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Diet in Jainism

Diet in Jainism

As per Samani Charitra Prajna the core principle of Jainism is Nonviolence and it is recommended in the scriptures to live nonviolent life. Food is the main source of energy to survive in the world. Bhagwan Mahavir talked about two types of diet – Hitkari (Beneficial) and Mitkari (Moderate). Jains are lacto vegetarian and even many are vegans. Many avoid root vegetables in their diet. Among the seven prohibited addictions, alcohol is one.

Fasting is considered a way of penance for purification of consciousness, Atma that is bound with karmas. There are many ways of fasting like abandon of all kinds of food for a day or more, unodari – that means eat less than hunger, ras parityag – give up food like butter, milk, oil for few days etc.  All these are methods to make our self-healthy as even today recommended by doctors.

 Control over diet or fasting means give rest to digestive system so that it can function smoothly. If digestive system is healthy, it will keep other parts of the body healthy. In Jainism, there is a mention of abstinence from night eating. Acharya Hemchandra, in his Yoga Shastra, says that the digestive system becomes inactive after sunset. So this time is not suitable to eat. Eating at night makes a person unhealthy. All Jain monks and Nuns do not eat after Sun gets down. Evan many lay followers do follow.

New Guidelines: Thyroid Disease during Pregnancy

New Guidelines: Thyroid Disease during Pregnancy

The Endocrine Society’s clinical practice guideline for the management of thyroid disease during pregnancy and after birth has been updated from its 2007 version. [August issue of the Journal of Clinical Endocrinology and Metabolism]

Diagnosing and treating patients with thyroid-related medical issues before, during, and immediately after pregnancy.

• Trimester-specific reference ranges for pregnant women, using a free T₄ assay, should be established.
• The nonpregnant total T₄ range (5–12 μg/dL or 50–150 nmol/liter) can be adapted in the second and third trimesters by multiplying this range by one and a half-fold.
• Free T₄ index appears to be a reliable assay during pregnancy.
• Propylthiouracil (PTU) should be the first-line drug for treatment of hyperthyroidism during the first trimester of pregnancy.
•  Methimazole (MMI) may also be prescribed if PTU is not available or not tolerated.

• Clinicians should change treatment of patients from PTU to MMI after completion of the first trimester because of the potential for liver toxicity.
• Breast-feeding women should maintain a daily intake of 250 μg iodine to ensure breast-milk provides 100 μg iodine per day to the infant.
• Once-daily prenatal vitamins should contain from 150 to 200 μg iodine in the form of potassium iodide or iodate
• Thyroid receptor antibodies should be measured before 22 weeks’ gestational age in mothers with “1) current Graves’ disease; or 2) a history of Graves’ disease and treatment with ¹³¹I or thyroidectomy before pregnancy; or 3) a previous neonate with Graves’ disease or 4) previously elevated [thyroid-stimulating hormone receptor antibodies (TRAb)].
• In women with TRAb at least 2- to 3-fold the normal level and women treated with antithyroid drugs, fetal thyroid dysfunction should be screened for during the fetal anatomy ultrasound done in the 18th–22nd week and repeated every four to six weeks or as clinically indicated.
• Evidence of fetal thyroid dysfunction could include thyroid enlargement, growth restriction, hydrops, presence of goiter, advanced bone age, tachycardia, or cardiac failure.
• Women with nodules from 5 mm to 1 cm in size should be considered for fine-needle aspiration (FNA) if they have a high risk history or suspicious findings on ultrasound, and women with complex nodules from 1.5 to 2 cm in size should also receive an FNA. “During the last weeks of pregnancy, FNA can reasonably be delayed until after delivery. Ultrasound-guided FNA is likely to have an advantage for maximizing adequate sampling,”

How To Prevent Getting Lifestyle Diseases Including Heart Attack

How To Prevent Getting Lifestyle Diseases Including Heart Attack

Wild animals do not get heart attack, blood pressure, diabetes or stroke. These are all lifestyle disorders. But they can occur in a lion caged in a zoo, a rabbit in a laboratory or a pet dog in the house.

