On fasting, workout during Ramzan

It is best to work out an hour after breaking fast with a light meal or an hour before morning meal.

Should one workout when on fast during Ramzan? If you’re a diabetic, can you fast? Health experts say both workout and diabetics fasting are possible with some careful considerations.

Sports medicine professionals say that workout should be done with extreme caution with an eye on hydration levels. “Regulars at gyms should also start slowly before they increase intensity and keep cardio to a minimum. Ideally, they should work out at lower intensity and volume than days when they do not fast. For those who are not used to regular workout, it is best avoid starting while on fast,” said Sharat Kumar, Sport Medicine Consultant at Apollo Hospitals.

He added that it is best to work out an hour after breaking fast with a light meal or an hour before the morning meal, which incidentally is the most common practise in gyms of the city.

The belief

Fasting during Ramzan is one of pillars of Islamic faith, required of every Muslim if health permits it. While many with conditions like diabetes, often forego fasting, doctors say a consultation with the physician can often reveal a sugar management that can help a diabetic also endure a fast. However, complications like renal and heart problems can make management of the condition difficult, thus often warranting advice against fasting.

Low blood sugar levels

“The key is to prevent hypoglycaemia or low blood sugar levels during fasting period. While any advice cannot be applied to all diabetics, fasting is possible if a diabetic’s sugar levels are well-managed before the onset of a fast,” said Srirang Abkari, an Internal Medicine Consultant at Global Hospitals.

Dr. Abkari adds that fasting is generally discouraged for type 1 diabetics but type-2 diabetics managing their blood sugar levels with just food, medication or some insulin can undertake fast.

He also suggested consumption of complex carbohydrate foods in lieu of foods rich in sugars.

Similar thoughts were echoed by Rakesh Kumar Sahay of Osmania Medical College in a journal published earlier this year.

Dr. Sahay had suggested that a pre-medical assessment, ideally two to three months before onset of fast, should be undergone, while adding that newer advances like insulin pumps and analogs combined with improved patient education and awareness have helped even those with Type 1 diabetes to fast during Ramzan

Teenage smokers at greater risk of developing lung cancer or heart disease

This World No Tobacco Day, Global Hospital Mumbai pledges to curb teenage smoking

Mumbai: May 31, 2016: Younger the age at which people start smoking, greater the certainty that they will end up with one of several life threatening diseases. Early smoking is associated with subsequent heavier smoking, higher levels of dependency, a lower chance of quitting, and an overall higher rate of mortality. Adolescent smoking causes serious risks to respiratory health, both in the short and long term. Youngsters who smoke are two to six times more susceptible to cough and increased phlegm, wheezing and shortness of breath than those who do not. Moreover, smoking impairs lung growth and initiates premature lung function decline which may lead to an increased risk of chronic obstructive lung disease later in life.

Dr. Dr. Praveen Kulkarni, Cardiologist, Global Hospital, Mumbai, says “Cigarette smoking during adolescence and young adulthood begins the damaging processes that leads to cardiovascular disease. Damage to the circulatory system becomes evident in young smokers, and may become clinically significant in early adulthood.”

Many teenagers and adults underestimate the effects of smoking, and do not believe it will have any effect on their bodies until they reach middle age. Smoking-caused lung cancer, other cancers, heart disease, and stroke typically do not occur until years after a person's first cigarette. The truth, however, is that smoking has numerous immediate health effects on the brain and on the respiratory, cardiovascular, gastrointestinal, immune and metabolic system. While these immediate effects do not all produce noticeable symptoms, most begin to damage the body with the first cigarette itself – sometimes irreversibly – and rapidly go on to produce serious medical conditions and health consequences.

Children are also more susceptible to the effects of passive smoking. Parental smoking is the main determinant of exposure in non-smoking children. Bronchitis, pneumonia, asthma and sudden infant death syndrome (cot death) are significantly more common in infants and children who have one or two smoking parents. Parental smoking has also shown to increase a child’s risk of resorting to smoking.

Dr. Dr. Samir Garde, Pulmonologist, Global Hospital, Mumbai, shares, “I have personally seen many cases where children have picked up smoking under the influence of smoker parents. I have been urging them to quit so that their young children are not exposed to this habit early on, especially at home. Habit of smoking is also picked up by adolescent and teenage girls which if continued in their early thirties; leads to herd of problems like - infertility (inability to conceive), intrauterine fetal deaths, premature deliveries and giving birth to asthmatic child! In short; tobacco smoking not only affects the individual but also destroys health of entire forthcoming generation! The incidence of smoking has shown a decline of 15% in the youngsters in The United States over the last one year. Since us Indians like to follow the westerners in many walks of life; giving up on smoking would be one most important area to follow their suit.”

