I have tried to make my own little mark in this world. My career as a Medical Educator and Clinician in Gastroenterology (see www.gastroindia.net) and my flirtations with Health Promotion, especially amongst school children (see www.hope.org.in) are shown elsewhere.This blog contains my attempts at creative writing, most being write-ups for Health Adda column of HT City of Hindustan Times (also see www.healthaddaindia.blogspot.com) as well as a few others, and some reflections and thoughts that have struck me from time to time on my life journey.Please leave your footprint on this blog with your comment.

Tuesday, May 31, 2016

Say Cheers to Water

While we could debate on whether the old health-tip of drinking at least 8 glasses of water a day is indeed valid, water has interestingly retained its top position as the most popular health drink in the world.

Over 60% of the human body is composed of water. Water assumes the status of a nutrient for carrying out many of vital functions. Apart from replacing the amount lost each day through sweating, respiration, urine and stools, water forms the medium for all our digestive juices, brain fluids, blood and enzymes.

When water intake does not match our output, the body becomes dehydrated. Urine becomes scanty and dark, tongue becomes dry, eyes sunken, the pulse thready and blood pressure low. Thirst is the body’s way of signalling that we need more water. If not replenished, weakness and failure of organs can follow, sometimes leading to death.

The amount of water we need to drink depends on several factors. People working outdoors in hot dry weather conditions may need to drink 15 to 20 glasses of water as they incur huge losses through invisible perspiration.

Here are some reasons why you should ensure that you drink enough water.

1. Dieters know well the value of water drinking in weight loss strategy. A very fit film actor of 70 who looks half his age, once told me that he has been drinking 18 to 20 glasses of water every day since his teens, and kept attributes his slim fit figure to this habit.
2. Water is a good remedy for fatigue and tired muscles. When water moves out of muscle cells, they shrivel and become flaccid. Drinking water, sometimes along with salt and electrolytes, helps restore their turgor and strength. A small tip here: many people drink water only when they feel thirsty after exercise. A healthier way is to drink lots of water in anticipation before you embark, on say a jog or marathon.
3. The difference between a glowing smooth skin and a wrinkled dry one could often be due to water. Good hydration ensures healthy skin turgor.
4. Water is essential for the health of our kidneys. Wastes and toxins are removed from the body by the kidneys through urine and water is the medium through which this is done. Consumption of adequate amounts of water not only helps keep the body clean of wastes but prevents stones from forming in the kidneys.
5. People with constipation often do well if they increase their intake of water and fiber. The latter tends to hold the water in the gut, preventing stools from getting hard.

Do not wait for thirst to remind you that you need a drink of water. Start the day with 3 large glasses, and drink 5 to 12 glasses a day. Weight watchers should drink 2 glasses before meals. And if your urine looks dark, it is a reminder that you need to step up your water consumption.

Cheers to a drink of water.

How Doctors Die

Unlike the perception of most relatives that doctors treat critical patients callously, they in fact often “over-do” than what may be reasonable.

Says a intensivist “Rescusciation or CPR (cardio-pulmonary resuscitation) looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
"I felt like I was beating up people at the end of their life. I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, I'm sorry, goodbye.' Because I knew that it very likely wa not going to be successful. It just seemed a terrible way to end someone's life."

Doctors fall ill and die just as others in society do. Interestingly in spite of all their knowledge about the body, its ailments and cures, they life expectancy is not much different than the general population.

What is indeed different is what they choose to go through themselves compared to what they do to others. In a revealing article “How Doctors Choose to Die”, Dr Ken Murray points out that doctors more often shun ‘advanced’ and ‘intensive’ therapy.

They more often refuse chemotherapy when diagnosed with advanced cancer, prefering to spend quality time at home. Their decision is perhaps based on their first hand experience of having witnessed the unpleasant adverse effects and futility of these treatments.

Doctors also more often choose to refuse aggressive terminal care treatment. They have seen what is going to happen, and they generally have access to any medical care they could want. They know enough about death to understand what all people fear most: dying in pain and dying alone.

They know modern medicine’s limits. Almost all medical professionals have seen “futile care” performed. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs.

In a way doctors can be accused of double standards, applying one set of advice to patients and one to themselves, but the important variable here is the expectation of relatives. If a patient becomes critical, even if he is 85 and is known to be suffering from a terminal disease, the wish of relatives is usually “ Do whatever is possible”.

In the litigant and finger pointing times such as ours, doctors therefore prefer not to leave any stone unturned. Relatives, many of whom may have flown in that day, may derive solace from having gone “all the way” in the care of their dad or mom.

it is this fear of guilt of “not having done enough” that makes relatives agree to submit their loved ones to the dehumanising terminal treatment: surrounded by strangers, hooked to machines, body punctured at several places and not a familiar loving face to see before they close their eyes.

