Monday, April 27, 2015

Still Smoking?? These Facts Will Definitely Blow You Off

How Is Smoking Related to Cancer?
Smoking can cause cancer and then block your body from fighting it:
·         Poisons in cigarette smoke can weaken the body’s immune system, making it harder to kill cancer cells. When this happens, cancer cells keep growing without being stopped.
·         Poisons in tobacco smoke can damage or change a cell's DNA. DNA is the cell's "instruction manual" that controls a cell's normal growth and function. When DNA is damaged, a cell can begin growing out of control and create a cancer tumor.
Doctors have known for years that smoking causes most lung cancer. It's still true today, when nearly 9 out of 10 lung cancers are caused by smoking cigarettes. In fact, smokers have a greater risk for lung cancer today than they did in 1964, even though they smoke fewer cigarettes. One reason may be changes in how cigarettes are made and what they contain.5
Treatments are getting better for lung cancer, but it still kills more men and women than any other type of cancer. More than 7,300 nonsmokers die each year from lung cancer caused by secondhand smoke.
Smoking can cause cancer almost anywhere in your body, including the.
·         Blood (acute myeloid leukemia)
·         Bladder
·         Cervix
·         Colon and rectum
·         Esophagus
·         Kidneys and ureters
·         Larynx
·         Liver
·         Lungs
·         Mouth, nose, and throat
·         Pancreas
·         Stomach
·         Trachea
Men with prostate cancer who smoke may be more likely to die from these diseases than nonsmokers.
Smokeless tobacco also causes cancer, including cancers of the:
·         Esophagus
·         Mouth and throat
·         Pancreas
How Can Smoking-Related Cancers Be Prevented?
Quitting smoking lowers the risks for cancers of the lung, mouth, throat, esophagus, and larynx.
·         Within 5 years of quitting, your chance of cancer of the mouth, throat, esophagus, and bladder is cut in half.
·         Ten years after you quit smoking, your risk of dying from lung cancer drops by half.
If nobody smoked, one of every three cancer deaths in the United States would not happen.

Tarvelling Frequently by Air? Here Are Tips To Keep Ears Safe.

Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they may result in temporary pain and hearing loss. Make air travel comfortable by learning how to equalize the pressure in the ears instead of suffering from an uncomfortable feeling of fullness or pressure. 
Normally, swallowing causes a little click or popping sound in the ear. This occurs because a small bubble of air has entered the middle ear, up from the back of the nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and re-supplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is not equal the ear feels blocked.
The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube remains blocked, fluid (like blood serum) will seep into the area from the membranes in an attempt to overcome the vacuum. This is called “fluid in the ear,” serous otitis or aero-otitis. Uncommon problems include developing a hole in the ear drum, hearing loss and dizziness.
The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies are also common causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.
Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.
Actually, any situation in which rapid altitude or pressure changes occur creates the problem. It may be experienced when riding in elevators or when diving to the bottom of a swimming pool. Deep sea divers, as well as pilots, are taught how to equalize their ear pressure. Anybody can learn the trick too.
Swallowing activates the muscles that open the Eustachian tube. Swallowing occurs more often when chewing gum or when sucking on hard candies. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent because swallowing may not occur often enough to keep up with the pressure changes.
During decent, if yawning and swallowing are not effective, pinch the nostrils shut, take a mouthful of air, and direct the air into the back of the nose as if trying to blow the nose gently, you should feel a pressure buildup but do not let the air out your mouth The ears have been successfully unblocked when a pop is heard. This may have to be repeated several times during descent.
Even after landing, continue the pressure equalizing techniques and the use of decongestants and nasal sprays. If the ears fail to open or if pain persists, seek the help of a physician who has experience in the care of ear disorders. The ear specialist may need to release the pressure or fluid with a small incision in the ear drum.
For some people, these techniques may not work.  If you fly frequently and have chronic issues with pressure or pain, you doctor may recommend placing small pressure equalization tubes.
Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed the baby during the flight, and do not allow him or her to sleep during descent. Children are especially vulnerable to blockages because their Eustachian tubes are narrower than in adults. 
Many experienced air travelers use a decongestant pill or an over the counter nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason. However, avoid making a habit of over the counter nasal sprays. After a few days, they may cause more congestion than relief.
Decongestant tablets and sprays can be purchased without a prescription. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.
Tips to prevent discomfort during air travel
  • Consult with your surgeon on how soon after ear surgery it is safe to fly.
  • •Postpone an airplane trip if a cold, sinus infection, or an allergy attack is present.
  • •Patients in good health can take a decongestant pill or nose spray approximately an hour before descent to help the ears pop more easily.
  • •Avoid sleeping during descent.
  • •Chew gum or suck on a hard candy just before take-off and during descent.
  • •When inflating the ears, do not use excessive force. The proper technique involves only pressure created by the cheek and throat muscles.
  • •These tips may also be used for people who scuba dive.

What is Sinusitis?

