Taare Zameen Par

THOMAS ALVA EDISON, inventor of the telephone, microphone, the phonograph and the electric light bulb, was thought to be a dunce at school. He could never learn the alphabet or math; his spelling and grammar were appalling.

Statistics show that about 10 per cent of school going children experience specific learning disability called Dyslexia (dys meaning difficulty and lexia meaning words) The World Federation of Neurology defines Dyslexia as "a disorder manifested by difficulties in learning to read, despite conventional instruction, adequate intelligence and socio-cultural opportunity".

Runs in families

There is evidence to show that Dyslexia runs in the families and is hereditary. A person can also become dyslexic due to external factors like birth trauma, oxygen deprivation or accidents resulting in brain injuries, epilepsy and drugs prescribed for the control of seizures can also cause dyslexia. The degree of dyslexia can range from mild to severe. Children who are mildly dyslexic learn to cope by themselves.

Children who display symptoms of dyslexia are not dull. Constant criticism and failure can affect the children emotionally. They develop low self-esteem and school becomes a stressful place for them. They may even be prone to depression and outbursts of anger. In many cases, it is not just the child who suffers but also the entire family. Parents are upset and angry at the child's non-performance. The child is pushed from school to tuition teacher and failure becomes a part of life.

Parents should accept the fact that the child has a learning disability and take suitable remedial measures. They should not compare the child with other children. They should consult other parents who have faced such pressures and also find out more about the problem.

Teachers also have a role to play in creating a positive environment. A school must have teachers qualified in remedial education to identify and give them help. A teacher who handles 40-50 children in a class will no doubt find it difficult to give individual help during the regular hours, but he/she can certainly try to meet the special needs of these children by giving them some concessions, especially in the primary classes.

Positive atmosphere

Both parents and teachers must try to create a friendly and cordial atmosphere for the children. They must not criticise the children constantly. These children are not lazy or dull. They need to be taught in a special way to bring out their best. They have several strengths. Adults must not give an impression that they are concentrating on the child's weaknesses alone.

Dyslexia can be identified early — by the time the child is five years old. Early identification and intervention is much easier than remedial education in late years. Schools can also adopt appropriate systems of modifications in their evaluation. There is an urgent need to establish learning centres and train more teachers and parents in recognising and dealing with this problem.

What to look for

A student who is dyslexic:

Will answer correctly orally but cannot do so in writing.

Will read "was" as "saw"; "14" as "41"; "91" as "61".

Has difficulty in differentiating the sounds of letters like `p' and `b' or `t' and `d'.

Loses pace while reading and often skips lines.

Draws well but has a very poor handwriting.

Hates spelling and reading

What parents can do

Help the child in the following ways:

To manage time

To put things in their places

To focus attention

To read and do homework

To take the right books to school

Give precise and clear instructions

Do not give punishments for clumsiness, delay in completing work

Give constant positive inputs

Instruct using `do's' rather than `don'ts'

Impart social skills

What teachers can do

Teachers can help in the following ways:

Give less written work

Test children orally

Give marks for content.

Introduce abstract ideas through pictures and objects

Give precise clear, short instructions

Give extra time to finish tests

Do not punish for poor handwriting or messy work

Emphasise quality of work

Avoid punishment for minor misbehaviour

Problem areas

Children with dyslexia may also have problems in areas like organisation, memory, physical coordination, attention and concentration, languages and social behaviour.

Organisation could include find the time, date and year, completing assignments, locating belongings.

Under Memory, the problems could include remembering directions; learning maths, new procedures, alphabets and spellings; identifying letters; remembering names and events.

Physical Coordination includes problems with manipulating small objects; learning self-help skills, cutting, drawing, handwriting, climbing and running and other sports.

Attention and Concentration include problems with completing a task, acting before thinking, restlessness, daydreaming.

Language problems may include pronouncing words, learning new words, following directions, understanding requests, relating stories, responding to questions, reading comprehension.

Social behaviour includes problems with making and keeping friends, impulsive behaviour, accepting changes in routine; interpreting non-verbal clues and working as a team.

DO YOU KNOW WHAT TO EAT ?

A SURGE in energy intakes is evident from our daily food consumption with the focus shifting from meals to snacks and from at-home to away-from-home foods. Forsaking healthy, home-cooked meals, many of us are today gorging on calorie-rich, nutrient-poor snacks, beverages and sweets.

This shift has become rather gigantic in the West, with many studies across age groups showing that people are consuming a large proportion of their daily food via snacks rather than sit-down meals. This trend favours quick, easy, often non-nutritious, foods and high-calorie treats.

Changing lifestyle

The situation is no different in India; fast foods, street foods and processed foods are becoming part of our lifestyle. Of these, energy dense foods coupled with negative lifestyle factors and lack of physical activity are contributing to debilitating health conditions.

Obesity and the incidence of non-communicable diseases are on the rise. In part, the problem is being attributed to the virtual replacement of conventional foods by processed products due to lifestyle changes. The concern is understandable, but today, only the processed food industry is under scan. It is necessary to understand that all processed foods need not necessarily be considered "junk foods". Similarly, all the fast foods and street foods need not necessarily be `junk'.

Health effects

Since junk foods are high in energy, excessive consumption, coupled with lack of adequate physical activity, may contribute to obesity.

Studies in the West, which tested this hypothesis, found that those who ate these foods, compared to those who did not, consumed more total energy, fat, added sugars and less fibre, fruits and non-starchy vegetables. This shift indeed has become a cause for increased risk of obesity. However, in these countries, junk foods (contributing empty calories) have virtually replaced traditional diets.

However, in the Indian context, there are no large-scale studies to understand the extent of junk food consumption and its role in causing obesity among people of different age groups. However, there are reports based on isolated studies on consumption of "fast foods" among the young people.

An All India Institute of Medical Sciences (AIIMS) study looked into the role of junk foods in causing obesity and hypertension among adolescents. Yet another study in Ludhiana found higher prevalence of obesity and hypertension among urban adolescents, who consumed junk food more frequently as compared to their rural counterparts.

Food labels


The food-based dietary guidelines for Indians formulated by the National Institute of Nutrition (NIN) clearly indicate that processed foods, sugar, salt and saturated fats should be consumed judiciously. Food labels play a pivotal role in helping people understand health effects of various ingredients and thus make informed choices. The Indian Government has initiated stringent regulations in this direction. The current laws make it mandatory to depict the name of the manufacturer, place of manufacturing, date of packing, best-before date and ingredients. Along with all these details, through latest amendments, the Government has now made it mandatory for packaged food makers to furnish the details about the number of kilocalories per 100 gm of the food along with the fatty acids, additives and the processing aids used (if any).

