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May07
ABOUT LAPAROSCOPIC SURGERY
1. What is Minimally Invasive Surgery?
Minimally Invasive Surgery, some people refer to this simply as MIS, is a broad term for any procedure performed with small incisions (or sometimes no incisions at all).
Laparoscopic Surgery refers to MIS in the abdominal cavity. A telescope and long, fine caliber instruments are inserted into the abdomen to see and perform the surgery. The incisions used are 5 to 10 mm in size. These incisions heal quickly after surgery, resulting in small "keyhole" scars. Sometimes, even finer instruments are used (2 to 3 mm) in what we call Needloscopic Surgery. This results in "pinhole" scars that are hardly discernable.
The same technique is called Thoracoscopic Surgery when used in the thoracic cavity (to approach the esophagus, for example) or Endoscopic Surgery when used elsewhere (for example in the neck for Endoscopic Thyroid Surgery).
2. Can my operation be done using Laparoscopic Surgery?
Almost any conventional operation can be done laparoscopically. This can something simple, like the removal or a gallbladder or appendix, to something very complex, like the resection of the stomach for cancer. Some of the complicated operations can be technically demanding, and a good outcome depends on the skill and experience of the surgeon. In general, we believe that, under our hands, the laparoscopic options gives a better result. Occasionally however, laparoscopic surgery is contraindicated in certain patients, and some operations may be too difficult to offer any substantial benefit over conventional open surgery.
3. What are the contraindications to Laparoscopic Surgery?
The only absolute contraindications are an unstable patient (for example, someone who is bleeding actively from trauma) or a patient who is unfit for general anaesthesia (since GS is always required for laparoscopy). In certain patients, the contraindications are relative and have to be evaluated individually. These patients include those who have severe heart or lung disease, have previous abdominal surgery, bowel obstruction or bleeding problems.
4. What about pregnant patients?
In general, we try to not to do elective surgery during pregnancy. In those cases where we must, we try to delay the operation until the second trimester, or until fetal viability, or till after delivery. If surgery is absolutely essential, laparoscopic surgery is as safe as open surgery, and even offers certain advantages. However, great care has to be taken with surgery and anaesthesia as the dangers are real: about 12% risk of miscarriage in the first trimester, 5 to 8% risk or preterm labour in the second trimester and 30% risk of preterm labour in the third trimester.
5. What are the benefits of Laparoscopic Surgery?
Since only "keyhole" incisions are used, the post operative functional recovery is rapid. Most patients are discharged from hospital faster and return to work earlier. There is less wound pain and the cosmetic outcome is excellent. In the long term, there are fewer problems with post-surgery bowel adhesions. There is also recent evidence to suggest that the reduced disturbance to the immune system during laparoscopy results in better survival after cancer resection when compared to open surgery. This is because the minimal insults allow the body to fight off circulating cancer cells more effectively.
6. Are there any disadvantages of Laparoscopic Surgery?
Laparoscopic surgery is technically more difficult than conventional open surgery. Moreover, as some of these procedures have only evolved in the last few years, not all surgeons are trained to perform them. Surgeon related errors can occur. Finally, laparoscopic surgery often takes longer to perform and may cost more in terms of equipment used - although this is not always so!


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May07
Education and Stress: Dr. Shriniwas Kashalikar
Education and Stress: Dr. Shriniwas Kashalikar

Most of us get disturbed by what is going on in the field of education. But we do not understand the causes of the chaos and the remedy for them.

We will be benefited if we review in brief the concept of education and merits and demerits of the traditional education system in brief.

Education is defined in various ways but it can be safely said to have three domains, which are as follows.
The first domain is called AFFECTIVE DOMAIN. This means the state of mind. In simple words affective domain relates to how we feel. Thus when our mind is full of alertness, attention, enthusiasm, buoyancy, affection, concern, joy, tolerance, self esteem, mutual respect, mutual trust, commitment, dedication, confidence, positive and victorious spirit, we would call it healthy affective domain. In addition the zeal and concentration needed in the pursuit of excellence in intellectual field, tenacity and endurance required in skillful activities and patience and commitment essential for satisfying and socially beneficial actions constitute affective domain. The purpose of education is to nurture this domain by designing suitable curricula and syllabi.

