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Facts and Tips on Eye and Care

Just imagine a vision free life. You can’t right? Eyes are such an important part of the body and caring for them is thus equally important. We’re aren’t aware that sometimes knowingly or unknowingly we make our eyes suffer. Here is a run down a few facts and some eye care tips to help you keep your vision safe. Let us first run through some facts and then a few tips on eye care.

Facts and Tips on Eye and Care

Sun glasses and Spectacles are good for eyes – There has been a myth that wearing spectacles for a long span affects eyes adversely. This is not at all true, spectacles are good for your eyes and only help in improving your vision and not degrading it.

Smoking is bad for your eyes – Yes, the fact is smoking is responsible for increasing macular degeneration. Smoking harms the blood vessels of the optic nerve as well as the retina and damages it. On a long run, it can also result in loss of eyesight.

Non removal of Eye makeup is harmful – These days girls use a lot of eye makeup accessories that include eye lash volumizers, eyeliner, maskara, etc. As per reports of experts the eye makeup can get into the eye layers and harm them. It is therefore important to remove all makeup after use and use antibiotic drops for eye protection.

Protect your eyes from the PC/ Laptop – As our life style has changed predominantly in the last decade or so, with most of the work being done on PCs/ laptops, eye protection becomes an ever concerning issue. We tend to spend most of our day on the PC or laptop and hence our eyes are put to risk. As per experts, its ideal to give your eyes some rest every couple of hours to avoid straining and vision blurring issues. Resting process includes shutting your eyes ever half and hour to forty five minutes for a few minutes, moisturizing them and lubricating them as well.

Do not wear lenses while asleep - Its a real bad idea to sleep with your eye lenses on. Doing this repeatedly can cost you your vision. So, remove lenses every night and soak them in a disinfectant. Also, while wearing them be careful to touch them with clean hands and store them in a clean case as well.

Eyes are not forever – Caring for your eyes is important, yes it is, but we need to remember that eye issues are going to occur as and when we age and at some point of time we all need to do a cataract surgery mostly. But, with proper eye care you can definitely prolong that time and have good healthy eye sight for longer years.

Well, stay outdoors, with nature, keep your eyes clean and lubricate them, moisturize them and protect them with sun shades and spectacles and keep them working efficiently for you for a long long time.

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First Strokes – Now Earlier Than Before

A recent study in USA has found that there has been a significant rise in the first stroke rates at younger ages. The startling figures indicate a growth in strokes rates for age groups of people under 55. The matter of concern lies in the fact that people who suffer from strokes at such earlier age and survive tend to have adverse effects on their health leading to disabilities of different types for a longer period post the stroke compared to the ones suffering from strokes at an old age of 65 plus.

Study also revealed that average age for stroke had decreased by two years and the common type of stroke occuring in these age groups is generally the ischemic stroke. The risk factors included type 2 diabetes with high blood pressure and atrial fibrillation.

First Strokes - Now Earlier Than Before

This above stays true for USA but coming to India, the figures are rather alarming. India tops the list of heart attacks in young age. The figures state that 78% of males between the age group of 30 and 35 are under the risk of heart attack. Further, because the arteries of Indians are narrow as compared to the caucasians, the risk is much more because of the genetical vulnerability.

The reason is early aging of the heart. Your calendar age may be in your 30’s but biologically your heart may be older by 8 -10 years, majorly due to unhealthy lifestyle and to some extent genes. The world is also coming to terms with the concept of heart age which is calculated on the basis of age, gender, total and HDL, blood pressure, diabetes, smoking, BMI and more. As per doctors, youth does not mean protection to the heart against stroke. With a rather unhealthy lifestyle that includes fats, excessive caffeine, alcohol and salts, it is only going to come sooner than later.

Generally speaking, Indians consume very less fruits, not even a single fruit every day rather. Moreover, the food is loaded with refined carbohyrdates and saturated fats and prolonged cooking destroys most of the nutrients from the food. Hence, it is but natural for heart diseases to occur at early ages.

The only benefit today as compared to earlier times is that with the advancement in technology heart attacks can be predicted accurately as much as 90%. Tests like CT coronary Angiogram, measure cartid IMT, high sensitivity CRP in blood, stress testing, lipid profile, blood sugar, BMI and more can help indicate the risk factors. Therefore, a 64-slice CT scan every few years post the age of 30 is advisable to Indians to check for blockages in the artery.

