Future Medicine August 2013

Taking up cudgels against breast cancer

Celebrity Fitness

Sherin Sam’s fitness secret

Special Focus

The Premium Health Magazine

Eye care: KERENG/2012/44529

www.futuremedicineonline.com

August 2013

The dos and don’ts

Breast

cancer’s UAE - AED 7 US - $5 India - `50

genetic roots

Mental diseases cause hyper sexual disorders

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EDITOR’S NOTE Know your genes and diseases

Y

ou are what your genes are. As half of your genes come from your mother and the other half from your father, chances are high for passing on genetic disorders from either of the parents. Experts say hereditary diseases or genetic disorders are not curable, but can be controlled or managed with treatment that entails change in lifestyle and food habits besides medications. Children inherit certain types of cancer say breast cancer or ovarian cancer- diabetes and psychiatric problems from their parents. However, all cases of breast cancer or diabetes are not hereditary and they could be caused by other factors such as environment, obesity, lack of physical exercise and high level of stress.

There could be hereditary diseases or not, we should keep a close tab on our health conditions with regular checkups.

Change lifestyle and dietary habits if need be. Early detection of any disease, especially cancer and diabetes, increases the chances of recovery because in the early stages, a patient may have many options. In the case of hereditary diseases, possibility of affliction can be found even before the birth of a child through prenatal tests. Although a disease can’t be preventable at this stage, precautions can be taken to control and manage the disease after the birth.

Genetic tests show whether you are predisposed to a particular disease and if both parents have a similar problem and chances are high for the offspring to inherit the disease, they can avoid such a situation by opting for methods like IVF. Despite the negative aspects, gene testing gives immense hope for humanity. Read the cover story, ‘It’s in your genes’ which analyses multiple cancers, diabetes and mental illness, and their genetic links.

They say eyes are the windows to the world. Among senses, eyes are the most prominent and so it needs maximum care. Don’t strain your eyes and give it enough rest in order to ensure normal, smooth functioning. But in the new generation, eyes are overburdened with longer hours of reading on computer screen and mobile and watching television. As a result, normal eyesight has largely suffered and the number of spectacle-free children has narrowed down.

This issue carries specialised articles which provide all information on the advancements in the field of ophthalmology which has evolved to be one of the most developed specialties in modern medicine. Besides, take note of dos and don’ts given here to prevent visual impairments.

As usual, beauty tips, fitness regime and many more interesting articles will keep you engrossed in reading this magazine.

August 2013 I FUTURE MEDICINE 5

COVER STORY

CONTENTS 18 30

Motivation

58

Nutrition

Premi Mathew is on a mission to create awareness on breast cancer through her initiatives ‘Protect your Mom’ and ‘Hair for Hope’

No more misguiding information on coconut as it enters the list of most wanted nutritious food

Hereditary

Diseases The chance that you and your partner are carriers of the same hereditary disease is low. In fact, less than one per cent of the couples who take the test will be the carriers of the same disease

Columns 14 54 34

Prepartum Care Dr Anita Gupta

46

Against the Odds

The real life story of Anjan Satheesh, a victim of cerebral palsy, persuades people to go ahead in the life with a smiling face despite all adversities

Cerebral Venous Thrombosis Dr M Pradeep

Eye Care Dr Shane Mathew

6 FUTURE MEDICINE I August 2013

32

Sex Q&A

Ask any sex related questions to Dr A Chakravarthy when you need to clear doubts that are haunting you relentlessly

33

Eye Care Special

New trends in ophthalmology Ophthalmology has evolved to be one of the most developed specialities in modern medicine.

Future Medicine shares the latest trends in Eye care and the facilities provided at various eye care centres

45 Surgeon Speaks

Dr Arivazhagan tells to Future Medicine about the qualities and ethics required for a surgeon

Beauty Tips

71 78

Fingernails need to be kept neat and clean as an untidy fingernail is a breeding ground for bacteria, fungi and other organisms

Celebrity Fitness Celebrated model Sherin Sam shares her fitness formula with Future Medicine

August 2013 I FUTURE MEDICINE 7

MEDICAL DIGEST

Azad Moopen named 6th most The centurion cancer powerful Indian leader in UAE survivor Dubai (UAE): The doctor-turned-entrepreneur, Azad Moopen, Chairman and Managing Director of DM Healthcare, the leading healthcare conglomerate with operations across the GCC and India, has been named the 6th most powerful Indian leader in the UAE at the inaugural edition of the top 100 Indian power list. The award was instituted recently by Forbes ME to honour the success of these exceptional Indian personalities, recognising their contribution in public life, society, communities and especially in business.

Dr Moopen was honoured with the title on June 25 by Shashi Tharoor, Indian Minister of State for Human Resource Development, at a function hosted by Forbes ME at The Oberoi, Business Bay, Dubai. “I am proud of being ranked in the top of the power list by the prestigious Forbes title. I am deeply grateful to them, and I consider this ranking as an honour to the entire Indian diaspora who are dedicated, sincere, peace loving and hardworking people with high intellectual capacity,” says Azad Moopen.

Bengaluru (India): Appaswamy who underwent cancer treatment two years ago at HealthCare Global (HCG) celebrated his 100th birthday. Dr Kumarswamy, Senior Consultant, Radiation Oncologist, HCG, said, “Considering his age, the risk of surgery was high. The tumour was present in the upper part of his left lung and it was about 3.8 cm in size. He underwent three sessions of cyberknife on alternate days from May 24 to 28, 2011. After three months, follow-up scan showed a scar tissue. After two years post treatment, he is now completely fine.” Expressing his gratitude, Appaswamy, the centurion cancer survivor, said, “One of our neighbours was diagnosed with throat cancer who took treatment at HCG. He advised me to take a second opinion from HCG. I met a team of specialists at HCG who suggested cyberknife treatment. I have recovered and am back to enjoying life with my great grandchildren at the age of 100.

Overweight may pose osteoporosis risk

Eat breakfast to improve your heart health

Washington (US): Obesity may be a risk factor for the frail bone disease osteoporosis, a study suggests. US researchers have discovered that some people who are overweight have hidden fat inside their bones that could make them weak and prone to fractures.

The Harvard Medical School team in Boston did body scans on 106 obese but healthy men and women. The findings are published in the journal Radiology. The scans reveal some people carry fat in hidden places like the liver, muscles and bone marrow as well as their belly, hips or thighs. Dr Miriam Bredella, who carried out the work, says apple-shaped people who carry weight around their waist may be at greatest risk.

Boston (US): A new

8 FUTURE MEDICINE I August 2013

study appears to confirm that when you eat is just as important for health as what and how much you eat. Skipping breakfast may lead to one or more risk factors, including obesity, high blood pressure, high cholesterol and diabetes, which may in turn lead to a heart attack over time,” the study shows. Lead author Leah Cahill of the Harvard School of Public Health (HSPH) and colleagues write about their findings in a July 23rd issue of the American Heart Association journal Circulation.

MEDICAL DIGEST

Low Vitamin D levels linked to old age problems Amsterdam (Netherlands):

A new study has found that low Vitamin D levels in people over 55 are associated with an inability to perform ordinary tasks of daily life.

Dutch researchers studied two groups of older people one of 725 men and women aged 55-65, and another of 1,237 older than 65— to see if they could walk up or down a 15-step staircase, dress and undress, stand from a sitting position, cut their toenails, walk outside unaided for five minutes, and use their own or public transportation. Then they did blood tests for Vitamin D levels.

After controlling for factors including age, physical activity and chronic diseases, they found that in both groups, a Vitamin D level below 20 nanograms per millilitre was associated with an increased number of disabilities compared with those with a normal level (Above 30).

The study was published online in The Journal of Clinical Endocrinology and Metabolism.

UN declares Nov 19 as World Toilet Day Singapore: The United Nations has declared November 19 as World Toilet Day. “I am sure there will be laughter among the press and the public when it is reported that the UN is declaring a World Toilet Day,” said Singapore charge d’affaires Mark Neo before a unanimous UN General Assembly vote in favour of the measure.

“Their laughter is welcome, especially if they recognise the prevailing and unhealthy taboo that prevents an open and serious discussion on the problems of sanitation and toilets globally,” Neo told the 193-member assembly.

The envoy went on to stress that 2.5 billion people around the world do not have proper sanitation, that 1.1 billion people defecate in the open and that providing toilets could save the lives of more than 200,000 children every year.

Singapore took up the toilet cause because of the efforts of Jack Sim, a citizen of the city-state known as “Mr Toilet” because of his efforts to improve sanitation around the world. UN Deputy Secretary General Jan Eliasson praised Singapore’s action. “Proper sanitation is a question of basic dignity,” Eliasson said.

Beer in honour of British royal baby released Pope criticises drug legalisation plans Rio de Janeiro (Brazil): Pope Francis has criticised

drug legalisation plans in Latin America at the inauguration of a clinic for drug addicts in Rio de Janeiro. The roots of drug abuse should be tackled, he said on his visit to Brazil.

Uruguay is close to allowing the legal sale of marijuana, with other countries pondering similar liberalisation.

Earlier, the Argentine-born pontiff celebrated the first Mass of his trip, at the Shrine of Our Lady of Aparecida. He warned tens of thousands of faithful against the “passing idols” of money, power and pleasure. After the visit to Aparecida, in the Brazilian state of Sao Paulo, the pope flew back to Rio de Janeiro. At the inauguration of a drug rehabilitation clinic at the Sao Francisco hospital, he hugged former addicts and heard their stories.

10 FUTURE MEDICINE I August 2013

London (UK): A beer named Heir Raiser in honour of the newest addition to the royal family has been released by a brewery in the UK. McMullen and Sons brewery in Hertford released Heir Raiser, which is four percent ale, the New York Daily News reported.

According to trade publication The Drinks Business, the beer has been described as a ‘light coloured, crisp refreshing pint with a light, hoppy finish.’

Earlier, to fete the royal couple’s wedding in 2011, Castle Rock Brewery in Nottingham released beers, which they called ‘Kiss Me Kate.’

MEDICAL CONFERENCE

International Congress on Patient Safety Hyderabad (India): The third edition of International Congress on Patient Safety will be held from September 6 to 7 in Hyderabad.

The first two editions were a grand success with the participation of more than 1,000 delegates, including CEOs, Medical Directors, Patient Safety Managers/ Coordinators, Healthcare Executives/Administrators, Risk Management Personnel, Primary Care Providers, Physicians, Nurses, Patient

Advocates, Clinical/Academic Educators, Researchers, Students and Quality Improvement Directors.

The focus of the third edition is on ‘MINDFUL PRACTICE’ by empowering the healthcare teams to face challenges. The conference will also focus on parallel healthcare verticals like Healthcare Insurance, Healthcare IT and Laboratory.

The conference will have two workshops on patient safety solutions implementation.

International Conference on Intelligent Biology and Medicine Mashville (US): International Conference on Intelligent Biology and Medicine (ICIBM 2013) will be held in Nashville, US, from August 11 to 13. Bioinformatics, Systems Biology and Intelligent Computing are synergistic disciplines that hold great promise for the advancement of biomedical research and development through the design of intelligent systems

to solve engineering practical problems as well as translational science problems.

Research and development in these areas impact science and technology, and synergies among these disciplines provide enormous potential. ICIBM aims to provide a forum for the cross-fertilization of ideas and promotion of interdisciplinary collaborations.

Annual Medical Students’ International Conference New Delhi (India): VardhmanMahavir Medical College and Safdarjung Hospital, New Delhi, will hold MEDSICON 2013 –The 3rd Annual Medical Students’ International Conference at Vardhman Mahavir Medical College, New Delhi, from August 9 to 11.

This unique academic event provides medical students from around the world an excellent opportunity to share their research experiences and interact with the greatest scientific minds of all times.

The organising committee plans to conduct workshops on essential surgical skills as well as newer medical topics helpful to a medical student in his quest for excellence in the medical field.

Workshops on socio-medical issues have also been planned to increase awareness amongst the medical fraternity. The conference will have scientific sessions, plenary sessions and a keynote address followed by 12 FUTURE MEDICINE I August 2013

the closing ceremony featuring cultural performances, felicitations and a banquet dinner. There will be a postconference tour for all delegates with the organisers, so as to help them interact on an informal platform and also experience the warm hospitality of the city.

PREPARTUM CARE

Take prenatal care for a

healthy baby

Prenatal care is the key to have a healthy baby and for taking good care of mother’s health. It is very essential for an expecting woman. The wellbeing of a baby depends on the healthcare you get while you are pregnant. Those who don’t get prenatal care are more likely to have a low birth weight. Prenatal care includes right checkup and prenatal testing which helps your doctor to spot health problems early.

Therefore, it is suggested to begin prenatal care as soon as you come to know about your pregnancy.

Prenatal tests

The first prenatal visit starts during six to eight weeks of pregnancy. On the first visit, weight measurement and blood pressure checkup is done. Ultrasound is done to ensure healthy pregnancy. Urine and blood samples are taken for various tests to ensure good health and rule out any risk factors.

Routine and microscopic test for urine is done. Blood tested for sugar levels to rule out diabetes. Other blood tests are done for blood grouping, to check for anaemia, blood cell count, infectious diseases such as syphilis, HIV, hepatitis and some other viral infections.

Thallesemia and thyroid dysfunction is also ruled out. Some other blood tests are redone later to rule out downs syndrome.

The Level two ultrasound is done at 18-20 weeks to rule out any fetal abnormality.

Balanced diet

Proper care during pregnancy is very important for the health of both mother and baby. Various tests and regular consultation with doctor are necessary during the period

By Dr Anita Gupta

14 FUTURE MEDICINE I August 2013

Having a balanced diet is a very important part of prenatal care. Because baby’s growth depends on whatever you eat. There are some foods that you should be more careful about when you are pregnant. Meat, eggs and fish that are not fully cooked could put you at risk of infection. Always wash fruits and vegetables thoroughly. Take dairy products regularly. This will give you

enough calcium. Do not drink unpasteurised milk or eat unpasteurised milk products.

Drink plenty of fluids. Include foods which have fibre. Don’t take laxatives before talking to your doctor. Try to avoid coffee and if you are habitual of drinking coffee or other drinks with caffeine, do not have more than one or two cups a day. Eat small meals frequently. Avoid spicy or greasy foods. Don’t lie down right after eating.

Consult your doctor before taking any medicine, including pain relievers or other over-the-counter medicines. Any medicine you buy without a prescription may cause birth defects.

Don’t lift heavy weight

Lifting heavy objects or standing for a long time can be risky. Radiation, lead and other heavy metals such as copper and mercury could be damaging to the baby.

Exercise during pregnancy

Exercise during pregnancy benefits overall health. It manages weight and helps at the time of delivery. Walking improves the blood circulation and swimming strengthens abdominal muscles. Always carry out exercise under the guidance of a physiotherapist.

Take folic acid regularly

Take folic acid every day during your pregnancy. Folic acid helps prevent problems with baby’s brain and spinal cord. It is best to start taking folic acid before you get pregnant. If you are taking a prenatal supplement, make sure you’re not taking any other vitamin or mineral supplement along with it unless your doctor recommends it.

Sex during pregnancy

Don’t be surprised if you have an urge of having sex during pregnancy. You can have sex but with safe positions, such as lying on side. Sex has to be avoided in some conditions of pregnancy which your doctor will tell.

Quit smoking

Don’t smoke. Smoking raises your risk of abortion and many other problems.

(Dr Anita Gupta is a Senior Consultant Gynaecology, Saket City Hospital, New Delhi) August 2013 I FUTURE MEDICINE 15

BOOK REVIEW

F

cus on About the book

management

16 FUTURE MEDICINE I August 2013

A comprehensive book on head injuries, Management of Severe Traumatic Brain Injury was written by a group of neurosurgeons, neurointensivists,and neuroanesthesiologists from Denmark, Finland, Norway, Iceland, and Sweden. The Scandinavian countries have a population of 25 million and 21 neurosurgical centres.

Scandinavian Neurosurgical Society was established in 1998. The major objective of the Scandinavian Neurotrauma Committee (SNC) is to improve the management of neurotrauma patients in the Nordic countries.

This book is a comprehensive manual of TBI management throughout the entire chain of care. The major goal was to create a template for good TBI care for the neurosurgical centres and to develop a practical and basic manual for young neurosurgeons and neuro anaesthesiologists dealing with

severe TBI. The evidence was classified into three levels according to quality and reliability. The classifications were refined through an independent review process and consensus discussion in the SNC. There are 59 authors in all who have contributed and they are all members of the Scandinavian Neurotrauma Committee and have extensive practical experience in the areas they write about. Neurosurgeons, neuroanesthetists, intensive care specialists and other specialties are included.

