CORONARY ARTERY DISEASE AND HOMOCYSTEINE

What is homocysteine? 

Homocysteine is an amino acid that is produced by the body, usually as a byproduct of consuming meat. Amino acids are naturally made products, which are the building blocks of all the proteins in the body.

Why is it important to monitor homocysteine levels?

Elevated levels of homocysteine (>10 micromoles/liter) in the blood may be associated with atherosclerosis (hardening and narrowing of the arteries) as well as an increased risk of heart attacks, strokes, blood clot formation, and possibly Alzheimer's disease.

In 1969, Dr. Kilmer S. McCully reported that children born with a genetic disorder called homocystinuria, which causes the homocysteine levels to be very high, sometimes died at a very young age with advanced atherosclerosis in their arteries. However, it was not until the 1990's that the importance of homocysteine in heart disease and stroke was appreciated.

What are the possible symptoms or features of elevated homocysteine levels?

Theoretically, an elevated level of homocysteine in the blood (hyperhomocysteinemia) is believed to cause narrowing and hardening of the arteries (atherosclerosis). This narrowing and hardening of the vessels is thought to occur through a variety of ways involving elevated homocysteine. The blood vessel narrowing in turn leads to diminished blood flow through the affected arteries.

Elevated levels of homocysteine in the blood may also increase the tendency to excessive blood clotting. Blood clots inside the arteries can further diminish the flow of blood. The resultant lack of blood supply to the heart muscles may cause heart attacks, and the lack of blood supply to the brain causes strokes.

Elevated homocysteine levels also have been shown to be associated with formation of blood clots in veins (deep vein thrombosis and pulmonary embolism). The mechanism is complex, but it is similar to the way that they contribute to atherosclerosis. In some studies, even moderate levels of homocysteine level showed higher rates of repeated incidence of blood clot formation.

Does lowering homocysteine levels prevent heart attacks and strokes?

Currently, there is no direct proof that taking folic acid and B vitamins to lower homocysteine levels prevents heart attacks and strokes. However, in a large population study involving women, those who had the highest consumption of folic acid (usually in the form of multivitamins) had fewer heart attacks than those who consumed the least amount of folic acid. In this study, the association between dietary intake of folate and vitamin B6 and risk of heart disease was more noticeable than between dietary intake of vitamin B12 and heart disease, which was minimal.

Many other observational studies have been performed to assess the effect of folate and the other B vitamins on heart disease. Most of these studies have concluded that oral intake of folate has been associated to lower risk of heart disease, possibly because due to lowering of homocysteine levels. The relation between oral intake of vitamin B12 and B6 and heart disease was not as obvious in many of these studies.

In one study, it was concluded that even in people with elevated homocysteine levels due to genetic reasons, oral intake of folate and possibly the other B vitamins was related to lower incidence of heart disease.

Most of these data, however, are obtained from observational studies rather than purely controlled scientific data. Therefore, it is important to mention that despite these studies suggesting an association between the intake of these vitamins and the lower incidence of heart disease, in general, there is no compelling clinical evidence to treat hyperhomocysteinemia other than homocystinuria (the severe genetic form) in regards to heart disease, stroke, or blood clots.

(Ref.: MedicineNet)

DENGUE IN LUDHIANA AND HOMEOPATHY

As per latest reports of Health Department published in Newspapers in recent few days, a warning alarm has again knocked the residents of the Ludhiana and moreover all across the Punjab. As per recent data from various Hospitals and Clinics of Ludhiana, almost 10+ fresh Dengue cases have been registered in the very fresh monsoon season of 2011. When residents of the Ludhiana and Punjab were almost trying hard to settle down the mental trauma of last year’s Dengue cyclone that blew away more than 1000 lives in Ludhiana and surrounding towns and cities of Punjab, at the same time again this year with just few monsoon rains Dengue has alarmed the state with fresh new cases.

Here I will nowhere talk about the role of Health Department or Government in preventive measures because it will be the wastage of time as everyone is well versed with the system of this country. Let’s here talk about what Homeopathy has to offer to the residents of the Ludhiana and moreover Punjab.

