Faith and Healing

Christmas is the perfect occasion to explore the complex relationship between faith and healing. The plummeting attendance of patients to hospitals and clinics at this time every year has several explanations: the faithful ascribe it to rejuvenation of faith, my medical colleagues to winter being the “healthiest” time of the year, and pragmatists to the cold and fog that deter patients.

The reason why malaria, dengue and encephalitis beat a retreat at this time is because the cold deters mosquitoes even more than people. Further, water borne infections drop sharply as foods are preferred hot or fried (aloo tikis, parathas, tea rather than sharbats, paani batashas and salads) in which germs die.   

Clinic attendance alone may not be a good indicator of the role of religious faith in a community’s health seeking behaviour. It is observed that a sharp drop in patients from concerned communities ,occur during Ramadan, around Diwali and Christmas, and may reflect social attitudes of deferring investigations or hospitalization till the festive time gets over, rather than a true decline in illness.

What then is the evidence that faith benefits health?

The faithful and devoted have been shown to live longer lives than their questioning counterparts, and fall ill less frquently. Faith, by providing a constant emotional support and a sense of purpose, helps reduce stress, keep stress hormone levels at lower levels, improves our ability to cope with hurdles in life, and also increases our capacity to accept and tolerate what is inevitable.

How the practice of faith by a community can be used to improve the health and well being of the followers unfortunately often depends upon its human leaders.

A church based approach to life-style change to reduce risk of heart disease was tried in South Carolina, USA. In this program called “Lighten Up”, church goers with rsik of cardio-vascular disease were given health messages and periodic health check-ups along with scripture-sudy. Of the 133 people covered by this program, 70% lost an average of 2 pounds, and showed significant improvement in their BP and triglyceride levels. Participants complied better to the health advice that came from their church, than if it had come from a doctor.

As most of our religious faiths have been in existence for centuries, and our practices are often steeped in tradition reinforced by time, any attempt to amalgamate modern thoughts or goals is unfortunately often met with reasonless resistance. With the levels of education and awareness rising steeply in society, a wise clergy could do well to encourage followers to live healthier lives based on modern scientific knowledge.

In earlier times, duties of a priest and doctor were often performed by a single person. Today the roles have split with priests focussing only on the soul and doctors caring only for the body. Religious bodies can make themselves more effective and relevant by going beyond theology and faith and encouraging health and well being among their followers.

Merry Christmas. 

As published in HT City (Hindustan Times) dated 25 December, 2011.

The LAST Drink

The recent tragedy in West Bengal in which 170 people died after drinking locally made hooch shows once again how vulnerable our poor are, and how poor are our mechanisms to ensure their safety.

Hooch, Moonshine or Jake is the name given to illicitly distilled illegally produced alcoholic drinks that do not conform to safety standards. They are made by fermenting sugary or starchy substances, distilling them to increase the concentration of alcohol, and often adding other substances for more punch. They have been produced for generations in home-made stills or barns, often under the cover of forests and swamps, and catered to poor labourers, farmers, rikshaw-drivers and hawkers.

Outbreaks of poisoning and deaths due to bad hooch have occured in various parts of the world from time to time. Major Indian tragedies have occured in Gujarat, Tamil Nadu, Kerala, Odisha and UP in the last 3 years, and despite the temporary reactions they elicited, the magnitude of tragedies has just got bigger.

Ethanol or ethyl-alcohol is the intoxicating agent in all alcoholic beverages. It is when unscrupulous manufacturers resort  to mixing other substances  such as methanol (methyl-alcohol), lye, rubbing alcohol, wood paint, paint thinner, bleach, formaldehyde, chemical fertilizers, leather and lead to the drink either as cheaper substitutes or to provide more “kick”, that they become poisonous.

Methanol, a cheaper substitute of ethanol or ethyl-alcohol, produces abdominal pain, acidosis, coma, blindness and paralysis. Treatment, if the victim is brought to medical attention in time, requires giving ethyl-alcohol to flush out the toxic methyl one, or dialysis, both of which are usually not available in small rural centres where these tragedies take place. Those who survive methanol poisoning are often crippled with blindness, paralysis and loss of livelihood.

Hooch tragedies tell much about our society; our scant health and safety standards and the deep cleft between the rich and the poor.

Bootleg country liquor comes cheap and is often the only intoxicant that the poor can afford. The hooch kingpins get more and more people, especially the earning members, hooked to expand their market. Thay also provide employment to the poor for making and selling it, develop financial clout, poliical patronage, and often become invincible lords of local rings.

Banning hooch would seem the obvious solution, but would push the poor, who have already been hooked to intoxication as succour to their struggling lives, to more expensive alternatives, thus promoting the sale of branded products. And do we expect the same law enforcers who are vulnerable to bribes and who allowed this to happen, to be different then.

