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Category : All ; Cycle : December 2009
Medical Articles
Dec21
diabetic retinopathy (IJO-98)
Diabetes mellitus is on the increase and seems to be emerging as a major public health problem for our country. Interestingly, for every patient who is known to have diabetes, another has the disease but is unaware of it. It is a multisystem disorder, including cardiovascular disease, renal failure, peripheral neuropathy, and retinopathy which may lead to blindness. The relationship of diabetes mellitus and retinopathy is most interesting. It has been reported in the literature from the developed world that 20 years after the onset of diabetes, nearly all patients with type I diabetes (insulin-dependent) and more than 60% of those with type II diabetes (non-insulin dependent) will have some degree of retinopathy. However, this also depends on the degree of metabolic control of diabetes.

Diabetic retinopathy is a leading cause of blindness amongst the working class (<55 years old) in the industrialized countries. The emerging scenario in the developing world suggests that diabetes and blindness secondary to diabetic retinopathy may soon be a major problem in this part of the world as well. Unfortunately, India has no figures for diabetic retinopathy as a cause for blindness as no proper survey has been carried out as yet. Our blindness figures still rest on the decade-old National Programme for Control of Blindness survey carried out in the mid-eighties.

Screening for diabetic retinopathy should be mandatory for all diabetics as diabetes mellitus is now assuming alarming epidemic proportions in the developing countries due to an increasingly inappropriate diet high in fat and carbohydrates, sedentary life styles, and obesity. Hence, screening for retinopathy is important. This should consist of dilated fundus examination of the diabetics at least once a year. This could best be achieved by a National Diabetic Retinopathy Screening Programme. Basic requirements for such a screening programme include identification of the population at risk, an efficient recall system so that patients are not lost to follow-up, an effective instrument for retinal viewing (an ophthalmoscope or a non-mydriatic fundus camera), an experienced interpreter of the findings, a screening protocol defining clinical parameters for referral and treatment, a system for effective management of the identified cases and their feedback, and finally, quality control.

Information obtained from various randomized control trials such as Diabetes Control and Complication Trial,[2] Diabetic Retinopathy Study,[3] Early Treatment of Diabetic Retinopathy Study,[4] and Diabetes Retinopathy Vitrectomy Study[5] are valuable both from overall health planning and individual treatment points of view. Good glycemic control can markedly reduce the retinopathy in patients with type I diabetes. Timely laser surgery can reduce risk of visual loss from proliferative diabetic retinopathy by 90%. Timely laser for diabetic macular edema can reduce the risk of moderate visual loss by 50%. Vitrectomy surgery may restore useful vision when retinopathy is too advanced for laser treatment.

Handling of the increasing problem of diabetes mellitus and its danger to sight should also include effective education and communication with the patients on the one hand, and with general ophthalmologists, primary care physicians, diabetologists, and allied health professionals on the other hand.

Dr Amol Wankhede
Retina eye centre, Nasik


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Dec17
Chikungunya & Skin
Chikungunya
Classification & external resources
ICD-10 A92.0
ICD-9 065.4, 066.3
DiseasesDB 32213
MeSH D018354
Chikungunya virus
Virus classification
Group: Group IV ((+)ssRNA)
Family: Togaviridae
Genus: Alphavirus
Species: Chikungunya virus
Chikungunya is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquitobites from Aedes aegypti mosquitoes, though recent research by the Pasteur Institute in Paris claims the virus has suffered a mutation that enables it to be transmitted by Aedes albopictus (Tiger mosquito). This was the cause of the plague in the Indian Ocean and a threat to the Mediterranean coast at present, requiring urgent meetings of health officials in the region.
Contents
1 Etymology
1.1 Linguistic confusion
2 Impact
3 Symptoms
4 Treatment
5 Epidemiology
6 Preventive measures
7 See also
8 Notes
9 External links
9.1 General information
9.2 News reports
Etymology
name is derived from the Makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. The disease was first described by Marion Robinson[1] and W.H.R. Lumsden[2] in 1955, following an outbreak on the Makonde Plateau, along the border between Tanganyika and Mozambique, in 1952. Chikungunya is closely related to O'nyong'nyong virus[3].

Linguistic confusion
According to Lumsden's initial 1955 report about the epidemiology of the disease, the term chikungunya is derived from the Makonde root verb kungunyala, meaning to dry up or become contorted. In concurrent research, Robinson glossed the Makonde term more specifically as "that which bends up." Subsequent authors apparently overlooked the references to the Makonde language and assumed that the term derived from Swahili, the lingua franca of the region. The erroneous attribution of the term as a Swahili word has been repeated in numerous print sources; Google lists over 15,000 results in a search for "chikungunya swahili". Many other erroneous spellings and forms of the term are in common use including "Chicken guinea", "Chicken gunaya," and "Chickengunya".

Impact
Chikungunya is generally not fatal. However, in 2005-2006, 200 deaths were associated with chikungunya on Réunion island and a widespread outbreak in India, primarily in Tamil Nadu,Karnataka, Kerala, and Andhra Pradesh. After flood and heavy rains in Rajasthan, India in August 2006, thousands of cases were detected in Rajsamand, Bhilwara, Udaipur, and Chittorgarh districts and also in adjoining regions of Gujarat and Madhya Pradesh, and in the neighbouring country of Sri Lanka. In the southern Indian state of Kerala, 125 deaths were attributed to Chikungunya with the majority of the casualties reported in the district of Alapuzha, primarily in Cherthala. In December 2006, an outbreak of 3,500 confirmed cases occurred in Maldives, and over 60,000 cases in Sri Lanka, with over 80 deaths. [1]. In October 2006 more than a dozen cases of Chikungunya were reported in Pakistan. A recent outbreak of the disease during June 2007 in Pathanamthitta, Kottayamand Alappuzha districts of South Kerala, India claimed more than 50 lives. It is confirmed officially that there are 7000 confirmed Chikungunya patients in these areas. Unofficial reports suggest that more than one hundred thousand are suffering from symptoms of chikungunya.[citation needed] Roamers are there telling that radio active waste from Tamil Nadu was deposited at the outskirts of this region which made the mosquitos to mutate and spread the disease like any thing..till now all the infected people are suffering from sever body pain and swelling The European Network for Diagnostics of "Imported" Viral Diseases [2] claims new phylogenetic variants of virus which are fatal have been identified on Réunion. [3]

Symptoms

The Aedes aegypti mosquito
The symptoms of Chikungunya include fever which can reach 39°C, (102.2°F) a petechial or maculopapular rashusually involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints which can be debilitating. The symptoms could also include headache, conjunctival injection, and slight photophobia. In the present epidemic in the states of Andhra Pradesh and Tamil Nadu, India, high fever and crippling joint pain are the prevalent complaint. The fever typically lasts for two days and abruptly comes down. However, other symptoms, namely joint pain, intense headache, insomnia and an extreme degree of prostration last for a variable period, usually for about 5 to 7 days. But, patients have complained joint pains for much longer time periods depending on age of the patient. With younger patients recovering within 5 to 15 days and middle aged recovering in 1 to 2.5 months and more for old people. It has been observed that the severity of the disease as well as its duration is less in younger patients and pregnant women. No untoward effects of pregnancy is noticed following the infection.

Dermatological manifestations observed in a recent outbreak of Chikungunya fever in Southern India (Dr. Arun Inamadar, Dr. Aparna Palit, Dr.V.V. Sampagavi, Dr. Raghunath S, Dr. N.S. Deshmukh), Western India (Surat) (Western India reported by Dr. Buddhadev) and Eastern India (Puri) (Dr. Milon Mitra et al) includes the following:
Maculopapular rash
Nasal blotchy erythema
Freckle-like pigmentation over centro-facial area
Flagellate pigmentation on face and extremities
Lichenoid eruption and hyperpigmentation in photodistributed areas
Multiple aphthous-like ulcers over scrotum, crural areas and axilla.
Lympoedema in acral distribution (bilateral/unilateral)
Multiple ecchymotic spots (Children)
Vesiculobullous lesions (infants)
Subungual hemorrhage
Photo Urticaria
Acral Urticaria
Cephalgia
Lumbago
Vomiting
Epistaxis and haemetemesis
Histopathologically, pigmentary changes, maculopapular rash, lichenoid rash, aphthous-like ulcers show lymphocytic infiltration around dermal blood vessels (Inamadar et al). Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.

Treatment
There is no specific treatment for Chikungunya. Vaccine trials were carried out in 2000, but funding for the project was discontinued and there is no vaccine currently available. A serological test for Chikungunya is available from the University of Malaya in Kuala Lumpur, Malaysia.

Chloroquine is gaining ground as a possible treatment for the symptoms associated with Chikungunya and as an antiviral agent to combat the Chikungunya virus. According to the University of Malaya, "In unresolved arthritis refractory to aspirin and nonsteroidal anti-inflammatory drugs,chloroquine phosphate (250 mg/day) has given promising results." [4] Research by Italian scientist, Andrea Savarino, and his colleagues in addition a French government press release in March 2006 [5] have added more credence to the claim that chloroquine may be effective in treating Chikungunya. The CDC fact sheet on Chikungunya advises against using Aspirin. Ibuprofen, Naproxen and other non-steroidal anti-inflammatory drugs are recommended for arthritic pain and fever.

Infected persons should limit further exposure to mosquito bites, stay indoors and under a mosquito net. Further, "supportive care with rest is indicated during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbaterheumatic symptoms." [6] Arthralgia remains troublesome even after 8 months.

Homoeopathy claims to have successful treatment for chikungunya. As they treat on symptomatology and not the diagnosis, they claim to have many medicines successful for prevention and cure of chikungunya.

Epidemiology
Chikungunya was first described in Tanzania, Africa in 1952. The first outbreak in India was in 1963 inCalcutta.[4] An outbreak of chikungunya was also discovered in Port Klang in Malaysia in 1999affecting 27 people [7] [8].

Preventive measures
The most effective means of prevention are those that protect against any contact with the disease-carrying mosquitos. These include using insect repellent containing NNDB, DEET or permethrin, wearing long sleeves and trousers (pants), and securing screens on windows and doors. It's also important to empty stagnant water where mosquitoes breed. [9].

See also
September 2007 peer-reviewed review article on Chikungunya virus. Free on JGV Direct
Dengue fever
Notes
^ Robinson Marion (1955). "An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53; I. Clinical Features". Trans Royal Society Trop Med Hyg 49 (1): 28-32.
^ Lumsden WHR (1955). "An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53; II. General Description and Epidemiology". Trans Royal Society Trop Med Hyg 49 (1): 33-57.
^ Vanlandingham DL, Hong C, Klingler K, Tsetsarkin K, McElroy KL, Powers AM, Lehane MJ, Higgs S (2005). "Differential infectivities of o'nyong-nyong and chikungunya virus isolates in Anopheles gambiae and Aedes aegypti mosquitoes". Am J Trop Med Hyg 72 (5): 616-21. PubMed.
^ Chikungunya-History. Retrieved on 2007-05-20


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Dec17
Standard guidelines of care: Laser and IPL hair reduction
RECOMMENDATIONS
Year : 2008 | Volume : 74 | Issue : 7 | Page : 68-74
Standard guidelines of care: Laser and IPL hair reduction

Rajesh M Buddhadev
Member, IADVL Dermatosurgery Task Force* and President and Director, NU Skin World & Nisarg Skin Lasers, Surat, Gujarat, India

Correspondence Address:
Rajesh M Buddhadev
President and Director, NU Skin World & Nisarg Skin Lasers & President, IDCALM ® , B-wing, 307 Tirupati Plaza, Complexes, Athwa Gate, Nanpura, Surat, Pin: 395001, Gujarat
India

Abstract

Laser-assisted hair removal, Laser hair removal, Laser and light-assisted hair removal, Laser and light-assisted, long-term hair reduction, IPL photodepilation, LHE photodepilation; all these are acceptable synonyms. Laser (Ruby, Nd Yag, Alexandrite, Diode), intense pulse light, light and heat energy system are the different light-/Laser-based systems used for hair removal; each have its advantages and disadvantages. The word «DQ»LONG-TERM HAIR REDUCTION«DQ» should be used rather than permanent hair removal. Patient counseling is essential about the need for multiple sessions. Physicians«SQ» qualifications: Laser hair removal may be practiced by any dermatologist, who has received adequate background training during postgraduation or later at a centre that provides education and training in Lasers or in focused workshops providing such training. The dermatologist should have adequate knowledge of the machines, the parameters and aftercare. The physician may allow the actual procedure to be performed under his/her direct supervision by a trained nurse assistant/junior doctor. However, the final responsibility for the procedure would lie with the physician. Facility: The procedure may be performed in the physician«SQ»s minor procedure room. Investigations to rule out any underlying cause for hair growth are important; concurrent drug therapy may be needed. Laser parameters vary with area, type of hair, and the machine used. Full knowledge about the machine and cooling system is important. Future maintenance treatments may be needed.