The biggest challenge, therefore, in cardiology internationally is – how to prevent getting lifestyle diseases including heart attack.

Most lifestyle disorders are linked to abdominal obesity which is the latest epidemic in the society in the west and is also becoming an epidemic in urban India which is now gradually shifting to middle class. It is linked to eating white sugar, white rice, white maida and not exercising.

Traditionally, Indian sages knew that Indians are prone to getting abdominal obesity, therefore, they promoted observing fast at least 80 days in a year which involves one fast every week, one extra fast on Ekadashi and two Navratras of nine days each at the onset of summer and winter. Traditionally, the Indian fast includes not eating cereals on the fast day. Avoiding cereals 80 days in a year does not allow a person to develop metabolic syndrome and insulin resistance which is responsible for inflammation of arteries and subsequent lifestyle disorders including heart attack and paralysis.

The other challenges at an international level in cardiology involve safer alternatives for surgery and angioplasty. Today, most angioplasties with stenting and bypass surgeries last 6-10 years. We want such procedures to last lifelong, obviously with control of risk factors. Stents are needed which can be resorbed completely.

A  large number of patients die because cardiac transplant facilities are not available in many countries, especially the Asian countries. Every country should have all transplants friendly laws so that any patient who dies in an accident with death of brain but living heart ends up as a heart living brain dead donor. In India, thousands of patients die every year for want of a heart donor.

Diastolic dysfunction, heart failure and atrial fibrillation are other new epidemics of the society.  In diastolic dysfunction, the heart does not relax properly and leads to breathlessness on exertion. It is again linked to obesity. If not treated in time, it ends up in the enlargement of the left smaller chamber of the heart called left atrium. This over a period of time gets enlarged and ends up into new epidemic of the society called Atrial Fibrillation where the heart beats are irregularly irregular. This is the commonest cause of paralysis in elderly age group.

Most of the lifestyle disorders are also linked to eating high salt diet and/or a diet high in transfats. Every country must come out with its policy and guidelines in which they must restrain various restaurants and hotels from using trans fats in their food and limiting the content of salt in their dishes.

They are also challenges for cardiologists. A cardiologist must practice what he preaches.  A patient will not listen to the cardiologist if he ( the cardiologist) is overweight and has abdominal obesity, drinks excessive alcohol or smokes.

 Cardiologists internationally also face legal threat. Most of the law suits in the west are on cardiologists, especially linked to the need of putting a stent or doing bypass surgery. Clear cut guidelines should be laid down and an impunity should be given to doctors, if they follow those guidelines.

It is a duty of the cardiological association  of every country to come out with transparent and standard guidelines in the treatment of heart diseases and when not to put devices in a patient.

Due to lucrative packages, a large number of cardiologists are shifting towards interventional cardiology. Very few people, a time will come, will remain in clinical, preventive or diagnostic cardiology. It will be sad scenario to watch, if it happens.

Young doctors and medical students should devote their life to combat these challenges. They must learn the principles of vedic philosophy, especially ethical earning.

They must follow the principles of counseling as taught by Lord Krishna to Arjuna. Krishna took 18 counseling sessions. In the first, he only listened, in the second he counseled in great detail, from 3 to 17, he gave reasoning at every stage and in the last session, he revised.

The budding doctors must remember that the word ‘Dr.’ as a prefix is given to them as an honour which differentiates them from the society. These prefixes or suffixes are not even available even to Prime Minister or President of India. They must maintain nobility of the medical profession.

In Islam, one of the five pillars mentioned is compulsory charity. The budding doctors should decide at this stage that throughout their life they will involve in doing 10% of charity on a daily basis.

Relaxation Therapy

Relaxation Therapy

1.     Relaxation techniques share two components: the repetitive focus (on a word, sound, prayer, phrase, body sensation, or muscular activity) and adoption of a passive attitude (towards intrusive thoughts.)

