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| HEALTH TRIBUNE | Wednesday, May 8, 2002, Chandigarh, India |
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What to do if you get a heart attack The four arms of the Red Cross Patient-centred care — a desirable ideal Heredity and mental disorders : close links AYURVEDA & TOTAL HEALTH
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What to do if you get a heart attack CHEST pain can be an early sign of
an impending major heart attack. The classical chest pain —called
angina pectoris — is a squeezing pain that starts in the centre of the
chest and can radiate to the shoulders, left arm, face or back. Angina
is your body’s way of telling that the heart — the very organ that
pumps oxygenated pure blood to all organs — is itself being starved of
oxygen-rich blood due to a blocked coronary artery (artery supplying
blood to the heart). However, the body’s message may not always be so
clear. About one third of all heart attack patients feel no muscle pain
at all. Angina may be replaced by a dull ache in the chest, a
"heartburn" or acid reflux, a vice-like pressure in the chest,
pain in a tooth, profuse sweating, nausea, light-headedness, fainting,
palpitation or unexplained anxiety or no sensation at all the so called
silent attack. One of the most common conditions that is confused with
a heart attack is midline lower chest burning pain due to the backflow
of stomach acid into the food pipe — the so-called
"heartburn" or "gas". However, the reverse also
holds true, ie, a patient with a heart attack may confuse it with
"gas" and not take timely treatment. The number of
"gas" patients who land up on my operating table with
preventable complications is just not funny. Timely action may have
prevented these. It is always best to err on the side of caution. Time
may be money for some, but for a heart doctor and his patient time is
muscle. The longer one waits before appropriate therapy the more
heart muscle is lost. The things to do if you think you are
experiencing a heart attack (or even have a doubt about it) are: *
Stop whatever you are doing and call an emergency, a relative’s or a
friend’s number. * Driving yourself to hospital is not
recommended. * If you are alone on the highway or the road, stop
the car, put the hazard-lights on and blow the horn continuously till
someone comes. * Avoid any physical exertion that could put more
stress on your heart. * If available, put a tablet of Sorbitrate
(nitroglyceride) under your tongue. This provides temporary relief by
dilating the narrowed coronary artery and also other vessels in the body
so that the heart has to work less. * Chew an Aspirin/Disprin
(not Disprin Plus)/Ecosprin — this thins blood and prevents clotting
that can lead to a major heart attack. * You may at this stage
suffer from a potentially fatal complication — namely, cardiac arrest.
You may feel suddenly dizzy and may be about to faint. At this stage you
have probably 10 seconds before losing consciousness. The immediate
treatment for this is cardio-pulmonary resuscitation (CPR) in which you
may be trained. But you cannot do it on yourself. You may help yourself
by coughing repeatedly and very vigorously. A deep breath should be
taken before each cough and the cough must be deep and prolonged as when
producing sputum from deep inside the chest. A breath and a cough must
be repeated about every two seconds without letup till help arrives, or
until the heart is felt to be beating normally again. Deep breaths get
oxygen into the lungs and coughing movements squeeze the heart and keep
the blood circulating. The squeezing pressure on the heart also helps it
regain normal rhythm. * When you get to an emergency room, tell
the staff that you may be having a heart attack. Make sure that the
emergency is recognised. Insist that a specialist doctor attends to you
right away. Faster access to life-saving treatment — clot busters,
beta blockers, emergency angioplasty or surgery — increases the
chances of survival. Pay attention to even the smallest chest pain to
avoid a major attack. A stitch in time does save nine! For more on
heart attack visit: www. americanheart.org Dr Bedi is Senior
Consultant Cardiac Surgeon at the Fortis Heart Institute, Mohali,
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The four arms of the Red Cross More than three hundred years ago,
Guru Gobind Singh deputed Bhai Kanhayya to attend to the wounded
