July Edition, 2016 of Health Spectrum

www.healthspectrum.org Title Code : UPENG04171 HEALTH STUDY/RESEARCH July 2016 Volume I Number I Price ` 75 Healing The Sufferings of People Healthcare In Rural India Adult Vaccination Dr. Sushma P Sinha Dr. H S Chhabra Dr. Mukesh Batra Dr. Raju Vaishya Dr. Vivek Nangia Dr. R K Tuli Dr. Rahul Gupta Dr. Rohan Khandelwal Dr. Yuvraj Kumar Dr. Dharminder Nagar Dr. Ira Chopra Dr. Shobhana Mittal Dr. Pallavi VaishyaHealth Spectrum

2 July 2016 Health Spectrum

LettersJuly 2016, Volume 1, Number 1 Doctors should provide Media to lauch monthly health simple, easy and accurate magazine ‘Health Spectrum’.Editor : Vinod Kumar health information to With increasing number ofManaging Editor : Sushila Kumari patients people seeking the Dr GoogleContent Head : Aarti Kapoor for medical problems, it isEditorial Advisors : I think one of the main problems important that we have a credibleDr. Jitendra Kumar in Indian medicine is the group of professionals who canDr. Manoranjan Sahay tremendous gap in knowledge give unbiased and scientificDr. Pallavi Vaishya that exists between patients and information to the public. Also aOur Repersentatives : doctors. This leads to doctors lot of information on the internetSama Irani (Mumbai) developing a paternalistic is for the western population andAloka (Ranchi) attitude and they investigate, does not suit the Indian public.Arun Kumar Mayank (Patna) prescribe and advise courses of For example, Avocado fruit forDeepa Tomar (Singapore) treatment which are accepted breakfast to loose weight. NonArt Director : Kripa Shankar by patients unconditionally communicable and life styleDesign & Graphics : K A Choudhary but may not always be in diseases are rapidly competingAdmin & Business : Satnam Singh their best interests. There is with infections and cancer andRegistered Office : 21, UNI Apart- a great need for vehicles to will eventually become thements, Sector-11, Vasundhara, provide health information to number one cause of medicalGhaziabad – 201012 (U.P.) patients which is simple, easily problems in India. A forumTel : +91 120 4320050 understood, authoritative and, like “Health Spectrum’ wouldM: +91 9013074414, +91 9868793203 most important, accurate. I have give opportunity to discuss theDelhi Office : 909-910, B-Wing, had experience of trying to prevention and management ofNaurang House, Kasturba Gandhi narrow this gap in knowledge these health problems and itsMarg, New Delhi :110001 through television programmes solutionsMumbai Office : 37/911, Adarsh Nagar, such as the World this WeekWorli, Mumbai- 400030 many years ago, via the internet Dr Arun PrasadEmail : [email protected] - Doctor NDTV and now Senior Consultant Surgeon -Website : www. healthspectrum.org www.Raxadoctor.com and am Minimal Access Surgery (Gastro delighted that a monthly health intestinal, Robotic, Bariatric &Views expressed in articles are the views of the magazine ‘Health Spectrum’ is Thoracoscopy), Apollo Hospital,individual author. They do not represent the being launched. I am sure it willviews or interests of Health Spectrum. become very popular. It deserves New Delhi. to be.Printed, Published and Owned by Magazine would do a Dr. Samiran NundyVinod Kumar Dean, The Ganga Ram Institute yeoman servicePrinted at Subhashini Offset Printers,F-10, Jagdish Nagar, Patel Nagar-III, for Postgraduate Medical I am delighted that a muchGhaziabad (U.P.) Education and Research, Sir needed health magazine “HealthPublished at 21, UNI Apartments, Sec- Ganga Ram Hospital, New Delhi Spectrum” is launched undertor-11, Vasundhara, Ghaziabad (U.P.) your watchful eyes. I amEditor : Vinod Kumar Health Spectrum : a confident that this magazineTitle Code : UPENG04171 platform to discuss health would do a yeoman service for Problems and solutions the people of India.Health Spectrum This is a good initiative by Medi Vivek Shukla Senior Journalist New Delhi [email protected] It gives me immense pleasure to know that Mr Vinod Kumar (Editor) is launching a monthly health magazine “Health Spectrum” with the objective to create health awareness in our society and will cover all aspects of Health and Medicine. I would like to congratulate Mr. Vinod Kumar & his entire team for the inaugural issue of the magazine. Dr. Sunita Godara Asian Marathon Champion 1992 Director-Health Fitness Trust President-Health Fitness Society July 2016 3

Contents July 2016 In The News 6 l Yoga takes over the world on second international day of yoga l President bestows Florence Nightingale Awards on 35 Nurses 7 l International Convention on World Homoeopathy Day 8 l Foundation Stone laid for three new Medical Colleges 9 7New Study/Research 12 Regular Columnsl Every fourth woman in urban Face to Face 24India either overweight or obese 10 Case Study 26l Electronic Waste: Health Fitness Mantra 38Hazards For 5 Lakh Child Labourers 11 Q&A 48l Dietary Habits & Processed 12 Beauty Care 32Foods Spurring Cancer Incidencein India When Beauty is more than Skin Deep – Dr. P. K. Talwar Articles Healthy Motherhood 33 l Is Left-handedness a Handicap for Training in Surgery? Know what to expect from high-risk - Dr. Rohan Khandelwal  27 pregnancies20 l Blue Light Hazard: Eyes Face Food & Nutrition 34 Threat from Blue Violet LightCover Story Important to take Balanced, Nutritious Diets -Dr. Ira Chopra  28 during PregnancyAdult Vaccination- Dr. Vivek Nangia l Cholesterol Woes 52 – Dr. Pallavi VaishyaCurrent Issue 28 Fitness36 Benefits of Swimming14 Parenting Alternative Medicine 40 44l Huge manpower gaps l Understanding Psychology of Your l Homeopathy: Treatment ofbedevil healthcare in rural Children - Dr. Shobhana Mittal the ‘Cause’ and ‘Effect’India: How Private Sector -Dr. Mukesh Batra Can Help - Dr Dharmind-er Nagar Holistic Medicine l Era of Holistic Medicare -Dr. R. K. Tuli l Redefining Wheel- 30chair: Empower Peoplewith Disabilities withTechnology-Dr. H. S. Chhabral India Needs 44Universal Neonatal Hear-ing Screening4 July 2016

Editor Speak Greetings and a warm The need for constant welcome to our very first health awareness issue of Health Spectrum! O ur health, which is an invaluable asset of our life, is determined and affected by an array of diverse factors — from the genes that we inherit from our par- India may be ents to the climate we live in and the work we do. But there is a growing bodywitnessing an Informa- of scientific evidence that shows our lifestyles play a huge part in how healthy we are. tion Revolution boom From what we eat and drink, to how much exercise we do, and whether we smoke or with the emergence of take drugs, every single factor is impacting our health, not only in terms of life expec-hundreds of TV Chan- tancy but also in terms of our ability to live without experiencing chronic diseases nels, newspapers andwebsites, but it is ironi- In India, the situation is absolutely different because Indians are discarding theircal that majority of peo- centuries-old lifestyle and traditional food and recklessly adopting a western life and ple still have no access junk food.to quality and authentic Due to this fast-changing scenario, India is witnessing an alarming spurt in health information. several lifestyle diseases. The disturbing fact that starkly stares in our face is that the Even in the 21st cen- country accounts for the highest number of diabetes cases and some other healthtury, people depend on problems like cancer and cardiovascular diseases. It is hardly surprising that India has hearsay or primitive become the world capital of several life-threatening ailments. health techniques. There are a number of factors contributing to the dismal health scenario in our country. Indians are genetically predisposed to a numbers of diseases, particularly cardiovascular problems, but vast disparities in the healthcare delivery and lack of awareness about medical facilities among the general public have largely contributed to it. It is imperative to generate mass awareness about the symptoms, repercussions, complications and treatment of a disease. Most of the time, ignorance about a disease proves fatal. India may be witnessing an Information Revolution boom with the emergence of hundreds of TV Channels, newspapers and websites, but it is ironical that majority of people still have no access to quality and authentic health information. Even in the 21st century, people depend on hearsay or primitive health techniques. It is precisely because of this reason that we, a small but dedicated team of health communicators, have decided to bring out “Health Spectrum”, with the avowed objective of disseminating scientifically proven health information among the general public. It is one baby step in that direction but our ultimate objective is to position the magazine as a bridge between Health Experts/Doctors/Researchers/ Health provid- ers and the general public. We hope that it will become a medium of communication between them. In this inaugural issue, we are honoured to share with our readers the profound and thought-provoking articles from some committed people. The first issue of ‘Health Spectrum’ is now in your hands. We appreciate your support and are delight- ed to have you as a reader of the magazine. We earnestly hope that you will constantly provide guidance and support to this initiative through a sustained readership. We will look forward to your suggestions and feedbacks for improving the maga- zine. After all, it is your magazine. We will surely publish the worthwhile comments from our readers. With warmest thanks, Vinod KumarHealth Spectrum July 2016 5

In The NewsYoga takes over the world onsecond international day of yogaYoga enthusiasts in cities world-wide rolled out their mats in mass classes to celebrate the second International Yoga Day. United Na-tions General Assembly has declared 21st of June asan International Yoga Day.From Times Square in New York city to the OperaHouse in Sydney, celebrations for Yoga Day spannedthe globe. Images of different Yoga postures weredisplayed at the headquarters of the United Nationsin New York in the build up to Yoga Day. “Practicingyoga can help raise awareness of our role as consum-ers of the planet’s resources and as individuals witha duty to respect and live in peace with our neigh-bours,” said Ban Ki-moon, the UN Secretary-General.This year, Prime Minister Mr. Narendra Modijoined thousands of people in Chandigarh as theypulled their mats out for a massive demonstration. PM Modi performs Yoga with 30000 participants in ChandigarhPrime Minister, dressed in a white-coloured t-shirtand trouser, along with a scarf, led the participants, to the common man suffering from diabetes.\"including defence forces personnel and school children, \"It will be an achievement if we can help in treatingfor the second International Day of Yoga celebrations at diabetes. From next year, we can take another disease. Butthe Capitol Complex amid tight security. A yoga enthusiast I want that for good health, we should address any onehimself, he performed asanas along with the people at the disease every year. We should run a public campaign withevent. an aim to address one disease,\" he added.Over 30,000 people from all ages - 10,000 each from Yoga is not only a way to get rid of a disease but it alsoChandigarh, Punjab and Haryana - performed yoga 'asanas' guarantees wellness. For holistic development of lives,on pink and blue coloured mats during the event. yoga is a great way, he said. On this occasion, Prime Minister released a set of com- Two awards from Next Yearmemorative postal stamps showing the various steps of the“surya namaskar,” or sun salutation. These are different \"India has given invaluable heritage to the world as westamps depicting the different Asanas of Surya Namaskar. celebrate the second International Yoga Day. The world hasTreatment of diabetes through yoga accepted it in their way. Today from the Indian government side, I am going to announce two awards. Next year, whenPrime Minister pitched for treating diseases like diabe- yoga day will be celebrated on June 21, then from India,tes through yoga. \"I want to request trainers who are associ- there will be a selection for two awards,\" Modi said.ated with yoga, from this public platform. From next year \"One at the international level for those putting in excel-when we celebrate yoga day, in this one year, you continue lent work in the field of yoga and the second one for thoseto do what you do for yoga but focus on one subject and working in the field within the country. One Internationalthis is my subject - diabetes - Diabetes and yoga,\" he said. Yoga Award and the second National Yoga Award,\" he said.\"All people belonging to the yoga field, whatever For the main event, the emphasis this year was on theknowledge they have, they must continue with the rest of participation of 'Divyangs' (handicapped persons), a termtheir yoga activities but this (diabetes) must be the main coined by Prime Minister Modi for the differently-abled.focus,\" Modi said. About 150 Divyangs were assisted in performing yogaExpressing concern over the rising number of patients 'asanas' at the Capitol Complex.suffering from diabetes, Modi asked yoga trainers to help in Punjab and Haryana Governor Kaptan Singh Solanki,controlling the disease. \"In India, patients suffering from di- who is also Union Territory Chandigarh'a Administrator,abetes are rising. We might be able to get rid of this disease Punjab Chief Minister Parkash Singh Badal and Haryanaor not but with the help of yoga, diabetes can be controlled. Chief Minister Manohar Lal Khattar were among thoseCan we start a public campaign to suggest measures in yoga present at the event.(by Vinod Kumar) n6 July 2016 Health Spectrum

In The NewsPresident bestows FlorenceNightingale Awards on 35 NursesThe President of India, Shri Pranab Mukherjee pre- The President presenting Award to Nursing Sister, Medical sented the National Florence Nightingale Awards to Speciality Hospital, Chandigarh, Ms. Jaswinder Bakshi. nursing personnel on May 12, 2016) on the occasionof International Nurses Day at Rashtrapati Bhavan. Ministry has undertaken number of initiatives for strength- ening of nursing cadre. The Florence Nightingale awards Speaking on the occasion, the President said nursing are given to the outstanding nursing personnel employedprofessionals are the backbone of the healthcare system. in Central, State/UTs. Nurses working in Government,Nurses play a vital role in all aspects of healthcare, be it Voluntary Organizations, Mission institutions and thenational health campaigns like polio eradication, mid-wife private institutions can apply with the due recommendationservices and community education. Their level of commit- of concerned State Government. The Florence Nightingalement and care are much valued in both urban and rural ar- Awards carries Rs.50, 000/- cash, a certificate, a citationeas, including remote areas of the country. Their contribu- certificate and a Medal.tion is critical in the achievement of the nation’s healthcaregoals. Their inputs into health sector policies are equally Also present at the award ceremony were Sh B Pimportant for they help in creating the necessary supportive Sharma, Secretary (Health and Family Welfare) and seniorwork environment for their practice. officers from the Ministry of Health and Family Welfare along with invitees. n The President said emerging global threats such asmicrobial resistance, new pandemics, infections, and natu-ral disasters have added to the pressure and demands onhealthcare services. The services of nurses are crucial fora response system that a government creates to meet thesechallenges. Nursing personnel in our country are increas-ingly better educated and well-trained. They are now moreadept at communicating with patients, and connectingwith citizens, communities and policy makers. In the nextfifteen years or so, the nature of their services will undergosignificant change. Training and capacity building in thisfield will require new levels of innovation and leadership.Yet, one thing will endure. And that is, the premium allcommunities in the world place on the sensitivity, empathyand humanity of Indian nurses. Minister for Health and Family Welfare, Shri J P Naddacongratulated the award winners and appreciated theirexemplary services. Shri Nadda also informed that theThe President Shri Mukherjee with Florence Nightingale Awardees. Shri J.P. Nadda and the Health and Family Welfare Secretary, Shri B.P. Sharma are also seen.Health Spectrum July 2016 7

