SOUTH INDIAN HERITAGE PROGRAMME
(168th HERITAGE LECTURE AND 228th
EVENT)
at TAG Centre TTK Road. Alwarpet,
chennai-600018.
Sunday April 26, 2015
Aging Gracefully
(With Diabetes, Hypertension and Heart Disease)
FACTS vs FEARS
Dr. C.V. Krishnaswami
CHAIRMAN TAG-VHS DIABETES RESEARCH CENTRE
EMERITUS HEAD VHS DIABETES DEPARTMENT
FORMERLY HON. Clinical Prof.
GOVT.STANLEY HOSPITAL, CHENNAI.
EDITOR, INDIA
THE JOURNAL SCIENCE ON HEALING OUTCOME (JSHO).
Mangalore, INDIA.
The Seven Ages of Man – William Shakespeare
Jaques.
All the world’s as a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurse’s arms.
And then the whining school-boy, with his satchel,
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honour, sudden and quick in quarrel,
Seeking the bubble reputation.
Contd…
The Seven Ages of Man – William Shakespeare – Contd…
Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lin’d ,
With eyes severe, and beard of formal cut,
Full of wise saws and modern instances,
And so he plays his part. The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
As You Like It, II. vii
Definition of Elder Citizen of classification and old age
Senior Citizens – 65-75 yrs.
Super Seniors 75-80 yrs.
Elder Citizens 80-90 yrs
Old persons > 90 yrs
What is the Secret of long life?
The real problems of old age are not Diabetes, Heart attacks and CAD,
Hypertension, Stroke, Parkinsonism etc: which require individual customized
medical attention for variable periods – short or long term.
They all require adjustment of Life style and specific non drug therapies which
would contribute to more than 50% towards recovery and regaining Health
expectancy.
Aggressive interventions either with drugs or with other invasive modalities
are as a general rule & Protocol did more harm than good, as shown by
several large scale studies – eg. ACCORD; DREAM; POISE etc.. Interventions
should be confined to selected cases of special situations only.
Also it was stressed with more than adequate evidence by Prof. B.M. Hedge
that long-term usage of pharmaceutical chemical agents in the so-called
prevention of Non-Communicable Diseases, and even their clinical trials are
highly unethical, immoral and unscientific.
So, What are the real issues affecting the Elder Citizens’ Health?
1.
Loneliness (alone and lonely PICA) → Depression.
2.
Insecurity and Fear of the unknown (→ Anxiety → Neurosis)
3.
Physical Disabilities (Eyesight, Hearing Locomotor, etc.) (Minor – Major)
(→Depression Frustration Self Destruction).
4.
Pain (Real, Low threshold, imaginary (hypochondriac) (→ Chronic & over
medication → GI/Kidney and other complications. In extreme cases severe
depression and self destruction).
5.
Obsession Inflexibility Aggression/Anger Repetition Forgetfulness etc →
causes problems both to themselves and more for their carers.
6.
Dementia:
a. Alzheimer’s → Difficult to manage with serious fatal outcome.
b. Non Alzheimer’s → Non-fatal but difficult to manage – needs family
medical, Para-medical and societal support.
7.
Miscellaneous Medical Problems – affecting day to day life ; Elders’ main day to day
concerns are sleep, bowel, appetite  or , Knee Pain movements, difficulty in urination
or urgency and incontinence of urine/bowel.
a. Medical: Difficult to Micturition, Catheter or RT, Ileostomy Bag, Self
Injections of Insulin, Incontinence, etc.
b. Non Medical: Running a home, Paying Bills, Going to work (Ageism),
Property plus cash minus.
8.
The A,B, C and D of dignity Conserving (Medical) Care.
(Harvey Chochinov Winnipeg, Canada – BMJ 28th July 07).
Healthcare providers have a profound influence on how patients experience illness and
on their sense of dignity. The A, B, C or D of dignity conserving at the bed side are:
A: Attitude B: Behaviour C: Compassion & D: Dialogue
This frame work can be applied to teaching, clinical practice across the multidisciplinary
terms offering care for the elderly.
9.
In Search of Good Death (Stephen Workman Dalhousie University Halifax, NS, Canada) – (BMJ,
10th March 2007).
*Decisions regarding interventions, CPR, Medications, alternative therapies etc.. who should
take decisions and when – onus of implementation and resultant responsibilities – family.
Minerva (BMJ 21 June 2008)
After the recent death of two friends, a doctor speculates why, as a profession, we are so bad at
dealing with dying – despite the obvious fact that, sooner or later, it is the certain fate of every
patient that we seen. He thinks that we shouldn’t think of death as an aberration or as a failure.