How to cite this article:
Buddhadev RM. Standard guidelines of care: Laser and IPL hair reduction.Indian J Dermatol Venereol Leprol 2008;74:68-74


How to cite this URL:
Buddhadev RM. Standard guidelines of care: Laser and IPL hair reduction. Indian J Dermatol Venereol Leprol [serial online] 2008 [cited 2009 Dec 17 ];74:68-74
Available from: http://www.ijdvl.com/text.asp?2008/74/7/68/42295

Full Text


Introduction



Hair reduction and hair removal are two of the most common cosmetology procedures performed by dermatologists all over the world. It is a safe and effective procedure.

Definition of Procedure



Any Laser/IPL/LHE-based equipment used for removal of unwanted hair should be labeled as "Laser and light based techniques for long-term hair reduction".

The word Laser is an acronym for Light Amplification by Stimulated Emission of RadiationIPL is an acronym for Intense Pulsed Light systemLHE is an acronym for Light, Heat and Energy device Any device that uses light and heat, either singly or both, and uses the basic principle of selective photothermolysis is included.The phrase "long term hair reduction" should be used rather than permanent hair removal as the global experience of Laser and light-based technology is hardly two decades old.

Evidence: Level A

Barlow RJ, Hruza GJ. Lasers and Light tissue Interactions: Lasers and Light Vol 1. Saunders (Elsevier India Pvt Limited); 2005. p. 978-81

O'Shea DC, Callen WR, Rhodes WT. Introduction to Lasers and their applications. Menlo Park (CA): Addison-Wesley Publishing Co; 1978.

Anderson RR, Parrish JA. Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524.

Arndt KA, Noe JM, Northam DB. Laser therapy: basic concepts and nomenclature. J Am Acad Dermatol 1981;5:649-54.

Tanzi EL, Jason R, Lupton M, Alster TS. Lasers in dermatology: Four decades of progress. J Am Acad Dermatol 2003;49:1-31.

Rodney D. Facial and Body Hair-Text book of Cosmetic Dermatology 2005 29: 275.

Rationale and Scope



Lasers are rapidly evolving with new machines being introduced each year. There are various claims made by the manufacturers, which are often not substantiated in clinical practice. Hence, variations exist in results and uniform recommendations are not possible in all cases. These guidelines outline the indications and treatment for removal of unwanted hair for cosmetic or medical reasons, various procedures and equipment that can be utilized, methodology, associated complications and expected results.

Indications



Removal of unwanted hair on the body for COSMETIC REASONS in a patient aged 15 years or older. (6) Evidence level BHirsutism Removal of hair for medical treatment purpose, e.g ., sycosis barbae/pseudofolliculitis where hairs are not unwanted, but can be removed for therapeutic reasons.

Other uncommon indications include hair from donor site and men undergoing sex change operations.

Evidence: Level A

Olsen EA. Methods of hair removal. J Am Acad Dermatol 1999;40:143-55.

Savant SS. Laser hair removal-Chapter 55: Text book of Dermatosurgery and Cosmetology 2005;55:454-5.

Dover JS, Arndt KA, Dinehart SM, Fitzpatrick RE, Gonzalez E. Task force-Guidelines of care for Laser surgery J Am Acad Dermatol 1999;41:484-95.

Liew SH. Laser hair removal: Guidelines for management. Am J Clin Dermatol 2002;3:107-15

Jackson BA. Lasers in ethnic skin: A review. J Am Acad Dermatol 2003;48:S134-8.

Kelly AP. Pseudofolliculitis barbae. In: Arndt KA, LeBiot PR, Robinson JK, Wintroub BU, editors. Cutaneous medicine and surgery: An integrated program in dermatology. Philadelphia (PA): WB Saunders; 1996. p. 499-502.

Contraindications



Absolute:

Less than 15 years of age.*An uncooperative patientAssociated photo-aggravated skin diseases and medical illness, e.g ., systemic lupus erythematosus (SLE) (evidence level A) Treatment area with active cutaneous infections, e.g ., herpes labialis, staphylococcal infections etc. (evidence level A)

Explanation: Age: No specific data exists on the precise age for Laser hair removal. There is no consensus on an age limit for Laser hair removal in adolescents. After taking all factors into consideration, the Task Force recommends that Laser hair removal may be performed above 15 years of age. However, proper counseling of the parent and the adolescent is important and the procedure should be performed only after proper considerations.

Relative



The Laser has to be used cautiously in the following indications only after proper counseling of the patient. Use of the Laser in these situations depends on the individual situation and on the treating dermatologist's judgment.

Patient having keloid and keloidal tendencies: Caution should be exercised in patients with keloids and keloidal tendencies. Such patients should be treated less aggressively, and only after proper counseling of the patients. A test patch may be performed to judge the keloidal tendency. Laser hair removal should not be performed if the treatment area has keloid. Superficial cuts and injury in the treatment area.Patient on long-term drugs that cause the skin to be more sensitive towards light, e.g ., minocycline, isotretinoin etc. Patients who have been taking the above drugs in the past can be taken for Laser treatment only after proper counseling.Patient with unrealistic expectations.Psoriasis and vitiligo patients should be treated cautiously (for risk of Koebnerization of treated area).Previous history of herpes simplex is a relative contraindication for Laser hair removal because of the risk of precipitation of active lesions. Laser hair removal being a cosmetic procedure, its risks should be seriously considered prior to performing the procedure. If the treating physician decides to perform the procedure, the risks and benefits should be explained to the patient. Also, the procedure should be performed only after getting proper informed consent and only after a course of acyclovir.

Evidence Level D

Dierickx CC, Grossman MC. Chapter 4 -Laser hair removal, Lasers and lights. Vol 2. In: Goldberg DJ, editor. (ISBN 1 4160 2360 7) 2005. p. 61-6.

Savant SS. Laser hair removal: Text book of dermatosurgery and cosmetology 2005;55:457.

Hair Reduction Systems



Different Laser systems are available:

Ruby laser-- 694 nm

Alexandrite laser-- 755 nm

Diode laser-- 800 nm

Neodymium - yttrium-aluminium-garnet (Nd:YAG) laser-- 1064 nm

Intense pulsed light system (IPL) without heat-- 550-1200 nm

Light and heat energy LHE-- 400-1200 nm

There is also no consensus on the most preferred and beneficial Laser or IPL broadband Light devices. Newer systems such as ELOS (electro optical surgical system) have also been introduced.Efficacy and safety of each system varies Each system has its own advantages and disadvantagesEach system has different power output/spot size and requires different lengths of exposure, which is also important in the selection of hair removal procedure according to the Fitzpatrick skin type classification of patient/client.The treating dermatologist should always refer to the manufacturer's / marketing company's specifications.Proper patient selection and tailoring of the fluence used to the patient's skin type, remain the most important factors in efficacious and well tolerated Laser treatment.

Evidence: Level A

Liew SH. Laser hair removal (guidelines for management). Am J Clin Dermatol 2002;3:107-15.

Jackson BA. Lasers in ethnic skin: A review. J Am Acad Dermatol 2003;48:S134-8.

Nanni CA, Alster TS. A practical review of Laser-assisted hair removal using the Q-switched Nd:YAG, long pulsed ruby, and long-pulsed alexandrite Lasers. Dermatol Surg 1998;24:1-7.

Smith SR, Tse Y, Adsit SK, Goldman MP, Fitzpatrick RE. Long-term results of hair photo-epilation. Lasers Surg Med Suppl 1998;10:43.

Gold MH, Bell MW, Foster TD, Street S. Long-term epilation using the EpiLight broad band, intense pulsed light hair removal system. Dermatol Surg 1997;23:909-13.

Battle E, Suthamjariya K, Alora B, Palli K, Anderson RR. Very long-pulsed diode Laser for hair removal on all skin types. Lasers Surg Med 2000;12:85.

Rogachefsky AS, Silapunt S, Goldberg DJ. Evaluation of a new super-long-pulsed 810 nm diode Laser for the removal of unwanted hair: The concept of thermal damage time. Dermatol Surg 2002;28:410-4.

Weiss RA, Weiss MA, Marwaha S, Harrington AC. Hair removal with a non-coherent filtered flashlamp intense pulsed light source. Lasers Surg Med 1999;24:128-32.

Physicians' Qualifications



General

Any qualified dermatologist (DVD or MD) may perform the procedure. The physician should have knowledge of skin, hair and subcutaneous tissue including structural and functional differences and variations in skin anatomy in general.

Specific

The Physician should have basic knowledge and training about skin and Laser physics. Basic knowledge of how the Laser works, is important for successful outcome and ultimate cosmetic results. Proper hands-on training of any system is mandatory before a dermatologist actually start doing it. It can be obtained from the equipment supplier's medical experts or from dermatologists/plastic surgeons experienced in performing the procedure.The physician should have appropriate hands-on training and experience in working with the particular Laser, IPL or LHE systems. Knowledge of basic anatomy of hair and the endocrine system is essential. The physician should be familiar with early recognition, prevention and treatment of Post-Laser (Postprocedure) contraindication such as hyperpigmentation or hypopigmentation, scarring, burns etc.

Evidence: Level A

Liew SH. Laser hair removal (guidelines for management). Am J Clin Dermatol 2002;3:107-15.

Alster TS. Getting started: Setting up a Laser practice. In: Alster TS, editor. Manual of cutaneous Laser techniques. 2nd ed. Philadelphia: Lippincott, Williams and Wilkins; 2000. p. 2-4.

Dover JS, Arndt KA, Dinehart SM, Fitzpatrick RE, Gonzalez E. Task force-Guidelines of care for Laser surgery. J Am Acad Dermatol 1999;41:484-95.

Dierickx CC, Grossman MC. Chapter 4-Laser hair removal, Lasers and lights. Vol 2, In: Goldberg DJ, editor. (ISBN 1 4160 2360 7). 2005. p. 61-6.

Savant SS. Laser hair removal: Text book of dermatosurgery and cosmetology. Publisher ASCAD; 2005. p. 457.

Taskforce Recommendation



The actual procedure of Laser hair removal is a simple procedure once the parameters have been determined. While it is preferable for the physician himself/herself to perform the entire procedure, this may not be possible in all situations, particularly in large body areas. It is therefore, acceptable for the nurse assistant/junior doctor to perform the procedure after proper training. However, the nurse assistant should perform the procedure only after the patient has been informed about this and only under the direct supervision of the senior physician, as per the directions of the physician and after the parameters have been determined. Further, it should be understood that the final responsibility for the procedure rests solely with the physician.

Facility



Laser hair removal is a simple procedure needing only minor facilities. It may be performed in the dermatologist's clinic/minor procedure room/day care theatre. The presence of a female nurse assistant is desirable for female patient /client. Proper lighting, operating table/cosmetic chair and comfortable seating for the treating physician are essential. Proper cooling systems need to be available for each individual machine, as per the manufacturer's recommendation. A cosmetic chair without a metallic surface (which may reflect Laser/light beams accidentally) and of washable material is preferred. An emergency hazard switch should be in place (for shutting off of all systems in case of any accidents).

