Renovascular hypertension is a form of secondary high blood pressure caused by the narrowing (stenosis) or blockage of one or both renal arteries, the blood vessels that supply the kidneys. This condition results in reducing the blood flow to the kidneys, prompting them to release hormones such as renin, which leads to increased blood pressure throughout the body. 

The most common underlying causes are atherosclerosis (plaque buildup in the arteries) and fibromuscular dysplasia (abnormal cell growth in the artery walls). Left untreated, renovascular hypertension can lead to chronic kidney disease and other serious cardiovascular complications.

Key Indicators of Renovascular Hypertension

• Sudden onset of high blood pressure before age 30 or after age 55
• Severe or resistant hypertension that doesn't respond to standard treatment
• High blood pressure with no family history
• Worsening kidney function after starting blood pressure medications
• Unexplained kidney shrinkage (one kidney smaller than the other)
• Flash pulmonary edema (sudden fluid buildup in the lungs)
• Abdominal bruit (whooshing sound heard over the kidneys)
• Episodes of vision problems or headaches
• Elevated blood urea nitrogen (BUN) and creatinine levels

Primary Triggers Behind Renovascular Hypertension

• Atherosclerosis (constricting of the renal arteries due to plaque buildup)
• Fibromuscular dysplasia (abnormal growth of cells in the artery walls)
• Renal artery aneurysm
• Renal artery embolism or thrombosis
• Vasculitis affecting renal arteries
• External compression of the renal artery (e.g., tumor or fibrotic tissue)
• Post-transplant renal artery stenosis
• Congenital defects in renal artery structure

Diagnostic Measures for Renovascular Hypertension

• Blood Pressure Monitoring: Persistent or severe hypertension despite standard treatment prompts further investigation.
• Serum Creatinine and BUN Tests: Elevated levels may indicate impaired kidney function linked to reduced blood flow.
• Renin and Aldosterone Levels: A high plasma renin activity level, especially when paired with elevated aldosterone, supports suspicion of renovascular origin.
• Urinalysis: May show signs of kidney stress or damage, though it is often nonspecific in this condition.
• Renal Duplex Ultrasound: Non-invasive imaging to assess blood flow and detect narrowing in the renal arteries.
• CT Angiography (CTA): High-resolution imaging of renal vessels using contrast dye to identify stenosis or blockages.
• Magnetic Resonance Angiography (MRA): Uses magnetic fields and contrast to visualize blood flow in the renal arteries, beneficial for patients who can't tolerate iodine-based contrast.
• Captopril Renography: Nuclear scan that evaluates kidney function before and after administration of captopril to detect functional differences due to narrowed arteries.
• Digital Subtraction Angiography (DSA): Considered the gold standard for diagnosing renal artery stenosis; provides detailed images and allows for possible simultaneous intervention.

Treatment Options for Renovascular Hypertension

• Angioplasty: A catheter-based procedure where a balloon is inflated at the site of arterial narrowing to restore blood flow to the kidney.
• Stent Placement: Often performed along with angioplasty, a stent (a small tube) is inserted to keep the artery open and prevent re-narrowing.
• Surgical Revascularization: Involves bypassing the blocked section of the renal artery or reconstructing the artery to restore normal blood flow. Typically considered when less invasive procedures fail or are not suitable.
• Nephrectomy (in select cases): Surgical removal of the affected kidney may be necessary if it’s non-functional and contributing to uncontrolled hypertension.
• Endarterectomy: Surgically getting rid of the inner lining of the artery if plaque buildup is extensive, usually performed in large or complex lesions.

Approaches to Managing Renovascular Hypertension

• Blood Pressure Control: Initial treatment focuses on controlling blood pressure to reduce cardiovascular and renal risks, using tailored combinations based on kidney function.
• Lifestyle Modifications: Includes dietary changes (low sodium, balanced nutrition), regular physical activity, smoking cessation, and weight management to support blood pressure control.
• Monitoring Kidney Function: Regular assessment of kidney performance to detect deterioration early and adjust management accordingly.
• Percutaneous Transluminal Renal Angioplasty (PTRA): A procedure where a balloon is used to open narrowed renal arteries, often followed by stent placement if needed.
• Surgical Revascularization: Reserved for cases where angioplasty is unsuccessful or not feasible; involves bypassing or repairing the narrowed segment of the artery.
• Dialysis (if required): Initiated in cases of advanced kidney failure unresponsive to revascularization or medical management.

Long-Term Outlook for Renovascular Hypertension

The outcome depends on the cause, severity of arterial narrowing, and how early the condition is diagnosed. If identified and treated early, especially in cases of fibromuscular dysplasia, blood pressure may return to normal or become easier to control. 

Atherosclerotic cases often require long-term monitoring, and full normalization of blood pressure may not always be achievable. Delayed treatment increases the risk of chronic kidney disease and cardiovascular complications. Regular follow-ups, adequate blood pressure control, and kidney function monitoring are essential to prevent long-term damage.

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At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to healthy kidneys. If you are looking for the best kidney specialist in Ahmedabad and Vadodara Race Course Road, Vadodara Bhayli, we've got you. 

With considerable years of experience, we have built a team of the best nephrologists in these regions to provide you with premium treatment and the best results. Safeguard your kidney health and contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier life.

Glomerular diseases are disorders that affect the glomeruli (microscopic filtering units within the kidneys). Each kidney contains around one million glomeruli, which are clusters of tiny blood vessels responsible for filtering waste, excess fluids, & electrolytes from the blood to form urine.

The glomeruli are part of the nephron, the functional unit of the kidney, and are lined with a specialized basement membrane, endothelial cells, and podocytes that together maintain filtration selectivity. When this structure is damaged, protein and blood can leak into the urine, and the kidneys' ability to filter waste is compromised.

Glomerular disease is not one condition but a group of disorders that can be caused by infections, autoimmune responses, genetic mutations, or systemic diseases such as diabetes or lupus. These conditions may occur suddenly (acute) or progress slowly over time (chronic), often leading to impaired kidney function or kidney failure if left untreated.

Function of Glomeruli 

A glomerulus is a compact tangle of capillaries housed within a structure called Bowman’s capsule. As blood flows into these capillaries, it is filtered through a three-layer barrier: the inner lining of endothelial cells (which contain pores), a shared glomerular basement membrane (which acts as a size and charge filter), and a final layer of podocytes (specialized epithelial cells with foot-like projections that further restrict passage). This barrier is designed to let water and small molecules pass through while retaining larger proteins and blood cells in the bloodstream.

Filtration is driven by pressure. Specifically, hydrostatic pressure from incoming arterial blood pushes plasma through the filtration barrier. The filtered fluid, called filtrate, then enters the tubules of the nephron, where electrolytes and other substances are adjusted before forming urine.

When glomerular disease sets in, one or more components of this filtration system break down. Damage to the basement membrane or loss of podocyte integrity can make the barrier too “leaky,” allowing proteins (proteinuria) or red blood cells (hematuria) to pass into the urine. 

In inflammatory conditions, white blood cells may infiltrate and disrupt the glomerular structure. Over time, persistent injury can lead to scarring (glomerulosclerosis), thickening of the basement membrane, or collapse of capillary loops, all of which reduce filtration surface area and lower the glomerular filtration rate (GFR).

The net result: the kidney becomes less efficient at clearing waste and maintaining fluid, electrolyte, and acid-base balance. Left unchecked, this dysfunction can progress to chronic kidney disease and ultimately kidney failure.

Symptoms of Glomerular Disease

• Swelling in the face, hands, feet, or abdomen (edema)
• Foamy urine (due to proteinuria)
• Blood in the urine (hematuria)
• High blood pressure (hypertension)
• Decreased urine output
• Fatigue
• Nausea or loss of appetite
• Weight gain (from fluid retention)
• Shortness of breath (from fluid overload)
• Muscle cramps or weakness (in advanced stages)

Causes of Glomerular Disease

• Vasculitis—blood-vessel inflammation
• Polyarteritis affecting small/medium vessels in kidneys and organs
• Granulomatosis with polyangiitis (formerly Wegener’s)
• Scarring conditions (glomerulosclerosis)
• Long-standing, uncontrolled high blood pressure
• Diabetes-induced nephropathy
• Focal segmental glomerulosclerosis (FSGS): patchy scarring, idiopathic or secondary to other conditions
• Infections and immune reactions
• Post-streptococcal infections
• Chronic viral infections (e.g., HIV, hepatitis B/C)
• Autoimmune triggers (e.g., systemic lupus)
• Genetic and familial forms
• Alport syndrome (inherited, often with hearing or vision issues)
• Familial glomerulonephritis variants of unknown etiology
• Cancer-related associations
• Gastric cancer
• Lung cancer
• Chronic lymphocytic leukemia

Tests and Diagnostic Procedures 

• Urinalysis: Detects proteinuria, hematuria, and presence of cellular casts. A basic but essential indicator of glomerular damage.
• Urine Protein-to-Creatinine Ratio (UPCR) or 24-Hour Urine Collection: Quantifies the amount of protein being lost in urine. Helps assess severity and monitor progression.
• Blood Tests: Measures levels of creatinine & blood urea nitrogen (BUN) to estimate kidney function. A low estimated glomerular filtration rate (eGFR) indicates impaired filtration.
• Serologic Tests: Screens for underlying autoimmune or infectious causes (e.g., ANA for lupus, anti-GBM antibodies, ANCA, hepatitis B/C markers, HIV, streptococcal antibodies).
• Complement Levels (C3, C4): Reduced complement levels can suggest certain immune-mediated glomerular diseases, like lupus nephritis or post-infectious glomerulonephritis.
• Imaging: Renal Ultrasound: Assesses kidney size, structure, and rules out obstruction or cystic disease. Also helps identify chronic scarring.
• Kidney Biopsy: The definitive diagnostic tool. Involves extracting a tiny tissue sample for microscopic examination. Identifies specific patterns of injury (e.g., focal segmental glomerulosclerosis, membranous nephropathy) and guides targeted treatment.

