World No Tobacco day.


It is world No Tobacco day.

WHO is on “Tobacco Exposed” theme this year.  it is about creating awareness on how tobacco industry ensures that people are hooked to tobacco. The target group is younger children. This is because

  • Kids are more influenced by advertisement
  • Younger users would mean longer users.
  • They are more likely to ignore health consequences.

Initially cigarettes were heralded as health beneficial, in 1952 first article on dangers of smoking emerged there was a drop of 20%in cigarette sales. 1954 the law of statutory warnings was passed.

India has now taken a stand to ban liquor and cigarette advertisement, yet, there is an increase in smokers particularly women who have had urban college education. This is because of surrogate marketing. Where the tobacco companies or their associates sponsor events. 54.1% sponsor contest or sweepstakes.

Celebrities and influencers are used. Post box office success of the movie Kabir Singh, udtha Punjab there has been a sharp increase in smoking.

Though there have been pressures from the health concerned public to ban tobacco, which is the cause of various health conditions. Banning would only result in illicit sale and increase of black money. Instead the governments of Karnataka and Maharashtra in India have come up with making it punishable offence.

In Goa we are permitted to make a citizen’s arrest for smoking in public places. But the imagery created by the successive movies is that Goa is one big ashtray, or smoking zone.

Cigarette smoke contains 69 carcinogens including ammonia, tar, carbon monoxide, urea, cyanide methane, formaldehyde, arsenic, lead, polonium-210. Secondary smoke inhalers inhale 50times greater levels of Ammonia and 5times greater levels of carbon monoxide.

the tobacco industry sponsors cancer research to identify and play up other cancer causing factors.

In the covid-19 era

  • Tobacco industry is sponsoring the covid-19 vaccine research as part of its CSR placing it as part of solution.
  • Tobacco industry supports non-peer reviewed papers that say smoking is not an associated risk factor in covid-19 cases.
  • UK based daily mail reported “Nicotine stops covid-19” on the basis of a non-peer reviewed study conducted by Dr.Konstantinos. this was championed by David Hockney who is known to have links to the tobacco industry funded forest group.

In the states tobacco companies have taken to email marketing and distribution of free samples at events.

To eliminate tobacco we need to work two ways. One is any movie showing more than certain % of tobacco usage should be  tagged for adult viewing. Ban celebrities and influencers from posting pictures of them smoking on social media.

Educating and the children

De-addiction and is usually done in various forms, substitution with nicotine patches, organic cigarette’s etc.

Dealing complications of tobacco addictions and the relapse of patients made me realize that we needed to work with something that would bring the transformation from within. Most people who quit smoking had great motivation to do so.

Though substitution, medications did help I found that for most smokers smoking was a smoke screen so that they did not have to face something in their personal space. It was quite often associated with low self esteem, or great need to suppress the vocal cords. Addressing these issues along with gradual weaning helped people to quit smoking.

The need of the hour still remains that we see that people don’t get on board.

worth a read Tobacco underground.

DM to conduct awareness workshop for your institute or group.


Tourette’s Syndrome

This is the month of Tourette syndrome awareness.

It becomes relevant now, because the tics or manifestations of Tourette’s syndrome can be easily misconstructed for symptoms of covid-19.

Tourette’s syndrome is a manifestation of certain tics, which are uncontrolled movements that occur due to unknown reasons. It is believed to be due dysfunction of the neural pathway in the Basal ganglion.

The disorder begins in childhood. The common manifestations/symptoms/tics being:

  • Blinking
  • Eye rolling
  • Grimacing
  • Shoulder shrugging, jerking of the head or other limbs
  • Jumping twirling
  • Touching objects and people.

At more sever stages it can manifest what is called as coprolalia. Coprolalia is using obscene words or being socially inappropriate. 40% of the Tourette’s victims develop to this stage.