Evidence Level A

Alster TS. Getting started: Setting up a Laser practice. In: Alster TS, editor. Manual of cutaneous Laser techniques. 2nd ed. Philadelphia: Lippincott, Williams and Wilkins; 2000. p. 2-4.

Smalley PJ. Laser safety management: Hazards, risks, and control measures. In: Alster TS, Apfelberg DB, editors. Cosmetic Laser surgery. 2nd ed. New York: Wiley-Liss; 1999. p. 305-19.

ANSI Z 136.3 For the safe use of Lasers in health care facilities. New York: American National Standards Institute; 1996.

Wausau WI. Standards of practice for the safe use of Lasers in medicine and surgery. American Society for Laser Medicine and Surgery; April 3, 1998.

Beck WC. Lighting the surgical suite. Contemp Surg 1978;12:9-13.

Drake LA, Ceilley RI, Cornelison RL, Dinehart SM, Dorner W, Goltz RW, et al . Guidelines of care for office surgical facilities: Part I. J Am Acad Dermatol 1992;26:763-5.

Drake LA, Ceilley RI, Cornelison RL, Dinehart SM, Dorner W, Goltz RW, et al . Guidelines of care for office surgical facilities: Part II, Self-Assessment checklist. J Am Acad Dermatol 1995;33:265-70.

Elliott RA. The design and management of an aesthetic surgeon's office and surgery suite. In: Regnault P, Daniel R, editors. Aesthetic plastic surgery: Principles and techniques. Boston: Little Brown; 1984. p. 46

Recommended practices for Laser safety in practice settings. AORN J 1998;67:263-4,267-9.

Informed Consent



A detailed consent form (see appendix 1) should specifically state that multiple sessions may be needed for significant hair reduction and that performing Laser hair removal will not prevent future hair growth due to any underlying cause. Patients should be provided with adequate information through brochures, photographs and personal consultation.

Counseling should include information on hair anatomy, medical reasons why hair grows, importance of drugs to be avoided, actual procedure (if possible with actual video or power point slides), likely side effects, numbers of approximate sittings required, interval between two sittings, per sitting cost etc. As with any cosmetic procedure, realistic expectations are important for patients, particularly because of the exaggerated claims that are mentioned in media advertisements.

Evidence: Level B

Savant SS. Laser hair removal -chapter 55: Text book of Dermatosurgery and Cosmetology. Mumbai: ASCAD; 2005. p. 457.

Dover JS, Arndt KA, Dinehart SM, Fitzpatrick RE, Gonzalez E. Task force-Guidelines of care for Laser surgery. J Am Acad Dermatol 1999;41:484-95.

Dierickx CC, Grossman MC. Chapter 4 -Laser hair removal, Lasers and lights. Vol 2. In: Goldberg DJ, editor. (ISBN 1 4160 2360 7) 2005. p. 61-6.

History and Examination



A complete and detailed history should be obtained to rule out associated illness. This should include history of any photosensitizing drugs, keloid and hypertrophic scars, history of recent sun exposure and tanning and occupations involving prolonged exposure to sun. Female patients must be evaluated properly to rule out the underlying cause for hirsutism. If necessary, a gynecologist's / endocrinologist's opinion should be sought. While no investigations may be necessary in most patients, specific tests such as complete blood counts, fasting blood sugars, urine analysis, serum LH, FSH, prolactin, DHEAS, free testosterone and USG-whole abdomen (PCOD) etc may be evaluated in consultation with the gynecologist or endocrinologist in selected patients.

Preprocedure Work-Up



The patient should be instructed not to use bleaching, plucking, thermolysis or electrolysis or waxing in treatment areas once he/she decides to start with the Laser hair reduction treatment. The patient should be instructed to avoid sunbathing, swimming in sea water and other activities which might produce tanning of treatment areas. Patient should avoid any over the counter (OTC) products / herbal remedies / homeopathic medicines etc. Photography: Preprocedure photographs of treatment areas are recommended but not mandatory and should mention the name of the patient, date of the photograph. This practice will make the work of the practicing doctor easier at a later date in case of patient dissatisfaction.

It has been recommended by many dermatologists that it is preferable to start with broad-spectrum sunscreens prior to Laser hair removal. As tanned skin is more likely to absorb Lasers (as it contains more melanin), it is thought to be more likely to develop Laser burns after the use of Lasers. However, there is no convincing data to support a mandatory pretreatment with sunscreen in all patients nor is there any data on the likely duration of use of sunscreen. Hence, no recommendations can be made for the routine use of sunscreens. However, if in a physician's opinion, the patient has had increased sun exposure, which may increase the chances of Laser erythema, the use of broadband sunscreens may be recommended. Likewise, if a patient has tanned skin, mild depigmenting creams like plain hydroquinone 2-4% may be used at night for 10-15 days before treatment. The taskforce recommends this preprocedure preparation only as an optional requirement to be chosen by the physician, and not as mandatory requirement. Level D

Test patch : An initial "test patch" has been practiced by many dermatologists. A test patch has the advantages of defining the precise treatment parameters and determining the pain threshold of the patient. It may also help determine the attitude and expectations of the patient. However, a test patch is not feasible in all cases and hence, is not to be recommended as a mandatory requirement. It may be considered in selected cases such as a nervous and unreliable patient with unrealistic expectations.

Evidence: Level C

Dierickx CC, Grossman MC. Chapter 4 -Laser hair removal, Lasers and lights. Vol 2. In: Goldberg DJ. (ISBN 1 4160 2360 7) 2005. p. 65.

Savant SS. Laser hair removal-chapter 55: Textbook of dermatosurgery and cosmetology. Mumbai: ASCAD; 2005. p. 457.

Dover JS, Arndt KA, Dinehart SM, Fitzpatrick RE, Gonzalez E. Task force-guidelines of care for Laser surgery. J Am Acad Dermatol 1999;41:484-95.

Laser Hair Removal Procedure



Hair should be trimmed with a electrical trimmer or the patient can shave the area a day earlier (at the time of treatment, hair length should not be more than 1-5 mm)

The area to be treated should be properly cleaned with soap/detergent and it should be free from make-up.

Local anesthesia is rarely required; however, in a nervous patient and in patients with poor pain tolerance (low pain threshold),, a topical anesthetic such as EMLA/Prilox® is recommended 30-90 minutes before the actual procedure

Adequate lighting on treatment area is essential.

Cooling is essential after the treatment; however, this depends on the system used. Some systems have inbuilt cooling devices, others do not. If inbuilt cooling is not available, ice cubes or cryogen spray may be used.

Depending on the area to be treated, the patient can be in a supine or sitting position (use of hydraulic chairs or operation tables is to be encouraged).

Standard precautionary measures should be observed for all devices:

Eyes of the patient should be wrapped with white gauze pieces or covered with eye protective devices such as goggles (as specified in the Laser manufacturer's manual). The treating doctor and assistant should use the goggles provided by the manufacturer.The treatment area should not be covered by metallic objects such as chains etcCosmetic chairs made of washable material and without any visible metallic surface, which may reflect light-Laser beams accidentally, should be used. An emergency hazard switch should be used-provided in all systems for immediate shut-off of systems in case of accidents.



If a "test patch" has been performed, the parameters of that patch may serve as the guide for treatment.

Each patient needs individualized parameters; hence, maintenance of individual records is vital.

Surgical jelly should be used as specified in manual except in the case of LHE systems, where it is contraindicated.

It is always helpful to inform the patient just before starting the treatment that actual delivery of Laser light is about to begin.

The hand piece of the system should be placed perpendicularly to the skin surface (gently but to press sufficiently to displace blood from capillaries and to bring the hair follicle nearer to the aiming source).

All areas may be treated in one sitting.

Overlapping of hand pieces in treating adjacent areas (10%) is generally accepted. The larger the spot size, the better is the penetration.

The presence of any severe erythema/blisters in the previously treated areas should alert the physician to reduce fluence or halt the procedure (rarely needed if proper selection of the patient and test patch has been performed).

After the entire procedure is complete, cryogen spray or chilled Eau Thermal water or ice packs may be used.

Proper sunscreen block or Lotion is applied.

Evidence: Level B

Russell SH, Dinehart SM, Davis I, Flock ST. Efficacy of corneal eye shields in protecting patients eyes from Laser irradiation. Dermatol Surg 1996;22:613-6.

Koay J, Orengo I. Application of local anesthetics in dermatologic surgery. Dermatol Surg 2002;28:143-8.

Epstein RH, Halmi B, Lask GP. Anesthesia for cutaneous Laser therapy. Clin Dermatol 1995;13:21-4.

Drake LA, Dinehart SM, Goltz RW, Graham GF, Hordinsky MK, Lewis CW, et al . Guidelines of care for local and regional anesthesia in cutaneous surgery. J Am Acad Dermatol 1995;33:504-9.

Dierickx CC, Grossman MC. Chapter 4 -Laser hair removal, Lasers and lights. Vol 2. In: Goldberg DJ, editor. (ISBN 1 4160 2360 7) 2005. p. 63-6.

Postprocedure



A. Analgesics are not usually needed. but paracetamol and other pain-reducing agents may be prescribed for three days.

B. Sunscreen lotion should be prescribed along with detailed instructions on how to use it.

C. Immediate and continuous sun exposure as well as working under halogen lights is to be avoided.

D. Depending on the area of treatment-proper schedule, with date and time should be given to the patient in their native language so that there is no lapse in treatment.

E. The patient should be counseled about possible, immediate perifollicular erythema and edema and damaged hair (explain to them that is transient or temporary).

F. In case of any persistent pain-blisters or vesicles in the treated areas, the patient should be asked to report for proper management.

Potential Side/Adverse Effects



Pain and discomfort may occur; mild oral analgesics may be prescribed. Vesiculation and local crusting are treated with antibiotic/steroid creams and mild emollients. Secondary infection is rare and can be treated with antibiotic cream and antibiotics Hyperpigmentation may occur infrequently and is treated with sun block and/or a mild steroid cream such as hydrocortisone and/or hydroquinone cream. This is usually temporary and needs to be explained to the patient. Localized hypertrichosis in other areas or compensatory hypertrichosis is rare, but may occur and cause anxiety to the patient. This also may need to be treated with Lasers.

Evidence: Level C

Nanni CA, Alster TS. Laser assisted hair removal: Side effects of Q-switched Nd:YAG, long pulsed ruby, and alexandrite Lasers. J Am Acad Dermatol 1999;41:165-71.

Top of Form

Lanigan SW. Incidence of side effects after Laser hair removal. J Am Acad Dermatol 2003;49:882-6.

Use of Eflornithine Cream Along with Lasers



Eflornithine can be used in a combination therapy along with Lasers. It may be started immediately after Laser treatment, and evidence seems to suggest some added advantage of this combination.

Evidence: Level C

Hamzavi I, Tan E, Shapiro J, Lui H. A randomized bilateral vehicle-controlled study of eflornithine cream combined with Laser treatment versus Laser treatment alone for facial hirsutism in women. J Am Acad Dermatol 2007;57: 54-9.

Tan E, Hamzavi I, Shapiro J, Lui H. Combined treatment with Laser and topical eflornithine is more effective than Laser treatment alone for removing unwanted facial hair: A placebo controlled trial. Presented at: The 4th Intercontinental Meeting of Hair Research Societies; June 17-19, 2004; Berlin, Germany. Abstract #P10.144.

Smith SR, Piacquadio D, Beger B. A randomized, double-blind, vehicle controlled, bilateral comparison study of the efficacy and safety of eflornithine HCl 13.9% cream in combination with Laser in the treatment of unwanted facial hair in women. Presented at: The 61st Annual Meeting of the American Academy of Dermatology; March 21-26, 2003; San Francisco, CA. Abstract #P649.

Conclusion



Laser-IPL-LHE (light-based devices) hair reduction technique is the most commonly performed cosmetic procedure all over the world. This gives excellent results in a patient if performed by a trained dermatologist in a proper manner. In India, IPL and different systems such as LHE. Alexandrite or Diode have been used for almost 7-10 years now. Experience has shown almost all systems to be effective. Careful patient selection, proper evaluation of individual cases, pre- and postoperative care-all are essential parts of this therapy to get satisfactory cosmetic results. It is also important to note maintenance therapy with further sessions of treatment may be needed. As in any cosmetic procedure, proper counselling of the patient plays a major role in good therapeutic outcomes.