Every day 80,000 to 100,000 young people around the world become addicted to tobacco. Secondhand smoke kills more than 600,000 people worldwide each year, including 165,000 children. If current trends are to continue, 250 million children and young people will die from tobacco-related diseases. This World No Tobacco Day calls for urgent attention to the widespread prevalence of tobacco use and to its negative health effects. Quit today to prevent a host of medical conditions at a later stage in life.

Say YES to Life, Quit Smoking

About half of all smokers die from smoking-related diseases. If you are a long-term smoker, on average, your life expectancy is about 10 years less than a non-smoker. Stopping smoking can make a big difference to your health. It is never too late to stop smoking to benefit your health. 

The process your body goes through after stopping smoking - in the 20 minutes to 15 years after your last cigarette and 6 ways to quit smoking has been revealed by Dr. Madhu Y.C, Senior Consultant Surgical Oncologist,  BGS Global Cancer Institute, BGS Global Hospitals, Kengeri. 

Benefits of Quitting Smoking

20-30 minutes after smoking cessation blood pressure and pulse have already started to drop, and the carbon monoxide in the blood will begin to drop after just eight hours.

In two days, sense of smell and taste should start to improve

After 1 to 9 months of quitting, coughing and shortness of breath decrease, your lungs start to regain normal function.

After 1 year of quitting, your excess risk of coronary heart disease is half that of an active smoker

After 2 to 5 years, your risk of Cervical cancer and stroke can fall to that of non-smoker, risk of cancer of the mouth, throat, esophagus and bladder are cut in half.

After 15 years of not smoking, your risk of death will have almost returned to that of a non-smoker. It takes this long for your risk of lung cancer, pancreatic cancer and heart disease to reduce to that of a non-smoker.

6 ways to quit smoking

Stress less

Too much work in the office, deadlines to meet, unhappy personal life? Is any one of this your reason to smoke? If so, think like a responsible adult. You need to look inwards and discuss with others in the family to address the problem at hand. Picking up a cigarette is not going to end your blues. In fact it will escalate your problems manifold. Dr. Madhu Y.C, Senior Consultant, Surgical Oncologist, BGS Global Hospitals, Bengaluru, confirm stress is a major factor in keeping some people smoking.

Exercise enough

Experts say ten minutes of cycling or jogging can significantly help people quit smoking. The researchers from the University of Exeter have shown that changes in brain activity, triggered by physical exercise, may help reduce cigarette cravings. Although it is still unclear, researchers believe that completing exercise raises mood (possibly through increases in dopamine) which reduces the salience or importance of wanting a cigarette.

Another possibility is that exercise causes a shift in blood flow to areas of the brain less involved in anticipation of reward and pleasure generated by smoking images.

A ten or fifteen minute walk, jog or cycle when times get tough could help a smoker kick the habit. There are of course many other benefits from a more active lifestyle including better fitness, weight loss and improved mood.

Tablets and patches

Smokers wishing to kick the butt can double their success rates by using nicotine patch.

People who use the patch before quitting are likely to spontaneously reduce the number of cigarettes they smoke because the patch satisfies their need for nicotine and makes the act of smoking less enjoyable.

Nicotine patch also decreases withdrawal symptoms.

Bupron XL 300mg is a doctor-recommended medicine which is meant to eaten daily for 60 days. By the eighth day, you will feel the urge has perceptibly gone down. But don't be overconfident as it is also the time when you may go back to smoking your normal, read huge, quota. Says from Global Hospitals, a chemist in Kengeri, "This medicine is so much in demand that we keep running short of it. The biggest plus is that it comes with no side-effects."

Chew the urge

There's a new cure on the block and that's a chewing gum. These are not ordinary ones, but nicotine-based chewing gums by which smokers can be wooed to desist from picking up a cigarette.

Also, the National Botanical Research Institute (NBRI), Lucknow, has developed herbal chewable tablets. These herbal tablets will not only help those who want to quit smoking, but are also useful for all those who want to give up other tobacco products like pan-masala and ghutka.

The chewable tablets are poly herbal formulations and nicotine free, said the scientists. The basic ingredients are cloves, ginger, cardamoms, cinnamon and tulsi. They have already been scientifically validated and standardised. Toxicity studies have revealed that the formulation is safe to use, officials have said.

