Challenge of C

Hepatitis C is now emerging as the commonest cause of liver cirrhosis and liver transplantation in developed countries. Most patients seem to have contracted it more than 20 years ago through transfusion of blood or blood products, as good screening tests for the virus were not available then.

Mr RKA, a 50 year old patient, who suffers from Haemophilia B, a condition in which the blood does not clot due to deficiency of a clotting factor, contracted Hepatitis C 35 years ago when he took injections of Factor 9 concentrates from an Italian company. This injection is made from pooled plasma of donated blood. Unfortunately, there were no tests then to screen these blood products for Hepatitis C.

Although he did not experience any “liver” symptoms for 15 years, he suddenly vomited blood one day from ruptured dilated veins in his food pipe, when he was diagnosed with liver cirrhosis. He was found to have hepatitis C in 1990 by blood tests that had become available then.

Getting rid of the virus was not easy. He had to take injections of interferon and oral tablets of ribavirin. Despite occasional fever, body aches and dipping haemoglobin levels that accompany the therapy, he persevered for a year. He was rewarded with excellent results – the virus had finally gone from his body for good.

He is now a successful businessman, and a proud father of 2 grown up children. His liver is keeping good health too, although he needs 6 monthly checks to ensure that a cancer does not develop in his cirrhotic liver.

With Hepatitis B infection being brought down rapidly by effective screening and vaccination policies adopted by over 150 countries, attention of scientists in the western world is turning more to the challenges posed by the C virus.

Hepatitis B is easily preventable with vaccine, available since 1982. It’s one of the safest and most effective vaccines ever produced. Today more than 150 countries use it in their immunization schedules. The disease has virtually disappeared from America, Europe and Japan where it is diagnosed only in immigrants and travellers. It is being ushered out in more than 100 other countries with the use of mass vaccination.

All it requires is three injections of the vaccine, the second injection after 30 days and the third after 5 months.

Hepatitis C does not have a vaccine yet. There are however 4 new promising oral drugs that are in the final phases of research, that may obviate the need for injections and shorten the course to a few weeks. They are expected to hit the market in 2015.

Each year on July 28 much needed awareness drives are launched to celebrate World Hepatitis Day as the day coincides with the birthday of Prof Blumberg, who won the Nobel Prize in 1976 for discovering the Hepatitis B virus.

His legacy lives on!

As published in HT City ( Hindustan Times) dated 28 July, 2013.

Wounds of the Mind

Failure to address the emotional trauma and psychological impact of survivors of natural disasters, such as the recent Uttarakhand Tsunami, often leaves a glaring hole in rescue and relief operations undertaken by state agencies.

For most of us, it would be impossible to imagine the emotional trauma and agony of those who have seen loved ones been dragged away by flood waters or buried alive by landslides, or perhaps even worse, just missing! How and what can be done for them?

At the outset it is important to know that pattern and sequence of reaction that a traumatized person goes through. The first stage is one of denial or disbelief at the suddenness of the upheaval. It is followed usually by anger, often directed at people around, government, at oneself or even God. The 3rd stage is of emotional bargaining. A typical thought in this phase is “Why did it have to be my son and not me?” The 4th is of depression: that deep sense of loss, hollowness and despair. It is only in the 5th stage that one accepts, and begins to cope by trying to pick up the broken pieces of life.

Psychological support is now accepted as an essential component of disaster management in developed countries. During the disaster, its needs to be merged with the more practical rescue efforts. A lot can be achieved by moving stranded people to safety, providing shelter, food and water, helping re-unite families and friends, and providing accurate information.

One of the reasons for the overwhelming gratitude and warmth that the defence personnel engaged in daring rescue operations received was due to their convincing actions directed towards these objectives. On the other hand, the possible reasons why government agencies and personnel drew ire was due to their slow response in the face of desperate demands, as well as lack of training in how to deal with the emotional needs that arise in such occasions.