Thursday, December 17, 2009


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Dec12
Venous Association of India Conference in Bangalore
We are organising an Annual Conference in Bangalore on 22nd and 23rd of Jan 2010. It is for all the doctors who are treating Venous diseases - like the General Surgeons, Vascular Surgeons, Radiologists, Cardiologists, Dermatologists.

For details please contact me for registration.

Dr.R.Muralidhar


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Dec11
study of gita
STUDY
OF
GITA



Dr.
Shriniwas Kashalikar




November 4, 2009, 10:30 am

GURURBRAHMA GURURVISHNUH
GURURDEVO MAHESHVARAH
GURUH SAKSHAT PARABRAHMA
TASMAISHRI GURAVE NAMAH

I salute my Guru, who is Brahma, Vishnu and Mahesh called Gunamaya i.e. the penultimate truth; and the Parabrahma; i.e. the ultimate truth.

What is the background of the sharing of my perceptions of Gita? Why did I study Gita?

It gives me great pleasure to share these experiences and perceptions of my study of Bhagavad Gita. Obviously; this is neither a translation nor a commentary. I may not call this an interpretation also. This is simply, a sharing of my experiences and perceptions of Bhagavad Gita! For the sake of simplicity, henceforth I am going to refer her as Gita. Another interesting thing, which may appear queer, is; I prefer to refer to Gita as “she” and not it. Because Gita is much more than a “living” and “loving” mother!

It was in early childhood that I used to hear some chapters such as 15th; being recited by my brothers and sister.

During our school days I remember to have learnt some shlokas from Gita Dhyana and some shlokas from Gita proper. But I don’t remember the details.

After this brief encounter, all that I heard during my medical college days, from leftist friends was not in favor of Gita. But what I heard from many others was high acclaim for Gita.

But somehow I was involved in many things other than Gita and probably kept on groping in the dark for quite some time. May be, this was because study of Gita did not seem to have application in medical profession or social development; or because study of Gita wasn’t thought very important by leaders in different fields. Most importantly, study of Gita was not promoted enough by the local, municipal, state and central governments; in India; to attract majority of people and especially young minds! Study of Gita was not associated with any apparent or tempting incentive!

I must appreciate however; that there have been many voluntary groups trying to spread the study and message of Gita all over the world, even though I had not come in their contact or influenced by their activity!

But after coming to Mumbai, flame of curiosity was ignited and interest in Gita was aroused, probably because I had begun to revisit Vishnusahasranam and Namasmaran, and/or I was becoming increasingly aware of my inadequacies.

Apparently it was also because; I wanted to study something world famous and ultimate in every sense; so as to boost my ego! Hence I began the study of Gita.

But now it appears that there was much more to it than this. Whether I studied Gita or Gita herself made me study her, is a moot question and I feel; the latter may be truer.

When did I start the study? What were the early experiences?

When I seriously began to study Gita; about twenty years ago, I found many contradictions in her.

For example, in 4th chapter, Lord Krishna says in the same verse, (Chaturvarnayam maya srustam…) that he created four VARNAS and also; he did not create them! Also, even as Lord Krishna advocates the war (Tasmat uttishtha Kaunteya yuddhaya kruta nishchaya…2nd chapter, nirashi nirmamo bhootva yuddhaya kruta nishchaya… 3rd chapter, Yadahankarmashritya na yotsya iti…..18th chapter), he also upholds nonviolence and control of mind in most of the chapters e.g. (Ahimsa satyamakrodham.. 16th chapter, Moodhagrahenamatnoyat …17th chapter, ) as a virtue.

Similarly, Lord Krishna disapproves Arjuna’s arguments in 1st chapter about VARNA SANKAR, which means indisciplined and unrestricted marriages directed by mere
attraction; in different groups, (Ashochyanaiva shochastvam prajnya vadanscha bhashase.. .2nd chapter) he uses the same argument (Yadi hyaham na varteyam …and Utside yurime lokam… 3rd chapter).

In 2nd chapter his argument (Akeertin cha pi bhootani…, Bhayat ranat uparatam…, Awacchya vadanscha bahoon…. etc) about “what people would say”, appears to be too superficial and not enlightening or philosophical (Please refer; page 121).

One can quote many such contradictions and uninteresting arguments as examples; but that is not the purpose of this writing, because as can be seen latter, these apparent contradictions kept getting resolved in the process of study. Hence, the purpose of this writing is; to share exciting changes in my perceptions of Gita and myself and hitherto impossible; amazing revelations; which occurred as I went on studying Gita, inspite of the contradictions and uninteresting arguments!

Why did I continue my study of Gita inspite of the contradictions and uninteresting arguments (which at that time were “real” and not “merely apparent”)? Why did I go ahead even further to byheart her?

The reason why I kept on studying Gita in spite of the contradictions was; I sensed that there was something in Gita, which I was not able perceive. This sensing of
something; which I was not able to perceive, kept on haunting me. I sensed that it was so precious that I could not resist myself! This was like an obsession of searching a secret treasure; inspite of difficulties and dangers! That sensation of something imperceptible in Gita kept on propelling me from within also! It was as if I was possessed by this sensation in and out!

In addition, I realized that I needed to correlate the shlokas or verses in different chapters so as to extract deeper meaning. This could have been possible only if I remembered all the 700 verses from different chapters, and contemplate on them, at any given point of time. This I thought was the only way to possibly resolve the contradictions; even while traveling or walking and without having to refer a book! So I started the uphill task (as I do not have the gift of very good memory) of by hearting Gita!

But frankly speaking, even as I am giving these apparently logical explanations, I had not quite understood why I kept on reciting and by hearting Gita, obsessively inspite of the contradictions!

It appears now, that Gita herself consumed my consciousness, without me being aware of it and kept on absorbing; my being in her!

Another reason for the persistence; (inspite of pains and agonies of frequent and serious disagreements); which was
beyond my desire or voluntary will, may be that; study of Gita has the roots in my previous birth. This study may be a continuation of what was left half way; in the last birth!

You may believe and appreciate this or discard as a flight of imagination! I leave it to your own perceptions and experiences!

But life actually encompasses the births and deaths and hence called ANUBANDHA and NITYAGA i.e. linked up and continuous! The continuity is evident in such phenomena.

Why did not I write earlier?

In the process of studying Gita; the thought to share my understanding used be very predominant. This may be a reaction of the excitement I derived from time to time from Gita or it may be because I thought; I have something to offer to the society! For this reason; I had tried to write on Gita about ten to twelve years back, but later I stopped halfway; as I was not quite satisfied and was not at ease; with my own interpretations, contentions and explanations, which appeared circular to me!


What is the feeling while sharing the perceptions of Gita today?

Not that I am sharing now, because I can claim to have understood Gita completely, but because, I am convinced that Gita enlightens us for the journey; that starts with ignorance, individuality; and timed mortal existence; and heads towards the destinations of self realization; universality and trans-temporal immortal consciousness; respectively! Or rather, it is because it is an urge to share something wonderful with the others, with whom I feel, I am united, irrespective of their caste, creed, religion, ideology, race, country and other characteristics; such as whether I know them or not!

I am keen to share this great treasure, because; at this juncture I see; that Gita deals with; 1) Molecular activities 2) Individual activities including various physical, instinctual, emotional and intellectual 3) The relationship of these with the society and universe and 4) The relationship of all these with past, present and future; and 5) The all encompassing cosmic consciousness i.e. the nature of our cosmic being.

I am enthusiastic to share because, though Gita does not deal with; the drudgery of enumeration and description of irrelevant peripheral details, she deals with the intricate principles involved in the intermolecular, inter-moment, interpersonal, international interactions and also the interactions at all the levels of consciousness. This may be termed cosmic dynamics or cosmic orchestra; including the role of an individual blossoming in it!

Do I understand Gita completely?

I have realized that I may not understand Gita, I may understand Gita partially, or I may misunderstand Gita. In any case it is useful; because; with the study of Gita, there starts the exciting voyage of enlightenment and blossoming!

Complete understanding of Gita is impossible, because it is trans-intellectual i.e. beyond the three levels of consciousness (SWPANA, SUSHUPTI and JAGRUTI, i.e. dream, sleep and wakefulness respectively) and four modes of communication (VAACHA) viz. PARA, PASHYANTI, MADHYAMA and VAIKHARI, i.e. roughly speaking; communication from the root of one’s existence without articulation(umbilical area), the primitive instincts communication (precoridal area), autonomic nervous system and neuroendocrine system (throat) and communication as articulated and spoken through central nervous activity (tongue, lips, palate etc) respectively. These modes of communication seem to express different levels of genuinity and varying distance from the objective truth.

What is the scope of the study of Gita in individual life?

However, even if I don’t understand Gita, due to above reason; I have the freedom and opportunity to keep on studying Gita and merge with cosmic consciousness to the
extent possible, and while doing so share the perceptions! I have the freedom to be empowered in the course of time; sufficient enough to relinquish at appropriate time; “my” then redundant; intellectual, instinctual, emotional and instinctual frameworks, material possessions and my body, happily and victoriously! This is akin to a blossoming flower; that emanates its pleasant fragrance (without reservations and any kind of pain or discomfort whatsoever) or a ripe fruit that drops from the tree!

What is the role of NAMASMARAN in the study of Gita?
Now before I go ahead, I must state here, that NAMASMARAN enabled the much necessary inner propulsion for continued study and “understanding” Gita to the extent possible; and Gita provided the paradigm shift and strong and stabilizing conceptual foundation that made it possible to adhere to apparently meaningless and unglamorous activity of NAMASMARAN! But most importantly it is the cosmic consciousness (Guru) that has made all this; i.e. study of Gita, Vishnusahasranam and NAMASMARAN possible!

Why wasn’t this published as printed book?

I am glad that it has been uploaded for free download and is being shared with millions, WITHOUT the delay caused by various formalities involved in printing, publishing advertising, transportation, shipment and marketing or
selling of hard copies. This delay due to several factors such as motivation, interest, commitment, capability, dynamism of the printers, publishers and the people involved in marketing and sale; of hard copies is avoided! I am also glad that this electronic publication is independent of any influence of charity, donations, sponsorship. This is what I call the grace of God or the benevolence of the cosmic consciousness!

In as much as I don’t want to keep any copyrights; so that anybody in the world; could utilize these shared perceptions freely, I would also like to clarify that; just as well meaning use of these would aid in imminent universal blossoming; the plagiarism of this material in any form with vested interests and mercenary motives; would prove detrimental to the plagiarists and their readers; and hence to everyone.

November 4, 2009, 4:30 pm.

In what way was it a difficult proposition to study and continue to study Gita?

Like any individual I was also engrossed in the cacophony of needs, wants, passions, infatuations, goals, dreams and aspirations, for myself and the society, which I was conscious of, there was; in addition; an inexplicable and subconscious undercurrent that seemed to give incomprehensible twists and turns to my life; often beyond
my tolerance and forbearance and stirred me from deep within! Added to all this was; the challenge of study of Gita, in which there way no monetary benefit or any solution to day to day problems. Study of Gita had (and even today does not have any value) in medical curriculum.
There was importance in medical curriculum! This apparent irrelevance and non utility of the study made it difficult and often disturbing!

But even as it appeared to create turmoil within my intellectual and emotional framework; I could not get rid of it, till today, due to the possible reasons mentioned earlier!

What is the bond that Gita creates?

It is just in recent times that I have started appreciating that Gita has the nectar of immortality that is beyond individual consciousness. But till recently; I felt that Gita (who kills one’s subjectivity), imparted a dying experience! This is why at earlier stages I felt it was terribly frightening to study and internalize Gita! But even then, Gita immersed me in herself!

In past, I used to sometimes worship Gita and sometimes contradict her; without seriously studying! I often merely used some quotations from Gita for proving my point and to impress the audience and feel good with myself.