Last year I had some marvelous experiences with Dengue Hemorrhagic Fever cases and the best one in ICU of a leading hospital of North India where a patient on Ventilator with Dengue Hemorrhagic Fever progressing to Acute Kidney Injury (Failure) and Fatal Hemorrhages was almost declared as Dead by the hospital faculty and after Homeopathy intervened the case, within 48 hours the same attending physician who declared the case as lost one, announced it a miracle in front of his colleagues, my colleagues and parents of the patient.

Here I need not to mention in details that what we did last year because boasting in Medical Sciences is nowhere accepted at all as each and every epidemic is a challenge at your end with different intensity every year. So let’s talk about what Homeopathy has for this season to save the maximum of precious lives before it gets too late.

As we know the role of Allopathic System of Medicine is very limiting in treatment of Dengue but at the same time Management of Critical ill patients is their best part that they do with best care and dedication for all epidemics. Allopathic System has no specific Medicine for Dengue and Homeopathy has a number of medicines for the same but then where lies the difference every year and why we end up with a huge loss every year?

The main aspect if LACK OF AWARENESS of the patients that Homeopathy has anything to do with Dengue. They definitely change this mind set when an experienced Homeopath of the area intervene in final end stage and save the patient but not most of the time because we too have certain limitations in end stage conditions. So better the patients and a common man should be aware that Homeopathy can save them from Dengue in both preventive and therapeutic states but mostly and only when intervention is carried out in initial attack of the disease.

Everyone among Homeopathic Fraternity knows that we have so many good indicated medicines for Dengue and few of them are Crotalus horridus, Phosphorus, Eupatorium perforatum, Arsenicum album, Rhus toxicodendron, China officinalis and many more. Before announcing any Genus epidemicus this year, we need to have few cases so that we could access after analyzing the few of these cases by collecting common symptoms of this year’s Dengue epidemic.

Rest what need to be prescribed is our internal matter for Physician’s but what a common man asks is that how to be safe in such epidemic or how to prevent it, which needs to be followed very strictly to lower down the number of infected patients.

So here I need to share few tips for my patients, a common man and everybody who will be reading this because Prevention is better than Cure but Intervention of right medicine at right time with right jerk is much more important in Epidemics, specially like Dengue.

The guidelines below will give you an overview of how you can prevent the Aedes mosquito from breeding.

Prevent Mosquito Breeding (Growth)

      - Clear any stagnant water in your air cooler unit.

- Remove water in plant pot plates. Clean and scrub the plate thoroughly to remove mosquito eggs. Avoid the use of plant pot plates, if possible.

- Loosen soil from potted plants to prevent the accumulation of stagnant water on the surface of the hardened soil.

- No tray or receptacles should be placed beneath and or/ on top of any air-conditioning unit so as not to create a condition favorable for mosquito breeding.

- Change water in flower vases. Clean and scrub the inner sides of vases. Wash roots of flowers and plants thoroughly as mosquito eggs can stick to them easily.

- Clear fallen leaves and stagnant water in your scupper drains and garden. These leaves could collect water or cause blockages to the drains, thus resulting in the buildup of stagnant water.

- Discard items that collect rain or run-off water, especially old tyres. Keep containers outside the home and gutters dry.

- Insist that public-health officials safeguard your community by eliminating stagnant water sites in construction and wastewater treatment areas.

Precautions for Safety from Mosquito Bites

·        Sleep on a bed inside a mosquito net.

·        When outdoors, wear long-sleeved shirts and long pants. Wear longer clothing that covers exposed skin in the arms and legs to thwart bites.

·        Apply insect repellants on skin. Use mosquito patches, sprays, or use high-tech gadgets such as the ultrasonic anti-mosquito repellant.

·         Warn children not to play near still water.

·        When available use air-conditioning. Attach screens to all windows and doors.

·        Avoid hanging clothes in dark corners as these serve as hiding places for mosquitoes.

Warning

·        Do not ignore mild symptoms of fever, body pains, and rashes on body or infections. Do 

     visit the nearby Physician to properly diagnose and treat the condition.

·         Self-medication or prescription of quacks (unregistered practitioners) / pharmacists is just like suicide in such cases because you never know which medicine is going to act in opposite direction in such cases like Aspirin can worsen Dengue patient’s condition very progressively. So always do visit a registered Medical Practitioner whenever you experience any symptoms.

