Dr Neha Sangwan talks about burnout amongst physicians

BURNOUT!

One physician’s story about losing her way and in the process, finding a path for many healers…

We’ve all gone through that feeling at some time or another when nothing tastes sweet, life seems to lose its meaning and every day is a battle. Burnout can be debilitating to anyone but is particularly serious for a physician. Doctors are supposed to heal others – how can they, when they need healing themselves?

Meet Dr. Neha Sangwan, a young physician based in San Francisco, CA. She has been on the precipice and seen just how traumatic burnout can be. In fact, Neha Sangwan was her own first patient!

Sangwan, who addresses this problem through her newly formed health strategy company, Intuitive Intelligence Inc., has treated over 250 physicians and nurses at one of the biggest HMOs in San Francisco and taught scores of workshops.

“The mantra of survival that proved beneficial in residency, ‘Eat when you can, sleep when you can, pee when you can,’ slowly erodes at us once we’re in practice,” she says. “We’re schooled in a culture that values placing our patients before ourselves. We are rewarded culturally by becoming superheroes in crisis, rather than for care and balance in our own lives.”

Ask her how she got into medicine, and she says frankly, “Because I had immigrant parents who came here in 1965 and ever since I was little asked me whether I’d be an engineer or a doctor. I thought there were only two options!”

Sangwan, who studied at the University of Buffalo Medical School in New York and did her residency at Temple University in Philadelphia, moved to San Francisco to work with a large HMO, and rose to become a partner. Since she was single with no family or children, she often took 36 hour shifts, missing out on food and sleep. Within three years of this frenetic lifestyle, she was burnt out.

“I was irritable, tired and worn out, short with people. I didn’t have very much patience. I was even short with my patients – I would cut them off as they were speaking – I just wanted to get through and get it done.”

The symptoms of burnout followed quickly – procrastination, apathy, cynicism and the blame game. Finally it all came to boiling point. She recalls, “I came in one day and I kept checking the same lab tests over and over again and I realized I wasn’t able to function on a level that would get me through18 patients. It was noon and I had seen only 2 patients – I kept double checking the same tests over and over.”

She felt that the solutions that traditional healthcare offered – anti-depressants, therapy and rest time – were not the answers she was seeking. She says, “The truth is what I needed was to know myself better, know my boundaries and be able to seek them, and not have to take responsibility for a system which probably needed more staff than we had.”

She realized that she had become a doctor to fulfill her parents’ expectations and that had carried over to her work where she was trying to please the system and please people, and had forgotten about herself.

“It was a huge lesson for me,” she says. “It was the beginning of understanding myself better and understanding how I got there. I had to own that I was saying yes when I really meant no. I think this plays a lot into the way physicians make decisions. We are typically people who come into this profession much better at taking care of others than we are at caring for ourselves. So there is no self care in health care.”

As she points out, physicians are rewarded for doing relentless 36 hour shifts and wear these punishing hours almost as a badge of honor, going without sleep, without meals. She says, “We are the very ones who understand that what that does to your cortisone level, your adrenalin levels, your work sleep cycles – all the things we care for other people about – we completely disregard in ourselves.”

Young physicians, especially, pick up a candy bar or a bag of chips for lunch at a vending machine, or grab a shuteye when they can. Externally they are handling sick people and emergencies, but try to manage their own stress with a soda or caffeine. She says, “We don’t fuel ourselves properly so our internal physiology is going crazy and we learn to numb out the signals from our body, running on that numbness until we crash.”

Dr. Neha Sangwan talks about dealing with burnout.

Sangwan had to ask herself hard questions – was medicine her calling and why was she so angry at the system?

She even took a trip to Bhutan to put things into perspective. She decided to make it her mission to help other physicians to find ways to avoid burnout. She took many workshops at the Center for Mind-Body Medicine, with Dr. Mark Hyman, a leader in nutrition and the healing power of food, and with Dr. Jim Gordon, the international leader in stress management. She says, “They helped school me on my place in the system and how I needed to take care of myself before I could take care of other people.”

She started work at the HMO once again but brought in a new idea – bringing self care to health care. She says, “When I came back I decided to put together a program for the staff because I saw there were so many people in my position – and there’s only help for burnout only at the end stage. It’s a badge of honor – until you can’t do it any more and then there’s a bit of judgment and pity.”

Sangwan got an innovation grant and created her own program for employee wellness and in the last four years has had 250 healthcare professionals go through the program. She has also trained six other physicians, as well as nurses and healthcare professionals to become teachers and has developed a program for leaders to recognize and address stress.

In the beginning, there was resistance to the workshops from physicians, almost as if it was a punishment for not performing one’s job well. But as word got around, it became almost trendy to attend Dr. Sangwan’s mind body stress class, with a wait list of people clamoring to get in!

The classes are popular with everyone from surgeons to nursing staff, and run with ten participants for two and a half hours a week, for eight weeks, teaching them to connect with themselves in order to face the incredibly hectic days ahead. Stress management, communication and nutrition are the major points used to teach the physicians that burnout is not fluff – it’s real.

Sangwan is affiliated with the Center for Mind-Body Medicine in Washington DC, which has 60 faculty members around the country who come together several times a year for workshops. Her own company addresses preventing burnout not only in physicians but also in people in corporations.

She herself has come to terms with her own role in medicine. As she told her parents, she is still a physician but in a different way from the traditional role they had envisaged for her. “I told them that I was going to be a doctor of the doctors – teaching them about their own self care. I really feel it’s important to educate physicians and have them take ownership and accountability for their health. It’s almost like if you’re not in a hospital bed, you’re not really sick. We want to look up codes in a book or see an abnormality in a cat scan to believe that it’s really there.”

There are many paths to a satisfying career and Sangwan encourages physicians to seek the one which suits them best. Dr. Emily Thomas, a physician who attended her classes because she was burnt out with the routine of a big hospital, found that opening her own medispa with its slower and calmer space was the answer for her. Now she runs her own successful business with several doctors and nurses working for her. The idea is to take inventory before burnout occurs.

“The stress will always change shape for living means stress,” says Sangwan who is enjoying her new profession. “If it doesn’t then it means people are sitting in their comfort zone. Any time you begin to feel stress, the good news is that you’re outside your comfort zone and you’re learning and you’re growing – and the downside is it’s a little uncomfortable. I think burning out changed my life – it jumpstarted me on a whole new career path, a whole new angle to my career that has been the most fulfilling that I’ve ever known. It was really my wakeup call.”

She adds, “My gift is that I can reach those physicians, who then impact so many thousands of people, much before they burn out. People ask me don’t you see patients any more? And I say to them, ‘These are my patients – they are actually the most important patients of the healthcare system.’”

CONQUERING BURNOUT

In burnout, besides the physical damage, there is mental stress too: relationships sour and it takes a huge toll on families.

There’s no substitute for a happy, well-rested, present doctor because then the healing of patients can actually take place. These doctors are more present for their families, they are physically active and their eating patterns change even at home. They almost always eat breakfast while before they used to run out the door. They don’t need to pop pills for insomnia or headache and are more evenly energetic throughout the day. Self awareness and communication helps physicians to understand themselves better and thus value themselves more.

For more information, visit www.intuitiveintelligenceinc.com

DOCTOR’S DILEMMA:

Is the Golden Age of Physicians Over?

One physician who realizes the toll burnout takes on physicians is Dr. Pankaj Vij, an internist with a large multi-specialty group. “Burnout is hugely serious – I have a lot of people in my family who are physicians and many of my colleagues are also saying they frustrated and skeptical about the whole system. It’s really hard work and no amount of money can justify what doctors do, day in and day out, whether here or in India.”

Vij, who did his medical studies at AIMS in Delhi, came to the US in 1993 for his residency at William Beaumont Hospital in Detroit. He has practiced medicine in different settings from a solo practice to a two-doctor medical office, and both were a source of pressure since they entailed dealing with insurance carriers, lawyers, payment collection and obtaining loans for office expenses.

He turned to working at a large HMO where he was freed from administration but did not have much autonomy. He says, “Actually seeing patients and helping people is the fun part – it’s dealing with everything else that makes it difficult. The health industry is the most regulated in America – it takes more time to do all the documentation after seeing a patient than it takes to see the patient!”

The resulting frustration often leads to burnout, and Vij went through it too. He attended Neha Sangwan’s classes on communication as well as several mind-body workshops. He says, “We can all benefit from clear communications in life, and it’s helped me, not only with patients but also with my own family, because I’m now more centered and focused.”

Vij also attended special training for providers at the Center for Mind-Body Medicine and says, “I chose to work with my patients using mind body techniques of yoga and meditation to induce relaxation and reduce stress, and return the body to a more natural state.”

As he points out, people think of the medicine as a glamorous, high paying profession and it’s the ambition of every Indian parent to have their children be physicians. Yet he thinks that one could make much more money in other professions, without the hassles. “So if you become a doctor, it’s not for the money – it’s for something else. Whatever you’re doing is to help another human being – you’re touching another person’s life and making it better.”

If doctors don’t heed burnout and drive themselves too hard, it will be detrimental to the profession. “People who are in the profession don’t look as if they are having such a good time,” says Dr. Pankaj Vij. “Ten years down the line, you will see fewer new people entering the field – there will be a shortage. The golden age of being a physician in America might be over, but by learning to look within and to communicate better, one can still find immense satisfaction. Mind-body medicine is an exhilarating voyage of self discovery that can heal the healer along with the patient.”

Tips on Stretching the Dollar & Gaining New Experiences

Lassi with Lavina shares with you the news you really need – news which if followed can save you bucks, enhance your life and take you into fresh adventures…

1.Enjoy New York Museums for Free

Ever wondered how to entertain the children – and not end up paying a bundle? New York City is rich in museums but sometimes the cost of admission for an entire family can become a bit expensive. Well, what could be better than free?

Visit the New York Hall of Science on Sundays between 10 – 11 am to get free admittance (That’s a saving of $ 38 per family of four) The museum is full to the rafters with wonderful experiments, gewgaws and interactive games, not to mention a fantastic Hall of Mirrors. Also included is a blockbuster exhibition ‘1001 Inventions – Discover the Golden Age of Muslim Civilization’ with a short film presided over by none other than Sir Ben Kingsley.

Ben Kingsley in 1001 Inventions

Even the Metropolitan Museum of Art has some programs by which students are admitted free. All New York City public school students, along with students from Bard Graduate Center, Barnard College, Columbia University, and the Institute of Fine Arts at New York University, may visit the Museum for free. So check with your children’s school to see if their student ID allows free admission to the museum.

At the Museum of Modern Art admission is free for all visitors during Target Free Friday Nights, held every Friday evening from 4:00 to 8:00 p.m. and this permits you to all other Museum galleries, exhibitions, and films. The good news is children 16 and under are free all the time at MOMA

If you want to get your kids interested in design, then check out the free programs and free museum admission for the whole family at Cooper Hewitt Museum of Design

Target Design programs introduce children and adults to the world of design through open-ended play, tours, and design workshops. Create your own designs—fashion, architecture, graphic design! Workshops are geared toward children ages 5–12.

