Health Adda

In times such as these, when every TV channel, newspaper or conversation is spewing fearful and despairing news, how does one cope and survive with the hope to see better times? Amidst galloping COVID 19 numbers, gruesome clashes on our borders, crumbling economy and a very uncertain future, I discovered a living story of exemplary coping and resilience that can make a difference to our lives. Her name is Ruth Ba der Ginsberg, 87 year old lady, the oldest judge of the Supreme Court of USA who is attending to her duties while undergoing chemotherapy for her third cancer. The present cancer that she is fighting is an advanced one that has spread to her liver, for which she is receiving twice weekly chemotherapy and is optimistic as the tumour is showing signs of regression. Her long life is as much a lesson in hard work and perseverance in reaching where she has in her career, as it is about coping and resilience with health problems and cancer. Her first date with cancer was in 1999 whe...

There is hardly any person in Uttar Pradesh who has not heard of Dr D K Chhabra, a senior neurosurgeon, who died recently. Over the decades his expertise, pragmatic advice and popularity had broken the shackles of his narrow surgical field coming to be known as a “brain-specialist”and a genuine adviser for all health problems. I got to know him in 1987 when I joined the upcoming Sanjay Gandhi PG Institute of Medical Sciences (SGPGI) in Lucknow as a young member of the faculty in Gastroenterology. He had moved from his alma mater the KG Medical College where he is still regarded as a legend. An omnipresent bachelor doctor living in the duty room readily available to help anybody anytime.He was tasked to heading and developing Neurosciences at SGPGI. He had an eye for detail and was tasked additionally by the director to set up not just his department, but the whole hospital, the building, equipment and the campus. DKC was a tall and handsome man who spoke little. But when he did inl...

It is indeed difficult in the midst of a raging pandemic to see any silver lining to the dark COVID clouds, but two sets of observations are emerging on an optimistic note. Let me start with a true story of a 34-year old otherwise healthy young man who came down with fever for 8 days, initially suspected to be typhoid, that refused to subside with several courses of strong antibiotics. By the time he reached a nearby hospital, he was found to be breathless requiring oxygen therapy (requirement 4 liters/minute). A COVID test was sent, but as no beds were available, he was asked to go to another hospital. After much pleading, he was kept in the emergency hold area on supportive care waiting for a bed to fall vacant. Over the next 2 days his fever and breathlessness deteriorated (requiring 15 liters/minute), while his COVID test came positive. He could luckily be shifted to a single ICU bed of a nearby hospital that fell vacant, just in time to be put on a ventilator. In the subsequent da...

The COVID19 story that started just 5 months ago as a regional outbreak and then snowballed into a massive pandemic, seems to have another facet that scientists are coming to terms with: a funny spin or DOOSRA for most aspects we thought we knew!  BLOOD VESSEL DISEASE There is increasing evidence that COVID that was thought to be a viral pneumonia quite like influenza, SARS or H1N1 is turning out to be BLOOD VESSEL disease. Studies on lungs of patients are showing that small vessels that supply blood to the lungs are choked with clots, in stark contrast to what we see in “pneumonia” where the blood vessels are intact but the small airspaces are filled with fluids and cells. This is helping explain why many patients have breathlessness and low levels of oxygen in the blood, and why providing high flow rates of oxygen rather than mechanical ventilation seems to help. Damage and choking of blood vessels in other parts of the body are being increasingly seen a...

One of the off shoots of the COVID 19 scare and lockdown and that many of my colleagues and I are witnessing is the growing use of TELEMEDICINE. It is not without reason that most good hospitals are now offering tele-medicine services, and many patients are benefiting from it. In fact, I thought it makes perfect sense for a patient of Chronic Hepatitis B who is doing well under my treatment with oral medications for the last 4 years and residing in a remote small town of Uttar Pradesh for example, not to spend time, travel cost and effort to visit me in my clinic to show his reports, have a 10- minute consultation, and get a fresh prescription, all that he may now get on-line by telemedicine using his smart phone. Telemedicine is emerging as the in-thing nowadays across the world where people are reaping the benefit of technology, having a face-to face consultation (without masks!) on video with a doctor after having shared all reports with him in advance. And you can do it fr...

