Monday, July 16, 2012

Ayurvedic doctors to perform eye surgeries



Jaipur: The National Institute of Ayurveda, Jaipur plans to hire modern ophthalmologists who will not only perform surgeries with a team of Ayurvedic eye specialists, but also train the postgraduate students of the department of Shalakya Tantra (eye and ENT) in cataract, glaucoma and other eye surgeries. “We will hire qualified ophthalmologists (eye specialists and surgeons) on part-time basis,” said Dr Ajay Kumar Sharma, director, NIA Jaipur, adding, “We will begin with cataract surgery, the most common form, and later cover other eye surgeries, like glaucoma.” The institute has already implemented two similar synergies between modern surgery and Ayurveda at department of Shalya Tantra (surgery) and department of Prasuti Tantra (gynaecology). “At Shalya Tantra department, modern surgeons have joined their Ayurveda counterparts in performing most common surgeries, like appendicitis, hernia, gall-stone and at department of Prasuti Tantra they are aiding to perform caesarean deliveries and other tubectomy,” Dr Sharma said. [Source: Bhaskar, Sunday, July 8, 2012]
Comments: I am cautiously optimistic about the concept. It seems like a good idea in that there are hundreds of thousands of blind Indians, especially in the rural areas who can easily be given sight by cataract surgery. The WHO/NPCB (National Programme for Control of Blindness) survey has shown that there is a backlog of over 22 million blind eyes (12 million blind people) in India, and 80.1% of these are blind due to cataract. (source) There is a significant dearth of eye specialists in these region, and trained doctors of alternative medicine can certainly help in this situation. However, my main concern stems from a quality point of view. The training of these ayurvedic doctors and the situation in many of there colleges is far from satisfactory. The regulatory body for these colleges is also not very effective. These doctors may lack knowledge of anatomy, physiology and other basic sciences, especially in comparison to their MBBS doctor counterparts. Finally, employing part-time ophthalmologists to impart training to Ayurvedic students may not be an ideal way to bring about a substantial change in the demographic of cataract surgery. Finally, many of these super-specialist Ayurvedic doctors are likely to practice in cities, defeating the basic purpose of this exercise. We need rural doctors in a large way (like the Chinese barefoot doctors) and this would probably be done better with the Ministry of Health proposal of creating a separate degree for Rural Medicine

Sunday, July 15, 2012

How can we prevent deaths at Amarnath Yatra ?


Preventing Amaranth Yatra Deaths

This year again people have died during the Amarnath Yatra. There have already been 67 deaths in 16 days of yatra. This is despite medical examination being made compulsory. Probably the organizers are accepting fake medical certificates. The certificate required is only from a GP. The fitness required for travel to altitudes above 10,000 feet usually should be from a specialist.
I think the easiest test which the government should stipulate is the 6-minute walk test. The purpose of this test is to assess exercise tolerance in chronic respiratory disease and heart failure. The test is also used as a performance-based measure of functional exercise capacity in other populations including healthy older adults.
The six-minute walk test measures the distance an individual is able to walk for six minutes on a hard, flat surface. The goal is for the individual to walk as far as possible in this duration. The individual is allowed to self-pace and rest as needed as they traverse back and forth along a marked walkway.
The six minute walk distance in healthy adults has been reported to range from 400m to 700m. The median 6MWD is 580 m for healthy men and 500 m for healthy women.
When the 6MWD is reduced, a thorough search for the cause of the impairment is warranted. The following tests may then be helpful: pulmonary function, cardiac function, ankle–arm index, muscle strength, nutritional status, orthopedic function, and cognitive function.
A fall in SpO2 of more than 4 % (ending below 93 %) suggests significant desaturation.
A 6-minute walk distance of ≤300 m is a simple and useful prognostic marker of subsequent cardiac death in patients with mild-to-moderate heart failure (Tex Heart Inst J 2007;34:166–9).
According to the American Thoracic Society, patients of idiopathic pulmonary fibrosis (IPF) who can cover less than 680 feet (200 m) during the six-minute test are four times more likely to die than those who can walk greater distances.
Minimal clinically important difference (MCID) is defined as the smallest meaningful change, judged by the patient or experts, determined by questioning or observing the patient. This change is necessarily larger than the change due to measurement error and day-to-day variability.
An improvement of more than 70 m (54-80) or 10% in distance walked appears to be clinically important and noticeable to patients.  Estimates of the minimum decrease in distance walked that are important to patients range from 24 to 54 m.
To sum up, it can be said that anyone with less than 200 m distance covered in the 6-minute walk test should not be allowed to go to the Yatra. Those who can cover a distance of 200-300 m need further tests.  Only those who can cover a distance of 500 meters should get a clearance from a GP without further testing.
My take: A very important piece of topical medical news, which is easy to do, requires no special expertise, & makes a lot of common sense, something not always seen in the field of medical testing !
I would also like to highlight that this practice of issuing 'fake' medical certificates needs to be curbed by at least sensitizing the doctors or sending notices to the ones responsible for giving certificates, regarding people dying on Amarnath Yatra. I believe that most doctors are not doing this for extra money, but to make it 'convenient' for people to travel to Amarnath Yatra. This is taken as a simple formality, and unfortunately leads to avoidable deaths. I recently read about a 24 year old mother of a child from Chandigarh, who died during this yatra, and I can imagine what trauma this would cause to the entire family. I would shudder to think that a medical certificate for this mother could have been issued by me, if they had come to me. This has made me even more careful regarding medical certificates, and I would urge other doctors to do the same. 

