Tag Archives: medicine

THE DILEMAS OF THE MEDICAL PROFESSION

2 May

There is a growing distance among the different sections of society, more so between the society at large and the inhabitants of the medical profession. This population is not only minuscule but is under- represented and inarticulate regarding its concerns, anxieties and problems. The spokesmen for the society are numerous and powerful with a ready audience. In this article I will try to be a spokesman for the other side.

The dilemma of choosing a branch of study is faced by all. Only a few choose the medical science as a profession, some out of choice, and many due to coercion by parents or by virtue of having to manage a nursing home to be inherited. Some few wanting to come onto the profession, but not succeeding opt for studies in foreign lands, mostly CIS countries likeRussia, Ukraine etc. Those coming out of choice do come in with a sense of dedication and willingness to serve, but the lengthy course and associated stress soon take their toll on their values. This is compounded when they find their friends and batch mates already into jobs, earning six-figure salaries, while they have to be satisfied with a measly stipend after a longer period of study. Add to that the fact that failure rates being so high, less than half complete their study in the stipulated 5 ½ years.

The next dilemma comes during internship; whether to work and learn during this period of a year (for whish it is intended) or to prepare for the post graduate entrance looming ahead. For in this branch only a student has to continue giving entrances for everything. Not doing a post graduation would leave him without a specialist degree and close further options, leaving him one of the nameless doctors wasting away in the hinterlands of the country for their sustenance. Yet preparing for the same has no guarantee of success, but one may have to spend some years to get through. And during that period, to be dependent on your parents, especially after being a doctor, is a mighty unpleasant experience.

The next dilemma facing the doctor choosing to do the PG is the choice of subject. Actually choice is only for the lucky few at the top of the rankings. For the rest it is only-take it or come back next year.

After completing the PG, the doctor is faced with choices of joining govt service, higher studies, joining pvt sector, or starting own practice. Each has good and bad points in its favour. A govt job gives security but with measly salaries. Of course, don’t count job satisfaction among the attributes, unless you are blessed. Keeping the govt tradition of putting round pegs in square holes, or vice versa, one may have to do works not even remotely connected to medicine. Yours truly had scrutinized scholarship forms and land records and measured areas of houses. Add to that posting in a god forsaken place, where you have to keep everyone happy starting from the local dada to the local leader so that you may survive to ply your trade. Or be prepared to get roughed up for some imaginary mistake you supposedly committed, starting from not attending to a patient to rape/molestation(so newsworthy events).Or better still, grease some palms to get a better posting. Now, this was not in the curriculum, was it? A pvt sector job gives you good salaries, but with no regards to anything else apart from profits. Please let go of your ethics, if you have any left by now. Higher studies entail the same problems described above, during post graduation. Starting your own practice involves a good investment and savings for the time till your practice starts looking up, which may be some years. You have to have an understanding father with deep pockets, so that he may support you, and by that time your wife (and may be kid) for some months(if you are lucky) or years(if not so).

Now assuming that our doctor has solved all this dilemmas, with his values wounded, but alive, he is faced with even more dilemmas. News like “doctor gives injection and patient dies” makes him feel like a cat caught in a car’s headlights. As if all the training he received in a decade and a half was for killing a patient .Also he comes under consumer protection act. Nothing wrong there except for some small points, like if patient is a consumer, why does he grudge you your fees? Oh! The doctor took Rs X for only writing three medicines. He cannot make them understand that the fees are for the expertise gained over years and not for writing only. The patient is always free to go to a ‘shop’ charging less. The other point is that why should other professions not be under copra? After all one can get killed when a bridge or building collapses, or by mosquito bites (dengue, malaria) and so many other causes. He is not sure whether he should attend to a patient brought to him when he is just about to die and try to revive him (which may not be possible medically)and risk being a breaking news for some TV channel, or first make an MLC ,so that his skin is saved, thereby losing a few vital minutes. Whether he should advise an investigation to rule out some problem. If he does, he risks being accused of taking commissions, and if not, then negligence, if the problem is discovered later.

