Asthma is a chronic respiratory condition affecting millions worldwide. It can cause symptoms such as coughing, wheezing, shortness of breath, and chest tightness, making it difficult to breathe. However, with proper management and treatment, asthma can be controlled, and its symptoms can be minimised. In this blog post, we’ll share tips to help manage your asthma and breathe easily.
Know your triggers – The first step in controlling your asthma is to identify your triggers. Triggers are things that can cause your asthma symptoms to flare up, such as pollen, dust mites, animal dander, cold air, or exercise. By knowing your triggers, you can take steps to avoid or minimise exposure to them.
Take your medications as prescribed – Medications are an essential part of managing asthma. If medications have been prescribed for your asthma, it’s important to take them as directed by your doctor. This may include inhalers, nebulizers, or oral medications. These medications help to control inflammation and open up airways, making it easier to breathe.Check out: Asthma: Debunking Myths About Using Inhalers
Follow an Asthma action plan – An asthma action plan is a written plan outlining the steps you should take when your asthma symptoms worsen. Doctors can help create an asthma action plan that includes instructions on when to take your medication, when to seek medical help, and how to manage your triggers.
Monitor your lung function – Monitoring your lung function is an important part of controlling your asthma. Doctors may recommend using a peak flow metre, which measures how well you can breathe out air. By monitoring your lung function regularly, you can detect changes in your asthma symptoms and take appropriate action.
Keep your environment clean – Keeping your environment clean is essential for controlling asthma symptoms. This includes reducing exposure to dust, mould, and other allergens. Vacuum regularly, wash bedding in hot water, and use an air purifier.
Stay active – Exercise is a part of a healthy lifestyle, even if you have asthma. Regular exercise can help improve lung function, reduce inflammation, and strengthen respiratory muscles. Talk to a doctor before starting new exercise programs, and take precautions, such as using your inhaler before exercising.
Manage stress – Stress can exacerbate asthma symptoms, so it’s important to manage stress levels. This includes practising relaxation techniques like deep breathing, meditation, or yoga. It’s also important to get enough sleep and make time for activities you enjoy.
In conclusion, asthma can be a challenging condition to manage, but it can be controlled with the proper treatment and lifestyle changes. By knowing your triggers, taking your medications as prescribed, following an asthma action plan, monitoring your lung function, keeping your environment clean, staying active, and managing stress, you can keep your asthma under control and breathe easy. If you’re struggling with asthma symptoms, talk to a doctor or asthma specialist about the best treatment options for you.
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Multiple myeloma is a type of cancer of the bone marrow and blood, specifically, a malignancy of plasma cells found in the bone marrow. Bone marrow is the spongy tissue found within bones and is the site of blood production. These plasma cells are specific types of white cells called B lymphoid cells whose primary function is to secrete antibodies which help in maintaining the body’s immune functions and helps prevent and fight infections. In normal circumstances, these cells cannot be detected in the peripheral blood of a healthy individual.
Multiple myeloma, also known as plasma cell myeloma, is a disease spectrum included under the broad category of heterogeneous pathologic conditions called Plasma Cell Dyscrasia (PCD). There are many other diseases included under the umbrella term of PCD, such as Monoclonal Gammopathy of Undetermined Significance (MGUS), AL Amyloidosis, Plasmacytoma, Monoclonal Gammopathy of Renal Significance (MGRS), Waldenstorms Macroglobulinemia (WM), and plasma cells leukaemia (PCL).
Multiple Myeloma Causes
Among these, multiple myeloma is one of the most prevalent diseases. It is primarily detected in the elderly population, with most cases presenting in patients above 60. In this disease, there is an uncontrolled clonal proliferation of plasma cells within the bone marrow, which starts secreting abnormal proteins or immunoglobulins (Ig), which are attempted to be removed by the kidneys. However, due to their larger size and a gradual load of these abnormal proteins, the clearance capacity of the kidneys is compromised. Eventually, they start accumulating within the kidneys causing chronic kidney damage.
Due to the proliferation of these abnormal malignant cells, the normal function of bone marrow also gradually starts getting affected, and the normal hematopoietic elements start getting suppressed. These cumulatively result in a number of haematological and biochemical changes within the body, such as anaemia (low haemoglobin), abnormal kidney function or elevated creatinine, elevated abnormal protein (called globulin), increased blood calcium level, and abnormal Ig. Their fragments are called free light chains and can be detected in the blood and urine. Due to the bones gradually losing calcium, they start getting weak and develop small breakages or lytic lesions, which can be detected by X-rays, PET scans or MRI.
Multiple Myeloma Diagnosis
Main investigations include a complete blood count, blood smear examination, kidney and liver function tests, biochemical parameters such as serum or urine protein electrophoresis, immunofixation and free light chain assays, bone marrow studies, karyotyping/ cytogenetics, next-generation sequencing (NGS), X-ray of bones or PET CT and MRI.
Multiple Myeloma Risk Factors
There are no specific risk factors for acquiring this disease. However, it occurs in a patient with a pre-existing MGUS, which is benign plasma cell dyscrasia. Hence such patients should be monitored frequently to rule out transformation to myeloma. Multiple myeloma is often associated with cytogenic or molecular abnormalities, which along with other biochemical parameters, help stratify the disease into low, intermediate or high risk, which may help decide the subsequent line of therapy.