Treatment Options for Glomerular Disease

• Immunosuppressive Therapy: Corticosteroids and other agents such as cyclophosphamide, mycophenolate mofetil, or calcineurin inhibitors are used to suppress immune activity in cases with autoimmune or inflammatory origin.
• Plasma Exchange (Plasmapheresis): In certain aggressive forms (e.g., anti-GBM disease, ANCA-associated vasculitis), plasma exchange is used to remove harmful antibodies from the bloodstream.
• Antibiotic or Antiviral Therapy: When glomerular disease is triggered by infections (e.g., post-streptococcal, hepatitis B or C), targeted antimicrobial treatment is essential to eliminate the underlying cause.
• Biologic Agents: In selected cases, biologics such as rituximab may be used, particularly for diseases like membranous nephropathy or lupus nephritis, where B-cell suppression is indicated.
• Kidney Transplantation: In end-stage cases where kidney function is irreversibly lost, transplantation becomes the definitive treatment option. May be considered after disease control or remission, depending on recurrence risk.

Management of Glomerular Disease

• Blood Pressure Control: Use of ACE inhibitors or ARBs to maintain target blood pressure and reduce proteinuria. Tight control slows the progression of kidney damage.
• Dietary Modifications: Restriction of sodium, protein, and fluid intake to manage edema and reduce kidney workload. Tailored by disease severity and lab values.
• Blood Sugar Control (for diabetic patients): Intensive glycemic control helps prevent worsening of glomerular injury in diabetic nephropathy.
• Cholesterol Management: Statins may be prescribed to manage dyslipidemia, which is common in nephrotic syndrome and increases cardiovascular risk.
• Monitoring Kidney Function: Regular testing of creatinine, eGFR, and protein levels in urine to assess response to treatment and disease progression.
• Managing Anemia and Bone-Mineral Disorders: Use of erythropoiesis-stimulating agents and phosphate binders as needed in chronic kidney disease stages.
• Vaccinations: Recommended immunizations (e.g., pneumococcal, influenza, hepatitis B) to reduce infection risk, especially in immunosuppressed patients.

Outlook and Prognosis for Glomerular Disease

The long-term outcome depends on various factors like underlying cause, speed of diagnosis, and response to treatment. Some forms, exceptionally mild post-infectious types, may resolve completely with supportive care. Others, particularly autoimmune or progressive scarring diseases like focal segmental glomerulosclerosis, often lead to chronic kidney damage.

When diagnosed early and managed aggressively, many patients can stabilize kidney function and avoid dialysis. However, delayed or inadequate treatment increases the risk of irreversible damage, reduced glomerular filtration rate (GFR), and eventual kidney failure.

Patients with chronic or relapsing forms require lifelong monitoring and may progress to end-stage kidney disease requiring dialysis or transplantation. Regular follow-up & adherence to treatment are critical for preserving function and extending survival.

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to healthy kidneys. If you are looking for the best kidney specialist in Ahmedabad - Gurukul, Vadodara - Race Course Road, Vadodara - Bhayli, and Gandhidham we've got you. 

With considerable years of experience, we have built a team of the best nephrologists in these regions to provide you with premium treatment and the best results. Safeguard your kidney health and contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier life.

Floor of the mouth cancer is a form of oral cancer that can grow in the tissues located beneath the tongue. This disease originates from the uncontrolled growth of abnormal cells in this specific area of the mouth. 

The majority of these cancers arise from the thin, flat cells called squamous, which line the interior of the mouth. When cancer develops in these cells, it is referred to as squamous cell carcinoma. 

The development of this cancer can lead to noticeable changes in the tissue under the tongue, such as the formation of a lump or a sore that fails to heal.

Recognizing the Symptoms

• A persistent sore, lump, or thickened area on the floor of your mouth
• White or red patches appearing on the tissue under the tongue
• Difficulty or pain when moving the tongue or swallowing
• Persistent mouth, jaw, or ear pain
• Numbness in the tongue or another area of the mouth
• Teeth are becoming loose for no specific reason.
• A noticeable lump in the neck
• Changes in your voice
• Unexplained weight loss

Understanding Cancer's Progression

Once the cancer in the floor of the mouth is diagnosed, doctors determine its stage to understand the extent of the disease and formulate the most effective treatment plan. The process generally uses the TNM system and is classified into four main stages:

• T (Tumor): This letter indicates the size of the primary tumor. A smaller number corresponds to a smaller tumor.
• N (Node): This refers to whether the cancer cells have spread to the regional or nearby lymph nodes in the neck.
• M (Metastasis): This tells us if the cancer has spread (metastasized) to other nearby organs, such as the lungs or bones.

Stages

• Stage 1: In this early stage, the tumor is considered localized. It measures 2 centimeters or smaller and has not yet spread to the lymph nodes or any other part of the body. The cancer is confined entirely to the floor of the mouth.
• Stage 2: At this stage, the tumor is bigger than 2 cm but not more than 4 cm. Similar to Stage 1, the cancer has not spread to the lymph nodes or any distant sites. It remains localized to its original area.
• Stage 3: This stage indicates a more advanced cancer. It can mean one of two things: either the tumor is larger than 4 centimeters but has not spread to lymph nodes in the neck, OR the cancer is of any size and has spread to a single lymph node on the same side of the neck as the tumor. The affected lymph node is no larger than 3 centimeters, and the cancer has not spread to distant parts of the body.
• Stage 4: This is the most advanced stage and signifies that the cancer is widespread. It is often divided into sub-stages, but generally, it means the tumor has grown into nearby tissues and structures, such as the jawbone, skin of the face, or deep muscles of the tongue. It may have spread to multiple lymph nodes, a large lymph node, or lymph nodes on both sides of the neck. In its most advanced state (metastatic cancer), it has spread to closer organs like the lungs or bones.

Factors Contributing to Cancer Development

• Tobacco Consumption: Using tobacco in any form—including cigarettes, cigars, pipes, and smokeless or chewing tobacco—is a primary risk factor.
• Heavy Alcohol Use: Frequent and heavy consumption of alcohol significantly elevates the risk. The risk is higher for individuals who both use tobacco and drink heavily.
• Human Papillomavirus (HPV): Infection with strains of this common virus is a known risk factor for developing oral cancers.
• Weakened Immune System: Individuals with a weak or compromised immune system, whether due to medical conditions or immunosuppressive drugs, are more susceptible.
• Age and Gender: The risk of oral cancers increases with age, with most cases being diagnosed in individuals over the age of 55. Statistically, men are more than twice as likely as women to develop these cancers.
• Nutritional Deficiencies: A diet that is low in fruits & vegetables has been linked to an elevated risk for developing oral cancers.
• Genetic Predisposition: Certain inherited genetic syndromes, though rare, can significantly increase the risk. These include conditions like Fanconi anemia and Dyskeratosis congenita, which can lead to a much higher-than-average risk of oral cancer at an early age.
• Precancerous Lesions: The presence of specific types of sores, known as lesions, in the mouth can be precursors to cancer. One such condition is leukoplakia, which appears as persistent white patches. While not always cancerous, these lesions can transform into cancer over time.

The Diagnostic Process

• Physical and Visual Examination: The process begins with a thorough examination of your mouth & neck. A doctor or dentist will look for any abnormal areas, such as sores or white patches (leukoplakia), and feel the floor of the mouth, tongue, and neck for any lumps or swollen lymph nodes, as this is often the first place the cancer spreads.
• Tissue Biopsy: This is the definitive way to diagnose cancer. A small sample of the abnormal or suspicious tissue is removed & sent to the lab for analysis. This procedure, known as a biopsy, can be done by cutting away a piece of the tissue or by using a thin needle to draw out cells (fine-needle aspiration), which is common for lumps in the neck. The lab tests will confirm if cancer cells are present.
• Using a Scope to See the Throat (Endoscopy): To check if the cancer has spread to deeper parts of the throat, a specialist may perform an endoscopy. This procedure involves inserting a flexible, thin tube with a camera on the end through the mouth to get a clear view of the throat and larynx (voice box).
• Imaging Tests: Once a cancer diagnosis is confirmed, various imaging tests are used to understand the tumor's size, location, & whether it has spread to the jawbone, lymph nodes, or distant organs. These tests are crucial for staging the cancer & may include:
• CT (Computed Tomography) Scan: Provides detailed cross-sectional images of the head and neck to assess the tumor and check for spread to bone and lymph nodes.
• MRI (Magnetic Resonance Imaging): MRI uses magnetic fields to create detailed images, offering a superior view of soft tissues like the tongue & muscles.
• PET (Positron Emission Tomography) Scan: Can detect cancer cells in all parts of the body by using a radioactive sugar that cancer cells absorb more actively than normal cells. It is often combined with a CT scan (PET-CT).
• X-rays: A panoramic X-ray of the jaw can help determine if the tumor has grown into the jawbone.

