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Dr K K Aggarwal

HCFI tips to reduce your risk of NAFLD

By Dr K K Aggarwal
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  • Consume a healthy plant-based diet which is rich in fruits, vegetables, whole grains and healthy fats.
  • Overweight or obese individuals should limit the number of calories consumed in a day and exercise more. Those who have a healthy weight should work to maintain it by opting for a healthy diet and exercising.
  • Exercise most days of the week. One should try to get at least 30 minutes of physical activity every day.

Express gratitude

By Dr K K Aggarwal
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  • Gratitude is a thankful appreciation for what we have.
  • Appreciate the roof over your head, the good health you have, people you have in your life who care about you.
  • Set aside a few minutes every day and think about five things you’re grateful for, whether big or small. Write them down.
  • Be specific and remember what each thing means to you.

Honey excellent for cough

By Dr K K Aggarwal
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A spoonful of honey can relieve night time cough in children and help them sleep better. In comparison with the cough syrup ingredient dextromethorphan or no treatment, honey seems better. According to a study published in the Archives of Paediatrics and Adolescent Medicine, the results are so strong that we can easily say that honey is better than no treatment and dextromethorphan is not.

There is no proven treatment effective for cough due to an upper respiratory infection like the common cold. Dextromethorphan is commonly used for cough but there is no evidence that it works and moreover, it carries some risks.

Honey is used across the globe as a home remedy for cough, and might provide a safe, effective alternative to cough medicine.

Investigators compared buckwheat honey, a honey-flavored dextromethorphan preparation, and no treatment in 105 children seeking treatment for night time cough due to cold. Children who received honey exhibited the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality seems to soothe the throat. Its high antioxidant content could also be a beneficial factor. Honey also has antimicrobial properties.

Honey is; however, not recommended for infants below one year of age due to the risk of botulism spores.

Should doctors be detached in dealing with their patients?

By Dr K K Aggarwal
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When dealing with patients, the traditional Patient-Doctor relationship model states that the doctor should remain cool, calm and collected at all times.

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

According to Osler, a rare and precious gift to doctor is the right of detachment. This right protects the doctors from powerful emotions that patients display in their presence, such as anger, frustration, grief, and rage. Additionally, it protects patients from the rolling emotions that doctors may feel towards them.

A detached attitude also shields doctors from empathizing with patients. A detached doctor may talk in a language that goes over the patient’s head.

Detachment is not like a light switch being turned on and off to suit the situation. Detachment as a practice cannot be in isolation if it becomes one’s personal style of distracting from the world.

One must  learn to empathize with the patients and yet be detached from its results. Doctors who follow Bhagawad Gita can understand the concept well.

Fever

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

  • Sepsis, a clinical syndrome, occurs due to the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often above 90 per minute.
  • Symptomatic inflammatory response syndrome (SIRS)is a clinical syndrome, which occurs as a result of 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, a condition with elevated body temperature, is not called fever. Examples – 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 called acute hyperpyrexia.
  • Hyperpyrexia is often seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti-fever drugs.
  • High temperature without infection can be seen in case of a hyperfunctioning thyroid gland.
  • Recreational drugs such as Ecstasy may cause fever without any infection.
  • Mild fever can also occur following exertion.

There is a ritual 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 out of the 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.

Diagnosis of hypertension in childhood requires repeated BP

By Dr K K Aggarwal
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It is needed to confirm the presence of hypertension on the basis of three blood pressure measurements at separate clinical visits.

Normative BP percentiles are based on data on gender, age, height, and blood pressure measurements from the National Health and Nutrition Examination Survey and other population-based studies.

A study published in the journal Pediatrics in 2013 noted that the initial BP measurement was normal (below the 90th percentile), pre–hypertensive (systolic or diastolic BP between the 90th or 95th percentile) and hypertensive (systolic or diastolic BP ≥95th percentile) in 82%, 13%, and 5% of children.

At follow–up, subsequent hypertensive measurements were noted in just 4% of the 10,848 children who had shown initial hypertensive values. The overall prevalence of hypertension in the cohort was 0.3%.

Forgetfulness and Age

By Dr K K Aggarwal
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As we cross the age of 40, most of us develop minimal cognitive impairment and a memory loss of very recent events or objects. This is age-related and should not be considered as dementia.

This can also be seen in patients who are vegetarians and have vitamin B12 deficiency. People often experience difficulty in naming objects and remember names of the people.

Just as a computer hangs when multi-tasking, so can the human mind. While handling multiple projects at the same time, one may experience thought blocks, which is natural. It is not a sign of a disease.

When we introduce ourselves to a new person, we often tell them our name first. It is possible by the time you finish your conversation, the person may forget your name. Therefore, one should either introduce himself at the end of the conversation or introduce oneself 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 a medical doctor, quite often we face these difficulties. Unless full information is given to us by patient on phone, mistakes may occur, especially, if it is a phone consultation.

Diet is linked to the diabetes epidemic

By Dr K K Aggarwal
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A study published in the journal Diabetes Care highlights the importance of the whole diet rather than focusing on certain foods or food groups that might be beneficial.

A diet rich in whole grains, fruits and vegetables (leafy green), nuts and low-fat dairy may help people lower their risk of type 2 diabetes by 15% over 5 years than those who ate the lowest amounts of these foods.

In contrast, adults whose diets were high in red meat, high-fat dairy, refined grains like white bread plus beans and tomatoes, saw their diabetes risk go up by 18% as a group.

Type 2 diabetes is closely linked to obesity and it is well-known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.

