Lessons from the Turkey Earthquake. Can we be better prepared for such an eventuality?

The recent earthquake in Turkey and Syria when the earth shook violently inflicting unimaginable trauma, claiming 50k lives and shaking up the thousands of those who survived death with wounds that might change their lives for as long as they live.

“Natural disasters’ are of 2 types: some that can be predicted, such as cyclones, where major advances in satellite technology and evacuation drives have reduced deaths significantly, while some such as earthquakes that are difficult to forecast.

1. Needless to say, modern buildings need to be “earthquake resistant”. Japan, a very earthquake-prone place, has significantly reduced impact of earthquakes on their buildings and peoples’ lives. Earthquakes still happen there, buildings do shake violently at times, but they rarely collapse like a pack of cards and kill its inhabitants.

2. The prime reaction evoked by shaking of the earth is FEAR; It generates either a FLIGHT or FIGHT response. Most who could, would have run to open spaces and escaped buildings and debris falling on their heads.

3. If one found oneself alive and conscious, the fear of missing loved ones can be overwhelming, a mother standing up to see her home reduced to debris with fear that her family could be trapped there.

4. For those who lost so much so suddenly, went through (still undergoing) !various stages of the GRIEF response: initial denial (this can’t be happening to me! Am I having a nightmare?), anger (why did the rescuers take so long? Why did the government allow this to happen?), bargaining (why did I not die instead of my son?), sadness and then finally acceptance (God’s will or Destiny!).

5. India’s disaster response has undoubtedly improved and matured as survival data from cyclones in recent years have shown. Induction of canine squad (4 dogs were taken by the mission to trace human bodies or survivors) was a great step!

6. Most mature international disaster response teams include a squad of psychologists and counsellors, who help people in their darkest bewildering hours. We need to build our strength there too!

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Can Heart Attacks be induced by Stress?

The recent sudden death of the 53-year old singer KK of a heart attack after a grueling evening performance in an overcrowded hall has shocked not just the public but medical scientists too.

The circumstances do not seem to leave much space for doubt. He was a non-smoker, and was not known to suffer from the usual known co-morbidities such as diabetes, hypertension, obesity, high cholesterol or previously known heart condition. Many who knew him personally, in fact testified on television that he was quite a health freak, with no “bad” habits.

What then could have caused his sudden fatal heart attack? Circumstances are clearly suggesting “stress”, that nebulous factor scientists have not yet learnt to define and measure. There were 7000 people thronging an auditorium meant for 2500 and it was unusually hot in there due to lack of adequate air-conditioning. The performance had been long requiring him to sing 20 songs back to back, perhaps as a part of the contract. And to top it all, he had to put on a friendly, high energy appearance and please the audience while he was clearly uncomfortable and sweating!

Medical science often tends to deny something that it finds it difficult to prove or measure. Although it may look fairly evident to the common on-looker. Let me therefore share another episode from the last fortnight.

Joe Garcia, the 47-year-old husband of one of the two teachers slain along with 19 children, in the devastating school shoot out at Uvalde, Texas, died of heart attack the next morning. The circumstances compel us to invoke that nebulous trigger again: It was not just the loss of his wife of over 24 years,  but the agony and unexpected manner in which it all happened.

He died suddenly soon after attending the memorial service of his wife, from what the press described aptly as “of a broken heart”. 

Observations form real-life strongly indicate that unusual stress, physical, mental or emotional, can precede or induce a heart attack. Cardiac events are the commonest cause of death across the world, particularly in urban India.

Learning how to manage stress may not sound all that scientifically erudite, but awareness, insight and  preventive strategies to deal with it may hold the key to our survival when conventional medical knowledge is not measuring up.

Big Losses in Third wave

The last three months of “Omicron” wave have been perplexing.

On one hand we witnessed a string of senior celebrities succumbing and falling one by one , succumbing to health issues arising from an episode of infection from the recent wave of the new “mild” variant.

The most notable of the stars were India’s 93 year old nightingale, Lata Mangeshkar, 91 year old Sandhya Mukherjee, 69 year old Bappi Lahiri, 83 year old Birju Maharaj and several others

The new variant was a described as “mild”, and indeed many of us contracted it and beat the infection within a few uneventful days. And yet, the large number of elderly people who succumbed, if not directly to the virus, but to a chain of health events and complications that ensued after it, raises uncomfortable questions.

Age seems to be an important factor…people above 80 proving to be more vulnerable and finding it difficult to recover back to normal health. Some had co-morbidities of course, such as obesity, sleep apnea, diabetes, and renal disease.