The setting of natural disasters does not provide the luxury of “one hour on the couch” kind of psychological counselling, says Divya Jain, a young counsellor at Fortis Memorial Research Institute, who feels the goal needs to be supportive rather than therapeutic at this stage. The way best way to deal with victims in such occasions is to listen with empathy, and legitimize their feelings. If someone is angry for instance, it is best to say “ I can understand. I would be angry too”.

What often works well is for people to realize that they are not alone in their grief. They often find solace in sharing their experience with fellow victims in relief camps, with disaster counsellors, NGO workers, religious heads and with doctors. Some need medicines to cope with anxiety and depression.

Wounds of the mind take long time to heal often for life. The government needs to be sensitive and keep psychological support in mind in its long term rehabilitation program.

 As published in HT City ( Hindustan Times) dated 14 July, 2013.

Nature’s Fury and Human Heroes

Natural calamities, such as the recent Uttarakhand Tsunami, are characterized by six Ds: destruction, death, devastation, disease, depression and despair. Yet, despite all this, it comes as a one-in –a-lifetime type opportunity for some to put their learning, ability and skills to real test.

For the soldiers and officers who daringly rescued thousands of jolted starving stranded pilgrims to safety, it was an opportunity that transformed them from unknown regulars to national heroes.

Several heroes must have been born in such conditions. States of sudden chaos and vacuum throw up new leaders who emerge from within the group, motivating those around and telling them what to do, setting common goals that fellow survivors feel compelled to join in for their collective survival, and showing the way through their own actions.

The opportunity for medics and para-medics in such situations is immense.

In the first phase, they run shoulder to shoulder with the rescuers, providing first aid and splinting broken spines and bones of the injured before moving them to safety. This is a vital oft-neglected step for which even rescued people often pay a heavy price with lives and disability.

Bones of the head (skull) and spine act as cages to protect the soft and vulnerable brain and spinal cord. Fractures here often cause compression with disastrous consequences.If they are dragged or lugged unknowingly, pieces of brokenbone may press and tear the tender nerves or cord, often causing permanent paralysis or death.

One of the essential steps in disaster management, therefore, is splinting of injured body parts before attempting to move the person. What it means is that wounded parts of the body should be immobilized to prevent further damage. The spine is best immobilized by placing the victim on a hard stretcher and strapping the body, broken limbs by tying to a piece of wood or branch, and mobile parts, such as dangling fingers, by bandaging or strapping to the stable ones. It is safer to keep the splint on till the victim is seen by an expert in a hospital and evaluated with x-rays or scans.

After the 1st wave of death from injuries and drowning, the 2nd wave follows at its heels with infections. People stranded without potable water, shelter or electricity are prone to pneumonia and diarrhoea, and their huddling together makes the germs spread quickly from one to the other. Antibiotics and vaccines are as important at this phase as clean water, food, blankets and shelter to prevent outbreaks and epidemics.

Another neglected aspect of disaster management is tackling the emotional trauma of those who have been through it all and seen wailing spouses been dragged away by swirling waters, parents being knocked down to death by falling boulders, and infants crying incessantly in their arms before falling finally silent.

How does one help them cope and persuade them to live on rather than jump into the waters? Think about it till we meet next week.

As published in HT City ( Hindustan Times) dated 7 July, 2013.

The Good Old GP

The family doctor is fortunately being resurrected again. Yes, he was almost dead the last few decades when the public’s obsession with specialties and specialists drove them to high-end tertiary care centers. What they often missed was good holistic care!

The family doctor’s role is the most challenging. He has to answer why the newly born cries after feeds, why the school going child is losing his appetite (or atleast that is what mom thinks), why the lady of the house gets the splitting attacks of migrain, how to measure and control the gentleman’s BP especially when there is tension at office, why grandad takes so long to pass urine, and how to manage the vomiting and diarrhea of the cousins who are visiting! In other words, he has to be the proverbial jack and dabble with all aspects of health from birth to death.

