Are You Drinking Too Much?

Cheers!  Alcohol, once tabooed in Indian society, has gained wide social acceptance today. Parties are no longer always as ‘dry’ as to keep the conversation hovering for hours around the weather, the boss, children’s school or politics. A couple of drinks make guests mingle better, voice their honest opinions about Katrina’s lips or Shakira’s hips, crack jokes and even sing a soulful gazal! Ladies have also started prefering spirits to Sprite as they join their men in the ‘wet’ soiree with equal gusto.

Exposure to alcohol is not really recent; humans and their forefathers (apes) have tasted alcohol through the ages while munching or sucking over-ripe fruits, most of which have fermeted cores.  The difference is in the concentration; it is a meagre 1-3% in naturally fermented foods as the yeasts die when the alcohol levels rise. And these low levels can’t make one tipsy!  It is through the process of “distillation”, discovered by man a few centuries ago,  that alcohol can be concentrated and beverages such as beer (4-7%), wines (7-15%), and spirits (brandy, whisky, gin, rum, vodka, 35-45%) produced, depending on the source of the substrate.

The line dividing harmless social drinking and “alcoholism” is often so fuzzy that a fun loving party-goer does not often realize when he is tresspassing the Lakshman-rekha. A familiar story is how he could stay off drinks during the Navratri days or the holy month till a few years ago, but can’t any more.The CAGE Questionnaire, with 4 simple questions, could help let you know if your drinking is getting dangerous.

1.      1)Have you ever felt you need to Cut down on your drinking?

2.      2)Have criticisms by family, friends, colleagues or neighbours over your drinking ever Annoyed you?

3.      3)Have you ever felt a sense of Guilt about your drinking?

4.      4)Have you ever needed alcohol in the morning as an Eye opener?

A “yes” to any of them indicates that you are in the trouble zone, and need urgent help from family, well wishers and experts. Other indicators of alcohol dependence are drinking alone, starting to drink in the morning or afternoon, inability to get sleep, trembling of hands or restlessness if a drink is missed or denied.

Kicking the habit is, by no means, easy and often requires both desire and will. A change of place, setting and circle of friends can help break away from the entapping vicious cycle. It is often helpful to meet an ex-alcoholic and have him share how he conquered the problem. Many cities have groups called Alcoholic Anonymous, a group of ex-drinkers who provide this kind of support to those wanting to quit alcohol. A specialist can make the process smooth and ensure that the withdrawal symptoms are not too painful.

It is pity that an occasional pleasure often turns a trap ruining careers, families, health and life. It is time to wake up and take the call.

As published in HT City ( Hindustan Times)  dated 27 june , 2010.

Heads will Ache!

Headaches are so common that not to have ever suffered from it raises doubts whether the head is indeed there. While most are innocuous and transient and pass away with time or with a painkiller, some could be indicators of worrisome underlying problems.

The head often aches when other parts of the body are under strain. It accompanies seasonal fevers, fasts, and often appears after a gruelling day under the hot sun. It is not uncommon after a sleepless night of exam preparation, international travel or watching the last of the day’s FIFA world cup matches. The heads of young women often ache before or during periods. It can be brought about by mental stress such as a rebuke by the boss,  a spat at work or a feud at home.

Migraine is a common but specific form of headache that occurs due to spasm of arteries in the head. In its typical pattern, these attacks start with mild ache starting in one half of the head, often associated with visual auras such as light flashes or sparling lights. Over hours it progresses to intense throbbing pain in the head, often associated with nausea, vomiting and restlessness. Painkillers don’t work at this stage. Falling asleep often terminates the attck but some patients have it going for a day or two.

Migraine sufferers often learn to recognize what triggers their attacks (menstrual periods, fasts, bright sunlight, lack of sleep, red wine or cheese, physical or emotional stress etc) as well as the early phase of an episode, as a painkiller pill popped in at this time helps abort a full blown throbbing attack. And avoiding the triggers help reduce the episodes. If they are disablingly frequent and intense, mild medicines such as propranolol or sibelium are very helpful.  Yoga and positive life style changes, if pursued regularly, often provide much relief.

Unlike most stress related headaches that come on by the end of the day, early morning headaches have a different connotation. When they occur in hypertensive patients they suggest that the BP is poorly controlled. In a diabetic, they indicate that the blood sugar levels are dropping too low at night (nocturnal hypoglycemia). Although rare, patients with increased pressure within their heads from causes such as tumors also complain of morning headaches, often accompanieds by vomiting.

The age also matters.  Headache in a school child is often due to eye sight disorder such as short sightedness, or stuffy choked ears or a blocked nose. Pain from sinusitis is usually located towards the front and gets worse with head movements.

In the middle or older ages, cervical spondylosis is a common cause, especially if the ache tends to radiate down to the neck and back and worsens with movements of the neck.

Analysing, diagnosing and treating headaches can be a challenge to doctors as well. A detailed clinical evaluation often holds the key that an expensive MRI scan cannot provide. And a gentle massage of the aching head by the spouse often achieves what the stongest painkillers fail at!

As published in HT City ( Hindustan Times) dated 20 june , 2010.