Well, for Indians, its time to change the lifestyle and adopt a healthy one loaded with fruits and exercises included to ensure that the biological age is much younger than the calendar and not vice versa.

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Source: https://www.livescience.com/56911-age-stroke-declining.html

Frozen Shoulder – Tips On Dealing With The Painful Shoulder Condition

Medically known as adhesive capsulitis, frozen shoulder usually affects only one shoulder. It is most commonly found in people with diabetic conditions. This condition causes the swelling of the articular shoulder capsule, swelling and stiffening of it and restricting mobility to an extent. Its medical name is derived from the Latin word adhaerens, capsula and it is meaning sticking, little container and inflammation respectively. This condition commonly occurs in the age group of 40 -60 years and most in women more than men.

Frozen Shoulder

A shoulder is made up of a speriodal joint. The other joint has a concave slaught where the round part of one bone fits in. Frozen shoulder is the consequence of thickening of the shoulder joints capsule due to the formation of the scar tissue there. This in turn results in tightening and immobility of the shoulder, even causing pain.

SYMPTOMS
The most common symptom is stiffness in the shoulder join and persistent pain. Frozen shoulder pain is divided into three stages namely painful stage, frozen stage and thawing stage.

Painful stage – This is the first stage of the condition and is very painful. The shoulder stiffens and restricts movement. The pain might aggravates at night.

Frozen stage – This is the second stage of the condition and results in worsening the stiffness of the shoulder. It is restricts the motion to a greater extent compared to the first stage and is painful. The pain thankfully doesn’t worsen.

Thawing Stage – This is the final stage of the condition wherein improvement in the shoulder can be noticed. The pain gradually fades and the shoulder movement improves. But, there are chances of it re-occuring though.

DIAGNOSIS
The diagnosis of frozen shoulder involves the following –
A close physical examination of the shoulders by pressing the pain points and checking the arm movement.
An X-ray to reaffirm the same or an MRI.

RISK FACTORS
The most common risk factors for frozen shoulder include -

Diabetes – It is one of the most common causes of frozen shoulder, though the reason is unknown.

Aging – This condition is common amongst people between age groups of 40 -60 years

Stroke – It also occurs amongst people who have suffered from stroke in the past
Other risk factors include Hypothroidism with overactive or underactive thyroids, Parkinsons disease and Cardiovascular disease.

TREATMENT
Treatment of frozen shoulder aims in increasing the mobility of the shoulder while decreasing the pain. Having said that, you need to accept the fact that the recovery of frozen shoulder takes a long time and can vary from 6 months to a few years as well.

Compression Packs – Use of Hot and cold compression packs on a regular basis can help you decrease the swelling and pain as well. Its better to use the two alternatively rather than using only one of them.

Exercise- Exercising regularly and mildly can help regain shoulder mobility to a good extent.

Pain Killers – Pain killers like ibuprofen and paracetamol or Tylenol can be taken in case of high pain but its important to not make it a habit. As frozen shoulder could last for a few years as well, its advisable to take them only in dire need and also check with your doctor first before taking any of them to confirm the suitability.

Transutaneous electrical nerve stimulation (TENS) - In this treatment procedure, small electric pads are applied to the skin through which small pulses of electricity are passed on with the help of a TENS machine.

Physiotherapy – A physiotherapist helps you through exercises that for lower pain and regaining mobility without straining the shoulder.

Shoulder Arthroscopy – This involves a small surgery wherein an endoscope is inserted through the small incision into the shoulder joint in order to remove the scar tissue.

Shoulder Manipulation – This involves a small surgery wherein the shoulder joint is moved gently and is done in a rather few cases.

Well, Frozen shoulder is a prolonged condition and needs to be tackled smartly with patience. With proper care it might as well fade away in half a year or so, but can rebound as well.

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ALL ABOUT MESENTERIC ADENITIES – INFLAMMATION OF LYMPH NODES IN THE MESENTERY

Before we talk about the condition, for those of us who aren’t aware of the less likely used term Mesentry, lets know what the term means. Mesentry holds the abdominal wall in place by attaching to it. Now, Mesenteric adenities or Mesenteric lymphadenitis causes swelling of the lymph nodes in the mesentry. Mild in nature, the infection is easily cured without treatment in a few days. Here’s a run down about the causes, symptoms, diagnosis and treatment of the same.

