Morning MEDtalks with Dr KK Aggarwal 29^th September 2018

Dear Colleague

Here are two links for videos to watch. Share them with your colleagues and friends.

1. Vedic Health - A Dialogue with Shri Ashwini Kumar Choubey  https://www.youtube.com/watch?v=wdorsM5IZTQ
2. TEDx Video: Doctor-patient relationship https://www.youtube.com/watch?v=i9ml1vKK2DQ

The spiritual heart: Your heart and my heart are one

“My Heart, Your Heart” … this is the theme for the World Heart Day this year, which happens to be today. This means to not only look after our own hearts but also of our loved ones. The day also signifies the importance of leading a healthy lifestyle, not only as individuals, but also to make sure that people we care about do the same.

This is what our Vedas also expound.

“Tat tvam asi” is a mahavakya in the ancient Sanskrit texts of the Upanishads. It translates as “I am that” and means “You and I are same” or “your heart and my heart are one”.

Whenever we point to our own self, we put our hand on our heart; we also put our hand on our heart when we say “I love you from the bottom of my heart”.

Does the consciousness reside in the celiac plexus (manipura chakra) or thymus plexus (anahata chakra)? We do not know. Manipura chakra is associated with fire and the power of transformation. The Anahata Chakra manifests unconditional love, forgiveness and patience.

Our ancient scriptures and the Bible say that the heart is the size of a thumb and it is in the heart that our consciousness (soul) resides.

1. In Svetasvatara Upanisad (5.8, 5.9). “Soul is the size of a thumb, bright as the sun, when coupled with conception and ego. But with only the qualities of understanding and soul, it appears the size of the point of an awl. This life is the hundredth part of the point of a hair divided a hundred times, and yet in it is infinity". Here the sruti is speaking metaphorically, because actually the soul is atomic in size. Therefore in the next verse (Svet. U. 5.9) the soul is compared to a fraction of the tip of a hair. These comparisons are meant to indicate that the individual soul is atomic rather than all-pervasive.
2. According to Vedanta Sutra, the idea that God resides in the physical heart the size of the thumb is for the sake of conceptualization during meditation, and is thus a metaphorical description. The size of the thumb refers to the size of the human heart. God is in reality all pervading and atomic at the same time.
3. Atharva Veda: the soul is a particle of God.
4. Jain metaphysicists refer to it as of varying sizes, small in a child, big in adults and old people and very big in elephants.
5. Nemi Chandra in Dravya sangrah -2: soul is characterized by knowledge and vision, has the same extent as its own gross body.
6. Katha Upanishad (1.2.20): Spirit, the size of a thumb "angush matra", is the inner soul, always seated in the heart of creatures.

Katha Upanishad Part Fourth XII. The Purusha (Self), of the size of a thumb, resides in the middle of the body as the lord of the past and the future, (he who knows Him) fears no more. This verily is That. The seat of the Purusha is said to be the heart, hence It “resides in the middle of the body.” Although It is limitless and all–pervading, yet in relation to Its abiding–place It is represented as limited in extension, “the size of a thumb.” This refers really to the heart, which in shape may be likened to a thumb. s light is everywhere, yet we see it focused in a lamp and believe it to be there only; similarly, although the life–current flows everywhere in the body, the heart is regarded as peculiarly its seat.

1. Garuda Puran: Ultimately, the soul, which is not more than the size of a thumb, reluctantly comes out from the body as the attachment with the world exists even after his.
2. Gaudiya acharya Sri Baladeva Vidyabhusana in his Govinda Bhasya commentary on the Vedanta Sutra. (1.2.7, 1.3.24-25.): During meditation Paramatma does appear to the yogi or devotee as a localized form in his heart, but in general Paramatma is all-pervasive and all-knowing.
3. Unknown: According to some Vedic scholars the soul enters the human form like 4-8 weeks after conception, like when the fetus is the size of a thumb.
4. Bhagavad Gita 15.15: I (soul) am seated in everyones heart, and from Me come remembrance, knowledge, and forgetfulness. By all the Vedas, I am to known. Indeed, I am the compiler of Vedanta, and I am the knower of the Vedas."
5. Vedanta Sutra II, 6,17: The person of the size of a thumb, the inner Self, is always settled in the heart of men. Let a man draw that Self forth from his body with steadiness, as one draws the pith from a reed. Let him know that Self as the Bright, as the Immortal.
6. Swami Muktananda, Play of Consciousness, p.85: The whole body is like a lotus which has four petals of four kinds, colours, and sizes....The first is the gross body, its colour is red. The second petal is the subtle body, in which we sleep and experience dreams. It is the size of a thumb, and its colour is white. The third petal is the causal body. It is the size of the tip of third finger, and its colour is black. The fourth petal is the supracausal body, which is as small as a sesame seed. Its colour is blue.... It is very brilliant; it is the foundation of sadhana; it is the highest inner vision."
7. Matthew 5;8: Soul resided in the heart: "Blessed are the pure in heart, for they shall see God."

