Live a life of foreplay Lesley Stedmon
The doctor who wages
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Dr V Mohan, Chairman, DMDSC, Chennai
Tibetan Medicine Cosmic effect Distance and institutional deliveries in rural India
EDITOR’S NOTE Healing powers of Tibetan Medicine
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eople’s faith in medical systems may vary. While some people religiously follow modern medicine, some others embrace the traditional medicines like Ayurveda. Various forms of medicines bring effective cure for chronic diseases like cancer and diabetes. It is the faith in a medical system that works for patients, especially those who suffer serious diseases for a long time. Today, patients all over the world without reluctance use alternative medicine and their attempts prove to be successful in most cases. Alternative medicine like Ayurveda, Homeopathy and others are fast gaining inroads in so far unknown territories but Tibetan medical system is yet to come out of the closet. There is hardly any knowledge in the world medical community about the traditional medical practice in Tibet and its universal healing powers. Relevance of Tibetan Medicine needs to be brought out of its oblivion. This issue of Future Medicine analyses important aspects of Tibetan medical system.
14th Dalai Lama brought the Tibetan traditional medical system as an alternative medicine which becomes more significant because of its treatment methods in harmony with nature. According to the Tibetan medical practice, cosmic energy plays a vital role in the well being of people and unless one’s mind is not cleansed, perfect health and wellness cannot be attained. Dr. Dorjee Rapten Neshar, Chief Medical Officer at MenTsee-Khang (Tibetan Medical and Astrological Institute of His Holiness the Dalai Lama) in Bengaluru, elaborates the healing effect of Tibetan medical system. He says Tibetan medical system strongly advocates the dynamic inter relationship between our body, environment, disease and the treatment. Homeopathy as an alternative medicine is facing many challenges in India mainly due to the existence of different schools of thoughts and lack of unity among practicing Homeopaths. The article on the contributions of Dr. Sreevals G Menon, MD, who has stood forth, passionately seeking a worthy place for Homoeopathy in the field of ailment and palliative treatment, is worth deliberation.
In-depth analysis of Parkinson’s disease is one of the areas we are addressing. Dr. Karen E Anderson, Clinical Associate Professor of Psychiatry and Neurology at Maryland Parkinson’s Disease and Movement Disorders Center, US, talks about the symptoms and causes of Parkinson’s disease. Besides, there are articles on ‘Delay ageing process to look younger’ and 10 simple ways to create sexual pleasure in your daily life and help bring passion back to your life.
CONTENTS 18 22
44 60 12 46 50 38
Dr Dorjee Rapten Neshar, The Chief Medical Officer at Men-Tsee-Khang, talks about the healing effect of Tibetan Medical System
While recommending an appropriate diet,Tibetan physicians consider which types of food are harmful and which might be beneficial, the amount of food to be eaten...
Diabetic foot Dr Johny Kannampilly
Diabetes treatment Dr Jothydev Kesavadev, MD
Parkinsonâ€™s disease Dr Ramkumar Menon
Acute Stroke Dr M Pradeep
Mental Illness Lakshmi Santhosh
Immunity & Nutrition Gayathri Asokan
6 FUTURE MEDICINE I June 2013
Tibetan Medical System
Cosmic effect Tibetan medical practice is very much confined to the people of Tibet and the outside world has little knowledge of the prevalence of an effective medical system. Today, like any other alternative medicine, Tibetan holistic healing is also drawing attention of patients worldwide
Indian Hospital Focus
HCG, Bengaluru Known as South Asiaâ€™s largest cancer care network, Bengaluru-headquartered HCG has been recognised as the best place to work in healthcare sector
Live a life of foreplay!
Here are 10 simple ways to create sexual pleasure in your daily life and help bring passion back to your life
The doctor who wages a war on diabetes India, according to recent statistics, has 63 million people with diabetes. Dr V Mohan and Dr Mohan’s Diabetes Specialities Centre are in a drawn-out war on this ‘silent disease’
33 Disease Special Parkinson’s
Slight tremor in hands, an unusual stooping posture and a variety of abnormal body movements of a person above 50 years old are the obvious signs of the disease
Israel has become one of the world’s most successful countries in medical innovation over 65 years of its existence
Bringing a great sigh of relief to the families who are traumatised by their differently abled children, Dr Sr Mary Eassy came with her alternative medicine-the Jivadhara treatment
June 2013 I FUTURE MEDICINE 7
Mediterranean diet helps beat dementia: Study WASHINGTON: A study
conducted by the US Department of Health and Human Services funded by the National Institute of Neurological Disorders and Stroke, has found that a Mediterranean diet
packed with fish, olive oil, low on fatty dairy products and meat can reduce the risk of memory problems later in life.
But the beneficial effects of eating a diet rich in omega-3 fatty acids do not extend to people with diabetes, according to the research published in Neurology, the medical journal of the American Academy of Neurology. The findings, described as the largest study of its kind to date, were based on dietary information from 17,478 AfricanAmerican and Caucasian people with an average age of 64. In healthy people, those who regularly ate a Mediterranean-type diet were 19 per cent less likely to develop problems in their thinking and memory skills than people who did not eat that way. “Diet is an important modifiable activity that could help in preserving cognitive functioning in late life,” said Georgios Tsivgoulis, a doctor at the University of Alabama, Birmingham, and the University of Athens, Greece.
Seven golden rules help
people live longer
LONDON: A few simple changes to diet and lifestyle can protect you against a string of killer diseases and add years to your life, a landmark study has shown.
Following seven golden rules not only cut the risk of dying from cancer by 20 per cent, but slashed risks of lung disease by half and heart attacks by 44 per cent, the study of nearly 380,000 people by scientists at Imperial College London found. The rules were drawn up six years ago by the World Cancer Research Fund and American Institute for Cancer Research. Now, by studying patients across nine
Sir Ganga Ram Hospital gets Six Sigma accreditation NEW DELHI: The 750-bed
Sir Ganga Ram Hospital, Delhi, has been awarded top quality accreditation–six sigma. Sir Ganga Ram Hospital has achieved the unique distinction of being the first hospital in the country to have been granted the coveted Six Sigma accreditation for its quality of patient care and healthcare administration.
and WHO. Sir Ganga Ram Hospital is India’s first and the world’s 4th largest healthcare company in the quality medical education. The
The honour was accorded after due diligence as per the The hospital authorities with the Six scope and terms Sigma accredition and conditions of accreditation by Six Sigma Star hospital is led by its Chairman Healthcare in association with the Dr DS Rana, a world renowned Ministry of Science and Technology nephrologist. 8 FUTURE MEDICINE I June 2013
European countries, the British scientists have shown that they help people live longer and healthy. The seven rules are: be as lean as possible without becoming underweight, be physically active for at least 30 minutes every day, limit consumption of energydense foods - those high in fat or added sugar and low in fibre - and avoid sugary drinks, eat a variety of vegetables, fruit, whole grains and pulses such as beans as well as five portions of fruit and veg a day, try to eat whole grains with each meal,limit consumption of red meat such as beef, pork and lamb to 500g cooked weight a week and avoid processed meats such as ham, salami and bacon, limit alcoholic drinks to two for men and one for women a day and it is best for mothers to breast feed exclusively for up to six months.
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Conference on emergency medicine PARIS: International Conference on Emergency Medicine is scheduled to be held in Holiday Inn, Paris, from June 27 to 28. The conference aims to bring together leading scientists, researchers and scholars to share their experiences and research results on all aspects of emergency medicine, and discuss the challenges encountered and the solutions adopted. The keynote address will be given by Aya Maher, PhD, the German University in Cairo, Egypt. Full-length papers, short papers, posters and abstracts that address the themes and topics for the conference, including figures, tables and references of novel research material, have been invited.
Academy of Regional Anesthesia meet from June 7 PUNE: Third annual conference of Academy of Regional Anesthesia (AORA) 2013 will be organised for the regional anesthesia enthusiasts in Pune from June 7 to 9. The theme for the conference is “Basics to controversies -understanding regionals.” “Regional anesthesia is developing as an integral part of anesthesia and pain management. The scientific session and workshop will be of immense value for the practising anesthesiologists and also the budding anesthetists,” says Dr Sandeep Mutha, organising secretary of the conference. A pre-conference workshop will highlight the basic and advanced techniques and “make us understand the intricacies of regionals.” “The conference will include live cases, lectures by eminent speakers, innovative techniques, newer advances, debates etc,” adds Dr Sandeep Mutha. The website www.aoraindia2013.com will provide details of registration, scientific programmes and submission of abstracts.
ICMPH 2013 to be held from June 24 BANGKOK: International Conference on Medicine and Public Health (ICMPH) 2013 will be held from June 24 to 28 at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. It is co-sponsored by the Ministry of Public Health, Thailand. The theme of ICMPH is “Healthy society beyond frontiers”. The meet is to promote healthcare for all people in this region without the hindrance of international boundaries. ICMPH is an opportunity to participate in an educational and research forum that is focused on exploring and promoting the latest advances in medical sciences and public health issues. 10 FUTURE MEDICINE I June 2013
Earlier surgery brings
better outcomes considered early rather than late, due to the high likelihood of developing severe medication side-effects with long-term treatment, better outcomes with earlier surgery, and a higher chance of avoiding, delaying or minimising the economic and social side-effects associated with advanced Parkinson’s disease.
Prior to surgery an MRI of the Brain is done. The team providing the treatment consists of neuropsychologist, clinical psychologist, and movement disorder surgery neurologist.
arkinson’s disease is a condition which results from the loss of a substance called dopamine in the substantia nigra of the brain stem. The three main problems in Parkinson’s disease are usually tremor, stiffness (rigidity), and slowness of movement (akinesia). Parkinson’s disease is treated in the first instance with medications, such as levadopa. Unfortunately, the effectiveness of such medications may decrease over a number of years, and they may also cause other abnormal involuntary movements.
What are the reasons for surgery? When medications are no longer working well or their side-effects are severe, surgery may be of value. The procedures most commonly used to treat Parkinson’s disease are deep brain stimulation (DBS), thalamotomy, and pallidotomy. Clinical studies and experience suggest that surgery should be 12 FUTURE MEDICINE I June 2013
What is deep brain stimulation? Deep brain stimulation works by implanting fine wires (electrodes) into one of three sites in the brain that are important in Parkinson’s disease. These are the subthalamic nucleus (STN), the thalamus, and the pallidum. The STN is the most common structure targeted. Benefits of deep brain stimulation The aim of DBS is to relieve some of the problems caused by Parkinson’s disease, such as tremor, stiffness, slowness, and uncontrolled movements. It tends to reduce motor fluctuations and increases the amount of time spent “on”. It also allows most patients to reduce their medications, often by a substantial amount. Who may benefit from surgery? Surgery can significantly improve the quality of life for patients with Parkinson’s disease. However, these operations are not suitable for all patients and thorough assessments must be carried out to ensure that the
Dr Ramkumar Menon Consultant neurosurgeon
likely benefits of surgery outweigh the risks. How long will the benefits last? This will vary from patient to patient. Typically, patients obtain a benefit for five to eight years or longer. The benefit gradually decreases with time (Due to progression of the underlying disease). A small proportion of patients may benefit from repeat surgery if the benefits drop off. Things to take care after discharge Routine light work should be performed for six to eight weeks. The patient will be reviewed after several weeks by the neurologist and neurosurgeon. The patient should not drive a motor vehicle or operate heavy machinery until permitted by the neurologist. If the patient has had deep brain stimulation, then precautionary information is given to the patient, such as avoidance of metal detectors at airports.
What should you notify your doctor of after surgery? • Increasing headache • Fever • Swelling or infection of the wounds • Leakage of fluid from the wound • Fitting (seizures) • Abnormal sensations or movements in your face, arms or legs • Weakness or numbness • Drowsiness • Any other concerns
(Dr Ram Kumar Menon, MS, DNB, MCh, has settled down in Thrissur, Kerala, where he works with Elite Mission Hospital and Care Well Clinical Centre as a consultant neurosurgeon)
SPECIAL COVERAGE World Diabetes Congress 2013
‘Reverse the diabetes mortality clock’
Inauguration of 5th World Congress of Diabetes KOCHI: A four-day world diabetes congress was
held by Diabetes India at Hotel Le Meridian’s convention centre in Kochi recently. Michael Hirst, President of International Diabetes Federation, inaugurated the congress. He said that campaigns on all fronts have to start now for the betterment of people with diabetes and to reverse the diabetes mortality clock.
The diabetes clock is ticking at the rate of one death and two new entrants every eight seconds and the objective of the world congress is to thereby stop the mortality clock and prevent the epidemic spread, said Dr SM Sadikot, President of Diabetes India. Referring to the present scenario and concerns in diabetes in India, a country where contrasting population of under-nutrition and over-nutrition coexists, Jean Claude Mbanyn, former president, International Diabetes Federation, said that the congress has to focus on building a society where diabetes prone environment does not exist so that the baton is not passed on to next generation. More research and studies have to be immediately started and the results should reach the patients, he said. Dr SR Aravind, Dr Anand Nigam, Dr Johny Kannampilly, and Dr Jyothidev Keshavdev spoke at the congress. 14 FUTURE MEDICINE I June 2013
Dr Sadikot underscored the importance of slowing the ticking of the clock i.e. one death every eight seconds and two newly diagnosed cases of diabetes every eight seconds. Dr Banshi Saboo, an endocrine physician from Ahmedabad, was the organising chairman of the convention, which was attended by over 4,000 national and foreign physicians and diabetes educators.
Dr Jothydev Kesavadev, the organising secretary of the world congress and the moderator of the glucose monitoring consensus guideline, stated that the lack of insurance and reimbursement policies for the majority in India has prompted the significance of formulating India specific guidelines for glucose monitoring.
The inauguration was marked by the Diabetes India’s declaration of metabolic syndrome as the biggest epidemic in human history with a clarion call for its prevention. In the four-day world congress, more than 3,000 national and international medical experts, scientists and researchers talked about the decisive action plans to reverse the diabetes mortality clock. A wide range of topics touching diabetes, its monitoring, awareness, management, treatment, control and nutrition were also discussed.
At the forefront of
medical innovation I
The Emergency Bandage
By Dipin Damodharan
srael has just celebrated its 65th birthday with a sense of pride and patriotism, and obviously, at the forefront of innovation. The Jewish state has become one of the world’s most successful countries in medical innovation over 65 years of its existence. Many describe Israel as the leader when it comes to competence in the medical profession. According to World Health Organisation, Israel is above most of the other Organization for Economic Cooperation and Development (OECD) countries in medical innovation. From Emergency Bandage to PillCam to ReWalk robotic exoskeleton, the Jews have been the poster boys of innovations in the medical sector for over several years. Here, Future Medicine looks at some of the key medical innovations of this powerful nation.