Dilemmas galore, yet these are not the only ones. So many more are experienced, yet untold. Due to the circumstances, under which a doctor has to work, and the negativity which has come to be associated to this profession, the number of students opting for the course has dropped appreciably. After all, why should a student spend the best decade and a half of his best years, toiling away only to do a thankless job. The money and time invested in this course, if invested differently will fetch much higher returns. And the days when a doctor wanted his children to be doctors are long gone. Now he wants them to be anything but a doctor, unless he has an established institution to give in inheritance.

This article is not to discourage anyone from entering this hallowed profession, but to make him aware of the pros and cons of the same. After all being a doctor has its advantages as well, least of them being a no retirement. The joy felt on seeing the thankful smile of a patient expressing his gratitude for his relief, compensates for many of the negatives. This branch of study requires utmost dedication, and concentration over a long period, probably throughout life. If you have it in you, then!

About the Author:

Dr B.K.Kundu,
Rheumatology Clinic,
Department of Medicine,
PGIMER, Dr RML Hospital
New Delhi-110001.
Email: bijit73@sify.com
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Mysteries of Vitamin D

24 Mar

 

Date: 24th March 2011

Author: Dr. Ajay Kantharia, M. D., Physician – Cardiologist & Critical Care Physician

About: Dr. Ajay H. Kantharia has an active practise since last 22 years. & has treated thousands of critically ill (cardiac, respiratory, abdominal & neurological) patients.He is the pioneer in starting Cardiac Ambulance Service in Mumbai, the success of which is seen by the number of cardiac ambulances mushrooming in the city of Mumbai today. This fully equipped ambulance service is available to anyone, at any time & to go anywhere-to any hospital/destination of his/her/your choice. He has a website from www.websitefordoctors.in

Phone no: 020-22843454, 020- 22843455, +919820036165

Website: www.ajaykantharia.com

Ayurvedic Orientation-I: SHAREER RACHANA (ANATOMY)

22 Mar

Our corporeal body is defined as Kaya, Shareer and Deha in Ayurveda.
It needs a special mention here that around twenty centuries B.C., the knowledge of anabolic and catabolic activities and their role in balancing health had come to the notice of ancient Indian physicians.   It is clear from the fact that, in different contexts, the physical body has been referred to in different terms such as Kaya, Shareer or Deha.   If we go deep into the etymological origin of these words, following facts come to our notice:

SR.NO.

WORD

ETYMOLOGICAL ORIGIN and ITS TRANSLATION

SUGGESTION

01.

Kaya

Chi / Chayane – Accumulating or multiplying continuously.

Anabolic activity

02.

Shareer

Shru / Himsane – getting destroyed or shedding out continuously.

Catabolic activity

03.

Deha

Dhi / Vardhane – growing or developing continuously (A sign of life)

Harmony in Anabolism and Catabolism

Our body is said to be made up of six parts “Shadanga” (Shad = 6, anga = parts).  They are:  Head, extremities and the middle part consisting of chest and abdomen.  While the head is the controller of all our activities and thinking, the middle part plays an important role in performing vital functions such as respiration, digestion, metabolism and excretion, the extremities are meant to perform physical activities and take part in locomotion.The smaller parts of our body are referred to as Pratyangas.

MEANING OF AYURVEDA

Etymologically, the word Ayurveda is made up of two basic terms viz., ‘Ayu’ and ‘Veda’ wherein ‘Ayu’ stands for life and ‘Veda’ means science or knowledge: thus Ayurveda means  `the science of life’.

To elaborate further, `Ayu’ not only means an alive body system but it is an active assembly of corporeal body (Shareer), Sensomotor organs (Indriyas), Mind (Mana) and Soul (Aatma).  Ayu or the life is supposed to originate right at the time of fertilization of ovum (Shonit) by the sperm (Shukra) during which time soul (Aatma) gets attached to it. The life ends when this omnipotent Aatma departs from it.   The life span of an average human being is said to be of around hundred years which depends on many extrinsic and intrinsic factors governing health (Swasthya).

Ayurveda looks not only into the physical aspect of life but it also goes deep into its humane aspect also.   That is why, while defining the life (Ayu), Acharya Charak, mentions that the science, in which the parameters which are beneficial (Hita), harmful (Ahita),  pleasurable (Sukh), or unpleasurable (Dukha) for life are described, is ‘Ayurveda’.The life therefore is a fleeting, mortal congregation of physical body, mind and soul, i.e. the physical as well as metaphysical components. The fusion of physically indistinct non-material components such as mind (Mana) and soul (Aatma), initiates the process of living.