·         Taking some home remedies, which is a fashion in Dengue season, like Juices of some fruits or some leaves or anything else is nowhere beneficial in Dengue. Only medicines can save a Dengue patient if intervened in time.

We Doctors surely will play our best part this year too but still it will be easier to fight this epidemic if society plays its role in sincere way because prevention, early diagnosis or treatment in initial stages can save so many lives.

As I breathe, I hope…

EIGHT TIPS FOR BREAKFAST

The morning meal “breaks the fast” and replenishes blood sugar (glucose) levels that are normally low after a night’s sleep. But it isn’t just a matter of timing. Whether the day’s inaugural meal is healthful depends on its content, too, according to the June 2011 Harvard Health Letter.

“Skipping breakfast throws off the normal circadian rhythm of fasting and feeding. Breakfast is the worst time to skip a meal,” said Dr. David Ludwig, a nutrition expert at Harvard-affiliated Children’s Hospital Boston, in an interview with the Health Letter.

The breakfast carbohydrates should have fiber and the proteins should be lean. You can healthful fats from foods like nuts or salmon. Here are eight tips from the Harvard Health Letter for putting together a healthful breakfast:

• Read food labels. Look for the information on serving size and calories. And if it’s a grain-based food, you want a whole grain of some kind (wheat, oats, etc.) to be first in the list of ingredients.
• 
  
• Know your coffee drink. Many of those elaborate coffee drinks are unhealthy high-calorie, high–saturated fat versions of your basic cup of coffee.
• Make processed eats like bacon a very occasional treat. Processed meats like bacon and sausage have been associated with a higher risk of colorectal cancer, heart disease, and type 2 diabetes
• Seek out quality carbs. Get your carbohydrates from whole grains, fruit, and vegetables.
• Eggs in moderation are okay. One a day is okay for most healthy people. The yolk is high in cholesterol, but eggs have proteins and vitamins and don’t appear to increase the risk for developing heart disease.
• Go easy on the fruit juice. Whole fruit is a better choice because it tends to have more fiber.
• Eat in, not out. The breakfast offerings at fast-food chains tend to be high in sodium and low in fiber. And the traditional fare (eggs and bacon, pancakes) can start the day with too many calories and too much saturated fat.
• Blend up a breakfast smoothie. Processed food is usually not healthful but a little home processing is okay. You can combine fruit, juice, yogurt, wheat germ, and other ingredients in a blender and make something delicious and healthful.

(Source - Harvard Health Letter)

'SURPRISING' New Recommendations on Triglycerides by American Heart Association

A new scientific statement raises the threshold for pharmacologic treatment of hypertriglyceridemia.

I just received AHA Guidelines for Hypertriglyceridemia and was shocked to read the new guidelines for Treatment protocol in High Triglycerides. I am not sure whether this will work in Indian Patients too or not because Lifestyle and Diet for Indians will definitely reflect a different picture of this protocol. I think this has to be reviewed again at our own clinical experiences with our patients. Let's see how it gonna work over here.

I've been surprised at the lack of fanfare surrounding the American Heart Association's recently published scientific statement on triglycerides and cardiovascular disease (CVD). The attention it did receive focused on the lower fasting triglyceride level that is now considered optimal: <100 mg/dL. In my opinion, the real headline was the committee's important statements in support of less drug treatment — in particular, the recommendation for a substantial increase in the triglyceride level that should trigger consideration of pharmacologic therapy.

After a careful review of the recent literature, the committee concluded that pharmacologic therapy should not be started until a patient's fasting triglyceride level is 500 mg/dL (in contrast to the Adult Treatment Panel's recommendation of 200 mg/dL). See the figure, which also appears on page 2308 of the AHA statement.

The AHA committee also explicitly acknowledges (on page 2297) that "the independence of triglyceride level as a causal factor in promoting CVD remains debatable. Rather, triglyceride levels appear to provide unique information as a biomarker of risk, especially when combined with low HDL-C and elevated LDL-C." This clear statement — together with the new, higher threshold for initiating drug treatment — represents a remarkable change.

