APPI Annual Convention Book 2006 (excerpt) by John D. Elliott

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CONTENTS Leadership

COMMITTEE CHAIRS, COORDINATORS, OFFICERS, BOARD, DIRECTORS

. . . 6–11

Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Messages . . . . . . . . . . . . . . . . . . . . . . . . 14–25 Welcome to Atlanta . . . . . . . . . . . . . . . . . . . . .

u Developments and News . . . . . . . . . . . . . . . . 39–52 u Reflections and Perspectives . . . . . . . . . . . . . . 53–88 u Medical and Health . . . . . . . . . . . . . . . . . . 89–138 u Our Universe:

MOTIVATION, PRACTICE, FINANCE, COMMUNITY, ESSAYS

. . 139–207

Author Biographies . . . . . . . . . . . . . . . . . . . 210–213 Article References . . . . . . . . . . . . . . . . . . . 214–216

Final Essays . . . . . . . . . . . . . . . . . . . . . . . . 218

2006 CONVENTION COMMITTEE

2 0 0 6 C O N V E N T I O N S TAT E C O O R D I N AT O R S

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EXECUTIVE DIRECTOR

REGIONAL DIRECTORS

2006 CONVENTION BOOK EDITORS Savitha Shama, MD John Elliott S.G. (Nik) Nikam, MD

Brian Maddox

Anil Khosla Region 3–NW Central

PUBLISHER Millennium Communications, Inc. Duluth, Georgia www.mcicom.com

Kiran H. Shah Region 4–SW Central

CREATIVE DIRECTOR John Elliott

Ashok M. Fulambarker Region 5–NE Central

Amit Chakrabarty Region 6-SE Central

COURTESIES: Sree Shama (cover model); Raj Pandya, MD; Beena Patel, MD; Somesh Karanjee; Sujit Basu (physician models), Abha Karanjee; Deepti Basu; Danielle Williams, Brooke Rankin (patient models)

Kirit R. Vaidya Region 7–New England

Gopal Reddy Gade Region 1–Pacific Jagannath Surpure Region 2–Mountain

Jagan N. Pahuja Region 8–Mid Atlantic

Pulipaka B. Rao Region 10–South

Ram Trehan Region 9–South Atlantic

President~~ S. Balasubramaniam

President-Elect~~ Hemant Patel, MD Vice President~~ Sanku Rao, MD

Secretary~~ Vinod Shah, MD

Treasurer~~ Ajeet Singhvi, MD

Pacific~ ~ Mountain~ ~ NW Central~ ~ SW Central~ ~ NE Central~ ~ SE Central~ ~ New England~~ Mid Atlantic~~ South Atlantic~~ South~ ~

Manish Mehta, MD Chair: J. S. Srao, MD Ram Upadhyay, MD Anil Khosla, MD Members: Jayesh Shah, MD Rita Ahuja, MD Narendra Kumar, MD Rita Frenchman, MD Jyotin Chandarana, MD Sunita Kanumury, MD Prasad Srinivasan, MD Sudeep Kukreja, MD Satish Anand, MD Arun K. Pramanik, MD Suresh K. Gupta, MD Dayan Naik, MD Gogi Ramappa, MD Jayesh Kanuga, MD Rajendra Gupta, MD AAPI

Views and opinions expressed by authors are their own and do not necessarily reflect the opinions of the editors or of AAPI. Information in this publication is not necessarily endorsed by AAPI, nor any industry standard, nor as a recommendation to be adopted by or applied to any member of this association. All efforts have been made to reflect accuracy of contents and any errors or omissions are unintentional.

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2006-7 CONVENTION COMMITTEE Regional Directors Board of Trustees Executive Committee

EDITORIAL

Insights and Reflections

Your Convention Book Holds a Significant Message My heartiest welcome to all of you attending the 24th AAPI Annual Convention! By taking time out of your busy lives, you are showing your passion and fellowship for AAPI, while furthering your learning. On behalf of AAPI, I’d also like to thank all the dignitaries for their messages of support and encouragement. And, as you have just read, our distinguished AAPI leaders have shared valuable information and updates of interest to all.

worldwide, the clinical studies on women’s health issues that has influenced our practice of medicine, the worldwide challenges of malaria and tuberculosis and advances in cancer and genetics.

The purpose of this souvenir book is to capture the essence of the convention and offer insights into the mission and membership of AAPI. The response for our call for articles was overwhelming and authors of varying breadth and depth of experience have graciously contributed to this effort.

In the Universe section our authors have touched upon genuine happiness, leadership roles, career, business, money matters, community service and even the lighter side of you. Read about public service through political involvement and future mission for our organization. Learn some valuable tips to get rid of your techno-phobia and discover how technology can be a key for your business success.

When you look into this book, you’ll see not only your reflections, but a glimpse into the future....

Often there is a longing to just practice medicine. In this Universe section, you’ll explore outsourcing business operations and even your very job! This section also tackles money matters and gives good insight into some important risk management strategies

We are proud of all the volunteer organizations and the individuals for their great spirit of giving. Their services epitomize the saying,“When people share their fears with you, share your courage with them.” Rounding out the Universe section, you’ll hear from community-minded authors who share their touching experiences, and also a bit of the lighter side. My sincere thanks to all the AAPI leaders, dignitaries, authors, sponsors, supportive committee members, staff, and assistant editors for their kindness and support. A special thanks to our publishing team members for their creativity, dedication, and for a job well done! And, as always, I’m thankful for the love of my children and husband, who take pride in my work. Putting together this souvenir book was far more than challenging for me! I quickly realized how much discipline and time it required. I had to polish my organizational capabilities, email skills, and communication style. I learned to work at hours that were separate from patient care and family time, burning the midnight oil. The part that kept me going was the sheer satisfaction and fun in accomplishing this. When we were inundated with things to do, our motivation was the old adage, “The best preparation for tomorrow is to do today’s work superbly well. In the end, if nothing else, my typing speed has tripled…now I type with three fingers. Sincerely,

In the Medical section, you’ll read about the dual challenges of diabetes and heart disease that we of Indian origin are facing. The projected statistics is alarming and calls for a concerted, aggressive, and relentless effort to change this trend. Further on in the section, authors have rightly keyed in on other major global health issues such as cancers that affect women

As the cover photo implies, when you look into this book, you’ll see not only your reflections, but a glimpse into the future for our group and profession. You’ll also find a few details about our host city, Atlanta–including its humorous side. We’ve organized all of the materials into four major sections. After you read some of the important news in our Developments section, you’ll enjoy our Reflections section–by and about you, our members and supporters. The articles in this area are about achievements, brotherhood across borders, adapting to changes, inspirations from our role models, dilemmas of medical ethics and the tragedy of an illnesses when it hits close to home. If you think that you are ready to slow down from your non-stop practice, read the authors’ fascinating perspectives on staying healthy and active. And let us not forget to have some fun with what we love–food! Rather, I mean cooking.

We all realize health is not just the absence of illness but the holistic scope of body, mind, and spirit. We are fortunate to have our roots in a culture that has a trove of knowledge about ancient healing methods, so read on as our authors give great insight into how we can incorporate our traditional ways of healing into modern medicine and expand health to its greater meaning.

like proactive asset protection, alternative disability insurance plans, cutting costs of your health insurance premiums and estate planning. Still have cash left? The last thing you want to experience is investment errors, so you’ll profit from some helpful hints from a nationally acclaimed columnist.

Savitha Shama, MD Internal Medicine

AAPI

WELCOME TO…

Atlanta has been dubbed everything from the “capital of the new South” and “the next international city” to “the best place to do business,” and of course, “Hotlanta”. It’s a great place to visit for even a short time. Fueled by the prosperity of local mega companies like Coca-Cola and Holiday Inn, the prestige of hosting the 1996 Summer Olympic Games and the energy of young upwardly mobile types who have migrated to the city in droves, Atlanta is on fire. (Not something to say a hundred years ago, however, given its Civil War trauma). This time the heat’s a good thing: from worldclass restaurants and a myriad of cultural attractions to a hip nightlife and sporting events galore, the city is cosmopolitan in every sense of the word. But Atlanta has also managed to maintain its historic character. Stop by the Atlanta History Center or visit the Martin Luther King Jr. Historical Site, a moving tribute to an American icon. Browse through the former home of famous author Margaret Mitchell or pop into the Jimmy Carter Library and Museum for details on the life and times of one of the most popular former presidents. Whether you choose modern urban endeavors or old southern pleasures, Atlanta will not disappoint. Here is just a sampling of some of the diverse and unique attractions you you’ll enjoy in the area.

Atlanta Botanical Garden features several distinct exhibit areas. The Fuqua Conservatory is a giant greenhouse enclosing different climate-controlled ecosystems. The steamy Tropical Rotunda features colossal-leafed plant life and towering rubber trees. Visitors feels like they are in a real rainforest. Outdoors, there are numerous paths to guide guests through planned nature walks. The influence of Japanese architecture is evident throughout, and quiet spots to sit and absorb the beauty of the landscape are abundant. Children are special guests at the Botanical Gardens. An interactive “kid’s space” is scheduled to be completed in 1999. Atlanta Cyclorama & Civil War Museum. In the 1880s, before there were epic motion pictures, there were Cycloramas. This 42-foot-high cylindrical oil painting depicts the Battle of Atlanta in 1864. Viewed from a 360-degree rotating platform, the vivid details of this historic Civil War battle are now restored and enhanced with music, narration and sound effects. Accompanying the Cyclorama is the Civil War Museum, highlighted by a steam locomotive from 1862. Atlanta History Center Museum. Life in Atlanta, the South, and the military are the focus of this museum, which also highlights materials native to Georgia, with a floor of heart pine and polished

Stone Mountain granite. Displays are provocative, juxtaposing Gone With the Wind romanticism with the grim reality of Ku Klux Klan racism.

there’s always plenty to do, especially in the summer. You can have a splashing good time in and out of the water at Robin Lake Beach.

APEX Museum, located in the Sweet Auburn area of downtown Atlanta, the APEX (African-American Panoramic Experience) Museum serves as a gateway to the Martin Luther King, Jr. National Historic District. The small but growing museum, housed in a beautifully restored 1910 building, chronicles the history of Sweet Auburn and offers changing exhibits on African Americans.

Centennial Olympic Park, a clean and well-maintained space, featuring a decorative mosaic of grass-green patches and various geometric shapes composed in red brick. The Quilt of Remembrance, a memorial to those killed by the bomb planted here during the 1996 Olympics, is the most notable of the park’s many artistic adornments. Every day at noon sharp jets of water suddenly burst from the six rings of an Olympic logo in a beautiful water display that includes programmed music.

Auburn Avenue Research Library, an amazing $10 million facility dedicated to African-American research. Be sure to check out the free lecture series, exhibits, and cultural events. Big Bethel African Methodist Episcopal Church, home to one of the oldest Black congregations in the United States. The original church, built in the 1890s, was destroyed by fire in 1920. Today’s building, constructed in 1924, has recently undergone a $1.8 million renovation. Callaway Gardens, a stunning 13,000acre resort and gardens, offers the perfect setting for a memorable summer family vacation, quick getaway, social or corporate event, or day trip. A variety of special events fills the calendar all year long so

Center for Puppetry Arts, a 22-yearold center which prides itself on being the largest organization in the US devoted to puppetry. The center offers puppetry classes, daily performances by center puppeteers and various companies, along with a great interactive museum that includes figures like the Muppets. Château Élan Winery, within the sweeping panorama of the north Georgia foothills, just 40 minutes north of Atlanta but a world away from the bustling city is Château Élan. On 3,500 acres, French provincial and southern hospitality combine to produce a superb leisure destination.

Hot lanta!

