October Edition of Health Spectrum, 2016

www.healthspectrum.org October, 2016 Volume I Number 4 Price ` 75Bone, joints& SpineMinimally InvasiveSpine SurgeryBreastCancerCordBloodBankingGive YourFace a LiftRear Seat BeltsCan Save Life Health Spectrum

2 October 2016 Health Spectrum

October 2016, Volume 1, Number 4 Dr. Raju Vaishya Dr. (Prof.) Raju Vaishya is the President of Arthritis CareEditor: Vinod Kumar Foundation & a Senior Orthopaedic & Joint Replacement SurgeonManaging Editor : Sushila Kumari at Indraprastha Apollo Hospitals, New Delhi. He is also well knownEditorial Head : Aarti Kapoor for his academic contributions.Editorial Advisors:Dr. Manoranjan Sahay Dr. P. K. TalwarDr. Pallavi Vaishya Dr. P. K. Talwar is a Senior Plastic and Cosmetic Surgeon & DirectorContent Team : of Cosmetic Laser Surgery Centre of India, Greater Kailash - I,New Delhi : Dr. Atul Kumar, Uday Kumar New Delhi. He was also associated with the Indraprastha ApolloManna, Adheesh Vats, Deba Prasad Sahoo Hospitals, New Delhi as a Senior Cosmetic Surgeon.Mumbai : Sama Irani, IPS YadavLucknow : Choudhary Zia Imam Dr. Rahul GuptaRanchi : Aloka Dr. Rahul Gupta is a Senior Neuro and Spine Surgeon at FortisPatna : Arun Kumar Mayank Hospital, Noida. He worked in many government hospitalsSingapore : Deepa Tomar including PGIMS, Rohtak, PGIMER Chandigarh & G B PantKuwait :Vartika Hospital, New Delhi.Bangkok : Dr.Alka GuptaArt Director : Kripa Shankar Dr. Rohan KhandelwalDesign & Graphics : K A Choudhary Dr. Rohan Khandelwal is a senior Onco-plastic Breast SurgeonAdmin & Business : Satnam Singh at W-Hospital (Gurgaon). He is also Head of Medical Affairs atWeb & Mobile : Mayank Tiwari Curofy (Doctors Networking App).Editorial Office : 21, UNI Apartments,Sector-11, Vasundhara, Ghaziabad – 201012 Dr. Ashwani MaichandTel : +91 120 4320050 Dr. Ashwani Maichand is senior consultant & Director at InstituteM: +91 9013074414, +91 9868793203 of Bone & Joint (MGS Hospital, Punjabi Nagh, (New Delhi). He isDelhi Office : 909-910, B-Wing, Naurang also Hon. Consultant to special protection group (SPG).House, Opposite : Hindustan TimesBuilding, Kasturba Gandhi Marg, Dr. Yuvraj KumarNew Delhi-110001 Dr. Yuvraj Kumar is a HOD & a Senior Consultant at Asian InstituteMumbai Office : 37/911, Adarsh Nagar, of Medical Sciences (AIMS), Faridabad. Special fellowship fromWorli, Mumbai- 400030 Great Ormond Street Hospital (GOSH), London & Royal NationalLucknow Office : 338, Prince Complex, Orthopaedic Hospital (RNOH), Stanmore.Hazaratganj, Lucknow -226001Singapore Office : 236, Westwood Avenue, Dr Rakesh Kumar5-42 SG 648363, Singapore Dr Rakesh Kumar is a consultant in the Dept. of Orthopedics atEWmeabislit:ein:fow@whwea. lhthesapltehcstrpuemct.rourgm.org Asian Institute of Medical Sciences (AIMS), Faridabad.Printed, Published and Owned by Dr. Murtaza kamalVinod Kumar Dr. Kamal is a practicing pediatrician at Safdarjung Hospital, NewPrinted at Subhashini Offset Printers, F-10, delhi. Dr. Kamal is associated with many medical research journalsJagdish Nagar, Patel Nagar-III, Ghaziabad including Elixir International Journal, USA and International(U.P.) Journal of Medical Pediatric and Oncology. (Page : 24-25)Published at 21, UNI Apartments, Sector-11,Vasundhara, Ghaziabad – 201012 Dr Prerna Motwani Dr Prerna Motwani is a dentist and writes about the health issuesERdNitIor: U: VPinEoNdGKu/2m0a1r6/68419 in India. Currently she works with Curofy as a Content Manager. Health Spectrum October 2016 3

October, 2016Cover Story Arthritis : Some Hard Facts 22 There are over a hundred types of Dr. Raju Vaishya arthritis. Nearly 300,000 children have arthritis, and almost every- one over the age of 60 eventually gets some kind of the wear-and-tear osteo-arthritis.Cover Story Health IssueDr. Rahul Gupta Dr. Yuvraj Kumar & 26 Dr. Rakesh KumarMinimally Invasive 26 Spine Surgery Rear Seat Belts 4 October 2016 Can Save Life? Health Spectrum

IN THE NEWS Cover Storyn WHO releases country estimates on air pollu- SHOULDER PAINtion exposure and health impact 8 31n After Hip Replacement, 101-year-old womanback on her feet 9 Dr.Ashwani Maichand Beauty Caren Indian-origin scientist's team create genetictool to predict heart disease 11 Give Your Face a Liftn Scrub Typhus cases in the Himachal Pradesh 34 11 HEALTH STUDY/RESEARCHn Hookah is more harmful than cigarette Is your waist is put- ting you at risk of 12 Breast Cancer?n 20 minutes of stretching raises healthy heartmarkers by 20% 13HEALTH STUDY/RESEARCHn Sleep : It puts even the most powerful men ontheir back - Dr Prerna Motwani 18Health Articlen Are You Scared of the Big, Bad Blue? 32Alternative Medicinen Easy tips for the prevention ofChikungunya 37n Yoga for Healthy Bone, joints& Spine : Vartika 38Child Caren Know your baby genes well 44Parentingn Stress can shatter your dreamsof being a parent : Vinod Kumar 42n How to be a Good Parent 46n Mental CarePsychological First Aid : Vartika 48Healthy MotherhoodRole of Ultrasonography in Pregnancy 50Health IssueCORD BLOOD BANKING 16 Do we Indians really need it?Dr Murtaza Kamal 20 Dr. Rohan KhandelwalHealth Spectrum October 2016 5

Editor SpeakObservance of a World Day should notbe reduceId to mere ritualam extremely delighted to present the fourth edition of Health Spectrum before you. In the month of October, a plethora of programmes associated with HEALTH were organized. Notable among these programmes were World Mental Health Day, World Arthritis Day, World Sight Day, World Osteoporo- sis Day, World Anaesthesiologist Day, World Trauma Day, World Menopause Day, Iodine Deficiency Day, World Obesity Day, World Polio Day, and CancerIt is equally im- Awareness Day. In addition, Back Care Awareness Week, Bone and Joint Healthperative to build National Awareness Week and Mental Health Week were also organised. Undoubtedly, these World Days play an important role in highlighting vari-and sustain aware- ous health issues and creating awareness about their solutions and remedies. ness campaigns However, on several occasions, it appears that these events are being observed throughout the only as a ritual. For the associated institutions and organizations, observing a World Days merely becomes a ritualistic exercise. However there is nothingyear for effectively wrong with observing World Days, but it is equally imperative to build andtackling health sustain awareness campaigns throughout the year for effectively tackling healthmaladies. This is maladies. This is especially important in our country because there is so much of ignorance and lack of awareness about health related matters that peopleespecially impor- start believing in hearsay and also become victims of quacks. An appalling real-tant in our country ity that stares in our face is the fact that our ignorance and superstition regard-because there is so ing mental illnesses are much more as compared to physical ailments. Ourmuch of ignorance ignorance and superstition regarding mental illnesses can be gauged from the fact that even schizophrenia and Bipolar Disorder are considered consequencesand lack of aware- of bad ‘Karmas’ of the past life or a divine curse. Because of such an appalling ness about health and regressive attitude, it becomes difficult to provide adequate treatment torelated matters that the patients. Forget about the treatment, patients with mental illnesses are even subjected to unspeakable physical torture and are also discriminated againstpeople start believ- through social ostracization. Even family members treat them in a horrific man-ing in hearsay and ner. In our society, a major cause for lack of awareness is also because of the fact also become vic- that popular mass media, especially visual media, relegate the news related to health to the lowest rung of its priority. Even in newspapers and magazines, thetims of quacks. percentage of news related to health is the lowest. In this backdrop, Health Spectrum and other health magazines have a special responsibility to provide authentic and elaborate information to the people on health matters. Our effort is to provide through the magazine not only authentic and comprehensive information to the people but also to present it in an inter- esting manner, which is normally not done by the other mass media. In the October issue, we are publishing special articles on the diseases and remedies related to bones, joints and spine, which have been contributed by not- ed bones and spine specialists. In addition, information has also been provided on matters like mental health. In the earlier issue, we had published an article by Dr. Kamal Murtaza, titled “Neonatal Screening: Do we Indians really need it?\" In this issue, we are publishing an article – “Cord Blood Banking: Do we Indians really need it?” In the subsequent issues also, this column will continue. Hope the October issue will agitate you, enlighten you, and create awareness too. I hope you will welcome the issue. We will eagerly wait for your suggestions. - Vinod Kumar6 October 2016 Health Spectrum

HEALTH STUDY/RESEARCHHealth Spectrum October 2016 7

IN THE NEWSWHO releases country estimates on air pollu-tion exposure and health impactNew interactive maps high- and outdoor air pollution together. levels at a grid resolution of about 10 light areas within countries Nearly 90% of air-pollution-related km x 10 km. that exceed WHO air quality deaths occur in low- and middle-in- \"This new model is a big step forwardlimits. come countries, with nearly 2 out of 3 towards even more confident esti-A new WHO air quality model con- occurring in WHO’s South-East Asia mates of the huge global burden offirms that 92% of the world’s popula- and Western Pacific regions. more than 6 million deaths – 1 in 9 oftion lives in places where air quality Ninety-four per cent are due to non- total global deaths – from exposurelevels exceed WHO limits. Informa- communicable diseases – notably car- to indoor and outdoor air pollution,\"tion is presented via interactive maps, diovascular diseases, stroke, chronic said Dr Maria Neira, WHO Director,highlighting areas within countries obstructive pulmonary disease and Department of Public Health, Envi-that exceed WHO limits. lung cancer. Air pollution also in- ronmental and Social Determinants\"The new WHO model shows coun- creases the risks for acute respiratory of Health. \"More and more cities aretries where the air pollution danger infections. monitoring air pollution now, satel-spots are, and provides a baseline for \"Air pollution continues take a toll lite data is more comprehensive, andmonitoring progress in combatting on the health of the most vulnerable we are getting better at refining theit,\" says Dr Flavia Bustreo, Assistant populations – women, children and related health estimates.\"Director General at WHO. the older adults,\" adds Dr Bustreo. Interactive mapsIt also represents the most detailed \"For people to be healthy, they must The interactive maps provide in-outdoor (or ambient) air pollution- breathe clean air from their first formation on population-weightedrelated health data, by country, ever breath to their last.\" exposure to particulate matter of anreported by WHO. The model is Major sources of air pollution include aerodynamic diameter of less than 2.5based on data derived from satellite inefficient modes of transport, house- micrometres (PM2.5) for all coun-measurements, air transport models hold fuel and waste burning, coal- tries. The map also indicates data onand ground station monitors for more fired power plants, and industrial monitoring stations for PM10 andthan 3000 locations, both rural and activities. However, not all air pollu- PM2.5 values for about 3000 citiesurban. It was developed by WHO in tion originates from human activity. and towns.collaboration with the University of For example, air quality can also be \"Fast action to tackle air pollutionBath, United Kingdom. influenced by dust storms, particu- can’t come soon enough,\" adds DrAir pollution’s toll on human health larly in regions close to deserts. Neira. \"Solutions exist with sustain-Some 3 million deaths a year are Improved air pollution data able transport in cities, solid wastelinked to exposure to outdoor air The model has carefully calibrated management, access to clean house-pollution. Indoor air pollution can be data from satellite and ground sta- hold fuels and cook-stoves, as welljust as deadly. In 2012, an estimated tions to maximize reliability. National as renewable energies and industrial6.5 million deaths (11.6% of all global air pollution exposures were analysed emissions reductions.\" ndeaths) were associated with indoor against population and air pollution Health Spectrum8 October 2016