The recent amendment also makes it compulsory that the numerical information on nutrients be expressed as percentage of Required Dietary Allowances (RDA) prescribed by the Indian Council of Medical Research (ICMR). These regulations will definitely go a long way in helping us make healthy choices.

However, experiences in developed nations indicate that there is a need to go a step further and make the labels more user-friendly by use of symbols. The traffic light scheme, designed to provide at-a-glance information on whether a food is high, medium or low in total fat, saturated fat, sugar and salt, is becoming more popular.

If not the nutrition awareness and ability to analyse the health effects of various foods, at least consumer education on these issues is essential for us to understand what is "junk" in these foods.

Dr.V. Sudershan Rao is a Senior Research Officer and G.M. Subba Rao is Research Officer at the National Institute of Nutrition, Hyderabad. E-mail: vemulasr@yahoo.com; gmsubbarao@yahoo.com

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What's what?

# Processed foods are those subjected to technological modifications either for preservation or to convert into ready-to-eat items like ready mixes, dehydrated foods, canned foods, confectionery, bakery, dairy products and breakfast foods. They require technology and machinery, and so are a little costlier. In India, manufacture of processed foods is rising in the unorganised, small-scale and cottage industries causing concern that they may not conform to food standards.

# Fast foods are pre-cooked or cooked to order within minutes like burgers, fried fish, milk shakes, chips, salads, pizzas and sandwiches.

# Street foods, as defined by Food and Agriculture Organisation (FAO), are a wide range of ready-to-eat items and beverages prepared and/or sold by vendors and hawkers, especially in streets and public places. Idly, Vada, Dosa, Chat items, sandwiches prepared and sold on the streets. Safety in handling and serving is a bigger concern than nutritional impact.

# Junk foods are those food that contain little or no proteins, vitamins or minerals but are rich in salt, sugar, fats and are high in energy (calories). Examples are chocolates, artificially flavoured aerated drinks, potato chips, ice creams and French fries.

# Any food, processed or unprocessed, street or fast food, can be termed 'junk' only if it has these above features.

WHEN DEPRESSED WHAT TO DO ?

ANAND felt miserable. He felt sad most of the time. He had lost all interest in his work and leisure activity. No activity was pleasurable. Favourite songs sounded flat. He had to push himself to do simple tasks, which appeared like a big burden.

He was convinced that his job was the cause for his mood state. He felt hopeless about the situation in the office. "I will feel better only when I throw this job away," he reasoned. As the thoughts intensified, he resigned. The HRD manager urged him to reconsider his decision, but Anand was adamant.

Consequences

For the first three days, he felt relieved that the burden was off. The sadness lingered. He hoped that he would be able to snap out of it soon. Three weeks later, the sadness, the low interest level and the inability to enjoy were still present. He did not have enough motivation to look for a new job.

Gradually, the consequences of leaving his job stared at him. Boredom, loneliness and the financial implications made him wonder whether his judgment was wrong.

He felt guilty about his resignation. He felt embarrassed to ask his ex-office to reconsider him. Ultimately when he did contact, the HRD manager pleaded helplessness.

Resignation, divorce, suicide are some decisions that would appear perfectly logical and rational when one is depressed. While depressed, one would perceive the world through a filter, tinted with sadness. The person tends to focus on the negative aspects of self, environment and the future. ("I am worthless", "This office has gone to dogs" and "By 2007, my skills will have no demand"). The negative thoughts will not be based on ground reality and will be irrational.

When all seem lost, suicide might appear to be the only logical solution. When the sadness fades away, many more solutions would become visible and the option of suicide would seem illogical.

Suicide is not the only decision that is irreversible. A hasty dispatch of a legal notice to one's spouse can lead to an irreversible spiral of events.

Do not take major decisions when you are depressed, as your judgment will be coloured by your mood state. Postpone them until your mood has improved.

Once your mood is normal, if you want to resign your job for other reasons, it is fine. In such a situation, you would plan your resignation, finances, alternate job etc.

Before considering divorce you might decide to work through your marital conflicts with your spouse. As for suicide, you will not get suicidal ideas when your mood is cheerful.

A CUP THAT CHEERS

THINK of tea drinkers and invariably the British come to mind. The fact is that tea arrived in the U.K. at about the same time as it did in Europe. But it was the British who took to it with a passion; changing the original Chinese brew by adding sugar and milk.

Over time, the upper classes saw tea taking as a sign of civilised behaviour, and as a fashionable social event. There were others in those damp cold climes who were comforted by the hot cuppa.

For tea aficionados, the 19th Century British Prime Minister William Gladstone said of the brew, "If you are cold, tea will warm you; if you are too heated, it will cool you; if you are depressed, it will cheer you; if you are excited it will calm you." Endorsements like that popularised the beverage in the U.K. Demand went skywards. Traders, planters and everyone dealing with tea were smiling all the way to the bank. In addition to booming tea sales, the dairy and sugar industry also grew.

New drink

Around the time tea became a hot item in Great Britain, in the U.S., Richard Blechynden, a tea plantation owner, accidentally discovered iced tea. The story goes that Blechynden was serving hot tea on a particularly blistering summer day at the 1904 World's Fair in St. Louis. The customers were looking for something tall and cool. Blechynden poured the beverage over ice and added a sprig of mint and a lime wedge. And, a delicious new drink was born.

Current statistics reveal that the average Brit puts back some 3.5 cups a day, compared to, for example, the average American who consumes less than half a cup. As figures go, however, the English are not really the world' s No. 1 tea drinkers. That honour goes to the Irish. Generally associated with whiskey and Guinness, the Irish actually put back more than four cups a day!

But let's go back to where it all started, to China where the average is one cup a day. In early China, it is said that tea was consumed for its health benefits. Some 4,000 years ago, tea's medicinal and healing properties were well known. No traditional Chinese meal setting is complete without a pot of tea. Whether it is breakfast, lunch or dinner, the ubiquitous pot is always around. Served in small cups, the light to amber brew is imbibed in small sips throughout the meal, between mouthfuls of food, to enhance the taste of food, and for reasons of health.

In the teeming marketplace of Wanchai, Hong Kong — where timeless Cantonese traditions fight for a place in the sun with Western influences such as Coke, Gatorade and so on — a popular tea-shop owner said, "No other food or drink can offer more benefits than tea". To drive home the point, he pointed to a framed picture behind him, "Better to be deprived of food for three days than tea for one".