Sinusitis means your sinuses are inflamed. The cause can be an infection or another problem. Your sinuses are hollow air spaces within the bones surrounding the nose. They produce mucus, which drains into the nose. 
If your nose is swollen, this can block the sinuses and cause pain.
There are several types of sinusitis, including
  • Acute, which lasts up to 4 weeks
  • Subacute, which lasts 4 to 12 weeks
  • Chronic, which lasts more than 12 weeks and can continue for months or even years
  • Recurrent, with several attacks within a year
Acute sinusitis often starts as a cold, which then turns into a bacterial infection. 
Allergies, nasal problems, and certain diseases can also cause acute and chronic sinusitis.
Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. 
There may also be mucus drainage in the back of the throat, called postnasal drip. Your health care professional diagnoses sinusitis based on your symptoms and an examination of your nose and face. You may also need imaging tests.
 Treatments include antibiotics, decongestants, and pain relievers. Using heat pads on the inflamed area, saline nasal sprays, and vaporizers can also help.

Sunday, April 26, 2015

What is lung Cancer?


Note: All cancers and patients are highly individual, so treatment will be tailored to their specific cases. Some information may become outdated, as new or better regimens are always being
researched/tested/approved. Not all chemotherapy agents are available in all countries. 

Suggestions for information to be included or needed changes in this overview are always welcome!

Excerpted from M.D. Anderson's adaptation of NCI's "What You Need to Know About Lung Cancer"

What are the symptoms of lung cancer?
Common signs and symptoms of lung cancer include:
• A cough that doesn’t go away and gets worse over time
• Constant chest pain
• Coughing up blood
• Shortness of breath, wheezing, or hoarseness
• Repeated problems with pneumonia or bronchitis
• Swelling of the neck and face
• Loss of appetite or weight loss
• Fatigue
These symptoms may be caused by esophageal cancer or by other conditions.

How is lung cancer diagnosed?
If any of the above symptoms do occur, your doctor will evaluate your medical history, smoking history, exposure to environmental and occupational hazards, and family history of cancer. The doctor will also perform a physical exam and may order a chest x-ray and other diagnostic tests. If lung cancer is thought to be present, a sputum cytology test will be ordered to exam your mucous cells under a microscope. To confirm the presence of lung cancer, the doctor will perform a biopsy—the removal of a small sample of tissue from the lung for examination under a microscope. A number of procedures may be used to obtain this tissue such as a bronchoscope, needle aspiration, thoracentesis, or thoracotomy.

What is staging?
If the diagnosis is lung cancer, your doctor will need to know the stage (or extent) of the disease. Staging is a way to find how far the cancer has spread and to which parts of the body. Lung cancer often spreads to the brain and bones. Once your doctor knows what stage your cancer is, he or she can plan your treatment. Some tests used to determine if the cancer has spread include CAT/CT scan (computerized tomography), PET scan (Positron emission tomography), MRI (magnetic resonance imaging), radionuclide scanning, bone scan, and/or mediastinoscopy/mediastinotomy.

How is lung cancer treated?
The treatment of lung cancer depends on a number of factors, including the type of lung cancer (NSCLC or SCLC); the size, location, extent of the tumor; and the general health of the patient. Many different treatments and combinations of treatments may be used to control lung cancer, and/or to improve quality of life by reducing symptoms. Treatments for lung cancer include surgery, radiation therapy, chemotherapy, and photodynamic therapy. Clinical trials are also a treatment option.

How is non–small cell lung cancer treated?
Patients with non-small cell lung cancer may be treated in several ways. The choice of treatment depends mainly on the size, location, and extent of the tumor. Surgery is the most common way to treat this type of lung cancer. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.

How is small cell lung cancer treated?
Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body (such as in the brain). Some patients have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation (PCI), is give to prevent tumors from forming in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

The gateway to Lung Cancer information at the National Cancer Institute NCI:

Do You Have lung Cancer?

If you are writing to say that you are worried because you have symptoms related to Lung Cancer but you haven't been to a doctor yet, here is a summary of what we are probably going to say to you:

* Don't panic!
* Consulting Google will only increase your fears.

Dr. Google can convince people that they are seriously ill when mostly they are not.

* You probably don't have Lung Cancer. There are many things that can cause symptoms similar to LC but most are not, in fact, LC!

* Unfortunately, we cannot tell you that you definitely do NOT have LC either. We are not doctors, and the ONLY way that LC can be diagnosed is with a biopsy. What we can tell you is that you are obviously concerned, so you should seek medical counsel for your own peace of mind. 

* In summary, if you are concerned, go see a doctor. If you are not satisfied with how they treat you, see another one. You are the greatest advocate for your own health, as you have the greatest stake in it.

* If you have been to a doctor who suspects Lung Cancer, or you are currently undergoing tests specifically for Lung Cancer, we will support you through diagnosis. You are free to post in this area of the Forum. However, if a doctor tells you that you do NOT have LC, please refrain from posting your fears on this site as there is nothing else we can do to help you. This has proven to be upsetting to our members who are currently battling LC or have loved ones who are.

If you have any questions about whether or not you should post, please feel free to send me a private message and I will let you know. Best of luck!

The Battle Against Polio!!!!

