Future June 2014
Medicine
Special Story THE GREAT SPACE ODYSSEY
SUNITA WILLIAMS talks on health in space Sexual Health
For your eyes only Campus Health Romance
An early
‘Please don’t forget to smile, if we meet again’
climax
Cover Story
RISE OF THE THIRD GENDER UAE - AED 7 US - $5 India - `50
Disease special Ophthalmology
PREVENTION
Killer stones
Sports medicine, Health Beat: Beauty Fitness yoga
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EDITOR’S NOTE Emergence of Third Gender
E
verybody is now talking about transgenders in the wake of the Supreme Court judgement recognising their status in civil society. Transgenders are jubilant as they get an identity though much delayed. Till the remarkable court ruling, they were not considered to be a part of our society and not entitled to the rights of a citizen of the country. For long, transgenders have been deprived of all the benefits like education, employment, familial comforts etc. So they were forced to engage in begging, prostitution and many other illegal activities for a livelihood. As far as a common man is concerned, there could be plenty of questions regarding the community like how do they manage this gender transition that includes castration and what is the medical assistance they seek to fulfil their dreams? Since the gender is recognised legally and society is supposed to accept them in due course, it would be easy for the medical fraternity to offer all assistance to the Third Gender. The cover story takes a peek into the health aspects of transgenders and medical facilities available to help them transform physically and jump into the bandwagon called the Third Gender. The special story in this issue is about astronauts- how they maintain their health while in space, how they spend time in the space station, how they sleep, what they eat and so many other things. American astronaut of Indian origin Sunita Williams who had spent around a year in the international space station in two stints shares her experience in and out of the space station along with her male colleagues. Besides the condition of space like gravity, day and night, the sight of our blue planet from the orbit and the deep space, she talks about how they survived without being afflicted with any disease and eating only particular foods. Read the full story which will keep you abreast of our fast expanding space science. This is a space odyssey that takes you up around 250 miles above the surface of the earth. A new column– From the Surgeon’s Diary- is introduced with this issue. It could be a medically significant incident in the life of a surgeon, be it a unique surgery or the survival of a patient against all odds. It could also be an eye-opener to all of us as the instances described here by the surgeons are about the endearing faith and undying human spirit as well as remarkable skills of surgeons/caretakers. The overwhelming response from our readers to the changes in respect to the layout and content of Future Medicine has encouraged us to bring about more such changes in the coming issues for the benefit of readers from all walks of life.
6 FUTURE MEDICINE I June 2014
DIABETES! CAN AFFECT EYES, HEART, KIDNEYS & FEET
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cONTENTS
70
52
SPECIAL STORY
The Great Space Odyssey
An early climax Premature ejaculation or PE as it is commonly known is a sexual dysfunction affecting young men aged below 40 years
US astronaut of Indian descent, Sunita Williams,who travelled 195 days to reach her space abode and spent almost one year there in two missions unravels the mysteries of living in space in an email interview facilitated by NASA to Sumithra Sathyan, Co-ordinating Editor of Future Medicine
30 For your eyes only Although eyestrain can be annoying, it usually isn’t serious and goes away once you rest your eyes. In some cases, signs and symptoms of eyestrain can indicate an underlying eye condition that needs treatment
33
14
Save your eyes
Jack of all fruits
Using a computer for long periods is one of the most common causes of eyestrain
The tasty jackfruit is filled with many health benefits. It contains high amount of carbohydrates
62
60
Trapped in the net
Do exercise, do aerobic
Social networking sites, such as Facebook and Twitter, are now used by 1 in 4 people worldwide
Regular aerobic activity such as walking, bicycling or swimming can help you live longer and healthier
DOCTORs sPEAK Palliative Care Dr M R Rajagopal Back Pain Dr Arun Oommen Infertility Dr Muhammed Ashraf Diabetes Dr V Mohan
8 FUTURE MEDICINE I June 2014
40
COVER STORY
Rise of the Third gender In the wake of the historic Supreme Court verdict, Sumithra Sathyan, Co-ordinating Editor of Future Medicine, looks into the murky world of transgenders and also talks to two eminent doctors in the US who have specialised in transgender surgery, Dr Sherman Leis and Dr Jayaram BN
Future Medicine is bringing out a Coffee Table Book on Top Medical Professionals , Entrepreneurs , Hospitals and Medical Equipment for ready reference. For more information please contact mobile: +91 99461 09218, Mail: info@dcmediacorp.com
Lustrous mane
48
Since hair is an important part of our personality, it is necessary to adopt the right approach to keep tresses healthy and lustrous
In tune with climate changes
16
Greeshma charya is the health tips for summer. When this climate is altered by monsoon clouds, the element initially affected is ‘Agni’
‘Give the gift of life: donate blood’
12
World Blood Donor Day falls on the birthday of Karl Landsteiner (June 14, 1868) who created the ABO blood group system
36 Fuel for running Based on research, an adult athlete requires 5 to 7g of carbohydrate per kilogram body weight. Every gram of carbohydrate produces 4 calories of energy
66 He came back from the brink A new column– From the Surgeon’s Diary- is introduced with this issue of Future Medicine. It could be a medically significant incident in the life of a surgeon, be it a unique surgery or the survival of a patient against all odds
Disclaimer: The content of Future Medicine is for information only. Readers are requested to seek advice of a doctor before attempting self medication
June 2014 I FUTURE MEDICINE 9
PHOTOSPEAK
A slithery wonder
Titanoboa "meaning “titanic boa,” is
an extinct genus of snake that lived approximately 60–58 million years ago, during the Paleocene epoch, a 10-million-year period immediately following the dinosaur extinction event. Titanoboa cerrejonensis is the only known species , which is the largest, longest, and heaviest snake ever discovered, which supplanted the previous record holder, Gigantophis. Size : By comparing the sizes and shapes of its fossilised vertebrae to those of extant snakes, researchers estimated that the largest individuals of T. cerrejonensis found had a total length of around 12.8 m (42 ft) and weighed about 1,135 kg (2,500 lb). Location: The snake was discovered on an expedition by a team of international scientists led by Jonathan Bloch, a University of Florida vertebrate paleontologist, and Carlos Jaramillo, a paleobotanist from the Smithsonian Tropical Research Institute in Panama.
10 FUTURE MEDICINE I June 2014
Scientists in America have unveiled a full-scale model of an ancient snake so large it could swallow a crocodile whole. ‘Titanoboa’ lived in what is now South America around 58-60m years ago, was 42 feet long and weighed more than a ton. The massive animal was the largest snake ever known to have lived, and was more than twice as large as the current biggest specimen. The terrifying snake’s existence was confirmed after scientists excavated a coal mine in Colombia, known to be the site of one of the world’s first tropical rain forests, and found its enormous vertebrae in the rock.They also found fossils of a new species of turtle boasting a shell as thick as a dictionary - but said even that would be unlikely to stop the Titanoboa in its frankly unsettlingly huge tracks
A full-scale replica of the pre-historic snake “Titanoboa” swallowing a crocodile, is previewed at Grand Central Station in New York.
Health Day
‘Give the gift of life: Donate blood’ World Blood Donor Day is observed on June 14 every year to create awareness about the importance of voluntary unpaid blood donation in all countries By FM Bureau
W
orld Blood Donor Day is one of eight official global public health campaigns by the World Health Organisation (WHO). The Day is observed on June 14 every year. It is an occasion to raise awareness about the cause of blood donation worldwide. Despite about 92 million yearly blood donations worldwide, safe blood is constantly on high demand, especially in the developing countries. World Blood Donor Day falls on the birthday of Karl Landsteiner (June 14, 1868) who created the ABO blood group system, which is still used to ensure the safety of blood transfusions. The campaign emphasizes the need for safe blood and blood products and also thanks voluntary unpaid blood donors for their lifesaving gifts of blood. With the slogan “Give the gift of life: donate blood”, this year’s campaign, the 10th anniversary of World Blood Donor Day, will focus on the value of donated blood to the patient, not only in saving life but also in helping them live longer.
Millions of lives saved
Transfusion of blood and blood products helps save millions of lives every year. It
12 FUTURE MEDICINE I June 2014
can help patients suffering from life-threatening conditions live longer with higher quality of life, and supports complex surgical procedures. It also has an essential, life-saving role in maternal and perinatal care. Access to safe and sufficient blood and blood products can help reduce rates of death and disability due to severe bleeding during delivery and after. In many countries, there is not an adequate supply of safe blood, and blood services face the challenge of making sufficient blood available, while also ensuring its quality and safety. An adequate supply can only be assured through regular donations by voluntary unpaid blood donors. The goal is for all countries to obtain all their blood supplies from voluntary unpaid donors by 2020. In 2014, 60 countries have their national blood supplies based on 99-100% voluntary unpaid blood donations, with 73 countries still largely dependent on family donors and paid donors. The global host for the WBDD 2014 event is Sri Lanka. Through its national blood transfusion service, Sri Lanka has been promoting voluntary unpaid donation to increase access to safe and sufficient blood and blood products.
Some of blood donor agencies
• Helpalife • Sujla Blood Donor • Indian Red Cross Society • Sankalp India Foundation • Alishbaa Zahi Creatives • BloodConnect • ISBTI – Indian Society of Blood Transfusion and Immunohaematology
Health Fruit
14 FUTURE MEDICINE I June 2014
Jack of all fruits Instant energy
The tasty jackfruit is filled with many health benefits. It contains high amount of carbohydrates that provides energy instantly. It is rich in antioxidants which protect from cancer, ageing and degenerative diseases. Due to rich antioxidants, it increases eye vision and protect from cataract and macular degeneration. It is a good source of potassium which maintains fluid and electrolyte level in balance. Also it improves bone and skin health. So jackfruit is the jack of all fruits.
Health benefits Immunity: Jackfruit contains an
excellent source of Vitamin C. With a high amount of Vitamin C and antioxidants, it increases immune system which protects against common diseases like cough, cold and flu. Vitamin C also increases immunity against infections.
Energy: The fruit contains high
Jackfruit is sweet and delicious. It has thorny projections outside and sweet, soft and golden flesh inside. It contains high amount of nutrients like vitamins, minerals, electrolytes, phytonutrients, carbohydrates, fibre, fat and protein. Jackfruit is also a good source of calorie and contains no cholesterol or saturated fats By FM Bureau
amount of carbohydrates. It contains a good amount of simple sugar like fructose and sucrose, thus provides a quick boost to energy. Since the fruit has no cholesterol content, it is safe. Protection from cancer: It contains high amount of antioxidants which protect from oxygen-free radicals. Free radicals are produced due to oxidative stress. These free radicals damage DNA of the cell and turn the normal cell into a cancer cell. But antioxidants neutralise these free radicals and acts as a shield to protect DNA from free radicals. Jackfruit protects from colon, lung and oral cavity cancer.
Blood pressure control: Jackfruit
contains a good amount of potassium. Potassium is required to maintain sodium level. Also high potassium is required to maintain fluid level i.e. to balance electrolyte. Thus it helps to lower high blood pressure and reduces the risk of stroke and heart attack.
Digestion: The fruit contains a
good amount of dietary fibre which makes it bulk laxative. Thus it improves digestion and prevents constipation.
Colon cancer: Dietary fats in a
jackfruit help to clean toxins from the colon. Thus it reduces the effects of toxin in the colon and protects from colon cancer.
Eye health: With Vitamin A, jackfruit is an important nutrient for eye health. It increases eye vision and protect from free radicals. As the fruit is a rich source of antioxidants, it is highly effective to prevent degeneration of the retina. So jackfruit protects from cataract and macular degeneration.
Skin health and ageing: Ageing is a natural process. But due to pollution, UV radiation and smoke, this process has been stimulated at an early age and it is faster than natural. The main cause of ageing is free radicals produced in our body due to high oxidative stress caused by pollution. But antioxidants have proven to destroy these free radicals to slow the ageing process. It has also been found that people eating high antioxidant foods have slow ageing effect. So jackfruit proves best food to slow the ageing process. Also eating jackfruit keeps skin moisture level high and protects from skin diseases.
June 2014 I FUTURE MEDICINE 15
Prevention
Killer stones
People suffering from kidney stones across the world are on the rise and lack of timely diagnosis and treatment can make it fatal
K
idney stones, also known as nephrolithiases, urolithiases or renal calculi, are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters.
What are kidney stones?
