HEALTH TRIBUNE Wednesday, March 27, 2002, Chandigarh, India
 

A good Resident is a valuable healer
Dr J.D. Wig (MS, FRCS)
, one of the famous surgeons of our region, tells Residents both senior and junior how immensely valuable they are. In a subtle manner, he makes the public aware of the worth of the Residents against whom they have hundreds of grouses everyday.

Pain in the neck
Dr Mandeep S. Dhillon, MS, MNAMS
P
ain in the neck is a frequent situation encountered in daily life. Almost all of us suffer from pain or stiffness in the neck or the shoulder of some point of time in our lives. Neck pain is more frequent in the sedentary urban population compared to the active rural population, basically due to the poorer muscle tone and improper posture of the former.

Ayurveda & total health
Holi but no chemicals
Ayurveda Shiromani Dr R. Vatsyayan,  Ayurvedacharya
B
earing close resemblance to the ancient Indian festival called Vasantotsva, Holi, the most colourful festival of our country, falls with a full moon in the month of Phalgun-Chaitra. There are many stories woven around the origin of this festival, some relating to the slaying of Holika, the sister of Hiranyakashipu, a king, and others attributed to the ultimate lover, Lord Krishna chasing Radha and gopis.

Homoeo tips
Problems of growth
Drs Vikas and Anu Sharma
H
omoeopathy is able to treat with success developmental disorders ranging from mild milestone delays to serious Sensory Integration Deficiency (SID) disorders like autism and Pervasive Developmental Disorder (PDD).

Conspirators in drug addiction
Dr Rajeev Gupta
The road to the management of drug addiction is full of ups and downs. It is not an easy drive for an addict, his family and the treating specialist. Such management needs a lot of patience.

Diet and health
From skin to stomach
Radhika Oberoi

Question: I am a 16-year-old girl. Although I have been eating plenty of fruits, vegetables and milk products and a good nutritious diet for the past 15 days, there is no apparent results on my skin.

Destination Arogya!
On March 31 (Sunday) North India will see the inauguration of its first interactive seminar on "Indian Systems of Medicine and Health Tourism" at Hotel Shivalikview, Chandigarh, under the aegis of the Department of ISM and H, Ministry of Health and Family Welfare, Chandigarh Tourism, CITCO and Northern Indian States' Departments of Ayurveda. 

 
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A good Resident is a valuable healer

Dr J.D. Wig (MS, FRCS), one of the famous surgeons of our region, tells Residents both senior and junior how immensely valuable they are. In a subtle manner, he makes the public aware of the worth of the Residents against whom they have hundreds of grouses everyday.

Residents,

You have been chosen to participate in the most privileged calling entrusted by the public that puts its health and lives in your hands. Stay focused and never lose sight of the ideals that brought you where you are today. No matter what speciality you choose, you will be doing it for at least three decades. And that is a very, very long time. So choose something for which you have the utmost passion. If your initial choice does not fulfil that, have the courage to change. Do not compromise.

The rewards of surgical science include the sense of satisfaction in solving complex problems as part of a team, the rapidity with which we can help people and the appeal of working with our hands. All these gifts we are given by virtue of having chosen this fascinating profession. The glorious mission we have accepted is to fulfil our proud obligation to those who come to us for the help that only we can give.

The period of residency (three years) is special. In no other profession are your strengths so appreciated, and your weaknesses so exposed. There is something very special about the friendships that you develop during this period. In years to come, you will remember these experiences. So, develop individual bonds and cherish them.

This period is a very difficult one. Everyone wants a bit of you patients, parents, wives, children and very little is left for yourself. This can put you under tremendous stress. Find something long walks, vigorous exercise, games, swimming, music, in fact anything you like. This will do you a lot of good.

In the hospital, greet the hospital staff the peramedics. The response is wonderful. When you talk to them, say to them good morning and have a nice day. This will make your life comfortable in the hospital.

