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Dr K K Aggarwal

How to make bones strong

By Dr K K Aggarwal
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Everyone builds bone up to the age of 30, and then, the process of bone resorption begins. It is, therefore, important for children to build strong bones so that they are not susceptible to fractures when they grow old. Here are some tips:

• For maximizing big bone mass during the bone forming years, one should live a healthy lifestyle, which includes adequate calcium intake, adequate vitamin D intake, optimal physical activity and avoidance of smoking and alcohol.

• To prevent subsequent bone loss in adults, one should adopt a similar approach, which includes regular weight-bearing exercise, avoidance of oversmoking and limitation of alcohol to an average of not more than 2 drinks per day.

• Cigarette smoking is associated with reduced bone mass and increased risk of fractures.

• Calcium supplements are recommended. The recommended daily intake of calcium for post menopausal females is 1200 mg daily (double diet + supplements).

• Vitamin D supplementation is recommended if dietary intake is inadequate. In India, the recommendation is 2000 units per day.

• It is recommended that 40% of the body should be exposed to sunlight uninterrupted for 40 minutes for 40 days in a year so that the body can form adequate vitamin D.

• Regarding weight-bearing exercises, the general recommendation is a minimum of 30 minutes of physical activity such brisk walking on most, if not all, days of the week.

• Heavy alcohol intake predisposes to hip fractures due to osteoporosis.

• Heavy drinking means more than 14 drinks in a week. One drink is equivalent to 30 ml of whiskey.

• Many drugs including steroids and antiepileptic drugs can cause bone thinning over a period of time.

Persist in your efforts and you will be successful

By Dr K K Aggarwal
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All success stories are stories of great failures. The only difference is that every time they failed, they bounced back. This is called failing forward, rather than backward. You learn and move forward. Learn from your failure and keep moving. The third avtara of Vishnu, the boar, signifies the same. The answer is persistence in your objectives.

Here are few quotes and success stories

1. “So never mind these failures, these little backslidings; hold the ideal a thousand times, and if you fail a thousand times, make the attempt once more. The ideal of man is to see God in everything”. II.152 (Complete Works of Swami Vivekananda)

2. “It is in the nature of things that many should fall, that troubles should come, that tremendous difficulties should arise, that selfishness and all other devils in the human heart should struggle hard, when they are about to be driven out by the fire of spirituality. The road to good is the roughest and the steepest in the universe. It is a wonder that so many succeed; no wonder that so many fall. Character has to be established through a thousand stumbles”. VIII.383 (C W of SV)

3. “Therefore, stand up, be bold, be strong. Take the whole responsibility on your own shoulders, and know that you are the creator of your own destiny”. II.225 (CW of SV).

4. “Successful people don’t do great things, they only do small things in a great way”

5. “One day a partially deaf four year old kid came home with a note in his pocket from his teacher, “Your Tommy is too stupid to learn, get him out of the school.” His mother read the note and answered, “My Tommy is not stupid to learn, I will teach him myself.” And that Tommy grew up to be the great Thomas Edison. Thomas Edison had only three months of formal schooling and he was partially deaf”.

6. “Henry Ford forgot to put the reverse gear in the first car he made”.

7. “Thomas Edison failed approximately 10,000 times while he was working on the light bulb”

8. “Henry Ford was broke at the age of 40”.

9. “Lee Iacocca was fired by Henry Ford II at the age of 54”.

10. “Young Beethoven was told that he had no talent for music, but he gave some of the best music to the world”

 

Low–heat cooking may reduce insulin resistance – Traditional Ayurveda cooking recommends low heat cooking and now a western study endorses it

By Dr K K Aggarwal
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Low–temperature cooking reduces insulin resistance among overweight women as per a 4–week study published in the journal Diabetes Care by Alicja B. Mark, PhD, from the department of nutrition, exercise and sports, faculty of science, University of Copenhagen, Denmark, and colleagues.

Cooking at high temperature such as with baking, roasting and frying — induces formation of advanced glycation end products (AGEs), which are associated with inflammation and believed to impair glucose metabolism in patients with type 2 diabetes. Common high–AGE foods include bakery products, cooked meat and roasted coffee.

