Inflammatory Bowel Disease

Inflammatory Bowel Disease
The smart young 35 year old career-oriented Divya’s (name changed) problems started two years ago with what appeared as an usual intestinal infection: cramping abdominal pain, loose stools and feverishness. She took her regular antibiotics, and although the symptoms improved slightly, they lingered and persisted.
Over the next 6 months, she had four major bouts, lost 6 kilograms of weight, became anaemic and weak, and passed blood in her stools a few times. She finally consulted a gastroenterologist who performed a colonoscopy, a test in which one passes a periscopic tube into the large intestine, and diagnosed her to be suffering from Crohn’s disease.
Like most of her age, she had never heard of Crohn’s disease. It is an autoimmune condition in which the body’s immune cells normally primed to target and kill invading germs, get misdirected and start attacking intestinal cells of its own body.
Her husband, a TV channel manager, was shocked too. The questions that seemed to flow endlessly in their minds were: How did it happen? Why did it happen? What is the cure? How long will it take? Will it impact her career? What about their plans for a baby?
To be rudely woken up into the world of Inflammatory Bowel Disease, the generic name for Crohn’s disease and Ulcerative colitis, cannot obviously be pleasant.
Most answers initially appear to be in the negative. The exact cause is not known. The disease does not have a “cure” except removal of the large intestine by surgery for ulcerative colitis, that comes with its own baggage of problems.
How long to take the medicines? Lifelong !! Are you serious? And can it turn cancerous? Yes (it may after many years). OMG.
Divya, who is now well and back to her job but on medications, will tell you how bad it had got. Initial disbelief led to anger and then to frustration. It was several months later, after several consultations, opinions and reading up on the net, that she and her husband finally accepted the reality and decided to fight on.
Thanks to a new group of medicines called “biologicals”, the treatment has become much better. Steroids, once the mainstay of therapy, are no longer a must. Remissions are easy to achieve and one can lead near normal lives with monthly shots.
Divya did take these injections with which she quickly on her feet and back into her job. They are pretty costly though, almost one lac for one dose, and she needed three for the initial induction. Luckily she had a health insurance which made it possible for her.
This week is IBD week. Every organisation has some or the other staff who suffer from this group of conditions. It is time we united and created awareness about this disease so that anyone afflicted does not have to suffer in isolation or shame. And we can bring help and information to their doors.

Life Without MOM !!

If you have been lucky to have had your mother care for you and nurture you in your infancy and childhood, thank your stars! How life could have been different without her is the subject of several scientific papers that deal with the unpleasant consequences of “Maternal Deprivation Syndrome”
Infants without moms make poor starts in life. They often do not grow well physically, lagging behind in height and weight, in what is termed “growth failure”. And funnily, this seems to occur despite the adequate nutrition reaching their guts.
Scientists are, as usual, trying to investigate what “factors” could be responsible. One explanation is deprivation of mother’s milk that lowers a child’s immunity. Breast milk is rich in anti-bodies and immune boosters that help protect the baby from recurrent infections, frequent episodes of diarrhea, pneumonia and absorption defects.
What scientists find intriguing is to segregate the “measurable” factors such as antibody levels passing from breast milk to the infant, for instance, from the un-measurable ones such as love, care, emotional support and confidence boosting that acts such as breast feeding, hugging, caressing and singing of lullabies might have on a child’s development.
Children growing up without their mothers are often emotionally handicapped from an early age. Their personalities and self-confidence do not develop well and their emotional responses remain muted. They are more prone to developing personality disorders or delinquencies than their well mothered counterparts.
The pain of growing up without a mom was well described by Steeve Jobs, the CEO of Apple Inc, whose unwed biological mother had given him up for adoption when he was an infant. Although raised well by foster parents, Steeve had never felt “normal”; he had taken to drugs in his young days and had suffered volatile moods, loneliness and depression. His search for his biological mother had remained unsuccessful, causing him frustration, till he developed and died of cancer himself.
Mom is a boon that we seem to take so much for granted, that we often do not realize how our lives might have been without her. Mother’s day is a good time to acknowledge and appreciate her and express our gratitude for having had her.
One way you could give back is to make sure she remains healthy and happy. Ensure that she takes her Vitamin D, calcium and vitamin supplements regularly. It is your turn to escort her through her regular medical visits for BP, diabetes, cholesterol, heart, hemoglobin, breast and pelvic check ups just as she did with you during the parent-teacher’s meetings when you were in school.
And it is your turn to make sure that you reciprocate and give her the time and emotional support that she needs from a grown up child, so that she remains fit and happy. And proud of having brought you into the world, and nurtured you with love and care!