Multiple Myeloma Symptoms
The main clinical features or symptoms in multiple myeloma will include fatigue and breathing difficulty due to low haemoglobin or anaemia, fever, a tendency to develop frequent infections as a result of low immunity, weight loss, appetite loss, bone pains usually presenting as low back pain, development of pathological fractures with minimum or no trauma, derangement of kidney function and passage of protein in the urine and features of peripheral neuropathy such as numbness, pain or tingling over the extremities. However, the diagnosis of myeloma can often be missed since most patients present with non-specific signs and symptoms, which patients may initially attribute to old age-related symptoms and may delay in seeking a medical opinion.
However, there must be a high level of suspicion for this condition to avoid misdiagnosis, which may result in disease progression and an increased likelihood for subsequent development of PCL, which is a potentially life-threatening condition.
Multiple Myeloma Treatment
The treatment of myeloma is determined by patient-related, disease-related and drug-related factors. Each patient is evaluated on an individual basis, and the appropriate line of therapy is decided by an expert group of doctors, ideally by a multi-disciplinary team approach. The treatment strategies include modalities such as Immunotherapy, Chemotherapy, Monoclonal Antibodies, Targeted therapies and Stem Cell Transplant, mainly the autologous type. However, allogeneic transplants may be used in relapsed or refractory cases in physically fit younger individuals. Moreover, CAR-T cell therapy is now an approved and promising therapeutic modality, which is a highly specialized immunotherapy involving genetically modifying a patient’s T cells to attack and fight multiple myeloma.
In eligible patients, including high-risk diseases, an autologous stem cell transplant is usually recommended in keeping with the chronic relapsing nature of the disease, as this therapy may help increase the remission period and reduce the likelihood of relapses.
Conclusion
Overall, multiple myeloma is a haematological malignancy presenting in older age which is treatable via a number of modalities. With current advancements in diagnostic methods, improved individualized therapeutic regimens, better facilities and supportive care, there has been a consistent improvement in the overall survival, progression-free survival and general quality of life in patients suffering from multiple myeloma.
Advances in cardiology have revolutionised the field of valve replacement, providing a breakthrough solution for patients who are not suitable candidates for traditional open-heart surgery. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive procedure that offers a safe and effective alternative to surgical valve replacement. In this article, we will explore the benefits and advantages of TAVR, highlighting why surgery may no longer be the only option for valve replacement.
TAVR: A Minimally Invasive Alternative:
TAVR allows for the replacement of heart valves without the need for open-heart surgery. Instead, a catheter-mounted valve is inserted through a small puncture in the groin and guided to the site of the old valve. Once in position, the new valve is deployed, leading to immediate clinical improvement. This procedure is typically performed in a cardiac catheterisation lab, reducing the risks associated with traditional surgery.
Faster Recovery and Reduced Hospital StayCompared to open-heart surgery, TAVR offers several advantages in terms of recovery time and hospital stay. Traditional valve replacement surgery requires a sternotomy, which involves the surgical separation of the chest, resulting in a longer recovery period of 6-8 weeks. In contrast, TAVR patients typically experience a shorter hospital stay of 1-2 days and a quicker overall recovery, similar to that of a stent procedure.
Local Anesthesia and Awake During the ProcedureTAVR procedures are performed under local anaesthesia, minimising the risks associated with general anaesthesia. Patients remain awake throughout the procedure, allowing for real-time communication with the medical team. This not only improves patient comfort but also enables quicker assessment of the valve’s functionality during the deployment process.
Suitable for Elderly and Frail PatientsOne of the significant advantages of TAVR is its suitability for elderly and frail patients who may be at higher risk for open-heart surgery. As the population ages, the number of patients needing valve replacement increases. TAVR provides a safer option for these individuals, enabling them to receive the necessary treatment with reduced risks and improved outcomes.
Validated Superiority and Widening ApplicationsNumerous studies have confirmed the effectiveness and superiority of TAVR compared to traditional valve replacement surgery. Initially approved for elderly patients, TAVR has expanded its applications and can now be considered for younger patients who are not eligible for surgical options or are deemed high-risk candidates. This widening of eligibility criteria has further solidified TAVR’s position as a viable alternative to surgery.
Case Study: Mr S’s Journey to a Successful TAVR Procedure
To illustrate the transformative impact of TAVR, let us delve into the case of Mr S, an 83-year-old gentleman who required a repeat aortic valve replacement. Due to his age and frailty, traditional open-heart surgery was deemed too risky. However, thanks to the advancements in cardiology, Mr. S was offered the opportunity to undergo a TAVR procedure. With a small puncture in his groin, the catheter-mounted valve was carefully positioned and deployed at the site of his degenerated valve. The procedure, lasting only one to one and a half hours, was performed while Mr S remained awake, and he experienced immediate clinical improvement. After just a brief hospital stay of two days, Mr S was discharged, and his recovery was remarkably smooth. The success of Mr S’s TAVR case serves as a compelling testament to the efficacy and benefits of this groundbreaking procedure, providing hope and renewed quality of life for patients who were once considered poor candidates for valve replacement.
The advent of TAVR has transformed the field of valve replacement, offering a minimally invasive and effective solution for patients who were previously limited by the risks and challenges of traditional open-heart surgery. With faster recovery, reduced hospital stays, and proven superiority, TAVR has become the go-to option for many patients requiring valve replacement. As the technology continues to advance, we can expect even greater refinements and broader applications, ultimately benefiting a larger population in need of life-saving interventions.
