Deep Brain Stimulation

Deep Brain Stimulation is the last resort for patients with Parkinson’s disease, commonly identified by trembling or shaking hands, loss of balance and coordination.

Deep Brain Stimualtion
DBS Image courtesy Michael J Fox Foundation

However Deep Brain Stimulation or DBS as it is called is not for every patient. DBS only helps patients who are still responsive to medication but are not able to achieve optimal efficacy in symptom management due to use over years.

With at least 90,000 implants worldwide, DBS today is the preferred choice for treatment of Parkinson’s disease.

DBS helps with problems of movement, tremors and involuntary movements associated with not only Parkinson’s disease but also dystonia, multiple sclerosis, severe psychiatric disorders such as OCD and even treatment-resistant depression.

What really happens in Deep Brain Stimulation?

During Deep Brain Stimulation surgery the patient is awake. A small battery-powered device pretty much like a pacemaker is implanted in the patient’s chest, near the collarbone or close to the abdomen. This device is connected to the electrodes in the brain by a wire. 
The device then sends electrical signals or impulses to target areas in the brain to help modulate dysfunctional circuits in the brain. These signals block the impulses that cause tremors, movement disorders, and other neurological dysfunction.
Due to stimulation and modulation, the brain is able to function more effectively.
Brain mapping gives us the exact location in the brain to be targetted, where nerve signals generate the tremors and other symptoms.

Imaging and recording technology maps the physical structure and functioning of the brain.

The surgery often takes several hours.

Side Effects of Deep Brain Stimulation can be, infection, swelling at the site of the implanted device, headache, confusion, stroke, seizure.

Advantages of DBS:

  • Continous symptom control , 24 x 7.
  • The patient can switch on and off the implanted device by a controller.
  • DBS can be performed on both sides of the brain to control symptoms on both sides of the body.
  • DBS is a reversible surgery unlike pallidotomy and thalamotomy
  • Symptoms of the patient can be controlled and stimulation adjusted specifically for each patient with DBS
  • The battery of the implanted device usually lasts for 3-5 years and post that can be recharged in what is known as a rechargeable device else the implanted device near the chest can be replaced in a small OPD procedure.
  • Many patients at an advanced stage of Parkinson’s, may benefit from Deep Brain Stimulation or DBS as it is called.

DBS cannot cure the disease but is able to provide significant and sustained relief to patients who have an erratic response to levodopa.

Tremors, however, can be controlled with Deep Brain Stimulation even for patients not responsive to levodopa treatment.

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DBS Image courtesy Michael J Fox Foundation

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Doctors are now looking at these early signs, Are you?

Diseases of the mind can rob us of our motor skills, sap our mental strength, make us lose control over our bodies. Many common known symptoms appear much later, however researchers are now looking at symptoms which start to appear early on.

Many of these symptoms are commonplace, however, an evaluation can help with early diagnosis and much better management and prognosis.

Parkinson disease
Parkinson’s disease

Loss of sense of smell:  If you have trouble picking smells and are not able to distinguish between smells, then it is something worth getting checking up from your doctor.

Loss of smell or hyposmia is now characterized as one of the earliest symptoms of  Parkinson’s.

Disturbed Sleep: A sound sleeper suddenly not able to sleep is of concern anyway but if accompanied by too much twitching, twisting, tossing and turning, it may be worth a visit to the doctor.

Disruption in regular sleep patterns has also now identified as one of the earliest signs of Parkinson’s.

Constipation: Change in bowel habits is of concern but if you find yourself skipping a day in between, it may be worth seeing a doctor. Diseases like Parkinson’s affect digestion and bowel movement much before other motor symptoms start to appear.

Sudden Stammering and rapid speech: Sudden change in speech such as speaking too fast or stammering may also indicate an onset of Parkinson’s.

Softer Voice: Families of patients have often mentioned softness in speech, a departure from normal speech, often with lack of expression as one of the early symptoms.

Depression: Many patients suffering from Parkinson’s were found to have been depressed years before an actual diagnosis of Parkison.

If one is depressed, it does not mean that one has Parkinson, but it may be worth a checkup for sure.