In The News International Convention on World Homoeopathy Day Prevention of various epidemic diseases through homoeopathy is huge, says Shri NaikShri Naik lighting the lamp to inaugurate the “International Convention on World Homoeopathy Day”, in New Delhi on April 09, 2016.T he Minister, Shri Shripad Yesso Naik also released a excellence in Homoeopathy. North The event was organized to com- commorative stamp and a Eastern Institute of Ayurveda and memorate the 261st birth anniver- souvenir on this occasion. Homoeopathy is being given impetus sary of the founder of Homoeopathy and work on All India Institute of Dr. Christian Friedrich SamuelShri Naik, in his inaugural address, Homoeopathy has been initiated, he Hahnemann, a German physician,expressed regret over the fact that the added. He also said that the centers who was a great scholar, linguist andpotential of Homoeopathy remains of excellence so formed would be acclaimed scientist. The theme of thelargely unexplored and, therefore, models for education, research and convention is ‘Integrating Homoe-underutilized in public health. This, patient care in specific fields. Shri opathy in Healthcare’.despite the fact that Homoeopathy is Sharan highlighted the importance of During the convention, speakerspractised in more than 80 countries research for scientific advancement deliberated upon various significantof the world and is known to be ef- of Homoeopathy. issues in Homoeopathy. It includesfective in various communicable and The International Convention special sessions on ‘Homoeopathy onnon-communicable diseases, chronic on World Homoeopathy Day was Cancer’, ‘Homoeopathy on Mentaldiseases and diseases of children organised by CCRH, an autonomous Health’, ‘Homoeopathy on Epidem-and mothers, he added. He said that, research organization of Ministry of ics’, ‘Homoeopathy on Public Health,during pregnancy, when expecting AYUSH, Government of India and an Clinical Research studies, Drugmothers are usually advised not to international organisation Liga Medi- Validation and Drug Development’take much medication, Homoeopa- corum Homeopathica Internationalis among others.thy is a safe alternative. The scope of (LMHI). Scientists and homoeopathy Among the invited guests wereprevention of various epidemic dis- doctors from 23 countries including Mohd. Nasim, Minister of Healtheases through Homoeopathy is also Brazil, Russia, South Africa, Italy, & Family Welfare, Govt. of Bangla-huge, but not yet tapped, he added. Netherlands, U.K., Austria, Armenia, desh, Mr. Mushtaq Alam, MinisterThe Secretary, Ministry of Canada, Israel, Australia, Bangladesh, of State for Health, Govt. of Nepal,AYUSH Shri Ajit M. Sharan in- Japan, France, UAE, Cuba, Nepal, Mrs. Fozia Manzoor, Counsellor offormed the gathering that the Turkey, Argentina, Slovenia, Pakistan, High Commission, Pakistan and Mr.Government of India is putting Ghana and Kenya participated in this Anura Jayawickrama, Health Secre-in all efforts to develop centers of convention. tary, Sri Lanka. n8 July 2016 Health Spectrum

In The News Foundation Stone Laid ForThree New Medical CollegesUA big boost to tertiary healthcare and medical education in the region: J P Nadda nion Health and Family Wel- fare Minister Shri J P Nadda laid the foundation stone for three new medical Collegesat Rajouri, Anantnag and Baramulla dis-tricts in Jammu and Kashmir, today. “Thenew Medical Colleges will strengthenthe medical infrastructure and give a bigboost to tertiary healthcare and medicaleducation in the region”, Shri Nadda stat-ed. He said that with total outlay of ₹ 189crore each, the three new Medical Col-leges will add 300 MBBS seats per yearin the States with 100 seats per College.In addition, the medical infrastructurein the districts will be strengthened withaddition of a 300 bed facility attached toeach college. Ms. Mehbooba Mufti, Chief Minister Shri J.P. Nadda and Ms. Mehbooba Mufti laying the foundation stone for the new Medical College, at Anantnag, in Jammu and Kashmirof Jammu and Kashmir; Dr. Jitendra Singh,Union Minister of State (I/C); ShriBali Bhagat, State Minister for Health& Medical Education; and Ms. AsieaNaqash, Minister of State for Health& Medical Education, Government ofJammu & Kashmir were also present atthe ceremonies.The Union Health Minister statedthat in addition to these new initiatives,the Government Medical College, Jam-mu and Government Medical College,Srinagar in the State of J&K have beentaken up for upgradation under PMSSYwith an outlay of ₹ 120 Crore (i.e. Cen-tral contribution of ₹115 Crore and Stateshare of ₹ 5 Crore) for each medical col-lege. He added that ₹ 2194.8 crore since Shri J.P. Nadda and Ms. Mehbooba Mufti laid the foundation stone for the newinception and ₹ 688.8 crore during last Medical College, at Rajouri, in Jammu and Kashmirtwo financial years has also been releasedto Jammu & Kashmir state for imple- 7th November, 2015 which includes creation of two AIIMS-mentation of programmes approved under National Health like institutions. Moreover, one time grant of up to ₹120Mission (NHM). Shri Nadda said that the State is receiving crore each for 2 State Cancer Institute at Jammu and Sri-higher allocation per capita like the North East (NE) States. nagar and up to ₹45 crore each for 3 Tertiary Care CancerState also has a provision of Hard Area Allowance, where Centre (TCCC) at District Hospital in Kupwara, Kishtwarmaximum of ₹ 20,000 is provided to Medical Officer. & Udahmpur districts has also been approved. Shri NaddaShri Nadda stated that the Hon’ble Prime Minister had said that these new initiatives shall significantly improve theannounced development package for Jammu & Kashmir on healthcare facilities in the State. nHealth Spectrum July 2016 9

New Study/Research Every Fourth Woman In Urban India Either Overweight Or Obese Obesity has added to the already existing woes of our country that has been strug- gling to come to grips with undernu- trition and infectious diseases. With a sub- stantial 40% of the country being under nourished and an estimated 20% ‘over nourished’, overall India has 60% mal- nourished people and “this is matter of concern. Recent surveys by various agencies This problem has added to the already have claimed that India has world’s existing woes of our country that has been third highest number of obese per- struggling to come to grips with undernutri- sons behind the USA and China and even as tion and infectious diseases. With a substantial experts claimed that the problem is more acute 40% of the country being under nourished and among women than men. an estimated 20% ‘over nourished’, overall On the basis of data of the third round India has 60% malnourished people and “this of the National Family Health Survey (NFHS) is matter of concern. and Indian version of Demographic Health Survey (DHS) which is conducted in more than As India is struggling to eradicate the 80 countries all-over the world, experts claimed problem of undernutrition and anaemia in urban India, about 25 percent of w omen meanwhile, our country already witnessed the are either overweight or obese, which is higher overweight and obesity problem which has than the prevalence among men (20%) . more than 30 million obese people, and the A sensational 44% of diabetes burden and number is increasing alarmingly. These find- an estimated 10% to 40% of certain cancer bur- ings only throw up the challenge of two dif- dens are attributable to overweight or obesity. ferent nutrition-related health problems in the Obesity reduces the life span of an individual country. India has to therefore grapple with the by an increased risk of diabetes, cancer, heart problem of undernutrition and anaemia in one attacks, stroke, kidney and liver failure. hand and overweight or obesity on the other hand. (by Shama Irani) n10 July 2016 Health Spectrum

HEALTH STUDY/RESEARCHElectronic Waste: Health Hazards For 5 Lakh Child LabourersIndia is expected to produce 30 lakh metric tonnes (MT) of electronic waste (e-waste) peryear by 2018 from the present 18.5 lakh MT. More than 95 percent of e-waste generated inthe country is managed by the unorganised sector and scrap dealers, the study revealed.I ndia’s 5 lakh child labourers face health risk due to dismantling and recycling the electronic waste produced in the country,according to a report by the Associ-ated Chambers of Commerce andIndustry (ASSOCHAM) – Frost andSullivan, India’s 5 lakh child labour-ers face a serious health risks due tothe electronic waste (e-waste) gener-ated in the country, according to astudy by the Associated Chambersof Commerce and Industry of India(ASSOCHAM)-Frost and Sullivan.According to the report, childlabourers in the age group of 10-14years who are found engaged in vari-ous e-waste dismantling activities,without adequate protection and the waste. Printed circuit boards, vocated bringing about a new legis-training in handling and recycling the for instance, contain heavy metals lation in the country which preventswaste, are at greater health risk. like antimony, gold, silver, chromi- the entry of children into the labour um, zinc, lead, tin and copper. The market, particularly the e-waste dis- India is expected to produce 30 method of extracting these materials mantling activities. It said childrenlakh metric tonnes (MT) of electronic from circuit boards is highly hazard- should not be allowed to collect, seg-waste (e-waste) per year by 2018 from ous and involves heating the metals regate or distribute e-waste.the present 18.5 lakh MT. in the open,” B K Rao, chairman of ASSOCHAM Health committee that The study further said that Mum- More than 95 percent of e-waste released the ASSOCHAM paper, said. bai tops the list of cities generat-generated in the country is managed ing high e-waste, with 120,000 MTby the unorganised sector and scrap The study showed the people produced there every year. Delhi-dealers, the study revealed. who are engaged in recycling e-waste NCR (98,000MT) and Bangalore without any proper training, includ- (92,000MT) follow Delhi in terms of E-waste includes discarded com- ing children, use primitive and haz- e-waste generation. Chennai, Kolka-puter monitors, motherboards, cath- ardous methods like acid stripping ta, Ahmadabad, Hyderabad and Puneode ray tubes, printed circuit board, and open air incineration for process- are the other cities in India that gen-mobile phones and chargers, compact ing e-waste. These methods are highly erate high quantities of e-waste, thediscs, headphones, white goods such unsafe and cause pollution by releas- study revealed.as liquid crystal display/plasma tel- ing toxins from the e-waste into theevisions, air conditioners and refrig- environment. It added that only 2.5 percent oferators. These products contain toxic India’s total e-waste gets recycledsubstances, including lead, cadmium, “Exposure can cause headache, ir- because of poor infrastructure andmercury, hexavalent chromium, plas- ritability, nausea, vomiting and eyes inadequate legislative frameworktic, polyvinyl chloride and other pain. Recyclers may suffer liver, kid- which has led to wastage of naturalheavy metals. ney and neurological disorders”, Rao resources, and irreparable damage to added. environment and health of the people “This deadly mix can cause severe working in industry. nhealth problems in those handling The ASSOCHAM report has ad-Health Spectrum July 2016 11

HEALTH STUDY/RESEARCH Dietary Habits & Processed Foods Spurring Cancer Incidence in IndiaNot just the numbers have increased, the age of incidence of cancer is also markedlyR low today, ringing a sense of alarm among doctors and expertsapid changes in dietary habits, increased 40s. The common factors that are responsible for the riseconsumption of packaged foods, high levels of in increase of cancer incidences are lifestyle, food habits,industrial and environmental pollution and the chemical usage such of pesticides, insecticides, fertilizers,inadvertent entry of chemicals in the human preservatives and likewise,” says Dr Mukhopadhyay.food chain are factors that are spurring an alarming rise in “Change in dietary habits from traditional to western,cancer incidence in India. increasing intake of processed/ preserved/packaged foodsDr Tanmoy Mukhopadhyay, Senior Consultant and decreasing consumption of raw vegetables and fruitsClinical Oncologist, Apollo Gleneagles Cancer Hospital, are factors that are being recognized as probable riskKolkata says not only has the numbers of several cancers factors. Another hazardous factor is dangerous industrialincreased in recent years, but in an alarming trend the and environmental toxicants that are rampant in our airaverage age of incidence has also reduced drastically in and water bodies and find their way into our fruits andrecent years. On an average, nearly 12 lakh new cancer vegetables. Excessive use of pesticides also pollutes fruitscases get added annually to the 25 lakh existing patients and vegetables, as does the use of chemicals that is usedacross the country. for artificial ripening of the fruits and vegetables,” adds Dr“The downward shift in the average age of cancer in- Mukhopadhyay, explaining the probable causes for risingcidence is also a very disturbing trend. Earlier, the risk of incidence of cancers.cancer was believed to increase with age. What was earlier Consumption of packaged foods has been a regu-considered a disease primarily of the old in now increasing lar practice of lifestyles in the west where incidence ofafflicting young men and women, even in their 30s and colorectal cancers has traditionally been high. Increasing12 July 2016 Health Spectrum

HEALTH STUDY/RESEARCHurbanization and convenience is prompt-ing more and more Indians today to adoptwestern lifestyles. Eating lots of red orprocessed meat increases the risk of bowelcancer, stomach and pancreatic cancers.Another reason for the rise in cancer inci-dence is the high consumption of alcohol,smoking and tobacco. “Lack of awareness is one of the lead-ing challenges faced by India in fightingcancer. A majority of diagnoses in Indiahappen in advanced stages (stages 3 or 4)unlike the West where regular screeningshave ensured that most cases are diag-nosed in early stages and treated. Delayin diagnosis often means that a treatabledisease becomes untreatable. Many peo-ple, especially in rural areas, tend to seelocal medical practitioners who might lacksufficient knowledge of the disease,” saysDr. Mukhopadhyay. According to the World Cancer ReportframtWdwaso2wiwtc2itAacnneihhehoemnm00fivogiievacaeeriltt11Hdpepedfmogroorevnh24“stmlrrneriarniO8nnese.Ieo.,nxeiaaeclna.soaAggegiecWfn2’p,scgyssnddegtsnodetatpewmrsemicrewauifdmahndontrsaeotdlsnomnheuoiihhdsnsg,iromolmmdnlecxewdeaiplib,Rnsclciianititreisaeiseetoetmainarsheneoaihttjnrssuncnsilnoosgigmeeminaeiehas2eftermtnioctigsc2eybrsah0w5eeaenabal,rsr0rraai1ellwicnneetosemycfedn0ncolh2iemaa5dhuccaedmsh7cf1dsstoeilsw.ncyrte,melio4bmotrKseyTea,nugrsa,eayktn,anlcmrh,oogrnocrseiiccaesatbcrennsloCirdaeoclhdiknseaetattadllglndoamduaneuaorlculnhctei.innctleaeurrrdoovnpIaipamAeedcancnrstncnmesagerysubcetehedrtorid,nthsntreemncfdmoawtountpciedderhtai(eudngwacmrarnpotloIserawcupdehnoitAeirttanoavnpahs,nreyoiselcstrifcRnocdaeltsd.ieopkhdsuhenaaotbncwCirraiipasitstndanuernn;ooameveiee)oessregmadlgnf,s,esdesafl,loeadsabon,ytreregenarltaacllroyfnoacltcsttwuiAfrpeftahortaeotnstroacnisyrrofatebsmddemyleptiwtbtulene-hhhewoareassbtarye,etlk,eInrylcan2adiis,atyfnsn2”,dsaao0st.g0cimcsesoiL0aIorci3natoesatrn,eeaweoaw0y0dnacloitnrstf0ehasidsrrtsfilnciun0eerhlDmdediebdttatdersdrrhroparaeseitnefieoeraniM,aTiadcntanymarbtoamuacvkrsnubgeeyhycmlctaaigktosiecrnoerefutriccinhjtbsieoanegtadukrsageob-yesrdcn-ksnlaor.-we,ttn-hihsnsiutcaamhrkncWmostutbet1cntmgcepohhhaaeosaal0rnuneordtyt;oaeaaennnxHrmdiiembtsLttpaudmocciWttdeessOarrHcbaeeeDibn2ieretfieatlarrclyeihb;lvthlivrtsc2lckdybboigriAueelataeaoa,nsMyweehhld0teoottnnttnlolcefae0ihciaIififctcuboaptostencoi,bpethapnehed0rooknviohshdosnrenahe05eendhc.ue7iooutigwydysas0aaIyosnr0llp,atebmtsergtcp%opcwaniismlacyyh7aieonceraorfsoeradd0ainaeue2itdarmdsln2wpstb%ialalts0nelhne0egyrikseaaostresa3tfxyae2geihecreocertutwni0topadao0htaa.tenisvhblyegerifeio,uuctdtiedv.cse.ensynhchobmsnrrihtesIldttfegetoviretetdxiertjasyeeiioednuhoiodk;ev-;nasrnslemf-sy,ot”t.f A sedentary lifestyle that includes lack of exercise, eating junk foods, inadvertent use of chemicals in foods can increase the risk of cancer. Keeping a healthy body weight can help reduce the risk of bowel, breast (post- menopausal), kidney, womb, esophageal, pancreatic and gall bladder cancers. Therefore, adopting such as regular exercise, eating food on time, intake of nutritious food, quitting habits like smoking and alcohol can help in preventing cancer. (by Sagarika Dutta)nHealth Spectrum July 2016 13