The deeper question is: Why do poor people who eke out their existence, take to intoxicating drinks? Do they too need entertainment , like their well-to-do counterparts? What options do they have? Could society or governments try to provide them with healthy entertaining engagements that would keep them from drinks and drugs? A well enforced ban would only then have a chance to work!

As published in HT City (Hindustan Times) dated 18 December, 2011.

Going nuts over choosing oil!

With my days of cricket feats and trecking tales slipping into history, and people calling me “uncle” rather than by my first name, I decided to explore ways of keeping at least my heart younger than my rapidly greying hair. I started by exploring whether the cooking medium in our kitchen needed change.

A mind boggling 479 million results emerging in a trite on googling “healthy cooking medium” bowled me into confusion. The search threw up oils and fats I had not heard of, many clamouring for the “best” spot. Seconds later I realized that most of this “information” was “promotion” stuff by manufacturers, marketeers and oil lobbies, as is often the case in the world-wide-web.

My grandpa’s wise saying “When too many opinions fly around, no one knows the truth” seemed to fit well here.  I therefore chatted up with Dr Sudeep, our young cardiologist, to find out what medical science was preaching these days.

 “Desi ghee”, derived from the nutritious milk of holy cows, whose virtues my grandpa had extolled in my pre-teen days, he told me, had become “toxic” to the heart despite my grandpa living actively on till 85 while liberally consuming it, and  without a coronary angioplasty or even a daily dose of asprin.

Saturated fats,it seems , are the worst of them all. They are solid or thick at room temperatures, and include ghee, vanaspati and butter. They get deposited in the arteries of the heart more easily than others.

Lighter oils from vegetable sources are in fashion: groundnut, sunflower, mustard, gingely, safflower, coconut, palmolein, soyabean, ricebran, olive, canola and many more. What seems to determine their ratings are their proportion of un-saturated fats (more the better), and the balance of MUFAs ( Mono-unsaturated ) to PUFAs (poly-unsaturated fatty acids), and Omega-3 to Omega-6 fatty acids?

The reason for this enormous confusion is that no one seems to know what the ideal mix of MUFAs to PUFAs, or Omega 3s to 6s is, allowing each oil-maker to stake a “healthy” claim for his product.

Coconut oil is a too high in saturated fats and is best had only on occasions with “avial”. Mustard oil is healthy with lots of unsaturated fats, but contains a bit of the undesirable erucic acid. Olive oil is good, at least for Italians whose hearts don’t ache despite gorging on cheese-stuffed pizzas. Samosas and kachoris fried in this oil however often taste like hospital-diet.

To my persistent “Which then?” the cardiologist finally confided, “There is no ideal oil; they all have pluses and minuses. Hence use different ones for different dishes or change the brand every month. And keep the family consumption to 2-3 Kg per month”.

We therefore now use mixed refined oil for routine cooking, changing the brand every other month, mustard oil to fry fish, olive oil in salad dressings........

To my “Can I take a spoon of ghee with daal?” Dr Sudeep however did not melt!

As published in HT City (Hindustan Times) dated 11 December, 2011.

Fight anxiety blues!

It's natural to worry during stressful times. Some people however feel tense and anxious day after day, even when there is little to worry about. When this lasts for six months or longer, it may be generalized anxiety disorder or GAD. This illness affects several of us. Unfortunately, many people don't know they have it, and hence miss out on treatments that lead to a better, happier life.

The main symptom of is a constant and exaggerated sense of tension and anxiety. You may not be able to pinpoint a reason why you feel tense. Or you may worry too much about ordinary matters, such as bills, relationships, or your health. All this worrying can interfere with your sleep and your ability to think straight. You may also feel irritable due to poor sleep or the illness itself.

Body problems that accompany excess worry are muscle tension or pain, headaches, acidity, diarrhea, trembling or palpitations.

What sets GAD apart from normal worries is the feeling that you can't stop worrying. You may find it impossible to relax, even when you're doing something you enjoy. In severe cases, GAD can interfere with work, relationships, and daily activities.

What causes GAD has been the subject of research. Genes passed down through a family may make some people prone, but that's not the whole picture. Scientists think that a mix of DNA, environment, and psychological factors are to blame.

There's no lab test for GAD, so the diagnosis is made based on your description of your symptoms.  What do you worry about? How often? Does your anxiety interfere with any activities? You may have GAD if you have been feeling anxious or worrying too much for at least six months.

An extreme form of GAD is Panic disorder, in which one experiences sudden attacks of terror. Symptoms can include a pounding heart, sweating, dizziness, nausea, or chest pain. You may think you're having a heart attack, dying, or losing your mind.

Few simple changes in your habitscan help too. It is best to avoid caffeine and nicotine, and get adequate sleep and rest. Try relaxation techniques, such as yoga or meditation. And be sure to exercise; there's evidence that moderate physical activity can have a calming effect.