Kidney stones are small stones that develop in urine containing increased levels of calcium, phosphorus, uric acid, or cystine. Kidney stones can be formed due to the following reasons:
• Insufficient fluid in the urine to dissolve stones
• Disease conditions (eg, parathyroidism)
• Genetic condition (cystinuria) • Digestive tract conditions like chronic diarrhoea
• Intake of certain medications • Recurrent infections and blockage of the urinary tract
• Diet rich in sodium, meat
products and/or calcium supplements Kidney stones vary in shape and size. They may range from 16 FUTURE MEDICINE I June 2014
By FM Bureau small, sand-shaped grains to large golf-balls. They can be smooth or jagged-edged. They cause severe pain, which may be associated with nausea, vomiting and passage of blood in the urine.
Four types of kidney stones Calcium stones: They account
for 80% of kidney stones. Calcium intake in individuals is common. However, in certain individuals, the extra calcium aggregates to form stones in the urine. Calcium stones then aggregate with other wastes and form larger stones. There are two types of calcium stones: calcium oxalate and calcium phosphate. Disease conditions such as hyperparathyroidism can cause calcium stones.
Cystine stones: Individuals
with a genetic condition called cysteinuria are predisposed to increased excretion of cystine into the urine, resulting in cystine stones. These stones account for less than 1% of kidney stones.
Struvite stones: These are formed following infection of the kidneys and account for 10-15% of kidney stones. Women seem to be more prone to struvite stones due to increased infections in the urinary tract. Struvite stones lead to internal complications and may require surgical intervention. Large struvite stones (staghorn calculi) can affect kidneys.
Uric acid stones: Increased levels of acid in the urine can cause uric acid stones which form 5% of kidney stones. A non-vegetarian diet (meat, fish) can cause uric acid stones. Consumption of alcohol, reduced urination, inflamed bowel conditions, gout, and genetic factors can also cause uric acid stones. Diet to prevent kidney stones
Doctors recommend drinking lots of water and other fluids to prevent formation of all types of kidney stones. A person should produce approximately two litres of urine each day.
Calcium-rich foods: Oxalate-rich
foods such as spinach, nuts, tea, beets, soy-based products, sweet potatoes and lady’s finger should be avoided. One should take calcium supplements cautiously as they tend to increase the risk of kidney stones. However, use of calcium products such as milk, cheese, etc does not increase the risk of kidney stones unless otherwise stated by a physician. Sodium and meat-products: Food rich in sodium and animal products should be eaten moderately. Lentilbased diets are preferred over meat products.
Medications
Uric acid stones: Allopurinol that prevents the synthesis of uric acid or an alkalizing agent to increase the alkalinity of the urine and dissolve stones may be prescribed.
Calcium stones: A phosphate
containing mediation or a thiazide diuretic may be prescribed.
Struvite stones: Infection causes
the formation of struvite stones. Hence, long-term use of antibiotics in small doses is recommended. When stones are large or block the urinary tract, the following four options may be utilised.
Extracorporeal Shock Wave Lithotripsy (ESWL)
The patient is treated with shock waves, directed towards the dense kidney stone. Repeated shock waves cause the stone to crumble, facilitating easy elimination through urine. Sometimes, a stent needs to be inserted to facilitate removal of the crushed kidney stone.
Patients require repeat procedures if ESWL does not eradicate all the stones in one session. Calcium oxalate monohydrate and cystine stones are resistant to ESWL treatment. Patients who are obese, pregnant, have bleeding disorders or urinary tract infections cannot avail the use of ESWL.
Ureteroscopy (URS)
This treatment involves the use of a fibre-optic instrument, a ureteroscope, to progress up the ureter via the bladder and visualise the stones present in the ureter. Once identified, a basket-like device can be used to capture the stones and remove them. If the stones are large, laser surgery is used. A stent is normally inserted to keep the ureter patent. The patient can return home the same day and resume normal routine in 2-3 days. The stent is removed in 1-3 weeks.
Percutaneous Nephrolithotomy (PNL)
Removal of large kidney stones can be done with an instrument called a nephroscope. The nephroscope is inserted into the kidney through a small incision in the back and stones are located. Laser beams are used to crush kidney stones. This procedure is normally recommended when ESWL or URS is not successful in removing large stones. The PNL procedure is preferred over open surgery due to the small incision that is made.
Open surgery
Large incisions are made in the kidney in order to remove the stones. Patients have a longer recuperation time in hospital
(approximately a week), compared to the other procedures. Patients are advised to drink a lot of water to increase the volume (approximately two litres a day) of urine excreted.
Parathyroid Gland Surgery
A benign tumour formed in the parathyroid glands can cause excess secretion of the parathyroid hormone (hyperparathyroidism). As a result, calcium levels increase causing the formation of kidney stones. Doctors may suggest removing the tumour or treating the hyperparathyroidism with medications.
June 2014 I FUTURE MEDICINE 17
Health Beat
What is T
he stomach normally secretes acid that is essential in the digestive process. This acid helps in breaking down the food during digestion. When there is excess production of acid by the gastric glands of the stomach, it results in the condition known as acidity. Dyspepsia, heartburn and the formation of ulcers are some of the symptoms. It is more common in highly emotional and nervous individuals.
Latest news in Health, Nutrition, Beauty, Sex, Yoga and Fitness
acidity? Most acidity problems occur • • •
After meals When lifting weight or straining and applying pressure in the intra-abdominal area At night while lying down
Common causes • • • •
Consumption of alcohol Highly spicy foods Non-vegetarian diet Non-Steroidal AntiInflammatory Drugs (NSAIDs)
Home remedies Tip 1: After all
meals, take a small piece of jaggery and keep it in your mouth and suck.
Tip 2: Boil one cup
of water. Add 1 tsp of Aniseed (Saunf ) to it and leave it a night. Strain the water in the morning and add 1 tsp of honey. Drink this three times a day.
Tip 3: To 1 ½
litres of water add 1 tsp Caraway seeds (shah jeera). Bring to the boil and simmer for 15 minutes. Sip while warm. Have the concoction 2-3 times a day for 5-6 days.
Tip 4: Powder
one clove and one cardamom; use the powder as a mouth freshener after every meal.
18 FUTURE MEDICINE I June 2014
Beauty Beat
Sparkling,
beautiful eyes Dull, lifeless and bloodshot eyes are the result of many factors – illness, fatigue, inadequate diet and dryness. Here are some tips for special, sparkling and beautiful eyes • Apple juice has proved to be beneficial to some people. Grate a fresh apple and squeeze the juice through a muslin cloth, soak cotton pads in the juice and place on closed eyes. Relax for 15 –20
minutes, repeat as required. • Keeping a bowl of hot water ready – first rub a piece of ice gently over eyelids in a circular movement, immediately follow
this with applying cotton dipped in hot water or splash it on the eyes, repeat this hot and cold procedure 7-8 times. Not only do the eyes feel rested but they definitely sparkle.
Coconut oil, an Ayurvedic miracle Coconut oil has been described as “the healthiest oil on earth.” Health benefits of coconut oil are many, both when used externally and consumed internally improves thyroid function while it also removes the stress on the pancreas. As it contains short and medium range fatty acids, it helps in removing excess weight.
Heart health:
Hair care:
Coconut oil is applied on the scalp and hair extensively in India as it prevents dandruff when massaged on a dry scalp. It nourishes damaged hair and is used as a conditioner.
Skin care:
Body and face massage with coconut oil delays wrinkles and prevents sagging skin. It helps in curing problems like psoriasis, dermatitis, eczema and dry flaky skin.
Weight loss:
This oil stimulates the metabolism and
Very high in saturated fats, the oil contains 50% of lauric acid which prevents high cholesterol and high blood pressure.
Digestion:
The saturated fats in coconut oil prevent growth of fungi and parasites that cause indigestion and related problems like irritable bowel syndrome. It helps in absorption of amino acids, vitamins and minerals.
Healing:
When applied on wounds and cuts, coconut oil forms a shield, preventing the entry of dust, bacteria and virus. It speeds up the healing process while repairing the damaged tissues.
NutritionBeat
How much water do you need?
E
very day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you
must replenish its water supply by consuming beverages and foods that contain water. So how much fluid does an average, healthy adult living in a temperate climate
Aspirin reduces risk of colon cancer
M
any studies have found that regular aspirin use reduces the risk for colon cancer.
Now scientists have found that aspirin may benefit some people far more than others. Aspirin apparently exerts a protective effect only in people with high levels of an enzyme called 15-PGDH, which is found in the gut’s lining. Researchers tracked aspirin use among 127,865 participants in two large national health surveys, and found 270 cancer cases in which 15PGDH levels were tracked. The study appears online in Science Translational Medicine.
Why olive oil is considered
healthy?
T
need? For men is roughly three litres (about 13 cups) of total beverages a day. For women is 2.2 litres (about 9 cups) of total beverages a day.
Eating fruits or vegetables is healthier than juice
J
uice probably is not any healthier than eating whole fruits and vegetables as the healthy fibre in them is lost during most juicing. And also, there’s no sound scientific evidence that extracted juices are healthier than the juice you get by eating the fruit or vegetable itself.
he main type of fat found in all kinds of olive oil is monounsaturated fatty acids (MUFAs). MUFAs are actually considered a healthy dietary fat. If you replace your diet of saturated and trans-fats with unsaturated fats such as MUFAs and polyunsaturated
fats (PUFAs), you may gain certain health benefits. MUFAs and PUFAs may help lower your risk of heart disease by improving related risk factors. For instance, MUFAs have been found to lower your total cholesterol and low-density lipoprotein cholesterol levels.
Weight Loss Beat
Almonds can fight
excess weight
A
lmonds are a rich source of protein and a wise alternative to red meat and eggs. Studies reveal that an ounce of almonds actually contains almost the same percentage of protein that lean meat has. What makes almonds a healthier alternative than meat is the high fibre content. Fibrous foods can effectively prevent fats and calories to be absorbed by your body. Studies say that fibre will bind the fat thus preventing it from reaching the intestinal wall and instead will be flushed out. Almonds contain oleic acid, a monounsaturated fat. It is commonly found in olive oil and is a huge contributor to decreasing the body’s cholesterol levels. Studies conducted at the University of Toronto show that the people who ate at least an ounce of almonds every day were found to have their LDL (low density lipoprotein or “bad
cholesterol”) cholesterol levels dramatically decreased. This will lower the risks of a person suffering from heartrelated conditions.
Benefits
Nuts, particularly almonds, are rich in Vitamin E which has anti-oxidant properties that play a key role in preventing the occurrence of heart ailments. One ounce of almonds daily provides about 40% of the body’s daily requirement of Vitamin E. There are also studies that confirm how almonds can help in protecting the body from developing cancer. The phytochemicals found in nuts are biologically active compounds that effectively prevent the formation of tumours. With the many active ingredients nuts have, they have been proven to provide a lot of health benefits other than the most recognisable benefits of almonds for weight loss.
June 2014 I FUTURE MEDICINE 21
SEX Beat
Good sex means
better health A
n intimate physical relationship helps to keep immune system humming. People who have regular sex have higher levels of defence against germs, viruses, and other intruders. Researchers at Wilkes University in Pennsylvania have found that the couples who have sex once or twice a week have higher levels of a certain antibody as compared to those who have sex less often.
Ideal for women’ s bladder control A strong pelvic floor is important for avoiding incontinence, something that will affect about 30% of women at some point in their lives. Good sex is like a workout for pelvic floor muscles. When you have an orgasm, it causes contractions in those muscles, which strengthens them.
Diabetes dampens
sexual
desire 22 FUTURE MEDICINE I June 2014
T
he problem of getting in the mood because you have less interest in sex or no orgasm is more common. They can also be more complex if you have diabetes. Poor blood sugar control can drag down your sex drive. So can depression, which is more common in women than in men. Some drugs used to treat depression may also dampen your desire for sex.
Blood pressure comes down
Research suggests a link between sex and lower blood pressure. Joseph J Pinzone, MD, CEO and Medical Director of Amai Wellness, says: “A landmark study found that sexual intercourse specifically (not self gratification) lowered systolic blood pressure.”
Best exercise
Sex uses about five calories per minute, four more calories than watching television. It gives you a one-two punch; it bumps up your heart rate and uses various muscles.
Good for heart health
A good sex life is good for your heart. Besides being a great way to raise your heart rate, sex helps keep your estrogen and testosterone levels in balance. Having sex more often may help.
Yoga Beat
Hale and hearty The continued practice of yoga will lead you to a sense of peace and well-being, and also a feeling of being at one with their environment
T
he European Society of Cardiology (ESC) EuroHeart Care Congress held in Glasgow, Scotland, reveals medical yoga and acupressure reduce blood pressure and heartbeat rates in patients with arterial fibrillation (AF), a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other serious complications. For the study, 80 patients with diagnosed PAF were randomised to the usual medical treatment plus yoga or just the usual treatment. Patients in the yoga group attended hour long sessions of yoga classes one time a week over a period of three months. The results
showed that after three months, those in the yoga group experienced significant decreases in both blood pressure and heartbeat rates as compared to those in the control group. Heartbeat rates and blood pressure actually increased in the group not practising yoga.
