Thursday, June 16, 2011
Wednesday, June 15, 2011
Can a person die after his prolonged fast is broken?
Nine days fast by Ramdev, death of another swami in Uttarakhand after 115 days fast and now a threat by Anna Hazare to go into fast again has opened a new chapter for one to revise the knowledge as to how to deal with such a person especially one is breaking the fast.
The 35 years old swami who died was protesting the Uttarakhand government's refusal to ban mining along a stretch of Ganga near Rishikesh. He had been on a fast since February 19 2011. On April 27, officials shifted him to Haridwar district hospital as his condition deteriorated but he still refused to touch food. When he slipped into coma on May 2, he was rushed to HIMS and put on life support system. The president of Haridwar Citizen Council, alleged the seer suffered a heart attack at Haridwar district hospital after being injected poison by hospital staff. Did he die of refeeding syndrome or the starvation effects is the question in the mind of the medical fraternity?
The basic aim of breaking any fast is to prevent occurrence of re-feeding syndrome, a metabolic complication that occurs when nutritional support is given to severely malnourished patients or to someone recovering from prolonged fast or hunger strike.
Any individual who has had negligible nutrient intake for 5 consecutive days is at risk. It occurs within four days of starting to feed. Patients who weigh less than 70 percent of ideal body weight or lose weight rapidly are at greatest risk for the syndrome.
During prolonged fasting the body conserve muscle and protein breakdown by switching to ketone bodies derived from fatty acids as the main energy source. The liver decreases its rate of gluconeogenesis thus conserving muscle and protein. Many intracellular minerals become severely depleted during this period, although serum levels may remain normal. Insulin secretion is suppressed and glucagon secretion is increased.
During re-feeding the metabolism shifts from a catabolic to an anabolic state. Insulin is released on carbohydrate intake resulting in increased glycogen, fat and protein synthesis. Insulin release triggers cellular uptake of potassium, phosphate, and magnesium which are already depleted and the stores rapidly become used up. When the serum concentrations of these electrolytes are reduced, serious complications, such as irregular heart beat can occur. Patients can also develop fluid and electrolyte imbalance, low phosphate levels, neurologic, lung, heart, neuromuscular, and blood related complications.
Irregular heart rhythm is the most common cause of death with other significant risks including confusion, coma and convulsions and cardiac failure. The diagnostic feature is presence of low phosphate, potassium, magnesium, vitamin B1 levels and fluid overload with edema feet. Low phosphate levels is the essential criteria for diagnosis.
If the refeeding syndrome occurs, doctors should immediately slow nutritional replenishment and correct low levels of phosphates, potassium and magnesium while monitoring the cardiovascular system.
In patients at risk of re-feeding syndrome, nutritional support is initially delivered at a maximum of 10 kcal/kg/day and raised gradually to full needs within a week. In extreme cases this energy intake is limited to 5 kcal/kg/day.
Before and during the first 10 days of feeding, it is important to give 200-300 mg oral thiamine a day, 1-2 vitamin B complex tablets three times a day or intravenous vitamin B, and a balanced multivitamin and mineral supplement each day.
One should monitor and supplement oral, enteral, or intravenous potassium, phosphate and magnesium in such patients.
On average, patients should receive 2-4 mmol/kg/day potassium, 0.3-0.6 mmol/kg/day phosphate, and 0.2 mmol/kg/day intravenous or 0.4 mmol/kg/day oral magnesium.
Moderately to severely ill patients with marked edema or a serum phosphorous < 2 mg/dL should be hospitalized to intravenously correct electrolyte deficiencies.
About the author
Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal is a Senior Consultant, Physician, Cardiologist at Delhi based Moolchand Medcity; President Heart Care Foundation of India; Chairman Ethical Committee Delhi Medical Council and has served as the Research and Academic Wing Heads of National Indian Medical Association.