I cannot recall witnessing the government machinery of this country so active, energetic, concerted and committed in its fight against a common enemy, as during the COVID outbreak this time. The next few weeks are going to be a “make or break” phase…when we might either breathe a sigh of relief, or suffer much for a long time. But I must share a story with you. Our house help who shares our home for 20 years got a call on her cell phone t hat one of her elderly aunts staying in a congested part of her hometown had died. She had been old and had a long-standing breathing problem. To my obvious next question “Was it COVID?”, she answered that she had not been tested. On pursuing further if there was time still before the body was disposed, as a precaution just in case, she said “It would be too much hassle… the police will land up at home, perhaps take grieving relatives elsewhere, involve expenses, and delay the last rites”. Officials, be it of the health department...

There is perhaps no other branch of science as in medicine where unexpected events and outcomes occur often enough to invoke ‘luck”  as an explanation. Every surgeon will have a story to tell of how the condition of an otherwise “stable” patient thought to have a very low risk suddenly plunged down after a small procedure despite everything being done right, much to his embarrassment and dismay! But when a patient’s condition tumbles down unexpectedly due to the “luck” factor and results in death, it is hard for relatives to accept. Take a look at the recent story of a 65-year healthy farmer who met with a road traffic accident and sustained severe injury to his right upper limb for which he was brought to hospital and underwent an amputation. A week later when he was sitting up in bed, eating his dinner and gearing up to go home, he experienced sudden severe chest pain and sweating. An emergency angiography done within hours, as he was luckily in hospital, sh...

The familiar white coat worn by physicians as their distinctive dress for over 100 years, has started generating  murmurs  of controversy. It is not uncommon to find the blood pressure to be higher when measured by a white-coat-wearing-doctor in the hospital or clinic than the readings obtained at home by relatives.  This is due to the anxiety that the white coat and the hospital setting evokes in patients, and has been termed “White Coat Hypertension”. Mature clinicians often routinely subtract a few points from these measurements when entering records in case charts or calculating the dose of anti-hypertensive medications to be prescribed. The white coat scares children too.  Kids often express their dislike for this dress by crying and screaming and by denying access to their bellies or chest for examination by paediatricians in this attire. Many pediatricians across the world have folded up their white coats and taken to informal colourful dressing to...

Doctors may not be the brainiest in society; yet the fascinating ways in which they think and make decisions has been the subject of interesting research. A book by Dr Jerome Groopman that deals with the subject has hit the best-seller list. There are some parts of the brain that a doctor uses preferentially over others, memory being perhaps one of the most important to start with.  It begins from the time a youngster thinks of taking the entrance exam to medical school – he is required to read, retain and reproduce a large number of factual information and names of body parts and functions. Unlike the engineering, management, or law students, medical aspirants are hardly required to use mathematical problem solving, creative thinking, logic or thinking out of the box.  But ask them names and profiles of thousands of organs, tissues, cells and drugs, and they will have it on their fingertips! In the next phase as they progress to clinical work, doctors learn to rec...

“The quantity and quality of medical research being undertaken in India is embarrassingly little”, said Dr MK Bhan, secretary, Department of Biotechnology, Government of India, while addressing a group of Indian gastroenterologists in a meeting in Delhi on 1st Aug.  He painfully pointed out how research was a low priority amongst most medical schools, and how very few doctors were taking up research as a career option. Many might well wonder why research is important at all in medical science. Is it not well-established medical practice that a patient seeks from his doctor or hospital? The National Institute of Health in USA has shown time and time again how research improves teaching, and teaching lifts the standards of care. It might be hard to accept at face value, but an example or two may make it clear. The treatment of breast cancer, for instance has undergone major upheavals over the last few decades. It started more than a century ago with the concept that the t...

The government’s and court’s recent knee jerk decision to clamp down on clinical research in the country is likely to prove regressive in the long run, for if there is one single factor that keeps modern medicine ahead of other systems, it is new discoveries and innovations fuelled by the indomitable spirit of research.  Heart diseases for instance can now be prevented by new drugs that lower cholesterol orprevent stickiness of clot-forming platelets, which are getting better by the day, thanks to research. Narrowed or blocked arteries of the heart can now be opened up by balloons or stents inserted through the hand, thanks again to bold research. Further, the occluded arteries can also be “bypassed” surgically using grafts or conduits, as our present prime minister’s health bears testimony to, as a consequence of daring experimentation by bold heart surgeons 30 years ago. What has made these “advances”possible however has been years of painstaking research, initially i...