Highlights A practical, comprehensive guide to the treatment of patients with severe head injuries from the time of initial contact to the rehabilitation centre.

In order to reduce the number of deaths, systematic management is essential, including prehospital treatment, admission, and diagnostics, acute management, neurointensive care and rehabilitation.

Recommendations are based on levels of evidence.

An overview gives a short theoretical run through the relevant literature with emphasis on the newest and the most important older articles.

Tips, tricks, and pitfalls provide some general rules, practical advice and expert views.

The background gives a thorough look on the relevant literature, and a final section deals with specific paediatric concerns.

Presents evidence-based recommendations for each diagnostic and therapeutic measure. Throughout, the emphasis is on the provision of sound clinical advice that will maximise the likelihood of an optimal outcome that includes helpful flowcharts for use in daily routine.

There are only a few areas in this book that have Level I evidence.

Most of the recommendations are based on Level II or Level III evidence.

As a whole, the scientific foundation for management of severe TBI is extensive, but rarely grounded on high quality evidence.

Magnitude of the problem Even though Scandinavia is considered one of the safest places on Earth, head injuries are still a major cause of morbidity and mortality, healthcare costs and catastrophic emotional turmoil for the victims and their families.

Around 200 out of 100,000 inhabitants are admitted with head injury every year. TBI mortality rate varies from around 10 per 100,000 in Denmark, Norway and Sweden, to approximately 20 per 100,000 in Finland.

The management of TBI constitutes a tremendous organisational challenge to healthcare professionals and healthcare organisers.

GOAL of TEAM managing severely head injured is to save many TBI patients and improve the quality of life.

This is achieved by clinical management on a scientific basis and a systematic and sustainable healthcare system that includes rehabilitation, facilitation of the survivors’ re-entry in society.

Evidence-based guidelines Evidence-based guidelines for the practice of clinical medicine provide recommendations based on the best scientific evidence available.

Standard, Guideline and Option–Level I, II & III Level I evidence: Properly designed (prospective) randomised controlled trial (The gold standard of clinical practice).

Level II evidence: Prospectively collected data or retrospective analyses based on clearly reliable data on well-defined population.

Level III evidence: Descriptive studies and expert opinions.

The Brain Trauma Foundation (BTF) published its first evidence-based guidelines for the management of severe TBI. First edition was published in 1995 (www. braintrauma.org), second revised edition in 2000 and the latest edition in 2007.

Do such guidelines help?

Application of the BTF guidelines has proven to improve patient outcomes and significantly reduce costs due to better patient outcomes.

Patients are twice as likely to survive if the BTF guidelines are followed.

Proportion of patients with “good” outcomes rose from 35 per cent to 66 per cent.

Proportion of patients with “poor” outcomes fell from 34 per cent to 19 per cent.

Potential savings – $3.8 billion (US national).

Active TBI quality assurance programme is supported by an Internet database (TBI-Trac) and a free guidelines assessment tool at www.tbiclickandlearn.com.

A 50 per cent reduction in deaths has been achieved in New York State over the last 10 years. The reduction in deaths was accompanied by an increase in intracranial pressure monitoring in those patients.

Prevention Focus not only on what we can do for the head injured patients but also preventing secondary brain injury.

We in India should also get far more involved in preventing the primary brain injury.

It means getting more involved in the political agenda and promoting trauma prevention initiatives.

Dr Ramkumar Menon

Consultant neurosurgeon Carewell Clinical Centre and Elite Mission Hospital August 2013 I FUTURE MEDICINE 17

COVER STORY Hereditary Diseases

It’s in your

genes

With the increasing ability to control infectious and nutritional diseases in the developed countries, there has come the realisation that genetic diseases are a major cause of disability, death, and human tragedy.

Rare, indeed, is the family that is entirely free of any known genetic disorder. Many thousands of different genetic disorders with defined clinical symptoms have been identified. Of the three to six per cent of newborns with a recognised birth defect, at least half involve a predominantly genetic contribution.

Furthermore, genetic defects are the major known cause of pregnancy loss in the developed nations, and almost half of all spontaneous abortions involve a chromosomally abnormal fetus. About 30 per cent of all postnatal infant mortality in the developed countries is due to genetic disease; 30 per cent of pediatric and 10 per cent of adult hospital admissions can be traced to a predominantly genetic cause. Finally, medical investigators estimate that genetic defects however minor are present in at least 10 percent of all adults.

Future Medicine examines the main categories of genetic disease focusing on the types of genetic mutations, the risks associated with exposure to certain environmental agents, and the course of managing genetic disease through counseling, diagnosis and treatment. Genetic Factors sare under the scanner in the wake of increasing incidences of multiple cancers (Ovarian and breast), diabetes and mental disorders Management of genetic diseases

The management of genetic diseases can be divided into counseling, diagnosis and treatment. In brief, the fundamental purpose of genetic counseling is to help the individual or family understand their risks and options and also to empower them to make informed decisions. Although effective treatments exist for some genetic diseases, for others there is none. Fortunately, with time and more researches, this set of disorders is slowly becoming smaller.

Genetic counseling

Genetic counseling represents the most direct medical application of the advances in understanding basic genetic mechanisms. Its chief purpose is to help people make responsible and informed decisions concerning their own health or that of their children. Genetic counseling, at least in democratic societies, is non-directive. The counselor provides information, but decisions are left up to the individual or the family.

Hereditary Diseases

Hollywood actress Angelina Jolie recently underwent a preventive double mastectomy after doctors estimated that she had an 87 per cent chance of developing breast cancer. Her mother Marcheline Bertrand died of ovarian cancer at the age of 56 and Angelina Jolie’s chances of developing breast cancer were very high because she inherited a mutated BRCA 1 gene from her mother. The BRCA1 is present in everyone but only mutates in one in 1,000 people. Anyone with the mutated gene has a 50-80 per cent chance of developing breast cancer. But Jolie’s risk figure was calculated to be even higher because of other factors, including family history.

In an interview with Future Medicine, Dr Debnarayan Dutta, MD (Radiation oncology) Consultant Radiation Oncologist, and CyberKnife expert, Apollo Specialty Hospitals, Chennai, talks about breast cancer as hereditary disease

Genetic factors increase

I

By Sumithra Sathyan s breast cancer a hereditary disease?

risk of breast

Many cancers in India are due to environmental and lifestyle issues. Lung cancer and head and neck cancer are related to tobacco use. High fat diet and sedentary lifestyle can cause colon cancer.

Change in dietary habits and environmental influences reduce the risk of these cancers. On the other hand, lots of other cancers are hereditary and genetic factors related and need appropriate approach for early detection and prevention.

Breast cancer, colon cancer and many childhood tumours such as retinnobastoma and wilms tumour have strong hereditary predisposition. Sporadic mutation of

cancer

August 2013 I FUTURE MEDICINE 19

COVER STORY Hereditary Diseases

Angelina Jolie

genome code is the common genetic factor related cause of cancer. In a proportion, inheritance of proto-oncogene from parents or deletion of tumour suppressor gene is the cause of hereditary cancers.

Is it possible to control hereditary breast cancer?

Hereditary cancer, especially breast cancer, is not preventable at this point. However, with early diagnosis and screening in high risk population, it is definitely controllable and curable.

How dangerous is breast cancer?

Breast cancer is dangerous like any other cancer. There is a need for awareness, establishment of high risk population, routine screening of high risk groups, treatment of early diagnosed patients, prophylactic surgeries in a cohort of very high risk population and treatment of recurrent/progressive disease.

Could we overcome breast cancer if we change lifestyle?

Hereditary cancer mainly breast cancer is not a lifestyle related disease. However, we can screen, diagnose and treat this cancer at young age.

How can we protect?

It is difficult to protect. However, screening can help in detection even before birth, like parents with history of retinoblastomas may detect or screen for retinoblastoma in their siblings before birth from amniotic fluid examination, USG. Many congenital disorders and hereditary malignancies can be detected in antinatal examination. There is a need for appropriate anti-natal examination if there is a history of genetic disease.

Cancers such as breast cancer or colon cancer, which has strong family history and hereditary predisposition, should be screened periodically to detect any early manifestation of cancer and treat accordingly. In a very small proportion of healthy persons with very high risk of hereditary cancer can have prophylactic surgeries to reduce the risk of cancer. People with strong family history of breast cancer and unfavourable genetic mutation (BRCA 1&2 gene mutation) may undergo prophylactic mastectomy. Prophylactic removal of the ovaries and total colectomy is also practised in high-risk persons.

Though these prophylactic surgeries reduce the risk of cancer significantly in high-risk persons, small risk of cancer still remains.

What are the reasons for an increase in the number of breast cancer patients?

Breast cancer is the main cancer in women both in the developed and the developing world.

20 FUTURE MEDICINE I August 2013

The incidence of breast cancer is increasing in the developing world due to increased life expectancy, increased urbanisation and adoption of western lifestyle. Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low-and middle-income countries where breast cancer is diagnosed in very late stages. Therefore, early detection in order to improve breast cancer outcome remains the cornerstone of the breast cancer control.

What about breast cancer control?

Public awareness on the breast cancer problem and the mechanisms to control as well as advocating for appropriate policies and programmes are key strategies to control breast cancer. Many low-and middle-income countries face a double burden of breast and cervical cancer which are the top cancer killers in women over 30 years old. These countries need to implement combined strategies that address

public health problems in an effective and efficient way.

Control of specific modifiable breast cancer risk factors as well as effective integrated prevention of non-communicable diseases which promotes healthy diet, physical activity and control of alcohol intake, overweight and obesity, could eventually have an impact on reducing the incidence of breast cancer in the long term.

Is early detection of cancer increasing chances for successful treatment?

Yes, early detection of cancer greatly increases the chances for successful treatment. There are two major components of early detection of cancer: education to promote early diagnosis and screening.

Recognising possible warning signs of cancer and taking prompt action leads to early diagnosis.

Increased awareness of possible warning signs of cancer, among physicians, nurses and other healthcare providers as well as among the general public, can have a great impact on the disease.

Some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent

evidence, mass population screening can be advocated only for breast and cervical cancer, using mammography screening and cytology screening, in countries where resources are available for wide coverage of the population.

Several ongoing studies are evaluating low cost approaches to screening that can be implemented and sustained in low-resource settings. More studies that evaluate low cost alternative methods to mammography screening, such as clinical breast examination, are needed.

What is the role of Mammography screening and self-examination in the breast cancer treatment?

Mammography is the only screening method that has proven to be effective. It can reduce breast cancer mortality by 20 to 30 per cent in women over 50 years old in high-income countries. Mammography screening is very complex and resource intensive.

There is no evidence on the effect of screening through breast self-examination (BSE). However, the practice of BSE seems to empower women, taking responsibility of their own health.

Therefore, BSE has been recommended for raising awareness among women at risk rather than a screening method.

Breast cancer is the main cancer in women both in the developed and the developing world. The incidence of breast cancer is increasing in the developing world due to increased life expectancy, increased urbanisation and adoption of western lifestyle indigestion, and chronic hoarseness. Early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin.

Is screening useful in breast cancer?

Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms.

Examples include breast cancer screening using mammography and cervical cancer screening using cytology screening methods, including Pap Dr Debnarayan Dutta smears.

Based on the existing

Advancements in treatments?

Human genome project and gene therapy are the latest projects in cancer treatment. Though there is a long way ahead before gene therapy can be used safely, this approach is going to be the future cure for hereditary cancer.

What are the chances of getting breast cancer when you don’t have a mutated gene?

Breast cancer happens due to sporadic genetic mutation and this phenomenon does not have any hereditary occurrence. Hormonal factors and other factors such as late marriage, childbirth, nuliparoussatus (No child) and hormonal replacement play a role in breast cancer. Hence, all breast cancers are not hereditary and these can happen even without known genetic mutation.

Your experience in the field?

Hereditary cancer mainly breast cancer is routine in clinical practice. Breast cancer and colon cancer are seen in families. Retinoblastomas are seen in subsequent siblings. Unfortunately, there are only a few organised hereditary cancer care services for screening, counseling, genetic testing and risk assessment in India. There is a need for nationwide systematic organisation for hereditary cancer care.

August 2013 I FUTURE MEDICINE 21

COVER STORY Hereditary Diseases

10-15 % of ovarian cancer is hereditary

September is

Ovarian Cancer Awareness Month

About 10-15 per cent of ovarian cancer may be due to hereditary gene mutations. But hereditary factors are insignificant in cervical cancer. The incidences of cervical cancer are expected to decrease further with the introduction of HPV vaccination. In an interview with Future Medicine, Dr Tan Niap Hong, Consultant Gynecologist, Prince Court Medical Centre, Kuala Lumpur, Malaysia, talks about ovarian cancer and its genetic links

I

By Sumithra Sathyan s ovarian cancer a heredity disease?

About 10-15 per cent of ovarian cancer may be due to hereditary gene mutations. But hereditary factors are insignificant in cervical cancer.

Researches are going on and we have yet to come to a conclusion.

What are the precautions to be taken to prevent the disease?

A balanced diet with low fat, appropriate body weight, exercise, chemoprevention (Eg. contraceptive pills reduce risks of ovarian cancer) and prophylactic surgery (Eg. removal of ovaries preempts ovarian cancer). Alcohol consumption and smoking increase the risks of cancer.

Are children vulnerable to ovarian cancer?

Gynecological cancers are very rare during childhood. But a healthy lifestyle habit has to be inculcated in children for secondary prevention in adulthood.

HPV vaccination during teenage years obviously will decrease the incidence of cervical cancer in adulthood. Today, a few birth 22 FUTURE MEDICINE I August 2013

defects could be diagnosed even when the baby is in the mother`s womb. This enables doctors to treat or even correct some problems before the baby is born.

A few birth defects occur due to chromosomal abnormalities.

Birth defects caused by single gene disorders such as haemophilia, thalassemia or sickle cell anaemia may lead to extreme pain.

The affected children require specialised treatment such as repeated blood transfusions.

Is the incidence of ovarian cancer decreasing?

Ovarian cancer in the UK increased over a 25-year period until 2000 and decreased after that. Cervical cancer has been declining in the developed countries because of cervical screening using papsmear. The incidence of cervical cancer is expected to decrease further with the introduction of HPV vaccination. The incidence of uterine cancer appears to be increasing. This is not surprising because uterine cancer (Mainly endometrial cancer) is associated with obesity and diabetes.

A

Statistics on genetic disorders

pproximately four million babies are born each year. About 3 to 4 per centof the newborns have genetic diseases or major birth defects.

Approximately one per cent has chromosomal abnormalities which can cause physical problems and mental retardation.

More than 20 per cent of infant deaths are caused by birth defects or genetic conditions (e.g. congenital heart defects, abnormalities of the nervous system, or chromosomal abnormalities).

About 10 per cent of all adults and 30 per cent of children are hospitalised due to genetically related problems.

‘Diabetes is undoubtedly a hereditary disorder’

November 14th

World Diabetes Day

Though diabetes is a hereditary disease, it can be preventable with lifestyle changes. Obesity, lack of physical exercise, high levels of cholesterol and untreated blood pressure are the triggering factors for the early onset of the disease

By Dr Jothydev Kesavadev

D

iabetes, the most popular complex endocrine disease, is undoubtedly a hereditary disorder. There are two types of diabetes- the less common Type 1 diabetes which occurs in children and the more common Type 2 diabetes which constitute 96 per cent of the total patient population with diabetes.

Type 1diabetes is a sporadic disease which probably happen secondary to a viral infection or an auto immune disorder which destroys the beta cells in the pancreas which secretes insulin.

Hence, the genetic nature of Type 1 diabetes is questionable.

However, it is not uncommon to observe siblings with Type 1 diabetes. According to the American Diabetes Association, in general, if you are a man with Type 1 diabetes, the chance of your child developing diabetes is 1 in 17. If you are a woman with Type 1 diabetes and your child was born before you were 25, your child’s risk is 1 in 25; if your child was born after you turned

25, your child’s risk is 1 in 100.

Your child’s risk is doubled if you developed diabetes before age 11.

If both you and your partner have Type 1 diabetes, the risk is between 1 in 10 and 1 in 4.

