Tag Archives: Aneurysm

The Story of a Deadly Brain Aneurysm..“Doc, was the treatment delayed?”

The Story of a Deadly Brain Aneurysm..
“Doc, was the treatment delayed?”

© Dr. Rajas Deshpande

“Doc, was the treatment delayed?”
The angry husband, Mr. Mane asked in a calm voice but the accompanying relatives had a menacing look upon their faces.

The patient, his wife Mrs. Sujata 35 years old, was brought unconscious two days ago, in a comatose state, at about midnight. I was out of city, so my colleague Neurologist rushed to the hospital and started treatment. We were constantly in touch, within an hour Sujata’s scans were completed, and she was shifted to a critical care unit. She had large bleeding in the brain, and was already beyond a possibility of surgical treatment.

About five years ago, she was diagnosed with an aneurysm in the brain. It is a defect in a blood vessel which balloons out as its walls become thinner and may rupture suddenly, causing either instant death or bleeding in the brain, many a times huge. This diagnosis needs immediate treatment, the right words that describe its risk are: “This is like sitting on a time bomb, not knowing when it is set to explode “.

Many patients do not have much symptoms besides headaches or minor neurological issues usually found on examination by a neurological expert. There are many NeuroIntervention specialists in India since last two decades, who can reach the balloon via a catheter/ tube and close the balloon/ aneurysm so the risk is eliminated and patient cured. Sometimes neurosurgeons are required to operate if the aneurysm has a wide base, and close the connection between the balloon and the artery from which it arises, by an open surgery. © Dr. Rajas Deshpande

Five years ago, we had informed all this to Mr. Mane and Mrs. Sujata. Like many educated patients nowadays, they obtained multiple opinions. Almost all doctors had told them what we had told. However one retired allopathic doctor, now quite old, and one non-allopathic practitioner told them “It is not necessary to do the surgery. Doctors these days advise unnecessary costly treatments”. They started some vitamins and health boosters. © Dr. Rajas Deshpande

The couple decided to wait. The came for follow up once after two years, we told them it was better to operate, but they said “We met our neighbour doctor, he is very senior, and he said that there’s no danger in waiting. I think he knows, see, nothing has happened in two years.. we are happy as it is!”

After that they did not follow up. They had even stopped allopathic medicines. They had come now, when she was beyond any possibility of rescue.

When after a day we told the family that she was brain dead, they asked the question above: “Was her treatment delayed?”.

After explaining to them that everything was done faster than even the best centers in America would have done, they calmed down.

Out of curiosity I asked Mr. Mane: “What did your neighbouring Doc say, the one who had advised to not operate her?”

“Oh, he was very kind. He said nature is cruel and anything can happen anytime to anyone. He arranged for an ambulance too for us.”.

Mrs. Mane didn’t make it, we all felt very sad that a young life that could have survived was lost to a wrong advice. Many doctors who do not specialise in certain complicated and advanced branches of medicine often try to please the patient by giving them an advice that attempts to impress the patient by saying what they want to hear.

It is true that sometimes surgeries are wrongly advised and performed, hence the social confusion about trust. There’s only one way out- explaining the patients and giving them credible websites to refer to, referring them to another specialist who is qualified in that branch. Some trust-less patients will still pay with their health and life. © Dr. Rajas Deshpande

If such cases go to the courts of law, challenging the speed and/ or efficiency of treatment, the honourable courts should consider delays and decisions at every step beginning from the day of onset of symptoms, the delays in visiting doctor, specialist, performing advised tests, obtaining another opinion if advised and getting the prescribed treatment in time. Just holding the doctors and hospitals responsible for not being able to rescue the patient at the last stage is not justified.

