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, September 28, 2010

Irritable Bowel & Barking Dogs

If “love” is the most misunderstood word in society today, “constipation” cannot be far behind. A recent study revealed that 5-22% of the population across the world are unhappy with the ways their bowels move and they use the same word to describe a variety of symptoms.
“Constipation” means different things to different people, from a feeling of incomplete evacuation (45%), straining at stools (30%), hard stools (10%), bloating and distention (20%) to several others. None of these meet the Western medical definition of “constipation” described as passage of less than 3 stools per week!
How bowel habits differ between peoples and regions, and the urgent need to redifine terms were highlighted during the recent Asia Pacific Digestive Conference in Kuala Lumpur, in which Asian doctors pointed out that the Western definition of constipation was inappropriate for Asians as hardly anyone would actually qualify while many feel they are constipated while passng stools quite liberally.
Bowel habits indeed vary widely not just between peoples and regions, but even between individuals. While many Indians believe that passing atleast one stool per day in the morning is crucial to health, the range could be considerable from 3 times a day, often after food or meals, to once on alternate days. Timing may not be so important after all as modern lifestyle may not often permit us to sit long on the pot before the early rush to school or work while evenings allowing more time to coax stressed bowels to relax and allow the passage.
Food and exercise are once again being thrown into center stage in debates on bowel habits. Our Indian diets of daal-roti-sabji have adequte amounts of fiber that absorb water and toxins, give volume to stools and stimulate the large intestine to move forward with regularity, keeping our constipation as well as our risk of colon cancer at bay. In USA, bowel cancer has become the commonest of cancers, making doctors advocate colonoscopic examination for screening in everyone above 45. If we change our food habits to burgers, sausage, ham and cheese, we will acquire the risks as well, just as Indian immigrants to western countries have started doing.
A few simple tips can be of use: If stools are hard or infrequent, green veggies, and fruits such as papaya, apple, pear or “bel” can help. If your stool tends to be loose and the frequencies high, try bananas and curd, and cut down on milk and cheese. If “gas” and bloating are your main symptoms, excess of gas forming foods such as sprouts, daals, peas, radish or milk could be the culprits; try cutting down on them and see if it makes a difference.
Unsatisfactory bowels movements however do compete with spouses, bosses, children and work place as a significant cause for unhappiness in life. The solution often lies in treating them as barking street dogs: if you heed them they bark more; if you ignore them, they often stop barking. 
As published in HT City ( Hindustan Times) dated 26 september , 2010.

Tuesday, September 21, 2010

Street Dogs and our CONSCIENCE

In the aftermath of a school child recently bitten by a street dog , attitudes and opinions on how we should deal with these canines have become divided as never before. The hardliners now have a case to justify their demand to kill these unwanted flea-infested animals who seem quite a nuisance on streets and colonies.
Interestingly, no matter how much we humans hate these creatures, they seem to love us; they live near human habitations and refuse to go and live by themselves in jungles, they wag their tails in gratitude for the rest of their lives if you have thrown a slice of bread at them even once, and their loyalty to humans can put ministers to shame!
As the story in Mahabharata goes, when Yudhisthir in his pursuit of truth, withdrew his emotional ties from all his relatives and earthly possessions, and was resolutely marching up the Himalayas towards Heaven, a stray dog started accompanying him on the rough path. By what we can imagine from Yudhisthir’s nature it is unlikely that he cuddled or petted the animal, but may have shared his food at times. After the hectic journey, when he reached the gates of Heaven he was so moved by the dog’s loyalty and companionship that he demanded the canine be admitted too, a proposal that Gods found preposterous.  It was then realized that the dog was God in guise, who was testing Yudhisthir’s capability to reciprocate the canine’s loyalty. I wonder how we would have fared in this test!
At the Sanjay Gandhi Institute residential campus we have had our share of problems too. A dog count showed we had 80 canines, withthe number growing rapidly as new litters of pups were added several times a year. No matter how cute the pups looked they wailed and remained un-cared on the streets. Our children painfully witnessed many die.
While we were wondering how to balance practicality with conscience we met a street-dog lover called Reema Singh who showed us the way. Why not take the female dogs to a good hospital, feed, vaccinate and sterilize them, and leave them where they belonged?
Our collaboration started 8 months ago with Dr Prerna and Mr Om Prakash from SGPGI and Dr Manish Tiwari from Animal Ashram. The initial concern of soulful campus dwellers were soon assuaged when they saw the same familiar dogs returning back after 2 weeks and in healthier forms! Our director, Prof RK Sharma and his kind hearted wife Dr Kumudini, led from the front, and now have seven loyal canine guards apart from their khaki clad security outside their gates.  This was a success story for our campus.
We have much to learn from street dogs. Apart from loyalty and gratitude, they test our tolerance and empathy. They inculcate feelings of compassion and care in us and our children and remind us that unpleasant problems in life cannot be solved by merely removing them from sight. And they help reveal a person’s nature. Watch that boy who throws a stone or kicks a sleeping dog. The chances are that he will get into crime when he grows up.
Tail piece:  Who loves you more – your wife or your dog? Lock them by turn up in a room for an hour and then release them. The dog will come out wagging its tail in gratitude? And wife?
 As published in HT City ( Hindustan Times) dated 19 september 2010.

