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Monthly Archives: August 2008

From 'Unbreakable'

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Two days ago my good friend Ravi (Dr Ravindra Mehta, Critical Care Specialist) called me into his ICU to check out whether or not one of his patients had a heart condition. What I found there elevated my respect for human life and its unheralded custodians infinitely.

 

Here was a 20 year old patient, afflicted by a rare condition called Osteogenesis Imperfecta (OI, Brittle bones syndrome, the disease suffered by Samuel Jackson in Unbreakable, only much worse here in our man’s case). Mere application of firm pressure on his limbs would break his bones. If you hugged him hard, his ribs would crack.

 

Years of fractures & reunions of the bones combined with various other medical complications had rendered this young patient a four-foot dwarf, with his rib cage and lungs deformed. His limbs were in plaster-casts due to recent fractures which were yet to heal. He was admitted with a presumed lung infection and after examining this guy I concluded that there was no heart related problem.

 

Then I saw this amazing thing:

 

There was another twenty-something young man with the patient. Before even I embarked upon examining my patient, this youth asked me what I was going to do. Just as I was trying to reassure him that I knew the nature of the bone problem here, he proceeded to caution me, a little apologetically, that even a little more than gentle pressure on the patient will break more bones and could you please be gentle. Educated guy, spoke to me in decent English. He was doing this to every nurse, doctor or ward boy who came to attend to the patient. He appeared to know what movements, and how much pressure on the patient was safe. He would not allow anything that appeared out of the ordinary to be inflicted on his ward.

 

So my questions were natural: Who was this young man accompanying the patient? Was he there all the time, providing such tender care round-the-clock? To me clearly, in a country like India with the healthcare services being as they are, this fragile patient with such an incapacitating disease, had survived merely because of this kind of extraordinary care.

 

The answers amazed me even more.

 

This young man caring for the patient was not alone: there were 5-6 others. Two were distant cousins, others were well wishers but none were real siblings. All of them educated and productively employed. This army was around for the patient, whenever he needed them, caring for his life, nurturing his delicate body. I didn’t ask how the patient got around in his own home, but whenever he needed to go out to pray, to shop, to watch a movie, to a hospital, this group of angels went with him, making sure that he was protected from the jostling. There was no money in this, no selfishness. And this was not a one time voluntary work, we have all seen: visit cheshire homes once a year, donate money to the orphanage once a year, go clean Cubbon park once a year….this service was there night and day, each day that it was necessary and days on end and round the clock, on occasions like the present hospitalization.

 

 

Beats most charities I know.

 

Quickly images flashed in my mind: mindless killings in the name of borders, religion, and caste on one side. So many NGOs making quick bucks in the name of charity on another side. Young couples wanting to terminate unborn children because they are not perfect, on yet another side.

 

But above all were these unsung heroes celebrating life

 

 

 

 

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An average elementary school student knows that carbohydrates provide instant energy, stored fats provide energy over longer durations of time and proteins are for building the cells, organ systems and the body itself. In addition we also learnt about micronutrients like minerals and vitamins for essential functions like generation of blood and vision. In societies where food is in abundance obesity is both a cosmetic and a genuine health problem. Dieting is a key step for weight control. However, there is no single dieting technique. What is good for the goose may not be good enough for the gander. In the absence of standardized methods, there hundreds of proprietary dieting techniques in the market.

 

Low carb diet, once almost synonymous with the Atkins diet has both proponents who swear by it and bitter critic. In general, the scientific community has been skeptical and some scientific bodies are openly against the concept of low carbohydrate diets.

 

What do believers say?

 

Diets that are rich in carbohydrate levels cause sharp surges in the blood sugar levels. In response to this, the body releases hormones like insulin into the bloodstream, which then act to bring down the sugar level. The net effect of this mechanism is to store excess energy as fats and this leads to obesity.

 

Foods are classified according to the level of blood sugar surge after their consumption. High glycemic index (GI) foods raise blood sugars to very high levels. Low GI foods are opposite. Most fruits and vegetables, meat, eggs, oils are low GI whereas processed sugar, sweets, white bread etc carry a high GI. Persons who consume excess simple sugars with high GI are at risk of developing obesity, diabetes, the metabolic syndrome, heart disease and strokes.

