Recently a new diagnostic test has come into lime light. I do not how many of you know of this. Even if you know of this test, it is possible you are not ordering it as often as it should be. What is this test? Where is it performed? Is it performed in the lab? Or somewhere else?
In New England Journal of Medicine (November 10, 2005) an interesting article was published under the title " .. And a diagnostic test was performed ". They quoted a case where a distinguished visiting professor, a fellow in allergy and immunology presented the case of an infant with diarrhea; an unusual rash ('alligator skin'); multiple immunologic abnormalities, including low T-cell function, tissue eosinophilia (of the gastric mucosa) as well as peripheral eosinophilia, and an apparent X-linked genetic pattern (several male relatives died in infancy). The attending physicians and house staff discussed several diagnostic possibilities, but no consensus was reached. Finally, the visiting professor asked the fellow if she had made a diagnosis, and she reported that she had indeed and mentioned a rare syndrome known as IPEX (immunodeficiency, polyendocrinopathy, enteropathy, X-linked). It appeared to fit the case, and everybody seemed satisfied. (Several weeks later, genetic testing on the baby revealed a mutation in the FOXP3 gene, confirming the diagnosis).
"How did you make that diagnosis"? asked the professor. Came the reply, "Well, I had the skin biopsy report, and I entered the salient features into Goggle, and it popped right up". In short, she "goggled" the diagnosis. William Osler must be turning over his grave. Where does this leaves us? Should we keep insisting on the bedside? At first glance one feels that this may change our traditional method of teaching, but on closer examination, one needs to be more good at bed side, so that you have all important findings noted, because the eye doesn't see what mind doesn't know. For proper goggling the diagnosis, one needs to feed the proper key words. If one feeds the proper key words, then only can he reach into the conclusion and a proper diagnosis.
Having made the diagnosis, you may again need to go to library and Internet to find out what will be the most appropriate treatment, from evidence based medicine database, so that a computer can e-mail the prescription to the e-druggist with no human involvement. The question arises, should we be depending so much on computer that we get hooked to it just like another addiction? We need to have a close watch on it. It may create such a situation that we may be using lesser of our memory chips and more of computer leading to memory difficulties (Palm Pilot dementia) 2 . We should not get so absorbed in this exercise of computer diagnosis and treatment or else we start behaving like an absent minded Professor who while boarding the train, kissed the porter and tipped the wife.
STUDY PROVIDES INSIGHT INTO STRESS BLOOD PRESSURE CONNECTION
Activity in the anterior cingulated gyrus - the part of the brain used for making decisions while coping with challenges and stress - correlates with changes in blood pressure, according to a new study suggesting that during stressful situations, activity in the anterior cingulated gyrus boosts blood pressure.
"Most people believe that stress plays a role in heart disease," said Peter J. Gianaros, PhD, assistant professor in the Department of Psychiatry at the University of Pittsburgh. "Studies show that large rises in blood pressure during mental stress place some individuals at risk for atherosclersis, hypertension and stroke." Until recently, little was known about the mind-body relationships involved in linking stressful experiences with rises in blood pressure in humans. Using functional magnetic resonance imaging (fMRI), researchers in the current study found that larger rises in blood pressure during mental stress coincided with higher levels of activity in the cingulated cortes, a brain region involved in experiencing negative emotion, and generating physiologic responses in the rest of the body. "This suggests that the cingulated cortex is a brain pathway by which stressful experiences increase our blood pressure," Dr. Gianaros noted
In the work, nine women and eleven men worked on a modified version of the stressful Stroop colour-word interference task while fMRI was used to monitor changes in brain activity, as indicated by blood oxygen level-dependent (BOLD) activation. In the Stroop task, subjects had to quickly name colour words that either were printed in the same colour as the word (e.g., red is printed in red), which most individuals find easy, or printed in a different colour (e.g., red is printed in green), which can be surprisingly difficult. The better the participants did at the task, the harder it got, which was rated as very stressful. During the task, higher mean arterial blood pressure correlated with more BOLD activation in the perigenual and mid-anterior regions of the cingulated cortex. "Physicians should learn from the paper how our worries, fears and anxieties are real things that are involved with the actions of the brain," commented Willian R. Lovallo, PhD, professor of psychiatry and behavioral sciences at the University of Oklahoma Health Sciences Center in Oklahoma City. "We may eventually understand the mechanism of how stress can cause disease, and how positive states of mind may promote health. This is a great step forward in our ability to understand how our mind affects our body". Comments from the field
This paper is the first time that anyone has shown how this part of the brain affects the size of our blood pressure response to stress. Dr. Gianaros is the first person to take a serious interest in understanding why some people react to stress with physiologic symptoms and some don't.
