Wednesday, March 08, 2006

Our Living conditions....Thank You all....

A big thank you to all my readers for having been so supportive with your comemnts. Though I would love to reply to each of you individually, it somehow doesnt seem possible with the amount of time on my hands:( Here is an article for your general information and which everyone should be aware of. This point for discussion was raised by one of you fine folks (Sans) and I am glad to reply. The question is:

Can living in an Airconditioned home 24 hrs (or 14/15 hrs) a day, "cause" or "agravate" cough, cold , fever, flu or any other respiratory disease?

Before I answer it in a simple 'Yes' or 'No' manner, let me give you a basic insight into what affects our living conditions in a room.

Human occupancy and activity vitiate air in occupied rooms and give a sense of discomfort to the occupants. The changes in air that take place in confinded places are both chemical and and physical.

A) Chemical Changes:
The air becomes progressively contaminated by carbon dioxide and the oxygen content decreases due to metabolic processes. An average person at rest gives off 0.7 c.ft of carbon dioxide per hour and this may increase up to 2 c. ft. during physical activity.

B) Physical Changes:
By far the important changes that occur due to human occupancy are the physcial changes. These are:

1) Rise in temperature:
The indoor temperature tends to rise as a result of the emanation of body heat. A man at rest gives off approximately 400 Btu per hour. One Btu (British Thermal Unit) is the quantity of heat required to raise the temperature of 1 pound of water to 1 deg F. Under conditions of physical exertion, the heat output may go upto 4000 Btu.

2) Increase in humidity:
There is an increase in the relative humidity due to moisture evaporated from the skin and lungs. The expired air contains about 6 percent of water vapour.

3) Decrease in air movement:
In crowded places, the natural movement of air is impeded.

4) Body odours:
Unpleasant odours arise from foul breath, perspiration, bad oral hygiene, dirty clothese and 'other' sources.

5) Bacterial pollution:
The exhaled air contains micro-organisms in suspension. These are principally saprophytic bacteria and may include pathogenic bacteria. These organisms are discharged into the air during coversation, coughing, sneezing and talking loudly.

Unless the vitiated air is replaced by fresh air, it may adversely affect the comfort, health and efficiency of the occupants. It is known that a feeling of suffocation or discomfort is experienced by the occupants in insufficiently ventilated rooms and also complaints of headache, drowsiness, leathargy and inability to concentrate. There is also the risk of droplet infection and lowered resistance to disease on prolonged exposure.

I guess you would have got a basic idea into the vitals of the air in an occupied room. Now lets analyse how an air conditioner can affect these.

Comfort zones may be defined as the range of temperatures over which the majority of adults feel comfortable, There is no unanimous decision on a singe zone for all people because comfort is a quite a complex subjective experience which depends not only on physical, physiological factors but also on psychological factors which are hard to determine.

Considering only the environmental factors: Comfortable thermal conditions are those under which a person can maintain normal balance between production and loss of heat, at normal body temperature without sweating.

In India zones evaluated are as below:

Pleasant and cool 69F
Comfortable and cool 69-76F
Comfortable 77-80F
Hot and uncomfortable 81-82F
Extremely hot 83+ F
Intolerably hot 86+F

Please note that these are corrected effective temperature and not the actual temperature recorded.

Considering ventilation, a person needs atleast 1000 to 2000 cu ft of fresh air per person per hour in order to remove the carbon dioxide and other noxious gases expired by him and others around him. He also needs about 50 to 100 sq ft of floor space to achieve the same.