Tuesday, September 14, 2010

Mosquitoes may bring India on its Knees

None of our clever politicians and planners could have thought that a burgeoning swarm of mosquitoes could change the course of emerging India and humble us. While children are dying like flies in and around Gorakhpur from the annual post-monsoon wave of mosquito borne encephalitis that year-after-year we promise to stem but never seem to be able to achieve, hospitals of the national capital are being deluged by dengue victims. Our financial capital, Mumbai, especially in its southern part where the rich and mighty live, is also being swamped with malaria, serving as a harsh reminder of our human vulnerability.
Of the several problems threatening the forthcoming Commonwealth games, mosquitoes and threat of diseases caused by them are emerging as key factors to keep international players and fans away.
There are 3 types of mosquitoes spreading diseases: Anopheles, the night biter spreading malaria, Aedes, the striped day time stinger spreading Dengue, and Culex transmitting encephalitis with its twilight stings. While we may not have much of an a la carte option to choose which of them to be stung by, mobilizing steps to protect ourselves from these deadly animals is the call of the hour.
Mosquitoes, as we all know, are breeding in the stagnant waters on the roadside, in water-clogged construction sites, in air-coolers in our windows, in tins and tyres left  in uncleared bins, in choked drains, in waterlogged paddy fields and most importantly, in polythene bags lying around in heaps in our neighbourhood. Students of Jaipuria School have taken an examplary initiative to not only ban and shun use of polythene bags themselves but to reach out to shops and local residents to do so as well. If sustained and encouraged, it can make a major health impact in the Gomti Nagar area for a start.
While most advertisements from mosquito-repellent manufacturers seem to appeal to our fears and focus on individal protection, it is more prudent to tackle the problem at the community level. Mosquitoes can fly for only around 400 metres. Hence keeping our neighbourhoods clean and dry is the crux. And if stagnant water is not possible to remove, pouring kerose kills the mosquito larve waiting there to take wings and strike.
During dengue epidemics, schools and offices have a special role to play as lethal stings occur in the daytime when people are at study or work. Apart from keeping the premises dry and clean, spraying mosquitoe repellents in room corners, under tables and in toilets, it is judicious to encourage children and staff to wear full -sleeved shirts and socks as the quill of Aedes is short and does not traverse a layer of cloth.
Mosquitoes have changed the course of history from time to time; by delaying the construction of Suez and Panama canals, to devastating populations in Indonesia and Kenya. Our CWG organizers should not underestimate the importance of mosquitoes as they may put a spanner in our preparartions next month.
 As published on HT City ( Hindustan Times) dated 13 september , 2010.

Tuesday, September 7, 2010

Colas have No Class

Cola drinks, once a symbol of American upmarket style, is now to be found perched mainly on the shelves of road-side ‘paan walas’ and local grocers. True, there still are Americans who drink more colas than water, and consume an average of 2 bottles per day of the tangy fizzy dark drink, but it has clearly fallen in stature as offering it to visitors or serving it at parties is no longer elegant.
Premiere schools in Lucknow such as La Martiniere College for girls have shunned colas from their canteen for the last 4 years. The story started with extensive campaigns by HOPE Initiative (Health Oriented Programs and Education) in 2005 creating awareness among the bright students about the long term harms of cola drinks. A heated debate followed in which the rights of an individual student  was pitched against the hazards of allowing gullible youngsters to be enticed by aggressive marketing to gulp colas and fall sick. The intelligent and alert La Marts students dcided on their own, that colas be best removed from their canteen shelves. And a very supportive administration obliged. Several other schools soon followed.
Take one glass of water, add 7 spoons of sugar and a concoction of chemicals, colours, and pesticides and you have a soft drink. There are atleast 4 undesirable health risks that make soft drinks dangerous.
Unbalanced nutrition: A soft drink contains around 160 kilocalories, all of which come from its sugar content. It contains no other nutrients to balance. The content of protien, vitamins and fiber is zero; hence these are referred to as “empty calories”. Making up the daily carorie requirement of around 1600 kcals with these sugars causes imbalanced nutrition and makes the body vulnerable to diseases such as diabetes and fatty liver.
Fluctuations in blood sugar: Simple sugars, as in soft drinks are easily and rapidly absorbed leading to rapid fluctauations in blood sugar and insulin levels. Diabetic are especailly vulnerable to these fluctuations.
Dental caries. Children, or for that matter even adults, who consume soft drinks frequently are more susceptible to dental problems. Try putting a few drops of cola on the tiled floor, leave it for a few hours, and see the stain!
Weak bones: Phosphoric acid, one of the components of cola drinks that provides the tangy taste, leaches calcium from the bones and make them weak and fragile.
Although the calorie problems are offset with the “diet” forms of colas, the other ones still remain.
I drink colas only in way-side dhabas to quench my thirst where clean water is not available. Drinking colas at home or serving them at parties is neither healthy nor chic anymore.It is paradoxical that the very country from which cola drinks originated has recently been in the forefront of campaigning against them on health grounds.
 As published in HT City ( Hindustan Times) dated 5 september, 2010.