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VOL. 15, ISSUE 8 1st May 2017 Monthly Free Circulation

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Interesting articles on:

Tips to tackle the Sizzling Summer�

A must read article on Pancreas- Thesleeping tiger�

World Asthma day falls in the month ofMay�How to keep fit and fight Asthma?

In ....Good health from the Kitchen.. all aboutthe inseparables Summer and Mangoes!!!

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GEMHospital performs Robotic Whipple�sProcedure for youngest patient in the World

Coimbatore based GEMHospital and Research Center,is the most sought after centrefor all Gastro-Intestine relatedpathologies and complicatedlaparoscopic surgeries.

Whipple�s surgery orPancreaticoduodenectomy is amajor surgery done for tumourof head of pancreas,periampullary region or distalportion of bile duct. In fact thisoperation is considered to bethe most complex gastro-intestinal surgery, second onlyto liver transplant surgery.

This surgery involvesremoval of a portion ofpancreas, distal portion of bileduct and duodenum withreconstruction of alimentary(feeding) channel and biliarypathways with a loop of smallbowel, which is anastomosedto pancreas, bile duct andstomach or first portion ofduodenum. Essentially thisprocedure is considered to betechnically demanding owingto the location of pancreas,proximity of major bloodvessels and multiple criticalanastomoses. This surgery isthe only curative option foraggressive malignancies like

cancer of head of pancreas.

This surgery may be doneby open, laparoscopic orrobotic approach. It is alreadyknown that GEM Hospital hasperformed the largest series oflaparoscopic whipple�sprocedure in the world and haspublished this in worldliterature. In fact, the sameprocedure has been done bylaparoscopy in a 12 year old girlin 2014 at Gem hospital and ithas been reported as theyoungest patient in the worldto undergo this majorWhipples�s operation bylaparoscopy.

The advantages ofperforming this major surgeryby laparoscopy includeabsence of large incision, lesserpain, decreased blood loss,quicker discharge fromhospital and faster return towork. In addition to all these,the robotic approach provideshigh precision in surgery withbetter clearance of tumoradvantages like 3d vision,enhanced degrees of freedomofmovement upto 540 degrees,greater precision ofanastomosis, filtering oftremor, improved surgeon

comfort with betterergonomics. GEM Roboticsurgery has ICG fluorescencewhich facilitates mapping ofspread of tumor lymphatics andnodes.

The patient is a 14 year oldgirl from Coimbatore who hadbeen evaluated outside andreferred to this centre forwhipples procedure forpancreatic tumor. This tumorwas 7 cm in the head ofpancreas called as solid pseudopapillary tumor of pancreas,which is common in youngfemales in early twentys.

Robotic whipple�soperation was successfullyperformed on this patient. Theoperative team included Prof.

C.Palanivelu (Chief surgeon),Dr. P. Senthilnathan, Dr.N.Anand Vijai, Dr. S.Srivatsanand Dr. Vivek( Anaesthetist).The procedure was performedusing the Da vinci Si roboticsystem.

The duration of theprocedure was close to 5 hoursand it was done in a bloodlessmanner, hence no bloodtransfusion was given. Thepatient had a very quick post-operative recovery. Enteralfeeding was started on second

post operative day.Patient wasdischarged as early asfifth post operativeday with no scars.Patient is on normaldiet. The biopsy of thetumour confirmed thatit was solid pseudopapillary tumor ofpancreas. This is theyoungest patient in theworld to undergo thismajor procedure byrobotic approach.

22222 PADHAMHEALTH NEWS May 1, 2017

Other SideReceiver or Giver!

