TYPE 2 DIABETES

  Diabetes begins when cells that normally respond to insulin, such as muscle and liver cells, become insulin resistant. Insulin is a hormone, a chemical "password" that tells a cell to admit glucose (blood sugar). When cells don't admit glucose into their interiors, sugar builds up in the blood, which has dire consequences for tissues and organs throughout the body. Diabetes is especially pernicious, then, because the damage it causes can crop up almost anywhere. Insulin resistance usually occurs several years before true diabetes develops. Insulin is secreted by the pancreas and "talks" to cells via insulin receptors on the cell membrane. Once these receptors allow glucose to enter the cell, it is either used immediately as fuel or stored for later use.  We now know that our bodies are nothing less than a constant conversation among chemicals that communicate with a trillion cells thousands of times per second.
To really understand what is happening, however, we must move from the molecular level to a person's lifestyle. In the sixth century BCE, an Indian physician, Susruta, is recorded as the first to diagnose diabetes and to prescribe a treatment. His analysis seems remarkably modern. Susruta wrote that diabetes was either congenital (what we would call Type 1 diabetes) or a result of poor diet and a sedentary lifestyle, often resulting in obesity (Type 2 diabetes). His prescribed treatment sounds familiar today: eating a healthier diet, taking long walks, engaging in sports such as wrestling and riding on a horse or elephant.
Your cells grow accustomed to the messages they receive; they have habits that reflect your habits. At present, those habits are trending the wrong way. About 80 millionINDIANS have diabetes -- that's about 6 percent of the population. About a third of these, 27 million people, are undiagnosed. Experts believe that diagnosed diabetes will increase 165 percent by 2050. That means that one in three people born in 2050 will be affected by the disease. Type 2 diabetes used to be called adult-onset diabetes because it almost never developed in children. Now, however, a disturbing number of cases are appearing in young people.
Ironically, as more people gain access to a comfortable way of living, lifestyle disorders create a backlash. Type 2 diabetes has become a global epidemic, too. The World Health Organization estimates that over 220 million people around the world have Type 2 diabetes (90 percent of people with diabetes worldwide), and it is among the top five causes of death in most developed countries. The economic cost of diabetes is enormous, not just to the individual, but to society as well. In the U.S., the total costs (direct and indirect) of diabetes in 2007 were estimated to be $174 billion.
Science still doesn't understand exactly how and why Type 2 diabetes develops, and this problem is the subject of intense research all over the world. It may be that something goes wrong with the insulin receptors or with the glucose transporting process. Whatever the causes, the pancreas responds to the increased levels of glucose in the blood by producing ever-greater amounts of insulin. For a while the increased levels of insulin do work to force the target cells to accept more glucose. This temporarily keeps blood sugar levels within their normal range. But over time the overworked pancreatic beta cells lose their ability to produce extra insulin -- they "burn out." Then blood sugar levels remain elevated, a condition termed hyperglycemia. Blood levels of insulin can also become very high: this is known as hyperinsulemia.
Type 2 diabetes can progress for months or years without symptoms, an insidious reason for the disorder being so dangerous. So it's important to be tested by a doctor if you have symptoms or risk factors for Type 2 diabetes.
Symptoms include:

• Frequent urination
• Increased thirst
• Slow-healing sores or frequent infections
• Constant hunger
• Unintentional weight loss
• Tingling hands and feet
• Blurred vision
• Fatigue and irritability
• Swollen gums

Risk factors for Type 2 diabetes
As we saw, prevention of Type 2 diabetes is simple and straightforward, or should be. What looks simple theoretically can turn out to be quite difficult. About 90 percent of people with Type 2 diabetes are obese or overweight: it's the number one risk factor for Type 2 diabetes. The number two risk factor is having a sedentary lifestyle (exercising fewer than three times a week). Other risk factors are being over the age of 45, belonging to certain races (including African American, Hispanic, American Indian, and Asian American), having a parent or sibling with the disease, and having had gestational diabetes (diabetes developed during pregnancy).
Because diabetes can progress for months or years without symptoms, anyone who is overweight or obese and who has one or more additional risk factors should be tested. With or without risk factors and symptoms, all adults should be tested for prediabetes or diabetes starting at age 45. Children or teens who are overweight or obese and have other risk factors, such as a family history of diabetes, should be tested starting at age 10 or at puberty, whichever comes first.
Widespread harm
Since prevention is obviously the main goal, I won't dwell on the damage caused by diabetes. Most of this damage is through its effects on blood vessels, both large and small. At high levels, glucose acts as a toxin on the cells that line blood vessels.

• Cardiovascular disease (disease of the heart and blood vessels) is the main cause of death in people with diabetes. About three-quarters of people with diabetes die of cardiovascular disease. People with diabetes have a two to four times higher risk of developing atherosclerosis and of having a stroke than people without diabetes
• Kidney disease. Because the kidneys are densely packed with millions of tiny filtering capillaries, they are especially likely to be damaged by diabetes. Symptoms may not appear until only 10 percent of the kidney's filtering function remains.
• Vision damage. The retina, the delicate membrane that lines the back of the eyeball, may be damaged by diabetes. High glucose levels injure the tiny capillaries in the retina, which start to break and bleed. Diabetes also increases the risk of developing cataracts and glaucoma.