Type 2 diabetes usually runs in families Type 2 diabetes has a stronger link to family history and lineage than Type 1. If mother or father has got Type 2 diabetes, chances are there for the children to develop the same. In general, if you have Type 2 diabetes, the risk of your child getting diabetes is 1 in 7. Some scientists believe that a child’s risk is greater when the parent with Type 2 diabetes is the mother. If both the parents have diabetes, child’s risk is about 1 in 2. The people with certain rare types of Type 2 diabetes have different risks. If a parent has a rare type called maturity-onset diabetes of the young, the child has almost 1-in-2 chance of getting it. Statistics has also shown an earlier onset of the disease in the offspring. In other

words, if the onset of diabetes used to be 65 years earlier, now the average onset of Type 2 diabetes is 35 years in Kerala. With the emergence of obesity among children across the globe, there are children aged 15 or even 12 years developing Type 2 diabetes which is secondary to consumption of high fat diet and lack of physical exercise. Though Type 2 diabetes is polygenic in inheritance with no single gene identified, the good news is that its prevention in young individuals is possible with meticulous adherence to healthy food habits and daily physical activity or we can at least postpone the onset of diabetes.

So Type 2 diabetes though widely recognised as a heredity disorder is a completely preventable disease. There is also an environmental triggering factor for the onset of disease. This environmental triggering factor may either be obesity, especially abdominal obesity, lack of physical exercise, high levels of cholesterol or untreated blood pressure. If onsets of risk factors are taken care of, diabetes is a preventable disease.

The author is the founder, Jothydev’s Diabetes and Research Centre, Trivandrum

COVER STORY Hereditary Diseases

October 10th

World Mental Health Day

Epigenetic patterns linked to early life experiences Parentally induced early environmental stress may in turn affect successive parenting style of the next generation

By Dr Zachary Kaminsky An area getting a lot of attention in the field of psychiatry is the reprogramming of epigenetic signals through early life experiences that can result in lasting changes in adult health. For example, exposure to early life stress can lead to immune system and stress response changes that in turn can be linked to cardiovascular disease, depression, various cancers, asthma, poor dental health, and various autoimmune diseases. Parentally induced early environmental stress may in turn affect successive parenting style of the next generation There is also growing evidence to suggest that a mother’s level of anxiety during pregnancy may cause epigenetic changes in the developing fetus that will alter stress response with the potential to influence later life health outcomes. Finally, while evidence as to the extent of the transgenerational transmission of epigenetic information through the germline in mammals is limited, there are a number of studies in mice 24 FUTURE MEDICINE I August 2013

where exposure to environmental toxins or through diet can result in a passage of altered epigenetic information through the generations via the germline, leading to altered health outcomes.

The extent to which such a phenomenon occurs in humans has been under debate for years.However, at least the possibility remains that the choices a person makes during their lifetime may impact their children through reprogramming of the epigenetic patterns in the sperm or ova. In summary, understanding the interplay between genetic variation, the environment, and the epigenetic code will enable a better means with which to interrogate the timing and further molecular consequences of environmental insults and enable more effective timing and molecular targets of effective intervention.

The author is working with Department of Psychiatry & Behavioural Sciences, Johns Hopkins University School of Medicine, USA)

Zachary Kaminsky Lab

The lab employs genome wide exploratory analyses using microarrays to identify disease associated epigenetic variation. The lab studies depression, postpartum depression, suicide and animal models of psychiatric conditions with better understand the molecular epigenetic underpinnings of psychiatric phenotypes.

October 31

World Fetus Day

Know your genes before planning to start a family

I

By Dr Suyashree Palkar nherited diseases cannot be cured but they can be prevented. Genetic disorders can affect the chromosomes (Normal number 46 in each cell), their number and structure, or involve single genes located within the chromosomes.

Children can be affected when they inherit two copies of the defective (Single gene) from each parent. Recessive inheritance or X linked inheritance is where the mother transmits the disease to her sons but not her daughters.

So if there is a history of pregnancy losses, mental retardation, birth defects and a family disease (In India, thalassemia, a blood disorder, and G6PD deficiency are common) or you are planning to start a family, it is important to visit a genetic counselor.

Genetic tests reveal whether a person carries gene mutations associated with certain inherited diseases. Screening tests such as measurement of the nuchal translucency (Between 11 and 14 weeks) and the triple marker test (Blood test of mother done between

6 and 20 weeks of pregnancy) help screen babies at high risk of chromosomal abnormalities.

The fetus can then be tested during pregnancy by a prenatal invasive procedure wherein blood, tissue or amniotic fluid is tested for the genetic makeup of the baby and genetic abnormalities are diagnosed using analysis of the chromosomes, analysis of biochemical products and molecular genetics (Multiplication of DNA parts using a polymerase chain reaction to identify the mutation). An increasing number of genetic diseases can be managed with treatment.

The genetic counselor can interpret your results, tell about the current state of research on your specific condition and help with the options that are available. Predictive testing for genetic alterations for cancer and diabetes can tell you whether you carry a gene mutation that puts you at risk of that disease.

In obstetrics and gynecology Thalassemia, a blood disorder where its haemoglobin content is not properly formed, is

Genetic tests will tell you whether you are exposed to any hereditary diseases. Though there is no complete cure, many genetic disorders can be managed with treatment common amongst Asians. Hence, it would be ideal to check the thalassemia status of every pregnant lady early in pregnancy. If she proves to be a carrier of the thalassemia disorder (Thalassemia minor), it is important that her husband be tested for the thalassemia status too. The couple has a 25 per cent chance of having a baby with thalassemia major (The blood disorder which will require regular blood transfusions) if both the parents are carriers. The fetus can then be tested at 12 to 13 weeks of pregnancy by a placental sampling for thalassemia major.

If the parents have had a previous baby with a chromosomal disorder, there is a one percent chance of recurrence of the same or another chromosomal disorder in the next pregnancy. The chromosomal disorder occurs due to a mistake during cell division.

If the parents have had a chromosomally abnormal baby, then they should both have their genetic makeup tested before the next pregnancy.

During the next pregnancy, the fetus should be tested by a placental biopsy or testing of the fluid around the baby (Amniocentesis).

The author is Foetal Medicine Consultant and Sonologist, Zulekha Hospital, Dubai

COVER STORY Hereditary Diseases

Genetic tests

raise hope

for humanity

H

ereditary diseases are carried by mutation in the single gene, multiple genes or mitochondrial DNA (Maternal). Inheritance of a specific disorder depends on the type of chromosome affected (Autosomal or sex chromosome). The inheritance pattern of mutations in autosomal chromosomes can be classified into autosomal dominant and autosomal recessive disorders. The inheritance pattern of mutations in sex chromosomes can be grouped 26 FUTURE MEDICINE I August 2013

The DNA-based genetic tests are established scientific methods to identify the mutated gene. The process involves the isolation of genomic DNA and direct DNA sequencing is used to confirm the mutation in a particular gene

By Dr Mahesh Kandasamy into three categories namely X-linked dominant, X-linked recessive and Y-linked hereditary disorders.

Mutations in the identical gene or different gene can lead to the same disease phenotype. Some diseases may result from the interactions of several genes and the environment.

Different mutations in different genes may predispose individuals to the same kind of disorders (Cancer, diabetes, heart disease and hypertension). Neuro degenerative disorder like Huntington’s disease, carriers with expanded-intermediate

range of CAG repeat number in the HTT gene, may not develop the disease but their children are at high risk of developing HD as the CAG repeat expansion increase from one generation to the next. In some sporadic cases, the defective gene might originate in first generation due to de nova mutation and the subsequent generation may continue to be affected by the disorder. An affected mother can pass the genetic disorder to children in mutations of the mitochondrial genome (Leber’s hereditary optic neuropathy)

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COVER STORY Hereditary Diseases

female’s egg contributes to mitochondrial DNA in the foetus.

Genetic tests

The DNA-based genetic tests are established scientific methods that are available to identify the mutated gene.

It involves the isolation of genomic DNA followed by the Polymerase Chain Reaction (PCR) using locus specific primers. Direct DNA sequencing is used to confirm the mutation in a particular gene. Genotyping can be performed on DNA extracted from the peripheral blood, tissues biopsies and amniotic fluid (Prenatal diagnosis). In genetic testing, it is very important that affected or unaffected carrier, parents of affected child, family members and caretakers are made aware of the testing procedure, the medical benefits and drawback of the test. They may require counselling for emotional, ethical, legal, social, economical and healthcare needs for the specific disease.

Research and medical system

These hereditary disorders are increasingly recognised and pose considerable challenges to the research and medical system. The clinical phenotypes of these disorders are highly complex and diverse. Even though there are a few available measures to manage the disease, there is no completecure. The treatment strategies are specific for each hereditary disease. Enriched environment, physical exercise, healthy nutrition and social interactions are often prescribed additionally to cope with the disease.

The major obstacle to develop novel therapy is largely due to incomplete understanding of the biology of the disease. The human genome project has helped us to identify a huge number of genes with defects. It further allows us to focus ongenotype–phenotype correlates of disease.

Strategies that are directed towards silencing the expression of defective genes and RNA interference are considered.

Recent advances in induced pluripotential stem cell (iPSC) technology offers a promising research platform to study the biology of these genetic disorders.

Using human disease specific iPSC, gene correction strategies provide the future perspective to revert the monogenic mutated gene into its normal state.

28 FUTURE MEDICINE I August 2013

Pros & cons of genetic tests

Genetic tests have already dramatically improved lives. Some tests are used to clarify a diagnosis and direct a physician towards appropriate treatments while others allow families to avoid having children with devastating diseases or identify people at high risk for conditions that may be preventable. Aggressive monitoring for and removal of colon growths in those inheriting a gene for familial adenomatous polyposis, for example, has saved many live.

Commercialised gene tests for adultonset disorders such as Alzheimer’s disease and some cancers are the subject of most of the debate over gene testing. These tests are targeted to healthy (Presymptomatic) people who are identified as being at high risk because of a strong family medical history for the disorder. The tests give only a probability for developing the disorder.

One of the most serious limitations of these susceptibility tests is the difficulty in interpreting a positive result because some people who carry a disease-associated mutation never develop the disease.

Scientists believe that these mutations may work together with other, unknown mutations or with environmental factors to cause disease.

A limitation of all medical testing is the possibility for laboratory errors. These might be due to sample misidentification, contamination of the chemicals used for testing, or other factors.

The author is a Research Scientist, Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, (NIMHANS), Bengaluru.

MOTIVATION

Taking up cudgels

Do you know one out of eight women will end up with cancer in their lifetime? Shocking right!

Has anyone of you thought of how could this alarming situation be tackled? Premi Mathew hailing from Kochi has a clear idea of resolving this menace. ‘Protect your Mom’and ‘Hair for Hope’are the initiatives of Premi to beat breast cancer by creating awareness

against breast cancer

By Shalet James

‘P

Premi mathew( centre) organising a Pink Day at a school in Dubai rotect your Mom’campaign targeting students commenced two years ago. It was the personal experience of Premi Mathew that led to the establishment of two projects- ‘Protect your Mom’ and ‘Hair for Hope’. She hopes to save all women from the threat of breast cancer through the campaign.

“The idea was born when breast cancer hit my family.

Since ours is a family of doctors, the lump was detected at Stage 2. PYM endeavours to warn every woman about lumps and other signs of breast cancer. Once cancer

30 FUTURE MEDICINE I August 2013

Premi Mathew Founder: PYM Foundation, Hair for Hope, India.

MBA with over 17 years of academic and teaching experience Email.pym20101@hotmail.com https://www.facebook.com/protectyourmom https://www.facebook.com/HairForHopeIndia www.protectyourmom.asia.

spreads, it turns fatal. But a few women go for regular checkups or even know that a simple self-examination could possibly save their lives. So we have initiated a unique way to create awareness among mothers through music, dance, art by children and youth. Mothers are usually too busy to take care of themselves so I thought it would be the best way to save every mom,” says Premi Mathew, Founder, ‘Protect your Mom’campaign.

Borrowing the strategy used by famous companies like Maggie and McDonald’s, PYM uses pester power to make mothers do self-exam for lumps.

The fact that cancer patients lose their hair due to chemotherapies pained Premi very much and as a solution to the problem, she came up with ‘Hair for Hope’campaign. Recently, when Nisha Mani, former Miss Kerala and wife of Jose K Mani, MP, cut her lustrous hair for the good cause, more people got inspired to be a part of this noble cause. To attract more school and college students to the cause, now young boys and girls in Dubai are actively involved in this campaign.

“Wigs made of natural hair are better.The ideal length of cutting hair to make wigs in India is 15 inches (since

assistance. Global Public School was the first in India to organise a mass hair donation with 13 people donating their hair within a week of the launch.

The PYM design and win contest started in 2011 invites people, especially students, to create awareness through skits, dances, posters etc. With over 100 good entries in 2012, including skits, dances, posters and videos at zero expense, PYM hopes to ensure 100 per cent awareness about lumps and early signs of breast cancer. Students in India can also win two air tickets to Abu Dhabi by emailing posters, songs, and dances to pym20101@hotmail.com. The best entries could be viewed on its website and Facebook page.

With over 10,000 members and a youngest brand ambassador of just eight years old, PYM has 3,500 fans in Facebook. Colleges/schools in India could join the campaign by organising even small PYM events and emailing the pictures to pym20101@hotmail.com Giving an opportunity to the people who wish to become a reason to bring smiles on the faces of the cancer patients, PYM endeavours to make it a global movement of students. “We want a student in every school and college in the world to promote the cause and spread the word until we educate the whole world about self-examination. If a five minute self-exam could save a life, every woman should know about it and we can do it without any expense through this movement,” adds the founder of ‘Protect your Mom’campaign.

Since Premi has been living with family in Dubai for 15 years, ‘Protect your Mom’ campaign is more active there.

The campaign that has succeeded in warning millions of people against breast cancer through Facebook and You Tube in the UAE was nominated for the 2012 Emirates Woman Award.

One of the posters submitted for the Protect Your Mom design and win contest in 2012 Protect Your Mom campaign held in Dubai last year Indian women prefer longer hair) and in the US eight inches. Hair should be shampooed, dried and is tied into a pony tail before it is snipped. Women usually trim their hair and dump it in the bin, so why not use it for a cause.

The campaign has already identified a wig maker at Kochi viz Hair craft who has agreed to convert hair into wigs @ Rs 3000 if donors supply 250 gms of hair. Chemically treated hair cannot be used. They also have a sponsor to pay for the charges of making a wig and a number of parlours have also expressed interest in supporting the campaign. Any school who would like to organise a hair donation campaign could contact them via email for all

Facts

A self-exam could help detect lumps and other signs of breast cancer at zero cost.

Early detection could cut down fatalities up to 95 per cent.

After the age of 20, it is better to do a self-exam every month and after 40, a mammogram every year.

August 2013 I FUTURE MEDICINE 31

SEX Q&A

ASK

Dr A CHAKRAVARTHY Ask any sex related questions to Dr Ajith Chakravarthy when you need to clear doubts that are haunting you relentlessly. His answers based on your questions will help you overcome the anguish over sex-related issues Whenever we have sex, after climaxing, all the semen which gets released doesn’t go inside her vagina. It comes out when I withdraw my penis. This affects my wife getting pregnant.

What should we do to hold my semen completely inside her to get pregnant?

Deepak Surendran, Kochi Normally, in missionary position, some of the semen may escape from vagina after ejaculation. If you want to retain more volume of semen, the doggy stylewould be a better position and tell her to maintain in the position for a few minutes after ejaculation.

Doctor, what is this sex therapy treatment. I am curious to know what happens during the therapy.

Siddharth Srivastava, New Delhi Sex therapy is a method of treating sexual problems which include erectile dysfunction, premature ejaculation, non-consummation, vaginismus, orgasmic disorders, painful intercourse etc.

Sex therapyutilises the principles of counselling and it involvesprescription of specific and structured erotic experiences which desensitises the fear and change in the perception about the erotic experiences. It does not involve any physical contact in front of the therapist or with the therapist.

Techniques applied in a sex therapy session are Sensate focus technique, in which couples fondle or manually manipulate the partner’s body, usually for relaxation purposes, without sexual contact, to experience the magical erotic pleasure and PLISSITtechnique which includes permission giving, limited information, specific suggestions and intensive therapy.

Sex therapy is normally carried out in stages that include education and counseling, structured sexual task, review of treatment, outcome of assessment and termination.

Are there any safe, effective penis enlargement treatments?

Nafeez Aslam, Kozhikode It is a myth that guys with longer penis are better 32 FUTURE MEDICINE I August 2013

Dr A Chakravarthy

Consultant in Reproductive and Sexual Medicine Thiruvananthapuram info@eSexologist.com

performers in bed. Fact is that, a guy who has an erect penis of more than three inches long and has good skill in love making can make partners reach orgasm. Also there is no evidence based effective enlargement medicine has been discovered so far. Of course, certain surgeries can make penis look relatively longer by cutting its suspensory ligament.

What is the definition of “sex addiction” and what does it entail?