Treatment Approach

Surgery 

Surgery is often the first treatment, especially for early-stage cancers. The goal is to remove the tumor along with a lining of surrounding healthy tissue to ensure all cancerous cells are eliminated. 

Depending on the cancer's size and how far it has grown, the procedure may involve removing a portion of the tongue or the jawbone (mandibulectomy). If there is evidence or a high risk of the cancer spreading to the lymph nodes, a surgeon will remove them from the neck in a procedure called a neck dissection.

Reconstructive Surgery 

Following extensive surgery to remove the cancer, reconstructive surgery is often necessary. Surgeons can rebuild parts of the jaw, tongue, or other structures using bone, muscle, or skin taken from another part of the body.

This step is crucial for restoring the ability to speak and swallow, as well as for maintaining facial appearance.

Radiation Therapy 

Radiation therapy is a treatment that utilizes powerful, high-energy beams, such as X-rays or protons, for the purpose of destroying cancer cells. It can be used in several ways: as the sole treatment for tiny cancers, after surgery to remove any remaining cancer cells, or in combination with chemotherapy to enhance its effectiveness. For advanced cancers, radiation may also be used to relieve symptoms like pain.

Chemotherapy 

Chemotherapy involves the use of strong drugs to destroy cancer cells throughout the body. For floor of the mouth cancer, it is typically administered in combination with radiation therapy (a treatment known as chemoradiation) to make the cancer cells more vulnerable to radiation. It may also be used to treat cancer that has either returned or spread to other parts of the body.

Targeted Therapy 

This newer class of treatment uses drugs designed to attack specific vulnerabilities in cancer cells. For instance, some drugs block proteins like the epidermal growth factor receptor (EGFR), which many oral cancer cells need to grow. Targeted therapy can be given alone or combined with chemotherapy for advanced cancers, often with fewer side effects than traditional chemotherapy.

Immunotherapy 

Immunotherapy works by activating the body's own immune system to recognize and fight cancer cells. Cancer cells can often produce proteins that allow them to hide from the immune system. Immunotherapy drugs, known as checkpoint inhibitors, block these proteins, effectively "unmasking" the cancer cells so the immune system can attack and destroy them. This treatment is generally reserved for advanced cancers that have spread or have not responded to other therapies.

Management and Recovery

Rehabilitation and Functional Recovery 

Treatment for floor of the mouth cancer can significantly impact essential functions like speaking and swallowing. A dedicated rehabilitation team is vital to help manage these challenges.

• Speech and Swallowing Therapy: A speech-language pathologist is a key member of the recovery team. They design exercises to strengthen the muscles of the mouth and throat, helping to improve swallowing (dysphagia) and the clarity of speech. They can teach new techniques for eating safely and communicating effectively. For some, this therapy may begin even before treatment to prepare the muscles and may continue for a long time afterward.
• Nutritional Support: A dietitian helps manage eating difficulties and prevent weight loss. They can recommend soft foods, high-calorie supplements, or, if necessary, coordinate the use of a feeding tube to ensure proper nutrition while you heal. They also provide guidance for managing long-term side effects like dry mouth or changes in taste.
• Managing Jaw Stiffness (Trismus): Radiation or surgery can cause the jaw to become stiff, making it difficult to open your mouth. A physical therapist can recommend specific, gentle exercises to maintain and improve your jaw's range of motion.

Follow-up Care and Monitoring 

Long-term monitoring is essential to watch for any signs of cancer returning (recurrence).

• Regular Check-ups: Follow-up appointments are most frequent in the first two years after treatment—often every few months. The frequency will decrease over time, but you will likely have annual check-ups for many years.
• Examinations and Tests: During these visits, your doctor will perform a thorough physical exam of your mouth and neck. Depending on your situation, you may also undergo periodic imaging tests like CT or PET scans, blood tests to check thyroid function (if you had neck radiation), and endoscopic exams to look inside your throat.

Lifestyle and Emotional Well-being 

Adjusting to life after cancer involves both physical and emotional changes.

• Quitting Tobacco and Alcohol: If you use tobacco or drink alcohol, stopping is the most critical step you can take. Continuing to use these substances makes treatment less effective, slows healing, and dramatically increases the risk of the cancer coming back or a new cancer forming.
• Emotional Support: A cancer diagnosis can bring feelings of anxiety, depression, and stress. It is integral to address your mental health. Talking with family, friends, a counselor, or joining a support group for cancer survivors can provide an important outlet and help you cope with the emotional challenges of recovery. Don't hesitate to ask your medical team for a referral to a mental health professional.

Prognosis and Long-Term Outlook

The long-term outlook for an individual with floor of the mouth cancer is most significantly influenced by the stage of the cancer at the time of diagnosis. As with most cancers, early detection is the most critical factor for a favorable outcome. When the cancer is found and treated before it has had a chance to spread, the prognosis is considerably better.

The 5-year relative survival rate provides a statistical estimate of what percentage of people with the same type and stage of cancer are alive five years after their diagnosis. For localized floor of the mouth cancer (cancer that has not spread beyond its original site), the survival rate is approximately 75%. 

However, if the cancer has spread to nearby regional lymph nodes, that rate drops to about 39%. For distant cancer that has metastasized to other parts of the body, the 5-year survival rate is approximately 25%. It's also important to note that a patient's overall health and commitment to lifestyle changes, such as quitting tobacco and alcohol, play a crucial role in improving their long-term prognosis and reducing the risk of recurrence.

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Fibromuscular Dysplasia is a condition characterized by abnormal cell growth in the walls of the body's medium-sized arteries. This is a non-atherosclerotic and non-inflammatory disease, meaning it is not caused by plaque buildup or inflammation. 

The abnormal development, known as fibroplasia, can cause the arteries to narrow (stenosis), bulge (aneurysm), or tear (dissection). FMD can affect any artery, but is most commonly found in the renal arteries, which supply blood to the kidneys, and the carotid and vertebral arteries

(supply blood to the brain). In many cases, more than one artery is affected.

Who's at risk?

• Gender: Women have a much higher risk of developing FMD
• Age: The condition is most frequently diagnosed in people between the ages of 25 & 50
• Smoking: Current or even former smokers are at a greater risk
• Genetics: A family history of FMD or other arterial diseases may increase susceptibility

Recognizing the Symptoms

General and Head/Neck-Related Symptoms

• High blood pressure (hypertension), which may be difficult to control
• Headaches or migraines
• A pulsing or whooshing sound in the ears (pulsatile tinnitus)
• Dizziness or a spinning sensation (vertigo)
• Neck pain
• A "whooshing" sound in the neck (bruit) that a doctor can hear with a stethoscope
• Chronic fatigue

Neurological Symptoms

• Symptoms related to transient ischemic attack or a stroke
• Unexplained numbness in the face, arm, or leg, often on one side
• Speech and comprehension difficulties
• Sudden vision changes in one or both eyes
• Drooping eyelid and a smaller pupil in one eye (Horner's syndrome)

Body-Related Symptoms

• Discomfort or pain in the chest
• Abdominal pain, especially after eating
• Unexplained weight loss
• Pain in the legs or arms when walking or being active (claudication)
• Impaired kidney function or kidney failure
• Cold limbs
• Unequal blood pressure in the arms

Diagnosing Fibromuscular Dysplasia

• Physical Examination and History: A physician will start by discussing your personal and family medical history and asking about any symptoms. During the physical exam, the doctor may use a stethoscope to listen for a characteristic "whooshing" sound, known as a bruit, over the arteries in your neck or abdomen. The presence of a bruit suggests turbulent blood flow, which may be caused by a narrowed artery.
• Duplex Ultrasound: This non-invasive test is often one of the first imaging studies performed to produce images of your blood vessels and measure the speed of blood flow. It is a valuable screening tool for examining the carotid arteries in the neck and the renal arteries.
• CT Angiography (CTA): This is a highly effective imaging test for identifying FMD. During a CTA scan, a special contrast dye is injected into a vein, and a powerful X-ray machine creates detailed, cross-sectional images of your arteries. This allows doctors to clearly see the distinctive "string of beads" pattern characteristic of FMD, as well as any aneurysms or dissections.
• Magnetic Resonance Angiography (MRA): Similar to a CTA, an MRA provides images of blood vessels but uses a strong magnetic field & radio waves instead of X-rays. A contrast agent is also typically used to enhance the visibility of the arteries.
• Catheter-Based Angiography: This invasive procedure is considered the gold standard for diagnosing FMD. It provides the most detailed images of the arteries. In this test, a thin, flexible tube (catheter) is inserted into an artery, usually in the groin, & guided to the area being examined. A contrast dye is then injected directly into the artery, and a series of X-rays is taken. This method can detect even subtle signs of FMD and offers the unique advantage of allowing for immediate treatment, such as angioplasty, during the same procedure.