Nerve damage, or neuropathy, is also involved. The myelin sheaths that surround nerve cells are very sensitive to changes in glucose concentration. Nerves can also be damaged when damage to the capillaries that feed them cuts off their blood supply.
Monitoring glucose levels
As standard practice, it's considered important for diabetics to monitor their glucose levels. Keeping track of your blood sugar allows quick responses to levels that are too low (hypoglycemia) or too high (hyperglycemia). It also helps in planning meals, activities, and medication times. The latest glucose monitors require only a tiny drop of blood, and it doesn't necessarily have to come from a finger.

But we also need to consider the stress caused by constantly monitoring any condition, whether it is diabetes or high blood pressure. In the body's feedback loops, all messages are received by the cell membrane, including messages relating to stress, your work environment, relationships, mood and general sense of well-being.  You cannot "feel" your blood sugar levels, and once you begin to change your lifestyle, there is every reason to focus on how your life is going in general, with much less focus on chemical monitoring. Blood sugar follows cycles, like everything else in the body. One day's high reading may be meaningless, but it can lead to panic and worry. Is it worth ruining a whole day in order to fixate on a number?
The key to getting past any lifestyle disorder, including Type 2 diabetes, is to move in the direction of balance and moderation. This doesn't mean grim discipline. Instead, you ask yourself on a daily basis:

• Am I doing something that makes me happy?
• Can I give up a little of what isn't good for me?
• How do I feel about my progress toward well-being?
• Can I foresee the weak or tempting moments I need to be most careful about?

In the spirit of making your life better, the preventive steps for Type 2 diabetes fall into place more naturally.
Weight loss
Anyone with prediabetes or diabetes who is overweight has a number of very good reasons to lose weight. For someone with prediabetes, losing just 5 to 10 percent of body weight significantly reduces blood sugar levels and reduces insulin resistance. For someone who weighs 200 lbs, that means losing as little as 10 lbs. When losing weight is combined with regular exercise, the risk of developing diabetes is cut by 58 percent. And there's another, very significant benefit: losing 5 to 10 percent of body weight lowers the chances of having a heart attack or stroke. If you already have diabetes, studies have found that weight loss can significantly reduce symptoms of diabetes and insulin resistance.
The American Diabetes Association recommends a slow-but-steady weight loss goal of .5 to one pound per week. It's very useful to consult a registered dietitian for help in changing eating habits, controlling overeating, and designing a diet plan you can live happily with and that provides the right sort of nutrition for diabetes.
Eating right for diabetes
There is no specific "diabetes diet."  A healthy diet for diabetes is the same as a healthy diet for anyone: rich in nutrients and fiber and low in refined carbohydrates, high-glycemic-index foods (like potatoes), and saturated and trans fats. The glycemic index (GI) classifies carbohydrates based on how quickly and how much they boost blood sugar compared to pure glucose. Foods that have a low GI are absorbed slowly in the digestive tract, raising blood sugar evenly over a long period of time.
Exercise
Exercising regularly is one of the best things you can do for diabetes. Exercise, whether anerobic or aerobic, induces both your muscles and your liver to take up more glucose, lowering your blood sugar levels. Exercise decreases insulin resistance, normalizes blood pressure, improves sleep and decreases stress.
Talk to your healthcare practitioner before starting a new exercise regimen. Choose something you enjoy and that's at the right level for your current fitness. It's best to exercise every day, at the same time.
Quit smoking
If you smoke, quit now. Smoking is especially bad for people with prediabetes or diabetes. If you don't now have diabetes, smoking makes it three times as likely that you will develop it. Smoking further damages already compromised blood vessels, constricting them and injuring them. It causes complications, like kidney disease, retinal disease and foot problems, to occur sooner, and increases risk of death. What's more, nicotine has been found to directly increase blood sugar levels.
De-stress
Being stressed stimulates the production of corticosteroids, the "stress hormones," which increase blood glucose levels. By the same token, studies show that reducing stress can lower blood sugar levels. Try meditation, biofeedback, or focused breathing techniques. Just doing something you enjoy, like gardening or reading, can be a good way to de-stress. Exercise (aerobic exercise, yoga, tai chi) is an excellent de-stressor. Support groups and therapy may prove very helpful as well.
Supplements and botanicals
These come into play only after you have seriously considered lifestyle changes; they are not a substitute, much less a cure-all. Some people with diabetes have found chromium or alpha-lipoic acid (ALA) to be helpful in controlling their blood sugar. ALA, an antioxidant, may also be useful in treating nerve damage.
Certain botanicals, including cinnamon, fenugreek, ginseng, bitter melon, aloe vera, prickly pear cactus, gurmar (an Indian herb whose name means "sugar destroyer") and Coccinia indica (ivy gourd) may help to control blood glucose levels. In Chinese and Indian traditional medicine, combinations of botanicals are used to treat diabetes, and there is some evidence that this results in a synergistic effect. Consult with an experienced practitioner of Chinese or Indian medicine if you would like to investigate these treatments.
Acupuncture
Some people with peripheral neuropathy -- pain in the hands and feet due to nerve damage from diabetes -- have found that acupuncture helps to relieve their pain. Acupuncture has few if any dangerous side effects, so it may be worth investigating this form of treatment.
Medications
If lifestyle measures don't sufficiently reduce blood sugar levels, then medications may be prescribed. Medications may lower glucose levels by increasing insulin production by the pancreas, boosting cell sensitivity to insulin, and delaying absorption of glucose from the intestines. Numerous medications are available, and often more than one is prescribed.
Insulin may be prescribed if taking noninsulin glucose-lowering drugs doesn't get blood sugar levels under control. Insulin must be injected using a syringe, an insulin pen, or with an insulin pump.
In mainstream medicine, diabetes is a circle of chemicals, leading from the insulin produced naturally by the pancreas to the insulin injections prescribed for millions of diabetics. Yet a much larger circle is actually involved. The circle of life embraces who you are and how you want to live. Diabetes, like every other lifestyle disorder, is an indicator that change is required. This doesn't mean chemical change. It means redefining how you want to achieve well-being in the healthiest possible way.
Around the Web: Type 2 - American Diabetes Association
Type 2 Diabetes: Symptoms, Causes, Treatments, and More
Type 2 diabetes - MayoClinic.com
Type 2 - American Diabetes Association
Diabetes mellitus type 2 - Wikipedia, the free encyclopedia
Type 2 Diabetes: Symptoms, Causes, Treatments, and More
Type 2 diabetes - MayoClinic.com
Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 ...
Type 2 Diabetes: What Is It?
Type 2 Diabetes - Causes, Symptoms, Treatment, Complications ...
Diabetes Risks, Symptoms, Treatment - eMedicineHealth.com