Tourette’s syndrome is essentially a neurodevelopment syndrome and manifests at childhood or early adolescence. Currently 1% of the children are diagnosed with this, it is often in association with OCD, or ADHD.

Tourette’s neither effects life expectancy nor does it effect intelligence. The diagnosis would be made by elimination, after the neurologists runs the relevant test.  To diagnose Tourette’s syndrome the following criteria is required

  • Multiple motor and one or more vocal tic should be present sometime during the illness.
  • Tics are recurrent, non-rhythmic actions or vocalization that can be suppressed for a period when a person focuses on stopping them.
  • 40% of the patients develop of coprolalia.
  • Most people develop a discomforting sensation prior to the manifestation of the tics. The discomfort vanishes once the tics are performed.
  • Tics could occur intermittently through the year, or many times during the day.
  • The onset is usually in childhood in any case before the age of 21.
  • Usually begins as a facial tic.

Medications are not often used to treat this condition. But lifestyle changes can be made.

  • The most important need is to find an support and self help group.
  • Focused physical activity is one way of managing Tourette’s syndrome as it distracts the individual from the onset of tics.
  • Most of them tend to creative, so tapping their creative side is another interesting options.
  • People with Tourette’s syndrome tend to be very empathetic. They can be part of volunteer outreach which helps in managing their self esteem too.

Chronic Fatigue Syndrome and Covid-19

May 1th is the world chronic fatigue symptom awareness day. Chronic fatigue syndrome is also known as myalgic encephalomyelitis.CFS 1

This syndrome is characterized by extreme fatigue, body pain and sensitivity to light. Previous years I have covered a lot about about CFS, the links are below.

chronic fatigue syndromechronic fatigue eats into the quality of life.

Post SARS a  study in Canada had 273 people infected, of which 44 died, 22 of the studied people who recovered from SARS exhibited very chronic fatigue syndrome like symptoms of fatigue, pain, muscular weakness and photosensitivity.

cfs 2Covid -19 though a belonging to the same corona virus family as SARS it is different virus. It would be necessary to be open to the possibility of increased CFS patients. Of course the symptoms need to be present at least for 6months post recovery before a diagnosis is confirmed and linked.

images courtesy internet.

Addiction -Gambling

Addiction to gambling is another major addiction which we fail to recognize

Gambling is not just slot machines and  casino’s it is lottery, raffle, even something as insidious as betting between friends.

Gambling for financial stakes happens in two conditions.

  1. It gives an emotional high due to the risk involved.
  2. It comes with hope of a windfall.

In either cases it starts off insidiously and then the addiction takes over. it gets fed by

  • Thrill
  • Glamour – particularly with gambling there is a lot of association of affluence.
  • Desperation for money.

The red alert happens when:

  • The individual has trouble controlling the impulse to gamble.
  • It happens at the cost of not being able to afford essentials.
  • People around you begin to become concerned.
  • There is a need to secretive.

the follow out of this addiction is felt in the social, economic and physical spheres. Emotionally the addict has to deal with anxiety, depression and sometimes even suicidal tendency. There is a tendency to self harm. Gambling usually comes with life style add-on like alcohol, drugs.

Medication does not really help. However the anxiety, and depression can be managed with medication.

Quite often I’m asked if hypnotherapy can help. Well hypnotherapy is not a magical cure. Like all addictions gambling has to go through the 12 steps. But where Hypnotherapy helps is in support. As a person is coming out of an addiction he or she has to deal with lot of other things. addictions are about flight, so it helps us take a reality check. Hypnotherapy can help us over come anxiety and craving without medication..



Yesterday was world asthma day.

Asthma is a respiratory condition, marked by attacks of spasms in the bronchi of the lungs causing difficulty in breathing. It is usually connected to an allergic reaction or other forms of hypersensitivity.

Though the exact aetiology of bronchial asthma is not known it is known that infiltration and inflammation by bronchial mucosa are important, pathologic features of asthma.

