A bone to pick.

Some things don’t get better with time. This is especially true of your bones. A common condition associated with aging is Osteoporosis.


Osteoporosis is a debilitating disease in which bones become fragile and porous over time. If left untreated, osteoporosis can be crippling. Any bone can be affected but of special concern are weight-bearing bones like the hip, spine and wrist. Osteoporosis may cause permanent disability or even death. Fractures caused by osteoporosis can have serious consequences, including loss of height, severe back pain, and deformity.


Unfortunately, osteoporosis is primarily associated with age. The older you are, the greater your risk of osteoporosis. Other risk factors include:
Gender. Women are more prone to osteoporosis because of the changes involved in menopause.
Bone structure. Small-boned and thin women are at greater risk.
Menstrual history. Early menopause increases the risk of developing osteoporosis. An early pregnancy can further escalate the risk.
Lifestyle. As usual, excessive booze and smoking are held guilty. Inadequate dietary calcium and lack of exercise increase the chances of developing osteoporosis.
Medications and disease. Certain drugs like corticosteroids and diseases like hyperthyroidism and arthritis can add to the risk.
Genes. Osteoporosis tends to run in families.


Think of your bones as a bank. The more you deposit early on, the more you can draw later. Building strong bones, especially before 30, and a healthy lifestyle can be the best defense against osteoporosis. Actually, under medical guidance, even an elder can undertake a graded exercise program. The best way to assess your risk and diagnose osteoporosis, is to get a bone density test.

Attribution: Bruce Blaus


If you have osteoporosis, don’t panic. The condition can be treated. Estrogen is prescribed for post-menopausal women. Alendronate is an effective inhibitor of bone loss and is the current drug of choice. Raloxifene is the latest drug on the scene.

Calcium and vitamin D play an important role in maintaining bone mass. But don’t gulp just any Calcium/Vit D supplement. Check the brand first and ask your doctor. You can still do supervised exercise to strengthen your bones and increase flexibility.


Take care to prevent a fall. Several drugs can cause dizziness, so watch out for side-effects. Wear sturdy, rubber-soled shoes. Minimize clutter in your house. Remove all loose wires, cords, and clean up any spills immediately. Install grab bars in the bathroom and make sure stairway and corridors are well lit.

Above all, try not to worry. Osteoporosis can be controlled, it needn’t tarnish the gold of your golden years.

Cheers … Srini.

Dil jalta hai!

gerd.jpgDo you keep getting a burning, stabbing pain in your chest, especially after a meal? It’s probably not a cardiac problem but likely to be a more mundane ailment. It’s called gastro-esophageal reflux disease (GERD).


Your stomach, as you perhaps know, secretes strong acidic juices for digestion. Usually these juices remain in the stomach. If the valve at the top of your stomach (called the lower esophageal sphincter  or cardiac sphincter) doesn’t close properly, those acidic juices can gush upward. The result is a chemical burn. This is the most common cause of GERD.  It can also be caused by a portion of the upper stomach protruding above the diaphragm, called a hiatal hernia.


GERD is painfully obvious. The characteristic symptom is a burning or stabbing pain under the chest bone, generally after a meal. It’s called ‘heartburn’ because it feels as if it’s coming from your heart. The pain can get quite alarming but in the absence of a genuine heart problem, it’s nothing to worry about.


No problem. There are a variety of treatment options.

Most cases of GERD can be handled by simple antacid formulations. These can be taken either as a liquid suspension or in the form of an antacid tablet.

Please note : Chewable antacid tablets (like Digene) are strictly meant to be chewed only. Never swallow an antacid tablet whole. You may damage your stomach lining.

‘Raft’ antacids or foaming antacids contain alginates which form a floating gel raft over the stomach contents. Such antacids put a damper on heaving gastric juices.

For tough cases, there are several acid-reducers available on prescription. Proton-pump inhibitors like omeprazole, antacids like ranitidine and cimetidine and other drugs like cisapride and domperidone are particularly useful. At least one of them will tame a stubborn case of GERD.

Rarely, if the GERD is really nasty, corrective surgery can take care of that disobedient stomach valve.


If you have chronic ‘heartburn’ or chest discomfort, first get it checked out to rule out any cardiac problem.

Eat slowly and chew your food well. The spiciness of the food doesn’t really matter.

Remain upright for at least an hour after a meal. Don’t just crash out after your ‘bhojan’.

If the heartburn persists, please see your doctor. Although GERD is not exactly fatal, it can cause scarring of the esophagus. Over many years, it may even lead to ulceration and esophageal cancer.