The second domain of education is called PSYCHOMOTOR DOMAIN. This implies ability to appreciate skills and ability to perform physical and mental skills, with speed, accuracy, elegance, ease of performance etc. This may involve appreciation and performance of skills such as surgery, playing a musical instrument, playing basket ball or doing carpentry! The purpose of education is to nurture this domain through not only designing suitable curricula, syllabi but also by providing sufficient practical and demonstration classes with all the necessary equipment.

The third domain is called COGNITIVE DOMAIN. Cognitive domain incorporates accurate perspective, contemplation, correct perception understanding, conceptualization, analysis and recall of problems, ability to evaluate, synthesize, correlate and make decisions, appropriate policies, plans and expertise in the management, administration, etc.

It is clear that all the domains have three components viz. Cognition [Perception], affect [Feelings] and conation [Response].

Let us consider the traditional system in a dispassionate manner and scrutinize the merits and demerits. It is obvious that we will not be able to consider all the details of the system as they varied from time to time and from place to place. But a general review of the system would help us to overcome our disturbance!

This can be done only if we rise above the petty considerations of religion, region, caste, political power and other vested interests. This would help us rectify the present education system.
Conversely, unless the existing education system is rectified appropriately subsequent generations may not be able to develop the three domains of education adequately.

Many of you may argue here that this task can not be accomplished by common people, but can be successfully accomplished only by the politicians, political advisors, the decision-makers and the top administrators.

This argument is valid, but not completely. It has to be appreciated that no statesman, no political leader, no policy maker and no administrator can bring about change in an existing system unless, there is consensus about these changes in the vast majority of people whose cooperation in such matters is very vital.

So let us take at least a cursory look at the traditional system of education in India.
The traditional education system in India in general ensured that:
a] Careers were not selected on the basis of monetary gains,
b] Careers were not selected arbitrarily on the basis of idiosyncrasies and whims,
c] Some lucrative careers could not be sought after obsessively, in preference to the others,
d] All careers ensured income and production from early age,
e] All careers ensured that society was benefited,
f] All careers ensured security to all the social groups,
g] All the careers ensured intimacy and closeness between young and old in the families.
h] All careers ensured ethical education and passage of experience from generation to generation.
In my view these were merits.

(But it is also true that: The traditional system was apparently marked by deprivation of scholastic education on mass scale, apparently unjustifiable distribution of a variety of jobs, deficient infrastructure for collective scientific and technological efforts, an element of arbitrary imposition of hierarchy and).

But the point here is to see how the transition from traditional system to the present one has failed to preserve and nurture the merits and discard the demerits and thereby lead to multiplication of problems!

As the education shifted from homes, home industries and farms to; nurseries, K.G. schools, schools, colleges, universities, corporate industries, research institutions etc.
Cognition suffered because of:
a] Huge number of students, in a single class making following three things almost impossible. These things are i] individual attention ii] dialogue iii] discussions,
b] Lack of adequate salary, accountability, incentive and economic security to the teachers taking away the initiative of nurturing cognitive domain
c] Increase in alienation with respect to student’s background and aptitude
d] Lack of adequate incentive to the students in the form of creativity, production and earning, service to the family and service to the nation, takes away the motivation required for building up cognitive domain
e] Lack of conviction essential in the growth of cognitive domain in the teachers and students because of outdated practical and demonstration classes, lack of interdisciplinary dialogue and in general the irrelevance of education to the realities of day to day life in as much as almost predictable consecutive unemployment at the end! The lack of conviction could be partly due to lack of participation by teachers in decision-making, policy making, development of curricula, syllabi etc.
f] Emphasis on recall and hence rote learning thereby denying free inquiry, reading, questioning etc. thereby directly thwarting the cognitive domain
g]] Too many examinations with irrelevant parameters or criteria of evaluation [besides being unfair in many instances] lead to misguided and in most cases counterproductive efforts thus adversely affecting the cognitive domain
h] Competitions where the manipulative skills, callousness, selfishness are given more respect, destroy the enthusiasm of growing in cognitive domain
i] Information explosion can affect cognitive domain by either causing enormous and unnecessary burden on memory or inferiority complex
j] Pressure of interviews causing constant tension and sense of inadequacy, right from the tender age,
k] Protracted hours of homework in schools denying the students their legitimate right to enjoy their childhood and make them physically, mentally and intellectually unfit to grow in cognitive domain
l] Irrelevant and unnecessary information loading in lectures in the form of monologue, leading to suppression of the spontaneity, originality, interest and enthusiasm so much required in cognitive development amongst the students,