Current IssuesHuge Manpower Gaps BedevilHealthcare In Rural India How Private Sector Can Help F or all the animated talk about India’s rapidly-growing, of the total population. medical-tourism attracting At a time when technology and healthcare sector and projec- infrastructure make distances shorter, we still have a long way to go in build- tions of it becoming a USD 280 billion ing the bridges to cover the gaps in industry by 2020, the fact remains that rural healthcare. Home to more than our health sector is bedevilled by ma- 60% of the national population, India jor disparities when it comes to acces- can no longer simply dismiss its rural sibility between urban and rural areas. sector as the ‘sick child’, and needs to According to estimates almost take essential steps in order to steer its Dr Dharminder Nagar 70% of the doctors in India are con- healthy recovery. centrated in urban centres, serving MD & CE Paras Healthcare, says around 30% of the total Indian popu- One of the raging issues in the that quality tertiary healthcare is lation. Urban India enjoys access to upliftment of health and sanitation innot available even to a bulk of urban almost 65% of the country’s  hospi- remote areas has been the sheer lack population living outside a few tal beds despite having less than 30% of trained medical professionals to ca- ter to the everyday needs of the habit- glittering metropolitan cities.14 July 2016 Health Spectrum

ants, who are thereby deprived of the We need more public Current Issuesbasic medical facilities necessary for private partnershipssurvival. to involve the private flung areas. It is intended to overcome sector in rural areas. geographical barriers, connecting us- Forget the rural hinterland, remote These partnerships ers who are not in the same physicalvillages and tribal areas, quality ter- can offer incentives to location with an aim to improve healthtiary healthcare is not available even doctors to offer ser- outcomes. Remote populations, whichto a bulk of urban population living vices in rural areas often lack minimal physician pres-outside a few glittering metropolitan for a small number of ence can benefit to a large degree bycities. For example, in north India days of a year. With telemedicine centres through whichwhile Delhi NCR remains a hub of the severe shortage of physicians can offer basic minimumbest multi-specialty hospitals, even a specialized cardiolo- consultation and medical advice.100 km move outside the region will gists, nephrologists, Notably, communicable diseases areleave you without a decent tertiary neurologists and gy- among the leading afflictions affectingcare hospital. This is evident from the naecologists, rural rural populations and basic consulta-fact that the Delhi NCR hospitals are populations often tion and hygiene advice can also go acrowded with people coming from Ut- have to make with long way in treatment and reducingtar Pradesh, Bihar, Haryana and even less skilled doctors or their incidence.West Bengal. worse quacks. PRIVATE-PUBLIC A lot of people have to travel long PARTNERSHIPSdistances to avail of life-saving treat-ments like dialysis. In the absence of We need more public private part-quality cardiac care in smaller towns nerships to involve the private sectorand villages, many people fail to sur- in rural areas. These partnerships canvive a heart attack as they are required offer incentives to doctors to offer ser-to travel long distances to nearby cities vices in rural areas for a small numberwith decent healthcare facilities. of days of a year. With severe shortage of specialized cardiologists, nephrolo- While primary healthcare facilities gists, neurologists and gynaecologists,continue to suffer from shortage of staff rural populations often have to makeand absenteeism, private sector finds with less skilled doctors or worselittle incentive in investing heavily in quacks. PPPs that can take skilledrural areas. However, through some doctors of reputed hospitals to offerlow cost but effective initiatives, the services in rural health centres andprivate sector can play a positive role in recommend patient transfer if needed,helping address the deficit of manpow- can play a role in bridging this gap.er in rural healthcare to some extent: TURNING TOTELEMEDICINE CENTRES SMALLER CENTRES Telemedicine, as we know, refers It is understandable that for a pri-to the use of information technology vate entity it doesn’t make much busi-to provide medical consultation in far ness sense to open tertiary care hos- pitals in villages. However, the needsHealth Spectrum for profit and social benefit can be bal- anced by opening hospitals in smaller towns and cities which cater to large surrounding populations. TRAINING LOCAL MANPOWER Notably, the deficit in manpower in rural areas is not just about doc- tors, it is about healthcare providers in toto. Even nurses, radiologists, pa- thologists and paramedics are hard to find. Launching training programs for nurses and paramedics in smaller cen- tres is another important initiative that can help address manpower shortage to an extent. n July 2016 15

HCuEArrLTeHntSITsUsDuYe/sRESEARCHRedefining WheelchairEmpower People WithDisabilities With TechnologyTechnology-backed wheelchair modification is the new route towards makingwheelchairs self-sustaining and dignified. writes Dr H S Chhabra. Dr H S Chhabra W hen our eyes first come across a However, a wheelchair doesn’t and shouldn’t Medical person sitting in a wheelchair, symbolize dependence, agony and disabil- we often feel a pang of over- ity. With some technical and social support, a Director & Chief of whelming sympathy and try wheelchair occupant in our society can becomeSpine Service at Indian our best to accommodate the occupant with much more independent and lead a dignifiedSpinal Injuries Centre, the best of intentions. The lack of wheelchair life. Afterall, they are free thinking intelligent friendly facilities and infrastructure in our na- individuals who like everyone else want to lead New Delhi tion, required to make the lives of these spe- a life with purpose. The genius physicist, cos- cially-abled people easier, can leave one quite mologist Stephen Hawkings whose body has red-faced and helpless at such a point. been severely affected by motor neuron dis- order continues to enamour the world by his In today’s time, there are millions of wheel- mental prowess, and theories about black holes chair occupants in India who suffer from the and the expanding universe. A highly advanced twofold consequences of unavailable spaces technologically equipped wheelchair has been dedicated to wheelchairs in pavements, pub- crucial in helping him lead a highly productive lic places and buildings, and the absence of a life despite the physical disability. low cost motorized wheelchair in the market. This is especially true for the rural and semi A number of small to major interventions urban population which faces the financial can go a long way in helping individuals with constraints that prevents ownership of such a disability lead independent and productive technological advancement, and also deals with lives using technologically equipped wheel- uneven terrain making such an entity essential chairs that can not only be used as a transport for survival. mechanism but also be flexible enough to ma-16 July 2016 Health Spectrum

Current Issuesneuver all areas of a house or a work- with the University of Pittsburgh, USA eration and has a light weight and easy-place, offer a greater adaptive driving closely for transferring the latest tech- to-fold and assembling consistency toexperience and even personal mobil- nology in the field to the Indian settings. enable portability. This will result in theity seating and positioning systems that A recent example of this collaboration fulfillment of the dream of both the or-make the experience more comfortable. is the low cost motorised wheelchair, ganizations in helping people with disa-For example, manual and electric wheel- ISIC-LOCOMO . ISIC has partnered bilities to lead self-reliant lives, with thechairs and foam, gel and air cushions for with the Ministry for the People with help of technology and modifications.proper seating. Disabilities in order to bring the vehicle to India, and remodel it according to In- It is high time that we stop feeling Specialized computer software and dian needs & terrain. At a relatively low sorry for these victims of unfortunateequipment like adaptive keyboards, and affordable cost of Rs. 45000 as com- circumstances, and instead empowermonitors and voice recognition pro- pared to the imported motorised wheel- the people with disabilities by enablinggrams are only few of the exciting tech- chairs (which cost a whooping 1.5 lakh), them to live a life of independence andnologies which can be explored. Ergo- ISIC-LOCOMO boasts of a unique sus- self-sustenance. After all, this effort isnomic workstations and modifications pension system to accommodate Indian a very small price to pay to restore thefor home and workplace with different environment conditions. It also features dignity of the disabled, and can onlyenvironment control units for home, a 360 degree joystick controller and re- bear the sweetest of fruits for the nationwork and school can completely change chargeable battery to ensure ease of op- in the future. nthe lifestyle of the individuals with dis-abilities. India can move towards finally July 2016 17becoming a disabled friendly nationthrough such initiatives. This is notonly an achievement that will reaffirmthe scientific and technological prowessand advancement of the nation, but willalso boost the human resource develop-ment by enhancing the standard of liv-ing and capabilities of these individuals.Researchers internally are working onincorporating path-breaking technolo-gies into the wheelchair. Designers haveeven conceptualized and put into devel-opment models of wheelchairs that canclimb stairs, move at faster speeds to al-low the users faster transport, be adjust-able into public transport systems andenable the users travel easily to and frofrom work. Approximately 65 million wheel-chairs are needed worldwide, and thosein less-resourced environments, suchas India, are faced with the difficultchallenge of accessing devices that canprovide functional mobility for an af-fordable price. Unfortunately, effortshave not addressed the needs of peoplewho would benefit from appropriatewheelchairs, and low-cost western styledevices are beginning to crowd themarket despite the fact they performpoorly, fail prematurely, and in somecases have been discontinued in thewestern markets. Though some such services areavailable in India as well, cost remainsan obstacle that prevents many fromavailing them. In this context, the De-partment of Assistive Technology ofIndian Spinal Injuries Centre is workingHealth Spectrum

Current IssuesIndia Needs UniversalNeonatal Hearing ScreeningMajority of Hearing Impaired Infants Fail to Receive Crucial Early Medical Attentionthat becomes a major obstacle in their normal growth & cognitive developmentH earing impairment is one of the most prevalent congenital disabilities in life. The theme for this year’s World Hearing Day India, with an estimated 8 per 1000 is ‘Childhood hearing loss: act now, here is how!’ infants born with moderate to pro- It aims to draw attention to preventable causes of hearing loss, right health measures needed to pre- found hearing impairment. However, more than vent the same and importance of early identifica- half of the children born with hearing defects fail tion and suitable, timely interventions in children to get timely medical intervention resulting in afflicted with hearing impairment. substantial language and speech development de- Unlike developed countries which have imple- lay and a consequent loss of growth and cognitive mented near universal newborn hearing screen- development. ing programs under which newborns are tested As we celebrate World Hearing Day (March at birth, India lacks such a system. Consequently, 3), experts in the field are pointing out the need to hearing disability is discovered much later in a establish better hearing screening mechanisms for large number of children. Hearing impairment newborn babies to ensure that all children born in children leads to substantial language and with hearing impairment are detected early on in speech delay that causes cognitive and develop-18 July 2016 Health Spectrum

mental challenges. This further leads speech, language, cognition and over- Current Issuesto academic challenges and delays in all development of the child. But, ab-learning. In the absence of a screen- sence of neonatal hearing screening plants that can allow significant im-ing at birth mechanism, suspicion of in the country delays identification, provement in hearing ability of evenhearing disorder by family members corrective measures and rehabilita- completely deaf persons. We needis still the main mode of detection of tion of such children. It is recognized to create greater awareness aboutchildhood hearing impairment, and that children identified with hearing the availability of such mechanisms.this diagnosis often doesn’t occur as loss prior to 6 months of age have bet- Today auditory brain stem implantslate as two years of age. ter chance of developing skills equiv- can enable even completely deaf chil- alent to their peers by the time they dren to hear,” says Dr Ameet Kishore, “Children learn 90% of their lan- enter kindergarten. The American Senior Consultant Surgeon, ENT &guage in early childhood (0-3 yrs) in- Academy of Pediatrics recommends Cochlear Implants at Indraprasthacidentally. This is possible only when that hearing loss in infants should be Apollo Hospital, New Delhi & Sphearthey are hearing well. A child absorbs identified and when possible treated Speeh & Hearing Clinic.a lot of information and cognitive before 6 months of age. Childrenability in the first 2-3 years of life, this identified much later may suffer from Lacks of a universal program toincludes ability to speak, pick up lan- irreversible and permanent impair- screen babies remains a major obsta-guages and identify objects. Without ments in speech, language, and cog- cle in early identification of disabilityability to hear, much of this crucial nitive abilities. and quick corrective intervention intime is lost on children and they may the form of hearing implants. Reduc-suffer significant cognitive losses. In “Permanent hearing loss is one ing the age of diagnosis is a majormost cases, children are brought to us of the commonest congenital disor- challenge for Indian healthcare. Uni-much later, at 2, 3 or 4 years of age, ders with the incidence being much versal screening at birth has foundsometimes even later. Most parents in more than the conditions newborns to have lowered the age at which in-India determine that their child may are routinely screened for. Despite fants receive hearing aids, from 13-16be suffering from hearing disability existence of mechanisms to test au- months to 5-7 months in developedmuch after birth when they experi- ditory function of newborn babies, countries. This prevents a huge bur-ence lack of response to sounds in this screening is rarely done in the den of secondary disability.a child or inability to speak. To im- absence of an established universalprove this, we need a system where all screening program. Besides, due to Children with a hearing disabil-children are tested at birth in hospi- major lack of awareness about new ity are at risk of delayed speech andtals. A cohesive universal system will age solutions, many people believe a language development and poorprevent delay in intervention,” says congenital hearing disability cannot academic performance as a result. InNeevita Narayana, leading Audiolo- be treated. However, today there are India, such children also sometimesgist and founder of Sphear Speech & not only advanced diagnostic tools face ridicule and may experience lossHearing Clinic. but also highly advanced solutions of confidence. When implanted on such as hearing aids, cochlear im- time, the new age devices can allow Early detection of hearing impair- plants and auditory brain stem im- complete assimilation of a child intoment can prevent related disability of the mainstream – including schools and social activity. How is the screening done? The screening is done in two sim- ple tests namely Otoacoustic Emis- sions (OAE) and Auditory Brain Stem Response (ABR). While the former involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound, in later, earphones are placed on ear, while electrodes are placed on the head and ears to measure the respond of the brain to emitted sound. Notably, the hearing loss could be indentified in the first test itself, as during the test a measurable echo should be produced when sound is emitted through the earphone in case of a normal hearing. However, no echo could signify the feared im- paired hearing. nHealth Spectrum July 2016 19