Job Mathew, Bengaluru The term “sex addiction” is no more used in modern medicine, rather, “Hyper Sexual Disorder” which is a type of mental disorder.It is proposed to be included in the Diagnostic and Statistical Manual of Mental Disorders version 5 by American Psychiatric Association.

As per DSM V, if a person repeatedly shows four of the following five criteria for six months or more, then the possible diagnosis would be hyper sexual disorder.

1. If a person is unable to concentrate or to do day to day activities beyond the sexual thoughts and fantasies 2. If negative stimuli provokes sexual thoughts or sexual acts. They might use sexual activity to alleviate boredom or depression 3. If the person is unable to keep his/her sexual fantasies and behaviours under control 4. If the sexual behaviour occurs in inappropriate ways or with inappropriate partners 5. If engaging repeatedly in sexual behaviour while disregarding the risk for physical or emotional harm to self or others These symptoms may involve physical sex with multiple partners, cybersex, telephonic sex, compulsive masturbation or a combination of these.

The distinguishing characteristic is the intrusiveness of sexual thoughts and actions; the sufferer may not really want to engage in it rather compelled to do it. Hyper sexual disorder could be caused by mental diseases such as dementia, bipolar disorders, schizophrenia, epilepsy, tumours of frontal or temporal lobe as well as by certain medications to treat Parkinsonism.

DISEASE SPECIAL

Eye Care

EYE CARE

Dr Shane Mathew, DNB FRCS, Senior Vitreoretinal Surgeon at Vasan Eye Care Hospitals

New trends in

ophthalmology

O

phthalmology has evolved to be one of the most developed specialties in modern medicine.

A quantum leap by technology over the last few decades in ophthalmology has led many to term the period as “golden age� in ophthalmology. Significant and rapid technological advancements have been made in the field of refractive surgery, cataract surgery and vitreo retinal surgery.

Almost all of these have been introduced in India. With the major eye care institutions coming into the scene, these facilities are now available at the doorsteps. Life without glasses was not an option for many people with refractive errors until contact lens came into vogue but had its own drawbacks. With technologically 34 FUTURE MEDICINE I August 2013

advanced ophthalmic surgery, long/ short sightedness or astigmatism and presbyopia can be corrected using advanced laser, implantable collamer lens or multifocal intra ocular lens implantation.

The last few decades have marked an improvement in corneal transplantation techniques and it is now possible to transplant only the selected layer of cornea that is affected. The pace of innovation has been fast especially in the field of IOL (Intra Ocular Lens) technology and techniques of cataract surgery that has become one of the most safest and predictable surgical procedures with faster recovery of vision.

The future is promising with nanotechnology which will change the

way of diagnosis and treatment of eye diseases. Considerable progress has been made in gene replacement therapies for retinal degenerations resulting from gene defects in photo receptor cells and in retinal pigment epithelial cells.

It would also help in treating acquired diseases involving angiogenesis, inflammation and degeneration with targeted sustained intraocular delivery of therapeutic proteins. Stem cells have already shown promising results in some of the eye diseases which did not have effective treatment in the past. Artificial vision with bionic eye which is a retinal prosthesis has already shown positive results which would help blind to see in the future.

The last few decades have marked an improvement in corneal transplantation techniques and it is now possible to transplant only the selected layer of cornea that is affected

DISEASE SPECIAL

New devices for

better eye care

By FM Bureau

Anti-ageing eye care massager This massage equipment uses the well-established infrared heat principle. It has a thermal effect on the body, accelerating blood circulation. The device can be used simply by placing it on the areas on the face that are prone to wrinkles, including forehead, around the eyes, lips and neck.

This device is excellent for skin care around the eyes with three functions available.

The first is the 360 degree rotational ball that increases blood circulation and relaxes nerves and muscles. The negative ion function strengthens immunity, accelerates skin metabolism and also calms muscles and nerves. A light therapy can also be used, with similar anti-ageing and antiwrinkle effects. Overall, the anti-ageing eye care massager is an excellent choice for those looking for a low price, convenient and effective beauty product aimed at encouraging the natural production of younger, firmer, contoured skin.

Optical coherence tomographer Dr Joseph Steiner, a recent graduate from the optometry school at Pacific Lutheran University, who practises at Drs McBride and McBride in Billings, has learned to wield the optical coherence tomographer (OCT). An OCT is a lot like an MRI machine, except that it examines the inner eye.

And it is a lot smaller. The one in Steiner’s office is about the size of a monitor for an older desktop computer.

When a patient looks into the machine’s viewfinder, the OCT uses light waves reflected off the back of the patient’s eye to map its anatomy. The OCT can take measurements that are as small as 500 microns. That’s half a millimetre, or about half the thickness of a compact disc. “The result is a multi-coloured, threedimensional image that can reveal

abnormalities. The two-minute test does not require a patient’s

eyes to be dilated, and it is safe,” says Steiner.OCT imagery allows optometrists to examine the health of a patient’s optic nerve as well as to look for signs of glaucoma, macular degeneration or cancer. If something appears unusual on the OCT test results, an eye doctor will conduct further testing.

August 2013 I FUTURE MEDICINE 35

DISEASE SPECIAL

Dos and don’ts to prevent

Dos Eating a diet rich in fruits and vegetables,especially dark leafy greens like spinach, kale, and collards, and carrots is good for eyes. Researches also have proved that eating fish high in omega-3 fatty acids is also helpful.

Do wear protective eyewear. This refers to safety glasses and goggles with side shields, used for sports, gardening and hobbies where flying objects may break ordinary eyewear.

Do wash your hands often to avoid eye infections.

Don’t touch your eyes with fingers after shaking hands with someone.

Do rest your eyes. Try closing your eyes when given the opportunity.

Take a break every 20 minutes to give your eye muscles a rest and look away about 20 feet for 20 seconds.

Get a yearly eye examination to stay away from cataracts, glaucoma, diabetic eye disease and macular degeneration.

36 FUTURE MEDICINE I August 2013

“Almost nothing need be said when you have eyes,” this is a famous quote from the novel The Boat in the Evening written

by Tarjei Vessas. This simply denotes how important eyes are to a human being. It is estimated that about 285 million people are visually impaired worldwide and of them, 39 million are blind. Here are some dos and don’ts to prevent visual impairment to an extent

Don’ts Don’t stare at the sun and other bright lights. Looking directly at bright lights and laser pointers can be harmful to your eyes.

Don’t stare too long at your computer screen, TV or reading material.

Reading in poor light can strain your eyes.

Avoid long hours at the computer or TV. Avoid dusty areas.

Avoid using another person’s soap, towel or handkerchief, etc.

Avoid self-medication Avoid reading in moving vehicles.

PERSONALITIES Sankara Eye Care Institution, Coimbatore

A million vision restoration

surgeries and still counting Sankara Eye Care Institution has been on a mission to provide eye care to rural poor and the institution has recently completed one million free vision restoration surgeries. Started as Sankara Eye Hospital in Coimbatore, the institution today has a network of field workers, doctors and paramedics across the country to accomplish its mission

T

By Prashob K P

hey knew what light was until fate snuffed it out. Some learned to cope with blindness, but some couldn’t. And the light remained a dream until the arrival of Sankara Eye Care Institution at their doorsteps.

Headquartered in Coimbatore, SECI has the belief that corneas know no religion and socio-economic conditions of society and they continue to touch lives by performing 500 free eye surgeries per day. SECI, the brainchild of Dr RV Ramani, has been tackling the problem of rural India for the past 35 years. In the pursuit of restoring the divine light, Sankara started an eye bank which has been maintained by a set of doctors who propagate the importance of eye donation. The organisation claims to be working on an 80:20 ratio where 80 per cent of the beneficiaries are the rural folk who receive treatment totally free and the rest 20 per cent are the upper class people who pay for the treatment.

Recently, the institution has completed one million free vision restoration surgeries, a project that mainly benefited rural poor.

One-room clinic

Dr Ramani, who had a flourishing practice in Coimbatore, wanted to do August 2013 I FUTURE MEDICINE 37

PERSONALITIES Sankara Eye Care Institution, Coimbatore

something more than his career. “I came to know that the trustees of Kamazhi Amman Temple located in the area were planning to set up a healthcare centre for the poor. My wife and me thought that it was a god given opportunity to serve the poor patients and fulfill our wish,” recalls Dr Ramani, Founder and Managing Trustee, SECI.

Dr Ramani took initiative to start a clinic and received the support of his colleagues who were willing to spend a day in a week to provide free healthcare at the clinic. In just five years, the one-room clinic grew to become an institution with nine primary medical healthcare centres. In 1985, Ramani shifted focus to eye care as he felt that the need for eye care in India is huge. “A friend of mine, Nataraj, came forward and donated 5.5 acres of land at Sivanandapuram in the Saravanampatty area of Coimbatore. The hospital came up on the land with the help of my friends. The hospital was named Sankara Eye Hospital.

Each block of the hospital was sponsored,” says Dr Ramani.

Through a comprehensive community eye health programme, SECI ensures that not a single person goes blind due to absence of readily available and timely care in the communities served by its various centres. “Under the Gift of Vision programme, we reach out to the patients through our network of field workers, doctors and paramedics,” says Ramani. The programme started with the active participation of Rotary International and Rotary Coimbatore Central and is now supported by District Blindness Control Society, Sankara Eye

38 FUTURE MEDICINE I August 2013

Foundation USA and Sight Savers UK. Presently, Sankara is serving in 69 districts in 11 states, including Gujarat, Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, Punjab and Uttarakhand.

Children’s eye care

SECI was among the first in the country to come forward to prevent child blindness. We have different programmes for separate age groups such as Swagatham-neonatal screening programme for the newborn, Maithri- a programme reaches out to the underprivileged children between the age of 3 and 6 years, Rainbow- a school screening programme in which teacher volunteers are identified and trained to do the preliminary screening and Nanna Kannu, a unique comprehensive programme for the children with visual defects.

The project implemented in partnership with Sight Savers International, Government of Karnataka and National Association for the Blind would reach out to 1,50,000 children in the first phase.

Education programme

In the field of ophthalmology, rapid changes in diagnosis are evolving.

Continuing medical education programmes are conducted to update the knowledge of the workers in the field. “The first BSc Optometry programme in Karnataka has commenced at our institution in Bengaluru. The Sankara College of Optometry is currently enrolls 20 students in a batch. Realising the need for well trained and qualified mid-level ophthalmic personnel (MLOP), the hospital has been conducting diploma in vision care technician since 2004,”

FOCUS Chaithanya Eye Hospital and Research Institute

For Your Eyes

Only Eyes are the wonderful sensory organs which help people learn about the world in which they live.

Eyes see all sorts of things - big or small, near or far, smooth or textured, colours and dimensions.

Eyes have many parts - all of which must function in order to see properly. Imagine how dark the world could be for someone who does not have proper eyesight. So the protection and care of eyes are the most important responsibility of an individual.

Chaithanya Eye Hospital and Research Institute, a superspecialty hospital in Thiruvananthapuram, is committed to eye care and the treatment of eye diseases. To deliver its vision - Prevention of blindness- the institute has been taking initiatives to reach each section of society with quality eye care. Manned by highly qualified doctors, trained medical and paramedical staff, the institute remains wedded to high ethical standards and the stateof–the–art treatment techniques.

In an interview with Future Medicine, Dr KGR Nair, MD, of Chaithanya Eye Hospital, talks about the potentiality of the hospital in the present context

By FM Bureau

Committed to eye care treatment

Chaithanya believes in ensuring eye care through Giving Light Protecting Vision and Spreading Hope. Recognising that advancement in eye care can proceed only with a multilevel approach, the institute strives to promote and provide superior patient care, community programmes for treatment and educational activities for the future ophthalmic service providers and research activities aimed at advancements in treatment modalities.

Chaithanya has extended its facilities by establishing centres in Kochi and plans to further expand to other parts of the state. Within a short span of 10 years, the hospital has established itself as the biggest

private sector hospital in Kerala.

Patients from overseas, including Maldives, Middle East, the UK and the US, are regularly treated at the twin facilities in Thiruvananthapuram and Kochi.

Free treatment, surgeries for poor

Simultaneously, a charitable trust working towards the prevention and elimination of blindness was started. Chaithanya Sight Foundation in association with the hospital has conducted close to 230 free rural eye camps. In these camps, thousands of persons were screened and intraocular lens implantations were carried out free of charge when required. Besides, in association with Help Age India, the hospital has conducted around 250 cataract surgeries for poor patients. At August 2013 I FUTURE MEDICINE 39

FOCUS Chaithanya Eye Hospital and Research Institute

present, a project to do free cataract surgeries for 1,000 poor patients is ongoing. Awareness programmes are also held regularly for rural population, school children, senior citizens etc.

The other institutions functioning under Chaithanya include the Chaithanya Sight Foundation, Chaithanya Eye Bank (Functioning in collaboration with Eye Bank Association of India), The Chaithanya Lasik Centre, a centre of excellence for refractive surgery, the Chaithanya Teleophthalomology Services to promote the use of teleophthalmologyand Drishti Opticals, a dedicated optical establishment.

The Foundation also publishes Sight Kerala, a magazine to promote eye care.

Eminent ophthalmologists and social workers regularly write in the magazine.

Ophthalmology PG training

The institute has accreditation of National Board of Examinations, New Delhi, to train candidates for the prestigious PG course-Diplomate National Board degree. Six doctors are trained each year for this course.

Doctors trained by Chaithanya

surgery. The trainers include Dr KGR Nair, Dr Minu Mathen, Dr Anil Radhakrishnan and Dr Swapna Nair.

hospital for preceptorship programme.

Final Year BSc Optometry students of School of Medical Education, Regional Institute of Ophthalmology Thiruvananthapuram and Little Flower Hospital, Angamaly, are given internship at the hospital.

Training in all sub specialties

Vitreo Retinal Clinic

The programmeis held with the patronage of Chaithanya Sight Foundation and Appasamy Associates, Chennai.

A six-month rotation in all sub specialties, including the Advanced Cataract Microsurgery programme, is in place. The training will be in various departments, including glaucoma cornea pediatric ophthalmology and vitreoretina.

Medical retina diagnosis and treatment

A two-month training in the medical retina diagnosis and treatment will familiarise the doctor with the use of indirect Dr K G R Nair, K G B Nair, Director Chief Consultant ( Finance & Administartion ) ophthalmoscope, slit lamp biomicroscopy, ultrasound OCT FFA ICG and their have secured placement in reputed importance in the diagnosis of ophthalmic hospitals in the country. retinal pathology. Training inlaser Fellowship programmes photocoagulation will also be The research institute offers undertaken. fellowshipprogrammes for Advanced Cataract Microsurgery. It is a two-month programme which includes didactic lectures,fellow presentation,wetlabtraining, live surgical demonstrations and supervised 40 FUTURE MEDICINE I August 2013

Internship in optometry

School of Optometry and Vision Science, University of New South Wales, in Australia regularly sends Final Year Bachelor of Optometry students to the

The Vitreo Retinal Clinic is involved in the management of diseases of the inner light sensitive layer of the eye.

Conditions like diabetic retinopathy, retinal detachment, AMD macular hole etc. are among the diseases.

Cornea service

The cornea service of Chaithanya Eye Hospital and Research Institute handles nearly the entire range of corneal disorders, including trauma, dry eye and infections. It gets steady referrals from ophthalmologists from all over Kerala, other southern states, Maldives and Gulf countries, for proper diagnosis and management of complicated corneal problems.

Research and development

Any science thrives on active research and development. At Chaithanya, learning from experience and keeping abreast with the developments made in ocular care throughout the world are an ongoing exercise. It tries to adapt to the latest techniques in Indian scenario in a costeffective manner. Chaithanya is also a nodal centre to understand the eye ailments of the region.

EYE CARE Lotus Eye Hospital and Institute, Coimbatore

Lotus keeps eyes wide open Lotus Eye Care Hospital with branches in main locations where quality eye care is required is trying to become India’s best corporate hospital

I

By Tony William

ndia accounts for 20 per cent of the 39 million blind people across the globe with 7.8 million blinds in the country. Cataract is found to be the cause of around 62 per cent blindness while 20 per cent is due to refractive error.

Glaucoma and corneal blindness accounting for six and one per cent respectively are the other causes Experts believe that many of these cases are curable if proper detection is done in time. “We believe in providing comprehensive preventive measures and thereby creating awareness about eye diseases,” says Dr K Sundramoorthy, Chairman, Lotus Eye Care Hospital.

A pioneer in high tech eye care in the country, Lotus Eye Care Hospital has so far performed over 40,000 procedures in lasik, epilasik, zyoptix ultimate, epizyoptix, blade free intralase and zyoptix supracor.