– Continued next page >

PHOTOGRAPHY: JOHN ELLIOTT (3, 4); GEORGIA ECONDEV AGENCY (BACKGROUND, 1, 6, 8); CHATEAU ELAN (7)

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Hotlanta! CNN Center, the global headquarters of the CNN News and also an entertainment-shopping-dining-hotel extravaganza. The crown jewel of the Center is the CNN Studios tour, a must-see for an impressive behind-the-scenes look at global news in the making. Fox Theatre, known as The “Fabulous Fox,” has had many close encounters during its lifetime. It originated as a mosque and movie house in the 1920s, but fell into financial difficulty during the Great Depression, and thrived again until the early 70s, when it struggled and was threatened by destruction until Atlanta Landmarks took over in 1976. Today, it is a majestic performance and special event venue, as well as a movie house in the summer. Georgia Aquarium, one of the area’s newest attractions, this facility houses hundreds of species of fish, taken from waters around the world. The exterior of the building was designed to look like a giant ship breaking through a wave. As guests enter the huge atrium inside the building, they will be led into the facility by “a wall of fish” guiding them inside. They then have the choice of entering five galleries. Located near Centennial Park, near downtown. Hammonds House, Georgia’s only independent fine art museum dedicated to presenting art by peoples of African descent. The museum houses an extraordinary collection of Haitian and African tribal art and serves as a resource center for Black artists worldwide. High Museum of Art, Atlanta, a stunning, porcelain-enameled building was designed by famed architect Richard Meier and is rivaled only by the art inside. Featuring American, European and African art, as well as decorative art and photography, the High Museum

boasts a permanent collection of over 11,000 pieces, many of which can be viewed from different levels of the four-story, glass atrium. Features a permanent gallery that you can visit anytime, as well as acclaimed feature exhibits such as Norman Rockwell, Picasso, and Pop Art. Jimmy Carter Library and Museum, the only presidential library in the southeast United States, honors the early life, political career, and presidency of Jimmy Carter. Museum open to the public 7 days; designed for a relaxed, leisurely visit. Enjoy a 30 minute historical film on the Presidency, visit the Oval Office and enjoy an exact replica of the beautiful Crown of St. Stephen, a gift from the people of Hungary. Ongoing and temporary exhibits are offered. Kennesaw Mountain National Park commemorates the 1864 Civil War battle for Atlanta. Union forces under General Sherman assaulted the heavily fortified Confederate positions on Kennesaw, losing more than 5,000 men. Eventually, Confederate forces retreated in defeat. Today, the park encloses 2,882 acres of protected land and boasts 16 miles of hiking trails. Lake Lanier Islands, a resort and waterpark spread across 1,200 acres, with numerous hotels, golf courses, boat rentals. The biggest attraction is the waterpark, featuring water-slide rides, a king-size wave pool, a mile and a half of white sandy beach, volleyball, live music and DJs. Martin Luther King Jr. Center for Nonviolent Social Change continues King’s work, holding workshops on famine and illiteracy, providing day care for needy families, and teaching nonviolent leadership skills. The Exhibition Hall houses King’s Bible and clerical robe, the Grammy Award he won for his “Why I Oppose the War in Vietnam” speech, and a replica of the Nobel Peace

Prize he won in 1964. The key to his Memphis motel room where he was assassinated in April 4, 1968, is also on display here. One of the Center’s most moving sites is King’s white marble crypt, which rests on a five-tiered reflecting pool in Freedom Plaza. The tomb is inscribed with his words: “Free at Last. Free at Last. Thank God Almighty I’m Free at Last.” An eternal flame, symbolizing the continuing efforts to realize King’s dream, burns nearby. Start at the visitor center and then work your way around the three main sites in this historic park: the home in which the leader of the Civil Rights movement in America was born, the church where he preached and the memorial site where he is buried. A major Atlanta attraction, the park draws some 500,000 visitors each year.

baseball team play in the newly built Phillips Arena.

Piedmont Park, now the center of outdoor and recreational activities in Atlanta, where virtually any game or activity imaginable can be found here. Piedmont also hosts various statuary and memorials that bear witness to the city’s history.

Sweet Auburn district. A walk down Auburn Avenue is one of the best history lessons Atlanta has to offer. The opportunities available in this Black residential and business district, even in the face of Atlanta’s segregation laws, inspired political leader John Wesley Dobbs to nickname the area “Sweet Auburn.”

Shrine of the Black Madonna Bookstore and Cultural Center, with a mission to transform the spiritual emptiness, economic powerlessness and social disorganization that the church believes has plagued the Black community. Six Flags Over Georgia, located a half-hour from downton, Six Flags offers hours of breathtaking fun. You can ride any of the eight roller coasters, catch a show at one of the performance venues, play games for prizes, or enjoy a meal in the shade. Sports venues. With so many winning sports teams in Atlanta, it’s hard to choose, but you’ll always find a game worth watching! The Atlanta Braves play at Turner Field, while the Falcons inhabit the 80,000-seat Georgia Dome, and the Thrashers hockey team and Hawks

T ’ N O D YOU LOVE ATLANTA?

Stone Mountain Park, located 20 minutes outside of Atlanta, and features a three-acre sculpture of Confederate leaders etched into the mountainside. Stone Mountain also has a restored Antebellum Plantation, featuring 18th and 19th century colonial mansions, slave cabins (the area was a haven for racism until recently), coach houses, and barns. The Park’s 3,200 acres contain numerous lakes, hiking trails, paved recreational paths, and a 1.3 mile climb to the top of Stone Mountain. From the top one can see Atlanta’s modern skyline and the nearby Appalachians. There are also a wildlife preserve and petting zoo operates year round. Finally, there is a nightly laser show that recreates historical events.

Underground Atlanta, a favorite attraction throughout the southern USA, Underground is known for its specialty shops, eateries, and special events such as the Midday Jazz Excursion and the annual Open Air Market. World of Coca-Cola, a popular Atlanta attraction, this tribute to the world-famous sugar drink, born a century ago in a local Atlanta pharmacy, fills three stories with everything you ever wanted to know about Coca-Cola, including its origins and connection with cocaine. A spectacular collection of memorabilia, entertaining, hands-on exhibits and video presentations as well as unlimited samples in many flavors await you.

AAPI

Culled from various sources Cartoons by Fitzroy James

The only way to get out of downtown Atlanta is to turn around and start over when you reach Greenville, South Carolina.

All directions start with, “Go down Peachtree” and include the phrase, “When you see the Waffle House.” Except, that in Cobb County, where all directions begin with, “Go to the Big Chicken.” If you ask anyone for directions, they will always send you down Peachtree. Peachtree Street has no beginning and no end and is not to be confused with: Peachtree Circle, Peachtree Battle, Peachtree Place, Peachtree Corners, Peachtree Lane, New Peachtree, Peachtree Road, Old Peachtree, Peachtree Parkway, West Peachtree, Peachtree Run, Peachtree-Dunwoody, Peachtree Terrace, Peachtree-Chamblee, Peachtree Avenue, Peachtree Industrial Boulevard, Peachtree Commons, or any other of the 55 streets that start with Peachtree. Also, once the road you’re on crosses another road, the name of the road you’re on changes. Some roads names change every half mile or so. Atlantans only know their way to work and their way home. Atlanta is the home of Coca-Cola. Coke’s all they drink there, so don’t ask for any other soft drink unless it’s made by Coca-Cola.

PHOTOGRAPHY: GEORGIA DEPARTMENT OF ECONOMIC DEVELOPMENT (1); JOHN ELLIOTT (2, 3, 4)

< Continued from previous page

days and it’s on all the channels as a news flash every 15 minutes for a week. Overnight, all grocery stores will be sold out of milk, bread, bottled water, toilet paper, and beer.

I-285, the loop that encircles Atlanta, which has a posted speed limit of 55 mph (but you have to maintain 80 mph just to keep from getting run over), is known to truckers as “The Watermelon 500.” Don’t believe the directional markers on highways. I-285 is marked “East” and “West” but you may be going North or South. The locals identify the direction by referring to the “Inner Loop” and the “Outer Loop.” If you travel on Hwy 92 North, you will actually be going southeast. Never buy a ladder or mattress in Atlanta. Just go to one of the interstates and you will soon find one in the middle of the road. The last thing you want to do is give another driver the finger, unless your car is armored, your trigger finger is itchy and your AK-47 has a full clip.

The gates at Atlanta’s Hartsfield-Jackson International Airport are about 32 miles away from the Main Concourse, so wear sneakers and pack a lunch.

Possums sleep in the middle of the road with their feet in the air.

The 8 a.m. rush hour is from 6:30 to 10:30 AM. The 5 PM rush hour is from 3:00 to 7:30 PM. Friday’s rush hour starts Thursday afternoon and lasts through 2 AM Saturday.

There are 10,000 types of spiders. All 10,000 live in Georgia, plus a couple no one has seen before.

Only a native can pronounce Ponce De Leon Avenue, so do not attempt the Spanish pronunciation. People will simply tilt their heads to the right and stare at you. The Atlanta pronunciation is “pawntz duh LEE-awn.” And yes, they have a street named simply, “Boulevard.” The falling of one raindrop causes all drivers to immediately forget all traffic rules. If a single snowflake falls, the city is paralyzed for three

2006

There are 5,000 types of snakes and 4,998 live in Georgia.

If it grows, it sticks. If it crawls, it bites. If you notice a vine trying to wrap itself around your leg, you have about 20 seconds to escape, before you are completely captured and covered with Kudzu, another ill-advised “import,” like the carp, starling, English sparrow, and other “exotic wonders.” It’s not a shopping cart, it’s a buggy. “Fixinto” is one word (I’m fixinto go to the store). Sweet Tea is appropriate for all meals and you start drinking it when you’re 2 years old. “Jeet?” is actually a phrase meaning “Did you eat?”

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A good Financial Advisor never clocks out. Markets close but the process of watching, evaluating and discerning never ceases. For us at Smith Barney, helping build your wealth is an unending process. The goal is not a number. The goal is a tireless work ethic that doesn’t wax and wane with market conditions. These are the reasons I work at Smith Barney. To discuss how I can work with you, please call me at (800) 825-5334 Ext. 2246 or (585) 389-2246.

© 2006 Citigroup Global Markets Inc. Member SIPC. Smith Barney is a division and service mark of Citigroup Global Markets Inc. and its affiliates and is used and registered throughout the world. CITIGROUP and the Umbrella Device are trademarks and service marks of Citigroup Inc. or its affiliates and are used and registered throughout the world.

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Developments

REPORTS

AAPI–Where Next? Sarala A. Rao, MD Chair, AAPI Board of Trustees.

Aristotle, Nichomachean Ethics

Our Greetings to all AAPI members and potential members from the team on the AAPI Board of Trustees. We are delighted to have you all here to attend the most eagerly anticipated event of the year, our annual convention. You have all made an excellent and wise decision to come with your family and friends. There is no better opportunity to meet fellow physicians, get acquainted with new members, reëstablish contact with our former colleagues and partners in AAPI and at the same time enjoy the wide variety of services and entertainment offered here. The hard work and dedication of our superb convention committee– so ably captained by Dr. Naresh Parikh and his dedicated team of physicians, their families and friends from the Atlanta region–have made this possible. I am sure you will agree with me that they deserve a big round of applause for their unrelenting effort, the results of which are all here for us to view and enjoy. How do you think all this came about? It sure did not happen overnight by magic! Our past leaders have played a prominent and important role in laying the foundation. Each year since its inception a team has been formed, consisting mostly of local physician leaders, ably supported by the AAPI main office and the President and Executive Committee of AAPI. They planned events–each one more elaborate and innovative than the previous one–improved on the process, considered what the membership desired in such a meeting to make it unique to our Indian culture and values; that is how the establishment of a family friendly meeting and convention evolved. Since in many of our other professional activities we leave our families behind, this is one occasion where we have attempted to combine our professional activities during the day with entertainment and extra curricular activities for the spouses and children in the evenings. Very important governance issues and Continuing Medical Education activities are the mainstay during the morning hours. In all of this we have partnered with our industry partners to provide useful information on a wide variety of topics such as financial planning, women’s issues–both health related as well as career-life-balance issues– a fashion show which is of interest to everyone, and separate children’s and young adult activities. We are grateful to our industry partners for their support and encouragement in formulating these plans and making it a big part of AAPI,

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to help make it a grand success. I urge all of you to go around the exhibit halls, visit the various booths, ask questions of the staff manning the booths and express your appreciation to them for their enthusiastic participation in these AAPI events. The evenings of course are for dining, dancing, singing, relaxation and having fun with friends and family. This is the most eagerly anticipated segment of the event. What does all this have to do with the board of trustees, you may ask? It is not an obscure group, segregated in a corner, agonizing over how to cross the t’s and dot the i’s and make life difficult and intolerable for everyone else despite what you may have heard and/or imagined! It is a dynamic group of AAPI members elected to a staggered term of three years and they form one of four pillars of AAPI responsible for governance issues. If everything is going along merrily according to the rules and regulations that are laid out in our bylaws, their existence is not indeed very noticeable. Human nature being what it is, however, questions of conflicts of interest or conformity with the written bylaws or questions of commission or omission seem to be always lurking behind the scenes. As part of the system of checks and balances promulgated in the AAPI Constitution, the Board of Trustees is charged with an oversight function to ensure the system of checks and balances are functioning as they are supposed to. They are also charged with the responsibility of management and oversight of the Patron Fund, an endowment fund created about 15 years ago to safeguard the funds collected from all the patron members of AAPI. They are responsible to ensure appropriate use of funds, investment strategy and ongoing growth of AAPI. They may also be called upon to mediate conflicts or differences of opinion among AAPI members. It is my pleasant duty at this time to inform all of you that all nine members of our team worked together to formulate a prudent, mild-to-moderate risk category of investment, with a profile of growth and income. In this we were ably supported and helped by our financial advisor and planner, Mathew Lapides of Merrill Lynch. The other very happy news I have the privilege of presenting to all of you is the purchase of an office condominium in Oakbrook, Illinois. This was accomplished via the use of funds from the Patron Fund. We are extremely thankful to the members of the task force created for this purpose by our President, Dr.Vijay Koli, Dr. Jagan Ailinani, who headed the force, and some prominent physician leaders from the local chapter. They worked very hard and fast to identify the location of an appropriate piece of property which met our needs and helped complete the deal. In late February we were able to move in and had a well attended “Open House” function to inaugurate our new home on March 11. All of us on the Board

of Trustees are extremely thankful to the entire membership of AAPI for their outpouring of support and encouragement in this endeavor. I want to leave you with a few thoughts and reflections on the role of AAPI members in the day-to -day affairs of our organization which we all love so dearly. All of us need to remember and remind ourselves and our fellow members that this is not an easy job and it does not run itself on auto pilot. It is highly complex, needs tremendous participation and input from all quarters, working in collaboration with each other in a manner that our future membership and leaders are proud of us. It is serious business and we are a professional organization facing our share of highs and lows. We are only as good as our membership is and only as strong as our numbers are. If you see someone sitting on the sidelines and Monday morning quarterbacking, do prod them into getting involved. It is the responsibility of the entire membership to stay informed about the rules of governance. How else can you be aware of things going alright or not? It is wishful thinking to assume that everything is going fine always and there is harmony and progress unimpeded by controversies. If this ever truly comes about, you can bet that someone or no one is thinking at all about what is going on. Differences of opinion do crop up on occasion. This is when the role of membership is crucial. All of us have to be alert. Express your opinion. Get involved in constructive engagement. Be vocal and advocate on behalf of the entire membership. Use E-mail productively by addressing your concerns to the appropriate AAPI leadership. Write letters to the editor of the AAPI Journal. Ask questions on the AAPIGRAM. Avoid going directly to the media before you even let anyone in AAPI know what your grievances are. You risk being trivialized your self as well as the organization when that happens–hardly a useful choice for members of a professional organization like ours! Lastly, if you had a good time, enjoyed the events and want to return for these and other AAPI events, go out and tell your fellow physician friends and colleagues; be our ambassadors, sign up hoards of new members and be an active participant in AAPI Governance and AAPI Affairs. Rome wasn’t built in a day nor is any organization that is strong, benevolent and long lasting. So go out and have fun but don’t forget to come back next year for our Grand Silver Jubilee Celebrations! Join us in double the numbers! After all, with 42,000 members of physicians of Indian Origin out there by last count, we have lots of room to grow! With your help we’ll make it happen!

