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 FEARSDr. C.V. Krishnaswami

CHAIRMAN TAG-VHS DIABETES RESEARCH CENTREEMERITUS 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 snailUnwillingly to school. And then the lover,Sighing like furnace, with a woful balladMade 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…

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 wideFor 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

The Seven Ages of Man – William Shakespeare – Contd…

Definition of Elder Citizen of classification and old age

Senior Citizens – 65-75 yrs.Super Seniors 75-80 yrs.Elder Citizens 80-90 yrsOld 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 customizedmedical attention for variable periods – short or long term.

They all require adjustment of Life style and specific non drug therapies whichwould contribute to more than 50% towards recovery and regaining Healthexpectancy.

Aggressive interventions either with drugs or with other invasive modalitiesare as a general rule & Protocol did more harm than good, as shown byseveral large scale studies – eg. ACCORD; DREAM; POISE etc.. Interventionsshould be confined to selected cases of special situations only.

Also it was stressed with more than adequate evidence by Prof. B.M. Hedgethat long-term usage of pharmaceutical chemical agents in the so-calledprevention of Non-Communicable Diseases, and even their clinical trials arehighly unethical, immoral and unscientific.

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 & overmedication → GI/Kidney and other complications. In extreme cases severedepression and self destruction).

5. Obsession Inflexibility Aggression/Anger Repetition Forgetfulness etc →causes problems both to themselves and more for their carers.

So, What are the real issues affecting the Elder Citizens’ Health?

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: DialogueThis frame work can be applied to teaching, clinical practice across the multidisciplinary terms offering care for the elderly.

‘Bhaja Govindam’

punarapi jananam punarapi maraNampunarapi jananI jaTare shayanamiha samsAre bahudustArekrpayA pAre pAhi murAre

Repeated birth, repeated death and repeated lying inmother's womb - this transmigratory process is extensive and difficult to cross; save me, O destroyer of Mura, through your grace.

Minerva (BMJ 21 June 2008)

After the recent death of two friends, a doctor speculates why, as a profession, we are so bad atdealing with dying – despite the obvious fact that, sooner or later, it is the certain fate of everypatient 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

(Postgraduate Medical Journal 2008;84:279-80).

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.

NDTV Streamer

In India there are 60 million plus Diabetics, and70 million plus Pre Diabetics

“6th IDF Report; Presently there are 387 million people withDiabetes Mellitus and by 2035 it is expected to go upto 592millions.Every 7 seconds a patient dies of diabetes.”

Ref. TOI & DC, 19/04/2015.

We are in an era of “DISEASE MONGERING” “SCAREMONGERING” & “STATISTICS MONGERING” (backed byworld bodies like WHO, IDF, ADA, AMA, FDA – Not tomention The Indian & Regional Cohorts who Knowtowthem)

What we need today is HEALTH MONGERING & HEALTHEXPECTANCY INDEX instead of Life Expectancy Index &World Wide Cost Effective & INCLUSIVE HEALTHCAREMODELS & SYSTEMS.

Books like these are allowed to be published though for some strange reason (s) not available in India.

On the positive side.We have the freedom of Speech & Freedom of dissent, if we use thesewithout Vituperation, Malice or wested motives & to perceived betterment ofhuman kind.

gen.med@alerts.stanford.edu

Jour. Watch Aging/ geriatrics Alerts for Dec 1, 2012

Aging / Geriatrics for December 1st 2012

Summary and commentHypertension in the Oldest OldNovember 29, 2012 | Allan S. Brett, MD| General MedicineAmong 85 – 90 – years – olds, high blood pressure was associated with lessconginitive 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. MDIn 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?

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 intoclassifying disease, and even psychiatrists have identified over 4000ways in which our minds may malfunction. Health for doctors is anegative 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 tobe defective – “dis-eased.”

Richard Smith

1. Tinetti ME, Fried T. The end of the disease era. Am J Med 2004; 116: 179-85.

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.

What is Health?

Mary Tinetti and Terri Fried have argued in the American Journal ofMedicine that thinking in terms of disease has become counterproductive.“The time has come,” they write”to abandon disease as the focus ofmedical care. The changed spectrum of health, the complex interplay ofbiological and non-biological factors, the aging population, and the interindividual variability in health priorities render medical care that is centeredon the diagnosis and treatment of individual diseases at best out of dateand at worst harmful. A primary focus on disease may inadvertently lead tounder treatment, over treatment, or mistreatment.”

Consider a patient called Lucy. She has heart failure, diabetes, asthma, andosteoarthritis. Her cardiologist treats her heart failure, her diabetologist herdiabetes, her diabetes, her chest physician her asthma, and herrheumatologist her osteoarthritis. Her general practitioner holds the ringand writes her prescriptions. But actually she’s not much interest in herdiseases, and she’s not worried about dying. Indeed, if she could get to seeher son in Australia one more time she’d welcome death: life has neverbeen the same since her husband died. She needs a travel agent, not fivedoctors, but doctors are supplied on the NHS and travel agents aren’t.

Richard Smith

Pursuing health and fleeing disease

1. Tinetti ME, Fried T. The end of the disease era. Am J Med 2004; 116: 179-85.

Death by Medicineby 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

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 insevere 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.

