The Tribune, Chandigarh, India

LIFESTYLE
Heart check-up a must for executives
H.S. Wasir

Executive health check-up programmes have come into vogue over the last about three decades since the concept of promotive health care was introduced in the medical curriculum. The terms "curative", "preventive" and "rehabilitative" health care were well known in medical texts. Promotive health care, that means augmenting the existing normal state of health and protecting the body against disease, may be new in modern medicine, but it was a well-established aspect of total health care in the Ayurvedic texts as one finds its detailed description in the Charaka Samhita. The modern definition of health as given by the WHO states it to be "A state of physical, mental and social wellbeing and not necessarily the absence of disease and infirmity".

Promotion of health (positive health) and prevention of disease (negative health) are the objectives of "positive health programmes" or the "executive health checkup". Various corporate organisations are managed by executives who work under rigid schedules, meeting deadlines with odd working hours, unhealthy eating, drinking and smoking habits and frequently staying away from their homes and families. This working environment exposes them to many risk factors injurious to their wellbeing. Such repetitive exposures may be the cause for their getting diseases like hypertension, diabetes, heart attacks, lung ailments, obesity due to lack of exercise and over-eating, the irritable bowel syndrome, insomnia and infections due to impaired body immunity.

The purpose of the executive health check-up programme is to examine the apparently normal people involved and often busy in their responsible jobs so as to pick up any abnormality at its sub-clinical (incubation)stage and thus take remedial measures at an early stage to prevent major catastrophes that will harm the executive in his/her most productive years, and adversely affect their family and the organisation for which he/she is working. Sometimes the organisation or the state spends huge sums to train an officer for a particular job such as Air Force or civil airlines pilots and their ill health may result in great damage to others as well, apart from self.

A detailed interrogation of the executive during history taking will reveal if the individual is having any risk factors which make him/her more prone to a heart problem in future. Accordingly, this advice will be given to protect against the controllable risk factors so that diseases like high blood pressure and heart attacks can be prevented. The risk factors which can be controlled are Smoking habit, sedentary living, lack of physical exercise, obesity, excessive alcohol intake, hostile behaviour, and wrong eating habits which result in high blood cholesterol, obesity and diabetes.

Physical examination: A routine physical examination in an apparently healthy executive will help us to detect (i) overweight, (ii) high blood pressure as, by and large, hypertension is a silent disease, and (iii) some abnormalities in heart valves, such as disease of aortic, pulmonary or mitral valve. Some disorders of the left ventricle and the right ventricle may not show any symptoms in individuals who are not engaged in any physical exercise and are leading a sedentary life. Most of these diseases are easily correctable by non-surgical and surgical means, but, if left unattended, may suddenly result in a serious outcome, at times even fatal. A routine medical check-up of executives will thus help in early detection and timely treatment of these heart problems.

Investigations: The cardinal symptoms of heart disease are palpitation, breathlessness, chest pain and fatigue. It may be interesting to know that any one or more of these symptoms may occur in disorders other than heart diseases, like anemia, thyroid disease, lung disease and simply being overweight. The routine investigation in the case of an otherwise "normal" looking executive, who might have been pushing himself/herself too much against his/her capacity and ignoring some of the above symptoms, may reveal:

* Low hemoglobin levels either due to wrong eating habits or small but chronic blood losses, which will need further investigation.

* Abnormal blood sugar levels — as many a times diabetes is also picked up on routine investigations, especially when there is a family history of diabetes. It is very rewarding that once diabetes is detected in early stages, mere change in lifestyle like doing regular physical exercise and modification in the dietary pattern is all that is needed to control the disease. If drugs are required, their dosages are small.

* High blood cholesterol as such or its variants are a major risk factor for heart attacks. When picked up during a routine check-up when it has as yet not resulted in a manifest heart disorder, it may be controlled by modification in lifestyles such as avoiding the consumption of food from animal origin like meats and dairy products, and doing more, regular physical exercise. Rarely may some drugs be needed to control high blood cholesterol. These days reasonably safe drugs are available for this purpose, such as statins.

* High blood uric acid, if detected on routine testing, can be managed by omitting certain items in diet such as red meat, red wine and red beans. High blood uric acid is harmful for the joints, kidneys and arteries.

* Abnormal lung function on a routine testing will be a strong alarm to quit smoking at that stage so as to prevent irreversible lung damage due to chronic bronchitis and to avoid getting lung cancer by continuing smoking.

* A routine X-ray of chest may help to detect any silent lung lesion such as a cyst or a "coin" lesion, especially in a smoker, and this timely observation will be warding off serious problems like cancer in future. Even if the X-ray chest is absolutely normal it will be a good reference for any future comparisons. The same holds true for an ECG.

