‘Undertaking detailed analysis’: Patients report eye inflammation, Intas recalls its drug batch

Representational image. Representational image.

With some patients reporting inflammation in their eyes due to Intas Pharmaceuticals’ drug Razumab, the company has advised the doctors to not use any drug of this particular batch. It has also recalled this batch from the market to undergo internal testing at its quality control (QC) lab.

“Intas is aware of few incidences of post injection inflammation reported pertaining to this specific batch, the reported incidences are well within the limits, which were managed by usual anti-inflammatory treatment. We are extremely conscious of our product quality and are undertaking a detailed analysis of the same. Since patient’s safety is paramount to us, hence till the time the analysis is completed, we have advised the doctors to avoid using the product from this specific batch,” Intas Pharmaceuticals’ spokesperson told The Indian Express.

According to an email sent by Raja Narayanan, secretary, Vitreo Retina Society – India (VRSI), to its members, the company has “advised not use Razumab injection of batch number 18020020”. The VRSI has total 750 ophthalmologists as its members spread across the country. “VRSI is gathering more facts on the situation. It is advised that all members be alert and exercise abundance of precaution with other batches of Razumab also,” Narayanan added in his email. In its preliminary report, the VRSI stated that

Intas has recalled all vials of this batch for internal testing at company’s QC lab.

This is the second time VRSI has reported the adverse reactions of Razumab. It first reported the adverse reactions in 2015, just two months after the brand was launched by Intas Pharmaceuticals. Consequently, Intas had curtailed the distribution of Razumab then. Ranibizumab is the name of the molecule; Intas Pharmaceuticals and Novartis sell them in the Indian market under the brand name Razumab and Lucentis, respectively. Lucentis is the market leader and is available for approximately Rs 75000 per 1 ml injection at a retail chemist.

In 2015, Intas became the first company globally to launch biosimilar version of Ranibizumab. According to retailers, Razumab is available at around 25 per cent lower price in the country. Meanwhile, Naryanan told The Indian Express that as a standard procedure, Intas Pharma has withdrawn this particular batch of Razumab that has caused adverse reactions in some patients.

Intas Pharmaceuticals’ spokesperson told The Indian Express: “It is a known fact that, few patients getting such intravitreal injections are likely to experience such inflammation, as also reported in published data and pack insert of innovator Ranibizumab (mentioned as 18 per cent of patients). The reported incidences are well within the limits.”

In people with a certain type of eye disease, new blood vessels grow under the retina where they leak blood and fluid. This is known as the “wet form” of macular degeneration. Ranibizumab is used to treat wet age-related macular degeneration. This molecule is also used to treat swelling in the retina caused by diabetes or by a blockage in the blood vessels.

The VRSI had issued a primary alert on March 18 after first incidents of intraocular (middle layer of the eye) inflammation were reported, after which it did a preliminary investigation. In preliminary investigation, it found that “total 11 eyes from 5 centers” have reported this inflammation.

“Batch (180200)20 was released from factory on February 28. Intas had released 824 vials of Razumab to stockists. 435 vials were purchased by various doctors/hospitals. 182 out of those 435 were used on patients. The first reports of inflammation were received on March 9. As soon as the first events were reported to Intas, the company gave two samples each for clinical testing to two VRSI members. Both reported inflammation after the first injection itself. Intas advised us to stop use of batch 20,” the preliminary report stated.

“Total 11 eyes from 5 centers out of 182 injections have officially reported inflammation. All patients were treated with topical steroids and some with oral steroids. Intas has recalled all vials of batch 20 and is undergoing internal testing in their QC lab. Other batches have not been reported to cause inflammation. Intas will share the QC report with VRSI in the next three days, “ the preliminary report of VRSI added.

Intas Pharmaceuticals’ spokesperson told The Indian Express: “Intas markets Razumab for debilitating eye complications of diabetes like diabetic macular edema, diabetic retinopathy where no other alternatives exist. We market it as social responsibility to alleviate sufferings of such patients of our country. As a responsible organization, we continuously strive to update the medical experts on the scientific aspects of our products and expected adverse events.”

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Source: http://indianexpress.com/article/business/companies/undertaking-detailed-analysis-patients-report-eye-inflammation-intas-recalls-its-drug-batch-4596914/

‘PGIMER is a victim of its own popularity…people have high hopes’

Professor Jagat Ram, Director, PGIMER. (Sahil Walia) Professor Jagat Ram, Director, PGIMER. (Sahil Walia)

You joined last month as the new PGI director. How challenging do you feel it is?