Once when I was ateenager, my father and Iwere standing in line to buytickets for the circus.Finally, there was only

one other family between usand the ticket counter. Thisfamily made a big impressionon me.There were eight

children, all probably underthe age of 12. The way theywere dressed, you could tellthey didn�t have a lot ofmoney, but their clothes wereneat and clean.The children were well-

behaved, all of themstanding in line, two-by-two

behind their parents,holding hands. They wereexcitedly jabbering aboutthe clowns, animals, and allthe acts they would beseeing that night. By theirexcitment, you could sensethey had never been to thecircus before. It would be ahighlight of their lives.The father and mother

were at the head of the packstanding proud as could be.The mother was holding herhusband�s hand, looking upat him as if to say, �You�remy knight in shiningarmor.� He was smiling andenjoying seeing his family

happy.The ticket lady asked the

man how many tickets hewanted? He proudlyresponded, �I�d like to buyeight children�s tickets andtwo adult tickets, so I cantake my family to the circus.�The ticket lady stated theprice.The man�s wife let go of

his hand, her head dropped,the man�s lip began to quiver.Then he leaned a little closerand asked, �How much didyou say?� The ticket ladyagain stated the price.The man didn�t have

enough money. How was hesupposed to turn and tell hiseight kids that he didn�t haveenough money to take themto the circus?Seeing what was going

on, my dad reached into hispocket, pulled out a 20 bill,and then dropped it on the

ground. (We were notwealthy in any sense of theword!) My father bent down,picked up the 20 bill, tappedthe man on the shoulder andsaid, �Excuse me, sir, this fellout of your pocket.�The man understood what

was going on. He wasn�tbegging for a handout butcertainly appreciated thehelp in a desperate,heartbreaking andembarrassing situation.He looked straight into my

dad�s eyes, took my dad�shand in both of his,squeezed tightly onto the 20bill, and with his lipquivering and a tearstreaming down his cheek, hereplied; �Thank you, thankyou, sir. This really means alot to me and my family.�My father and I went

back to our car and drovehome. The 20 that my dadgave away is what we weregoing to buy our own ticketswith.Although we didn�t get to

see the circus that night, weboth felt a joy inside us thatwas far greater than seeingthe circus could ever provide.That day I learnt the value

to Give.The Giver is bigger than

the Receiver.If you want to be large,

larger than the life, learn toGive.Only if you Give can you

Receive more. The Givers

heart becomes the Ocean,in tune with the Almighty -The SourceLove has nothing to do

with what you are expectingto get - only with what youare expecting to give - whichis everything.

Precious giftA wise woman who was

traveling in the mountainsfound a precious stone in astream.

The next day she metanother traveler who washungry, and the wise womanopened her bag to share herfood. The hungry traveler sawthe precious stone and askedthe woman to give it to him.

She did so withouthesitation.

The traveler left rejoicingin his good fortune. He knewthe stone was worth enough togive him security for a lifetime.But, a few days later, he cameback to return the stone to thewise woman.

�I�ve been thinking,� hesaid.

�I know how valuable thisstone is, but I give it back inthe hope that you can give mesomething evenmore precious.Give me what you have withinyou that enabled you to giveme this stone.�

Sometimes it�s not thewealth you have but what�sinside you that others need.

(Source: Internet)

PADHAM HEALTH GUIDE 19

A Comprehensive book onFoot care for Diabetics

� ForwardMarch� The Human Foot-Architectural Marvel� Diabetes Mellitus� Changes in the foot of the Diabetics� Wound healing in Diabetes� Foot infection in Diabetes� Gait Analysis in Diabetics� Role of antibiotics in Diabetic Foot Sepsis� Ulcers and Non-Ulcers� Clinical assessment of foot disorders in diabetes� Foot care awareness in patients with diabetes� Surgical Management for diabetic foot� To walk or not to walk�.?� Why an amputation for Diabetic foot sepsis?� Foot ulcers and their management� Podiatry and Diabetic foot care� Community Foot Care programmes and Foot

Education

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May 1, 2017 PADHAMHEALTH NEWS 33333

It is jokingly remarked thatthere are three seasons in

Chennai- Summer, HotSummer and Very hotsummer!!! Very often theelderly and infants fall victimsto the oppressive heat. Herethe individuals temperaturecontrol system, whichproduces sweating to cool thebody, stops working. .

Heat stroke- also knownas sunstroke is a lifethreatening emergency .Thevery young and the very oldare most prone to heat Stroke.Infants do not tolerate heatwell since their sweat glandsare not well developed. Theseillnesses occur mostcommonly to persons notaccustomed to hot weather

When a person is affectedby heat stroke :Move the person to a

cooler place. Quickly cool thebody. Immerse victim in a coolbath, or wrap wet sheetsaround the body and fan it.Watch for signals of breathingproblems. Keep the personlying down and continue tocool the body any way youcan. If the victim refuseswater, is vomiting, or there arechanges in the level ofconsciousness, do not giveanything to eat or drink. Seekmedical help very soon.