Despite general agreement on the pivotal role and necessity of “clinical trials” to usher in better treatments and to keep pushing the boundaries of what medical science can achieve, the term continues to evoke suspicion and cynicism in the minds of the public. The history of clinical trials has been both epoch making as well as shameful. During my recent discussions with an international pharmaceutical organization that has developed some promising new molecules for Hepatitis B and C and was trying to identify reliable hospitals and clinical investigators in India, I was told that clinical trials are banned in some states in the country. Some investigator-doctors here had obviously flouted safety and research norms and jeopardised the lives of innocent patients.  But why did they do it? The possible reasons:there is often unusual eagerness to recruit patients in a trial as successes in the eyes of industry sponsors as well as financial remuneration are linked with the numb...

The family doctor is fortunately being resurrected again. Yes, he was almost dead the last few decades when the public’s obsession with specialties and specialists drove them to high-end tertiary care centers. What they often missed was good holistic care! The family doctor’s role is the most challenging. He has to answer why the newly born cries after feeds, why the school going child is losing his appetite (or atleast that is what mom thinks), why the lady of the house gets the splitting attacks of migrain, how to measure and control the gentleman’s BP especially when there is tension at office, why grandad takes so long to pass urine, and how to manage the vomiting and diarrhea of the cousins who are visiting! In other words, he has to be the proverbial jack and dabble with all aspects of health from birth to death. Being a scarce commodity, a good family doctor can be difficult to find. His qualifications should include a “proper degree” and easy accessibility. He should not ...

Preventive health checks, while picking up some diseases at an early stage and paving the way for timely corrective measures, do not unfortunately guarantee against sudden natural deaths as we learnt recently. Mr DC, who had undergone a comprehensive executive health check-up a month earlier, died in a dramatic manner. This 59 year old fitness freak had gone to the club pool at 6.30 in the morning for his routine swim, had done his usual 5 laps and was then spotted by some fellow swimmers to be standing in one corner with uncustomary quietness.When the guards hauled him out of the pool, he was dead. The sense of disbelief among family and friends was especially stunning as his recent health check had been normal and the doctor had given him a thumb’s up. He was not a smoker, did not suffer from diabetes or high blood pressure and was not overweight. His cholesterol levels were normal. His ECG, both at rest as well as during the 9 minutes that he ran sprightly on the treadmill (TM...

Why delivering good gratifying medical care is so complex is because it involves not just knowledge, skills and ethics but another vital component that is often overlooked, called medical etiquette. Medical etiquette is simply good proper behaviour that is expected of physicians and nurses when dealing with patients. Simple, etiquette is usually not given much importance during medical training in this country and is hence often found woefully lacking in our professionals. Consequently, do not be surprised to meet a top-notched specialist with a string of degrees below his name, who may forget the etiquette of offering you a seat when you enter his chamber, and continue talking on the phone. A resident doctor, who comes to train with us to become a superspecialist, is often grossly deficient in etiquette. In the busy and crowded OPD, I see him often examining a female patient in the presence of 10 unrelated spectators. In the ward, I see him doing an ascitic tap (drawing fluid ...

Of the many things patients have taught me is why they like some hospitals and hate others. You will find streams of grateful patients in a shabby government hospital for in stance, while there would be many who would choke on their drinks in a party with the mere mention of that hospital’s name. The factor that seems to sway opinion most is the final outcome of an index patient; if he was brought in moribund and finally walk out, then all the dirty linen, the “paan” stained corridors, the constant drone of mosquitoes and the rude words from nurses are often forgiven, and the hospital assumes the symbol of a new life. If the end goes awry, as often it does in a referral hospital where critically ill patients are shunted to, the hospital becomes blotched in the minds of relatives and friends across generations. But how do first timers, who have often come in for a consultation or procedure react to a new hospital? The initial impressions often prove crucial. Was the entrance clean and ...

I learnt how the dress of a doctor sometimes affects relationship with his patient, the hard way. Mrs Sinha (name changed), who had been in and out of  hospital several times due to a chronic liver problem, confided that her confidence sapped each time Dr A was on duty. The reason: he dressed shabbily in crumpled loud-cloured audaciously printed T-shirts, jeans and chappals, kept dirty stubble on his face, and had a sweaty odour. “How can I trust and confide in a dcotor who dresses so carelessly, and expect him to be careful with my treatment?”  A person’s nature, attitude and character are often reflected through his attire. A doctor’s dress may help convey a subtle message to his patients and their relatives. In present times when fashion and dress codes change so frequently and radically, doctors are often confused on how to dress appropriately yet smartly. Some stick to the classic “old look” of wearing dull coloured loose pleated trousers, standard white regular collare...