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5c3d8e9e3275-53 | in an ambush in a lob and if we had to go for the morning I mean just in case our viewers or our listeners and very thick jungles and we went for an oppression and eight days we were in ambush it's not that you get up for the morning coil and walk 100 meters and then and come back and make all the noise on the leaves which have fallen you just take five side rolls do the thing and come back oh and you don't move you don't breathe you eat your food there only because if you move or if you you know breathe loudly you have to hear the silence the first time I heard this dialogue okay Captain God bless his soul he got uh you know lost his life in operation he says sir you have to listen to The Silence silence speaks and sure enough if you're just listening and when a terrorist is coming in the silence is broken so eight days you would just remember that was one of them otherwise we have gone | 9aMAU7C_ymU |
5c3d8e9e3275-54 | remember that was one of them otherwise we have gone for 14 days self-contained operations what is a self-contained self-contained you whatever you can carry on a back okay okay and you survive within that arms and the man George Bernard balance whether you carry chocolates you carry ammunition it's up to you what what is the kind of food that is given these days we have meals ready to eat it's something like what's available in the open market also you just boil it and there's a plow there's a Dal there's a halwa there's a t Russians olden days we used to carry shakar Paras even today my troops like rajputana rifles yards and rajputs they preferas because that would give away smoke and smoke and fire and smells I mean smells so smells so that is not done we generally eat whatever the weight is and some little pickle and generally we prefer to eat it next to a spring you eat you drink your water you wash your hands and the smell goes okay so you | 9aMAU7C_ymU |
5c3d8e9e3275-55 | your hands and the smell goes okay so you move to your next Ambush location so what is the mental preparation that goes into a special forces person like this who knows that he may not come back home it's a again I'll put it there it's a training and second is the buddy system the three things which are very important in any Soldier confidence in himself which comes from confidence in his body confidence in his commander and confidence in his weapon if out of these three people Commander weapon and his partner buddy if out of these three things people or things one is not up to it soldiers moral the confidence will go down I will be very scared to work with a person I'll be very scared to go into an oppression if I knock my weapon may not fire I'll be very scared to go into an oppression if I feel my commander is not you know intelligent enough or professional enough he can guide me into a certain death so three things confidence in your commander confidence in | 9aMAU7C_ymU |
5c3d8e9e3275-56 | death so three things confidence in your commander confidence in your weapon confidence in your body bring in the confidence in you well we have tremendous amount of confidence in you and in in our forces and uh you talked about Bollywood picturization okay you are very active on Twitter and everybody all of us have watched all these series of how the now that's on based on real operations the Israelis have been doing their real operations for many decades we have been doing it for more than 30 years now you think sir uh we can create our own type of for the series based on operations in Kashmir yes why not because point is our oppression the so transparent our patients are so professional our nation and International Community must know how we do it when we go into International seminars with the international defense personnel people walk up to Indian army officers and ask you as to how come you have you know sort of finished the Insurgency in the Northeast and you have curtailed this Insurgency so wonderfully in | 9aMAU7C_ymU |
5c3d8e9e3275-57 | have curtailed this Insurgency so wonderfully in Kashmir the terrorism so they walk up to you with wide open eyes yeah and we need to tell our stories today's world like we're doing this podcast it's basically telling what you feel if you don't tell someone how will he know what is your worth and the younger generation would never know to motivate the younger generation to tell the world of our transparency of operations we need to tell our stories and I think a very good idea and I hope ad GPI is listening and I hope the agnivirs uh are the ones you know I'm hoping that they are listening in into this podcast and jensaf we're going to have you back when your book hits the stands I'm looking forward to reading your book and uh even though you're saying there's a lot which you haven't said uh maybe one day we'll get to know that about that too definitely when the book comes out you will get a personal copy and uh I would love to have once again | 9aMAU7C_ymU |
5c3d8e9e3275-58 | copy and uh I would love to have once again a discussion absolutely after you have gone through it and uh then you can ask more pointed questions absolutely thank you so much for coming here thanks a lot man thank you very much always a pleasure interacting with you thank you thank you thank you for listening in or watching Ani podcast with Smitha prakash please like And subscribe on whichever platforms you have listened to this on namaste [Music] | 9aMAU7C_ymU |
323bbab2a15e-0 | kovid is going to stay for years it is going to live as we are living it may change its character so from government point of view we have to have continuous server lengths in the whole over World it has to be surveilled for till it lasts it is going to last till human being is going to as we are invading into uh jungles invading into Forest new and new viruses are going to come new and new infections are going to come youngsters in the late 20s early 30s late 30s and so on who have had cardiovascular events it is something that can be attributed to both one is that for two or three years people were even scared to go out to the park for a brisk walk and then obviously long covet especially the Delta wave I have also been reading multiple studies that favor the long-term effects of covid on heart health now there's a trend okay I am going full body checkup Labs have got their you know some lab parameters yeah so full body check up | vN8xWECXKiY |
323bbab2a15e-1 | know some lab parameters yeah so full body check up even God cannot check your whole body if these type of full body checkup gives you pseudo confidence one thing that the nation needs to understand is that we are not superhumans and and it is not possible that you called us at 10 45 and if we didn't pick up then it doesn't mean we don't care about you it just means we might be sleeping welcome to another edition of ani podcast with Smitha prakash is the covet pandemic over are the covet vaccines and the boosters that we have taken are they going to keep us safe enough if we hit another wave what about children do they need boosters are the flu shots which they have to take this winter is that going to keep them safe from covet if at all there is another wave what about random tests that doctors seem to be prescribing these days are doctors losing their skill sets just because they have everything is based on a lab-based medical analysis and the therapy is also based on | vN8xWECXKiY |
323bbab2a15e-2 | lab-based medical analysis and the therapy is also based on these kind of tests which are done in Laboratories to answer these questions I spoke with Dr Arjun dang who runs one of the busiest diagnostic laboratories in New Delhi in the podcast is also Dr dhiren Gupta pediatrician senior consultant at the sir gangaram Hospital also in New Delhi thank you very much for speaking with us doctor uh Dr Gupta explained to me at what stage are we in the pandemic in the fight against pandemic uh because there there is talk that you know we might be heading for a fourth wave but then there are some who say that the pandemic is over so there's a little confusion so could you tell me where we are right now yeah uh I'll be explaining in the two ways one is a professional and second is for any human being I'm also human being at my wrong normal human being right Normal public this uh covet is going to stay for years like influenza it is going to | vN8xWECXKiY |
323bbab2a15e-3 | stay for years like influenza it is going to change the character it may come in other form what presently we are dealing with many patients might be suffering from covet but that kovid is not life-threatening that is like a mild influenza in very few of patients it is life-threatening it is affecting their life so that's why people are forgetting it now as a as a professional body if one out of 10 patients still they are suffering from covid right but we are not very much concerned like a patient it comes with influenza or with any virus like RSV virus they are in simple words they are suffering from some respiratory infection some small pneumonia or some asthma has got exaggerated because of that virus we just give symptomatic treatment no specific treatment is needed and when we talk about covid pandemic probably is likely to go in a say month or two month time so pandemic means in the whole world it is spreading so that status likely to | vN8xWECXKiY |
323bbab2a15e-4 | whole world it is spreading so that status likely to go but it is going to stay and it is going to live as we are living it may change its character unless a new virus comes with a sudden change in character with like we say antigenic shift major antigenic shift like which happened in influenza H1N1 came it came with new virus absolutely new and virulent virus which can affect some body part we are not worried we are not majorly concerned so from government point of view we have to have continuous server lens in whole over World it has to be surveilled for till it lasts it is going to last till human being is going to be oh really yes yes yes like influenza normally RNA virus or DNA virus and you have seen the smallpox also came in different way like a monkey pox so as we are in invading into jungles invading into Forest new and new viruses are going to come new and new infections are going to come so | vN8xWECXKiY |
323bbab2a15e-5 | come new and new infections are going to come so we don't know actually human science human doesn't know if you talk about kovid nobody knew about second wave when the second wave in the first after first wave everybody declared oh now we are code free we are clapping we are you know throwing uh Showers of Flowers and all that and suddenly second wave came now following that everybody you must have seen and A to Z person is speculating now another will become another we will come and it has to be true in some way so they will say okay we were truth because we were true because we speculated this way so probably the virus and nature is much more different what we much more faster in evolution than human being about uh you know that this um that covet is never really going to go away but you're a pediatrician so obviously my question to you will be that what about children uh because when the Delta wave came at that time uh you know when the casualty figures came out | vN8xWECXKiY |
323bbab2a15e-6 | uh you know when the casualty figures came out and then there was also this talk that children are not going to get as affected as adults but when Omicron came in in 2022 uh then we saw and then schools reopened so then the number of children affected uh were there now have they got the vaccines have has or have all children across the country got vaccines and what about boosters do children need boosters yeah now first question is regarding the Omicron how it affected the Pediatric age group when we talk about first waveform it didn't affect it directly as a virus viral viral pneumonia but how what happened after say four to six weeks some inflammatory syndrome in form of Mis appeared during first and second wave now came Micron right till Omicron came a pediatric age group was not vaccinated unfortunately what happened during Omicron or just before Omicron when we started vaccinated pediatric age group our vaccine was not Omicron preventive vaccine so it was | vN8xWECXKiY |