MESENTERY

Causes - The lymph nodes belong to the lympathic system and are spread across the body. These lymph nodes store lymphocytes or white blood cells that are body’s soldiers against any attack in form of infections or more. Thus, lymph nodes are body protectors in a way. Whenever there is an attack like infection, the number of WBC’s in the lymph nodes increase resulting in painful swelling. Mesenteric adneitis could be either bacterial or viral or due to some sort of inflammatory bowel disease (IBD) or cancer.

Signs and Symptoms - The early symptoms vary from simple cold or sore throat to upper respiratory infection or pain around the belly button and lower right side of the abdomen. Sometimes, this type of pain could be misinterpreted as appendicitis or ectopic pregnancy. Other common symptoms include fever, nausea, vomiting or diarrhea.

Diagnosis and Treatment – The pain that Mesenteric lymphadenitis causes is generally very mild in nature and hence does not require any sort of intervention.

Complications and more – In case the pain is severe in nature which could rarely happen, or if there is some irregularity in bowel movement, you are advised to seek medical consult as soon as possible. Further more, if your infection lasts for a longer period which is not the case with Mesenteric lymphadenitis generally, it could be severe bacterial infection, requiring immediate treatment. Any neglect in the matter, could lead to it spreading through the blood stream causing a life threatening condition known as Sepsis. So, you need to be informed and take necessary action if symptoms mentioned above persist.

Well, this is a condition not known to many people and generally gets healed without intervention but in cases where complications arise, medical help needs to be sought without fail

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HYDROGEN RICH WATER – BENEFITS

Hydrogen enriched water is loaded with health benefits that include inflammation and wrinkle reduction, aiding in metabolizing glucose and fat faster. To take advantage of these benefits you need to drink only two glasses of hydrogen rich water or 500ml as compared to studies that say that our body requires 8 to 10 glasses of water per day.

Here is a run down some of the major health benefits that Hydrogen rich water provides -

HYDROGEN RICH WATER

Protects your Brain – Our brain gets damages due to several reasons like stroke, surgery or oxidative stress over time. Hydrogen rich water consumption protects you against the neurological damage that is caused due to any such brain injury.

Improves Fat and Glucose Metabolism – Studies and research carried out on rats has revealed that hydrogen rich water improves the glucose metabolism and fat in people suffering from type 2 diabetes as well. Furthermore it effects are also found on cholesterol, fatty liver and obesity.

Prevents Bone loss and Osteopenia – Alkaline or hydrogen enriched water helps in maintaining the PH in your blood without much of a use of magnesium and calcium stores in the bones and muscles. It thus helps in retaining the minerals and proteins inside the bone tissue, ultimately preventing bone loss and osteopenia, a condition caused to the reduction of the same.

Works well against Inflammation – A research experiment conducted on mice revealed that drinking hydrogen rich water relieved the mice suffering from inflammatory bowel disease. Another other study also proved that it could relieve lung inflammation, liver disease and specifically help asthmatic condition.

Eases Cancer Treatment Radiations side effects – Radiation therapy on A study on cancer patients undergoing radiation therapy showed that patients drinking two quarts of hydrogen rich water everyday over six weeks showed lower blood levels of oxidative markers and thus better quality of life compared to tap water drinkers undergoing therapy.

Well, the data available on the long term benefits of hydrogen is not much but primary studies do indicate that hydrogen rich water could certainly help, considering the benefits mentioned.

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Liver Cancer – Causes, Symptoms, Diagnosis, Treatment

Liver cancer is one of the less common cancers in India and not as such reportable. It is mostly in urban areas of India and ranges upto 7.5 per 100,000 in men and over 2 per 10,000 in women in its common form called Hepatocellular Carcinome (HCC).

Liver cancer has mainly four types of which HCC is the most common. The others include Cholangiocarinoma, Liver Angiosarcoma, Hepoblastoma. Almost 75% of the people in India suffer from HCC.Liver Cancer - Causes, Symptoms, Diagnosis, Treatment

CAUSES
The different causes of liver cancer include damaged liver at birth defects, chronic infection, alcohol abuse, cirhosis, aflatoxin and more

SYMPTOMS
The symptoms in liver cancer differ depending upon the type of the cancer. Though the most common indicators include Loss of apetite, sudden weight loss, liver swelling, jaundice, itching, vomiting, abdominal pain to name a few.

