Dr Chandril Chugh

FAQs On Carotid Artery Disease/Carotid Stenosis

FAQs On Carotid Artery Disease/Carotid Stenosis

1. What are carotid arteries?

These are two large tubes which take blood from the heart to the brain through the neck. You can feel them pulsating in the neck, if you press lightly (only one side) just away from the midline.

2. What is carotid stenosis?

Over time cholesterol may get deposited in the arteries and form a plaque which tends to block the flow of blood. As this plaque keeps getting bigger the artery may get completely blocked or occluded.

3. What are the risk factors for carotid stenosis?

High blood pressure, Cholesterol, Diabetes, Obesity and smoking are some of the risk factors.

4. Do I need to get my carotids fixed?

Dr. Chandril Chugh, Senior Consultant & Head – Interventional Neurology, Max Super Speciality Hospital, Saket, says not all carotid stenosis need procedural treatment, in fact, most don’t.  Treatment depends on a lot of factors like age, sex, risk factors and symptoms.

5. Does carotid stenosis increase my risk of stroke?

Yes, it does.

6. Can it be controlled by medicines only?

Yes, of course.

7. If I need a procedure for carotid stenosis what options do I have?

Carotid Stenting and Carotid endarterectomy (open surgery) are two options available.

8. I am scared of open surgery, what do I do?

Endovascular minimally invasive surgical options, can be used to do carotid stenting.

9. How long do I have to stay in the hospital?

Stay usually lasts for about 2 days. It may change depending on the clinical condition of the patient

Originally Published On Max HealthCare - Faqs On Carotid Artery Disease/ Carotid Stenosis

Also Read: 

• Here's How You Can Manage PTSD Triggers

• The Effects Of Depression In Your Body

• Alzheimer's Disease Effects On Brain

by Dr Chandril Chugh

Why sleep is important for brain health

Why sleep is important for brain health?

Skimming on sleep can cause a myriad of issues. Sleep is regenerative, restorative and rejuvenating. It gives time to the body to reboot and the brain to consolidate and refresh itself.

I can’t remember anything, can’t focus. Your brain won’t function optimally. Sound sleep is paramount for proper brain function. More than usual we hear people complaining of lack of concentration, decreased attention span, blanking out in the middle of a conference, poor memory and task execution. Sleep helps the brain to rearrange itself. In a way the brain is able to clear the clutter and form new connections amongst brain cells to function better. More the number of connections, better the memory and brain function.

Those mood swings are for real. Your brain regulates the hormones and the neurotransmitters. These chemicals are basically responsible for the way you feel. Chemical compounds like dopamine, serotonin, oxytocin helps us to feel good, happy and upbeat. Sleep plays an important role in their regulation. Lack of sleep can make you irritated, impulsive and angry. The moment when you overreact and have an outburst are more likely to happen when you have not slept well.

Lack of sleep makes you slow. Sleep deprivation slows down the brain’s ability to react quickly. Tired drivers and pilots tend to have more accidents and that is a well known fact. Sleep deprivation slows down the brain, akin to getting drunk. Just like you should not be driving under the influence of alcohol the same applies to sleep deprivation.

Beautiful are those who sleep. Literally! Consistently skimping on sleep can lead to dark circles, puffy eyes, premature wrinkling and sagging of your skin. Stress hormones like cortisol increase when you are sleep deprived. Cortisol breaks down the muscle and collagen in the skin leading to premature ageing.

Lack of sleep can affect your heart. Sleep deprivation can increase your risk of developing high blood pressure, which can lead to cardiac disease later on in life.

Sleep your way to weight loss. Lack of sleep leads to hunger pangs and cravings which can derange your weight loss goals. Moreover the stress hormones slow down the metabolism and make it hard to gain lean muscle which in turn affects weight loss as well.

Immunity is dependent on sleep. When you’re tired and even moderately sleep-deprived, your immune function is compromised. Infections like flu, common cold are more common in people who don’t get adequate sleep and are chronically stressed.

Originally Published On Max HealthCare - Importance Of Sleep In Brain Health

Also Read: 

• Here's How You Can Manage Your PTSD Triggers

• What Is Parkinson Disease?

• All You Need To Know About Brain Hemorrhage

by Dr Chandril Chugh

Stroke: It's a Choice! Don't Call It a Disease

For ages we have known that prevention is better than cure, it holds true even for a Stroke. Stroke or brain attack is a lifestyle associated disease and it is entirely your choice on how you choose to prevent it.

