Health

ENT Telehealth in India: It’s here #Healthwealthbridge

By Dr.Amrita Basu(MBBS,MS) on April 4, 2020 15

ENT Telehealth: It’s here

If you want a telehealth consultation ,you can contact me at dramrita @healthwealthbridge.com.Call or message .Video,audio ,text consultations is available,

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No one can escape writing about the new Coronavirus . With the current scenario, I have written about and even appeared for an interview with Blogchatter about Coronavirus. It’s also one form of telehealth. Offering health education through technology.

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Health of the Nation Report — Apollo Pro Health

Telehealth/Telemedicine allows Registered Medical professionals to assess, evaluate, diagnose, counsel, offer treatment. In remote locations, patients can access medical expertise quickly, efficiently, and without travel.

How to find your doctor in Indian Medical Council Register

I started offering telemedicine advice since 2013 when I signed up with the Lybrate platform. Lybrate needs registered medical practitioners to upload their qualifications, including registration number and details, to the platform for verification. You can check the Doctor’s credentials, reviews, advice, and many more.

I started my website Healthwealthbridge in 2014 to have a platform to explore writing, but also write about ENT diseases, common healthcare FAQ s, health, nutrition, and educational material for those who want to take responsibility for their own health. It’s now also a quick and easy way to offer Telehealth/telemedicine services. The following part has necessary self-promotional elements, but I think you will forgive me.

Healthcare is a two-way street.

Until you commit to being responsible and choose the right healthy lifestyle practices, few things can help you. India’s population has made the doctor-patient ratio facing a crisis. More so in the Coronavirus issue amongst many.

People are ignoring Self-quarantine and self-reporting rules and totally ignoring Lockdown in many places. But all is not lost. If we take care of listening to good advice, follow the lockdown, we will be okay.

But if not …

It’s now the survival of the fittest -Darwin said it and its still true.

Many health care practitioners are moving to offer services through audio, video, email, and text chats.

India released a National Digital Health Blueprint detailed framework in January 2020. This is good, and we need to adapt to it quickly. Both Doctors and patients.

Luckily the penetration of telecom services is much better than other sectors, and this helps us provide health education, primary care, First aid, follow-ups at different levels, even at a remote location.

Remember, you can text me, send audio messages, send video messages, request live telecalls, WhatsApp calls, and video consultation. Consulting through telehealth protects patients under the same confidentiality with restrictions for a specific category of medicines. In case you are interested, you can enquire with your Doctor whether they are providing telehealth services/Telemedicine services.

You can text, send audio, video or schedule an audio/video consultation and Pay through NEFT/PayTM or other modes

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ENT TELEHEALTH INDIA DR.AMRITA BASU — ENT TELEHEALTH INDIA

Difficulty Swallowing? Dysphagia in Cancer #BlogchatterA2Z

By Dr.Amrita Basu(MBBS,MS) on April 3, 2020 8

Difficulty swallowing or dysphagia is a common ENT complaint. It’s the ENT surgeon bread -butter version complaint. Today I will tell you about the danger hidden behind such a common and innocuous symptom.

A few months back a 75-year-old man had come to my clinic with his daughter-in-law. The complaint was the inability to swallow food for one month. On detailed questioning, the initial complaint of dysphagia started almost two months back with on and off the review by quacks(you know my thoughts about that) and alternative therapy. He had never visited an ENT doctor for his complaints. He also had not been given any prescriptions for alternative medical therapy.

He was suffering so much, that swallowing his own saliva was difficult. He was severely dehydrated, hardly ate anything. But he was still smoking. Without going into too many details, I can tell you that his HRCT of the thorax(chest) showed a growth obstructing more than two-third of his food pipe. I referred them to Apollo Kolkata and Tata Medical Centre Kolkata and explained to them about the need for urgent intervention.

Time is crucial for malignancies as such and more so for your breathing tubes and food pipe.If every time you swallow saliva

It has a long list of causes and can be divided easily into acute or chronic.
The most infectious condition with pain throat also has difficulty swallowing like in tonsillitis and Pharyngitis. If you have hawking, repeated clearing of the throat and a postnasal drip, that can cause dysphagia too.

When it’s difficulty swallowing with pain, its called odynophagia.

Fear of swallowing or Phagophagia occurs in Rabies, hysteria, tetanus
Globus hystericus is a sensation of a lump in the throat often associated in chronic anemia and common in women.

Today I will talk about malignancy causing dysphagia and the signs you should be aware of.