Being a scarce commodity, a good family doctor can be difficult to find. His qualifications should include a “proper degree” and easy accessibility. He should not be the “white coat monster” to scare the kids with injections if they don’t eat their veggies. He should be more like a family friend whom you can consult for almost anything. Another essential quality is “openness”. Considering the varied aspects he is called upon to address, he should not be expected to know everything in detail (what is a specialist there for?), but should be willing to seek help and guidance from peers, books or the net. Here is a simple test: if he looks irritated with your persistent questions, or disapproves of you finding something about an illness from the internet and bringing it up, he is not quite your guy! On the other hand, if he says he is unsure and needs to read up or consult, go for him!

The family doctor should know the unique aspects of your body system and that of your family; your allergies, the painkillers or antibiotics that agree with you, your other medical conditions such as diabetes, hypertension, hypothyroidism, peptic ulcer, proness to fits or panic (we call them co-morbidities) that often get thrown off gear during illnesses, and your nature. Treatment or care should ideally be provided in this total context, an aspect that specialists are prone to overlook.

I find that most of the patients who come to seek treatment at a speciality centre do not have family physicians. When I specifically ask them to find one near their homes, they appear reluctant and often seem to lack faith in their GPs.

GPs therefore need to reinvent their role and win back the trust of their patients. Their steady presence and ready availability should be their USPs. It is he who needs to maintain the balance between over-investigating and aggressive super-specialists and innate quacks, and emerge as the medical anchor of the family.

For specialists, patients keep changing but the diseases remain the same. For family physicians, diseases keep changing while the patients remain the same. 

As published in HT City ( Hindustan Times) dated 30 June, 2013.

Emergency Medical Kit

The regular depiction in TV serials of a doctor arriving home immediately when summoned on telephone to attend to an emergency, could not be farther from reality. Most doctors do not attend home calls, and the chances of getting one in the middle of the night when you are down with an attack of incessant vomiting or an allergy could be almost impossible.

It makes sense therefore, to keep some medicines at home or carry on travel. Here are some tips on how to make your own emergency medicine kit:

1. Keep medicines that you are familiar with, and preferrably, have taken before, so that it is not a first timer during an emergency and that too in a new place.
2. If you are not good with tongue twisting drug names, put them in labelled envelopes according to indications. For example, you could have paracetamol tablets in an evelope labelled “Fever, Body pains”, or loperamide in one labelled “Loose motions”
3. Keep them in your hand baggage, in a separate pouch or flap. I recall how a fellow passenger, who had a history of asthma, came down with a severe attack during a long flight from Delhi to Frankfurt. He had packed his bronchodilator puffs all right, but in the checked-in luggage! I had to administer an injection of deriphylline, which fortunately the emergency kit of the airline had, to him in mid-air.
4. Know your special needs: For example an asthmatic should ensure he travels with his bronchodilators, those with diabetes should carry not just their anti-diabetic drugs but also some sweets or sugars, in case their head spins due to a drop in blood sugar.
5. Consult your family doctor; he would know which medicines are safe and good for you.

The kit could contain medicines to deal with these common emergencies:

1. For allergy, hives, itching, running nose, watery eyes, brochospasm: Allegra/ Alspan/ Cetriz/Avil tabs
2. Loose motions (watery) : loperamide (Imodium)
3. Acidity/ heartburn: Digene or Gelusil tablets/ Ranitidine or Omeprazole
4. Nausea or vomiting : Domperidone or ondansetron (Emset MD)
5. Motion sickness : Avomine
6. Infections: tummy or urine infections, fever: Ciprofloxacin or ofloxacin/ cephalosporins like Cetil or Sporidex
7. Throat or chest infections: cephaloporins or amoxycillin or Septran
8. Fever, body aches, sprains, injury: Paracetamol/Ibuprofen
9. Crampy pain in abdomen or painful periods: Spasmindon, Cyclopam/ Meftal spas are some antispasmodics
10. Also carry drops for blocked nose (Otrivin), a few Bandaid strips, a local antiseptic cream (Betadine) and a few Oral Rehydration sachets (Electral) and laxatives (like Naturolax) especially if you are travelling to the west.
11. Make sure you have your family physician’s cell number at all times
12. If you have any medical problem such as diabetes or blood pressure, carry these medicines in sufficient numbers. Your family doctor will guide you regarding any special medicines that you should keep for your unique needs.