Affective domain suffered due to,
A] Isolation of the children from their parents and their domestic environment at an early age [Making the parents also equally sad]
B] Lack of warm bonds due to huge number,
C] Cut throat individualistic and petty competition,
D] Inadequate facilities of sports, trekking, educational tours, recreation and physical development etc
E] Alienation from one’s social environment and culture

Psychomotor domain suffered due to
A] Almost total lack of opportunities to actually participate in skillful activities such as drawing, painting, sewing, sculpturing, carpentry, knitting, weaving, music, agriculture, horticulture, other handicrafts, various sports, performing arts etc.
It is important to realize that promotion of psychomotor domain is evident but in its caricature form. It has no concrete economic realistic basis. The activities have no economic incentive and no productive element.

The present education system in India; basically and almost completely prevents a huge section of society such as teachers, students, clerks, servants, sweepers and many others such as education inspectors, etc. from being creative and productive. In addition it causes colossal loss of space, electricity, construction cost and so on. In addition because of the typical emphasis on rote learning it leads to phenomenal waste of educational material such as paper, bags, pencils, ball pens etc.

Lack of productive element in education not only causes colossal loss to nation but it also causes economic loss to children while suppressing and starving their psychomotor domain! The lack of productive element and economic incentive is a single most important cause of
1] Reduction in the dignity of labor amongst those who continue to learn, as well as reduction in the income of the concerned families and the nation
2] Lack of education, lack of employment and starvation or criminalization amongst those who are forced to drop out because the poor villagers’ children normally contribute to the earning of the family.
3] Inhuman suffering of those dropouts, who somehow manage to get into cheap labor for subsistence.
It has to be appreciated that billions of rupees are spent on construction, decoration and maintenance of schools and colleges. Billions more are spent on payment of millions of teachers and other staff members engaged in unproductive exercises. Billions are spent on electricity, and so called educational material. Billions more are spent on the exams conducted to test the “capacity and merit of rote learning”. This way we weaken the national economy, jeopardize the developmental activities and force millions of students to drop out due to economic reasons and get into the hell of child labor, besides starving and suppressing the cognitive, affective and psychomotor domains of millions. In short, present day education system harnesses [amongst those who continue to learn] arrogance coupled with lack of confidence leaving all the domains viz. cognitive, psychomotor and affective, [including creative and productive skills and physical health] defective, deficient and underdeveloped. Further, when this education fails to give a job, it tends to create vindictive attitude transforming an individual into a criminal or develops frustration and transforms an individual into a mental wreck.

It must be appreciated that some institutions and individuals are making illustrious efforts in the direction of rectifying the education at their level.

But the chaos in the present education and the resultant conceptual stress cannot be managed effectively, unless we propagate this conceptual understanding about education and try to see that suitable changes are made to nurture cognitive, affective, psychomotor and productive domains all over the world.

In short it can be stated that every school, college, university etc must become the centers of production and service besides being centers excellence in science, art, literature, philosophy etc.
The student must have economic incentive for what he/she is privileged to make. Besides, everybody connected with education directly or indirectly must be involved in production or service.
Everyday approximately
20 % of the time must be spent in production, service etc.
20 % of the time must be spent in physical activities
20 % of the time must be spent in personality development and
20 % of the time must be spent in entertainment
20 % of the time must be spent on cognitive domain
Production may be of suitable items and service can involve community projects such plantation, cleanliness etc.
Physical activities can include sports, exercise, trekking, hiking etc.
Personality development refers to broadening of perspective through various means such as invited guest lectures, seminars, discussions on holistic health, educational tours and visits to places where the student gets exposed to rapid developments in the society such as laboratories, airports, government offices, share market, farms etc.
Entertainment could include playing musical instruments, dance, painting or anything that makes a student happy such as mimicry, singing, story telling, drama, movie etc.
Development of cognitive domain can include teaching of languages, history, geography, mathematics etc with utmost emphasis on interpretation and relevance in day to day life. Thus typical questions in the examination of history, languages should be totally done away with. The subject such as economics, psychology, civics, philosophy, logic, sociology etc must include field work and made relevant to the present society.

