Finding My Clinic Space.

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dentistSometimes, things happen just like that.

With Myra it has been a constant, she has vertigo, and she has tendency to depression alternating with anger, she was almost declared Bipolar.

She came to as a last resort, and what we discovered was she had massive passive-aggressive behaviour. She had career and financial blocks that were giving her mood swings. Interesting thing about her vertigo was that she had this belief that she was stagnant and stuck while the world moved on. that manifested as dizziness.

Through the session it came out that the tradition at their house was kids worked on the dinning table, and when it was time to eat they moved their books out, if an adult wanted to iron they moved their things, and whoever sitting close to the plug point had to shift. So she was not really rooted into her academic and career self.

Though she did do medicine, and does have a home practise, it is a home practise she also writes for medical journals and public health articles she has no desk space or a place that she can call her own, there is no rooting.

after dealing with her I realized I was quite he much at the same space, in 1993 when I started my clinic, I really didn’t do it systematically like a business. Its only after so many years of practise I realize that a clinic is also a start-up I have to honour my workspace and the energy I put into it.

I have also in the last 5 years experienced the lacunae caused by a designated workspace. Here I am wondering how I will go about it. one option is of course the polyclinic or the shared space for doctors.

When I started my dental clinic I did not bother about demographics and stuff like that, I just went in like bull in the china shop. What am i looking at,  it should be a place that is accessable, yet should not be very loud.

Early practise in dentistry started off from family and friends and eventually it grew. With hypnotherapy it has to be subtler. Of course my sleep apnoe and tobacco patients do come in. so that is an okay space. Now hypno-clients in India a slightly up-market so my venue needs to be on the up-market side too.

A major criteria for me when I bought the clinic space in 1993 was layout, if I had the knowledge that I have now, i would converted the lower floor into my clinic space and rented the mezzanine. Unfortunately the epiphany came too late.

I am actually looking at chair space, since my dental chair can double up as my hypnochair.

  • I need a waiting space, a space to keep magazines,
  • Space for group therapy
  • Then there are spaces needed when I have training sessions, both in house or group.

Just investing in space until have regular group therapies or seminars somehow does not make sense. More importantly until I get all these things right investing into a space does not make sense. Sharing a workspace here makes more sense.

In my second clinic, space was an issue I would use the church or community hall. But putting things together is a pain.

Teaming up with alternate health centres’ would be a good idea, but wellness centers or health centers that I have seen have tied up with spas and tourist resorts that is a place where I do not want to go.

smokerrs

one of the many campaigns we run.

Of course co-workspace seems a good idea, the infra-structure is in place so I do not have to run around for a wi-fi connection, printer, scanner.

The events room and coffee maker are in place.

The business address and common office staff, again. There are concerns like http://kowrk.com that actually put together, people and optimize the available workspace through co-working. Unfortunately  Delhi- Mumbai-Bangalore are the only places they operate in India, else they are present in 4 countries with about 95 co-working spaces

http://kowrk.com/?utm_source=PR&utm_medium=PR&utm_campaign=IndiPR

 

World Tuberculosis day

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WORLD TB

WHO banner 2016 — image courtesy Google.

Yesterday was the world tuberculosis awareness day,

The government of India has launched Revised National Tuberculosis program in goa, the event at GCCI  was to create an awareness of it all. The chief guest Francis D’Souza I was very articulate and very crisp in what he had to share, I really admired the man for not venturing into Googled details to an audience who probably know much more about it since they are working hands on.  he had just one question to ask his audience which was probably the most relevant… “x– Number of people dying in Brussels in a bomb blast makes headlines, why are we not making headlines about TB which kills 2.5 lakhs of people each year?

There was no vocal media person present who could answer his question, nor was anyone present.

Technically the world Tuberculosis day was March 25th.

The event was attended by and large by people from the medical fraternity, few TB caregivers. The session was entirely technical focusing on diagnosis, the availability of CNAAT, facility.