“Coming together is a beginning. Keeping together is progress. Working together is success.” –Henry Ford

It is possible to fail in many ways…while to succeed is possible only in one way.

Best Wishes

Developments

REPORTS

AAPI Charitable Foundation

From

Drs. Prakash & Usha Desai

“This is the gist of all worship: to be pure and to do good to others. He who sees the Lord in the poor, in the weak, and in the diseased really worships Shiva. Great work requires great and persistent effort for a long time.” – Swami Vivekananda

This is what AAPI Charitable Foundation has been doing for the last fifteen years. AAPI Charitable Foundation has provided continuous and necessary care for the sick and destitute through its fifteen clinics in rural and deprived areas throughout India. We also provide preventative immuniza-

Are you an Indian or of Indian origin living in the United States and are older than 18 years of age? You are invited to participate in an research study being conducted at Emory University named Sleep and Heart in Asian Indians(SAHAI). This study seeks to explore the potential relation between obstructive sleep apnea and cardiovascular illness in Asian Indians. Your particpation takes about 15 minutes of your time filling an online survey instrument from the comfort of your home. The information you give will be stored in a HIPA-compliant database at Emory University.

2005 tsunami flooding in India (Andra Pradesh)

tions, eye camps, fixtures for the disabled, and other services to almost a million people. This year, we have inaugurated two more clinics in Andhra Pradesh: Jagtial at Karimnagar and Kaali AAPI Rural Clinic. They continue to hold camps and provide HIV care.

For details: Please contact Srinivas Bhadriraju, MD (PI) sbhadr2@emory.edu

AAPI Charitable has participated whenever and wherever calamity has struck, whether in India or the United States. We have raised more than fifty thouAAPI

2006

sand dollars for Katrina and given fifty-five thousand dollars for tsunami reconstruction. We have also built five hospitals: a trauma hospital in Latur, Maharashtra and four hospitals in Gujarat in collaboration with other NGOs. We have not only contributed financially, but have also conducted fieldwork for administering care in these disasters.

2005 Katrina flooding in New Orleans, USA (St. Bernard Parish)

The following is a list of the clinics throughout India: Durganagar, Jammu Gurgaon, Haryana Jagtial, Andhra Pradesh Proddatur, Andhra Pradesh Jigni, Karnataka Sambalpur, Orissa Ammanpettai, Tamil Nadu Visnagar, Gujarat Mandi, Himachal Pradesh Worli, Bombay Indore, Madhya Pradesh Kaali, Andhra Pradesh Kartarpur, Punjab Rozda, Rajasthan Hospet, Karnataka

We would like to open one clinic in each state in India. As it is, our annual budget is $180,000 and requires constant attention for collection. We also want to engage in other preventative programs in India, but our efforts are hampered due to lack of funds. You may laugh or wonder what we are trying to achieve in a country of over a billion people with over five lakhs of villages.

To this, I would respond with a tale from the Ramayana. When the great bridge was being built across the sea to Lanka, a host of animals came. Monkeys, bears, and other large beasts lifted huge stones for construction. One little squirrel was also in their midst, transferring dirt within the stones to hold the bridge together. The other animals laughed at what they perceived to be its insignificance. Lord Rama picked up the squirrel and admonished them saying that this squirrel does more than its share, a remarkable lesson for all to learn. If we can all join together to give back to our people in India, we too can be like the squirrel. A hundred dollars per person can go a long way. Please contact any of the following for further information: Dr. Krishan K. Aggarwal 304.723.2825 Dr. Shashi S. Shah 516.365.4853 Dr. H.N. Ramaprakash 260.432.1973 Dr. Brahma N. Sharma 412.682.2100

Reflections I N S I G H T S

AAPI

•

C O M M E N T A R Y

•

O P I N I O N

Reflections

“Aathi Sarvathra Varjayathe”

Best Wishes

Denounce Things That Are Extreme

from

By Raghuveer Halkar, MD A gentleman in his late seventies was sitting next to me in one of my recent airline travels.

THE

ADMINISTRATION

It turned out that he is a retired radiologist who had started a group practice which is now being managed by his son. I just could not resist and asked him, “Tell me what you think has changed in the practice of medicine that bothers you”. He said, “These days there is no incentive for group fidelity!”

SMITH NORTHVIEW HOSPITAL VALDOSTA, GEORGIA

Now I saw what he was driving at. The partners are not very much committed to the group and they can move to any other group and quickly receive the same pay and benefits. We hear about this in the business world often, as high rate of employee turnover. Lack of fidelity is one major cause of employee turnover. But this lack of fidelity has also become pervasive in our greater society as well. In “olden days,” a person worked all his or her life for one company and the company in turn promised lifetime employment. The life of a company or an

institution was certainly longer than the work life of an individual. The worker became a stake holder in the company, his future and wellbeing depended on that of the company. Presently, the life of companies has become shorter than the life of a worker. The take over phenomenon continually changes the company’s mission and vision. Workers are no longer stake holders in a company; they are at best share holders. Few have allegiance to the same company and companies also do not offer nor promise life time employment. Fidelity is treated as weakness. What is fidelity or lack of it? Basically it amounts to change.

Change is the only constant in life. Most of us do not like changes and we often resist them. –Continued next page

Seeking clarification, I asked him, “What does that mean?” He said “Young man” (probably to flatter me), “when I ran the group every

one had to work five to ten years to be a partner, started at a low salary, and only reached a senior salary after ten years. Now, in two or three years, they are full partners and there is hardly any difference in pay between senior and junior.”

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2006

Reflections active lifestyle is conducive to a long, functional life span. Observational data suggests that benefits are maximized if one can gradually move into less stressful avocation and hobbies by age sixty. The transition can be difficult. So we need to plan early.

Aathi Sarvathra

– Continued from previous page. Changes are inevitable in life. An MBA friend of mine has a different outlook toward employee turnover. He thinks it has some positive aspects: it brings new ideas and new way of things. Changes bring challenges, but they also bring new opportunities and people who are able to use these opportunities to their advantage are often the successful ones. We–the Indian community that has migrated to USA–have adopted well. Practice of medicine was physician-centric 30–50 years ago, when physicians were on the top of the pyramid. Now physicians are just middle-level blocks in the pyramid and healthcare is becoming managed care or group/ institution-centric. I hope eventually it will turn into patient-centric.

“End does not justify means” and “It is the path you tread and not the heights you reach”; growing up in India I was fed and raised on these lines. But I knew better. I had heard what Kenneth Galbraith (considered one of 20th century America’s most famous economists) had said: “Everything is fiscal and in the long run all of us are dead.”

I knew very early in life that, only for the winner, winning did not matter. Growing up in India had taught me that history is written by the victor. My mentor in Kuwait often reminded me, “Life is complex and the purpose of all learning is to make it simple”. I worked there for a nationalized health program. There was a turf battle too–a different one. Everyone wanted to keep their turf as small as possible. Now I am here in USA and I am told to make things complex and make them not too profitable lest some

We have accepted most changes quite well. I am not talking about the changes in how we dress, eat or drink. That is often easy. The changes we have to make in attitudes and personal philosophies are the most difficult ones.

It is clear that if we stay physically and mentally active, most of us can expect to live well into our 80s. How can we stay physically and mentally active? As we gain more control of our worldly lives, we are offered a smorgasbord of options. We can pursue leisure activities, attain spiritual goals or nurture grandchildren, just to name a few. Certainly, after decades of hard and stressful work, after playing musical chairs all our lives, we are entitled to do whatever we can afford to do. We need to take time to enjoy life.

one may take it away from us. We want as large a turf as possible. “Don’t give a fish to a hungry person, but teach him how to fish,” we were told. Now I know that if I give him a fish he will come back again and I am in control. Teach him how to fish and soon he will be my competition. After all there are only so many fishes in the sea. These are the few examples of difference in attitudes and philosophies, which I had to adapt to in my new life in USA. Have I changed? Yes. But I often think I have created a blend of old and new values. I have no problems with changes. The issue often is the rate of change and amount of change. Too rapid and too much of a change amount to revolution. Probably what we all wish for is an evolution and not a revolution. The Sanskrit quote “Aathi Sarvathra Varjayathe” comes to my mind. It is better to shun anything that is extreme. –About the author, page 215

The Challenge To Stay Challenged By M. Vinayak Kamath MD Not since the ancient Huguenots has the world seen as successful a migration as that of Indians to the United States in the last half century. More impressively, all indications are that the second generation is going to reach even greater heights and be a force to reckon with in terms of their intellectual, financial and geopolitical clout. We can take a bow! But what is the future? As we learn to counter, treat and prevent cardiovascular and metabolic diseases, the kaleidoscope shifts to looming problems of dementia, Alzheimer’s and arthritis. Numerous studies have concluded that a simple and

AAPI

The fact remains, however, that unless we are challenged, we do not achieve –a fact as true at age seven as it is at age seventy. It is not in our own best interest not to be challenged. The goal is find activities that are stimulating and satisfying but not stressful. But wait. Is it all about us only? Is it all about a mechanical, pleasure filled existence? Is it all about bagichay ki seva and afternoon chai? Our success, in large parts, is due to our education in India (practically free) and the opportunities that were offered to us in the United States (opportunities not available anywhere else in the world).

We need to consider our larger obligations to society as well when we plan our future. We have much to offer, even in areas outside our chosen profession. So look around, opportunities abound. I can think of no nobler way of staying physically and intellectually fit and yet helping others at the same time. Done right, it is a lot of fun too. Most of us have altruistic links to our motherland. But history tells us that we will be richly rewarded if we pay particular attention to our responsibilities towards our adopted land, especially since our future lies here within these Unites States. History also tells us, repeatedly, of the dangers of not doing so. So plan early, enjoy a long life and leave a mark. Future generations will thank you. –About the author, pages 210-213

POETRY

HUMOR

The First Dance By Monita Soni

It was a very snowy weekend The children were tumbling in the soft blanket Making angel wings with there arms Eyes sparkling with glee Snowflakes clinging avidly

The teacher recited as the children came on stage Yato Hasta Stato Drushti Yato Drushti Stato Manha Yato Manha Stato Bhava Yato Bhava Stato Rasaha

I called her indoors, to drape the saree It was her first dance performance The rich navy and pink kanchipuram Her long deep auburn hair Braided with jasmine flowers

Keep the song in your throat Let your hands tell the story Your glance follow the gestures Let your mind be in sync with your eyes This will create the right expression............ For the audience to experience the rasaha

The lipstick was easy but licked away In a moment, the eye make-up Took some time, the result Was stunning, but not to Her taste, tears welled, ready to flow

I do not know if it was the loving teacher Or the devout innocent students But the effect of the first dance Was tremendous The little girls with black kohled eyes Danced their way into our hearts The angels in the snow made magic........

After some deft corrections and a Lot of reassurance, the maiden was Ready for her first dance I looked at her, and looked away My heart about to burst

Reflections

UNE

We’ve collected some interesting diagnoses from various medical records. The following are actual doctors’ notes written on patients’ charts.

DIT ED

1. Patient has chest pain if she lies on her left side for over a year. 2. On the 2nd day the knee was better and on the 3rd day it disappeared completely. 3. The patient has been depressed ever since she began seeing me in 1993. 4. The patient is tearful and crying constantly. She also appears to be depressed. 5. Patient’s past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days. 6. Discharge status: Alive but without permission.

Hands of India By John Elliott

7. Healthy appearing decrepit 69 year-old male mentally alert but forgetful. 8. I saw your patient today, who is still under our car for physical therapy.

You carry her on swaying hips; Heaving ox carts, cane and sticks. Burden raised, saree caught, Nostrils flared, choli taut; Fruits arranged for blessings bought.