Slight Tremors, Shaking: Many families have mentioned noticing a slight tremor or shake years before actual diagnosis. If you suddenly notice minor tremors or shakes in your finger, lips, chin, arm, feet especially when stressed or excited, it may be worth a visit to the doctor.

Most of the above-mentioned symptoms can be specific to many other medical conditions but slight tremors may truly be specific only to Parkinson’s

Stiffness: If you find yourself or a loved one with not only stiff joints, but also stiff muscles, it’s not good news.  Joint and muscle stiffness, feeling weighed down or in general not being able to move very well,  is bad news always but if you find others commenting on stiffness, lack of movement and if you feel your body is like lead, heavy and stuck to the ground, it could be due to onset of Parkinson’s.

Change in handwriting: One of the early signs even prior to diagnosis is a change in handwriting. Words suddenly crowding together, handwriting becoming smaller is one of the early signs pre-diagnosis.

Parkinson’s is often difficult to diagnose and is not curable. However medical management can help patients by way of significant improvement in symptoms such as tremors, shaking, stiffness.

Balancing exercises, stretching also helps along with speech therapy when required.

Usually, medication involves giving patients Dopamine, a neurotransmitter which signals the brain. Parkinson patients are deficient in dopamine.

Some patients show significant improvement in symptoms with levodopa while a few remain unresponsive.

Carbidopa-levodopa given orally or by way of infusion as Parkinson’s will progress is the usual course of treatment. An improvement in symptoms with carbidopa-levodopa usually confirms the diagnosis of Parkinson’s.

Many patients at an advanced stage of Parkinson’s, may benefit from Deep Brain Stimulation or DBS as it is called.

DBS cannot cure the disease but is able to provide significant and sustained relief to patients who have an erratic response to levodopa.

Tremors, however, can be controlled with Deep Brain Stimulation even for patients not responsive to levodopa treatment.

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Quickie on what our skin says about our health!

Our skin has the largest surface area of our body and fortunately says a lot about our body too.

So here’s a quickie on health problems, indicated by telltale signs on our skin:

Problems with Gall Bladder, Liver:  Excessively yellow skin can be indicative of excessive bile,  bilirubin production, and subsequently a problem with the gallbladder or liver disease.

HypoThyroid: Pale looking skin along with clammy, cold skin, hands and feet may indicate an underactive thyroid. Hypothyroid is a serious medical condition which may lead to even heart disease at a later stage and hence proper medical management is critical.

Varicose Veins: If you find deep blue veins visible, on your legs, it could be a sign of varicose veins. Veins help blood circulate properly.  Blood leaking and pooling into veins is often a sign of things not working well. Varicose veins may be accompanied by pain, cramping and tingling on the soles of the foot and even difficulty walking.

Varicose Veins

Varicose veins are different from spider veins. While spider veins are thin and look like the spiders’ web, varicose veins are larger, thicker and often raised on the skin.

Time to connect with a doctor is when the veins start to pain and trouble.

Spider Veins
Spider Veins

Badly damaged veins may lead to a clotting and a condition known as Deep Vein Thrombosis. Treatment may include wearing compression stockings or sclerotherapy, that is injecting the vein to shut it down and even surgery.


Swollen Lymph Nodes: Swollen lymph nodes in the neck, collarbone, armpits, groin can be a sign of an infection or worst case Lymphoma.

Extremely Itchy Scratchy Skin: Extreme itchiness especially in your lower limbs, without insect, mosquito bites, without visible skin rashes may be an early sign of lymphoma.

Extreme itching worse than that experienced due to dry skin, with or without reddish inflamed skin could be what is known as Hodgkin’s itch and calls for a visit to the doctor.

