Wednesday, 23 August 2017

Be tuned to the signals of nature

Be tuned to the signals of nature The human body is made up of matter. If you break the matter, it is converted into atoms and then to subatomic particles (protons, electrons and neutrons), photons, quantum and wave in sequence. Matter can therefore be converted into non-matter. Photon is a state where you are both matter and non matter. In quantum mechanics, this is called wave particle duality in which every particle can be described as a particle and also as wave. When two photons particles interact or become ‘entangled’ and then separate, they are connected at a speed much faster than the speed of light and act similar even when separated by huge distances. Einstein called this connection as “spooky action at a distance” as according to him this was impossible. This phenomenon answers many of the mysteries of consciousness. Because at the level of photon, we are connected to everybody in the universe. When we learn to live in the present, there is harmony between our inner rhythm and the rhythms of the nature, a phrase described in Vedic text as “ritam bhara pragya” Ritam (rhythm), Bhara (full of), Pragya (mind) or simply put, a “mind full of rhythm”. This is the extreme parasympathetic state of the body and represents a state of mind where the thought waves are synchronous with the order of the universe. It is the interface between the disturbed and the undisturbed state of consciousness. It can be achieved by deep meditation. People who meditate have been said to acquire many powers like telepathy, reverse telepathy, spontaneous fulfilment of desires, meaningful coincidences, synchrodestiny etc. Our consciousness or the soul is the silent state of mind with infinite powers. These powers are hidden under the smoke of mind, intellect and ego. Ritam bhara pragya is controlling the mind, intellect and ego. Our Vedas say that nature regularly sends us signals that show that you are on the right path or have taken a wrong turn in life. But we are oblivious to them because at that particular moment, we are living either in the past or in the future. The state of Ritam bhara pragya brings us in close contact with nature, enabling us to pick up the signals of the nature. Once the state of ritam bhara pragya is achieved, we start living in the present. Living in the present is sometimes referred to as mindfulness. If we live our lives mindfully, we will get more out of life. Because then the intention becomes powerful, and one starts experiencing spontaneous fulfilment of desires. This is also the level where one experiences Siddhis, or the super normal powers described by Patanjali in the Yoga Sutras. Disclaimer: The views expressed in this write up are entirely my own. Dr KK Aggarwal

Increase intake of fluids to avoid kidney stones

Increase intake of fluids to avoid kidney stones Those with kidney stones have more chances of developing a chronic kidney disease New Delhi, 22 August 2017: Statistics reveal that the lifetime prevalence of kidney stones is approximately 13% in men and 7% in women. Without treatment, approximately 35% to 50% of those with kidney stones will experience recurrence within 5 years from the first stone. As per the IMA, increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects. Kidney stones are formed due to the accumulation of dissolved minerals on the inner lining of the kidneys. There are several types of kidney stones: calcium stones, uric acid stones, struvite stones and cysteine stones. Calcium oxalate stones are the most common. People with kidney stones are at a significantly higher risk of developing chronic kidney disease. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Lack of water in the body is the primary cause of kidney stones. In the absence of enough water to dilute uric acid (a component of urine), the urine becomes more acidic. This acidic environment is conducive for the formation of kidney stones. Kidney stones can grow as large as a golf ball and have a sharp, crystalline structure. Small stones can pass without pain. Larger stones, on the other hand, can obstruct urine flow. This can be very painful.” Some of the common symptoms of kidney stones include severe pain in the groin and/or side and back below the ribs, colicky pain, blood in urine, nausea and vomiting, pain on urination, burning sensation during urination, constant urge to urinate and fever and chills (in case of an infection). Adding further, Dr Aggarwal, said, “Certain medications can increase the risk of developing kidney stones. Long-term use of vitamin D and calcium supplements cause high calcium levels. Family history, dehydration, high protein, sugar, sodium diet, obesity and some disease conditions such as hyperparathyroidism are also risk factors. A previous history of kidney stone increases the risk of developing subsequent stones.” The following tips can help prevent kidney stones. Stay hydrated: This is the best way to avoid kidney stones. When one consumes less water, their urine output decreases making it more concentrated and less likely to dissolve urine salts that cause stones. Consume calcium in right amounts: Eat a moderate amount of foods with calcium, such as milk, cheese and other dairy food. Calcium oxalate stones are the most common type of kidney stone, hence, people believe that they should avoid eating calcium. Reduce dietary sodium: Increased salt in urine prevents calcium from being reabsorbed from the urine to the blood. This causes high urine calcium, leading to kidney stones. Limit foods rich in oxalate: Dietary oxalate is typically found in spinach, chocolate, beets, nuts, rhubarb, strawberries, tea and wheat bran. Eat less animal protein: Foods high in animal protein are acidic and increase uric acid. High uric acid levels may cause both uric acid and calcium oxalate kidney stones. Maintain a healthy body weight through diet and exercise.

