Doctor Gireesh, Gireesh, Neurology, Neurospecialist, Neurophysician, Neurophysician in chennai

This site consists of answers to questions asked by the patients and public to Doctor K. GIREESH eminent neurophysician and neurosurgeon in his regular out patient clinic and answeres to questions which he has received by post or fax or email and online chat.

(Q) 1. Could you please tell me doctor what is blood poisoning?
(Rekha ,Coimbatore)

(A) K. Gireesh: Blood Poisoning is a serious and potentially life-threatening condition characterised by the presence of pathogenic microorganism (especially bacteria) in the blood. It is also called septicaemia.

Blood poisoning may result from infection in a wound or operation site or a tooth abscess. Also as a result of an infection in the gall bladder, appendix, burns or abscesses. Elderly persons and babies are more at risk, and people with lessened immunity, e.g. those suffering from cancer. Preventive measures include seeking prompt medical attention for infections, wounds and injuries, and having regular dental checkups and treatment.

Symptoms are as follows: a temperature that rises rapidly to a high level along with shivering chills, flushing, copious sweating, pains and aches, and a fall in blood pressure. The person feels generally unwell and requires prompt medical attention as there is a risk to shock and death. This is especially the case in a vulnerable person who has an existing illness.

Treatment: involves admittance to hospital and antibiotic therapy. Antibiotics may be required in large amounts until the condition is brought under control. If blood poisoning has arisen as a result of infection in some other organ or part of the body (e.g. the gall bladder), surgery may be necessary to treat this.

(Q) 2. Doctor please tell me how heat stroke occurs?
(Sunil, Chennai)

(A) K. Gireesh: Heatstroke is a severe condition that follows overexposure of the body to excessive heat.

All age groups and both sexes especially elderly persons are most at risk.

The cause of the symptoms is loss of fluid and salt through excessive sweating, leading to disruption of the salt/water balance, lowered blood volume, metabolic disturbance and shock. Preventive measures include taking enough time for acclimatisation to the heat and increasing the amount of fluids drunk. People who are required to carry out hard, physical work need to drink salt solutions to compensate for the loss that occurs in profuse sweating.

The symptoms include failure of sweating and all temperature regulation, headache, muscular cramps, hot, dry skin and high body temperature. The heartbeat rate is rapid, and there is a loss of consciousness, followed by coma and death, which can occur quite quickly. The person requires immediate emergency attention to save his or her life and admittance to hospital.

As the body is overheated it must be cooled immediately by sponging or immersion in cool water, and fanning, the body may be wrapped in wet sheets. Once the temperature has returned to just above normal (38.9C), the person should be dried and wrapped in a dry blanket. When consciousness returns, drinks and salt solutions are needed or may have to be given intravenously. Convalescence may take some time and it may not be possible for the person to continue former activities in the prevailing climate.

I have been suffering from sever pain in the (R) thumb and first two fingers. The pain is more at night. My family doctor diagnosed this as carpal tunnel syndrome and advised mea to consult a neurologist. Could you please tell me about Carpal tunnel syndrome?

- Karpakvalli, kodambakkam
Chennai.

Carpal tunnel syndrome is a nerve disorder the fingers, thumb and hand.

Description : a nerve disorder affecting the fingers, thumb and hand.

Persons most commonly affected : are adults of both sexes but more common in women aged 30 to 60.

Median nerve supplying hand is involved.

Symptoms and indications : a tingling or burning sensation in the first three or four fingers of one or both hands, pains that may shoot up the arm, numbness and weakness in the hand. The symptoms are usually most severe at night. A person with these symptoms should seem medical advice.

Causes and risk factors : the condition is caused by pressure on the median nerve by an overlying ligament in the wrist. This is brought about by trauma such as a lot of work with the hand and wrist, injury to the wrist or inflammatory conditions, especially arthritis. The condition can often be cured or improved.

Treatment : includes resting the hand and wrist, sometimes requiring a splint, which often resolves the condition. However, if it does not respond, surgery may be needed to divide the ligament in the wrist that is compressing the median nerve.

My child aged 7yrs had watery loose stools several times after taking a bottle of cool drink. I rushed to the hospital nearby. The doctor said "Hope it is not cholera" and added if its cholera it deadly. Could you please tell me something about cholera and how to prevent it?