It is postulated that as long as the components of soul and mind (Jeevatma) are intact, the biological forms of the material elements present in our body keep on functioning actively and keep us alive; but no sooner the Jeevatma departs, the biological materials start disintegrating.  This state is known as Mrityu (death). That is the reason; the life is re-defined as the fusion of physical body, senso-motor organs, mind and soul.
The physical part of body is a combination of biological components such as Doshas (Omnipresent vital catalysts), Dhatus (Tissues / humoral components);  Agnis (Chemicals / Bio-transformers)  and Malas (Waste components);  whereas the metaphysical part consists of mind, soul and subtle elemental factors (Tanmatras) which are naturally implanted in the sensory organs so as to provide us the faculties of hearing, touch, vision, taste and smell.   When all the above factors act in harmony, it is defined as Swasthya (health).  Contrariwise, a state of disharmony / chaos is known as Roga (disease).

Ayurveda says that the forces we see predominating the external world predominate our internal milieu also.    The living body is nothing but a mini universe in itself.   According to the established theories mentioned in philosophies the whole material world is made up of five basic elements.  viz. Aakash, Vayu, Teja, Apa and Prithvi, comparable with ethereal, gaseous, energy, fluid and earthern masses respectively which are material in nature and also, Aatma (Soul), Mana (Mind), Kala (Time) and Disha (Space) which are non-material.   While different permutations and combinations of these elements without any life-force lead to the formation of inanimate materials / minerals or metals, their congregation, coupled with the life-force give birth to the animate world, which could be of higher level. Animal Kingdom known as Bahirantash chetana. This is a lower level. Plant Kingdom is known as Antashchetana.
The biological components mentioned above, viz., Doshas (vital catalysts),  Dhatus (tissue / humoral components), Agnis (biochemical transformers) and Malas (waste materials) are nothing but the biological  forms of the five basic elements only.

During embryological development and further on, the Doshas and Dhatus get amalgamated in genetically coded proportions and form / constitute various physical organs such as heart, liver, stomach, etc.
The science of Ayurveda has also elaborated on certain special Sanskrit terms for different structures in the body.   These terms are self explanatory in themselves.   A brief review of the important ones is mentioned here under:

  • Doshas (Vital Catalysts)
    The Doshas (vital catalysts) are the most important constituents as they catalyse and/or carry out all vital functions in their normalcy, and initiate the disease process in states of disequilibrium / vitiation.
  • Dhatus (Tissue Components)
    Dhatus are the tissue-humoral systems of the body. They are always formed in a fixed sequence. In different permutations and combinations the Dhatus form various physical organs of the body according to the genetically coded informations.   They are seven in number.  Their comparison with modern terminology may be as follows: Rasa ( Plasma and Lymph); Rakta (Blood cells); Mamsa (Muscle tissue); Meda (Adipose tissue);  Asthi (Bone tissue); Majja (Marrow tissue); Shukra (Tissue and humoral components related to reproductive / anabolic functions)

PRATYANGA  (Smaller Parts)

These parts of body are located in the larger Angas (parts).  This list includes brain and all parts of cranium, stomach, back, umbilicus, nose, chin, bladder, neck, ears, eyes, eye-brow, temporal bone, axilla, breasts, testis, knees and fingers.   Pratyanga also includes Kalas (various membranes), and internal parts like liver, spleen, lung, caecum, heart,  bones, joints, Siras and Dhamanis.   Strotosas are also included in these Pratyangas.

AASHAYAS (Pouchy Structures )

According to Acharya Sushrut *  there are eight Aashayas (pouchy structures) in our body.   These Aashayas are hollow pouches, meant for storage of specific material and have a surrounding outer covering.    They are named as Vatashaya, Pittashaya, Shleshmashaya, Raktashaya, Aamashaya, Pakvashaya, Mutrashaya and in female the eighth Aashaya is Garbhashaya. (* Author of Sushrut Samhita – The magnum opus on the principle and practice of surgery with ENT and Ophthalmology written in 1000 B.C.)