Tuesday, 22 August 2017

Who can give consent?

Who can give consent? Dr KK Aggarwal Informed consent is an integral and crucial part of medical treatment today. It is not only a procedural requirement, but also a legal requirement. Not taking consent is gross negligence. Consent has to be taken before starting a treatment or a procedure. For consent to be valid, it should be voluntary i.e. given without coercion, informed and the patient should be competent to understand the information given. Consent indicates a respect for patient autonomy, a very important principle of medical ethics. This means that patients have the decision making capacity and doctors need to respect their right to make decision regarding their care. And, no doctor treats a patient without informed consent. Who can give the consent? Informed consent must ideally be taken from the patient himself/herself. In a traditional Indian setting, if the husband is hospitalized, the wife, at times, may not be taken into confidence by the relatives about the gravity of the situation or otherwise. Most often, it is one of the family members who usually sign the consent in such cases. If the patient is unconscious, then the spouse should authorize one person as a legal heir to take legal decisions, in case the spouse does not want to take decisions or is not informed. In an emergency situation when the patient is not able to give consent, then treatment may be given without consent, if there is no other person available to give consent. But, the onus lies on the doctor to prove that the treatment given was lifesaving. The facts of the case must be documented. The Medical Council of India (regulation 7.16) states that “Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed”. The MCI should revisit the regulation 7.16 and come out with a clause of “next of kin” consent or “surrogacy” consent, which should also include “all legal heirs” and not just one as part of the consent. Disclaimer: The views expressed in this write up are entirely my own

Stress is a major cause for temporomandibular joint disorders

Stress is a major cause for temporomandibular joint disorders Practicing relaxation techniques can help relieve symptoms New Delhi, 21 August 2017: As per recent studies carried out throughout India, there is a rise in the number of people suffering from TMD (temporomandibular joint) disorders. About 52% of the Indian population suffers from varying degrees of TMD and of these, 22% are affected both in the right and left TMJ. As per the IMA, a lot of these disorders can be attributed to increase in stress levels, especially among the young. TMJ connects the lower jaw to the skull. Although there are many reasons for TMJ disorders, including improper alignment of the teeth or trauma, it can get aggravated by stress as well. This is the only moveable joint in the entire face. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The TMJ is a ball-and-socket joint which can erode due to many reasons. Under stress, a person tends to clench their jaw or grind their teeth (bruxism). Due to this, the muscles become taut and the joint does not get any rest leading to inflammation, pain, and dysfunction. TMJ disorders can lead to a clicking sound or grating sensation when a person opens their mouth or chews. However, provided there is no pain or limitation of movement associated with this jaw clicking, treatment may not be necessary. Many symptoms of TMJ syndrome can respond well to home remedies or stress reduction and relaxation techniques.” Some symptoms of TMJ disorders include pain the jaw, dull ache or radiating pain towards the cheek, ear or neck, a tired feeling to the face, toothaches, headaches, clicking or popping sounds while yawning or even limited movement of the jaw. Adding further, Dr Aggarwal, said, “There are many other conditions which cause symptoms similar to TMJ disorders. These include a toothache, sinus problems, arthritis, or gum disease. A dentist will conduct a careful patient history and clinical examination to find out the exact cause and ascertain whether the symptoms are due to any TMJ disorder. Treatments for TMJ disorders range from simple self-help advice and conservative treatments to injections and surgery.” Some home treatments for these disorders include the following. • Over-the-counter medications: NSAIDs such as naproxen or ibuprofen help relieve muscle pain and swelling. • Heat or cold packs: Applying an ice pack to the side of the face and temple area for about 10 minutes can help. • Eat soft foods: Yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains are good choices. • Avoid extreme jaw movements: It is good to keep yawning and chewing to a minimum. Avoid any activity that requires you to open your mouth wide. • Posture: Practice good posture to reduce neck and facial pain. • Learn relaxation techniques: As stress is a major cause for these disorders, it is better to consider some stress reduction therapy and techniques such as yoga and meditation.