The Key facts of TB are

  • TB ranks alongside HIV/AIDS the world’s top infectious disease.
  • 2014 9.6 million people fell ill with TB and 1.5 million people died from the disease, including 380 among people living with HIV.
  • 95% of TB deaths occur in low and middle income countries
  • TB is among the top 5 causes for death of women between 15-44yrs.
  • Globally we are talking about 480000 people developing MDR-TB drug resistant ones.

Facts in India:

  • 40% of the Indian population is infected with TB.
  • 18 Lakh people in India develop TB, each year, of which 8 lakhs are sputum positive that means the rest are not lung or chest infection, but emerge elsewhere in the body.
  • Since the most effected age group is 15 – 55 it causes tremendous economic disruptions.
  • TB is associated with social stigma, so many cases go unreported.
  • TB kills more women in India than any other infectious disease.

 

Ending TB will only be achieved with greater collaboration within and across the government and partners from civil society, communities, researchers, the private sector and development agencies. This means taking a whole of society and multidisciplinary approach, in the context of universal health coverage.

There are programs for developing diagnostic test, drugs and vaccines to improve delivery we are still talking about dealing with the disease after diagnosis.

We like to say that fragile health system and low economic conditions are challenges, but from what I can see, the challenge is creating the awareness.

Somethings that did occur to me…

  1. If a day dedication is meant to create awareness, then why were there no media? The reporters and doordarshan took off along with the minister.
  2. Why did we not create an action plan?
  3. One of the doctors I do not know her name, I presume she is a doctor, said,”oh! I have anganwadi teachers I train them” – how much are going to burden the anganwadi teachers,
  4. How about routine checkups, and public health education by the primary health centers at the schools of the community they cater to?
  5. How about every news paper particularly vernacular running a health awareness column?
  6. How about looking at other streams of health care?
  7. We are talking about Pharma-vigilance for drug efficacy, how about pharma-vigilance that prohibits over the counter selling of drugs?

    TB

    Image courtesy Google

Like Mr. Roland Martins pointed out, the purpose of the day was to create awareness, identify the weak links of where we are failing and create an action plan. We need prevent health to prevent, and then diagnosis to properly diagnose, and finally the treatment and patient care. If health education does occur, we can go about investing in research and marketing of drugs and diagnostic and make our pounds, dollars and rubles.

http://www.who.int/features/factfiles/tuberculosis/en/

http://www.who.int/en/

 

Self Injury Awareness Day

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self injury 3

Image courtesy Google.

“Other times, I look at my scars and see something else: a girl who was trying to cope with something horrible that she should never have had to live through at all. My scars show pain and suffering, but they also show my will to survive. They’re part of my history that’ll always be there.”

― Cheryl RainfieldScars

Cheryl is not the only one, there are many out there. 1st of March and weeks leading upto it, is the day dedicated to the grassroot  event  of creating a global awareness campaign. There are people who share to be more open to their own self harm , special efforts are made to create awarenss about self injury and self harm.

Since I have recovered from a 40% burns accident I have often accosted this question, is it self harm, why did you do it? I have been accused of being self centered without  considering my mother or daughters, well in all honesty I can say that it was an accident.  But self-harm/injury is not just the act of petulant  affluent teenagers it happens across sex, races, ages and backgrounds.

The word self harm describes a wide range of behaviours, and is usually a physical response to an emotional pain, this can become addictive. People are known to do varied things from cutting, burning, pinching themselves, other ways include drugs, alcohol, eating disorder. Even psychosomatic manifestations are sometimes triggered by self-harm tendency. What I have noticed both as a dentist and as a hypnotherapist, is quite often focusing on the feeling  rather than the actual infliction often provides the key to recovery and rehabilitation.

Self harm often happens  when the individual is overwhelmed with emotions like anger, fear, worry, depression or low self esteem, and this appears a way to manage or control negative feelings. Self harm quite many times is for of self-punishment for something someone has done, or even as an escape route for acute emotional abuse.

People do question what falls under the label of self harm. Well the bottom line is anything that causes harm  even the slightest and in a small way makes you feel emotionally  better  would fall under the umbrella of self-harm. What is relevant is not the label, but recognizing when help is needed and providing support.

