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In Hindi there is one proverb; Hamamme sab nange hote hai. This means in public bathrooms; every one is naked.

We wear clothes, cover our bodies and try to ignore our basic, in born, physical attributes. We try to be oblivious to our primitive (natural) constitution. Moreover; through good clothes; we try to ignore poverty and feel rich!

We try to also cover our basal nature by assumptions. We try to assume that we are dispassionate, selfless, noble hearted, honest, and kindhearted; in fact; full of all majestic and heroic virtues.

The more we are adamant on covering ourselves; the more we become intolerant to ourselves and others and breed indiscriminate violence. Openness of every kind is opposed and coercively crushed in such situations.

But by merely enclosing and covering our bodies; in clothes (often glamorous and fashionable) and our basic instincts and emotional make up; in certain assumptions; we can not get rid of them; in actuality.

If we realize this; then we would become more tolerant and naturally; more loving. This is the merit of open society. But the indulgence and its mercenary glorification and consequent deterioration is the demerit.

If we are realistic, then we identify our physical, instinctual, emotional and intellectual attributes. Then we can work to evolve ourselves and others in appropriate manner.

Can we accept that we are slaves of our instincts, emotions and intellect? Can we accept that we also; are potentially primitive, barbaric, criminals, corrupt and mean? Can we accept that we also are ethnocentric? Can we accept that all that we hate and loathe; is potentially within us; and would spill over if the circumstances are conducive?

Can we accept that being better is not as simple and as instant; as merely changing clothes or washing make up? Can we admit that whenever we seem to have improved, we come across a situation that bares open our meanness?

Can we accept that we are unable to voluntarily blossom and become buoyant, generous? Can we admit that we are unable to love all?

Can we realize that no one can transform us (by appropriate punishment or through prayashchitta) into sublime, unprejudiced and innocent individuals; because they themselves are the helpless victims? (They can jail us, coax us to pay tax, pay donations, but can not inspire us to voluntarily stop exploiting! They can force us to behave in a gentle manner; but can not erase the sexual, infatuative, and other bizarre ideas, whims and fancies from our mind!)

Can we agree that for us to blossom, we have to create an environment of a holistic perspective of globally beneficial policies, plans, laws, rules, regulations, conventions and fashions, which in turn would be conducive to our blossoming?

Can we dare to bare ourselves from within and thereby be considerate to ourselves and others?

Tolerance born out of experience and honesty; would add accuracy and globally beneficial dimension to every thought, feeling and activity of ours!

Is this possible? This is certainly possible and ought to be achieved! But are we ready to be totally naked from within; and see ourselves? Are we ready to rise above our assumption, beliefs and disbeliefs; and verify this; through the practice of NAMASMARAN?

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A Baby with Broken Bone A Parents guide for fractures in children.
A Baby with Broken Bone A Parents guide for fractures in children.

Fractures in children following injury are common and cause sudden panic among parents. Children are not small adults but a different sub set of patients and thier injury pattern is completely different. Hence ,It is important for the Parents/ Gaurdians to understand these basic trends of injury in children.
It is estimated that significant Percentage of children sustain fracture between 0-16 years ( 42 % boys & 27% girls). The children have soft bones and stong ligaments therefore any small injury fractures a bone rather than causing soft tissue ( ligament) injury. A normal Xray does not exclude the fracture completely and if clinical symptoms predominate ( tenderness, pain , swelling) its better to immobilise with plaster etc. In such cases a xray after few days will reveal a hairline or previously unseen fractue. Majority of the fractures are treated with immobilisation ( Slings or plaster). It is important that displaced fractures are properly aligned. This is better achieved if child is under anaesthesia or sedation. Angular malalignment up to 15 degree is well tolerated however any rotational malalignment is not tolerated. The normal process of bone remodeling in a child may correct malalignment, making near-anatomic reductions less important in children than in adults. Remodeling can be expected if the patient has two or more years of bone growth remaining. Because the amount of remodeling is not predictable, displaced fractures should still be reduced to maximize the chances of achieving acceptable alignment.
The fractures in children heal fast and non unions are very rare. While this faster healing has the advantage of little immobilisation period , it leaves with little time for manipulation if the fracture is malaligned. This is significant if proper medical help is not taken within 3-5 days because after this the fracture becomes sticky and getting alignment is difficult even under anaesthesia. Majority of children do not show all the classical signs and symptoms of fractures and many will still walk with limp. Hence any subtle signs need to be properly investigated and evaluated by Specialist.
The fractures in children are also peculiar due to presence of Growth plates which are found at ends of bones. These are responsible for the growth and ulimate height attained over the years. The transition area of bone and growth plate is the weakest part of the bone and is most likely to be fractured. If medical treatment is not taken promptly it could result in Growth Arrest (the bone stops growing) or bowing of bone . However sometimes fractures in children may stimulate longitudinal growth of the bone, which may make the bone longer than it would have been had it not been injured. Some degree of fracture fragment overlap and shortening is, therefore, acceptable and even desirable in certain fractures to counterbalance the anticipated overgrowth. This is particularly true for fractures of the femoral or tibial shaft.
Children tolerate prolonged immobilization ( Plaster or Slings) much better than adults. Disabling stiffness or loss of range of motion is distinctly unusual after pediatric fractures. After cast immobilization, physical therapy is rarely needed because children tend to resume their normal activity gradually without much supervision. Playing in a swimming pool may speed up return to full function, if desired. Even though fractures of growing bones generally heal with a large callus, this new bone is still fibrous and not yet restored to its original strength. Because of this, the child should avoid collisions or contact activities for two to four weeks, depending on activity level and age, after discontinuing immobilization.
The distal radius is perhaps the most common fracture site in children and adolescents. The incidence of fractures of the distal forearm has increased 40% over the last 30 years, with most of the increase occurring in fractures associated with recreational activities. The peak incidence of distal radial fractures ( around wrist) coincides with the peak growth velocity for children, because of the relative porosity of the bone during this time. The usual mechanism of injury is a simple fall on the extended wrist. Other areas commonly fractured are supracondylar ( above elbow), clavicle , leg bone and thigh bone. Toddler's fractures occur most commonly in children younger than 2 years old who are learning to walk. Frequently, there is no definite history of a traumatic event, and the child is brought to the clinic because of reluctance to bear weight on the leg.
A majority of fractures in children younger than 1 year are caused by physical abuse, and a significant percentage of the fractures in children younger than 3 years are the result of abuse. Although all children are potentially at risk of maltreatment and abuse, first-born children, premature infants, stepchildren, diabled children and children with both working Parents are at greater risk. It is not unusual for young children to fall, but it is unusual for them to sustain a significant injury from the fall alone. It is rare for an infant to sustain a fracture from a fall from a sofa or changing table. It is important to see whether the reported history of the trauma is consistent with the pattern, severity, and extent of the injury. Femoral fractures in children younger than 1 year are highly suspicious for child abuse . Because scapular fractures result only after significant force, a scapular fracture in a child without a clear history of violent trauma should raise suspicion of abuse.
Fractures during childhood are common. Being knowledgeable about injury patterns, typical mechanisms of injury, and physical findings helps ensure adequate evaluation and treatment.
Dr. Harinder Batth
Orthopedic Surgeon