Scientific research around the world is now corroborating what the Chinese chai-wallah said. A recent study at Harvard Medical School, published in the Journal of American Heart Association, May 07, 2002, was found that tea drinkers not only reduce their chances of developing heart disease but that they may be actually prolonging their lives after a heart attack. Regular tea drinkers had "significantly elevated survival rates as compared with those who didn't".

Health benefits

This is probably the first large scale scientific study to suggest that drinking tea can actually protect the heart after damage has already occurred. Researchers suspect that the antioxidant-rich flavonoids, water-soluble natural chemicals that abound in green and black teas, may provide the link between tea consumption and survival.

In earlier studies, there was evidence to show that these chemicals can prevent the "oxidation of low-density lipoprotein, and that they can enhance the blood vessels' ability to relax in patients with cardiac disease". Research also indicates that tea lowers total cholesterol levels, as well as improving the ratio of good (HDL) cholesterol to bad (LDL) cholesterol.

The beverage of choice in many parts of the world, long touted as having healing properties is now being backed by credible scientific evidence be it heart attack or cancer or rheumatoid arthritis or high cholesterol. A cup of tea at least twice a day may make a big difference to health.

British poet William Cowper described tea as "the cup that cheers but does not inebriate". That was in the 18th century. Today as we explore and find out its secrets and benefits, perhaps it's time to take a second look at the humble brew.

ORTHOPAEDIC INJURIES-PROBLEMS IN WOMEN

WOMEN are predisposed to developing certain musculo-skeletal problems in middle age. The differences in bones and joints of men and women help one understand women's increased susceptibility to certain injuries, knee, ankle and foot problems and stress fractures. This is not confined to athletes, even housewives and working women are prone to these problems.

Differences

There are both anatomic and physiological differences. There is more fat around the upper arm, buttocks and thighs gives women a more rounded appearance. When women undergo orthopaedic surgery, they require a slightly different protocol for pain management, physiotherapy and thromboembolic prophylaxis.

The extra padding around the arm, thighs and buttocks in women may lessen their chances of injury to the acromio-clavicular joint, clavicle, humerus after a sports-related fall. The female pelvis is wider than that of men. So the hip from which the thighbones descend is more widely set and there is a resultant outward muscular pull on the kneecap. The Q angle, formed by the direction of the pull of the quadriceps tendon and the patellar tendon, is more in women (17° against 5° in men.) Wide hips lead to an increased Q angle and can cause knock-knees, outward twisting of the shinbone and pronated feet.

The most common complaint in young and middle-aged women is anterior knee pain, which frequently arises from the under surface of the kneecap (patella) due to softening of the cartilage and wear and tear.

Common complaints

The main cause of this is misalignment due to the increased Q angle. It causes a more powerful component in the outer thigh muscle leading to a lateral vecot force on the kneecap. Thus the kneecap moves slightly out of joint.

Women's knees are more likely to dislocate outward. They can also be titled slightly outward thus predisposing to one-sided wear and tear. Pain in the knees can increase while climbing stairs or squatting. Some girls add to their problems by wearing high heels. The downward flexion gait increases the compressive force at the knee joint. Luckily, this pain can be banished after special exercises and only a small proportion require kneecap surgery.

Another knee problem that has been observed in sportswomen is a higher incidence of anterior cruciate ligament injuries. The exact reason for this is not yet clear. It may be partly due to the decreased size of the intercondylar notch at the lower end of the femur (thighbone), different biomechanical pattern of muscular activity and landing mechanism.

Women are more prone to developing bunions. This is more common in the West and may be due to improper footwear. Hallux valgus, a condition in which the big toe angles outwards excessively, is more common in girls. Callosities may develop on the inner side of the toe joint. Wearing high heels may lead to contracture of the Achilles tendon leading to tendon problems behind the heel and also pain under the heel. Women have lesser muscle mass than men due to hormonal differences.

Hormones

Female hormones also lead to ligamentous and tendon laxity. They also influence bone mass and density. Estrogen causes conservation of bone mass and osteoporosis results after menopause. Exercise-induced amenorrhea can lead to osteoporosis. Post-menopausal women develop stress fractures in their feet after prolonged and repetitive exercise and need to increase their intake of calcium. Women athletes can also develop stress fractures of the tibia.

Since cosmetics is an important factor in women, surgical incisions and wound closure techniques need to be planned well. Women tend to opt for minimally invasive arthroscopic techniques for shoulder and knee surgery.

Women also have a lesser pain threshold than men. After surgery, they require more painkillers. Persistent pain can lead to slow rehabilitation and calls for a more effective pain management.

Why Undescended Testis Surgery in children ?

IN some mammals the testis stays inside the body and comes out only during the breeding season. In human beings, the testis is located outside the body in the scrotal sac. The sperm production is best at temperature two degrees less than the body temperature. This is why the testes are located outside the body.

How it happens

When the baby is formed in the womb, the testis starts developing inside the baby's belly. As the foetus grows, the testes gradually descend and reach the sac. When this does not happen, or is arrested half way, the result is "Undescended Testis". This is seen in 30 per cent of boys born before date (preterm). Among full term boys, the likelihood is one to three per cent.

When the newborn is examined, the paediatrician may suspect the problem when the scrotum is poorly formed. In such cases, one can wait for three to six months for spontaneous descent. After six months, the chances of spontaneous testis descent are low and one should seek medical help.

Problems

If the problem is not corrected at the right age, the following problems may occur:

Infertility: When the testis does not descended, it is exposed to higher body temperature, and sperm production is affected. In later life the patients have reduced sperm count and thus have problems in fathering children (50-70 per cent less than normal).

Torsion: When the testis is not descended, it is free to move around. This makes it easy to get twist and cut off its own blood supply. The scrotum gets red and tender within a few hours. If an emergency operation is not done within six hours, the testis is lost.

Testicular Tumour: There is also a small risk of tumour development. If the testis is not brought down, the tumour can develop without being noticed and become advanced before treatment.

Correction

For boys with Undescended Testis, surgical correction is recommended within one year (maximum two years). The testis is usually found in the lower part of the belly and fixed to the scrotum after achieving enough length. When the testis is too high inside the belly, a laparoscopic operation is performed to bring it out in two stages with the help of key hole surgery.

Usually the success rate is 95 per cent. When only one testis is affected, and surgery is performed at the right time, there is 80 per cent chance for fertility and paternity. When both testes are affected, there is still 50 per cent chance.

