मौका अच्छा है

ज़िंदगी थम सी गई है । 

पहले  वाले  सुहावने  दिनों  ने कह  दिया  है  बाय- बाय  !!!

अब  तो  घर  के  चहुँ  ओर लक्ष्मण- रेखा है,  

पांव  बढ़ाया नहीं  कि रावण  का  ख्याल आता है ।

            ***

अब  आते हैं  वो  दिन याद, जब  हमें  केश- कर्तनालय 

में  " चंदू- नाई" द्वारा प्रवचित  दिव्य-ग्यान  प्राप्त होता था । 

'चुनावी माहौल'  से लेकर सचिन की बल्लेबाजी, 'पप्पु के जोक्स' से लेकर 'मोदीजी' के राजनैतिक फैसलों की व्याख्या,वह चुटकी बजाते कर लेता था । 

" चंदू- नाई" की विद्याभंडार और विभिन्न दर्शनग्राही चाह देखकर तो हम केशकर्तन ग्राहकगण दातों तले उँगली दबाते रह जाते हैं ।

" चंदू- नाई" की ज्ञान-परिधि असीमित है । अपने ज्ञान बंटन के मध्य  ज़नाब अपने उस्तरे को विश्राम देते हैं, तत्पश्चात वे अपने जेब से प्लास्टिक की एक पुड़िया निकालकर उसके अंदर रखे खैनी को बाएं हाथ में लेकर एक चमचमाती डिबिया 

दूसरे जेब से निकालते हैं।डिबिया में रखे सफेद चुना लेकर खैनी को अपने अंगूठे से अच्छी 

तरहा मसलते हैं, फिर दो तीन बार धमाधम दूसरी हथेली से खैनी को ठोकते हुए  बाएं हथेली के दो उँगली से अपने निचले होंठ को 

दबाकर दाहिने हाथ में रखे खैनीचूना मिश्रण को मुख में अर्पण करते हैं ।कुछ देर में उनके मुख पर एक अजीब सी दिव्य आभा मंडराती है,  हमें 

ज्ञात हो जाता है कि उनके मस्तिष्क में विचार तरंगों को फिर से गति 

मिल गई है ।उनके ज्ञान सागर में लहरें पुन: ज्वारभाटा की तरह उछल रहीं हैं। 

अब ज़नाब फिर से अपना व्याख्यान आरंभ कर देते हैं।

अब की बार शब्द मुख में स्थित खैनी से छनकर निकलते हैं और 

कर्तनालय में मौजूद हम सभी अज्ञानी श्रोतागण  फिर से  मंत्रमुग्ध हो "चंदुलाल"  की वाणी का श्रवण करते हुए ज्ञानसागर में गोता 

लगाने लगते हैं ।

कोई भी व्याख्यान में खलल डाले 'चंदुभैया' को यह कतई ना भाता है । उसके मुताबिक इससे उसका लिंक टूट जाता है।फिर भी हमने एक दिन हिम्मत कर पूछ ही लिया, 

" चंदू भैय्या,आप यह खैनी खाना बंद क्यों नहीं कर देते?"

" चंदू- नाई"  ने तपाक् से जवाब दिया, " क्यूं बंद करें? "

हमने कहा, " आईना देखो ।"

अब केश कर्तनालय में तो आईनों की कमी नहीं, जिधर देखो,  उधरआईना । 

" चंदू- नाई"  ने आईने में झांका ।माथा देखा,  आँखें देखी,  गाल देखे,  ठुठनी भी देखी, केश भी देखे, फिर कहा, "क्यूं, सब  ठीक ही तो है।"

हमने कहा, "चंदू  भैय्या,  अपना मुख तो खोलिए"

" लो खोला"

"अब अपनी दंतावली देखिए"।

"देख लिया"

"क्या देखा? "

"कुछ गलत नहीं, सब कुछ सही है", चंदुलाल ने भरोसे से कहा ।

"आपकी दंतावली देखिए महाराज,  सफेद दांत घिस- घिस कर पीले और कत्थई रंग के हो गए हैं"।