A room should have the following ventilation means:
a) Natural ventilation, by means of doors and windows and preferably they should face each other providing 'cross ventilation'.

b) Exhaust ventilation, where air is extracted or exhausted to the outside by fans.

c) Plenum ventialtion where fresh air is blown into the room by centrifugal fans so as to create a positive pressure and displace the vitiated air. This type of ventilation is usually used for supplying air to air conditioned buildings where air is supplied through ducts at desired points. Usually most ducts do not supply air or they arent cleaned well which leads to infection.

d) Balanced ventilation which is a combo of both exhaust and plenum ventilation systems.

e) Air Conditioning: Ok, now we come to the most important part here...finally, atlast;))))

By definition, air conditioning is: the simultaneous control of those factors that affect botht he physical and chemical conditions of the atmosphere within any structure. These factors include: temperature, humidity, air movement, distribution, dust, bacteria, odours and toxic gases. most of which affect human health and comfort.

Actually with very good use of air conditioning it is possible to maintain a germ free atmosphere as they do in operating theatres. Frequent disinfection of the air conditioned area is a must. In general the temperature difference between the outside air and the air conditioned air should not be more than 10-15 deg F and the presence of 'transition rooms' is also necessary so that people may not be suddenly exposed to high or low temperatures.

The next time you step into your office, please haul up your HR guy or house keeper and ask him if your work area has all these required ventilation systems to prevent infection;))))

Does having the AC continously ON has any negative impact on a person's cough and cold or fever? will it increase it??"

As you will have understood, the ac is meant for our comfort and used properly it will not aggravate cough or fever. But there is a possibility that some people might have the chills if they are exposed to continuous chill air (like sitting right under the ac duct or so).

Actually most offices in Chennai are over cooled rather than being comfortable. The ac ducts arent cleaned, the area isnt disinfected, and there is nil ventilation. God help the executives who spend about 12 to 14 hours slogging it out inside :(

Thank you once again folks and please do visit this place regularly and leave behind a line or two as comments or mail me to let me know your opinions. You really do not know how much it means for me to read your comments!

Wednesday, January 04, 2006

Time to pat my back;)

Folks (especially Sury;) wanted to know what happened to me, whether I passed out in front of the puter or whether I blacked out while on a New Year shopping spree. Unfortunately it isnt any of those good things, but I have been unusually busy the past 10-15 days. The very few minutes that I get and can call my leisure, I spend it by happily irritating my wife, which also happens to be my favourite pastime!

Peeps, I want to tell you that I have been interviewed by a major newspaper, The Hindu, and have been published in the Downtown section of its December 18th edition. Curiously there isnt an online report and I have taken a lousy pic of the article and posted it as a proof that I aint fibbing

Another event that really took me in a wave of gratitude was that the Paramount Pearls Flat Owners and residents association felicitated me and presented me with a wonderful gift during their 1st year cultural sabha inauguration for the services I had rendered to them during the horrid monsoon season. Its nice to know that people do think of doctors in a good way instead of being consumerish (I have a problem, I come to you, you render service, I pay you money)

The memento I was presented with is a beautiful carved Tanjore plate (Thanjavur thattu) that has a peacock as the central decor. The pic is here for you to have a peek at. Click on it to enlarge. It was presented to me by stage actor, comedian Bosskey of Hari-Giri fame on Jaya TV.

Thats it with me patting my own back and I am glad that the year 2005 came to a grand finale literally. Ever since I got published in The Hindu, I've been having a lot lot of calls and I am really busy that I feel sad I cant update this site as often as I would love to, anyway, I shall make time for myself so that I can catch up with you fine folks.

Wishing all my readers and their loved ones a Happy and Fruitful 2006 and may the Good Lord bless everyone with Good Health.

Friday, December 16, 2005

Grey cloud...silver lining...

6 15 I am woken up by the mobile ringing by my side.

A tense voice of a male: "Doctor could you please come mom seems to have collapsed"

"Yea, will be there in 15 mins"

"Thanks doctor"

On arrival, the old lady is cold...dead maybe for about an hour. Though the son knows it, he wants to confirm it.

The air around is still and there is a pregnant pause. "Yes, she has passed away", I say with much solemnity. Tears stream down the man's face. He is about 57. A death is a death, old or young though the grief felt when a young soul passes away is incomparable.

"Doctor, can I inform my relatives?"