During my study in college and medical college I used get
enamored by unusual terminology and bombastic uncommon words and feel elated. Many a times quoting Gita, added to this elation!

But now I know that I was merely; getting enamored or repulsed by experiencing the periphery; similar to enjoying or hating the fruit by tasting its skin!

What is the significance of reciting Gita?

In India, Gita is recited, chanted, by hearted by many. Earlier I thought this was stupidity or slavish mentality. At times I thought this was blind belief. But today I confess frankly that I was more immature at that time, than what I am today! Today as a student of physiology for over 30 years, I feel that Gita can especially benefit all the children in the world to develop and tone up their central nervous system (including the speech areas and speech articulation with biomedical feedback) and enhance their evolution during this life! This is true not merely for a child but for any and every person of any age in the world. This is true even if Gita is by hearted without understanding the intricacies, which one can appreciate at a later stage of development!

As a student of physiology, I am also sure that; by hearting of certain facts, meaningful hymns, philosophical or scientific sutras (e.g. those from Ayurveda, Gita, and Arithmetic), without questioning; lets the child build; the
edifice of knowledge and then work on it. Up to a certain age there is no capacity in us to analyze and comprehend certain aspects of life and hence insistence on clarification should not be encouraged as it can act as hindrance in the learning. In fact by hearting even if the child did not understand the meaning is as essential; as feeding the baby, even if it did not understand the nutritive principles in that food!

While studying Gita I realized that questions themselves should not be discouraged, but encouraged, but it must also be clear that all questions may not be answered and if answered, the answers may not be understood. Hence insistence on clarification; as a precondition to by hearting; should not be encouraged.

What is the role of patience and humility in learning Gita?

Another point in learning Gita is; an approach with humility and patience. They are very important.

Besides, hidden meanings are not understood by casual reading and/or egocentric approach under the spell of egalitarian, utopian or any such philosophical thought.

Moreover; Gita can not be appreciated if we are already prejudiced by individualistic trends or socialistic dogmas; often hidden under the guise of analytical fervor and/or scientific temper.

Patience (which is born from honesty, commitment and readiness to go beyond individual subjectivity and paradigms of every kind and sometimes called SHRADDHA) opens the doors to enlightenment and blossoming at individual and global levels!

What is the benefit from study of Gita?

Now I realize that study of Gita can empower a serious student of Gita to live with unconditioned acceptance, love and respect for every moment and situation, and work in consonance with nature; to one’s complete fulfillment and greatest satisfaction.

Gita enables one to blossom in such a way, that subjectivity gets shed off smoothly; while global unity and harmony begin to pulsate in one’s heart!

It is worthwhile to share with you here; that today I feel that; opportunity to study Gita is a one of the greatest treasure in my life for me.

November 4, 2009
9:45 pm.

How do we reconcile the socialistic and individualistic ideas with the principles of Gita?

During my first few years of study of Namasmaran, Vishnusahasranama and Gita, I was instinctively or intuitively feeling, that the essence of these teachings was not at all in opposition to the idea of social justice and material abundance; explicit in socialistic and leftist way of thinking. I felt strongly; that inequality and exploitation were aberrations; and in no way; teachings of Gita, Vishnusahasranam and NAMASMARAN (as sometimes erroneously thought even by me). I sensed the essence of Gita and Vishnusahasranam and the NAMASMARAN embodied the spirit; unifying the essence of the leftists, rightists, believers, nonbelievers and all others!

But it is after ongoing study that it became clear that being not equal can mean; merely being different and complementary (and not necessarily unequal in the sense of constituting antagonistic relationship of exploiter and exploited). Then I took it upon myself to further clarify the essence to myself and share it with others. Because; I had in myself (which were in the outside society), the leftist, rightist, individualistic, socialistic and good and bad elements; such as superficiality, pettiness, prejudice and ideological adamancy!

In what way was the study of Gita useful in practically realizing the ideals of life?

I was possessed by only one question: How to see more clearly and then show that essence of Gita,
Vishnusahasranam and NAMASMARAN; is the key to blossoming of all, irrespective of their identity viz. atheist, leftists, Hindus, non-Hindus, and others belonging to different cultural and socioeconomic groups?

I had sensed, as mentioned earlier, that Gita, Vishnusahasranam and NAMASMARAN had the best from capitalist or individualistic doctrines in terms of individual blossoming and the best of Marxist, leftist, socialist or communist doctrines in terms of global blossoming and welfare of all; and unite all streams in the society!

So, from this point of view, I wrote my comments or interpretations on Gita and Vishnusahasranam and Namasmaran, so as to highlight the innate unity and bring everyone together, irrespective caste, creed, religion and even socioeconomic group!

Did I get frustrated any time; in the process of studying Gita?

But as the time passed, I started realizing that even though my efforts were honest (according to me), they were subjective and incomplete. They did not convey absolute or objective truth and hence, did not match the demands of the time! But having not understood this enigma; I was really frustrated. I didn’t quite understand the subtle difference between subjective and objective perspectives. I was unable
to see how my efforts; admired by most readers; could apparently make no impact (in terms of socio cultural and politico economic conditions, to my satisfaction) on myself and the society!

How does Gita (or NAMSMARAN) help in overcoming the frustration?

But in spite of my frustration, I still felt quite strongly that my convictions if real; then must blossom the universe in every possible way at some point of time. So I was not too much vagrant or did not go too astray!

Gradually I began to realize that, even as my conviction was correct according to me, it could be more subjective and hence it was essential to practice NAMASMARAN with greater commitment and grow more and more objective. Having realized this onus my head, it became increasingly clear that it was useless and/or counterproductive to simply despise my own short comings! Because, self pity amounted to being suicidal, i.e. violent to myself!

Having accepted the NAMASMARAN as top priority, it also became clear that it was inappropriate to hate the shortcomings of the others. Because, that is being in a subtle way, violent to others! Thus, I stopped despising what ever was happening in the society which was unpleasant to me!

I realized that there was no sense in getting frustrated, feeling guilty, accepting defeat or blaming disagreeable activities and view points of others (theists, spiritualists, atheists, leftists, secular etc because I was a part all this some point in time). I also found no sense in feeling sad about the misinterpretations of Gita, Vishnusahasranam and NAMASMARAN by their worshippers and/or their detractors (because I was a party to this also!).

I also realized that, what is required, is blossoming together and empowering one another; through the study and practice of Gita, Vishnusahasranam and NAMASMARAN respectively.

I thought this would assist us to grow from within and actualize intellectual, emotional, instinctual and physical actions; in terms of globally nurturing policy making, planning, administration and implementation and engender individual and global blossoming!

November5, 2009, 10:00 am

What were the first impressions of 1st chapter?
Initially when I began to read Gita, I felt that I am reading a story of war. I was rather put off by the list of names and the description of conches they blew.

Later I read about the repulsion of Arjuna about the idea of
war and violence and his arguments about the disastrous effects of war. I felt that there was nothing intellectual and it all seemed to be too obvious to be stated.

But I kept on by hearting it apparently; as a kind of exercise of memory and probably also to fill the void in me; and actually because Gita “swallowed” me as I have mentioned earlier!

I did not quite understand the exact meaning MOHA for long time.

Some said that Arjuna was afraid and some said that it was his love for the family members. Some felt Arjuna was right and some said he was wrong. But I never seemed to understand how this was related to the day to day problems in life of a common man and me; and why Gita was acclaimed as the greatest exposition of philosophy!
Some said that the description of war was symbolic and actually Gita relates to the higher self in an individual with lower self.

This seemed impressive but could not explain the relevance of Arjuna’s arguments about VARNA SANKAR i.e. haphazard and lawless marriages amongst different strata and groups in society and their ill effects.
How can we get clarifications to the doubts formed while studying the 1st chapter?

At this juncture; it is clear; that Gita actually deals with the individual existence, universe, the time and cosmic consciousness. She also deals with different stages of human development from SADHAKA i.e. seeker and SIDDHA i.e. enlightened individual and the various ways and techniques to attain the ultimate state of liberation.

Initially I used to feel that Gita relates to individual emancipation and hence felt that there was nothing in terms of solution for the welfare of world. This was because of the repeated description of STHITAPRAJNA (a person beyond the influence of painful and pleasurable influences in life) and absence of any reference to dream society! This could be because of my ego (not necessarily unjustified or condemnable, but not accurate either), which prevented me from seeing my unity with the universe and how the STHITAPRAJNA state was related to social welfare. Hence I could not see how Gita could help in social emancipation! In addition, the obsession and yearning that “I have to change the world for better” was the stumbling block in getting satisfactory solution from Gita!

Moreover; I was expecting some kind of a blue print for the universal welfare; and since I did not find it; I used to feel that Gita is individualistic and hence of no consequences for the global welfare. Naturally I was not quite in love with Gita. In fact I read and studied it with reluctance and as if because; somebody was pushing me from within to study it persistently.

Due to my honest (though subjective) concern; I was obsessed by global welfare, of which I had faint sketch in mind. But I was neither finding any reflections of the sketch in reality; nor was I completely convinced by it. I was probably looking for clearer blueprint in Gita. But since Gita does not give any such blueprint, I was rather getting depressed by reading Gita. Study of Gita was thus a kind of invited trouble!

However gradually; this turmoil began to subside; when I started to realize that the role of Gita is not to provide any blueprint; but to inspire the student to create a universal blueprint conducive to blossoming (in a most democratic) of everyone in the world!

What were the hurdles in the process of studying Gita?

Sometimes I thought Gita was produced on battlefield, sometimes I felt that it was not a creation of one individual. Sometimes I felt that many people have added different verses out of context and relevance. But these feelings did not deter me from studying Gita, because; these feelings had nothing to do with what I was looking for in Gita! I was really not concerned and bothered whether Gita was created by one or many and whether on battlefield or elsewhere!

Some people said that it was not proper to read Gita at
home as it leads to conflicts in home and some people said that it was inauspicious to read it because it was read after some one’s demise. Although these views sometimes disturbed me temporarily; while studying Gita; they could not deter me from studying her!

I however felt that Gita was not very pleasant like a romantic poetry and did not generate elation or ecstasy. She seemed to ruthlessly remind unwanted, unnecessary and unrelated questions and problems such as those of war and death!

Arguments that Gita preaches violence and the opinion that she promotes inequality and exploitation appeared too superficial and based on casual reading with preformed notions and prejudices; though they harmed my enthusiasm to some extent.

Many people in the world alleged then and do so even today; that; Hindu scriptures such as VEDAs, SMRUTIs (Compilations of rules, regulations and practical techniques for social stability, growth and harmony) advocate inequality (and hence exploitation). This was because of the labor division that continued through generations, in a structured form. It is true that various influences such as military invasions and religious persecutions tore apart the fabric of holistic Hindu philosophy and way of life, into somewhat arbitrary, coercive and at times absurd traditions
and conventions, but it does not render the Hindu
philosophy as such; exploitative, outdated and counterproductive. These views create doubt and suspension in one’s mind even before a Hindu like begins to study books such as Gita.
Can Gita guide the world today?

I began to understand that Gita philosophy (the cosmic dynamics) reveals to us our position and role in the eternal orchestra and guides us to live to our fullest satisfaction; while simultaneously aiding the blossoming of the universe.

I realized that by studying Gita superficially one can not see her potential to rejuvenate, regenerate and even revive the chaotic and turbulent human civilization all over the world. I therefore felt greater and greater need to explore the heart of Gita. I started getting as if haunted by a beautiful and barely seen blurred “melodious light” in the core of Gita.

Gita begins with the description of legions of Kauravas and Pandavas on the Kurukshetra. Thus Gita directly begins with the most crucial dilemma or tricky situation one can have in life viz. the question of life and death! All conflicts in life are concentrated in this situation! This makes Gita the ultimate counselor!

I now feel that; Gita deals with war of higher self with the
lower self in an individual, where the lower self is attached
to many likes and dislikes! This attachment is depicted in terms of attachment (like that for suicidal and destructive addiction) for the relatives even if they were social psychopaths. This attachment leads to despondent retreat to lower self and passive acceptance of and involvement in degeneration and decay of one’s own true self (and that of the universe). This is surrender of higher self to lower self, or surrender of higher self of the society to the lower self of the society, that is called MOHA of Arjuna, which I guess is common to most people in the world (which is why Gita is universal).