The eye hospital has made an impressive journey from a single eye care hospital to a network of eye care centres in Tamil Nadu and Kerala.

Reception of Lotus Eye Hopsital, Coimbatore

Under the leadership of Dr

Sundramoorthy and his team of ophthalmic experts who are highly qualified with vast experience in each specialty, Lotus is working to take away avoidable blindness.

“Today, Lotus is known for its excellence in ophthalmic services with personalised care. Using technological advancements in the field, the hospital is rendering its services to thousands of patients, including those from around the world,” says Dr Sundramoorthy.

The hospital has shown keen interest in acquiring the latest technology for the ophthalmic treatment. In 1998, Lotus introduced multi scan Lasik for the first time in India and in 2002 acquired Esiris Custom Lasik. In 2004, Lotus introduced Epilasik for the first time in South East Asia.

In June 2005, Lotus introduced the most advanced technology of Zyoptix Z100 and combined two superior technologies Epilasik and Zyoptix known as Epizyoptix to achieve Supervision. In 2011, Lotus introduced Zyoptix Supracor technology (Lasik for 40 plus age August 2013 I FUTURE MEDICINE 41

DISEASE SPECIAL Lotus Eye Hospital and Institute, Coimbatore

Dr K Sundramoorthy group for presbyopia correction) for the first time in Tamil Nadu.

Lotus Eye Care Hospital with branches in main locations where quality eye care is required is trying to become India’s best corporate hospital.

Lotus has two branches in Coimbatore, two branches in Salem besides centres in Tiruppur, Mettupalayam and Kochi.

Committed to society

With a mission to enable proper eye sight, Lotus is actively participating in the activities of District Blindness Control Society (DBCS) which endeavours to reduce the prevalence of blindness. The Lotus Vision Research Trust (LVRT), a non-profit public charitable organisation, provides

world class eye care to patients. LVRT has helped 30,000 poor patients in different parts of Tamil Nadu with free cataract and intraocular lens surgeries along with retinal, glaucoma and cornea treatments free of cost. The hospital also ensures that proper postoperative care is given to them.

Lotus regularly conducts eye care awareness programmes, free eye checkups in urban and rural areas and educative programmes for the benefit of society. Lotus has been recognised under Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme to treat economically poor.

Through its rural outreach programme ‘Aim for Seva’, Lotus along with Arsha Vidya Gurukulam, Anaikatti, about 32 km from Coimbatore, offers free service to those in the remotest parts of the country. Lotus has also initiated community projects like Life Time Vision Project for diabetes, Ilam Vizhigal Youth Eye Care Project for school children, Crystal Clear Vision Project, Golden Eye Care Services and Sarkarai Kangal.

“Today, I am glad to announce that we have successfully

42 FUTURE MEDICINE I August 2013

carried out more than one and a half lakh surgeries, including highly complicated ones, besides 30,000 surgeries free of cost to poor patients,“ says Dr Sundramoorthy.

A training centre for PG

Lotus is a training centre of International Council of Ophthalmology (ICO) for post graduate students from within the country and abroad.

It is a recognised hospital for DNB Ophthalmology by the National Board of Examinations. Lotus has short term and long term fellowship programmes such as cataract, glaucoma, retina, refractive surgery, cornea and paediatric ophthalmology. Lotus is also running educational institutes that include Lotus Bausch and Lomb Institute of Optometry and Lotus School of Ophthalmic Nursing.

More centres planned

About the expansion, Dr Sundramoorthy says Lotus plans to establish centres in different parts of India, especially eastern India where eye care is not as good as the other parts of the country.

“I want to make more contributions in the field of eye care through innovations and introduction of new technology.

The teams of young ophthalmologists at our hospitals are constantly pursuing research and development activities to enhance the quality of surgical care provided to our patients,” he says.

PERSONALITIES Dr Tony Fernandez

Dr Tony Fernandez,

a doyen of

eye care Dr Tony ensured that no person remained with defective eyesight just because he had not enough money

By Tony William

T

here was a time when the relatives of deceased persons disagreed with doctors on

donating eyes of the dead. In some cases, the grieving family members used abusing words against doctors who came with requests to donate the eyes of the deceased “Since then, much water has flown down the river and people’s attitude has changed over the years,” recalls Dr Tony Fernandez, the crusader against blindness and the man who made the sleepy town of Angamaly synonymous with ophthalmology in Kerala.

Dr Tony started his career in the UK in 1961. After four years, he returned to India and joined Madurai Medical College as Assistant Professor. He played a crucial role in setting up the second squint department in South India at a time when squint was not even considered as a disease. He joined Angamaly Little Flower Hospital in 1969 at the insistence of a friend. Inspired by Dr Murugappa Channaveerappa Modi, a pioneer in the mass eye surgery in India, he started his crusade against blindness.

Dr Tony organised eye camps in the length and breadth of Kerala.

Various social organisations like Lions Club and Rotary Club and religious organisations provided support for such camps. “We used to perform operations in schools by converting two classrooms into an operation theatre. The eye camps were treated

by villagers as festivals. They used to prepare food for the patients and us,” says Dr Tony.

It was Dr Tony who set up an eye bank at Angamaly Little Flower Hospital in 1970, the first eye bank under a private hospital in South India, with the participation of the public. At that time, only Ahmedabad Medical College had an eye bank.

“But the response to the eye bank was very poor. Various factors, including religious beliefs, hindered people from donating their eyes. Professors and local priests were always helpful in such situations. We used to get eyes from Sri Lanka as the Buddhists were always willing to donate their eyes,” says Dr Tony.

Dr Tony ensured that no person remained with defective eyesight just because he had not enough money. He mainly depended on aids by international organisations which became crucial in the expansion of the department of ophthalmology at Little Flower Hospital. Thus, a five-bed department of ophthalmology became a full-fledged department.

After retiring from Little Flower Hospital and Research Centre (LFHRC), Dr Tony established Dr Tony’s Super Speciality Eye Institute at Aluva. His son Dr Freddy T Simon is the Managing Director and Senior Consultant of the institute which

August 2013 I FUTURE MEDICINE 43

PERSONALITIES Dr Tony Fernandez

Dr Tony Fernandez who has done around 1,000 transplants takes the credit for introducing new eye surgeries in Kerala, including intraocular implantation refractive keratoplasty and corneal transplantation.

Dr Tony was the president of All India Ophthalmic Society and the editor of its journal. A recipient of BC Roy Award for the best socio-medical doctor and Padma Shri, Dr Tony has also won a number of national and international awards for his contributions in the field. stands apart from other eye clinics. This is the only hospital in the state where I Lasik treatment is conducted.

“I Lasik treatment was introduced to ensure accuracy and maximum safety. At the same time, recovery period is comparatively less. In this method, laser instead of a metal blade is used to reshape the cornea in order to improve eyesight,” says Dr Freddy. “For cataract surgery, we introduced a new state-of-the-art machine called ‘Infinity’ last month,” he adds.

The institute offers specialities in cornea, refractive surgery and LASIK, glaucoma, cataract (Sutureless), vitreoretina medical and surgical, pediatric ophthalmology and squint, community ophthalmology, low visual aids, contact lenses and optical shop.

Eye care

Eye is the window to the world. Eyes are so important in the life that we have to take maximum care of it. Listen to Dr Tony’s advice for the protection of eyes.

Wash your eyes in regular intervals with cold water.

Atmosphere is hot and it will help the eyes to look fresh.

Always read in the correct light. Ensure that the computer screen light is in the correct way. During continuous reading either it is mobile or computer screen, give rest to eyes. In the case of specs, use only corrected glasses.

Corporate social responsibility

The institute is conducting free eye camps in villages as part of its CSR activities. “Besides, the institute educates teachers on how to find students with serious eye problems and refer the students to clinics if proper medical care is needed,” says Dr Freddy.

44 FUTURE MEDICINE I August 2013

SURGEON SPEAKS Dr Arivazhagan

‘A surgeon should be

dedicated and compassionate’

pathetic condition of my village saddened me and with God’s grace and with my parents’ blessings, I excelled in my studies and decided to take MBBS. After watching surgeons performing operations to save precious lives, a desire to become a surgeon grew in me.

Surgical experience As I am a cardiac thoracic surgeon, every surgery remains memorable for me.

Still the surgery which I had done on a patient whose heart function was poor and had multiple blocks comes to my mind quite often. Many big hospitals had rejected this particular case and finally the patient came to Medi Hope Super Speciality Hospital.

The surgery was successfully carried out and today he is 75 years old and is living a healthy life.

Surgeon’s qualities A surgeon should have magic in his hands. He should be dedicated and compassionate.

Dr Arivazhagan is a cardiacthoracic and vascular surgeon in Medi Hope Super Speciality Hospital. He did his MBBS and MS in General Surgery from Bengaluru Medical College. He did Mch from Sri Jayadeva Institute of Cardiology, Bengaluru.

Dr Arivazhagan specialises in beating heart, Coronary Artery Bypass Grafting (CABG) and valve surgeries. With a rich experience of over 20 years, he was also a visiting consultant with National Hospital, Colombo, and Male Medicals, Maldives.

He has presented papers at national as well as international conferences and seminars

By FM Bureau Inspiration to become a surgeon I come from Kolar, a remote place in Karnataka. My father was an employee at Bharat Gold Mine and mother was a homemaker. We had to

struggle a lot during my childhood.

There were no good treatment facilities at the village and the people had to come to Bengaluru for consulting doctors and for major surgeries. The

Ethics Should perform surgery only when necessary and be always available to patients’ call at crucial situations

Improve healthcare system We should give quality healthcare for patients with the help of the best technology. If possible, every hospital should take initiative to conduct camps in the rural areas and the poor people should be given free medicines and surgeries. I always make it a point to conduct camps and serve the poor and recently we conducted a camp where 30 people underwent eye surgeries free of cost.

August 2013 I FUTURE MEDICINE 45

AGAINST THE ODDS Anjan Satheesh

Real life

hero trumps

Anjan Satheesh presenting his work, a caricature, to former president APJ Abdul Kalam

Never regret what you don’t have in the life.

This is the lesson we all have to learn from Anjan Satheesh, a victim of cerebral palsy.

The real life story of Anjan can persuade people to go ahead in the life with a smiling face despite all adversities

By FM Bureau

46 FUTURE MEDICINE I August 2013

A

njan’s left eye is cloudy and lacks sight. He cannot speak and hear properly. Besides, due to crippled legs bent from the knees, he walks with the help of a wooden crutch. Despite all, Anjan always appears with a smiling face.

Anjan Satheesh, 25,is the favourite teacher of the differently abled students at Adarsh Charitable Trust, Kurrekad, Kochi. Adding colours to the life of these students, Anjan tries to identify and develop talent in every student here. Drawing caricatures and replicating nature as well as life situations on the canvas, Anjan passionately works as a drawing teacher at Adarsh.

When Anjan was born on September 29, 1987, his parents N Satheesh Kumar and Lethika realised that there was something wrong with

their child. Soon, it was discovered that he had problems with his sight. Tests revealed that Anjan had glaucoma in both eyes. Immediately, two surgeries were done. But there were other problems also. Anjan’s neck would roll around. He was unable to turn over and lay on his back all the time. His legs remained stiff and unstretchable.

And he didn’t respond to sounds. The traumatised father and mother without any second thought took Anjan to AIIMS in New Delhi. Then after a thorough check-up, Anjan was diagnosed with cerebral palsy.

They brought Anjan back and admitted him to the Raksha Institute of Special Education in Kochi run by the Spastics Society. “It was the only institution in Kerala at that time which catered to the cerebral palsy victims,” says Lethika.

At age five, Anjan joined a regular school but he found it difficult to follow lessons since he couldn’t hear at all. Anjan was then brought to Adarsh Charitable Trust for physiotherapy sessions. Later, Anjan managed to pass Class X exams with the help of his parents who taught him at home. Thereafter, he did an animation course at Toon’s Academy in Thiruvananthapuram.

Instead of cursing their fate and remaining worried of the situation, Anjan’s parents encouraged him to lead a normal life and always stood by him. “Since Anjan couldn’t speak, he used to draw things and make us understand what he wants. Earlier, we didn’t give much attention to his artistic skills but later we realised that Anjan was very passionate about drawing,” says his mother.

Adarsh Charitable Trust has now become a second home for Anjan as he enjoys working there. “Anjan is an independent person. He does everything on his own.

If anything goes wrong with the computer system or someone’s mobile phone, it is Anjan who solves it,” says Ciya George, head of Finance and Administration.

Anjan’s elder brother Ashwin works as a Software Engineer in Saudi Arabia, his father is a Federal Bank Manager and his mother works in High Court. Anjan is also fortunate of being a member of the Kerala Cartoon Academy (KCA). “KCA has helped him a lot to develop his artistic skills and is giving opportunities to attend functions and camps,” says Lethika.

A tech friendly, Anjan also works in Maya,3D Software and Photoshop. Anjan came into the limelight when he gifted his artwork to Oscar-winner Resul Pookutty and C Rangarajan, the former Governor of the RBI. Displaying his cartoons and sketches of Osama bin Laden, Mahendra Singh Dhoni and Sachin Tendulkar, Anjan gestures that he was also lucky to draw a caricature of APJ Abdul Kalam and gift it to him at a function at Adarsh Charitable Trust. Anjan says that the happiest moment in his life is when he comes to Adarsh Charitable Trust and teaches drawing, painting, and computer skills to the children with Down’s syndrome, autism, cerebral palsy and learning disability.

Some of the works of Anjan Satheesh August 2013 I FUTURE MEDICINE 47

FOCUS Medi Hope Super Speciality Hospital and Research Centre

By FM Bureau

48 FUTURE MEDICINE I August 2013

T

D

Medical Specialities

he adage “Health is wealth,” makes more we are trying to provide the best medical service with sense these days as the number of fatal a touch of humanity. We conduct camps every month diseases and patients is alarmingly increasing in rural areas and have done many heart surgeries day after day. Though longevity has and other surgeries free of cost because we believe increased considerably, people in general that every patient should get the best treatment. We are more prone to the life-threatening diseases. Even have set up Medi Hope Charitable Trust which will be youngsters fall prey to chronic diseases like diabetes registered soon to fulfil this purpose,” says Dr Amit and cancer. According to the experts in the field, Agarwal, Chairman and MD of MediHope Hospital lifestyle changes are the main causes of the unhealthy Group. development in our society. So making people realise Medi Hope Hospital also plays a the value of health and helping them improve their major role in boosting medical health condition are very much important. tourism as they are Medi Hope Super Speciality Hospital and Research receiving patients Accident & Emergency Centre is making a change in the present health from Africa, Anaesthesiology & scenario providing quality healthcare which is UAE and Intensive Care affordable and accessible to all people. Founded by Cardiology Dr Amit Agarwal, Medi Hope Super Specialty Hospital Dentistry & Orthodontics and Research Centre is located in Indiranagar, Otolaryngology (ENT) Bengaluru. It is a multi-speciality hospital General Surgery designed with the most advanced Internal Medicine medical technology. The centre Obstetrics & Gynaecology strictly adheres to the Ophthalmology r Amit Agarwal, MBBS, MS international Orthopaedics (Ortho),Fellowship in Arthroscope, guidelines and Paediatrics Arthroplasty& Septic Bone & Joint Gastroentrology Surgery (Germany),took MBBS Minimal Access Surgery from JSS Medical College, Mysore Urology University, in 2000. He did his Pain Management Masters in Orthopaedic Surgery at Cardiac Surgery Kempegowda Institute of Medical Neurosurgery Science, Bengaluru, in 2004. In Cosmetic Surgery 2007, he obtained his Fellowship in Joint Replacement Joint Replacement and Arthroscopy Paediatric Surgery Surgery from Hamburg, Germany. An orthopaedic surgeon par excellence, Dr Agarwal has hands-on experience in joint knee replacement surgery for over seven years. His vision is to provide world class medical facility Maldives which is affordable and accessible regularly. As Medi for all.

Hope believes in holistic approach, the hospital has an Ayurvedic department. Yoga and meditation classes are also held here.

“We are doing research in stem cell therapy and have already done research in various fields, including hair transplantation, peripheral vascular diseases and oesteoarthritis.

As part of expansion, we are setting up branches international in Hyderabad and Durgapur in West Bengal. Mumbai patient service and Goa will have our branches in the future. We will protocols. introduce an In Vitro Fertilisation (IVF) wing very soon,” With excellent infrastructure says Dr Amit Agarwal. and expert surgeons from across the Free consultation through email and tele conference globe, the hospital has a right environment with physicians have operation theatres, OTS with for faster recovery of patients. The 200-bed laminar air flow and laminar shields, 1.5 Tesla MRI, 64 hospital has more than 100 doctors and consultants, slice spiral and cardiac CT scan, bone densitometry, VIP and over 150 nurses and support staff. suites, ICU/ CCU backup, dialysis and mammography “Our aim is not to corporatise the centre. Instead, are the other features of the hospital.

