www.healthspectrum.

org

August 2016

Volume I

HEALTH STUDY/RESEARCH

Number 2

Risks of
Saving Lives

Over 75% Of Doctors Have Faced Violence At Work

India Needs A Culture Of Sanitation

Face to face with Dr. Bindeshwar Pathak, Sanitation Man of India who managed to
relieve more than one million people forced to earn their living as manual scavengers
Health Spectrum

Price ` 75

2 August 2016

Health Spectrum

August 2016
Cover Story

Risks of Saving Lives

18
In The News

l India continues to be Polio-Free 8

l Solar for Healthcare Initiative 9

Discourse

l Better Half of a Breast Cancer 10

Health Articles 

l Traumatic Brain Injury

14

l Spontaneous Brain Haemorrhage

: Prevention and Cure
16
l Migraine headaches

Doctors in our country are at rising risk in the workplaces

due to the angst of distressed relatives. Many reports concern medical professionals being roughed up, even killed, by
patient's disgruntled relatives. There are a numerous cases
of violence against healthcare professionals leading to death
of some doctors as well as nurses by patients relatives. This
situation seems to be similar in most of the countries in this
region including China, Bangladesh and Pakistan.

Case Report 

l Ballistic trauma : Retrieval of

bullet from knee by Athroscopy
22

26

India Needs A Culture Of

Sanitation : Dr. Pathak
Health Spectrum

48

Health Tips

l Tips of Dr. Sunita Godara to

Reduce stress

Q&A

l Hypertension : The Hidden Danger30

Face to Face

l Yoga : A Novel Integrative Therapy 40

l How to Treat SleepApnea with
Homoeopathy42

Health Issue Healthy Motherhood 

l Certain Myths Of Women
India Needs organised
Health You Need To Know
trauma systems

24

l Conjunctivitis: Most Common

Eye Problem
43
l Dont ignore the snoring and its
harmful effects
46

Alternative Medicine 

12
Alternative Medicine

36

50

l Gamming Addiction

39

l Triggers of Cancer

47

l Weights Loss

33

Health Study

l Contraceptive failure

44

Beatuty Care

34

Miracle story of Kamal Returning Afresh & Anew :

Dr. P. K. Talwar
Kaur

August 2016 3

Dr. Raju Vaishya

August 2016, Volume 1, Number 2

Editor: Vinod Kumar
Managing Editor : Sushila Kumari
Editorial Head : Aarti Kapoor
Editorial Advisors:
Dr. Manoranjan Sahay
Dr. Pallavi Vaishya
Content Team :
New Delhi : Dr. Atul Kumar, Uday Kumar
Manna, Adheesh Vats, Deba Prasad Sahoo
Mumbai : Sama Irani, IPS Yadav
Lucknow : Choudhary Zia Imam
Ranchi : Aloka
Patna : Arun Kumar Mayank
Singapore : Deepa Tomar
Kuwait :Vartika Tomar
Art Director : Kripa Shankar
Design & Graphics : K A Choudhary
Admin & Business : Satnam Singh
Web & Mobile : Athar Haque
Editorial Office : 21, UNI Apartments,
Sector-11, Vasundhara, Ghaziabad 201012
Tel : +91 120 4320050
M: +91 9013074414, +91 9868793203
Delhi Office : 909-910, B-Wing, Naurang
House, Opposite : Hindustan Times
Building, Kasturba Gandhi Marg,
New Delhi-110001
Mumbai Office : 37/911, Adarsh Nagar,
Worli, Mumbai- 400030
Lucknow Office : 338, Prince Complex,
Hazaratganj, Lucknow -226001
Singapore Office : 236, Westwood Avenue,
5-42 SG 648363, Singapore
Email : info@healthspectrum.org
Website : www. healthspectrum.org
Printed, Published and Owned by
Vinod Kumar
Printed at Subhashini Offset Printers, F-10,
Jagdish Nagar, Patel Nagar-III, Ghaziabad
(U.P.)
Published at 21, UNI Apartments, Sector-11,
Vasundhara, Ghaziabad 201012
Editor : Vinod Kumar

Dr. (Prof.) Raju Vaishya is President of Arthritis Care Foundation &

a Senior Orthopaedic & Joint Replacement Surgeon at Indraprastha
Apollo Hospitals, New Delhi. He is also well known for his
academic contributions. (Page : 22-23)
Dr. P. K. Talwar
Dr. P. K. Talwar is a Senior Plastic and Cosmetic Surgeon & Director
of Cosmetic Laser Surgery Centre of India, Greater Kailash - I,
New Delhi. He was also associated with the Indraprastha Apollo
Hospitals, New Delhi as a Senior Cosmetic Surgeon. (Page : 34-35)
Dr. Rahul Gupta
Dr. Rahul Gupta is a Senior Neuro and Spine Surgeon at Fortis
Hospital, Noida. He worked in many government hospitals
including PGIMS, Rohtak, PGIMER Chandigarh & G B Pant
Hospital, New Delhi. (Page : 16-17)
Dr. Harish Kapila
Dr Harish Kapila is a Senior Consultant, General and Laparoscopic
Surgery at Max Smart Super Speciality Hospital, Saket, New Delhi.
He was associated with Moolchand Khairati Ram Hospital and Sita
Ram Bhartiya Hospital as General Surgeon. (Page : 12-13)
Dr. Jitendra Kumar
Dr. Jitendra Kumar is the Director of Nephrology and Transplant
Medicine at Asian Institute of Medical Sciences (AIMS), Faridabad.
He is an expert in many procedures such as CRRT, hemoperfusion,
CAPD and kidney transplant. (Page : 30-32)
Dr. Sushma P. Sinha
Dr. Sushma P. Sinha is a Senior Consultant Obstetrician
Gynaecologist, IVF & Infertility Expert & CO-ordinator and
Laparoscopic & Robotic Surgeon of Institute of Obstetrics &
Gynaecology at Indraprastha Apollo Hospitals, New Delhi. (Page
: 48-49 )
Dr. Sonia Lal Guptal
Dr. Sonia Lal Gupta is a Neurologist (Headache & Stroke Specialist)
at Metro Centre for Neurosciences, Noida. She is one of the world`s
youngest and most qualified neurologists. She was formerly Asst.
Prof. of Neurology at Loyola University, Chicago. (Page : 24-25)
Dr. Nikhil Seth
Dr. Nikhil Seth is Senior consultant eye surgeon and Head of
Department, Department of ophthalmology at Asian Institute of
Medical Science (AIMS), Faridabad. (Page : 43)

Dr. Ananda Balayogi Bhavanani.

Dr. Bhavanani is the Deputy Director of Centre for Yoga Therapy,
Education and Research (CYTER), MGMC & RI, Pillayarkuppam,
Pondicherry. He is a renowned yoga therapist, researcher and author
of more than 20 books on Yoga. (Page :40-41)

Title Code : UPENG04171

4 August 2016

Health Spectrum

Health Spectrum is the

need of time

Health Spectrum will be a

milestone for all

I hope that the "Health Spectrum"

magazine will create awareness in the
field of health and sanitation. Your
magazine is the need of time. The more
the awareness about health issues is
created among the people, the better it
would be for the society. This would also
lead to a healthy society as healthy mind
is only possible with a healthy body. A
person with good health will be able to
think rationally and logically. Our Prime
Minister, Shri Narendra Modi has taken
many initiatives regarding public health
which include Amrit yojana, Health
Cards for poor, Clean India Mission,
promotion of Yoga on International
level and decision to increase the age
of retirement for doctors. In addition to
all this, the government is also working
on plan to open new hospitals across
the country. "Health Spectrum" should
also create awareness about government
policies and programs in health sector,
so that the general people can avail the
benefits of these government programs.
Shri Arun Singh
National General
Secretary, Bhartiya
Janta Party
A-57, Parvana
Apartments, Mayur
Vihar Phase-I
Delhi-110091
arunsinghbjp@gmail.
com

I congratulate and appreciate

Mr.Vinod Kumar for launching Health
Spectrum magazine. Health problem,
one of the high rise problems, facing
each one in current scenario. I wish
Health Spectrum will be a milestone
for all.
Alternative therapies are distinct
philosophy and science which strengthens
the age-old faith in correction of bodily
disorder, restoration and maintenance of
health through elements freely available
in nature. Our body has inherent curative
powers to heal the problems whether
its physical, mental or psychological.
One can enjoy perfect health by proper
regulation of eating, drinking, thinking,
breathing, working and other social
activities on a natural basis. Be Healthy
Be Happy.
- Dr.Alka Gupta
Holistic Health Coach,
Bangkok (Thailand).
info@alkagupta.com

Great Initiative, especially

in a country like India

Thank you for sharing the 1st issue

of Health Spectrum. I must say, it is a
great initiative, especially in a country
like India. I have been to India more
than 30 times. I am also aware of some
of the health problems of Indians and
their causes. Maybe I will consider
sharing some of experiences relating to
health in the magazine. My best wishes
to the founders of the Health Spectrum
Magazine.
Dev Rakhah
Writer, Educationist,
and Social thinker
London, U.K (Email :
devrakhah@yahoo.com

Health Spectrum

Bridging the gap between

the hearsay and the facts
It is a tremendous relief that Health
Spectrum has come out with its first
ever amusingly informative issue. It is
indeed blissful and a rather colossal add
on in terms of serving as a substantial
source for trustworthy health related
information. Gobsmacking, in-spite of
many health related magazines already
doing the round in the country, this
one is different however in terms that
it is aimed at bridging the gap between
the hearsay and the facts. It collates
excerpts from experts in medicine and
fitness lines, serving as a perfect treat
for those looking for effective ways to
fight ailments and read about healthy
lifestyle habits.
A big applaud to Mr. Vinod Kumar
and his creative team for taking this
up for social good! Even though the
availability of information over internet
is massive but a trustworthy source of
genuine information is hard to access
and remains time consuming.
Looking forward to "Health
Spectrum" becoming one of the best,

and most trusted magazines in our

country.
- Akanksha Chaudhary
Writer & Assistant
Professor (Human
Resources),
Delhi Technical Campus,
Greater Noida - 201306

Bridge between Health

providers and the general
public
Health Spectrum is a good
initiative. Today a number of people
seeking help from Google and Facebook
for medical problems, it is important
that we have a credible group of
professionals who can give unbiased
and scientific information to the public.
I am confident that this magazine
would give opportunity to discuss the
prevention and management of these
health problems and its solutions.
Health Spectrum will full fill the
objective of disseminating scientifically
proven health information among the
general public. This magazine will act as
a bridge between Health providers and
the general public. We hope that it will
become a medium of communication
between them.
Dr. Sameer Kalani
Senior Psychiatrist,
Cosmos Institute of Mental
Health and Behavioural
Sciences (CIMBS), New Delhi

Take a hard line against

malpractices
I am delighted that a much needed
health magazine Health Spectrum is
launched under your watchful eyes. I am
confident that this magazine would do a
yeoman service for the people of India.
Apart from that I also hope that not only
create health awareness in the society but
you would also take a hard line against
shady doctors and those hospitals which
are indulging in malpractices.
Vivek Shukla
Senior Journalist, Previously
worked with Hindustan
Times Group, New Delhi
vivekshukladelhi@gmail.com

August 2016 5

Editor Speak

We want to be a
platform to
promote health
awareness and
offer an avenue
for meaningful
debates on
challenges and
problems in the
healthcare sector.

am pleased to present to you the second edition of Health Spectrum.

The inaugural edition had a great and heartening feedback from different
sections of readers as well as the medical community, and we got some
collaboration suggestions some of which we accepted with pleasure.
As a fledgling health magazine in India, we want to be a platform to promote health awareness and offer an avenue for meaningful debates on challenges and problems in the healthcare sector. We also want to empower our
readers to lead a happy, healthy and disease-free life. It goes without saying
that there cannot be any substitute for a robust health, which is a prerequisite
for both physical and mental well being. We have an unwavering goal to meet
this objective through the magazine, which can be a trusted friend and counsellor in all aspects of their lives.
This edition puts spotlight on some of the day-to-day health challenges
and problems and encourages us to reflect on how we treat the people (health
providers) who take care of our health while we are at work. It also explores
the causes of increasing incidents of attack on doctors. There are numerous
cases of violence against healthcare professionals, and, at times, have resulted
in deaths of doctors and nurses by patients relatives. A study by the Indian
Medical Association (IMA) reveals that more than 75% of doctors across the
country have faced at least some form of violence. Nearly 75% of doctors feel
that they are unsafe in this country and they fear for their lives. This is a serious problem because as healthcare professionals, doctors should be able to
invest their energy into saving lives of people, not their own.
In this issue, we also put focus on increasing road accidents and lack of an
organised trauma system in India, which has the highest number of road accidents in the world. Every minute a life is lost in road accidents in our country
but there is no systematic trauma care centre.
We have included articles on prevention and treatment of diseases like
hypertension, Spontaneous Brain Haemorrhage, migraine, conjunctivitis,
sleep apnea and Traumatic Brain Injury. The articles in this issue are all written by people who are engaged in providing healthcare to the public. They
have freely shared their viewpoints with lots of gusto and passion. I encourage
you to do the same. However, we want to clarify that Health Spectrum is a
platform for different shades of opinions, and many writers may not may not
be conducting clinical trials or research. As such, we do not confirm statements made by any author. The magazine insists that readers should consult a
medical doctor prior to following any opinion or advice or using any product
or service published in the magazine.
On that note, I invite you to explore this magazine. So please, sit back and
dive into this issues selection of articles and discussions.
We will look forward to your suggestions and feedbacks for improving the
magazine. After all, it is your magazine. We will surely publish the worthwhile
comments from our readers.
With warmest thanks,

(Vinod Kumar)

6 August 2016

Health Spectrum

HEALTH STUDY/RESEARCH

Health Spectrum

August 2016 7

In The News

India continues to be Polio-Free

ndia continues to be polio free as the country has eradicated wild polio virus and the last case was seen on 13th
January, 2011, and it is more than 5 years that no wild
polio virus has been detected.
Last case of Wild Polio Virus Type 2 in country was reported 17 years back in 1999. The detection of vaccine derived polio virus (VPDV) does not change the polio free
status. It only indicates the robustness of the surveillance
system and willingness of the country to detect any kind of
polio virus even from the environment
(sewage). Vaccine derived polioviruses
are rare strain of the polioviruses that
have genetically mutated from the strain
contained in the Oral Polio Vaccine
(OPV)
According to a report of Ministry of
Health and Family Welfare , a rapid surveillance review of the area revealed that
the population immunity against polio
type 2 is high as trivalent oral polio vaccine (tOPV) was in use in the state until
24th April, 2016 and two mass vaccination campaign were conducted in January and February, 2016. As per recent
sample survey in the area, 94% children
were found to have received at least 3
doses of OPV. Therefore, chances of its
transmission in concerned area is unlikely.
According to report, however, as a
precautionary measure against Polio, a special immunization
drive is being held, covering high-risk areas of Hyderabad
and Rangareddy districts, starting from 20th June, where an
estimated 300,000 children will be protected against polio
using Inactivated Polio Vaccine (IPV). The special immunisation campaign will ensure all vulnerable children living in
high-risk areas are given protection against polio.
As part of the special campaign being organised now,
children between the age group of six weeks to three years
will be given an additional dose of the injectable polio vaccine (IPV). Vaccination booths will be set up in the areas
being covered in these campaigns. However, there will be
no door-to-door vaccination campaign. Parents of children
living in these areas will be encouraged to ensure that their
children get the IPV dose from the nearest vaccination
booth which will provide additional protection against all
types of polio.
The last case due to wild poliovirus in India was detected
on 13 January 2011 and the country was certified polio-free
by WHO in March 2014. The polio-free certification pertains to the absence of wild poliovirus and thus country remains polio-free.
India continues to maintain a highly sensitive surveillance system for polio. All cases of paralysis with sudden

