Category Archives: HEALTH

About alternative medicine, ayurveda, accupressure, exercise, yoga, home remedies

What happened when fashionable footwear became common in Kerala?

I don’t know when footwear became so common in Kerala. Because if you google ‘Kerala 1970’ or ‘Kerala 1975’ you will see that there are very few images of people in footwear. But one thing is sure that before the 90’s Keralites used to buy only water resistant rubber or plastic footwear.

In Kerala rain is unpredictable and in the bygone days, people had to walk a lot. There was no way to protect the shoes from getting wet. So in earlier days, people used to buy, water-resistant, rubber or plastic chappals.

And there was no compulsion for children to wear shoes to school because rain is unpredictable in Kerala.

When we went for the vacation during our childhood, to Kerala, we used to carry clothes that dry fast, and water-resistant footwear.

In the 1980’s, for instance, there were fewer private transports. People had to walk for 15-20 minutes, mostly on unpaved roads, to reach the bus stops. On rainy days there were potholes and puddles. That required durable footwear rather than fashionable footwear.

fashionable footwear

Since water resistance and design does not go together it was hard to find fashionable footwear in Kerala. If someone wore a fashionable shoe all eyes would be on those shoes.

From the 90’s there was an emerging fashion sense of footwear. Pointed and flat heals have become common. Sneakers and leather shoes are used as daily wears in the rain prone Kerala

Nowadays, everyone has a collection of shoes for various occasions. Yes, they own a pair of shoe for the rain too. But not the lacklustre plastic or rubber chappals of the yonder years. Now there are fashionable rainy shoes. And durability is not the issue.  What is more important is the good looks.

The 90’s is an important time period because it was in 1989 that an ad company gave Kerala the tile of ‘God’s own country’. The title changed the image of Kerala. And slowly Kerala became one of the sought after tourist destinations in the world. 1990 was also the beginning of globalisation and privatization.

A large number of Keralites started travelling aboard for work. People started getting exposed to other culture and there was more income. Also, a growing number of Indian and foreign tourists were visiting Kerala.

Keralites whether they were in Kerala or abroad, got exposed to other cultures. Cultural shock was reduced. The quality of life improved for Keralites. There were changes in the dressing also. Half sarees and sarees were replaced by salwar kameez. Rubber and water resistant plastic footwear were replaced by leather and designer footwear.

Own vehicles to travel

When you wear costly leather shoes, that can get spoiled in rain. Naturally, your concentration will be towards protecting the shoes from the rain. Most Keralites own vehicles like a car or a two-wheeler. Now there is no need to walk to the bus stands.

Front  yards paved with tiles

And the front yards are decorated with paved tiles. So there are no more puddles in front of the house. You can walk on the tiled pavements which are attractive and prevent the shoes from getting soiled.

fashionable footwear

Waterproof Houses

The houses and public buildings are now built rainproof. Not a single drop of rainwater enters the houses.  And the car parking is covered. you can get into the car without the shoes and clothes getting wet in the rain.

No space for rainwater to penetrate underground

The worrying factor is that when you cover the ground in front of your house with tiles, you are not allowing the rainwater to penetrated underground. When we use engineering and design to beautify the surrounding and protect ourselves from rain, do we play a role in the flood that hit Kerala?

Watching rain without getting wet

Before 1990’s people did not like to visit Kerala during the rainy season. Because the rain hampered the tour programme. But now people enjoy coming to Kerala because they can watch the rain, without getting wet, by sitting in the balcony or while travelling in an Airconditioned Car.

We think of rain as a spoiler when we visit Kerala to enjoy the lush green landscape. We forget that rain is responsible for the lush green landscape.

Building boundary walls, blocking rainwater

We build boundary walls around our property without leaving an outlet for the flood water to drain. In this way, we are preventing the rainwater from flowing and draining into the rivers.

Building houses inspired by the West

When we model our houses like those in Western countries, we must understand that those countries do not get rainfall like Kerala. When we build houses and public buildings, we must take into consideration the geography of the area.

What are the possible solutions?

Do not build houses on paddy fields

During this flood, many people were complaining, in television interviews, that the flood water cannot drain into the rivers or seas because their route is blocked by the manmade constructions. Some houses are built on the paddy fields, whereby the flood water cannot go underground in those places.

Do not block the route of the rainwater

There is a saying in Hindi “Paani apna rastha nahi bhoolta”. Which means water does not forget its route. If the water knows the way, the human being in the area also must be knowing the way the rainwater flows to drain in the river or sea.

