20 December, 2013

OATS (AVENA SATIVA)

Oats were defined as "eaten by people in Scotland, but fit only for horses in England." The Scotsman's retort to this is, "That's why England has such good horses, and Scotland has such fine men!"

Oats is a recent addition to our menu. Oats is a European and North American crop. It was not considered as important as wheat or barley in the olden days. Oats were mostly weed like plants. It is said that Oats were first brought to North America with other grains in 1602 and planted on the Elizabeth Islands off the coast of Massachusetts. As early as 1786, George Washington sowed 580 acres to oats. By the 1860s and 1870s, the westward shift of oat acreage in the United States had moved into the middle and upper Mississippi Valley, which is its major area of production today. Russia, Canada, the United States, Finland, and Poland are the leading oat producing countries.

Oats has been used as livestock and human foods since ancient times. It has been used as pasture, hay or silage. Oat straw has been used as bedding for livestock.

There has been an increase in oats used for human food in recent years. Oat Bran has received considerable attention from the medical community for its role in reducing blood cholesterol. Nutrition experts believe that Beta glucans, the water-soluble fibres present in oat bran inhibit cholesterol, which helps prevent heart disease. Several breakfast cereals and bread products are made from oat flour and rolled oat products.
Oats might help reduce cholesterol and blood sugar levels and control appetite by causing a feeling of fullness. Oat bran might work by blocking the absorption from the gut of substances that contribute to heart disease, high cholesterol, and Diabetes

Dr.Riyaz Sheriff


16 December, 2013

The Hindu - My article

This came at the most perfect time for me. I had just been thinking of writing a blog post about Medical Second Opinion. Geetha Padmanabhan apporached for my views on second opinion..

The Result

Just a second! - The Hindu

I appreciate The Hindu for their futuristic thinking.

I specially thank Geetha Padmanabhan for handling this topic elegantly.

17 November, 2013

WORLD DIABETES DAY - GOOD NEWS!


November 14th…. Things that come to our mind – CHILDRENS DAY - HOLIDAY

Other minor things that happened on this day
  • 1922 – The BBC begins radio service in the United Kingdom
  • 1967 – American physicist Theodore Maiman is given a patent for his ruby laser systems, the world's first laser.
  • 2001 – War in Afghanistan: Afghan Northern Alliance fighters take over the capital Kabul.
  • 2003 – Astronomers Michael E. Brown, Chad Trujillo, and David L. Rabinowitz discover 90377 Sedna, a Trans-Neptunian object.
  • 2008 – The first G-20 economic summit opens in Washington, D.C.
  • 2010 – Germany's Sebastian Vettel of Red Bull Racing wins Formula One's Drivers Championship to become the sport's youngest champion.
  • 2012 – Israel launches a major military operation in the Gaza Strip, as hostilities with Hamas escalate.
Finally

World Diabetes Day.. November 14th

Everybody talks about it. All Diabetes Centres use this opportunity to advertise.

All leading Diabetologists give interviews in Harvard Engish…

Then comes November 15th..

Everything is forgotten till next year..

But this year Times of India had published an article on NON INVASIVE GLUCOMETERS… yes!! Exactly!! You might not need blood or prick yourself to find out the blood sugar values…

I am very excited about this article because I had written a blogpost on NON INVASIVE GLUCOMETERS  in February 2013

PAIN- FREE BLOOD SUGAR MONITORING
PAIN- FREE BLOOD SUGAR MONITORING


Here is the article from TOI for those of you who missed!!



 Healthcare has advanced rapidly in the past few decades, but it is still impossible for patients to escape the needle. Studies show that up to 10% of the world’s population, especially diabetics, have an intense fear of needles and would go to any extent to avoid them. To put an end to this phobia, several novel non-invasive techniques have been developed to test blood sugar levels in diabetics.

    Conventionally, diabetics check blood sugar levels by pricking their finger with a needle to take a drop of blood for testing. “Pricking your finger multiple times a day is painful, time consuming, and can cause calluses and sensitive fingers. It is difficult if the patient has visual limitations, As a result, many patients avoid or limit blood glucose monitoring.