No need to set your heart on fire for no reason.

Cheers … Srini.

For more information:


Stinking pits!

Do innocent bystanders collapse every time you lift your arm? Do teeming crowds magically give way when you pass through?  You may have a bad case of Bromhidrosis, the medical way of saying – You Stink !

Why does BO happen?

Most of the time, BO is caused by excessive sweat. Your body has two types of sweat glands. The eccrine glands, found all over the body, are inoffensive glands which produce odorless sweat that cools down your body. The real culprits are the apocrine glands, which are found in the hairy parts of the body. Especially the axillae (armpits) and … um well … certain other places.

The apocrines produce mating scents. Which is fine. Unfortunately, since the apocrines populate areas of the body that are hot and humid, they also encourage the mating of bacteria. BO is the outcome of the vigorous activities of these bacteria in said hot and humid climes. It may also be that your apocrines are overactive and you sweat more than lesser humans.


Shave. Bacteria love hairy surroundings. So… shave.

Bathe. Preferably every day. Preferably twice a day. There’s no need for an ‘antibacterial’ soap. You’ll smell like a doctor’s clinic. So just use any good brand … but bathe.

Watch your diet. You smell of what you eat. Cut back on dairy products, onions and garlic. Mustard oil stinks … no matter what people up North may say. Eat plenty of greens and leafy stuff.

Keep yourself hydrated.

Cotton is effective in absorbing sweat. Please do use cotton socks and undies … and it would be nice if you could wear fresh ones every day. Ask anyone who’s lived in a hostel. Believe me, I know.

Use deodorants sparingly. Deo’s only cover up, they don’t remove the problem.


If you’re hyperhidrotic, that is, if you sweat a lot, you may need an astringent or anhidrotic (anti-perspirant). Astringent lotions containing aluminium or zinc salts effectively shrink your overactive apocrine glands. Potassium permanganate lotion also works well as a local antiperspirant. You’ll need medical advice first before trying out a prescription anhidrotic, so check with your family medic.

Bromhidrosis is medically harmless. It won’t kill you.

But the solitude might.

Cheers … Srini.


Testing times.


At some point in your life, you’ll be tested – by a clinical laboratory.

Medical tests provide information that your doctor may need to find out what’s wrong with you.

The sad fact is many clinical labs in India have poor quality standards. Until things change on the clinical scene, you have to ask your doctor:


Why?  Is the test usually done for your age group or will it diagnose a specific illness you may have?

What if?  If the result is abnormal, do you really have the illness? If the test result is normal, are you still safe?

When?  What’s the best time of the day to do the test?  Do you need to be on an empty stomach or avoid certain foods that may affect the test results?

Where?  The most important question and sometimes, the difference between life and death.  If your doctor seems to promote one particular testing lab., you need to know why.

Don’t hesitate to ask around about different labs. And don’t get deceived by corporate cleavages.  That dazzling receptionist won’t be doing the test – the chemist inside the lab will. In general, look for a testing lab that has the NABL certification.

And after? Will your existing treatment change in any way after the test?

Then what?  Suppose you don’t take the test at all, then what?  Will you suddenly drop down dead?

Most doctors honestly tell their patients if a given test isn’t really necessary or if they’re ordering the test merely to reassure the patient.  And if your doctor refuses to order a test in spite of your insisting on it, please listen to him.


Tests can be wrong.  They may produce a normal result even when illness is present  (a false-negative) or they may produce an abnormal result even in good health (a false-positive).

Many routine tests have not been subjected to rigorous research regarding their usefulness.  Cardiac stress tests for example, occasionally produce normal results even in patients with significant heart disease.

Ask about the risks associated with the test procedure itself.  An MRI scan is non-invasive and safe, but some patients can get really scared inside the coffin-like MRI tunnel.  I’ve seen several patients who had to be sedated before an MRI. When it was my turn for an MRI, I was a bit nervous too.

Whereas, a coronary angiogram or a colonoscopy is a clearly invasive test and carries a definite element of risk.  So don’t feel shy to ask, it’s your right.

Clinical tests are expensive, uncomfortable and sometimes cause unnecessary worry.  So be clear about why you need that clinical test.

Stay healthy. Stay safe. As Nature intended.

Cheers … Srini.

Prescriptions for safety



Let’s talk about medicine safety, shall we? Safe medicine use depends largely on you, and your understanding of the drug, its benefits and its risks.

What you need is clear communication with your doctor and your pharmacist.

This is what you should know:

The medicine’s name

Modern meds have three names. The chemical name is the full official name of the drug. Chemical names can be tongue twisters so the drug is commonly known by a short generic name. A drug manufacturer gives the drug a unique brand name.