Ensure that rainwater is able to penetrate underground

When we construct roads and houses, or hardscape the front and back yards, we must ensure that the rainwater is given its due space to seep underground or flow into the river.

Do not ignore rain and rainwater

We cannot live in Kerala by ignoring the rain. If there is too much rain then there is the flood. If there is a scarcity of rain then there is drought. A few months ago Kerala government was planning to produce artificial rain by cloud seeding because of the scarcity of water in some regions.

The manmade constructions are one of the many reasons for the flood. If we make some correction in the constructions of houses and public building, and it’s surroundings, we can prevent flood to some extent.

There is a saying in Malayalam, “Annaan kunjum thannaal aayathu.” which means “every little help”.  The proverb comes from the story of the little squirrel that helped Lord Rama in building the bridge. Lord Rama blessed the squirrel by stroking on the back. Which caused three striped to form on the squirrel. And Lord Rama said that the service of the small one also matters in the completion of a big project.

I feel that our houses are the smallest block of development in Kerala. We must provide options in our homes for rainwater harvesting and also for the excess water to flow into the river. Our small action helps in increasing the water table levels in our area.

In television interviews, you can see the flood victims blaming the government. We forget that we are also part of the Government. Some things we can also do. Instead of waiting for the Government to do something, we must take ownership of developing our village in an environment-friendly manner.

We are indebted to nature. In a State like Kerala, which is Nature’s bounty,  you cannot ignore Nature and her fury and carry on development.

In this flood, the water was around 5 ft high. A bigger flood had happened in 1924. The flood which is known as the great flood of 99 Malayalam Era (ME) is said to have risen to 12 ft. The flood killed thousands and washed away a rail line. Even in that flood the reason for the flood was said to a manmade construction – the breaches in the Mulleperiyar dam.

Find a rain friendly fashion

Nowadays we wear leather chappals that get spoiled in rain. And jeans that take a long time to dry. We must find an alternative fashion which is rain friendly. The design of our homes and garments must be rain friendly. We must enjoy getting wet and dirty in the rain.

fashionable footwear

When in Kerala blend with rain

When you are in Kerala, instead of finding methods to protect yourself from rain, blend with nature. Give rain the utmost priority in all your activities.

 

 

 

 

10 reasons Why you must bicycle today, on world’s first ‘World Bicycle Day’

Today, June 3 has been declared as, the first, ‘World Bicycle Day’ by the UN. According to the UN declaration, one of the benefits of cycling is that “the synergy between the bicycle and the user fosters creativity and social engagement and gives the user an immediate awareness of the local environment”.

There is more to Cycling………….

Cycling is beneficial in improving your health, reducing pollution and increasing your understanding of your surrounding.

Feeling One with Nature

The oneness that you feel with nature is unique and cannot be experienced by using any other means of transportation. You cannot feel the experience even by walking.

Science-fiction are just fictions

We read so many science-fiction about the future where people will be far-removed from nature. They live in a technological habitat, surrounded by the gadgets and with little interaction with nature or fellow humans. Go cycling to change your perception. Man can coexist with nature even when they are immersed in technology.

Return to Nature

Now there is a change in perception. People are understanding the importance of Nature. There are many ‘back to nature’ and ‘sustainable development’ activities. The interest that people show in the kitchen garden, home cooking and nature tours are an indication that we understand that for the existence of the human species we need to live in tandem with nature.

Striving to Co-Exist

Understanding nature and striving to co-exist with the natural environment is a necessity. Nowadays most of us take a break from our city life, permeated by technology, and travel to places that are almost untouched by the automation.

Balancing Nature and Technology

We go back to nature because we know nature has much to offer to our existence. We get rejuvenated in our health by spending some time with the environment.  We tend to be more creative when we are closer to nature.  Preserving the environment is a selfish need of the human species. So we have the Nature movements and the Sustainable development models.

Cycling for Sustainable Development

When you cycle you will feel the breeze. You will see all the flora and fauna and humans around you.  As you are travelling in the open space, not in a closed vehicle, you will feel one with nature. That feeling of oneness is the beginning of your positive outlook towards the environment and other species.

World Bicycle Day

Feel the Surrounding

Yes, you can feel the nature with your five senses. When you travel in a car you are in a closed environment and artificial air conditioning.

Less pollution

There two types of pollution that happen when you Cycle. Since Cycle does not run on fuel,  you are saving the environment from gas emitted from fuels. On the other hand, your body becomes more immune to pollution. Your lungs and internal organs are healthier because of more intake of oxygen.

