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).

BURN, BABY, BURN

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.

SYMPTOMS

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.

TREATMENT

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.

SOME TIPS

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:

http://www.webmd.com/heartburn-gerd/default.htm

Testing times.

Medical_Laboratory_Scientist_US_NIH

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:

SOME TEST QUESTIONS

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.

BEAR IN MIND

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

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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.

Expiry

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

MORE PRECAUTIONS

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.

The Paowallahs of amchi Mumbai.

800px-Vada_Pav
CC image by Deepesh

What is Mumbai without its pav?

Vada-pav, pav-bhaji, maska-pav, bhajiya-pav and just plain old chai with pav. The humble pav is Mumbai’s icon, it is uniquely and typically Bombay, it exemplifies the bindaas attitude that defines the City of Dreams.

The word ‘pav’ does not come from the alleged practice of bakers using their feet to knead the dough! No bakery in Bombay is known to do this (at least I hope not). The word ‘pav’ actually comes from the Portugese ‘pao’, which means bread. The technology for pao-making was brought to India by the Portugese in the late 15th century.

After the Portugese took over Goa, that state fell into economic ruin. Many Goans migrated to Bombay, and settled in a place called Cavel, near Dhobi Talao in South Bombay. One such Goan was Vitorino Mudot, an enterprising young man from the village of Assagao. In 1819, he set up the first bakery in Cavel, and started making Portugese-style pao.  Vitorino encouraged his fellow Goans by giving them jobs in his bakery and by helping them set up their own bakeries. Vitorino Mudot became a rich man in the process.

In 1843, one of his own assistants, Salvador Patricio de Souza, forcibly took over the business. He in turn grew rich and powerful, and diversified into banking, real-estate and cotton. Under his reign, Goans monopolised the bread-making business in Bombay. After he died in the late 1890’s, the Goans were undermined by the aggressive Iranis. The pav business in Bombay is now dominated by north Indian muslims, most of whom are in the Grant Road area.

The golden age of the Goan pao-makers is long gone, but the nickname given to them still remains – makapao. It’s not a polite nickname, but the easy-going Goans take it sportingly (usually, but not always!)

So the next time you bite into a spicy vada-pav, don’t forget to pay your respects to Vitorino Mudot, the young baker from Assagao.

Cheers … Srini.

A dose of Dosa.

sks-174245.JPGIt’s a multi-billion dollar industry in India, not to mention the rest of the world. It is breakfast, lunch, dinner, evening snack, fast food and health food, all in one. The dosa is, well, the dosa.

The idli isn’t really Indian in origin, but the dosa is totally desi. Dosa making goes all the way back to 600 AD, somewhere in south India.

The masala dosa on the other hand, was invented in the 1960’s, at Woodlands Hotel, Udupi, by one Kadandale Krishna Bhat. Potato curry was usually served separately with plain dosas. During a potato crisis in the 1960’s, Krishna Bhat served dosas with a layer of pureed potato curry applied inside the dosa, to save on potatoes. Thus was born the masala dosa.

In its classical form, the dosa is made with parboiled rice and urad dal, ground together in a ratio of 3:1, fermented overnight. As with the idli, the process of fermentation increases the dosa’s nutritive value, making it a super-food. There are several dosa versions without rice, like the ragi dosa, adai, pessaratu (made from moong dal), wheat dosa, cabbage dosa, and what not.

The traditional dosa is a powerhouse of nutrition. The normal dosa has about 80 calories only. It has significant amounts of vitamin B, carbohydrates, protein and almost no fat (provided it is not fried in ghee). Instant dosa mixes are simply not as good. And hotel dosas are generally not safe. Instead, make them at home, with parboiled rice and urad dal. Add some home-made potato curry, or better yet, add a lightly spiced paneer or soya curry, and you have one terrific low-cal, high-protein meal.longest dosa.jpg

There are almost as many dosa variants as there are cooks in India. Onion dosa, banana uttappa, pineapple uttappam, set dosa, benne dosa, neer dosa, and some weird ones like Amitabh dosa (six feet long. I’ve eaten one such), Punjabi dosa, and Schezuan dosa and chop suey dosa (of all the things!). They’re all great, of course.