(Source: Publication on AHA Guidelines 2011)

LAUNCHED ONLINE TREATMENT WEBSITE

Please visit and give suggestions visiting http://www.onlinehomoeopathict​reatment.com/

"A CASE OF PNEUMOCYSTIS PNEUMONIA"

A case of pneumocystis pneumonia in Male patient aged 23 years with severe cough, weight loss, expectoration, palpitation after taking 8 months Allopathic Treatment with No Relief being cured with PULSATILLA 0/1 - 0/2 and 1 dose of TUBERCULINUM 200c. (in 3+ months only)

(Full Case History will be added later on, Reports are attached below)

                 

(BEFORE TREATMENT 1/8/2010) 

  (AFTER TREATMENT 21/12/2010)

  

                                                             

“DUM     SPIRO    SPERO”

(As I breathe, I hope)

- A CASE OF CORONARY ARTERY DISEASE –

(99% Blockage of Left Anterior Descending Artery with Left Ventricular  Hypertrophy)

Patient named Mr.Surinder Singh, aged 60 years, being diagnosed with CORONARY ARTERY DISEASE with 99% blockage of Left Anterior Descending Artery and initial arteriosclerotic changes in Left Circumflex Artery advised immediate Percutaneous Transluminal Coronary Angioplasty (PTCA) stent knocked the door of Hahnemannian Sciences, may be as the last resort, but still on crucial time with right decision.

·         Angiography Reported        :   5^th May, 2010

·         D.O.A (at Cardio Life Care) :   20^th May, 2010

(After discharged from Coronary Unit,  MediCiti Hospital, Ludhiana)

·         Case C.R.No. (Our Clinic)   :   1796-DB-162

ü  CHIEF COMPLAINTS

o   Chest Pain (for last 6 months)

o   Breathlessness  (for last 6 months)

o   Cough    (for last 4-5 months)

o   Swelling of Lower Extremities (for last 4-5 months)

o   Palpitation (for last 3 months)

o   Diziness (last 2-3 months, ocassionally)

ü  H/O CHIEF COMPLAINTS

o   Chest Pain (for last 6 months)

- Location         : Substernal region

- Extension       : -------

- Aggaravation  : Slight Exertion

- Amelioration   : -------

o   Breathlessness  (for last 6 months)

-  Pt. Complained of breathlessness on slight exertion. Even routine work causes exertional dyspnea. (No complaint of Orthopnea or Paroxysmal Nocturnal Dyspnea)

o   Cough    (for last 4-5 months)

- Non productive cough. Aggravated after breathlessness. Relieved by resting for few minutes.

o   Swelling of Lower Extremities (for last 4-5 months)

- Swelling of ankles and legs. Pitting edema.

o   Palpitation (for last 3 months)

- Increased Heart Beat with awareness of heart beat. Occurs anytime in the day and goes of its own. Increased mainly with breathlessness.

o   Diziness (last 2-3 months, ocassionally)

- Diziness after palpitations and exertion.

ü  PAST MEDICAL & DRUG HISTORY

o   Patient had attack of angina 3 months back with malignant hypertension and was hospitalised.

o   H/O Hypertension for last 3-4 years.

o   H/O Diabetes Mellitus T-2 for last 5 years.

o   No other specific illness in past years.

o   Regularly taking Allopathic Drugs since last 1 year i.e. Gemer forte, Ecosprin, Nitrocontin, Cardace, Embeta XL, Isrdil and some other  drugs (sos).

ü  FAMILY HISTORY

o   F/H/O Hypertension           -  Mother

o   F/H/O Diabetes Mellitus     -  Mother, Father, Sister, Brother

o   F/H/O Cancer                     -  Sister (Elder Sister died of CA Breast at 40-45 years of age)

o   N/H/O Pulmonary Koch, Asthma in family.

ü  PERSONAL HISTORY

o   Chronic Alcohalic (last 15-20 years). Abstained for last 2 years after Doctor’s advice.

o   Non-Vegetarian Diet, ocassionally.

o   Non Smoker / No other Stimulants or Narcotics consumed ever.

