REMEMBERING PROF. J.N. KAKKER BY HIS O.P.D TEACHING - WRIST PAIN

 

Prof. J. N. Kakker was our teacher in Orthopedic Surgery in King George’s Medical College, Lucknow. He was always meticulously dressed in a suit and everything about him reflected grandeur and opulence. He was trained in the U.K and he spoke English with a British accent. With patients however, he suddenly metamorphosed into a desi Dacsaab! He was a wonderful teacher and a very sought after thesis guide among post graduates. His lectures were well planned, just enough for M.B.B.S students, and always laced with anecdotes and jokes.

 

However, it was during our posting as undergraduate students in Orthopedics wards that we came to know him better. He would leave his coat in his room, wear a new starched white apron every morning, and come out for rounds. His team of residents, Dr. Shishir Rastogi, Dr. Sanjay Rastogi, Dr. P.K. Jain, to name a few, would accompany him from his room to first the Orthopedics ward, where our ward teaching by one of his residents would be in progress. “Which Batch?” he will enquire. “F Batch, Sir” we will reply in chorus. He would then briefly enquire what was being taught and which patient was being discussed. Then go with his resident team towards his beds to continue with his rounds. Once the round of this ward was complete he would come back to our Batch and start his teaching. We were expected to write the patient history and examination in a case sheet and one of us would present the case. He would then quiz every person in the batch about the case. Looking back today, I don’t think he was testing our knowledge; he was actually interested in knowing whether his resident team was doing a good job with our ward teaching. Physical signs would be meticulously elicited and discussion would be threadbare.

 

Once the ward teaching was over, he would ask us to accompany his team for the rest of his round – to private rooms, and traumatic paraplegia unit. Then our white apron procession will march towards the Administrative Block, turn right and walk towards Sardar Patel Hostel, walk down the slope, cross the gate, turn right and walk towards the Rehabilitation & Artificial Limb Centre (RALC). Invariably a meter gauge train would be crossing the railway over-bridge and our entire white apron procession will wait for it to cross, lest some unthinkable stuff dropped from the train on us! I wonder what would be the spectacle for the onlookers in the Shahmina Road crossing, a bunch of white apron wearing adults, with their hands protecting their eyes from the sun, looking up at a passing train!

 

RALC was the crown jewel of our Orthopedics department. It was way ahead of time, with state of the art rehabilitation facilities. Even in 1978-79 they were providing highest quality Prosthetics and Orthotics and Rehabilitation Care to the physically challenged persons, and it was a pioneer institution of that era. The services offered by RALC were related to musculoskeletal problems, brain injury stroke, spinal cord injury, acute and chronic pain management, amputee, work injuries, orthopedic injuries, sports medicine, pediatric neuromuscular-skeletal problems and the developmental delays, osteoarthritis, metabolic bone diseases, osteoporosis etc. Prof. Kakker had patients in RALC and his round would complete only after greeting these patients and reviewing their progress. Every visit to this place was an eye opener for us and the so called disabled routinely mesmerized us by their ability to do exercises in a swimming pool, practice walking on artificial limbs, and getting wax bath, infra-red heat treatment and electrical stimulations.

 

Prof. J.N. Kakker stayed in River Bank Colony, very near the RALC, but he had place in Aliganj, which he had converted into a nursing home, usually managed by his son, who was not a doctor. I remember having assisted Prof. A.K. Wakhlu and Prof. Sandeep Kumar in that hospital. It was small but nice and cozy and the room which was converted into an operating theatre was big, air conditioned and well illuminated. Prof. Kakker's illustrious teaching career in KGMC, which started way back in 1965, came to an end in 1986.

 

Today I recall a case discussion in Prof. J.N. Kakker’s outpatient. The middle aged lady, who was overweight, presented with pain in her wrist. By then we had been shown a case of Carpal Tunnel Syndrome by Dr. G. Ramakrishna, a Senior Resident in Surgery and so we made the diagnosis. The patient had

• Burning, tingling or numbness, especially between the thumb and ring finger. 
• Needing to take breaks to rest during daily activities like kneeding dough or typing. 
• Sensation in the fingertips when flexing or extending the wrist. 
• Perceptions of swelling or stiffness in the wrist, hands or fingers. 