I am trying to understand whatever the issues which are pending, the issues which need to be given priority and then the burning issues at the institute. The appointment has obviously come as a big responsibility for me and my priority shall remain to ensure teamwork so that we can take the institute to a new level. I want to raise the institute to the next level so that we match the top global medical institutes in patient care, research and training. I will take along all the employees of PGIMER whether they are faculty, residents, nurses and technicians.

What are the issues which you think need to be dealt with immediately?

There are a number of issues. The first important thing is the number of patients in the OPD are increasing. In the OPD, it varies from 9,000-12,000 patients and equal number of attendants are there which makes the number not less than 20,000 a day. The rush is triggering another problem as well — the parking remains filled all the time. Now we have started the process so that we can set up a few more parking lots on campus. Another issue is the long queues at the OPD. For that, online registration is an option, but not many people are opting for it. We are now in talks with some private companies so they can suggest how we can handle the rush. We are also evaluating the manpower required.

What about the emergency and the trauma center which remains packed and patients are even in the corridors?

We are working towards ending this problem. We are planning to request the consultants that for all those patients who are admitted in the emergency and trauma, once they are stabilised and when the patients come out of that emergency stage he/she should be shifted to the wards. If the consultants feel the patient is fit, he or she can be even sent to the hospitals from where the patient has come (back referrals). We are also making arrangements to start one OT which was closed in the new OPD, to help the patients who are on the waiting list and have to undergo ortho related minor surgeries.

But then there are those referrals, which are unnecessary and can be dealt at a local level?

Yes, focus is on coordination with the state governments of several states. We may offer training to the doctors and other medical staff of the hospitals located in the neighboring states to avoid unnecessary referrals to the PGI.

Why do you think there is so much flow of patients to the PGI?

I think, we are a victim of our own popularity. People have high hopes from PGI and they prefer to visit us rather than other hospitals.

Research is important for any institute. What are your plans to boost it?

Our technical research has to improve and I think we need to take it to another level. We should have cutting-edge technology. We have started steps which will give research activities a boost.

Of late, agitations have become a routine. Even now, the nursing association has sent some recommendations regarding some issues in which they have threatened a strike.

We always try our best here to solve the problems. The case which you are talking about, they have some proposals and we are examining it. But threatening to go on strike at the beginning itself, I don’t think that is a right approach.

What are the plans for the Sarangpur land? Which new centers are coming up?

We have started internal discussions about what new facilities can come up on the 50-acre land which has been sanctioned to PGI at the Sarangpur area. We have now written to all the HOD’s to come up with ideas on what new facilities could come up on the land, keeping in mind the current situation of the PGI and also the institute’s priorities for patient care. We have some proposals from the department.

How’s the Sangrur satellite center going? Are people visiting for treatment?

The Sangrur satellite centre is now picking up. People are visiting for treatment on a daily basis. In the future, the number of patients who visit on a daily basis will further increase.

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Source: http://indianexpress.com/article/education/pgimer-is-a-victim-of-its-own-popularity-people-have-high-hopes-chandigarh-4597054/

A prescription for the doctor

Last week, as I studied communication theories and patient-centred communication frameworks for shared decision-making in healthcare in a classroom in Harvard University on a rainy Boston afternoon, doctors in Maharashtra went on strike over alleged assaults in emergency rooms. Based on reports I read from here, the attacks were said to be particularly violent, and the strike and protests from doctors that followed were also longer and more momentous. But apart from that, it was a story that plays out repeatedly in India, and one that I worked on at some length in Delhi as a reporter.

When politicians or the judiciary insinuate, or articulate directly, as they did this time, that doctors should not strike like other professionals, basing their argument on some higher moral obligation, the blame for triggering these reactions is put on news reports. I saw this repeatedly in my interactions with doctors as a journalist and now I see it in the classroom.

Communication is linked with public health, and doctors, programme managers and researchers involved in the myriad sectors of the field across the world, often find their paths crossing those of journalists. As someone who covered public health in India for a while, and now donning the student hat on the statistics, epidemiology and implementation science of it all, I find myself torn, trying to be “fair” in my reactions and assessments in these classroom debates.

