Categories
Healthcare Delivery

Working towards a Lean Healthcare system

With the increasing emphasis on the application of concepts of lean management in hospitals across the world, gaining popularity as ‘Lean Healthcare’, Value Stream Mapping (VSM) is an elementary tool that allows one such implementation. The common principle behind lean management is ‘to do more using less’. The VSM model is particularly designed for hospitals and healthcare settings that have a direct influence on the admission of patients and their time of treatment. This article presents a case study of a tertiary care hospital of India where the ‘Lean transformation-VSM’ of the ‘Patient-admission’ process is administered for the reduction of time taken by the admission process. Efforts were made to reduce the admission of the patient for making the process smoother and faster when compared to the existing process in the hospital.

The first step involved in the experiment was to gather information of existing patient admission process followed in the hospital by: Direct observations, Interviews and Patient follow-ups. A comprehensive study of the patient admission operations was accomplished, which was later successfully utilized to recommend improvements to reduce delays. Analysis of the existing state was done using a ‘time-motion study’.

The non-value-added steps were identified in conducting the ‘Root-cause Analysis’ of every step involved in the patient admission cycle. A new process was designed by syndicating them, streamlining or reviewing the categorization of events to support greater competency or even discarding few steps. Efforts were made to implement the ‘Modified value stream process map’.

The result was astonishing! The entire experiment helped in bringing down the time of whole process of admitting the patients from an average of 25 minutes per patient to 15 minutes per patient. The hospital was able to achieve almost 40% of reduction in overall patient’s time for their admission process. This in turn offered the hospital with the earnings of higher patient satisfaction.

The understanding of recreation and the steps involved in conducting this recreational study built a strong groundwork for verifying and validating the simulation model-VSM.

John F. Kennedy said ‘We must use time as a tool, not as a crutch’. Efficient optimization with the help of Lean Management can enhance not only the operational efficiency but also the quality of care provided to the world. The experiment was just a drop into the wide oceans of Lean!

About the Authors


Dr. Feroz Ikbal
Assistant Professor,
Tata Institute of Social Sciences Mumbai campus
EmailID: feroz.ikbal@tiss.edu


Dr. Megha Jogi
Master of Hospital Administration (MHA),
Tata Institute of Social Sciences Mumbai campus
EmailID: meghajogi9@gmail.com
With the increasing emphasis on application of concept

Categories
Healthcare Delivery

Common causes of pain in foot and ankle in the elderly

Our feet tolerate a lot of pressure whenever we stand, walk, or run. The pressure of our entire body weight is transmitted to our foot. Mobility in the joints of our feet is responsible for our ability to walk on uneven surface, shock absorption and thus enabling forward propulsion of our body. As we grow old, there are lot of factors- systemic (related to blood vessels, nerves and skin) and local (wear and tear of joints, stiffness, deformities and weak bones) that can contribute to pain in the foot. Foot pain in elderly can cause walking difficulty and further impair balance. This could lead to loss of independence which would be detrimental to their overall well-being.

The most common triggers of pain in foot and ankle region in elderly are:

Trigger #1: Corns/callus

The skin on the heel and ball of the toes is thicker to withstand pressure which these areas encounter during weight bearing. With ageing, the pressure remains constant but the ability of the skin and fat to withstand stress diminishes, thus predisposing to calluses. Callus is an area of thickened skin in the sole of feet in response to increased pressure. It may be simply due to loss of fat with age, due to underlying unnoticed deformities in the foot or may be a prequel of something sinister like an ulcer in a diabetic patient.

Corns are painful areas of thickened skin that might occur due to ill-fitting shoes. As people grow old, the shape of the foot may change and resultant misfit shoes may predispose to corns. They are most commonly seen in outer aspect of little toe, top of small toes as well as in space between the toes.

Treatment:

Wearing a well-fitting comfortable footwear is the first thing to do when you notice corn or callus. Medicated corn caps may be tried but with caution as it can dissolve the normal skin as well thus worsening the situation. Corn caps and salicylic acid creams are contraindicated (not to be used) in diabetics and with poor blood flow. For diabetics, evaluation of the foot is necessary if a callus is noticed. Pairing of calluses can be done for painful corn and excessive callus by a foot and ankle specialist but an underlying bony problem needs to be identified as well.

