Thoracic Back Pain: what it is, identifying, preventing, and treating it

Pain in the upper and lower back, in the region known as the thoracic spine, is almost as common an ailment as lower back pain. The thoracic spine is the region below the neck and above the ribcage with 12 backbones with disks ranging from the T1 to T12 vertebrae.The thoracic spine or the middle and upper back, as it is also commonly called, plays an important role in the body: it anchors the rib cage to protect vital chest organs, such as the lungs and heart, and provides core stability to the body.

While the cervical or lower spine is built for mobility, the middle and upper back provides your body proper stability. There are various ways in which the muscles, ligaments, bones, and disks in the spine can injure nerves in the thoracic spine and cause back pain.

Symptoms of thoracic back pain

Symptoms of middle and upper back pain vary with the cause of the pain.

Some common symptoms of mid back pain because of daily activity or extra exertion during exercise or added activities during the weekend are:

• Dull pain
• Muscle ache
• Muscle stiffness or tightness
• Sharp or shooting pain
• Tenderness
• Burning sensation
• Headache

The above symptoms are typical of musculoskeletal strain, though they are known to occur with spinal injuries as well. However, if your thoracic pain is related to the nerves, bones, or disks of your thoracic spine, you will experience:

• Chest pain
• Numbness or tingling in your legs, chest, or arms
• Incontinence (loss of bowel control and/or bladder leakage)
• Pain down the legs
• Pain in the lower back
• Weakness in your legs or arms

What causes thoracic or middle back pain?

Some common causes of thoracic back pain related to daily lifestyle are:

• Overuse injuries: Also known as overuse injuries. This involves repeatedly using the thoracic part of the spine (for sport or work) for prolonged durations.
• Muscular irritation
• Lack of muscular strength
• Poor posture or sitting or standing in a slouched position for long durations.
• Prolonged sitting at a computer
• Using a backpack
• Obesity: There is a strong correlation between obesity and back pain. When body weight increases, so does the risk of back pain.

Middle or upper back pain can also be caused by some medical conditions. Though they are less common, thoracic back pain is likely to originate from them as well. They are:

• Trauma or injury from sports-related activities or whiplash from a car accident.
• Degenerative, metabolic, inflammatory, infective, or neoplastic conditions.
• From medical conditions such as osteoporosis, osteoarthritis, ankylosing spondylitis, or Scheuermann’s disease.

Preventing thoracic back pain

You can also work towards preventing everyday musculoskeletal strain that, over prolonged periods, causes thoracic back pain:

• Improve your posture:

  - Keep your shoulders back while standing

  - Avoid slouching while sitting or standing

  - Take breaks to stand and stretch if you sit for long durations of time through the day.

  - If you have a sedentary job that requires you to spend long hours at the desk, use an ergonomic chair that supports your back properly and adjust your computer monitor, mouse, keyboard, and mouse positioning to maintain good posture while working.

• Change your sleeping position: If you sleep on your back, you are more likely to cause misalignments in your spine and have upper back pain. It is suggested that you sleep on your side in the foetal position with a pillow between your knees.

Treatment for thoracic back pain

Though middle or upper back pain is painful and inconvenient, it is usually not a cause of serious concern. Many cases settle down on their own over time without any specific treatment. However, medical treatment and intervention should be sought immediately when the pain develops suddenly and severely, as in the cases of accidents and other injuries, and worsens progressively.

Treatment for thoracic back pain ranges from home remedies and everyday changes to surgeries. They include:

Home remedies:

Musculoskeletal strain can be treated at home with:

• Gentle stretches and rotations
• Application of ice to reduce inflammation and pain
• Heat compress to ease stiffness and improve mobility
• OTC pain medication such as paracetamol, ibuprofen.

Medical treatments:

• Prescription medication: Prescription anti-inflammatory or muscle relaxants may be given by your doctor to ease your middle or upper back pain. If depression is suspected to play a role, anti-depressants for long-term use may also be prescribed.
• Injections: Pain medication is injected at trigger points to provide relief and as means to pursue interventions such as exercise and physiotherapy.
• Physical therapy: Physical therapy and chiropractic care may be combined with medication or other interventions to ease and treat thoracic pain.
• Surgery: Surgery is rarely sought as means to provide relief for upper or middle back pain, but it can be chosen as the course of action if the problem is in the spine as in the case of vertebrae fracture, deformity, or a herniated disc.

The most common procedures for thoracic spine injury are:

• Spinal laminectomy/spinal decompression: Bony walls of the vertebrae may be removed by surgery to ease pressure on the nerves.
• Microdiscectomy: A minimally invasive procedure can be carried out to remove a spinal disc that is bulging and pressing on a nerve causing pain.
• Vertebroplasty or kyphoplasty: A glue-like bone cement can be injected to repair compression fractures caused by osteoporosis.

The outlook or prognosis for thoracic back pain depends on your general level of fitness, age, and the underlying cause. Most cases of upper or middle back pain resolve by themselves with some rest and without explicit medical intervention within a week or two. It is advisable to resume normal activities gradually to interfere with the recovery and avoid risking re-injury. Medication, physical therapy, and surgeries are often reliable and means to provide long-term relief from thoracic back pain. To learn more about pain in the thoracic spine, its prevention, and treatment, consult the orthopaedicsurgeons at the Sagar Brain & Spine Institute, the best orthopaedic hospital in Bangalore.