HEALTH STUDYIN/RTEHSEENAERWCHSAfter Hip Replacement, 101-year-old womanback on her feetA101 year old woman from Pa- the surgical procedure but Doctors Dr. Ashwani Maichand nipat, had a fall at her home. convinced them that early mobility of After that she was suffering the patient is must for the complete minimize the surgical stress on theform severe pain in left hip but kept recovery at this age. Hence, surgery body. So our team with an experienceon limping for few days but on fifth was must but screw fixation was out of 6000 joint replacements have comeday the pain became worse and she as it requires 3 months of bed rest. All up with the idea of hip replacementcouldn’t move at all. Her family never specialists from cardiology, nephrol- by MIS technique,” said Dr. Ashwanithought she would be active again. ogy and anaesthesia were involved so Maichand, Director of Institute ofBut doctors at a city based Hospital as to optimize the patient for surgery. Bone & Joint (MGS) Hospital.gave them hope and successfully op- Once everyone was satisfied, cement- According to Dr. Maichand, “inerated on her. The result: 101 year old ed hip replacement was done by MIS traditional / open surgery, an incisionlady was back on her feet. This medi- technique. / cut of about 6 inches is given, thecal feat was one of the rare events in No blood transfusion was required, muscle supporting the hip have to bethe medical field. patient was never shifted to ICU and split and then stitched back after thePatient’s family contacted Dr. she started walking from day 1 with operation. During this there is lots ofAshwani Maichand & team of Insti- walker but without any pain.X-Ray of bleeding which mostly requires bloodtute of Bone & Joint (MGS) Hospital, the hip showed fracture neck of femur transfusion. Most of these patientsNewDelhi. X-Ray of the hip showed left side. need at least 1 or 2 days of ICU stay.fracture neck of femur left side. She “Till recently a hip fracture in an The post op period is painful becausewas also suffering from hyperten- elderly patient was considered a of muscle injury and it takes aroundsion and her kidney function was not terminal event. The reason was that a month for independent walking. Soupto the mark as expected in this age. if we operate, the surgery was major, to exclude all these post op complica-The family was very anxious about it involves blood loss, further trauma tions, MIS Technique is a boon for to the frail body and many a times this age group of patients. In this Health Spectrum patient ended up in ICU. Most of technique, a 2.5 inch incision / cut is these patients are already suffering given on the skin, no muscles fibres from multiple organ diseases like are damaged, and there is hardly 20 diabetes, hypertension, kidney & ml of blood loss. Ninety percent of heart problem. Hence they are always these patients don’t require any blood considered a high risk patient for a transfusion or ICU stay. The overall hip surgery. Another negative factor hospital stay is also 2 to 3 days. It not in these patient is that if we try to fix only reduces the post op discomfort the fracture with screws and plates, but also minimizes the financial bur- they get loose because of severe den on the family.” n osteoporosis and patient lands up in another surgery few months later. October 2016 9 The second option is that we don’t operate at all. These patients with so many other diseases if are kept bed ridden they will develop bed sores, chest infection, urinary infections and deterioration of pre-existing diseases. So the big question is whether to operate or not? Second question is – which surgery? Fixation or Replace- ment? And third question is how to

IN THE NEWSIndian-origin scientist's team create genetictool to predict heart diseaseAn Indian origin researcher Nilesh Samani and his team genetic risk of developing CHD. good at evaluating risk until middle- of scientists have created a Currently, clinical risk scores are age. On the other hand the GRS,new tool that can calculate the genetic based on known risk factors for CHD which is based on your DNA, can berisk score of people likely to develop such as cholesterol level, having high applied at any age,\" he said.coronary heart disease, an advance blood pressure or diabetes and smok- \"Earlier identification of people whothat may pave way for early and per- ing. would most benefit from lifestylesonalised preventive interventions. However, such scores are imprecise changes and medication to reduceGenetic factors have long been known and unable to identify a large propor- their risk of a heart attack could saveto make a significant contribution tion of people who develop CHD. The countless lives,\" he added.to CHD risk. Recent advances in researchers showed that the GRS was The research was published in thegenetics have led to the identification independent of the clinical risk scores European Heart Journal. nof many Single Nucleotide Polymor- and by combining the two risk scorephisms (SNPs) - very small differenc- tools they were better able to predictes in our DNA that vary from person people who were at risk of developingto person. CHD in the next 10 years.By looking at over 49,000 SNPs, re- \"This is the first really large studysearchers created a score, known as a showing the potential benefits ofgenomic risk score (GRS) and showed using a genetic risk score over andthat the higher the GRS the higher above current methods to identifythe future risk of CHD. people at increased risk of coronaryPeople with a GRS in the top 20 per heart disease,\" said Nilesh Samanicent had an over 5-fold higher life- from the University of Leicester.time risk of CHD than those in the \"We already know that CHD starts atbottom 20 per cent. an early age, several decades beforeThe study from University of Leices- symptoms develop, and preventativeter in the UK is the first to look at a measures should ideally be appliedmuch larger number of SNPs to give much earlier, especially to those whoa fuller picture of an individual's are at increased risk,\" Samani said. \"Current clinical risk scores are notScrub Typhus cases in the Himachal PradeshIn view of the rising number of cases and reported deaths due to of Scrub Typhus in Himachal Pradesh, Shri J P Na- dda, Union Minister of Health and Family Welfare had sought a detailed report from the State Government. Having received the detailed report, the Union Health Minister has assured all support to the Himachal Pradesh Governmentin managing the endemic disease observed in this region.Shri Nadda added that the Union Ministry is willing to send an expert committee to the State on its request.“The Ministryis very closely monitoring the situation and if requested shall provide all logistical and technical support to the HimachalGovernment to strengthen their capacity to effectively manage the situation. This has been conveyed to the State, he added.While the Health Minister pressed on the need to start rigorous awareness campaigns regarding the preventive steps to betaken by the people at the community level, he has also directed the officials of the Health Ministry to be alert and gear upactivities to be taken for awareness generation, prevention and control of Scrub Typhus.Scrub Typhus is an acute illness caused by a bacterium OrintiaTsutsugamushi, which is transmitted by the bite of an in-fected mite larva present in the soil having scrub vegetation. Himachal is an endemic region as it has a large scrub vegeta-tion. n10 October 2016 Health Spectrum

HEALTH STUDY/RESEARCHHookah is more harmful than cigaretteHookah less harmful than ciga- It contains smoke from the tobacco diovascular and respiratory illnesses, rette is a popular misconcep- as well as smoke from the heat source led to low birth weight, lung, esopha- tion that may have serious (e.g., charcoal) used in the hookah. geal and pancreatic cancer. Sadly, notramifications for the youth especially Hookah smokers may be at risk for many hookah smokers understand theamong the females. Smoking water some of the same diseases as cigarette implications as many think hookah ispipes or hookahs can be more harmful smokers.These include oral cancer, not as harmful as cigarette..than cigarettes, doctors have warned. lung cancer, stomach cancer, cancer of The scary part about hookah smok-While many hookah smokers may the esophagus, reduced lung function ing is its effects on pregnant women,think this practice is less harmful than and decreased fertility. who may not be aware that they aresmoking cigarettes, hookah smoking The smoke of the hookah gets filtered inhaling tobacco. This puts the babyhas many of the same health risks as through water, but smoking tobacco in danger and the child may be borncigarette smoking. through water does not filter out can- prematurely, be underweight, or haveHookahs are water pipes that are used cer-causing chemicals, such as nico- breathing trouble.to smoke specially made tobacco that tine. These can damage the lungs and Compared to a single cigarette, hook-comes in different flavors, such as ap- heart as much as cigarette smoke. As ah smoke contains higher levels ofple, mint, cherry, chocolate, coconut, the tobacco goes through the water, it arsenic, lead, and nickel. It produceslicorice, cappuccino, and watermelon. creates a cooling effect inside the chest 36 times more tar and 15 times moreAlthough many users think it is less unlike cigarettes which burn the occa- carbon monoxide than cigarettes, asharmful, hookah smoking has many sional smoker. In both cases, carcino- smoking a hookah requires longer andof the same health risks as cigarette gens get deposited in your lungs and harder drags.smoking. these can lead to respiratory diseases Tobacco related diseases kills aboutAccording to Centers for Disease Con- and cancer. 2500 Indians daily and over 10 lakhtrol and Prevention (CDC) an hour- Since hookah involves inhaling a large Indians every year. And it is estimatedlong hookah smoking session involves amount of smoke in a short span of that about 5500 youth and children (as200 puffs, while smoking an average time, the damage done to the lungs are young as 8 years old), initiate tobaccocigarette involves 20 puffs. In-fact sec- high and can cause wheezing, menin- use daily. India has 12 crore tobaccoondhand smoke from hookahs can gitis and acute bronchitis.Over a pe- users, according to the Global Adultalso be a health risk for nonsmokers. riod of time, it can develop into car- Tobacco Survey (GATS) 2009-2010. n Health Spectrum October 2016 11

HEALTH STUDY/RESEARCH20 minutes of stretching raises healthyheart markers by 20%Simply stretching legs or arms for as little as 20 minutes a day can help improve the health of heart in signifi- volved”, Dr. Trehan adds cant way. Dr. Kapoor tells that “The study introduces new effectiveCardiologist Dr. Rajneesh Kapoor, Director Interventional route for physical fitness among masses. Stretching canCardiology at Medanta The Medicity, conducted a study help break ill effects of long sedentary hours, can poten-to analyze the effects of stretching on cholesterol levels tially motivate physical fitness among all population groupsand mean heart rate. A total of 22 subjects suffering from and can amplify benefits for brisk walk or running.”knee joint pains and who were unable to walk reasonable Commemorating World heart Day 2016 that falls on 29thdistance were enrolled in the program. September 2016 .Dr. Kapoor tells that he hypothesized that since during He told that “Heart disease is the biggest killer, accountingstretching there is notable work done by body it should up to 50% of total deaths in India. By being physically ac-yield cardio vascular health benefits, similar to like it hap- tive for 45 minutes a day and 6 days a week, be it brisk walkpens with exercising. He tells that the effects of stretching or treadmill or gardening or household works or dancingon heart were measured by monitoring levels of triglycer- or sports and likewise, the incidence of heart attack can beides, low density lipoproteins and mean heart rate, all of prevented by as much as 60 percent. Combine it with quit-which are potent heart health markers. ting smoking , healthy diet, managing stress and 8 hoursThe study subjects aged between 55 to 65 years in age. All sound sleep,90 % chances of coronary artery disease ( thatof them were made to perform simple stretching exercise leads to heart attack) setting in can be prevented” nfor 5 minutes, 4 times a day. Their triglyceride, LDL andmean heart rate levels were recorded at the beginning ofstudy and after one month.Dr. Kapoor highlights that his study found average 20 per-cent decrease in Triglycerides, 12% decrease in LDL levels.Average mean heart rate dropped from 84 to 70, henceshowing an17% improvement.These were very significant improvements in just onemonth from only 15 minutes stretching sessions a day, headded.He says that the quantum of benefits from daily 20 minutestretching, as noted in study, is comparable with that ofmild aerobic exercise. Since it’s very user friendly it can bepracticed by anyone and anywhere. And If anyone knowspandiculation ( angdai lena) , he or she knows how tostretch.Additionally, study subjects reported notable bettermentin their gastro intestinal functions. Dr. Kapoor explainedthat flexibility workouts can lead to stretching of intestineswhich in turn can better the process of digestion, therebyresulting in better gastro intestinal functions.Dr. Naresh Trehan , Chairman Medanta The medicity toldthat “stretching can be an effective exercise option for thosewho are unable to walk or run for any reason. He says thathe regularly performs stretching and breathing exercisewhenever he gets a chance, be it in car, home or office.“I also recommend it to my patients post bypass surgerybecause it yields significant benefits with least efforts in-12 October 2016 Health Spectrum

Health Spectrum October 2016

HEALTH STUDY/RESEARCHRear Seat Belts In case of a head-onCan Save Life? collision, a person sit- ting on the rear seatIDr. Yuvraj Kumar & Dr. Rakesh KumarIn the same breath the Ministry without a seat belt in-n India 1370 road accidents and the Traffic Research Wing creases the chance ofhappen everyday, out of has also voiced out request to fatalities by 50%. Notwhich 400 result in death. analyze the trends and to evolve only does the rear pas-As per the Annual Report senger, bear the maxi-published by Ministry of Road clear-cut policy responses. mum brunt of a crash,Transport & Highways in 2016, 77% of road accidents happen but they are also cata-“Road accidents are now glob- due to fault of the driver. Need- pulted forward, hittingally recognized as a serious less to say, the driver’s fault puts the person on the frontpublic health problem.” Rs. 6 lives of co-passengers and other seat into an explodingbillion have been earmarked people in vicinity at fatal risk. air bag. The use of rearduring 2016-17 for the remedia- Rear seat belt can save 12-15 seat belts reduces thesetion of road engineering defects. lives every year risks by 73% and chil- dren are likely to be14 October 2016 92% safer if they use rear seat belts. Health Spectrum

