What Most Patients Get Wrong – And How to Fix It | Dr. Sadhana | Dr. Aditya Dontam | Scanu Labs

 What Most Patients Get Wrong – And How to Fix It | Dr. Sadhana | Dr. Aditya Dontam | Scanu Labs

https://m.youtube.com/watch?v=tX1WAbJo8xQ

Glucose tolerance test. Most of the ladies we see most of the cases as a GDM gestational diabetes most common disease dehydration they're just normal. Why is like thyroid coming idiopathic? The mother is not affected by thyroid or PCO or whatever but the female is having it. Because there are cases, there are scenarios where people tends to be again normal. Working individual initially they used to sleep for 6 hours or 8 hours. Now it has been reduced to less. At what age one person has to get his first blood test? Symptoms get tested. Normal initially if he used to sleep for 6 hours or 8 hours now it has been reduced to less. sleep disturbances. There's some problems associated like OSA obstructive sleep. So everything depends on what exactly is the problem. The patient is 16 years old. First cycle of sleep. school age. Again, they'll go into that cycle. People coming from multiple states. and which includes MBBS student. Hi good evening namaste this is Dr. Sadna chief consultant radiologist and managing director of scanul labyram today we have our guest Dr. Aditya he has done his undergraduation in Andra Medical College one of the topmost medical college in Andra and he has done his pro postgraduation in as New Delhi. So Dr. Adita kindly let us know how your journey started as a doctor. So uh first initially but when I went into the as first thing I have I would like to say that as had actually taught me the work culture. So how to focus and how to make a plan out of everything is what the as has actually taught me in physiology physiology as you know that it's mostly the functioning of body how is it functioning and physiology is something which people thinks like it is most of teaching oriented field but unfortunately when I went into the as I have understood it has a lot of scope to understand the teaching modules as well as the patient care. So patient diagnostics diagnostics understanding is something physiology can actually contribute. So where all did you work and how is your work thing and how you have approached scan and what is so first of all how you want to take to the topmost uh I had a very good collaboration with the scan where the idea of integrating AI into the healthcare was fascinating in scan. So I thought the physiology it might contribute here and which will definitely will help the patient care is what I strongly believe and scan you and myself are like trying our best to get this thing inculcated into the patient care. So physiology most of the times it can be used as a preventive tool. So Danosum scan you and myself are like trying to put into AI modeling or into the healthcare and it will definitely help the patient care is what we strongly believe. So preventive health care how will it help the patients or the normal person or like each and everyone has. So question basically so first of all blood pressure nearly 60% of the population are suffering which can include middleage populationic nervous system is the most common system which regulates the blood pressure. So initial stage if I can quantify how much is the loss of this autonomic system with simple measures actually hypertension can be delayed or either we can control in a way where it won't be in any person. So autonomous nervous system because diabetes hypertension first. So can you elaborate on this? Yes definitely even when this is the first concept when I learned when I joined the nervous system. So nerve system includes both the systems sympathetic and the parasympic system it's called as battery of tests where there are multiple tests at least if we carry some five to six tests in that battery sympathetic loss parasympathetic loss. So again there's a multiple maneuvers like so definitely your heart rate is increasing. So if we quantify 10% load sympathetic overity in terms of sympathetic activity parasympity so that is one advantage we get from atomic nervous system testing. So which we call simply as a or autonomic function testing. Okay. Even diabetes has a quantifying test as such. Is it HBA or anything else? Yes. Uh diabetes again is a plethora of causal factors are there. First of all pancreas pancreas insulin release and there are certain cases which we call it as insulin resistance. So pancreas insulin type 1 diabetes completely diabetes. There are certain tests where we can understand if the person can develop diabetes in future which we call again a predicting modeling age wise, gender wise, classification. Already western countries are working through it and they have a good database with from their population. Unfortunately India Luna best institutes are trying to achieve that database where they construct a predictive modeling out of it and ina we need a lot of patient sampling for that where we can group age grouping, gender grouping risk factors multiple parameters. we again put it into a AI modeling where we can at least predict if this person can get diabetes in future or not. Okay. So currently if I have to add on little bit diabetes so regular checkups for the lipid profile blood sugar diabetes symptoms which we mostly call it as polyura polypia multiple times than usual. So definitely most of the doctors and me particularly always try to recommend that at least four months basic tests which include random blood sugar hb1c glucose tolerance test. This is very very good test actually. Glucose tolerance test most of the ladies general public or males or normal people like is it really necessary mostly we see most of the cases as a GDM gestational diabetes