DEPRESSION

It's not news that depression has become a kind of invisible epidemic, afflicting millions of people. We live at a time when depression is approached as a disease. That has a good side. Depressed people are not judged against as weak or self-indulgent, as if they only need to try harder to lift themselves out of their sadness. Yet depression, for all the publicity surrounding it, remains mysterious, and those who suffer from it tend to hide their condition -- the medical model hasn't removed a sense of shame. When you're in the throes of depression, it's hard to escape the feeling that you are a failure and that the future is hopeless.

Before considering how to handle depression, let's ask the most basic question: Are you depressed? The bad side of the medical model arises when people rush to be medicated because they don't like how they feel. Doctors barely bother to get a correct diagnosis, because the easiest thing to do -- and the thing that patients demand -- is to write a prescription.

Let's see if we can get beyond this knee-jerk reaction.

Becoming sad or blue isn't a sure sign of depression. Life brings difficulties that we respond to with a wide range of normal emotions: sadness, anxiety, resignation, grief, defeated acceptance, helplessness. Moods are cyclical, and if these feelings are your response to a tough event, they will subside on their own in time. If they linger, however, and there seems to be no definite cause or trigger, such as losing your job or the death of a loved one, depression is accepted as the conventional diagnosis.

Depression isn't one disorder, and even though an array of antidepressants have been thrown at the problem, the basic cause for depression remains unknown. For a diagnosis of major depression, which is more serious than mild to moderate depression, at least five of the following symptoms must be present during the same two-week period:

• Depressed mood (feeling sad or empty; being tearful)
• Markedly diminished interest or pleasure in all, or almost all, activities
• Significant weight loss when not dieting, or weight gain, or decrease or increase in appetite
• Insomnia or hypersomnia (sleeping too little or too much)
• Slowing of thoughts and physical movements
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

If you can count five or more of these as being present, know that your list must contain "depressed mood" or "diminished interest or pleasure" before you'd be considered medically depressed. We've come to recognize different kinds of depression that fit certain circumstances:

• Dysthymia is mild, chronic depression. It must present for at least two years for a diagnosis of dysthymia.
• Seasonal affective disorder (SAD) is a form of depression that generally arises as the days grow shorter in the autumn and winter.
• Postpartum depression begins after a woman has given birth and may get worse as time goes on.

Even though no one knows exactly what causes depression, it is clearly a state of internal imbalance. Balance is essential for the healthy functioning of both your body and your mind. The upsetting factors that make it more likely you will get depression form a long list: genetic predisposition, being female, death or loss of loved one, major life events (even happy ones, like a graduation), other mental illnesses, substance abuse, childhood trauma, certain medications, serious illness, and personal problems such as financial troubles. What these things have in common is that they disrupt the normal balancing mechanisms of mind and body. A treatment that aims at restoring balance therefore makes the most sense, and you can participate in these.

Re-balancing yourself forms its own long list of things you can do:

• Be aware that you are depressed and seek help.
• Treat your body well, including exercise.
• Reduce stress.
• Get enough sleep meaning a minimum of eight hours a night.
• Address situations that would make anyone sad, such as the wrong job, a bad relationship, normal grief, and serious loss. Don't passively wait for time to heal your wounds.
• Regain a sense of control.
• Examine your reactions to difficult situations. You will often find that reacting with helplessness, passivity, retreating inside, and turning passive lie at the root of your depressed state.
• Spend time with people who give you a reason to feel alive and vibrant. Avoid people who share your negative responses and attitudes. Depression in some sense is contagious.
• Rely to a minimum on antidepressants and apply your main efforts to other therapies. Pills should be as short-term as possible. They work best in removing the top layer of sadness so that you have a clear space to address the real underlying issues.
• Talk about your problems and share your feelings with those who can listen with empathy and offer positive steps.
• Make friends with someone who has recovered from depression or is handling the condition well.

