Editorial Team Editor: Dr. Biji Thomas George
Editorial Note “A clear and focused mind will last a lifetime. Getting your mind
Associate Editor: Dr. Yousef Abdel Mohsin El Qabbany
in shape is nothing less than the key to sustainable success in the
Issue Manager: Shyju Joseph
All of us face diﬃculties in waking up in the morning some days. We may have had a late night, chatting with friends at home or online. Else, we may have been watching a late night movie. We wake up sleepy, and remain sleepy the whole day. It aﬀects our work, our levels of concentration and can cause severe errors in our work which aﬀect other people too.
Magazine Coordinator: Anu Joseph Design & Layout Dantis Mathew
world” Russell Simmons.
For most of us, this problem disappears when we get a good night’s sleep. We wake up the next day, refreshed, focused and ready to take on the world! Imagine the plight then of people who never have a good night’s rest. No, I’m not talking about our night duty nurses!! There are a lot of people who suﬀer from a disease called “Sleep Apnea”, where the person cannot breathe properly at night and suﬀers from lack of oxygen as a result. This often manifests as snoring and leaves the suﬀerer in the same mental and physical state as a person who has had very little sleep.
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The same problems happen to those who suﬀer from prostate problems. Due to the frequent need to visit the toilet at night, their sleep is also disturbed and they never get a good night’s sleep. They too, therefore, remain exhausted and sleepy the whole day. This issue has articles, contributed by our expert and senior specialists in these ﬁelds, on both Sleep Apnea and prostate problems. Our regular news and quiz articles are, as always, there. Please send in your comments and questions. Keep caring.
Dr. Biji George Editor
ZZ Z Z Z
Snoring& Sleep Apnea Dr. Sridhar Ramachandren
FRCS, MS, DLO Sr. Consultant, ENT, Head & Neck Surgeon.
Snoring is a sound resulting from turbulent airﬂow that causes tissues to vibrate. Sleep apnea is reduction or a temporary stopping of breathing during sleep. What are the causes of snoring ? The commonest reason in children is enlarged tonsils and/or adenoids. Septal deviation, lax palate, enlarged tongue, tonsils or nasal turbinates can lead to snoring in adults. How common is snoring and Sleep apnea? Very common. 50% or more of the general population snore and it is more common if you are overweight. What are the eﬀects of snoring and sleep apnea ? Snoring and disturbed sleep lead to daytime sleeping and lack of concentration. Children’s school performance may be aﬀected. Sleep apnea has been linked to hypertension and heart diseases.
What are its eﬀets? • It is one of the causes for high blood pressure. • Heart disease • Daytime sleepiness • Lack of concentration Are there any remedies ? Treatment initially starts with advice to reduce weight When required, nasal sprays could also be used. Surgical intervention may sometimes be needed depending on the cause or severity of the condition. Surgical Treatment Available include: OPD/ Daycare Procedure • Turbinal Reduction by Radio ablation • Palatal Stiﬀening using various techniques Surgical • Tonsillectomy • UPPP (Uvulopalatopharyngoplasty). • Tongue Base Reduction.
Stress Urinary Incontinence Stress Urinary Incontinence is the term used to denote leakage of urine as a result of increased intra-abdominal pressure (which occurs during coughing, sneezing, lifting
heavy objects etc). It is a common condition in the women
and is a result of weakness of the pelvic ﬂoor muscles or
I am a 56 yr old male school teacher. These days I have to
urethral hyper mobility. Gross obesity and multiple vaginal
pass urine more often and my urine stream is weak. My
deliveries will worsen the condition.
sleep is disturbed as I have to get up often at night to pass
Kegel exercises could help to some extent in controlling the
urine. Is this a sign of prostate cancer?
leaky bladder. The purpose of the exercises is to increase the pelvic muscle volume and to develop stronger reﬂex contractions following quick rise in intra- abdominal pressure. The patient is asked to draw up, instead of to bear down, and the physician should conﬁrm the contractions by vaginal or rectal examination. Usually, it is recommended that contractions should be sustained for 5-10 seconds followed by an equal period of relaxation. Development of muscular hypertrophy is a slow process and probably needs longer exercise periods with maximal tension. Repeated series of contractions should be performed every day, but the total number of recommended contractions varies between 30 per day to 160 per day.