And she would wake up at night with wrist pain.

We showed him that only the sensory part of Median nerve was involved and there were no motor sighs. We planned a Nerve Conduction Velocity test to prove the diagnosis and then release the transverse carpel ligament to treat it.

 

Prof. Kakker was very impressed with our F Batch and then he started his teaching. The wrist may be only a small part of your musculoskeletal system, he said, but it’s one of the most complex and delicate structures in the human body. The wrist anatomy consists of several joints, eight bones, tendons, ligaments, nerves, and blood vessels all crammed in a very narrow area.  That’s why diagnosing wrist pain can be quite tricky. And, we use our wrists a lot - from grabbing and holding onto objects to complex movements like writing and typing. Therefore, wrist pain can be quite debilitating and certainly interferes with one’s daily life. 

 

Depending on the underlying cause, the type of wrist pain one can experience varies from tightness and lack of mobility to sharp pain. So we can expect

     ·        Sharp and sudden pain in the hand
·        Difficulty moving the wrist or gripping objects
·        Swollen wrist or fingers
·        Redness or warmth around the wrist
·        Numbness or a pins and needles sensation in the hand

These symptoms often get worse at night. But, we should not go away with the impression that all pains around the wrist are because of Carpel tunnel Syndrome, he cautioned. So let us understand the differential diagnosis of wrist pain:

1. Arthritis

Arthritis refers to joint inflammation that leads to swelling, stiffness, and pain. It's a very widespread issue, and contrary to popular belief, arthritis can affect adults of any age. There are many types of arthritis, but three particular forms known to affect the wrists are:

Rheumatoid arthritis – This is an autoimmune disease that damages and wears down the joints, typically in both wrists. Painful swelling and reduced mobility are common symptoms.

Gout - a form of arthritis where sharp uric acid crystals build up in joints and cause pain and swelling.

Osteoarthritis - the degenerative type of arthritis associated with wear and tear and advanced age. When the cartilage that surrounds the joints degrades, bones rub against each other, leading to pain and swelling.

Depending on the form of arthritis, causes and treatments vary tremendously. 

 

2. Carpal tunnel syndrome

Carpal tunnel syndrome is an extremely painful disease that affects 5% of the population. Anyone, particularly office workers, artists, and manual laborers can be affected by the condition. Carpal tunnel syndrome occurs when the median is compressed as a result of friction or inflammation. Symptoms can develop in one or both wrists and tend to get worse at night. One can experience pain, weakness, numbness, or a pins and needles sensation in the palms and fingers (except for the little finger).

Mild cases of carpal tunnel syndrome are treated by wearing a wrist brace, applying hot or cold compresses, and taking over-the-counter anti-inflammatory (NSAID) medications (e.g. ibuprofen, asperin) to reduce the pain.

More serious cases may require surgical release of the transverse carpel ligament and neurolysis of Median nerve.

Some people advocate steroid injections, but we don’t think it helps.

I have written a blog on Carpal Tunnel Syndrome in the past and if you wish to read it, please click: https://surajitbrainwaves.blogspot.com/2022/04/carpel-tunnel-syndrome.html

 

3. Ganglion

Ganglion cysts are benign lumps filled with fluid. These cysts typically appear on the back of the wrist or hand, and they can either be painless or quite bothersome. The cause of these cysts is unknown, but the American Academy of Orthopedic Surgeons points out that they appear more often in individuals aged 15-40, women, and gymnasts. Ganglion cysts can sometimes go away on their own. The most constant book in an English household is the Bible. The English try to squish their ganglion by repeatedly striking it with the Bible – the Bible treatment.. Wearing a splint, draining the ganglion cyst, or surgically excising it are other options.

 

4. Carpal boss

A bump on the dorsum of wrist that’s accompanied by wrist pain may also be a sign of a carpal boss. Also known as a carpometacarpal boss, this is a bony lump that forms where the carpal bones meet the radius. Unlike a ganglion cyst that’s mobile and somewhat squishy, carpal bosses are firm and immobile bumps. The exact cause is unknown, but they are believed to be caused by degenerative changes, repetitive stress, prior injury, or localized joint instability that leads to bone spur formation in this area. It usually occurs in younger adults - between 20 and 40 years of age. It tends to appear near the base of the index or middle finger. A carpal boss doesn’t need treatment unless it causes symptoms. Conservative treatment like splints, and analgesics are tried initially. Surgically it can be burred down to shape.

