EYESIGHT
Myths about cataract surgery
Dr Mahipal S. Sachdev

You have been told by someone at some time, “You’ll damage your eyes if you don’t take proper rest after your cataract surgery!” But do you really know what is or is not good for your eyes?

Very few people must have noticed the news a few weeks ago that Prime Minister Manmohan Singh had been operated for cataract in both his eyes. A person, who can hardly rest and is on his toes all the time, is back to his duties in no time. At least that should carry away all misconceptions about the rest being required after cataract surgery.

Truly, cataract surgery has come of age, with literally drive-in, drive-out surgery with no postoperative restrictions being imposed on the patient.

In the past, patients had to stay overnight in a hospital for cataract surgery. Fortunately, modern-day cataract surgery has evolved a lot. The patients undergoing phacoemulsification literally get up from the operating table immediately after surgery, walk to the recovery room, and are ready to go home in a few minutes with only a transparent eyeshield/dark goggle as evidence of surgery.

Most patients notice a significant improvement in vision a few hours after surgery, and it is expected to be “optimal” by the next day. In some patients, this may take slightly longer, depending on many factors. Most of the regular activities can be resumed in a day or two.

Similarly, another common concept is that one should not get the cataract operated in the rainy season. Patients want to wait for the winter for their cataract surgeries. With the advancement in the field of medicine, season doesn’t make a difference in the outcome of surgery. With the availability of latest broad-spectrum antibiotics, the risk of infections has been minimised.

Post-operatively patients are interested in knowing if they can have their normal meals or not. There is no diet restriction after cataract surgery for a normal person. A diabetic person will have sugar restriction while a hypertensive will have salt restriction.

We have seen some patients who wear dark glasses all the time, and are afraid to see bright light after cataract surgery. They think that will damage their eyes. Dark glasses are advised to prevent the glare which a patient feels post-operation. One is supposed to wear them as long as one gets accustomed to natural daylight. Light doesn’t harm the eyes.

When to get the second eye operated upon is a dilemma for many. Both eyes are usually not operated together. So, the second eye can be operated upon the very next day of the first eye or at an interval as desired by the patient. The healing of one eye does not affect the second eye.

Another very common misconception is to wait for the surgery till the cataract becomes mature or ripens. With the advent of phacoemulsification surgery, cataract surgery can be done much earlier than that. Most important, post-operatively, is to follow the medicines meticulously.

Cataract blindness is a health problem of major proportions in the developing world. Nearly 41.8 per cent global blindness, in which 23.5 per cent is contributed by India, is caused by cataract alone. Blindness is a disease which has severe economic repercussions and adversely affects productivity.

People should be told more and more about surgery’s benefits and only then can ever-increasing cataract blindness be cured.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. email: msachdev@bol.net. in

Laughter for healthy and happy life
Radhakrishna Rao

Under the stress of today’s fast-paced lifestyle focused on materialistic gains and wealth creation, many of us are slowly forgetting the art of laughing, considered the best medicine for soothing ruffled sentiments and calming the disturbed nerves. Indeed, laughter can be quite an infectious expression of a joyous, care-free human spirit. Not surprisingly, research studies are pointing out the possibility of laughter boosting one’s health and happiness.

In recent years, for the thousands of hard-pressed young professionals constantly under the strain of a demanding work schedule, laughter has proved to be a highly rewarding de-stressing experience, resulting in the creation of a wealth of inner joy and peace.

Many medical professionals in India’s IT capital, Bangalore, hold the view that laughter helps soothe one’s body and mind. This can increase one’s productivity. It is said that while you need 7-8 muscles to frown, it takes just two muscles to put a pretty smiling appearance.

According to Dr Sunil of the Bangalore-based M.S.Ramaiah Memorial Hospital, laughter decreases the impact of stress hormones that constrict blood vessels and suppress immune activity. This implies that laughter has the potential to bring down blood pressure and strengthen the immune system. Laughter exercises are considered one of the most ideal pathways to stay happy and healthy.

Medical researchers and psycho-analysts in the West, too, are finding many benefits from laughing and staying cheerful. Even the anticipation of a sound and good laughter is known to be good for one’s health. As it is, a long period of stress is known to weaken the immune system with serious consequences for the overall physical well-being of a person. It is here that laughter can help one de-stress and stay healthy and happy.

Dr Lee Bark of Loma Linda University in California along with a team of researchers has found that laughter boosts the production of mood-elevating human hormone, B-endorphins, by a considerable extent. He strongly recommends laughter as a medicine and therapy.

In view of the growing realisation of the benefits of laughter, a number of laughter clubs have come up all over the country. The first such club in India was set up by Dr Madan Kaleria in Mumbai. Today that club has branches all over the country.

Those who have participated in laughter sessions say that laughter has made them remain cool and composed even at the height of tension.

Osteoporosis in elderly: correct diet a must
Dr R. Vatsyayan

Bones form the basic framework on which all other structures and organs of the body are strung or contained. Considered as one among the seven types of body tissues by ayurvedic masters, bones always remain active and a changing physical constituent. While a new bone is laid down, old one is replaced without ever being noticed normally by a person. As one grows older, more bone is absorbed than laid down, making them lighter, thinner and weaker. This condition is known as osteoporosis.

