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Dr K K Aggarwal

World Osteoporosis Day: 5 steps to healthy bones and a fracture-free future

By Dr K K Aggarwal
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1. Exercise regularly: Weight-bearing, muscle-strengthening and balance-training exercises are best.

2. Ensure a diet rich in bone-healthy nutrients: Calcium, vitamin D and protein are the most important for bone health. Safe exposure to sunshine will help you get enough vitamin D.

3. Avoid negative lifestyle habits: Maintain a healthy body weight, stop smoking and reduce alcohol intake.

4. Identify your risk factors: and bring these to your doctor’s attention, especially if you’ve had a previous fracture or have specific diseases and/or are taking medications that affect bone health.

5. Take osteoporosis medicine, if needed: Treatment will help to improve bone miner density (BMD) and reduce risk of fracture.

(Source: http://worldosteoporosisday.org/2016/campaign)

Why are coconut and kalash used in all poojas?

By Dr K K Aggarwal
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If nature wanted you to drink coconut water in non-coastal areas it would not have grown coconuts in the coastal areas is a common naturopathic saying. Coconut water is the treatment for most humidity-related illness in coastal areas. It is sterile water and has been used in surgical practice as a sterile fluid. It is also used as a replacement for oral rehydration solution. Hence, because of its many uses it is regarded as the ‘Tree of Life’.

Coconut is one of the most common offerings in a temple, during weddings, festivals, when one acquires a new vehicle or in a Grihapravesh or the house warming ceremony etc. It is offered in all sacrificial fires whilst performing the Homa (fire rituals). The coconut is usually split and placed before the Lord and is later distributed as Prasadam. The fiber covering of the dried coconut is removed except for a tuft on the top.

The marks on the coconut make it look like the head of a human being. The splitting of a coconut symbolizes the conquest of the ego. The outer covering represents the body, the juice within, one’s inner tendencies (vasanas) and the white kernel, the mind. One should be as firm as the outer shell of the coconut but the same time as soft like the inner fruit of the coconut.

A coconut or Sriphala (fruit of the gods) is the only fruit used to symbolize God while worshipping any deity. It is used in the making of a Purna-Kumbha, (‘purna’ = full, ‘kumbha’ = pot or kalash) an independent object of worship. The earthen pot full of water and with fresh mango leaves and a coconut on top is placed as the main deity or by the side of the deity before starting any Pooja. The pot symbolizes Mother Earth; water, the life-giver, the leaves, life (air) and the coconut, divine consciousness (space). All religious rituals start with the worship of the kalash with coconut as symbol of Lord Ganesha. The coconut is also worshipped as symbol of the Godhead – the three eyes symbolic of the eyes of Lord Shiva. (Trayambaka – Rudra). Sage Vishwamitra got the first coconut tree grown on this earth by the power of his tapa. Its hard shell inspires one to have tolerance and do hard work for attaining success. The coconut also symbolizes selfless service. Every part of the tree – the trunk, leaves, fruit, coir etc. are used to make thatches, mats, tasty dishes, oil, soap etc.

Coconut water is used in the preparation of many ayurvedic drugs. The kernel is used to gain strength and improve eyesight. Its water is nourishing. Coconut oil is used to nourish the hair. It has glucose, phosphorous and carbohydrates. Germs cannot penetrate its hard kernel. Ancient Indian healers burnt its outer shell to prepare tooth powder, eyebrow creams and ointments for burns. Coconut milk is made by grating the endocarp and mixing it with warm water. This produces a thick, white liquid called coconut milk which is used extensively used in Asian cooking, for example, in curries. Coconut water from the unripe coconut, on the other hand, is drunk fresh as a refreshing drink.

Tender coconut water is used in the rituals of abhishek, since it is believed to bestow spiritual growth on the seeker. On the auspicious occasion of Rakhi Purnima (Rakshabandhan), coconuts are thrown into the sea as offerings to Varuna, God of the Sea. In western India, this festival is called Nariyal Purnima (Coconut Full Moon).

