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.


Thursday, October 29, 2009

Know Your Personality Type

Ever noticed how people respond and behave differently in classrooms, boardrooms, bedrooms or on playfields?  It depends on our personality type. And it is the type of personality we have that deteremines not only how we react and perform, but also our predeliction to health disorders. Try and see in whcih of these you fit best.
Type A personality is easy to recognize; people with this type are hard chargers, aggressive and ambitious. They are always struggling to win or lead, are restless with hunger in their bellies and are often dominating. They enjoy adventure and often make greatachievers.
Their constantly charged state generates frequent surges of stress hormones called adrenaline and corticosteroids, from their adrenal glands. The health price they often pay for their achievements is high blood pressure, diabetes, heart disease, stroke and peptic ulcer.
Type B personality is the opposite of type A. They are laid back, cooperative and not easily provoked to anger. They are peace loving by nature, and make good companions, friends or team members. They have larger amounts of the “calming” hormone called endorphins, in their system.Their restful nature protects them from the stress related health disorders often seen in people with Type A personality.
The typical Type C person is a martyr. He is compliant, eager to please and hence often prone to hopelessness and depression. They give up easily. Studies have shown people with Type C to be vulnerable to cancers and malfunctions of the immune system.
Type D has been relatively recently identified and studied. People of this type are notable for negative thinking, worrying, suppressed anger and a tendency to respond to stress by withdrawal and denial. They stew, simmer, and blame themselves and others. And when it comes to feelings, they rarely voice strong emotions like anger, and are disinclined to acknowledge them.
A recent piece of research by a group of Dutch scientists have shown that people with this personality type fare badly in overcoming a stressful situation such as a major illness or hospitalization. While a person with a type A will fight and come out of a difficult situation, a type D will succumb easily. Their blood carries higher levels of inflammatory mediators, generated by their constant internal conflcts.
These are the 4 major types of personalities; all of us may not be staright fits but usually show predominance of one of these. Some may have “overlap” personalities.
Learning to recognize these personalities may help in several ways; we may understand and adjust better to our bosses, colleagues, partners and children. Type A people, for instance could benefit from managing stress better from an earlier age. Recognizing these types could also help doctors tailor therapies to their patients better.
As published in HT City ( Hindustan Times)

Tuesday, October 27, 2009

Hepatitis B: Is your Family Protected ?

When Siddharth, a 22 year old, went to donate blood for his mother’s treatment, he was shocked to hear that he harboured the Hepatitis B infection! He was fit, played for his college cricket team and had not sufferred from jaundice. Hence his disbelief!
Hepatitis B is usually a silent infection. This year’s global awareness campaign  “Am I number 12?” was aimed at drawng attention to this frequency. In India, the rate is somewhat less; 43 of 2500 apparently healthy people tested positive during a free checkup camp in the city. Around 20-40 million people in India are infected, 6 to 10 times more than HIV. It spreads through infected reused needles, poorly tested transfused blood, sharing of instruments such as shaving blades or ear piercing needles, from a “carrier” mother during child birth, or unprotected sex with an infected person.
What makes Hepatitis B worrisome is its silent nature for many years during which the virus nibbles away at liver cells, leading ultimately to liver failure (cirrhosis) or liver cancer. These individuals feel quite normal for years. When symptoms do appear, much of he liver is already badly damaged!
Siddharth was lucky to be diagnosed before his liver was damaged; he was put on medications with which the infection is now well suppressed. His mother, who had vomited blood, was diagnosed to have cirrhosis from a prolonged infection with the virus. His younger brother also tested positive, both children having probably acquired it from her during child birth.
Screening test for Hepatitis B has become a standard recommendation during antenatal checkups so that the newborn of a “carrier” mother can be protected with immediate vaccination and Hepatitis B immunoglobulin injections just after birth. It is however hardly followed as facilities for testing are not available in most government hospitals, community and primary health centers. Routine vaccination of new borns with the vaccine (cost Rs 8/- per pediatric shot, 3 shots required for full protection, after 1 and 6 months of the 1st) has still not been included in the government vaccination schedule in most parts of India. More than 150 countries, some less economically developed than ours, have adopted it and brought down the infection rates drastically.
The vaccine used to be fairly expensive, costing Rs 1500/- for 3 adult doses. With many companies manufacturing it, the cost  for 3 doses has dived to around Rs 50/-, for a lifetime of protection. In spite of this, we found that only one third of school students in Lucknow had received the shots. The rates were as low as 0 to 6% in rural schools. The issue is less about cost now, and more about awareness. While the Gates and other foundations have helped spread awarenss about HIV infection, Hepatitis B, which infects and kills more than 10 times as HIV, is at large. HOPE Initiative, a Lucknow based organization, through its unique B-Rodh project, with support from Bristol Meyers Squibb (BMS) Foundation, is sending this message to 5 lac children and their families in Uttar Pradesh. You can become B-safe @Rs 50/- for your lifetime, certainly a worthwhile investment.
 As published in HT City ( Hindustan Times) dated 25 october, 2009.