* ECG: An abnormal ECG (electro-cardiogram) does not always denote a serious heart problem, and a normal resting ECG does not rule out an underlying heart disease. An abnormal resting ECG makes us look into some heart disorders and if none is found, a repeat ECG after six months or a year is all that is needed for follow-up. A normal ECG at rest does not always reveal the underlying state of the heart, and in conditions like angina that occurs on exertion or emotional tension, ECG abnormality can be picked up only on exercise or during a continuous dynamic electro-cardiography done generally for 24 hours during the time when a person continues to be doing all his/her normal activities. This is called Holter Study.

* Exercise test or tread mill test (TMT): When the ECGat rest is normal; an exercise test is advised for the executive check-up, especially in pilots and others whose professions involve many other lives while on duty. A person with an abnormal exercise test or TMT should in consultation with his cardiologist undergo other investigations like echocardiography, stress thallium and at times coronary angiography to know for certain the state of coronary arteries that supply oxygenated blood and nourishment to the heart. If some blocks are found in any of the coronary arteries, we have the means to clear these blocks in the same sitting during angiography so that any serious outcome may be avoided in these "apparently" normal individuals, and thus preventing sudden cardiac death, which is the most dreaded presentation of coronary heart disease (heart attack).

* Holter study: When a person has symptoms of palpitation or giddiness, fainting feeling or chest discomfort at different times during work or at leisure, but during the time of being examined in the doctor’s office there are no symptoms and the ECG is also normal, it is with this background that a Holter Study (continuous ECG recording during work, play and leisure) is advised. his study helps us in detecting any abnormalities in heart rhythm (slow, fast or irregular heartbeats) and in the diagnosis of silent myocardial ischaemia.

* ABP: Like the ambulatory ECG, ABPM (ambulatory blood pressure monitoring) can measure blood pressure continuously during work and leisure. This modality is helpful in detecting paroxysms of high and low pressure and to see the efficacy of various antihypertensive drugs during a 24-hour period. The interpretation of blood pressure record has to be done very carefully due to the motion artifacts, which may distort the mean pressure recording. The other drawback in this procedure is that repeated inflations of the rubber cuff may bring in an uncomfortable feeling, sometimes even painful, and this may disturb the individual, specially during sleep, thus adversely affecting the pressure readings. Therefore, it is not recommended routinely but only under special circumstances as decided by the evaluating physician.

* Echocardiography: The role of routine echocardiography in an apparently normal person is limited but may be useful in detecting silent heart problems.

* Stress thallium: This test is advised when the TMT result is abnormal in a person who otherwise is totally symptom-free. Stress thallium helps in detecting any areas of impaired blood flow to the heart muscle.

* Angiography: By angiography of the heart and blood vessels we can have a direct look at the various heart chambers and coronary arteries — the blood vessels that supply nourishment to the heart. The procedure, which is relatively safer in experienced hands, involves introducing fine catheters into the heart and coronary arteries to measure pressures and take cine films of the heart in action by injecting radio opaque material.

The decision about doing angiography should be made on an individual basis by the consulting cardiologist. In general, a person with abnormal TMT should have angiography even if he has no symptoms during daily activity. At present angiography is the only test which can for certain tell us if there are any significant abnormalities in the heart and the coronary arteries needing any remedial measures. A normal angiogram goes a long way in reassuring the executive that all is well with his heart in spite of some abnormalities in the ECG or the TMT report. This finding of a normal angiogram comes as a great relief and the executive’s mind is now at peace to fully devote himself/herself to the job and the family.

* Interpretation of test results: Both the abnormal and normal reports of the various tests conducted in these otherwise healthy individuals must be interpreted carefully and conveyed in a very caring and not scaring way even if some reports are found abnormal. The idea of these routine tests in the executives is to make them aware of any risk factors so that they actively contribute to their own health care instead of leaving everything to the doctor.

The writer is Chief Cardiologist & Medical Adviser, Batra Hospital & Medical Research Centre, New Delhi.

The fall and rise of paramedical science
A.K. Banerjee and Madhu Meeta

Paramedical science is an inseparable part of the health care system and runs parallel to medical science in the diagnosis and treatment of diseases. Diagnostic tools like the clinical laboratory, the X-ray, the ultrasound, CT and other invasive or non-invasive methods and therapeutic technical modes like physiotherapy, occupational therapy and speech therapy are part of the paramedical system.

There was a time when paramedical work was entrusted to semi-literate compounders and ward assistants. It was looked down upon as the paraphernalia of medical management that used to depend more on the clinical acumen and professional judgement. Investigations were neither available nor affordable.

