Future Medicine

KERENG/2012/44529

Popularising Waterbirth

Special Focus

Barbara Harper

Dr Rajkrishnan Chandrasekharan

www.futuremedicineonline.com

Effective Dental Care

May 2013 l `50 $8

Surprising Saga of

success

John Kuriakose, Founder, Dentcare Dental Lab

BLISSFUL BIRTH Alternative methods of delivery

10 ways to maximize sexual pleasure during pregnancy

EDITOR’S NOTE Women’s health & childbirth

W

Volume 2 Issue 5 | May 2013 Editor Ravi Deecee Head-Operations M Kumar Assistant Editor Dipin Damodharan Chief Copy Editor K S Rajagopal Senior Reporters Lakshmi Narayanan Prashob K P RESPONSE TEAM Coordinating Editor Sumithra Sathyan Reporters Tony William Shalet James Neethu Mohan Design & Layout Kailasnath Anil P John Shyam P S Web Manager Sreenath S

ADVT SALES Senior Managers Kainakari Shibu Rajasree Varma Anu P M Biju P Alex K S Syam Kumar M K Haridas Vinod Joseph ( Delhi) Rohil Kumar A B (Bengaluru) Managers Febin K Francis Bipin Kumar V S MARKETING Sr Manager Sabu Varghese Mathew Assistant Managers Priya P A Mobin E Mathew Liju P John Circulation Athul P M Sone Varghese Vishnu

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DC Media Publication 4 FUTURE MEDICINE I May 2013

omen’s health is a primary concern of all nations, especially in the west, as it is directly linked to the development of a society. Developed countries can claim women there enjoy a far better position in respect to health and education than their counterparts in the countries like India and China. The health scenario in Europe and America is impeccable and deserves to be followed by Asian and African countries. The status of women in India in terms of health and education is dismal.

Just take infant and maternal mortality rates in the country for instance. While western counties are discouraging caesarean sections which are minimal, the rate of C-sections in India is alarmingly high. Who is to blame for this practice in our country?

It has been proven that medical intervention during childbirth unless most necessary is detrimental and affects the health of both mother and baby. In view of this and the other findings, medical practitioners the world over try out alternative methods of delivery such as waterbirth and hypnobirth. These methods are totally natural and consist of some techniques which ensure maximum safety and pleasure for both mother and baby during the process.

Alternative methods have already gained popularity in the west and more and more mothers opt for it nowadays.

However in India, the very idea of waterbirth and hypnobirth raises many eyebrows. Knowing the benefits of it, Indian medical fraternity has also started promoting these methods despite the initial reluctance. And happy know that a couple of centres exclusively for waterbirth and hypnobirth have come up in India too and it has become a subject of serious discussion in the medical parlance of the country. Hope such facilities would be accessible for all women who plan to have a blissful birth in the days to come.

The cover story includes all aspects of alternative methods of childbirth besides psychiatric disorders during the postpartum period and increased sexual pleasure during pregnancy. An interesting story on the journey of Dr E P Krishna Menon from a veterinary surgeon to an oncologist, an article on the importance of exercise to prevent and control diabetes, a couple of articles on the proper care of teeth, hospital profiles and beauty as well as health tips make this issue of Future Medicine precious for all readers.

Also, we incorporate in the issue all relevant reports of the latest scientific advancements in the medical field and remarkable achievements of medical institutions and practitioners.

COVER STORY

CONTENTS 18 22

Columns

25

48 56 34 15 47 38

Waterbirth Barbara Harper has revolutionised childbirth with the introduction of waterbirth techniques which give both mother and baby maximum comfort and pleasure during the process

Hypnobirthing

JOYFUL DELIVERY

In an interview with Future Medicine, Dr Sunil Prakash, founder of California Hypnosis Institute of Delhi, talks about hypnobirthing and its specialities

Children’s health Diane Coffey

Neurosurgical disorder Dr Ramkumar Menon

Dental care Dr Rajkrishnan Chandrasekharan

Excessive hair growth Dr Divya Ramkumar

Dysfunctional uterine bleeding Dr N P Vijayalakshmy

Tooth decay Dr Ravi Hebbali

6 FUTURE MEDICINE I May 2013

Alternative ways of childbirth such as waterbirth and hypnobirth have become a part of modern medicine and medical practitioners have already explored its possibilities. It is found that alternative methods ensure more comfort and maximum safety of mothers as compared to caesarean sections. Future Medicine analyses various aspects of the new phenomenon

62

Indian Hospital Focus

Narayana Hrudayalaya, Bengaluru Dr Devi Prasad Shetty is called the ‘king of cardiac care’ and his network of Narayana Hrudayalaya hospitals is an epitome of affordable healthcare

58

The man who dared to take on cancer

Meet Dr E P Krishna Menon, a veterinary graduate-turned-oncologist and cancer research scientist who has developed nine cancer medicines

40

Dentcare: Surprising saga of success It was a journey from the miseries of life to prosperity, guided by the grace of the Almighty. John Kuriakose, founder and owner of Dentcare Dental Lab, made the best use of the lessons he learned from his distressing past

33

Special focus Dental care Diet and exercise alone can’t stabilise an established diabetic, but along with medication it can improve the patient’s health condition

60

Diabetes Diet and exercise More important than drugs are lifestyle modifications for prevention of diabetes and prevention of complications in already established diabetics

78

Milk bank Coming donor breast milk banks!

Donor breast milk banks are coming up in the country following the developed countries to provide succour to these babies May 2013 I FUTURE MEDICINE 7

MEDICAL DIGEST

MVM Healthcare to launch more products CHENGANNUR: With a

mission to provide affordable quality medicines to the masses, MVM Healthcare, a new division of MVM Ayurvedic Research Lab, the makers of products Krishnathulsi Cough Syrup and

Krishnathulsi Hair Tonic, has been formed. At present with two products available in the market- K-Vol Inhalant capsules and Curepaingel, MVM Healthcare plans to launch more products in the near future.

K-Vol Inhalant capsule is a herbal formulation consisting of natural vapours and aromatic oils such as Eucalyptus oil, Pine Oil, Menthol and Camphor. It is highly beneficial for the quick relief of common cold, sinusitis, pharyngitis and congestion of upper respiratory tract. K-Vol Inhalant capsule costs Rs 29.95/10 capsules.

Curepaingel is an effective pain gel with a unique combination of diclofenac and herbal oils.It provides quick and lasting relief from back, joint and muscular pain.Curepaingel is priced at Rs 39.95 for 25gm pack.

Obama announces brain mapping project WASHINGTON: Speaking at the White House, US President Barrack Obama announced an initial $100m investment to shed light on how the brain works and provide an insight into diseases such as Alzheimer’s and Epilepsy.

President Obama said initiatives like the Human Genome Project had transformed genetics; now he wants to do the same with the brain.

The project, Brain Research through Advancing Innovative Neurotechnologies

SC rejects Novartis cancer drug patent bid NEW DELHI: The Supreme

Court has rejected drug-maker Novartis AG’s plea for a patent on cancer drug Glivec, a verdict that is expected to pave tha way for Indian firms to provide affordable drugs to poor cancer patients.

or BRAIN, will be carried out by both public and private sector scientists.

Obama said: “There is this enormous mystery waiting to be unlocked, and the BRAIN initiative will change that by giving scientists the tools they need to get a dynamic picture of the brain in action and better understand how we think and learn and remember. And that knowledge will be transformative.”

Novartis argued that it needed a patent to protect its investment in the cancer drug, Glivec, while activists said the company was trying to use a beeline to make more money out of a drug that did not have a patent.

The decision has global significance since India’s generic drug industry, pegged to be valued at $26 billion, supplies much of the cheap medicine used in the developing countries.

Novartis called the ruling a “setback for patients,” and said patent protection is crucial to fostering investment in research and development of new and 8 FUTURE MEDICINE I May 2013

better drugs.

Ranjit Shahani, the Vicechairman and Managing Director of Novartis India, said: “Novartis will not invest in drug research in India. Not only Novartis but also any company that is planning research in India.”

The project will begin in 2014, and will involve the National Institute of Health (NIH), the Defence Advanced Research Projects Agency (Darpa) and the National Science Foundation (NSF).

“As humans, we can identify galaxies light years away, we can study particles smaller than the atom, but we still haven’t unlocked the mystery of the 3lb of matter that sits between our ears,” he said.

MEDICAL CONFERENCE

ARA meet to begin on May 2 BOSTON: The 38th Annual Regional Anesthesiology (ARA) and Acute Pain Medicine Meeting will be held

by Kenes International in Boston, Massachussetes, US, from May 2to 5.

The meet will focus on the latest research and scientific developments in the field.Refresher courses, general sessions, parallel sessions, workshops, intensive comprehensive workshops, ultrasound workshops, problembased learning discussions, poster presentations and a comprehensive technical exhibition will be organised as part of the meet.

Media can make a change in healthcare BANGALORE: Amen, one of India’s fastest

growing Healthcare Management Consultancies specialised in Healthcare Recruitments, Event Management, Training and Consulting would be organizing a workshop on Social Media and Facebook Marketing for Healthcare at Bangalore on the 4th of May 2013. The Workshop is being conducted in association with EchoVME, a Chennai based Digital Marketing Company, with

• • • • • • • •

Introduction to Facebook Marketing – Redefining Your Marketing Skills Establishing Your Facebook Presence Why Facebook Marketing for Healthcare Facebook Advertising – How to Generate Leads Using Facebook Advertisements Importance of Content and Varieties of Content Feedback Management Facebook Products & Apps Facebook Insights

The participants would also take home knowledge on Creating a Facebook Page and a facebook Ad. However, in addition to Facebook Marketing, a few general topics on Social Media such as Ethics in Social Media Marketing for Healthcare, Listening and Engaging on Twitter, LinkedIn and your Professional Brand, Google+ Marketing for Business etc. would be covered.

Paniel Jayanth

Sorav Jain

Mr. Sorav Jain as the Chief trainer. The workshop would focus mainly on Facebook Marketing covering topics such as :

“This workshop is of immense importance to Healthcare Professionals today and we would also be looking at conducting such workshops across other parts of the country”, shared Mr. Paniel Jayanth, Founder & Chief Strategist of AMEN. It has conducted more than 50 Healthcare management Conferences and Workshops in the past 7 years.

May 2013 I FUTURE MEDICINE 9

NEWS PLUS

Care World TV bags

healthcare award

C

are World TV has received Medgate Award 2013 for the best health and wellness TV Channel. Ajit Gupta, MD of Care World TV, received the award from Rashid Alvi, MP, at a function held in New Delhi on March 22.

Receiving the award, Ajit said, “It was a great pleasure and honour to receive the prestigious award. Health and wellness is the only motive of Care World TV and I am very happy that our audiences are happy with our services.

Over a period, we have developed a very good viewership which definitely means Care World TV is able to win the heart of people.”

Awards were presented to India’s Top Hospitals and India’s Best Doctor (Speciality wise). Young Surgeon of the Year Award, Life Time Achievement Award, India’s Top Healthcare

10 FUTURE MEDICINE I May 2013

Architect Award, Entrepreneur Excellence Award and Women Entrepreneur in Healthcare Award were also given away on the occasion.

Care World TV has always focused on body, mind and beauty. Apart from the vast data base which caters to every heath requirement, Care World TV addressed the essential needs of the affluent and the not-so-affluent, particularly the latter who cannot invest in expensive spas and wellness institutes, cannot engage trainers and dieticians at exorbitant rates.

Medgate Award 2013 means a lot to Care World TV and it will boost the channel. Available on major cable networks across the country, Care World TV can be also accessed on Doordarshan DTH, Dish TV, Videocon DTH, and SUN DTH.

HEALTH STUDY

Eat more fish to stay healthy

By Dipin Damodharan

G

ood news for seafood maniacs.

A new study conducted by Harvard School of Public Health (HSPH) and University of Washington has found that eating seafood would reduce the risk of dying from heart disease. “Older adults who have higher blood levels of omega-3 fatty acids—found almost exclusively in fatty fish and seafood—may be able to lower their overall mortality risk by as much as 27 percent and their mortality risk from heart disease by about 35 percent,” the new study states.

Researchers found that older adults who had the highest blood levels of the fatty acids found in fish lived, on average, 2.2 years longer than those with lower levels.

“Although eating fish has long been considered part of a healthy diet, few studies have assessed blood omega-3 levels and total deaths in older adults,” said lead author Dariush Mozaffarian, Associate Professor in the Department of Epidemiology at HSPH. “Our findings support the importance of adequate blood omega-3 levels for cardiovascular health, and suggest that later in life these benefits could actually extend the years of remaining life.”

12 FUTURE MEDICINE I May 2013

Many previous studies have found that eating fish reduces the risk of dying from heart disease. It is for the first time that its effect on other causes of death or on total mortality has been the subject of a study. “Eating fish, which is rich in protein and heart-healthy fatty acids, reduces the risk of dying from heart disease,” Michael Henckel, a New York-based health expert and researcher on sea foods, tells Future Medicine.

“With this new study, the researchers sought to paint a clearer picture by examining biomarkers in the blood of adults not taking fish oil supplements, in order to provide the best assessments of the potential effects of dietary consumption of fish on multiple causes of death,” a press release of HPSH states. “The researchers examined 16 years of data from about 2,700 US adults aged 65 or older who participated in the Cardiovascular Health Study (CHS), a long-term study supported by the National Heart, Lung, and Blood Institute. Participants came from four US communities in North Carolina, California, and Pennsylvania; and all were generally healthy at baseline. At baseline

and regularly during follow-up, participants had blood drawn, underwent physical examinations and diagnostic testing, and were questioned about their health status, medical history, and lifestyle,” the report says.

The researchers analysed the total proportion of blood omega-3 fatty acids, including three specific ones, in participants’ blood samples at baseline. After adjusting for demographic, cardiovascular, lifestyle, and dietary factors, they found that the three fatty acids— both individually and combined— were associated with a significantly lower risk of mortality. One type in particular—docosahexaenoic acid, or DHA—was most strongly related to lower risk of coronary heart disease (CHD) death (40 percent lower risk), especially CHD death due to arrhythmias (electrical disturbances of the heart rhythm) (45 percent lower risk). Of the other blood fatty acids measured DPA was most strongly associated with lower risk of stroke death, and EPA most strongly linked with lower risk of nonfatal heart attack. None of these fatty acids were strongly related to other, noncardiovascular causes of death.

PERSONALITIES Dr Pradeep Chowbey

A pioneer in

laparoscopic surgery A

n internationally renowned laparoscopic surgeon, Dr Pradeep Chowbey is considered one of the first surgeons to perform laparoscopic cholecystectomy in North India. He has worked with a determination to develop, evaluate and propagate Minimal Access, Metabolic & Bariatric Surgery in India and the Asian subcontinent. Dr Chowbey earlier established the Minimal Access, Metabolic & Bariatric Surgery Centre at Sir Ganga Ram Hospital, New Delhi, in 1996, which was the first such centre in the Asian subcontinent.

Dr Chowbey and his team have been instrumental in the technological advancements in the field of laparoscopy, hernia and obesity for the last two decades. Chowbey aims to provide less painful treatment to every patient. He has spearheaded pioneering clinical works to set the guidelines for laparoscopic and endoscopic hernia surgeries.

A recipient of Padma Shri in 2002 for his notable medical achievements, Chowbey currently serves as Vice Chairman and Chief of Surgery and Allied Surgical Specialties and Director of Max Institute of Minimal Access, Metabolic and Bariatric Surgery (MAMBS) at Max Healthcare Institute Ltd., New Delhi.

He is also an advisor to various government bodies, universities, medical institutions and hospitals.

Dr Chowbey got featured in the Guinness Book of Records 1997 and Limca Book of Records in consecutive editions (2000- 2012) for performing most minimal access surgeries. He has also participated in more than 700 workshops and conferences, and has trained more than 5,000 surgeons from across the globe.

Dr Pradeep Chowbey

“I appreciate your work and may this healing touch reach all the needy ones.�

- His Holiness the Dalai Lama

Dr Pradeep Chowbey, MS, MNAMS, FRCS (London), FIMSA, FICS, FAIS, FACS, FIAGES, FALS The positions he holds: Honorary Surgeon to The President of India, Honorary Surgeon to Armed Forces Medical Services and Surgeon to His Holiness The Dalai Lama Founder President: Asia Pacific Hernia Society (APHS) President Elect: International Federation for the Surgery 14 FUTURE MEDICINE I May 2013

of Obesity and Metabolic Disorders (IFSO) President: Asia Pacific Metabolic and Bariatric Surgery Society (APMBSS) and International Federation for Surgery of Obesity and Metabolic Disorder (IFSO) - Asia Pacific Past President: Obesity and Metabolic Surgery Society of India (OSSI) Trustee and Past President: Indian Association of Gastrointestinal Endo-Surgeons (IAGES)

BEAUTY CARE

Unwanted hair growth

in women H

irsutism is the excessive hairiness in women in those parts of the body where terminal hair does not normally occur or is minimal - for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern.

