How to Choose the Best Endocrinologist in Kolkata?

An endocrinologist is a medical specialist that can diagnose and treat problems and diseases related to the glands and their hormones. The doctors are specialists in issues related to the metabolism of the body, biochemical processes that make the body function and others. An endocrinologist can also treat issues related to the mechanism by which the body breaks food and turns it into energy.

An endocrinologist can treat people of all aged and gender, including children. Endocrinologists that specialise in treating children are often referred to as paediatric endocrinologist.

What does Endocrinologist do?

An endocrinologist can diagnose, treat and prevent problems and diseases related to the following areas:

  • Adrenal glands which are located on top of the kidneys and are responsible for controlling health vitals such as blood pressure, metabolism, response to stress, sexual hormones, and others.
  • Bone metabolism leading to problems such as osteoporosis, Vitamin D deficiency, etc.
  • High blood cholesterol or lipid issues related to heart problems
  • Hypothalamus, a part of the brain which regulates the temperature in the body, hunger and thirst.
  • Excessive growth or gigantism
  • The pancreas that makes insulin and other digestive substances in the body
  • Thyroid, a gland that primarily controls metabolism, energy, and the growth and development of the brain in the body.
  • Reproductive glands including ovaries in women, testes in men
  • Parathyroids, which are small glands in the neck responsible for controlling calcium in the bloodstream
  • Pituitary, a gland in the bottom of the brain which helps to maintain a balance of hormones in the body
  • Diabetes
  • Endocrine gland cancer
  • Lack of growth or stature
  • Infertility, in some cases
  • Excessive or underproduction of hormones
  • Menopause and related hormonal issues

That said, diabetes is the most common issue treated by endocrinologists. Patients with diabetes can also seek consultation from a general physician. However, in many cases, specialist counselling from an endocrinologist is required. These cases include:

  • People who are new to diabetes and need to learn to manage it well
  • People who use an insulin pump or take insulin shots due to high diabetes
  • People who have severe complications because of diabetes
  • People for who the general diabetic treatment is proving ineffective and whose level of diabetes has gone beyond a certain level

What is the value of an Endocrinologist?

An endocrinologist is a specialist that has deep expertise in hormonal conditions and is equipped to treat them with best possible methods, including conventional and modern medical methods. Unlike a general physician, an endocrinologist has expert knowledge of hormones and related diseases and hence, can provide better treatment than a general doctor.

Moreover, in many cases, an endocrinologist can help non-traditional patients, for who traditional treatment methods have failed to provide any results. And in most situations, traditional methods have worsened the conditions. In such instances, an endocrinologist can help devise a tailored treatment plan depending on the hormonal condition of the patient, to maximise effectiveness. For example, a patient might not respond to traditional methods of treatment because of the presence of cystic fibrosis, which affects the way their body responds to treatments. Hence, in such cases, an endocrinologist can provide specialist expertise in devising a plan best suitable to the patients’ case.

Further, since hormones and related diseases constantly change, an endocrinologist is up-to-date with the latest treatment methods and technologies. This provides the patient with a more effective treatment.

When to visit an Endocrinologist?

A person should visit an endocrinologist upon experiencing any hormone-related issues such as:

  • Unexplained weight loss or gain
  • Problem in sleeping
  • Fertility issues
  • Vaginal dryness or related reproductive problems
  • Skin rashes or dry skin
  • Changes in sensitivity to hot and cold temperatures
  • Unexplained and too much sweating
  • Anxiety issues
  • Depression
  • Fatigue, headache, discomfort
  • Irritability
  • Bloating
  • Changes in blood pressure
  • High cholesterol
  • Metabolic disorders
  • A problem in heart rate
  • Weakening bones
  • Alterations in blood sugar concentration
  • Excessive thirst
  • More frequent urge to urinate than normal
  • Changes in appetite
  • Changes in voice, especially in females
  • Tenderness in the breast
  • Blurry eye vision
  • Puffy or swollen face
  • Problems in sex
  • Thinning of hair
  • A bulge formation in the neck
  • Enlarged thyroid gland or goitre
  • Thyroid nodule or lump

What to expect in the first visit to an Endocrinologist?