Unexpected Bruises on the skin may indicate leukemia

Leukemia or Blood Cancer: Any bruises which you seem to get without remembering banging into something or getting hit, large bluish, purple patches on the skin are may be a sign of blood cancer, ALL( Acute Lymphoblastic Leukemia) or AML( Acute Myeloid Leukemia) and need investigation as soon as they are noticed


 ITP and other Bleeding Disorder:  Get Bruised easily or purple splotches which could be large patches known as “Purpura” or small purple specs known as “Petechiae” on the skin could also indicate a bleeding disorder known as ITP and may need further investigation.
Purpura, Petechiae may indicate ITP
Purpura, Petechiae may indicate ITP or other bleeding disorders

DiabetesUnhealed sores on the foot, brown spots on the legs could indicate diabetes. Diabetes damages capillaries and blood leaks forming rough, round, oval brown spots on the skin.

Addison’s disease: A dark coloring or pigmentation on the skin, around the lips, face, soles of the feet, palms may also indicate an endocrine disorder known as Addison’s disease. A diagnostic test measuring cortisol can diagnose Addison’s disease.

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Diagnosing and Treating an Enlarged Heart

In continuation of our last blog on what is an enlarged heart, today we would discuss ” how to diagnose an enlarged heart and treatment options for the same

Enlarged Heart, treatment options
Enlarged Heart, treatment options
Early diagnosis is critical to managing an Enlarged Heart.
Upon a physical examination, a cardiologist may hear a murmur in the heart, unusual heartbeats, water retention in the legs, abdomen, fluid retention in the lungs.
After a physical examination, a few tests that may be carried out are :
  • Angiogram or catheterization, checks for blockages in the heart. A flexible tube is inserted via the groin, dye injected and pictures of the heart taken to check for blockages and heart function. In case of blockages, stenting or angioplasty is carried out at the same time.
  • ECG uses electrodes to detect heart activity.
  • Echo, uses sound waves to detect heart activity and take pictures of the heart.
  • MRI is used to take pictures of the heart and blood vessels to detect anomalies.
  • CT Scan is also used to take pictures of the arteries in the heart and is often used for patients with pacemakers and other implanted devices.
  • Stress Echo: The patient is made to exercise and then heart tests are administered. Along with ECG, Stress Echo shows heart rate, rhythm, and activity.


  • Some of the common treatment options are:


  • Angioplasty or Stenting are often carried out when blockages or fat, calcium deposits are found in the arteries.Stents can be bare metal or drug-eluting which help open up the arteries.
  • CABG or an open heart surgery in case of multiple blockages also help.
  • Heart Valve surgeries, such as single valve repair,  DVR( Double valve replacement ),  MVR(Mitral valve replacement, Mital valve repair), VSD, ASD  help take care of valve-related heart problems which impair blood flow and lead to an enlarged heart over time.
  • VAD or Ventricular assist devices, help in heart failure by helping a weak heart pump blood. VAD can be, LVAD( left ventricular assist device) or RVAD( Right ventricular assist device). ICD combo devices and Pacemakers also help weak hearts or a heart with impaired function.
  • Heart Transplant is the very last option when all else fails to support patients with extreme heart failure.
To discover and compare, the cost of  CABGPDA, VSD, ASD repair, Truncus arteriosus, TOF, Fontan Repair, Angiogram, AngiographyAngioplasty,  Heart Transplant, LVAD, from the best heart hospital in India, click here.

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Enlarged Heart

We often hear of an enlarged heart, what does it mean? How does one’s heart get enlarged? And how does it affect our health?

Heart Disease
Heart Disease
Our heart is a pear-shaped muscle pumping oxygen-rich blood throughout the body.
Sometimes due to certain factors, birth defects- congenital heart defects, our heart muscle has to work much harder causing it to enlarge or become bigger in size.
Once the heart becomes enlarged, it is almost impossible to get it back to the original size.Therefore timely detection and management is the key.
Let’s try and explore factors which lead to an enlarged heart, a medical condition, which is impossible to cure but can be managed medically.
  • Congenital heart defects or heart defects one is born with us as PDA, VSD, ASD, Mitral valve defect, left untreated lead to high pulmonary pressures, which in turn lead to thickening of the arterial wall and also an enlarged heart.Though most babies are routinely scanned for congenital heart defects in developed countries, treatment upon detection and early intervention and management still remains the key.Many parents despite detection, are often scared to get surgical interventions without realizing that they are hampering both mental and physical growth and putting children at risk of enlarged heart and other complications later on in life.