Self harm is strongly associated with borderline personalities and self harm is one of the nine diagnostic criteria for bipolarity, depression, anxiety, maniac episodes psychosis. Childhood traumas severe abuse, neglect, abandonment can lead to self harming tendency.

There are people who express feelings of emptiness, loneliness, inability to express themselves, abusive relationship that lead them to self injury.

The signs and symptoms quite much resemble addictions, there are secret stashes, rituals,. Sometimes these are cyclic, there might be anxiety, then impulse, then resistence, tension and release, this could be followed by shame.  People with tendency to self-harms  may have frequent accidents, claiming or appearing to be clumsy in order to explain the wounds or bruises.  there is a tendency to be irritiable, prefers to alone for long periods of time,would have self esteem issues.

Triggers

Stress à causes overwhelmed, unable to cope, exposed and sensitive. àtriggersàself injuryà now the person feels release, relief, calmness and  in control.

Dissociation àfeels numb lost, unreal, alone and dissociated.–> triggers à self injuryà this in turn feel real, alive, functional and ready to act.

dealing with self injury involves the psychiatrist, psychotherapist, sometimes physician too.

self injury 4

Image courtesy Google

what we do if hypnotherapy is the option is— since hypnotherapy deals with belief systems, we help the individual alter their belief system, this is possible only we can view the trigger event with clinical detachment. We would also create triggers and support system within the individual to resolve the causative irritant. Hypnodrama often comes to play in dealing with the primary trigger episode. After which the new belief is fortified using EFT or self hypnosis.

 

 

Bridging the Gap

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image courtesy google.

image courtesy google.

Healing the parent child relation.

https://corporatehealthtrainer.wordpress.com/2015/10/29/domestic-violence-parent-abuse/

https://corporatehealthtrainer.wordpress.com/?p=600&preview=true

after the previous articles, no matter how hopeless it sounds, the adolescent children particular as they mature to adulthood, can come around to forgive their parents. If the parent was abusive when the child was younger,  then just a simple sorry will not help.

Though Hypnotherapy and Family constellation both help us resolve these issues, I have used this in my clinic by healing the inner child, there are other ways too.  It begins with

Trying to understand despite of being convinced that we have done nothing, there is something in our behaviour that the child has perceived. After all, the parent is the most omnipotent figure in the child’s life. Listening is the first step.

Don’t be defensive – even a whiff of self righteousness can disturb the equation.

Writing out an apology may work the child will be able to read it over and over again. Till it becomes acceptable.

If you have made a mistake then accept it.

If your child wants to continue the war, particular if the child is adolescent or young adult do not engage. Make it clear the war is over the child is still angry but in the long run it prevents you from saying hurtful things and it also sends the message that you want to peace.

Find an intermediary to send the olive branch. The child maybe more receptive to hear from someone else. This is a double edged sword, the surrogate make act as the lightening rod for the rage.

It takes a lot to bring things back to normal. Counselling and therapy may be required. Like I said, there various modes available once we acknowledge that we are dealing with the issue of a abusive child. the most important thing to do will be not give up on child and to continuously stay connected.

tapeworm and cancer

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image courtesy google

image courtesy google

John Doe had come to a Colombia hospital with multiple large tumours in various parts of his bodies, when the local doctors biopsied those tumours they found cells that acted like cancer cells when it came to destruction but behaved differently otherwise.

The most prominent feature was that the cells were 10 times smaller than that of the normal human cancer cell. The doctors called in Centre For Disease control and prevention for help. What the pathologist there saw was,that the cell did indeed grow in a with a high rate of multiplication and there was overcrowding which was cancer like, but there was fusing of cells which is rare in human cells.

The initial theory was that it was new type of infectious organism, but eventually it revealed to contain a DNA snippet of a dwarf tapeworm known as Hymenolepis nana. This was further confirmed by a researcher and tapeworm expert at the National History Museum in London. The discovery that the cells had tapeworm DNA was a big surprise.