Monday, July 2, 2012

A Few Words About Breasts - Nora Ephron


Nora Ephron  

Esquire, 1972
I have to begin with a few words about androgyny. In grammar school, in the fifth and sixth grades, we were all tyrannized by a rigid set of rules that supposedly determined whether we were boys or girls. The episode in Huckleberry Finn where Huck is disguised as a girl and gives himself away by the way he threads a needle and catches a ball—that kind of thing. We learned that the way you sat, crossed your legs, held a cigarette, and looked at your nails—the way you did these things instinctively was absolute proof of your sex. Now obviously most children did not take this literally, but I did. I thought that just one slip, just one incorrect cross of my legs or flick of an imaginary cigarette ash would turn me from whatever I was into the other thing; that would be all it took, really. Even though I was outwardly a girl and had many of the trappings generally associated with girldom—a girl’s name, for example, and dresses, my own telephone, an autograph book—I spent the early years of my adolescence absolutely certain that I might at any point gum it up. I did not feel at all like a girl. I was boyish. I was athletic, ambitious, outspoken, competitive, noisy, rambunctious. I had scabs on my knees and my socks slid into my loafers and I could throw a football. I wanted desperately not to be that way, not to be a mixture of both things, but instead just one, a girl, a definite indisputable girl. As soft and as pink as a nursery. And nothing would do that for me, I felt, but breasts.
I was about six months younger than everyone else in my class, and so for about six months after it began, for six months after my friends had begun to develop (that was the word we used, develop), I was not particularly worried. I would sit in the bathtub and look down at my breasts and know that any day now, any second now, they would start growing like everyone else’s. They didn’t. “I want to buy a bra,” I said to my mother one night. “What for?” she said. My mother was really hateful about bras, and by the time my third sister had gotten to the point where she was ready to want one, my mother had worked the whole business into a comedy routine. “Why not use a Band-Aid instead?” she would say. It was a source of great pride to my mother that she had never even had to wear a brassiere until she had her fourth child, and then only because her gynecologist made her. It was incomprehensible to me that anyone could ever be proud of something like that. It was the 1950s, for God’s sake. Jane Russell. Cashmere sweaters. Couldn’t my mother see that? “I am too old to wear an undershirt.” Screaming. Weeping. Shouting. “Then don’t wear an undershirt,” said my mother. “But I want to buy a bra.” “What for?”
I suppose for most girls, breasts, brassieres, that entire thing, has more trauma, more to do with the coming of adolescence, with becoming a woman, than anything else. Certainly more than getting your period, although that, too, was traumatic, symbolic. But you could see breasts; they were there; they were visible. Whereas a girl could claim to have her period for months before she actually got it and nobody would ever know the difference. Which is exactly what I did. All you had to do was make a great fuss over having enough nickels for the Kotex machine and walk around clutching your stomach and moaning for three to five days a month about The Curse and you could convince anybody. There is a school of thought somewhere in the women’s lib / women’s mag / gynecology establishment that claims that menstrual cramps are purely psychological, and I lean toward it. Not that I didn’t have them finally. Agonizing cramps, heating-pad cramps, go-down-to-the-school-nurse-and-lie-on-the-cot cramps. But, unlike any pain I had ever suffered, I adored the pain of cramps, welcomed it, wallowed in it, bragged about it. “I can’t go. I have cramps.” “I can’t do that. I have cramps.” And most of all, gigglingly, blushingly: “I can’t swim. I have cramps.” Nobody ever used the hard-core word. Menstruation. God, what an awful word. Never that. “I have cramps.”
The morning I first got my period, I went into my mother’s bedroom to tell her. And my mother, my utterly-hateful-about-bras mother, burst into tears. It was really a lovely moment, and I remember it so clearly not just because it was one of the two times I ever saw my mother cry on my account (the other was when I was caught being a six-year-old kleptomaniac), but also because the incident did not mean to me what it meant to her. Her little girl, her firstborn, had finally become a woman. That was what she was crying about. My reaction to the event, however, was that I might well be a woman in some scientific, textbook sense (and could at least stop faking every month and stop wasting all those nickels). But in another sense—in a visible sense—I was as androgynous and as liable to tip over into boyhood as ever.