In a way asthma is a hyper response to exaggerated bronco-constriction to various stimuli. This could be triggered by various factors allergy, drugs, dust, stress cold air, chemicals etc.

When associated with a family history and present from young age it is Extrinsic and when it manifest in the middle age with no family history then it is Intrinsic.

Clinically asthma manifests as:

  • Episodic: this acute, treatable with bronchodilators and triggers are usually recognizable like allergy, upper respiratory track inflammation or psychological trauma.
  • Status asthmatics: an acute sever attack does not respond to standard treatment with adrenaline and aminophlline. This usually accompanied by evidence of respiratory failure.
  • Chronic this is long standing enough to make changes in the lungs. If  the asthma is chronic and accompanied with emphysema like it often is then it is called as COPD this  presents as persistent dyspnoea  and wheezing of various severity.  What happens in this case is that persistent inflammation results in thickening of the mucosal wall of the bronchioles in addition to reduced elastic recoil.

Principles of therapy:

Treatment is directed towards decreasing inflammation as well as promoting bronchodilation. Available measures are:

  • Elimination of trigger factors that is allergens if detected.
  • Avoid respiratory irritants like chemicals and tobacco
  • Drug therapy use of antibiotics and bronchodilators.
    • Bronchodilators
      • Sympathomimetics:
        • With alpha and beta effects like adrenaline and ephedrine.
        • With only Beta-effects like isopreline
        • With predominantly Beta-effects like salbutamol.
      • Theophylline and its derivatives.
      • Anticholinergic drugs.
    • Anti-inflammatory drugs :
      • Disodium chromoglycate.
    • Measures to correct dehydration and acidosis. Also to ensure oxygenation.
    • Programs of graded exercise training to avoid physical stress induced attacks.

The old school does not put lot of importance to psychological treatment, other than guiding the patient to handle the situations.

But metaphysically – asthma is inability to inhale life. that is inability to be inspired, to breathe for oneself. It arises from suppressed sadness and being suffocated. A deep rooted dissatisfaction with the self does not allow the person to enjoy life, or do things in the best interest of the self. Frustration of not finding a way of pleasing authorities, particularly parents doing things the way others want it to be done, negating the self are parts of the issue. This comes from a deep-rooted fear of abandonment. Particularly being abandoned by people who are significant.

A good place to start healing would be with the affirmation

It Is Safe Now For Me To Take Charge Of My Own Life. I Choose To Be Free.

World Malaria Day 2020

Just before the lockdown became very stringent. But we knew it was imminent, I went to the pharmacy to buy out monthly stock of medication. With most medical stores being closed I had to go to “Jeevan Rekha’ medical store at Caranzeleum. Of course they maintained the distance, facemask etc . etc. But in comes a woman, she asks for 6 bottles of hand washes, 6 bottles of Dettol, and strips of Chloroquine.

The pharmacist haggled over the hand washes, and Dettols and I think she got 4 of each. Well good for her that she stocked the rest of us landed in a mess. But then the pharmacists assistant said, “Chloroquine  prescription”

She said, she didn’t have one, she pulled strings with the pharmacists and did away with 4 strips. What she wanted it for well Allah jaane. I have named the pharmacy here just in case someone would like to pull him up, please do. But it is against ethics for pharmacists to vend out these medicines.

The idea was Chloroquine was prophylactic for  novel covid19 virus. Well Chloroquine does help in handling some virus but is understudy as far as covid19 goes.

April 25th is World Malaria day. The theme of the year is “Zero malaria starts with me”  this is a grassroots campaign. 3.3billion people in 106 countries are at the risk of being infected by Malaria.627000 is the death toll. Sub-Saharan countries and Asia being high risk areas.

India is endemic both for Vivax and Falciparum. India accounts for 75% of the cases in South-East Asia and 41% of the death toll.