8 August 2016

onset in children up to 15 years (which is called Acute Flaccid Paralysis or AFP) are picked up by the polio surveillance
network. Each of these cases is followed up and their stool
samples tested for poliovirus in WHO accredited laboratories. In addition, sewage samples are collected from over 30
sites spread across the country for poliovirus detection at
regular intervals.
According to Ministry of Health and Family Welfare,
Between Jan 2015 and May 2016, a total of 14 sewage sam-

ples collected from different parts of the country tested

positive for VDPVs. All of these have been responded to urgently and appropriately with polio vaccination campaigns.
None of these VDPVs detected in the sewage infected any
children, so far.
The response by the health authorities to the VDPV in
Hyderabad is in accordance with World Health Organization protocols to mitigate any risk of spreading of the virus. WHO, UNICEF and Rotary are supporting Ministry of
Health and Family Welfare in rolling out the polio campaign.
Strong measures have been put in place in India to mitigate the risk of an importation and spread of poliovirus from
countries with continued circulation of poliovirus. Country
has done two nationwide polio campaigns this year. Polio
vaccination is being carried out at international borders and
is a must for people travelling to polio affected countries.
The polio eradication programme in India continues to
protect children from the crippling disease by conducting
two nationwide mass polio vaccination campaigns and two
to three sub-national campaigns each year. Intensive efforts
are also being undertaken in India to improve routine immunization coverage that involves administering polio vaccines, in addition to other vaccines, to infants under the
Universal Immunization Programme (UIP). n

Health Spectrum

In The News

Solar for Healthcare Initiative

he Indian Council of Medical Research (ICMR) has

signed an MoU with the Council on Energy, Environment and Water (CEEW), a policy research institution, to launch a new Initiative on Solar for Healthcare.
The collaboration will focus on providing effective health
care delivery at the last mile by reducing uncertainty in critical infrastructure, particularly electricity supply via cost effective solar-based solutions.
Dr. Soumya Swaminathan, Director General, ICMR said:
The collaboration with CEEW will bring together synergies
between the objective of time to care as mandated in the
National Health Mission (NHM) and clean energy as outlined under the National Solar Mission (NSM). Under this
collaboration, on a pilot basis, we will install solar systems
at select PHCs in partnership with three state governments
and evaluate its impact on healthcare delivery and health
outcomes. The aim of the collaboration is to create resilient
health systems in rural India, benefitting primarily women

Health Spectrum

and children.
As of 2015, nearly 35 million citizens in rural India rely
on un-electrified PHCs for primary health services. In the
absence of electricity, services catered by health institutions
such as institutional deliveries, paediatric emergencies, and
administering of vaccines get severely affected. Electricity access in health centres is also imperative as a means to
facilitate communication services, tele-health applications
and to retain skilled health workers. Dr. Arunabha Ghosh,
CEO, CEEW, said, The collaboration with ICMR supports
the systematic and productive advancement in national policies, regulations and actions to leverage solar energy for a
social purpose: enhancing the quality of healthcare delivery
at various levels of governance.
The synergy between health and energy are the two specific goals of this initiative, and the efforts within this collaboration advances on both fronts. n

August 2016 9

Discourse

Better Half of a Breast Cancer Patient

w
Dr. Rohan Khandelwal
Consultant - Onco-plastic
Breast Surgeon

W-Hospital (Gurgaon)

Head - Medical Affairs at

Curofy (Doctors Networking
App)
Email : rohankhandelwal@
gmail.com

10 August 2016

estern statistics reveal that nearly

seven out of ten marriages touched
by breast cancer do not survive
and ultimately lead to divorce. With the
incidence of breast cancer increasing in
young Indian women, this problem will
soon be evident here as well. In fact, during my tenure in Bangalore, I did come
across a few patients who were deserted by
their families after their diagnosis of Breast
Cancer.
Although there is no magic formula
for a couple to weather this difficult period, but some of these points can help
husbands support their wives during their
Breast Cancer treatment.
Stand by her during the treatment &
tell her that you love her
In a marriage or any intimate relationship, silence is not golden. The strong silent type need not apply for the position of
husband, lover, best friend, confidante and
supporter of a woman with breast cancer.
Your bride, your wife, needs and wants to
hear from you. Actions may speak louder
than words, and you may take all the right

actions, but speaking words brings comfort, reassurance and knowledge of your
inner feelings. She cannot read your mind.
Being there for her is more than physical
or economic security. Words have meaning. And the three most important words
in the English language at this time, at this
moment, when together you are facing her
mortality, are: I love you.
Involve her in the decision making
It is not easy for a lady to deal with the
diagnosis of breast cancer. Often it has
been seen in India that husbands and family members make clinical and personal
decisions on their behalf. Although these
ladies appreciate some of the decisions but
they would love to be part of others, which
involve their future.
A simple example is deciding between
a mastectomy & breast conservation surgery. Family members err towards the side
of mastectomy but in reality a lot of young
patients actually want breast conservation
surgery. It always helps to consult them in
private and then take a collective decision.
Go to Her Appointments
It is not what you do when you accompany her to treatment, but rather the act itself that speaks volumes to her. It also gives
you some sense of empowerment. You are
more than a helpless spectator cursing the
damned disease. You have to join the battle
and be her rock solid foundation.
Sometimes humor helps
Funny, it does. Theres even a study to
prove it, by psychologist Sharon Manne
of the Fox Chase Cancer Centre in Philadelphia. Couples who laughed at cancer
coped better with the stress of treatment.
We know that the act of laughing is itself
healing. It makes us feel better and helps
us get better.
Continue to enjoy as a couple she is
NOT invalid
Treatment can be grueling and tiring,
but you both need to live your life as fully
as possible. Continue to enjoy what you
enjoy individually and as a couple, particularly the latter. Dont let cancer put an
end to your personal and social life.
If you follow these simple steps, you
can also become a Proud Husband of a
Breast Cancer Survivor!!. n

Health Spectrum

Health Issue

India Needs organised

trauma systems

R
Dr. Harish Kapila

Senior Consultant
General and Laparoscopic Surgery

Max Smart Super Speciality

Hospital
Saket, New Delhi-110017
Email : dr.harisk@gmail.com

12 August 2016

oad accidents kill approximately 1, 50,000 people per

year in India out of a total of
500,000 accidents reported every year.
Every minute a life is lost in road accidents in our country. We have an accident rate of 140 per 10000 vehicles
compared to 2per 10000 in west.
Injuries rank fourth as a cause of
death for all age groups in this country. It is the leading cause of death
among children, adolescents and
young adults. Injuries account for
more premature deaths than cancer,
heart disease or HIV infection.
Recent studies suggest a bi modal
pattern of trauma deaths with a reduction in late deaths. The majority of all
deaths still occur within minutes of
the injury, either at the scene prior to

arrival of medical emergency services,

enrooted to the hospital, or in the first
hours of care. These immediate deaths
are typically the result of massive hemorrhage or severe neurological injury.
Deaths represent only small part of
injury disease burden. The amount of
economic and social burden it entails
is colossal. Injury accounts for 20% of
years of potential life lost (YPLL) before the age of 65. This is more than
any other disease like malignant neoplasm (15%) and heart disease (12%).
Definitive care for trauma patients
is offered by government hospitals,
corporate hospitals and a large number of clinics across the country. Facilities that offer treatment for trauma
patients, at different levels, report 1030% of their beds occupied by victims

Health Spectrum

Health Issue
of road accidents. Most government hospitals offer free care
but the quality of care differs from one centre to another.
Most university hospitals provide a reasonable level of care.
These hospitals are able to fulfill the role of tertiary care centres but critical care remains a weak link in such settings for
a variety of reasons. Private and corporate hospitals, located
mainly in big cities, are well equipped, offer good operating facilities and intensive care units. But, few run dedicated
trauma services. There are no norms to govern their standards of healthcare delivery.

Level II It works in collaboration with level I centre. It

provides 24hr availability of all essential specialties, personnel and equipment. It is not required to have a residency
programme.
Level III It does not have full availability of specialists.
It does have resources for emergency resuscitation, surgery
and Intensive care of most trauma patients. It has transfer
arrangements with other centres.

Problems due to lack of

organised trauma systems

l Pre hospital care in most cities is nonexistent. Even if

patients reach the hospital, the golden hour concept is
still a distant dream.
l Ambulances services are poorly organised and there
is no centralised agency to monitor the services. The
training of paramedics in the ambulances is an important concern.
l Concept of Triage is followed in less than 50% hospitals. Casualty medical officers are the only physicians to
provide resuscitation.
l There are no dedicated trauma surgeons in India. Clinical decisions are often delayed in the absence of clear
perceptions of responsibilities amongst different physicians.
l Rehabilitation is mainly restricted to physiotherapy.
Occupational rehabilitation is generally missing at
most centres.
l Finally, there is no central trauma registry in any institute.

What is the way out of this tragic situation?

The answer to above problems lie in having dedicated

trauma centres in various cities across the country. A trauma
system is an organised approach to acutely injured patients
in a defined geographical area that provides full and optimal
care and that is integrated with local medical emergency.
A trauma ce nter is a hospital equipped to perform as
a casualty receiving station for the emergency medical services by providing the best medical care for the trauma injuries, 24 hours. In order to qualify as a trauma centre, a
hospital must have a number of facilities including a high
quality intensive care ward and an operating theatre, well
equipped in terms personnel and equipment.

Classification of trauma centres

Trauma centres are classified on the basis of resources

available and the number of patients admitted regularly.
These are categories that define the national standards for
trauma care in hospitals.
Level I A level centre has full range of specialists and
equipment available round the clock and admits a minimum required annual volume of severely injured patients.
It has a programme of research and is a reference centre for
other centres.

Health Spectrum

Level IV A level IV center provides the stabilization and treatment of severely injured patients in remote
areas where no alternate care is available.

Importance of treatment at trauma centres

John Hopkins Bloomberg school of Public health and

University of Washington conducted a research survey to
study the effectiveness of treatment of a trauma victim at
a specialised trauma centre against the treatment at a non
trauma centre. The research provided convincing evidence
to suggest the treatment of a trauma victim at a trauma centre reduces the risk of deaths by 25% for the injured patients.
Review of multiple expert panel studies led to the conclusion that care delivered at trauma versus non trauma centre
may be associated with less inappropriate care, A significant reduction in preventable deaths in very severely injured
patients was also noticed. Based on currently available evidence, the conclusion can be made that the development of
trauma systems is important and must be supported.

Conclusion

Currently even the best emergency services and trauma systems are largely ineffective in preventing those
deaths that occur at the site of accident. Efforts at preventing the occurrence of injury events or reducing the
severity of injuries incurred will be the most effective
means of reducing the large number of immediate deaths.
Continued efforts at development of trauma systems that
foster rapid and efficient means of triage and transfer to
higher levels of care and research in the area of trauma,
hemorrhage, infection will eventually serve to decrease
the late and delayed deaths. n

August 2016 13

Health Article

Traumatic Brain Injury

raumatic Brain Injury (TBI) or

Head Injury is a major cause of
death and disability worldwide
especially in children and young adults.
It is seen that males suffer more frequently than females and the causes are
mostly vehicular accidents, falls, sports,
and violence. Preventive measures include use of helmets, seat belts, and
driving safely. The Brain is the CPU of
the body, so we always must protect it.
Head Injury results mostly from an
accident where the head suffers a hit
and the force of the hit could be violent
enough to cause permanent or temporary brain damage and could lead to disruption of brain and bodily functions.
Sometimes, even minor injuries
which are often overlooked, could lead
to serious after effects and must not be
ignored. These effects of injury which
could be cognitive (thinking, understanding, learning, reasoning and remembering), social, emotional and
behavioral. Depending on the type and
level of injury, and the time elapsed
from time of injury to time of reaching
hospital, the outcome could range from
complete recovery to permanent disability or even death.
According to the National Institute
of Health (US) and Mayo Clinic, there
are six main brain functions that may
get affected by an accident involving
the headand they all show some form of
symptoms.

Nerves

When an injury occurs to the Nerves in

and around the skull, the following may
be noticed:
(a) Facial muscle paralysis or loss of
sensation
(b) Double vision
(c) Loss of sense of smell
(d) Loss of vision
(e) Problems with swallowing

Intellect

Depending on the severity of Injury,

there could be changes in normal functioning abilities like:
(a) Memory

14 August 2016

(b) Learning and reasoning

(c) Judgment
(d) Attention or concentration span
(e) Problem solving and decision
making capability

Communication

TBI could cause disruption in communication skills and social problems like:
(a) Difficulty in understanding speech
or writing
(b) Disorganized thinking
(c) Confusion, awkwardness and slurring of speech.

Behavioral

Behavioral changes as follows may be

noticed after a head injury:

(a)
(b)
(c)
(d)

Lack of self control

Risky behavior
Verbal or physical outbursts
Loss of confidence

Emotions

Emotional changes may include:

(a) Depression and anxiety
(b) Mood swings and increase in irritability
(c) Changes in self esteem
(d) Insomnia and other sleep related
problems

Affects on Senses

(a) Ringing in the ears

(b) Hand eye coordination
(c) Tingling, pain or, itching of the skin

(d) Dizziness
(e) Difficulty in recognizing objects
(f) Abnormal posture
It is important for parents to know
that small children with moderate to
severe head injury may have some of
these symptoms, but may not be able to
communicate them. Children also show
other signs like persistent crying, refusal
to nurse or eat, and irritability. In adults,
TBI is mostly caused due to Road Accidents, but in small children, it is mostly
accident, falls and child abuse. If any of
the foregoing symptoms are noticed in
children or adults, have them examined
by a doctor immediately. As far as possible, a Head Injury victim must be seen
by a Doctor in the golden hour.
The incidence of TBI is increasing
globally and India is leading the pack.
The largest bracket is in the age group
of 15 to 25 and thereafter it is 26 to 45.
The age groups at most risk of mortality
are adults over 70 year age and children
between 5 to 9. In a country like India
where there are large tracts of poverty,
especially in the rural areas, there is a
tendency to ignore mild or moderate
cases of Head Injury as the people often do not understand the significance
of such injuries. It is important for the
Government, various informed groups
and NGOs to educate our masses
through all methods at our disposal
including the PanchayatSystem and
District Hospitals on how to recognize
irregular behavioral patterns in their
wards and in case of any doubt, have
them examined at a hospital. The earlier
the better. n
Ranbir Talwar
Commodore (Retd), VSM
Executive Director
Indian Head Injury Foundation (IHIF), New Delhi
Chitra Sony
Senior Executive
Indian Head Injury
Foundaion (IHIF)
New Delhi

Health Spectrum

Health Spectrum

August 2016 15

HEALTH Article

Spontaneous Brain Haemorrhage

Prevention and Cure

S
Dr. Rahul Gupta

Senior Neuro & Spine

surgeon

Fortis hospital

Noida
Email : rahulguptaneuro@
gmail.com

pontaneous brain hemorrhage accounts for about 10% of all strokes

and is fatal in about 50% of the cases.
Its incidence, in contrast to other types of
strokes, has not declined. According to
Dr. Rahul Gupta, Senior Neuro and Spine
surgeon at Fortis Hospital, Noida, Hypertension accounts for about half of these
hemorrhages; the rest are due to tumors,
aneurysms and vascular malformations,
inflammatory and degenerative vasculopathies and hematologic and iatrogenic
disorders of coagulation.

Brain haemorrhage

Brain haemorrhage is bleeding into the

brain tissue or its surface due to rupture of
blood vessel. It can be spontaneous or due
to head injury.

Symptoms of Brain haemorrhage

Most often presentation is sudden severe headache, vomiting and transient

16 August 2016

unconsciousness. Sometimes, headache

may be gradually progressive and associated with limb weakness or epileptic attack
(seizure).

Reasons for Spontaneous Brain

haemorrhage?

It is usually associated with high blood

pressure (BP). Different types of brain
haemorrhage may have different reasons.

Different types of brain haemorrhage?

Intracranial haematoma (ICH) is frequently seen in people with uncontrolled

high BP. Sometimes, it may be due to defect in vessel wall (like aneurysm, AVM).
Uncommonly, a brain tumour may also
develop an ICH. Another type of haemorrhage may be Subarachnoid haemorrhage
(SAH) which is due to aneurysm supture. Another type is subdural hematoma
(SDH) which is due to trauma or con-

Health Spectrum

HEALTH Article
sumption of blood thinners.