Key Points
1. Significant Percentage of children sustain fracture between 0-16 years ( 42 % boys & 27% girls).
2. A normal Xray in children does not exclude the fracture completely.
3. Remodeling is expected if the patient has two or more years of bone growth remaining.
4. Children tolerate prolonged immobilization ( Plaster or Slings) much better than adults.

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Inactivity Worsens Knee Arthritis Keep Moving
Inactivity Worsens Knee Arthritis Keep Moving

For thousands of people with knee arthritis, performing routine tasks such as climbing stairs, bending over, or even walking can be painful, prompting many sufferers to avoid them altogether in favor of a more sedentary lifestyle. But a new study confirms what many had suspected: If you don't use your muscles, your arthritis will get worse. Theres scientific proof to back up this recommendation that patients with osteoarthritis of the knee to keep moving and stay active despite the pain -- based on the notion that inactivity would make their condition worse.

"In the short term, pain can be reduced by avoiding physical activity. In the long term, however, low activity levels will result in a deterioration of physical condition, especially in muscle weakness,"

"Due to this muscle weakness, joints become less stable and their ability to carry a load is reduced. This results in increased disability," "Consequently, the patient avoids activity even more, thus entering a viscous circle toward increasing physical disability."
Part of the problem may be that inactive people develop doubts about their capabilities -- which causes them to avoid certain everyday tasks even with no clear physical reason for this.
The people who avoided activity were more likely to be disabled than people who continued on with simple activities or used rest in between activities to make it through the day. During acute pain in knee arthritis small periods of rest during work and exercise is recommended . This protocol allows mobility and pain control simultaneously. Not all the exercises are good for a painful arthritic knee and some may even aggravate the pain. The best are isometric quadriceps , light workout for calf and hamstrings , Quadriceps strengthening and stationary cycling etc.
Patients with Knee Arthritis should remain active and perform routine exercises to maintain muscle strength and mobility. Such active patients who later undergo Knee Replacement recover much earlier than the patients with weak muscles.
Dr. Harinder Batth, M.S (PGI)
Joint Replacement & Orthopedic Surgeon

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Knee Replacement in Cardiac Patients
Knee Replacement in Cardiac Patients / Walk your way to healthy heart
As our population ages more and more patients are undergoing Cardiac interventions like angioplasty (Cardiac stenting) or CABG(Heart Surgery). The favourable outcome of these procedures is largely determined by ability of such patients to exercise after surgery. However large numbers of patients have limited ability to walk because of knee arthritis. Tackling knee arthritis and easing the pain is of foremost importance in such patients.

Many people are misinformed about such cardiac patients undergoing knee replacement and fear about possible risks and complications. If some precautions are adhered the risks are not more than any other case.
The blood thinning drugs (Aspirin, Clopidegrol) are stopped 5-7 days prior to surgery. These drugs are restarted postoperatively at appropriate time. However other drugs for blood pressure are to be continued.
Simultaneous both knee replacement is not advisable in cardiac patients and is associated with more risks. A staged procedure after 4-6 weeks interval is quite safe. This is however more costlier.
We evaluated cardiovascular fitness after hip and knee replacement, found that the post-operative resumption of physical activity was associated with increased fitness, and that patients following joint replacement were fitter than the patients with arthritic joints who were treated non-operatively.
The major purpose of total knee arthroplasty is improvement in the patients quality of life. Successful total knee replacement enables increased levels of exercise and this can be beneficial to patients with anxiety, depression, High cholesterol, obesity, high blood pressure, coronary artery disease, diabetes mellitus and osteoporosis .
Liaison between the surgeon, anaesthetist and cardiologist is recommended.
Dr. Harinder Batth

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What Are the Risks of Delaying My Knee Replacement Surgery?
What Are the Risks of Delaying My Knee Replacement Surgery?