and it develops after the pregnancy normal physiological process it's not a pathological so if it benefits there definitely benefits a normal person for a better understanding and baby also gets affected because of gestational diabetes. So definitely we recommend to get it done so that is it a problem of a pancreas or is a problem of insulin resistance. So for baby grow which is again interrelated to each other but definitely it can be applied to normal public also but people takes it on a little painful side because we have to collect sample on a multiple time points multiple time. So for that people may not be that conducive to get that test done. So better guy if FBS HBAC is getting me the same result why I have to go to the GTT. So that is a perception and nobody refers to GTT. So they keep very simple test like FBS or RBS and HBN. So diabetes, hypertension. Yes, definitely. So first of all first associate the idea the first idea of integrating AI in the healthcare was actually fascinating from the team of scanu and that actually encourages me to see study and grow grow more so what exactly I'm doing in the scan first of all currently I'm like looking into the lab so range so whatever data we are getting from the lab so we are trying to understand what is the disease burden in the vig first place. So our disease if you start with that and start educating the people in that particular domain which we see most prevalent most kidney disease hormonal issues diabetes. So abnormal glucose reports, abnormal HBAC reports. So this is what we have understood out of this journey with the scan. So we are trying to focus we can do something for these patients and patients definitely scan is a pioneer in doing that in preventing a disorders which are more common in this society is what I strongly believe again. So Dr. Hypertension, diabetes, creatine hormonal issue. Yes, definitely. So first of all final breakdown or excytory product or it's a last product which can't be used by the body anymore. So this product has to be eliminated by a kidney major function which shares around greater extent of cardiac output. So most of the blood pump max system it has to eliminate most of the excretary products through the kidney system and again body is producing extrary product. So that has to be cleared by the kidney. But in case some some reason kidney most of the common injuries which you say or which you see nephritis or ptoite injury kidney. So that is like a indirect marker of a kidney injury. But a person who is having a protein diet in a excess quantity protein breakdown definitely creatin as a waste product is more when compared to a normal person. So dehydration state as we know that again body is composed of ECF and ICF extracellular volume and intracellular volume. So system has its own ability which will try to save the extraellar volume. So already so the double effect. So creatin it's not always because of kidney injury but kidney injuries it's indirect marker but there are other reasons also which might be for a normal individuals which is who are having a dehydrated state or increased muscle mass or who is having a protein intake for a very long period. So bodybuilding levels are tend to be on higher levels. And how about the hormonal issue in females? Yes. Uh again uh hormonal issue is indirectly linked to your hypothalamus which is a key regulator of all the hormonal axis. So hypothalamus if you see it's a very small organ and which controls the whole hormonal axis. So any injury to the brain is again leading to a damage in regulatory system in the first place. Thyroidis hypothalamus target which actually gives a specific action to each of the body organs. So all this again that gets damaged. So again brain eh and hypoxic injury which is again hypothalamus again which is a part of the brain if it experiences any hypo hypoxic conditions or maybe the vascular injuries again which causes a changes in the hypothalamus that's the first reason which I could suggest and second reason target organs itself damage a if they are damaged so chipnet thyroid is a one hormonal uh organ or a gonads is one hormonal organs so if these organs are damaged in their own place inflammation infection. So, so it's a very broad topic. Again there's a hyper hypo every lot of plethora of symptoms. So every symptom we try to treat them and what we have seen excess in a hormonal access is thyroid thyroid. So a thyroid key in case how to prevent that thyroid problems is what we are trying to target and most of the cases I'm seeing the thyroid and hormonal issue in extremity of ages 15 to 20 years menstrual cycles around 45 to 50 years they not even using any medication function or else they're like they're just normal. Why is like thyroid coming idiopathic to everyone? Diabetes, hypertension, parents. Thyroid all of a sudden why it is coming to most of why most of the people are being affected parents most of the parents but most of the cases where I have seen the mother is not affected by thyroid or PCO or whatever but the female is having it is it only because of stress or is is there any other external factor but hypothalamus injury vascular injury like they have like normal brain MR brain they doesn't have anything even pituitary will be normal everything will be normal but they will be having hypothyroidism and they will be having PCOD at least they are like looking normal they are like less the BMI is within normal limits and all so I'm seeing most of the cases like even I was asking myself like why why are they being even affected so that's the reason I wanted to ask this question Yes, again uh this is a very new finding which people are are seeing. So I just want to summarize your whole question like okay family history