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"Ambulatory" Tests in Private Practice

OP Kapoor
Day by day new tests are available to family physicians for a better diagnosis.
When a patient’s symptoms occur at a particular time or after a particular exertion or activity, and the ‘resting’ examination and investigations are normal, the diagnosis may be made by asking for “Ambulatory” tests. These tests are done as an outdoor procedure, by attaching the patient continuously to a “monitor”, for may be 24 hours or more.
The following are the examples:
  1. Ambulatory BP monitoring is done to exclude white collar hypertension and true hypertension.
  2. Ambulatory ECG monitoring is done to help diagnose cases of paroxysmal cardiac arrhythmias and unstable angina pectoris.
  3. An Event recorder is ambulatory ECG monitoring done for a few days or a week, which is switched on just before the patient gets an attack of giddiness or fainting or seizure.
  4. Ambulatory EEG monitoring is available to diagnose patients getting repeated attacks of epileptic seizures.
  5. Ambulatory continuous pH monitoring of oesophageal secretions is available to diagnose patients of GERD now known as TLOSR. The latter terminology stresses the fact that the gastro-oesophageal reflux is intermittent and therefore missed by other investigations.
  6. Finally, if you have a Pulse Oximeter in your clinic, lend it to the patientís spouse to make a diagnosis of sleep apnoea syndrome. If at night during snoring, the patient has 15 attacks of apnoea per hour lasting for more than 10 seconds and if during the attack, SPO2 is lowered, the diagnosis is confirmed without the complicated Polysomnography test, which requires hospitalisation.
  7. Wire- mesh face shield – for protection of whole face.
  8. Combined wire and polycarbonate face guard – In sports like cricket, hockey etc.
  9. Keep a watch on children when they are playing with bow and arrow so that they don’t get injured or they do not cause damage to fellow players or observers around. There had been dramatical increased incidence of such cases when Ramayan TV serial was going on.
  10. To increase the awareness of grievous nature of ophthalmic injuries in public masses as well as school going children so that acts like throwing stones or arrow are avoided.

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.