“OVER MEDICATING SENIORS”

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 69per 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, HeartAssociation)

MIMS May 2007

Condition Deaths Cost Author

Adverse Drug Reactions 106,000 $12 billion Lazarou1 Suh49

Medical error 98,000 $2 billion IOM6

Bedsores 115,000 $55 billion Xakellis7 Barczak8

Infection 88,000 $5 billion Weinstein9 MMWR10

Malnutrition 108,800 -------- Nurses Coalition11

Outpatients 199,000 $77 billion Starfield12 Weingart112

Unnecessary Procedures 37,136 $122 billion HCUP3,13

Surgery-Related 32,000 $9 billion AHRQ85

TOTAL: 783,936 $282 billion

Death by Medicine by Gary Null, PhD, Carolyn Dean, MD, ND Martin Feldman, MD, Debora Rasio, MD, Dorothy Smith, PhDANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION [Value of EMR in Reducing this]

Less is moreProfessor BM Hegde,hegdebm@gmail.com

When I first wrote about the Sheffield-Bristol study of heart attacks in the 1960s whichshowed that patients with heart attacks with good risks had lesser mortality when leftalone at home managed by their GPs, compared to those with similar features who arewhisked away to the ICU in the regional hospitals, people thought I was concoctingstories.

The new study I referred to earlier was done at the Harvard Medical School with thehypothesis that if all cardiologists went for their annual conference for one week seriousheart patients would die in excess. At the end of five years of prospective study whatthey found shocked the researchers. “Holy heart attack! Researchers have found thatcertain high-risk heart patients stand a better chance of survival if they go to a teachinghospital when all the cardiologists have left town,”

(Anupam B. Jena, Vinay Prasad, Dana P. Goldman, John Romley. Mortality andTreatment Patterns Among Patients Hospitalized With Acute Cardiovascular ConditionsDuring 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

Salary / day10,000/-

Salary/ Month300,000/-

Salary / day6,000/-

Salary / Month180,000/-

Salary / day3,000/-

Salary / day90,000/-

Salary / day1,000/-

Salary / Month30,000/-

Salary / day500/- Salary / Month

15,000/-Salary / day

<=100/- Salary / Month<=3,000/-

All Values in Indian Rupees (INR)

Envisaged Premium Categories and the Economics of the NanoHealth Ensurance Plan All Values in Indian Rupees (INR)

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.

Category

Daily

Premium

Monthly

Premium

Annual

Premium

Annual premium

(100,000 persons)

(corers)

Premium 'A' 100 3000 36000 360 Premium ‘B' 60 1800 21600 216 Premium ‘C' 30 900 10800 108 Premium ‘D' 10 300 3600 36

Free/Nano Subsidised Group (E) (SG) 5 150 1800 18

Free/ Nano Group (F) (NG) 1 30 360 3.60

Total annual premium collection 741.60

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, allhealth problems are automatically covered fully. You are treated as a dignified and respectedpartner in our Health Care Services Venture. Your positive feed-backs and inputs will be sought tobe implemented by the organization to better the Quality of service Quotient.

b) Unnecessary medical or surgical or other interventions (which cause more harmthan good) are scrupulously avoided and with this same money that is being spent presently bythe system (governmental and non-governmental healthcare agencies). This model can servedouble 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 aswell as the society. Far superior to the national health service NHS model of the U.K which waswholly dependant on the government which collected premium from all working people of allages and all walks of life.

d) You get an exclusive, unique and secured on-line EMR which could be retrieved anywhere in the world, anytime you are faced with medical problem or emergency toassist your doctors (a very important life-saving medical tool) not available in mostinsurance systems in the world.

WHERE WILL THE NHE BE AVAILABLE?

TAG VHS Diabetes Research CentreChennai, Tamil Nadu, India.

We envisage to implement this NanoHealth Ensurance model in a limitedmanner for about 1000 persons at TAG –VHS Diabetes Research Centre to show itsefficacy, practicability, viability &superiority in terms of Health, Wellness &Disease & Treatment outcomes.

Pioneering research is to be undertaken by the Voluntary Health ServicesDiabetes Department at The TAG – VHS Diabetes Research Centre, during the past4 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 conceptchampioned by Prof. B.M. Hegde.

WHERE WILL THE NHE BE AVAILABLE?

All these go into the successful, Patient - centered outcomes, with full scientificdocumentation 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 Paida-Lajin technique of universal self healing method, after meticulous and extensivescientific study; brought to us by the Pioneer Chinese healer Master Hongchi Xiaowww.paidalajin.com.

What is Paida Lajin? Master Xiao (extreme right) with a patient.Photos: Kalyani Candade/ TAG VHS Diabetic Research Centre Yourbody has been designed to heal itself, he avers with unshakable faith. All it needs is a little help, and theintent 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’, causingimbalance 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 twosimple concepts that anyone can practise: ‘pai-da’ or slapping, and ‘la-jin’ or stretching. The slapping andstretching 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 thebeginning 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. Sofocus on slapping the joints — inner elbows and wrists, all around the knees, feet and ankles, and all overthe head and face, working for at least 10 minutes on each part. If you don’t have the time, focus on only afew 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 shouldpaida 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 thisby stretching the tendons and increasing flexibility. While lajin is best done on a lajin bench, modificationsinclude using chairs or lying on the floor and stretching along a wall. He also recommends squatting andusing doorframes for forward stretches.

What about side effects? There are many, he smiles. Weight loss. Better skin. Increased energy. Activation ofreflexology 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