Author: Shahzeb Khan

The SPIKES Protocol in Action
The SPIKES protocol is a strategy to break bad news effectively and communicate with the person or people involved with empathy and professionalism.
It is primarily developed for healthcare settings to help healthcare professionals break bad news to patients and their families effectively.
Bad news is any news or information that changes a person’s view of the future in a negative way.
For example, delivering the news to a patient that his test report shows a terminal condition like cancer, telling a patient that he has a chronic disease like diabetes or high blood pressure, or telling the relatives of the patient that the patient is no more because of treatment failure, etc.
These types of news are very challenging for healthcare professionals and need a structured approach to follow. Here, you not just transfer the information, which will change the patient’s view of the future, but at the same time deal with the emotions of patients and their relatives and also give them the future strategy to follow.
In this blog post, we will learn what the SPIKES protocol, is, where we can apply it, and why it is so effective for healthcare professionals.
What is SPIKES?
The word SPIKES stands for
- S: Setting up the Interview
- P: Patient’s Perception
- I: Patient’s Invitation
- K: Giving information or knowledge to patients
- E: Emotions or Empathy
- S: Strategy or Summary
Step-by-step breakdown of the SPIKES protocol:
Setting up the interview
The healthcare professional should arrange a sitting with the patient and its relatives for the purpose of breaking bad news. The place should be quiet and private to minimize the interruption and make your communication more effective. Always make sure that the patient is accompanied by their relative or friend.
You just do not break bad news to a patient in a hospital corridor or in a busy clinic setting.
Perception
The next step in the SPIKES protocol is to know the patient’s understanding of the situation. A healthcare professional must build a rapport with the patient and ask them what he or she knows about the disease or the tests ordered and how it will affect the patient.
Invitation
Breaking bad news is not just passing information to the patient and their relatives. You first ask them if they really want to hear about the information. Don’t just break it without first knowing the patient’s invitation to hear it.
Knowledge
In this step, the healthcare professional passes the information or the bad news. The news delivered should be straight forward without any confusing statements or medical jargon that the patient does not understand.
It should be in small chunks, with the first warning them that you are going to share with them something not really good, to make the patient mentally prepare. then deliver some information and wait for a few moments to let the patient absorb it, and gradually you pass exact information.
Emotions or empathy
In this, you have to deal with the emotions of the patients and their relatives when the news is delivered; there a number of emotional reactions to it.
The healthcare professional must be aware of it and how to deal with those emotions with empathy. It could be complete silence with the patient becoming completely blank or denial from the patient side.
Summary or strategy
In this step, the healthcare professional recapitulates the steps with the patient, making sure he understands what has been delivered completely. Here you also give them a future strategy to follow, which is to give them a roadmap for what to do next.
Why SPIKES protocol Works
The reason why the SPIKES protocol works so effectively is because it provides a six-step approach toward breaking bad news. This structured approach makes it easy to deliver the bad news, deal with patients emotions with empathy, and give them future strategies.
Other alternatives to SPIKES PROTOCOL
The SPIKES protocol is not the only one to break bad news to the patient and their relatives. There are also other protocols certain approaches to do it in step wise manner
BREAKS protocol
B: background
R: rapport
E: explore
A: announce
K: kindle
S: summaize
ABCDE protocol
A: advance preparation
B: building a therapeutic environment
C: communication
D: dealing with reactions E: encouraging and validating the emotions
Conclusion
The SPIKES protocol is a structured, six-step approach primarly designed for healthcare professionals to deal with difficult situations effectively and with professionalism. You must follow these steps to improve your communication and deal with patients emotions with empathy.
March 17, 2025
5 Simple lifestyle changes to improve your heart health
Do you know that cardiovascular diseases are the leading cause of deaths? Four out of five people die every year of heart diseases.
The heart being one of the main organs of the human body, without which life is not possible. The Heart health is very crucial as it supplies oxygen-rich blood to the whole body and oxygen-poor blood to the lungs. The supply of blood is made possible by nonstop pumping of the heart 24 hours a day without taking a break.
For better functioning of the heart to supply blood to the whole body, its health is very crucial. There are a number of factors that can affect heart health. Some of these factors are modifiable, and some are not.
This blog post will explain the 5 simple lifestyle changes to improve your heart health, which will result in better functioning of health.
1. Embrace a heart-healthy diet
To improve your heart health, you must be conscious of the diet you are consuming. Is it good for your heart health, or do you need some adjustments in it? A heart-healthy diet contains more fruits and vegetables, more whole grains, and limits the use of salts and sugar.