Upon experiencing symptoms, a person must visit an endocrinologist for appropriate diagnosis and treatment. In the first meeting, the endocrinologist will ask the patient some questions to diagnose the problem and understand the symptoms. These might include:

  • Diet and food habits
  • Ongoing medications
  • Family history of hormonal disorders
  • Existing medical problems such as allergies

A patient should ideally list all symptoms to get an exhaustive diagnosis. In many cases, an endocrinologist can enquire about symptoms which might not be directly related but can have an impact. It is important to answer all questions with the utmost honesty and sincerity as possible.

The doctor will also check general health vitals such as blood pressure, heart rate, pulse, and also analyse the condition of teeth, hair, skin, and mouth to arrive at a conclusive analysis. In some cases, an endocrinologist might also suggest a blood and urine sample test.

Based on the holistic evaluation, the endocrinologist will devise a treatment plan.

How to choose the best endocrinologist in Kolkata?

For a person experiencing any hormone or related issues and needs to visit an endocrinologist in Kolkata, the following steps can prove very useful:

  • Understanding symptoms and listing them down
  • Making a comprehensive list of all endocrinologists in Kolkata by taking referrals from family and friends, and using general Google search and platforms such as Practo and Justdial
  • Narrowing the list based on specific parameters such as hospital and private practise years of experience, proximity, etc.
  • Shortlisting further and assessing the credentials, expertise, specialities and knowledge of the endocrinologists through an exhaustive online search.
  • Selecting an endocrinologist that has several years of experience, holds valid credentials and certifications, is licensed, close to home, and has authentic patient referrals. It is best to read online reviews for a more authentic search.
  • Once the analysis is complete, make the call and book an appointment with the endocrinologist.

In Kolkata, CMRI (Calcutta Medical Research Institute) is regarded as the best multi-speciality hospital with experts in all fields including endocrinology.

Hay Fever

Hay fever also known as allergic rhinitis is an allergic response of the body to allergens – indoor and outdoor. These allergens include pollen, dust mites, the saliva of the cats, small skin particles of cats, dogs, and other fur animals.

Hay fever typically causes symptoms such as the cold, runny nose, itchy eyes, congestion, sneezing, and sinus pressure. However, it is not caused due to a virus. The condition can make people, mostly children, feel uncomfortable, sick, and can also hamper performance at work or school. However, with the right treatment, precautions and avoidance of triggers, hay fever can be easily manageable.

Symptoms of hay fever

Hay fever usually has cold-like symptoms, including:

  • Runny nose
  • Congestion
  • Sneezing
  • Red, watery or itchy eyes (typically caused by the allergens)
  • Cough
  • Fatigue and nausea
  • Postnasal drip
  • Itching in the nose, in the roof of the mouth or the throat
  • Swelling and discolouration of the skin under the eyes

That said, these symptoms and more could appear and worse at a particular time of the time. Some of those periods include:

  • Early of spring when there is tree pollen
  • Late spring or summer which causes grass pollen
  • Fall when there is ragweed pollen

Moreover, dust mites, cockroaches, etc. are considered to cause this issue all year round. However, the symptoms in case of dander can intensify in the winters, especially when the houses are mostly closed. Fungi spores can also trigger this issue all-year around.

Typically, hay fever goes off on its own as soon as the exposure to the allergens is removed. However, in cases, where the problem persists or some other symptoms, such as below, appear, a person must seek immediate medical attention:

  • There is no relief from hay fever symptoms even after losing contact with the allergens
  • Allergy medications have intensified the problem or have not provided any relief to the issue
  • Additional health condition such as sinus infection, asthma, etc., which is worsening the symptoms

Distinguish between hay fever and the common cold

Even though hay fever has col-like symptoms, it is not the same as a common cold. Here are some of the common differences between the two:

  • Hay fever causes runny nose and water-like discharge without any fever. However, common cold causes mild-fever and results in a runny nose and thick, yellowish discharge.
  • Hay fever occurs typically right after the person is exposed to allergens. But common cold happens to post 2-3 days of the exposure to the virus.
  • Hay fever lasts as long as the person is exposed to the allergens. However, the common cold goes off between three to seven days.