HEALTH STUDY/RESEARCH Seat Belt Safety: 5-Way Protec- Dr. Yuvraj Kumar Dr. Rakesh Kumar tionResearch shows that in case of and rupturing her lungs.\"a head-on collision, a person Fortunately even for her, she Keeps the occupants of thesitting on the rear seat without was in the able hands of an vehicle inside.a seat belt increases the chance expert doctor who treated her It’s clearly a myth that peopleof fatalities by 50%. Not only well and she would be fine after are better off being thrown cleardoes the rear passenger, bear 6 months of bed rest. from the crash. People thrownthe maximum brunt of a crash, from a vehicle are four timesbut they are also catapulted Here are some critical ques- more likely to be killed thanforward, hitting the person on t1i.onWs :hy isn’t it mandatory for those who remain inside.the front seat into an exploding Restrains the strongest parts ofair bag. The use of rear seat belts all passengers to wear seat belts? the body.reduces these risks by 73% and 2. Why is it assumed that only Restraints are designed tochildren are likely to be 92% front seat passengers are at risk? contact your body at its strong-safer if they use rear seat belts. Even though the data seems to est parts. For an older child andHere we want to share a vivid indicate otherwise. adult, these parts are the hipsaccount of a polytrauma (mul- 3. Almost all the developed and shoulders, which is wheretiple traumatic injuries) case. countries have already made it the seat belt should be strapped.\"Son is driving Toyota Corolla, mandatory for all passengers to Spreads out any force from thethe car is cruising at 130 kmph wear seat belts. It is dishearten- collision.on Delhi Mathura Highway and ing to see our government have Lap-and-shoulder belts spreadmother is seating in the rear such regressive approach. Why the force of the crash over a wideseat. This is a respectable well- can’t we just be logical and look area of the body. By putting lesseducated law abiding family so, at data rather than always look stress on any one area, they canthe son has put on the seat belt. up to the developed nations and help you avoid serious injury. AA trailer suddenly decides to decide what should be done? shoulder strap also helps keepcut in the highway like he owns 4. Apparently, the traffic is your head and upper body awaythe road and the son cruising at a state subject in the federal from the dashboard, steering130 kmph gets very little reac- structure of the Indian consti- wheel, and other hard interiortion time to apply the brakes, tution, traffic regulations have parts of the automobile shouldrams into the trailer. Thankfully, to be notified and enforced by you stop suddenly or be hit bythe front seat belt and air bags each state. Any national law another vehicle.acted instantaneously saving the does not yet govern the use of Helps the body to slow down.son’s life and sparing him with seat belts by rear seat occupants. What is it that causes injury?only mild bruises. But when he Why don’t we have a national A quick change in speed. Seatregains consciousness he finds law so that states can enforce it belts help extend the time itout that laws of physics weren’t over time? n takes for you to slow down in aso kind to his mother who Dr. Yuvraj Kumar is a Head of crash.wasn’t wearing rear seat belt and Department & Senior Consult- Protects your brain and spinaldue to tremendous momentum ant & Dr Rakesh Kumar is a cord.jumped out from the car along Consultant in Dept. of Orthope- A seat belt is designed to protectwith the windshield, shattering dics at Asian Institute of Medi- these two critical areas. Head in-almost 17 bones in her body cal Sciences (AIMS), Faridabad. juries may be hard to see imme- diately, but they can be deadly.Health Spectrum Likewise, spinal cord injuries can have serious consequences. October 2016 15

HEALTH STUDY/RESEARCHOctober is Breast Cancer Awareness MonthIs youBr wraeisat iss tpuCttainng cyoeu rat?risk ofincelastdecadebreast cancer has been on a Ssteady rise in India. It the production of estrogen in the body which accelerates the growth of breast tumor. What does the research say? Researchers from UCL Univer- is now the most common cancer in sity college, London studied 98,324 many cities and 2nd common cancer women of >50 postmenopausal age in rural areas, accounting to 25% of who had no history of breast can- all female malignancies. Increased cer. These women were made to fill incidence of breast carcinoma has questionnaires detailing their history been attributed to a variety of factors of health, height, weight, lifestyle and including obesity, decreased breast- also their skirt sizes. The participants feeding, alcohol consumption and were followed up subsequently over smoking etc. years and their health, lifestyle and Though obesity has been long associ- skirt sizes were documented. DuringDr. Rohan Khandelwal ated with the prevalence of breast the follow up 1090 women developedConsultant - Onco-plasticBreast Surgeon cancer, it has traditionally been meas- breast cancer. ured in BMI, ie the average distribu- The result showed that “Between 25W-Hospital (Gurgaon) tion of fat all through the body. What and postmenopausal age, an increaseHead - Medical Affairs atCurofy (Doctors Networking BMI fails to do is to identify where in Skirt Size by one unit every decadeApp) the fat is actually accumulating. increased the risk of postmenopausal According to a study published in breast cancer by 33% while decreaseEmail : rohankhandelwal@ BMJ, a woman’s waist size is a better in Skirt Size was associated with low-gmail.com predictor of breast cancer than BMI. ering of risk.” The fat tissue around waist though The Impact more metabolically active, increases Expanding waist has been associated16 October 2016 Health Spectrum

HEALTH STUDY/RESEARCHwith other forms of cancer in the informed that they can now take What can I do to reduce mypast including that of pancreas, charge of their health and changeprostate, ovaries and cervix. It’s the course of it. risk of breast cancer?no surprise that the belly fat alsoplays a role in breast cancer. But The Intervention Lifestyle changes have been shown in studiesthis result showed that the in- to decrease breast cancer risk even in high-riskcrease in skirt size, independent of The only way to reduce belly fat women. The following are steps you can takeBMI, increased the risk of breast is by doing regular exercise and to lower your risk:cancer and that fat accumulated burning it off. Regular exercising Limit alcohol. The more alcohol you drink,around waist is more dangerous not only reduces the risk of breast the greater your risk of developing breast can-than fat accumulated on other cancer but also of other cardiovas- cer. The general recommendation — basedparts of the body. cular diseases. 30 mins of exercise on research on the effect of alcohol on breastThis visceral fat can do more harm 3-4 days a week is what is recom- cancer risk — is to limit yourself to less than 1to a person’s body than the sub- mended for women. drink per day as even small amounts increasecutaneous fat. Causing increased By simple interventions like regu- risk.levels of estrogen, insulin resist- lar exercising, abstaining from Don't smoke. Accumulating evidence suggestsance and fatty liver. alcohol and smoking and main- a link between smoking and breast cancer risk, taining a healthy weight a woman particularly in premenopausal women. In ad-The Implication can reduce her breast cancer risk dition, not smoking is one of the best things by 20%-30%. n you can do for your overall health.Increase in waist size can be Control your weight. Being overweight orlinked with the sedentary lifestyle Dr. Rohan Khandelwal is a sen- obese increases the risk of breast cancer. Thisand unhealthy food habits of this ior Onco-plastic Breast Surgeon at is especially true if obesity occurs later in life,generation. With obesity emerg- W-Hospital (Gurgaon). He is also particularly after menopause.ing as a global epidemic, women Head of Medical Affairs at Curofy Be physically active. Physical activity can helpnow have a simple method to (Doctors Networking App). you maintain a healthy weight, which, in turn,check their health and take ac- He is a Fellowship trained Breast helps prevent breast cancer. For most healthytion against it. Instead of going Cancer Surgeon from the Univer- adults, the Department of Health and Humanthrough the hassle of measuring sity of Maryland, USA. He has Services recommends at least 150 minutes atheir weight and height to meas- published many scientific papers week of moderate aerobic activity or 75 min-ure their BMI, women can just on Breast Cancer and he is fre- utes of vigorous aerobic activity weekly, plusmeasure the size of their waist. quently invited as a guest speaker strength training at least twice a week.With the discovery of this as- in many gatherings to talk about Breast-feed. Breast-feeding might play a rolesociation between waist size and his experiences regarding the best in breast cancer prevention. The longer youbreast health, women now have management of Breast Cancer. He breast-feed, the greater the protective effect.the power to change the course of is actively engaged in promoting Limit dose and duration of hormone therapy.their health. They not only have to the early detection and manage- Combination hormone therapy for more thanbe made aware of the importance ment of Breast Cancer. three to five years increases the risk of breastof their breast health but also cancer. If you're taking hormone therapy for menopausal symptoms, ask your doctor aboutHealth Spectrum other options. You might be able to manage your symptoms with nonhormonal therapies and medications. If you decide that the ben- efits of short-term hormone therapy outweigh the risks, use the lowest dose that works for you and continue to have your doctor monitor the length of time you are taking hormones. Avoid exposure to radiation and environ- mental pollution. Medical-imaging methods, such as computerized tomography, use high doses of radiation. While more studies are needed, some research suggests a link between breast cancer and radiation exposure. Reduce your exposure by having such tests only when absolutely necessary. October 2016 17

SleepHEALTH STUDY/RESEARCHIt puts even the most powerful men on their backWhether a person is a daily - Dr Prerna Motwani Libby a college freshman, fighting wage labourer or CEO of depression with prescription anti- a multinational company, 60 hrs a week,added a residents shift depressants and a dubious history ofsleep doesn’t differentiate. Everyone can easily stretch to 36 or 48 hours. cocaine use was brought in on theneeds to clock a set number of hours Under these circumstances, a doc- night of 4th october 1984, with fever,on bed. tor is supposed to make sound and jerking body and disorientation.But in today’s fast paced life, where major decisions pertaining to his/her She was admitted and evaluatedeveryone wants get ahead of time, patient's life. What if there is some by two residents, Luise Weistein, asomewhere sleep is being compro- error of judgement? Who is to be held freshly graduated intern and Gregmised. To achieve a certain standard responsible? stone, who was one year senior toof living we are working for inhuman Something like this happened in New Weistein. Unable to diagnose, thehours and sacrifice our health. York, USA years ago, and it changed residents termed it as,”Viral syndromeWhen sleep fails, health declines,in the way Americans treated their doc- with hysterical symptoms.”, whichturn poor sleep and bad health tors. just means hyper reaction to milddecreases the quality of life and take The Incident: infection. Meperidine was prescribed,happiness away. In 1984, 18 year old Libby Zion, died a sedative, to control her agitations.Doctors all over the world are known within 24 hours of hospitalization. From there the two residents left toto work for long and odd hours. On Her father, Sidney Zion, a columnist attend to the 40 other patients theyan average a physician works for over in New York Times, did what every- were covering. one of us would want to do. Avenge his daughter's death.18 October 2016 Health Spectrum

HEALTH STUDY/RESEARCH Sleep Disorder SymptomsOnce left unattended, Libby became established a blue-ribbon panel of Look over this list of commonmore agitated. When the residents experts headed by Bertrand M. Bell, signs of a sleep disorder, and talkwere contacted ,they asked the nurse an outspoken primary care physi- to your healthcare provider if youto put her under medical restrains, cian at the Albert Einstein College of have any of these signs on three orso that she doesn’t harm herself and Medicine in the Bronx, to evaluate the more nights a week:another sedative haloperidol was training and supervision of doctors inprescribed. the state. n It typically takes you moreAround 6:30 in the morning, her In 1989, New York state adopted the than 30 minutes to fall asleep attemperature hit 107 degrees. Weistein Bell Commission's recommendations night.was called again and quick measures that residents could not work more n You awaken frequently in thewere taken to reduce her temperature. than 80 hours a week or more than night and have trouble falling backHowever, before this could happen, 24 consecutive hours and that senior to sleep.Libby suffered a cardiac arrest and physicians needed to be physically n You awaken too early in thepassed away. present in the hospital at all times. morning.For the hospital it was just another This commision brought forward n You often don't feel well restedcase with a bad outcome, but it shat- the human side of doctors. People despite spending seven to eighttered Sidney Zion and his family. saw them as being capable of error hours or more asleep at night.The aftermath: and their working conditions were n You feel sleepy during the dayGrieving the loss of their child, Zion's improved significantly. and fall asleep within five minutesparents became convinced their In India doctors are still made to do if you have an opportunity to nap,daughter's death was due to inade- 36-48 hours shift, and any error on or you fall asleep unexpectedly orquate staffing at the teaching hospital. doctors part is met with violence. at inappropriate times during theIn a New York Times op-ed piece, Are we waiting for our own Libby day.Sidney Zion wrote: \"You don't need Zion case to happen? Do we need an n Your bed partner reports thatkindergarten to know that a resident enraged and aggrieved family of an you snore loudly, snort, or makeworking a 36-hour shift is in no con- innocent victim to fight for the hu- choking sounds while you sleep, ordition to make any kind of judgment man treatment of doctors? your partner notices your breath-call—forget about life-and-death.\" It’s high time Indian system got up ing stops for short periods.The case eventually became a pro- and gave doctors their right to sleep n You have creeping, tinglingtracted high-profile legal battle, with and sound health, if not for them then feelings in your legs that are re-multiple abrupt reversals; case reports at least for their patients. lieved by moving or massagingabout it appeared in major medical Is India ready for it’s own Bell’s Com- them, especially in the evening orjournals. mission? n when you try to fall asleep.In May 1986 Manhattan District n You have vivid, dreamlikeAttorney Robert Morgenthau agreed Dr Prerna Motwani is a dentist and experiences while falling asleep orto let a grand jury consider murder writes about the health issues in In- dozing.charges. Although it declined to in- dia. Currently she works with Curofy n You have episodes of suddendict, the jury issued a report strongly muscle weakness when you are an-criticizing \"the supervision of interns as a Content Manager. gry or fearful, or when you laugh.and junior residents at a hospital in n You feel as though you cannotNew York County.\" move when you first wake up.In response, New York State Health n Your bed partner notes thatCommissioner David Axelrod your legs or arms jerk often during sleep.Health Spectrum n You regularly depend on wake-promoting products, such as caffeinated beverages, to stay awake during the day. October 2016 19