Natural cure for bad breath
Yoga offers specific breathing techniques, commonly known as ‘pranayama,’ in order to aid in the complete balance of the entire system. The ancient sages observed that it had a potent influence over the respiratory and digestive organs. One of the many benefits through mastery of breath control was a sweeter-
smelling exhalation. There are countless pranayama techniques. However, one of the most approachable is a technique called ‘kapalbhati’. Different schools teach the method in various ways, but the common thread of the practice is the emphasis on the exhalation. First, take a comfortable seat and allow the belly to relax and extend. Then begin to rhythmically contract the belly (the sensation is akin to someone punching the stomach at regular intervals and forcing the air out of the nose). Keep a steady rhythm, with the eyes closed, and complete up to 100 rounds (50 for beginners). Worry not about the inhales, as they happen automatically with the pumping action of the tummy.
June 2014 I FUTURE MEDICINE 23
Herbal Remedies Beat
Cancer treatment: Resorting to alternative medicines
M
any people are increasingly turning to alternative medicines for the treatment of cancer. One reason that people often cite for exploring these alternatives is that the treatments for cancer so often come with their own set of side-effects that can be quite devastating. While even common herbs that are often seen in one aspect or another in daily life can cause side-effects or interactions with medications, their benefits to an individual are still worth exploring. The following herbs have shown tremendous promise when it comes to being able to fight cancer.
Cat’s claw (Uncaria tomentosa)
This herb is a powerful stimulant of the immune system. It also makes the cleanup process of the white blood cells even more streamlined. In addition to helping to minimise the effects from chemotherapy and radiation, this herb has been shown to reduce the size of cancerous tumours, particularly when skin cancer is involved.
Feverfew
A study from the Rochester University in New York puts the spotlight squarely on this herb. Researchers were shocked to discover that feverfew was
24 FUTURE MEDICINE I June 2014
better at killing leukemia cells than cytarabine. Parthenolide, the active ingredient in feverfew, has been fasttracked by the Federal Drug Administration (FDA).
Wheatgrass
So powerful that one of the most esteemed private hospitals in South East Asia sings praises of the freshly juiced wheatgrass. This herb offers a plethora of health benefits. These include enough chlorophyll to equal 12 kg of broccoli. It also acts as a kidney-and livercleansing agent as well as a purifier of the blood.
Sheep’s sorrel
Used in herbal remedies such as Essiac, sheep’s sorrel cleanses tissues and helps in their regeneration. In fact, some research has even shown that it helps tissues and cells regain their normal attributes after being damaged by cancer.
Wormwood
An ancient Chinese herb, wormwood has often been proven to perform better than some malaria medications. Due to its strong anti-yeast and anti-microbial properties, it can be an effective component of an anticandida diet. Wormwood has properties that are directly anti-cancerous. Some cancer treatments, for example those used for leukemia, can result in an excess of yeast. Some doctors feel that excess yeast can even be a cause of cancer.
Body pain
/ ADVICES
Dr Arun Oommen, Consultant Neurosurgeon, Lakeshore Hospital and Research Centre, Kochi
I’m a 44 year old lady.I have been having recurrent pain over back, neck and shoulder for a long time . There is also tingling sensation over feet, thigh and hands. I don’t feel any weakness but this sensations prevent me from doing my work properly,… I even can’t sleep properly on many days. I have consulted many doctors. Even an MRI of spine was done which does not show any major problem… What is my problem and how can I get rid of it? --Rajani Suresh , Abu Dhabi Your problem seems to be Fibromyalgia which is a common and disturbing ailment. Fibromyalgia is estimated to affect 2–8% of the population, with a female to male incidence ratio of approximately 9:1. Fibromylgia is basically a functional somatic syndrome ie a physical response to depression and stress. Exact cause is unknown but is believed to involve psychological, genetic, neurobiological and environmental factors. The same genes causing fibromyalgia are also associated with other functional somatic syndromes and major depressive disorder. The central symptom of fibromyalgia, namely widespread pain, appears to result from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing.. Fibromyalgia patients have a lower threshold for pain because of increased reactivity of painsensitive nerve cells in the spinal cord or brain . Neurochemical abnormalities that occur in
fibromyalgia also regulate mood, sleep and energy, thus explaining why mood, sleep and fatigue problems are commonly comorbid with fibromyalgia Mode of inheritance is currently unknown, but it is most probably polygenic
Clinical presentation Fibromyalgia is characterised by chronic widespread pain and allodynia (a heightened and painful response to pressure. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some people also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling and cognitive dysfunction. Pain may be localised in areas such as the shoulders, neck, low back, hips, or other areas. Not all people with fibromyalgia experience all associated symptoms.
Precipitating/ associated factors Fibromyalgia is frequently associated with stress-related
June 2014 I FUTURE MEDICINE 25
ADVICES /
Back Pain
disorders such as chronic fatigue syndrome, posttraumatic stress disorder, irritable bowel syndrome and depression A systematic review found significant association between fibromyalgia and physical and sexual abuse in both childhood and adulthood,. Poor lifestyles including being a smoker, obesity and lack of physical activity may increase the risk of an individual developing fibromyalgia
Treatment
No universally accepted treatment for Fibromyalgia..more over response to treatment is all poor and inconsistent. Treatment plans that incorporate medication, patient education, aerobic exercise and cognitivebehavioral therapy have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms Cognitive Behavioural Therapy and related psychological and behavioral therapies have a small to moderate effect in reducing symptoms of fibromyalgia. The greatest benefit occurs when Cognitive Behavioral Therapy is used along with exercise
Medications
Commonly used include anti depressants like duloxetine and milnacipran and the tricyclic antidepressants (amitriptyline) Anti-
26 FUTURE MEDICINE I June 2014
seizure medication like gabapentin and pregabalin may be used. Weak opioid like tramadol may be tried but not strong opioids..The combination of tramadol and paracetemol has demonstrated efficacy. The use of NSAIDs is not recommended as first line therapy. A combination of antidepressants and anti epileptics for 3-6 months may be required to produce some improvement in symptoms
Exercise
Improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia In particular, there is strong evidence that cardiovascular exercise is effective for some patients. Long-term aquatic-based exercise has been proven beneficial as it combines cardiovascular exercise with resistance training
Diabetes
/ ADVICES
Dr V Mohan, Chairman and Chief Diabetologist, Dr Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai
I’m 50 years old and have diabetes for the last 15 years. I take insulin every day in the morning. But, even after taking medicines and insulin continuously, I feel very tired. How can I get rid of this? Please give me an appropriate advice --Mahesh Sen , Calcutta
You have mentioned that you have diabetes of 15 years duration and that you are taking insulin daily in the morning. But you have not mentioned about your blood sugars. High blood sugars can make you tired. Also if the blood sugar goes down at a particular time, you can get tiredness due to hypoglycemia (low sugar). So it is very important to keep the sugar under good control. There could be other causes for tiredness like associated illnesses which can make you tired. You should consult a doctor and keep your sugar under good control.
Causes of Hypoglycemia
In people with diabetes, hypoglycemia (low blood sugar) develops when there is not enough sugar (glucose) in your body to be used as fuel for cells. A number of different factors can cause hypoglycemia, including certain medications and diet. Certain medical conditions can also make hypoglycemia more common in people with diabetes.
Symptoms
Most people feel symptoms of hypoglycemia when their blood sugar is 70 mg/dL or lower. Each person with diabetes may have different symptoms of hypoglycemia. You will learn to recognize yours.
Early symptoms
Confusion , Dizziness , Feeling shaky ,Hunge, Headaches,Irritability,Pounding heart; racing pulse,Pale skin,Sweating,Trembling,Weakness, Anxiety June 2014 I FUTURE MEDICINE 27
ADVICES /
Infertility
Dr Muhammed Ashraf, Medical Director, CRAFT Hospital
I am a 32- year- old working in a reputed bank abroad. I have been married for five years now but we have not been able to complete our family. We have been trying for the past three years and consulted a few doctors for a solution to this issue. But we have not been able to elicit any results from all the routine consultations. After the tests and diagnosis my wife was normal and had no issues at all but apparently I have some problems in the semen sample and I have been taking medicines for more than a year for this now. Meanwhile I think it’s worthy to mention that consequential of work pressure I used to smoke but have never used alcohol. We are very emotionally stressed. Please help us solve this issue --Rajeev Nath/UAE First of all I would like to tell you . Being stressed and taking tension are the first things to avoid when you are facing such an issue. You have been married for 5 years which is comparatively a lesser period of time when we look at cases that come to us. But good that you decided to take this seriously now. Even at work I suggest you try and reduced stressful situations to get better results for whatever medication and treatment you undergo. Coming to your issue, from your mail there seems to be an issue in your semen. However, as the diagnosis is missing , it is difficult to exactly know what the issue is. Usually there are many reasons for abnormal semen parameters. In some cases there will be changes that occur in the fertility hormones so a latest
28 FUTURE MEDICINE I June 2014
detailed hormonal study is very important to pinpoint the real issue here. But more importantly that life style changes are now increasingly seen to cause problems of infertility. Studies show that nicotine is found in the eggs of a woman if her husband is a smoker. So you have to completely quit habits of smoking and alcohol if you are seriously trying for a family. In your mail it is not mentioned what your weight is and your partners weight is .Obesity is a major detrimental factor that can cause infertility. So get a controlled lifestyle, consult a good clinic with all allied facilities available under one roof .Meanwhile it would be good to look for a case of Variocele and if all these factors are corrected a right attempt of ART can give you the desired results
ADVICES /
Irritable and angry
Dr M R Rajagopal, Chairman, Pallium India
Diagnosed to have cancer, my husband underwent treatment and is now reasonably well, yet we all worry that the disease may come back any time. Our present major concern is that he is always angry and snaps at me and my children all the time. Sometimes we spend a whole day without talking to each other. Does cancer affect the mind? -Nanditha Haridas, Kozhikode
T
hink of yourself when you have a headache or a toothache? Does the pain make you irritable? Who do you show your irritability most to? Not to your boss in your office or to the policeman in the corner, I venture to guess. You are most likely to show it to your children or to your mother – whoever is safe for you. That is human nature. In the case of your husband, his whole world has turned upside down. (So has yours). Possibly he is feeling tired all the time. It is natural that he would have fears and anxieties, which are manyfold worse than your toothache or headache. It is but natural that he would be irritable and angry. When your husband displays anger, try to remember that his anger is really against cancer, his fate or against God. The cancer, fate or God is available physically to show anger to. It comes out against you and children. Once you have understood this, it is possible to move towards a solution. Sit down with him when he is reasonably well, and initiate a conversation. Tell him you see that he is always worried and stressed. Ask him to share his feelings with you. When he does, please do not interrupt; you must patiently listen. Do not say meaningless things like, “Everything is going to be alright” or “Stop thinking about it.” Those are conversation stoppers. May be he will cry; it is alright to cry with him. It is important not to stop him if he talks about death. He may have real concerns about it and open discussion about it will help. Palliative care professionals undergo training in communication skills in situations like this. It may be wise to consult one of them if you are unable to handle it yourself.
Disease Special
Eyecare
30 FUTURE MEDICINE I June 2014
For your eyes only Eyestrain occurs when your eyes get tired after intense use, such as driving a car for extended periods and reading or working at a computer. Here are the symptoms, causes and the risk factors
A
lthough eyestrain can be annoying, it usually isn’t serious and goes away once you rest your eyes. In some cases, signs and symptoms of eyestrain can indicate an underlying eye condition that needs treatment. Although you may not be able to change the nature of your job or all the factors that can cause eyestrain, you can take steps to reduce eyestrain.
Symptoms
Eyestrain signs and symptoms include: • Sore, tired, burning or itching eyes • Watery eyes • Dry eyes • Blurred or double vision • Headache • Sore neck • Sore back • Shoulder pain • Increased sensitivity to light • Difficulty focusing Computer use or the use of other digital electronic devices can cause many of these symptoms.