Vatashaya may be compared to colon.Pittashaya may be compared to gall-bladder, which stores bile. Shleshmashaya may be compared to lungs.Raktashaya may be compared to organs like liver, spleen  and heart.Aamashaya is compared to stomach.In Pakvashaya, organs like large and small intestine are included.Mutrashaya is compared to Urinary bladder.Garbhashaya is compared to Uterus.

PRANADHISHTHANAS (Vital Organs)

These are the vital spots of the body where Prana (Life) resides. They are ten in number. They include Shankhapradesh ( tempora), three Marmas i.e. Hrudaya (heart), Shira (head) and Basti (bladder); Kantha (neck), Rakta (blood), Shukra (viatl fluid), Oja and Guda (anus and rectum). It is believed that injury to any of these organs or loss of blood and vital fluid leads to instant death.

UPADHATUS (Secondary products)

These are noted to be formed by seven Dhatus, mentioned earlier. They are formed as follows – Stanya (milk) and Aartav (menstrual blood flow) are formed by Rasa DhatuKandara (tendons) and Sira (blood vessels) are formed by Rakta DhatuVasa (fat) and Twak (skin) are formed by Mamsa DhatuSnayu (Ligaments) and Sandhi (joints) are formed by Meda DhatuDanta (teeth) are formed by AsthiDhatuKesha (Hair) are formed by Majja DhatuOja is formed by Shukra Dhatu.

TWACHA (Skin and Underlying Facia )

Twacha is Upadhatu of Mamsa Dhatu, which is formed during fertilization process itself. It is made up of seven layers. They are: 1) Avabhasini; 2) Lohita; 3) Shweta; 4) Tamra; 5) Vedini; 6) Rohini 7) Mamsadhara

PESHIS (Muscular Structures)

The Muscular structures of body carry veins, arteries and nerves in them.    There are five hundred Peshis  in our body, out of which four hundred Peshis are in upper and lower extremities,  sixty six  Peshis are in middle part of the body and  thirty four Peshis are  in head and neck.
It would be very difficult for us to compare the number and types of muscle tissues mentioned in Ayurveda with that of the description we get today in the books of modern anatomy.

KANDARA (Tendons)

These are tendons of the body, which are responsible for movements like extension, contraction etc. They are sixteen in number out of which eight are in extremities, four in the neck and remaining four in the back. The tendons of extremities cover the region of thighs and shoulders and get extended till the roots of the toes and fingers.  The tendons of neck cover the chest and reach upto the head on one side and to the joints on the other side. The tendons of back extend to the ball joints of the shoulders above and the buttocks below.

SNAYU (Ligaments)

These may be compared with ligament and bursae, which connect the joints and muscles together.  These Snayus are of four types Sushir (porous), Pruthal (broad), Pratanvarti  (stretched) and Vrutta (circular). Aamashaya, Pakvashaya have Sushir Snayus. Chest, back and brain have Pruthal  Snayus. Legs and hands have Pratanvarti and Vrutta Snayus.
There are nine hundred Snayus in our body, out of which six hundred are situated in the extremities, two hundred and thirty three in the trunk region and seventy in the neck region.

DHAMANI (Arteries)

There are different opinions about Siras and Dhamanis. It is considered that origin of both Siras and Dhamanis is from Umbilicus. There are twenty four Dhamanis in the human body. According to Sushrut, Dhamanis are different from Siras by virtue of continuous pulsatory  movement (Sanskrit : Dhmanath Dhamani ).   Some Dhamanis may also be compared with cerebro-Spinal nerves. According to another opinion, Dhamanis carry Rasa (lymph) and blood within it.

SIRA (Veins)

Siras are those vessels which tend to take Doshas (impurities) along with them. The movement of Doshas in them is like a smooth flow (Sanskrit : Saranath Sira). There are seven hundred Siras in the body and which  can be compared to blood vessels or lymph vessels.

SROTAS (Channels)

Channels of circulation or tracts within the body are called Srotas. They are named so because of their tendency of trickling or oozing (Sru : `to flow’) of secretions through them.   They are the pathways (Ayana) for the nutrient products; waste-products and Doshas during the process of metabolism.   Srotas enable their products to reach their destination (viz. assimilation of nutrient substances by different parts of the body, or elimination of waste products from the body). They transport the Dhatus which are undergoing transformation.  They are physical structures (murti-mantah), and specific in their functions.  While the basic sites of Srotas with different functions are fixed depending on the biological material they are carrying, their openings are innumerable.  The Srotas can be compared with the unicellular end structures like capillaries or alveoli of lungs.

