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Dr K K Aggarwal

Harvard 8 tips for buying shoes that are good to your feet

By Dr K K Aggarwal
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Start with your own feet, and look at what’s already in your closet. Stand barefoot on a piece of paper or cardboard, and trace the shape of each foot. Now take your shoes, one by one, and place them on top of the drawing. If you’re like most people, your “comfortable” shoes will closely match the outline of your own feet.

Identify the shoes that cause pain. If you’re a woman, most of these will be shoes with narrow toes or high heels. Check to see if the toe of the shoe is narrower or shorter than your own toes.

Wait until the afternoon to shop for shoes — your feet naturally expand with use during the day and may swell in hot weather.
Wear the same type of socks that you intend to wear with the shoes.
Have the salesperson measure both of your feet. If one foot is larger or wider than the other, buy a size that fits the larger foot.
Stand in the shoes. Make sure you have at least a quarter– to a half–inch of space between your longest toe and the end of the shoe.
Walk around in the shoes to determine how they feel. Is there enough room at the balls of the feet? Do the heels fit snugly, or do they pinch or slip off? Don’t rationalize that the shoes just need to be “broken in” or that they’ll stretch with time. Find shoes that fit from the start.
Trust your own comfort level rather than a shoe’s size or description. Sizes vary from one manufacturer to another. You’re the real judge.
Feel the inside of the shoes to see if they have any tags, seams, or other material that might irritate your feet or cause blisters.
Turn the shoes over and examine the soles. Are they sturdy enough to provide protection from sharp objects? Do they provide any cushioning? Also, take the sole test as you walk around the shoe store: do the soles cushion against impact? Try to walk on hard surfaces as well as carpet to see how the shoes feel.

What is charity?

By Dr K K Aggarwal
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Some time back after returning from a free health check-up camp, I met a processor of Cardiology from Lucknow and started boasting that I had seen 100 patients free today. He said do not get excited. Charity is a positive, but still not the absolute positive, unless it is done without any motive or done secretly. He said that you were honored on the stage; you got blessings from the patients and people talked about you in positive sense. It was an investment in the long run and not an absolute charity. When you serve, never be honored on the stage by the people to whom you are serving. If you get that then it is like give and take. The purpose of life should be to help others without any expectations.

Understanding helping others

When you help others, it should not harm somebody else even though your help is unconditional. If you promote somebody by superseding another deserving senior person, this is not a help as the person to whom you are helping will give you one blessing but the person to whom you have harmed will give you 10 curses. Ultimately you end up with minus 8 points. Helping other means that it should give happiness to you, to the persons you have helped and also to others to whom you have not helped.

Helping always pays

The difference between American and Indian models is that Indians always think of now and do not invest in future. Americans always plans for the future. When we help somebody, we want that the same person should expect you by helping you when you are in need in a shorter run. But charity does not believe in that. Your job is to help others and negate your negative past karmas. You never know, may be decades later you might receive help from a person who you had helped decades earlier. Help should never be linked to returns.

CT not required in appendicitis

By Dr K K Aggarwal
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When a patient has all the signs of acute appendicitis, waiting to get a CT scan to confirm the diagnosis is not required.

Compared with a straight-to-surgery approach, the CT strategy is linked to delayed surgery and increased risk of a burst appendix.

Pre-operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis. If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned. These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.

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. All aspects of health are not defined in Allopathy. During MBBS, medical students are taught more about physical health. Social and mental healthcare is covered only in few lectures. Community health is a separate subject but is 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 and 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 Ayurvedic point of view, for a person to be healthy, he/she 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), which have two basic functions to perform; firstly, metabolism (pitta) and movement (vata). Vata, pitta and kapha are called doshas in Ayurveda. Samana dosha means imbalance 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 balance in malakriya means. Ayurveda says for a person to be healthy he/she has to be mentally and spiritually healthy, which will only be possible 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 lust and desires, greed and ego. This can be done by learning regular pranayama, learning the dos and don’ts in life, living in a disciplined atmosphere and learn to live in the present. Regular pranayama shifts one from sympathetic to parasympathetic 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-daily 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 one should 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. Fewer the breaths 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 should follow the principle of moderation and variety in diet and exercise, regular pranayama and meditation and positive thinking.

Pharma companies can no longer gift freebies to Indian doctors

By Dr K K Aggarwal
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Excerpts from a report by Rupali Mukherjee in TOI news dated Dec 23.

1. Doling out freebies, cruise tickets, paid vacations and sponsorship to educational conferences and seminars for doctors by pharmaceutical companies has been banned from January.