Trigger #2: Ingrown toe nail

Cutting of toes nails require flexibility in joints of the body, manual dexterity and a good vision. Unfortunately, all of these are affected with age thus limiting the ability to cut the toe nails. The nails also become dull and brittle with age thus making them more prone to nail disorders. All these factors topped up with inability to maintain a good toe nail hygiene predisposes elderly people to develop toe nail disorders. Ingrown toe nails happen when the side of the nail grows under the skin next to the nail. It mainly affects the big toe but can involve any other toe. Inflammation secondary to nail growing under the skin may cause pain, swelling, redness or pus discharge under the nail.

Treatment:

Soaking feet in warm water, cutting toe nails straight, pushing the skin away with a cotton ball and using over the counter medicine or creams can be used in the beginning for those who develop ingrown toe nails. An infected ingrown toe nail needs oral or topical antibiotics but in few cases may need surgery to decompress the infection. In cases where the condition does not settle down despite the above mentioned procedures, a small surgical procedure to remove full/ part of toe nail may be needed.

Trigger #3: Bunion

A deformity where big toe deviates towards the second toe is called bunion. In elderly population, development of arthritis and other mechanical factors can predispose one to develop bunions. Also, wearing narrow toed shoes in adulthood predisposes one to have bunion and lesser toe deformities in elderly. Bunion may lead to pain not just in the big toe but can also cause secondary pain under second or even third toe.

Treatment:

Once a bunion develops in elderly, the only way to remove it is by surgery. However, measures like using a proper footwear and doing some exercises can help in alleviating the pain arising from bunion. Also, bunion pads, inserts and arch supports can be used for symptomatic relief. In severe cases, surgery is needed to align the toe to its normal position by releasing the soft tissues and even cutting the bone. These surgeries are normally performed as day surgery by foot and ankle specialists and patient can immediately walk post-surgery with a special shoe.

Trigger #4: Flat feet

As the ligaments and muscle responsible for maintaining the arch stretch out with time, in old age the arch of the foot reduces its height. This condition is named Adult Acquired Flat Foot (AAFD). Due to this problem, people may experience pain in inner aspect of ankle and in severe cases on outer aspect, which is worse with physical activities. They may also notice swelling in the inner ankle or arch region. People also notice a change in the shape of the foot. A consequence of this deformity is alteration of not just the foot but the whole lower limb biomechanics and thus can result in overpronation, ankle/foot sprain, hip/knee/lower back pain, limb length discrepancy and loss of stability. 

Treatment:

Evaluation and treatment of flatfoot requires a comprehensive knowledge of this deformity and resultant altered biomechanics as well as critical clinical judgement. Mainstay of treatment in earlier cases may be insoles including medial arch support and heel wedges as well as physiotherapy to strengthen and stretch the muscles of your feet. Surgery is reserved for those cases which are way too advanced or have failed a trial of non-operative management and can vary from heel shift procedures and tendon transfer to fusing the joint in severe cases.

Please refer to my detailed article on flat feet for more info on this ailment and treatment protocols: https://bit.ly/3b9idoe

Trigger #5: Arthritis/Osteoarthritis

The progressive wear and tear of the joints due to a multitude of reasons trigger arthritis. The loss of protective cartilage in the joint as we grow old leads to osteoarthritis. It may cause episodes of inflammation which manifests as pain, swelling and stiffness around the joints.

In India more than 180 million people in India suffer from arthritis and its prevalence is much higher than many well-known diseases such as diabetes, AIDS and cancer. According to arthritis foundation, close to half of the people in their 60s and 70s may be suffering from arthritis affecting their feet. It can reduce the walking speed and can lead to impaired balance thus leading to difficulty in performing daily activities in the geriatric population.

Treatment:

While we should understand that there is no research-proven treatment as yet that can reverse/ stop the progression of arthritis, there are still a lot of options that can reduce the symptoms. Wearing comfortable shoes, exercises, weight reduction, gentle massage of the foot and over the counter pain killers and creams may help us combat the symptoms associated with arthritis. In more advanced cases, surgery may be needed which may include cleaning of the joint (debridement), fusion (arthrodesis) or replacement (arthroplasty).  

About the Author

Any pain in the foot or ankle should be evaluated by a foot and ankle specialist to accurately diagnose the condition. Dr. Anuj Chawla is one of the leading Orthopedics and foot & ankle surgeon in India. He can be contacted at dranujchawla@gmail.com. For consultation with Dr. Anuj, book an appointment by visiting the website: http://dranujchawla.com/.