My personal favorite: Kheema dosa – traditional dosa stuffed with chicken kheema. Superb stuff. (My mom would be scandalised!).

Cheers … Srini.

The Great Weight-loss hoax – part 2

obesity-crop-187102.JPGUnderstand this:

Obesity is a medical condition. Like all other medical conditions, obesity needs medical attention. Period.

So, first and foremost, you must consult your primary healthcare provider.

Disregard all promotional hype about supplements or herbals. Remember, this stuff is not made by people who deeply care about your weight or your health. These are people who want your money.

That does not necessarily mean that all nutra-peddlers are dishonest. But it also means that they are not necessarily scrupulously honest.

You have a medical condition. You talk to a medical professional.

So what are my options?

If you’re a few kilos overweight, and below a BMI of 26 or so, then a sensible doctor would advise proper diet and exercise – and nothing more.

Dieting means eating smart, making the correct choices, and still eating well. Exercise does not mean huffing and puffing in a stinking, expensive gym. It means getting off your butt, getting into moderate aerobic and anaerobic workouts, and also workouts that improve your flexibility and balance, like hathayoga.

The first-line treatment for weight management has always been, and will always be, diet and exercise.obesity-crop-1920.JPG

Across the world, every single government agency that regulates public healthcare solidly endorses this line of treatment. Diet and exercise.

What if I’m really obese?

If you’re above BMI 27 and you have a family history of diabetes or coronary disease, you are morbidly obese. Don’t worry. Your doctor has several options:

1) Prescription meds: These are medicines approved by the USFDA or the relevant government agency in your country, and available only on prescription.

Do they work? Yes, they do, within reasonable limits. And when taken under medical supervision.

Are they safe? There is no “safe” drug.

There is no “safe” dietary supplement or nutraceutical either.

In a medical context, “safe” means that the drug has been approved after rigorous testing over several years, and the benefits of the drug outweigh its potential side-effects.

Even so, any responsible doctor will think twice before prescribing a drug for weight-loss.

Six prescription drugs are in common use for obesity management. I won’t mention any names, in case you think I’m promoting any particular medicine. Each of them is useful in treating severe obesity and each has its own benefit-to-risk profile.

How long do I take prescription meds?

This is the difference between scientific obesity management and nutra-quackery.

Prescription meds are taken under medical supervision for limited periods of time. Depending on your response to the drug, your doctor may prescribe it for a few weeks to a few months. The doctor’s objective is to use drugs to bring down your weight to the point where you can take up a diet and exercise program. At this point, the drug will be discontinued.

The nutra-peddler on the other hand, will try to convince you that you should buy his “safe” nutraceutical stuff for the rest of your life. It’s “just” a dietary supplement, you will be told.  You can take his “safe” dietary supplement for the rest of your life and remain slim and sexy for the rest of your life.

Yeah, sure.

If you’re expected to consume a nutraceutical, every single day, for the rest of your life, don’t you think you should be deeply worried about its long-term effects on your body? And don’t you think your nutra-peddler should give you safety data on his weight-loss supplement? By long-term, one means over a period of ten years at least.

In most cases, your nutra-peddler won’t give you this data. Because he doesn’t have it. Because long-term safety studies cost money. Because it’s cheaper to hire a smart lawyer instead.

2) Surgery

For patients whose obesity is potentially life-threatening, and cannot be managed even with prescription drugs, a doctor will consider bariatric surgery. The objective of bariatric surgery is to temporarily or permanently reduce the size of your stomach, and thereby restrict the amount of food you can eat.