Find a wise person who can help you to undo your most negative beliefs by showing you that life has other, better possibilities.

Because everything on this list requires a choice, bringing yourself back into balance means that you are aware enough to make decisions and have the ability to put them into practice. Quite often depressed people feel too helpless and hopeless to face the right choices, in which case outside help is needed, meaning a therapist or counselor who specializes in depression.

Here's a general picture of how to make a plan for your own healing.

Psychotherapy, or talk therapy, works as well as medication for many people. It may be used alone or in combination with other forms of treatment. Studies have shown that psychotherapy can cause changes in brain function similar to those produced by medications. Focused, goal-oriented forms of therapy such as cognitive-behavior therapy appear to be the most effective in treating depression.

Diet may play a part in protecting against depression. Mediterranean countries have low rates of depression compared to countries farther to the north--and it isn't just because they get more sunlight or have a more relaxed way of life. One large-scale study tracked almost 3,500 people living in London for five years and found that those who ate a Mediterranean diet were 30 percent less likely to develop depression. Researchers speculate that the foods in the Mediterranean diet may act synergistically together. Olive oil, nuts and fatty fish are rich in omega-3 and other unsaturated fatty acids, and fresh fruits and vegetables contain flavonoids and phytochemicals that are full of antioxidants and folates (B vitamins).

Aerobic exercise is a very effective for depression. It's been shown that moderate aerobic exercise done just 30 minutes a day, three times a week, can reduce or eliminate symptoms of mild-to-moderate depression and can help with severe depression.

It's well known that exercise stimulates the release of endorphins, the "feel-good" chemicals (which function as neurotransmitters). Less well known is the startling effect of exercise on the structure of your brain. Exercise stimulates the creation of new nerve cells in the hippocampus, your brain's center of learning and memory, so that it actually increases in size. This is especially relevant because depression, unless countered with effective therapy, causes the hippocampus to shrink in size. Exercise has also been shown to raise levels of serotonin and norepinephrine and to multiply the number of dendrite connections in neurons.

Yoga has been shown to lessen stress and anxiety and promote feelings of well-being. Communication between your body and your mind is a two-way street. Certain yogic practices can signal the brain that it's all right to relax and prompt the parasympathetic nervous system to initiate the relaxation response. For instance, slow, deep, conscious breathing is also a vital element of yogic practice. This form of breathing is very effective in prompting the relaxation response to counter elevated levels of stress hormones. Someone with depression might be advised to practice "heart-opening" postures that elongate their thoracic spine. They may be told to stand with their shoulder blades drawn together so that their lungs are lifted and they are able to breathe more freely. An important component of yoga is paying close attention to what's going on in the body at all times and locating and releasing any areas of tension. Yoga should ideally be practiced with the guidance of an experienced teacher.

Meditation can be a useful treatment for both stress and mild-to-moderate depression. Numerous studies have examined the effects of mindfulness meditation, designed to focus the meditator's attention on the present moment. One study measured electrical activity in the brain found increased activity in the left frontal lobe during mindfulness meditation. Activity in this area of the brain is associated with lower anxiety and a more positive emotional state. Subsequently, the researchers tested both a group that hadn't meditated as well as the meditators for immune function. They did this by measuring the level of antibodies they produced in response to a flu vaccine. The meditators had a significantly greater reaction, which indicates they had better immune function.

I know that the easiest solution is to pop a pill, and in this country powerful forces back up the promise that drugs are the answer. Keep in mind that antidepressants only alleviate symptoms, and that in the long run couch therapy has proven just as effective in changing the brain responses associated with depression. The real goal should be to re-balance your life, gain control over the disorder, understand who you are, and elevate your vision of possibilities for yourself. All of that is harder than opening a pill bottle, but every positive choice leads to real healing and a much better life in the future.

PLATELETS REVISISTED

 