The medical term for excessive hair growth that affects women is hypertrichosis. PCOS (poly cystic ovarian syndrome) is the commonest cause of hirsutism. Some of the other conditions may increase the normally low male hormones.

The other causes are: • Congenital adrenal hyperplasia, in turn mostly caused by 21-α hydroxylase deficiency.

• Cushing’s disease • Growth hormone excess (Acromegaly) • Tumors in the ovaries • Adrenal gland cancer, Von Hippel–Lindau disease • Insulin resistance • Stromal hyperthecosis - in postmenopausal women • Obesity: As there is excessive peripheral conversion to androgens • Use of certain medications such as tetrahydrogestrinone, phenytoin, minoxidil Polycystic ovary syndrome is the most common endocrine abnormality in women of reproductive age, and its prevalence is estimated to be 4-8 per cent in studies conducted in Greece, Spain

and the US. The incidence of PCOS is increasing the world over along with the rise in Type 2 diabetes mellitus (T2DM). PCOS has been found to be affecting 28 per cent of unselected obese and five per cent of lean women. The health budget of India is unlikely to meet the expenses for imposing lifestyle intervention comprising dietary, exercise and behavioural therapy, tackling fertility, cosmesis, metabolic consequences like glucose intolerance, dyslipidemia, non-alcoholic steatohepatitis, coronary artery disease and consequences thereof.

Dr Divya Ramkumar Dermatologist & Cosmetologist Many women with PCOS demonstrate challenges to feminine identity and body image due to obesity, acne and excess hair; also, infertility and long-term healthrelated concerns include the quality of life and adverse impact mood and psychological well-being.

Gynaecologists and endocrinologists report that nearly 35 per cent of women in India in their reproductive age suffer from PCOS. Besides a failure to ovulate, PCOS also causes an overproduction of androgens (male sex hormones) and estrogen, resulting in excessive facial and body hair in women.

“Exercise and weight loss are the best ways to improve insulin sensitivity and improve the metabolic abnormalities associated with PCOS. Weight loss improves menstrual cyclicity, rate of ovulation and likelihood of a healthy pregnancy,” they say.

What can your doctor do?

Your family doctor will be able to provide many of the drug treatments available (These are probably best taken in consultation with a specialist). Treatments aim to improve several aspects of PCOS, including fertility, via the stimulation of ovulation, reduction of the insulin resistance and reduction of the increased hair.

How can you reduce the increased hair?

There’s a range of nondrug treatments available for hirsutism. Once a serious increase in male May 2013 I FUTURE MEDICINE 15

BEAUTY CARE Dr Divya Ramkumar

hormone levels has been excluded, then local cosmetic options can safely be considered. These include bleaching, depilatory preparations, waxing, plucking, laser hair removal, electrolysis and shaving.

Each is usually effective, but expert advice should be taken because each method has its own problems. Bleaching and depilatory preparations can occasionally cause a local allergic reaction.

Waxing and plucking though a little more effective than shaving cause folliculitis that lead to inflammation and infection of hair follicles, requiring topical antibiotic creams.

Electrolysis that gives permanent hair removal and requires multiple sessions is painful and cannot tackle large areas of the skin.

At Carewell Skin & Laser Centre, we occasionally identify women who have not yet consulted their medical practitioner about symptoms consistent with PCOS, whilst treating excess and unwanted hair. We encourage them to consult their medical practitioner so as to investigate the underlying causes and confirm or exclude PCOS as a cause.

It is important to discuss symptoms with your medical practitioner and investigate the possibility of PCOS rather than delaying and consequently exposing yourself to the risk of long term health problems like diabetes and cardiovascular disease.

Women with PCOS typically experience symptoms associated with excess androgen levels, including excess hair growth (hirsutism) and acne. An increased growth of coarse hair can occur on the face, nipple, chest, thighs or in the middle of the lower abdomen.

For most women the appearance of excess and unwanted hair is distressing, and affects their self esteem and body image.

Women should not be

16 FUTURE MEDICINE I May 2013

Gynaecologists and endocrinologists report that nearly 35 per cent of women in India in their reproductive age suffer from poly cystic ovarian syndrome.

Besides a failure to ovulate, it also causes an overproduction of androgens (male sex hormones) and estrogen, resulting in excessive facial and body hair in women embarrassed to consult professionals.

Carewell Skin & Laser Clinic therapists are experienced, qualified and accredited to perform safe laser hair removal. Laser hair removal is an appropriate treatment with results superior to home remedies for excess and unwanted hair, and laser is a safer and more effective treatment than electrolysis or IPL. Laser hair removal is the foremost and clinically proven way to manage hormonal facial hair.

As your treatment progress, you will first notice the change in texture of the hair. Hair will grow back finer, lighter and less noticeable. As laser treatments continue, after 6 – 8 treatments you will start to notice significant reduction in the amount of hair that is growing back. Up to 80 per cent reduction can be expected, in some cases up to 90 per cent hair loss can be achieved. Some patients require an ongoing maintenance treatment programme for the management of coarse hair.

When treating delicate areas such as the face, it is very important that you choose a medical grade laser.

Carewell Skin & Laser Centre uses

Genuine Diode Laser (808nm) with a dynamic cooling device for best results and your comfort.

Some women with PCOS also exhibit male-patterned hair loss (alopecia) as well as acne. The moderate to severe acne usually associated with PCOS can result in unsightly scarring. We use techniques like microdermabrasion, derma rollers, Fractional CO2 (carbondioxide) and laser & chemical peeling to overcome this condition which could be demoralising to women.

A further common symptom of PCOS is obesity, with up to 70 per cent of women being affected to some extent. Women with PCOS tend to gain weight in the abdominal region rather than on the buttocks or thighs, the usual areas women “put on” weight.

Often the weight gain is related to ‘insulin resistance’, a condition that is typically associated with PCOS. Some women with PCOS who have insulin resistance are of normal weight, so regular testing is recommended and the absence of weight gain should not be considered as cause of complacence in managing PCOS. Insulin is a hormone that allows the conversion of glucose (sugar) into energy. When insulin resistance occurs, the body produces more of the hormone to compensate; the elevated insulin level stimulates the body’s fat cells to make fat from nutrients and to store it, causing weight gain. A high level of insulin may also cause further increase in the production of androgens by the ovaries.

After evaluation, we offer nonsurgical weight reduction and inch loss to our patients with indubitable results. We follow a triad of passive exercises from the clinic, active exercises from the patient’s part and diet regulation, and the results are maintained by following a healthy lifestyle!

COVER STORY

Birthvillage

Joyful Delivery In the developed and developing countries, including India, increased use of medical technologies during childbirth is a matter of concern. It is evident that the development and application of unjustified interventions is causing complex health problems for women. However, the trend of institutionalised births is fast spreading in India.

According to an estimate, caesarean deliveries are more than 30-50 per cent in many states against the mandated 10-15 per cent by World Health Organisation. It indicates an impending public maternal health problem.

In this context, alternative ways of childbirth such as waterbirth and hypnobirth are important and medical practitioners have already explored its possibilities. It is found that alternative methods ensure more comfort and maximum safety of mothers as compared to caesarean sections. Here, Future Medicine analyses various aspects of the alternative methods of childbirth.

Priyanka Idicula’s Birthvillage in Kochi, Barbara Harper’s Waterbirth in the US and Dr Sunil Prakash’s California Hypnosis Institution in New Delhi are some of the known centres of natural birth.

“I

By Sumithra Sathyan

will do anything to experience childbirth the way nature intends it to be.” It was the determination of 27-year-old Seethalakshmi who was pregnant with her second child. She talked about her experience during her first delivery and explained why she took a decision to have natural birth this time.

“I came to Birthvillage from a remote place where the information regarding alternative methods of childbirth was limited. In Birthvillage, I met Priyanka Idicula, the founder of the organisation, who understood my anguish and the pain of having caesarean. I told her about my desire to have Vaginal Birth after Caesarean (VBAC) this time. I began attending Lamaze classes with my husband Pramesh. He supported me.

18 FUTURE MEDICINE I May 2013

Priyanka explained to me about the pros and cons of VBAC and all the options that a woman preparing for VBAC needed,” said Seethalakshmi.

Childbirth has a spiritual angle to it.

The childbirth brings a mother closer to her inner powers. Knowing this fact, Seethalakshmi clad in white dress began chanting ‘mantras’ as labour progressed.

“I drank juice and kanji, (rice gruel).

They bathed me in warm water. I should say it wasn’t just a bath but a massage.

Pramesh, my mom and my daughter stayed with me. It was truly a fantastic feeling to have your loved ones nearby helping and encouraging at every step.

On December 17, 2010 at 7.05 pm, I gave birth to my child on a birthing stool.

It was a proud moment in my life,” she

May 2013 I FUTURE MEDICINE 19

COVER STORY

Birthvillage

said. Seethalakshmi can confidently say that she has experienced every aspect of labour and there is so much power that one feels when she is in control of her own childbirth.

Ojaswini is three years old.

The name denotes energy and health.

She lives happily Priyanka Idicula, Founder, with her parents.

Birthvillage Ojaswini is the first baby born in Birthvillage. A unique natural birthing centre, Birthvillage was established in December 2010 by Priyanka Idicula. It is South India’s first established birth centre that offers antenatal, postnatal, mother and baby care with a holistic approach. Its goal is to provide individualised care.

Birthvillage is a new concept where parents can also be involved in their daughters’ normal delivery. It is run by midwives and it follows the midwifery model of care. The institution works in association with Birth India (www. birthindia.org) to address maternal and foetal health in India.

“We give mental and physical support and

Mothers with their babies at Birthvillage 20 FUTURE MEDICINE I May 2013

care to the mother. Here, we seek support from both the mother and the father because we want to send across the message that childbirth is not just a ‘woman’s role’ or a ‘feminine process’ but it is the sharing of love and devotion as well. We make birthing a pleasurable, holistic and spiritual experience. It should also be a memorable moment for every mother and father,” Priyanka said.

Birthvillage currently has a natural birth rate of 87.5 per cent with 70 per cent waterbirths. They also offer Lamaze childbirth education classes, prenatal yoga, breast feeding support groups, and women care.

As per the latest medical reports, the number of caesarian births has increased steeply in Kerala. Studies conducted by the Kerala Sastra Sahitya Parishad (KSSP) indicate that C-section deliveries increased from 11.9 per cent in 1987 to 21.4 per cent in 1996 in the state. The National Family Health Survey II findings released in 1998- ‘99 put the rate at 29 per cent and the current estimates indicate that nearly 35 per cent of childbirths in Kerala are through surgical operations.

According to the National Family Health Survey 1992-’93, two states- Kerala and Goahave shown the highest number of C-sections.

Studies show that in India, the rate of C-sections is much higher in private hospitals than in public health facilities.

Parental education, good nutrition,

Plan for the midwifery model of care exercise, support, commitment and above all preparing spiritually for childbirth are necessary to stop the growing trend of C-section.

Midwives attend the majority of births in the developed countries like the US, Israel, Sweden, France, Denmark, Spain, United Kingdom, Finland, Norway, The Netherlands, Switzerland, New Zealand and Austria. In these countries, midwives attend 70 to 100 per cent of low risk births. These countries generally have the lowest infant and maternal mortality rates.

s n o i t u a

a) Antenatal appointments : • Discussing midwifery model of care, limitations of birth outside hospital, client responsibilities, care costing and payment schedule • Personal, medical, obstetrical and family history • Evaluate dates with LMP and EDD • Physical exam • Order lab work for parental tests b) 2-8 weeks monthly check-ups

c) 36–40 weeks twice monthly check-ups with the midwife at the birth centre

c e r P

Mind and body Birthing is only a natural phenomenon where mother and child are the main characters. We need to support them. For a natural birth, mother should be healthy.

She should eat healthy food with proteins, and do exercise. After delivery, she should keep fit physically. Spiritual thinking is also important.

Reading books It reflects in the mind of her baby too. The baby will react to the book’s content. If mother reads spiritual/ classical/ inspirational /motivational books, the baby reacts to books in a positive manner. It will affect the baby positively.

Postpartum depression This is a sensitive topic that is on the rise in Kerala. A mother must be free to express her feelings postbirth to her caregivers and to her loved ones.

Patience to birth Every mother has to know when she can give birth.

The baby will react to her mother about the birthing and she knows when it will happen. There are reasons when a C-section may be required which may apply to 10 per cent of the pregnant women. The reasons must be backed with science and not comfort and convenience.

Birthvillage’s six care practices which support normal birth • Labour begins on its own • Freedom of movement throughout labour • Continuous labour support • No routine interventions • Spontaneous pushing in upright – neutral position • No separation of mother and baby after birth

Midwifery model of care The midwifery model of care is based on the fact that pregnancy and birth are normal life processes.

The midwifery model of care includes: •

Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle

•

Providing the mother with individualised education, counselling and prenatal care, continuous hands–on assistance during labour and delivery, and postpartum support

•

Minimising technological applications

•

Identifying and referring women who require obstetrical attention

•

The application of this women–centered model of care has proved to reduce the incidence of birth injury, trauma and caesarean section

•

Compared to the standard medical management, the this model of care is a fundamentally different approach to pregnancy and childbirth

May 2013 I FUTURE MEDICINE 21

COVER STORY

Waterbirth

Popularising

waterbirth

M

y journey to achieve a gentle waterbirth began with the exploration of my own birth experience. In the spring of 1984, I learned of a technique called “rebirthing,” and engaged a professional therapist with whom I worked diligently to replace my cultural and personal beliefs that birth must be painful and a struggle.

I had heard about waterbirth from a former patient in the clinic where I was employed as a nurse. This woman told me she was preparing for a waterbirth and showed me an article from a magazine that had photographs from Russia of a birthing woman in glass tank with a baby between her legs. I made it my goal to find as much medical 22 FUTURE MEDICINE I May 2013

and scientific information on this subject. At that time, there were only a few articles on waterbirth, one of which had been published in a French Medical journal in 1803.

My search took me to anthropology libraries and I found that many cultures had indigenous practices of labouring and giving birth in water. The original Hawaiians, the Maori tribes, the coastal tribes of Ghana, Africa and all were seen labouring and giving birth in warm water. This information along with the article about Russia inspired me to prepare for a waterbirth for my second child. I took a trip to France in the summer of 1984 to meet Dr Michel Odent in the city of Pithivier, where

Barbara Harper has revolutionised childbirth with the introduction of waterbirth technique which gives both mother and baby maximum comfort and pleasure during the process. Though the concept of waterbirth was not accepted by medical practitioners in the beginning, it is now gaining popularity worldwide.

Barbara Harper’s this article should be a definitive reference on the subject waterbirth this physician had been offering women in labour a warm bath in a deep round pool. I witnessed a birth there and was impressed with the facility and the pool, which was round, blue and very deep so a woman could easily achieve whatever position her body and her baby would dictate. She could squat, change positions and have an almost gravity free environment in which to move. All the pressure was off her back, her legs, as she was now buoyant. The buoyancy creates a hormonal response which gives her extra doses of oxytocin, the hormone responsible for creating not only labour contractions but also a sense of ease and pleasure.

Research on the use of water for

labour confirms that woman’s labour is significantly shorter.

While in France, I also visited a hospital where the famous obstetrician, Frederick Leboyer, practised and they also encouraged women to give birth in water.

Their philosophy was simple. Whatever increases a woman’s pleasure in labour, increases her ability to surrender to the process and the baby.

Why waterbirth?

In a waterbirth, a baby flows through his mother, into warm watery fluid that is similar in temperature to the womb – the perfect place for growth and development. The baby is gently lifted onto his mother’s chest either by the mother herself, or the doctor or nurse. Once on the chest, he stays there and is given time to transition to life, to make the conscious quiet efforts biologically and neurologically to activate his systems for oxygenation, metabolism, nutrition, temperature regulation. Trained doctors or midwives watch quietly as he is welcomed softly and talked to by only his mother and father, voices that he knows and easily recognises. Everything stops as everyone witnesses and holds the space for this new being to enter into a life of intention.

Each woman who desires a gentle birth, including a waterbirth, has a choice and doctors, midwives and nurses have the responsibility to assist women in finding their centre. The use of water assists in this process in ways that are amazing and extremely beneficial. There are many other things that we can do to help prepare women for giving birth in this way, but water immersion is a good first step. Doctors need to engage in the study of physiologic birth and apply the principles of gentle birth. These are subjects that the majority of doctors today did not learn in medical school.