Conceptual stress arising out of chaos in education can not be managed effectively unless and until a situation where millions are “imprisoned” in unproductive work and millions are forced into unemployment and inhuman cheap child labor is eradicated through law and government rules, besides public awareness.

The details of practical steps can be developed by interactions amongst the people active in the field of education all over the world.

DR. SHRINIWAS KASHALIKAR


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May07
Public Hospitals in India Dr. Shriniwas Kashalikar
Public Hospitals
in India

Dr.
Shriniwas
Kashalikar


Since the public services and especially public health services, affect most of us, it is essential to find out the root causes of their deficiency and try to deal with them. This is one of the intellectual measures of stress management and benefits every individual concerned.

The causes of degeneration of quality of public health services in public hospitals in India; is the prevalence of the two concepts on which these institutions work. These concepts are, free medical care and economic dependence of these institutions on the government revenue and donations.

FREE MEDICAL CARE
The free medical care gives rise to parasitism, beggarly tendency, meekness and irresponsibility towards personal and public health amongst the patients.

The free medical care creates a special and extremely favorable situation and golden opportunity for the powerful, rich and famous individuals to exploit the government revenue and tax payers’ money.

The free medical care leads to zero returns and subsequent deterioration in the facilities given to patients and employees.

The free medical care associated with perpetual absence of returns leads to unjustifiably low salaries, delay in filling the vacancies, excessive working hours and duties, and delay in promotions.

This state of affairs demoralizes the sincere and dedicated employees and promotes irresponsibility, lethargy, absenteeism, corruption etc.


ECONOMIC DEPENDENCE OF THESE INSTITUTIONS ON THE GOVERNMENT REVENUE AND DONATIONS
The public hospitals are not self-sufficient and do not have any productive/commercial projects to support them. Naturally since there are no returns either from patients or from any other source, for what is spent, the public hospitals are always in loss.

This has lead to inadequate progress in terms of inadequate facilities, inadequate salaries, inadequate employment in terms of number of employees in almost every category, protracted duty hours, worsening working conditions, worsening of staying conditions for the employees and crowding of patients due to huge patients/employee ratio.

All these factors have lead to deterioration of the quality of medical care. In fact because of this a large number of lower middle class and even poor patients turn to private practitioners, consultants and hospitals.

This deterioration can be overcome by trying to make the public hospitals self-sufficient. For this, the concept of free medical care has to be replaced by more just system of payment. This would bring adequate revenue to ensure progress in terms of adequate facilities, adequate salaries, appropriate employment which could ensure normal duty hours, improvement in working conditions, improvement in staying conditions for the employees and preventing excessive and many times [because the services are free] unnecessary crowding of patients.

One may raise the objection that this is difficult to implement in case of very poor, helpless, unsupported patients.

It is very true that no sensitive and sensible individual would think of doing it as well. These patients who are in agonies, in emergencies, or helpless etc. should be made exception and a separate arrangement can be made for them. But in most other cases the problem can be overcome by making provision for payment through “services” or soft loans.

Another way to make the public hospitals self-sufficient is by buttressing them with productive / commercial projects. One can think of more innovative plans as well.

This is important because:
A] it would inculcate a sense of responsibility towards one’s own health, towards public funds, towards public services, amongst everyone including the patients.
B] it would generate the sense of accountability, satisfaction and fulfillment amongst the employees
C] It would ensure optimal progress in medical care especially in terms of holistic approach
D] It would improve the lives of patients as well as employees
E] It would make the revenue hitherto squandered on free medical care available for other developmental work thereby facilitating national progress.
F] it would reduce the corruption born of out of injustice
G] it would reduce the crowding and degeneration of private medical care.

