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Dr K K Aggarwal

What is the importance of silence?

By Dr K K Aggarwal
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True silence is the silence between thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. Meditation is the process of achieving silence.

Observing silence is another way of deriving benefits of meditation. Many yogis in the past have recommended and observed silence now and then. Mahatma Gandhi used to spend one day of each week in silence. He believed that abstaining from speaking brought him inner peace and happiness. On all such days he communicated with others only by writing on paper.

Hindu principles also talk about a correlation between mauna (silence) and shanti (harmony). Mauna Ekadashi is a ritual followed traditionally in our country. On this day the person is not supposed to speak at all and observes complete silence all through the day and night. It gives immense peace to the mind and strength to the body. In Jainism, this ritual has a lot of importance. Nimith was a great saint in Jainism who long ago asked all Jains to observe this vrata. Some people recommend that on every ekadashi one should observe silence for few hours, if not the whole day.

In his book, The Seven Spiritual Laws of Success, Deepak Chopra talks in great detail about the importance of observing silence in day to day life. He recommends that everyone should observe silence for 20 minutes every day. Silence helps to redirect our imagination towards self. Even Swami Sivananda in his teachings recommends observation of mauna daily for 2 hours. For ekadashi, take milk and fruits every day, study one chapter of Bhagawad Gita daily, do regular charity and donate one-tenth of your income in the welfare of the society.

Ekadashi is the 11th day of Hindu lunar fortnight. It is the day of celebration, occurring twice a month, meant for meditation and increasing soul consciousness. Vinoba Bhave was a great sage of our country known for his Bhoodaan movement. He was a great advocator and practical preacher of mauna vrata.

Mauna means silence and vrata means vow; hence, mauna vrata means a vow of silence. Mauna was practiced by saints to end enmity and recoup their enmity. Prolonged silence as the form of silence is observed by the rishi munis involved for prolonged periods of silence. Silence is a source of all that exists. Silence is where consciousness dwells. There is no religious tradition which does not talk about silence. It breaks the outward communication and forces a dialogue towards inner communication. This is one reason why all prayers, meditation and worship or any other practice whether we attune our mind to the spiritual consciousness within are done in silence.  After the death of a person it is a practice to observe silence for two minutes. The immediate benefit is that it saves a tremendous amount of energy.

Silence is cessation of both sensory and mental activity. It is like having a still mind and listening to the inner mind. Behind this screen of our internal dialogue is the silence of spirit. Meditation is the combination of observing silence and the art of observation.

(Disclaimer: The views expressed in this write up are my own).

Children with the following risk factors should be referred for early dental evaluation

By Dr K K Aggarwal
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  • Mother/primary caregiver with active cavities
  • Parent/caregiver with low socioeconomic status
  • Prolonged breastfeeding or bottle-feeding (>12 months)
  • Frequent consumption of sugary beverages and snacks
  • Use of a bottle at bed time, especially with sweetened beverages
  • Use of liquid medication for longer than three weeks
  • Exposure to passive tobacco smoke
  • Children with special health care needs
  • Insufficient fluoride exposure
  • Visible plaque on upper front teeth
  • Enamel pits or defects

 

All about depression

By Dr K K Aggarwal
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  1. Depression is a major public health problem as a leading predictor of functional disability and mortality.
  2. Optimal depression treatment improves outcome for most patients.
  3. Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
  4. A non–psychiatrist physician misses the diagnosis of depression 50% of times.
  5. All depressed patients must be specifically asked about suicidal ideations.
  6. Suicidal ideation is a medical emergency.
  7. Risk factors for suicide are psychiatric known disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide.
  8. Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  9. World over about 1 million people commit suicide every year.
  10. Seventy–nine percent of patients who commit suicide contact their primary care provider in the last one year before their death and only one–third contact their mental health service provider.
  11. Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
  12. Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.
  13. In the US, suicidal rate is 10.5 per 100,000 people.
  14. In America, suicide is increasing in middle aged adults.
  15. There are 10 to 40 non–fatal suicide attempts for every one completed suicide.
  16. The majority of suicides completed in US are accomplished with fire arm (57%); the second leading method of suicide in US is hanging for men and poisoning in women.
  17. Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
  18. Fifty percent of successful victims have made prior attempts.
  19. One of every 100 suicidal attempt survivors will die by committing suicide within one year of the first attempt.
  20. The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older.
  21. Females attempt suicide more frequently than males but males are successful three times more often.
  22. The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children or married with children in descending order.
  23. Living alone increases the risk of suicide.
  24. Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  25. A recent sense of failure may lead to higher risk.
  26. Clinicians are at higher risk of suicide.
  27. The suicidal rate in male clinicians is 1.41 and that in female clinicians is 2.27.
  28. Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  29. The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  30. Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
  31. Major risk for suicidal attempts is in psychiatric disorders, hopelessness and prior suicidal attempts or threats.
  32. High impulsivity or alcohol or other substance abuse increase the risk.

