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| HEALTH TRIBUNE | Wednesday, February 20, 2002, Chandigarh, India |
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Helping the pilgrim at the gates of Time
PLAGUE Superfacially yours for years Investors in people HOMOEOPATHIC TIPS AYURVEDA & TOTAL HEALTH |
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Helping the pilgrim at the gates of Time Despite advances in treatment, many times situations arise when there is no more we can do in the darkening sea of illnesses. There is little or no hope of recovery and death appears certain. We feel the sense of frustration. There seems to be no solution for this problem. The line between hope and helplessness is very thin. The immediate goals are the identification of sources of strength and relief from suffering and discomfort. The healthcare provided at this stage must ensure flexibility to meet the needs of the patients as well the families which are desperately looking for some ray of hope. Medical care focuses on providing comfort and improving the patient's subjective wellbeing. Care should be patient as well as family-centered. What should a doctor do? The medical man can show(i) respect for the dignity of the patients and relatives; (ii) be sensitive to and respectful of the patient's and family's wishes; (iii) ensure alleviation of pain and other distressing symptoms; (iv) recognise, assess and address psychological and social problems (v) and provide access to therapies that may be expected to improve the patient's quality of life. Survival too is important, and while a few weeks extra benefit may not appear much to the doctor, to the patient it may be highly significant. Communication is one of the most powerful "medicines" available in his ability to bring comfort. it is thus vital that healthcare professionals should be considerate with their words while talking to patients and family members. One has to look into the patient's feelings of hopelessness, helplessness, and worthlessness. The loss of identity and dignity is obvious. The fear of being a burden on others may be greater than the fear of pain. The time of discharge from the hospital, when an individual is not expected to recover, is one of the most anxiety-producing events a patient and his family ever experiences. Sensitive listening and careful observation can be more effective in finding out what the patient is feeling. It is important to learn how to give negative information tactfully. Information may be given in portions that can be assimilated, and used constructively. It takes boldness to act when one is uncertain, and courage to remain silent when one has nothing to say. The control of distressing symptoms is the most important aspect of patient management. As symptoms develop they should be treated with skill and creativity. Symptoms change quickly and we must maintain a high level of awareness. Poorly controlled symptoms distract the individual from the more central concerns of the family. Much can be done to alleviate pain by explaining the mechanism underlying the disease to reduce anxiety, and by showing concern for the patient to raise morale. Most patients are afraid of the process of dying. These fears often remain unspoken unless the patient is given an opportunity to express them and to talk about the prognosis. A full and frank discussion may result in immediate improvement in the mental state and the resolution of pain. Reassure the patient that pain can be effectively controlled. Nausea and respiratory distress can be ameliorated if not eliminated. Progressive weakness is emotionally draining. Find out what the patient actually does and how long it takes him to do things. Help at the time of putting on stockings or lacing up shoes is important. If walking unaided is too difficult, independence in using a wheel chair and limited walking can be offered. It is a process of looking into the glass and finding what is still there. Food and eating can become a battleground as the patient has a progressive loss of appetite and loses weight. Be sensitive to the emotional state of the family as well as that of the patient and offer help. Patients have increasing physical symptoms and decreasing physical functions, psychological stress of loss of control and loss of hope, fear, anger, depression and grief. Family members have their own feelings as well as those of the patient to deal with. Often, they may have to put aside their reactions to cope up with those of the patient. The sense of aloneness is relieved by anticipating help. One may be required to stand close to the "heart" of the patients and families in the crisis. Compassion, communication, carefulness and keeping cool are the tasks of a healthcare professional when he is faced with such situations. Helping individuals and their families and friends pass through this process comfortably means doing a great service. We should help patients live meaningfully. Dr J.D. Wig, the
concerned surgeon, takes special care of the patients by bringing in
empathy to the healing process. He is based at the PGI, Chandigarh.