You have to be gentle and caring. Sit at the bed side of your patients. Say a few words to them. Quietly ask how he or she is feeling. You can never imagine the immense sense of satisfaction resulting from your soothing words, especially in a patient with advanced cancer and other life-threatening illnesses. It is an enriching and gratifying experience. Treat the patient as a fellow human being.

You may encounter despair, fear, anger, and a large number of questions and demands from the relations of patients. They may be looking for honest answers. Face them politely. Be kind to them. Never ever brush them aside.

Patients and their families will write to you throughout the year. Cherish the contents of those writings, particularly at times when you feel undervalued or unwanted, as we all face this from time to time. I find comfort in the words so thoughtfully expressed by those whom I have the privilege to serve. You too will have the same feeling.

Many bemoan the state of doctors almost everyone administrators, bureaucrats and even some of your mentors, leaving you discouraged, disillusioned and despondent about your future. The charge is levelled everyday in every forum that doctors want more money. Money is the last thing a committed doctor worries about. You want a congenial, in atmosphere to work in which you can develop a creative mind, and give your best. The present scenario is gloomy. You are often used to settle scores. Resist it, reject it and rise above it. Do not let others beat you down. Your workplace is a temple of learning and patient care. Channellise your energies towards learning.

We have to know and care for everything involving our patients, in addition to the immediate problem that we have been summoned to treat. We are committed to listening to the needs of our patients and understanding how to help them most effectively. A patient is a fellow human being.

Crucial intraoperative decisions that we make will affect the entire course of the patient's life and that of the life of everyone who depends on the patient.

Surgeons are masters of the visual and the tactile. See who our patients really are and feel what it is like to be in their place. We should be the sources of fulfilment of the hope of every person who comes to a surgeon for the help that only a surgeon can give. One of the essential qualities of a surgeon is his interest in humanity. Caring for the patient is a sacred ordination. We must learn to listen to the "person" in the patient and treat patients as persons.

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Pain in the neck
Dr Mandeep S. Dhillon, MS, MNAMS

Pain in the neck is a frequent situation encountered in daily life. Almost all of us suffer from pain or stiffness in the neck or the shoulder of some point of time in our lives. Neck pain is more frequent in the sedentary urban population compared to the active rural population, basically due to the poorer muscle tone and improper posture of the former.

Some common causes of pain are sprained ligaments, minor malalignments of the joints, and prolonged improper posture. The more serious conditions are prolapsed disc with nerve compression, infections or spinal tumours. Cervical spondylosis is encountered in the middle aged and elderly population, with the wear of spinal joints and discs (inevitable with age).

The head is constantly being balanced on the neck, and is kept erect by the continual activity of neck muscles. The poor posture (adopted by office workers, and by reading or watching TV in bed), stretches these muscles, which weaken, and accumulate abnormal stresses. This leads to the minor displacement of neck joints, which causes the "crick in the neck".

Pain is felt in the shoulder blade region, and may even radiate to the shoulder, with movement restriction. This is easily cured once the joint comes back into position, often accomplished by minor manipulation or by rest and mild medication. This is where the "bone-setters" get their fame, by causing a dramatic improvement in symptoms after manipulating the neck. However, neck manipulation has very specific indications, and a wrongly manipulated neck or a jerk given for a case with nerve compromise or a latent infection could lead to an avoidable disaster!

Stiff necks are temporary, aggravated or brought on by sleeping in the direct draft or coolers or air-conditioners, and may be the precursor of a mild viral infection. Years of poor posture and lack of exercise precipitate this; the condition is self-limiting, and in most cases the pain will subside and neck movement will be regained after a few days. It helps to give moist heat to the area (wrap a warm wet towel on the back of the neck), restrict neck motion for a couple of days and use simple medication like Brufen or Paracetamol. No local application is beneficial, but it may give a feeling of relief. Pain persisting for a few days needs to be checked by your doctor.

Not all neck pain is benign, and occasionally may reflect a serious pathology. All of us will get some type of pain related to the wear and tear of the cervical spine (spondylosis). the first attack should warn us that the problem is setting in and it is time for remedial measures. There is no way of reversing the degeneration, but further progression can be retarded. With age, the neck motion range decreases, producing strain even in daily activities.