I started with a 28 AA bra. I don’t think they made them any smaller in those days, although I gather that now you can buy bras for five-year-olds that don’t have any cups whatsoever in them; trainer bras they are called. My first brassiere came from Robinson’s Department Store in Beverly Hills. I went there alone, shaking, positive they would look me over and smile and tell me to come back next year. An actual fitter took me into the dressing room and stood over me while I took off my blouse and tried the first one on. The little puffs stood out on my chest. “Lean over,” said the fitter. (To this day I am not sure what fitters in bra departments do except to tell you to lean over.) I leaned over, with the fleeting hope that my breasts would miraculously fall out of my body and into the puffs. Nothing.
“Don’t worry about it,” said my friend Libby some months later, when things had not improved. “You’ll get them after you’re married.”
“What are you talking about?” I said.
“When you get married,” Libby explained, “your husband will touch your breasts and rub them and kiss them and they’ll grow.”
That was the killer. Necking I could deal with. Intercourse I could deal with. But it had never crossed my mind that a man was going to touch my breasts, that breasts had something to do with all that, petting, my God, they never mentioned petting in my little sex manual about the fertilization of the ovum. I became dizzy. For I knew instantly—as naïve as I had been only a moment before—that only part of what she was saying was true: the touching, rubbing, kissing part, not the growing part. And I knew that no one would ever want to marry me. I had no breasts. I would never have breasts.
My best friend in school was Diana Raskob. She lived a block from me in a house full of wonders. English muffins, for instance. The Raskobs were the first people in Beverly Hills to have English muffins for breakfast. They also had an apricot tree in the back, and a badminton court, and a subscription to Seventeen magazine, and hundreds of games, like Sorry and Parcheesi and Treasure Hunt and Anagrams. Diana and I spent three or four afternoons a week in their den reading and playing and eating. Diana’s mother’s kitchen was full of the most colossal assortment of junk food I have ever been exposed to. My house was full of apples and peaches and milk and homemade chocolate-chip cookies—which were nice, and good for you, but-not-right-before-dinner-or-you’ll-spoil-your-appetite. Diana’s house had nothing in it that was good for you, and what’s more, you could stuff it in right up until dinner and nobody cared. Bar-B-Q potato chips (they were the first in them, too), giant bottles of ginger ale, fresh popcorn with melted butter, hot fudge sauce on Baskin-Robbins jamoca ice cream, powdered-sugar doughnuts from Van de Kamp’s. Diana and I had been best friends since we were seven; we were about equally popular in school (which is to say, not particularly), we had about the same success with boys (extremely intermittent), and we looked much the same. Dark. Tall. Gangly.
It is September, just before school begins. I am eleven years old, about to enter the seventh grade, and Diana and I have not seen each other all summer. I have been to camp and she has been somewhere like Banff with her parents. We are meeting, as we often do, on the street midway between our two houses, and we will walk back to Diana’s and eat junk and talk about what has happened to each of us that summer. I am walking down Walden Drive in my jeans and my father’s shirt hanging out and my old red loafers with the socks falling into them and coming toward me is... I take a deep breath... a young woman. Diana. Her hair is curled and she has a waist and hips and a bust and she is wearing a straight skirt, an article of clothing that I have been repeatedly told I will be unable to wear until I have the hips to hold it up. My jaw drops, and suddenly I am crying, crying hysterically, can’t catch my breath sobbing. My best friend has betrayed me. She has gone ahead without me and done it. She has shaped up.
Here are some things I did to help:
Bought a Mark Eden Bust Developer.
Slept on my back for four years.
Splashed cold water on them every night because some French actress said in Life magazine that that was what she did for her perfect bustline.