August 2013 I FUTURE MEDICINE 49

SUCCESS STORY KVM Hospital

Say hello to Halo Vest KVM Hospital in Alappuzha district successfully treats Hangman’s fracture with the Halo Vest application

By FM Bureau

K

VM Hospital’s Neurosurgery Department started

by Dr Avinash Haridas has recently performed Halo Vest for treating a 17-year-old RTA victim with high cervical spine injury – Cervical C2 level, Hangman’s fracture. This is a potentially lethal injury similar to that caused by judicial hanging (Hence the name Hangman’s fracture). It can cause quadriplegia and cardiorespiratory arrest.

Dr Avinash who was trained at National Hospital for Neurology and Neurosurgery, Queens Square, London, did the first Halo Vest application in Alappuzha district of Kerala.

The patient who had a moderate head injury was initially treated with Philadelphia Hard Collar.

But considering the young age of the patient and the reasonable distance between fracture fragments, the doctor decided to treat him with Halo Vest, instead of open reduction and internal fixation stabilisation surgery.

There is a massive cost difference between a Hard Collar and Halo Vest. Hard Collar may cost between Rs 600 and Rs 1000. Foreign Halo Vest for e.g. by Johnson & Johnson may cost around Rs 1.25 lakh. The carbon graphite Halo Crown or glass-composite 50 FUTURE MEDICINE I August 2013

Halo Ring with titanium alloy skull pins (screws) used in foreign Halo Vest is expensive. Another factor is that the amount of care required for a patient in a Halo, is perhaps 10 times the amount of care required for an operatively treated patient.

“If a Halo Vest is not well applied or is not well cared for, it can result in complications like loosening of screws which can be very painful for the patient and infected pin sites which in rare cases can penetrate the skull causing brain abscess. Due to this, many doctors prefer to do an operation to fix the fracture,” says Dr Avinash.

The real advantage of using Halo Vest is that it is non-invasive and does not involve permanently implanting metal work in the body.

Operative stabilisation can have potential complications like infection,

CSF leak, neurological injury causing paralysis, incorrect screw placement and metal work failure, which may require further operations. More importantly, a successful Halo Vest treatment will help preserve the full range of a person’s neck movement, whilst an operative fixation is accompanied by a reduction in the range of possible neck movements.

The efforts of Dr Avinash and his team can bring about a change in healthcare. “Actually, we have been able to bring down the cost of neurosurgery. At our institution, we have world-class neurosurgical facilities. But people are currently not aware of it,” he said. For doctors like Dr Avinash who left a promising career in England with an ambition to serve his countrymen and put Indian neurosurgery on the world map, it is a cause for concern.

DISEASE SPECIAL Sudarshanam Netra Chikilsalayam

An eye on ophthalmic diseases & treatment Netra Chikilsa (Ophthalmology) is a specialty area in traditional medicine. Sudarshanam Netra Chikilsalayam in Thiruvalla, Kerala, is a well known centre for treating various eye disorders.

The Chikilsalayam was founded in 1990 under the auspices of late Kanchi Kama KodiPeedom Chandra Sekharendra Saraswathi Swamigal of Kancheepuram.

In an interview with Future Medicine, Dr BG Gokulan, Chief Physician and Founder, Sudarshanam Netra Chikilsalayam, talks about the present ophthalmic diseases and its treatments in Ayurveda.

Dr Gokulan was trained under Padmasree Dr SS Badrinath, a renowned ophthalmologist at Sankara Netralaya in Chennai, in all areas of sub specialties in ophthalmology with special emphasis on diagnosis and documentation

By FM Bureau What are the main diseases treated at Sudarshanam?

Neurovascular diseases of eyes are mainly treated at Sudarshanam. There are various medicinal applications to act upon the eyes and the body. The major among them are kashayadhara, nasya, tarpana, putapaka, pichu, shashtikapindasweda, talam, shirodhara, shirovasti and 52 FUTURE MEDICINE I August 2013

chakshushyavasti.Most of the procedures are carried out on a daily basis.However, people from distant places can stay in the modest facility on the campus with vegetarian diet.

Sudarshanam Netra Chikilsalayam is focusing primarily on children. Ayurvedic therapies are much sought-after for healthy vision and medications are highly effective.Numerous patients of shortsight (Myopia) are

treated here and at its partner hospitals in other cities in the state and outside.

Name some new generation eye diseases and its treatments?

Computer Vision Syndrome (CVS) is one of the new generation eye diseases.All come under the purview of panchakarma management or say detoxification techniques. Sudarshanam Ayurveda Panchakarma Centre has a good track record of treating such diseases with no recurrence even after about five years. Such cases are normally referred for urgent surgeries in modern medicine.

Dr ChitraRajan is a Senior Physician at Sudarshanam, with over two decades of experience in diagnosis and various panchakarma applications.

Normally,a course of therapy takes about 7 to 14 days. Sometimes, it takes 21 days and rarely stretches up to 41 days based on the individual disease history. There is a refreshing programme at the hospital for computer professionals and those who work more on computers. This therapy is not just for the eyes but for the whole body as well.

What is ‘VisionPro’ and how does it work?

It is a specially designed Ayurvedic treatment or a combination of different programmes. According to Ayurveda, the body is made of panchamahabhutas (Five basic elements) and the physiology is controlled by various balances of Tridoshas (Three humours

Methodology In VisionPro, thrust is given to refreshing the eyeball and treating the associated symptoms with therapies such as tarpana, nasyakashayadharashashtika and other oral medicines and oils for head as the situation demands. A general as well as specified mode of therapies and medications are adopted lasting 7 to 14 or seldom 21 days, which looks torevitalising the body. Decoction of ghee or oil and sometimes raw herbal juice are used for these applications. They are totally safe and harmless to the body and to the bio-system and works well as a cure. The application of these herbal medicines in the eyes or nostrils gives a soothing and relieving experience to the person during and after the therapies.VisionPro Deluxe is a combination of eye as well as the whole body therapies, including the purification techniques popularly known as panchakarma. or unseen concepts) in the body termed as Vata, Pitta and Kapha which are visible only through their mode of action. Ayurveda looks into the balancing of these humours and panchamahabhutas in a healthy body.

VisionPro is designed taking into consideration the changing habits of food and total lifestyle that has spawn various hazardous diseases and disorders.

August 2013 I FUTURE MEDICINE 53

Cerebral Venous Thrombosis

CVT disorder more likely among youth

Dr M Pradeep MD, DM

Neurosonology, USA, FINR (Switzerland) Senior consultant& Interventional Neurologist

Although cerebral venous thrombosis has been recognised since the early 19th century, it is still a disease in which the diagnosis is often overlooked because of the wide variety of clinical presentations, causes and outcome.

Key points

C

erebral Venous Thrombosis (CVT) is a disorder in young people. Both females and males between the age of 21 and 40 years are most frequently affected. However, systemic illness and malignancies which predispose to CVT include the very young and old people.

Although cerebral venous thrombosis has been recognised since the early 19th century, it is still a disease in which the diagnosis is often overlooked because of the wide variety of clinical presentations,

54 FUTURE MEDICINE I August 2013

Cerebral venous thrombosis is associated with an extensive range of medical disorders.

Treatment is primarily focused on thrombus resolution, with either anticoagulation or endovascular approaches in cases with rapid neurologic deterioration.

Intracerebral hemorrhage due to cerebral venous thrombosis is not necessarily a cause to withhold anticoagulation

causes and outcome. Common symptoms and signs of CVT are headache, seizures, altered sensorium, focal deficits and papilledema.

Headache is the most frequent presenting symptom in 70-80 per cent of patients. 12-15 per cent of the patients present with seizures and in 40-68 per cent, they occur sometimes. Focal deficits and impaired sensorium are seen in approximately 60 per cent of the cases. Altered sensorium is usually due to raised intracranial pressure.

The most common cause of cerebral venous

thrombosis in women of childbearing age is hypercoaguability associated with the postpartum period, pregnancy or oral contraceptive pills. In a meta-analysis of the effect of oral contraceptive pills on stroke, current oral contraceptive pill users had a 16 fold increased risk of cerebral venous thrombosis compared to non users.

However, in developing countries, the puerperium is the most frequently associated with this entity in young women. Cerebral venous thrombosis mostly occurs during the first three weeks of postpartum.

Conditions such as dehydration, particularly in neonates, peripartum women, and elderly individuals can contribute to the development of cerebral venous thrombosis.

Another high risk group appears to be neonates or young infants in the setting of severe dehydration. The cerebral venous thrombosis occurred at six weeks (Dehydration and post viral infection were the causes), three months (Sagittal sinus thrombosis associated with acute lymphocytic leukemia was the cause), and 15 months (Severe dehydration was the cause). These data suggest that cerebral venous thrombosis is a more common cause of stroke in neonates and infants than in older children and adults.

Cerebral venous thrombosis should be suspected in individuals exposed to prolonged air travel who present with symptoms consistent with increased intracranial pressure. Severe elevations of intracranial pressure can mimic encephalitis or meningitis.

Appropriate cerebrospinal fluid and radiological studies help to differentiate between these conditions.

High quality MRI is the initial procedure of choice for a patient suspected of suffering from cerebral venous thrombosis. MRI noninvasively detects absence of blood flow in cerebral venous sinusis, images the thrombus itself,demonstrates associated brain infarction, edema or hemorrhage detects structural causes of the thrombosedsinus (Such as tumour), and rules out other conditions such as arterial stroke or abscesses.

Until the recent developments in MRI, CT of the brain was the initial test of choice in the diagnosis of the cerebral venous thrombosis. Like MRI, it may rule out other conditions such as arterial stroke or tumours and visualise cerebral edema, infarction, or hemorrhage associated with cerebral venous thrombosis. Treatment of cerebral venous thrombosis has four major components: 1) Limitation or elimination of the thrombus,2) Treatment of the underlying cause of thrombus formation (If one is found), 3) Treatment of seizures and 4) Management of increased intracranial pressure.

Almost all patients with cerebral venous thrombosis should initially receive full dose heparin (1.5 times to 2.0 times normal partial thromboplastin time). Current recommendations include full-dose heparin (Partial

thromboplastin time 2.0 times to 2.5 times normal) in all patients without hemorrhage. A similar approach can be considered in patients, with cerebral venous thrombosis and hemorrhagic infarction, but alternately lower levels of anticoagulation with heparin (Partial thromboplastin time 1.25 times to 1.5 times normal) can also be considered.

If a persistent abnormality in the haemostatic or thrombolytic systems is discovered during laboratory testing, lifelong anticoagulation treatment may be considered. Sources of systemic and local infection should be sorted carefully and treated with appropriate antibiotics. Intravenous steroids may be appropriate in patients with known lupus or Behcet disease. Intravenous phenytoin or phenobarbital should be used to control seizure, but prophylactic antiepileptic treatment in a patient without seizure is not necessary.

One of the most difficult treatment issues is the control of increased intracranial pressure. Ideally, one should try initially to avoid dehydrating treatments such as mannitol and furosemide because they may lead to further clot extension. Azetazolamide may be associated with less dramatic fluid shifts and has been used by some investigators. Cerebrospinal fluid drainage by repeated by lumbar punctures is a useful treatment option.

Lumbar peritoneal shunting should be reserved for patients with chronic symptomatic intracranial hypertension that is unresponsive to other therapies.

In some cases, the standard treatment may be unsuccessful and the patient may develop worsening levels of consciousness or extension of the thrombus by brain imaging. In these settings, thrombolytic therapy may be considered. The total dose of urokinase ranged from 1.5 million to 7 million units and the duration of treatment varied from 12 hours to 18 hours. Shorter duration thrombolytic therapy may not result in recanalisation. Several mechanical clot disruption techniques may be used as well, including angiojet,stenting and other devices. Endovascular thrombectomy may now be performed with a variety of mechanical tenchniques and devices, including direct aspiration. In summary, almost all patients with cerebral venous thrombosis should receive intravenous heparin, treatment for the underlying cause (if known), and non-dehydrating treatment for increased intracranial pressure. Patients with cerebral venous thrombosis who have parenchymal blood on brain imaging may still be candidates for heparin therapy, but only with close monitoring of the clinical state and brain images.

Those patients who clinically worsen or who show clear evidence of clot extension on MR imaging, despite the best standard therapy including heparin, may be candidates for thrombolytic therapy. Pregnancy and the peripartum period are associated with a higher risk of cerebral venous thrombosis.

SOCIAL CAUSE Abhaya

Where the mind is

without fear

Abhaya was born out of a deep concern for the helpless mental patients of Government Mental Hospitals of Kerala. The relentless efforts of Abhaya brought the attention of the public, the government and in particular the judiciary to the pitiable conditions of the mental hospitals.The most significant achievement of Abhaya was that after 150 years of isolation, the mental hospitals of the state were thrown open to public scrutiny. Consequently, the mental health scenario of Kerala has undergone a healthy change. The scientific methods adopted

by Abhaya in dealing with the problems of the mental patients are worth emulating

By FM Bureau

56 FUTURE MEDICINE I August 2013

A

bhaya offers a multi-level psychiatric, rehabilitative and counselling services for the mentally ill patients, helpless women, deprived girl children and victims of alcohol and drugs.

Athani, a home for the destitute women in Vanchiyoor, Thiruvananthapuram, provides the helpless women with all facilities and gives training to ensure their employment. Abhaya has a 24-hour Helpline for women. It also provides medical and legal aid to women in distress. A free legal aid programme for women was started in January 2005. The legal aid centre has since been upgraded as Lok Adalat with a sitting judge of the District Court as presiding judge and two other members - an advocate and a social worker. The Lok Adalat is held on every second Saturday.

Abhayagramam, situated on the outskirts of Thiruvananthapuram, Kerala, is instrumental in providing psychiatric treatment, rehabilitation, skills development and training the mentally ill patients. More than 80 homeless girls are given shelter, rehabilitation, and education here under a state government scheme.

Karma, Mitra, Bodhi, Sradha

Bhavanam and Abhayabala are functining at Abhayagramam.

Karma

It provides free treatment, care and skill development training to mental patients. They learn to stitch, make articles with banana-fiber and bamboo, paper covers etc. They have lessons in singing and do gardening and farm work. They are free to roam around, play and relax. It is a mental health centre with a difference.

Mitra

A mental health and de-addiction centre, Mitra is a full fledged hospital with all facilities. All kinds of mental disorders and substance abuse are treated here. A team of psychiatrists, psychologists and nurses look after the patients. Apart from the most modern drug therapy, individual, group, family as well as marital counseling and psycho diagnostics are offered here. Mitra is the only paid centre of Abhaya, the proceeds of which are used to support free units.

Bodhi

Bohhi is a free de-addiction centre for the victims of alcohol and drugs.

It is a 15-bed hospital which has an out-patient unit also. A team of experts consisting of a psychiatrist,

a general physician, counsellors and social workers caters to the needs of the patients.

Sradha Bhavanam

Mental illness needs life long care. Sradha Bhavanam rehabilitates the mentally ill patients and also provides short term and long term accommodation to them.

This centre is exclusively for women mental patients.

Abhayabala

It is home for the deprived girl children.

Girls from the lowest income groups and girls from high risk groups who had gone through harrowing experiences in the young age come to this home seeking shelter.

They are all going to school and slowly getting over their traumatic past. There are resident teachers and other special teachers who help them in their studies and other activities.

Rehabilitation of street children is a new responsibility taken up by Abhaya. A number of girls hailing from Tamil Nadu and Andhra Pradesh come to Abhaya on the directives of the court.

They are given informal education under the state government scheme ‘Sarva Shiksha Abhiyan’ and training in different occupational skills. They are now coming back to normal life.

NUTRITION

Co co nu t

The elixir of life

By FM Bureau

No more misguiding information on coconut as it enters the list of most wanted nutritious food. The studies have concluded that the saturated fat in coconut not only helps our body absorb nutrients and fight viruses but also reduces cholesterol level 58 FUTURE MEDICINE I August 2013

N

o more issues concerning coconut which is in a safe zone now. Coconut oil is composed of a group of unique fat molecules known as medium-chain fatty acids (MCFA) which are technically categorised as saturated fat. This fat can actually protect you from heart attack or stroke. Although coconut oil is predominately a saturated fat, it does not have a negative effect on cholesterol. Natural, nonhydrogenated coconut oil tends to increase HDL (High Density Lipoprotein) cholesterol and improve the cholesterol profile.