Dr. Chandril Chugh, Head, Interventional Neurologist, Max Super Speciality Hospital, Saket,  says the majority cases of stroke are due to a sedentary lifestyle and an unhealthy diet. Also, some of us are prone to having a stroke due to genetic causes, which is a different topic altogether. Preventing a stroke is not rocket science and it can be prevented easily.  

Know about the Stroke Prevention Strategy

High blood pressure

The single most important thing that anyone can do to prevent stroke is to control their blood pressure. The easiest way to control blood pressure is through exercise and diet, if needed medications. Normal blood pressure is less than 120/80 mm hg and anything higher should not be ignored.

High Cholesterol

Second amongst the usual suspects is cholesterol.  One easy way to manage cholesterol is to increase fruits and vegetables in the diet, and avoid fried foods. Consuming healthy fats from nuts (almonds or walnuts), fish oils and oils like olive oils and flaxseed oil is also beneficial. If the diet doesn’t work then medications can come to rescue.

High Sugar

Sugar beyond the normal value is not good for the body. It is important to realize that, and eliminate or at least limit the intake of sugary foods like cold drinks, juices, cookies, biscuits, chocolates, sweets etc. One 500 ml bottle of cold drink contains about 55 gm of sugar which is equivalent to 11 teaspoons of sugar….you can aptly call it the Devil’s drink,  it’s not going to do any good to you.

Smoking

The smoke that travels through the lungs into the blood ,gets circulated throughout the body and gets mixed with blood, causing the blood to become sticky,causing a stroke. Stay away from smoking. There are two kinds of people who don’t smoke: The healthy ones and the ones who are paralyzed due to stroke.

Diet

My advice for diet is simple, you can eat anything that comes out of the ground (fruits, vegetables) or is white (low-fat milk) or sometimes pink (fresh fish or lean chicken).  Stay away from anything in a plastic packet or a bottle.

Exercise

A good diet with regular physical exercise is the secret to good health. If you follow this routine you won't have to worry about the first three points of the discussion.

Doctor

The last piece of stroke prevention puzzle is the doctor.

“Your brain is the Ferrari of your body, and you don’t take your Ferrari to a roadside mechanic”. Choose wisely.

Originally Published On Max HealthCare - Stroke: It's a Choice! Don't Call It a Disease

Also Read: 

• Here's How You Can Manage PTSD Triggers

• The Effects Of Depression In Your Body

• Alzheimer's Disease Effects On Brain

by Dr Chandril Chugh

Who Is The Real “Hero” Of Stroke Care

Who Is The Real “Hero” Of Stroke Care?

We know more about our clothes and cars than we know about our health and body. It is astonishing that we spend more time to research about which laptop to buy, but when it comes to our own health most of us take a passive approach. This deficiency of knowledge is even more evident when it comes to dealing with emergencies.  “Ït is too late now, I am sorry!”  Unfortunately, we have heard this line more often in the real-life than in films. 

The question arises, what can we do to change this? How do we tackle this deficiency? Dr Chandril Chugh, Senior Consultant, and Head, Interventional Neurology, explains this with an example.

We had a 70-year-old female brought to the emergency room by her granddaughter for confusion and difficulty walking due to weakness on the right side. The granddaughter was sure that the symptoms had started right after breakfast. It took them 45 minutes to drive, so they were in the hospital within the first hour of the symptoms. The patient was evaluated and head imaging was done which showed occlusion of the left middle cerebral artery (largest blood supply to the brain).

An Interventional Neurologist intervention was necessary, who recommended Mechanical Thrombectomy. The patient underwent the procedure successfully and was discharged without any deficits. The entire family was happy and satisfied with the treatment. Now my question is: who deserves the credit for this good outcome- The Interventional Neurologist, Neurologist or the emergency physician?  I personally believe that the “Hero” of this scenario is neither of the above but, the granddaughter. If she had not recognized the symptoms and brought her grandmother to the hospital in time, then we would not have been able to achieve what we did. She was aware of the stroke symptoms and took the right decision of coming to the hospital. When it comes to dealing with emergencies like Stroke or Brain attack, information and knowledge are life-saving.

Below mentioned are the important aspects of stroke diagnosis and care.

How do you recognize a stroke?

STROKE: REMEMBER THE 6 S METHOD TO DIAGNOSE STROKE

• SUDDEN (symptoms usually start suddenly)
• SLURRED SPEECH ( speech is not clear, as if drunk)
• SIDE WEAK ( face, arm or leg or all three can get weak)
• SPINNING (Vertigo)
• SEVERE HEADACHE
• SECONDS (note the time when the symptoms start and rush to the hospital)

Can stroke be really serious?