 

5. Wrist injuries

A wrist injury is one of the most widespread causes of wrist pain. We often fall on outstretched hand and use the hand and wrist to protect our body from the fall. Swelling, bruises, or disfigured joints can result from injury. But remember that an injury can occur even if pain following the fall is the only symptom; this is because nerves and other soft tissues can become injured too.  Sprains are a common ligament injury of the wrist. When a ligament is overly stretched or partially torn, your patient will experience pain while moving the wrist, and may also have swelling, bruising, or tingling.

Wearing a splint, keeping ther wrist elevated, resting, cold compresses, and taking NSAIDs to relieve pain can all help heal the sprain faster. That being said, we highly recommend an X-ray of the wrist so that we do not miss fractures around the wrist. Missing a wrist injury – bony or soft tissue, can be fatal because if the bones or ligaments don’t heal well, we may be left with chronic wrist pain.

 

6. Wrist tendonitis

Inflammation of the tendons, also known as tendonitis, is another extremely common cause of wrist pain. In the wrist area, tendons connect the muscles of the forearms with the hand and finger bones. It is these tendons that allow the hands to open and close a fist. When any of these tendons become inflamed, the result is tendonitis. The symptoms of tendonitis are:

     ·        Morning stiffness
·        Dull pain
·        Grinding sensation when moving the wrist
·        Warmth or swelling in some cases.

Tendonitis usually occurs with overuse of the wrists. This can happen with repetitive wrist movements (like typing, writing, playing golf, or tennis) or as a result of injury.

The domiciliary care of tendonitis is similar to other conditions that cause wrist pain: rest, immobilization with a splint, icing, hand exercises, and taking NSAIDs. When these home treatments are not effective, a professional may advise you to get steroid injections directly into the wrist or, in rare cases, surgery.

 

7. Cubital tunnel syndrome

Just like carpal tunnel syndrome we ca have cubital tunnel syndrome or ulnar neuropathy. This condition occurs when the ulnar nerve, while passing from upper arm to forearm gets pinched at the bend right behind the elbow, behind the medial condyle of humerus. Sufferers describe the pain they experience when the ulnar nerve is compressed as “being hit in the funny bone,” but the pain may also extend downward and cause pain, numbness, and tingling in the wrist or even the ring and little fingers.

There are many causes of cubital tunnel syndrome. These include:

     ·        Arthritis of your elbow.
·        Bending elbow for a long time.
·        Bone spurs.
·        Cysts near elbow joint.
·        Past elbow dislocation.
·        Past elbow fracture

The treatment is mainly symptomatic: rest, immobilization with a splint, icing, hand exercises, and NSAIDs. Those suffering from cubital tunnel syndrome are advised against leaning on the affected elbow, as this may increase the pain. Padding the elbow with a soft cushion may also be helpful. Depending on the severity of the condition, symptoms may go away quickly. But in some cases, they never fully resolve on their own, and surgery is required.  

 

Then Prof. Kakkar added that there are several less common causes of wrist pain too. Here are just a few: 

1.      De Quervain’s tenosynovitis - a painful condition caused by inflammation in the tendons surrounding the thumb.

2.      Kienbock's disease - an illness that affects young adults and triggers the destruction of Lunate, a carpal bone. It loses its blood supply, leading to bone  death, pain, stiffness, and potential arthritis.

3.      Benign or cancerous tumors in the wrist. - Most tumors are benign. The most common tumor types are osteoid osteoma, osteoblastoma, and giant cell tumor. Metastatic carpal tumors are most commonly from lung carcinoma. Chondrosarcoma and hemangioendothelial sarcoma are the most common primary malignancies.

4.      Wrist bursitis - the inflammation of the liquid-filled sacs that protect the joints.

5.      Systemic lupus erythematosus - a systemic autoimmune disease that can affect the joints.

 

Such case discussions and bed-side and OPD teachings were hallmark of our Orthopaedic posting. Orthopaedics always attracted graduates very high merit for post-graduation and was essentially a male domain with only one female resident.

