Tuesday, August 3, 2021

Lung Transplantation for End-stage Lung

An end-stage lung condition is defined as lung destruction leading to extensive respiratory disability and a state of crippling. Such a patient is completely bed-ridden and continuous oxygen dependent. The patients get severely malnourished, lose muscle mass and weight. In recent times, there is a significant increase in prevalence of end-stage lung problems and oxygen dependence especially after the COVID pandemic. Such a condition frequently results from some of the following common conditions:

1.      Extensive post-COVID lung fibrosis

2.      Progressive fibrosing illnesses of the lungs due to interstitial lung diseases

3.      Chronic obstructive pulmonary disease

4.      Vascular Lung Disease,  Primary pulmonary hypertension

5.      Other chronic diseases: Suppurative Lung Disease, Cystic fibrosis,  Bronchiectasis


Patients with end-stage lungs can be helped with several modalities besides the routine drug treatment such as the Respiratory Rehabilitation; Yoga and pranayama therapy; Breathing exercises; Nutrition support and muscle building; Psychological supports

Lung transplantation: Lung transplantation is offered as a last hope for some of such patients available at a few select centres, mostly in South India. Lung transplantation requires a large infra-structure and plan for availability of the organs besides the expertise and the costs.

Patients who are fit for lung transplant need to be carefully selected and undergo preoperative pulmonary physiotherapy and RR so that they can get best results from the transplant

These patients also need a long term post operative physiotherapy and rehabilitation program so that the advantages of transplant can be maintained. They also require regular surveillance for early signs of rejection and other complications with help of blood investigations, radiology, bronchoscopy and biopsies.


Monday, July 27, 2020

Respiratory Problems due to Obesity

Obesity i.e overweight is a common condition the world over, including in India. It is not altogether wrong to say that there is almost an epidemic of obesity particularly noticeable in the developed countries. Even the developing countries are not spared of the menace of over-weight.

Obesity is common among adults as well as children. It is largely attributed to a sedentary lifestyle and excessive use of ‘junk foods’ rich in fats, carbohydrates, and calories. Even though a good weight is surely a sign of a healthy body, overweight is considered as a ‘medical problem’ or even a ‘disease’ in itself. Excessive weight is an unnecessary burden on the body which poses risks for almost all body systems. In particular, it is responsible for muscle and joint problems and diseases of the heart and the lungs.


Effects on the respiratory system

Obesity affects the respiratory system in multiple ways. Some of the important effects are described as under:

  •  Lung function:  Lung function is poorer in overweight persons. To a large extent, the lung capacity is adversely affected by excess body weight. Thoracic and lung expansion is restricted due to the mechanical effects of fat on the chest wall and diaphragm in obese people. The clinically significant restriction is generally present whenever there is massive obesity defined by the patient’s weight-to-height ratio of 0.9-1.0 kg/cm or greater. Obese people may complain of breathlessness due to poor lung function even in the absence of definite lung disease.
  • Asthma: There is some association of asthma with obesity. Obese asthmatics have more significant symptoms of breathlessness, wheezing, and cough. Moreover, asthma is difficult to control in obese patients. This is particularly worrisome in obese children who present with a severe form of asthma.
  • Chronic obstructive pulmonary disease (COPD): COPD is a progressive form of airway obstructive disease which is more commonly seen in smokers. Obesity is usually not a problem with most patients of COPD who often complain of significant weight loss and muscle wasting. Obesity may however be present in patients with chronic bronchitis in whom it will add to the symptoms of breathlessness.
  • Obstructive sleep apnea (OSA): OSA is an important problem characterized by intermittent obstruction of the upper respiratory tract especially during sleep. The obstruction occurs due to loss of tone and inability of the pharyngeal muscles during sleep to keep the airways open and thus resulting in its partial closure. It causes momentary cessation of breathing and fall in oxygen saturation, snoring, and other physiological effects. In due course of time, OSA is responsible for hypertension, diabetes, cardiovascular and cerebrovascular diseases.
  • Obesity is an important risk factor for OSA, a potentially fatal disease. Patients with OSA tend to fall to sleep within minutes and even while driving resulting in frequent and sometimes fatal accidents. Undoubtedly, OSA is the most serious complication of obesity. Weight reduction is an important component of the treatment of OSA. Mild OSA may even be reversed with the treatment of obesity.
  • Obesity hypoventilation syndrome (OHS): OHS is characterized by hypoventilation i.e. decreased (than normal) amount of air entering the lungs with each breath resulting in lower oxygen saturation and increased carbon dioxide pressure in the blood. In the long run, the condition leads to failures of the respiratory and cardiovascular systems. Weight reduction is the most important component of treatment.

