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Dr K K Aggarwal

Some tips to avoid dyspepsia from HCFI

By Dr K K Aggarwal
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Identify the triggers For some these triggers could be food such as dairy products. Identifying the foods that trigger the symptoms and avoiding them is crucial.

Go for less gassy foods Avoid beans, cabbage, and cauliflower as these can cause gas. Consume more of foods that are rich in omega-3 fatty acids.

Eat smaller meals This will help your digestive system to adjust better to the condition.

Keep yourself adequately hydrated Drink plenty of water and other fluids. However, limit the consumption of caffeine and alcohol.

Top 5 Pain Interventions to Avoid

By Dr K K Aggarwal
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In response to a call from the American Board of Internal Medicine (ABIM) Foundation for recommendations on the most overused interventions, the American Society of Anesthesiologists (ASA) has issued a list of top 5 tests and therapies that are of questionable usefulness in the field of pain medicine. 

The list includes the following recommendations for doctors:

  • Don’t prescribe opioid analgesics as first–line therapy to treat chronic non–cancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before pharmacologic intervention. If drug therapy appears indicated, try nonopioid medication, such as nonsteroidal anti–inflammatory drugs, or anticonvulsants, before starting opioids.
  • Don’t prescribe opioid analgesics as long–term therapy to treat chronic non–cancer pain until the risks are considered and discussed with the patient. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient’s responsibilities (e.g., urine drug testing) and the consequences of noncompliance with the agreement. Be cautious in coprescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low or estrogen.
  • Avoid imaging tests, such as MRI, CT, or radiography, for acute low back pain without specific indications. Avoid these interventions for low back pain in the first 6 weeks after pain begins if there are no specific clinical indications (e.g., history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain doesn’t require imaging, and performing such tests may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.
  • Don’t use intravenous sedation, such as propofol, midazolam, or ultra–short–acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This recommendation does not apply to pediatric patients.) Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain–relieving effects of the procedure and the potential for false–positive responses. Follow ASA Standards for Basic Anesthetic Monitoring in cases where moderate or deep sedation is provided or anticipated.
  • Avoid irreversible interventions for non–cancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation. Such interventions may be costly and carry significant long–term risks of weakness, numbness, or increased pain.

Top 5 Pain Interventions to Avoid

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Top 5 Pain Interventions to Avoid

In response to a call from the American Board of Internal Medicine (ABIM) Foundation for recommendations on the most overused interventions, the American Society of Anesthesiologists (ASA) issued its list of top 5 tests and therapies that are of questionable usefulness in the field of pain medicine.

The new list includes the following recommendations for doctors:

  • Don’t prescribe opioid analgesics as first–line therapy to treat chronic non–cancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before pharmacologic intervention. If drug therapy appears indicated, try nonopioid medication, such as nonsteroidal anti–inflammatory drugs, or anticonvulsants, before starting opioids.
  • Don’t prescribe opioid analgesics as long–term therapy to treat chronic non–cancer pain until the risks are considered and discussed with the patient. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient’s responsibilities (e.g., urine drug testing) and the consequences of noncompliance with the agreement. Be cautious in coprescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low testosterone or estrogen.
  • Avoid imaging tests, such as MRI, CT, or radiography, for acute low back pain without specific indications. Avoid these interventions for low back pain in the first 6 weeks after pain begins if there are no specific clinical indications (e.g., history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain doesn’t require imaging, and performing such tests may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.
  • Don’t use intravenous sedation, such as propofol, midazolam, or ultra–short–acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This recommendation does not apply to pediatric patients.) Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain–relieving effects of the procedure and the potential for false–positive responses. Follow ASA Standards for Basic Anesthetic Monitoring in cases where moderate or deep sedation is provided or anticipated.
  • Avoid irreversible interventions for non–cancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation. Such interventions may be costly and carry significant long–term risks of weakness, numbness, or increased pain.

Patients with acidity should avoid chocolates and peppermint

By Dr K K Aggarwal
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Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management along with empirical treatment is unsuccessful or who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity..

He said that symptoms that may suggest complicated disease include loss of appetite, loss of weight and difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food which makes the food pipe valve lax. The examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

Hurry, worry and curry are the three main factors for causing acidity apart from alcohol and smoking. People with acidity should consume less of fermented, sour, salty and pungent foods.

Avoid drunk or drugged driving

By Dr K K Aggarwal
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The dangers of drinking alcohol and driving are well known to all. But, it is also important to recognize that taking drugs and driving too can be as dangerous, Drugged driving or driving under the influence of any drug that acts on the brain can adversely affect your, vision, reaction time and judgment and driving skills. This not only endangers your life but also of your co–passengers as well as others on the road.

Tips for safe driving

  • All through the year, especially during the holiday season, take steps to make sure that you and everyone you celebrate with avoids driving under the influence of alcohol or other drugs.
  • Always designate a non–drinking driver before any holiday party or celebration begins.
  • Arrange for someone to pick you up
  • Do not let a friend drive if you think that they are impaired. Take the car keys.