DO YOU LIKE AIRPLANE FOOD?

 

I you do, let me assure you, you are in a horrible minority. Yes, some airlines serve better food than others like Air France, and some used to serve good food in good old days like Air India in the Maharaja’s reign. But, by and large airplane food is certainly notorious, with the number of people boarding a flight and not complaining about the food by the end of it can be counted on finger tips. With that being said, we must admit that most of us still eat the food served because what other choice do we have? We are in the air, the flight lengthens, and the hunger and boredom begin to sink in until finally, the in-flight meal starts looking like an attractive option...

But if you are already eating airplane food and drinking the drinks served as well, you may very well want to be aware of what you should eat and what you should avoid. This is not my personal opinion, but the opinion of most seasoned travellers:

 

1. This is not home-cooked food, but purely industrial food

If you've ever entertained the illusion that airplane food was prepared in the airline's top kitchen, where the best chefs cook for you, then know that this is a pretense that has nothing to do with reality. Yes, Sahara Airlines used to serve Tunde’s world famous kebabs I their flights, but that was to promote their home city, Lucknow. The food in the aircraft is 100% industrial and prepared in huge kitchens adjacent to the airport which serve many airlines at the same time. In these kitchens, the largest of which are located in Switzerland, Germany and Dubai, hundreds of thousands of dishes are sold daily to dozens of airlines, with the value of this thriving industry touching 10 billion euros a year. The food for the flights is prepared and packed by the kitchens’ production workers and machinery, loaded on to every flight, and then reheated by flight attendants before serving you.

2. Do not trust the "fresh" label affixed to the box

The food on the plane is cooked long in advance Many dishes served in the air carry the label "fresh" but know that the truth is that most meals served on the plane are produced long before they are served to the passengers, often between 12 and 72 hours before the flight originated. The salads, desserts, pastries, plastic cutlery and the napkins that are served on the flight are packed after being prepared and placed inside the boxes intended for them until they are loaded onto the plane just before takeoff. The hot meals are prepared in large pots, then moved to plastic containers, covered with aluminum foil, and are shock frozen at 5 degrees Celsius for about an hour and a half, and then packed into large metal boxes until they are delivered to the plane before taking off.

 

3. Opt for meat cooked in sauce and avoid pasta and rice

If you are a vegetarian, and your flight going to or coming from India, you may have a problem with your choice of meals. There is no concept of vegitarian food in Chinese, Tiwanese and Japanese flights, and you will not get it if you have not pre booked. When the flight attendants reach your row and ask “chicken or fish?” there is only one way to ensure you get a meal that isn’t too dry or bland: find out which of the options contains more sauce. The explanation is simple: meat stews cooked in a sauce, as well as liquid dishes such as soup, are the best options when you are on the plane because they are filled with rich and spicy flavors that compensate for the meager taste of the other dishes served on the flight. Also, choose dishes that include tomatoes, mushrooms or Parmesan cheese, ingredients that’ll make your food more palatable, without the need to add too much salt. On the other hand, avoid noodles, pasta, rice or fried foods because they tend not to keep a uniform texture when reheated on the flight and become a big tasteless lump.

4. Don’t buy a first class ticket thinking you’ll get better food

First class passengers tend to think that, unlike Economy, they get their food fresh and cooked on the spot, because it is served in elaborate, fancy dishes with metal cutlery, sometimes accompanied by a rather persuasive plating ceremony by the polite hostesses. However, this is only an illusion because even the food served in first class is cooked and prepared on the ground, in the very same kitchens where economy class meals are cooked. Airline chefs take care to prepare a guide for the plane's crew, which teaches them how to serve the food in a more convincing and enjoyable manner that will make the passenger believe they are getting good quality food. In addition, there is also the issue of serving with metal cutlery, which has been shown to have a completely psychological effect on the taste of food. People who dine with metal cutlery rate the quality of the portions served as better than people who ate the same food with plastic cutlery. This is information the airlines have acquired from their feedback forms. Therefore, the illusion that first-class food is better is merely psychological and airlines know and take advantage of this fact.

