 |
|
| HEALTH TRIBUNE | Wednesday, August 22, 2001, Chandigarh, India |
|
A life span of 100 by 2050 Suicide is preventable Fortis and Dr H.S. Bedi honoured QUESTIONS &
ANSWERS Vitiligo is yielding HEALTH BULLETIN
|
|
|
A life span of 100 by 2050 MORE than 2500 years ago, a young prince was overwhelmed with suffering in life, at birth, in old age, disease and death. He renounced his princely pleasures to discover a panacea for human suffering. For 12 long years he visited many holy places and holy men. He roamed in hills, dales and jungles of India till emaciated down to his bones, under a Banyan tree at Gaya, while in meditation, he was enlightened. He became the Buddha. He gave humanity an eight-fold path to peace and happiness in life. But, alas, he discovered no panacea for disease and old age, except fateful self-surrender! Himself, at 80, he died of food poisoning with no cure at that time. It was for science during the past millennium to discover the cause and treat disease. Since time immemorial, old age has also been regarded as a conglomerate of all diseases. The myth of geriatric helplessness was exploded in the last century. Old age is no longer a burden upon oneself or on the family. Fifty years ago our life span was 33 years. It is now 66 years. Fifty years hence it will be 100 healthy years, thanks to the marvels of biomedical sciences. Think of any incapacitating ailment peculiar to old age. On timely and frequent monitoring it is either preventable, or easily curable, with scientific knowledge and multi-pronged tools of technology now available. Cataract, glaucoma (chitta & kala motia) and senile retinal/macular degeneration, for long incapacitating old-age scourges in yesteryear, with present-day sophisticated techniques of phaco-emulsification, intra-ocular lens implantation and laser therapy, in competent hands, can restore vision to normal standards of acuity, without ugly and thick glasses in spectacles. Hypertension, angina, ischaemic heart and coronary artery disease, strokes, hemiplegia and myocardial infarction are no longer dreadful old-age fatal episodes. Monitored well in time and with proper lifestyle, these are preventable, and can be efficiently managed. Thanks to the ever-increasing pharmacological armamentarium, cardiac intervention techniques like angiography, angioplasty and stenting, open heart surgery, neurosurgical techniques to open out clogged blood vessels of the brain and the heart! Cancers of the prostate, the breast and the cervix can now be discovered well in time by ultrasound, mammography, computerised tomography, magnetic resonance imaging, serum enzymatic estimations and painless histo-pathological biopsies. Their early detection can ensure their total elimination by surgical, radiotherapeutic and chemotherapeutic techniques, and a full life span can be guaranteed. Age-related degenerative bone and joint diseases like osteoporosis and osteoarthritis can be detected well in time by bone densitometry and imaging techniques and are preventable by dietary vitamins and minerals supplements, including glucontin and glucosamin alkaloids, which are helpful in the regeneration of inter-articular cartilage lining of joints. Modern physiotherapy, yoga, acupressure, magnetic and diathermy techniques go a long way in the prevention and cure of many a joint afflictions. Arthroscopic intraarticular cleansing of degenerated debris within the joints and total knee and hip joint replacements in cases of advanced incapacitating irreversible degeneration of painful joints have given a new long lease of pain-free normalcy and mobility to these otherwise incurable and excruciatingly painful orthopaedic maladies. With proper diet, oral hygiene and regular monitoring, teeth can survive for as long as the upper and lower jaws of the face in life. No tooth need be pulled out under the stress of a toothache and infection, with modern root canal treatment. In-socket fixed prosthesis should now replace the cumbersome dentures in the 21st century. Long strides of progress are being achieved every year in dealing with old-age psychic and psychiatric disorders like depressive psychosis, parkinsonism, senile dementia and Alzheimers disease, leading to tremors, rigid and slow movements, imbalance, gradual degeneration of brain cells and progressive loss of memory. Dopamine agonists administered at an early stage of parkinsonism appear to thwart the degeneration process and help maintain the quality of life, unlike the currently used levodopa group of drugs, which have several undesirable side effects. In a recent issue of the journal of the National Academy of Sciences of the USA, Ikuo Nishimoto of Keio University, Tokyo, has identified a substance called Humanin, a protein comprising 24 amino-acids, which prevents the degeneration of brain cells, and has a promising future to control Alzheimer's disease. Lately, the role of embryonic stem cells to cure these neuro-psychiatric disorders and also several other genetic ailments including diabetes, during the coming decades, is yet another ray of hope for a Nobel laureate. Pre and post menopausal psychotic disorders, weight gain and many irksome symptoms complex due to hormonal imbalance can be skillfully managed by hormonal replacement therapy, counselling, diet control, yoga, exercise and an elite beauty parlour, in women on the threshhold of old age and well into old age. Elizabeth Taylor, well over 70, looks 40 and has chosen her ninth husband! We are operating three geriatric health-care centres, exclusively for Senior Citizens at Chandigarh, Mohali and Panchkula.
