Myths on CAD cure
Dr G. D. Thapar

HEALTH BULLETIN
Ashoka dispels women’s grief
Dr R. Vatsyayan, Ayurvedacharya
Ashoka (Saraca indica) is a medium-sized evergreen tree which is found throughout the India subcontinent — more commonly in the central and eastern Himalayas and also along the western ghats. This tree is often confused with the tall, and ornamental tree, botanically known as Polyalthia longifolia.

Q&A

• Your child’s teeth
• Blood donation & you - II

Myths on CAD cure
Dr G. D. Thapar

I have read with dismay a spate of articles in the lay Press in the recent past about coronary heart disease (CHD or CAD), i.e, angina and heart attacks. Statements such as, "India is having an epidemic of ischaemic heart disease", "By 2010, the world's 60% heart patients will be in India," or "Every Indian male over the age of 25 and every female over 35 should be tested for heart disease", abound in these articles. One finds tests written, the cost of which ranges from Rs 400 to Rs 14000. Readers are made to believe that "our genes are playing havoc" with Indian hearts, and that technology (meaning expensive tests, angioplasty and bypass surgery) hold the key to a healthier heart. Improving a faulty lifestyle, the real answer to the problem, takes a back seat. Somebody who knows the facts must place them before the gullible public before damage is done.

No doubt, there has been an increase in the number of heart patients in our country over the past 50 years. It is also true that the disease is now increasingly observed in younger persons. The reasons are many: better diagnostic facilities, greater awareness, the population explosion coupled with the doubling of the lifespan so that many more persons live to the age when heart disease is common. But the most important and correctable reasons are: rapid industrialisation and urbanisation with the consequent prosperity, unremitting stress and change of food habits from simple vegetarian food to rich fatty animal diets, a glaring lack of physical activity and exercise due to the ever-increasing number of cars and scooters, obesity and, of course, smoking. No amount of testing can help what an improvement in one's lifestyle can achieve.

In spite of this apparent increase in the incidence of CAD, it is wrong to say that we are passing through an epidemic of heart disease. It is not understood from where such statistics are produced. It is a well-known fact that medical statistics in India and other Third World countries are notoriously bad an unreliable. The projections mentioned above seem to have been made from the limited experience with Indian expatriate populations abroad, who are exposed to tremendous stress and sudden changes to an affluent but unhealthy lifestyle consequent on their migration. Those statistics and conclusions based on them should not and cannot be extrapolated on the total population of India.

Genetically speaking, we in India, Pakistan and Bangladesh are not just similar but the same. How come that only Indians are going to die of heart disease in large numbers?

The articles referred to above are likely to have only a singular effect — one of mass hysteria and fear psychosis of heart disease, which itself can have adverse repercussions on the people's health and make them run for expensive testing and hi-tech treatment, which, as you will see, will be counterproductive.

While it is true that anybody after the age of 40 or 50 can have a heart attack and even die of it, there is no test devised as yet which can predict with a degree of accuracy as to who is going to have a heart attack and when.

Instead of the fear of a heart attack, change your lifestyle, which in any case you will need to do whether or not you submit yourself to expensive testing or hi-tech surgery. No amount of testing, which should be reserved for patients who really need them, is going to help a person who is otherwise healthy but may direct many to undergo unnecessary angioplasty or bypass surgery with all their risks and expense.

The present status of high-tech treatment: The effectiveness of bypass surgery in relieving the symptoms of angina is almost 90%. Therefore, the failure of anginal pain to respond to adequate medication is a legitimate indication for surgery, and should be reserved for the patients whose symptoms of angina are intolerable and remain unrelieved in spite of adequate medical therapy, or for those who are at a high risk of heart attack such as persons with unstable angina. But it needs to be clearly understood, and has been demonstrated by numerous studies that neither bypass surgery nor angioplasty protects patients against future heart attacks. These methods offer a survival advantage except in the rare cases of disease affecting the main stem of the left coronary artery.