Gita simultaneously deals with the actual war also; because she looks at the individual and society in a holistic way. She conceives and teaches to appreciate that the condition of war within and our response to that war; naturally manifest in family and social life. If our response is of surrender due to MOHA then it is detrimental to an individual as well as the society.

I think, I can appreciate this (previously thought unwanted and irrelevant and hence unpleasant) unavoidable and eternal war within and out! In fact knowledge of Gita makes it clear that presence of this war and its comprehension is a golden opportunity to live in SWADHARMA and achieve individual and global blossoming! Strange (To state the war as opportunity) though it may appear it is true that this internal and external
war is a product of evolution! Animals have no choice!
They neither can glorify their instincts nor can they condemn it! Neither are they endowed with the freedom to choose indulgence nor are they free to opt for abstinence! They do not have the golden opportunity to live in SWADHARMA as there is o conflict.

Arjuna’s response of MOHA is a response to inner war (that invariably manifests in the society)! Such despondent response to the lower self of an individual is invariably reflected in the form of a retreat to the lower self of the society i.e. psychopathic and detrimental elements in the society!

Gita not only depicts the individual and global despondency; but it also depicts; an intellectual explanation and justification of such despondency in the form of apparently sublime values and concerns; as advanced by Arjuna.

Thus Arjuna is dismissing the idea of killing teachers, brothers and other loved ones by forecasting the social holocaust in terms of the ruining of families and the exploitation of widows and mutilation of social discipline and harmony; leading to ill effects on the departed souls and the abyss thereof! Arjuna represents erudite but erroneous arguments! Thus Gita creates a strong case for individual and social mediocrity, individualism, pettiness,
gullibility, defeatism, and despondency with intellectual explanations and justifications, which span from individual and social life; to even life after death!

It is at this point that I realized that Gita is unique in NOT providing an arbitrary blue print that upholds individualism or socialism; but enlightens the root of our being and provides freedom and blossoming of individuals and the universe simultaneously. This understanding has wiped out my previous reservations about Gita (of being individualistic or addressing merely personal needs or problems) and made me far more comfortable with Gita than I used to be earlier. I now understand that Gita is more personal and more social in true sense because she takes us to the core of both! This makes her really and absolutely accurate, just and totally democratic in true sense, which the individualistic and socialistic philosophical frameworks are not! I felt very happy for having persisted on the study of Gita and having come out of the limitations and inadequacies of individualistic and socialistic philosophies.

Through depicting the individual and social despondence (represented by ARJUNA VISHADA) Gita creates a ground for an eternal discourse to shun the individual, social and universal tendencies to sink and decay!

Gita enters into 2nd chapter and then offers the omnipotent and omniscient panacea to such despondence and decay that surfaces repeatedly in the human civilization
throughout history; from millennia to millennia and time and again; from the very source of eternally provident and rejuvenating cosmic consciousness!

November 5, 2009; 10:00 pm

How is MOHA a universal problem and the resurrection from MOHA a universal solution?

After creating a strong case for the despondence; like a devil’s advocate; in 1st chapter; the propounder of Gita straight away proclaims in 2nd chapter; the aphorism that you don’t die!

This aphorism can cause a massive shock for any serious reader and I was no exception. Isn’t it natural that normally our mindset cannot understand, agree, believe or realize the concept of immortality of soul?

I however; kept on reading it, but without really understanding, agreeing, believing and of course realizing! In fact this discussion in 2nd chapter made me feel miserably torn in two conceptual premises! Neither could I agree with the claim of immortality, which was beyond my comprehension and even imagination; nor could I felt that I was a complete mortal with no traces of life after the death of my body! I could never imagine myself discarding my body like “old clothes” or in; living in absence of the body,
but I could not dismiss the claim of immortality also; because I “knew” (though I had not personally realized) that a) nothing is destroyed b) consciousness; thoughts, feelings, time, space, energy etc do not have the same kind
of “existence”, “birth” or “death” and c) ‘beginning and end’ are human concepts; derived from the limitations of physiological state, consciousness, perceptions, thinking, feelings and the information processing in the neurons and their network!

Now I realize that such tearing off; of my conceptual premises lead to dialectical process breaking down the sectarian ideas and promoted evolution of the holistic perspective.

Arjuna has indicated his disgust for a war that involves killing of near and dear ones. He is selfless and has no interest in any gains from such a war that involves shading of blood of his teachers, brothers and other close ones. So Arjuna is NOT afraid of war like a timid creature, but his conscience has paralyzed him! Arjuna like any sensitive, honest, brave and conscientious individual despised the killing of his brothers. I am sure that any sensitive and conscientious individual would relate with the plight of Arjuna; because it results from information processing through neuroendocrine, autonomic and central nervous systems; and hence is universal!

But having said that; as I went on studying Gita, it started becoming clearer, that human beings are not merely physiological; they are potentially much more than that!

November 6, 08:20 pm

After listening to Arjuna’s plight, Lord Krishna, who is cosmic consciousness, personified; (and hence can see; what others don’t; and can’t; and is conscious of what others are not); sees that Arjuna is not able to see the truth beyond the physiologically restricted sensory perceptions, like most people in the world! This inability to see beyond physiological boundaries (inaccurate perception), leads to faulty feelings arrogance or despondence (as that of Arjuna), and faulty actions (refusal to participate in war by Arjuna).

Lord Krishna notes that Arjuna has been paralyzed (inappropriate conation or response) due to inappropriate feelings (affect) resulting from this erroneous perception (cognition). This syndrome (actually universal) is called MOHA.

Lord Krishna therefore sets out to explore and salvage the human potential of Arjuna (and mankind) that has been paralyzed and wake him to his immortal self, (and thereby rectify cognition, affect and conation) from the despondent slumber of physiological confinements. Lord Krishna does this in a step by step manner, with different explanations.

As a friend, philosopher and guide; he disapproves Arjuna’s response as totally unbecoming for Arjuna. He declares it as totally inappropriate and impotent!

He explains to Arjuna that love and attachment to the
bodies of all the warriors representing sociopathic elements; (by virtue of dominance of lower self in us; which clouds our perceptions, vulgarizes our feelings and deteriorates our actions) is inappropriate. Such wars keep repeating in the societies (between socially benevolent elements and sociopathic elements) and also in the individuals (between the lower self and the higher self).

Lord Krishna shows that waking up and rising to one’s immortal existence engenders the appropriate actions and one should not get deterred by any considerations born out of MOHA.

Lord Krishna further clarifies, that the warring factions and the war (which also goes on in the individual as well as in the universe); had beginning and end but its core (cosmic consciousness) is immortal. Arjuna (and we all) should realize it (by evolving through the various means described in scriptures such as NAMASMARAN), and express himself enthusiastically with all might, in such wars (outside and inside)! These outer and inner wars are actually considered as golden opportunity, because, animals do NOT have such a choice to fight against the forces of darkness (within and outside).

This is called DHARMYA YDDHA (one which is in tune with cosmic principles and hence inevitable; and NOT religious war) because it is in tune with as well conducive to reach the cosmic consciousness. This is similar to
clinically accurate surgical treatment; which can be required for the health of the whole body (and society) and is totally different from indiscriminate violence or indiscriminate nonviolence, born out of ignorant and subjective premises.

It has to be remembered that through out hereafter; Lord Krishna keeps describing how one can conquer (not coercively suppress) the physiological (individualistic and petty) elements in body (which mar the consciousness and cause MOHA). He further also shows that uninterrupted (conscious) union with immortal soul is called YOGA; and the actions born through it are accurate, precise and appropriate; and in tune with the infallible cosmic principles! He enlightens Arjuna (and the world) that such state of being (in union with immortal consciousness) and actions springing therefrom (SWADHARMA); is called YOGA (which in essence is not different from TYAGA and SANYASA).

Lord Krishna guides Arjuna about this state and assures him that this state brings peace (for that individual and the universe) even in the face of bodily death.

Since Lord Krishna talked so much about this state of union
with immortality, which makes us desireless; the next question would be “Why not remain united with the immortal and be peaceful, instead of warring?”

Arjuna asks this question in the 3rd chapter.

How are Gita and NAMASMARAN complimentary? What do we gain from them?

But before I go ahead to 3rd chapter; and share my understanding (?) about Gita, I must make it clear, that study of Gita, Vishnusahasranama and NAMSMARAN compliment each other tremendously.

I have a feeling that NAMASMARAN; which I call a mega-fusion, a mega-process; or a mega-fountainhead; is sure to absorb the whole universe in itself i.e. immortal cosmic consciousness and in turn, as and when consciousness adequately blossoms in an individual through NAMASMARAN, the concepts of immortality in Gita would become tangible! The vice versa could also be true!

It is this awakening to one’s immortality; that I think; Arjuna (and the people of world) could gain from Gita; and that is more precious than anything else in the world; and even the world itself!


November 7, 2009; 12:10 pm

How easy is it to realize and practice SWADHARMA? How is it relevant to behavior of an individual, family
and society?

In 2nd chapter Lord Krishna declares the aphorism of immortality of the core of universe and individual; and human potential to realize this core that embodies cosmic consciousness.

But Arjuna (and student of Gita like me) cannot experience the immortality right away!

Lord Krishna therefore (apart from explaining the ways to rise and conquer the obstacles in the way of reaching the cosmic consciousness) gives other supportive arguments to emphasize the importance of SWADHARMA i.e. behavior born from the state of union with cosmic consciousness.

Thus Lord Krishna indicates to Arjuna that the greatest value in life is SWADHARMA (and not some so called spiritual or material achievement, so called and often hyped miracles and mere material abundance respectively) and hence any person who goes astray (due to his subjective; whether individualistic or so called religious/socialistic; paradigm) from this SWADHARMA; is bound to be ridiculed as coward (Akirtim chaapi Bhootani… and Bhayat ranat uparatam, 2nd chapter). This essence of value
system is the eternal glory of Gita that has been revitalizing mankind from millennia to millennia!

Further, Lord Krishna reiterates that all the efforts of human civilization e.g. VEDAs are essentially born from
and culminate into cosmic consciousness; and get expressed through individuals according to their constitutions. Those who know this; are always connected with the cosmic consciousness (YOGA); and do not get distracted by the illusive results (success or failure) and those who do not know this; get cut off from the cosmic consciousness and their perceptions, feelings and the quality, methodology and the elegance of their actions get marred. They develop the illusion that their limited existence is the doer of everything; (treating the subordinate as master); and vacillate between pride and pain from the changing results of their inappropriate actions.

The 2nd and 3rd chapters begin with Arjuna’s reluctance to participate in the war, and remain contented without bothering about the gains of a bloody war!

But Lord Krishna identifies the subtle nihilism, cynicism or pessimism hidden in this attitude. He identifies this darkness and drives the point; that such “ascetic” extremism is suicidal for the individual and the society and not conducive to liberation!

Lord Krishna guides Arjuna in 3rd chapter, (Na hi kashchit kshanamapi…) that, it is impossible to live without action. (Isn’t it true that irrespective of whether we want or not, billions of biophysical and biochemical activities go on in our body and mind? Isn’t it true that even for the universe
and universal consciousness this is true?). He clarifies that any one who tries to live in inaction, deceives himself or herself. The only way to liberation is to practice SWADHARMA.

Lord Krishna says, whether the cosmic consciousness expresses itself in actions through you, or through the actions you reach the cosmic consciousness; both are essentially not different. The first is called JNANAYOGA, where apparently consciousness is predominant and latter is called KARMAYOGA, where apparently; the actions are predominant. Thus the actions which spring from the cosmic consciousness (e.g. as a result of the practice of NAMASMARAN), are the ones which lead to realization of cosmic consciousness also, and hence are called liberating or freeing actions (SWADHARMA)!

Lord Krishna then highlights the cycle of nature in which universe manifests from and again dissolves into the consciousness and suggests that when the society and the individual conform to the innate principle of nature, they blossom together.