In these centres, it is not uncommon to encounter senior citizens, over 70 and even over 80, asking for aphrodisiacs, for both the spouses, of course "in confidence" to boost the age-related lowering libido. With the advent of "Viagra" and now its Indian version, the cost be damned, for this ever-increasing tribe, old age is certainly no longer a burden! They quote Sherali Farzali, Muslimov of Azerbaijan, who died at 142 and married his umpteenth wife at 137. But he never used "Viagra'. May you live at least a 100 healthy years. Dr M.L. Kataria, the seniormost and selfless health counsellor of Senior Citizens, is known as theHealer of the Slums in North India. (Address c/o The Tribune, Chandigarh)
|
|
Suicide is preventable SUICIDE in India is dealt within Section 309 of the Indian Penal Code which states:“ Whoever attempts to commit suicide and any act towards the commission of such an act shall be punished with simple imprisonment for a term which may exceed up to one year or with fine or both”. The law does not allow a person to take his own life. Attempted suicide has been abolished as an offence in many European countries, and in the USA and the UK. In a recent editorial titled “ Attempted suicide — Anachronism of the Twentieth Century” published in the Indian Journal of Psychiatry, Dr J K Trivedi presents a strong case for changing Section 309 of the IPC. According to Justice R A Jahangir ( 1996), in an age when the theory of punishment is moving away from deterrence to reformation, it is really shocking that an anachronistic provision like Section 309 of the IPC should continue to be on the statue book. This view has been supported by that of Justice Sacher :“ There is need for a human civilised , socially oriented and conscious penology”. He further says:“ Instead of society hanging its head in shame that there should be social strains that a young man (hope for tomorrow) should be driven to commit suicide, it compounds its adequacy by treating the boy as a criminal. Instead of sending the young boy to a psychiatric clinic, it gleefully sends him to mingle with criminals as if trying its best to see that in future he does fall foul of the primitive section of the Penal Code”. While assessing the suicide trauma, sociologists consider the act as the senseless death of an individual. It is a long lasting tragedy. The distress experienced by those who are left behind is unfathomable. Schneidman has put it thus: “ The person who commits suicide puts his psychological skeleton in the survivor's emotional chest. Many families are unable to forget the pain even after decades of the act. Strong guilt feelings grip the families and the tendency to blame each other becomes a common way of coping”. Considering the number of the persons who have made suicidal attempts or who succeed in ending their lives and the magnitude of the problem, what are the remedial measures being adopted for preventing the large-scale human tragedy ? What forces or organisations are we going to create to meet this challenge ? Can we depend entirely on psychiatrists to treat the vast majority of psychologically disturbed individuals ? With their limited number, psychiatrists are unable to provide the real answer. We will have to create a great human resource of educationists, behaviour scientists, social scientists, parents, teachers and volunteers who can develop adequate sensitivity to this problem. Many successful attempts have been made by non-governmental organisations to help these people and provide them with support at the time of crisis. But their number is still very limited. This concept is gradually coming up, alas, in big cities only. (Concluded) The author attends to patients with a suicidal tendency at “MANAS” — Psychology and De-addiction Centre, Tagore Nagar, Ludhiana. Ph 47822
|
|
Fortis and Dr H.S. Bedi honoured THE Fortis Heart Institute, Mohali, added a feather in its cap on Independence Day when its seniormost cardiac surgeon — Dr Harinder Singh Bedi — was honoured with a state award: the Punjab Sarkar Parman Patra — 2001. The award was bestowed on Dr Bedi by Chief Minister Prakash Singh Badal at Firozpur. The honour, says the citation, has been done in recognition of Dr Bedi's achievements in the field of cardiac surgery and for his sincere devotion and service to the people of Punjab. He has performed more than 3000 open heart surgeries in five years in Punjab. His innovative techniques have brought him praise and work from Sydney to Ohio abroad and from Escorts to Fortis in India. |
||
|
QUESTIONS
& ANSWERS Q What are the common complaints of a patient of kidney stones? A
The commonest complaint is pain in the loin, the other being blood in urine (haematuria). In addition to the stone, the patient may also suffer from urinary-tract infection. Such a person complains of fever, a burning sensation and frequency of urinatione. At times the patient may also pass a small stone along with urine. Rarely, he may present himself as a case of kidney failure.