If I were to say stroke is really bad, you will probably not believe me. Luckily, some studies have made my job easier. According to a study done by researchers in 2006 in the USA, a patient with ischemic stroke loses 190,00,00 brain cells every minute, about 14000,000,000 nerve connections are destroyed every minute and 12 km (7.5 miles) of nerve fibres are lost every minute. The end result is the patient gets paralyzed for life and becomes dependent. That's pretty scary!!!

Is there a treatment available for stroke?

Yes. The Stroke treatment depends on which kind of stroke the patient has. Up to 85 % of all strokes are ischemic (blocked blood vessel). For ischemic brain attack, there is an option of intravenous medication called tPA (recombinant tissue plasminogen activator) available which can be given to the patient within the first 3 to 4.5 hours of the symptom onset. The patients who have a blockage in a large blood vessel can be offered a procedure called mechanical thrombectomy, which involves removing the blockage in the blood vessel and restoring the blood supply.  This procedure is done through a small nick in the groin and there is no open surgery involved. Recent trials have shown that patients do exceedingly well post mechanical thrombectomy and have a greater chance to live life independently.

Till what time can you do mechanical thrombectomy?

Mechanical Thrombectomy can now be offered up to 24 hours from the onset of the symptoms but, sooner it’s done better the patient does.

What is the single most important factor in stroke care?

The most important part of stroke care is not the doctor or the hospital, it’s the patient! As most of the strokes are painless, patients tend to ignore their symptoms and hence delay the treatment. If the patient and the family are aware of stroke symptoms they can reach the hospital in time and can get treated.

Originally Published On Max Health Care - Who Is The Real “Hero” Of Stroke Care

Also Read: 

• Sleep Strategies For Complex PTSD
• 5 Tips To Cope With Tragic Flashbacks
• Self-Care Techniques For Trauma Survivors

by Dr Chandril Chugh

Role Of The Nervous System In Bipolar Syndrome: Know All About It

Ever wondered why people with mood swings can go from super energetic to deeply sad without warning?

That could be more than just emotions at play. The real cause often lies deep inside the brain — where your nervous system controls everything from emotions to thoughts. Understanding how the nervous system works is the key to understanding bipolar disorder.

In this blog, we will explain how the nervous system influences bipolar disorder, what brain changes take place, and how science is helping treat it. Let’s make it super easy to understand, even if you’ve never read about this before.

What is Bipolar Disorder?

Bipolar disorder is a brain-based disorder with many clinical manifestations and comorbidities, leading to severe disabilities in the patient. Mixed episodes characterize this condition, i.e. its symptoms swing between mania and depression. It is important to note that while depression has commonly been associated with the disorder, a bipolar diagnosis need not necessarily include depressive episodes, though it can.

Bipolar disorder is a complex medical state whose etiology involves genetic and epigenetic factors acting alongside environmental components in causing manifestation of the disease. Bipolar disorder affects virtually all areas of the human body, from energy levels and appetite to muscles and even libido.

Who It Affects?

• Around 40 to 50 million people across the world have bipolar disorder.
• It usually begins between ages 15 and 30.
• Men and women are affected equally.

It is one of the leading causes of disability among young people worldwide.

Types of Bipolar Disorder

There are several types of bipolar disorder. Each type affects the brain and behavior differently:

• Bipolar I: Severe mood swings. Periods of mania can last at least 7 days or need hospital care.
• Bipolar II: Less intense highs (called hypomania) and deep depression.
• Cyclothymic Disorder: Many mood changes over time, but less severe than Bipolar I or II.

Each of these types shows different patterns in brain activity.

Early Symptoms to Watch Out For

Recognizing symptoms early can help in getting treatment.

• Sudden mood changes without a clear reason
• Talking fast or being easily distracted
• Sleeping too much or too little
• Risky behaviors or poor judgment

Stat Box: 1 in 5 people with bipolar disorder attempt suicide — National Institute of Mental Health (NIMH)

Pathophysiology of bipolar disorder

The behavioral and physiological manifestations of Bipolar disorder are complex, showing itself not only as profound changes in mood, but also in the form of a range of neurovegetative and psychomotor features.