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PLAGUE Epidemics of infectious diseases, such as plague, cause more scare than death. In ancient times, it was the general punishment of the innocent for admonition of their rules as in the familiar instance of Pharaoh, the Immune. It is because of the rapidity of the spread and the number of people who get involved that panic spreads. But there is no need to panic in modern times. Plague spreads primarily by the bite of the flea which lives as ectoparasites on rats or other wild rodents. The micro-organism, Yersinia (or Pasteurella) posts, present in the gut of the plea, are transmitted to humans with the bite. A widespread epidemic, is therefore, likely only when there is a massive rise in the rat population and their deaths, compelling the rat fleas to find alternative sites to live. An epidemic generally follows a natural disaster such as an earthquake, famine or flood as happened in Surat and Latur in 1994. Sporadic cases and small clusters of patients, are, however, frequently reported from all over the world. Even in the USA, the spread of plague to urban rats was documented in Los Angeles in 1983 and as recently as 1992, a 32-year-old man died of pneumonic plague in Arizona. It is the airborne spread of the infection that causes greater concern. Patients, whose lungs get infected with the plague organism and who suffer from pneumonia, can pass on the organisms to those in the immediate vicinity through coughing and sneezing. The organisms are carried in fomites — the tiny droplets forcibly coughed out by the patient and inhaled by a person in front. Similarly, the organisms can be transmitted by kissing. It is because of the inhalational spread that pneumonic plague is the most feared form. Moreover, the lung involvement affects the vital functions of respiration which is rather serious and frequently fatal. The infection can also involve the skin and glands of those who handle carcasses of infected rats, rodents or rarely other predators including the feline, foxes, coyotes and dogs. Lungs, and occasionally other organs, such as the blood, brain and meninges, may be involved secondarily after the primary infection. The disease is beyond my practice", said the doctor in Macbeth. Plague, like the disease in Macbeth, is fatal when untreated. Fortunately, the Yersinia bacilli get killed by antibiotics like tetracyclines, strepstomycin, gentamycin, chloramphenicol, trimethoprim, sulfa methodoxazole, quinolones and others. Treatment is simple if an early diagnosis is made. The fear of a large-scale spread in the normal conditions is unnecessary and must be avoided. Preventive steps are required for the close contacts, including the hospital personnel directly involved in the care of patients. Simple measures such as the wearing of masks, gloves and hand washing are useful. Other general precautions of sterilisation are equally important. Normal hygienic steps were curtly suggested in American medicine: "perpetual warfare ought to be waged against those who wilfully cough and sneeze in the open without protecting the face with a handkerchief." Professor Jindal
is a renowned chest specialist. He heads the Department of Pulmonary
Medicine at the PGI, Chandigarh. |
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Superfacially yours for years Several approaches to the management of wrinkles can be considered once the defect has been identified. Static, gravitational wrinkles can be treated with any of a number of augmentation materials, including fat injections. The advantage of using fat is that it gives the possibility of some degree of permanence. During the ageing process and as a part of certain diseases, individuals lose the fat substance in areas around the mouth, in the checks and in the temples. The ability to replace the fat with autologous tissue is beneficial from the standpoint of no rejection or allergic reaction. At the donor site, which is either the flank, abdomen or lateral thigh, strands of tissue are sucked into the syringe and then the fat is gently centrifuged. This fat is reintroduced into the different layers of the tissue of the face. For more superficial correction of finer lines and wrinkles, collagen is the gold standard because it has been used in more than one million patient procedures. Prior to injecting collagen, a double skin test is recommended, as about 3% of the population is allergic to it. Collagon comes in two forms — Zyderm for more superficial correction in the upper dermis and Zyplast for deeper penetration into the dermis. Some newer competitors to collagen are being used and these superficial fillers are the hyaluronic acid-based products —Hylaform gel and Restylane. Hylaform gel is derived from the head of a cock and Restylane from bacterial fermentation. Both of these gels are clear and when placed in the skin are hard to detect, hence preferred. Hyaluronic acid products might last a little longer than collagen which lasts only a few months. For dynamic wrinkling, the most effective treatment is botulinum toxin type A, which is recommended for treating the upper third of the face in the forehead area, at the root of the nose, for bunny lines on the sides of the nose, for crow's feet and for asymmetry of the eyebrows. The duration of correction is approximately four months. The use of botulinum toxin (Botox)as a chemical browlift has proved to be a wonderful approach to restoring the desired curved brow appearance in women. The focus of cosmetic surgery has changed from the big surgical procedures requiring general anaesthesia, operating rooms with surgical risks, and significant post-operative recovery periods to simpler and less invasive techniques. A few of the latest skin rejuvenation