One of the effective methods of treatment by psychotherapy is called cognitive behavioral therapy or CBT. A counselor helps you identify your negative thoughts and actions. CBT may include homework, such as writing down the thoughts that lead to excess worry. You will also learn calming strategies.

Medications, called anxiolytics, that relax you help provide a good start. Antidepressant drugs work well to lower anxiety. Usually, a combination of medicatines and CBT work best for most.

If anxiety is spoiling your life, seek help to get it under control, and bring the relaxed smile back on to your face. 

As published in HT City ( Hindustan Times) dated 4 December, 2011.

DON'T LET PIMPLES SCAR YOUR LIFE

Pimples or acne, a common skin disease of adolescence, can sometimes play havoc and change lives.

My cousin, roughly my age, and I had care-free fun-packed school lives till acne made their appearance on his face in his teens. They erupted relentlessly, often in large crops, caused redness and swelling, refused to die down, and caught everyone’s eye. He sulked and avoided people, spent much time trying new ointments and lotions every evening, and became depressed. Thirty years later, while I see the same innocence and affection in his eyes from childhood days, others initially notice only his scarred rough face.

Acne vulgaris is characterized by pinheads, blackheads & whiteheads often on scaly red oily (seborrheic) skin. It occurs due to blockage of skin follicles by shedding keratin and sebum (oily secretion from the glands of the hair follicles), causing them to swell, and at times, getting red and inflamed. Infection with bacteria, present on the skin, often compounds the picture, making the acne red and angry, and leading to formation of pustules.

To the embarrassment of growing youngsters, the hormonal connection is all too obvious. Acne make their appearance in adolescence when levels of sex hormones, especially testosterone, in the blood, rise, inducing skin follicles to enlarge and make more sebum. These hormones are not exclusive to boys; hence growing girls also suffer from acne.

The tendency to develop acne runs in families. For example, school aged boys with acne often have other members in their family with acne. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.

A diet rich in sugars, fat and chocolates worsen acne, while fiber consumed in good amounts seem to bring relief. Studies also show that stress could be a factor, both bringing on acne, as often happens before exams or dates, as well as being brought on by it.

Keeping the face glowing and free from acne can be challenging for many. Generous helping of fibrous fruits and green veggies indeed help, as does strict avoidance of pastries, sweets, chocolates and thinking of the opposite sex.

Regular exercise helps too: increased blood flow following a run assists maintenance of skin cells as it brings in oxygen and nutrients while removing waste. It also reduces stress levels; adolescents who work hard in the fields do not suffer from acne; most afflicted are city dwellers with sedentary lives!

The skin needs care too. Frequent washing with an antiseptic soap to keep it oil-free is the first step. You may use wet tissues to wipe your face if washing is not practicable during work or college. Skin applications include benzoyl peroxide (acts on the germ Propionibacterium acnes), salicylic acid (removes keratin), retinoids and aloe vera.

Acne on the face of young people serves to remind us that small things located at strategic places in crucial times can indeed have far-reaching impacts!

As published in HT City(Hindustan Times) dated 20 November, 2011.

HEALING TOUCH

Music, which started from 7 basic musical notes derived from sounds of nature or songs of various animals, has evolved considerably over time from mere entertainment to a form of therapy. It is being increasingly recognized that music can make a difference not just to our moods and relationships but to our health and recovery.

Our exposure to “music” probably starts from the 20^th week in the womb when the baby’s hearing faculties develop, and he “listens” to his mother’s heartbeat. The fluctuations of her heart rate brought on by anxiety, frustration, relaxation or rest are stored in the fetal brain as memories, often reflecting in later years, the moods and attitudes of the two-some.

Adolescents attach great importance to music often huddling as friends or partners based on a common taste or liking to a type of music – slow classical, to rhythmic melodies, to vocal,deep-throated emotional renderings, to pop, jazz or hard rock. This common “taste” often brings together people of similar emotional dispositions, common backgrounds and at times, common intra-uterine experiences. Little surprise then that music bonds so well!

The areas where music therapy has been used range from mood disorders in adolescents, learning disorders in children, heart diseases in adults, stress management, recovery from stroke and high blood pressure.

Although there are several techniques of using music as therapy, most schools follow the steps of assessing the patient’s need, studying his backgound and preferences, planning and preparing a varied combination and dose of music – not just listening, but playing or singing, composing and song-writing, and moving to music.

According to the Mayo Clinic, USA, around 3% of adolescents suffer from mood disorders, of whom 1% commit suicide. An average American adolescent listens to 4.5 hours of music every day. Those suffering from either variety of mood disorders, depression and bipolar, respond very well to music therapy, reporting emotional, social and daily-life benefits, along with formation of one’s own identity. It also provides a creative outlet for release or control of emotions, and improves coping behaviour, self esteem and mood swings.

