Balancing Skill and Health

One of the disheartening sights is the unusually large number of wheelchairs lined up at arrival terminals at airports when a flight from India arrives. 

With our average life expectancy being around just 70, do we get infirm and immobile early, taking to the wheel chair or seeking physical support too easily as we grow old? And if we do show signs of aging early, is it just “genes”, or how we looked after ourselves in the preceding decades leading up to it?

Dr Michael Roizen from the Cleveland Clinic, an expert on longevity and aging, points out that our ability to maintain balance is a good indicator of how long and healthy we are and can expect to live. 

He describes a “one leg test”, that is a senior person’s ability to stand on one leg for 10 seconds; those who can achieve the feat are three times more likely to live longer and healthier lives than their same-aged counterparts who could not!

Holding balance indicates three aspects of a person’s health. For one it gives an idea about the strength of our leg, spine and body muscles. 

Second, the act of balancing requires nerves, muscles, eyes, vestibular system (behind our ears) and brain to fire and function in a balanced and coordinated manner, and provides a quick assessment of the state of neurological decline that accompanies aging. 

And third, patients who suffer from neuropathies, especially diabetics, find it hard to perceive sensations from the legs, and hence their balance.

He noted that those who could hold their balance, were more alert and had better cognition or learning abilities.

How then can we hold on and strengthen our balancing skill? The tree-pose or Vrikshasan asana seems tailored for just that. 

Other methods include toe-heel walks, walking on a straight line or walking up stairs without holding the rails. 

Walking on a wall or a beam, or in its most challenging form, on a rope, is what it is all about. Many elders would reminisce how they used to do it then when they were young and active. Wouldn’t of course advise my senior compatriots to revisit their agile childhoods now!

Giving up too easily and taking to the wheel chair could enhance our motor deterioration. Regular practice could slow our age-related  decline in movement, and of our balancing skills. 

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GERD

Do you get burning sensation behind your chest bone, or have sour food come into your mouth? Do you wake up at night with “heartburn” or “acidity”, and need to drink water or take antacids for relief? If this happens more than once a week, you are suffering from GERD (Gastro-Esophageal Reflux Disease) one of our modern day maladies.

GERD is caused by refluxing of acid that is normally produced by the stomach, into the food pipe or esophagus, due to malfunctioning of the one-way valve located at the stomach-foodpipe junction (GE valve). A recent nation-wide survey from 25 centers, conducted by the Indian Society of Gastroenterology, found that 8.4% of Indians suffer from this disorder. If you are a sufferer, you have 80 million in India for company!

GERD is a lifestyle disorder, but also tends to run in families suggesting a genetic component as well. Its frequency has jumped up in recent decades replacing Irritable Bowel Disease as the commonest GI disorder. 

Obesity. fatty food ( pastries, fried food, cheese, cream), chocolates, pungent spices cause relaxation of the GE valve as do alcohol, nicotine and caffeine and are notorious for causing GERD, accounting for the early morning “heartburn” often experienced after that perfect late night party. 

Diagnosis of GERD is fortunately not difficult as the symptoms are quite typical. The commonest test advised is an endoscopic examination, during whcih the doctor examines whether ulcers have formed in the food pipe or if the lower oesophageal valve is very loose. Long standing severe reflux may occasionally cause scarring and narrowing, and sometimes lead to cancer. 

Changes in life style certainly help. Regular exercise, maintenance of ideal body weight, avoiding all the predisposing foods and beverages, a small early dinner and elevating the head end of the bed, do work. Those who can’t change their ways, prefer to take pills that reduce acid production in the stomach (Proton Pump Inhibitors or PPIs) or tighten the GE valve. They work well, but only as long as you keep taking them.  

Refluxers are confronted with a hard choice of “Pleasure and Pill” or “Frugal Pauper”. Not easy!

Is Anger Ruining your Health?