Treatment Approach

Fibromuscular Dysplasia is not a curable condition, but available treatments are successful at managing its symptoms and minimizing the risk of significant health problems.

The primary goals of treatment are to control high blood pressure and prevent events like strokes, artery dissections, or aneurysm ruptures. The specific treatment plan is tailored to the individual, depending on the arteries affected and the severity of the condition.

Medical and Lifestyle Management

For many individuals, especially those with mild symptoms or no symptoms, managing the condition with medication and healthy habits is the first line of defense.

• Blood Pressure Medications: Controlling hypertension is crucial. Several types of drugs are effective, including Angiotensin-Converting Enzyme inhibitors, Angiotensin II Receptor Blockers (ARBs), beta-blockers, and calcium channel blockers. Often, more than one medication may be needed to achieve the target blood pressure.
• Antiplatelet Therapy: To prevent blood clots from forming in the narrowed arteries, a daily low-dose aspirin is commonly recommended for most patients with FMD.
• Smoking Cessation: Quitting smoking is the best step you can take. Smoking damages blood vessels and can worsen the effects of FMD.

Procedures and Surgical Options

When medication is not enough to control blood pressure, or if there is a significant reduction in blood flow causing symptoms, a procedure to open the artery may be necessary.

• Percutaneous Transluminal Angioplasty (PTA): This is the most common and preferred procedure for treating a narrowed artery caused by FMD. It is a minimally invasive technique where a specialist guides a catheter with a small balloon at its tip to the affected artery. The balloon is then inflated, gently stretching the artery wall open to restore normal blood flow. Unlike in procedures for plaque buildup (atherosclerosis), the placement of a stent is rarely necessary in FMD angioplasty.
• Surgical Revascularization: In rare and complex cases where angioplasty is not technically possible or has been unsuccessful, open surgery may be an option. This could involve bypass surgery, where a graft is used to create a new path for blood to flow around the blocked artery.
• Aneurysm Repair: If an aneurysm is present, treatment depends on its size, location, and whether it is causing symptoms. Small, stable aneurysms may simply be monitored with regular imaging tests. Larger or growing aneurysms may need to be repaired through procedures like endovascular coiling or surgical clipping to prevent them from rupturing.

The Long-Term Outlook

For the majority of individuals, the long-term outlook with Fibromuscular Dysplasia is positive. While FMD is a lifelong condition for which there is no cure, it is highly manageable, and most people can lead an everyday, active life.

FMD is not considered a universally progressive disease, meaning that for many patients, the condition does not inherently worsen over time. However, new areas of FMD can develop in different arteries, or complications can arise, which is why consistent, long-term medical follow-up is essential. The primary risks associated with FMD are the development of aneurysms or the occurrence of an arterial tear (dissection), which can lead to serious events like a stroke.

The key to a positive long-term outcome is diligent management. This includes strictly controlling blood pressure with medication, taking antiplatelet therapy such as aspirin if recommended, and adopting a healthy lifestyle, particularly by not smoking. 

Regular surveillance with imaging tests allows your medical team to monitor the affected arteries and proactively address any changes or potential complications, ensuring that FMD has a minimal impact on your overall life expectancy and quality of life.

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With considerable years of experience, we have built a team of the best cardiologists in these regions to provide you with premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier heart.

Spontaneous coronary artery dissection, although rare, is a serious condition that occurs when there is a tear in the inner wall of a coronary artery (supplies applied oxygen-rich blood to the heart). 

This tear creates a false lumen, an abnormal channel within the arterial wall, causing blood to flow inside the layers of the artery wall. This leads to compression of the true lumen (the normal channel), restricting blood flow to the heart muscle.

It typically affects otherwise healthy individuals with no history of heart problems and can result in acute coronary syndrome, heart attack, arrhythmias, or sudden cardiac death. SCAD is most commonly observed in women, particularly those between the ages of 30 and 60, and it can occur during or shortly after pregnancy. 

It has also been linked to fibromuscular dysplasia (FMD), connective tissue disorders, extreme physical stress, and emotional stress.

Common Signs That Indicate SCAD

• Chest pain or discomfort
• Pain in the arm, neck, back, or jaw
• Shortness of breath
• Nausea
• Sweating
• Dizziness or lightheadedness
• Rapid heartbeat (palpitations)
• Fatigue
• Loss of consciousness (in severe cases)

What Can Lead to SCAD?

• Tear in the coronary artery wall: A spontaneous break in the innermost layer of the artery leads to blood accumulation within the wall, forming a false lumen and compressing the true lumen.
• Fibromuscular dysplasia (FMD): A non-atherosclerotic arterial condition that weakens artery walls and is strongly associated with SCAD, especially in women.
• Peripartum and postpartum state: Hormonal and hemodynamic changes during and after pregnancy can weaken coronary vessels, increasing susceptibility.
• Extreme emotional stress: Severe psychological distress can trigger a spike in blood pressure and heart rate, contributing to vessel wall rupture.
• High-intensity physical exertion: Intense exercise or sudden strain has been linked to SCAD in some cases, especially in otherwise healthy individuals.
• Connective tissue disorders: Ehlers-Danlos syndrome or Marfan syndrome, can structurally weaken artery walls, making them prone to tearing.
• Use of certain hormones or medications: Hormonal therapy or certain vasoconstrictive drugs may influence vascular tone and increase risk.
• Underlying arteriopathies or vascular inflammation: Some patients exhibit signs of vascular abnormalities not directly linked to FMD, but these suggest an underlying predisposition.
• Spontaneous with no identifiable trigger: In many cases, no single cause is found, and the dissection occurs without any known underlying condition.

How SCAD Is Diagnosed?

• Coronary angiography: This is the primary diagnostic tool used in suspected cases of SCAD. A dye is injected in the coronary arteries through a catheter, allowing real-time X-ray imaging. It helps detect irregularities, such as tapered narrowing or dissection flaps. However, some SCAD cases may resemble atherosclerotic narrowing, so interpretation requires expertise.
• Intravascular ultrasound (IVUS): An ultrasound probe is inserted into the artery to generate cross-sectional images of the vessel wall. It can confirm the presence of a false lumen or an intramural hematoma when angiographic findings are unclear.
• Optical coherence tomography (OCT): This test uses light waves to provide high-resolution images of the artery's inner layers. OCT is beneficial for visualizing small tears or subtle dissections not easily seen with angiography or IVUS. It's often used when the diagnosis is uncertain.
• Electrocardiogram (ECG): Detects electrical changes in the heart that suggest a heart attack or lack of oxygen due to reduced blood flow. ST-segment changes or T-wave inversions may be observed.
• Cardiac biomarkers (blood tests): Blood is tested for markers like troponin and CK-MB, which are elevated when heart muscle damage occurs. While not specific to SCAD, elevated levels support the suspicion of an acute coronary event.
• Echocardiogram (echo): An ultrasound of the heart is used to assess overall heart function and detect complications, such as reduced ejection fraction, wall motion abnormalities, or pericardial effusion, following a SCAD.
• CT coronary angiography: It may be used in certain low-risk patients or follow-up scenarios. This non-invasive imaging can visualize the coronary anatomy, though it is less definitive than catheter-based angiography.
• Screening for associated conditions: Once SCAD is confirmed, additional testing (e.g., CT or MR angiography of the head, neck, and abdomen) may be performed to evaluate for fibromuscular dysplasia or other vascular abnormalities across different body regions.

Treatment Approaches for SCAD 

• Conservative medical management (preferred in stable cases): Most SCAD patients are treated without invasive procedures, except if blood flow to the heart is preserved (TIMI flow grade 2–3). The artery often heals on its own over time. Close monitoring in a cardiac care unit is standard during the acute phase of care.
• Antiplatelet therapy: Aspirin is commonly prescribed long-term to prevent clot formation in the affected artery. A second antiplatelet agent (like clopidogrel) may be used for a limited period based on clinical judgment.
• Beta-blockers: The medications reduce heart rate and blood pressure, lowering the mechanical stress on artery walls. They may also reduce the risk of SCAD recurrence.
• Nitrates or calcium channel blockers (if needed): Used to control chest pain or coronary artery spasm, especially when angina persists after the acute event.
• Avoidance of thrombolytics: Fibrinolytic drugs are generally avoided in SCAD, as they can worsen bleeding into the vessel wall, expand the dissection, and increase the risk of complications.
• Percutaneous coronary intervention (PCI): Reserved for high-risk cases where the artery is severely blocked or the patient is unstable. Stenting in SCAD can be technically challenging due to fragile vessels and extended dissections, with higher complication rates than in typical heart attacks.
• Coronary artery bypass grafting (CABG): Considered only in severe cases involving critical left central artery dissection or multivessel SCAD when PCI is not feasible. It is rarely required.
• Cardiac rehabilitation: Structured rehab programs help patients regain confidence, safely return to daily activities, and manage emotional stress. Psychological support is also encouraged due to the traumatic nature of the event and the often young age of patients.
• Lifestyle adjustments and recurrence prevention: Patients are advised to avoid intense physical exertion, manage stress effectively, and monitor their blood pressure regularly. Follow-up imaging may be used to monitor the healing process.
• Hormonal considerations in women: In women who developed SCAD during pregnancy or while using hormonal therapy, future use of hormonal contraceptives or fertility treatments should be discussed carefully with a cardiologist.