Few tips to stay cool :� Morning 4 am to 7 am

is the coolest part of the day

Scorching Summer is on!

and is ideal time for strenuousactivities.

��It is better to stay indoorsas much as possible. Thoughelectric fans do not cool theair they help to cool the bodyby evaporating the sweat.

��Wear lightweight, light-colored clothing. Light colorswill reflect away some of thesun�s energy.

�Eat small meals and eatmore often. Avoid fatty andspicy foods.

�Avoid using salt tabletsunless directed to do so by aphysician.

��Drink plenty of fluidsand water even if you do notfeel thirsty. Body needs waterto keep cool. Water is thesafest liquid to drink duringheat emergencies. Avoiddrinkswith alcohol or caffeinein them. They can make youfeel good briefly, butmake theheat�s effects on the body

worse.

A �fruitful� meal plan!In this scorching weather

one can easily fall ill and thatis the reason doctors keepstressing the need for fruits inthe diet. Be it seasonal likewatermelon ormango or an alltimer like banana do include afruit in your daily diet.

Fresh and dry fruits contain

substantial quantities ofessential nutrients in a rationalproportion. They areexcellent sources of minerals,vitamins and enzymes. Theyare easily digested andexercise a cleaning effect onthe blood and the digestivetract. Fresh and dry fruits arenot only good food but alsogoodmedicine.

Fruits are a valuablesource of anti-oxidants.Taking of fruits or fruit

juice is the most pleasant wayof hydrating the organism.The water absorbed by sickpersons in the form of fruitjuice has an added advantageof supplying sugar, vitaminsandminerals at the same time.The fibrous matter in fruits,cellulose, aid in the smoothpassage of the food in thedigestive tract and easy bowelaction. Hence, regular use offruits prevents and cures�constipation�.

Fruits furnish minerals tothe body. Dried fruits such asapricots, raisins and dates are

rich in calcium and iron.These minerals are essentialfor strong bones and goodblood respectively.

All fruits promote intestinalelimination. This keeps thebody free from toxic wastes,which creep into the bloodfrom an overloaded, sluggishintestinal tract. Thecarbohydrates of fruits arechiefly in the form of sugar,

dextrins and acids, which areeasily digestible and arecompletely absorbed. Hence,they are very useful for sickand invalids for quick energyand heat.

Fruits, as dependablesources of vitamins, exert atonic effect in the body. Incase of sickness, it will beadvisable to take fruits in theform of juices for its quickabsorption.

Curative properties offruits:Generally, fruits are highly

beneficial inmaintaining acid-alkaline balancein the body. Theysupply neededelements for thebody�s ownhealing activityand cellr egene ra t i on .Certain fruits cancombat specificailments.

�

Wa t e rme l o n smake the bestkidney cleansersand it containsiron.

��Dried figsare especiallyuseful in the case ofconstipation, as they are highin fibber

��Apples are good for bothconstipation and diarrhoea.Atleast two apples should betaken daily for properevacuation of bowels.

Tooth-decay can beprevented by regularconsumption of apples as theypossess a �mouth cleansingproperty�.

�� Banana is highly

beneficial in the treatment ofulcer, being bland smooth,easily digestible and slightlylaxative. It neutralises theover-acidity of gastric juiceand reduces irritation of theulcer.

��Dates stimulate sluggishbowels. They should beimmersed in water at nightafter making them into a finesyrup the next morning tosecure laxative effect.

��Indian gooseberry (amla)is considered an effectiveremedy for heart disease. Ittones up the functions of all theorgans of the body.

��Orange juice is the mostideal liquid food in fevers liketyphoid, tuberculosis andmeasles. It gives energyincreases urinary output andpromotes body resistanceagainst infections, therebyhastening recovery.

��Lemon can be good foodremedy incase of digestiveproblems and rheumatism.

��Apple, date and mangohave a direct action on thecentral nervous system.