 

5. Bring salt and pepper from home to spice up your meal

Bad taste is not necessarily due to the quality of the food served to us, but also because of the physical conditions we are in; At 30,000 feet above ground, air pressure is very low and humidity drops to less than 12 percent. These factors make our nose dry and our taste buds become numb, which makes assessing the true quality of our food a challenging task. Studies have shown that our ability to taste salt plummets by 30 percent, and the ability to taste sweetness is 20 percent lower than when we are on the ground. So, the next time you board a flight, bring a little salt and pepper in a bag and sprinkle some on your meal to add flavor and compensate for what was lost due to the difference in altitude.

 

6. Politely refuse the stewards' offer of coffee and tea

The sparse air pressure in the passenger cabin causes water to boil at a temperature of only 90 degrees, as opposed to the 100 degrees required for it to reach a boil on the ground, and as a result, the flavor of hot drinks served becomes somewhat tasteless. In addition, the water that is poured into the coffee or tea served to you is not always bottled mineral water, but rather comes from the planes water system, which isn’t necessarily cleaned thoroughly between flights, especially if layover times are short. Bacteria may not die if the boilig point of water comes below 100!

 

7. Bring wet wipes with you and wipe down the folding tray

It may be a bit startling and surprising to hear, but the folding tray, attached to the back of the chair in front of you, is considered the dirtiest surface on the plane, with more bacteria on it than on the toilet seat in the bathroom. Unfortunately, airlines do not take much care in cleaning it, so it is important that you bring a wad of wipes with you and thoroughly wipe it down before eating your meal on it. Also, don’t place your personal items on it, and certainly refrain from placing any food you are about to put in your mouth on it, whether served during or after the meal.

 

8. Drink alcoholic drink early in the flight and opt for something bubbly

If you drink alcoholic beverages on the plane - beers, wines, liqueurs or anything else offered by flight attendants, you do so early in the flight before your taste buds dry up due to the air pressure. If you are among the people who like to sip wine on the flight, know that wine that normally tastes good on the ground can lose its taste completely when in the air. Therefore, experts recommend, ordering high-quality wines, such as Argentinian wine, which is produced at 1,500 meters above sea level, where air pressure is similar to the pressure in the passenger compartment. Champagne and sparkling wines are an even better option for drinking on an airplane, because the flavor distribution mechanism is different from that of regular wines, and the bubbles that rise up the nose and mouth allow the body to taste and smell despite air pressure conditions. In any case, it is important to remember that low air pressure on the plane causes blood thinning in the body, which can lead to alcohol levels being higher in the air than on the ground, so it is strongly recommended to avoid overdoing it with the drinks when flying.

 

9. Avoid eating too much on the plane

Despite the gnawing hunger experienced when flying and the many temptations offered by flight attendants, the bottom line is that you should avoid eating too much in-flight. This is mainly because airplane meals are far from healthy, with every food item containing about 360-400 calories, adding up to an additional 1,500 calories to your body for the whole meal. In any case, due to sharp differences in air pressure, you will likely end your flight a little more swollen in the legs and bloated in the tummy, throw in these extra meals and you’ve got a recipe for a gassy disaster.

Airplane food tastes bad mostly because your body can’t taste it properly. Your ability to perceive salt and sugar drops by roughly 30% at cruising altitude, thanks to a combination of dry air, low cabin pressure, and engine noise that collectively dull your senses. The food itself isn’t always as terrible as you think. Your mouth and nose just aren’t working the way they do on the ground. But, that does not mean that the food is excellent, usually it is average.

KIDNEY DISEASE IN DIABETICS

 

I have been practicing Plastic & Reconstructive Surgery for 40 years now and over the years if ignorance has constantly plagued my patient population it is their understanding of Diabetes. I still see patients who are known diabetic for the last twenty years, walking in with two recent investigations, often totally unrelated to their disease. They know they are diabetic, but they have no idea how diabetes is harming them. They have no information about diabetic endarteritis, and how it affects their target organs – kidneys, heart, eyes and feet, and so naturally they are taking no notice of it. Their constant lament is that no doctor can control their blood sugar levels and the latter keeps on fluctuating constantly! I have in my previous blogs on Diabetes often mentioned about this problem. If you want to read them please click:

https://surajitbrainwaves.blogspot.com/2023/02/diabetes-myths-and-facts.html

https://surajitbrainwaves.blogspot.com/2025/05/are-you-diabetic-let-me-help.html

 

 

In this blog I would like to emphasize how kidneys are at risk in diabetics. For millions of people living with diabetes, the kidneys are quietly working overtime — and often, by the time something feels wrong, significant damage has already been done, because 75% of healthy kidney tissue is reserve, and not needed if the remaining 25% are fully functional. Diabetic nephropathy, or kidney disease caused by diabetes, is one of the most serious complications of diabetes. It can creep up on you almost silently and by the time the patient shows symptoms, the kidneys are significantly damaged.