Opt for counselling

Nimhans has a Tobacco Association Clinic that comes to the rescue of those who want to quit smoking or any other form of tobacco. Experts feel users of such deadly commodities should seek medical counselling as it's not easy to give it up. However, a combination of group or individual counselling, Nicotine Replacement Therapy (NRT) and medication is necessary in most cases.

Group counselling on the telephone or on the Internet by creating de-addiction and support groups may offer encouragement more so when the morale is low.

Hypnosis will work

This technique helps by giving suggestions of reminders to relax during times of craving, or unconscious commands, which create a negative impression in the brain. There are many hypnotists in your city, do consult with one and give up the habit.

Think, feel, quit...

Get ready for plain packaging: Plain packaging of tobacco products is an important demand reduction measure. It reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of advertising, limits misleading packaging and labelling, and increases the effectiveness of health warnings. For World No Tobacco Day, 31 May 2016, WHO and the Secretariat of the WHO Framework Convention on Tobacco Control are calling on countries to get ready for plain (standardized) packaging of tobacco products.

On World No Tobacco Day BGS Global Cancer Institute doctors have recommended to support and implement the WHO Framework Convention on Tobacco Control.

Dr. Madhu Y.C, Senior Consultant Surgical Oncologist at BGS Global Cancer Institute, said, “Our recommendation is that the warnings should be 80 percent, not the debated 40-45 per cent, and they should be as dramatic as possible. It must be understood that nicotine addiction is a medical problem like any other drug addiction and not just a habit as the tobacco lobby would like us to believe.” He said it needs preventive measures and it also has its own treatment, both medical and based on behavioural therapy.

Doctors at BGS Global Cancer Institute said tobacco use initiation is coming at a much younger age – at less than 10 years. “At a younger age, tobacco acts like a gateway drug meaning young tobacco users start using more drugs as they grow older,” Dr Madhu said. 

Dr. Madhu further added that it can also helps India to relieve economic burden of tobacco related disease. As the estimated economic cost of Tobacco was USD 22.4 billion and it was 1.16% of our GDP. This was 12% more than the combined state and central govt expenditure on health in 2011-12. The total central government revenue from tobacco production in the year 2011-12 accounted to only 17% of estimated economic cost of tobacco.

Source: WHO

Is Health Care expensive?

Health care cannot be expensive and will never be. It is only the sickness care that is becoming expensive. As we earn our wealth through employment or otherwise, we should earn our health through conscious living. When we say conscious, we mean one should be aware of his or her body, mind, intellect and possibly something deeper, soul or spirit. If one is preoccupied with world, no doubt world gives wealth but robs the health. As Great Master Dalai Lama once said ‘You spend all your health to earn wealth, but later you spend
all your wealth to preserve health’. A noble saying well understood, but ill practiced. Growing population, progressive urbanization, economic and target pressures, leave behind a person reeling under the rubble of modern world. Good balanced nutrition, regular exercises, yoga and importantly, good company would definitely provide the health care. So health care is never expensive. Unfortunately knowing this yoga masters, meditation centers, gyms, have made health care, paradoxically expensive. But a man of conscious
living needs no one as a guide.

Why has sickness care become expensive?. In 2004, 4.8 million (59.4 percent) of the estimated 8.1 million Indian deaths were due to NCDs (Non-Communicable Diseases, life style diseases etc). In 2004, assuming that all care-givers and sick individuals above the age of 15 years were productive, yielded an annual income loss from NCDs of approximately One Trillion Rupees as noted by the Economists. More than one-third of all income losses were due to CVD and hypertension.

It is important to note the observation that overall, these data confirm the important role that the private sector plays in the provision of healthcare services in India. What does this mean? The NCDs are chronic, the morbid squeal are innumerable, and procedures needed are technically demanding and labor intensive. On the top of it, the need of unequivocally outstanding expertise, all of which seem to be largely prevalent in the private sector. The modern medicine is heavily dependent on sophisticated technology. The innovations in medicine and the instrumentation automatically compel the care providers to upgrade the systems. The redundant instruments tragically remain inoperable. Hence, financial burden on the private sector unimaginably grows. The infrastructure costs are growing geometrically, managed only by well established centers.The label of Heath as Industry tragically results in doubling the establishment costs. So the sickness
care costs too are becoming, if not geometrically but arithmetically expensive and seem to become prohibitive for a citizen of average income. Many instruments are still imported; many consumables are still produced outside the country. In an ambiance of financial equations, undoubtedly average man suffers. But curiously, compared to costs internationally, the medical expenditure for complex procedures such as transplantations, in our country is extremely affordable. Increased subscription of health insurance, indigenization of instruments, a well architected health policy that helps all, can certainly change the scenario but, seems to be a distant possibility as of now.