Sunday, October 18, 2009

Shedding Weight After Diwali

In the aftermath of Diwali, most weight watchers are expected to see blue for some time. The scale will remain stubbornly up for a while, making you wonder whether you had behaved really as badly with your eats and exercise the last week to deserve this! And where exactly was the problem?  In what we ate or just the few days that we skipped our exercise routine?
Those who exercise vigorously, pile up kilos rapidly as soon as they stop. Look at the erstwhile sportsmen and dancers. Diego Maradona, the soccer legend from Argentina, became morbidly obese when he stopped playing. His condition was so desperate that he had to undergo a weight reducing bariatric surgery to loose a few score kilos! Many of our vintage cricket heroes seem to have similar problems. Dancers of Bhartnatyam and Kathak pile up kilos when they stop their rigorous practice. Similarly, gym goers are likely to put on more weight when they stop than their “regular walker” friends. My tennis buddies at SGPGI, who play 40 minutes every morning, are not getting lean either.
There is some bad news for gym goers and sports buffs from the research world. Three recent studies have shown that as many as 30% of those who exercise regularly do not lose weight. In fact a few acually gain some, raising concerns about our modern obsession of working out in gyms and taking to vigorous sports as part of our present day lifestyles.
While  exercise workouts is believed to help redistribute body weight, converting  fat into s muscles, the fat percentage in the body also seems to remain unchanged in many. The reason: increased calorie consumption resulting from enhanced appetite caused by the exercise itself. Many “reward” themselves with fatty food after their workouts.
Further, the calories that we burn by exercise are relatively small compared with what our desi mithais and snacks contain. The caloric content of some of the food that we would have eaten recently are high; a glass of soft drink (100 kcals), a sweet (100-300 kcal/piece), dry fruits (300 kcal for a handfull), a samosa or kachori (150 -300 kcal/ piece). If you have snacked through the day visting friends, you might have consumed an extra 1000 to 3000 kcals a day during this phase.
Burning them is not going to be easy. To lose 300 kcals, we have to jog 30 minutes, or cycle for 70 minutes or lift weights for an hour. My tennis buddies and I will have to play an extra set daily for 4 weeks to lose what we have recently gained.
Diet therefore holds the key to losing weight.  Try large bowls of clear soups and salads before meals, suhki roti and boiled veggies, 8-10 glasses of water a day. Stop eating when you are half full and still hungry. And get rid of all the sweets, snacks and pastries from your home.  You might then regain your shape in the next few weeks. Good luck!
As published in HT City ( Hindustan Times) dated 18 october , 2009.

Thursday, October 15, 2009

Have a Safe Diwali

While Diwali is an occasion for praying, expressing love and greeting friends, we give expression to our festive spirit by lighting lamps, eating sweets, exchanging gifts and bursting crackers. The spirit of the “festival of lights” often however gets shrouded in the manner in which we celebrate it, and every year, this period of joy and gaiety turns into a nightmare for some.
Health and life come under considerable threat during Diwali: the air we breathe gets smoky and polluted with suspended particles and toxic fumes, triggering attacks of breathlessness and asthma. Crackers cause deafness, usually temporary but sometimes permanent, especially in children. The loud noise of crackers often triggers heart attacks in the elderly. Burns are common, claiming several lives and maiming many every year. Igniting of firecrackers releases fumes of cadmium, lead, copper and magnesium that cause a variety of problems from anemia to nervous ailments, making us feel tired and sleepless by late evening.  And remember that the crackers you buy and burn could be the spoils of child labour.
Gorging on sweets is a distinct Diwali health hazard. Sweets at home, sweets at any home you visit and boxes of sweets that come home as gifts. They are high in fats and sugars, make our weights and blood sugars soar, and thicken the arteries of our heart. Do we need to keep binging on them every year as tradition?
Consumerism reaches its peak this time every year. A plethora of glittering Items and goods are dispalyed on sale, and whether we need them or not, buy them we must! Jewellery, electronic items, cars, utensils, clothes, almost anything that we can splurge on seems justifiable at this time. We also spend good amounts of money beautifying and lighting up our homes and offices, to impress Godess Lakshmi who come visting. We consume large amounts of electricity and fuel, deprivng many of our less fortunate countrymen whose homes remain dark and cold.
While celebrating Diwali this year, try some of the following this year:
1.     Use diyas: they are truely traditional, aesthetic and bring home the true spirit of Diwali.
2.     Avoid crackers. If however you must, use them sparingly in open spaces and before 10 PM. Make sure you wear cotton and have a bucket of cold water nearby.
3.     Try eating and serving fruits or low calorie sweets rather than the rich commercial ones
4.     Curb your buying binge.
5.     Focus more on what Diwali is meant for: express love, greet friends and pray for peace.
6.     Try out a new way of being happy this year: the joy of GIVING. Visit a hospital, orphanage or a home for the challenged, with a few boxes of sweets or toys. See the way the faces of the sick or lonely light up with joy and gratitude. It might be the brightest light you can get yourself this Diwali. And this will certainly earn you bonus blessings from Goddess Lakshmi. Happy Diwali.
As published in HT City ( Hindustan  Times) dated 11 october , 2009.