1. The normal platelet count in adults ranges from 150,000 to 450,000/microL.
2. The mean value in males is 237,000/microL.
3. The mean value in females is 266,000/microL.
4. Thrombocytopenia or low platelet count is defined as a platelet count less than 150,000/microL.
5. About 2.5 percent of the normal population has platelet count lower than 150,000 /microl (as a normal variant).
6. A recent fall in the platelet count by one–half is abnormal even though it may still be in the normal range.
7. Thrombocytopenia is not usually detected clinically until the platelet count has fallen to levels below 100,000/microL.
8. Variation of the platelet count in a given individual is limited. Differences in the absolute platelet count greater than 70 to 90,000/microL will occur by chance less than one percent of the time.
9. Surgical bleeding due solely to a reduction in the number of platelets does not generally occur until the platelet count is less than 50,000/microL, and clinical or spontaneous bleeding does not occur until the platelet count is less than 10,000 to 20,000/microL.
10. Platelets survive in the circulation for 8 to 10 days, after which they are removed from the circulation by cells of the monocyte–macrophage system, as a result of programmed apoptosis.
11. The youngest platelets in the circulation are larger and more hemostatically active. Thrombocytopenic patients, who do not have serious bleeding, suggest that the small numbers of young platelets in these patients are more hemostatically active than mixed age platelets in normal subjects.
12. In dengue no transfusion is needed unless the count is lower than 2% of the baseline levels.
13. Platelet count can be falsely low in a number of clinical situations:
    • If anticoagulation of the blood sample is inadequate, the resulting thrombin–induced platelet clumps can be counted as white cells by automated cell counters. The WBC count is rarely increased by more than 10 percent.
    • Approximately 0.1 percent of normal subjects have EDTA–dependent agglutinins which can lead to platelet clumping and spurious thrombocytopenia and spurious leukocytosis.
    • Pseudothrombocytopenia can also occur after the administration of the abciximab.
    • EDTA–induced platelet clumping can be diagnosed by examination of the peripheral smear. One should do a repeat count in a non–EDTA anticoagulant.
    • If platelet clumping is observed, the platelet count is repeated using heparin or sodium citrate as an anticoagulant. If citrate is used, one should remember to correct the platelet count for dilution caused by the amount of citrate solution used; no such correction is needed for heparin. Alternatively, one can use freshly–shed non–anticoagulated blood pipetted directly into platelet counting diluent fluid.
    • Patients with cirrhosis, portal hypertension, and spleen enlargement may have significant degrees of "apparent" thrombocytopenia (with or without low white cells and anemia), but rarely have clinical bleeding, since their total available platelet mass is usually normal.

BOMB BLAST INJURIES

Blast injuries can be of four types.
 

1.Primary blast injuries are the injuries to the hollow gas-filled organs like the lungs, ear drum or intestines leading to their rupture. These occur as a direct result of the impact of the over pressurized blast wave on the body. 

2. Secondary blast injuries occur due to flying debris and bomb fragments leading to penetration or penetrating injuries such as to the eyes.

3. Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures as a result of the fall.

4. Quaternary blast injuries are due to direct effect of burn or crush injuries. 

The most important triage to manage blast injuries is not to waste energies and resources on patients with non-serious injuries.  The first thing is to check for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non-serious injury. 

All patients exposed to a blast must have eardrum examination as the first step. If the ear drums are intact, the patient can be discharged with first-aid treatment. If ear drum is ruptured, an X-ray chest should be done immediately. All such patients should be observed for eight hours as primary blast injuries are notorious for delayed presentation. 

Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture. This is used as a screening procedure for admitting a patient. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent. 

Half of all initial casualties seek medical care over first hour. Double this number after one hour and you will know the total casualties. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs. 

Always expect upside down triage as the most severely injured arrive after the less injured who self-transport to the closest hospitals. 

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

UNDERSTANDING NICOTINE/TOBACCO

Understanding and Coping With Nicotine Withdrawal

 

 

More people die from tobacco use than suicides and murders combined. So why do smokers continue to light up when statistics like these make it clear that they should quit? Nicotine addiction is powerful, which makes quitting difficult--but it is possible. There are now 45 million smokers, but 47 million successful quitters. By understanding nicotine addiction and withdrawal, you can be better prepared to crush out this destructive habit for good.

Understanding the Addiction

When you smoke, nicotine speeds to receptors that trigger the release of dopamine, your body's feel-good chemical. Nicotine causes dopamine to be released in several parts of the brain: the mesolimbic pathway, the corpus striatum, the nucleus accumbens and the frontal cortex . Over time, the receptors where nicotine can connect become desensitized. This means that they lose some of their ability to send signals that result in the release of dopamine, and other neurotransmitters. As a result, more nicotine receptor sites are created. The overall effect is that smokers who have developed additional receptors need more nicotine to avoid having withdrawal symptoms.

The longer you smoke, and the more you smoke each day, the more severe nicotine addiction becomes. The craving for nicotine intensifies and becomes more frequent. Ignoring the cravings brings on unpleasant withdrawal symptoms. And what alleviates those? Yes, more nicotine.

The Rewards of Nicotine

Let's face it: If there were no positive outcomes to smoking, no one would ever do it. "There are many motivations to smoke," says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University and author of The Lonely Patient and The Addict. "The dominant one is physical dependence--that is, smokers who try to stop have withdrawal symptoms, and cigarettes relieve the symptoms. But nicotine can also improve attention and vigilance. Smokers smoke when they need to concentrate or focus. Smoking helps some people feel in a better mood, or they feel a high, a buzz. Some smokers enjoy the taste and smell of a cigarette. Finally, smoking serves as an appetite suppressant. People smoke to control their weight." While all medical experts agree that the health risks are not worth these beneficial aspects, many smokers have a real fear of losing the sense of control and other pleasurable sensations when they stop. So, how can quitters learn to conduct their daily routine smoke-free? Understanding what to expect and planning for withdrawal symptoms is a great place to start.