Anger, the all too familiar negative emotion, has survived in humans over generations only because it has occasionally brought positive outcomes! Children and students fell in line, juniors completed their work on time, and leaders scored brownie points in fights and rallies.

Recent studies point out that an excess dose of anger could harm our health. If you are described by students, friends, neighbors or relatives as the “angry” type, and suffer from frequent outbursts or intense anger that burns inside for long periods, your health could be at risk.

1. Angry people are more prone to high BP and heart problems. Anger releases stress hormones such as catecholamines (epinephrine and nor-epinephrine) and corticosteroids. They make the heart beat faster and push up the BP.

• Frequent angry outbursts trigger the “Fright, Flight, Fight” response. The depiction in earlier movies of an elderly person livid with rage, collapsing on the floor during the outburst, can and does occasionally happen!

• Anger is now well known to worsens anxiety. Prolonged anxiety drains the “positive” neurohormones such as serotonin and dopamine, thereby pushing one to depression.

It is therefore not uncommon to see a person who has been a fiery angry person for most of his active life, recoil into a dim corner with depression at a later age.

• Anger can interfere with the way our immune system works. In an interesting study conducted by Dr Jennifer Graham Engeland in Pennsylvania, USA, researchers noted higher values of inflammatory markers called immunoglobulins, in samples obtained from “angry” people. 

These markers are usually associated with arthritis, frequent illnesses, heart disease and injury to organs.

• At a closer look, the immune bio-markers went up whenever the volunteer experienced anger, coming down when the mind relaxed and turned to a “positive” emotion.

Anger is an “old” emotion. Modern strategists are discovering better ways to solve the same problems like parenting, teaching or dealing with others in a group, where anger used to come a handy instrument in earlier times. Now we need to move on, protecting our health in the bargain.

Heart Attacks and Sleep Deprivation

Sleep is emerging as a new risk factor for heart disease.

Adequate sleep, both in terms of duration and quality, is proving to be essential for heart heath. The relationship may be a complicated one though. Excess sleep of more than 9 hours is harmful, and may understandably be making the body sluggish and vulnerable.

But those sleeping less than 7 hours a day on average have been found to have a higher frequency of heart disease.

The healthy sleep duration therefore seems to be between 7 and 8 hours. And early risers fare somewhat better than late ones.

The quality of sleep also seems to clearly matter: those with sleep apnea (orthostatic sleep apnea), snoring problems, sleeping disorders such as difficulty in falling asleep or waking up frequently at night, suffer more frequently from heart ailments.

Which then are the “types” of heart ailments associated with unhealthy sleep? Heart attack rates are clearly up, as are rates of high heart failures and coronary artery disease.

Experts attribute the increased cardiac risk to higher blood pressure levels and increased levels of certain circulating hormones during the night, in those with sleeping problems.

Cardiac disease is the largest killer in urban India today, and doctors as well as patients are familiar with the 7 conventional risk factors: tobacco, high BP, high cholesterol, Diabetes, strong family history, lack of exercise and obesity. “Sleep” is on the threshold of joining in as the 8^th risk factor for cardiac diseases.

Interestingly, some of the risk factors are intricately interrelated, and may not be so difficult to handle. Adequate physical exercise, for example, could additionally solve the problem of overweight as well as lack of sleep, apart from being protective to the heart.

What then prevents you from catching 7 hours of good sleep every night? Late night parties, television or late hours at work? Sleep therapists strongly advise an early light dinner, and switching off all electronic devices (TV and cellphone) at least an hour before sleeping time. It could be worth following their advice to protect your heart!

Sticky Mind of OCD

The minds of some people are troubled by recurring and lingering thoughts, that seem to get stubbornly stuck, refusing to go away. This “obsession” often leads to patterns of repetitive compulsive behavior that they feel compelled to perform, and unable to stop.

OCD, the acronym for Obsessive Compulsive Disorder, is fairly common, affecting 2-3% of us. You might have noticed it in yourself or in a relative or friend, when someone checks and rechecks, and re-rechecks if the dishes are adequately cleaned, or the door is properly locked or if the items on the table or kitchen are geometrically organized in their places to perfection.

