Category: Blog

Introduction:

Swallowing difficulties, medically known as dysphagia, can be a challenging condition affecting individuals of all ages. If you or a loved one experiences symptoms such as coughing, throat clearing, breathing difficulty during feeding, or the sensation of food getting stuck in the throat, it’s crucial to seek professional help. In this article, we’ll explore the importance of swallowing assessments, how they are conducted, and the available instrumental assessments, with a focus on the Video Fluoroscopic Swallow Study (VFSS)

The Importance of Swallowing Assessments

If you suspect you have swallowing difficulties, the first step is to consult your doctor. They will likely refer you to a speech therapist for a swallow assessment. Swallowing assessments are essential for several reasons:

1. Accurate Diagnosis: A thorough assessment helps pinpoint the exact nature and severity of the swallowing difficulty, ensuring appropriate treatment recommendations.

2. Personalized Care: Based on the assessment results, a speech therapist can develop a tailored treatment plan, which may include food modifications, specific head positions, or exercises to strengthen swallowing muscles.

3. Safety: Identifying swallowing issues can prevent choking episodes and enhance safety during mealtimes, reducing stress for both individuals and their families.

How a Feeding Assessment is Conducted

During a feeding assessment, a speech therapist will evaluate your swallowing patterns in a clinical setting. Here’s an overview of what to expect:

1. Food Consistencies: You will be asked to consume various food consistencies to assess how well you manage different textures.

2. Monitoring: The speech therapist will closely monitor vital signs, breathing patterns, and voice quality throughout and after the feeding process.

Instrumental Swallow Assessments

In some cases, further instrumental assessments may be necessary to gain a more in-depth understanding of swallowing difficulties. One of the most commonly used instrumental assessments is called VFSS.

Video Fluoroscopic Swallow Study (VFSS): VFSS is a moving X-ray examination of the mouth and throat conducted while eating and drinking. During this test, you consume foods coated with Barium, allowing healthcare professionals to:

• Observe whether food enters the airway instead of the esophagus.
• · Assess the functioning of different parts of the mouth and throat during swallowing.
• · Determine which food textures are safe for you to consume.
• · Explore whether different head positions aid in safe eating and drinking.

Who Can Undergo a VFSS?

VFSS is a versatile assessment suitable for individuals from neonates to pediatrics. However, it’s essential to note that VFSS involves radiation exposure. Therefore, your doctor and speech therapist will carefully consider whether it’s appropriate for your specific situation.

Conclusion

Swallowing difficulties can significantly impact an individual’s quality of life, making early diagnosis and intervention crucial. If you suspect swallowing issues, consult your doctor, and they can refer you for a swallow assessment. Through assessments like the Video Fluoroscopic Swallow Study (VFSS), healthcare professionals can provide personalized recommendations and improve the safety and enjoyment of mealtimes. Remember that your healthcare team is there to support you on your journey to better swallowing health.

What is palliative care?

Palliative Care is an approach to care that helps people with a life-limiting illness to have the best possible quality of life. It is available for everyone – of any age, race, culture, background, and religion. Palliative care aims to prevent and treat serious health-related suffering that may occur because of the medical condition or its treatment.

A life-limiting illness is an illness that can’t be cured. You may hear this type of illness called ‘life-threatening’ or ‘terminal’. People might also use the terms ‘progressive’ (gets worse over time) or ‘advanced’ (is at a serious stage) to describe these illnesses. Examples of life-limiting illnesses include:

• Advanced stage cancer
• End-stage organ failure – e.g. heart failure, renal failure, liver failure
• End-stage dementia
• Acute traumatic brain injury
• Patients with multiple organ failure

When having palliative care, the patient and their family are always in control of decisions about their health, medical treatment, or well-being.

Depending on your needs, palliative care may include:

• Medicine and other therapies to help relieve pain and other symptoms.
• Support for your family members.
• Help to meet your spiritual, religious, or cultural needs.
• Help and equipment to live comfortably at home where possible.

When is palliative care applicable?

Palliative care can be used at any time in your illness, not just for people who are near the end of life. If there are difficult-to-control symptoms (e.g., difficult pain, nausea, breathlessness, itch) then palliative care may be able to help. Having palliative care does not mean there is no hope, you have ‘given up’ or your families don’t care. Palliative care is given alongside your usual medical treatments and there is always something that we can do to make our patients feel better.

What is end-of-life care?

End-of-life care involves treatment, care, and support for people who are nearing the end of their life and is an important part of palliative care. End-of-life care is for people who are thought to be in the last year of life, but this timeframe can be difficult to predict. Some people might only receive end-of-life care in their last weeks or days. 