ü  GENERALS (including Aetiological Factor at Mental Level)

o   A/F Bad News [6-8 months back, patient had raid on his chemist shop and got entangled in some sort of fake legal matter. His son had to stay in police custody for 3 months after that and this incident changed his life from head to foot. After that he started experiencing these symptoms. He had a very good reputation in the town but after this incident felt all his reputation gone. This was the most worst news of my life ever (Patients Wording)]

o   Loquacity 2+

o   Suspicious 1+

o   Dictatorial 1+

o   Selfish 1+

o   Fear of Heart Disease (marked) 3+

o   Sleep is disturbed because of Anxiety 1+

o   Anxious in Dreams, Dreams about Anxiety.

o   Speech of the patient was hasty. (3+)

o   Thirst : Thirstlessness 1+ (3-4 glasses of water per day in summer days)

o   Hot patient with profuse perspiration on face.

o   Left Sided (Left Side effected, and sleep on left side as well)

ü  PHYSICAL EXAMINATION

o   Pulse    : 68/m

o   B.P       : 150/100 mmHg

o   Temp.   : 98.4`F

o   R/R       : 24/m

o   No sign of Clubbing, cyanosis, icterus, anemia.

o   CVS Exam : S1 S2 Normal, Tachycardia, Low Pitched – S4 sound audible.

o   Lower Extremities pitting oedema.

o   P/A soft, non tender.

o   Chest B/L clear.

ü  INTERVENTIONAL INVESTIGATIONS REPORTS

o   CORONARY ANGIOGRAPHY REPORT (dt.: 5^TH May, 2010)

- Left Main Coronary Artery          : Normal

- Left Anterior Descending Artery : 99% stenosis after D1.

- Left Circumflex Artery                 : Plaque at proximal part.

- Right Coronary Artery                 : Free of any sinificant disease. PDA Normal.

Summary               :- CAD (significant single vessel disease)

Recommendation  :- PTCA with stent to LAD

ü  NON-INTERVENTIONAL INVESTIGATIONS REPORTS

o   ECHOCARDIOGRAPHY & COLOR DOPPLER (dt.: 5^th May, 2010)

(REPORTED IN DICHARGE SUMMARY OF ANGIOGRAPHY)

- Left Ventricular Hypertrophy

- LVEF  :  48%

- ? Mild Apical Septal Hypokinesia

o   ECHOCARDIOGRAPHY & COLOR DOPPLER (dt.: 28^TH Jan, 2010)

- Left Ventricular Hypertrophy

- LVEF  :  60-65%

- ? Mild Hypokinesia at Basal Septal & Apical LV segment

ü  LABORATORY INVESTIGATIONS REPORTS (5^th May, 2010)

o   HgB   : 14.8 gm%

o   TLC   : 7600 cmm

o   DLC   : N-64, L-30, M-04, E-02

o   Platelets : 2,19,000/cmm

o   Blood Urea : 23n mg/dl

o   Creatinine :  0.79 mg/dl

o   FBS : 127 mg/dl

o   HCV / HbsAg Non Reactive

ü  DIAGNOSIS

o   CAD (svd) 99% stenosis of LAD

o   Mild LV Dysfunction

o   LV Hypertrophy

o   HTn

o   DM T2

ü  PRESCRIPTION (20^TH May, 2010)

·         Lachesis mutus 200c 1 dose STAT (20.5.2010)

·         Lachesis mutus 200c 2 doses (alternate days i.e. 22.5.2010 / 24.5.2010)

·         Sumbulus moschatus ‘Q’ 10 drops BD (started from 25.5.2010)

·         PL Liquid 10 drops TDS

·         PL 1 TAB. TDS

·         Baryta carbonica 200c 1 dose (intercurrent) Weekly i.e. 27^th May; 3^rd, 10^th, 17^th, 25^th June

·         EMERGENCY KIT (SOS)

Arnica montana 10 M           -   1 TAB SOS (CHEST PAIN, To replace Sorbitrate)

Rauwolfia serpentina ‘Q’     -    10 drops SOS (High Blood Pressure)

ü  MANAGEMENT

·     Continue to take Blood Pressure and Diabetes Tablet (Allopathic) on regular basis. All other ALLOPATHIC Drugs withdrawn on first day.

·         Proper Diet Chart advised.

