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Dr K K Aggarwal

Diclofenac, used for the treatment of pain and inflammation caused by arthritis, is associated with a significantly increased risk of cardiovascular complications and should be removed from essential–medicines lists.

It is listed on the EML of 74 countries, increased the risk of cardiovascular events between 38% and 63% in different studies. The increased risk with diclofenac was similar to the COX-2 inhibitor rofecoxib, a drug withdrawn from worldwide markets because of cardiovascular toxicity.

Dr David Henry at Institute for Clinical Evaluative Sciences, Toronto who conducted the review along with Dr Patricia McGettigan at London School of Medicine and Dentistry said that its use is much more common in other non–Western countries.

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The blue neck Shiva called Neelkanth symbolizes that one should neither take out the vices or negative emotions nor suppress them. Instead one should alter or modify them.

The blue colour in mythology symbolizes slow poison that includes attachments, anger, greed, desires and ego. Blue neck means to hold on the negative emotions temporarily so that it can be neutralized at appropriate time.

Suppressed anger releases chemicals which can lead to acidity, asthma, angina, future heart attacks and diarrhea etc. Similarly expressed anger can cause social unhealthiness and acute heart disease.

The only way to mange anger is to take the right and not the convenient action. One should neutralize anger by willful cultivation of opposite, positive of different thoughts.

Anger is a known risk factor for heart blockages. Anger can evoke physiological responses that are potentially life threatening in the setting of underlying heart blockages. It has a dominant influence on the severity, frequency, and treatment of angina.

This Vedic message of Shiva is being validated by many western scientists.

Anger has many phases

1. Anger Expression Inventory
2. Assesses anger frequency (trait anger)
3. Anger intensity
4. Anger expression (anger–out)
5. Anger suppression (anger–in)
6. Anger recall.

Both anger–in and anger–out are associated with heart blockades.

a. Dr. C. Noel Bairey Merz, from Women’s Health at Cedars–Sinai Medical Center has shown women who outwardly express anger (anger–out) are at increased risk especially if they also have other risk factors like age, diabetes and high cholesterol levels. The findings are a part of Women’s Ischemia Syndrome Evaluation Study, a multi–center, long–term investigation sponsored by the National Heart, Lung and Blood Institute.

b. Anger–in is also related to severity of blockages. Dr. TM Dembroski in 1985 has shown that potential for Hostility and Anger–In are significantly and positively associated with the heart blockages disease severity, including angina symptoms and number of heart attacks. Suppressed anger is also associated with increased carotid arterial stiffness in older adults, a condition making them prone to future heart attacks and paralysis.

c. In univariate correlational analysis by Anderson DE from National Institute on Aging, Baltimore, Maryland in 2006 has shown a significant positive association of anger–in with artery stiffness.

d. Suppressed anger has also been shown to increase blood pressure by Thomas and group from University of Tennessee.

e. Recall of suppressed anger has been shown by Dr D Jain in 2001 from Yale University to be associated with angina, heart LV dysfunction and rise in upper blood pressure.

f. G Ironson and colleagues from Department of Psychology, University of Miami in 1992 has shown that anger recall produces more stress than the actual stress in a treadmill. Intensity of anger was associated with severity of angina. In the study vasoconstriction only occurred with high levels of anger. There also showed that there was no narrowing of non–narrowed arteries indicating that anger recall produce coronary vasoconstriction in previously narrowed coronary arteries.

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IBD linked to heart disease

By Dr K K Aggarwal
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Inflammatory bowel disease is associated with increased risks for stroke, myocardial infarction and ischemic heart disease, particularly in women.

A meta–analysis and systematic review has shown that increased odds for cerebrovascular accidents including ischemic and hemorrhagic stroke –– and for ischemic heart disease according to Siddharth Singh, MD, of the Mayo Clinic in Rochester, Minn., and colleagues.

These risks are specifically elevated in women versus men, with women having a 28% increased odds of cerebrovascular events and a 26% increased odds of ischemic heart disease.

The study was presented in a poster presentation at the American College of Gastroenterology meeting in San Diego.

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The Spiritual Meaning of Lord Shiva

By Dr K K Aggarwal
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Most of us worship Lord Shiva without understanding the deeper meaning behind him. In Hindu mythology, Shiva is one of the three forms of God (Brahma, Vishnu & Mahesh).

The Parmatama or spirit or GOD can be equated to a mixture of three forces representing Generator, (Creator or Brahma); Organizer; (Maintainer or Vishnu); Destroyer (Winding up or Mahesh or Shiva).The same three forces are also present inside our body to perform any work, which can be linked to create or generate an idea, maintain or organise the contents of the idea, and then destroy or wind up so that new work can be undertaken through Ganesha – the Lord of new happenings.

For day to day life, one has to understand and implement the principles of Lord Shiva which can be known by understanding the meaning of Shiva.

Shiva is worshipped in the sitting meditating pose, sitting on a deer’s skin at white Himalaya in the background of blue sky. Shiva is also depicted in the form smeared with the ash of graveyard, having a snake on neck, Ganga coming out of his matted hairs, three eyes, blue neck, trishul on one hand and damru on his other hand.

All these symbolic representations have a deep spiritual meaning and tell us about Shiva’s principles of success.

Shiva’s third eye means thinking differently or using the eyes of our mind and the soul. The message is, whenever you are in difficulty, use your intelligence and wisdom or think differently for getting different options. The third eye opening also represents the vanishing of ignorance (darkness or pralaya).

Shiva sitting in an open–eye meditating pose indicates that in day–to–day life one should be calm as if you are in the meditation rose. Calmness in day–to–day practice helps in achieving better results. In allopathic language it is equivalent to mindfulness living.