Hospitals turn Havens for Criminals

After the Satyam scam, the accused owner B Ramalinga Raju  has managed to stay on in 5 star comfort rather than in the usual jail, thanks to his loyal pack of doctors and lawyers. They could convince the court and extract an exemption citing his multiple medical problems, including high blood pressure. 

He, like 30% of the Indian population of his age, had  high blood pressure for several years, even in the good Satyam times. Surveys of urban Indians show that around 70%  have one or more of the follwing health problems: high blood pressure, diabetes, weight related problems such as obesity or painful knees, heartburn (acidity), fatty liver disease, occasional breatlessness or chest discomfort, sleeplessness or thyroid dysfunction. Most would be on periodic checkups or on some medications for them.

What then is the big deal? They remain party goers and globe trotters with these “medical problems” till the police comes calling. Suddenly then doctors and lawyers are summoned, who move the courts to paint him seriously ill and seek protection from being sent to jail, getting him admitted to a hospital instead. Hospitals  ofcourse, are more respectable places, and allow co-conspirators, relatives and “well wishers” to come and meet easily, permit the accused to remain in touch through communication devices, and are easier places to run away from. Harshad Mehta, Abdul Karim Telgi, the Johri brothers of Century Consultants, Manu Sharma are some glaring examples.

And doctors are easier people to deal with. You can get them to certify for you through either inducements (politicians use their power to scuttle their transfers or arrange promotions, businessmen compensate by other means) or threats.

An accused politician once turned up as a patient and demanded that he be kept in our private ward for weeks till all his tests were done. Each day he had a new complaint that needed further tests. After 5 days when I was exasperated and suggested that we perform a colonoscopy necessitating pushing a 2 meter pipe up through his anus, he demanded transfer to cardiology ward, where he hstayed for another week.

Why are the police so cautious, and the courts so lenient convict complain of ill health? The lesson of Rajan Pillai, the Britannia baron is hard to forget. This high profile convict had complained of chest pain and blood vomiting, but the police and the judge had ignored his request for medical attention suspecting him to be malingering. He was subsequently bled to death in jail, from ruptured esophageal varices due to his liver cirrhosis caused by alcohol. Civil society was scathing in its attack on the police and the court. No one now wants to take a chance any more.

While the “voiceless”   aam jail inmates seem to have no symptoms and hardly require any medical attention it is interesting that considerable concern is shown by the police, courts and doctors to hig profile convicts. Playing safe is good, but an over-cautious approach can viciate justice by protecting criminals. 

Doctors and the Hollow Men

On rare occasions even medical consultations can turn interesting. One such was when a senior banker who came to see me as a patient and crossed beyond symptoms, sighs and sorrow to literature. He had been a student of English literature himself before taking to banking, and what pulled the trigger was his expression of surprise at a medical specialist like me writing a weekly column for HT City.

His surprise rose to incredulous levels when I told him that five of the most celebrated writers had been medicos. My count began with Sir (Dr) Arthur Conan Doyle, the creator of Sherlock Holmes of “The Hounds of Baskerville” fame. What makes the detective stories so fascinating is Doyle’s deep knowledge and use of forensic medicine that both the offender uses to inflict harm and the detective, Sherlock Holmes, uses to crack the mystery with. Most agree that Doyle remains one of the favourite mystery writers of all times.

Another gifted writer was Dr W Somerset Maugham, my favourite for many years. His stories involved doctors, society and feelings. He was adept at describing tumultous human emotions and their conflicts. His book “The Painted Veil” describes the emotional travail of a young dedicated microbiologist whose trauma of discovering his wife’s unfaithfulness goads him to risk his life and explore a dangerous epidemic, to which he succumbs, blurring the lines between valour and suicide. His semi-autobiography, “Of Human Bondage", is the story of a young child handicapped with a club foot, who becomesa doctor, and the intricate interplay of his childhood frustrations, romantic obsessions and acquired professional pleasure, and remains a “must-read” for all literature lovers.

The story of how Dr AJ Cronin, a Scottish doctor, became a celebrated novesit is interesting. Soon after graduating from medical school and starting practice, he contracted tuberculosis, necessitating rest for 6 months. With not much else to do he started writing novels and soared as a writer with books such as “Hatter’s Castle” and “The Stars Look Down”. His writings deal with social themes often viewed through the eyes of a doctor.

Dr Richard Gordon, famous for his ’Doctor’series (such as “Doctor at Sea”), brings forth the humorous aspect of life as seen through the eyes of a doctor. The funny anecdotes in his books can make the most serious of readers laugh and giggle. Try not to read him in airports and trains, as fellow passengers may suspect you of insanity!

We Indians too have had our share; the literary giant Balai Chand Mukhopadhyay who wrote under the pen name “Bonophul” and produced immortal classics like “Bhuban Shom” (remember the movie that won the Berlin award!) was a medical practitioner who wrote novels and stories when the patients were in low ebb.

Proudly having said all that, I finally turned to my banker patient and asked him if any of his profession could match us doctors. He quietened me with just a single name “TS Elliot”, the despondent sardonic American poet and my most favourite!

‘That is the way the world ends, Not with a bang, but with a whimper’. He must have incurred heavy losses, I thought.