He also points out that those who don’t conform to these
principles, never blossom themselves and also become obstacles in the blossoming of others. This happens because of their being overwhelmed by their own subjectivity (individualistic, religious bigotry or socialistic whims and compulsions). This can happen also because of
the superiority or inferiority complex developed about their environment, conditions and apparently (due to sick value system) unglamorous or despised nature of their SWADHARMA.

Lord Krishna elaborates that since everybody is not exactly the replica of another person and the constitutions are different; the external nature of SWADHARMA varies. He reiterates; that even in such a situation; it is important not to get bogged down by the deceptive external and internal influences and persist on one’s SWADHARMA, even if one has to die in return!

Initially this appeared a bit harsh. But when I keenly thought over, I realized that living devoid of
SWADHARMA is itself like death! Hence SWADHARMA is preferable even in the face of death, because it is the only express highway of individual and global blossoming!

November 7, 2009, 3:30 pm.

How to appreciate the universal, transtemporal and relevant nature of SWADHARMA?

In the 4th chapter, Lord Krishna expands this concept of SWADHARMA and informs Arjuna that this is the knowledge that has run through generations and millennia.

Like any physiological individual, Arjuna also doubts Lord Krishna’s statement and then Lord Krishna reveals to him His immortal and true nature and that it is He (cosmic consciousness) that keeps reincarnating and re-manifesting; as and when the universe becomes oblivious of Him. (I feel that this is true in an individual, society as well as universe!).

Lord Krishna asserts; that he manifests (through rising consciousness in an individual as well as society) and annihilates the demonic and devilish forces of darkness, (inside and outside) which obstruct the blossoming of individuals, society and the whole universe. He also reiterates that one, who realizes this, (either is united or) unites with the immortal consciousness!

After revealing His cosmic nature, Lord Krishna elucidates how from the consciousness; different VARNAs i.e. four salient characteristic personalities manifest (though the consciousness does not produce them; in the physical sense of that word) and how they function! This is like involvement of space (in this case it is not mere physical and nonliving space because cosmic consciousness is like living or superliving space that encompasses everything!) which is essential for world activities, but does not directly participate in them.
He also states that people work according to their stage of evolution; through different yajnas, pranayamas, and humble dialogue with a guide and reach enlightenment.

Lord Krishna points out how the conflicts between upper and lower nature can sabotage one’s progress and assures that SWADHARMA or YOGA liberate the individual (and society and the universe) and hence appeals Arjuna; to get rid of any doubt whatsoever and tread the path of SWADHARMA single mindedly.

November 8, 2009 11:30 am

What is the difference between SANYASA and YOGA? How are they relevant to common man’s life?

In 5th chapter the discussion begins with a doubt; about the choice between SANYASA and YOGA.

I think the word KARMA SANYASA (Sanyasah karmayogah cha nih shreya sakarvibhau tayostu karmasanyasat …..) here, pertains to renunciation or asceticism; i.e. departure from all the day to day activities required for the normal family life and social life and YOGA pertains to participation in these activities; by following SWADHARMA.

The meaning of SANYASA as explained in 18th chapter is
renunciation of activities of personal interest. Individuals in the last years of life adopt SANYASA in India, i.e. give up activities of personal interest.
But the SANYASA for a common man would mean, giving
up all activities which are not embodied in the SWADHARMA. So any one; who engages himself or herself in SWADHARMA, invariably practices SANYASA by quitting everything; not included in SWADHARMA. Similarly YOGA for a common man would mean total, loving, committed and victorious involvement with all the skill and energy; in the activity included in the SWADHARMA!

Gita has reconciled SANYASA and YOGA. Both are complementary (because life is inevitably associated with renunciation of something and involvement in something at every stage of life.

Renunciation of something or other at different stages of life; is coupled with involvement in something or other at different stages of life. But renouncing in a swift and loving manner and not out of hatred or inertia; and doing the work without attachment to the fruit (in short vested interest or subjective considerations); constitute SANYASA and YOGA respectively. They culminate in cosmic consciousness; and the proportion of SANYASA may be more in one; and proportion of YOGA may be more in another; depending upon proportion of emotional and
intelligence quotient and neuroendocrine and physical capabilities; thus constituting two ways suitable for two varieties of individuals.

Why should Arjuna repeat this question regarding SANYASA and YOGA; in 5th chapter again? How are they relevant?

The answer is; understanding supremacy of SWADHARMA is not adequate. Because, in spite of understanding; the inertia keeps on surfacing and prompting an individual; to escape from the worldly responsibilities; giving one excuse or another. In India; there were tides of ideologies glorifying irresponsible “asceticism” from time to time. Even today, there are various breeds of “spiritualism” and “SANYASA” spreading like pandemics in the world causing masses to move into irresponsible inaction, indolence and parasitism (probably as a reaction to harrowingly and violently stressful petty pursuits intermingled with fanatic ideologies of extreme individualism, extreme religious bigotry or extreme views of socialism)!

Arjuna’s repetition of the question underlines the importance, span and sway over the world; of such irresponsible “asceticism” and “petty pursuits”.

Lord Krishna reiterates the vital or shall we say life saving importance of SWADHARMA; for individual, social and
global growth and blossoming. He confirms that SWADHARMA is more meritorious than “asceticism” in which one may conquer one’s petty selfishness; but can
succumb to the escapist, defeatist and irresponsible indolence and inertia, which drags the individuals, society and the world into abyss of misery!

Lord Krishna makes it clear that SANYASA i.e. external renunciation (due to incidental cause) is usually impulsive and not true renunciation. Such renunciation is because of repulsion for day to day activities or SWADHARMA; (due self inflicting nature, SWADHARMA appears mediocre and unattractive; to them; though actually it can serve the purpose of blossoming one and all) that engenders misery.

It is true that some individuals are born more evolved than the rest and hence neither get interested nor get involved in the day to day transactions of family and society, because of enlightenment and not inertia. They like Adya Shankaracharya; renounce the world and accept SANYASA just as ripe fruit falls from the tree. Some understand and realize the true nature of the world through SANKHYA philosophy without going through the experiences a common man and may lead a life different from a common man e.g. Dnyaneshvar o Dnyaneshwar. Being aware of this, Lord Krishna clarifies that we should not get enamored or infatuated (and tempted to emulate) by the heroic nature of SANYASA and SANKHYA philosophy (due to our subtle escapist or lethargic nature)
but stick to our SWADHARMA, because even as the SANYASA, SANKHYA and YOGA (SWADHARMA) look different; ultimately culminate into the same pedestal of cosmic consciousness!

Having said this; Lord Krishna elaborates the sublime characteristics of practitioner of SWADHARMA, which elevates the individual in a blissful state that is beyond physiological boundaries and beyond all petty and subjective considerations of life!

November 8, 2009, 4:30 pm

What are the practical expressions of SWADHARMA useful in individual blossoming?

In 3rd chapter it is stated that one who cooks and eats merely for his petty pleasures (which are actually detrimental to his blossoming) is a thief.

This is a very important aspect of Gita. Gita encourages individuals to be active physically, instinctually, emotionally and intellectually and according to one’s capabilities and skills, but with the goal of getting freed from the subjectivity and merging with the cosmic consciousness.

Gita states that; one (e.g. an intellectual or spiritual leader) should never dissuade (BUDDHIBHEDA) any other person; from his or her skilled and productive activities of livelihood; such as crafts, arts and other. One should in fact; encourage these and try to do oneself; all such activities in life; but with the sole aim of conforming to the absolute truth and universal blossoming!

Lord Krishna reiterates this even in 5th chapter.

In the 6th chapter Lord Krishna reinforces this point and describes certain ways by which man can merge with the objective reality.

He therefore makes it clear; right in the beginning that any one who works without attachment to the results, is a SANYASI and also a YOGI and not the one who does not do his duties (as prescribed by the scriptures with the intention of individual and global blossoming), out of escapism and inertia.

Just as He imparts the insight in SANYASA by pointing out the dangers of inaction and indolence and importance of getting rid from the results, He also espouses and elucidates the nature of YOGA, which in true sense means all activities done to merge with the absolute. This YOGA is impossible in presence of SANKALPA i.e. subjective (erroneous) projections or utopia! You can imagine that individual or subjective goals (SANKALPA); act as leakages and hinder the merger of individual consciousness
with the absolute consciousness! It is exactly like leakages in the pipes through which you cannot pump water to higher floors. So getting rid of these leakages (SANKALPA) is true SANYASA, without which YOGA is not possible!

Even though these concepts pertain to individual and global blossoming, they also make sense in day to day activities. Thus if you don’t depend on results; you can avoid self destructive responses (out of excitation or depression) to the results of your activities; and live life buoyantly!
But it has to be appreciated; that in everyday life action is usually associated with results. Thus some understanding and anticipation of results is bound to be and has to be there, so that you can perform the action elegantly and diligently. Gita upholds such continued improvement in technique by anticipation of results; from which your feelings and responses are not marred. This is emphasized in (Buddhiyukto jahateeha …yogah karmasu kaushalam) 2nd chapter!

November 8, 2009 7:pm

There are many postures, mudras, pranayamas etc apart from proper nutrition, sleep etc. which are important aspects of life, which ought to be cultivated right from childhood, so that YOGA becomes possible.

Lord Krishna does not elaborate in details on this, but
suffice it to say that once the goal viz. self realization is identified and given topmost priority and importance, then one can adopt suitable techniques; according to one’s physical and social environment, conducive to reach the goal! This is very important because during development to save us from dangerous infatuations born from some
aphorisms (e.g. Aham Brahmasmi, Brham Satyam Jagat Mithya), which tend to make an individual totally unrealistic and schizoid!

Lord Krishna reassures Arjuna (and everyone) that dedication and consistent study and practice make YOGA (the correct process and progress to self realization) possible. Lord Krishna also maintains that even if an individual loses his body before reaching the goal, his efforts are never wasted and realizes the YOGA i.e. progress towards self realization in the next birth, (he/she is adorned with the necessary qualities).

What are the pragmatic implications of YOGA in social life?

Lord Krishna also clarifies the importance of YOGA in terms of actual practice (which seems to beneficially evolve the physiology) rather than mere reading and understanding and further emphasizes the importance the focus on the goal viz. self realization i.e. complete submission of the subjectivity to Lord Krishna i.e. objective or cosmic consciousness.

6th chapter; (like the 16th,17th and 18th chapters) is important for any educationist, education policy maker, educational administrator, teacher or trainer in the world, so as to work holistically; because it outlines the actual factors which contribute to the process of blossoming, including diet and nutrition in brief!

It is easy to understand how this would have far reaching and beneficial impact on the world in terms of perspective, policies, plans and implementation; for individual and global blossoming, which is imperative today, because; no individual nation can grow or perish in isolation, without beneficial or adverse impact on the other nations; for long period.

The practical relevance of this is on policy making. For example, global reduction in the production of two wheelers and small cars; in preference to mass transport vehicles such as buses, has impact on global environment, fuel consumption, traffic jams, accidents, pollution, wearing out of roads, crowding of local trains (in metros) and so on.

If principles of Gita (the essential nutrients for individual and global blossoming) are imbibed and digested by decision makers of the world, then such globally beneficial policies can emerge in all the fields of life.

How does the description of cosmic nature (in 7th chapter) of the Lord help one to blossom?

In 7th chapter Lord Krishna narrates his omnipresent nature to Arjuna and indicates how only few realize this nature and how others do not realize this! He explains that he is the light beyond the physical light and remains unseen by eyes!!

November 9, 2009 11:30 am

In 1st chapter, there is depiction of subjective; and hence (inspite of being very conscientious); erroneous perception, feelings and response of Arjuna.

In 2nd chapter there is elaborate explanation of cosmic consciousness and contingent nature of physical existence of the nonliving and living world! There is also a detailed account of the characteristics of the individual who realizes this immortality and expresses accurate cognition, affect and conation.