Dr. Anuj’s social channels:
Twitter: @dranujorthoFacebook: https://www.facebook.com/doctoranujchawla/

Categories
Healthcare Delivery

Can pharmacists reduce the disease burden of doctors?

The following is a guest post by Pharmacists and Medical Expert Katta Anand Srinivas

Problem: There is one doctor for every 1,445 Indians as per the country’s current population estimate of 135 crore, which is lower than the WHO’s prescribed norm of one doctor for 1,000 people. This is a known stat and this problem has been highlighted over and over again. My attempt with this writeup is to highlight if we can manage our existing talent resources of Pharmacists (PharmD graduates or Post-graduates / Doctorate in Pharmacology only) professionals to reduce the burden on Physicians.

Facts: Before going into the details of how Pharmacists can contribute to the subject under discussion, it is worthwhile to look at the current health status of Indians in workforce.

  • Lifestyle diseases are hitting India where it hurts — its workforce
  • Over 61 per cent of all deaths in India are due to lifestyle.
  • 33% of the population above 30 are suffering from one or more lifestyle diseases.
  • Every 12th Indian a diabetic — India ranks second in the list of countries with highest diabetes patients.
  • Nearly 26% of deaths in India are caused due to heart ailments.
  • The number of overweight and obese people in India doubled.
  • 42.5% of corporate employees suffer from depression
  • 52 per cent of corporate employees are afflicted to lifestyle diseases
  • lifestyle habits of employees result in productivity loss worth Rs 24,000 crore to the IT sector in Bengaluru every year which is around 7% of the IT sector’s total revenue in the city.
  • Employees in the age group of 30-40 years of age contributes to highest share which is 42 per cent of total cost to IT sector due to productivity loss.
  • 23% of women and 19% of men in the workforce are obese.

Discussion: This lifestyle diseases are mostly caused in the younger population due to Metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These

conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

High Blood Pressure: White coat hypertension is a condition affecting patients whoexperience stress or anxiety at a medical setting such as doctor’s office or hospital. This results in a higher than normal blood pressure reading during their visit. White coat hypertension is reported to occur in as many as 25 per cent of the population, increasing the risk of misdiagnosis.

Undiagnosed Hypertension: As per one of the study 10.1 % among the study population were not even aware that they have hypertension until they observe symptoms related to heart disease, makes the scenario rather grim. When left undetected, hypertension can cause damage to the cardiovascular system and internal organs, such as the kidneys.

Globally, 51% of stroke (cerebrovascular disease) and 45% of ischaemic heart disease deaths are attributable to high systolic blood pressure. At any given age, the risk of dying from high blood pressure in low- and middle-income countries is more than double that in high-income countries.

A patient might visit a doctor’s office maybe twice a year or sometimes only when they are sick, unlike their visit to their local chemist. Chemist / Medical stores are visited by the patients at least 3-4 times a month for buying prescription medicines, OTC, Diapers, Feminine hygiene, cosmetics and patients might see the pharmacist / pharmacy when they pass by, as they reside in the same community. This increases the comfort level and reduces the anxiety hence less chances of white coat hypertension. Additionally, hypertension screening at the local chemist shop as they are frequently visited by people (above the age of 30) for minor ailments like diarrhoea, headache, muscle sprain, band aid, vomiting thus reducing the cases of undiagnosed hypertension.

Diabetes Mellitus (“diabetes”) is one of the fastest growing chronic diseasesworldwide, and is associated with significant morbidity, mortality, and health care costs. Diabetes is characterized by high levels of glucose in the blood (hyperglycaemia).

The statistics related to diabetes mellitus globally are alarming. The International Diabetes Federation (IDF) Diabetes Atlas, Seventh Edition, 2015, provides the following estimates: one in 11 adults have diabetes (416 million), nearly half (46.5%)

of adults with diabetes are undiagnosed, and a person dies from diabetes every 6 seconds.

Adults with diabetes have a two- to threefold increased risk of suffering a heart attack or stroke compared to those without diabetes. The microvascular complications of diabetes mellitus make it the leading cause of preventable blindness (Diabetic Retinopathy), renal disease (Diabetic Retinopathy), and amputation (Peripheral Neuropathy and vascular disease) in developed countries.

Diabetes has widespread effects, for every 4 people who have Type 2 DM, about one is undiagnosed. Some of the factors that put a person at risk for diabetes include a family history of the disease, obesity, physical inactivity, high blood pressure, and high cholesterol.