Diagnosis of Brain haemorrhage

CT scan is the investigation of choice. Angiography of

brain helps to identify cause of bleeding. Sometimes MRI is
required to look for bleeding inside tumour.

depends on delay in treatment given to the patient. In

SAH, if patient conscious before surgery then recovery is
very good. Chronic SDH patients do very well within a
week time.

Bleeding inside Tumours

A6. Small ICH can be managed with medicines. Surgery

is required if the ICH is large, causing pressure effect on
brain and if the patient is unconscious.

Some brain tumours may present with bleeding inside

them. MRI helps in diagnosis. Removal of tumour along
with blood is the treatment. Without any delay, patient
should be taken to a hospital equipped with facilities of CT
scan, MRI and Angiography.

Treatment of SAH

Tips for prevention

Treatment of ICH

In 90% cases, SAH is due to aneurysm supture. Angiography is mandatory to identify aneurysm. There are 3 types
of angiography. Digital Subtraction Angiography (DSA)
done in Neurocathlab is the best method. Others are CT or
MRI based angiographies. After diagnosis, aneurysm needs
to be secured by clipping or coiling to prevent re-rupture.
Vasospasm (shrinkage of blood vessels) is a dreaded complication of SAH, which may lead to
neurological deficits. It is managed
with medicines.

Most important is frequent monitoring and control

of blood pressure with medication and lifestyle modification. Brain haemorrhages are more frequent in early morning especially in winters. Drinking lot of water and timely
consumption of medicines is essential. Minor headaches
should not be neglected and a Neurosurgeon/Neurologist
should be consulted.

Coiling or Clipping of
Aneurysm

These are methods to prevent

re-rupture of an aneurysm. Coiling is done in Neurocathlab, where
without opening the skull, the aneurysm is packed with coils. It is a
relatively new method with excellent results. In clipping, the skull is
opened, aneurysm is exposed and a
clip is placed across its neck. This is
a time tested method and provides
permanent cure.

Trreatment of SDH

SDH is usually seen after trauma.

Chronic (late) SDH may present
with subtle symptoms, many weeks
often minor trauma and is common in elderly. It may occur in patients consuming blood thinners like
Ecosprin. Reversal of blood thinning
effect is essential before surgery.
Chronic SDH needs two holes in
skull and drainage under local anaesthesia.

Prognosis of brain
haemorrhage

In small ICH, patient recovers well in 3-6 months with minor

deficits. In large ICH, patient needs
prolonged hospitalisation and rehabilitation and chances of recovery

Health Spectrum

Brain haemorrhage is
bleeding into the brain
tissue or its surface due
to rupture of blood vessel.
It can be spontaneous or
due to head injury.

Burden of Brain haemorrhage on the population

Spontaneous brain haemorrhage is very common and almost

50% patients expire before they can
be shifted to a tertiary care hospital. Patients who are unconscious
before surgical treatment take
months to recover. Unfortunately,
there are few centres for rehabilitation in India and patient has to be
shifted home after definitive treatment. Hence, role of prevention
and timely intervention cannot be
overemphasised. n
Dr. Rahul Gupta is the man behind the department of Brain and
spine surgeon at Fortis Hospital,
Noida. He was trained at Nagoya
Japan, which has made him an
expert in Endovascular procedures.
He worked in many government hospitals including PGIMS,
Rohtak, PGIMER Chandigarh &
Govind Ballabh Pant institute of
Postgraduate Medical Education &
Research, New Delhi.
Dr. Rahul Gupta has performed
surgeries on hundreds of patients
with head and spine injury. He has
treated numerous complex spine
ailments like metastatic tumors, osteoporotic fractures (vertebroplasty),
degenerative diseases and listhesis.

August 2016 17

Cover Story

Risks of
Saving Lives

- Vinod Kumar

octors in our country

are at rising risk in the
workplaces due to the
angst of distressed relatives. Many reports concern medical professionals being roughed up,
even killed, by patients' disgruntled
relatives. There are a numerous
cases of violence against healthcare professionals leading to death
of some doctors as well as nurses
by patients relatives. This situation
seems to be similar in most of the

18 August 2016

countries in this region including

China, Bangladesh and Pakistan.
According to a recent study by
the Indian Medical Association
(IMA), over 75 percent of doctors
in India have faced some form of
violence at work. An another study
published in medical journal The
Lancet said that delay in attending
to a patient, request of advance payments, or withholding a deceased
body until settlement of final billing
are a few of the reasons why angry

DOCS AT RISK
Nearly 50% of violence

reported form ICUs

or after a patient has
undergone surgery, says
ongoing IMA study
Kin & attendants of
patients behind 68 % of
such cases
Visiting and peak hours
most prone to violence,
besides the tense moments during transfer
of critical patients to hospital
Experts say figures would
be higher as most doctors dont report such
incidents

Health Spectrum

Cover Story
relatives tend to lose their temper and
attack doctors.
In view of growing violence many
doctors feel that medicine has become
a 'dangerous' profession, and they
should be provided 'security'. A report
suggests that almost 70% of doctors
wont want their own children to go
into the medical profession.
Increasing commercialization and
corruption coupled with unethical
practices by some medical professionals, lack of communication between
doctor and the patient, poor image
of medical profession, lack of faith
in judicial system and the police and
insufficient security for doctors have
lead to increased violence against the
healthcare professionals which has
highlighted the importance of patients
satisfaction and patient safety.
A number of news reports also
throw light on the fact that violence in
healthcare sector has been increasing at
an alarming level throughout the country. Doctors become an easy target for
the blame game by sensational media
reports. Since a wide gap exists between
the patients expectations and the reality, patients who feel they have not been
looked after properly then take the matters in their own hands. These incidents
have certainly decreased the self esteem
of the doctors. Health Spectrum has
speaked to many doctors and health
activists. According to them, it is high
time that authorities in our country
should wake up and initiate some effective measures. Some of these could be
as under:
1. Strict accreditation of medical and dental schools ordering
closure of all those institutions
with poor quality and standards.
Those institutions which fail to
get accreditation should be given
some time to improve and make
up the deficiencies failing which
they should be closed down.
2. The number of enrollments in
each medical and dental school
should be based on the number,
quality of teachers and other
teaching facilities.
3. Doctors should never assure
100% cure and avoid negligence.
4. Each patient should be adequate-

Health Spectrum

Violent society is detrimental to the

practice of humane medicine
It May Be Asking Too Much Of Doctors To Be So Active, Given The
Present State Of Affairs. We Can Begin Small, By Promoting Ethical And
Honest Voices From Our Profession. We Can Also Increase Our Credibility
By Condemning Colleagues Who Collude With Criminal Politicians.
A violent society is detrimental to the practice of humane medicine; it
negates all the 'achievements' of modern medicine. The medical profession
must do more than just condemn such violence; it must reflect on the ethics of its own practice. For doctors, this means not perpetrating violence
through their practice, through the medical system or through collusion
with the perpetrators of violence. It also means practising an active social
ethics, being at the forefront of preventing violence and caring for all victims of violence, irrespective of their crimes and ideological affiliations.
-Dr. (Prof.) RAJU VAISHYA
President, Arthritis Care Foundation &
Sr Consultant Orthopaedic & Joint Replacement Surgeon
Indraprastha Apollo Hospitals, New Delhi

Periodic updating of
the condition of the
patient to the attendants is necessary.
Healthcare professionals in general
and junior doctors
in particular must
develop proper communication skills and
empathy.
ly examined, investigated and
treated.
5. Negligence should not be accepted under any circumstances.
6. Over confidence and too much
cautiousness in patient care
should also be avoided.
7. A realistic appraisal of the prevailing situation and commu-

nication to the patient and their

attendants, relatives should be
ensured.
8. Patients should be involved in
decision making regarding their
treatment giving them adequate
information about the possible
complications.
9. Periodic updating of the condition of the patient to the attendants is necessary. Healthcare professionals in general and junior
doctors in particular must develop proper communication skills
and empathy.
10. Every healthcare facility must
have a liaison office to deal with
the media and respond to their
queries. No media personnel
the electronic media in particular should be allowed to enter
the healthcare facilities without
permission and they should be
briefed by the liaison officer or
the hospital spokesman. Media
in particular has to show responsibility while reporting health
issues and those covering health
must have some core knowledge
of health issues.
11. All healthcare facilities must have

August 2016 19

Cover Story

Nearly 75% of doctors fear for their lives

I solemnly pledge myself to consecrate my life to
service of Humanity. This is the first declaration that we
make as a doctor. The day we get our degrees and start
practicing, a new life begins for us, a life that was pledged
for humanity.
Doctors are considered as ambassadors of wellness
and health, whom the society can look up to. Its no wonder that more than 50% of our population wants their kids
to grow up and become a physician. Yet, doctors are the
most misunderstood underrepresented and overworked
community in India.
A resident is supposed to work for 36 hours continuously, without making any error. Today, under every circumstance a doctor is expected to be efficient, congenial
and ever smiling. Any break in this perfect behaviour is
dealt with extreme backlash, usually in the form of violence.
Violence amongst doctors is not something new, its
something that we read every now n then in the newspaper, condemn on social platform and then forget till the
time another doctor gets beaten up.
Many blame this on the commercialisation of healthcare, which has led to a trust deficit between doctors and
patient. But many of the incidents have happened even
before the treatment was started. A resident ophthalmologist was beaten up in Jaipur till his hand was broken, all
because he asked a patient to get in line for OPD. A dentist
was beaten up in Pune because he wanted to step out for
lunch after spending hours treating patients, and the patients waiting outside thought it was too much to ask for.
India as a country has grown largely intolerant towards doctors. Medicine is a noble profession, so how did
we come to this point where violence against doctors has
become an everyday occurrence?

ing and its no wonder human that a few mistakes occur.

If you overload an individual with work beyond human
capacity, mistakes are bound to occur.
2)
Deplorable condition of government run hospitals - Thousands of doctors graduate every year in India, out of these only 10% get to do a post graduation.
What about the 90% who didnt? They either try to find
jobs or set up their own private practice. In a country that
has a skewed patient: doctor ratio, its an irony that there is
a dearth of jobs for healthcare professionals. But unfortunately, government does not want to increase the number
of vacancies in government hospital, and a few hospitals
that do have vacancies are in deplorable conditions.
Patients who get treated in such institutions are obviously dissatisfied; they cant express their anger on the
government so they blame it on the person nearest to
them, the doctors.
3)
Commercialisation of healthcare ecosystemIts no secret that private hospitals have led to unethical
medical practices. They exist to make profit and make no
qualms about it. They justify their pricing by providing
world class amenities to patients, but in the process a profession that was considered noble by everyone became a
service to be provided. A doctor is still a healthcare professional who saves life, but a patient becomes a consumer
who wants a perfect service. In such a scenario, if the doctor falters in anyway he/she has to face the wrath of the
patients.
Nearly 75% of doctors feel that they are unsafe in this
country and fear for their lives. As a healthcare professional, they should be able to invest their energy into saving lives of people, not their own.

1) Skewed patient: doctor ratio - According to a

report there are only 0.7 doctors per 1000 people in India.
This means that every doctor is overloaded with work,
sometimes beyond human capacity. The sheer volume of
patients that a single doctor has to treat is overwhelma proper boundary wall with adequate security system in place
with monitored entry of public.
Security guards should be posted
inside the hospital particular in
most sensitive areas like Emergency, Intensive Care Units, and
Operation Theaters.
12. There is a need to improve the
Doctor-Patient relationship. Under no circumstances the previous hospital or the referring doc-

20 August 2016

tor should be criticized.

13. Avoid using words like you have
come late.
14. In desperate situations, the patient must be given the choice of
calling another doctor for second
opinion if they so desire.
15. Professional specialty organizations should play their role and
come up with a mechanism of self
monitoring of their members to
ensure ethical medical practice.

- Dr Prerna Motwani
Writer with Curofy

16. Relationship between the Physicians and the Pharmaceutical

Trade and Industry needs to be
looked into and Guidelines prepared by the National Bioethics
Committee on the subject should
be implemented which will go a
long way in eliminating unethical
practices.
In short there is an urgent need
to make the healthcare facilities a
safe environment for the healthcare

Health Spectrum

Cover Story

Hospitals should have

better communication
with the patients
There is no doubt that violence against
doctor is increasing but cannot initially put the
blame on the violator. Empathy is one thing
that is missing now a day in medical profession
because of lack of trained medical professionals and increasing work load leading to less
time left for communication between doctors
and patient that is the root cause of these violent episodes.
As a doctor, I myself have been a patient
in one of the busiest hospital of Delhi, where
I could not get to see the doctor who operated on me, before or after the surgery, being a
surgeon myself I could understand there busy
schedules and did not react as most of the majority who react to it, Probably as a doctor, I
know everything is going to be fine, but non
medicos get anxious very fast, when their close
one has a medical aliment which they have no
clue about, and the cold attitude from the hospital and staff make them go angry and leading
to taking out there frustration on the doctor.
Its neither their fault nor the doctors. Its failure of communication and the warmth touch
and assurance they need from medical side,
which lots of hospitals fail to delivery. Hospitals should have special "patient _medical
staff " purely dedicated to communicate with
the patients and their attendant and apprise
them of condition of the patient.
Dr. Monisha Kapoor.
J-18, Near SBI Bank, Saket
Mehrauli-Badarpur Road
New Delhi-110017
Phone: +91 11 40666307/08
Mobile: +91 9811439395
professionals to work only then they can be expected to work with devotion and dedication.
Breaking News on the Television Channels regarding death of patients due to doctors negligence
has only served to work against the patients own
interest as now the healthcare professionals are
very reluctant to handle serious cases, hence many
precious lives which could have been saved are
being lost. n

Health Spectrum

Over 75% of doctors have faced

violence at work, study finds
Violence against doctors varies from physical assault to threatening behaviour to mere verbal abuse.
NEW DELHI: Those who save lives are themselves at risk. More
than 75% of doctors across the country have faced at least some
form of violence, initial findings of an ongoing study by the Indian
Medical Association (IMA) have revealed.
Doctors faced maximum violence when providing emergency
services, with as many as 48.8% of such incidents reported from
intensive care units (ICUs) or after a patient had undergone surgery,
the study said. Relatives and attendants of patients were often found
guilty of such actions. According to the findings, data of the past
five years showed that escorts of patients committed 68.33% of the
violence.
However, experts said the findings did not reflect the actual
situation as not all cases were reported. The gravity of the problem
is much more. "All cases of violence are not reported. Doctors often
understand the situation of relatives who are in distress and do not
report such cases. Mostly, those cases are reported where the doctor
feels serious threat of life or has already faced so," IMA secretary
general Dr KK Aggarwal said.
Violence against doctors varies from physical assault to threatening behaviour to mere verbal abuse. While most incidents of violence were found to have occurred during visiting hours and peak
hours, when doctors are busy and visitors are around, the study
found that doctors and paramedical staff also had to face rage while
transporting serious patients to hospital.
"The transport time is very crucial. This is also a kind of emergency service and relatives of patients are nervous and under stress.
Any delay or even an unintended negligence results in huge rage
and anger among the patient's escorts," the head of emergency services in a leading private hospital said.
While IMA is advocating a stringent law at the Centre to address the situation, doctors and healthcare experts say there is a
strong need for counselling of relatives and escorts of patients.
Doctors need to keep patients and their relatives in the loop
from the very beginning. "Patients should be told the truth, about
the adverse effects and also given the choice of alternative treatment," Dr Talat Halim, director, trauma and emergency at Fortis
Hospital, said. He added that medical practitioners needed to show
empathy with patients as well as their escorts, who are often in distress when in hospital.
Experts also pointed out the need to streamline processes in
hospitals and at other healthcare delivery centres. For instance, a
lot of violence-related cases happen when the patient passes away.
While hospitals insist on clearing payments before handing over
the body, distressed escorts often get into fights in such situations.
Experts said such processes needed to be streamlined and handled
by non-medical people.
The trend of violence against doctors is also on the rise in China. In 2006, around 5,500 medical workers were injured by patients
or their relatives. However, in 2010, such cases increased to 17,000.
Source : Times of India, May 4, 2015