2. Prioritize regular physical activity
Sedentary lifestyle is one of the major risk factors for developing heart diseases. Regular physical activity has many benefits, including improving physical fitness, reducing extra weight, and better managing blood pressure and diabetes. The U.S. Department of Health and Human Services recommends 150 minutes of moderate aerobic exercise per week or 75 minutes of vigorous intensity exercise per week for adults.
3. Manage stress effectively
Stressful feelings for a long time with any of the number of reasons causing them to have a negative impact on our body and mind. It makes people unfocused on themselves and their surroundings. In these situations, you lie down for too long, avoid physical activity, consume high-calorie meals without much nutritive value, and sometimes take too much smoking and alcohol. Managing stress effectively can have a positive impact on your body, mind, and heart health. Talk to your healthcare professional if you are dealing with these kinds of situations.
4. Quit smoking
Smoking is another major risk factor in developing heart diseases. It damages the heart and blood vessels. The damaged blood vessels are favorite spots where blood clots and fats accumulate. When these clots dislodge from the primary source, they go to the heart and lungs, causing severe diseases called embolism. In order to improve your heart health, quitting smoking is your number one priority.
5. Monitor your numbers
Routine medical checkups at least once a year are necessary. Your healthcare provider will take a detailed history, do a physical examination, and do some investigations. Its purpose is to detect any abnormality early and treat it promptly. Monitor and take a record of blood pressure, blood sugar, and blood cholesterol. Keep it under normal limits to decrease your chances of heart diseases and improve your heart health.
Conclusion
To improve your heart health, you must take a diet having plenty of fruits and vegetables, limit the use of salts and sugars, and manage your extra fats by regular exercise, especially aerobic exercises. Quit smoking, as it is the major risk factor for heart diseases.
Book an appointment with your healthcare provider to check if you have any risk factors for heart-related problems. It will help you to take action to improve your heart health.
March 6, 2025
Diabetes Type 1: Travel tips for people with
Sports, fitness, nature and healthy lifestyle concept. Young female runner wearing sneakers or running shoes while hiking or jogging in park on sunny day. Cross country or trail woman runner outdoors
Introduction
It is a type of diabetes in which the body’s insulin-producing mechanism is destroyed by its own body cells (autoimmunity). Therefore, these patients regularly need external insulin for their glucose breakdown. These people need regular glucose monitoring and insulin injections. So they are at increased risk of either high blood sugar (hyperglycemia) or low blood sugar level (hypoglycemia).
If you are suffering from type 1 diabetes and intending to travel. This blog post will empower you to travel with confidence by keeping in mind your safety.
Planning and preparation
Planning weeks or days before your travel makes your trip more safe and enjoyable. Keep in mind your medical management; you should need to have extra of everything like insulin, glucose monitor, injections, lancets, etc.
Applying for your health insurance, make sure and discuss your condition that it is included in insurance policy, giving all the facility of hospitalization, etc.
Research the area you are intended to travel to. Make sure there are pharmacies near by, clinics, and hospitals if needed in case of emergency.
- Medical management
- Travel insurance
- Destination research
Travel consideration
Consider your meal and insulin schedule if you are travelling in different time zones
- Time zone changes
- Altitude
- Physical activity
- Stress management
Food and hydration
Having plenty of food and water for your trip is also necessary. Make extra effort to have a bag on your hand with juices and food for high energy.
- Dietary planning
- Hydration
Communication and safety
Learn some basic and lifesaving phrases of the language people talk in those areas you are traveling to.
- Medical information
- Emergency preparedness
Conclusion
February 26, 2025
“Gastroparesis: Causes, Symptoms, and Treatment”
an senior diabetic grandfather with pain and stomache discomfort of gastroparesis
If you are feeling nausea and vomiting persistently, having stomach discomfort, and feeling full after eating a little, probably you are suffering from gastroparesis.
The word gastroparesis means paralysis of the stomach. It is a chronic disorder in which the stomach’s ability to pass food to the small intestine is reduced or lost. It is also called delayed gastric emptying.
The stomach is supplied by the vagus nerve, which contracts stomach muscles to pass food from it to the small intestine. The vagus nerve is affected by a number of reasons, including diabetes, autoimmunity, drugs, infections, etc.
It is a chronic disorder affecting the quality of your life. Understanding it is the first step towards its management.
This blog post describes in detail the symptoms, causes, diagnosis, treatment options, and complications it causes if not treated properly.