Pharmacists are in a prime position to identify these and other risk factors in patients. Routine and simple tests such as blood glucose testing conducted at health fairs and wellness clinics at pharmacies across the country are an example of how a simple test conducted in the pharmacy or by the pharmacy team may provide an efficient method for identifying a patient with a potential diagnosis and help direct them to appropriate medical attention.

For those who are diagnosed, pharmacists can provide counselling about monitoring glucose levels and how to manage out-of-range levels, including developing an action plan for what to do for hypoglycaemic episodes. Pharmacists can counsel on an appropriate diet and exercise routine to compliment medication management in treating diabetes. This can be especially useful in underserved areas where access to nutritionists or dieticians may be unavailable.

The number of treatment options for diabetes has increased substantially over the past few years, and pharmacists are best positioned to help patients understand the fundamentals and intricacies regarding the medication. For patients requiring insulin, the pharmacist can help instruct the patient on how to administer the medication, as well as answer common questions and concerns.

Community pharmacists are the most accessible health care professionals, as no appointments are required to see them, and to have the highest level of patient contact. Pharmacists are key players in the betterment of patients’ health, not just in terms of screening but in the lifelong management of the disease.

Lifestyle Modifications: it is reported that being overweight or obese contributessignificantly to the burden of diabetes (44%), ischemic heart disease (23%), and certain cancers (range 7%–41%). Yet, obesity is preventable, and strategies to prevent diabetes and cardiovascular disease both include the common goal to optimize peoples’ weight through diet and exercise.

Obesity is currently a worldwide pandemic. Of the world’s population, an estimated 35% of adults are overweight – defined by the World Health Organization (WHO) as a body mass index (BMI) of ≥25 kg/m2. Globally, an estimated 12% of adults are obese (BMI ≥30 kg/m2), half of whom live within just a handful of countries, including the United States of America, People’s Republic of China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.

The rise in obesity can be attributed to multiple factors, most notably modern lifestyles, which allow for easy access to inexpensive unhealthy foods, sedentary lifestyle, and environmental factors that limit access to healthy diet and exercise management. Effective management of the obesity pandemic requires the promotion and fundamental acceptance of healthy lifestyle habits, which in turn depend upon the availability of resources such as affordable nutritious food options and access to venues that promote exercise. In addition, counselling and guidance by health care professionals is necessary for disease state prevention and treatment. The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases outlines several objectives to be attained by 2020, including increasing physical activity; decreasing the risk of premature mortality from cardiovascular disease, cancer, diabetes, and chronic respiratory diseases; and halting the rise in diabetes and obesity.

Pharmacists were well suited to delivering weight management services, especially given their regular contact with patients. Participants felt that pharmacists were already well trained to perform basic physical assessments such as weight, waist circumference, blood glucose monitoring, and pharmacotherapy counseling, while additional training could be easily obtained for services that would encompass dietary counseling, guidance on physical activity, and behavioral counseling. Programs that have been developed exist either within community pharmacies alone or as part of collaborative agreements between pharmacists, physicians, and other health care providers. Pharmacists have demonstrated that they can improve drug therapy for patients through medication therapy management (MTM) for chronic diseases such as hypertension, diabetes, and dyslipidemia. Increasing the awareness and knowledge of lifestyle modification strategies may help pharmacists implement more comprehensive MTM services.

Other Areas: A Pharmacists goes through a gamut of questions in his everyday work. They can range from which medication to use for a rash, which is a preferred diabetic meter, demonstrating an asthmatic patient as to how to use an inhaler. An elderly gentleman who came to pick up his blood thinner medication wanted to know which foods he needs to avoid when he is on this medication and a teenager required insights from the pharmacist on which acne cream needs to be used. There was also a concerned mother of a 5 yr old boy who needed recommendation of which medication she can use for her son’s diarrhoea and vomiting. Pharmacists can be a valuable resource of smoking cessation.

Conclusion / Summary: Pharmacy is a profession that is expanding beyond the traditional compounding and dispensing of medication towards a more professional advisory and primary health care role. They are an integral part of the community and serve as an important source of knowledge. Pharmacists are dynamic, patient-centric professionals committed to fulfilling the health care requirements of their patients and they would serve in reducing the burden of our Doctors for treating minor ailments, answer queries related to medicine and medical devices and also provide guidance in disease management.