soldiers during his battles against the Mughal armies. One day he was
marched before the Guru for also tending the fallen enemies. When
asked to explain, he told the Guru that he saw him alike in friend and
foe. The Guru embraced him. And he thus initiated the universal Red
Cross with its four arms of compassion, care, comfort and cure,
irrespective of country, caste, creed and colour. Today is World Red
Cross Day. It is being observed in every country, every city and town
in various ways. The light ignited by Florence Nightingale, "the
lady with the lamp", has not been extinguished. It burns
perpetually, for ever, to dispel darkness and despair, and to
disseminate rays of hope and health. Routinely, on such a day,
medical camps are held, but with a lot of fanfare. Or a step further,
a blood donation or an eye camp may be held. At the end of the day a
pithy and figureful press report is released to the media, with a few
'action photographs, a VVIP "dissecting" the inaugural red
ribbon! And that is the end of the Red Cross Day and the much
publicised programme. But this is not so with the Red Cross Society
of the Union Territory of Chandigarh. Everything is done differently
in Chandigarh, by far the best of all the Union Territories. Under
the dynamic leadership of its charismatic chairman (cum Deputy
Commissioner), Mr M. Ramashekhar, IAS, a robustly pragmatic Secretary,
Mr Prithi Chand, PCS, and a down-to-earth vanguard leader, Air
Commodore (Dr) Randhir Singh, this year the World Red Cross Day will
start on the 8th of May, will not end at sunset and continue
throughout the year, till the next World Red Cross Day! The ingenuity
of the programme, a brain wave of the Chairman of the Red Cross
Society, is to identify the most neglected and languishing disabled
children, by a house-to-house grass-root level survey (as was done
during the last census), through a number of subcentres in and around
the city in the entire Union Territory. The principal nodal
disability centre has already been set up by the Chandigarh
Administration under the dynamic head of the Orthopaedic Department
and Medical Superintendent of the Government Medical College and
Hospital, Prof Raj Bahadur. The year-long programme for disabled
children will take off from Karsan village on the north-eastern
periphery of Chandigarh, where a humble beginning has already been
made by the author of this article along with a team of doctors,
social workers, technical staff and invitees, including Madam
Georgiane (from the USA), Mr G.S. Sandhu, a renowned physiotherapist
trained in the USA, assisted by Mr Sanjay Garcha (US-trained), Charter
President Lion Ranvir Uppal, Lion Capt Sushil Kapoor, Lion President
R.P. Singh and their colleagues. We have identified and enrolled 150
disabled children for this centre for a comprehensive and holistic
approach to solve the problems of the individual child. These include
medical/surgical treatment, prolonged physiotherapy, education,
vocational training and rehabilitation — the ultimate aim for each
child. On the World Red Cross Day various medical teams deputed by Dr
Rameshwar Chander, Director Health Services, and the Government
Medical College and Hospital will assess the
surgical/medical/psychiatric requirements of each child for a
follow-up at various hospitals. The percentage of disability for each
child will be assessed. The omnipresent Director of Social Welfare,
Madhvi Kataria, has agreed to simplify the cumbersome documentation
and procedure to issue disability certificates and to grant the
disability pensions on the spot, where possible. It is a unique
example where all the wings of the Chandigarh Administration will
converge on a village (Karsan) on the Day for door-delivery of
compassion care, comfort, and cure to the disabled children suffering
in this area. This is only the beginning. The programme will continue
throughout the year to cover the entire Union Territory. By a rare
foresight of the Chandigarh Red Cross Society Chairman, this, a mere
one-day programme, has been enlarged and launched as a year-round
Mission for the Disabled Children. No wonder, the compassionate
Administrator of Chandigarh-cum-Governor of Punjab, Lt-Gen J.F.R.
Jacob, cancelling other engagements, has agreed to grace and guide
this unique battle against disability afflicting innocent
children. Dr M.L. Kataria, who began a one-man NGO slum medicare
dispensation a few years ago, now runs 16 rural centres in and around
Chandigarh.