HHEeAaLlTtHhSIsTsUuDeY/RESEARCH CORD BLOOD BANKING Do we Indians really need it? Dr Murtaza Kamal The last century has ad- banks-mainly private banks have Senior Resident vanced a lot in the medical mushroomed in the last 5 years. These field and this 21st century cord blood banks collect umbilicalDepartment of Pediatrics and Child is taking huge leaps both in medical cord blood at the time of delivery of Health knowledge and technologies. Stem the baby and store them for future use cell transplantation is one such drop of the baby- claiming to be useful for a VMMC & Safdarjung Hospital in this vast ocean. A lot of cord blood lot of diseases in the coming years for New Delhi-110025Email: [email protected] October 2016 Health Spectrum

the baby. that it reduces the risk and severity of Health Issue The placental blood, which is graft versus host disease (GVHD), in transplant patients post transplant. world the only indications of stem cellgenerally discarded in routine prac- transplantation. Money is being spenttice, is a rich source of stem cells. The It a study done in our country in on the storage of these cord blood, incord blood stem cells have distinc- 2015, it was found out that more than the cord blood banks. Need is to asktive proliferative benefits like it has half of the practicing doctors in our what is the likelihood or the chancehigher proportion of immature stem country are unaware of the correct that the cord blood which has beencells which have increased clonogenic indications of cord blood transplanta- stored will be used in the future for thisgrowth benefits with increased cell cy- tion. Hematologic diseases (both be- baby for the right indication. Survey incle rate. One of the major advantages nign and malignant), genetic diseases this regard yields very less likelihoodof this cord blood transplantation is and immune deficiencies are in today’s of the same (1:1,00,000 chances); i.e. there is only as little chance as a single baby in 1,00,000 babies in which cord blood has been stored will utilize this cord blood for autologous stem cell transplant. Indian Council of Medical Re- search (ICMR) has raised concerns ethically over the blooming up and advertisement of cord blood bank- ing and storage for future self use. Till now, no scientific basis is there for the preservation of this cord blood and its future self use. It is also not correct to use this cord blood apart from bone marrow transplantation outside of clinical trials and amounts to malprac- tice. Concerns are also there regarding quality of these storage banks. Moving on to the other hand, there are situations in which this cord blood proves to be very useful and is also recommended. Conditions may be there in which a child is suffering from blood cancer (leukemia), and the sibling is not HLA identical. The cord blood if stored in this condition will be life saving for this child. Medical science is an ever chang- ing science from times immemorial. The scientific researches for the bet- terment of humans will always be a continuous process. Choice should be personal for the storage of cord blood and it should be well informed choice. n Dr. Murtaza Kamal is a practic- ing pediatrician at Safdarjung Hospi- tal, New delhi. Dr. Kamal is associat- ed with a number of medical research journals including Elixir Internation- al Journal, USA, International Jour- nal of Medical Pediatric and Oncol- ogy, Indian Journal of Case Reports & Yuva Journal of Medical Sciences.Health Spectrum October 2016 21

Cover StoryArthritis :Some Hard FactsPreDsird.e(nPtr,oAfr)tRhrAitJiUs CVaAreISFHouYnAda- Arthritis afflicts structures treatment. Early precise diagnosis tion & inside the joint and rheu- means excellent prognosis. Late or matism outside the joint faulty diagnosis generally means theSr. Consultant Orthopaedic & Joint viz. muscles, tendons, bursae. When joint may get deformed. Rheuma- there is inflammation inside the joint toid arthritis is thrice as common in IndraRperpalasctehmataeAnlstpSoulrlogeHonospi- it is known as arthritis. women. Osteo-arthristis comes up generally in old age after 50-55 years. New Delhi Types of arthritis The cartilage inside the joint which acts as a shock absorber undergoes22 October 2016 There are over a hundred types wear and tear. This results in pain of arthritis. The two most common especially on movement. Difficulty and best known types of arthritis are in coming down the stairs and dif- osteoarthritis, a wearing away of the ficulty in walking are characteristic cushioning cartilage in the joints : symptoms. and rheumatoid arthritis, an auto- immune disease that causes painful There are 68 joints in the human and often disabling joint inflamma- body and all of them are susceptible tion. A precise diagnosis is impor- to arthritis. Arthritis can hinder the tant and is critical to the outcome of Health Spectrum

Cover Storynormal functions of the joint. How- Diagnosis of arthritis several new drugs for rheumatoid ar-ever, the disease, once diagnosed, can thritis. In severe cases of joint damage,be controlled by prompt and contin- Until a few decades ago, a diagnosis surgery can help restore joint functionued treatment. Arthritis strikes almost of arthritis was deeply discouraging to and mobility. There are now new, con-twice as many women than men, but patient and doctor alike. While most ventional and alternative treatments,rheumatic diseases can attack people the benefits of self-help programmes,of any age or race, and either gender. kinds of arthritis are plus treatment specific to the differentNearly 300,000 children have arthritis, chronic and can’t be types of arthritis.and almost everyone over the age of 60 cured, one doesn’teventually gets some kind of the wear- have to face a life of Pain killersand-tear osteo-arthritis. pain. One can live a normal life, with Pain killers alleviate pain, but they Genetics Markers arthritis. Today, do not affect the pathology inside the though researches joint. In long term use, painkillers can Research has revealed that certain haven't found a cure be very dangerous as they can causekinds of arthritis can be inherited. for most arthritis, stomach & intestinal ulcers, kidneyThese hereditary traits produced by there is an array of failure, higher incidence of heart at-genes are called genetic markers. The prescription drugs tacks & brain strokes etc. So diseasegenetic markers that interest arthritis to help with more modifying drugs have to be used . Forexperts are the proteins known as the serious kinds of ar- rheumatoid arthritis these are choro-human leucocyte antigen’s or HLA, thritis, including quine, sulfasalazine, methotrexate andwhich are located on the surface of now leflunomide (Arava) & biologicalmost cells in the body. Genetic studieshave shown that more than 60 percent October 2016 23 Arthritis is torn cartilage. The menisci are a different form of cartilage found in the knee. They are roughly semicircular wedges, two in each knee, that function to cushion the joint, absorbing a great deal of stress, and also more evenly distributes stress across the joint.of adults with rheumatoid arthritis havea marker antigen called HLA-B27 hashelped the scientists detect ankylosingspondylitis and Reiter’s syndrome.Health Spectrum

Cover Storyresponse modifiers. For osteoarthri- but there is no cure for most kinds of spine. Total Joint Replacement (TJR)tis disease modifying drugs are high- arthritis. Don’t give up your regular represents a major advance in the man-lighted by availability of glucosamine medication to try unproven therapies. agement of severe, crippling arthritis.and chondroitin. These are actually Using proven therapies, you’ll most More than 5,00,000 patients undergonutritional supplements and hence are likely be able to enjoy a high quality of Total Joint Replacement each year, incalled nutraceuticals. These are very life despite having arthritis. USA alone. Joint replacement surgerysafe and practically without any side not only relieves the pain & sufferingeffects. These help to form the new car- Surgeries of a crippling arthritic, but give a newtilage i.e. the shock absorber in the os- lease of life to the joint & improves theteoarthritic joint. Intra-articular (Joint) Surgery may benefit a patient when quality of life tremendously.injections of Hyluronic acid help in in- arthritis progress to the point where itcreasing the viscosity & lubrication of seriously interferes with your ability to Advances in joint replace-the joint in Osteo-Arthritic joints. move easily, causes severe pain or de- ment surgery forms joints. Lifestyle & Arthritis In recent years there has been More common types of surgery for some revolutionary advances in joint Lifestyle changes can also help, osteoarthritis include replacement surgery. Till recently theespecially if you take an active role in joints, which were commonly replacedmanaging your condition. Maintaining Debridement : were that of knee joints and hip joints.an appropriate weight, exercising regu- The surgeon smoothes out irreg- Now the other parts of body can alsolarly and avoiding joint injuries can be replaced as that of shoulder, elbow,lessen your chances of getting osteo- ular joint surfaces, and removes loose wrist, finger and ankle joints.arthritis and help you cope better with bits of bone or cartilage that could bethe symptoms of all kind of arthritis. contributing to inflammation. It has been observed that Asian bones are not only small but also more Alternative Therapies Osteotomy : fragile as compared to European and Doctors cut and re-set bones to re- American bones. This discovery has Alternative therapies may also help, align the joint. This procedure is most led to better joints, which are betterwith many arthritis symptoms. Self- often performed on the knee joint replicates of original joints and theirhelp programmes can give coping skills Arthrodesis life span has also increased to 20 to 25and practical advice. Mind/body prac- Also called “joint fusion”, your years. The improvement in the designstices such as meditation and relaxation doctor may suggest this surgery when & materials used in artificial joints havecan relieve pain, stress, and depression. joints are seriously damaged. It’s usu- contributed to increase the life span ofYoga also offers some benefits. Swim- ally done on sections of the spine but these joints. Some new bearing sur-ming can help maintain conditioning may involve ankles and other joints. faces, like metal on metal, ceramic onwith low impact on joints. But don’t Arthroplasty ceramic & development of cross linkedbelieve claims of help from herbs and This is another term for total joint poly ethylene has shown to increase thedietary supplements that “cure” arthri- replacement; your damaged joint is re- life of these joints by reducing the weartis or suggest that they “re-grow” carti- moved and replaced with a plastic or rate & providing an efficient low fric-lage. Some may help relieve symptoms, metal joint. Most often done or knee and hip joints, arthroplasty can be Health Spectrum24 October 2016 done on any joint except those of the

Cover Storytion artificial joint surfaces. Hence, it is now possible to implant Prevepnetiovpelme ceaansutraeksey: oungthese joints even in younger patients with crippling arthritis. 1. Lose weight, or at least avoid gaining. Extra pounds Contemporary Total Knee Replacement (TKR) which is are awful on joints: They increase the burden on them,currently one of the most frequently performed orthopaedic and have a destructive metabolic effect. A chemical re-surgical procedures, has developed over the past 30 years. Al- lated to obesity upsets the balance between the buildupthough the goal of TKR is simple, the means of accomplish- and breakdown of cartilage, meaning the natural degra-ment are complex as surgeons & engineers strive to design a dation of cartilage moves more quickly than the renewalprosthetic joint that will function like a human knee. Success of process that's supposed to restore it. The effect is a netthe procedure not only is dependent on the skills of the surgeon loss that, over time, becomes osteoarthritis.& his team, but is also coupled with the design of the implant 2. Do exercise that doesn't damage joints. That includes& instrumentation. A scientific sound design must be comple- low-impact biking and swimming, along with yoga andmented by easily used instruments & a technique that assumes pilates, plus walking if it's not too fast, and weightlifting,accuracy & reproducibility. as long as it's not stressful. If you walk, make sure you have comfortable shoes, and try to walk on surfaces that Although the procedure is among one of the most success- are relatively flat. Asphalt is better than concrete.ful in Orthopaedic Surgery, the debate continues as to the best 3. Watch your biomechanics. How you lift and carry var-treatment option regarding TKR. Newer types of joints like ious objects, or perform physical tasks, including playingUnicompartmental, Mobile bearing, High flex knees, Hybrid sports, can make a big difference to the health of yourHips, Hip Resurfacing, Metal on Metal & Ceramic on Ceramic joints. The back is the most obvious part of the body thatimplants have been introduced for use recently. can be strained, but nearly all joints can be damaged by poor biomechanics. For instance, something as simple as Minimally Invasive Surgery gardening can put stress on joints if you dig at the dirt with your fingers instead of using a proper tool. Proper Not only there have improvements in the materials, designs mechanics while playing sports will do far more than& instrumentation of joint replacement surgery, but new tech- improve your athletic performance. It also minimizesniques of replacing joints using small cuts (Minimally Invasive strain on joints from head to toe that can manifest laterSurgery or MIS), computer assisted navigation surgery, & robot as osteoarthritis.assisted surgery are becoming popular, as they are likely to pro- 4. Prevent and treat injuries. Too many ankle sprains, orvide more accurate placement of artificial joints with minimum insufficient treatment following sprains, can put you onof discomfort to the patient. the road to arthritis in your ankles. And once you alter the mechanics of your ankles to compensate for that, you The future of joint replacement surgery is bright in India. can begin a process where the mechanics of other jointsThe number of total joint repalcements being done in India is are also altered, through your knees up to your hips,increasing at a rapid rate in the recent past. Total Joint Replace- etc. So, take care of your injuries, whether to the ankles,ment surgery has come here to stay forever, as it has proved knees, or elsewhere.worldwide over in the last 3 decades, through its excellent re- 5. Taking supplements is also a potentially useful step.sults. A great amount of research is being carried out to fur- Glucosamine and chondroitin both show evidence ofther improve both the materials used in the replacement parts helping cartilage avoid deterioration, at least to a degree.and in their design to make them function smoothly and as There are also two relatively new supplements that have‘normally’ as possible. With more trained personnel available shown promise in trials: A.S.U (unsaponifiable part ofin time to come & lower cost of prosthesis would certainly help avocado and soybean), and hyaluronic acid (H.A.). Ain making the TJR to become extremely popular treatment op- recent study, Theodosakis points out, suggested thattion. n those supplements had no positive effect on joint pain. That, he asserts, is arguable but, even if true, mitigation Dr. (Prof.) Raju Vaishya , a surgeon of international re- of pain isn't necessarily the same thing as diminishingpute, is best known for his swift surgical skills in the field of the deterioration of cartilage. Theodosakis adds that evi-Orthopedic & Joint Replacement. He has been working at In- dence is strong that both supplements help diminish de-draprastha Apollo Hospitals, New Delhi as a Professor and terioration, is a positive result even if they don't relieveSenior consultant. He is the founder president of Arthritis pain. That positive is, he says, especially noteworthy inCare Foundation. Apart from his distinguished clinical work younger people, for whom pain is not an issue yet, butin the field of arthroscopic and joint replace¬ment surgery, for whom preventing deterioration is.he is well known for his academic contributions. He has morethan 150 published articles in various International and na-tional peer-reviewed medical journals and has been regularlyinvited to give lectures, chairing sessions,etc. in Orthopaedicconferences around the world. He has been awarded for thebest paper publication on nu¬merous occasions by Delhi Or-thopedic Association and Apollo Hospitals. His work was rec-ognized in the Limca book of records in 2012, 2013 & 2015 fordo¬ing bilateral Total Knee Replacement in 93 years old gen-tleman, bilateral Total Knee Replacement in the oldest couplein a single sitting, ACL reconstruction on oldest man.Health Spectrum October 2016 25

