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Dr K K Aggarwal

Definition of Health

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

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

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

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

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

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

Samadosha, samagnischa,

Samadhatumalkriyah,

Prasannatmendriyamanah,

Swastha iti abhidhiyate.

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

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

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

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

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

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

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

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

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

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

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).

All about depression

By Dr K K Aggarwal
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• Depression is a major public health problem as a leading predictor of functional disability and mortality. • Optimal depression treatment improves outcome for most patients. • Most adults with clinical significant depression never see a mental health professional but they often visit a primary care physician. • A physician, who is not a psychiatrist, misses the diagnosis of the depression 50% of times. • All depressed patients must be enquired specifically about suicidal ideations. • Suicidal ideation is a medical emergency. • Risk factors for suicide are known psychiatric disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide. • Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone. • World over about 1 million people commit suicide every year. • 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. • Twice as many suicidal victims had contacted with their primary care provider as against the mental health provider in the last month before suicide. • Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths. • In the US,the suicidal rate is 10.5 per 100,000 people. • In the US,incidence of suicide is increasing in middle aged adults. • There are 10–40 non–fatal suicide attempts for every one completed suicide. • The majority of suicides completed in US are accomplished with firearm (57%); the second leading method of suicide in US is hanging for men and poisoning in women. • Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt. • Fifty percent of successful victims have made prior attempts. • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt. • The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older. • Females attempt suicide more frequently than males but males are successful three times more often. • The highest suicidal rate is amongst those individuals who are unmarried followed by widowed, separated, divorced, married without children and married with children in descending order. • Living alone increases the risk of suicide. • Unemployed and unskilled patients are at higher risk of suicide than those who are employed. • A recent sense of failure may lead to higher risk. • Clinicians are at higher risk of suicide. • The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27. • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts. • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration. • Management of a suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up. • Major risk for suicidal attempts is in psychiatric disorders, hopelessness and prior suicidal attempts or threats. • High impulsivity or alcohol or other substance abuse increase the risk.

15 Ways To Reduce Or Stop Drinking

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If you are dependent on alcohol, or have other medical or mental health problems you should stop drinking completely. Reduction of heavy drinking may be a more acceptable goal for some patients who lack readiness to quit drinking.

The frequency of heavy drinking (more than 5 drinks per day for men and 4 for women) has the highest correlation with negative life consequences such as impaired driving, interpersonal problems and injuries.

You need to cut down if in the past one year you have taken one or more times, more than 5 drinks in a day (4 drinks for women). This positive response to a single question “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, is recommended for use by the National Institute on Alcohol Abuse and Alcoholism. The sensitivity and specificity of this question is 81.8 and 79.3 percent, respectively.

One can also know the dependence of alcohol by using the CAGE questionnaire.

1. Have you ever felt the need to Cut down on drinking?
2. Have you ever felt Annoyed by criticism of your drinking?
3. Have you ever had Guilty feelings about your drinking?
4. Do you ever take a morning Eye opener (a drink first thing in the morning to steady your nerves or get rid of a hangover)?

One positive response to any question suggests need for closer assessment; two positive responses are seen in the majority of patients with alcoholism. Two positive responses have a sensitivity of 77 percent and specificity of 80 percent in patients with alcohol dependence. Over 80 percent of nonalcoholic patients have a negative response to all four questions and virtually none has a positive response to more than two questions.

National Institute on Alcohol Abuse and Alcoholism suggests the following for stopping or reducing alcohol:

1. Put it in writing why you want to reduce or stop: Write what you want to achieve, for example, will feel healthier; will sleep better, will improve my relationships.

2. Write confessions: learn and practice various confession exercises. This will help you take care of inner guilt which may be the precipitating factors.

3. Set a drinking limit: Those who are cutting back should set a limit as per your health. Most healthy people should limit to less than 40 ml in one hour, 80 ml in one day and less than 240 ml in a week. Women should take less than half of this amount.

4. Keep a diary of your drinking. For initial 3-4 weeks, keep track of every drink. Note the situations you are most likely to drink. Give each situation a rating out of ten. Try avoiding those situations for the next few weeks.

5. Don’t keep alcohol within your reach. Remove alcohol from your living place. This can help limit drinking.

6. Eat your drink. Drinking slowly can help. Sip and do not gulp. Sip soda, water, or juice after each drink. This is called Mindful drinking. If you are aware of your drinking, you will cut back on it. Otherwise, you will drink more.

7. Never drink on an empty stomach.

8. Keep weekly one or two spiritual fast/s. This will allow alcohol-free days. Decide not to drink a day or two each week.

9. Observe spiritual retreats: Observing spiritual retreats (Navratri by Hindus, Ramzan by Muslims, and Easter by Christians) with no drinking can help. Or try abstaining for a week or a month to see your commitment to not drinking.

10. Become a tortoise: Learn to withdraw yourself from all stimuli which can force you to drink.

11. Watch for peer pressure. Learn to say no. Do not drink just because others are, and you shouldn’t feel obligated to accept every drink you’re offered. Stay away from people who encourage you to drink.

12. Keep busy. Take a walk, play sports, go out to eat, or catch a movie. When you’re at home, pick up a new hobby or revisit an old one. Painting, board games, playing a musical instrument, woodworking — these and other activities are great alternatives to drinking.

13. Ask for support. Let friends and family members know that you need their support.

14. Guard against triggers. Stay away from people and places that make you want to drink. In Yoga it is called Pratahyara and means staying away from the external stimuli. Lust cannot be removed by staying in a lustful atmosphere.

15. Be persistent. Most people who successfully cut down or stop drinking altogether do so only after several attempts.