2. The government has woken up belatedly to curb unethical marketing practices of pharma companies by spelling out a uniform code of conduct for the industry. The code will be voluntary to start with, and kicks in from January 1. It will be reviewed after six months; if not implemented "effectively", the government will "consider"' making it mandatory, sources told TOI.

3. At present, the pharma industry follows a "self-regulatory'' code that curbs unethical sales promotion and marketing expenses, bans personal gifts, and all-expenses paid junkets for doctors and their families, but there have been several instances where companies have violated the code, industry experts say. They say the code exists only on paper as companies try to influence prescriptions through several ways.

4. This is the first time in years that the code has been finalized by the government, as earlier attempts to do so got mired in bureaucratic red tape. 

5. Industry experts say that the government's Uniform Code of Pharmaceutical Marketing Practices has been modelled on the Medical Council of India (MCI) guidelines for doctors and healthcare professionals, which were further tightened in 2012.

6. The code clarifies the relationship with healthcare professionals. Regarding gifts, it says "no gifts, pecuniary advantages, or benefits in kind may be supplied, offered or promised to persons qualified to prescribe or supply drugs, by a pharma company, or any of it agents including retailers, distributors or wholesalers".

7. It says "in any seminar, conference or meeting organized by a pharma company for promoting a drug or disseminating information, if a medical practitioner participates as a delegate, it will be on his/her own cost."

8. It further says that gifts for the personal benefit of healthcare professionals and family members (both immediate and extended) such as tickets to entertainment events are also not to be offered or provided by pharma companies, nor cash or monetary grants for individual purposes. Hospitality should also not be extended to any doctor or their family members.

9. The industry associations have to upload the Uniform Code on their websites and will be responsible for informing its members, and the government in case of violations.

10. The code also adds that "where there is any item missing, the code of MCI as per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002 as amended from time to time, will prevail''.


eMedinewS Comments: Dr K K Aggarwal

•	MCI code of ethics exists for doctors. Any violation can only be challenged in High Court.

•	 Pharma companies until now were affected for any violation in the Income Tax exemptions.  Now pharma companies will also be governed by a similar ( like MCI) code of conduct. 

•	Unless both pharma and doctors group are covered in their respective code of conduct the problem will not be over. So far the MCI code did not cover pharma companies violating MCI regulations' 

•	It is same like, if doctors violate any MCI code they are punished under violation of MCI ethics regulations but same violations if done by medical establishments they are not punished. The need of the hour is to have uniform code of conduct for medical establishments' also.

•	Another answer is to bring medical establishments and pharma companies also under the preview of MCI ethics regulations.

Is caffeine good for the health?

By Dr K K Aggarwal
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  1. Caffeine is the most consumed stimulant in the world.
  2. It is consumed in the form of coffee and tea.
  3. At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in the daily diet.
  4. Short term benefits include mental alertness and improved athletic performance.
  5. Short-term adverse effects including headache, anxiety, tremors and insomnia.
  6. Long-term adverse affects include generalized anxiety disorder and substance abuse disorders.
  7. Long-term benefits are dose-dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout. Both caffeinated and decaffeinated coffees are also associated with a lower risk of type 2 diabetes.
  8. Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long-term risk factor for myocardial disease.
  9. Most studies show a modest inverse relationship between coffee consumption and all-cause mortality.
  10. Caffeine withdrawal is a well-documented clinical syndrome with headache being the most common symptom. (Source: Uptodate)

Spiritual Prescriptions – Controlling the Inner Noise

By Dr K K Aggarwal
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Yoga Sutras of Patanjali define yoga as restraint of the mental states (Chapter 1.2). In the state of total restrain, the mind is devoid of any external object and is in its true self or the consciousness. To control the mind many Vedic scholars have given their own formulas.

Being in touch with one’s own consciousness requires restraining of the mind, intellect and ego on one hand and the triad of rajas, tamas and satwa on the other hand. Every action leads to a memory, which in turn leads to a desire and with this a vicious cycle starts.

The mental turmoil of thoughts can be equated to the internal noise and the external desires and objects to an external noise.

The process of withdrawing from the external noise with an aim to start a journey inwards the silent field of awareness bypassing the internal noise is called pratihaara by Yoga Sutras of Patanjali. It involves living in a satwik atmosphere based on the dos and don’ts learnt over a period of time or as told by the scriptures.

To control inner noise based thoughts we either need to neutralize negative thoughts by cultivating opposite thoughts or kill the origin of negative thoughts.

Not allowing thoughts to occur has been one of the strategies mentioned by the scholars. One of them has been neti-neti by Yagnayakya.