From the haze, some can discern, Vestige of outrage parched throat burn: Ignore dacoit of baksheesh passed! Hawala severing veins outclassed: Bapuji’s karma nearly slashed.

Standing tall from your chore, Breath emerged from hidden store; Sweat upon hammer, brick upon stone; Mighty nation, yet so alone; One lakh of years your children shone.

But early morn sounds the bell, Clears the mind, so gods can smell, The scent of ninety crore garlands, Each so sweet, yet grains of sands, Impassioned prayers a goldenbird lands.

12. Between you and me, we ought to be able to get this lady pregnant.

Dark strands of Ganges braided tight, Mysterious eyes of Kashmir’s light; Soft lips are the temples below; Our trembling torches barely show, The majesty of forgotten glow.

We saw an India with outstretched hands; Proud soldiers marching, magnificent bands; Heroes welcomed from tortured roads; Sharing hosts, gourmets’ loads; Sonorous tabla; millennias’ odes.

16. Patient was alert and unresponsive.

Through samsara you emerge; Looking back, ahead you surge. Yes, Hind, you could have been, What you were in Bharat’s din: Yet ahimsa’s victory led a planet’s kin.

And to this land we will return; Its clasping hands shall we not spurn; The songs of India not denied; This brother, this sister have now replied: Memory of you we shall not hide.

9. The patient has no past history of suicides. 10. She is numb from her toes down. 11. Patient had waffles for breakfast and anorexia for lunch. 13. Patient has left his white blood cells at another hospital. 14. The skin was moist and dry. 15. Occasional, constant, infrequent headaches. 17. She stated that she had been constipated for most of her adult life, until she got a divorce. 18. The patient refused an autopsy. 19. The patient was to have a bowel resection. However, he took a job as a stockbroker instead. 20. Skin: Somewhat pale but present. 21. Patient was seen in consultation by Dr. Blank, who felt we should sit on the abdomen and I agree. 22. Large brown stool ambulating in the hall. 2006

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Visit our Booth at the AAPI 24th Annual Convention for a complete listing of products. AAPI

2006

Medical

TUBERCULOSIS: A TIME BOMB . By Mani Cheruvu, PhD and Satish Bhadriraju, M.D

Tuberculosis (TB) claims one person every fifteen seconds worldwide and one person every minute in India. Someone in the world is newly infected with TB bacilli every second. One third of the world’s population is already infected with TB bacillus. About 5-10% of these TB infected people not infected with human immunodeficiency virus (HIV), becomes sick or infectious at some point during their lifetime. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. This grave scenario is complicated by the emergence of multi-drug resistant (MDR) strains of the bacillus and its synergy with HIV. TB is a contagious disease spread through air, caused by bacteria called mycobacterium tuberculosis. . The bacteria usually attack lungs but can attack any part of the body such as kidney, spine, brain, etc. TB disease is curable and the most common medicines used to treat TB include first-line (isoniazid, rifampicin, ethambutol, pyrazinamide) and second-line (kanamycin, ofloxacin, ethionamide) drugs. Even with the availability of all these drugs, TB disease is far from under control, let alone eradicated. Numerous factors are attributed to this, with one of the most concerning ones being non-adherence of the patient to the 114

drug regimen. TB treatment usually lasts around 6-9 months. It is highly essential for the patient to adhere to the regimen until completion. Non-adherence can lead to disease progression in the patient and can have drastic implications in terms of development of drug resistant strains and their subsequent transmission in the community. The World Health Organization, in order to enhance patients’ adherence to drugs, recommends what is referred to as DOTS (Directly Observed Treatment, Short-course) as part of TB control programs in various nations. This is a mechanism in which someone accountable would help patients take the drug at the required time in their presence. DOTS has five components:

• Government commitment, • Case detection using sputum microscopy, • Standardized short-course chemotherapy , • Regular drug supply, and • Standardized monitoring and reporting system that allows assessment of individual patients as well as of overall program performance.

The goal of TB control in India is to reduce the chain of transmission by detecting at least 70% of all infectious TB cases in the community and curing at least 85% of these cases. The Revised National TB Control Program (RNTCP) in India, based on the principle of DOTS and on the strengths of a national TB program, was implemented in pilot areas in 1993. After initial testing, rapid scale-up of the RNTCP began in late 1998. Though RNTCP has had impresAAPI

sive achievements so far, sustaining and expanding the program in the context of a less developed socioeconomic environment is a major challenge. In addition, other detrimental factors with relevance to the Indian scenario include: sub-optimal primary health care system, a large and unregulated private health care system, and the dual threats of HIV and MDR-TB. Considering the operational constraints in achieving the goals of TB control in India and also the existing lacunae in knowledge, the focus of research in India has shifted to priority areas such as:

• Involving the private health sector in the DOTS program • Implementing patient-oriented treatment services • Reducing delays in diagnosis • Increasing the access to and utilization of TB services • Preventing and treating TB among HIV-infected persons • Preventing and treating MDR-TB • Increasing and sustaining political commitment to DOTS expansion • Developmental research in terms of newer diagnostic tools, drugs and vaccines, etc.

The essential role of non-governmental organizations (NGOs) in health promotion of the community has also been recognized. The Indian government has come out with five schemes for collaboration with NGOs and, to date, around 800 NGOs are officially providing RNTCP services. The other important area identified was an information, education and communication (IEC) campaign. IEC involves awareness generation among general population including self-reporting by symptomatic cases. IEC is a very important tool and the Central TB Division has already made considerable amount of IEC material available under RNTCP. India is a diverse and large country. Implementing, sustaining and widening DOTS in such a varied background to reach all sections of the society is a

By the time one would have gone through this article in about four minutes, the world has witnessed 16 deaths due to TB

The government of India has taken laudable steps in strengthening the TB control program by involving various segments of the society. Innovative schemes like Public-Private Mix (PPM) DOTS projects are being implemented throughout the country. Over 80 corporate sector units are involved in RNTCP. 2006

major challenge for India today. On the other hand, it should be noted that TB is a global disease, a disease without borders. To reiterate the fact that we are all sitting on a TB time bomb, it must be realized that by the time one would have gone through this article in about four minutes, the world has witnessed 16 deaths due to TB. Out of these, four deaths are from India alone. –About the authors, page 210-213

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By Hari Sharma, MD, FRCPC

Ayurveda is said to be as old

Ayurveda is a holistic system of

extensive materia medica describing

as humanity. It is knowledge that is

health care that deals with the whole

the therapeutic use of medicinal plants.

inherent in the laws that govern

life

range of life, from its origin in the

Ayurveda has as a goal the creation of

throughout the universe and a branch

deepest level of human consciousness–

perfect health for the individual rather

of a complete body of knowledge

pure consciousness–to its expressions

than simply the absence of disease.

known as Veda. This science of health

in mind, body, behavior, and the

was founded by the great seers of

environment.

is the reminder that the mind and con-

ancient India. Through their deep

uninterrupted oral tradition of clinical

sciousness exert a deep influence on

insight into the depths of nature s

knowledge

written

our physiology. If priority is given to

functioning, they came to know the

texts.

theoretical

the development of consciousness,

laws that govern our health and life.

framework

Thus the word Ayurveda means the

insights

science of life.

physiological

Ayurveda

predating

There

that into

also

has

the a

provides

valuable

psychological functioning,

and

The main contribution of Ayurveda

the physiology will have the greatest capability to resist disease by keeping – Continued on following page

Ayurvedic Nutrition Recommendations from Cooking Expert Dr. Sunanda Ranade

Food, sleep, and sex have sometimes been considered in India as the three pillars of humanity, with the most important being food. Good nutrition necessitates that the food be properly cooked, taken at a proper time, in a proper quantity that nourishes the body and mind. Prepared thus, the food enhances the growth of the tissues, deals well with the wear and tear of the tissues caused by our daily movements, and eliminates waste properly. According to traditional ayurveda, health requires an equilibrium of three energies, and well maintained Agni (digestive fire). This leads to happiness of soul, mind and maintenance of sensory organs. Fresh food grown organically contain more Prana (vital force), which provides even more energy. A variety of grains, vegetables, roots and beverages like pure water openly exposed to air and sun are the best, natural nutrition for humans. Many other foods are unnatural and may even act like foreign bodies if not properly assimilated in the stomach, quickly accumulating partially digested in excretory and other organs. When they cannot find their way out, they reside in the tissue crevices by law of gravitation (Ama) and, – Continued on page 121 sidebar

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AYURVEDA The Science Of Life

Medical

AYURVEDA Vata represents motion and flow. It is at the basis of all activity. Pitta represents bodily functions concerned with heat and metabolism. It directs all metabolic and catabolic activities, biochemical reactions, and the process of energy exchange. Kapha represents structure and cohesion of the organism. It is responsible for biological strength, natural tissue resistance, and proper body structure.

The Science Of Life

–Continued from Previous Page

aligned with the invincible forces of nature that created it. The technology for evolution of consciousness is meditation.

Ayurveda sees problems of health as being an imbalance in a person s individual physiological constitution. One s constitution is called one s Prakriti. If the Prakriti is out of balance, it creates Vikriti, the basis of disease. Ayurvedic physicians (Vaidyas) first look at their patients as whole human beings who are unique in their Prakriti. They then look at the Vikriti, or imbalance, that has occurred. Vaidyas then make recommendations for

The human constitution is made up of the combination of consciousness and matter. Matter is represented by Vata, Pitta, and Kapha. When the relationship of consciousness and Vata, Pitta, and Kapha is in balance, a state of total balance and perfect health is created. In Ayurveda, this state of health is known as Swastha, which means established in the Self, established in the wholeness of life.

restoring balance in the physiology, including dietary recommendations, nutritional supplements, and behavioral adjustments. In the Vedic texts, the five fundamental categories of matter and energy responsible for material creation are called panchamahabhutas. They are known as Akasha (space), Vayu (air), Tejas (fire), Apas (water), and Prithivi (earth). They are created as a result of the self-interacting dynamics of pure consciousness. The combination of panchamahabhutas results in formation of the three doshas, which are known as Vata (combination of space and air), Pitta (combination of fire and water), and Kapha (combination of water and earth). The doshas are fundamental, irreducible metabolic principles that govern the functioning of the entire body as well as the entire universe. These doshas are the connection between the human body and the universe on the material level.

Vata predisposes toward diseases of the nervous system, pain syndrome, cardiovascular illness, rheumatic disorders, constipation, anxiety, worries, and fear. Pitta predisposes toward ulcers of the alimentary tract and chronic inflammatory skin diseases, and is also responsible for anger, envy, and jealousy. Kapha predisposes toward diseases of the respiratory system, diseases of the kidneys, diabetes mellitus, obesity, hardening of the arteries, and tumors. It is also responsible for feelings of attachment and grief. The doshas are affected differently by the food eaten, the season of the year, the time of day, and so on. Ayurveda maintains that all approaches to health can be maximally effective only if appropriate dietary measures are instituted simultaneously to support the restoration of physiological balance. Ayurveda has no single diet that is purported to be suitable for all individuals and all situations. The prescription of diet is individualized, being based on the diagnosis of the individual s current dosha status and taking into account seasonal influences, the individual s age and digestive capacity,

Food contains packets of intelligence analyzed by taste. Ayurveda recommends that all six tastes be represented in each meal.