HCuEArrLTeHntSITsUsDuYe/sRESEARCH Adult Vaccination Dr. Vivek Nangia “Prevention is better than Cure” is something as important for adults as it is for children. Director of Pulmo- that we have always known of. But did we The adolescents and adults suffer a muchnology, Medical ICU know that the most effective way to preventand Sleep Medicine at an infectious disease or its severe outcome, is a greater burden of illness and death due toFortis Hospital, Vas- vaccination? vaccine preventable infectious diseases thanant Kunj, New Delhi do children. The success of our national Vaccination annually prevents ~6000000 childhood immunization program has result-20 July 2016 vaccine preventable diseases worldwide. Vac- ed in the dramatic reduction in the incidence cines contain the same germs or sometimes of vaccine-preventable infectious diseases in only a part of the germ that cause disease, but the younger population but for it to benefit they have either been killed or inactivated to the population at large it needs to be comple- the point that they do not cause a disease but mented by vaccination in adults. The vaccine stimulate the immune system to produce an- recommendations for the adults depend on tibodies, thus providing immunity from the factors like age, lifestyle, high-risk medical disease. conditions, travel plans, and what vaccines one has received in the past. Diseases that used to be common around the world, including polio, measles, diph- Not everyone was, or is, fully vaccinated theria, pertussis (whooping cough), rubella as a child. If one missed getting vaccines for (German measles), mumps, tetanus, rotavi- diseases like Measles, Mumps, And Rubella rus and Haemophilus influenzae type b (Hib) or Chickenpox (or varicella) as a child — or can now be prevented by vaccination. any of those diseases themselves – then one must get the vaccination as an adult. However, when we think of vaccines, we envision teary-eyed children at the doctor’s For diseases like Diphtheria, Tetanus, clinic.Vaccines and immunization in India, Pertussis(whooping cough) immunity is not so far, have been primarily directed towards lifelong. One may have received the DPT vac- infants and children, although, vaccination is cine in childhood but a booster shot of Tdap Health Spectrum

Current IssuesImportance of adult vaccinationYou may think that vaccines are only for children and may not realize that even adults get sickfrom vaccines preventable diseases. You need vaccines throughout your adult life, more so inthe later decades when your immune system starts getting weak and you are prone for morediseases. Vaccines are important to your health and here are some reasons why.v You may be at risk for serious vaccine preventable diseases that are still commonv Chronic diseases like Diabetes, Heart disease, Kidney disease or Lung disease increases the risk of some vaccine preventable diseases:v Diabetics, in particular, are highly vulnerable to many infections.v You can’t afford to risk getting sick:v You can protect your health and the health of those around you by getting the recommended vaccines:v Immunization provides the safe and best protection against vaccine preventable diseases:and then Td vaccine is recommended For diseases like cine, even if they have suffered fromevery 10 years. Diphtheria, Tetanus, the disease. Pertussis(whooping An estimated 43 million episodes cough) immunity is Hepatitis B is a severe liver disease.of ARI (acute respiratory infections) not lifelong. One may It is 50-100 times easier to be infectedare documented, of which 4–12% of have received the DPT by hepatitis B than by HIV. It can berespiratory illnesses, are due to influ- vaccine in childhood acquired by coming in contact withenza Influenza(common Flu) spreads but a booster shot of an infected person’s blood or othervery easily and can be a serious illness. Tdap and then Td vac- body fluids. This could happen duringBesides being very debilitating, it can cine is recommended a sexual intercourse or just by shar-also be life threatening, especially, in every 10 years. ing personal items like toothbrushthose with a weak immune system. In- and razors. Most infected people arefluenza virus undergoes mutations and symptom free in the initial stages, thuschanges in its genetic constitution very they appear normal and yet are capa-often, thus creating new strains and ble of transmitting the disease to oth-rendering the previous immunity use- ers. One’s partner may not appear ill,less. Hence, each year a new vaccine is but could be carrying the disease. A 3developedto protect against the three doses course of Hepatitis B vaccinationor four strains of influenza anticipated is all it takes to acquire protection fromto be most commonly circulating in this deadly disease. It also reduces thethe upcoming flu season. All children, risk of liver cancer to some extent.adolescents and adults must receive aFlu vaccine every year at the onset of Human Papilloma Virus (HPV) isautumn, if they do not have a medical another common sexually transmittedreason not to receive the vaccine. July 2016 21 Herpes Zoster or Shingles is a dis-ease primarily of the adults. It is causedby the same virus that causes chickenpox and can occur more than once. Itmanifests as a rash anywhere in thebody including face and eyes with ex-cruciating pain. This pain could in-terfere with day to day activities likeeating, speaking, sleeping and couldlast for months.All adults more than50 years must receive the shingles vac-Health Spectrum

Current Issuesviruses which is the most common (> 65 years of age), cigarette smokers Human Papillomacause of cervical cancer in women and in those suffering from asthma, Virus (HPV) is an-and oral and genital cancers in men HIV, chronic diseases of heart, lungs, other common sexuallyand women as also of genital warts liver or kidneys and diabetes. Those transmitted virusesin both the genders. At least half of suffering from cancers, leukemias, which is the most com-sexually active individuals get infect- lymphomas, those on chemotherapy mon cause of cervicaled with HPV sometime or the other or immunosuppressive therapy are cancer in women andin their lives. The vaccine to prevent also vulnerable to acquiring this dis- oral and genital cancersHPV is most effective when admin- ease.India alone constitutes to around in men and women asistered at the onset of puberty (12-13 43 million childhood pneumonia cas- also of genital warts inyears of age) but can be given to girls es(23% of the world’s total) and the both the genders.until the age of 26 years and boys up estimated incidence of 0.37 episodesto the age of 21 years. per child-year for clinical pneumonia can be easily and effectively pre- is predicted. vented by appropriate vaccination. Pneumococcal disease is caused For those traveling to Sub Saharanby a bacteria, and can lead to seri- There are two types of pneumo- Africa and Tropical South America,itous life threatening infection in the coccal vaccines (PCV 13 and PPSV is mandatory to take the Yellow Feverlungs, brain and bloodstream. It can 23) that are now available and both vaccination.A single dose is sufficientalso cause debilitating disease in must be given to all the elders. In the to protect against the disease for asthe joints, heart, ears and sinuses. It younger age group PPSV 23 or both long as 10 years.is transmitted through droplets re- may be given depending upon theleased by an infected person while medical condition. Research has shown that cost in-talking, laughing, coughing or sneez- volved in vaccination is significantlying. Anyone can get pneumococcal Typhoid and Hepatitis A are dis- outweighed, by the long term ben-disease. The risks are higher in elders eases which are transmitted through efits that it provides. In today’s busy contaminated food and water and and high pressure lives, missing work because of a preventable illness can result in major financial losses. With ever increasing costs of healthcare, the cost of the vaccine is only a frac- tion of what one would have to incur towards its treatment, leave alone the irreparable organ damage that the in- fection may leave behind, if one sur- vives it.Vaccines work with the body’s natural defenses to reduce the chanc- es of acquiring certain infections and suffering from their complications. Unlike most medicines, which treat or cure diseases, vaccines prevent them. Vaccines are regarded as one of the top ten effective public health inter- ventions. Gift yourself a vaccination program this festive season and lead a more confident, protected life. Re- member, you are never too old to get vaccinated. n22 July 2016 Health Spectrum

HEALTH STUDY/RESEARCHHealth Spectrum July 2016 23

Face to Face‘Healing thesufferings ofpeople’- Himanshu PatraDr. (Prof.) Raju Vaishya , a surgeon ofinternational repute, is best known for his swiftsurgical skills in the field of Orthopedic &Joint Replacement. He has been working atIndraprastha Apollo Hospitals, New Delhi as aProfessor and Senior consultant for the last 20years having total working experience of over 35years. He is the founder president of ArthritisCare Foundation.Dr. Raju has an outstanding academic careerthrought. He did his basic medical educationMBBS and MS in Gwalior ,India, and subse-quent higher super specialty training and educa-tion (M Ch and FRCS) in the United Kingdom.Apart from his distinguished clinical workin the field of arthroscopic and joint replace-ment surgery, he is well known for his academiccontributions. He has more than 150 publishedarticles in various International and nationalpeer-reviewed medical journals and has beenregularly invited to give lectures, chairingsessions,etc. in Orthopaedic conferences \"tfthrtaRCoaereeackyrtobrhja.eetruriInnh,pannVaoeioaesnslarsdItoeinaagasgaatdahriindbieeziynadlssaoaenut(hfsrisalseoabt.itvnrnrAhueeagirsviglbnhneaoheoerntdlesduydonerlbfapdbttianrrronbecoeaonkefwninetdsishnf)se,ai\"orosrDunberarde.lccsooumne-around the world. He has been awardedfor the best paper publication on nu-merous occasions by Delhi OrthopedicAssociation and Apollo Hospitals. Hiswork was recognized in the Limca bookof records in 2012, 2013 & 2015 for do-ing bilateral Total Knee Replacement in93 years old gentleman, bilateral TotalKnee Replacement in the oldest couplein a single sitting, ACL reconstructionon oldest man. Dr. Raju talks to HealthSpectrum about his success story ofprofessional practices.Q. As a successful doctor, what isthe secret of your success?Ans. Passion, dedication and honesty24 July 2016 Health Spectrum

towards the profession. Face to FaceQ. How do you take your career as a doctor? Q. Had you not been doctor, what would you have been?Ans. It is a very noble profession and gives us the opportu- Ans. Scientist.nity to heal the sufferings of people. Q. What makes you happy or satisfied?Q. What are the challenges as a healthcare provider? Ans. Relieving peoples’ sufferings to the best of my abilitiesAns.Need to understand the patient’s problem, expecta- and a happy & supportive family.tions and provide an amicable solution, holistically. Q. How do you see yourself after 10 years from now? Ans. Would love to retire from an active clinical practice,Q. According to you, What is the most important aspect of but would provide guidance, teaching and social work forthe healthcare to be focused? the younger doctors and general public.Ans.Lot of emphasis needs to given for preventive medi- Q. Any event in your life, professional or personal whichcine than the curative therapy, as ‘prevention is always has influenced you most?better than cure’. Ans. Meeting, Dr Prathap C Reddy, Chairman, ApolloQ. What are the steps Government should initiate to pro- group of hospitals in London (in 1989), when I was work-vide quality healthcare to the masses? ing in UK. He showed a glimpse of hope and light of betterAns.National programs to improve the sanitation, to healthcare opportunity in India. This helped me in return-provide clean and safer water, basic education to children ing back home to serve the needy people of India. Andabout the health, safer roads and working environment for there has been no looking back since then.workers and laborers. Government should also provide the Q. What is your opinion so far corporatization is con-healthcare facilities within easy reach to all the population cerned?across India. Ans. Corporatization should be taken as a blessing and boon for the Indians. A lot of new technologies have beenQ. What are the reasons that the patients are not willing transferred here, as a result highly professionals retainedto visit private healthcare centres? and returned back in our country. Instead of brain drain itAns. The patients have problems of searching doctors of has become a brain gain (a reverse trend).their choice. They are equally not interested to visit the Q. What’s about medical tourism?government hospitals. In government hospitals patients Ans. It is a good concept and a successful one. Patientsmostly do not get adequate and prompt care as per their from other countries visit India and also take treatmentexpectations. Therefore, they look for private hospitals. In which has been cheaper in comparison to other de-India, private sector has contributed almost 50% to health- veloping countries. It has a lot of potential to boost thecare. Public, private partnership is the need of the hour in healthcare business. India is on move, many things will bethe healthcare sector. happening in years to come in the health care sector. nQ. What are the changes you see in the field of HealthCare?Ans. There is a sea change as far as patients’ awareness isconcerned. They have various options like google searchmachine etc. of searching doctors and gaining someknowledge before coming to doctors. Things are changingvery fast.Q. Usually, doctors have more or less hectic schedule ofclinical activities, how do you balance between your workand family?Ans. It is often very difficult to keep a strict balance be-tween the professional work and the family commitments,as a doctor. But an efficient time management can help incoming over this challenge.Q. What are your hobbies? How do you find times forthose?Ans. I like sports like playing Lawn tennis, Table tennis,Swimming and watching Cricket. Medical research andpublication are other passions and hobbies for me.Health Spectrum July 2016 25

Case StudyMedical EmergencySudden Brain Hemorrhage patient recovered after brain surgery.PATIENT CONDITION Chief Surgeon Spontaneous brain haemorrhage isA 55 year old housewife found uncon- Dr. Rahul Gupta, very common and almost 50% pa-scious at home by neighbors. She was Senior Consultant Neurosurgeon, tients expire before they can be shift-taken to nearest Hospital in Buland- Fortis hospital, Noida. ed to a tertiary care hospital. Patientsshahar and CT scan was done at after Team Members : who are unconscious before surgical2 hours which showed brain hemor- treatment take months to recover.rhage. She was referred to Fortis Hos- Dr Anil Dhar Unfortunately, there are few centrespital, Noida for brain angiography, Dr A P Singh for rehabilitation in India and patientPatient was admitted in Fortis Hospi- Dr Manish Marda has to be shifted home after definitivetal in unconscious condition. She had treatment. Hence, role of preventiondifficulty in breathing. cathlab, where without opening the and timely intervention cannot beINVESTIGATION skull, the aneurysm is packed with overemphasised.She required ICU care and ventila- coils. It is a relatively new method Brain haemorrhage is bleeding intotor for breathing. Her heart was not with excellent results. In clipping, the the brain tissue or its surface dueworking properly. She was resusci- skull is opened, aneurysm is exposed to rupture of blood vessel. It can betated in ICU and brain angiography and a clip is placed across its neck. spontaneous or due to head injury.was done after 2 day. There was an This is a time tested method and pro- Spontaneous Brain haemorrhage isaneurysm which has caused brain vides permanent cure. usually associated with high bloodhaemorrhage and she needed surgery pressure (BP). Different types of brainto prevent rebleeding. But she was haemorrhage may have different rea-not fit for any anaesthesia. After one sons.day, her condition was further dete- SURGEONS ADVICEriorated and blood pressure falled to For preventing brain haemorrhageminimum level. Her pupils dilated frequent monitoring and control ofand doctors thought she will not able blood pressure with medication andto survive for more than two or three lifestyle modification are most impor-hours. tant. Brain haemorrhages are moreSURGERY frequent in early morning especiallyWith efforts by critical care and neuro- in winters. Drinking lot of water andsurgery team her condition improved. timely consumption of medicines isShe was then operated upon after 36 essential. Minor headaches shouldhours. surgery was successfully per- not be neglected and a Neurosurgeon/formed at Fortis Hospital, Noida. Sug- Neurologist should be consulted. (byeons has to perfomed craniotomy and Vinod Kumar) nclipping on the patient. surgeons hadto open the skull because there was a Health Spectrumlarge blood clot also which was to beevacuated.AFTER SURGERYAfter surgery she had severe pneu-monia and she stayed in ICU and shekept on ventilator for 10 days. Thenshe became conscious and shifted toward.Now after oen month she has re-gained all her brain function. There issome left side weakness, but her con-dition is improving fastly.ABOUT COILING/CLIPPINGCoiling or Clipping of aneurysm aremethods to prevent re-rupture of ananeurysm. Coiling is done in Neuro-26 July 2016