About the Author

Katta Anand Srinivas is a Pharmacologist, Clinical Pharmacist, Medication Counsellor, Marathoner, and Yoga Practitioner. He has received his MS in Pharmacology from the University of Toledo, Ohio, USA. He is a licensed pharmacist in Washington State and North Carolina, USA and a
a certified reviewer of Elderly Medications from American Pharmacists Association, USA. Anand also runs a website http://www.askyourpharmacist.in.

You can contact Anand at contact@askyourpharmacist.in

References:

  1. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/white-coat-hypertension/faq-20057792
  1. https://www.business-standard.com/article/pti-stories/doctor-patient-ratio-in-india-less-than-who-prescribed-norm-of-1-1000-govt-119111901421_1.html

https://www.medbroadcast.com/channel/medications-and-your-health/how-your-pharmacist-can-help/the-role-of-a-pharmacist

Categories
Healthcare Delivery

Introduction to Psychiatric Conditions

By Dr Kiran Manduva

Mental health is an often ignored aspect of overall health. It is a truism that there is no health without mental health. In fact, mental health is so crucial to one’s overall well being that a physically disabled or otherwise afflicted person can still be a happy and productive member of society if his mental health is taken care of. There are many examples of such people who ‘ve beaten tremendous odds in life to come up and make their mark on society. That is simply not possible without a robust psychological state of being. Thus, despite health being a holistic entity, if I had to choose, I will place psychological health a notch above physical health.

Instead of going into technical details and statistics, I will try to present a bird’s eye view of the problem at hand. At the risk of sounding simplistic, I will divide the psychological disorders into six groups, for the purposes of the present article. These are

  1. Major psychiatric disorders including schizophrenia, bipolar disorder, severe depression etc.
  2.  Minor psychological conditions including anxiety, minor depressions, stress-related conditions,
  3. Personality disorders, marital discord.
  4. Substance abuse including tobacco chewing and smoking, alcohol addiction, cannabis abuse etc.
  5. Neuro-developmental disorders like Mental retardation, autism, ADHD, SLD
  6. Dementias especially Alzheimer’s disease.

The above is an informal classification presented here for the sole purpose of simplifying the subject matter for the laypeople so that a better understanding of the issue can be achieved. This is not meant to an exhaustive list and some of the rarer conditions are not covered in the classification. These categories are not watertight and many conditions span the different groups based on their severity and other variables. Often, a person can suffer from multiple conditions from different groups because psychological disorders are not discrete entities, as categorised below. Rather, psychological disturbance can manifest itself in multiple ways and quite often in more than one form, simultaneously, in the same person.

Below, I shall dwell upon each of these groups of disorders in brief- how they arise, how they impact the person and how they can be treated.

The disorders in the first category, the major psychiatric disorders, like schizophrenia, bipolar disorder, severe depression etc can loosely be termed ’psychoses’, in which, the person develops delusions and hallucinations, which cause him to lose touch with reality. These disorders usually have a heavy genetic component and also depend on the maternal health (especially fevers etc) when the patient was ‘in utero’. These can normally be treated only with medication with adequate psychological, social and occupational support for reintegration into the society. In many cases, the patient may need to be on the medications for a fairly long period of time.

The second category, the minor psychological conditions like anxiety, depression and stress related conditions arise mainly due to two reasons. One – as a genetic accompaniment to major psychiatric disorders that someone else is suffering from in the larger family. Two – due to various interpersonal issues, family disharmony and social conditions like school and work related stresses, poverty, unemployment etc. Many of these patients need a variable period of treatment with psychological medicines that ameliorate the neurotic symptoms. These conditions can also be treated with better coping skills, self empowerment, breathing exercises, Yoga etc. Once the person is better, the medicines can be slowly tapered off and allow the natural defences of the person to deal with the issue.

The third category is that of personality disorders and its consequences. These are people who have a particular pattern of seeing themselves or relating to others, and many times, these might result in interpersonal disharmony and suffering to either the patient himself or to the others. A frequent cause of marital discord is the existence of some traits of any personality disorder in one or both the partners. Many violent crimes, including domestic violence, child sexual abuse and other criminal violence can also be due to personality disorders in the perpetrator. This often needs a comprehensive approach including medication, counselling and the intervention of other agencies like child care services and law enforcement services including the police

The fourth category is that of substance abuse. There is a steep hike in the number of people addicted to various substances like nicotine (smoking tobacco), alcohol and cannabis. The youth of the society are more prone to it due to their innate impulsive and rebellious nature of their behaviour. This can result in significant damage to ones long term health and productivity, apart from causing family disharmony. This needs treatment with medication, counselling and in many cases a relatively long period of treatment in a rehab centre.