HOW TO TACKLE GUM DESEASE ?

PERIODONTAL Disease (PD) is commonly referred to as "Gum Disease". "Periodontal" means surrounding the tooth. PD is the disease of the surrounding structures of the tooth — the bone, gums and fibres that attach the tooth to the bone. There are different kinds and may affect one or multiple teeth. It can be broadly classified into the following stages.

Gingivitis: This is the first stage in which only the gums are affected. The gums get red, puffy and tend to bleed easily. This is a reversible stage and can be cured with simple procedures.

Early Periodontitis: Gingivitis, if untreated, progresses into Early Periodontitis when plaque and calculus burrow in between the gums and the tooth creating a pocket. This weakens the support and makes the tooth loose. This stage generally requires more advanced forms of treatment, which may also be surgical.

Advanced Periodontitis: This is the most severe form that sees a lot of bone damage. The teeth become very mobile. This stage is quite difficult to treat and requires very advanced treatment modalities.

Causes

The prime cause is plaque, a sticky film composed of bacteria and its by-products that are constantly formed around the teeth. If not regularly removed it turns into a hard calcified substance called calculus, which can only be removed with special instruments. The bacteria in plaque produce toxins, which cause differing grades of infection leading to destruction of the periodontal structures. Other factors that might aggravate PD are smoking, pregnancy and puberty, medications like Phenytoin and Nifidepine, uncontrolled diabetes and other systemic diseases.

Symptoms

The most common symptoms are bleeding gums, especially while brushing; red and puffy gums; persistent bad breath; gums separating from the teeth; pus-like discharge from the gums; mobile and drifting teeth with discomfort while biting.

Some people do not have any of these symptoms. Many experience almost no pain till the tooth has reached its last almost untreatable stage.

Treatment

A general dentist usually treats early forms. To manage advanced stages a Periodontist or a specialist in the diagnosis, prevention and treatment of PD is required. A small measuring instrument called the periodontal probe is used and X-rays are taken to assess the destruction. The treatment varies from scaling procedures to surgical therapy. In some cases Tissue Regenerative therapy may be suggested. Scaling is the removal of all visible plaque and calculus. Contrary to popular belief, this does not harm your teeth. Patients are generally advised to get their teeth scaled once a year. Advanced treatment involves surgical correction to arrest the disease and to repair and regenerate the lost structures.

Prevention

Once PD is treated, patients require Supportive Periodontal Treatment (SPT). During SPT, the periodontist evaluates periodontal health, examines and removes any new formation of plaque and calculus and traps the disease process, if it recurs, in its initial stages. This addresses only 50 per cent of the problem, it will arrest the disease process and possibly repair some damage. The other part is to be able to maintain the state of health in what is now slightly compromised dentition.

PD is a chronic disease and often recurs without ongoing supportive therapy. Supportive therapy involves getting a regular check up and scaling once in six months; brushing regularly twice a day; and seeing the dentist the moment any symptom appears.

Brushing

Use fluoride toothpaste as fluoride makes teeth stronger and more resistant to acid attacks. This in turn helps to prevent tooth decay. Brushing the teeth combats plaque, which builds up daily. Removing plaque not only makes the teeth feel clean, but also helps to prevent bleeding gums, and makes your breath fresher too. Try to brush in the morning and last thing at night. Brushing at night is important as it protects teeth against acid attack while you are asleep.

Choose a soft or medium (not hard) brush with a small head to reach difficult corners. Replace the brush once it wears out.

Place the bristles of the toothbrush where the teeth and gums meet. Then, move the toothbrush back and forth using small, gentle movements to remove plaque from the gum region where it collects.

Hold the toothbrush like a pen, so that brushing is not too hard. Use a finger grip, not a fist grip. Don't hurry. Make time to clean every tooth.

Always remove partial dentures and braces before brushing and clean them separately.

Your dentist or hygienist can check if teeth are cleaned properly and can remove any tartar that may build up that brushing can't remove.

They can also give advice about the need for dental floss or other special cleaning aids.

Bariatric Surgery treat severe obesity

There are many reasons to lose weight and maintain a healthy lifestyle. Some people have serious health concerns. Others want to feel better about their appearance. Many are simply tired of the burden of being overweight and want to improve their daily quality of life.

Weight loss surgery is a life-altering decision — one of the most important decisions a person will ever make. With that in mind, we've pulled together the information you need about obesity, weight loss surgery, making the choice, finding a surgeon, life after surgery, and additional resources to help in the decision-making process.

Bariatric Surgery is an effective alternative to treat severe obesity. Only people who suffer from morbid obesity (body mass index higher than 40) can have bariatric procedures.

WHAT IS MORBID OBESITY ?


Medically, the word "morbid" means causing disease or injury. Morbid Obesity is a serious disease process, in which the accumulation of fatty tissue on the body becomes excessive, and interferes with, or injures the other bodily organs, causing serious and life-threatening health problems, which are called co-morbidities.

Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases, also known as co-morbidities. These co-morbidities are conditions or diseases that result in either significant physical disability or even death. As you read about morbid obesity you may also see the term "clinically severe obesity" used. Both are descriptions of the same condition and can be used interchangeably. Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. Morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that morbid obesity symptoms build slowly over an extended period of time.

HEALTH EFFECTS OF MORBID OBESITY

Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal bodily function. These "co-morbidities" affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life-threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life, cause endless frustration and can seriously shorten life, as well.

Shortened Life Span

Dysmetabolic Syndrome X
This recently recognized syndrome, involving abdominal obesity, abnormal blood fat levels, changes in insulin sensitivity, and inflammation of the arteries, is assciated with a markedly increased risk of heart and blood vessel disease. It is also a precursor to the onset of Diabetes in adults.

Heart Disease
Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Heart disease is the leading cause of death in the world today, and obese persons tend to develop it earlier in life, and it shortens their lives. Coronary disease is pre-disposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.

High Blood Pressure
Essential hypertension, the progressive elevation of blood pressure, is much more common in obese persons, and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If your doctor finds you have high blood pressure, the first thing he or she will recommend to you is weight loss (but doctors have never been able to tell us how).

High Blood Cholesterol
Cholesterol levels are commonly elevated in the severely obese -- another factor predisposing to development of heart and blood vessel disease. This abnormality is not just related to diet, but is an effect of the massive imbalance in body chemistry which obesity causes.