The muscles weaken and cannot carry out even routine supportive functions. The treatment involves muscle strengthening and regaining movements without pain; most patients are able to carry out a home exercise programme. The therapeutic effect is cumulative, and is only observed after a few weeks.

With disc prolapse, pain is sudden, is related to strain, radiates to one or both arms, and maybe associated with a tingling sensation or numbness. The discs are like gel-filled balloons in between the bones, which acts as shock absorbers. They lose water with age and become more susceptible to strain. The "gel" may be squeezed out and pressed upon an adjacent nerve.

The treatment involves rest (aided by collars or traction), and medication to reduce pain and muscle spasm. This is followed by gradual rehabilitation once the pain subsides. Rare cases, that don't improve, will need the surgical removal of the offending disc.

Some mention of the role of collars and traction in the treatment of neck pain is mandatory. A collar is a device that partly restricts movements, and helps in pain relief by enforcing rest. Long-term use is harmful, as muscles become weak. It is ideally used when pain is excessive and is followed by muscle strengthening. Traction is of two types; intermittent traction is given for acute spasm or cervical spondylosis, with the aim of relaxing the muscles. Concomitant local heat (microwave or shortwave diathermy) also helps; excessive use is detrimental in the long run. Continuous traction, used in disc prolapse, also has a similar function, but mainly serves to keep the patient in bed!

We must realise that neck pain is caused by a diverse set of problem, the principal one among which is the cumulative insult caused by an abnormally bent posture at this region. A basic understanding of postural correction and a simple regimen or exercises will prevent most neck pain.

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Ayurveda & total health
Holi but no chemicals
Ayurveda Shiromani Dr R. Vatsyayan, Ayurvedacharya

Bearing close resemblance to the ancient Indian festival called Vasantotsva, Holi, the most colourful festival of our country, falls with a full moon in the month of Phalgun-Chaitra. There are many stories woven around the origin of this festival, some relating to the slaying of Holika, the sister of Hiranyakashipu, a king, and others attributed to the ultimate lover, Lord Krishna chasing Radha and gopis.

This festival of merrymaking is celebrated by millions of us by sprinkling dry or wet colours on one another; it matches the full bloomed riot of the splendid spring. Traditionally, Holi was played by making colours from flowers and herbs which were available in plenty during the season. Many of these are known for their therapeutic and beneficial effect on our health, particularly the skin. Even today, in some parts of the country, Holi is played by people throwing flower petals on one another.

With the passage of time, the spirit and essence of our festivals, including Holi, have been taken over by deviant tendencies. Most of the Holi colours sold in the market are oxidised metals or industrial dyes mixed with other chemicals. For example, the green powder has copper sulphate in it, the purple element is chromium iodine. Silver is made from aluminium bromide and black is that dangerous lead oxide. Shiny colours are obtained by mixing powdered glass and peels of mica cakes into these chemicals. The powdered volume is increased.

There are reports that some of the chemicals which constitute these colours are highly toxic and can cause even cancer. More and more people, who handle colours or play Holi with them, complain of conjunctivitis, visual impairment, chest problems like asthma and pneumonia, skin reactions and dermatitis.

More serious problems are also attributed to the systemic absorption of the baneful chemicals. Apart from the danger of chemical colours, even the way we play Holi is becoming harmful. Throwing water balloons with force can cause injury to the eyes and the ears. Rowdy and indecorous behaviour results in spoiling the grace of this great festival.

Today, much of the gaiety and fervour supposed to be associated with Holi can be regained by opting for safe organic colours. Ayurveda, the most eco-friendly medical system in the world, suggests that one should use various herbs and flowers to prepare natural colours. For instance, flowers of the Tesu or Palash tree or that of Simbal (soaked or boiled in water) that gives red or yellow colour. Khadir or kattha, the thing eaten in betel leaves, when mixed in water, turns into a beautiful brownish liquid.