We need to realize medicine is peripheral to death, not the other way around
‘Bhaja Govindam’
(Postgraduate Medical Journal 2008;84:279-80).
punarapi jananam punarapi maraNam
punarapi jananI jaTare shayanam
iha samsAre bahudustAre
krpayA pAre pAhi murAre
Repeated birth, repeated death and repeated lying in
mother's womb - this transmigratory process is extensive and difficult to cross; save
me, O destroyer of Mura, through your grace.
NDTV Streamer
In India there are 60 million plus Diabetics, and
70 million plus Pre Diabetics
“6th IDF Report; Presently there are 387 million people with
Diabetes Mellitus and by 2035 it is expected to go upto 592
millions.
Every 7 seconds a patient dies of diabetes.”
Ref. TOI & DC, 19/04/2015.
We are in an era of “DISEASE MONGERING” “SCARE
MONGERING” & “STATISTICS MONGERING” (backed by
world bodies like WHO, IDF, ADA, AMA, FDA – Not to
mention The Indian & Regional Cohorts who Knowtow
them)
What we need today is HEALTH MONGERING & HEALTH
EXPECTANCY INDEX instead of Life Expectancy Index &
World Wide Cost Effective & INCLUSIVE HEALTHCARE
MODELS & SYSTEMS.
On the positive side.
We have the freedom of Speech & Freedom of dissent, if we use these
without Vituperation, Malice or wested motives & to perceived betterment of
human kind.
Books like these are allowed to be published though for some
strange reason (s) not available in India.
[email protected]
Jour. Watch Aging/ geriatrics Alerts for Dec 1, 2012
Aging / Geriatrics for December 1st 2012
Summary and comment
Hypertension in the Oldest Old
November 29, 2012 | Allan S. Brett, MD| General Medicine
Among 85 – 90 – years – olds, high blood pressure was associated with less
conginitive and physical decline.
Reviewing: Sabayan B al. J Am Geriatr soc 2012 Nov 60: 2014
What’s the Optimal HbA1c Level in Elders?
August 9, 2012 | Allan S. Brett. MD
In an observational study, glycosylated hemoglobin between 8% and 9% was best.
Reviewing: Yau CK et al. J Am Geriatr Soc 2012 Jul 60:1215
What is Health?
Pursuing health and fleeing disease
But what is health? For most doctors that’s an uninteresting
question. Doctors are interested in disease not health. Medical
text books are a massive catalogue of diseases.
Richard Smith
There are thousands of ways for the body and mind to go wrong,
which is why disease is so interesting. We’ve put huge energy into
classifying disease, and even psychiatrists have identified over 4000
ways in which our minds may malfunction. Health for doctors is a
negative state – the absence of disease. In fact, health is an illusion.
If you let doctors get to work with their genetic analysis, blood tests,
and advanced imaging techniques, then everybody will be found to
be defective – “dis-eased.”
1. Tinetti ME, Fried T. The end of the disease era. Am J
Med 2004; 116: 179-85.
What is Health?
Pursuing health and fleeing disease
Mary Tinetti and Terri Fried have argued in the American Journal of
Medicine that thinking in terms of disease has become counterproductive.
“The time has come,” they write”to abandon disease as the focus of
medical care. The changed spectrum of health, the complex interplay of
biological and non-biological factors, the aging population, and the inter
individual variability in health priorities render medical care that is centered
on the diagnosis and treatment of individual diseases at best out of date
and at worst harmful. A primary focus on disease may inadvertently lead to
under treatment, over treatment, or mistreatment.”
Richard Smith
Consider a patient called Lucy. She has heart failure, diabetes, asthma, and
osteoarthritis. Her cardiologist treats her heart failure, her diabetologist her
diabetes, her diabetes, her chest physician her asthma, and her
rheumatologist her osteoarthritis. Her general practitioner holds the ring
and writes her prescriptions. But actually she’s not much interest in her
diseases, and she’s not worried about dying. Indeed, if she could get to see
her son in Australia one more time she’d welcome death: life has never
been the same since her husband died. She needs a travel agent, not five
doctors, but doctors are supplied on the NHS and travel agents aren’t.
1. Tinetti ME, Fried T. The end of the disease era. Am J Med 2004; 116:
179-85.
