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Dr K K Aggarwal

Padma Shri and Dr B C Roy National Awardee

You see people the same way as you are

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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’

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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

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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

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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

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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.

Think Differently

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There are three ways to manage stress. One is to think opposite, while the second is to think different and the third is to think positive.

Thinking opposite has been advocated by Patanjali, thinking differently by Adi Shankaracharya and thinking positive by Gautam Buddha. Out of the three approaches, the Indian Vedic philosophy focuses on thinking differently. Thinking positive and thinking opposite may not be feasible at the time of an adversity.

Thinking differently has been emphasized in mythology at multiple places. The 10 heads of Ravana, five heads of Brahma, elephant head of Lord Ganesha, fish incarnation of Lord Vishnu and third eye of Lord Shiva, all remind us of the principle of thinking differently.

We can see or analyze a person or a situation with the eyes of our physical body (physical eye) or eyes of the mind (thinking and analyzing) and eyes of the soul (consciousness-based decision).

Lord Buddha said that a good action should be based on truth, should be necessary and bring happiness both for the person doing it and the society.

The 3H principle advocated in the West is also based on the same principle, which means before any action, think from your Head and from the multiple options available, choose from the Heart and then order the Hands to do the job.

The first incarnation of Lord Vishnu, fish, indicates the capacity of swimming against the stream. The third eye of Lord Shiva symbolizes thinking from the mind and choosing the right answer from the heart. The 10 heads of Ravana and five heads of Brahma also denote thinking to get multiple options.

The example of thinking differently comes from the dialogue between Urvashi and Arjuna. Once Urvashi, in a mind full of Kama, went to Arjuna and said “If you are not going give me a son like you today, I am going to curse you”.

Arjuna was in a dilemma but he thought differently and said – “Why do you want to wait for 25 years to get a son like me; from today I am your son, Mother.”

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

Hepatitis A, E and typhoid are the hygiene markers of a city

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It is diseases such as jaundice with hepatitis A in children and E in adults, typhoid, cholera and gastroenteritis that reflect the hygiene status of a city and not the occurrence of dengue and malaria.

Food- and water-borne diseases can be eradicated by the following public awareness formula: When in doubt follow the principle, “heat it, boil it, cook it, peel it or forget it”. This means that in an unhygienic environment, one can eat an orange or a banana but not a tomato or apple. Other steps are:

  • Do not eat salad that has been left open for more than 2 hours even if it is washed properly.
  • Do not consume cooked food that has been left on the table for more than 2 hours.
  • Vegetables grown under the ground or over the surface of the ground should be washed properly before eating them raw. They may be the biggest source of worm infection in the brain, a condition called neurocysticercosis.
  • Boiled water is the safest water to drink.
  • Ice made from unhygienic water can be the source of most water-borne diseases.

It is our duty to keep our home and city as clean as possible. We must regard our city as our extended home, a garden as our farmhouse and roads as our personal walking tracks.

Meditation can change genes

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The Amarnath cave was chosen by Lord Shiva to narrate the secrets of meditation, immortality and creation of Universe to Parvati.

A spiritual journey requires a spiritual frame of mind and a commitment of 7-10 days for self-purification. Most spiritual destinations are located high up in the mountains to provide a pollution free environment and involve a difficult travel so that nobody can reach the destination before 7-10 days. This duration helps in controlling the mind, intellect, ego and getting rid of the desires, attachments and greed. On the path of spiritual journey as one is travelling alone without carrying the worldly attachments, one invariably reaches the destination in a positive state of mind and in a meditative phase to experience the truth of life and answers to unanswered questions.

The Amarnath Story

Once Parvati asked Shiva to let her know why and when he started wearing the beads of heads (Mund Mala). Shiva said whenever you are born I add one more head in my beads. Parvati said,” My Lord, my body is destroyed every time and I die again and again, but you are Immortal. Please let me know the secret of this.” Shiva replied that it is due to Amar Katha.”

Spiritual Significance

The spiritual significance of the above is, that here Shiva represents the Soul and Parvati the Body. The soul never dies and is immortal. The soul is the energized filed of information and in computer language is like the web of energized information. Every time any work is done (sanskara), a copy of the same is kept in the memory in both the soul and the spirit.

The further part of the story is the katha or the process of doing meditation and its benefits.

The story

“Parvati insisted on being told the secret. For long Shiva continued postponing.  Finally on consistent demand, he made up his mind to tell the immortal secret. He started for a lonely place where no living being could listen to it. He chose Amarnath Cave.”

Spiritual Significance

The first principle of learning how to meditate is dedication and persistence. Second is silence or a place with no internal and external disturbance. In ashtanga yoga, it is called Pratyahara (the withdrawal of senses).

The story

“Shiva left His Nandi (The Bull) at Pahalgam or Bail Gaon; his moon from his hair (jata) at Chandanwari; his snake at the banks of Lake Sheshnag; his Son Ganesha at Mahagunas Parvat (Mahaganesh Hill) and his five elements at Panjtarni.