" चंदू- नाई"  का दिमाग चकराया, उसने अपने दांत तो देखे थे, 

लेकिन ख्याल नहीं किया था कि इतने घिस गए ।

रुंऑसे सूरत से कहा, " अब का करें डाक्साब"।

अब आया ऊंट पहाड़ के नीचे, मैंने सोचा ।अब दर्शन शास्त्र में गोता लगाने की बारी मेरी थी ।

उत्साहित होकर कहा "दांत ही नहीं खराब होते,चंदू भैय्या,     मुख में कर्क रोग भी हो सकता है ।"

"ये करक रोग का होत है, डाक्साब ? "

"कर्क रोग यानी कैन्सर"

जन साधारण आज हिंदी से ज्यादा अंग्रेजी समझता है ।अब मेरी बात  चंदू- नाई  के पल्ले पड़ी ।

"कैन्सर !"

"हां,  कैन्सर । मुख का कैन्सर, गले का कैंसर,  अन्न नली का कैंसर और जो धुम्रपान करते हैं,  उनको फुफ्फुसीय यानी छाती का कैंसर ।"

"लेकिन का करें डाक्साब,  मुंआ ये आदत ही ना छुटे ।"  चंदू- नाई  अपना भरोसा खो चुका था ।

"धीरज से और मन की शक्ति से काम लोगे,  तब ना छुटेगा,  ये 

मुंआ गंदा आदत," मैंने कहा।

             ****

" कॉरोना" के चलते आज जब सभी पान की दुकानें बंद हैं,  तमाकू मिलना दुर्लभ है ।अब का रोना,  यानी काहे को रोना? मौका तो अच्छा है,  ये गंदा आदत त्याग कर दो ।

आप सब सुधी लोगों से भी हाथ जोड़ विनति है, सुध में आएं,  

तमाकू,  खैनी,  पाऊच, पान, धुम्रपान, और हां, मदिरा पान भी छोड़ दें,  दंतावली चमकेगी, कैंसर का पीछा छुटेगा, घर बरबाद होने से 

बचेगा । 

"कॉरोना के लॉकडाऊन" का फायदा तो उठाएं |

               ***

मौका वाकई में अच्छा है ।

Kidney problems in females

On International women’s day 

Kidney problems are common in females. In addition to the usual kidney problems that can affect males, females face some problems unique to them.

Urinary Infections 

Anatomically females are placed in a disadvantage because of short length of urethra. Infections are very common in married women. The best way to prevent infections is to void urine immediately after sexual contact. Plenty of fluid intake also help in preventing urine infections.

Female hormones have protective effect against infections , these make vaginal secretions acidic which do not allow infections to persist. After menopause, protective effects of these hormones are lost and so infections are more common post-menopause.  

Effect of contraceptive Pills  

Long term use of contraceptive pills tend to increase blood pressure and also tend to increase risk of blood clotting. If neglected these may turn serious.

Females tend to take pain killer drugs on and off for body aches which damage kidneys over a period of time and cause CKD which is irreversible. This is potentially avoidable cause of kidney failure. Smoking, use of pills and drug abuse are on the rise  among urban college going girls which puts them to the risk of high blood pressure and kidney disease. 

 Pregnancy related urinary problems

Urine infections in pregnancy affect growth of fetus and increase chance of spontaneous abortions. So these should be treated early and effectively.

Few decades back, unwanted pregnancies were terminated  by quacks which used to cause sepsis and complications like kidney failure. With legalization of abortions, septic abortion are less common in India though stray incidences do happen.

Association of leakage of protein in urine and high blood pressure is labeled as Pre-eclampsia. If it is associated with fits (seizures) its called as eclampsia. 

HELLP syndrome is exclusively seen in pregnancy, this is characterized by jaundice, anemia and low platelet count. These are very serious disorders and need hospitalization and close supervision as these may damage kidneys and may be life threatening both to the fetus and mother. 

During pregnancy, all women should have their blood pressure checked and urine examined. In the second trimester of pregnancy, blood pressure tend to be lower. Any pregnant women with high blood pressure or protein in urine must consult a doctor immediately to prevent avoidable complications. 