323bbab2a15e-7 | was not Omicron preventive vaccine so it was actually waste to vaccinate the Pediatric age group because Omicron was not preventable by those vaccines and the Pediatric age grew specially infants got direct infection in form of upper respiratory tract infection or severe is sort of you can say upper Airway obstructive lesions this pediatric pediatric patient presented with right so there was a difference between the first and second wave that was in form of misc that is multi-system inflammatory syndrome pediatric age group presented and following that in Omicron because of upper respect infection we have seen many infants Landing in hospitalization but there was no misc after a micron so it is little bit complicated for if I simplify the things that pediatric pneumonias were always never been major problem in whether it was Omicron or for second pneumonia it was post-infectious inflammatory syndrome during first two waves and direct upper respect infection in third wave that is Omicron and unfortunately none of the vaccine | vN8xWECXKiY |
323bbab2a15e-8 | is Omicron and unfortunately none of the vaccine even the present context none of the vaccine is preventive for Omicron that's why over the time you must have seen that yet only the children no I'm talking about in general so we don't know what is the vaccine status should we get vaccine in a new vaccine even if the new vaccine which is going to benefit Omicron should we get it done because Omicron is a milder one uh thank you for joining us Dr Dang uh everybody needed you in the city in in Delhi during the wave Delta wave especially uh tell me what has been your learning curve uh during you know this the alpha wave the Delta wave and now uh post that absolutely firstly it's a great privilege being here thank you for having me and I think the entire Paradigm of Diagnostics and especially the learnings that we've had have been Paramount throughout the pandemic and and I still remember that this was just before the Delta wave and uh just like a small | vN8xWECXKiY |
323bbab2a15e-9 | before the Delta wave and uh just like a small example are called volumes of patients calling into a customer care for collections or requests increased five-fold and this was a time when the entire healthcare industry was actually facing the problem of their staff also falling unwell with half the city already infected so I think the one lesson that we got is that you can be dependent on processes but not people and that is where actually Automation and Technology really actually made its way through the front door and I think that was for the positive as well because this was the time when at least the ivd industry or the Diagnostics industry and all of Healthcare in India also Embrace that technology to increase throughput and also serve the masses throughout the pandemic but apart from this also there have been immense learnings and and not only on how to overnight scale up especially during the Delta wave how to use innovative ways to collect more samples report more samples but but also have that process dependency and not be dependent on your people | vN8xWECXKiY |
323bbab2a15e-10 | that process dependency and not be dependent on your people because at that time our staff was themselves a lot of them were getting infected uh doctor you had these mobile testing centers that you know those Drive-In ones they must have shut down after uh right now my one question was that you invested so much in putting those up getting permits because it wasn't easy like absolutely to get those permits to set up those you had those couldn't those have continued I'm going to move away from covet because I've already spoken about covet um couldn't those have continued and you could have done like the other things the lifestyle disease uh checks which you know people don't do it right nobody goes to check whether they have diabetes or not whether they have high blood pressure these basic things are not checked and you know one is reading more and more that India is the diabetes capital of the world and things so these These are drive-through places should have continued so so uh yes so we had four initially out of which | vN8xWECXKiY |
323bbab2a15e-11 | uh yes so we had four initially out of which two are still functional and like you said both of these are currently being used for routine Wellness testing and what has actually happened over these months or years is that the patient's mindset or the consumer's mindset has become that they don't want to enter a big big Health Care institution or a hospital or a lab to get there sample done so a lot of people actually prefer just driving by in their car and getting their samples done from the car only so till date we still have two of these open in South Delhi only and one in West Delhi and where a lot of people make bookings and come in and at the end of the day for us it's the patient satisfaction and that feeling of safety that they get and being inside a car obviously reduces this exposure and maximizes safety for the patient just to be sitting in their own comfort in their safe Zone in the car and do all their tests and like talking about these | vN8xWECXKiY |
323bbab2a15e-12 | and do all their tests and like talking about these non-communicable diseases like diabetes hypertension Etc as well now what we have seen is that throughout the pandemic all of these have been on the back burner for a lot of people and obviously with that apprehension of not being able to or wanting to step out to a hospital or a healthcare space they've just ignored it even if you look at the incidence of cancers even the incidence of blood pressure autoimmune diseases diabetes hormonal diseases all these are really flaring up now because people have obviously ignored them past the 24 36 months of the pandemic yeah uh Doctors Hospital thousands of people come per week I'm sure you uh you cannot tell your patients like your hospital also right you have so many patients that you see uh this is a problem that that everybody is facing uh they don't want to go to the hospital after this fear of you know hospitals do you see that but you know whether as a pediatrician | vN8xWECXKiY |
323bbab2a15e-13 | see that but you know whether as a pediatrician physically so what is the solution then how do we deal with this issue of crowding in hospitals first issue as a doctor if you ask me this phone calling and taking advice I hate this one though I did a lot uh phone calling during Kobe time that was different we were dealing with just one disease standard parameters are standard problems we know what is happening in this patient right I did lot of adult kovid right in thousands not in hundreds per day I remember for three days I couldn't take bath during just because of kovid adult kovit calls right even though you're a pediatrician I started taking round in adult kovid Ward I used to be alone and nobody knew the treatment right even so I I got myself attached to the kovit from the beginning so disease evolved in front of me so with the help of a lot of my friends who do adult who were adult physician so I trained myself right one thing is that | vN8xWECXKiY |
323bbab2a15e-14 | so I trained myself right one thing is that second now we come to this uh electronic calling or you know online calls and all that as a patient you are going to be at major loss if you don't show your yourself physically and just take a call just taken a suggestion from a doctor write advice from a doctor not showing them physically and Googling doctor is that also that is that you know the answer right no no I need to know how is it what happens what happens uh first I'll talk about this online calls ninety percent of the things do settle when you talk to the page doctor or patient in front sitting in front of you look at the eyes and patient examination you touch the patient over the time people look at the MRI CT scan X-ray and they don't touch the patient they don't talk to the patient and that's why patient also feel dissatisfied so I always feel that this should not be done so if patient is in front of you you talk to them socially | vN8xWECXKiY |
323bbab2a15e-15 | is in front of you you talk to them socially you talk to them medically you take them proper history you write your notes and then you move ahead right then you can take another phone call that okay what has happened how are you and unless I don't see them once physically it's very dangerous for the patient to just have call and get the treatment get the investigation lab should come after they have consulted a doctor physically not just online that Kobe time is gone now yeah now the second question what you were asking last one the Googling that people are Googling the problem with the Google is like like like I diagnose the disease it said it's a temporary or it's not a I'm not sure it is just a speculation of a doctor that you are suffering some disease and you start googling in Google what they will catch 10 percent of the complicated disease process they will come as a first so you will be dead scare going through that and 90 percent disease is going to | vN8xWECXKiY |
323bbab2a15e-16 | going through that and 90 percent disease is going to be mild right so you are you are opening a dead pandara box a scary Pandora box for you as a normal human being as a population and then you become panicky and then you gain start uh you know window shopping for a doctor so you are going to spend unless a cc money you are going to produce anxiety and without any actual disease which has got some complication so you are suffering from the milder disease because of Google you have made it dedicated right so definitely you should avoid I am not talking about as a doctor myself I've seen a doctor prescribing some medication I Googled the medication and I found it dreaded side effect in the front and I did not took it then I went to the doctor I told him and I am consuming that same medication for past three years so when it can impact a doctor can you imagine a normal human normal population uh Dr Dang I'm going to ask somewhat | vN8xWECXKiY |
323bbab2a15e-17 | population uh Dr Dang I'm going to ask somewhat similar question an offshoot of what he has said you know this uh the connection between diagnosis and therapy and that doctor spending lesser and lesser time and maybe this is what patients say let me tell you I mean you may not agree with that but patients say that doctors spend lesser time with them I can understand when it is a rule setup when a doctor has you know literally dozens of patients to see in a day the the pressures are too much but then uh patients say that where doctors spent time with us touched as as Dr Gupta was saying touch the patient he needs to do that because he's a pediatrician but the Lesser and lesser time that doctors spend and more more dependence on labs and for tests right that that whole connection where the therapy is based on your tests which are done and lesser on on clinical examination clinical examination absolutely do you see that in your uh absolutely so a very interesting question and I | vN8xWECXKiY |
323bbab2a15e-18 | your uh absolutely so a very interesting question and I would say that there are both sides to the coin on in this and me being from a family of doctors I I saw my grandfather who was an MD physician and he was the doctor during the partition days he was an mbbs doctor but the amount of knowledge that he he had and the amount of skills of clinical General examination WhatsApp was talking about that he possessed probably in that time with no Diagnostics available was at another different level I've seen your dad while I'm sorry to interrupt you I've seen your dad while walking in lodhi Garden people would stop him and say kid doctor and you know this is what happens right I think doctors whenever you people go out even for dinners or whatever free May advice no I completely agree so so when uh my dadaji he was an mbbs but the amount of skills that he possessed without any dependence on any Radiology pathology etc those days in in the 1940s and 1950s so obviously | vN8xWECXKiY |