According to the UN cycling has ‘has a positive impact on climate”. If more people use cycle then there will less pollution.

World Bicycle Day

Health Benefits

When you cycle your cardiovascular fitness increases. There is the movement of joint and muscular flexibility. A number of diseases are prevented or becomes less severe by cyclings like diabetes, some cancers, arthritis and diseases.

Perfect transportation during traffic jams

On a day when there is a traffic jam, you can speed through the traffic. There is o excuse for being late to work.

In many countries, there are depots where you can rent a cycle and go the office. There is the twin benefit; you are following a fitness regime on a working day as well as having a pollution free commutation.

According to UN “The bicycle can serve as a tool for development and as a means not just of transportation but also of access to education, healthcare and sport”.

Enjoy bicycling today and share your experience in the comment box.

 

Alternative ayurvedic treatment for Knee Replacement

ayurvedic treatment for knee replacement
There is a general perception among the public that Ayurvedic treatments are for rejuvenation, or in simpler terms ‘to get refreshed’. However, in my recent visit to an Ayurveda hospital, I discovered that ayurvedic treatments heal a number of diseases. Many patients, who were rejected by the mainstream doctors, found successful recovery through ayurvedic treatments for diseases like cancer, skin diseases and knee replacement surgeries. Today I would like to share some of the anecdotes about patients who came here in search of alternative ayurvedic treatment for knee replacement. They came in search of a last resort to escape undergoing knee replacement surgery, or to escape the huge financial expense incurred in the surgeries. Find out why walking with thin people will help you lose weight quickly.

Forty years of knee osteoarthritis and still going strong

A nun used to take care of the elderly during her younger days. She used to carry the bed-ridden old people on her shoulder. As a result, she developed pain in her knees when she was around 40 years old. She consulted an orthopaedic doctor and he said that he can only prescribe painkillers for this disease so she should better go for ayurvedic treatment.
So she consulted an Ayurveda doctor and started taking ayurvedic internal medicines and external oil application. Only after she was sixty years old she had to take complete ayurvedic therapy for three weeks followed by 45 days of internal Medicine and oil massage.
Every five years she undergoes the three-week massage therapy that includes various bolus applications administered by masseurs.  Now she is above eighty and she is as active as an eighty-year-old should be. She says her timely switching to Ayurveda saved her. She has witnessed many of her friends, who did not treat the disease properly, die of arthritis and rheumatic pain. 

Saved the money

A fifty-year-old man was asked by a doctor to deposit Rs. 4 lac for knee replacement surgery. On the day before making the payment he consulted a  doctor friend who in turn got him introduced to an ayurvedic doctor. He was asked to take three weeks of ayurvedic therapy followed by 45 days of internal medication and external oil application. After a period of three months of ayurvedic treatment, he completely recovered with no requirement of knee surgery.
ayurvedic treatment for knee replacement

Knee replacement postpone for 5 years

A sixty-eight-year-old lady was asked to undergo knee replacement surgery so she consulted the ayurvedic doctor. The ayurvedic doctor also recommended knee replacement surgery. But the lady did not have the huge amount to spare so she wanted to undergo Ayurvedic treatment so that she can postpone the surgery for some more time. After undergoing the ayurvedic treatment, the doctor has guaranteed her another five years without going under the knife.
A US journal, Arthritis and Rheumatology, has found that 30% of the knee replacements in the US might have been unnecessary. In India also the condition doesn’t seem to be any different. Consulting an ayurvedic doctor before going for a knee replacement surgery may save money and also help in escaping from going under the knife.

Spare just 30 minutes a week for complete health and fitness

In order to remain fit and healthy one needs to exercise regularly and maintain a healthy diet. In India, 90% of the population do not follow any health and fitness regime or a healthy diet.

In India, we are aware of the benefits of exercise and diet. But we are unable to follow a health and fitness regime for a long time. There are many reasons to why we cannot  follow a fitness regime:

  • India is not a sporting nation.
  • Health and fitness come last our list of priorities of our daily routine.
  • Most people leave early in the morning for office and come late in the evening, so there is the time constraint.
  • Exercise and walks make you feel tired, thereby making you cut short some other daily routines.
  • There is no time to exercise after the daily chores.

health and fitness

Benefits of EMS fitness training

EMS technology, used at ZYNK Fitness Studio, gives you fitness and health by just working out for 30 minutes, every week, in their fitness studio.