End-of-life care aims to help you to live as comfortably as possible in the time you have left. It involves managing physical symptoms and getting emotional support for you and your family and friends. You might need more of this type of care towards the end of your life.

End-of-life care also involves talking to you and your family and friends about what to expect towards the end of your life. The people looking after you will talk to you about your needs and wishes, and make sure they consider what you want in the care they provide.

Where can I receive palliative care?

Depending on your needs and other requirements, you may receive palliative care at home, in a hospital, or in other care facilities. Many patients can be seen in the outpatient clinic but sometimes admission to the inpatient unit is required to optimize your symptoms, typically 1 to 2 weeks, before returning home.

It may be important for some patients and families to spend as much time as possible at home. In this case, we will work together with you to try and make this possible. We will work with your primary medical team and home care teams to try and facilitate care at home wherever possible.

Where can I see the palliative care team?

The palliative care team is based primarily at Burjeel Medical City in Mohamed Bin Zayed City, Abu Dhabi but clinics are also held at Burjeel Hospital Abu Dhabi and Burjeel Specialty Hospital in Sharjah.

As the Holy month of Ramadan approaches, Muslims across the globe prepare themselves spiritually, mentally, and physically to cope with fasting. It is a time at which one refrain from food, drink, and general elements of inappropriate character. Fasting alone has a number of well-documented benefits which include glucose homeostasis, improved cardiovascular function, reduced cholesterol levels, blood pressure regulation, and enhanced immune system function.

So why would you want to exercise during Ramadan anyway? Well for those who lead active lifestyles, having to stop exercising can have negative effects on exercise capacities developed throughout the year. Additionally, research has shown that not exercising during this period could lead to a regression in exercise-induced adaptations, hence why maintenance is paramount. However, exercise during Ramadan poses a challenge to fasting individuals. The reduced caloric intake results in low fuel levels, which may have some adverse effects if the training program is not appropriately customized to the individual observing the fast. During this period, workouts will feel generally harder as a result of increased fatigue and perceived levels of exertion.

Workout Right During Ramadan

Whether to exercise or not during Ramadan is a personal choice as every individual may have their own fitness goals. Current research suggests moderate intensity exercise during Ramadan offers an ideal safe zone within which exercise capacities can be maintained, without adverse effects. This exercise intensity has also demonstrated a number of positive effects on the human body, which promote optimal immune function. In regards to resistance or strength-based training, the focus during this period is to ‘Deload’, which enhances general training capacities, as it facilitates recovery and promotes improved performance levels.  

Moderate Intensity Exercise

Moderate-intensity exercise is any exercise that increases your heart rate by at least 50-70% and lasts between 45-60 min. If you can hold a conversation while exercising, then you are in the correct zone. If you prefer a more scientific approach, then you can calculate your Target Heart Rate using the formula below

• Calculate your Resting Heart Rate (RHR), the heart rate when you first wake up
• Then calculate your Maximum Heart Rate(MHR)
  • 220 – (your age) = Maximum Heart Rate
• Then subtract your RHR from your MHR
• Finally, calculate your Target Heart Rate (THR)

Maximum Heart Rate: Resting Heart Rate x (Training Intensity Percentage) +RHR = THR

Example:

Yusrah, 30, wants to continue her cardio training 2-3 times a week after Iftar. She has an RHR of 70 BPM and wants to exercise at 65%  intensity for 45 minutes. Her THR is 133bpm
220 – 30 = 190 (MHR)
190 – 30 = 160
(160 – 70) x 70% + 70 =  133bpm (Target Heart Rate)

How to Deload a Resistance Training Program

The term ‘Deloading’ is often used in literature to refer to reduced volume training achieved either by reducing the volume of the workout, its intensity, or even both. Below is an example of a pre and Ramadan resistance-based program:

• Pre-Ramadan: 4-5 times weekly resistance training at high volume. 5-7 movements. 25-30 sets. 5-7 rep range.
• During Ramadan: 3-4 times weekly resistance training at a reduced volume. 2-4 movements. 8-10 sets. 5-7 rep range. Exercise intensity (weight being lifted) remains constant.

Important Note: For those focusing on resistance or strength-based training, you will likely lose some of your ‘gains’ achieved during the year, both size and strength. However, the extent to which this reduction occurs depends significantly on your training experience i.e the longer you have been lifting the less you are likely to lose, relatively speaking. Secondly, post-Ramadan, once you are able to return to your normal routine and intensities, these adaptations tend to return within a short period of time. However, caution must be exercised post-Ramadan when returning to baseline lifting volumes. Adopting a progressive approach to training load is essential in order to prevent injury.

