PULMONARY FUNCTION TEST

Twenty years ago, when I started my practice and decided to do pulmonary function tests to assess lung function, my colleagues ridiculed me. Everybody knows about a blood test, a sugar test, a ECG but a test to diagnose lung disease was not known.

This is understandable, as in India, any cough is TB unless proved otherwise. All asthmatics in that period would have had anti-TB medication at some point in their life.

Twenty-five years later, the situation remains the same in non-metropolitan areas. Lung Function test is an important component in screening for chest disease but, to my surprise, many have not even seen a spirometer. So here is the basic information on pulmonary function test.

What is Pulmonary function test?

Pulmonary function tests are done to assess one’s lung function. It requires simple equipment like Peal flow gauge or a spirometer.

When are they ordered?

Pulmonary function tests are ordered when one is suffering from asthma, or COPD or is undergoing a surgery — whether cardiac, pulmonary or abdominal. It is important to know lung function before the surgery because the lung plays a major role during anaesthesia and in the post-operative period. If the lung function is not assessed preoperatively, recovery will be delayed in the post-operative period causing anxious moments to patient, physicians and attendants.

Is it possible to diagnose diseases?

No. But it will tell you that the function of the lung is not normal and that this needs some care either as medications or some further tests like CT scan or bronchoscopy.

What is a spirometry?

It is a technical word used for pulmonary function tests. A person is asked to breathe through the mouth piece into the spirometer. The machine calculates the values based on the speed at which he blows and the volume that he has blown and a print-out is obtained.

Though it is effort-dependent and children may find it difficult, when done properly in appropriate circumstances the information can be mind blowing and decisions with regards to the type of anaesthesia and management in post-operative period will be altered.

Is it useful in smokers?

Yes. It is possible to diagnose smoking-induced lung disease by doing special tests. Routine spirometry tests do not detect defects in lung function as nicotine gets deposited in small airways to start with. Only after the majority of the small airways are affected does the nicotine get deposited in the large airways. This is when they start experiencing the symptoms. By this time the damage to small airways is permanent and nothing can be done. Many smokers live in the false belief that if they stop smoking their lungs will come back to normal.

But smoking-induced lung damage takes long to manifest and hence there is great reluctance to seek advice in contrast to cardiac events, which are sudden and shake the whole fabric of the family.

Pulmonary function tests can be used to diagnose illnesses like asthma or COPD and also to screen people on a mass scale. It should be compared to a BP apparatus. With a spirometer one can assess a person’s lung function with ease.

ORTHOGNATHIC SURGERY : NO NEED TO HIDE YOUR FACE

A perfectly symmetrical face is considered to be the most beautiful and attractive in all ages and all regions. However, not all are fortunate to have a symmetrical face with normal proportions.

In addition to the skull, eye and nose, the upper and lower jaws bones are the most important to provide the framework for the face. The upper jaw (maxilla) and lower jaw (mandible) grows through childhood, but main growth happens during adolescence.

Any growth disturbance leads to facial asymmetry. Some of it manifests during early childhood, but many of them show up during adolescence. Adolescence is a very important period of life and facial difference puts the teenager at risk of psychological disturbance and distorts self-image.

The Orthognathic surgery aims to improve facial appearance by reshaping and repositioning facial bones and the jaws along with the teeth. With present advances in medical field, orthognathic surgeries are safe.
Lower jaw

In the case of excess or deficiency of the lower jaw, the protrusion of the lower jaw is very visible from the side. In profile, this is seen as prominence of the lower part of the face and particularly the lower lip. Some individuals may also have asymmetric jaws. Apart from the deformity in the patient’s appearance, there may be problems with chewing and speech in some cases.

Some individuals with mandibular retrusion appear to have a small and/or underdeveloped lower jaw causing gum deformities. The overgrowth bone can be set back and fixed. The small mandible can be advanced or distracted to bring it to normal proportions.