The kit is like the spare tyre that you keep in the car boot on long drives. And there can be a little doctor in each of us to pull us out of unexpected health troubles!

As published in HT City ( Hindustan Times) dated 9 June, 2013.

Life’s Burdens

Life-stories of my patients have convinced me that the burden does not fall equally or even randomly on our shoulders. Some seem to have had far more than their fair share.

A 65 year old gentleman, Dr S, came to see me in my clinic last week with obstinate symptoms of gas, dyspepsia, constipation and bloating that 10 gastroenterologists and 25 types of medicines had not been able to relieve. All his investigations had thrown up normal results.

I realized that there was something that had evaded the attention of my predecessors, and despite my tightly crammed clinic schedule, decided to change track from writing yet another prescription  that was doomed to fail, to looking at him as a distressed fellow-human in need of help.

Very soon, I came to realize that with his growing years, his attention had drifted from being a committed doctor raising a family of 3 cheerful children, to worrying about what would happen to them after his demise. His eldest was a daughter of 40 who had been recently widowed and was staying with him with her children. His next was a 38 years old chronic schizophrenic son, who was so mentally disturbed that he was entirely dependent on him. His 3rd was a “normal” 35 year old son who had his own small business and family, on whom Dr S did not want to pass on his burden. To top it all, his wife of 45 years had recently turned funnily “spiritual” and had left it to her husband to find practical solutions to their family’s problems!

As I listened to his fears and concerns, I wondered what I would have done if I were in his shoes. Words of comfort started sounding hollow and, medicines, I realized, could get him some sleep in the nights, but not provide any meaningful solutions.

But as his underlying distress finally found an expression in my clinic, his dyspeptic symptoms got some relief.

Another 60 year old man who had been suffering from similar “gas” and “bloating” that had remained intractable for 15 years despite consultation with 15 doctors had another touching story. His symptoms had started on an August evening when while returning home from work in the evening, he had seen an unexpected crowd at the entrance, and then on entering, had seen his 25 year old only daughter lying dead on the floor, struck a few minutes back by a speeding car just outside their garden gate. Since then, his life had lost all meaning and his dyspeptic symptoms had taken hold.

Somatic or body symptoms often have their origin in stressful or traumatic life events or situations. Labelled as “Psycho-somatic”, they often manifest through symptoms related to the gut, head, heart or genital organs. Their solution lies not in scoffing them off as “all-in-the-head” but to a deeper understanding of life’s travails and traumas, worries and challenges.

As published in HT City ( Hindustan Times) dated 28 April, 2013.

Ophelia Syndrome

There are times, situations and relationships in which you find yourself helplessly dependent on someone dictating what you should do, than thinking and deciding yourself.

The “Ophelia Syndrome” describes a person being too dependent on another, who simply tells you what to do, and you can't quite break free off.

Patients, especially in India, are often prone to it. Overwhelmed by the trauma of illness, ordeal of hospital visits, plummeting family support and strained pockets, they often give in submissively to what the doctor dictates, best described in their words, “doc, do whatever you think is best”.

To understand the syndrome, it is worthwhile delving into Hamlet, the Shakespearean tragedy in which Ophelia is the crazy girl in love with the hero, but being insecure and confused, lives by the dictates of her dominating father, Polonius, and goes on to base her feelings and opinions on his. Shakespeare masterly summarizes the relationship in 2 lines when Ophelia says,“I do not know, my lord, what I should think,” and, Polonius responds by, “I’ll teach you. Think yourself a baby.”

Doctors have traditionally played Polonius, and patients have donned the role of Ophelia, due to insecurity, confusion and dependency, in this 2-way relationship.

There is a more organic basis to this syndrome as well. Described in his own teenaged daughter, Dr Carr reported how she had become depressed, forgetful, confused and weak for months preceding the diagnosis of Hodgkin’s lymphoma, and how she had regained her mental functions, especially memory, after successful treatment.

In milder forms, Ophelia Syndrome is seen commonly in students. I must confess suffering from it myself.

In this condition the student is made to think, feel and decide what his teachers, parents or peers want him to, and he unknowingly accepts and follows.

Polonius-ization of thought is best demonstrated in the dates and events taught and memorized in history, or the names and attachments of muscles, nerves and bones that he learns by rote. The approval that he seeks and gets is what has already been defined, and he has to toil towards getting it by adherence and obedience. There is no scope for free thinking or exploring in this defined system.

The system also defines how he ought to feel when the results come in. The scales and responses are pre-set. If he brings in more than 90% that has been benchmarked “good”, he can stake claim to happiness (provided of course that there are not too many in that school batch who have also got that much, and perhaps more!).

Our career paths often follow the same route, as do our lives. When asked “What do YOU really think?” Ophelia had had none of her own.

This confused young woman who had not dared to think and feel for herself, finally ends her life in the play.

As published in HT City ( Hindustan Times) dated 31 March, 2013.

Thyroid Disorders

One of the three common causes of poor performance of students in schools and colleges has been ascribed to insufficient functioning of a small gland situated in the front of our neck, called Thyroid. While weighing only around 50 grams, the thyroid gland produces a hormone thyroxine which regulates how our body functions, or its “metabolism”.

As the role of the hormone is to pace up the body and mind and keep us active and alert, its deficient production leads to just the opposite effects: dullness, lethargy, sluggishness, drowsiness, lack of concentration and obesity.

Indeed it is this “dullness” and lethargy that makes poor learners and performers of students, when the role of the thyroid is often overlooked and the blame is placed on other factors such as the role of parents, distractions by television, or even the quality of teachers!

There are several ways and phases in which hypothyroidism, or inadequate function of the gland, may present. It presents as cretinism in infants and small children. These kids are stunted in growth, have coarse skin, are retarded mentally and show growth failure. Deficiency of iodine is often the underlying cause.

When it manifests in adults, especially women, the signs are often subtle, with increasing weight, fatigue, heavy infrequent periods, cold intolerance, high blood pressure, increased blood levels of cholesterol, hoarseness of voice, coarse skin, loss of eyebrows, or even depression, in isolation or in combination. Some may also have a “goitre” or prominent swelling of the gland in the neck, due to long term deficiency of iodine.

Thyroid problems are indeed common in adults with 10-30% showing evidence of dysfunction when tested.

Detecting Hypothyroidism is easy. A simple blood test that estimates TSH (Thyroid stimulating hormone) tells you where you stand. In early hypothyroidism, TSH values (normal 1-5) are increased above normal limits, demonstrating that more pressure is required by TSH to flog a tired thyroid gland to produce thyroxine. With further progressive weakness of the gland, thyroxine levels start falling despite TSH levels climbing further.

Once detected, treatment is quite easy and requires the hormone to be taken every day as replenishment. The daily dose, best taken in the early morning on an empty stomach, needs to be titrated by the doctor. Improvement is usually obvious in weeks, with friends often noticing a change in appearance and personality.

A rarer form of thyroid disorder is one in which the gland produces an excess of the hormone, called hyper-thyroidism.  It presents as prominent bulging eyes, rapid pulse rate, weight loss, and excessive sweating. Treatment here aims at slowing down the overactive thyroid gland.

Thyroid disorders are often so indefinable and subtle in their signs, and yet have such far-reaching effects on the functions of our body, mind and personality that experts recommend testing it as a part of general check-up. And with treatment being so simple and rewarding, the stakes of missing it are indeed high.

As published in HT City ( Hindustan Times) dated 5 May, 2013.

Scare of Disease

Constant or recurring fear of disease can be a major disease by itself. Some patients are so terrified of falling ill that they spend the major part of their lives in the disabling habit of visiting doctors and undergoing tests to ensure they are free of disease.

This phenomenon is called Hypochondriasis,and is characterized by an excessive preoccupancy or worry about having a serious illness.

 Hypochondriacs become unduly alarmed about any physical symptoms they detect, no matter how minor they may be. They are convinced that they have or are about to be diagnosed with a serious illness.Even sounds produced by organs in the body, such as those made by the intestines, seem like symptoms of a very serious illness.Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease.

This intense phobia or anxiety about developing a disease often originates from the nightmarish experience of having watched a close relative who has suffered a similar illness. Cancer phobia is one such.  It is not uncommon in my practice, to see a healthy young person demanding and undergoing several ultrasounds, endoscopic examinations, and even CT scans, and going through that cycle again and again, driven through a constant fear of developing cancer.

Amit, a 45 year old employee of a multi-national company, consulted me with complaints of irregular movement of bowels for 10 years. His work entailed frequent travel, eating out and late untimely meals. He had undergone 3 colonoscopy examinations, the last being as recent as 6 months. My advice to regulate his diet and increase the intake of fibre did not satisfy him. He requested another colonoscopy.

On probing I discovered that he had an intense fear of colon cancer. This phobia had its origin in his middle school days, when his grandfather had complained of bowel symptoms and had been diagnosed with colon cancer. In the following months, he had witnessed the relentless deterioration in his condition culminating in a painful death.

Hypochondriasis is hyper-vigilance of the body's situation and a tendency to react to the initial perceptions in a negative manner that is further debilitating. Numerous intrusive thoughts and physical sensations push them to check with family, friends, and physicians. Other people are so afraid of illness that they will avoid medical professionals. Yet others live in despair and depression, certain that they have a life-threatening disease and no physician can help them.

Hypochondriacs often suffer from anxiety or depression.  Another problem, as was with Amit, was that the reassuring effect of a negative investigation gets shorter and shorter as they go through cycles of intrusive thoughts followed by compulsive checking, a form of obsessive compulsive disorder.

Amit improved with counselling, life style changes and mild medications to tackle his anxiety.

As published in HT City ( Hindustan Times) dated 10 March, 2013.

A Good Breakfast can Boost your Grades

A good breakfast can help students score better in the coming examinations.

Evidence suggests that eating breakfast really does help students learn. After fasting all night, the brain needs a fresh supply of glucose — or blood sugar. That's the brain's basic fuel.

"Without glucose," explains Terrill Bravender, professor of Pediatrics at Duke University, "our brain simply doesn't operate as well. People have difficulty understanding new information; they have a problem with visual and spatial understanding, and remembering."

Haven’t we all had the experience of our brains struggling desperately to get that crucial name, term or date during the exam, which we had known till yesterday? Slips in calculation are more frequent when the brain runs without enough fuel.

Dozens of studies from as far back as the 1950s have consistently shown that children who eat breakfast perform better academically than those who don't. In a recent study of 4,000 elementary school students, researchers measured the effects of eating breakfast by administering a battery of attention tests. To measure short-term memory, researchers read a series of digits out loud — 5, 4, 2 and so on — and asked the children to repeat them. The children were scored on how many digits they could remember correctly. To test verbal fluency, the kids were asked to name all the animals they could think of in 60 seconds. Across the board, breakfast eaters performed better than those children who had skipped breakfast.

Does it then matter what we eat for breakfast?

Most experts recommend non-sugared cereals made up of complex carbohydrates that have low glycemic index.

The glycemic index is a measure of how quickly the carbohydrates in food are absorbed into our bodies and converted to fuel. When it comes to sustained brain power, food that is low on the scale — such as whole grains — is preferable. Even though a bowl of sugary cereal and a bowl of old-fashioned oatmeal or chapatti may have the same number of carbohydrates, they have very different glycemic loads.