Ongoing Management of SCAD Patients

• Regular cardiology follow-ups: Routine check-ups are crucial for monitoring heart function, reviewing medications, and evaluating progress over time.
• Repeat imaging (if indicated): Follow-up coronary imaging may be done to confirm healing of the artery, especially if symptoms persist or recur.
• Structured cardiac rehabilitation: Participating in medically supervised rehabilitation helps restore physical stamina, manage anxiety, and reduce the risk of recurrence.
• Medication adherence: Long-term use of beta-blockers and low-dose aspirin is often recommended to support vessel stability and mitigate future risk.
• Avoidance of extreme physical stress: High-intensity workouts, heavy lifting, and sudden exertion should be avoided; instead, patients are advised to adopt moderate, consistent physical activity routines.
• Stress management and mental health care: Psychological counseling or therapy is encouraged due to the emotional impact of SCAD, especially in younger individuals who were previously healthy.
• Monitoring for recurrence symptoms: Any return of chest pain, shortness of breath, or some other cardiac symptoms should be promptly evaluated and addressed.
• Assessment for related conditions: Further evaluation for fibromuscular dysplasia or other vascular disorders may be needed if not already done.
• Hormonal guidance for women: Women who experienced SCAD related to pregnancy or hormone therapy may need specialist input before using hormonal contraceptives or planning future pregnancies.

Long-Term Outlook

Most people recover well from SCAD, especially with early diagnosis and appropriate management. The affected artery often heals naturally within weeks to months, and many patients regain normal heart function. 

However, SCAD does carry a risk of recurrence, with studies showing repeat episodes in up to 10–30% of patients over time. Ongoing medical follow-up, lifestyle modifications, and adherence to prescribed medications are crucial in reducing this risk. 

While the condition can be life-altering, especially for younger individuals with no prior heart issues, long-term outcomes are generally favorable when managed carefully.

Daily Life and Adjustments

Living with SCAD means adapting to a new normal with careful attention to heart health. Most people can return to regular activities over time, but they’re encouraged to pace themselves, avoid high-intensity physical strain, and prioritize stress management. 

Cardiac rehabilitation plays a key role in building physical and emotional resilience. Staying connected with a cardiologist, taking medications as advised, and recognizing early warning signs are essential parts of daily life. 

Emotional recovery is just as important—many patients benefit from support groups or therapy to cope with anxiety or fear of recurrence. With the proper support and lifestyle choices, most people with SCAD go on to lead whole, active lives.

Sterling Hospital is Your Partner in Heart Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to a healthier heart. If you are looking for the best  cardiovascular surgeons in Ahmedabad, Vadodara, Rajkot, or  Gandhidham, we've got you. 

With considerable years of experience, we have built a team of the best cardiologists in these regions to provide you with premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier heart.

Sarcoidosis is an inflammatory disease that causes small clumps of immune cells, known as granulomas, to form in various organs throughout the body. These granulomas are clusters of macrophages and other immune cells that form in response to a trigger, although the exact cause remains unknown. Over time, granulomas can alter the structure and function of the affected organs.

Sarcoidosis most affects the lungs and lymph nodes, but it can involve the skin, eyes, liver, heart, brain, spleen, and other organs. The disease can present with or without symptoms and may develop gradually or appear suddenly.

The condition is classified as a multisystem granulomatous disorder with an unpredictable course. In some cases, it resolves on its own, while in others, it can become chronic and cause permanent damage.

Who Is More Likely to Be Affected by Sarcoidosis?

Sarcoidosis can affect people of all ages, but it is most commonly seen in adults between the ages of 20 and 40. The condition is slightly more frequent in women than in men. People with a family history of sarcoidosis have a higher risk, suggesting a possible genetic link.

Common Symptoms of Sarcoidosis

• Persistent dry cough
• Shortness of breath
• Chest pain or discomfort
• Fatigue
• Fever
• Weight loss
• Swollen lymph nodes
• Skin rashes or reddish bumps (often on the shins)
• Eye redness, pain, or blurred vision
• Joint pain or stiffness
• Enlarged liver or spleen
• Heart rhythm problems
• Neurological symptoms (e.g., numbness, facial paralysis)

What Causes Sarcoidosis?

• Genetic predisposition: People with a family history are more likely to develop the disease, suggesting inherited immune system traits may play a role.
• Environmental or occupational exposure: Dust, mold, chemicals, insecticides, or other airborne irritants have been studied as potential triggers.
• Infectious agents: Some research suggests a link with bacteria such as Mycobacterium tuberculosis or Propionibacterium acnes; however, no specific infection has been definitively proven to cause sarcoidosis.
• Autoimmune mechanism: The condition may represent a form of immune dysregulation, where the body mistakenly identifies its own tissues as threats.

How Is Sarcoidosis Diagnosed?

• Physical examination to assess symptoms like cough, skin lesions, or swollen lymph nodes
• Chest X-ray to check for the enlarged lymph nodes or lung abnormalities
• High-resolution CT scan for detailed imaging of affected organs, especially the lungs
• Pulmonary function tests to analyze lung capacity and airflow
• Blood tests to look for the signs of inflammation, calcium levels, and organ function markers
• Biopsy of affected tissue (e.g., lymph node, skin, lung) to confirm granuloma presence
• Bronchoscopy with lavage or biopsy to collect lung samples for testing
• Eye exam if eye involvement is suspected
• ECG or cardiac MRI if heart symptoms are present
• PET scan or gallium scan in complex cases to assess active inflammation and organ involvement
• Exclusion of other diseases, like tuberculosis or fungal infections, that also cause granulomas

Treatment Options for Sarcoidosis

• Regular monitoring for mild or asymptomatic cases, as the disease can resolve on its own
• Corticosteroids (usually oral) to reduce inflammation and suppress the immune response
• Immunosuppressive drugs for patients who don't respond well to steroids or need long-term treatment
• Hydroxychloroquine for skin lesions or high calcium levels (in selected cases)
• Tumor necrosis factor (TNF) inhibitors for severe or treatment-resistant sarcoidosis
• Inhaled medications for lung involvement with fewer systemic side effects
• Organ-specific treatments, such as anti-arrhythmic therapy for cardiac sarcoidosis or eye drops for ocular symptoms.
• Oxygen therapy is indicated if lung function is significantly impaired.
• Pulmonary rehabilitation to improve breathing and physical stamina
• Surgical intervention (rarely) in cases of severe organ damage (e.g., lung transplant)

Managing Life with Sarcoidosis

• Routine follow-ups to monitor organ function and detect flare-ups early
• Adherence to prescribed treatment to control inflammation and prevent complications
• Healthy lifestyle choices include a balanced diet, regular sleep, and avoiding smoking
• Regular exercise to maintain lung function and muscle strength, as tolerated
• Protecting eyes by wearing sunglasses and attending scheduled eye checkups
• Stress management techniques, such as mindfullness, yoga, meditation or therapy, can reduce immune system triggers
• Monitoring for side effects of long-term medication, especially steroids
• Getting vaccinated (with doctor’s advice) to minimize the risk of infections while on immunosuppressants
• Patient education to understand symptoms, track disease activity, and recognize warning signs
• Joining support groups to stay informed and emotionally supported through shared experiences

Can Sarcoidosis Be Prevented?

There is no known way to prevent sarcoidosis, as the exact cause remains unclear. However, reducing exposure to dust, chemicals, mold, and other environmental irritants may help lower the risk in people with a genetic predisposition. 

Prompt treatment of symptoms and regular health checkups can help manage the disease early and reduce long-term complications. People working in high-risk occupations (such as farming, firefighting, or industrial settings) should use protective gear and minimize inhalation of unknown substances whenever possible.

Living with Sarcoidosis

Living with sarcoidosis involves ongoing management rather than a cure. Most people can lead everyday lives with proper treatment and monitoring. It’s essential to attend regular checkups, follow your medication plan, and monitor for any changes in symptoms.

Fatigue is common, so pacing daily activities and prioritizing rest are essential. Staying physically active, eating a nutritious diet, & avoiding smoking or pollutants can help protect affected organs, especially the lungs. Emotional support through counseling or support groups also plays a key role in coping with long-term effects.