“When I worked on the Polio Vaccine, I had a theory. I guided each (experiment) by imagining myself in the phenomenon in which I was interested.  The intuitive realm……… the realm of imagination guides my thinking.
-Dr. Jonas E.Salk, American Virologist and Discoverer of Polio Vaccine.
(Dr. Araveeti  Ramayogaiah)
Dr. Araveeti Ramayogaiah
Dr. Araveeti Ramayogaiah
On January 13, 2014, we achieved three years of Wild Polio Free India (WPFI), a historical mile stone occurs only once.  I am thrilled and satisfied but not on cloud nine and I am equanimous.  For me it is – “Justice delayed – Justice denied” for the people at the helm it is – “Better late than never”.
8.5 lakh Accredited Social Health Activists (ASHAs), 2 lakhs Auxillary Nurse Midwives (ANMs), 1.5 lakhs supervisors, 13 lakhs Anganwadi teachers, Several lakhs of volunteers, community mobilisers, several activists, media  etc contributed for success.  The Nation salutes all those soldiers who made it.
On January 14, 2012 almost all print media including ‘The Hindu’ published beautiful photograph of Honorable U.S.  Secretary  of Health  and Human services  Madam   Ms. Kathleen Sebalius administering oral polio vaccine  – OPV (Sabine vaccine) to a child in New Delhi.  The irony is that US do not use this vaccine to its children.  US uses inactivated polio vaccine – IPV (Salk vaccine) which is injectable and safe.
On February 11, 2014 India celebrated the success on Polio in the presence of Dr. Margaret Chan, Director General of World Health Organization at an official function held in New Delhi.  It was attended by honourable President of India, Prime Minister of India, Union Health Minister and Leader of opposition in Loksabha.   What pains most is that except Doordarshan, hardly any TV channel telecasted the event live.   It is my practice to read 10 daily news papers on every day.  None of the papers of February 12, 2014 reported that event.   I could not decipher the reasons, but this trend discourages future elimination programmes and also discourages the millions of volunteers who made it possible!.  As a matter of fact the whole country should celebrate it.
Pulse Polio Immunization (PPI) is the one of the key interventions in elimination of Polio.   Our country launched nationwide pulse polio programme in 1995-96.  In 1994 itself, the programme was started in State of Delhi.
In the long journey spanning two decades, we have brought down polio cases from 28,587   in 1997 to 1 in 2011 and Zero in 2012, 2013 and 2014.    The nation passed through mixed feelings of enthusiasm, complacency, euphoria and distress.  The country has traversed from enthusiasm to ritual mode, from people’s participation to bureaucracy driven, from volunteerism to fee for work, from no special allocation of budget to PPI to allocation of special budget for P.P.I. When there was less budget it was every body’s programme and with huge budget it turned into one sided programme.
Peoples’ participation:     
Peoples’ participation is one of the three pillars of primary health care.  In the last few years, I have observed the programme at several places. In the year 2013, I monitored the PPI programme as a state programme officer in Nizamabad district of A.P. and covered 80 percent of the district.
Though we achieved wild polio free status of 4 years, the long term stumbling block still remains i.e., “missing peoples’ participation”. The 1978 Alma Ata declaration considers people as prime movers for shaping their health but not passive recipients. The 1946 Bhore committee report clearly says that it is essential to secure active co operation of the people for the development of health programmes. The world health day theme of 1988 was’ Health for all-All for health’, which explains self. The 1994 International conference on population and development advocated community needs assessment (CAN) approach where planning itself should be from the community i.e., “Bottom up approach”.
Despite all these pronouncements, it is agonizing that people are not involved anywhere in the health delivery. The major cause could be growing capitalistic evolution of Indian society, kleptocritic and plutocratic phase of Indian democracy and plaguing chronic capitalism.
In this scenario, fee for service becomes a new mantra for delivery of any service and or for that matter a massive public health programme like polio eradication too. In a system of “fee for service”, the programme makes vast majority of people as aliens, simple recipients and not real players. This is a weak foundation and harms in long term and may even results in reversal of achievements already made.
Still there is a light at the end of the tunnel. Health functionaries at various levels should visit schools and create awareness in the school children and rope them in during their formative years. On every PPI day, non officials like ward members, sarpanches, corporators, mayors and members of legislative bodies should be roped in, in a big way for formal inaugurations and symbolic administration of polio drops by them. The ‘only booth approach’ of earlier years created massive peoples’ movement in the community, where as ‘house to house’ makes people sit in their houses for health functionaries to visit them. Thus it becomes one sided. House to house programme should be phased out. For the nation that is crying for tangible results in public health can’t afford to keep away any health functionary away from the programme. Massive main streaming of specialist doctors of secondary hospitals, practitioners of private sectors and corporate sector is the need of the hour. All the influential persons in the community should become part of the programme. A volunteer from a NGO or a student from a school is not peoples’ participation. In Turkey Imams played crucial role in improving immunization levels and in Srilanka Buddhist monks played vital role to improve public health. We need to emulate them. Several such innovations can be thought off to make PPI programme a really peoples’ participatory one. The best practices of eighties viz. Village leaders training [VLT] camps and Orientation training camps [OTCs] and the spirit of early years of PPI should be revived. As we make a sincere beginnings, new innovations will emerge and ultimately peoples’ participation becomes spontaneous and natural. Peoples’ participation in PPI helps in the success of other on going public health programmes and future public health programmes.