The Early warnings

Its the progressively increasing painless difficulty swallowing. Most common in a smoker with a history of regular high volume alcohol intake. Presenting with maybe a hot potato voice is cause for worry /Cancer of the upper part of the throat, often present with difficulty swallowing. So does cancer of the esophagus.

There may or may not be a lump in the throat/change of voice and difficulty breathing. Sudden significant unexplained weight loss is common in cancer of food pipe.

Anything more than two weeks’ duration needs the help of diagnostic tests . A Fibreoptic laryngoscopy is an office procedure to have a peek into the pharynx/larynx and pyriform fossa. If that looks clear, you need a Barium, swallow esophagus, and a CECT Neck and HRCT thorax as further workup.

As a rule of thumb, if the malignancy arises from the vocal cords and then spreads to food pipe, hoarseness precedes dysphagia.

Malignancy causing Dysphagia

Pharyngeal malignancy
Oesophageal malignancy
Laryngeal malignancy involving food pipe.

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Treatment depends on the site, size, spread, and type of cancer.
Prognosis is dependent on histological type, local spread, metastasis, and patient profile. In more cases, the correlation between smoking and alcohol abuse is very high in such cancers. Surgery and adjuvant therapy are planned after a full review . Nowadays Proton therapy is another modality that is considered.

Cancer of the Tongue: Chewing habits to chew on!

By Dr.Amrita Basu(MBBS,MS) on April 3, 2020 12

Cancer!The C-word which now has competition from Corona.Just like COVID19 prevention, with lockdown and social distancing
, for this cancer prevention works.

The slightly raised edges, feeling of roughness, giving rise to a small nodule that breaks down and forms an ulcer. The ulcer doesn’t heal with all your self-medication, alternative medicines and several multivitamin tablets supplied by the friendly pharmacy shop owner. This is, in short, the life story of cancer of the tongue

I have written about throat cancer and extensively about mouth cancer. Cancer of the tongue falls under mouth cancer or oral cancer, and broadly the treatment policy follows a similar pattern.It often follows the abuse of gutkha paan masala and other tobacco chewing habits.

If you want some different reading material with the letter C, try Coronavirus outbreak, Taiwan fight with New Corona virus:why they ignored Chinese data, or Home Quarantine For Corona: the right way

How does tongue cancer present?

It can present in the anterior two-thirds(45%) or posterior one-third of the tongue. The majority of those in the anterior part is seen at the lateral border of the tongue.
Nonhealing ulcer of the tongue.
A raised area with areas of ulcer and tissue piled up. There may be bleeding from the tongue.
The doctor will take a wedge biopsy or an excisional biopsy depending on the size of the lesion.

In uncontrolled diabetes, a nonhealing ulcer may often confuse clinical diagnosis.

On palpation of the tumor/ulcer, it most often will have an indurated base In advanced cases there will be a pain in the tongue
There will be difficulty in complete protrusion of tongue and difficulty articulating clearly. This happens due to the spread to the floor of the mouth.

If cancer involves the posterior part and base of the tongue, the treatment is often difficult.
A neck lump is an indication of spread to the neck or may be due to secondary inflammatory changes in the lymph node. Loosening of teeth of the lower jaw indicates, spread to the mandible,if not proved otherwise.

Where can Tongue Cancer it spread?

The floor of the mouth.
Mandible(lower jaw).

Cancer of the posterior part of the tongue can spread to tonsils, pharynx and into the larynx
Most people (70%)will have neck mass at presentation. Sometimes neck nodes on both sides may be involved.

What tests will be needed?

Diagnostic tests involve biopsy, FNAC MRI tongue, and imaging for the neck and chest. Mandibular involvement and status of dentition need to be evaluated.

The MRI of the tongue and a CECT of the neck and chest helps us know about the spread of the disease.

An FNAC from the neck mass will help in finding out the nature of the neck lump, and the biopsy of the tongue ulcer will help us know about the tongue lesion.

Treatment often involves.

Treating primary lesions depending on size. Excision is done with adequate margin and reconstruction depending on mass resected. The neck needs to be treated. A combination of surgery and radiotherapy may give best results

Preoperative counseling:Why is it crucial?

To stop all addictions.

Treat withdrawal symptoms.

Improve lung function.

Improve oral hygiene.

The potential need for tracheostomy and loss of voice explained.

The possible need for re-construction with flaps explained.

Speech therapy needed postoperatively.