Responding to Sudden Cardiac Arrest

What is sudden cardiac arrest?

Sudden cardiac arrest (SCA) is a fast occurring and potentially life-threatening situation where the heart unexpectedly malfunctions and stops pumping blood. During an SCA, blood flow to the brain and other vital organs is disrupted. Unless medical attention is provided almost immediately, the risk of fatality increases rapidly.

A sudden cardiac arrest is different from a heart attack – an SCA is an electrical problem in the heart. A heart attack, on the other hand, occurs when there is a disruption of blood flow to some part of the heart muscle. The heart’s electrical system regulates the rhythm and rate of the heartbeat. Complications with this electrical system can cause irregularities in heartbeats known as arrhythmias. Arrhythmias can cause the heart to beat too slowly, too fast, or in irregular patterns. Such irregular heartbeats can result in the heart to stop pumping blood – these result in sudden cardiac arrest.

Patients suffering from cardiovascular conditions are at a higher risk of suffering a sudden cardiac arrest. However, SCA can occur in seemingly healthy people with no known history of heart disease or obvious risk factors to SCA.

What causes sudden cardiac arrest?

There are several risk factors that can cause irregularities in heart rhythms leading to a sudden cardiac arrest:

• Scarred or thickened heart muscle from coronary artery disease, prior heart attack, cardiomyopathy, viral infections, hereditary conditions, and other conditions that can damage and scar the heart tissue.
• Electrical abnormalities
• Poorly managed heart failure
• Coronary artery disease
• Blood vessel complications
• Use of recreational drugs
• Cardiomyopathy
• Family history and genetic conditions
• Smoking

Signs and symptoms of a sudden cardiac arrest

In order to respond to a sudden cardiac arrest, it is important that you are able to recognise the symptoms in this emergency situation. Watch carefully for signs such as:

• Lack of consciousness/ sudden loss of responsiveness: The person is not conscious, is collapsing, has collapsed, or isnot able to respond to your query when you ask if he or she is okay.
• Lack of pulse: During SCA, the heart stops beating and you may not be able to feel a pulse.
• No or abnormal breathing: The person may be breathing weakly or not at all.

How to respond during a sudden cardiac arrest (SCA)?

In the event that you observe the abovementioned symptoms in a person, you must act quickly and follow these steps immediately:

• 1. Check for responsiveness: Ask the person if they are all right and tap them to check for any signs of response. If the person is not moving, speaking, able to blink or react to your question in any way, and is unresponsive, follow through with the following steps.
• 2. Alert people around you and call for emergency medical services immediately. You can call 108, 102, or 112 for medical emergency help in India.
• 3. If the person is not breathing at all, perform cardiopulmonary resuscitation (CPR).
• 4. To administer CPR:

  - Clasp your hands together and place both your hands on the person’s breastbone.

  - Push hard and fast in the centre of the chest, making the chest move inward about an inch.

  - Push fast and at a controlled rate of 100 to 120 pushes a minute, and let the chest resume a normal position after each push. (Pushing to the beat of the song Staying Alive will get you approximately the 100-120 pushes.)

  - Continue performing CPR until medical help arrives or an AED is made available.

• 5. Use an automatic external defibrillator (AED) if available: A portable defibrillator comes with a mechanism for voice commands that gives you step-by-step instructions. AEDs are designed to provide audible commands to an untrained person at a time of cardiac emergency. The AED will diagnose the rhythm of the person’s heart before delivering a shock. The electric shock to restore normal heart rhythm will be delivered by the AED only if the person is suffering a cardiac arrest
• 6. In case there is no AED available and you are still waiting for emergency medical help to arrive, continue delivering CPR.

Most people who have suffered a sudden cardiac arrest survive if they receive help very quickly. The fatality rates of SCAs, however, are very high – 95%. Most fatalities occur because the person is alone, the people around did not know CPR or call emergency medical help, or if the emergency medical help does not arrive within the 10 minutes to avoid brain death. Though such statistics may seem discouraging, a healthy lifestyle with regular exercise, a balanced diet with low sugar and oil, and avoiding habits such as smoking and drinking go a long way in preventing heart disease and cutting risks of sudden cardiac arrests. For more information regarding your heart health and risks of cardiac disorders, book an appointment with the best cardiologists in Bangalore at the Sagar Heart and Vascular Institute.

The Dangerous Connection Between Diabetes and Heart Attacks: Are You At Risk?

The risk of heart disease increases with diabetes. Heart disease, also known as cardiovascular or coronary disease, can lead to a heart attack or stroke. A diabetes patient is twice as likely to develop heart disease and suffer a heart attack than someone who doesn’t have diabetes, and at a younger age as well. The longer you suffer from diabetes, the more your risks of heart complications increase.

Cardiovascular conditions affect your blood circulation too. This, in turn, make your diabetes complications worse. Thus begins a vicious cycle between heart disease and diabetes in which poor management of one condition worsens the other.