These symptoms are due to enlargement of prostate. Usually it is due to non cancerous enlargement (BPHBenign Prostatic Hyperplasia) which aﬀects most men after the age of 40 yrs. Although having BPH does not increase your risk of having prostate cancer, it is possible to have both BPH and prostate cancer. Early symptoms of both conditions are similar, hence it is important to see your doctor if you are experiencing urinary symptoms or have a family history of prostate cancer. A healthy prostate is about the size of a walnut and sits just below the urinary bladder, surrounding the urethra (the tube that carries urine and semen out of the penis). After the age of
Mild cases of stress may beneﬁt from medications. The
40, the prostate may begin to enlarge. As its size increases, the
drug used depends on the results of the tests done to rule
prostate squeezes the urethra which slows the ﬂow of urine,
out over active bladder which
resulting in symptoms.
can mimic symptoms of
stress incontinence. Severe and disabling stress urinary incontinence usually needs surgery for correction. Typical surgery is simple and involves transvaginal insertion of a synthetic tape to support the mid portion of the urethra and is curative in majority of the patients. It requires usually one day admission in the hospital. Complicated cases may require abdominal surgery which is more extensive.
BPH is a progressive disease. It can lead to bladder damage, infection, blood in the urine and even kidney damage silently. It is usually easy to make a diagnosis of BPH with proper history, digital rectal examination and a few blood tests. Diagnosis of prostate cancer is usually made on prostate biopsy.
Department of Urology
Several treatments are available for BPH including Watchful waiting, Medicines, TURP (Transurethral Resection of the Prostate) and other minimally invasive surgical
Dr. Krishna Prasad V Sr. Consultant MS, M.Ch(Uro), DNB(Uro), FRCS,FEBU(Uro)
techniques. Availability of a wide variety of newer medications not only allows relief of bothersome symptoms but also has reduced the need for surgery. There are medications to relax the muscles of your prostate to improve the urine stream, block hormones that cause prostatic growth and relax your bladder to improve continence. You and your doctor should jointly determine the best treatment option for you.
BLOOD IN URINE I have blood in my urine (haematuria)? Do I have cancer ? Blood in urine can be microscopic (detected by urine test) or macroscopic (seen by the naked eye). Remember that 70 to 90% of microscopic haematuria is not associated with urological problems. However, macroscopic haematuria can be caused by one of the following urological problems: stones (in kidney, ureter or bladder), infection, injury (to kidney, bladder or urethra), cancer (of kidney, bladder or prostate), and other causes (renal cysts, medical kidney diseases, blood disorders, medications like warfarin). Your doctor will do the following tests to reach to the underlying cause: urine culture, renal ultrasound and CT scan or cystoscopy (looking inside the bladder) as necessary. The treatment will be directed to the cause which is found.
Dr. Joseph K Mathew Sr. Consultant MBBS, MS, MCH (Urology)
Dr. Mohammed Al-Marhoon Sr. Consultant BSc, MD, MRCSEd, PhD
NEWS Our New Doctor • Consultation, second opinion & management of low & high risk pregnancies • Management of medical & other complications (diabetes, hypertension, etc) in pregnancy • Obstetric, gynecologic, 4D ultrasound, including diagnostic & therapeutic procedures (amniocentesis, cordocentesis etc)
Dr. Bernd K. Wittmann
MD, FRCSC (Canada) Sr. Consultant Obstetrics and Gynecology Perinatology (Maternal-Fetal Medicine)
For appointment & more details Call: 98088705 / 24557200
• Counseling, investigation and management of: • Recurrent miscarriages and other pregnancy losses • History of anomalies or genetic problems • Preterm delivery • Infections • Uterine anomalies, ﬁbroids, surgery • General gynecologic and perimenopausal problems, sexual dysfunction. • Check on hormone status, balance, imbalance, changes, ﬂuctuations & levels.
International CME cosponsored by Merck Serono, was held on 27th March. Sessions were taken by Dr. Sivakumar T on Management of Headache, and German Professor Wilfred A. Nix presented on low back pain, mixed pain and treatment options. The conference was attended by over 80 guests.
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Disclaimer This magazine does not attempt to endorse or promote any information presented. Please keep in mind that information about health matters changes constantly as new studies are performed and new treatments are discovered. Consult your physician or other health professional for your health related advice.