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any disease or imbalance present, sources and purity of food, and other factors. Digestion is also of prime importance in maintaining health. The end product of truly healthy diet and digestion is said to produce significant amounts of ojas. Ojas is said to be the most important biochemical substance

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mediating the influence of consciousness on the body. When present in abundance, ojas gives strength, immune strength, contentment, and good digestion. Inefficient digestion and metabolism, on the other hand, result in production of toxic material in the body called ama, the buildup of which results in disease. Proper dietary measures strengthen the digestive and metabolic fires known as Agni and eliminate impurities from the physiology. Agni is created by the three doshas and functions in different areas of the body to carry on metabolic activities. Agni converts the food in the body to help form the bodily tissues. It is well known that without the proper heat, food cannot be cooked. Similarly, inside the body, Agni or heat is generated in various tissues to give rise to the necessary chemical secretions, metabolic reactions, and functional processes associated with optimal digestion. Some aspects of diet emphasized in Ayurveda are taste and food qualities. The six tastes are sweet, sour, salty, pungent, bitter, and astringent. The taste of food is related to the properties of food. Food contains packets of intelligence analyzed by taste. Ayurveda recommends that all six tastes be represented in each meal. Ayurveda categorizes food according to six major food qualities: heavy, light, oily, dry, hot, and cold. Food qualities and taste also affect the doshas, so the proper combination is needed to maintain balance in the physiology. Which tastes and food qualities should predominate in the diet depends on the dosha status of the individual. Ayurveda includes detailed discussions of lifestyle and behavior and their impact on health. Behavior, speech, and emotions are important aspects of the human psyche that affect health. Emotions can be understood as fine fluctuations of consciousness; as such, their impact on the more expressed physical levels of the body is understood to be immense. Interestingly, traditional virtues such as respect for elders, teachers, loved ones, and family members; pardoning those who wrong you; practicing nonviolence; not speaking ill of others behind their back and so on, are understood to promote health for the individual s mind and body, as well as for the community and society as a whole. The input from the five senses–hearing, sight, touch, taste, and smell–creates changes in the physiology, and each experience is metabolized in its own way. When food is digested, assimilated, absorbed, and metabolized, the byproduct of metabolism affects our physiology. Similarly, the information from the different senses is metabolized and affects our behavior. Therefore, it is important to experience health-promoting input through –Continued on following page

2006

Medical

Ayurvedic Nutrition

– Continued from sidebar, page 119

becoming fermented, produce diseases affecting body and mind. This cycle leads to premature aging or even death. Natural food brings calmness to mind, clear understanding as well as a proper way of thinking. It helps you to find your healthy way. It also enhances the sattva guna of mind. Ayurveda has given emphasis on vegetarian food but same time explains properties of various types of meat and fish for treating diseases. This food being heavy in nature brings dullness to the mind; therefore one should not consider having the nonvegetarian food, especially who are accustomed to vegetarian food. The entire gastro-intestinal canal of the human, various digestive secretions that are poured for digestion, the length of the intestines, as well as structure of his oral cavity and the teeth are ideal for vegetarian food. Experiments also prove that non-irritant vegetarian food is admirably suitable for development of children physically and mentally. Food should be prepared in clean kitchen, ideally after the cook has recently bathed and is wearing fresh clothes. One should cook on low fire and steamed cooking is always best. Often, however, in this world the majority of the people are engaged with hectic activities and they may not have enough time to prepare proper food for themselves. Regarding the quantity (Rashi) of consumption, ayurveda says it depends upon one’s age, constitution, agni, country and the time of intake. You have to consider seasons also. Warm or cold food in summer and hot, slightly spicy foods in winter is beneficial. For proper digestion (Samyak Pachan) of food, breathing should be at ease and one should strive to feel light and happy. One should eat the food in a clean, calm place with cheerful surroundings. If appropriate, pray to the god and visualize that the food is going to nourish your body. Avoid too cold or too hot food, as it affects digestive capacity and lowers the digestive fire. Currently, many people prefer to take breakfast while driving the car, perhaps biting piece of baked goods or sipping coffee. But this also affects – Continued on following page

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AYURVEDA

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and body in tune with the functioning of the laws of nature. By promoting behavior in accord with natural law, these routines maintain the integrity of key biological rhythms.

The Science Of Life

–Continued from page 121

Ayurvedic pharmacology (called Dravyaguna) utilizes the synergistic cooperation of substances as they co-exist in natural sources. It uses either single plants, or more often, mixtures of plants whose effects are complementary. In terms of Ayurveda, the effectiveness of herbal mixtures may ultimately be explained by the idea that plants, especially herbs, are concentrated repositories of nature s intelligence which, when used properly, can increase the expression of that intelligence in the body. Special preparations known as Rasayanas promote longevity, stamina, immunity, and overall well-being.

each of the five senses to maintain balance in the physiology. Daily rhythms and seasonal rhythms also affect our psyche and physiology. The changes in the seasons are understood to create fundamental shifts in our biochemistry and metabolic style. Variations in sunlight, heat, cold, wind, and moisture are metabolized by the body. These variations in nature are

Adjusting one’s behavior to health-promoting daily and seasonal routines puts the mind and body in tune with the laws of nature.

Integrating Ayurveda into the current medical system holds great promise for the future of healthcare in the U.S. About the Author, page 210–213.

mirrored by variations in the human physiology. The seasons and time of day are classified according to the doshas. Thus, changes in the weather and the time of day affect the physiology of the body. This is seen in the predominance and manifestation of diseases due to Vata, Pitta, and Kapha during their respective seasons. For example, colds and respiratory problems are predominant in the springtime. This is Kapha season, and Kapha predisposes toward diseases of the respi-

Ayurvedic Nutrition – Continued from sidebar, page 121

the digestion, leading to diseases like hyper acidity. At a minimum you have to carve out 15 minutes for breakfast and 30 minutes for lunch & dinner each, to eat food peacefully which ultimately going to nourish your body.

ratory system. Also, when one season changes into another season, there is an accumulation of doshas. At this time, the likelihood of aggravation of the doshas, resulting in disease, is more likely. Ayurveda recommends daily and seasonal routines to maintain balance in the physiology. Adjusting one s behavior to health-promoting daily and seasonal routines puts the mind

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Never eat food sitting in front of TV, watching horror movies or while working on computer. These experience have a bad impact on digestive secretions. The mantra of this century seems to eat ready-to-cook, instant or fast food, all of which is full of preservatives, chemicals and artificial colors and result in diseases such as cancer. Enormous use of Teflon-coated utensils and disinfectants in the kitchen also leads to different diseases. Frozen, canned food having less life force in it is not useful at all. Our younger generation is victim of all this things. Hence we see many more diseases cropping up in our society. For well being of the human race, and for the maintenance of good health, it is better to follow the ayurvedic principles of food, its proper preparations and its effect on bodily energies. Charaka, wise and ancient sage, has said that those following all these principles live healthy, enjoyable and long life. About the Author, page 210–213.

AAPI

Ayurveda Into The Future

By Aparna Sundaram, MD

Indian culture’s current attraction stems from many sources. It is one of the world’s fastest growing economies. Many people who were once unfamiliar with all that India has to offer are now acquiring new knowledge of our beautiful motherland. The global marketplace is replete with images of Bollywood and fashion trends like bindis and kurtis. The IT industry and outsourcing are readily identified with locations such as Bangalore or High Tech City. There’s no question that India is at center stage in the present era of globalization. Even before this trend started, however, the influence of Indian culture was felt around the world. Marco Polo carried Indian spices back to Italy. Some of these spices included the same exotic flavors (e.g., cardamom) that go into making chai–now a household word and a top seller at Starbucks. Indeed, the saying that “everything old is new again” can also be seen in healthcare. Many people are opting for a simpler way of life, taking guidance from wisdom traditions such as those of the East. More and more people are becoming aware of Ayurveda, the world’s oldest system of healing. Ayurveda is a comprehensive system of health and lifestyle management that places great emphasis on self-care and harmonizing the interactions among the various systems that make up a person’s unique environment. A Google search of “Ayurveda” revealed 14,500,000 hits. Ayurveda’s use of natural remedies such as herbs has made it popular among both the lay and scientific communities. India’s native neem tree is making headlines for its antimicrobial powers. The benefits of haldi (turmeric) are being studied through NIH funding. In fact, the National Center for Complementary and Alternative Medicine has funded several studies on Ayurveda. In Arizona, for example, researchers are investigating the effects of ginger, turmeric, and boswellia on the treatment of inflammatory disorders such as arthritis. The Cleveland Clinic Foundation is studying a compound called cowhage to determine its potential to reduce or even prevent the often disabling side effects of treatment with conventional drugs for Parkinson’s disease. In addition to herbs, many Westerners’ palettes are also being influenced by Ayurveda. Much of traditional Indian cuisine is prepared according to the principles of this ancient science of life. Two examples of Ayurveda’s influence on our eating habits include 1) an emphasis on eating a variety of foods, particularly their taste and color and 2) vegetarianism. Ayurveda places importance on having all six tastes in a given meal. This combination benefits not only optimal physiological functioning by stimulating the taste buds and promoting digestion, but it also contributes to an optimal psycho-spiritual state of being that empow-

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ers the individual to make healthy choices in other areas of his or her life. India is over 80% vegetarian. Many cooking techniques date back to ancient times. The Atharva Veda, which is largely a treatise on Ayurvedic principles, classified foods according to sattvic, rajasic and tamasic qualities. In this system, meat was noted to be deplete energy, similar to overeating or consuming over-ripe foods; these foods were discouraged as they were not beneficial to the whole being which included mind, body and soul. Today, many people from around the world are choosing to become vegetarian. Reasons for this change include the health benefits of a plant-based diet over one that involves animal proteins (consumption of animal products have been linked to cancer and heart disease), spiritual and religious beliefs–such as the morality of killing animals, and economic and environmental considerations. In fact, the International Vegetarian Union will hold its annual convention in Goa this year to highlight India’s role in vegetarianism. Our knowledge of vegetarianism and healthful nutrition can be incorporated into our medical practices. For example, we can counsel patients to not only do certain Yoga asanas, but we can also provide a list of beneficial herbs and spices as well as healthful recipes. In this manner, we can assist patients to make informed–and very practical–decisions on lifestyle modifications. As both the population and the economy of India continue to grow, its contributions to the world will become increasingly more visible through continued exports of not only tangible products, but also of cultural insights. Those of us who have been in the US for many years have already witnessed the wave of change. Let us, as physicians of Indian origin practicing in the US, take advantage of our unique opportunity to serve not only as medical guides to our patients but also as cultural health ambassadors. We are at a momentous time in history. We are in a position to facilitate the ushering in of true integrative medicine by blending our roots in the East with our modern training and delivery methods of the West. We can serve as role models for both our patients and our families by exemplifying this integrated lifestyle approach in our own daily routines as well as in communications with others. As Mahatma Gandhi once said, “Be the change that you want to see in the world”. We have much to be proud of. Let us embrace our ancient traditions as they take us into the future. About the Author, page 210–213.

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Vegetarian Diets in Prevention and Treatment of Chronic Disease By Reed Mangels, PhD, RD, LDN and Sudha Raj, PhD, RD

A vegetarian does not eat meat, fish, or fowl or products containing these foods.1 Within the general category of vegetarianism, there are several sub-categories. Lacto-ovo vegetarians include dairy products and eggs while lacto vegetarians exclude eggs but include dairy products. Vegans exclude all animal products. Practitioners may also encounter individuals who describe themselves as “vegetarian” but who occasionally do include fish, poultry, and even meat in their diets. In most countries, vegetarians are only a small proportion of the population. For example, 2.5% of the US adult population consistently follows a vegetarian diet.2 India is exceptional in that perhaps as many as 35% of the population follows a traditional lacto or lacto-ovo vegetarian diet; vegan diets are very rarely practiced.3 However, vegetarian diets may not be maintained by some Asian Indians due to acculturative changes when they move to the United States.4 Studies of Vegetarians Studies of Seventh-day Adventists (SDA) have provided insights into the health effects of vegetarian diets. Close to half of the SDAs in the United States either follow a vegetarian diet or eat very limited amounts of meat. About one-fourth of SDAs consistently follow a lacto-ovo vegetarian diet; about 3% are vegan.5 Other large studies in the United Kingdom 6,7 and in other countries 8–10 have increased our knowledge of health effects of vegetarian diets. Cardiovascular Disease Vegetarians have been consistently shown to have lower rates of cardiovascular disease. For example,

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an analysis of five prospective studies involving more than 76,000 subjects found that vegetarian men had a 31% lower risk of mortality from ischemic heart disease than non-vegetarian men while vegetarian women had a 20% lower risk than non-vegetarian women.11 Vegetarians in Bangalore, India had a 20% lower risk of for myocardial infarction compared with non-vegetarians.10 Vegetarian SDA men have half the rate of fatal myocardial infarctions as do non-vegetarian SDA men and also have a lower risk of developing cardiovascular disease.12 Vegetarians’lowerserumcholesterolconcentrations can explain some of the differences in cardiovascular disease risk between vegetarians and nonvegetarians. A review of nine studies found that, in comparison to non-vegetarians, lacto-ovo vegetarians had 14% lower total cholesterol concentrations while vegans averaged 35% lower.13 Vegetarians also tend to have lower concentrations of LDL cholesterol, similar triglyceride concentrations, and may have lower HDL concentrations than non-vegetarians.1, 14 Elevated triglyceride concentrations reportedly seen in some vegetarians may be improved by partial substitution of carbohydrate with either protein or monounsaturated fat.15 The lower HDL levels seen in some vegetarians may be due to low intakes of dietary fat or alcohol.1 A number of factors in vegetarian diets positively affect cardiovascular disease risk. These include typically lower intakes of saturated fat and dietary cholesterol, higher intakes of fiber, soy products, vitamin C, vitamin E, and phytochemicals.1

Vegetarian diets particularly the lacto and lactoovo patterns can have high levels of saturated fats making them very similar to non-vegetarian dietary patterns.23 Sources of saturated fats in vegetarian diets include cheese, milk, ice cream, baked goods, butter, and eggs. Dietary counseling may be required to enable clients to reduce the saturated fat in their diets.

AAPI

vegetarian diet and a statin drug in reducing risk of coronary heart disease.26 An Indo-Mediterranean diet rich in whole grains, fruits, vegetables, and nuts was used in subjects who were at high risk for coronary artery disease. Some subjects were vegetarian while about a third ate meat once or twice a week. The subjects were compared to a control group consuming a diet similar to that recommended by the National Cholesterol Education Program (NCEP). The intervention group had fewer sudden cardiac deaths and heart attacks as well as lower blood pressure, and reduced blood cholesterol and LDL cholesterol levels.27 Cancer Consumption of meat, especially red meat and processed meat (ham, bacon, luncheon meats, etc.) has been repeatedly associated with increased risk of co-

A number of factors in vegetarian diets positively affect cardiovascular disease risk.