Causes of hay fever

In the case of hay fever, a person’s immune system takes a non-harmful airborne substance as harmful and starts to produce antibodies to prevent this harmless element. On every occasion that the person makes a contact with the same substance, the antibodies produced for prevention send an alarm to the immune system to release a chemical, known as histamine, in the bloodstream. This chemical causes a reaction in the body of the person and produces symptoms and signs of hay fever.

Risk factors of hay fever

Hay fever can happen to anyone at any age. However, the factors below increase the chances of a person to be affected by the condition:

  • A person that has other allergies or asthma
  • A person who has eczema
  • A person with a family history (mainly parents and siblings) of allergies
  • A child whose mother smoked during the first year of his/her life
  • People who work or live in areas constantly exposed to allergens

Complications of hay fever

Hay fever, if not treated well, can cause the following complications:

  • Interfere with the quality of life by making the person less productive and restricting them to enjoy life to the fullest.
  • Hay fever can cause a person to take excessive leaves from work or school
  • A person suffering from hay fever can find it difficult to sleep well or might stay awake most hours of the night. This can, in turn, cause tiredness and a feeling of being unwell.
  • Hay fever can intensify the problem of asthma in people
  • Hay fever can cause sinusitis, which is an infection or the swelling of the membrane which surrounds the sinus.
  • Hay fever can cause painful ear infection

Prevention of hay fever

There is no definitive way to avoid hay fever. However, if a person has the issue, taking medications to minimise symptoms and staying away from triggers can help ease the issue.

Diagnosis of hay fever

To diagnose hay fever, the healthcare professional will conduct a quick physical exam, understand the medical history, and then might recommend the following tests to confirm the analysis.

  • Skin prick test: In this particular test, the doctor pricks trigger allergens into the skin of the person and then watches for the reaction of the body. In case, a person is allergic, a hive develops in a particular area.
  • Allergy blood test: Also known as the radioallergosorbent test (RAST), this measures the body’s immune system response to specific allergens in the lab.

Treatment of hay fever

The best way to treat hay fever is to stay away from allergens and triggers. However, in case the hay fever is not too severe, some over-the-counter medications can work to provide relief from symptoms. In case, the symptoms are worse, the patient would need some prescriptive medications.

Alternatively, some other forms of treatment include allergy shots also known as immunotherapy; under-the-tongue allergy tablets, and frequently rinsing the sinuses.

Overall, hay fever is not a serious medical condition but can cause some very discomforting symptoms and hamper the quality of life if not prevented or treated well.

Sore Throat

Sore throat is a condition which causes pain, scratchiness, dryness in the throat. This problem usually intensifies upon swallowing of food or liquid. The most common cause of sore throat is a viral infection but usually, the condition resolves on its own.

But in cases, where the sore throat, specifically streptococcal infection, occurs because of bacteria, the condition may require medications such as antibiotics. However, other forms of sore throat may require more intense treatment depending on the cause.

Symptoms of sore throat

Symptoms of sore throat depend on the cause of the problem. However, some common signs of the condition include:

  • Pain or dryness in the throat
  • A scratchy feeling in the throat
  • Problem in swallowing
  • Soreness or swelling in the neck or jaw
  • Swelling or redness in the tonsils
  • White patches or pus formations on the tonsils
  • Hoarse or barely audible voice

However, the underlying problem of sore throat can also tend to show some symptoms, such as:

  • Nausea
  • Vomiting
  • Sneezing
  • Runny nose
  • Cough
  • Fever
  • Body pain

Also, in children, if the sore throat does not go away on its own soon, the parents should get immediate medical care in case there are other symptoms, such as:

  • Problem in breathing
  • An issue in swallowing food or liquid
  • Abnormal drooling

Moreover, if an adult experiences sore throat with the below symptoms, immediate medical attention must be sought.