    Alternative methods like near infrared spectroscopy (NIR) can be used instead, say doctors. “NIR is still in the trial stages and determines glucose levels through the skin using varied light waves. Non-invasive devices that measure blood sugar levels include Glucotrack, which can be imported from abroad. It is a small sensor that is clipped to the earlobe and connected to a handheld control and display unit. It uses ultrasound, electromagnetic readings and thermal technology to obtain blood glucose readings,”

    Mass screening devices have also been developed to test a large number of patients in clinics. The Government General Hospital uses a device called EZ Scan to screen patients. “Close to 1,000 patients come to the Institute of Diabetology in GH every day, so it is difficult to screen all of them personally. With the new machine, the patients have to place their hands and feet on electrodes and their height, weight and age is recorded. Based on the sweat secretion, the device gives the results within two minutes,” he said.
    Machines can also determine blood glucose levels from the skin fluorescence, said head of Madras Diabetic Research Foundation Dr Mohan. “We use the SCOUT DS machine on which patients place their hands. Light from the machine enters the skin and scatters on the tissue. The sugar levels are read from the skin fluorescence,” he said.
    Dr Mohan’s clinic also uses Diagnoptics AGE Reader, a noninvasive equipment that diagnoses the risk of diabetes and its cardiovascular, nephrological and neurological complications by measuring accumulation of advanced glycation endproducts. “These new methods are precise, reliable and save a lot of time. Above all, the patient is relieved from the prick of the needle,” he said. 

Thank you TOI for this article.....

Although many machines mentioned are still in the experimental stages there is light at the end of the tunnel...

Dr.Riyaz Sheriff M.B.B.S.,PGDHS(Diab).,CMD

09 September, 2013

LOSE WEIGHT!

One of the major reasons for increased medical problems is Obesity
There are many ways in which a person can lose weight. Results may vary depending on diet and physical activity.

When it comes to safer medicines to tackle obesity one name stands out among various pharmacological agents available

"ORLISTAT"
The original product introduced was XENICAL

in India this drug is sold in various names. Here is the list of them....

COBESE, JM-SLIM, LIPOCUT, LIPOPHAGE, OBELIT, OBETY, OBFREE, OLISAT, ORLE, ORLEAN, ORLICA, ORLID, ORLIFE, ORLIMAC, ORLISS, REESHAPE, TROYSLIM, VYFAT, ZEROFAT

What is this drug??

Orlistat is a drug designed to treat obesity. It isalso known as tetrahydrolipstatin.  It is marketed as a prescription under the trade name Xenical by Roche. It acts by reducing the fat absorption from our diet and reducing the caloric intake.

Orlistat is the derivative of lipstatin, a potent inhibitor of pancreatic lipases isolated from the bacterium Streptomyces toxytricini. The effectiveness of orlistat in promoting weight loss is definite, orlistat in addition to lifestyle modifications, such as diet and exercise, lose about 2–3 kilograms. Orlistat also modestly reduces blood pressure, and appears to prevent the onset of type 2 diabetes, whether due to weight loss itself or to other effects.

Orlistat works by inhibiting gastric and pancreatic lipases, the enzymes that break down triglycerides in the intestine. When lipase activity is blocked, triglycerides from the diet are not hydrolyzed into absorbable free fatty acids, and are excreted undigested instead. Only trace amounts of orlistat are absorbed systemically; the primary effect is local lipase inhibition within the GI tract after an oral dose. The primary route of elimination is through the feces.

Side effects-

Steatorrhea (oily, loose stools with excessive flatus)

 fecal incontinence and frequent or urgent bowel movements.

Precautions

Absorption of fat-soluble vitamins and other fat-soluble nutrients is hampered. A multivitamin tablet containing vitamins A, D, E, K, and beta-carotene should be taken once a day, at bedtime, when using orlistat.

Possible interactions with other drugs-

Reduces plasma levels of cyclosporine
impairs absorption of Amiodarone

Orlistat better avoided in -


  • Malabsorption
  • Hypersensitivity to orlistat
  • Reduced gallbladder function
  • Pregnancy and breastfeeding

13 August, 2013

HOW WE GET FOOLED!!!

The US-FDA  has cracked down on  alternative or natural treatment for diabetes, including ayurvedic and homeopathic remedies. Fifteen companies in the US, including some that procure alternative diabetes medications from India, have been warned by the FDA, asking them to stop sale in the US claiming to treat, cure, and prevent diabetes.