Diet to Maximize Your Workout Potential During Ramadan

The fasting individual is only able to eat and drink between sunset and before the break of dawn. This window is further narrowed by the special 1-hour ‘Tarraweh’ prayers performed after the final prayer of the day (Isha). To optimize output and recovery, a focused nutritional approach must be adopted. Adequate consumption of high-quality proteins, carbohydrates, vitamins, and minerals produces better outcomes for exercise recovery. Small portioned but frequent meals between Iftar and Suhoor can be achieved, with 1g of high-quality carbohydrate per kilogram of body mass at least an hour before and after the exercise session. Additionally, 20-25g of high-quality protein post-exercise has been demonstrated to restore amino acids, which are essential for protein synthesis.

Tips to Remember

• Plan your workouts carefully
• Focus on ‘maintenance’ of exercise capacity
• Follow a nutritious, energy-rich healthy diet
• Double down the hydration between Iftar and Suhoor
• Be gentle and kind to yourself

What are Congenital Heart Diseases/Defects (CHDs)?

Congenital Heart Diseases/Defects (CHDs) are heart abnormalities at birth. CHDs can impair the structure and function of the heart. It is the most prevalent congenital disability, affecting 1 in every 100 children. Before they turn one year old, at least 25% of these kids will need treatment or surgery.

Congenital Heart Disease (CHD) Awareness Week is observed internationally from the 7th to the 14th of February every year. It is observed to raise awareness and honor those affected by the disease.

The most common Congenital Heart Diseases include: 

• Bicuspid Aortic Valve  
• Ventricular Septal Defects  
• Atrial Septal Defects  

Early detection of cardiac problems can improve the prognosis for children with CHD.

Risk factors

Certain conditions might increase the risk of a child having a Congenital Heart Defect. These include:

• Rubella infection during pregnancy
• Diabetes in pregnancy
• Certain medications
• Drinking Alcohol
• Smoking 
• Family History and Genetics
• Genetic conditions, for example, Down syndrome, Turner’s syndrome

Diagnosis of Congenital Heart Disease

Trained Fetal Medicine Consultants and Fetal Maternal Specialists can diagnose almost 90% of congenital cardiac diseases or abnormalities at 20 weeks of gestation. In utero, diagnosis is vital to plan postpartum care and treatment. Critical congenital heart disease screening should be made available after a baby is born to compare and check the baby’s saturation in different limbs. This can help in the early detection of any critical heart defect. Healthcare providers, parents, or caregivers may suspect a heart defect in older children due to a fast or slow heart rate, fast breathing, pale skin, changes in temperature, or energy level. Children diagnosed with certain inherited (for example, Marfan’s syndrome) or genetic conditions are at risk for CHD, and a pediatric cardiology evaluation is recommended.

Treatments for Congenital Heart Diseases

The type and severity of CHDs determine the treatment. Some heal on their own or have no effect that requires intervention. Significant defects often require extensive treatment. 

Treatment could include:

• Medications
• Cardiac Catheter Procedures (interventional procedures)
• Open-Heart Surgery
• Heart Transplant

Children who need interventional procedures or surgery for their heart condition must remain under the supervision of a Pediatric Cardiologist or Adult Cardiologist for life. This ensures that any issues or complications can be identified early and that preventative measures are in place to safeguard them and ensure they live a full, happy, and healthy life.

What is Atrial Septal Defect (ASD)

Atrial Septal Defect (ASD) is a congenital heart defect with a hole between the heart’s upper two chambers. These upper chambers are called atria. A Secundum ASD is a defect or hole in the central part of the atria. The effect of a secundum ASD on a patient and its treatment will depend on the size of the defect. Occasionally, other heart defects are also present when a patient has a secundum ASD. 

Other types of atrial septal defects include:

• Primum ASD
• Sinus venosus ASD

Symptoms of Atrial Septal Defects

Most children and babies with secundum ASD have no symptoms. Usually, ASD is only found when a doctor or nurse hears a murmur at a routine check-up. A heart murmur is extra sound healthcare professionals hear when listening to the heart. 

If the secundum ASD is significant, signs or symptoms might include:

• Heart Murmur 
• Growth Issues
• Fast Breathing 
• Frequent Chest infections  

If left untreated, medium or large secundum ASDs can cause problems later in life:

• Abnormal Heartbeat
• Effort intolerance with exercise or even daily activities
• Trouble Breathing 
• Blue-toned Skin 

Secundum ASD Treatment

A small secundum ASD may close without intervention around 2 to 5 years old. The child will remain under review by their pediatric cardiologist during this time. If symptomatic, surgical closure will be considered if the defect is too large or the child is too small for transcatheter closure.