The Emergency Bandage: The American soldiers call it ‘Israeli bandage’. First used for saving lives during a NATO peacekeeping operation in Bosnia and Herzegovina, the ‘Israeli bandage’ is a first-aid device used to stop bleeding from hemorrhagic wounds caused by traumatic injuries in pre-hospital emergency situations. Invented by Bernard Bar-Natan, the Emergency Bandage is manufactured by First Care Products in Lod, Israel. PillCam: PillCam permits a video
ReWalk robotic exoskeleton
recording of the internal organs. Better describe it as a digestible camera pill that provides a video of the gastrointestinal tract. The PillCam ESO video capsule allows
doctors to view the inner lining of the esophagus. The capsule has miniature cameras are on both ends. The PillCam was invented by Gavriel Iddan, an electro-optical engineer.
MR guided Focused Ultrasound Surgery (MRgFUS): This technology combines a high intensity focused ultrasound beam that heats and destroys targeted tissue, non-invasively and Magnetic Resonance Imaging system (MRI) which visualises patient anatomy, and controls the treatment by continuously monitoring the tissue effect.
ReWalk robotic exoskeleton:
ReWalk is a commercial bionic walking assistance system, utilising powered leg attachments to enable paraplegics to stand upright, walk, and climb stairs. The system is powered by a backpack battery, and is controlled by a simple wristmounted remote which detects and enhances the user’s movements. ReWalk robotic exoskeleton enables paraplegics to walk.
Babysense device: It helps prevent crib deaths and of a robot that performs spine surgery
Non-invasive medical device to help to treat Alzheimer’s disease:
Neuronix developed this medical device to help to treat Alzheimer’s disease. It combines electromagnetic stimulation with computer-based cognitive training, is already approved for use in Europe, Israel and several Asian countries. The device has a chair containing an electronic system and software in the back and a coil placed at the head.
Tibetan Medical System
Cosmic effect Tibetan medical practice is very much confined to the people of Tibet and the outside world has little knowledge of the prevalence of an effective medical system there though it has undermined for various reasons. It was the 14th Dalai Lama who re-established the traditional medical system as an alternative medicine. Today, like any other alternative medicine, the Tibetan holistic healing is also drawing attention of patients worldwide to its treatment methods in harmony with nature. According to the Tibetan medical practice, cosmic energy plays a vital role in the well-being of people and unless your mind is not cleansed, you cannot attain and enjoy perfect health
Tolerance is not an easy word nowadays. You need extraordinary qualities to overcome the trials and tribulations of life. This journey is spiritual and at the same time is material, but it gives you eternal bliss at the end. If you have a Guru or a teacher to guide you, things will be easier. The Guru must have gone through all these or deals it with tolerance. In short, he must be as deep as an ocean. The 14th Dalai Lama is one such Guru, a spiritual leader of a community that has gone through all sorts of difficulties. His life itself is a spiritual journey through this temporal world, but he survived all these mundane things By Sumithra Sathyan
n order to preserve and promote Tibetan Medical System or SowaRig pa, the science of healing, the unique tradition, The 14th Dalai Lama re-established Tibetan Medical and Astrological Institute better known as Men-Tsee-Khang in Dharamshala (India) in 1961. The Institute now has over 40 branches all over India and Nepal serving the local health needs. There are societies for Tibetan Medicine abroad where the doctors pay periodical visit for conducting classes and consultation. Future Medicine introduces His Holiness the Dalai Lamaâ€™s Tibetan Medical System as an Alternative Medicine for mental and physical wellness. Dr Dorjee Rapten Neshar is the Chief Medical Officer at MenTsee-Khang (Tibetan Medical and Astrological Institute of His Holiness the Dalai Lama) in Bengaluru. He was trained in medico-spiritual initiations for the more esoteric practice of Tibetan Medicine as well. In recognition of his outstanding contribution in the field of a Alternative medicine, Dr Dorjee was awarded the Gold Medal and Gem of Alternative Medicine in 1995 and 1996 by the Indian Board of Alternative Medicine, Calcutta. He has also received the International Award of Excellence from the American Organisation of Intellectuals Inc, New
sea-buckthorn- bush 20 FUTURE MEDICINE I June 2013
York, US. Dr Dorjee in pulse diagnosis In
an exclusive interview, Dr Dorjee talks about the healing effect of Tibetan medical system
Tell us about the Tibetan Medical System and how it differentiates from other medical systems?
The fundamental concept of Tibetan Medical System revolves around the theory of five cosmophysical elements and three humoral energies (Nes-pa), the balance and imbalance of which attributes to health and disease respectively. The food and lifestyle, seasonal factors and mental conditions are considered to be four causative factors responsible for the manifestation of Nes-painto disease. Based on the Buddhist concept of
mind and body relationship, Tibetan medicine recognises Marigpa, the ignorance as the root cause of all the suffering. Ignorance literally means not knowing the existence of the Self because of which one suffers from three inborn mental poisons like lust or desire, hatred or anger, delusion or confusion all of which gives rise to various forms of imbalance in our body system which can be grouped under rLung, mKrsipa and Badkan. Therefore, unless we study and purify our mind from its black clouds of negative mental afflictions, we cannot enjoy the clear blue sky of perfect health. Tibetan medicine strongly advocates the dynamic
interrelationship between our body, environment, disease and the treatment. All of them are made up of same basic element of nature known as five cosmophysical elements: earth, water, fire, air and space, which form our life sustaining energies. And particularly, our body (Micro-cosmic) enjoys very close and dynamic relationship with our external environment (Macrocosmic), the balance of which directly affects our life and existence. Therefore, the environmental pollution and its related health hazards were clearly mentioned in the centuries old medical text. And, the message here is that if we want to enjoy good health and happiness, we should first respect and keep our environment healthy and unexploited.
The medicines used are chiefly natural herbs. Besides, some precious and semi-precious stones, salts, minerals and some animal extracts are also being used. The therapeutic effect of medicines is mainly determined by their inherent taste, potency and qualities. They are combined in keeping with their taste and potency so as to ensure total quality health of the patient without any unwelcome side-effects. Besides the medicines, many accessory therapies are used as part of patient care and pain management, relaxation, and palliative care.
How is a disease diagnosed in Tibetan Medicine?
The diagnosis of a disease is carried mainly through interrogation, visual examination and palpation. Visual examination involves study of the five sensory organs, stool and urine. Palpation involves examination of the body organs, energy meridians, and pulse of the patient. Most significantly, the pulse and urine analysis forms the most distinctive and important part of Tibetan diagnostic methods. One of the unique features of the Tibetan medicine is its close relationship with the Tibetan astronomical and astrological aspect. The changing season and its effect on our body can be best explained through the astrological calculations. Tibetan doctors also consider a wide range of astrological calculations during the collection and preparation of the medicines. Astrological calculations are also made before giving some minor surgeries and accessory therapies to ascertain the exact location of life force energy so that our vital life force energy in the quantum field is not disturbed which otherwise, could prove very costly for the patient. Seven extraordinary pulse information are established through the complex inter-relationship between Mother Son and Friend Foe calculations. The knowledge of interdependent relationship between each season, the six cosmic elements, body organs, pulse characteristics, and their relation to disease and treatment regimens are quite distinctive features of Tibetan Medicine.
Please explain the treatment system?
Tibetan Medicine considers the right approach to the patient and treatment as a very important factor rather than the treatment itself. The doctor-patient
Medicine Buddha June 2013 I FUTURE MEDICINE 21
relationship is considered to be the gateway of the successful healing. Doctors are viewed as medicine Buddha with infinite compassion and dedication to patient care; his instructions as Buddhaâ€™s own teaching with unmistakable truth and rewarding, and medicines as deathless nectar revitalising and life-giving. Doctors too view their patients as precious human being who should be treated with the devotion given to his or her beloved mother. The ethics of Tibetan Medicine and its physicians are interspersed with the teachings of Buddha Dharma to its highest practical level. The ultimate aim of Tibetan medicine is to provide the evergreen tree of our body system with the two blossoming flowers of health and longevity bearing three fruits of spirituality, prosperity and happiness.
What is Tibetan Medicine most effective for?
In addition to many common ailments, Tibetan Medicine also offers very effective treatment in controlling and even curing major diseases like asthma, arthritis, diabetes, hypertension, sinusitis, eczema, anxiety, general cardio-vascular, liver and kidney related-problems, nervous disorders, gynecological problems, gastro-intestinal disorders, chronic cold and allergic problems, psychosomatic problems,
heart-related issues, etc. The medicines also help in controlling primary cancer cases.
The best way to take â€˜precious pillsâ€™?
Soak the pills in a half cup of hot water and leave them for 30 minutes. You can remove the pills with a spoon, put the pills in your mouth and drink the remaining water.
Are there any side-effects for Tibetan Medicine?
Tibetan Medicine uses purely natural herbal recipe that goes down to treat the root of the problem. These medicines are very safe as they are prepared without adulteration and known to have no side-effects.Tibetan medicine formula is very balanced. For example, the formula sPos10, is one of the medicines we use to treat arthritis but it also has in its ingredients Saussurealappa which is for the stomach and Adhatodavasica which is to regulate blood pressure.
What about healing?
The natural herbal remedies are available in various forms to suit the disease condition. The understanding and administration of proper diet and lifestyle changes forms a crucial part of the disease management and optimum healing process. Besides, various forms of accessory or complementary
Dr Dorjee (Middle) with his colleagues
22 FUTURE MEDICINE I June 2013
therapies are given as part of pain and disease management, relaxation and rejuvenation. Although Tibetan medicine treats almost all the common and major diseases, it is found particularly effective in treating many chronic diseases like allergic asthma, arthritis, diabetesmellitus, heart and cardiovascular problems, gastrointestinal and colic problems, nervous diseases, various skin diseases, thyroid and psychosomatic problems etc.
It is said that Tibetan Medicine is very effective in cancer treatment. Your comment?
Cancer is known as Dres in Tibetan Medical System. The name Dres was given following its resemblance to the shape of a fruit: like a coconut or like a solid mass of outgrowth from the internodes of big tree branches. The 63rd chapter “Oral transmission Tantra” of the 4 Great Tantra, the classical Tibetan medical text, explains in some details about this dreadful disease.
Tibetan medicine formulas
Aweto - herb used for Tibetan medicine
In order to restore the balance, to improve the immune mechanism, and for the healing to take place, herbal formulations in the form of pills and decoction should be given orally. Since the nature of tumour is solid hard, hot medicine bath, or an external application should be employed to dissolve the tumour.To flush out the dissolved cancerous cells or tissues from the body channels, vene–cleansing is strongly advised with the help of experienced practitioner.To reduce the pace of infection and inflammation, and to curb the speed of progression of cancerous cells, vene-section is frequently advised with the expert’s help.To slow down or stop the pathways of proliferation or angio-genesis, moxabustion(A traditional Chinese medicine therapy using moxa made from dried mugwort) is used. It plays an important role in the traditional medical systems of China (Including Tibet), Japan, Korea, Vietnam, and Mongolia. Enlightened Lamas and the respected Sangha community are also being consulted for the following reasons: 1. To counteract the harmful spirits that sometimes get total hold over the whole disease process and its treatment response 2. To minimise one’s bad Karmic effects, and to remove any hidden obstacles to the treatment response 3. To uplift patient’s aura and positive spirit
What is the legal status of the Tibetan Medical Centre?
Mullein - herb used for Tibetan medicine
Men-Tsee-Khang is a charitable, cultural and educational institution of His Holiness the 14th Dalai Lama, registered under the Indian Societies Registration Act of 1860 (No: 1290/79). It has exemption under section 80G of the Income Tax Act 1961 (No.CIT/PTA/1 & 93-94/80-G/1813). The institution is registered under section 12A (a) of the Indian Income Tax Act 1961. June 2013 I FUTURE MEDICINE 23
Friends of Tibet
A foundation for
ethu Das, a fine arts graduate from The Maharaja Sayajirao University of Baroda,accidentally reached Dharamshala, the seat of the Tibetan Government-in-exile. There he was moved by the stories of Chinese atrocities in Tibet against the Tibetan political prisoners. He founded the Friends of Tibet (India) in 1999 with one member, an organisation he never registered officially till now. Now, Friends of Tibet (www. friendsoftibet.org) has several chapters in India and abroad. Sethu Das is also the Executive Director of World Tibet Day and one of the founding members of Friends of Tibet Foundation for the Wellbeing. Around 50 years back, His Holiness the 14th Dalai Lama founded a medical university at Dharamashala in Himachal Pradesh where Tibetan students undergo a rigorous five-year integrative medical course. Friends of Tibet Foundation for the Wellbeing aims at the restoration, propagation and promotion of the endangered traditions and practices of the Tibetan Medical System.It is totally a volunteer service among the members of the Friends of Tibet.
“Healthy relationships are a result of love and compassion. A compassionate doctor is much worthier than a dose of medicine he gives. The number of medical camps could be outdone by one caring medical practitioner. This limitless love and compassion comes to man from the Cosmos which is full of Universal Energy that attracts man to the centre of happiness. Therefore, any healing is a total inclusion of man and his natural environment and that helps man to experience the joy of good life. It is this ‘togetherness’ that becomes the truth of life. The Friends of Tibet and Wellbeing does not believe in collecting and accumulating funds for its future activities—yet another self-imposed Buddhist discipline,” says Sethu Das. The 29th edition of the Wellbeing Tibetan Health Camp was jointly organised by the Friends
24 FUTURE MEDICINE I June 2013
Sethu Das, Founder, Friends of Tibet of Tibet and Men-Tsee-Khang, the Tibetan Medical and Astrological Institute of His Holiness the 14 th Dalai Lama, from May 8 to 11 at Ashirbhavan in Kochi. A number of patients attended the camp and found relief for their ailments. Sincere efforts by the Wellbeing volunteers, excellent care from the doctors and the healthgiving atmosphere helped them bring back smiles on their faces. Anyway, Tibetan Medicine has got some magic that energises even the gloomiest patients. There was Buddhist morning prayers before
consultations actually began by doctors whose unconditional love, humility and empathy boost the morale of the patients there.
Quiet happy with the relief from their severe ailments, the participants now eager to know more about Tibetan Medicine and healing practices. They even ask about pulse diagnosis, holistic medicine etc.
Healing power of Tibetan Medicine
The Tibetan race as a whole is deeply attached to prayer. The Wellbeing camp organised by MenTsee-Khang and Friends of Tibet in Kochi in the past three years is also not different. Each day at the camp begins with the chanting of the mantra of the Medicine Buddha. Bhaiajyaguruvaiduryaprabharaja (‘Medicine Master and King of Lapis Lazuli Light’) is the Buddha of healing and medicine in Mahayana Buddhism. “Medicine Buddha”, is described as a doctor who cures suffering using the medicine of his teachings. The prayer if chanted daily will provide calmness to the mind and the heart. The Tibetan Medicine in its fullness is not just dependent on medication. It is deeply dependent on the religion. Ideas like astrology and lucky charms which are considered as irrelevant by the modern medicine and modern sciences are considered important by the Tibetan medical practitioners.
“Your sickness/unhappiness is not only a product of your workings in this world but it is linked to one’s activities in other births also. What is the modern science’s answer to such miseries? Nothing they consider it as just ridiculous. But such things do influence you. Even the most atheistic persons will certainly agree with the ups and downs of one’s life which cannot be answered using our common logic. This is a true in the case with almost all persons.