(Disclaimer: The views expressed in this write up are my own).

Some tips to take care of your teeth and prevent tooth decay

By Dr K K Aggarwal
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  1. Brushing helps in preventing the build-up of plaque and bacteria which can cause tooth decay and periodontal diseases.
  2. Floss every day as this helps clean the crevices where the brush cannot reach.
  3. Avoid sugary and starchy foods as sugar in such foods reacts with the bacteria in saliva to form an acid that erodes the tooth enamel leading to tooth decay.
  4. The tongue too harbors bacteria. Therefore, it is a good idea to invest in a tongue scraper and clean it each time you brush your teeth.
  5. Consult a dentist if your gums are inflamed or if they bleed. Do not ignore any pain in the teeth and/or gums.
  6. Get your teeth checked every six months. Dental cleaning and check-up twice a year is imperative.

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.

(Disclaimer: The views expressed in this write up are my own).

Tips from HCFI for malaria prevention

By Dr K K Aggarwal
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  1. Malaria mosquitoes grow in fresh water collected in the house. It is therefore important to not let water stagnate in your house and the surrounding areas. Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is cleaned properly once in a week, there are no chances of mosquito breeding.
  2. Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered. If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
  3. Using mosquito nets/repellents in the night may not prevent malaria because these mosquitoes bite during the day time.
  4. Malaria mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
  5. Wearing full sleeves shirt and trousers can prevent mosquito bites. Mosquito repellent can be helpful during the day.

Spiritual prescriptions learnt from patients

By Dr K K Aggarwal
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In a hospital practice, we all witness suffering all the time. When we were young, in medical college, quite often we were disturbed seeing the sufferings of the people. But, in our practice, we have learnt many spiritual prescriptions from our patients. These have not only helped us to heal our patients but also changed our perception to health and sickness.

I recall Swami Bodhanand, a disciple of Swami Chinmayananda, was once hospitalized under our care. When I asked him to give me a spiritual message, he told me only two words “Detached Attachment”. He said, “As a doctor you should behave like a lotus leaf. It is wet as long as a drop of water is there, but once the drop is out, the leaf is as dry as if the water was never there.” The message was that “we should be attached to our patients as long as they are with us. The day they die, we should be completely detached from them or else we will not be able to treat other patients”.

I saw another spiritual guru through our Chief Anesthetist. The fee he paid to me was a spiritual message “Suno Samjho Jano Karo – Hear Understand Wisdom and Do”. He said that hearing is different from listening, listening is different from wisdom and wisdom is different from doing. Unless you hear, understand what you have heard and implement, the learning has no value.

One of my Buddhist patients gave me a spiritual learning, which has helped me a lot in my routine clinical practice. He taught me the basic Buddhist message that there is suffering all over; there is a reason for every suffering and it is possible to maintain sufferings. This message fits into the main message of Hinduism and also the main teaching from Garud Purana.

In Hinduism, we know that the very fact that we are born in this life means that in our last life, we could not get liberation as Hinduism believes that after liberation you are not reborn. Not getting liberated in the last birth means that some sufferings were left in our life. The basic purpose of this birth, therefore, is to face sufferings. When the basic purpose of our birth is to face sufferings, then why suffer from these sufferings. Every time we suffer, we should thank God that he has reduced one more. The period in between two sufferings is called a happy period (Sukh). In fact that period is nothing but a period of rest given by God to us to prepare the body for next suffering. This as a concept of counseling helps my patients in managing most of their mental disturbances.

Sometimes not telling a patient that he is suffering from terminal cancer works. One of my patient’s father aged 83 years was found to have extensive cancer of the prostate. Medically, we all gave him three months’ to live. My patient did not have the courage to tell his father or the family members that he (the father) had extensive cancer. He took me into confidence and played a game with the family. We gathered all the family members and told them that with the surgery this cancer had been cured. A party was organized in the evening to celebrate the cure. The magic happened; he lived almost a symptom–free life for the next 9 years. I have tried this on many of my patients thereafter and it works. The probable explanation was loss of fear of death, a confidence in his doctor and faith in himself.

The way to live up to the age of hundred is to go on working in life. My great grandfather–in–law was 75 years old, when I got married. That year, he gathered all family members across the world and said that his purpose of life was over and, he would like a collective family photograph and like to quit the world. Nothing happened for a year and on 20th July next year, he again played behaved the same way. Family from across the world gathered but he remained alive for another year. This went on for three years. Suddenly, we played a spiritual trick on him and told everyone to convince him that he is going to live for 100 years as he has many more work of the family to be done. Every year, we gave him law students from within the family to be taught (he was a lawyer himself), or gave him the responsibility of finding a boy for some eligible girl in the family. We made him teach and search for suitable bride/bridegrooms for years together and he actually died at the age of 100 years. This is the beauty of positive attitude in life.

