Anna is within us

Time to awaken sleeping “Anna” in each one of us
http://www.itimes.com/users/iti475269/blogs

Buddha represents the “enlightened one”. Buddha is a state of mind and not a person. So is Anna today. He represents the corruption free state of mind. Anna represents the Satvic state of mind in each one of us which is not under the influence of Tamas or Rajas.Each one of us is controlled by .... more

#AskDrKK: What is Cyberbullying?

# DrKKAnswers: Cyberbullying involves harassing, threatening or embarrassing young people through the use of technology, such as computers (especially Facebook) or cell phones.
As per Nemours Foundation the warning signs are for a net saving child:

• A child acting distressed after being on the Internet.
• Showing changes in mood, appetite or sleep patterns.
• Withdrawing from social gatherings and not wanting to go to school.
• Seeing grades fall in education.
• Having behavior problems at home or school.

#AskDrKK: What are the risk factors for osteoporosis in men

As per American Academy of Orthopaedic Surgeons the risk factors are

1.     Drinking excessive amounts of alcohol or using tobacco.

2. Not exercising regularly.
3. Having a low body-mass index.
4. Getting insufficient vitamin D and calcium.
5. Taking certain medications, including anticonvulsants, oral glucocorticoids or heparin.
6. Getting older.
7. Having a family history of fractures related to fragile bones.
8. Certain health conditions, including asthma, thyroid disorders or rheumatoid arthritis.
9. Having low levels of certain hormones, including testosterone or estrogen.

#AskDrKK: How to reduce smoking?

#DrKKAnswers: Do not smoke the 1^st cigarette in the first hour of waking. Smokers who smoke the 1^st cigarette within half an hour of waking are at 59% higher head and neck cancer risk and 79% elevated lung cancer risk compared with those who smoke 1^st cigarette after an hour of waking up

As per a study published in the journal cancer by Joshua E. Muscat, PhD, of Penn State College of Medicine in Hershey  those who started on their first cigarette 31 to 60 minutes after waking were at significantly elevated risk as well (42% and 31%, respectively).

While any smoking boosts cancer risks, an early start in the day is particularly risky because it signals stronger nicotine dependence.

1.       1^st study described results among 1,055 head and neck cancer patients and 795 controls. Cancers were 2.11-fold more likely with smoking within 30 minutes of waking and 1.63-fold more likely with a first cigarette within 31 to 60 minutes of waking.

2.        The other study described analysis of 4,775 newly-diagnosed lung cancer cases and 2,835 controls. Current smoking and greater number of cigarettes smoked per day were linked to higher lung cancer risk. There was 2.64-fold higher risk of cancer with smoking within 30 minutes of waking and 1.58-fold higher risk with smoking 31 to 60 minutes after waking.

Persistence is the key in any spiritual attainment

Rome was not built in a Day: With ‘Abhyas’ or constant practice, one can conquer all the obstacles in life. The sutra “Rome was not built in a day” has a deep spiritual meaning. In the path for self-realization, regular practice is the principle behind all paths: Bhakti, Karma or the Gnana marg. Persistence is the key in any spiritual attainment.

Regular hard work can also change one’s past bad karmic actions. All karmas irrespective of their nature should be converted into good karmas. This can be better understood by the following example. While painting a red coloured wall with green paint with the intention to make it green, it first gets converted into yellow colour. But repeated painting with green will ultimately make it green.

The red colour here can be compared to bad past karmas and green colour to good present karmas. By indulging in positive activities time and again, one can dissolve the impressions of the bad actions done in the past. To start with, there may be a reaction from the others (which is equivalent to the yellow colour in the above example) but if the person does not lose his confidence at that moment and continues with his good present karmas, he will ultimately end up in changing his bad past converting it into a good present and a better future. This requires continuous and repeated practice.

Self-realization and meditation are difficult processes. They involve attaining a thoughtless state, in other words, a state of experiencing the silence. All the paths for self realization are difficult, but with regular practice, one can achieve it without any problem. The path of Bhakti is often considered the path of choice for the majority of people as it is the easiest path to follow. The path of Bhakti involves a triad of “duty, devotion and discipline”. But any duty, devotion or discipline done only for a short time will not end in success, unless it is practiced over a longer period of time.

A classical example can be seen in Islam. Ramadan is a classical example of hard work leading to an atmosphere of brotherhood, love, compassion and truthfulness with significant reduction in negativity amongst the community. For one month, all the Muslims participate in a self-training programme to reduce negativity and build positivity in their lives. The classical discipline to be maintained is fasting. Fasting here does not mean only fasting food or water alone. It also means controlling negative thinking, negative speech, and indulging in any negative action.