ArticlesIs Left-Handedness a Handicap for Training in Surgery?espite the progress made matter in the long run (in by our society, left hand- terms of a surgical career) edness is still not widely and I would urge an aspiring surgeon not to give up theD accepted. Parents like to dream of pursuing a careersee their children write with their in surgery because of beingright hand initially and start correct-ing them if they use their left hand. left handed. There have beenDespite coming from a family, where many studies conducted onmy mother is left handed, I have this topic and they havefaced the music many times in my found no difference in surgi-life for using my left hand. My teach- cal outcomes between righters at school used to scold me for my and left handed surgeons.awkward way of writing despite hav-ing a reasonable hand writing (whichis uncommon for doctors?? ). In spite Some helpful points for a left handed surgical trainee:of the scoldings, I persisted with my v Don’t switch awayown way of writing and one advan- from your dominant hand.tage of my style was that nobody Get good at doing the basicscould copy my work during the ex- with your left hand (cuttingams. straight with a scalpel, basic dissection, basic suturing), then learn how to do every-Uncommon way of writing in India thing right-handed. If youbut common in the west. start too early trying to doI always wanted to become a sur-geon from the second year of medical everything with both hands,school and while observing my sen- you’ll probably flounderiors (who were mostly right handers) around and not improve asoperate, the thought of a left hand- quickly as you should.edness being a handicap crossed my Dr. Rohan Khandelwal v Learn to tie knotsmind many times. My teachers, most right handed first, sinceof whom were right handed, did not Consultant - Oncosurgeon (Breast Services) you’re going to learn to tiehave much to say when I approached W Pratiksha Hospital, Gurgaon with both anyway.them with this query as a medical Head - Medical Affairs at Curofy v Use scissors withstudent but none of them discour- your right hand initially. Email Contact : [email protected] +91-9810072878aged from taking surgery as a career. Learning to cut left handedThe thought of working as a left with right-handed scissors ishanded surgeon started haunting me cessful left handed gynaecologist, was tricky, especially with heavyagain when I started my residency. a constant source of inspiration dur- Prolene or other sutures.Initially, I did find things a bit diffi- ing this tough period. v Once you’re good with your dom-cult because all the instruments were After the initial hiccough’s, my inant hand, by all means work on am-designed for right handed surgeons seniors became accustomed to my left bidexterity. Being able to operate withand left handed instruments (like left handedness and taught me the skills both hands has been advantageous tohanded golf clubs) were not widely more patiently. In no time, I mastered me as I’ve progressed through resi-available. Most of my seniors, initially the techniques with my left hand and dency.found it difficult to teach me the basics then started to hone my skills with the v Don’t let being a lefty deter youand used to get a bit annoyed when I right hand as well. In fact, I tie right in any way from pursuing a surgicalused to start operating by standing on handed knots better than left handed career.the left side of the table (for those who knots (probably because I was taughtare not aware, most of the procedures by a right handed surgeon). In the end I can just say one thing : I may be left handed, but I am alwaysare done by standing on the right side Now when I look back, being right right! nof the table). My mother, who is a suc- handed or left handed really does notHealth Spectrum July 2016 27

Articles Blue Light HazardNot Just UV Radiation, Eyes FaceThreat from Blue Violet Light as Well T he effects of harmful Ultra Violet Dr. Ira Chopra Radiation on the health of skin and This development has prompted a newConsultant Eye Surgeon, eyes have been well documented wave of research and studies in the field of and much talked about in recent ophthalmology as well as ophthalmologic op- Paras Hospitals, years. However, researchers today have iden- tics. But before moving on to that let’s under- Sushant Lok, Gurgaon tified that ultra violet light is not the only stand with greater precision the effects of blue harmful component of light when it comes violet light on the structures within the eyes. to visual health. The Blue Violet spectrum of What is Blue Light? visible light is another component that has the potential to cause damage to retinal cells The small spectrum of the electromag- of the eyes. In fact, researchers have coined netic radiation which our human eyes are a new term to describe the danger this light capable of perceiving is termed ‘visible light’. spectrum presents to critical structures with- A human eye typically responds to wave- in the eye. They call it “blue light hazard”. lengths between 390 to 700 nm (nano metre). This entire visible spectrum can further be Interestingly, blue violet light (wavelengths divided into different bands which includes between 380 and 500 nm) is not just emitted blue, green and red lights. Blue light has a by the sun but also by artificial sources of light wavelength of between 380 nm and 500 nm, such as LEDs, CFLs, and digital devices such making it one of the shortest, highest-energy as computers and smartphones. Given the in- wavelengths. While this range of visible light creased usage of new age lighting devices and spectrum plays a generally beneficial role on an increasingly ubiquitous existence of smart- health, in particular by regulating the internal phones and computers, what we are witness- biological clock, a small but specific section of ing today is a much higher exposure to blue this band has been found to cause damage to violet light than say five years back. retinal cells.28 July 2016 Health Spectrum

Because they have shorter wavelengths and higher fre- Articlesquency and higher energy, blue light waves create flicker-ing and glaring effect on the eyes. This is perhaps why pro- time spent on chatting and surfing the Internet can be help-longed exposure to computers, television and smartphones ful in reducing eye strain, headaches and digital mental fa-causes strain to the eyes, headaches or fatigue. Researchers tigue.believe that prolonged exposure to blue light may cause reti-nal damage and contribute to age-related macular degenera- Using screens and digital devices in a correct posture istion, which can further lead to loss of vision. In most cases, also important. Make sure the screen causes minimal glare,this photochemical damage accumulates over a lifetime. reduce brightness and surrounding lights and make sureWhere is Blue Light? the screen is always right ahead of your face to ensure least strain on the eyes. Well, it is everywhere! While sun is the main source ofblue light emission, it is certainly not the only source. To- Take regular breaks from screen time. Stand up fromday, we are literally surrounded by sources of blue light and your desk every two hours and just walk around the work-therefore continuously exposed to it. place for five minutes. Blink more often. While solar radiation is considered to have 25% to 30% Wearing protective eye wears in front of digital screensblue light, the modern, energy efficient light sources such as has emerged as the most viable preventive option in the faceCFLs and LEDs emit significantly higher amount of harmful of increasing prevalence and exposure to blue light radia-blue light (roughly 26% of the light from CFLs is blue while tion. Studies have also showed that wearing protective lens-an estimated 35% of light emitted by LEDs lies in the blue es with blue light filters helps reduce symptoms of eye strainportion). On the contrary, the conventional, incandescent and fatigue. nlamps which were widely used till a few years back, werenoticed to emit very little blue light. July 2016 29 Besides, our eyes hardly stops working in front of digi-tal screens today. The digital screen technology has evolvedradically over the years, and many of today's electronicdevices use LED back-light technology. Computers, cellphones, flat-screen televisions and tabs are just among a fewof the devices that use this technology. With their wide-spread use, not only has our cumulative exposure to bluelight increased, but the duration of exposure is also radicallyhigher today.What are the Solutions & Preventive Mechanisms? The natural filters of the human eye do not provide suffi-cient protection against blue light. Therefore, any preventivemechanism has to start with greater awareness and attemptsto reduce exposure of harmful blue light. Researchers havealso been off late working on mechanisms to help selectivelyfilter the harmful wavelengths of blue light while transmit-ting the beneficial ones. In this context, researchers at Essilor and the Paris Vi-sion Institute have succeeded in identifying the very narrowband of blue light that is associated with photo toxic damageof the retinal cells. The culmination of this research has ledto the development of lenses that has the ability to selectivelyfilter the narrow but harmful wavelengths of blue light thatare damaging to the eyes while allowing the healthy band ofblue light to play its normal roles. The technology has beenincorporated in the latest spectacle lenses manufactured byEssilor such as Crizal Prevencia and Eyezen.Protecting Your Vision Limiting the amount of screen time is very important forthe generation that lives by digital devices. While one can-not do away with the requirements of work, we can certainlyreduce the leisure time spent on digital devices. ReducingHealth Spectrum

HPEAaLrTeHntSiTnUgDY/RESEARCHUnderstanding Your ChildrenPsychology Of A s an adult, we may be of what- Dr. Shobhana Mittal ever chronological age. But dislikes also transform.Whether you have Attending psychiatrist,  as a parent, we are only as old your hands full with a tight work scheduleCosmos Institute of Mental as our child is. Parenting is an or deadlines at the work place, set aside Health and Behavioural on-going process, which is both challeng- time for your child to stay in tune with Sciences, New Delhi. ing as well as rewarding. As a parent, un- them and let them know that you are there derstanding and responding to your child for them. begins from the moment the baby is born. Be it teething aches, nappy change, grow- It is important for parents to grow along ing pains, bruised knees or teenage trou- as their child grows. If a parent wishes that bles, being a parent is a never-ending role their teenager opens up to them honestly where one evolves and learns on-the-job. and shares their problems with them, the Each child is unique, with their own set foundation of healthy communication lies of strengths, weaknesses and personality in early childhood itself. It is important to traits. Understanding your child can go a spend quality time with your child right long way in strengthening your bond with from a young age. Parents must pay at- your child and nurturing their growth and tention to the apparently small thingstheir development in a wholesome way. young one has to say- how their day was, what sports they played, what they learnt KNOW YOUR CHILD: in class, who their friends are. It is impor- tant to understand your child’s fears, appre- Spend time & Communicate : The key hensions as well as strengths and abilities. to having a trusting relationship with your Sharing these seemingly small things goes a child is to know your child as an individ- long way in forming a channel of commu- ual. Not all children are similar in traits nication between a parent and a child, and and each child differs in their personality, facilitates an environment of trust and be- interests, temperament and adaptability to longingness. It also helps the parent know change. As children grow, their likes and and understand their child better.30 July 2016 Health Spectrum

BUILD YOUR CHILD’S As a parent, it comes Parenting SELF ESTEEM naturally to tell your child about “dos in teaching your child to be respon- The growing years can be tough and donts”. But the sible and enable them to make wellon a child, with challenges like- key to efficient par- thought of decisions.It is important tochanges in their body that occur with enting lies in teach- make your child realize their respon-adolescence, increasingly critical ing your child to be sibility at an early age.evaluation at the academic front and responsible and en-adopting mature social roles. These able them to make Often, parents focus on punishingcan take a toll on a child’s self-esteem. well thought of de- their child when the child commits cisions.It is impor- a mistake. But for learning positive As a parent, you are the main tant to make your behaviour, encouragement of goodsource of confidence and encourage- child realize their behaviour is also important. Whenment for your child. Children often responsibility at an your child finishes their homeworklook to their parents for validation early age. on time orputs their toys back in theand support. Constant criticism from box after playing, a word of praise cana parent with little encouragement balanced manner, keeping over-all go a long way in encouraging theircan hamper a child’s self-esteem.It growth and development in mind. responsible behaviour. Let your childis important to instil confidence in learn from their mistakes, rather thanyour child by acknowledging their TEACH YOUR CHILD TO preventing your child to make smallstrengths, lending them gentle en- BE RESPONSIBLE mistakes.Also, ask your child’s opin-couragement and allowing them to ion in some family decisions, be itdevelop their individual talents in As a parent, it comes naturally to which colour to paint the house oractivities like sports, music or dance. tell your child about “dos and donts”. which destination to choose for the But the key to efficient parenting lies next family outing. Try and under- STIMULATE ALL ROUND stand the logic behind your child’sDEVELOPMENT OF YOUR outlook rather than the shortcomings of their opinion. Involving children CHILD in decision making helps them de- velop confidence and improves their Just like it is important to take judgement, which helps them makecare of your child’s academics, it is responsible decisions as growing up,also essential to stimulate an over-all development of your child.““The NEVER LOSE TOUCH OFgrowing years are crucial not just for YOUR INNER CHILD!the psychical growth, but also for theintellectual, social and emotional de- It is important to stay flexiblevelopment of your child.Right from and look at things from a child’s per-a young age, children learn to form spective. You need to be your child’ssocial bonds, share with others, learn friend at times, in order to allow themto deal with their emotions and sat-isfy their curiosity. It is important to open up to you. At thethat parents provide their child with same time, limits have to be set to provideopportunities to develop in a boundaries for chil- dren. Juggling yourHealth Spectrum role as a parent and as a friend can be a tough balancing act.As par- ents, it is easy to forget what it was like to be a child. Sometimes, it is im- portant to step into your child’s shoes and look at things from their point of view. For this to happen, it is important to stay in touch with your inner child! n July 2016 31

HBeEAaLuTtHy SCTaUreDY/RESEARCHWhenBeauty IsMore ThanSkin Deep Having a greater control over their looks has empowered a lot of women, and leading the charge to ‘empower through beauty’ areA dynamic women aesthetic physicians in India yesha, 28 was always trou- guest travelers all the time as an air quick and do not carry the need of go- bled by the deep acne scars hostess, it is of utmost importance to ing under the knife. Facial contouring on her face that had been have a good appearance. Not only to to redefine features is another popular there since teenage. No enter the profession, but also to re- aspect of facial aesthetics today and amatter how well she used concelaers main in it. Same is true for women in number of women like to get their lipsand other make up tools, there was no showbiz or women who have roles in augmented, their cheeks highlightedhiding them. With people often en- front of the camera such as actors and and their chins redefined. Proceduresquiring about the cause of these scars, news anchors. For all such women, to do away with scars, pigmentationnot just this affected her appearance cosmetic procedures are really helpful. an acne marks are among the mostbut also her self esteem tremendously. Even women outside such professions popular,” adds Dr Talwar.Established in her profession and today are actively seeking options to If we talk about the field of der-earning well, Ayesha decided to take improve their appearance, and there mato cosmetology, the leading namesgreater control over her body and met should be absolutely nothing wrong that prop up in our minds in India arean aesthetic physician. A few session with it,” says Dr P. K. Talwar, leading invariably all women. Studying medi-with skin lasers, and her scars are now cosmetic & plastic surgeon and direc- cine, but decisively choosing aestheticonly marginally visible. Ayesha hasn’t tor of Cosmetic Laser Surgery Centre medicine as their careers, womenbeen happier and has never felt more of India, New Delhi. have literally overrun this field.confident. For women in such careers and Of course, there has to be a differ-For the new age bold and confi- fields, cosmetic procedures are a way ence between undergoing cosmeticdent girls like Ayesha, life is to be lived to keep themselves fighting fit, much procedures and becoming obsessedon their own terms and cosmetic pro- like fitness training is for athletes. To- with them. The latter is not recom-cedures are just one resource that offer day, an increasing number of women mended and doctors always advicethis sense of empowerment. are taking recourse to cosmetic treat- clients to be realistic in their expecta-Whether we like to believe it or ments, both surgical ad non invasive, tions and not become dependent onnot, beauty is a desirable thing. Who to achieve some of their dreams. In cosmetic procedures.doesn’t want to look beautiful? Yet, this sense, having a greater control With increase in purchasing pow-there has always been this lingering over their appearance makes them er and greater exposure to the enter-belief that there is something wrong empowered. tainment industry, the awareness andin taking a cosmetologist’s help in im- “More popular though are non-in- demand has grown in the cosmeticproving our appearance. vasive treatments like Botox, fillers, la- industry. (by Sushila Kumari) n“For a lot of women, a greater con- sers, medi-facials, oxygen and vitamintrol over their bodies and appearance infusion therapies etc that areis a boon. For a woman who hosts32 July 2016 Health Spectrum