Cover StoryMinimally Invasive Spine Surgery Over the past decade, tech- When most people think about nological advancements have having spine surgery, they typi- changed the face of spine sur- cally imagine a lengthy and gery. Dr. Rahul Gupta, Sen- painful procedure. They envision days, possibly ior surgeon, Fortis hospital, weeks spent in the hospital, and an unpleasant Noida says that technology has recovery. Even more frightening, many worry greatly improved over the past that the procedure will not have the desired 10 to 20 years, What previous- outcome and that they will be left in a worse ly could only be done through condition than they were prior to surgery. open surgery now can be ac- Over the past decade, technological ad- complished through small in- vancements have changed the face of spine cisions, offering patients less surgery. Technology has greatly improved over pain, reduced blood loss, less the past 10 to 20 years, What previously could scar tissue formation and fast- only be done through open surgery now can be er return to normal activity, accomplished through small incisions, offering patients less pain, reduced blood loss, less scar SeDniro.rRNaehuurloG&upSptaine tissue formation and faster return to normal surgeon activity, Through MIS procedures, surgeions can ef- Fortis hospital fectively treat spine disorders with minor dis- ruption of spine anatomy, which is normally Noida associated with traditional, open surgery. In Email : rahulguptaneuro@ addition to common ailments such as sciatica, which can be alleviated by a simple microdis- gmail.com cectomy, minimally invasive procedures are used to treat other problems of the spine as26 October 2016 well. This includes, but isn't limited to con- ditions such as spinal stenosis, scoliosis, frac- tures, tumors, infections, spinal instability or nearly all conditions of the spine. What is MIS In general, the goal of minimally invasive spine surgery (MIS) surgery is to stabilize the vertebral bones and spinal joints and/or relieve pressure being applied to the spinal nerves — often a result of conditions such as a spinal in- stability, bone spurs, herniated discs, scoliosis or spinal tumors. The term \"Minimally Inva- sive\" in most cases, when describing a surgical procedure, refers to a technique using small in- cisions to gain access to the particular area of the body needing treatment. By avoiding a larger incision, there can be Health Spectrum

Cover Storyless force from the retractors on the night and day, What once was often Benefits of MISsurrounding tissues, less tissue dissec- times considered risky and requiredtion, and usually better preservation extensive recovery can now be per- Because of the reduced trauma toof the surrounding blood supply to formed through small incisions as an the muscles and soft tissues (com-the tissues in the operated area. Ideal- outpatient. These advances are ulti- pared to open procedures), the po-ly, these factors lead to quicker healing mately better for the patient with less tential benefits are:and a recovery with less pain, although complications. y Better cosmetic results fromthese differences have not been proven smaller skin incisions (sometimes asconclusively. For an \"open\" procedure As opposed to open spine surgery, small as 2 centimeters)(non-MIS), the surgical wound is minimally invasive surgical approach- y Less blood loss from surgerylarger and more dissection is required. es can be faster, safer and require less y Reduced risk of muscle dam-Retraction on the muscles, when kept recovery time. The comparison be- age since less or no cutting of thein place during a long procedure, has tween minimally invasive and open muscle is requiredbeen shown to cause damage to these surgery can be made when describing y Reduced risk of infection andmuscles, with some of these effects a lumbar fusion. This procedure typi- postoperative painpossibly permanent. cally has the patient lying face down y Faster recovery from surgery during the surgery, with the work done and less rehabilitation required MIS Versus Open Surgery on the back side (posterior). With an y Diminished reliance on pain open case, the incision is usually in the medications after surgery The difference between minimally midline and the muscles are spread to In addition, some MIS surgeries areinvasive fusions and open fusions is the sides by retractors. Since the natu- performed as outpatient procedures and utilize only local anesthesia — so there is less risk for an adverse reaction to general anesthesia. As with any surgical procedure, no matter how minimal, there are cer- tain risks associated that include but are not limited to: y Possible adverse reaction to the anesthetic y Unexpected blood loss during the procedure y Localized infections, no mat- ter how small the incision area And, though uncommon, there is al- ways a small chance that the initial MIS surgery cannot be completed, requiring either a second procedure or full open surgery. Conditions Treated Using MIS Pro- cedures y Degenerative disc disease y Herniated disc y Lumbar spinal stenosis y S pinal deformities such as scoliosis y Spinal infections y S pinal instability y Vertebral compression frac- tures y S pinal TumorsHealth Spectrum October 2016 27

Cover Story Risks associated With Minimally Invasive SpineMinimally invasive procedures in the lumbar spine. (a) Minimally invasive dis- Surgerycectomy. (b) Minimally invasive laminectomy. (c) Minimally invasive TLIF. It's important to remember that even though spine surgeries can beral tendency of the muscles is to return to popular belief, lasers are very rarely done using a minimally invasiveto the midline, the force can be fairly used in MIS surgeries. A number of technique, it is still a surgery, andhigh at the spot where the retractor is methods can be used to minimize therefore not without risk. Poten-in contact with the muscles. If the sur- trauma during MIS surgery. Some of tial risks associated with surgerygeon tries to minimize the length of the more common techniques include: include anesthesia complications,the incision with the open technique, blood clots, allergic reactions, andhe/she may have to use the retractors lTubular Retractor: adverse effects due to undiagnosedto spread harder to see the areas where lPercutaneous placement medical problems, such as silentthe work needs to be done. These re- of screws and rods: heart disease. Injury to nerves andtractor-induced forces can be reduced lDirect lateral access blood vessels can also occur. In ad-somewhat by, paradoxically, making routes: dition, during minimally invasivea longer incision. With a minimally lThoracscopic access route: spine surgery, the surgeon may haveinvasive approach, usually a tubular Common MIS Surgery to convert to an open surgery if cir-retractor is used. After the appropriate Treatment Options cumstances require.level of the spine is identified with x- A number of specific techniquesray, first small, then sequentially larger have been deployed for MIS surgery.tubes are placed, one over another, to Though the field continues to develop,dilate (expand) the opening. The force the list below highlights some of the In addition, there are some conditionson the muscles is distributed more most common options: that are not truly accessible with MISequally in a direction like spokes on a lDiscetomy surgery. nwheel, with less localized pressure and lSpinal decompressionthus less potential for muscle damage lMIS TLIF (Transforami- nal lumbar interbody fusion) Dr. Rahul Gupta is the man be- How Minimally Invasive hind the department of Brain andSpine Surgery Works Are you a candidate for MIS spine surgeon at Fortis Hospital, Because the spinal nerves, verte- surgery? Noida. He was trained at Nagoyabrae and discs are located deep inside Japan, which has made him an ex-the body, any approach to gain access Your doctor will be able to tell you pert in Endovascular procedures.to the spinal area requires moving the which MIS surgeries, if any, might be an option for treating your spinal Dr. Gupta, has rich experiencemuscle tissue out of the way. In gen- condition. In some situations, MISeral, this is facilitated by utilizing a surgery may not be as safe or effec- of working as faculty in teach-small incision (s) and guiding instru- tive as traditional open surgery. If so,ments and/or microscopic video cam- your doctor will be able to inform you ing government institutes. He haseras through these incisions. Contrary about the relative risks and benefits. performed thousands of complex vascular, endo-vascular, skull baseTubular Retractor on Spinal Disorders and minimally invasive brain sur- geries. He has mastery in dealing with spine ailments. He has been actively involved in teaching and research activities in the Department of Neurosurgery at PGIMER, Chandigarh and at G B Pant Hospital, Delhi.28 September 2016 Health Spectrum



Cover Story SHOULDER PAIN Dr.Ashwani Maichand Pain in shoulder is a very fre- shoulder can be caused by diseases quent presentation in routine such as: Sr. Consultant & Director orthopaedics OPD. The origin of Gall bladder disease pain can be from Cervical Spine, from Liver disease Institute of Bone & Joint Chest, from Abdomen and from Shoul- Heart disease (MGS Hospital, Punjabi der itself. As a clinician, its our respon- Disease of the spine in the neck. sibility to make a proper diagnosis How Are Shoulder Prob- Bagh before treating the patient. The causes lems Diagnosed? New Delhi and presentations of actual shoulder Doctors diagnose shoulder problems Email : a_maichand@ pain vary according to the age group. by using: yahoo.co.in What Causes Shoulder Medical history Problems? Physical examination30 October 2016 Many shoulder problems are caused Tests such as x rays, ultrasound, and by the breakdown of soft tissues in the magnetic resonance imaging (MRI). shoulder region. Using the shoulder SHOULDER PAIN IN YOUNG too much can cause the soft tissue to There are two types of young patients – break down faster as people get older. One who are office workers (sedentary Doing manual labor and playing sports lifestyle) & Second – People participat- may cause shoulder problems. ing in sports activities (Athletes) Shoulder pain may be felt in one small Office Goers: These patients come with spot, in a larger area, or down the arm. pain starting from base of neck and Pain that travels along nerves to the spreading to both shoulders. Unfortu- nately, most of them are being treated as Cervical Spondylosis patients. Infact they have muscle imbalance problem which can be easily treated by simple Health Spectrum

Cover Storyexercises which patient can do even in office. What can I do to help myselfAthletes: Athletes participating in over head spots when I have shoulder pain?like Tennis, Swimming, Cricket…. etc. come tous with shoulder pain. This type of pain presents There are several ways you can help yourself if you have shoulderwhen the athlete rise to throw/hit something over pain.his head. It is called “Dead Arm Syndrome”. The Apply heat or cold to the jointreason behind the pain is repetitive trauma to joint If your shoulder pain is due to a recent injury or is inflamedcapsule in a particular position. It causes scar- (warmer to touch than the other side), an ice pack may be helpful.ing and tightening of one area of the joint lead- Leave the ice pack in place for 10 minutes or so.ing to abnormal movements. They can be treated For most other types of shoulder pain, heat packs can help to easeby physiotherapy and modification of activities in the pain, particularly if your muscles feel sore and tense. You canearly stage. Unfortunately many of these patients use:either compromise with their performance level a reusable heat pad (which you can buy from chemists and sportsor come so late that surgery is required. shops)SHOULDER PAIN IN ELDERLY a microwaveable wheat bagThere are various conditions in elderly patients a hot-water bottle.causing shoulder pain. Don't put heat or ice packs directly onto your shoulder, to avoidFROZEN SHOULDER: Patient complains of stiff- burning or irritating your skin. Wrap them in a towel (a dampness of shoulder, pain in all attempted movements towel for ice packs) before you put them on your skin.and disturbed sleep. It is most commonly found Improve your posturein diabetes and bed ridden patients. It is usually Poor posture or working habits can make shoulder problemstreatable by regular physiotherapy but very few re- worse. This can include shoulders becoming rounded and slouch-sistant cases need Arthroscopic Surgery. ing, particularly when you're sitting at a desk.ROTATOR CUFF TEAR: With ageing process, Leaning forwards for long periods when sitting, with pressurethe tendons of rotator cuff muscle become weak through your arm or with your arm held tightly by your side, canand brittle. They get torn with minor trauma. The make the problem worse, especially if some of the pain is comingsymptoms are difficulty in lifting the arm and from your neck.night pain. 50% of these patients can be treated Changing your position frequently and sitting in a supportedconservatively but rest 50% need Arthroscopic upright position may be helpful.Repair. Your upper body posture improves if your lower back is sup-IMPINGEMENT: These patients have reduced ported. When sitting, you may need to place a pillow or cushiondistance between the ball and socket of shoulder behind your lower back, depending on the chair. Make sure yourjoint. Whenever they try to lift their arm over- arm is supported and that you feel comfortable. If your shoulderhead, they feel painful restriction. The treatment is really sore, consider supporting your arm using a cushion oris generally physiotherapy but sometimes injec- pillow on your lap.tion in the joint is also helpful. In extreme cases, Look into a mirror and make a conscious effort to hold yourArthroscopic Decompression is done. n shoulder blades up and back. This should make your chest stand out as if you were taking a deep breath.Dr. Ashwani Maichand is senior consultant & If your shoulder is painful to lie on, sleeping in the following posi-Director at Institute of Bone & Joint (MGS Hos- tions may reduce the discomfort:pital, Punjabi Nagh, (New Delhi). He is also Hon. Lie on your good side with a pillow under your neck.Consultant to special protection group (SPG). Use a folded pillow to support your painful arm in front of yourTill date he has performed more than 6,000 joint body.replacement and arthroscopic surgeries. Another pillow behind your back can stop you rolling back ontoDr Maichand had the privilege of working with your painful side.the masters of joint replacement and arthroscopy If you prefer to sleep on your back, use one or two pillows underin India and abroad. He completed his M Ch in your painful arm to support it off the bed.2009 from American Institute of Medicine. Reduce the strain on your shouldersSpeciality Interest : Minimal Access Orthopae- Generally it's best to carry out your normal activities, but don'tdic Surgery including MIS Joint Replacement, over do it. Your body is designed to move but you may need toArthroscopic Surgery, Endoscopic Spine Surgery pace yourself and try to gradually do a bit more each day.and Limb Salvage Surgery.He also worked at Dr B L Kapur Memorial Hos- October 2016 31pital & Sir Ganga Ram Hospital, New Delhi.Health Spectrum