 

 

In addition to obesity, there are other dangers of carbohydrate-rich diets. Higher blood levels of insulin & insulin-like hormones can also lead to other problems. There are no simplistic explanations but there seems to be a cause-effect relationship between diet, GI index, insulin levels, genesis of diabetes and atherosclerosis.

 

Low carbohydrate diets contain very little carbohydrates and high content of proteins and fats. Consumption leads to lower glucose surge in the blood. Consequently there no extra energy to be converted to fats, thus leading to anti-obesity effect. In addition, the believers advocate this diet for combatig diabetes and high triglyceride levels.

 

What do the critics say?

 

Most medical experts believe low carb diets as non-physiologic. Two major arguments are put forward: one, lack of adequate instant energy and many micronutrients is a feature of many low carb diets and two, excess of proteins and fats in the low-carb diets are frowned upon. Though over a period of time, many professionals – especially those who treat diabetes have advised their patients to restrict carbohydrates to some extent. But in general experts have generally criticized low-carb, high protein & fat-unregulated diets.

 

What’s new?

 

A recent article in the New England Journal of Medicine compares three types of diets: a low-carb (20 grams of carbohydrate per day), a low fat diet (1500-1800 calorie diet with less than 30% energy coming from fats) and a more balanced mediterranean diet. This study showed that the low-carb diet produced the biggest weight loss and enthusiasts will be encouraged to note that none of the purported side effects were seen during the study period.

 

Obviously most western diets and many urban Indian diets have excess calories. The rise of modern epidemics of diabetes and heart disease in urban India may have to do something with this caloric excess. Low-carb diets, if proven completely safe maybe a preventive step.

 

Though not universally accepted yet as a physiological diet, low-carb diets are on the verge of capturing the physicians’ fancy with this study. Clearly, more clinical work is required so as to earn an official status to low-carb diets, certainly their advocates will be more confident now.

 

Cutting out carbohydrates maybe not as easy, especially in households where meat is not eaten or eaten on select days of a week. If not a stringent less than 20 gram carb diet is unfeasible, a more realistic moderate calorie restriction maybe the answer for our generation.

I am sure doctors, lawyers and human rights experts, all have their own opinions about the just cocluded drama-on-TV about the Mehtas’ plea with the courts to allow them to terminate the pregnancy because, the unborn child has a congenital heart defect. I am bouncing my thoughts off on you: if you have an argument or another opinion, let me know:

 

Anomaly scan, the ultrasound examination to detect major congenital defects in the fetus is reliable between 20 and 24 weeks of pregnancy. Prior to that period, the scans are inaccurate.

 

MTP law in India allows termination up to 20 weeks of pregnancy, but congenital defects in the unborn baby cannot be the reason for termination.

The first issue which needs to be resolved requires a full discussion on ethics: should pregnancies where the fetus has serious birth defects be allowed to be terminated? An analogy exists here: If during late pregnancy, baby is found to have anomalies like hydrocephalus (large water-filled head), often labor is artificially induced with drugs. One of the surgeries described involves decompressing the head of the baby before birth. Here, in fact the baby’s age of gestation is far more advanced than the 26 weeks of Mehtas’ baby. So a serious discussion is required which will address three questions

 

  1. Should MTP law incorporate birth defects for allowing abortions?
  2. If so, in view of the technical factors (anomaly scan being unreliable at 20 weeks, should the maximum limit for abortions be extended to 24 weeks?
  3. What defects are serious enough to merit abortion? Every minor defect cannot be considered just because everyone needs to have perfect babies

 

Before any of this can be seriously debated, one aspect needs to be kept in mind. In India, laws can be easily manipulated to ones’ advantage. For instance, what should prevent an unscrupulous doctor to issue certificates of congenital defect and terminate an unwanted female fetus? Unless, very serious checks and balances are in place, abortion laws can be easily misused.

 

If caution is not exercised, only healthy babies maybe born, but most of them maybe only boys!