Tuesday, June 14, 2011
Making of a good leader
One of the main reasons for any conflict is engaging in “violent communication” on a daily basis. A violent communication is based on judgment and not observations. A violent communication can be in thoughts, action, speech or writings. A non-violent communication, on the other hand, is either based on observations or on individualized opinions. These observations or opinions are always written or spoken as quote-unquote.
“Congress calls Anna Hazare 'unelected tyrant' (TOI)”
“Hazare team targets ‘arrogance of power’ (Calcutta Telegraph)”
“Threat to democracy is from unelected tyrants, says Congress (TOI)”
These are few of the latest headlines in the media that reflect a war of words and hence, violent communication between the Government and Anna Hazare team.
If we look at the current scenario, both Baba Ramdev earlier and now the Anna Hazare team are violently communicating through the media.
The three ‘Cs’ of violent communication are: Criticize, condemn and complaint.
Using violent communication is expected of a politician, in this age of Kalyuga, but for a Satyagrahi team or a saint to communicate in such a manner is beyond comprehension.
Most of the recent statements of Anna Hazare team, through media, press conferences and during their Satyagraha demonstrations, have used phrases that give an impression of violent communication.
A medical perspective on this is that reading a violent communication incites negative feelings in the heart of the readers, which can even produce a feeling of anger.
Any righteous fight, which is based on violent communication like criticism, condemning and complaining will soon lose its credibility.
When Anna Hazare started his movement, he began on a positive note based on the Gandhian philosophy of non violence. Here, one must bear in mind that violence does not only stand for riots; it also denotes violence in your speech and thoughts.
The general public joined Anna Hazare in large numbers, especially, the younger generation, in his non violence approach to anti corruption. His non violent approach won the attention of the general public, media and the government and a committee was soon constituted. But, since then, the communication to the public by the Anna Hazare team has not been based on the principles of non violence.
In Sat Yuga and Treta Yuga, when the majority of the people were truthful and there was Ram Rajya, there too were people like Ravana and his team, though in minority, still created hell for the society. Similarly, the Dwapar Yuga, the era of Lord Krishna, had people like Kansa. Likewise, in Kal Yuga, when we have majority of Ravanas and Kansas, we are bound to have Satyugi people, even though in minority. Just as Ravana and Kansa created havoc for the society in their respective eras, in Kal Yuga too, some Satyugi people, even if in minority, can create havoc for the Kalyugi people in majority.
After the death of Bhagwan Sai Baba, many people began thinking that they have got another Avtar in the guise of Anna Hazare to lead this Satyugi minority population.
Whether a person is a Satyugi or Kalyugi is decided by presence of some or all the four characteristics as mentioned in Srimad Bhagwad: Truthfulness (Satya), Selfless hard work (Tap), positive thoughts (purity) and Daya & Daan (Charity).
1. If all the four characteristics are present, the person is Satyugi.
2. If truthfulness is absent, the person is Tretyugi
3. if both truthfulness and hard work are absent, one is Dwaparyugi
4. When only Daan & Daya are present, the person is Kalyugi.
To become a Satyugi in today, one should follow the principles of communicating the non-violent way.
If Anna Hazare group continues to communicate violently, they will lose their credibility in the public.
Saam Daam Dand Bhed is taught and practiced as a fundamental principle in politics. It is understandable that politicians in power will try to instigate Anna Hazare so that he responds using violence in his speech and in this way lose his credibility in the public.
And this is what has been happening over the last few days. Everyday we are witnessing members of his team attacking the government with violence in their speech. Anna Hazare should realize that public sympathy is with Anna Hazare; he is respected as a Gandhian and not his team mates. If they continue using violent communications, this movement will lose its importance and impact.
Is somebody listening?
About the author: Padmashri & Dr. B.C. Roy National Awardee, Dr. K K Aggarwal is a Senior Consultant, Physician, Cardiologist at Delhi based Moolchand Medcity; President Heart Care Foundation of India; Chairman Ethical Committee Delhi Medical Council and has served as the Research and Academic Wing Heads of National Indian Medical Association.
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