Saturday, October 3, 2009

Healthcare India- 2009-2010

Several of the hospitals in India have become world class, leaving very little to be gained by Indian patients planning to go overseas for treatment. The best scanners (CT, MRI, PET etc) are now available at home, treatment of heart diseases (coronaru angioplasty, stenting, bypass surgery, valve replacements) is widely and safely available with excellent results that are predicatable, and transplantation of kidneys, bone marrow and liver has matured with time and numbers. Cancer treatment is also excellent and avavilable through many regional cancer centers across the country. Medical tourism has become a flourishing business in India, thanks to the high quality and reliability of health care in some Indian hospitals.
The advances in medical care in India have unfortunately occured in private corporate hospitals. They cater to an urban middle class with rapidly expanding paying capacity for their health needs. They have also been quick to see and utilize the inevitable need for medical insurance to meet growing healthcare costs.
These swanky edifices with most modern gadgetary have however created a class divide within society. The poor, the official estimate of which is approximately 400 million, have only government hospitals to turn to. These crowded fly infested places with irregualr supply of vital equipment, medicines and doctors have left the not-so-rich frustrated. They are grossly inadequate: many do not have ultrasound machines, blood banks, standardized laboratories, a full complement of trained personnel, adequately stocked pharmacy or contemporary expertice.
The importance that our government gives to health can be gauged by the fact that a mere 0.8% of India’s GDP goes to health, compared withy 16% in USA and 7% in the UK. The costs of equipment, procedures and medications have risen steeply, as have people’s expectations from hospitals. Although there are over 150 government medical colleges in India, most do not even have the equipment and procedures that students are expected to see, use and learn during their training periods there.
Let us take 2 examples: while the curent appropriate treatment for gallbladder stones is laparoscopic cholecystectomy, over half the medical colleges do not provide this service. With around 5% of adult Indians estimated to harbour gallstones and many likely to become aware of their presence due to the ubiquitous availability of ultrasound clinics, most would get their surgeries done in private nursing homes or hospitals. The other example pertains to Hepatitis B: although 4% of Indians harbour this infection (40 million), the test for its detection is not available in the majority of these medical colleges. It is an essential part of anti-natal screening, but how can an expecting mother visiting these hospitals get themseleves tested and protect their newborns if the test is not available there at all? And while 160 countries have added Hepatitis B vaccination to their childhood immunization programmes, India stands out like a sore thumb as not being one of them due to financial constraints!
The selection of sites for creating new medical colleges also defies common sense. While the building can be constructed anywhere, and desperate students may travel to any corner, what about faculty and patients. Why would a talented faculty surgeon, with 2 school children stay in a remote place which does not have good schools? And are we trying to fill faculty posts somehow, or aiming to attract good faculty to ensure quality education for the nextgen docs? And why would poor patients staying in slums around big cities spend on transport to reach some remotely located medical college that is also often lacking in facilities? I leave it to you to judge!
There could have been reason for the government to argue that tertiary care, being costly, may be best left to the private sector, that medical colleges should strive towards good, standard-of-care secondary tier health care, and played a exemplary role in primary care and disease prevention. After all, foreach patient with lung cancer or heart attack, there are 100 who are waiting to be diagnosed and a 1000 at risk, waiting to get affected by disease. Our record of accomplishment in primary prevention has been dismal. The sales of tobacco, which accounts for 50% of all cancers in India, has infact gone up, alcohol shops have been allowed to crop up along highways encouraging drunk driving and road trafiic accidents, and polythene bag heaps around settlements explain why mosquitoe borne diseases continue to claim somany lives in India.
What should we expect in 2010. A thoughtful plan for our health services could be good for a start.