Managing Nicotine Withdrawal

The physical symptoms of nicotine withdrawal are rough stuff. The brain and body still crave nicotine's positive effects, so its absence causes quite an uproar. Quitters can experience any combination of irritability, anxiety, depression, sweating, headaches, insomnia, confusion, cramps and weight gain. Understanding what feelings and symptoms accompany nicotine withdrawal is important, because there are steps you can take to manage your symptoms.

1. Craving for nicotine If you aren't using a nicotine replacement treatment, you may have cravings. Cravings last only a few minutes, but will feel much longer at first. Stay busy, especially during the times when you used to smoke. Plan a small snack or distracting task during these times.

2. Irritability The frustration of leaving your desire for nicotine unfulfilled affects your mood. Know that your emotions will be intensified for the first few weeks after you quit. Talk about your mood, and the fact that you've quit smoking, to anyone in the line of fire. Going for a walk or other exercise can take the edge off.

3. Anxiety Smokers with pre-existing anxiety disorders have a harder time quitting. Other quitters may have new feelings of anxiety. Anticipating this frame of mind, and knowing that it's related to quitting is the first step. Try to wait it out, or take a break to talk to a friend who knows what you are going through.

4. Depression Some of the prescription drugs for smoke cessation treatment also treat depression. If you are quitting without those, realize that you may start to feel down. If you have planned a support system and engaging distractions for your transition to the non-smoking life, rely on them.

5. Sweating Metabolic changes and increased circulation after quitting smoking may bring on sweating. Dress to stay cool, and drink plenty of water.

6. Tingling in hands and feet Your circulatory system is making positive adjustments after you quit, which can create some new sensations. A tingle in the extremities is a good thing. Just wait it out.

7. Headache Could be a circulatory effect, or a result of tension and anxiety from craving. Take ibuprofen or acetaminophen if you usually do. Try deep breathing or meditation to relieve tension.

8. Cramps and nausea Smoking can cause peptic ulcers and other digestive ailments. As your digestive tract recovers from your time as a smoker, you can feel temporary discomfort. Avoid spicy, irritating foods as you wait for this phase to pass.

9. Insomnia Nicotine is a stimulant, so it has definitely affected your sleep-wake cycle. Treat yourself to extra soothing activities before bedtime: a warm bath, a massage, total quiet.

10. Mental confusion Nicotine gives smokers focus and clarity. Its absence can make you feel a bit foggy. When confusion takes over, stop. If you're in the middle of a task, take a break. Confusion gradually dissipates as you adjust to the absence of nicotine.

11. Weight gain Some smokers fear gaining weight so much they don't attempt to quit. Most quitters gain fewer than 10 pounds.  "Weight gain following smoking cessation is mostly due to decreased metabolic rate, increased food intake, and decreased physical activity" after quitting, says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University. "Also, an enzyme called lipoprotein lipase (LPL), which affects fat cells' metabolism, becomes more active after you quit. And some appetite control agents, including leptin and neuropeptide Y, are influenced by nicotine." Dr. Stein notes that those who are concerned about gaining weight are more likely to relapse after quitting. Exercise would be a great substitute for smoking, if you're concerned about gaining weight.

Most of the nicotine withdrawal symptoms are short-lived, and symptoms pass in time, usually in less than a week. Withdrawal is the most uncomfortable part of quitting, but getting past this rough patch is the first real challenge in staying away from tobacco for good!

KNEE JOINT

Your knee joints are one of the unsung heroes of your body. If you're like the average Indian, you take just over 5,000 steps a day -- and each one of those steps places a force equal to three to six times your body weight on your knee joints. It's no wonder that by the time you reach age 60, chances are good you will have developed osteoarthritis of the knee, a sometimes-painful condition caused by wear and tear to the knee joint. More than 50 million Indians currently have this condition, and that number is expected to soar as high as 100 million during the next two decades as baby boomers age and become obese, a major risk factor for the disease, increases. While many people with knee osteoarthritis never have symptoms, others experience stiffness and dull pain, especially upon waking, or, in extreme cases, severe pain that limits their mobility.

What is osteoarthritis? In a healthy knee joint, a slippery tissue called cartilage fills the spaces between the bones and cushions the bones as they move. Osteoarthritis (OA) occurs when the cartilage wears away due to daily use -- or overuse. The ends of the bones begin to rub against each other and often develop spurs and cysts. In addition, the tissue that lines the joint may become inflamed and the ligaments and muscles that support the joint weaken.

Most people who develop knee OA are over 45. The disease is more common among women than men, and having osteoporosis or a previous knee injury increases your risk. While genetics plays a role in about 20 to 35 percent of cases, one of the biggest risk factors is something you can control -- your weight. Overweight women (defined as having a body mass index (BMI) of 25-28.9) have a four times greater risk of knee osteoarthritis, and overweight men (BMI 26-29.9) have five times the risk of normal-weight men.

Prevention and relief: There is no cure for osteoarthritis, but there are steps you can take to reduce your chances of developing the disease and to manage the symptoms if you already have it.