People from Uttar Pradesh call it 'sathiya gaya hai' (for person who have crossed 60) while from those belonging to Punjab say'bahatariya gaya hai' (Person who have reached 72). Even the Indian medical fraternity until very recently thought such activities of aged people to be signs of senile behaviour. But of late, certain strange behaviours of aged people in our family, society, like forgetfulness, suspicion, over excitement or depression are considered the symptoms of Alzheimer's disease. Alzheimer's is a neurodegenerative disease, or if put in simple words it means, gradual fall of neurons that is responsible for memory, intelligence etc, in human beings. Alzheimer's is a common form of dementia affecting over three million lives in India.
So, what are the symptoms that differentiate a normal aged people and one who is suffering from Alzheimer's? P K Sethi, Head, Department of Neurology, Sir Gangaram Hospital, New Delhi says, Â"Alzheimer's symptoms include forgetfulness, suspicion, over excitement or depression or in other words, its a disease that affects an individuals regular task of life. The diseased person might forget to dress, to swallow food and even fail to recognise their near and dear ones.Â" Citing a case study Sethi says, Â"I have a patient who is 85. His wife is 75. But, she is responsible for everything right from dressing him to feeding, so she has to take help from her servant.Â" Sethi adds that in spite of appreciating her efforts, he suspects his wife is having an affair with the servant.
The burden of the caretaker of such patients is not merely physical, but more importantly, emotional. They struggle every minute not only in taking care of the patient, but also live with the agony that the person for whom they are having sleepless nights is gradually slipping away from them. Earlier, it was said that counterparts of the Western countries are more susceptible to this disease, but with growing life expectancy in India the disease is taking its toll in India too.
Most of the people do not recognise the disease on time, which makes the situation even more grave for the patient, Says Sethi. Â"People in India are still unaware. They take the patient for medication only when some drastic deviation is noticed from their routine affair.Â" he adds. Is the disease curable? Sethi replies, Â"As such there is no cure for the disease but it is curable to an extent, which can make people at least better behaved.Â" Pondering on the big question, Is there any way people can avoid catching up with this disease? Giving a psychological and social perspective to it, Sethi advises that there are at least three ways to beat the disease. One should keep his/her brain occupied in some or the other constructive work, after the so called retired age.
The different ways to keep the mind engaged is to indulge yourself in social activity, play cards, visit temples etc. The second important way is to go for physical activity that includes walks, routine exercise, yoga etc. Last, but not the least is have a good self image, otherwise the person might suffer from depression and isolation. In that context, the role of family members becomes very crucial, says Sethi. It has been estimated that the number of people above 60 would rise to 137 million as against 76 million at present. The disease might assume alarming proportion if the government does not give due attention. As the World Alzheimer's day is celebrated on September 21, its high time that people should be made aware about the disease.
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Dr. APJ Abdul Kalaam's speech in Hyderabad . A must read for every Indian.
I have three visions for India . In 3000 years of our history, people from all over the world have come and invaded us, captured our lands, conquered our minds. From Alexander onwards, the Greeks, the Turks, the Moguls, the Portuguese, the British, the French, the Dutch, all of them came and looted us, took over what was ours. Yet we have not done this to any other nation. We have not conquered anyone. We have not grabbed their land, their culture, their history and tried to enforce our way of life on them. Why? Because we respect the freedom of others. That is why my first vision is that of FREEDOM.