Many other herbs such as turmeric or haldi have been known for their beneficial effect on the skin and so is besan. Both of these household items are used as ubtan or face pack. Dissolving a little haldi in water makes bright yellow colour. This can also be used as a paste. The powder of red sandal, dried and pounded marigold, harsingar and chrysanthemum flowers and crushed leaves of mehndi or henna make attractive, natural and sweat smelling colours.

Holi is an exuberant occasion of goodwill and cheer. Let us resolve not to spoil its spirit and sanctity. So, let us celebrate it in a healthy way by saying no to chemicals and also by adopting natural colours. Happy Holi!!

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Homoeo tips
Problems of growth
 Drs Vikas and Anu Sharmar

Homoeopathy is able to treat with success developmental disorders ranging from mild milestone delays to serious Sensory Integration Deficiency (SID) disorders like autism and Pervasive Developmental Disorder (PDD). A recent study published by British Homoeopathic Journal (2001) 90,183-188 ("Treatment Hyperactive Children") indicates that the homoeopathic treatment of ADHD (Attention-Deficit Hyperactive Disorder) is far more beneficial and safe for children than the use of allopathic drug called methylphenidate. The average time needed to reach an optimal homoeopathic treatment effect" is 3.5 months on a range of 1-16 months.

Homoeopathic medicines Tatrentula H, Carcinocin, Nat Mur, Thuja, Baryta Carb and Calcarea Carb are a few of the very efficacious ones in treating developmental disorders. Another medicine which has made its appearance on the homoeopathic table is Secretin and is being used for treating autism where a leaky gut is often a presenting symptom. Secretin is a gastric hormone which helps in the breakdown of peptides. In a proposed theory, high levels of peptides are said to be responsible for an "opoid" kind of effect on the brain, resulting in the classical symptoms of autism. Homoeopathically, Secretin is used in a highly diluted form.

With such effective medicines being introduced in homoeopathy to treat autism, the science of healing has a lot to offer in the field of neurological developmental disorders. For long, homoeopathy has been the Cinderella of medicine. The time has come for this lowly handmaid to shed the cloak of passivism and boldly proclaim what good it can do. In subsequent features more will be said, on the above mentioned disorders. (Next week: Hyperactive children)
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Conspirators in drug addiction
Dr Rajeev Gupta

Psychiatric Director, MANAS, Ludhiana
The road to the management of drug addiction is full of ups and downs. It is not an easy drive for an addict, his family and the treating specialist. Such management needs a lot of patience. Since the number of addicts is growing fast in the country, particularly in our region, it is important to understand some of the difficulties which are commonly faced while managing them in clinical practice.

Lack of concern on the family's part: It is my experience that many family members do not consider addiction as a serious problem. They take it lightly. They wrongly believe that their son or daughter is using drugs only for fun and when he or she will develop insight, he or she will leave the drugs he or she has been taking. There is nothing like "light drug use". Every case of drug abuse should be taken seriously and adequate measures should be adopted to check it.

Shyness of the family members: It is commonly observed that most of the people feel shy of contacting healthcare professionals for seeking help for their addicted family member(s). Because of this shyness, they lose very precious time. They keep on making a common sense approach to the problem. It is only when the situation deteriorates that they go in for psychiatric consultation. In the case of addiction, the sooner one realises the gravity of the situation, the better it is for all concerned.

Coexisting psychiatry mobidity: Addicts commonly suffer from coexisting psychiatric ailments like severe anxiety, depression, gross suspiciousness and unprovoked violence. These psychopathologies further complicate the situation. They worsen their social behaviour. For any treating doctor, it is important to realise the presence of the abnormal emotional experiences so that adequate and timely treatment can be instituted.

Poor motivation: To come out of a problem one needs to have motivation. Most of us are greatly blessed by Mother Nature in having such motivation. It is everybody's desire to rise on the life's ladder. It is motivation which makes one work for excellence.

The motivation of an addict is badly blunted. I often feel that a good number of them do not want to come out of the mess. They hardly show any interest in breathing fresh air. They show no concern for their constant deterioration.