323bbab2a15e-19 | in in the 1940s and 1950s so obviously the skill levels were very high but I also feel that post that 1986 consumer act that was passed where anyone could literally go go to the court and say that okay there's this medical provider and that they they diagnose this without any documentation post that doctors have also started asking for a lot more tests to document the diagnosis and then have management based on that documentation so that has also increased the Diagnostics but at the same time I heard this terminology called hyposkelemia so our generation doctor is now are so dependent on just reports and Diagnostics and technology-based platforms to to actually advise the patient like so I was saying that they don't really give value to actually examining the patients has also happened but again the flip side is that I feel that's a very good thing as well because you're not firing in the dark you have your clinical skills you have your clinical examination at the same time you have the power of science to overcome everything | vN8xWECXKiY |
323bbab2a15e-20 | time you have the power of science to overcome everything else and then have pinpoint treatment based on the precise the diagnosis that you get right Dr Dang I agree with you and I think uh you know when we used to hear in the 80s that you know in America uh medical uh costs were so phenomenally high and insurance that doctors needed to take and that's why you know doctors moved from private practice into hospitals because you know if there is a medical legal case you're stuck you you don't have the insurance of that level to deal with it so that time we used to sing Chalo babre at least but doctor you were saying about your brother who's also a doctor and practicing abroad and uh do you do you see that now in India too that because of these medical legal cases and things like that do you feel that your generation of doctors also now has they have to practice from these big institutional or big players in the market who can protect you legally because you know if | vN8xWECXKiY |
323bbab2a15e-21 | market who can protect you legally because you know if there are cases against you it's hard to fight it uh you know Frankly Speaking if you ask him personally I am Bland of the old thoughts and the new investigatory approach right so unless you classically manage your patient clinically you should not get the test done especially in pediatric age groups are very sensitive they are like very innocent kids right right whether it's a family anxiety or whether it's a doctor anxiety am I missing something you are subjecting a innocent person for a test and next time he will be dead scare of the Medical Science so you are in you are actually imposing a scare that is going to stay a trauma in in a child who is very innocent so it's a double s food like as a doctor Dr Dang said yesterday there was very busy cleaning as I told you I take 10 feet from 15 minute per patient I don't in hurry whether it is going to take 8 PM 10 pm there | vN8xWECXKiY |
323bbab2a15e-22 | it is going to take 8 PM 10 pm there were lot of fights and two patients said that we are in hurry we have to leave something I told them that I cannot hurry up just because I want to see you early because problem is with me I am going to miss the diagnosis right and it is a loss of the patient it is never a loss of a doctor I'll feel bad so what I found another thing I want to add as I told you when you go to some marriage party people will come doctor is you tend to give some advice that advice is without examination without putting your brain and that is going to harm this patient why this casual advice you can say you are many miscarriage diagnosis secondly investigations if you something like a full body checkup now this is a trend okay I am going full body checkup Labs have got their you know some lab parameters yeah so full body checkup even God cannot check your whole body when he build your body there will | vN8xWECXKiY |
323bbab2a15e-23 | your whole body when he build your body there will be some fallacy there will be some deficiencies these type of full body checkup gives you pseudo confidence what happens you got your full body checkup just a biochemical there are millions of chemicals they are not just hundreds of chemical this lab is going to check there are millions of chemical so first of all you should get consult a doctor get him physically examine get your examine then you get your Labs so this is the problem there has to be blend between the clinical and laboratory only then I feel that we'll have best of the signs doctor we just talked about you know I just touched upon it which I want to come back to uh was about these uh tests for uh diabetes you know and I want to come to this thing about diabetes in children uh I have seen many instances where a parent said whether it is obesity or whether it is diabetes and then by the time the child hits 18 diabetes is already set in right is | vN8xWECXKiY |
323bbab2a15e-24 | child hits 18 diabetes is already set in right is it something thing that we need to do much more maybe at school level testing or what is it that how do we stop this uh issue so we know that India is you know there's a capital of diabetes World capital of diabetes and same I found that past three years either because of Lifestyle either because of covered antibodies either because of too much eating and sitting sedentary work the diabetes on rice and second disease is tuberculosis we it says again come it is the massive rise in tuberculosis casein I'm talking about Good families I am not talking about just uh you know exposed to Chulas and all that not just that no so these are the two diseases which I have got other than vitamin D deficiency autoimmune disease and so blah blah but I'm I'm talking about these three diseases vitamin D deficiency psychological diabetes and tuberculosis this is on Rice reason could be what I told you and what doxub has | vN8xWECXKiY |
323bbab2a15e-25 | be what I told you and what doxub has elaborated in and we not only need to test some way somehow [Music] so they copy you right so we need to check ourselves also and unfortunately most of the homework is on WhatsApp so they get excuses when we adult can just get distracted because of phone think about kids who have got immature mind yeah right so it gives you power but it takes part of concentration also the phone that is the major problem so what I feel that of course we should cache them as early especially at 8 10 years old child we should catch them and lifestyle diseases it is a totally preventable disease even if the family is full of diabetic you can delay it you can delay it and even if you are having diabetes you can have best of the lifestyle look at the vasi makram he's also diabetic look at how he plays how fit he is right yes so over the years probably awareness is very important Among Us and India why because all | vN8xWECXKiY |
323bbab2a15e-26 | is very important Among Us and India why because all mothers are you know pamper their kids like anything food is a substitute for everything food is the religion food is uh you you can say a way to pamper our guests Dr tank I want to come uh to ask you know to take it forward from where he was saying uh you know you're a young doctor lifestyle diseases as Dr Sab was saying is something that we are bringing it upon ourselves whether as parents whether as whatever you know professionals because we are hard-pressed for time do you think you see at least when I was in school the medical room that you had was only for injuries absolutely nothing more than that at least in my generation there were there were the teachers were only interested there was nothing beyond that like the school didn't look for that whole well-being concept is not there and my generation I think the the wrong things of eating the wrong lifestyle started from our school and college days nobody told us you know those kind | vN8xWECXKiY |
323bbab2a15e-27 | college days nobody told us you know those kind of things were not there what are you saying do you think that schools need to be more proactive when it comes to you know a healthy lifestyle right from you know preteen uh onwards what do you think absolutely I feel I feel that your younger days whatever is imbibed in you like you were saying stays with you for the rest of your life and in in your curriculum to have something that talks about healthy habits that talks about how to prevent diseases when you're older how to actually spread that awareness also among your fellow beings and classmates I think that's very important but also I think we have technology again favoring the youngsters like like I see you're wearing a wearable watch on your on your wrist that will actually measure your pulse and that will measure your glucose and that will measure your heartbeat and your various things so I'll tell you yes it came to me only when after I had a very severe attack let me | vN8xWECXKiY |
323bbab2a15e-28 | when after I had a very severe attack let me be honest with you it came when I had a very severe attack of covid with uh during the Delta wave and it was then that I was told okay you know you get to I've never checked so so exactly so I'll tell you a small story about an NBA player in the US and I recently read it and there was this person who was wearing an Apple Watch and he was playing basketball and he had an arrhythmia rhythmia is something like an irregular heartbeat and he's one of the most fit athletes but he still felt it but his watch actually showed a notification that please see a cardiologist so he went to the cardiologist just listened to this the cardiologist diagnosed him with something that we call as hypertrophic cardiomyopathy this is a disease that happens most commonly in athletes post their diagnosis they did a genetic test for three of his brothers out of which two also had hypertrophic cardiomyopathy they | vN8xWECXKiY |
323bbab2a15e-29 | of which two also had hypertrophic cardiomyopathy they didn't know yeah so they took the preventive steps the treatment and now he's perfectly fine so this is how something as small as an Apple Watch on our wrist or any of these watches that we have can can give a notification that can ultimate Italy actually save lives multiple lives mind you so this is again something that the youngsters have inculcated obviously like doxa was saying obviously there are more phones than WhatsApp but then this the Silver Lining to that dark cloud is that yes from your younger days only if you are more proactive about these different health conditions I think it can go a long way yeah Dr it's up this is very important I think specially with younger children you know those who are smart enough to understand to know that something is happening to them like you know I know of a friend whose son is a is a teenager and uh at some point of time he called up his mother who is who's also a | vN8xWECXKiY |
323bbab2a15e-30 | he called up his mother who is who's also a physician mind you and he called her up at the workplace and said that I think I need to be taken to the hospital so she said what happened saying I haven't told you but I have been taking this x drug for uh for Sleep which I didn't tell you but I have taken this and I think I have overdo post now you know while we were talking earlier uh doctor about you know Googling and the negatives but this child could figure out that what he has done is he could figure out that he has taken the route so you know he was taken and there was a stomach wash and everything was cleared but sometimes technology can affect do you I think it is it has to be Bland of both both right and regarding technology it has become so easy to get and so easy to be used by people like I do respiratory I take care of respiratory diseases in pediatric patients and allergic diseases but I | vN8xWECXKiY |
