"You are what you eat": importance of diet, how to relate money and savings to diet

I say to my patients, to understand weight loss and methods, simply do opposite to what you do when you save money in banking. I hope this article puts this in perspective.

The phrase "You are what you eat" is a decent way of saying "you are what you put in your mouth". The latter phrase can make people who are obese or overweight cry but it does make sense. One of my friend and colleagues in UK used to say this latter phrase when advising on the risk factors of overweight.

When you want quick access to your money, you leave some funds in the current account. . You put your salary or income in this account. you keep only enough money to keep you afloat in the current account. You keep a reserve account, called savings account where you save a larger amount which you can transfer quickly to the current account when necessary.

Where you think you have surplus money for the time being, you look for investments, assets and shares. The money you save in these methods, will not be available for you straight away. you need to mobilise them to realise the money to the savings or the current account. In other words, it will take time.

Now compare this scenario in banking to how your food is sorted once we consume.

Blood glucose is the current account
Liver, muscles acts as the savings account[ glycogen]
Fat acts as the investment account equivalent.[fat]

Weight gain and loss is exactly the same process of banking when you think of carbohydrate we consume. The carbohydrate we consume, namely the rice and wheat first goes to the current account. There is surplus of glucose, to what is needed for the brain, the kidneys and the muscle and all the nerves in the form of ATP. Some amount of blood glucose is put in the savings account, namely the liver and muscle as glycogen.

When there is lot more food consumed in the form of glucose, they are converted to fat and stored in various sites like our belly. Rightly or wrongly they can be termed as our asset or the investment.

But in fact we should plan our glucose consumption completely the opposite way to how we do banking as i had compared.

We need to earn less
so that we only have money for the current account and savings account
In turn we can mobilise our fat reserves in our assets and investment account to empty them.

Sounds Drastic in banking terms, does it not!. But this is true for our glucose metabolism.

Consume less glucose
so that we have only reserves in liver, muscles
In turn we can mobilise our fat reserves in our bellies and other parts of our body to empty them

The above picture shows how we can plan this. remember the base of the pyramid is still the glucose base of our diet. Hence do not starve to reduce weight, instead have more servings but less in amount

please go to this link if you want to learn more

http://www.medbio.info/Horn/Time%201-2/carbohydrate_metabolism.htm

or even better

http://www.health.gov/dietaryguidelines/dga2000/document/contents.htm

as the authors of the above link say

"Aim....Build....Choose for Good Health"
Regards

Chockalingam

Road Traffic Accident Prevention, A common Man's Hippocratic Oath

I am sorry about the pictures and unfortunately this is the reality in India

These are the rules one can try to follow in India

Let us make an Oath

I will always wear a seat belt when I travel in a car

I will always wear a helmet when riding a bike

I will always walk on the opposite side of traffic so that the on coming vehicles can clearly see me

I will never cross the road in front of a moving vehicle,because

I will never trust the driver on the road

I remember using a vehicle is for comfort of travel and not to reach quickly

I will not travel at night unless it is an emergency

I will never drive in the opposite lane of a road

I will always use public transport where it is practical and not use my vehicle

I will never drive close to the vehicle ahead, equally

I will make sure the vehicle behind is not too close to me, because

I will always leave racing drivers to overtake me [get away from danger]

I will reduce the speed when there is traffic and vice versa.

More rules to follow

I will go through the traffic signs and teach more people and friends and families

please go to this web site which teaches more traffic signs for Indian Driving Conditions

http://www.indiandrivingschools.com/road-traffic-signs-signals.html

Regards

Chockalingam

Arthroscopic Surgery at our KMC Speciality Hospital, Trichy, India: Key hole surgery

This is the article published in KMC News 2010

Arthroscopic surgery [Key hole Surgery] at our KMC Specialty hospital
Dr S Chockalingam FRCS, FRCS [Trauma and Ortho]

Joint replacements have now become the standard of care for advanced arthritis. These joint replacement surgeries for arthritis of knee, hip and shoulder have become common at our hospitals. The less known treatment method for joint pain in younger individuals will be discussed in this article.

This less known treatment method namely arthroscopic treatment for joint pain is now increasingly used in our city as in the Western world. An arthroscope is a telescope,[ type of endoscope] the size of a pen when introduced into the joint, helps us to evaluate the joint and introduce instruments to repair or remove the injured structures

Professor Kenji Takagi in Tokyo used a cystoscope back in 1919 to look inside the joint. Eugen Bircher a Swiss Politician/Army Physician is considered as the father of arthroscope where he used a thoracolaparascope to view the joint. Japanese surgeon Masaki Watanabe gets the credit for using arthroscopes for interventional procedures rather than for merely diagnosing the problems.