The Chandogya Upanishad by Swami Krishnananda (78) talks about another quality of the coconut that has a spiritual resonance: “the coconut that is raw sticks to the shell. That is the condition of the bound soul. Consciousness sticks to the shell of this body. But in the case of the liberated soul, it is inside the body, no doubt, but is not sticking to the body, even as the dry coconut is not touching the shell. It makes a sound inside if we shake it. It is detached from the shell, though it is there tentatively. Even so, consciousness is not confined to the body, even though it is inside.”

In the Chidakasha Gita by Paramahansa Nityananda, the coconut tree is described as a state of meditation: “At another time all feeling comes to a standstill. Sometime the body becomes quite motionless like a coconut tree”.

Ganesha’s favorite food is made up of a sweet core of candied coconut pulp covered with a layer made of white flour. The insipid outer shell is said to represent the gross physical body, the sweet inside stands for the resplendent soul.

When the Asuras and the Devas churned the milky ocean, Lord Dhanwantri appeared bearing the pot of nectar, which blessed one with everlasting life. Thus, the kalasha also symbolizes immortality.

 

 

Exercise impact on the knee

By Dr K K Aggarwal
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Different exercises produce different impacts on the knee joints. The best and safest exercises that cause minimum impact on the knee in patients post knee replacement or knee arthritis are walking, biking, hiking, riding an exercise bike, riding an elliptical trainer and walking on the treadmill. In sports, one can play doubles tennis but not singles. One can also participate in downhill or cross–country skiing. Jogging and golf swings produce maximum stress.

• Biking generate the least force, producing impact of about 1.3 times the body weight.

• Treadmill walking is the next best, producing forces of 2.05 the body weight.

• Walking on level ground generate forces of 2.6 times the body weight.

• Tennis produces forces of 3.1 to 3.8 times the body weight, with serving producing the highest impact.

• Jogging produces forces of 4.3 times body weight.

• Golf swings produces forces of 4.5 times body weight on the forward knee and 3.2 times body weight in the opposite knee. Positions and activities that place excessive pressure on the knee joint include:

• Squatting and kneeling

• Twisting and pivoting

• Repetitive bending (multiple flights of stairs, getting out of a seated position, clutch and pedal pushing, etc.)

• Jogging

• Aerobics, dancing

• Playing stop and go sports (basketball, sports that use racquets)

• Swimming using the frog or whip kick Exercise equipments that place excessive pressure on the knee include:

• Stair stepper

• Stationary bicycle

• Rowing machine

• Universal gym utilizing leg extensions

The preferred exercise equipment for the knee should provide smooth motion of the knee, maximal toning of the front and back thigh muscles (quadriceps and hamstring muscles), minimal jarring and impact to the joint and the least amount of bending to accomplish toning.

Activities that are acceptable alternatives to the above include:

• Fast walking

• Water aerobics

• Swimming using the crawl stroke

• Cross country ski machines

• Soft platform treadmill

• Trampoline

 

Definition of Health

By Dr K K Aggarwal
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Health is not mere absence of disease; it is a state of physical, mental, social, spiritual, environmental and financial well-being. Allopathy does not define all aspects of health.

During MBBS, medical students are taught more about the physical health. Social and mental health are covered only in few lectures. Community health is a separate subject but never given its due importance. Spiritual health is not defined at all and financial health is hardly covered.

Yet, in day-to-day practice it is the social, financial, spiritual and community health, which is the most important during patient-doctor communication. It is incorporated in the four basic purposes: dharma, artha, kama and moksha.

Dharma and artha together form the basis of karma which is righteous earning. You are what your deep rooted desires are. Most of the diseases today can be traced to a particular emotion, positive or negative. Anger and jealously are related with heart attack, fear with blood pressure, greed & possessiveness with heart failure. Unless the mind is healthy, one cannot be free of diseases.

The best description of health comes from Ayurveda. In Sanskrit health means swasthya, which means establishment in the self. One is established in the self when there is a union of mind, body and soul. Most symbols of health are established around a shaft with two snakes and two wings. The shaft represents the body, two snakes represent the duality of mind and the two wings represent the freedom of soul.

Sushrut Samhita in Chapter 15 shloka 10 defines the ayurvedic person as under:

Samadosha, samagnischa,

Samadhatumalkriyah,

Prasannatmendriyamanah,

Swastha iti abhidhiyate.