Pancreas is an importantorgan and it has a lot offunctions. It is a digestive

organ, helps digestion of fats,proteins, and carbohydrates bysecreting many enzymes. It isan endocrine organ. Itsecretes insulin, which is offundamental importance in thehandling of glucose. If thepancreas is not functioningproperly, diabetes maydevelop.

It is situated in theabdomen behind the stomach.It spreads behind from theduodenum on to the left and itis described as �it hugs theduodenum, rolls over thespine and kicks thespleen�.

Ducts in the gland helpsecretion of enzymes whilehormones are directlyreleased in to the blood. Themain duct opens in to theduodenum in ampulla of vaterand there it joins the bile duct.Hence blockage there canlead to obstruction of bothpancreatic and biliary ducts.Sometimes there can beanomalies in the ductalpattern.

Pancreatitis is aninflammation of the pancreas.The two major causes ofpancreatitis are alcoholingestion and gall stones.Alcoholic pancreatitis iscommon in men and gallstone-induced pancreatitis iscommon in women.

Gall stones impacted inampulla of vater and reflux ofbile in the pancreatic ductcauses pancreatitis. Biliarytract disease and alcoholismaccount for more than 80% ofhospital admissions for acute

Pancreas - The Sleeping TigerByConsultant SurgeonDr. G. Sivakumar

pancreatitis.

Pancreatitis is classified aseither acute or chronic. Acute

pancreatitis presents withsevere abdominal pain. Thepain is so severe andunrelenting that it can bemistaken for any of the acuteabdominal conditions thatrequire immediate surgery.Chronic pancreatitis ischaracterized irreversible andprogressive changes in thepancreas that results in seriousloss of exocrine and endocrinepancreatic function anddeterioration of pancreaticstructure.

Pancreatitis occurs whenpancreatic enzymes startsdigesting itself and producesevere reaction. Amylase theenzymes that help digestion ofcarbohydrates in food becomeactive inside the pancreas andstart digesting the pancreas.This enzyme is liberated in theblood and the blood level ofamylase is increased hundredfolds.

On entering the systemiccirculation, these activatedenzymes and toxins increasecapillary permeabilitythroughout the body and may

produce shock (fall of bloodpressure). If ARDS (AdultRespiratory DistressSyndrome) occurs assistedventilation with positive endexpiratory pressure may berequired. When the disease isconfined to the pancreas thepatient recoverswell but whenmultiple organ failure occursthe outlook is grim.

The pain is usually verysevere and in some the diseaseprogresses rapidly on todevelopmultiple organ failure.Usually the kidneys, lung,clotting system and liver fail.Infection complicatingpancreatitis can producesevere, early multiple organfailure.

In gallstone inducedpancreatitis gall stonesimpacted in bile duct needs tobe extracted to facilitate flowof pancreatic secretions. Thegall bladder also needs to beremoved. The surgicalremoval of gall bladder can betimed at a later date after theinflammation of the pancreashas subsided. Laparoscopicremoval of gall bladder isdone.

Pancreatic duct disruptionmay cause ascites (fluid in theabdomen). When the fluidcollection is confined to thespace behind the stomach it iscalled pseudo cyst. Thesecysts may require surgicalcorrection.

Serum amylase and lipaseconcentrations increase on thefirst day of acute pancreatitisand return to normal in 3 to 7days. Patient may developmild jaundice because ofcompression of the commonbile duct.

Ultrasound of the pancreasandCT scan help in diagnosis.If CT shows only mildpancreatic edema, theprognosis is excellent; amarkedly swollen pancreasdenotes a more severeprognosis.

Chronic pancreatitis mostcommonly results fromalcoholism and gall stones. InIndia idiopathic calcificpancreatitis occurs amongchildren and young adults.Tapioca in food is blamed forthis condition. Progressivedestruction and fibrosisproduce symptoms.

Persistent abdominal andback pain with diabetes, malabsorptionmakes one suspectchronic pancreatitis. Backpain may be mistaken forspinal pain and alcoholicscomplaining of persistent painmay be dubbed as neurotics.Majoritybeingalcoholics, poorcompliance of treatment is therule.

