Heart surgery: Elderly do well with special care 
Dr Harinder Singh Bedi

In the area of cardio-vascular surgery, the word “elderly” stands for the people aged 80 and above. The heart is basically a muscular pump, and beats more than 100,000 times a day, pumping roughly 2,000 gallons of blood through 60,000 miles of blood vessels every 24 hours. By the time a person reaches 80, his heart has done an amazing amount of work. With age, it becomes less elastic, making it unable to relax completely between beats. The walls get thickened and it may enlarge in size.

Life expectancy in the US is 75.5 years. Octogenarians constitute about 3 per cent of the American population. The average 80-year-old is expected to survive at least eight years. The older population in India — which was 56.7 million in 1991, 72 million in 2001 — is expected to grow to 137 million by 2021.

Today India is home to one out of every 10 senior citizens of the world. Both the absolute and relative size of the population of the elderly in India will gain strength in future. By 2010, 60 per cent of the world’s coronary heart patients will be in India. The elderly population makes a big percentage of this as cardio-vascular disease is the most frequent single cause of death among the elderly. As many as 40 per cent of all octogenarians have symptomatic cardio-vascular disease and a significant number of these may benefit from surgery.

Age being an independent risk factor for the development of coronary artery disease, the incidence of symptomatic coronary artery disease (CAD) requiring coronary artery bypass grafting (CABG) in the elderly is bound to increase. The broad demographic trend mentioned above towards a more aged population and the use of ballooning in younger patients has led to an increasingly greater number of high risk elderly patients affected with symptomatic and surgically correctable CAD becoming candidates for CABG.

There has always been hesitation to use an aggressive treatment with the elderly heart patients, as it is thought that the risks associated with these procedures are somewhat higher. New techniques, researches and studies have been able to counter these fears to a great extent. Recent cardiac surgical literature, including our own experience, has shown that cardiac surgery even in the elderly is quite safe. The findings have important implications for our older citizens.

However, not all octogenarians are candidates for cardiac surgery. A careful assessment of the associated medical conditions, especially cerebrovascular, pulmonary and renal, should help in the decision making. The risk — the benefit ratio must always tilt in favour of the patient before embarking on any intervention. Before any intervention we must know if added years are an onus or bonus.

According to some authorities, older people may be seen as less deserving of expensive resources. However, my view is that the wealth of a country is not derived only from those currently active but is built on a heritage of skills, knowledge and processes developed by countless past generations , and the young and old are equal heirs to this inheritance.

Important points:

A meticulous pre-operative workup is essential to avoid surprises in the operation and peri-operation period. A very detailed pre-anaesthesia check-up (PAC) with pre-emptive measures taken well before surgery (eg cessation of smoking, addition of bronchodilators, teaching of breathing exercises, etc) is a must. The surgical procedure should be absolutely well planned so that not even a minute of operation time is wasted and a complete and thorough but expeditious correction of all defects should be the aim — it has to be a “commando” precision operation — quick in, do a complete job and quick out.

Especially for the elderly patient I employ the KISS approach — Keep It Safe and Simple and this has paid rich dividends for my patients. This approach was taught to me by my teacher — the late Dr Prof Mark X Shanahan — Chairman of Cardiac Surgery at St Vincents Hospital in Sydney, Australia.

The writer is Head, Cardio-Vascular & Thoracic Surgery, Christian Medical College & Hospital Ludhiana. The article is based on a guest oration that the writer gave at the World Congress on Cardiology on October 3 in New Delhi.

Ayurveda & You
How to take green tea to remain healthy 
Dr R. Vatsyayan

With a long history of human use dating back to more than five thousand years, green tea is made from the dried leaves of a small shrub scientifically called Camellia sinensis. It is believed that the Budhist monks during their long meditative sojourns and journeys in India and China used to drink green tea as an energy brew. But it is surprising that the ancient ayurvedic masters, who had studied the effects of thousands of herbs and plants, including many sedatives and stimulants on human body, paid no attention to tea. Today, we have a lot of data based on scientific research regarding the health benefits of green tea.

Green tea is a potent anti-oxidant and is rich in catechin polyphenols, the scientifically recognised substance which is its active principle. Since green tea is in unprocessed form, it has more of the natural stuff, which can neutralise free radicals, the disease and damage-causing agents in the body. The traditional Chinese medicine views green tea as a freshening and mood-stimulating agent having diuretic, digestive, anti-viral and scavenging effects on the body. It counters the various toxins which arise in the body due to external or internal reasons.

Several clinical studies have shown that green tea helps prevent atherosclerosis, age-related hardening of the arteries and in the long run lowers the risk of coronary heart disease. It reduces bad cholesterol, and researchers are of the view that green tea may also have an important role in the prevention of cancer. Green tea has been found to lessen the inflammation associated with Crohn’s disease and the ulcerative colitis, and it can slowdown the progression of diabetes, counteract the ill-effects of alcohol and boost the metabolism to burn fat and loose weight.

Making a perfect tea and setting its proper dose is a question which cannot be easily answered. In Indian conditions one to three cups of tea in a day are considered normal and one tea bag or two to four gm of it should be put under boiling hot water for a minute or two to gain its maximum benefits. Though milk and sugar can be added to the green tea brew, its quantity should be as minimum as possible so that the original aroma of the tea is not be lost. Ginger, tulsi, mint or cardamom can also be boiled into this brew.