Diabetes Mellitus
Overweight persons are 40 times as likely to develop Type II, Adult-Onset, Diabetes. Elevation of the blood sugar, the essential feature of Diabetes, leads to damage to tissues throughout the body: Diabetes is the leading cause of adult-onset blindness, a major cause of kidney failure, and the cause of over one half of all amputations. Diabetics suffer severely from their disease, and once Diabetes occurs, it becomes even much harder to lose weight, because of hormone changes which cause the body to store fat even more than before.

Sleep Apnea Syndrome
Sleep apnea -- the stoppage of breathing during sleep -- is commonly caused in the obese, by compression of the neck, closing the air passage to the lungs. It leads to loud snoring, interspersed with periods of complete obstruction, during which no air gets in at all. The sleeping person sounds to an observer like he is holding his breath, but the sleeper is, himself, usually unaware that the problem is occurring at all, or only notices that he sleeps poorly, and awakens repeatedly during the night. The health effects of this condition may be severe, high blood pressure, cardiac rhythm disturbances, and sudden death. Affected persons awaken exhausted and often fall asleep during the day -- sometimes even at the wheel of their car, and complain of being tired all the time. This condition really has a high mortality rate, and is a life-threatening problem.

Obesity Hypoventilation Syndrome
This condition occurs primarily in the very severely obese -- over 350 lbs. It is characterized by episodes of drowsiness, or narcosis, occurring during awake hours, and is caused by abnormalities of breathing and accumulation of toxic levels of carbon dioxide in the blood. It is often associated with sleep apnea, and may be hard to distinguish from it.

Respiratory Insufficiency
Obese persons find that exercise causes them to be out of breath very quickly, during ordinary activities. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater, with any physical activity. This condition prevents normal physical activities and exercise, often interferes with usual daily activities, such as shopping, yard-work or stair climbing, making even ordinary living difficult or miserable, and it can become completely disabling.

Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
Acid belongs in the stomach, which makes it to help digest your food, and it seldom causes any problem when it stays there. When it escapes into the esophagus, through a weak or overloaded valve at the top of the stomach, the result is called "heartburn", or "acid indigestion". The real problem is not with digestion, but with the burning of the esophagus by the powerful stomach acid, getting to where it doesn't belong.. When one belches, the acid may bubble up into the back of the throat, causing a fiery feeling there as well. Often this occurs at night, especially after a large or late meal, and if one is asleep when the acid regurgitates, it may actually be inhaled, causing a searing of the airway, and violent coughing and gasping.

This condition is dangerous, because of the possibility of pneumonia or lung injury. The esophagus may become strictured, or scarred and constricted, causing trouble with swallowing. Approximately 10 - 15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.

Asthma and Bronchitis
Obesity is associated with a higher rate of asthma, about 3 times normal. Much of this effect is probably due to acid reflux (described above), which can irritate a sensitive airway and provoke an asthmatic attack. The improvement of asthma after surgery is often very dramatic, even before much weight loss has occurred.

Gallbladder Disease
Gallbladder disease occurs several times as frequently in the obese, in part due to repeated efforts at dieting, which predispose to this problem. When stones form in the gallbladder, and cause abdominal pain or jaundice, the gallbladder must be removed.

Stress Urinary Incontinence
A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. This condition is strongly associated with being overweight, and is usually relieved by weight loss.

Degenerative Disease of Lumbo-Sacral Spine
The entire weight of the upper body falls on the base of the spine, and overweight causes it to wear out, or to fail. The consequence may be accelerated arthritis of the spine, or "slipped disk", when the cartilage between the vertebrae squeezes out. Either of these conditions can cause irritation or compression of the nerve roots, and lead to sciatica -- a dull, intense pain down the outside of the leg.

Degenerative Arthritis of Weight-Bearing Joints
The hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement surgery may be needed, to relieve the severe pain. Unfortunately, the obese person faces a disadvantage there too -- joint replacement has much poorer results in the obese, and complications are more likely.. Many orthopedic surgeons refuse to perform the surgery in severely overweight patients

Venous Stasis Disease
The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood "uphill". The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin. Blood clots also can form in the legs, further damaging the veins, and can also break free and float into the lungs -- called a Pulmonary Embolism -- a serious or even fatal event.

Emotional/Psychological Disease
Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, and cannot enjoy theatre seats, or a ride in a bus or airliner. There is no wonder, that anxiety and depression might accompany years of suffering from the effects of a genetic condition -- one which skinny people all believe should be controlled easily by will power.

Social Effects
Seriously obese persons suffer inability to qualify for many types of employment, and discrimination in employment opportunities, as well. They tend to have higher rates of unemployment, and a lower socioeconomic status. Ignorant persons often make rude and disparaging comments, and there is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness. Many severely obese persons find it preferable to avoid social interactions or public places, choosing to limit their own freedom, rather than suffer embarassment.

Deciding to have weight loss surgery can be difficult. But for many obese people, it offers a treatment option that can lead to a healthier life. Weight Loss Surgery Options provides you with an introduction to obesity surgery and explains who qualifies for weight loss surgery.

Many obese people are turning to stomach surgery to help them get on the road to a healthier life. Learn about the different procedures doctors are performing for weight loss

Benefits of Bariatric Surgery


The benefits of this surgery are more than skin deep. Baraitric Surgery will not only help you look better; more importantly, with proper post-surgical care, it will help you feel better and healthier.

Most patients lose at least 50 per cent of excess body weight. Most people with hypertension and/or diabetes no longer need medications.

A return to normal periods for young women with abnormal or absent menses and improvement of fertility. Improved sexual function for many males. Reduction of periods of sleep apnea. Eliminates or slows the disabling effects of arthritis. Improved self-esteem and more energy.

PROCEDURES FOR OBESITY SURGERY

Different types of surgery for treating Obesity or Surgical Operations for Morbid Obesity

The Laproscopic Adjustable Gastric Banding


The band is placed laparoscopicaly "key hole surgery".The band can be adjusted by injecting fluid into it as an outpatient.Reversible Hospital stay 2-3 days

In this procedure a band made of silastic material is placed around the stomach near its upper end creating a small pouch and narrow passage into the larger remainder of the stomach.

The surgery involves forming a small pouch in the upper part of the stomach that effectively becomes a new baby stomach. The sialistic band is wraped around the upper portion of stomach all around to form a "baby stomach." The narrow opening or stoma is formed by the bands two ends joining together. This band has a balloon on it which can be inflated or deflated in later stages so as to increase or decrease the size of stoma. This step makes the SAGB a stoma adjustable operation. This can be done anytime after the operation with the help of port kept under the skin at the time of operation, Now the food still goes down the normal way and is digested in the bowel normally. The big difference is that the pouch will only allow a very small amount to be fitted in at one time and when this happens satisfaction is achieved and hunger will subside until the pouch eventually empties into the duodenum. So you feel full after eating a small amount of solid food and your intake of food can be kept to two or three tiny meals a day with no desire to eat between meals.