The vitiation of any of these Srotas (channels) is caused by exaggeration or inhibition of normal functions; occurrence of tumours in different sites and the shifting of the effected components to different areas of operation, manifested in the form of metabolic disorders.

Date: 22nd March 2011

Author: Dr. Mahesh Sharma —M.D.(Ay. Medicine)

About: Dr.Mahesh Sharma is an expert of Ayurveda by profession. He is a practicing as a consulting Ayurvedic physician since 1977. Having practiced as a general practitioner for a short stint of 3 years, he opted to be a specialist and hence, pursued specialization in “Internal Medicine” and completed M.D. in the year 1983 from Osmania University. Besides his own consultancy clinic, he was invited on board by different institutes/organizations to render his services. Dr. Mahesh Sharma has a website from WebsiteForDoctors

Contact: http://ayursharma.com

Common Eye Problems!

1 Dec

Date: 30thNovember 2010

Author: Dr. Kaushik Shah

About: Eye Surgeon, Ashwini Eye Care Clinic

Eyesight is one of the most precious gifts that nature has given to mankind. It’s only because of the eyes; one can enjoy the beauty of this world. It’s impossible to imagine life without sight. Though a very small part of body, eye is one of the most complex human organs. It has various parts, all of which are responsible for normal vision. Smallest structural or functional alteration in the functioning of an eye can cause tremendous visual disturbances.

Refractive error or need of glasses is one of the most common eye problems. It can start at any age. This is due to alteration in length, shape & / or capacity of eyes. There are various types of refractive errors which can be checked by an expert eye specialist & accordingly glasses can be used to improve clarity of vision. Other option for glasses is Contact Lenses. Glasses can be removed completely by a LASER procedure called LASIK after the age of 18 years once the power of eye is stabilized. LASIK is a very safe procedure with high grade accuracy, least possible side effects & excellent results. As refractive error can arise at any age, one eye check up by an eye specialist is must for each & every child at the age of 5 years irrespective whether he is having eye problems or not.

Glasses can be removed by LASER procedure called LASIK after the age of 18

Cataract is another most common eye problem which is nothing but clouding of natural human lens. It’s not a disease but normal aging process. Hence it’s seen in old age commonly though it can occur at any age because of various reasons & can be there by birth also. Cataract affects quality of vision to a great extent. The only treatment for this is surgery. Cataract can’t be cured by glasses or medicines. Due to advances in technology, the entire surgery can be done through a very small 2.8 mm incision & high quality artificial lens is implanted in the eye. Its day care procedure, no hospitalization is required & patient can go home immediately after surgery.

Cataract has to be removed by advanced cataract surgery (Phacoemulsification) & replaced by modern intra-ocular lens

Squint or crossed eye is again a very common eye problem. It also can occur at any age & can be treated by glasses, exercises or surgery. Any person or child with squint has to be examined by expert squint specialist as early as possible irrespective of the age of the affected because if not treated in time, it can have severe impact on vision of the affected. Children with squint need special attention by squint specialist.

Squint corrected by surgery

Glaucoma, which is also called as silent thief of eyesight, occurs due to damage of the Optic Nerve. Raised pressure inside the eye is one of the main risk factors for this. This is also seen in old age & if not diagnosed & treated in time can cause gradual & permanent loss of vision. Treatment modalities include eye drops, LASER & surgery.

Though very small part of human body, eye is very important & delicate organ. Most of the diseases affecting eyes can have impact on the vision & hence any symptom of eye problem should be taken seriously & immediately eye check up by an expert eye specialist should be done to avoid vision threatening problems in future.

Dr. Kaushik Shah, Ashwini Eye Care Clinc, Baner

ADVANCES IN CATARACT SURGERY – LIFE-CHANGING RESULTS FOR PATIENTS

6 Aug

Date: 6th August 2010

Author: Shroff Eye Hospital

About:  Shroff Eye Hospital is India’s First Eye Hospital that the Joint Commission International (International Division of JCAHO, USA) has given accreditation for excellence in patient care and health care delivery. Shroff Eye is also India’s first and only Wavelight Concerto 500 Hz LASIK center- The Worlds Safest and Fastest LASIK.