NERVE AFFECTED
The stomach is supplied by the vagus nerve. The role of it in the stomach is to contract stomach muscle to push food forward from it to the small intestine and make your gut motility and life easy.
When it is damaged or lost due to any causes mentioned below, your stomach is no longer able to push food forward.
This lack of ability to push food forward results in gastroparesis or delayed gastric emptying.
Causes of gastroparesis
Gastroparesis is caused by a number of diseases. Some are known, that is, diabetes and post-surgery, and some causes are unknown, called idiopathic.
Some causes of gastroparesis are
Diabetes: Diabetes is the number one known cause of gastroparesis. Long-standing uncontrolled blood sugar damages nerves of the stomach. It results in delayed contraction of muscle to push food forward.
Neurological Disorders: Some neurological disorders like Parkinson’s disease, multiple sclerosis, and scleroderma damage nerves, including the vagus nerve, and thus cause gastroparesis or delayed gastric emptying.
IDIOPATHIC: When there is no known cause to the disorder, we call it idiopathic. Often the patient is not diabetic, having no history of surgery, infection, or any autoimmune disease.
AUTOIMMUNE: Sometimes a person’s own immune system is activated and produces agents called antibodies. They attack its own body cells, considering them foreign invaders. Autoimmune disease also causes gastroparesis.
Infection: Viral infections caused by rotavirus and norovirus also cause gastroparesis. Sometimes bacterial infections also cause it.
Drugs: medicines used for high blood pressure, psychiatric or psychotic disorders, and as pain relievers can also slow stomach and intestinal motility.
Although it may not cause gastroparesis in patients already having the disorder, these drugs can worsen it.
Common drugs causing slow stomach and intestinal motility are clonidine (blood pressure medicine), lithium (used for treatment of bipolar disorder), opioids (pain relievers), etc.
Symptoms of gastroparesis
Patients feel a number of symptoms
·         Nausea and vomiting
·         Abdominal pain and discomfort
·         Bloating and gas
·         Loss of appetite
·         Sensation of fullness and satisfaction
·         Acid reflux and burning
·         Blood sugar changes
·         Weight loss
·         constipation
Diagnosis of gastroparesis
Gastroparesis is diagnosed clinically from a detailed history and proper examination. Some investigations are required to exclude other causes of persistent vomiting and stomach discomfort.
·         SCINTIGRAPHY: It is performed to measure the rate of stomach emptying. The patient takes a small portion of food with radioactive material.
A scanner goes through your belly to measure the amount of time the radioactive material, food, takes to pass from stomach to small intestine.
It is helpful to find out if your stomach emptying time is short or long to label your condition as less severe or more severe, respectively.
·         BREATHE TEST: Eating food having substances that are absorbed by the body. When it is absorbed and appears in your breath. This test is also used to label the disease as mild, moderate, or severe.
The one taking less time to appear in breath is mild, and taking a long time is severe.
·         UPPER GI ENDOSCOPY: Upper gastrointestinal endoscopy is done to rule out other possible causes of stomach delayed emptying, such as obstruction, GI Ulcers, gastritis, etc.
·         UTRASOUNDOGRAPHY: This is also performed to rule out other possible causes of delayed gastric emptying, that is, problems of the kidneys, liver, or pancreas, etc.
It is a non-invasive test using high-energy sound waves to detect abnormalities in the body, specifically soft tissue.
Treatment options
The treatment of gastroparesis is to find and treat the underlying cause. Identifying the specific cause of gastroparesis and correcting it improves the symptoms.
Treatment options include lifestyle modifications, medical therapy, and surgical correction.
It depends upon the individual severity of the disorder. Here is the brief discussion of each one
- LIFESTYLE MODIFICATION
The first treatment for patients with gastroparesis is lifestyle modification. Doing all the activities that improve your symptoms and avoiding all those things that worsen the symptoms.
Some lifestyle modifications are
·         Eating small portions of food more often than taking heavy meals two or three times a day.
·         Avoid using foods with too much fat and fibre, which are difficult to digest and pushed forward by the stomach to the small intestine.
·         Having a light exercise like walks after taking meals to improve your gut motility
- MEDICATION THERAPY
Medications used are
·         To correct the underlying cause
Addressing the underlying cause of gastroparesis is the main focus, along with treating the symptoms.
·         Improve gut motility
Metoclopramide is the only drug approved by the Food and Drug Administration (FDA) to improve gut motility.
Some healthcare professionals also use azithromycin and erythromycin for this purpose.