July 17 is Target Design Kids festival where kids become designer for a day; From June to October every Tuesday you have an Imagination Playground for children designed by architect David Rockwell for children to be children.  Every Saturday there are children’s workshops to design clothes for dolls and build stage sets and model homes. For more information, call (212) 849-8353.

The Museum of the American Indian is always free. At the Rubin Museum of Art admission is free for all every Friday from 6–10 p.m. Seniors get a free day on the first Monday of every month. You can also download a coupon to bring a friend for free to the Rubin Museum at any time. In fact the good news is that from March 1 you can download and print the Museum Discovery Pass for unlimited two-for-one admission to the following museums this spring:

American Folk Art Museum
Asia Society Museum
International Center of Photography
Jacques Marchais Museum of Tibetan Art
Museum of Arts and Design
Museum of Chinese in America
Noguchi Museum
Rubin Museum of Art

Inside the Rubin Museum Photo: Peter Aaron/Esto

2. SAJA offers scholarships for budding journalists

Always wanted a career in journalism? Now you can actually get scholarships to ease the high cost of pursuing that elusive degree. The South Asian Journalists Association (SAJA) is offering $36,000 in student scholarships in various categories. Students from the United States, Canada and South Asia can apply for the awards but must be enrolled in a North American educational institution. Applicants with financial hardship may be given special consideration. Recipients are expected to give back to SAJA by volunteering at the annual convention or at other events during the year.

• Three SAJA scholarships for high school students $1,500 each
• One SAJA Engendered scholarship for an undergraduate student $1,000
• Three SAJA scholarships for undergraduate students of $3,000 each
• One SAJA Engendered scholarship for a graduate student for $1,000
• One SAJA Atlantic Monthly New Media scholarship $1,500
• Three SAJA scholarships for graduate students of $5,000 each
• One SAJA CNN scholarship for broadcast journalism for an undergraduate student for $2,000
• One SAJA CNN scholarship for broadcast journalism for a graduate student for $2,000

• The 14 scholarships range from $1000 to $5000 each.
• Applications must be submitted via e-mail by 11:59 p.m. (Pacific time), Tuesday March 15, 2011.
• Applicants may be interviewed by phone or in person by a member of the scholarship committee.
• Winners will be notified in April. Download the entry form:   2011 SAJA Scholarships.doc

3.  Help for Ethnic Media to Learn the Ropes

If you’ve ever felt overwhelmed and confused by the digital revolution, help is at hand! The Ford Foundation has awarded the CUNY Graduate School of Journalism a total of $300,000 to provide training and support for the community and ethnic press in New York City. An earlier $150,000 award was earmarked for teaching digital media skills to ethnic and community journalists so they can expand their online news offerings. The $150,000 grant will help the CUNY J-School lay the groundwork for establishing a New York Community and Ethnic Media Center.

If you’ve wanted to understand social media, learn to take videos and more, connect with the CUNY Graduate School of Journalism for free classes here

4. Love Movies? Be a volunteer at the Tribeca Film Festival

Opening night at the Tribeca Film Festival

Want to see movies for free and be within breathing distance of the stars? Then volunteering at the Tribeca Film Festival might be a great idea!

Here are the details for the 10th annual Festival which  runs from April 20 – May 1, “We need smart, fun people to help us make it happen. Volunteering is a great way to meet fellow film fans, see festival films for free, and just plain have an awesome time. Many different departments need help, so we’re looking for all kinds of skills and availability. The only requirement is that you be 18 years of age or older. Volunteers will also receive goodie bags and an invitation to our exclusive Volunteer Thank You Party.”

More details and volunteer applications  here

New York is a great place to explore and experiment with new worlds. We welcome tips and suggestions from readers.

What do you think are the best little known secrets of the city?

Ayurveda offers many health and well-being therapies including Shirodhara therapy - photo-Santhigram Kerala Ayurvedic Company of USA

Ayurveda Takes Root in America

Will students be heading to American universities to get their degrees as Ayurvedic doctors? Will patients seek out practitioners of this 5000 year old system of medicine from India when next they have health problems? And will Ayurveda form the basis for new health and beauty products, even of restaurant menus, in the US?

Highly unlikely, you say.

Well, remember yoga? This once equally obscure ancient practice from India is hardly considered Indian anymore and has gone global. Now there’s a yoga studio in practically every mall across America! Everyone from the waitress in the fast food place to seniors in the local Y does yoga. In fact, yoga has been embraced to such an extent that there are now American versions from chair yoga to baby yoga to even doga – yoga for dogs!

As the world turns ever more complex, people yearn more for the natural and the organic, the simple and the pure. Ayurvedic practitioners are gradually taking root in the US, and Ayurveda is entering the lexicon in everything from spas to restaurants to supplements and cosmetics.

Ayurveda uses many herbs and plants, including roses

Ayurvedic Spas and Treatments

Yes, Ayurveda’s name is being heard more often, with many of the Western spas providing Ayurvedic massage and treatments, the most noted being Deepak Chopra’s Chopra Center for Wellness in New York and CA. There’s Pratima Skincare and Spa in New York, founded by Dr. Pratima Raichur who has written ‘Absolute Beauty’, a book on skincare based on Ayurveda, and who also offers a whole line of Ayurvedic beauty products.

Indeed, products which are based on Ayurvedic formulations are increasing in the US, and include Shahnaaz Husain’s herbal products which are well-known both in India and the US. The latest to join the Ayurveda Gold Rush is an Italian-American, Laura Callegari, who has created the Bhaktiveda products which range from Tulsi body lotion to Neem hand cream to Indian-rose scented bath salts.

Bhaktiveda is one of the many product lines based on Ayurvedic formulations

While Ayurveda is not as visible as yoga, it’s certainly gaining ground in America. The irony is that while many mainstream Americans are more adventurous and open to the principles of this healing system, Indian-Americans generally are reluctant to accept this indigenous form of medicine, even though they still practice many of the home cures which have their basis in Ayurveda.

“I have hardly any Indian patients,” says Pratibha Shah, an Ayurveda practitioner in Philadelphia, who is the secretary of Association of Ayurvedic Professionals of North America (AAPNA.) “Is there a demand for Ayurveda? Yes, absolutely there is a demand, but the clients are primarily Americans because the Indians who come here are still not oriented toward their own traditions – I have not seen that yet.”

AAPNA is holding an international conference in Miami, Florida in October which will perhaps answer many of the questions people have about Ayurveda viability in the US. The keynote speaker is Ricky Williams, Running Back for the Dolphins and an avid Ayurveda student. The theme of the 3 day conference is ‘Anti-Aging and Rejuvenation through Ayurveda.’

Indeed, Ayurveda has a past history in America and over the years, it has been winning converts as a part of complementary medicine, along with other natural and holistic traditions including acupuncture, massage therapy and Reiki healing. Some major hospitals which are devoted to allopathy are now introducing Integrative Medicine, which includes many of these disciplines.

The Mayo Clinic, as well as the Memorial Sloan-Kettering Hospital, have sizable Integrative Centers which offer everything from Yoga to music therapy to acupuncture and Reiki along with allopathy. Neither offers Ayurveda though Memorial Sloan-Kettering’s Integrative Center does provide an online list of hundreds of herbs and their compatibility with cancer treatment drugs.

Ayurveda conference in the Indian Consulate

Ayurveda’s History

To introduce Ayurveda and showcase Ayurvedic massage, supplements and beauty products to the mainstream, the Indian Consulate in New York organized a conference with Ayurvedic experts and vendors from India and the U.S. One of the speakers was Dr. Scott Gerson, who holds degrees in both Ayurveda and allopathic medicine, and established the National Institute of Ayurvedic Medicine (NIAM) in the US in 1982.

Having been on both sides of the medical divide, he described the single most important difference between eastern and western medicine.  “We view all people as a dynamic flow of energy and it is this underlying energetic matrix that crystallizes into the physical body,” he said, explaining the dynamics behind Ayurveda. In Western treatments, however, he said, doctors look instead to label people, they want the name of the disease because without that they cannot prescribe a course of action which will suppress the pathological process.

Ayurveda has many treatments for well-being, including Nasyam therapy - Photo: Santhigram Ayurvedic Company

He added, “In Ayurveda, we ask a completely different set of questions, and I believe, a more accurate, more human set of questions. We ask what is the energetic state of this person and is this person in balance? Where this imbalance in this person’s mind and body, and is that causing an obstruction in the energy, the life force which is the key to all health and disease?”

He explained that whereas Ayurveda takes time, in a very real sense it is timeless, and you capture your tension in the very moment you’re preparing tea in the morning or the oil for your massage. He advised, “Find some entrée into Ayurveda, whether it’s the massage or the herbal medicines, or the yoga exercises which will open up a whole new world for you.”

Yet Ayurveda continues to remain on the periphery for, unlike in India, where it is recognized as a medical system, here Ayurvedic practitioners are not licensed.  Dr. Amala Guha, Professor of Immunology and Medicine Director, Complementary Alternative Support Care (CASE) at the University Of Connecticut School Of  Medicine, is one of the Ayurvedic experts who is working to get this ancient science educational credit in this country.

The University offers Understanding Ayurveda, an introductory Ayurveda course to first and second year medical students, as well as advanced credit courses for which the students also get to travel to India.

Guha, who is the President of the International Society for Ayurveda and Health, is also the editor of Elements, a journal for alternative medicine. Her expertise in cancer immunology is combined with training in Ayurveda, and she is a reviewer for the National Center for Complementary and Alternative Medicine, which is a branch of the National Institutes of Health (NIH)

She looks with an unbiased eye at some of the hurdles Ayurveda faces in this country: “It’s very difficult, as the credibility of practitioners is being questioned. Another challenge we face is supplements are not known as therapeutic or health models and being free from scrutiny, there’s no quality control. Many of them are adulterated with heavy metals. After taking them, people sometimes land up in our emergency rooms. We cannot deny that these things are happening. In NY itself three herbal supplements were banned.”

Ayurvedic cuisine utilizes herbs and vegetables. (Photo-Hinduism Today)

How different is the situation in the US, as compared to India?  We asked Prathiba Shah, an Ayurvedic expert who practiced Ayurveda in Delhi for 12 years before moving to the US and taking on the same profession in Philadelphia. She was the Chief Medical Officer in the Central Government Health Scheme in Delhi. It had outpatient departments with its own pharmacies which offered allopathy, homeopathy, Ayurveda, and Unani medicine all in one place. She says, “So the patients have a choice of different treatment modalities under one roof.”

Whereas under British rule, Ayurveda and other traditional forms of medicine were looked down upon in India, things are quite different now with all the traditional forms being integrated into the mainstream healthcare of the country. As Shah points out, Ayurveda is gaining popularity because it lacks drug side-effects and is a holistic system where the body is treated as an entity, and the approach is to find out the root cause of a problem and make the whole system healthy.