HEALTH STUDMYo/RthEeSrEAHRoCoHdKnow what to expect from July 2016 33high-risk pregnanciesR emember Kia from ‘Ki and Ka’ and her reac- tion on realizing that she was pregnant. For her the world shattered as she presumed her career to come to an end. Kia rightlyrepresented the ambitious careerist working womenof today, for whom pregnancy and child birth is nomore a priority, till at least they achieve certain levelof success in their career. And by then they are most-ly in their 30s, may be late 30s or early 40s also. Pregnancy for these women may not be smooth.With age, other comorbid complications like thyroid,gestational diabetes, high blood pressure, pile in dur-ing pregnancy making the journey tougher. However,thanks to medical development, today such high-riskpregnancies can be managed at ease with care. According to Dr. Leena C D, Consultant Obstetricsand Gynecology, Columbia Asia Hospital, Hebbal therehas been an increase in the number of high-risk preg-nancy cases. “Mothers with a history of recurrent miscarriages, hy-pertension, diabetes, ART pregnancy, too many surgeries,abnormality of the uterus, etc. comes under the high riskpregnancy. Also, lately a lot of women have started optingfor pregnancy at a later stage in life. Women older than 35years of age often fall under the high risk category,” saidDr. Leena The first 12 weeks of the pregnancy are most crucialespecially for women with a past history of recurrent loss.One can identify complications by hypertension after 20weeks and by diabetes after 24 weeks. It’s extremely crucialthat these issues are identified as early as possible in thepregnancy to avoid complications and miscarriages. “One has to be extremely careful during a high-riskpregnancy. In case there is a history of more than threelosses, the chances of miscarriage can increase from 5% -25%,” added the doctor. Here are a few suggestions by Dr. Leena for to-be-mothers with high-risk pregnancies:v It is important to go for frequent check-ups with yourdoctor.v Ask your doctor for anti-platelet drugs requirements.v Get the heartbeat checked ever 2 weeks for any com-plications.v Get all the necessary tests done for early detection ofcomplications like hypertension, diabetes and thyroid.v Restricted activity is one of the most important factorsduring this period. (by Jytoti Chaudhary) n Health Spectrum

HEALTH STUDY/RESEARCH Food & Nutrition34 July 2016 Pre pregnancy nu- trition is as important as nutrition during pregnancy, as both help to determine fetal growth and therefore size and health of an P infant at birth. regnancy is a wonderful milestone in the life of a woman. It is an experience that a woman would like to nurture in her heart for a lifetime. It is a time when a woman will be overwhelmed with a variety of emo- tions ranging from the happiness of being pregnant to the anxiety about the proper health, growth and development of young baby to be. Child bearing imposes both physical and mental strain on the body and mind. To be able to counter this, it is important that the mother has a healthy diet during pregnancy. A nutritious and rightly bal- anced diet during pregnancy ,is important not only to maintain the maternal nutritional needs and the development of a healthy fetus but also to provide continuous adjustments in maternal body composition and metabolism. While it is important to have proper nutrition and right diet during pregnancy, pre-pregnancy nutrition is equally important, as it helps deter- mine fetal growth and therefore size and health Health Spectrum

Food & Nutritionof an infant at birth. Well balanced, nutritious Following are the nutritional requirements Dr. Pallavi Vaishyadiet also plays a great role post pregnancy as during pregnancy:well by ensuring a good health to the mother Senior Nutrition Consulant,and child during lactation. Energy & carbohydrates: Additional en- Kailash Hospital, Noida ergy is required during pregnancy to support Conceiving is not an easy process and the metabolic demands of pregnancy and fetalrequires both health and mind to be prepared growth.to take the leap. A major part of the nutri-tion given to the body during pregnancy is Protein: During pregnancy there is a needpartaken by the fetus. for additional protein. It is to support the synthesis of maternal and fetal tissues. The Therefore, it becomes important for a efficiency of conversion of dietary protein towoman to store her nutrition much in advance milk protein is 70%. So the need for protein isbefore she decides to get pregnant. Hence, it is greatest when lactation has reached its maxi-important to ensure intake of nutritious and mum.well balanced diet pre pregnancy. And,since nutritious diet provides Minerals: In pregnancy the needs for cal-strength during lactation, post cium, iodine, iron and zinc and in lactationpregnancy nutrition becomes calcium and iron increases.equally important. Vitamins: During pregnancy Vitamin The drain of pregnancy and D, Vitamin E, Vitamin K, Vitamin C,child feeding is such that itoften leads women excessively Thiamine, Riboflavin, Folic Acid anddeprived of nutrients. In women Vitamin B6and during lactation Vi-who do not take conscious tamin C and Vitamin B are highlycare of their nutritional status, essential.this can be dangerous for both Fluid intake: You need toshort-term and long-term health. drink plenty of water. At least 4-6Calcium is one of the most crucial glasses in addition to what is con-mineral needed for the growth of a tained in the form of milk and otherfetus and this deprives pregnant women ofa lot of their own body reserves. beverages. This should be taken throughout pregnancy and in lac- During pregnancy, the nutrient to the fetus tation, an increased fluid is necessaryis provided by the food taken by the mother. for adequate milk production.While nutrients such as mineral, vitamins Supplements: These should beand others are required for the mother to stay taken as per doctor’s prescription.healthy to be able to deliver the child, nutri- Self-medication is not recom-tious diet is also important to ensure proper mended.supply of nutrients to the developing fetus. In Besides a healthy and variedmany cases women recover their bone calcium diet, it is also important to bringafter they have delivered the baby and have changes in the lifestyle such asbreastfed her, many are left with depleted practicing light exercises regularlybones for life. This can be prevented if you and avoiding stress and tension.take care of your calcium intake and bone You should try not to overloadhealth from early years and ensuring a healthy your system and keep it fresh. nfrom the time you decide to get pregnant.Health Spectrum July 2016 35

FHiEtAnLeTsHsSTUDY/RESEARCHHealth Benefits ofI t may seem ironic, given that hu- er types of impact exercise, swimming relative to air means that your mus- man beings are land dwellers, that is impact-free and can be practised by cles are forced to work harder in a pool one of the most comprehensive people of all ages. It also works out your than they would on land. The effect is and effective forms of exercise entire body.” similar to resistance training, used towe know involves dunking ourselves increase muscle strength, says Ashokinto an alien environment. Humans are Also, according to Santosh Jacob, a Seth, chairman and chief cardiologist,not naturally designed to swim very ef- doctor of sports medicine and founder Escorts Heart Institute and Researchficiently, unlike penguins, sharks, seals of the Indian Academy of Sports Re- Centre, New Delhi, and himself a scubaand Michael Phelps. This, however, is search, Chennai, swimming is one of diver certified by the Professional As-exactly what makes it such a powerful the few exercises “that incorporates sociation of Diving Instructors. “Also,fitness tool. Exercise—effective exer- respiratory and cardiovascular ef- unlike other forms of aerobic activ-cise, at any rate—must necessarily take fort (breathing and blood circulation) ity (such as running, tennis or aerobicsyour body out of its comfort zone, and without stressing the joints”. So with classes), swimming requires you to useswimming achieves this quite literally. a scorching summer around the cor- almost all your muscles at the same ner, you have good reason to ditch the time, both upper and lower body,” he It is also inherently safer, despite sweaty gym for a cool pool. adds. All swimming techniques, ex-what Jaws and Baywatch would have cept the backstroke, harness the del-you believe, than almost any form of Resistance training toids (upper back/shoulder), abdomen,land exercise, says Gokul Kamath, glutes (buttocks), hamstrings (back ofcoach of the national swimming team Swimming’s standout quality is that thighs), quadriceps (front of thighs)in 2006-07. Kamath, currently head it is at once both kinder to, and more and plantar (foot) muscles to varyingcoach at the Navi Mumbai Sports Asso- demanding of, your body than any degrees.ciation, says: “Unlike running and oth- land exercise. Water’s higher density36 July 2016 Health Spectrum

HEALTH STUDY/RESFEitAnReCsHs The higher density of water also says, “It is perhaps the only form of ing. A combination of freestyle and but-counteracts gravity, reducing stress on exercise that provides aerobic benefits terfly is ideal for the experienced swim-joints and muscles. “All forms of activ- from raising your heart rate and in- mer; a mix of freestyle and breaststrokeity or exercise put stress on our joints,” creasing your lung capacity (because it is best for beginners.”says Dr Jacob. “A joint with pre-existing needs breath control), as well as exer-arthritis will definitely be aggravated by cising muscles throughout your body.” Post Commentsrunning, as it is an impact exercise. But Ruchira Tendolkar, technical director,when swimming, you exercise at 30% of BFY Sports and Fitness, Mumbai, notes   The breaststroke, Dr Jacob adds, isyour body weight and, hence, cut out that the benefits of a daily swim include perfect for warm-ups, and has the low-the risk of musculoskeletal stress, which stronger heart and lungs, better blood est potential to pull or strain your mus-may lead to the degeneration of joints circulation, increased strength and en- cles. Freestyle is somewhat more vig-and aggravation of muscle tears.” durance, and enhanced neuromuscular orous and requires more effort, while coordination. “These translate into a re- the butterfly stroke makes the highest Indeed, Dr Seth says, not only does duction in risk factors for lifestyle dis- demands on your muscles—especiallywater ensure there is no direct impact eases (coronary artery disease, diabetes your back and shoulders—and lungs.on joints, it also prevents the jerks that and so on), such as improvements in The backstroke is slightly different fromare part of even gentler aerobic exercis- lipid profile, better control of blood glu- the rest as it relies less on muscle power,es such as walking. “All movements in cose, reduction in blood pressure and a activating mainly the muscles of the ab-swimming are controlled, slowed down reduction in weight as well,” she adds. domen, groin and neck.by the resistance of water, which meansthere is hardly any risk of injuring your- Swimming also offers special ben- Weighty mattersself,” he says. efits for seniors. “It increases a person’s capacity to use oxygen, which deterio- Experts are not unanimous in en- This is significant for everyone, rates with age,” says Dr Jacob. Dr Ten- dorsing swimming as simply a goodfrom pregnant women to someone re- dolkar adds that it helps maintain flex- weight-loss tool. An hour at moderatecovering from injury—indeed, pretty ibility, which also tends to decline with intensity (raising your heart rate to 60-much anyone with a reduced capacity advancing age. 70% of its maximum capacity) in a 60kgfor tolerating jarring, repetitive work- man burns 540-650 calories.outs. Different strokes “For significant weight loss, it wouldGood for the heart While running—and to a lesser have to be sustained for a much long- extent weight training—restrict your er time,” says Dr Seth. Or you would Swimming is particularly beneficial joints and muscles to a limited range need to work harder, making it an in-for pregnant women as it strengthens of movements, swimming is more flex- tense workout (90% of maximum heartthe abdominal muscles, of particular ible. Depending on your level of fitness, rate), which depends on your effortimportance to carrying a baby. It also you can adopt the demanding butterfly and fitness level rather than speed, Drstrengthens the back muscles, making it stroke, the milder freestyle or the fluid Jacob points out. That’s the differenceeasier for mothers-to-be to support the breaststroke. between, say, a brisk walk in the parkextra weight during pregnancy. Other versus one that leaves you sweaty andcommon issues associated with preg- Dr Jacob says: “The butterfly stroke breathless.nancy—high blood pressure and joint is the most demanding of all and burnsstiffness—can be eased by swimming. the most calories, while the backstroke Recreational swimmers don’t usu- and the breaststroke are less demand- ally make that effort, Kamath notes. To Swimming reduces blood pressure shed serious inches, therefore, they mayand lowers the resting heart rate, re- be better off adding other cardiovascu-ducing risk of cardiovascular diseases. lar (such as running, cycling or aero-“Though there are no evidence-based bics) and anaerobic exercises targetingstudies on the effect of swimming on is- specific muscle groups.chaemic heart disease (characterized byreduced blood supply to the heart mus- Dr Seth also notes two drawbacks tocle), a controlled workout involving 30 swimming. The first is that access to aminutes of freestyle or breaststroke can pool, and a hygienic one at that, is notdefinitely reduce the risk of a heart at- universal. Not only must it be well chlo-tack,” says Dr Jacob. rinated, it must enforce rules of shower- ing well to clean up before a dip. “Un- But what about people with exist- fortunately, we Indians tend to regarding heart conditions? For them, Dr Seth swimming itself as a bath,” says Dr Seth.advises caution, “Patients with heartdisease can drown if there is a problem The other caveat is weather. Unlesswhile in the pool, so before swimming it is a heated, enclosed pool, you have tothey need clearance from the doctor.” wait for summer. Which, fortuitously, is right now. (by Priyanka Sharma) n For the rest of us, though, Dr SethHealth Spectrum July 2016 37

FHiEtAnLeTsHsSMTaUnDtYr/aRESEARCH FITNESS FUNDA OF A DOCTORDr Yuvraj Kumar is Head of Department of Orthopedics and Joint Replace-ment at Asian Institute of Medical Sciences (AIMS), Faridabad. Dr. YuvrajKumar is an orthopedic surgeon who has done fabulous work in Spine Sur- gery & Joint Replacement . Dr. Yuvraj is a fitness freak. He took part in a number of marathons. Dr. Yuvraj Kumar running in Mumbai Health Spectrum Marathon on January 17, 201638 July 2016