Recurring and lingering thoughts occur in almost all of us, but most are usually able to recognize them and stop them. It is when they assume a disproportionate frequency and intensity that one just cannot seem to stop, that they are called obsessive, and may require help.

There are several common types of OCD depending on what the thoughts seem to get stuck on:

1. Cleanliness: many suffer from the obsession of keeping the kitchen, home, office, car or table spotlessly clean, annoyed at the sight of a speck of dust or scrap. Lady Macbeth in Shakespeare’s play is said to have demonstrated all the features.
2.  Safety: some are excessively concerned about safety, often checking and rechecking if all the doors are locked, windows are secured, gas has been turned off and so on.
3. Hoarding and Counting: many are deeply strained at the thought of having to part or throw away any scrap or small change.
4. Lingering and obsessive sexual thoughts are common especially in young people. Some are unable to take their minds off from them, hooking on to cellphones or their minds constantly engaging in erotic thoughts that they cannot free it from.

OCD can be frustrating, causing inability to concentrate on other issues such as studies, generating feelings of guilt, anxiety or depression.

Fortunately, OCD is treatable. Some medicines such as SSRIs and SNRIs, restore the balance and effectivity of the naturally neurotransmitter in our brains, called serotonin, that regulate our mood and thinking, and can be quite useful.

CBT (Cognitive behavior Therapy) is an effective counselling technique that helps train the mind to trace its paths, identify where it is dragging you and then train and modify the behavior it tends to trigger.

Eat Less to Live Long

Moderate limitation of calorie intake can make healthy people stay fit and live long. This has been the finding from a recently concluded controlled human CALERIE (Comprehensive Assessment of Long-term effects of Reducing Intake of Energy) trial undertaken by Yale School of Medicine and Pennington Biomedical Research Center.

The design of the trial was simple. Of the two hundred healthy volunteers who participated, some were asked to restrict their intake of calories by around 10-20% (14%) while others were asked to eat as they normally did, that is till they felt full.

Subjects were evaluated at baseline, 1 year and 2 years for subtle metabolic and immunogenic changes that could suggest effects on life span and health.

Interestingly, those who consumed a calorie restricted diet showed improvement in their metabolic and immune responses. This was primarily through harnessing PLA2G7, a macrophage produced protein platelet activating factor acetyl hydrolase, that has been established to correlate with healthier lives and longer life-spans.

This study conducted by two senior scientists, Dr Eric Ravussin and Dr Vishwadeep Dixit, went on to find what could be other reasons by which calorie restriction (CR) could be working o the body.

They noted that the thymus gland, located in the upper chest and considered to be the orchestra-master of the body’s immune system, showed much less age-related decline in CR subjects; their better-preserved thymus glands could produce more T-lymphocyes that regulate the body’s immune system.

Further, CR subjects showed less inflammation in the body. We know that the triad of disordered metabolism- immunity- inflammation is what causes aging, and age-related diseases shortening our life spans. Restricting calories slowed or reversed this process, allowing the body’s immune system and tissues to remain young and healthy.

One of the corollaries of this study is to address which of the 29 weight reducing diets is the healthiest. It appears that restricting calories in any form seems to be beneficial. Whether the focus is on carbohydrates or fats do not possibly matter much in the long term with regard to prolonging life-span.

The moral of the story seems to be: if you are healthy, get into the habit of reducing your calorie intake. The best way is to stop eating when you are two thirds full. That is you still have space in your stomach to fill. This could translate into less metabolic health problems and a longer healthier life.

COVID Vaccination for Children in India.

What has changed over the last two years since COVID landed in India in March 2020 is that the number of cases have spiked yet again, and unlike the 1^st wave when children were largely spared by the virus, more children are falling sick this time during the 3^rd wave.