Management

Weight reduction is the most significant component of all forms of problems associated with obesity. Dietary control and physical exercise are important but often difficult to achieve.  Frequently, one has to resort to other measures of weight reduction which may include bariatric surgery. The doctor can advise about the type of management required in a case. Standard treatment of the respiratory disease associated with obesity should be done as appropriate for the individual patient.

Wednesday, January 15, 2020

The Shrunken Lungs


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Dr Surinder K. Jindal, MD, FCCP, FAMS, FNCCP
(Emeritus-Professor, Postgrad Instt Med Edu & Research,Chandigarh, India)
Medical Director, Jindal Clinics,SCO 21, Sector 20 D, Chandigarh, India 160020
Email: dr.skjindal@gmail.com  Ph. 0172-4911000; 0172 4911100

COPD


---------------------------------------------------------------------------------_-----
Dr Surinder K. Jindal, MD, FCCP, FAMS, FNCCP
(Emeritus-Professor, Postgrad Instt Med Edu & Research,Chandigarh, India)
Medical Director, Jindal Clinics,SCO 21, Sector 20 D, Chandigarh, India 160020
Email: dr.skjindal@gmail.com  Ph. 0172-4911000; 0172 4911100

Monday, August 6, 2018

FENO - a new test for asthma


FeNO

FeNO or fraction of exhaled nitric oxide, has emerged in recent years as one of the new tests to diagnose and monitor asthma. Asthma is one of the most common diseases in humans, with children especially afflicted. The diagnosis of asthma is primarily a clinical one and the management too has been based more on the clinical sense of the treating physician. However, with increasing patient populations and more information about new subtypes of asthma, a test was needed to help support the clinician’s diagnosis and management strategy. FeNO has stepped up to meet the gap.

It may come as a surprise to many that the normal lungs produce some amounts of nitric oxide or NO. The amount produced is minuscule though, in parts per billion. In disease states - such as asthma – the amount of NO produced increases significantly. This finding cal be exploited in routine clinical practice to support the diagnosis of asthma and to monitor treatment.

Asthma is mainly of two types – eosinophil predominant and non-eosinophil predominant (eosinophils are a kind of blood cell). The eosinophil predominant type of asthma responds very well to inhaled steroids while the non-eosinophil type does not. Therefore, the differentiation of asthma into these two subtypes is of importance in the management of the disease. The only way to do this other than the use of FeNO is to do sputum (saliva) analysis, which besides being messy is also time consuming. The FeNO test can be very helpful in this situation. FeNo levels will be high in patients with eosinophil predominant asthma and will be normal in the non-eosinophil predominant subtype. So, by checking the FeNO levels one can decide whether or not to start inhaled steroids.

FeNO levels are very useful in monitoring the response to treatment. In patients who are compliant with treatment and are improving, the FeNo levels should fall. In patients in whom there is a partial improvement, checking serial FeNO levels will help in decision making, i.e. whether to stop, decrease or increase treatment. These levels can used in conjunction with standard spirometry for additional information.

Children are often unable to perform rigorous pulmonary function testing. They find it easier to perform FeNO testing, which is done by gently blowing into the mouthpiece of the measuring device for 10 – 12 seconds. The result is subsequently displayed on the screen in a few seconds.
In summary, FeNo is a non-invasive, easy to perform, quick and reliable test which is an useful adjunct in the management of asthma, especially in children and difficult cases. 

Wednesday, August 17, 2016

Latest bronchoscopy data



                


We have touched  a triple century... Here is the latest bronchoscopy data from our center.













 



Data current as of  15/8/16.




Monday, August 15, 2016

Amritsar bronchoscopy hands on workshop


A workshop was conducted by the Department of Pulmonary Medicine, Government Medical College, Amritsar on Bronchoscopy and Medical thoracoscopy where I was invited to give talks on TBNA, EBUS-TBNA and Medical Thoracoscopy along with hands-on workshop. Thanks to the organizers for inviting me. It was educational interacting with the post graduate students.