August 2016 21

Case Report

Ballistic trauma

Retrieval of bullet from knee by Arthroscopy

Chief Surgeon : Dr. (Prof) RAJU
VAISHYA
President, Arthritis Care Foundation &
Sr Consultant Orthopaedic & Joint
Replacement Surgeon

Indraprastha Apollo Hospitals, New

Delhi
Team Members : Dr. Vipul Vijay, Dr. Harsh
Singh & Dr. Amit Kumar Agarwal

Case presentation
A 45-year-old policeman who allegedly misfired a 0.38
caliber bullet from his service revolver, presented to our
emergency 12 h after sustaining the injury to his left knee.
The knee was in a flexed position while disembarking from
the van and came in the way of the bullet with the entry
wound located just inferior-medial to the knee joint. The
bullet traveled three centimeters in the proximal tibia (The
proximal tibia is the upper portion of the bone where it widens to help form the knee joint)., over
the inferior-medial aspect of left knee,
joint before lodging in the inter-condylar notch of the knee joint. Initial wound
dressing was done at a local center, following which patient presented to our
emergency with a locked knee.
Investigations
The position of the bullet was confirmed on plain antero-posterior and
lateral radiographs. Since the retrieval of
the intra-articular bullet was considered
an emergent procedure, no other radiologic investigation was done. All other
routine blood parameters were within
normal limits.
Treatment
The patient underwent arthroscopy-assisted bullet retrieval from the knee joint, under general anesthesia and
tourniquet control. Through the antero-lateral-inferior portal, a large hematoma was washed out, and a thorough diagnostic knee examination performed. There was a partial tear
of the anterior cruciate ligament, and the bullet was found
displaced in the lateral gutter, due to the fluid distention.
The lateral femoral condyle cartilage showed focal damage
and both menisci were found to be intact. The exact location and ideal direction of the portal on the lateral aspect
of the knee was confirmed using a spinal needle. The third
portal was created directly over the spinal needle with an
11 number surgical blade. A fine-toothed artery forceps was
introduced into the joint from the third portal to hold the

22 August 2016

bullet. The skin incision was extended

when the bullet was subcutaneous, and
the bullet was extracted under arthroscopic guidance. The redundant soft
tissue and the frayed articular cartilage
were debrided to achieve balanced margins. All the six compartments (medial and lateral compartment, supracondylar
space and inter-condylar notch, medial and lateral gutters)
were reinspected for any remaining foreign particles and
charred tissue. Adequate joint debridement and lavage was
done, with an additional extrarticular debridement of the
entry wound, before closure and an ankle free static knee
immobilizer was applied. The patient was started on third
generation cephalosporin and aminoglycoside postoperatively iv for 3 days and oral for 3 weeks.
Outcome and follow-up
The postoperative radiograph revealed a hairline fracture
of the tibial condyle that was obscured in the initial radiographs behind the bullet and was decided to be treated
conservatively. The knee immobilization was continued for
another 3 weeks given the undisplaced fracture. The patient

Health Spectrum

Case Report
then underwent a magnetic resonance imaging (MRI) of the
knee to delineate better the injury pattern to the soft tissues.
The MRI revealed marrow edema in the lateral femoral condyle and the proximal tibia around the tibial eminence (Fig.
7). It also corroborated the intra-operative findings of articular cartilage injury to the lateral femoral condyle. On the
basis of the MRI findings, the patient was advised to continue knee immobilization for another 2 weeks, and gradual
physiotherapy and range of motion exercises were started.
There was no evidence of any infection or significant history
of catching in the knee. This case was managed conservatively, and he regained complete range of motion from 08
to 1308 at the end of 3 months. The patient has remained
asymptomatic with no effusion or synovitis in the knee till
the last follow-up of 2 years.
Discussion
Intra-articular bullet as a foreign
body has been sparingly reported in
the literature. Bullet injuries around
the knee are usually caused by intention or as part of criminal punishment. Rarely, this may be caused by
accidental injury. The mechanism of
injury in this case report is unique as
it was caused due to accidental firing
of the bullet from an unlocked gun,
which accidentally fell from its holster. Also, although late migration of
bullets from thigh has been reported,
early arthroscopic retrieval of a bullet from the knee has been rarely
reported in literature. The common
foreign bodies in the knee that have
been described are pencil lead, plastic bottle caps, glass and metallic
debris, etc.1 The main problem with
any intra-articular foreign body is
the risk of bacterial contamination
that may lead to late onset infective
arthritis. A retained bullet can further compound the problem due to the possibility of lead
induced arthritis. According to Hurst, there are four main
criteria for achieving ideal results with the removal of foreign bodies. These are early diagnosis, adequate debridement and lavage, immobilization as deemed necessary and
restoration of function.8 Eliciting proper history and trying
to understand the mechanism of injury is of prime importance. Keeping a high index of suspicion for the possibility
of intra-articular migration of a foreign body may help in
early start of management. The presence of an entry wound
should always force the examiner to look for the location of
the foreign body. The presence of the foreign body in the
peri-articular region must prompt a regular follow-up as delayed migration of the bullets has been reported.
The key to prevention of the sub-acute or late septic arthritis
is adequate debridement and thorough lavage of the joint
and it can be achieved satisfactorily through arthroscopicassisted technique. The most common causative organisms

Health Spectrum

in military ballistic injuries are Clostridia and beta-hemolytic streptococci. The most effective antibiotic for these
organisms has been penicillin but given the possibility of
penicillin resistance, cephalosporin or erythromycin may
be added.
In view of risk of lead induced arthropathy and the bullet
serving as a nidus for infection, retrieval of bullet should
be executed, sooner than later. It is known that a metal object freely floating or lodged in the intra-articular space can
cause late erosion of the vital structures inside the knee and
may even lead to delayed arthritis of the knee. There is an
even higher chance of an early lead toxicity induced by the
bullet and disseminated in the systemic circulation by the
free synovial fluid.
The main advantages of an arthroscopic-assisted removal
of the shell is the minimal operative trauma to the joint,
small skin incision, preservation of
the blood supply to the joint and
the overlying soft tissue envelope,
the possibility of examination of the
joint in detail, and shortened recovery and rehabilitation time. In the
present case, the knee immobilization was, however, continued for a
longer period because of the associated fracture of the tibial eminence.
The patient was still able to achieve
full painless range of motion at the
end of 3 months.
The ideal placement of the portal for
extraction of the foreign body is of
paramount importance and should
be dictated by its location. Care
should be taken in avoiding a far lateral portal to decrease the chances
of encountering inferiorlateral-ascending geniculate vessels, leading
to excessive amount of bleeding. A
precise knowledge of anatomy and a
thorough experience in carrying out
arthroscopic procedures around the knee is mandatory before undertaking this procedure.
In the present case, an undisplaced fracture would have
been picked up accurately if a computerized tomography
scan had been undertaken before the procedure. The bullet, in the preoperative plain radiographs came in way of
the fracture and obscured delineation of the fracture line.
An MRI of the knee was performed in the postoperative
follow-up for delineation of the fracture and to assess any
more associated intra-articular injuries. Since the fracture
was undisplaced and did not carry any significant risk for
displacement or an intraarticular step-off, it was decided to
treat it conservatively with immobilization in a knee brace.
This present case report suggests that an early arthroscopic removal of bullet along with antibiotic cover can help
achieve a satisfactory result with minimal long-term morbidity. n

August 2016 23

Health Article

MIGRAINE

HEADACHES
M
Dr. Sonia Lal Gupta
Consultant Neurologist (Headache & Stroke
Specialist)

Metro Centre for

Neurosciences,
Noida
Email : drsonialal@
gmail.com

24 August 2016

igraine headaches are one of the most

common conditions which can affect
us. It is more common in women
than men. Having a family history of migraines
increases the chances of having them too.
Migraine headache is a unilateral or bilateral headache which is typically pulsating and
throbbing in nature accompanied by nausea/
vomiting, light and noise sensitivity. These
headaches can last for 4 hours upto 72 hours.
Typically, patients with migraines like to stay in
a dark room and try to sleep, hoping for some
relief.
Migraines can be of 2 types:
1. Migraines with aura
2. Migraines without aura
Auras are neurological symptoms that appear before the headache pain and occur in
mostly about 40% of the patients. Most common aura`s are visual changes (seeing colored
lights or rainbow colors) but may also include
speech disturbances or numbness in the arm
lasting for 5- 60 minutes. These auras are followed by headache which can last upto 72 hours.
Even after the pain is gone, a lot of patients complain of fatigue which can last upto 24 hours.
If migraine headaches occur for more than
15 days a month- they are known as chronic
migraines. Chronic migraines can be debilitat-

ing for the patient as they affect the day to day

life, both personal and professional. Hence it is
very important to treat migraines before they
become chronic and debilitating.
Migraine headaches can be caused by various triggers which include food triggers like
red wine, chocolate, Monosodium glutamate
(MSG). Other triggers can be lack of sleep,
stress, weather changes, hot weather, bright
lights and dehydration. Some women, have migraines around their periods as well.
It is very important to recognize these triggers. Once the triggers are known, the treatment
can vary and also preventing these triggers can
avoid migraine attack.
Migraine diaries can be very useful in documenting these triggers and migraine attacks
when patients seek medical help.
Prior to meeting the doctor, it is very helpful for
patients to note the following in their migraine
diaries:
v Symptoms : Write their migraine symptoms
and be prepared to provide information about
the pain location, character, and associated
symptoms (e.g., nausea, vomiting, light sensitivity)
v Patterns and characteristics: Follow the
onset and history of their headache symptoms
over time. This will help determine any patterns

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Health Article
or triggers, such as menstruation, travel, allergies or stress.
v Medications: Record all medications (both prescription
and over-the-counter) that they are taking and recall past
treatments and their outcome that they take or have taken for
headache. Also record other possible triggers that may impact
headache such as caffeine, vitamins, or dietary supplements.
v History: Learn about any possible family history of headache. Migraine often runs in families and this will help confirm a diagnosis.
v Illnesses: Provide the necessary information about other
medical conditions that may influence their headachessuch
as depression, sleep irregularities or eating disorders.
By giving all the above information to the doctor, it can
effectively help diagnose the type of headache the patient has
and hence effectively treat the headache.
Migraines occur due to the release of neuro-chemicals in
the brain which causes over-activity or excitation of the brain.
This over-activity causes the migraine attacks. Hence it is important to treat these headaches with the right medications,
which can help lower the activity and chemicals and hence decrease the headache.
There are 2 types of treatments which have to be given for
migraine control.
v Acute treatment of migraine: This means to effectively
treat the pain and other symptoms of the migraine when they
occur. There are multiple medications like paracetamol or
ibuprofen which are available over-the-counter which can be
used for treating the pain. The most important feature to treat
the migraine attack is to treat it early. The longer you take for
treating the headache, the more difficult it is to get the pain
under control.
There are migraine-specific medications called triptans
which the doctor can prescribe for treating the pain. Triptans
specifically work on the chemicals relea sed during an attack
and is very effective in getting the symptoms under control is
taken in time. They are not recommended to patients with a
history of heart disease or stroke.
Medications for nausea and vomiting can also be used
along with the other acute medications to effectively control
the symptoms.
v Migraine prevention :
Migraine patients do not want to suffer from an attack, so
prevention is important, even if they suffer from only one attack a year. Those who suffer from frequent attacks will need
more aggressive prevention strategies that sometimes include
medication. This decision is made by discussing treatment and
management options with the doctor.
Migraine prevention is indicated if the patient has
v Disabling attacks despite appropriate acute treatment
v Frequent attacks (>1 per week)
v Insufficient or no response to acute drug treatment
v Poor tolerance or contraindications for specific
acute pharmacological treatments
v History of long-term, frequent, or excessive use of
pain medications (analgesics) or acute medications that make
headaches worse (or lead to decreased responsiveness to other
drug therapies)

Health Spectrum

The goal of the migraine preventive therapy is to:

v Reduce frequency, severity, and duration of attacks
v Improve responsiveness to treatment of acute attacks
v Reduce level of disability
v Maintain cost of care for migraine treatments
v Reduce excessive or overuse of acute medications
When migraine preventive therapy is started, it may take
2-3 months before the patient may notice the decrease in frequency of headaches. Hence, it is important to be diligent in
taking the medications as prescribed by the doctor. If there
are any side effects, the doctor should be told right away, so an
alternative can be used.
Treatment with Botulinum toxin injections is of the only
approved treatment for chronic migraines. In these, we inject
the Botox medication in various muscles along the forehead,
head and neck muscles, which are frequently involved in the
migraine attack. The treatment is given every 3 months and

at-least 3 treatments are recommended to see the gradual lowering in the frequency and intensity of the headaches. This is
a good option for patients who have daily headaches and who
have side effects from other preventive therapy as these injections are localized and hence have very few side effects.
Nonpharmacological treatments like meditation, Biofeedback and physical therapy are also effective for decreasing the migraine frequency and should be done along with the
above treatments.
Migraine headaches can be treated effectively and it is
important for patients to go to their physician and let them
know about your headaches. Proper management and treat
ment of these headaches can help improve the quality of life
effectively. n
Dr. Sonia Lal is one of the world`s youngest and most qualified
neurologists. She was formerly Asst. Professor of Neurology at Loyola
University, Chicago. She is a Diplomate from American Board of
Neurology, American Board of Vascular Neurology, United Council
of Neurological Subspecialities - Headache Medicine and American
Society of Neuro Imaging - Transcranial Doppler. Special Interest in
Botox Injection for Migraine.

August 2016 25

Face to Face

Meet Dr Bindeshwar
Pathak, Sanitation
Man of India

India Needs
A Culture Of
Sanitation

- Vinod Kumar

r. Bindeshwar Pathak is a great humanist, social reformer and icon of sanitation

movement in contemporary India whose pioneering initiatives have made an impactful change in the lives of millions of people. In particular, his innovative ideas
in the field of sanitation and his crusade against manual scavenging have positioned him as a front-ranking social reformer. Because of his efforts, the erstwhile manual
scavengers, who were hated and ostracized, are now being increasingly integrated into the
mainstream society; they can now dine with their fellow human beings irrespective of their
castes and offer prayers in temples. He has played a significant role in creating a new paradigm of equity and equality and building a new culture which embraces the poor and extols
the dignity of labour.
Inspired by the ideals of Mahatma Gandhi to abolish manual scavenging and leveraging
new age technology, Dr. Pathak founded Sulabh International Social Service Organisation
in 1970 and launched a social reform-cum-environmental upgradation movement. His objective was to address the problem of environmental degradation and health hazards caused
by the practice of defecation in the open and use of bucket toilets.
In search of a solution, Dr. Pathak developed an eco-friendly twin-pit compost pour-flush
toilet technology for the individual households as an alternative to the cost-prohibitive sewerage or septic tank-based system of excreta disposal. The technology he developed continues to
be relevant in India where over 130 million people are without access to a toilet.
Heres an extract from an interview with Dr. Bindeshwar Pathak, the man behind one of
the most amazing success stories of social entrepreneurship in India: www.sulabhinternational.org. Thanks to Sulabh sanitation, more than one million people have been able to banish
the odious tag of being manual scavengers.