Malaria is an endemic caused by two kinds of parasite, the Plasmodia Vivax and Plasmodia Falciparum. These majorly seen in the tropics and subtropical region. The transmission occurs when an infected female anopheles mosquito bites. The prophylactic drug for this was created after observing the indigenous people using quinine to prevent this. One of the most popular drugs used is Chloroquine.

The lockdown due to covid19 has resulted in the supply chain of essential anti-malarial commodities breaking down. The tools required for testing are overloaded, and are unavailable. The supply of insecticides are also not available. This would result in increased malaria induced fatality. Like during the time of Ebola outbreak the malarial victims are more susceptible to  the infection.

Adding to this is the burden of increased demand for Hydroxychloroquine which is a prescription drug and has less adverse effect as compared to Chloroquine. The data to justify this buying is insufficient. Hydroxychloroquine is very similar to Chloroquine but less toxic.

Like all medicine Chloroquine and Hydroxychloroquine also come with their adverse effects.

  • Allergy outbreaks caused by intolerance. This would manifest as pruritus, itching, nausea, diarrhoea, running nose.
  • Ocular complications like blurring of vision diplopic or double vision. These are reversible.
  • Miscellaneous effects like acute psychotic episodes, seizures.
  • IV dispensing could cause hypotension or drop in blood pressure which could be fatal.

    world malaria day 2
    zero malaria begins with me, sleep under a mosquito net.

With increased travel, people are now being effected by what is called as “airport malaria” where the infected female anopheles mosquito travels in the aircraft either on a host or in the cargo thus a person from Malaria free zone gets infected by Malaria. The diagnosis here is made through elimination of differential diagnosis and taking an detail travel history.

studies on anti-malarial drugs for covid19 clinical trails.

Alcohol Awareness.

alcohol awarenessApril is the month of alcoholic awareness.

 7th April is the world health day and the day for alcoholic addiction assessment.

Alcoholism is addiction to alcohol that is makes it difficult to quit. The individual consumes alcohol despite of the price that he or she has to pay for it, in terms of physical health, monetary health, social standing.  This is because alcohol causes changes in the brain which makes it difficult to quit it.

When an individual quits alcohol or any addiction it is about having to cope up with physical follow outs, in addition returning to the family, work, and social space.

Alcoholism is can cause ulcers, worsen diabetic states, sexual issues, birth defects, bone loss, vision problem, and decreased immune function,

The road to quitting begins with assessing the extent of addiction. It is long drawn and quite exhaustive.

Quite a few people prefer hospitalization to handle. The first stage begins with DETOX. The follow out of this could severe withdrawal, where tremors, hallucinations and seizures could be seen.  Therapy focuses on anxiety and handling depression.

Medications  have been tried and are found to be partially useful.

  • Disulfram makes the person puke when they take alcohol.
  • Camprosate helps to handle craving.
  • Naltrexone stops the high that comes with increased alcohol levels.

Recovery from alcohol addiction is a long drawn process. It is best done in twelve steps of the Alcoholics Anonymous.

The heart of the suggested program of personal recovery is contained in Twelve Steps describing the experience of the earliest members of the Society:

  1. We admitted we were powerless over alcohol – that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Hypnotherapy helps the addict as he or she walks along the path of recovery. It helps to place an emotional structure in place with deep relaxation and visualization. It helps the person also cope up with the physical and symptoms and the emotional exhaustion that follows.

Hypnotherapy however plays a great role in helping the family to cope with the impact of having an alcoholic in its circle.

images courtesy internet.

Community Health during Pandemics.

When a pandemic hits it changes a lot of things. the past years infections and pandemic occurring seem to be on the raise. After SARS, Ebola the latest is the Corona virus.  There is so much of noise around it, that the actual concerns seem to get lost.  If I were to look at it  like a rider these are the challenges that appear.

Corona outbreak:

  • Ethnology, clinical symptoms, treatment.—these are primary focus which my colleagues are focusing at. All streams of medicines are working on it.
  • Prevention of the spread. That does require certain precautions.