DIAGNOSIS
The tests that are used for diagnosis include angiography, laparoscopy, alpha fetoprotein blood test, biopsy test and imaging tests like ultrasound, magnetic resonance imaging and more. Though, it is very difficult to diagnose liver cancer at an early stage.

RISK FACTORS
The most common risk factors associated with Liver cancer include Cirrhosis, Diabetes, Hereditary liver diseases, Obesity, Aflatoxins, Alcohol consumption., hereditary liver diseases to name a few.

PROGNOSIS
The cancer stages include localized, regional and distant. While localized means that the cancer cells are still inside the liver and haven’t spread across. At the regional stage, the cancer cells spread to nearby organs and in the distant stage which is considered as an advanced stage, the cancer cells have spread across tissues and organs distant from the liver. The survival rate for 5 years in patients with liver cancer is just about 2% or less for distant stage, around 7% for regional and over 25% for localized.

TREATMENT
The treatment depends on the diagnosis that includes the type of liver cancer, its stage and the patient as well. The various treatments generally include liver transplant, surgery, alcohol injection, targeted drug therapy, radiation therapy and more.

PREVENTION
Everything boils down to maintaining a healthy lifestyle when it comes to prevention of illnesses and conditions. Eating a balanced diet and regular exercise is the best way to prevent the occurrence besides regular health checkups after a certain age.

Though liver cancer is not so relevant in India, it is advisable to take care of your body so as to avoid the many man-made causes of the dreaded illness.

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Why is VIMS one of the Best Colleges for Medical Education

Medical education as we all know is one of the most sought after educational courses in India ever since its inception. Every year thousands for Medical Aspirants slog to the best of their abilities to crack the medical entrance test namely Common Entrance Test & more, for a chance to pursue one of the highest paying degree courses in India and around the world as well.

 Vydehi Institute of Medical Sciences

Well, there are many different streams and courses to opt for in the education field in India already, but one field that is still the top scorer in the parents choice of educational courses is Medical Education. So, in case you are willing to join the MBBS or associated medical courses, take it for granted that your parents are definitely going to back you to the fullest. Most of them would be willing to fight all odds to make their child a doctor, even if they have to spend a fortune. So, you need not worry on that front at all. Your worry now remains, cracking the entrance tests and finding the right medical college, for a shining career in medicine.

Let us consider, you are a star scorer and have immense chance of cracking the entrance and getting a variety of college choices to opt from. Now, the second phase involves homework or groundwork for a medical college that offers you best infrastructure, quality education, practical experience and supports you with job opportunities as well.
Considering the location of the college and your education budget does matter, but budget issues could be sorted out if the college is worth, that’s what seems a good idea – ask career experts and they’ll say the same.

Apparently, there are umpteen medical colleges across India, but there are certain important points to consider before selecting a medical college to join in, as already mentioned before. Make a checklist of the points to help you shortlist them and finally narrow down to one of your choice.
Speaking of medical colleges, one college that needs to be checkout is Vydehi Institute of Medical Sciences, Bangalore only because it offers medical education of high standards. Located in EPIP area of whitefield, this temple of medical education was established in the year 2000. It has 250 seats available for admission under MBBS undergraduate courses and 56 under post graduate category.

Recognized by the Medical council of India and affiliated to Rajiv Gandhi University of Health Sciences, VIMS also has tie ups with global universities like University of California and Georgia. It is nestled amidst a lush green and sprawling campus of 65 acres. Supported by a multi-specialty hospital with facilities of advanced healthcare systems, VIMS & RC focuses on delivering comprehensive, integrated medical education and innovative healthcare technology and research.

This state of the art infrastructure that includes numerous facilities like advanced education and recreation facilities, research and development offerings, library & hostel setup for in depth knowledge acquisition and professional training is just but a part of the comprehensive educational unit it is. Supported by scholars as faculty to for excellence in medicine, VIMS & RC is also equipped with a 1600 bedded multi-specialty hospital for hands on training.

VIMS & RC, thus is not just any medical college, it is actually a powerful platform for aspiring doctors to transform themselves from ordinary human beings to extra ordinary people with a purpose and ability to serve the society and its people as a medical professionals and saviors in a way.