26 August 2016

Health Spectrum

Face to Face
Q. Sanitation and clean toilets are
essential for public health. How?
Ans. Sanitation significantly impacts not only our health, but also
our social and economic development. About 50 diseases, including
diarrhoea, cholera, typhoid, infectious
hepatitis, polio and cryptosporidiosis
are caused due to lack of sanitation
and clean toilets. My own sisters son
died due to diarrhoea at the age of 6 or
7. Poliomyelitis is one of the most dangerous diseases caused by lack of sanitation. This disease may cause muscular weakness resulting in inability to
move. This can occur over a few hours
to a few days. It is called "Lakwa" in
the common parlance. It is a proven
fact that lack of sanitation triggers a
lot of diseases.
It is quite distressing to note that
till recent times in Indias urban areas, more than 85 per cent houses had
bucket toilets, which were cleaned by
untouchables of the society. Even
now, public toilets in several areas of
the country are hardly used as they
are dirty and unhygienic. It has a very
negative effect on our health.
Q. Has Sulabh done any study to
establish how sanitation and health
are co-related?
Ans. We have not conducted any

such study, but All India Institute of

Hygiene & Public Health (AIIHPH)
has done a study to establish the fact
that sanitation is closely interlinked
with health.
Q. Even today people are not aware
of the importance of sanitation and
Cleanliness. We can see garbage everywhere but people do not bother to clean
their surroundings. How can people be
made aware of sanitation as a vital
fact of their lives?
Ans. During the Mohenjo-daro
and Harappa period, India had a welldeveloped sanitation system. When the
Aryans came, they divided the society
into four varnas - Brahman, Kshatriya, Vaishya and Shudra. Sanitation
work was assigned to the Shudras,
who were later came to be known as
untouchables. So only one section
of the society did the work of cleanliness. The three other segments in the
Varna system Brahman, Kshatriya
and Vaishya treated cleaning their
house and toilet as below their dignity.
Thus, the culture of sanitation failed

to strike roots in our country. After

Mohenjo-daro and the Harappan civilisation, India developed a notorious
image of being a country with poor
habits of sanitation.
In India, there is a predominant
notion that a particular section of the
society will clean toilets and sweep the
roads. We have to change this culture.
In fact, cleanliness is related to culture;
there is an imperative need for developing a robust culture of sanitation.
During the Konark period, there was
a practice that no one would defecate
near human habitations. They had to
go to a distance and they also covered
waste material with grass and soil. So
the living environment was very hygienic. But times have changed now.
People do go to toilets in their home but
they do not want to clean their toilets
or homes by themselves. They depend
on others. This is our main problem.
Q. Do you think Clean India mission of Prime Minister Narendra Modi
will have the desired im-

tion of the
c
e
s
e
n
o
ly
n
o
re is that,
n
In India, cultu
oads, and clea
r
n
a
le
c
,
ts
e
il
an to
society will cle
is related to
s
s
e
n
li
n
a
le
c
y
ctuall
is
other areas. A
culture. There
is
th
e
g
n
a
h
c
ve to
.
culture. We ha
e of sanitation
r
u
lt
u
c
f
o
d
e
e
an

pact? Will it be successful in

its mission?
Ans. Prime Minister Shri Narendra Modi has come out with an
idea that has made people realise that cleanliness is crucial and
pivotal for their well being. Now
everybody is talking about toilets,
cleanliness and sanitation. In my
school, teachers and students used
to clean toilets. No Prime Minister before Shri Modi had given so
much of importance to sanitation
and building toilets. His concept
and concern are the same as that
of Mahatma Gandhis. Gandhiji
had said, I want a clean India
first and independence later. The
vision and initiative of the Prime
Minister will become a reality
only when everybody starts clean-

Health Spectrum

August 2016 27

Face to Face
ing their toilets and maintaining hygiene in their households and offices.
Only then India will become a clean
country.
The Prime Ministers motive has
been a laudable one. Even while was in
the USA, he talked about the imperative need of having hygienic toilets.
His Swachh Bharat Abhiyan (Clean
India campaign) has created a huge
awareness about sanitation.
Q. The Modi Government has imposed a 0.5 % cess for Clean India
campaign. Do you justify this?
Ans. Your money is Governments
money. Cess is justified because the
government wants to implement new
ideas and it needs money for that. The
point is where from the money will
come? Who will give the money for
such a huge project?
Q. What are the future plans of Sulabh?
Ans. We are in full support of the
Prime Minister for his Clean India
movement. We have constructed 1.5
million household toilets and 8,500
public toilets which are being used
by 20 million people daily. We have
talked to government companies like
ONGC and SAIL and also corporates
like Mittal and Bharti. We have to synergise our efforts to provide toilets in
both rural and urban areas. We are determined to fulfill our Prime Ministers
dream of a clean India. Not only Su-

elp others.
h
to
le
b
a
s
u
e
God has mad
er world, a bettt
e
b
a
t
e
n
la
p
ke our
We should ma
ch together.
r
a
m
ld
u
o
sh
s
of u
l
ter society. All
ers, others wil
th
o
e
v
lo
u
o
y
y. If
Love ever ybod
also love you.

labh, even several other organisations

are joining this lofty mission.
Q. What Challenges and problems
you had to face?
Ans. I have faced many challenges
in my life social, economical and ecological. There was a time when I was

28 August 2016

opposed by my father,
brother and father-in-law. I had to
face lots of problems even during my
childhood. I had to sell land in my village and ornaments of my wife. I had to
sleep on railway platform. Once I even
thought of committing suicide. But I
am a man of determination; I have my
goals, missions, ambitions and commitment. I worked with honesty and
integrity. Gandhi Ji wanted one more

life to rescue the untouchables. Martin

Luther King Junior had said: I have
a dream to see that the sons of former
slaves and the sons of former slaveowners will be able to sit down together
at the table of brotherhood.
I am happy that in my life time I
have freed thousands of untouchables
from the shackles of untouchability
and brought them in the mainstream
of society.
Q.What is your message for the
people of India?
Ans. God has made us able to help
others. We should make our planet
a better world, a better society. All of
us should march together. Love everybody. If you love others, others will also
love you. n

Health Spectrum

HEALTH STUDY/RESEARCH

Health Spectrum

August 2016 29

Health Article

Hypertension
the hidden danger
Hypertension is a major contributor to avoidable death and disease in India, with an
increasing impact in the rural areas. Over 140 million people are believed to be suffering
from high blood pressure in the country and the number is expected to cross the 214
million mark in 2030. Hypertension is a major risk factor for cardio-vascular diseases
that killed 2.7 million people in 2004 and will result in the death of over 4 million
people by 2030.

ur body needs oxygen and other nutrients for proper functioning. This
is achieved through circulation of
blood. To achieve this purpose, our heart
pumps blood through blood vessels to each
and every cell of the body. Because of this
pumping activity, blood flows under some
pressure.
This is similar to the water supply of our
houses. Water flows because of pressure.
Normally the pressure should be just adequate to achieve flow to even distant taps
Dr. Jitendra Kumar
but at the same time it should not be that
Senior Nephrologist
high that pipe gets damaged or there is some
Director of Nephrology and
leakage. But some times the balance is disTransplant Medicine
turbed and blood pressure increases from
Asian Institute of
Medical Sciences (AIMS) a normal acceptable level, this condition is
known as hypertension.
Faridabad
During heart contraction (systole) presEmail : jitendranephro@
sure inside the blood vessel becomes maxigmail.com
mum. This pressure is known as systolic
pressure and is normally 120 mm of mer-

30 August 2016

cury. Whereas when heart relaxes (diastole)

pressure normally decreases to 80 mm of
mercury and is called diastolic pressure. So
a normal BP is expressed as 120/80 (Systolic
BP/Diastolic BP). Millimeter of mercury
(Hg) is a method to measure pressure. It
means that pressure of blood is enough to
lift a mercury column to the said height.

How to measure your blood

pressure?

If we put one tube inside the artery of

a patient, through a pressure-measuring
device, blood pressure can be directly estimated. This is the method applied in intensive care unit where exact measurement is
required in presence of various variables.
A balloon cuff (1) is wrapped around
arm. Then through a balloon pump (2)
the cuff is inflated to a pressure above the
blood pressure. When pressure in the cuff
becomes more than that of blood pressure,

Health Spectrum

Health Article
blood to forearm ceases to flow. Now
seeing the mercury column (3), cuff
is gradually deflated and blood flow
is listened through a stethoscope (4).
When pressure in (3) is similar to
systolic pressure, blood starts flowing
and a sound is heard at (4). After some
time sound disappears and this corresponds to the diastolic pressure.
Instead of mercury column, pressure can be measured by a dial manometer also. There are some more
simple electronic versions for home
use. Ambulatory Blood Pressure monitors have been developed to monitor
BP continuously for 12 to 24 hours as
patient is sleeping or performing normal activity.

Normal and high blood

pressure

It is very difficult to define normal blood pressure. When a group of

healthy people will be examined, all of
them will have different values. Not
only this, a same person may have different value at different times. If you
are angry or tense, blood will flow
more rapidly and your blood pressure
will increase. There is a term called
white-collar hypertension. Here blood
pressure is high when in a doctors
clinic but at home blood pressure is
normal. Similarly when you are calm
and quiet, after a good night sleep,
your blood pressure will be lower.
These are normal fluctuations. So, to
define hypertension BP should be persistently high. And it should have been
measured at least twice during two
separate examinations after the initial
screening.
At normal blood pressure, a person should lead a normal life. This BP
is less than 120/80. As per the Seventh
US joint national Committee on Prevention, Detection and evaluation of
High Blood Pressure (JNC-7), if BP
is more than 140/90, it is termed as
hypertension. Values in between (120139/80-89) are pre-hypertension.
In children and pregnant women
blood pressure should be lower.

Why does one develop

hypertension?

This occurs due to a combination

of genetic and environment factors.

Health Spectrum

In more than ninety percent people

there is strong family history of hypertension and the cause cannot be
pinpointed. This is called essential
hypertension and occurs most commonly between the ages of 35 and 55
years. In rest of the patients there may
be a specific cause most important being diseases of kidney or hormone.
Contraction of main abdominal artery
and intake of steroid drugs are among
other causes.
Every effort should me made to
exclude the presence of underlying
offending condition especially when
onset of disease is in extremes of age
and there is no family history. Plan of
treatment may be totally different in
these patients.
High salt intake, excessive weight,
lack of exercise, mental stress, alcohol
intake, crowding are the environmental factors, which increase blood pressure.

Why one should treat

hypertension?

Treatment of hypertension is simple. But many people do not take treatment because of ignorance. If left untreated, hypertension can decrease the
life span by 10 to 20 years. So cost of
this ignorance is heavy.
Hypertension can damage various
organs. Because heart has to pump
against pressure, its size gradually
increases. This further leads to heart
attack and cardiac failure. Delicate
blood vessels of eyes get damaged due
to high pressure leading to disturbance of vision. In brain, damage of
vessels can cause formation of blood
clots or bleeding causing stroke (paralysis). Sudden rise of BP can cause
blindness and coma. 10 % of patients
die of kidney failure. Bleeding from
various sites such as nose, lungs and
menstruation is also common.

Do you have hypertension?

What are the symptoms?

Anger and headache are not reliable symptoms. Hypertension may be

found in children and sanyasis also.
Early morning headache at back of
the head may be found in severe hypertension but normally there is no
direct correlation between headache

and presence or degree of hypertension. So periodic measurement of BP

is the only solution.
Other symptoms are- Dizziness,
palpitation, easy fatigue, nasal bleeding, blurring of vision, chest pain,
breathlessness and fits.
If there is underlying kidney disease then there may be swelling of face
and feet, urinary difficulty in form
of frequency, difficult voiding, inadequate voiding or decreased urine output. Presence of obesity, rounding of
face, muscle weakness, episodic headache, palpitation and perspiration are
found if there is underlying hormonal
disease.

When high BP is detected for

the first time

First, presence of hypertension is

confirmed by repeated measurements.
Person should be calm and quiet and
should have taken some rest before BP
measurement. If presence of hypertension is confirmed, then initial evaluation is done to
v Determine cause of hypertension
v Determine extent of damage especially on heart, kidneys and
eyes
v Determine presence of other disease, which help in deciding best
treatment plan.
A competent doctor should make
a thorogh examination at presentation. He should measure BP in both
arms in, sitting and standing position.
He should make note of all the pulses.
Following basic tests must be doneurine examination, kidney function
test, hemoglobin level, sodium and
potassium level, blood glucose and
cholesterol level, eye check up for retina and ECG. Depending on requirement, the doctor may prescribe, chest
X-ray, ultrasound abdomen, Doppler
study, Nuclear scan, other blood tests
including assessment of hormonal diseases.
If there is no family history, if onset
is abrupt or if hypertension has started
before 35 years of age or after 55 years
of age or if BP is difficult to control,
there is high probability of underlying disease. In two persons with same
level of high BP, the hypertension may
be twenty times severe if there are un-

August 2016 31

Health Article
derlying risk factors such as-onset in
young age, male sex, persistent diastolic pressure above 115 mm Hg., obesity, smoking, alcoholism, diabetes,
high cholesterol and presence of damage to heart, kidney, eyes and brain.
These people need more aggressive
treatment.

Target blood pressure

Lifestyle and dietary

management

Lifestyle has a major bearing on

BP management and all patients, even
if they are on medicines, must be encouraged to follow general non-pharmacological methods.
Relief of stress is important. One
may have to change his job or his attitude towards job and life. Relaxation
techniques and Yoga will be of help.
Smoking and alcohol intake
should be minimized.
Weight reduction of 4.4 kg over 6
months is proven to decrease BP by
2.5 mm Hg. Caloric reduction is important.
Exercise as per physical limitation
of a person should be encouraged.
It helps in Bp control directly and
through weight reduction. Exercises
like jogging, swimming are better than
weight lifting and push-ups.
Role of diet has been proven in
several clinical trials. In this regard,
important aspects are- calorie, salt,
potassium, calcium and fat. Calorie
should be restricted to achieve normal
weight. Salt restriction is beneficial in
lowering BP and it also increases the
efficacy of medicines. Some types of
patient are particularly salt sensitive
such as- kidney patient, elderly and
diabetics. Up to 5 gram of common
salt per day is desirable. There is no
need and use of completely stopping
salt. Increased intake of potassium
has same effect as that of salt restriction. Potassium is found in fruits and
vegetables. But kidney patients should
better be avoiding potassium. High
calcium intake has also been found
to be beneficial for BP control. Fat restriction helps in reducing weight and
in limiting damage to blood vessels.

Drugs for high blood pressure

Although lifestyle and diet is definitely important, they may not alone

32 August 2016

be sufficient. Then a person should

not feel disheartened. Requirement
of medicine is not a sign of failure of
patients effort on lifestyle modification. There are many groups of antihypertensives from which the best
can be chosen for a particular patient.
Various groups of medicines with examples are as underv Diuretics- Furosemide, Hydrochlorothiazide.
v ACE-inhibitors- Enalapril, Ramipril, Lisinopril
v Angiotensin receptor blockers.
(ARB)- Losartan, telmisartan,
Irbesartan.
v Antiadrenergic- Clonidine, methyldopa, Doxazocin, Prazocin,
atenolol, propranolol, labetalol.
v Vasodilator- Minoxidil. Hydralazine
v Mineralocorticoid receptor antagonist- Spironolactone
v Calcium Channel blocker- Amlodipine, Nifedipine, Diltiazem
Treatment has to be individualized. A doctor should start with the
best possible medicine as per patient
need. For example, diuretics are better
for elderly and patients of heart failure
but may precipitate gout.. ACE-I and
ARB are better for patients of diabetes
and of heart attack but ACEI can cause
dry cough and foetal damage in pregnancy. Drugs like propranolol reduces
anxiety but is harmful in asthma.
Drugs like Prazocin may be beneficial
in prostate enlargement. Calcium antagonist can better control BP but may
cause swelling of feet. Proper choice of
medicine along with a change in life
style and diet will be able to achieve
target BP.

Treatment should be started when

BP is more than 140/90. If diastolic
BP is less than 89 and systolic is more
than 160 then again treatment should
be started in patients above 65 years of
age. Patients who have fluctuating BP
and those who are not receiving treatment, should be followed six monthly
so that treatment may be started at
proper time.
In patients of diabetes and evidence of organ damage, target BP
should be 130/85. Lower is better and
in some patients especially those with
kidney diseases, it is advocated to
achieve a target of 120/75. In patients
in whom target is not being achieved,
there are several possibilities. Prescription might be faulty with inclusion of inadequate and inappropriate
drugs. Or patient may not be taking
medicines as prescribed. Excessive
salt intake makes BP control difficult.
Some times BP remains high due to
concomitant use of medicines such as
steroids, contraceptive pill or even nasal drops for cough and cold.