lack okay external factors lack the what we are seeing as a very abnormal thyroid disorders is what I can understand from the question and what is the reason behind it. So there is something called as feedback regulation. So hypothalusyroidal level it gives a backward signal to a hypothalus to stop that. So feedback then we see that the signal continues. So that is one more reason if feedback Hindu could damage again there's a hypothetical reason and proposed reasons. So there's nothing coming up. So most of things are in the literature not in the books. So first thing is change of light and day and light cycle. So expose that is increasing eventually when compared to a previous days. So that is one reason. Second is increasing academic pressure or the stress which they are seeing from the environment of the family, friends, peers, everybody and that simply is like a stress induced. Third is the lifestyle modification again with the increased peer group stress extreme population say they are mostly affected by the peer influence. So influence lifestyle modifications. So all these normal physiological parameters first of all. So maybe that again it's a hypothesis it's seen in the literature that all these things are actually works together to keep your body in a normal condition. But if it varies definitely things are varying is again this is a proposed mechanisms but this has to be looked upon and it has to be uh come up with a very strong mechanisms and prevent there are cases there are scenarios where people tends to be again normal lifestyle modifications in terms of exercise yoga again they tend to go into the normal state. So they reduce their stress, they they balance their work life everything and then again they come back to normal. So I think this can be a probable explanation for the things what we see in extreme populations as you have mentioned preventive healthare at what age one person has to get his first blood test or likeu alert. Okay so again preventive healthcare is something which targets not to get disease in a future. So first of all if person himself feels that he experienced some kind of a different lifestyle when compared to his normal lifestyle. So if working initially if he used to sleep for 6 hours or 8 hours now it has been reduced to less. So what the sleep can disturb symptoms get tested is what is recommended plus respect to the working people again it depends on the age it depends on the gender it depends on the risk factors which they persist. So family history already have certain history like cancer leant some disorders which runs in the family. So definitely they are recommended to take the preventive steps plus preventive again it's very particular about particular diseases and malignant recommendations which varies from 6 months to one year in terms of location in terms of growth. So some markers can tumor markers. So everything depends on what exactly is the problem. So once the problem is there it's very easy to tell them how frequently they have to get tested if the problem is not there. But still if somebody has to get tested. So again after 35 years it's always better to look after their health in terms of their heart, liver and their lipid profile at the minimum the changes at least for every one year they can monitor their own health in respect of this main organs like this. So I know after 35 years mamography change call each and every year check change call. How about the teens? Because why I'm stressing is you put hormonal issues 20 years less than 20 years they'll be having thyroid issues or whatever even males like teens slogan before 20 before 25 is it really necessary to get tested? Again it's always uh depends on the age, gender and uh risk factors because nobody knows what is coming up. Nobody can appreciate what is coming up until unless they have a clue of what to start with. It's better. So females teenagers if a simple thing a simple parameter like menstrual cycle if menstrual cycle is not coming normally if the cycle length is more or the bleeding time is more the flow is more. So all these things can be appreciated by the parents or the individual themselves and talk to their parents PC again related to the obesity insulin resistance. So there are instances where doctors recommend that please reduce the weight so it will improve the insulin resistance capacity and things will again come down. So small small things if we notice to our own health if I'm getting little trouble with my own systems that will be helpful to start with a first step of preventive healthcare. So first thing is for preventive healthcare the education the health education has to be strong and people should be uh knowing about their own health. So it's their right to know about their own health and appreciate small changes even though sleep 10:00. So at least try to find out a reason. If not consult a specialist who can actually tell them what is a problem why you're not getting a sleep at that particular time. So that can be a start point of your understanding your own health and preventive health care. So lifestyle modification. Can you elaborate something on nutrition, gym, exercise and everything? Yes. Like which is a better? So preventive healthare as we have discussed since a long time like preventive healthare diet which plays a major role. So balanced diet guidelines guidelines. So National Institute of Nutrition which gives the guidelines of what to eat and how much to eat and what is the target calories which you have to reach. So again it depends on the age, gender and your BMI. So you have to target are you so the balanced diet includes are you trying to reduce your weight are you trying to increase your weight. Balanced also like comments upon how