DR. SHRINIWAS KASHALIKAR


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May07
Torsion of the fallopian tube in a pre menarcheal 12year old girl: A rare case report
Isolated torsion of the fallopian tube in pre menarcheal girls is very rare. However correct diagnosis and treatment are needed in order to optimize salvage of fallopian tube. While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone, first described in 1890(Sutton, 1890) remained a rare occurrence with an incidence of 1 in 1.5million women(Hansen, 1970). It most frequently during menstruating years, but also has been reported in pre and pause menopausal women. It has also been reported in infants and pre menarcheal girls. Many etiologies for tubal torsion have been suggested including hydrosalpinx, tubal carcinoma, prior tubal ligation(Krissi et al 1997), ovarian and paraovarian masses, pregnancy, hydatid of Morgagni and peristaltic abnormalities. The condition may also occur in pregnancy, labour and pre menstrual period.
Diagnosis of this condition is often delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain.

Case Report:
13year old Miss. X, who has not attained menarche, was referred to our centre with history of lower abdominal pain of two days duration and with an ultrasound scan report showing right ovarian cyst of 5x3cm, for diagnostic laparoscopy. She has no significant past medical and surgical illnesses. She has not attained menarche. On examination there was no pallor, vital signs were stable, has normal secondary sexual characters, systemic examination was normal. Abdominal examination revealed no palpable mass or tenderness. Transabdominal scan showed uterus to be 3.5x2.2cm, endometrium 3mm, right adnexal mass of 4.5x4cm seen, which is anechoic with fine basal echoes. Left ovary was not seen. Ultrasonic diagnosis of right ovarian cyst was made and laparoscopy was decided. At laparoscopy the peritoneum, appendix, pouch of Douglas and upper abdomen were normal. Uterus was normal looking, both ovaries normal. Right tube was twisted thrice along with a paratubal cyst of 4cm. The cystic mass appeared bluish. Untwisting of the right tube , right paratubal cystectomy done, edges reformed. Intraoperative and post operative period were uneventful. The patient was discharged was discharged the next day. HPE diagnosis was consistent with paratubal cyst(twisted).


Conclusion:
Isolated fallopian tube torsion is rare entity especially in pre menarcheal age. At first episode of torsion of fallopian tube, tubal preservation must be the rule unless the tube is totally necrotic. A timely diagnosis and surgical intervention may allow preservation of the tube.


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May07
LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA
In the year 1992 the first report on the Incisional Hernia Repair by Laparoscopic method was published. Number of case reports appeared in the literature since than.
Aims
Indications: Any ventral or scar hernia with 3cm or more fascial defect can be repaired with laparoscopy easily.
Swiss-Cheese Hernias (Multiple small defects) is a good indication for the laparoscopic approach, allowing a clear delineation of all defects.
Relative contraindications: Obstructed/incarcerated hernia, multiple operations
Methods
Operative techniques
Method 1: Intraabdominal intraperitoneal using mesh prosthesis to close and cover the defect.
Method 2 The mesh is placed in the preperitoneal space in order to prevent the adhesions. This method mimics the conventional approach and avoids formation of adhesions.

Results The postoperative pain was significantly less. There was no ileus, no wound infection. The patients were discharge within 3 days.

Discussion: The laparoscopic ventral or scar hernia repair is still a debatable topic. It can be used in selected patients with less postoperative morbidity.
Method 1 is using intraperitoneal mesh hence there is tendency for adhesions.
Method 2 uses preperitoneal mesh having very few indications. It very difficult as the plane in preperitoneum can be achieved easily in small and moderate size hernial sacs

Conclusion
Laparoscopic ventral and scar hernia repair still need a controlled trial. At present only selected ventral hernias are suitable for laparoscopic repair.


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May07
LAP MANAGEMENT OF ABDOMINAL TRAUMA
Objective:Laparoscopy is used for management of abdominal trauma (blunt as well as penetrating) hence minimizing the open laparotomies.

Methods:180 laparotomies for abdominal trauma were performed at Jabalpur Hospital from Dec.1999 to may 2005.Out of these 27 were managed laparoscopically.All of these were subjected to baseline investigations.The selected patients were subjected to diagnostic laparoscopy.18 of these
had blunt trauma and 9 had penetrating injuries.
In blunt trauma group 9 patients had to be converted to open surgery and rest 9 underwent laparoscopic management.
In penetrating trauma group only 2 cases needed open surgery and rest 7 were managed laparoscopically.