Female genital tract is close to urinary bladder and ureters. Malignancy of female genital tract can easily spread to involve urinary bladder and ureters causing obstruction to urine flow affecting one or both kidneys. Similarly prolapse of uterus can cause pulling of ureters and cause damage to kidneys by obstructing urine flow.

Lupus is a disease which affects young females much more than males. In fact 9 out of 10 persons suffering from lupus are females. This is a disease in which our own body produce proteins  which damage our own tissues. These proteins are called antibodies (because they act against our own body). This is characterized by hair loss, joint pains and skin rash. But lupus is most dangerous if it affects kidneys. There is leakage of protein in urine, increase in blood pressure and often leads to kidney failure. It may be devastating for females. Pregnancy can increase lupus manifestations.

Females with chronic kidney disease (CKD) tend to have high blood pressure, swelling of body, appetite loss, nausea , vomiting, itching, bony pains, menstrual irregularity etc. Pregnancy is rare in females with CKD. 

Obesity is common among urban females due to life style changes. Junk food, high calorie drinks, modern gadgets, dependane on mobiles and television associated with lack of exercise cause obesity. This increases risk of diabetes. Both obesity and diabetes are associated with chronic kidney disease. 

In this International women’s day, besides the social aspects attention must be paid to women’s health. Women and child health go hand in hand. Healthy mother means healthy child. Women need good nutrition, adequate rest, easily available ante-natal care and well equipped health centers with well trained staffs and round the clock emergency facilities. Timely interventions and health education can prevent kidney diseases.

Kidney Problems in females

On International women’s day 

Kidney problems are common in females. In addition to the usual kidney problems that can affect males, females face some problems unique to them.

Urinary Infections 

Anatomically females are placed in a disadvantage because of short length of urethra. Infections are very common in married women. The best way to prevent infections is to void urine immediately after sexual contact. Plenty of fluid intake also help in preventing urine infections.

Female hormones have protective effect against infections , these make vaginal secretions acidic which do not allow infections to persist. After menopause, protective effects of these hormones are lost and so infections are more common post-menopause.  

Effect of contraceptive Pills  

Long term use of contraceptive pills tend to increase blood pressure and also tend to increase risk of blood clotting. If neglected these may turn serious.

Females tend to take pain killer drugs on and off for body aches which damage kidneys over a period of time and cause CKD which is irreversible. This is potentially avoidable cause of kidney failure. Smoking, use of pills and drug abuse are on the rise  among urban college going girls which puts them to the risk of high blood pressure and kidney disease. 

 Pregnancy related urinary problems

Urine infections in pregnancy affect growth of fetus and increase chance of spontaneous abortions. So these should be treated early and effectively.

Few decades back, unwanted pregnancies were terminated  by quacks which used to cause sepsis and complications like kidney failure. With legalization of abortions, septic abortion are less common in India though stray incidences do happen.

Association of leakage of protein in urine and high blood pressure is labeled as Pre-eclampsia. If it is associated with fits (seizures) its called as eclampsia. 

HELLP syndrome is exclusively seen in pregnancy, this is characterized by jaundice, anemia and low platelet count. These are very serious disorders and need hospitalization and close supervision as these may damage kidneys and may be life threatening both to the fetus and mother. 

During pregnancy, all women should have their blood pressure checked and urine examined. In the second trimester of pregnancy, blood pressure tend to be lower. Any pregnant women with high blood pressure or protein in urine must consult a doctor immediately to prevent avoidable complications. 

Female genital tract is close to urinary bladder and ureters. Malignancy of female genital tract can easily spread to involve urinary bladder and ureters causing obstruction to urine flow affecting one or both kidneys. Similarly prolapse of uterus can cause pulling of ureters and cause damage to kidneys by obstructing urine flow.

Lupus is a disease which affects young females much more than males. In fact 9 out of 10 persons suffering from lupus are females. This is a disease in which our own body produce proteins  which damage our own tissues. These proteins are called antibodies (because they act against our own body). This is characterized by hair loss, joint pains and skin rash. But lupus is most dangerous if it affects kidneys. There is leakage of protein in urine, increase in blood pressure and often leads to kidney failure. It may be devastating for females. Pregnancy can increase lupus manifestations.