323bbab2a15e-31 | in pediatric patients and allergic diseases but I have found that now everything is portable if I want to do uh regarding this something known as adenoidal hypertrophy that is tonsil and that can lead to decrease in oxygen deficiency in the night and parents won't come to know that your child is actually suffering from this disease no yogurt pulse oximeter in every home correct you just apply your pulse oximeter to a patient to a child who is having some nasal problem some snoring problem or some sleep restlessness in the night and you will be able to diagnose oh my child is suffering from actually a major problem which is not very much evident in the daytime so I mean to say this type of Technologies are available and every each this kovid has taught us that technology has got its own uses and and people and kids are very smart means I have got two kids one is in IIT roorkee he's just entering he's very smart he knows that how to take care of his | vN8xWECXKiY |
323bbab2a15e-32 | smart he knows that how to take care of his health and what type of diet should be I should be using and and more than the parents you know if family says parents says it won't affect them but the social media especially peer group pressure that I've got good physics you what you have so probably that has that takes them to different level which we cannot imagine so there is positive there is negative but the problem is of the immature mind of say 10 year 80 year old child that is a pro that is the population which is very immature right but they take negative out of the positives so if you're talking about young adults your son uh and you know that they are aware but Dr Dang even I mean I would ask both of you you know uh young adults suddenly getting these heart attacks and dying in a gym dying at work uh everybody's saying that there seems to be something uh inexplicable is this like long covet what is happening why so many young people who show | vN8xWECXKiY |
323bbab2a15e-33 | is happening why so many young people who show no signs of ailment suddenly just dropping dead so it is indeed tragic and shocking also and there have been youngsters in the late 20s early 30s late 30s and so on who have had cardiovascular events and I think it it is something that can be attributed to both one is that for two or three years people were even scared to go out to the park for a brisk walk so their exercise their gym their games everything actually reduced drastically so that would be one and then obviously long covet especially the Delta wave and pose that when we got a lot of people that had prolonged symptoms for over over three to six months I think that has something to do with do with it I have also been reading multiple studies that favor the long-term effects of kovid on heart health and it can probably be because of both that's what do you agree Dr Gupta and uh what is the solution because as a parent you are you know | vN8xWECXKiY |
323bbab2a15e-34 | the solution because as a parent you are you know your son is an IIT you say so the pressures must be so much on him uh in addition to you know his his uh course that he's doing this also like you said peer pressure everybody wants to look good it's a it's the Instagram age so everybody wants to be fit look good there is that pressure and then you also I'm sure you know you have pre-teens who are your patients so this this whole thing how much of vitamins are people pumping in and all these supplements this is a very dangerous Trend I mean it's good in a way that they are aware that they need to be healthy but this vitamin pumping all this is how is it how detrimental is it one terminology is overdoing overdoing is harmful right one should know one should recognize their own body on capability strength and weaknesses right and something like as the parents you always feel that the you know right height right and so family and pediatric when they | vN8xWECXKiY |
323bbab2a15e-35 | right height right and so family and pediatric when they look at the social media I should look like this they should know they have got some strength and some weaknesses if we overdo the things right then you'll end up in problem so why it is happening because of social media everybody comes to know that 40 year man 27 year old man is a popular I died because of exercise and gyming now that is the undue pressure over that guy he he tried to become uh try to match some other person but he forgets his own capabilities strength and weakness right so that is the problem so you try for 20 30 years you were just a sedentary person suddenly because of social pressure you start looking okay 22 kilometers but if you are forgetting he has got different genetic makeup I put different genetic makers right my capability for 30 years I was just a sedentary worker all of a suddenly so this uh this is going to happen so that will help so one should know their limits so it | vN8xWECXKiY |
323bbab2a15e-36 | will help so one should know their limits so it should not try to match some other person and one last point I want to add genetic is something that is poured in in the Medical Science and money diseases in many patients who have got some death unknown death in the family they should counsel the genetic genitist and they will get you the idea okay you can get sequencing genomic sequencing or something so so that we can predict that you have also got some problem which can lead to sudden death like cuties and from some problem in the ECG some problem in the heart which is not apparent but can become apparent if you are exercising if your stress in the stress so probably we should consult a doctor if something has happened in your family like a young person has died and that will help you in future Dr Dang then who should one go to like if as Dr Gupta said that you know you're feeling you're feeling this uh that so and so has uh your cousin or | vN8xWECXKiY |
323bbab2a15e-37 | that so and so has uh your cousin or your sibling or somebody has passed away due to a heart related issue you need to go to your GP how do you get to know that it's a genetic disorder or whatever so a genetic disorder essentially can either be lifestyle related like doxa was saying cvd that's a cardiovascular disease or it can also be what is actually more known to science today is an oncology ailment that someone's had in the family especially if if someone's had a breast cancer or there's a male who's had a colon cancer then obviously our oncologist will guide you in a lifestyle disease your physician will guide you you to go go to a suitable person a person who can tell you exactly about the diagnosis earlier and what test is required for you also there is precision medicine now that is very interesting and as per the makeup of your genes the medication that you are being given will be suitable to that like what Dr Gupta was | vN8xWECXKiY |
323bbab2a15e-38 | be suitable to that like what Dr Gupta was saying now even for diseases like obviously for cancer Etc it is very personalized the treatment depending on the the signature of the cancer and your genes but also apart from that you have even medication for diabetes even other autoimmune disorders where it's actually tailor-made so that it suits you well so this realm of science is called pharmacogenomics so again there is this is this huge area that that is being we are waiting to leverage it so that we can get the maximum benefits from it Dr your hospital where you work the there are thousands of people who come uh every week and you you know literally dozens of patients that you need to see but in spite of telemedicine in spite of us having so many hospitals and all we still have a shortage of doctors in this country we still have patients who have to come in from Villages camp in cities and you know one had thought that things will change but it's still uh | vN8xWECXKiY |
323bbab2a15e-39 | had thought that things will change but it's still uh there it's still that Primary Health Care facilities are there in our Villages but when it comes to you know having these these complicated tests as you were mentioning uh Dr Dang we still need to come to cities the major metros actually the problem is with the primary health what is happening we don't have good infrastructure in The Villages like many of my colleagues I'm 53 so many of my friends now I have settled in Australia Villages they opt to settle in the village you ask your child you ask your you know growing child who is in medical science tell them that go and serve in the village nobody will agree yeah right there is some problem what is a problem you don't have good infrastructure in the village nobody wants to go there now unless we have got very strength and Primary Care will require tertiary case like our Hospital actually if you look at Sri Lanka now they are in a problem due to different reason but | vN8xWECXKiY |
323bbab2a15e-40 | they are in a problem due to different reason but they have got very good Primary Care at primary lab level if you are able to tackle the situation with preventive medicine is always better than it cure better than the Cure you cannot cure most of the disease like even if you are having genetic disease if you have a genetic predisposition for cardiovascular disease but if your lifestyle is perfect right from the infancy then probably despite of predisposition you may not have symptomatology later on right so preventive medication is unfortunately lacking in India at all except few vaccination right so we need to have we need to have good infrastructure in the at the Village level and good infrastructure not MediCal infrastructure I am talking about in general infrastructure wherein person can live suitable life uh Dr Deng corporates are entering into uh you know into the whole Hospital scene and into the diagnostic scene does that mean that this problem which Dr Gupta was talking about where you know in villages | vN8xWECXKiY |
323bbab2a15e-41 | was talking about where you know in villages we don't have Primary Health Care Center do you think that once corporates come in and they're given incentives to set up these uh Primary Health Care Centers and diagnostic Centers do you think things will improve with that absolutely I think more than this being a destination about strengthening time Primary Health Care it's for our country it's going to be a journey and I think a very vital step in that journey is going to be the larger players like these corporate Hospital chains actually penetrating this tier two tier three cities in small smaller areas where there is a dearth of these Primary Healthcare facilities now also what's very important apart from setting up a brick and mortar kind of a structure where there is a suitable doctor and a healthcare staff is also awareness initiatives now also in in rural areas in villages that are simple thing things like pap smears for cervical cancer for ladies and other simple tests like a PSA test for | vN8xWECXKiY |
323bbab2a15e-42 | and other simple tests like a PSA test for an elderly male like what uh what Dr Gupta was saying that prevention so that at least instead of this entire system or ecosystem where it's all about sick care we actually flip it and make it more about preventive care or well care like we call it so that we have minimum people who are actually falling sick so yes awareness education like what you were talking about and also penetration into these rural areas by these bigger corporate chains who can provide that brick and mortar and a doctor I think are all a part of the picture okay Dr Gupta I want to ask you about this what is tomato flu there was this whole panic situation one is the Tomato flu and the other one was monkey pox has it come in is it coming was it right uh the Panic that was setting in actually you know um media and people are more aware if some negative news gets in or some catchy name like tomato like monkey right here so | vN8xWECXKiY |
323bbab2a15e-43 | catchy name like tomato like monkey right here so monkey actually monkeypox right or monkeys start with the 15 monkeys um all right uh Dr Ryan we've spoken so much about patients about children everybody now I have to ask you about the health care of doctors you know uh you read in the paper sometimes that doctors are under severe pressure and uh some have even committed suicide you know because now tell me uh what is it about you know doctors falling ill like this having mental pressure that they can't cope can't doctors see for it I mean it's a very basic question that a doctor should be able to tell you know that he's or she is slipping into some kind of a depressive State and needs help do doctors hesitate in seeking help or hesitate in accepting that there might be something wrong so very pertinent question and I'm glad we are getting a chance to discuss this but I'll divide it into two parts one is through your mbbs and your mdn residency days now obviously | vN8xWECXKiY |
