So this post is related to the amount of reading I have done on the subject in the past few days. Yes my wife is pregnant and now her ribs hurt, especially the left side of her body. Why? Well rib pain is very common during the later part of pregnancy. The uterus is growing bigger, and reaching the height of the breast bone, compressing the diaphragm, sometimes the babies head can be wedged causing compression causing an inward to outward pressure on the ribs, or worse subluxation or dislocation.

Sorry moms, there is no real fix for all this besides giving labor. However, do avoid NSAIDs, narcotics, but try Tylenol. If you want more of a natural approach, a heating pad to the area can work. I am having my wife perform stretches which help greatly. Most women experience rib pain worst when they are sitting for prolonged periods at a desk job or driving. Try to sit upright, maintain a good posture, and a comfortable maternity bra is a must! Below is a simple online you tube video for examples of stretches.

KEEP STRONG MOMMA – DR SARELA.

 

Simply put this is an overgrowth of a bacteria called clostridium difficile. The body has a balance of tons of bacteria, and if there is a tip in the scale you can have an overgrowth of one type of bacteria or another. When the scales tip in the favor of C diff, this bacteria can be dangerous. Usually there is a story of some patient that has been on long term antibiotics, or exposed to somebody that has the condition. It is usually treated with Vancomycin or Flagyl. As a last ditch effort to treat this infection a fecal transplant can be utilized. What’s a fecal transplant you say? It were you actually take somebody else’s stool process it and give it to the patient rectally. By doing this you provide bacterial flora that tip the scales back into a normal balance. The classic presentation of this, is explosive diarrhea, and sometimes bloody diarrhea. The main rule of thumb when treating patients with this condition is always wash your hands. C diff is transmitted via contact, so hand washing with soap is a must.

Always wash your hands – DR SARELA.

What happens when your sodium level is low on routine labs? Now there are a lot of causes of low sodium (Hyponatremia) which is quite complex to go into but one should know at least the effects of low sodium. First the normal range of sodium is usually around 135 – 145 mEq/L. Common causes of low sodium are dehydration, kidney failure, medication side effects, or having excess body swelling. Depending on the severity, the usual side effects most patients I encounter have headache, muscle cramps, weakness, and report being tired all the time. This is usually with Na levels in the 120s – 130s. When levels are in the 110’s, people have confusion, altered mental status, and can have seizures. Worst case scenario is coma or death. If this applies to you, make sure you see your physician to be worked up for the cause!

-Stay healthy, DR SARELA.

Great question! Most of the time patients are told don’t eat green leafy vegetables while on Coumadin, but are never told why? I’ll try to explain it in simple terms. Vitamin K is a key element in the body that helps form a blood clot. The more vitamin K rich food, think the more thick your blood. Coumadin works against vitamin K and thus thins your blood. Common uses of Coumadin are for cardiac mechanical valves, clots in the lung (Pulmonary Embolism), clots in the calf (Deep Venous Thrombosis), or the condition called atrial fibrillation – ie. irregular heart beat.

Some common foods to avoid if on Coumadin are the HIGH vitamin K rich foods; broccoli, brussel sprouts, cabbage, collard greens, green tea, kale, romaine lettuce, soybeans, and spinach. Medium rich vitamin K foods are; asparagus, green beans, blackberries/blueberries, grapes, kiwi, cashews, ensure boost supplements, vegetable juice.

Now rest assured, if you love green veggies you do not have to eliminate them completely. The key is to have a steady diet of greens, and titrate the Coumadin level up or down based on your diet. Once you reach a steady state, it will be easier for your primary care doctor to manage your levels.

-DR SARELA

 

I had a patient that surprised me today. She was being treated for a medical condition, but we ended up talking about a topic unrelated to her condition. That topic was chickens! Yes chickens! I spent about 20 minutes picking her brain on how to raise chickens, how to make a coop, controlling the hens, and determining when the optimal was to check for laid eggs. Now granted, the topic was off base, but I learned more about my patient than I ever did. I was able to communicate and earn a sense of trust within a few minutes. The overall point is, you never know what you can learn from others.

-Be open to learn random things, DR SARELA.

 

A few patients of mine while on the floors today asked, what is Emphysema as I mentioned that the chest X-ray or CT showed signs of this.

This is a disease caused by the break down of the lung from a cause, usually smoking. It is a chronic disease, meaning a long term issue that has been going on for months sometimes years. It causes difficulty breathing. Sometimes so much difficulty that patients require oxygen support as well. Emphysema is one type of COPD (chronic obstructive pulmonary disease). The reason why its called obstructive is, it take a long time to exhale to get all the air out of lungs. Emphysema has no cure, but your lung function can improve if you stop smoking.

-Stop smoking everybody, live longer DR SARELA.

 

 

On my trip in Kauai I have sampled a variety of new and strange things. Sure it takes some courage to get out of your standard and sometimes boring ways, but isn’t that living? The common theme in Hawaii is, “live like it’s your last day.” It’s a theme that is encountered ever time I listen to the traditional music, or here about a local remenescing. I decided to embrace this mindset with my wife. We have tried a variety of local foods, frankly I can not pronounce. We even have a fancy toilet, an electronic bidet, that I tried! Live life, take the new course, and become a child again and explore!

-Adventure is waiting DR SARELA

Hello all. I found myself caught in the dumps, and felt to transition out of the slump and the difficult month I decided to take a vacation with my wife to Hawaii. We are looking forward to enjoy the time away, and use the vacation as a stepping platform for a new beginning!  I feel that any patient hospitalized can benefit from a purposefully scheduled vacation after getting over a medical illness. I sometimes see patients very depressed after hospitalization. They may feel there is no progression with their health, especially after multiple hospitalization in the year. Use the vacation as a way to reset the body, reset the mind, reset the soul. Use this time to reflect on the past, and prepare for the future!

-Vacation to cleanse the soul, DR SARELA

 

There is a lot of confusion regarding when to start blood pressure medication. I will try to explain it very simply so that you don’t have a headache! The latest recommendations for blood pressure management are found in the JNC 8 guidelines. Essentially a lot of the information is obtained and adapted from European studies.  The quick and simple is outlined below: