Say Cheers to Water

While we could debate on whether the old health-tip of drinking at least 8 glasses of water a day is indeed valid, water has interestingly retained its top position as the most popular health drink in the world.

Over 60% of the human body is composed of water. Water assumes the status of a nutrient for carrying out many of vital functions. Apart from replacing the amount lost each day through sweating, respiration, urine and stools, water forms the medium for all our digestive juices, brain fluids, blood and enzymes.

When water intake does not match our output, the body becomes dehydrated. Urine becomes scanty and dark, tongue becomes dry, eyes sunken, the pulse thready and blood pressure low. Thirst is the body’s way of signalling that we need more water. If not replenished, weakness and failure of organs can follow, sometimes leading to death.

The amount of water we need to drink depends on several factors. People working outdoors in hot dry weather conditions may need to drink 15 to 20 glasses of water as they incur huge losses through invisible perspiration.

Here are some reasons why you should ensure that you drink enough water.

1. Dieters know well the value of water drinking in weight loss strategy. A very fit film actor of 70 who looks half his age, once told me that he has been drinking 18 to 20 glasses of water every day since his teens, and kept attributes his slim fit figure to this habit.
2. Water is a good remedy for fatigue and tired muscles. When water moves out of muscle cells, they shrivel and become flaccid. Drinking water, sometimes along with salt and electrolytes, helps restore their turgor and strength. A small tip here: many people drink water only when they feel thirsty after exercise. A healthier way is to drink lots of water in anticipation before you embark, on say a jog or marathon.
3. The difference between a glowing smooth skin and a wrinkled dry one could often be due to water. Good hydration ensures healthy skin turgor.
4. Water is essential for the health of our kidneys. Wastes and toxins are removed from the body by the kidneys through urine and water is the medium through which this is done. Consumption of adequate amounts of water not only helps keep the body clean of wastes but prevents stones from forming in the kidneys.
5. People with constipation often do well if they increase their intake of water and fiber. The latter tends to hold the water in the gut, preventing stools from getting hard.

Do not wait for thirst to remind you that you need a drink of water. Start the day with 3 large glasses, and drink 5 to 12 glasses a day. Weight watchers should drink 2 glasses before meals. And if your urine looks dark, it is a reminder that you need to step up your water consumption.

Cheers to a drink of water.

How Doctors Die

Unlike the perception of most relatives that doctors treat critical patients callously, they in fact often “over-do” than what may be reasonable.


Says a intensivist “Rescusciation or CPR (cardio-pulmonary resuscitation) looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
"I felt like I was beating up people at the end of their life. I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, I'm sorry, goodbye.' Because I knew that it very likely wa not going to be successful. It just seemed a terrible way to end someone's life."

Doctors fall ill and die just as others in society do. Interestingly in spite of all their knowledge about the body, its ailments and cures, they life expectancy is not much different than the general population.

What is indeed different is what they choose to go through themselves compared to what they do to others. In a revealing article “How Doctors Choose to Die”, Dr Ken Murray points out that doctors more often shun ‘advanced’ and ‘intensive’ therapy.

They more often refuse chemotherapy when diagnosed with advanced cancer, prefering to spend quality time at home. Their decision is perhaps based on their first hand experience of having witnessed the unpleasant adverse effects and futility of these treatments.

Doctors also more often choose to refuse aggressive terminal care treatment. They have seen what is going to happen, and they generally have access to any medical care they could want. They know enough about death to understand what all people fear most: dying in pain and dying alone.

They know modern medicine’s limits. Almost all medical professionals have seen “futile care” performed. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs.

In a way doctors can be accused of double standards, applying one set of advice to patients and one to themselves, but the important variable here is the expectation of relatives. If a patient becomes critical, even if he is 85 and is known to be suffering from a terminal disease, the wish of relatives is usually “ Do whatever is possible”.

In the litigant and finger pointing times such as ours, doctors therefore prefer not to leave any stone unturned. Relatives, many of whom may have flown in that day, may derive solace from having gone “all the way” in the care of their dad or mom.

it is this fear of guilt of “not having done enough” that makes relatives agree to submit their loved ones to the dehumanising terminal treatment: surrounded by strangers, hooked to machines, body punctured at several places and not a familiar loving face to see before they close their eyes.

Natural Ways to Get Sleep

It is funny that while sleep is a natural state of relaxation in which we spend one third of our daily lives or a third of our total life years, many of us seem to struggle to get it.

Sleep, in contrast to wakefulness, is a condition when our conscious mind switches off leaving the stage to the unconscious mind that often reveals itself in the form of dreams. Healthy sleep in adequate amounts is essential for our brains, minds and bodies.

Popping a sleeping pill has become an easy way out. At the last count there are over a hundred types of sleeping pills available for treating ‘insomnia’, the medical term for lack of sleep, with 3 of every 20 Indians consuming them. Most medications however provide an abnormal drugged form of sleep, create dependence or have adverse effects.

Getting enough of the natural sleep and at the appropriate time therefore continues to be a challenge.

The commonest form of sleep disorder especially in young people is difficulty in falling asleep.

It is sometimes due to excess consumption of caffeine, a cerebral stimulant, especially in the evenings. Saying no to coffee, tea and chocolates especially after dusk helps.

Another form of cerebral stimulation that interferes with sleep is watching thriller movies or heated arguments on television before bedtime. Therefore much though I like watching ‘what the nation wants to know’, I have started tuning in to ‘bhabiji ghar par hai’ to get into the right mood to fall asleep. Working on computers at night can drive sleep away too.

A dark silent cool room without mosquitoes and a comfortable bed often suffice. Additional sleep inducers could be soft instrumental music, bhajans or lullabies, or soothing aromas. Reading a book can be an effective strategy for some.

What do you do if these simple measures are not enough?

The strategy that works best for me is physical exercise. On days that I am able to get a 30-minutes session of tennis, shuttle or brisk walk, I find myself dosing off by 10 even when mud-fest on TV is reaching deafening levels.

Two other simple tricks also work well.

One is to relax all muscles of the body, working up stepwise from the toes to the forehead, making sure that the body is loose and limp. Direct the mind to slowing and relaxing the rhythm of breathing. Then focus the mind on a soothing scene. What works for me is to visualize sheep grazing on the hilly Himalayan meadow while I try to count them. Another sleep inducing mental exercise is to subtract 7 from 100 and count backwards.

Falling asleep requires wiping off excitement, fears and anger, and shutting off the conscious mind to let the body go limp and loose into that dream like state. The more one practices the easier it gets. And saying a silent prayer often improves the quality of the mist that wafts in.

GM Diet for Weight Loss

In recent times, my growing paunch has become an embarrassment especially when I counsel my obese patients about shedding fat. Hence I have been exploring an easy quick way that would be compatible with my lazy nature, to get back to shape.

I came to know about the GM diet that several people I have now met seem to have tried and found useful. Further it comes with a vegetarian adaptation that can suit most Indians. I understand that it has become the most popular weight losing diet in the country.
The GM diet is named after General Motors company of the USA where it was first developed to help obese employees shed weight, get back a healthy glow and feel energised. It was tested and endorsed by the reputed Johns Hopkins Research Centre.

It is based on a principle of rotating foods on a day to day basis and drinking lots of water to detoxify the body. Its biggest advantage is that it does not make you starve as many diets do.
The expected weight loss is between 2 to 5 Kg in 7 days. Yes, alcohol is forbidden during this period, as also are milk laden tea or coffee and packaged fruit juices.

The week’s schedule goes like this:

Day 1 is the all fruits day when you are expected to eat only fruits of all types, except bananas, mangoes and lichis. Melons and watermelons are particularly recommended, as are guavas. There is no restriction on amount.

Day 2 is all veggies day, when you should subsist on only vegetables: raw, boiled or steamed, and of all varieties. No restriction on quantity except just one potato.

Day 3 is a mixture of days 1 and 2. Except for bananas and potatoes, you can eat a mixture of fruits and vegetables on this day—as much variety and amount as you like.

Day 4: The menu is bananas, milk and soup. You can eat up to eight bananas and three glasses of milk on this day and consume as much of the soup as you like.

Day 5 is a festival day when you can have a tasty meal. You can munch on tomatoes, sprouts and cottage cheese (paneer) or soya chunks. Make a tasty soup with them and drink it. Make sure you increase your water intake on this day.

Day 6: The recommended food for this day is sprouts, cottage cheese and other vegetables excluding tomatoes. The tasty soup and lots of water should help you through your day.

Day 7: On the last day you can have fresh fruit juice, one cup of brown rice or half chapathi and other vegetables you would want to eat.

If you undertake moderate exercise of 15 to 30 minutes a day in addition, the weight loss in 7 days can be impressive. And you can repeat it as often as you wish.
Worth a try for a week to see if it works.

Medical Strangulation

Gunja, a 31 years old pretty vivacious woman who works as a medical administrator in a corporate hospital and stays alone in an apartment, is perpetually frightened ever since she survived a near death experience from suffocation a year ago.


Over the last two years, every now and then she suddenly breaks out into angry itchy hives all over her body, along with a feeling of choking that makes her gasp for breath.

She recounts in horror when she had a particularly bad attack one early morning while she was alone at home. Soon after the skin hives started appearing, she experienced a feeling as though someone was tightening a noose around her throat. She gradually turned blue and lost consciousness.

Luckily, she had been able to pick up her cellphone and make a call to her doctor-friend who, sensing something seriously wrong had rushed to her home and injected her with adrenaline, which had saved her in the nick of time.

Subsequent tests showed that she suffered from a rare condition called angio-edema, in which an individual is prone to develop swelling (or edema) of the soft tissues and mucous membranes of the body on provocation by certain foods, medicines, bee stings, wasp bites or minor trauma. When the swelling occurs in the neck, especially around the wind-pipe, it obstructs the air passages, sometimes causing death from suffocation.

Angio-edema is rare, but many probably die due to lack of recognition and timely action. Gunja has been fortunate in that she works in a hospital, and her caring medical colleagues have been able to put

her through the requisite tests and prove that she indeed has a deficiency of a C1 q esterase enzyme that is the hallmark of this condition.

Medical suffocation, be it from angio-edema, or anaphylaxis a severe form of allergy, requires prompt recognition and action. Though intravenous injections of anti-allergics and corticosteroids often work, the specific therapy to turn things around is a subcutaneous injection of adrenaline.

A special pre-loaded adrenaline pen, or epipen as it is called, looks quite like an insulin pen, and is easy to self-use. It is helped save many lives. One just needs to jab it on one’s thigh and inject it.

That delay can cost lives was realised when a 14 year old Irish girl, Emma Sloan died of peanut allergy in a restaurant a few years ago. Seeing her daughter get breathless in a restaurant, her mother had rushed to the nearby chemist’s shop to procure an epipen. The Irish chemist refused to dispense the injection without a valid medical prescription. The young girl had collapsed and died minutes later.

Saving lives is sometimes all about timing and promptness. In the words of JFK, “The difference between salad and garbage is in the timing”.

My naughty mind often wonders what would be the fate of such patients if our courts were to decide on their treatment?

Try Fasting to Get in Shape

While loosing weight can indeed be a formidable challenge for those suffering from obesity, my experience suggests that most do not really try hard enough to get back to shape! They go through the customary dietary consults and sermons on regular exercise, give the appearance of being convinced and motivated, but turn up after a couple of months without having shed any weight.
Sometimes, their weight paradoxically go up after they start going to the gym. Many manage to get off fats, but increase their consumption of starch and sugars. It is true that one gram of butter or oil provides 9 Kcal while sugars and starch provide only 4 Kcal, but snacking on potato chips or drinking fruit juices can add more to your belly than a thin smear of butter on a brown toast.

On trying to unravel the mystery of why some gain weight after starting workouts instead of losing it, many admit to increasing their food intake in response to hunger that exercise drives up.
What seems to lie at the root of the weight problem is how to cut down on the calories we consume.

Fasting, within limits, may not be a bad thing to try. The health effects of periodic fasting are generally positive and has been promoted by most religions. It helps loose weight by shedding excess body fat, improves diabetes and high BP, and has been shown to reduce cancer risk. Studies have shown that periodic fasters have lower risk of heart disease and tend to live longer.

Glucose is the body's primary fuel source and is essential for the brain’s functioning. When denied glucose for more than 4–8 hours, the body turns to the liver for glycogen, a storage form of glucose, to be used for fuel. At this point, the body also uses small amounts of protein to supplement this fuel. This fuel will last for up to 12 hours before the body needs to turn to glycogen stored in muscles, lasting for a few more days. If glucose is still denied at this point, muscle wasting is prevented by temporarily switching to fat as the fuel source, meaning fat is converted into ketones. Ketones, while not sugars, can be used by the brain as a fuel source as long as glucose is denied.

The body continues to use fat for as long as there is fat to consume. It will generally indicate to the faster when fat levels are running extremely low (less than 7% and 10% of body weight for males and females, respectively) with an increased urge for food.

If you are serious about losing weight, there is hardly any hope if you do not restrict calories. Periodic fasting may be worth a try as long as you do not binge after the fast is broken.?

Uberification of Health Care

The imaginative concept of matching transportation demands of people with cab facilities using a smartphone platform that Uber is credited to having created is now beginning to be applied to health care as well.

At the outset, let me share with you what I understand of Uber. It is an on-line transportation company that develops, markets and operates the Uber mobile app, which allows consumers with smartphones to connect with Uber drivers through a software platform for taxi service. Uber itself does not own any assets such as cars, or hire the drivers.

Uber was founded by Tavis Kalanick and Garrett Camp as recently as 2009 in San Francisco, but the impact and success of this “start up” has reverberated across the world, being now valued at US $ 62.5 billion.

Fresh successful ideas in one domain often tickle the minds of entrepreneurs in other fields. Healthcare experts are now trying to explore if they can bring about a revolution in their sector as well.

The proposition seems to be as follows: there are several people who need medical help, just as there are several doctors who can deliver them, but connecting them quickly is the real challenge. Our traditional rigid system of “going to a hospital” that is located at a distance, is rigid, and has multiple layers of hurdles is not easy for someone in urgent need.

This was sought to be short-circuited with the development of telemedicine services, by which a patient could get medical advice through an internet based software service or telephone. This format however works only for simple ailments, as there is not much scope for to-and-fro discussion, physical examining the patient, or getting prescription medicines.

The next major step, which enabled a patient to see the doctor and discuss his problems, came with skype based consultations. One could see the doctor on the screen and a to-and-fro discussion was possible. The only shortcoming Skype consults however is the lack of physical feel that is sometime important in clinical medicine. For follow ups, say for instance to tweak insulin doses in a diabetic, physical examination may not always be necessary, and Skype consult can be very convenient for patients.

The new concept of Uberification goes a step further. Can there be smart phone based app that helps patients in emergencies, such as an outbreak of allergy or high blood pressure or acute diarrhea, to get quick medical help from a nearby doctor who is available to visit his home?

This new strategy could be important for several reasons. Ailments which require the physical presence of a doctor would be possible, home care could get its long needed boost, and medical emergencies needing prompt responses would be easy to deliver.

“Unlike cabs, the main challenge in India would be to ensure a uniform and high quality of care by different doctors”, says Dr Dilpreet Brar. Upper class citizen have already started signing up on MediCube that she has launched in Indian metro-cities recently.

Plasma therapy for Baldness to Joint Diseases

Excessive hair loss, or alopecia as it is medically called, now has a promising new therapy. Doctors are using platelets from the patient’s own blood to stimulate hair growth.

Platelets are small little particles present in blood that play an important role in plugging leaking arteries and in clotting. They also contain a large number of “stimulating factors” that stimulate degenerating tissues to grow again.

There are several of them such as platelet derived growth factor (PDGF), growth stimulating factor (GSF), epidermal growth factor (EGF), vascular epidermal growth factor (VEGF) and mediators like Interleukin 8 which stimulate growth of hair follicles and cells of several tissues such as nerve cells, bones, cartilage and muscles. This newly discovered property has suddenly catapulted plasma into centre stage.

Plasma rich platelet (PRP) therapy as it is called, involves drawing a sample of autologous (patient’s own) blood, mixing it with an anti-coagulant that prevents it from clotting, spinning it in a test-tube, and taking out the platelet rich portion of the plasma. It is then injected into the scalp or other tissues with a very fine needle, like the insulin needle. Typically 2 to 4 mL are injected in each session, that are then repeated 2 weekly 4 to 6 times.

Several studies have shown this therapy to work in reducing hair loss and improving hair growth, either alone or in combination with other treatments such as minoxidil or hair transplantation. Safety issues around transmitting infections are hardly any as it is the patient’s own blood that is used. It is also cheap and simple.

There is however still some concern about how effective it really is. Some trials have shown impressive success while others have not. Experts believe this difference could be due to the variation in skill and expertise for separating and concentrating platelets.

PRP therapy now has a wide range of evolving applications: plastic surgeons are using it to treat scars and skin grafts while orthopaedic surgeons are treating degenerative joint disorders like osteoarthritis with it. It has become particularly popular in sports-medicine for treatment of injuries of tendons, ligaments and joints. Even neurologists are using it to stimulate regeneration of nerves.

Interestingly, the first use of PRP was in 1997 in Italy for treatment of dead and degenerating heart muscles. Perhaps the fascination of cardiologists with stem cells for the same purpose, made PRP recede to the background over the last 2 decades.

If it delivers on its present promise and proves to be effective, PRP could be a much simpler, safer and cheaper therapy to help stimulate growth of a variety of degenerating tissues, from sleeping hair follicles in balding scalps to the tired muscles of broken hearts.

Good Old Aspirin for Cardiac Emergency

Heart attacks are common above 40, often coming at odd times, without warning, and are the commonest killer of our modern times. The best chances of reducing the severity of an acute attack and improving the chances of survival are by chewing aspirin at the very start and reaching a hospital within 2 hours.
A doctor colleague of mine, Dr Anil Behl, has started a unique form of social service, of putting 4 aspirin tablets in a plastic pouch and keeping it available at all times with the security check-post of his housing colony. He has backed up this simple act by informing all residents of his colony by email and posters, that should anyone have early symptom of heart attack, they should immediately procure the pills from the security room and chew them while waiting for further help to arrive.
During a heart attack, blood clot forms in the arteries of the heart blocking the flow of oxygen-rich blood to heart muscles. Clot formation begins with clumping of small blood particles called platelets. What aspirin does is that it prevents stickiness and clumping of platelets,. When taken during a heart attack it therefore slows clotting and decreases the size of the clot.
Most cardiologists swear by aspirin for several reasons.
For those who have had a previous heart attack, long-term use of aspirin reduces the chances of having a second one.
It is useful for those who have never had a heart disease before but are at increased risk of having one. This group includes people above 40 who have diabetes, high blood pressure, increased blood levels of cholesterol and smokers. Those with a strong family history of heart disease also come in the “risky” category.
A daily dose of low-dose aspirin has been shown to reduce the risk of a first heart attack in this group. Cardiologists also recommend aspirin to all those who have had a cardiac artery bypass surgery or angioplasty. The reasons are much the same. It prevents platelets to clump thus reducing the chances of clot formation in the arteries of the heart.
Heart attack presents as heaviness or pain in the center of the chest, often radiating to the neck or left arm or back, sometimes associated with sweating and uneasiness. It is often felt as “gas” and vomiting by some.
Aspirin is of course the first step that can be taken at home or on the way to a hospital. An angiography, and opening up of the blocked arteries by angioplasty, performed within the first 6 hours, reduces damage and death of heart muscles, and the best chances of long-term survival.
It makes sense to keep aspirin handy at all times, not just for you, but others around you who might need it in an emergency.

Microbial Garden in Your Gut

The paradox that scientists are trying to come to terms with is that our “healthy” human body is loaded with germs, and that these germs might be conferring positive health to our bodies. To be specific, we carry over a trillion (1014) bacteria in our guts. And they belong to as many as 400 different species. If we could scoop them all out and place them on a weighing scale they would weigh as much as 1.5 to 3 Kg, even more than the clothes we wear!

The presence of this huge bustling wild-life sanctuary of little animals or microbial garden in our guts has puzzled scientists for decades. There was a time when “germs” were those terrible little things that caused nasty infections and often took lives. In fact, when some of these germs migrate from the gut to “abnormal” places such as the urinary tract, they produce illnesses such as urine infections.

The logical approach that scientists therefore took in the last two centuries was to rid the body of all germs, in an attempt to “sterilise” it. They soon realised that removing the “good” germs often cleared the field for disease-producing bacteria to invade the body and cause diseases.

It has now become clear that just as good germs need our warm moist slushy guts to survive, breed and colonize, we need them just as much to act as guards preventing invading germs from coming in and causing diseases.

The most dramatic example in current times is a condition called “antibiotic associated diarrhea (AAD)” or the upset tummy that many of us experience when we take antibiotics for infections such as those of the chest, urine, skin or bones.
The gripes and ‘loosies’ we get are best managed by consuming “good” germs, called probiotics, either in the form of curd or yogurt, or as preparations that come as capsules or liquids. A particular variety of healthy germs called Saccharomyces boulardi has been shown to work best for this condition.

Scientists have now gone even a step further. Why not take germs from a person with a healthy gut and “transplant” or put them into people with weak guts? Stool transplant or Faecal Microbiota Transplant (FMT), as it is called, involves taking stools from healthy donors, running it through labs to ensure absence of harmful ones, and instilling them into the intestines of patients through a tube passed from either end of the gastrointestinal tract.

There are 25 medical centres in the USA that have started doing FMT, as have some in India. In conditions such as C difficile toxin disease, the results with this procedure are thrice as good as any other form of treatment.

While these are still early days and one has to study and observe more to recommend it in wider indications, the initial results are very promising.

The Chinese seemed to have known all this from as far back as the 4th century BC. They had a practice of young mothers feeding a small bit of their stools to their new borns to make their guts strong.

And we seem to have come a full circle now with faecal transplantation to regain our health!

Emergency Medical Kit

he regular depiction in TV serials of a doctor arriving home almost instantaneously when summoned on telephone to attend to an emergency, could not be farther from reality. Most good 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 well neigh impossible.
It makes perfect sense 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 preferably, have taken before, so that it is not a first timer during an emergency and that too in a new place.  If you take a new antibiotic while on travel, and come down with hives, things can get rather complicated.
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 envelope labelled “Fever, Body pains”, loperamide in one labelled “Loose motions” or Avomine in one labelled “Motion sickness”.
3. Keep them in your hand baggage, in a separate pouch or flap. The best of medicines kept in the checked-in-luggage will be of no use to you should you need it in an emergency.
4. Know your special needs: For example an asthmatic should ensure he travels with his bronchodilators, those with heart disease must have their nitrates, those with diabetes should carry not just the blood sugar lowering drugs but also some sweets or sugars, in case their head spins due to a drop in blood sugar.
A practical step would be to try making your medical kit to deal with:
1. Allergy, hives, itching, running nose, watery eyes, brochospasm: Allegra/ Alspan/ Cetriz/Avil
2. Loose motions (watery) : loperamide (Imodium)
3. Acidity/ heartburn: Digene or Gelusil tablets/ Ranitidine or Omeprazole
4. Nausea or vomiting : Domperidone or ondansetron
5. Motion sickness : Avomine
6. Infections: Tummy or urine infections, fever: Ciprofloxacin or ofloxacin/ cephalosporins Throat or chest infections: cephaloporins or amoxycillin or Septran
7. Fever, body aches, sprains, injury: Paracetamol/Brufen
8. Crampy pain in abdomen or painful periods: Spasmindon, Cyclopam/ Meftal spas are some antispasmodics
9. Band-aids and antiseptic creams for abraisions and hurts.
10. Laxatives ( Isabgula husk, lactitol or PEG pouches)
Laxatives are particularly important for people with chronic constipation who travel overseas. One tends to unknowingly suppress bowel evacuation during long journeys, especially flights. Further, the diet in most western countries tend to constipate as they are low on fibre and often contain cocoa.
It is not uncommon therefore for stools to harden, causing anal fissures and piles.
It is indeed paradoxical that despite mushrooming of hospitals and clinics, getting a good doctor when in need is a matter of rare luck.
(I have avoided commercial names of medicines, which your pharmacist will help you with)

Are we prepared for ZIKA?

I had honestly not heard of ZIKA virus till recently, when this hitherto unheard virus shot into international fame for allegedly damaging the brains of babies growing in their mother’s wombs, and having them being born in vegetative states with mental retardation. 

It is true, that ZIKA, which spreads through mosquito bites, does not seem to be dangerously fatal to the humans it stings, but the suspected havoc it causes to expecting mothers, who go on to deliver deformed mentally retarded babies, and the effect of this trauma on their families is often perceived by many to be worse than death.

Although ZIKA virus epidemic is raging in distant countries like Brazil, Mexico, Africa and other South American nations, it would be silly to adopt an “ Abhi Dilli Door Hai” stance. The same strain of mosquito that spreads ZIKA, called Aedes aegypti, is rampant in most ‘nukkars’ and ‘galis’ of India. At the moment it is fervently engaged in spreading other viruses such as Dengue and Chikungunya here. 

But when ZIKA arrives here after getting past the Indian immigration, it will find the Aedes mosquitoes eagerly waiting to carry it to a huge number of human Indian hosts living in populated towns and cities, many of who would be pregnant mothers. If swarms of Aedes mosquitoes could carry the Dengue and Chikungunya viruses, bringing governments to their knees, why would they not carry ZIKA?

Most people who catch the ZIKA infection do not show symptoms. Few (around 20%) develop fever, body aches, rash and congestion of the eyes that pass off in a few days. Hardly anyone dies. But some adults develop neurologic problems such as paralysis of muscles.

But the problem is, that unlike Dengue, there is no easy test to detect the infection. How then would an expectant mother know if she suffered the ZIKA infection during pregnancy? Or worse, how would she know that the baby growing in her womb has not been unknowingly harmed by the infection that she did not get to know about? 

This is what is making young mothers and couples in ZIKA affected areas go crazy, some even committing suicide after giving birth to deformed babies with small heads (microcephaly).

The World Health Organisation has sounded an international alarm, and the Indian government has echoed it. But in the absence of specific diagnostic tests, specific drugs to kill the virus or a vaccine to prevent the infection, how do people and nations that have swarms of mosquitoes breeding passionately face this dangerous threat?

The solution could lie beyond the virus, in its transmitter, the mosquito that carry it. And making settlements free of mosquitoes could solve the problem not just of ZIKA, but that of Dengue, Chikungunya, malaria and many more.

Civic bodies seem better positioned to solve this health problem than medical people. And we could play our little individual roles to check the mosquito-menace near our homes, schools and offices.

Plastic Bags are a Health Menace

Plastic carry bags that are so liberally doled out by grocers and store-keepers are emerging a major health hazard and killer.

They are made of polythene, a product of petroleum and can be seen littered on roadsides, drains and fields while you travel by car or train. They choke landfills and drains and have even caused floods. They block the intestines of cattle and marine animals when they are ingested mistakenly while grazing, and kill around 10, 00,000 each year by painfully strangulating their intestines or by choking.

Disposing these bags is not easy; their burning releases toxins that are harmful to environment and us. Burying them causes the landfills to choke as polythene does not breakdown and decompose easily, and when they do, release toxins into the soil that find their way into the food chain.

Sometimes plastic bag litter can cause more problems. According to Nobel Peace Prize winner, Professor Wangari Mathaai, discarded bags fill up with rainwater and become perfect breeding grounds for malaria-bearing mosquitoes. Researchers from United Nations Environment Program have recommended banning of plastic bags to check malaria and save lives in several such countries.

Social costs of plastic litter add up as well; countries lacking comprehensive waste management often sprout underground economies of ragpickers — typically children who wander refuse heaps and collect potentially recyclable materials for sale to shady businessmen operating from official dump sites.

The problem with plastic bags is that it has become the victim of its own success. It is cheap, light, impervious and convenient with around 5 trillion produced each year. Their menace can be contained by the 4-Rs — Reduce, Recycle, Re-use, Repair.

Several developed countries have concentrated on re-use. Unfortunately the disposal, collection and recycling of used plastic bags in poor countries pose logistic problems with less than 1% ever been recycled.

It is time that visionary governments impose a ban on plastic bags.

If we take our jute or cotton “jholas” when we go to the grocers, it would reduce the use of plastics. Celebrities could make it a fashion statement and the media can publicise it. Retailer chains could offer an option of jute bag carry aways, at a little extra price; many of us wouldn’t mind it.

And if we could ensure clearing of the littered bags in our vicinity, we could reduce the breeding places of mosquitoes and the harm they cause to cattle. A difference, no matter how small, is urgently worth making, and we can set examples and inspire others to join in.

What does Research say about Happiness?

The secret to happiness may have to do with relatives and friends rather than money and fame, reports a recent scientific study.

The findings of a 75 years long study undertaken by Harvard University researchers to find out what makes people happy and healthy as they go through their lives, was presented by Dr Robert Waldinger, the fourth director of the long research project, in his crisp 12 minute TED talk “What makes a good Life. Lessons from the longest study on Happiness”, recently (http://ted.com/talks/robert_waldinger_what_makes_a_good_life_lessons_from_the_longest_study_on_happiness).

This unique study, the longest ever undertaken to study happiness, tracked the lives of hundreds of young people, rich and poor, starting from their teenage to their nineties.

On expected lines, most youngsters, at the time of initial interview in 1930 when the study started, had mentioned money as the most important thing they thought they needed to make them happy. Some had said they wanted fame, and several others had said that they wanted both money and fame to achieve happiness in life.

Over the 75 years, the participants were interviewed periodically and their perceptions of happiness were recorded each time to see if they changed.

By the time they were 50 years old, two types of people could be identified: those with lots of “relationships”, that is close bonds with relatives, friends and people, and another who were loners.

When followed up further till their 80s and 90s, the researchers evaluated how happy the participants were and had been in their lives, and tried to see a pattern in their lives that could correlate with their state of mind and health.

In the TED talk, Dr. Waldinger says that the research failed to show any correlation of the wealth or fame they had achieved, with their health and happiness.

What the researchers noted however was that the happy nonagenarians were far more likely to have had more relationships, often with many relatives and large families, or larger number of friends.

On trying to look back at the lives of participants, the researchers note that those who had many good strong relationships at age 50 were far more likely to be happy and healthy in their nineties.

Dr. Waldinger therefore goes on to conclude, that in order to be happy in life, investing time in relationships seem to be more important than acquiring money or fame. Building close warm bonds with relatives and friends seem to pay rich dividends later on.

Ever since I heard this talk, I am working to change my schedule to make more time for those seemingly unimportant occasions such as a cousin’s grandchild’s birthday, or a friend’s son’s marriage. Meeting people and spending time interacting with relatives and friends seem to be what we need to rediscover and get back in our increasingly busy lives.

I strongly urge you to listen to the talk and make up your minds.

Diabetes and the Liver

One could wonder why in diabetes, a condition in which the blood sugar concentration in the blood goes up, need we worry about the liver? Or for that matter, even take the blood sugar reports seriously at all.

Doctors have begun to realise that the elevated blood sugar value is only the tip of the iceberg. Patients with type 2 diabetes, the common form of the disease that occurs in adulthood, often go on to develop problems with several other organs of the body, such as kidneys, brain, blood vessels, heart, feet and the liver.

At the root of the problem in Type 2 Diabetes, is the observation that contrary to intuitive logic, the blood levels of insulin in this condition is increased!

Insulin resistance (IR) as its is called brings with it several changes in the body such as thickening of the basement membrane, the floor on which cells of all organs of the body are lined up and pushes up fatty acids in blood circulation, that then gets deposited in the liver and blood vessels.

Fatty liver is seen in two-third of diabetics. It usually has no clear symptoms in the early stages often getting recognised during investigations for abnormal readings on liver function tests (AST, ALT or GGT levels in blood) or during an ultrasound examination.

It is however not an innocuous condition. Research shows that patients with extra fat in their livers die earlier, that is, their lives are shorter than their fat-free counterparts.

What happens to people with Fatty Liver? Some of them go on to develop a state of weakness of the liver called Liver Cirrhosis. In this condition, liver cells die insidiously and are replaced by scar tissue. The organ gradually starts functioning poorly, sometimes causing swelling of feet or retention of water in the abdomen. The veins in the food pipe can get engorged and rupture, causing blood vomiting.

When the liver gets very weak due to Liver Cirrhosis, transplantation of the diseased organ is sometimes required. This condition is getting so common that it makes up around a third of all causes of liver transplantation.

Another recent finding that research has shown up is that patients with diabetes and fatty liver are at increased risk of developing liver cancer. They often come silently or are incidentally picked up on imaging tests, but progress aggressively over few months. Scientists are debating whether all type 2 diabetics with excess fat in their liver should be monitored periodically with CT scans or MRI scans to watch for early liver cancer.

Diabetes therefore is a condition of not merely increased blood levels of sugar. Although it has a genetic basis, its severity and outcome is decided by how we eat, and exercise, and get our periodic checks done to ensure our organs are keeping healthy.

Liver is a large organ with lots of reserve, but it is wise not to ignore it in diabetes. 

Healthcare in Our Country

One recent morning while I was gloating about our country’s claim to be seated among the developed powerful nations of the world, my car stopped at a traffic signal and a dirty starving man begged me for some money to eat a meal. While parting with a tenner, I asked him what made him beg. He said he had been a small farmer in UP, but had lost his land, home, money and living, trying to provide treatment to his son who had been stricken with cancer for two years.

Treatments have improved and many diseases are now curable, but they have come at huge costs that continue to spiral. And when a loved one falls prey to disease, emotions compel us to go to the last post to save his or her life.

Administrators view healthcare sector as a graveyard for government investments. A government hospital does not fetch money on a regular basis, unlike manufacturing industries, housing, liquor or tobacco businesses. And the political benefits of cutting red ribbons of hospitals before elections do not match the grandeur of inaugurating “large buck” projects.

Our planners and politicians, who are handicapped with visions limited to 5 years, have therefore found it prudent to pass the onus of caring for the sick and ailing, to private players. And industrialists, property dealers, liquor barons, brick kiln owners and their likes have responded by building hospitals, with profit in their eyes and philanthropy on their lips!

Business gurus argue that Health Care is after all an industry (why get emotional about it?) growing at 13% pa, and a safe bet to invest in. To meet the demands of this industry, a new breed of “health care professionals”, have come up. If you ask one such honcho what he did before joining a corporate hospital, don’t choke, if he tells you that he sold automobiles or insurance!

The norms that they have brought with them are those of any other industry: impressive-looking infrastructure, elegant ambience, modern equipment, predictable service with smiles, reputed doctors and of course, good publicity.  And they wait eagerly for returns that their investments would bring, called “ROI”.

This breed has created new jargon. Their efforts start with increasing “foot falls” (people visiting the facility), that hopefully lead to increased “conversions” (people undergoing procedures or admissions that really bring in the mullah), and a positive P and L bottom line.

Private hospitals cater to 70% of the country’s health needs and have sometimes done well, wringing in technology and advances ahead of government hospitals (liver transplant and robotic surgery being two examples).

But they come at a price, and occupy the space that our planners have created for them.

The next morning, I looked around for the destitute at the traffic lights, clutching a Rs 100 note in my hands, to make small amends for having joined the healthcare industry, that had robbed him of all he ever had and made him a beggar!

Food Fetish in Medical Descriptions

Strange as it may sound, doctors have an obsession for food items when describing body parts, organs or even human excrements.
It often starts with the relatively innocuous description of kidneys as bean-shaped organs and the human brain as walnut shaped, that most students of biology are familiar with.
But they soon go on to use “café-au-lait” marks, salmon patches, and cherry red spots to describe different types of skin lesions that tell tales of diseases from a brown nevus or angioma or bleeding spots.
And when doctors, who by the way derive their professional origin from butchers, delve inside the human body while cutting up corpses during autopsy, they resort to food items to describe what they see. If the liver shows alternating red and white stripes as in early cirrhosis the description goes as “nut meg liver”. If the intestine shows a central narrowing due to a cancerous tumour, an “apple core lesion” seems to depict it best.
Familiar fruits are most commonly used to describe the size and shape of tumours and swellings: from “ berry like” small ones, to “lemon” sized bigger ones, to “orange” shaped yet bigger ones and then on to “melon” shaped large tumours. References to our familiar fruits mango and coconut are however conspicuously absent as most writers of modern medicine have been of British or American origin.
When doctors start peeping into the stomach or other organs through the endoscope, this food-based description takes yet another turn. Scattered erosions of the stomach are described as “salt and pepper”, polyps as “pea-like” and a gastric antral vascular ectasia as “water melon stomach".
“Bunch of grapes” is a common descriptive term used for large varices (dilated blood vessels) located in the stomach or rectum, while “cherry red spots” help depict if they are in imminent risk of bleeding. “Curd like” or “cheese like” white patches suggest fungal infections of the food pipe while “cauliflower” lesions depict large cancerous growths in the gut.
When an abscess forms in the liver as often happens in amoebic infection, the reddish brown liquefied content is described as “anchovy sauce”.
Radiologists are not far behind in this race. Apart from the “apple core” lesions of luminal cancers, the swollen pancreas in auto-immune pancreatitis is likened to a “sausage” and shadows in the lungs to seeds of millet to castor, depending on their size.
But the most nauseating description is of human excrements. It is “rice water” stools in cholera, “pea-soup” stools in typhoid and “currant jelly” stools in intussusception.
It could be hazardous to have a doctor over for dinner. If you see him getting too chatty with guests, make sure you keep him well away from this topic the entire evening, should you want your guests to eat well rather than retch and scamper to the wash-room when food is served.

Eclipse of Hepatitis C

A hugely positive note with which 2015 is signing off on the medical front is the revolutionary treatment of Hepatitis C that is set to transform the lives of 12 million Indians and several fold more across the world. Around 1-2% of Indians harbour this chronic viral liver infection, most of them unknowingly and many coming to know of it when they have already developed liver cirrhosis or liver cancer. Treatment over the last 3 decades has been either unusually difficult, with weekly injections of interferon, or impossible (due to weakness or low platelets precluding this form of therapy).
Three oral “miracle” drugs have burst into the world’s therapeutic arena, and what could not have been better is that this treatment is now available in India at less than 1% of the international price!
Sofosbuvir is the prime new anti-viral medicine for treating Hepatitis C that was discovered and launched in USA and Europe by Gilead company at the prohibitive cost of US$ 1000 (Rs 60,000) per tablet to be taken daily for 3 to 6 months, amounting to Rs 1 crore for a full course of treatment. It is now available in India for Rs 400 per tablet.
Sofosbuvir needs to be taken with another supportive drug for better results, called Ledipasvir (for genotype 1, 4 or 6) or Daclatasvir (for genotype 2,3) that also reduce treatment duration to just 3 months. Last week, the latter two drugs also became available in India at affordable prices. The total cost of treatment with these oral regimes is approximately Rs 50,000 over 3 months, with a very high (more than 90% chance of cure) and with hardly any side-effects.
The news has been quick to spread across the world where the treatment cost by original international branded medicines is still upwards of Rs 1 crore. This has led to a huge surge of “medical tourism” with plane loads of patients from across the globe, streaming into India to reap the benefit.
Hepatitis C has been painfully difficult and expensive to treat for 20 years with weekly injections of Peg-Interferon along with a weak anti-viral tablet called Ribavirin given for for 6 to 12 months. Almost every patient who has taken this therapy has felt miserable with adverse effects such as fever, weakness, falling blood counts, anemia and depression.
And in addition to the high cost (Rs 1.5 to 3 lac) and several months of ordeal of treatment, relapses have been frequent: the virus often reappearing quickly on stopping treatment. For specialists, meeting such patients who had invested a lifetime’s savings and endured a year’s tribulation but missed achieving a “cure” has been helplessly humbling.
Hepatitis C had its moment of public recognition when the well-endowed silverscreen celebrity Pamela Anderson of Baywatch fame got diagnosed with it. The sensational manner in which she contracted it made it even more popular: she had shared the needle for a skin tattoo with her boyfriend, Tommy Lee, who had carried the infection. The gossipy tale went further to her litigating against him for concealing the information, but as often happens there, they finally united by wedlock!
All this is soon poised to become history as treatment becomes simple and easy.

Coping with Midlife Crisis

When a 57 year old well-established doctor suddenly decided to quit his stable government job of 25 years, 8 years ahead of his retirement age, change his career path, move to a new town, buy a swanky car, many were taken by surprise.

When a lady of 52 years, decided to leave her career of 15 years as a school-teacher, to dive into her passion of Hindustani classical music, her friends and family were taken aback.

When a 40 year-old successful industrialist running a health care industry suddenly deciding to leave his corporate life and take to spirituality and social service, his colleagues were stunned.

Many men and women, usually between 35 and 65 years, often show a change of mood, or surprising behaviour, that smack of mid-life crisis. It was described first by Elliot Jacques in 1965, and since then been recognised the world over.

The common symptoms and signs include:
1. Change of job, often giving up one that had been going smoothly for years, and taking up a more challenging one.
2. Making new friends, often younger, and dropping old ones
3. Splashing on a new car, youthful dresses, a luxury trip
4. Mood changes such as snappiness, low feelings or unexpected joviality
5. Asking questions on meaning and purpose of life, looking back and assessing one’s achievements, wondering if life should have been lived differently
6. Picking up new hobbies. Several people take to photography, music, theatre, social work or art at this age.
7. Impulsive decision making such as changing partners, filing for divorce or having an affair.
8. Obsession with health and fitness
9. Increase in alcohol consumption

While researchers recognise that some people demonstrate such strange behaviour during the middle years of their lives, there is much speculation on the reasons behind it. Some people seem to be seeking a break from that monotonous life when their children leave the nest, freeing them of their daily parenting responsibilities. Many, on the other hand, look to fulfilling their dreams and aspirations in the evenings of their lives before the dusk of old age sets in.

Middle age brings with it change in moods and behaviour. Depression is common, manifesting often as those strange questions that keep popping up: “What have I done in life?”, “What am I living for?”, “What did I wish to achieve and where have I reached?”, “What are the things I still want to do before hanging up my boots?”.

These are indeed difficult questions that can make anyone shift uncomfortably in bed, but what is funny, is that they seem to crop up at this age, often making people feel low, or paradoxically in some, emboldening them to do strange things.

Depression and confusion may require a few sessions with a professional or a trusted colleague. Meditation, healthy food and exercise certainly help.

Midlife crisis is however not inherently a bad thing. On the positive side, it helps people to wake up and realise their unexplored potentials and goals before they walk into the sunsets of their lives. For many then, it can serve as a midlife course-correction than a crisis.