Neuroscientists have shown that some portions of the brain show electrical activity when we listen to music. One of the methods being used by them therefore is to use music to stimulate these portions that have been knocked down by stroke. Indeed regular exposure to music has been shown to enhance recovery of both mental and physical functions in stroke patients.

I was fascinated to attend a programme for the elderly in Australia.These 80 year olds were made to feel lively again with music, and as they tapped their toes or shook their legs, they improved their neuro-muscular coordination, muscle strength and balance. And doing it with partners of the opposite sex added that extra zing.

The potential of music is waiting to be tapped. Listen to it and let it make a difference to your health and lives.

As published in HT City( Hindustan Times) dated 13 November, 2011.

Wrinkles and poets!

As a first step towards conquering ageing, scientists seem to have discovered that a portion of our 23 pairs of chromosomes, called telomeres shorten with time, and might underlie the process. And what goes with it is a gradual decline in the activity of an enzyme present in our cells, called telomerase.

With over 60% of people in developed countries facing the winter of their lives, research institutions such as the National Institute of Health in USA have included ageing as one of their major thrust areas.. Answers are being sought with urgency from laboratories on why the disturbing changes of wrinkling of the face, graying of hair and weakening of bones occur, and if these can be prevented.

Ageing is the accumulation of physical, psychological and social changes that occur with time. What is intriguing is why 2 person, who went to school together and lived similar lives show these changes so differently. Why did the former chief of IMF, Dominique Stauss-Kahn have to hit news-headlines recently for his youthful “ranting” escapade at the age of 65, when the mood of most at that age in India would be, “Why should the aged eagle stretch its wings? For these are no longer wings to fly, / But merely vans to beat the air”.

Distinctions should be made between "universal ageing" (age changes that all people share) and "probabilistic ageing" (age changes that may happen to some, but not all people as they grow older including diseases such as diabetes, heart disease and osteoporosis.

Chronological ageing may also be distinguished from "social ageing" (cultural age-expectations of how people should act as they grow older). As poets often express the signs and symptoms much better than scientists, I quote again from  TS Eliot. “ I grow old, I grow old / I shall wear the bottoms of my trousers rolled / Do I dare eat a peach? (blood sugars have gone up!) / I shall wear white flannel trousers, and walk upon the beach. / I have heard the mermaids sing, each to each./ I do not think they will sing to me”.

While ageing is generally negative as most actresses fearfully watching the mirror, and players apprehensively measuring their strength and stamina will tell you, it is not all bad.. The mind remains active for many long years after the physical decline has started. It is therefore no surprise that actors and players often turn to politics as the next productive phase of their lives.

Given the physical and cognitive declines seen in ageing, a surprising finding is that emotional experience improves with age. Older adults are better at regulating their emotions and experience negative feelings less frequently than younger adults.  

It is therefore not surprising that sons and grandsons often look more besieged and disturbed than the calm-looking octogerian with a multitude of diseases and limitations! Perhaps it si nature’s way to prepare us; at least till we find means to stratch our telomeres to longer lengths!

As published in HT City( Hindustan Times) dated 6 November, 2011.

Recovering from Diwali

The eerie silence that follows Diwali can usher in gloom as the weighing -machine needle tauntingly veers to the right at this time of every year. Remorse at our recent gorging is the norm at such times, and getting back to shape with all the barfis and laddoos still filling the refrigerator, the challenge.

Getting back to exercise in this phase poses major hurdles. Our playmates have yet to return to the turf from their Diwali bashes. The bright five-thirty summer mornings have been swallowed by the night. And with the nip in the air, it is prime time to curl up and glimpse a few more frames of pleasant dreams as we wait for our morning cup of hot tea to drag ourselves out of bed.

Where and how then do we begin to arouse ourselves, start moving and regain the lost waist lines and belt holes?

Step 1: Shrug off the laziness.

My German friend Winfried, tells me that there is no equivalent to “wake up” in their language; they only have “stand up”!. I found this German habit of literally standing up beside the bed on waking up from sleep, quite challenging during my initial days at his home. At the sound of the alarm the whole family, children included, would toss their blankets and stand up as though ordered by an army commander. Although he was a compassioante friend with tremendous softness for his Indian visitor, he was intrigued to see me laze in bed a few extra minutes, and often asked me if I was running fever.

Step 2: Get going

Revert back to your daily quota of exercise. Those who exercise vigorously, pile up kilos rapidly as soon as they stop. Gym goers, players and dancers are particularly vulnerable. Each day without exercise counts. Therefore put on your jeans and sneakers and get going today; don’t wait for tomorrow.

Step 3: Give away the extra food in your house

The calories that we burn by exercise are relatively small compared with what our desi mithais and snacks contain: a glass of soft drink (100 kcal), a sweet (100-300 kcal), a handfull of dry fruits (300 kcal), a samosa or kachori (150 -300 kcal).