If medical scientists could drop their jargon for a while, the word they would describe elderly vulnerable people as “frail”.

Interestingly FRAILTY has now become an accepted term in medical literature to describe a condition that “occurs as a result of aging associated declines in energy, strength, and function, that increases the person’s vulnerability to stress and disease.

It is typically seen in people above 65 and seems to increase with age, and is often associated with any or all of five factors: unintentional weight loss, exhaustion, low energy, low grip and slower walking speed.

Frail people seem to fare badly from any stress, be it an injury, or heart attacks, to a chest infection. Interestingly, the triggering event often passes, leaving behind dysfunctional organs, one to start with, affecting others in turn.

The death certificate often mentions “Multi organ dysfunction” often hiding FRAILTY as the underlying cause that caused it all!

The last wave has indeed claimed several valuable lives, targeting FRAIL senior people off guard and making them succumb.

Cancer Survivor Wins Olympic Gold Medal

If “cancer” and “chemotherapy” evokes fear and hopelessness in you, you must read this.

Last week, Canada’s 27 year-old Max Parrot soared to victory at the Beijing winter Olympics in the snowboard competition, enthralling many watchers with his flying antics and winning the gold medal.

Five years ago, Max was diagnosed with Hodgkin’s Lymphoma, when he noticed a lump in the neck. It is a type of cancer of the body’s immune cells that occurs in lymph glands.

The mainstay of therapy for this group pf cancers, is Chemotherapy, where several cycles of drugs are administered into the body to target and kill the cancerous cells.

Not unexpectedly, he described 2018 as a year when he felt to be at “zero” level, fighting not just his cancer, but the adverse effects of therapy. He describes his experience as “lying in a hospital with no energy, no muscles and no cardio”.

For an active sportsman, the interruption of his career, mental trauma and disappointment is not hard to imagine.

Over the past few decades, cancer treatment has moved from the almost “invariably progressive and fatal” to a good deal of success. According to American Cancer Society, the chances of long-term survival of patients of Hodgkin’s Lymphoma (measured as 5 -year survival rates) have moved up to 90%. In other words, nine of every ten patients are expected to respond and survive 5 years. Even more reassuring is that most who do, are often cured for life!

As for Max, the treatment comprising 12 cycles of chemotherapy, was exhausting. What kept him going were probably his young age, and desire to get back on the snow board, his favorite sport.

Within a few months after his therapy he had started training again. And many people, including his Canadian friend and colleague who won the bronze medal, were happy that he managed to prove himself.

His comeback to competitive sports sends several messages to the world.

For one, developing a cancer does not necessarily mean that one is doomed. Second, advances in therapy has made it possible to control and cure some of them. And third, return to normal life is possible if one has the determination to fight on!

“Languishing” is the New Feeling of the Times

A new term has been coined to the most common “mood” that a large number of people are experiencing during the last two years of the pandemic. It is called LANGUISHING.

Many of us, 12 percent to be precise, are experiencing a range of difficult-to-describe feelings. It is a departure from the happy days of 2019 and earlier, when life had more freedom, excitement, predictability and social interactions.

COVID Pandemic has changed all that, plunging many into grief (loss of life of loved ones, loss of jobs) or anxiety (worrying about whether it could be my loved ones next). Quite a few however, who have managed to escape from these two extreme emotional states of depression and anxiety are feeling numbed and listless too.

Could you be suffering from “languishing”, which can be described as follows?

1. Difficulty in concentrating
2. Not feeling truly happy and cheerful
3. Feeling of numbness and apathy
4. Feeling restrained and constantly feeling lack of freedom and opportunities
5. Diminished sense of humor, excitement and hopefulness about the future

“Languishing” is not quite as low a feeling as that of depression (persistent sadness, negative thinking) or anxiety (state of uneasiness of uncertainty), but one where the mood has been beaten and flattened out into one that compares with inmates confined to a jail or whom a similar predictable day follows another not-too-exciting day: Restricted freedom, lack of social contact, and uncertainty of future!

Many psychologists feel that lack of social contact could be a key factor in causing it. On-line education and work could be sounding good and seeming to deliver everything, but absence of physical contact with school or office mates could be making many withdrawn, quieter, introvertish and numb.

How then does one break the shackles and stop languishing while COVID restrictions and the fear it has instilled takes time to go? The solution seems to lie with “FLOW”: yet another new term that describes a deep engagement or passion, or ambition that keeps the mind focused and creative, with a sense of purpose, encouraging our pent-up energies to flow into something creative. Working on a project, for example, could help break the jinx.