  • Problem in breathing
  • Issue in swallowing
  • A sore throat that lasts more than a week
  • Rash
  • Pain in the joints
  • A problem in opening the mouth
  • Blood in the saliva
  • Formation of a lump in the neck
  • Swollen neck or face
  • High fever
  • Ear pain
  • Hoarse voice, which does not improve for more than a week

Causes of sore throat

The most common cause of sore throat is the virus such as cold and flu. But in some conditions, bacterial infections can also lead to a sore throat.

Viral infections such as colds, measles, chickenpox, COVID-19, influenza, mono, croup, etc. can cause sore throat. Moreover, bacterial infections such as Streptococcus pyogenes can also lead to a sore throat.

That said, some other causes of the problem include:

  • Allergies to dust, molds, pet dander, etc.
  • Dryness because of mouth breathing
  • Irritants including tobacco smoke, chemicals, etc.
  • Muscle strain because of excessive yelling, talking, etc.
  • Gastroesophageal reflux disease (GERD)
  • HIV infection
  • Tumours

Risk factors of sore throat

A sore throat is a very common condition and can impact people of all ages. However, some people may be more prone to the problem than others. These include:

  • Children between 3-15 years of age
  • People who are more exposed to tobacco or similar type of smoke
  • People that have existing allergies to molds, dust, etc.
  • People that are highly exposed to chemical irritants
  • Individuals that get serious or frequent sinus infections
  • People that have a weak immune system

Prevention of sore throat

The best way to prevent sore throat is to maintain good hygiene and avoid germs by:

  • Washing hands regularly
  • Avoiding sharing of food
  • Coughing or sneezing
  • Using alcohol-based sanitizers
  • Limiting touching public places and common surfaces
  • Regularly cleaning all devices such as telephones, TV, etc.
  • Avoiding close contact with ill people

Diagnosis of sore throat

To assess a sore throat, the doctor will foremost conduct a physical exam that can include:

  • A lighted instrument, which is used to look inside the throat, ears and nasal passages.
  • Softly checking the neck to detect the presence of any swollen glands
  • Listening to the breathing

In many cases, the doctors conduct a throat swab test to check for sore throat. The doctor uses a sterile swab and rubs it over the back of the throat to obtain a sample of secretions. This sample is then sent to the lab to get the results.

Treatment of sore throat

A sore throat which is generally caused due to a bacterial infection does not harm and typically goes away in a maximum of 7 days, without any medical care. However, to reduce pain and fever, the doctor might suggest some pain relievers or fever medications.

In case, the strep throat is caused because of bacterial infection, the doctor will suggest antibiotics. The full course of antibiotics should be taken, even when the symptoms get over sooner. In case, the medications are not taken properly, the sore throat infection can worsen or spread to other body parts.

Moreover, non-completion of the antibiotic course for sore throat can lead to rheumatic fever in children or even kidney inflammation.

That said, some lifestyle and home remedies that can help improve the sore throat issue include:

  • Getting plenty of rest and sleeping well
  • Drinking more fluids
  • Opting for more warm liquids and foods such as tea, ice pops, etc.
  • Gargling with saltwater
  • Using a cool-air humidifier to remove the air, which can potentially lead to a sore throat
  • Avoiding irritants such as tobacco smoke, cleaning agents, etc.

Overall, sore throat can easily be prevented and treated after diagnosis. However, regular check-ups can help ensure the infection is monitored and prevented.

Spleen Enlargement

The spleen is the organ of the human body, located just below the left rib cage in the top part of the abdomen towards the back. The spleen is the part of the lymph system and functions as a drainage section, which protects the body from various infections. The spleen has white blood cells, which take in bacteria, dead tissue, and any foreign substances, and remove them from the blood. It also helps to maintain a healthy ratio of white and red cells, as well as the platelet count. The spleen recycles iron in haemoglobin and filters antibody-coated bacteria.