Advances in the fiber optics in the 1970s and 1980s have now helped to the current design of these arthroscopes which come in various small sizes for various joints. We now have this facility to treat joint problems and I have shown the use of this surgical technique in managing joint problems at KMC Speciality hospital

The following conditions are some of the patients who have been treated at KMC Speciality hospital with our state of the art instruments using this technique.
1. Diagnosis of unexplained knee pain where Tuberculous synovitis, synovial chondromatosis and other conditions and treatment of septic arthritis of all joints.
2. Meniscal tears:This is one of the commonest indication for this procedure. Even though sports injury is a common mechanism of these meniscal tears, it is fairly common in middle aged women and men in India.
3. Cruciate ligament tears. Ligament reconstruction of the anterior cruciate ligament done through this minimally invasive technique has perfected this reconstruction
4. Shoulder pathologies. The shoulder is only second to the knee in the numbers where this technique is being used here at our hospital. Decompression of the subacromial space and Shoulders that dislocate repeatedly are common indications
5. Ankle and other joint pathologies. So far we have treated variety of pathologies with this minimally invasive technique at KMC


Regards

Chockalingam

Bikes, Nature and Relaxation and health

I recently became a member of a group which enjoys trekking. Though i have not done a trekking expedition with the group so far, i did a bike ride. The ride was in the lower most fragmented Eastern Ghats called Pachai Malai hills. Nature beats you to anything we can build!

The nature included hills, valleys, trees, falls. It is astonishing to see the nature close to it on foot and closest to reach there is the bike. there are areas in this stretch where car is not the best way to see and by foot it would take a long time.

Time is something we find difficult to get hold of, and bikes make it easier to save some of this precious item. I got hold of Yamaha RX 100 which reminded me of post MBBS days when one of my dear friends had this bike.

I liked this bike more than the Hero Honda which we had ourselves. The Yamaha give you the thrill of acceleration though it did not have the power of the newer bikes trying to negotiate the hills with a pillion rider.

Negotiating the hills gave the pleasure partly due to the bike itself and mostly it was relaxing. we would have stopped in few places where the sceneries were breathtaking. Whereas in other areas simply we stopped since it was idyllic or should i say serene!

Relaxation is one of the areas to give the mind and the brain a chance to recuperate.

answers.google.com/answers/threadview?id=513495



The above link mentions that we have 7 thoughts per second and it certainly taxing if you are on the job where decisions are made such as my profession of being a doctor. The decisions are often involve well being of others and you take the responsibility.

Mental health is a prerequisite to physical health. A relaxed mind is a prerequisite to mental health. If a bike ride in the hills close to the nature is what it takes, go on make it!

I have done already!

if u want to know more of bikes in India go and visit

www.myindiaguide.com/bikes/bajaj/bajaj-avenger-220.html


and this is my favourite bike

Warm Regards

Chockalingam

Arthroscopy surgery at Trichy to cure joint problems of knee, shoulder and other joints

Sports Injury Service and Advanced Arthorscopic Surgery Service At KMC Speciality Hospital

Sports is becoming more of a passion as much as a hobby in our Country. Winning World level events has attracted more of our young boys and girls to partake in sports and even take this as their profession. As each profession carries its risks, sports poses us the biggest risk to these young generation in the form of injuries.

Injuries in sports mostly affect the musculoskeletal system. The muscles, tendons, bones and the joints are the components of this system. The joints are complex structures having cartilage, ligaments attached to the bone through soft tissues.

Most sports injuries are managed initially with the following fundamental principles. Remember the mnemonic RICE whenever one gets injured. Rest the injured part, apply Ice, apply Compression and Elevate the injured part. The practice of applying warmth in the form of hot water pack/bottle to the injured part is not recommended.

Physiotherapists either at the sports arena or at the hospital can treat majority of minor injuries to the muscles and tendons. The spasm associated with the muscle and tendon injuries can be treated with stretching and local treatment as described above. Some of these injuries especially the minor ligament injuries need rehabilitation by attending a dedicated physiotherapy department.

KMC Speciality Hospital has a dedicated Physiotherapy department to treat these injuries. The devices available in the department cover all areas of the body. They are designed to treat with mobilisation, stabilisation and retraining.
Though the initial pain and suffering improve with these simple measures and physiotherapy treatment, the long term recovery depends on detection and treatment of major injuries. These major injuries often feel like minor injuries after rehabilitation. However the key to return to sports and normality relies on recognising these as needing further treatment.