Ultimately, I resigned myself to a bad toss and began to wear padded bras. I think about them now, think about all those years in high school I went around in them, my three padded bras, every single one of them with different-sized breasts. Each time I changed bras I changed sizes: one week nice perky but not too obtrusive breasts, the next medium-sized slightly pointy ones, the next week knockers, true knockers; all the time, whatever size I was, carrying around this rubberized appendage on my chest that occasionally crashed into a wall and was poked inward and had to be poked outward—I think about all that and wonder how anyone kept a straight face through it. My parents, who normally had no restraints about needling me—why did they say nothing as they watched my chest go up and down? My friends, who would periodically inspect my breasts for signs of growth and reassure me—why didn’t they at least counsel consistency?
And the bathing suits. I die when I think about the bathing suits. That was the era when you could lay an uninhabited bathing suit on the beach and someone would make a pass at it. I would put one on, an absurd swimsuit with its enormous bust built into it, the bones from the suit stabbing me in the rib cage and leaving little red welts on my body, and there I would be, my chest plunging straight downward absolutely vertically from my collarbone to the top of my suit and then suddenly, wham, out came all that padding and material and wiring absolutely horizontally.
Buster Klepper was the first boy who ever touched them. He was my boyfriend my senior year of high school. There is a picture of him in my high-school yearbook that makes him look quite attractive in a Jewish, horn-rimmed-glasses sort of way, but the picture does not show the pimples, which were air-brushed out, or the dumbness. Well, that isn’t really fair. He wasn’t dumb. He just wasn’t terribly bright. His mother refused to accept it, refused to accept the relentlessly average report cards, refused to deal with her son’s inevitable destiny in some junior college or other. “He was tested,” she would say to me, apropos of nothing, “and it came out a hundred and forty-five. That’s near-genius.” Had the word “underachiever” been coined, she probably would have lobbed that one at me, too. Anyway, Buster was really very sweet—which is, I know, damning with faint praise, but there it is. I was the editor of the front page of the high-school newspaper and he was editor of the back page; we had to work together, side by side, in the print shop, and that was how it started. On our first date, we went to see April Love, starring Pat Boone. Then we started going together. Buster had a green coupe, a 1950 Ford with an engine he had hand-chromed until it shone, dazzled, reflected the image of anyone who looked into it, anyone usually being Buster polishing it or the gas-station attendants he constantly asked to check the oil in order for them to be overwhelmed by the sparkle on the valves. The car also had a boot stretched over the back seat for reasons I never understood; hanging from the rearview mirror was a pair of angora dice. A previous girlfriend named Solange, who was famous throughout Beverly Hills High School for having no pigment in her right eyebrow, had knitted them for him. Buster and I would ride around town, the two of us seated to the left of the steering wheel. I would shift gears. It was nice.
There was necking. Terrific necking. First in the car, overlooking Los Angeles from what is now the Trousdale Estates. Then on the bed of his parents’ cabana at Ocean House. Incredibly wonderful, frustrating necking, I loved it, really, but no further than necking, please don’t, please, because there I was absolutely terrified of the general implications of going-a-step-further with a near-dummy and also terrified of his finding out there was next to nothing there (which he knew, of course; he wasn’t that dumb).
I broke up with him at one point. I think we were apart for about two weeks. At the end of that time, I drove down to see a friend at a boarding school in Palos Verdes Estates and a disc jockey played “April Love” on the radio four times during the trip. I took it as a sign. I drove straight back to Griffith Park to a golf tournament Buster was playing in (he was the sixth-seeded teen-age golf player in southern California) and presented myself back to him on the green of the 18th hole. It was all very dramatic. That night we went to a drive-in and I let him get his hand under my protuberances and onto my breasts. He really didn’t seem to mind at all.
“Do you want to marry my son?” the woman asked me.
“Yes,” I said.
I was nineteen years old, a virgin, going with this woman’s son, this big strange woman who was married to a Lutheran minister in New Hampshire and pretended she was gentile and had this son, by her first husband, this total fool of a son who ran the hero-sandwich concession at Harvard Business School and whom for one moment one December in New Hampshire I said—as much out of politeness as anything else—that I wanted to marry.
“Fine,” she said. “Now, here’s what you do. Always make sure you’re on top of him so you won’t seem so small. My bust is very large, you see, so I always lie on my back to make it look smaller, but you’ll have to be on top most of the time.”