Domperidone, a dopamine agonist, is also used to enhance gut motility and
·         To avoid the adverse effects of this disorder
Gastroparesis causes nausea, vomiting, stomach discomfort and malnutrition
Medicines used are
For nausea and vomiting
Pain relievers
Proton pump inhibitors
- SURGERY
When lifestyle modifications and medical therapy are applied for a long duration without any improvement in the symptoms, surgery is performed as a last resort.
There are a number of surgical procedures available for gastroparesis; that is
·         Pyloroplasty: A portion of muscle at the end point of the stomach (Pylorus) is surgically removed.
·         Gastrojejunostomy: the stomach is directly connected to the jejunum instead of the duodenum.
·         Gastrectomy: In this procedure, part of the stomach is surgically removed. This procedure is normally performed for weight loss in obese patients.
·         Gastric electrical stimulation: An electrical device is implanted in the stomach to stimulate it to push food forward.
COMPLICATIONS
·         DEHYDRATION: Due to persistent vomiting, continuous fluid loss from the body causes dehydration.
·         MALNUTRITION: Due to early satiety, not taking enough food and nutrients causes malnutrition. Also become worse by persistent vomiting.
·         FOOD NOT DIGESTED: Food not digested properly accumulates in the form of balls in the stomach called bezoars. Which causes persistent nausea, vomiting, and weight loss.
·         BLOOD SUGAR LEVEL: Patients with gastroparesis cannot pass food (sugar) from stomach to small intestine. When food stays longer than normal in the stomach, blood sugar drops, causing hypoglycemia.
When, after a long time, food (sugar) passes to the intestine, it suddenly increases blood sugar. These actions are very dangerous for people with diabetes. Gastroparesis worsens diabetes, while diabetes worsens gastroparesis.
·         AFFECT QUALITY OF LIFE: Persistent nausea, vomiting, and abdominal pain affect the quality of life, both personal and professional.
February 26, 2025
Link Between Diabetes and Stomach Pain: A Case Study
Do you know the link between diabetes and stomach discomfort?
A 43-year-old male patient presented to my clinic with the complaints of stomach discomfort, gas, and bloating with loss of appetite.
On further questioning, he has been diabetic for the last 6 years. Not aware of his high blood pressure.
He is not using any medication for diabetes or occasionally taking for a day or two. Upon asking why he is not using diabetic medicines, he told me that people say diabetic medicine causes renal problems.
Vitally, he was
Pulse: 92/min
Blood pressure: 160/90
Fever: a-febrile
Respiratory rate: 16
Oxygen saturation: 99%
Random blood sugar: 313
My diagnosis was delayed gastric emptying, also called gastroparesis, which results in food taking more than normal time to pass from stomach to small intestine.
The management of gastroparesis or delayed gastric emptying is
He was counseled about diet management
, daily exercise,
regular blood pressure , and RBS monitoring
and advised medicine for stomach discomfort,
diabetes, and hypertension and called for follow-up.
I helped him understand his condition and debunk some of his myths on the spot. But keeping in mind his literacy and understanding level, he was not information overloaded on the first visit.
February 26, 2025
Varicose veins: What is it and how to treat it
Human legs with varicose vein illustration
When superficial veins (near the skin) become enlarged and twisted, it is called varicose veins.
It occurs at any part of the body but is more common in the legs. It is not a serious medical condition, and most of the time it does not need any treatment. But sometimes it creates serious complications like pain, discomfort, discoloration of legs, and ulcers.
Veins carry blood back to the heart from all parts of the body. It contains single-way valves. When these valves become weak or damaged, they cannot push the blood. As a result, blood became accumulated and the veins became enlarged and twisted.
CAUSES
The function of veins in the body is to push the blood to the heart from all over the body. It contains a single valve, so the blood flow is in one direction. The valves prevent blood from going in the opposite direction. Varicose veins occur when either there is problem with the valves in the veins or there is some obstruction to the flow of blood
· PRIMARY CAUSES
More than 95% of varicose veins are caused by problems with the valves in the veins. When the valves become weak or damaged, the blood flows in the opposite direction. It results in the pooling of blood in the legs, causing twisted and enlarged superficial veins.
· SECONDARY CAUSES
When there is obstruction to the flow of blood due to any reason. The blood accumulates in the superficial veins of the legs, making them enlarge and twisted. About 5% of varicose veins are caused by secondary causes.