323bbab2a15e-44 | mbbs and your mdn residency days now obviously during this time especially or mbbs and your md the curriculum is so robust and so stressful along with the classes that you have to attend I think that that pressure of the exams like you have your board exams Etc this is probably probably multi-fold and there's so much at stake especially like again what Dr Gupta was saying about that peer pressure that everyone wants to do well so I think it is more of actually inculcating that mental health chapter in all mbbs and uh and and medical students so that they can actually understand what is mental health and also have that uh that service that if someone wants to reach out to someone they should have that accessibility so that they can get counseling they can get therapy and so on and so forth and I I really feel that is lacking in the current Indian medical institutes that we have you must have done your PG after several years after Dr Gupta is done uh did you have that kind | vN8xWECXKiY |
323bbab2a15e-45 | Gupta is done uh did you have that kind of in your Medical College was there anybody reaching out no nothing we had our fixed academicians our teachers professors batchmates Etc but I I don't call any anything being so accessible like the way I feel that it should be with all these strategies that these uh tragedies that we are hearing also now coming to the flip side now um even with practicing doctors I think one one thing that the nation needs to understand is that we are not super humans and and it is not possible that you called us at 10 45 and if we didn't pick up then it doesn't mean we don't care about you it just means we might be sleeping or it means that we might be in the middle of dinner or something important so I think it's it's also that expectation that where especially in a country like India like abroad have a lot of friends in the US in the UK and five post five PM they are off for work but here I think | vN8xWECXKiY |
323bbab2a15e-46 | PM they are off for work but here I think it's also the immense amount of passion that we work with that even if it if it's 8 30 and if you're sitting with your own family and someone calls you your family also wants you to pick up because a one minute call that you have with them it's probably gonna put them at ease and help them out the entire night or maybe a day so I think that empathy and that passion together is what fuels our fire but I think that will eventually take a toll on it yeah and I think accessibility to the right therapist or somewhere where you can be heard I think it's critical again and obviously a very important work-life balance is something also that all doctors should maintain having Hobbies or playing a sport I know easier said than done but that is the need of the hour Dr Gupta I'm sure there is no work-life balance that you have you as a pediatrician I'm sure you need to be available or you | vN8xWECXKiY |
323bbab2a15e-47 | I'm sure you need to be available or you are available to your patients I will say that I'll spoiled my whole life if I talk if I try to follow and I didn't follow even one person one percent of that and I have paid for that the right and and all life not lifestyle lot of problems but what I would like to see like right from the mbbs and first of all I totally agree with him totally agree with him and just I want to add extra that's 60 percent of curriculum should be removed from medical science like for a mbbs doctor why I need to find out what is happening in the cell on under the microscope when I am not going to chase a histopathology as my curriculum right hmm so these type of unnecessarily unnecessary burden over a brain brain is a brain right right it has got limitation we should try not to over test it so in India already we are over populated so for one seat there are 25 000 candidates yes over and above you are | vN8xWECXKiY |
323bbab2a15e-48 | are 25 000 candidates yes over and above you are giving unnecessarily which are not going to unnecessary curriculum it's 60 percent if it's just rubbish 30 percent is scanning history just you want to carry the Legacy but doesn't burden the things by giving the medical history as a 30 of the curriculum secondly there are something super Specialists need to know why you are talking why you are telling the ambious person to cram up the things which doesn't have practical implication for at least next 10 years for him so my feeling is that many of the things because my other son is doing mbbs he is in final year he is he's a very mature guy he's you know I've found that he's much much more mature when I was if I compare myself when you were studying when I was in final year but almost 60 percent is the curriculum should be removed immediately right the professor should now should come in the actually in the public domain and should try to reduce their uh the burden | vN8xWECXKiY |
323bbab2a15e-49 | domain and should try to reduce their uh the burden of the whole society Medical Society Dr Dang you were saying about how you know uh in America or in the UK or in in any of these Western countries patients don't call up the doctors in the middle of the night and all I'm sure both of you get calls and I mean we are all guilty of doing it I wouldn't say just you know the random people are even I have I'm guilty that I could I could have waited till next morning to call up my doctor but I need to know now okay you know and especially I think uh Dr Sab I will say to you because in India at least are always available 24 hours I'll ask you Dr sub and then I'll come to you uh Dr Dang yeah I should know okay when I should seek a doctor in a clinic second when I should seek a medical facility so in an emergency suppose pediatricians 24 hours 365 days I totally agree because you need medical facility but you should | vN8xWECXKiY |
323bbab2a15e-50 | totally agree because you need medical facility but you should go to a hospital an emergency foreign foreign foreign 48 hours and then drive several hours away get that covered negative and then suppose your flight got delayed and I was like you know boasting so much like you just need to go didn't you feel at that time a sense of Pride that at least we had those facilities at that stage no I think I completely agree with you I think the healthcare ecosystem in India is should be praised more especially when when you look at the availability and affordability and also the accessibility to a doctor I would say Obviously rural areas and I'm not talking about year three four but at least the major academic problem no but yeah absolutely but now if you compare say a big city like a London for example to a Delhi or a Bombay you will see a striking difference now the cost of the same test there is about 10 to 15 times of a simple blood test the same blood test that you'll do in | vN8xWECXKiY |
323bbab2a15e-51 | blood test the same blood test that you'll do in Delhi versus what you'll do there I can vote that if you get it done from a good lab in Delhi I would say that is more reliable like if you were to just tell me in say dollar terms because we've got viewers listeners who live abroad like in dollar terms one test here and one test in say the US okay so so this was uh this was basically a few months back and I I had a friend who went and got a covet antibody test done there and they wanted a fisa vaccine so there I think it cost them some 800 US dollars for the same test that happens here for a thousand rupees 1000 1500 rupees so yeah so yeah exactly so you're doing do not even compare this exactly so yeah but there's also a point that all almost all testing there is Insurance driven and here it's out of pocket so is this going to happen here to do you see because I am seeing like | vN8xWECXKiY |
323bbab2a15e-52 | here to do you see because I am seeing like we were talking about this whole thing about you know you have to get tests done these days and then there is the whole malpractice thing do you think it's going to happen here too where tests could become so phenomenally expensive or because of corporates coming in will be will it become cheaper what is going on so I think I think that's a mystery that we we have to we have to wait and watch but but I do feel that uh with this uh entire industry having that picture of lucrativeness because of which you have your Pharma players you have your uh corporate hospitals you you have a lot of these e-commerce players now entering Diagnostics I think eventually in in a few months or a year or two the bubbles going to burst now what the the masses also need to understand that the same test now everyone experienced that with the rtpcr you have the same little card kit that you use at home that's the antigen | vN8xWECXKiY |
323bbab2a15e-53 | kit that you use at home that's the antigen test that is not at all as reliable as the gold standard that's the rtpcr and that's a fraction of cost of the RT PCR but in the end the report will say covet negative and positive so that's same test can be done in dozens of different ways at different quality benchmarks so obviously that is something that the end consumer of the patient will also eventually understand Dr just before we conclude I have to ask you Dr sub uh uh [Music] do we have to give kids flu shots do we have to give Elders flu shots and because the symptoms you know of flu and covid are so similar so flu shortly yes yes yes flu and it is a preventable disease and especially high risk cases your innate immunity and it should it will help I would last comment on what he said there are two things quality and quantity India is just Indians and India economy is based on quantity not quality unfortunately what is going to happen like you | vN8xWECXKiY |
323bbab2a15e-54 | quality unfortunately what is going to happen like you get in CT scan for the chest is carries huge radiation it should be of the best of the center with the best of the quality but if you get that CT scan of very low quality though it cost by even if cost doesn't matter but instead of ruling out the disease quality is so so bad that you cannot get another CT scan and the patient will land up in major problem because you were you were dealing with a poor quality investigation and the purpose of that investigation was not served so again what he said that too many too many investigations given as a package just to lure the patient rather than focusing on high quality Limited Test right is going to backfire very soon okay and it is backfiring many of the patients foreign possible for this whole set of questions that I have for you regarding what we need to do you know during the Winter's uh you know when we when we are heading towards this period thank you very much thank you | vN8xWECXKiY |
323bbab2a15e-55 | heading towards this period thank you very much thank you thank you for having us thank you thank you for having me thank you for listening in to a i podcast with Smitha prakash like or subscribe in whichever platform you listen to this in namaste thank you [Music] | vN8xWECXKiY |
46d8282a8b56-0 | first myth I want busted is that pollution affects only lungs it's wrong pollution affects every part of the body from brain to toe pollution starts impacting us even before we are born today a child born in a polluted city becomes a smoker from the first breath of his life next 20 years India is going to see an epidemic of lung cancer air purifiers masks etc etc are knee-jerk reactions smog Towers whoever is proposing them they've been put up with Fanfare in the city of Delhi they are a huge waste colossal waste of public money letting this human right clean air be the election issue for 2020. you are watching or listening to a i podcast with Smitha prakash today we have with us Dr arvind Kumar chairman of the Institute of Chess surgery chest onco surgery and lung transplantation at medanta hospital and founding and managing Trustee of the lanke foundation now I spoke to him about a whole host of issues which include uh you know | uEFsXpXA8Qs |