The pathophysiology is undoubtedly moderated by interconnected limbic, striatal and fronto-cortical neurotransmitter neuronal circuits, and the interacting cholinergic, catecholaminergic and serotonergic neurotransmitter systems thus represent very attractive candidates.

Thus, it's not surprising that clinical studies over the past 40 years have for the foremost part rested upon the conceptual foundation that monoamine signaling and hypothalamic-pituitary-adrenal (HPA) axis disruption are integral to the pathophysiology of both depression and mania .

A true understanding of the pathophysiology of manic depression must address its neurobiology at different physiological levels, i.e. molecular, cellular, systems, and behavioral.

Abnormalities in organic phenomenon undoubtedly underlie the neurobiology of the disorder at the molecular level and this may become evident as we identify the susceptibility and protective genes for Bipolar disorder in the coming years.

Hippocampus and bipolar disorder

Interest in hippocampal volume stems from neuropsychological and neuropathological studies that implicate this structure within the pathophysiology of bipolar disorders. For instance, enlarged right hippocampal volume is claimed to be related to poor neuropsychological functioning in manic depression , and findings from a neuropathological study have indicated a discount and dysgenesis of varied neuronal cell lines in entorhinal and hippocampal cortex of bipolar patients.

Also, in people with bipolar disorder, certain parts of the hippocampus are smaller than they are in both people with major depressive disorder and in people without mood disorders.

Which hormone causes bipolar disorder?

Neurotransmitters aren't the only chemical messengers within the body. Hormones are also used by the body as chemical messengers. The thyroid is an endocrine organ located within the neck that produces hormones. It has been the main target of much mood disorder research.

Depression is usually related to low levels of hormones, a condition referred to as Hypothyroidism. Mood elevation is usually related to high levels of hormones (Hyperthyroidism). Treating hypothyroidism by supplementing or replacing hormones may sometimes alleviate depression.

Similarly, reducing levels of high hormones with lithium may ease manic symptoms. Given that up to half of patients with a rapid-cycling sort of bipolar disease even have hypothyroidism, the involvement of the thyroid in producing or enabling bipolar disorders for some patients is a strong possibility.

What Happens in the Brain During Bipolar Disorder?

Brain Imaging Studies

Modern brain scans have shown clear changes in people with bipolar disorder:

• fMRI shows high activity in the amygdala during manic episodes
• PET scans show low activity in the prefrontal cortex during depressive episodes

These patterns are now helping doctors study brain function in bipolar disorder more closely.

Chemical Imbalances That Trigger Mood Episodes

Mood swings happen when the brain’s chemistry goes off balance:

• Dopamine and serotonin in bipolar patients shift drastically
• The HPA axis (stress control system) does not function well

These imbalances are a core neurological cause of bipolar disorder.

Structural Brain Changes in Bipolar Disorder

Research shows that the brains of bipolar patients are physically different.

Table: Brain Area Changes in Bipolar Patients vs. Healthy Controls

These physical changes affect how moods are controlled in the brain.

The Nervous System’s Role in Bipolar Mood Swings

Mania and Nervous System Overstimulation

During mania, the nervous system goes into overdrive:

• Racing thoughts and nonstop talking
• High energy and restlessness
• Poor sleep and risky choices

This shows high activation of the sympathetic nervous system, part of the body’s stress system.

Depression and Nervous System Slowdown

Depressive episodes are the opposite of mania:

• Constant tiredness
• Slower thinking and speaking
• Sleeping too much or too little

Here, the parasympathetic system dominates, creating low-energy states in the body.

Can Nervous System Disorders Mimic Bipolar Disorder?

Yes. Some brain conditions may show similar signs:

• Multiple Sclerosis (MS): Mood shifts due to brain inflammation
• Stroke: Changes in mood or behavior after brain damage
• Parkinson’s Disease: Emotional changes linked to nerve loss

This makes correct diagnosis critical. Doctors need to rule out other nervous system diseases before confirming bipolar disorder.

Also Read

• Tips To Manage Migraines During The COVID-19 Pandemic
• What Is Parkinson Disease? 
• Sleep Strategies For Complex PTSD

FAQs

Can bipolar disorder damage your nervous system?

Yes, long-term untreated episodes may affect how nerves in the brain function. Repeated mood swings increase stress on the brain, which can impact its chemical balance and structure. These changes can make symptoms worse over time. Early diagnosis and consistent care help reduce the risk.

Is bipolar disorder a neurological or psychological condition?

Bipolar disorder is both neurological and psychological. The condition begins with changes in brain function and chemical balance (neurological). These changes then affect thoughts, emotions, and behaviors (psychological), so both areas need attention during treatment.