Thursday, May 12, 2016

Natural Ways to Get Sleep

It is funny that while sleep is a natural state of relaxation in which we spend one third of our daily lives or a third of our total life years, many of us seem to struggle to get it.

Sleep, in contrast to wakefulness, is a condition when our conscious mind switches off leaving the stage to the unconscious mind that often reveals itself in the form of dreams. Healthy sleep in adequate amounts is essential for our brains, minds and bodies.

Popping a sleeping pill has become an easy way out. At the last count there are over a hundred types of sleeping pills available for treating ‘insomnia’, the medical term for lack of sleep, with 3 of every 20 Indians consuming them. Most medications however provide an abnormal drugged form of sleep, create dependence or have adverse effects.

Getting enough of the natural sleep and at the appropriate time therefore continues to be a challenge.

The commonest form of sleep disorder especially in young people is difficulty in falling asleep.

It is sometimes due to excess consumption of caffeine, a cerebral stimulant, especially in the evenings. Saying no to coffee, tea and chocolates especially after dusk helps.

Another form of cerebral stimulation that interferes with sleep is watching thriller movies or heated arguments on television before bedtime. Therefore much though I like watching ‘what the nation wants to know’, I have started tuning in to ‘bhabiji ghar par hai’ to get into the right mood to fall asleep. Working on computers at night can drive sleep away too.

A dark silent cool room without mosquitoes and a comfortable bed often suffice. Additional sleep inducers could be soft instrumental music, bhajans or lullabies, or soothing aromas. Reading a book can be an effective strategy for some.

What do you do if these simple measures are not enough?

The strategy that works best for me is physical exercise. On days that I am able to get a 30-minutes session of tennis, shuttle or brisk walk, I find myself dosing off by 10 even when mud-fest on TV is reaching deafening levels.

Two other simple tricks also work well.

One is to relax all muscles of the body, working up stepwise from the toes to the forehead, making sure that the body is loose and limp. Direct the mind to slowing and relaxing the rhythm of breathing. Then focus the mind on a soothing scene. What works for me is to visualize sheep grazing on the hilly Himalayan meadow while I try to count them. Another sleep inducing mental exercise is to subtract 7 from 100 and count backwards.

Falling asleep requires wiping off excitement, fears and anger, and shutting off the conscious mind to let the body go limp and loose into that dream like state. The more one practices the easier it gets. And saying a silent prayer often improves the quality of the mist that wafts in.

GM Diet for Weight Loss

In recent times, my growing paunch has become an embarrassment especially when I counsel my obese patients about shedding fat. Hence I have been exploring an easy quick way that would be compatible with my lazy nature, to get back to shape.

I came to know about the GM diet that several people I have now met seem to have tried and found useful. Further it comes with a vegetarian adaptation that can suit most Indians. I understand that it has become the most popular weight losing diet in the country.
The GM diet is named after General Motors company of the USA where it was first developed to help obese employees shed weight, get back a healthy glow and feel energised. It was tested and endorsed by the reputed Johns Hopkins Research Centre.

It is based on a principle of rotating foods on a day to day basis and drinking lots of water to detoxify the body. Its biggest advantage is that it does not make you starve as many diets do.
The expected weight loss is between 2 to 5 Kg in 7 days. Yes, alcohol is forbidden during this period, as also are milk laden tea or coffee and packaged fruit juices.

The week’s schedule goes like this:

Day 1 is the all fruits day when you are expected to eat only fruits of all types, except bananas, mangoes and lichis. Melons and watermelons are particularly recommended, as are guavas. There is no restriction on amount.

Day 2 is all veggies day, when you should subsist on only vegetables: raw, boiled or steamed, and of all varieties. No restriction on quantity except just one potato.

Day 3 is a mixture of days 1 and 2. Except for bananas and potatoes, you can eat a mixture of fruits and vegetables on this day—as much variety and amount as you like.

Day 4: The menu is bananas, milk and soup. You can eat up to eight bananas and three glasses of milk on this day and consume as much of the soup as you like.

Day 5 is a festival day when you can have a tasty meal. You can munch on tomatoes, sprouts and cottage cheese (paneer) or soya chunks. Make a tasty soup with them and drink it. Make sure you increase your water intake on this day.

Day 6: The recommended food for this day is sprouts, cottage cheese and other vegetables excluding tomatoes. The tasty soup and lots of water should help you through your day.

Day 7: On the last day you can have fresh fruit juice, one cup of brown rice or half chapathi and other vegetables you would want to eat.

If you undertake moderate exercise of 15 to 30 minutes a day in addition, the weight loss in 7 days can be impressive. And you can repeat it as often as you wish.
Worth a try for a week to see if it works.