2.     They induce relaxation response characterized by decreased arousal and diminished sympathetic activity (decreased heart rate and lower blood pressure).

3.     There occurs increased EEG slow wave activity.

4.     Relaxation techniques may be subdivided into two methods, deep and brief, or by the specific strategy used to induce the relaxed state, including progressive muscle relaxation, autogenic training, and breath training.

5.      Adverse reactions are intrusive thoughts, fear of losing control, upsetting sensory experiences, muscle cramps, sexual arousal, and psychotic symptoms [1].

6.      Adverse reactions are relaxation-induced anxiety or relaxation-induced panic.

7.     Relaxation-induced anxiety is a gradual increase in behavioral, physiologic, and psychological anxiety, whereas relaxation-induced panic is severe anxiety of rapid onset [2].

8.     Patients with a history of generalized anxiety disorder or panic disorder and those with a history of hyperventilation are more likely to experience these adverse effects.

9.      Patients should also be introduced to deep breathing techniques that often accompany relaxation in a gradual manner and not more than couple of minutes at a time.

10.   Relaxation techniques can recue pain in cancer [3].

References

1.     Jacobsen R, Edinger JD. Side effects of relaxation treatment. Am J Psychiatry 1982; 139:952.

2.     Adler CM, Craske MG, Barlow DH. Relaxation-induced panic [RIP]. When resting isn’t peaceful. Integr Psychiatry 1987; 5:94.

3.      JAMA 1996; 276:313.

CDC: New Recommendations for Treating Gonorrhea

CDC: New Recommendations for Treating Gonorrhea

• The treatment recommendations for gonorrhea have changed substantially during the past 5 years.
• Because of a high rate of antimicrobial resistance, fluoroquinolones are no longer recommended to treat gonorrhea.
• To treat a potential coinfection with chlamydia, the treatment regimen for gonorrhea should include either a single dose of azithromycin or 1 week of doxycycline, even if testing for Chlamydia trachomatis is negative at the time of treatment.
• The mainstays of treatment for gonorrhea have been intramuscular ceftriaxone or oral cefixime.
• However, there is concern regarding the susceptibility of Neisseria gonorrhoeae to cefixime.
• The CDC now recommends that gonorrhea be treated with ceftriaxone 250 mg intramuscularly in a single dose, not with cefixime. Ceftriaxone should be combined with azithromycin 1 g once only or doxycycline 100 mg twice daily for 7 days.

Massage Therapy

Massage Therapy

1.     Is used as a form of medical therapy since ancient times.
2.     Ayurveda text written 5000 years old also talks about it
3.     The Yellow Emperor’s Classic of Internal Medicine, written more than 2500 years ago and believed to be the first book on Chinese medicine, includes information on Tuina, an ancient form of massage, and acupressure (applied finger pressure to points that are putatively sensitized by organ impairment) [1].
4.     Massage is systematic manipulation of the soft tissues of the body to enhance health and healing [2].
5.     It includes a group of manual techniques that include applying fixed or movable pressure.
6.     The primary characteristics are the application of touch and movement.
7.      Studies in patients with limited or advanced cancer suggest at least temporary benefit for pain, other symptoms and mood [3,7]
8.     It is well proven in pain management
9.     Massage also produces VIP hormone which dilates the arteries and increases the flow
References
1.     Monte T. World medicine: the East and West guide to healing your body, Putnam, New York 1993.
2.     Goats GC, Keir KA. Connective tissue massage. Br J Sports Med 1991; 25:131.
3.     Ferrell-Torry AT, Glick OJ. The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs 1993; 16:93.
4.     Weinrich SP, Weinrich MC. The effect of massage on pain in cancer patients. Appl Nurs Res 1990; 3:140.
5.     Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage 2004; 28:244.
6.     Listing M, Reisshauer A, Krohn M, et al. Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psychooncology 2009; 18:1290.
7.     Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med 2008; 149:369.