Foreign and domestic companies whose products claiming to mitigate, treat, cure or prevent diabetes and related complications, were sold online and in retail stores have been asked to tell FDA  within 15 days how they will correct the violations.

The FDA has also advised consumers not to use these or similar products because they may contain harmful ingredients or may be otherwise unsafe, or may improperly be marketed as over-the-counter products when they should be marketed as prescription products.

Many of the illegally sold products include claims such as "prevents and treats diabetes," and "can replace medicine in the treatment of diabetes," FDA said.

These illegally sold products, according to FDA, include Dietary supplements and Ayurvedic products described as "medicine of the healing arts that originated in India" with claims to treat, cure, and/or prevent diabetes.

This is what a responsible country does....

What do we do????

Get fooled by advertisements...

we see pamphlets in all colors stuck on road claiming to cure hydrocele without surgery, diabetes without tablets, hernia without surgery. Recently some have gone to the extent of treating cancer and AIDS.

Wake up!! Don't be Fooled!! Think logically!! Act rationally!!

09 July, 2013

VOICES FOR PIOGLITAZONE

Pioglitazone finally had some supporters.

Here is an article from HINDU

Govt should reconsider ban on diabetes drug, say doctors | Business Line

INDIAN EXPRESS

Ban on anti-diabetes drug pioglitazone shocks doctors

ZEE NEWS

Doctors flay blanket ban on diabetes drug Pioglitazone

MUMBAI MIRROR

Choice before diabetics: Painful insulin or costly but less-effective drugs

SAKAL TIMES

Diabetes expert demands withdrawal of ban on pioglitazone


with the way our cost of medication is going up drugs like these should not be banned. I sincerely feel Pioglitazone needs a second chance in the Indian market.

27 June, 2013

RIP PIOGLITAZONE - YOUR SERVICES WILL BE REMEMBERED!

THREE DRUGS TO FACE THE GUILLOTINE TODAY

1) PIOGLITAZONE
2)ANALGIN
3) DEANXIT..

I personally feel pioglitazone deserves a chance. every drug has side effects. To suggest it with caution is the Doctor's responsibility. Newer drugs are hard to come by these days.The ones that come are pretty costly. How will a middle class patient survive? Hopefully government reconsiders this decision.

22 June, 2013

INSULIN TIMINGS!


Many of our Patients are on insulin. The most common reason why insulin does not control blood sugar is that we do not understand the dynamics of insulin. Here I have put a concise format so that everybody can understand which insulins has to be taken when....


Insulin preparation
Generic name
Onset
Peak
Duration
Rapid-acting
Insulin Aspart
5-10 minutes
1-3 hrs
3-5 hrs

Insulin Lispro
< 15 minutes
½-1½ hrs
2-4 hrs

Insulin Glulisine
< 15 minutes
½-1½ hrs
1-2½ hrs
Short-acting
Regular
½-1 hr
2-3 hrs
3-6 hrs
Intermediate- acting
NPH
2-4 hrs
4-10 hrs
10-16 hrs
Long-acting
Insulin Glargine
1 hr
No peak
24 hrs

Detemir
1-2 hrs
No peak
6-23 hrs, depending on dose
Combinations
70% NPH +30% Regular
½-1 hr
There are2 peaks: 2-3 hrs &4-10 hrs
10-16 hrs

70% Aspart Protamine +30% Aspart
5-10 minutes
There are2 peaks: 1-3 hrs &4-10 hrs
10-16 hrs

50% Lispro Protamine +50% Lispro
< 15 minutes
There are2 peaks: ½-1½ hrs &4-10 hrs
10-16 hrs

75% Lispro Protamine +25% Lispro
< 15 minutes
There are2 peaks: ½-1½ hrs &4-10 hrs
10-16 hrs
Feel free to tell me if this helps!!

31 May, 2013

JUSTIFIED?


One small question to all of you.. All of us follow western  guidelines for treatment of Indian patients. Will western guidelines match the profile of Indian patients? Why we don't have guidelines for many diseases in India. What is preventing us from developing our own guidelines?