Beat the Heat this Summer !

Long hot spells, when the sun bakes the earth and the mercury rises to create new records, pose major challenges to health and life. Our bodies dry up (called dehydration; remember that 2/3 of our body is made up of water) or get excessively heated (called heat or sun stroke due to the body’s thermostat failing to maintain our temperatures around 370C), posing a threat to life.
The simplest way to stay well and energetic during summer is to keep your body well hydrated at all times. Start the day with two or three glasses of water in the morning as soon as you wake up.
The trick is to drink fluids before you start feeling thirsty, because by the time you feel it, the body has already started signalling to you that it is getting dehydrated. When you start for school or work in the morning, make sure you drink two more glasses of water.
In dry hot weather, water is lost from the body through breathing and invisible perspiration. It is therefore wise to anticipate it before you set out. Your energy levels will be far better this way. And keep drinking water the whole day till dinner time.
The commonest mistake that many people make is to start the day without adequate hydration, and then drink water when thirst starts reminding us that our body is drying up. We often then overcompensate later continuing to drink till late evening, then often having to get up at night to urinate.
We need to synchronise our water consumption with the diurnal need of summer days. Dehydration is common in summers and claims around 2 million lives every year, especially in developing regions.
Children are more susceptible, and once grossly dehydrated, often find it impossible to regain health. Symptoms and signs include fatigue, headache, low BP, dizziness, fainting, dry mouth and reduced amounts of urine that is usually dark yellow. It is often precipitated by an attack of vomiting or loose motions. Drinking large amounts of water (around 6-15 glasses a day) and increasing the intake of salt (through pickles, papads, salted nimbu paani or lassi) are the cornerstones of prevention and treatment. It is important for children to be always hydrated; if not, growth and development could be affected. Luckily, children usually have intense thirst sensation; the trick is to help them develop a liking for water and not juices or softdrinks. Heatstroke is common during these dry hot spells when the body’s heat regulatory mechanism fails to maintain a balance between heat production and heat loss (losing it to from 370C of the body to the 460C of the atmosphere could well be impossible at times!). As a result, the body temperature rises causing the person to be pale, hot, irritable, confused or unconscious.
Children and the elderly are at greater risk, as are athletes, construction workers, labourers or military recruits.
It is a medical emergency and requires moving the person to a cool shade, lying him down on the floor or ground, pouring water on the head and body, placing ice cubes under the armpits and moving him to a clinic or hospital. Caps, sunglasses, wearing loose cotton clothing and avoiding anti-perspirants help

Sugar Addiction

Sugar Addiction

You will be surprised to know that of all the addictive agents that you can list such as tobacco, alcohol, caffeine, betel and drugs, one that has probably sneakily getting you hooked from early childhood and making the largest impact on your health could be your addiction to sugar.

Sugar, scientists point out, poses far greater danger than we seem to realize; it is a toxin that harms our organs and disrupts the body’s usual hormonal cycles. Excessive consumption of sugar, they say, is one of the primary causes of the obesity epidemic and metabolic disorders like diabetes, as well as a culprit for cardiovascular disease. More than 20% of urban Indians and 10% of urban school children and adolescents in India are obese largely due to excessive consumption of sweets and sugar.

That the landscape of health across the world and especially in India is undergoing drastic change is reflected in the WHO’s recent report attributing over 60% of urban deaths in our country to life-style disorders of the heart, brain or cancers, replacing the old causes such as infections and starvation.  And what lies at the heart of these metabolic causes seems to be our addiction to sugar!

Our “Pavlovian” dependence on sweets start from infancy when we are introduced to sugar water, kheer, sweets and ice-cream.  And think again, how do we reward or show our love for someone? By giving him or her sweets, chocolates, rasagullas or laddoos!

The excess sugar that enters our body requires excess amounts of insulin to be secreted by the Beta cells of our pancreas. Over time, these cells get exhausted leading to diabetes. And as sugar cannot be stored in our body effectively, it is converted to fat that gets deposited in our buttocks, paunch, livers and heart!

Around the world, a growing body of opinion – the 'No Sugar’ movement – is leading a global fightback and warning that our sweet habit is completely out of control. Sugar, whether added to food by you or the manufacturer, is the greatest threat to human health. And unless we wise up and quit en masse, we don’t just risk personal obesity and disease, but national bankruptcy and collapse as the toll our ill health takes on our countries’ economies threatens to destabilise the modern world.