Burning the extra fat equivalent to 3000 to 5000 kcals gathered during Diwali is therefore not easy. To lose 300 kcals, we have to jog 30 minutes, or cycle for 70 minutes or lift weights for an hour. And do that for 6 long months.

Diet therefore holds the key to losing weight.  Subsist on clear soups, salads, 8-10 glasses of water a day and a morsel or two of sukhi chapatis. Stop eating when you are half full and try going hungry.

And give off all the sweets, snacks and pastries from your home to those who need them.  It will do a lots of good  to both!

As published in HT City(Hindustan Times) dated 30 October, 2011.

Breast lumps and caffeine

Caffeine, contained in coffee, tea, cola drinks and chocolates, has been in the eye of a storm swirling around breast lumps for quite some time. Says Dr Amit Aggarwal, consultant in the Department of Endocrine Surgery at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, “If young girls can give up coffee, tea and chocolates, their breast lumps often disappear miraculously”.

The issue had erupted few years ago when a lime-soda drink (7-Up) manufacturer had started advertising its drink as safe for women because it does not contain caffeine. Understandably, it upset the manufacturers of Coca-Cola and Pepsi-Cola, which do contain caffeine. They contend that 7-Up's advertising campaign was based on unsubstantiated health concerns.

Avoiding caffeine a xeno-estrogen, can be practically difficult. "Xeno" means foreign. Estrogen is the female hormone that causes breast development and dominates the first part of the menstrual cycle. Scientists now believe that xenoestrogens can cause fibrocystic breast disease and breast cancer. A strict avoidance of tea, coffee, chocolates and cola drinks do wonder to some breasts.

Breast lumps, localized swellings that feel different from the surrounding breast tissue, are indeed common, and occur in around 50% of women between ages 20 and 50. Contrary to the fearful thought that grips the mind on hearing of breast lumps, 90% of them are benign or non-cancerous.

Fibrocystic disease of the breasts, earlier called “fibroadenosis”, is overwhelmingly the commonest cause for breasts to feel lumpy and tender. They often get worse before periods.

Fibroadenoma is the other variety in which a localized firm to hard mobile swelling can be felt in the breast tissue. They often lie for years, and once their benign nature has been established, can either be left to lie for years without risk or removed by small surgery with minimal scar.

The conventional approach of aggressively removing most breast lumps by surgery, resulting to scarred breasts, is now somewhat outdated. Modern clinicians, by clinical examinations and backed by appropriate tests such as mamograms and cytology, can distinguish the cancerous from the non-cancerous quite accurately, and prefer to suggest less mutilating therapies for the benign lumps.

One of the simple strategies that Dr Aggarwal strongly advocates is attention to diet. Fatty food and caffeine are two major culprits. Switching to a high fibre diet that is low in animal fats, and avoiding caffeine often help many women.

Another recent strategy, that some belive works is a daily supplement of Vitamin E, that can be used in addition to the restrictions. “Drugs such as Danazol, with their side-effects, should be used only when these simple measures have failed”, says Dr Aggarwal.

As published in HT City(Hindustan Times) dated 23 October, 2011.

CRUELTY METER!

The young remorseless killer Andres Behring Breivik, who cruelly snuffed out 92 innocent young lives in Oslo recently in a cruel saga that shocked the world, had shown similar traits towards animals in his younger days. He is said to have loved hunting, and enjoyed killing innocent animals. Little surprise then that he shot 25 teenagers dead when they tried to swim away, like shooting fleeing birds.

The increasing violence in schools and society in recent years has, in most cases, began with cruelty to animals.  High-school killers in the USA such as Kip Kinkel and Luke Woodham of USA, tortured animals before starting their shooting sprees as did Eric Harris and Dylan Klebold, who shot and killed 12 classmates, admitted to mutilating animals.
 Dr. Harold S. Koplewicz, director of the Child Study Center at New York University. says about potential criminals, “You have a child who has symptoms of aggression toward his peers, an interest in fire, cruelty to animals, social isolation; many warning signs that the parents or school have ignored.” 

History is replete with serial killers whose violent tendencies were first directed at animals. Albert DeSalvo (the “Boston Strangler”), who killed 13 women, trapped dogs and cats and shot arrows at them. Dennis Rader (the BTK killer), who terrorized people in Kansas, had hanged a dog and a cat in his teens. A study in Australia revealed that “100 percent of sexual homicide offenders examined had a history of animal cruelty.”

It seems clear that acts of cruelty to animals are not mere indications of a minor personality flaw in the abuser; they are symptomatic of a deep mental disturbance. Research in psychology and criminology shows that people who commit acts of cruelty to animals don’t stop there—many of them move on to their fellow humans. Abuse of innocent helpless animals should ring alarm bells. These people are likely to abuse helpless people in family and society too.