The spleen is typically the size of a human fist but conditions such as infections, liver diseases, specific cancers, etc. can cause it to swell and increase multiple time in size. That said, an enlarged spleen is not always a cause of worry. Sometimes when a spleen becomes enlarged it might imply it has become overactive and is functioning at its full capability. This is referred to as hypersplenism.

However, in other conditions, where the enlarged spleen tends to press on the other organs, it can impact the blood flow to the spleen. This will, in turn, affect the capability of the spleen to filter blood properly. Also, if the spleen becomes too big, it can remove an excessive number of red blood cells from the body, which can lead to a medical condition known as anaemia. Furthermore, the enlarged spleen can cause the body to experience infections more than usual.

Symptoms of spleen enlargement

In many cases, an enlarged spleen or called splenomegaly, might not cause any symptoms. However, in other conditions, the problem can have the following symptoms:

  • Abrupt pain or a feeling of fullness in the abdomen (precisely the upper left part), which can spread to impact the left shoulder
  • Anaemia
  • Fatigue
  • More risk of bleeding
  • More risk of infections
  • Feeling more full than usual even after a small meal

However, if the pain in the upper left abdomen intensifies or there is no relief, the patient must be taken to a doctor at the earliest.

Causes of spleen enlargement

An enlarged spleen can be caused because of multiple infections and diseases. However, the condition can be temporary and mild or could be severe and cause a lot of symptoms. Some of the factors that can lead to enlargement of the spleen include:

  • Viral infections
  • Bacterial infections
  • Infection in the inside layer of the heart
  • Cirrhosis or other critical liver issues
  • Malaria or similar parasite-based infections
  • Blood cancers including leukaemia
  • Lymphomas
  • Disorders or issues with the metabolic functioning of the body
  • Medical conditions that destroy the red blood cells earlier than their expiry age
  • A blood clot in the veins
  • Strain on the veins of the spleen or liver

Risk factors of spleen enlargement

Spleen enlargement can occur at any age and in any gender. However, some people are at higher risk of developing this condition. These include:

  • Children and young age adults that suffer from infections such as mononucleosis
  • People with inherited metabolic issues that impact the spleen and liver, such as Niemann-Pick disease
  • People who are more exposed to places where malaria is common

Complications of spleen enlargement

Spleen enlargement is not corrected and treated with adequate medical help can cause complications, such as below:

  • Infections: If not treated timely, an enlarged spleencan drastically reduce the healthy red blood cells from the body, as well as reduce the platelets and white blood cells. This can make the body more prone to infections, as well as bleeding. It can also cause a condition known as anaemia.
  • Ruptured spleen: Generally, even when the spleen is of normal size, it is more prone to being ruptured in an accident, such as a car crash. However, the possibility of spleen rupture increases manifold when the spleen is enlarged. In case, the spleen is ruptured, it can lead to excessive bleeding into the abdominal cavity, which can be life-threatening.

Diagnosis of spleen enlargement

As mentioned in many patients, the enlarged spleen does not cause any symptoms. However, it can be diagnosed by a physical exam. Moreover, thin people can feel their spleen size increase than normal. In the physical exam, the healthcare provider gently examines the upper left abdomen portion to check for pain, tenderness or feel the size of the spleen.

Further, the doctor can use the following tests to confirm the analysis:

  • Blood tests including a complete blood count assessment to determine the number of red blood cells, white blood cells, and platelets.
  • Ultrasound or Computerized Tomography (CT) scan be used to diagnose if the spleen has enlarged in size and if it is pressing on other nearby organs.
  • Magnetic resonance imaging (MRI) can be used to check the blood flow from the spleen

In some cases, the doctor may subject the patient to further deep tests to understand the cause of the issue. These can include a bone marrow exam or a liver function test. In some severe cases, the doctor can also remove the spleen, when there is no identifiable cause. Once the spleen is removed, the doctor can use a microscope to check for lymphoma of the spleen.