Vegetarian diets have been successfully used as interventions for cardiovascular disease. For example, Dean Ornish, MD, placed patients with moderate to severe coronary heart disease on a regimen that included a very-low-fat vegetarian diet, moderate aerobic exercise, smoking cessation, and stress reduction. Participants who followed the vegetarian diet and other lifestyle changes demonstrated a regression of coronary atherosclerosis while the control group had a progression of atherosclerosis and more than twice as many cardiac events.24,25 A near-vegan diet high in phytosterols, soluble fiber, and soy protein has been seen to be as effective as a lacto-ovo PHOTOGRAPHY : © 2006 JOHN ELLIOTT

The position of the American Dietetic Association and the Dietitians of Canada on vegetarian diets states, “Appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases.”1 This article will review the evidence for health benefits of vegetarian diets in disease prevention and treatment.

Possible negative effects of vegetarian diets include lower intakes of omega-3 fatty acids and higher homocysteine concentrations. Blood homocysteine levels have sometimes 16, 17 but not always predicted an increased risk of coronary heart disease.18 In vegetarians, elevated homocysteine levels appear to be due to poor vitamin B12 status 19–21 since both folate and pyridoxine levels are typically adequate in vegetarians.19,22 In addition, Asian Indians are more likely to have polymorphisms in the genes responsible for homocysteine metabolism21, thus further increasing risk of hyperhomocysteinemia. Vegetarians can be encouraged to seek out plant-based sources of omega-3 fatty acids and to use reliable sources of vitamin B12 in order to reduce these potential risk factors for cardiovascular disease.

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lon cancer.28–30 Not surprisingly, nonvegetarians have a higher risk for colorectal cancer than do vegetarians.12, 31 Meat consumption also appears to increase the risk of bladder 5, prostate 12, and pancreatic 32 cancer. One study of South Asian migrant women from the Indian subcontinent living in England found that women who ate the most meat had a greater risk of cancer than lifelong vegetarians.33 Vegetarians’ risk of lung, uterine, and stomach cancer does not appear to differ from non-vegetarians. Dairy products have been associated with an increased risk of prostate cancer.34 A low-fat vegetarian diet has been used in men with prostate cancer.35 After one year, PSA decreased 4 percent in the men on the vegetarian diet but increased 6 percent in controls. No members of the experimental group required conventional medical therapy after a year whereas six men in the control group had significant progression of the prostate cancer. The lower risk of cancer seen in vegetarians may be due to vegetarians’ higher intakes of fiber, dried beans, and fruits and vegetables. In addition, vegetarians tend to have a lower proportion of secondary bile acids in feces 36 and lower levels of fecal mutagens 37 while vegans have lower levels of serum insulin-like growth factor-I 38,39, all of which may offer significant protection against specific cancers. – Continued page 129

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Medical – Continued from page 127

Dr. Sudhakar Jonnalagadda

Hypertension Vegetarians tend to have lower blood pressure than non-vegetarians 1, 14. Vegetarians also tend to have a much lower incidence of hypertension, even when controlled for vegetarians’ lower body weights 40–42 . Non-vegetarians are almost three times as likely to have severe hypertension, requiring medication compared to vegetarians.5 Vegans tend to have the lowest blood pressure and the least hypertension, followed by lacto-ovo vegetarians and fish eaters.5

Clinical Assistant Professor, Division of Gastroenterology/Hepatology at the Medical College of Georgia Diplomat, American Board of Internal Medicine Board Certified in Gastroenterology Highly Specialized in Liver Diseases and Liver Transplant Medicine

State-of-the-art Endoscopy Center, utilizing the latest technology to screen for colon cancer, ulcer disease as well as diseases of the small bowel with capsule endoscopy.  Our staff are comprised of highly trained professionals, ensuring privacy and personalized care.

The lower blood pressures seen in vegetarians do not appear to be due to differences in BMI, exercise, dietary fat, fiber, potassium, sodium, magnesium, or calcium.1 Perhaps the lower glycemic index of vegetarian diets or a composite effect of many synergistic factors is responsible for the lower blood pressures seen in vegetarians.1 Vegetarian diets have been successfully used as treatment for high blood pressure.43 Type 2 Diabetes SDA vegetarian men and women have almost half the risk of developing type 2 diabetes when com-

Licensed by the state, 034-295 • Nationally Accredited by AAAHC

SDAs.12 Vegetarians have also been shown to have greater insulin sensitivity and lower blood glucose levels than non-vegetarians.44 Low-fat vegetarian diets have been used in the treatment of type 2 diabetes.45, 46 For example, more than one-third of the subjects who followed a vegetarian diet and who were being treated with insulin were able to discontinue insulin use.45 Similarly, close to three-quarters of those taking oral hypoglycemic agents were able to discontinue these medications.45 Serum cholesterol was reduced 22% and triglycerides were reduced 33% in those following a low-fat vegetarian diet.45 Obesity On average vegetarians are leaner than non-vegetarians.47 In a British study, overweight or obesity was twice as common in non-vegetarian men and 1.5 times more common in non-vegetarian women compared to vegetarians.48 In Sweden, middle-aged women who were vegan had a 65% lower risk of obesity than non-vegetarians; lactovegetarian women had a 46% lower risk.49 Vegan diets with 10% of calories from fat have been successfully used to promote weight loss 50, 51. Other Diseases Vegetarians are less likely to have diverticulitis than non-vegetarians 52 possibly because of their higher fiber intake. Even after controlling for obesity, gender, and age, non-vegetarians are more than twice as likely as vegetarians to suffer from gallstones.53 Vegetarians also appear to have a lower risk of rheumatoid arthritis and osteoarthritis.5 Meat consumption averaging 2.5 servings per day is associated with a relative risk of gout of 1.41 compared to meat consumption averaging 0.5 servings per day.54 Beef, pork, and lamb were all associated with an increased risk of gout.54

pared with non-vegetarians.12 British vegetarians are much less likely to die from diabetes compared to non-vegetarians.5 Vegetarians’ lower mean body mass index (BMI) and higher fiber intakes may explain part of the difference in incidence of type 2 diabetes. Even after adjustment for weight, however, vegetarian men still were at much lower risk for diabetes than were non-vegetarian men in a study of

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Summary

Vegetarians have lower rates of cardiovascular disease, colon and prostate cancer, hypertension, type 2 diabetes, and obesity than non-vegetarians. Numerous factors in vegetarian diets can account for these differences. Vegetarian diets have been successfully used in the treatment of cardiovascular disease, hypertension, diabetes, and obesity. References, Pg. 218; About the authors, page 210–213.

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Our Universe •

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M O T I V A T I O N • P R A C T I C E • F I N A N C E • C O M M U N I T Y • E S S A Y S •

•

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Live in the present, for it is the only moment you have. Keep your attention on what is here and now; look for the fullness in every moment. Accept what comes to you totally and completely so that you can appreciate it, learn from it, and then let it go. The present is as it should be. It reflects infinite laws of Nature that have brought you this exact thought, this exact physical response. This moment is as it is because the universe is as it is. Do not struggle against the infinite scheme of things; instead, be at one with it.

Listen to your body’s wisdom, which expresses itself through signals of comfort and discomfort. When choosing a certain behavior, ask your body, “How do you feel about this?” If your body sends a signal of physical or emotional distress, watch out. If your body sends a signal of comfort and eagerness, proceed.

DEEPAK Chopra

Relinquish your need for external approval. You alone are the judge of your worth, and your goal is to discover infinite worth in yourself, no matter what anyone else thinks. There is great freedom in this realization.

Shed the burden of judgment – you will feel much lighter. Judgment imposes right and wrong on situations that just are. Everything can be understood and forgiven, but when you judge, you cut off understanding and shut down the process of learning to love. In judging others, you reflect your lack of self-acceptance. Remember that every person you forgive adds to your self-love.

When you find yourself reacting with anger or opposition to any person or circumstance, realize that you are only struggling with yourself. Putting up resistance is the response of defenses created by old hurts. When you relinquish this anger, you will be healing yourself and cooperating with the flow of the universe.

Do not contaminate your body with toxins, either through food, drink, or toxic emotions. Your body is more than a life-support system. It is the vehicle that will carry you on the journey of your evolution. The health of every cell directly contributes to your state of well being, because every cell is a point of awareness within the field of awareness that is you.

–About the author, page 210-213

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Take time to be silent, to meditate, to quiet the internal dialogue. In moments of silence, realize that you are re-contacting your source of pure awareness. Pay attention to your inner life so that you can be guided by intuition rather than externally imposed interpretations of what is or isn’t good for you.

Replace fear-motivated behavior with lovemotivated behavior. Fear is the product of memory, which dwells in the past. Remembering what hurt us before, we direct our energies toward making certain that an old hurt will not repeat itself. However, trying to impose the past on the present will never wipe out the threat of being hurt. That happens only when you find the security of your own being, which is love. Motivated by the truth inside you, you can face any threat because your inner strength is invulnerable to fear.

AAPI

Know that the world “ out there” reflects your reality “in here.” The people you react to most s t r o n g l y, whether with love or hate, are projections of your inner world. What you most hate is what you most deny in yourself. What you most love is what you most wish for in yourself. Use the mirror of relationships to guide your evolution. The goal is total selfknowledge. When you achieve that, what you most want will automatically be there, and what you most dislike will disappear.

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Understand that the physical world is just a mirror of a deeper intelligence. Intelligence is the invisible organizer of all matter and energy, and since a portion of this intelligence resides in you, you share in the organizing power of the cosmos. Because you are inseparably linked to everything, you cannot afford to foul the planet’s air and water. But at a deeper level, you cannot afford to live with a toxic mind, because every thought makes an impression on the whole field of intelligence. Living in balance and purity is the highest good for you and the Earth.

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PHOTOGRAPHS COURESY AUTHOR

TEN KEYS TO HA PPINESS 10 3 2 1

Universe

THE PRACTICE

An Interview of Dr. K. Patel

YODA’S KEYS TO BUSINESS SUCCESS

Editors prologue: The following is an indepth interview of one of our esteemed AAPI members as conducted by Yoda. For readers who do not know his history, Yoda is one of the main characters in George Lucas’ sci-fi smash film series, “Star Wars”. A Jedi master, Yoda is a senior member of the Jedi Council and arguably the wisest in the Star Wars Universe. His unique background lends his interesting “Yoda speak”.

Yoda: A wise man on this planet they tell me you are, Dr. Patel. To you, people listen. Within these costly, risky times, please share with me, your friend and ally, Yoda, the secret of your health care business success. Dr. K: Ah, Yoda, you are too kind. I am more than happy to share my wisdom with you, but truthfully, it is no secret. You are correct, the cost of care continues to climb, but one only need look at the root of the problem and the solution will make itself apparent. Yoda: I must unlearn what I have learned. Apparent it is not. The cost of care soars out of this galaxy whilst reimbursement has plateaued, or worse yet, declined. Your secret, please share. Dr. K: My so-called secret is the use of technology and empowering the providers and patients to have greater responsibility in the care management. Yoda: Managed care? Something new, this is not. Deny care to cut costs and save money? Surprised to hear this, I am. Dr. K: Perhaps that is the perception of many, my friend, but quite the contrary. In this model, the mission is to assure providers render the most appropriate care. Care that is supported by guidelines and evidence-based medicine set forth by consensus of our health care

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industry’s experts, the equivalent of your Jedi council. This is not always the least expensive care option; rather, it is an emphasis placed upon providing the highest quality of care. This is my so-called “secret” you reference- we simply implement the correct tools and technology and the results follow: outcomes improve and, in turn, the cost of providing care decreases. It is not rocket science, my dear friend (laughs). It is long overdue… Yoda: Apologize, I must. Denied or withheld, care is not? How does one then save money?

Dr. K: Please let me clarify further. In managed care, as it typically exists today, health insurance companies take on financial risk and as such, they hold their purse strings very tightly. When a provider attempts to obtain health insurance approval to assure payment for costly tests or procedures, these companies scrutinize every detail to save pennies. The provider wastes countless unreimbursed hours attempting to prove the rationale for his or her decision, while the companies spend many healthcare dollars, dollars which could be better spent on the care they review, to render their denials. It is a lose-lose situation for the patient and the provider. This model has even ceased to prove profitable for the health insurance companies! It is a broken system at best.

point of care. By utilizing this technology, a group of providers, nurses and patients function as a combined entity with real time information to support the patient’s care and needs. This model of collaboration serves to reduce the need for third party intermediaries, such as disease management companies. In addition, the technology we incorporate into the EHR allows for physicians to reap higher revenues by more easily demonstrating improved HEDIS scores and pay-for-performance measures. These benefits have encouraged the providers we work with to adopt electronic health record technology at a rate which far supersedes the industry average which is between 10-20%.

sist physicians caring for complex patients. Every provider has the latest information available to him or her at the point-of-care, providing the keystone for the most effective, highest quality patient care. As you can see, my dear friend, it is not a secret, rather years of experience and looking at one’s tracks in the past to see the path to the future. Yoda: I should have known, Dr. Patel. Just as a Jedi knight, it is the future you see. Intriguing concept, I must say. You are a little old to join the Jedi, but a

force. Please know, my friend, you can call me any time. I will make myself available to you or anyone who would like to discuss my endeavors further. This is about working to-

Universe

gether for the survival and betterment of health care for all, it is not all about strategies or secrets… we should all work together. Yoda: Yes, yes, to Dr. Patel they will listen, and for good cause. Look to the past, we must, and the solution is made apparent. For your time and wisdom, kind sir, Yoda gives thanks. May the Force be with you always…..