When to consult a doctor
If home treatments don’t work to relieve your eyestrain symptoms, see your eye doctor. See your doctor if you have ongoing symptoms that may include: • Eye discomfort • A noticeable change in vision
By FM Bureau
• •
Double vision Headache
Causes
Common causes of eyestrain include: • Extended use of computer or digital electronic devices • Reading for extended periods • Other activities involving extended periods of intense focus and concentration, such as driving a vehicle • Exposure to bright light or glare • Straining to see in very dim light Using a computer for long periods is one of the most common causes of eyestrain. This type of eyestrain is called computer vision syndrome. In some cases, an underlying eye problem such as eye muscle imbalance or uncorrected vision can cause or worsen computer eyestrain.
Risk factors
Risk factors for eyestrain include: Activities that require intensive or extended use of your eyes for tasks such as using a computer, studying printed materials or driving • Underlying eye problems such as an eye muscle imbalance or uncorrected vision (refractive error) • Stress or fatigue • Extremely dry air or moving air from heating and air conditioning
•
Disease Special
Eyecare
Complications
Eyestrain doesn’t have serious or long-term consequences, but it can be disruptive and unpleasant. It can make you tired and reduce your ability to concentrate. In some cases, it may take days for all eyestrain symptoms to go away after you’ve taken steps to change your activities or environment or treated any underlying cause.
Preparing for your appointment
If you have eye discomfort, headache or vision changes that don’t improve with self-care, make an appointment with your doctor. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
Using computer for long period is one of the most common causes of eyestrain. This type of eyestrain is called computer vision syndrome. In some cases, an underlying eye problem such as eye muscle imbalance or uncorrected vision can cause or worsen computer eyestrain
32 FUTURE MEDICINE I June 2014
What you can do
•
List any symptoms you’ve been having and for how long. • Write down your key medical information, including other conditions with which you’ve been diagnosed and all medications and supplements you’re taking. • Keep a daily log of the time you spend on activities that strain your eyes, such as working in front of a computer monitor, prolonged reading or exposure to glare. • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor. Below are some basic
questions to ask a doctor who is examining you for eyestrain. If any additional questions occur to you during your visit, don’t hesitate to ask. • What is the most likely cause of my signs and symptoms? • Are there any other possible causes? • Do I need any tests to confirm the diagnosis? • What treatment approach do you recommend? • What changes could I make to my work or home environment, including my computer desk, to help reduce symptoms? • What other self-care measures should I be taking? • When should I return for a follow-up appointment? • Should I see a specialist?
Save your eyes Y
our eye doctor will ask you questions about factors that might be causing symptoms. Your doctor will perform an eye check, including testing your vision. The doctor may ask you about your work habits, such as your seating and computer positions, and the length of time you normally spend on a computer each day.
Treatments and drugs
Generally, treatment for eyestrain consists of making changes in your work habits or environment. In some cases, eyestrain may improve if you get treatment for another underlying
eye condition. For some people, wearing glasses that are prescribed for specific activities such as using a computer or reading may help reduce eyestrain. Your doctor may suggest that you do regular eye exercises to help your eyes’ focus at different distances.
Lifestyle and home remedies
A few simple adjustments in how you read, work or use the computer can give your eyes a much-needed rest. Consider these simple tips to reduce eyestrain. While doing close-up work,
make sure you have light that’s well directed on what you’re doing. Use a brighter light source if you need one, especially if you have reduced vision. When reading printed materials, try to position the light source behind you and direct the light onto your page. If you’re reading at a desk, use a shaded light positioned in front of you. The shade will keep light from shining directly into your eyes. While watching television, keeping the room softly lit may be more comfortable than having a high contrast between the TV screen and the surrounding environment.
Disease Special
Eyecare
Tips for computer work
Computer use is a common cause of eyestrain. If you work at a desk and use a computer, take some of the strain off your eyes by making sure your work space is set up in an appropriate and eyefriendly way.
Adjust your position:
Position your monitor directly in front of you 20 to 40 inches (about 50 to 100 centimetres) from your eyes. If you need to get close to read small type, consider increasing the font size. Keep the top of your screen at eye
level or below so that you look down slightly at your work. If you wear bifocals, you may have a tendency to tilt your head backward so that you can see through the lower portion of your glasses. To adjust for this, consider lowering your monitor a few inches or buying glasses designed for computer work.
Check the lighting and reduce glare: Bright
lighting and too much glare can strain your eyes and make it difficult to see objects on your screen. To check glare, sit at your computer with the monitor off. This allows you to see
the reflected light and images. Note any intense glare. The worst problems are generally from sources above or behind you, including fluorescent lighting and sunlight.
Adjust your monitor:
If possible, place your monitor so that the brightest light sources are off to the side, at a right angle to your monitor. Consider turning off some or all of the overhead lights. If you need light for writing or reading, use an adjustable desk lamp. Close blinds and shades and avoid placing your monitor directly in front of a window or white wall. Use a glare-reducing screen to minimise glare from overhead lighting. Finally, adjust the contrast and brightness on the monitor to a level that’s comfortable for you, making sure the letters on the screen are easy to read. 34 FUTURE MEDICINE I June 2014
Keep your monitor clean: Wipe the dust
from your computer screen regularly. Dust on the screen lowers contrast and may contribute to glare and reflection problems.
Position your keyboard properly: Place your
keyboard directly in front of you. If you place the keyboard too high, too low or at an angle, it may cause discomfort and fatigue in your eyes, wrists and hands.
Keep reference materials nearby: Place
reading and reference material on a document holder beside your monitor and at the same level, angle and distance from your eyes as the monitor is from your eyes. This reduces how much your eyes need to readjust and how often you need to turn your neck and head.
Relax and refresh Take eye breaks: Throughout
the day, give your eyes a break by forcing them to focus on something other than on your computer screen. A good rule of thumb is to follow the 20-20-20 rule: Every 20 minutes, take your eyes off your computer and look at something 20 feet away for at least 20 seconds. It’s reasonable to take a break every 15 to 30 minutes for one to three minutes. Do other works, such as phone calls or filing, during this time. Try to stand up and move around at least once every hour or so. If possible, lean back and close your eyes for a few moments.
Blink often to refresh your eyes: Because many people blink
less than normal while working at a computer, dry eyes can result from prolonged computer use. Blinking produces tears that moisten and refresh your eyes. Make a conscious effort to blink more often.
Consider using artificial teardrops: Over-the-counter
artificial tears can help prevent and relieve dry eyes that result from prolonged sessions at the computer. Your doctor can suggest which drops might be best for you. Lubricating drops that don’t contain preservatives can be used as often as you need. If the drops you’re using contain preservatives, don’t use them more than four times a day. Avoid eye drops with a redness remover as these may worsen dry eye symptoms.
Improve the air quality in your work space: Some changes
that may help prevent dry eyes include using a humidifier,
lowering the thermostat and avoiding smoke.
Practice relaxation: Ease muscle tension with relaxation exercises. Place your elbows on your desk, palms facing up. Let your weight fall forward and your head fall into your hands. Position your head so that your hands cover your eyes, with your fingers extended toward your forehead. Close your eyes and take a deep breath through your nose; hold it for four seconds, then exhale. Continue this deep breathing for 15 to 30 seconds. Perform this simple exercise several times a day.
Massage your eyelids and muscles over your brow, temple and upper cheek once or twice daily: This can be performed with
your bare hands and fingers or can be done using a warm towel over closed eyes. Gently massage your upper eyelid against your brow bone for about 10 seconds. Follow by massaging your lower eyelid against the lower bone for about 10 seconds. This process can stimulate your tear glands, which may help prevent dry eyes. Massaging the muscles in the area around your eye (orbit) also helps relax those muscles, which may reduce some of the symptoms of eyestrain.
Get appropriate eyewear: If you wear glasses or contacts, make sure the correction is right for computer work. Most lenses are fitted for reading print and may not be optimal for computer work. Glasses or contact lenses designed specifically for computer work may be a worthwhile investment.
Sports Health
Fuel for running Carbohydrate plays a key role in the body of an athlete to stay on top form for peak performances. It provides energy for working muscles and the central nervous system,and enhances the metabolism of fat for energy production
H
ow different is an athlete’s diet from any other person’s eating habits? Is there a special diet to enhance athletic performance? Perhaps these questions race through our minds while watching athletes energetically dashing across playing fields—be it track events, soccer, basketball, cricket, hockey or swimming. Let’s take a look at how much and how many carbohydrates an athlete needs to include in the diet each day to stay on top form for peak performance. Based on research, an adult athlete requires 5 to 7g of carbohydrate per kilogram body weight. Every gram of carbohydrate produces 4 calories of energy. Such a large amount of carbohydrate is required by an athlete because it plays several key roles in the
36 FUTURE MEDICINE I June 2014
By FM Bureau body like providing energy for working muscles, the central nervous system, enhancing the metabolism of fat for energy production and preventing protein from being utilised for energy. These functions are directly related to the performance of an athlete. About 50 to 60% of calories in the diet must be from carbohydrate sources. The carbohydrate requirement for an individual is between 200 and 300 grams per day. For an adult looking to restrict carbohydrate intake, 120 grams per day is the accepted minimum. For children, the requirement is between 100 to 200 grams per day. Carbohydrates are found in foods such as grains, fruits, milk and its products. Vegetables contain a small amount of carbohydrates. After
When planning a diet for an athlete, carbohydrates should be moderated whether in the form of food or sports drinks. As every individual’s physical and metabolic makeup is different, carbohydrate should be given depending on the body’s response to the diet and also its impact on training digestion, carbohydrates enter the blood stream in the form of glucose and the glucose that is not utilised is stored as glycogen in the muscle tissues and liver.
Role of glycogen
The glycogen deposits in the body will be depleted during exercise if glucose is not available. If carbohydrates are unavailable, the body breaks down the protein to produce energy. This is detrimental because the protein ceases to serve its primary function of muscle building and also excess breakdown of protein in the body can lead to nitrogen production which may cause stress on the kidneys.
How much carbohydrate is needed?
Carbohydrate requirements for an individual vary for different sports. An endurance event will require more energy than a short duration event. The type of carbohydrate to be given can be determined by its glycemic index (GI). The choice of carbohydrates for exercise varies based on the GI of the chosen foods. Before beginning exercise it is important to consume carbohydrate to optimise glycogen stores. Two to four hours before exercise, an athlete can consume a meal rich in complex carbohydrates and low in protein and fat. Ideally 65 to 125g of carbohydrate can be consumed. Foods like a vegetable
sandwich with whole grain bread or a cup of yoghurt with fruit or a cup of pasta can be eaten 2 to 4 hours before exercise. One to two hours before exercise a fruit like banana or pomegranate or crackers with peanut butter or cheese will help elevate the glycogen levels without causing the athlete any discomfort. Thirty minutes before exercise liquids are recommended and if thirsty, a few sips of sports drink can be taken right before the exercise. During exercise, carbohydrate stores in the body have to be replenished especially for events lasting longer than 90 minutes. For endurance events, carbohydrate must be consumed 30 minutes into the event. Dry fruits, banana, sports gels and drinks are good options. After exercise, most people neglect carbohydrate and focus more on protein. Consuming a moderate
amount of carbohydrates within 30 minutes of completing the exercise optimises glycogen stores. Research has shown that protein utilisation in the body is more effective when taken along with carbohydrate. When planning a diet for an athlete, carbohydrates should be moderated whether in the form of food or sports drinks. As every individual’s physical and metabolic make-up is different, carbohydrate should be given depending on the body’s response to the diet and also its impact on training. It has been established that carbohydrates provide energy for day to day activities and also for exercise. There is a wide range of carbohydrate foods to choose from, depending on the athlete’s needs. While making food choices, fibre content, glycemic index, type of sugar and time of consumption must be taken into consideration for the best results on the field.
Campus Health
Campus romance has been a very sensitive subject ever since people started going to schools and colleges. No parents would allow this as they think falling in love with someone when you are still studying is detrimental and will affect the studies and life later. But is it that bad as they think? By FM Bureau
‘Please don’t forget to smile, if we meet again
C
ampus life is exciting. Especially for the first timers on the campus, entering a college just after their high school studies can be a wonderful experience. When they were in high schools, there were only studies as they had to prepare for the college entrance exams. Now they are free from the pressures of their parents, away from home, out of range of the roving eyes of the elders. It is time to have new friends, fun and have the first taste of romance. In fact, it is not love, it’s only an infatuation. Yet it’s genuine as one falls for him or her here is not because of the other person’s social status, caste, religion or wealth. But in most of the cases, this wonderful life doesn’t last for long. Many are forced to part their ways abruptly. Many girls get married even during their studies and settle down. Boys move to faraway places for higher studies or employment. Yet, these are a few things we love to cherish all through our lives. No doubt romance on campus makes our life really beautiful and complete. “Forget about the heartbreaks and disappointments,” says counselor and psychologist Dr S Shankar. “It can be beneficial too. There are many incidents where the Cupid played a larger role in pushing people to think unconventional and find new meaning to life. Love is inspiring and it makes people more creative and brings in great achievements,” he adds. “This is the time when students start knowing about other people and interact with them closely. For them, it is a different experience, different from what they experience at home. It does not mean that encourage them. Just ignore it and love your children more intensely. It is natural that children seek to establish friendships and relationships outside home, especially if they feel neglected or ignored at home. Remember love is the most powerful antidote in one’s life,” says Dr Shankar. “My college days were at a time when parents and the college authorities were very orthodox and strict. We, boys and girls were not allowed to talk in the corridors or at the library or go for a tea together at the canteen, let alone walks around the campus.