Structural abnormalitiescan be visualized by plain x-rayof the abdomen, abdominalultrasound or CT and ERCP.The pancreatic duct isirregularly dilated andinadequate drainage ofpancreatic secretion leads topain. There are various test toascertain the digestivefunction of the diseasedpancreas.

A relapse of chronicpancreatitis may requiretreatment similar to that ofacute pancreatitis. The patientmust stop alcohol intake.Pancreatic digestive enzymesmay be supplemented. Insulinis required to treat diabetesmellitus caused by chronicpancreatitis.

The pancreaticpseudocyst, if persisting needssurgery. The dilated ductalsystem of the pancreas isdrained by surgery and thisgives good pain relief.

Patients with chronicpancreatitis are at increasedrisk for pancreatic cancer. Inchronic pancreatitis thepancreatic gland developsmass and it is difficult todifferentiate it from cancer of

the pancreas. It may requirebiopsy and if still inconclusivesurgical removal is done.

Pancreatitis especially thechronic variety needs correctassessment, continual therapyand above all a compliantpatient.

Pancreatic cancer- Causesand Risk FactorsPancreatic cancer is a

disease in which malignant(cancer) cells form in thetissues of the pancreas. Deathof Apple co-founder SteveJobs due to pancreatic cancerhas brought into focus this rareand aggressive form of cancer,which is causing concern inIndia following a rise inincidence of the disease.

Where is the Pancreassituated?The pancreas is a gland

about 6 inches long that isshaped like a thin pear lying onits side. The wider end of thepancreas is called the head, themiddle section is called thebody, and the narrow end iscalled the tail. The pancreaslies behind the stomach and infront of the spine.

What is the function ofPancreas?The pancreas has twomain

jobs in the body:

To produce juices that helpdigest (break down) food.

To produce hormones, suchas insulin and glucagon, thatcontrol blood sugar levels.Both of these hormones helpthe body use and store theenergy it gets from food.

The digestive juices areproduced by exocrine pancreascells and the hormones areproduced by endocrinepancreas cells. About 95% ofpancreatic cancers begin inexocrine cells.



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How common is Pancreaticcancer?According to medical

experts, pancreatic cancer isranked fourth in cancer-relateddeaths in the US, after lung,prostate and colorectal cancer.Traditionally it is a male-predominant cancer, howeverthe recent increase in theincidence of PancreaticCancer in women over the lastthree decades is because ofincreased smoking behaviourin women.

The incidence ofPancreatic cancer is highest inAfrican -Americans. It has anegligible 5 year survival rateof 6.7%. At the time ofdiagnosis, 52% of patientshave distant disease, 26%have regional spread. Theglobal prevalence rate ofpancreatic cancer is 9 casesper 100,000 people. The cancerform has seen a rise in India inrecent times.

According to Delhi Cancerregistry, Mizoram in India hasthe highest prevalence ofpancreatic cancer. Theincidence of Pancreatic cancerin India is 0.5-2.4 per 100000in men.

Risk Factors for PancreaticCancer:Anything that increases

your risk of getting a diseaseis called a risk factor. Havinga risk factor does not meanthat you will get cancer; nothaving risk factors doesn�tmean that you will not getcancer. Risk factors forpancreatic cancer include the

following:

Age > 50 years

Smoking- 74% increasedrisk of Pancreatic cancer

Obesity- 12% of allpancreatic cancers areattributed to overweight andobesity,Risk increases by10%for a 5 point increases in BMI(Body mass Index) score

Diet- Increasedconsumption of processedmeat and saturated fats.

Long-standing diabetes-especially, newly diagnoseddiabetics > 50 years of age.

Chronic pancreatitis- 1%of pancreatic cancer caseslinked to chronic Pancreatitis.

Hereditary PancreaticCancer- 5-10% of cases ofPancreatic cancer.

Hereditary pancreatitisruns in families and usuallyoccurs at a young age, oftenbefore the age of 30. Thesepatients have a risk that is 50-60 times greater thanexpected. Certain hereditaryconditions, such as hereditarypancreatitis, multipleendocrine neoplasia type 1syndrome, hereditary non-polyposis colon cancer(HNPCC; Lynch syndrome),vonHippel-Lindau syndrome,ataxia-telangiectasia, and thefamilial atypicalmultiplemolemelanoma syndrome(FAMMM) are risk factorsfor Pancreatic cancer.