(Disclaimer: The views expressed in this write up are my own).

How to keep your memory sharp?

By Dr K K Aggarwal
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  1. Manage your stress, especially pressures of deadlines and petty arguments.
  2. The biggest stress is an ongoing sense of extreme anxiety. This can be managed by deep breathing, meditation, yoga and by mindful approach to living.
  3. Get a good night’s sleep. The most common reason for poor sleep is difficulty in falling asleep and staying asleep. Many drugs are used to treat insomnia, which can also impair memory.
  4. If you need a sleeping medicine, it should be used in the lowest dose for the shortest period of time.
  5. Get up at the same time in the morning.
  6. If you smoke, quit.
  7. If you do not drink, do not start.
  8. Alcohol makes it difficult to perform short term memory tasks such as memorizing list. Alcohol induces vitamin B1 deficiency, which can cause dementia.
  9. 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.

How to Improve Your Soul Profile

By Dr K K Aggarwal
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  1. What is my purpose of life?
  2. What is my contribution going to be for my friends and family?
  3. Three instances in my life when I had my peak experiences.
  4. Names of three people who inspire me the most.
  5. Three qualities which I admire the most in others.
  6. Three of my unique talents.
  7. Three qualities I best express in my relationship.

These 21 answers will characterize one’s soul profile and can be used as a passport for every action performed in life and to be used as a reference in any difficulty. The principle is that in everyday life, one should act from the Soul Profile and not from the Ego Profile. While the Soul profile cannot be manipulated, the Ego Profile can be.

(Disclaimer: The views expressed in this write up are my own).

Some tips to reduce noise pollution from HCFI.

By Dr K K Aggarwal
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  1. Signboards displaying ‘Silence zone’, ‘No honking’ must be placed near schools and hospitals.
  2. Efforts should be made to ban the use of horns with jarring sounds, motorbikes with damaged exhaust pipes, and noisy trucks.
  3. The use of loudspeakers in parties and discos, as well as public announcements systems should be checked and discouraged.
  4. Noise rules must be stringent and strictly enforced near such silence zones.
  5. Planting trees along roads and in residential areas is a good way to reduce noise pollution as they absorb sound.

Eating Out Tips

By Dr K K Aggarwal
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  1. Curb portions: Always order for one if you are two people and if you are alone set aside some of what is on your plate to bring home.
  2. Resist refined carbohydrates.
  3. Load your plate with colorful choices at the salad bar with vegetables, fruits and small amounts of lean protein. Skip the creamy and ranch dressings.
  4. Choose dishes that are grilled, roasted, steamed, or sautéed.
  5. Don’t be afraid to request a salad, vegetables, or fruit instead of starchy side dishes.
  6. If you are a non–vegetarian, order only fish or seafood.
  7. If you decide to have dessert, share it with your dining companion(s).

Five Types of People – from Nastik to Astik

By Dr K K Aggarwal
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Following are the five types of people:

  1. Nastik: Those who do not believe in God.
  2. Astik: For whom God exists.
  3. Those who believe that God also exists in them (I and the God are the same)
  4. Those who believe in Tat Tvam Asi (God not only exists in me but also in you)
  5. Those who believe that God is in everybody

People who believe that God exists are fearful people and they always fear God. People who see God in themselves, live a disciplined Satvik life and do not indulge in activities that are not God-friendly.

People who believe that God is not only in them but also in you, treat every person the same way as they treat themselves. People for whom God is everywhere always work for the welfare of the society.

(Disclaimer: The views expressed in this write up are my own).

Elderly should beware of commonly prescribed group of drugs

By Dr K K Aggarwal
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Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to “slow down” in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anticholinergic drugs used to treat acid reflux, Parkinsons disease and urinary incontinence may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include nifedipine (antihypertensive), ranitidine (reduces stomach acid) and tolterodine (medication for incontinence).

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.

Positive Attitudes

By Dr K K Aggarwal
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All those out there who feel you are at your wits end wondering how things don’t ever work out for you, can now relax and dwell on all those failures that life has taken you through and turn failure into success.

  1. Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
  2. Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
  3. Failure doesn’t mean you have been foolish. It does mean you had a lot of faith.
  4. Failure doesn’t mean you’ve been discouraged. It does mean you were willing to try.
  5. Failure doesn’t mean you don’t to do. It does mean you have to do it in a different way.
  6. Failure doesn’t mean you are inferior. It does mean you are not perfect.
  7. Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
  8. Failure doesn’t mean you should give up. It does mean you must try harder.
  9. Failure doesn’t mean you’ll never make it. It does mean it will take a little longer.
  10. Failure doesn’t mean God has abandoned you. It does mean God has a better idea.

(Disclaimer: The views expressed in this write up are my own).

Cycling can cause erectile dysfunction

By Dr K K Aggarwal
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Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. For those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling, less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.