It is hard to explain to anyone outside of journalism, the sheer doggedness it takes for journalists to go out every day in fields we learn about almost entirely just through telling stories about them, how we navigate systems and forces in specialised and super specialised fields, with no learning tools, making our own mistakes. Identifying stories that are worth telling, and the multiple stakeholders involved in each story, and chasing them to get that utopian “balance” is no mean feat. As an academic, a practitioner, a “source” of news, it is equally painful to see one’s narrative, one’s years of blood and sweat, being “twisted” for what has come to be everyone’s pet peeve about journalism — “sensational headlines”.

An argument that was brought up time and again in class discussions had to do with news stories on hospital-based deaths shooting up after the strike, with no effort to collate the average mortality or morbidity rates in the weeks or months prior to the strike. And even if the deaths did go up, the doctors in my class(es) argued, what was the evidence to relate them to the strike? Co-relation, as they teach you in any introductory statistics course, does not imply causation.

But what does a journalist reporting a story do when the counsel for a state agency (in this case, the Brihanmumbai Municipal Corporation) makes this argument in court? Taking state agencies at their word is not journalism, but not reporting an official statement made in court is also arguably not journalism either. Ideally, such a story should be followed with data analysis on mortality over, say, the last six months in the same hospitals.

Though this would still not establish whether or not the deaths over the last week were due to the strike, without eliminating confounders and a dozen other statistical nuances, it would demonstrate some effort at fact checking. But in a developing story, how many newsrooms would allow a journalist that freedom of time and space? And even if they did, how many journalists have the skill set to do that kind of analysis? Is this even the mandate of journalists or something academics must do and share their results with journalists? Before making official statements about these figures, should state agencies be engaging in this fact-checking themselves?

But antagonising those who are trying to tell their stories may not be very sound strategy for doctors. This is especially so at a time when public opinion seems crucial to achieving their rightful demands to workplace security. Patients’ kin engaging in violence in ERs is not a problem unique to India. Learning from communication strategies in other countries across the developing world, might be a good starting point. Doctors, particularly resident doctors, are the frontline face of public hospitals in India. As unfair as it may seem, the truth is that patients’ kin in public hospital emergencies do not understand who makes decisions on purchases of ventilators or medicines. To achieve that level of health literacy in patients in government hospitals will take some time.

Till then, the choice to not communicate and stay restricted in the silos of surgery rooms and research laboratories does not really exist for medical practitioners. As this strike underlined, physicians, administrators and public health professionals need to recognise communication as a skill that needs learning as any other.

As the world debates best practices for shared decision-making in healthcare, the images of doctors wearing helmets in workplaces, as creative as they may be as token protests, are not those that India’s public healthcare system should be associated with. There has to be a middle ground somewhere, for doctors and patients to communicate better, despite the resource constraints.

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Source: http://indianexpress.com/article/opinion/columns/a-prescription-for-the-doctor-strike-maharashtra-patient-4596883/

Mercury’s march: 1,142 heatstroke cases, 4 deaths in a month in Maharashtra

With four deaths due to heatstroke in a week, the state health department has sprung into action, training doctors and earmarking dedicated beds for patients in all district hospitals. According to the Directorate of Health Services (DHS), air-conditioners and air-coolers are being installed in separate wards at district hospitals for patients affected by hyperthermia.

In the month of March alone, 1,142 hyperthermia patients were attended to by the government-run ambulance service, 108, across the state, of which maximum were from Amravati (89) followed by Mumbai (81), Pune (72) and Yavatmal (70).

The toll-free ambulance aims to provide first aid to save critical time. “The protocol is to reduce body temperature by taking the patient to a cooler shed and by removing excessive clothing,” said an official from the helpline, adding that patients might be given oral rehydration solution (ORS) to stabilise them before reaching hospital.

“We have identified 18 to 20 districts where summers are most harsh. Training to medical staff and allocation of four beds each in district hospital have been done. In other districts, doctors have been sensitised about treatment for heatstroke,” said Dr Satish Pawar, director at DHS. Dhule, Jalgaon, Solapur, and districts falling under Marathwada and Vidarbha have reported higher temperatures with maximum soaring above 40 degrees Celsius this year.

The high cases of heatstrokes, where body temperature rises above normal due to prolonged exposure to intense heat, have been attributed to prolonged drought-like conditions in the state in the last two years. Data from the emergency ambulance service shows a steady rise in hyperthermia cases in last three years. From 185 patients handled in 2014 (April to May), the count of hyperthermia patients rose to 1,255 in 2015 and 2,688 in 2016.