Thus, N-acetyl-para-aminophenol is the heavy chemical name for a drug commonly known as paracetamol (or acetaminophen) and sold under popular brand names like Crocin, Metacin and Tylenol.

Doctors usually prescribe brand names. There’s no problem in taking an alternative brand if the prescribed brand is not available. Your retail pharmacist will guide you on brand alternatives.

Brand names can be confusing, so please read the label very carefully.

Phenoxyl is a brand of the antibiotic amoxycillin. Phensedyl, however, is a brand of cough syrup. Phensedyl has been banned by the Indian government, by the way.

Tell your doctor to write legibly and to mention the drug’s generic name along with his preferred brand. A mature, responsible doctor will understand and oblige. The doctors I know do oblige. If the doctor still insists on scribbling … dump him.

Your safety is more important than his ego. Dump him.

Why the medicine is prescribed

I’m astounded at the number of patients who take medication simply on faith. If you’re not clear why you’re taking any drug, for heaven’s sake, please ask.

How it is to be taken

This is important. Some medications are best taken on an empty stomach for maximum absorption. Some are taken on a full stomach to prevent gastric irritation. Many drugs have to be taken on a schedule. Keep a written record, particularly when several medications are being taken. Or get yourself a pill box.

Side effects

The words that make nutra-peddlers and alt-meds drool. Anything you ingest, including dietary supplements and “natural” herbal stuff, has side-effects. Be thankful that in the case of ‘allopathic’ drugs, detailed information on all drugs is readily available. So be sure to clarify matters with your doctor.

Precautions of use

Drugs can interact with food, nicotine, alcohol and other drugs. Please avoid alcohol with any drug. It is absolutely foolish to drink alcohol while on sedatives. You might die, you see.

Also, inform your doctor if you’re taking any so-called alternative medicine or dietary supplement. Several herbals and nutraceuticals (the ones which allegedly have ‘no side-effects’) adversely react with prescription drugs.

The bill

Insist on a bill from the pharmacist. The bill must clearly mention the batch number of the drug and the name of the prescribing doctor. The pharmacist may insist on a prescription if you insist on a bill. I know this is India … but the law is the law. If a particular drug requires a prescription, you get one. Period.

Besides, this is India, and there are naughty people who make spurious drugs. Get a prescription. Get a bill. And don’t lose them.


Always check the expiry date on the label – especially for sterile products like eye drops or injections. If the date is illegible simply refuse to buy the drug.

Beware of OTC’s!

Over-the-counter drugs, by law, do not need a prescription. Cold remedies, certain painkillers, syrups and the like are legally advertised in the media and sold over the counter.

That doesn’t make them safe. Many of them do have adverse effects.

Phenylpropanolamine (PPA), used in many OTC cold remedies has been recently banned in the US since it can cause a stroke in some people. Chlorpheniramine maleate (CPM), also found in cold remedies, can cause palpitations. Many OTC anti-allergy remedies can cause intense drowsiness.

banned drugs


There’s plenty of reliable information available, so ask your pharmacist before buying any OTC drug. Most pharmacists have reference books in their shops.

Medication tools

Various types of aids are available for forgetful people. These include medication calendars, instruction sheets, color-coded bottles and blue-pill-box-7576187.jpg calendar trays. Many of these knick-knacks are given away to doctors by medical reps, so shamelessly ask your doctor


Do not ever change dosage without informing your doctor. Don’t stop a medicine because you think it isn’t working. Some drugs have to be taken for several days before they work. Conversely, don’t stop just because you feel better. Some drugs, like antibiotics, have to be continued to prevent a relapse.

If you miss a dose, do tell your doctor. Call the doctor promptly if an unusual reaction occurs.

Keep your drugs in their original containers to prevent confusion.

Just destroy any expired medicines in your cabinet. Only an irresponsible moron will donate expired drugs to charity. Drugs are not recyclable.

And please don’t get carried away by any ‘side-effects’ hype.

Modern drugs are effective and safe, when used responsibly. They save lives, including those of people who swear by ‘alternative’ medicine.

Listen to your doctor and to your pharmacist. And get a good dose of your own medicine.

Stay healthy. Stay safe. As Nature intended.

Cheers … Srini.

Hawa ke saath saath!

farters.jpgDo you give out your best under “pressure”?  Do you frequently explode into action?  Do you blow your own trumpet, loudly and regularly?  You have the one problem that no one wants to have  – Flatulence.

What is Flatulence?