much which percentage of carbohydrate or protein or the fat percentages has to be in your given diet with respect to your calorie intake. So if your if your target is to increase in weight the calorie intakes are on a higher side when compared with your BMI and if you're targeting for a lower or to target for a lower weight or to targeting for a decreasing of your weight the targets are little changed. So accordingly the diet is the first manipulator which can start a change. So again a dietician or myself as a physiologist can are promoting to have a good diet chart or a good diet plan. So that that itself is a start of the preventive life uh preventive care for your own health. Second thing as you have again mentioned the exercise again it depends on the body weight 80 years 50 years old male who is having a BMI BMI of around 30. So definitely the own weight is hurting them. So it's very difficult for them to do exercise at that instance. So for them we have to start with a very low intensity exercise and then slowly increase to a medium intensity and then the high high intensity according to the body composition, BMI, age, additional risk factors like osteoporosis. We have to plan which kind of exercise can be suitable. So is it includes a cardio is it includes a weightlifting training or it includes a endurance training. So parameters we have to plan a proper diet chart and a proper exercise plan. Recently emerging field is a yoga. So yoga first of all developed from India itself but it's kind of a neglected field but yoga is actually when you start doing it the people are seeing the benefits out of it. multiple literature which shows a genomic level evidence which is been modulated by a yoga. So again with respect to what disorders they have what kind of preventive we are planning to we are we are taking care of this all aspects for example 100% of the people I see eight people coming back like even after persistent actions of one month or two months like what would be the physiology in them like I'm not saying that maintain I'm not talking about the people who are not maintaining it but it would be demotivating for the people who are even going to the gym doing their diet and even after that most of the people like I have heard around five to six people I'm doing all the things I have to do but I'm not decreasing even 1 kg or 2 kg so it is demotivating me and I'm not going to the gym this is what I heard from most of the people. So what do you want to say regarding that? Yes, it's actually uh what you have pointed out is a actual problem what we see in a society. So as Rishiesh is the one which started the lifestyle clinic and I have been a close association with that and where I have seen like uh how they are trying to treat the uh patients using a lifestyle modifications and they say the coherence percentage or the people who are adherent to their own like they are preparing all these things and they're giving to patients they see that there's a very weak coherence or very weak adherence to these protocols because again all these things are physiologically manipulative. So even if the diet or the exercise or the yoga can be manipulated very easily with your workload itself. So workload is a very big factor which plays a major role when related to your stress hormone day and nightlight cycle and your sleep cycle. So all these things has to be balanced to attain a homeostatic or attain a homeostatic balance of your body. So we feel that okay there are some components are done but still because of certain lifestyle modifications like recently I have been came across with the very teenagers who are having a bad habits of maybe smoking or having alcohol. So all these are some things which people might ignore but again these things somehow might affect the body physiology in terms of the hormonal balance and it might lead to a same same cycle what the person is having initially and again all these preventive changes are not uh instant action. So a person has to be or a patient has to be or a subject has to be conducive persistent and disciplined and wait till they achieve the results. Normally they say 21 days if you do something you will be used to that and all. So if even people are not decreasing or they are not able to attain the actual weight within 3 months or 6 months like 21 days 3 months what would be the minimum time like will it change from person to person or will it like uh so I I can say that uh there are certain dictims in the society where you train for 21 days and you attain whatever you want but again it depends on a individual itself. So I'll just tell you a small example of a uh weight loss uh uh plan. So first of all we start with if you have to plan a diet or uh plan uh exercise protocol or yoga protocol, sleep protocol. So first of all we go with a simple parameter as a BMI. But again I emphasize that BMI is not a good parameter to say what is your body composition. So there are multiple systems emerged in the society where we call it as body composition analysis which gives the true balance of the fat of the fat percent of and the protein content or the muscle mass. It gives a ratio between that. So now what is our target to reduce the weight? So are we targeting to reduce the protein which is never a a target. We are trying to reduce our fat. So to reduce our fat we have certain strategies in our diet. We have certain strategies in the exercise. So again each person even they have a same weight category they will have a different body composition analysis or body compositions. So again again very subjective and very tailored to each person. So we have to assess a person completely and then give something which can be helpful for them. Personal gym trainer is a better