About Dr Ashwin Nanda

With 10 years of experience behind him as a general practitioner, Dr. Ashwin Nanda has over the years moved away from just prescribing medication to his patients to getting them to adopt a healthier lifestyle by focusing on nutrition and wellness. According to him this line of treatment has realized better results and satisfaction among his patients diagnosed with lifestyle diseases. Lifestyle to him means leading a quality life to be it at work or at home with family and friends. Personally, too he leads a healthy lifestyle by exercising regularly, eating mindfully and meditating.

January 26, 2019 By Dr Ashwin Nanda 2 Comments

Organ Donation – Gift of Life

A decade ago as a medical student, I had come across a blind man selling torches in the local trains. I asked him just out of curiosity the reason for his blindness to which he replied that he lost his sight in childhood after an accident which permanently damaged the blood supply to the retinas. He then went on to ask why I brought up the question and when I told him I was studying to be a doctor, he smiled and said, “I have a question for you”? I anticipated, he would want to know about recent advances in medicine that could probably restore his sight. But, I was wrong, instead, his question was different. His question was whether he could still donate his eyes. I was absolutely overwhelmed when he asked this. That is the day when I realized one can lose his eyesight but, still have a vision. With a sense of respect for him, I explained to him that his corneas could indeed be donated after his demise.

Organ transplantation is a marvelous procedure of modern medicine which helps the recipient gets a new lease of life. The only issue is, untimely demise of a loved one plunges the family and friends in so much grief that donating the deceased person’s organ doesn’t come to mind most times. It takes a mighty heart to brush aside the sorrow and take the step of organ donation, to give the gift of life to someone when you have lost a loved one.

Organ donation is permitted by law after a person is declared brain dead.A brain dead person has no chance of revival as all his brain activity has stopped permanently and completely. The medical fraternity follows very strict standards laid down by the Transplantation of Human Organs Act, 1994 to determine if someone is brain dead or not.

In India, it takes 4 well qualified doctors to declare brain death before a person’s organs can be harvested. The biggest hesitation in organ donation is that the body will be disfigured. The surgeon makes a single neat incision from top of the chest to the navel and after organ harvesting, it is stitched professionally and the body is handed back in the most dignified state. The organ/organs are stored in cooled containers with special preservative fluid.

Organ donation from brain dead individuals in India is very less compared to Europe and US. Live donor numbers are increasing steadily since it is possible for a relative to survive on a single kidney and even the left lobe of liver can be donated by a live donor as the liver regenerates.

2 lakh corneas are needed annually in India but only 50,000 donations happen. 5 lakh people die annually waiting for a lifesaving organ. Presumed consent for organ donation is used to increase the pool of potential donors in countries such as Austria, Belgium, Czech Republic, Finland, France, Greece, Hungary, Israel, Italy, Luxembourg, Norway, Poland, Slovenia, Spain, Sweden, Singapore and Turkey. After the death of the individuals the state becomes the custodian of the dead body, who take out the organs for transplant. Spain has the highest rate of organ donation at 36 / million. India is at 0.26/million only.

Who, What and How Can you donate?

1) Kidneys, Heart, Lungs, Liver, Small Bowel and Pancreas can be donated for transplant. Tissues that can be donated include eyes, heart valves, bone, skin, veins and tendons.

2) Every healthy person can donate. Old age is not a deterrent to donation. Person’s physical condition, not age, which is the deciding factor. Organs and tissue from people in their 70s and 80s have also been transplanted successfully.

3) Specialist health care professionals decide in each case which tissue and organs are suitable.

4) Your near and dear ones should be aware of your will to donate your organs. In case of your untimely demise they can inform concerned authorities to harvest your viable organs.

5) Kidneys, liver, heart need to be harvested within 6 hours of death whereas corneas within 12 hrs.

“Green corridor” is the term used when a lane from the airport to the hospital where the organ recipient is waiting is kept totally vacant for speedy transport of the organ by the doctor who has retrieved it from a donor in another city. The city traffic police officers go all out to ensure a smooth transit with zero stoppage. The nobleness of organ donation is highlighted by the efforts put in by them to help the cause.

Organ donation is easier said than done. This article is an attempt to increase awareness about this cause so that we all can create the mindset to be willing to donate organs. All religions promote this practice since extending life is considered an act of God.

So let’s pledge our organs and live even after we are gone.

