Monday, June 24, 2013

New Guidelines for High Blood Pressure

 New European High Blood Pressure Guidelines

  • The European Society of Hypertension and the European Society of Cardiology have come out with new guidelines for the management of high blood pressure.
  • In patients with diabetes, the lower blood pressure should be kept below 85 mm Hg
  • The new recommendation is that all blood pressure patients should be treated to keep the upper blood pressure lower than 140 mm Hg.
  • In patients with diabetes, the lower blood pressure should be kept below 85 mm Hg
  • In patients younger than 80 years, the upper blood pressure can be kept 140-150 mm Hg
  • Blood pressure higher than 140/90 increases the risk of cardiovascular disease.
  • The salt recommendation is 5 to 6 gram per day.
  • Reducing salt to 5 gram per day can reduce upper blood pressure by up to 2 mmHg in normal persons and 4 to 5 mmHg in patients with high blood pressure.
  • Loosing 5 kg of weight can reduce upper blood pressure (systolic) by 4 mmHg.
    • Regular aerobic exercise training in high blood pressure patients can reduce upper blood pressure by 7 mmHg.
  • Drug therapy should be started typically within a few weeks if diet and exercise are ineffective in higher-risk patients. Low or moderate risk patients may be given a trial of lifestyle modifications for few months.

Monday, June 17, 2013



Nostalgia is nothing but “A sentimental longing for the past, typically for a period or place with happy personal associations”.

I was in Palayamkottai yesterday to speak at a surgical meeting. I had arrived early in the day so that I could visit the house where I spent 6 months in 1961 as a kid.

My father had been a government gazette officer being transferred from pillar to post. Wherever he went, we did too. Palayamkottai it was for 6 months. Though I was only in 3rd standard many decades ago, my memories are afresh as though it was yesterday.

As I sauntered on the neighbourhood… from my old school with adjacent church..… to my rented home of the past, it was nostalgic to walk back the same route I frequented some 50 years ago.

The church has now become a cathedral…. The service was over when I reached. I still managed to meet the senior priest to say hello.

 The Massive Holy Trinity Cathedral         

View of the Alter

View of the pews from the Alter

The main roads have widened a lot. There hardly used to be any cars on the road, but now so much of motorized traffic even on Sundays. TST ( Thallu Sir, Thallu) and TVS (Thalla Vendam, Sir) buses have been replaced by all sorts of colorful, faster buses with louder horns and over flowing passengers.

I traced the short cut which my sister and I used to take and visited the chapel in Adaikalapuram- now called St John’s Church with a cemetery where we, with our neibourhood friends used to play hide and seek!... ‘Robbers and Police’… brown uniform with brown belt across the waist and across the chest, pistols, whistles and all!

Adaikalapuram Chapel with Cemetry on its right ( Not seen on this picture)

The old house where we lived for 6 months still remained the same with the unaltered houses on either side. The street as I used to remember was wide... but looks mighty narrow now! The street also had vivid memories of ‘Kutchi’  ice cream man with a push cart ringing his bell during the day. At nights a different vender used to come with a larger cart with ‘petromax light’ with snacks and ‘Panju mittai ‘(cotton candy).

The old house is still the same! ( 'Green green grass of home'- Tom Jones)

Vijayakumar (God alone knows where he lives now!) who lived at the end of the street just adjacent to a fast moving stream, used to be one of my regular playmates in the evenings and sometimes late nights. He was living with his grandparents who used to feed me lime juice whenever I visited them. Street hockey was very popular and once when his grandfather bought him new hockey stick, he got me one too! Such was the friendliness of the neighborhood.

View of the street for football, hockey and what not!

The stream at the end of the street was always full of clear water and more so after monsoon… a favorite jaunt for the young folks to cool off. My father was an avid swimmer and naturally wanted his son to be too. His attempts at making me one were however futile! Out of frustration, one morning he set it up with some bigger boys to catch me in the stream when he threw me in ….. I bitterly complained to my mother about the incident. My fever the next day helped a lot and she put her foot down as she did not want her offspring to be drowned! Like all good mothers’ her words prevailed and that was the end of my swimming! …… Sad to see that the stream has been replaced by gutter water and rubbish… ;even the steps leading down are covered with waste material.

Sterling stream ... now a sad site!

My father frequent left station on official camps and I used to open his typewriter and hammer away.My sister, like all good siblings used to sneak in on me! Once too many times I had been discovered and had my ears tweaked to dissuade me…. But when I grew up and went to medical college, same father was proud to give the very same to me for making my notes. My typed notes were stuck onto my Bailey and Love Surgical Book! (which I still cherish!)

Even the school held great memories too. History teacher wanted to make a point about a war. She made 2 of us boys get into a playful fight and I was supposed to win; but my classmate had other ideas and almost beat me up to a pulp in front of the class. I still remember the anxiety on her face when she separated him from above me!

While walking back from school, I used to eye a clock cake in a bakery in the show case…. It was always there. The bakery is still but not the clock cake!

As I look back, we had enough time to learn a lot besides academics like music, casual reading ( Perry mason, Alistair MacLean, P G Wodehouse among books, and Phantom, Mandrake the magician among comics were my favorites)... marbles, tops, foot ball on the streets, hockey, ‘pandey’ ( played with kids hopping over squares and stones), gilli dhanda, kite flying… times have changed a lot.I did not see a single kid on the street.. that too on a Sunday, unheard of in our times!