It is time to have new friends, fun and have the first taste of romance. In fact, it is not love, it’s only an infatuation. Yet it’s genuine as one falls for him or her here is not because of the other person’s social status, caste, religion or wealth
The only place we talked freely was at the bus stop, under a fully blossomed Gulmohar tree. The students were really scared of the principal who could appear in front of you at any time. Still people fell in love. It did not affect their studies generally. But there was one case, I remember, that a girl became a mental wreck after a failed love affair. In fact, the boy got a job in a faraway place and the contact was lost. The only mode of communication those days was writing letters. This was an exceptional case. Most other relationships ended up with a sentence in the autograph, “Please don’t forget to smile, if we meet again.” “Though as a parent I don’t fully agree with the idea of a campus love maturing into an inseparable relationship, I am also against students being put on a leash to protect them from campus romance. The students should also know one thing that there is a life after the campus and it is entirely different. Get into friendships, but avoid relationships. Then the memories of your campus adventures will be sweeter,” says Dr Shankar.
June 2014 I FUTURE MEDICINE 39
Cover story Transgender
Rise of the
Third
Gender
Sex and gender are two different entities, which are often confused and misunderstood to be the same. Sex is a physical feature of having male or female anatomical structures or organs whereas gender is a psychological phenomenon
W
hen a child is born,the baby is assigned as male or female on the basis of physical sex characteristics which are immediately apparent at the time of birth or investigations during pregnancy. But there are no tests or investigations to ascertain the gender of the baby at the time of birth or before. In most other cases, anatomical sex and psychological gender are in congruence, this means a male child develops with characteristics of male, likes to play with cars, rough sports and male ambitions, and at appropriate times develops attractions to the opposite sex and vice-versa. In rare cases, there will be discordance between anatomical sex and psychological gender. A baby born neither male nor female is a transgender. They are known as ‘Hijra’ in India and forced to lead an ‘unaccepted life’ in the society. They are a happy lot today as a Supreme Court verdict in April recognized them as the “third gender” for the first time giving the social acceptance. The verdict of the Apex Court has in fact opened a new chapter for about two million people in India who qualify for the third category of humanity. In the wake of the historic Supreme Court verdict,
Sumithra Sathyan, Co-ordinating Editor of Future Medicine, looks into the murky world of transgenders and also talks to two eminent doctors in the US who have specialised in transgender surgery, Dr Sherman Leis, Surgeon, Professor, Lecturer and Founder of Philadelphia’s Center for Plastic and Reconstructive Surgery, and Dr Jayaram BN, a well known plastic and reconstructive surgeon, who has worked in some of the best institutions in the US.
“I’ve been living the life of a married man for 20 years. I have a successful career and three children. All this time, however, I have battled gender dysphoria and the deep sadness that comes from living a lie. From the earliest age, I’ve been unhappy being a male. I believed I would find happiness only once I was true to myself. I recently had my self-diagnosis confirmed, and I’m initiating a transition to living as the real me. There is June 2014 I FUTURE MEDICINE 41
Cover story Transgender a cost involved: pain to my family and stress on my career. Ethically, is it right to be “true to myself” even if that authenticity ends my otherwise happy marriage and damages the emotional stability of my three children? If I had to maintain the lie, the emotional cost would be tremendous; a transition would share the pain with all who love me but might result in happiness. What’s the ethically correct thing to do?” The above is a famous letter from a reader (name withheld) to Chuck Klosterman, The New York Times ‘Ethicist’, which reflects the pain and anguish of the reader who seeks a sexual transition.
The journey of transition
“There are a number of such cases across the world. It is believed that sexual transitioning is a journey that is touched on by a myriad of factors: surgical, psychological, hormonal, aesthetic, legal, and more. Each transition is an intimate, distinct experience, so our patients will have many unique questions and concerns throughout the process. Therefore, we have created a more personalised experience,” says Dr Sherman Leis. “We personally support the patient emotionally by being available to discuss all aspects of the transition with the patient and by answering all the questions in a realistic and honest manner. We clarify and objectively provide correct, balanced information, dispelling unrealistic or erroneous concepts prevalent in public sources and addressing fears and anxieties. Patients are guided to obtain counseling from a mental health professional specifically trained in gender identity concerns. This could be a psychologist or psychiatrist with training and experience
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in this field.”
Mental and physical transition
Best practices for hormone therapy are reviewed with the patient in order to help with the many levels of mental and physical transition. Hormones will change the body as well as the personality in both subtle and, sometimes not so subtle ways, toward the desired gender. ‘‘We offer guidance and advice to our patients before, during and after the entire process and hope to provide support years after the surgeries. I believe there is no type of surgery or any other field in or out of the medical world which creates such a profound and positive change in both the physical, emotional, and mental status of a person as with transgender surgery. After many years of surgical experience, I have never observed a more positive improvement in self-image as I have seen with my transgender patients. This is what gives me such a strong feeling of self-purpose and satisfaction in work every day, knowing that I am helping another person to have a happier and more fulfilling life,’’ says Dr Sherman.
Main concern of psychologists and psychiatrists
‘‘The main concern
The verdict
T
he transgenders who don’t identify themselves either male or female and are known as ‘Hijra’ in India are jubilant after the Supreme Court verdict last April recognizing them as the “Third Gender”, ending a struggle for decades for recognition and social acceptance. The verdict has in fact opened a new chapter for about two million people in India who qualify for the third category of humanity. The Supreme Court order is a turning point in the struggle of transgender people and other sexual minorities in India. The landmark ruling grants them, who are born male and live the life of a female; or who are born female, but live the life of a male, but not recognised as a male or a female, the right to choose a gender. They are given three options to be identified in the society as “Male, Female or the Third Gender.” The court ruling also ensures reservation for the Third Gender under the OBC category to pursue education or for entering government service. This will no doubt, improve their social status and acceptance. Earlier, they were not chosen for a dignified job. Discriminated everywhere, even by family members, they were forced to do all kinds of illegal works,
including sex work, for a living. Another highlight of the judgment is that they don’t have to undergo a sex reassignment surgery now to prove their gender. On the strength of the ruling, the Third Gender cannot be now denied admissions to educational institutions or employment due to their gender. Now they can seek hospitalisation for treatment, which was denied earlier the confusion over their gender they could not be admitted to either male or female ward. The court in its ruling also pointed out that “gender identity is one of the most fundamental aspects of life which refers to a person’s intrinsic sense of being male, female or transsexual.” “Discrimination is so large and pronounced, especially in healthcare, employment and education, leave aside social exclusion. Now, it is time for us to recognise the rights of transgenders as a separate category and to extend and interpret the Constitution in such a manner as to ensure a dignified life for them,” observed the Bench of Justices KS Radhakrishnan and AK Sikri, who pronounced the judgement protecting the right of the Third Gender to live with dignity.
of psychologists and psychiatrists is that these patients who seek sex reassignment surgery are normal in all other aspects of psychological personality. Their main task is to evaluate and study these patients thoroughly for an extended period of observation to rule out psychosis, personality disorder not related to G I D. “Transgender surgery is performed on otherwise perfectly normal healthy people other than GID. Therefore, psychiatrists take all the responsibility in recommending this type surgery for a patient. Without his unequivocal opinion, these patients will not be accepted for surgery. It is a rule to have these patients evaluated by more than one psychiatrist and only on the concurrent opinion of psychologists and psychiatrists, the patient is accepted for surgery. There are other equally important requirements the patient has to fulfill before undergoing sex reassignment surgery,’’ says Dr Jayaram.
Cover story Transgender
Gender dysphoria It is a fundamental unease and dissatisfaction with the biological sex one is born with (one’s body) which results in anxiety, depression, restlessness, and other symptoms. The dysphoria often acts as a catalyst to change one’s body and gender expression (how one presents to the world) to be more in keeping with what is felt to be one’s gender identity (the gender that one feels oneself to be). In simpler terms this means that natal (biological) males, who are gender dysphoric have unease, dissatisfaction and even disgust with their male genitals, body hair, angularity, facial hair, musculature and any other attributes that one typically identifies with “maleness”. Natal females who are gender dysphoric can have similar feelings with developing breasts, fuller hips, long hair, menstruation and other attributes that are associated with femaleness. For many transgender individuals being transgender is not just about wanting to live in the social role of the other gender (to some degree), but it’s also about a fundamental dissatisfaction with one’s body.
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Surgical procedures The surgical procedures include facial feminisationAlteration of facial features and/or structures (nose, brow, jaw, etc.), breast augmentation - Placement of breast implants, buttock enhancement or reduction - Shaping buttocks to more feminine contours and thyroid cartilage reduction - Reduction of Adam’s apple, vaginoplasty ‘Bottom surgery”; conversion of genitalia from male to female, and vaginoplasty methodology.
Facial feminisation
It includes surgical procedures that alter the face to create more classically feminine characteristics, such as a higher brow, a more refined feminine nose, less pronounced Adam’s apple, and others. For the transsexual woman, facial feminisation greatly enhances the socialisation process as a woman.
Breast augmentation
This surgical procedure involving the placement of breast implants to increase the size and improve the shape of the breasts. According to the American Society of Plastic Surgeons, breast augmentation is one of the most commonly performed cosmetic surgeries in the
United States. Those who desire a larger breast than hormones produce should explore having breast augmentation surgery, in which a breast implant (prosthesis) is inserted under the existing breast through an incision.
Buttock enhancement or reduction
Both male-to-female (MTF) and female-tomale (FTM) transgender patients schedule buttock enhancement or reduction surgery if they desire shaping their buttocks to achieve a classically feminine or masculine look. The classical feminine form features buttocks that are rounder and fuller. Some hip shaping may be necessary as well. Classically masculine
Dr Sherman Leis buttocks are smaller, angular, and firmer.
Thyroid cartilage reduction
People who are undergoing a male-tofemale (MTF) transition consider having chondrolaryngoplasty or thyroid cartilage reduction surgery to reduce the classically male characteristic, the Adam’s Apple. Having thyroid cartilage reduction surgery, more commonly known as a “Trach Shave”, reduces the prominence of the Adam’s Apple to provide a more feminine appearance.
Vaginoplasty
It is a surgical procedure that essentially converts penile and scrotal tissues into a vagina, clitoris, and labia. This procedure is usually combined with labiaplasty that further refines the labia and external vaginal area, giving it a classically female appearance.
Dr Jayaram B N
Vaginoplasty methodology
This one-stage procedure is done under general anesthesia in the lithotomy position (legs elevated and separated in stirrups). All incision sites are infiltrated with zylocaine containing epinephrine, which constricts blood vessels and reduces bleeding.
Health hazards Challenges:mental and physical
The health hazards of transgender people are not much different from the health problems of any normal people, except for the psychological stress of possessing genital features that are opposite to their gender identity. This causes serious stress and anxiety in lifestyle, and when this disparity between anatomical sex features and psychological gender becomes intolerable, they seek correction through surgery
Cover story Transgender to change their sex organs in accordance with their psychological gender. “I have been doing surgeries for 40 years, but mostly transgender surgeries for the past 10 years and have done 3000 to 4000 surgeries during this time. The challenges of living life in your desired gender are not difficult if you feel comfortable in your desired gender,’’ says Dr Sherman.
The need for post transition support People have been focused on ‘transitioning’ for so long in their own
private thoughts and the process is so involved that very often the individual and perhaps their therapist are not as focused on what happens afterwards. The gender dysphoria has been such a problem in one’s life that ‘transitioning’ comes to be seen as the solution. Many other problems, emotional and otherwise, are understandably not addressed because of the overwhelming nature of gender dysphoria, and so it can be something of a rude shock to find these issues emerge after transition.
India’s first transgender entrepreneur A different voice Kalki Subramaniam
grew up with the stigma of a transgender insulted by others in schools and colleges, but that only made her a strong person. She fiercely campaigns for social, political, and economic equality and rights of transgender and inter-sex people. Kalki is now the founder of Sahodari Foundation, an organisation working for the social, economic and political empowerment of transgenders in India.