Contact: anand@shroffeye.org, www.shroffeye.org

Cataract is one of the most commonly known eye conditions causing visual impairment. People who remember when cataract removal involved general anesthesia, days in the hospital, weeks immobile at home and the subsequent need to wear thick glasses may find it hard to believe how much the procedure has changed. Some may be needlessly postponing surgery as a result.

While in the past people waited until a cataract was fully “ripe” and nearly blinding before having it removed, the current recommendation is to have the surgery as soon as a cataract interferes with normal activities, including driving, watching television, climbing stairs, playing games, cooking and reading. In fact, the more advanced a cataract becomes, the more difficult it is to give the desired result.

Every patient’s eye is unique, and surgery must be tailored to the individual

Cataract Surgery can now be customized to reduce and usually eliminate dependence on glasses for distance, intermediate vision and reading

The Evolution of Cataract Surgery-

“No-Stitch” “No Stress” Customized Cataract Surgery

The fundamental aim of cataract surgery, the removal of the opacified natural lens to improve vision, has remained the same for hundreds of years. However, the way in which this is achieved and the expectations of people undergoing the procedure have changed drastically. Advances allow cataract surgery to be customized for every patient.

Today, cataract surgery is nearly always performed under local or topical (eye drops) anesthesia and takes less than 15 minutes.

Microsurgical Techniques

Today the surgery is done through a very small stitch-less, self-sealing incision in the cornea. Earlier this incision used to be 6 mm, then 3 millimeters and now a very tiny incision of 2 mm called Micro Incision Cataract Surgery (MICS). MICS (Micro Incision Cataract Surgery) with stable advanced Intra Ocular lenses helps patients resume work early.

Foldable Advanced Lens Implants

Standard intraocular lenses are monofocal—that is, focused for one distance, usually far. These patients still need glasses for near and intermediate distances. The development of multifocal intraocular lenses offers a further option for patients

“We can reduce drastically, if not eliminate, nearsightedness and farsightedness without the need for glasses or spectacles after the surgery,” said Dr Anand Shroff, Cataract Surgeon, Shroff Eye Hospital, Mumbai. “We discuss in detail the needs, lifestyle and visual demands of the patient alongside the preoperative assessment which greatly helps us plan which implant is most suitable for their needs and expectations. The visual potential of the patient can be realized in many different ways, and when looked at in this context very few cataract procedures are the same”.

Patients now have different options and their surgeries can be tailor-made for them, called ‘Customized Cataract’ surgery, which is customized based on their needs, desire to be free from spectacles and their need to get back to work as soon as possible. Customized matching of lenses covers the entire range of requirements and results in highly satisfied patients.

Many people now do not want to wait for a cataract to occur, but start looking for options to correct both, their reading and distant vision. They opt for ‘PRELEX’ or Presbyopic Lens Exchange even before the cataract starts to interfere with their daily activities. Such options look after all focal points of vision: near, intermediate and distance.

In some people vision is further impaired by rather severe astigmatism, an irregularity of the cornea which makes it difficult for the eye to bring light to a point focus on the retina, no matter how good the glasses you use. So, at the same time that the cataract is removed, the astigmatism can be corrected using new implants called ‘Toric IOLs’.

‘Wavefront Implants’ have taken the cataract lens market by storm.  These are Aspheric Optics which mimic the optics of a ‘young eye’ and give exceptional contrast and night vision.

To aid the eye surgeon get accurate measurements of the lens power, the Zeiss IOL Master is an amazing device. It is engineered as a non-contact optical device that measures the power of the IOL to be implanted. Using partial coherence interferometry, the IOL Master is consistently accurate to within ±10 microns or better. Also, because the IOL Master is non-contact (nothing touches the eye itself), there is no need for anesthesia and there is no potential for spread of contamination or inter-operator variability in measurement.

With the use of accurate diagnostic and measurement tools, combined with very small incisions  and surgeon precision, we have not only delivered stable and exceptional results but also have made our patients extremely satisfied with their outcomes, said Dr Anand Shroff.

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