·         Exercise daily 30 minutes in fresh air.

ü  FOLLOW UP (28^TH June, 2010)

N.B. - Patient reported on 28^th June, 2010 & told that in last more than 1 month time he had 2 severe attacks of chest pain, but emergency pain sos medicine relieved him (Arnica 10M).

Had 4-5 times sudden rise in Blood Pressure and Emergency Medicine was taken with relief in B.P.

o   Chest Pain relieved 70%, as said by patient, only 2 severe episodes since last month (above mentioned) and 3-4 mild pain attacks which were relieved of their own with rest. No pain on exertion now.

o   Breathlessness is almost gone since started the medicine. No breathlessness on exertion. Now patient walks 30 minutes morning and evening daily without any chest discomfort or breathlessness.

o   Cough is relieved. Had cough relief from the very first day of medicine.

o   Swelling of Lower Extremities is decreased. Edema is non-pitting now.

o   Palpitation decreased. Rare palpitation on vigrous exertion only or during anxiety.

o   Diziness almost gone.

·         NEW SYMPTOMS

o   Urination frequency increased.

o   Constipation for last 20 days, ineffectual urge for stool in morning.

o   Perspiration on face increased.

o   Blood Sugar is normal since medicine taken.

ü  PHYSICAL EXAMINATION

o   Pulse    : 74/m

o   B.P       : 130/90 mmHg

o   Temp.   : 98.4`F

o   R/R       : 20/m

o   No sign of Clubbing, cyanosis, icterus, anemia.

o   CVS Exam : S1 S2 Normal, Tachycardia.

o   Lower Extremities non-pitting oedema.

o   P/A soft, non tender.

o   Chest B/L clear.

ü  LABORATORY INVESTIGATIONS (DATED 28^th June, 2010)

o   HgB   : 12.8 gm%

o   TLC   : 10,800 cmm

o   DLC   : N-79, L-18, M-01, E-02

o   Platelets : 2,17,000/cmm

o   ESR : 10 mm in hr.

o   PBF : Normocytic Normochromic

o   S Uric Acid : 4.7 mg/dl

o   CRP : Negative

o   Cholestrol Total : 134.8 mg/dl

o   S. Triglycerides : 147.1 mg/dl

o   HDL Chol : 55.1 mg/dl

o   LDL Chol : 50.28 mg/dl

o   VLDL : 29.42 mg/dl

o   Blood Urea : 38.7 mg/dl

o   Creatinine :  0. 9 mg/dl

o   S. Sodium : 138.9 meq/l

o   S. Potassium : 4.9 meq/l

o   S. Chloride : 105.9 meq/l

o   LFT : Normal Range

o   RBS : 139.8 mg/dl

o   HCV / HbsAg Non Reactive

o   Urine R/E : Albumin – nil; Sugar - ++

ü  PRESCRIPTION (28^th June, 2010)

·         Lachesis mutus 200c 1 dose STAT (28.6.2010)

·         Sumbulus moschatus ‘Q’ 10 drops TDS (started from 29.6.2010)

·         PL Liquid 10 drops TDS

·         PL 1 TAB. TDS

·         Baryta carbonica 200c 1 dose (intercurrent) Weekly i.e. 3^rd, 10^th, 17^th, 25^th, 31^st  July

ADVISED Withdrawl of Blood Pressure and Diabetes Allopathic Tablets in 2 day gap.

o   ECHOCARDIOGRAPHY & COLOR DOPPLER (dt.: 10^th July, 2010) (After 50 days of Treatment)

- LEFT VENTRICLE IS NORMAL IN SIZE WITH NORMAL SYSTOLIC FUNCTION

  (LV ENLARGEMENT IN PREVIOUS REPORTS OF ECHOCARDIOGRAPHY)

- LVEF  :  55% (Raised from 48 % in previous report)

- Hypokinesia of Apical Septum and Apex.

PATIENT being advised CT Angio later but he refused and continued to take Medicines.

This case has been published in HOMEOBUZZ HOMEOPATHIC JOURNAL by B.Jain's and a Research Paper has also been published in Souvenir at International Congress at New Delhi last year.

REPORTS ATTACHED (EVIDENCE BASED HOMEOPATHY)