Diabetes and your heart

The health of your heart depends on the health of your veins and arteries. With diabetes and high blood sugar levels, the blood vessels and the nerves that control your heart can get damaged.

People with diabetes also face a greater danger of heart failure. With heart failure, the heart is unable to pump blood throughout the body effectively. This can lead to a build-up of fluids in the lungs and make breathing difficult.

Diabetes also increases the risk of other medical conditions that are detrimental to your heart health:

• High cholesterol or triglycerides: Low HDL cholesterol (“good” cholesterol) and high LDL (“bad” cholesterol) can lead to the hardening of arteries.
• High blood pressure: Your cardiovascular health suffers from having diabetes and high blood pressure with the increased force of blood through your arteries damaging artery walls.

Can you get “silent” heart attacks?

A common side effect of diabetes is neuropathy. Neuropathy is a kind of nerve damage that causes symptoms such as numbness, weakness in the extremities (hands and feet), and tingling sensations. This condition can also damage nerves that lead to your blood vessels and heart, making it difficult for you to gauge warning signals like pain and discomfort in your body.

In such a scenario, neuropathy can mask the pain and symptoms of a heart attack. A sort of mute button on the pain associated with a heart attack in the jaw, chest, and arm may seem fortuitous, but can be deadly if the patient is unable to identify the tell-tale symptoms of a heart attack and seek timely medical intervention.

Managing diabetes for taking care of your heart

The link between heart health and diabetes is not just down to elevated blood sugar levels; there are other conditions, such as high blood pressure and cholesterol, that go together in damaging blood vessels and complicating heart conditions.

The following tips and lifestyle changes can help you manage diabetes and your heart:

• Get regular exercise:
  Increased physical activity helps manage diabetes by improving your body’s sensitivity to insulin, the hormone that regulates blood sugar levels. Regular exercise also improves your heart health and reduces blood sugar levels. You should aim to get at least 150 minutes of moderate–intense exercise, such as brisk walking or light jogging, every week.

  
  

• Maintain a healthy body weight:
  For overweight diabetic patients, even modest weight loss of 5% - 7% of body weight can result in a considerable reduction in blood sugar and cholesterol.

  
  

• Follow a healthy, balanced diet:
  Avoid processed carbohydrates such as most fast foods, sweets and sugary drinks, and foods made from all-purpose flour. Reduce your alcohol and red meat consumption. Eat more vegetables and fruits, whole grains, and lean proteins.

  
  

• Reduce stress:
  Stress is closely linked to cortisol levels and blood pressure. Sustained stress is one the most common causes of high blood pressure and in turn can lead to unhealthy habits such as excessive drinking, eating, and smoking. To manage stress, seek help from friends and family, a mental health counsellor, try meditation, or get regular exercise.

  
  

• Manage your ABCs:
  

  • A: Get your HbA1C tests done every 2 – 3 months to measure your average blood sugar levels and try to keep them in the target range as recommended by your doctor.
  • B: Try to keep your blood pressure to levels below levels recommended by your doctor.
  • C: Manage your cholesterol levels.
  • s: Stop smoking (and avoid starting at all costs.)

People with diabetes are at a much higher risk of developing heart disease and heart attacks. Minimising risks of heart attacks that arise with diabetes isn’t just down to keeping your blood sugar in check – it is important to manage other contributing factors as well. In addition to the steps mentioned above, your doctor may also prescribe you medication to manage your blood sugar, cholesterol and triglyceride levels, and blood pressure to reduce the risk of a cardiovascular event.

For more detailed information about diabetes, heart conditions, and how to prevent emergencies like heart attacks, book an appointment with the best heart specialists in Bangalore at the Sagar Heart and Vascular Institute.

Insomnia In Teens Can Cause Heart Attacks

A vast number of adolescents are not getting sleep regularly. Though this may not come as a surprise to many parents, this trend can have a worrying impact on teenagers’ heart health. Health experts recommend more than 8 hours of sleep for adolescents aged 14 – 17 and more than 9 hours of sleep for those aged 11 – 13. Only about 50% of children get more than 7 hours of sleep, with older teens sleeping even less than their younger counterparts.

Why is sleep important?

As adults with many responsibilities, a good night’s sleep may seem like a luxury. However, sleep plays an integral role in the body’s recovery and optimal functioning. Good quality sleep is important for mental health, energy levels, blood pressure, metabolism, and – in particular – cardiovascular health.

Insomnia has high comorbidity with many cardiovascular diseases, including coronary heart disease, hypertension, incident cardiovascular disease, and heart failure. Additionally, regular poor sleep increases the risks of medical conditions such as diabetes and obesity and shortens life expectancy.

What are the risks for our teenage children?

Previous research has found links between insomnia in children and childhood obesity, and consequently, with higher blood pressure. As per a study published in the journal Pediatrics, researchers found that nearly 33% of adolescents slept for around 7 hours every night and that nearly half of them were fully asleep for less than 85% of the sleep time. All in all, the median sleep duration was a measly 7.35 hours every night for around 800 adolescents in the study ranging 11 – 17 years in age.

Researchers found that teenagers who did not get adequate sleep regularly had a higher body mass index (BMI) and belly fat, high blood pressure, abnormal cholesterol or blood lipids, and insulin resistance – a condition that increases the risk of diabetes.