India’s P.P.I. suffered from several infirmities also viz. Very low routine  immunization , pockets of un immunized children during NID  rounds,  irresponsibility  and non accountability  of various functionaries , lack of political and administrative will,  morbid  individualism  and poor environmental sanitation. For the District Magistrate whom I met in one of the rounds as the state program officer, it was a sarcasm. He said, “Pulse polio… !  it is  signing the cheques and cutting the ribbon!  Okay, I will do”. One of the Chief Ministers of this country openly expressed his fatigue and said this was not his priority. Several bureaucrats asked me, “How long this Doctor!”
During 1998 to 2002, I was a teacher in Government medical school at Guntur in the department of preventive medicine.  During one of the PPI rounds, telling the dates of PPI to them, I asked 20 and odd internees about the importance of those days.  None could answer.  In fact the city was reverberating with huge I.E.C. (Information, Education and Communication) activities.  There is paramount need to sensitize medical students on nation’s health needs.
Inter sectoral coordination:
Inter sectoral coordination is one of the 3 Pillars of Primary Health Care. There is even missing intra departmental coordination in our country.  For a specialist in a Secondary Hospital, the programme is Greek and Latin.   In fact one specialist confessed to me that he doesn’t know how many drops are put in to child’s mouth.  In this scenario, the role of intersectoral coordination can be simply imagined.
India is one of the country with gigantic private medical care services.  PPI is not their cup of tea.  There is a need to main stream every medical system and functionary to a public health activity like PPI.
Yet we have achieved Three Year of W P F   status!  Let us salute mother nature for her benevolence.  Most of the child survival interventions are interdependent and contribute for the success of multiple parameters.
With hunger index of 66,  Infant Mortality rate of 41, 42% of undernourished  children , skewed  Juvenile  Sex ratio of 914:1000,  Poor breastfeeding and infant feeding practices, we are blessed at least in one area i.e. Poliomyelitis.  Thanks to un-touchable practices of wild polio virus and let us all pray great nature to bless the virus not to change its mind.
Way forward:
Now maintaining Wild Polio Free Status for ever is a real challenge.  I am neither an academician, nor an expert nor a scientist.  I am an ordinary person involved at field level. Experts believe that the ensuing period is very critical and should be handled by introducing Injectable Polio Vaccine (IPV).  I firmly believe that my country can do that and achieve the goal.   Let us not hesitate as IPV being an injectable vaccine.  After all we are already using injectable vaccines viz DPT, BCG and Hepatitis B in universal immunization programme.  Let us meet   the future ahead with IPV which is safe and prevents vaccine Associated Paralytic Polio (VAPP).  Let us not debate on cost of IPV as nothing is costlier than lives of children.
On this occasion, let me warn the nation that there is a looming threat of importation of virus and prepare to face it.  In 2009-2010 as per WHO fact sheet of October 2011, twenty three previously polio – free countries were reinfected due to import of the virus.  With the prevailing internal turbulence, Pakistan and Afghanistan do not change to non endemic status even in far future and we are under constant threat of importation.  The importation of wild polio virus in to China (which was free from Polio since 2000) poses a risk to us.  Very recently importation took place into Syria.  The Polio virus   does not respect national borders.   Let us be vigilant   at our borders with high level of surveillance and stop any type of importation.  With the present achievement we hope to give final push and tame the virus.
Still many people in our country think that PPI is the all and end all for eradication of Polio.  Poliomyelitis is an infection transmitted from feco-oral route.  We have to address the issues of safe water and sanitation on war footing.
For a nation  that is committed,  the issues of migrating populations , high-risk  areas, remote and interior places , influence of opinion makers  do not pose any  threat and nation  has all the will and wherewithal  to face the challenge.  The nation enjoys the work but do not get fatigued as the jumping children with joy is paramount priority to the nation.
No matter  how much money  we spent , how much networking we build , how much social mobilization  we make  – it is only winning the trust of people  that can gain popularity for mission mode programme like pulse polio immunization.
The nation is heading for another PPI programme on January 18, 2015 and February 22, 2015.  Let us all actively associate with this programme to make it a grand success.
“Once polio  is eradicated , the world can celebrate the delivery of major global public good – something  that will equally benefit all people, no matter where they live”, said the WHO.
“Our greatest responsibility is to be good ancestors” said jonas E salk.  Do we have that spirit?
Bye, Bye Polio!
Founder – Organization for Promotion of Social Dimensions of Health (OPSDH)
Former Additional Director of Health of A.P.
Former State Coordinator, Breastfeeding Promotion Network of India (BPNI)
Formal, Consultant, Indian Institute of Health and Family Welfare, Hyderabad.