I believe that India got its first vision of this in 1857, when we started the war of independence. It is this freedom that we must protect and nurture and build on. If we are not free, no one will respect us. My second vision for India is DEVELOPMENT.
For fifty years we have been a developing nation. It is time we see ourselves as a developed nation. We are among top 5 nations of the world in terms of GDP. We have 10 percent growth rate in most areas. Our poverty levels are falling. Our achievements are being globally recognized today. Yet we lack the self-confidence to see ourselves as a developed nation, self- reliant and self-assured. Isn't this incorrect? I have a THIRD vision.
India must stand up to the world. Becausse I believe that, unless India stands up to the world, no one will respect us. Only strength respects strength. We must be strong not only as a military power but also as an economic power. Both must go hand-in-hand. My good fortune was to have worked with three great minds. Dr. Vikram Sarabhai of the Dept. of space, Professor Satish Dhawan, who succeeded him and Dr. Brahm Prakash, father of nuclear material. I was lucky to have worked with all three of them closely and consider this the great opportunity of my life.
I see four milestones in my career: Twenty years I spent in ISRO. I was given the opportunity to be the project director for India 's first satellite launch vehicle,SLV3. The one that launched Rohini. These years played a very important role in my life of Scientist. After my ISRO years, I joined DRDO and got a chance to be the part of India 's guided missile program. It was my second bliss when Agni met its mission requirements in 1994.
The Dept. of Atomic Energy and DRDO had this tremendous partnership in the recent nuclear tests, on May 11 and 13. This was the third bliss. The joy of participating with my team in these nuclear tests and proving to the world that India can make it, that we are no longer a developing nation but one of them. It made me feel very proud as an Indian. The fact that we have now developed for Agni a re-entry structure, for which we have developed this new material. A Very light material called carbon-carbon.
One day an orthopaedic surgeon from Nizam Institute of Medical Sciences visited my laboratory. He lifted the material and found it so light that he took me to his hospital and showed me his patients. There were these little girls and boys with heavy metallic callipers weighing over three Kg. each, dragging their feet around.
He said to me: Please remove the pain of my patients. In three weeks, we made these Floor reaction Orthosis 300-gram callipers and took them to the orthopaedic centre. The children didn't believe their eyes. From dragging around a three kg. load on their legs, they could now move around! Their parents had tears in their eyes. That was my fourth bliss!
Why is the media here so negative? Why are we in India so embarrassed to recognize our own strengths, our achievements? We are such a great nation. We have so many amazing success stories but we refuse to acknowledge them. Why? We are the first in milk production. We are number one in Remote sensing satellites. We are the second largest
producer of wheat. We are the second largest producer of rice. Look at Dr. Sudarshan, he has transferred the tribal village into a self-sustaining, self-driving unit. There are millions of such achievements but our media is only obsessed in the bad news and failures and disasters. I was in Tel Aviv once and I was reading the Israeli newspaper. It was the day after a lot of attacks and bombardments and deaths had taken place. The Hamas had struck. But the front page of the newspaper had the picture of a Jewish gentleman who in five years had transformed his desert land into an orchid and a granary. It was this inspiring picture that everyone woke up to. The gory details of killings, bombardments, deaths, were inside in the newspaper, buried among other news. In India we only read about death, sickness, terrorism, crime. Why are we so NEGATIVE? Another question: Why are we, as a nation so obsessed with foreign things? We want foreign TVs, we want foreign shirts, we want foreign technology. Why this obsession with everything imported. Do we not realize that self-respect comes with self-reliance? I was in Hyderabad giving this lecture, when a 14-year-old girl asked me for my autograph.
I asked her what her goal in life is. She replied: I want to live in a developed India . For her, you and I will have to build this developed India . You must proclaim. India is not an under-developed nation; it is a highly developed nation. Do you have 10 minutes? Allow me to come back with a vengeance. Got 10 minutes for your country? If yes, then read; otherwise, choice is yours. YOU say that our government is inefficient. YOU say that our laws are too old. YOU say that the municipality does not pick up the garbage. YOU say that the phones don't work, the railways are a joke, The airline is the worst in the world, mails never reach their destination. YOU say that our country has been fed to the dogs and is the absolute pits. YOU say, say and say. What do YOU do about it?