With the development of medical science and its attendant spurt in complex mechanisation of medical equipment, there had been an inadvertent growth in paramedical science. This automatically prompted a demand for trained paramedical manpower. However, at this time paramedical education was an important but integral part of medical education. Medical students were taught the procedures and methods. The concept of independent existence of paramedical education was still unrecognised.

In the day of consumer litigation, help from properly trained paramedical personnel is invaluable in reaching a correct diagnosis or in formulating as sophisticated mode of treatment. However, in spite of its importance in the health care industry, the potential of paramedical science as an organised form of education is still vastly underestimated. The government did not bother about forming any strategy to promote an independent paramedical education. There is no paramedical council like the Medical Council, the Nursing Council or the Pharmacy Council to govern the particular system of education.

Exploiting this legal loophole, many unscrupulous people opened training centres. In the absence of any governing authority, administrative, regulation of centralised system, such pigmy-sized dubious centres mushroomed all over India. They distributed diplomas, not knowledge. They produced qualified paramedics, not educated ones. They made paramedical training a profitable business, not a source of social service.

Fortunately, this callous attitude is changing. Universities, though taking the advantage of the absence of any governing council, unknowingly came to the rescue of paramedical education. Instead of "khokhas" producing paramedics, now there are a well-planned streamlined curriculum, latest equipment, professional ambience, qualified tutors, and, above all, a credible controlling body to implement quality norms.

The writers are President and Vice-President, respectively, of the Bengal Institute of Paramedical Training, Raikot (Punjab).

INFO CAPSULE
Happy heart is healthy heart

WASHINGTON: US researchers have said that in order to enjoy good health it is necessary to share warm relationships and have open conversation, whether with a spouse, a sibling or a friend.

"Some kind of open communication is very beneficial, and you don’t necessarily have to be married. Some people have very strong social networks outside of marriage," Columbia University psychologist Matthew Silvan said, according to a report published in the Health Scout. ANI

Demystifying cancer

NEW DELHI: The title of the book "The Joy of Cancer," may spring a surprise with its strangely dichotomous affirmation, but it is in fact a rare statement of courage from the author who finds joy not just in winning his battle against the deadly disease but in sharing that experience with the readers.

According to the author, Anup Kumar, who currently heads the Corporate Communications department of a leading industrial organisation, the book is the outcome of the emotional and physical anguish that followed the diagnosis of his lung cancer which had advanced to the last stages.

"The Joy of Cancer," to be launched by Sunil Dutt, MP, is intimately autobiographical, speaking about the intensely personal details of a destructive and destroying illness. The author demystifies the disease, removing the psychological dread associated with cancer. PTI

Soya milk & breast cancer

LONDON: New research suggests that soya milk and tofu — soya bean curd — may reduce the risk of breast cancer. Diets rich in soya appear to affect the make-up of breast tissue, according to scientists from the charity Cancer Research, UK. It carried out the research with the National University of Singapore and the US National Cancer Institute.

Women who ate a lot of soya were much less likely to have the "dense" tissue associated with breast cancer, the researchers say. AFP

Breakthrough in surgery

Hyderabad: A path-breaking surgical procedure called Hands Assisted Laparoscopic Surgery (HALS) was performed by Dr Anji Reddy, Consultant, Surgical Gastro-Enterologist and Laparoscopic Surgeon, recently at Apollo Hospital here.

HALs is considered to be a major revolution in the field of surgery after the introduction of keyhole surgery (laparoscopic surgery) a decade ago.

A 40-year-old male patient from Bacheli in Madhya Pradesh, suffering from intestinal bleeding, was operated at the hospital using the HALS technique. He had recovered and was waiting to be discharged. UNI

Polio-free zone

Copenhagen: The World health Organisation declared its European zone of 51 countries free of the polio virus that can cause paralysis and sometimes death.

To be certified poliomyelitis-free, a WHO region must prove that three years of extensive surveillance have found no wild polio.

Southeastern Turkey was the last area within the health body's European sphere to have had polio. The last case was reported in November, 1998, in a Turkish province along the Iranian border. The virus eventually was traced back to northern India.

The European zone, which includes the former Soviet republics and has 873 million inhabitants, became the third WHO region decreed free of polio. AP

Fish and liver cancer

SINGAPORE: Scientists are engaged in an ambitious new project in the hope that a tiny, transparent fish will help them understand the development of liver cancer, a very common form of the disease in the Asia-Pacific region.

About 50 researchers and scientists are focusing on the zebrafish during the next five years at the Genome Institute of Singapore, assisted by millions of dollars in government grants, The Straits Times has reported. Like humans, zebrafish can be prone to cancer. DPA