  • Lifestyle-related complications such as hypertension or high blood pressure also lead to an enlarged heart over a period of time.In case of high blood pressure, the heart has to pump harder to deliver blood to the rest of your body, thereby thickening and enlarging the heart muscle.High blood pressure may also enlarge the upper chambers of the heart, the left ventricle and also weaken the heart long-term.


  • Coronary artery disease or CAD (blocked arteries requiring stenting, angioplasty) can also lead to a heart attack. A part of the heart muscle dies during a heart attack, causing the heart muscle to work harder to supply blood to the entire body which over long-term leads to an enlarged heart.


  • Abnormal Heart Beat or Arrhythmia is often ignored but may cause an enlarged heart over a period of time.


  • Anemia or low level of iron in the body, where the body doesn’t have enough Red Blood Cells to carry blood to the body, leads to rapid, irregular heartbeat causing the heart to pump harder to make up for lack of sufficient oxygen in the blood.Sicklers or patients suffering from sickle cell anemia are at an increased risk and despite hearsay, a Bone Marrow Transplant or a BMT remains the only curative treatment for Sickle Cell Anemia, Thalassemia Major.


  • Thyroid disorders, also lead to various heart diseases over a period of time leading to an enlarged heart.
The biggest complications arising from an enlarged heart are heart failure,  SCA or SCD (sudden cardiac arrest or sudden cardiac death) or what is known as a silent heart attack in laymen language.
Heart Failure: During heart failure, the heart muscle weakens and the ventricles, stretch or dilate to a point that the heart cannot pump blood efficiently, leading to a sudden cardiac arrest.
Silent heart attack or SCD: An enlarged heart causes the heart rhythm to be so slow that the muscle is unable to move blood or it may cause a heart rhythm, so fast that the muscle is unable to beat properly resulting in sudden death.
More on diagnosis and treatment options in our next post.
Stay tuned in for more.
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Women’s Day! Weight Loss- The Healthy Way

This women’s day lets talk about something that on top of mind for most women, though its importance for all of us, is no less, “Weight loss the healthy way“.

Women's Day
Womens Day

Many of us believe, cutting down on fat is the way to weight loss.  Research, however, shows cutting down on carbs is the way to go.

Here are a few quick ways to cut down on carbohydrates and lose weight the healthy way.

Avoid Bread: Cutting down on bread especially the white bread ones, reduces intake of carbohydrates. Most bread is made of refined flours and even the enriched ones, multigrain, ragi ones have a fair share of carbohydrates. Replacing them with Multigrain millets such as Ragi, Rye, Amaranth, Barley, raw steel cut Oats, Multigrain rotis( Indian flatbread) is a wiser choice.

Avoid fruit Juices: Fruit juices even the ones labelled 100% fruit juice, have no fibre content and are often no better than sugary beverages. Though some juices are enriched with vitamins, the same can also be provided with seeds and nuts.

Replacing fruit juices with whole fruits is a much better option as whole fruits have a good fibre content and are also a good source of vitamins and minerals.

Freshly squeezed cucumber juice with mint, coriander is also a better choice over prepackaged fruit juices.

Eliminate Sodas and Energy Drinks: Sugary sodas, drinks are best avoided.
Lemon flavoured water, Lemon-ginger infused water, cucumber infused water are good healthier substitutes.

Protein, Protein, Protein: Loading up on protein, lean meats creates a feeling of fullness and ensures that you eat lesser calories through the day. having sufficient protein also ensures lesser muscle loss while exercising.

Adding protein to your daily breakfast instead of sugary cereals, rich in carbohydrates, is a good way to start the day.

Load up on the veggies: Loading up on veggies, adding them to breakfast, lunch and dinner is a good option as not only does eating veggies not only gives us much-needed nutrients but also creates a feeling of fullness and cuts carb cravings.

These easy diet modifications will help not only take inches off your midline but will also lead to a healthier U.

And of course, 30 minutes of exercise at least 5 days a week will add an extra punch.