- Mrs. Gonsalvez, Perambur
by e-mail

Cholera is a severe bacterial infection of the small intestine.

Description : a severe bacterial infection of the small intestine. Cholera remains a serious killer disease in many countries, especially in conditions of overcrowding and poor sanitation e.g. refugee camps. During epidemics, the death rate exceeds 50% with children and elderly persons being at particular risk. The disease is rare in the UK and such cases that occur are contracted abroad. Strict standards of hygiene, sanitation and nursing ensure that the infection does not spread, and prevent an epidemic. Early and prompt detection and treatment enable most patients to make a full recovery. This vigilance remains necessary because cholera caused thousands of deaths in the last century during wide-spread epidemics in many countries.

Causes and risk factors : the disease is caused by the bacterium vibrio cholerae. It is spread by contamination of drinking water by faeces of those affected by the disease, and also by flies landing on infected material and then crawling on food. In countries where cholera is present, drinking water must be treated or boiled and strict standards of hygiene used in food preparation. Efforts should be made to eliminate flies from houses and to ensure that they do not come into contact with food. Risks remain wherever there are conditions of overcrowding, poverty and poor sanitation.

Symptoms and indications : there is considerable variation in the severity of symptoms and in the manner in which they present themselves. In mild cases, the patient may hardly feel ill, whereas in those severely affected during epidemics, death may occur very rapidly within a few hours. In most cases, three stages of cholera are recognised. During the first stage, there is copious diarrhoea and vomiting, with the production of characteristic 'rice water stools' containing flakes of fibrin (a protein substance formed in the blood during blood clotting). There are severe pains and cramps, extreme thirst and increasing signs of dehydration. In the second stage, death may occur due to dehydration and collapse. The person's skin is cold and wrinkled, the eyes are sunken, the pulse becomes imperceptible and the voice is a hoarse whisper ('vox cholerica'). During the third stage, the person may start to recover and gradually improve and the symptoms subside. Relapse is still possible at this stage, particularly in the form of a fever. A person who has travelled abroad and has any signs of illness should seek medical advice.

Treatment : requires isolation of the patient and scrupulous attention to hygiene during nursing. This includes treatment and very careful disposal of the body waste of the infected person, to prevent the spread of the disease. Treatment of the patient involves bed rest and the taking of tetracycline or other sulphonamide drugs to kill the cholera bacteria. The patient requires salt solutions to counteract the dehydration that occurs, and these are taken by mouth and/or given intravenously. Prevention of cholera is by means of vaccination but this is only effective for about six months.

1. Could you please tell me doctor what is blood poisoning?

Blood Poisoning is a serious and potentially life-threatening condition characterised by the presence of pathogenic microorganism (especially bacteria) in the blood. It is also called septicaemia.

Symptoms are as follows: a temperature that rises rapidly to a high level along with shivering chills, flushing, copious sweating, pains and aches, and a fall in blood pressure. The person feels generally unwell and requires prompt medical attention as there is a risk to shock and death. This is especially the case in a vulnerable person who has an existing illness.

Treatment: involves admittance to hospital and antibiotic therapy. Antibiotics may be required in large amounts until the condition is brought under control. If blood poisoning has arisen as a result of infection in some other organ or part of the body (e.g. the gall bladder), surgery may be necessary to treat this.

2. Doctor please tell me how heat stroke occurs?

Heatstroke is a severe condition that follows overexposure of the body to excessive heat.

All age groups and both sexes especially elderly persons are most at risk.

Q. I have been suffering from sever pain in the (R) thumb and first two fingers. The pain is more at night. My family doctor diagnosed this as carpal tunnel syndrome and advised mea to consult a neurologist. Is Carpal tunnel syndrome a disorder ?

- Karpakvalli, kodambakkam
Chennai.

A. Carpal tunnel syndrome is a nerve disorder the fingers, thumb and hand.

Description : a nerve disorder affecting the fingers, thumb and hand.

Persons most commonly affected : are adults of both sexes but more common in women aged 30 to 60.

Median nerve supplying hand is involved.

Q. My child aged 7yrs had watery loose stools several times after taking a bottle of cool drink. I rushed to the hospital nearby. The doctor said "Hope it is not cholera" and added if its cholera it deadly. What happens when cholera occurs and how to prevent it?