option or the nutritionist or a physiologist who is a better option. So currently if I see the government policies most of the times certification gym trainers NASM guidelines there are multiple certification courses where they get a certificate and they certified to do certain things and which includes a body composition analysis diet charts nutrition advice they are certified to give it. So once they're certified it's always recommended to take from a certified people because they are trained in that aspect and definitely as a physiologist we are trained in those particular domains and other than us there are many people as you have just mentioned gym trainers separate nutrition course nutritionists so they can actually give a better insights in those particular domains what they have trained and certification course is definitely and it's internationally accredited so again and self-proclaimed gym trainers If they certified and they have the proper documentation of their degrees definitely I suggested please go ahead and get a good health care lifestyle modifications gym food and sleep disturbances or else what will uh what does sleep plays a role because each and everyone goes through Insta feed, Facebook feed before sleep and even after they wake up they'll go through the insta and updates and then only they'll do their daily activities. So how does it affect the normal body physiology? So first I'll start with what I have learned in as there was one poster of my old as faculty first time I saw phone light specifically blue light it actually disrupts the sleep quality and surprisingly they have dissected the whole mechanism also. So they have seen that blue light blue light actually disrupts the melatonin secretion which is again very important hormone to regulate your sleep and maintain your circadian rhythm. So blue light which is again a predominant wavelength of your most of the smartphones gadgets which we use regularly laptops max and this is the first time I saw in the poster stick onto the as walls in the department of physiology. So from there I have actually worked on on the sleep and uh we have gone through multiple cases also. I'll tell you small small cases what we have dealt in as so most of the common symptom or most common problem most of the most soft part of the mouth it just goes and obstructs the airflow which just vibrates during the expiratory phase. So to be problems most of the times multiple modalities I'll not go into into the deep of those things but this is one common problem there's some problems associated like OSA obstructive sleep apnea which is again or the central sleep apnea most common problem air flow inflow and outflow obstruction the saturation goes down sometimes and saturation There will be again blood saturation very important one key feature or key parameter which the heart tries to maintain saturation it gives an alarming signal to the brain and suddenly the person wakes up. So this disrupts or this breaks the sleep cycle. So sleep multiple cycles sleep non rapid eye movement sleep rapid eye movement sleep two stages multiple cycles repeat so in the whole duration of the sleep duration of and phases increase so all cycle we call it as a quality sleep time of the sleep, sleep onset. These all parameters which we will decide as decrease sleep quality and again person himself has a problem of snoring that leads to the sleep problems. this again changes which they see in the whole body their whole body will be lethargic attentiveness part immune modulation so nutrition gym exercise how does sleep affect people sleep advantages disadvantages physiology of the body changes okay so first of all uh sleep topic first poster which I have seen related.  So blue light is most key hormone which has to regulate sleep. So major role. So first of all the patient is 16 years old bought by their parents while mother So first it went to a general medicine endocrinology and psychiat Over a period of 10 days. One of my colleague was doing this recording. start then we are trying to analyze that recording first cycle of sleep starting. So that actually is the first first signal which we got that she has a disrupted sleep and she has a damaged sleep. So she has that actually has increased carefuls then they understood maybe the social YouTube something she's more into the phone that actually disrupted her sleep cycle and this started which was ignored by their parents parents and then they have just done nothing they just reduced the sleep melatonin supplements sleep time was slowly came to the back to normal and she is again normal and it took over 3 months for her to recover back so time But they have understood that increase in screen time and increase in the sleep decrease in the sleep quality if we balance these two it actually can bring a change in the life. So even Facebook Melatonin supplements like is it recommended on a daily basis or else only if they want to start something new in their life but instead of doing something obviously phone is it recommended to give melatonin supplement so that they around 6:00 or 7:00 so that at least 3 months recovery rather than sleep music slow music are they recommended or melatonin supplements like normal vitamin supplements so melatonin recent drug which has been approved by FDA started coming up. So even doctors better in higher institutes know this drug market availility because of the FDA approval. So now it came into the market. I think better education supplements definitely supplements are not the first thing to go with both things are true and they are birectional. So definitely first thing. So it takes a discipline to train our body. It's it's called as conditional training to our mind. So slowly slowly train mind