What's your opinion?

Note- I am not against guideline from another country. It's my humble opinion that blindly following guidelines will not be appropriate. Docs tend to do so.. guidelines should match our population, eating patterns, BMI, climatic conditions etc etc....

29 May, 2013

GASTRO & URINARY SYMPTOMS IN DIABETES


Long standing Type 1 & Type 2 Diabetes affects the motility of gastrointestinal and genito-urinary tracts. Patients may present with symptoms like

Gastrointestinal

Delayed emptying of stomach



  • Anorexia
  • Nausea
  • Vomiting
  • Early satiety
  • Abdominal bloating






Altered small & large bowel motility



  • Constipation
  • Diarrhoea




Genitourinary symptoms

Cystopathy



  • Inability to sense full bladder
  • Failure to void completely
  • Incontinence
  • Recurrent urinary tract infection





Erectile dysfunction



  • Failure to sustain erection
  • Reterograde ejaculation



Female sexual dysfunction



  • Reduced sexual desire
  • Dyspareunia
  • Reduced vaginal lubrication




TREATMENT



  • CONTROL BLOOD SUGARS
  • SMALLER FREQUENT MEALS
  • DRUGS TO INCREASE MOTILITY OF INTESTINE (CONSULT YOUR DOCTOR)
  • DIABETIC DIARRHOEA CAN BE MANAGED BASED ON THE ETIOLOGY
  • CYSTOPATHY
  • TIMED VOIDING
  • SELF CATHETERISATION
  • ERECTILE DYSFUNCTION
  • SEXUAL DYSFUNCTION IN FEMALES
  • VAGINAL LUBRICANTS
  • TREATMENT OF VAGINAL INFECTIONS
  • SYSTEMIC / LOCAL ESTROGEN REPLACEMENT THERAPY



05 May, 2013

13 April, 2013

STOP DIABETES!!


Hello everybody!

Hope you all are enjoying life!

Over the past 3years I have written my small bit about Diabetes. I have written about Diabetes, Its Manifestations, Complications, Treatment options and also about the drugs and devices we can expect in future. But we live in an era of prevention it’s a crime if I don’t talk about it.

Diabetes cannot be cured but can surely be prevented!!!

Why talk about prevention?

In the city where I live around 20% people are diabetics. That’s close to 1.2million diabetics in the City of Chennai alone. Out of this big number approximately 50% will be taking treatment and only 50% of these patients will be on regular treatment.  I feel that this number is only the tip of the iceberg.

 The real area of concentration should be those who are at risk of developing diabetes and those in PREDIABETES. Prediabetes stage can be as long as 10 years. This gives us the most valuable time to correct the risk factors for developing Diabetes. If these clients (I address this group as clients because technically speaking they are not suffering from disease) undergo proper testing we can delay the progression of Prediabetes to diabetes and in some cases even prevent the conversion of Prediabetes to diabetes.


What do we get by doing so??

First Satisfaction that I have helped somebody!

Next we can provide them a Healthy, Productive & Stress free life!

We can also reduce the economic burden (because finally Money Matters!!)

Detect Prediabetes and you reduce
  • ·         Stress due to health related issues
  • ·         Expenditure on medication
  • ·         Expenditure on visits to clinic
  • ·         Expenditure on blood tests
  • ·         Needle pricks
  • ·         Leave from work
  • ·         Irritability
  • ·         Inferiority complex
  • ·         Chances of developing Sexual problems
  • ·         Chances of developing Hypertension
  • ·         Chances of getting a Heart attack
  • ·         Chances of developing Neuropathy, Retinopathy & Nephropathy
  • ·         Stress to the partner and family
  • ·         Insurance premium (just kidding!!)


So how exactly we find out Prediabetes??

Simple!!


Sample 1 - Blood test taken in fasting
Sample 2 - one hour after taking 75gms of glucose
Sample 3 - 2 hours after the fasting sample.
 It’s always a good habit to combine this test with HbA1C.

People tell me doing OGTT is tough...

Its al in the way you see it...
Normally we do fasting and postprandial blood sugars
OGTT is just one extra prick but.....
This test can tell you with high level of confidence about your Sugar status.

So THINK....... PLAN...... TEST .......& PREVENT when you have the chance!!