"Yes, please do"

He calls his brother and he breaks down into a sob. Eeerie moments... heart rending. I stand near the wall waiting for the man to compose himself so that I can fill out the DC (death certificate).

I have this strange habit of not writing a DC in the pen I use to write prescriptions. I ask if any of the relatives of the deceased person has a cheap pen that can be thrown away after writing...if yes..then I chuck it away after writing. Small sentiments. What's life without those?

I hand over the DC and leave the place conveying my condolences. Came home and had a cup of coffee. The day starts on a bad note. There is an Amman Temple near my house but have never visited it in the three months that I shifted here. Went there and spent some time. Pretty peaceful place.

Shortly thereafter another call. This time someone has a swelling of the legs and she has come down from the US. As I finish attending the patient, another call, another panicky male voice: "Sir, my grandmom has wheezing and now she seems to have collapsed....umm... she isnt responding...could you please come over.

There in a jiffy, but by then they have brought the old lady downstairs by the elevator to rush her to the nearest hospital in Adyar...No pulse...Pupils fixed and dilated. 'Everything' was over in a matter of few minutes said the grandson.

"Doctor, is there any point in taking her to the hospital?"

"No, I dont see any."

"Ok sir thanks for coming, we would need the DC...could I collect it in an hour's time?"


The grandson came in another hour and I wrote out a DC for his beloved grandmom. Again I ask him if he has a pen he can afford to throw away. Yes he does.

A lady asked me exactly a month ago when I went through the same ritual of asking for a cheaper pen: "Doctor, why is that you seem to follow such a sentiment, arent doctors beyond all those?"

"No we arent...what makes you think we are any different from you wrt death?"

"Sorry if I sound inquisitive...what do you normally feel when you see death and pain"

"Seeing Death, humbles a person...categorically explains to him the brevity of life and the uselessness of narrow mindedness."

"Guess you are right sir."

So my dear folks...I neednt reiterate that in the short span that we inhabit this planet, lets strive to be kind and good to everyone and make this a better place for us and for generations to come.

Merry Christmas and Happy New Year!

Friday, December 09, 2005

My fav beggars/panhandlers!

Prove that begging and not prostitution is the oldest profession in the world.

Actually the first prostitute tried begging and when that didn’t work or when lusty males leered at her and wanted sex, she gave in, haggled over the price of her body and made easy money. (She looked down upon begging thereafter)

Isn’t it obvious? So there you go...QED

My area-Velachery-as are other places in Chennai, is full of beggars/panhandlers. I am not here to argue whether one should shell out a coin or not give them any thereby 'discouraging' them to beg. I have my personal favourite beggars. (It is very much the same way you guys have fav actors, politicians and cricketers)

There are 3 notable ones and each has a specific area and they will not be found begging outside of their 'fort' and any other panhandler encroaching into theirs will be prosecuted badly with a flurry of words and sometimes even fisticuffs.

The lady near the FoodWorld Supermarket:
She is about 80 (at least looks like that, I've never ventured asking her age, coz I am a prudent male...never ask femmes their age...ask no question and get no lies) She is just a bundle of bones covered in skin, poor thing. What is worse, she has those horrible truncal tremors...tch tch tch...her body (trunk) keeps shaking so violently and she finds it very difficult to walk. Probably she has Parkinson's. Despite her difficulty she approaches every stranger with a plea for money. There is an eatery below the FoodWorld and when garbage from there is thrown into the nearby dustbin she shuffles towards it and bends into it (almost throwing herself inside) searching for something that could be of use.

You would be wondering how such a shaky woman can even reach out her hand to ask for alms. In Parkinson's typically tremors take place when the limbs are at rest as opposed to when there is movement. (Movement decreases the tremors). I don’t fail to give her a coin or two whenever I go to the supermarket. My thoughts go...: Does she have a son or daughter, maybe her son is a nice man and the daughter-in-law shooed her off...maybe her daughter is a nice lady but her son-in-law doesn’t allow her anywhere near the house. Poor she!