In India, Ayurveda has been incorporated into governmental health facilities as well as many institutions like Max Health Care which has centers all over India, as well as other private health centers in North and South which offer both western and eastern medicine and the option to choose the form of treatment.

So why has the same not happened in the US?

Here the practice of Ayurveda is not licensed – and that’s a major stumbling block. Most health plans would not reimburse the costs of Ayurvedic treatments – and there is also the credibility question with patients. If something is not licensed by the government, how much can they trust it?

Still, Ayurveda is being practiced widely in the US at different levels, from Panchakarma, which is the high level of Ayurveda, to basically lifestyle consultations, supplement support and diet charts. Although Ayurveda is not licensed, it can be practiced in a limited form due to the Freedom of Health Act which exists in various states.

With a good Ayurvedic practitioner on your side, you can at least get your bearings, and learn to control your own health issues.  Pratibha Shah, for instance, has reared her family totally on Ayurveda. “Though we have a PCP – personal care physician – and go for routine physical exams every year, we’ve never had to visit any doctor for health issues in the past six years.”

Of course, if one has major illnesses or a life-threatening situation, then one should opt for mainstream medicine.  Shah says, “What I strongly emphasize is that the preventative health care that is in Ayurveda, no other system of medicine can match up to that. The first line of treatment if someone has a problem is to make changes in lifestyle, in diet and if you can get someone to determine your body type, have a diet chart and according to that make sure you’re eating right.”

Ayurveda’s Future

Indeed, it’s the integrated approach both patients and providers need to keep in mind. Shah also likes to point out that allopathy has life saving capabilities but more than allopathy these are advancements of technology. “If you have an MRI,   its technology that’s you’re using, not a system of medicine,” she says. “MRI can be used by an Ayurvedic physician also. Laser treatment for gallstones is not allopathy – its technology;  I’m not against that but once you know you have a gallstone you can start avoiding fatty fried food which forms gallstones. So that’s the kind of approach that should be taken.”

As with everything Indian, the opportunities to listen to Ayurvedic speakers, try remedies and treatments and just learn more about this ancient system are increasing, especially in certain states like California and New York. AAPNA has announced Ayurveda Day in October, to coincide with the birth celebrations of Lord Dhanwantari, the creator of Ayurveda. On Ayurveda Day, free Ayurveda awareness lectures, workshops, and other special events will be conducted in various American cities.

Travel to India is also familiarizing many Americans and second-generation Indian Americans with the benefits of Ayurveda, its treatments, massages and products. Since tourists go to India specifically for Kerala’s famous massage treatments, it seems a smart move to bring those treatments to the US. Santhigram Kerala Ayurvedic Co, a Kerala style Ayurvedic wellness center which has branches in India, now has four centers in New Jersey to offer the traditional Kerala Panchakarma therapy. A fifth center is scheduled to open in Houston, Texas.

According to Gopinathan Nair, CEO of Santhigram, “Our specialized Ayurvedic and Panchakarma therapies help alleviate specific problems like back and neck pain, frozen shoulder, migraine, insomnia and joint pain, besides revitalizing the body.” Having targeted the Indian areas of New Jersey, Nair says 70 percent of the clients are Indians but Ayurveda is getting popular with Americans too.  He says, “In fact, the latest center is in Denville where the white population is more and we started getting these clients from Day 1.”

At the opening of the center in Denville, noted business leader Sreedhar Menon vouched for the power of Ayurvedic therapy, describing how it had helped him avoid knee transplant surgery. At this event, NJ State Assemblyman Upendra Chivukula said he would make efforts for legislation supportive of Ayurvedic medicine in New Jersey, as is being done in California.

More and more, trained talent from India seems to be coming to the US. Ambika Nair, who was the personal physician to the former president of India, K.R. Narayanan, is now with Santhigram, along with other Ayurvedic practitioners.

Ayurvedic supplements are big business in the US but there are often concerns about what goes into those bottles. One manufacturer who has met that challenge is Uday Gupta of American Ayurveda- he simply manufactures the products right here in the US. “We found that most of the products from India do not meet the FDA guidelines on the content of heavy metals, and this way we also have quality control,” says Gupta. “Most of the ingredients are from California, though we get those which are unavailable here from India.”

Asked as to who the clients are for products ranging from Blood Cleaner Capsules and Regularity Capsules to herbal teas and oils, Gupta says, “Both Indians and Americans. Interestingly, we find that most of our clients are healthcare professionals, including physicians practicing mainstream medicine.”

Ayurvedic food at Yogi's Kitchen ( Photo: Lavina Melwani)

Ayurveda’s Meals

Walking in New York’s Curry Hill area, you see Yogi’s Kitchen, a brand new eatery devoted to serving food cooked purely according to Ayurvedic principles, and served in steel thalis.  It’s such a guilt-free space it doesn’t even have a deep fryer! ”Even our papads are roasted,” says Mamta Mulloi, who owns this little restaurant in Manhattan with her husband Dinu. “We don’t do a la carte because in that people will order only one dish – and that will not have all the elements to make it a balanced meal.”

In Ayurvedic meals it’s important to have balance with all the five vital elements being present. Spiritual Awakening South Thali gives you a complete gastronomical experience of a balanced, lightweight and yet savory meal consisting of rice, roti, sambar, rasam, pulikulambli, poriyal, avial, and kootu, while the Spiritual Awakening North Thali substitutes the main dishes with dal, kadhi and two vegetables. Both thalis include yogurt and sprout salad as the protein source, and also include papads and dessert.

The Mullois hope to educate their consumers,  and plans are on to have a small library of Ayurvedic books on hand, as well as Ayurvedic information. They point out that the spices in the food aid digestion and strengthen the immune system. The black pepper in the rasam is great for preventing colds and throat infections and the garlic in the food lowers cholesterol, inhibits rheumatism besides having anti-cancer and anti-bacterial properties. Many of the dishes have turmeric, that wonder spice which is reputed to be a natural blood-purifier and improves liver function, skin tone and is an antiseptic.

Ayurvedic delight at Yogi's Kitchen - The Spirtual Awakening Thali (Photo (c) Lavina Melwani)

Yes, in bits and pieces Ayurveda is certainly entering our lives. As the mainstream spas offering Ayurvedic massages and treatments increase, the tongue-twisting word ‘Ayurveda’ becomes easier to handle for many Americans. Applying a slather of these soothing herbal products to one’s hands or soaking in a warm bath suffused with sandalwood or jasmine, one cannot but feel that with such a start, the day is already off to a positive start.

We can take as much as we want, or as little as we want, from dosha consultations to diet changes to organic toiletries to oil massages. We can start with small steps, right in our kitchen, investigating the potent health cures in the Indian spice box.

Ayurveda is all about balance, and don’t we all yearn for that in our busy, over-scheduled lives?

(c) Lavina Melwani

(This article first appeared in Khabar magazine)

Prostate Cancer and the South Asian Male

It’s the hidden killer which is often discovered too late.

The incidence of prostate cancer amongst South Asians  in the US is just 4.6 per 100,000 population as compared to 104.3 per 100,000 amongst non-South Asians.  Yet when they come in for treatment, 85 percent  of them are usually in the late stages, as compared to late stage prostate cancer diagnosis for non-South Asians which is around 15 percent.

Given the sheer numbers of the South Asian  population around the world, it is imperative they get checked early.  Dr. Ashutosh K. Tewari, an expert on prostate cancer and robotics, discusses  the hard facts.

Dr. Ashutosh K. Tewari, a leading expert on prostate cancer and robotics

Tewari, a noted expert in the fields of prostate cancer and robotics, has performed over 3500 surgeries.  He is a professor of both urology and public health at Weill Cornell Medical College. He also  serves as the Director of the Prostate Cancer Institute and the LeFrak Center for Robotic Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. His prostate cancer program is one of the largest in the world, and he has performed over 2,500 robotic prostatectomies in New York since 2004.

The Indian Genome and Prostate Cancer

Tewari has maintained a strong commitment to India despite being away from the country for 20 years. He has recruited several dozen Indian-born researchers and clinicians for his fellowship program, and over 100 Indian urologists have trained with him in the US. Many of these trainees have gone on to positions in India’s leading institutes such as Medanta’s Medicity, Delhi and Sanjay Gandhi Institute of Medical Sciences in Lucknow. He has been a visiting faculty member to AIIMS, SGIMS, Pune, and Hyderabad where he has performed surgeries. Clinically he has treated hundreds of Indian men with prostate cancer both in India and in the US.

His work with Indian men has led to the discovery that there may be something scientifically different about the Indian genome. Prostate cancer in Indian men is often more aggressive in nature than their Western counterparts. His lab is exploring this hypothesis further and aims to design preventive care and treatment programs specific to the genomic and environmental characteristics of the Indian subcontinent. He has initiated this study in the US, with tissue samples that he has collected from his Indian patients. He is also using his role as Prostate Cancer Health Council for the State of New York to gain support for this study. Tewari is aware of the lack of preventive care measures in the field of prostate cancer in India, and aims to generate prostate cancer awareness in India.

He is building a prostate cancer institute in Pune, India to provide a world-class treatment and diagnostic center for Indian men. It will not only give Indian men access to the scientifically advanced treatments that are used in the western world but will also give them an opportunity to receive care specifically catered to the Indian lifestyle. Tewari’s team will consist of Indian physicians and researchers and he will travel to India himself to train his team and to perform surgery. He will also diagnose patients on a daily basis and plans to use a telepresence portal when he cannot physically be present at the Institute.

Prostate Cancer – Q and A with Dr. Tewari

How common is prostate cancer among South Asian men?

Recently, World health Organization reported the incidence of prostate cancer in the Indian population to be 4.6 per 100,000 population compared to 104.3/100,000 as found in United States. Even though the incidence rates of prostate cancer in Indian populations are much less than that seen in the western world, it is an important cohort of patients due to its sheer size that needs specific studies and subsequent treatment guidelines.

2. Is it something genetic or more common in the Indian-subcontinent?

From our recent studies, we have come to conclusion South Asian men present with more aggressive disease than Caucasians. Other Studies comparing the stage of disease at presentation have shown that the majority of patients (85%) in India presenting for treatment of prostate cancer are detected at late stages (T3 and T4). In contrast, late stage prostate cancer is diagnosed in 15% of the males in the United States that present for treatment. There is published data about the incidence and survival of prostate cancer in this group of population; however, very little has been studied about actual characterization, clinical presentation and genetic behavior of the prostate cancer.
3. What are the warning bells?

Not everyone experiences symptoms of prostate cancer. Many times, signs of prostate cancer are first detected by a doctor during a routine check-up.  Some men, however, will experience changes in urinary or sexual function that might indicate the presence of prostate cancer. You should consult with your doctor if you experience any of the symptoms below.