From the Ayurvedic point of view, for a person to be healthy, he must have balanced doshas, balanced agni, balanced dhatus, normal functioning of malkriyas and mind, body, spirit and indriyas full of bliss and happiness.

Human body is made up of structures (Kapha) that perform two basic functions: firstly, metabolism (pitta) and movement (vata). Vata, pitta and kapha are called doshas in Ayurveda. Samana dosha means balance of structures, metabolism and movement functions in the body. Agni in Ayurveda is said to be in balance when a person has normal tejas and a good appetite.

Ayurveda describes seven dhatus: rasa, rakta, mamsa, medha, asthi, majja, shukra and they are required to be in balance. They are equivalent to various tissues in the human body.

Ayurveda necessitates proper functioning of natural urges like urination, stool, sweating and breathing and that is what balances in malakriya means.

Ayurveda says for a person to be healthy he has to be mentally and spiritually healthy which will only happen when his or her indriyas are cheerful, full of bliss and devoid of any negativities. For indriyas to be in balance one has to learn to control over the lust cum desires, greed and ego. This can be done by learning regular pranayama, learning the do’s and don’ts in life, living in a disciplined atmosphere and learn to live in the present.

Regular pranayama shifts one from sympathetic to para sympathetic mode, balances the mind and thoughts and helps in removing negative thoughts from the mind. For living a disabled life one can follow the yama and niyama of yoga sutras of Patanjali or dos and don’ts taught by various religious gurus, leaders and principles of naturopathy. Living in the present means conscious or meditative living. This involves either learning meditation 20 minutes twice a day or learning subtle mental exercises like mind–body relaxation, yogic shavasana, self–hypnotic exercises, etc.

According to Yoga Sutras of Patanjali, a person who eats thrice a day is a rogi, twice a day is a bhogi and once a day is yogi. The take home message is: to live more, eat less.

Swar yoga defines the importance of respiration and longevity. According to this yoga shastra, everybody has a fixed number of breaths to be taken during the life span.

Lesser the number a person takes in a minute more is the life. It also forms the basis of pranayama which is nothing but longer and deeper breathing with reduced respiratory rate. To be healthy one can remember to follow the principle of moderation and variety in diet & exercise, regular pranayama & meditation and positive thinking.

 

If you have high BP keep your sugar lower than 90

By Dr K K Aggarwal
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Hypertension is a risk factor for type 2 diabetes. If not properly managed they are likely to end up with diabetes with subsequent high risk of kidney damage.

The results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) study have shown that the major predictor of new-onset diabetes (NOD) in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg/dL. The risk increases by 5.8 times for each 18mg/dl rise above 90 mg/dL.

Other risk factors are higher weight, higher blood pressure and higher triglyceride levels. Hypertensive patients on atenolol (beta blocker drug) with or without a diuretic are also at risk.

On the other hand, high BP patients on amlodipine (calcium blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use and age older than 55 years are protected from developing diabetes.

 

Prakriti, Vikriti and Sanskriti

By Dr K K Aggarwal
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Prakriti is when a person lives for himself or when his actions are centered towards oneself. Sanskriti is when one lives for the sake of others and vikriti is nothing but distortion in one’s living.

Greed is one type of vikriti which can make a ‘nar’ a ‘narbhakshi’ and later ‘nar rakshas. On the other hand, if a person works towards sanskriti it can convert him or her ‘nar’ to ‘narottam’ and from ‘narottam’ to ‘Narain’.

The aim in life, therefore, should be to work not for oneself but for the welfare of the others. These people gradually start working for themselves often for the family, society, nation and universe respectively.

Lord Buddha also said that any action done should follow the rule that it is directed for the welfare of all. Gandhi also propagated Sarvodaya or dedicating one’s actions to the welfare of all.

The basic fundamental teaching of the Vedic science is also based on Sarvodaya. Sahdev in Mahabharat and Bharat in Ramayan also talked about the sarvodaya properties, which every human being has.

Dr. Deepak Chopra in his book ‘7 Spiritual Laws of Success’ also writes that one should always ask his or her consciousness when meeting a person as to how one can help the other person.

Even a feeling of helping someone can make a difference.

Be Alert from Symptom of Heart Attack

By Dr K K Aggarwal
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If you are not sure whether you are having heartburn or something more serious –– like a heart attack –– you should get yourself checked out.