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide the utmost care and comfort throughout your journey to a healthier life. We've got you covered if you are looking for the best pulmonologist in Vadodara, Rajkot, or  Gandhidham. 

Our pulmonary department is built with a team of the best pulmonologists in these regions to provide premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a healthier future.

Pulmonary fibrosis is a serious lung condition where the tissue deep inside the lungs becomes damaged and scarred. The scarring then causes the lungs to stiffen, which impairs their ability to expand properly and take in sufficient oxygen. 

Over time, the scarring worsens, and people often find it increasingly difficult to breathe. It is not an infection or cancer, and it cannot spread from one person to another. The condition can progress slowly or quickly, depending on its cause & the individual's overall health.

Some people develop pulmonary fibrosis due to prolonged exposure to environmental irritants, like the dust or smoke. In contrast, others may get it as a side effect of certain medications, autoimmune conditions, or radiation therapy. In many cases, however, no clear cause is found. These cases are known as idiopathic pulmonary fibrosis. 

Symptoms

• Shortness of breath, especially during activity
• Persistent dry cough
• Fatigue
• Unexplained weight loss
• Aching muscles and joints
• Clubbing (widening and rounding) of fingertips or toes

Common Causes 

• Long-term exposure to harmful particles

Regular inhalation of substances like silica dust, asbestos fibers, coal dust, or metal particles can lead to lung irritation and scarring over time

• Certain medications

Some drugs used in chemotherapy (such as bleomycin), heart medications (like amiodarone), and certain antibiotics (like nitrofurantoin) are known to cause lung damage in rare cases

• Radiation therapy to the chest

People who undergo radiation for cancers like breast or lung cancer may develop fibrosis months or years after treatment, especially if high doses were used

• Autoimmune diseases

Conditions in which the immune system attacks the body, such as rheumatoid arthritis, systemic sclerosis (also known as scleroderma), and polymyositis, can lead to chronic inflammation in the lungs and ultimately result in scarring

• Viral infections

Some viral illnesses have been linked to the development of pulmonary fibrosis, though this is less common

• Genetics and family history

A small number of people inherit genetic mutations that increase their risk of developing fibrosis, particularly if more than one family member has been affected

• Idiopathic pulmonary fibrosis (IPF)

In many cases, no cause is found despite thorough testing. These are labeled idiopathic, and IPF is the most common and studied form of this type

Who's More Likely to Be Affected

• Age above 60
• Male gender
• Smoking (current or past)
• Long-term exposure to dust, fumes, or pollutants
• Working in mining, farming, construction, or metalworking
• History of viral infections
• Use of certain medications over time
• Undergoing chest radiation therapy
• Presence of autoimmune diseases
• Family history of pulmonary fibrosis
• Genetic mutations linked to lung disease

Complications of Pulmonary Fibrosis 

• Worsening breathlessness

As scarring progresses, lungs lose their ability to take in oxygen, making even mild activity exhausting over time

• Low blood oxygen levels (chronic hypoxemia)

Long-term oxygen deprivation can lead to fatigue, confusion, and damage to vital organs

• Pulmonary hypertension

High pressure in the arteries of the lungs forces the heart to work harder, which can lead to heart strain or failure

• Right-sided heart failure (cor pulmonale)

The right side of the heart may weaken due to persistent high pressure in the lungs, causing swelling in the legs, liver, and abdomen

• Frequent lung infections

Reduced lung function raises the risk of respiratory infections, which can be severe or recurrent in nature

• Lung collapse (pneumothorax)

Rare but serious, it occurs when air leaks in the space between the lung & the chest wall

• Blood clots

Limited mobility and poor lung function can increase the chances of developing blood clots, particularly in the legs or lungs

• Lung cancer

People with pulmonary fibrosis, particularly idiopathic forms, may have a higher chance of developing lung cancer over time

How Is Pulmonary Fibrosis Diagnosed

• Medical history and symptom check

The doctor asks about breathing problems, cough, work history, past illnesses, and any family members with lung disease

• Physical examination

Using a stethoscope, the doctor listens for “crackles” in the lungs, often described as Velcro-like sounds during breathing

• Pulmonary function tests (PFTs)

These measures how well the lungs hold air and how efficiently oxygen moves into the blood. A reduced lung capacity may suggest fibrosis

• Oxygen level check

A pulse oximeter or arterial blood gas test is used to determine the amount of oxygen circulating in the bloodstream

• High-resolution CT (HRCT) scan

This imaging test provides detailed views of lung tissue. It can reveal scarring patterns specific to pulmonary fibrosis, especially in idiopathic cases

• Chest X-ray

It may show lung damage or rule out other lung problems, but it’s not detailed enough to confirm fibrosis on its own

• Exercise testing (e.g., 6-minute walk test)

Measures how well the lungs function during physical activity and whether oxygen levels drop with exertion

• Blood tests

Help rule out autoimmune diseases or infections that may be causing lung symptoms

• Bronchoscopy with lavage

A tube is inserted into the lungs to collect some fluid. This helps rule out infections or detect inflammatory cells

• Lung biopsy (surgical or through bronchoscopy)

In some cases, a small tissue sample is needed to examine the type and extent of lung scarring under a microscope, especially when imaging is unclear

Management and Treatment

• Antifibrotic medications

Drugs like pirfenidone and nintedanib (for idiopathic pulmonary fibrosis) can slow the progression of scarring, though they do not reverse existing damage

• Oxygen therapy

Supplemental oxygen helps maintain adequate oxygen levels, reduces breathlessness, and supports daily activity, especially in advanced stages

• Pulmonary rehabilitation

A supervised program that includes breathing exercises, physical conditioning, and nutritional counseling to improve lung function and energy levels

• Cough management strategies

Since cough can be persistent, patients may benefit from speech therapy or medications to reduce the urge to cough

• Treatment of associated conditions

Conditions like gastroesophageal reflux disease (GERD) or pulmonary hypertension are often managed alongside fibrosis to minimize complications

• Vaccinations

Staying up to date with flu, pneumonia, and COVID-19 vaccines helps prevent infections that could further harm lung function

• Lung transplant

In select patients with severe disease and good overall health, lung transplantation is considered when other treatments no longer help

• Psychological support and palliative care

Counseling, support groups, and palliative care services can help manage emotional distress, especially as the disease progresses

Day-to-Day Self-Care

• Follow your treatment plan strictly.

Take medications on time, attend all follow-up appointments, and report any new or worsening symptoms immediately

• Use oxygen as directed

If supplemental oxygen is prescribed, use it consistently—even if symptoms seem mild—to avoid low oxygen levels that can silently worsen health

• Avoid exposure to lung irritants

Avoid exposure to smoke, dust, strong fumes, and areas with poor air quality. Wear a protective mask if exposure is unavoidable

• Stay physically active within limits

Gentle exercises, as recommended by a doctor or rehabilitation specialist, can help maintain stamina and alleviate breathlessness

• Eat balanced, small meals

Nutritious meals support energy levels and overall health. Smaller, more frequent meals may also help minimize breathlessness during eating

• Manage stress and emotional health

Practice relaxation techniques, such as deep breathing, mindfulness or meditation, to promote relaxation. Speak to a counselor or join a support group if needed

• Prevent infections proactively

Wash your hands regularly, avoid close contact with individuals who are sick, and stay up to date with all recommended vaccines

• Rest when needed

Fatigue is common. Plan your day with rest breaks and prioritize essential activities to conserve energy

• Monitor your oxygen levels

If advised, use a pulse oximeter at home to monitor oxygen saturation and detect early signs of low oxygen levels

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide the utmost care and comfort throughout your journey to a healthier life. We've got you covered if you are looking for the best pulmonologist in Vadodara, Rajkot, or  Gandhidham. 

Our pulmonary department is built with a team of the best pulmonologists in these regions to provide premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a healthier future.

Addison's disease (primary adrenal insufficiency) is a rare disorder where the adrenal glands, located on top of each kidney, fail to produce enough of two critical hormones: cortisol and aldosterone.

Cortisol helps regulate metabolism, blood pressure, immune response, and the body's reaction to stress. Aldosterone maintains sodium and potassium balance, which directly influences blood volume and pressure. 

When the adrenal cortex (outer layer of the adrenal gland) is damaged—most commonly due to an autoimmune reaction or infection—it leads to a gradual but progressive loss of hormone production.

This condition affects everyone of all ages & genders, and it develops gradually over time. 

However, under stress such as infection or injury, it can lead to a life-threatening crisis due to sudden hormone deficiency.

Who is at Risk of Developing Addison's Disease?

Addison's disease can affect individuals of any age, but it is most commonly diagnosed in people between the ages of 30 and 50. Both men and women are equally affected. The condition is more likely to occur in people with autoimmune diseases, namely type 1 diabetes, autoimmune thyroid disease (like Hashimoto's thyroiditis), or vitiligo, as the immune system may mistakenly attack the adrenal glands. It can also occur in patients with a history of tuberculosis or being treated for the same.