These symptoms include:

• A need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Weak or interrupted flow of urine
• Painful or burning urination
• Difficulty in having an erection
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips, or upper thighs

Because these symptoms can also indicate the presence of other diseases or disorders, such as BPH or prostatitis, men will undergo a thorough work-up to determine the underlying cause. These may include

• Digital Rectal Examination
• PSA testing
• Biopsy
• MRI

4. How can people take charge and control this disease?

The ultimate goal of prostate cancer prevention strategies is to prevent men from developing the disease. Unfortunately, despite significant progress in research over the past 16 years, this goal has not yet been achieved. Both genetic and environmental risk factors for prostate cancer have been identified, but the evidence is not yet strong enough to be helpful to men currently at risk for developing prostate cancer.  Early detection and screening has proven to catch prostate cancer early when it is curable and localized.

Dr. Ashutosh K. Tewari, a leading expert in prostate cancer

5. Tell us about the robotics program.

Robotics  have ushered in a new era of minimally invasive surgery that has challenged both open and pure laparoscopic surgery. Robotic surgery involves tele-manipulation devices that allow the performance of complex surgical tasks with dexterity and minimal fatigue due to their ergonomic design, expanded degree of movements, tremor filtering, and 3-D stereoscopic visualization.  The excellent view of the operative field provided by this master-slave system coupled with the unrestricted ability to execute almost any surgical task has ensured that robotic surgery has become the most popular approach for radical prostatectomy in the United States.

Treatments for prostate cancer have two fundamental competing goals: complete eradication of cancer and minimal morbidity. The term ‘trifecta’ has been coined to illustrate the three goals of cancer control, continence, and coitus (potency).

In order to meet these goals, we use a da Vinci master-slave robotic system and have developed a minimally invasive, robotic-assisted radical prostatectomy (RARP) technique by standardizing a unique sequence of surgical steps, appropriate visual angles using different lenses, optimal retraction strategies, precise suturing steps, and anatomical sparing of the neurovascular structures, as well as by incorporating time-tested open surgical principles. This has been refined further by an understanding of the local anatomy of the nerves and meticulous dissection without the use of thermal energy to control bleeding points. This technique, which we call ART (Advanced Robotic Technique) results in excellent oncological and surgical outcomes, and causes minimal bleeding in expert hands. With this technique, patients and their families have been able to benefit from the quicker convalescence, reduced hospital stays, lesser analgesic requirements, lower blood transfusion rates, and, improved cosmesis compared to the open approach. I was involved in the initial 1000 cases performed at the Vattikuti Institute in Detroit and took over the role as Director of Robotic Center and Prostate Cancer Institute at the New York Presbyterian Hospital.

6. Your advice to South Asian men on how to safeguard themselves?

Why is prostate cancer so common in the Western culture and much less so in Asia and why when Asian men migrate to western countries the risk of prostate cancer increases over time? We believe the major risk factor is diet – foods that produce oxidative damage to DNA. So here are tips on preventing or slowing the onset of the disease.

Eat fewer calories or exercise more so that you maintain a healthy weight.

• Try to keep the amount of fat you get from red meat and dairy products to a minimum.
• Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
• Eat more fish – evidence from several studies suggest that fish can help protect against prostate cancer because they have “good fat” particularly omega-3 fatty acids. Avoid trans fatty acids (found to margarine).
• Try to incorporate cooked tomatoes that are cooked with olive oil, which has also been shown to be beneficial and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy and green tea are also potential dietary components that may be helpful.
• Avoid smoking for many reasons. Alcohol in moderation, if at all.
• Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer
• What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may “fuel the cancer”, and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin.
• Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
• If you are age 50 or over, or have a family history of prostate cancer, you need more than a good diet can guarantee. You should consider a yearly rectal examination and PSA test. 

For more about prostate cancer Check this out

Heart healthy food includes legumes, nuts and fresh greens

It Need not be a Food-Fight between Healthy & Tasty

When Nanda Nandkishore, a hi-tech professional in San Francisco, went for a complimentary advanced heart risk screening test that was being offered to the TiE charter members, he was shocked to find that most of the results in his test turned out to be in the ‘High Risk’ category.

Nanda and his wife Purnima, who was in microbiology before switching to business, had both come to the US to pursue higher education, and had become successful professionals, like a lot of their friends. They found that the risks for heart disease were something many of them had.

“A  lot of  Nanda’s  friends, who were in the same age group,  are struggling with high cholesterol problems,” says Purnima “ Some have had heart attacks, while some have adopted a healthier lifestyle and are controlling the risks without having reached a stage of heart attack or stroke.”

According to the World Health Organization, by 2010, 60% of the world’s cardiac patients will be Asian Indian. The scary part is we are already in 2010! Indeed South Asians are predisposed by genetics for a higher probability of heart disease, but the lifestyle and diet habits can have a huge impact on whether they actually get the disease.

Other statistics are also grim: According to CDC, in 2008, Asian Indians adults had twice the prevalence (14%) of diabetes compared with other Asian populations living in the United States (Chinese, 6% and Japanese, 5%).  According to the adults surveyed, 21% reported having hypertension and 9% reported having heart disease.

For the Nandkishores, the change in lifestyle came when Nanda sat down with his cardiologist to discuss controlling his risk factors.  The cardiologist suggested statins,  a regular exercise routine,  and modifications in his diet.

“Nanda asked whether he could try exercise and diet first before getting on statins, so, we sat down with the dietitian who works with the cardiologist, and she gave us a framework to start looking at different foods – the good, the not-so-good, and the ugly,” says Purnima.

“Nanda himself wanted the change, and was willing to put in the required effort to make it happen.  The key is that the individual has to want the change to happen from the inside.”

Purnima Nandkishore, author of Amrit, a book on heart healthy Indian cuisine

Cooking Heart Healthy Meals

Since Purnima loves to cook and experiment with flavor combinations, she decided to help her husband change his diet by using a different set of ingredients to come up with the same taste and texture sensations to make the traditional foods.  She turned to reading different medical studies and pulled in important factors from the Modified Cretan Diet, the OmniHeart study as well as ingredients from Ayurveda. She says, “So my recipes evolved and my kitchen become a fusion cooking experiment station.”

The changes in Nanda’s lifestyle after following this diet have been dramatic. He has lost over 10 lbs over the last five years, has better stamina for hiking and other physical activities, and also has a better physique, a welcome side-effect.

You can look at the result as a progression in reduction of risk factors -  the chart is available online at: http://www.amritforheart.com/story.html.

Purnima decided to create a cookbook that would help others to get a heart healthy diet, while maintaining the flavors of traditional Indian cuisine. ‘Amrit: Luscious and Heart Healthy Indian Meals’ was the result.

Since some of the recipes used canned fish as fresh was unavailable in many places, she was concerned about the salt content which would not be acceptable for those trying to control heart disease. To make sure she got the most thorough and analytic information she contacted Dr. Frank Sacks at Harvard University who was Chair of the Design Committee of the DASH study (Dietary Approach to Stop Hypertension).

He directed her to Karen Yee who had worked on DASH and OmniHeart (a follow-up study that looked at the ideal proportions of food for lowering risk factors that lead to heart diseases). So each recipe has a detailed nutritional analysis by Yee, who is a senior research dietician at Brigham & Women’s Hospital.

Purnima, with her background in microbiology and interest in healthy eating,  also did a lot of researching to fine-tune Nanda’s  diet.  She was particularly inspired by The Alameda Seven Study in which 7,000 people in Alameda County (CA) were studied for 25 years for these 7 habits.

The Seven Habits

1. Adequate sleep, 7-8 hours per night;
2. Regular vigorous physical activity (3 kcal/kg/day)
3. Maintaining recommended weight
4. Not smoking
5. No or Moderate alcohol
6. Eating breakfast daily
7. Eating meals daily – not grazing

The study showed that by the age 45 a man with:

3 or less habits will live to the age of 67; 4 to 5 habits will live to the age of 73; and 6 to 7 habits will live to the age of 78

Studying the problem of heart disease and South Asians, Purnima found four problems for that community:

Higher stress life. stress is a result of lack of control over things.  For new immigrants and for high-striving South Asians it is present in everyday life.

Priorities & Goals. South Asians have set education and material wealth as their goals – physical activity and diet do not show up high on our priorities and goals list (can we name five athletes and five body builders of South Asian origin in the US?

Traditional South Asian Diet is high in carbohydrates, and proportions on our thali are not conducive to good heart-health – a shift to the US usually made the traditional diet worse by adding more refined carbohydrates, and fats easily accessible.

Physical activity level – was moderate when you walked or bicycled your way to school and played badminton after school.  Now there is a car to go to work, sit at your desk to do the work and TV to relax with, when you get back from work.

Since Nanda’s success in combating the risk factors of heart disease, Purnima has become an evangelist for lifestyle and diet changes. She gives free talks and writes about heart healthy eating in various publications. She says, “I feel journalists, community and religious heads as well as thought leaders can influence and encourage proactive thinking, open-minded adoption of prevention measures, and promote the use of conscious informed decision making for South Asians.”

Indeed, once one gets used to the changes in diet, it’s hard to go back to the bad old ways. Earlier, Nanda had loved capers with his salmon but now has lost his taste for this salty delicacy and complains that many store bought items are too salty or too sweet for him. Over the last five years he has gotten so used to healthier foods that he no longer likes the rich, deep-fried foods.

Popular Myths – Heart Disease & Indian Cuisine

In the book Purnima has a special section for readers from the Indian sub-continent dispelling some popular myths. Many Indian vegetarians feel that since they do not eat animal products, their risk of getting heart disease is less.

She cites a 2003 review which calls Indian vegetarianism “a form of contaminated vegetarianism because this diet allows consumption of excessive amounts of saturated fatty acids and trans-fatty acids, liberal amounts of high-fat dairy products and simple carbohydrates. The practice of deep frying and reusing fried oil, and using ghee (which is made by heating butter), all create oxides – compounds that are harmful to health.”

Other problems with traditional Indian food, as pointed out in ‘Amrit’:

Deficiencies in the vitamins B6 and B12, common among vegetarians, could lead to an over-accumulation of amino acid homocysteine in the blood, known to be a risk factor in heart disease.

Important nutrients like ascorbic acid and folic acid and minerals are lost during the preparation and cooking of Indian food.

Keeping all this in mind, Purnima has adapted foods inspired by OmniHeart Trial and the Modified Cretan Mediterranean Diet. She has also adapted recipes in Amrit to have less salt because Indians are often prone to high blood pressure, one of the risk factors for heart disease and stroke.

While the no-frills ‘Amrit’ is not a beauty queen of a book (it has no photographs but the luscious matching images to the recipes in the book can be found on the website of the book),  it does have useful factors about safe cooking practices, tools and equipment and ingredients, even sharing which ones need to be refrigerated and which can be kept in the pantry.

As Purnima observes, the recipes are not short or quickie ones – they are a labor of love and best done with other family members. The dishes are certainly offbeat – there is Begum Ki bhing which is a herring quiche. As you all know, herring is rich in Omega-3 and low in mercury. Each serving provides 1.17 gm of Omega-3 and 88 mg of Omega-6 fatty acids.