Whether the cells had cancerous property before they entered the man’s body or whether they became cancerous in his body is not clear. this was the first time parasite driven cancer cells had spread within an individual.

As we debate whether the cancer was true or not, the bottom line is the man did have cancer, and he would have did if he was not treated effectively.

Cancer is not known to be transmissible in human expect in very rare cases, from mother to foetus. Even among animals scientists have discovered only two contagious cancers so far, one in dogs which is non-fatal and the other in Marsupials of Australia called Tasmanian devils.

image courtesy google

image courtesy google

the cause of the tapeworm mutating into a cancerous form is not really known. Actually even the fact that tapeworm get cancer was not known. It is possible that other parasites do too. Or it could have been an one off situation due to the medications that the gentleman was taking or something else totally.

There are about 75 million people living with tapeworm infection, it might be time to check them too, though most of them are asymptomatic.

That does raise the red flag right.

domestic violence– commandments for Parental health..

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image courtesy google.

image courtesy google.

carrying on from the previous article https://corporatehealthtrainer.wordpress.com/2015/11/05/domestic-violence-classical-sequence-leading-to-parent-abuse/

Some  fundamental rights of parents, this contributes to their overall health.

  1. The right to be free from abuse – like all abuse this is about gaining control, the key here is to set limits, refuse to give time, money or advice till you find the behaviour appropriate.
  2. The right to be guilt free – parents tend to feel accountable to the happening in the family, and when things go wrong the guilt steps in, when you do draw a line with the child it is essential that you are guilt free. If the child is not able to forgive you, or still worse if you are not able to forgive yourself it is time to seek help.
  3. Right to peace of mind – somewhere along the way with children leaving home there is increased freedom and peace of mind. But if the child is struggling with issues of substance abuse, spousal mistreatment, health or financial problems or criminal activities can disturb the parents. The parents need to claim their peace of mind. It would mean that the parents have to permit themselves to enjoy life, have fun go out with friends.
  4. Right to expect reasonable behaviour from adult child. Young adults living at home should be working or going to school or both. They should also actively contribute to maintain the house. If they are working full time then they should take on the sole responsibility for their personal expenses, including their phone bills, car insurances etc. Interactions have to be respectful, and the parents sleep schedule should be treated with consideration.
  5. The right to be imperfect the acceptance that one does not have to be perfect. A good enough parent recognizes his or her own strength or limitations and is comfortable about doing an adequate job. This honesty in accepting fallibility brings in better bonding with the child.
  6. The right to decide what to do with your own money. financially helping children is okay, it is a gift and not an obligation. Parents do not owe their children the lifestyle to which they may have become accustomed to. When children move back home it is essential to keep finance clear.
  7. The right to decide to manage your time. – most important gift you can give yourself and others is the gift of time. Constantly babysitting your grandchildren may create an expectation that will eventually cause issues. You do not owe anyone an explanation if you choose to relax
  8. The right to choose your social circle – as an individual you have the right to choose who you would like to associate with. Usually kids do not interfere with this except in India in the case of a parent especially maternal involvement romantically.
  9. Right to retirement – many times parents are forced to defer their financial plans to help children who are struggling financially or emotionally for years. But this is also a choice not mandatory.

.Ensuring that as Parents if can respect our space, and draw boundaries though in the Indian context it might seem sacrilege it could go a long way in maintaining healthy relationships.

Figuring the normal in a Newborn’s skin.

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Image courtesy google.

Image courtesy google.

When we say a soft as child’s skin we get the image of pink,rosy image that the television flashes, but is it?

The expression “still wet behind the ears” to describe someone who is inexperienced is inspired by the condition of a new born. A new born baby is generally covered with various fluids during delivery like, amniotic fluid, blood could be maternal or of the child, this kept the child safe and warm in the mother’s womb. The new born is also coated with a pasty, white material called the vernix caseosa  which actually means made up of the foetus.

All this is cleaned off in the first bath. The first cleansing also prevents the rapid fall in the neonatal body temperature which would have occurred if the drying is left to nature.