Symptoms of pancreaticcancer:Jaundice (yellowing of the

skin and white of the eyes).

Pain in the upper ormiddleabdomen and back.

Weight loss for no knownreason.

Loss of appetite.

Fatigue.

Why is it difficult to detectPancreatic cancer in theearly stages?There aren�t any

noticeable signs or symptomsin the early stages ofpancreatic cancer.

The signs of pancreaticcancer, when present, are likethe signs of many othercommon gastrointestinalillnesses.

The pancreas is hiddenbehind other organs such asthe stomach, small intestine,liver, gallbladder, spleen, andbile ducts, hence routine USG(ultrasound) abdomen doesnot pick up early lesions in thePancreas, detailedinvestigations like CTabdomen or EndoscopicRetrograde CholangioPancreatography (ERCP) arerequired.

Whipple�s Surgery-Pancreo DuodenectomyEarly malignancies of

Pancreas is usually treated byWhipple�s operation,medicallycalledPancreoDuodenectomy.This involves resection of headof pancreas and its adjoiningduodenum and common bileduct. Various advances ingastrointestinal surgery have

contributed in achieving lowermortality and morbidity bymany surgeons.

This highly demandingprocedure requires the highestlevel of surgical training andexcellent technical skills.

The history of thispancreatico - duodenectomyextends from the late 19thcentury.

In 1898Halsted was thefirst to successfully remove the

head of thepancreas.

In 1935Wh i pp l e e t a lperformed thefirst reported totalduodenectomy asa part of his two-stage procedure.It was modifiedby Waugh &Clagett in thepresent form.

The excellentoutcomes in therecent past havebeen very

successful has led to anincreasing number of centresand surgeons in performingpancreaticoduodenectomieson a daily basis.

A major factor in thewhiples success was his effortto prevent pancreatic leak.

Recent advances insurgery advances and criticalcare have resulted in reductionof early mortality to less thantwo percent.


The first Tuesday of everyMay is observed as WorldAsthmaDay.With the currentpollution levels reaching a newhigh, and variousminor/majorillnessmaking inroads into ourlives, the need for greaterawareness and bettertreatment ofAsthma is highernow than before.

Recently a lung healthcamp was conducted in PressClubOf India wheremembersof the media fraternity werescreened for their lung healthand the results that cameacross were more worrying.

A press release statedthat in all, 100 journalists andphoto journalists were testedfor lung health. Of them, 10were diagnosed as asthmaticand threewere found sufferingfrom COPD (ChronicObstructive PulmonaryDisease). 5 were already onmedication and 8 were newlydiagnosed.

Meaning thereby, nearly 10percent of the population issuffering from lung ailments.The data may be taken as awake- up call for coursecorrection. Breathe freemovement is well timed in theinterest of lung health. Peopleneed to hurry to know theirlung number by undergoingSpirometry test.

Asthma is common amongchildren and adults and thetreatment procedure variesaccordingly.

Consultant ChestSpecialist, Dr. G.S.Kailashgives handy tips for peoplesuffering from Asthma.

How to control yourasthma and keep asthmaattacks from starting:

��Stay away from thingsthat start your asthmaattacks.

��Take asthma medicinesthe way the doctor says totake them.

��Go to the doctor 2 or 3times a year for check-ups.Go even when you feel fineand have no breathingproblems.

When you know there isasthma in the family, youmaybe able to keep your babyfrom getting asthma.

��When you are pregnant,do not smoke.

��Keep tobacco smokeaway from the baby and outof your home.

��Put a special dust-proofcover on the baby�s mattress.

��Keep cats and otheranimals with fur out of yourhome.

Some asthma attacks aremild. Some asthma attacksget very serious. People candie from a bad asthma attack.People with asthma maywake up at night because ofcoughingor trouble breathing.