Advantages of The Laproscopic Adjustable Gastric Banding

There are several weight loss surgeries available today but adjustable Gastric Band is superior to many of them. It has several features that make it the safest method of weight control.

* Simplicity - The procedure is simple to perform with a short operating time.
* It can be placed laparoscopically without a large incision.
* It does not require any opening in the gastrointestinal tract that reduces the risk of infection.
* Safety: There is no staple line to burst.
* It is adjustable and can be customised to individual needs.
* It is fully reversible. The band can be emptied, for example, during pregnancy or prolonged illness allowing your stomach to return to former configuration or it can be removed (although removal is not indicated)
* It is tolerated well by most persons of all ages and physical conditions.
* This operation may be particularly suited to persons who are from 80 to 200 pounds overweight.
* Short hospital stay (around 24 hours)
* Lowest complication rate.
* There is no mal-absorption or "dumping syndrome." The person can fully digest vitamins and minerals

Frequently Asked Questions for Laproscopic Adjustable Gastric Banding


Who is a Good Candidate for Adjustable Gastric Banding?

You may be eligible for the lap band system surgery if :

* Your BMI is =40, or you weigh twice your ideal weight or are at least 100 pounds (45Kgs.) more than your ideal weight.
* You have been overweight for more than 5 years
* Your serious weight loss attempts have had only short-term success.
* You are not suffering from any other diseases that may have caused your obesity.

How much weight will I lose?

This is not predictable; most of the patients will never be skinny people. But the majority can and do achieve a normal, healthy weight for their height and bone structure. Success after bariatric surgery is defined as losing 50 percentage of excess body weight. After a Laparoscopic Adjustable Gastric Banding, one loses an average 60 percentage of excess body weight at 18 months.

With both these options, how do I choose the right one?

After educating yourself to all the aspects of these operations you can decide with your surgeon which is the best operation. Both the operations can be performed laparoscopically in almost everyone.

The Lap-Band requires significant post-operative manipulation, has a re-operative rate that is high, but is the simplest procedure to perform. The Lap-Band probably has the lowest average weight loss and is a much slower weight loss than the other operations. The operative mortality is the lowest of all the procedures. There are occasional patients that do not lose significant weight after this operation

The gastric bypass is the most studied of all the bariatric operations. It is generally a safe and effective operation. There is a higher early complication rate than the Lap-Band.

Is it true that I'll never be able to enjoy eating again if I have weight control surgery?

No. Patients who follow the guidelines to eating after weight control surgery will become people who eat food for quality and flavor, not for volume. They enjoy food more after surgery than they did before surgery. They pay more attention to what they are eating, are often pickier eaters, and don't feel guilty about eating food.

Are there foods I can no longer eat?

You will be on a liquid diet at first progressing to a soft diet then to solids for the six-week healing phase. When properly adjusted, there are some foods that no longer are as easy to eat but most of bandsters can eat anything, just very small amounts. One can have trouble with soft mushy breads, tough or dry meats, skins of certain fruits or vegetables such as grapes, potatoes and tomatoes or very fibrous foods like asparagus or pineapple.
What should I be eating?
A. Protein and produce, if it isn't one of those two items then it is something that should not be part of your daily diet. Chicken and vegetables, Beef and vegetables, Fish and vegetables, some fruit thrown in there and a little dairy and you are good to go!.

Can I drink alcohol or soda pop?

Alcohol is not a good idea because it is a stomach irritant and is high in calories. It is always better to consume solid food with daily 1200 calories rather than drink them. However, one can have a drink occasionally. Beer, soda pop or any carbonated beverage is not recommended because of the potential to stretch your pouch. You may find the carbonation very uncomfortable after you are properly adjusted. However an occasional (once a week) drink may be consumed in moderation.

What if I go out to eat?

Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions.

When I reach my goal weight do I need to remove my band?

No, most of the patients plateau with weight loss when they get close to a normal weight and stop losing. If you continue to lose beyond your ideal weight, some of the fluid may be removed from your band to stabilize your weight. Most banded people regain most if not all of their excess weight if the band is removed.

If I get pregnant will I be able to get enough nutrition for my baby?

Many patients have become pregnant after both gastric bypass and the Lap-Band procedure. In fact, several studies have demonstrated that significant weight loss can improve fertility and one recent, excellent study from Australia showed that weight loss after the Lap-Band improves fertility in morbidly obese women. There is also a syndrome called Polycystic Ovary Syndrome (PCOS), which can lead to infertility. This syndrome involves excessive hair growth and hormonal changes that generally resolve with dramatic weight loss after bariatric surgery. As far as getting enough appropriate nutrition to have a safe pregnancy, this has not been a demonstrated problem with either the Lap-Band or the gastric bypass. However, you are recommended to consult with your bariatric program nutritionist to be safe if you do get pregnant.


What are the short term and long term dietary restrictions after banding?

First week post-op: you will typically be on a full liquid diet. Second week post-op: you will typically eat puree/soft foods diet. High calorie liquids should be avoided after the liquid stage. Other than that, it depends on individual tolerances.
Gastric Bypass


Gastric pouch 30 ml. Part of small intestine is bypassed. Greater weight loss. Hospital stay 5-7 days Vitamin mineral supplementation required.

In this procedure a small stomach pouch is created by stapling the stomach. This causes restriction of the food intake. Next a "Y" shaped section of the small intestine is attached to the pouch to allow food to by-pass the first part of small intestine. This causes reduced calorie and nutrient absorption.

Advantages of Laproscopic Gastric Bypass RNY

* After gastric bypass surgery, weight loss is more predictable and usually maintained. Average excess weight loss is usually higher than with purely restrictive procedures.
* One year after surgery, weight loss can average 65% to 70% of excess body weight. After 10 to 14 years, some patients have maintained 50-60% of excess body weight loss.
* 96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved according to a 2000 study of 500 patients. It also helps in leg swelling, high cholesterol, urinary incontinence etc.

Sleeve Gastrectomy


With this procedure, the surgeon removes approximately 60 per cent of the stomach laparoscopically so that the stomach takes the shape of a tube or "Sleeve".