Reduce the risk of heart disease

“HDL is the good cholesterol that helps to protect against heart disease. Our total blood cholesterol contains both HDL (good) and LDL (bad) cholesterol. A much more accurate way to judge heart disease risk is to separate the two types of cholesterol. Therefore, the good and bad cholesterol ratio is universally recognised as a far more accurate indicator of heart disease risk.

Because of coconut oil’s tendency to increase HDL, the cholesterol ratio improves and thus decreases risk of heart disease,” says TK Jose IAS, Chairman, Coconut Development Board. CDB is very active in giving support to the organisations that conduct scientific studies on coconut and coconut oil.

Coconut oil reportedly inhibits various microorganisms, including bacteria, yeast, fungi and enveloped viruses. Some of the viruses inactivated by coconut oil include HIV (Causing AIDS), measles virus, herpes simplex virus-1 and cytomegalovirus.

“Never use hydrogenated coconut oil. The best oil to use is virgin coconut oil, which is extracted by the traditional method. It contains nutrients and healthy fats and is a healing substance. This oil has a long shelf life and it doesn’t go rancid like the other vegetable oils,” adds TK Jose.

The studies conducted by Dr DM Vasudevan, former Principal, Amrita Institute of Medical Sciences, Kochi, observed that hair and skin conditions improved after the coconut oil replacement therapy. The study was conducted among the selected adolescent girls who were given 15gm of coconut oil for their consumption through diet and extra 10 gm was given for body application. Regarding total cholesterol level in control group (Using other oil), only 15mg of cholesterol was reduced after dieting but using coconut oil 35mg of cholesterol was reduced.

Against Alzheimer’s and diabetes

A medical breakthrough revealed a promising way

T K Jose, IAS,

Chairman, Coconut Development Board

of boosting the cognitive function and performance in Alzheimer’s disease in the form of the MCT (Medium Chain Tri-glyceride). The Neurobiology of Ageing published a research study in 2004 revealing that the major fat found in coconut oil called the MCT can help improve the cognitive performance in humans.

Almost all Alzheimer’s patients showed improvement in their ability for memory recall after receiving a single dose of coconut oil. Accordingly, the study showed an improvement in the distribution of the ketone bodies obtained from the MCT in the blood plasma level, a response that occurs within 90 minutes from its administration in humans.

Medical experts are now telling that coconut oil is one fat that can safely help regulate blood glucose levels and protect against insulin resistance. A recent study published by The American Diabetes Association, concluded that, “dietary supplementation with MCFA maybe beneficial for preventing obesity and peripheral insulin resistance”.

A light moisturiser that removes the excess oil from the skin and can also be used as a conditioner or shampoo for oily hair.

Regular consumption of the coconut water helps in blood circulation Coconut water is a rich source of natural fiber, natural calcium, magnesium, and natural potassium.

It helps in the problems of kidney, reduces the risk of cancer and diabetes. It also helps in digestion.

Coconut water is a rich source of natural fiber, natural calcium, magnesium, and natural potassium- making it a healthy electrolyte drink.

FOCUS Indo American Hospital Brain and Spine Centre

A village graced with the

Indo American Hospital Brain and Spine Centre has grown to become a renowned super specialty centre which is doing yeoman’s service for the poor and the needy by providing them modern, specialised, high quality care at an affordable price.

The hospital has just introduced state-of-the-art MRI

60 FUTURE MEDICINE I August 2013

best healthcare Indo American Hospital Brain and Spine Centre was a gift given to the people of Chemmanakary by Dr K Bahuleyan, a neurosurgeon based in the US. He wanted to ensure that the people of his native village are not deprived of the best healthcare facilities available in the world

By FM Shalet James

C

hemmanakary, a village near Kochi,got a facelift when Dr Kumar Bahuleyan took initiatives to provide comprehensive healthcare for the village where he grew up fighting poverty. A renowned neurosurgeon, Dr K Bahuleyan always made it a point to visit Chemmanakary regularly although he was busy practising in Buffalo, USA. Unhappy with the pathetic condition of healthcare facilities at his village, the US-based Dr K Bahuleyan established Bahuleyan Charitable Foundation (BCF), a not-for-profit private organisation, in 1989. Later,Dr K Bahuleyan, MBBS (Madras), MD (US), FACS, FRCS (Edinburgh), FRCS (Glasgow), gave wings to his dream by establishing Indo American Hospital Brain and Spine Centre at Chemmanakary in Vaikom, Kerala, in 1996.

Since then, Indo American Hospital Brain and Spine Centre has grown to become a renowned super specialty centre which is doing yeoman’s service for the poor and the needy. Providing all facilities available in the finest hospitals in the world, this super specialty hospital is a supreme blend of the American technology and the Indian tradition which includes Most modern Operative Microscope (Zeiss NC31), the first in South India, Most powerful & modern drill

system (Midas Rex and Anspach Drills), modern and imported Anaesthesia and Monitoring equipments,18-channel EEG and EMG Machine, Neuro Endoscope, Stereotaxic lekshell G (first Hospital in Kerala) and C-arm with DSA Facilities.

“Problems of the Brain and Spine can be devastating and usually very frightening for patients and families. We understand this and we try to create a friendly and comforting environment by providing them modern, specialised, high quality care at an affordable price. We have just introduced a brand-new state-of-the-art MRI. Here, all decisions are taken with the goal of providing the best medical care rather than increasing profits. BCF is actively engaged in trying to contribute to the community, consistent with our Founder’s dream,”says Dr M Aravind Babu, FCAP, Chairman & Managing Director

Bahuleyan Charitable Foundation India

Bahuleyan Charitable Foundation (BCF) came into lime light in 1993 by building a small clinic in India for young children and pregnant women and also installing latrines, roads and a water supply for the villagers. Today, BCF India is a multi-activity organisation that includes hospitals, a nursing college, a physiotherapy college and a community development centre. BCF also conducts several medical camps and is actively engaged in community services. In order to strengthen the community orientation

August 2013 I FUTURE MEDICINE 61

FOCUS Indo American Hospital Brain and Spine Centre

MRI Scanner of the healthcare activities of BCF, a separate community health centre was opened in January 2006.

The health centre, besides creating health awareness in the community, provides free OP consultation on all week days and undertakes immunisation activities in conjunction with the primary health centre at Maravanthuruthu. The health centre also provides IP treatment to the residents of Maravanthuruthu and Udayanapuram panchayaths.

Considered one of the topmost authorities in neurosurgery in the US, Dr Bahuleyan had envisioned a comprehensive healthcare plan for his native village.

BCF College of Nursing

The college is located at Chemmanakary, Kulasekharamangalam, on the banks of Vembanad Lake, 9 km from the Vaikomtown. Adjoining the college campus to the North is Kalathil Resort Pvt Ltd which is a sister concern of the

hospital.

BCF College of Physiotherapy

The main objective of the BPT degree programmeof 4 ½ years duration by this college is to produce graduates having specialised knowledge in human anatomy, physiology and clinical sciences which will enable them to provide comprehensive physiotherapy care to all people in any situations. With a wellplanned and supervised clinical training programme, state-ofthe-art library and e-library, the students will be enabled to utilise the latest technological innovations, provide quality healthcare, conduct resultoriented studies in various settings and utilise the research findings to improve the quality of physiotherapy treatment.

A non-profit institution with the goal of providing the best possible medical care rather than trying to increase profits at the possible expense of quality or sacrificing services, The mission of Indo American Hospital is to provide the best treatment at a minimal cost.

Dr Babu (CMD) Mrs. Sylvi Mani (Director, BCF Inc.) & Dr Hema Rajesh (Medical Superintendent) 62 FUTURE MEDICINE I August 2013

Dr Bahuleyan, Founder, hosting the ‘International Neuro-Scientists’ Summit, 2012, at Indo-American Hospital

Dr Aravind Babu, FCAP, LL.B, Chairman & Managing Director

Major Departments • Neurosurgery • Neurology • Neuro Radiology with World Class MRI • Physical Medicine & Neuro Rehabilitation • Neuro Anaesthesiology • ENT, Head and Neck Surgery • Clinical/Neuro Pathology • Orthopaedics

Focus Dhanwanthiri Vaidyasala

A boon called

Dhanwanthiri

Dhanwanthari Vaidyasala’s pioneering efforts in institutionalising Ayurvedic medicine marketing and treatment in Kerala is commendable. Started with a few medicine manufacturing units in 1993, Dhanwanthari Vaidyasala developed into a national brand with a vast network of sales outlets and treatment centres

D

By FM Bureau

hanwanthari Vaidyasala, named after Dhanwanthari, the God of Ayurveda, is one of the oldest centres of Ayurveda in Kerala. It was late Vaidyan CN Namboothiri who founded and established Dhanwanthari Vaidyasala in 1933. He pioneered the concept of institutionalising Ayurvedic medicine marketing and treatment in Kerala. Dhanwanthari presently is an integrated Ayurvedic company with interests in medicine manufacturing, treatment, research and development.

The company has a network of 350 sales outlets and full-fledged treatment centres in the state apart from the branches in other states.

Dhanwanthiri Ayurveda Vaidyasala

The first hospital was set up at its

headquarters in Thodupuzha. Later, a hospital was started in Kozhikode.

Panchakarma clinics were established in Thiruvananthapuram, Kochi, Kottayam and Kannur. The Platinum Jubilee Block of the hospital in Thodupuzha started functioning in 2009 making it a 50-bed hospital with seven treatment rooms. It is now recognised by the Ministry of AYUSH under the treatment reimbursement scheme. An additional Block is scheduled to be completed in 2014.

The treatment division has the doctors and therapists trained by Dhanwanthari Vaidyasala with a focus on the curative aspects in Ayurveda. Chief Physician Dr CNN Namboothiri is qualified and trained in both Ayurveda and Allopathy. He is supported by his son, Dr N Satheesh Kumar, the COO of Dhanwanthari, and a August 2013 I FUTURE MEDICINE 65

FOCUS Dhanwanthiri Vaidyasala

panel of specialist doctors.

“After seven years of academic career in Gurukulam, a school functioned as per the tradition of Kerala, Vaidyan CN Namboothiri, at the age of 23 years, started this firm with a few Ayurvedic manufacturing units in 1933. He developed the Dhanwanthari Vaidyasala into a national brand in late 1930s and he had patients from North Indian states and abroad in those days.

He carved out a niche for the firm by placing it meritoriously and proving himself an eminent physician. CN Namboothiri had visited America and Europe in early 1970s on requests from his patients,” says Dr Satheesh.

Traditional methodology

Each and every medicine is prepared at Dhanwanthari following the rules laid down in the ancient texts. Dhanwanthari maintains traditional methodology for the preparation of Ayurvedic medicines.

The containers for the preparation of fermented products are earthen vessels which will ensure the ideal condition for the natural fermenting agents.

Dr CNN Namboodiri, Chairman

Dr N Satheeshkumar, Managing Director

‘‘The vessels for production are either brass or copper in specified shapes. This will help in maintaining the natural colour of medicines and oils, and also to avoid harmful and toxic

66 FUTURE MEDICINE I August 2013

colour. In addition, we have adopted the sterilisation of pots, mortar etc. to keep the hygiene standards.

For thermal processing of decoctions, firewood that will give controlled and continuous heat is preferred.

This is essential for adequate drug extraction and to check the extraction of unwanted alkaloids like Tannins,’’ Dr Satheesh adds.

Sports medicine

Dhyanwanthari has adopted modern technology only in pre-processing stages like raw material analysis, disintegration, and pulverisation, concentration of kashayams, herbal extraction process and in post production packing. These modern techniques facilitate the dissemination of higher values and worth of Ayurveda among the common people.

Sports medicine is relatively a new branch in Ayurveda.

Dhanwanthari Group for the first time in India used Ayurvedic medicines Anoop N, to enhance Managing Director performance and to manage injuries to sports persons. But this science needs further innovation and research to meet the requirements in the field. ‘‘The first such sports centre was

launched by Dhanwanthari in 2008 at the Regional Sports Centre in Kochi. In 2010, Usha School of Athletics, initiated by the former Olympian PT Usha, officially announced their tieup with Dhanwanthari Vaidyasala to complement their pursuit of creating Olympians. Already, work has been initiated for an Ayurvedic Centre at Muttom Shooting Range in Kerala affiliated to National Rifles Association of India,’’ says Dr Satheesh.

Manufacturing

At Dhanwanthari, priority is given to strike a balance between traditional practices and modern post-production techniques. Strict adherence to age-old practices, coupled with a pragmatic approach to contemporary needs, has enabled Dhanwanthari to maintain its goodwill and reputation over decades. There are about 400 classical preparations using about 1,500 herbal raw materials.

Ethical division

This division deals with the medicines with classical Ayurvedic base. These prescribed medicines belonging to the pharma sector inlcude Kolstrahlin Capsules– cholesterol, Glycin Powder – diabetes, Inflacin Capsules Viral - infections, flu, Chikun Guniya etc, Nishakathakadi Capsules – diabetes, Anulax–Antacid and Alpina LinimentJoint and muscle pains.

Focus Kerala Ayurveda Limited

Banking on ‘resort type’

Ayurveda

Kerala Ayurveda Limited finds resort type Ayurveda is the best way to popularise India’s own medical system among foreigners who are particular about ambience, hygiene and cleanliness

K

By FM Bureau

erala Ayurveda Limited (KAL) is the only full spectrum, listed Ayurveda company in India and its hospital at Aluva has been recognised with “Green Leaf” certification by the Department of Tourism, Government of Kerala, for

Dr K Anilkumar, Executive Director, KAL

outstanding facilities and services.

KAL encompasses academies, products, clinics, hospitals, resorts and services. It has been functioning for over 60 years and has over 400 classical and proprietary formulations that leverage the beneficial effects of over 1,200 medicinal herbs.

Founded by late Vaidyan KGK Panicker, a renowned Ayurvedacharya, in 1945 at Aluva in Kochi, KAL has scaled new

heights with advanced technology and highly qualified, dedicated staff. With a network of new clinics and taking into account future growth prospects, KAL turned a public limited company in 1996.

In 2006, Bengaluru-based Katra group took over the company that depended on ‘resort type’ Ayurveda for its growth, notes Dr K Anilkumar, Executive Director, KAL. “Though there are negative aspects, the practice of ‘resort type’ Ayurveda provides us with an opportunity to introduce Ayurveda to people abroad. As far as foreigners are concerned, factors like ambience, hygiene and cleanliness are most important.

Almost 70 per cent under this segment are of a good quality but the remaining 30 per cent cause damage to Ayurveda,” says Dr Anilkumar.

Speaking about the neglect faced by the Ayurveda sector in Kerala at the hands of the department of Ayush, Dr George Davis, Cluster Head, Health Sciences, said Central Council of Indian Medicine (CCIM) is controlled by some vested interests in North India. “Funds mobilisation and distribution point to this fact.

There are only two members in August 2013 I FUTURE MEDICINE 67

FOCUS Kerala Ayurveda Limited

CCIM representing South India,” he adds.

He criticised CCIM’s decision not to provide Central Government Health Scheme (CGHS) accreditation to Ayurveda hospitals in Kerala. “But the situation is changing with the growth of medical tourism and the flow of foreign currency,” he says.

The quality of medicines is very important in Ayurveda. The ingredients need to be of high quality to get the desired results. KAL is often a relief centre for the patients suffering from neuromuscular disorders, particularly arthritis, low back ache, and multiple strokes. Clinical research is done in diabetes, bone related diseases and degenerative diseases at its hospital in Aluva.

Speaking about the corporate social responsibilities of KAL, Dr Anilkumar said that it regularly conducts diabetes camps at their clinics.

Medical camps are also conducted regularly in the neighbouring villages. “Last month, we organised a camp at Assisi school, Aluva. Students were asked to identify medicinal plants around them and to learn their medicinal properties. The response was very good and the students brought around 1,000

68 FUTURE MEDICINE I August 2013

medicinal plants and an exhibition of plants and their medicinal qualities was conducted. A quiz programme was also conducted for the students. An awareness class for parents was also held,” says Dr Anilkumar.

KAL is manufacturing Ayurvedic and patented medicines at its plant near International Airport, Kochi. Equipped with the state-of-the-art facilities, it ensures the preparation of over 300 Ayurvedic medicines and 30 ethical products developed by the R&D department of KAL. KAL also has a prestigious herbal garden with more than 1,200 species of rare and endangered medicinal plants. The plants introduction, acclimation and commercial cultivation of selected varieties have brought better quality raw materials for the production of high quality medicines.