treatments are laser procedures, chemical peels, and microdermabrasion, which enable patients to be treated in an office setting with little risk of complications. While these treatments need to be repeated to maintain results, patients experience little down time and can return to work quickly. Lasers with their latest advancements allow healing to occur much more rapidly with minimal patient discomfort. By emitting a beam of light that is absorbed by the water in skin cells, these high energy lasers improve superficial and moderately deep wrinkles, like those on the upper lip, the crow's feet around the eyes, as well as the shallow wrinkles on the cheeks and forehead which are of great cosmetic advantages. Pulsed carbon dioxide laser resurfacing, which uses heat energy to selectively destroy the outer and middle layers of the skin, has become the standard for moderate to advanced ageing skin. The advantages are that they successfully erase deeper facial wrinkles, but this type of laster resurfacing is a major procedure requiring anaesthesia, recuperation, and down time. The Erbium Yag laser selectively removes the outer layer of the skin with less heat exchange. It can be used as a superficial or medium depth resurfacing procedure, but cannot predictably go as deep as pulsed carbon dioxide laser-resurfacing. Most recently, the Erbium Yag laser was used to accelerate the healing time from a pulsed carbon dioxide laser procedure by removing the heat damaged tissue. A current laser technique for improving wrinkles is the non-ablative laser, which utilises the long wave-length Q-switch. Yag lasers have successfully been used to remove pigmented lesions, tattoos and excess hair. This procedure combines the laser's deep penetration to improve wrinkles while cooling the skin's surface to minimise the visible damage. With repeated treatments, this new technology produces a noticeable effect on moderate ageing skin. Chemical peels are one of the most flexible treatments to rejuvenate the ageing skin. By evaluating the patient's skin type, pigmentation and degree of the sun damage, a dermatologist can individualise the strength of alphahydroxy acids (AHAs are a class of compounds that have recently generated much interest in the treatment of the ageing skin. The most commonly used ones are lactic and glycolic acids as they are the most effective. Glycolic acid causes detachment of keratinocytes in a low concentration, and epidermolysis at higher concentrations and when used consistently, leaves a smoother, nonscaly surface with the normalisation of keratinisation. With long-term use, the AHAs have been shown to increase both collagen and elastin synthesis and promote protein generation. There is also an increase in the glycosaminoglycan (CAG)concentration and a reversal of atrophic changes. Controlled studies using AHAs for six months have shown an approximately 25% increase in skin thickness. Many of the over-the-counter products often contain AHAs in dilutions, which are too low to be effective. Microdermabrasion: Microdermabrasion was invented in Italy 15 years ago. During microdermabrasion, crystals of aluminium oxide are blown onto the skin and then removed with a vacuum line. The goal of this "sand-blasting" technique is to mechanically remove the outer layers of the skin so that they can be replaced by new smoother, younger skin. Dermatologists conducted a clinical study to evaluate the effects of microdermabrasion. The study's measurements concluded that microdermabrasion was effective for the improvement of the mild ageing skin with minimal wrinkles. People should note that anyone considering a cosmetic procedure for the ageing skin should consult to dermatologist a determine which course of treatment is appropriate for him or her. Dr Gurinderjit Singh, is a senior consultant and Head of the Department of Dermatovenereology and Hair Transplantation at Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana. (Concluded)
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Investors in people Leading corporates, including Satyam Infoway, Tatas, Hindustan Lever, GE Capital Services, Escorts. Oracle, Nokia, Airtel, Ford Foundation and the Food Corporation of India have one thing in common: they are "investors in people". They have provided the numero uno employment benefit a progressive organisation can offer to its members and their family members, that is access to free and qualitative healthcare facilities — round-the-clock and nationwide. They have all subscribed to the health insurance - backed managed care schemes of various Third Party Administrators (TPA). This concept of managed care, prevalent in developed countries, is now being promoted in India through TPAs such as Family Health Plan (FHP — an Apollo group company). Sedqwick Parekh. Emmed Life (a Dabur group company), Genins India Ltd., Medicare TPA Services and Paramount Healthcare Management Limited. These TPAs offer tailor-made solutions ideal for small to large corporations, in the public or private sector. The yearly premiums are affordable. The existing standalone mediclaim policies are not very popular since they have serious limitations. Subscribers have to pay upfront for hospitalisation bills which could run in lakhs and then claim reimbursement from insurance companies at much inconvenience and delay. Moreover, a large number of people are left without medical cover of any sort. The process of managed care is simple:
The advantages are many: 1. Assurance of emergency and qualitative medical care — nationwide. 2. Affordable and fixed cost. 3. No upfront payment or reimbursement of bills. 4. Pre-existing diseases and maternity covered. 5. Value added services like free ambulance, health workshops etc. Managed care is ideal for small to large enterprises in the public or private sector. INSCOLis a member of the preferred healthcare provider of almost all TPAs. Mr Daljit Singh