1. Control your weight. You can greatly reduce your chances of developing knee OA by maintaining a normal weight or shedding at least some of any excess weight. Losing even a few pounds can make a big difference in the load you place on your knees. Recent studies have found that when overweight people with knee arthritis lost just one pound, it resulted in anywhere from a twofold to fourfold reduction in the load placed on their knee joints. One report estimated that losing 10 pounds would take 48,000 pounds of weight off the knee joint for every mile walked. That, in turn, can reduce wear and tear on the cartilage and prevent osteoarthritis from developing. In fact, losing 11 pounds over a 10-year period decreases the chances of developing osteoarthritis of the knee by 50 percent, according to one recent study. Losing weight can also help reduce knee pain if you already have arthritis.

If you are overweight, talk to your doctor about a healthy weight loss program that includes eating lots of fresh vegetables and fruits, lean protein and whole grains.

2. Exercise. Regular, low-impact exercise will not only help you to lose weight, it can help prevent knee OA and manage symptoms in other ways. Often people who have arthritis of the knee cut back on their physical activity to avoid pain. But that's the worst thing you can do. It's critical to keep the knee joint mobile and flexible and to strengthen the muscles around it. You can do that by combining aerobic exercise with strengthening and flexibility exercises.

Aim for at least 30 minutes of low-impact aerobic exercise five days a week. Walking, biking and golfing are all good choices because they don't place stress on your knee joints. Exercising in water is also a great way to work out because the water supports your weight and gives your knees a break. Studies show that water exercise such as swimming or water aerobics can be especially helpful in reducing pain and improving function in those who already have knee OA.

Exercises that strengthen the muscles around the knee and the quadriceps (thigh) muscle can help protect your knee joints and may actually help prevent osteoarthritis. These exercises can also reduce pain and improve your mobility if you have arthritis. Try isometric exercises where you push or pull against resistance. Stretching exercises like yoga and tai chi can prevent and reduce stiffness in your knee joints.

Talk to your doctor before starting an exercise program -- especially if you have pain in your knees. You may need to begin by working with a physical therapist to learn how to strengthen the muscles around your knees in a safe way.

3. Protect your joints. An injury to your knee can alter the alignment in the joint and that can make the cartilage wear away. So take precautions to avoid injuries to your knees if possible, especially if you do a lot of sports. If you do injure your knee, get immediate treatment to reduce your risk of damaging the cartilage. Wearing a knee brace may help support your knee and reduce pain if you already have arthritis.

4. Pain relievers. Aspirin and other non-prescription pain relievers such as acetaminophen, ibuprofen and naproxen can reduce arthritis pain, but regular use can produce serious side effects. Talk to your doctor about the safe use of these pain relievers.

5. Other treatments. Glucosamine and chondroitin are two natural substances that are found in cartilage. Researchers have been studying whether or not they help relieve arthritis pain when taken as a dietary supplement. Recent studies suggest that they don't help any more than a placebo, but some doctors suggest taking them for three months to see if there is any benefit.

Some doctors prescribe anti-inflammatory gel to relieve pain or injections of hyaluronic acid to lubricate the joint and act like a shock absorber. In very severe cases where other treatments do not provide relief, your doctor may recommend surgery to replace the knee joint.

The best treatment of all is prevention, of course, and the best way to prevent osteoarthritis is to keep your weight down and get in the habit of regular exercise. If you do develop osteoarthritis, an early diagnosis can mean a better outcome -- so see your doctor right away if you notice pain or swelling in your knee.

FEW WORDS ABOUT ANGER

Anger is difficult to work with, but like many challenges, the rewards are great. Rage sweeps you away, and before you know what's happened you're already upset, and you don't notice what's been going on until hours later. To start with you may only be able to notice your anger when it begins to subside. This is okay. Any noticing is good. 

So as you practice mindfulness, notice anger, and name it. You can say "Angry Mind!" Look at your body and see where the anger is. It might be your stomach, or shoulders, the muscles in your neck. Breathe relaxation into that part of your body. With anger, you may notice it first in the body as tension -- a headache, or upset stomach -- or you may pick it up more easily in your mind. It doesn't matter. But do both parts of this exercise. Name the anger and breathe into the tense spot. 

 

You may be wondering about the moral ground of anger. Isn't it wrong to be angry? But by noticing you are not ignoring it. In fact you are giving it due honour. Usually people leap so quickly to act on anger, or to judge (What should I do? Am I right to be angry? Whose fault is it? Hers!) that often they forget to notice the simple fact that they are angry. Of course it's not good to lose your temper and shout, and mostly it's very counter-productive. There's war, violence, genocide, murder, child-abuse and bodily harm, all of them arising from anger and fear. Australia has law-courts, prisons, and armed forces. But putting this right can only happen when each person can address personal anger in their own hearts, and acknowledge silently to themselves, "I'm angry." Be very tender with yourself, just as you would be with a small child. 

. For self-protection our anger needs to be in good shape. If you are a quiet person coming off amphetamines (which raise self-confidence and self-assertiveness) you should check the health of your anger. To check the health of anger, start by noticing it. 

If you are angry a lot of the time, and taking it out on other people, this exercise will help. You should also talk to your counsellor about it. If you are not having counselling, then find a wise and sober friend. Name the problem to them, as honestly and openly as you can, including the good bits of the situation. Telling another person is a simple form of naming and acknowledgment. Yoga, dancing and swimming will help the anger in your body. 