Results: Laparoscopically managed patients had no missed injuries and no deaths or significant complications.

Conclusions:Selected patients of abdominal trauma managed
laparoscopicaly showed quick recovery and minimizing the expenditure and more so of loss of man hour.


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May06
leg exercises for prevention of osteoporosis and osteo arthritis
Exercise prescription for fitness
In this mechanised world the only muscles we are using are our fingers for various controls.
The only weight we are carrying is our own body weight.
In all, a sedentary lifestyle accounts for some 250,000 premature deaths annually

At any age of life exercise makes an integral part of physical as well as emotional and psychological fitness.But exercise has to be integrated into our daily life as much as we are brushing our teeth daily.
THE BENEFITS OF EXERCISE IN A NUTSHELL
• Even in the elderly woman, exercise can attenuate certain effects of aging and sedentary
lifestyles.
• Regular exercise may decrease the incidence and severity of hot flashes, which occur in
75% of menopausal women. Menopausal women typically benefit most from exercise in
combination with estrogen replacement therapy.
• Weight-bearing exercise, resistance training and high-intensity fitness regimens can reduce a
woman's risk of fractures and help retard sarcopenia.
• Cardiovascular effects of exercise are also dramatic, as studies have shown that perimenopausal
women who are more physically active and gain less weight have lower elevations of LDL,
total cholesterol and triglycerides than their heavier, less active counterparts.
Components of fitness are
 Cardiorespiratory fitness
 Weight control and fat distribution and body composition
 Muscular strength
 Endurance,
 Flexibility


Various types of exercises are:
 Stretching exercises
 Toning exercises
 range of movement exercises
 strength building exercises and resistance exercises to increase BMD and decrease sarcopenia
 meditation or relaxing exercises
some precautions while doing exercises are
1. Warm up is must
2. Take plenty of water
3. Room temp should not be very hot
4. Switch on the music to enjoy your exercise
5. Vary your exercises so that you are not bored
6. Make a group and enjoy your exercise and be cheerful.
7. First learn proper way of doing exercise and then slowly you can add weights
8. DON’T GIVE UP ! RESULT WOULD COME SLOWLY BUT WOULD COME DEFINITELY.
9. Intensity of exercise can be measured by various means:
• Talk test
• 2. Heart rate test
• 3. Borg rating of perceived exertion (RPE) scale
• 4. MET Test.
Heart rate test is easy to use and is calculated form MHR
.MHR (maximum heart rate is 220-age in years and targeted heart rate for moderate exercise should be 60 -80 % of your MHR and for severe intensity of exercise it can be 85-90% of MHR
10.When ever you start exercising first thing is to do warm up and this can be done either by cycling or treadmill walking or just by stretching the group of muscles you are going to exercise.
11.Take lots of water inbetween,
12.learn proper technique of doing these exercises and exercise whole body , but in one day you can do one or two group of exercises.
In this session we would tell about leg execises which can be done at home.

Warm up
If you are doing with tread mill see to it that the surface is not inclined.Warm up can be by simple walking even.or by sationary cycling for 5- 10min.
If you have to lose weight then these execises can be for longer period like 15-20 min.but for toning up and strength building warm up 5-10 min. is ok.
Walking as an exercise



Walking to be effective has to be at a brisk pace. Slow walking does not give any benefits of weight losing or even for cardioprotection.you should do at a pace that you are barely able to talk.
Foot wear should be proper and ideally it should not be on hard surface.




Stretching is a vital component of any exercise program. A brief stretch after any workout is a nice way to relax-and it helps prevent injury and maintain flexibility. Furthermore,stretching helps reduce back pain from osteoporosis, as well as other aches and pains.
Leg exercises
Leg exercises should be done to strengthen your all leg muscles and give them full range of motion and some of these exercises are following which can be done at home.



