Can you do Cardiac Resuscitation?

If you were to see a person “drop dead” all of a sudden, are you capable of doing the hands only Cardiac resuscitation?

Here are some facts for you: 

1. Around 700, 000 (7 lac) people have Sudden Cardiac Arrest (SCA) where the heart suddenly stops beating and pumping blood to organs, leading to sudden death every year in India.
2. Around a third are in persons under 50.
3. What makes the difference between dying and coming back to life for of a person who develops SCA is timely revival with CPR (cardio-pulmonary resuscitation).
4. Calling the ambulance or a doctor is what we all do, but by the time they arrive (over 15 minutes or more, even in many countries) is the time when the organs of the body have undergone irreversible damage. Hence many are declared “brought dead” by the time they reach the hospital. Timely CPR while waiting for help is ESSENTIAL.
5. Most cardiac arrests occur at home; some in place of work or in public places. It could happen to someone close to you too.

Sudden cardiac arrest (SCA) made a dramatic re-entry in the public minds recently when Damar Hamlin, a 34 year-old celebrated American football player, suddenly collapsed on the ground during a match, to the horror of spectators. It took just a couple of minutes to realize that he had sustained a sudden cardiac arrest (SCA). His heart had stopped beating, and he was almost dead.

Para-medics then rushed on to the field and started thumping Hamlin’s chest, giving him external cardiac massage. He was resuscitated within nine minutes, restarting the stopped heart, just in time to save his brain from damage! He was then shifted to hospital where he was treated further, and is now back home. 

The American Cardiac Association acknowledges and stress how TIMELY action (mind you, not BEST, by a famous cardiologist) can save more lives, and reinforced the need for banking on paramedics and “common” people to provide it. 

Several movements are already on to provide training and make every person “CPR literate” as one never knows when the situation could arise. 

Institutions such as schools, colleges, work offices and transport crews are particularly encouraged to learn first aid and CPR. 

Remember it could happen in your home too; many of us live years cursing doctors and hospitals for someone we lost but shrink away from the uncomfortable question “could you have done things differently?” 

Learn about CPR by reading up about Damar Hamlin’s story and join in on a CPR training course. 

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What makes Pele feature Health Adda?

The Brazilian soccer legend, Edson Arantes do Nascimento, more popularly known across the world by his nick name Pele, died at the age of 82 of complications arising from colon cancer.

Pele achieved more fame and stature as a sportsman than anyone could possibly have. He started playing football as a child in an impoverished locality kicking socks filled with paper, got recognized for his extraordinary skill and mastery of the game at the age of 16, and went on to play as a professional soccer player for his country bringing Brazil into the world map of soccer.

His mind boggling achievements include scoring a Guinness World record of 1279 goals in 1363 games, becoming the youngest winner of the world cup at 17 and winning the FIFA world cup three times for Brazil. It was not without reason that FIFA conferred on him the title of “Player of the Century”. 

He went on to become a global icon of not just soccer, but sports across the world. He was also known for his philanthropic activities and for working tirelessly to encourage and pull poor children in Latin America out of poverty through the game of soccer.

He played at a time when television had not come into our homes. We tend to therefore forget two things: more recent heroes appear larger in size, and second, television and social media can alter the “size” of icons!

What stands out about Pele was his passion and commitment to what he did. He is famously quoted as saying “I was born to play football, just as Beethoven was born to write music and Michelangelo was born to paint”. I wonder if I found or did justice to a singular life’s purpose!

He was diagnosed to have colon cancer some time ago. At the time it was detected and surgically removed, it had spread to other organs. He was therefore undergoing chemotherapy for widespread cancer. 

He faced his end quite like a true sportsman, gracefully wishing his relatives (his wife, 6 children and other relatives) farewell from his hospital bed a day before he died.

Colon cancer is the third commonest cancer world-wide affecting 2 million people and killing 900,000 annually. The best chance to beat it is to have it detected at an early stage by a “routine” screening colonoscopy at age 45 onwards. 