When asthma is not undercontrol, the sides of the airwaysin the lungs are always thickand swollen.An asthma attackcan happen easily. During anasthma attack, less air can getin and out of the lungs. Peoplecough and wheeze. The chestfeels tight. During an asthmaattack, it looks like this insidethe airways of the lungs. Thesides of the airways get evenmore swollen. The airways getsqueezed. The airways makemucus. Here�s how you needto act fast when an asthmaattack starts for the individual.

��Know the signs that anasthma attack is starting, i.eCough, wheeze, tight chest,wake up at night.

��Move away from the thingthat started the attack.

��Take a quick-reliefasthma medicine.

��Stay calm for 1 hour to besure breathing gets better.

Consultant Physician andYoga Expert Dr. KrishnaRaman explains how yogacan help tackle asthma:

Though an asthmatic cannever really be completely freeof the disease, it is possible tostrengthen the system by theaddition of the parameter ofyoga to the regimen oftreatment. In some cases, thepractice of yoga should becontinued along withmedication for manymonths.

Yoga is very useful for thetreatment of asthma as itprimarily works by stabilisingthe autonomous nervoussystems. According to yoga,quietude in the body alwaysstabilises irritable responses.The parasympathetic tone is inexcess in asthma; exercisesalways help balance theautonomic tone by raising thesympathetic.

The practice of asanasduring an attack is different

from when the patient is freeof symptoms. All asanas areuseful. If the patient is stable,standing poses can bepractised. Back bends arevery helpful to open the frontallungs and relax the bronchialmuscle.

The role of Pranayama:

Pranayama can comehandy when environmentaleffects aggravate thesituation. The sympathetictone is raised and vagal tonelessened; in other words, abalance is obtained. Theeffect can be felt soon afterthe practice of pranayama isover.

A single long inhalation hasbeen shown to enhanceairways relaxation. Theresistance to air flow inasthma occurs in medium-sized airways. The slower andlonger the inhalation, the betterthe relaxation. The exhalationin yoga is never forced as itwould narrow the bronchi. Itis rather a slow, verydeliberate process. It can takeas much as one minute tocomplete an inhalation andexhalation.

The normal respiratoryrate is 16 to 17 per minute. Inpranayamic practice, this isbrought to one or two perminute. One can well imaginethe relaxation of the bronchialtree. Regular practiceimproves ventilation, bettercontrol of smooth muscle asthe process of breathing helpsin voluntary opening ofairways.

There is a gradual changein the frequency of attacksand then a reduction in theirseverity.The breathing soothesthe lining of the bronchial treeand prevents hypersensitivityto external allergens. Hencethe chemical irritation of thelining is less. In pranayama, thevarying rates of inhalation andexhalation give added benefits.

TacklingAsthma As pranayama works at themicrocellular level, stabilisationoccurs over a prolonged periodof time.

P h y s i o t h e r a p i s t ,Shubha Kamakshi explainshow Physiotherapy cancome in handy whentackling Asthma:

Breathing exercises:

Take in Air through nosefor 1 second and blow it offfor 2 to 3 seconds. Thisenhances good pulmonaryfunction.

Relaxed Postures : (a) onecould physically relax andease their posture in such away that they clear the airway.So patients sit on a chair andassume forward leansupporting posture over 1 to 2pillows over a table. Theyshould turn to one side andbegin to perform the breathingexercises. (b) also thechildren can breathe either bywhistling, paper blowing, orblow candles.

Localised basal expansionand gasp and breath techniquecan also be followed.

Chest Mobility Exercises

1.Exercises: Sit erect onthe chair and lift both the armsup and take a deep breathinside andbent downwith yourarms touching the groundwhile you sit breathing out for2 to 3 seconds. Maintain thebreathing ratio by 1:2 or 1:3.

2. Hold both your handsbehind your neck by bendingyour elbows in sitting posture.Take a deep breath, move theelbows apart from each otherfor 1second, and breath out for2 to 3 seconds and get theelbows closer.

3. Cycling and swimmingare also good aerobic exercisesto prevent Asthma.



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The mercury levels havebeen soaring high and thenewspaper headlines screamabout how the country isbracing itself for a very hotsummer. What�s summerwithout Mangoes?! This issueof Good Health Naturally, wewill be discussing the goodnessofmangoes andwhy it is fondlycalled the King of Fruits.