A ccording to the United States Department of Health Fitness Mantra and Human Services, physical fitness is defined as “a set of attributes that people have or achieve that find intrinsic motivation but once you do it is similar to the Sun relates to the ability to perform physical activity.” burning from within. I have been fasting on Saturdays for last twenty years, run- ning and working out consistently for last ten years. Patients,Being an orthopedic surgeon means absolute precision, a nick colleagues, friends and family regularly ask me for advice and Iat a wrong place could be potentially life threatening. I strive to do share my two cents of wisdom but I often hear back excusesachieve perfection in my work and it starts at 5 am in morning about demanding job, work related travel, body soreness, no ac-with a run in the ground twice a week and work out at the gym cess to gym etc. While I am certainly privy to these issues but Ithrice a week. Immediately after work outs I have whey protein always figure out a work around. I am not going to share hacksshake with magnesium tablets followed by a quick cold-water or steps to lose weight or tricks to achieve fitness. I want everyshower. reader to understand in plain English “There is no short-cut.Breakfast is a healthy bowl of multi-colored fruits (ensures There are no tricks. There are no meds.”balanced mix of vitamins and minerals), grounded almonds Now, the big question, “How I do achieve intrinsic moti-and raisins (soaked in water overnight as vation to achieve fitness?” There are no for-it increases digestibility) with honey, four mulae, for every individual it can be triggeredboiled eggs, and one chapatti with green veg- Dig Deep. Look within. by different by different reason. I am going toetables. Hit the work, which is basically 70 share what worked for me and hope that itto 80 patients in OPD or multiple surgeries Choose Fitness. helps you too.lined up. v Start with going out in the morn-Lunch is normal north Indian meal- two ing or evening. Just walk, jog, run or stretchchapattis with green vegetables, legumes, but the important thing is, “Go out everyday.”curd, and salad. Sometimes, if you miss the v Find a partner or group, not a nec-lunch, due to unavoidable situations or oth- essary step but it helps to have a like- mindederwise also ensure that you keep trail mix, support system withwhom you can share,energy bars or dry fruits in your office not learn and improve.just for yourself but your team too. During v Set long-term (year wise) andsummer it is absolutely essential to remain short-term(month wise) goals such as Ihydrated and maintain electrolytic balance, would run Half Marathon in 2017 or I woulddrink lots of water, have coconut water, wood achieve 8% body fat by December, 2017 andapple juice, or any electrolyte powder. I would incrementally improve distance by 1Ideally, we should have an early dinner km per month or improve speed by 30 sec-around 3 to 4 hours before going to bed but onds per month per kilometer or decreaseour cultural and work setting makes it dif- body fat by 0.5% per month.ficult. I generally have dinner 2 to 3 hours v Use Jugaad, find a work aroundbefore going to bed. Dinner is fish curry on impediments, if you are travelling just keepWednesday and Friday, Chicken or Mutton your running shoes with you and if you can’ton Sunday and Monday, Green Vegetables even do that then stretch or do body weightand Legumes on Tuesday, Thursday and Saturday along with 2 exercises.chapattis and salad. v Once, you exercise consistently for one or two months, youAlthough, I have been working out actively for last 10 years, will start forming a new fitness craving habit and you will startthe seeds were sown long time back. When I was a kid my enjoying your new fitness regimen along with the endorphins.mother would wake me up at 4 am and then she would wake up v Eat a balanced diet. Say no to processed foods. Ensure thatcouple of other families in the colony we would all go together your meals have 50% vegetables or fruits, 25% carbs and 25%for a walk. protein.Life is a journey and so is fitness. Fitness is not only aboutexercising but also a fundamental shift in the mindset. You Fitness is a state of mind, when you exercise regularly youmust have heard countless success stories, the only thing they would start to see its benefit:have in common is relentless commitment to not giving up. So, v High energy and confidence, which will infect andit is with fitness you must not give up and keep travelling the impress, your colleagues and bosses at work.path not for the low hanging fruits on the sides but for the joy v You will be more optimistic which help in your in-of travelling. Yes, you may enjoy the low hanging fruits too, but terpersonal relationship with family, clients and external stake-the point I am trying drive through is that those low hanging holders.fruits shouldn't be your reason. v You will possess greater mental strength, which willPeople exercise for various reasons such as losing weight, help you get through the times of adversity.looking beautiful, doctor made it mandatory, health condi- v Cognitive functions will improve thus, helping youtions, lifestyle diseases etc. While these are all valid reasons, the make better and more efficient decisions.problem with extrinsic motivational factors is you lose incen- Once you get addicted to a state of mind that is fit and sup-tive once the goal is achieved. I want you to look within, dig ported by a healthy body, trust me you would find your intrin-deep and find intrinsic motivation. It is extremely difficult to sic motivation. nHealth Spectrum July 2016 39

HAlEtAeLrTnHaStiTvUeDMYe/RdEicSiEnAeRCH Homeopathy Treats The ‘Cause’ And Also ‘Effect’Dr Mukesh Batra H omeopathy is not just a sys- icine employs the same principle, in cer- tem of medical treatment; it tain instances — it prescribes stimulantsLCEH, FSRH (MED) P is an advance in the area of to ‘treat’ kids with attention-deficit hy-(LOND), MDH (USA), FBIH mind-body, holistic medi- peractivity disorder (ADHD). Likewise,(UK), a homeopath of inter- cine. It involves treating the individual it employs minute doses of allergens,national repute, is Founder- having the illness, or disease, with highly such as pollen, to desensitise allergic in-Chairman, Dr Batra’s Group. diluted substances, prescribed primarily dividuals. The only ‘dissimilarity’ withA writer, photographer, singer in pill form, with the aim of triggering homeopathic remedies is that the me-and philanthropist, Dr Batra the body’s natural capacity for healing. dicinal substances used are in the formhas been honoured with several of ultra-high, non-toxic dilutions. Theyfellowships and over 50 na- Homeopathy was founded on the law are called homeopathic potencies.tional and international awards. of similars, or ‘like cures like’ principle. Put in précis, “A substance that causes Picture this. You were, the other day, a set of symptoms, when taken in large affected by a sudden or rapid onset of fe- doses, can in ‘small, minute doses’ treat ver, which escalated into high tempera- similar symptoms.” A homeopath, a pro- ture in no time. Your face appeared ‘red fessional graduate or post-graduate with hot’ and dry, along with flushed eyes. a university degree in the subject, will Your lips and mouth were pale; your match and prescribe the most appropri- tongue ‘angry’ crimson. What followed ate remedy, based on such ‘like’ symp- next was sweating and confusion. There toms each individual or patient presents was little thirst; but, there was a strong with. craving for sour foods or drinks. Your other symptoms included a raw, aching To cull an example — drinking too feeling in the eyes, with sensitivity to much coffee can cause sleeplessness and light and tearing, throbbing pain deep disquiet. Taking the homeopathic rem- inside your ear. edy, Coffea Cruda, made from coffee beans, can homeopathically treat ‘like’ According to the concept of ‘like symptoms — a result of overexcitement, cures like,’ as referred to earlier, a sub- or joy, a pay hike, or a huge reward on stance that is capable of provoking such the job. Interestingly, conventional med- symptoms in an otherwise healthy indi-40 July 2016 Health Spectrum

vidual can also therapeutically act on simi- HEAALTltHerSnTaUtDivYe/RMEeSdEAicRiCnHelar symptoms in a person who is ill. Thehomeopathic remedy, Belladonna is em- CASE EXAMPLESployed, when accompanied by such symp-toms — as described above. Such a set of CASE-1symptoms actually resembles Belladonnapoisoning. The interesting fact is Belladon- Vivian (name changed), a thirty-year-old restaurant manager, reported,na, in spite of its toxic nature, has for long “I’m allergic to everything, including food.” His nasal anguish showed inbeen used as an antispasmodic, relaxant, or the form of a cloudy discharge that flowed day-in and day-out. When hesedative, in herbal medicine. Homeopaths sat through case-taking, he wiped his nose, with tissue paper, more than ause Belladonna, in its potentised form, to dozen times. His eyes appeared swollen, tickly and watery. Vivian told ustreat high fevers with inflammation and that when he slept he had an annoying sore feeling in his throat. He alsopain, among other symptoms — and, with complained of cough, and headache. He felt better at home, not outdoors.complete safety. He also said that he had ‘exhausted’ every conventional over-the-counter (OTC) cold and allergy medication available. Most of us are ‘coached’ to acknowledgethat the only way to stamp out infection is We prescribed him Allium Cepa, a homeopathic remedy, made fromwith conventional antibiotics. This is based red onion. After six months of homeopathic treatment, and regular follow-on the precept that antibiotics destroy mi- ups, Vivian called in to say his nose was relatively dry. There was no itch-cro-organisms, such as bacteria, and allow ing; and, his sneezing bouts had reduced considerably.the body to recover from illness. Interest-ingly, antibiotics have no effect on virus Though Vivian experienced continual sneezing, for a month or two, he— yet, they are misused by many for viral said that this too eased slowly. By the time he came for one of his follow-infections, most often without a doctor’s ups, a year later, his allergic symptoms had receded to a significant extent.prescription. CASE-2 From the homeopathic standpoint, ahomeopathic remedy is given, where the Three-year-old Vilas (name changed), presented with itching erup-symptom pattern of the remedy ‘match- tions (atopic dermatitis), all over his body, exuding blood and pus; hises’ with the symptoms of the illness and t-shirt and shorts were stained with blood stains. His parents informed usstrengthens the body’s own ability to fight that Vilas suffered from this misery since birth. They had tried the best ofthe infection from the inside out and also conventional treatment, but in vain. On detailed case-analysis, we foundrestores balance. that Vilas, as his parents complained, was highly irritable, crying and screaming, all the time. Interestingly, he was comparatively calm when he According to homeopathic principles was carried around by someone. However, when he was put down on bed,the real cause of infection is not just the he would start yelling and also get belligerent. We asked his mother aboutmicro-organism, but the person’s body, or her emotional status during pregnancy; she revealed that she went throughcompromised immunity, and susceptibility, a lot of suppressed emotions and anger during the time.which provides the fertile ‘soil’ for bacteriaor viruses to survive, thrive, and prolifer- Based on her symptoms of ‘suppressed’ anger during pregnancy and excessive ‘resentment’ in her child, we gave Vilas the homeopathic remedy, Chamomilla Recutita. In about 2-3 months’ time, it not only reduced the itchiness, eruptions and discharges, but also calmed him down and made him sleep soundly. His eruptions too reduced after 5-6 months — this was something that had not happened before. This is the unique feature or clinical exquisiteness of homeopathy. It treats the person, not just the illness or disease in isolation — in other words, the individual’s symptom-picture, their distinct personality, temperament and also response to illness.Health Spectrum ate. When the natural balance of the body is restored with homeopathic treatment, the micro-organism will not find the augmented inner work- ings of the body favourable for growth. Remember, when you are in good health and well- July 2016 41

Alternative Medicinebeing, you will not develop symptoms Homeopathy treats the Homeopathy suggests that thereat the drop of the word, infection, as individual as detailed exists within all living beings a smartothers may do. You will also not show earlier, so it does not ‘resident’ power responsible for main-‘open’ vulnerability. limit its treatment to taining balance in body, mind and the diagnosis of an ill- emotions and also healing. Samuel Homeopathy actually views ill- ness in isolation, or on Hahnemann, MD, the founder ofness as disagreement, or undermined the surface. When you homeopathy, called this energy thebalance — occurring first at the most are ill, your illness has ‘vital force’ — whose corollary infundamental levels. This ‘causal’ dis its own unique pattern Eastern thought is prana, mana andcrepancy is the source of all illness — of symptoms. chi — or, life force. The vital force isit shows itself eventually as symptoms, not tangible; its effects are, however,created by the body in the process of obvious in both health and illness.trying to correct the imbalance. It is In modern parlance, the vital force isthis imbalance, again, that homeopa- the body’s immune system or defence,thy addresses, using symptoms as a responsible for preventing illness andchannel to select the natural substance maintaining and bringing all bodilythat can be of assistance in the process systems back into equilibrium. Thistowards restoration of health. defence mechanism is not merely physical; it also has emotional aspects linked to it. Homeopathy treats the individual as detailed earlier, so it does not limit its treatment to the diagnosis of an illness in isolation, or on the surface. When you are ill, your illness has its own unique pattern of symptoms. You may tend to ‘catch’ certain illnesses that result from a particular pattern of imbalance with your immune system — one that is unique to your body, temperament, emotions and environ- mental factors. No two individuals, as homeopa- thy suggests, having the same illness, by name, will present with the same symptoms. Two patients, for example, having a high fever state may show different reactions — one may want to be covered with a thick blanket (feels cold); the other may shove away even a thin covering (feels hot). This is in- dividualistic. It calls for the use of two different homeopathic remedies. To put the idea in perspective — there are over a dozen homeopathic medicines, for instance, for migraine, a disorder triggered primarily be emo- tional stress. The migraine you pre- sent with — ‘feels better’ with a hankie tied around the head — will require a homeopathic remedy that matches your particular, or unique, symptom. Your friend’s migraine (‘feels worse’ by pressure), on the other hand, will re- spond to an entirely different homeo- pathic remedy. n42 July 2016 Health Spectrum

HEALTH STUDY/RESEARCHHealth Spectrum July 2016 43

HoEAliLsTtHicSMTUeDdYic/RinEeSEARCH It's the Era ofHolistic Medicare Dr. R. K. Tuli Holistic Medicine is the wholesome approach nised systems of medicine.MBBS DHA DAc(Srilanka) to Health by a synergy of evidence based ‘sci- It calls for us to grow beyond inherent re- CHt(USA) MAcF(China) ence’ of modern medicine with the time hon- MD PhD FRSTM&H(UK) oured ‘art’ of drug-free modalities of all the strictions of the so called evidence based 'sci- officially recognised traditional systems for ence' of modern technology. An ever increas- FICA (USA) promotion of Positive Health and Total Well- ing number of people wish to explore benefits Chief Consultant Holistic ness ‘Body-Mind- Soul. Well known Holistic of the 'art' of time honoured officially recog-Medicine Fmr. Indraprastha Medicine Expert Dr. R. K. Tuli says that all nised traditional or alternate systems of health Apollo Hospitals & Indian wise people think, talk and wish to practice which have a proven record having helped theAir Force * “SOHAM” The Holistic Medicine these days. humanity over thousands of years. Clinic for Holistic Medi- Why Holistic Medicine? The good news is that we, now, have very CARE & CURE It’s been universally recognised that it would rich expertise available to complement the bestD-961, New Friends Colony, of drug-based specialities of medicine with var- never be possible to meet all the health expec- ious drug-free modalities of recognised systems New Delhi-110025 tations of the humanity with the conventional of health to ‘Eliminate all Sickness’ from its root model of healthcare based exclusively on the cause and restore ‘Positive Health & Total Well- modern allopathy system of medicine. There- ness 'Body, Mind & Spirit' in each individual. fore, the World Health Organisation (W.H.O.) recommended and our National Health Policy This all inclusive complementary approach has promulgated integration of all the recog- to health helps to extend the best of each sys- tem of medicine, at the same time overcome inherent deficiencies in the respective systems,44 July 2016 Health Spectrum