Technically most of these procedures are reversible but it is not advisable to contemplate reversal as person can regain the loss weight. Band slippage incidence has reduced with the modified band placement technique, improved band design and standardization of band adjustment protocol.

Bariatric surgery continues to benefit people struggling with morbid obesity, most importantly it saves lives. But finally it is you who has to remember that "health is the thing that makes you feel that now is the thing that makes you feel that now is the best time of the year!!"
Frequently Asked Questions for GASTRIC BYPASS


How do I know if I qualify for weight reduction surgery

You qualify if:

* You weigh twice your ideal body weight or You are overweight by 100 lbs or more
* You have a BMI (body mass index) more than 40 or
* You have a BMI more than 35 with co-morbidities (illnesses related to being overweight).
* You are overweight for 5 years or more
* You have failed to lose weight or sustain weight loss under supervision
* You are willing to comply with lifestyle and diet changes


Will I have to stop smoking?

Patients are encouraged to stop smoking at least one month before surgery. Smoking increases the risk of lung problems and can reduce the rate of healing. It increases the rate of incisional hernia and leaks by interfering with the blood supply of healing tissues.

How long will I stay in the hospital?

As long as it takes to be self-sufficient. Although it can vary, hospital stay (excluding the day of surgery) can be 3 to 4 days for a laparoscopic gastric bypass, and 5-7 days for an open gastric bypass. After leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.
How soon can I drive?

For your own safety, you should not drive until you are no longer taking narcotic medication for pain and can respond quickly to traffic. Usually this takes 7-14 days after surgery.

What will I eat after surgery?

You will be on intravenous fluids on the day of surgery. The day after we may do a swallow study to be sure there is no leak in the staple line. If there is no leak, you will be started on liquid diet 24 to 48 hours after surgery. Intake is limited to 1 or 2 ounces per meal so that the stomach can heal properly. If this is well tolerated, next day you will be advanced to blanderised soup. You will be discharged on liquid diet. We begin patients with liquid diets, moving next to semi-solid foods and about 4 to 6 weeks later, back to solid foods. This transition is necessary to allow time for your newly created stomach pouch to heal properly. Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.

What happens to the lower part of the stomach that is bypassed?

The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food. It still produces the secretion necessary to absorb Vitamin B12 and contributes to endocrine hormonal balance and motility of the intestines in ways that are not entirely understood.

What if I am really hungry?

This is usually caused by the types of food you may be consuming, especially starches (rice, pasta and potatoes). Increasing protein intake is helpful. There may also be a psychological problem with lack of food in your life "head hunger". Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.
Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit.

I am thinking about getting pregnant. Will I be able to have children after weight loss surgery?

Many women have had successful pregnancies after weight loss surgery. There is nothing per se that would prevent pregnancy. Infact, bariatric surgery enhances fertility in those who have had difficulty in conceiving. We recommend, however, that you wait until your weight loss is complete before becoming pregnant. This may take a year or more. The effect of rapid and prolonged weight loss on the developing fetus is unknown but it could have dire consequences and pregnancy is not recommended until a stable weight has been attained.

What can I do to prevent excess hanging skin?

The amount of excess skin depends on the age, skin elasticity, total weight loss and how much the skin was stretched. Many people, heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back". Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight.

Will exercise help with excess hanging skin?

Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with flaps of loose skin.

What will my long term diet be like ?

* Eat three small meals a day.
* Keep a record of your dietary intake. Include everything you eat and drink: the date, time and amount of each meal. Start keeping this record (food diary) from one week after the surgery so if you begin having problems with vomiting, diarrhea or malabsorption. we can review your food record and make recommendations.
* Not only is there an adjustment to make about the quantity but also quality of food you should eat. When you are able to eat solid foods again, eat food high in protein. Protein foods are very important for the healing of staple line of your pouch. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods. Hair loss is one effect of not eating enough protein.
* You will also have to learn to eat slowly and chew your food thoroughly. Food not chewed properly will not pass through the narrow stoma and may cause vomiting.
* Stop eating as soon as you feel full. If you do not stop, you may have vomiting and it will put strain on the staple line.
* Do not eat sweets! This includes sweetened chewing gum, candy and regular sodas. Beware of hidden sweets (cereals with honey or sugar coatings).
* You may be unable to tolerate certain foods, especially those containing fat and sugar. A balanced diet of 1000 – 1200 calories a day is recommended.
* Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
* Never drink water or any fluid with the meal. Drink fluids thirty minute to an hour after meals. Taking fluids before or at meal time may cause bloating, low food intake, vomiting, or dumping syndrome. It will also flush the food through the stoma and you will feel hungry again.
* Do not drink flavored beverages, even diet soda, between meals



Will I be allowed to drink alcohol?

You will find that even small amounts of alcohol will affect you quickly. Alcohol is high in calories and will significantly alter your calorie balance. It is suggested that you drink no alcohol for the first year. Thereafter, you may have a glass of wine or a small cocktail for social purpose not more than once a fortnight.

Will I need supplemental vitamins?

Most surgeons recommend a daily multivitamin for the rest of your life. Vitamin B12 injections are sometimes suggested once a month for the first year and every six months thereafter. It may also be taken orally or sublingually (under the tongue) by many patients.

ADVANCES IN EYE SURGERY

The loss of an eye can be traumatic especially because of the disfigurement it causes. Look at the advances in eye surgery.


MR. Mahesh ., 34 years, lost his right eye following an injury 10 years ago. His eye was now blind, painful and disfigured. He was forced to resign his job in a hotel, as his red, watering eye was beginning to attract attention of his clients.

Mr. M. had become more introverted and painfully conscious of his appearance. All his efforts to secure a new job were unsuccessful since his applications were turned down just by looking at his photograph. He was in a state of intense depression and had given up all hope.

Traumatic loss

Stories such as these are not uncommon as the loss of one's eye can be devastating and can cause enormous distress to the affected person. The eye is lost following trauma secondary to sports injuries, chemical injuries (acid/ alkali), debilitating eye disease or occupational hazards.

Following the injury, initially efforts are made to save the eye, but if the injury is severe, the eye cannot be saved and it becomes small and shrunken in appearance (pthisical). Also sometimes due to an increase in the intraocular pressure and weakening of the walls, the eye can become large, disfigured and painful. This causes it to look abnormal and affects the person's facial appearance. This causes intense emotional distress, affects the person's personality and interferes with personal and professional life.