After attending over 600 waterbirths in my career as a midwife and doula, I know for certain that birth is the safest for mother and baby when not disturbed unless there is a true emergency. In the professional courses that I and my Waterbirth International team teach across the globe, we often joke that there is really nothing for a doctor or midwife to do except take the pictures of the birth. But, in

reality, the doctor or midwife has been trained to know what physiologic birth looks like and realises quickly when someone needs intervention. In this way, the doctor or midwife becomes more like a life guard, a guardian of the process, of the space and the baby. I often ask, “Does the life guard on the beach get paid if they don’t have to rescue anyone that day?” The answer, of course, is yes, absolutely.

Over the past 30 years, I have been contacted by many celebrities and helped many experience gentle births and waterbirths, connecting them with midwives for either home or hospital birth. In the UK, the National Health Service offers warm water immersion to every woman who desires to use this gentle form of non-pharmacological pain management. In the US, we now have approximately 10 percent of all US hospitals offering waterbirth and double that number that offer a warm bath in labour.

The waterbirth movement is growing worldwide. I just returned from a three-week stay in India where we identified seven cities that now offer waterbirth and trained over 300 new doctors, midwives and nurses in multiple cities. Waterbirth is actively done in over 90 countries around the world in medical facilities. If you add in the number of birth centres and home birth practices, the number of babies who have been born in water is now over a quarter of a million.

Challenges In the beginning of my waterbirth career, I was laughed at, scorned and even charged with crimes like practicing medicine without a licence. All of that have changed through research, diligence and education. It is with great pleasure that I enter medical schools and large teaching hospitals, especially in the US, with present courses for residents, medical students, midwives, practicing obstetricians and nurses.

When a mother is prepared to give birth through education about her baby and her body, she enters the labour ward with ease and determination. She knows that she is the vessel through which this new being makes its entrance into the world. If she is assisted May 2013 I FUTURE MEDICINE 23

COVER STORY

Waterbirth

to relax, surrender and be the guide for her baby, working with her baby and letting the baby dictate the speed, the timing and the rhythm of the birth process, the new being will have a totally different view of life on this Earth. This type of birth also empowers the mother to be a better mother, both on an emotional and chemical level. It is extremely rare for mothers who have experienced an undisturbed waterbirth to report postpartum depression.

Most births today are hurried with the use of chemicals for induction of labour or artificial rupture of the amniotic sac, or worse, scheduled for surgical removal. These acts rob the mother and the new being on a hormonal and a spiritual level. There are very specific points throughout the neurological development during gestation when the sequence and timing of the wiring of the brain is done in an ordered and logical progression. When these neurological patterns are interrupted by outside influences, such as drugs or chemicals to speed labour or environmental forces, it creates a different kind of brain pattern.

A mother needs care, comfort, quiet, calm, support and kind words of encouragement to be able to release her baby in a gentle and loving way. She also needs to receive her baby immediately onto her breast and the baby must stay there for a minimum of two to three hours.

The worst possible thing to do in a birth is immediate cord-clamping and separation of the mother and baby. This act is a violation of an innate biological agenda, which has lifelong consequences. The womb is the perfect place for keeping the fetus warm, oxygenated, nourished and protected. The fetus has a behaviour in the womb that is perfect and complete for that place or habitat. The newborn baby has a behaviour that is perfect and complete for only one place the mother’s chest, which is the perfect place for keeping the newborn warm, oxygenated, nourished and protected. When this newborn is separated

24 FUTURE MEDICINE I May 2013

from the ONLY place where he is programmed neurologically to function, the brain actually loses some of its capacity to wire for connection, attachment, self-determination, love and trust.

Waterbirth International Any hospital on the planet, with enough education and the right birth pool equipment can begin a water immersion programme. The quality of birthing pools today is extremely good. When I had my first waterbirth in 1984, I actually built my own tub. Not a good choice, as it broke just after the baby was born and flooded my bedroom with 300 gallons of water. Today, the Birth Pool in a Box is available worldwide. It was designed by midwives, doctors and birthing mothers.

Research demonstrates that with proper awareness of infection control, there is less likelihood of an infection for either mother or baby during a waterbirth. After the use of the Birth Pool in a Box, the liner is removed, the tub is wiped down with an antibacterial solution and it is ready for a new liner for the next birthing mother.

There are other manufacturers that have produced similar economical and easy to use birth pools.

Waterbirth International is a respected source of information, referrals, education and inspiration for mothers and practitioners all over the planet. My travels for lectures, workshops, classes and educational trainings have taken me to 52 countries. The night I gave birth to my son, Samuel, I never dreamed that the message of gentle warm water for labour and birth would be so sought-after and accepted on a global scale. If we want a gentle peaceful earth, it must begin with gentle peaceful birth.

(Barbara Harper is a registered nurse, certified labour doula, certified childbirth educator, midwife and certified kangaroo mother consultant.

She is the founder of Waterbirth International Lighthouse Point, Florida)

Hypnobirthing

COVER STORY

Experience the

joy and magic of

hypnobirthing Hypnobirthing is another way of childbirth which gives relaxation. Hypnobirthing does not mean that you will be in a trance or a sleep. Rather, you will be able to chat and be in a good spirit. Totally relaxed, but fully in control, you will always be aware of what is happening to you and around you. Most importantly, you will learn how to put yourself back in control of your birth rather than blindly turning your birthing experience over to your doctor or midwife. With hypnobirthing, you’ll discover that severe pain does not have to be an accompaniment of labour. You’ll learn how to avoid the fears and anxieties you may currently have about giving birth. With hypnobirthing, you discover and experience the joy and magic of birth. In an interview with Future Medicine, Dr Sunil Prakash, founder of California Hypnosis Institute of Delhi, talks about hypnobirthing and its specialities

By Sumithra Sathyan

What is hypnobirthing and how significant is it?

Hypnobirthing is a complete birth education programme that teaches simple but specific self hypnosis, relaxation and breathing techniques for a better birth.

Hypnobirthing does not require any particular belief system or prior experience. Some of our mums (Especially their husbands) have been very skeptical at first - until they experience it for themselves. In fact, the more skeptical they are to start with, the more evangelical they are when they discover the power of hypnobirthing. Just imagine welcoming each surge! Feeling peaceful... relaxing... and even smiling as your baby comes closer to you!

In short, hypnobirthing allows

you to experience birth in an atmosphere of calm relaxation, free of the fear and tension that prevents the birthing muscles of your body from functioning as Nature intended them to.

Can all women undergo this style of birthing?

Yes, every woman must undergo this type of birthing system. It is common and most successful.

What is the peculiarity?

Here are the things you will learn that are not covered in most antenatal classes.

• Breathing techniques that actually help the birth (It’s not the panting that most people think they have to do. Think about it- why should anyone want to hyperventilate during labour?)

May 2013 I FUTURE MEDICINE 25

COVER STORY

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Hypnobirthing

How to massively reduce the need for any medication at all How to reduce your risk of needing an episiotomy during birth with a stunningly simple massage technique How to be confident and informed when dealing with the medical staff - when to question, what to ask...and when it’s time to let them take charge How to release any fears you might have about childbirth... regardless of where they come from How to bring about your own easy start of labour with these simple, natural techniques, if you go beyond your “estimated due date” Most importantly, you should know how to relax and stay calm and in control regardless of what’s happening around you

Hypnobirthing is designed as a structured but informal class format that teaches about the physical, emotional and spiritual aspects of birth. You’ll learn why your body does what it does, as well as how.

In addition to classes, you’ll receive a professionally produced 196page textbook “Hypnobirthing: A Celebration of Life”, a relaxation tape or a CD set, and numerous 26 FUTURE MEDICINE I May 2013

that you may reveal some aspects of yourself which you normally keep hidden, the reactions of people around you to how you are coping, the welfare of you and your baby.

Dr. Sunil Prakash, Hypnotherapist, Founder of California Hypnosis Institute of Delhi weekly handouts..

If so, how do you help her undergo hypnobirthing?

As has been stated earlier, hypnosis, specially self-hypnosis, plays the most important role. We boost the moral of the birthing mother and she does wonder in spite of being week or ill medically.

Our hypnotherapy classes acts as

the medicine for her. The stresses of labour can motivate you to work with them. They may release energies within you that you hadn’t previously recognised and it will help you cope with the birth experience.

Childbirth stress appears in many forms. Pain associated with uterine contractions, concern about coping with pain, the possibility

These are just a few of the stresses associated with childbirth.

Each woman reacts differently. In labour, levels of stress have the potential to be high depending on how pain and anxiety are managed.

Relaxation techniques are designed to reduce muscle tension and ease the pain and stress of childbirth.

They are not difficult to learn and many women find them useful in other stressful circumstances too.

Learning how to relax offers several benefits.

During pregnancy, many women find that relaxation helps them get off to sleep at night and to have a rest during the day. Relaxation techniques help you cope with the

physical and emotional stresses of labour in various ways. Relaxation is known to have effects on the sympathetic nervous system, which may assist the labour process. By relaxing in between contractions, many women find that they can face the next contraction with renewed energy. Relaxation also reduces muscle tension and so helps counteract fatigue. After the baby

is born, new parents find that life after delivery is hectic, demanding, and tiring. Relaxation can also make baby’s feed time more enjoyable.

After all, a relaxed mother is more likely to cope well with the stresses of early parenthood.

Hypnobirthing -The Mongan Method is as much a philosophy as it is a technique. The concept is not new, but rather a “rebirth” of the philosophy of birthing as it existed thousands of years ago and as it was recaptured in the work of Dr Grantly Dick-Read, an English obstetrician, who, in the 1920s, was one of the first to forward the concept of natural birthing. Over a period of time, we have been conditioned to believe that birth is a traumatic and painful experience. Most women nearing birth have constant worry about the amount of pain, their own inability to deal with it and also the constant fear of well-being of the baby. All this anxiety leads to increased levels of catecholamine, which ultimately causes increased pain during labour. The method teaches that, in the absence of fear and tension, or special medical circumstances, severe pain does not have to be an accompaniment of labour.

Hypnobirthing does not promise painless birthing though many hypnobirthing mothers do report having a relatively pain-free birth or one that they were able to manage easily.

How do you make it a ‘new option’ of delivery?

I am a healer and consider that when God has created our body then he must have thought about its fruitful use. My purpose to practice is to inform and advocate the childbearing moms not to play with nature and let accept what nature has made for us. This natural birth has been for ages, then why play with it now.

Have hypnobirthing babies any specialities?

Yes. We find that babies born using hypnobirthing tend to be calmer, feed better, sleep better and experience less trauma, because they are gently and calmly breathed into the world at their own pace.

Scientific research has also shown that the babies usually have higher Agpar scores as well (A measure of how well your baby is doing immediately after the birth, and then

five minutes later).

Husband’s role?

Instead of your husband or partner being a helpless onlooker, he become a central part of the birthing process helping you stay calm and focused on the techniques you’ve been taught. As a result, the fathers feel proud to have been able to help and to be an active part of the birth.

Imagine how close that makes them feel to you and the baby!

Dr. Sunil Prakash is a past Life Regression Therapist, Theta Healer Institutions. He worked with FMS, Delhi , Hypnosis Motivation Institute, US, California Hypnosis Institute, California , US, HypnoBirthing Institute, US, Tasso Institute, Netherlands,ThetaHealing Institute of Knowledge, US, Academy of Hospital Admn, Noida.

Can a pregnant woman who has some medical problems undergo hypnobirthing?

Unless there are congenital problems or some real serious gynec problem where the child cannot be given birth by normal means, everyone can undergo hypnobirthing.

Any challenges in future?

No challenge. It is a challenge in itself. Birthing moms have to understand the need for the natural birth and not to fiddle with what nature has created. They have to change their thought process. They have to insist on natural birth if they want their child to be normal, intelligent and strong.

May 2013 I FUTURE MEDICINE 27

COVER STORY

Expert Comments

‘Prepare for various bodily changes’ For a woman, joy of motherhood is tinged with the apprehensions the first time. To get full pleasure out of the experience, we need to prepare the expectant mother for various bodily changes she may undergo during the period. We need to encourage a healthy and active lifestyle. Proper attention has to be paid to nutrition and a regular experience schedule. Immunisations and health measures like use of folic acid in the first three months are vital. Colourful fruits and vegetables, proteins in adequate quantities and avoiding fat are important. Regular medical examinations by qualified gynecologists are necessary to monitor pregnancy. It is best to stay away from use of alcohol and smoking.

Dr Loveleena Nadir, Senior Consultant, Gynecology, Fortis La Femme, New Delhi

‘Caesarean rates need to be reduced’ What is needed is to reduce caesarean sections, but what can be done for that is not yet clear.

All patient managements can be put under strict protocols, so there will not be much pressure on obstetrician and it may reduce the caesarean rate.

Dr K K Gopinathan, Executive Director, CIMAR Hospitals, Cochin

‘Maternity has undergone complete transformation’ Our pathway ensures that women are seen through the pregnancy, labour and postnatal period only by midwives. This reduces the risk of interventions and we feel that unless women particularly want an epidural or continuous electronic fetal monitoring, they will benefit from our care. Caesarean rates now fall between 19 per cent and 25 per cent, induction of labour for post-term women is less than 14 per cent and our VBAC success rates are 68-75 per cent. Waterbirths are now around 67 per cent and the use of pethidine is less than three per cent.

Kathryn Gutteridge, Consultant Midwife and Clinical Lead for Low Risk Care.

Helen Giles, Manager of Serenity and Halcyon Centres, the UK 28 FUTURE MEDICINE I May 2013

COVER STORY

Postpartum Depression

Psychiatric disorders

after childbirth

Postpartum blues It appears that about 50-85 per cent of women experience postpartum blues during the first few weeks after delivery. Given how common this type of mood disturbance is, it may be more accurate to consider the blues as a normal experience following childbirth rather than a psychiatric illness. Women with the blues commonly report mood swing, tearfulness, anxiety and irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last a few hours or a few days.

Postpartum depression PPD typically emerges in the first two-three months after delivery but may occur at any point after delivery. Some women actually note the onset of milder depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times in a woman’s life. The symptoms of postpartum depression include depressed or sad mood, tearfulness, loss of interest in usual activities, feeling of guilt, feeling of worthlessness or incompetence, fatigue, sleep disturbance, change in appetite, poor concentration and suicidal thoughts.

Postpartum psychosis Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1-2 per 1,000 women after childbirth. Its emergence is often dramatic with the onset of symptoms as early as the first 48-72 hours after delivery.

The majority of women develop symptoms within the first two postpartum weeks. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganised behaviour

During the postpartum period, about 85 per cent of women experience some types of mood disturbance. For most the symptoms are mild and short-lived.However, 10-15 per cent of women develop more significant symptoms of depression or anxiety. Postpartum psychiatric illness is typically divided into three categories: Postpartum blues, postpartum depression and postpartum psychosis.

While postpartum blues is the mildest, postpartum psychosis is the most severe form of psychiatric illness 30 FUTURE MEDICINE I May 2013

How to prevent PPD Patients with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in this area.

Clinical evaluations for postpartum mood and anxiety disorders are medication management, consultation regarding breast feeding and psychotropic medications, recommendations regarding nonpharmacological treatments and referral to support services within the community.

(Latest report of The Massachusetts General Hospital Center for Women’s Mental Health)

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BEAUTY CARE

Take extra care of skin

during pregnancy

Pregnancy is a stressful time for women. Pregnancy hormones bring about enormous changes to almost every part of a woman’s body, including skin. Mamma-to-be needs to adjust daily skincare to ensure that she feels and looks great. Here are some tips to keep your skin fresh and healthy during the gestation period Check the suitability of your normal beauty products

The first thing to do when you find you are pregnant is to check the products that you use normally.

You may find that some products are unsuitable for the skin. Switch to products which are suitable for use during pregnancy.

Avoid using soap

Soap removes natural oil from the skin, so try using a moisturising body wash instead. This will maintain the essential oil in the skin and make it glow.

Don’t spend too long in the bath

Prolonged contact with water dehydrates the skin and leaves it looking dry and dull. To avoid this, use a moisturising bath soak to rehydrate the skin.

Drink water

Drink lots of water. Water is a natural cleanser of the skin as it flushes out the pollutants from the system.

Take extra care of your face

Some women find that their skin becomes oilier during pregnancy. Use a high-quality, pregnancy-safe, facial cleanser to help even things out.

Get good sleep

Sleep is found to have a great effect on the health of the skin. A person who sleeps contently is found to have a glowing skin and the same applies to pregnant women too.

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We always neglect the need of proper dental care which leads to oral cancer, gum diseases and related ailments. According to a study report, almost 48 per cent of cancer cases in the country are of oral or mouth cancers. For keeping a happy smile always we have to think seriously about oral hygiene...