Excess or deficiency of upper jaw is caused by less or restricted growth of the upper jaw. It is more commonly found in cleft lip and palate and following trauma to the upper face.

Due to poor growth and development of the upper jaw, these individuals may appear to have lower jaw protrusion even if mandible growth is normal. Excess of upper jaw will cause a gummy smile or protruding upper teeth. The height of the upper bone can be reduced and fixed which will correct the gummy smile and protruding teeth.

Jawbone deformities are caused by protrusion of both jaws, resulting in a "gummy smile", with excessive show of front teeth. This often causes difficulty in closing the lips and therefore in concealing the front teeth. These individuals often compensate by trying to hide this with a tight lip closure, making their lips appear small and constricted.

The treatment differs according to age and degree of protrusion. Generally, from the teenage to young adult years, the patient may require orthodontics to correct the condition. However, in the older people and in severe cases the problem needs to be addressed by a combination of orthodontics and surgery to the jawbones.
Corrective surgery

Though these are major surgeries, the majority will not have any complications. Most incisions are placed inside the mouth and are not visible. In rare cases incisions may need to be placed on the skin but these are camouflaged and not obviously visible to a casual observer.

After surgery, the patient will be on a diet of liquids and semisolids for a few weeks and also need to take care of oral hygiene. Most go back to work within 10 days depending on the extent of surgery.

Occasionally there may be complication following surgery. Some may have sensory disturbances following lower jaw surgery, which are reversible. However this numbness does not affect daily life or the movement of the lower lips.

Other rare complications are bleeding after surgery, infection and exposure of plates.

However, the important feature of this surgery is acceptance of new face by patients. Young patients adapt to the new face quite happily. However, after 30 years, the patients may find difficult to adjust to the new face.

TRUTH ABOUT C-SECTIONS

Despite the fact that caesareans are far more common these days, the operation is still surrounded by a considerable amount of mystery. There are number of myths associated with this surgery. So let’s set the record straight.


It’s a common belief that if you have one caesarean delivery, you have to have caesarean sections in your future pregnancies. This is not true. Having a surgical delivery does not mean, as it once did, that you’ll have your future children by caesarean section as well. In fact, about 70 per cent of women who try a vaginal birth after caesarean (VBAC) succeed.

Whether to do a C-section or not in the future pregnancies will depend on the indication of first C-section and the status of the current pregnancy. For example, if it was a recurring indication like a contracted pelvis, then definitely you need a surgery again. However, if it was for some indication like foetal distress, then vaginal delivery is possible. However, the labour will have to be monitored strictly.

Mother-child bonding is less after a C-section

This is absolutely false. There is no difference in maternal child bonding after C-section. In fact caesareans are now done under regional anaesthesia, in which the mother is awake during the procedure, she can immediately start bonding with the baby.

No breast feeding after C-section.

It’s a common belief that one should not breast feed after C-section as there is a fear of the stitches opening up. This is however not true, and a mother can breast feed her baby immediately after the surgery.

C-section babies are healthier than babies delivered vaginally.

This is again not true. Babies born vaginally are as healthy as babies delivered after C-section.

No exercises after C-section.

Most women believe that they cannot and should not exercise because they have undergone surgery. This is not true. Gentle exercise such as walking, pelvic floor or abdominal exercises are actually beneficial and will help in recovery. However, after a caesarean allow a minimum of six weeks for the incision to heal before beginning a strenuous exercise programme.

C-sections are always associated with backache.

This is not true. Some women may have backache for few days after C-section. This is usually due to the injection given in the lower back for spinal anaesthesia. This can be avoided by drinking lots of water and avoiding use of a pillow for first few days post surgery.

Dietary restrictions after C-section.

Most women advise a variety of dietary restriction like avoiding milk, ghee, rice during the post-operative period as according to them this can impair healing of scar. This, however, is just a myth and the patient can resume her normal diet within a day or two after caesarean.