Patients delay knee replacement surgery for a number of reasons, mostly out of fear and misinformation. Most patients delay unnecessarily for several perceptual reasons: fear of the unknown, fear of surgery, fear of losing a body part, fear of the post-op surgery pain, fear that they will end up worse than they started. But once they have undergone knee Replacement patients are thankful and wish they had done it sooner.
The risks related to delaying knee replacement surgery often involve the deterioration of the joint, increased pain, and lack of mobility. Depending on the severity of the joint disease, a surgeon may attempt several less invasive, non-surgical methods first (including glucosamine, anti-inflammatory medications, cortisone injections, and physical therapy). If none of these methods appear to be working or if the patient has become sedentary due to joint pain, knee replacement surgery is recommended. For many of the reasons listed above, patients sometimes consciously delay their knee replacement surgery, which can have some of these risks:

* risk of deformities developing inside and outside the joint
* risk of muscles, ligaments and other structures becoming weak and losing function increased pain / inability to manage pain
* increased disability/lack of mobility
* difficulty with normal activities of daily living

When a knee replacement surgery is delayed, there are also several risks that arise with regard to the surgical procedure. For example, the risk of deformities due to postponement tends to make knee replacement surgery a more complicated process. The surgery may then take longer and require a longer amount of time under anesthesia. In addition, postponement can limit knee replacement options. For example, joint disease that is spotted early on and treated may only require a "unicompartmental knee joint on the medial side." But after delay, destruction to the knee joint becomes so severe that a total knee replacement (a more complex surgery) is required - with possibly even the addition of a knee cap ("patellar") resurfacing. Recent studies have shown that timing does make a difference in joint replacement surgery. Timing of surgery may be more important than previously realized and, specifically, that performing surgery earlier in the course of functional decline may be associated with better outcome. In other words, if surgery is performed early it may be more successful. When a patient is relatively healthy and gets a knee replacement, the patient is more likely to recover sooner and with less complications. Knee replacement surgery is not recommended for everyone, and one must consult the doctor if it is required. But if you are a knee replacement surgery candidate, postponement can lead to a number of unnecessary and avoidable issues.

Dr. Harinder Batth
M.S ( PGI)
Orthopedic Surgeon

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CMV infection with vasculitis with Kawasaki disease
Sarthak,6 month/M/ch/ product of nonconsgiaunous marraige persented to us with complain of anemia and ,hepatosplenomagaly. baby was investigated throughly and it is found that baby with IGM postive for C M V.

After 2 month of apprentely asymptomatic period baby developed right hand bluish discoluration, to conform etiology CT angio done it ifound that there is fusiform swelliing of whole subclavion ,brachial and radial artery with nonvisuliation of radial artery

Radiologist make diagnosis of Kawasaki diseseas
Baby put on LMW heparin with IVIG.

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central serous retinopathy
In today's busy and stressful life, number of new diseases are coming up which are actually modifiable. Common person can never think of losing their vision because of there stressed life which they think is a part of life.
One such disease is Central Serous Retinopathy. In this disease fluid ( subretinal fluid) gets accumulated between sensory retina and retinal pigment epithelium. It is seen more commonly in males but doesnt mean females are less involved. There
are known factors which predispose the patients for this disease like hypertension, type A personality, use of steroids in any form. Endogenous steroids and increasd sympathetic activity are also contributory.
My purpose of writing this article is not to tell about the dsease per se as information regarding CSR can be retrived from multiple sources, but to make people aware about the small modifications in life which can help to decrease recurrence thus increasing the possibility of retaining good vision.
Just telling the patient to avoid sress doesnt finish our duty towards patient . Patient actually doesnt know what to do and how to do, so he/she ends up doing nothing . The whole purpose of our examining patient finishes. The best part of CSR is it is self resolving, so ask patient to relax by going for morning walk , doing meditation , reading books( whether religious or whatever he likes), listening to music, playing games , drawing, may be shopping....
I jst talked about this to a sister in the hospital what would you do relax yourself if you get full one week leave( which is no doubt unthinkable in our set up), her reply was,I will sleep, and go for shopping because then I have to join back. That means people are more worried about futur and dont live and enjoy present. Maximum of patients of CSR wich we see has stress has the precipitating factor and no other factors mentioned above.
Believe me this is the only disease where you can control your vision with a smile on your face. Always remember to avoid-HURRY, WORRY and CURRY.....

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Discover The Secrets To Become Fertile
Discover The Secrets To Become Fertile

Dr Paras Shah

Chief Consultant Sexologist & Fertility Specialist

SAL Hospital

Rajasthan Hospital

"So, when are you planning to have a baby?" This is the commonest question most newly married couples in India are asked - sometimes even as soon as they have returned from the honeymoon! There is a lot of pressure on couples to have a baby, especially in traditional families, where the wife's role is still seen to be one of perpetuating the family name by producing heirs.

Many couples still naively expect they will get pregnant the very first month they try (the result of watching too many Hindi films, perhaps!) and are concerned when a pregnancy does not occur. They go through a brief interlude of doubt and concern when they do not achieve pregnancy the very first month they try and start wondering about their fertility.

Like a surprising number of couples these days you've been hit with a bolt out of the blue... you're infertile. Whether you're newly diagnosed or have been dealing with the discovery for a while now, what you learn here will make all the difference in whether you ever hear your own child call you "Dad or Mummy".

Before worrying, remember that in a single menstrual cycle, the chance of a perfectly normal couple achieving a successful pregnancy is only about 25%, even if they have sex every single day.

Getting pregnant is a game of odds - it's a bit like playing Russian Roulette and it's impossible to predict when an individual couple will get pregnant! However, over a period of a year, the chance of a successful pregnancy is between 80 and 90%, so that 7 out of 8 couples will be pregnant within a year. These are the normal "fertile" couples - and the rest are "labeled" infertile - the medical text book definition of infertility being the inability to conceive even after trying for a year.

Like more than ten million other Indians, Rakesh and Jolly desperately wanted a baby but couldn't seem to conceive. After a consultation, they were sent home with doctor's orders: Have sex when Jolly was most fertile, and have it often.

While that may sound like a dream come true, infertile couples like the Priya say it can be stressful. "I didn't want to be one of those women tapping on her watch, saying 'Now' at the bedroom door," says Jolly, "so I tried to be seductive in creative ways."