- Mrs. Gonsalvez, Perambur
by e-mail

A. Cholera is a severe bacterial infection of the small intestine.

Description : a severe bacterial infection of the small intestine. Cholera remains a serious killer disease in many countries, especially in conditions of overcrowding and poor sanitation e.g. refugee camps. During epidemics, the death rate exceeds 50% with children and elderly persons being at particular risk. The disease is rare in the UK and such cases that occur are contracted abroad. Strict standards of hygiene, sanitation and nursing ensure that the infection does not spread, and prevent an epidemic. Early and prompt detection and treatment enable most patients to make a full recovery. This vigilance remains necessary because cholera caused thousands of deaths in the last century during wide-spread epidemics in many countries.

Causes and risk factors : the disease is caused by the bacterium vibrio cholerae. It is spread by contamination of drinking water by faeces of those affected by the disease, and also by flies landing on infected material and then crawling on food. In countries where cholera is present, drinking water must be treated or boiled and strict standards of hygiene used in food preparation. Efforts should be made to eliminate flies from houses and to ensure that they do not come into contact with food. Risks remain wherever there are conditions of overcrowding, poverty and poor sanitation.

Symptoms and indications : there is considerable variation in the severity of symptoms and in the manner in which they present themselves. In mild cases, the patient may hardly feel ill, whereas in those severely affected during epidemics, death may occur very rapidly within a few hours. In most cases, three stages of cholera are recognised. During the first stage, there is copious diarrhoea and vomiting, with the production of characteristic 'rice water stools' containing flakes of fibrin (a protein substance formed in the blood during blood clotting). There are severe pains and cramps, extreme thirst and increasing signs of dehydration. In the second stage, death may occur due to dehydration and collapse. The person's skin is cold and wrinkled, the eyes are sunken, the pulse becomes imperceptible and the voice is a hoarse whisper ('vox cholerica'). During the third stage, the person may start to recover and gradually improve and the symptoms subside. Relapse is still possible at this stage, particularly in the form of a fever. A person who has travelled abroad and has any signs of illness should seek medical advice.

Treatment : requires isolation of the patient and scrupulous attention to hygiene during nursing. This includes treatment and very careful disposal of the body waste of the infected person, to prevent the spread of the disease. Treatment of the patient involves bed rest and the taking of tetracycline or other sulphonamide drugs to kill the cholera bacteria. The patient requires salt solutions to counteract the dehydration that occurs, and these are taken by mouth and/or given intravenously. Prevention of cholera is by means of vaccination but this is only effective for about six months.

Q. My grand father has tremulousness of his hands and he walks very slowly. The tremulousness is considerably disturbing him. He has been diagnosed to have parkinson's Disease What is this disorder?
Shaji, Trivandrum (online chat)

A. Parkinson's disease or Parkinsonism is a progressive condition occurring in mid to later life, due to degenerative change in a part of the brain. It results in a rigidity of muscles and tremor when resting and unsteadiness in walking.

Person most commonly affected : elderly adults of both sexes both more common in men

Organ or part of body involved : part of the brain (ganglia located at the base of the cerebrum) that controls certain muscle movements.

Symptoms and indications : early symptoms include a fixed expression of the face and lack of blinking, resulting in a mask-like look, tremor of the hand when sitting still, which reduces with movement and does not occur when the person is sleeping. This may also affect the arms and legs. Movements eventually become slow, and there is a loss of the postural reflexes that help to maintain the person in an upright position. The person develops a typical shuffling gait and the body stoops. There is a tendency to fall forward or backwards or to break into a run to prevent falling. Voice and speech may be affected and there may be difficulty in swallowing. A person with symptoms of Parkinson's disease should seek medical advice.

Causes and risk factors : the cause is believed to be a degenerative change in the basal ganglia of the brain, resulting in a deficiency of the naturally occurring substance, dopamine, which transmits nerve impulses. However, in some cases, it may result from a lack of other 'neurotransmitters'. Parkinson's disease also arises as a result of the taking of certain drugs, e.g. phenothiazine tranquillisers and reserpine. Parkinson's disease may arise after inflammation of the brain, brain tumors, injuries or degenerative disease, ingestion of manganese or carbon monoxide and HYDROCEPHALUS. Drug abusers may develop Parkinson's disease from injecting a form of heroin.