What part of the brain is responsible for bipolar disorder?

The key brain areas involved are the amygdala, hippocampus, and prefrontal cortex. These are parts of the limbic system, which helps control emotions and decision-making. Irregular activity in these regions can lead to unstable mood patterns.

How does the nervous system affect mood swings?

Mood swings are closely linked to how the nervous system regulates brain activity. During mania, nerve signals move faster, causing hyperactivity. During depression, they slow down. These changes in signal speed create the extreme highs and lows seen in bipolar disorder.

Can brain scans detect bipolar disorder?

Brain scans like MRI and PET can show changes linked to bipolar disorder, such as differences in brain activity or size. However, scans alone are not enough for diagnosis. Doctors also consider symptoms, medical history, and psychological evaluations.

What neurotransmitters are involved in bipolar disorder?

Three main brain chemicals are involved: dopamine, serotonin, and norepinephrine. These neurotransmitters influence energy, mood, and focus. When their levels are off balance, a person may experience mood shifts linked to bipolar disorder.

Is bipolar disorder caused by brain chemical imbalances?

Yes, chemical imbalance in the brain is a primary cause. When neurotransmitter levels change too much, they disrupt mood stability. This imbalance can be triggered by stress, genetics, or other brain changes.

by Dr Chandril Chugh

Neurosarcoidosis: Symptoms, Treatment And Causes

Sarcoidosis is a chronic disease that involves a collection of inflammatory cells in an abnormal quantity. These cells together form a lump which is also known as a granuloma. This disease can affect any part of the body; however, its most common in lungs and lymph nodes. Lymph nodes have a bean-shaped structure and are present all across the body. They carry lymphocytes or more commonly known as white blood cells which helps us to fight any infection or disease.

Neurosarcoidosis is a Neurological manifestation of sarcoidosis affecting the central nervous system, i.e., spinal cord, brain and optic nerve. It is uncommon but a severe kind of sarcoidosis. While it most commonly occurs in facial and cranial nerves, other parts of the nervous system are equally at the risk of inflammation or abnormal cell deposits.  

Causes of Neurosarcoidosis Disorder:

The Cause of Neurosarcoidosis is unknown. But some infections, immune system disorders or genetics can contribute to it. Also, approximately five to ten percent of people who have sarcoidosis in other parts of the body have chances to develop it in their nervous system. Only 1 per cent of people are likely to acquire Neurosarcoidosis, without having sarcoidosis in any other part of the body. Speaking of demographics, people between the ages of twenty to forty are seen developing this disorder, and it is more common in Swedish and African-American people; however, it can occur in anyone.

Symptoms of Neurosarcoidosis:

Symptoms of Neurosarcoidosis vary as per the part of the brain that has been affected by the disease. In some cases, it may exhibit symptoms similar to Multiple Sclerosis, a condition where the immune system attacks the covering sheath protecting nerve fibres and thereby disrupts the communication between the brain and rest of the body. The reason behind the similarity of symptoms is that Neurosarcoidosis also weakens the myelin coat around the nerve fibres.

To tell the difference, doctors perform a set of diagnostic tests including CT scan, Chest X-ray, blood tests and biopsy to ascertain if the symptoms are from Multiple Sclerosis or Neurosarcoidosis. 

Following are the symptoms of Neurosarcoidosis based on the area of the brain that has been affected by it.  

Brain or cranial nerves:

• Dementia
• Loss of hearing
• Speech difficulties
• irritability
• hallucinations
• Seizures
• Confusion
• Loss or alteration of ability to smell or taste
• Headaches
• Vision issues
• Facial paralysis

Peripheral nerves:

• Numbness and tingling
• Weak and vulnerable muscles
• Partial or incomplete paralysis in some body parts

Pituitary gland:

• Frequent urination
• Fatigue
• Excessive thirst
• Changes in the menstrual cycle for women

Neurosarcoidosis diagnosis

The diagnosis of Neurosarcoidosis can be a complicated procedure. There is always a room for diagnostic error in this disease as the primary examination involves the finding of granulomas. Still, the same can easily be the result of any other illness. For the proper diagnosis of the sarcoidosis, following three criteria are required as per the statement jointly passed by the WASOG (World Association of Sarcoidosis and Other Granulomatous Disorders), the American Thoracic Society and the European Respiratory Society:

• Clinical and Radiologic manifestation
• Granulomas not exhibiting caseation
• No indication or proof of alternative disease  

Once the disease is suspected, the diagnosis is further continued to obtain histological verification of the same, and estimate the degree & severity of organ involvement. Additionally, to determine the course of treatment, it is also evaluated during the diagnosis of whether the disease is stable or progressing.