Transcatheter Closure

A thin tube is placed into the blood vessel in the leg. With the help of X-rays and Ultrasound equipment, the thin line is moved through the blood vessel to the heart. When the tube gets to the heart, a tube is used to put a small device that closes the hole.   

Surgery 

If a secundum ASD is too large for transcatheter closure or the patient symptomatic and too small to undergo transcatheter closure, open-heart surgery is done to close the secundum ASD.

What are running Injuries?

Running injuries are repetitive strain injuries of the Lower limbs (Hip, knee, ankle, and Foot). It can happen with both beginners and experienced runners, and there are common. A vast majority of running injuries are not severe; however, the evaluation of the injured runner still demands detailed musculoskeletal examination and thoughtful consideration of more dangerous potential causes of the symptoms. Proper clinical diagnosis and recommendations can speed recovery and return to activity. 

Most common running injuries and their symptoms:

• Runner’s knee – dull pain around the front of the knee, felt either while active or after sitting for a long time
• IT band syndrome – aching or burning pain outside the knee (which may extend up to the hip), typically felt when active.
• Shin splints – pain at the front or inner-facing portion of your lower legs that worsens with activity
• Plantar fasciitis – pain at or near the bottom of the heel, typically felt after exercise (not during) or early the following day.
• Achilles Tendinitis – pain in the lower leg just above the heel that may be accompanied by restricted motion when attempting to lift your toes
• Stress fracture – pain or aching (usually in the shin or Foot) that’s felt during the activity and worsens over time.

How to prevent running injuries?

Slow and Steady: 

One of the most common reasons for an injury that physiotherapists will see in runners is an overuse injury. The basic rule of thumb for running training is a 10% weekly increase and no more than a 10-15min increase in the long run.

Muscles Strength:

Another common reason for running injuries, especially weakness of the hip (Gluteal muscles) and Core muscles (Muscles around the spine). These muscles are called stability muscles. When there is a weakness in these muscles, it leads to an abnormal loading mechanism around your joints, and that contributes to Injuries. Incorporating specific strengthening exercises into these muscles prevents you from potential injuries. 

 Flexibility: 

Apart from strength of the muscles, flexibility Muscles play a significant role in running injuries. Suppose any of the muscles in the lower limb ( Hip, Knee, and ankle) are tight from previous injuries or due to lifestyle. In that case, it directly affects the joint segments’ mobility, force production, and running mechanics, leading to injuries. Regular dynamic, Static regimes pre, and post-running, respectively, not only help you from the recovery and prevents injuries.

Improper running technique:

Yes, you read it right. Running is a form of exercise with a correct technique similar to squats, deadlifts, or activities. If the method is incorrect, it leads to injuries, e.g., directly landing on the heel. Each step might contribute to plantar fasciitis.

Ideal recovery time:

Experts to be the most critical component of a fitness-training program often note rest and recovery. Your success with a running program (or any fitness program, for that matter) is determined by your body’s ability to adapt to the stress of the activity. Resting and recovering well means ensuring you get 7-9 hours of sleep per night, stay hydrated, and eat a balanced diet.

How to recover from running injuries?   

Suppose you have any pain while running/ after running, which is not improving with the ideal recovery time. We recommend you meet one of our physiotherapists; they will conduct a detailed assessment, which includes checking your strength in your core and lower limb muscles, the flexibility of the lower quadrant muscles, and an analysis of your running technique.

Based on the assessment findings, our physical therapist will provide you with a structured exercise program to help you recover faster.

Chronic ankle instability is persistent pain on the outside of your ankles, usually occurs after you suffer from an ankle sprain that is not healed completely. The pain typically will appear whenever you engage in some kind of physical activity & often lead you to feel instability on your ankle area while applying weight.

What are the parts of the ankle?

Ankle joint is made of up of two bones of lower leg namely “tibia” & “fibula” and first bone of your foot is called as talus. These bony structures are stabilized by ligaments and tendons. Your outer part of the ankle is supported by Lateral collateral ligament, your inner part of the ankle is supported by Medial collateral ligament.

What is ankle sprain?

The tissues which connect bone to bone are called as ligament. When you sprain your ankle, one or more of your ligaments are stretched or torn, causing damage to the ligaments & tendons around the ankle. Tendon is the part of the muscle which is directly connected to the bone.  20% of the people who had an ankle injury may develop chronic ankle instability if it’s not taken care of.

How does the ankle instability feel like?

• Pain on the outside of your ankle
• Tenderness around the ankle
• The feeling your ankle is going to “give out.”
• Stiffness 
• Chronic discomfort and swelling

How is chronic instability is diagnosed?