Q I am 30 years old. I am in good general health. I have been found to have a stone in my left kidney. It does not give me any problem. Do I require tests and treatment? A A kidney stone may remain silent for years together. This is known as "asymptomatic stone". The answer for the treatment depends upon the size, the number, the exact location of the stone and whether it is giving rise to any problem. A few investigations are required to have a proper evaluation. Please consult a surgeon for advice. Q Is an operation a must for a kidney stone? A No. An operation is not a must for all kidney stones. A small-size stone (upto 3 to 4 mm) does not require any intervention. It is likely to pass out itself. A large stone (up to 2 cm) may be broken into small pieces by lithotripsy and the small particles are washed out in urine. A stone, which cannot be broken or in case the lithotripsy facility is not available, can be taken out by an operation. Q Is key-hole surgery available for kidney stones also? A Yes. Key-hole surgery known as percutaneous nephrolithotomy (PCNL) is being practised in many good centres, including the PGI. But all cases are not suitable for this technique. Q We know a person (not a doctor) who distributes some medicine for kidney stones and claims a very high success rate. Is there any reliable medicine for dissolving kidney stones? A A small percentage of kidney stones are uric-acid stones and these are not seen in a plain X-ray. Uric-acid stones can be dissolved by medicines. However, the majority of kidney stones are formed of oxalate, calcium and phosphates. These are seen in a plain X-ray. In allopathy there is no medicine which can claim success in dissolving such stones. It may be true for other forms of therapy also. As mentioned previously, small kidney stones can pass out and it may be just coincidental that the patient has been taking some form of treatment at the given time. The credit often goes to that medicine! In a nutshell, kidney stones seen in a plain X-ray cannot be dissolved by medicines. Q My two-year-old daughter is in the habit of eating small stones, chalk pieces etc. A Small stones taken mouth cannot give rise to kidney stones. These will pass out along with stools. However, this habit should be taken care of as it may give rise to other problems. Dr Bose is Professor and Head of the Department of Surgery at the PGI, Chandigarh. Dr S.K. Singh is Associate Professor of Urology at the PGI. |
||
|
Laparoscopic
surgery
Q What is laparoscopic surgery or minimally access surgery? A
It is a surgical technique in which no formal incision is made. Instead, small (5 mm to 10 mm) incisions are made for the insertion of a telescope and operating instruments into the body cavity. With the advancement in technology, the size of the instruments has come down to 3-5mm and these work as well as the big instruments. The beauty of this surgery is that body organs are neither exposed to the atmosphere nor touched by hands. Q
What are the benefits of this surgery? A There are many advantages of laparoscopic surgery. The patient experience much less pain and recovers faster than after open surgery. Cosmetically, it is better. Medications are minimum. The patient can leave the hospital on the day of the operation. The chances of wound infections are much less than in open surgery. Similarly, the formation of the fibrous bands in the body cavity, due to surgery, is minimum. Consequently, the chances of blockages in the intestine after the operation are remote. Q
How is it performed? A The surgery is performed under general anesthesia. The skin of the abdomen is cleansed; a small incision (1 cm) is made just below the naval (umbilicus) to allow the insertion of telescope also called laparoscope (an instrument to look inside the body). It is attached with a camera that is connected to a monitor. A needle is inserted into the incision and carbon dioxide is injected to create space into the abdomen. This allows easier viewing and manipulation of the organs. The laparoscope is inserted first. Later, two or three 5 mm thick instruments are inserted under direct vision. A telescope is attached with a monitor. The surgeon operates by manipulating the instruments from outside while looking towards the monitor. (To be continued) The writer is an expert laparoscopic surgeon and Additional Professor at the PGI, Chandigarh. |
||
|
Vitiligo is yielding Q What is the skin disorder that manifests itself with the complete loss of skin pigmentation? A Vitiligo is a depigmenting disorder caused by the loss of epidermal