No wonder, it is one of the most sought after institutions for excellence in medical education for all the aspiring students with a passion for healthcare education.

Cancer Treatment In India – The Current Scenario

Cancer is said to be one of the most common conditions amongst Indians and the sad part is India is listed as the third highest in cancer deaths in the world. The graph is pointing north and there is an estimated forecast of 25% increase by the year 2020. These are by far alarming figures. So, we need to be ready to fight the dreaded diseases and the first step to it is awareness about the conditions and its treatments.

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CANCER & ITS CAUSES
Every year over 6 lac people in India succumb to cancer in India. The most common cancers in India amongst men are oral, lung and throat cancers while the in women its breast cancer, cervix cancer and ovarian cancers. Even colon, prostate and kidney cancers are common types on cancers amongst the aged group. Apparently, causes of 25% of the cancers including bone, leukemia and more aren’t known yet. The majority cancer cases in India are that of oral cancers in men caused due to excessive intake of tobacco and its products. In women, cancer of the breast, uterus and kidney are caused due to obesity issues and genetic issues. Cervical cancer is a result of personal hygiene issues. The major causes of all remain tobacco use, obesity and cancer causing pathogens.

TREATMENT IN INDIA v/s ABROAD
Every other day, we wake up to the news of some celebrity catching cancer and also that most of them moving abroad for treatment. But, the words coming out of the horses mouth speaks a different story. Ask the leading oncologists and cancer specialists in India, and they say that India is one of the best destinations for cancer treatment. Primary reason is the cost factor. While comparing the treatment cost overseas in Dollars or Pounds, India almost 500% to 700% cheaper. Furthermore, due to globalization getting the latest medications in India is quick, at the most late by 3 months or so. India not only has expert oncologists, it is also equipped with the latest equipments and treatment facilities across cancer hospitals.

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CANCER TREATMENT TYPES
The course of treatment depends upon the diagnosis of the condition and its current stage. The commonly used cancer treatments in India include Surgery, Chemotherapy, Radiation therapy, Immuno therapy, Hormone Therapy, Stem cell transplant, targeted therapy and precision medicine. The treatment might include one or combination of two or more treatments from the above, the common ones are radiation therapy, chemotherapy and surgery.
The latest in cancer treatment in India is Cyber Knife Surgery, a non invasive, pain free robotic radiation therapy with no side effects as such.

COST OF CANCER TREATMENT IN INDIA
The cost varies depending upon the cancer type, stage of cancer, the treatment type and hospital as well. While chemotherapy treatment includes traditional, standard or cytotoxic chemotherapy and radiation therapy includes systematic radiation therapy (SRT), Radioimmuno therapy, Instaoperative radiation therapy (IORT), to name a few. The cost depends on the type of the therapy and the number of the cycles. Well, radio therapy is said to be the most expensive of all.

VOICE - Vydehi Oncology Institute and Center of Excellence

Well, Cancer does cost, but there’s always a way out. Some NGO’s in India work towards financing patients through this life threatening condition. Even some hospitals in India do offer Cancer treatment facilities at subsidized rates. One such hospital is Vydehi Insitute of Medical Sciences, Bangalore. The oncology centre VOICE at VIMS offers cancer treatments at almost 30% less cost compared to any other cancer treatment institute or hospital in Karnataka. While offering Financial assistance for advanced treatments like IGRT/ IMRT/ SBRT/SRS /HIPEC to all, it also provides free cancer treatment to BPL card holders of Karnataka. Besides housing highly qualified and experienced oncologists and cancer specialists, this centre is lately equipped with a hi-tech radiation zone that features Versa HD -Stereotactic Precision Radiotherapy unit (Triple F). Featuring high precision beam shaping and tumor targeting, Versa HD is designed with new capabilities to provide a faster and more accurate treatment for a wide range of cancer conditions.

Chikungunya in India – Causes, Symptoms, Treatment and Prevention

When it comes to life threatening diseases, the first few names that come to our minds as Indians are Cancer, Heart attack and aids, as these are the most common ones in India. But when it comes to non threatening diseases we tend to take things lightely. Sometimes, we might pay for such careless approach. Considering the weather conditions in India, hygiene issues and that it forms apt conditions for breading mosquitoes primarily in Tropical regions, making everyone highly vulnerable to get infected by Chikungunya.

chikungunya-in-india

Chikungunya is rampant in the whole of India and mosquitoes are the careers for it. Let us understand the causes, symptoms, treatment and prevention of both.