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A transgender rights activist, an actor and a transsexual woman herself, Kalki holds two Master’s degrees in Journalism and Mass Communication and International Relations. Through Sahodari, she works with the entrepreneurship training which can positively change the poor transgender and intersex people’s livelihood choices – a life away from begging and a life with dignity. With the public, she advocates against the
Kalki Subrahmaniam
transgender discrimination and hatred, and voices for inclusion of transgender and intersex people at all levels. She has lectured at numerous seminars, colleges and universities in India and the US. Basically, Kalki is an actress who makes documentaries. She is also the editor of the Tamil magazine for transgenders called Thirunangai. She also works as an independent media specialist. She develops web-based projects and is a scriptwriter for documentaries and animation. films.
Festival of the ‘Third Kind’ Koovagam, a remote village in the Ulundurpettai taluk in Villupuram district of Tamil Nadu, is primarily known for its annual 15-day festival of transgender and transvestite people, in the Tamil month of Chitrai (April/May). The festival takes place at the Koothandavar Temple dedicated to Aravan
(Koothandavar). The participants marry the Lord Koothandavar, thus reenacting an ancient myth of Lord Vishnu who married Kootandavar after taking the form of a woman called Mohini. The second day of the festival is about mourning the death of the groom by breaking their bangles and singing and
dancing ritualisticly. An annual beauty pageant and several other competitions like singing are held. The festival premises are also venues for several seminars to discuss the basic rights and health care issues of transgender and transvestite people. People from different places attend this festival.
Koovangam Fest
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Beauty Care
Lustrous mane The healthy, shining and lustrous hair enhances personality of an individual hence it requires proper care and regular maintaince
By Dr Apoorva Shah
D
espite the wonders of science and technology, most of us still continue to look to the age old wisdom for help to maintain a healthy mane. These home truths need to be nurtured to suit modern lifestyle. It is a fact that women generally learn about their hair from their mothers and grandmothers. Since hair is an important part of our personality, it is necessary to adopt the right approach to maintain healthy and lustrous tresses. Here are some myths and facts about hair
Myth: A woman should brush her hair one
hundred strokes everyday to keep it healthy and shiny.
Fact: This was true at the time when
conditioners weren’t invented. Brushing does help distribute the natural hair oils but more than 8 to 9 strokes of the hairbrush a day, can damage your hair. Excessive brushing can tear the hair, pull it out and damage the cuticle layer causing split ends, especially in people with dry and colour-treated hair. Over-brushing does no good for oily hair either – it merely stimulates the sebaceous glands and thus, increases the level of sebum in the hair.
Myth: Shampoo is harmful to the hair and
causes hair loss.
Fact: Women in India seem to have an
unfounded fear of shampoo. It is indeed harmful to the hair to have a continuous supply of moisture to it, but shampooing is not the culprit. Rather it is advisable not to wash your hair more than thrice a week (with or without shampoo), unless you find it distinctly greasy or dirty. If you are a sports person or travel a lot and thus your hair gets dirty, don’t hesitate to use a shampoo while washing your hair – only make sure it is formulated for daily use. Shampoo is merely a cleansing agent and whether you use it in the form of soap or a liquid makes no difference, as long it is suited to your hair type. Moreover, shampoo has no effect on hair loss; neither does it cause an increase in the production of sebum (oil). The hair that falls out during shampooing is already in the Telogen phase. We notice the hair fall more during shampooing because the hair in the Telogen phase becomes agitated. People with oily hair should, in fact, shampoo their hair more frequently. But excessive hair fall is a cause for worry and should not be ignored. Consult your trichologist if you notice excessive hair fall.
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Beauty Care Myth: Shaving hair will make it grow thicker.
Fact: Despite the fact that it has
become almost mandatory to shave a baby’s head at least twice in the hope of promoting good hair growth, there is no evidence to suggest that shaving helps. The quality of our hair is determined by a number of factors such as our diet, lifestyle, state of our health and hereditary factors. It is very important to have a balanced diet, rich in proteins. Our hair also requires minerals like iron, copper and zinc in the right proportions and deficiency of these will affect the condition of our hair. This holds good even for body hair, where many women shy away from using the razor although it is one of the most convenient and safe modes of hair removal.
Myth: Cutting hair frequently will cause it to grow long faster.
Fact: Many girls have cut their hair
in the hope of making it grow long, only to discover that the hair is taking a long time to grow. The fact is that we cannot really hurry our hair in its growth process but we can keep it healthy by eating a balanced diet, drinking plenty of water and washing and brushing it correctly. Trimming the ends of the hair will help, only for getting rid of split ends. If split ends are allowed to remain, they will continue to split higher, causing hair to break off and thus
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shortening the hair.
Myth: Oiling hair will rejuvenate hair regrowth.
Fact: Despite the fact
that oiling performs the essential function of conditioning of the scalp, it will not stop hair from falling if you are suffering from hair loss, nor will it accelerate the rate of hair re-growth. Oiling acts as a scalp conditioner. Make sure that when you oil your scalp, it should remain in the scalp for a minimum of four hours and maximum eight hours.
Myth: It is normal to lose 50-100 hair a day
Fact: Our hair does go
Dr Apoorva Shah, a pioneer of through a natural cycle of growth and fall and as Trichology in India, through the part of this process we Meenaxiben and Rekhaben Shah Memorial lose a certain amount of Trust, strives to bring in a positive outlook hair after our hair has in the lives of cancer patients. This Trust completed its period of not only provides free treatment to the growth. The fact is that cancer patients but also helps restore their there is no fixed numbers self image, prestige and confidence. of hair lost that can be considered abnormal. Excessive hair loss may even skip generations. simply means losing more hair than Myth: Standing on the head leads to you naturally lose. A Trichologist can hair growth. best check this, by calculating your Fact: It is often misunderstood that A/T ratio (i.e. ratio of growth to ratio poor blood circulation is a major of fall). The A/T ratio, in normal hair cause for retarded hair growth, hence is 80:20; any deviation in this will the myth that standing on one’s head lead to hair loss or excessive encourages hair growth. hair growth. Myth: Switching shampoos can make Myth: Baldness is hair look healthier. inherited from the father’s side of the Fact: It may seem so, but ideally family. hair can’t tell the difference between Fact: Male and female brands or build up tolerance to any product. Your shampoo will work hair loss patterns can the same every time you lather up, be inherited from week after week, month after month. either the father’s If you have very oily hair or favour side or the a particularly sticky styling product mother’s side. that contains wax, it does pay to use a This inheritance cleansing shampoo every day to wash away residue.
Sexual Health
An early
climax
A detailed history of the man’s sex habits, prior sexual trysts, as well as that of the partner must be elicited while treating a couple affected by premature ejaculation By FM Bureau
P
remature ejaculation or PE as it is commonly known is a sexual dysfunction affecting young men aged below 40 years. It could be simply explained by saying that it is the male climax or ejaculation occurring before either of the partner is ready for it. In colloquial terms, it could be described as ‘coming within six thrusts’ or ‘coming within two minutes.’
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It is very often thought to be psychological in origin, where a man who is very anxious or has oversensitive genitals ejaculates before penetration or soon after penetration and that it does not yield the desired satisfaction to the couple. When such a situation leads to frustration, lack of enjoyment from sex, and finally depression, it is deemed to be a case of
premature ejaculation. The condition has been linked to instances of abuse or traumatic experiences related to sex in childhood or anxious individuals. It could at times be secondary to hormonal problems or problems related to the prostate gland. A detailed history of the man’s sex habits, prior sexual trysts, as well as that of the partner must be elicited while treating
a couple affected by premature ejaculation. Sometimes, it could be an instance of the female partner taking a rather too long time to climax, or not climaxing at all, as opposed to a man ejaculating prematurely. An examination of the male usually does not reveal any abnormality. Treatment lies in both partners understanding the problem, and approaching
it in a relaxed manner. Various exercises, positions and maneuvers are recommended to delay the ejaculation for that wee bit longer. Medications useful for this condition are the anti-depressants, which actually delay ejaculation as a side-effect and not as a primary effect. local anesthetic creams are available which when applied over the penis, numb it and thereby delay the stimulation and ejaculation process. Though research is on for better drugs, nothing can surpass an easy attitude, understanding and patient approach to this problem. Healing old emotional scars, perhaps with the help of a psychologist, also goes a long way in overcoming this problem.
Treatment lies in both partners understanding the problem, and approaching it in a relaxed manner. Various exercises, positions and maneuvers are recommended to delay the ejaculation for that wee bit longer June 2014 I FUTURE MEDICINE 53
Sexual Health
Female sexual dysfunction
F
emale sexual dysfunction is defined as persistent and recurrent problems with sexual response or desire seen in women. Women experience problems with sexual function at some point in their lives. Sexual dysfunction is quite common affecting almost 30-50% of women globally. Sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. A breakdown in any of these areas may lead to
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sexual dysfunction. This can be a lifelong problem, or it can happen later in life. Female sexual dysfunction may be due to a number of causes. Traumatic injury to the genitals or pelvic region, surgical intervention, extensive bike riding, underlying medical conditions, hormonal imbalance, and medications can cause sexual dysfunction. The American Psychological Association (APA) classifies female sexual problems as-
•
Mental disorder - loss of sexual desire or arousal • Discomfort during intercourse • Diminished blood flow to the vagina • Trauma-related aversion to sex • Inability to achieve orgasm Almost all causes of sexual dysfunction are treatable. Communicating the concerns and understanding one’s body and its normal response to sexual activity are important steps toward gaining sexual satisfaction.
Wellness
In tune with climatic changes Acclimatising to climatic changes is a must for healthy living. Though we don’t recognise the changes, our body will react to it very fast. There are some precautionary measures prescribed in Ayurveda to overcome the adverse effects of the changes By Dr N Satheesh Kumar
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L
ike all living beings, human body and mind are subject to the changes in the environment. In Ayurveda, Rithucharya has described the pathological changes occurring in tune with climate changes and precautions to be taken to tide over the adverse effects. It is common that epidemics break out in low-lying areas and spread to other parts during monsoon, especially in the beginning. In the case of dengue and chikunguinea, mosquito is identified as vector for respective virus. But the precipitation of these diseases at the time of monsoon is due to
innate disease mechanism. Comparing to the older generation, it has been seen that endurance in terms of maintaining good health is reducing day by day. This can be due to unhealthy food habits and defective environment management. According to the basic principles of Ayurveda, the elements of body constantly try to maintain equilibrium in metabolism, ageing and in all situations the body has been exposed to. The quantitative control is possible by indentifying signs and symptoms. In animals and plants, the selection is so natural and extreme climate variations minimally affect these species. In our
Do’s Bitter food stuff like paval, kovakkai, inchi (chukka), kurumulaku, thippali, Induppu (Pot chloride), grapes, honey etc. may be included in regular food intakes. Akil, gulgulu, kunthirkkam, muthanga, vasanabhi, thulasi, poothanakku etc. are evidently effective
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Wellness
Don’ts Avoid exposing to initial rain as it contains the air and land impurities of last summer. Sour foods to be reduced Excessive oily food, curd and yeast containing food to be reduced development, we had lost this natural way of living. Greeshma charya is the health tips for summer. When this climate is altered by monsoon cloud, the initially affecting element is ‘Agni’ or the metabolic fuel of the body. Various metabolic enzymes daily secreting as per body requirements and considering external factors like heat, humidity can get confused by sudden cooling outside. So during this time, corresponding food and simple drugs like ginger are valuable in uplifting ‘Agni’. People may not be aware of the changed requirement of body due to the sensitivity defect, but when defective exposure to micro organism, allergy etc. occurs, clinically ‘Agni’ becomes significant. In epidemics, Ayurveda physicians stress on resuming innate immunological molecules of the body rather than anti-microbial or anti- fever management. In many places of Kerala, when the dengue fever occurred last year, Amruthotharam kashayam which comprises three simple herbs proved effective in managing the disease. The preventive measures mentioned in Varshacharya 58 FUTURE MEDICINE I June 2014
(doctrines at arrival of rainy season) are to uplift personal and environmental hygiene by herbs and methods like fumigation, checking insects, mosquito etc. Water quality can be achieved by adding selective herbs, boiling, sterilisation etc. The most important area of management is to potentiate immunity. Selective immunology issues in connection with climate change irrespective of cause like infection or allergic manifestation can be effectively managed in Ayurveda. During monsoon, all the three vital factors of body tend to vitiate. Neurological diseases, soft tissue disorders, diseases like asthma, many metabolic disorders etc. may be aggravated in Kerala. This may occur in Europe in snow season as per the biological clock there. If the medical practitioners in the country identify the public health issues due to climate changes timely, they can be managed with simple medicines. If health authorities educate communities on preventive measures, many future medical issues can be addressed. (The author is Director of Dhanwanthari Vaidyasala, Thodupuzha)
Yoga Wellness
Relieving back pain Back pain is caused due to stress and tension in the muscles that support the spine. Sedentary lifestyle, overuse or under use of the back and postural mistakes are unconscious triggers to the widespread problem of back pain. Regular exercise is a redeeming feature that brings relief to back pain
B
ackache strikes when the muscles are under fatigue, commonly at the neck or lumbar region (where most twisting, turning or bending occurs). Frequent backaches occur due to overstrained or over stretched muscles, improper sitting positions, stress, lumbar scoliosis and earlier injuries. Many conditions cause back pain and they can be treated with conscious and gentle yoga practice. It has proven to be a safe and effective way to alleviate many forms of back pain and prevent its recurring bouts. However, all cases of back pain need to be evaluated by a medical expert for diagnosis and treatment.
movements will help to increase joint flexibility. It also helps to maintain and improved strength and flexibility in the hips, shoulder and neck movements.