Neurosarcoidosis treatment

Treatment varies based on the symptoms and severity; however, there is no cure for the disease. Currently, available medications/treatments help achieve symptomatic relief from pain without treating autonomic dysfunction. And they also sometimes lead to side-effects, seldomly severe, which is why one needs to discuss the potential side-effects of recommended medications beforehand and to decide if they are worth the possible benefits.  

Some of these treatments are - 

• Occupational therapy
• Pain management medications or therapy
• Immunosuppressive and immunomodulatory medications
• Physical therapy

Conclusion

Neurosarcoidosis does not have any standard prognosis as the severity, and the symptoms vary from person to person. And only two-thirds of people suffering from it achieve temporary or permanent diminution of pain & other symptoms and can go back to living their lives normally. However, those who do not experience remission need to continue the treatment and manage their symptoms throughout life. And to do so, a multidisciplinary approach is advised, which demands considerable participation of patients to work on somatic along with psychosocial aspects of this capricious disorder. Participation can be in the form of regular visits to the neurologist, coordination with doctors and therapists and a proper medication routine - right drug, right dose at the right time!

Also Read: 

• Sleep Strategies For Complex PTSD

• 5 Tips To Cope With Tragic Flashbacks

• The Effects Of Depression In Your Body

by Dr Chandril Chugh

The Struggles Of Coping With PTSD During Social Isolation

Social Isolation 

The term which we looked at as the preventive measure from an outbreak of a novel disease may have given rise to another pandemic. It may have helped considerably in the prevention of COIV19, but it certainly has an adverse impact on the psychological profile of people. The medical survey conducted in India in August 2020 on a small group of people to gauze the mental impact of coronavirus induced lockdown showed 28.2% of the respondents have PTSD, and the rest may not have been diagnosed with PTSD yet but have developed similar symptoms. Like excessive sweating, breathing troubles, sleeping & eating disorders, etc.

Why social isolation is a trauma?

The isolation was forced and was not practised willingly. One day all of a sudden, the entire world was shut down to prevent the disease we never heard of before. And then it turns out the situation is more severe as we started calling it a pandemic. So, as people were confined to their places, they experienced a feeling of no control over the circumstances, the fear of contracting the disease or losing loved ones, sense of despair as not seeing things turning back to their default state, etc. And coupled with all the significant personal and work-life alterations it led to, social isolation became the number one reason for PTSD in 2020. 

Why is PTSD treatment necessary?

PTSD exerts a damaging impact on mental and physical health and can lead to trouble in sustaining relationships. Besides, the risk of developing depression or indulging in deliberate self-harm is six times higher in people with PTSD. And they are also five times more vulnerable to other anxiety disorders compared to a person without PTSD. So coping up with this disease is essential. 

PTSD treatment can be anything from a simple change of habit to seeking professional help. It is different for every individual based on their coping mechanism and severity of the disease. 

PTSD treatment

1. Reach out - People with PTSD often struggle in isolation as they find it challenging to open up and share their difficulties. They are scared of having people not able to comprehend their situation. In fact, in many cases, people themselves don't realize that they are struggling with PTSD until symptoms become unendurable. We all need to understand that PTSD is not uncommon and that if it is hard to explain it to family and friends, then there is always an option of seeking professional help, but leaving it untreated is not an option.
2. Heedfulness - PTSD patients relive the traumatic event, again and again, and are overwhelmed with stress and anxiety in every minute of it. But by just spending two minutes a day practising meditation, prayer or any other mindful technique with a goal to focus on the present without the fear of past or future, can help in calming the body and mind. Although it may just lead to a moment of relaxation, it will bring back the taste of normalcy and hope that sanity is achievable. And before you know, these small regular victories will make a huge difference. 
3. Exercise - Exercise has commendable results in stress-relieving by regulating mood and emotions. It pumps up the production of feel-good neurotransmitters, known as endorphins. So, sweat out the PTSD. Make your own exercise regime. All you have to do is pick a physical activity that amuses you like yoga, dance, cycling, running, walking, swimming, etc. and practice it every day maybe just for 10 minutes to start with. Remember, the goal is to enjoy and relax, not to overwhelm yourself. Be consistent, set small goals and decompress. 
4. Psychotherapy/ PTSD Therapy: There are several therapies designed to help people cope up with the disease. The aim of this write up is not to tell you about the treatment you should go for. As the course of treatment will be decided once a thorough diagnosis is performed under medical supervision. However, we aim to let you know that there is more than one option for you to fight the disease. And that the treatment is customized as per psychological profile.