46d8282a8b56-1 | a whole host of issues which include uh you know children and the elderly suffering from lung Related Disorders because of pollution now you know the the frightening thing is that when you are looking at the statistics the data which is there doctors say that 80 percent of most Lung Care patients that they are seeing today are non-smokers they they used to be smokers in the 80s but now they're non-smokers so what they saw as pink lungs of babies uh in the 80s and in the 90s also now kids as soon as they start as soon as they take the first breath of air especially in North India they become smokers so by the time they are in their 20s they are like heavy duty smokers and they have those what used to be known as smokers lungs simply because they are breathing what happens do lawmakers not know about the situation that we are in we as parents as as young adults we are all concerned about our children about our parents uh how do we | uEFsXpXA8Qs |
46d8282a8b56-2 | about our children about our parents uh how do we protect them and protect ourselves and some of us who've had covet we have already got compromised lungs now so we whether we were smokers or whether we were fit and energetic we are all suffering from lung Related Disorders and if we do not sort it out we are looking at an epidemic in a few years time a cancer epidemic in India these are questions that we discussed in our conversation each one of us is is affected whichever part of India you are living in we are all affected and even if you aren't living in India if you have relatives and friends who are living in India they are also vulnerable today so listen in to my conversation with Dr arvind Kumar thank you very much for speaking with us Dr arvind Kumar um the first question I have is you know uh when I was as a parent as as someone who has an aging parent in-laws you just tend to worry about air pollution and the effect it | uEFsXpXA8Qs |
46d8282a8b56-3 | to worry about air pollution and the effect it has on vulnerable groups you know if you have a parent who has diabetes or if you have diabetes or you have children with lung Related Disorders like asthma the pollution in North India thanks to or no thanks to this paraly burning and things it's become so chronic the past couple of years you at least I feel that you know like when I go for a seminar or conference you're continuously hearing people coughing in the audience if it's not India you go and address anybody abroad or you address anybody in Northeast India or in uh in South India that issue is not there but North India it's like everybody is having some kind of you know this chest congestion cough and related issues as a doctor you tell me how do we handle this Smitha first of all thank you very much for having me on this podcast it's indeed an honor for me to be doing this podcast with you thank you sir coming to pollution | uEFsXpXA8Qs |
46d8282a8b56-4 | podcast with you thank you sir coming to pollution issue it's a very very important issue not just for the present generation but more importantly and sadly an aspect not adequately highlighted it's a vital issue for our next Generation Now why do I say that I say that because when we breathe in 24 hours we breathe 25 000 times in the process inhaling about one ten thousand liters of air every day and when you have toxins present in this air they go into our lungs from the lungs they get absorbed into the blood and through the blood they go to every part of the body from head to toe so first myth that I would like to burst through this podcast is that pollution affects only lungs right no big no lungs are the portal of entry for the pollutants into the body but once into the body they affect every organ so that's myth number one busted because of the blood uh yes so so when they go to the lungs and especially these smaller particles | uEFsXpXA8Qs |
46d8282a8b56-5 | go to the lungs and especially these smaller particles and the gases they reach up to the periphery so the same site from where the oxygen absorption takes place these toxins also find their way into the blood okay and they come to the heart and then they get circulated across the body so somebody who may not have asthma or any lung related disorder but has a heart issue is also a victim of of pollution now because that polluted blood is coming to the heart and the heart not being strong enough to pump fresh blood or good blood or whatever cannot get rid of the toxins right am I simplifying that you're simplifying it I'll come to this point so the first myth I want busted is that pollution affects only lungs it's wrong pollution affects every part of the body from brain to toe that's one two most of the people feel that pollution affects adults because we are on the roads and outside more often and therefore it affects the sad and I will repeat | uEFsXpXA8Qs |
46d8282a8b56-6 | therefore it affects the sad and I will repeat this word s-a-d sad the sad part of the story is pollution starts impacting us even before we are born oh there is data available now that if a pregnant mother breeds polluted air the pollutants from her blood cross the placental barrier and go to the child whose under development in her uterus and starts affecting that child if it's first trimester it affects development of organs and thereafter growth so from congenital malformations to intrauterine growth retardation to premature delivery to death inside the uterus all these are being reported recorded with higher incidence in polluted cities in pregnant women than in non-polluted city so it's not just cities right because uh yes in cities we have when I when I say cities I mean areas let me correct myself not cities because it's not a city specific problem this problem now is becoming as rampant in The Villages the causes may be different but it impacts people in villages as well | uEFsXpXA8Qs |
46d8282a8b56-7 | different but it impacts people in villages as well because of a coal burning or using food as so there the cause is a use of solid fuel inside the households so when the lady will cook the food on a Chula inside a room big room the smoke fills up the room and people who are sitting in that room who are usually the elderly people of the house and the little children who are sitting near the Chula they inhale and it has been shown that the particulate matter levels may be as high as 25 to 30 000 per meter a millimeter cube in these smokers because uh traditionally The Way Homes were constructed in India there was no concept of open kitchens or ventilation in the kitchen so even in a large house you know like if you go to Villages the uh the larger homes they don't have they don't have crossed ventilation they don't even have some of them don't even have ventilation as such just a door so there's no not even a window and usually what | uEFsXpXA8Qs |
46d8282a8b56-8 | so there's no not even a window and usually what happens is that the wood is placed outside the room in some cases in South India the wood is outside the room and there is like a passage like thing and then there's a Chula and the smoke goes out but in some cases when you don't have that facility of having the wood outside then the wood is inside you know the and it's cooked inside so more houses will have wood kept inside the room the chulha also inside the room the cooking is done there it may or may not have a window and usually the smoke fills up that room the little children are sitting next to the Chula the elderly people are sitting in the room so everybody is subjected everybody in the house from the children to the lady to the elderly people everybody smokes and this is one of the commonest causes of pollution related morbidity and mortality in our rural area so I have spoken to some people when you know when we go out for | uEFsXpXA8Qs |
46d8282a8b56-9 | some people when you know when we go out for coverages when we when I was doing a story on this ujjwala yojana and you know so there is a resistance to using uh you know uh non um you know coal and wood uh in cooking is this is a question it's the same way that you know when the swachh Bharat story I was doing people don't want the toilet inside the house so there is these are cultural resistance to it but there is a need for awakening right there is just like at one point of time in the 70s uh Family Planning uh program was undertaken on this massive thing even the immunization schedule by and large people know that you need to have small families by and large people know that but this has still not percolated yes so there are two reasons for this one is this what you rightly said was that the elderly person in the house will say guess he's used to having that Chula of Allah Roti and he cannot do without | uEFsXpXA8Qs |
46d8282a8b56-10 | Chula of Allah Roti and he cannot do without it so he insists on the Tula being used even though the cylinder may be lying in the house so that's one cultural taboo which we are trying hard to break by making lot of videos in various Regional languages and sending them out to actually the gas Distributors who can then share them with the people trying to tell them that in the process of having that swadwala Roti you're actually playing with the lives of your children the housewife and the elderly people so that's one second reason is economic that and the first cylinder free of cost but thereafter they had to get the chulha the cylinder refilled by paying some amount when they get wood from the jungle it usually comes free of course so there again they think that it makes economic sense to use wood rather than Chula and I as Doctor am trying to tell them that it does not make economic sense because when the people in the house fall sick because of this smoke it costs | uEFsXpXA8Qs |
46d8282a8b56-11 | house fall sick because of this smoke it costs them much more the treatment part than what they have saved in the cost of the cylinder so again it's an issue about awareness I think this supply has been done what we need to do is to create massive awareness that chulha is the way to go it makes economic sense it makes cultural sense and because also makes a gastronomic sense to make food on the Chula rather than the on on the gas burner rather than the Chula doctor since you uh you know you're an expert and you you deal with chest and lung disorders uh and transplants too Everybody Knows by now that tobacco plays a large role in this but off late I've been reading that uh it's not you know those who come with lung cancer and stuff it's not just tobacco it's it's more than the than that it's like it's not smokers lungs anymore lung cancer uh has so allow me to share my 30 years uh experience as a lung cancer | uEFsXpXA8Qs |
46d8282a8b56-12 | share my 30 years uh experience as a lung cancer surgeon I started my career at all India Institute in 1988. when I look at my initial data 90 of my lung cancer patients were smokers mostly men and people in 50s and 60s this you're talking in the 80s late 80s and early 1990s I looked at my last 10 years data recently and I was horrified to find that now 50 percent of the patients are so-called non-smokers and I'll give you the reason why I'm using the word so-called non-smokers 40 percent of the patients today are women non-smokers from non-smoking families and the peak age from 50s and 60s has come down to 40s and I have 10 percent of patients in 30s and my youngest patient was a 24 year old girl from a non-smoking family now this is now why is this happening this is the what who director General has called second tobacco epidemic so if you look at the chemical composition of the tobacco smoke and the | uEFsXpXA8Qs |