Females with chronic kidney disease (CKD) tend to have high blood pressure, swelling of body, appetite loss, nausea , vomiting, itching, bony pains, menstrual irregularity etc. Pregnancy is rare in females with CKD. 

Obesity is common among urban females due to life style changes. Junk food, high calorie drinks, modern gadgets, dependane on mobiles and television associated with lack of exercise cause obesity. This increases risk of diabetes. Both obesity and diabetes are associated with chronic kidney disease. 

In this International women’s day, besides the social aspects attention must be paid to women’s health. Women and child health go hand in hand. Healthy mother means healthy child. Women need good nutrition, adequate rest, easily available ante-natal care and well equipped health centers with well trained staffs and round the clock emergency facilities. Timely interventions and health education can prevent kidney diseases.

On occasion of WORLD KIDNEY DAY

Shed weight, be slim and enjoy life !!

Obesity is not a disease. It is a lifestyle affliction. It is a symptom. It is a side-effect of poor habits and it can be reversed.

Risks associated with Obesity

Obesity is an excess of body fat resulting in a significant impairment of health and longevity . Obesity is dangerous .  Diabetes , hypertension , heart disease , arthritis , liver disease , cancers , psychological and sleep disorders  are associated with obesity . Chronic kidney disease is three times more common in obese individual. Obesity is also associated with kidney stone and cancer of kidneys . Mortality is higher among obese people .

What cause Obesity

In a study conducted covering  many schools in Delhi,  children of different socio economic groups , 24.4 % children were found to be  obese in private schools while only 1.5% of children in government schools were obese . This indicates that children of affluent society are prone for obesity . Why is it so ? Childhood obesity is best tackled at home through improved parental involvement, increased physical exercise, better diet and restraint from eating. 

Whatever we eat gives us energy  or calories. Different foodstuff has different energy value , for example 100 grams of cucumber has 15  calories but 100 gms of jalebi has 300  Calories.  Also once ingested , Jalebi gives instant energy while cucumber  takes more time to get assimilated .

We spend this energy in  two ways – one , to maintain  our basic metabolic processes like respiration , heart beat etc  and secondly for activities like walking , running , weight lifting etc . We spend 100 calories for moderate pace walking for an hour .So eating 100 gms  jalebi is equivalent to walking for three hours ! So think of calories before we eat or drink . 

All junk foods like burger , noodles , ready to eat fast foods , samosa are rich in calories .  Alcoholic beverages are also rich in calories , 30 ml of whiskey contain 75 calories.

If we ingest more calories than what we spend , we accumulate that energy in the form of fat.

Body mass index ( BMI )

Body mass index ( BMI ) tells us about our nutritional status ,whether  malnourished or obese . BMI is calculated as weight in kilogram  divided by square of height in meters ( weight / height ² ).  As per WHO , BMI below 18.5 is underweight , 18.5 to 25 normal , 25-30 overweight and more than 30 is obesity . For Asians , more than 25 is considered as obesity .  

Ministry of Health & Family Welfare along with the Indian Council of Medical Research released updated guidelines (in 2012) that a BMI over 23 kg/m2 is considered overweight. Further definitions: Normal BMI: 18.0-22.9 kg/m2, Overweight: 23.0-24.9 kg/m2, Obesity: >25 kg/m2.

Earlier , Obesity used to be a sign of prosperity and limited to affluent class but now we consider it as a sign of  physical inactivity , because obesity is seen even in poor and middle class people.

Excessive food intake and inactivity is main reason for developing obesity. We hardly spend energy if we just relax and watch television. Eating junk food while watching television or playing mobile  games is easiest way in gaining calories i.e. energy.

Obesity leads to diabetes

Obesity is believed to account for 80-85% of the risk of developing type 2 diabetes. Obese people are up to 80 times more likely to develop type 2 diabetes than those with a BMI of less than 22 . 

Adipose cells release ‘pro-inflammatory’ chemicals, which make the body less sensitive to insulin by disrupting the function of insulin responsive cells and their ability to respond to insulin.

This is known as Insulin resistance - the hallmark of type 2 diabetes. 