Parents of children as well as older students are finding themselves in a quandary: should they go ahead and take the vaccine that they are being offered for protection or wait and see what is happening to others who do?

What is hanging in balance is resuming schools, studies, education and “career” that have taken a severe beating and break the shackles of fear and restrictions to move on with their “normal” (read pre COVID) lives or stay fearfully confined to home and continue with “on line” studies.

COVID vaccination has therefore been extended in a phased manner to children across most parts of the world. The Indian government has approved COVAXIN, a smaller dose of the  Indian made vaccine made from the inactivated whole virus and now proven to be safe and effective, to 15-18 years old.

Since its launch in mid-January 2022, over one crore students have taken the 1^st shot. Serious adverse effects have been hardly any; around 10-20% have reported mild soreness at injection site, fatigue, or fever that lasted less than a day.  

The turbulent last two years have seen health experts at cross roads on almost every aspect of the SARS-Cov-2 pandemic, from its origin to our fanciful expectations of cure from a long string of remedies (HCQS, Ivermectin, Remdesivir, steroids, antibiotics, anti-inflammatory agents etc).

The only two common denominators that have kept them united have been “masks” or COVID appropriate behavior, and the observation that those who received COVID vaccinations seemed distinctly protected from developing severe COVID or dying from it if they got infected.

Parents and school teachers need to acquaint themselves with the facts and benefits of vaccination, and encourage children to take the jabs, earlier the better, and get on with their education and lives.

Third Wave of COVID and the Omicron variant

Once yet again, when we had begun to think that the COVID pandemic had faded out, the number of new cases has suddenly spiked up in many parts of the world, largely due to the Omicron variant with its 30 plus mutations.

The prevailing sense of “coolness” in most people despite the rising numbers is due to two factors. One: many who have received two doses of the vaccine are enjoying a sense “protection” from future infections. And if indeed we do get infected, they feel, it is bound to be mild and transient. Second, initial evidence from South Africa has given us an indication that the outcome of infection with the Omicron strain is usually non-serious or non-fatal.

Why bother then?

The Omicron variant is 4 to 6 times more contagious than its predecessor, the Delta variant. Hence the number of people likely to be infected are huge. And due to its several mutations, protection from Omicron by vaccine derived antibodies are not likely to be good.

But why bother still, if it runs a mild course and does not have the potential to kill, as Delta did?

The best way I heard an international health expert sum up the situation was “A small portion of a very large number is still a large number!”

And as predicted, hospital admissions, have started climbing steeply in many parts of the world, many of whom are double-jabbed. Deaths are also not too far behind; Russia and east Europe are reporting large numbers already.

Further, children are falling ill much more this time than they did during the first two waves.

Governments of several countries who had become smug with the success of successful vaccination programs, are jerking up and imposing “restrictions” once again; closing restaurants, theatres, public gatherings and schools.

Health administrators are feeling the heat and sanctioning booster jabs, that they had been COVID Third Wave and the Omicron variant resisting. They are back once again to the drawing board “creating” beds and health care facilities, reminding me of the saying, “A mistake repeated twice is a conscious bad decision”.

And health administrators are once again in TV studios extolling the virtues of “mask” and “social distancing” while allowing crowds to swell in rallies and protests.

One silver lining is the availability of two new anti-viral drugs: Molnupiravir and Paxlovid, both at the threshold of their launch. If taken early in the infection, they seem to block viral replication and reduce the risk of “serious” outcome.

The COVID story seems far from over, and as the French president recently cautioned, “the next few weeks or months are likely to be challenging”. Let us err on the side of caution!

Health Risks of Drinking Alcohol

Almost everyone knows that excessive drinking of alcohol can be hazardous to health, especially to the liver, but here are a few points that you might want to keep in mind this season.