 

What Is Diabetic Nephropathy?

When blood sugar levels stay high over time, they can gradually damage the tiny blood vessels inside our kidneys — the ones responsible for filtering waste from your blood. The result is diabetic nephropathy: a progressive form of kidney disease that affects a significant portion of people with both type 1 and type 2 diabetes. The condition is more common than many people realize. Roughly 1 in 3 adults with diabetes will develop some degree of kidney disease over the course of their lifetime. It's also one of the leading causes of kidney failure worldwide, making early awareness genuinely life-saving.

 

The condition unfolds in five stages, each measured by something called the Glomerular Filtration Rate (GFR) — essentially a score for how well our kidneys are doing their job.

• Stage 1: Mildly increased GFR, no clinical signs of disease.
• Stage 2: Elevated GFR, significant micro-albuminuria,  potential progression to end-stage renal disease. (Albumin in urine in microscopic amount)
• Stage 3: Overt diabetes, clinical albuminuria, and increasing proteinuria (Significant protein loss in urine)
• Stage 4: Severe loss of kidney function, GFR <15 mL/min/1.73m², requiring  renal replacement  therapy.
• Stage 5: End stage renal disease , GFR <10mL/min, requiring dialysis or kidney transplantation

 

In stage 1, the kidneys are damaged but still functioning well. By stage 5, the kidneys have failed entirely and dialysis or a transplant becomes necessary. What makes this progression so dangerous is that the kidneys are remarkably resilient organs — they can continue working even when significantly damaged, masking the problem until it becomes serious. This is why diabetic nephropathy is sometimes called a "silent disease."

 

The Earliest Warning Signs

Most people feel nothing in stage 1. It's only around stage 2 — when the GFR drops below 89 — that the first, often subtle, symptoms begin to surface. And subtle they are. Patients often dismiss them and attribute them to a bad week or a busy lifestyle. I usually try to look for:

·        Fatigue that doesn't match your activity level

·        Loss of appetite with no obvious reason

·        Persistent headaches

·        Dry or itchy skin unrelated to the weather

·        Nausea or vomiting with no clear cause

·        Mild swelling in the arms and legs

 

I always tell my patients that if any of these sound familiar — especially if they have diabetes they shouldn't brush them off. One particularly telling symptom worth mentioning is foamy or bubbly urine. This occurs when the kidneys begin leaking protein — something healthy kidneys are designed to retain. While it can be easy to overlook, it's one of the more distinctive early signals that something may be wrong.

 

Why should the patients visit their doctors?

A doctor – a physician, an endocrinologist, can detect diabetic nephropathy even before patients feel a thing. Routine blood and urine tests can reveal early red flags, including:

·        Elevated creatinine levels — creatinine is a waste product that healthy kidneys filter out efficiently. When it builds up in the blood, it suggests the kidneys are struggling.

·        Protein in the urine (proteinuria) — specifically a protein called albumin. Its presence in urine is one of the earliest and most reliable indicators of kidney damage.

·        Low albumin levels in the blood — as the kidneys leak protein, blood albumin levels drop, which can eventually affect everything from immune function to fluid balance in the body.

 

In some patients, a doctor may also order a renal biopsy — a minor procedure where a tiny sample of kidney tissue is examined under a microscope to assess the extent of damage. This is typically reserved for more complex or uncertain cases.