The man near the ATM (I am not telling which ATM for fear of being mugged there by you folks):
This man has Hansen's--med term for leprosy. I always imagine him to be Lazarus. He is quiet, has a contented look about him and doesn’t force peeps to give him money. I think of him as a brilliant chap. Maybe he could've become a software professional and coz of the draconian caste based seat reservation system in TN, he narrowly missed out on getting into an engineering college. (These days in TN it is enough if you have secured a 'pass' in the 12th Board eggzams...some colleges have so many seats that aren’t filled up at all).

But sometimes I think he is really stupid...why would I (or for that matter anyone) go to an ATM? Most likely to withdraw money coz I don’t have a pie on me. And when I come out of the ATM, I am not going to have a pocket full of change coz the machine hands out soiled dirty notes as opposed to spanking crisp ones in the times of yore when ATM's were more of a tourist must-see-place and dear hubby took his wifey and daughter along with him into it and explained with an air of importance on how it functions to his kid and better half while I waited patiently outside getting redder as the seconds went by as slow as Ravi Shastri's batting. (Yea it is a wonder that he hit six sixes in an over)

Well, I try to fish a coin from my trouser pocket and meanwhile our man waits with bated breath to see how much I am going to come up with after fiddling in my trouser pockets for a whole 30 seconds. Alas there is only a 25paise coin and I can sense his frustration. He even curses me under his breath. Meanwhile a svelte femme is getting out of the ATM and our man can get a whiff of the heavenly perfume she is wearing and gallops towards her as if he were going to carry her off a la Prithiviraj Chauhan.

I imagine: How would it be if that bugger-beggar went and planted a kiss on her luscious cheeks

The lady near the Temple:
She isn’t a beggar technically. She sits inside the temple compound and on the pretext of watching over the footwear which the devotees leave behind she 'extends her hands', I repeat, 'extends her hands' while the person comes to retrieve his/her footwear. An unofficial footwear valet you could say!

I happily gave this lady a coin almost daily (coz I visit the Temple everyday, I am a holy fellow you see) till the day I saw a scene. I thought she was a destitute (she looks like a right royal hag) but one day her son came to get the morning 'collections' from her! Mother and son were speaking to each other affectionately and that bugger handed over a tiffin box (with food) for her lunch and left after bidding good bye and best wishes. I asked the hag who he was and that is how I know he is her son.

Back at home I told my mom what had happened. My mom nonchalantly: "Didn’t you know that the old hag is the mother in law of our neighbour's servant lady? She has a daughter who is married to a rich man it seems” "Oh dang! These peeps are well 'settled' eh? Hope she isn't married to a H1B visa holder and on a H4 herself” I thought to myself. But even then I don’t refrain from handing over a coin to her. Maybe she is some Goddess who masquerades as an old lady just to test my charitable sense. I have read so many Amar Chithra Katha comics that say God came in a beggar's avatar to test the devotion and charity of devotees. I wouldn’t want to take a risk, so I continue giving my favs a coin or two whenever I see them (rather whenever they panhandle me). I am a miser. Uff!

Monday, December 05, 2005

All you wanted to know about that nagging back pain!

Chronic back pain is a common problem with a large health and social cost. Around a quarter of adults have had back pain in the last month, with one in 40 reporting disabling back or neck pain. Each year around 5% of patients consult their primary care practitioner with back pain, resulting in 137 consultations per 1000 patients. This means a practitioner with 1750 patients will typically see at least one patient with back pain each day.

Facts about back pain:
It's common to see minor abnormalities on x ray films of the lumbar spine. Two randomised studies did not show any benefit in outcome from performing lumbar spine x rays. One found that they have an adverse effect on outcome. They also expose patients to large amounts of radiation.

It's common to see minor abnormalities on magnetic resonance imaging (MRI) scans of the lumbar spine. This is an expensive investigation that's unlikely to improve the patient's outcome. One randomised controlled trial showed that patients who had an x ray had a similar outcome to patients who had a magnetic resonance imaging scan.