Further Reading!!!



HbA1C
Diabetes Commercialised
sexual problems
Diabetes risk factors

Metabolic syndrome

11 April, 2013

CANAGLIFLOZIN - ONE MORE SOLDIER TO BATTLE DIABETES!




 Canagliflozin - This new compound has been recently approved by FDA for use in Diabetes.


Technically speaking it’s a Selective sodium-glucose transporter-2 (SGLT2) inhibitor.

This group of drugs are considered to provide a novel approach to treatment of Diabetes.


 So what do these drugs do?


To put in very simple terms these drugs reduce the tolerability of kidney to sugar in the system so more amount of sugar is excreted in the urine thereby reducing the levels of glucose in the blood.


Many molecules are under research and some of them have reached the stage of clinical trials


To name a few


Remogliflozin
 


Sergliflozin
 


Dapagliflozin

Many other molecules are yet to be named...


The one successful candidate which had obtained FDA approval is Canagliflozin.


As I said earlier it’s a Selective sodium-glucose transporter-2 (SGLT2) inhibitor indicated as an adjunct to diet and exercise in treatment of Type 2 Diabetes


Dosage is 100mg per day taken before first meal of the day. Dose can be raised upto 300mg/day.


As like any other medicine known to man this drug also comes with some side effects


Around 10% patients, especially the females faced problems with associated genital fungal infections. Other minor (1-6%) side effects were increased urination, fungal infections in males, vulvovaginal pruritis, thirst, constipation, nausea, and abdominal pain


LIKE FOR ANY OTHER DRUG EVEN THIS DRUG HAS TO BE TAKEN UNDER PROPER MEDICAL SUPERVISION


We are yet to get reports about long term safety and about the usage of this drug in pregnant women and children. Also before we start using this drug we will have to see the effect of this drug in Indian population. So till we get the results let’s keep our fingers crossed and hope that this drug or other molecules of this family succeed. These drugs will give us more confidence to deal with Diabetes in a much more affective way and give all our dear patients a better future!

29 March, 2013

ANNOUNCEMENT!

HI ALL,

I am very happy to share with you all that i will be posting my Microbiology related posts in my blog named "LITTLE ONES AROUND US"

I thought that adding Microbiology to this site would dilute the whole purpose of this blog (TO CONCENTERATE FULLY ON DIABETES AND ITS RELATED ASPECTS)

Hope you all will give the same love and support to my new blog as well!!

Dr.Riyaz Sheriff

15 March, 2013

CHOCOLATES IN DIABETES!

Eating chocolates spoils your blood sugar control!!

True!

But there is one kind of chocolate that will benefit you..

THE DARK CHOCOLATE

Advantages
  • Dark chocolate contains 70-80% cocoa
  • Good source of antioxidants
  • Improves blood flow
  • Helps in release of endorphins, makes you feel happy
  • Helps reduce insulin resistance
  • Hardens tooth enamel
  • Rich in vitamins and minerals
Dark chocolate has many benefits but is also rich in fat.... So careful with the quantity!

06 February, 2013

PAIN- FREE BLOOD SUGAR MONITORING


Hi all,


Maybe a year back I had put up a post on Non invasive glucometer of the future. It’s every patient’s dream to check his blood sugars without pain. We, doctors would always be happy to provide such a painless option to the patient. It would also help us in better treatment. There are so many companies trying different technologies for non invasive measurement of blood sugars. Finally I found one which sounds promising. I felt it’s worth a share with you people.










This particular glucometer is from a company called Grove instruments. The device uses near-infrared (NIR) spectroscopy to read the Blood Glucose Level. For the device to function properly and give accurate readings, the grey slot of the device must be placed over high blood flow area, such as the finger or the earlobe. It takes a real-time Blood glucose level from the blood using light.  The current international standard requires glucometer to differ from the blood standard by less than 20% before the instruments is released to the public for mass usage. The data from the clinical trials shows that Grove’s device has a mean average relative difference (MARD) of 8 to 12%.  Grove Instruments has maintained this MARD for the past two years.