source : 

Tuesday, April 7, 2015

7 healthy ways for a healthy life!!!

It is not only important to monitor what you eat or drink but also how you time it all. If we discipline ourselves towards a better lifestyle, maintaining good health won’t be such a task. It is World Health Day today. It is a good reason to take complete responsibility of inculcating healthy habits into our life.

Follow these 7 changes to your lifestyle to feel better and live healthier-

1) King’s Breakfast: Most people don't feel like eating much at breakfast. However, ignoring or skipping breakfast sets a bad rhythm for the rest of your day and weakens your immune system. Having breakfast is a must and the ideal breakfast is one which is low in carbohydrates and has a good portion of protein. For people short on time, a seasonal fruit with raw nuts and a little yogurt can be a good option. Eggs and Milk can also do wonders.

2) Water Intake: Inadequate water causes dehydration and can lead to a number of problems. Most common ones are headaches, dry skin, impaired sleep, joint problems, poor concentration as well as digestive disorders. Best way to address this problem is to keep water handy wherever you are. Try to drink about two liters of water each day. More, if its hot outside or after workouts.

3) Sleep Well: Sleep time is rejuvenation for your body. If you don't get enough sleep, you will deprive your body the time to recover and tackle whatever the next day has to offer. Try to be in bed earlier and get at least 7 hours of sleep daily, sleep also helps in maintaining circadian rhythm and also boosts memory and immunity.

4) Physical Training: A good mix of aerobic as well as strength training is quite important for your health. You feel more energetic and productive when you physically work out. People who exercise regularly are generally happier than those who are inactive.

5) Stress Releasing: Stress is a major factor in inducing various forms of illnesses. Stress increases the amount of free radicals generated in the body and may cause hypertension and diabetes. Try to give yourself some time every week to do things that you enjoy – like reading, meditation or enjoying the outdoors.

6) No Self Medication: Often one wrong medicine causes much more harm than any medicine at the right time, does good. Try to avoid popping pills without doctor’s recommendation. Many side effects or reactions to an existing medication or condition can lead to uncalled for problems and complications later. Don’t rely on sources like chemist or a relative to guide you, they might not look at the right details due to lack of knowledge. Say no to self medication.

7) Avoid Fried junk foods : These are the sources of saturated fatty acids the main culprit in causing obesity and heart problems, instead feast on baked items.

Monday, April 6, 2015

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lets have a discussion on this - A year as a doctor’s apprentice- by Dr Varun Patel

Dear friends,
 This articles had sent ripples in the media about a year ago, I thought to share it . Read the blog and comment in the comments section.
here are the links to published news of the same blog…/exinterns-blog-has-docs-fuming-…/…/pune-from-abandoning-patients-to-slap……/resident-interns-blog-revea…/…/articlesh…/26814341.cms

 I have completed my internship, which was just for one year but felt as if it is an end of an era. This year was the best so far in terms of learning medicine but it was also worst ethically and has left a deep impact somewhere deep down in my conscience. I have been shown a glimpse of reality which I used to feel was only a part of books and newspapers. From abandoning an unknown patient to slapping a pregnant woman in labour, I have seen the worst possible scenarios which I would like to share here. This is what you go through when you work as a doctor’s apprentice.
Dr Varun Patel
Dr Varun Patel
You wake up at dawn, iron your clothes and apron, open up your newly bought stethoscope and are ready, totally pumped up to serve patients on the very first day. But the whole excitement crashes as soon as you enter the hospital chaos and the hospital staffs leave no room at all to humiliate you in worst possible way. ‘Aye Intern!’, ‘Aye Intern!’ and you turn back, that’s an instinct, because it takes a while for a mind to adjust to the reality, and you see a Mausi (ward maid) shouting at you to get off the recently mopped floor. On the first day itself they make you regret your decision to join this profession. You are startled at the trailer itself and you don’t feel like watching the movie anymore.
A month passes by and you get acquainted to the routine insults and are compelled to treat the patients in an unhygienic way, yes, you heard it right, unhygienic is the right way. You spend few hours in the casualty and you will see the resident doctors fighting over a patient. Nobody wants the patient admitted in his own ward. They call it ‘Batting’, you would see them proudly blabbering around – ‘Hey! Aaj Maine 6 Bat Kiye’, meaning he got rid of six patients that day. Where do these patients go! You wonder. They get admitted to the wrong department where they don’t get a proper treatment or else they are encouraged to go home, in spite of their vulnerable health.
You are just getting yourself accustomed to batting, when your eyes suddenly catch the sight of a patient sitting outside the casualty (shown in the picture below), inside the hospital campus. You inspect him to find out a ‘diabetic foot’ totally necrotized till an extent which requires an amputation. You want to help him; so you talk to the person in charge and try to take the patient inside, when you hear a roar… the CMO (casualty medical officer) is shouting at top of his voice; he is shouting so loudly that you tend to focus on the loudness rather than listening to what he is trying to say. Then over a period of time you start understanding his rhythmic squawks; you are shocked to learn that you are not supposed to help patients like this. Bringing patients in will increase the workload!
Instead the CMO asks you to shoo the patient away. Now, it is unethical for you and you refuse. But his smell becomes so unbearable that the guard shoos him away with a stick. That’s the moment when you feel helpless for the first time in your career. It makes you think, “Are you really treating a patient in need?” A government hospital is not expected to show such a behaviour towards the poor; wasn’t it bloody built for the poor?
A patient waiting outside the casualty department of Sassoon General Hospital, Pune. Photo: Dr Varun Patel
A patient waiting outside the casualty department of Sassoon General Hospital, Pune. Photo: Dr Varun Patel
You feel like you have seen everything when you land up in the worst possible departments one by one. You are trying to insert an intravenous catheter into a patient’s vein, when your ears fall on something which pops up a memory of Aamir Khan (from Satyamev Jayate) in your mind.
Aamir Khan in Satyamev Jayate
Aamir Khan in Satyamev Jayate
“I have sent the patient with Code Blue.” And the resident puts down the receiver. You then find out that he was talking to the chemist regarding his own ‘cut’ (the per cent income he gets for a referral of a patient to that chemist’s shop). If you have read carefully, the first question that baffles you is: What is Code Blue? Codes are implemented for secret communication:
• Code Blue: Make a Bill of Rs 4,000
• Code Black: Make a Bill of Rs 7,500
• Code Red: Make a Bill of Rs 10,000
The chemist gets this code from the resident and accordingly he formulates a bill, 35 per cent of which goes to the resident doctor. Aamir Khan was opposed by so many doctors for his proclaiming episode on doctors. You now realize the essence of it and understand the reason for the opposition.
A pregnant woman in a government hospital.
A pregnant woman in a government hospital.
“Giving birth should be your greatest achievement not your greatest fear,” said Jane Weideman since a woman needs a lot of support during pregnancy. But in an Indian government hospital giving birth to a child is not a unit less than suffering the third degree torture in jails.
Pregnant women are beaten like anything and, worst of all, the doctors feel it as justified. Before delivery it’s obligatory for an obstetrician to do a Per Vaginal (PV) examination, which according to norms is to be done with rubber gloves on and with the use of a lubricant. You will not even once see a government hospital using a lubricant over rubber gloves during a PVE. It’s discernible that the woman will be in pain without a lubricant and would shout out of pain but the thing you find implausible is when the doctor hits her and asks her to keep her mouth shut.
Unreasonable usage of Buscopan and Drotaverine to speed up the labour and unwanted episiotomies with accompanying fundal pressure manoeuvres (which are contraindicated) leave you baffled. You decide at that very moment that none of your loved ones will ever deliver in a government hospital hereafter. It’s better to be childless than making a woman go through such crucifixion.
You meet malpractices at each and every step. You discover that the true sense of ‘noble’ (profession) is lost somewhere. For one whole year you have to suffer both physically and mentally. You try to fight your inner conscience. You try to make changes, bring reforms. But after myriads of attempts when nothing works, you realize that ‘ignorance is bliss’ and learn to live with it and instead write an article about it.
Dr Varun Patel
Junior Resident (Emergency Department)
Lok Nayak Hospital, New Delhi
The blog was originally published in:

Can’t make doctors work over 12 hrs, hospitals told

The Delhi government has issued a circular restricting duty hours of resident doctors in all hospitals in the city to not more than 12 hours per shift per day. While in theory and in the rulebook of foreign accreditation agencies this is the norm, in practice it was never followed with resident doctors often forced to do back-to-back shifts, sometimes clocking up to 36 hours without a break.
In the circular issued on March 16, Director (hospital services) Dr Sanjay Agrawal wrote: “All director/medical superintendents and heads of clinical departments of hospitals/institutions/departments are advised that in case resident doctors are assigned continuous duties across multiple shifts in their hospitals/institutions/departments, then this practice must stop forthwith and duty rosters for resident doctors are prepared in a way that they are out on clinical duties not exceeding 12 hours in a shift in a day.”
Longer durations of clinical duties can only be sanctioned by the director or medical superintendent of the hospital but even in such exceptional cases, the total duration ofthe shift cannot exceed 17 hours, the circular specifies. In all such cases, the concerned authority would have to inform the secretary (health and family welfare) in the government of Delhi through email.

“Doctors routinely work 36-hour shifts twice, sometimes even thrice a week. As a postgraduate student, we often clock up to 100-120 hours in the hospital. This is insane in a high-precision vocation like medicine because fatigue would inevitably take a toll on your clinical judgement, your ability to concentrate and in case of surgeons especially, mere physical ability. It is a violation that has gone on for too long,” a senior doctor at Maulana Azad Medical College said, on condition of anonymity.
While hospitals in both the private and public sectors are still working out schedules to follow the new guidelines, there are some though who feel that not mentioning the maximum number of work hours per week was the government’s sleight of hand, so as not to provoke a debate on the ticklish issue of manpower shortage in hospitals.
“While specifying shifts is certainly an improvement, a better way to do this would have been to lay down that like every other worker in the country, a doctor will not work more than 40 hours. They did not do that because the moment that is specified, there would be questions about the number of staff members in the hospital. There, the government may find itself in a spot even worse than in private.
What this may essentially do for doctors is to force them to work without a weekly off,” another doctor at a Delhi government hospital said.
source :

Wednesday, April 1, 2015



Asthma is a condition that affects the airways of your lungs, i.e. the tubes that carry air in and out of your lungs. In asthma, the muscles around the airways tighten and become narrow. This makes it difficult to breathe. There is also an inflammation (a swelling), in the lining of your airways, and sometimes, a sticky mucus or phlegm builds up that blocks the airways, making breathing difficult. Often, there is a wheezing sound. In asthma, your airways are thus very sensitive and react to many irritants called triggers, like cigarette smoke, pollen or cold air.

Now if you have asthma or know of anyone who does, the first thing you do is:Don't worry. You are not alone. According to the World Health Organisation (WHO), around 300 million people currently suffer from asthma. It is the most common chronic (long duration) disease among children. The WHO report also states that asthma affects about 25-30 million in India alone. 

While earlier, asthma had a lot of stigma attached to it, today, thanks to more information about the disease and modern medicine, you can live normal, active life despite your asthma. Film stars have asthma, cricketers have asthma, prominent business people have asthma and they have not allowed it to come in the way of their success. So there's no reason why you should let asthma stop you or your loved one from making the most of life.