In the study patients randomized to a high–AGE diet were instructed to fry, bake, roast, or grill their food, eat bread with the crust and choose other high–AGE foods from a list. The low–AGE group was told to boil or steam their food, eat bread without the crust, and choose lower–AGE foods from a list. They were also randomized to supplements of either fructose or glucose.

At 4 weeks, no effect was seen from the fructose or glucose on insulin resistance, as assessed by the homeostasis model assessment of insulin resistance (HOMA–IR) and the calculated insulin sensitivity index (ISI) or on any secondary measures. But the AGE content of the diet did make a difference. Weight, BMI, and waist circumference all decreased in both the high– and low–AGE groups, but to a greater degree among those in the low–AGE group compared with the high–AGE group. Overall, the low–AGE group consumed about 15% more protein, 10% more carbohydrates, and 22% less fat than did the high–AGE group

What is the difference between smile, hug and laugh?

By Dr K K Aggarwal
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Smile is a sign of joy while hug is a sign of love. Laughter on the other hand is a sign of inner happiness.

Neither of them are at the level of mind or intellect. All come from within the heart. They are only the gradations of your expressions of your happiness.

It is said you are incomplete in your dress if you are not wearing a smile on your face.

Hug comes next… and laughter the last. Laughter is like an internal jogging and has benefits similar to meditation.

But be careful we must know when not to laugh. The most difficult is to laugh on oneself.

 


Kidney patients can become pregnant

By Dr K K Aggarwal
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Pregnancy is not contraindicated in most women with diabetic nephropathy (kidney disease).

Maternal and peri-birth outcomes are generally good with tight control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are increased compared to non-diabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction and preterm birth.

Pre-conceptional treatment with drugs like angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic.

Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

Women with moderate to severe renal impairment (serum creatinine level >1.5 mg/dL, proteinuria >3g in 24 hours) may benefit from renal transplantation or dialysis therapy before initiating pregnancy.

 

Doctors are God later and human beings first

By Dr K K Aggarwal
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Doctors are regarded as God because their primary job is to save the life of a patient. In fact, they are the messengers of God to look after the health of the sick person. But, Doctors are God later and human beings first.

To err is human and every doctor is likely to make mistakes. The very fact that a doctor is getting himself insured under Indemnity insurance means that medical errors are recognized as a part and parcel of Government policies.

For any error, the Court has decided a financial compensation to the patient and that compensation is paid by the insurance company as the doctor is covered under the Indemnity insurance. Medical negligence on the other hand, if proved, is not covered under the insurance. Therefore, medical negligence has to be differentiated from medical errors.

The error of judgment and difference of opinion are accepted in the law as not negligence and there are ample Supreme Court judgments to support that. Medical accidents are also exempted from being termed negligence by various Supreme Court clarifications/judgments. For a doctor to be punished under medical negligence, there has to be a proof that he willfully did some omission or commission, which led to the death or caused harm to a person.

A doctor is also not required to possess the maximum degree of skill and knowledge but is required to possess only an average degree of skill and knowledge. Therefore, when an expert is called for an opinion, he should never give an opinion from his level of perception and knowledge but should take into consideration the knowledge of an average doctor of that specialty.

Recently, a friend forwarded a report to me, which showed that in US when the doctors went on a strike, the number of deaths in the city during the strike period reduced. I totally agree with this observation and I am of the firm opinion that if allopathic medical profession ceases to exit, the number of deaths per day will be reduced. But at what cost? It will invariably be at the cost of increased morbidity, impaired quality of life and more sufferings. In that scenario people with sexual dysfunction will live without enjoying sexual life; people with heart failure will live on the bed all the time, patients with TB will be back in sanatoriums, patients with fractures will be bedridden for months together and patients requiring orthopedic surgeries will remain with life–long deformities. To have a better quality of life, one has to pay the price as any intervention or surgery done to improve the quality of life invariably will carry some risk and mortality. Even a simple bypass surgery of the heart carries a mortality of up to 0.5–1%. But for the family whose patient dies that 1% mortality is 100%.