Abnormalities are commonly found on magnetic resonance imaging scans. A review of eight studies of magnetic resonance imaging in asymptomatic adults found:

* Bulging discs in 20% to 79%
* Herniated discs in 9% to 76%
* Degenerative discs in 46% to 91%.

Measuring the ESR or plasma viscosity is the best test for excluding malignancy or ankylosing spondylitis. This costs hardly 20rupees!

Evidence suggests that investigating simple back pain is unnecessary. A careful history and examination, if indicated, should exclude any serious cause.

Few treatments have been shown to benefit people with back pain.

Spinal manipulation has not been shown to be effective for chronic low back pain when compared with no treatment. Massage is likely to benefit people with chronic low back pain. But the evidence is weak and based on studies that might have had methodological flaws. There is better evidence for the benefits of exercise classes.

Acupuncture has not been shown to be effective for treating chronic low back pain.

Facet joint injections are likely to be ineffective or harmful.

We also don't know whether the following treatments are effective: electromyographic feedback, epidural steroid injections, lumbar supports, muscle relaxants, physical conditioning programmes, specific exercise regimens such as the McKenzie approach, and transcutaneous electrical nerve stimulation.

Weight loss surprisingly does not reduce back pain but weight gain can aggravate a back ache.

General exercise appears to benefit people with chronic low back pain. There are some data, including cost analysis, supporting the use of an exercise class using cognitive behavioural principles.

Multidisciplinary treatment consisting of intensive physical and psychosocial training by a team often using a group approach, and avoiding passive physiotherapy, reduces pain and improves the day-to-day activity of patients with chronic back pain.

Few people who have been off work with back pain for more than six months ever return to work. Usually patients are worried about returning to work. Returning immediately after an acute back pain episode to full duties might cause their condition to deteriorate in the short term, reducing chances of returning fully to work. A supportive employer can help many people return to work.

Few therapies offered by outpatient physiotherapy departments as a uni-disciplinary treatment are likely to be effective for people with chronic back pain. But it might be worth considering a graded exercise programme, if your local physiotherapy department offers one.

In one study, 32% of patients who presented with back pain reconsulted within three months.21 The same study found that only 21% of those interviewed three months after seeing their GP with back pain were free from symptoms. The authors concluded: "Low back pain should be viewed as a chronic problem with an untidy pattern of grumbling symptoms and periods of relative freedom from pain and disability interspersed with acute episodes, exacerbations, and recurrences."

Surgical intervention is rarely indicated for chronic simple back pain. Understandably, few orthopaedic surgeons are interested in non-surgical management. Their time is probably better spent delivering treatments proved to be effective.

A systematic review found tricyclic antidepressants, but not SSRIs, to be moderately effective in the treatment of chronic low back pain in patients without depression.

Surprisingly paracetamol eight times a day is very effective in back ache!

Sunday, December 04, 2005

A gondola ride in Chennai

I do have colourful dreams, sometimes even interactive dreams, but never in my bizarre dreams did I imagine that I would travel by boat inside Chennai city!

Ask me how this happened. I have a call at 9 am in the morning asking me to visit a kid of 7yrs who had a high temperature. I packed my bag and took out my vehicle and on reaching the area I could see water as far as my eyes could. Nearby on a lamp post was tethered a catamaran (boat) that was used by the residents of the area to ferry themselves across. Gosh! A few days back the thoroughfare to the apartment complex was dry and neat. Come the second spell of rains and it turns into a Venice. My area gets to the headlines each time for the wrong reasons when it rains.

I parked my vehicle on a dry spot on the main road and boarded the gondola;)))) This boat isnt rowed but pushed by two people from the behind and pulled by a person from the front. Kindly note, the people who help push the boat arent paid by anyone! They do it as a service and sometimes some Good Samaritan might hand them a ten buck note to meet their coffee/tea/snacks expenditure.