May 2013 I FUTURE MEDICINE 33

DISEASE SPECIAL Dental treatment

Computer guided dental surgery simplifies the treatment process. It increases the accuracy of the procedure to fix dental implants as dentists are able to predetermine the best possible site for implant insertion. This can be very reassuring for the patients, especially those who are nervous or anxious about having dental treatment

Dr Rajkrishnan Chandrasekharan, Dental Specialist, Dr Rajkrishnan’s Dental Clinic, Tripunithura

34 FUTURE MEDICINE I May 2013

Computer guided dental surgery

giving a facelift T

ooth is an important feature of the human body and that tooth loss is a major concern. Besides chewing, teeth help keep steady jaws and gums in place. Tooth loss also affects speech and appearance. Tooth loss leads to change in dimension of the face causing wrinkling of facial skin around the mouth. So, replacement of the lost tooth is inevitable.

The replacement options are classified into tworemovable and fixed. The removable dentures are conventional, uncomfortable and obsolete while the fixed replacement option is more acceptable as it is less bulky and more comfortable. They could be either bridges or implant supported prosthesis. Bridges were the earlier fixed option whereby the teeth adjacent to the missing tooth area are trimmed in all dimensions and are used as abutments to support the bridge. The disadvantage is that you are abusing adjacent teeth to restore the missing one and also it is difficult to keep the underside of the bridge clean which leads to poor oral hygiene, gum infection and decay of

adjacent teeth.

The dental implant supported prosthesis is the most modern, scientifically proven and hygienic.

This involves replacing missing tooth with a titanium screw, this substitutes the tooth root and integrates with the bone [osseointegration]. Like tooth root,dental implants are secured in the jaw bone and are not visible once surgically placed. The crown or the prosthesis is secured on to the implant to replace the missing tooth in the mouth.

For the best of the results with tooth replacement with implants, case selection and treatment planning are of utmost importance. Most of the implant failures occur due to lack of proper case selection and treatment planning. Earlier, the treatment planning was done with clinical examination, study models and X-Ray images. The radiographic imaging is compromised as it shows only two dimensions and does not give anyinformation on the third dimension.

It also does not reveal the precise information on bone quality and measurements. The professionals end up with problems in getting the final restoration (crown) in proper alignment and occlusion. Besides, there were risks of encroaching onto the vital

May 2013 I FUTURE MEDICINE 35

DISEASE SPECIAL Dental treatment

structures like nerves, blood vessels and sinus chambers.

All these shortcomings are eliminated in dental implantology with the advent of computer guided implant surgery. A dentist can now see the placement of dental implants in the jaw bone in three dimensions. This eliminates the guess work involved and determines which part of the jaw bone offers the best sites for dental implant. It also allows dentists to create permanent restoration prior to surgery and place the restoration on the day of surgery. Computer guided implant surgery provides greater patient satisfaction and simplifies the dental implant treatment process.

This revolutionary system offers a more accurate and safer positioning of dental implants and provides the patient with a proper functional teeth and greater aesthetics. This technology 36 FUTURE MEDICINE I May 2013

enables your doctor to get an advanced, detailed look of all the sections of the jaw bone, surrounding tissues and the nerves.

The procedure The patient’s mouth is clinically evaluated and the routine study models are made. On the study model, a scientific model is created. The radiographic looks similar to an acrylic denture which replaces missing teeth. The teeth are aligned on this in the same manner that we want the final implant supported restoration to be aligned.

The scientific model is tried in patient’s mouth to confirm that it fits into the mouth passively.

The patient’s jaws are then scanned with a CT machine(Dentascan)with the radiographic template in place and in occlusion. The scanned image is evaluated with the help of an imaging software in the computer. The most popular guided surgery

imaging software available is ‘Nobel Clinician’ developed by The Nobel Biocare, Sweden.

The features in the software help the dentist to understand bone density and to make proper measurements. It helps the dentist to see the jaw bone in three dimensions and in various sections. There will be a clear understanding on the exact locations of the vital structures like blood vessels, nerves and sinus cavities. The exact available height and width of the bone for implant placement can be assessed. This also helps him choose the size and length of the implants, abutments well before the surgery. He can also have the prosthetic restoration designed on the software at this stage. Based on the design made by the dentist, a surgical stent (template) is made which can be fitted in the patient’s mouth. It will be a near replica of the radiographic template made earlier but with metal sleeves in corresponding sizes of implants chosen and in corresponding locations each implant is planned to be placed. The surgical stent is tried and placed inside the patient’s mouth and secured by the anchor pins. The guided surgery drill kit is different from the regular implant drill kit. With these special drills, burr hole are made in the pre-designated spots guided by the sleeve. The sleeves are positioned in such a manner that the drills will not go further in terms of length and width than the predetermined ones. The chosen implants are placed in these burr holes through the sleeves in the surgical template and screw tightened. The surgical template is then removed from the patient’s mouth. The planned prosthesis can be screwed on to the implant.

The highlight is that this is incision less surgery as there is no need to raise the flap to place implants. There is minimum bleeding and minimum post op pain,swelling and discomfort. The healing time is reduced considerably.

May 2013 I FUTURE MEDICINE 37

DENTAL CARE

Dr Ravi R Hebballi Consultant Oral & Maxillofacial Surgeon

Healthy diet to avoid

tooth decay T

ooth decay is one of the most common disease affecting teeth. It can be very painful and unsightly, and may lead to tooth loss if not treated. Tooth decay is preventable and manageable if detected early. Teeth which are badly damaged and destructed due to decay may not be saved sometimes but other options for their replacement are available.

A tooth is made up of crown and root portions. The crown is what is seen in the mouth and the root is hidden in the bone. The roots hold the teeth in position and help in functioning of the teeth.

The crown portion is made up of outer enamel, inner dentin and the inner most dental pulp. The white visible section of the teeth is called the enamel. It is made up of minerals, especially calcium and phosphate. The bacteria in our mouths produce acids when they break down carbohydrates. In the presence of these acids, some of the 38 FUTURE MEDICINE I May 2013

calcium within the enamel dissolves and is lost from the tooth surface. This process is known as demineralisation.

When demineralisation happens, it causes dental decay. Superficial damage to tooth can be repaired at this stage.

Dental erosion is the irreversible loss of tooth enamel and the dentin which are dissolved away by the acid in the diet or outside factors like gastric acid from vomiting. In severe cases, erosion can lead to total destruction of tooth.

Diet and dental health Diet plays a significant role in both dental caries and dental erosion. Good nutrition prevents many dental problems and is important from the outset. A balanced diet throughout childhood and adulthood is good for teeth and also for general health.

Sugar intake and its frequency are causing tooth decay. Small quantities of sugar consumed

frequently over a period of time will cause more damage than the same quantity consumed on a single occasion.

Fluoride and dental health Fluoride makes tooth enamel harder and more resistant to acid attack. It also affects plaque by reducing acid production. Fluoride occurs naturally in water in some parts and is sometimes added in fluoridation schemes. High fluoride intake however can result in fluorosis (white flecks in the surface of the tooth enamel).

Tips for good teeth Apart from regular brushing and flossing and frequent dental checkups, the following dietary measures can help minimise tooth decay and erosion: • •

• •

Avoid eating sticky and sugary food between meals Avoid eating sugary food over extended periods. For example, eat a whole chocolate bar in one go rather than constantly eating it over a long period Preferably eat raw vegetables, fruits, or whole meal bread as snacks Don’t have anything except water after you’ve brushed your teeth at night

The teeth of children below six years, and the elderly are particularly vulnerable to dental decay. In children, the tooth enamel is still being developed and is relatively soft and in the elderly, the tooth enamel is worn and brittle.

Do not wait for pain to tell you to see a dentist. Dental decay starts much earlier than when toothache sets in. Catch those cavities early and keep shining and keep smiling!

May 2013 I FUTURE MEDICINE 39

DENTALCARE INNOVATION Dentcare Dental Lab

Dentcare: Surprising saga of success It was a journey from the miseries of life to prosperity, guided by the grace of the Almighty. John Kuriakose, founder and owner of Dentcare Dental Lab Pvt. Ltd, made the best use of the lessons he gained from his distressing past. Having started in a small room, he has now moved to a multi-storied laboratory. This shows his dedication to his work and positive attitude. The lab is of superior quality, has excellent product range, best-in-class technology and state of the art manufacturing process

J

By Prashob K P

ohn Kuriakose’s family was very poor that they found it difficult to make both ends meet. Adding to their woes, John’s father and grandfather were mentally deranged.

His mother was worried about whether the kids get afflicted with the mental disease which appeared to be hereditary and the kids were even an object of ridicule at school and in the neighbourhood. They were called sons of mad Kuriakon (“Bhranthan Kuriakon”).

John completed his SSLC and was forced to work as a rubber tapper to support the family. The family was socially isolated. Dejected mother thrice attempted suicide. Young John was disappointed and desperate. The future was blank.

At this struggling times, his mother attended Prof M Y Yohannan’s Christian Revival Fellowship and 40 FUTURE MEDICINE I May 2013

continuously attended the prayer meetings there. Though there were serious objections from the church against this and an attempt to ostracise the family, they stead fastly went ahead with Fellowship.

For the first time the family had a glimpse of peace and happiness. This came as a turning point in the life of John. There was hope and strength of faith. John was filled with enthusiasm and determination.

While working as a rubber tapper, he wished to have a decent job with a salary of at least Rs 250. But how could a person with just passing marks in the S.S.L.C exam can even dream of such a job? But John earnestly believed in Prof Yohannan’s word that if one leads a sinless life, God would shower on him prosperity and fulfill the ambitions in life. He took this as a gospel of his life. His prayers were

soon answered to his surprise, he was offered the job of an attender at a dental clinic.

At the clinic, he learned the tricks of the game. During the six years at the clinic, he had been exposed to the complexity of artificial dental prosthesis. He had a dream of setting up the best dental lab. There began a sparkling new chapter in his life.

Today, John shares his past with anyone and without any inhibition to inspire and motivate them. He says it was divine intervention that brought about a change for the better in his life. The power to think positively, he says, came from his mother, who had ardent faith in Jesus Christ. Now John Kuriakose is the founder and owner of Dentcare Dental lab, who took a threemember dental lab to a 50,000-square feet world-class dental laboratory.

John says: “I started my career as an attender in a dental clinic.

Considering my sincerity in the job, Dr Reji Mathew, owner of the clinic, promoted me as his assistant, which was an opportunity for me to learn more about dentistry. I noticed dentists struggling with ill-fitting crowns and bridges.

Gradually, I thought of setting up a lab, which could provide quality products to the dentists. I worked hard day and night doing part time jobs to save money to set up a small lab. With the knowledge of six years gained from dentistry, I set up a lab in a small room at Muvattupuzha, a town in Kerala, South India in 1988.”

His brothers came forward to support him. He was very keen on providing quality services to the clients. A few dentists encouraged this venture. He completed the

dental technician course from Balaji Dental College, Chennai and devoted his time to the growth of the lab, and the results motivated him to grow further.

John started to attend seminars and sessions around the world to learn more about the dental scenario and trends. He says: “I started travelling around the world keeping pace with changing trends in technology. I was totally consumed by the passion to set up a lab in India with global standards. I got training from countries like the USA, Germany, Japan, Switzerland, Italy, Sweden, Austria, Denmark etc. The training gave me a deep understanding of techniques and technology of major dental companies like VITA, Ivoclar Vivadent, Shofu, Bego, Degudent, Nobel Biocare, 3M ESPE, Dentaurum etc.”

During the last 25 years, John has attended over 200 training sessions and participated in a number of national and international dental conferences including International Dental Show in Cologne, Germany. He has been honoured with many national and state level awards. John’s family, wife Mrs. Jessy John who is the executive director and chief quality controller of Dentcare, the young buds Joshua, Joel, Job and Jonathan adds strength to all his initiatives Dentcare Group Synonymous with superior quality, excellent product range, best-in-class technology and state-of-the-art manufacturing process, Dentcare Group of dental laboratories is the largest of its kind in India and could be one among the largest few in the May 2013 I FUTURE MEDICINE 41

DENTALCARE INNOVATION Dentcare Dental Lab

State-of-the-Art Lab region. The company is ISO 9001:2008 certified and 13485:2012 certified and has CE marking: 1293. The company will soon be getting FDA and ISO 14001:2004 (Environmental). The 50,000-square-feet laboratory carries out all works related to dental prosthesis. An exclusive export unit of 75,000 square feet will be added this year.

The company has over 9,000 customers, including dental colleges, dental hospitals and clinics. He says: “We have an efficient workforce consisting of skilled dental technicians. All services are supervised by highly qualified

Board of Directors of the Dentcare Dental lab 42 FUTURE MEDICINE I May 2013

chief technicians who have been trained under master technicians from countries like Germany, Switzerland, Japan, US, Italy and Sweden. We have employed renowned master technicians from Europe to bring a global perspective. We also have a group of prosthodontists on our roll to ensure quality.�

Products and Services The products include crowns, bridges, veneers, inlays, onlays etc. The lab offers the best choice in CAD/CAM metal-free prosthesis in India like Lava 3M ESPE (Germany), Cercon Degudent (Germany), Procera Nobel

Indian population is afflicted with various dental diseases.

The accessibility of rural patients to clinic is very low, but things will change soon within the next 10 to 15 years.

DMLS System Biocare (Sweden), and IPS e-max Ivoclar Vivadent (Switzerland). Last year, the company introduced DMLS (direct metal laser sintered) PFM, EOS (Germany). “Our staff are also sent for training abroad frequently. We are ready to invest for quality. The lab has separate divisions for titanium-cast partial, telescopic crowns, Implant supported dentures (Cement Retained Custom Implant Abutment, Screw Retained Crown/Bridge, Hybrid Wrap Around Bridge, Overdenture Bar and Clip, Custom Bar and Clip) and Precision attachments. Complete Dentures and Removable Partial Dentures are from renowned brands like BPS (Switzerland), Sunflex, Bredent (Germany). Vitallium chrome cobalt dentures are also available,” John adds. The lab uses German-made raw materials, which are the best-quality materials in the world. “As far as Dentcare is concerned, we would never use any material which is harmful to the patient. We would never compromise on

quality to beat competition. This makes Dentcare different from others,” insists John.

Dentcare uses modern equipments that are mainly imported from Europe, US and Japan. The registration department uses computer-generated job cards and bar-coding system to ensure complete traceability. All departments are computerised and scanning of each work is done at every stage. “Technology is changing at digital pace and we are very particular about upgrading technology on a continuous basis. We are always one among the first to introduce new technology. Intraoral scanners, model printers etc. are the new mantras in digital dentistry.

I can proudly say that we dare to experiment to setting up a research and development division which is my long cherished dream and I am earnestly working towards that,” says John.

Global Opportunity “Within 10 years, China and India are expected to be the top economies globally. There will be stiff competition between the two countries in almost all fields. China has large-scale production facilities, but a skilled and educated workforce gives an edge to India,” says John.

John says that a major chunk of

Customer Satisfaction The guiding light of Dentcare is the management policy it follows. According to John, “we never compromise on quality. Our aim is to provide best-quality service to our customers. Our strong faith in God and firm commitment to the safety of patients who use our products are our greatest strengths. My employees are my valuable asset and they consider this lab as their second home and we call the Dentcare as ‘Dentcare Family’. If someone enters this field with the sole aim of making money at the shortest possible time, I must say he is misguided. This field needs a lot of patience, commitment and sacrifice.

In the long run, one can survive in this field only by ensuring quality consistently and continuously. Every year many labs get closed”.

John’s immediate priority is to build an export exclusive unit to cater to the needs of dentists in any part of the world. The infrastructure development for this is going on and expected to be completed by 2014. “We want to retain the position of technological superiority. In the long run we will try to emerge as one of the largest and the best labs in the international arena. I still have a dream unfulfilled - It is to set up an international training centre for dentists and technicians and to set up a research and development division to gift innovative dental technology to dental fraternity. I am working towards that goal and I believe it will be materialised with the help of my Lord Jesus Christ,” John shares his dream.

May 2013 I FUTURE MEDICINE 43

DENTAL CARE Dental Tips

Healthy foods to protect gum, teeth Here are some foods that naturally cleanse and brighten your gum and teeth, and also protect them from bacteria Pineapples

Cheese is rich in protein, calcium and phosphorus, all of which can help buffer the acids in your mouth. Calcium and phosphorus also assist in the remineralisation or repairing of your teeth.

Enjoy reduced fat cheese to minimise heartunhealthy saturated fat in your diet.