Healing benefits •
•
Yoga for upper and lower back pain
Lower back pain is caused due to excess sitting that can weaken the back muscle and results pain in your lower back. It may also be due to some other reasons like poor postural habit and sudden lifting of heavy objects, whereas upper back pain usually occurs between the neck and top of the lumbar spine. It is caused due to stress, anxiety, shoulder pain and neck pain. These symptoms can leads to stiffness and aching in your lower back and upper back of the body. Yoga is another form of exercise that will help relieve you from both lower and upper back pain. Practicing yoga poses and exercise
•
Yoga strengthens muscle groups. Many postures in yoga strengthen the back and abdominal muscles and help the body maintain a proper upright posture and movement. Stretching and relaxation reduces tension in stress carrying muscles. When these muscles are well conditioned, it helps to offset back pain. Yoga eases lower back pain, by stretching and strengthening the muscles of the lower back. It increases blood circulation, which brings healing nutrients to the injured tissues. Yoga also helps maintain a natural curvature of the spine that is crucial in avoiding lower back pain. Thus, Yoga is an excellent therapy for healing injured and sore back muscles, speeding time to recover from an injury and preventing re injury. It also reduces the risk of disability due to back pain. In short, Yoga increases awareness of the body and keeps the body healthy and supple.
Fitness Health
Do exercise, do aerobics
Regardless of age, weight or athletic ability, aerobic exercise is good for you. The following are 10 ways that aerobic activity can help you feel better and enjoy life to the fullest
R
By FM Bureau
egular aerobic activity such as walking, bicycling or swimming can help you live longer and healthier. Need motivation? See how aerobic exercise affects your heart, lungs and blood flow. Then get moving and start reaping the rewards.
How your body responds to aerobic exercise
During aerobic activity, you repeatedly move large muscles in your arms, legs and hips. You’ll notice your body’s responses quickly. You’ll breathe faster and more deeply. This maximizes the amount of oxygen in your blood. Your heart will beat faster, which increases blood flow to your muscles and back to your lungs. Your small blood vessels (capillaries) will widen to deliver more oxygen to your muscles and carry away waste products, such as carbon dioxide and lactic acid. Your body will even release endorphins, natural painkillers that promote an increased sense of wellbeing. 60 FUTURE MEDICINE I June 2014
What aerobic exercise does for your health
Regardless of age, weight or athletic ability, aerobic activity is good for you. As your body adapts to regular aerobic exercise, you’ll get stronger and fitter. Consider the following 10 ways that aerobic activity can help you feel better and enjoy life to the fullest. Aerobic activity can help you:
• Keep excess pounds at bay Combined with a healthy diet, aerobic exercise helps you lose weight and keep it off.
• Increase your stamina Aerobic exercise may make you tired in the short term. But over the long term, you’ll enjoy increased stamina and reduced fatigue.
• Ward off viral illnesses Aerobic exercise may activate your immune system. This may leave you less susceptible to minor viral illnesses, such as colds and flu.
• Reduce your health risks Aerobic exercise reduces the risk of many conditions, including obesity, heart disease, high blood pressure, type 2 diabetes, metabolic syndrome, stroke and certain types of cancer. Weight-bearing aerobic exercises, such as walking, reduce the risk of osteoporosis.
older adults.
• Manage chronic conditions Aerobic exercise may help lower blood pressure and control blood sugar. If you have coronary artery disease, aerobic exercise may help you manage your condition.
• Strengthen your heart A stronger heart doesn’t need to beat as fast. A stronger heart also pumps blood more efficiently, which improves blood flow to all parts of your body.
• Keep your arteries clear Aerobic exercise boosts your highdensity lipoprotein (HDL), the “good,” cholesterol, and lowers your lowdensity lipoprotein (LDL), the “bad,” cholesterol. This may result in less buildup of plaques in your arteries.
• Boost your mood Aerobic exercise may ease the gloominess of depression, reduce the tension associated with anxiety and promote relaxation.
• Stay active and independent as you age Aerobic exercise keeps your muscles strong, which can help you maintain mobility as you get older. Aerobic exercise also keeps your mind sharp. At least 30 minutes of aerobic exercise three days a week appears to reduce cognitive decline in
• Live longer Studies show that people who participate in regular aerobic exercise live longer than those who don’t exercise regularly.
Take the first step
Ready to get more active? Great. Just remember to start with small steps. If you’ve been inactive for a long time or if you have a chronic health condition, get your doctor’s OK before you start. When you’re ready to begin exercising, start slowly. You might walk five minutes in the morning and five minutes in the evening. The next day, add a few minutes to each walking session. Pick up the pace a bit, too. Soon, you could be walking briskly for at least 30 minutes a day and reaping all the benefits of regular aerobic activity. Other options for aerobic exercise could include cross-country skiing, aerobic dancing, swimming, stair climbing, bicycling, jogging, elliptical training or rowing. If you have a condition that limits your ability to participate in aerobic activities, ask your doctor about alternatives. If you have arthritis, for example, aquatic exercises may give you the benefits of aerobic activity without stressing your joints. June 2014 I FUTURE MEDICINE 61
Social Health
Trapped in the Net About 42% of online adults use multiple social networking sites. The majority of the users are under the age of 30 although the number of older users is on the rise. A look at how does this behaviour affect our physical and mental health By FM Bureau
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n 1971, the first email was delivered. More than 40 years on, social media has taken the world by storm. Social networking sites, such as Facebook and Twitter, are now used by 1 in 4 people worldwide. Such activity may seem harmless, but some researchers suggest social media may affect our mental health and well-being. But are such claims exaggerated? A look at whether we should limit our use of social media. In essence, social media defines an array of Internet sites that enable people from all over the world to interact. This can be through discussion, photos, video and audio. Facebook is the leading social networking site, with more than 1.2 billion global active users every month. The site’s popularity is followed closely by MySpace, Twitter, LinkedIn and Bebo. The latest statistics show that around 42% of online adults use multiple social networking sites. Perhaps not surprisingly, the majority of social media users are under the age of 30, although the number of older users is on
the rise. Around 45% of Internet users aged 65 or older now use Facebook, increasing from 35% in 2012. But what attracts us to social media? Of course, one of the main attractions for connecting to the Internet was, and still is, the ability to better connect with the world around us. For example, the Internet allowed us to send emails as an alternative to the timely process of sending letters through the mail. Social media has built on this premise. This is Facebook’s mission statement: “Facebook’s mission is to give people the power to share and make the world more open and connected. People use Facebook to stay connected with friends and family, to discover what’s going on in the world, and to share and express what matters to them.” This sums up what the majority of social networking sites endeavour to achieve, and there is no doubt that the general public has succumbed to the world of social media, perhaps a little too much.
In essence, social media defines an array of Internet sites that enable people from all over the world to interact. This can be through discussion, photos, video and audio. Facebook is the leading social networking site, with more than 1.2 billion global active users every month
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Social Health
Social media addiction
We all have our own reasons for using social media. Some of us like to browse at other people’s status updates and photos, while others use the sites as a way to vent their emotions. But according to Dr Shannon M Rauch of Benedictine University at Mesa, AZ, one of the main reasons we use social media is for selfdistraction and boredom relief. “Therefore, social media is delivering reinforcement every time a person logs on,” she says. What is interesting is that the researchers found that people who are more anxious and socially insecure are more likely to use the social networking site. A research team, led by Dar Meshi of the Freie Universität in Germany, found that individuals who gained positive feedback
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about themselves on Facebook showed stronger activity in the nucleus accumbens of the brain - a region associated with “reward” processing. This stronger activity correlated with greater Facebook use. From these studies, it appears that many users who are addicted to Facebook use the site as a way of gaining attention and boosting their self-esteem. But can this behaviour have negative effects on mental health and wellbeing?
Negative impact
In 2012, Anxiety UK conducted a survey on social media use and its effects on emotions. The survey found that 53% of participants said social media sites had changed their behaviour while 51% of these said the change had been negative. Those who said their lives had been worsened by using social media also
A research team, led by Dar Meshi of the Freie Universität in Germany, found that individuals who gained positive feedback about themselves on Facebook showed stronger activity in the nucleus accumbens of the brain - a region associated with “reward” processing. This stronger activity correlated with greater Facebook use
reported feeling less confident when they compared their achievements against their friends. Another study found that social interaction on social media sites, specifically Facebook, may have a negative impact on face-to-face encounters for individuals who already have high levels of anxiety. Another concern regarding social media use is cyber bullying. The majority of social networking users are under the age of 30, and most of these are adolescents. According to Enough is Enough (EIE), an organisation that aims to make Internet use safer for children and families, 95% of teenagers who use social media have
witnessed forms of cyberbullying on social networking sites and 33% have been victims of cyber bullying. Could Facebook to improve mental health? Although many studies point to the negative impacts of social media on mental health and well-being, some researchers say they could have the opposite effect. Social networking sites could be a useful tool in identifying individuals with mental health issues. Overall, it appears that the exact effects of social media on our mental health and well-being remain to be seen. But one thing is certain that our use of social networking sites is unlikely to fade anytime soon.
According to Enough is Enough (EIE), an organisation that aims to make Internet use safer for children and families, 95% of teenagers who use social media have witnessed forms of cyberbullying on social networking sites and 33% have been victims of cyber bullying
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Surgeon’s Diary (A new column– From the Surgeon’s Diary- is introduced with this issue of Future Medicine. It could be a medically significant incident in the life of a surgeon, be it a unique surgery or the survival of a patient against all odds. It could also be an eye-opener to all of us as the instances described here by the surgeons are about the endearing faith and undying human spirit as well as remarkable skills of surgeons/caretakers.)
Dr Arun Oommen
He came back from the brink Abhimon, 26 years Chakkana Thunikarthil Aroor near Kochi Kerala -688 534 Ph- 9995362554
O
n that ill-fated night, Abhimon was crossing the road when a
speeding SUV banged at him leaving him in a comatose state with a severe head injury. He had profuse internal bleeding in his brain with a fracture skull. After initial resuscitative measures, he underwent urgent surgery for stopping the profuse bleeding and for removing
the clot within the skull. His brain was badly damaged and swollen, so one side of his skull was removed for giving space for the swollen brain and also for better care and assessment by the neurosurgeons. The removed skull piece was placed in the abdomen. He was in a very critical state in coma and ventilator support for around three weeks. Fortunately for
everyone’s surprise, he started recovering and was removed from the ventilator but he had severe memory loss and paralysis on one side of his body. He had to be fed through gastric tube. With intensive care and rehabilitation at Lakeshore Hospital in Kochi, Abhimon was recovering gradually. He started moving his limbs and his memory started regaining. His skull defect
was later corrected using the bone piece which was kept in the abdomen. Now Abhimon has started walking on his own, regained almost full memory- all these were attained after three months of intensive care and rehabilitation. He is now keen to resume his old job as a welder. All these happened due to the intense determination of Abhimon and his caretakers. June 2014 I FUTURE MEDICINE 67
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Special Story
Space Health
Sunita Williams
THE GREAT SPACE ODYSSEY
Sunita Williams revels in the sun’s bright light while floating outside the International Space Station. The image was taken during a spacewalk to finish repairs on a vital power unit on Sept. 5,2012. The photo shows Williams, in a spacesuit, appearing to grab the sun with her right hand during a break from space station repairs. Her crewmate Akihiko Hoshide, of the Japan Aerospace Exploration Agency, snapped the spacewalk photo during a rest break
US astronaut of Indian descent, Sunita Williams,who travelled 195 days to reach her space abode and spent almost one year there in two missions unravels the mysteries of living in space in an email interview facilitated by NASA to Sumithra Sathyan, Co-ordinating Editor of Future Medicine 2014 IMEDICINE FUTURE MEDICINE 71 March 2014 June I FUTURE 71
Special Story
S
Space Health
unita Williams, the second woman of Indian origin to have been selected by NASA for a space mission after Kalpna Chawla. She holds three records for female space Travellers, longest space flight (195 days) number of space walks (four) and total time spent on space walks (29 hours and 17 minutes). Sunita Williams is an American citizen of Indian origin. She was born on 19th September 1965 at EuclidOhio in the US. Her parents Deepak Pandya and Bonnie Pandya reside in Falmouth, Massachusetts. Dr. Deepak Pandya is a famous neuroanatomist. Williams’s roots on her father’s side go back to Gujarat in India and she has been to India to visit her father’s family in 2007. She is married to Michael Williams. American Space Agency NASA selected Sunita Williams in June 1998 and her training was started in August 1998. During the training she developed the skills in technical briefings Physiological training and preparing for T 38 flight training, as well as learning water and wilderness survival techniques. In 2008, Williams was designated as NASA’s Deputy Chief of the Astronaut Office, and has served in that role through her most recent mission back to space.