Inside the apartment complex, the water came upto my knees but somehow I managed to wade through the water and get to the flat and examined the kid and wrote out a prescription. The parents were so thankful that I arrived inspite of the inconvenience. A tsunami of satisfaction overcame me!

Saturday, December 03, 2005

Chennai jottings...2

The Chennai flower vendor is a usual sight on all street corners in residential areas and more near temples. The vendor is usually an obese/cachectic lady clad in a dirty cotton saree and is especially known for her superior haggling skills. She is helped in her job by her dutiful husband who has to go down on his knees to extract a few bucks out of her to help himself to a 'cutting'* of rum or buy a few beedis.

Come rain or sunshine they can be seen stringing flowers together at their regular spots with an upturned cardboard box that serves as a counter for vending their flowers and one buys a 'muzham' of malli poo/jaadhi/mullai etc over the counter!

A 'muzham' is a measurement of length that is unique to the flower business. It supposedly spans the length from the tip of the right index finger to the cubital fossa (the crease where the arm meets the forearm) of the vendor. Since this varies from person to person and between the sexes, it is usually the femme who measures out the 'muzham' and she sees to it that she bends her palm at the wrist so as to decrease the already miniscule length.

A 'muzham' of malli poo (jasmine) costs anywhere between 3 rupees in the summer to 10 during the rainy season. Ask them why is it costs so much and the ever ready rebuttal would be one of the following:
a) the flowers arent in season no
b) it is raining
c) it is too hot and the flowers get damaged while transportation
d) it is the marriage 'season'
e) it is the festival season

So my dear pals due to the above reasons the quintessential flowers cost a fortune perennially. A usual sight would be thus:

Customeress: "How much do I get for 10 rupees?"

Vendoress(?) nonchalantly: "One and a half muzham"

Customeress as if she has just heard the news that a tsunami has formed in the Indian Ocean and is heading straight towards her house: "What?"

Vendoress: "Yes Ma'am, since it is the festive season, the flowers are in high demand, the going rate at the Koyambedu market is 123456 bucks a kilo."

Customeress: "You people have some lame excuse or the other throughout the year!"

Vendoress: "What to do ma'am, we can give it at subsidised rates only if we can afford it, otherwise we run the risk of a loss. Don't forget ma that I too have three kids to feed"

Customeress: "Ok ok enough of your sad story, give me 2 'muzhams' for 10 bucks.

Vendoress: "No ma, definitely it isnt possible, the rates for the flowers are too high today" (so saying, she measures out the strung flowers on her skinny, short hand)

Customeress: "No, no nothing doing, you haven't taken the right measurement, you have bent your wrist, the flowers are too little, that surely isnt 1 and half muzham"

Vendoress: "No ma, why would I ever cheat, I swear on God that it is the right measurement, see for yourself" (and she runs through the measurement the same as before but a wee bit quicker this time)

Customeress: "For my hand that would be hardly 3/4th of a muzham. Cheri, what else option do I have rather than buying this from you!"

Vendoress: "Inikki adjust pannikko ma, naalaikku rate kammiyaayidum unakku niraya poo tharen." (Kindly adjust today ma'am, tomorrow when the rates go down I shall give you more)

But then...the same thing happens 365 days a year.

There is something to the jasmine flowers that even the ordinary looking Tam girl seems to have a fresh radiance about her once she dons the white flowers on her neatly braided hair. A classical look, a 'homely' look, that right look most Tam males want when they want to take a femme home and tell their Moms: "Ma, this is Nandhini and she is my friend...of late we are contemplating marriage!"

*Cutting: A cutting of any alcoholic drink is 90ml. A 'quarter' pronounced locally as 'kotter' is 180ml, so a cut in 180 is 90. FYI a 'half' is 360 and a 'full' is 720ml.

PS: Actually I wanted to take a pic of the vendoress, but then her possessive husband didnt allow me to and instead wanted his pic taken. Dang! Double dang! ;))))))