Brain Fog

Fogginess of the brain is a frequently reported symptom these days, and can be best described as

1. Cloudy thinking, 
2. inability to concentrate the way that one earlier could 
3. Lapses in memory
4. Losing train of thought such as forgetting in mid-sentence what you were planning to say, or asking the other person “what was I saying?” frequently
5. Getting distracted easily, with the feeling that the mind is refusing to focus
6. Poor motivation 

We all experience these symptoms once in a while, but if they become disturbing enough to be noticed and affect the quality of life and work, you could be suffering from Brain Fog. 

Reporting of Brain Fog has gone up significantly since the COVID pandemic. It is included as one of the features of Long COVID or Post-COVID Syndrome. 

It is now well recognized that the COVID virus may cause inflammation or swelling of several organs and tissues. The main brunt has been on the lungs but involvement of other organs have thrown up their own typical signs in their own ways such as heart (heart attacks), liver (increased liver enzymes), intestines (abdominal pain or diarrhea) and brain (loss of smell). 

It is therefore possible that another milder but less dramatic form of brain inflammation, could produce the symptoms of Brain Fog, that could last long.

Brain Fog may however occur in people who have not had COVID too. 

If persistent, one could run through the check list.

1. Check your blood sugar, blood pressure, Hemoglobin, Vitamin B12 and Vitamin D levels
2. Look out for hormonal changes, especially irregularity of periods or thyroid dysfunction
3. Are you over worked, stressed out, or sleep deprived?
4. Are you on medications for sleep or depression? Are you consuming alcohol?

For a start, try

• 7 to 9 hours of sleep daily for a few days
• Caffeine could help: try a cup of coffee or tea to stimulate your brain.
• Exercise: a daily dose of 30 minutes of cardio could improve blood circulation to the brain

If the symptoms persist, other possible underlying conditions could be 

• Air pollution (try a vacation to the hills or get an air purifier especially at night)
• Depression especially if you experience recurrent negative thoughts, irritability, and low moods
• Early onset dementia could be a worry, but fortunately, most people improve with the above measures and gain back their brain’s vitality.

The symptoms are frustrating, but usually resolve. Consult your doctor for help if you do not get well.

Oral Rehydration Therapy and Dr Dilip Mahalanobis

It would be difficult to find an adult today who has not heard of Oral Rehydration Solution (ORS), or does not know that Oral Rehydration Therapy (ORT) is what we should rush to provide to save the life of someone who has started passing watery stools.

It was not so simple prior to the 1970s! Cholera epidemics came as waves and spread across the world, ravaging populations. Survival then hinged on whether one could get quick access to a hospital for intravenous saline drips. 

One of the flash points of the cholera story was when an outbreak occurred in a refugee camp near the India-Bangladesh border during the 1971 war. A young pediatrician called Dr Dilip Mahalanobis, was tasked to treat thousands of children with diarrhea in a make-shift hospital that had just 16 bed, and a very limited supply of intravenous fluid bottles!

Necessity became the mother of invention, when Dr Mahalanobis started feeding dehydrated children with an oral solution made from water, sugar and salt. He noticed that the death rate dropped from a whopping 30% to 3%!

The idea of trying oral rehydration solution in children who were pouring watery stools from the other end had seemed ridiculous then and had defied conventional logic. His   approach had its basis on laboratory experiments that had shown glucose and sodium, if given together, to help each other get absorbed via a glucose-sodium co-transporter at the intestinal cell’s brush border. It could then drag water into the body partly reversing the fatal effects of dehydration.

ORS is now a household name, and is made up of a mixture of glucose, salt (sodium chloride), and Potassium chloride in exact proportions that can be made into a solution with water. It now comes in few new avatars as well: mixed with lycine, rice powder, zinc, selenium, or in a hypo-osmolar (diluted) form.

Scientists unanimously agree that ORS has been the crowning discovery of the medical profession of the last century and has saved more lives than any other. It continues to save a million lives annually. 