The sugar trail seems to be coming back to haunt India. Sugarcane has been grown in India since 500 BC. We learnt to make the white crystals from the juice much before the European tongue had its first taste of sweet  around 1500. In fact, sugar was called the white spice and was considered more preciious than gold, and shipped to Europe by the colonizers.

The movement is led by Robert Lustig, professor of paediatric endocrinology at University of California, San Francisco, author of Fat Chance: The Bitter Truth About Sugar, numerous scientific and press articles, and presenter of “Sugar: the Bitter Truth”, a YouTube clip viewed more than 3,300,000 times.  

It is time we woke up and fought our most primodial addiction to save our

selves and our future generations!

Violence against Doctors

Violence against Doctors

Last week’s gory incident in which a renowned super-specialist, Dr. Rohit Gupta was mercilessly beaten up by disgruntled relatives in a private hospital in Allahabad has shocked not just doctors, but most sensible members of society.

The CCTV video showing the goons drag Dr Gupta to a room in the hospital and thrash him for over 15 minutes, has gone viral and evoked sharp outcry. Dr Gupta who sustained a fracture of his jaw bone and multiple other injuries is undergoing treatment in another hospital. He had gone to visit the 80 year old critically sick patient at 4 AM in the morning, who died, when this incident occurred.

The fall out of such an event causes great harm to society, especially patients in dire need of medical help at odd hours. I am sure Dr Gupta, having learnt the lesson of his life, will refuse to take calls at odd hours. And so will many other doctors practicing in small hospitals and nursing homes.  If society and administration doe not inspire confidence in doctors about their safety, they are expected to retract to safer zones.

It is not without reason that doctors tend to concentrate and practice in big cities and are reluctant to settle or open clinics in small towns and villages. Vandalizing clinics and beating up doctors is not uncommon in small setups making good doctors flee to safer pastures.

Grief and frustration are legitimate emotional responses of relatives especially in the event of death of a loved one. But anger often leads to violence. And unless the law enforcers provide adequate security to doctors, they are likely to play safe and not attend to suffering patients in desperate need, at odd hours.

The good old family physician who would make a home visit on a telephone call, has almost disappeared in most places. Well qualified doctors are reluctant to visit homes. The most badly affected are the frail and elderly. Apart from the inconvenience, it is the huge costs that families will have to bear to take them now to hospitals to seek medical attention.

Violence against doctors receives a perverted sanction from movies and television serials too. It is not uncommon to see bereaved relatives in TV serials catching a doctor by the collar when he breaks the bad news.

One could argue that doctors are sometimes rude, calloused and insincere in their dealings that evoke the ire of relatives.  That the medical profession is no longer held as noble and revered as it once was, is often attributed to a doctor’s monetary greed and sometimes, unethical ways. I  am sure there are black sheep in every profession, and the medical fraternity is no exception.

But the use of violence as an instrument to “teach” doctors a lesson is bound to boomerang and jeopardize the needy and the poor. 

It would be a great disservice to the community if civil society does not condemn such violence against doctors and ensure that the culprits are punished. 

ISG Advocacy Committee

Dear Colleagues,

In the last Governing Council Meeting held in Kolkata, several memebrs felt the need for enlarging the scope of our society from its present role of promoting good gastroenterology practice, need based research and awareness about digestive disorders, to advocate and implement policies that promote Digestive Health (DH) .The glaring example is our country’s paradoxical position of having 4 of the 10 richest men in the world, and yet not being among the 150 odd countries that provide Hepatitis B vaccination to all infants. While we may point fingers at the government, have we, as a united body, done enough to advocate or lobby for such causes that concern us?

The Advocacy Committee, as I understand it, is a move in this direction.

How do we go about it?

I suggest that we seek as many suggestions as possible from al, the members, generate discussions and debate on any or all issues and try develop a consensus building approach to go forward. This blog is therefore a brainstorming and consensus-forming platform; it in no way seeks to reduce the sanctity of the ISG website. A blog may provide an opportunity to discuss issues on an ongoing basis, and may help us formulate and consolidate our thoughts and plans that we may place before the Governing and General Bodies of the ISG when those meetings occur.

To initiate discussion, I am putting down some of my ideas as a template for you to respond.

Aims and Objectives

1.      To identify issues pertaining to digestive health that need change  in the community

2.      Generate consensus among members regarding the type of change required.

3.       Identify agencies through which the change can be brought about (such as local or central government, world organizations, NGOs etc)

4.      Undertake research and planning to estimate the magnitude of the problem, strategies for change and the quantum of resource needed for effecting the change.