Grove instruments claim that this is the first true non-invasive device that has a shot of making it to mass production for human usage. The other key aspect to this device is the time it takes to produce a result, 20 seconds or less. That is quicker than an individual can prick their finger and take a reading; making Grove’s device more time efficient, cleaner, and less painful than the current state of BGL testing. By having this device as a means of BGL testing, the average number of times a day an individual checks their BGL should move closer to the recommended four times a day. This technology has been patented. It is supposed to have cleared all safety standards and will be in mass production soon. I am trying to get it touch with the company to find out when this machine will be available in the market. Will update you people as soon as I get some good news
Till then..... Bye
Enjoy life!! 

15 January, 2013

EVERY MAN'S DREAM!!

The Guy's Rules
At last a guy has taken the time to write down this all Finally, the guys' side of the story. We always hear "the rules" from the female side. Now here are the rules from the male side. These are our rules! Please note.. these are all numbered "1" ON PURPOSE!


1. Men ARE not mind reader

1. Shopping is NOT a sport. And no, we are never going to think of it that way.

1. Crying is blackmail.

1. Ask for what you want. Let us be clear on this one: Subtle hints do not work! Strong hints do not work! Obvious hints do not work! Just say it!

1. Yes and No are perfectly Acceptable answers to almost every question.

1. Come to us with a problem only If you want help solving it. That's what we do. Sympathy is what your girlfriends are for.

1. A headache that lasts for 17 months is a problem. See a doctor.

1. Anything we said 6 months ago is inadmissible in an argument. In fact, all comments become null and void after 7 Days.

1. If you won't dress like the Victoria's Secret girls, don't Expect us to act like soap opera guys.

1. If you think you're fat, you probably are. Don't ask us.

1. If something we said can be interpreted in two ways and one of the ways makes you sad or angry, we meant the other one .

1. You can either ask us to do something Or tell us how you want it done. Not both. If you already know best how to do it, just do it yourself.

1. Whenever possible , Please say whatever you have to say during commercials.

1. Christopher Columbus did NOT need directions and neither do we.

1. ALL men see in only 16 colors, like Windows default settings. Peach, for example, is a fruit, not! A color. Pumpkin is also a fruit. We have no idea what mauve is.

1. If it itches, it will Be scratched. We do that.

1. If we ask what is wrong and you say "nothing," We will act like nothing's wrong. We know you are lying, but it is just not worth the hassle.

1. If you ask a question you don't want an answer to, Expect an answer you don't want to hear

1. Don't ask us what we're thinking about unless you are prepared to discuss such topics as football, cars, bikes or games

1. You have enough clothes.

1. You have too many shoes.

1. U r in shape. Round IS a shape!

1. Thank you for reading this. Yes, U may have to sleep on the couch tonight if u pass this on; But did you know men really don't mind that? It's like camping.

13 January, 2013

THE BITTER PILL...

Hi all,

Every time i sit to write something on my blog i think of my experiences with my patients.. Later on i started to wonder what patients might be thinking about doctors. i wanted some patient to just come forward and tell or rather write.. This was made possible after i joined Indiblogger. Indiblogger gave me a chance to see thousands of bloggers all over india.. I was surprised to see the number of bloggers in india.. I started attaching my posts and while working on Indiblogger i came across various blogs, different topics, different ways of looking at life... The experience was thrilling! Thanks Indiblogger! 
We, Doctors generally see that patients above 60 years are depressed about something or the other. They generally isolate themselves... But here in indiblogger i came across a beautiful , well written blog  My clutter,My life.  i was amazed to see that this blog is being well managed by a senior citizen by name  Pattu Raj from Hyderabad. i found that she was a fun loving and cheerful senior citizen ( very rarely do we come across such great people) . I made up my mind and requested her to write a guest post for my blog which she graciously accepted. 
The next surprise was in store for me was the way she has dealt the subject. I had requested to write on "What patients feel about Doctors"  She managed to give me a beautiful post. The points in the post were beautifully handled. At the end of the post i really started to feel that something should be done to streamline medical profession. So here comes My interactions with Doctors by Mrs.Pattu raj


MY INTERACTIONS WITH DOCTORS - PATTURAJ

Visiting doctors used to be nightmare. In childhood, it was Ayurveda powders and Municipal Hospitals. Mostly Ayurveda, an old Doc having hair on his ears, and a scowl. His powders were all same color , but it healed I suppose.