Health ArticleBlue light is taking a toll on your child’s eye health without you even realizing.Are You Scared of the Big,Amardeep Wahi was a happy, Bad Blue? healthy 15-year-old, un- an hour, especially if there are no partial blindness. Things usually til he began getting head- breaks in between) can adversely become worse for children who al-aches. His mother realized that affect a child’s physical and psy- ready have poor eyesight or thosehe wasn’t getting enough sleep, chological behaviour. with cataract.because when she’d knock on hisdoor to say ‘Good night’, he’d be on Effect Defect Game Onhis phone or tab.The culprit, says doctors, is blue Naturally, increased screen time Dealing constantly with deviceslight. But what’s the deal with it means overexposure to blue light, will soon leave your child and youanyway? The sun emits it, after all. resulting in what is known as digi- exhausted—you’ll be exhaustedTrue, and that’s for some part of tal eye strain. Some of the immedi- from all the nagging! Obviously,the day. But when your child is on ate effects include teary or red eyes there’s no way we can completelyvarious screens through the day, and the lack of concentration and avoid digital devices or ban them.there’s a possibility that it’ll affect sleep. Over a period, there may be But, there are ways to reduce thehim adversely. a change in psychological attitude negative impacts. as well (listlessness and disinter- Tell your child to be ‘smart’ whileBlue Light Banter est). using smart phones. Advise him When children focus on the screen, to take frequent breaks and holdBesides the sun, blue light can also they set aside everything else, and the phone at a ‘safe distance’ frombe emitted in the form of HEV are sucked into the game or so- the eyes—at arm’s length. There is(High Energy Visible) light by cial media network. Soon enough, another aspect to focus on: findelectronic gadgets such as tablets, there’s a convergence of the eye out why your child is always onsmart phones, lap tops, e-readers, muscles, which limits blinking. his phone. Is he feeling left out inor even TV sets. It’s the sort of light This leads to dry eyes. school or on the playground? Is hethat brings out the clarity in your Too much blue light exposure making poor online content choic-TV set or mobile phone. But its can also give your child sleepless es?flickering, glaring effect, have both nights—just like the ones Amar- You can make a No-Phone-to-Bedshort- and long-term effects on the deep had. It affects levels of the rule that everyone in the family fol-eyes. sleep-inducing hormone known lows. Parents set the best examples,Blue light cannot be blocked easily as melatonin. Sleep disruption, in so do make good lifestyle choicesby the human eye, unlike UV rays. turn, can lead to exhaustion and yourself. But if your child doesSo, it penetrates all the way to the fatigue, which can make your child have eye irritation do take him toretina with ease. Children’s eyes are unwell. an ophthalmologist and get himcomparatively sensitive and vul- However, from a long-term per- protective lenses which are able tonerable. Over-exposure (for over spective, it may lead to juvenile better filter blue light than the na- macular degeneration or even ked eye. n - Adheesh Vats32 October 2016 Health Spectrum

Cover StoryHealth Spectrum October 2016 33

Beauty Care RhytidectomyGive Your Face a Lift Your face is a significant part Technically, it is also called a of your identity. If your facial rhytidectomy. This type of cosmetic appearance is always looking surgery reshapes the lower one-third tired, worn out, or haggard, it can of the face by removing excess facial take a toll on your self-confidence. skin. Some facelift procedures also According to statistics, facelifts are include the tightening of underlying increasingly popular among both men tissues. To achieve the best result, it is and women. The first facelift was per- often combined with other additional Dr. P. K. Talwar formed in Berlin in 1901 by surgeon procedures addressing the forehead,Senior Plastic and Cosmetic Surgeon Eugen Holländer. cheeks, brows and eyes. Face lift surgery can restore a more A facelift is the most comprehensive Director rested and youthful appearance to approach to treating facial wrinklesCosmetic Laser Surgery Centre your face, helping you to age more and sagging caused by aging. The sur- gracefully in the years to come. gery varies in range from minimally of India invasive ‘lunchtime lifts’ to more E-34, Greater Kailash - I, What is Facelift extensive, sophisticated surgery. A facelift removes excess skin, tightens New Delhi - 110048 A facelift is a surgical procedure underlying tissues and muscle andPhones: +91-11-29236550, 29236912 that is typically used to give a more youthful appearance to the face. E-mail - [email protected] Website : www.drpktalwar.com34 September 2016 Health Spectrum

redrapes skin on the face and neck. It can correct midface sag- The faceliftging, marionette lines, jowls and a double chin, maintaining itsreputation as the ‘gold standard’ for facial rejuvenation. Every proceduresyear, thousands of people undergo successful facelift surgery andare pleased with the results. The traditional faceliftHow is a facelift procedure performed? A traditional face lift will involve your surgeon making a surgical incision along your hairline,Most facelift techniques focus on the lower facial areas, such as down past the front of your ears and into thethe jawline, jowls and cheeks. A facelift can also focus on the hairline behind the ears. Because of the carefulmidface or the forehead. In some techniques, deeper facial tis- positioning of the incision, your scarring willsues may be repositioned or tightened to restore a more youthful be hidden within the hair and natural creasescontour. In other techniques, removal or addition of fat or other of the face and it will fade quickly until it issoft-tissue fillers may be necessary to achieve the best results. barely visible. Once the incision has been madeToday, many different techniques exist with outcomes that can the surgeon will very carefully separate the skinbe consistently reliable, safe, and durable. Your incisions will from the underlying tissue, before reposition-depend on the area of the face that is targeted and the amount of ing excess fat and tightening facial muscles. Thechange you want. skin will then be lifted and stitched into placeOnce the incisions are made, various degrees of ‘undermining’ along the original incision and any excess skinof your skin is performed, and the deeper layers of your face are removed.lifted. Undermining separates the overlying skin of the face andneck from the muscles and tissues deep to the skin. This frees or Once the surgery is complete, your face will beloosens facial and neck skin so it can be redraped at the end of wrapped in bandages to prevent infection andthe procedure, making sure skin is smooth. to support your face while the skin heals, butThen, your surgeon will raise the skin from the temples, cheeks, these will usually be removed the day before youand neck, and lift and reposition the underlying connective tis- are allowed to go home from hospital. Drainssue, removing excess fat and skin. If this procedure is performed will also be stitched into place behind the ears toin conjunction with a neck lift, the surgeon will draw the neck allow excess blood and fluids to drain from themuscles together, stitching them together at the midline to form area - these are sometimes left in for the first fewa strong sling of muscles that supports the entire neck and jaw. days but this is decided on a case-by-case basis.Your surgeon may also include liposuction of the neck and jowls.Facial implants may be added to increase cheek or chin volume. New surgical techniquesFinally, your surgeon redrapes the skin over the new underly-ing structure and closes the incisions with stitches and/or small There are new methods for performingmetal clips. Where needed, drainage tubes may be inserted. A facelifts. New surgical options are constantly be-padded, supportive dressing is usually applied. ing developed.These advances aim at improvingThe goal of your aesthetic plastic surgeon and the entire staff is to cosmetic procedures:help you achieve the most beautiful and natural-looking results,and to make your surgical experience as easy and comfortable as  Lasers: A face-lift procedure called la-possible. ser neck and jaw liposculpture and resurfacing, uses lasers. This can be done through a one-inchWhat a Facelift Procedure Entails incision under the chin using only a local anes- thetic.The primary procedure for a facelift is minimally invasive andonly takes a small amount of time to complete. The procedure  Endoscopy: Endoscopic techniquesbegins with the administration of anaesthesia in order to make are now used to do face lifts and brow lifts. Thisyou comfortable during the surgery. This can include either method allows for smaller incisions. As a result,general anaesthesia or intravenous sedation. Once the anaesthe- there are fewer traumas to tissues, and a fastersia has been administered, the incision will be made. Where this recovery time. Facial structures are raised, andincision takes place largely depends on the type of facelift you are there is no need to cut away folds of skin. How-looking to have done. ever, this type of procedure also depends on theFor a traditional facelift, the incision begins at the hairline and patient.extends around the ear and towards the lower scalp. For a limitedincision facelift, the incisions at the temple are smaller and only  Liposuction: This method is used to re-extend around the ear. Once the fat has been sculpted and rear- move focal deposits of fat in the face. It is usu-ranged for a better looking face, the incisions will be closed and ally used in the area between the chin and neck.will fade relatively quickly. Liposuction can be combined with a face lift or performed separately.When You Should Receive a FaceliftHealth Spectrum September 2016 35

Beauty CareDr. P. K. Talwar with latest laser machines used to perfom painless laser cosmetic SurgeiesIt’s important to understand that people that don’t have health condi- that you will receive when getting aaging, stress, heredity and environ- tions that would cause problems with facelift. For instance, you’ll automati-mental conditions are just a few of the the healing process. cally have a much more youthful andfactors as to why you may begin to Nonsmokers are preferable over natural look to your face, which willlose your youthful appearance. How- smokers as well. It’s also important aid in aging gracefully as the yearsever, this exceedingly safe procedure that you have realistic expectations of pass by. This will also help to boostwill ensure that your face remains as what this procedure will do for you your confidence levels.youthful at the age of 40 as it was at and have a generally positive outlook A few of the primary advantages of25. about the results from the procedure, having this procedure done includeIf you notice signs of aging and which will make preparations for a repairing loose skin for a smootherbelieve that you could look better, a facelift much easier. look, providing improvements forfacelift if perfect for you. Full con- facial contours for a better lookingfidence with your appearance can Risks and Recovery Time jawline and tightening your facialdo wonders to your personal and muscles for less tension in the face. nprofessional lives. These signs of aging Like any surgical procedure, there areinclude a loss of skin tone in the lower a few risks involved as well. These in- Dr. Talwar is one of the leading cos-portion of the face, creases below the clude bleeding, risks with anaesthesia, metic and plastic surgeon in India.eyelids and along the nose, sagging infections, fluid accumulation, skinaround the middle portion of the face discoloration, prolonged swelling, Since 1996 he has been runningand drooping fat. numbness, pain that persists and poor Cosmetic Laser Surgery Centre of In- wound healing. dia. He was also associated with theIdeal Candidates for This As for recovery time, you will gener- Indraprastha Apollo Hospitals, NewProcedure ally be provided with instructions on how to treat your face once the Delhi (India) as a Senior Consult-Thankfully, it doesn’t require much to surgery has been completed. Overall, ant, Cosmetic Surgeon. His clientelebe an ideal candidate for this proce- recovery time is typically anywhere includes Top Models and Film Starsdure, so there’s practically no reason from two to three weeks. from neighbouring countries, Sportto worry about being denied for it.The best candidates largely include Benefits of a Facelift Stars and a lot of foreign tourists. There are a wide variety of benefits36 October 2016 Health Spectrum

Alternative MedicineEasy tips for the prevention of ChikungunyaThere has been no cure ob- It is said to drink a lot of water in make your immune system strong served to treat the ailing case of suffering from Chikungunya. to fight against such dreadful and chikungunya till date. Doctors Doctor says to have coconut water paining causing disease. This basicand Researchers have been working as it contains all essential miner- remedy is easily prepared at home tokeenly onto this issue to solve the als and electrolytes that make your relieve the patient from excessive painproblem more easily and quickly. body charged. It helps in making you and discomfort. Being a natural antiOnce affected by the virus causing stronger and strengthens your im- biotic, pepper is very effective andthis disease make one’s life hell to mune system to fight against all sorts works to boost your immunity power.survive. It causes high body pain of diseases.and continues with discomfort and Tulsiitching. Here are some easy home Papaya leavesremedies to prevent this disease to getcaught off and stay protected.Fenugreek leavesGet some fenugreek leaves and boil Squeeze out juice from the leaves and boil tulsi leaves in water and consumethem in water. Now consume that consume it warm. To prevent yourself the potion daily at least 4 times in awater to keep yourself away from getting affected by the disease, con- day to make your body strong andDengue and Chikungunya. This will sume it daily. It will help your body to deprived of all kind diseases andhelp you fight combat against the form more platelets than before and ailments. It helps prevent virus fromvirus causing Chikungunya and help help from reducing the body immu- attacking you with Dengue and Chi-boost your body immunity. nity. kungunya. It also helps in boosting the immune system to fight againstCoconut water Black Pepper other seasonal viral infections. Apart from home remedies, consultHealth Spectrum your homoeopathic doctor for speedy and safer cure. Boil black pepper with tulasi and con- Dr. Pankaj Aggarwal sume it twice a day. Doing this will Senior Homoeopathy Physician Agarwal Homoeopa- thy Clinic New Delhi October 2016 37

Alternative MedicineYoga forHealthyBone, joints& SpineIf you’re a passionate yoga prac- starting to provide some concrete During your first class, you prob- titioner, you’ve probably noticed clues as to how yoga works to im- ably won’t be able to touch your toes, some yoga benefits—maybe you’re prove health, heal aches and pains, never mind do a backbend. But if yousleeping better or getting fewer colds and keep sickness at bay. Once you stick with it, you’ll notice a gradualor just feeling more relaxed and at understand them, you’ll have even loosening, and eventually, seeminglyease. But if you’ve ever tried telling more motivation to step onto your impossible poses will become pos-a newbie about the benefits of yoga, mat, and you probably won’t feel so sible. You’ll also probably notice thatyou might find that explanations like tongue-tied the next time someone aches and pains start to disappear.“It increases the flow of prana” or “It wants Western proof. That’s no coincidence. Tight hips canbrings energy up your spine” fall on strain the knee joint due to improperdeaf or skeptical ears. Improves your flexibility alignment of the thigh and shinbones.As it happens, Western science is Tight hamstrings can lead to a flat- Improved flexibility is one of the first38 September 2016 and most obvious benefits of yoga. Health Spectrum