Monday, 21 August 2017

Affordability or quality of service? Choose both

Affordability or quality of service? Choose both Every citizen in the country has a right to receive safe and quality medical treatment. Achieving universal health coverage is a target (3.8) under the Sustainable Development Goal (SDG 3). All member states of the UN including India have committed to try to provide universal health coverage to all their citizens by the year 2030. Universal health coverage means good quality health care that is Available, Accessible, Affordable and Accountable. The Institute of Medicine, USA (IOM, 1990) has defined quality in health care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. The American Medical Association (AMA, 1991) has defined quality as “the degree to which care services influence the probability of optimal patient outcome”. When a patient seeks health care, he/she looks for availability, quality and affordability. Safety, desired outcome of treatment and respect are becoming more and more important to the patients today. It’s not just clinical care based on best practices alone that decides quality of care. Several other factors also constitute patients’ perception of quality of care such as cleanliness, reliability, responsiveness, communication, empathy, patient-centered with patient as an equal partner is decision making. But, quality always comes at a price. Quality treatment is costlier but in the long-term, it is economical as it is associated with fewer hospital-acquired infections, complications, adverse drug reactions, re-hospitalization, as well as fewer system failures. Quality is always preferred but it may not always be feasible because quality care may increase the cost of treatment. So, should we focus on affordability or should we focus on quality? Every hospital or health care establishment must try to improve and maximize quality within the resources that are available to them and with the best use of those resources. Poor quality service indicates poor utilization of resources. Both quality and affordability need to be balanced, especially in a country like ours, which has one of the highest out of expenditures on health in the world. Disclaimer: The views expressed in this write up are entirely my own

Lifestyle changes and stress can cause premature ovarian failure in women

Lifestyle changes and stress can cause premature ovarian failure in women Although the condition cannot be reversed, certain treatments and lifestyle changes can control associated symptoms and risks New Delhi, 20 August 2017: A recent survey has indicated that about 4% of Indian women experience signs of menopause between 29 and 34 years of age. This is alarming given the fact that most women reach menopause between the age of 45 and 55. As per the IMA, the reason behind this is likely to be Premature Ovarian Failure (POF), some contributing factors for which include changing food habits and work culture with increased stress. POF is a loss of normal function of the ovaries before the age of 40. Women with this condition can have irregular or occasional periods for years and might even become pregnant.However, it is not the same as premature menopause. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "POF results from the loss of eggs (oocytes). The atmosphere today, lifestyle habits, food adulteration as well as consumption of processed food can lead to many changes in a woman’s body. These factors are responsible for the rise in the number of cases of POF in young adults. It is a good idea for women who have missed their period for three months or more to consult a doctor and determine the exact cause. Changes in period cycle may be due to pregnancy, stress, or a change in diet or exercise habits. However, it is best to get evaluated on time.” The symptoms of POF resemble those of a natural menopause and include change in the pattern of periods, hot flashes, mood swings, crying spells, and sleeplessness. A woman can have POF if her FSH level (follicle stimulating hormone) after a blood test is more than 25mIU/L. Adding further, Dr Aggarwal, said, “Although there is no proven treatment for POF, there are other alternatives such as adopting a healthier lifestyle which can help to a certain extent. Certain treatment procedures focus on the problems that arise from estrogen deficiency. Apart from this, assisted reproductive techniques have shown a ray of hope for those with issues such as these.” Some natural treatment methods can be tried to relieve hot flashes. Here are some tips. • Eat soy as it contains phytoestrogens. Some of the best sources of soy are tofu, soy powder, soymilk, and soy nuts. • Exercise, as an active lifestyle can lower the risk of premature menopause. About 30 minutes of aerobic exercise thrice a week is ideal. • Make sure that you get an ample supply of Vitamin D, E, zinc, and magnesium. • Eat foods that are rich in calcium such as cheese, almonds, green leafy vegetables, milk, fortified cereals like corn flakes, and raisin bran.