Leave aside a few wrong ones, but most surgeons only advise a surgery after deeply thinking about all possibilities, risks and outcomes. Sometimes even when the outcome is uncertain, they must operate. At such times their reputation and career is at a stake, because every mistake is nowadays amplified into a media blast. Still they think about what’s the best for the patients, and try to do their best. Surgeries and procedures, even the costliest, are the cheapest in India since last thirty years- surgeon’s fees are still lowest in all branches, and if we consider the medicolegal and media risk and a violent mobs backed by some politicos, actually the doctor is at a high risk during every major surgery. © Dr. Rajas Deshpande

A doctor is not a merchant or politician to sweet talk to the patient and give them a pleasant but wrong advice and jeopardise their future just to “retain the customer“. This is a noble profession where sometimes strongly worded and unpleasant solutions are essential to save the patient. To expect all the patients and relatives to understand complicated medical concepts and treatments (which takes even brilliant doctors years to grasp) is comical.

We sincerely hope that our society recognises the huge stress every doctor goes through, every day, trying to do their best for patients.
We also wish that the law, politicians and media note that it is often the delays before admission that kill the patients than those after.

© Dr. Rajas Deshpande

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WHEN NOT TO DO YOGA

WHEN NOT TO DO YOGA
INTERNATIONAL YOGA DAY UPDATE:
© Dr. Rajas Deshpande

Even as an Allopathy practitioner, I respect Yoga immensely, and owe much to it: my father insisted that I spend the sunrise hour performing Yoga throughout my school years, and later Mr. Mohandas at the “Kaivalyadham” on Marine Drive Mumbai polished some of my concepts.

However, Yoga is not always safe for all.
Here are some diseases which may worsen / flare up with Yoga, and certain conditions where the “Posturing” / “Aasanas” can lead to complications. Please talk to a well trained / qualified Yoga expert before adopting any routine Yoga schedules. Do not learn Yoga from “partially trained / unqualified” or “Student” practitioners.

The following medical conditions may worsen with Pranayama or other breathing exercises:
Vertigo
Epilepsy
Tinnitus
Bleeding in the Brain especially due to Aneurysms, Tumor
High pressure of CSF (Hydrocephalus) in the skull / brain
Psychiatric Diseases like Mania
Cardiac Failure / Severe Heart Disease
Certain muscle Diseases like Myasthenia / Myopathy
Middle ear disease
Tendency towards aspiration of food in certain degenerative brain diseases
Adverse effects of some medicines may be exaggerated (giddiness, vertigo, tinnitus, blurred vision etc.)

Patients with following diseases must consult an allopathic specialist also before starting a Yoga schedule:
All conditions mentioned above
Uncontrolled or severe blood pressure
Heart Disease, especially valvular and hypertrophic, untreated
Severe anemia
Decompensated Liver or Kidney Disease (Highly abnormal tests)
Diseases of the Spine, Nerves, Bones or Muscles
Infections, especially in Brain and Chest
Brittle bones / fracture tendency / myeloma / deficiency states
Bleeding and Clotting disorders
Ataxia / Balance Disorders
Some types of Parkinsonism where balance and / or swallow are affected.
© Dr. Rajas Deshpande

Sheershasana (Headstand) is extremely dangerous in patients with high blood pressure, aneurysms and other blood vessel related diseases of the brain, as the high pressure due to gravity may cause bleeding in the brain. If you have recurrent headaches, get a proper medical check up before embarking upon Yoga lifestyle.

The following patients must also especially avoid Sheershasana (Headstand)

Migraines / Severe Headaches / Sinusitis
Gastrointestinal Reflux Disease / severe Acidity
Patients who have had recent stenting in the blood vessels of neck or brain.
Cervical disc disease / Spinal diseases (some)
Bleeding in the eyes / retina.

Pregnant women and elderly must take special precautions while performing Yoga. All children must be supervised.

Yoga is an extremely useful lifestyle that helps achieve and maintain good health and longevity for most.
We must learn to use it wisely.

The list of contraindications above may not include all conditions in which Yoga must be avoided. Please talk to your Yoga Master and Physician both before starting Yoga.

Happy Yoga Day! Wishing best health and long life to all!!

© Dr. Rajas Deshpande