Last year, maximum calls came from Amravati (393) followed by Mumbai (206), Yavatmal (148) and Chandrapur (122). This year, Bhira village in Raigad reported maximum temperature in India on March 29 at 46.5 degrees Celsius.

On Sunday, the India Meteorological Department reported that maximum temperatures reached 41 degrees in Amravati, 40.8 degrees in Beed, 41 degrees in Bhira, 42 degrees in Jalgaon and 32 degrees in Mumbai (Santacruz). Patients affected by heatwave are given cold water bath, admitted in a room with an air-cooler or air-conditioner, and efforts are made to bring down their body temperature. Exhaustion in sun is also responsible for heatstroke, officials said, adding that prolonged exposure to sun must be avoided and regular water intake must be ensured in this season.

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Source: http://indianexpress.com/article/india/mercurys-march-1142-heatstroke-cases-4-deaths-in-a-month-in-maharashtra-summer-weather4596960/

Maharashtra: Over 400 security guards deployed in major hospitals

Over 400 security guards from the Maharashtra State Security Corporation were posted in major hospitals, such as KEM, Nair and Sion, to step up security for working doctors. The move comes after the state had assured protesting doctors last week to take stringent security measures at government hospitals, to prevent cases of assaults by patients’ relatives. According to Dr Suleman Merchant, dean at Sion Hospital, an emergency hotline (3374) has been initiated for doctors. The number has been linked to Rapid Action Force, who will dispatch a team whenever a doctor makes a distress call. Additionally, colour-coded passes have also been launched across all government hospitals. Relatives of patients will be issued different coloured passes for out-patient department and in-admission patients. Over 4,500 doctors had gone on a five-day-long strike to protest against attacks on resident doctors after an orthopaedician was brutally assaulted in Dhule, Maharashtra.

According to the state government, more posts for security guards will also be allotted in coming days. “Plans to install wireless intelligent alarm system are also underway,” said Merchant. “Only two relatives per patient will be allowed. We have already set up CCTV system. MCGM security will man civic hospitals,” said BMC’s Additional Municipal Commissioner Idzes Kundan. The government has assured to improve security in 14 government medical colleges, especially outside casualty and emergency wards, along with the BMC-run hospitals.

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Source: http://indianexpress.com/article/mumbai/maharashtra-over-400-security-guards-deployed-in-major-hospitals-4595819/

PGI starts discussions on use of Sarangpur land

The Postgraduate Institute of Medical Education and Research (PGIMER) has started internal discussions about what new facilities can come up at the 50 acre land which has been sanctioned to PGI at the Sarangpur area in the city by the Chandigarh Administration. UT Administrator and Governor of Punjab V P Singh Badnore has already extended all his support to the PGI administration about the transfer of the land to PGI. PGI sources said that senior PGI officials are again meeting the Governor regarding the matter. At PGI earlier this week, a meeting too was held which was attended by senior faculty members. During the meeting, discussions were held about which centers could come up at the allotted land.

Sources said the institute’s director Jagat Ram has now written to all the HODs to come up with suggestions about possible new facilities at the center, “keeping in mind the current situation of the PGI and also the institute’s priorities for patient care.” Among the proposals which are being discussed, PGI officials said, are included screening OPD, trauma and emergency care, new state of art facility hospital, genetic and chronic rehabilitation centre, cancer centers and others.

PGI officials believe that the new facilities would help in improving patient care at the institute. “So far, nothing has been decided on which new facility will come up at the land, but the new facility will definitely decrease the rush at the main campus,” said a senior official. The official went on to say: “For example, if screening OPD or trauma centre comes up at Sarangpur, it will help to bring the rush down at the main campus. The OPDs and the trauma centre currently are always jam-packed.”

The rush of patients at the PGI is one of the major problems faced by the institute currently. Newly joined director Dr Jagat Ram has been maintaining that finding solutions to the huge rush will be his priority. Currently, as per PGI statistics, around 10,000 patients visit the OPD every day. Adding to the rush are family members who accompany the patients to the OPD which makes the number of people visiting the OPD not less than 20,000 a day.