As a symbol of sacrificing the earthly world, Shiva and Parvati did Tandav dance. After leaving behind all these, Shiva enters the Holy Amarnath Cave along with Parvati. Lord Shiva takes his Samadhi on the Deer Skin and concentrate.”

Spiritual Significance

In the process of meditation, one first gets rid of desires (Bull Nandi or the mind), discriminating, expectations and power of analyzing thoughts (moon or the intellect) and ego (snake). Once that is done, one is away from the worldly desires totally (Ganesh and finally the five elements). Now the body is in symphony with the soul (Tandava dance).

The story

“To ensure that no living being is able to hear the Immortal Tale, Shiva created Rudra named Kalagni and ordered him to spread fire to eliminate every living thing in and around the Holy Cave. After this, He started narrating the secret of immortality to Parvati. But as a matter of chance one egg which was lying beneath the Deer skin remained protected. It is believed to be non-living and more over it was protected by Shiva-Parvati Asan (Bed). The pair of pigeons which were born out of this egg became immortal having listened to the secret of immortality (Amar Katha).”

Spiritual Significance

It again signifies the importance of undisturbed state of mind at the time of meditation. Fire indicates the internally meditation generated spiritual fire or agni which burns all the negative thoughts and negative energies. The egg of the pigeon indicates that spiritual knowledge can transform at the level DNA. It also tells us that those who are sitting near the meditating person also get benefitted.

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

What should you do if you don’t have soap and clean, running water?

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Washing hands with soap and water is the best way to reduce the number of microbes present on them.

If soap and water are not available, one can use an alcohol-based hand sanitizer having at least 60% alcohol. Alcohol-based hand sanitizers have the ability to reduce the number of microbes on hands in certain situations, but they can’t eliminate all types of pathogens.

To be in harmony with the body (five elements represented by Draupadi), one must acquire five qualities or in other terms, live a focused life, full of strength and not being disturbed with loss or gain and finally working for the welfare of the society without having any partiality towards anyone.

  • Balanced mind: Yudhishthir (“sthir” or balanced in “yudh” or disturbed state of mind)
  • Focused vision (Arjuna)
  • Using internal power or strength (Bhima)
  • Not being partial or remaining neutral (Nakul)
  • Working for the welfare of the society (Sahdev)

With this, one can kill 100 negative qualities that a person can have (the 100 Kauravs). The hundred negative qualities are acquired because of cunningness (Shakuni), not working with the eyes of the soul (Dhritarashtra) and keeping a blind eye to any wrong happening (Gandhari).

The main negative qualities are taking decisions in daily life situations (Duryodhana: dusht in yudha or war) and choosing wrong choices as a ruler (dusshasana: dusht and shasan).

The positive qualities, once acquired, will also win over other negative qualities like blind faith or undue attachments (Bhishma pitamaha); unrighteous loyalty (Dronacharya) and unrighteous ego (Karna).

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

Shoe Hygiene

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  • Avoid poorly fitting shoes.
  • Patients with diabetes should avoid walking bare feet.
  • Very tight shoes can cause pressure ulcers.
  • High heels can be worn occasionally, but if you wear them more often, it can lead to significant foot pain and other problems such as bunions, corns and calluses and more complex conditions like misshapen hammer toes or worsening excruciating pain in the ball of the foot.
  • Shoes that are tight and constrict the natural shape of the foot can cause foot pain.
  • Women, who regularly wear high heels, walk with shorter, more forceful strides and require more muscles to walk.
  • Shoes can be classified as:

o Good shoes or low risk shoes: athletic and casual sneakers.

o Average mid risk shoes: hard or rubber–soled shoes – special shoes and work boots.

o Poor or high risk shoes: ones that do not have support or structure such as high heels, sandals, sleepers.

  • Pointed toed shoes disrupt the natural shape of the feet.
  • If you like heels, choose the ones that are not higher than 2″ and are wide.
  • It is always better to buy shoes in the evening as the foot swells up by evening. If you buy them in the morning, the shoes may feel tight in evening hours.
  • Always try both the shoes while you buy them as one foot may be smaller or larger than the other one in some people.
  • Always buy the shoes that are wider than your foot, i.e., wider than broadest part of the foot.
  • The actual size of the shoe may vary from manufacturer to manufacturer.
  • Your foot tends to become longer and wider as you age. Therefore, always check the size of your shoes every two years.
  • Narrow shoes with heels should only be used for a function, dinner or a formal party, especially where you do not have to stand for a longer time.

Vedic principles behind cognitive behavior therapy

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1) What is counseling?

A: The mental process involves generation of a thought or idea, which is analyzed and then acted upon. Thought, analysis and action, are the three processes of human mind. Counseling encompasses actions at all the three levels.

2) What are different types of counseling?