All these comorbidities can drastically increase the risk of cardiovascular disease in teenage adolescents.

Why are our teenagers not sleeping properly?

Though medical conditions such as sleep apnoea affect sleep patterns directly in around 25% of men and around 10% of women, the primary cause of poor quality and inadequate sleep is mostly down to the lifestyle and poor sleeping habits.

Teenagers are caught between long school days, homework, projects, extra-curricular activities, with early school timings contributing to less sleep. With Generation Z brought up on mobile devices and social media, phone screens and computers take up a majority of the attention span of young and older teens. They ignore sleep, stay up late with the blue light from their devices keeping their brains awake, making it harder for them to fall asleep. In fact, the CEO of Netflix, Reed Hastings, once declared that the streaming service’s biggest competition is sleep – and that they’re winning.

How do we get teenagers to improve their sleeping habits?

When it comes to sleep and its dangers to our teenager’s heart health, we cannot just sit back and claim that “teens will be teens.” Their future health is at risk and this situation demands action.

The following tips can help your teenagers get the sleep they need:

• Develop discipline with devices and time on electronics:
  Make a rule that electronic screens and devices are powered down close to an hour before bedtime. Have your teen put his or her phone, tablet, laptop, and other mobile devices somewhere besides his or her room.

  Light-emitting devices and “blue light,” in particular, block the release of the sleep hormone melatonin and delay sleep. Also, just knowing that the device is at an arm’s length and new content and notifications is available in the app feed are adequate to keep your teen’s mind awake.

  
  

• Plan and prioritise sleep:
  If daily activities and school work make it impossible for your teen to get the necessary 8 hours of sleep, something has to give. Sit with your child, map out the day, and evaluate the way your teen spends his or her day. You will soon find the activities to prioritise to ensure good sleep for your teen.

  
  

• Go sugar- and caffeine-free after 5 PM:
  The caffeine and “sugar rush” from energy drinks, sugary sodas, and other sweets stay in your teen’s system for about 4 to 5 hours. Staving off these foods well before sleep time will help negate their ability to keep your child awake past his or her bedtime.

  
  

• Set sleep goals:
  Use reminders or alarms to remind your teenager of the time to start winding down and settle down to sleep. You can also encourage your teenager to make “sleep pacts” with his or her friends so that they all turn off their phones and say their goodnights at the same time.

  
  

• Maintain a regular schedule:
  Do not fall into the trap of “catching up on sleep” on weekends. Averaging out lost sleep over weekdays/ school nights with more sleep during weekends sounds like a tempting idea to maintain good cumulative sleep hours, but is a lost cause. Regular nightly sleep of good quality is what will most benefit your teenager in the long term.

Our teenagers’ future is the most important priority for us. That is why we warn them against developing bad habits and the risks of substances such as tobacco, drugs, and alcohol. This is precisely why we need to talk to them and help them understand the importance of sleep as well. Good sleep is necessary for your child’s development and good health and insomnia poses a serious threat to these. To learn more about how insomnia can affect your teen’s health or cardiovascular health, reach out to the best cardiologists in Bangalore at the Sagar Heart and Vascular Institute.

All you need to know about Delta Plus Variant

Since last 2 years, global healthcare is going through a challenging phase. What continues to keep the whole world on their toes is how to jointly deal with two situations; Pandemic and Panic. The Covid-19 virus continues to keep everyone guessing, but what still lingers in the mind of millions across the globe is, continued panic.

Just as all of us in India and overseas begin to heave a sigh of relief that the second wave is slowly coming to control, experts have found out another variant of the virus, this time, even more deadly and dangerous than the earlier ones – The Delta Plus.

Here, we talk about the Delta Plus Variant, the symptoms, risk factors and how to manage the situation.

What is the Delta Plus Variant?

Ever since it came into limelight for the first time in 2019, Coronavirus has been constantly changing forms and turning out into something more fearsome than its previous version. Labelled as, ‘a variant of concern’, this new mutant version of the Delta strain of Covid is known as Delta Plus.

The Delta Plus (B.1.617.2.1/ (AY.1) is seen as the next generation of SARS-COV-2. Research continues across the world to understand its severity and implications in greater depth. Studies conducted so far suggest that the Delta Plus variant is the result of the mutation in the spike protein of SARS-COV-2, which helps the virus enter the body and infect the human cells.

What are the symptoms of the Delta Plus Variant?

Top Virologists from across India and overseas have said that the symptoms of the Delta Plus variant are a combination of the Delta variant as well as its partner, Beta. They include, cough, diarrhoea, fever, headache, skin rash, discolouration of fingers and toes, chest pain, and shortness of breath.

Patients may present some other symptoms too like Stomach ache, nausea, vomiting and sudden loss of appetite.

Why is the Delta Variant a cause of concern?

Delta Plus has shown an increased ability to spread almost 60-70 times faster than its predecessor, the Delta variant. According to experts and studies conducted, this variant can easily attack the lungs and cause immense damage, leading to serious complications. According to one of the former senior most scientists associated with the Indian Council of Medical Research, two graded mutations which have occurred within the Delta variant have contributed to higher and faster transmission efficiency. This makes the Delta variant even more threatening than its predecessors.