Ginger

Sesame seeds help “brush” away the plaque on teeth. Chewing nuts can also provide this coarse, scrubbing action.

Sesame seeds also contain bone and teethstrengthening calcium. .

Ginger protects against periodontal disease, an inflammatory process that causes the loss of bone and supportive connective tissue in the mouth.

Ginger can spice up foods while acting as an anti-inflammatory.

Carrots

This vegetable is rich in Vitamin A, which is needed for healthy tooth enamel. Eating them raw stimulates saliva.

Basil

This is a natural antibiotic that reduces bacteria in the mouth.

Basil’s essential oils, rosmarinic acid, linalool and oleanolic acid inhibit the growth of bacteria.

44 FUTURE MEDICINE I May 2013

Cheese

Pineapples can help whiten teeth. Research shows that the enzyme bromelain in pineapples acts as a natural stain remover. Bromelain also helps break up plaque, the sticky film of bacteria that accumulates on your teeth. The bacteria in plaque produce acids that can erode the enamel of your teeth and lead to dental caries.

Sesame seeds

Onions

Onion contains the sulphur compounds, thiosulfinates and thiosulfonates, which reduce bacteria that cause tooth decay. Eating them raw is a must as cooking will destroy these tooth-friendly compounds.

Broccoli

Broccoli is rich in iron, which helps form an acid-resistant film or barrier that can protect the enamel of teeth.

Dental Tips

DENTAL CARE Visit your dentist at regular intervals: Visit your dentist at the intervals they recommend for you. This will be individually assessed based on your personal dental requirements and can be three months, six months, one year, or longer in certain cases.

Use good-quality toothpaste: You

should brush your teeth twice a day with a fluoride toothpaste and floss once a day.

Use toothpaste that is clinically proven to reduce the chances of you getting dental disease.

Use dental floss: Use dental floss to clean in between the teeth where plaque collects. Floss before you brush to remove any plaque from these areas.

Change your toothbrush frequently:

Choose an ADA-accepted toothbrush that has polished bristles because they are less likely to injure gum tissue. Use a softbristled toothbrush with a size and shape that allows you to reach all tooth surfaces.

Replace your toothbrush every three to four months, or sooner if the bristles become worn or tattered.

Eat tooth-cleaning foods: Foods that are firm or crisp help clean the teeth as they are eaten. Include apples, raw carrots, celery and (unsweetened) popcorn in your diet.

Hydrate: Drink about a glass of water

every hour. Water not only helps keep your digestive system healthy and hydrate your skin but it also helps keep your teeth white. The more water you drink, the more bacteria you flush out of your mouth, leading to less risk of gum disease, fewer cavities, and fresher breath.

Avoid sugary foods: Even if you are an adult, avoid sugary foods. Sugar plus bacteria equals oral plaque. Plaque then leads to bleeding gums, tooth decay and cavities, Plus, the acid in refined sugars and carbonated beverages dissolves tooth enamel.

Clean your tongue: Clean the surface of your tongue daily. By using a tongue cleaner, you remove countless bacteria that otherwise live, particularly on the rougher top surface of your tongue. Bacteria can contribute to bad breath (halitosis) and damage dental health.

NEW PRODUCT Collagen Peptide

Collagen Peptide helps prevent osteoarthritis Nitta Gelatin India Limited has come up with a new product called Collagen Peptide which helps control osteoarthritis.

Studies show that oral consumption of Collagen Peptide initiates repair of the damaged cartilage, the soft tissues found in between bones.

Osteoarthritis is the most common form of arthritis caused by mechanical abnormalities involving degradation of joints. Wear and tear, injuries and excessive strain on the joints due to strenuous physical activities are the main causes

46 FUTURE MEDICINE I May 2013

Why is it important to take collagen supplements?

The natural protein collagen distributed to tissues, joints, tendons and skin makes up to 25 per cent of the total protein in our body. This is what holds us together. But our collagen level deteriorates at about 1.5 per cent per year from the age of 25. This is why, as we mature we experience joint ache, and injuries take longer to heal. Therefore, collagen supplements are vital to

such positive physiological benefits becomes possible, it will be an enormous step forward to health.

What is Collagen Peptide?

Collagen Peptide is the hydrolysed form of collagen, a fibrous protein present in the extracellular matrix of living cells. After hydrolysis, the product loses its gelling ability and makes it soluble in cold water.

Collagen Peptide is also known as Collagen Hydrolysate, Gelatin Hydrolysate, Hydrolysed Collagen.

It differs greatly from other proteins as it contains amino acids glycine, proline and hydroxyproline in a concentration that is around 10-20 times higher than that of other proteins. These amino acids play an important role in building fibrous tissues. Insufficient supply of these amino acids results in painful joints, brittle fingernails and hair. Many studies indicate that Collagen Peptide has a preventive and regenerative effect on bones, cartilage, tendon etc. Collagen Peptide also contains all the essential amino acids except tryptophan.

maintain joint health and prevent wear and tear.

In recent years, collagen has been found to physiologically activate the human body. The proper usage of an enzyme that splits the peptide bonds will enable the control of the amino acid sequence involved in the digestion of the collagen. If the intentional ingestion of peptides with amino acid sequences that result in

Who can take Collagen Peptide?

Collagen Peptide is for anyone wanting to stay fit, healthy and prevent joint disease. It is especially useful for those at risk of osteoarthritis such as the elderly, the overweight, sportspersons or those involved in strenuous physical activities and those with past joint injury and a family history of osteoarthritis. It can provide relief to the people suffering from osteoarthritis and arthritic conditions by reducing inflammation, decreasing pain, and improving joint function, flexibility and mobility.

GUEST COLUMN

Ovulatory and anovulatory DUB:

Causes, diagnosis

Dr N P Vijayalakshmy Chief Medical Officer, Vijaya Institute of Medical Sciences

and treatment D

ysfunctional uterine bleeding (DUB) is defined as abnormal vaginal bleeding in women with no clear etiological factor. It can occur at any time of the age between menarche and menopause in ovulatory and anovulatory women.

It is commonly seen at puberty and after the age of 35 years, and, in most of these patients, irregular ovulation is seen.

In normal menstrual cycle, woman loses around 35 ml of blood, which she bleeds within 3-5 days at interval of 28-30 days. In DUB, as much as 80 ml of blood can be lost in each cycle wherein the regularity of the cycle may not be altered but bleeds for more number of days heavily.

In some women, periods become vey irregular and the bleeding is profuse and prolonged where she passes plenty of clots leaving behind the women very anemic.

Most of these women suffer from iron deficiency .Sometimes, interval between cycles is reduced to less than 21days.

The diagnosis of DUB is done by excluding many causes. Pregnancy or abortion is the first one. The other main causes are pelvic pathology, systemic diseases and iatrogenic causes. Fibroids contribute to menorrhagia, depending on its location in the uterus. The other conditions which can be treated are endometrial polyp, cervical polyp, endometriosis and adenomyosis. Pre-malignant conditions like endometrial hyperplasia and carcinoma have o be ruled out. Some of the systemic disorders are hypothyroidism, systemic lupus and erythematosus. Iatrogenic causes are hormones, contraceptives, intrauterine contraceptive devices

and anticoagulants.

When the above are ruled out, DUB can be diagnosed. An anovulatory DUB is mainly due to unopposed estrogen effect on endometrium, sometimes leading to hyperplasic and neoplastic changes. Ovulatory DUB is mainly due to local factors like defect in endometrial process. Treatment can be medical or surgical. Endometrial curettage and histopathology report will help in deciding the treatment. There are different varieties of medicines.

Mainly hormones like oral contraceptives, and progestins in the second half of cycles. Dianazole is a hormone with mild androgenic property.

Anti-fibroneltic agents like tranexamic acids prevent the activation of plasiminogen and decrease the menstrual loss.

Surgical management is to stop acute episode

by D&C (dilation and curettage). Endometrial ablation is an alternative for hysterectomy. There are different types of energy modalities used. Ablation does not involve the removal of uterus. When there is no pathology, endometrial ablation is a good alternative to hysterectomy. This results in short hospital stay, low cost, and early resumption of duties. Hysterectomy, the removal of uterus, can be done through laprotomy or laparoscopy.

In conclusion, women at any age having irregular excessive bleeding with no particular etiology have to undergo investigation and choose proper treatment. Women have to undergo medical and surgical treatment as per the test result.

Dr N P Vijayalakshmy MD, DGO, is the Chief Medical Officer of Vijaya Institute of Medical Sciences, Kadavanthra, Kochi, Kerala

May 2013 I FUTURE MEDICINE 47

GUEST COLUMN

Diane Coffey

Does mother’s status

affect the child’s stature?

Both women’s status and children’s health in South Asia are abysmal. Can a well-defined link be established from women’s status to child health?

This column presents results of a study that uses variation in the status of women in joint rural households to show that children born to lower status daughters-in-law are shorter than those born to higher status daughtersin-law, despite there being no apparent difference in pre-marriage characteristics of parents

I

n the mid-1990s, Ramalingaswami, Jonsson, and Rohde suggested that women’s very low status in South Asian societies likely plays an important role in determining children’s health.

Indeed, 15 years later, both women’s status and children’s health continue to be very poor in South Asia. The under six sex ratio in the 2011 Indian census was 914 girls to 1000 boys, and the most recent nationally representative estimates from India suggest that almost half of children under five years old are stunted, or 48 FUTURE MEDICINE I May 2013

more than two standard deviations shorter than the World Health Organisation’s (WHO) international reference norms for healthy children.

Although it is clear that both the situation of women and girls and the state of children’s health in South Asia are abysmal, it has been difficult to establish well-identified links from women’s low status to child health.

In this column, I discuss my recent research with Reetika Khera and Dean Spears, which uses variation in the status of women in joint rural households to identify an effect of

women’s status on child health. In brief, we find that the children born to lower status daughters-in-law in joint rural households are shorter than those born to higher status daughters-in-law, despite there being no apparent differences in the pre-marriage characteristics of their mothers and fathers.

Women’s status in joint households The Indian joint household typically consists of older parents, their sons, and the sons’ wives and children. Although the majority of households in rural India today

consist of nuclear families, and this has been the case for several decades, joint households are nonetheless common, particularly among households with young children. Indeed, about 11 percent of children under five in the National Family Health Survey (NFHS) three lived in joint households.

is certainly not carefree and without displays of subordination, they can be more at ease in the presence of their husband’s younger brothers, and often have authority over the women married to younger brothers.

Women married to a younger brother are expected to be particularly modest and self-effacing, especially in front of senior males. In many families, these women are expected to veil their faces, sit on the floor, and remain quiet in the presence of their husband’s father and older brothers. While life for the women married to older brothers

First, we used the NFHS to show that women married to younger brothers report having less say in household decisions than women married to older brothers.

Additionally, we used the India Time Use Survey to show that they also spend less time outside on a normal day than women married to older brothers, suggesting that

Joint households are characterised by patriarchy and by age-hierarchy: women are subordinate to men and younger members are subordinate to older members. Older brothers generally have higher status than younger brothers, and a woman’s status is derived by her husband’s status in the household. Women are expected to display subordinate behaviour when they are in their husbands’ homes.

Lower status of choti bahu despite pre-marriage similarities In Hindi, the woman married to the younger brother is called the choti bahu, or “small daughter-in-law,” and the woman married to the older brother is called the bari bahu, or “big daughter-in-law.”

Although status differences between bari and choti bahus are fairly well accepted in the anthropological and demographic literatures, we found confirmatory evidence for this pattern in large datasets from India.

May 2013 I FUTURE MEDICINE 49

GUEST COLUMN Diane Coffey

their mobility is more limited. Finally, the NFHS shows that choti bahus have lower body mass index scores than their higher ranking counterparts.

One might think that perhaps these differences in indicators of women’s status are due to differences in the women before they get married, but we find no evidence of this. Bari and choti bahus have the same amount of education (if anything choti bahus are a bit more educated, likely because they are, on average younger), were married at the same ages and have similar heights. Adult heights, like child heights, are an important indicator of health in childhood, and of genetic height potential. The fact that there are no height differences between bari and choti bahus is an important part of the argument that women’s status is the key difference between bari and choti bahus that leads to a difference in

the heights of their children. We likewise check for differences and find that they also have similar education levels, employment statuses, and heights.

Women’s status and children’s heights We identify an effect of women’s status on children’s height by comparing children living in the same joint household whose mothers are assigned different social status as a result of their marriage to older or younger brothers. Thus, we are comparing cousins who share much of the same social environments, economic resources, and disease environments, all of which importantly influence child health and child height. The analysis also takes into account factors specific to the child and their nuclear family (including, of course, the child’s age).

We find that children of bari bahus are about a fifth 50 FUTURE MEDICINE I May 2013

to a third of a standard deviation taller than the children of choti bahus.

Height differences are apparent across the distribution of mothers’ heights, and when comparing children of the same birth order in their nuclear families. For a subsample of the children we can control for characteristics of their fathers; this does not change the result that children of choti bahus are shoter, on average, than children of bari bahus.

Why these findings matter These findings are important for several reasons.

First, they provide causal identification of an effect of women’s status on child height and human capital accumulation. This has been difficult to show both because women’s status is hard to measure, and because poor women’s status often goes along with

other things that damage children’s health, like low education. Second, they advance a growing literature documenting that human capital is malleable in early life, which is important since early life health insults have lasting consequences. Third, these findings remind us that households in rural India are not unitary decision makers, which makes policy intervention to reach vulnerable women and children particularly challenging.

Diane Coffey is PhD Candidate in Public Affairs and Demography at the Woodrow Wilson School at Princeton University and a visiting researcher at the Delhi School of Economics. She is also co-founder of rice (www.riceinstitute.org), a research organization that aims to improve early life health in India By arrangements with www.ideasforindia.in)

MEDICAL TERM

Placenta previa Placenta previa is a serious pregnancy related problem which may become life threatening for both mother and unborn child. In this case, placenta’s position blocks the cervix–baby’s way out. In normal pregnancy, placenta attaches itself above uterus but in placenta previa, it gets attached to the downside of uterus

Symptoms

Placenta previa does not necessarily show signs until woman reaches 20th week of her pregnancy or even later.

Sometimes, doctors discover it when the woman is taken to the labour room. Bright read coloured painless bleeding during the second or third trimester of pregnancy could be the initial sign of the existence of placenta previa condition. Signs of placenta previa is different from person to person.

Some women may also experience cramp, and slight labour. There are 10 per cent chances that a woman will be wrongly diagnosed with placenta previa and seven per cent chances that the condition exists, signs are there and yet doctors have not been able to timely diagnose it.

Causes

What causes placenta previa is not known. One in 200 women suffer this condition and those who are at more risk are the ones who are giving birth in their advancing age, i.e. women in late 30s and 40s, those who smoke during pregnancy,

women with history of placenta previa in their earlier pregnancies, history of abortion or miscarriage, & cesarean section, multiple pregnancies (exceeding five); history of uterine surgery or irregularities, living in high altitudes etc are some of the causes that may lead to placenta previa.

Therefore, placenta previa causes are also different and can not be limited to a narrow spectrum of problems.

Treatment

There is no treatment for placenta previa, it can only be controlled. Therefore, the woman with placenta previa is generally asked to go on complete bed rest, avoid lifting heavy things and straining physically, and abstain from sexual intercourse. The patient should be admitted to hospital immediately if she is still bleeding. It will help doctor decide whether the condition requires immediate C-section and bring blood loss under control. Taking gestational period into consideration, doctors may also decide to give steroid shots to mother to help grow unborn’s lung.

May 2013 I FUTURE MEDICINE 51

WELLNESS YOGA

Marichyasana (Marichi’s Pose) How to do it: Sit on the floor or yoga mat with your legs extended in front of you. Bend your knees with both shins inward and left leg in front. Keeping your left leg bent, reposition the leg so that the left foot is flat on the floor.

Inhale, raise the left arm, then exhale as you reach the left arm around the left leg while your right arm reaches around from the other side to grab the left hand. (Can’t reach your hand? Grab your waistband or hip.) Keep your head down toward your right knee. Hold for 15, 30 or 60 seconds, breathing regularly. Switch legs and do on the other side.

Benefits: Massages the abdominal organs, stretches the shoulders and strengthens the spine

52 FUTURE MEDICINE I May 2013

Adho Mukha Svanasana (DownwardFacing Dog Pose) How to do it: Begin on your hands and knees. Make sure your hands are aligned under your shoulders and your knees under your hips. On an exhale, turn your toes under and stretch your knees. Reach your heels toward or onto the floor. Keep your head between your arms. Remain in the pose for one to three minutes.

Benefits: Putting your head below your heart reverses gravity and helps blood and lymph circulate.