It is obvious that; even as reading per se; is not enough to bring about the transformation in an individual and the world; the role of reading and understanding the “road map of blossoming” in the process of conscious evolutionary transformation of an individual and thereby the world; can not be denied.

The 3rd, 4th, 5th and 6th chapters describe the concept
SWADHARMA and some of the relevant techniques in brief; but which can vary according to geographical, historical, social, religious and other circumstances.

7th chapter is meant for reinforcing these ideas by pointing out how people in, crisis, need, greed or intellectual and emotional yearning may get attracted to the absolute truth.

In 7th chapter Lord Krishna reveals His omnipresent nature and indicates how He i.e. cosmic consciousness; is present in every visible and invisible aspect of the universe (including human hearts) and how only few realize this nature and how rest others; do not realize this! This can become clear to a discerning student; when he would appreciate the stanza elucidating how Lord Krishna is a light beyond the physical light and remains inaccessible to most!

Throughout 6 chapters; one finds the common idea of the rising of consciousness in an individual and the world; and thereby getting freedom from petty, mean and trivial but strong bondages. In 7th chapter there is endorsement of this and also further buttressing of this point by indicating how the cosmic consciousness encompasses every living and nonliving matter, energy, space and time; and how awareness of this enables one to reunite with this immortal self.

Naturally Arjuna would ask about the nature of the
universe and relevance of it to human life. Thus cosmic dynamics is described by Lord Krishna in 8th chapter. Lord Krishna assures Arjuna that a person blossoms to get freed from the shackles of subjectivity and reunites with one’s true self, through the knowledge of inseparable bond between the cosmic panorama and the individual and their relationship!

But before we discuss this further, isn’t it important to clarify AHIMSA, which is indirectly discussed right from 2nd chapter?

AHIMSA i.e. nonviolence; appears in chapters many chapters apart from 16th. In my view this AHIMSA refers to negation or disapproval of indiscriminate violence committed under the influence of utter darkness of ignorance (a variety of subjective activities destructive to self, society and the universe) and also strong protagnosim of surgical violence committed to destroy everything that opposes the union with cosmic consciousness i.e. individual and global blossoming.

Unqualified and indiscriminate nonviolence is NOT advocated in Gita, which is clear from the repeated appeal by Lord Krishna to Arjuna (and every one) to participate tin the war against darkness and destruction (outside and inside).

It is important to realize this; to avoid; perennial;
schizophrenic state; of upholding indiscriminate nonviolence, (without being completely convinced) and practicing violence with petty selfish motives (again without being fully convinced).

In our society often indiscriminate violence is legitimately practiced by killing animals to eat (not for survival, but for the petty pleasure of gustatory pleasure (taste), killing
people of other countries for the so called out religious or ideological fanaticism, causing mass violence through adulteration, selling addictive, policies to promote alcohol consumption, use force to suppress peaceful demonstrations and protests, and most importantly unleashing many policies (in all the fields) detrimental to the blossoming of individuals and the universe.

If we understand that AHIMSA means NOT indiscriminate nonviolence; but; protection and promotion of everything conducive to individual and global blossoming and destruction of everything that jeopardizes the blossoming of individuals and universe, then it would resolve the conflicts in the minds of all young and old and everywhere in the world and promote practice of SWADHARMA and blossoming of individuals and universe.

If we keep on trying to uphold AHINSA as indiscriminate nonviolence, then it creates value crisis and semblance of schizophrenia (contrasting, conflicting and contradictory thoughts/feelings and actions); in everyone and everywhere.

What are the obstacles in the way of SWADHARMA?

I found that the prescription of blossoming and merging with the absolute consciousness through various techniques and through comprehension of the nature and interactions
between the cosmos and the individual in 7 chapters; and practicing SWADHARMA;; are not as simple as they appear!

In daily routine we tend to get overwhelmed and confused or bewildered (and cut off from our true self) by the deceptive influences coming from our body, family, society, world and the products of all these in terms of literature, art, media, education etc. This makes the self realization (dissolving the subjectivity in objective truth) and self expression (i.e. SWADHARMA), which are mutually nurturing and promoting; very difficult.

The inappropriate perception generates agony and urgency to respond. But since the response is usually ineffective (because of not being in conformity or harmony with the nature) one becomes agitated and/depressed.

But one can not “see” how and what would rectify the “perceived” pathos in personal or global life; and hence tends to enter in a vicious cycle of increasing distress.

N


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Dec10
SWINE FLU
Dear Doctor

Keeping in view the present trend of increase in number of cases of Swine Flu in Chandigarh, Panchkula, Mohali and it’s surrounding areas and in general throughout India, although there is awareness among people about disease, nevertheless, it is important public need to know what kind of preliminary investigation is required for the diagnosis.

More-over, there is narrow line in the differential diagnosis of different kinds of flu and it becomes extremely difficult for the General Practitioner in suburb areas and even in cities to diagnose without proper facilities of laboratory investigations. Also people of lower income strata may be reluctant to go for certain tests advised by the doctor for provisional diagnosis.

There ought to be some proper advice and guidance in this regard which is very much need of the time and all GP’s require the direction how to tackle such kind of exigencies.

How it would be advised that won’t it be far better to dispense / prescribe Tamiflu (Oseltamivir) to all those patients who-so-ever is suffering from Flu or Flu like symptoms, keeping in mind to save a life instead subjecting a patient unless otherwise confirmed to a fatal outcome once there is delay in diagnosis.

And also there are many other medicines which have far more side effects than Tamiflu (Oseltamivir) and are freely available in Indian market.

Regards



Dr Tejinder M. Aggrwal, MBBS, GAMS
Phoenix Hospital & Diagnostic Centre
SCO 8, Sector 16, Panchkula 134109
Ph: 0172-5054321, 5011333
Fax: 0172-5011334
M: 0-931-610-1112

CC: The Editor, The Tribune, HT, IE


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Dec08
LESS surgery International Workshop at MPUH
MULJIBHAI PATEL UROLOGICAL HOSPITAL, NADIAD

JAYARAMDAS PATEL ACADEMIC CENTRE

2nd International Live Operative workshop
On Laparo-Endoscopic Single Site (LESS) Surgery


Jayaramdas Patel Academic Centre (JPAC) at the Muljibhai Patel Urological Hospital (MPUH), Nadiad is organizing the 2nd International Multi-disciplinary Summit on Laparo-Endoscopic single Site (LESS) Surgery during December 10th to 12th, 2009. This Course will feature leading international faculty and will cover the entire field of LESS surgery including state-of-the-art lectures, live operative surgery and ‘hands-on’ workshop wherein delegates will be able to practice with the entire gamut of LESS instrumentation. Around 140 delegates will be participating in the Live Operative Workshop.

With the LESS surgery, the minimally invasive surgery has just got further minimal. Experts will be demonstrating removal of large organs and growths through the navel. Unlike in laparoscopy, where four cuts are made on the abdomen, in LESS just one small incision is made on the navel. Pain and recovery period for the patient will be much less.

JPAC had organized the first successful Single Port Surgery Instruction Course in August last year. Since then the field, now called ‘LESS’ surgery has progressed exponentially and more than 1000 LESS procedures have been performed world-wide. Stimulated by increased interest in LESS technology by surgeons and patients, there has been an ongoing improvement and refinements in new technology in access devices and instrumentation.

The International faculty who will be participating in the 3-day Workshop includes Drs Mihir Desai (USA), who is also the Course Director, Lee Richstone (USA), Michael Kia (USA), Abhay Rane (UK) and Rene Sotelo (Venezuela). The prominent national faculty includes Drs Prashanth P Rao, Pradeep P Rao, G.V. Rao and Jyotsna Kulkarni. From MPUH, Dr. Mahesh Desai, Chairman, Department of Urology & Director of JPAC and Dr. R B Sabnis, Vice-Chairman, Department of Urology will also be participating alongwith other Urologists.


P.A. Joseph
Officer on Special Duty
MPUH, Nadiad 387001
Mobile 9327941331

www.mpuh.org


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Dec04
IS IT NECESSARY TO KILL MICROORGANISMS TO CONTROL AN INFECTION?
THERE ARE LOT INFECTIONS PREVAILING IN THIS WORLD STARING FROM SIMPLE RHINITIS TO DEEP INFECTIONS LIKE TUBERCULOSIS, MENINGITIS, A I D S AND SO ON. EVEN THOUGH LOTS OF ANTI- BIOTICS ARE PREVAILING INFECTIONS ARE THE MAJOR CAUSES OF DEATH WORLDWIDE. THIS DOESN’T MEAN THAT ANTI BIOTICS ARE INEFFECTIVE, BUT ARE INSUFFICIENT TO TACKLE EVERY INFECTION PREVAILING. MOREOVER VIRAL DISEASES ARE CAUSING MAJOR HEALTH PROBLEMS NOW DAYS, WHICH ARE UNMANAGEABLE BY ANTIBIOTICS. SIDE EFFECTS AND DRUG RESISTANCE ALSO PROMPT THE MEDICAL WORLD, TO FIND AN ALTERNATIVE TO ANTI BIOTICS. IS IT NECESSARY TO KILL MICROORGANISMS TO CONTROL AN INFECTION? EVERY DAY NEW INFECTIONS ARE BEING BROUGHT UP AND THE MODERN MEDICAL WORLD SPENDS LOT OF MONEY AND EFFORT TO FIND OUT A VACCINE AND ANTI-PATHIC DRUGS. SOLUTION FOR A NEW INFECTION WILL BE EMERGED BY RESEARCHES AFTER A TIME PERIOD AND THEN THE INFECTION BECOME WEAK AND A NEW ONE WILL BE MAKING DAMAGES. THIS IS A CHAIN AND ACTUALLY WE ARE NOT REACHING ANYWHERE. FOR EXAMPLE ‘BIRD FLUE’ WAS A MAJOR CAUSE OF DEATH 2 YEARS BACK. NOW H1N1 IS CAUSING PROBLEM. SOME YEARS BACK VIRAL HEPATITIS B WAS CONSIDERED TO BE FATAL INFECTIOUS DISEASE, AND BELIEVED THAT IT WILL CAUSE GREAT DAMAGE TO HUMANS IN THE COMING YEARS. BUT THE WHOLE SITUATION IS UNPREDICTABLE AND NEW INFECTIONS OUT BREAK WITHOUT MUCH AWARENESS OF HEALTH WORKERS. HERE THE ONLY SOLUTION IS THAT RESEARCHES SHOULD BE AIMED TO FIND OUT THE METHODS TO SUCCESSFULLY MANAGE AN INFECTION WITH OUT LOSS OF LIFE, PRIOR TO THE DISCOVERY OF ITS CAUSATIVE ORGANISM. THERE SHOULD BE A GENERAL PRINCIPLE THAT COVERS THE WHOLE INFECTIONS. HOMOEOPATHY IS SUCH A SYSTEM OF MEDICINE, WHICH HAS GOT THE TECHNIQUE TO TREAT AN INFECTION SUCCESSFULLY FAR BEFORE ITS PATHOGENESIS IS BEING FOUND OUT. HOMOEOPATHY WAS HIGHLY EFFECTIVE IN RECENT CHIKUN GUNYA INFECTION SPREAD OUT IN THE STATE OF KERALA[INDIA] EVEN BEFORE THE DISEASE WAS ACTUALLY DIAGNOSED . THE HOMOEOPATHIC MEDICINES CURE A CASE OF INFECTION WITHOUT KILLING A MICROORGANISM. HOMOEOPATHIC MEDICINES HAVE GOT NO POISONOUS EFFECT TO KILL ANY LIVING ORGANISM. THEN HOW HOMOEOPATHY DO WONDERS IN INFECTION? THIS PHENOMENON INDICATES THAT ANTI BIOTIS AND VACCINES ARE NOT UNAVOIDABLE IN INFECTIOUS DISEASES. RESEARCHES SHOULD BE MOTIVATED BY THE COMBINED EFFORT OF HOMOEOPATHS AND MEDICAL RESEARCHERS TO STUDY AND UTILISE THE EFFECTIVENESS OF HOMOEOPATHY IN MORE AND MORE INFECTIONS.


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