuals in the highest versus lowest quantity of cruciferous vegetable intakes (6 times/week versus <1 time/week) had 27% lower odds of MI .
Analysis of data from two 12-week Randomised control trial in 130 participants with mild or moderate CVD risk found that the consumption of 400 g/week of high-glucosinolate broccoli resulted in a significant reduction in LDL- Cholestrol concentration in Plasma.
High intakes of cruciferous vegetables have been associated with lower risk of bladder, breast, colorectal, endometrial, gastric, lung, ovarian, pancreatic, prostate, and renal cancer.
Conclusion : We should definitely include Cruciferous vegetables in our patients diet. In case of Hypothyroid patients instruction should be to take cooked / streamed cabbage only and limit it to certain extent by adding other option to the salads.
See lessC-Peptide Test
C peptide report is very useful in predicting the prognostic journey of any DM patient irrespective of the patient's BMI, weight loss history, and medication history. It is also useful in deciding certain intricacies of treatment including diet and drug tapering too. Hence it can surely be advised iRead more
C peptide report is very useful in predicting the prognostic journey of any DM patient irrespective of the patient’s BMI, weight loss history, and medication history. It is also useful in deciding certain intricacies of treatment including diet and drug tapering too. Hence it can surely be advised in most of our DM cases.
But it is very important to check in following circumstances
1. History of weight loss (irrespective of medicine history)
2. History of DM more than 15 years
3. History of Insulin dependency more than 2 years ( irrespective of BMI/wt loss history)
4. Diabetes is diagnosed before 30 years of age, especially in low to average BMI patients.
but all said C peptide is not a benchmark of Sadhya-Asadhyatva in DM patients and should not be constructed as much. It is always important to give equal importance to clinical history.
See lessMedicine
Primary Management : With history of Multiple joint pain, Soth ( Swelling) we have to treat patient like a case of Aamvaat. So first line of Rx is Pachan. I prefer to start with Amari Churna in high dose along with Flexit tab, Templex, Dolorex and Rasna 7. Anulax/AMari oil can be used for nitya vireRead more
Primary Management : With history of Multiple joint pain, Soth ( Swelling) we have to treat patient like a case of Aamvaat. So first line of Rx is Pachan. I prefer to start with Amari Churna in high dose along with Flexit tab, Templex, Dolorex and Rasna 7. Anulax/AMari oil can be used for nitya virechan. Also advice swedan/hot fomentation at home preferably with valuka pottali Daily once. Reducing symptoms along with steroid dependency is imp.
Additional thoughts:
In a 40 year female menstrual and Obs history is imp. If need for yoni sodhan is identified can add Dashmool kwath/Dashmoolarishta too.
Investogatiom
CRP and ESR levels can be used to prognostically monitor this case. Given the medicine history monitor Sr Creat regularly.
See lessMedicine
Hello doctor, the very scenario you described seems best related to Vaatrakta. Hence in this case I would advice adding Flexit tablet and Laxsa liquid for mridu rechan. Goodilax and Aloori mentioned in previous ans would work in any case of Hyperuricemia as they act beautifully on liver where Uric aRead more
Hello doctor, the very scenario you described seems best related to Vaatrakta. Hence in this case I would advice adding Flexit tablet and Laxsa liquid for mridu rechan. Goodilax and Aloori mentioned in previous ans would work in any case of Hyperuricemia as they act beautifully on liver where Uric acids are metabolised from purines.
See less