GENESIS
Cikungunya, a RNA virus is responsible for causing chikungunya and is spread through two species of Aedes type mosquito. The name of the condition finds its origin from a description in Makonde language and means ‘to be contorted”. Apparently, it is derived on the basis of the posture issues that develop amongst the victims on account of severe joint pain. It was first discovered in the year 1952 in Tanzania. Even though it is considered to be a tropical disease, the affected populace includes that of Africa and Asia, including India.

SYMPTOMS
The symptoms of Chikungunya surface within a few days after the mosquito bites the victim and includes high fever, joint and muscle pain, rash and swelling around joints. Rarely, the symptoms could include heat rash, measles, nausea, conjunctivitis and vomiting. Chikungunya is not a fatal condition but is accompanied by persistent joint pain that may last for upto a year or more post recovery.

DIAGNOSIS – Based on the symptoms the doctor may ask for a Blood Test to confirm the same.

TREATMENT
There is no prescribed medicine or treatment for Chikungunya though doctors recommend fluid intake as much as possible. Besides, OTC drugs like ibuprofen, acetaminophen and naproxen are taken to ease out fever and joint pain.

PREVENTION
Prevention is always the best idea and as mosquitos are the root cause of this problem, its advisable to stay away from them. Some basic and simple precautions include using mosquito nets, mosquito repellents, keeping the surroundings clean, wearing body covering clothes, avoiding travel to regions bearing the brunt of chikungunya outbreak, to name a few.

Chikungunya is fast taking India in its claws and its high time we fight back and put in individual efforts towards eradicating this condition from the country. Sp its advisable to take the afore-mentioned simple steps to stay away from it.

5 TIPS ON LIVING WITH ASTHMA

5 TIPS ON LIVING WITH ASTHMA IN INDIA

Lets begin with some good news for asthma patients. The life expectancy of asthma patients is no less than any other normal human being, upto 80 years on an average. So, if you are a child, a teen, youngster and you have to live with it, atleast be happy that its not cutting off your life span. Yes, there are a lot of issues like breathing difficulties and more that you come as package deal with the condition, but working around the same can be of great help, certainly.

STAY AWAY FROM TRIGGERS AS MUCH AS POSSIBLE

If you have been an asthamatic for a long while, you are sure to know the triggers that give you attacks. It could be dust mites, smoke, cockroaches, nitrogen oxide emissions, warm blooded pets, etc. If you’re not , you simply need to keep a check on your eating habits, exercise, weather conditions, surroundings and observe. You will soon figure out the triggers that are most likely give you attacks. Once you know them, try to stay away from them or avoid them as much as possible. Stay alert. Stay safe.

TIPS ON LIVING WITH ASTHMA

THE RIGHT DIAGNOSIS FOR THE RIGHT TREATMENT

When you have asthma, the diagnosis matters a lot. The right diagnosis can help you out with the correct therapies and regimen to avoid the occurrence of attacks. Improper diagnosis is just beating around the problems and not getting to the heart of it. So work closely with your doctor across seasons so as to help yourself the apt treatment.

TAKE YOUR MEDICATIONS REGULARLY AND CORRECTLY

Sometimes, we tend to pay less attention in the process of using inhalers which are an integral part of an asthamtic’s life. As stupid as it may sound, the truth is some of us don’t even know whether we are using the inhaler optimally. The medication from the inhalers has to reach the bronchial tubes to be effective enough and for that to happen, taking the medication properly is important.

TAKE CARE OF YOURSELF

As they say a stitch in time saves nine, once you have asthma, taking care of yourself is important and could help you keep away from asthma attacks to a great extent. Simple precautions like using a scarf and keep yourself warm during cold weather, staying away from highly polluted areas or traffic and taking medications on time and reaching out to the doctors sooner in case of problems would certainly ease your life.

Pollution in India is taking a toll, particularly metro cities that are densely populated, not to forget the recent smog issues faced by New Delhi, one of its kind to see. This is definitely going to up the asthma patient count drastically. In order to deal with pollution or with asthma life long,  following certain routines and taking needed precautions to avoid it, is a highly advisable.

For More info contact to Department of TB & Chest

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