Explanation regarding Adjuvant radiotherapy/chemotherapy or both, depending on tumor-free margin after biopsy report.

Need for post-operative followup at a Head Neck Cancer /tumor clinic.

Battery in toys: You better avoid!

By Dr.Amrita Basu(MBBS,MS) on April 2, 2020 9

BATTERY!Not something you want your children to play with
As a Postgrad trainee in Safdarjung two, emergency cases really pushed our buttons. Tracheostomy in the ER and little kids swallowing batteries or inserting in nose and ears.

Now tracheostomy is a topic for another chapter, but the battery is something I need to warn you against. Those cute little cars and battery-operated toys may have disc battery (looks like a coin ) or small button batteries. Both are dangerous in little hands. They have a tendency to insert it in ears, nose, or swallowing it.

The Good news

With a button battery in ear or nose depending on size, they can be seen on Xray and removed with or without anesthesia. Button battery on being swallowed, may pass out through stool and not cause any problem. These are all good outcomes.

The Bad News

The worrying issues are when the button battery is missed by a parent who brings the child late to the ER. If in the nose it can cause septal perforation nasal bleeding and more.

In the ear, it can cause the destruction of the tympanic membrane and middle ear structure, potentially harming hearing ability.

But the biggest problem is probably a swallowed disc battery when it gets stuck in the food pipe or eso[phagus. That can be life-threatening.

After 3 hours, it starts leaking chemicals that first burn the mucosa, then the muscle layer and the serous layer or outer covering of food pipe. Once that happens, a potentially fatal condition called mediastinitis can occur.
All this can be avoided if you don’t give toys whose batteries can be taken out by prying fingers.

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In case such an unfortunate incident occurs, you need to visit the ER quickly. It requires an ENT department facility for removal with a hypopharyngoscopy or Esophagoscopy general anesthesia and a pediatric ICU setup, for potential complications. Remember, prevention is definitely better than cure.

In Kolkata, all the Government Medical Colleges have an Emergency facility for ENT, and so does most other Government Medical Colleges in Delhi. For other places, you can also check online for the services offered.

Acute Otitis Media: When the ear aches! (Plus book free) #BlogchatterA2Z

By Dr.Amrita Basu(MBBS,MS) on April 1, 2020 14

Earache is common in growing children. It may be due to wax,acute otitis media, otomycosis, and airplane ear. Earache due to Acute otitis media is one of the commonest conditions children come to me with. But what exactly is Acute otitis media or AOM?

Acute Otitis Media:This can cause earache and ear discharge too!

Whenever doctors say it’s an acute condition, we mean that the duration of the illness is possibly less than three months or 12 weeks old. In case something is more than 12 weeks in duration, it becomes chronic.

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How is the Health of the Nation: The report is an eye-opener!

Acute otitis media is a condition in which the mucosal lining of the middle ear gets inflamed and can cause earache, blocked feeling in the ear, decreased hearing, and fever.

When the inflammation increases, then there may be fluid accumulating in the middle ear. This infected fluid causes the eardrum to bulge outside, increasing the severity of pain and is often accompanied by high-grade fever. If the condition is not reviewed by an ENT surgeon, then the eardrum can burst under pressure giving rise to discharge of mucopurulent discharge from ear, This is often followed by a decrease in earache.

When something like this happens, it’s called ASOM or Acute suppurative Otitis Media. This condition is common in children and in lower socio-economic conditions. With increasing age as the tendency of repeated URI and ear infections decreases. But maybe in those with Allergic Sinusitis and Allergic Rhinitis the problem may persist even as adults.

The eustachian tube in children is shorter and at a lesser angle to the horizontal than that in adults. This causes more secretion to accumulate. That’s why children are more at risk of developing Acute otitis media. Also, breastfeeding in a supine position can cause regurgitation of milk into the middle ear through the eustachian tube and can aggravate the problem.

What you need to know if your child has ear discharge for the first time.

You must consult an ENT surgeon for an opinion regarding the Tympanic membrane. One episode of ASOM and a proper course of antibiotics will help in the healing of the eardrum. But in the case of recurrent cold, the same ear may discharge repeatedly.

The plan is to stop recurrent URI and improving the child’s immunity goes a long way in helping with this. In the case of a runny nose for more than five days, the same problem can recur. Remember, if you have a cold, your child can catch it too.

What do you need to do?

Prevent cold and flu s as far as possible Visit a doctor if cold for more than 2 days. Avoid breastfeeding in the supine position and always have the head end elevated while feeding. In case of persistent or recurrent Acute otitis media a full battery of tests may be needed.