Hence we need experts who can diagnose and be able to treat them with the modern treatment methods. At KMC Speciality Hospital, we have surgeons trained and practiced abroad in treating these injuries. Treating them with modern treatment methods practiced in western countries is the key for getting back to normality.

Modern methods of treatment of the sports injuries often involve keyhole surgery to the joints. This is called Arthroscopic Surgery. Arthroscopy started as far as back in 1910s, though the treatment with this technique was possible after 1970s in Japan.

The Advanced Ortho Care at KMC Speciality Hospital has a dedicated state of the art High Definition Arthroscope with HD monitor for excellent visualisation and treatment of the injured part. The supportive power instruments, electronically controlled pump system and Radiofrequency Ablation techniques are at par with the most advanced hospitals in the world.

The problems, which can be treated with these Arthroscopic techniques, are many and can only be listed as a guide as follows.
1. Cartilage injuries of the knee: Meniscus Injuries in the knee and Wrist cartilage injuries
2. Ligament Injuries: Anterior and Posterior Cruciate Ligament Injuries in the knee
3. Tendon injuries of the muscles in the shoulder: Rotator Cuff Injuries and SLAP lesions
4. Recurrent Dislocations: Dislocations of the shoulder and kneecap, which often recur in young sports people
5. Recurrent and persistent pain in joints: Impingement of the joints, which affect mostly shoulders, ankles and elbow
6. Post trauma stiffness of the joints
7. Instabilities of the joints: shoulders and ankles
8. Infections of joints
9. Arthroscopic fusions of joints especially ankle


Some of the other Advanced Ortho treatment Methods provided at KMC Speciality Hospital are as follows
1. Joint Replacements of Knee, Hip, Shoulder, Elbow and Ankle using imported implants with international standards [Swedish, UK and Australian Standard]
2. Partial joint replacements with implants originating from Oxford,UK.
3. World Class treatment methods of simple and major Trauma using principles of international Swiss [AO] and American Standards [ATLS]
4. Treatment of deformities in Children with Ponseti Method [Canada]
5. Treatment of complex trauma and deformities using Russian Technique [Ilizarov technique]
6. Treatment of Fractures in Children using French Technique [Nancy]

Doctors Day India: Modern Technology of Arthroscopic Surgery for joint problems in Trichy

Pain Relief with Modern Technology at our doorstep: Key hole surgery to the Joints [Arthroscopy]
Dr S Chockalingam
Pain is highly unpleasant physical sensation caused by illness or injury, according to Oxford Dictionary. Joint pain not only causes this unpleasant sensation, but also disables a patient. Inability to do walk, sit, squat or wash ourselves without pain is quite common among us; often we do not like to talk about them.
We attribute lot of these inabilities to our age, illness such as diabetes or arthritis. Yet most of these problems are mechanical problems of our joints and the surrounding tissues. Tendonitis, ligament injuries and cartilage problems which affect so much of our sports stars, do not leave the rest of us from causing pain and disability.
These mechanical problems causing disabilities to our knees and shoulders are very common. Technology comes to our rescue in recognizing and correctly solving these problems. Arthroscopy of the joints help us to bring the benefits of key hole treatment like laparoscopy.
Arthroscopy is the key hole surgery to most joints in our body to provide treatment with advanced equipment. This treatment reduces discomfort to the patients, increases the accuracy of surgical technique and hence often relieves a patient’s disability to return them to normality.
The technical expertise in providing such a specialized treatment is more important than the equipment itself

. The message I would like to leave on this Doctors’ Day is to “commend the efforts by the doctors who strive to provide the best to our patients by bringing the modern technology right to our doorsteps to alleviate our pain and disability”.

Chest Injuries in trauma: The major killer in India after road traffic accidents: Seat belt should be worn in cars and buses

Breathing and Chest Trauma

Dr S Chockalingam

One of the major killer injuries is Chest Trauma. In fact the chest trauma is the commonest killer for a driver behind a steering wheel especially when not wearing a seat belt. Chest trauma is one of the injuries, which is treatable in a patient who can reach a hospital alive. Appropriate treatment can save many lives if recognised promptly. This appropriate treatment is often a simple intervention as opposed to a thoracotomy. Any doctor irrespective of their specialist interest should safely perform these simple interventions.

The following content focuses briefly on the essential anatomy, physiology of the chest. The main focus is then on recognising these injuries and acting swiftly to save one’s life. Early recognition of these injuries will also help in preventing late deaths.