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Patient-centred care — a desirable ideal IN the past, physicians tended to make
decisions for patients with little patient input. The practice of
medicine has become more patient-centred due in part to the increasing
respect for the patient’s autonomy and the belief that medical care
should be responsive to the sufferer’s preferences and needs. Those
who are more active participants in their care may have better health
outcome. Many times patients, after meeting the doctor, do not
understand the illness clearly or appreciate the treatment plan. One
may have the feeling that one did not talk about the things that one
wanted to know about most. The best way to help both your doctor and
yourself is to write down your complaints. Emphasise on the most
important one. This will help the doctor to focus on what matters most
to you. The doctor is there to serve you. If you do not understand
something, ask the doctor again. Your questions will help the doctor
to do a better job. By making your best effort to communicate in an
orderly and effective manner, you become an active partner in your own
health. Surgeons are increasingly required to provide patients with
in-depth information about the proposed treatment, the risks involved
and the alternatives. Physicians must first understand the patients’
preferences for participation in the decision making process. Patients
may be unable or unwilling to express their desired role. Physicians
may be poor judges of patients’ preferences. Time constraints may
hinder the establishment of adequate rapport between the patients and
the physicians. Many patients desire to have information about
treatment options. However, they prefer a passive role to an active
role in making treatment decisions. Recognising and accepting patients’
preferences for a passive role in decisions may be more appropriate,
forcing them to make decisions which they are not comfortable in
doing. Being given a choice of treatments may be associated with
increased emotional distress for the patients. Informed
decision-making includes two broadly defined concepts: information
disclosure and patients participation. This is different from informed
consent which means that the patient agrees with a predetermined
decision arrived at by the doctor. There is a need to disclose the
advantages and drawbacks of treatments and to encourage individual
choise. Providing detailed information to those who do not want it and
imposing a choice on those who prefer their doctors to assume the
responsibility for making treatment decisions are harmful. Discussing
alternatives is an essential element for informed decision-making.
Information disclosure reassures patients and counteracts their
anxiety. Patients may fear information and prefer to delegate the act
of decision making to doctors. They wish to avoid regret and
self-blaming for negative consequences associated with a poor
decision. They may lack the confidence to assert their needs during
the consultation and may worry about annoying their doctor by
appearing to question his authority. Doctors need to respond to subtle
cues from patients and appropriately tailor information and
encouragement of participation to the wishes of their patients. They
should not dominate consultations — a behaviour that limits
opportunities for patients to voice their concerns. Doctors must
engage patients in an honest decision about the prognosis and
treatment and ensure that those being treated understand this
information. The surgeon needs to concentrate on the questions that
really matter to the patients. Patients may benefit from the
physicians’ efforts to identify their preferences for participation
in decision-making and supporting them in making often difficult choices. The distinction between problem-solving and decision-making
should rest on a genuine partnership between doctors and patients.
Patient-centred care is a desirable ideal. Medicine cannot afford to
ignore the patients’ emotional status. Providing complete
information during the difficult period of an illness increases the
sufferer’s perception of the surgeon as compassionate, caring and
empathic, and relieves anxiety.
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Heredity and mental
disorders : close links HEREDITY plays a highly significant role in
the etiopathogenesis of many medical diseases. The same is true of
psychiatric disorders. The significance of a positive family history
of mental disorders has been clearly highlighted in the ancient texts
of the Indian system of medicine. Recent medical evidence has
established the role of hereditary factors in the etiology and
prognosis of these disorders. The purpose of this article is to
provide readers with a clear perspective on this highly important
subject. The role of twin studies: Mental disorders like
schizophrenia, depressive disorders and other non-organic psychoses
are certainly more common among identical twins than among the
non-identical ones. Identical twins share the same genetic material
and can be considered as natural clones. Pedigree studies: If
one meticulously follows the family history, of the blood relatives of
psychiatric patients and compares these with those of not having any
mental disorder, one finds that the first group is often heavily
loaded with one or the other mental disorder in varying degrees. It
has been observed that there have been families where every member has
fallen victim to one or the other psychiatric ailment. Medical
literature has established that vulnerability to anxiety and
depression has a strong heredity basis. The spectrum of mental
disorders: More evidence is showing that there is a tendency of
the "mental disorder spectrum" being inherited; some members
have a clear-cut mental illness while others suffer from deviations
which may not amount to the level of a well defined mental
illnesses. It is clear that in case of "Depressive Spectrum
Disease", depression, alcohol dependence and sociopathy go
together in many families. What is the nature of inheritence? : In
case of medical illnesses, scientists are clear about the nature of
the inheritence factor and they can pinpoint the diseased genes. But
in the case of psychiatric disorders one fails to be precise and can’t
blame a single gene for causing mental illness. Polygenic
inheritence: Today the general consensus is that in case of
psychiatric illnesses, it is the polygenic inheritence which forms the
basis of the transmission of the disease from mentally sick parents to
their children. It means that you can’t blame one gene. Many genes
play a part in causing mental illness. These genes get manifestated
under acute or adverse circumstances. For example, in a given case
that has inherent proneness to developing schizophrenia, depression or
mania, mental illness may get precipitated following the use of
intoxicants, drugs, or alcohol — or by significantly painful
life-events. The role of genetic counselling: Marriage among
patients having serious psychiatric ailments is not recommended.