Friday, February 19, 2016

Changing scenario of Sarcoidosis in India


There has been a rapid change in recognition and spectrum of sarcoidosis in India in the last decade. This was considered a rare disease almost till the end of the last century even though the disease was recognized and reported from different places. The change is remarkable considering the fact that the number of publications on the subject has suddenly jumped in the last decade. Of 340 total papers which are listed in PubMed since 1980, about two-third (228) have appeared in the last 10 years. There were only rare publications before 1980. The increase can be attributed to several different causes:
  1. True increase in incidence
  2. Increased awareness of disease among physicians. Many cases of sarcoidosis were dismissed as tuberculosis in the past.
  3. Increased availability of diagnostic tests such as chest CT scanning, fiberoptic bronchoscopy and endo-bronchial ultrasound sound guided fine needle aspiration (EBUS-FNA)
  4. Insistence of physicians as well as patients in making a confirmed diagnosis than starting anempiric treatment

Clinical spectrum of sarcoidosis: There is also a change in the spectrum of disease and organ involvement described in the reports of the recent past. Previously, it was mostly the pulmonary involvement i.e. hilar and mediastinal lymphadenopathy which was commonly described. Now, there is a greater recognition of extra-pulmonary involvement including that of the liver, spleen, nervous system and other organs. Moreover, atypical pulmonary presentations such as miliary involvement of lung parenchyma and pleural effusions are frequently reported. It is again a moot question whether this finding is a true change in the spectrum or only an increased recognition because of the factors already listed above.

Sarcoidosis tuberculosis enigma continues to bother physicians in India not only because of similar presentations of both diseases but also since the treatments are different for the two diseases. Corticosteroids, which are used for sarcoidosis may in fact precipitate tuberculosis and are necessarily avoided except in a few specific situations. There is no place to start the treatments for both conditions simultaneously as had been a common practice in the past. It is therefore important to make a firm diagnosis before starting treatment for either condition.

The other major shift which has happened relates to the more frequent use of non-steroidal drugs. Drugs such as methotrexate, hydroxy chloroquin and other immunosuppressants are now available for use for relapse and in the presence of co-morbidities with or without corticosteroid therapy, depending upon the clinical condition.  


S.K. Jindal

Medical Director, Jindal Clinics, Chandigarh

Monday, January 11, 2016

Medical Encounters: True stories of patients – Memoirs of a Physician By Dr. S. K. Jindal




Jindal Clinics is proud to announce the release of the latest book by Dr. S. K. Jindal - the medical director of the institute and ex head, Department of Pulmonary Medicine, PGI Chandigarh.

The book, meant for general reading chronicles the stories of some of the patients seen by the author during a career of about half a century. It provides glimpses of the trials and tribulations faced by patients and their doctors in their heroic struggles against disease and death. It also tends to project the physician’s handling of the myths and dilemmas about disease management and treatment modalities faced by different patients. 

The pen portraits reflected in this fascinating book encompass the lives of Prime Ministers, Governors, Chief Ministers, Judges, highly placed officials, army-men, police officers, newly married couples, precocious teen agers, wealthy men and farm labourers. It is a captivating story of life and living process. Full with vignettes from history, classical civilization, epics and mythology, it is enjoyable to read and meaningful for the doctors, the patients and the care-givers into disease management. A brief synopsis of its contents follows:
 
Foreword

Prologue

1.      The Childhood Adventures: Life in a community riddled with superstitions about health in a haunted house during 1950s in small towns of Punjab. Medical practice was rather scarce and simple maladies were often handled in medieval fashions.  

2.      Dissection Hall: Vivid scenes from the ‘dissection hall’ of the medical college (Government Medical College, Patiala) during the author’s first year of MBBS in 1966-67. Does the virtual dissection now provide the same attachment with human body?

3.      Patient with Scalded Palms: Lessons during bed-side case demonstration in the Skin Out-patient department. Was the reason of scalded palms in an otherwise healthy young man?

4.      Labour Ward: Melodrama in the busy ‘labour-room’ of the hospital while witnessing the first delivery by the author during the final year MBBS. 

5.      Bhag Singh: A former army soldier who used to brag about fighting with enemy forces and cockroach sized mosquitoes was admitted with cancer. Both he and the doctor were quite afraid of catheterization at night for urinary obstruction. 

6.      Emergency Ward: Facing the first death in the over-crowded Emergency of the Postgraduate Institute of Medical Education & Research, Chandigarh in 1972. 

7.      JP – The quintessential Leader or 1975: Story of Jai Prakash Narain during the period of Emergency in India when he was interned in the hospital at Chandigarh. His care was a real challenge for which the author along with senior doctors faced political reverberations.