Yoda: Your secret, that is? Dr. K: No, that is only a portion of the solution. We have applied this technology with providers in Management Services Organizations (MSOs). These are groups of providers banding together who assume some financial risk in the health care dollars spent; this serves as an additional incentive to spend healthcare dollars wisely and emphasizes quality of care to achieve the highest outcomes. Higher quality results in higher rewards. It is a win-win-win situation for all entities involved, patient, provider and payer.

Yoda: As I assumed. Your model differs, it does? Tell me more, you will?

Yoda: Always in motion is the future. You are truly one with the forces of healthcare!

Dr. K. I am happy to share. My model differs further in that it is a technology driven system of collaboration rather than separation. Our physicians adopt electronic health record (EHR) technology which brings them together with their patients and offers them greater control of the care they provide at the

Dr. K: But wait, I have not finished, my friend! The most exciting part I have yet to tell! Our MSOs and provider groups utilize innovative tools within the electronic health records and electronic medical records. We have embedded evidencebased chronic condition care treatment guidelines within the EHRs to as-

AAPI

friend of the Jedi you shall always be… Dr. K: Well, as I told you earlier, it is no secret, and it is certainly not rocket science, or should I say, “droid science.” (Both laugh) We need to look for new ways to improve our heath system. Denial of care is a path to the “Dark Side”. Keep abreast of technology, working smarter not harder. Focus upon quality of care and the provider-patient relationship and you will stay successful and one with the

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–About the author, page 210

Universe

Treatment For Acute Problems Infecting Medical Malpractice: Proactive Planning

penses, would be highly desirable to most medical practices.

By Benjamin Renzo, JD and Lalat Pattanaik

Medical practitioners understand that the greatest challenge facing their profession is escalating liability insurance premiums and the constant threat of being sued for medical malpractice. Popular recognition of the problems infecting medical malpractice is unmistakable and the statistics relating to this dilemma are sobering.

is able to establish an effective asset protection strategy, creditors are less likely to pursue frivolous litigation and proactively seek a settlement. Based on the Uniform Fraudulent Transfer Act (UFTA)

Proactively Planning for Statistical Inevitability

and fraudulent transfer laws it is imperative to plan in advance of any creditor claims and one must set forth a legitimate economic and business purpose as part of the asset protection strategy.

• Use of off shore or on shore family limited partnerships, irrevocable trusts, or other entities to transfer ownership and control of assets, and • Wage accounts in states where such accounts are protected for the head of the household.

The ability to use an asset, now, to generate immediate benefits without selling them off at a discount would be highly desirable to most medical practices

Due to capacity and cost issues, many physicians reduce or completely drop their malpractice coverage. Consequently, a daunting crisis arises when a malpractice judgment is issued in excess of a doctor’s malpractice coverage limits. Unlike non-professional business owners, a physician is also personally liable for all damages arising from his or her professional negligence. As a result, a physician’s personal assets and business assets could be liquidated to satisfy a malpractice judgment creditor. Thus, effective asset protection planning will deter creditors by either taking advantage of federal and state exemptions, stripping equity or creating legitimate, costly obstacles to satisfy the judgment. Assuming a physician

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Common Early Stage Planning Some commonly used asset protection strategies that a physician may (or should already) have in place are as follows (state law may vary with respect to the availability and effectiveness of the below strategies):

• Appropriately titled property (e.g. tenancy by the entirety/transfer to a spouse. Of course the spouse could get divorced or get sued resulting in additional problems), • Use of homestead exemption planning, • Use of life insurance and annuities– particularly in states where the values accumulated therein are considered exempt assets under state law;

The above are just a sampling of common strategies. There are however, several simple timetested, yet often overlooked planning platforms that physicians and their advisors also need to evaluate. For example, the use of a leveraged “equity stripping” platform and the use of ERISA plans are often appropriate considerations in light of a comprehensive asset protection need for physicians.

Leveraged Equity Stripping: Asset Protection Without Factoring Typically, a judgment creditor will look to the physicians practice to satisfy a judgment in excess of liability insurance limits. Accounts receivables (A/R) are most often the practices most accessible, valuable and vulnerable assets. In addition, receivables are a “non-interest” bearing book entry until actually collected (often called a “dead asset”). The ability to use such an asset, now, to generate immediate benefits without selling them off at a discount (i.e. without factoring) or disrupting the ability to collect and use 100% of the collected proceeds for operating ex-

AAPI

Typically the equity in a practice is its one full year of gross billings. To “strip” that “equity” for asset protection, economic and alternative risk purposes requires the following:

1. The practice borrows funds equal to 1-year gross billings from an institutional asset based lender, including a lifetime term, LIBOR interest only (fixed or variable) rate, 2. A perfected UCC-1 lien against the practice assets–including the A/Rs, equipment, and real estate, if any; 3. The UCC-1 lien forces future creditors to payoff the priority UCC-1 lien holder before the A/Rs may be liquidated to satisfy the judgment; 4. Loan proceeds are transferred to the physician in a tax efficient manner (various methodologies exist depending on the structure); 5. Finally, the stripped equity (or borrowed funds) is deposited into a fully liquid structure to generate a positive return (through the use of ”no surrender charge” insurance and/ or annuity vehicles); 6. The financial instrument serves as secondary collateral for the lender though a collateral assignment.

As an example, consider a radiology practice owned by a 47year-old physician. The practice borrows $1 million at an interest rate of 7% –which equates to $70,000 annual interest payment (in certain instances, this interest may be deducted by the practice, resulting in a net cost of approximately $42,000, assuming a 40% tax bracket). The loan results in a $1 million lien on the practice as-

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sets. The loan proceeds are then deposited into a specialized insurance or annuity policy offering tax deferral on earnings and linked to the S&P 500 or other market indices. In certain states (FL, TX, & GA for example) the insurance and/or annuity may be exempt from creditors whereas the A/Rs were not. In addition, the strategy may provide substantial economic benefits not traditionally associated with asset protection:

• $4 Million of life insurance protection • $3,680,000 of tax free income stream between the age of 65 and 88, through income tax free policy loans • $1,400,000 to heirs, even after above policy loans, assuming death at age 88 • A mechanism for business succession planning in a partnership setting • A leveraged buy/ sell arrangement between partners, which eventually turns into a nonqualified retirement plan if the buy/sell is no longer needed

For a potential net annual outlay of $42,000 in the example above, the physician gains peace of mind by placing a difficult hurdle before a potential creditor looking to disrupt his revenue and retains the chance to receive immediate and future economic benefits.

Most Commonly Underused Asset Protection Platform: ERISA Plans While the equity-stripping concept is great for protecting an asset that will create future cash-flow (A/Rs), it does not address income already earned and collected in excess of what is needed for personal income and operating overhead. The practice typically distributes such profits, and the physician pays taxes on them and then holds them in the form of personal assets unprotected from creditors. One of the most statutorily sound platforms for legally absorbing this extra income and protecting it from creditors, however, is through ERISA retirement and employee benefit plans. If the plan is qualified under the federal Employee Retirement Income and Security Act of 1974 (ERISA), then 29 U.S.C. § 1056(d)(1)–commonly known as the “ERISA AntiAlienation Provision”–protects pension assets from creditors. Moreover, the protection from creditors afforded by ERISA is quite extensive. Pension plans protected by ERISA include qualified plans like profit-sharing plans, money purchase plans, defined benefit plans, 401(k) plans and health & welfare benefit plans such as 501(c)(9) VEBAs. Physicians need to be cauContinued on page 198

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YOUR MONEY

Universe

COMMUNITY

By Malathi Koli, MD

Standing on the beach in Nagapattinum, I admired the stillness in the expanse of the ocean. Waves were slowly turning over the shore close to where I stood. One could hardly imagine that a couple of year ago, those waves were thunderously crashing on the shore. That is when their woes began. Tsunami waves took away much, including hope, from the people of Southeast Asia. South India was, unfortunately, no exception. The survivors–especially women–found themselves naked as the force of the tsunami robbed them of the very clothes they were wearing, ashamed to come out in open for days to come. They were suddenly and violently stripped of all–homes, loved ones, livelihood, tools of their profession, even dignity. Disaster strikes without warning and with devastating effects. The tsunami of Dec 26, 2004 at the coasts of India and other Asian countries was no exception, as over 10,700 lives lost and 582,000 families were displaced. The aftermath for the survivors is they are trying to build their life back many after losing even up to two dozen relatives. One village of 500 people had to deal with over 3,000 bodies washed

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ashore. By sheer personal will and communal support, they cleared the coast of those bodies and undertook makeshift mass burials. Now on a leafless, dry tree painted on the board, a small memorial and a poem written by the local primary care physician stands as a testimony for this tragedy. Several voluntary organizations are providing assistance in building brick homes to replace thatched roof huts for these fishermen in Keechankuppam-Nagapattinum. When I went for my second trip to visit these people, I could see immense loss on their faces. A school teacher who does the

roll call in the class keeps calling names of missing students or sits and stares, unable to teach anymore. Another woman, having lost all four children, shuts herself inside the temporary shelter, with feelings of guilt, and shame for letting her 2 yearold float away; she could not save the child. A fisherman, alarmed just by the sound of waves, yet attempts to go to sea. He knows no other trade in to make living. I met a primary care physician who, having gone through a bout of depression, wrote the eulogy poem that stands as a memorial at the burial site; he volunteered at the camps and

AAPI

In spite of these miseries, I also saw signs of active rebuilding of lives. Sewa Bharati, a NGO in collaboration with the Charitable Foundation of American Association of Physicians of Indian Origin (AAPI-CF) is planning to build a mental health clinic. AAPI-CF offered a grant of $15,000.00 to initiate the project. A site has been chosen right in Keechankuppam village. The clinic will be up and going in the next few months. Sewa Bharati is also involved in volunteering services to build houses, to hold women’s support groups and to run an orphanage for young girls from age 6 to 14. This orphanage in Nagapattinum is unique because it is like a regular house hold. These children are clothed, nurtured, sent to school and given culturally traditionally uplifting life styles by volunteers. This house is called “Anbu Illam” (House of Love).

tor the progress and will provide a report on biannual basis.

AAPI joined hands with Indo-American Psychiatric Association to form a task force In March 05, I traveled through I would like to add we had our the affected coastal areas and share of disaster in Louisiana, held two, day-long workshops and Texas via Hurricane Kato train interested counselors in trina, and Rita. Houston housed Post Traumatic Stress Disorder, 100,000 evacuees, while San AnDepression, and Alcoholism. tonio received over 25,000 peoThey were taught to identify paple. A makeshift mental health tients with immediate psychiatclinic was set up with the initiaric needs. These patients were tion of local psychiatrists, Dr. Salreferred to local general physily Taylor, myself and others. We cians, who in turn referred diffikept giving three to four hours of cult cases to a psychiatrist in the service, twice a week for 6 weeks nearby urban Kamalvathi, a survivor of the 2004 devastating tsunami, to clear patient undergoes treatment in Cuddalore, India. areas. backlogs. Through the training camps, I trained over 100 in three different cities. They were able to identify and bring patients to the primary care doctors. A primary care doctor in Nagar Koil near Kanyakumari started his own mental health clinic with financial aids from local sources. He is effectively using the workshop manual that was given dur-

When I went for my second trip to visit these people, I could see immense loss on their faces. Anyone interested to offer funds, please send your tax deductible donations to AAPI-CF. AAPI is committed to provide mental health services with the help of visiting psychiatrists and allied professionals. These individuals will travel to tsunami-affected areas and work through the upcoming mental trauma center. Sewa Bharati will moni-

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lands, Sri Lanka as well as south east coast of India.

ing the training. AAPI members stepped up to the plate to offer help. Dr Shobha Gupta singlehandedly raised $10,000.00 for this cause. AAPI joined hands with Indo-American Psychiatric Association to form a task force led by Drs. Van, Srinivasan and me. Between the three of us, we covered Andaman, Nicobar Is-

There were many patients with preëxisting psychiatric conditions who arrived without their medications. Some had worsening of their problems and about 1013% had to be hospitalized, while others needed psychiatric interventions for acute shock, loss bereavement. Quite a few exhibited panic attacks, nightmares, reliving the experience. Many were cramped in the refugee camps; 200 people in each room in Kelly Air force Base. It took over 10 weeks to triage them, relocate them and bring some normalcy to their lives. Based upon this experience, I can sum everything up with what one of the Katrina victim said, “San Antonio Thumbs Up!” It was indeed hard work but it was a rewarding and enriching experience for me. –About the author, page 218

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ILLUSTRATION : HOKUSAI; PHOTOS : ASSOCIATED PRESS

Waves Are Gone, But…

attended to thousands of patients for their physical ailments, becoming acutely aware of their psychological needs. He has written several songs and recorded the music, so people can mourn for their loved ones and may have some relief, while he is dealing with his own pangs of anxiety and depression.