Sugary food, such as sweetened custard or milk shake, get into your body quickly and cause a peak in blood-sugar levels, but the levels then fall dramatically after two hours or so. Oatmeal or bread, composed of complex carbohydrates mixed with fibre, on the other hand, release energy slowly, producing a steady rise in blood sugar and providing enough energy to last through the morning.

What's more, complex carb eaters don't experience a steep drop in blood-sugar levels that can bring with it a release of hormones that affect mood, concentration and memory.

An examination is not just about what you know, but what and how you can recall, apply and put that across on that day. Intelligent students therefore, realize the importance of strategizing and enhancing their performance.

A good wholesome breakfast, often neglected by students and parents, can help students perform better in examinations.

As published in HT City ( Hindustan Times) dated 24 February, 2013.

Looking beyond Marks

Students who do well in examinations and score high marks are no doubt bright and hardworking, but many who do not are often equally intelligent and turn out to be even more successful in life. Some of the famous achievers such as Bill Gates, Einstein and Thomas Edison have not been stellar performers in school, highlighting a deep disconnect between performance in examination and success.

Intelligence Quotient or IQ for instance,measures a person’s logical or analytical ability and is conventionally regarded as the main arbiter his potential. Our deep cultural bias that puts a premium on such scores is reflected in the questions that parents and teachers ask of children, such as “Who is the best student in your class? Who is the topper of your school?” and so on, giving undue importance to only scholastic success.

In this rigid system, children who have other skills and capabilities such as leadership, music, games and organizational ability are often made to feel second rate. The question that comes back to haunt parents and students in this model is ”What will get you admission in a good college or  job – marks, football or friends?”.  While these comments are often made by well-meaning, insecure middle- class parents to motivate their children to achieve scholastically, they reinforce the narrow views of ability, and rob children of self-esteem.

Taking a step further, our conventional yardstick  has come under attack. In fact, contemporary theories by experts such as Howard Gardener indicate the existence of Multiple Intelligence (MI).

Creative, Social and Emotional Intelligence are some forms that are being increasingly recognized and assessed. In a recent workshop on leadership at the Indian School of Business, Hyderabad, I learnt that corporates and industrial houses are no longer looking to hire top scorers or those with high IQ but are putting more weightage on the candidates’ nature, character, adaptability and ability to get along in a team.

It is time parents and teachers shifted focus from a student’s accomplishment to his effort. Encouraging this “growth mindset” has greater lasting value and propels a student ahead. A failure or set-back is taken as an impetus for doing better next time in the “growth” model” rather than a complete collapse of one’s confidence and esteem in the “accomplishment” model.

While we often ridicule many politicians for not having scholastic credentials, some of them demonstrate excellent abilities to lead and enjoy large followings suggesting that they have high social intelligence scores.

Some children may have exceptional creative abilities and could be future successful entrepreneurs. There are yet others who excel in their ability to adapt to changing surroundings and circumstances, and will come up on top in their jobs or business, demonstrating tremendous “Adaptive Intelligence”. 

It is time we learnt to appreciate the unique potential of every student and stopped assessing them through the narrow prism of IQ, exams and grades.
As published in HT City ( Hindustan Times) dated 17 March, 2013.

When Health Checks are No Guarantee

Preventive health checks, while picking up some diseases at an early stage and paving the way for timely corrective measures, do not unfortunately guarantee against sudden natural deaths as we learnt recently.

Mr DC, who had undergone a comprehensive executive health check-up a month earlier, died in a dramatic manner. This 59 year old fitness freak had gone to the club pool at 6.30 in the morning for his routine swim, had done his usual 5 laps and was then spotted by some fellow swimmers to be standing in one corner with uncustomary quietness. When the guards hauled him out of the pool, he was dead.

The sense of disbelief among family and friends was especially stunning as his recent health check had been normal and the doctor had given him a thumb’s up. He was not a smoker, did not suffer from diabetes or high blood pressure and was not overweight. His cholesterol levels were normal. His ECG, both at rest as well as during the 9 minutes that he ran sprightly on the treadmill (TMT test) had been normal. The aortic valves of his heart had however shown calcification, which the doctor had passed off as “incidental”, not requiring any therapy.