Healthy relationships are a result of love and compassion. A compassionate doctor is much worthier than a dose of medicine he gives. The number of medical camps could be outdone by one caring medical practitioner Such a riddle’s answer is nothing but prayer in all theistic designs. Certain communities offer a number of religious rituals to cleanse one’s self,” Appu John, another volunteer of Friends of Tibet, says .
The Tibetan community also offers the same but not basically through priests but through doctors. Hence in Tibet, healing is a process deeply associated with prayers. You pray so that your heart is cleansed; you wear the amulets so your prayers are reassured in these physical forms. The prayers are answered as you progress in your prayer full life.
Friends of Tibet Wellbeing Camp June 2013 I FUTURE MEDICINE 25
Tibetan herbal healthcare products
lyrical and fluent speech production
Tsephel Dhutse- Boost the life span
Tobmean Chudue Gyatso-Health Tonic
Sorig health tonic is formulated from pure natural herbs in accordance with Tibetan medical text. It may help to optimise physical vigour, vitality and sensory organs, relieves chronic fatigue syndrome. It may act as an aphrodisiac, especially effective in maintaining kidney heat.
Gaay-Pa-Sowae Chulen- Elixir of Rejuvenation
It prolongs life span, is effective in retaining youthful appearance and lustre, increases vigour, triggers the sensitivity of sensory organs like eyes, improves memory and intelligence power. It is especially effective as an Aphrodisiac.
Chongchen Chulen- Energise the body
Energise the body Chongchen chulen (vital nourishment) is formulated according to Tibetan medical texts. This Chulen may be effective for the weak body caused due to longtime exposure to illness, breathing problems, dizziness, hiccough, anorexia, and pulmonary associated disorder. It is especially helpful to regain vital health. Prolonged intake may benefits to promote sexual power.
Lhophel Dhutse- Sharpens intelligence
Lhophel Dhutse (Wisdom nectar) is prepared with a combination of pure herbal ingredients based on the traditional Tibetan medical text. It may help to nourish, improves intelligence and memory power of children. It also promotes
26 FUTURE MEDICINE I June 2013
Tsephel Dhutse (Elixir of life) is formulated according to Tibetan medical text. It assists to boost body energies and prolongs the life span. It is also effective in strengthening the immune system.
Kaem-Meen-Dashun- For Slimness
Natural herbs that can effectively help to enhance slimness and may reduce body weight. Helps to prevent breathing difficulties, excessive mucus, fatigue, balances blood sugar level, and liver dysfunction, regenerates blood cells, and promotes blood circulation and reduces swelling of glands.
This Chilli powder is formulated from pure natural herbs according to Tibetan medical text. It is especially effective to restore digestive heat, acts as an anthelmintic, enhances the food taste and improves appetite. It contains chilli, horse mint, caraway, black pepper, dracocephyllum tanguticum, chives etc.
People all over the world have a wide variety of diets, lifestyles and ways of thinking. In Tibet, the centuries old wisdom has helped to create a blend of spices that can be used in food to help digestion and cleanse the system. Herbal spices promote digestion, increase circulation. Helps promote a healthy mind and body. Cardamom maintains a healthy digestive system and helps stomach irritation whilst ensuring a healthy liver and spleen. This can be used to bring out flavour of salads, all meals and also helps promote a healthy appetite.
Delay ageing process
younger Ageing is a natural process and it takes a toll on all beings, but we can delay the process or even reverse it to an extent taking extra care of our skin which shows the first sign of ageing
Dr Divya Ramkumar Dermatologist & Cosmetologist
geing is a continuous and inevitable process which is genetically controlled. It is a result of various intrinsic and extrinsic factors like UV radiation, chemical pollutants and irritants, gravity, poor nutrition, stress and lifestyle (e.g. smoking). The skin appears aged because of dryness, deepening of expression lines and wrinkles, loss of elasticity and irregular pigmentation. Anti-ageing is the field of medicine that focuses on slowing and /or reversing the ageing process to improve the quality of life. It includes lifestyle modification, use of nutritional supplements and dermatological treatments. How you take care of your skin, what products you use and how you use them are also a large part of looking young.
Ageing can change skin’s appearance as early as your 30th birthday or by later in midlife, depending on your habits. You can’t control certain factors, like falling estrogen levels that lead to sagging skin or the genetics that give you a particular bone structure. But there are also plenty of external influences on how your skin gets damaged and the right anti-aging care can help blunt skin damage.
Some tips for healthy and younger looking skin •
Wear sunscreen daily. The sun never takes a break from exposing you to ultraviolet light and clouds are not total UV blockers. These rays accelerate signs of ageing. Sun damages elastin and causes a loss of collagen, which translates to drooping, a lost jaw line, and wrinkles. It also adds discoloration and roughens texture. Use a sunscreen that offers broad-spectrum protection (UVA and UVB) and has an SPF of at least 30. Be sure to apply sunscreen to all skin that is not covered by clothing and reapply often. If you tend to forget sunscreen, try the newer makeup bases and moisturisers with UV-protection built in. On the downside, you might not get the optimum amount of SPF, but the plus for many women is that at least they remember some protection every day -- which is better than going without.
When people first see signs of ageing (Fine lines, brown marks, smile lines and crow’s feet), they become conscious about anti-ageing care. The good news is that it’s never too late to respond to what you see. 28 FUTURE MEDICINE I June 2013
• • •
• • •
Topical retinoid, alpha hydroxyl acids and oral and topical antioxidants like vitamin A, C, E have potent anti-ageing effects. Green tea, coffee berry and turmeric are other substances being used. Biological modulators like aloe vera, tea extracts, soy, and ginseng are other products being tried. Effective exfoliation by chemical peels, especially medium depth and deep peels (Glycolic, TCA, Pyruvic, Phenol etc) reverses sun damaged skin by literally peeling away sun-induced pigment and fine lines, as well as boosting natural collagen production. Microdermabrasion is performed with a jet of fine crystals that are propelled and then vacuumed across the skin’s surface to remove dead and damaged cells. Botox (botulinium toxin) is a popular nonsurgical injection that temporarily reduces or eliminates frown lines, forehead creases, crow’s feet near the eyes and thick bands in the neck. It reduces dynamic wrinkles and overactive facial expression and has an action for about six to nine months. Non-ablative radio frequency and thermage activates your skin’s cells to produce new collagen and elastin and tightens the skin. Intense pulsed light and dermal rollers are also being used for skin rejuvenation. Wear UV-protective clothing. A host of new apparel blocks UV rays, making these clothes especially good for outdoor exercise. Try to avoid mid-day sun and use umbrellas whenever necessary. Moisturising traps water in the skin which can help reduce the appearance of some fine lines and improve your complexion. Use soaps sparingly or switch to a milder soap to reduce dryness. Stop using products that sting or burn unless prescribed by a doctor. Irritating the skin makes signs of ageing more visible The skin is the body’s largest organ, after all. So diet directly affects how you visibly age. Take plenty of fruits and vegetables and also enough of protein and iron. Eat plenty of omega-3 and omega-6 fatty acids. Ideally, they should come from natural sources, including olive oil, ground flaxseed, and fish such as salmon. Drink water -- in all its forms -- all day long. Count green tea and coffee in your daily total. Try to limit alcohol as much as possible. Cut way back on processed foods and sugars and of course smoking! Try to make exercise a part of your daily routine and get adequate sleep. June 2013 I FUTURE MEDICINE 29
institutional deliveries in
rural India India has the highest rate of maternal deaths in the world. A major cause is that a significant proportion of women continue to deliver babies at home without the presence of a skilled attendant. This column says that distance to health facilities is a key barrier to seeking delivery care at a facility By Emily Dansereau, Santosh Kumar, Christopher Murray
ne-fifth of the 287,000 maternal deaths worldwide in 2010 occurred in India (WHO 2012). India is very likely to miss the Millennium Development Goal (MDG) for maternal mortality. The current Maternal Mortality Ratio (MMR) in India is 212, whereas the countryâ€™s target in this respect, as per the MDGs, is 109 by 2015.
Institutional deliveries or facility-based births are often promoted for reducing maternal and neo-natal mortality. Yet, many women in low and middle income countries, including India, continue to deliver babies at home without the presence of a skilled attendant. About a half of all births in India in 2007-2008 occurred at home without skilled attendance (District Level Household Survey (DLHS-3)). Institutional deliveries 30 FUTURE MEDICINE I June 2013
in India range from about 35 per cent in Chattisgarh to 76 per cent in Madhya Pradesh. Of the 284 districts in nine high-focus states which accounts for 62 per cent of maternal deaths in the country, institutional delivery is less than 60 per cent in 170 districts (Annual Health Survey (AHS) 2011).
Besides reducing maternal and neo-natal mortality, institutional deliveries are also believed to improve health-seeking behaviour and practices in the period following childbirth. Children born at a health facility are more likely to be vaccinated and breastfed (Odiit and Amuge 2003). Properly vaccinated and adequately breastfed children are less likely to be malnourished and have better health. Additionally, poor childhood health can have an adverse effect on educational
attainment as well as on adult work productivity, and can hence affect adult earnings (Bleakley 2010). Therefore, institutional delivery can also be thought as an investment in human capital and can play an important contributory role in the development process of the economy.
Barriers to visiting a health facility
Women face various barriers to visiting a health facility to seek delivery care. These include cost of care, access to clinics, cultural factors, quality of care, and a lack of health awareness.
To relax the financial barrier, the Government of India launched Janani Suraksha Yojana (JSY) in 2005. JSY is a conditional cash transfer programme that provides a cash incentive to women who give birth at public health
facilities. Rural women receive Rs. 1400 ($28 approx.) and urban women receive Rs. 1000 ($20 approx.,) upon delivery at a public health facility. All services provided at the public health facility are free of charge.
The success of JSY has been mixed so far - the percentage of mother availing financial assistance ranges from less than 15 per cent in Jharkhand to about 60 per cent in Odisha (AHS 2011).
Too far to travel
Physical access is an important barrier as longer distances entail higher transportation and opportunity costs. Distance to health services exerts a dual influence on use - it is a disincentive to seeking care in the first place, and also an actual obstacle to reaching care after a decision has been made to seek it (Thaddeus 1994). The adverse effect of distance is stronger when combined with lack of transport, poor roads, and poor quality of care. In a recent study, we attempt to unravel the causal effect of distance to health facilities on institutional delivery in rural India (Kumar et al 2013). It is very important to understand the effect of the access barrier as it greatly depends on contextual factors.
For instance, distance may become irrelevant in a setting with highquality health facilities and transport infrastructures. Some studies have shown that households are keen to travel longer distances for high-quality care (Collier et al 2002).
Analysing the distance barrier
Using DLHS-3, a nationally representative household dataset, we find that distance to health facility is a significant barrier and adversely affects the number of institutional deliveries in India. For a 1 km increase in the distance to health facility, there is a reduction of about four per cent in the chances of opting for an institutional delivery. At the average distance of 9 km from a Primary Health Centre (PHC), there is a 64 per cent chance of opting for institutional delivery. Additionally, the study finds that women who live 5-9 km away from the nearest health facility are 13 per cent less likely to opt for institutional delivery as compared to women that live 0-5 km away from the nearest health facility. When the distance increases to more than 9 km, the chances of institutional delivery are reduced by 30 per cent (as compared to a distance of up to 5 km). Based on a
thought experiment conducted as part of the study, we find that if additional facilities are built such that the maximum distance of a health facility is restricted to 5 km, institutional deliveries will rise significantly. We also find that women living in households that own cars or other motorised vehicles are more likely to deliver in health facilities. Poor road connectivity also deters women from visiting a health facility for delivery care.
What should be done?
Our findings indicate that in countries such as India, where distances to health facilities are quite large in rural areas, geographical access to health care is a significant barrier to institutional delivery. An increase in the density of health facilities and providers in rural areas is likely to greatly help improve maternal and neo-natal care. A comprehensive cost-effective analysis should be undertaken to demonstrate that the benefits would outweigh the cost of building new facilities. In addition, it is important to improve road and transport infrastructure to reduce inequity in access to health facilities, and thereby, increase institutional deliveries.
About the authors Emily Dansereau: Emily
is a Post Bachelor Fellow at the Institute for Health Metrics and Evaluation, and an MPH candidate at the University of Washington. Her research interests lie in health systems, with a focus on costs, access and inequalities. In particular, she is interested in the intersection of supply and demand side barriers to quality care. She previously worked implementing public health programs in Haiti, and holds a BA from Stanford University.
Santosh Kumar: Santosh is
a Lecturer of Global Health Economics at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. An applied micro-economist by training, Dr. Kumar is part of the Impact Evaluations and Health Service Delivery Constraints research teams, where he identifies the supply-side and demandside barriers to effective healthcare in developing countries. His research interests are in development and health economics. Before joining the faculty at IHME, Dr. Kumar was a David E. Bell post-doctoral research fellow at the Harvard Center for Population and Development Studies.
Christopher J.L. Murray:
Christopher is a Professor of Global Health at the University of Washington and Institute Director of the Institute for Health Metrics and Evaluation (IHME). A physician and health economist, his work has led to the development of a range of new methods and empirical studies to strengthen the basis for population health measurement, measure the performance of public health and medical care systems, and assess the cost effectiveness of health technologies.
(By arrangements with www.ideasforindia.in) 32 FUTURE MEDICINE I June 2013
PARKINSON’S James Parkinson (1755-1824) - an English apothecary surgeon, political activist,
paleontologist and geologist, wrote An Essay on the Shaking Palsy in 1817. In that work, he is thought to be the first to describe ‘paralysis agitans’ (Shaking palsy), a condition which Jean-Martin Charcot renamed Parkinson’s disease 60 years later
DISEASE SPECIAL Parkinson’s Disease
A malady that
sets in with
old age Slight tremor in hands, an unusual stooping posture and a variety of abnormal body movements of a person above 50 years old are the obvious signs of a disease called Parkinson’s. Nervous system disorder is found to be the cause of unusual limb movement and body posture, and expressionless face of a person with Parkinson’s. Men are more vulnerable to the disease. In many case, life becomes miserable as they are unable to carry out daily routines independently In an interview with Future Medicine, Dr Karen E Anderson, Clinical Associate Professor of Psychiatry and Neurology at Maryland Parkinson’s Disease and Movement Disorders Center, US,talks about the symptoms and causes of Parkinson’s disease
34 FUTURE MEDICINE I June 2013
By Sumithra Sathyan How can we diagnose Parkinson’s disease?
Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, muscle control, and balance of the body. Parkinson’s disease is a group of conditions called motor system disorders, which are associated with the loss of dopamine-producing brain cells. These dopamine-associated motor disorders are referred as Parkinsonism. Movement problems are the main symptoms of Parkinson’s which include tremor or trembling of arms, jaw, and head and impaired balance and coordination. Symptoms often start with tremor which may occur in the following ways: Tremors may first be only occasional, starting in one finger. It is often rhythmic, four to five cycles per second, and frequently causes an action of the thumb and fingers known as pill rolling. It may occur when the limb is at rest or when it is held up in a stiff unsupported position. They usually disappear briefly during movement and do not occur during sleep. Tremors can also eventually occur in the head, lips, tongue, and feet. Symptoms can occur on one or both sides of the body. About a quarter of patients with Parkinson’s do not develop tremor.