The fifth category is that of neurodevelopmental disorders that afflict children right from their very early age. This is due to the altered brain structure and includes conditions like mental retardation, autism, attention deficit hyperactivity disorder, specific learning disability. These children have a different trajectory of development of milestones, behavioural and academic problems. They need lot of intensive psychological intervention.

The sixth category is that of dementias, the most common being Alzheimers dementia. This is a disorder of the elderly brain degenerating and is more prevalent in the community as the proportion of the elderly increases in the society. It is a problem that is only going to increase in the country and needs lot of family support, medication and institutional old age care.

It is imperative that any person suffering from any kind of emotional or behavioral problem approach a mental health professional without delay or stopping oneself due to the stigma normally attached to psychological conditions. With proper treatment, many are able to lead a near-normal and productive social and occupational life. The public health strategies for different conditions need to be tailored to the particular subgroup of disorders and is an uphill task for the country to ensure the availability and effective delivery of health care services to all the needy.

About the author

Dr Kiran Manduva did his MBBS in 2001 and studied Psychiatry from NIMHANS in 2005. He is interested in deaddiction, psychotherapy for victims of sexual abuse and neuroscience. He is especially interested in novel public health approaches to make psychiatric care accessible to all.

Categories
Healthcare Delivery

How Vitamin D Deficiency could be silently killing you

In 2014 my wife decided to hire a trainer to help her with her fitness. I was curious how this would work and hence I also decided to go with the same trainer. I spoke to the trainer from the Chennai airport where I was on that day on a business trip and then processed to hire her.

I am no stranger to workouts and I had been leveraging trainers before in the various gyms that I had visited. But this was different. As my training started the first thing I remember was that there was intense pain in my muscles and joints. Despite pain killers, the pain would not go away. The trainer kept telling me that it was a matter of time and things would improve. She even brought in another trainer, who helped me with some stretching exercises and twisting. But when things got worse I had to consult my family physician. One look at me, he said, well my friend when was the last time you checked your Vitamin D levels? That started a quest for settling my Vitamin D levels which continues till this day.

Vitamin D Deficiency Symptoms
D vitamin is known since it is produced by the exposure to sunlight light. It is an important element that a human body requires. Deficiency is a critical problem. The below mentioned are a number of the common signs of lack of D vitamin. Vitamin and mineral basic’s consumption is critical for a human body to work. There is a lot of information what’re the sources of these nutrients and concerning the significance of the nutrients.  

In 2010, the venerable Institute of Medicine (IOM) issued a report based on a lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently, a level below 20 was considered a vitamin D deficiency. (Source:
https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893 )

Below are the charts I have kept for my Vitamin D Levels. As you can see I started with a deficiency around 11 and now have managed to keep myself above the 20 mark for the last 5 years.

Key Symptoms

Weakness and Pain: The weakness of bones and muscles is the first sign that there might be a problem. Rickets in children and Osteomyelitis in adults are among the largest of deficiency of D vitamin deficiency symptoms. Weak bones are vitamin d.’s feature However they generally occur at an early age or older age.

Obesity: individuals who’re obese are more common in showing that the signs of lack of D vitamin. Now, this could be one of the reasons for the obesity epidemic in India.

Feeling Low: Difficult to explain but lack of sunlight is known to cause subclinical depression. This often leads to mood swings, lethargy among others

Other Symptoms: Some other signs are knock-kneed appearance, low blood calcium level, high blood pressure level, reasons why that the vitamin d deficiency occurs are given below.

Reasons for Deficiency

The numerous reasons why that the vitamin d deficiency occurs are given below.

  1. Less exposure to direct sunlight
  2. Extensive use of sunblocks and sunscreen
  3. Lack of absorbing of D vitamin.
  4. Hereditary factors

The given are a number of the readily recognize able signs of vitamin D deficiency symptoms. So what do you do?? In my opinion these should be your next steps.

  1. Visit a doctor- Please do not self medicate, please do visit a doctor
  2. Check your Vitamin D Levels regularly from a NABL certified Lab
  3. Plan for at least 30 minutes of outdoor activity daily specially in the morning- Walks, Jogs or just stretching in the park is a good idea.
  4. Keep a record of your levels

I trust this article is helpful in understanding your symptoms and seeking the right help. As always we are open to your questions and we will do our best to answer them.