RISK FACTORS
The risk factors for varicose veins
- Sometimes its flow in family we called inherited disease
- Sedentary lifestyle
- Smoking
- Prolong standing and sitting with legs crossed
- Female gender
- Pregnancy
SYMPTOMS
Most of the time, varicose veins do not cause any symptoms. Sometimes it causes symptoms and limits daily activities.
- Heaviness and aches in the legs
- Twisted veins in the legs
- Rashes on the legs near the damaged veins
- Change the color of the skin to red or blue
- Sores and ulcers
DIAGNOSIS
The diagnosis can be done by
- History: Your healthcare provider will take a detailed history from you, including any symptoms you feel, medical and surgical history, family history, and your lifestyle, to know about your activity level.
- Physical examination: Your healthcare provider will do a thorough physical examination of your legs in standing and sitting positions.
- Investigation: Varicose veins can be diagnosed clinically from your history and physical examination. Sometimes your healthcare provider will order an ultrasound called a Doppler or duplex ultrasound. It is a simple, non-invasive investigation to check the blood flow in the veins
TREATMENT
Varicose veins occur in all forms and shapes. Sometimes it is very minimal, causing no symptoms or discomfort. In this case, it requires no treatment. Sometimes it is more severe, causing symptoms and limiting daily activities.
Based on your underlying condition and the level of discomfort it causing, your healthcare provider will advice a treatment from the below list
1. LIFE STYLE CHANGES
Lifestyle modification is necessary to decrease the progression of disease. If the disease is diagnosed in its early stages, just simply modifying your lifestyle will be sufficient without any medical or surgical treatment.
- Maintain a balanced weight decrease the pressure on veins in the legs.
- Physical activity is necessary as the disease progresses with a sedentary lifestyle. Physical activity like walking contracts the muscles in the legs. These contracting muscles put pressure on the veins in the legs to push blood forward.
- The chances of varicose veins and their progression increase in people working, which require standing or sitting for long periods of time.
- Quit smoking, as smoking can damage vein valves. It makes the valve already weak.
2. COMPRESSION BANDS
Compression bands or stockings put pressure on the superficial veins to push the blood to the deep veins. It can be knee length or thigh length, depending upon your level of disease. Although there is no role of compression stockings in the reduction of the progression of disease, it helps to reduce the symptoms and discomfort.
3. ENDOVENOUS THERAPY
- Ultrasound-guided foam sclerotherapy
- Laser therapy
- Radiofrequency therapy
·         ULTRASOUND GUIDED FOAM SCLEROTHERAPY
A sclerosing agent is injected into the superficial veins of legs under ultrasound guidance. It makes the veins shrink and fibrose. This therapy improves the symptoms of varicose veins. There are chances that varicose veins will recur after some time.
·         LASER Therapy
In this method, a laser fiber is inserted into the superficial veins through ultrasound guidance. The valves are already damaged or weakened. These veins are then destroyed by laser energy.
·         RADIOFREQUENCY
This technique of therapy is similar to laser therapy, except in this technique, high thermal energy is used.
4.     SURGERY
Superficial veins of legs collect the blood from superficial parts of legs that are from the skin. It goes upward and, at certain points, goes deep to meet the deep veins of the legs. The points where the two meet are behind the knee region and below the inguinal region.
Surgeries of varicose veins consists of
- Ligation of the veins
- Stripping the veins
- Phlebectomy
· HIGH LIGATION AND VEIN STRIPPING
The surgeon makes a transverse cut behind the knee or below the inguinal region. The small saphenous vein and great saphenous veins are identified and ligated where they meet the deep veins of the legs. The superficial veins are then removed.
· PHLEBOTOMY
After the main veins are removed, these even smaller veins do not fade away on their own. The surgeon makes small superficial cuts to remove these small veins.
Complication of varicose veins
- Pain
- Inflammation
- Superficial venous thrombosis
- Deep venous thrombosis
- Venous ulcers
- Pulmonary embolism
Prevention
- Main a balanced weight
- Exercise regularly
- Avoid standing or sitting for too long
- Keep the legs above while sitting and lying
- Quit smoking
- Apply compression stockings
Conclusion
Varicose veins are enlarged and twisted in the lower legs. Although it is not a serious medical condition, in some people it becomes symptomatic and causes pain, heaviness, skin discoloration, and leg ulcers.
There are multiple treatment options available, from simple lifestyle modifications to surgeries. If you feel any symptoms or want to cosmetically correct your varicose veins, see your healthcare provider and discuss treatment options with him.
February 26, 2025