7-10 million living with PD According to The Parkinson’s Disease Foundation of America, as many as one million Americans live with Parkinson’s disease. Each year, approximately 60,000 Americans are diagnosed with Parkinson’s disease. That is 1 in 272 people have the disease. This number does not reflect thousands of cases that go undetected. However, it is also estimated that 1.10 per cent of the US population, or 1 in 90 people, have the disease and do not yet know it. An estimated 7 to 10 million people worldwide are living with Parkinson’s disease.
Fifteen per cent of those between the ages of 60 and 74 have been diagnosed with Parkinson’s disease. Between the ages of 75 and 84, the percentage rises to almost 30. The onset of the disease is generally around the age of 58. Symptoms usually begin in the upper extremities, and are usually unilateral (one-sided) or asymmetrical at the onset. It appears to affect whites more than African Americans or Asians. An estimated four percent of people with PD are diagnosed before the age of 50. Men are one and a half times more likely to have Parkinson’s than women.
June 2013 I FUTURE MEDICINE 35
DISEASE SPECIAL Parkinson’s Disease
Motion and motor impairment: A number of PD symptoms involve motor impairment caused by the abnormalities in the brain. Slowness of motion, particularly when initiating any movement (A condition called Akinesia or Bradykinesia), is one of the classic symptoms of Parkinson’s disease.
Patients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady. After a number of years, muscles may freeze up or stall, usually when a patient is making a turn or passing through narrow spaces, such as a doorway. Patient’s posture can be unstable and there is an increased risk for falls. The ability to swallow, digest and eliminate may slow down, causing eating problems and constipation. Muscles may become rigid. This symptom often begins in the legs and neck. Muscle rigidity in the face can produce a masklike, staring appearance. Motor abnormalities that limit action in the hand may develop in late stages. Handwriting, for instance, often becomes small. Depression and anxiety are common in patients. Dementia or confusion can develop in the later stages of Parkinson’s disease. Some patients experience a decreased sense of smell.
How the disease occurs?
Parkinson’s disease occurs due to the following process in the brain:
PD develops as cells are destroyed in certain parts of the brain stem, particularly the crescent-shaped cell mass known as the substantianigra. Nerve cells in the substantianigra send out fibers to tissue located in both sides of the brain. There the cells release essential neurotransmitters that help control movement and coordination.Nerve cells in the substantianigra (It is a brain 36 FUTURE MEDICINE I June 2013
structure that located in the mesencephalon (midbrain) that plays an important role in reward, addiction, and movement) send out fibers to the corpus stratia, gray and white bands of tissue located in both sides of the brain. There the cells release dopamine, an essential neurotransmitter (A chemical messenger in the brain). Loss of dopamine in the corpus stratia is the primary defect in Parkinson’s disease. Dopamine deficiency is the main feature in PD. It is one of three major neurotransmitters known as catecholamine’s which help the body respond to stress and prepare it for the fight-orflight response. Loss of dopamine negatively affects the nerves and muscles controlling movement and coordination, resulting in the major symptoms characteristic of Parkinson’s disease. Dopamine also appears to be important for efficient information processing, and deficiencies may also be responsible for problems in memory and concentration that occur in many patients.
What are the causes of Parkinson’s disease?
The exact cause of Parkinson’s disease is unknown. Scientists think that Parkinson’s is probably due to a combination of genetic and environmental factors. Genetic factors: Specific genetic factors appear to play a strong role in earlyonset Parkinson’s disease, an uncommon form of the disease. Recent research suggests that multiple genetic factors may also be involved in some cases of late-onset Parkinson’s disease. Environmental factors: Environmental factors alone are probably not a cause of Parkinson’s disease, but they may trigger the condition in people who are genetically susceptible. Some evidence implicates pesticides and herbicides as possible factors in some cases of Parkinson’s disease.
DISEASE SPECIAL Parkinson’s Disease
A retreat for chronic
Ayurveda is a medical system introduced for treating the physical and mental ailments ranging from symptoms to syndromes. Its methodology is based on diagnosis while dealing with acute and chronic diseases. This multi-faceted medicinal system treats the disease at any stage through a series of traditional treatments based on scientific explanations. Ayurveda is all about how to maintain life in a state of perfect health and takes a patient in entirety on physical, mental and spiritual levels while treating a disease. With the advanced research bringing to light the influence of mind over body, Ayurveda is fast becoming a holistic alternative to all other systems of medicine. Tharavad Ayurveda Retreat at Kuttippuram in Malappuram district has a calm and peaceful village atmosphere.Well-appointed traditional Kerala style cottages and other facilities amid lush green paddy field and coconut groves have the splendour of a feudal era. In an interview with Future Medicine, Ashtavaidyan Alathiyoor Narayanan Nambi, a doyen of Ayurveda, who belongs to one of the Ashtavaidya families of North Kerala,explains the methods of treatment for Parkinson’s disease 38 FUTURE MEDICINE I June 2013
By Sumithra Sathyan In Ayurveda, how can we define Parkinson’s disease?
It is mainly known as ‘kampavata’ in Ayurveda. The disease is also related to the mind –75 per cent related to body and 15 per cent the mind. According to Ayurveda, most of the diseases of the ‘vata’ are essentially the conditions of degenerative diseases of the nervous system. ‘Kampavata’ is one such condition caused by imbalance of ‘vata’. The treatment for ‘kampavata’ consists of both internal and external administration of drugs in different forms aimed to reverse the ‘vata’ imbalance.The person loses the balance of the body and sometimes the mind also. Trembling hands as well as fingers and imbalance of the body are the main symptoms of Parkinson’s.
Is there a treatment in Ayurveda for the disease?
In Ayurveda, the treatment is given to the individual and not to the disease.So Ayurveda needs totally a different way of treatment sometimes it is not practical in our fast pace lifestyle. Yet, Ayurveda was found to be an effective treatment for patients with Parkinson’s disease. Ayurveda has an integrated approach to the prevention and treatment of illness and tries to maintain or re-establish the harmony between the mind, body and forces of nature.
Dhara: Itis a unique treatment method developed by the eminent Vaidyas of Kerala. It is one of the distinctive and efficientforms of treatment practised by only the physicians of Kerala.The central nervous system is profoundly relaxed and energised by this
Pizhichil:The method combines the effects of both ‘snehana’ and ‘swedhana’. This treatment is performed by pouring medicated oil on to the body in continuous streams and being gently massaged by therapists for 45 to 90 minutes. This is extremely soothing and relaxing. Sirovasthi: Among all ‘sneha’ (Oil application) treatments, this is the most important. Herbal oil in lukewarm condition is poured in to a cap which is fitted on the head for 15 to 60 minutes per day, according to the condition of the patients
is conducted by masseurs for about 60 to 90 minutes per day for 14 days.
Vasthi: This is a kind of enima with herbal decoction in specially medicated oil.This is very effective in painful rheumatic problems,nervous complaints and stomach disorders.This treatment is one of the best purification processes. Udwarthanam: This special herbal treatment is conducted by applying herbal paste or powder all over the
further progression of the disease. Quality of life can be improved drastically with these custom made therapies. If the patient is already on Allopathic medication, these treatments and medicines can be comfortably combined with them. Our Ayurveda treatment regime proves effective in controlling the side-effects of Allopathic medications and even in reducing the dosage of Allopathic medications.
Is it a long term treatment? A ‘vata’ pacifying diet
Kativasthi: In this treatment, specially prepared warm medicated Ashtavaidyan Alathiyoor oil is kept over P S Menon, Chairman Jayakrishnan, CEO Narayanan Nambi the lower back with herbal paste boundary. body and deeply massaged and proper dietary habits Duration of treatment is into with specific movements are essential for a long term usually 45 minutes to 1 hour. for 1 hour. success. Additional ‘vata’ Kizhi: Various herbal Nasyam: In this treatment pacifying regimens, including leaves (Ilakizhi) or herbal method, herbal juices and daily oil massage and sensory powders(Podikizhi) are applied medicated oils are applied therapies complete the to the whole body in boluses through the nose.This is one treatment regimen. Finally, with hot medicated oil for 45 of the important treatments in a supportive environment minutes per day for a period the ‘panchakarma’. should be created which is not of 7 to 14 days. At Tharavad,exclusive overly stimulating. Meditation Navarakizhi: Under this ‘panchakarma’ therapies and yogic practice is the treatment method,the whole and internal medicines cornerstone of all holistic body or any specific part for treating Parkinson’s Ayurvedic programmes as thereof is made to perspire disease are offered. These they cultivate a ‘sattvic’ mind by the application of certain treatments are found to be and teach the patient how to medical pudding externally very effective not only in manage their internal energies. in the form of boluses tied in controlling the symptoms This is essential for good a muslincloth. This treatment of PD but also in arresting health. June 2013 I FUTURE MEDICINE 39
DISEASE SPECIAL Parkinson’s Disease
Surgical treatment is a mainstay of
PD management Not all patients are appropriate for Deep Brain Stimulation surgery for different reasons.The surgery which is a multidisciplinary activity includes a neurologist specialised in movement disorders, neuropsychologist, primary care provider and an experienced neurosurgeon
t is important to realise that there is no known cure for Parkinson’s disease (PD) and the drugs mainly are used to improve the symptoms. Multidisciplinary management with supportive measures such as gait training, social support and patient education is very important. Surgical treatment (Deep Brain Stimulation) has become a mainstay of PD management, but not all patients are appropriate candidates for varying reasons. Medical management Drug therapy need not be started immediately on diagnosis of PD. It is necessary only when symptoms are bothersome or produce disability. The majority of PD drugs act by either replenishing or mimicking the action of dopamine(The chemical deficient in PD). Supportive measures for improving the quality of life • Exercise and walking for flexibility, strength and balance • Regular exercise and physical therapy that incorporate massage, heat, exercise, and balance/gait retraining • Speech therapy, which may 40 FUTURE MEDICINE I June 2013
Dr Dwarakanath Srinivas, MS (PGI), MCh (AIIMS), Additional Professor, Neurosurgery, NIMHANS, Bengaluru
improve speech volume As the disease progresses, problems start worsening, among which the most common are motor fluctuations, dyskinesia (Abnormal involuntary choreoathetotic movements or dance-like movements) of any or all parts of the body, dystonia (Involuntary, continual muscular contractions resulting in abnormal postures), freezing and falls. It is important to note that freezing has a poor response to medication. To prevent falls,patients should avoid doing two tasks at the same time. Surgery for PD Surgery is directed at treating motor disability in which response to anti-Parkinsonian medications is complicated by severe motor fluctuations and dyskinesia. Careful patient selection is an important factor in evaluating patients for DBS surgery.
In this procedure, two electrodes are inserted to a specific area of the brain and connected to a battery (neurostimulator or IPG) via a connecting wire. High-frequency electrical stimulation is given
which interferes with or modulates abnormal brain circuitry. The effect lasts as long as stimulation continues and ceases when stimulation ends. The key to successful surgery is precise placement of electrodes of upto submillimetre accuracy and usually the STN (Subthalamic nucleus) is the target. When stimulated, it can improve tremor, bradykinesia, rigidity, dyskinesia, and dystonia and reduces levodopa requirements. A) Patient selection: Appropriate candidates for PD surgery include: • Idiopathic PD and continued response to levodopa. • Disabling motorsymptoms despite optimisedmedication regimens • Low surgical risk with intact cognitive function • Adequate social support
Exclusion criteria for DBS:People with dementia and cognitive impairment and active psychiatric illness are usually not considered for surgery. It is important to remember that certain symptoms do not improve with surgery. These include freezing, backwards falling/imbalance,
dementia or apathy,anxiety or depression, speech problemsand most non-motor symptoms. B) Procedure It is important to remember that surgery is a multidisciplinary activity and includes a neurologist specialised in movement disorders,neuropsychologist, primary care provider and an experienced neurosurgeon. All patients undergo a detailed preoperative evaluation to determine the fitness for surgery, a detailed medical physical examination. The DBS system consists of three components: the lead, the extension wire, and the neurostimulator or IPG. The surgery is performed under local anesthesia with adequate analgesia. A stereotactic frame is fixed, a brain MRI and CT is obtained and surgical coordinates or measurements for the target are made using surgical software systems. Intra-operative electrophysiological monitoring (Using a small microelectrode) and extensive clinical testing is
performed and the precise site is decided and the electrodes are placed. Side-effects are also assessed during the procedure. The patients typically require electrode placement on both sides. These electrodes are connected to a neurostimulator placed under the skin just below the collarbone. Postoperatively antibiotics are given and the patient recovers from surgery. What can you expect from surgery? DBS is best used for the cardinal motor symptoms, particularly tremor, rigidity, and bradykinesia, and motor fluctuations such as “wearing off” phenomena. Some patients experience improvement in gait as well. Symptoms such as swallowing or urinary symptoms, rarely improve. Although DBS does not cure Parkinson’s disease, it significantly improves the key motor symptoms and the quality of life. It prolongs the ‘on’ time, reduces fluctuations significantly reduces the drug induced side- effects such as dyskinesia. The dosage of medicines
is greatly reduced thus the patients have fewer drug-induced sideeffects. An important benefit is tremor control, which improves significantly with DBS. After surgery, motor function improves by approximately 55 per cent-70 per cent from baseline, activities-ofdaily-living scores had improved by 49 per cent -60 per cent. Precautions for patients with DBS The pacemaker can cause interference with both ECG and EEG. Turning the machine off during their recordings is the best solution. If an MRI has to be performed, it should be performed with head coil and tesla strength of 1.5 or less. Diathermy is contraindicated for all patients with DBS implants. Diathermy is a type of ultrasound therapy that helps reduce pain. This therapy involves applying a heat coil to the skin or body, which heats brain electrodes and can cause serious brain injury or death. Those undergoing dental procedures should preferably take oral antibiotics. June 2013 I FUTURE MEDICINE 41
DISEASE SPECIAL Parkinson’s Disease
Ayurvedic line can curb progression of damage be considered. ‘Sneha swedas’ (Oleation and sudation) in Ayurveda like ‘pizhichil’ ‘ilakkizhi’ and ‘navarakkizhi’ can regain lost muscle strength to certain extent. ‘Nasyam’ and ‘vasti’ are the main ‘panchakarma’ treatments effective in Parkinson’s disease as it can ease the involuntary movements of the body and release muscle sapsm and can reduce the pace in which the disease progresses. Supportive therapies like ‘sirovathi’ and ‘sirodhara’ are usually considered to arrest the progression of damage in the central nervous system
Treatment for Parkinson’s involves: •
Dr S Sajikumar, Chief Physician and MD, Dhathri Ayurveda
ampam’ or uncontrolled/involuntary movements of the body is the major sign in Parkinson’s disease. Hence, we can define the disease as ‘kampavata’. A patient also manifests other ‘vata prakopa lakshanas’ like constipation, dry skin, loss of weight etc.
‘Vata’ aggravation causes ‘dhathu kshaya’ or degeneration of tissues. It manifests in the patient as muscle-wasting. Degeneration of certain area of brain cells can be considered as ‘kapala majja kshayam/dhathu kshayam’ which is a common sign of ‘vata prakopa’.