Gujral is an experienced healthcare manager and Director of INSCOL, a
tertiary care hospital in Chandigarh. |
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HOMOEOPATHIC
TIPS will it be beyond belief if someone told you that he or she feared his or her own voice? More astonishing, if a homoeopath had a specific medicine for this symptom listed in his book! Along with 400 different fears with near specific remedies, you will find this symptom in the Complete Repertory. Unquestionably, the instance exemplifies homoeopathy's perception or understanding of the intricacies of the mind. More common fears are social phobia, agoraphobia (fear of open spaces or crowds), claustrophobia (fear of closed places) and acrophobias (fear of heights). Social phobia, also called social anxiety disorder, involves overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a persistent, intense and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. The fear may be so severe that it may interfere with work or school, and other ordinary activities. Many people with social phobia recognise that their phobia is an exaggeration. But they may be unable to overcome it. They often worry for days or weeks in advance about a dreaded situation. Argentum Nitricum, Lyssin and Gelsemium lead the homoeopathic table in treating social and agorabhobias. Claustrophobic individuals are fearful of closed and narrow spaces, making themselves unfit for travelling in tunnels and lifts and working in basements. Homoeopathic medicines, Lycopodium and Pulsatilla, are asked for treating this situation. Life can be very distressing for people suffering from acrophobia (fear of heights). It can be seen in Alfred Hitchcock's classic "Vertigo'. Poor Madeliene! For sure, a dose of Argentum Nitricum would have changed the course of the story — yes, perhaps! Treating phobias requires a deep insight into the case; do consult your homoeopath before using any of these medicines. Drs Vikas and Anu
Sharma are based at 1290, Sector 21-B, Chandigarh (Telephone 721501;
E-mail heilkrafte@sify.com). |
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AYURVEDA & TOTAL HEALTH Bhilawa: a herbal all-rounder Bhilawa is one of those few herbs which have evoked much trust and confidence among the exponents of the ayurvedic system of medicine. Called Bhallataka and Agnimukha in Sanskrit and marking nut in English, its scientific name is Clerodendrum serratum. Its tree, which grows up to the height of 30 feet, is found throughout tropical India. Bhilawa fruits are used as a medicine. Mentioned in all the ancient ayurvedic treatises bhilawa has been described as sweet and astringent in taste and sweet in post-digestive effect. While it is light, unctuous, sharp and highly hot in action, it pacifies kapha and vata but aggravates pitta. The bhilawa fruit contains anacardiac acid and an oil which causes blisters if touched without adequate precaution. Bhilawa bestows a wide range of beneficial effects on the human body. For the digestive system, it is a carminative, digestive, anthelmetic and liver-stimulating medicine. In relation to the cardiovascular system, it acts as a heart stimulant and is seen as a diuretic in initial action on the urinary system. On prolonged use, bhilawa reduces the urine output. It has a marked effect on the nervous system and is considered to be a very good nervine tonic. It improves the metabolism and also acts as an excellent aphrodisiac and rasayana. Since bhilawa is counted among upavishas (semi-poisonous drugs), ayurvedic pharmacology prohibits its use in the raw form. To make it body-friendly, ayurveda prescribes some methods to purify it. The most common of these is to rub it well with two rough stones or boil it in a cow's urine and then thoroughly wash it by water. Purified bhilawa has great therapeutic and healing properties. It is used in the treatment of a number of diseases. Bhilawa is very effective in vata afflictions like paralysis, sciatica and rheumatoid arthritis. It is also used in the treatment of problems like anorexia, and indigestion and since it has been described as bhedaniya (accumulation-breaking herb), it is the drug of choice where the pathology is due to srotavarodha (blocking of body channels). Bhilawa reduces portal hypertension and is a good medicine for piles. It is also used in the treatment of glandular swellings. Though ayurvedic texts mention the use of bhilawa in general debility, some scholars have said that to gain its rejuvenative and immuno-strengthening effect it should be used in ascending and descending numbers. It is used in a number of other disorders like the enlargement of the spleen, skin diseases like leucoderma and in chronic undefined fevers. Bhilawa is also a trusted weapon against male sexual insufficiency. Bhilawa is very hot in effect. It does have some unsavoury effects on the body. Excessive or wrong utilisation can result in skin rashes, pruritis, boils and inflammation of the urethra. It should be given with caution to children, pregnant women and persons of pitta prakriti to those who suffer from high blood pressure, ulcer and agitated anxiety neurosis. Many classic preparations like amritabhallataka avaleha, Sanjivani Vati and Narasin Churana contain bhilawa and are used by physicians since time immemorial. Though bhilawa is a highly efficacious herb, keeping in view the nature of the drug, it is advised that it should be used under expert supervision and not as a household remedy. Punarnava: the herbal diuretic). Dr R. Vatsyayan is
based at Ludhiana. (Phones: 423500 and 431500; e-mail-sanjivni@satyam.net.in) |