Basically, tea is a herb and like many of the herbs it is used to boost the energy level. Green tea and black tea are derived from the same plant but the former contains a less amount of caffeine. People who excessively use caffeine-containing substances, including green tea, may experience irritability, palpitation, lack of sleep and a certain amount of dependence on or addiction to it.

Indiscretion regarding the time and quantity of green tea may also cause acidity, gastritis, nausea, loss of appetite, excessive urination and headache. Green tea may have interactions with some of the antibiotics, anxiolytic and antihypertensive medicines.

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

Brain: The grey matter that makes us who we are
Jeremy Laurance

The brain is our most complex but least understood organ. We can name its parts but our knowledge of what each part does, or how, is rudimentary. In The Brain Book, journalist Rita Carter has assembled what is known about the nerve centre of each individual and explains with the aid of images and graphics its structure, function and disorders.

A complex interplay of genes, culture and upbringing contribute to people's belief systems, which provide a framework for their experience. But certain aspects may directly reflect brain activity. Some scientists have suggested that supernatural experiences may be the result of disturbances in the brain.

The feelings of ecstasy that accompany them have been attributed to tiny seizures in the temporal lobes. Temporal lobe disturbance has also been associated with the sense of an invisible presence that people who claim to have seen ghosts often report. Out-of-the-body experiences have been linked to reduced activity in the parietal lobes, which normally maintain a stable sense of space and time.

Creativity

There is a striking difference in the brains of musicians who play from a score in front of them and those who improvise. Brain imaging studies have shown that the frontal lobes are activated when musicians are reading the notes but turn off in improvisation, allowing ideas to "float".

Research suggests that this reflects wider creative processes. When the brain relaxes out of sharp attentiveness, shown by tightly-compressed gamma waves on the EEG, into its "idling" mode, marked by slow alpha waves, that is when new ideas tend to occur. Stimuli that might otherwise be ignored are allowed to enter awareness and can resonate with thoughts, memories and existing knowledge.

Personality

Studies of the brain have raised the possibility that personality may be "visible" from the activity in different brain areas.

At the crudest level, a person with a "sensitive" brain - one that produces more activity in response to a mild stimulus - are less likely to indulge in sensation-seeking or adrenaline sports than those with "insensitive" brains, who need a lot of stimulation to produce the same level of excitement. Extroverts have reduced activity in response to stimuli in the neural circuit that keeps the brain aroused - involving the prefrontal cortex, anterior cingulate cortex and the thalamus.

People who like novelty have strong links between the hippocampus and the striatum while shy people show a strong reaction to unfriendly-looking faces in the amygdala. Optimism, cooperation and aggression can be traced to activity-specific brain areas.

—The Independent

Health Notes
Fantasy sports can improve test scores

Washington: Fantasy sports can help improve mathematics test scores in schools, says a University of Mississippi researcher.

To reach the conclusion, Kim Beason, associate professor of park and recreation management at UM, teamed up with Dan Flockhart, a former California middle school teacher who has written a series of mathematics textbooks.

The study showed that fantasy sports has increased math test scores, in areas ranging from algebraic formulas to fractions, by nearly 50 per cent among middle school students.

“This is huge,” Beason said. “Across the board, both boys’ and girls’ test scores are up dramatically.” — ANI

Lazy cancer survivors at increased diabetes risk

Washington: Childhood cancer survivors leading sedentary lifestyles are at an increased risk of developing diabetes and heart disease, say researchers.

Cancer treatments such as cranial radiation can damage the hypothalamus and pituitary; the result is an abnormal metabolism, which increases the risk of obesity and diabetes.

Moreover, chemotherapy with the drug anthracycline increases the risk of heart disease; and radiation to the body can cause blood vessels to become less pliant.

“Physical activity is a key step that survivors can take to reduce the health risk of these effects,” said Dr Kiri Ness, of the Epidemiology and Cancer Control Department at St. Jude. — ANI

Cervical cancer jab as deadly as the disease

London: A leading expert who helped develop the cervical cancer vaccine has claimed that the jab may be more deadly than the disease.

Dr Diane Harper, the University of Missouri-Kansas, warned the vaccine was being “over-marketed” and the information about its potential side-effects was not as popular.

The researcher, who was involved in the clinical trials of the controversial drug Cervarix, said though the risks, “small but real”, could be worse than the risk of developing cancer itself.

“All this jab will do is prevent girls getting some abnormalities associated with cervical cancer which can be treated. It will not decrease cervical cancer rates at all,” the Daily Express quoted her as saying. — ANI

Women’s fitness: Soccer better than running

Washington: Playing soccer can help women get in better shape than just running, say researchers.

Lead researcher and Associate Professor Peter Krustrup from University of Copenhagen said that many women find it difficult to fit in sport and exercise in their busy daily lives, and many give family and especially small children as the main reason for not finding the time.

The study showed that flexibility of running as exercise form actually makes running harder to stick to for most women than soccer, which requires a fixed time and place.

“What is really interesting is that the soccer players differed from the runners in their motivation,” said associate Professor Laila Ottesen. — ANI