Hypertension is common among first-time mothers

If not treated, it leads to pre-eclampsia and then eclampsia

 

The study’s authors screened 416 pregnant women attending antenatal outpatient department of two private teaching hospitals in Telangana between January and July 2015. To determine the occurrence of hypertension attributable to pregnancy, the authors only selected those women without past history of hypertension. The screened women were aged between 20 and 35 years. Women with other conditions that may suggest past history of hypertension were also excluded.

Among the 416 women screened, 34 – or eight per cent – were found to be hypertensive, with blood pressure readings consistently over 140/90 mm Hg. Alarmingly, 80 per cent of these women were primigravidae or pregnant for the first time, according to a discussion of the findings in the Journal of Evidence Based Medicine and Healthcare.

Common cause of death

“It is important for women to get their blood pressure checked during antenatal checkups. For uncontrolled hypertension can have fatal consequences for the mother and the baby,” said Dr. Srirang Abkari, a practitioner of internal medicine at Global Hospitals who was not associated with the study.

Hypertension is one of the most common causes of deaths during pregnancies.

Uncontrolled hypertension, whether induced by pregnancy (during or after the 20{+t}{+h}week) or existing, may lead to conditions like pre-eclampsia, a condition characterised by unusual amounts of protein in urine and uncontrolled-hypertension that affects the foetus.

Risk

If the risk of complications due to hypertension is high, delivering is suggested depending on how far the pregnancy has progressed. If not treated, hypertension leads to pre-eclampsia and then eclampsia, marked by seizures.

The condition warrants abortion to treat the mother. In the Telangana study, the authors noted pre-eclampsia in about 15 per cent of primigravidae women with hypertension, as against 7 per cent in women with hypertension who have been pregnant before.

Regular monitoring

Dr. Abkari notes that women with hypertension can give birth with regular blood pressure monitoring. Those with readings suggesting borderline PIH can benefit from exercises and diet modifications, including regulation of salt intake, without medication. However, uncontrolled high BP warrants medication certified for use during pregnancy, he added.

The authors suggested that pregnancy-induced hypertension may be common among Indian women, while stating the need for population studies to establish its prevalence.

Source:  The Hindu

NPPA decision to cut post-surgical drug prices,big relief for transplant patients

Arnity Homji (57) has a reason to smile. With the National Pharmaceuticals Pricing Authority (NPPA) deciding to slash the prices of immunosuppresive drugs by 50%, she would be saving Rs 10,000 a month.

Immunosuppresive drugs are post-surgical medicines that needed to be taken lifelong by transplant patients to avoid rejection by the organ transplanted. Homji's daughter underwent a heart transplant in 2014 in Chennai and has been on immunosuppresive drugs.

The NPPA, which controls drug prices, has slashed prices of immunosuppresive drugs like Tacrolimus, Mycophenolate and Ciclsosporine last month.

Daara Patel, secretary general of Indian Drug Manufacturers' Association (IDMA), said that the NPPA notification came recently.

"As per the notification, manufacturers have to bring down prices. According to my knowledge, this is for the first time the prices of these drugs have been brought down," said Patel.

Transplant patients spend lakhs of rupees on surgery and end up spending more on post-surgical drugs, he said. "After surgery, it is compulsory that patients take immunosuppresive drugs lifelong. It is good that NPPA has decided to bring the prices of these drugs to a reasonable level," said Patel. On an average, patients spend almost Rs 10,000-15,000 per month on anti-rejection drugs. "Apart from medicines, we have to undergo blood test every month. So, the monthly cost comes to Rs 30,000. Charitable organisations do help with funds during surgery but not after that," said Homji, who lives in Bandra.

Parents of Dhruv Ranalkar (8), who underwent a kidney transplant at PD Hinduja hospital recently, said that they spend Rs 12,000 on anti-rejection drugs. "The decision will help save money. I am the only breadwinner in the family," said Dhananjay, who works in a private firm in Nashik.

Renowned cardiologist from Mumbai said "This move by the NPPA will go a long way as organ transplant patients have no choice but to take medicines. A successful organ transplant depends on the patient complying to immunosuppressive drugs."