The recipe also contains turnip which provides protection against ischemic stroke, often caused by blood clots in the heart. Another ingredient in the dish is Fromage Blanc, which is a smooth and creamy ‘freshly churned makkhan’ substitute but is thankfully full of protein and devoid of fat! So you get the idea – most dishes let you have your tasty desi ‘sawad’ but are full of ingredients which are good for your heart.

The book contains special entrees spotlighting protein such as Gulabi Machli or Smoked Trout, and Sultani Banda or Jack Mackerel Cutlets. The one dish meals include Aloo Methi Frittata or Potato Fenugreek Frittata or Charminar Makke aur Sahjan Ke Tukre – Corn & Drumstick Squares.

There are special sections for North Indian dishes, vegetables, condiments and desserts. How does Kaju Karela – Bitter Melon with Cashews sound? Other unusual flavorful dishes are methi muffins, olive achaar, and spinach and tomato soup. Desserts include such delicacies as Kaju Laddu, and Aamrus Ashcharya – Gingered Mango Surprise.

Kaju Balls from Amrit, a book on heart healthy Indian cuisine

Indian Desserts a No-No in Heart Disease?

Wondering how you can eat Kaju Laddus (cashew balls) if you are at risk for heart disease? At the end of each recipe Purnima gives a ‘smaran’ or synopsis of the health benefits of various ingredients used. These laddus are made from coconut flour, agave nectar (a natural sweetener) and cashew nuts which are a source of unsaturated fatty acids, tocopherols, squalene and phytosterols which help block cholesterol absorption. Cashews also have a lower fat content than most other nuts, says Purnima. So each ingredient in the book has a fascinating profile of its benefits for the heart.  The nutritional breakdown of ingredients is most useful for those trying to find the most heart-friendly eats.

The 50 recipes ensure that even if you are watching out for your heart, you will still get to eat well and enjoy your food. More details at www.AmritForHeart.com

Check out recipes for Punjabi Polenta and South Indian Chutney here

A doga class in progress

Are you into yoga? What about your dog? If you didn’t know this already, there is yoga for dogs, known as Doga and it’s beneficial to your pets. Brenda Bryan teaches Barking Buddha Doga to dogs while her colleague Kelly Page teaches Ashtanga Yoga to humans at WestsideYoga and Doga in California (www.westsideyogadoga.com),  using different ways of teaching to reach a similar goal of union connection and joy.

Here Brenda Bryan describes the value of doga for both humans and animals. “When I first began developing Barking Buddha Doga, I didn’t think of it as something beyond a fun activity to do with your dog. My dogs, Honey and Gus enjoyed the attention and I enjoyed spending quality time with them.  I also really loved watching the sweet interactions between the humans and dogs who attended the classes.  But what I’ve really noticed is how the dogs have taught me to go with the flow, be more patient and not to cling to how I think things should be.

We’re working with dogs here, there are always surprises, some pleasant, some not so much.  But whatever the situation, whether it is a dog whining or barking through class, or the young energetic dog making a “dogic” breakthrough and becoming zen on the mat, the dogs make me a better human through my experiences with them on the yoga mat and in everyday life.

Dogs with their naturally open hearts and healing nature make the perfect yoga partners.  The word yoga means union and dogs being pack animals are all about union.  Union in yoga means to connect to    the divinity within.  Basically this means connecting to your most perfect, wonderful self and then feeling that same connection to those around you.

Both human and canine benefit from a doga class

Our dogs are naturally without ego and all about love so they can help us discover the connection to our wonderful selves by first connecting to the love we have for them.  In doga as we benefit from the poses physically we can also learn from our dogs. As we deepen our connection and our relationship with our dogs, we can benefit from our dogi’s open hearted nature to open our own hearts and then maybe bring a little more love into the world around us.”

Bryan has written a book titled Barking Buddha: Simple Soul Stretches for Yogi and Dogi, and here she tells you about the value of the yogic path for dogs. She shows several doggie mudras which will benefit both human and canine. A few examples:

Heart to Hound Mudra: Place one hand on your heart and one on your dogi’s chest or heart area. This is a sweet mudra that focuses your energy on the love you have for your dog and the love your dog has for you.

Inner Dog Mudra: Rest your forehead on your dog’s forehead. In this mudra the intention is to open up to your dog’s consciousness and connect the energy of your minds.

If the book doesn’t make a believer of you, it will at least make you smile. And that’s good for your health. So although I’m not a dog owner I recommend what brings you and your dog together!

Dr.Ketan Badani with teen students who may be future surgeons

A walk through New York-Presbyterian Hospital’s mini medical city….

The meandering, thundering steel dragon, also known as the No. 1 subway train, rushed on, its belly filled with countless strugglers and dreamers all commuting to the gritty Upper West Side. At crowded 165^th street, it disgorged a huge chunk of humanity – patients and families, small children, doctors and nurses – all headed to the New York- Presbyterian Hospital, one of the great teaching hospitals in the city.

With so many human lives interlinked with its services, you see that this hospital is the lifeblood, the nerve center of the urban community. Indeed, it is a landmark in New York, a blending of past, present and future as it provides succor to patients and hope in the form of some of the most cutting edge technologies in medicine.

As I walked from the subway station, I fell into step with a nurse who was headed to the hospital. She mentioned that she had worked there for 27 years, and recalled that a parking lot once stood where one of the gleaming new buildings now has arisen.

New York Presbyterian Hospital/Columbia University Medical Center

Indeed, the New York-Presbyterian Hospital has changed and metamorphosed over the years so that it is now actually five hospitals in one: it is one of the most comprehensive university hospitals in the world, with leading specialists in every field of medicine.

A mini medical city has arisen in the span of an avenue block and several streets, and around it this Washington Heights neighborhood has flourished. It shows the power of collaboration for what was once a single hospital has multiplied into several. It comprises of New York-Presbyterian Hospital/Columbia University Medical Center, New York-Presbyterian Hospital/Weill Cornell Medical Center, a branch in Westchester, the Allen Center in north Manhattan, and the Morgan Stanley Children’s Hospital. All of them are affiliated with two Ivy League medical institutions, Columbia University College of Physicians and Surgeons, and Weill Medical College of Cornell University.

Dr. Ash Tewari, Director of Robotic Surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center

And that brings us to the physicians, for what makes a great hospital is great physicians. The hospital is #1 in the New York City metropolitan area and #6 in the nation, according to U.S. News Media Group’s 2009-2010 edition of America’s Best Hospitals.

Interestingly enough, the hospital has several staff members from physicians to trainees who are of Indian origin. There are several physicians of Indian descent who are leading the charge here and we spoke with some of them to learn of the cutting edge technologies that are being employed.

Dr. Laxmi Baxi specializes in high risk pregnancies

Dr. Laxmi Baxi was probably one of the first Indian physicians to work there and has been at the hospital for 32 years. Baxi, who is the attending OB-Gyn at the Sloan Hospital, Columbia University Medical Center,  is also a professor of clinical obstetrics and gynecology at Columbia University. Baxi, who specializes in high risk pregnancies, has been listed amongst the best doctors in New York by New York Magazine for the past 18 years and amongst the best doctors in America for the past five years.

“When I joined, I was the only Indian in the entire hospital in the faculty of OB-Gyn,” she recalls of those days back in the 70’s. “There was only one female and she was about to retire and there was no other woman in the department.”

Baxi, who had her education at KEM University and Seth GS Medical College in Mumbai, has worked with many distinguished physicians on the faculty at the New York Presbyterian, including Dr. Henry Clay Fricke. She says:  “They were people who had seen the world and they had great respect for people who came from outside, and they liked my training and the work I had done.”

“My role is recognizing the complications and problems in pregnancies and having a strategy on how to deal with it, and understanding how it will impact the future of the family,” she says.   At the hospital there is the opportunity for collaboration with research scientists, and so she is able to expose the patients to the latest developments and thus offer them better care for themselves and their families.

Weill Cornell Medical Center

One of the most dramatic cases she remembers is of a patient from London who had been told she should write off the pregnancy. Baxi identified that the fetus had heart block and was in failure, and with astute management, the pregnancy was carried to near term. Says Baxi: “The baby – no longer a baby – is one of the smartest and brightest young girls today.”

She finds that the difficult pregnancies are often a symptom of other health problems such as lupus or bleeding, clotting or genetic disorders which her patients were not aware of. She is almost an internist amongst ob-gyns, and likes the role: “I like to be a detective and it gives me a high to identify problems, because now we can go for it and have a good outcome. I like to pass this to my students too so we have better doctors tomorrow.”

The Chief of Transplant Surgery and Director of Kidney and Pancreas Transplant programs at New York-Presbyterian Hospital-Weill Cornell Medical Center is also an Indian, Dr. Sandip Kapur.  Kidney transplants are vital as in the US alone there are over 90,000 patients waiting for a donor. His clinical expertise is in kidney, whole organ pancreas and islet cell transplantation, and he’s the first and only surgeon in the tri-state area to perform a successful islet-cell transplant to cure Type 1 diabetes.

“Our particular expertise is in offering all known opportunities for transplantation,” he says. “We’ve had very good success in innovating different programs for living donation.”

Dr. Sanjay Kapur, Chief of Transplant Surgery

Kapur, whose family hails from Delhi, is also an Associate Professor of Surgery at Weill Cornell Medical College and an Associate Attending Surgeon at New York -Presbyterian Hospital-Weill Cornell Medical Center. He heads the oldest kidney transplant program in New York State, one of the highest volume programs in the country, and is  a pioneer in developing innovative strategies that allow transplants in difficult situations. An example is the ABO program where a patient is able to receive a kidney from a donor when blood types don’t match.

Kapur led the Weill Cornell transplant team that performed the nation’s first three-way living-donor kidney transplant surgery, and this could revolutionize the field of transplants.   “One of the things that’s developed over the last year is the concept of NEAD – the never ending altruistic donation – what’s involved is people offering to donate a kidney to someone who they don’t know,” says Kapur.

“With an altruistic donor, you can create a chain of transplants where at the end there’s always a donor to start another chain. Mathematically it becomes a very powerful mechanism for increasing the donor pool. We’ve been able to transplant almost 70 percent of our waiting list which would otherwise not have been possible.

He adds, “Without these opportunities many of these people would languish on dialysis for five, six, seven, eight years and potentially have a shorter life span because of it.”

Dr. Ash Tewari at the da Vinci Surgical System

Another area of cutting edge technology is the field of robotic surgery where two of the leading Indian physicians are Dr. Ash Tewari and Dr. Ketan Badani. Prostate cancer is the second most common cancer in America, affecting 1 in 6 men, and the New York Presbyterian is one of only three hospitals in the US which are equipped to treat prostate cancer with robotic surgery.