Moving to a big city brought me face to face with young doctor experience. Younger formative years had a romantic view of medical personnel, their lives full of lofty service, inspiring me to join the profession. That did not materialise, I was scared of Zoology, a compulsory one to master those days for medical admissions, thus generating an unattainable glamour.

But when I went for a medical examination before a new job, the lady doctor( who did not even had a MBBS) with an unpleasant face performed some examinations, without me realising that she was shaming me . It was a thorn in the mind for many years. Another bold co-worker had the courage to object to such rude behaviours and got the examination stopped for all lady employees. A very bad experience indeed. Later I understood how her husband being on our office rolls, is the leverage for her to be on our office payroll. Way of the world we thought.

Her husband was a law unto himself. He would prescribe the same red tonic and Anacin for any ailment. In fact his tonic was so good ( alcohol content), which went by the name cough syrup, a favourite with many male employees who used to fill bottles, by posing as phlegmatic. We ladies stayed clear of him except when he would grudgingly give fitness certificate before joining duty from sick leave.

We also had a young doctor practicing near our home, in a garage. He was a kind person, and used to slowly explain, if asked. My dad used to accompany us, so he would talk to him. We did not have much interaction, but I remember he made us aware of penicillin and resistance. Antibiotics were slowly making appearances, but Doctors were not prescribing them easily.

The shock of motherhood, wailing baby, brought me face to face with paediatricians. A very kind and sweet doctor was recommended, who patiently explained what it is to take care of baby ( No knowledge of Spock at that time). For years we consulted him, and now heard that his son has taken over the practice.

Later , moving into our home in a newly developing area brought us in contact with an young Doctor . The rapport was admirable, we English speaking patients, young , he wanting to have a name and develop practice. We all grew together and he would simply write medicines which we would swallow get well, and recommend him to all and sundry. The area developed into a centre of its own. Our Doctor too prospered, increased his fees on the gold rate, and we did not mind. We were getting good care. He would come for old age care, answer calls, and he was good.

Years passed by, while Antibiotic was the norm of the decades for every illness, a new company product would be prescribed. Internet, medical articles in popular magazines, friendly advice from Overseas friends who were also doctors gave some insight into use of medications in India.

The doubts started creeping. Why so many medications?- a nagging question . The Doctor would give some convincing answers to calm us. As the years passed, we noticed that he would prescribe certain company medications, and insist that we use the pharmacy he suggests. We also knew he was charging more than other doctors. Still with due respect to his age, and experience ( it is 30 years and more). He went for some training certified programmes and started calling himself this specialist, that specialist. He is authoritative, therefore most of the patients are afraid of him.

He never thought patient should be informed about the medications that he prescribed or he needs them to understand the side effects. He hardly will communicate, and simply wave away the questions.

All our associations with him for decades, did not cut ice with him , one day. When I had a severe pain, writhing, at midnight, we did not know what was wrong, he refused to come home pleading he was too sleepy and we should look for someone else. That was a slap in the face. But we let it pass.

We also started noticing that he was prescribing too many medications for small illnesses. When we asked him he would forcefully say something or change the topic. We were getting more knowledge of medicines from the Internet. Over a period of time , we started rechecking the medications and find out whether it is really necessary to take so many antibiotics for one illness. He would slyly insist we need to buy medicines only form the pharmacist he recommends, and do pathological tests in places he would point out! We understood.. the game. However he was our GP and that was that.

There was another young man practicing, not so suave as the other one, but was willing to charge much less, a son of soil, attracting lot of clients. Initially he was fine, but over the years, a chance encounter with him showed his true face.

Three years back, when I was brimming with pride about my health staying in good stead despite 6 decades on the age front, a sudden onslaught of body heat, toe tingling, sore, tiredness, and fatigue urgently called for consultations., in the absence of GP. Surprisingly this doctor was grumpy and looked bored. My BP was very high. A big shock, to me and husband. My mind racing to the hectic months I had at home due to sever home cleanings, a strain of trips undertaken and guests care. I was ticking in my mind to stop alla dn take rest and be back to normal soon. The doctor was writing down sugar test, which made me exclaim, I never had this sugar problem so far! He smiled crookedly and announced," Where BP is the Sugar is sure to follow"!.