Here are a few websites through which you can register and pledge your organs

www.mohanfoundation.org/

http://www.transplantindia.com/

donatelifeindia.org/

http://www.organindia.org/

October 11, 2017 By Dr Ashwin Nanda Leave a Comment

The Bipolar Journey

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In 2013, the celebrity world across the world was shocked when they heard that Catherine Zeta-Jones of Mask of Zorro, ‘Chicago’ and ‘Ocean’s Twelve’ fame declared she was suffering from ‘Bipolar II disorder’ and had checked into a hospital for treatment. There were a lot of discussions in media related to Bipolar Disorder- a kind of mood disorder which even the elite cannot escape away from if it grips them.

Similarly, I had a patient named Jalaj (name changed) who was detected with bipolar mood disorder. He got to know of his condition in a fairly unpleasant way. It began with him having trouble in his married life due to his unexplained aggression. Initially, his parents and wife were apprehensive to consult a psychiatrist because they considered seeking help for mental health a taboo. They thought he was stressed due to the financial burden. But, eventually, when his behaviour got worse, they consulted a psychiatrist who after diagnosing declared him to be ‘Bipolar’. His family, wife and friends stood by him in his trying times and he recovered in 6 months without medication. Unfortunately, most of us consider taking anti-depressants to be a sign of mental weakness.

When fights and Jalaj’s behaviour went out of control, it was on the insistence of his wife that the family consulted a shrink for professional help. On taking Jalaj’s history, the psychiatrist found that he had suffered a bout of depression 4 years ago also which was his first episode. He was 20 years old then.

Bipolar mood disorder typically starts in early adult life, between 18 to 22 years of age. Jalaj’s first episode of depression was also for no obvious reason. His wife Dimple reported that during the two years of their married life she did feel he had a lot of mood fluctuations. These mood fluctuations are called cyclothymic mood changes in medical terminology. The person swings between a mildly good and mildly low mood throughout the day and entire life. When his father came to know of his son’s diagnosis he confirmed that Jalaj’s grandfather was also bipolar. He used to have the bout of depression every 3 years and recover from it in 6 months. Bipolar Disorder is strongly hereditary and runs in families.

Let’s understand what is Bipolar?

A person afflicted with bipolar mood disorder goes from mild depression into moderate and then severe depression followed by a return to normal state for few months and then goes into mild mania and then hypomania in a cyclical and periodic manner throughout adult life. The word BIPOLAR means having two extremes which are poles apart. The medical reason is that the neurotransmitters serotonin, dopamine and norepinephrine fluctuate for no explainable reason. Hence it’s a chemical imbalance.

5% of world population is estimated to be bipolar. Impulsiveness is another hallmark feature of a bipolar. They hardly think before doing most things. When in an excessive happy mode, a bipolar tends to go on a buying spree. A bipolar person is also prone to aggression, alcohol, smoking and drug addiction, hypersexuality or promiscuous behaviour in mania phase.

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Treatment

Treatment for Bipolar is psychiatric counselling and regular medication to control mood swings. Jalaj was counselled by a psychiatrist who made him understand that if he doesn’t take medication he will be jeopardizing his family life and career. Bipolars need daily and regular medication to function normally. The medicines called mood stabilizers prevent the mood fluctuations and prevent mania and depression.

Jalaj takes medication as prescribed and follows up with the shrink once every 3 months. Thankfully he is leading a happy married life again and Dimple also understands what he goes through and is able to counsel him. Daily meditation also helps Jalaj deal with his mood fluctuations. 8 hrs of sound sleep is essential on a daily basis for him so that he does not lose his sanity.

It is critical that bipolars’ take treatment because there are chances of attempting suicide during a major depressive phase. Many bipolar utilize the hypomania phase to be more creative and productive and achieve professional stardom. In a way, they turn it into a gift. Bipolar can be well controlled and one can lead a healthy life. On a lighter note, a bipolar person has a happening life with lots of ups and downs.

September 9, 2017 By Dr Ashwin Nanda 9 Comments

Know all about Dengue and Chikungunya and how to prevent it

Chikungunya and Dengue have created havoc in the capital city of Delhi and certain other parts of the country. The death toll from the two vector-borne diseases has been climbing every day even as the number of affected people crossed 2,800. It has been reported that according to the National Vector Borne Disease Control Programme (NVBDCP), the number of chikungunya cases in Delhi had spiked to over 2000 till September 11 as fever clinics in the city continue to be swamped with patients.