Take a person on his way to Singapore . Give him a name - YOURS. Give him a face - YOURS. YOU walk out of the airport and you are at your International best. In Singapore you don't throw cigarette butts on the roads or eat in the stores. YOU are as proud of their Underground Links as they are. You pay $5 (approx. Rs.60) to drive through Orchard Road (equivalent of Mahim Causeway or Pedder Road) between 5PM and 8PM. YOU comeback to the parking lot to punch your parking ticket if you have over stayed in a restaurant or a shopping mall irrespective of your status identity. In Singapore you don't say anything, DO YOU?
YOU wouldn't dare to eat in public during Ramadan, in Dubai. YOU would not dare to go out without your head covered in Jeddah. YOU would not dare to buy an employee of the telephone exchange in London at 10 pounds (Rs.650) a month to, "see to it that my STD and ISD calls are billed to someone else." YOU would not dare to speed beyond 55 mph (88 km/h) in Washington and then tell the traffic cop, "Jaanta hai sala main kaun hoon (Do you know who I am?). I am so and so's son. Take your two bucks and get lost." YOU wouldn't chuck an empty coconut shell anywhere other than the garbage pail on the beaches in Australia and New Zealand. Why don't YOU spit Paan on the streets of Tokyo? Why don't YOU use examination jockeys or buy fake certificates in Boston? We are still talking of the same YOU. YOU who can respect and conform to a foreign system in other countries but cannot in your own. You who will throw papers and cigarettes on the road the moment you touch Indian ground. If you can be an involved and appreciative citizen in an alien country, why cannot you be the same here in India?
Once in an interview, the famous Ex-municipal commissioner of Bombay, Mr. Tinaikar, had a point to make. "Rich people's dogs are walked on the streets to leave their affluent droppings all over the place," he said. "And then the same people turn around to criticize and blame the authorities for inefficiency and dirty pavements. What do they expect the officers to do? Go down with a broom every time their dog feels the pressure in his bowels? In America every dog owner has to clean up after his pet has done the job. Same in Japan. Will the Indian citizen do that here?" He's right.
We go to the polls to choose a government and after that forfeit all responsibility. We sit back wanting to be pampered and expect the government to do everything for us whilst our contribution is totally negative. We expect the government to clean up but we are not going to stop chucking garbage all over the place nor are we going to stop to pick up a stray piece of paper and throw it in the bin. We expect the railways to provide clean bathrooms but we are not going to learn the proper use of bathrooms. We want Indian Airlines and Air India to provide the best of food and toiletries but we are not going to stop pilfering at the least opportunity. This applies even to the staff who is known not to pass on the service to the public. When it comes to burning social issues like those related to women, dowry, girl child and others, we make loud drawing room protestations and continue to do the reverse at home. Our excuse? "It's the whole system which has to change, how will it matter if I alone forego my sons' rights to a dowry." So who's going to change the system? What does a system consist of?
Very conveniently for us it consists of our neighbours, other households, other cities, other communities and the government. But definitely not me and YOU. When it comes to us actually making a positive contribution to the system we lock ourselves along with our families into a safe cocoon and look into the distance at countries far away and wait for a Mr. Clean to come along & work miracles for us with a majestic sweep of his hand or we leave the country and run away. Like lazy cowards hounded by our fears we run to America to bask in their glory and praise their system. When New York becomes insecure we run to England. When England experiences unemployment, we take the next flight out to the Gulf. When the Gulf is war struck, we demand to be rescued and brought home by the Indian government. Everybody is out to abuse and rape the country. Nobody thinks of feeding the system. Our conscience is mortgaged to money. Dear Indians, The article is highly thought inductive, calls for a great deal of introspection and pricks one's conscience too.... I am echoing J.F.Kennedy's words to his fellow Americans to relate to Indians.....
"ASK WHAT WE CAN DO FOR INDIA AND DO WHAT HAS TO BE DONE TO MAKE INDIA WHAT AMERICA AND OTHER WESTERN
COUNTRIES ARE TODAY"
Lets do what India needs from us.