A personal or family history of autoimmune conditions increases the risk of developing these conditions. It can also develop as a result of infections that damage the adrenal glands, namely tuberculosis, HIV, or fungal infections. 

However, this is less common today, especially in developed countries. In rare cases, Addison's disease may occur due to genetic disorders, adrenal gland surgery, cancer spreading to the adrenal glands, or prolonged use of certain medications that suppress adrenal function.

Key Signs and Symptoms of Addison's Disease

• Fatigue
• Muscle weakness
• Unintentional weight loss
• Loss of appetite
• Darkening of the skin (especially in scars, creases, and gums)
• Low blood pressure
• Salt cravings
• Nausea or vomiting
• Abdominal pain
• Diarrhea or constipation
• Low blood sugar (hypoglycemia)
• Irritability or depression
• Joint or muscle pain
• Dizziness or fainting
• Irregular or absent menstrual periods in women

Why does Addison's Disease happen?

The most common cause of Addison's disease is autoimmune adrenalitis, in which the immune system mistakenly attacks the adrenal cortex, leading to gradual destruction of the hormone-producing cells. This accounts for the majority of cases in developed countries.

Other causes include infections, such as tuberculosis, which can directly damage the adrenal glands. Less commonly, Addison's disease can result from metastatic cancer, bleeding into the adrenal glands (adrenal hemorrhage), or genetic conditions like congenital adrenal hyperplasia or adrenoleukodystrophy. 

Surgical removal of the adrenal glands or long-term use of certain antifungal or steroid medications that interfere with adrenal hormone production can also trigger the condition.

How is Addison's Disease Diagnosed?

• Medical history & physical exam: Review of symptoms, blood pressure, skin changes, and personal/family history of autoimmune disease.
• Blood tests: Measure cortisol, ACTH (adrenocorticotropic hormone), sodium, potassium, glucose, and aldosterone levels.
• ACTH stimulation test: This test assesses how well the adrenal glands respond to synthetic ACTH; a limited or no rise in cortisol confirms the diagnosis.
• Insulin-induced hypoglycemia test (when needed): Evaluates pituitary function by checking cortisol response to low blood sugar.
• Plasma renin activity test: Measures renin levels to evaluate aldosterone deficiency and fluid balance.
• Autoantibody tests: Detect adrenal antibodies to confirm autoimmune origin.
• Imaging tests: CT scan of the abdomen to check adrenal size, structure, and look for infections, cancer, or bleeding.
• MRI of the pituitary gland: Performed if secondary adrenal insufficiency is suspected due to pituitary disorders.

How is Addison’s Disease Treated?

• Daily hormone replacement therapy: Long-term use of synthetic corticosteroids to replace missing cortisol and aldosterone.
• Oral hydrocortisone or prednisone: Taken in specific doses, usually twice daily, to mimic the body’s natural cortisol rhythm.
• Fludrocortisone acetate: Replaces aldosterone and helps maintain sodium & potassium balance, as well as blood pressure.
• Increased salt intake: Often recommended, especially during hot weather or physical activity.
• Adjusting medication during stress or illness: Temporary increase in steroid dose during infections, surgery, or injury to prevent adrenal crisis.
• Injectable corticosteroids: Emergency use in patients who cannot take oral medication due to vomiting or during an adrenal crisis.
• Medical alert identification: Wearing a bracelet or carrying a card to inform healthcare providers in emergencies.
• Regular follow-ups: Monitoring hormone levels and adjusting medication as needed.

Managing Life with Addison’s Disease

Managing Addison’s disease requires daily attention and lifelong adherence to hormone replacement therapy. Patients must take their medications as prescribed and never skip doses, as even a short interruption can trigger symptoms or an adrenal crisis. 

In the time of physical or emotional stress, such as illness, surgery, or injury, medication doses often need to be increased to meet the body’s elevated demand for cortisol. It’s important to recognize early warning signs of under-replacement, such as fatigue or dizziness, and respond promptly. Carrying an emergency corticosteroid injection kit is essential for situations where oral medication can’t be taken. 

Patients should also stay hydrated, monitor blood pressure, and, if advised by their doctor, maintain a diet with sufficient salt. Routine medical check-ups are crucial for monitoring hormone levels and adjusting treatment accordingly. 

Education plays a crucial role—patients and their close contacts should be trained to recognize the symptoms of adrenal crisis and respond promptly. Wearing a medical ID bracelet helps ensure that proper care is received in the event of an emergency.

🩺 Sick Day Rules for Addison’s Disease

1️⃣ If you are unwell (fever, cold, infection, minor illness), double your usual steroid dose until you recover.

2️⃣ Keep taking your fludrocortisone (if prescribed) at the usual dose.

3️⃣ If you are vomiting, unable to keep medicines down, or feel very weak/dizzy, take your emergency injection (hydrocortisone 100 mg IM/SC) immediately.

4️⃣ After the injection, go to the nearest hospital immediately for further treatment.

5️⃣ Always carry a steroid emergency card and inform healthcare workers about your Addison’s disease.

6️⃣ If you are having surgery or a procedure, inform your doctor beforehand so they can give you extra steroids.

7️⃣ Keep a supply of oral steroids and injectable hydrocortisone at home.

8️⃣ Drink plenty of fluids and monitor for dizziness, extreme fatigue, or confusion.

9️⃣ Never stop taking your steroids suddenly.

🔟 Teach family/friends how to give the emergency injection in case you cannot do it yourself.

Esthesioneuroblastoma, a.k.a olfactory neuroblastoma, is a rare & aggressive cancer that originates in the upper part of the nasal cavity, particularly in the olfactory epithelium (tissue responsible for the sense of smell). 

It arises from neuroectodermal cells and is part of small round blue cell tumors. This malignancy is distinct from other nasal or sinus cancers in its origin and histology. 

It can invade nearby structures, including the sinuses, eye sockets, and brain, especially if not detected early. The tumor, though, can occur at any age, is most commonly diagnosed in adolescents and middle-aged adults.

What Are the Symptoms?

• Nasal congestion or blockage (usually on one side)
• Frequent nosebleeds
• Reduced or lost sense of smell
• Facial pain or pressure
• Swelling around the eyes or tearing
• Vision problems, such as double vision
• Headaches
• A noticeable mass inside the nasal cavity
• Loosening or pain in the upper teeth
• Neurological symptoms (in advanced cases) such as seizures or personality changes

Clinical Staging of Esthesioneuroblastoma

Esthesioneuroblastoma is commonly staged using the Kadish staging system, which classifies the tumor based on its anatomical spread. This system helps determine the severity of the disease and guides treatment planning.

• Stage A

The tumor is confined strictly to the nasal cavity without involving any surrounding structures

• Stage B

Tumor extends into one or more of the paranasal sinuses (e.g., ethmoid, maxillary, sphenoid, or frontal) but remains within the sinonasal region

• Stage C

The tumor has extended beyond the nasal cavity and sinuses into surrounding areas, including the orbit, skull base, and intracranial space. It may also involve cervical lymph nodes or show signs of distant metastasis.

Note: Some clinicians also refer to a modified Kadish system that includes a Stage D to represent cases with distant metastasis, although this is not universally adopted.

Complications Linked to Esthesioneuroblastoma

• Invasion into surrounding structures like the orbit or the brain
• Loss of vision or eye movement due to orbital involvement
• Spread to cervical lymph nodes or distant organs.
• Recurrence after treatment
• Intracranial pressure or brain damage in advanced cases
• Side effects from radiation or chemotherapy (e.g., cognitive issues, sinus damage)
• Difficulty breathing or speaking if the tumor obstructs the airways
• Long-term functional impairment depends on tumor location and treatment

How Is Esthesioneuroblastoma Diagnosed?

• Clinical examination

The process begins with a thorough examination of the head and neck. An ENT specialist checks for nasal masses, obstruction, or deformities through anterior rhinoscopy or nasal endoscopy.

• Imaging tests – CT scan

A computed tomography (or CT) scan of the head and sinuses helps assess the size of the tumor, bone involvement, and structural erosion, especially in the nasal cavity, ethmoid sinuses, and skull base.

• Imaging tests – MRI

Magnetic Resonance Imaging (or MRI) is crucial for determining soft tissue involvement, particularly to assess whether the tumor has extended into the brain, eye sockets, or other surrounding structures. It gives a clearer picture than a CT for evaluating intracranial spread.

• PET scan or whole-body imaging

A PET scan or other advanced imaging techniques may be used to detect regional or distant metastases, including those in lymph nodes or other distant organs.

• Biopsy

A tissue biopsy is mandatory for confirming the diagnosis. The sample is collected through nasal endoscopy and sent for histopathological examination.

• Histopathology and immunohistochemistry

The biopsy tissue is analyzed under a microscope. Esthesioneuroblastoma typically appears as a small, round, blue cell tumor. Immunohistochemical markers, such as synaptophysin, chromogranin, and neuron-specific enolase (NSE), aid in distinguishing it from other nasal cancers.