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Source: http://indianexpress.com/article/india/pgi-starts-discussions-on-use-of-sarangpur-land-4595936/

Now, a web portal to rate how ‘patient-friendly’ your doctor is

In 2015, city-based doctor Dr Arun Gadre conducted a study of problems faced by doctors who were trying to practice ethically. He met 78 doctors across India to interview them on the present status of private healthcare in India. Recalling how the doctors shared their experiences with him, Gadre said, “it was sort of a whistle-blower outburst of frustration among doctors about the stark commercialisation of the profession.” Based on his study, he wrote a book in Marathi — Kaifiyat — followed by a second part of the book launched by Gadre’s friend, Dr Abhay Shukla. The second book, Dissenting Diagnosis, talked about solutions to the problem of unethical medical practices.

Last year, Gadre and Shukla, along with other like-minded doctors, Dr Anant Phadke and Dr Abhijit More, launched the Pune Citizen Doctors Forum (PCDF). On the occasion of World Health Day, on April 7, PCDF will launch a web portal — http://www.medimitra.org — that will allow patients to rate their doctors by registering the doctor’s name on the portal and answering six questions. The questions are: What is your overall experience, did the doctor give you adequate time, did the doctor explain your disease and the required treatment, did the doctor answer your queries, did your doctor refer you to a specific drugstore, and do you think the charges were transparent?

Based on the answers given by the patient, the system will automatically generate a score and based on that score, the doctor’s name will be automatically added to the list of patient-friendly doctors. “The forum will not do anything… it’s the patients who prepare the list. The patients can give their feedback while remaining anonymous. We want the patients to judge their doctors more objectively. If more patients register their doctors and share their opinion, the list will be valid. The information may be useful for other patients looking for ethical doctors. For instance, if a patient is looking for a cardiologist, s/he may visit the website and look for cardiologists registered there,” explained Phadke.

The Forum has an advisory board which comprises eminent persons from medical and social fields, such as senior gynaecologist Dr Sanjay Gupte, RTI activist Vivek Velankar, Dr Pratibha Kulkarni, and senior activist of consumer rights, Suryakant Pathak, among others. The managing committee members include doctors as well as people from other backgrounds — Dr Sharda Bapat, Dr Shreeram Geet, Dr Madhavee Agashe, Ulhas Sawant and Deepak Tawri, among others.

The Forum aims to organise discussions among patient-friendly doctors and local residents on topics such as the patients’ rights and responsibilities, dilemmas in rational, ethical practice, the policy of health care for all, to understand each other’s problems and help each other take remedial steps, to make patients aware of not only their rights but also of their responsibilities, to prepare and publish with the help of such doctors, standard educational material in the layman’s language.

The primary aim of the portal is to overcome the growing ‘trust deficit’ between patients and doctors. “We don’t want to make sweeping statements against doctors. There are good and bad people in all professions. There is a community of doctors who want to practice medicine ethically. It is a dwindling community but it does exist… there is a section of enlightened citizens as well as a group of ethical and rational doctors. We want to bring these two groups together…,” said Dr Phadke.

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Source: http://indianexpress.com/article/cities/pune/now-a-web-portal-to-rate-how-patient-friendly-your-doctor-is-4595745/

Mumbai: Govt cracks whip on hospitals for overpriced medical devices

The state government has filed cases against top city hospitals found to be overcharging for stents and other equipment used to treat heart ailments, Minister for Food and Drugs Administration (FDA) Girish Bapat said on Thursday. Replying to a Calling Attention motion moved by Congress legislator Sanjay Dutt and 26 others, Bapat said the government had already filed cases against eight city hospitals under the Consumer Protection Act. The state government since January has been using provisions of Legal Metrology law, he added.

The state government has now cracked the whip on eight hospitals in Mumbai, ensuring that medical equipment like stents, catheter and balloon device are sold to patients at the Maximum Retail Price (MRP) and are not overcharged, he said. Although the state government has fixed the price of stents and other equipment, hospitals were still found to be overcharging. Dutt and the other legislalors in the Upper House demanded to know what action was taken against these hospitals. “It’s not just these eight hospitals in Mumbai that are overcharging, there are many other hospitals across the state openly doing this. They are misguiding patients and their relatives for making profits. I spoke to many patients who have undergone angioplasty and they told me the same story: expensive stents were recommended to them by hospitals. When the state government takes a good step, it should also ensure it is implemented well,” Dutt said.