They both put more emphasis on foreplay, for instance, so they didn't view each other simply as an egg manufacturer and a sperm-delivery guy. "I'd try to think of my husband as a sexy man, not just the guy who didn't get me pregnant," says Jolly. "Sometimes, before intercourse, I'd focus on some physical aspect of him that I particularly adore, and that would turn me on."

Obviously, it worked -- the Priyas' daughter, Vidhi, is now three.
The Stopwatch Mentality

Sex can become tedious when they have to time intercourse to accommodate numerous lab tests or maximize their chances of success. Spontaneity can be replaced with sex as a compulsory act sex on a schedule.

Besides this timetable pressure, there can be loss of self-esteem (if, for instance, the woman feels like a failure for not becoming pregnant) and the financial burden of fertility treatments. But through it all, there are ways to minimize the toll.
How Women and Men Respond

First, a couple should understand that each of them tends to react a bit differently, experts say. "A woman in this situation may feel alienated from her body, so it may be hard for her to feel sexual," says Dr Archana Shah, Consultant Gynecologist and fertility Specialist, Rajasthan Hospital, Ahmedabad. "She may feel like little more than a set of ovaries and even begin asking herself, 'What's the point of having sex if I'm not getting pregnant?' "

Lack of desire, in turn, can decrease natural lubrication, making sex painful, Dr Archana says, and resulting in even less sex.

In addition, A man may feel like nothing more than a sperm donor and become so distanced that he has difficulty achieving erection or orgasm. Some men even fake orgasm to get sex over with.
Relieving the Pressure

Both partners should avoid getting into "performance" mode. It can help to realize that the window of opportunity for conception stays open longer than what is suggested in movies, where characters often engage in lunch-hour sex in order to conceive while the woman is fertile. Sperm can live in the cervical mucus for about two days before ovulation, according to Dr Archana.

In general, infertile couples are advised to have intercourse between 12th and 18th day of her period, if possible every other day. These are the fertile days for her. Simply stated, the more sex the better! Couples who have intercourse less frequently, have a diminished chance of conceiving. I tell all my patients its much more fun making a baby in your bed room than coming to me! (And think of all the money youll be saving its like being paid to make love to your wife !)

Also remember that you cannot "store up" sperm, which means that there is really no advantage to abstaining from sex if you are trying to conceive. In this case, more is better, and in fact studies have shown that fresh sperm have a better chance of achieving a pregnancy than sperm which have been stored up for many days.

However, sex shouldn't be confined to the time of fertile days. Unless instructed otherwise by their doctor, couples should make love throughout the month, not just when they think they might conceive. That might help them separate sex from conception and sex will become a natural part of life again.
Sex as Recreation, Not Just Procreation

Thinking of sex not as a chore but as fun, the way it used to be, can help. "We did our best to have a good time -- having sex in different rooms, different positions and go to even hill station," Mahi recalls.

Couple should set a romantic mood with things like shared baths and massages. It's also a good time to explore sexual fantasies and erotica.

If you have been having sexual intercourse two or three times a week at about the time of ovulation, without any form of birth control for a year or more and are not pregnant, you meet the definition of being infertile. Pregnancy may still occur spontaneously, but from a statistical point of view, the chances are decreasing and you may now want to start thinking about seeking medical help. There is no "right" time to do so and if it is causing you anxiety and worry, then you should consult a doctor. Even though you may be embarrassed and feel that you are the only ones in the world with the problem, you are not alone. Many couples experience infertility and most of them can be helped.

Unfortunately, while infertility is always an important problem, it is usually never an urgent one. This often means that couples keep on putting off going to the doctor. "We'll take care of it next month". Tragically, many find that time flies, and before they realize it, their chances of getting pregnant have started to decline, even before they have had a chance to take treatment properly. Set your priorities, so that you have peace of mind that you tried your best. After all, if you don't take care of your own infertility problem, who will ? Kicking yourself when you are 40 years old for failing to take treatment when you were younger will not help. Remember that everything in life comes back, except for time!

Staying positive and looking ahead to the day would hold a brand-new family member in your arms.

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Inclusion of Ayurveda in Primary Education is Essential
Inclusion Of Ayurveda In Primary Education

- Professor, Vd. M. P. Prabhudesai
Bhaisheb sawant Ayurved Mahavidyalaya,
Sawantwadi, Dist.- Sindhudurga, Pin 416510.
Maharashtra, INDIA.