In a war there are always collateral damages and so are there follow out of natural disasters.

Beginning with the word Pandemic – Pandemic mans worldwide spread of a new disease.

Since the disease is new healthcare personal are require training to deal with it.

The community particularly the high risk population need to be informed and educated in a culturally acceptable format.

There should be a certain level of preparedness within the community to combat the challenges.  Let’s look at the current scenario.

Pain point What the government is doing What can be done
Diagnosis cases Checking at all entry points. Make it mandatory for citizens to get screened, at the panchayat health centres.

Create diagnosing booths like polling booths. Medical students and doctors of the community can man them.

Isolation and treating the cases. Centres have already been created.

Health personals are being trained in protocols and procedures.

Identify definite corona treatment centres and other hospitals and nursing homes should be open for other medical issues. This would be standardizing the treatment cost.
Preventing further spread. Educating the public.


This is a place of major issues are coming.


Instead of having people rush to the grocery store, it might be safer to have the grocery store deliver it them. Amazon and Flipkart are expensive. We could tap into the humble postal system to help us deal with this. The number of people on the road would be less.

An out of work daily wager could order grocery from the local kirani store.

  • This could then be delivered by the postman.
  • While delivering the postman takes down the name and the aadhar number of the customer.
  • The vendor submits, the bill, with the customer aadhar number and his own GST number the government would transfer the exact amount to the vendor.

This would make all transactions clear and the tax payer will not be unnecessarily burdened. The outflow will be actual.  The same would be medicines.

Student nurses can be recruited for nursing requirements, this could be either used as criteria for credits or as certified internship. Of course they would have to be endorsed by the local primary health centre.

Our temples and gurudwara’s are also equipped to cook for large number of people, they could make packets which can be given to the needy. Lot of us have containers that we collect from take-aways we wash them and donate them to the temples and gurudwaras. Think about it.

Let us shut down all 24 hour news channel, so 1200 reporters, 20 channels and their staff will be off the road. Dear old doordarshan would be more practical with its three times a day bulletin

WhatsApp has to be shut down this would reduce the rumours and panic being spread.

TB- Covid Tango on world TB Day

world TBday 2020

March 24th is the annual WHO TB awareness day.

1/3 the world population is infected with this. Why am I talking about a disease that is long forgotten when there is a prima donna like the corona virus taking the centre stage.

Just mute the button on corona virus and consider the similarities between the two.

  • Both hit the respiratory system.
  • Both are airborne.
  • Both get discharged into the atmosphere with sneezes and spits.
  • The risk group is also quite similar
    • Senior citizens
    • Immune compromised.
    • Poor health care.
    • Lack of adequate hygiene in the environment and personal.

As I mentioned before both TB and corona virus are air borne respiratory disorders. So tools that are used in diagnosis of TB could be useful here. actually Cepheid’s GeneXpert has just been updated to do the corona virus tests too. this helps lot of middle-income countries to massively expand covid testing.

Considering the TB statistics of  1/3 the world population being infected. 1,500,000 people died of TB as of 2017-2018 while 484,000 are ill due to drug resistance. India accounts for a quarter of the TB deaths.

Between 2006 and 2014 India registered 340 billion cases.

Between 2018-2019 2.15 million new cases have been diagnosed.

WHO has now declared the task force to focus on latent tuberculosis and treat it.

Tuberculosis is caused by Mycobacterium tuberculum. This is an unusually waxy bacteria with due to the presence of mycolic acid on it. World TB day is commemorated every 24th of March as that was the day Robert Koch discovered the bacteria. Various strains that exhibit similar symptoms are mycobacterium Laprae (leprosy) Mycobacterium Avium and Mycobacterium Bovine.  They all exhibit similar symptoms.

Symptoms of TB are:

Cough, fever, loss of appetite and weight loss. Haemoptysis or blood discharge during cough is seen in later stages.  Though the respiratory track is the primary site metastasis could occur to any organ.