Treatment and Support to manage the Delta Variant

Although medical experts are of the opinion that it is a bit early to predict the effectiveness of the existing vaccines on the new variant, they are of the firm opinion that Vaccination and safety measures such as wearing of face masks and maintaining physical distance are extremely critical to fighting the Delta Plus coronavirus variant, Detailed research continues on a war footing to find out more on how to arrest this rapidly surging variant.

The Bottom Line

At Sagar Hospitals, our interdisciplinary team of experts handle Delta plus variant infections in our patients, with utmost care and efficacy. In light of the continued variations observed in the behaviour of the Corona virus, it becomes increasingly difficult to predict when and how the virus will lose its stranglehold on human life. Till a concrete solution is arrived at, it becomes our independent responsibility to take care of ourselves and not ignore the slightest of the symptoms.

To know how you can be safe from the dangerous consequences of the Delta variant, meet our expert doctors at Sagar Hospitals for complete guidance and steps to be taken to stay safe and healthy.

Steps to Covid Recovery Plan

Covid-19 has been a pandaemic with a difference. Different in many ways as it continues to change faces. While to begin with, the symptoms of Covid-19 were similar to those of a patient with a common flu, with passage of time, patients started presenting with newer type of complaints which ultimately resulted in testing positive for the virus.

A unique point about this particular virus is that even if a person considers himself to have completely recovered, there is still every possibility that he may catch the infection again. This makes it extremely important for not only the recovered patient but those around him, to continue to strictly follow Covid-19 safety protocols as laid down by the health department and government.

In addition to Basic Protocols like wearing of mask, washing hands at regular intervals and maintaining a physical distance, there are certain important steps to be followed, to ensure a steady recovery from the dreaded virus.

Steps towards recovery from Covid-19

As it would happen with many patients, who would recover from various types of serious diseases, the fear of contacting the illness once again, can continue to haunt even Covid patients. Hence, it is required to formulate a methodical recovery program to ensure that start feeling confident all over again.

Taking care of emotional well-being

The very fear of having contacted Covid-19 can cause lot of anxiety to patients and their families. Hence it is extremely important for the families to ensure that the patient stays positive. It is necessary not to dwell on tough days passed by and prepare mentally towards recovery to begin with. Getting back to routine activities slowly will help in creating a fresh feeling of confidence.

Maintain a healthy diet routine

It is very important not to miss your daily meals. Include energy rich cereals in your diet like cereals, pulses, milk and milk products. Consume more of seasonal fruits and vegetables and leafy vegetables. These help in strengthening the immune system. Stay hydrated as much as possible and drink lots of water.

Regain Your Strength

Covid-19 can cause extensive damage to the lungs and respiratory system. Hence recovery would take some time. It is not a bad idea to reach out to an occupational therapist. He can help you on your road to recovery, by helping in adjusting to new energy levels. To support your recovery program, cut down on excess and strenuous activities.

Practice Breathing Exercises

Breathing Exercises can be extremely useful in helping giving momentum to the lungs. Regular sessions of Pranayama and Chest exercises can help reduce breathlessness.

Get yourself tested for Covid-19

Recovery symptoms can vary from person to person. Hence, it is advisable to have a Covid test is any symptoms persist for a long time. For those who recover, chances of getting re-infected are low for the first three months.

The Bottom Line

Covid-19 has shown itself to be a very tricky virus to deal with. The need of the hour is to continue to stay safe even after full recovery. It is extremely important to follow all safety protocols as chances of getting re-infected due to ignorance can be very high. Today, we have vaccines at our disposal which can make a huge difference. Getting vaccinated should be top priority after the scheduled period of recovery is over. How long Covid-19 will continue to keep us humans on our toes is unknown but following safety protocols should never be compromises.

Mental Preparedness before getting vaccinated

The Covid-19 virus came with no prior warning. Not only did it rattle the global healthcare sector, but also threw the global economy, completely out of gear. Exactly a year ago, researches and studies began to find out an answer to the dreaded virus. It was not impossible but a dream for sure, then. Today, thanks to the stupendous and tireless efforts of our distinguished scientists, the dream has transformed into reality, in the form of indigenously developed Covid-19 vaccinations, much to the delight of everyone.

While vaccinations have been administered in the past to prevent diseases like Cholera and Polio, the Covid-19 vaccine had to be a new discovery and tested not once but multiple times, to prove that it is completely safe and effective. Over and above this, convincing the consumer about its safety with bare minimal side effects too was a challenge for doctors. All this required getting people mentally prepared to take the vaccine.

Here, we talk about how to get mentally prepared to take the vaccine.

Vaccines and Covid-19

A cocktail of emotions, while dealing with the Covid-19 pandemic, including extreme fear, anxiety, panic, grief, guilt, loss of loved ones and uncertainty about livelihood, have all led to countless health issues. Today, with two of the most effective vaccines developed by our own country and successfully in use, citizens can breathe a bit easy with hope of surviving the effects of the deadly virus. Being the first of its kind to be developed within India, there surely will be certain doubts among citizens on its effectiveness and after effects. However, the point to be remembered here is that no vaccine is released for public use unless it is certified to be completely safe and adequate alternative medication is made available to cope up with any possible after effect. It is more to be prepared mentally and feel completely confident.