• Cognitive Therapy: This is a type of talk therapy that indulges you in deep thinking and initiates conversations. It helps you to put into words the thoughts that are seemingly inexplicable and thereby encourage you to pin out negative feelings or mental patterns that are keeping you stuck. 
• Exposure therapy: This PTSD therapy as the name suggests exposes you to the situation or the memory that frightens you, but without compromising your safety. It lets you re-enter the traumatic event that led to PTSD at the first place, and gives you an opportunity to process it, understand it which you might not have received when the actual event occurred. This therapy is suitable for patients who are in denial and fear to let their emotions out. 
• (EMDR) Eye movement desensitization and reprocessing: This is an interactive psychotherapy technique that combines exposure therapy with a set of guided eye movements. Along with letting you re-enter the traumatic situation safely, it also helps you to change your reaction to it for processing it better. 

Now you may think that the world is coming to an end, but remember this too shall pass and it's only after the darker cold nights, the sun feels brighter and warm.

Also Read: 

• Sleep Strategies For Complex PTSD

• 5 Tips To Cope With Tragic Flashbacks

• The Effects Of Depression In Your Body

by Dr Chandril Chugh

Here’s Why PTSD Gets Worse Before It Gets Better

Here’s Why PTSD Gets Worse Before It Gets Better

“It gets worse before it gets better”- this is a statement often quoted by people who’ve undergone or overcome a psychological disorder. Well, it holds true for PTSD too. PTSD is a disorder that hits you like a wrecking ball - it is a wholesome that affects your mind and body, usually for a long period of time. 

Many people feel worse before they feel better during trauma recovery. And this can be confusing, scary, and discouraging.

But what if we told you this stage is normal? What if worsening symptoms are actually a sign that your mind is doing deep, important healing work?

In this blog, we will explain why PTSD often intensifies during recovery, what you can expect, and how to stay strong through it all.

What is PTSD?

Before understanding why healing can feel so heavy, let’s understand what PTSD really is.

Defining PTSD (Post-Traumatic Stress Disorder)

PTSD is a mental health condition triggered by a traumatic event. It might be something you saw, lived through, or even heard about.

According to the DSM-5, PTSD is diagnosed when someone has intense, disturbing thoughts and feelings related to their trauma long after the event has ended.

Statistics from the National Center for PTSD show that about 6% of people in the U.S. will have PTSD at some point in their lives. Veterans, survivors of abuse, car crash victims, and many others are included in this group.

Symptoms of PTSD

Symptoms can vary, but most people with PTSD report these:

• Intrusive thoughts: Sudden memories, flashbacks, or nightmares
• Avoidance: Staying away from places, people, or feelings that remind them of the trauma
• Hypervigilance: Always feeling on edge, startled easily
• Negative mood changes: Feeling numb, guilty, or angry

As people begin therapy, they start facing these feelings instead of avoiding them. This process is called emotional reprocessing, and it can be intense.

Why PTSD May Worsen During Recovery?

It sounds backward, but getting better sometimes starts with feeling worse. Here’s why.

What "Worse Before Better" Really Means

In the trauma healing world, there’s a concept called the healing crisis. It’s when your symptoms spike as you start doing real emotional work.

• You begin to talk about things you’ve avoided for years
• Buried memories may surface
• Your nervous system gets activated, causing anxiety, irritability, or panic attacks

This isn't a sign of failure. It’s your brain finally starting the real work of healing trauma symptoms.

Activation of the Nervous System During Treatment

When you begin therapy for PTSD, your body can enter fight, flight, or freeze mode again, even if there's no danger now.

Here's what happens in your brain:

This spike in your trauma response explains why anxiety or flashbacks may increase during early treatment.

Re-experiencing Trauma Through Exposure Therapy

Many therapies used to treat PTSD involve going back into the memory safely. This is called exposure therapy or EMDR (Eye Movement Desensitization and Reprocessing).

During these sessions:

• You revisit memories you avoided
• You feel the emotions linked to the event
• You reframe the meaning of what happened

According to studies, people may feel worse for a few weeks but improve significantly after completing these therapies.