Essential Anatomy:

The Chest is comprised of the lungs and pleural cavity, heart and pericardium, mediastinum and its contents, chest wall with the ribs and the muscles, diaphragm.

Essential Physiology:

The function of the chest is mainly two fold, gas exchange chamber and a safe haven for the heart and major vessels.

1.The lungs with the bronchial tree and alveoli function as gas exchange chamber. Oxygen gets in to the circulation and CO2 is excreted. The Chest Wall with the pleural cavity and the diaphragm acts as the motor behind to facilitate the gas exchange.

2. A safe place to keep the important organ, the heart and the main blood vessels.

Recognition and treatment of the chest injuries:

In our Medical School, we are taught the art of clinical Medicine. These would be taking a detailed history, thorough examination and ordering appropriate investigations before instituting treatment. The management of trauma is a clear exception to this approach. Hence we have to recognise the injuries and treatment the life threatening injuries before proceeding to the next step. This is most appropriate in chest trauma.



Recognition of Chest Injuries:


A patient who had trauma should always have the primary survey starting with

Ensuring a patent Airway with Cervical Spine Protection before moving on to the chest injuries. The injuries to the airway presents with similar features to the chest injuries. Airway obstruction with
1. Strider
2. Inability to talk
3. Broken tooth
4. Secretions in the pharynx
5. Gross swelling of the neck

Should be managed before moving on to the chest injuries.

The recognition of the chest injuries is essentially two fold.

1. Assess the breathing
2. Assess the cardiac function

These are done by

1. Look
2. Feel
3. Percuss
4. Auscultate
5. Use adjuncts

Look:

1. Equal chest wall movements
2. Engorged veins in the neck
3. For open wounds
4. Abnormal chest wall movements

Feel:

1. Tenderness
2. Crepitus
3. For equal chest wall movements
4. Pulse rate
5. Tracheal position, midline or deviated



Percuss:

1. Hyper resonance
2. Dull note on percussion

Auscultate:

1. Air entry on both sides
2. Heart sounds
3. Abnormal sounds suggesting obstruction
4. Blood pressure

Adjuncts:

1. Pulse oximetry, Pulse, Blood Pressure assessments
2. Chest X ray
3. ECG

Serious Injuries to be recognised promptly:

1. Conditions which affect mainly breathing
a. Massive air collection around the lungs: massive pneumothorax
b. Massive blood collection around the lungs: massive hemothorax
c. Chest wall injuries leading to flail chest
d. Open chest wound with pneumothorax

2. Conditions which affect the heart and circulation

a. Massive blood collection around the heart: Cardiac Tamponade
b. Massive blood collection around the lungs: massive hemothorax


Treatment as you recognise these serious injuries

1. Needle decompression and chest drain for massive pneumothorax
2. Cover open wounds with air tight dressings immediately
3. Resuscitate with oxygen and blood prior to
4. Chest Drain for massive hemothorax
5. Ventilate with oxygen, ambo bag for flail chest before intubation
6. Needle decompression of pericardium in rare instances

The rest of the chest injuries can wait until we complete the primary survey and management of other major injuries.
Other Injuries, which will become life threatening in due course and hence should be recognised and treatment started. These are

1. Pneumothorax which is not massive
2. Hemothorax which is not massive
3. Major airway injury of tracheobronchial tree
4. Blunt injury to the heart
5. Major vessel injury such as aorta
6. Mediastinal often open injury
7. Injury to the diaphragm
8. Multiple rib fractures

Please remember the power cable for chest wall function is “the intercostals nerves and the phrenic nerve and the brain” ultimately. Hence any injury to the spinal cord, brain and the phrenic nerve will affect breathing even when the chest wall is not injured.

Summary

We have to be familiar with understanding of the following features associated with major chest injuries

When observing the patient

1. Chest pain and air hunger
2. Distress in breathing
3. Sucking open, but often-small wounds in the chest wall.
4. Flail chest

When eliciting the signs

5. Absent breath sounds
6. Engorged neck veins
7. Subcutaneous emphysema
8. Tachycardia and Hypotension
9. Deviated trachea
10. Muffled heart sounds
11. Cyanosis

When assessing with
12. Abnormal saturation with Pulse oximetry
13. Chest x ray abnormalities in trauma
14. ECG changes of blunt cardiac injury

The key message of this review on Chest Trauma is never underestimate these injuries as often these injuries kill a patient within few hours of injury and if not will adversely affect the outcome in the first few days of admission to the hospital