If all else fails and your BMI still remains over 31, weight loss surgery or bariatric surgery ( Gastric sleeve, gastric bypass) may be good options to consider and may get your blood pressure, diabetes and other obesity-related health conditions under check.

To know more about bariatric surgery, cost in India, click here.

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And lastly wishing firmer boobs, no love handles, flat belly’s, groovy curves to all the beauties and cuties. Happy Women’s day!

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Sugar and cancer- Best Friends?

The question here really is ” Is there a link up between sugar and cancer? And if yes, is the scare for real ?
PET Scan, one of the best-known cancer detection tests, uses, radioactively labelled glucose to detect sugar hungry cancer cells.
While carrying out a PET CT scan, patients are made to drink radioactive glucose water. The radioactive glucose gets actively taken by glucose hungry cancer cells due to which the cancer cells light up. The well lit up cancer cells indicate spread of cancer or spread of cancer cells in various parts of the body.
PET Scan
PET Scan showing well lit cancer cells
As the test works on a cellular level, a PET Scan is the most accurate test for determining spread and growth of cancer.
Sugar basically feeds and fuels cancer cells here due to which the radioactive glucose get taken up, very quickly by the cancer cells in the body.
Research shows that the metabolism of cancer cells is very different from healthy cells. Cancer cells use a process called “Glycolysis” to fuel their growth and the uptake rate is over 10 times that of normal healthy cells.
This clearly means that sugar consumption is connected to cancer and any cancer treatment, must focus on total elimination of sugar in the diet.
Another reason for eliminating sugar is the release of insulin by our pancreas. Whenever we consume sugar, our pancreas release insulin. Insulin promotes cell growth. Breast tissue, for example, has insulin receptors and excess insulin promotes malignant cell growth putting women consuming excess sugar at double the risk of breast cancer and pancreatic cancer. For men, sugar consumption doubles their risk of prostate cancer.
Sugar also creates an acidic environment in the body, ideal for cancer cells to thrive beside suppressing the immune system response of the body.
Consuming 10 tsp of sugar can suppress phagocytes by almost 30% in the next 1 hr and then almost 50% in the following hour and it takes about 5 hrs each time for the body’s immune system to recover completely. Which means that with each glass of Orange Juice( typically 9 tsp of sugar), our immune system is suppressed for almost 5 hrs, which means decreased immunity or response to cancer cells while fuelling growth via glycolysis and increase in insulin.
Sugar consumption, especially in the middle and older years, therefore puts us at increased risk of developing cancer and is a total “NO” while on cancer treatment.
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Your Poop-Is it telling you something ?

Poop comes in all shades, often a result of what we eat and chemical changes due to bile as our food gets digested.

Normal poop color is brown though sometimes if we eat green leafy vegetables it could be on the greener side. A sudden color change could be indicative of a health problem.


Know what your poop color indicates and when it could mean trouble:
Green: Green colored stool could be due to iron supplements, green leafy vegetables, however, it could also mean that the food is moving too quickly through the large intestine as a result of which bile doesn’t have the time to break down the food completely.
White, Clay or Grey: Whitish, grey or clay-colored stools indicate lack of bile and often indicate a problem with gallbladder or liver. The problems could be as varied as liver cirrhosis needing a liver transplant or liver failure due to hepatitis A, Hep B or Hep C.
Yellow: Unless, you are having too many yellow colored liquids, yellow stools indicates, excess fat or poor fat absorption.
Poor fat absorption could be due to blocked bile ducts, a problem with the pancreas, and may indicate lack of enzymes for food digestion or may even point towards chronic pancreatitis, celiac disease.
Red: Unless you have been eating beets, carrots, tomatoes, cranberries, food with red coloring, bright red colored stool may indicate bleeding due to hemorrhoids, anal fissure, and even colon cancer or cancer of the rectum or even bowel cancer.
Black: Black colored stools, may indicate bleeding from the intestines, stomach which may even indicate stomach cancer and need an immediate follow-up call with a doctor.
A diet rich in blueberries or black licorice, iron supplements, bismuth subsalicylate could be other exceptions.
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A Quickie on role of “Robotics in cancer treatment ?