Now with advances in cosmetic and reconstructive surgeries, a lot can be done to improve the appearance. This involves three stages:

# Removal of whole (enucleation) or part (Evisceration) of the disfigured eye.

# Placement of a spherical artificial implant inside the socket.

# Fitting of an artificial eye (Prothesis) one to one and half months later once the wound has healed completely.

Advances

In the past, multiple implants were tried from glass to acrylic. In recent years, advances have been made in the development of newer implants, which has led to the introduction of porous implants. These have tiny pores in them, which allow the blood vessels to grow into them, thus firmly anchoring them in their place. The risk of these implants coming out (expulsion) is much less and also the post-operative movements of the artificial eye are much better. With these advances in treatment, people can seek treatment early and lead happy, confident and productive lives.

Loss of an eye may also result from severe infection, injury or cancer and cause permanent disfigurement with physical and psychological consequences. Various interventions tailored to the individual patient like prosthesis fitting with or without socket surgery, more or less, restores normal appearance to help them lead socially acceptable lives.

Mr. M. underwent Evisceration with implant insertion and has been fitted with an artificial eye. He is back to work with a leading hotel and people do not know that his left eye is artificial unless he tells them. For him it is his second innings of life.

LAUGH MEANS GOOD HEALTH

Humour and laughter have a good effect on your immune system.

WHEN was the last time you laughed really hard — a hearty, side splitting belly laugh that suddenly grabbed you and sent you reeling out of control?

Modern science is beginning to confirm that this kind of laughter is not only enjoyable but also health promoting. Laughter is an invigorating tonic that heightens and brightens the mood, gently releasing us from tensions and social constraints.

Best antidote

Laughter is an affirmation of our humaneness, a face saving way to express our anxieties, fears and other hidden emotions to others. It breaks the ice, builds trust and draws us together into a common state of well-being.

Humour may be one of our best antidotes to stressful situations. When confronted with a threatening situation, animals have two situations either they flee or they fight. We humans have a second alternative: to laugh. By seeing the humour in stressful situations we may be able to change our responses to the threat. When we laugh, we simply cannot be worrying deeply at the same time.

What research shows?

If you hate to do a regular workout, laughter may be the exercise programme you've been looking for! Laughter is called "inner jogging". A robust laugh gives the muscles of your face, shoulders, diaphragm and abdomen a good workout. Heart rate and blood pressure temporarily rise, breathing becomes faster and deeper and oxygen surges through your bloodstream. Sometimes your muscles go limp and your blood pressure temporarily may fall, leaving you in a mellow euphoria. A good laugh can burn up as many calories per hour as brisk walking.

During a good hearty laugh, your brain orchestrates hormonal rushes that rouse you to a high-level alertness and numb pain. Researchers speculate that laughter triggers the release of endomorphines, the brains opiates. This may account for the pain relief that accompanies laughter.

It has been long recognised that stress weakens the immune system, thereby increasing the vulnerability to illnesses. Only in the mid 1980s, however, did researchers study the impact of humour and laughter on the immune system. Research showing that individuals with a better sense of humour have stronger immune systems is important since it shows the importance of making the effort to improve your sense of humour.

How to use humour

Babies start to laugh when they are 10 weeks old: six weeks later they are laughing about once every hour. Four-year-olds laugh once every four minutes. The average grown up is said to laugh only about 15 times per day. Sadly, our culture seems to inhibit humour. We learn to associate growing up with "getting serious" and being serious is somehow associated with being solemn and humourless. Sometimes we repress our good humour, because we are afraid that others will think we are frivolous or foolish. Here are some suggestions for repairing your sense of humour and regaining healthy laughter.

Expose yourself to humour: There is a lot of funny material around. Actively seek out things that make you laugh.

Keep a humour journal: Get into the habit of listening to the unintentionally amusing remark. Watch for the wonderfully funny young children spontaneously say or write. Listen for the amusing slips of tongue or the amusing error or the clever pun.

Tell a joke: Having a good sense of humour doesn't mean you have to have a store of jokes or tell them perfectly. Do not worry about how well you are telling it. Sometimes screwing up the delivery can create something that's even funnier than the original joke.

Laugh at yourself: Focus on yourself rather than others. If you expect to do everything right all of the time, then you can't afford to have a sense of humour. But if you can allow yourself the inevitable mistakes and stupidities then you can laugh at yourself. Those who can laugh at themselves have a much stronger sense of self worth and higher esteem than those who can't. The real test of seeing whether or not you can laugh at yourself is if you can take a bit of teasing. We all need a few things that we are willing to be teased about by our nearest and dearest. But they really do have to be things you can see the funny side of too.

Try humour instead of anxiety or anger: A stressful situation can sometimes be transformed into a bit of fun if you can see the humour in it. Next time you are livid about something try to make your point with humour instead of anger. Humour can also help reduce anxiety. If you are terrified of speaking in public or of making a presentation, for example, imagine your audience wearing funny hats. Practise by imagining a stressful situation. Then invent a humorous response to it and rehearse it.

Hang out with happy people: Make sure that people around you are fun to be with. Certain people make you feel relaxed and happy. Others are too depressing, or relentlessly serious. Try to avoid getting bogged down by them. Spend more time with people who boost your mood.

Put on a happy face: Research has shown that just changing your facial muscles can set off different physiological changes. It can also trigger different thoughts that affect moods of sadness, happiness and anger. So when we put on a happy face in times of adversity, we are actually changing our neurohormone levels and they change our moods. So if you can't laugh, smile. And if you can't smile, fake it.

Avoid negative humour: Not all humour is positive and healthy. Watch out for scorn, sarcasm, ridicule and contempt and inappropriate humour. And don't joke about people's names. They have to live with them. It is important to be sensitive to each occasion and know what humour really helps.

Humour therapy

"The art of medicine consists of keeping the patient amused while nature heals the disease." Chances are that you have never been in a hospital with a humour programme. If ever there are two things that don't go together, it is humour and hospitals.

The last decade has seen a revolution in healthcare as more and more hospitals become convinced of the therapeutic power of humour. Patients increasingly demand more personalised relationships with caregivers and humour helps establish it.

The best-known approach to bringing humour and laughter to the hospital settings is the use of clowns. Another common approach is to create a humour cart. This can be wheeled into the patient's rooms and has funny audio and videotapes, books of cartoons, games and funny props.

A few hospitals have entire rooms devoted to fun and humour for ambulatory patients. One of the first humour rooms was established at St. Joseph's hospital in Houston, the U.S.

Humour can be a powerful medicine and laughter can be contagious. It's reassuring in these days of deadly epidemics and sometimes painful, expensive medical treatments that laughter is cheap and effective. And the only side effect is pleasure.