Ayurvedic line of treatment will be ‘santharpanam/brimhanam’. If there is an ‘avarana of kapha or ama’ and indigestion involved, an initial support of ‘deepana and pachana’ shall
42 FUTURE MEDICINE I June 2013
Treatments to ease the discomfort and reduce the intensity of signs and symptoms so that the suffering of the patient can be reduced Repair/replacement of ‘dhathu kshayam’ through therapies as well as medicines Traditional Ayurvedic medicines like ‘vidaryadi kashayam’, ‘maharasnadi kashayam’, ‘astavargam kashayam’ ‘bhadradarvadi kashayam’ etc. with avarthis like ‘ksheerabala 101 or dhanwantharam avarthy’, ‘yogaraja guggulu’ and ‘vidaryadi/ indukantham ghritham’ are common choice of drugs. ‘Kapikachu’ (naykkuranaparippu) contains natural dopamines/ Ldopa which is the biochemical even modern medicine uses for replacement therapy in Parkinson’s. ‘Choornam’, ‘lehyam’ or ‘ksheerapakam,’ ‘kapikachu’ are used in Ayurveda on par with medicines used in modern medicine.
Prevent diabetic foot Dr Johny Kannampilly Consultant Diabetologist & Diabetic Foot Specialist, Lakeshore Hospital
to save your feet Due to the damage to the nervous system, a person with diabetes may not be able to feel his feet properly. Smoking disrupts the healing process and is a major risk factor for infections.If not treated or controlled early, diabetic foot problems may lead to amputation of legs or feet Diabetic foot
Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body’s ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious. • Due to the damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. This is called peripheral neuropathy. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop. • Damage to blood vessels and impairment of the immune system due to diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor
44 FUTURE MEDICINE I June 2013
blood flow, antibiotics cannot get to the site of the infection easily. If the infection spreads to the bloodstream, this process can be lifethreatening.
Fifteen per cent of diabetics will have diabetic foot problems, 50 per cent of these will undergo amputation and 80 per cent of these amputations can be prevented if treated early by the diabetic foot specialist.
Several risk factors increase chances of developing foot problems and diabetic infections in the legs and feet. Footwear: Poorly fitting shoes are a common cause of diabetic foot problems. • If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible. • If the patient has common foot abnormalities such as flat
feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
Nerve damage: People with longstanding or poorly controlled diabetes are at risk of havingdamage to the nerves in their feet. The medical term for this is peripheral neuropathy. • Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking. • A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetic neuropathy may not be able to perceive a stone. Its constant rubbing can easily create a sore. Poor blood circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to the injured tissues is
improperly fitting shoes, or poor venous circulation.
poor, healing does not occur properly. Trauma to the foot: Any trauma to the foot can increase the risk for a more serious
problem to develop.
Other signs of poor circulation include: • Pain in the legs or buttocks that increases with walking but improves with rest (claudication) • Hair no longer growing on the lower legs and feet • Hard shiny skin on the legs • Localised warmth can be a sign of infection or inflammation, perhaps from wounds that won’t heal or that heal slowly.
Athlete’s foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly. Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations.
• Persistent pain can be a symptom of sprain, strain, bruise, overuse, improperly fitting shoes, or underlying neuropathy. • Redness can be a sign of infection, especially when surrounding a wound, or of abnormal rubbing of shoes or socks. • Swelling of the feet or legs can be a sign of underlying inflammation or infection,
Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete’s foot, and ingrown toenails may lead to more serious bacterial infections. Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem. A limp or difficult walking can be a sign of joint problems, serious infection, or improperly fitting shoes. Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or lifethreatening infection. Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection. New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a person’s risk for leg and foot problems. June 2013 I FUTURE MEDICINE 45
Dr M Pradeep MD, DM
Neurosonology USA FINR (Switzerland) Senior consultant& Interventional Neurologist
after stroke R
apid diagnosis of stroke and initiation of treatment are important to maximize recovery, prevent recurrence of stroke and prevent complications.
Treatment of acute stroke patients in specialised stroke units correlated with lower mortality rate, reduced length of hospital stay and potentially reduced cost. Development of a stroke team is advantageous to expedite emergency care which involves attention to protection of the airway, to avoid obstructions, hypoventilation and aspiration pneumonia. Mild hypothermia protects the brain from ischemic injury; mild hyperthermia worsens ischemic outcome. Prevention of pulmonary complications is necessary in the bed-ridden patient. The mortality rate from pneumonia is as high as 15 per cent to 25 per cent in stroke patients. Aspiration was documented by videofluroscopy modified Barium Swallow examination in more than a third of patients with brain stem strokes, in one-fourth with bilateral hemispheric strokes and one tenth of patients with unilateral hemispheric strokes. If there is evidence of orpharyngeal dysfunction, it is important to place a temporary enteral feeding tube to minimize the risk of aspiration. The next step 46 FUTURE MEDICINE I June 2013
is assessment of circulation. Evaluate BP and cardiac function. Cardiac monitoring is recommended for the first 24 to 48 hours after stroke. Concomitant cerebral and myocardial ischemia can occur in approximately three per cent to 20 per cent of cases. Ischemic stroke can be completed by a variety of cardiac arrhythmias.
In patients with stroke, the BP should be monitored frequently or even continuously for the first 48 to 72 hours. It is not unusual for the BP to be transiently elevated after a stroke. Optimal arterial pressures post stroke appears to range from 160 to 200 mm Hg for systolic BP and 70 to 110mm of Hg for Diastolic Bp. Lower or higher pressure are otherwise associated with an increased volume of stroke in CT scan four to seven days post stroke. It is important not to over treat blood pressure and cause hypotension. The most important objective is to maintain adequate cerebral blood flow in the presence of impaired auto regulation. The American Heart Association guidelines suggest lowering the arterial blood pressure immediately post stroke only if the patientâ€™s blood pressure is above 220/130 mm Hg and unless the patient is a candidate for thrombolytic therapy, in which case a target goal of less than 185/110 mm Hg is appropriate prior to thrombolysis. NIHSS value of greater than 15 is an indicator of a
large infarction. Once stability of the airway, breathing and circulation is determined and a focused neurological examination is performed to assess neurological stability, the patient should be sent immediately for a brain CT scan. This can point the way to treat the patient with TPA (Tissue Plasminogen Activator) or to avoid anticoagulant in patients with intracranial bleeds. TPA is given either intravenously (IV) or Intra-arterially (IA). It is thrombolytic agent. IV TPA is given up to 4 .5 hours and IA TPA is given up to 6.5 hours after stroke. This is the golden period for the treatment of acute ischemic stroke. Treatment during this period enhances the chances of maximum recovery of the patient. In intra-arterial thrombolysis catheters are introduced into the cerebral artery involved in stroke in the brain and TPA is delivered directly onto the clot. Mechanical clot removal devices like Merci Retriever are also used in removing the clot from the brain.
Attention should be directed not only to treating stroke, but also to preventing complications. A variety of neurological and medical complications can occur after a stroke. During the first week after stroke, the most common cause of deterioration is development of brain edema. Brain edema begins to develop within the first several hours after stroke and reaches its peak within 72 to 120 hours. Those at greatest risk for development of cerebral edema are those with large infarctions often caused by large-artery occlusion.
Corticosteroids are not indicted for acute ischemic stroke. For cerebellar strokes with edema and herniation, posterior fossa decompression may be lifesaving. In the second through the fourth weeks, pneumonia is the most common cause of non-neurological death. Many cases of pneumonia are caused by aspiration of food, saliva or regurgitated gastric secretion, or bacterial pathogens in saliva. Basal ganglia infarct seems to predispose patients to pneumonia because of frequent aspiration during sleep. Other potential complications
oropharyngeal dysfunction require parenteral or tube feeding.
A variety of neurological and medical complications can occur after a stroke. During the first week after stroke, the most common cause of deterioration is the development of brain edema include seizures, cardiac arrhythmias, electrolyte disturbances, deep vein thrombosis, Decubitus ulcers and urosepsis.
Preventing stroke recurrence
General measures include control of associated risk factors such as hypertension, hyperlipidemia and diabetes. To stop cigarette smoking as well as use of anti-thrombotic agents (platelet anti-aggregants and anti-coagulants), anti-hypertensive agents and statin therapy, remains the mainstay of medical therapy for stroke prevention. A large proportion of strokes should be preventable by controlling BP, stopping cigarette smoking, treating cardiac rhythm abnormalities.
If there is a significant carotid artery stenosis, it can be associated with an increased risk of stroke. The atherosclerotic lesion in the carotid arteries can be either stented or removed by endarterectomy to prevent stroke. Oral anticoagulants are used in patients with prosthetic cardiac valves and in atrial fibrillation to prevent strokes.
Frequent neurological checks are necessary for early recognition of neurological changes associated with herniation, recurrent or progressive stroke or complications such as seizures. Anticonvulsant medications should be initiated if a seizure occurs.
Lower extremity deep vein thrombosis is common in stroke patients who are non-ambulant. This can be prevented by intermittent pneumatic compression of the lower extremities and by using Heparin preferably a LMWH (Low Molecular Weight Heparin). Prophylactic doses of heparin can be safely given to patients receiving Aspirin. The patientâ€™s nutritional status and fluid requirements should be assessed. Swallowing function should be assessed before intake of fluid or food is initiated. Patients who have significant
June 2013 I FUTURE MEDICINE 47
ALTERNATIVE MEDICINE Homoeopathy
not a pseudo-scienceâ€™ 48 FUTURE MEDICINE I June 2013
Homoeopathy needs no introduction. Yet, there are many who view it with unconcealed derision and distrust. It is a system that has passionate followers as well as powerful detractors. Detractors mention that Homoeopathy has no scientific basis. However, the proof of the pudding is in the eating. Homoeopathy does cure! Well, it is a claim that seems to contravene conventional scientific logic. Over the years, many persons have placed their complete trust in this system of medicine and gone forth to expand the domains of this medical system through study, research, experiments and observations. It is time for the world to acknowledge the rightful claims of Homoeopathy as a powerful alternative system of treating aliments. Homoeopathy has established its credentials in India. India can boast of great leaders who have made giant strides in this field. There are many famous homoeopathy teachers here. And many schools of thoughts! Here, Future Medicine takes a look at Homoeopathic practice in Indian and abroad, and the contributions of Dr Sreevals G Menon, MD, in the field
r Sreevals G Menon, MD, has stood forth passionately seeking a worthy place for Homoeopathy in the field of ailment and palliative treatment. He is a man of very rich accomplishments. He started out as a graduate in Homoeopathy from Father Muller’s Homoeopathic Medical College, Mangalore in 1996. He took his MD from Govt. Homoeopathy Medical College, Calicut in 2000. What made him stand apart was his understanding of the profound possibilities that lie embedded in Homoeopathy. His family history had no connection to Homoeopathy. Yet, from his varied clinical experiences, it was clear to him that Homoeopathy definitely was not a pseudo-science which should fear to show its face in the limelight. In fact, it was a medical system that seemed to propose the possibility of a higher science.
The very fact that he pledged his house for a bank loan to finance his first Homoeopathic venture should speak volumes about his deep faith in his volition, which also turned out to be his vocation. He started with a 10-bed RM Homoeopathic Hospital in Ramanattukara, Kozhikode. It was not just a clinic, but a full-fledged diagnosis, treatment, physiotherapy and rehab centre, with sophisticated lab and pharmacy.
AIHMS Homoeopathy Ltd
Dr Menon took his next stepAIHMS Homoeopathy Ltd. It was not a single unit, but a chain of units spread throughout Kerala. It was a corporate venture with him as the Founder and Director. It was a very pioneering enterprise in a field of medicine wherein people still needed persuasion to repose their faith. Yet, support for AIHMS flowed in from the contented patients and their relatives, from all corners of the state. Currently, there are seven units functioning. The eighth one is soon to open in Tiruvalla. In each unit, there are 24 specialities. There is a unit each in Dubai and Muscat, functioning in close collaboration with the local companies there. Apart from all this, AIHMS has started a separate branch, AIHMS Academy. This branch focuses on imparting training to doctors and
Dr Sreevals G Menon
students of Homoeopathy. AIHMS Academy also supports national and international Homoeopathic events with its faculties and conducts seminars and workshops.
Dr Menon has been quite active both at the national and international levels, promoting the cause of Homoeopathy. At the national level, he worked as the state and national office-bearer of IHMA for the last 12 years, apart from holding many other positions. He was the first Keralite to present a paper in the European Homoeopathic Congress. He was also an invitee to the National Romanian Congress for Homoeopathy and Alternative Medicine held at Bucharest. He collaborates and works in close association with many international luminaries to promote Homoeopathy everywhere.
What ails homoeopathy?
There are many questions that desperately seek answers. For example, what is the actual machine that affects the cure in Homoeopathy? What is this ‘Vital Force’ that is seen mentioned in this system of medicine? How can one face such tantalising accusations like Homoeopathy is a quack medical system? What is wrong in current-day Homoeopathy practice? What about
the homoeopaths in India? What ails homoeopathy in India? Why is it that there are so many different schools of Homoeopathy in India?
Dr Menon has discussed the exact machinery that works in Homoeopathy. Many patients would vouch for the fact that Homoeopathy has done wonders for them. Yet, there is the question of what is the medicine that did the work. For, modern medicine cannot agree that there was a medicine involved. Modern medicine has its own conceptualisations on what causes a disease and what can bring about a cure.
Standard of Homoeopathy in India
Is homoeopathy treatment par excellence in India and abroad? What are the defects? He opines that Indian Homoeopaths are of very good standards in terms of academic brilliance and in clinical experiences, compared to homoeopaths abroad. However, there is a cultural issue that has to be surmounted over here in India. It is the culture of too much individualism or the mentality to maintain an aura of a recluse, from other homoeopaths professionally. This has led to the creation of many schools of thoughts.
Dr Menon talks about the need for a strong organisation that can be on par with the IMA. He says that such an organisation would have rewritten the fate of every homeopath here. Currently there is no single mouthpiece of formidable reputation to voice the common concerns and opinions of the homoeopaths.
June 2013 I FUTURE MEDICINE 49
Catch mental health disorders
before it turns worse
India needs a system for regular screenings for mental health conditions of people. If any disorders are diagnosed in the early stage, it will be easy to find a solution. And such a screening process will also help eradicate the stigma associated with mental illness
hen mental illness descends on us or a relative, the existing stigma and misinformation can cloud our ability to treat the condition. It is common for people to resort to religious ceremonies or miss the symptoms of the disease altogether. People with treatable mental conditions are thrown out of their homes and left on the streets in both the US and India.