Mango belongs to theScientific family ofAnacardiaceae and genusMangifera. Thewidely popularIndian mango is knownscientifically as Mangiferaindica. It is widely cultivatedin the tropical and subtropicalareas. Known as Manga(Rawmango)/Mambazham(Juicyand pulpymango) inTamil and(Kachha/Paka)Aam in Hindi-Mango is one of the few edible

Good Health - Naturally!!Good Health - Naturally!!Good Health - Naturally!!Good Health - Naturally!!Good Health - Naturally!!By Janani Koushik

items whose etymology datesback to India.

Statistics have it that the firstusage of the word is said tohave been derived from theMalayalamword ofmanna andthe Portugese word of manga-which eventually refined itselfto Mango as in New English.The first description ofMangoes on a recorded textdates back to 1510- in Italianby Ludivico di Verthema.Ancient mythologicalscriptures also tell us manyinteresting aspects aboutMangoes. The famous�Thiruvilayadal� story of howa Mango was used to testbetween Lord Ganesha andLord Muruga- and how whendeclared lost- Lord Murugafumedaway to thehills ofPalaniis known to all.Also- due to its

sanctity- mango leaves areadorned on the entrance porchof a house where anycelebration is being held.Alsoin Jainism, theGoddessAmbikais depicted as sitting below amango tree.

India comfortably leads theworld in Mango production,followedmuchbehindbyChina,Thailand and Indonesia.Mangoes are rich in a varietyof nutrients such asVitamin C,VitaminA,Dietaryfiber,VitaminB 6, and Potassium to highlighta few. The unparalleled juicyand pulpy taste of mango- thatsupersedes all its healthbenefits. The flavor that we allso relish is due to the chemicalssuch as terpene, furanone,lactone and ester classes.Mango has assumed epicpoprortions with regards to itstaste that it is declared as theNational Fruit of India, Pakistanand Philippines. It is also thenational tree of Bangladesh.

The high levels of VitaminC inmangohelp in lowering theserum cholesterol levels. Alsothe admissible levels ofpotassium in mango help incontrolling heart rate and bloodpressure. It is also known to

be rich in a variety ofantioxidants such as quercetin,isoquercitrin, astragalin, fisetin,gallic acid and methylgallat �help in protecting the bodyagainst various illness. It alsoacts as a skin cleanser byunclogging the pores of the skinand adding freshness to theface. Due to the presence ofdietary fiber in mango- it isknown to boost the digestivefunction and helps in burningthe additional calories and inturn- helps in weight loss.There are also reports thatsuggest regular consumptionofmangoes aid in regulating theinsulin levels and hencerecommended for diabetics.

With mangoes marchinginto the market during thesummer- exam time, there arealso studies that have proventhat mangoes are rich inGlutamine acid- which is anessential protein responsible forconcentration and memorypower.Also- The tartaric acid,malic acid, and a trace of citricacid found in the fruit help tomaintain the alkali reserve of thebody. If under any particularmedication- consult your docbefore feasting onmangoes this

summer- as theelders in thefamily wouldhave suggestedthat Mangoesdon�t work toowell whenhaving an upsetstomach- or is astrict NO for alactatingmother.

Clear your doubts with yourdoc well before.

There are a host of recipesthat indulge inmangoes in India.Up North- just Aam Ras (pulpof mangoes- beaten smoothlywith sugar or honey added) isa great accompaniment forRoti/Poori.AlsoMangoLassi isanother famous drink thatcombines the best of bothworlds- Taste of mangoes andthe chillness of Lassi for themaddening summer.

In South- especially since itmarks the beginning of theNew Year (Ugadi/ VarshaPirappu /Visu)- a sweet cumsour recipe of raw mangoes ismade called asManga Pachidi.Mangoes are also procured inlarge numbers and chopped intosmall pieces and made as tefantastic pickle- that go wellwith every dish ever cooked!Mangomilkshakes are anotherhealthy way to beat the heat.Brace the heat- go shopping andget home a bag full of lovelyripe and raw mangoes!


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Editor :ChitraSivakumarSub-editor: JananiKoushik

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