Robotic surgery
robotic robot-assisted brain surgery,

Robotics or computer assisted surgeries are helping patients with advanced cancer care. Robotic surgery effectively means’ robotic systems designed specifically to assist surgeons perform, complex surgical procedures with precision, control and dexterity.

These are often difficult to reach cancerous tumours, which the surgeons are able to view with increased vision and hence excise with precious thanks to video assisted robotic systems.

In general,  the surgeon uses the robotic systems, arms to perform the surgery instead of his own hands. Most good systems come equipped with cameras and 3D imaging to enable surgeons to view deeper locations inside the body and reach the diseased tissue with greater range of motion and precision.

Cyberknife, Gamma Knife, Novalis, Da Vinci are various forms of robotics systems available to assist surgeons.

Robotics can today be used for prostate cancer treatment, oral cancer treatment, breast cancer treatment, throat cancer treatment, thyroid cancer treatment, ovarian cancer treatment, uterine cancer treatment, oesophageal cancerbrain tumour surgery, treatment of bone and soft tissue sarcoma, lung cancer,  and several other cancers.

Even basic procedures like thyroidectomy, hysterectomy can now be done robotically and several surgeons are trained to perform robotic thyroidectomy and robotic hysterectomy.

Though we will cover each of these procedures in greater detail in subsequent posts, here are a few significant benefits of minimally invasive, Robotics assisted surgeries

  • Fewer incisions- Maximum size of incisions is usually not more than 7mm .
  • Significantly lower blood loss as compared to open surgeries.
  • Targeted, Higher Dose of Radiation.
  • Less Trauma, pain Quicker, faster recovery.
  • Reduced hospital stays of sometimes even one day( specific to surgery)
  • Added benefits for obese and diabetic patients with co morbidities where wound healing and open surgery complications need to be avoided.

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How common are Fibroids ?

Fibroid treatment
uterine fibroids

Fibroids affect 1 out of every 4 women, atleast once in their lifetime. Usually affecting women in the age group pf 30-50, fibroids can be as small as a pea or as big as a melon.

Fibroids increase or decrease in size and can even go away. Fibroids are sensitive to oestrogen levels and tend to swell when the level of oestrogen is high  for example in heavier women typically  weighing over 70 kgs or more.

On the other hand, fibroids can shrink when the level of oestrogen goes down and hence tend to shrink on weight loss or post menopause.

Fibroids are also called Uterine Myomas, Fibromyomas or Leiomyomas.  Most Fibroids grow within the muscle tissue of the womb.

What are the common problems associated with fibroids ?

Heavy, Painful Periods: Bleeding is often heavier with fibroids and is often accompanied with pain. Besides affecting quality of life, heavy periods may lead to anaemia.

Bloating, Swelling: Large fibroids, may lead to swelling in the lower abdomen and discomfort in the lower abdomen and lower back.

Painful Intercourse: Fibroids growing near the vagina or the cervix may lead to pain during intercourse.

Bladder Problems: If a fibroid presses on the bladder which is in front of the womb, it may cause frequent urination.

Bowel Problems: Though extremely rare, if a fibroid presses on the bowel, which lies behind the womb, it may cause constipation.

Infertility: If the fibroids grow into the cavity of the womb, they can sometimes block fallopian tubes which can hamper conception and cause Infertility. In such cases an IVF often helps, post fibroid treatment.

Miscarriages: Though rare, sometimes fibroids may cause repeat miscarriages.

Early labour and possibility of a C-section: Sometimes fibroids, may result in an early labour and even a C -section instead of a normal delivery.

There are several ways to treat fibroids, which includes medical management and also surgical options.

Surgical options for treatment of fibroids are:

Hysterectomy: is removal of the womb when fibroids are causing symptoms and pain. If fibroid are small in size, the womb can be removed via the vagina and if the fibroids are large, then the womb may need to be removed via an incision in the lower abdomen.

Myomectomy: is surgical removal of fibroids and can be done either laparoscopically or hysteroscopically( through the vagina). In myomectmy, the fibroids are removed but the womb is left.

Uterine Artery Embolisation: can also help with treatment of  fibroids.

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