Sunday, 20 August 2017

Govt. move to fix ceiling prices of knee implants: The need of the hour

Govt. move to fix ceiling prices of knee implants: The need of the hour Dr KK Aggarwal Early this week, the National Pharmaceutical Pricing Authority (NPPA) fixed and notified the ceiling prices (inclusive of trade margins) of orthopedic implants used in knee surgeries, both primary knee replacement surgery as well as revision surgery, under para 19 of Drugs (prices control) order (DPCO 2013) with immediate effect. In 2005, orthopaedic implants were notified as ‘drugs’ by the Ministry of Health and Family Welfare vide its S.O. 1468 dated 6th October 2005. Consequent to this, Drug (Prices Control) Order (DPCO) 2013 became applicable to these implants, which also came under the purview of the NPPA, which is mandated to monitor the prices of all notified drugs including notified devices. An estimated 1.5 to 2 crores patients require arthroplasty; however, out of these which only about 1 lakh plus well off patients are in a position to pay for it every year because of the very high cost of orthopedic implants (NPPA Notification, August 16, 2017). As per WHO estimates, osteoarthritis will be the fourth leading cause of disability by the year 2020. The ceiling price of different materials and components used in the implant in primary knee replacement system has been fixed between Rs. 4,090/- to Rs 38,740/-. Similarly, the ceiling price of different materials and components used in the implant in revision knee replacement system has been fixed between Rs. 4,090/- to Rs 62,770/-. As per the notification, “All manufacturers/marketers of knee implants having MRP lower than the ceiling price specified plus goods and services tax as applicable, if any, shall continue to maintain the existing MRP in accordance with paragraph 13 (2) of the DPCO, 2013”. The earlier average MRP of cobalt chromium, the most commonly used knee implant has reduced by an average of 65%. The MRP has been capped at Rs. 54,720/- now Wfrom the earlier 1,58,324/-Knee implants made up of special metals like titanium and oxidised Zirconium has been capped at Rs 76,600/- with price reduction by 69%. The price of high flexibility implants have been capped at Rs. 56,490/-, again with a price reduction by 69% (Press Information Bureau, August 16, 2017). All hospitals/nursing homes/clinics performing orthopedic surgical procedures using knee implants are now required to comply with the ceiling prices notified. The patients cannot be charged any additional charge over and above the ceiling price notified “except applicable goods and services tax, if any, paid or payable”. The Indian Medical Association (IMA) welcomes this move of the govt. to fix the ceiling price of knee implants as now these implants have become more affordable and within reach of the common people. Many more patients will now be able to undergo the procedure, which earlier they could not because of the very high costs of the implants. Earlier this year, the Govt. had fixed the ceiling prices of coronary stents, which also came as a relief to the general public. Disclaimer: The views expressed in this write up are entirely my own.