Death by Medicine
by Gary Null, PhD, Caarolyn Dean, MD, ND Martin Feldman, MD, Debora Rasio, MD, Dorothy
Smith, PhD
Ref . http://www.encognitive.com/files/Part%20I--Death%20by%20Medicine.pdf - 2007
“OVER MEDICATING SENIORS”
Rosuvastatin: Risky in Indians (FDA RED ALERT)
Western drug regulators have made it obligatory that prescribers inform all patients that rosuvastatin can cause muscle injury which in
severe cases “Can cause kidney damage and other organ failure that are potentially life-threatening.” Hence patients should
“promptly report signs and symptoms of muscle pain and weakness, malaise, fever, dark urine, nausea or vomiting” to their doctors.
Aspirin Increases Stroke Risk (FDA RED ALERT)
The use of low dose aspirin – a day not only does not reduce but actually increases the risk of heamorrhagic stroke by a whooping 69
per cent in males.
There is no beneficial effect on the risk of ischaemic stroke.
These are the results of a meta – analysis of 95,000 patients enrolled in six randmonised controlled clinical trials. (Ref. AM, Heart
Association)
MIMS May 2007
Death by Medicine by Gary Null, PhD, Carolyn Dean, MD, ND Martin Feldman, MD, Debora
Rasio, MD, Dorothy Smith, PhD
ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL
INTERVENTION [Value of EMR in Reducing this]
Condition
Adverse Drug Reactions
Deaths
Cost
Author
Lazarou1 Suh49
106,000
$12 billion
98,000
$2 billion
Bedsores
115,000
$55 billion
Infection
88,000
$5 billion
Malnutrition
108,800
--------
Outpatients
199,000
$77 billion
Starfield12 Weingart112
Unnecessary Procedures
37,136
$122 billion
HCUP3,13
Surgery-Related
32,000
$9 billion
AHRQ85
Medical error
TOTAL:
783,936
$282 billion
IOM6
Xakellis7 Barczak8
Weinstein9 MMWR10
Nurses Coalition11
Less is more
Professor BM Hegde,
[email protected]
When I first wrote about the Sheffield-Bristol study of heart attacks in the 1960s which
showed that patients with heart attacks with good risks had lesser mortality when left
alone at home managed by their GPs, compared to those with similar features who are
whisked away to the ICU in the regional hospitals, people thought I was concocting
stories.
The new study I referred to earlier was done at the Harvard Medical School with the
hypothesis that if all cardiologists went for their annual conference for one week serious
heart patients would die in excess. At the end of five years of prospective study what
they found shocked the researchers. “Holy heart attack! Researchers have found that
certain high-risk heart patients stand a better chance of survival if they go to a teaching
hospital when all the cardiologists have left town,”
(Anupam B. Jena, Vinay Prasad, Dana P. Goldman, John Romley. Mortality and
Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions
During Dates of National Cardiology Meetings. JAMA Internal Medicine, 2014; DOI:
10.1001/jamainternmed.2014.6781)
Ref – http://www.pubmedinfo.com/lessmore.aspx
Nano Health Ensurance Economic Groups
All Values in Indian Rupees (INR)
Salary / day
10,000/Salary / day
6,000/Salary / day
3,000/Salary / day
1,000/Salary / day
500/Salary / day
<=100/-
Salary/ Month
300,000/Salary / Month
180,000/Salary / day
90,000/Salary / Month
30,000/Salary / Month
15,000/-
Salary / Month
<=3,000/-
Envisaged Premium Categories and the Economics of the Nano
All Values in Indian Rupees (INR)
Health Ensurance Plan
Category
Premium 'A'
Premium ‘B'
Premium ‘C'
Premium ‘D'
Free/Nano Subsidised
Group (E) (SG)
Free/ Nano Group (F)
(NG)
Daily
Premium
Monthly
Premium
Annual
Premium
Annual premium
(100,000 persons)
(corers)
100
60
30
10
3000
1800
900
300
36000
21600
10800
3600
360
216
108
36
5
150
1800
18
1
30
360
Total annual premium collection
3.60
741.60
Note: If 100,000 Persons are enrolled in each Category the Total Premium will be ` 741.6 Crores / annum.
For groups (F) Free or Nano Group & (E) Nano Subsidised Group the total Annual Premium for 100,000 Persons each
amounting to ` 21.6 Crores can easily be waived & absorbed by groups A to D.
The premium paid by 4,00,000 persons (Group A – D) will be ` 720 Crores can provide full health cover for the other
2,00,000 persons free of cost.