When we meet somebody and form a relationship with another person, we go through five stages: Euphoria, reaction, adjustment, liking and loving.

The stage of euphoria is due to release of phenylethylamine, dopamine and norepinephrine. Dopamine makes them feel good and norepinephrine stimulates the production of adrenaline, which makes the heart beat faster. The stage of reaction is based on release of adrenaline and noradrenaline. Adjustment is the balance of all hormones. Endorphins and serotonin abound in the stage of liking. The endorphins or opiate-like peptides calm and reassure with intimacy, dependability, warmth, and shared experiences. The last phase is the real spiritual love or the state of ‘rasa’, where your emotions are one with the other. This is “made for each other” and denotes a parasympathetic state of mind.

Only the beta-blockers have been proven to reduce mortality in heart disease. They block the sympathetic response of the body and convert it to the parasympathetic state, the relaxed state.

The parasympathetic state can also be achieved by doing parasympathetic exercises, which are healing, e.g. progressive muscular relaxation, yoga, pranayama, shavasana (also called kayotsarga, which means total relaxation of mind, body and speech with self-awareness) and meditation by thinking differently, thinking opposite and thinking positively.

A parasympathetic state can also be achieved by neutralizing the noise of attachment, expectations and desires or going through these, but bypassing them.

Increase in physical activity is recommended for a healthy heart. A long walk not only offers physical benefits, one also gets the benefits of nature as one’s inner stimuli are exposed to the outer stimuli during the parikrama. The proximity with nature helps in the inward spiritual journey and shifts one from the sympathetic (disturbed) to parasympathetic (relaxed) mode described by lowering of blood pressure and pulse rate. 

“Our goal continues to be to achieve the vision of universal access to quality diagnosis and treatment for TB and address the social determinants of TB through a multi-sectoral response.” This was stated by Shri JP Nadda, Union Minister of Health and Family Welfare during his address at the ‘High Level Meeting on Tuberculosis at 73rd session of United Nations General Assembly (UNGA) at New York’. He further said that Prime Minister Shri Narendra Modiji has shown personal commitment to tackle TB head-on as India plans to eliminate TB by 2025, five years ahead of the SDG target of 2030, by launching the TB Free India Campaign.“We have adopted a patient-centred and community-based model to end TB,” the Union Health Minister further emphasized.

Intensive lowering of systolic BP is beneficial for primary prevention of cardiovascular morbidity and mortality in non-diabetic patients at high (≥15%) and intermediate (≥10% and <15%) cardiovascular risk, according to a secondary analysis of data of Systolic Blood Pressure Intervention Trial (SPRINT). Participants without CVD and chronic kidney disease aged under 75 years, were included in the analysis.

A significant reduction in the primary outcome events with intensive treatment was seen in patients at high risk (0.86% per year vs. 1.81% per year; hazard ratio (HR) 0.51; 95% confidence interval (CI) 0.31 to 0.85; p = 0.010), and at intermediate risk (0.60% per year vs. 1.46% per year; HR 0.37; 95% CI 0.17 to 0.82; p = 0.014) but not for those at low risk (0.75% per year vs. 0.57% per year; HR 1.14; 95% CI 0.55 to 2.38; p = 0.714) (European Journal of Preventive Cardiology, online Sept. 26, 2018).