A: Counseling involves two principles – Cognitive counseling and behavioral counseling. Behavioral counselling focuses only on the actions, while cognitive counselling focuses on the changes in either the thought process or in the interpretation of the thought process.

3) What is cognitive behavior therapy?

A: As opposed to pure behavior therapy where a person is counseled to do pre-defined things at regular intervals, cognitive behavior therapy is aimed at changing the actions by altering observations of the interpretation of a particular situation.

4) What is the origin of counseling in India?

A: The origin of counseling dates back to the Vedic era. Upanishads were nothing but text books on counseling based on the original knowledge of Rigveda, Yajurveda, Samveda and Atharvaveda.

5) Is there a relationship of Bhagavad Gita with counseling?

A: Bhagavad Gita is counseling done by Krishna that aims to resolve the conflict in Arjuna’s mind whether to fight or not. Counseling at that time was done by the elders in the family.

6) Are the principles of Bhagavad Gita followed today?

A: All the principles of cognitive behavior therapy today have their roots in the principles that have originated from Bhagavad Gita.

7) What is the first principle?

A: The first principle is that counseling cannot be done in 1 or 2 sessions. It requires up to 18 sessions which is what Krishna did in Bhagavad Gita. Bhagavad Gita contains 702 dialogues in the form of Shlokas. A proper counseling involves in-depth conversation between the counselor and the patient.

8) What is the second principle of counseling?

A: The second principle of counseling is to listen to the patient in the first session in great detail. Krishna did the same in Bhagavad Gita. In Chapter 1, only Arjuna speaks and Krishna listens. A patient listening is half the healing done.

9) What is the third principle?

A: The third principle states that the second (first interactive) session between counselor and the patient should be the longest one. Chapter 2 of Bhagavad Gita is the gist of Krishna’s counseling.

10) What is the fourth principle?

A: The fourth principle is that after giving a detailed counseling in the second session, the patient is expected to be confused. In start of Chapter 3, Arjuna says to Krishna “I am confused. Sometimes you are talking about one path and other time you are talking about another path. Guide me again.” The third counseling session is the most important where one has to counsel slowly and in great detail.

11) What is the fifth principle?

A: The fifth principle is to give reasoning to the counseling. One should not take the patient for granted. Krishna discusses each and every aspect of life with Arjuna in great detail giving scientific reasoning at every stage.

12) What is the sixth principle?

A: Provide reassurance to the patient repeatedly. During his counseling, Krishna assures Arjuna on multiple occasions to do his job and not to worry. I am with you.

13) What is the seventh principle?

A: The seventh principle involves creating some fear in the patient’s mind. This is what Krishna does while showing his virat swaroop. This especially works in patients of addiction. Some degree of fear with re-assurance from the counselor works well.

14) What is the eight principle?

A: The summing up counseling session should be as long as the second session. Chapter 18 of Bhagavad Gita is as big as Chapter 2 where the whole Bhagavad Gita is summarized again.

15) What are the ingredients of counseling?

A: Counseling involves in-depth knowledge of dharma, artha, kama and moksha. They are greatly described in Dharmashastra, Arthashastra, Kamasutra and Upanishads through various Vedas.

16) What is stress?

A: Stress is the reaction of the body or the mind to the interpretation of any situation.

17) How can stress be managed?

A: Stress can be managed by either changing the response of the body through yogic living, or changing the interpretation by understanding the principles of counseling or changing the reaction by wilful actions.

18) Are different nitis of our scriptures based on counseling?

A: Yes. Vidur Niti was the counseling given by Vidur to Dhritarashtra when he was not sleeping and Chanakya Niti involved how to rule a country. Yoga Vashishtha was the counseling given by Vashishtha to Rama to acquire higher levels of spiritual knowledge.

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

Hospital safety incidents have 20% mortality

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Patients who experience a patient safety incident have a 20% likelihood of dying as a result of the incident. The 16 different patient safety concerns include:

  1. Complications of anesthesia
  2. Death in low mortality diagnosis related groups
  3. Bed sores
  4. Failure to rescue
  5. Foreign body left in during procedure
  6. Physician-induced pneumothorax (air in the lungs)
  7. Selected infections due to medical care
  8. Postoperative hip fracture
  9. Postoperative hemorrhage or hematoma
  10. Postoperative physiologic and metabolic derangements
  11. Postoperative lung failure
  12. Postoperative pulmonary embolism or deep vein thrombosis
  13. Postoperative infections
  14. Postoperative wound dehiscence in abdominopelvic surgical patients
  15. Accidental puncture or laceration
  16. Transfusion reaction

Win Relationships and Not Arguments

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It is a well-known saying that when you are arguing with a wrong boss, you may win the argument but you may invariably lose the relationship and not argument. Lord Krishna was born after Lord Rama and Krishna taught us when to say ‘sorry’ even if you are not at fault. Never hurt the ego of a person who is under influence of alcohol or boss when he is angry.