A study extending over eight years of 150 patients who were advised bypass surgery but refused to abide by the advice and continued on medical treatment is interesting. For those with only one (or two) artery disease, the annual mortality was 0%. For those with the disease of all the three arteries or the left main coronary artery, it was 1.3% — much below what the immediate surgical mortality would have been if they had been operated upon. Other studies have shown similar results.

Is surgery or angioplasty required for an acute heart attacks? No. It is usually more dangerous to have angioplasty or surgery than the heart attack itself. There is far less danger with conventional medical treatment. The exceptions are cardiogenic shock (angioplasty can salvage some of these patients), the rupture of the interventricular septum or continuing unstable angina after medical treatment of the attack.

Considerable progress has been made in the drug therapy for CHD. It can be said with confidence that in the group which would be expected to respond equally well to surgical or medical therapy, the former offers no survival benefits but exposes the patient to many risks and complications which are not insignificant.

In an average stable case of angina, it is wrong to assume that you may have a massive heart attack and can die unless you have immediate angioplasty or surgery. Yes, that can sometimes happen, but with hi-tech treatment the chances of such a happening are greater.

It is sad to see patients like a 40-year-old female hypertensive patient who had no symptoms of heart disease but out of fear of heart disease underwent a battery of tests, including angiography; many others underwent angioplasty without ever undergoing medical treatment. Sometimes, a heart-attack patient is recommended a routine angiogram before he leaves the hospital, even though his convalescence period had been uneventful and symptom-free. The test under these circumstances serves no purpose, is not without risk and is not required for guiding medical therapy. You need not consider even angiography unless your anginal pains are intolerable and refractory to medical treatment or your angina changes to an unstable condition and surgery has to be considered.

Said the prestigious British Medical Journal:"Although the potential benefits bestowed by measures aimed at the prevention of CADare enormous, the eagerness of physicians (and patients) to use high-technology diagnostic measures and treatment approaches has not been matched by similar zest for measures aimed at prevention". These measures are detailed below:-

Over-enthusiasm and unrealistic expectations from hi-technology will only lead to the disrepute of these valuable tools besides causing avoidable expenditure. Doctors as well as patients need not become victims of the technological explosion and its commercialisation.

Dr G. D. Thapar, Bhishma Pitamaha for the region's medical practitioner, was formerly Director (Medical) and chief of the medical unit at the Willingdon (RML) Hospital, New Delhi. He is a concerned cardiologist. His work at Tripoli University is widely referred to. He lives in Ambala Cantonment.

HEALTH BULLETIN
Ashoka dispels women’s grief
Dr R. Vatsyayan, Ayurvedacharya

Ashoka (Saraca indica) is a medium-sized evergreen tree which is found throughout the India subcontinent — more commonly in the central and eastern Himalayas and also along the western ghats. This tree is often confused with the tall, and ornamental tree, botanically known as Polyalthia longifolia. The use of Ashoka as medicine was known to Indians since ancient times. References in this regard are found even in the Ramayana. Some of the leading lights of Ayurveda, who have had the first-hand clinical experience with Ashoka, include Charak, Sushruta and Bhavamishra.

Ashoka is highly acclaimed for its utility in gynaecological problems. it has been described as kashaya (astringent) and tikta (bitter) in taste and laghu (light) and rooksha (dry) in effect. The bark, leaves, flowers and seeds of the plant are of medicinal value. The main chemical constituents of the bark are tannin, catechol, an essential oil, organic calcium and iron compounds. Ayurvedic texts describe more than 50 preparations for the treatment of a variety of ailments in which its stem bark is used as one of the main ingredients.

The herb stimulates the uterus, making helpful contractions more frequent and prolonged. Ashoka also has an astringent but stimulating effect on the endometrium, and the ovarian tissues, and is useful in many gynaecological problems such as uterine bleeding associated with fibroids and the treatment of leucorrhoea. It is used with success in cases of internal bleeding, piles and haemorrhagic dysentry.