The Four Stages of PTSD Recovery?

Recovering from PTSD isn't a straight line. It's more like diving into deep waters—unpredictable, often scary, and filled with emotional waves. But each stage, no matter how painful, brings you closer to healing. Let’s break down these therapy stages to understand what happens at each step and why the symptoms may feel more intense as you heal.

FAQs

1. Can PTSD really get worse during therapy?

Yes. As you revisit painful memories and emotions, symptoms like flashbacks or panic can increase. This is normal. Many patients experience this during exposure therapy or EMDR. Still, it's a sign your brain is doing real healing work. Book a consultation with Dr. Chugh if unsure.

2. How long does the "worse before better" phase last?

It varies. Some people feel worse for a few weeks, others for months. It depends on the trauma, therapy type, and your support. The key is consistency. If you're unsure, speak with Dr. Chugh to evaluate your PTSD treatment stages.

3. What if I feel like giving up?

Many people do at some point. It doesn’t mean you’re weak. It means your brain is working through a very real storm. You don’t have to do it alone. Reach out to Dr. Chugh or a therapist trained in trauma recovery process.

4. Is medication necessary for PTSD?

Not always. But in some cases, medication can help stabilize mood, improve sleep, and reduce anxiety. Dr. Chugh can help assess if you need extra medical support based on your symptoms.

by Dr Chandril Chugh

What Makes Neurology Complex: Learn About The Medical World

What Makes Neurology Complex: Learn About The Medical World

Neurology is that branch of medicine which deals with Neurological disorders of the nervous system, which includes the brain, blood vessels, muscles and nerves. A Neurology specialist is a doctor who is trained to diagnose and treat these disorders.

When a patient seeks consultation with a neurologist, they foremost evaluate whether there is a problem in the nervous system of the patient or not and only after determining the problem, continue with the treatment. 

If you are planning to see a neurologist, you might have a lot of questions in your mind about what will be required of you and therefore, here we will address each of your queries specifically.

1) Would I be referred to a neurologist?

If the general physician believes that the patient has a neurological problem and needs special attention, they may refer the patient to a neurologist. In such a case, they would refer the patient to a specialist who can effectively examine the patient and also provide proper treatment when necessary. 

2) Why would you need to see a neurologist?

A neurologist is trained to diagnose and treat a range of conditions. Here are some reasons to see a neurologist: 

1. Neuropathic pain occurs due to any damage that leads to nerve injury and may be sharp, shooting or burning. You may also have neuropathic pain from damage to your brain or spinal cord and occur after a stroke. 
2. Parkinson's disease: Parkinson’s is caused by the loss of brain cells which produces the chemical dopamine, which is necessary for body moment. 
3. Seizures: It's a sensation in the brain accompanied by uncontrolled moments and at times, may also lead to unconsciousness.
4. Migraine: A migraine is a severe form of headache that is very disturbing.
5. Nerve injury: Any nerve injury to the Spinal cord or brain caused by an accident can also lead to a Neurological disorder.

These symptoms can lead to memory loss, loss of sensation and visual changes may occur in some patients. Therefore, it is important to get the proper treatment to treat these medical conditions, for which one needs to see a Neurologist.

3) What does a neurologist treat you for? 

A Neurologist treats you for Disorders and Diseases of the nervous system. What to tell your Neurologist depends upon how an individual feels.

Suppose your primary care doctor refers you to a Neurologist. During the first appointment, the neurologist will check out your previous medical reports and have conversations with you to know more about your medical history.

After that, they scrutinize the information in front of them which helps them make decisions. If necessary, a physical examination and neurological exam can also be conducted to know the depth of the problem.

The doctor may also try to reach for the right diagnosis by testing the moments and study the effects of these exams. It can include body moments, breathing, and sense of touch.

During a physical exam, the doctor looks at body movements, studies the posture, sense of balance and any difficulties that the patient may be having in performing a specific task or activity in the exam.

Types of Neurological tests 

1. Electroencephalogram (EEG): Measuring the electrical activity in the brain from the Electrodes applied on the scalp.
2. Electromyography and nerve conduction studies (EMG/NCS): Nerves and muscles are tested through Electrodes and fine needles placed on the skin.
3. Lumbar Puncture: A Spinal fluid sample is taken to determine any serious problems. 
4. CT, MRI, and PET scanning are some other diagnostic tests. 

The treatment can be dynamic and totally depends upon the patient body and also their past medical history.

by Dr Chandril Chugh