5.      Advocate the issues with the concerned agencies

6.      Monitor progress of the group as well as hurdles encountered.

This is aimed as an activity for social change; hence I feel all of us (along with our sister societies INASL and SGEI) could work together. In the end, it would be worthwhile for all of us to be part of a movement that brings positive change to society, rather than splitting ourselves to claim credit for it.
A.   Issues that need advocacy

This list could be long and needs your inputs, but may be broadly divided into the following sections and subsections.

1.       Health Care Delivery

a.       Hepatitis B related (example)

                                                                 i.      Vaccination programmes and implementation at different levels

                                                                ii.      HbsAg screeing /testing at antenatal check-ups

                                                              iii.      Ensuring HBsAg testing, vaccination and protection of all health care workers

                                                               iv.      Formulating regulations for health care providers who are HBV infected

b.      Endoscopy : availability, standardization and reporting of services

c.       Water and Civic Services for prevention of water borne infections

d.      Prevention and diagnostic strategies for common GI and Liver cancers, developing screening or surveillance programmes for high risk groups

e.      Act as facilitator for providing information on free/low cost special services for rare diseases like Gaucher’s Disease ( Dr Aabha is quite active in this area) or Wilson’s Disease etc

f.        Others

2.       Teaching and Training:

a.       Gastroenterology education

                                                                 i.      Creation of Gastroenterology departments in medical colleges (how many in the sate, where, justification, requirements of facilities and staff, scope of the department, common curriculum etc)

                                                                ii.      Ensuring adequate representation of Gastroenterology education (topics, contents) in

1.       Postgraduate (MD, DNB) training

2.       Undergraduate (MBBS) training.

                                                              iii.      Others

3.        Research:

a.       Identifying  thrust areas for research in India

b.      Advocate with research agencies for designing and funding of research on these topics.

                                                                 i.      Multi-centric

                                                                ii.      Single centre / Single PI based, on relevant topics

c.       Ongoing field / data based research by a team of “Research Core Group” to identify unmet needs and plan startegies.

4.        Policies

a.       Identify policies that need change/ thrust

b.      Advocacy with the concerned agencies

5.       Budget

a.       Adequate budgetary allocation may be attempted by the advocacy group at different levels

                                                                 i.      Central and state government, for Digestive Health (DH) related issues

                                                                ii.      Internationa agencies, for issues related to DH in India or region (south Asia)

B.  B.    Whom to Advocate with

a.       Government

                                                               i.      Central

                                                             ii.      State level

                                                            iii.      District or local level

b.      International Bodies such as WHO, UNICEF, WGO etc

c.       Industry

d.      NGO’s

e.      Public / media / support groups

C.  Approach
I suggest a consensus building inclusive approach. ISG members may express their views by e-mail or post them on the blog, thus generating discussion and debate. We could use the same approach for nominating people to diferent subcommittees of the Advocay Group.
D.  Structure of the ISG Advocacy Group

I suggest we have the following subcommittees to tackle specific tasks:

a.       Negotiators or Lobbyists: this group ( please suggest a better name) should comprise senior members with standing, who have reach and can advocate on behalf of ISG with the government or agencies, listed in “B”. Nominations are welcome. Some senior members can be invited to join this subcommittee.

b.      Research Wing: should comprise members who are good at gathering data, evaluating scientific reasons and evidence, and preparing presentations for supporting the senior lobbyists.

c.       Core subcommittee: to coordinate and keep all members of the Advocacy Group comnnected and monitor progress. This role could be performed by the president and Hon Secretary, along with 1or 2 others ( might be important to maintain continuity of the program as the President’s term will be short and the change too frequent.

E. Examples of the Advocay role played by other societies

         I understand that the pediatric society has played an important role in recommending or rejecting                the role of Pneumococcal vaccines being promoted in India, arguing that the strains in the vaccines do not match the ones that occur in India. I am sure there will be many examples. Please share your observations that we may emulate, on the blog.

F.        The functioning of the committe will have to be monitored, time lines will have to be followed and impact evluation done from tome to time. I propose that the progress be placed before the Governing Council of ISG 2 times a year by the Core Sub-committee, for the purpose.

This is a concept paper. I request all of you to provide your suggestions, comments and ideas, preferrably on the blog, so that we may have a truely open discussion forum and evolve a consensus building approach. I will upadet the blog fortnightly till we resolve the plan of action and decide our course. Seeking your active participation.