You see people the same way as you are

By Dr K K Aggarwal
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Honest people see everybody as honest and dishonest people see everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel that everybody is honest. However, if you take bribe, then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.

Never judge people with your personal experience. Once, a doctor said that every doctor takes and gives bribe because he was running an imaging center and every doctor who approached him asked for a bribe. But he did not take into consideration the doctors who did not approach him.

Beware of fatty liver

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  • Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis (fatty liver), when no other causes for secondary hepatic fat accumulation (heavy alcohol consumption) are present.
  • NAFLD, if not treated, may progress to cirrhosis and is a major cause of cryptogenic cirrhosis.
  • NAFLD is subdivided into: Nonalcoholic fatty liver (NAFL) or simple fatty liver with no liver inflammation and nonalcoholic steatohepatitis (NASH) or fatty liver with liver inflammation.
  • Patients with NAFLD may have mild or moderate increase in SGOT and SGPT levels (liver enzymes).
  • However, normal SGOT and SGPT levels do not rule out NAFLD.
  • When raised, SGOT and SGPT levels are usually 2 to 5 times the upper limit of normal.
  • In acute viral hepatitis, the SGOT/SGPT ratio is less than 1 (unlike alcoholic fatty liver disease, where the ratio is usually greater than 2).
  • The degree of SGOT and SGPT elevation does not point to the degree of liver inflammation or fibrosis. Additionally, normal SGOT, SGPT levels do not exclude clinically significant histologic injury.
  • Alkaline phosphatase may be raised to 2 to 3 times the upper limit of normal.
  • Serum albumin and bilirubin levels are often within the normal range, but they may be abnormal in patients with cirrhosis. When cirrhosis develops, the patient may have prolonged prothrombin time and cytopenias.
  • Serum ferritin greater than 1.5 times the upper limit of normal in patients with NAFLD may point to presence of inflammation.

The spiritual meaning of the word ‘Artha’

By Dr K K Aggarwal
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Dharma, Artha, Kama and Moksha are the four fundamental principles of our very existence which means earning righteously with a desire to fulfil the inner happiness.

Righteous earning is called ‘Artha’ and mistakenly it has been linked to materialistic money. In mythology, Artha is synonymous with Lakshmi, Saraswati and Kali where Lakshmi represents righteously earned materialistic wealth, Saraswati represents wealth of knowledge and Kali represents wealth of wisdom to fight the bad in you and in the society.

In any country, it is the wealth of knowledge, which is more important. India was ruled initially by warriors (Kali), later by money (Lakshmi) and in future will be ruled by knowledge (Saraswati).

It is the human resources, which today decide the growth of a company and the amount of money invested. If you have good human resources, your company is going to succeed.

Prevention strategy relies on lifestyle

By Dr K K Aggarwal
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Stenting may not always be the answer to treating heart disease with stable angina.

A German study has shown that patients with stable coronary artery disease who underwent an exercise regimen had significantly higher rates of event-free survival compared to those who were subjected to percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event-free survival – no stroke, heart attack, or death – compared to 50% of stented patients after a span of four years. Exercise is an important part of any type of prevention, and it should be introduced for anyone with stable coronary heart disease.

The study was a continuation of a pilot study published in 2004 in Circulation. That study included 101 male patients and noted that after one year, 88% of patients who exercised had an event-free survival compared to 70% of stented patients. The updated study present data on an additional 100 patients, who did moderate intensity exercise for two weeks under hospital supervision, which was followed by use of an exercise bike at home. Patients with stable angina exercised at 80% of their threshold, and after four weeks of exercising, their angina threshold increased.

The clear message is to get 30 to 60 min of moderate-intensity aerobic activity every day. About 30% of heart disease could be prevented by 2.5 hours of walking per week.

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 key is that every time they failed, they bounced back. This is termed as failing forward, rather than backward. You learn and move forward. Learn from your failure and keep moving.

The third avatar of Vishnu, the boar, signifies the same. The answer is persistence in your objectives.

Here are a few quotes and success stories:

  • “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)
  • “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)
  • “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).
  • “Successful people don’t do great things, they only do small things in a great way”
  • “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”.
  • “Henry Ford forgot to put the reverse gear in the first car he made”.
  • “Thomas Edison failed approximately 10,000 times while he was working on the light bulb”
  • “Henry Ford was broke at the age of 40”.
  • “Lee Iacocca was fired by Henry Ford II at the age of 54”.
  • “Young Beethoven was told that he had no talent for music, but he gave some of the best music to the world”

(With inputs from Dr Vivek Chhabra and Ravi Ponangi)

Chocolate, not tea, good for the heart

By Dr K K Aggarwal
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Regular intake of polyphenol-rich cocoa products, such as dark chocolate, may be considered a part of dietary approaches to lower blood pressure (BP); however, there should be no total gain in calorie intake.

Drug treatment is the basis of BP control, and it should be accompanied by lifestyle measures,including exercise and proper diet.

An occasional cup of cocoa can be taken but not chocolate milk, because it is high in sugar and fat.

A survey of medical literature noted that cocoa-rich products, and not tea, help reduce high BP. The survey covered 10 studies on cocoa, involving 173 participants, and five studies on tea with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP.

The average reduction was 4 to 5 mmHg in systolic pressure and 2 to 3 mmHg in diastolic pressure, which was sufficient to reduce the risk of stroke by 20% and of coronary heart disease by 10%. No such reduction in BP was noted in any of the studies involving tea, which continued for an average of four weeks. Tea and cocoa contain different kinds of polyphenols; while tea has flavan–3–ols, cocoa has procyanids.