46d8282a8b56-13 | the chemical composition of the tobacco smoke and the polluted air you find that a large number of cancer causing chemicals are actually common in both so whatever is present in tobacco smoke can causes cancer is also present in polluted air and therefore is causing cancer the reason why we are seeing all this earlier is that earlier people used to get exposed to pollution when they would go out so typically around late teens early twenties their exposure to pollution used to start or they used to start smoking at this age we know that you need exposure to cancer causing agents for about 20-25 years before the tissues become cancerous so you start smoking at 2025 at 25 by 50 you are ready to get lung cancer today a child born in a polluted city becomes a smoker from the first breath of his life and again I'll explain why I'm saying that suppose India today so a child born there is in August of 2022 or September of 2022 is a smoker | uEFsXpXA8Qs |
46d8282a8b56-14 | of 2022 or September of 2022 is a smoker by October so no not by October from the very days breath of his life if in October the PM 2.5 level in Delhi is 300 micrograms per cubic meter in terms of equivalence to smoking there is a conversion formula 22 micrograms of PM 2.5 is equal to one cigarette so if you have 220 microgram level it's equal to 10 cigarettes so a child born in Delhi on the day when the 24 RPM 2.5 is 220 plus will smoke and get damage equal to 10 cigarettes on the day one of his or her life so you cannot prevent you cannot what do you do as a parent so when you start smoking from the first breath of your life by the time you are 25 years old you've actually smoked for 25 years and you're ready to get lung cancer that's why I'm seeing lung cancer in non-smokers in girls and in people in 20s and 30s and I dare say it on your podcast that | uEFsXpXA8Qs |
46d8282a8b56-15 | and I dare say it on your podcast that next 20 years India is going to see an epidemic of lung cancer and we are already tending to see that because our medical fraternity our policy makers everybody is aware but nobody will do any medical fraternity is aware medical fraternity is making noise about it we formed a group called doctors for clean air where across the country we are trying to share this information with schools resident welfare associations politicians bureaucrats and everybody trying to make them so we have a triple A approach so we make them aware when they are aware they will be awakened to the danger and when they are awakened we expect that they will take some actions no but this is something which is not new right this has been happening so at least for about at least 10 years as far as I what is new is that till few years back pollution was considered an environmental and a chemical issue talked about by environmentalists talked about by uh chemists and other people | uEFsXpXA8Qs |
46d8282a8b56-16 | talked about by uh chemists and other people researchers as a chemical kind of an issue truly it's not that it's a health issue and presenting it to the masses as a health issue is something which I think has started only in the last five years so people usually think that debts at in large numbers happen because of communicable diseases but what you are saying is that it's going to be a non-communicable disease the dent is being caused by pollution related illnesses today is more than HIV AIDS tuberculosis malaria Dengue and this kovid combined okay that's quite frightening the the reality is that we should have a clause in every death certificate in the in every hospital did pollution contribute to this death and I'm pretty sure that in 90 plus deaths across the country today you would find that pollution would have had some role to play but as I said it's causing brain attacks so let's start let's start looking at the impacts it has so in children as I said | uEFsXpXA8Qs |
46d8282a8b56-17 | the impacts it has so in children as I said in the intrauterine life it causes congenital defects it causes growth retardation death inside when the child is not make uh sorry to interrupt doctor but can you make a direct correlation for example just just a Layman's way of uh asking you that uh somebody a child can uh can uh probably have an attention uh deficit kind of a thing is that related I'm coming to that yeah so there have been studies across the world there are people who've spent their whole lives researching these issues what I'm talking is not my conjecture I'm also I'm talking of the hard data which is available which I have read so when I say it impacts the the children the the growing fetus in the uterus there is real data available when the child is born they have in the immediate postpartum period they have bronchiolitis so which is the equivalent of asthma in children all the time we are saying that these days children are becoming | uEFsXpXA8Qs |
46d8282a8b56-18 | we are saying that these days children are becoming very naughty they are very hyper active right that actually is inflammation of the brain now it is known that these pollutants go to the brain and they cause neural inflammation which initially manifests itself as hyper uh Active Child or attention deficit disorder and later on it has been shown to reduce the IQ levels also so these children may not attain their ideal IQ levels because of exposure come to lungs it causes bronchiolitis this causes asthma it's one of the commonest causes of pneumonia deaths in under five children in the country it causes numerous cancers as you grow it causes COPD and now the most dreaded lung cancer come to Heart COPD is a chronic obstructive disease in which your lungs becomes swollen up with air and you're not able to get oxygen so smoking what used to be a cause but now pollution exposure is emerging as the major cause come to Heart system uh many children in schools | uEFsXpXA8Qs |
46d8282a8b56-19 | cause come to Heart system uh many children in schools these days are being discovered to have premature hypertension you know people in teens that's that again is related to pollution it's been shown time and again that whenever there are peaks of pollution a week or 10 days later all hospitals in those areas report much higher levels of people presenting with heart attacks so it's known to predispose to heart attacks and contribute to heart attacks it's known to predispose to brain attacks so lung is affected heart is affected blood vessels are affected brain is affected and reproductive organs again it is being presented as one of the cause for decreased libido and decreased sexual performance come to two new additions where very sad and very frightening recently we did a study of over thousand school children in Delhi and compared them with equal number of children in Mysore and Kottayam which are two less polluted cities we found 29 incidents of asthma in Delhi children we found 38 incidence of overweight | uEFsXpXA8Qs |
46d8282a8b56-20 | in Delhi children we found 38 incidence of overweight or obesity in Delhi children compared to other two cities and there was a correlation between obesity and Asthma how so the theory is that pollution is causing obesity obesity predisposes you to asthma and pollution also causes asthma directly so it's a double whammy which pollution is causing it's causing asthma directly it's causing higher incidence of obesity which is then contributing to asthma and latest now there is evidence emerging that even diabetes the rising incidence of diabetes in India may have something to do with pollution because the pollutants are getting deposited in the pancreas and in the peripheral tissue predisposing people to diabetes obesity diabetes hypertension heart disease heart attack brain attack brainless development heightless development the list is endless endless now I'm sure when when you say these things at your awareness meeting everybody is aware of it at least to some extent but the point is policy makers should know right those who | uEFsXpXA8Qs |
46d8282a8b56-21 | the point is policy makers should know right those who are planning this country's growth trajectory for the next 20 years we're talking about Amrit Khal and things about where where India is going to be in the next 20 years 25 years 50 years where will we be if if we have an endemic of cancer uh sorry an epidemic of cancer in our country we are 1.3 billion uh now in 2022. if we have millions of people with cancer how do we deal with this issue do our policy makers not realize the enormity of this because see a lot of pollution related things can be handled like I when I went to uh uh when we our teams are going to Punjab every time covering this thing you talk to any chief minister your uh anybody has handling Health agriculture Vehicles stop the vehicular pollution why do you go to the farmer you are anti-farmer if you talk to the vehicle manufacturers your anti industry how do we deal with this crisis so my experience I have had | uEFsXpXA8Qs |
46d8282a8b56-22 | deal with this crisis so my experience I have had occasions to interact with all these segments of people from decision makers politicians bureaucrats journalists school children principals Civil Society police people because we've been addressing everyone body we've even gone to parliamentarians we had a meeting with parliamentarians I gave them a picture of a normal pink lung and a lung of a non-smoker delhiite where there were a lot of black black deposits and they showed it in the parliament also all that has happened so these people are aware when you say they all agree as something needs to be done but the thing is that somehow that awareness is not converting into the immediate and massive actions which need to be taken the urgency of situation somehow has not dawned on them what is this it's a medical emergency if we don't set it right today we are endangering the lives of our children for me it's a medical emergency everything else can stop we need to go and fix this problem that | uEFsXpXA8Qs |
46d8282a8b56-23 | stop we need to go and fix this problem that kind of an emergency or urgency and a desire to take instant action with instant end results that's not there if we take actions which are likely to give their results in 1520 time a whole generation would have suffered morbidity mortality because of this problem doc so what is the solution it can't be one solution right it's not mask Peno it's not in you know give you inoculation no it's not that no so priorities have to be set right first rule is that anyone who says that I'll let pollution happen and then take measures to clean the polluted ear he does not know even the basics or ABCD so smog Towers whoever is proposing them they've been put up with Fanfare in the city of Delhi they are a huge waste colossal waste of public money no country in the world has solved its air pollution Problem by putting smoked offers so this is a farce total farce colossal waste of precious public money | uEFsXpXA8Qs |
46d8282a8b56-24 | total farce colossal waste of precious public money that's number one number two it's a public problem air purifiers masks etc etc are knee-jerk reactions personal solutions to what is basically a public problem we've done it with electricity when electricity was not there instead of fixing we went for inverters and generators that was the first time we sought a private solution to a public problem second time we did it with water when the supply was not good we started carrying our private bottles unfortunately there is an attempt to do the same with air also people don't realize you can be without water for five days you can be without electricity for n number of days you can't be without air for more than two minutes and you cannot carry your own air I'm sitting in your studio I'm breathing the air can I bring my air curtain from my house and say oh I'm safe with this air curtain no so the solution lie is in cleaning the air across the country and not putting these | uEFsXpXA8Qs |
46d8282a8b56-25 | the air across the country and not putting these wastage of smoke Towers which are all social so this is the first realization which has to come solution lies in addressing the sources that's number one sources are many so vehicles are a big source unfortunately is given a huge amount of attention but I would like to clarify that it's something which happens a certain part of the ear contributes a certain quota during this part and if you take totality of the picture its contribution to a total is actually a much smaller segment than the attention that is given to it so a lot of pollution is coming from vehicles huge amount of pollution is coming from coal fired power plants okay they are the biggest problem they need to have devices fixed to reduce the emissions from them and this was something which Ministry of environment took it up on its own Co Moto about five years back and fixed very rigid norms for all of them to implement in a certain time frame which was a beautiful welcome step unfortunately | uEFsXpXA8Qs |