How the EMS technology works

Electro Muscle Stimulation (EMS) technology stimulates the muscles in the body just as in workouts. The movement of the muscles is called the contraction. The fitness achieved from exercise depends on the number of contractions of the muscles. The EMS technology used at Zink produces 3600 contractions in 30 minutes which is not achieved even by two hours of Gym exercise.

In a normal gym routine, every time a contraction is done by the muscle the message is sent to the brain.  Thus the process becomes tiring. In the EMS technology, every contraction produced by the electrode is effective as 10 contractions in a normal gym workout. When the information of one contraction is sent to the brain, the muscle has already done 10 contractions with the EMS. Therefore we feel relaxed while doing an EMS fitness routine.

The Zynk fitness trainers say that during a normal gym routine some of the muscles do not get exercise. But in EMS training, 90% of the body muscles are activated.

The person is made to wear a specially made jacket with EMS electrodes. The size of the jacket varies from person to person. The EMS used at Zynk fitness is wireless.

health and fitness

Who can do the workout using EMS

Athletes

This technology has been used by professional athletes like Usain Bolt, Karim Benzema, and many others. Athletes do EMS training for more strength, more endurance, more speed and more flexibility. EMS shot into prominence when YohanKots, a Soviet Scientist, revealed that EMS could boost strength by up to 40% in elite athletes.

Weight loss

According to Vani Trivedi, of Zynk Fitness, “For 48hours after workout body in on a weight loss mode.” With a proper diet and EMS training, you can lose weight in 90 days.

Sitting job complications

For those who suffer from neck and back pain due to continuous sitting jobs, EMS therapy is very effective. EMS technology used in rehabilitation and training for people under physiotherapy.

Post pregnancy

EMS helps to tone the body and helps achieve the original weight and tone. It supports the regeneration of deep muscle fibres and connective tissues affected by pregnancy.

Benefits of using EMS

All areas of the muscles are covered

In the gym, all areas are not covered. But with EMS 90% of the muscles are covered. Electrode works all over the body.

Improves skin tone

EMS is very effective for skin. The skin glows after undergoing the training. As one gets older skin gets sagging, and it not toned and tight. Your skin tone improves with EMS training.

Keeps you young for longer

Growth hormones are responsible for our looking younger. Celebrities do botox to look younger. By EMS training you can boost growth hormones well. It will keep you younger for longer.

Keeps you fit and healthier

When you age, size of bone gets weaker and smaller. EMS does systematic work of bones and muscles and not joints. You feel oiling happened in every bone. Every bone feels fresh and light. Therefore your confidence increases.

There is an overall improvement in health and fitness because of deep tissue strengthening, improvement in the cardiovascular system and improvement in blood circulation.

Why at zynk Fitness?

There are over 1000 similar centres around the world, this is the first  EMS fitness studio in India. You can workout without being tired. Even after having a long day’s works you feel rejuvenated after the Zynk fitness training.

Besides if you come for the Zynk fitness session before going to the office, you can have a shower and look fresh. As there is negligible sweating you feel relaxed after the workout.

The is no pain of exercise and you do ten times more of fitness training. The trainers at Zynk say that EMS works on the muscles and bones, and not on the joints. Injuries happen when there is overload on the joints.

According to the Zynk fitness trainer, the EMS workouts produce long-lasting results using simpler workouts.

 

What is the behavioural approach used in ADHD? (ADHD Part -IV)

What is the behavioural approach used for treating ADHD?

The behavioural approach, for instance, is to increase the attention span of the child. In mild to moderate only behavioural management is needed.  It could be in the form of a game, depending on the age of the child. Depending upon the developmental level of the child we give them tasks to improve their attention skill:

Games and Activities

What is the behavioural approach used in ADHD?We prescribe certain games and activities where the child can sit and persist with the task. That will improve the child’s attention span.

At School

What is the behavioural approach used in ADHD?For the classroom instruction, we sometimes give a letter to the teacher suggesting where he should be seated.  The teacher should have proximity to the child. Seat given to the child should not be near the window side, door side or outskirts. The child should be given aisle seat so that he can have eye contact with the teacher. These will help him focus on activities in the classroom. The teacher should be monitoring the child so that his attention doesn’t wander. They should examine the notebooks frequently so that the books are complete. The child should be called his or her name. If he is called by his name, his attention span will persist.