[ There was an All India Level Convention arranged on the subject 'Ayurveda - Education & Research', in Coimbtore (India) in July 1991. It was sponsored by Gujarat Ayurveda University (Jamnagar), Central Council of Indian Medicine, L.S.P.S.S. (Coimbtore), & A. V. R. Foundation (Coimbtore). The thoughts delivered by Dr. M. P. Prabhudesai were accepted by the convention in form of resolution, which was passed unanimously. Those thoughts are being elaborated as follows --].
Dear & honorable audience / readers, before going to plan the education - policy for the under-graduate & post-graduate courses of Ayurveda, it is my earnest request to go through the following facts.
Our present educational policy is based totally on the guidelines laid down by the Western educationalists (including Lord McCauley), which were influenced by the political elements present before our independence. But, one should never forget that there was 'The Best System of Education' available in our India since good old days. Not only that, we had our own best universities like Takshashila, Nalanda which imparted best quality education, even to foreign students. Unfortunately, this fact has been totally forgotten / ignored by the present educationalists & by the political leaders as well, who always try to enforce 'their own'(?) guidelines. The nations, which are always, alert about the greatness of their own country, their own tradition, heritage & culture and self-respect can flourish & progress like anything in a very short period, e.g. Israel, Japan. Instead, even after 44 years of Independence, we Indians are totally dependent upon the Westerns, almost for everything. A total period of 25 years (??) was elapsed from independence, to get Government recognition to Ayurveda, after which the B.A.M.S. (Ayurvedacharya) course was adopted by various universities in India. This recognition was thought about only after the realization of Ayurveda-awareness aroused in Western-countries. This is one example of our typical Indian (and not Bharatiya)-mentality
At present, Ayurvedic education is approved at college-level. Unfortunately, first five-six months of the student admitted for Ayurvedic course, are wasted simply in getting accustomed to the Ayurvedic basic principles & the specific terminology. They are never been taught anything about Ayurveda up to twelfth standard, which is supposed to be the minimum basic qualification to get admission to B.A.M.S. The students get worried about, when they come across the names of Ayurvedic scientists like Charakacharya, Sushrutacharya, Vagbhatacharya etc. & similarly, the basic principles like Tridosha Siddhant, Panchamahabhoot Siddhant etc. During ten years of my teaching experience (19771986) in Ayurvedic colleges in Mumbai, I have experienced that, due to the fact mentioned above, many scholar students have left the course to seek admission for another course and in this way, Ayurveda has lost the talent.
This never happens in case of the students who get admission to a course (other than Ayurveda), related with modern science. Explanation of this fact is quite clear. The student is familiar with the basic principles & the terminology of modern science, which he knows even from his primary education. So, he can easily 'digest' the courses like M.B.B.S., Engineering, Science-subjects, Commerce etc. when he gets admission there.
In present situation, there seems only one solution for this, and that is ---- to include introduction of the basic principles of Ayurveda along with the concerned scientists & philosophers, very from the primary education, that too, step by step.
It is assumed that the national policies regarding various subjects, including educational one, should be based on the culture & heritage, social-lifestyle, geographical situation and similar other factors which are concerned with that particular country. While experiencing the 'present yearly changing pattern' of the education-system prevalent in India, it is quite evident that this assignation is not followed at all. There may be various reasons behind this situation. But it is regretted to observe that nobody, either any political or any social leader has ever tried to seek any solution and to follow it, honestly. According to me, the cause of this fact can be our 'traditional slave-psychology'. Our so-called thinkers are always worried about the western scientist's approval (??) / criticism, even if they decide to think anything new to the westerns. That will be the "holiest day" when our own thinkers will be out of this psychological-dependence. It will not be out of the subject, to quote here the famous sher ---
IwX hr H$mo H$a ~wbX BVZm Ho$
ha VH$ara Ho$ nhbo, IwXm IwX ~Xo go nyN>o -
"" ~Vm Voar aOm `m h ?''
If we leave our inferiority-complex and if we try to revise and follow our own system of education based on Ayurveda and other Indian Philosophical-Sciences (Darshan-Shastras) that are supplementary & closely related with our social, moral, psychological, cultural and geographical conditions; then only our 'Bharat' will shine like anything, always ahead, among the world.
Ayurveda, our own medical science is totally relevant with our Hindu-culture, Hindu-lifestyle & Hindu-religion. (The word 'Hindu' used here implies An ideal living-style matching with the Indian-culture; and not the present constricted meaning made famous by our politicians.) Even though, the students completing their primary, secondary or even college education are familiar only with the basic principles of modern science; but they never know anything about the philosophical foundation upon which our Indian Sciences are based. On the contrary, it is seen that 'the thinkers' in India go on jesting & criticizing this ancient Indian Medical Science, of being based on imaginary and strange philosophy that has no practical background & without any research. Naturally, the younger generation of students is more attracted towards Modern Medical Science that has got world-wide reputation & dignity, easier access in getting Govt. facilities, dazzling background, propaganda of its researches, which claim to give quicker results in treating diseases & so on. That is why, the student who has passed twelfth standard & who is inclined to get admission for a medical course; tries hard for the M.B.B.S. course on top priority. When it becomes impossible to get admission there or for similar courses based on modern science, then he becomes helpless & gets admission, reluctantly, to the Ayurvedic course, i.e. B.A.M.S., where, as narrated in the beginning, he experiences totally different atmosphere, as Ayurveda is based on entirely different basic principles, not known to him before.
Now we will go through few examples proving my thoughts -----
1. In the present system of education, the student learning in primary school knows about the square meal, vitamins, calories etc. as essential information about diet. But he never knows that, according to Ayurveda, 'all eatables available in the world are divisible in six tastes (Rasa) and our daily meal should contain all the six tastes in a particular proportion'. He may know this basic rule, only after getting admission to Ayurvedic course, that too after twelfth standard. Otherwise this rule may remain unknown to him for his whole life. In reality, I do not think, any other science, except Ayurveda, has ever thought about 'the diet' in all respects. At the time, when the western world had progressed (??) in consuming roasted meat instead of eating it raw, we Bharatiyas used to have delicious & dainty dishes containing all six tastes. In fact, the detailed description about dietetics regarding when / where / how / what & how much to eat, who should eat, not only that but why to eat; is so elaborately available, with due explanation, in Ayurvedic texts that if one tries to write in details, thousands of pages will be insufficient, or if one tries to speak, he may require many days to explain in details. Even then, there is no any single reference about 'the Ayurvedic view of diet' in present primary or further education.
2. The student learning in primary education knows 'the Darwin's theory of evolution'. Similarly, he knows various hypothesise regarding the origin of this globe. But it is almost rare for him to know 'the Prakriti-Purush Siddhant' described in Bharatiya Sankhya-philosophy or the basic Bharatiya ideas about Srishti-Utpatti described according to 'Pilu-Paka', 'Peethar-Paka' and 'Dwyanuk-Tryanuk' Siddhantas are never heard.
3. The names of the modern scientists that give a nice tongue-exercise while pronunciation like Newton, Luis Pasture, Graham Bell, Einstein, Madam Curie, Galileo, Harvey etc. are well-known to the primary students, along with their topics of research as well. But they do not have mere acquaintance with the Bharatiya scientists like Charakacharya, Sushrutacharya, Vagbhatacharya, Bhaskaracharya, Kanad Maharshi, Aryabhatta (this is the only exception, due to our patriotic scientist, The President of Bharat at present, Dr. Abdul Kalam, who named the satellite), Dalhan, Dridhabala, Madhavacharya, Bhrigu etc. The Vedic Mathematics, which aroused an excitement in the western world due to its speed competing with the computer, we remained inert about it for so many days. Many such examples can be quoted.