The heart’s ability to beat continuously and unobtrusively 100,000 times a day or 36 million times a year is often taken by us for granted.  But quite like the engine of a car that can stop unpredictably on the road (as indeed happened to thecar in which Mr Rajiv Gandhi was travelling during Mrs Indira Gandhi’s funeral procession), the heart can surprise us.

The commonest cause of natural sudden death is abrupt stopping of the heart. If it occurs during sleep, the person just fails to wake up. If it occurs to a pilot or driver at work, it can cause fatal accidents. I remember watching a couple waltzing on the dance floor on the eve of new-year, and moments later, seeing the gentleman collapse on the ground with a “cardiac arrest”.

A “heart attack” or myocardial infarction (MI) as we commonly understand is due to an abrupt blockage of arteries that carry blood to the muscles of the heart. It is usually associated with pain or heaviness in the chest.

On the other hand, a bolt-from-the-blue “cardiac arrest”, even before the person has had a chance to complain, is often caused by arrhythmias or rhythm disturbances that sometimes prove fatal. With heart muscles going into a state of rapid irregular twitching, called ventricular fibrillation, pumping of blood halts abruptly and death occurs within seconds to minutes.Those with calcified heart valves are ten times more prone.

Fatal cardiac arrhythmias, though rare, can take us by surprise, and remind us of our vulnerability as mortals. TS Eliot might well have said “And that’s the way some lives end, not with a bang or whimper, but with a twitch!”
As published in HT City ( Hindustan Times) dated 2 June, 2013.

Compassion or Crime?

Lazer, who had reached a ripe old age and had become blind, bedridden and pitiful from constant pain from many age related ailments, had begun to weigh heavily on the hearts of the Mithals. Unable to see him in constant agony anymore, they decided to put him to sleep as a final act of compassion.

Vibhav, who is now taking up a job after completing law-school recalled how Lazer had entered their home and hearts as a tender one month old pup, when he was in class 2. Over 16 years, Lazer had played several roles from being the youngest child to Rashmi and Ambrishto a younger brother, playmate, friend and guard to Varun and Vibhav.

Laze had brought that special mirth and cheerfulnessto their home: playfully teasing the children out of bed by pulling off their sheets, naughtily hiding their socks when they were readying for school, guarding their home all day, welcoming them back with incessant wagging of histail, and playingball with them in the evenings.

But as one year of a dog’s life is equivalent to seven of man, Lazer fast-tracked from a baby to youth to mid-life to senility in 16 years (equivalent to112 of a man) with cataract, diabetes, weak heart and paralytic legs, as he lay immobile and groaning constantly in pain. After much deliberation, he was released from his painful state by euthanasia or mercy killing.

While most animal lovers would approve of mercy killing for suffering animals, extrapolating a similar approach to humans never fails to stir the hornet’s nest.

 Counter arguments usually begin with our arrogant positioning that Manis not an animal! While there certainly are differences, the similarities of the cycle of life and death are inescapably similar and humbling. Any person who has lived with and seen an elderly relative struck with an incurable progressive disease like cancer, wither and groan to the predictable painful end, will testify having wished an early respite for their loved ones.

Opposition to Euthanasia comes from both religious and legal quarters. The faithful argue that since man is incapable of creating life, how can he assume the right to snuff it out? Some go further to explain that the miseryneeds to be suffered through as it is ordained.

On the legal and technical front are 3 major concerns: how sure can we be that the situation is truly irretrievable? How sure can we be that this is what the suffering person, who is presently comatose, would have wanted done, and lastly, with sanctioning to (mercy) kill, what is the possibility for ingenuous humans to misuse it for selfish gains?

The Mithals heaved a sigh of relief on letting suffering Lazer go, preferring to keep the memories of his younger frolicking days in their hearts. And as we remain uncertain about how to deal with humans in similar situations, we keep doing what we are best at – procrastinate.
As published in HT City ( Hindustan Times) dated 22 June, 2013.