The other method is to pass through these inner thoughts and not get disturbed by it and that is what the process of meditation is. This can be equated to a situation where two people are talking in an atmosphere of loud external noise. For proper communication one will have to concentrate on each others voice for long till the external noise ceases to disturb. In meditation, one concentrates on the object of concentration to such an extent that the noisy thoughts cease to bother or exist.

One of the ways mentioned by Adi Shankaracharya in Bhaja Govindam and by Yoga Sutras of Patanjali (Chapter 2.35) is that whenever one is surrounded by evil or negative thoughts one should meditate open the contrary thoughts. For example, if one is getting evil desires after seeing bare breasts of a young lady, one can think that these very breasts gave me an opportunity to drink milk when I was born.

Similarly when one is feeling greedy, one can think of donating something to somebody. Deepak Chopra in his book Seven Laws of Spiritual Success talks in detail about the importance of giving and sharing. He says one should never visit his friends or relations empty handed. One should always carry some gift of nature, which if nothing is available can be a simple smile, compliment or a flower. By repeatedly indulging into positive behavior and thoughts, you can reduce the internal noise, which helps in making the process of meditation or conscious living a simpler one.

Washing out negative thoughts is another way mentioned by many Vedic scholars. Three minutes writing is one such exercise which anybody can do. Just before sleep anybody can do three minutes writing where you can write down all your emotions and then discard the paper. Another exercise is to reward or punish one self at bed time for the activities done during the day by either patting or slapping yourself.

Food poisoning with rice dishes

By Dr K K Aggarwal
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Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit

  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic-type food poisoning associated with B. cereus
  • The organism is frequently present in uncooked rice, and heat-resistant spores may survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating such as stir frying
  • Two distinct types of toxin-mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one-third of individuals. Symptom onset is usually within one to five hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice-based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.

An empty mind is the devil’s house

By Dr K K Aggarwal
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It is an old saying that “Khali dimag shaitan ka ghar”.
Empty mind means when you are doing nothing and Shaitan means negative thoughts. In terms of Vedic Sciences, negative thoughts mean absence of positive thoughts and they are often equated to darkness which is absence of light.

Positive thoughts always need efforts and exertions while negative thoughts are spontaneous and without exertion.
It is recommended that one should think differently and positive otherwise there will be spontaneous appearance of negative thoughts.

Darkness is spontaneous and naturally present and to bring light one has to make efforts by switching on the light or the nature has to ask the Sun to come and give the light.

Padma Shri Awardee Dr K K Aggarwal Receives Orator of the Year 2014 Award by St Mathew’s School

By Dr K K Aggarwal
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Padma Shri Awardee Dr K K Aggarwal Receives Orator of the Year 2014 Award by St Mathew's School

New Delhi, December 20, 2014: Recognizing outstanding contribution in the field of social work St. Mathew’s Senior Secondary School New Delhi honored Dr. K K Aggarwal with the Orator of the year Award 2014 in New Delhi on its Foundation Day.

An eminent cardiologist, President of Heart Care Foundation of India and the Senior National Vice President Indian Medical Association, Dr Aggarwal has also worked extensively towards helping the lower sections of the society.

Commenting on the occasion, Dr Aggarwal, Sr. National Vice President of the Indian Medical Association and the President of the Heart Care Foundation of India said, “I am honored to receive such a prestigious award from the St. Mathew’s Sr. Sec. School. Every individual has a right to live a healthy life and keeping this mind we started the Heart Care Foundation of India and till date have continued to help many patients live a healthy and normal life. The trust recognized my efforts towards the society and it gives me immense happiness and encouragement to keep doing the same throughout life.”

Dr Aggarwal is the recipient of three National Awards, namely the Padma Shri for brilliance in medicine, Dr. BC Roy award for excellence in socio-medical awareness and DST National Award for Outstanding Efforts in Science & Technology Communication. DR Aggarwal is also Limca Book of Record holder in CPR 10.

Ten ways to ease neck pain

By Dr K K Aggarwal
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  • Don’t stay in one position for too long
  • Position your computer monitor at eye level.
  • Use the hands-free function on your phone or wear a headset.
  • Prop your touch-screen tablet on a pillow so that it sits at a 45° angle, instead of lying flat on your lap.
  • Keep your glass prescription up to date otherwise you tend to lean your head back to see better.
  • Don’t use too many pillows as it can stifle your neck’s range of motion.
  • Before you move a big armoire across the room, consider what it might do to your neck and back, and ask for help.
  • Get a good night’s sleep.
  • See your doctors if neck pain is associated with radiating pain, weakness, or numbness of an arm or leg.
  • Also see the doctors if you have fever or weight loss associated with your neck pain, or severe pain.

How to Improve Your Soul Profile

By Dr K K Aggarwal
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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 twenty one 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.