Treatment of spleen enlargement

The type of treatment for the issue depends on the underlying cause of spleen enlargement. For example, if the enlargement is diagnosed to happen because of a bacterial infection, the doctor will prescribe antibiotics to treat the cause.

In case, the patient does not have any symptoms or no known cause, the doctor would suggest waiting until any complications occur. However, frequent check-ups would be required to assess the condition.

In other instances, where the enlarged spleen has caused a lot of complications, the healthcare provider may recommend a spleen removal surgery. However, the surgery can have possible risks depending on the general health of the patient. Hence, must be considered after careful evaluation with the doctor.

Glimmer of Hope

Glimmer of Hope

Intro: A precious tool in critical care physician’s hand, a ventilator is a life-saving and respiratory support and does not augur the end of life

Life is uncertain and in unexpected circumstances, anyone can end up on life support. While being on a ventilator is usually perceived as the end of life, it is just not true. Ventilator is an essential life support which every doctor and hospital gives to save the life of a patient and not to end life.

Necessity of Ventilation

Ventilator is a life-saving and respiratory support. Various parameters of a patient are checked before being put on ventilation. Doctors use other tools like non-invasive ventilation, high flow nasal oxygen therapy first to avoid a ventilator. It is only when those measures fail and respiratory status continues to deteriorate that a ventilator is brought in.

The Duration

It depends on the primary condition of the patient. In case of a patient suffering from Pneumonia, the ventilator gives the lungs rest. It is similar to dialysis to help the kidneys. Ventilator takes care of respiration and once the primary problem is resolved, the patient is taken out of the ventilator. In post-operative cases when lungs are weak, ventilator is given for support of the lungs. It could be for just a day. However, bad lungs, less muscle power may require prolonged ventilation.

Weaning Off Ventilation

It is a protocol driven thing. The process starts from the very day a patient is put on ventilation. Oxygen support as well as pressure on the ventilator is decreased to see how a patient is adapting. There are some international criteria and once the patient satisfies those, s/he is taken off ventilator.

While on V, what complications can be arise

The ventilator tube is directly attached to trachea. Disconnection or less oxygen delivery can cause oxygen deprivation and serious trouble to patient, even cardiac arrest. Ventilator-associated pneumonia (VAP) is the most common infection as the tube is a foreign device. The precautionary measures are called ventilator precaution bundle.

Precautions To Take

Ventilator is a dual instrument. In the initial days, it gives support and rest to the lungs. But prolonged use can cause multiple problems like ventilator associated infection as it is an invasive foreign device in the body. The breathing tube that is put in the trachea can allow bacteria to enter lungs. Oral hygiene care together with aspiration of secretions and upright posture may reduce the risk of ventilator complications.

Prolonged Ventilation

Neurological patients often need prolonged ventilation. In such cases, smaller sized tubes are inserted in trachea through which ventilation is delivered. On and off ventilation is also practised. In initial period, a tube is inserted in the oral cavity. When it cannot be taken out 7-10 days later, a smaller size tube is put in through a small procedure known as tracheostomy. It is better than having the big tube in the oral cavity. Such patients can also be discharged after a tracheostomy, provided they require no special medicine support. Nursing care is a must.

Tracheostomy patients who do not require ventilation are unconscious. Patients with paralysis, neurological problems or other conditions find it difficult to cough up secretions; so direct suctioning of the trachea is done to clear the airway. Post this, they can go home. Mini ventilators can also be arranged at home when only respiratory support and no other support is needed.

New Technologies

Ventilator has been changing since invention. Modernised ventilators require less medicines and dose of anaesthesia. Ventilator synchronisation is much better now. Besides there are new gadgets like non-invasive ventilation that does not require tubes to be put in and high flow nasal oxygen therapy. A dead person cannot be put on ventilator and unlike what is shown in some movies, it cannot revive one who is dead.

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