My suggestion regarding inclusion of Ayurvedic Principles in the syllabus of primary education may have a few objections: ~
Originally, all the Ayurvedic literature is in 'Sanskrit' language; so it may prove to be very difficult either to learn or to teach it.
The solution for this problem can be as follows the teachers of primary schools should undergo a special orientation-course to learn basic principles of Ayurveda, which should be explained in the regional language after keeping the original terminological Sanskrit words as they are. Similarly, the Sanskrit-language, which is an optional subject at secondary-school level, should be made compulsory from primary level. It is my earnest suggestion that the Sanskrit should be approved as our National Language by making special necessary amendments in our constitution. (So that it may be possible to nullify the opposition of the South Indians to the present national language, i.e. Hindi). Then after, I would strongly propose to upgrade the Sanskrit Language to become the international language, as the scientists (especially the Western Ones) have accepted it as a language that can be easily & totally fed to computers.
The other objection will be will the Westerns understand, whatever we try to teach about Ayurveda & other Bharatiya Philosophy in the specific terminology and will they approve it?
My answer to this query is we need not worry about that. If at all the Westerns are keenly interested to know our Oriental Sciences they have to get accustomed to our Sanskrit language & terminology as well. If it is inevitable to learn Russian, German or French when our Bharatiya students wish to get further education in Russia, Germany or France, then why should we waste our energy to try to translate our inherited wisdom in their language (which is almost always impossible, due to the want of clarification of the real / implied meaning), to make them understand our science? We 'Indians' unnecessarily make a bugbear of English language. We feel helpless if we do not have mastery over it. But it is my own experience that English is not much honored in Europe except England. It will not be out of track if I narrate my experience regarding this.
In May 1989, I was invited to read my research-paper in The World Congress of Yoga & Ayurveda, in Italy. Then there was a study-tour in Switzerland, Germany, Holland, France & England. During the whole tour, I experienced that very few people could speak or understand English, except at the international airports, at starred hotels and in England itself. In the roadside restaurants or in coffeehouses we had to convey our message through gesticulations by hand and the people were proud & alert regarding their own language. During lunch-recess we had been in a library in Rome. After going through the register, we asked the librarian, "Don't you have any English books here?" and she burst out angrily, "Why you want English books? You better learn our Italian language & you will get the whole knowledge you want, which, perhaps, may not be available in English." What a live & burning pride for her own language and her own nation! And we Indians (not Bharatiyas or Hindustanis) are still to fix a single name for our country!!!
There might be one more objection Ayurveda is not based only on axiom, so does not have any practical approach. The Tridoshas (i.e. Vat, Pitta, & Kapha) and Pancha-Mahabhootas described in it, cannot be demonstrated individually & practically. On the contrary, the modern medicine is practical-based science. Various bacteria (that are responsible for diseases, according to this science), the blood & its components, various invasive & non-invasive diagnostic techniques etc. can be perceived through our sensory organs. If this is the fact, then why to learn Ayurveda?
If one goes through the basic principles of Ayurveda with minute observation, the answer is quite evident. The 'Pratyaksha Pramana' ("Aj {V' which means Bp`J`, i.e. axiom) is accepted also by Ayurveda. But according to it, its pervasion through our sense organs is very limited, while the real knowledge remains beyond the capacity of our sense organs & that is unlimited.
"`j {h An, AZn A`j&' - Chraka Samhita.
This is one of the basic principles of Ayurveda. So that, Ayurveda has accepted two more Pramanas, i.e. AZw_mZ (means inference) & AmmonXoe (means eXm_m` i.e. admonition by authorized seers); out of which 'inference' is accepted, to some extent, by the modern medicine. But, all the Basic Bharatiya Darshan Shastras also accept the third one, i.e. admonition & Ayurveda is no way an exception to this. In fact, according to Bharatiya philosophy, Anumana is superior to Pratyaksha & Aptopadesha is supposed to be the supreme one. This is simply a philosophical explanation.
But one may agree that, though not perceivable, the presence of Tridoshas (i.e. Vata, Pitta & Kapha) either in natural or unnatural state, can easily identified with the help of the guidelines laid down by Ayurveda. It is always experienced practically, that proper treatment given in various diseases (due to the vitiated state of Tridoshas), according to the Aptopadesha, relieves the patient from diseased state. In certain diseases where modern medicine falls short in curing them, like jaundice, urinary stones, asthma, rheumatic disorders, various digestive disorders, certain female-specific diseases, some types of cancer etc., Ayurveda certainly proves to be better in giving successful results, that too, without any surgical intervention. If this fact is proved, the ultimate inference that could be drawn is 'inclusion of basic principles of Ayurveda in primary education is a must'.
While narrating the rules for maintenance of health, Ayurveda has thought about 'the psyche' (the body) & 'the mind' individually. The rules regarding physical health are described under the heading "{XZM`m'(the daily regimen) & "F$VwM`m' (the seasonal regimen), while the rules regarding mental health are described under the heading "gXdm' (the daily behavior). If, our own ancient medical science i.e. Ayurveda, having such a nice background, is included in the primary education, our students & because of them their guardians as well, will have an introduction with our real Bharatiya thoughts, will improve their health and at the same time, I am quite confident that only Ayurveda will be an additional asset to get the motto of W.H.O., i.e. ' health to all', in reality.
'Mass-immunization' is compulsorily undertaken everywhere, with investment of so many crores of currency, to implement the above motto of W.H.O. But, it is realized that in the idea of 'health' only 'body' is taken into consideration. It is observed that, due to various vaccinations & successful (??) treatment against various diseases, the average length of human-life seems to be elongated; but it will be self-deception to declare that the human-health is improving. Because, majority of the chronically diseased patients disagree to live with 'such life dependent on mouthful of medicines'.
To my mind, the above motto of W.H.O. may turn into reality, only if, Ayurveda is included in primary education & daily and seasonal regimen and behavior is strictly observed according to it; because the basic aim of Ayurveda is, to gain not only elongated but also disease-free healthy life. This may be clarified by following example _wI (the mouth) is under influence of Kapha dosha, according to Ayurveda. The eatables that are bitter or astringent in taste, control Kapha dosha from getting increased, but sweet eatables help Kapha to increase. Once this secret is known, the students along with the whole community, will stop using tooth-powders / pastes of the well-known multinational companies and because of this only precaution, many of the teeth complaints that are getting increased day by day, would be prevented.
In our good-old literature, we read that the saints & the kings in ancient days could live for some thousands of years, even though there were no any vaccinations or the modern amenities available. This was possible only because of observing the daily & seasonal regimen along with daily behavior according to Ayurveda.
Ayurveda states that 'Sadvritta- palan' (ethical behavior) is essential for healthy mental state and I am quite sure that if this is included in primary education, in Ayurvedic manner, many of the unethical deeds, seen increasing during present days among the younger generation, will be certainly checked.
In this way, if the education of Ayurveda, which is supplementary for the sound state of physical as well as mental health of the community & which forms the basis for the student seeking admission in Ayurvedic college, is included at primary level; then, I am quite confident that, the talented class of students, which used to turn towards Ayurveda unwillingly & helplessly, will give its first preference to Ayurveda with due interest & willingness.