The usual symptoms of asthma are:

 Tightness in chest: A constricted feeling in the chest, like someone is squeezing or sitting on it.

Shortness of breath: Breathlessness i.e. you can't get enough air in or out of your lungs. Breathing out is especially tough.

Recurrent or persistent Coughing: A cough that doesn't go away. Coughing often occurs at night or after exercise.
Wheezing: A whistling sound that's usually heard when breathing out.

Other symptoms:

Disturbed sleep due to coughing at night
 Breathlessness while exercising
Please note: Asthma symptoms vary from person to person. Someone may have all the symptoms while another may have only coughing or wheezing. Do keep a close watch on your symptoms and discuss them with your doctor to help diagnose your condition correctly. And remember that with the proper treatment you can control your asthma symptoms.

How is Asthma Diagnosed? 

If you or your loved one has been diagnosed with asthma, there's absolutely no need to worry. There's no need to panic, or change your job or your city. Olympic athletes have asthma, top cricketers have asthma, actors have asthma, politicians have asthma, but they have not let it interfere with their normal life. 

The key to getting your asthma under control is to understand your triggers, watch out for your symptoms, and to take your medication correctly. But first it must be diagnosed correctly.

In India, many parents do not want to accept that their child has asthma. They would prefer to hear that their child has 'wheezing bronchitis' or 'allergic bronchitis' rather than the word 'asthma'. They go from doctor to doctor thus causing hardship for the child and immense stress for themselves, when in actuality if asthma is detected early and treated on time, their child could lead a normal life, faster. Children should be children and an asthmatic child if treated properly can do everything a normal child does - from going to school regularly, playing sports and yes, even eating ice cream!

Asthma is easy to detect but sometimes it is mistaken as a recurrent cough and thus not taken seriously or treated on time or treated with cough syrups. Often, asthma runs in the family. To help your doctor diagnose your asthma or your child's asthma, you will have to answer your doctor's questions as correctly as possible. The questions will be regarding your symptoms, your family history, the medications you are taking, the allergies you have and so on. This is called medical history. Most diagnosis is based on medical history. The doctor will also conduct a physical examination and recommend that you take some tests like the Peak Flow Meter (Breathe-o meter) and Spirometry tests. To know more, read on.

Peak Flow Meter 

A Peak Flow Meter is a simple, affordable, hand held device which helps diagnose breathing problems and asthma in children and adults. 

Just as you have a BP instrument to check blood pressure and the Glucometer for diabetics, the Peak Flow Meter is like a thermometer for asthma. As a patient, you will have to blow into the mouthpiece of the device, and the reading will be taken to check your lung power. Most doctors have the device in their clinic but it is also available at most leading chemists if you want to keep your asthma in check.

If you have asthma and are checking your lung power with the Peak Flow Meter , and you notice a drop in the reading, it means that your asthma is not well controlled and you are likely to get an attack in the near future or within days. This is like an early warning signal to increase the dosage or the number of times you should take your medication. When the Peak Flow Meter reading is normal, it suggests that your asthma is under control.

Spirometry Test

A Spirometry Test is a more sensitive and sophisticated test which detects the signs of asthma early. The Spirometer is used to measure how much air your lungs can hold and how efficiently the air moves into and out of your lungs. In other words, it gives a good indication of your lung power and gives you accurate details about your breathing capacity. The lab or the doctor conducting the test will give you a printed graph of your reading, just as you get a graph when you do your ECG test.

Both the Peak Flow Meter (Breathe-o meter) and Spirometry tests are used to diagnose asthma and also help you measure your progress when your asthma is under control.

However, since these tests are not recommended for children below six years of age, you as a parent have to work together with your pediatrician, to make sure that your child's asthma is diagnosed early and correctly, by paying close attention to your family history and triggers. You will also be required to visit your doctor regularly so that together you can monitor your child's progress.

A trigger is anything that irritates the airways of the lungs and causes the symptoms of asthma. Everyone's asthma is different and it is likely that there will be more than one trigger that causes your asthma. Your trigger could be anything from dust mites and pets to pollution and pollen. It is important that you know your triggers and then do your best to avoid them. Because asthma can be controlled and you can live a normal life. 

It may be difficult to identify your particular trigger but sometimes the clues are obvious. For eg: when your symptoms start within minutes of coming in contact with a cat or dog or bird. Or when your symptoms start when the air is polluted with the smoke of fireworks. You could possibly be allergic to something in the air which irritates your airways and brings about the attack.

The most common risk factors for developing asthma is environmental exposure to inhaled substances and particles that may cause allergic reactions or irritate the airways like house dust mites, tobacco smoke, chemical irritants in the workplace (in industries like coal, cement, paint, asbestos, mining, sugar, pesticides to name a few), air pollution and outdoor allergens like pollens. The risk is also high for those who live in congested areas, are exposed to damp walls, and the fumes of wood fire cooking.

Here are some common triggers and helpful tips to avoid an asthma attack.

House dust mites
House dust
Smoking and air pollutants
Smoking and
air pollutants
Your occupation / workplace
Your occupation/ workplace
Colds and viruses
Colds and
Molds, fungus and pollen
Molds, fungus
and pollen
Mosquito coils, room fresheners, cleaning products
Mosquito coils, room fresheners, cleaning products

House dust mites:
Dust mites are the most common trigger. They are tiny creatures that live and thrive in dust in carpets, mattresses, sofas, curtains, and yes, even in soft toys.