For prostate cancer patients, the robotic approach has numerous improvements over conventional prostatectomy, including smaller, less painful incisions, reduced blood loss and scarring, shorter hospital stay, excellent cancer control, early return of urinary function and low risks of impotency.

Tewari is the Director of Robotic Prostatectomy and Prostate Cancer-Urologic Oncology Outcomes at Brady Urology Institute at the Department of Urology, and an Associate Professor of Urology. He is also an Associate Professor of Public Health and Outcomes in the Department of Public Health and Outcomes at The Weill Medical College of Cornell University.

He credits his early medical training in India for preparing him for his posts in some of the premier medical institutions in the US, and has performed more than 2,000 robotic procedures for prostate cancer, and helped develop award-winning techniques that reduce potential risks of surgery, including incontinence and impotence.

Tewari, who hails from Kanpur, was recently named Director of Robotic Surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center where a $ 3 million gift established the LeFrak Center for Robotic Surgery which supports research and a center to train physicians in robotic surgical techniques. The state of the art equipment includes the da Vinci Surgical System by Intuitive Surgical, which comprises a surgeon console and a patient-side robotic mechanism with an endoscopic camera and miniaturized surgical instrumentation.

As Tewari explains, in prostate cancer surgery, this equipment improves the ability of the surgeon to operate around muscles and delicate nerves, thus ensuring a better outcome for patients. Tewari himself was trained by Mani Menon, MD who pioneered the field of robotic urology and developed the VIP technique of Robotic Prostatectomy.

He says, “There’s always a human side of prostate cancer and one of the most rewarding part of this career is that you really can make a difference in patients who have early prostate cancer, for the key is to find this cancer early enough so you can get them back to their quality of life and the life expectancy that they deserve.”

Dr. Ketan Badani is the Director of Robotic Surgery at New York-Presbyterian Hospital/Columbia University

While Tewari is at the Weil Cornell Medical Center, Dr. Ketan K. Badani, is  the Director of Robotic Surgery at New York-Presbyterian Hospital/Columbia University and Assistant Professor of Urology at Columbia University.

“The most satisfying part is having something that we think will help patients, trying it and finding that it actually does help them,” says Badani, who was born and grew up in the US. He is one of only a few surgeons in the world who has performed over 1000 robotic surgeries, and has published landmark articles on robotic prostatectomy and enhanced nerve-sparing techniques to preserve sexual function in patients.

“The nice thing is that here is a technology that is actually revolutionizing the way we treat prostate career, solely based on technological advancement,” he says. “My generation of people is more technologically involved, and that’s where my interests lie, so combining medicine, technology and surgery is a perfect fit for me.”

Indeed, it will be intriguing to see where the next generation of physicians takes research and innovation in this new technological age.

On a lighter note, the hospital is certainly encouraging the young ones! More than a dozen students enrolled in New York-Presbyterian Hospital’s Lang Youth Medical Program tested the capabilities of the new robotic surgical machine which allows physicians to conduct prostate and kidney procedures using high-definition 3-D video for improved clarity and detail. The young future surgeons manipulated the arms of the da Vinci System to move, unwrap and sort candies – surgery was never so sweet!

In fact, the Lang Youth Medical Program of Morgan Stanley Children’s Hospital of New York-Presbyterian is a six-year science education and mentoring program to motivate future scientists and physicians. Students, still in their teens, get to observe surgeries and go on medical rounds, and are also given mentoring, internships and tuition assistance for a career in science or medicine. It looks like the future of medicine is in good hands.

A HUNDRED YEAR OLD STORY…

It all started with the merger of The New York Hospital and The Presbyterian Hospital, both respected names in New York. In fact, over the years, some of the noted medical advances have been due to physicians or scientists from these hospitals, from the development of the Pap test for cervical cancer to the synthesis of penicillin to the first successful embryo-biopsy pregnancy and birth in the U.S. Other firsts include the first clinical trial for gene therapy for Parkinson’s disease, the first indication of bone marrow’s critical role in tumor growth, and the world’s first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient.

The merger of The New York Hospital and The Presbyterian Hospital made possible the development of three, state-of-the-art Centers of Excellence. They include a Gamma Knife Center for the treatment of brain tumors, a comprehensive Liver Transplant Center, and a Lung-Reduction Center for the treatment of severe emphysema and bronchitis.

In fact, it was ranked higher in more specialties than any other hospital in America by the US News and World Report. So what are the specialties of this hospital? Between them, the five facilities include AIDS care, preventive medicine, women’s health, trauma centers, vascular health, digestive diseases, reproductive medicine and minimal invasive surgery, and have been recognized as centers of excellence in many of these disciplines. Being in a university hospital for cutting edge research, the patients benefit from many of the innovations such as research in burn treatment, cardiac ischemia and atherosclerosis, breast cancer, and cystic fibrosis

This mini medical city in one city block is a powerhouse of activity combining everything from out patient clinics to a school of nursing and an eye institute. Old and new buildings merge together. If there is a hundred year old building, there is also the sprightly Children’s Hospital – one of the best in the country – with welcoming Maurice Sedak images on the wall where live entertainment for the children is also piped into the room for patients too sick to venture out. Step out and you find the sounds of the city are all around as cars and buses and pedestrians rush by and new construction for the hospital continues to be built.

The same energy is visible in all the centers of the New York Presbyterian Hospital spread around New York. New centers to be opened include two state of the art heart care facilities.

Recently the hospital initiated myNYP.org which is an online personal health record for patients, a welcome way for patients to be more aware and involved in their own healthcare since it allows them to store medical information from their hospital visits. It is indeed an ongoing story with many more chapters to be written.

© Lavina Melwani

Many of us have had a loved one – be it a parent, a grandparent, a dear aunt – disappear into that all encompassing Black Hole, that distant planet of Alzheimer’s. They may physically be with us but the essential person has vanished into a Never Never Land. They see you and yet they see you not. You are a stranger where once you were a part of their life. Unbreakable bonds between loved ones are severed and through no one’s fault.

Indeed, patients with this devastating disease are like a tribe of lost people. Alzheimer’s destroys brain cells so that memories are lost: marriage vows, everlasting love all become illusions and relationships disintegrate.

‘Sometimes you have to let go of what you can’t live without.’ This is the tagline of ‘Away from Her’, the poignant film about the effects of Alzheimer’s on a marriage. This much acclaimed film touched a chord with filmgoers because it addressed a concern that is increasingly intersecting people’s lives as populations age. In it Fiona, played by Julie Christie, has Alzheimer’s and as she disappears bit by bit, she cannot recognize her much loved husband, and forms a relationship with a stranger in the nursing home.

Reel life is often reflective of real life. Recently we learned that retired US Supreme Court Justice Sandra Day O Connor’s husband of 54 years, John, who has Alzheimer’s disease, had fallen in love with a fellow patient at the nursing home where he lives. His wife was happy for him, seeing him cheerful and comfortable.

Alzheimer’s changes lives in many ways: O Connor, who was the first female Supreme Court justice in the US, had retired in 2005 in order to oversee her husband’s treatment in a care center in Phoenix, and accepting her husband’s new relationship was just one more act of caring for her spouse.

“Our nation certainly is ready to get deadly serious about this deadly disease,” she told the Senate Special Committee on Aging and urged Congress to speed research.

Indeed, this ravaging disease is affecting more and more families, stealing memories, making people invisible and erasing meaningful lives lived, as if they never existed.

Alzheimer’s, which destroys brain cells and causes problems with memory, thinking and behavior, affects 5 million people in America and about half the population over the age of 85 in the US suffers from Alzheimer’s. By 2006 there were 26.6 million people worldwide living with the disease, according to the 2^nd Alzheimer’s Association International Conference on Prevention of Dementia in Washington DC last year. This figure is expected to quadruple by 2050 to more than 100 million with 1 in 85 people worldwide living with the disease.

It is a disease without a cure and there is an accelerating worldwide effort under way to arrest this growth. There is a lot of research being done in the US, and we talked about these developments with Dr. Sam Gandy, Chair, National Medical and Scientific Advisory Council of the Alzheimer’s Association. He is also Sinai Professor of Alzheimer’s Disease Research, Professor of Neurology and Psychiatry, and Associate Director of the Mount Sinai Alzheimer’s Disease Research Center in New York City,

“It’s heartbreaking in almost every way you can think of,” says Gandy of the impact of Alzheimer’s disease. “Either the patients no longer recognize their children or spouse or they develop personality changes and become unmanageable or are institutionalized. It’s a very cruel disease.”

Gandy is an international expert in the metabolism of the sticky substance called amyloid that clogs the brain in patients with Alzheimer’s. In 1989, Gandy and his team discovered the first drugs that could lower formation of amyloid. He has written more than 150 papers, chapters and reviews on this topic.

In fact, Gandy has been in hot pursuit of amyloid since the 80’s. Ask him about it and he says, “Yes, that’s all we think about.”

“Alzheimer’s is the most common cause of late life brain failure,” says Gandy. “In about 3 percent of the cases it’s completely genetic and in those cases we are sure that the genes that are causing the disease had to do with the buildup in the brain of this gooey material which clumps and forms plaque called amyloid.”

As he points out, the pathology is identical and it looks just the same in the clinic and under the microscope but while the final common pathway is the same, researchers can’t be absolutely sure until they are able to develop an effective way of getting rid of amyloid.

Indeed, the good news is that many trials are being conducted, and among the most exciting are the ones which are aimed at preventing amyloids from building up or helping the brain to clear amyloids away. Gandy says there are three types of anti-amyloid drugs that are being tested. The first type of intervention is not really a drug but a vaccine so it is possible to either vaccinate people with the amyloid protein to make their own antibodies or else to make the antibodies in the laboratories and infuse them periodically, like chemotherapy.

The second type are plaque busters and involve medicine that keeps the amyloids from clumping, and the third is enzyme modulators which target enzymes called secretases; these enzymes make amyloid and some of them break amyloids down so the drugs either turn up the good pathway and cause amyloids to be broken down or they block the bad pathways and prevent amyloids from ever forming.

When can one see the results from these trials? According to Gandy, the results are starting to come through: the first plaque buster which was tested last year unfortunately failed, but progress is expected this year with the vaccine and one of the secretases modulators, a drug called Florizan.

“All of the drugs that are being developed for amyloids are totally unlike any other drugs that have been developed before,” says Gandy. “We’ve never tried to develop a way before to prevent amyloids from forming. So this is all very new territory.”

Asked about tests for Alzheimer’s, Gandy mentioned that the best way is still by basically undergoing a psychological test to see how the brain is functioning but new tests are on the horizon, brain scans that allow you to visualize Amyloid buildup.

He says, “ We hope that those will be available in a couple of years: until now we have been able to confirm the diagnosis of Alzheimer’s after death but if these scans hold up and are validated we will be able to potentially confirm the diagnosis during life and that will be a big help.

The scans will certainly tell us about the amyloids and we know that amyloid buildup is always part of the problem – we are not sure if sometimes there’s another process also going on that is both poisonous to nerve cells and gives off amyloids as a side reaction or side product. That’s the sort of alternative models we are investigating. We know amyloids play a role but we just can’t be absolutely sure if amyloids are the only thing going on.”