That remark was a jolt to my pride and senses. Is this the way doctors break news to patients about possible problems? Where are ethics, I was seething with confusion and frustration. I am sure my BP went a few notches in those moments. Meanwhile, the blood sugar test was conformed the high Blood Glucose levels.

Needless to say, I never went back to the said Doctor, to save my pride, and avoid his leering smile of I told you so.

We had another family friend, who is also a doctor and who was also a Type 1 Diabetic. He was consulted urgently and he prescribed some medicines. He advised use of sugar free, and less use of sugary stuff, and less rice, but otherwise continue living normally , with walks whenever possible. The problem was he was not living the city , he was also prone to high irritability which he concealed. I was not comfortable consulting him at all. He would direct my husband to inform me about my problems and solutions , which I was unhappy. I am the patient , why tell the husband?

The GP was back and I consulted him with the reading. He made some sympathetic noises and said, do not worry, I will look after you!. How comfortable I felt. He gave medications and I followed them reverently. The blood glucose level was in manageable levels, and I was back to near normal for a few weeks. Once again some complaints cropped up and I sought the GP's help. He increased doses, and forgot about me. I was very disturbed. Why are the doctors not explaining the side effects of medications? The long term consequences of Type 2 diabetes, meal plans?

That drove to the Internet Where I found similar questions posed by Type 2 sufferers all over the world. I found that one common medication does not go well for all patients. In the west, the Doctors are required to explain to the patients about the medications, side effects and about the illness.

I was at sea. My GP would not be open to discussions at all. He would brush aside everything saying 'oh' and change the topic. I was gaining the impression that he was prescribing remedies that would add to his collection and the pharma companies and diagnostic centres. I also gathered similar opinions from his other patients, who knew him since decades. That he was fond of over drugging., sometimes at the cost of the patient.

But we had fewer choices. He is nearer to the house. His timings are very good. We only need to needle him to get information. We know he over drugs us, now we are cautious.

Another incident reduced my trust in doctors. GP simply increased my dose of Diabetic medicine doubling the dosage. The first day, the effect was mild. Next day, I could not even get out of bed. I was utterly weak with nightmares in my sleep through 24 hours. My alarmed family checked the Internet and found that it could have been overdose. We called the doctor on phone since I could not move out of bed. He simply dismissed it by saying " ok revert back to your smaller dose"!

The experience of shoddy treatments, the careless dismissal of patients, the over drugging, all made me lose faith in today's GPs. Now I am more careful when I get prescriptions. I buy from reputed outlets, and look for all the side effect before popping them up. Meanwhile, I think of all those patients who flock to the Clinics, gullible, without any knowledge of side effects to their bodies, and despite medications , their deteriorating health . Sad.

I learnt a lot about Type 2, what I should do, and how to go about my diet. I bought books, found out about home testing blood glucose levels, buy my strips and keep a watch.

I feel for those who get attracted by big Diabetic camps, sign boards proclaiming doctors as " Diabetologists' mushrooming all over the country. Is it really ethical practice? Do the experts really give suitable wholesome knowledge for the chronic ailment and measures to curb, with suitable advices? I wonder.

A lot needs to be improved in patient care and communication between doctor and patients in India. The ignoring of patients requests for details, and the shoddy way the drugs are prescribed , tests conducted , leads to patient losing confidence in the doctor. Different patients perceive differently, but ultimately they are the ones to bear the brunt of medications. In major illness, the patient or their relative needs to be explained , certain facts of the illness and medications prescribed. Those well-educated patients who have idea of illness and medications are able to understand side effects and make choices while getting treated.

Out of fear of being critical some patients may not even say anything to the doctor, even though they have observed side effects and , have stopped taking the drugs. In such a scenario the doctor will continue to prescribe similar drugs and the patient will continue to suffer. Not having a channel of sound communication with the doctor , usually results in overdose and more side effects affecting the patients, In India, doctors largely lacks this patient communications skills.



Finally Wikipedia says:

"A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important. Some medical specialties, such as psychiatry and family medicine, emphasize the physician-patient relationship more than others, such aspathology or radiology.

The quality of the patient-physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician"









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