Parivrtta Trikonasana (Revolved Triangle Pose) How to do it: Consider taking your Yoga-Paws to work and moving your practice into the fresh air. Begin by stepping your feet three-and-a-half to four feet apart. Inhale your arms up to shoulder height, parallel to the ground. Turn your right foot to the right so that our toes point to the front of the mat. Angle your left foot in to about 45 degrees.

Turn your torso to the right.

Inhale and continue turning your torso to the right, leaning over your right leg. Place your left hand on the inside or outside of your right foot or along the outside of your right leg (avoiding the knee). Extend the right arm up and straight out of the shoulder.

Look up at your raised hand or, if that is uncomfortable for your neck, look down at your left hand. Hold for 30 seconds to one minute. Come to Tadasana (Mountain Pose). Take a few deep breaths. Then reverse.

Benefits: Stimulates the abdominal organs and opens the chest to improve breathing. This is best done before you eat lunch.

SEXUAL HEALTH

Sexual pleasure

unlimited

LESLEY STEDMON Sexual health educator, Canada

In our society, we do not see much information on sexual pleasure during and after pregnancy. Seldom the words sex and pregnancy come together and yet ironically sex is what brought us to this point! Here are top 10 ways to maximise sexual pleasure during pregnancy

Listen to your body: The first trimester is exhausting for pregnant women.

Coupled with nausea and breast tenderness, sexual intercourse may be the last thing on your mind! Just as your body and relationship are transitioning, so is your sexual expression. It is never static. Sexuality is fluid and always changing. How we choose to express and feel it makes the difference. This is an excellent time to build intimacy with your partner through touch, massage and enjoying the quietness.

Take advantage of the increased estrogen your body is producing: During pregnancy, a woman’s body produces 150 times more estrogen per day than a non-pregnant woman does in a lifetime. This hormone is mainly responsible for libido, so take advantage of it while you can! The plancenta also makes testosterone which heightens your libido as well.

Lots of lube: Estrogen is primarily responsible for vaginal lubrication.

You may not have to use as much, if any, additional lubrication during sexual play.

Morning delight: Fatigue in general takes its toll on a pregnant woman.

Consider having sexual intercourse the first thing in the morning when you have the most energy. Nothing zaps libido like fatigue.

Try upright position in the first trimester: This will help alleviate nausea as well as avoid extra pressure on very sensitive breasts.

Taste this! The second trimester (usually) brings relief of nausea as well as heightened sensory perception. Your senses of taste, smell and touch heighten. Use them to your advantage during sex play. Oral sex at this point can be amazing, thanks to your increased tactile sensations!

Feeling like “Relaxing�: In the second trimester, your pelvic girdle and other joints will start to relax in preparation for birth, thanks to the hormone relaxin.

This relaxation as your change in centre of gravity due to your blossoming belly puts you at high risk of accidents. Consider sexual positions that keep you safe and grounded like rear entry or woman on top.

Connect. As you enter the third

trimester, fatigue may return, life slows down, and sexual play becomes more about comfort, connection and relaxation. Use this time to nurture intimacy and solidify your relationship for the amazing transitions ahead. Remember that you were a couple before the baby and will need to rely on each other during the beautiful and challenging few months ahead.

The return of libido. The third trimester may bring with it the libido that may have waned over the past few months. Some women report having zero sex drive but most have a raging libido similar to that of a teenage boy. Whatever your speed may be, take advantage of it.

Explore yourself. Take time to nurture yourself and see how your body responds to touch. Your sexuality is fluid and dynamic and pregnancy provides an awesome laboratory to experiment in. You can share your findings with your lover or keep them to yourself to feed your fantasies! Enjoy and make the most of this wonderful experience. Take advantage of your heightened senses and own the power of what your amazing body is capable of!

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, decision-making, 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.

May 2013 I FUTURE MEDICINE 55

Neurological Disorder

Dr Ramkumar Menon

Neurosurgical disorders

Consultant neurosurgeon

causing maternal mortality Neurosurgical disorders are a significant cause of nonobstetric death and disability in pregnant women. The most common neurosurgical conditions are intracranial hemorrhage, hydrocephalus, intracranial tumours, disc rupture and head trauma Intracranial bleed SAH (Sub Arachnoid Hemorrhage) occurs in 10-20:100 000 pregnancies with devastating consequences, with reports quoting maternal mortality rates between 35-83 per cent.

Rupture of intracranial aneurysms (Rupture of the blood vessels) in the brain is believed to occur with a higher incidence during pregnancy. In addition, the risk of aneurysmal rupture rises each trimester, from six per cent in the first trimester to 55 per cent by the third. Presentation is similar to as in the non -pregnant population with sudden onset severe headache often accompanied with preceding sentinel headaches in the previous weeks. Subsequent neurological sequelae range from isolated cranial nerve lesions to a rapid reduction in Glasgow Coma Scale (GCS) and unconsciousness. Most SAHs are thought to occur due to intracranial aneurysms.

Hydrocephalus Pregnancy is associated with an increased rate of VP (Ventriculoperitoneal) shunt complications .This is thought to be due to a combination of increased intra-abdominal pressure and anatomical changes resulting in shunt displacement or occlusion. Management of VP shunt complications will be dependent 56 FUTURE MEDICINE I May 2013

upon symptoms, gestational age and guided by clinical status and imaging.

Primary brain tumours There is no increased risk of developing primary central nervous system tumours during pregnancy and the incidence is around 6 per 100000 pregnancies. Some tumours such as meningiomas may express oestrogen or progesterone receptors and as such rapidly increase in size in the pregnant state. Previously, asymptomatic and undiagnosed tumours, therefore, may become symptomatic due to an increase in size. In addition, immunological tolerance and haemodynamic changes may also result in tumours becoming symptomatic in the pregnant state. Choriocarcinoma , is an aggressive gestational tumour that metastasizes to the brain. Presentation is variable and may include focal neurological defects, seizures or signs of raised intracranial pressure.

Spinal conditions Symptomatic disc herniation is reported to have an incidence of around 1:10000 pregnancies .Hormonal changes including increased concentrations of relaxin and altered body posture are argued to exacerbate previous spinal problems but there is no increased risk of de novo

disc herniation in the pregnant group. 85 per cent of patients with symptomatic disc herniation will get better with conservative management within six weeks. In contrast, women presenting with worsening neurological deficit may require surgical intervention.

Trauma Trauma is another leading cause of incidental death during pregnancy. Trauma in itself complicates seven per cent of pregnancies and may well involve cranial or spinal injury that will necessitate surgery. The parturient involved in a multi trauma will present significant clinical challenges in the care of mother and fetus. The emphasis is on maternal resuscitation and in life threatening multi trauma, caesarean section may be performed to improve maternal haemodynamics.

Fetal compromise may also be the result of maternal hypoxia, hypovolaemia, acidosis, acute blood loss, infection or as a result of drugs used during the resuscitation process.

(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)

LIFE SKETCH Dr E P Krishna Menon

The man who dares

to take on cancer Human medicine and veterinary medicine may be entirely two different streams of science. But here is a man who has treaded the path of both the streams breaking the preconceived notion of treating veterinary medicine and human medicine differently. Meet Dr E P Krishna Menon, a veterinary graduateturned-oncologist and cancer research scientist who has developed nine cancer medicines and also owns four American pharmaceutical companies

By Prashob K P

B

etween animal and human medicine there is no dividing line—nor should there be. The object is different but the experience obtained constitutes the basis of all medicine - Rudolf Virchow, German Pathologist.

58 FUTURE MEDICINE I May 2013

Virchow’s words leads to the concept of “One Medicine”.

This One Medicine approach can be capsulised as the life of Dr E P Krishna Menon, a veterinary graduate- turnedoncologist and cancer research scientist. Holding degrees in human and veterinary science,

Dr Menon developed nine cancer medicines. “The perception that veterinary medicine and human medicine are different is outdated. In both cases, the treatment regimen and methodology are developed through research by a host of scientists and chemists.

The perception that veterinary medicine and human medicine are different is outdated. In both cases, the treatment regimen and methodology are developed through research by a host of scientists and chemists. Veterinarians conduct tests in animals for efficacy and detection of the toxic effects while the clinical researchers evaluate the compound in human subjects Veterinarians conduct tests in animals for efficacy and detection of the toxic effects while the clinical researchers evaluate the compound in human subjects. In modern world, diseases are evaluated at molecular level and the disease progression in all species is similar. In my case, therefore, holding both degrees in veterinary and human medicine is a real advantage,’’ says Dr Menon.

Born in 1946 in the Alappuzha district of Kerala, Krishna Menon wanted a career in business. It was his father, Adv Vasudeva Panicker, who insisted him to join the veterinary college at Mannuthy, Thrissur. After completing the course, he wanted to do higher studies in dairy technology. But unfortunately, it didn’t happen.

Then, Menon joined a veterinary pharma company, Shaw Wallace, as sales representative. Within a year, he was promoted as regional manager.

Shaw Wallace had a football team and Menon was the captain. West Indies cricket team happend to see one of his matches. Francis Alexander, a veterinary doctor, who was in that cricket team, invited Menon to Jamaica. Menon was appointed as veterinary officer there. Three years later, he moved to Cayman Islands as Commissioner of Agriculture. “Working as the Head of Agriculture Department in Cayman gave me an opportunity to look into the problem of a certain condition in dogs and cats. Heart-worm disease is caused by an organism similar to the one causing filariasis in human. I gave the same medicines of filariasis to the dogs and cats at a dosage that is acceptable to the animals. I got the idea from Dr K P D Nair and Dr Jacob Cheeran, Professors at the veterinary college, Mannuthy,“ he said. It was a turning point in his career. Dr Thom Silver, WHO’s Pan America consultant, met Menon to know more about the African Swine Fever which was spread all over at Katie Islands of West Indies. Dr Thom liked Menon’s finding and made a review of the fever. It was Thom who introduced Menon to Dr Tom Frei, a Nobel Prize winning scientist. “My acquaintance with Frei strengthened my decision to become a pharmacologist,” says Menon.

During that time, Tom Frei was the Scientific Advisor to a company called Pfizer. He offered

Menon a job in his firm as a scientist. A bachelor’s degree in BVSC and some work experience in Jamaica were the only plus points Menon had.

Menon came very close to Tom while working at the firm. But within three months, Tom forced Menon to quit the job and took him to Harvard University. Tom made Menon a scientist at his laboratory in Harvard. But as per Harvard’s law, one should have doctorate to work there. As Menon didn’t have a PhD, it was a major challenge before him. But Tom was not ready to give up.

He admitted Menon as a PhD student under his guidance. And it’s the time for Menon to act. He took his first PhD in pharmacology in 34 months.

Foliage mechanism was the research subject of Menon.

In the early days, methotrexate was one of the medicines used for cancer treatment. Tom got Nobel Prize for conducting studies on the proliferating mechanism in methotrexate. Menon also participated in that study. These events help create an interest in oncology. His further studies and research were based on oncology.

With the support and guidance of Frei, Menon took MD. After that, he joined Harvard University as Associate Professor. It was a transition from veterinary science to human science. Soon after leaving Harvard, Menon joined as the head of the lung project at Sandoze, a pharmaceutical company. At that time, the Bayer director invited Menon to his company as the head of the cancer department. Most of his research activities have been conducted at Bayer. After Bayer, he joined Eli Lilly as the head of the oncology department.

During the 12 years of service there, Menon developed different cancer medicines. Among his medicines, Gemzar and Alimta alone bring around 400 crore dollars in revenue per year.

After leaving Eli Lilly, Menon started his own venture, Nanoviricide. In India, it has branches in Pune and Bengaluru. With the support of Frei, he started Cellceuticals in 2008. He is also a visiting professor at four American universities. Menon has been recognised with awards, including Employee of the Year (1998) and Scientist of the Year.

May 2013 I FUTURE MEDICINE 59

Diabetes Treatment

Dr Jothydev Kesavadev, MD CEO & DIRECTOR Jothydev’s Diabetes Research Center, Trivandrum

Diet and exercise

alone not enough

Diet and exercise alone can’t stabilise an established diabetic, but along with medication it can improve the patient’s health condition

M

ore important than drugs are lifestyle modifications for prevention of diabetes and prevention of complications in already established diabetics.

Though diet and lifestyles can be generalised, ideally the advices are customised to each individual based on several physical and laboratory findings.

If one member of a family is diabetic, it will be most ideal for all members of the family to follow the same healthy diet which is low in sugar and low in fat rather than providing separate food for the patient. Apart from the three main meals, the patient should be encouraged to have snacks in between.

Both fasting and feasting will trigger diabetes and its complications. There is a common belief that medication can be avoided even in uncontrolled diabetes if diet and lifestyle modifications are quickly adhered to. In most individuals, this may not work. Since diabetes has a genetic component along with

contribution from environmental factors, medications may be required in the majority along with diet and exercise.

In other words, if blood sugar, blood pressure or cholesterol is unacceptably high, trying to control it with only diet and exercise can worsen the situation.

Exercise is advised on a daily basis for a minimum of 30 minutes. For comparatively younger individuals, exercising on 3-4 days a week may be sufficient. It is better to avoid severe exercise and exercise lasting longer duration. In the prevention of diabetes, avoiding fat and normalising blood pressure and cholesterol levels are critical.

But once diabetes sets in, it is better to completely avoid direct sugars. Fruits may be taken between the meal timings but not immediately after the meals.

However, if the patient has already developed complications in the kidney, then reduction in the intake of protein is also advised, in the absence of which the kidney disease will rapidly progress to the

end-stage kidney disease requiring dialysis.

Importance of cholesterol and blood pressure Type 2 diabetes is a complex disorder, of which abnormal blood sugar is only one of the components. The other two major components include the abnormal lipids and blood pressure which if elevated, has to be aggressively treated and normalised. Medication to control both will also be required for a life time but frequently modified based on laboratory parameters. Medication should never be stopped by the patient themselves when the parameters are found to be normal.

Insulin treatment Insulin was a remarkable discovery which changed the lives of people with diabetes. Insulin is required as part of treatment at some stage of the disease whatever be the type of diabetes. If a doctor feels that a patient should be put on insulin, the patient should never request the doctor not to.

That is the biggest mistake and that alone contributes to the enormous number of complications.

The major fear of insulin treatment is the possibility of low sugar. This could be avoided or minimised with the help of home blood glucose monitoring with a quality glucometer and slowly increasing or decreasing the dosages of insulin.

Several types of insulin are available. There is the older human insulin and the newer analogue or designer insulin.

The long acting analogue insulins are Lantus and Levemir. Biphasic insulin has a long acting and a short acting component: example Mixtard 30/70 (Human insulin), Novomix 30/70 (Analogue insulin). Most insulins have to be taken 15-30 minutes before food. In Type 1 diabetes, the patient should ideally be put on one long acting injection once or twice daily and three shots of rapid acting insulin per day, each one to be given before main meals. Insulin may be injected with the conventional insulin syringes or with pens or pumps. Insulin shots are virtually painless.

Incretins in diabetes Incretins are a new group of medications which had been introduced recently in the treatment of diabetes. Unlike older drugs, incretins have an action on insulin production to reduce blood glucose and on glucagon production to increase the blood sugar value whenever the blood sugars tend to go low. Liraglutide (Victoza) is GLP-1 analogue which is available in pen devices similar to insulin injections.

Unlike the usual insulin injections, Liraglutide will not only normalise the blood sugar values without a tendency for low sugar but will also help loose body weight and normalise the cardio vascular risk parameters.

The major side-effects of these drugs are the occurrence of nausea, vomiting and abdominal discomfort in certain individuals during the initial few days to weeks.

DPP-4 inhibitors or gliptins are oral drugs. Sitagliptin (Januvia), Vildagliptin (Galvus), Saxagliptin (Onglyza) and Linagliptin (Tradjenta) are all popular and available in India.

These drugs unlike the injectable ones will not produce any weight reduction. But gliptins when given as oral therapy or with or without insulin will have plenty of advantages not seen with usual drugs. The major drawback of in cretin therapy is the cost associated with it. Being newer generation drugs, both the oral therapies and the injectables are presently very expensive May 2013 I FUTURE MEDICINE 61

INDIAN HOSPITAL FOCUS Narayana Hrudayalaya, Bengaluru

Ensuring affordable Dr Devi Prasad Shetty is called the ‘king of cardiac care’ and his network of Narayana Hrudayalaya hospitals is an epitome of affordable healthcare in the country.

The group has 17 hospitals with around 5,700 beds. Cardiology, eye, trauma, orthopaedics, neurosciences, dental and cancer care are the specialities under the NH hospital group which is planning 30,000 low cost beds by 2020

By Prashob K P

T

he Indian healthcare industry is moving on the affordability, quality and availability formula.