"Wishing best of health to all"

Contact :~
Prof. Vd. M. P. Prabhudesai
A / 8, Vijayanand Society,
New Khaskil Wada, Sawantwadi,
Dist. - Sindhudurga 416 510.
Maharashtra, INDIA.

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End stage renal disease (ESRD) occurs when chronic kidney disease worsens to the point at which kidney function is less than 10 % of normal. The kidneys fail to function at a level needed for day-to-day life. Kidneys main function is to remove wastes and excess of water from the body, which gets accumulated in renal failure leading to toxicity. The treatment includes kidney transplant or dialysis with dietary management.

ESRD always follows a chronic kidney disease; the most common cause is diabetes and high blood pressure. Other causes are

1. Diseases affecting arteries reaching or leaving the kidneys.
2. Congenital abnormalities of kidneys
3. Polycystic kidney disease
4. Too much abuse of pain medications or other drugs
5. Toxic chemicals
6. Autoimmune disorders like systemic lupus erythematosus (SLE), scleroderma
7. Injury
8. Glomerulonephritis
9. Kidney stones and secondary infections
10. Reflux nephropathy
11. Various other kidney diseases

Symptoms include

1. General ill feeling and fatigue
2. Pruritis (itching) and dry skin
3. Weight loss without effort
4. Headache
5. Loss of appetite
6. Nausea and vomiting
7. Swelling
8. Bone pains
9. Bad breath
10. Abnormally dark skin
11. Changes in nails
12. Bleeding easily bruises, nosebleed, blood in stool
13. Impotence
14. Restless leg syndrome
15. Sleeplessness
16. Excessive thirst
17. Frequent hiccups
18. Amenorrhea
19. Drowsy and confused state
20. Cannot concentrate or think clearly
21. Numbness in different parts of the body
22. Cramps or twitching of muscles.
23. Abnormal health and lung sounds
24. Diminished or no urine production

ESRD leads to buildup of waste products and fluid in the body, which affects most body systems and functions, including, blood pressure control, red blood cell production, electrolyte balance, vitamin D and calcium levels and thus bone health. Hence the patient on dialysis needs to undergo various tests often to manage the condition -

1. Sodium
2. Potassium
3. Phosphorus
4. Calcium
5. Magnesium
6. Albumin
7. Cholesterol
8. Electrolyte
9. Complete blood count (CBC)
10. Erythropoietin
11. Parathyroid hormone (PTH)
12. Bone density test

Treatment and management -

Management and treatment of ESRD includes kidney transplant or dialysis and dietary management, it is essential for the patient to know and understand everything about the treatment especially about dialysis and its types.

Why dialysis dialysis helps to remove and maintain waste products, fluid and the electrolyte balance in the body. A special diet is important as dialysis alone does not effectively remove all the waste products. And dietary management also helps minimize the amount of waste build up and to maintain the fluid, electrolyte and mineral balance in the body between the dialysis.

One needs to do lots of changes in their diet

ESRD patients need high protein, low sodium, potassium and phosphorus diet and a restricted fluid intake. Lets consider each in little details -


Urine out put drops during kidney failure. Most dialysis patients urinate very little or not at all, and therefore fluid restriction between treatments is very important. Without urination, fluid will build up in the body and cause excess fluid in the heart, lungs, and ankles.

Your nutritionist will calculate the daily required amount of fluid on the basis of
The amount of urine output in 24 hours
The amount of weight gain between the dialysis treatment
Amount of fluid retention
Levels of dietary sodium
Whether you are suffering from congestive heart failure.

Avoid or minimize eating food with too much of water like soups, jell-o, popsicles, ice creams, grapes, melons, palm fruit, coconut water, lettuce, tomatoes and celery.
Use smaller glasses.
Take sips of water
Minimize sodium intake. Avoid salty food
Freeze juices in an ice tray and suck them to minimize thirst (do count these ice cubes in your daily fluid intake)
Avoid getting too hot, going out in sun.

Sodium balance

As said above ESRD patient need to avoid high sodium diet. Hypertension in ESRD is mostly due to positive sodium balance and volume expansion (accumulation of too much of fluid in the body). ESRD patients on dialysis can effectively treat or control hypertension without antihypertensive drugs just by having a low sodium diet (2 g/day). Also low sodium diet will make you feel less thirsty and thus help avoid gulping extra fluids.