Appreciation and Rewards

What is the behavioural approach used in ADHD?The parents and teachers are instructed to reward the child whenever he behaves well. Usually, his hyperactivity or impulsive behaviour is judged as indiscipline in the school. He is scolded and not much of positive comments are obtained by the child. Parents and teachers are asked to look out for even the smallest good behaviour. He must be praised and rewarded with gifts. He must be given small responsibilities in the class like carrying the books to the staff room so that he feels that he is worthy. In this way, his behaviour is likely to improve.

At home

Medication for ADHD (Attention Deficit Hyperactivity Disorder)Parents are asked to give clear instruction to the boy to keep his shoes, bags and toys in its proper place.  Thus his life will become more structured. Whenever he complies with the parents’ expectation of the kind of behaviour they expect from him he can be rewarded.

Nurturing their Abilities

What is the behavioural approach used in ADHD?When we assess the child we assess their potential. Some of them are good at sports. So encouraging them in sports is part of the behavioural therapy. Some may be good in arts or electronics, so channelizing their ability will help them.

‘Time Out’ Method

What is the behavioural approach used in ADHD?Parents are trained to deal with impulsive behaviour. Sometimes they have to set limits when the child is exceeding certain limits. In very severe situations parents may be asked to keep the child in a room so that anger comes down. It is not a punishment but a principle of ‘time out’.  This principle has to be applied only sometimes.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

How ADHD is diagnosed?(ADHD Part -III)

How ADHD is diagnosed?(ADHD Part -III)

How is ADHD diagnosed?

On a simple physical examination, you will not find anything abnormal. MRI or CT scan will not show any abnormality. If you do a functional brain imaging you may find that these circuits are dysfunctional.

A simple physical examination will not reveal anything abnormal.

Usually, we do not diagnose ADHD when the child is 3 or 4 years unless it is a very severe condition. We wait till the child is 5 or 6, by the time the child will go to school and some external discipline will come.

Who Defines criteria for Diagnosis of ADHD?

Authorities like International Classification of Diseases (ICD) by World Health Organisation (WHO), American Psychiatric Association(APA) and Diagnostic and Statistical Manual of Mental Disorders(DSM) are the world authorities that define criteria for diagnosing ADHD.

What is the process of Diagnosis?

Diagnosis of ADHD is not based on any laboratory test. We do not have a lab test or a scan to Diagnose ADHD. It is based on the history provided by the parents and teachers and the direct observation of the child by a trained professional. It is a clinical diagnosis. Functional brain imagery is available only in research labs.

What is the next step after ADHD is diagnosed?

So once you diagnose ADHD, the next step is to educate the parents and teachers. We take collateral information from teachers also. In our centre, there is a form called ‘teacher’s observation report’ about the child. The teacher fills information about child’s behaviour in school and class. We also ask them to bring their notebook because that may show some careless mistakes which are common in ADHD.

Parents and teachers might think that the child is only an indisciplined, overprotected and pampered child.

We collect information from other sources if available.  All those assessments are taken into account and if the assessment satisfies for ADHD, we teach and educate the parents about the problem. And after completing the assessment we talk to the parents. We need to educate the parents. They might think that the child is only indiscipline, overprotected and pampered child.  We talk about options to manage the problem. And see whether he is able to cope with the management procedures.

When do you finally Confirm that a child has ADHD?

We have to check for any medical conditions that are like ADHD. For instance, some may have epilepsy or anaemia. So there has to be a physical examination. The next step is to examine for some conditions that occur with ADHD. For instance dyslexia, a specific learning disorder (SLD) which is known as a learning disorder.

There are two approaches to manage the disorder- behavioural approach and pharmacological approach.

Almost two-thirds of the children with ADHD also have SLD along with it. ADHD is rated as mild, moderate and severe depending on the number of symptoms present and the functional impairment it produces. Mild cases may not require medication. In moderate and severe cases the option of medicine is given to the parents.

What are the procedures to manage the disorder?

After all the assessment we call a section once again with the parents. Education is given to them, explaining the problems and giving them management options.

We teach the parents, give suggestions to the teacher and encourage the child is the behavioural components of ADHD.

There are two approaches for managing the disorder – behavioural approach and pharmacological approach.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

READ MORE…

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

What is the behavioural approach used in ADHD? (ADHD Part -IV)

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

What is ADHD (Attention Deficit Hyperactivity Disorder)?

Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder. Some say that there is no such disorder, which is incorrect. It is a worldwide accepted condition. It is a brain development disorder occurring in about 5 to 7 percent children.

It is a brain development disorder occurring in about 5 % to 7% children.