Indian Medical Tourism Incomplete without Yoga Department in every Hospital

By Dr K K Aggarwal
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Recently in one of the interaction the Indian Tourism Minister Dr Mahesh Sharma said that India is going to be the hub of medical tourism because of its hospitality and culture.

It is correct but for that a slight paradigm shift is required in the way we practice medicine in the country. 

Most western patients come to India to take advantage of Yoga and Ayurveda in addition to the western medicine.

Only for a lower cost we cannot attract medical tourists for long as sooner or later the China will over power us in future for medical treatments.

Our Prime Minister has convinced the world to have an international Yoga day. But unfortunately we do not have a yoga department in every government or a private medical institution.

Let India be the first country to have a yoga and an Ayurveda department in every hospital in addition to the western medicine.

The time is to promote traditional Yoga and Ayurveda. Unfortunately as they are not getting an uplifment they are ending up in cross pathy which is not on the interest of both their profession as well as the community.

Recently a review of studies examining the benefits of yoga suggests that Yoga practice provides significant benefits on cardiovascular risk factors, including LDL cholesterol and systolic blood pressure.

Those who practiced asana-based yoga reduced their LDL-cholesterol levels by 12.1 mg/dL and systolic blood pressure by 5.2 mm Hg and increased their HDL-cholesterol levels by 3.2 mg/dL. 

In addition, the yoga practitioners also saw significant reductions in body-mass index, diastolic blood pressure, total cholesterol, triglycerides, and heart rate. Overall, the yogis lost 2.35 kg compared with non exercisers.

Individuals who cannot or prefer not to perform traditional aerobic exercise might still achieve similar benefits in cardiovascular-disease risk reduction by Yoga.
The review, which is published December 15, 2014 in the European Journal of Preventive Cardiology, included 32 randomized, controlled trials involving 2768 participants.

[The author Dr K K Aggarwal is Senior National Vice President Indian Medical Association and President Heart Care Foundation of India]

Kidney patients more at risk for future heart attacks

By Dr K K Aggarwal
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Chronic kidney disease patients with kidney function less than 60% have now been added in the list of criteria for defining people at highest risk for future heart attacks.

In a large cohort Canadian study published in The Lancet led by Dr Marcello Tonelli at University of Alberta, patients with only chronic kidney disease had a significantly higher rate of heart attacks than those who only had diabetes. Those who had already had a heart attack had the highest overall rate of heart attacks.

Chronic kidney disease should be regarded as a coronary heart disease risk equivalent, similar to diabetes, as patients with the condition have high rates of cardiovascular events, particularly when they also have proteinuria.

When chronic kidney disease was defined more stringently with kidney function less than 45% and increased proteinuria, the rate of first heart attack was higher in those with both chronic kidney disease and diabetes than in those with either disorder alone.

Ganesha, The Stress Management Guru

By Dr K K Aggarwal
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If Lord Krishna was the first counselor who taught the principles of counseling, Lord Ganesha taught us the principles of stress management.

We should worship Lord Ganesha and become like him whenever we face any difficulty or are stressed out.

The elephant head of Lord Ganesha represents that when in difficulty, use your wisdom, intelligence and think differently. It can be equated to the Third Eye of Lord Shiva. Elephant is supposed to be the most intelligent animal in the kingdom. Hear wisdom implies to think before speaking. Lord Budha later also has said that don’t speak unless it is necessary and is truthful and kind.

The big elephant ears of Lord Ganesha signify listening to everybody when in difficulty. Elephant ears are known to hear long distances. Elephant eye see a long distance and in terms of mythology, it represents acquiring the quality of foreseeing when in difficulty. The mouth of Lord Ganesha represents speaking less and hearing and listening more.

The big tummy of Lord Ganesha represents digesting any information gathered by hearing to people in difficulty. The trunk represents to use your power of discrimination to decide rom the retained information. It also indicates to do both smaller and bigger things by yourself. Elephant trunk can pick up needle as well as a tree.

The broken and unbroken teeth of Lord Ganesha represent being in balance in loss and gain. It indicates that one should not get upset if the task is not accomplished and also not get excited if the task is accomplished. In times of difficulty, Ganesha also teaches us not to lose strength and control one’s attachments, desires and greed.

The four arms of Lord Ganesha represent strength. Ropes in two hands indicate attachment, Laddu or Sweet in one hand represent desires and mouse represents greed. Riding over the mouse indicates controlling one’s greed.

Lord Ganesha is worshiped either when one’s task is not getting accomplished or when a new work is initiated. In these two situations, these principles of Lord Ganesha need to be inculcated in one’s habits.