• Hyams' grading system

Once confirmed, the tumor is graded using the Hyams system (Grade I–IV), based on features like cell differentiation, necrosis, mitotic activity, and rosette formation. Higher grades indicate more aggressive disease.

• Spinal fluid analysis (in select cases)

If the tumor has spread near the brain, a lumbar puncture is performed to check cerebrospinal fluid (CSF) for malignant cells.

How Is Esthesioneuroblastoma Treated?

• Surgical removal

Surgery is the primary treatment. The goal is basically to remove the tumor entirely with clear margins. Depending on the extent of spread, this may involve minimally invasive endoscopic surgery or open craniofacial resection if the cancer has invaded the skull base or nearby structures.

• Radiation therapy

Post-surgical radiation is commonly recommended, especially in cases where complete removal isn't possible or if the tumor is high-grade. Radiation helps reduce the risk of recurrence by targeting any residual cancer cells.

• Chemotherapy

Chemotherapy may be used in advanced-stage cases, particularly if the tumor has reached the lymph nodes, brain, or other distant parts of the body. It's also considered when surgery and radiation alone are insufficient.

• Combined approach (multimodal therapy)

Most patients often benefit from a combination of two or more treatments. For instance, surgery followed by radiation, or a sequence of chemotherapy, surgery, and then radiation, depending on the case.

• Ongoing surveillance

After treatment, long-term follow-up is essential. Regular imaging and physical exams help monitor for recurrence, which can happen even years later.

• Re-treatment for recurrence

If the cancer returns, treatment may involve a second surgery, additional radiation, or systemic therapies, based on how and where the recurrence occurs.

Side Effects of Treatment

Treatment for esthesioneuroblastoma can lead to a range of side effects depending on the type and intensity of therapy. Surgery may result in facial swelling, sinus issues, or changes in smell and vision, especially if nearby structures are involved. 

Radiation therapy can cause fatigue, dry mouth, skin irritation, nasal dryness, and long-term damage to nearby nerves or tissues. Chemotherapy may lead to nausea, lowered immunity, and fatigue. In some cases, cognitive changes or hormonal imbalances can occur if treatment affects brain structures. 

Note: Regular follow-ups are crucial for managing and monitoring these effects.

Management

Management focuses on routine monitoring, rehabilitation, and early detection of recurrence. Patients typically require scheduled imaging, such as MRI or CT scans, every few months for the first few years, followed by annual scans. 

Endoscopic nasal exams are done to assess local recurrence. Vision, smell, and neurological functions should be regularly evaluated. Rehabilitation may include physiotherapy, speech therapy, or counseling based on the affected areas. 

If hormone-producing glands were impacted, endocrine follow-up is needed. Any new symptoms such as nasal blockage, headaches, or visual changes must be promptly investigated. A multidisciplinary team manages long-term care, comprising specialists in ENT, oncology, neurology, and endocrinology.

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Dehydration happens when the body loses way more fluids than it takes in, making it harder for organs and tissues to function correctly. Water plays a massive role in regulating body temperature, lubricating joints, delivering nutrients to cells, and removing waste. 

When there's not enough water in the system, even basic biological processes can begin to falter, starting with fatigue, dizziness, and a dry mouth, and potentially leading to much severe complications, such as kidney problems, heat-related illnesses, or even seizures in extreme cases.

Who Faces the Highest Risk of Dehydration?

Certain groups of people are more vulnerable to dehydration due to how their bodies manage fluids or how their lifestyle, environment, or medical condition affects fluid loss. 

Infants and young children are at high risk because they have a higher body water content, and their small size makes them more sensitive to even minor fluid loss from vomiting, diarrhea, or heat. 

Older adults are also more susceptible, as the sensation of thirst tends to weaken with age and kidney function gradually declines, making it harder for them to conserve water. People with illnesses like diabetes or kidney disease face added risk due to increased urination or medication side effects. 

Individuals who exercise strenuously or work outdoors in hot, humid climates lose more fluids through sweat, especially if they don't replace them promptly. Even those with temporary issues like a fever, stomach infection, or excessive alcohol intake can become dehydrated quickly if fluid intake is not maintained.

How Dehydration Builds Up in the Body

• Inadequate fluid intake: Not drinking enough water the whole day—especially in hot weather or during illness—can start the dehydration process
• Excessive fluid loss: Conditions like diarrhea, vomiting, or sweating heavily during physical activity can quickly reduce the body's fluid reserves
• Fever: A rise in body temperature leads to increased fluid loss through sweating, and the higher the fever, the faster dehydration can occur
• Frequent urination: This can result from uncontrolled diabetes, certain medications like diuretics, or alcohol consumption, all of which cause the body to lose more water than it retains
• Burns or skin injuries: Large burns or skin damage disrupt the body's ability to retain fluids and increase fluid loss through damaged skin
• Underlying health conditions: Kidney disorders, adrenal gland issues, or hormonal imbalances can interfere with the body's ability to maintain fluid balance

Signs Your Body Needs More Water

• Dry mouth and tongue
• Thirst
• Dark yellow urine
• Reduced urine output
• Headache
• Dizziness or lightheadedness
• Fatigue or tiredness
• Dry, cool skin
• Rapid heartbeat
• Rapid breathing
• Sunken eyes
• Low blood pressure
• Confusion or irritability
• Muscle cramps
• Lack of sweat despite heat or exertion
• Weakness
• Fainting
• Constipation
• No tears when crying (in infants and young children)
• Sunken soft spot on the head (only in babies)

How Much Water Do You Actually Need?

There's no single formula that fits everyone when it comes to daily water intake. Needs vary depending on age, body size, activity level, climate, and underlying health conditions. However, as a general benchmark, adult men should aim for about 3.7 liters (around 15.5 cups) of fluids per day, while adult women should target approximately 2.7 liters (about 11.5 cups). 

This includes water from all sources—drinks, food, and even metabolic water produced inside the body. People who spend time outdoors, exercise regularly, are ill, or live in hot climates may need more than this baseline. 

Waiting until you feel thirsty isn't a reliable approach, especially for older adults, as the thirst signal weakens with age. A practical way to monitor hydration is by checking your urine—if it's pale yellow, your fluid levels are likely on track.

What Helps Reverse Dehydration?

• Drink small, frequent sips of water
• Use oral rehydration solutions (ORS) for moderate dehydration
• Include fluids that contain electrolytes, especially after heavy sweating or illness
• Avoid caffeinated, alcoholic, or sugary drinks while rehydrating
• Eat water-rich foods like fruits (e.g., watermelon, oranges) and vegetables (e.g., cucumber, lettuce)
• Rest in a calm, shaded environment to reduce further fluid loss
• Monitor urine output and color to track improvement
• For children or adults with severe dehydration, seek medical care for IV fluids
• Manage underlying causes like vomiting, diarrhea, or fever to prevent continued fluid loss

Smart Habits to Prevent Dehydration

Build hydration into your routine rather than relying on thirst as a reminder. Start your day with a glass of water, and keep fluids readily available throughout the day, whether at work, during travel, or while engaging in any outdoor activity. Increase your intake during illness, warm weather, or physical activity—even if you don't feel thirsty.

Choose fluids with electrolytes when you're losing more than just water, such as during intense workouts or gastrointestinal illnesses. If you're caring for older adults or young children, watch for early signs, such as reduced urination or dry lips, and encourage them to drink plenty of fluids regularly. 

Eating hydrating foods, such as fruits, soups, and yogurt, can also significantly contribute to daily water needs.

Long-Term Impact of Repeated Dehydration

While occasional mild dehydration can be corrected quickly, frequent or prolonged dehydration can have a significant impact on the body. Over time, it increases the risk of kidney stones & urinary tract infections due to the concentration of urine and reduced waste removal. 

Chronic fluid shortages can also impair digestion and reduce the body's ability to regulate blood pressure, leading to episodes of dizziness or fainting. In older adults, persistent dehydration may accelerate cognitive decline or increase the risk of falls. 

For individuals with heart, kidney, or endocrine issues, repeated dehydration can worsen their existing conditions and complicate treatment outcomes.

When Should You Seek Medical Help?

Mild dehydration can be managed at home, but some situations require urgent medical attention. If someone hasn't urinated for eight hours or more, is confused, unusually drowsy, or has a parched mouth and skin, these may be signs of moderate to severe dehydration. 

In children, watch for sunken eyes, no tears when crying, or a dry diaper for several hours. If vomiting or diarrhea persists for longer than 24 hours, or if there's a high fever along with signs of dehydration, it's essential to consult a doctor immediately. 

Individuals with underlying conditions like diabetes, kidney disease, or heart problems should not delay treatment, as dehydration can worsen these conditions rapidly.

Your Journey to Better Health Starts Here

At Sterling Hospital, we're dedicated to being your trusted partner in achieving better health across Gujarat. We prioritize your comfort and well-being every step of the way, providing the utmost care throughout your journey to a healthier life. 

Contact Sterling Hospital today to schedule a consultation and embark on a healthier future.