In a follow up program on Aaj Tak, the film actor, Aamir Khan had said that every household in India has a negative story to tell about medical doctors. Aamir probably misunderstood or could not differentiate medical errors, medical accidents from medical negligence. People equate money with medical success. Most of the medical disputes occur in private sector when the patient’s relatives have to pay money for an unsuccessful surgery or treatment. Attempts have been made to compare the results of medical treatment in India from that of abroad. They are totally incomparable as the amount of fee charged by doctors in India is practically a fraction of the fee that is charged in the west. The patient load in India per doctor is also responsible for potential medical errors.

One should also remember that the Drug Controller Government of India (DCGI) does not inform doctors about banned drugs, introduction of new drugs or introduction of new equipment. Most doctors depend on technology to be learnt through the manufacturers of respective machines. The manufacturers either bring the training persons from abroad or support the training of Indian doctors abroad. Their interest is ultimately covered as the doctors once trained ultimately end up in purchasing their technology.

When a new drug is launched, as there is no information from DCGI to individual doctors, they are forced to attend symposia by drug companies, which now come under the purview of an unethical doctor–pharma relationship.

Most doctors will write pharmaceutical drugs of a company, which people think is in lieu of a commission they are getting. The reality is that a doctor will invariably write a drug of a company who is constantly spending in efforts in educating doctors about new technologies and innovations as both Medical Council of India and the Government of India Health Ministry have no such provisions for the doctors. On the other hand, not attending medical educational programs is considered a professional misconduct

5 foods that fight high cholesterol

By Dr K K Aggarwal
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Oats give you soluble fiber. Add a banana or some strawberries to get more soluble fibers. Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal.

Nuts: Eating almonds, walnuts, peanuts and other nuts is good for the heart. Eating 2 ounces of nuts a day can slightly lower LDL by about 5%. Nuts have additional nutrients that protect the heart in other ways.

Foods fortified with sterols and stanols. Companies are adding them to foods ranging from margarine and granola bars to orange juice and chocolate. They’re also available as supplements. Getting 2 grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%.

Fatty fish. Eating fish 2 to 3 times a week can lower LDL in two ways: by replacing meat, which has LDL–boosting saturated fats and by delivering LDL–lowering omega–3 fats

Stress is the reaction of the body and mind to the interpretation of a known situation

By Dr K K Aggarwal
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You cannot be stressed unless you know the person, place or the situation. The same situation may or may not cause stress unless it is interpreted in such a way that it is uncomfortable to the person, and then it ends up causing stress.

Management of stress, therefore, involves either removing the known situation or changing one’s interpretation or preparing the body in such a way that the stress does not affect mind and the body. But, removing the known situation may not be possible all the time. For example, if you are stressful in a job, resigning may not be feasible. The modality, therefore, is to change your interpretation towards the stressful situation i.e. start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Changing of the interpretation is what in allopathy is described as cognitive behavior therapy, the origin of which comes from Ayurveda and in Bhagwad Gita where Lord Krishna counsels Arjuna following principles of Cognitive Behavioral Therapy.

In the first chapter, Lord Krishna only listens to Arjuna indicating the importance of listening, listening and listening. The second counseling session or the second chapter is the longest conversation between Arjuna and Krishna and shows the importance of first effective counseling session. From 3rd to 17th chapters, Krishna explains what he has conveyed in chapter 2 and this tells us the importance of reasoning out every doubt that a person under stress has. During this session, Krishna creates both fear as well as consoles Arjuna again indicating the importance of these two factors in counseling. In the last chapter, Krishna revises what he has taught, which is consistent with the last rule of counseling to make sure that the patient has learnt what has been taught to him.

Apart from counseling, one can also prepare the body in such a way that stress does not bother him. This can be done by learning the art of pranayam, relaxation, meditation, regular exercise, Dosh-specific diet and using certain Ayurvedic Rasayans, which sterilize the brain functions. Brahmi, an Ayurvedic herb, is one such Rasayan, which boosts the brain. Avoid taking allopathic anti–anxiety drugs, unless necessary which, of course, may be required in an acute panic state.