Since mental health disorders are often not diagnosed, the solution can be to incorporate mental health checkups into normal primary care. This solution was implemented by a team from the Centre for the Economics of Mental Health in London on rural populations in India and Pakistan. They screened individuals in these areas and found 12 per cent to 39 per cent in each group had a common psychiatric problem. Making these checkups a normal part of urban and rural life could help catch mental health disorders before they progress. Further treatment decisions could then be made early by the individual and their family. Also, if mental health checkups are a part of routine medical care, it could reduce the stigma associated with it. While many of us feel sound in mind and body, anxiety or depression can set in after a traumatic event or change in life. For others,the diseases are more severe and have been a constant problem sinceyoung age. There is recent evidence that likelihood of certain psychiatric disorders is correlated to particular genetics. Jordan Smoller, MD, ScD, of Massachusetts General Hospital in Boston, and his colleagues reported in The Lancet that autism, attention deficit-hyperactivity disorder
(ADHD), bipolar disorder, major depressive disorder and schizophrenia all are linked to common genetics in individuals, at least within European ancestry. Itâ€™s not clear what leads to these different manifestations of mental health and the pathway by which this genetic makeup increases risk. Gender can also affect the types of disorders that could arise in an individual. Men and women share different burdens of mental illness. A report by the US Department for Health and Human Services shows that while women in the US experience posttraumatic stress at higher levels while men are more likely to begin substance abuse. The complexities of different mental health conditions require an approach that is considerate of both the individual and the families affected. If these conditions do have a hereditary connection, then the implications can be even more significant for the family. Healthcare systems in the US and India need to acknowledge the prevalence of mental health disorders, some that are temporary such as postpartum depression or chronic such as bipolar mania. Implementing regular screenings for mental health conditions instead of waiting for symptoms to become severe can be the first step in addressing this problem.
(Lakshmi Santhosh is a freelance journalist. She has an undergraduate degree in Economics from UC Berkeley and is currently doing Masterâ€™s in Biotechnology at the University of Pennsylvania. She has worked for EC Media in Bengaluru and the San Francisco Business Times in California, US)
Halasana (Plough pose) •
Yoga plays an important role in rejuvenation. Follow the steps carefully to benefit from the traditional practice set to increase longevity and youthfulness
• • •
Benefits • • •
It makes spinal cord strong and flexible Cure problems related to thyroid gland Helps to remove problems related to pancreas, liver and spine
52 FUTURE MEDICINE I June 2013
Lie down on your yoga mat straight and relaxed. Put your arms by your side with palms facing the floor. Now slowly lift up your legs from the floor such that a right angle is formed between your upper and lower torso. Push floor with your hands so that it gets easy for you to lift your legs. Breathe and relax. Next bring your legs more towards your upper torso and slowly lift your hips off the floor supporting and balancing yourself with your hands. Continue lifting your legs and bring it beyond your head as much as possible to touch the floor beyond your head with your toes. At this point, lift your back further so that now only your shoulder and your head is resting on the floor. Now your back has formed an arch. Straighten your spine and support the two sides of your waist with your hands, elbows on the ground. Breathe normally. Hold posture for 15-30 seconds before returning to normal position.
Dhanurasana (Bow pose) • • • •
Lie down on your belly with hands by your side with palms facing upwards. Bend your knees to bring the heels near your buttocks. Now take your hands back and grasp your ankles. Rest your body weight on your abdomen. Now pull your ankles more with your hands. As your pull your ankles more, your upper torso automatically rises. And now your body looks like a bow. Keep your breathing normal.
Benefits • • •
Reduces stress Improves digestion Great for ant-ageing
Benefits • • •
Increases energy and counteracts depression Reduces fat Increases the digestive power
Bharadvajasana (Twisted seated pose) • • •
Sit on the mat cross-legged with both hands extended on the mat on both your sides. Inhale deeply and strengthen your spine. Shifting your left hand from the mat place it on your right thigh and twist your torso to the right. Exhale when you twist your body. Hold this position for 30 seconds. Now turn your torso to your left while placing your right hand over your left thigh. Stay for another 30 seconds.
Immunity & Nutrition
Gayathri Asokan Consultant Nutritionist/ Lecturer, Nutrisolutions, Kochi
‘False dietary pattern is the main cause of infections’
utrition is the science of food that works in the body. Food plays a major role in growth and development. The main functions of food are energy giving, body building and protective functions. A well balanced diet gives all the nutrients for various functions and it is essential throughout the day since water-soluble vitamins like Vitamin-C and B-Complex which are lost through urine and sweat are needed daily.
Micronutrient deficiencies due to false dietary pattern are very high in our country which is the major cause of infections. A well balanced diet having proper proportions of macronutrients like carbohydrates, protein and fat as well as micronutrients like vitamins, minerals, water and fiber must be included accordingly. Every person is different and so their dietary needs. Some foods that are rich in nutrients have a good benefit for many, but the same may not be suitable for another person. So it is best to follow a customised dietary pattern according to your work, body functions etc.
A well balanced diet with all the essential nutrients can help prevent many diseases, including Parkinson’s disease, cancer and Alzheimer’s. The
main nutrients that play a key role in improving the immunity or preventing infections are:
Vitamin A- It is a powerful antioxidant, especially carotenoids in orange yellow vegetables and fruits, iycopene that is present in tomatoes are found to prevent infections, including cancer. Foods that contain Vitamin A are green leafy veg, liver, cheese, milk, sweet potato, mango, papaya etc. Vitamin C -It is considered as anti-infective vitamin, which is also an antioxidant, that helps to prevent infections and reduces stress. Main sources are citrus fruits, green mango, leafy vegetables, sprouts, amla etc. B-vitamins like Vitamin B6, B12, folic acidwhich is essential for WBC formation and multiplication. Sources are leafy vegetables, baker’s yeast, liver, beans, peas, fruits and other vegetables. Vitamin E-It is also a powerful antioxidant which is also called sex vitamin as it is essential for child bearing and it can also protect the body from cancer and Alzheimer’s. The main sources are wheat germ, molasses, whole grain, nuts, vegetable oils etc.
Iron-It is very essential for growth and immunity and in India 50 per cent of women and 70 per cent of children below five years is suffering from iron
Every person is different and so their dietary needs. Some foods that are rich in nutrients have a good benefit for many, but the same may not be suitable for another person. So it is best to follow a customised dietary pattern according to your work, body functions etc deficiency anaemia. The deficiency may paralise the immunity and it affects the overall performance. Sources include liver, meat, mussels, green leafy
vegetables, dry fruits etc.
Zinc-It helps prevent cold and protect primary barriers from infections and also essential for various functions, including brain development. Sources are fishes, shell fish, poultry, whole grain etc. Essential fatty acids like omega 3 and omega 6 are also essential, which is present in fishes like sardines, flax seed, other vegetable oils. Trace elements like chromium, copper, selenium, magnesium are also helpful.
Diet for Parkinsonâ€™s diseases- It is the disease that results in the degeneration of neurons that involved in the production of dopamine, which results in uncontrollable shaking and muscular rigidity and in later stage it results in dementia. A well balanced diet is essential for the patients having this disease. The nutrients that are proved to prevent Parkinsonâ€™s are polyphenols and flavanoids. So include foods like coffee (3-4/day), apple, berries/ oranges, tea, green tea and red wine. So plan a proper balanced diet according to your health status which provide the recommended dietary allowance (RDA) that include whole grains, legumes, fruits, vegetables especially green and yellow coloured, milk and milk products (low fat), lean meat, fish etc. The vegetarians must include enough milk, pulses and sprouts daily in order to get adequate protein. Our traditional meals with curd or butter milk are ideal as it is a pro-biotic which helps to prevent diseases, improve the skin texture, prevent ageing and stomach related problems.
The skills a toddler develops
at different stages T
he progressive attainments by a child of skills that involve both mental and muscular activity such as the ability of the infant to sit, crawl, walk, talk, control bladder and bowel functions and solve cognitive problems. Between 12 and 36 months, a toddler acquires autonomy, independence, control of bodily functions and refinement of motor and language skills. The child likes to explore the environment, strives for self-assertion and personal interaction with others. Toilet training should begin between 18 and 24 months, when voluntary control of the anal and urethral sphincters is usually achieved. When the child masters some motor skills, is aware of his ability to control the body and can communicate adequately, training will not be a task. Bowel training is to be given before bladder training as the urge to empty the bowel is stronger than the urge to empty the bladder and the need is less frequent and more regular. Night time bladder control may not be achieved until the child is four or five years of age. Behaviour modifications giving rewards for achievements have been found successful with both normal and mentally retarded children. The milestones 6 weeks - Smiles. 8 weeks - Able to fix his gaze at a bright dangling object 20 cm from his face and moves his head to follow it. 12 weeks - Looks at own hand and holds head steady. 16 weeks - Turn head to sound. Bring head up in line with trunk. 20 weeks - Reaches out and grasps objects voluntarily. 24 weeks - Roll from front to back at will and follows a rolling ball up to three metres. Reaches out and grasps objects in palms. Turn to the source of sound 45 cm from his ears. 28 weeks - Sits unsupported. 32 weeks - Transfers objects from one hand to the other. 36 weeks - Stands with support. Can hold and chew a biscuit. Reacts more quickly. Locates the sound 90 cm away. Babbles a series of syllables. 40 weeks - Takes a few steps with support. Crawls on hands and knees. Develop a pincer grasp and can pick up a small sweet between index finger and thumb. 44 weeks - Creeps on abdomen on the floor and imitates speech sounds. 1 year - Says single words with meaning. 13 months - Walks unsupported. 15 months - Holds a cup and drink. 56 FUTURE MEDICINE I June 2013
Dr Mini Unnikrishnan (Owner of Pattolil Homoeo Clinic, Kayamkulam)
18 months - Builds a tower of three cubes. No longer puts objects in the mouth. 2 years - Says word sentences. Has a vocabulary of 300 or more words. Use pronouns. 3 years - Dress himself. Able to ride a tricycle and to feed himself well. 4 years - Hops and skips on one foot. Catches and throws a ball. Is independent, boasts, shows off. 5 years - Ties shoelaces, cuts with scissors, try to please, interested in facts about the world, gets along with parents.
Lesley Stedmon Sexual health educator, Canada
Live a life of
Ownership of our sensuality and pleasure often take a backseat in our busy everyday lives where we are overworked, overtired, under aroused and ultimately undersexed. Here are 10 simple ways to create pleasure in your daily life and help bring passion back to your life Communicate! 93 per cent of what you
say does not come from your mouth. Sex is another form of communication. If your verbal and body language are not congruent, you are not communicating your sexual wants and needs effectively, and you will probably end up with a very confused partner. Communicate what you want by asking, telling, or showing your partner!
Set goals! As we age, the way we express ourselves sexually will change as we move through lifeâ€™s natural transitions. Set goals about how you want your sexual self to look in 10 years, not what worked for you 10 years ago. As you evolve, so will your sexual self. Grow with it and donâ€™t fight it!
Get out of your head and back into your body: Quit thinking about what position
makes your legs look the longest and your stomach the flattest and get back into enjoying the whole sexual journey, not just the destination. Let go of expectations and give yourself permission to accept the pleasure you are receiving.
Lubricate: Sexual activity without enough lubricant can be painful. The amount of natural lubrication from the vulva and vagina is not an indication of how aroused you are. There are several factors which influence the amount of vaginal lubrication produced. Test out some favourites, from silicone to water-based to oils (not with latex condoms!) and
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SEXUAL HEALTH Lesley Stedmon
experiment different body parts to lubricate, like the crook of your elbow, and behind your knees!
Be assertive! We learn through taking risks and being vulnerable. Weigh out the risks of asking for what you want versus staying with your old sexual patterns. Why stay with your old pattern if you have not tried the new one? Say No! We are all overworked, over tired and totally over sexed. Practice saying no to things that are eating into your time you could be dedicating to building intimacy to your sexual self. Cell phones? Turn off to turn on! Practice saying YES to inviting intimacy and sexual expression into your life on a more regular basis. You will not be sorry!
Vibrate: Regular genital stimulation creates neural pathways to pleasure. Masturbation is natural, healthy and a legitimate sexual practice. Masturbation is not a second rate activity; it is the basis for all human sexual expression. Self-loving on a regular basis strengthens neural pathways, laying the groundwork for increased pleasure. Live a life of foreplay! Foreplay does not
have to be confined to those moments before sexual activity, I like to call these moments be-foreplay! Living a life of foreplay is the basis for intimate connection with another person; it is about the longer kisses, touching hips while doing dishes together, special calls and emails midday and the smallest touch filled with loving intention when passing the ketchup.
Discover yourself: You know your body
better than anybody! Self exploration and pleasuring solidify how your body responds and how you like to be touched. Discover a new erogenous zone and share it with your partner. Try stroking the inside of your wrists or earlobes. There are so many areas yet to be discovered!
Practise aural sex: Note the natural sounds
that emanate from your body when you experience pleasure, whether it be sexual pleasure or an oral delight from some amazing cheesecake or the most succulent fresh raspberries! Note how your body responds to foods, smells and sights that you find pleasurable. Now transfer those â€œsoundsâ€? to your bedroom! You can also incorporate your raspberries into your sexplay to double your oral and aural pleasure!
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Lesley Stedmon is a Canadian sexual health educator, sex coach and registered nurse dedicated to continuously communicating healthy and positive messages about sexuality. She has facilitated sexual health workshops in schools and community agencies since 2003 and speaks on a wide range of topics, including sexual development, pleasure, decisionmaking, sexual safety, intimacy, masturbation and sexual communication. Lesley is a member of the College of Registered Nurses of BC, the Alberta Society for the Promotion of Sexual Health, the VI Wholistic Sexuality Alliance, and the Sex Information Education Council of Canada.
n i r ito
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m a t r s a n g o u C s d o o l b
y r ato
Dr Jothydev Kesavadev, MD CEO & DIRECTOR Jothydevâ€™s Diabetes Research Center, Thiruvananthapuram
Diabetes unlike any other disease, mainly involves treatment of three parameters: blood sugar, blood pressure and cholesterol. All the three require continuous monitoring and modifications in the treatment regimen on a periodic basis
here are several therapies for diabetes and patients have to spend sufficient time with diabetes educators, or pharmacist to learn in depth on the timing and method of administration of injections and oral drugs. The sulfonyl urea group of drugs like glimepiride or glycozide has to be taken 10-15 minutes before food. Metformin can be taken before food or after food in the case of abdominal discomfort. Alpha glucosidase inhibitors like Acarbose, Voglibose or Miglitol should be administered along with food. In addition to individually packed drugs, many drugs are available as combinations of two or more drugs and it is absolutely mandatory that patient should have sufficient knowledge on when and how to take all these drugs. Comprehensive treatment of diabetes to prevent long term complication will involve multiple drugs in addition to the usual ones to normalise the blood sugar. This includes statin to reduce cholesterol, ACEI/ARB to normalise blood pressure and also microalbuminuria if any. Uncontrolled blood pressure may require one or even up to five different drugs. The ultimate aim of therapy should be to achieve targets for all metabolic parameters. The absence of continuing treatment with multiple drugs without achieving targets of therapy may be considered equivalent to no treatment.
Monitoring in diabetes
Diabetes unlike any other disease, mainly involves treatment of three parameters: blood sugar, blood pressure and cholesterol. All the three require monitoring and modifications in the treatment regimen on a periodic basis. Blood sugars are ideally monitored with the help of a quality glucometer.