More than half of partnered individuals who screen positive for dementia report they are sexually active. A nationally representative study of more than 3000 older adults in the US who reported having a partner showed that 59% of the men and 51% of the women with dementia said they were sexually active. Overall, whether they had a partner or not, 46% of the men and 18% of the women with dementia were sexually active (Journal of the American Geriatrics Society, online September 12, 2018).

Flu killed and hospitalized more people in the US last winter than any seasonal influenza in decades, according to new data released Thursday. It’s the most detailed picture of the devastating reach of the respiratory virus, which sickened millions of people as overwhelmed hospitals pitched tents to treat patients.

Do you know Chikungunya spreads between 20 ^oC and 34^oC but the peak transmission occurs at 29^oC? No transmission takes place below 17 ^oC and above 34 ^oC.

Texting, emailing, and web surfing on your smartphone and computer and unexpected side effects

1. The repetitive motions of texting and typing can lead to general hand pain from underlying osteoarthritis. Using these gadgets doesnt cause osteoarthritis, but if youre prone to it, it can increase your symptoms.
2. Using your thumbs too much to text can cause strain or overuse injuries of the tendons that run from the wrist to the thumb (De Quervains tenosynovitis). Symptoms include gradual or sudden pain over the thumb side of the wrist, which can move up the forearm.
3. Pushing buttons too hard with your fingers can lead to inflammation around the tendons and pulleys that enable the fingers to bend, increasing the risk for trigger finger (stenosing tenosynovitis). Symptoms include pain, popping, and a feeling that the digit is locking when you bend or straighten it.
4. Carpal tunnel syndrome—a condition in which the median nerve is compressed as it passes through a small area at the wrist known as the carpal tunnel. Typing may bring out the symptoms of the condition, such as pain, tingling, and numbness in the thumb, index finger, middle finger, and inner half of the ring finger.
5. Leaning too much on your elbows may worsen cubital tunnel syndrome, in which the ulnar nerve is compressed where it passes through tissue near the elbow called the cubital tunnel. Symptoms include pain, numbness, or tingling in the ring or little finger.
6. Looking down at an electronic gadget for long periods can lead to neck and back pain. Its the posture and the amount of time in that posture that matters. It can also irritate the occipital nerve where the spine connects to the base of the skull, which can cause headaches
7. Treatments for hand or wrist conditions include taking a break from the offending activity; splinting; short-term use of over-the-counter painkillers exercises to stretch the tendons; and sometimes steroid injections.
8. If texting with your thumbs causes pain, use other fingers to text, or use a stylus.
9. If you have hand deformity or pain, use voice commands, or use a fatter stylus to put less stress on the thumb joint.
10. To ease carpal tunnel pain, set up your workstation so that your forearms are parallel to the floor, your wrists are straight and in line with your forearms, and your elbows are relaxed and bent at a 90-degree angle at your waist.
11. Using a vertical mouse places the hand in a less stressful position. And keep the mouse in front of you, not to the side
12. To relieve back and neck pain, adjust your posture when using a device. "Keep your gaze parallel to the floor as opposed to downward," Dr. White suggests. Its helpful to raise the computer monitor so its level with your eyes. Do the same with handheld devices by propping them on a few pillows. (Source Harvard)

The Board of Governors taking over was inevitable. The Niti Aayog had always wanted to change the structure of MCI for long. However, it was getting postponed either by pressure from the medical community including IMA or by the opposition political parties.

The NMC Bill had been put before the Parliament twice but had not been passed. It may not get passed in the winter session too. After that it will be National election time.

The bureaucracy is very adamant in making this change. The term of the MCI was getting over on 5th November. If the govt. had started the MCI re-election period, this would mean being elected for five years.

The Supreme Court had already consented to an overarching control of a 5-member committee.

So, the best way for the government was to not continue with the MCI beyond 5th November and run it with a 5-7 member Board of Governors as the Congress had done in the past with the same members who had been running it for the last one year with additional two members.

Most of these members nominated to the Board of Governors have proven integrity. Dr Sanjay Shrivastava, who has been appointed the Secretary General has a wide experience of the MCI.

The whole procedure has been advanced by one month with an idea that by the time the next parliament sits, they will have had enough time to adjust. The government is hoping to get the NMC Bill passed in November. If not, continue with the Board of Governors for the next one year.

Till the NMC comes, the present infrastructure and staff of MCI continues.

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President HCFI