Many parents are startled by mottling of the skin of the newborn. This is a lacy pattern of small reddish and pale areas, and this occurs quite often because of the normal instability of the blood circulation at the skin surface.

Bluing of the skin called as acrocynosis is sometimes seen for the same reason and this more in cold environment.

Red marks, and petechiae that is tiny specks of blood that have leaked from small vessels in the skin are quite often seen due to the trauma of squeezing through the birth canal. This disappears within the first two weeks.

Bearing down to cry or having a bowel movement sometimes turns the infants hye beet-red or bluish purple.

Some newborns particularly the premature ones  exhibit lanugo or fine soft hair. This could be on the face, shoulders and back of the child this is usually because the child sheds most of this hair in the uterus before delivery but preterm babies may not. In any case this hair disappears in a few weeks.

Birth marks may not be seen in all babies, however sometimes salmon patches are seen in some babies. These are pink or red areas that disappear within the first year. These are called some really fancy names like angel’s kiss, stork bite and may be see on the bridge of the nose, eyelids or brows.

Then there are flat patches of slate blue or blue green colour that resemble ink stains and these are called the Mongolian spots. These fade away with age too.

Collection of capillaries could form a raised red strawberry like mark, which are pale at brith , it enlarges and becomes red in the first few months of birth and eventually gets absorbed within the first six years.

Cafe-au-lit spots are light brown coffee with milk like appearing spots on the skin of some infants, these cause concern only if they are large, or more than six  on the body for they might indicate an underlying medical condition. however these do get darker with age.

Common brown or black moles or the pigmented nevi, could be present at birth or appear or darken as the child gets older. Larger moles or ones with unusual appearance should be brought to the doctor’s attention for they may require removal.

Prevention of occurance of rashes is a major concern. Some harmless rashes may be present at birth like discussed before some may appear during the first few weeks,. Tiny, flat yellow or white spots round the nose and chin are caused by the collection of secretion in the skin glands, these disappear within the first few weeks are called Milia.

Miliaria  is another harmless condition that will go with the first few weeks with normal skin for despite its fearsome name it is a rash consisting of red blotches with pale or yellowish bumps at the center.

Pustular Melanosis is a condition characterized by brown blisters scattered all over the neck, back , and limbs. These disappear without treatment. Interestingly many children exhibit sucking blisters on fingers hands or arms because the foetus can suck while in the uterus.

Keeping the skin soft essentially means keeping it hydrated, free from rashes, scabs, and callus.

This is essential since supple skin means less tendency to tear and adequate body protection.  Some ways we can keep the baby’s skin healthy would be —

  • regular oil massage, we used coconut oil treated with tender teak leaves for both my daughters. Followed by warm water bath.
  • Breast feeding at scheduled interval and once the child can take solid then introduction of light locally available food. Packed baby food would require greater water intake.
  • Clothes of natural fibre that allows the child to breathe.
  • Nutritious maternal health. So that the nutrient availability is there.
  • Meticulous care of skin over the joints and between the fingers and toes as they are spots that tend to develop rashes.
  • Cloth or linen diapers are the best as they allow air and keep the tissue dry yet hydrated. It also stimulates the proper functioning of the temperature regulatory system of the body. and they should be changed very regularly.
image courtesy google.

image courtesy google.

The skin which is the largest, and heaviest regulatory, protective and sensory organ of the human body undergoes vast changes from its intrauterine life to the neonatal to infancy. Once we are aware of it then we are able to take the relevant care that it calls for.

Thanks to Dr.Jayagowri Hadigal of Sonia Clinic Udupi. for her valuable inputs. Dr.Hadigal is practising Pediatrician for the past 35 odd years. She heads umpteen Pediatric Health care programs and Preventive Health Care program.

“Pampers brings you the softest ever Pampers Premium Care Pants. Its cotton-like softness is #SoftestForBabySkin and allows it to breathe, thus keeping baby’s skin soft and healthy, and your baby happy. ”

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