Ashoka has been efficacious in regularising menstrual disturbances without producing any side-effect. Its effect on the ovarian tissue may produce an oestrogen-like activity that enhances the repair of the endometrium and stops bleeding. In metrorrhagia, in addition to decreasing the uterine bleeding, it regularises the interval between two cycles. Besides treating the symptoms of fatigue and generalised weakness, the use of Ashoka provides immense relief from painful menses, the premenstrual syndrome and non-specific white discharge.

The daily full dose of the powder of the Ashoka bark is up to 10 gm in three divided doses in a day. However, a decoction of it can also be prepared by boiling it in water. The famous classic Ayurvedic medicine Ashokarishta and Pushyanug Churna contain Ashoka and are in use for several centuries for several problems of women. However, Ashoka should be given with caution in thrombotic disorders.

The writer is an Ayurvedic physician. He is based at the Sanjivani Ayurvedic Centre, Ludhiana. (Phone: 423500).

Q&A
Your child’s teeth
Dr Ashish Sharma

A As soon as your baby's teeth appear, you should clean them with a wet piece of gauze or damp washcloth after feeding. When the rest of the teeth have come in, brush them gently with an extra-soft, baby tooth brush. It helps to have your child lay his/her head in your lap so you can see the teeth better when you brush.

Remember that the teeth of the babies who sleep with a bottle of milk (formula) or fruit juice in their mouth can suffer from decay known as Milk Bottle Tooth Decay. So the bottle should be removed as soon as the feed is over. Do not use the bottle as a pacifier.

A When your child is about a year old, it's time he or she sees a dentist. Early visits can prevent minor problems from becoming major ones, and even though you are checking your child's teeth, you may not recognise a problem. Don't wait until there is a decayed or injured tooth to introduce your child to a dentist; make the first visit a positive one.

• Familiarise your child with the dentist and his dental office by taking him or her along with you; letting your dentist know in advance allows time for getting acquainted.

• Do not scare him/her about the visit; your child has no reason to be afraid.

• Your child may enjoy a "ride" in the dental chair; perhaps your dentist will use the dental mirror to show your child his or her teeth.

• Take the cue from the dentist who's experienced at dealing with children, and don't expect perfect behaviour from your child.

A Imitation is the best way to teach your child how to brush and floss. Children as young as two years can learn to brush by watching you, although you should follow up with a thorough brushing of their teeth.

Get the children into the habit of brushing at least twice a day with a good, toothpaste and toothbrush which gives the maximum benefit to children. Parental supervision, is however, essential up to the age of six to prevent/minimise the swallowing of toothpaste and teach the correct technique of brushing. Ensure that children rinse and spit after brushing. Parents should also floss their toddler teeth. By the age of 10, children should be able to floss by themselves. Most of all, be sure to praise your child for clean teeth, a nice smile and good oral health habits!

A Out of all age groups, children are most susceptible to cavities. It's important that they brush twice a day to remove plague, the colourless film of bacteria that forms on teeth and leads to tooth decay and gum disease.

A well-balanced and nutritious diet promotes good oral health, however, try and reduce "between-the meals snacks specially of foods which contain sugar or carbohydrates in order to inhibit acid formation in the mouth. Do not get into the habit of giving your child a sweet to stop a tantrum or as a reward.

And, remember, regular dental checkups are the key to healthy oral development!!!

Dr Sharma is a consultant dental surgeon based in Chandigarh. (Phone 702045, 706202).

Blood donation & you - II
Dr Sumitra Dash

The social psychology and motivation to donate blood is complex. Factors such as the convenience of donation, peer pressure, the receipt of blood by a family member and perceived, community needs are important factors that are superimposed on the individual’s basic social commitments. Many times fear born out of ignorance regarding blood donation deters a donor from donating blood. Here are answers to more commonly asked questions about blood donation.

Dr (Mrs) Dash is Additional Professor of Haematology at the PGI, Chandigarh. She worked as a consultant in haematology and was in charge of the Central Blood Bank at Salmanya Hospital, Bahrain, from 1991-99.