Forward this mail to each Indian for a change instead of sending Jokes or junk mails
.Thank you.
Abdul Kalaam
New Delhi , Feb. 20: Whether it's classical, jazz, or pop, music can speed up improvement in patients recovering from stroke, according to a new study that has prompted doctors to call for the introduction of music therapy for stroke survivors. Doctors in Finland have found that stroke patients who listened to music for about two hours a day showed more improvement in their memory, attention, and mood than patients who were not exposed to any music or who only listened to audio books. "Everyday music during early stroke recovery offers a valuable addition to the patient's care," said Teppo Sarkamo, a researcher at the cognitive brain research unit at the University of Helsinki , and lead investigator of the study published today in the journal Brain . Music would be an "easy-to-conduct and inexpensive means to facilitate cognitive and emotional recovery," Sarkamo said.
Stroke is a condition in which blood flow to the brain is cut off temporarily and can lead to multiple symptoms such as loss of memory, speech, and sometimes even paralysis. Standard therapy involved drugs, rest, and physical rehabilitation.
Sarkamo and his colleagues have found that three months after the stroke, patients who listened to music had 60 per cent improvement, in their verbal memory, in contrast to only about 30 per cent in the patients who did not listen to any music.
The ability to focus attention, perform mental operations also increased by 17 per cent in the group of patients who were exposed to music compared to no improvement in patients who did not listen to music or listened only to audio stories.
"This could turn out to be a landmark study," said Prahlad Sethi, emeritus consultant neurologist at the Sir Ganga Ram Hospital, New Delhi , and president of the Brain Care Foundation of India.
"Music has long been known to be soothing, and people with acute or chronic illness have sometimes been encouraged by doctors to listen to music, but this study provides us with the first scientific evidence to consider introducing music as therapy to stroke patients," Sethi told The Telegraph .
I go to the gym in Siri Fort Complex early morning as a part of my daily exercise routine. The goal is to remain fit and hopefully have a long innings in my life and continue to carry working in my profession as a physician neurologist.
One day when I was on the treadmill I realized that I was walking rather hurriedly with short quick steps. My goal was to reach my exercise target as fast as I could. Nothing else mattered to me at that moment. I happened to look towards my right and I found a friend of mine also walking on the treadmill. He looked at ease, calm and peaceful taking long steady strides apparently enjoying his workout. On the way back home from the gym, my colleague’s calm peaceful face and long steady strides on the treadmill were itched on my mind. I tried to justify my hurried rushed style on the treadmill…I am not as tall as him nor do I have his long legs. I felt satisfied that I had met my goal on the treadmill that day.
After a couple of days, I decided to try my friend’s “treadmill style of walking”. I punched in the same distance target on the treadmill, the same speed and incline but instead of taking rushed small steps, I began to walk with slow steady long strides. To my surprise after about 5 minutes, I began to feel calm and peaceful. A relaxed feeling enveloped me.
On my drive back home I kept thinking what had just transpired. How did this small change of walking style create such peace and calmness in my mind? I had walked on the same treadmill the same distance the same incline and the same length of time. I had reached the same target but the peace and satisfaction was so much more. Instantly I thought cannot we apply the same analogy to life?
Life is like a treadmill; call it the treadmill of life. We all have to learn to wait patiently for our turn to get on this usually fast moving treadmill. During the waiting period one has to be patient. We need to remember that opportunities will come our way sooner or later. One needs to set ones goals in life: what you want to achieve, how you plan to achieve it and at what speed you plan to go about accomplishing those goals. These goals, the speed may not be clear to us at the start but the desire to achieve those goals should certainly be there. One needs to be passionate about it. But passionate does not mean desperate. One should enjoy the ride.
“A journey of a thousand miles must begin with a single step.”—Lao Tzu
“The journey not the arrival matters.”—T. S. Eliot
A wise man once said “If you don’t know where you are going, any road will lead you there.” So as we travel on the adventure called life we should enjoy the journey and the experiences which we encounter along the road.