Summary

Hypertension is a very common

disease. But many people are not
aware about their disease due to absence of clear-cut symptoms. This ignorance can reduce the life span of a
person by up to 20 years and can lead
to serious complications such as heart
failure, kidney failure and brain hemorrhage. So regular BP measurement
even in absence of symptom is desirable. When hypertension is detected,
one should not jump with BP lowering drug but a complete evaluation
of patient is mandatory. Lifestyle and
dietary management has an important
role in treatment but along with this,
medicines may be required. There are
numerous medicines from various
groups to choose from. An aware and
motivated patient with the help of a
competent doctor can lead a normal
healthy life. n

Dr. Jitendra Kumar is the Director of

Nephrology and Transplant Medicine at
Asian Institute of Medical Sciences (AIMS),
Faridabad. He is an expert in many procedures such as CRRT, hemoperfusion,
CAPD, and kidney transplant.

Health Spectrum

Q&A

Articles

Weight

Loss

Q. Can someone lose 108 kg in 18 months just by controlling diet (low-fat, low sugar, low-carb diet) and exercise (walking, yoga)?
A. The recommended weight lose is about 3-4 Kg per
month. To lose 1 Kg of fat one has to lose 7500 calories.
Walking at a brisk pace for 30 minutes you can only lose
133 kg.
Q. So this means that people in obese or super obese category can lose over 100 kg weight just by controlling diet
and exercise and there is no need for weight-loss surgery, fat-burning capsules, intense exercise or any other
method?
A. To achieve a very big goal like 100 kg of weigh
lose, involves a complete change in lifestyle, eating habits, exercise, involving intense training and extreme dedication and motivation. It is not impossible, but very-very
difficult and hence people do take the help of weight lose
surgeries, capsules etc. under medical supervision and
once their goal looks closes reset to diet and exercise for
maintenance.
Q. What diet plan will you chart out for people like
Anant Ambani (Son of Mukesh Ambani)?
A. Creating a deficit of 1000 calories in the diet of
an obese person would lead to a weight loss of about 1
kg per week.
High calorie foods, such as chips, candy bars, soda or
sugar filled beverages, fried foods, pizza, burgers, sweats
etc. significantly increase the daily calorie consumption.
High calorie foods should be replaced with low calorie options like fresh fruit and vegetables. Salt should be
kept minimum. Drinking water instead of sugar or calorie filled beverages boosts weight loss.
A small regular meal boots the metabolism. Foods
should have a low glycemic index like whole grain,

Health Spectrum

Before Weight Loss

After Weight Loss

breads, pluses with skin, vegetables etc.

Q. What are the recommended exercises and is a trainer
required?
A. High intensity cardio like jogging, swimming,
running, cycling should be combined with weight training to get the desired results.
Losing 3-4 kg of weight per month is the recommended weight loss. If one loses a lot of weight very
quickly, it might be loss of water weight or even lean tissue as it hard to lose that many fat calories such a short
period.
A trainer is utmost important. All exercise should be
done under supervision.

Dr. Pallavi Vaishya

Nutrition Expert
Kailash Healthcare, Noida
&
Healing Touch Clinic
New Delhi

August 2016 33

Beauty Care

Returning
Afresh
& Anew
of a Break
a
e
Id
w
e
N
e
th
is
ft
n with a Faceli
o
ti
a
c
a
V
a
g
in
in
b
Com

Dr. P. K. Talwar

Senior Plastic and Cosmetic Surgeon

Director

Cosmetic Laser Surgery Centre

of India

E-34, Greater Kailash - I,

New Delhi - 110048
Phones: +91-11-29236550, 29236912
E-mail - drtalwarpk@gmail.com
Website : www.drpktalwar.com

34 August 2016

pending a week at the seaside;

roaming around aimlessly in
the mountains; retreating to the
countryside to rejuvenate your body
and mind! These are some ideas that
lure people to a vacation. However,
some people today are adding another
interesting dimension to their idea of
a break: the idea of rejuvenating your
appearance with a lavish cosmetic
procedure.
The idea is to return from a break
not just rejuvenated in the mind but
also in body and skin. A vacation also
provides enough time to seek an aesthetic physicians advice and decide
on what procedure your face needs.
It also provides the crucial downtime
needed for some procedures to settle
down.
At 36, Aditi Rao had spent most
of her last decade working day in and
day out, with hardly any major vacation, other than a few days spent with
family. She was travelling so much for
work that travelling for leisure seemed
a bad idea to her. She felt a desperate
need of a break and decided to take 15
days off in a planned way. Among the
things planned for the fortnight was a
few hours with an aesthetic physician
to help her treat her facial aesthetic
concerns and regain the glow of youth.

After a procedure with Botox and

Juvederm fillers to erase fine lines and
wrinkles, and fill up her under eye
hollows, she flew to Istanbul, a city
she wanted to visit for a long time. Not
only is she rejuvenated in mind, she
cant take off her eyes from the mirror.
Now, she is raring to return to work.
Greater exposure to the entertainment industry, greater connectivity
and free flow of information of developments across the world, and increase in purchasing power are some
factors that have made Indians more
amenable to the medical aesthetics.
Over the past decade, there has been
a considerable increase in the number
of people opening up to medical aesthetics and cosmetic procedures to get
better facial features, and a younger
looking skin.
However, unlike the west where
plastic surgery is more acceptable and
widely practiced, most Indians are still
apprehensive about going under the
knife. This is why non-invasive cosmetic procedures and injectables are
the most popular in India.

Here are some procedures

that women and men seek:
Botox: Botox remains one of the
most popular cosmetic procedures in

Health Spectrum

Beauty Care
India,
and arguably the most popular among
men. As we reach our mid 30s, the
bunch of lines and wrinkles that appear around our eyes when we laugh
or smile, start becoming permanent;
so do the stress lines of the forehead.
A Botox shot can prevent the crows
feet and forehead lines by relaxing the
muscles responsible for them. A quick
procedure makes you appear less
wrinkly, more relaxed, and younger.
Older women also take recourse to
Botox to treat the wrinkles and sagging appearance of the neck. It is also
very effective in achieving an eye brow
lift, or a beautifully arched appearance
of the eye brow.

Lip Augmentation: Lip enhancement is another popular procedure that is sought by women of all
ages. The younger ones come influenced by the in-vogue pouty appearance with a perfectly created Cupids
bow that looks luscious and attractive.
As we age, the facial features including the cheeks and lips experience a
loss of volume. This is accompanied
by appearance of fine lines around
the mouth that do not look quite attractive. A session with hyaluronic

acid fillers such as Juvederm can turn

around your appearance, giving you
more pronounced lips and smooth
skin around the mouth.

Skin rejuvenation procedures: There is nothing more dis-

couraging than a dull, dry and lackluster looking skin. The environment
we live in, the high degree of pollution
and stress, along with unhealthy eating
and drinking habits puts a lot of stress
on out skin, leaving it dull, pigmented, dry and sheen less. A lot of people
seek aesthetic solutions for skin rejuvenation. Procedures such as chemical

peels,
micro
dermabrasion,
and laser skin resurfacing help exfoliate the damaged outer layer of skin,
reducing scars, pigmentation and
dead cells. Quick procedures with Juvederm Refine help skin retrieve its
lost glow.
Correcting under eye hollows:
Dark circles and under eye hollows are common in young men and
women today. With greater exposure
to digital screens, faulty lifestyles and
lack of nutrition, this problem aggravates. Even as we advice patients
to correct their sleeping patterns and
eat a healthy diet, we offer quick solutions to improve the appearance of the
eyes. When administered intelligently
under the eyes, hyaluronic acid fillers
can reduce the hollow appearance and
give the eyes a healthier look. Laser resurfacing can help reduce the appearance of dark circles.

How a vacation helps:

Some of these procedures need

more than one session and also require some time to settle down completely. This is what makes a vacation
visit to an aesthetic physician even
more helpful. The new age vacationers
travel, meet new people, spend time
relaxing and eating, and add to their
leisure a visit to an aesthetic physician
that helps them return with a new rejuvenated self post their breaks. n
Dr. Talwar is one of the leading
cosmetic and plastic surgeon in India.
Since 1996 he has been running
Cosmetic Laser Surgery Centre of
India. He was also associated with the
Indraprastha Apollo Hospitals, New
Delhi (India) as a Senior Consultant, Cosmetic Surgeon. His clientele
includes Top Models, Film Stars from
neighboring countries, Sport Stars and
a lot of foreign tourists.

Health Spectrum

August 2016 35

Alternative Medicine

Miracle story of
T

Kamal Kaur

he 83-years-old woman, Kamal

Kaur from a village in Meerut
District has successfully undergone drug-free Holistic Medicine therapy, for intolerable and uncontrollable
Pain due to Severe Osteoporosis and
suspected Cancer leading to Fracture in
D-12 Vertebra of her Spine, at "SOHAM"
- The Clinic for Holistic MediCARE &
CURE that specialises in curing people
suffering from various incurable ailments with conventional drug based systems or surgery.
According to Dr. R. K. Tuli, "Smt.
Kamal Kaur was brought to me on the
04th of February 2016, with complaint
of severely intolerable Pain (10/10 on
Pain Assessment Scale) in her middle
spine, restricting all her movements
for the previous two months, with
progressive deterioration in her symptoms in spite of treatment by reputed

36 August 2016

Health Spectrum

Alternative Medicine
specialists at different hospitals.
Accompanying reports revealed
that she suffered from Fracture
D-12 vertebra, Severe Osteoporosis, Osteoarthritis of Spine &
Knees and Anemia with just 6.0
gms. per deciliter of Haemoglobin; her body weight was 85.0
Kgm. for her height of mere 155
cms., putting her at risk of other
morbidities."
This reporter met this lady last
week having attended the therapy
at Dr. Tuli's New Friends Colony
Clinic for the last three months.
She was found to be bursting
with boisterous energy in appreciation of the therapy that has relieved her pain, restored her full
mobility, she has lost 10 kgm. of
her body fat; she finds a pink visible on her cheeks as her haemoglobin has improved to 12.0 gms.
She reported of not only normal
life after being severely restricted
for several years, but states to enjoy her health today better than
in preceding ten years.
Shri Jagdish Singh, the son of
Smt. Kamal Kaur, a master's degree holder from Meerut University and a garment exporter revealed that doctors in several big
hospitals had attributed her excess weight and muscle wasting
to have completely damaged her
back bone and knees, restricting
her to a bed for the last several
years. They advised that she urgently needed to go under Cancer surgery and demanded huge
money for her treatment. But,
when her condition deteriorated
to a threatening level, the family
decided to seek Holistic Medicine treatment with Dr. Tuli.
Jagdish Singh cursed himself
for delaying his mother's treatment by Dr. Tuli as he recalled
that his family has patronised
Dr. Tuli for over 25 years for his
holistic therapy, and it has each
time come to their rescue with
100% success rate whether it was
for cure of Infertility of his wife,
severe Bronchial Asthma of his
father, Heart Disease, Oral Can-

Health Spectrum

cer, Hiatus Hernia-GERD, Lupus-SLE with Sarcoidosis, Kidney Failure, Slip Disc-Sciatica,
Arthritis of Knees needing total
joint replacement, and a range
of ailments amongst his family
members and friends circle.
As per his reputation with
us, Dr Ravinder K. Tuli assured
her that his therapy shall alleviate her pain and suffering in
next few days and here she is in
front of everyone proving magical success of the all inclusive
drug-free system of treatment.
He stated that he didn't reveal to
him at that stage that the doctors
suspected Cancer of the Spine.
In retrospect, as the reports and
clinical condition reveals that
she has been absolutely cured
of all her visible and non-visible
ailments and the quality of her
health at this stage speaks in her
own words.
Dr. Tuli explained that Holistic Medicine is the latest emerging speciality in the developed
world and it's a board certified
speciality in the US for nearly the
last 20 years. It complements the
'science' of evidence based modern medicine with the 'art' of time
honored and highly reproducible
drug-free modalities of the various officially recognised alternate
or traditional (AYUSH) systems
of health to overcome inherent
deficiencies of modern system of
medicine to improve 'quality of
life' and 'add life to years' of each
individual. According to him
this 'synergy' of all the systems of
medicine, in fact, helps to eradicate the root cause of all kinds
of sickness, initiate healing, effect
true CURE, and restore positive
health and total wellness in majority of patients.
Finally, it offers an opportunity to all health practitioners
to achieve highest professional
satisfaction, and simultaneously
restore old glory of the medical
profession. n

- Adheesh Vats

PROFESSIONALS
OWN EXPERIENCES
Holistic Medicine is SURELY
the highest form of Healing.
Dr. Tulis team is really aiding
the Divine Healer and in the
process motivating their patients in the right direction.

- Dr. (Prof) Kusum Sahgal, Fmr.

Principal, Director & Professor Lady
Harding Medical College, New Delhi

I had brought my wife Veena Gupta

after I was fed up with allopathic treatments as in spite of the best she continued to suffer from multiple problems of
Mental Depression-OCD; Hypothyroidism; Fibromyalgia; Obesity; Cervical
Spondylosis + Vertigo with Osteoarthritis of Knees & Ankles + Restless Legs
and APD-GERD + Fatty Liver, etc. After
drug-free Holistic Medicine therapy at
SOHAM just over the last two months,
I am THRILLED with the improvement
and shall continue with it till she is in
absolute Positive Health. I wish more
people take advantage of this treatment
pioneered by Dr. Tuli. My Good Wishes
and Blessings.
- Dr. (Prof.) A. K. Gupta
Fmr. Dean, Maulana Azad Medical College &
Technical Expert on World Bank Blindness Project,
Govt. of India.

I used to feel exhausted and breathless dyspnoea on mild exertion and had
been diagnosed to suffer from progressive Interstitial Lungs Disease (I.L.D.).
After consulting all the doctors here and
abroad (U.K. & U.S.A.), many of whom
were my former students, I had decided
to retire when I was told nothing much
could be done. But, after having this
drug-free Holistic Medicine treatment
for about four months, Ive tremendous
improvement in my health and I really

August 2016 37

Alternative Medicine
now BELIEVE about the theory of
LIFE-FORCE which can CURE many
incurable ailments.
-Dr. Shanti Talwar
Sr. Consultant Paediatric Surgery, Apollo
Hospitals and Fmr. Director, Professor & Head
Maulana Azad Medical College, New Delhi.

I came to Dr. Tuli in a desperate condition with unbearably severe

LOW BACK PAIN due to Inoperable
Advanced L-S Degenerative Spondylosis + DDD & PIVDs L1 to L5, Spinal Canal Stenosis and Radiculopathy
BLLs causing Anxiety, Sleep Disturbance & Hypertension. I already had
both Knees as well as a Hip joint replacement. I got very positive vibrations and a feeling of reassurance at
his SOHAM Clinic. I felt very relieved after only a first few treatments.
At the end of recommended course I
am completely relieved and Id like to
share that I am able to play better Golf
today than I did 10 years ago! Thank
You Dr. Tuli & your very polite and
efficient team. May God Bless all of
you.
- Dr. Kavita Sama
Sr. Obst & Gynaecologist, SAMA Nursing
Home & Sir Ganga Ram Hospital.

I am pleased to share that I had

brought my bed-ridden mother here
more than 15 years ago as she suffered from severe Rheumatoid Arthritis with multiple crippling deformities. She had, also, developed
serious side-effects to drugs including heavy dose of prednisolone prescribed to her at AIIMS, New Delhi.
I am highly obliged to Dr. Tulis team
and the drug-free holistic method of
treatment for total cure of my mother
from the very cause of disease, recov-

Dr. R. K. Tuli

What is Holistic Medicine?