 

This is exactly why regular check-ups are so important for anyone living with diabetes. Current medical guidelines recommend that people with type 2 diabetes get screened for kidney disease annually from the time of diagnosis, and those with type 1 diabetes from around five years after diagnosis. My follow up schedule of investigations for my diabetic patients is:

1.      Physician’s consultation (MD Medicine / DM Endocrinology)          – monthly

2.      Blood Urea and Serum Creatnine                                                        - 2 monthly

3.      Blood Sugar – Fasting & PP                                                                - monthly

4.      HbA1C                                                                                                - 6 monthly

5.      Ultrasound of Kidneys, Ureters and Bladder                                       - 2 yearly

6.      Serum Lipid profile                                                                              - 6 monthly

7.      E.C.G                                                                                                  -6 monthly

8.      Fundus examination by Ophthalmologist                                            - 6 monthly

9.      X.Ray Chest                                                                                        - 2 yearly

 

Why is prompt diagnosis and treatment of Nephropathy important?

 If diabetic nephropathy is left undetected or untreated, the symptoms become harder to ignore. These include:

·        Constant fatigue

·        A persistent sense of feeling unwell

·        Shortness of breath

·        Difficulty concentrating

·        Foamy urine

·        Swelling in the hands, feet, and around the eyes

·        Blood pressure tends to climb and this accelerates the damage.

 

 In later stages other kidney functions too get affected:

1.      They struggle to regulate important minerals like potassium and phosphorus. This can lead to muscle cramps, bone weakening, and dangerous changes in heart rhythm.

2.       Anemia — a shortage of red blood cells — is also common, as the kidneys produce a hormone called erythropoietin that signals the body to make red blood cells. When kidney function declines, so does this signal, resulting in anaemia. This leaves many patients feeling persistently exhausted regardless of how much they rest.

 

Who is Most at Risk?

Beyond having diabetes itself, certain factors raise the odds of developing diabetic nephropathy:

·        A family history of kidney disease

·        High blood pressure

·        Obesity

·        Smoking

·        Type 1 diabetes diagnosed before age 20

·        Indians as a race are prone to diabetic nephropathy more than Caucacians

·        Existing eye or nerve damage from diabetes

 

A Vicious Cycle

High blood pressure and diabetic nephropathy form a particularly vicious cycle — kidney damage raises blood pressure, and high blood pressure in turn accelerates kidney damage. So, the real challenge is to break this cycle early, often with medication. This is one of the most important steps in managing the condition.

 

Prevention

While we can't undo damage that's already been done, there's a great deal we can do to slow it down — or prevent it from starting in the first place.

1.      Keep blood sugar in check. This is the single most important thing a diabetic patient can do for their kidneys. Consistently high glucose levels are the root cause of the damage, and studies show that tight blood sugar control can significantly reduce the risk of developing nephropathy.

2.      Manage your blood pressure. Target blood pressure for people with diabetes and kidney disease is generally below 130/80 mmHg. Medications called ACE inhibitors or ARBs are often prescribed specifically because they protect the kidneys beyond their blood pressure-lowering effects.

3.      Watch what you eat. A kidney-friendly diet typically means reducing sodium, limiting protein intake (which reduces the workload on the kidneys), and cutting back on potassium and phosphorus in later stages. Working with a dietitian can make this much more manageable.

4.      Quit smoking. Smoking narrows blood vessels and reduces blood flow to the kidneys, directly worsening their function. It also raises blood pressure and interferes with diabetes medications.

5.      Stay active. Regular moderate exercise helps control blood sugar, lower blood pressure, and maintain a healthy weight — all of which take pressure off the kidneys. A daily walk 4 Km in 40 minutes is ideal.

6.       Avoid NSAIDs. Common over-the-counter pain relievers like ibuprofen and Brufen can be hard on the kidneys. They are called nephro-toxic drugs. People with diabetic nephropathy are generally advised to use alternatives under medical guidance.

 

Kidney damage from diabetes cannot be reversed — but it absolutely can be slowed down, especially when caught early. Treatment options range from diabetes medications and dietary changes to dialysis and kidney transplants in advanced cases. Newer classes of diabetes medications, including SGLT2 inhibitors, have also shown promising results in protecting kidney function and are increasingly being prescribed for this purpose specifically. The most powerful thing you can do? Don't wait for symptoms. If you have diabetes, make kidney health part of your regular medical conversations. A simple blood or urine test and the habit of visiting the doctor every month, even when seemingly in good health could make all the difference — and in this case, catching something early isn't just good news, it's a genuine lifeline.