melanocytes. There are both familial and nonfamilial forms and the overall incidence is 1 per cent. Vitiligo has been reported to be associated with autoimmune disorders including the thyroid disease and diabetes mellitus. Many patients have circulating
anti-melanocyte antibodies which may play a role in melanocyte destruction. However, the cause of vitiligo is unknown. It affects all races and both sexes. Q When does vitiligo have its onset? A The peak incidence occurs in the third decade of life, but 50 per cent of the cases occur before 20 years of age. Vitiligo has been reported in all age groups with an onset as early as at birth and as late as 81 years of age. Q Do any factors influence the onset? A The patient presenting with vitiligo usually describes asymptomatic areas of the skin which have rapidly lost all pigment. Rarely does the patient recall an associated illness, but skin trauma is commonly reported as causing vitiligo lesions. Q Is vitiligo treatable? A Yes. The most effective treatment is psoralen plus ultraviolet A radiation
(PUVA). Vitiligo repigments in small parts from the border and mostly from the hair follicle. Therefore, the more deeply penetrating UVA is necessary to stimulate the hair follicle
melanocytes. The use of psoralen allows for lower doses of UVA per treatment. For most of the cases, psoralen is administered systematically in the form of pills. Fifty to 75 per cent of the patients repigment following PUVA being given twice weekly. Many patients require 15 to 25 treatments to initiate repigmentation and 100 to 300 treatments for maximal
repigmentation. Following repigmentation, the patient is slowly weaned off
PUVA. The fully repigmented skin has an 85 per cent chance of remaining pigmented. For patients who decline PUVA treatment, topical steroids are helpful. All patients with vitiligo should use sunscreens to protect depigmented skin from damage. Q What is miniature punch grafting? A Miniature punch grafting is one of the most successful surgical methods used to treat stable vitiligo which fails to respond to medical treatment. Dr Gurinderjit Singh is a Senior Consultant and the Head of the Department of Dermatovenereology and Hair Transplantation at the Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana. |
||
|
HEALTH BULLETIN Dr R. Vatsyayan, Ayurvedacharya AS a healing plant, aloe is something of a celebrity. This one-foot-to-two-feet-tall perennial herb is found all over India. In many homes it is a practice to grow it in flowerpots. Since the herb imparts youthful energy and increases femininity, its Sanskrit name is Kumari. More commonly it is known as ghrit kumari or ghee kunwar. On the cutting of its thick and fleshy leaf, aloe yields a sticky, shining and transparent gel which is its medicinal part. If dried in the sun, the gel turns into a wax-like non-transparent blackish substance called kumarisar or musabbar. Bitter, hot and pungent in its post-digestive effect, musabbar is more often used by the exponents of Unani medicine than by their ayurvedic counterparts. Aloe is a carminative, digestive, diuretic and anti-inflammatory medicine. Given in large doses,, it acts as a purgative and kills intestinal worms. Besides having rejuvenative properties, it also benefits if it is given in cases of liver and spleen disorders. Aloe enhances the blood supply to the uterus and helps in its contraction. Due to the presence of certain enzymes, polysaccharides and nutrients, it has a positive cosmetic value. Experimental studies have also confirmed its anti-bacterial and anti-fungal action besides wound-healing properties. Aloe is a popular home remedy. It is used to meet many situations. Here are a few tips for using it in our day-to-day life:
Dr R. Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana. (Phones 423500 and 431500; Cashless hospitalisation The idea of such hospital care is getting enormous response. Readers are advised to write to Mr Daljit Singh Gujral, Director, INSCOL, Sector 34, Chandigarh on ring the hospital on any of the following numbers: 667903, 667876, 388883, 645428. |
 |
|
Described as bitter, cold, unctuous and heavy, aloe finds mention in many ayurvedic texts. Though it alleviates all the three doshas, according to its actions on human body, aloe has been classified as bhedaniya (accumulation-breaking herb), netrarogaghna (alleviating ophthalmic diseases) and pleharogaghna (ameliorating diseases of the spleen).