To determine whether you have a chronic ankle instability the orthopedic doctor especially foot and ankle doctor, will ask your duration of the symptoms, and we will conduct detained physical examination which includes some kind of special tests and functional tests, if required he may order for imaging (X-ray/Ultrasound/MRI) studies for your ankle. Based on the collective information chronic instability is diagnosed.

How is the chronic ankle instability treated?

Most of the time chronic ankle instability is treated without surgery. In severe cases of ankle instability doctor may recommend for surgery which is minimally invasive procedure, which is often done as a day care surgery (on the same day of surgery you can go home).

When should you consider Surgery?

• When the ligament is stretched beyond the point of physiological limit.
• Complete rupture of the ligament.
• Presence of loose body within the joint.
• Excessive amount of damage to joint surface (Articular cartilage)

What is the conservative management for chronic ankle instability?

• Anti-inflammatory medicine
• Physical therapy
• Bracing.

What is the role of Physiotherapy in chronic ankle instability?

Physical therapist will assess other joints of your involved leg like hip and knee to identify if there are any contributing factors from these uninvolved joints caused your initial ankle sprain. Studies suggest that weakness of the hip muscles is one of the leading causes for ankle injuries in professional athletes and in common population as well.

After the detailed assessment your Physiotherapist will decide your plan of care based on your activity levels, and goal to be attained in general therapy plan can be divided as pain management and graded exercise program.

What is the pain management delivered by the physiotherapist?

• Soft tissue massage.
• Joint mobilization.
• Laser therapy.
• TECAR therapy.

Usually pain management treatments are based on the structures (Ligaments/Tendon/Articular surface) involved.

What kind of exercises you will do?

Exercise program is based on extend of your injury, your activity level before the injury and what are your goals – like getting back to any kind of sports are activity. Usually, it’s ranging from basic range of motion exercises, flexibility exercises, strengthening exercises and proprioception exercises (exercises to regain the joint control).

The most important thing to remember is the torn ligaments in your ankle need to heal, so you need to rest from any activity that might be aggravating your pain. 

Kidney cancer is a disease in which malignant (cancer) cells form in the tissues of the kidney. The majority of cases are non-metastatic, meaning they cannot spread to other parts of the body. However, metastatic kidney cancer can develop into a more dangerous form called renal carcinoma.

Symptoms of Kidney Cancer

Symptoms may include:

• Blood in the urine that is pink or red
• Pain or a lump in the lower back, abdomen, or groin
• Fatigue
• Fevers
• Weight loss
• A urine test showing protein levels that are high or low

Causes and Risk Factors of Kidney Cancer

The cause of kidney cancer isn’t known. Still, researchers think it’s related to a combination of factors, including age, family history, genetics, and environmental factors like exposure to certain chemicals or radiation. It is often diagnosed at an advanced stage because it usually does not cause noticeable symptoms until it has spread to other parts of the body.

Several risk factors increase your likelihood of developing kidney cancer. These include,

Age: People older than 50 years old have a higher risk of getting kidney cancer than younger adults.

Gender: Men are more likely to develop this type of cancer than women.

Diagnosis

A diagnosis of kidney cancer requires a biopsy (the removal of a small amount of tissue for examination under a microscope). This can be done with needle aspiration (sample collected by inserting a needle into the kidney), open surgery, or laparoscopic surgery.

When a doctor suspects that you have the condition, they will perform a physical examination and may order blood tests to check for signs of inflammation or infection in your kidneys. If there are no signs of these complications, you may then undergo imaging tests such as CT scans or MRIs.

These tests provide detailed images of your kidneys, bladder, and other organs. Once your doctor has reviewed all available information about your symptoms and medical history, along with any imaging results, they will determine whether or not you require further treatment, such as chemotherapy or radiation therapy.

Treatment

The condition may be treated by surgery, chemotherapy, radiation therapy, or immunotherapy (where the immune system is used to fight cancer). Some patients may receive a combination of these treatments. Surgery may involve removing part or all of the kidney or an entire lobe (half) of one or both kidneys. Chemotherapy uses drugs to kill cancer cells or stop them from growing and dividing. Radiation therapy uses high-energy beams from machines outside the body to destroy tumors in or near the kidneys. Immunotherapy uses medications that help stimulate your immune system so it can fight off cancer cells more effectively than usual.

Burjeel Medical City Abu Dhabi provides the most advanced treatments available for your condition. Our team of leading experts, including nephrologists, surgeons, pathologists, oncologists, and radiologists, have years of experience treating kidney cancer and have helped many patients achieve positive outcomes.