Paradoxically, the scientific paper written by Dr Mahalanobis was rejected by a scientific journal when first submitted. And more disturbing is that he died last month at 87 in Kolkata unsung, without getting a Nobel or any national (Padma) award!

Recognizing “Long Covid”

COVID 19 is just over 2 years old, and is still continuing to teach. In July 2022, that is last month, the American government adopted “Long Covid”, a new name for Post COVID Condition (PCC), as a disability under the Americans with Disabilities Act. 

What does all this mean? Was it not enough to go through the SARS-COVID-19 illness that claimed over 15 million lives, and emerge alive, looking to get our health and lives back to how they were before 2020?

Not quite for many! A growing number of patients are reporting a wide range of symptoms even after “recovery” or discharge from hospital. The CDC ( Center for Disease Control), USA, lists them as:

General symptoms:

1. Feeling of tiredness, fatigue or malaise
2. Post exertional malaise, when they get worse after physical or mental exertion
3. Low grade fever

Respiratory or heart symptoms:

1. Breathlessness
2. Palpitations
3. Persistent cough
4. Chest pain

Neurological symptoms:

1. Difficulty in thinking or concentrating often described as “brain fog”
2. Headaches
3. Sleep problems
4. Dizziness
5. Pins and needle feeling
6. Change in smell or taste
7. Anxiety or depression

Digestive symptoms:

1. Diarrhea
2. Abdominal pain

Other symptoms: 

1. Joint pains
2. Rash
3. Menstrual disturbance

These symptoms can persist from the time of COVID episode, or return, or occur anew. Malaise, brain fog and mood changes are the most commonly reported ones. Drivers with cognitive dysfunction or “brain fog”, for instance, have reported difficulty in being able to drive again.

Many physicians have also noticed new onset of diabetes or heart disease in their patients after an attack of COVID infection. A range of “autoimmune disorders”, joint pains, multi-organ immune disorders after an attack have also been reported.

It is not quite clear who are more prone to Post Covid Conditions. Disease severity correlates, but some seem to get it even after mild attacks.  Those requiring steroids seem to develop diabetes more often. 

There are no specific tests to diagnose “Long Covid”, making diagnosis a challenge. Further, many of these symptoms are quite common in the population too. 

While science is still evolving, and COVID has still not gone away, many more lessons are still to unfold for us.

Patient-Doctor Communication and Cellphones

Social media and teleconsultations have been enabling and facilitating patients to contact doctors, often by-pass the limitations of physical of distance and time.  This gathered momentum especially since the Covid Pandemic when physical consultations were just not possible. But even after the opening up of Covid restrictions this communication method does not seem to be in any mood to go away.

On the positive side, every smart-phone literate man is now able to reach out easily to a medical professional for help. And penetration of cellphones in India, as you know. Has been phenomenal. The health issue could be a simple  one such as a toothache, headache, loose stools, fever, abdominal cramps, or an allergy. The advice from the doctor often reaches within minutes by an e-prescription cutting down suffering time to a fraction.

In the “traditional” mode one would have had to wait it out till the next working day, travel a distance of several miles, meet up with a doctor, obtain a prescription, get the medication from the store and then start treatment, all involving long delays, harassment and costs.

 There are two sides to every coin; questions are being asked about how safe and appropriate are teleconsultations where the doctor has not seen and examined you in person.

Let us take an example of a diabetic patient trying to regulate the dose of medications to keep his sugar in check. If he has been to the doctor once or twice, and the monitoring and titration is being done at home, all he needs to do is transmit  his sugar values to his doctor by WA, who then advises him on increasing or reducing the dose. Does this require wasting a day attending a clinic?

Although a detailed physical examination is traditionally recommended, most doctors seem to feel it may not be all that essential  for every clinical problem; history, seeing the person on a video screen, and going through his investigation reports, often suffice to deduce a working diagnosis and plan the treatment.

Video consults are not without limitations of course. If a 50-year old man starts experiencing chest pain and sweating at a music performance and a heart attack is suspected, teleconsultation will be a waste of time; shifting him to a cardiac emergency service might save him.