HAMSTRING STRETCH

Sitting on the ground, with one leg straight and the other one comfortably bent in front of your body, bend at the waist and lean forward, keeping your back as straight as possible and don’t arch it. Reach with your arms towards the foot until a stretch is felt under your thigh. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh area, without aggravating your condition.




Gluteus Stretch
Lying down on your back, bend your right knee, and place your left leg over the right leg, resting the outside of the left ankle slightly above the right knee. Place your right hand around the outside of your right thigh and place the left hand around the inside of your right thigh. Lock the two hands together. Now pull forward towards your chest to achieve a stretch in the left gluteus portion of your buttocks. Do the exact opposite to achieve a stretch of the right gluteus portion of the buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh and buttocks area, without aggravating your condition.



Calf Stretch
Start with stretching the right Gastrocnemius portion of the right calf area. While standing, place your right leg in front of you and your left foot directly behind you. Place the toes of your right forefoot up against a door or other flat wall surface, keeping your heel down to the floor. Lean against a wall or other stationary object, both palms against the object. The leg you want to stretch is back, several feet from the wall, your heel firmly positioned on the floor. Your other leg is flexed about halfway between your back leg and the wall. Start with your back straight and gradually lunge forward until you feel the stretch in your calf. "It is important to keep your back foot straight and angled 90 degrees from the wall," . Hold each stretch for a minimum of 30 seconds. Any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the calf area of the leg, without aggravating your condition.

Quadriceps Stretch
Start with stretching the left Quadriceps muscle. While standing hold a solid surface for support and bend back your left leg. Grab your left ankle and pull that foot to your left buttocks while simultaneously pulling your left thigh backwards while keeping your back straight. Pulling your thigh backwards is a very important part of this stretch, as it will place the stretch in the mid-thigh instead of overloading the pressure on the knee. Do the exact opposite to achieve a stretch of the right Psoas portion of your front upper thigh area. Hold each stretch for a minimum of 30 seconds. Any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the Quadriceps muscle area of the upper thigh, without aggravating your condition.






Inner side of thigh muscles stretch or adductor stretch

Our muscles do not work alone when we perform certain exercises. Our adductor muscles are working simultaneously with others while doing squats, leg presses, or lunges. Make sure that your adductor muscles are in their good condition everytime you perform stretching activities.
To stretch the groin simply place the feet together pull in toward yourself grab onto your ankles and apply force with your elbows down on your legs. If your doing this stretch correctly you'll feel a pulling on your upper inner thigh.






Front Lunge
The lunge is a dynamic exercise that targets the muscles of the thighs, back, and buttocks,
strengthening the bones in the hip and spine. The wide leg squat addresses the same muscles,
but the lunge includes balance and coordination as well.
Starting position: Stand next to table or counter with your feet hip-width apart, knees
slightly bent. Lightly hold on to the counter with one hand.
1-2-3-Forward: Take a large step forward with your right leg. Land on the heel of your right foot, and then roll your foot forward until it is fl at on the fl oor. Keeping your body erect, bent both knees so that your hips drop straight down. Your front thigh should be almost parallel to the floor, and the knee of your back leg should approach the floor. The knee of your forward leg should be over your ankle, not past your toes. The heel of your back leg will come off the floor. Your weight will be equally distributed between your front foot and the ball of your back
foot.
This exercise can be done with holding free weights in your hands, and as your strength goes on increasing you can increase weights or you can do with weights attached to a barbell and barbell is held at the upper part of your back.



Pause for a Breath
Return: Push back forcefully with the front leg to return to the starting position.
Pause for a breath, and then repeat the move.
Reps and Sets: Alternate legs as you step forward until you have done 8 reps with each leg – this
is 1 set. Rest for a minute or two and do a second set.
This exercise can be done without weights or slowly you can add weights.

Wide Leg Squat
It strengthens the muscles of your front, back, and inner thigh as well as your buttocks and the hip-bones, i.e.hamstrings, quadriceps and gluteus muscles.
Stand about 6 inches in front of the chair with your feet a little wider than shoulder-width apart. Take a deep breath and flex your knees and then aim your buttocks back and slowly lower yourself into the chair. Your knees should remain above your ankles;your knees should never go beyond your toes.
Pause, and slowly stand. Then repeat the move 8–10 times and three sets of same repetitions.