Universe

ESSAY

Music, Mind, & Medicine Since the dawn of Medicine, there has been a passionate and emotional bond between music and medicine. With a keen interest in the sound physics, cardiologists have developed an unique obsession about music.

ecently I came across an article on the legendary composer Johannes Brahms. It was particularly appealing to me that he dedicated three string quartets to doctors–“Two to his friend, master surgeon and amateur musician Theodor Billroth,” and the third to a physiologist. It was fascinating to know that their relationship was mutual. The extraordinary skill with which Billroth (one of the greatest cardiac surgeons in the history of medicine!!) executed surgery in Vienna, while humming Brahms Quartet, while Brahms has been known to be inspired to greater creative heights watching his friend, the surgical genius in his element. I listened to some Brahms. The music is soul-stirring and intensely emotional in nature. A physician tends to be emotionally sensitive, despite going through the daily routine of dealing with stark realities of life and death, hope and despair, joy and sorrow, pride and humiliation. It is these aspects of a physician that makes him or her to have a spiritual journey: a unique passion many physicians share is the love of music, which in my belief is intrinsically linked to spirituality.

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AAPI

Musical connections to medicine date back as far as the ancient Greek era and continue in vitality in modern times as well. Apollo, the god of healing in Greek mythology, is seen with a lyre; Aesculapius, Apollo’s son, has been associated with the flute. A search of the philatelic history and literature revealed at least three personalities who were associated with both music and medicine and were honored by the issuance of a stamp: the French composer, music critic, and conductor Hector Berlioz (1803–1869), the Russian composer Alexander Borodin (1833–1887), and the Indian musician and conductor Zubin Mehta (1936– ). Several other Indian musicians like Ariyakudi Ramanuja Iyengar and Dwaram Venkatasami Naidu, have been honored with similar stamps.

Cardiology and Music: Cardiologists may have have provided more members for various bands than any other group. Why so many cardiologists? According to one band member, “Cardiologists are the only physicians who are deeply involved with the interpretation of sounds: frequency, intensity, duration, and time—not unlike musicians.” Richard Bing (b. 1909) is a composer, cardiologist, and researcher of international repute and a recipient of the prestigious Claude Bernard Medal for his scientific work. This cardiologist-composer stated, “Writing music enriches me to look at science in a different way. It helps me emotionally to feel more in tune with science. You see, I am a romanticist. I perceive science as an emotional exercise of searching the mysterious”.

The legendary Indian musician Subramaniam was passionate about music also studied medicine. In the mid-1950s, a group of staff physicians at the Mayo Clinic organized the “Notochords” (a medical term that refers to a remnant of the embryonic spine). The original group consisted of musicians who played the alto, tenor, and baritone saxophone, clarinet, trumpet, trombone, banjo, violin, string bass, drums, and piano.

Dr. Eugene Braunwald is widely considered a legendary figure in the field of medicine, cardiology (the only cardiologist to be a member of National Academy of Sciences), clinical researcher. He is considered one of the all time great teachers of internal medicine and is also known to be passionate about music. Toscanini is his favorite musician, and Braunwald agrees that in medicine, as in music, you need to see the “whole picture”. He

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says, “you need a conductor who can balance the oboes with the violin, and formulate schemes”. Many scientists have even designed musical instruments that are widely in use today. With reference to physicians a few examples include: Virginia Apgar–the obstetrician whose name accompanies every newborn when they are assigned an Apgar score– is known to have made her own stringed instruments. Rene Leannec, an early nineteenth-century physician, painted, played the flute and invented the stethoscope. A long hollow tube: the stethoscope, his brainchild is not far from the design of his passion, the flute. A trained musician’s ear who is also a physician may be exquisitely sensitive to sound and may easily differentiate the many whispers of the heart, which depending on their intensity, duration, and pitch may have a significant impact on the clinical decision-making. Healing Power of Music: A look into classical Indian music reveals a link between music and healing dating centuries earlier. Two of the musical trinity of car– Continued on page 205

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By Satish Bhadriraju, MD and Chitravina N. Ravikiran

about the

AUTHORS Radheshyam M. Agrawal, M.D., is Senior Attending Physician Division of Gastroenterology Allegheny General Hospital, in Pittsburgh, Pennsylvania

teenage sons and 2 ferrets. She is currently associate chief of staff for Geriatrics and Extended Care at Hampton Medical Center in Hampton, Virginia.

Deepti Agarwal is currently a 4th year medical student at SUNY-Stony Brook Medical School in New York. Prior to medical school she was at the University of Pennsylvania, where she majored in Biological Basis of Behavior and Health & Societies. In her free time, she enjoys traveling, working out, playing tennis, and spending time with family and friends.

Satish Bhadriraju, MD, has done his Internal Medicine residency from McLaren Regional Medical Center/Michigan State University in Flint, Michigan. He currently works as an internist with Baldwin Family Health Care and as hospitalist with Gerber hospitals in Fremont, Michigan. His interests include cardiology and sleep medicine. His other passions includes South Indian carnatic classical music. He is active in the promotion of music and its relation to Medicine.

Radheshyam Agarwal, MD, is Senior Attending Physician in the Division of Gastroenterology at Allegheny General Hospital, in Pittsburgh, Pennsylvania. His special appointments include: 1994 member, Medical Licensure Workgroup of the Council on Graduate Medical Education (COGME), U.S. Department of Health and Human Services; 1994-1996 Chairman, Board of Trustees, American Association of Physicians from India; 1994-2000 Governor, Board of Governors, American College of Gastroenterology 2005 Member, State Board of Medicine, Commonwealth of Pennsylvania 2006; Medical Legal Advisory Board on Elderly Abuse and Neglect, Commonwealth of Pennsylvania; 2006 Asian American and Pacific Advisory Council of Pennsylvania. Jay Barua is a Second Vice President – Wealth Management and Financial Planning Specialist with Smith Barney located in Fort Wayne, Indiana. Sara Battar, MD is an Osmania University alumnus. She has been with the Department of Veterans Affairs since 1995. She received the 2004 president’s award from the Federal Executive Council of Iowa for exceptional leadership in caring for the elderly veterans. She was inducted into the Palliative Care Hall of fame virtual learning center site in 2005 www.va.hospice.gov. She resides in Yorktown, Virginia with her husband and 2

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Marianna I. Borkovskaya, volunteered with AVSAR in February 2006. She is a MS IV student at The University of New Mexico School of Medicine, USA. She can be reached at mbork77@yahoo.com. AVSAR is the Alliance of Volunteers for Service, Action & Reform (www.AVSARindia.org). Dr. Jeffrey W. Chell is a native of Minnesota and a University of Minnesota graduate, came to the NMDP from Allina Health System where he most recently served as president and chairman of the board of the Allina Medical Clinic, a medical practice of more than 600 health care providers with headquarters in Minneapolis, Minn. He also served concurrently as the system vice president for clinical services of the Allina Health System. Deepak Chopra has written over 42 books and released more than 100 audio, video and CD-ROM titles. They have been translated into 35 languages with over 20 million copies sold worldwide. In 1999 Time magazine selected Dr. Chopra as one of the Top 100 Icons and Heroes of the Century, describing him as “the poet prophet of alternative medicine.”

Reena Chopra, B.H.M.S., PhD, is a consultant homeopath and CEO of My Healthy Nutrition.

aminers in Atlanta, and is currently the chairman of the medical board.

Enas A. Enas, M.D., is Director of the Coronary Artery Disease in Indians Research Foundation. cadiusa@msn.com

Malathi Koli, MD is a psychiatrst based in San Antonio, Texas.

Rita Frenchman, MD is an anesthesiologist living in Hendersonville, Tennessee with plastic surgeon husband, Kush, and dogs Raja and Rani. She is currently member of Board of Trustee, publications committee, and ethics and grievance committees of AAPI . She is founder and past president of “AAPI of Tenn”. Her favorite past times are blogging, gardening and crocheting. She is mom to Meghana and Aparna, mom-inlaw to Shankar, mom-in-law-to-be to Viraj and grandma to Arjun and Rohit.

Purushotham Kotha. MD, FACC is currently practicing cardiology in San Diego, California. Besides other clinical trials, he has conducted the DIA, NAIHDP, IRIS studies related to Asian Indians. He has published scientific papers in reputed medical journals and is chairperson of the CAD committee of AAPI, past president of SAPI and helped host the AAPI convention of 2004 in San Diego. He is a voluntary clinical Instructor at the University of California, San Diego. He created and edits the popular medical information Website geared towards the health issues of Indians (www.heartsmart.info). He has been coaching and helped four IMGs from India to get into residency programs in the U.S so far. He enjoys working with AAPI, can be reached at pkotha@heartsmart.info.

Raghuveer Halkar, MD is with the Nuclear Medicine /Radiology department at Emory University in Atlanta, Georgia. Veena S. Gandhi, MD. was born in Botad, India. A graduate of Patna Medical College, Patna, India, she has been in private practice since 1975 and is on active staff at Virtua Hospital, Voorhees, New Jersey. She is Vice President of VHP of America for 8 years and is a member of the board of directors for Ekal Vivyalaya Foundation. She was named woman of outstanding achievement for 1994, by the Camden county girl scouts and in 1994 was voted one of south New Jersey’s best physicians. Rajesh Jyotishi, of Shalin Financial Services, Inc., has been an insurance agent and financial planner for more than fifteen years. He is one of the founding partners and is also the host of the “Moneywise” section in Khabar Magazine. For questions, he can be reached at RJ@ShalinFinancial.com. M. Vinayak Kamath, MD, a 1973 graduate of MGM Medical College, Indore MP, is chief of Cardiothoracic Surgery at University Hospital in Augusta, Georgia. In 2004, he was appointed to the Composite State Board of Medical Ex-

AAPI

Ram R. Krishna, MD, is an orthopedic Surgeon based in Yuma, Arizona. He has served as chairman of the Arizona Board of Medical Examiners and currently continues to serve as a board member. He is actively involved in various business ventures like banking as Vice President of Yuma Community Bank and owns and manages extensive commercial real estate properties. Dr. Krishna came to Arizona in 1981 to establish his medical practice soon after completing his medical education. Originally from Bangalore, India, “Dr. Ramkrishna”–as he is affectionately known to his colleagues and friends–graduated with an MBBS in 1970 from Bangalore Medical College. Murali Krishnamurthy is chairman of the Sankara Eye Foundation, USA. Learn more about SEF at: www.giftofvision.org or by phoning: 1-866-Sankara

Dr. Sivaprasad Madduri can be reached at madduri@semo. net

Bhagirath Majmudar, MD is professor of pathology and associate professor of gynecology – obstetrics at the Emory University School of Medicine in Atlanta, Georgia. His honors include several awards as an “Outstanding Teacher” from undergraduate medical students and residents of Pathology and Gynecology Obstetrics, Dean’s Award as an outstanding Teacher of Emory University School of Medicine (2004), and winner of Evangeline Papageorge Award, the highest award given by Emory University (2005). He has authored over seventy research papers on Surgical Pathology and is a member of the Cervical Cancer Committee at the Georgia State Health Department, Chairman and Secretary of Pathology Section of the Southern Medical Association and is a mentor for a number of high school, college and medical students.. Dr. Majmudar is also a spiritual leader and priest for Indian community and a Hindu priest for 30 years and a poet, playwright, actor, writer and scholar of Sanskrit language. Ami Shah Nagarajan, MD, is a board certified internal medicine Doctor working at Bausch and Lomb in Rochester, NY; she works in the Global Pharmaceutical division, developing clinical trials. Ami has her medical degree from Wright State University of Medicine and finished her Internal Medicine residency at Rush Presbyterian Hospital in Chicago, IL. She has been active with both AAPI and IAMA. Kamesh Nagarajan is a wealth management advisor working with Indian physicians, nationally, on integrating their asset protection, estate planning and investment planning goals. He has his law degree (J.D.) from Syracuse University College and a B.A. from Vassar College in Economics. Kamesh travels and speaks at many Indian medical conferences around the country.

M. P. Ravindra Nathan, MD, FACC, FACP, MRCP (Lond) is editor of the AAPI Journal, lives in Brooksville, Florida.

Susheela Ravindra Nathan, MD, FAA, lives in Brooksville, FLorida. P. K. Natrajan, MD, FACOG, CCD, is a boardcertified Ob-Gyn with special interest in Osteoporosis prevention and treatment. He is certified by the International Society of Bone Densitometry with a degree of CCD (Certified in Clinical Densitometry).He finished his ObGyn training at Aultman Hospital Canton Ohio and Ohio state university in Columbus Ohio. He completed a 3 year fellowship in Reproductive endocrinology at the Medical college of Georgia under Dr. Robert Greenblatt, Dr. Virendra Mahesh and Dr. Paul McDonough. He has been in private practice in Augusta, Georgia, since 1981.He has recently authored a book on “Hormone Replacement Therapy“ and has published numerous articles, written chapters in books and lectured nationally and Inter nationally on osteoporosis, hormone therapy and other topics. His pastimes are playing golf and music. S.G. (Nik) Nikam, MD, FACC, FACP: He has been involved in cardiology practice for the past twenty years performing cardiac catheterizations, coronary interventions, managing cardiac surgery patients at the Texas medical center, Houston. Raj Pandya, MD, practices orthopedic surgery in Atlanta, specializing in sports medicine. He is Director of the Atlanta Knee and Shoulder Clinic, and chairman and founder of Unicore Health, an integrated health services company. Dr. Pandya graduated with honors from the accelerated BS/MD program at the University of North Carolina at Chapel Hill, selected to the Phi Beta Kappa (Continued on next page)

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