The Bhagavad Gita has described the five gateways to hell as attachment, desire, anger, greed and ego. Controlling them requires practice. A month of observance of controlling one’s five senses and not indulging in the five gateways of hell trains one enough to make
these parameters a part of one’s life. The positive attitude practiced over one month tends to stitch it in one’s consciousness, and ultimately in a majority, becomes a part of one’s life.

The same practice is also there in Hindu religion during “Navratras”, but unfortunately, not all people observe this as dedicatedly as the Muslims. Any Muslim not observing Ramadan is not considered a true Muslim but such is not the case in Hinduism.

Apart from the internal journey to self-realization hard work plays a role even in day-to-day outer journeys be it married life, family life, social life or office life.

Hard work is the key to success provided one controls the above five gateways to hell and practices the triad of non-expectation, detachment and being non-judgmental. Attaching oneself with actions but detaching from the results is the key to both internal as well as external success.

More blogs: http://www.itimes.com/users/iti475269/blogs

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council. 

Ask Dr KK: How dangerous is living alone after a heart attack?

Dr KK Answers:  As per a study in Am. Journal of Cardiology, living alone after a heart attack is linked to an increased risk of death in the next 4 years. The mortality risk one year after a heart attack was roughly the same for individuals living alone compared to those living with someone else. However, the mortality risk was 35% greater for individuals who lived alone 4 yrs after the heart attack.

ASK Dr KK: What is TEMPI?

Dr KK Answers: TEMPI is a New Mysterious, Life-Threatening Blood Disease Affecting Kidneys.

Harvard doctors have identified 3 people with TEMPI, which worsens over time & causes painful fluid buildup around the kidneys, shortness of breath that can require oxygen, dilated blood vessels under the skin and spontaneous bleeding in the brain. (New England Journal of Medicine). It is not caused by cancer, infection, or by genetics. Has an abnormal antibody protein in blood.

Ask Dr KK: How to get rid of gas in the stomach?

1.       Eat slowly, chewing your food thoroughly

2.        Exercise regularly to help keep food moving.

3.        Deal with your stress

4.        Don't drink through a straw, and sip your beverages rather than gulp them.

5.        Avoid or limit consumption of foods and drinks that cause you discomfort.

6.        Avoid foods that contain sorbitol or other sugar alcohols (found in drinks, candy, gum and breath fresheners)

7.        Drink plenty of fluids to help move food through the colon.

8.        Substitute Rice for grains that produce gas.

9.        If you are lactose-intolerant try avoiding dairy product.

10. Use spices that are known to prevent or relieve gas such as asafetida, ginger, fennel, turmeric, peppermint, coriander, chamomile and sage.

Avoid cardiac catheter based imaging procedures if not a must

One should not opt for imaging studies unless it is a must; they are not safe and can cause cancers in long run.

A UK analysis published in the Journal Lancet in 2004 had shown that fluoroscopic X Ray radiation exposure during catheter-based coronary angiography can cause up to 280 cases of cancer per million examinations performed.

The mean duration of fluoroscopy in electro physiologic cardiac interventional procedures ranges from 15 to 67 minutes. The radiation dose from one hour of fluoroscopy during electro physiologic ablation procedures can result in 0.7 to 1.4 excess fatal malignancies per 1000 women and 1.0 to 2.6 per 1000 men as per two studies published in American Journal of Cardiology (1998) and Circulation (2004)

 At doses used in diagnostic and interventional procedures, ionizing radiation releases free radicals that may cause DNA damage. This radiation-induced cancers may develop decades after exposure, and include myeloma, blood cancers, lung cancer, thyroid cancer, breast cancer, bone cancer, and skin cancer.

Effective dose of radiation is measured in sieverts (Sv) or millisieverts (mSv). A whole body radiation dose of 1 Sv is associated with a 4 to 5 percent increased relative risk of fatal cancer. (1 Sv = 1000 mSv).

Mild exposure is called when the exposure is < 3 mSv, Moderate >3 to 20 mSv, High 20 to 50 mSv and very high exposure means >50 mSv.

The effective dose related to any radiologic procedure can be considered in the context of the annual effective dose to individuals from natural background radiation sources, including radon, cosmic rays, terrestrial, and internal sources. This background effective dose, approximately 3 mSv, does not pose a significant risk of future cancer to individuals.

A typical X ray procedure results in a total effective dose of 8.3 mSv per hour of fluoroscopy.  The mean cardiac fluoroscopy time in managing paroxysmal atrial fibrillation is 57 minutes, atrial flutter is 20 minutes, ablation is 22 minutes and Pulmonary Vein isolation is 39 minutes.