Holistic Medicine is an
optimum synergy of all
the recognised systems
of medicine as it extends benefits of all, at
the same time overcoming deficiencies inherent in each system individually, to extend the
best in harmless health
care to each individual.
Its a board recognised
specialty in the U.S. for
over two decades, and
leading medical institutions all over the world are seeking to extend its benefits to their patients.
Holistic Medicine takes care of the human being as a whole, and thereby
helps to eradicate all the ailments of an individual concurrently and restore
Positive Health and Total Wellness, Body-Mind-Spirit.
Holistic Medicine integrates the wisdom of Western, Indian, Chinese &
New Age evidence based science of medicine with the time honored reproducible art of Health: Holistic Medicine = Modern + Traditional + New Age
Medicine.
ery from all the deformities and her
freedom from heavy toxic medication. It was a medical miracle that
stands proven till today! My mother
has now crossed the age of 80 years
and she continues to independently
manage her entire household without
any help at this age!! Long live Holistic Medicine!!!
-Dr. Anand K. Gupta
Senior Family Physician &
Dermatologist, New Delhi

Ive been given a SECOND LIFE!

I had slipped into Hepatic Coma
& Total Renal Shut Down following Chronic Progressive Multi-Virus
Hepatitis. My family sought the ser-

vices of Dr. R.K. Tuli, the renowned

Holistic Physician at the stage when
specialists at AIIMS gave up on me!
Due to his sincere and vigorous support Ive fully regained my liver functions. Whats amazing is that the
universally INCURABLE C & E
Antigens and the entire Virus load
have been eliminated from my body.
My health has bounced back to be
better than in previous ten years, and
Ive resumed my medical practice
nearly after three years of its closure
due to my morbidity.
-Dr. Deepak Chandra
Senior Family Physician,
Vishnupura, Kanpur (U.P.)

SOHAM, the Clinic for Holistic MediCARE & CURE is dedicated to Eradication of all Sickness and
restore Positive Health and Total Wellness of each individual as a whole, body-mind-spirit, by a synergy
of the evidence based science of modern medicine with the time honoured art of natural, drug-free,
harmless and highly reproducible modalities of all the officially recognised systems of traditional medicine. This synergy is termed HOLISTIC MEDICINE as it complements all the systems and specialities of
medicine to add life to years of each individual, and improve the final outcome of every sickness. It helps
to minimise dependence on medical interventions, manage all the diseases of an individual concurrently,
and enable even permanent cure of the vast range of conventionally incurable diseases. Dr. R. K. Tuli and
Dr. Poonam Tuli combine to offer over 90 years of their collective expertise to lead a committed team to
achieve unique, incomparable, and cost-beneficial healing & Health For All. n

38 August 2016

Health Spectrum

Gamming Addiction

Q&A

Video gaming stimulates the dopamine neurotransmitter pathways

in the brain - thereby making it an addictive activity for some.
Instant gratification of pleasure experienced during gaming can
lead to poor impulse control in children. Spending too much time
on gaming can deeply impact a child's physical health as well as
psycho-social well being. Here is Q& A about Gamming Addiction.

Dr. Shobhana Mittal

Attending psychiatrist
Cosmos Institute of Mental
Health and Behavioural
Sciences
New Delhi.

Health Spectrum

Q. How bad gaming addiction can be for young kids?

Gaming stimulates the
dopamine neurotransmitter
pathways in the brain, thereby
making it an addictive activity
for some. Instant gratification
of pleasure experienced during gaming can lead to poor
impulse control in children.
Spending too much time on
gaming can deeply impact a
child's physical health as well
as psycho-social well being.
Q. How parents can ensure
their kids are not hooked to
playing video games?
Parents need to set ap-

propriate limits for their

children with regards to the
type of videogames permitted and time spent on them.
Video games at a very young
age should be avoided, so that
children can have an opportunity to develop other interests
and hobbies at this age. Children should be encouraged
to participate in alternate fun
activities depending on their
interest, including playing
outdoor sports, music, dance,
art or interacting with other
children their age, which
would contribute to a child's
all round development. n

August 2016 39

Alternative Medicine

YOGA
A NOVEL
INTEGRATIVE
THERAPY
M
Dr. Ananda Balayogi
Bhavanani
Deputy Director

Centre for Yoga

Therapy Education
and Research (CYTER)
MGMC & RI
Pillayarkuppam
Pondicherry
Email : yoga@mgmcri.
ac.in

40 August 2016

odern medical advancements

provide the rationale for the integration of various traditional
healing techniques like Yoga, Naturopathy,
Ayurveda, Siddha and Music to promote
healing, health, and longevity. The Govt
of India is currently promoting indigenous systems of health in a strong manner through the Ministry of AYUSH. The
limitations of modern medicine in managing stress induced psychosomatic, chronic
illnesses is the strength of these traditional
healing systems and hence a holistic integration of both systems enables best quality
of patient care.
It is imperative that advances in medicine include the wholistic approach of Yoga
to face the current challenges in health care.
The antiquity of Yoga must be united with
the innovations of modern medicine to improve quality of life throughout the world.
No wonder that Dr. Dean Ornish, the eminent American doctor who has shown that

Yogic lifestyle can reverse heart disease

says, Yoga is a system of perfect tools for
achieving union as well as healing.
According to Dr B Ramamurthy, eminent neurosurgeon, Yoga practice re-orients the functional hierarchy of the entire
nervous system. He has noted that Yoga not
only benefits the nervous system but also
the cardiovascular, respiratory, digestive,
endocrine systems in addition to bringing
about general biochemistry changes in the
yoga practitioners.
We are today faced with numerous debilitating chronic illnesses related to aging,
environment, and hedonistic lifestyle, such
as cancer, diabetes, osteoporosis, and cardiovascular diseases as well as many incurable diseases such as AIDS. Modern medical advancements provide the rationale for
the integration of various traditional healing techniques including Yoga to promote
healing, health, and longevity. It is imperative that advances in medicine include the

Health Spectrum

Alternative Medicine
wholistic approach of Yoga to face the
current challenges in health care. The
antiquity of Yoga must be united with
the innovations of modern medicine
to improve quality of life throughout
the world. While modern medicine
has a lot to offer humankind in its
treatment and management of acute
illness, accidents and communicable diseases, Yoga has a lot to offer in
terms of preventive, promotive and
rehabilitative methods in addition to
many management methods to tackle
modern illnesses. While modern science looks outward for the cause of all
ills, the Yogi searches the depth of his
own self. This two way search can lead
us to many answers for the troubles
that plague modern man.

Scientific basis of applying

yoga as a therapy

Numerous studies have been

done in the past few decades on psycho-physiological and biochemical
changes occurring following practice
of Yoga. A few clinical trials have also
been done that have shown promise
despite Yoga not being ideally suited
for the scientific gold standard of double-blind clinical trials. Some of the
researched benefits that are quite well
proven are given below to facilitate an
understanding of how Yoga works at
least at the physical level though we

Health Spectrum

are yet to research and understand

subtler effects of Yoga.

Some physiological benefits of

yoga:

v Yoga induces autonomic nervous

system equilibrium with a tendency toward parasympathetic
dominance rather than stress-induced sympathetic dominance.
This is of great potential in psychosomatic stress related illness.
v Heart rate and blood pressure
decrease implying better relaxation, reducing load on the heart.
v Respiratory rate decreases and
respiratory efficiency improves.
The amplitude and smoothness
of respiration increases along
with all the pulmonary parameters like tidal volume, vital capacity and breath-holding time.
v EEG - alpha waves increase.
Theta, delta, and beta waves also
increase during various stages of
meditation
v Cardiovascular efficiency increases.
v Gastrointestinal function and
endocrine function normalizes.
v Excretory functions improve
v Musculoskeletal flexibility and
joint range of motion increase
v Posture improves while strength,
resiliency endurance and energy

level increase
v Weight normalizes, sleep improves, immunity increases and
pain decreases

Some psychological benefits of

yoga

v Somatic and kinesthetic awareness increase

v Mood improves and subjective
well-being increases
v Self-acceptance and self-actualization increase
v Social adjustment increases
v Anxiety, depression and hostility
decreases
v Psychomotor functions such as
grip strength, balance, dexterity
and fine motor skills, eye hand
coordination and reaction time,
steadiness and depth perception,
and the integrated functioning of
body parts improve
v Cognitive functions such as attention, concentration, memory,
and learning efficiency improve

Some biochemical effects of

yoga

The biochemical profile improves,

indicating an anti-stress and antioxidant effect which is important in the
prevention of degenerative diseases.
v Decreased levels of: blood glucose, total white blood cell count,
total cholesterol, triglycerides, LDL and VLDL.
v Increased levels of:
HDL cholesterol, ATPase,
hematocrit, hemoglobin,
thyroxin, lymphocytes, vitamin C and total serum
protein. n
Yogacharya Dr Ananda
Balayogi Bhavanani is a
medical doctor, Yoga therapist, researcher and author of
more than 20 books, DVDS
and two hundred articles on
YOGA. He is a Yoga Expert
on CCRYN and Ministry of
AYUSH committees for International Day of Yoga celebrations and currently Deputy
Director of the Centre for
Yoga Therapy, Education
and research in the Sri Balaji
Vidyapeeth at Pondicherry.

August 2016 41

Alternative Medicine

How to Treat SleepApnea

with Homoeopathy
Symptoms
1. Problem in inhaling
2. Feeling short breathe
3. Feeling tired whole day
4. Night time awakening
5. Feeling irritated
6. Forgetfulness
7. Feeling tired just by doing a
light work
8. Snoring
9. Memory Loss

Homoeopathic Remedies

leep Apnea a disease which

we do not know that how is
it dangerous for your physical as well as psychological health?
Actually, Sleep Apnea is a respiratory
disease related to breathing function of
your body resulting in day sleepiness,
inability to work physically. If, this disease increases then it pave way to enter
other diseases like diabetes, high blood
pressure, stroke etc. There are number of patients in India and Overseas
which is totally under the grip of this
disease and taking regular help of other
branches of medicines.
It is basically of two types: Central
and Obstructive. In central Sleep Apnea brain fails to send signals to the
breathing muscles and it is known to
be the less common among patients
and in obstructive Sleep Apnea air is
obstructed from flowing into and out
of the nose resulting in reduction of
oxygen level in the
body as a result patient starts snoring at night. It basically persists in lying position and is highest percentage
among patients all over globe and there
is more percentage of men who are

Health Spectrum

more prone to get this disease in their

life span so they should be more careful and immediately consult Homoeopathic
expert but it never confirms that
women are far away from this disease
so they also should be aware if any
symptom persists with respect to the
respiratory problem or difficulty in inhaling fresh air.
But, Homoeopathy acts as a boon
for treating this disease because it can
treat both types of Sleep Apnea without giving any problem to the patients
but all is depend on the remedy that a
Homoeopathic Physician prescribe to
a particular patient according to ones
age and seriousness of disease. It is
concluded by
asking different questions regarding his ailment and how is he feel? Let
us look.
Keep faith in Homoeopathy, it
definitely works in crucial times and
has ability to cure the diseases from its
root. n
by Dr. Samiksha Choudhary
R L Jussal Memorial Clinic
Paschim Vihar, New Delhi

1. Arsenicum album is prescribed for individuals who

have breathing difficulties.
2. Sulphur is a commonly
used homeopathic remedy
especially given in breathing
congestions.
3. Lachesis is a remedy prescribed for uncontrollable
conditions which sometimes
persist at night.
4. Spongia is also a better option when there is a feeling
of blocked chest area.
5. Opium is also prescribed for
the patients who feel confused after sleep disorder.

Prevention
1. Stop smoking.
2. Stop the consumption of
liquor.
3. Do some respiratory exercises in morning hours before
sunrise.
4. Eat healthy food especially
fibrous eatable items in your
diet.

August 2016 42

HEALTH Article

Conjunctivitis: Most
Common Eye Problem

Dr Nikhil Seth

Senior consultant eye surgeon

Head of Department
Department of ophthalmology

Asian Institute of Medical

Science (AIMS)
Faridabad

43 August 2016

onjunctivitis is a common communicable disease and spreads mostly

during summer and the rainy season. It is basically an infection and inflammation of the conjunctiva redness and
swelling of the thin protective membrane
of eye and can be caused due to any kind
of viral or bacterial infection, irritants,
abrasions chemical reaction, dust allergy,
pollens, contact lens, eye cosmetics etc."
Besides washing your hands, the different ways you can prevent conjunctivitis,
Conjunctivitis generally spreads through
touching or contact. The virus spreads
during monsoon when the weather conditions are ideal for it. Its incubation period
is 3-7 days and is highly contagious, as it
gets transmitted by hand-to-eye contact
and can happen at any age. Here are some
of the simple precautionary measures to be
followed:
Your eyes may turn red due to dust, lack
of sleep; strain on the eyes, allergy cold,
so how to differentiate. One is advised to
consult a doctor if the following symptoms
persist for more than 2-4days: Redness of
eyes, watering, itching, discharge, eye discomfort in bright light, swelling around the

eyes, sticky eyes and swollen eyelids.

But if you want to try to cure yourself
from the contagious eye sore, theres only
so much you can do. If a patient is suffering from conjunctivitis, then at home
they are advised to follow these tips:
v Wash the eyes with previously boiled
water
v Ice or cold compression thrice a day
v Self-medication should never be attempted as it may further harm your
eyes
v Person should be isolated; no school,
office or public gathering
v Keep the eyes clean
v Use dark glasses
v Never start self-medication
v Consult an eye specialist as early as
possible; till eye specialist is not available, start with lubricant eye drops
v Never use steroid eye drops
With these guidelines and strict precautionary measures in place, you can stop the
contagious spread of this conjuntivitis.
If symptoms persists after 3-5 days do
consult your eye specialist as it can be a potential complicated conjunctivitis involving cornea and can lead to various serious
visual problem including corneal ulcer;
dermatitis etc.
Ice or cold compression thrice a day,
frequent hand wash with soap, avoid itching or touching of eyes, use of preservative
free artificial tear drops should be the best
self treatment plan. n

Do's and Don'ts

vDo not touch/hand shake
vDo Not rub your eyes; avoid busy
common places
vAvoid contact with patients having
red eye ,common cold or recurrent sneezing patients
vDo not touch taps or door handles
vDo not share common towels, pillows, beds, toiletries
vDo not share common eye cosmetics
vIf already suffering from eye flu,
then do not use contact lenses
and say no to swimming for the
time being."
vDo not use steroid eye drops or
over the counter drops.