Treatment : the condition cannot be cured but symptoms can be managed and relieved by means of various drugs, the most important of which is levodopa. The drugs used in the treatment of Parkinson's disease must be individually tailored to the needs of each patient and are administered under specialist medical care. Side effects from drug treatment may occur and should be immediately reported to the doctor. Also, the patient's response to the drugs may vary over a period of time and treatment requires monitoring and possible alteration with time.

Q. A week age I had a heavy meal from a fast fovelrestaurant. Within 4 hrs I developed severe vomiting, stomach pain. My family doctor told me it was food poisoning and of course treated me and I got cured. Well how does food poisoning occur and what should I do to prevent it?

Rajesh, Mumbai (Email)

A. (K. Gireesh) Food Poisoning is poisoning resulting from eating contaminated food or ingesting poisonous chemicals, fungi or berries.

The Symptoms are in general, food poisoning results in nausea and vomiting, diarrhoea, abdominal pain and possibly headache and fever. The symptoms and the time of onset vary with the type of food poisoning, but will usually commence between one and twenty-four hours of intake.

Staphylococcal food poisoning from meat, milk or egg products generates symptoms abruptly within two to eight hours and the attack is usually short - lived with complete recovery. Only susceptible individuals are likely to be at risk. Clostridium perfringens is associated with food poisoning from meat and meals that are reheated, and symptoms are produced with eight to twenty four hours.

Numerous species of Salmonella cause food poisoning with symptoms following eight hours to three days after ingestion. Such infection are found in the meat and/or milk of domesticated cows, pigs and poultry and also in uncooked or lightly cooked hen's eggs.

Cause include Salmonella are bacteria causing the symptoms. Although the animals mentioned above may be infected, they do not necessarily display symptoms, but products made from them create the poisoning. Salmonella are generally killed by heating to 60°C for about 15 minutes. Staphylococcal and clostridial food poisoning are caused by toxins released by the bacteria and in these cases, heating does not destroy either the toxin or the bacteria. It is therefore essential that hygienic conditions prevail at all stages of food production.

Although the number of outbreaks of food poisoning has increased over recent years, it is not usually a fatal condition, but certain groups of people will be at greater risk, i.e. babies and the very young, pregnant women, the elderly and the chronically ill.

Treatment : in the main, treatment is more preventative, i.e. affected foods should be avoided and preparation and storage of foods should comply with good practice and appropriate regulations. Depending upon the severity of the attack, treatment may just involve bed rest, or, if there is severe vomiting, intravenous infusions of electrolytes may be required. Thereafter, the diet should be bland until recovery is assured.

Meniere's disease

Q : A month ago I had severe vertigo and ENT surgeon diagnosed that I am suffering from Meniere's disease what is this disability?

- Mrs. Rukmini
St. Thomas Mount

A : (Dr. K. Gireesh)

Meniere's disease first described by the Frenchman, Prosper Meniere in 1861, which affects the inner ear causing a range of symptoms.

Person most commonly affected : both sexes in middle age but slightly more common in men.

Organs or part of body involved : the membranous labyrinth of the inner ear, usually affecting one side only.

Symptoms and indications : this usually begins with some hearing loss in one ear, followed after a period of months by a severe attack of giddiness or vertigo. This occurs suddenly, often waking the person up from sleep at night, and is accompanied by ringing in the ear. This is usually followed by vomiting and sweating. The symptoms usually subside in a few hours but the person is unsteady with loss of balance for some days after wards. Another attack may follow in about one week or after some months. With each attack, the loss of hearing becomes worse until the person is completely deaf in the affected ear. A person with symptoms of Meniere's disease should seek medical advice.

Treatment : involved a variety of different drugs to control symptoms and also, possibly, surgery. An affected person should rest in bed until symptoms have subsided. Diuretic drugs to prevent fluid accumulation may be prescribed. No method of treatment is completely successful but some symptoms can be relieved.

Causes and risk factors : the cause is unknown but the symptoms are due to an overaccumulation of fluid in the labyrinth of the inner ear. It has been suggested that this may be an allergic reaction or due to spasm of tiny blood vessels supplying the inner ear.