Schools, parents, communities and courts in developed countries are beginning to realize that shrugging off cruelty to animals as a “minor” crime is like ignoring a ticking time bomb. Communities must recognize that abuse to any living being is unacceptable and endangers everyone.

It is worth teaching children to care for and respect animals. After an extensive study of the links between animal abuse and human abuse, two experts concluded, “The evolution of a more gentle and benign relationship in human society might be enhanced by our promotion of a more positive and nurturing ethic between children and animals.”

Parents would do well in not ignoring even minor acts of cruelty to animals by children. If children can be taught to love animals, starting with the most helpless, sad, deserted ones on the streets, they will learn to love fellow humans, their sibs, parents, friends and future spouses as well. But for that, parents and teachers need to lead by example!

As published in HT City(Hindustan Times) dated 16 October, 2011.

Bright strokes to pink health!

A recently held poster-making competition organized by HOPE Initiative (www.hope.org.in) on 22^nd September in which 170 artistically-inclined school students representing 36 schools took part, once again drove home the point that perceptions and emotions, rather than dry bits of medical information, often shape our attitudes towards health and its hazards.

Pix 1: Students pouring imagination and colours on to their posters

The Governor of UP Shri BL Joshi, who graced the ceremony in Lalit Kala academy as chief guest, expressed appreciation and intrigue at the imaginative and creative ways in which students from class 6 to 12 had depicted topics ranging from “Life Style Diseases” to “Road Traffic Accidents”.

Pix 2 : Shri BL Joshi surveying the posters

“Health” can be as boring a topic, if students are lectured on the virtue of eating apples, to an as amazingly exciting one if they are encouraged to research and present issues as they see through their own eyes. Sample this poster on “Life Style Diseases” by Arindam Aggarwal of Jaipuria School, 

which was unanimously judged the best.

Pix 3: Poster on Life Style Diseases

One of the reasons behind HOPE Initiative’s success to transform the topic of “health” that sounds remote to students 

to one that engages them, has been its innovative methods

 through which it has touched the lives of around 500,000 students and their families through 2500 programmes in 

1200 schools of UP over 7 years.

Pix 4. : Award winning poster on hepatitis

What added icing to the cake were the glittering ceremony and the rare honour of receiving the prize from as important a person as the Governor, and getting their pictures with him clicked and saved for posterity.  “Health” got the boost among students it 

deserves. Cheers!

Pix 5 and 6: Awardees with Shri BL Joshi

As published in HT City(Hindustan Times) dated 9 October, 2011. 

The Lesson of My Life

As a medical specialist, armed with voluminous knowledge of diseases, skills and several years of experience, I had started exuding a good degree of confidence, somewhat more than what my wife felt was desirable.

It was around then that a frail, 83 year old lady came to see me for abdominal pain, jaundice and fever. She was as apprehensive of me as a doctor as I was of her old age. The duct through which bile flowed from her liver to the intestines was blocked and converted into a bag of pus with stones. It was not without trepidation that I offered to pass a rather thick endoscope down her throat to the intestines, pass an electric wire into the lower portion of her bile duct and cut out and clear the passage through ERCP. I did not mince words in explaining to her sons the considerable danger that the procedure carried in her vulnerable condition. The patient on her part agreed to take the chance.

With two of my juniors keeping strict vigil on her pulse and respiration, two nurses assisting me with the instruments, and innumerable beads of perspiration breaking out shamefully on my forehead, I gently manoeuvered the endoscope  past her vocal cords into her foodpipe. Then it seemed to descend effortlessly down to her intestines.

I inserted the electric knife into the lower end of the clogged bile duct, pressed on the footswitch slitting the narrow opening and letting out a gush of pus and dirty bile into the gut. The procedure couldn’t have been more perfect. Several of her children, grandchildren, well-wishers and friends looked admiringly at me as I explained with pride the complicated lifesaving feat that I had accomplished.

Encouraged by her dramatic improvement at my hands, her daughter-in-law came to consult me for gallstones, one of which had slipped into her bile duct. She was around 40, young, pretty and appeared a picture of perfect health and happiness. I proposed the same ERCP to her.

This day somehow turned to be another day.The bile duct opening was sticky and blocked and wouldn’t let the electric wire-knife in. I changed the angle and tried again and again, but did not succeed. I went on trying all the tricks I had learned during my training fellowships in Japan and Germany, but failure haunted me. My clothes were soaked in sweat when I finally gave up.

I lay in bed soaked in shame and hurt, trying to rerun the events of the day in my mind, wondering where I had gone wrong. After wandering through the catacomb of logic and science without a meaningful answer, I began to realize there was perhaps something quite beyond my brains, my hands and my skills. As the thick crusts of arrogance began peeling off my heart, I could hear the words of Ambroise Pare, a 16^th century French surgeon, echo in my ears:” I cleaned his wounds but God healed them”!