How do we prepare mentally to get vaccinated?

With different types of vaccines available now to choose from, the doubts in the minds of citizens about which one is most effective, is quite understandable. In many ways, Covid-19 vaccines are just like the other vaccines, you would have seen before. It is therefore necessary to plan your vaccination schedule in such a way that you give yourself sufficient time to recover from possible after effects of the vaccine, which in most of the cases, are very mild.

Here are a few suggestions.

1. Plan your appointment

It is wise to plan your appointment before any significant commitment to help you overcome any mild side effect. Choose a vaccination centre close by to your residence.

2. Maintain the same vaccine across both the dozes

It is very important to the same vaccine type till you finish both the schedules dozes. Any change of vaccine type in the intermediate period can lead to certain side effects.

3. Have pain relievers on hand

Side effects are normal after vaccination. Most people experience mild side effects like fever, pain at the vaccination site or headache. It is good to keep some pain relievers like paracetamol tablets in stock.

4. Stay hydrated

Have your routine breakfast or lunch depending upon your scheduled appointment for vaccination and stay hydrated. Some people may get nervous when they get any kid of shot. This can make them feel dizzy. Proper nutrition and hydration can combat that.

5. Avoid Alcohol and Smoking

Stay away from Alcohol and Smoking before and a couple of days after vaccination. This will help in managing after effects of the vaccine in a better way.

The Bottom Line

Intense efforts have gone into the development of vaccines for Covid-19. While vaccination is extremely important, it is also necessary to adhere to Covid-19 protocols strictly, to stay protected. The best solution to reduce anxiety is to go the nearest designated vaccination centre and get vaccinated.

For more information on Covid-19 vaccinations please get in touch with our medical experts at Sagar Hospitals in Bangalore. Stay Safe Stay Healthy.

Long COVID explained. Are you at risk?

Covid-19 has taken its toll on the healthcare infrastructure globally and nowhere is it more apparent in India. The struggles of finding oxygen cylinders, concentrators, hospital beds, and ICU beds with ventilators have made the health crisis impossible to ignore and the focus of the nation’s attention.

Accounts of recovered Covid-19 patients and various studies around the world, however, seem to signal a more drawn-out, lingering struggle. Though there isn’t an exact definition for “Long COVID,” it is synonymous with the long-term impact of Covid-19 even after a patient tests negative for it. While Covid-19 symptoms seem to pass for most people after recovery, some seem to suffer the effects of the illness weeks and even months after the initial infection. New studies show that both the elderly and the young are susceptible to Long COVID.

Here, we discuss Long COVID in detail, the risks, its symptoms, and how to manage the condition.

What is Long COVID?

Long COVID is a term that describes the post-Covid-19 symptoms experienced by patients much after they have recovered from the initial infection. While most people with mild to moderate infections recover within 2 weeks, Long COVID patients experience post-Covid-19 complications that persist for months. Though there isn’t a precise duration that is used to define Long COVID, symptoms that persist for 8-12 weeks and beyond are generally considered to qualify for Long COVID. People suffering from these symptoms are known as long-haulers.

Research from multiple studies and on-ground emerging testimony from medical professionals identify two main groups of long-term symptoms: respiratory and multi-organ. Respiratory symptoms such as breathlessness and cough are most common and also include lung fibrosis, headaches, and fatigue. The second group of symptoms affects many organ systems of the body, including the heart, the nervous system, kidneys, and more. In the study from COVID Symptom Study app (UK), 4182 people reported long-term symptoms such as cognitive impairment (or “brain fog”), anxiety, heart palpitations, numbness, and “pin and needles.”

How many people get Long COVID? Who is at most risk?

Details regarding the number or proportion of people that suffer from Long COVID are still emerging. People with comorbidities, however, are a group at risk in particular.

A study by the Stanford School of Medicine found that more than 70% of patients hospitalised for Covid-19 suffered various symptoms months after recovering from the initial infection.

In a study led by the University of Leicester of over 1000 participants who had required Covid-related hospitalisations reported that 70% patients did not make a full recovery 5 months after being discharged. Nearly 18% of those who were working before contracting Covid-19 could no longer continue working afterward. A further 19% reported having undergone a health-related change at their workplace.

According to the estimates provided by the Office for National Statistics, 20% of long-haulers in the UK found their daily activities and quality of life severely impacted by Long COVID symptoms.

Studies are showing that it is not only the hospitalised patients with moderate to severe COVID that are susceptible to Long COVID, but non-hospitalised patients with milder cases as well. As per a survey conducted by the US CDC (Centers for Disease Control and Prevention), 35% of non-hospitalised patients with mild Covid-19 suffered various symptoms well after 21 days. This includes patients in the 18-34 age group where 20% reported ongoing symptoms.

Overall, research shows that nearly 33% of non-hospitalised Covid-19 patients will be experiencing Long COVID symptoms up to 3 months later, and some for even 6 months or longer. In comparison, only 10% of flu patients are still sick after 14 days.

What are the symptoms of Long COVID?