Helpful tips: Avoid carpets if you can and get someone to vacuum regularly. If you have asthma, get someone else to do the cleaning or get it done when you are not home. If your child has asthma, get the house cleaned when they are at school.

Remove all soft toys from beds.

Wash soft toys and dry them in the sun every 2 weeks.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Pets are a common trigger of asthma symptoms. Their fur, feathers, saliva, flakes of skin, or urine can cause asthma symptoms.

Helpful tips: Avoid keeping furry and feathered pets. Keep them away from your main living and sleeping areas.

If you must keep a pet, keep fish instead.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Smoking and air pollutants: 
Most of the time, we breathe in polluted air that can trigger asthma symptoms. Cigarette smoke, fumes from car exhausts, smoke from fireworks, smoke from wood fire cooking...contain lots of different particles that could irritate the airways.

Helpful tips: If you have asthma, stop smoking. It is injurious to your health.

Politely request smokers to stop smoking since even passive smoking is not good for you.

If your family members smoke, request them to smoke outdoors, since cigarette smoke gets trapped and lingers in the curtains, carpets and upholstery for a long time.

Avoid travelling during peak hours when pollution is at its highest.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
BulletteYour occupation/workplace: 
Your job or your place of work could sometimes be a trigger. People working in the jewellery business, the printing, pesticide , quarries, painting and plastic industries, chefs and bakers, solderers and metal platers, foam workers and spray painters, hair dressers and carpenters, are known to be more prone to asthma. Perhaps, it is the smell of certain chemicals or the particulate matter that could be the cause of irritation in the lungs.

Helpful tips: Take appropriate precautions, take your Controller correctly and regularly, and of course see your Doctor who is in the best position to advise you.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
BulletteColds and viruses: 
Colds and viral infections are very common triggers of asthma. Since everybody at some time or the other suffers from a cold, these are impossible to completely avoid.

Helpful tips: Eat healthy, stay fit. Wash your hands as often as possible. Avoid touching your face with your fingers.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Strong emotions, stress or even laughing too much can trigger asthma symptoms.

Helpful tips: Take care of your stress and have a balanced attitude to life.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Exercise is good for everyone including those with asthma. But some people get more breathless than others during or after exercising. If your asthma is under control, you should have no problem exercising. However if the symptoms get worse, please consult your doctor.

Helpful tips: The best exercises for asthma are yoga, and sports like swimming, hockey, cricket, football, since they do not involve continuous running and allow you to have breaks in between.

Consult your family doctor before you exercise or join a gym. Tell your gym instructor, or the sports coach in school about your asthma and tell them aboutyour Reliever or Rescuer medicines.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Most people with asthma do not have to follow a strict diet but some people could be allergic to nuts, eggs, fish, cow's milk, shell fish, yeast products, some food colourings and preservatives, wines, fizzy drinks, processed foods. Click here to see how parents have no fear that asthma might harm their children

Helpful tips: Avoid foods with preservatives and packaged artificial foods. Also check if your allergens are nuts, eggs, cow's milk, shell fish and yeast products. Do read the fine print on packaged foods carefully.

Check with your doctor about doing an Allergy Test.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Yes, hormones can be an asthma trigger, particularly in women. Some may experience asthma symptoms during puberty, before their periods, during pregnancy, and during menopause.

Helpful tips: Consult your doctor, if you feel that hormones could trigger your symptoms.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Some medicines may trigger symptoms. These include medicines for flu, heart problems, glaucoma to name a few.

Helpful tips: Consult your doctor and always tell him the medication you are on.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
BulletteMolds, fungus and pollen: 
Flowering plants which release pollen can trigger symptoms. You should also watch out for fungus on damp walls, damp clothes, wet bathrooms and piles of rotting leaves in the garden.

Helpful tips: Keep your home well ventilated. Make sure your walls at home are not damp.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
A sudden change in temperature, windy days, hot humid days are also known to act as triggers for some.

Helpful tips: Try to avoid going for early morning walks when foggy. Wear a scarf over your face when it's windy. Avoid going in and out of areas that have extreme temperatures ...from an air conditioned room to hot humid conditions outside.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
BulletteMosquito coils, room fresheners, cleaning products:
The chemicals in these products could be triggers for some people. In fact, in an independent research conducted by the Chest Research Foundation, Pune, India, burning one mosquito repellent exposes you to particulate matter air pollutants equal to 75 to 137 cigarettes!

Helpful tips: Install wire mesh mosquito nets in your windows to keep mosquitoes away. Avoid strong smelling cleaning products and keep your rooms well ventilated rather than using artificial room fresheners.
House dust mitesPetsSmoking and air pollutantsYour occupation / workplaceColds and virusesEmotionsExerciseFoodHormonesMedicinesMolds, fungus and pollenWeatherMosquito coils, room fresheners, cleaning products
Please note: There is wisdom in the old saying, 'Prevention is better.'. If you have asthma, it is best to keep a close watch on your triggers and avoid them.Always consult your doctor about any doubts you may have about your triggers, your symptoms and treatment.