Valuable lessons often come from unsuspecting sources and in innovative ways. 

As published in HT City( Hindustan Times) dated 2 October, 2011.

Road Deaths- Where are we going wrong?

The recent death of the young 17 year old Ayazzudin, the son of our ex-cricket skipper Mohd Azharuddin, and his cousin Ajmal, in Hydeabad in a 2-wheeelr accident once again sent that familiar shiver down our spine. These 2 kids were trying to beat their own speed record on their superbike gifted to them by their indulgent well-off parents. These precious lives having been lost, and condolences paid, it is time we faced where we are heading.

 Deaths due to road traffic accidents (RTA) in India registered a sharp 6.1% rise between 2006 and 2007. However, road safety experts say the real numbers could be higher since many of these accident cases are not even reported. "There is no estimate of how many injured in road accidents die a few hours or days after the accident," points out Rohit Baluja, member of the UN Road Safety Collaboration and Commission of Global Road Safety representing Asia. RTA is all set to be the 5^th largest killer in society very soon.

We Indians are very unsafe in the job of driving. India, with 1% of global cars, account for 6% of the world’s RTAs, a bit of statitistics that can’t do us proud. It is estimated that an accident occurs every 7 minutes in India; by the time you have read my column 2 lives would have been lost!

While road deaths have started coming down in developed countries, they are spiralling up in developing ones like India. In our true Indian spirit, we have everyone to blame for the disaster: the government for bad roads, the traffic police for not ensuring safety on roads, mobile phones, alcohol,  fate, and much more.

We are quick to blame the police for “harassing” and taking bribes when our children are caught without helmets.The poor traffic policemen, bombarded by phone calls from seniors to let go of so-and-so VIP’s son, has virtually given up on trying to enforce this rule on the road. But whose loss is it?

Teachers of schools and colleges have also happily absolved themselves. “We cannot see what they do outside the campus”, has become the familiar song.

And when parents lose their children to RTA, they must find a scapegoat: the government, the police, the school, the roads, peers, and friends.... virtually everyone, except their own selves who indulged their children but did not groom them to be responsible!  There is no running away from the painful truth.

As published in HT City( Hindustan Times) dated 25 September, 2011.

HOT HEADS TAKE HEAD!

If you are the one of the “mujhe gussa ata hai” types, watch out! Your proneness to anger might be putting your life to risk.

Recent studies show that angry people have a five times greater chance of dying before age 50 than their cool headed counterparts. Anger elevates blood pressure, increases threat of stroke, heart disease, cancer, depression and anxiety disorders. To make matters worse, angry people tend to seek relief from the ill-moods through other health-endangering habits, such as smoking and drinking, or through compulsive behavior such as workaholism.

What seems to be more harmful is the persisitent simmering form of anger than the quick short-lasting bursts. The normal experience of overt anger lasts only a few minutes, but the prolonged forms, such as resentment, impatience, irritability and grouchiness can go on for hours and days at a time. They stimulate secretion of stress hormones such as adrenaline and cortisol, which wreck havoc to health.

Anger depresses the immune sysytem. According to a study from Ohio State University, those who had less control over their anger tended to heal more slowly from wounds. Researchers gave blisters to 98 participants and found that, after 8 days, those who had less control over their anger also tended to be slower healers. These participants also had more cortisol in their system during the blistering procedure, suggesting that they may be more stressed by difficult situations as well.

We observe commonly that angry dissatisfied patients do not respond well to treatment and seem to be more vulnerable to complications and delayed recovery. I recall how a fuming bureaucrat, who had to wait for 10 minutes in the OPD while I was examining another patient, broke into an asthmatic attack. My suggesting that he cooled down for his own sake made him even angrier, necessitating hospitalization for severe breathlessness!

If anger has survived over the ages and been passed down the generations, it must have had its survival benefit. We all know that angry customers often get their way with clerks and managers, angry teachers drive their students to complete their assignments, angry bosses get their employees to deliver results on time, and angry children get their parents to be more yielding.

In our present times, anger has however become an outdated tool. Its potential to achieve small temporary gains is hugely offset by its habit forming nature and harmful effects on health. The automatic answering machine does not respond more quickly to an angry customer or the slow internet to an angry browser.

It is time you changed your mind to change your heart. Start by noting down at the end of each day the times and settings when you were angry, and reflect on how you could have dealt with the situation cool-headedly and better. Anger will soon beat a hasty retreat from your life when you see how silly it makes you behave.

As published in HT City( Hindustan Times) dated 18 September, 2011.

Understanding Dreams!

Do you remember what you dreamt last night? Even if you can’t and are under the impression that your sleep was dreamless, you would have actually dreamt more than 2 hours or 25% of the time that you slept.