Bariatric surgery can result in significant and sustained weight-loss. But remember that any surgical procedure, even a simple tooth cavity filling, has an element of risk. And also remember that bariatric surgery is not a cosmetic procedure, like a liposuction or a facelift. Bariatric surgery is a serious intervention and it does carry some risk. When it is performed by the right surgeon, the procedure can be life-changing.

Any kind of surgical intervention is used as a last resort, and bariatric surgery is no exception.

But then, most obesity patients can be readily treated with diet and exercise, and if really necessary, a short course of prescription drugs.

Obesity can be psychologically devastating. I’ve seen how bad it can get.

In my opinion, nutra-peddlers who exploit your fear to sell you worthless and very expensive nutra-crap, are the lowest forms of human life on this planet.

I have spoken.

Srini.

 

Key references:

The NHLBI’s Obesity Education Intitiative, under the US government’s Dept of Health and Human services provides a wealth of information and booklets that you can download. I would seriously recommend that you read them.

Here’s the link:

https://www.nhlbi.nih.gov/health/resources/heart#obesity

Nutra Tamasha – The great weight-loss hoax – Part 1.

obesity-crop-187102.JPGTamasha: In India it means “farce”.

Obesity: In the world of nutraceuticals, it means “cash-cow”.

Nutra-peddlers can always count on your irrational obsession with your waistline – to improve their bottomline.

Every profit-making nutraceuticals manufacturer (and there are a lot of them, thanks to you), has at least one “guaranteed” product in his arsenal for weight loss. You can safely bet that half their profits come from your paranoia about your bulging belly and your jiggling butt.

Whether any of these weight-loss nutraceuticals or dietary supplements actually work is debatable. Very debatable.

The root cause of the problem is social. We have weird, illogical, physiologically unattainable and medically ridiculous standards of beauty. We judge others by their physical appearance, not by their competence.

In other words, the root cause of the problem is not the nutra-peddlers, but you.

Nutra-peddlers know this very well and they exploit your stupidity to the hilt, as they ply you with one “scientific” dietary supplement after another, each backed by “research”, each guaranteed to make you as sexy as Adonis (or Aphrodite), and each equally worthless.

What’s obesity anyway?

Ah. That’s a good question. Innocent laypeople (that’s you), cannot distinguish between normal weight gain and morbid obesity.

I said, normal weight gain. It is perfectly normal to gain some weight as one ages. Obviously, you cannot expect to be as slim and hard at fifty as you were at twenty. Normal human beings tend to gain some weight, as their metabolic rates decline with age.

The technical term is basal metabolic rate or BMR. Simply put, BMR is an indicator of how much energy you consume at rest. As you age, your BMR will decrease. This is a natural process and not something to be tampered with.

Many nutra-peddlers claim that their products, uniquely, can increase your BMR and make you lose weight dramatically.

Bullshit.

It is exceptionally difficult to raise your basal metabolic rate, partly because it is difficult to accurately measure your BMR in the first place. No nutraceutical or dietary supplement that I know of can increase your BMR to the point where you will lose weight just like that.

If any supplement does increase your BMR, then I would definitely wonder about what that supplement actually contains – because only certain prescription drugs are known to affect BMR, and those drugs have nasty side-effects.

How do I know if I’m just overweight or really obese?

What you need to know is your body-to-mass index, also known as BMI. It’s easy to calculate. Simply divide your weight in kilos by your height in square meters.

For a 6 foot tall man weighing 80 kgs, his BMI would be 80/(1.83)^2 = 23.8.

Another quick calculation is your waist-to-hip ratio. That’s easy. Measure waist, measure hips. Divide.

A BMI of more than 26 is generally considered obese. If your BMR is more than 30, that’s morbid obesity.  If your waist-to-hip is more than 1.2, and your BMR is in the high twenties, it would be a good idea to seek professional help.

Mind you, professional help. Not nutra-crap in a bottle.

Up next: How to properly treat obesity.

Stay tuned.

Srini.

 

Key reference:

Weight control, US Dept of Health and Human Services.

https://nccih.nih.gov/health/weightcontrol