Christmas was a great time of cheer! There were so many carol rounds by churches, Sunday schools, youth groups, school groups….. always dropping in at our homes on cycles, small trucks with ….. Much singing, guitars, piano accordions, violins reciprocated with warm coffee, horlics, cakes, biscuits wherever you went! Where have they all gone?

I caught up with my friend Premkumar Joseph a leading eye surgeon who lives closeby. We shared some of the old times in his garden and a meal together.Old friends are like old wine... they get better with the passage of time!

With Dr Premkumar Joseph

I guess that kids of today still have a great time watching TV cartoons, playing computer games, social networking etc. But times have really changed. And as we also adapt to the changes rapidly, little do we realize how much has changed unless we visit our roots and relive our  earlier days . Trip to Palayamkottai helped me just to do that! 

Rewinding rapidly your life even for half a day will make you appreciate life better!

Friday, June 7, 2013


Medical Symbol – RIGHT AND WRONG ones

Most medical associations around the world including the Indian ones carry the medical symbol.


( The wrong one)

Caduceus is the staff  with two encircling serpents with over shadowing pair of wings. According to Greek and Roman mythology, caduceus was carried by Hermes (Greek) and Iris. It is also seen in the left hand of Mercury according to ancient Roman history for guidance of the dead and protection of merchants, shepherds, gamblers, liars, and thieves.

Caduceus is actually associated with trades, occupations and the gods. It is also associated with astrology and planet Mercury. With reference to its ancient relationship to commerce and negotiation, the caduceus is used as a symbol for these as well as printing due to the association with Mercury.

The origin of two snakes is assumed to be due to the shepherd’s crook used as a staff. Other iconographers opine that the wand entwined by two serpents represented a god in the pre-anthropomorphic period. Why snakes? Serpents have, in all cultures, been associated with health and healing, perhaps because they can shed their skin and rejuvenate themselves. In honor of Asclepius, snakes were often used in healing rituals and non-venomous snakes were allowed to crawl on the floor in dormitories where the sick and injured slept.

Caduceus is wrongly attributed to as a medical symbol in North America and elsewhere due to similarities of the to actual correct medical symbol- the Rod of Asclepius.


( The correct one)

As for description,the rod of Asclepius has only one serpent and no wings. Because of the close similarity, the confusion between the two arose.

Asclepius is the Greek god of health and healing. He is also the son of Apollo, the Greek sun-god. His mother died when he was still in her womb. Apollo  the father of Asclepius cut the womb of his wife,pulled his unborn child out and declared that his, Asclepius, would be responsible for the human fight against disease and death.
More famous than Asclepius is the rod with a single serpent wound around it known as the Asclepian. This became the symbol of doctors and modern medicine. This must be differentiated from the Caduceus, or a rod with two serpents around it, which refers more to the occult arts and which was carried by the Greek god Hermes when he took souls from the land of the living to the land of the dead.

Asclepius was so good in health and healing that many people who were supposed to die did not die. Hades, the god of the dead, was so annoyed that he complained to Zeus, god of the sky, who struck Asclepius with a thunderbolt and killed him. Asclepius and his staff with the serpent were then cast upon the sky as a constellation.

The incorrect use of caduceus with 2 serpents was popularized by Captain Frederick  Reynolds or Colonel John van Hoff of United States Army Medical Corps in 1902.

US Army Medical Corps

The rod of Asclepius is the dominant symbol for professional healthcare associations in the United States as well as many countries. A study showed that 62% of professional healthcare associations used the rod of Asclepius as their symbol. 76% of commercial healthcare organizations used the Caduceus symbol.

The difference exists as professional associations are more likely to have a real understanding of the two symbols, whereas commercial organizations are more likely to be concerned with the visual impact a symbol to sell their products.

The original mistake has led to the adoption of the wrong symbol. The long-standing and abundantly attested historical associations of the caduceus with commerce, theft, deception, and death are considered by many to be inappropriate in a symbol used by those engaged in the healing arts. This has led to mounting criticism about the use of the caduceus in the medical field of healing and care.



Perseverance means “Steadfastness in doing something despite difficulty or delay in achieving success.” 

It means that you will go on doing it no matter what.

The first thing is to identify what you want to do- namely your goal. Goal setting is first and most important.

(Mervyn John working his way on up in tae kwon do) 

It is also important to have one goal. There is a lot of truth in the saying “Do one thing at a time and do that well is the best of rules that anyone can tell”

Once the goal is decided on, you must plan on ways of doing it right.

Also plan on pit falls or failures on the way – as you are bound to meet the difficulties on the way.

Once you finish the planning, take the plunge and start the action. It may be playing the violin daily or reading 100 pages a day, writing 50 pages a day  or exercising 20 minutes daily. Do not procrastinate; this only kills the motivation.

Make time for the activity daily, however tired you are. Do not say you do not have the time for the activity. You can always make time for what you really want to do.

Just when you start doing your activity daily, you will meet failures on the way. Do not stop- keep going on. If you keep on getting failure many times, then you need to take a look at the technique and take in some expert advice for correction.

Stay away from people who are negative minded and who discourage you.

It is best in the beginning not to discuss your resolution to many people, as this will give you the feeling that you have already achieved quite a lot.

Do not quit until you win. Winners are not quitters and quitters are not winners!

Remember it is not who starts the marathon but who finishes it!