The most common symptom of coronary heart disease is chest pain (angina) or discomfort, which can also occur in the shoulders, arms, neck, jaw or back. People may mistake this pain for indigestion, which can be dangerous. Sometimes, it’s impossible to tell the difference between the symptoms of heartburn, angina and heart attack.

A heart attack occurs when the blood supply to part of the heart muscle is severely reduced or stopped. This can result in death or disability, depending on how much of the heart muscle is damaged. Unfortunately, many people may not be aware they are having a heart attack.

There are some useful pointers that might help a person know whether they’re having a heart attack or not, but when in doubt, one should check it out.

Symptoms of a heart attack include the sudden onset of tightness, pressure, squeezing, burning or discomfort in the chest, throat, neck or either arm. When these symptoms are accompanied by nausea, vomiting, sweating, shortness of breath or a fainting sensation, Dr. Aggarwal says one should be especially suspicious that you might be having a heart attack. People who have any risk factors that may predispose them to a heart attack should be particularly cautious.

Main points

• Heart attack pain is never pinpointed

• Heart attack pain never lasts less than 30 seconds.

• If you smoke, have diabetes, high cholesterol, high blood pressure, are overweight or have a strong family history of heart disease and have any symptom related to the chest or heart, you should be alert.

Direct all your energy towards the should and nor the ego

By Dr K K Aggarwal
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The epic Mahabharata can also be understood as a science of inner Mahabharata happening in everybody’s mind.

Lord Krishna here symbolizes consciousness and the five Pandavas, the five positive qualities of a person and they are – righteousness (Yudhishthir), being in focus (Arjuna), power to fight injustice (Bheem), helping others (Sahdev) and learning to be neutral in difficult situations (Nakul). Panchali indicates the 5 senses, which can only be controlled when these five forces are together.

Dhritrashtra symbolizes ignorance, Duhshasan negative ruling quality (dusht while ruling) and Duryodhana (dusht in yudh) as one who is not balanced in war.

To kill the negativity in the mind, one has to take conscious-based decisions. Every action, if directed towards the consciousness or the soul, is the right action. To kill the 100 Kauravas (the 100 negative tendencies a person can have) controlled by Duryodhan and Duhshasan along with Shakuni (the negative power of cunningness), one has to redirect one’s positive qualities towards the consciousness and take right decisions.

The five Pandavas (positive qualities) made soul (Lord Krishna) as their point of reference (Sarthi) and won over the evils (Kauravas).

Bhishma Pitamah, Karana and Dronacharya, all had winning powers individually but they all gave support to the negative thoughts and made Duryodhana as their point of reference and ultimately had to die.

The message is very clear – if one directs his or her positive powers towards ego as the reference point in long run, they will be of no use and, in fact, will be responsible for one’s destruction.

In Ramayana, Ravana was a great scholar but he directed all his energies and powers towards his ego and ended up in misery.

One should cultivate, therefore, positive mental attitude, positive thoughts instead of directing them towards desire, attachment or ego and should direct them to soul/consciousness for a positive outcome.

How to keep your memory sharp?

By Dr K K Aggarwal
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• Manage your stress especially deadline pressure and petty arguments.

• The biggest stress is ongoing sense of extreme anxiety. The stress can be managed by deep breathing, meditation, yoga and by mindful approach to living.

• Get a goodnight sleep. The most common reason for poor sleep is difficulty falling asleep and staying asleep. Many drugs used to treat insomnia can also impair memory.

• If you need a sleeping medicine, it should be used in the lowest dose for the shortest period of time.

• Get up at the same time in the morning.

• If you smoke, quit.

• If you do not drink, do not start.

• Alcohol makes it difficult to perform short-term memory tasks such as memorizing a list.

• Alcohol induces vitamin B1 deficiency, which can cause dementia.

• Protect your brain from injury as repeated minor head trauma can cause brain damage.

• Wear seat belt when riding in motor vehicle.

• Wear helmet while driving or riding motorcycle.

Why do we place our hands over the flame?

By Dr K K Aggarwal
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Flame is the “flame” of true knowledge. At the end of any aarti, we place our hands over the flame and then touch our eyes and the top of the head. It means “May the light that illuminated the Lord light up my vision; May my vision be divine and my thoughts noble and beautiful.”