Why does the mucous discharge occur in Otitis media?

Your middle ear (the part of your ear behind the eardrum, containing ear ossicles ) has plenty of mucous-secreting glands.

Otitis(ear) media(middle) is the condition when there is inflammation of the middle ear. It can be acute, chronic, or another variant called secretory otitis media. Mucoid discharge from the ear occurs, when there is inflammation of the middle ear mucosa, associated with a defect in the tympanic membrane. Typically this condition may be associated with Allergic Rhinitis.

Why does negative intratympanic pressure occur in the stage of tubal occlusion of AOM?

The eustachian tube connects your middle ear with the nasopharynx (the part of your throat behind the nose), and gets blocked during cold/URI, due to edema. The mechanism of maintaining air pressure inside the middle ear gets hampered, causing negative middle ear pressure. The negative pressure causes inward bowing of the tympanic membrane known as retraction; This causes pain in the ear.

Due to the inflammation in the middle ear mucosa as the cells start secreting fluids, the air in the middle ear gets progressively reduced. But as more and more mucous gets accumulated, the eardrum then starts bulging outward with severe pain.That happens in AOM or acute otitis media. The eardrum looks like a pus-filled balloon that can burst if not appropriately treated.

Why acute otitis media occurs:Cause of Earache — Acute Otitis Media : When the Ear aches!

How quickly can a perforated eardrum recover from damage?

Traumatic ear perforation can heal by 7 to 10 days—the latest by three months. The ear meanwhile needs to be dry with appropriate medicines, prevent water entry strictly..

Ear perforation due to infection like Chronic Otitis media, however, need surgery. Initially, ear drops, but the definitive treatment is surgery for chronic otitis media.

Ear problems and Solutions

ENT Telehealth consultation

How to Stay Home (during New Corona Virus threat) under Home Quarantine #StayHome #LockdownIndia

By Dr.Amrita Basu(MBBS,MS) on March 26, 2020 33

The New Coronavirus health care problem is a battle none of us saw coming when 2020 celebrations were happening. Except, maybe China. They probably knew or guessed.

15 to 20% of the common cold is caused by different types of Coronavirus, this new Coronavirus / COVID 19 / Wuhan virus whatever you call it, COVID19 is no rose. It’s a plot straight from the medical thriller that Robin Cook would be proud of. But the reality is often wilder than fiction, and now we need to get ready to fight this battle the right way.

Here are a few precautions that can aid us during this critical time: #StayHome #LockdownIndia

If you go outside for supplies, wear a mask. If you don’t have the right kind, make your own.
Remember you need an N95 mask for adequate protection against this virus. But other masks will at least stop you from instilling it from a surface onto your nose or face or eyes.
When you come back home, wash your hands, and spectacles. Disinfect your wallet phone cover, phone, and belt bag with sanitizer
Take a warm water bath with soap and water and then wear fresh clothes before sitting anywhere at home after coming back.
Don’t enter the room with children or the elderly without cleaning up
Don’t sit here and there before you wash
Have a separate area for keeping your outside stuff like a tray or bucket before you have a chance to sanitize them.
Stay home as far as possible

At this time, when we are waiting to get the COVID 19 vaccine and effective treatment having the right health insurance covering Coronavirus treatment will be beneficial.

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You must know about the Coronavirus signs and symptoms which are covered by your health insurance, and for this, you can reach out to your own insurance provider to know more .

6 Myths about the Wuhan Coronavirus COVID19

It has nothing to do with China.

It was Wuhan in China, where it first started and they kept it a secret.

2. It’s going away when summer comes.

We can all hope for that, but there is no conclusive evidence for it.

3 Herd immunity will work.

Herd immunity will require many people to get infected, which means many people can lose their lives. It’s also not even sure that herd immunity will even work.

4 One person can infect only one person, and more people cannot be affected.

One person can infect one or many depending on his contacts and his virus load. It’s zoonotic, which started from an animal, and jumped to humans. We don’t know where it can jump again. Since it’s a new strain of virus showing high infectivity and ability to adapt, we need to be very careful.

5 Social distancing is stupid and doesn’t work.

Social distancing works by reducing the number of people a potentially infected person can infect. It works. That’s how China could reduce the caseload.

6 Home quarantine means I sit and chat with my family.

No, it means you stay in a separate room preferably one with a door which can be closed and which can be separated from the rest of the house

Use separate utensils.