The frequency and timing of monitoring is based on type of diabetes and mode of treatment. In Type 1 diabetes, blood sugar has to be monitored four-eight times daily and dose of insulin is determined based on the blood glucose value before food. In Type 2 diabetes, less frequent monitoring is sufficient. Postprandial increases in the blood sugars are strongly linked to heart attacks, strokes and cancers in diabetics. In an individual without diabetes, blood sugar value measured two hours after food will never go above 140 mg/dL.
even aware of a dangerously low sugar can easily be picked up with the help of CGM. Initially, CGM was only a research tool and now it has gradually evolved as a part of routine investigation in both Type 1 and Type 2 diabetes. Being a relatively new technology, it goes without saying that CGM is a little bit expensive.
In subjects with uncontrolled blood pressure or with kidney disease it is recommended to have home blood pressure monitoring as well. Though home monitoring of parameters sounds expensive, in the long run it is extremely cost effective. In the absence of such monitoring, treatment expenses in diabetes will reach 10-20 times higher after 15-20 years of diabetes due to the occurrence of several complications.
Continuous glucose monitoring
We at Jothydevâ€™s Diabetes Research Centre started performing continuous glucose monitoring (CGM) way back in 2004-2005. In the past, it was a sophisticated investigation, but now this investigation has become very simple and an easy to perform routine technology. Unlike a blood glucose which is measured in the laboratory or in a glucometer, continuous glucose monitoring as the term indicates provides a video of blood glucose reading measured once in every 5-10 minutes continuously from one day to several days. A tiny sensor needle is attached to the skin of the abdomen to record the blood glucose reading. This is a painless procedure and this sensor will measure the voltage in the interstitial fluid which gets translated into blood sugar values. The blood sugar values can be downloaded or uploaded to official websites which will generate graphs on each date of the monitoring. Continuous glucose monitoring data will provide different trends of blood glucose variations. The data can be intelligently utilised for making therapeutic decisions, for example, to change the type of insulin or to introduce other oral therapies etc.
Studies have shown continuous glucose monitoring data are critical in evaluating the blood glucose variations in response to diet, exercise, emotions, anger etc. CGM is a unique investigation since it provides the blood glucose continuously, including the time when the patient sleeps. Hypoglycemia unawareness or the existence of autonomic neuropathy as a complication of diabetes which is so severe that the patient is not June 2013 I FUTURE MEDICINE 61
SPECIALITY CENTRE FOCUS DMDSC, Chennai
The doctor who wages a war
on diabetes Increasing cases of diabetes is a cause for concern worldwide. Dr V Mohan and Dr Mohan’s Diabetes Specialities Centre are in a drawn-out war on this ‘silent disease’. Lifestyle changes following globalisation and economic boom are cited as the main reasons for an increase in diabetes cases. India, according to recent statistics, has 63 million people with diabetes By Prashob K P
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Dr Mohan’s Diabetes Specialities Centre (DMDSC) in Gopalapuram, Chennai
iabetes is crossing all the limits. Around 371 million people globally have the disorder, of them 187 million do not even know they are suffering from the condition. This statistics makes diabetes
Late Dr Rema, Co-Founder, DMDSC
first among the line up of chronic conditions like cancer, cardiovascular and respiratory diseases. Around 4.8 million people die of diabetic complications. The International Diabetes Federation (IDF) statistics show that 63 million people in India have diabetes and it predicts the number will rise up to 101 million by 2030. Ageing population, globalisation and economic boom leading to increasing obesity rates are responsible for the growing cases of diabetes in India. Late Prof Dr M Viswanathan, Known as the ‘silent
Father of Dr Mohan
disease’, it is diagnosed in the very late stages and often it has caused damage to organs. Dr V Mohan and Dr Mohan’s Diabetes Specialities Centre (DMDSC) in Gopalapuram, Chennai, are on guard thwarting the alarming threat of diabetes in the country. Started in 1991, DMDSC is considered as one of the international centres of excellence in diabetes. Dr Mohan is also the President and Director of the Madras Diabetes Research Foundation, one of the largest stand alone diabetes research centres in the world. “It was my father, Prof M Viswanathan, a renowned diabetologist, who wanted me to take up medicine and to specialise in diabetology. He left Stanley Medical College prematurely when he was a Professor to start a
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SPECIALITY CENTRE FOCUS DMDSC, Chennai
centre for diabetes-MV Hospital for Diabetes and the Diabetes Research Centre at Royapuram in Chennai. In 1971, I stepped into the world of medicine, especially concentrating on diabetes. Right from my first year of medical studies, I used to assist him in his work on diabetes. It was a great experience,” says Dr Mohan.
He also assisted his father in research and had published several research papers even when he was an undergraduate student. By the end of his academic studies, he gained concrete knowledge both in theory and practical aspects of diabetes. From 1981 to 1991, he worked with his father as a Diabetologist and a Researcher at the MV Hospital and Diabetes Research Centre. The days shared with his father at MV elicited his keen interest in research activities. In between, he was abroad for two years, one year in England for advanced training at the Royal Post Graduate Medical School, London, where he worked as a Wellcome Research Fellow and then in Germany, where he was awarded the Alexander Von Humboldt Fellowship to do research at the University of Ulm under the renowned diabetologist and researcher Prof EF Pfeiffer. His wife Dr Rema who was an
ophthalmologist who specialized in diabetic eye diseases (retinopathy) also accompanied him for further studies in her field of specialisation too. Dr Mohan’s earlier work was on the Fibrocalculous Pancreatic Diabetes (FCPD) where he carried out the first long term followup studies and described its epidemiology and natural history. He also proposed the first set of criteria for Fibrocalculous Pancreatic Diabetes which later came to be known as ‘Mohan’s Criteria for FCPD’.
Dr Mohan receiving Padma Shri Award from former President Pratibha Patil 64 FUTURE MEDICINE I June 2013
In 1990, Dr Mohan and Dr Rema decided to start their own venture. “Both of us had some plans, especially in the research area. We wanted to conduct it in a big way apart from building a world class diabetes specialties centre. In 1991, we started our independent journey with Dr Mohan’s Diabetes Specialities Centre,” says Dr Mohan. “Initially, we faced severe fund shortage because we were totally engaged in studies and research activities. So our savings were weak. However, several of our close friends and patients joined us as shareholders. We also had to take huge loans and the centre first functioned in a rented building,” he adds.
Genomics is now coming to diabetes centre also. Neonatal diabetes is now common and we have an advanced research lab to conduct genetic mutation testing
Institutions under Dr Mohan’s Group • Dr Mohan’s Diabetes Specialities Centre • Sai Rural Diabetes Specialities Centre • Madras Diabetes Research Foundation (MDRF) • Dr Mohan’s Diabetes Education Academy (DMDEA) • Dr. Mohan’s Health Care Products (DMHCP) • Diabetes International Research, Education and Charitable Trust (DIRECT)
The centre kicked off with just four consultant doctors and a staff strength of 20. Today, the institute has a workforce of over 1,100 employees with nearly 60 consultants and 100 people doing research work. The group currently has a total of 13 branches -11 in Tamil Nadu and two in Hyderabad. An international branch is to open in Muscat very soon. DMDSC is recognised as a WHO Collaborating Centre for Non Communicable Diseases Prevention and Control. The Research Foundation (Madras Diabetes Research Foundation) established by him in a single room of the hospital in 1996 has also grown extensively. It is also an ICMR Advanced Centre for Genomics of Diabetes. “Genomics is now coming to diabetes centre also. Neonatal diabetes is now common and we have an advanced research lab to conduct genetic mutation testing,” says Dr Mohan. Dr. Mohan’s Diabetes Specialities Centre also carries out several campaigns and awareness seminars. Over 2,000 diabetic camps have already been conducted free of cost.
Under the label of Dr Mohan’s Healthcare Products, the centre offers brown rice and footwear for diabetes patients. Dr Mohan’s Diabetes Education Academy, recognised as an International Diabetes Federation (IDF) Centre of Education, was launched in 2008 to conduct structured training programmes for professionals in the care of diabetes and its complications. “An individual needs to spend only a minute to find out if he is diabetic or prone to diabetes in the years ahead using a simple risk score called Indian Diabetes Risk Score (IDRS) developed by us. The test asks for age, family history of diabetes, waist measure and physical activity level. We are trying every way to tackle or put this disease under control” says Dr Mohan.
“As diabetes is a silent disease, an annual check-up is a must for everyone. The HbA1c test is best to see whether the disease is under control. Undue stress, commonly seen in youngsters, also paves way for diabetes. However, thorough check-up and proper treatment can keep diabetes at bay,” Dr Mohan adds. June 2013 I FUTURE MEDICINE 65
FOCUS Nice Neotech Medical Systems Pvt. Ltd.
neonatal care facilities Nice Neotech Medical Systems is the last word in manufacturing and providing high quality medical equipment used in Neonatal Intensive Care Units. With cost-effective and user friendly equipment, Nice Neotech has totally revamped the facilities in neonatal care in the country. It brings in innovative ideas in designing equipment to meet ever-changing complex needs of the end user
aring premature and congenitally ill infants is no longer a problem in our society. In the past, these infants were cared at homes either by mothers or midwives without any medical interventions. It was in the middle of the 19th century some of the hospitals started to install Neonatal Intensive Care Units
equipment, Nice Neotech Medical System, based at Vannagaram, Chennai, is creating a new path in India’s healthcare equipment industry. The organisation is led by Sheeba Wilson as Director and P Wilson as Managing Director. The medical equipment of Nice Neotech Medical Systems reflects the innovative, pioneering spirit to
design in its entire spectrum of medical equipment.
“We have an excellent team to constantly upgrade our manufacturing systems through research and development. That’s how we engineer innovative applications for modern medical treatment systems and also introduce novel ideas which help us to improve,” says Suresh Madhavan, General Manager (Marketing) of Nice Neotech Medical Systems Pvt Ltd. The product range includes infant incubators, transport incubators, infant resuscitators, transilluminators, infant open care systems, infant radiant warmers, phototherapy units, pulse Suresh Madhavan, General Sheeba Wilson, Director P Wilson, Managing Director oximeters, infant trolleys, Manager (Marketing) NICU (Neonatal intensive (NICU) for caring the infants using meet the ever-changing complex care unit) accessories, baby needs of the healthcare industry specially designed incubators. Now, weighing scales, oxygen hoods, and with simple, durable solutions. the scene has changed, most of the infant CPAP (Continuous positive Technology is the transformational hospitals in the country have well airway pressure). force leading to advancements in equipped NICU units with cutting “The company had registered neonatal care. Understanding the edge technologies. a turnover of around Rs 6 crore demands of end users, the company in the last financial year. The With standard neonatal has been carrying out changes in dynamism of our marketing team
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and introduction of new hi-tech products are guiding us to a new chapter of growth. This year, we hope that our turnover will cross Rs 10 crore,” adds Suresh Madhavan.
Neonatal pays due attention in maintaining international quality of their products. “We provide cost effective, user friendly, and affordable quality equipments to the medical fraternity and remain proactive after sales service. Our mode of service makes us stand out from others. It’s a kind of cyclic process, install-service-reinstall, every step is monitored by expert hands,” says Suresh. The client list of neonatal itself shows the quality of their product. ‘Nice’ stands for ‘Neonatal Intensive Care Equipment’, which amplifies the objectives of the organisation. Currently, the company is also
investing heavily in research and development programmes for production of third generation infusion pumps, syringe pumps, humidifiers (Neonatal and adults), neonatal CPAP, and ventilators. Nice Neotech’s R&D teams are driven by a group of qualified engineers specialised in relevant fields. Nice Neotech enjoys the good will and confidence of innumerous customers all over India since it has kept the promise of delivering qualitative products intact.
The products of Nice Neotech are exported to South Africa, Turkey, Nepal, Malaysia, Thailand, Sri Lanka, and Bangladesh as of today. Nice Netech is already having good market in all the southern states like Karnataka, Andhra Pradesh and Kerala and they are starting new branch offices in these states to tune with the aggresive marketing strategy. They also thinks to enter Europe and the Middle East markets very soon. Absolute thoroughness at all levels, close cooperation with medical organisations, continual monitoring and updation of technology have been the strengths of Nice Neotech.
Nice Neotech, which supplies 23 models of warmers and three models of incubators, has two full-fledged modern manufacturing units in Krishna Industrial Estate in Chennai. With 16 international and 26 domestic dealers, Nice Neotech has a commendable marketing network. “Incubator with servo humidity, humidifiers, O2 analyser, apnea monitors are the products in the pipeline,” adds Suresh. To ensure perfect care to newborns, Nice Neotech is committed to delivering effective medical equipment and accessories that can consistently meet customer and regulatory requirements and serve the healthcare needs with the highest integrity and cost efficiency. Protection during the critical neonatal stage is crucial.
A newborn gives us joy and happiness along with hope, an utmost care is needed at neonatal stage. As a NICU equipment provider, Nice Neotech is dedicated to protect this smile through their quality equipment.
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FOCUS Mother Care Hospital, Palakkad
to start second innings Keeping quality and affordability, Palakkad-based Mother Care Hospital is all set for a makeover. The management plans to bring all facilities under one roof and also to grow as a medical campus by 2015
erala shows a substantial growth in the healthcare sector as of today. This growth story didn’t happen overnight. A humble beginning was made in 1956, with the state’s formation. Since then, Kerala has made persistent efforts to enhance public access to affordable medical
M V Thomas, Managing Director
care across the state, especially in the field of primary healthcare. But there’s more that needs to be done for people at the bottom of the social pyramid today. They are in critical need of better access, mainly on account of the spiralling healthcare costs. The concentration of a majority of multi/ super specialty hospitals in the metros has only relegated the remote parts of the state to the backburner. That’s where the state is faced with a new challenge. This is where some not-for-profit organisations have taken the lead. Envisaged as a healing touch to Mannarkkad’s healthcare system, a town in Palakkad district, Mother Care Hospital, started in Dr K J Sebastian, Medical 2008 by a group of NRIs, offers supreme healthcare facilities and Director
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the most experienced medical and paramedical professionals.
But this group too couldn’t insulate itself from the pitfalls of mismanagement, rendering most of its operations inactive for a number of years. The days of misery are now a thing of the past, as Mother Care Hospital is now on the path of steady recovery in its new avatar as a super specialty hospital. The muchawaited makeover comes under the stewardship of MV Thomas, Managing Director, who recently took full control of the hospital. Thomas has been with Mother Care Hospital right from the start. His commitment to provision of affordable healthcare services saw him moving from the sidelines as a mere shareholder to a position where anything and everything is at
his command. “Lack of focused plans was the reason for initial trouble and also the managerial lapses. But now, I’m confident to move forward and implement my plans,” says Thomas.