Alternative Medicinetening of the lumbar spine, which can you start to strain those muscles. its fluid is squeezed out and a newcause back pain. And inflexibility in Hold up that forward-leaning bowling supply can be soaked up. Withoutmuscles and connective tissue, such ball for eight or 12 hours a day and it’s proper sustenance, neglected areasas fascia and ligaments, can cause no wonder you’re tired. And fatigue of cartilage can eventually wear out,poor posture. might not be your only problem. Poor exposing the underlying bone like posture can cause back, neck, and worn-out brake pads.Builds muscle strength other muscle and joint problems. As you slump, your body may compen- Protects your spineStrong muscles do more than look sate by flattening the normal inwardgood. They also protect us from curves in your neck and lower back. Spinal disks—the shock absorbers be-conditions like arthritis andback This can cause pain and degenerative tween the vertebrae that can herniatepain, and help prevent falls in elderly arthritis of the spine. and compress nerves—crave move-people. And when you build strength ment. That’s the only way they getthrough yoga, you balance it with Prevents cartilage and joint their nutrients. If you’ve got a well-flexibility. If you just went to the gym breakdown balanced asana practice with plenty ofand lifted weights, you might build backbends, forward bends, and twists,strength at the expense of flexibility. Each time you practice yoga, you take you’ll help keep your disks supple. your joints through their full rangePerfects your posture of motion. This can help prevent Betters your bone health degenerative arthritis or mitigateYour head is like a bowling ball—big, disability by “squeezing and soaking” It’s well documented that weight-round, and heavy. When it’s balanced areas of cartilage that normally aren’t bearing exercise strengthens bonesdirectly over an erect spine, it takes used. Joint cartilage is like a sponge; and helps ward off osteoporosis.much less work for your neck and it receives fresh nutrients only when Many postures in yoga require thatback muscles to support it. Move it you lift your own weight. And some,several inches forward, however, and likeDownward- and Upward-FacingHealth Spectrum Dog, help strengthen the arm bones, which are particularly vul- nerable to osteoporotic fractures. In an un- published study con- ducted at California State University, Los Angeles, yoga practice increased bone density in the vertebrae. Yoga’s ability to lower levels of the stress hormone cortisol (see Number 11) may help keep calcium in the bones. Supports your connective tissue As you read all the ways yoga improves your health, you prob- ably noticed a lot of overlap. That’s because they’re intensely interwoven. Change your posture and you change the way you breathe. Change your breathing and you change your nervous system. This is one of the great lessons of yoga: Everything October 2016 39

Alternative Medicineis connected—your hipbone to your tional movement patterns usually Releases tension in your limbsanklebone, you to your community, have poor proprioception, whichyour community to the world. This has been linked to knee problems Do you ever notice yourself holdinginterconnection is vital to under- and back pain. Better balance could the telephone or a steering wheel withstanding yoga. This holistic system si- mean fewer falls. For the elderly, this a death grip or scrunching your facemultaneously taps into many mecha- translates into more independence when staring at a computer screen?nisms that have additive and even and delayed admission to a nursing These unconscious habits can leadmultiplicative effects. This synergy home or never entering one at all. For to chronic tension, muscle fatigue,may be the most important way of all the rest of us, postures like Tree Pose and soreness in the wrists, arms,that yoga heals. can make us feel less wobbly on and shoulders, neck, and face, which off the mat. can increase stress and worsen yourRelaxes your system mood. As you practice yoga, you be- Maintains your nervous sys- gin to notice where you hold tension:Yoga encourages you to relax, slow tem It might be in your tongue, your eyes,your breath, and focus on the present, or the muscles of your face and neck.shifting the balance from the sympa- Some advanced yogis can control If you simply tune in, you may be ablethetic nervous system (or the fight- their bodies in extraordinary ways, to release some tension in the tongueor-flight response) to the parasym- many of which are mediated by and eyes. With bigger muscles like thepathetic nervous system. The latter the nervous system. Scientists have quadriceps, trapezius, and buttocks,is calming and restorative; it lowers monitored yogis who could induce it may take years of practice to learnbreathing and heart rates, decreases unusual heart rhythms, generate how to relax them.blood pressure, and increases blood specific brain-wave patterns, and,flow to the intestines and reproduc- using a meditation technique, raise Eases your paintive organs. the temperature of their hands by 15 degrees Fahrenheit. If they can use Yoga can ease your pain. AccordingImproves your balance yoga to do that, perhaps you could to several studies, asana, meditation, learn to improve blood flow to your or a combination of the two, reducedRegularly practicing yoga increases pelvis if you’re trying to get pregnant pain in people with arthritis, backproprioception (the ability to feel or induce relaxation when you’re hav- pain, fibromyalgia, carpal tunnel syn-what your body is doing and where ing trouble falling asleep. drome, and other chronic conditions.it is in space) and improves balance. When you relieve your pain, yourPeople with bad posture or dysfunc- Health Spectrum40 October 2016

Alternative Medicinemood improves, you’re more inclined lished in the British medical journal bottom number—and the higher theto be active, and you don’t need as The Lancet, compared the effects initial blood pressure, the bigger themuch medication. ofSavasana (Corpse Pose) with simply drop. lying on a couch. After three months,Drops your blood pressure Savasana was associated with a Boosts your immune system 26-point drop in systolic blood pres- functionalityIf you’ve got high blood pressure, you sure (the top number) and a 15-pointmight benefit from yoga. Two studies drop in diastolic blood pressure (the Asana and pranayama probablyof people with hypertension, pub- improve immune function, but, so far, meditation has the strongest scientificHealth Spectrum support in this area. It appears to have a beneficial effect on the functioning of the im- mune system, boosting it when needed (for example, raising antibody levels in response to a vaccine) and lowering it when needed (for instance, mitigating an inappropriately aggressive immune function in an autoimmune disease like psoriasis). Gives your lungs room to breathe Yogis tend to take fewer breaths of greater volume, which is both calming and more ef- ficient. A 1998 study published in The Lancet taught a yogic technique known as “complete breathing” to people with lung problems due to congestive heart failure. After one month, their average respiratory rate decreased from 13.4 breaths per minute to 7.6. Meanwhile, their exercise capacity in- creased significantly, as did the oxygen saturation of their blood. In addition, yoga has been shown to improve various measures of lung function, in- cluding the maximum volume of the breath and the efficiency of the exhalation. Yoga also promotes breathing through the nose, which filters the air, warms it (cold, dry air is more likely to trigger an asthma attack in people who are sensitive), and humidifies it, removing pollen and dirt and other things you’d rather not take into your lungs. n Written by Vartika October 2016 41

HEALTH ARTICLE Beware!Stress can shatter yourdreams of beingn today’s modern, fast paced soci- a parent ety, it is easy for people to become areas of our lives, interferes with theIstressed. For years, scientists have reproductive process and is a cause tion of male hormone, testosterone, for infertility and miscarriages. Gen- which may subsequently cause a erally, a stressed person is not a very loss of libido in men and affect their healthy person. People living withbeen researching the causes leading reproductive health. high stress levels are typically overlyto stress and its impact on human In women specifically, it's important tired and filled with nervous tension,health. With the world becoming to differentiate between constant and which may cause them to choosemore technologically advanced each sudden stress. If the stress level is poor dietary and lifestyle habits.day, most of us spend a big chunk of high but fairly consistent, the body How to manage stress?our time with our cell phones, laptops will likely acclimate to it and can stillor tablets, which are glued to our ears ovulate each cycle. It's sudden stress Health Spectrumor our eyes. Apart from the other – such as an accident or a death inhealth hazards technologyhas to our the family – that can throw the cycleeyes, spine and limbs, it also affects us off and interfere with ovulation,andmentally leading to stress, and stress therefore can cause women to be un-in turn not a good sign for men and able to conceive naturally. This, how-women planning to start a family. ever, varies from woman to woman.It is seen that around 2-3% of couples Some women find that even a trip outare diagnosed with infertility in India of town can delay ovulation. Othersevery year. In men, studies link high have found that a severely traumaticlevels of stress hormones as one of incident did not impact their cycle atthe reasons for the decrease in the all.production and quality of sperms. During pregnancy, a woman is oftenAccording to internal reports, male in various emotional states becauseinfertility occurs in about 30% of of the hormones. A woman tryinginfertile couples. Psychological stress to carry a pregnancy to term duringis seen to boost the levels of stress stressful times can also place the foe-hormones while lowering the produc- tus at risk. Stress, as it does in many42 October 2016

HEALTH ARTICLEIn order to manage one’s stress levels, it is important to follow a practice Causes of INFERTILITYor habit that helps in keeping it under control and not affect your lifenegatively. Here are few suggestions to help keep the stress levels down Many physical and emotional factors canand thus less impacting the fertility. cause infertility. It may be due to problems• Make sure one gets enough sleep in the woman, man, or both.• Ensure a balanced diet Female infertility may be caused by:• Get an adequate amount of healthy exercise daily Autoimmune disorders, such as antiphos-• Meditate or start practicing Yoga pholipid syndrome (APS)• Seek counselling Birth defects that affect the reproductive• Explore ones passion and interest tractElectronic devices impact our health directly or indirectly, but we can Cancer or tumorbe smarter about how we use our smart phones. Simple lifestyle changes Clotting disorderslike avoiding sleeping with cell phones under the pillow, distancing cell Diabetesphone and laptop from belly when pregnant and use of texting more Drinking too much alcoholthan prolonged talking can go a long way in ensuring a healthy life. Exercising too muchSecondly, manage your work well. Stress at work is unavoidable and in Eating disorders or poor nutritionthat case, it is crucial to learn to cope well. When things are not going ac- Growths (such as fibroids or polyps) in thecording to your wish, take a deep breath, relax and meditate often. There uterus and cervixare many yoga and exercise techniques that relaxes the muscles and Medicines such as chemotherapy drugscalms your mind. Remember, health is as important as your work. Hormone imbalancesHow to deal with infertility? ObesityIt is important to understand that infertility could be because of lifestyle Older agefactors or certain medical conditions. If a couple has been trying to con- Ovarian cysts and polycystic ovary syn-ceive for more than a year with no results, consulting a fertility specialist drome (PCOS)is recommended. Once the problem is diagnosed, it is crucial to keep Pelvic infection or pelvic inflammatory dis-stress under control. There was a time when In-Vitro Fertilisation (IVF) ease (PID)was mostly associated with older couples trying for a baby. But now the Scarring from sexually transmitted infec-age of couples opting for IVF is getting younger and doctors believe that tion, abdominal surgery or endometriosisstress and hectic lifestyle are one of the leading factors contributing to in- Smokingfertility. Apart from the very thought that a couple is not able to conceive Surgery to prevent pregnancy (tubal liga-causing stress, IVF becomes a very stressful process for many because of tion) or failure of tubal ligation reversalthe medications. (reanastomosis)Stress relief should be a part of every couple’s conception plan even if Thyroid diseasethey are going through IVF. In most IVF centres, there are clinical coun- Male infertility can be caused by:sellors who help with the emotional turmoil that a couple is in.Today Birth defectsvarious advanced infertility treatments are made available in India, how- Cancer treatments, including chemothera-ever 70% of all cases require only minimum treatment. n py and radiation Exposure to high heat for prolonged peri-Writer Dr.Puneet Arora is a Fertility Consultant in New Delhi ods Heavy use of alcohol, marijuana, or cocaine Hormone imbalance Impotence Infection Medicines such as cimetidine, spironolac- tone, and nitrofurantoin Obesity Older age Retrograde ejaculation Scarring from sexually transmitted infec- tions, injury, or surgery Smoking Toxins in the environment Vasectomy or failure of vasectomy reversalHealth Spectrum October 2016 43

Child CareKnow your babygenes wellAhealthy baby is a happy Written by Niby Jacob Elackatt and second trimester screening. When baby. As parents, one a higher than usual risk is identified would always want to en- Is your preg- by a screening test, couples are oftensure good health for their baby even nancy checklist referred to a genetic counsellor or abefore the baby is born. The best way missing some- clinical geneticist for a genetic consul-to ensure good health of the baby, be- thing? A prena- tation. The clinical geneticist or geneticfore it’s birth is by talking to your doc- tal screening, counsellor helps the couple in the deci-tor or a genetic counsellor and taking might be! sion making process of whether or notup prenatal tests. to pursue diagnostic tests and supports Out of the 50 babies that are born, cy through prenatal testing. Such tests them through the testing process.one has some defect. That constitutes are often recommended by a gynae-2% of the total number of new born cologist or sonologist. The recommen- During a genetic counselling ses-babies. The causes for these birth de- dations can be based on family history, sion, the genetic counsellor helps thefects may be genetic i.e. passed on personal history or pregnancy history couple understand the intricacies offrom parents or chromosomal or it of the mother. the identified risks and what it couldmay be due to exposure to environ- result into. Details about how suchmental factors such as viral infections, Screening tests are offered to all conditions are diagnosed, strategies ondrugs, or a medical condition affecting pregnant women irrespective of the how a family may cope with the risk ofthe mother. In some of the cases, there personal medical or family history, a genetic condition during pregnancy,is no apparent cause. and these results give an estimate of are shared to help them to deal with Testing during pregnancy is op- the probability that a baby has a health the issues associated with a genetictional and should be discussed with a problem. Examples of screening tests condition after birth, should it be pre-doctor, or a genetic counsellor. Making are ultrasounds, non-invasive prena- sent in the baby.a decision to have a test or not is al- tal testing, first trimester screening,ways up to the couple. In general, there Diagnostic tests provide accu-are two main types of prenatal tests – a rate results and are always offered asscreening test and a diagnostic test. a follow up to a screening test where Many birth defects in infants can a higher than moderate risk is identi-be identified early during the pregnan- fied for a certain genetic condition or anomalies are identified on ultrasound scan. These tests are conducted to con-44 October 2016 Health Spectrum