 

Poor hygiene habits may lead to typhoid

By Dr K K Aggarwal
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Typhoid fever is caused by a bacterium called Salmonella typhi, which is transmitted via ingestion of food or drink that has been contaminated by the feces or urine of infected people. Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions.

Though the cases occur round the year, more cases are seen during the summer and rainy seasons.

Symptoms usually develop 1–3 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhea and enlarged spleen and liver. A healthy carrier state may follow acute illness.

It can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food.

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid.

Few salient facts about Typhoid fever

• Typhoid does not affect animals and therefore transmission is only from human to human.

• Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water.

• Careful food preparation and washing of hands are crucial to preventing typhoid.

• Typhoid fever in most cases is not fatal.

• Prompt treatment of the disease with antibiotics reduces the case–fatality rate to approximately 1%.

• When untreated, typhoid fever persists for 3 weeks to a month.

• Resistance to common antibiotics is now common.

• Typhoid that is resistant to common antibiotics is known as multidrug–resistant (MDR)-typhoid.

• Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia.




The Science Behind Bhabhuti and Ash

By Dr K K Aggarwal
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Satya Sai Baba was known to give Bhabhuti as prasad to his visitors. In mythology also, Rishi Munis gave Bhabhuti to their followers.

Lord Shiva is known to have Bhabhuti on his skin. Many people believe that Ash or Bhabhuti reminds one that the human body is perishable and will be converted into Ash ultimately after the death of the physical body.

But there is also another meaning behind this mythological ritual of applying Ash onto the body.

Fire in mythology means the fire of knowledge, knowledge about the true self consciousness. Knowing about true self is obstructed by negative thoughts, animal tendency, egoistic vanities and foolish attachments.

Kama Krodha Lobha Moha and Ahankara fall into the same category. Burning negative tendency, animal behavior, ego and attachment into the fire of knowledge is what spirituality is. Once you burn your negative tendencies in the fire of knowledge, the resultant Ash or Bhabhuti which is to be ingested as the Prasad is what Rishi Munis gave to their seekers.

Rishis are different from Pandits as Pandits are the ones who have knowledge but may not have spiritual experiences.

Rishi Munis have both the knowledge and the personal experiences. The Rishi Munis are the ones who have learnt to burn their negative tendencies and ego into an Ash and help their followers in turn to burn their negative tendencies.

The Ash given to their seekers is a constant reminder that the seekers need to burn their negative tendencies and convert them into the same ash.






Fever does not mean presence of infection. There are many situations where there may be fever without infection. Such fevers do not need antibiotics.

By Dr K K Aggarwal
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• Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.

• Symptomatic inflammatory response syndrome (SIRSI means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.

• Many antibiotics can cause fever; unless they are discontinued, fever will not subside.

• Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs.

• Hyperthermia may not respond to anti–fever drugs.

• When fever is more than 41.5°C, it is acute hyperpyrexia.

• Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.

• High temperature without infection is found in case of a hyperfunctioning thyroid gland.

• Recreational drugs such as Ecstasy can also cause fever without any infection.

• Mild fever can also occur after exertion.

There is a ritual and tradition of offering food to God before eating

By Dr K K Aggarwal
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This is a Vedic reminder to oneself that one should eat only those foods that are offered to God. Each time you offer food to God, it is a reminder to you to change your decision and choices. For example, alcohol, tobacco, onion, garlic, radish, etc. are not offered to God. If they are part of your food, there are chances that you will not consume these food items, if you observe this ritual.
Cheating is permitted one day of 21 meals in a week. Over a period of time people have stopped following this ritual and now eat some foods, which cannot be offered to God in all their 21 meals. This is the reason why the incidence of lifestyle diseases is increasing in the community.

How to recognize cardiac arrest

By Dr K K Aggarwal
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• Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

• As per guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

• If the person does not respond, the rescuer should call for help or ambulance and initiate excellent chest compressions.

• Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

• Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

• After assessing responsiveness, health care providers should quickly check the patient’s pulse.

• While doing so, it is reasonable to visually assess the patient’s respirations.

• It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

• The key point is not to delay CPR.