Multiple medical tests involving radiation exposure lead to high cumulative doses of radiation. In one study in 20 year period a heart patient may end up with 15 procedures involving radiation exposure. Of these four may be high dose procedures (≥3 mSv). The cumulative estimated effective dose from all medical sources exceeds 100 mSv in 31.4 percent of patients.

Use of CT may account for 1.5 to 2 percent of all future cancers in the United States.

The 2006 Biological Effects of Ionizing Radiation VII lifetime attributable cancer risk model predicts that 1 in 1000 persons exposed to 10 mSv (single diagnostic CT scan of the neck, chest, abdomen, or pelvis) will develop cancer due to that single exposure.

The lifetime attributable cancer mortality risk attributable to a single radiation exposure in a one year-old child is 1 in 550 following an abdominal CT and 1 in 1500 following a brain CT.

It has been estimated that 29,000 future cancers could be attributed to CT scans performed in the US in 2007 alone.

1 in 500 women and 1 in 660 men will develop cancer from their abdominal CT scan if the procedure is performed at the age of 20.

A 45 year-old adult undergoing one single full-body CT procedure would accrue an additional lifetime attributable cancer mortality risk of 0.08 percent from a single scan.

The lifetime attributable cancer mortality risk is 1.9 percent lifetime for thirty years of annual scans.

All patients should be given a general idea about the magnitude of the proposed radiation dose. The exposure should be compared with an estimated effective dose to a single chest x-ray (0.02 mSv), a transcontinental airplane flight (0.02 mSv), or annual individual radiation dose from the natural background (3.0 mSv).

The dose from a single abdominal CT scan is comparable to the collective dose of 400 chest x-rays or natural background radiation for three years.  

Ask Dr KK: Why does the groom rides on a mare in the marriage?

Dr KK Answers:  In marriage riding on mare means controlling one’s senses. Horse represents senses and mare the uncontrolled senses. The first thing a groom has to learn  is to tighten his senses and that what reining the mare means . 

Ask Dr KK: What is the importance of gaining weight after the age of 18?

Even very modest gain of more than 5 kg after the age of 18 years in women and 20 years in men increases the risk of coronary heart diseases and type-2 diabetes at all levels of initial BMI

 (NEJM 1999:341.427).

Ask Dr KK: What is the maximum dose of paracetamol (acetaminophen) which can be combined in another drug?

In January, the US FDA mandated drug makers to include not more than 325 mg of Paracetamol in each tablet or capsule of combination medicines. 

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: At what dose Paracetamol (acetaminophen) and cause acute liver failure?

Practically all patients who take paracetamol (acetaminophen) in excess of 350 mg/kg develop severe liver toxicity unless appropriately treated. Clinically they present with SGOT or SGPT levels (AST or ALT) > 1000 IU/L.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is the toxic dose of Paracetamol (acetaminophen)?

Toxicity is unlikely to result from a single dose of less than 150mg/kg in children or 7.5-10 gm in adults. Toxicity is likely to occur with a single ingestion greater than 250 mg/kg or those greater than 12 gm over a 24 hours period.   

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is the therapeutic dose of Paracetamol (acetaminophen)?

The therapeutic dose is 10-25 mg/kg per dose in children and 325-1000 ml per dose in adults given every 4-6 hours with maximum recommended daily dose of 80mg/kg for children and 3 gm in adults.

3g is the recent change from an early recommendation of 4gm in adults.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How common is paracetamol (acetaminophen) poisoning?

Acetaminophen (Paracetamol) is widely available and lay people commonly underestimate its toxicity. Acetaminophen accounts for more over doses and overdose death each year in the United States than any other drug. Acetaminophen induced acute liver failure is common, 50% of them being intentional or suicidal and other 50% unintentional or cardiac poisoning.


About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK:What is the difference between Paracetamol and acetaminophen?

They are same. In India it is called Paracetamol and in America it is known as acetaminophen.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: What is the significance of gasping respiration in CPR or CCCR?

Agonal/gasping respiration is ineffective respiration and should be an indication for cardiac resuscitation. In fact, gasping is the sign that your resuscitation is likely to be successful.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: How effective should be breathing in CPR?

One should not push more than 50% of the tidal volume in each breath. Don’t push air into the stomach as it will impair hemodynamics. If the respiratory rate is more, it will also impair hemodynamics.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.  

Ask Dr KK: In CPR what should be the compression to breathing ratio?

When giving cardiopulmonary resuscitation involving breathing–chest compression cycles, the ratio should be 30 compressions: 2 breaths. This ratio should not be more than five cycles in two minutes.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association, Past Academic and Research Wing Head IMA, Chairman Ethics Committee Delhi Medical Council.