46d8282a8b56-26 | time frame which was a beautiful welcome step unfortunately since then that deadline has been deferred three times and now stands deferred to 2025. for reasons which I need not spell out here okay where are these located mostly across the country across the country right so if so electric vehicles are a wonderful welcome step but mind you electric vehicle needs electricity to charge it right and if that electricity is from a coal plant from a coal plant you are addressing the problem only half of it hmm so we have to address it in totality people have to understand it people have to cooperate also it's not that you can only blame the government it is a problem caused by everybody and it is a problem which will be solved by the participation of everybody but who will do it making rules alone is not the answer you know Supreme Court passed the order about cracker burning two years back I was also involved in in that course I used to go for the hearings and all but people violated that there | uEFsXpXA8Qs |
46d8282a8b56-27 | the hearings and all but people violated that there were people who made videos and showed that look it's past 10 o'clock I'm burning cracker do what you can what are you trying to prove Supreme Court is not passing its order for its sake its passing order for everybody's sake so that awareness in public has to come that it's for your own benefit it's like government imposing helmet and seat belt for your sake on you it's for your benefit minister is not getting benefited if you wear a seat belt government those who make these policies they also are breathing the same air absolutely so you would think that they'd be more aware and they will make sure that these coal plants Implement those laws which they have passed but what what can I do as a parent what can I do as I feel that there has to be a Citizens movement to promise movement across the country next election should be fought on the issue of Clean Air uh I would like this opportunity to take this opportunity | uEFsXpXA8Qs |
46d8282a8b56-28 | I would like this opportunity to take this opportunity to inform United Nations has declared clean air as a human right it happened just about six weeks back so we can say am I human rights my human right this human right clean air be the election issue for 2024. I know it sounds very radical those who will listen and sing human rights but you know it is true stuff that we think is not imperative it is if it is survival as you are saying and Survivor I mean each one of us first things of our children right as a that's the first thing that you think is your parent and your child most of us would do that and if we can't ensure survival of our parents or of our children then this is talking of progress progress everybody wants to be successful entrepreneur CEO blah blah blah I'd like to tell everybody that the first requirement for achieving any of these is a healthy body and if your body is unhealthy if you have host of problems from brain to toe | uEFsXpXA8Qs |
46d8282a8b56-29 | if you have host of problems from brain to toe you cannot achieve success doctor what about covid most most of us who've had covid uh we are battling with this long covet issue breathlessness if I could climb uh you know four or five flights of stairs without without even forget about gasping without even Breathing heavily I could do that now I can't even do two without gasping without taking a pause and this is like it it doesn't seem to go even after an hour after a year so there were three types of people from covet one who had very very very severe lung involvement and went to ICU and probably did not survive there was a group which had negligible or no lung involvement who returned to normalcy after their kovid episode and there was a group in between which had lung involvement which was not severe enough to take them to the ICU but was severe enough to compromise the lung function to some extent now this group is the one which is actually | uEFsXpXA8Qs |
46d8282a8b56-30 | extent now this group is the one which is actually complaining of reduced exercise ability reduced exercise tolerance earlier they could climb five flights of stairs now they get breathless on the second floor itself so these people when we are doing CT scans are showing some amount of fibrosis in the lungs which is the long term effect of the lung involvement there are some medicines being tried but till date there is no medicine which has been proved to be definitely effective but what is definitely proved to be beneficial is graduated increasing exercises breathing exercises and you know the other cardio exercises which tend to restore the elasticity of the lung and the lung function to normal levels but it's but I must teach you a bonding here that there are cases where people have gone for massive exercises suddenly and there have been fatalities also so when you go back to your exercise regime it should be very very slow gradually increase give your body time to adjust you know body has suffered damage | uEFsXpXA8Qs |
46d8282a8b56-31 | time to adjust you know body has suffered damage don't impose massive exercise from day one it can cause catastrophe as it has in numerous cases across the country so slowly increasing maybe first day you just exercise for five minutes let it go for two weeks then make it seven minutes then two weeks then make it nine minutes as your body gets used to but with exercise you can actually get back a lot of your original function second is there is a huge amount of anxiety which people are having and I see lot of such cases in my OPD lot of them are I.T professionals they read a lot on the internet and because of that they develop more symptoms than they actually ought to be having going by their lung standards and all we need to do is to calm them down things are okay just have patience do some pranayama do some relaxation exercises and surprisingly they start feeling much better doctor also the reason is uh for example a fit person uh got covered right and so mentally to | uEFsXpXA8Qs |
46d8282a8b56-32 | fit person uh got covered right and so mentally to to accept that you may not be able to work out as much or you may not be able to do and to slow down in today's day and age slowing down if you tell somebody to slow down is like telling that person die you know do you understand everybody is on this on a like a conveyor belt so the first thing that is needed is not to be on the conveyor belt right slowing down does not mean that you will not reach your destination you'll probably reach your destination you just need to pause recover your health after that you will be able to run fast enough to reach there do you get a lot of patients who tell you uh in the past like since you've been practicing medicine since the late 80s do you get that a lot today that the anxiety levels have increased so much that it's impacting on physiological many many many fold increase in the anxiety levels and I'm telling you that these post covet syndrome of | uEFsXpXA8Qs |
46d8282a8b56-33 | telling you that these post covet syndrome of course it's there long covet post covet syndrome whatever term you want to eat it's there but the magnitude that is being talked about has a lot to do with the anxiety that has been created around it oh yeah even I'm so lot of people come to me they say I can't do this I can't do that and I take them with me I say let's climb stairs and I start talking to them and we climb four flights upstairs then suddenly yeah so you realize that it was actually anxiety which was preventing them I'm not saying everything is anxiety show all I'm saying is that anxiety is also playing a huge role and we need to control that do you see that in children or just one thing I'll add sure what I have noticed is that you know kovid and all those lockdowns and ICU stays they actually Disturbed our 24 hour schedule and as it is there are a lot of people who work till 2 am | uEFsXpXA8Qs |
46d8282a8b56-34 | are a lot of people who work till 2 am 3 AM 4 AM then sleep till 11 o'clock there is something called body cycle if we just restore the body cycle so 10 pm to 6 a.m was what the body is used to sleeping if you keep the body awake during that time and you try to sleep during you're going against the physiology of the body so I tell these people make a fixed time that okay by this time I'll go to sleep I'll get up at this time do a little bit of exercise do a little bit of meditation whichever form of meditation you wish to calm down your body and then make yourself busy in some productive work and pay attention to work when you get busy with work suddenly you forget that you were ill so people are not working they're saying no no no I need to get fit because I have a lot of work to do so that anxiety of doing lot of work is actually preventing them from getting fit and when they come to me all I | uEFsXpXA8Qs |
46d8282a8b56-35 | getting fit and when they come to me all I do is to talk talk talk talk to them and talk them out of it and most of them actually come out of it okay the the you were talking about the body uh needing that sleep from 10 o'clock to six o'clock you said or minimum five to six hours is what an adult needs but into more than duration quality is important if yes disturb what is happening thing people are doing less and less of physical activity and more and more of mental activity when you go to bed at 11 o'clock if you have 100 calculations going on in your mind where am I going to get that Emi and you know all those things so much of pressure obviously you won't get sleep and medicines are not the solution because medicines give you artificial sleep which just gives you some sleep hours but not sleep relaxation so when you get up in the morning you feel groggy you feel tired and your output goes down which further complicates the problem I | uEFsXpXA8Qs |
46d8282a8b56-36 | goes down which further complicates the problem I I mean I of course I can't say that my job is more high stress than yours you're saving lives but you talk to anybody doctor everybody says that oh the stress level is so much he sleeps only four hours and that's why he's the CEO and you know people are actually with great pride they say we need only four hours of sleep so four or five or six can vary from people to people I know so many Doctor friends of mine who sleep four hours but then they sleep well and they get that REM sleep during which you have actually relaxed so I would say around six hours is what an adult needs it's not necessary so four are six hours is Jesus just numbers put by people if you sleep for six hours and do not get adequate relaxation somebody sleeps for four hours and gets adequate relaxation he's in a better position so quality of sleep is more important than the duration so uh you know migraines are a major issue especially | uEFsXpXA8Qs |
46d8282a8b56-37 | uh you know migraines are a major issue especially for women and uh of course women whenever uh you know they say they siddhar Dora and nobody used to believe it right and I remember people used to say yes hysterical right hysterical was a word yeah hysterical used right and they used to say but it's only like you said it's that deep sleep is something which was not there right it's only when the smart watches came that's that you get to know something I use the word sleep ours you know when we sleep say around 11 o'clock so early morning between 4 to 5 30 or 6 is the time when we get what is called REM sleep it's called rapid eye movement sleep which is the deepest form of sleep which needs to leads to maximum relaxation yeah so when you get that proper quality of sleep yeah you get up Absolutely Fresh but when you are working you know the whole night yeah and then during the day time when actually the body is prepared to be awake because of the | uEFsXpXA8Qs |