Many Long COVID patients experience the same Covid-19 symptoms from their initial infection, albeit for months. Post-Covid-19 symptoms can range from 4-12 weeks for most long-haulers and longer (up to 6 months or more) in rarer cases. Some people can develop new symptoms also, such as hair loss, and undergo cycles of improving and then getting worse.

Symptoms of Long COVID include:

● Fatigue: Severe fatigue and tiredness is a common Covid-19 symptom that, according to researchers, is prevalent in recovered patients weeks after testing negative for the initial illness. Covid-19 severely affects the immune system and the body as a whole, and it is apparent from patient testimonies. Long-haulers complain of long-term fatigue and an inability to resume physical/ daily activities at pre-illness levels for months.

● Anxiety and depression: Covid-19 can put an immense mental strain on patients with the possibility of health levels plummeting in a short span of time. This is worsened in the backdrop of health services under duress with necessary medical resources in short supply—all while isolating or quarantining. This toll on mental health can continue much after the initial recovery (as PTSD in extreme cases) and be exacerbated by other physical post-Covid-19 symptoms.

● Brain fog/ cognitive impairment: Brain fog is a common post-COVID symptom that can severely disrupt the functioning of the central nervous system. Covid-19 can have a direct impact on the brain and when it affects other organ systems as well, this effect is compounded.

Brain fog can interrupt cognitive abilities, resulting in confusion and mental fatigue. It can make it very hard for people to concentrate effectively and focus on tasks.

● Shortness of breath/ dyspnea: Patients can still suffer from an inability to breathe smoothly weeks after recovering from their initial Covid-19 infection. This can indicate fatigue and low oxygen levels in the body and can lead to chest pain if not managed in time.

● Heart palpitations: The immune response to fight the coronavirus infection can cause high inflammation in the body that can damage healthy tissue, including the heart and lungs. Post-Covid-19, this can manifest as rapid or irregular heart rates or palpitations.

● Chest pain: Chest pain post-Covid-19 can happen due to myalgia (muscle pain or soreness) from a severe bout of COVID. This can make the area sore to the touch and movements such as turning or twisting the chest can be painful. Long-haulers can also suffer from non-cardiac or non-specific chest pain that can be sharp or dull. These symptoms can ail recovered patients for weeks.

● Joint or muscle pain

Treatment and support to manage Long COVID

Considering that Long COVID can impact many organ systems, health experts from across the globe and at Sagar Hospitals suggest a multi-disciplinary approach for dealing with Long COVID. Doctors from various disciplines such as infectious diseases, cardiology, pulmonology, and others must work together to focus on increasing the lung capacity and physical strength of Long COVID patients.

Our doctors at Sagar Hospitals suggest pacing yourself, taking adequate breaks, and gradually increasing the amount of exercise to manage breathlessness and fatigue. Flexibility exercises and controlled strength training can help relieve joint and muscular pain. Finally, our experts advise you to not ignore your mental health and to be kind to yourself during recovery.

In light of recent research and numerous testimonies from recovering Covid-19 patients, post-Covid-19 symptoms that stay with people for months after the initial infection may be the next global healthcare challenge. Long COVID has proven to affect not just hospitalised patients but patients suffering mild COVID as well. These lingering post-Covid-19 symptoms can severely impact the daily lives of patients and even affect employment. As more studies are conducted on Long COVID, more information on its impact on recovering patients will come to light.

To find out about multi-specialty and multi-expertise medical teams that focus on providing holistic care to rehabilitate recovering Covid-19 patients, reach out to our experts at Sagar Hospitals.

Mucormycosis: what is the “black fungus?”

As the second wave of the Covid-19 pandemic rages across India, a fungal infection known as mucormycosis (or commonly as the "black fungus") is being reported in increasingly high numbers amongst recovering and recently recovered Covid-19 patients. The country now faces the prospect of multiple health crises with the "black fungus" being declared a pandemic by many states. The rampant mucormycosis infections have added yet another dangerous complexity to the recovery of Covid-19 patients and created more panic amongst the citizenry.

What is the "black fungus?"

Mucormycosis is a rare but serious fungal infection caused by a group of moulds known as mucormycetes. These moulds are prevalent in our natural environment as spores in the air and in places such as the soil, plants, manure, and decaying vegetables and fruits. It is so ubiquitous that it can be found even in the nose and mucus of a healthy person.

Mucormycosis generally affects immunocompromised individuals (people with a compromised ability to fight viruses, germs, and other environmental pathogens). Patients recovering or recently recovered from Covid-19 typically suffer from a weakened immune system, and are being found to be susceptible to mucormycosis infection. The infection affects the sinuses, the lungs, and the brain.

With an overall mortality rate of 50%, it can easily be life-threatening in immunocompromised people.

What are the risk factors for contracting this infection?

In spite of the seemingly close association with Covid-19 recently, "black fungus" does not spread by direct contact - neither by person-to-person contact nor by droplet spread. This fungal infection also does not spread through oxygenation, humidifiers, or water. The fungal spores are found indoors as well as outdoors and enter the respiratory tract via inhalation.