A healthy bone consists of a strong mesh made of protein and minerals particularly calcium. Bones are at their strongest when peak bone mass is reached around the mid-twenties of a person. Ayurveda considers old age as the vata period when all tissues and fluids of the body start drying up. The risk of getting osteoporosis continue to rise as we get older. Women are more prone to this condition and menopause and other hormonal reasons are cited to be responsible for it.

However, for both men and women, long-term immobility, excessive smoking and drinking and taking low levels of dietary calcium are strong reasons for bones becoming porous and brittle in old age. Digestive disorders that affect the absorption of nutrients such as inflammatory bowel disease and celiac disease, long-term use of steroids, thyroid disorders and autoimmune diseases like rheumatoid arthritis and a certain level of heredity predisposition are other notable causes of osteoporosis.

Osteoporotic conditions can be present without any symptoms for decades, because it doesn’t cause symptoms unless bone fractures. Osteoporosis also doesn’t affect the whole skeleton to an equal degree. Elderly people with fractures of the spine, feet and hip present typical changes occurring in bones due to osteoporosis. Most of the times such incidents occur during the course of normal activity and are called minimal trauma fractures. Due to poor bone quality a hip fracture in old patients may be difficult to heal even after surgical intervention, and this condition requires long-term nursing care.

Prevention of osteoporosis in elderly persons is as important as its treatment. Unfortunately by the time X-rays and other measures can detect the disease, nearly a quarter of the bone mass is already lost. Though exercise has multiple health benefits and its lighter forms are recommended for older people, it doesn’t improve the quality of bones. With advancing age and conditions like heart disease, obesity, diabetes and hypertension, exercise should be monitored by a physician because its extreme forms may not be good for old and brittle bones.

Building strong and healthy bones requires a nourishing diet right from the childhood for both males and females. Milk and milk products like curd, cheese and clarified butter contain sufficient calcium, and skimmed milk doesn’t reduce much of its calcium quantity. Green and leafy vegetables, whole grain cereals, fish and poultry products are rich sources of natural calcium, protein and vitamins. Smoking and the use of alcohol specially in women have adverse effects on the absorption of calcium.

Ayuveda recommends certain asthi-sandhaniya herbs to treat osteoporosis. Apart from these, preparations of Ashwagandha, Shatavari, Laksha, Arjun, Giloy and Guggul promote healthy bones. Classic medicines containing organic compounds of calcium like Praval Panchamrit Rasa , Lakshadi Guggul, Abha Guggul and Godanti Bhasma can also be prescribed to susceptible cases of osteoporosis.

The writer is a Ludhiana-based senior ayurvedic consultant. Email-yourhealth@rediffmail. com.

‘Right to choose’ your doctor
Colin Brown

Patients will be able to choose which surgeon they want to carry out their operation under changes to the UK’s NHS designed to improve quality of treatment.

A constitution for the NHS will give patients new statutory rights of choice for the first time, including the right to express a preference for the GP they want to see. According to plans outlined by ministers, they will be helped by their doctors to choose the right surgical team with data on survival rates, the average length of stay in hospital, the frequency of readmission, the incidence of hospital-acquired diseases and patient satisfaction ratings.

Patients’ ratings of the care they receive will also be used to hand out up to £9m in bonuses to the best healthcare units and GPs. Information on service quality will be displayed on “dashboards” in hospitals, GP surgeries and the web.

Hospital units which make blunders that should “never happen”, such as removing the wrong leg in surgery, could lose the additional sums – about 3 per cent of the hospital budget.

Lord Darzi of Denham, appointed last year by Gordon Brown as a Health minister to oversee the reforms, said: “This is about giving more clout to patients. By measuring quality across the service and publishing that information for the first time, both staff and patients can work together to make better informed choices about their care.”

Patients will also be able to choose their GP practice under the NHS constitution. “You have the right to choose your GP practice and to be accepted by the practice unless there are reasonable grounds to refuse in which case you will be informed of those reasons,” it says.

Ministers have dropped the idea of penalising patients who refuse to quit smoking after a heart attack or refuse to slim if they are diagnosed as obese. The constitution says:

“The concept of ‘responsibilities’ was thought to be sensible and fair. Discussions with patients, the public and staff also indicated that while some sanctions may be acceptable, responsibilities should mainly act as a guide for individual behaviour.”

The Darzi report will be followed by an NHS Constitution Bill this autumn, which seeks to end the “post code lottery” over expensive drugs being refused by some primary care trusts, even after the drugs have been approved by the National Institute for Clinical Excellence (Nice), which issues guidance on the effectiveness of treatments.

“If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you,” says the constitution.

Personal health budgets for people with conditions such as diabetes or multiple sclerosis will also be piloted to give patients greater control over their care, in a move welcomed by the MS Society’s chief executive, Simon Gillespie.

The new NHS constitution will include a “right to choose”, which should mean you never have to put up with unhelpful receptionists, or uncaring or incompetent doctors. When you visit a surgery, you have the right to choose which doctor will see you, and if you don’t like one practice, you could visit a website called NHS Choices and hunt for another. And the funding will follow the patients, so losing you as a patient will cost the surgery as an inducement to them to look after you properly. You will also have the right to check your medical record online, and correct it if necessary.

— The Independent