DT Health: Expert Talk - Carpal tunnel syndrome and middle-aged women

The median nerve is an important nerve that is responsible for sensation in your fingers and for movements of the thumb. The nerve passes through a tunnel from the forearm into the hand and any compression/irritation to the nerve can result in this syndrome. The tunnel is an unyielding one with bone on one side and a tough ligament on the other and is present in the palm close to your wrist. 

Its function is to provide sensation to the thumb, index and middle fingers and also for the movement of the thumb. So whenever there is compression of this nerve, an individual may experience tingling or numbness mainly involving the thumb, index and middle fingers and pain, sometimes radiating up to the elbow or shoulder, and worse at night. There can be a weakness in the hand and difficulty in doing some fine actions with the hand. 

The initial treatment is mostly non-surgical in the form of the rest of the wrist with a splint, medications in the form of anti-inflammatory drugs and some physiotherapy. If these fail to give relief, surgery can be done. In surgery, the tightness within the tunnel is relieved by cutting the ligament in the palm close to the wrist. Conventionally it is done by an open method wherein a 2-inch-long incision is made in the palm and the ligament is divided. This leaves a longer scar, prolonged pain and a longer period of rehabilitation. However, advancements in surgical techniques and the availability of modern gadgets now offer keyhole carpal tunnel release. 

In this new technique called endoscopic carpal tunnel release, the specially trained surgeon makes a 1-cm cut near the wrist, passes an endoscope into the tunnel and under vision cuts the ligament. The scar is much smaller, hardly any pain and one can return to work within 24 hours. 

Chronic Obstructive Pulmonary Disease (COPD) patients are highly susceptible to respiratory infections. People tend to ignore their lungs or give less importance to them, compared to other health aspects. COPD is a long-term condition where the airways of the lungs get narrowed and the air is trapped in the lungs, causing difficulty in breathing out. It is mainly characterised by constant and progressive breathlessness, cough, sputum production and wheezing. 

Some of the symptoms of COPD include occasional breathlessness, especially after a workout or physical activity. There can be mild but persistent coughs. In the later stage, one might start avoiding stairs and physical activities. It worsens with time and becomes hard to ignore with experiences that might include breathlessness, wheezing, chest congestion, fatigue, swollen feet, ankles or legs and weight loss. It is likely to get worse if one continues to smoke or is regularly exposed to passive smoking. 

Amol Naikawadi, Preventive Healthcare Specialist from Indus Health Plus says that being physically active and working out can help improve breathing, fitness, and quality of life. Also a balanced diet and health weight can help. People suffering from severe COPD have to be hospitalised. Those with low oxygen levels in their bodies are at higher risk of getting anxiety and depression. Prevention is better than cure and keeping lungs healthier is much more efficient than getting it cured once it gets damaged. To keep your lungs healthy, avoid cigarattes, secondhand smoke, air pollution, or industrial exposures, as well as stay physically active. 

There are several diagnostic procedures including Spirometry, chest x-ray, CT scan, Arterial blood gas anlaysis and Genetic test for alpha-1-antitrypsin deficiency. "Early detection can manage the disease well and help it get treated," says Amol Naikawadi. 

Dr KS Satish, Consultant Pulmonologist and Chest Physician at Vikram Hospital says people in India are largely unaware of the seriousness of the disease. COPD is the second commonest cause of death after heart disease. India is home to one-third of the world's COPD patients. More than a million people die of COPD every year. 

Diabetes can affect fertility and reproductive health in both men and women. Type 1 and 2 diabetes can affect the hypothalamic pituitary ovary (HPO) axis and cause menstrual disturbances like delayed menarche, alterations in the menstrual rhythm and potential consequences on fertility and fecundity. Obesity and PCOS lead to irregular menstrual cycles like delayed/irregular or absent periods. It can cause damage to fallopian tubes and leads to infertility or hypothyroidism and hypogonadism in women. Diabetes can lead to sexual dysfunction like premature ejaculation, delayed ejaculation, retrograde ejaculation, erectile dysfunction and poor sperm quality.

We have seen that 80 per cent of patients dischared after COVID, regardless of whether they had a mild, moderate or severe form, have some heart sequelae too. COVID-19 generates fibrosis in the lungs, it also affects other organs within the human body such as the heart, liver or pancreas. In the case of the heart, it goes to the heart muscle and inflames it, causing mycarditis, then comes the arrhythmia and heart attack. People with established risk factors such as high blood pressure, previous cardiac arrhythmias and previous heart failure or other comorbidites might encounter more severe pictures of cardiac complications and that should not be taken lightly. Of every four heart attacks, three were saved pre-COVID, but now two die and only the other two are saved.