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Health Study

Contraceptive failure
Leading Cause For
Unwanted Pregnancies
Among Young Women
by Vartika Tomar

ontraceptive failure is cited as the most

common cause for unwanted pregnancies in the India. Such unplanned pregnancies very often end up in abortions,
according to an analysis done by Ipas Development
Foundation. This is more significant for young
women in the age group of 15-24 years.
More than 80% abortions in India are a result of
contraceptive failure. While the percentage is 79%
among women below the age of 24, for those more
than this age, the percentage goes up marginally to
82%.
Dr Sushanta Banerjee, Senior Director, Research
and Evaluation said that, ``this suggest even those
young women who have exposure to modern technologies (amenities and thoughts) are not aware of
sexual and reproductive health issues. As pointed
out in another study among young women, more
than 90% young women do not have any knowledge
about sex and pregnancy and more than half of the
young women do not have correct kn owledge on
oral contraceptive pills.
Risk to life or grave injury to mothers mental and physical health account for 16% abortions
among women more than 25 years of age, and 18%
for those below 24 years. Only 1% to 2% pregnancies are terminated for congenital abnormalities in

44 August 2016

the fetus while abortion in the case of rape survivors is negligible, the analysis suggests.
Ipas Development Foundation (Ipas India) did
the analysis for over 3 lakh women who had sought
to terminate their pregnancies.
The analysis corroborates another study by Ipas
India ``How prepared are young, rural women
in India to address their sexual and reproductive
health needs? A cross-sectional assessment of
youth in Jharkhand. The study was done by Sushanta K. Banerjee, Kathryn L. Andersen, Janardan
Warvadekar, Paramita Aich, Amit Rawat and Bimla
Updahyay which says irrespective of marital status,
rural young women are ill equipped to deal with
their sexual and reproductive health. This assessment of young womens awareness of SRH matters
and current practices of utilizing healthcare services for reproductive health issues including abortion and post-abortion complications suggests a
need for a comprehensive, youth-focused behavior
change communication intervention.
Moreover, after four decades of legal abortion
in India (MTP Act), almost all young women were
unaware that abortion is legal.
Despite national policies, participants married
young (mean 15.7 years) and bore children early
(53 % with first birth by 17 years). Women achieved

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Health Study
low composite scores on knowledge
around sex and pregnancy, contraception, and abortion knowledge.
Around 3 % of married young women
reported experiencing induced abortion; 92 % of these women used private or illegal providers. Married and
unmarried women also had limited
agency in decision-making, freedom
of mobility, self-efficacy, and financial
resources. Most of the women in the
sample received SRH information by
word of mouth.
A majority of 1381 married and
unmarried women participants (52
%) reported seeking SRH treatment
or advice from a private facility or
provider. Thirty-eight percent also
reported seeking SRH services from a
traditional healer or unqualified rural
medical practitioner.
Of the 23 married women reporting an induced abortion, only 4 %
sought treatment from government
facilities (where services are virtually
free and provided by trained providers). Instead, most (52 %) went to a
private facility, or to a chemist/rural
practitioner (43 %); few private facilities are approved to provide abortion
by the government, and chemists/
rural practitioners are not legally allowed to provide induced abortion in
India. Reliance on private sector was
also observed for the 90 women who
reported an induced abortion.
Married women were more likely
to have received information on SRH,
contraception and abortion than unmarried women. Among those who
did receive any information, both

A majority of 1381
married and unmarried
women participants (52
%) reported seeking SRH
treatment or advice from
a private facility or provider. Thirty-eight percent
also reported seeking SRH
services from a traditional
healer or unqualified rural
medical practitioner.
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married and unmarried women reported family and friends as the

primary source for all three types of
information (71% vs 79 %, respectively). Besides family and friends,
married women were more likely
to have received information from
outreach, whereas unmarried more
likely to obtain information from
mass media. Receiving any abortion
information was low for both groups,
with unmarried women being significantly less likely to receive any abortion-related information compared to
married women. Importantly, a large
proportion of women deny having

is not legal in India.

Linear regression modeling indicated that married women and women with middle or secondary education were more likely to have accurate
knowledge in all three knowledge
domains, older women (1924 years)
had a better understanding of sex and
pregnancy and contraception than
younger women, and women with
a high standard of living had better
knowledge about contraception and
abortion. Exposure to any SRH information from any source was found
to have strong association with the
knowledge level of all three SRH re-

received any information about SRH

issues (29 %), contraception (19 %) or
abortion (93 %), while 94 % of young
women received no information on
all three topics.
Knowledge about SRH issues was
extremely limited in both groups, although married women knew more
than unmarried women in all three
knowledge categories. Of note, 55 %
of young married and 71 % of young
unmarried women could not correctly respond to any of the questions
about safe abortion. Furthermore, 10
% erroneously believed that abortion

lated issues.
``Interventions intended to address the SRH needs of young population must consider the need of
highlighting access to youth-friendly
health facility. This approach will not
only raise their awareness but also
enable them to translate information
into practice through improved agency. At the same time, it is important
to build formal and informal peer
networks of young women to ensure
social support within the same community, Dr Banerjee suggests. n

August 2016 45

HEALTH Article

DONT IGNORE THE SNORING AND

IT'S HARMFUL EFFECTS
Good Sleep is one of the three essential pillars of good
health apart from exercise and diet.

Dr. Prerana Garg

Chief Physician & Director

Aviss Health Pvt Ltd

Centre for Sleep Disorders

Gurgaon, Haryana
Email : director@avisshealth.com

46 August 2016

What is Snoring?
Snoring is the loud hoarse or harsh
sound that occurs when your breathing is partially obstructed in some way
while you're sleeping. Snoring occurs
when the flow of air as we breathe
makes the tissues in the back of our
throat vibrate and makes those irritating sounds. It can occur during any
stage of sleep. Snoring is more than a
bedtime nuisance and it shouldn't be
ignored.
Prevalence of Snoring
Snoring is a common phenomenon in society. Snoring affects 20
percent of the adult population and as
much as 60 percent of men above 40
years of age. Snoring can be classified
into a) Simple b) Symptomatic. Symptomatic refers to snoring associated

with daytime lethargy and excessive

daytime sleepiness. Men snore more
(25%) than women (15%) and older
subjects snore more than the young.
Why do we Snore?
Snoring happens when there is obstruction of a persons airways. Many
factors influence snoring.
1. Most often, muscles in the roof of
the mouth (known as the soft palate) or the back of the throat relax
and partially block the flow of air.
2. Obesity - Extra tissue in the throat
can vibrate as you breathe in air in
your sleep, causing you to snore.
People who are overweight, obese
or pregnant often have extra bulky
throat tissue.
3. Genetic factors which cause

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HEALTH Article
snoring include extra throat tissue
as well as enlarged tonsils, large
adenoids, long soft palate or long
uvula.
4. Allergies, Congestion and Certain Nasal Structures- Anything
that prevents you from breathing
through your nose can cause you
to snore. This can include congestion from a cold or flu, allergies or
deformities of the nose such as a
deviated septum.
5. Alcohol, smoking, aging and certain drugs and medications, including muscle relaxants cause
your throat or tongue muscles to
get relaxed which may cause you
to snore.
These all raise your risk for Obstructive Sleep Apnea a condition that

causes you to temporarily stop breathing when you are asleep and the heart
and brain isnt able to get enough oxygen to function properly.
Why cant we afford to Ignore Snoring?
Snoring may be early sign of future
health risks. Besides being a nuisance
to your bed partner or roommate,
loud and frequent Snoring is a common symptom of sleep apnea, a serious sleep disorder and a risk factor
for heart disease, stroke, diabetes and
many other health problems which in
turn can result in further complications. In children snoring is usually
due to enlarged tonsils and adenoids.
OSA in children can cause learning
disabilities. While not everyone who
snores has this sleep illness, snoring

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is a warning sign that should be taken

seriously.
If you or your loved one have any
of the following symptoms along with
snoring you may have Sleep Apnea
Excessive daytime sleepiness (to the
extent that people fall asleep behind the
wheel)
v Choking or gasping while you
sleep
v Pauses in breathing
v Morning headaches
v Difficulty concentrating
v Moodiness, irritability or depression
v Frequent need to urinate during
the night
When should you visit a sleep clinic/
Sleep Disorders Centre?

Sleep Centre refers to a clinic/

Centre dedicated to the diagnosis and
treatment of sleep disorders. Your
family doctor may refer you to a sleep
doctor if he / she suspects something
serious underlying your inability to
sleep well. A Sleep medicine physician
or a Sleep Specialist is trained to treat
Snoring and detect and diagnose sleep
apnea using sleep study or polysomnography. Sleep apnea is manageable
using several approaches including
CPAP (continuous positive airway
pressure), oral appliance therapy and
surgery.
Snoring is generally regarded as a
cosmetic issue by patients. We're hoping to change that thinking so patients
can get the early treatment they need,
before more serious public health issues arise. n

Q&A

Triggers of
Q. When it comes to what triggers
cancer, whom will you blame first -Bad lifestyle, gene mutation (family
history), ageing or a combination of
all?
Its a combination of all the
above. Lifestyle is a major contributor especially obesity as it increases
the risk by 30%
Q. How one can keep
cancer at bay (if not
triggered by mutations)?
Healthy lifestyle,
no tobacco, maintain
an optimal weight
Q. In case if someone is diagnosed with c a n cer, what next: Embrace the situation and fight it off or let it happen?
Cancer treatment and prognosis
is directly dependent on the stage of
the disease
Stage 1cure rate >90%
Stage 2cure rate is 60-80%
Stage 3cure rate 40%
Stage 4-- < 10%
Q. What woman should know?
Every woman should be breast
aware i.e. she needs to know what is
normal and report any abnormality.
Every woman irrespective of family history needs to have a mammogram done every year after the age of
40. Breast cancer is the fastest growing disease in women in India, it
cant be prevented but if caught early
it has lesser chances of causing harm
than dengue fever. n

Dr. Rohan Khandelwal

Onco-plastic Breast Surgeon

W-Hospital (Gurgaon)

August 2016 47

Healthy Motherhood
This may be partly true. Although vigorous sexual activity
may be dangerous, but a gentle
sex during pregnancy is not
that harmful. Semen contains
some amount of prostaglandins
which may provoke miscarriage in same cases. So using a
condom even during pregnancy
is always better.

Certain Myths Of Women

Health You Need To Know

Dr Sushma P. Sinha

Senior Obstetrician, Gynaecologist, IVF & Infertility Expert &

CO-ordinator, Laparoscopic &
Robotic Surgeon, Institute of
Obstetrics & Gynaecology

Indraprastha Apollo Hospitals, New Delhi-110076

Email : sinha_sushma@hotmail.com

48 August 2016

Q. Menstrual blood is impure and it has

to come out. Even if the bleeding is heavy
it shouldnt be stopped.
Ans- Menstrual blood is actually the
endometrial lining(lining of the womb)
mixed with blood from the blood vessels
supplying the lining of the womb.
Sometimes these blood vessels are
not able to contract (close) completely
and lead to heavy blood flow which is ultimately the blood from the body blood
stream. Flow ofa lot of blood will lead to
anaemia and weakness. One should rather
seek a medical help for it.
Q. Eating sour or spicy foods during menstruation may lead to heavy bleeding.
Ans- There is no proof of changes in
blood loss related to food. Eat whatever

you like. Though one should eat healthy

and hygienic food to have a normal bowel
activity during menstruation.
Q. One should not take pain killers during
periods.
Ans-Taking few pills for pain alleviation during menses is safe. Not taking a
pill and being in agony disturbs ones daily
activities& has a profound psychological
impact as well.
Q. Having intercourse atcertain times
during the cycle decides the chance of
having a male or a female child.
Ans- Absolutely untrue. There is no
such science which can support this myth.
Sex of the child is determined by chromosomes and there is no such mechanism

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Healthy Motherhood
related to any affinity for X or Y chromosome according to the day of the
cycle. There is no reason to resort to
many practices.
Q. Oral contraceptive pills lead to
weight gain.
Ans- Well this might be partially
true with the older pills used decades
age, but the very low dose pills available at present are quite safe and have
almost 99.9% efficacy in preventing
pregnancy if taken properly. They dont
cause any obesity and have minimal
side effects although they should never
be used without prescription of a doctor as safety differs from person to person& detailed information should be
given and warning signs need to be discussed together with some general examination of the patient are done prior
to starting the pills.
Q. Copper T is not advisable for women who had a Caesarean delivery.
Ans- This is not true. Whether a
normal delivery or C-Section Copper
-T is effective for almost all women
who have delivered a baby before&
with equal safety & efficacy.
Q. Copper T interferes with your sea
life.
Ans- The reason one goes for an
option like Cu- T is to have sex without
risk of unwanted pregnancy. Women
think that the thread that comes out
of vaginal opening is going to be a distraction. However, the thread is present
only in the upper part of vaginal opening and rarely come in contact with
male organ during the act.

adverse effects or pregnancy.

Q. One should not exercise during
pregnancy.
Ans- Moderate exercise is advisable
during pregnancy. Being active and
working all through the pregnancy is
rather recommended than taking rest.
However, a sleep of 8hrs at night and
1hr. in day time if possible is preferable
during pregnancy. Yoga and breathing
exercise also help allay stress.
Q. Each and every fibroid should be
operated.
Ans- Just on sight of fibroid on ultrasounography on routine checkup
women get frightened. It is never advisable to operate each and every fibroid
unless there aresymptomslike very
heavy periods pain infertility.Even before operating other medical methods
available can be taken into consideration if surgery is not acceptable.

This may be partly true.

Although vigorous sexual
activity may be dangerous, but a gentle sex during pregnancy is not that
harmful. Semen contains
some amount of prostaglandins which may provoke miscarriage in same
cases. So using a condom
even during pregnancy is
always better.

Q. Having sex during pregnancy

may lead to miscarriages.
Ans- This may be partly true.
Although vigorous sexual activity
may be dangerous, but a gentle sex
during pregnancy is not that harmful. Semen contains some amount of
prostaglandins which may provoke
miscarriage in same cases. So using a
condom even during pregnancy is always better. n

Q. Eating fruits like papaya or pineapple harm your pregnancy.

Ans-There is no evidence that
papaya or pineapple cause miscarriage or any kind of harm
to the pregnant patient. Too
much of anything is not
good during pregnancy and
doctors advice to eat a bowl
with variety of fruits. Too
much of sugary fruits like
mango, dates, banana and
litchi regularly may shoot
up the sugar levels and have

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August 2016 49

HEALTH Tips

Tips of Dr. Sunita Godara to Reduce stress

1. Get up 15 minutes earlier
2. Prepare for the morning the night
before
3. Avoid tight fitting clothes
4. Avoid relying on chemical aids
5. Set appointments ahead
6. Don't rely on your memory ... write
it down
7. Practice preventive maintenance
8. Make duplicate keys
9. Learn to say "no" to things which
you think not good for us
10.Set priorities in your life
11. Avoid negative people
12. Use time wisely - Time Management
13. Simplify meal times
14. Always make copies of important
papers
15. Anticipate your needs
16.. Repair anything that doesn't work
properly
17. Ask for help with the jobs you dislike
18. Break large tasks into bite size portions
19. Look at problems as challenges
20. Look at challenges differently
21. Un-clutter your life
22. Smile
23. Be prepared for rain
24. Tickle a baby
25. Pet a friendly dog/cat
26. Don't know all the answers
27. Look for a silver lining
28. Say something nice to someone
29. Teach a kid to fly a kite
30. Walk in the rain
31. Be aware of the decisions you make
34. Believe in yourself
35. Stop saying negative things to
yourself
36. Visualize yourself winning
37. Develop your sense of humor
38. Stop thinking tomorrow will be a
better today
39. Have goals for yourself
40. Get enough sleep
41. Say "hello" to a stranger
42. Ask a friend for a hug
43. Look up at the stars
44. Practice breathing slowly
45. Practice a monster smile

50 August 2016

46. Keep a journal

47. Quit trying to fix other people
48. Have a support network of people,
places and things
49. Read a story curled up in bed
50. Do a brand new thing
51. Stop a bad habit
52. Buy yourself a flower
53. Take time to smell the flowers
54. Find support from others
55. Ask someone to be your "ventpartner"
56. Do it today
57. Work at being cheerful and optimistic
58. Put safety first
59. Do everything in moderation
60. Pay attention to your appearance
61. Strive for Excellence NOT perfection
62. Stretch your limits a little each day
63. Look at a work of art
64. Talk less and listen more
65. Maintain your weight
66. Plant a tree
67. Feed the birds
68. Practice grace under pressure
69. Stand up and stretch
70. Always have a plan "B"
71. Learn a new doodle
72. Memorize a joke
73. Be responsible for your feelings
74. Learn to meet your own needs
75. Become a better listener
76. Know your limitations and let others know them, too
77. Tell someone to have a good day in
Latin
78. Throw a paper airplane
79. Exercise every day
80. Freely praise other people
81. Get to work early
82. Clean out one closet
83. Play patty cake with a toddler
84. Go on a picnic
85. Take a different route to work
86. Leave work early (with permission)
87. Put air freshener in your car
88.. Eat popcorn
89. Write a note to a far away friend
90. Go to a ball game and scream
91. Cook a meal and eat it by candlelight

92. Recognize the importance of unconditional love

93. Remember that stress is an attitude
94. Remember God several times a day.
95. Remember you always have options .
Dr. Sunita Godara is
an asian marathon
champion & fitness expert.. She is an eminent
international athlete
marathoner of repute.
She has completed 76
full marathons (42.2km)
till date and won 25 Golds, 12 Silvers
& 13 Bronze medals across the globe in
26 countries. She is director of Health
Fitness Trust and President of Health
Fitness Society.
Email : sunitagodara@gmail.com

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July 2016 51

HEALTH SPECTRUM

Title Code : UPENG04171