Similarly, children of one of the parents having severe mental
disorders run a higher risk of getting into the whirlpool of mental
ailments as compared to those who have no genetic loading of
psychiatric ailments. Since stress and intoxicants can trigger off
mental illnesses, those who have a heavy genetic burden of psychiatric
illness should try to live a stress and drug-free life. The
author is a Ludhiana-based psychiatrist. |
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AYURVEDA
& TOTAL HEALTH Called by many names such as Aragwadha, Chaturungal, Karnaikar and Rajvriksha in Sanskrit and Cassia fistula scientifically, amaltas has been amply described in ancient Indian literature including the Ramayana and the Mahabharata. Its medium-size tree is found throughout the greater part of India and is favoured for planting along roadsides and in gardens. Though all parts of the tree are medicinal, it is the long cylindrical fruit that generally represents the herb. Amaltas has been used in Ayurveda as a gentle laxative which can be taken safely even by children and expectant mothers. Charaka was so much impressed by its efficacy that in his compendium he named a special chapter after it. Sweet in taste and heavy, soft, unctuous and cold in effect, amaltas is a pacifier of vata and pitta but has also been described as the purifier of vitiated pitta and kapha of the colon. Though the root, leaves, flowers and fruit pulp of amaltas have common laxative properties, all of these have different medicinal value also. Whereas the root is a strong purgative and killer of intestinal worms, the leaves are a blood purifier and anti-inflammatory. Amaltas flowers have demulcent and lubricating properties and the fruit pulp is a soft laxative. It is also an anti-pyretic, a diuretic and an expectorant agent. Ayurvedic texts have indicated the use of amaltas in a wide range of diseases. Though its most common use is for relieving constipation, it is also a very efficacious drug in various skin diseases like scabies, pruitis, boils and glandular swellings. Amaltas is used in liver disorders, upward flow of the abdominal gas (udavarta), bronchitis, arthritis and some of the metabolic disorders. Since amaltas is easily available, it can be safely utilised as a household remedy in a number of diseases. Here are a few tips: Constipation and piles: As a soft and safe laxative, 10 to 20 gm of the pulp should be soaked in a glass of water for a few hours. After straining, this water can be taken at bed time. To manage occasional piles, boil together 10 gm each of amaltas pulp, hararh and munakka and take this decoction for a few days at bed times. Besides clearing the bowels, it also helps in checking the bleeding resulting from external or internal warts. Gout and rheumatoid arthritis: As a first step towards the treatment of arthritis ayurvedic texts recommend using Rasna Saptak Qwath which, along with other ingredients, contains almaltas. Yet as a home Remedy in rheumatoid arthritis, a decoction of its pulp can be taken as a vehicle with 2 gm of the powders of sonth, hararh and giloy. Skin diseases: The dressing of the juice or paste of the leaves of amaltas is very effective in ringworm infections. It is also applied in chilblains. The famous Aragwadharishta is a useful medicine in a number of stubborn skin diseases. Caution: To avoid adulteration, it is better to purchase the dried amaltas fruit instead of the pre-extracted pulp. Fresh pulp can be obtained by breaking it open. Though the use of amaltas is generally safe, an overdose can result in griping in the abdomen besides temporary discolouration of the urine. Dr R. Vatsyayan is an ayurvedic consultant based at Ludhiana
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