WHAT ARE THE HIGHLIGHTS OF NANO HEALTH ENSURANCE
MODEL?
a) Once you are registered there are no more tedious forms to be filled or permission
required;
No questions are asked about past, present or future illnesses or diseases. Once registered, all
health problems are automatically covered fully. You are treated as a dignified and respected
partner in our Health Care Services Venture. Your positive feed-backs and inputs will be sought to
be implemented by the organization to better the Quality of service Quotient.
b) Unnecessary medical or surgical or other interventions (which cause more harm
than good) are scrupulously avoided and with this same money that is being spent presently by
the system (governmental and non-governmental healthcare agencies). This model can serve
double the number of beneficiaries with very much superior outcomes (Health indices)
c) This model is self-sustainable model without any external economic burden to the government as
well as the society. Far superior to the national health service NHS model of the U.K which was
wholly dependant on the government which collected premium from all working people of all
ages and all walks of life.
d) You get an exclusive, unique and secured on-line EMR which could be retrieved any
where in the world, anytime you are faced with medical problem or emergency to
assist your doctors (a very important life-saving medical tool) not available in most
insurance systems in the world.
WHERE WILL THE NHE BE AVAILABLE?
TAG VHS Diabetes Research Centre
Chennai, Tamil Nadu, India.
We envisage to implement this Nano
Health Ensurance model in a limited
manner for about 1000 persons at TAG –
VHS Diabetes Research Centre to show its
efficacy,
practicability,
viability
&
superiority in terms of Health, Wellness &
Disease & Treatment outcomes.
 Pioneering research is to be undertaken by the Voluntary Health Services
Diabetes Department at The TAG – VHS Diabetes Research Centre, during the past
4 years in the field of energy medicine.
a) Pulsed Electromagnetic Field energy therapy (Prof. B.M. Hegde)
b) EDTA Chelation Therapy;
c) Dynamic Acupuncture Mediated Meta Physical (DAMM) Therapy (Rajan Iyer)
d) Collaboration with Ayurveda, Homeopathy, Yoga and Wellness concept
championed by Prof. B.M. Hegde.
WHERE WILL THE NHE BE AVAILABLE?
All these go into the successful, Patient - centered outcomes, with full scientific
documentation done at our centre and available on-line for anyone to view, learn,
understand and for critical discussion at (www.tagvhsdrc.com)
We have recently introduced a new complementary therapeutic modality called PaidaLajin technique of universal self healing method, after meticulous and extensive
scientific study; brought to us by the Pioneer Chinese healer Master Hongchi Xiao
www.paidalajin.com.
What is Paida Lajin? Master Xiao (extreme right) with a patient.Photos: Kalyani Candade/ TAG VHS Diabetic Research Centre Your
body has been designed to heal itself, he avers with unshakable faith. All it needs is a little help, and the
intent to heal.
Forget the name of the disease. The body is one whole connected being. Focus instead on the meridians,
and the flow of ‘chi’ or vital energy through the body. Blocked meridians hinder the flow of ‘chi’, causing
imbalance between the forces of yin and yang. This is the primary cause of disease.
The solution is to unblock the meridians. After years of travel and research, Master Xiao put together two
simple concepts that anyone can practise: ‘pai-da’ or slapping, and ‘la-jin’ or stretching. The slapping and
stretching work together to clear the meridians of blocks and help the body get rid of disease.
How exactly does it work? Slapping repeatedly at one point builds heat, causing blood vessels to expand,
and ‘chi’ to flow strongly. Yang rises, yin melts and long-held toxins and blocks are released.
Patients experience what many call bruising; Master Xiao describes it as poisoned blood or ‘sha’, which is the
beginning of healing. For some, there is a healing crisis, where the condition worsens and then resolves.
Often, there is intense pain. But pain points the way to healing, he explains. “No pain, no gain!”
Comparing the flow of ‘chi’ to that of a river, he explains that most of the garbage collects in the bends. So
focus on slapping the joints — inner elbows and wrists, all around the knees, feet and ankles, and all over
the head and face, working for at least 10 minutes on each part. If you don’t have the time, focus on only a
few places per session. It is important to pay attention to the area being slapped.
He calls it meditative paida, and suggests that you have a conversation with your body. Over time, we should
paida every inch of our body for best results.
And the stretching? ‘Jin-suo’ is a shortening of tendons that causes stiffness and disease. ‘La-jin’ reverses this
by stretching the tendons and increasing flexibility. While lajin is best done on a lajin bench, modifications
include using chairs or lying on the floor and stretching along a wall. He also recommends squatting and
using doorframes for forward stretches.
What about side effects? There are many, he smiles. Weight loss. Better skin. Increased energy. Activation of
reflexology points on our hands when we slap…
The list is long, and worth the effort. We have nothing to lose but our diseases.
Ref. The Hindu, April 12, 2015
Paida-Lajin Video Trailer
THANK YOU