Loss of sensitivity: Addiction leads to the loss of sensitivity. Without sensitivity human beings lose their special social position which is unique to homo sapiens. Addicts lose empathy for their family and friends. They withdraw into their self-made shells. The pain and suffering of others do not affect them. As the process of addiction proceeds, they lose their sensitivity and awareness of themselves and hardly show any concern for their physical, psychological or social deterioration.

Regression: As the time passes, most of the addicts regress to a lower level of mental and social functioning. They are not repulsed by their lost status in the family and society. They start adjusting themselves to the lower levels of the social ladder. They hardly react even to sub-human existence.

Peer pressures: Addicts make small groups of their own. These groups give them shelter, support and solace. They feel comfortable amidst their peers. When any of them tries to come out of the group, pressure builds up from the fellow-addicts. No peer wants a member to live a drug-free life. I have often observed that once an addict is admitted for treatment, his friends try their best to contact him and provide the destructive drugs.

After leaving the drugs, one is cajoled or coerced into a retreat.

I advise such patients to go away from their respective towns for a few weeks or a few months so that they are away from the bad company.

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Diet and health
From skin to stomach
Radhika Oberoi

Question: I am a 16-year-old girl. Although I have been eating plenty of fruits, vegetables and milk products and a good nutritious diet for the past 15 days, there is no apparent results on my skin.

Answer: Skin requires a balanced nutrition. These nutrients take time to reach the skin when we improve upon certain things. It may take weeks, or even months, to get the desired results. Do not expect wonders overnight patience always pays!

Question: It is true that constantly losing and gaining weight can have a bad effect on our skin?

Answer: Yes. Eating too much and becoming over-weight thickens the layer of fat under the skin and consequently stretches it. Crash dieting not only deprives the body of essential nutrition required to be healthy and good-looking but also leads to the appearance of lines and wrinkles.

Question: Suggest some diet tips for getting rid of constipation.

Answer: Have plenty of fluids. About 10 to 15 glasses of liquid are advised. Warm fluid taken early in the morning on empty stomach (such as hot water or weak tea) helps some people to evacuate the bowel. Opt for green leafy vegetables and whole fresh fruits that provide roughage. Unrefined cereals and whole dals should be preferred.

Don't sieve the flour. Extra wheat bran can be added to chapatis to produce bulk. Bananas, guavas, papayas, and dried fruits like prunes, figs, raisins, dates and apricots are also useful.

Vitamins of the B-group, preferably as the brewer's yeast, help some patients to regulate the bowel function.

Extra potassium in the form of vegetable soup and fruit juice can be taken.

Avoid refined cereals like sago, semolina, refined starch products as cornflour, custard powder, arrowroot powder and bakery products as cakes, pastries and biscuits. Avoid fat-rich spicy foods. Take small, frequent meals and regular exercise.

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Destination Arogya!

On March 31 (Sunday) North India will see the inauguration of its first interactive seminar on "Indian Systems of Medicine and Health Tourism" at Hotel Shivalikview, Chandigarh, under the aegis of the Department of ISM and H, Ministry of Health and Family Welfare, Chandigarh Tourism, CITCO and Northern Indian States' Departments of Ayurveda. The seminar will attempt to find an answer to the question: why does Ayurveda, or for that matter any other Indian system of medicine, find little favor with patients and the Government? There will be startling curative disclosures.

The seminar will try to dispel various misconceptions prevailing in the country about the efficacy and curative powers of the Indian systems of medicine. Ayurvedic, homoeopathic and unani practitioners, high-ranking officers, eminent citizens and media experts will participate in it.

An important feature of Arogya will be an exhibition (March 31 - April 2) in which a number of government departments, manufacturers of medicines and Ayurvedic institutions will display their products, including medicines and cosmetics. People will hear a series of lectures and see the herbs which go into the preparation of medicines. Free consultation will be available.

The event has been conceived and will be coordinated by ITFT (Institute of Tourism & Future Management Trends) Chandigarh.

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