It is the duty of the healthcare industry to address the needs of urban and rural poor alike. It was Dr Devi Shetty’s vision of affordable healthcare that persuaded him to start Narayana Hrudayalaya (NH) in Bengaluru in 2001. With this concept, he set up a network of healthcare institutes in a short period. The group has now 17 hospitals with around 5,700 beds. Cardiology, eye, trauma, orthopaedics, neurosciences, dental and cancer care are the specialities under the NH hospital group. The group is planning expansion with 30,000 low cost beds by 2020. A visionary leadership, technology driven treatments, strategic management and organisational culture help NH hospitals carve a niche in the country’s healthcare industry.

Henry Ford of cardiac care What is common in Dr Shetty and Henry Ford?

Henry Ford brought mass production to the world with the Model T Ford car at the beginning of the 20th century. Dr Devi Shetty is rewriting the history of cardiac surgeries through his venture Narayana Hrudayalaya. Being a healthcare entrepreneur, Devi Prasad Shetty, founder and Chairman of Narayana Hrudayalaya, is a philanthropist crusader with a missionary zeal. Influenced by the philosophy of Mother Teresa, he blends compassion and care.

His vision is to provide quality healthcare for the masses worldwide.

Known for his unconventional ideas, Devi Shetty

62 FUTURE MEDICINE I May 2013

has innovative solution to most of the ills afflicting the Indian healthcare sector. He believes that if everyone reserves a small amount from their monthly mobile phone bills to a micro insurance health scheme, their healthcare needs will be taken care of. Narayana Hrudayalaya also plans to adopt 2,000 children every year from rural West Bengal and other states and mentor them to become doctors by offering soft loans.

He also believes in the empowerment of paramedical staff involving them in the delivery of care. He proposes an equitable distribution of world class healthcare for the masses at an affordable cost.

Creating focused healthcare factories Rather than being a multi purposed one, Narayana Hrudayalaya focused on specialised ventures with standard facilities. The core competencies, precisely defined by the organisation’s policy and its humanistic approach, are backed by its technological and economic strengths. The institute has adopted a unique formula for lowering healthcare costs

healthcare for all Why we are affordable?

and increasing accessibility. It has created ‘health cities’ with huge capacities in terms of infrastructure. Apart from NH Multispecialty Hospital, NH Devaraj Urs Hospital, NH Hospital, Narayana Cayman University Medical Centre, SDM NH, and RTIICS (Rabindranath Tagore International Institute of Cardiac Sciences) NH, the group also runs Mazumdar Shaw Cancer Centre, one of the world’s largest cancer hospitals with 1,400 beds, in association with Kiran Mazumdar Shaw of Biocon.

It also has dental clinics and diagnostic centres, and the services include academic research, telemedicine, corporate health services, international medicine and stem cell research apart from healthcare, with a special focus on cardiology, oncology, medicine, surgery (general and specialised) and diagnostics. Performing a large number of cardiac surgeries, numerous dialysis at a modest cost, surgeries on children

We believe that low-cost healthcare is the way forward in India and outside. Ten years ago, cost was not an issue for the US hospitals. Today, the US and Europe are struggling to offer healthcare to their citizens. The only way the cost can come down is by economies of scale, wherein hospitals would be doing a large number of procedures utilising the Dr Devi Shetty infrastructure for at least 14-16 hours a day. Today, people retire at the age of 60, but live on to celebrate their 95th birthday. In such a scenario, we have to look at an alternative methodology to fund healthcare.

Healthcare costs cannot be borne out of pocket. It is like somebody availing of an insurance cover for his car.

Put it simply, you can’t afford it. We need a mechanism wherein every citizen of our country can contribute a tiny amount of money every month towards healthcare. When everyone pays a small amount of money, it becomes a huge pile of money which can take care of about 5-7 per cent of the people who need healthcare.

Narayana Hrudayalaya has a different philosophy altogether. Today, when a new hospital comes up, the promoters would tell the employees that this hospital is built for the rich people, but we also care for the poor.

Whereas, when we start a hospital, we tell the employees that our hospital is built for the poor, but we also care for the rich. This is the fundamental difference. As long as we look at the poor people as the main customer of the organisation, the entire concept of low-cost healthcare cannot become viable. We perform the largest number of heart surgeries in the world today. We attract patients from 76 countries. We train heart surgeons from the United Kingdom, the United States and many other Asian and African countries. This is happening because of the numbers. Unless we build large size projects reducing costs, the cost of healthcare will not come down, and quality will not improve.

Excerpts from the interview with Dr Devi Shetty published in Future Medicine 2012 August issue

May 2013 I FUTURE MEDICINE 63

INDIAN HOSPITAL FOCUS Narayana Hrudayalaya, Bengaluru

the world.

and the highest amount of bone marrow transplants at Mazumdar Shaw Cancer Centre in India, the NH group of hospitals is creating ripples in the healthcare industry.

By handling greater volumes, the organisation has been able to prepare its physicians towards greater proficiency levels.

Since the super specialists at Narayana Hrudayalaya hospitals see large volumes of cases and perform no more than two to three types of procedures, they excel in their domain.

Most of these hospitals attain clinical and quality outcomes that are among the best in 64 FUTURE MEDICINE I May 2013

Yeshaswini Insurance Scheme For addressing the healthcare issues of the masses, Narayana Hrudayalaya had launched a micro health insurance scheme, Yeshaswini, in collaboration with the Karnataka state government.

The scheme now has close to four million farmers as members contributing Rs 18 per month. It covers the expenses of 1,650 surgeries. In the first 20 months of the scheme, 85,000 farmers had free medical treatment, 22,000 had free surgeries, and another 1,400 had heart surgeries.

Shetty also founded Arogya Raksha Yojana, a joint venture of Narayana HrudayalayaPL, Biocon and ICICI, to provide free OPD consultation, cashless surgical facility and diagnostics at discounted rates.

A distinctive rural healthcare service, Hrudaya Post was launched with the Karnataka postal circle to enable rural heart patients to scan and send their medical records to Narayana Hrudayalaya for consultation.

Cutting cost from top to bottom Narayana Hrudayalaya scans their each step from the beginning to get the best value for money. The institute critically examines its entire supply chain and process such as the cost of land, the technologies used and the manpower. Narayana Hrudayalaya partners

with the governments and real estate owners to get land at subsidised rates and procure medical technology on lease or convince the vendors to park their machines in the hospital instead of outright purchase and buy consumables from them, thus saving on expenditure.

Thus, Narayana Hrudayalaya is able to commission large-scale projects and scale them up across the country. To attract and retain the best manpower, Narayana Hrudayalaya pays compensation at par with the best. Bulk purchases of all medical stores and consumables, at discounts, directly from the manufacturers and managing all inventory efficiently by eliminating wastage are the norms of the group. Within the Health City, various specialties share expensive imaging equipment and other facilities like laser, cyber knife, blood bank etc. run round the clock instead of 7-8 hours daily, thus increasing asset utilisation.

At Narayana Hrudayalaya, approximately 40 per cent of patients pay a reasonable price for their treatment, a small percentage - those who want the comforts of private rooms pay a premium, the majority pays less than the market rate and 10 to 20 per cent pay virtually nothing. For the needy patients, the hospital’s charitable trust raises money to help compensate for the material costs of their treatment. At Narayana Hrudayalaya in Bengaluru, 40-60 per cent of paediatric heart surgeries are partly funded by charity and donations.

Blending technology, medical care Through telemedicine and other ICT applications, Narayana Hrudayalaya automates processes and shares medical expertise with remote parts of India and other countries. It has migrated to digital radiology for better throughput and image quality. Without IT backing, service industries cannot survive. IT cannot cure, but it can make healthcare safer for the patient.

Thus, by providing healthcare for masses in an affordable manner, Narayana Hrudayalaya hospitals and Devi Shetty are creating a benchmark in the Indian healthcare industry. Looking to the global healthcare scenario, Shetty’s vision is much more different than the rest. His innovational thoughts and ideas create a new path and also inspire other players in the private healthcare space.

‘We cut cost wherever we can’ For maintaining affordable healthcare, we cut expenses wherever we can. Lots of challenges are there. It depends on the way how we tackle it. Right from design and construction, we sought new ways to be economical.

It has kept the design compact, reduced empty spaces and used prefabricated structures.

Also, instead of marbles and expensive furniture, the hospital has Viren Shetty used simple tiles and low-cost seating, reducing the cost per bed to Rs 12-18 lakh. The high cost of infrastructure is a major limiting factor for healthcare providers. To bring down costs, Narayana Hrudayalaya is running the Mysore facility like a startup. Though 2.5 million heart surgeries are required in India every year, only 90,000 are performed. The country needs 2 million additional beds to serve the current needs of the population. Our aim is to add 30,000 beds in small-to-medium towns in the next five years.

All our innovations are based on affordability theory. Shortage of healthcare manpower in India has impacted the cost of human resources, which is increasing.

And hence, every institution of Narayana Hrudayalaya will double up as an academic institution conducting training programmes for a range of medical professionals from cardiac surgeons to sterilisation technicians. People simply do not have the money to pay for the expensive healthcare intervention. So, we should constantly try to juggle to offer services to the poor and make it affordable for people who can pay some money.

Viren Shetty, Senior Vice President, Strategy & Planning

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FOCUS Lakeshore Hospital, Kochi

Making rapid

strides in healthcare Lakeshore Hospital has made rapid strides in the country’s healthcare sector with its 35 clinical departments of international standards, catering to patients from around the world. Located in Kochi, Kerala, the hospital has brought in the latest healthcare technologies and the best medical professionals in the country, in order to ensure its global healthcare standards. As Lakeshore Hospital enters its 10th year in the medical field, Dr Philip Augustine, MD and CEO of Lakeshore Hospital, talks to Future Medicine about the successful journey of the hospital, its specialities and future plans. A leading gastroenterologist and healthcare administrator, Dr Philip Augustine is also known for his expertise in gastrointestinal endoscopy and research in pancreatitis and pancreatic cancer Shalet James How did the idea of setting up a multi-specialty hospital come to your mind?

Before joining Lakeshore Hospital, I had been practising medicine in Kerala for nearly 25 years.

I started my career at Koothattukulam and then for 10 years, I worked in Kochi. It was then in the 1990s and 2000s that technological advances in medical field rapidly happened. Gastroentrology had lot to gain from Dr Philip Augustine 66 FUTURE MEDICINE I May 2013

technological advances. Endoscopy, ultrasonography, CT scan and MRI scan were all coming up and these facilities were lacking in our state and many patients were even referred outside the state for advanced treatment. It was then that I realised world class amenities are very important to boost modern medicine in Kerala. So, the idea of having a world class facility for modern medical treatment came to my mind.

What makes Lakeshore Hospital unique?

I am also a beneficiary of technological advances in the field. When I went to the US in 1984 and got training in abdominal ultrasonography and advanced endoscopy, there was a tremendous progress in the diagnostic possibilities of gastrointestinal diseases. So,

Achievements • • • • • •

First insulin pump therapy in South India Advanced endoscopic training centre for gastroenteroligists from various parts of India and foreign countries, including the US First liver transplant for an overseas patient (from Japan) in Kerala First living related liver transplant in Kerala First liver dialysis in Kerala First bone marrow transplant in Kerala

• • • •

Reputed Oncology Centre of Kerala which pioneered peripheral stem cell therapy in adults and children Ultramodern joint replacement division with India’s first digitally integrated orthopedic operation theatre with airflow guided system Bilateral total hip replacement using ceramic head with metal liner for the first time in Asia First centre in Kerala, second in the country and third in the world to perform keyhole kidney transplant

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FOCUS Lakeshore Hospital, Kochi

I wanted to bring such world class facilities here. We brought in the best professionals to head our departments and also brought advanced technologies for the first time in the state. We were also the first to conduct live donor liver transplant in Kerala. We were the first to utilise insulin pump in South India and did joint replacement surgery using metal-onceramic technology for the first time in Asia.

Tell us about the world class facilities provided at Lakeshore?

We knew that patients will come from overseas for treatment here, so we have provided world class amenities in the hospital, right from multinational cuisine up to the latest available medical technologies like cardiac electrophysiology, including global monitoring, for the first time in the state.

Other advanced treatment facilities include liver transplant, kidney transplant, bone marrow transplant and endoscopic facilities, including double balloon enteroscopy, wireless capsule endoscopy and spyglass cholangiopancreatography. Neurological facilities like pinhole procedures for aneurism clipping, advanced urological procedures, including keyhole kidney transplant, are available exclusively at Lakeshore. We have many facilities to detect cancer in its early stages and effectively treat them.

What brings the patients to Lakeshore Hospital?

Lakeshore Hospital is known for its fast track services, quick diagnosis and quick treatment. People choose Lakeshore Hospital for these reasons. World renowned medical 68 FUTURE MEDICINE I May 2013

faculty and infrastructure are the other factors. It is not an over statement to say that Lakeshore is a brand name in healthcare in the country.

Any plans to expand Lakeshore or its facilities to other parts of Kerala or India?

We are upgrading the facilities on our present premises adding more beds and other facilities, including a dedicated international wing for overseas patients, a wellness centre and a state of the art cancer centre. Once it is completed in two years’ time, we would be establishing hospitals in various cities in Kerala. We also have plans for extending our services to the Middle East.

The role played by Lakeshore in promoting medical tourism?

As there is an increase in the number of patients from abroad, the hospital has introduced a special cell that functions exclusively to take care of their needs. For further expansion, we had also conducted international conferences and exhibitions regarding medical tourism in association with the Kerala government, Kerala Tourism Department and the Confederation of Indian Industry (CII), so that we could bring under one umbrella all the major hospitals in the state, especially those with NABH accreditation. As Chairman of the healthcare sub-committee of CII Kerala, I was instrumental in successfully conducting three such international conferences. Lakeshore is proud to be in the fore front of medical tourism in Kerala.

FOCUS Kerala Medical College and Hospital, Palakkad

Committed to providing

quality treatment to poor

Kerala Medical College and Hospital, located at Mangode, Palakkad, was started with the aim of providing quality treatment to the financially weaker section of society. The hospital is run by a public Charitable trust with Dr P A Nazar as chairman and managing trustee. In an interview with Future Medicine, he talks about the problems faced by the medical college and the role played by the common people in aggravating it Bureau

What are the objectives of the trust?

It is a public charitable trust, registered in 1994.

Dr P A Nazar

There are six trustees, of whom I am the only medical professional.

Our motto is to run a charitable hospital, where the best medical facilities are available at a very reasonable price.

Since running a hospital is highly expensive, how do you deal with cost cutting?

Our primary intention is to help people by giving the best treatment at a fair price. The people realise this and so they prefer our services to other hospitals.

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FOCUS Kerala Medical College and Hospital, Palakkad

More patients would mean more business for us. We give medical treatment to the needy in society, and our name has been popularised by word of mouth alone. The real purpose of the hospital has been understood by the people and that has helped us in maintaining our high level of standards.

There is a general apprehension that most medical colleges do not have adequate number of patients to be called medical colleges. What is your opinion?

The apprehension is warranted. It is no secret that many hospitals are manipulating their records. But, then the laws are differently applicable to private colleges and government colleges. Some government medical colleges lack the infrastructure stipulated by the Medical Council for the number of seats they have, and yet these colleges survive, while many private medical colleges with far better infrastructure are refused recognition, citing invalied reasons.

Laws should be equally applicable to everyone.

What are the main problems faced by the medical sector in Kerala?

Ignorant patients and inexperienced doctors are the two greatest dangers in the field.

Experience can be gained through treating more patients, and many doctors are being trained often under the guidance of faulty faculty.

Nowadays, people indulge in ‘doctor shopping’ by running to different specialist doctors for simple ailments. The problem with specialists is that they would view an ailment only from their field of expertise and the patient ends up undergoing all sort of tests and thereby

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incurring heavy expenses as well.

What are the recent trends in the field?

One is family medicine and the other is geriatric medicine. The population of old people is increasing and the Medical Council of India is encouraging hospitals to start courses in geriatric medicine. Another recent trend is the keyhole surgery where the patient can expect minimal stay in hospital. People want expert care with minimal intervention and minimal hospital stay. In some cases, keyhole surgery is the best, but certain surgeries, like the one for hernia, are best done under supervision.

Could you tell us more about the hospital?

The hospital is situated in 35 acres of land with plenty of scope for more expansion. We are looking at the possibility of expanding it with medical tourism. Currently, we have 2,40,000 square feet of building space. We are focusing on trauma, orthopaedics, gynaecology and general medicine. The construction of the college building and hostel is going on.

Apart from your profession as doctor, how have you been involved in helping people in the medical field?