to offer a ‘synergy’ of all of them to ensure ‘Health For All’ at all ages of HEALTHHSoTliUsDtiYc/RMEeSdEiAcRinCeHlife and all stages of sickness. This latest speciality of medicine is calledHolistic Medicine. It’s a board certified specialty in the U.S. for nearly Inherenttwo decades, and is catching up very fast amongst the developed na- Deficienciestions. Continuous Research & Development by the profession shall help Of Allopathicto improve scientific protocols. We must give top priority to adopt it into Medicine:our main health care delivery system and make living years happy andproductive for all. 1. It’s not easily acceptable, neither accessibleWhat is Holistic Medicine? to majority of people in the country, result- ing in delays in commencement of appropri- Holistic Medicine is the wholesome approach to Health by a synergy ate treatment, leading to serious complicatioof evidence based ‘science’ of modern medicine with the time honoured ns.‘art’ of drug-free modalities of all the officially recognised traditionalsystems for promotion of Positive Health and Total Wellness ‘Body- 2. It treats the human being as a mere physicalMind- Soul’, i.e., being, with a specialist taking care of just a limited part of the body with ‘allo’, i.e., exter- Holistic Medicine = Modern + Traditional + NewAge Medicine nal medicinal or surgical interventions. Best [Conservative Medicine + Life-Style & Stress Management + Ash- of the support based on this limited concepttanga Yoga + Nutrition +Acupuncture-Reflexology + Panchakarma- comes with inevitable limitations, side-ef-Detoxification + Physiotherapy + Counseling-Hypnotherapy + Reiki- fects, cumulative toxicity and complications.Pranic Healing + Chakra Balancing + Regenerative Medicine] This approach to health matches up to our Vedic concept that health 3. By the time a disease is detectable by mod-is the greatest wealth, and we need health whether to achieve personal, ern diagnostics, it’s invariably too late tofinancial, spiritual growth, or even moksha. It’s guided by the ancient reverse its basic cause and effect true cure.Charaka Samhita which states that life is the combination of the body,the senses, the mind and the ‘atma’; they cannot separated from each 4. This system treats just ‘tip-of- the-iceberg’other, and from this integration ensues ‘ayush’. symptoms of the disease, with rarely beingWhat are the objectives of Holistic Medicine? able to take care of its underlying cause,1. To improve the health and add life to years of each individual. leading to progressive deterioration in2. To complement All the Systems & Specialities of Medicine. health, onset of various side-effects, cu-3. To improve the Final Outcome of Every Sickness. mulative toxicity, complications, inevitable4. To enable Permanent Cure in Maximum Patients. morbidity and mortality.5. To overcome Iatrogenesis by Minimum Medical InterventionsWhat are the benefits of Holistic Medicine? 5. It lacks care of mental, emotional and spir-1. It treats the human being as a whole 'body, mind & soul'. itual needs of the people.2. It offers ‘synergy’ of all the drug-free modalities of recognised sys- tems of Health. 6. It does not address to the increasing3. It’s equally beneficial at all the levels of health. incidence of diseases due to life-style and4. It helps to take care of all the ailments of an individual concurrently psychosomatic disorders; or to needs of the as it follows the Hippocrates' observation that \"The natural heal- increasing population of the elderly from diseases related to process of aging. 7. Also, it does not offer solution to changing pattern of communicable diseases, especially due to emerging viruses or immune distur- bances. 8. It’s based on high capital investment and ex- pensive technology, making its cost beyond reach of most people. It’s estimated that nearly 4% of population in our country falls below poverty line annually due to exorbi- tant costs of medical treatment. 9. According to official statistics, in spite of all the technological advances and availability of world class medical care in our country over the past three decades, the incidence of all common diseases has increased more than FOUR FOLD during the same period.Health Spectrum July 2016 45

Holistic Medicine ing force within each of us is greatest An ever increasing Gout, Diabetes & All Complica- force in getting well.\" number of people wish to tions, Menstrual Disturbances-5. It's drug-free therapy: No drugs, No explore benefits of the PCOD, Infertility, Menopause & An- interventions, No Dope, No Iatro- \"'art' of time honoured dropause, SEXUAL Health: PME, ED, genesis; thereby ensuring the Hip- officially recognised tra- Frigidity, etc. pocrates' dictum, \"Primum Non- ditional or alternate sys- Nocere\", i.e., First Do No Harm. tems of health which have SUBSTANCE ABUSE – ADDIC-6. It’s highly Efficient, as well as Cost & a proven record having TIONS RESISTANT INFECTIONS: Time beneficial. helped the humanity over PUO, MDR-TB , Viral Infections: HIV7. It’s very simple and easily accessible; thousands of years. / AIDS, Hepatitis, etc. can be rendered anywhere & every- where by skilled hands. Terminal Sickness, Cancer, etc. NATURAL CHILD BIRTH /8. It optimizes healthcare by comple- PARALYSIS: Trauma, Polio, Stroke, FAILED FERTILITY menting existing infrastructure at no extra cost. etc. SPORTS MEDICINE & INJURIES:9. It tremendously enhances profes- STRESS / PSYCHOSOMATIC DIS- To improve & sustain performance, fast- sional satisfaction and glory of the er recovery and early rehabilitation. n profession.. ORDERS: Anxiety, Depression, Chron- ic Fatigue, Neurosis, Psychosis, etc. Dr. Ravinder K. Tuli is a global pioneerWhat are the diseases curable by Holis- in spearheading the clinical concept of Holis-tic Medicine? AUTOIMMUNE DISTURBANC- tic Medicine. He is the founder of Society for ES: Arthritis, Nephritis, Thyroiditis, Holistic Advancement of Medicine “SOHAM”. The holistic approach to medicare Diabetes-Type-1, ILD, SLE, Multiple He was invited to establish the world’s first-works to restore 'milieu interior' of the Sclerosis, etc. ever Department of Holistic Medicine at theindividual to initiate one's own inher- state-of- the-art multispeciality tertiary careent natural healing ever ready to initi- ALLERGY – ASTHMA - ECZEMA Indraprastha Apollo Hospitals, New Delhi inate the process of recovery. It leads to – FOOD SENSITIVITY year 1996.eliminate the root cause of all diseasesand help to restore positive health. It'll, DEGENERATIVE DISEASES: Ar- Dr. Ravi Tuli is a 1964 batch alumnuswithout any conflict, complement medi- thritis, Spondylosis, Disc Disease, De- of the prestigious Armed Forces Medical Col-cal procedures to improve outcome in mentia, Parkinson’s or Alzheimer’s dis- lege, Pune. He has been medical adviser to Airall emergency and acute conditions, and ease, etc. Force Sports Control Board, as well as Indianenhance efforts to cure all diseases of the Hockey Federation representing India in sev-person, that too concurrently. The brief ATHEROSCLEROSIS: Hyperten- eral events abroad. He’s been official doctorindications may be as given below. sion, CAD, Post-PTCA or CABG, PVD, of Pakistan & West Indies cricket teams Gangrene, etc. touring India. PAIN: Headache-Migraine, Arthral-gia, Neuralgia, Neuropathy, Fibro-Myal- METABOLIC & HORMONAL Dr Tuli has been rewarded with variousgia, Trauma, Phantom, etc. om, etc DISORDERS: Obesity, Dyslipidemia, national and international accolades. PALLIATIVE CARE: Incurable or E-mail: [email protected]; Website: www.holisticmedicare.com46 July 2016 Health Spectrum

HEALTH STUDY/RESEARCHHealth Spectrum July 2016 47

Q&AIs the IVF technology usedin the right direction? Recently 72-year-old Daljinder Kaur delivered a baby boy in Hisar after two years of IVF treatment. Ironically, the Amritsar-based cou- ple had the baby to inherit property worth nearly Rs 5 crore that was being denied to them by relatives. This news inadvertently triggered a debate on the need to regulate assisted technologies such as in- vitro fertilisation (IVF). Renowned IVF expert Dr Sushma P. Sinha answers general querries about use and misuse of IVF technology Dr Sushma P. Sinha How ethical is to give IVF treatment to old IVF conception is almost zero after the ageInstitute of Obstetrics & age couples? of 45 years.Why? Because god has put a limit This is absolutely not at all ethical.How can to the reproductive age in view of the prob- Gynaecology, a mother of 72 years bear a child when her lems which can occur in advance age. You are Indraprastha Apollo own body is going downhill & she is prone to pushing her to carry a baby when she has /or multiple geriatric problems? Even a women of prone to have osteoporosis (thinning of the Hospitals more than 35 years of age is called elderly for bones), high blood pressure/diabetes/ weak- New Delhi bearing a child in medical profession as com- ness /debility,heart attack and is at risk of in- plication rates go up as the age advances. The creased morbidly & mortality. And what after48 July 2016 probable complications are always explained- the child birth? Taking care of a child, feed- by an obstetrician to her when she comes for ing her sitting straight many a times in a day antenatal check-up. The chance of Natural / is not easy. Patients even at 48yrs find it dif- Health Spectrum

Q&Aficult & sometimes go into postpartum Law has still not been past although it is Approx 15% of couples makes it a bigdepression.I personally never do donor in process. Once law comes stringent ac- chunk of the whole of the population.IVF in a women above 50; tion taken against the defaulters should Population explosion is one issue butHow old is too old to be a mother? hopefully bring the change. agony of a childless couple is not to beIn my opinion motherhood should not ignored. As an IVF expert I feel it eve-be allowed after the age of 50. Research How important it is for India to deal ry day so do the couples & the familyhas shown that 33years onwards the with fertility issues? members. The physical & the psycho-ovarian reserve starts going down. Af- It is an important issue in India. Approx. logical problems caused by infertil-ter the age of 35chance of pregnancy is 15% of couples are suffering from infer- ity adds load on the government healthlower than before that.Indian women tility. Their desperation is unimagina- sector and also it increases the suicidalhave faster ovarian ageing & the chance ble. Lot of them suffer for depression & rates. The disturbed family environmentof pregnancy lowers with each added other psychological problems. It is a so- affects the performance of the employee.year making it less than 10% after the cial stigma & leads to lot of mental and The latest data shows that urban popula-age of 40. Nothing is without a reason in physical torture of the lady in the house tion growth in India is lower than somethe nature. If at all donor eggs are used though a man is equally responsible for of the western countries.in people with poor/ lower ovarian re- infertility.serve or in case of recurrent IVF failure, How are other countries dealing withmotherhood should not be allowed after In a country, where population is al- fertility issues?the age of 50. ready exploding, how such events can In western countries the government affect the country? provides the services free of cost or in-What should be the ideal age for usingIVF treatment?The ideal age of conception is between21 to 30yrs and in today’s perspectiveone can say 21 to 35. Younger the wom-en, higher the chance of conception butlowest age should not be less than 21.What are the risks involved for both the It is an important issue in surance companies do cover this prob-mother and the baby? India. Approx. 15% of lem unlike India where there is noThe risks for mother can be develop- couples are suffering from government support. Poors can’t affordment of diabetes, hypertension (high infertility. Their desperation Infertility treatment,IVF or IUI in India.blood pressure), anaemia, constant body is unimaginable. Lot of them Some of the government hospitals havepain, exhaustion, depression, worsen- suffer for depression & other recently started it but look at the load oning of other pre-existing elements. Risk psychological problems. It is them. There also they have to pay someof bleeding during pregnancy, risk of a social stigma & leads to lot amount which is still a lot for the pov-infection due to poor body immunity of mental and physical tor- erty ridden population. netc. The child can be lower than average ture of the lady in the housein weight. Risk of abortion &prematu- though a man is equally Dr Sushma P. Sinha is a Senior Consultantrity increases leading to complications responsible for infertility. Obstetrician Gynaecologist, IVF & Infertil-in the new born baby &can cause long ity Expert & Co-ordinator Laparoscopic &term complications like developmental Robotic Surgeon at Institute of Obstetrics &problem. The nurturing of baby will be Gynaecology in Indraprastha Apollo Hospi-affected due to the mother’s own poor tals, New Delhihealth leading to the future physical andpsychological problems in the child.Is there any law or body governingAssisted Reproductive Technologies(ART) in India?Indian council of medical research(ICMR)has laid down certain guidelineswhich are there for more than 10yrsnow,according to which IVF is allowedonly between the age of 21 & 50. Whypeople are not following the guidelines?Health Spectrum July 2016 49

HEALTH STUDY/RESEARCH Simple Ways Toget Rid OfT he term ‘cholesterol’ has a bad ble and insoluble. Increase your intake tachios have a low glycemic index, are reputation and most of us fear of soluble fiber. Both have heart-health naturally cholesterol free, and are source falling prey to it. Yes, high lev- benefits, but soluble fiber also helps low- of protein, fibre and antioxidants. These els are considered to be the er your LDL levels. So include oats and properties make consumption of pista-cause for a host of illnesses, including oat bran, fruits, beans, lentils, and veg- chios potentially useful for those at riskheart disease, blood pressure and diabe- etables in your daily platter. for obesity and heart disease.Other thantes, but did you know that cholesterol is these, opt for wholegrains, unprocessednot the culprit. This lipid produced by “Another very effective change you food, fruits and vegetables daily in yourthe liver, is vital for many body process- can make is to replace products high in daily diet. Include flaxseed, sunfloweres, such as insulating nerve cells in the saturated fats like butter with lower fat seeds and fatty fish in the diet to increasebrain and providing structure for cells. alternates likelow fat table spreads.Low good cholesterol. Replace high-fat dairyThe problem starts because of lower lev- fat table spreads are good for health,but, products with low-fat milk products.els of high-density lipoproteins (HDL). make sure that when selecting a tableOn the other hand, low-density lipopro- spread, choose the one that has 0% Cho- Daily exercise for atleast 30 minutesteins (LDL) form deposits on the walls lesterol and 0 g trans fat on the Nutrition is also essential. A simple brisk walk dai-of the arteries, thus limiting blood flow Facts label”, added Dr Jain. ly, riding a bike, swimming or just play-and causing cardiovascular diseases.It ing your favourite sportis helpful. Evenmust be noted that it is the higher LDL To further enhance your efforts in taking the stairs instead of the elevatorand lower HDL levels, and not the cho- improvingyour cholesterol to healthy or doing a few sit-ups while watchinglesterol they carry, that raise the chances levels include nuts in your diet, espe- television can make a difference.of developing heart disease. cially pistachio. A recent study by the Diabetes Foundation of India (DFI) Remember your health is your re- Dr Narender Pal Jain, Professor in and the National Diabetes, Obesity and sponsibility. Only you can take its bestMedicine, Dayanand Medical College Cholesterol Foundation found that pis- care. (by Vinod Kumar) nand Hospital, Ludhianasays, “It is impor-tant to incorporate healthy changes inlifestyle and i dentify & reduce consump-tion of foods which mayincrease yourrisk of heart disease. And this is applica-ble to everyone with any body type. Highcholesterol levels can result in heart ail-ments for any body type. Therefore,haveyour cholesterol checked regularly re-gardless of your weight, physical activityand diet.” To reduce your bad cholesterollevels, start by limiting food with high-levels of saturated fat and trans fat. Manypackaged foods, such as potato wafersand bakery products, which use refinedgrains such as maida (all-purpose flour),are low in fibre and contain trans fats.Additionally, reusing of cooking oil alsoincreases trans fat levels. Again, frequentconsumption red meat, whole milkproducts, ghee and coconut oil, can in-crease LDL as they are rich in saturatedfats. Limit the intake and substitute themwith fresh unprocessed foods. There are two types of fiber, solu50 July 2016 Health Spectrum