again redrawn back or it whole secretion will be in a normal cycle which initiates a circadian rhythm. So the normal physiology so interependent parameters if they have their own discipline of their work plan everything is done and they stick to it definitely that can be a gamecher for this sleep quality disturbances. Okay. And uh in physiology is there anything about mental health to comment on school. So it's one of the psychiatric issues. Psychiatric issue issues it's more of a pressure or the stress from the external community educational pressure teachers pressure family pressure. So again if you have to think in a physiological action leads to increased stress or increase cortisol hormones increase stress hormones hormones. So, so it tends to either they become so depressive or low and they suddenly go into a very extreme decision or they go into a maniac we call it as psychosis hyper extreme. So it all depends on what kind of a neurotransmitter or what kind of a communication is damaged in the brain.  like Maggie company firstology or else mental health from the school age definitely first of all because of the increased academic pressure They have to be social interaction. There are multiple ways. So that is a major key factor social which comes from a family friends peer group interaction and only focuses theademic pressure most of the times it's not that evident but again documented cases proper support from the family and how about the family pressure or work pressure in IT or doctors or MBBS students or PG students psychologist or psychiatrist or like psych psychologist they'll keep counseling for each session they have to pay so they won't go for If they go for a psychiatrist, he will be giving tablets and most of the time either it will be hormones either happy and most of the depress. So what else can we help for this mental health issue from physiology or from scan you most of the basic for example bed sheet they again they'll go into that cycle. So law psychology psychiatry when these fail phys what can physiology do? Yes. uh this is again so first of all how it can be implemented and what we are trying we I can just explain you in detail so first of all major problem because it's a first college or a very top college in the India cultural diversity so people coming from multiple states maybe it's a andra northeastern states bihar Bihar, West Bengal, multiple states. So to get a social group, whole college 150 members as a batch is a people similar culture. students. We have a different cultural background which different social on the spot.  I should not like judge them on basis of the gift. So what type what to be done there because it's a culturally and socially different backgrounds  and which includes MBBS students which includes paramedical students which include DMs everything like super they are committing suicides. So as has a very strong work culture which they maintain as a student's welfare committee. So e committee law what they have planned is there is a psychiatrist and a psychologist. So they have a free access 24/7. There's a duty allotted to a consultant assistant professor associate duty and a psychologist. a duty law only 24/7 they have to give services to the students which will avoid these kind of things in future. So, student welfare committee but now the NMC has given a very strict guidelines to maintain all these committees to prevent these kind of a things in me being in a scan. So we are actually looking forward to maintain a counseling room if people are patient relatives for free consultations. If they have any problem, let's have a discussion. Let's have a open discussion. It's what we are trying to promote from scan. So that at least if they have some physical disorders like diabetes, hypertension definitely that will be helping them psychiatric problems if they can get those information. Definitely we can take a necessary steps. Definitely this is more of a psychiatric component. Psychiatrists are available. Good psychiatrists are available. At least we can refer them to the psychiatrist. Good psychiatrist so that they can take a proper or appropriate treatment for that. So as a lab director in scanu what is your future vision and missions and already yes so what we are trying to build is to understand the prevalence of the disease So we have got some data to understand. So over a period of all this 8 months I have have certain data which I have trying to analyze. So first of all we'll start with something as a preventive care. So a preventive care first advantage this is what my further uh output would be. So we are planning to like first give a free consultation and to promote the health education. So health education if I can educate a person to go to a specific doctor or maybe guide them to a specific test so that they can understand next upcoming project first step. Second as a physiologist I really want to integrate EEG with MRA that again can supportive diagnosis to certain extent it's not a strong diagnostic tool it's just a functional markers and that to layers of the brain work so any we cannot see in the M can be put up by the EEG. So next step we want to integrate AI physiology and the patient care. Thank you sir for explaining the physiology of our body most common issues family inheritance issues further missions it was very informative sir thank you so much thank you s it's actually a pleasure talking to you and I think physiology as a diagnostic tool and uh I I thank you to take this opportunity to bring the podcast and to uh promote physiology as a diagnostic tool and also thanks can you to like inculcate this idea and to work together so that we can promote our healthcare in future. Thank you sir. Thank you. It's my great pleasure.