In certain brain development disorders, the physical features are visible. In Cerebral Palsy and Down Syndrome, for instance, the physical features are evident and hence these are accepted as real disorders. But, when you look at a child with ADHD they may not have any visible physical anomaly. And therefore it is not recognized as a medical condition. The behavioural manifestation of ADHD could be passed on as a naughty behaviour of a normal childhood, or even smartness. In these children there are no physical abnormalities, they have behavioural problems.

What are the mental functions that are affected in ADHD?

Attention deficit

What is ADHD (Attention Deficit Hyperactivity Disorder)?

 

The ability to focus attention is the function of the brain. As far as a school child is concerned he should have approximately 30-40 minutes of attention span.  There should be a coordination of eyes, hands and mind. Brain should be able to focus these functions.  That varies from person to person, but with children with ADHD, attention holding function is very grossly impaired.

What happens is that the child will not be able to persist with the task. In the classroom, he will not be able to pay attention for a long time, and this will affect his academic performance.

Hyperactivity

What is ADHD (Attention Deficit Hyperactivity Disorder)?

Generally, a five or six-year child is able to sit quietly and keep calm when they are engaged with some serious activities. But children with ADHD will not be able to control their action. They will be very fidgety, restless, squirming on the seat and moving around.   In addition to the distractibility, if the student is restless he can disrupt the whole class. The energy might be considered as the smartness of the child; however, it is an illness. It is “Disruptive” overactivity. Normally school going children are active and exuberant. That is not hyperactivity. Disruptive overactivity is called hyperactivity.

In addition to the distractibility, if the student is restless he can disrupt the whole class. The energy might be considered as the smartness of the child; however, it is an illness. It is “Disruptive” overactivity. Normally school going children are active and exuberant. That is not hyperactivity. Disruptive overactivity is called hyperactivity.

Impulsivity

What is ADHD (Attention Deficit Hyperactivity Disorder)?Impulsivity means they are unable to hold their responses. Whenever they are angry they may use bad words. They may be talkative in class and they may find it difficult to wait for their turn in group activities. They may blurt out answers even before questions are finished.  They are unable to hold their emotions. Impulsivity can land them in trouble.

When attention deficit, hyperactivity and impulsivity combine that produces this syndrome called ADHD.

What can be the reason for ADHD?

The exact reason cannot be pointed out. The genetic factor could be a reason for ADHD. Many parents say that the father also was hyperactive in his childhood, but in those days, no one realized that it was ADHD. Nobody is sure why it happens in some children.

Nobody is sure why it happens in some children. Basically, there could be some genetic influences.

Basically, there could be some genetic influences. It could be some infection or toxins that the mother carried when she was pregnant. Many a time we are unable to pinpoint that this is the cause, but these are the possibility. Scientific research has shown that the circuits in the brain that control the motor activity – brain circuits which control the impulsive reactions – these circuits are dysfunctional.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

READ MORE…

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

How ADHD is diagnosed?(ADHD Part -III)

What is the behavioural approach used in ADHD? (ADHD Part -IV)

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

Do you know ADHD occurs in about 5% to 7% children? If a child behaves a little different from others, then teachers recommend them to be taken to the psychiatric counsellors. The counsellor might diagonise the disorder as ADHD (Attention Deficit Hyperactivity Disorder).

There are many concerns among parents: Whether we should take the child for a counselling section? If the counsellor says that the child has to take medicine, then do we really have to follow the advice? Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? Will there be any side-effects of the medication? Will the child be branded as mentally unfit, if he goes for the counselling sections?

I had a discussion with Dr. Varghese Punnoose, an MD in Psychiarty regarding ADHD (Attention Deficit Hyperactivity Disorder) and its medication. He discussed every aspect of the disorder from the symptoms to the medication and the misunderstandings. Dr. Punnoose is specilaised in Child Psychiatry.  He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala. 

Read on to know more about Medication for children with ADHD………..

When do you prescribe medicine for children with ADHD?

In moderate to severe ADHD, we give the option of medication to the parents. Medications are not prescribed on the first day that the child comes to us. The medication is suggested only after two or three sitting. After a complete assessment, if the child needs medication, the parents have to take the decision. The child is a minor by legal terms and they cannot take a decision on their own. And we do not force our decision. We give a recommendation of medication as an evidence-based scientific option. Medications available in India are mainly two types – Methylphenidate, a stimulant group of medication and Atomoxetine.

What are the concerns parents have regarding the medications?

Many a times parents are apprehensive about the medicines that the doctor prescribes for hyperactivity. They are doubtful that the medicines are sedatives which will damage the child’s brain or make him dull and sleepy. Or the child may develop some addiction or dependence on medication.