As with any new tool, one has to balance the benefits and risks, and use it with discretion. Regulations will undoubtedly follow, but a knee jerk reaction of banning might teleconsultations run the risk of taking us all several steps back in a country where reach of medical services have lagged far behind cellphone penetration.

Protect yourself from the HEAT WAVE

Summer has come early this year and with a ferocity that threatens to cause us harm, and even kill.

                     During long hot spells, our bodies dry up (called dehydration; remember that 2/3 of our body is made up of water) or get excessively heated up (called heat or sun stroke) due to the body’s thermostat failing to maintain our temperatures around 37⁰C), posing threat to life.

                        Dehydration is the commoner one and claims around 2 million lives every year, especially from developing regions. Children are more susceptible, and once grossly dehydrated, often find it impossible to regain health. Symptoms and signs include fatigue, headache, low BP, dizziness, fainting, dry mouth and reduced amounts of urine that is usually dark yellow. It is often precipitated by an attack of vomiting or loose motions.

                     Drinking large amounts of water (around 6-15 glasses a day) and increasing the intake of salt (through pickles, papads, salted nimbu paani or lassi) are the cornerstones of prevention and treatment. It is important that children be always hydrated; if not, growth and development could be affected. Luckily children usually have intense thirst sensation; the trick is to help them develop a liking for water and not juices, or softdrink.

                     Heatstroke is common during these dry hot spells when the body’s heat regulatory mechanisms fail to maintain a balance between heat production and heat loss (losing it to from the 37⁰C of the body to the 46⁰C of the atmosphere could be impossible!). As a result the body’s temperature rises causing the person to be pale, hot, irritable, confused or unconscious. Children and the elderly are at greatest risk, as are athletes, construction workers, labourers or military recruits.

                      It is a medical emergency and requires moving the person to a cool shade, lying him down on the floor or ground, pouring water on the head and body, placing ice cubes under the armpits and moving him to a clinic or hospital. Caps, sunglasses, wearing loose cotton clothing and avoiding anti-perspirants help.

                     Take the heat wave seriously as it can indeed kill.

Sugar Addiction and Fatty Liver

The word “addiction” brings to mind alcohol, tobacco and psychotropic drugs. But sugar is emerging as a new addiction that we might be ignoring, and passing off as just an innocuous fancy.

Many of us describe ourselves as having a “sweet tooth”, and indulge our taste buds and liver with excess of sugar.

In a recently concluded National Conclave on Fatty Liver Disease, doctors described how true addiction to sugar and sugary drinks is emerging as a major cause for concern.

Statistics are worrying. Several Indian hepatologists reported excess fat in the liver of up to 50% of Indians, especially those living in cities. The Body mass Index (BMI) of urban school children have been rising with over 30 % being overweight. And what seems to be the common denominator is excess consumption of sugars, sweets and fruit juices.

Addiction to sugar is now established. Those suffering from it show all the typical symptoms from regular “wants”, to increasing demands, to craving. And if one is to go without sweets for a day or two, show anger and irritability (withdrawal) as well.

A special subset of sugar addiction is FRUCTO-HOLISM, fructose being the predominant sugar in fruits and juices. Scientists have noticed that that fructose sugar causes more accumulation of fat in the liver compared with the regular SUCROSE.

In a chilling account of what we have always considered innocuous, and perhaps even healthy, excess fructose have been shown to get converted to fat and deposited in the liver, causing fatty liver.

But why should that worry us? It is now clear that those who have extra fat in the liver are at increased risk of developing the METABOLIC SYNDROME: a conglomeration of excess body weight, diabetes, hypertension, high blood lipids and all of them translating into increased risk of cardio-vascular disease.

Cardiovascular (heart attacks) and metabolic diseases (diabetes) have emerged as the commonest cause (60%) of death and ill health in India. And what might be fueling them could be our social practice and indulgence in sweets and fruit juices. “It is time we took note and changed our practices and preferences.

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.

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.