Doctors are God later and human beings first

By Dr K K Aggarwal
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Doctors are regarded as God because their primary job is to save the life of a patient. In fact, they are the messengers of God to look after the health of the sick person. But, Doctors are God later and human beings first.

To err is human and every doctor is likely to make mistakes. The very fact that a doctor is getting himself insured under Indemnity insurance means that medical errors are recognized as a part and parcel of Government policies.

For any error, the Court has decided a financial compensation to the patient and that compensation is paid by the insurance company as the doctor is covered under the Indemnity insurance. Medical negligence on the other hand, if proved, is not covered under the insurance. Therefore, medical negligence has to be differentiated from medical errors.

The error of judgment and difference of opinion are accepted in the law as not negligence and there are ample Supreme Court judgments to support that. Medical accidents are also exempted from being termed negligence by various Supreme Court clarifications/judgments. For a doctor to be punished under medical negligence, there has to be a proof that he willfully did some omission or commission, which led to the death or caused harm to a person.

A doctor is also not required to possess the maximum degree of skill and knowledge but is required to possess only an average degree of skill and knowledge. Therefore, when an expert is called for an opinion, he should never give an opinion from his level of perception and knowledge but should take into consideration the knowledge of an average doctor of that specialty.

Recently, a friend forwarded a report to me, which showed that in US when the doctors went on a strike, the number of deaths in the city during the strike period reduced. I totally agree with this observation and I am of the firm opinion that if allopathic medical profession ceases to exit, the number of deaths per day will be reduced. But at what cost? It will invariably be at the cost of increased morbidity, impaired quality of life and more sufferings. In that scenario people with sexual dysfunction will live without enjoying sexual life; people with heart failure will live on the bed all the time, patients with TB will be back in sanatoriums, patients with fractures will be bedridden for months together and patients requiring orthopedic surgeries will remain with life–long deformities. To have a better quality of life, one has to pay the price as any intervention or surgery done to improve the quality of life invariably will carry some risk and mortality. Even a simple bypass surgery of the heart carries a mortality of up to 0.5–1%. But for the family whose patient dies that 1% mortality is 100%.

In a follow up program on Aaj Tak, the film actor, Aamir Khan had said that every household in India has a negative story to tell about medical doctors. Aamir probably misunderstood or could not differentiate medical errors, medical accidents from medical negligence. People equate money with medical success. Most of the medical disputes occur in private sector when the patient’s relatives have to pay money for an unsuccessful surgery or treatment. Attempts have been made to compare the results of medical treatment in India from that of abroad. They are totally incomparable as the amount of fee charged by doctors in India is practically a fraction of the fee that is charged in the west. The patient load in India per doctor is also responsible for potential medical errors.

One should also remember that the Drug Controller Government of India (DCGI) does not inform doctors about banned drugs, introduction of new drugs or introduction of new equipment. Most doctors depend on technology to be learnt through the manufacturers of respective machines. The manufacturers either bring the training persons from abroad or support the training of Indian doctors abroad. Their interest is ultimately covered as the doctors once trained ultimately end up in purchasing their technology.

When a new drug is launched, as there is no information from DCGI to individual doctors, they are forced to attend symposia by drug companies, which now come under the purview of an unethical doctor–pharma relationship.

Most doctors will write pharmaceutical drugs of a company, which people think is in lieu of a commission they are getting. The reality is that a doctor will invariably write a drug of a company who is constantly spending in efforts in educating doctors about new technologies and innovations as both Medical Council of India and the Government of India Health Ministry have no such provisions for the doctors. On the other hand, not attending medical educational programs is considered a professional misconduct.



Walking Tips

By Dr K K Aggarwal
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• It requires no special clothes or equipment, and it’s free.

• Make walking fun by going to places you enjoy, like a shopping center or park.

• Bring along someone to chat with, or listen to some of your favorite music (but keep the volume low enough to hear the sounds around you). • Think about safety as you plan when and where to walk.

• Walk with others when possible, and take a phone and ID with you.

• Let someone know your walking time and route.

• If it’s dark outside, wear a reflective vest or brightly colored clothing.

• And always be aware of your surroundings.