The lyrics of the song “Wear Sunscreen” by Baz Luhrmann sum it up perfectly and I shall quote:
“Don’t worry about the future. Or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubble gum. The real troubles in your life are apt to be things that never crossed your worried mind, the kind that blindside you at 4 pm on some idle Tuesday.
Do one thing every day that scares you.
Sing.
Don’t waste your time on jealousy. Sometimes you’re ahead, sometimes you’re behind. The race is long and, in the end, it’s only with yourself.
Don’t feel guilty if you don’t know what you want to do with your life. The most interesting people I know didn’t know at 22 what they wanted to do with their lives. Some of the most interesting 40-year-olds I know still don’t.
Maybe you’ll marry, maybe you won’t. Maybe you’ll have children, maybe you won’t. Maybe you’ll divorce at 40, maybe you’ll dance the funky chicken on your 75th wedding anniversary. Whatever you do, don’t congratulate yourself too much, or berate yourself either. Your choices are half chance. So are everybody else’s.
Dance, even if you have nowhere to do it but your living room.”
Sometime when I go to my gym I find all the ten treadmills occupied. I have learnt to wait for my turn. There is a card posted on the fall which requests the members to be considerate of others and not to use the treadmill for more than 15 minutes at one stretch. Often I find people ignore that sign. I have learnt to be patient and wait for my turn.
“When I Consider How My Light is Spent” is one of the best known of the sonnets of John Milton. The last three lines are particularly well known, although rarely quoted in context.
“When I consider how my light is spent,
Ere half my days, in this dark world and wide,
And that one Talent which is death to hide
Lodged with me useless, though my Soul more bent
To serve therewith my Maker, and present
My true account, lest he returning chide;
“Doth God exact day-labour, light denied?”
I fondly ask. But patience, to prevent
That murmur, soon replies, “God doth not need
Either man’s work or his own gifts; who best
Bear his mild yoke, they serve him best. His state
Is Kingly. Thousands at his bidding speed
And post o’er Land and Ocean without rest:
They also serve who only stand and wait.”
Once your time comes and you are on the treadmill, you can choose your style (run versus walk) and your speed. If you choose to run , run only as fast as you need to. Be kind to your knees, you shall need them when you get old!
Once when I entered my gym, I found only one treadmill unoccupied. I ran to occupy it before anyone else could. To my surprise it was still running. In my haste I had jumped on to a running treadmill and nearly fell. This is true for life too. Running to achieve your goals, taking short cuts does not always yield the desired results. Sometimes one falls and falls hard.
In Delhi, power cuts are frequent and unexpected. My gym lacks a back-up generator. Sometimes I will be walking on the treadmill and it will come to a sudden unexpected stop when we suffer a power outage. I have learnt to be aware of this and have avoided a couple of nasty tumbles. Life too sometimes throws lemons at us, curveballs which strike us when we least expect them. A sudden unexpected loss in business or a sudden unexpected health emergency like a heart attack or stroke. Be aware of this, be humble for the higher we rise the harder we fall.
The cooling off period is a very important part of my treadmill routine. The treadmill slowly decelerates, the incline gradually declines to baseline. After a vigorous work-out the cooling off period is intended to gradually lessen the impact on the muscles and the heart and to return them to their pre-exercise physiological state. One feels relaxed and has a feeling of “that was a great workout”. Similarly in life, one day retirement looms. One should anticipate this and be prepared for it. It is time to mentally and physically step off the treadmill of life but not leave it altogether! We each have to find hobbies and tasks to keep our brains occupied so that we do not slip into the throes of depression. Some among us shall choose to mount the treadmill again and find a new job, others shall dismount from the treadmill completely and choose to spend time with family and friends.
The humble treadmill which we encounter in our gyms can teach us many valuable life lessons.
In the words of Frank Sinatra:
“
And now, the end is near
And so I face the final curtain
My friend, I’ll say it clear
I’ll state my case, of which I’m certain
I’ve lived a life that’s full
I traveled each and every highway
And more, much more than this, I did it my way”
(Song: “My Way” by Frank Sinatra)
© 2013 Dr. P.K.Sethi. All rights reserved.
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