Though there are some linkages cited by doctors with overuse of zinc and iron supplements, the main risk factors for contracting mucormycosis infections are believed to be the following:

● Drug-related compromised immunity from steroid overuse, immunosuppressant drugs, or chemotherapy.

● Diabetes or hyperglycemia (high blood sugar levels).

● Immunocompromised patients suffering from conditions such as cancers and HIV/AIDS.

What is the link between Mucormycosis and Covid-19?

In spite of the seemingly close association with Covid-19 recently, there is no direct link or causation between Covid-19 and mucormycosis.

There are, however, many factors that are closely connected to Covid-19 cases that increase a patient's susceptibility to contract the infection:

● Diabetes: Uncontrolled diabetes contributes to weakening the immune system. With an already compromised immune system, a Covid-19 patient has an additional complication with diabetes. A history of uncontrolled blood sugar levels not only exposes these patients to the risk of contracting more severe illnesses but also encourages the "black fungus" infection to thrive in the body.

● Steroids: Steroids are used to reduce inflammation in the lungs of Covid-19 patients and help control lung damage when there is an overly strong reaction from the immune system to fight the coronavirus. These drugs, however, can in addition to controlling the immune response also weaken it severely. They also push up blood sugar levels in diabetic as well as non-diabetic patients.

This sets upon a cycle of conditions that can leave a Covid-19 patient severely immunocompromised. First, diabetes (or poor sugar control) reduces the body's immune defences, then Covid-19 worsens it, and finally, non-judicious use of steroids cripples the immune system. This plummet in the immune response of Covid-19 patients leaves them vulnerable to a mucormycosis infection.

● Comorbidities, immunodeficiencies, and immunosuppressants: Patients suffering from comorbidities (such as diabetes) or immunodeficient conditions (such as HIV/AIDs) already have a weak immune system to protect them. Patients taking immunosuppressive medications (such as chemotherapy, corticosteroids) to fight severe diseases and environmental pathogens are in a similarly vulnerable situation. Such patients are at a high risk of contracting fungal infections. Ailing Covid-19 patients, whether diabetic or surviving with immunosuppressant drugs have low defenses against fungal infections such as mucormycosis.

What are the early symptoms to watch out for?

Mucormycosis, with a mortality rate of 50%, can be life-threatening. Though controlled mainly with antifungal medication, it is not uncommon for patients to require surgery and lose an eye or the upper jaw.

It is important that you pay attention to early signs of a possible mucormycosis infection to prevent severe complications:

● Pain and redness around the eyes and nose, accompanied by fever.

● Swelling of the forehead and headaches.

● Local pain and swelling in the one side of the face or cheekbone.

● Loosening of teeth and reduced jaw involvement.

● Blackish discolouration or crusts around the bridge of the nose or palate.

● Blurred or double vision, accompanied by pain.

● Pulmonary symptoms such as nasal blockage/ discharge (bloody or black in colour), nosebleeds, reduction in facial sensations.

● Respiratory symptoms such as trouble with breathing, chest pain, and coughing.

How do you prevent or minimise "black fungus" infection?

Mucormycosis remains a rare infection amongst non-immunocompromised people.

Experts at the Sagar Hospital advise the following to prevent a black fungus infection in immunocompromised patients:

● The fungi spores thrive in damp, high moisture environments. Unsanitary environments where patients are being treated or oxygenated can become a source of infection in the absence of proper ventilation and cleanliness. All environments of recovering patients, whether medical or home, must be kept as sanitary as possible.

● Unsystematic and overuse of steroids can push down immunity and raise blood sugar levels. The prevalence of both these conditions increases the chances of contracting a mucormycosis infection. One way to stall the possibility of the fungal infection is ensuring that Covid-19 patients, in treatment as well as after recovery, are administered the right dose of steroids at the right time and for the right duration. Patients should avoid self-medication and treatment should be strictly under a doctor's guidance.

● It is strongly recommended that hyperglycemia be monitored and controlled. Blood sugar levels of diabetic as well as non-diabetic patients being treated for Covid-19 must be kept in check. Doctors should also monitor patients discharged from Covid-19 treatment for blood glucose levels, especially in diabetics.

Treatment

Management of Covid-19 patients is an interdepartmental effort of internal medicine specialists, ENT specialists, microbiologists, ophthalmologists, dentists, and maxillofacial surgeons. At Sagar Hospitals, our interdisciplinary team of experts handles mucor infections in our patients with utmost care and efficacy.

For Covid-19 patients being treated for mucormycosis, our experts strongly recommend controlling diabetes and hyperglycemia, reducing steroid use, and discontinuing the use of immunosuppressant drugs. Following medication and procedures, intravenous antifungal treatment may be required.

While primarily treated with antifungal medication, a mucormycosis infection may eventually necessitate surgery.

The "black fungus" has become a pandemic in India in its own right and naturally created worry in a population already reeling from the pandemic. While not a common infection at all, mucormycosis is a high risk for the immunocompromised such as Covid-19 patients. Overuse of steroids and uncontrolled blood sugar levels further makes patients even more vulnerable to this fungal infection. However, infection can be prevented and treated with monitoring of hyperglycemia, strict control of steroid use, and control of immunosuppressant conditions. For more information on mucormycosis and its control reach out to our experts at Sagar Hospital.