“If you are worried about your weight, then space is not a bad place to be, with the lack of gravity. But fitness is another thing, for while astronauts must be in peak condition when they leave planet Earth, it is quite tough to train in space when nothing offers resistance On July 15, 2012, she launched aboard the Russian spacecraft Soyuz TMA-05M from the Baikonur Cosmodrome as a part of Expedition 32. Two days later, the spacecraft docked with the ISS for a four month stay. In September, Williams became the Commander of Expedition 33, making her the second woman to ever hold that role. During that same month, she performed her sixth spacewalk, regaining her record for most spacewalks performed by a woman. She also became the first person to do a triathlon in space, after completing the Nautica Malibu Triathlon. While the main event was held in Southern California, Williams used the ISS treadmill, stationary bike, and the Advanced Resistive Exercise Device to complete exercises that equaled swimming in microgravity.
The interview When you work outside the Space Station would you float away if you let go? There will be a total change in the daily routine of an astronaut in space, such as a change in the sleep-wake schedules, In fact, can you sleep at all on the spaceship or whether you have to keep awake throughout your stay. Considering sleep is a must for any being on earth to maintain body balance and
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strength, how will a sleepless or irregular sleep affect your health? We have a safety tether that is a line of wire that holds us to the structure of the ISS. We also have cloth tethers and a rigid tether which we use when we need to let go and use both hands for some work we are performing. If the wire tether broke for some reason and we weren’t holding on we could float away pretty easily. In that case we have a SAFER (Simplified Aid for EVA Rescue), which is like a little jet pack on our backs that we can use to fly ourselves back to the ISS. Although we are trained to use it, we try very hard not to get into a situation where we would have to. We sleep in sleep stations. These are little rooms that each of us have. They are like the size of a refrigerator. In there we have our personal items and a sleeping bag. The sleeping bag is tied to the wall so we don’t float all over the place. We usually try to sleep about 8 hours. We are on Greenwich Mean Time usually. What do you eat? What is your favourite space food? If you fall sick, for some reasons, what are the effective measures to meet such a situation? We have food from both the U.S. and Russia. It comes in a couple different packages. Some of it we re-hydrate, some of it is in cans, and some of it just needs to be heated up. There are all sorts of foods, from lasagna to chicken with peanut sauce to lamb with vegetables or fish with seasoning. We also have all kinds of vegetables, but again they are not fresh. Usually they need to be re-hydrated. Dessert comes in all shapes and sizes, from dried fruit, to cookies, to candy, berry cobbler and brownies.Our food is half Russian and half American. Some of it is dehydratedand some of it is ready to eat. All we really do it hydrate food and heat it up.All of this type of food is in a package and just needs to be heated up in the oven. There is a lot of variety even in the desserts which include things like candy, pudding, fruit cocktail and cookies. On the Russian side we have beef, lamb, chicken and rice or potatoes in a can usually. The cans just need to be heated and then we eat right out of them.The food is generally bland so we have bottles of sauces to spice it up, like hot sauce andsoy sauce.
Why did you want to be an astronaut?
O
h, becoming an astronaut for me was a little bit of happenstance. You know, it’s interesting, some people have since they were a little, little kid, that’s all they wanted to do was be an astronaut; well, I never thought it was possible. I mean, I grew up in a family with a, a dad who immigrated from a, India, and my mother who was an X-ray technician in a hospital, they, met each other when he was going through residency and there was nothing in my past that had lended itself to anything, that had to do with space except for watching “The Jetsons” and “Star Trek” and stuff when I was little. So I never thought it was possible. I mean, it just wasn’t a topic in our, in our household, it was more about, you know, medicine—I loved animals, I wanted to be a vet, veterinarian—and then my brother went to the Naval Academy, my sister went to Smith College, and I’m lookin’—I’m the youngest one—I’m looking after that, what would, what would I want to do? And my brother was, of course, pursuing engineering, my sister was biochemistry, and I was thinking, biochemistry seems way too hard for me, so, the plans of being a veterinarian were sort of put on the side as my brother, talked me into going to the Naval Academy, and he did because I like outdoorsy things and he knew he could hook me with that. He said, Suni, you get to jump out of airplanes and do parachuting and go camping and stuff like that, and I was like, oh, OK. And so I sort of fell into that and I think I’m just as stubborn as my parents and my brother and sister where when we start something we really don’t like to, quit in the middle of it. I was I ended up being a helicopter pilot and had the opportunity to go to Test Pilot School, and that was the, the very first time it even dawned on me that,
that, you know, this was a pathway to be an astronaut ’cause we are able to come down to Johnson Space Center for a tour as our Test Pilot School class did every, once a year, and here I met John Young for the first time who talked about landing on the moon and talked about used a vertical landing system to land on the moon—oh, that sounds like helicopters so, I thought, wow, maybe I have what it takes to be an astronaut if I get my master’s degree.
I grew up in a family with a, a dad who immigrated from India, and my mother who was an X-ray technician in a hospital.There was nothing in my past that had lended itself to anything, that had to do with space except for watching “The Jetsons” and “Star Trek” and stuff when I was little.
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Special Story
Space Health
How does the digestive system function? For the digestive system, it takes a while to feel hungry. The food is floating around in the stomach so you don’t get that feeling of an empty stomach until your stomach muscles adapt to push the food down into the intestines. This takes a while - maybe a week or so. ikewise, it takes a while for your intestines to learn to really push the food through since nothing is pushing the food down and through. But those muscles adapt too and your body knows when it is time to get rid of the excess. During prolonged missions, how do astronauts maintain their body fitness, considering the space they have to live is small and microgravity? We have 3 types of exercise equipment up here. A treadmill, a bicycle, and a weight lifting machine. They all have a way to hold us down on the machine. The treadmill uses bungees and a harness. We are clipped in the bicycle using the pedals you see on racing bikes. The weights are actually rubber cords that we pull to stretch through a machine connected to a harness we wear. The equipment and exercises are necessary so that we can stimulate our muscles and bones particularly in our legs. We don’t do any walking up here so our legs don’t get much exercise. If we didn’t do anything, our bones and muscles would deteriorate because we don’t need them here. The body realises this and starts to adapt by not using energy to build muscle and bone in these areas. This is fine for living in microgravity, but will be bad for when we come back to Earth or when you future explorers land on the moon and Mars. You will need to be able to walk around!
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It is hard to understand just how adapted we are to gravity and how everything our body does is based on living in a gravity environment. What is really amazing is how well the human body can figure out what it needs to do to adapt and it does. The human body is an incredible machine, so take care of yours
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Special Story
Space Health
We work in T-shirts and shorts, but sometimes need a sweatshirt. Outside the temperature varies quite a bit. There is no atmosphere to speak of to protect us from temperatures outside which range from about -200 to +200 degrees
It is reported that astronauts in microgravity usually lose their sense of direction and feel uncoordinated or clumsy and it takes time for the human brain to adjust to the new terms of life in space. Could you give some details about the condition and how they overcome this situation? Just like the muscles and bones, the body starts to adapt! Fluid shifts since gravity is not keeping it down. For example, most astronauts look like their heads have swelled up a bit once on orbit. That is the fluid shift keeping more fluid in your upper body since it doesn’t have gravity pulling it down. Likewise, our hearts may not be working as hard because they don’t have to pull the blood up from the lower extremities of our legs. It is hard to understand just how adapted we are to gravity and how everything our body does is based on living in a gravity environment. What is really amazing is how well the human body can figure out what it needs to do to adapt and it does. The human body is an incredible machine, so take care of yours. What can you see in space from the Space Station? Asteroids? Garbage? Exploding stars? What is the temperature where you are? Is it hot or cold? Well, we aren’t that much closer to those things than you are. We are only about 200-250 miles above the Earth. So, we just see things a little clearer than you do on Earth because we have no atmosphere up here to blur the view. We can see the darkness of space pretty clearly and the thin layer of our atmosphere that protects our planet from space. It is nice inside the Space Station. The temperature is usually around 75 degrees F. We work in T-shirts and shorts, but sometimes need a sweatshirt. Outside the temperature varies quite a bit. There is no atmosphere to speak of to protect us from temperatures outside which range from about -200 to +200 degrees F. There is thermal shielding on the Station as well as on the space suits to keep us the right temperature. Do you have to change the clocks in your computers to match up with those on Earth, because time goes slower for you when you are going so fast? How do you know if it’s day or night? We work off of Greenwich Mean Time. But there is a difference in our time versus the ground time. That is because we get our time from GPS. Since these are satellites, their time does drift, so there is actually about 14 seconds difference between the time onboard and that on the ground. That difference has grown throughout the 7 years life of this Station, so it isn’t too much. Unfortunately, I don’t think I am getting any younger up here even though we are travelling at approximately 17,500 mph. It keeps changing. In our one-day of 24 hours, there are 16 sunrises and sunsets. In an orbit we see 45 minutes of daylight and 45 minutes of night approximately. We have windows so we can see if it is daylight or night outside. Our day is really just dictated by time. For example, right now we get up at 02:00 GMT and go to sleep at 17:30 GMT.
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Sunita Williams with father Deepak Pandya in New York
People on earth take breaks in between their work. Since there is only one work schedule in space, I presume, how do you manage it? We do take some breaks out there. We take a little rest and take pictures, or just take a break. The work isn’t strenuous all the time, just at times. Moving around is really pretty effortless. When you are trying to move something, like a valve or manipulate a tool, that can be difficult. We have a tethers and a semi rigid ball-stack, we call a BRT, body restraint tether. So, if we do get tired of holding on, we put one of these tethers on to the surface of the Station and then can let go. The tethers work very well to hold us in place so we don’t have to spend the effort doing so.The EVAs count as exercise time and I would agree it is a physical activity. I was pretty tired after each of my EVAs. I don’t think it is like lifting weights or sprinting the entire time. It is more like a marathon, so you just get tired after a while. An astronaut faces a long-term isolation from his/her family and friends. He is forced to live in close quarters with other astronauts, There is literally no mobility, life is rather monotonous and the only thing what he/she can watch is the earth. How will he/she overcome such a situation? we have videoconferences with our families every couple weeks. We also have a phone up here that works when we are in contact with certain satellites. So we can call home every orbit for about 15minutes. What did you miss the most from Earth? My family, my dog (Gorby), and dunking cookies in milk. June 2014 I FUTURE MEDICINE 77
BEAUTY SPOT
Model Lifestyle Actress Aavaana who hails from Mumbai.Recently made an impressive debut in the Malayalam film industry with the movie Medulla Obalankatta. Already she has a couple of projects in her kitty.
.....................Diet.......................
Breakfast Begins her day with a balanced breakfast which includes a cup of cereal with milk and seasonal fruits.
Lunch Being a Bengali, she loves to eat fish curry and a cup of rice along with dal and salad.
Dinner One chappati with chicken or fish curry
Snacks Every two or three hours she takes nuts or fruit/fruit juice
...............Beauty tips.................
Drink plenty of water and tender coconut water. Workout is very important along with diet. Use sunscreen and cover face with scarf to avoid sunlight. Most important thing is to visualise yourself being happy and healthy. Engage yourself in activities that make you happy. Your inner happiness reflects on your face.
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