I nodded. “Thank you,” I said.
“I have a book for you to read,” she went on. “Take it with you when you leave. Keep it.” She went to the bookshelf, found it, and gave it to me. It was a book on frigidity.
“Thank you,” I said.
That is a true story. Everything in this article is a true story, but I feel I have to point out that that story in particular is true. It happened on December 30, 1960. I think about it often. When it first happened, I naturally assumed that the woman’s son, my boyfriend, was responsible. I invented a scenario where he had had a little heart-to-heart with his mother and had confessed that his only objection to me was that my breasts were small; his mother then took it upon herself to help out. Now I think I was wrong about the incident. The mother was acting on her own, I think: that was her way of being cruel and competitive under the guise of being helpful and maternal. You have small breasts, she was saying; therefore you will never make him as happy as I have. Or you have small breasts; therefore you will doubtless have sexual problems. Or you have small breasts; therefore you are less woman than I am. She was, as it happens, only the first of what seems to me to be a never-ending string of women who have made competitive remarks to me about breast size. “I would love to wear a dress like that,” my friend Emily says to me, “but my bust is too big.” Like that. Why do women say these things to me? Do I attract these remarks the way other women attract married men or alcoholics or homosexuals? This summer, for example, I am at a party in East Hampton and I am introduced to a woman from Washington. She is a minor celebrity, very pretty and Southern and blond and outspoken, and I am flattered because she has read something I have written. We are talking animatedly, we have been talking no more than five minutes, when a man comes up to join us. “Look at the two of us,” the woman says to the man, indicating me and her. “The two of us together couldn’t fill an A cup.” Why does she say that? It isn’t even true, dammit, so why? Is she even more addled than I am on this subject? Does she honestly believe there is something wrong with her size breasts, which, it seems to me, now that I look hard at them, are just right? Do I unconsciously bring out competitiveness in women? In that form? What did I do to deserve it?
As for men.
There were men who minded and let me know that they minded. There were men who did not mind. In any case, I always minded.
And even now, now that I have been countlessly reassured that my figure is a good one, now that I am grown-up enough to understand that most of my feelings have very little to do with the reality of my shape, I am nonetheless obsessed by breasts. I cannot help it. I grew up in the terrible fifties—with rigid stereotypical sex roles, the insistence that men be men and dress like men and women be women and dress like women, the intolerance of androgyny—and I cannot shake it, cannot shake my feelings of inadequacy. Well, that time is gone, right? All those exaggerated examples of breast worship are gone, right? Those women were freaks, right? I know all that. And yet here I am, stuck with the psychological remains of it all, stuck with my own peculiar version of breast worship. You probably think I am crazy to go on like this: here I have set out to write a confession that is meant to hit you with the shock of recognition, and instead you are sitting there thinking I am thoroughly warped. Well, what can I tell you? If I had had them, I would have been a completely different person. I honestly believe that.
After I went into therapy, a process that made it possible for me to tell total strangers at cocktail parties that breasts were the hang-up of my life, I was often told that I was insane to have been bothered by my condition. I was also frequently told, by close friends, that I was extremely boring on the subject. And my girl friends, the ones with nice big breasts, would go on endlessly about how their lives had been far more miserable than mine. Their bra straps were snapped in class. They couldn’t sleep on their stomachs. They were stared at whenever the word “mountain” cropped up in geography. And Evangeline, good God what they went through every time someone had to stand up and recite the Prologue to Longfellow’s Evangeline: “... stand like druids of eld... / With beards that rest on their bosoms.” It was much worse for them, they tell me. They had a terrible time of it, they assure me. I don’t know how lucky I was, they say.
I have thought about their remarks, tried to put myself in their place, considered their point of view. I think they are full of shit.

Love the article, and enjoyed reading it. Gives a tantalizingly new perspective on a subject that I spend time thinking. Hope you have fun too :)