Obesity leads to Hypertension

Obese persons have enhanced sympathetic tone,  activation of the renin-angiotensin system (RAS), hyperinsulinemia, structural changes in the kidney, and elaboration of adipokines (hormones produced in fat itself) such as leptin. Renal sodium retention also increases. There is activation of the RAS in hypertension with elevations of circulating renin, angiotensinogen, and angiotensin II.

The pressure of fat deposits around the kidneys, coupled with increased abdominal pressure secondary to central obesity, has been suggested as an additional cause of disordered renal sodium reabsorption.

Glomerular  hyperfiltration observed in obesity sets the stage for progressive glomerular loss and loss of renal function and associated increases in arterial pressure.

Hypertension is associated with well-known sequelae, including coronary artery disease, cerebrovascular disease, renal insufficiency, atherosclerosis, left ventricular hypertrophy, atrial fibrillation, and congestive heart failure.

Obesity damages kidneys

Multiple mechanisms have been postulated whereby obesity directly impacts kidney disease including hyperfiltration, increased glomerular capillary wall tension, and podocyte stress .

Kidneys are also damaged due to hypertension and diabetes due to obesity , increased abdominal pressure on kidneys . Atherosclerotic renal artery stenosis is also a potential mechanism.

How to prevent  or control obesity

To reduce obesity , one must control eating food stuffs rich in calories , eat more of fibers , take fiber rich foods more frequently  to keep hunger at bay and also exercise .Walking or cycling for 40 minutes daily for most of the days of a week  is a good habit. This habit should start right from childhood.

The ancient proverb , ‘ breakfast like a king , lunch like a prince and dine like a pauper ’ holds true for all. You can avoid obesity by following this simple rule. But this simple rule is most difficult to follow . Group therapy is the best way to treat obesity. A group of motivated obese people walking together , exercising together and sharing each others food is a nice way to shed weight. This keeps them motivated to loose weight without going into depression .

Once a person starts shedding weight , diabetes and blood pressure get easily controlled , kidney disease comes under control and arthritis can be avoided.

If you wish to enjoy life , just shed few pounds !

Does the Religion prohibit Organ Donation ?

‘ My religion is very simple , my religion is kindness ’- Dalai Lama

All the religions around the world have emphasized on importance of love , charity , sympathy and empathy . Donation of food , alms , cows and  land have been well documented in religious scriptures . The giving of an organ is an opportunity for generosity. The giving of part of one’s body to a person in need is an example of a very high level of generosity.

In Mahabharata , an incidence is mentioned wherein  Karna donated his life-saving Kavach to Indra as the later approached him as Brahmin  in disguise , knowing it  well that this would cause his death in the battle.

No religion is against organ donation. Centuries ago , when the religious scriptures were written , blood or organ donations were not invented but these have become a reality today. So we need to focus on stretching the spirit of donation to organ donation to save lives . The jest of the religious scriptures  is that the saving  of  life  overrides all objections . Organ donation is thus a greatest sacrifice one can do.

There are certain religious groups who believe that the God created them as whole and  they prefer to return to Him as whole. With this belief , many people  bury amputated limbs, foreskin from circumcision ,  amnion and placenta from delivery. This belief also prevent them from organ donation .

In Islam, religious leaders, ‘ustazs’ , ‘ulamas’ and mufti have different interpretations on organ donations , but all agree that holy book Koran does not forbid tissue donation.

‘MUFTI’  are experts in Islamic law qualified to give authoritative legal opinions know as fatwas. Mufti are appointed by government  to deal with Islamic matters. ‘FATWAS’ are religious rulings made by ‘Fatwa Committee’ as official stand by government  on various issues. ‘Fatwa Committee’ chaired by MUFTI includes prominent religious leaders, lawyers, doctors and other members of public. Fatwas are not legal binding. Often these religious leaders have come out with fatwas to donate organs . But  despite Fatwas,  people are often reluctant to donate organs.

A religious practice that often comes in the way of organ donations among different  communities is that a body must  be buried as soon as possible after death – the sooner the better usually less than 8 hours , often because of procedural delays it is not possible. If the officials co-operate then this delay is avoidable.

Christianity promotes organ donation. John Paul II  stated that ‘ We shall receive our supreme reward from God according to the genuine and effective love we have shown to our neighbor ’. Bible  states , “Give, and it will be given to you. A good measure, pressed down, shaken together and running over, will be poured into your lap. For with the measure you use, it will be measured to you.” (Luke 6 : 38).”