Researchers may be wrapped up in statistics and tests but often Alzheimer’s hits them on a personal level too. “It’s a very tragic disease – I’ve seen it not only as a scientist and a physician but as a family member,” says Gandy. “My father’s mother died of a dementing disease – probably Alzheimer’s – and I spent much of my life just watching her sort of slowly disappear. Even at the very beginning she lost the ability to recognize us and for 15 years we visited her every Sunday afternoon – and she had no idea we were there.”

The individual and the universal mix in this devastating disease and unless checked, Alzheimer’s could become the healthcare crisis of the 21^st century. Researchers led by Ron Brookmeyer, PhD, Professor of Biostatistics and Chair of the Master of Public Health Program at The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, have created a multi-state mathematical computer model, using United Nations’ worldwide population forecasts and data on the incidence and mortality of Alzheimer’s. It is estimated that by delaying Alzheimer’s disease onset by one year the number of Alzheimer’s cases in 2050 could be reduced by 12 million.

“A global epidemic of Alzheimer’s disease is coming,” Brookmeyer says. “However, even modest advances in preventing Alzheimer’s or delaying its progression can have a huge global public health impact.”

Dr. Gandy paints a hopeful picture for the future: “We are developing these new medicines which we think will actually slow the progression and target the underlying genes and pathology. Most of what we know about the disease we’ve learnt in the last 20 years and just these genetic discoveries alone have made it possible for us for the first time to develop an animal with a model of Alzheimer’s on which we can test drugs.

Until 13 years ago there was no animal model of Alzheimer’s and we were just testing on models that were very remote. Now it’s possible to take a human Alzheimer’s gene and put it in a mouse, and the mouse will develop in its brain Alzheimer’s pathology and that’s how we test these medicines before we test them on people.”

© Lavina Melwani

Graphics and photo of Dr. Sam Gandy:  The Alzheimer’s Association.

THREE WHO ARE FINDING A CURE

A coalition of leading Alzheimer’s disease organizations announced the first three recipients of “Tomorrow’s Leaders in Alzheimer’s Disease Research” prizes; a new award mechanism to recognize outstanding young scientists in Alzheimer’s and dementia research.

Sterling C. Johnson, Ph.D. – Associate Professor of Medicine at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and Research Scientist, GRECC, William S. Middleton Memorial Veterans Hospital, Madison. His research uses brain imaging in conjunction with neuropsychological measurement to study cognitive disorders of memory and self-awareness.

Dora Marta Kovacs, Ph.D. – Associate Professor of Neurology at Harvard Medical School, Boston, Massachusetts, and Associate Neuroscientist, Neurology Service, Massachusetts General Hospital, Boston. Her research focuses on the molecular events underlying neurodegeneration in Alzheimer’s disease.

James J. Lah, M.D., Ph.D. – Associate Professor in the Department of Neurology, Clinical Core Leader of the Alzheimer’s Disease Research Center, and Investigator in the Center for Neurodegenerative Disease at Emory University School of Medicine, Atlanta, Georgia. His research is driven by the goal of understanding basic, disease-causing mechanisms to improve the care of individuals with neurodegenerative disorders.

(Source: Alzheimer’s Association)

]]> http://www.lassiwithlavina.com/health/the-riddle-of-alzheimer%e2%80%99s/html/feed 0 http://www.lassiwithlavina.com/health/take-that-cancer/html http://www.lassiwithlavina.com/health/take-that-cancer/html#comments Wed, 26 Aug 2009 01:40:03 +0000 Lavina Melwani http://www.lassiwithlavina.com/?p=672 Acupuncture, Reiki and hypnosis are some of the unconventional new weapons in the war against cancer…

Can acupuncture really alleviate the painful symptoms of cancer? Can massage therapy grant therapeutic balm to those whose bodies have been ravaged by radiation? And can exercise really increase your chances of bypassing cancer?

Meet Sarah, a breast cancer survivor, who has suffered from extreme fatigue after numerous chemotherapies. Yet after just three acupuncture sessions, she feels a remarkable surge in her energy level, going from 4 to 8 on a scale of one to ten.

Then there’s Tom, a neck cancer patient who has suffered from xerostomia or dry mouth after the radiation treatments which destroy salivary cells, and can neither neither eat nor speak properly – he too has turned to acupuncture for some powerfully good results.

Sarah and Tom (names have been changed) are just two among thousands who are waging the battle against cancer symptoms with many unlikely and unconventional tools – be it acupuncture, Reiki, hypnosis, music therapy, massage, yoga and meditation, or aerobics.

A decade ago, a physician who suggested any of these therapies to alleviate the symptoms of cancer would probably have been looked upon as a quack. Yet today these are some of the cutting edge solutions which are being researched and practiced at no less an institution than Memorial Sloan-Kettering Cancer Center in New York, which is considered the gold standard in cancer care.

While the hospital is world-class and known internationally for its crusading work in cancer care, the Integrative Medicine Service which promotes complementary therapies is less known, a kind of hidden asset.

The Bendheim Integrative Medicine Center is on 1^st Avenue and 74^th Street, about six blocks from the main hospital, a temple of tranquility with lots of greenery. This spa-like center was set up in 1999 and today sees over 20,000 people a year, offering patients and survivors an improved quality of life through unconventional methods.

“I think we are in a very new era of cancer care where we are able to cure people, and many millions of patients around the world are now cured of cancer or are at least in long term remission,” says Barrie Cassileth, PhD, Chief, and Integrative Medicine Service at MSKCC. “There are many concerns these survivors have and also many enduring symptoms, for these cancer treatments – because they are so successful- are also very difficult and often produce serious side effects and problems.”

Cassileth, who has worked in integrative medicine and studied the psycho-social aspects of cancer for more than 25 years, came to MSKCC to create this new center. “I found that cancer patients were using a wide array of therapies on their own, some ineffective and potentially harmful, others very helpful,” she says.

“My research, clinical activities, and policy efforts since that time have aimed to alert patients and oncology professionals to the sometimes useless or harmful therapies promoted incorrectly as viable cancer ‘treatments,’ and to ensure that complementary therapies are studied with appropriate scientific rigor and are available to patients as adjunctive care for the control of physical and emotional symptoms.”

Integrative medicine is a synthesis of topnotch cancer treatment plus attention to symptoms using complementary therapies, which are, as Cassileth points out, non-pharmacological and rational, and can provide symptom relief and control of many toxicities associated with cancer that are otherwise not manageable.

Indeed, this is a new field but is growing not only in the US but also in Australia, Western Europe, Japan and China. She says, “It’s becoming a worldwide activity based on the recognition that cancer care must include attention to the symptoms that patients suffer from and which really have to be managed.” Asked if Integrative Medicine was becoming a part of cancer care in India, she said, “In India, to my knowledge, there is not a formalized effort to bring these modalities into the mainstream cancer treatment context.”

While many hospitals in the US are now offering education or some therapies or even doing research on Integrative therapies, this center remains the most complete with a full-blown program encompassing inpatient and out patient care, training for therapists and also cutting edge research and clinical trials studying the effects of such unconventional therapies.

Cassileth, who is the founding President of the International Society for Integrative Oncology, is the principal investigator of several research studies funded by the National Institutes of Health and also heads one of five NIH-supported Botanical Research Centers.

Jyothirmai Gubili, MS , Assistant Editor at the Integrative Medicine Service works on About Herbs, the website about herbs, botanicals and other products and their effects on cancer patients (http://www.mskcc.org/aboutherbs)

“A lot of cancer patients take dietary supplements and herbs and we often have questions from oncologists as to the true effectiveness of these herbal medicines and supplements,” she says. “Traditionally herbs have been used around the world in many civilizations for medicinal use but specifically for cancer there isn’t much evidence, and that’s the key issue here. Many patients aren’t aware that herbs have active compounds and can interfere with medication.”

Take turmeric, for instance: In vitro studies indicate inhibition of cytochrome P450 1A1, which may result in increased blood levels of certain medications. Garlic may induce the cytochrome p450 3A4 isoenzyme, resulting in enhanced metabolism (and decreased effectiveness) of certain drugs.

Herbs are investigated at the Botanical Research Center for their anti-tumor potential for which it received a grant and collaborates with Cornell University and the Institute of Chinese Medicines in Hong Kong. Many laboratory studies and clinic trials are underway, looking at botanical agents, usually compounds from China. As Cassileth points out, the botanicals from India are not being researched as Ayurvedic compounds contain hundreds of different constituents and it’s virtually impossible to study them.

The center works in clinical research and lab investigation trials within many departments of Sloan Kettering. According to Cassileth, “We are looking for something that can enhance the benefits of chemotherapy or surgery or radiation therapy .in treating cancer. We focus on botanicals that have the ability to enhance immune functions in positive ways so they give an extra boost to the person’s own body in fighting the cancer.”

There have been several studies underway for years at the center on various botanicals but there is special interest in medicinal mushroom extracts. As she explains it, these have the ability to change immune functions in the body and there is ongoing research to determine the interaction.

The center offers Mind Body therapies, massage, meditation, hypnosis, yoga, Reiki, acupuncture, and music therapy as well as physical fitness and exercise programs.

“It was a taboo until a few years ago for a cancer patient or survivor to get out of the chair and exercise but recent studies have shown that exercise can help patients improve their quality of life,” says Gubili, who is from Hyderabad.

Tara, a breast cancer survivor who joined the exercise regimen reported increased strength and flexibility and also lost the excess weight she had gained following the radiation treatments. The fitness expert not only offered counseling but tailored the program to her needs.

The benefits of these varied therapies are that pain, nausea and insomnia are decreased and patients are more relaxed during procedures and treatments. They are able to cope with anxiety, stress and depression and the traumas of changes in their body and lifestyle, such as amputation or loss of hair.

“Patients tell us all the time that they never could have gotten through their cancer treatments without the therapies we offer,” says Cassileth. Many are able to reduce their intake of pain medication with the help of meditation and massage which can alleviate muscle dysfunction.

Acupuncture has been particularly helpful for patients who have dry mouth, caused by radiation which destroys the salivary glands. “Their lives are really ruined and there’s no way to treat this and patients are immobilized. Acupuncture, however, works in many cases and it’s a remarkable life change. For the first time patients, sometimes in years, are able to talk and eat properly because we are able to bring back salivation with acupuncture.”

Indeed, new data from a randomized, controlled trial at the center found that acupuncture provided significant reductions in pain, dysfunction, and dry mouth in head and neck cancer patients after neck dissection. Seventy patients at the center participated in the study and were randomized to receive either acupuncture or usual care, which includes recommendations of physical therapy exercises and the use of anti-inflammatory drugs.