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May05
HOROSCOPE AND NAMASMARAN: DR. SHRINIWAS KASHALIKAR
HOROSCOPE AND NAMASMARAN

DR.
SHRINIWAS
KASHALIKAR

While reading books by Mr. Ramachandra Krishna Kamat (who has edited Shri Gurucharitra), about Namasmaran I found reference, which indicates that the practice of NAMASMARAN goes on purifying the various 12 houses in the horoscope.

I think further reference was made to Shri Tembe Swami i.e. Paramahansa Parivrajakacharya Shri Vasudevananda Saraswati Maharaj who has endorsed or upheld this conviction.

I also found that Shri Gondavalekar Maharaj i.e. Brahmachaitanya Maharaj from Gndavale (Satara, Maharashtra) expressing a view that NAMASMARAN takes you beyond the influence of planets.

He has also expressed the opinion that NAMASMARAN takes “you” beyond time.

The readers can study and explore the purport of these views and share their views with others.

DR. SHRINIWAS KASHALIKAR


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May05
FREEDOM FROM GOD: DR. SHRINIWAS KASHALIKAR
FREEDOM FROM
GOD

DR.
SHRINIWAS
KASHALIKAR

God and His worship have been a part of human civilization for millennia. In fact many philosophers and seers consider God to be unanimous with truth, rather, absolute truth.

However for an ordinary person like me faith in God appeared to be paranoid! I never could really understand or appreciate why an individual should suffer the burden of this belief or faith in some other entity alien from himself or herself.

In addition, God and everything associated with God insisted on surrender; unquestioning and unconditioned surrender!

The freedom of an individual and his or her behavior, emotions, thoughts and reasoning were brutally challenged in these “God” phenomena and stories and doctrines associated with them.

I observed that suppression of such reasoning lead to thriving of coercion, oppression and exploitation.

My urge for freedom, rational thinking and my conscience thus felt suffocated in everything associated with God.

But it was not easy to overthrow the overwhelming influence of religious and pious activities and their deep impressions from the early childhood. This was also because, everything sublime, selfless, subtle, serene and supreme also; was associated with God and related phenomena.

In the course of time, I came across the theory and practice of NAMASMARAN and realized that there is no necessity to believe or disbelieve God. What is important is practicing NAMSMARAN like we practice bath or brushing. The objective change common to individual and the universe become self evident. The imagery; both atheist and theist begin to disappear.
The prejudice about theist or prejudice about atheist disappears. In fact all prejudices disappear!

You may not believe in anything I have shared here. It is up to you to verify if the chasm between ideals and practices of human beings can be narrowed through NAMASMARAN.

DR. SHRINIWAS KASHALIKAR


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May05
Pralhad Said: Dr. Shriniwas Kashalikar
PRALHAD SAID

DR. SHRINIWAS
KASHALIKAR

PRAYENA DEVA MUNAYAH SWAVIMUKTIKAMA
MAUNAM CHARANTI VIJANENA PARARTHA NISHTHA
NAITANVIHAYA KRUPANAN SWAVIMUKTI EKO
NANYAM TADASYA SHARANAM BHRAMATONUPASHYE

Oh Lord, in general, most of the great saints, sages, yogis and rishis renounce the world, live in seclusion and observe silence in search of salvation/liberation for themselves.

Since you are the only savior for my billions of brothers and since they can not get salvation from anywhere else [in case I do not seek it from you for them],
I do not want to be a mean person to seek liberation for myself alone.

So says the great Pralhada as is articulated in SHRIMAT BHAGAVATAM.

This is especially important in view of the fact that though stress [and hence conceptual stress also] is a universal phenomenon, it is not understood by all! Only a few fortunate ones would be able to understand and manage it. It is their privilege and DHARMA to help others in managing stress. In this regard it is interesting to note that in these days neither individual liberation nor individual stress management are possible! They are intricately and inseparably bound with the liberation and stress management of billions others!

Bhagiratha [who is said to have brought the river Ganga from heaven to the earth] and Prometheus [who is said to have stolen fire from the gods] to save the mankind and many others have set examples for us to follow.

DR.
SHRINIWAS
KASHALIKAR


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