Communicate at least with a 1-2 meter /3-4 feet distance. With speech cough sneeze we risk making droplets airborne which can travel horizontally 100cm and vertically 50 cm. No unnecessary chit-chat.In some studies , the distance covered by the virus seems to be more than 11feet.

Wear a mask if you are potentially in contact with an infected person or have traveled from a place with positive COVID19 cases in India or outside India.

If you are in home isolation as asymptomatic COVID 19 or recovering

The person must stay in a separate room with a separate bathroom facility.

Prevent your room’s door from being opened all the time.
You can research DIY sites, for creating a negative pressure room(this is not tested).
Wear the mask which you have. Dispose of it properly. Never touch the outer surface of the mask while wearing it.
Take care to wash your hand with soap and water frequently.
Medicines are being tested, prophylaxis is planned, and Vaccines are under trial. We need to sit tight, stay at home, and stay safe.

The utensils for food etc should be separate. He should always be wearing a mask during any interaction.

A distance of 11 feet (that’s the maximum, the aerosol can travel horizontally according to data) must be kept while talking to someone else.

Keep entertainment options in the room.

Only one person wearing gloves and mask will be a caregiver and occasional companion. The room should be well ventilated with preferably windows opening outwards. No interior windows.

Central AC is to be avoided.

Good cough hygiene, and hand hygiene to be maintained at all times.

Stay hydrated, and talk to a healthcare setup dedicated to COVID in your locality. Stay indoors. In case of difficulty breathing call the emergency number. All protocol of government needs to be strictly followed.

How you can help?

Coronavirus is causing havoc on the lungs and heart. The myocarditis and the failure of lung function are making survival difficult without a ventilator and an ICU setup.

The problem is for a highly infectious disease like this requires a negative pressure ICU.

We need responsible behavior from citizens. Without that, nothing will work.

For makeshift quarantine facilities and isolation ICU, you need sound HVAC systems, which will create a negative pressure room to avoid contamination and cross infection. If you are an engineer, you can help ideate about making quicker test kits, protective gear masks, negative pressure systems for isolation rooms and quarantine facilities, and portable ventilators. You could help the Government by staying at home too, donating, or sharing your ideas.

Staying Home during New Corona Virus and Health Insurance #StayHome #LockdownIndia

When did Stay Home or lockdown phase one officially start in India?

It started on 24th March 2020. Now it’s in its fourth phase as of May 19th, 2020. Officially the lockdown is being continued till 31st May 2020.

Why do you need to stay home according to the rules?

The stay home guidelines is to help you stay safe. It helps prevent the risk of community transmission. Sometimes younger people get affected and could unwittingly be the vehicle of spread, to more at-risk individuals like the elderly. Staying home keeps you and your loved one safe.

Know more about Health Insurance .

Insurance is a subject matter which is personal and should only be taken after full perusal of all information provided by the service provider. Healthwealthbridge and Dr.Amrita, doesn’t claim to be a financial expert and is only sharing her personal experience in this matter. All financial decisions should be taken after reading the offer document carefully.

Health

ENT Telehealth: It’s here

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You can text, send audio, video or schedule an audio/video consultation and Pay through NEFT/PayTM or other modes

Lybrate Profile Link Dr.Amrita Basu

Sharing is good Karma!

Difficulty swallowing or dysphagia is a common ENT complaint. It’s the ENT surgeon bread -butter version complaint. Today I will tell you about the danger hidden behind such a common and innocuous symptom.

The Early warnings

Malignancy causing Dysphagia

Featured post

Sharing is good Karma!

How does tongue cancer present?

Where can Tongue Cancer it spread?

What tests will be needed?

Treatment often involves.

Preoperative counseling:Why is it crucial?

Sharing is good Karma!

The Good news

The Bad News

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Sharing is good Karma!

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What you need to know if your child has ear discharge for the first time.

What do you need to do?

Why does the mucous discharge occur in Otitis media?

Why does negative intratympanic pressure occur in the stage of tubal occlusion of AOM?

How quickly can a perforated eardrum recover from damage?

Sharing is good Karma!

Here are a few precautions that can aid us during this critical time: #StayHome #LockdownIndia

Featured post

6 Myths about the Wuhan Coronavirus COVID19

If you are in home isolation as asymptomatic COVID 19 or recovering

How you can help?

When did Stay Home or lockdown phase one officially start in India?

Why do you need to stay home according to the rules?

Sharing is good Karma!

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