When life “normalizes” again in the future to pre-2020 times, feelings of languishing will hopefully diminish. But overcoming it early could help prevent it from scarring our personalities, when we emerge out of the pandemic

It is time to get passionately purposeful and get into the FLOW now.

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!

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.   

Sudden Cardiac Deaths: Looking the other way till it actually strikes?

An interesting event occurred recently when an otherwise healthy doctor suddenly lost consciousness and collapsed on the floor with a thud at his home. Attempts by anxious relatives to wake him up by calling or sprinkling water on his face did not work the way it normally does in fainting attacks we witness commonly brought on by prolonged standing in school assemblies or standing in line for long spells.

When partial consciousness returned, he checked his own pulse, and found it to be feeble and slow, around 20 per minute!

His pulse rate continued to be just 20 per minute (normally around 70), when he reached the emergency 40 minutes later, where he suffered another cardiac collapse. It was only when a wire could be inserted to his heart from his groin and his heart “paced” to 70, that circulation to his brain and body was restored.

After stabilizing him in the ICU for 2 days, a permanent pacemaker device containing a battery and two wires that reached down sending electric impulses to the muscles of the heart, that he could be sent home. He was of course lucky; most such cases are retrospectively given the label of unexpected sudden cardiac deaths.

While we are aware that the muscular heart pumps blood, we often overlook the sensitive network of pacemaker and “conduction tissue” that generates electric signals to initiate the “heartbeat”.   When the heart paces with fear or romance, it is brought on through this system. If it snaps, as in a condition called “heart block”, the heart finds it difficult to beat as there are no impulses to initiate the contraction.

Of the 2 million sudden cardiac deaths that occur in India every year, 20% are due to these “rhythm or electrophysiological disorders” that usually present as episodes of giddiness, or loss of consciousness. They differ from the common “heart attack”, a term that usually denotes blockage in the coronary arteries supplying blood to the heart of which chest pain remains an important symptom.

Electrophysiological disorders range from increase in rate to irregularity of rhythm to extreme slowness, and the range of therapies vary from medicines, to pacemakers to other fancy devices.

When the light does not come on when you turn the switch on, the problem might well be with the electricity supply, voltage or the wiring.  And these group of disorders are turning out to be important reasons for of increasing frequency of unexpected sudden cardiac deaths claiming apparently healthy lives.

Omicron variant of Sars-cov-2 virus

Last week’s health news was disturbing: the new twist to the Covid pandemic that has been going on now for over 2 years and was seeming to come under control with vaccines and other measures, could see yet another wave.

The protagonist of the pandemic, the SARS-Cov-2 virus, which has been mutating from time to time to make it more contagious and to evade our vaccine induced immunity, has lived up to its notoriety! It has mutated again, and this time at over 30 sites, possibly 50, making it potentially quite a different animal altogether!

If you are familiar with the Greek alphabets, Alpha, Beta, Gamma and the all too famous Delta that wrecked the havoc of the infamous second wave, it is Omicron this time.

It is yet another Greek alphabet chosen to label the new mutated variant that has been reported first from South Africa.

What makes the new Omicron variant (B.1.1.529) scary right now is that it has 30 mutations in its spike protein region…the portion by which the virus attaches and enters the human cell, raising the possibility that vaccine induced immunity may not work to protect us from this strain. Also, there is speculation that the strain could be more contagious than the last one, DELTA, which was bad enough.

This news evokes a déjà vu feeling. In February 2020, many of us (I included) had thought that COVID was a strange infection occurring in distant lands, and would not come here to harm us. If the two waves, one of 2020 and the 2^nd one of Aril-Mat 2021 are anything to go by, we had underestimated the fury of a new infectious virus with a strong capacity to mutate.

The Omicron variant has already landed in Western Europe, making some countries close its borders to International travel, especially from Africa. The global stock market has nose dived fearing another blow to international travel, manufacture and trade.

And scientists are anxiously waiting to see how the new strain behaves on 3 fronts: contagiousness (how infectious is it likely to be, and how easily might it spread?), severity (ability to cause serious disease and kill), and how dodgy it might be to the vaccine generated immunity that has emboldened us (can those who are double vaccinated develop serious disease and die?). The answers are not known, but it makes sense to go back to COVID appropriate behavior (masks, social distancing, hand sanitizing, testing and isolating, till we have the answers