Avoid canned, processed food, processed smoked meat.
Avoid food with salt topping viz chips, nuts etc.
Read labels carefully select one that reads low sodium, no salt added, sodium free, unsalted.
Avoid foods that list salt near the beginning of the ingredient list.
Choose food which contains salt less than 100 mg per serving.
Remove salt shaker from the table.
Cook food without salt instead use herbs for flavoring.
Avoid preserved foods ketchups, sauces, pickles, popadums
Do not use salt substitutes, they contain potassium. And potassium is also restricted in kidney disease.

Potassium balance

Normally a high potassium diet is recommended to control hypertension and thus minimize the risk of stroke and heart failure, but in case of ESRD, they cannot tolerate high potassium diet as they cannot excrete potassium from their body. High potassium levels in blood will lead to life threatening hyperkalemia induced arrhythmia.


Avoid fruits high in potassium banana, musk melons, cantaloupes, kiwis, honeydew, prunes, nectarines, coconut water, tomatoes, avocado, oranges and orange juice, raisins and dried fruits.
Have fruits like peaches, grapes, pears, cherries, apples, berries, pineapple, plums, tangerines and watermelon.
Avoid vegetables high in potassium spinach, pumpkin, winter squash, sweet potato, potatoes, asparagus.
Choose vegetables like broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant (aubergine/brinjal), green and waxed beans, lettuce, onion, peppers, watercress, zucchini and yellow squash.
Avoid legumes, milk and bran cereal.
Limit intake of potassium up to 2 gm per day.


Patients with ESRD will also need extra iron.

Consume food high in iron levels lima and kidney beans, beet root, green leafy vegetables (avoid spinach), finger millet, chicken, liver, pork.
Eat iron fortified cereals
Take iron supplements as advised by your physician or dietician.

Calcium and phosphorus

In ESRD phosphorous levels are high as it cannot be excreted from our body. Even in early stages of renal disease, phosphorus levels can become too high. High phosphorus levels will lead to itching, vascular calcifications, secondary hyperparathyroidism and low calcium levels. Thus the calcium deposited in the bones is used up leading to osteoporosis. Hence a phosphate restricted diet is recommended.

Limit intake of dairy foods milk, yogurt and cheese.
Can consume dairy products like margarine, butter, cream cheese, full fat cream, brie cheese, and sherbet as they are low in phosphorus.
Consult your dietician and take calcium and vitamin D supplement, helps control calcium phosphate levels.
Avoid caned processed food.

If phosphorus levels are not managed with diet, your physician may prescribe you phosphorus binders.

Weight Management

ESRD patients loose weight without any reason, thus their weight needs to be monitored and managed with proper balanced diet. ESRD patients average calorie intake reduces to lower than 30-35 kcal/kg/day leading to malnutrition. To prevent malnutrition related morbidity and mortality, ESRD patients on dialysis need to undergo a periodic nutrition screening and tests, comparing initials body weight with usual and ideal body weight, dietary reviews, and food diary assessment.


You must be confused when I say ESRD patients need high protein, as most known fact is patients with renal diseases should limit their protein intake. True as when protein breaks down in our body urea is formed this cannot be excreted in urine and is toxic when it builds up in the blood stream. This limited protein diet is until patient is put on dialysis. As protein losses are higher in patients undergoing dialysis, they need to consume a high protein diet. Recommended dietary protein in hemodialysis patients is 1.2 g/kg body weight/day and 1.2-1.3 g/kg body weight /day for patients on peritoneal dialysis. If dietary protein calorie intake is not adequate, patients should take dietary supplements under the guidance of a nutritionist, and if required they should be tube feed or parenteral nutrition should be provided.


Eat high quality protein fish, pork, eggs, kidney beans, Bengal gram, and soy for every meal.
Add egg white or egg white powder or protein powder to your diet.

Carbohydrates -

If you are overweight and have diabetes, then you have to limit your carbohydrate intake, however if you are losing weight you need to take high carbohydrate diet. As carbohydrates are good source of energy. Your physician or dietician will recommended the amount of carbs required in your diet.


Include fruits, vegetables, breads and grains, as they are high in fiber, minerals, vitamins and a good source of energy.
If you are advised a high calorie diet, consume hard candies, sugar, honey, jelly, pies, cakes, cookies.
Avoid desserts made from dairy, chocolate, nuts and bananas.


ESRD patients on dialysis are recommended to limit intake of saturated fats and cholesterol as they are at high risk of developing coronary artery disease. They mostly have high triglyceride levels, high LDL (low density lipoproteins) and low HDL (high density lipoproteins). Though you are recommended to eat a high calorie diet, you need to avoid foods that raise your triglycerides and cholesterol levels

Include foods that are high in monounsaturated and polyunsaturated fats and little of saturated fats. Like sesame seed oil, flaxseeds, olive oil, and cotton seed oil.
Avoid canola oil, coconut oil, fats, poultry and chicken with skin.


ESRDS patients are recommended to have low fat diet and restricted fluid intake. Thus many patients need to take a vitamin supplement as fat soluble (A, D, E and K) vitamins and water soluble vitamins cannot be absorbed adequately form the diet and water soluble vitamins are also lost during dialysis treatment. Mostly these vitamins are given through vein during the dialysis treatment.

To manage all the above nutrients in the right quantity to suit your needs is not an easy task and it cannot be done own your own. DO NOT SELF DIET it can risk your health. This article is for your information and knowledge. Consult a nutritionist who can design a diet fit for your special needs. Always take your family along to understand your dietary needs so they can help you follow your diet. If you follow proper diet and physical activity as recommended by your physician and your nutritionist will help you feel good and lead a relatively healthy life with the ESRD.

Dr Varsha B Patel

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