Flatulence is just air trying to escape from your digestive tract – from the wrong end.   Bacteria in your intestines form gases from the food you eat, and these gases have their own distinctive stench, unfortunately,

Excessive gas may signal a problem with your intestines. If it is serious enough, it can warrant a visit to the doctor.  Flatulence can also generate alarming but harmless symptoms like chest pain and breathlessness.

What causes flatulence?

Medicines: There are innumerable medications that can cause flatulence, some of these being antibiotics, pain killers, antidepressants and anthelmintics (worm killers).

Infection: Gastro-intestinal ailments like worms, ulcers, colitis, gastroenteritis, and irritable bowels can cause flatulence.  A liver disorder can also cause acute flatulence.

The Big Culprit: however, is your diet. Not just what you eat, but how you eat.

Relieving the pressure:

There are some things you could do to prevent embarrassment (and pollution):

Diet Control:  In particular, watch your intake of,

  • Lentils and Beans
  • Papaya and bananas
  • Milk and milk products
  • Baked goods and fluffy, whipped stuff
  • Any food that contains baking soda
  • Carbonated drinks and beer.

Eat slowly.   Mom was right.  Chew your food nice and slow.  If you eat too fast, you will invariably gulp in lots of air, which will make a noisy exit later.

Herbal remedies  Ginger, Hing (asafetida), fennel (saunf) and caraway (ajwain) are useful in controlling flatulence. This is one reason why it’s a tradition to chew saunf after a meal.

OTC (over the counter) formulations.  There are many branded formulations in the market but the most effective ones will contain Simethicone  (or dimethicone) which makes it easier to pass out the gas and Activated Charcoal, which adsorbs excess gas and removes it from the system.


By itself, flatulence is harmless, although those around you may not agree.

If however, you have had chronic flatulence for more than four weeks, one suggests a visit to the doctor.  It may just be that you have a GI disorder.

Besides, don’t you want to do your bit for the environment ?

Heh, heh.


Relax … with JPMR.

Stress! The one word that gives nutra-peddlers and alt-meds a real hard-on. It costs companies hundreds of lost man-hours and keeps a lot of quacks in business.

Here’s a time-tested relaxation technique you can try yourself.  It’s called Jacobson’s Progressive Muscular Relaxation or JPMR.  It was originally developed by Dr. Edmund Jacobson.  Various versions of JPMR are peddled by many ‘experts’ as their own invention.  It’s simple, it’s safe and it works.

This is the version that I learnt many years ago, from my friend who is a clinical psychologist.

Choose a quiet place where you can sit or lie down undisturbed.  Relax your entire body. Take a few slow, deep breaths.  Imagine the tension flowing out with each breath.  Now contract your feet as you inhale. Hold for about five seconds, then relax as you breathe out, still imagining the tension flowing out with the breath.  Notice the feel of the muscles as they are contracted or relaxed.

Progressively contract your calves, upper legs, buttocks, abdomen and chest.  Tighten your fists, hold and release.  Same for your forearms. Raise your shoulders, hold and release.  Slowly raise your head, hold and release.  If you’re sitting, try to tighten your chin against your collar bone, hold and release.

Do any neck movements very slowly, or you might strain your neck muscles.

End with your face, tensing and relaxing the muscles of your mouth, jaw, eyes and scalp.  Raise your eyebrows, release.  Screw up your face, hold and release.  Purse your lips tightly, hold, release.

Now lie still for five minutes, just feeling your relaxed muscles.  Turn to one side and get up slowly.  Remember, each ‘hold’ should be for about five seconds and each ‘release’ around five seconds.  Exhale slowly with each release, inhale with each contraction.

Important: With each exhalation, repeat a soothing word like ‘relax’, or ‘calm’.   That particular word, coupled with the muscular relaxation, will eventually become a relaxation cue for your brain. In other words, you are training individual muscle groups to relax on cue.

Dr Jacobson proved that excessive stress and anxiety can increase muscular tension and cause a strong contraction of muscle fibers. Conversely, if the muscles were made to relax, then mental tension would correspondingly reduce.

This is the basic theory behind JPMR.  Something the quacks won’t tell you – when you pay their fancy fees.

Believe it or not, this deceptively simple technique actually does work.  JPMR can be combined with any other relaxation system you’re following. It gels well with yoga and Indian meditation techniques, for instance.

Or, you can practise JPMR as a stand-alone method. It works quite well as a quick relaxation trick, before a stressful event like a business presentation – or a date.

Hang loose and relax.  You have nothing to lose – but your tension.

Cheers … Srini.