The snake around the neck represents one’s ego. One should keep the ego out and control it and not let it overpower you. The downward posture of the head of the snake represents that ego should be directed towards the consciousness and not outwards.

The blue neck (Neelkanth) represents that one should neither take the negative emotions out nor suppress them but alter or modify them. The blue color indicates negative thoughts.

The same in the neck indicates that negative slow emotions akin to negative emotions are neither to be drunk nor to be spitted out but to be hold temporarily and with continuous efforts (matted hairs) with cool mind (moon) and with positive thoughts (Ganga) should be directed towards the consciousness keeping the ego directed towards it (sheshnag).

Suppressed anger or any other negative emotions will release chemicals in the body causing acidity, asthma, angina and diarrhea. Expressed anger on the other hand will end up into social unhealthiness.

The ash on the skin of the body of Shiva reminds that everything in the universe is perishable and nothing is going to remain with the person. The message is that ‘you have come in this world without anything and will go back without anything, then why worry’.

The Trishul in one hand represents control of three factors i.e. mind, intellect and ego. It also represents controlling your three mental gunas i.e. Sattva, Rajas and Tamas. The damru, the hollow structure, represents taking all your ego and desires out of the body.

The blue sky represents vastness and openness and the White Mountain represents purity and truthfulness.

If one adapts to Shiva’s principles in day–to–day life, one will find no obstacles both in his routine life as well as to one’s spiritual journey.

On the Shivratri day, the custom is to fast. The fast does not just indicate not eating on that day, but its deeper meaning signifies fasting of all bad things in life like – “seeing no evil, hearing no evil and speaking no evil”. Fasting also indicates controlling the desires for eating foods (like fermented, sweet, sour and salt) and control the negative thoughts both in the mind, deed as well as actions.

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Honey excellent for Cough

By Dr K K Aggarwal
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A spoonful of honey can quieten children’s’ night time cough and help them — and their parents — sleep better.

When compared to the cough syrup ingredient dextromethorphan or no treatment, honey came out on top. As per a study from Archives of Paediatrics and Adolescent Medicine, the results are so strong that one is able to say that honey is better than no treatment and dextromethorphan was not. There is currently no proven effective treatment for cough due to an upper respiratory infection like the common cold. While dextromethorphan is widely used, there is no evidence that it works, and it carries risks.

Honey is used around the world as a home remedy for cough, and might provide a safe, effective alternative to cough medicine. To investigate, the researchers compared buckwheat honey, a honey–flavoured dextromethorphan preparation, and no treatment in 105 children who had sought treatment for night time coughs due to colds. Among the three groups, children given honey had the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality may be soothing to the throat, while its high antioxidant content could also be a factor. Honey also has antimicrobial effects. Honey is not recommended for infants younger below one year of age because of the risk of botulism spores.

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In dealing with patients the traditional Patient–Doctor relationship model has been that doctor should remain cool, calm and collected at all times.

Doctor’s approach needs to be strictly scientific, logical, objective, methodical precise and dispassionate. This model has been since the era of William Osler, the father of modern medicine. The term used is imperturbability which means coolness and presence of mind under all circumstances.

Osler said a rare and precious gift to doctor is right of detachment. The right of detachment insulates the doctors and protects them from the powerful emotions that patients display in their presence like anger, frustration, grief, rage and bewilderment. It also insulates patients from the rolling emotions that doctors may at times feel towards them.

However, a detached attitude also insulates doctors from empathizing with patients. A detached doctor may talk in a language that is over patient’s head.

Detachment is not like a light switch that you can turn on and off to suit the situation. Detachment as a practice cannot be in isolation if it becomes your personal style of distracting from the world, it may not be just for the patients but also from your colleague, family friends and even yourself.

I recall when I joined by hospital the first lesson given to me by my boss was not to get unduly attached with patients. As etiquette, we were taught not to socialize with patients. Even today the new American Guidelines talk that doctors should not socialize with their patients on social media including Facebook. Even doctors are human beings and their personal life should not be known to the patients. As far as law suits are concerned, it is equally true that known close patient’s file a law suit much more than unknown people because over a period of time they know your weakness. One should learn to empathize with the patients and yet be detached from its results. Doctors who follow Bhagwat Geeta understand this concept very well.

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Fecal Microbiota Transplantation (FMT)

By Dr K K Aggarwal
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Fecal Microbiota Transplantation (FMT) has emerged as highly effective treatment of C. difficile. FMT as emerged as a highly effective treatment for recurrent C. difficile infection. The transplantation refers to the infusion of a suspension of fecal matter from a healthy individual into the GI tract of another person to cure a specific disease through a colonoscopy. It is based on the concept that stool is a biologically active, complex mixture of living organisms with great therapeutic potential for C. difficile infection. Most patients with C. difficile infection respond to metronidazole, vancomycin but 15–35% may have recurrence. Patients who have one recurrence have 45% chances of a second recurrence, and after a second recurrence, 65% will have a third recurrence. The current treatment of recurrence is additional course of metronidazole, oral vancomycin, or prolonged oral vancomycin. FMT is commonly performed by colonoscopy but doctors have used nasogastric tube or nasoenteric tube, gastroduodenoscopy and enema.

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Leverage your strengths

By Dr K K Aggarwal
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• Know your strengths
• According to a British study, only about one–third of people have a useful understanding of their strengths.
• If something comes easily, you may take it for granted and not identify it as a strength.
• If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
• Strengths which most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.
• Strengths are so important that they’re worth cultivating and applying in your daily life, even if they don’t come naturally to you.

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