Researches on these lines are ongoing and have standardised agro-technology for 20 high value medicinal crops.

Speaking about expansion, Dr Anilkumar said the group plans to launch around 50 branches in all major cities of India.

FOCUS Punarnava Ayurveda Hospital

No compromise on principles of Ayurveda Punarnava Ayurveda Hospital has been in the forefront of delivering quality healthcare without compromising on the principles of Ayurveda. The hospital believes there is nothing wrong in using the advancements in modern medical science to make diagnosis foolproof in Ayurveda

I

By FM Bureau

f Ayurveda has a brand ambassador, no state other than Kerala could excel in such a position with its rich tradition in this ancient science.

But what do we do to sustain this ancient science?

If Dr AM Anwar, Chairman and Managing Director, Punarnava Ayurveda Hospital, is asked this question, he would say, “We have not yet identified or used this ancient science to its full potential. We don’t have a department of Ayush.”

He said already enough damage has been done to the traditional practice of Ayurveda in the way of massage and therapies. God knows how genuine these treatments are, he adds. “It is true that these centres are attracting a lot of customers, but the conventional Ayurveda practitioners receive a setback in this context as they find it hard to uphold the values of the ancient medical system. You can find three types of Ayurveda practices in Kerala itself.

The authentic Ayurveda practitioners who are not ready for any compromise on treatment come in the first category. Another group of practitioners eye on maximum profits through massages and other related treatments. They provide expensive accommodations like resort villas and suites in high-end hotels to their customers. In the third category, you can find the customised mode of Ayurveda. Here, no compromise on Ayurveda principles is made, but they provide better accommodation and other facilities to their customers. Punarnava Ayurveda Hospital belongs to this category where Ayurveda is the guiding light,” says Dr Anwar.

Established in 1993, Punarnava Ayurveda Hospital Pvt Ltd has been in the forefront of delivering quality healthcare without compromising on the principles of Ayurveda. “Punarnava means rejuvenating the body and that is what we have been doing since our inception,” says Dr Anwar.

August 2013 I FUTURE MEDICINE 69

FOCUS Punarnava Ayurveda Hospital

Punarnava which focuses on curative treatment, today offers specialties in neuromuscular diseases, arthritis and rheumatic diseases, osteoarthritis knee joint, psoriasis management, neck pain, low back pain, supportive therapy for developmental delay in children, multiple sclerosis management, obesity management, hemiplegia, myasthenia gravis and Parkinson’s Disease. Besides, Punarnava provides wellness programmes like rejuvenation, body purification therapies and slimming.

Ever heard of ‘Precise Ayurveda’? Well, hear it from Dr Anwar himself: “At Punarnava, we make use of modern disease diagnostics methods. There is nothing wrong in using the advancements in medical science to make the diagnosis foolproof. Even the traditional texts in Ayurveda advise so. We are not reluctant to seek a second opinion from modern medical practitioners for better diagnosis. Modern medical facilities are utilised for giving Kashayam through tubes. That is why we call our treatment modality ‘Precise Ayurveda,” he says.

70 FUTURE MEDICINE I August 2013

Even though Punarnava does not attend to emergency patients the hospital is fully equipped to meet any emergency situations after the admission of a patient. “In fact, this is the only Ayurvedic hospital with a basic emergency facility,” he adds.

Speaking about the strength of Ayurveda, he said in the past people followed a healthy lifestyle based on the principles of Ayurveda and there had not been any medical intervention unless it was urgent.

According to Dr Anwar, modern medicine applies some methods used in Ayurveda. For instance, in Ayurveda diet control and avoidance of certain food have been very much a part of treatment, but now modern medical practitioners have also started suggesting diet control to their patients.

The first unit of Punarnava was started in Kollam, Kerala. Today, Punarnava has four hospitals in the Ernakulam city itself. InPatient facilities are available at its four branches located at Panampilly Nagar, Vytilla, Kaloor and Edapally with 225 beds altogether. A separate department functions at KIMS Hospital,

Thiruvananthapuram. Punarnava has patients from 26 countries, including the US, the UK, Germany and Japan.

Punarnava’s Edapally branch is ISO 9001: 2008 certified, a Green Leaf accredited Ayurvedic hospital and is also expecting NBAH accreditation soon. The main building which houses consultation and pharmacy is a Nalukettu.

Standard AC and Non-AC double bed rooms with private wash rooms and well equipped treatment rooms and physiotherapy departments are there at Edapally.

Punarnava Bamboo Lagoon located just 3 km from Vytilla, Kochi, consists of eight elegantly designed independent villas on the banks of the river, Kaniyampuzha.

Lush greenery and a mini swimming pool, all in a serene environment, will soothe your mind and body.

This centre is well equipped with full-fledged treatment rooms and physiotherapy departments.

About expansion, Dr Anwar said: “Quantity must not affect quality.

This is the motto of Punarnava Ayurveda Hospital. Hence, we don’t plan much expansion soon.”

BEAUTY TIPS

Fingernails need

extra care to look good Fingernails need to be kept neat and clean as an untidy fingernail is a breeding ground for bacteria, fungi and other organisms. A well-trimmed nail looks nice and gives shape to the finger. Here are some tips to make your fingernails look their best

K

eep your fingernails dry and clean. This prevents bacteria, fungi and other organisms from growing under your fingernails. Wear cotton-lined rubber gloves while washing dishes, cleaning, and avoid long soaks in the tub.

Trim and file your fingernails regularly.Trim your nails straight across, then round the tips in a gentle curve. It might be easiest to trim and file your fingernails when they’re soft, such as after bathing.

When you use hand lotion, rub the lotion into your fingernails and cuticles too.

To prevent nail damage, don’t use your fingernails as tools to pick, poke or pry things.

Avoid biting your fingernails or pick at your cuticles. These habits can damage the nail bed. Even a minor cut alongside your fingernail can allow bacteria or fungi to enter and cause an infection.

If you have a nail problem that doesn’t seem to go away on its own or is associated with other signs and symptoms, consult your doctor or dermatologist for an evaluation.

Weak fingernails can be a problem. Long nails are more likely to split or break.

Apply moisturiser to your fingernails and cuticles several times throughout the day and before bed.

A thin coat of clear nail polish can help keep moisture in your fingernails.

Don’t use nail polish remover more than once a week.

When you need to use nail polish remover, choose the acetonefree variety.

Changing your diet or taking daily multivitamins isn’t likely to strengthen your nails. However, research suggests that the nutritional supplement biotin might help strengthen weak or brittle fingernails.

August 2013 I FUTURE MEDICINE 71

FOCUS Kottakkal Arya Vaidya Sala

KAVS

makes Ayurveda known world over Kottakkal Arya Vaidya Sala is not just a hospital but an institution where a lot of research in different areas of Ayurveda is ongoing. Cultivation and conservation of a number of medicinal plants for posterity are also a major concern of KAVS

I

By FM Bureau

f the West identifies Kerala with Ayurveda, much of its credit goes to Kottakal Arya Vaidya Sala, thanks to the efforts of legendary figure and philanthropist Vaidyaratnam PS Warrier who gave this ancient science a new

Vaidyaratnam P S Varier, Founder, AVS 72 FUTURE MEDICINE I August 2013

direction. Today, Arya Vaidya Sala (AVS) established by him is the global face of Ayurveda.

Based at Kottakal in Malappuram district of Kerala, the healthcare organisation still upholds many of its humanitarian values rather than

Dr P K Warrier, Managing Trustee & Chief Physician, AVS

Dr K Muraleedharan, Addl. Chief Physician & Superintendent, AVS

running it as a lucrative business.

According to Dr K Muraleedharan, Additional Chief Physician and Superintendent, AVS, several factors make AVS unique. “Vaidyaratnam PS Warrier himself learned Ayurveda in the Gurukula system and later acquired knowledge in Allopathy through Dr Varghese at Mancheri.

He understood the totality of both. It paved the way for the modernisation of Ayurveda. He foresaw a competition between Ayurveda and modern medicines.

He knew the reality that if all people seek remedy in modern medicine, Ayurveda will have no future and it was necessary to create a space for Ayurveda.

Aerial view of KAVS As a first step, PS Warrier established a college instead of a hospital. He believed that to sustain Ayurveda, there should be practitioners and the science needs to be shared for its growth. Here comes the importance of bridging the gap between Ayurveda and modern medicine. His first instruction to the students at Ayurveda College was to study anatomy and physiology.

PS Warrier customised it for the modern world in its four areas such as production, treatment, education

and research. Collection of herbs and preparation of medicines are not always possible for patients, a factor which he observed long ago. Even if they prepare a medicine, it can vary in its prepositions for several reasons and ultimately their disease cannot be cured. As a result, the patients may lose faith in Ayurveda.

The credit for introducing mechanisation to AVS goes to the late Dr PM Warrier and Dr PK Warrier.

It helped in two ways -to meet the demands and the production of

new generation medicines. Tablets, kashyams and other related products were developed keeping in mind the changing trends in the healthcare sector. It also helped in optimum utilisation of available resources especially when scarcity of medicinal plants posed a challenge.

Dr PK Warrier admits that the world has changed a lot and new diseases have emerged. “Treatments for new diseases are the need of the hour. We have new resources. Making use of these resources is also crucial,� he says.

FOCUS Kottakkal Arya Vaidya Sala

Ayurveda Hospital & Research Centre, Kottakkal Most often, Ayurveda is presented in a fragmented way in the international scenario. For instance, The Journal of American Medical Association (JAMA) had once remarked that Ayurvedic medicines have high level of heavy metal content like mercury, lead or arsenic. Then AVS introduced new machinery in the research and development department which could check the heavy metal content in the medicines manufactured there. Today, through organoleptic (Through senses like smell, sight, touch and taste) and mechanical analyser, AVS ensures that its medicines are safe.

Dr Muraleedharan says, “The doctor must intervene only when the body needs it. Human body has self-healing potential. Never ignore this healing potential of the body.

For even small diseases, we take high quantity of medicines and the immunity of our body is lost as a result of it.”

About the research, he says research in cancer, arthritis and back pain is ongoing at AVS. Research in medicinal plants, processing and production is also taking place, he adds. Research projects are taken up as either inhouse endeavours or collaborative ventures with the Council of Scientific and Industrial Research, the Department of Biotechnology and the Department of Science and Technology of the Government of India. Major research in phytochemistry, botany and tissue culture is conducted with support from Indian Council for Medical Research (ICMR) and Department of Biotechnology (DBT).

The medicinal plant related findings help the public in conservation, cultivation, evaluation, processing, and product development. AVS has a centre for medicinal plant research which was inaugurated by former President of India Dr APJ Abdul Kalam and has been recognised as a Centre of Excellence by the government.

“For maximum or optimum utilisation, we are doing research on medicinal plants which are fast disappearing from our surroundings. It also accords priority to conservation and cultivation of medicinal plants,” points out Dr Muraleedharan.

On the cultural front, a Kathakali troupe, known as the PSV Natyasangham, is maintained for the promotion of the ancient classical dance drama.

Herbal garden at AVS

MEDICAL FILMS

A couple of films here depicting psychological aspects of people in most difficult situations will keep you glued to the screen

The Doctor

Directed by Randa Haines, The Doctor is based on the book A Taste of My Own Medicine by Ed Rosenbaum. The film portrays an arrogant surgeon, Dr Jack MacKee, (Played

by William Hurt), who is diagnosed with throat cancer. Jack’s views and perspectives change when he begins to see medicine, hospitals, and doctors from the patient’s perspective.

Wit

Released in 2001, Wit is based on a Pulitzer-prize-winning play

by Margaret Edson and directed

by Mike Nichols. Emma Thompson played a hardnosed- but-witty English professor who is diagnosed with terminal ovarian cancer. As she is thrust into the unpredictable realm of disease and experimental treatment, she reflects on the illness, treatment, and the people who care for her.

One Flew Over the Cuckoo’s Nest -- ---

Something the Lord Made

Directed by Joseph Sargent, Something the Lord Made was released in 2004. The movie depicted the relationship between a white, wealthy heart surgeon and black, poor carpenter.

The film was based on the National Magazine Award-winning article Like Something the Lord Made by Katie McCabe. The film was written by Peter Silverman and Robert Caswell.

The Painted Veil

Released in 2006, The Painted Veil narrates the story of the marriage of a young London socialite and a bacteriologist living in Shanghai. After the wife is discovered to have had an affair, the couple move to a remote village, where amid poverty and disease they find new purpose and forgiveness. The movie is based on the novel of the same name, written by W Somerset Maugham and directed by John Curran.

One Flew Over the Cuckoo’s Nest is a 1975 drama film directed by Miloš Forman and based on the 1962 novel written by Ken Kessey.

The film stars Jack Nicholson and Louise Fletcher. Nicholson plays a small-time criminal who gets himself declared insane so that he can avoid jail time. Once admitted to a state mental hospital, he challenges the authority of Nurse Mildred Ratched who runs the ward with an iron fist.

Compiled by Neethu Mohan

WELLNESS YOGA

Padahastasana

Benefits

Strengthens abdominal organs

Eliminates possibilities of bloating of abdomen, constipation, indigestion and other gastric problems

Make spine more flexible, resilient and straight

Removes extra fat from the abdomen region

Padahastasana steps are much useful for increasing height

• First of all, stand in Tadasana pose then exhale to bend yourself in downward direction • Place legs in straight position and touch feet with finger tips and if you feel at ease, then try to touch palms to the ground •

Keep your face on legs

• Stand in this posture for a few seconds • Inhale steadily to get back to initial position • Repeat this practice after relaxing for some time

Gomukhasana •

Perform staff pose

• Bend your left leg, bring its heel under the right thigh, close to right hip • Bend your right leg over the left knee and let your right heel come close to left hip. Your right knee should be positioned directly above the left knee •

Place your palms on the feet

• Press the sitting bones on the floor and point the crown of the head to the ceiling • Bend the left elbow. Bring your left forearm behind your back • Position the back of the left hand in the middle of your back, close to shoulder blades. The left forearm and the fingers of the left hand should point upward •

Inhale while extending the right

76 FUTURE MEDICINE I August 2013

arm over your head • Bend the right elbow and keep your right elbow between the shoulder blades.

The right palm should face your back and the fingers of the right hand should be pointed downward • Clasp the fingers of the left hand with the right hand • Pull your shoulders away from each other to experience the stretch in the shoulders and opening up of the chest • Remain in this pose from 10 seconds upto half a minute before releasing the hands to returning to staff pose

Simhasana

• Sit with your legs folded under you so that your toes are pointing straight behind and you are sitting on your heels.

•

Keep your spine straight but as relaxed as possible

• Close your eyes and look to your third eye. (The third eye is a symbolic eye in the centre of the forehead.

In ancient India, it was assumed that the pituitary gland was located here, although now we know differently.)

•

Close your mouth, touch your palate with tongue

• Inhale a deep breath through your nose while the tongue is still touching palate • Exhale in one violent move while sticking out your tongue and opening your jaws as much as possible. Also, your arms should be thrown out and stretched with your fingers splayed • Roar at the top of your voice while exhaling. The roar should be with a “Haa” sound and should not be a long drawn out one. Rather, it should be one violent explosion of breath that empties your lungs in the shortest time possible •

Hold this pose for between 20 and 30 seconds

• Do not inhale immediately after this pose.

Inhale after the specified 20-30 seconds

Benefits

•

Repeat it five or six times

Stretches arms and shoulders Relaxes shoulders Opens the chest

Benefits

Physically, the lion pose benefits the face and the throat

Relives tension

August 2013 I FUTURE MEDICINE 77

Celebrity Fitness SHERIN

SAM

My fitness secret

P

ositive thoughts and yoga keep my mind and body fit

Daily Exercise

E

arly morning, I do Surya namaskaram, yoga and go to gym, and I never go to bed without doing meditation.

Diet

I

don’t take any special diet. I take equal amount of salad for the food I consume and I drink a lot of water.

Advice to stay fit

D

o yoga and meditation.It controls your diet automatically and keeps you fit.

(Sherin Sam is a famous model and the winner of the Ford Supermodel of India World 2009). She has walked the ramp for designers like James Ferreira, Nida Mahmood, and Shantanu Goenka at wills Life Style India Fashion Week, Summer Spring etc.

As told to Neethu Mohan 78 FUTURE MEDICINE I August 2013

DIABETES! CAN AFFECT EYES, HEART, KIDNEYS & FEET

CONTROL DIABETES, PREVENT COMPLICATIONS WORLD CLASS DIABETES CARE

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Email: drmohans@diabetes.ind.in Website: www.drmohansdiabetes.com