The treatment group received four sessions of acupuncture over the course of approximately four weeks. Both groups were evaluated using the Constant-Murley scale, a composite measure of pain, function, and activities of daily living. Pain and mobility improved in 39 percent of the patients receiving acupuncture, compared to a 7 percent improvement in the group that received usual care. An added benefit of acupuncture was significant reduction of reported xerostomia, or extreme dry mouth.

Cassileth believes integrative medicine helps patients and survivors alike: “Neuropathic problems or extreme dry mouth can endure for years or decades and sometimes for the patient’s entire life. These cannot be treated by mainstream medicine – we can treat them.”

She also underscores the role of physical activity as being crucial, from bed yoga to chair aerobics to more active exercises. “Fitness is probably the only therapy where we directly impact survival. Any cancer patient should walk 20 minutes a day briskly and that actually increases the chances of survival by 50 percent. The results are very dramatic – it’s more than any chemotherapy.”

Integrative Medicine, while not curing cancer in any way, can help in even advanced metastasis by bringing about symptoms relief, and giving patients a more positive attitude. Says Gubili: “It’s about getting patients to express themselves creatively. And I think that helps – you’re still alive and the goal is to help you with the illness you’re going through.”

Sarah, in her 20’s, was terminally ill with leukemia. Being so young, she fell into a deep depression, becoming withdrawn and uncommunicative, even with her own family. She had loved playing the guitar and piano but had given it all up as the disease progressed. Music therapy was the answer; the therapist brought in the guitar and a keyboard and as they played her favorite songs, the smile came back to her lips and in the final days, music helped the family to come together again.

Our Kids Kicking Cancer Program

Black belt martial art instructors empower young patients to partner in their healing – physically, spiritually and emotionally. Martial arts moves are accompanied by imagery, meditation and breathing techniques that teach how to push away pain, fear and anger. Patients are taught to develop the true inner power that is the focus of this ancient art. Sessions are offered in group and individual settings at bedside. Karate forms are developed to maximize the potential of each student so that he or she can use these techniques wherever and whenever needed the most.

Source: MSKCC.

FACTS ABOUT HERBS

The Integrative Medicine Service’s Web site, About Herbs, offers evidence-based information about herbs, vitamins, and unproved cancer treatments at no charge to professionals and the public.
In most cases, it is not advisable to use herbs for children or for pregnant or breast-feeding women. All herbs and other supplements should be stopped about one week before surgery because they may interact with anesthesia or interfere with normal clotting. There is a great need for patient education in this matter because improper use, chronic usage or overdose of many botanicals and supplements can result in adverse reactions.

Source: MSKCC

Text© Lavina Melwani

Photo credit: MSKCC

For most of us, doing just one thing imperfectly well in life is a major challenge. And then you have Dr. Atul Gawande who does many things – and does them all perfectly well. Surgeon, writer and professor – he has searched for excellence in all these roles and often achieved it.

To look at his resume is to wonder if it’s the resume of just one man – or several!

Just listen to this: Gawande is a staff member of Brigham and Women’s Hospital, the Dana Farber Cancer Institute – and the New Yorker magazine! He is also Assistant Professor of Surgery at Harvard Medical School, Assistant Professor in the Department of Health Policy and Management at the Harvard School of Public Health, and Associate Director for the BWH Center for Surgery and Public Health. He has published research studies in areas ranging from surgical technique to US military care for the wounded, to error and performance in medicine. He is the director of the World Health Organization’s Global Challenge for Safer Surgical Care.

When he was in his 30’s, he became a senior health policy advisor in the Clinton presidential campaign and White House from 1992 to 1993. In 1998 he became a staff writer for the prestigious New Yorker magazine and in 2003 he completed his surgical residency at Brigham and Women’s Hospital, Boston, and joined the faculty as a general and endocrine surgeon. And on top of all that he is also a dad! He and his wife Kathleen Hobson are the parents of three – Walker, Hattie, and Hunter. All this achieved by the age of 40!

Gawande, who grew up in Ohio, is himself the son of two physicians: his father is an urologist and his mother a pediatrician. He received his B.A.S. from Stanford University, and M.A.in politics, philosophy, and economics from Oxford University, He then went on to get his M.D. from Harvard Medical School, and M.P.H. from the Harvard School of Public Health.

No surprise then that in 2006 he received the MacArthur ‘Genius’ Award for his research and writing. In fact he’s written not only for the New Yorker but other topnotch publications like Slate and the New York Times. His writings have appeared in the annual Best American Essays and in Best American Science collections.

Atul Gawande is one physician who has always delved deep into his profession to examine it with an unbiased eye – warts and all. His first book, written while he was a resident, ‘Complications: A Surgeon’s Notes on an imperfect Science’ turned the spotlight on a resident’s life and became a finalist for the National Book Award in 2002 and was published in more than a hundred countries.

“It was written from the perspective of someone who was just starting out in medicine,” he recalls. “I was trying to understand in that set of stories how and why medicine is imperfect and if medicine is imperfect, how do we become remotely competent?”

And now as his journey into the medical world has continued, he’s written ‘Better: A Surgeon’s Notes on Performance.’ A throng had gathered in a book store in Manhattan to hear him read – his fan base is huge for the concerns he raises are on everyone’s minds.

“Over the last few years I’ve been trying to answer a slightly different set of questions,” the tall, lanky Gawande says. “I feel I may be competent at what I do but there’s a slightly harder question: what’s the difference between those who are merely competent and those who are good? What makes medicine particularly interesting is that failure is so easy – it’s right around the corner.”

Indeed, he has not only written about the possibilities of errors and human failures in medicine, but has also worked to bring about real-life changes. .  Through initiatives at the Center for Surgery and Public Health at Brigham and Women’s Hospital, Gawande is working to improve medical practice.

Among his innovations are bar codes to prevent surgeons from accidentally leaving sponges and instruments in patients He says: “For the last eight years, my research agenda has focused on making advances in two areas: understanding and ultimately reducing injuries from error in surgery; and improving policies affecting the provision of surgical and medical care. More recently my work has expanded to address questions in global health–in particular, how to meet the growing demand for care for surgical diseases in poorer countries.”

‘Better’ is all about going that extra mile, of crossing the chasm from average to being the best possible, and indeed the book is not just for physicians but for anyone who struggles to do better, to search for excellence.

He says about researching that book, “The first thing I found was that it wasn’t how smart people at the top of their game were – they weren’t geniuses or smarter than anyone else – instead what they tended to have is a capacity to look for fallibility in themselves, in others and in the system around them and then to try to find ways to overcome that fallibility.

“One of the things we find difficult to acknowledge is that in medicine there is a bell curve –that there is a spread between the bottom and the top in our profession – that most of us were not in fact at the top but right there in the mediocre middle.”

‘Better’ is full of fascinating stories – from emergency rooms in America to rural village hospitals in India to the killing fields of Iraq where military surgeons are fighting tremendous odds to save soldiers who have burns over almost hundred percent of their bodies or three limbs blown away.

“We have no idea whether it is possible to live a good life with no arms and only one leg. But we don’t want the doctors to give up. Instead, we want them to consider it their task to learn how to rehabilitate survivors despite the unprecedented severity of their injuries. We want doctors to push and find a way.”

He tells of how a doctor’s persistence can have wonderful results even in mundane situations: his own 10-year-old daughter Hattie suffered from psoriasis and the doctor had continuously given her steroid creams and medications, to no avail. She would just have to live with the situation, until she outgrew it. Yet along came another doctor who took the challenge and tried something new: he put her on an ordinary antibiotic which did not work on adults but sometimes did on children – in two weeks, her scaly patches were gone.

“The seemingly easiest and most sensible rule for a doctor to follow is: Always Fight,” he says. “Always look for what more you could do. I am sympathetic to this rule. It gives us our best chance of avoiding the worst error of all – giving up on someone we could have helped.”

In ‘Better’ he tries to analyze what makes a doctor fight the odds and get better results. Why is it that at an average hospital center you have a 33 year life expectancy while some of the best centers give you a chance of a 47 year life expectancy? Can one take the know-how that exists at the top of the bell curve and take it elsewhere?

In the old days it was different but in today’s medical world there are just so many possibilities to beat the odds. “We are in a situation where we have 6600 different drugs available to us, we have hundreds of ways we could go about making a diagnosis and thousands of possible treatments,” he says. “What you come to then is a realization that for all our technology and science and know-how, it’s all become more human because the decisions we make when it’s one doctor and one patient sitting down, the smallest choices can make a world of difference. There’s the possibility to do better for people and as a result there is a possibility to do worse.”

Indeed, for anyone in any job, the self-doubt is there. To the large crowd listening to him spellbound, Gawande said rhetorically, “What if I turn out to be average? If I was one of the worst, the answer would be easy – I’d turn in my scalpel. But what if I am a B, working as I do in a city which is mobbed with surgeons? How could I justify putting patients under the knife?

“I could tell myself – someone’s got to be average. If the bell curve is a fact then so is the reality that most doctors are going to be average – there’s no shame in being one of them, right?

Except of course there is.

What’s troubling is not being average but settling for it. Everyone knows that average-ness for the most part is our fate. And in certain matters – looks, money, and tennis – we would do well to accept this. But in your surgeon, your child’s pediatrician, your police department, your local high school – when the stakes are our lives and the lives of our children – we want no one to settle for average.”

So what can a physician do? As Gawande points out, few get grand chances to plan a polio vaccination for 4.2 million children in southern India or create innovative ways to save soldiers in Iraq. So what’s the role of a doctor in the larger scheme of things, what difference can one individual make?

“No doctor wants to believe the he or she is a bit player, though. After all, doctors are given the power to prescribe more than 6600 potentially dangerous drugs. We are permitted to open human beings up like melons. Soon we will even be allowed to manipulate their DNA.”

Yet the reality is that each doctor is just a cog in machine. In his book, Gawande suggests ways in which physicians can make a difference, and be a ‘positive deviant.’ One suggestion is ‘write something.’ “For all its complexity, medicine is more physically than intellectually taxing. Because medicine is a retail enterprise, because doctors provide their services to one person after another, it can be a grind. You can lose your larger sense of purpose. But writing lets you step back and think through a problem. Even the angriest rant forces the writer to achieve a degree of thoughtfulness.”

‘Change’ is another one of his mantras for he feels physicians should not take the safer, easier course but try to seek out solutions: “As successful as medicine is, it remains replete with uncertainties and failure. This is what makes it human, at times painful, and also so worthwhile.”

To the large and anxious crowd at his reading, who wanted to know what they could do as patients, he smiled and empowered them too: “You get into the plane, is there anything you can do about the people in the cockpit? Turns out you can!”

He urged them to ask questions, overcome medication errors by bringing along their medicines for clarification, and always know what they were signing for. His parting words, “Never leave a sick person alone. Hospitals don’t make it easy – there’s no hotel room, no room service for you, but don’t leave a sick family member alone – you can make a difference just by being the glue to communicate for them. You are not there to challenge but to be a huge resource for the patient who’s faced with different doctors and nurses morning and evening.”

(C) Lavina Melwani