In a heart transplant, patients spend around Rs 20,000-25,000 a month on these drugs for the initial 12 months and Rs 10,000-12,000 a month after that. "For a poor family, spending Rs 20,000-25,000 a month on medicines is a huge thing," said Agarwal.

Dr Ravi Mohanka, chief surgeon and head of the department, liver transplant and hepato-biliary surgery at Global hospitals, said it is a respite to all organ transplant patients.

Heart transplant: Rs 22-30 lakh

A heart recipient has to spend Rs 20,000-25,000 on post-operative care for six months. Lifelong medication costs Rs 10,000-15,000 every month

Kidney transplantation: Rs 4-6 lakh

A kidney recipient has to spend Rs 12,000-15,000 on post-operative care for six months. Lifelong medication costs Rs 10,000 every month.

Liver transplant: Rs 25-30 lakh

A recipient has to spend Rs 10,000-15,000 a month on medications.

Immunosuppressant drugs or anti-rejection medicines suppress or reduce the strength of the body's immune system , thereby lowering the body's ability to reject a transplanted organ such as a liver, heart or kidney.

A transplant patient has to compulsorily take immunosuppressant drugs as the body recognises a transplanted organ as a foreign mass. This triggers a response by the body's immune system to attack it.

source: DNA

High Blood Pressure or Hypertension

Hypertension is defined as blood pressure is higher than 140/ 90 mm Hg. This threshold of blood pressure has been set to define Hypertension for clinical conveniences as patients benefit once they bring their blood pressure below this level. 

Normal level of blood pressure is 120/80mm Hg.

Pre hypertension range is 120-139 or 80-89 mm hg.

Stage 1 Hypertension is 140 to 159 mm Hg systolic or 90 to 99 mm Hg diastolic .

Stage 2 Hypertension is 160 or higher systolic Or 100 or higher diastolic.

Hypertensive crisis is when blood pressure above 180mm Hg systolic or above 110mm Hg diastolic.

Causes of Hypertension are:1.Age :- everyone is at greater risk of  Hypertension as get older.

2. Size:- Being overweight or obese is key risk factor for Hypertension.

3. Sex:- Males are more prone in younger age and women at older age

4. Lifestyle:- Greater intake of dietary salt, Excessive alcohol, Low dietary  potassium, Physical inactivity, Hereditary causes and family history,  Chronic poorly managed stress

5.Other causes :- Diabetes Mellitus, Kidney diseases, Pheochromocytoma, Cushing syndrome, Congential abdominal hyperplasia , Hyperthyroidism, Hyperparathyroidism, Pregnancy, sleep apnea.

Symptoms: Hypertension per say does not causes symptoms but Hypertension can cause by quietly damaging Cardiovascular system.

·         It  causes Arteriosclerosis which means hardening of arterial walls , this will cause complications like Enlarged or weakened heart.

·         It can results in Aneurysm which is abnormal bulging  of wall of artery),

·         Blood vessel narrowing can cause Kidney failure, Heart failure,

·         It can  diminishes blood supply to brain and legs,

·         Stroke

·         Chronic Heart Diseases

High Blood Pressure is diagnosed by measuring Blood Pressure by using instrument named sphygmomanometer.

Treatment of hypertension: Lifestyle changes not only for treatment but also for prevention of diseases which includes Salt restriction, moderation of alcohol consumption, High consumption of vegetables and fruits and low fats. Reducing weight and maintaining it. Regular physical exercise. Stress reduction .Drug treatment for hypertension are diuretics, beta and alpha blockers, calcium channel blockers, central agonists, peripheral adrenergic inhibitors, vasodialtors, ACE inhibitors, Angiotensin receptive blockers,

Choice of the drugs depends upon individuals and any other condition they may have, while single drug is used in monotherapy but we can use combination for two drugs as and when they  are required.

Hypertension and Stroke:

Stroke:- is a disease that affects the blood vessels supplying the brain. Stroke occurs when blood vessel is blocked by clot is called ischemic stroke , or blood vessels bursts and bleeds into brain parenchyma hemorrhagic stroke. High blood pressure can damage arteries throughout the body. About 87% of strokes are ischemic and 13 % of stroke are hemorrhagic stroke.

Warning sign are FAST:

F Face dropping to one side, Ask the person to smile , Is person’s smile uneven ?

A Arm weakness, one arm will be weak or numb, Ask person to raise both the arms, does one arm drift downwards?

S Speech Difficulty, Is speech slurred? Is person unable to speak or hard to understand?

T Time to call , its emergency.