The metaphysical implication of aarti extends further. The sun, moon, stars, lightning and fire are the natural sources of light. The Lord is the source of these wondrous phenomena of the universe. It is due to Him alone that everything exists.

As we light up the Lord with the flame of the aarti, we turn our attention to the very source of all light which symbolizes knowledge and life. Also, the Sun is the presiding deity of the intellect, the moon, that of the mind, and fire, that of speech. The Lord is the supreme consciousness that illuminates all of them. Without Him, the intellect cannot think, the mind cannot feel and the tongue cannot speak. The Lord is beyond the mind, intellect and speech.

How can these finite entities illuminate the Lord? Therefore, as we perform the aarti we chant: Na tatra suryo bhaati na chandra taarakam, Nemaa vidyuto bhaanti kutoyamagnib Tameva bhaantam anubhaati sarvam, Tasya bhasa sarvam idam vibhaati “He is there where the sun does not shine, nor the moon, stars and lightning. Then what to talk of this small flame (in my hand), everything (in the universe) shines only after the Lord, and by His light alone are we all illumined”

In our spiritual journey, even as we serve the guru and society, we should willingly sacrifice ourselves and all we have, to spread the “perfume” of love to all. We often wait a long while to see the illuminated Lord. But, when the aarti is actually performed, our eyes close automatically as if to look within. This is to signify that each of us is a temple of the Lord.

Tips to clinically differentiate between different types of fever

By Dr K K Aggarwal
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• If a patient comes with fever with chills and rigors, think of Malaria in north and filaria in Vidarbha region in India.

• In malaria, chills are in the afternoon; in filaria, the chills occur in the evening.

• Fever with joint pains on extension often is due to Chikungunya (flexion improves the pain)

• Think of dengue if there is fever with itching, rash and periorbital pain.

• In fever with single chills, think of pneumonia.

• Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children.

• Fever with red angry–looking throat: Think of streptococcal sore throat

• Fever with red epiglottis: Think of Hemophilus infection

• Fever with cough and or nasal discharge: Think of common flu

• Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu

• Fever with toxic look, persistent fever: Look for typhoid

• Fever with no or low rise in pulse: Look for typhoid

• Fever with urinary symptoms (burning, frequency): Rule out urinary infection.

• Fever with high TLC (white cell count) and liver pain: Rule out liver abscess

• Fever with watery diarrhea, with no blood or mucous: Rule out acute gastroenteritis • After the fever is over, jaundice appears: This is viral hepatitis

• After the fever is over, one feels very weak: Rule our dengue hemorrhagic fever.

Why do we close our eyes for meditation?

By Dr K K Aggarwal
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Whenever we pray, think of God, undertake an internal healing procedure, kiss someone, or meditate, we automatically close our eyes.

It is a common Vedic saying that the soul resides in the heart and all the feelings are felt at the level of heart.

Most learning procedures in meditation involves sitting in an erect, straight posture, closing the eyes, withdrawing from the world and concentrating on the object of concentration. Yoga Sutra of Patanjali describes pratihara (withdrawal of senses) as one of the seven limbs of yoga, Yama, niyama, asana, pranayama, pratihara, dharma, dhyana and Samadhi.

After pranayama, one needs to withdraw from the world and the senses and then start dhyana on the object of concentration. The process of pratihara becomes easy and is initiated with the closing of the eyes.

The inward journey starts with the detachment of the body from the external world and in yogic language, it is called Kayotsarga.

In the initiation of hypnosis also, a person is made to lie down, look at the roof and withdraw from the world. The procedure involves asking the person to gently roll the eyeball up until he goes into a trans. Rolling of the eyeballs upward has the same physiological significance as that of closing the eyes.

When we close our eyes, there is a suppression of sympathetic nervous system and activation of para sympathetic nervous system. During this period, blood pressure and pulse reduce and skin resistance goes up. A person goes into a progressive phase of internal and muscular relaxation.

The inward journey is a journey towards restful alertness where the body is restful yet the consciousness is alert. The intention is to relax the body and then the attention is focused on the object of concentration. Most visualization and meditation techniques involve closing of the eyes.