1. The effect of alcohol and its health risk may vary significantly from one individual to another. Its effect on the mind or behavior can range from relaxation, to sleepiness to euphoria to boisterousness to aggression to violence. It is therefore worth keeping in mind that in gatherings and parties, people may behave in unpredictable ways sometimes ruining the evening with accidents, violence or aggression.
2. Persons taking cholesterol lowering drugs called statins, often experience severe fatigue, muscle pain and soreness of the body when they take alcohol. This effect is due to both of them (alcohol and statin) competing for the same metabolic pathway in the liver. Medicines that lower triglycerides (fibrates) can sometimes cause severe muscle aches especially after a drink.
3. Certain medicines, the anti-amoebic drug called metronidazole and many others, may interfere with alcohol metabolism and cause severe side-effects such as flushing, palpitations, chest pain or restlessness, a phenomenon described as Antabuse-like reaction. This is caused by the medication interfering with alcohol metabolism causing the toxic metabolite acetaldehyde to accumulate in the body.

If you are on any medications, check with your doctor regarding whether they are safe to go with drinks.

• Pancreatitis is a potentially serious and dangerous complication of alcohol use. While most who develop it have long history of significant consumption, there is a unique individual variation: some develop severe abdominal pain and major episodes with as little as just one drink.
• HOLIDAY HEART SYNDROME. Excess amounts of alcohol consumed during the festive season may cause changes in the heart: from increased heart rate, elevated blood pressure, to disorders of heart rhythm. The commonest one is called atrial fibrillation, in which the heart beats rapidly and irregularly. It may need hospitalization, medications and sometimes electric shock to the heart to reset the rhythm. It is sometimes associated with increased risk of stroke and heart attacks.
• Binge drinking, as often happens around this time of the year, is associated with a higher risk of these complications.
• If you suffer from heartburn or Gastro-esophageal reflux disorder expect it to get worse with alcohol this season.

Alcohol is best avoided altogether, but if drink you must, sticking to a single drink for women and two for men should be the upper limits as recommended by heart specialists.

Time makes all the Difference in an Emergency

The relatively high proportion of people who suffer and emergency and do not make it alive is well related to the significant delay in appropriate treatment reaching them. Some of the common situations are:

1. Chest pain, heart attacks, cardiac arrhythmias
2. Stroke
3. Accidents, especially involving the head or neck, or when there is associated bleeding.
4. Severe Allergies; especially with breathlessness, often called anaphylaxis
5. Seizures, fits, coma
6. Difficulty in breathing
7. Bleeding from intestines or a perforation.

Others such as appendicitis, gallbladder pain, pneumonia, sepsis or cancers are of course important, but a few extra minutes may not make so much difference in the immediate outcome unlike the seven listed above.

During an unexpected emergency last week when I had a close brush with death, one of the main reasons behind my survival was TIME. Paying attention and doing things ON Time may make a lot of difference should you have an emergency.

1. Save the EMERGENCY numbers on your cell phone: Hospital emergency ( at least 2), Ambulance services, Doctor (your personal one), a critical care expert, apart of course that of the police and fire services.
2. Share these numbers with each member of the household as well as neighbors…don’t keep them to yourselves alone.

When I suddenly lost consciousness due to a cardiac arrest, each second could matter. As I was not in a position to call anyone (was unconscious), my wife had the presence of mind to call 3 numbers…that ensured.

It might well be possible or necessary for others to call on your behalf.

• Keep the home address save on your smart phone, preferably with a location indicator on Google map. It makes it much easier for the ambulance to reach home than trying to give verbal instructions all the way.
• Keep money at home, in case you do not use credit cards
• Informing relatives and explaining things to them should wait till the above emergency issues have been lined up.
• Try not to bargain with doctors when they are trying to save your life. I have seen some people wanting to have a detailed discussion and seek endorsement of distant relatives, when each second could matter
• Make sure that you have an ADEQUATE Health Insurance policy, preferably a cashless one. Make sure you declare all your health issues when you take your policy…don’t hide facts like diabetes, hypertension so that they do not become reasons for rejection.

Do these today please, and do not postpone till tomorrow, as you never quite know when it could become necessary.