8.      Sherlock Holmes: A senior police officer who suffered from a relatively uncommon respiratory disease, was quite reluctant. It was Sherlock Holmes who helped in treatment.

9.      The two oustees: Struggles and superstitions of two village folks who suffered from chronic respiratory disease, both were displaced from the land where Chandigarh was built as the state capital of Punjab after Indian partition.

10.   Culture Shock: A young man from Denmark developed illness while visiting as a tourist. Both he and his friend had a tough time in the hospital in the beginning; both got adjusted very soon. On the other hand, Griffth who suffered from chronic obstructive pulmonary disease was evading law because of drug abuse and trafficking.

11.   ‘Morrie’ of Punjab: A senior Professor had a chronic muscle disease; his life was almost a replica of the Morrie immortalized by Mitch Albom (see ‘Tuesdays with Morrie’).

12.  The American Dream: Handling of a friend with asthma in Seattle during Fellowship in USA in 1982-83. He was a tough nut to crack - willfully avoiding treatment for his problem.

13.  Pickwick Papers: Obese patients with respiratory sleep disorders. The main character like the fat Joe of Pickwick Papers was blissfully unaware of his illness.

14.  God’s own People: Patients with respiratory problems belonging to ‘below poverty-line’ category faced multiple hardships. Their innocence was often overwhelming and over-bearing.

15.  Perseverance: A resolute youth was determined to cure disabling emphysema of his grand-father. His misdirected treatment proved disastrous.

16.  Mr Prime Minister: Visit to Nepal for a medical consultation. The Prime Minister had an exceptional medical knowledge.

17.  Mountain out of a mole hill: Pleasure of curing small problems which looked threatening to others. But one needs to know the problem!

18.  Corporate Honchos: Treatment of the rich and the mighty. One of them who suffered from a respiratory sleep disorder was quite secretive about his visit to the doctor.

19.  ‘If a man’s lungs pant with his work’: Problems of handling two senior judges who suffered from brittle asthma! The severe and almost near-fatal attacks used to develop with an electrifying speed. 

20.  Erythrocyte Sedimentation Rate: Misconceptions about and misinterpretations of non-specific medical tests! The test report was a good excuse for the two patients to repeatedly visit the hospital.

21.  Teenage Hiccups: Abrupt and angry outbursts of sick teenagers who needed tender care.

22.   Weakness of the Powerful: The powerful politicians including Chief-ministers and Governors who suffered from asthma or other respiratory diseases were as weak as the ordinary folks. Inhalation therapy was particularly difficult to teach and gullibility was the greatest weakness.

23.   Marital Woes: Sickness as a stigma for ‘soon to marry’ girls and boys. One young lady who suffered from asthma defied medical advice with serious consequences.

24.   The Stigma of Inderjeet: Isolation of young Inderjeet for her tuberculosis. She conquered her illness with courage and bravery.

25.  University Dons: Teachers at the University were generally difficult to convince. Professor Ahuja used to underplay his illness, while several others were over concerned, sometimes about hypothetical illnesses.

26.  Swami Anand: A pious and spiritual man who imbibed the greatest human values! 

27.  The Devilish Test: Misinterpretation of a simple medical test brought an engagement almost to a break-point. It was the medical counselling which helped.

28.  Yasin Mohammad: A bear performer who suffered from asthma was quite magnanimous. Petty favours by unrecognizable patients proved to be pleasant, sometimes even embarrassing.

29.  Barriers: It was difficult to communicate with an old man with hearing impairment. Yet the old man was quite satisfied!

30.  The Big League: The VIP attitudes of a few senior officers often interfered with good medical management. It was always better to shed the mask of bigness while seeking treatment.

31.   Holy Water – The Last Wish: A holy priest was afraid of admission in the hospital for the fear that his last wish may not be fulfilled. The medical personnel and the facilities need to respect the wishes of patients with terminal illnesses.

32.   One More world to go: ‘Not to be defeated’ attitude of a terminally sick patient.

33.  Dilemma of Critical Care:  The real question is ‘When to opt for assisted respiratory support?’ 

34.  Knowledge – Explosion: 21st century – the era of lung transplantation, advanced life-prolonging treatments and internet with a quagmire of information.





The book is available for purchase at: 

 Partridge India    000 008 10062 62



www.nobleandbarne.com