These are much-distorted facts which are being propagated partly from ignorance and partly from some vested interest.

These are much-distorted facts which are being propagated partly from ignorance and partly from some vested interest. These medicines are specifically developed by scientific authorities with evidence for their efficacy as well as safety. They are used all over the world. Methylphenidate is available in the last thirty/forty years. Atomoxetine is available for the past 10-15 years.

Is there any benefit of the medication?

They will not cure ADHD, but they will correct some of the symptoms of ADHD. 70% of the children will improve attention span. The child will be able to hold attention for a long time.  They can bring down hyperactivity not by sedating but by bringing down the extra overactivity. The brain gets a better control of motor activity.

Most of the side effects are not serious, that is why these medicines are approved for paediatric treatment.

There is no sedation or tranquillizing. The brain gets more ability to control the impulses. So the attention span improves that translates to improvement in academic functions. Hyperactivity and impulsivity in reduced. That translates to improvement in behaviour. 60%-70% children get benefitted from medication.

Will the medications cause any side effects?

Of course, they produce side-effects. But no major side effects like brain damage or addiction. Most of the side effects are not serious, that is why they are approved for paediatric treatment.

Government is very strict about approving medicines for paediatric cases. These two molecules have passed all the tests, and they are time-tested.

Loss of sleep

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childThe possible adverse effects that we come across are if we give methylphenidate as a night time dose. The medicine will interfere with sleep. Usually, they are given as daytime dose – one in the morning or one in the afternoon.

Loss of appetite

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childThe second problem is that they may produce loss of appetite and weight loss. In some children, it may produce anorexia, loss of appetite. But again it is for a limited period. After a few weeks, they will get out of it.

Growth retardation

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childThere were apprehensions that use of Methylphenidate could result in growth retardation. But long-term follow-up studies have not demonstrated any significant growth retardation in children on Methylphenidate. However, height monitoring is recommended.

What is the consequence if the medication is withdrawn?

If at all the parents are worried, then there is no problem in withdrawing the medicines or discontinuing the treatment. Very rarely some children may develop liver dysfunction or some other issues for which the children are carefully monitored. But practically we do not come across such issues.

How long to continue medication?

There is no clear-cut answer because we cannot prescribe the medicines are not like a course of antibiotics for the infection. This is a system dysfunction which varies from child to child.

Initially, the children are monitored weekly, then monthly, then once in three months, once in six months. And if the attention span in improving and ADHD score is coming down and the child is able to manage without medication, then the child may not require medication.

If you discontinue, the only thing is that some advantage that you would get from the medication.

In most of the cases, children are diagnosed with ADHD when they are in fourth standard, fifth standard or sixth standard. And they may continue medication up to ninth, tenth or eleventh also. That varies from person to person. There is no worsening.

Sometimes parents are apprehensive that if they stop the medication then thinks will become worse. Nothing like that happens. Only thing is that some advantage that you would get from the medication will not be there if you discontinue.

Why there are some apprehensions regarding the medications?

There are apprehensions about methylphenidate, the stimulant group of medications. Methylphenidate can be abused by adults that is why there is a lot of restriction on prescription. Only a qualified psychiatrist can prescribe this medication. Because of the restriction, parents are worried that this is a very dangerous component. The abuse potential in the paediatric case is nil. This has been used for the past three or four decades.

Atomoxetine does not have such restriction for the prescription. Deciding which medication to give for the child is a clinical decision. There are conditions where we prefer methylphenidate and there are conditions where we prefer atomoxetine.

Is it compulsory to take Medication for ADHD (Attention Deficit Hyperactivity Disorder) child?

We always tell the parents that medication is not the only thing; it is part of the whole package. The main emphasis is on educating the parents and teachers and encouraging the child. All are involved to improve the behaviour of the child. In moderate to severe cases medications are used so as to take away the biochemical block. If the medication is taken then the behavioural therapy becomes more effective. But if the parents are unwilling then they are not forced to take medications.

What about suicidal behaviour due to Medication?

Suicidal behaviour is not related to ADHD. Impulsive behaviour may lead on to impulsive self-injurious behaviour. However, there are no such reports in India. Whenever there is such reporting it will be put to stringent examination by authorities like The Food and Drug Administration (FDA), of the United States of America. And if at all there is the slightest suspicion of such kind of a problem they will immediately order to suspend/ban the product.

If at all there is the slightest suspicion of such kind of a problem authorities like FDI will immediately order to suspend/ban the product.