Child Carefirm the diagnosis in the baby. Such Many birth defects in problem before birth, the parentstests may have associated risks in some infants can be identified are given information about thecases. Examples of diagnostic tests in- early during the pregnancy health problem that has been iden-clude chorionic villus sampling (CVS) through prenatal testing. tified. Depending on the stage ofand amniocentesis. Such tests are often recom- the pregnancy, a couple will be able mended by a gynaecologist to discuss options of planning for The screening and diagnostic test or sonologist. The recom- the birth of the baby or ending thereports are made available at the ear- mendations can be based pregnancy. Whether one decides toliest possible that is within 2-4 weeks, on family history, personal continue or end a pregnancy, sup-depending on the type of test and con- history or pregnancy his- port and information will be offered.sidering the nature of urgency. The re- tory of the mother. Pregnancy can be terminated up toports are handed to the couple by a ge- 20 weeks if the baby is diagnosed tonetic counsellor or a clinical geneticist have a genetic problem.who understands the report, and canhelp with the further course of action. Although the doctor or genetic counsellor can never guarantee the When a baby is found to have a birth of a healthy baby, couples often feel reassured about their assessedHealth Spectrum level of risk, and are likely to feel more confident in their decision- making about screening and testing options. Although the mention of a pre- natal test may be quite daunting, the benefits of undergoing screening can be reassuring and helpful. Talk to your doctor or genetic counsellor to learn more about prenatal testing options for yourself. Some of the factors which in- crease the likelihood of a baby having health problems are: • The When the mother is in her mid-30s or older (not necessar- ily her first pregnancy) • Where there is a close relative or a previous child with a serious health problem • There has been exposure to some chemical or other environ- mental factors during the pregnancy • One or both parents of the baby has a health problem that may be passed on • One or both parents of the baby are known ‘carriers’ of a particular faulty gene • Where the parents are related by blood (e.g. first cousins) n Writer Niby Ja- cob Elackatt is a Ge- netic Counsellor with Strand Life Sciences Pvt. Ltd. Bangalore. October 2016 45

ParentingHow to be a Good ParentBecoming a parent doesn’t come with an instruction manual. the cry persists for more than 1 hour, feed in the morning. Parenting isn’t easy, and the first or the cry associated with rash, fever, Fighting in Front of Your Babyyear can be the toughest as you strug- or vomiting, please call the attention Be careful about fighting in front ofgle to find your footing in your new of your pediatrician. your infants. Even babies who are justrole as mom or dad. Don’t worry, all Panicking Over Anything and Eve- a few months old can sense the nega-parents stumble their way through at rything tive vibes of parents arguing.first, learning as they go and racking Lots of new parents panic at normal Snapping at each other after a stressfulup an impressive number of mistakes things their babies do, such as vomit- day is common, but if things start toalong the way. Here are some common ing, crying, or even bowel movements. get intense or conflicts become moremistakes that new parents make their They wonder if their baby is eating frequent, be conscious of expressingfirst year and how you can avoid them. enough or too little, having too many your anger in front of the baby.Not Letting Your Infant Cry It Out or too few bowel movements, spit- Not sleeping when baby sleepsWhen babies cry, It's a normal reac- ting up too often, crying too much. Most new moms have heard the advicetion from parents to want to make Remember, babies are more resilient that they should sleep whenever theirthem stop. We always thought some- than we often realize. Talk to your baby sleeps, but all too often it seemsthing is wrong with them and as par- pediatrician for the things that you to fall on deaf ears. For first-time par-ents, it's our duty to fix it. But really, really should be concerned about and ents, sleep can be scarce—especially incrying is part of being a baby. don't sweat the small stuff. the first few months—but instead ofNothing may be wrong with your Waking Baby Up to Breastfeed napping when their baby naps, theybaby. She may be perfectly fine: well You really don't need to do that. Don't end up folding laundry instead. Thisfed, clean diapers, rested... but yet, wake her up to breastfeed. If the baby is a big mistake! Sleep when you can.they will still cry. Often it's ok to let is sleeping through the night, it's best Being overly overprotectiveyour baby cry it out. Nevertheless, if for the baby. Therefore, Mum should New parents tend to sense danger at sleep as well. The little baby can breast- every turn and worry about every little46 October 2016 Health Spectrum

Parentingthing. They mean well, but all that All parents stumble their things are likely just fine.over protectiveness actually does more way through at first, learning Neglecting your marriageharm than good. Children learn by as they go and racking up an For first-time parents, a new baby iswatching their parents, so if yours ob- impressive number of mis- their sun, moon and stars. Yes, theserves an overly worried mom or dad, takes along the way. new addition needs your focus andthey may grow up being too afraid to energy—but not all of it! A marriageever take risks. Making mistakes and baby is unlikely to catch the flu from requires nurturing too. So put in thetaking a few tumbles is how children a leisurely stroll through the neigh- effort, even if it’s reserving some timelearn to handle all the challenges life borhood. Instead of holing yourselves for a quiet candlelit dinner once theis going to throw at them, so keeping inside for weeks on end, try to spend baby has gone to sleep. Growing upthem in a safety bubble can hold them some time outside on a regular basis. in a warm and loving environment isback from learning some major life Comparing your baby to other ba- important to your baby’s well being, solessons. Keep an eye out for real dan- bies make sure your other half is a prioritygers, of course, but don’t stop them Many parents stress themselves out by too.from playing with other kids for fear comparing their baby’s development Not accepting help when it is offeredof a skinned knee. to the development of other babies. New parents often don’t trust any-Not leaving the house Try to avoid this, as it will only cause one to take care of their baby, so of-First-time parents have a habit of undue worry, and is unfair to your fers of help are waved away. This is akeeping the baby and themselves little one. Every child is different and mistake. Being a parent—especially alocked inside the house for the first develops at a different pace. While new parent—can be exhausting andseveral months of life for fear that the one baby may begin walking at nine overwhelming. Every mom and dadbaby will catch something. While it’s months old, another may not start un- needs a break every now and then.true that a newborn’s immune sys- til their one-year birthday. Don’t wor- Don’t deny yourself some downtime,tem is weak and more susceptible to ry about how fast or slow your baby is or you’ll risk becoming burnt out. Yougerms, that only means that it is best developing. As long as your doctor has don’t have to be a superhero. Let lovedto avoid crowds—not the outdoors in no concerns about health or growth, ones help out and take some time togeneral. Fresh air and a little sunshine care for yourself. You will be a betterare good for the entire family and the parent because of it. n Health Spectrum October 2016 47

MentHaElACLaTHreSTUDY/RESEARCHPsychological First AidPFA can save thousands of livesMental Health Experts suggested to preparations to give away possessions a feeling of despair, fatigue, anxiety,promote psychological first aid (PFA) may be red flag signs of potential an inability to interact normally withwhich can save hundreds of lives risk for suicide. If any such signs are others, unusual displays of temperevery year. noted, family members and next of and so on.Dr. Manu Tiwari, Senior Psychiatrist kin must intervene and help the per- “Psychological disorders like Depres-at Fortis-Escorts Heart Institute, New son suffering from suicidal ideation sion, Bipolar Disorder, Schizophrenia,Delhi said that about 100,000 Indians find timely help from mental health Addiction or Personality Disorder arecommit suicide every year, many care experts. Timely intervention in treatable if timely help is provided.others suffer injuries, some become the moment of crisis can help save People attempt suicide or take ex-unable to function to capacity due to their life,” said Dr. Sunil Mittal, Senior treme steps when they are no longerstress-related factors. But psychologi- Consultant Psychiatrist and Director, able to bear the psychological paincal first aid (PFA) could help a person Consultant Psychiatrist at Cosmos and become overpowered by a feelingget over the effects of stress and Institute of Mental Health and Behav- of hopelessness. Stressful life eventsdepression. ioural Sciences, New Delhi. like death of a loved one, financial“Suicides can be prevented if early Dr. Ajay Dogra, Senior Psychiatrist at loss, retirement, academic difficulties,warning signs are recognized and Jeewan Anmol Hospital, New Delhi ragging and relationship difficultiestimely help is provided. Untreated said that Dr. Tiwari said that support can be triggers for an act as seriousMood Swings, recent life trauma, can come from a relative, friend or as suicide,” said Dr. Shobhana Mittal,sudden calmness after mood swings, colleague, but it is best dealt with by Consultant Psychiatrist at CIMBS.talking about suicide and making professionals. The symptoms could be Dr. Ajay Dogra said, “with the aim to48 October 2016 HealthHSepaletchtrSupmectrum

Psychological disorders like Mental Care Depression, Bipolar Disorder, Schizophrenia, Addiction or What is Psychological first aid Personality Disorder are treat- able if timely help is provided. Psychological first aid was the theme of this year’s World Mental Health Day (10th October). Psychological first aid or PFA is an on-site in-alleviate mental distress at its source, tervention intended to help people affected by a sudden traumaticpsychological interventions are the occurrence, such as a mass-casualty event. It recognises that victims experiencefirst attempts to provide the emotional a variety of initial reactions after a traumatic event including psychological andsupport that is often undermined in behavioural reactions. It’s been proven that this technique decreases the chancesuch times. Combating this emotional of developing post-traumatic stress disorder, a debilitating condition that affectsstrife might seem to be overwhelming, many people who experience a life-threatening event.but with professional help can halven When PFA is applied in a timely and appropriate manner, most victims tend to recover well with the support of friends and relatives and only a fewthe distress. Hence, as helping profes- require further specialist support.sionals, we aim to reach out to those The World Health Organisation mentions three important PFA principleswhose concerns don't surface, and which should be the backbone of any strategy: (i) the Look principle (assess-maybe considered rather insignificant ing the safety of the area as well as identifying people in serious distress); (ii)in the larger realm of things.” the Listen principle (approaching people in need of support, asking them about“Psychological intervention in the nick their needs and listening to them while calming them down); and (iii) the Linkof time can considerably impact lives principle (helping people to address their basic needs, access support servicesin a more meaningful way. Thus, theinitiative of 'psychological first aid' and cope with their problems byrecognises the agony of the common giving them accurate informa-man and tries to provide intervention tion and connecting them withwithout delay,” said Dr. Tiwari. n their loved ones and other social support). Health Spectrum A good PFA strategy would advise caregivers of the impor- tance of speaking slowly and concisely, maintaining a calm presence, giving encouragement and hope to survivors, avoiding speaking in terms of symptoms or diagnoses, avoiding patronis- ing talk and, most importantly, avoiding any attempts to debrief the victims by asking them for details of what happened, which would force them to relive the traumatic experience. Caregivers should also take into consideration the age, vulnerability and cultural back- ground of the victim. Children should be faced at eye level and special care must be taken to identify survivors having pre-existing disabilities and work with them in a quiet area. For victims coming from a different cultural background, caregivers should be sensitive to particular customs including the choice of attire and the manner of greeting different family members. A PFA strategy is essential because it’s been proven that successful pro- vision of PFA depends on coordinated actions within a structured framework where roles and decision-making are clearly defined. PFA should, therefore, be provided as a key part of the emergency response and not as an afterthought. n October 2016 49

Healthy Motherhood Role of Ultrasonography in PregnancyUltrasonography is a safe and sor Sanjay Mohanty, Department of laborare also significantly more likely to affordable technology that Fertility Studies, International Institute undergo scans. has saved millions of wom- for Population Sciences, examined link-en from pregnancy-related complica- ages between routine pregnancy care, The researchers conclude that ultra-tions and deaths, but has, unfortunately- complications, and pregnancy loss (in- sonography plays a diverse role duringand more commonly, come to be seen as cluding induced abortion, spontaneous pregnancy, one that ranges from moni-a tool used primarily for gender-biased abortion, and still births), and the use toring the development of the fetus tosex selection. Among women who had of ultrasonography in India. The study identification of the sex of the fetus.undergone at least one ultrasound, 80% is based on the experiences of 41,376 “By enabling detection of pregnancy-went on to have live births. Contrary to women who reported pregnancies over related complications,this technologycommon assumption, only about 5.4% a period of five years and indicates that has played an important role in improv-women who had reported at least one increased ultrasonography use is pre- ing maternal health outcomes for wom-pregnancy loss (still birth, spontane- dominantly due to an increase in pre- en across the country and it would beous abortion and induced abortion) had natal care. The technology has played a wrong to solely associate the increasingalso undergone an ultrasound. pivotal role in identifying complications availability of ultrasonography to the ``Though the role of ultrasound and possibly helped in saving women’s increase in gender-biased sex selection,’’for identification of sex of the fetus has lives. says Professor Mohanty.been established, the linkages betweenpregnancy complications and the use of The study demonstrates statistically While further research may be un-ultrasound have rarely been explored,’’ high correlation between antenatal care dertaken on this association, these find-says Dr. Banerjee. and ultrasonography, indicating that ings strongly suggest that, working to- Using data from the third round of women seeking antenatal care are more ward curbing its use for gender-biasedNational Family Health Survey (NFHS- likely to undergo the scan to monitor sex selection, doctors offering services3), Dr. Sushanta K. Banerjee, Senior their pregnancies. Additionally, women to women during pregnancy shouldDirector, Research and Evaluation, Ipas who were alerted about any pregnancy- have unrestricted access to ultrasonog-Development Foundation,and Profes- related complications such as vaginal raphy to monitor their pregnancies and bleeding, convulsions, and prolonged prevent or manage complications. n50 October 2016 HealthHSepaletchtrSupmectrum