By detaching from the external stimuli, one suppresses the activities of the five senses and shifts ones awareness from disturbed to undisturbed state of consciousness. The inner journey helps in producing a state of ritambhara pragya where the inner vibrations of the body become in symphony with the vibrations of the nature.

People who visit Vaishno Devi by traveling long distances on foot enter the cave and as soon as they see Maa Vaishno Devi they close their eyes. This is natural and instant. Because Maa Vaishno Devi is not felt in the murti but her presence is felt in the heart and that presence can only be felt by closing the eyes.

Most yogic techniques like shavasana, yoga nidra, body-mind relaxation, progressive muscular relaxation, hypnosis involves closing the eyes in the very first step. Daytime nap is also incomplete without closing the eyes. Shok sabha and 2 minutes maun sabha are also practiced with the eyes closed. When we think of someone or try to remember something the body automatically closes the eyes and one starts exploring the hidden memories. For recalling anything one must withdraw from the external world through its five senses.

Only advanced yogis or rishis acquire the power where with eyes opened they are in a state of ritam, bhara, pragya. These yogic powers are acquired by practicing advanced sutra meditation for hours, days and years. Lord Shiva has been shown in a meditative pose sitting on Kailash Parvat with the eyes semi opened. But for ordinary persons like us where the aim is to be in that phase only for 20 min. twice a day, the best is to close our eyes as the first step towards the process of meditation.

 

Even children can have acidity

By Dr K K Aggarwal
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Children who have continuing recurrence of cough and croup could be suffering from stomach acid reflux problems.

Croup or ‘Kali Khansi’, as it is called in local parlance, is recognized by a loud cough that often sounds like the barking of a seal. It can cause rapid or difficult breathing, and sometimes wheezing. Croup is thought to be caused by a virus, but reflux acidity has been suggested as a possible trigger.

In gastroesophageal reflux disease (GERD), stomach acid causes swelling and inflammation of the larynx, which narrows the airway. It can trigger more swelling with any viral or respiratory infection.

Identifying children with GERD could help treat and improve recurring croup. It is unusual for a child to have three or more bouts of croup over a short period of time. These children need to be evaluated.

The same is true for adults also. Patients with non responding asthma should be investigated for underlying acidity as the cause of acute asthma.

Forgetfulness and Age

By Dr K K Aggarwal
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By the time we cross 40, most of us suffer from minimal cognitive impairment and have a memory loss of very recent events or objects. This is age related and should not be confused with dementia.

This can also happen in patients who are vegetarians and vitamin B12 deficient. People often have difficulty in naming objects and name of the people.

Just as a computer hangs up while doing multiple tasks, so does the human mind. When you handle multiple projects at the same time, you may experience thought blocks, which is natural and not a sign of a disease.

When we introduce ourselves to a new person, we often tell our name first. It is possible that by the time you finish your conversation, the person may forget your name. Therefore, one should either introduce themselves last after the conversation is over or introduce oneself at both times i.e. at the start and at the end of the conversation.

Some people introduce themselves before the conversation and hand over their visiting card at the end of a conversation. This is also taught in how to market yourself.

As medical doctors, we face these difficulties quite often. People send SMSs without their names or call without telling their names. For example, I once got a call “Malhotra Bol Raha Hoon Pehchana Kya?” As a doctor, we may have had hundreds of Malhotras as our patients and it is not expected from us, especially, after the age of 40 to recall a person just by his surname. Unless we are given complete information by the patient on phone, mistakes can be made, especially, if it is a phone consultation. In any way, phone consultation needs to be avoided. Even Supreme Court in one of its judgments said that giving phone consultation may amount to professional misconduct on the part of the doctor.

Diabetes mainly linked to obesity

By Dr K K Aggarwal
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Type 2 diabetes mellitus is strongly associated with obesity.

More than 80 percent of cases of type 2 diabetes can be attributed to obesity.

1. There is a curvilinear relationship between BMI and the risk of type 2 diabetes.

2. Lowest risk is associated with a BMI below 22 kg/m2

3. At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.

4. Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes.

5. The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg.

6. Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial.

7. Weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes.

8. Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels.

9. Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contributes to high lipid levels and high blood pressure.