 Some truths that TB can teaches with regard to corona virus.:

  1. Harsh reality once the disease stops killing people in the richer countries money dries up. TB is now a forgotten threat, it belongs to the marginalized society the disease of the poor and marginalized.

  2. Mutation of the pathogens is constant, so medicines and treatments that work today will develop resistance at a later day.

  3. Panic causes greater havoc than the disease proper.


tuberculosis 2TB is a old, tricky forgotten killer, but it still remains the largest killer. It could be the right time, to take the laws against spitting seriously. And learn basic hygiene routine like covering the mouth while sneezing, coughing or yawning. Washing the hands and sanitizing surfaces. Parallel testing for TB might be a good idea particularly if GeneXpert is being used.

More importantly it might be relevant to monitor the interaction between existing epidemics and the newly emerging pandemic. Corona virus is definitely aggressive and has to be handled so, but not at the cost of other killers left unattended.



This Movember Ensure your young adult’s Emotional Health.

movember 1Mental health in Movember lets look at the young adolescent mental illness.

Kids and gizmos are very complex relationship. one hand it is essential for communication and learning on the other it causes a disconnect and addiction. A 2016 report says that 50% of kids feel addicted to the device.

Frontiers in psychiatry does not define smart phone as addiction, but however evaluates it on the spectrum of addiction and the finding were

  1. Using the device in prohibited or dangerous contexts.
  2. Being involved with the device enough to withdraw from the family.
  3. Negative impact on school, family, social and emotional functioning.
  4. Continuous excess use despite negative effects.
  5. Constant checking of the phone despite of it disturbing sleep.
  6. Using of phones gives satisfaction or counteracts dysphonic moods.
  7. Constant needs to respond to messages and alerts.
  8. Anxiety when phone is not accessible or cannot be used.

The use of phone is not only essential it is also quite healthy. However there should be an educated understanding of the responsibility and a plan to set boundaries.


I phones, tablets, laptops should removed from the bedroom to allow restful sleep.

Screen free time zone should be set in parents are to follow the rules too.  However if more that 50% of the above holds true then one could use an app called breakfree, or opt for CBT to deal with the addiction.

Mental health is an growing concern in Male wellness, this is on the increase both in young adults and in men over 50. Among the young adult male concerns often seen are

  • Anxiety disorder 32% in 13-18yr. Range.
  • Depression 13% in 12 -17 yr. Range.
  • ADHD 9% age group 13-18yrs.
  • Eating disorder is seen in almost 33.33% 13-18yrs.

FOMO: It is social anxiety fear of wrong decisions. In 1996 Dan Herman  aggregated the symptoms and noted that increase in social media addiction seems to be the cause of this disorder which is essentially the fear of not being included. This arises from the social media tag lines of “don’t be left behind.” The basic issue here is anxiety and low self esteem.

Self harm is another major adolescent issue. It is the 2nd leading cause between 15-24yr olds.  It more in kids who have been in accidents or have a lost a parent.

Borderline Personality Disorder is another rising concern. You might be given a diagnosis of BPD if you experience at least five of the following things, and they’ve lasted for a long time or have a big impact on your daily life:

  • You feel very worried about people abandoning you, and would do anything to stop that happening.
  • You havevery intense emotions that last from a few hours to a few days and can change quickly (for example, from feeling very happy and confident to suddenly feeling low and sad).
  • Youdon’t have a strong sense of who you are, and it can change significantly depending on who you’re with.
  • You find it very hard to make and keep stable relationships.
  • Youfeel empty a lot of the time.
  • You act impulsively and do things that could harm you (such as binge eating, using drugsor driving dangerously).
  • You often self-harm or have suicidal feelings.
  • You have very intense feelings of anger, which are really difficult to control.
  • When very stressed, you may also experience paranoiaor dissociation.