Under the leadership of Thomas, Mother Care is all set for a restart. The hospital is spread over one lakh square feet within a total area of three acre land. The management is on the move to utilize every space of the land for healthcare activities. Focusing on quality and affordability Mother Care is all set to cure the healthcare issues of the people. In near future, all basic and advanced diagnostic and therapeutic facilities will be available at Mother Care. The hospital plans to offer speciality care in the field of General Medicine, Cardiology, General and Laparoscopic surgery,
Gynaecology, Orthopaedics, Paediatrics and Ophthalmology. Apart from all the facilities, well-qualified and highly committed professionals are heading all the specialty departments which are supported by a group of dedicated paramedical staff. “We are planning to bring all facilities under one roof with high quality service. Orthopaedics, dental, neonatal, IVF and a full-fledged trauma care are the departments we are focusing on in the initial stage. Each department will be headed by two specialist doctors. By 2015, the hospital will be transformed into a full-fledged medical campus,” says Dr KJ Sebastian, Medical Director. Currently, the hospital has five operation theatres and four ICUs, including a neonatal ICU. As Palakkad is blessed with natural beauty, we are also planning to introduce
medical tourism packages. We have air conditioned suite rooms for this,” says Dr Sebastian.
“We offer standard wages to our work force. Without their support, we can’t go further. We also have plans to start nursing, paramedical institutes within the hospital land,” adds Thomas. The hospital conducts regular camps and awareness classes. The hospital also gives treatments for needy people who are economically weak. “Nowadays, the healthcare sector is considered as business entities. But profit-making is not my agenda and also against the unethical practices which is very common in the healthcare industry. A kind of rapport between the patients and doctors will be maintained. That will also help the hospital to grow,” says Thomas. June 2013 I FUTURE MEDICINE 69
FOCUS PK DAS Institute of Medical Sciences, Palakkad
Setting new standards in healthcare
Focusing on affordable healthcare, Nehru group of institutions is now making an entry into the healthcare industry with the launch of PK DAS Institute of Medical Sciences
pioneer in the galaxy of educational institutions, Nehru College of Educational and Charitable Trust, popularly known as Nehru group of institutions, is now stepping into the healthcare sector by launching PK DAS Institute of Medical Sciences (PKDIMS), a state of the art super-specialty hospital, near the Bharatappuzha river in Ottapalam, on the Shoranur-Palakkad highway. The Trust was started in
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By Prashob K P 1968 under the leadership of late PK Das, a renowned chartered engineer, eminent academician, industrialist and a philanthropist, with the aim to bring in state of the art standards in the field of higher education.
“Our aim is to provide worldclass healthcare at an affordable cost. We offer a level of expertise and a standard of clinical excellence which are world-class and at par with topmost healthcare centres in India
and abroad which in turn attracts leading consultants, healthcare providers and patients,” says Adv Dr P Krishnadas, Chairman.
A huge investment was done by the group for incorporating worldclass facilities, major departments and medical teams. “We have expert hands and resources to develop highly specialised units in all specialties and we believe many of these will be recognised as centres
Adv Dr P Krishnadas, Chairman of excellence in the near future for the quality of care and outcomes achieved,â€? says Krishnadas. For maintaining a superior level of care for patients, PKDIMS team constantly updates their equipment and services. PKDIMS strives to set the standard for excellence in personalised healthcare with warmth, comfort and a genuine respect for each individual patient.
PKDIMS has specialty clinics in anesthesiology in which they provide pain relief services and completely monitoring intensive care for trauma patients. The department of cardiology provides a broad range of services in the diagnosis and the management of heart diseases.
The ENT, Head and Neck Surgery areas are equipped with the latest and most advanced instruments to deal outpatients, surgical patients and inpatients. The dermatology department offers services pertaining to general dermatology, cosmetic dermatology and venerology. The nephrology and dialysis department is equipped to provide the full range of nephrology services, including outpatient care and follow-up of all kidney diseases such as
renal biopsy, pre-dialysis CKD care, pre-transplant workup and post-transplant follow-up as well as inpatient services in addition to dialysis services for acute and chronic cases. In the neurology department, advanced neuroradiologic facilities, including magnetic resonance imaging, computer tomography scan and neck vessel Doppler, are using. A dedicated 24-hour neurosurgical intensive care unit with ventilators and
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FOCUS PK DAS Institute of Medical Sciences, Palakkad
multichannel invasive monitors for all beds are provided in the neurosurgery department. Other departments like Gastroenterology, Orthopaedic, Arthroscopic & Joint Replacement Unit, Paediatric Surgery, Pulmonology, Rheumatology and Urology are also providing better services and facilities. The hospital also offers various health check-up packages such as executive health check, comprehensive heart check, comprehensive diabetic check, women check, body check and know your heart.
The hospital has a built up area of two lakh square feet which constitutes eight floors located over a land area of 20 acres. The facilities include suite rooms, air conditioned deluxe rooms, general wards, conference hall, an auditorium with a capacity to accommodate 300 people, air conditioned consultation rooms, proposed birthing suites, bystander accommodation and internet connections. A neat and well stocked food court and cafteria which is managed by dietician is also attached to the hospital. The hospital management is also alert on waste management. The waste disposal is carried out by a centralised and efficient biomedical waste management system. Seven lifts services are provided for patient comfort. Ample parking space with round the clock security services is also provided by the management. All the activities of the hospital starting from the fixing of appointments to prescription printing and billing are automated and video conferencing facilities are also available.
â€œOur vision is to bring world-class healthcare within the reach of every person and also to maintain excellence in medical education and research. Ours is a multispeciality tertiary care hospital with focuses on providing world-class and holistic healthcare services to community, training medical and paramedical professionals and promoting research. The hospital is further committed to be eco-friendly and ensure occupational health safety of patients, their relatives and healthcare workers. We are also planning to set up a full-fledged medical college by 2014,â€? says Krishnadas. The hospital also conducts medical camps and awareness seminars either in association with some clubs or independently. The hospital also focuses on medical tourism which is also a huge potential area.
About the Trust
Late PK Das, Managing Trustee and Founder Chairman Primary objective of Nehru College of Educational and Charitable Trust was to render dedicated service to cause of higher education in Aeronautical Engineering and subsequently the rest of engineering branches, Management, Arts, Science, and Paramedical Sciences. The Trust was headed by late PK Das, Managing Trustee and Founder Chairman. He was a wellknown educationist with rich experience in meticulously planning and establishing educational institutions. He is a great industrialist with an overwhelming entrepreneurship spirit and excellent business acumen. The Trust is now headed by Adv Dr P Krishnadas, Management Trustee, Dr P Krishnakumar, CEO and Secretary and Dr P Thulasi.
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INDIAN HOSPITAL FOCUS HealthCare Global Enterprises, Bengaluru
HCG-A name to
be reckoned with
cancer care Known as South Asia’s largest cancer care network, Bengaluru-based HealthCare Global Enterprises (HCG) Ltd was established in 2004. With more than 1,150 beds,350 oncologists and 2,500 plus staff, HCG presently has a network of 27 centres across the country. Here, B S Ajai Kumar, Chairman, HCG, speaks to Future Medicine about the journey of HCG in the world healthcare Shalet James Recently, HCG has been recognised as the best place to work in healthcare. What makes the organisation achieve this status?
HCG culture is fused with passion and empathy.We groom our employees in this culture and give them intense training in hospital activities and also help them develop communication skills. We have stringent guidelines for the appointment of employees as we give more importance to the employee’s attitude than qualification. As a cancer specialtycentre, there is a need to create a calm and friendly atmosphere in the hospital. We believe in empowering employees and give them the option to set
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their own standards provided they fulfill their goals. We respect everyone and encourage mutual respect. In HCG, no employee is inferior or superior.
Could you tell us about the new developments in the treatment of cancer?
In cancer care,we bring in the latest advancements in therapy, research and technology. Today, we work in multidisciplinary clinic where patients are examined by radiation oncologists, medical oncologists and surgical oncologists. We have the equipment like IMRT,IGRT and cyber knife, one of the most advanced equipment used in the treatment of cancer. Molecules molecular imaging and MR
spectroscopy scan are also used here. We have a pathology department with molecular diagnostics and when a patient comes for the treatment of breast cancer or colon cancer, we tell the patient what are the biomarkers that make this disease very aggressiveand how this disease is going to respond toa particular treatment orwhat type of treatment the patient should take. This makes the treatment a personalised one.
Can a positive atmosphere help cancer patients lead a better life? Yes. Cancer patients benefit a lot from the positive atmosphere. In my days of practice in the US,there were doctors who used to refer to the cancer patients as “Oh you unfortunate victim
Major milestones • • • • • • • • • •
First to introduce Artiste with CT on rails in Asia First to introduce cyber knife robotic radio surgery in India First to introduce cyclotron and the only cGMPrecognised unit in India First bone marrow transplant in Karnataka First bloodless bone marrow transplant in Asia Introduced to India the world’s most advanced MRI System–3 Tesla Skyra First to use brain implants in India First to introduce digital Mammogram ( 98 accuracy in diagnosing breast cancer) First to introduce PET MRI in Asia Only oncology network recognised by the pan African network connecting 54 countries
of cancer”. On hearing this statement, the patients lose all hopes in life. As cancer is a chronic disease, horrifying terms like fourth stage,advanced, palliation and terminal should never be used by oncologists. As doctors, we should learn to say that I will treat your disease. This very positive attitude of the doctors will bring about drastic changes in the cancer patients. I remember one of my patients in the US who was suffering from bone cancer. She was in pain and left alone for her destiny. This was when I got a chance to treat her. I explained to her that she is not in her last stage and I said we will be doing our best to treat her. This very pep talk gave her a motivation to live her life to the fullest and she decided to do all her favourite things. All her wishes were facilitated by the hospital. After eight years, when I was in India, I got a call from the US that she is very sick and refusing to have any drugs. The next day, I reached there and told her not to give up but she only responded by thanking me for the eight beautiful years she lived with cancer. That night, she died in peace. This very incident makes me work hard for the happiness of my cancer patients.
What are the major reasons for cancer?
One of the major reasons is the fast food culture and lack of exercise. Breast cancer is mostly seen in urban women who are addicted to fatty foods. Another reason is genetic predisposition that is if a mother has cancer, the daughter may be more inclined to have cancer but can be prevented by good lifestyle. Yoga also helps reduce stress thereby manages cancer better.
Are you conducting cancer awareness programmes?
We have conducted over 1,000 camps in Mysore and Gundlupet in Karnataka and the surrounding areas of Bengaluru. We are going to hold the largest camp in North Karnataka.
We are working on 20 projects which will soon be fulfilled. We are also planning a major project in South Delhi and three more Centres in Africa, including Dar es Salaam in Tanzania, Nairobi in Kenya and Lagos in Nigeria.
What is your vision?
Our vision is to become leaders in oncology. When one gets cancer, he/she should think of HCG.
Born in August, 1951 in Bengaluru, Dr B S Ajai Kumar did his MBBS at St John’s Medical College, Bengaluru during 1968- 73. In 1975, he joined the University of Virginia, Charlottesville,US. He did his fellowship in Radiation Oncology and Medical Oncology at the MD Anderson’s Tumour Hospital and Institute, Houston, US.
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A couple of American films released in different times tell the tales of medicos and medical professionals in trying times
Released in 1990, Flatliners is an American horror movie starring Kiefer Sutherland, Julia Roberts, Kevin Bacon, William Baldwin and Oliver Platt. The movie narrates the experiments made by five medical students to find out what lies beyond death. Joel Schumacher directed the movie.
Article 99 is an American movie directed by Howard Deutch. The movie depicted the efforts of two doctors who came as interns at Veteranâ€™s Administration Hospital. Within short days, they realised that the administration gives more importance to politics and bureaucratic system than patients. With the support of other doctors, they fight against the whole system. The movie was released in 1992.
Released in 2008, Dark Floors is directed by Pete Riski. The movie revolves round an autistic girl Sarah, residing at a hospital and because of security reasons Sarahâ€™s father decided to take her home. Things take an unexpected turn when they board an elevator with strangers in it.
Mash is an American satirical black comedy film released in 1970. The film portrays the story of a unit of medical personnel stationed at a Mobile Army Surgical Hospital (MASH) during the Korean war. The movie was directed by Robert Altman.
Written and directed by Harvey Miller, Bad Medicine is a comedy film. It was released in 1985. The movie is about a youth named Jeffrey Marx, who is rejected by all the prestigious medical schools because of his low grades and his father sends him to a sub-standard medical school and the rest of the movie depicts his efforts to help the poor villagers there.
Compiled by Neethu Mohan 76 FUTURE MEDICINE I June 2013
Giving a new lease of life Innovative methods of treatments could bring out remarkable results in many chronic illnesses. When old ways of treatment fail, new ones succeed, provided there should be a leading light to pay the new path
Dr Sanjay and Dr Sr Mary Eassy treating the patients
ringing a great sigh of relief to the families who are traumatised by their differently abled children, Dr Sr Mary Eassy came with her alternative medicine-the Jivadhara treatment. Jivadhara Institute of Neuro Development and Research, promoted by Jivadhara Charitable Research is a medical institution founded in 2009 at Angamaly, Ernakulam, Kerala. It was the support and acknowledgement given by Prof Dr PK Rajiv, Head of Neonatology Department, NMC Speciality Hospital, Dubai, which encouraged Dr Sr Mary Eassy, MD,PhD, to start Jivadhara.
The Jivadhara treatment combining two alternative medicines-Acupuncture and Electrohomeopathy-is used for various conditions such as cerebral palsy (CP), mental retardation (MR), autism, behavioural disorders and genetic disorders like Down Syndrome, Rett Syndrome and Edward Syndrome and various other chromosomal, neurological and congenital disorders. Acupuncture helps to create balance 78 FUTURE MEDICINE I June 2013
By Shalet James in the body’s vital energy while Electrohomeopathy medicine brings balance in the body’s vital fluids. “A child’s mental development mostly takes place in first 2-3 yrs, so if a child affected with any such disease is brought here as early as possible, the Jivadhara treatment gives better outcome. As the age and the complexity of the disease increase, results could take more time,” says Dr Mary Eassy, Director of Jivadhara Institute.
“We make sure that the treatment and service provided here is the best,” added Sr Mary Eassy. Depending on the needs of each child, physiotherapy, speech therapy, vocational skill training, prayer therapy, music therapy and counseling are included in the Jivadhara treatment. The treatment phase is important in Jivadhara and follows a modular system whereby each course of treatment lasts 12 days followed by an interval of 15 days before the start of the next course. “I have just joined here. I got an opportunity to understand the concept of Acupuncture and Electrohomeopathy,” says Sanjay
Emanuel Nanda, Pediatrician, Jivadhara Institute Struggling to accommodate the patients in a small building, Sr Mary Eassy wants to increase hospital space with help from people.
“I had difficulties in my pregnancy and due to that my child had blood clot in the brain and was in the ventilator for many weeks. We had lost all our hopes and were in a great dilemma. It was then our doctor referred us to Sr Mary Eassy. He was five months old when we started the treatment. He slowly started responding positively to each course of treatment. After 12 courses, he became perfectly alright. Now, he is four years old and is the most smart and studious student in his class. We are really grateful to Sr Mary Eassy and to the Jivadhara treatment,” says Leena, mother of Emmanuel. Expecting help and support from Govt and non governmental agencies to do further research in this field, the vision of Sr Mary Eassy is to extend their service by setting up Jivadhara Institute in different parts of the world to bring happiness in the life of millions.
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