As you collect anger, you are giving yourself a chance to allow your anger a place in your life, giving it a value. It starts to take its rightful place, to come forward appropriately. You gain a few seconds before you react. Those few seconds heal every war that was ever fought. 

UNIVERSAL MYTHS

We miss more than we see or experience...

Because we experience life in matter through the body or filter, we are fooled into believing that matter is the only thing around. Our matter body and our conscious mind are in synchronicity with the perceptions we create from our surroundings. We do not experience all the other energies or realities ,for example we cant see or experience microwaves though our cell phone can feel it, or we cant feel radiowaves though our radioset can catch hundreds of stations as so many radiowaves surrounds us. They are from a different dimension or realm. Since we experience only a fraction of what's going on - we are deceived by our human awareness system. Our awareness system is very limited, but on the other hand, it is a brilliant masterpiece of creation for it is only aware of certain aspects of creation. Quite the feat, for all this is done on purpose! The great Co-Creators are very very crafty...

UNIVERSAL MYTHS

Creation is always new...
The universal mind is and contains consciousness as well as the so called unconsciousness or the Non-Being. The Universal Mind and its manifestations is a Dynamic Energy that changes continuously. Creation is always new! There is nothing outside of this universal mind for all things and beings live within the Unbroken Wholeness. We are this unbroken wholeness or the Universal Mind. It is our mind, but we are tuning out all realities except the physical! The sages of the past used to call this Absolute Reality or Quantum Soup --- the Void. It indeed is a "Nest of Nothingness" out of which all things arise or manifest. From this Absolute Reality all things are created by the directed energies we call thought or mind. The more we are able to focus our thoughts - the more we are able to create. To learn to do this is what the school of earth is all about. We are apprentice creators!

UNIVERSAL MYTHS

Nothing is outside of ourselves...
We all create our own individual reality out of the Infinite-Holographic-Absolute-Reality that surrounds us and in which we live. We live right within it and are it! We could also call this reality the Reality of God! Also - actually only God exists... only Spirit exists... only Consciousness exists! We are One with this Infinite-Holographic-Absolute-Reality, but we only experience a fraction of its Unbroken Wholeness when we are Human Beings. This Absolute-Reality is like a palette from which we select our realities like a painter selects the paints from his palette. What we see and experience as our physical reality is a specific selection or vibration of the essence of the universe. The Absolute Reality in which we live is also called the Universal Mind...

UNIVERSAL MYTHS

All Things are Energy-Force-Fields...
Another remarkable thing is, that there is no objective reality separate from the observer. The reality we experience is self created and we select it from the Absolute Reality that surrounds us. We only experience our own perception of that Reality! So, again - in actuality - physical reality as an objective reality does not exist. Our perception is the reality we think we experience and it is formed from the Infinite Reality we look at. All of us, individually, create our own reality on the  spot - by means of our perceptions! Yeah, this is hard to believe - I know! Further more, all things (read energies) in creation are aspects of each other and one aware energy can experience other energies. These other energies not necessarily are as aware as human beings. Some are less aware and others are more aware. There are different densities of energies with different levels of awareness...

UNIVERSAL MYTHS

We are not color blind - we are dimension or density blind...
One of the secrets is - our body is a lens - a filter. It experiences a specific physical reality only - which in and by itself is not actually there - it is an illusion or MAYA as hindu philosophy put it.For example our eye can see only a small part of ELECROMAGNETIC SPECTRUM which spans from cosmic rays 2 big meter waves. It is like seeing though a small hole in the wall. There is no objective reality out there! We create it on the spot in our head. It is like only seeing the color red in a picture that contains a myriad of other colors and then say: I see a red building - it's all red! Possibly we only see one part in a million of the Total Reality that surrounds us. This one millionth part we call Physical Reality. All other realities are filtered out by our awareness system. We are surrounded by all these other realities, but they are not experienced or noticed by human beings. We do not even suspect that they are there! What a surprise...

FRUITS AT ENGAGEMENT

UNIVERSAL MYTH

We are a fuzzy bit of- stuff that vibrates...
Matter is more than 99.99999% emptiness! There is nothing there but a fuzzy bit of stuff that vibrates like crazy and makes us believe that matter is solid. How come? Another question is - why can't we see through matter if it is more than 99.99999% emptiness? Why do we see and experience solidness? On top of all this, in all the years we go to school - why aren't we told that matter is an illusion? What is the secret? Why keep us dumb...??

TRUE PREDICTION

A  patient of mine who was coming to me regularaily for last 10 odd years ,asked me on one of his visits 4 years ago. What your son is doing?.I told him that he is doing MBBS at Pune. He asked me out of blue "When it is going 2 B MA square." I could not comprehend him what he was trying 2 ask. So I asked him 2 explain what he meant by this..He said "UR name starts whit letter M, so does UR wife's (My wife's name being Dr Mamta Pande) so UR M square. UR son name starts with letter A ,so marry him with a girl whose name starts with A.and U will B  MA sqaure. " I gently told him that there is no girl on horizon and it is still 2 early 2 marry him ,as he is in 3rd year MBBS.

On 13 Feb 2011 my son got engaged 2 Dr Anushree ,thus making A sqaure and we are now MA square.  His Predictions have come through,happily though.