Bapat admitted that the FDA faced a staff crunch in enforcing the law and added that the government was taking the help of retired officers and NGOs to enforce regulations. Elaborating on the action taken against the eight hospitals, Bapat said, “Eighteen medical devices are included in the list, which have to be sold at their original MRP only. Action was taken against eight hospitals which were found overcharging – Fortis, Breach Candy, Lilavati, Kokilaben Dhirubhai Ambani, Asian Heart Institute, Global, L H Hiranandani and Sir H N Hospital,” Bapat said.

He informed the House that these hospitals were found to have been charging about Rs 1.05 lakh to Rs 1.90 lakh for a stent while they procured the same from importers at Rs 50,000 to Rs 90,000. Bapat said to help people reach out to the FDA, government notices had been put up at all the hospitals with complaint numbers of the legal metrology department, email and WhatsApp number where people can lodge complaints.

Raising a supplementary query, Dutt said the government must keep a vigil on the attempts by hospitals to inflate bills by adding other charges of doctors and services provided by the hospitals. To this, Bapat admitted that sample medicines meant for doctors have been found to be sold to patients in some hospitals. “The government will call a meeting to discuss the issues soon and decide on next course of action,” he said.

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Source: http://indianexpress.com/article/cities/mumbai/mumbai-govt-cracks-whip-on-hospitals-for-overpriced-medical-devices-4593276/

Dopamine levels fall and fluctuate during a migraine attack

Have you suffered from a migraine attack? (Source: Thinkstock Images) Have you suffered from a migraine attack? (Source: Thinkstock Images)

A recent research has shown that dopamine levels fall during the migraine attacks.

Using PET scans of the brain, the University of Michigan researchers showed that dopamine falls and fluctuates at different times during a migraine headache.

ALSO READ | Why migraines are more common among women

This could help scientists better understand dopamine-based therapies for migraines as well as a patient’s behaviour during an attack.

The connection between dopamine and migraines has long been a poorly understood therapeutic and research area, said researcher Alex DaSilva. Dopamine, sometimes called the brain’s feel-good neurotransmitter, helps regulate emotion, motivation and sensory perception.

Physicians and emergency rooms often give migraine patients dopamine antagonists, drugs that block overactive dopamine receptors, to level off wild dopamine fluctuations and ease migraine attacks.

DaSilva and colleagues took various measurements of brain activity and dopamine levels of eight migraine sufferers and eight healthy patients during migraine attacks and between headaches. They compared study participants to each other with and without headaches, and also migraineurs to healthy patients.

When migraine patients were between headaches, their dopamine levels were as stable and even as the healthy patients, DaSilva said. But during an attack, the migraine patients’ dopamine levels fell significantly.

“This dopamine reduction and fluctuation during the migraine attack is your brain telling you that something is not going well internally, and that you need time to heal by forcing you to slow down, go to a dark room and avoid any kind of stimulation,” he said.

The study appears in the journal Neurology.

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Source: http://indianexpress.com/article/lifestyle/health/migraine-attack-headache-dopamine-based-therapies-4592418/

Is It Common to Pee While in the Dental Chair?

Pop star Iggy Azalea’s embarrassing confession has others wondering if it could happen to them. The diva admitted on Twitter that she wet herself while sedated at the dentist’s office! Is this one more reason to be scared of going to – and maybe going at – the dentist’s office!?

“It hasn’t happened to me, but it does happen,” says Dentist Dr. Chris Strandburg. “The medicines they use to sedate you can make you REALLY relaxed!”

His suggestion for patients who are nervous about staying dry – if you’ll be having anesthesia, limit what you eat and drink before your appointment.

Watch: Preventing Tooth Decay

And for patients who are nervous about visiting the dentist in general, Dr. Strandburg has some more helpful tips:

• Break the fear cycle! When you step in the door, admit you’re nervous and ask the receptionist to make it an easy visit. Meet the dentist and get comfortable.

• Dr. Strandburg says that starting with an easy procedure like a simple filling can get many patients over their dental fear.

• If all else fails, anesthesia is an option! Just make sure to make a bathroom stop before climbing in the chair.

Watch: Visiting the Dentist for the First Time

ER Physician Dr. Travis Stork notes that regular dental cleanings and good oral hygiene can actually reduce your risk for inflammatory disorders, including heart disease — it’s especially important for diabetics and pregnant women. “If you’re afraid of this guy – don’t be!” he concludes.
Courtesy: https://news.yahoo.com/health/

Source: https://news.yahoo.com/news/common-pee-while-dental-chair-235031150.html