The attitude of Buddhism is in perfect agreement with organ and tissue donation; and in Buddhist Scriptures there are stories where donation of tissues have been referred to as an act of charity earning merits . In the Sutra of Golden Light, a Mahayana Sutra, where the Buddha in a previous lifetime (as a young prince) is said to have encountered a starving tigress and her cubs and killed himself in front of her to provide her with food .

What is important for a person at the time of death for a Buddhist is not the condition of their body but of their mind. A state of non-attachment to the body is desirable at this time, and this could be aided by the generosity involved in deciding that one’s body could be used to help others after death.

According to statistics provided by India’s Organ Retrieval Banking Organization, every year 1- 1.5 lakh kidneys are required in the country but only 3,500-4,000 are transplanted. At the same time 15,000-20,000 liver are required every year but only 500 are transplanted. If people donate the organs after death then these shortages will be overcome and many lives can be saved .

We must realize that concept of brain death is the reality today , once a persons’ brain is dead , he or she  ceases to survive .

As I leave this transient world

Let me kindle a ray of hope

In the eyes of those

Who can not see

A breeze of fresh air for those

Who can not breath

An  elixir of life for them

Whose kidneys have failed

Let my heart beat in those

Whose  heart is fluttering to stay alive .

( Author is eminent Kidney Transplant Physician and founder member of Central India Kidney Foundation )

Organ Transplantation

One step forward , two back

This Saturday , the nation shall observe Organ donation day with the aim to spread awareness about organ donation . But over the years it has become a reality that the rosy and flowery words of organ donation has become a thorny and painful path for the doctors who are actually carrying out organ transplantation .

The Government of India wants to promote organ donation and transplantation. They have made laws to see that organ donation and transplantation can be done smoothly without exploiting the poor but they have not safeguarded the doctors.

Every time a kidney racket is exposed doctors are the first to be victimized. 

While it is a well established fact that many patients suffering from organ failure like kidney , liver or heart failure die every day awaiting organs , the very doctors  who make it happen face arrest and humiliation by the hands of authorities. Recently five doctors of a Mumbai hospital have been arrested and put behind bar for alleged unrelated unlawful transplant. 

Story goes like this – a patient suffering from kidney failure comes to a nephrologist with his wife as donor. Nephrologist conducts certain tests and finds wife suitable for kidney donation . He forwards the case to authorization committee who find the relationship of husband and wife as genuine and give permission for transplant. Just prior to transplant , police moved in and arrested the patient , donor and the doctors stating that the lady was not a real wife!

Now the question arises whether a doctor is also responsible for scrutinizing the documents whether these are real or fake ? We doctors are not trained for this .We are not the watch dogs . After spending 18 precious years of our life studying medicine and then building a career by full devotion to the well being of patients over a decade or two , suddenly we face a humiliation and treated as criminals for an offence we have not committed . 

The result of this action by law enforcement authorities is disastrous . As a doctor , our primary responsibility is towards health of our patients , but lately a doctors’ priority has become his  own safety . 

Organ transplant is full of challenges and risk. Like any other major surgery donor nephrectomy has its own risks. The recipient is always at risk …risk during surgery due to suboptimal health, risk after surgery due to post operative problems and of course the effects of drugs  both short term and long term. It is the doctor who accepts  all the challenges and goes ahead just so that the patient gets a good quality of life, just so that the patients can go ahead and enjoy seeing their children grow up and fulfill some of their life’s dream. For a doctor the whole process is very stressful ….before , during and even after surgery.

General perception is that doctors mint money through organ transplantation but is that really true ? Will any doctor go through the stressful process of doing a transplant and caring for the patient and then face the humiliation of being jailed , loose respect , loose the license to practice and destroy his reputation so painstakingly built over years just for money ?

Its time for the lawmakers and implementing authorities to rethink about their approach of insolence of  a devoted professional who is in no way concerned with confirming identity of a donor – a  job to be done by  police  ……..

By harassing doctors , the authorities are in fact harming the organ transplantation program.