I have been writing in magazines and newspapers about the various myths and misconceptions in the medical field and also running campaigns to educate the people about them. I have authored two books dealing with general health of adults and children. We believe in charity and in helping thousands of people who are financially backward, and we are doing our best to achieve that goal.

FOCUS Poonthottam Ayurveda Ashram

Reclaiming real Ayurveda;

turning doctors into healers Poonthottam Ayurveda Ashram is located in the serene, rural atmosphere of Kulakkad, near Cherpulassery, in Palakkad district, Kerala. It is ideally situated amidst the lush greenery of herbs on a calm landscape.

Accessible to people belonging to all categories, Poonthottam Ayurveda Ashram has been paving the way for restructuring the principles of Ayurveda as it was during the ancient times.

Chief Physician Dr Raveendranath talks about the misconceptions that have hindered the growth of Ayurveda in India and about his hopes of a turnaround in the near future Bureau

What are the reasons for the malpractices in the field of Ayurveda?

As a student belonging to the third batch of Coimbatore Ayurveda College, I was fortunate to be a part of a batch that followed the gurukula

Dr Raveendranath system, which, to me, is the best system of education. Nowadays, there is severe dearth in quality of teachers, which has thrown the entire system into disarray – the colleges simply cannot maintain the standards needed to give quality education in

Ayurveda. The root cause of it all is the inefficiency of our school education system, which bars the students from understanding the greatness of Ayurveda medicine all the way till PlusTwo. Modern medical science has scientific explanation for its efficacy and they argue that Ayurveda does not have such a system. What do you think of this?

Scientific approach is different for the two, and the two follow different basic principles.

Ayurveda follows an accurate research methodology set down

by Charaka, but modern-day science follows a completely different path of research.

Why are present-day Ayurveda practitioners unable to bring about further growth in the field?

A major reason is that the physicians have kept away from practising medicine. In the current system, the role of the physician is only to decide on which sort of treatment is to be used; he is not involved in the actual application of the treatment process. This was not so in the classical period when the rule was that those who May 2013 I FUTURE MEDICINE 71

FOCUS Poonthottam Ayurveda Ashram The healer is always within you. The treatment process is all about helping that healer to deal with your body and mind. Our duty as physicians is to create an environment suitable for this healer to act in the perfect manner – Dr P M S Raveendranath, Chief Physician supervised; it has to be given by the physician to the patient.

What are the treatments you give here?

Any specialisations?

We have no specialisations. We receive all sorts of patients, and we give all sorts of treatments except Shalya Chikitsa.

have not learnt Ayurveda should never practise it and those who have learnt Ayurveda should never keep away from practising it.

Have you had to make compromises with your treatment methods?

Earlier, we used to give the raw materials to the patients who then prepare the ‘Kashaayam’ in their homes. However, not many are willing to take all that effort these days.

So, I had to go back to preparing the ‘Kashaayam’. From last year, ‘Kashaayam’ is being given in the form of tablets, which is a deviation from the classic method of treatment.

Not following the ‘Tridosha concept’ is another limiting factor to Ayurveda?

No, the ‘Tridosha concept’ is a complete and comprehensive concept. Of the three ‘Doshas’, ‘Vata’ means movement, ‘Pitta’ means transformation, and ‘Kapha’ means stability. Life cannot exist beyond these three factors. The three ‘Doshas’ can be interpreted in various ways, 72 FUTURE MEDICINE I May 2013

and, through their interpretation, the concept deals with everything involved in life. So, there is no need to disregard the ‘Tridosha’ concept.

The younger generation these days mostly looks for guaranteed employment prospects and opts for a doctor’s job in a hospital. What made you choose this different path?

I would say that I never had the inhibition of tradition. I say inhibition, and not advantage, because, following tradition often has got more inhibitions than advantages. Even before joining the course, I used to be a pupil of a reputed physician.

While I was a pupil of this physician, I could witness a lot of undesirable elements that have crept into the practical application of Ayurveda.

The two things that I follow, as a rule, are the two things that my teacher never did – that is, making own medicines, and the physician treating the patient personally. I believe that it is the physician who should be the one who treats. Healing can never be

What are your views on medical practice degenerating into business?

My chief aim is to mould a generation which would enter into medical practice after understanding the humane side involved in it.

Here, the Ayurveda students who have completed BAMS are given training on treatment process, and the transformation of these students from being a doctor to a physician is the greatest service rendered by our institution. The advantage of treating the patient by the physician himself is that the physician gets better insight into the treatment method which cannot be derived from textbooks alone. Only through this method will Ayurveda develop further.

Do you prepare your own medicines?

Yes, we do. We have a herbal garden, and a herbal forest spread over two acres. Medicines are prepared exclusively for our own use.

One of the first decisions we made was that we would never market our medicines, because marketing creates a demand, which often affects the quality of the medicines.

What is the ultimate goal you intend to achieve through your Ayurveda Ashram?

My concept is to develop this institution as an ideal centre where the students who have completed their course can observe and study the treatment methods in Ayurveda.

However, I do not plan to make this centre any bigger. My dream is to have individual centres like this in all places to promote the benefits of Ayurveda among the people.

FOCUS Bipha, Kottayam

A confluence of old and new

Blending Ayurvedic medicines and contemporary delivery systems, Bipha has made a mark in the healthcare industry. The company is committed to discovering, developing and delivering Ayurvedic medicines in its purest forms

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jay George Varghese, Managing Partner of the Kottayam-based Ayurvedic medicine manufacturing company, Bipha, believes in ethics and values in the healthcare service. He is also committed to discovering, developing and delivering Ayurvedic medicines in its purest forms. As part of its ambitious growth plans, Bipha plans to enter healthcare and hospitality industry also.

Founded in 1929 by the renowned and gifted Ayurveda physician Koshy Varghese, known as Pappy Vaidyan, Bipha has been manufacturing Ayurvedic medicines

using traditional methods. It focuses on research and innovation so as to develop patented formulations.

Proprietary technologies have also been developed to prepare the

Dr Ajay George Varghese, Managing Partner, Bipha

medicinal properties of Ayurvedic medicines in minute dosages and retain them for longer periods. A wide range of products include classical medicines, patented medicines and lifestyle products.

The company offers more than 300 products, of which 242 are licensed and 110 are very active. It was Bipha which made Ayurvedic tablets for ‘kashayas’. Bipha has two factories at Devalokam and Ettumanoor in the Kottayam district.

It has an excellent distribution system with 200 distributors in India. The company also exports its products to Australia, Oman, Qatar, May 2013 I FUTURE MEDICINE 73

FOCUS Bipha, Kottayam

Kuwait, Sri Lanka, Maldives, US, Denmark, The Netherlands, UK and Singapore. At present, Bipha has achieved a turnover of Rs 24 crore and its projection for the next year is Rs 30 crore.

Bipha Vaidyasala A unique Ayurvedic clinic offering specialised solutions for lifestyle disorders, Bipha Vaidyasala is known for its corporate identity, standardised design, services and delivery model. Through its retail shops, Vaidyasala offers a wide assortment of Ayurvedic formulations from various parts of India in addition to Bipha products. Bipha Vaidyasala has launched an Ayurvedic tele consultation facility in India, which is probably the very first attempt in the history of Ayurvedic clinical practice.

The public can access information of diseases, products, and lifestyle advice or consultation regarding the health problems through its free helpline. Bipha Vaidyasala offers proven and time-tested Ayurvedic treatments for diabetes, hypertension, cholesterol, cardiac diseases, liver diseases, joint disorders, allergies, piles, sinusitis and migraine. Through 74 FUTURE MEDICINE I May 2013

its Ayurvedic spa, Bipha offers authentic rejuvenation and curative therapies to global customers, and aims to be the global leader in Ayurvedic healthcare in the future.

The automated unit of Bipha was set up in 1945 to manufacture pharmaceutical formulations in Industrial Estate, Ettumanoor. With the introduction of ‘kashaya’ tablets in 1971, the plant was upgraded to suit the need of patented Ayurvedic formulations.

Automated machines handle the entire process of punching, coating and filling ensuring accuracy and hygiene.The plant at Ettumanoor has an installed capacity to manufacture 2.5 lakh tablets per day, 60,000 capsules per day and 180 litres of liquids per day. The production process is meticulously documented and monitored in compliance with specified parameters. Products are continuously tested from ingredients level to completion.

The company adopts a patented technology to enhance active concentration and enable dosage compaction with maximum efficacy. Bipha conducts routine clinical trials for its products and has so far

conducted 12 clinical trials in association with leading institutions to validate product claims. Innovation has beome a core philosophy of Bipha since its inception. Bipha was instrumental in the development of many path-breaking products, segments and technologies which are today benchmarks to the Ayurvedic industry.

The product range includes Eezout for constipation relief, Minuzit for managing obesity and overweight, Tristrol for controlling cholesterol levels, Ovrital for protecting the liver damaged due to alcohol consumption, Bigcig- nonnicotine based smoking cessation aid, Aathma- a wide range of personal care products with pure Ayurvedic ingredients and Tulsi for the upkeep of general health and gloskin.

Hotel Ambadi in Thekkady is also a venture of Bipha. Spreading its wings in hospital, hospitality and drug manufacturing areas, Bipha is committed to innovate, discover and develop new products through its Ayurvedic formulations which can cure all ills in the medical science.

Prepared by Kainakari Shibu

FOCUS Welcare Hospital, Palakkad

A neurologist with

many firsts With a set of renowned doctors and well trained staff, Palakkad-based Welcare Hospital is on a mission to provide quality healthcare for all patients in an affordable manner. The hospital brings multispecialty services under one roof with all amenities

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n the healthcare area, dedicated to the people of Palakkad, Welcare Hospital is on a mission to provide quality healthcare in an affordable manner.

Situated near Mercy College, Palakkad, the hospital offers full-fledged facilities in various specialties. A set of well qualified and reputed doctors, skilled nurses, technicians and other paramedics makes the hospital provide high quality healthcare to all patients at affordable costs. Above all, it’s a holistic approach of the management that is committed to ensure quality healthcare which is accessible to all.

Till recently, the people of Palakkad used to go to the neighbouring states seeking specialised treatments. With Welcare Hospital bringing super specialty services under one roof, quality healthcare became access to patients which was far from their reach once. Additional services and facilities, and new specialties are being added to the existing ones on a regular basis. The hospital comprises 35 departments such as Neurology, Urology, Fertility unit, Respiratory Diseases, Pediatrics, Ophthalmology, General Surgery, Plastic and Reconstructive Surgery, Dental and Maxillo Facial Surgery, General Medicine, Trauma Care Unit, ENT Surgery, Diabetology, Psychiatry, Gastroenterology,

Dr M Pradeep, Head, Neurology Department, Welcare Hospital May 2013 I FUTURE MEDICINE 75

FOCUS Welcare Hospital, Palakkad

Obstetrics, Radiology and Imaging, including whole body MRI and CT scan.

The hospital has its own pharmacy that serves round the clock and is well stocked. An ambulance with mobile ventilator, defibrillator, oxygen supply and emergency drugs along with trained personnel is available on call for 24 hours service. Senior doctors are residing within the campus.

Neurology blessed with an expert The major highlight of the hospital is the neurology department headed by Prof Dr M Pradeep, who is the state’s first neurologist to

be certified in neurovascular sonology in the US. He is a pioneer in Transcranial Doppler (TCD) in the state. TCD is done to detect vascular diseases of the brain. TCD is highly useful in management of stroke. Dr Pradeep always enjoys his work and constantly hones his knowledge and, also updates his skill in par with international developments. Considering his industrious performance during studies, Calicut Medical College selected him to deliver the silver jubilee oration, which is the honour given to the best student of the batch. “The oration hall was the very same examination hall where I had written all my MBBS 76 FUTURE MEDICINE I May 2013

examinations,” recalls Dr Pradeep.

Unlike many other super specialties, in neurology, a neurologist has to spend little more time with the patients. A detailed history will be required, followed by a detailed neurological examination. That’s time consuming. If you don’t spend enough time in eliciting a good history, the chances of missing elements are more, Dr Pradeep says. After taking DM in neurology from the world renowned Institute of Neurology, Madras Medical College, he got trained in neurovascular sonology and stroke at

University of Texas, Houston, and at Wake Forest University Baptist Medical Centre, North Caroline, the US. He also got trained in international neurology (FINR) at University Hospital, Zurich, Switzerland. A veteran in this field, he got opportunities to work across the world. But his love for the homeland made him work here.

Welcare gives thrust on quality treatment by making specialist doctors’ services available round the clock along with due attention on quality nursing care. Thus, creating a healing environment, the hospital develops as a curing centre for all patients.

MEDICAL FILMS

Top five must watch medical movies based on pregnancy

Juno

Released in 2007, Juno is a CanadianAmerican comedy-drama directed by Jason Reitman and written by Diablo Cody. The film deals with a teenage girl who is faced with an unplanned pregnancy and the subsequent events that follow.

Away We Go

Away We Go is a 2009 comedy-drama directed by Sam Mendes. The movie is about a couple expecting their first child, and, to find a perfect place to start their family they travel around the US. The misadventures and the problems they face on their way are depicted in the rest of the movie.

Rosemary’s Baby

Fools Rush In

Directed by Andy Tennant, Fools Rush In is a romantic comedy. It was released in 1997.

The movie portrays the story of Isabel and Alex.

After a one-night stand, Alex realises that Isabel is pregnant and they decide to get married. The aftermath they have to face constitutes the rest of the movie.

Rosemary’s Baby is a 1968 American psychological horror film written and directed by Roman Polanski, based on the bestselling 1967 novel of the same name by Ira Levin. The movie is about a young couple who moves into a new apartment, only to be surrounded by peculiar neighbours and occurrences.

Then the wife becomes mysteriously pregnant, and paranoia over the safety of her unborn child begins controlling her life.

Baby Mama

Baby Mama is a 2008 comedy film written and directed by Michael McCullers and starring Tina Fey, Amy Poehler, Sigourney Weaver, Greg Kinnear, Dax Shepard and Steve Martin .This movie tells the story of a successful, single businesswoman who dreams of having a baby.

She discovers she is infertile and hires a working-class woman to be her unlikely surrogate.

Compiled by Neethu Mohan

May 2013 I FUTURE MEDICINE 77

Coming

DONOR MILK BANK

donor breast milk banks!

It is a revolution of sort in the care of preterm babies. Donor breast milk banks are coming up in the country following the developed countries to provide succour to these babies

By Neethu Mohan

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n the days to come, mothers of preterm babies need not be worried as donor breast milk banks are coming up in the country.

Once a network of such milk banks is established, it will be easy to buy breast milk for the babies who are unable to feed on mother’s milk.

Lots of preterm (less than 34 weeks) or low birth-weight babies are born in India. The main problem with these babies is they have undeveloped intestines and are less capable of digesting any milk other than that of mother. Preterm babies cannot coordinate sucking and swallowing. Therefore, they are unable to feed on mother’s milk and in some cases, mother’s milk would not be sufficient for babies and they end up on a drip. These babies are at risk of infections.

Though donor breast milk banks exist in the Western countries, unfortunately there are no such facilities in India. The Women Centre Donor Milk Bank in Tamil Nadu is a new initiative in the area.

It is following the guidelines issued

by National Institute of Clinical Excellence (NICE, UK) in 2010 and Human Milk Banking Association of North America. Such banks will benefit these babies when mother’s milk production does not start on time or the supply of milk gets interrupted.

Feeding these babies with either mother’s milk or donor bank milk is a natural way of reducing the risk of serious, life-threatening infections, enabling them to be discharged from hospital earlier.Though the idea of donor breast milk bank is progressive, disadvantages are also 78 FUTURE MEDICINE I May 2013

there like any other technological developments in the medical field.

Before the establishment of such facilities, people should be aware of the pros and cons of such banks.

“Since the concept of donor breast milk bank is new to the Indian people, most parents will be skeptical about it. Milk banks will be having its own merits and demerits, so there should be complete awareness about the facility,” says Dr Raghavendra Prasad, Gynecologist, Sun Rise Hospital, Kanhangad.

What is donor breast milk bank?

Donor breast milk bank is a service which includes collecting, screening, processing, storing and prescribing donated human milk by lactating mothers to babies who are not biologically related to the donor.

Premature babies who weigh less than 1,500 gm (very low birthweight) and less than 1,000 gm (extremely low birth-weight), and sick babies will benefit from the donor milk bank when their mothers are unable to produce sufficient milk.

Advantages of mother’s milk Breast milk is considered to be the best for the baby. It protects babies from problems like necrotising enterocolitis (serious and life-threatening disease involving the intestines). Mother’s milk fed babies have better IQ than formula milk fed babies.

Who can donate?

Healthy lactating mother of term or preterm babies who are not on any medications and have no significant illnesses in the past or present can donate.