The first common cause of death in adolescence is accidents, the second is suicide. For an adolescent to commit suicide there can be a large number of factors.  If the child was on a medication when he committed suicide then that has to put for scientific scrutiny. None of the studies so far have shown such results, if in case there were any issues stringent measures would be taken. So far no instructions have come. In India, approval is there only for atomoxetine and Methylphenidate.

How long will the medicine remain the system after the medication is withdrawn?

It will be there in the blood for maximum two days. It is not going to be permanently deposited in the system.

Should medication continue in adulthood?

Almost 60 percent of the symptoms may continue. Whether medication is to be continued in adulthood is a very controversial topic. In our centre, we do not generally encourage medication for the adult. We leave it as an option for children and adolescents.

Why controversies regarding ADHD?

Controversies happen because of overdiagnosis of ADHD. From certain reviews, I find that overdiagnosis is done in certain provinces in the United States. From there the movement has come that children are being medicated unnecessarily. The overdiagnosis issue is not an issue in India. Here the issue in underdiagnosis.

Why there are advocacies against medications for ADHD?

There should be some advocacy to protect the right of the citizen. Children need protection. Advocacy is good because there will be checks and balances. The opposite result happens when deserving children, who should get the advantage of medication, are denied medication because of the stir.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

READ MORE…

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

How ADHD is diagnosed?(ADHD Part -III)

What is the behavioural approach used in ADHD? (ADHD Part -IV)

3 New year resolutions for people with arthritis

Every year we take new year resolution to give up a bad habit or to begin a good  one. This years theme for World Arthritis Day on October 12th was “It is in your hand, take action” to live life to the fullest. Most of the people with arthritis, whom I know, put in lots of efforts so that they can keep in pace with the demands of the world and live life like normal human being. The excruciating pain, fatigue and disability are some of the hindrance for a arthritis patient. Some succumb to the condition, while other turn all the obstacles into opportunity. If those suffering from arthritis take some new year resolutions to improve their lifestyle then they too can live their life to the fullest.

Arthritis is becoming quite common in Delhi, especially after the yearly outbreaks of Chikungunya virus.  People experience joint pain and difficulty to walk even a few months after they had Chikkungunya. Now a days, if you stagger, people inquire if you were suffering from Chikkungunya.

There is lot of commonality between Chikkungunya and Arthritis pain, and in some cases Arthritis pain and deformation are triggered after a Chikungunya attack.  People of any age can get arthritis, but if you take some precautions you can avoid worsening of the  condition. If you chart out a healthy lifestyle pattern for yourself, some of the damages get repaired and you can enjoy a normal lifestyle.

Most of the arthritis patients I meet have come up with their own creative methods to mitigate the pain. Some rely on allopathic medicines, others on Ayurveda and some on herbal remedies. They now know which food causes pain and which one relieves pain.

On this New Year, those suffering from arthritis should take the New year resolutions to live life to the fullest. Here are a few, new year resolutions, ideas based on the experience of those arthritis patients who have overcome all odds by following a healthy lifestyle:

Eat the right Food

Preferably follow a vegetarian diet, which is easier to digest. Some fishes are good, but egg and meat are better not to be consumed regularly. Have lots of water especially on an empty stomach.

And sometimes it is good to fast. Most religions have fasting period in the religious calendar. If you follow the fasting with discipline that will help relieve the pain. If you have never fasted in your life, then consult a doctor before fasting. Arthritis is an auto-immune disease where the body cells are attacking one another. Experts say that  during fasting period the body cells get time to relax and repair.

Walking and Exercise

Of all the medicines, walking is the best prescription for arthritis. Some say that they walk instead of driving or riding a scooter. But that is not enough. Every day you must walk atleast 20 minutes, as part of fitness regime. Consult your doctor to find out how much time is recommended for your walking and exercise. Also find out if you are permitted to Jog. Walking is the best medicine for arthritis. If you walk atleast 5 days a week, you can maintain a healthy lifestyle. When you feel pain, doing exercise will mitigate the pain.

Meditation and Spirituality

Mental and spiritual well being is a crucial aspect of arthritis. The condition aggravates when one is mentally disturbed. Hence you should spend atleast an hour every day for Meditation. You must find the inner peace and the soul connect. Many patients with RA positive,and some even chronically bed ridden, claim to have been miraculously cured because of their belief in God. Some doctors recommend meditation  for an hour daily. Being at peace with oneself and avoiding stress helps in coping with arthritis.