Dreams are successions of images, ideas, emotions and sensations occurring involuntarily in the mind during certain stages of sleep. Good or bad, dreams always take us to some interesting places.  They can range from normal and ordinary to the surreal and bizarre. Dreams can at times spring a creative thought or give a sense of inspiration. Dream imagery is usually absurd and unrealistic and they are generally outside the control of the dreamer. They can vary from frightening, exciting, magical, and melancholic to adventurous.

Dreaming is as old as human history; it finds mention in ancient Mesopotamian, Chinese, Assyrian, Greek and Indian texts. Credit for the first serious attempt to study and understand dreams, called Oneirology, go to the European scientist-philosopher Sigmund Freud, who described it as “the royal road to the unconscious” mind when we lose our consciousness during sleep.

Men and women probably dream just as much but women tend to remember dreams better, especially during pregnancy. Several factors influence dreams of which smell is particularly important. People exposed to smell of rotten eggs while sleeping, report bad dreams when woken up. On the other hand, smell of roses during sleep produce pleasant dreams.

Sound also affect the quality of dreams. The sound of falling water often results in dreams of swimming or seas, and can often trigger bed wetting, as often happens when it rains at night. A child sleeps well when soothing “lories”are sung to him.

Bad dreams are not uncommon, and often take the form of falling or being chased. They generate a lot of anxiety and may wake you up with panic and sweating. They are common when the body or the mind is in pain, when the external stimuli such as smell and sound are unpleasant, during indigestion and when the blood sugar drops during sleep as in some diabetics on insulin. It is also associated with use of certain medications like propranolol or barbiturates. Dreams of choking and strangulation are common when suffering from blocked nose, chest infection, or during passive smoking.

Good sleep, of which dream is an essential part, helps our brain to regulate mood, solve problems, reduce stress and feel refreshed. Dreamless sleep, as happens with certain sleeping drugs or under the effect of alcohol, lacks these benefits.

Your dreams could tell you much about the state of your health. If you are getting pleasant dreams, you are probably physically well, getting adeqaute sleep and are in a stable state of mind. If you are getting recurrent bad dreams, there is something that is desperately trying to draw your attention. Listen to it!

As published in HT City( Hindustan Times) dated 11 September, 2011.

The Stature of Height in Health

Height has its imposing value. Most heroes in “Mills and Boon” books, in whose arms ladies swoon, are tall and have broad shoulders. A good height is therefore something that most of us wish during our growing years, some, quite desperately.

Lionel Messi, the most talented soccer player of present times, who is 5’ 7” had a problem with height. His growth stalled during childhood. One can imagine his anguish when a school going Lionel saw fellow Argentinian kids surpass him in height as he remained stunted.

He was diagnosed to be deficient in growth hormone, a protein secreted by the pituitary gland located beneath our brain, which regulates height. This deficiency can ofcourse be partly corrected if the hormone is replaced from outside, before the growing bones have frozen. Hormone replacement, as is done with insulin for diabetes or thyroxin tablets for thyroid deficiency, is feasible, but growth hormone therapy was exorbitant at that time, and his family could not afford it.

What came to Messi’s help was his extraordinary talent in soccer that caught the notice of Barcelona Football Club officials. He was offered a place in the Barcelona junior team in exchange for treatment with growth hormone. With therapy, he caught up a few inches but still remains short though extra-ordinarily talented.

Several factors go in to deciding how tall we grow. The genes we inherit from our parents play a major role. Nutrition and illness during the growing years are crucial as well. Protein, the building material, if deficient in our diets, stunts growth, as does repeated bouts of illness in school days.

Apart from finding a place in romantic novels and movies, does height however really matter?  Does Messi’s modest height lower his stature as a master soccer player?  Does it matter that Sachin Tendulkar, the master blaster or the legendary Deigo Maradona are only 5’5”.

Perhaps to prove to themselves and to the world, short people do exceedingly well, and leave indelible marks in all walks of life. John Keats, the English poet, Pablo Picasso the famous painter, Ludwig van Beethoven the music composer and Woody Allen the actor-director, were all just above 5’.

Short men have wielded the greatest powers, Alexander, Napolean Bonaparte and Julius Caesar stand tall in history with short heights. Winston Churchill, Nikita Krushchev, Lal Bahadur Shastri and Abdul Kalam were also short but changed history.

The music world has its share of talented short men: Bob Dylan, Bono, Elton John are all on the shorter side of mid 5.

Short people often make up in mental strength and will power what they often lack in height or physique. Bapu, with his meagre height of 5’3” brought down the British Empire in India.

Staure seems to stand taller in the long run than height, and future romantic novels could do well with short passionate heroes than the out-dated tall ones!

As published in HT City( Hindustan Times) dated 4 September, 2011.