The World Health Organisation has said that in recent years, globalisation of travel and trade, unplanned urbanisation and environmental challenges including climate change has had a “significant” impact on transmission of vector-borne diseases.

However, the key to averting such an adverse outcome is timely diagnosis and appropriate monitoring along with supportive care.

Let me begin with the basics about dengue and chikungunya…….the culprit for both is the Aedes aegypti mosquito and hence a person can be infected with both diseases simultaneously by its bite. Viruses are the cause of both problems, which enter the mosquito when it bites a human suffering from dengue or chikungunya.

The most likely time for this mosquito to bite is 2 hrs after sunrise and 2 hrs before sunset but, probability of a bite occurring is anytime during daylight hours. So it’s active during the time when most of us are also likely to be outdoors.

Chikungunya begins with sudden onset of high fever, ranging from 101 to 105 degree Fahrenheit accompanied by severe pain in joints. Other symptoms like chills, headache, fatigue, abdominal pain, nausea, vomiting, diarrhea, reduced appetite and conjunctivitis can also be seen. Rash occurs typically on day 2 or 3 when the fever has subsided along with itching.

The Complete Blood Count (CBC) may show reduction in the total White cell count and platelet count, though neither are severe nor life threatening. IgM (Immunoglobulin M) antibody against Chikungunya can be detected in blood after 5 days till months after onset of symptoms. Joint pains and stiffness can last for weeks or months and can be distressing.

Treatment involves paracetamol to control fever, although NSAIDS (Non-Steroidal Anti Inflammatory Drugs like Brufen and diclofenac) may be needed to reduce fever and joint pains as paracetamol may not suffice. Ice compress on the joints can reduce pain. Ensuring water intake of at least 3 liters/day for adults is a must to counter the dehydration resulting from high fever. Antihistamines reduce the rash and itching. Extreme joint pains get relieved by oral steroids.

Dengue is equally dangerous and spreading. According to New Johns Hopkins Bloomberg School of Public Health’s research finds that the Dengue virus is the most rapidly spreading virus transmitted by mosquitoes and is a major source of illness in the tropics and subtropics, infecting as many as 400 million people annually.

Dengue symptoms are no different from Chikungunya. Both have similar onset with high grade fever (102 to 105 degree fahrenheit), headaches especially behind the eyes, back pain, muscle & joint pains, weakness. Rash can also occur. Cold and cough, vomiting and diarrhoea may accompany other symptoms. The diagnosis can be done through blood tests like Dengue NS1 which comes positive during first 3 days of fever & Dengue IgM which is detected from 5^th to 7^th day from onset of fever.

Treatment of uncomplicated dengue is same as chikungunya. Hospitalization is a must in worsened abdominal pain & vomiting, significant fall in blood pressure, breathlessness and platelet count going lower than 30,000. Platelet transfusions may be needed along with fluid infusion.

There are no antiviral medicines yet for dengue and chikungunya. Prevention of mosquito bites is the easiest way of avoiding these diseases, wearing full length shirts & trousers helps, applying mosquito repellent & using mosquito nets goes a long way in avoiding bites.

The Aedes aegypti mosquito breeds in stagnant fresh water which is avoidable by disposing used plastic bottles & discarded tyres properly. Pooling in plant trays and coolers also needs to be prevented. Also one should cover water containers that can be mosquito breeding grounds.

August 2, 2017 By Dr Ashwin Nanda Leave a Comment

Understanding Autism

I have had firsthand contact with 2 children with autism in my complex and hence I wish to share my experience with these children and talk about Autism. An autistic child lives in her/his own world and finds it quite difficult to associate and relate to the external world. The child takes a long time to bond with another person, even the mother child bonding takes very long to develop. Children with autism seldom establish eye contact, do handshakes and give high fives like their counterparts. They seem extremely shy but the issue is deeper than just being plain simple shy.

Let me take you through these kids’ stories and also in the process talk about what is Autism?

This is the story of Rudraesh, 13. He is the second son and his mother recalls that when he was brought home from the maternity ward after 4 days, he cried a lot for the next 2 days. This behaviour of his was peculiar as she remembers her elder son never reacted this way. In hindsight, she says that it was typical of an autistic child to be uncomfortable in a new environment. When her son did not develop the social milestone of smiling at another person which her elder one had, she got worried and consulted the paediatrician who confirmed her fear that he was autistic.

Autism is a spectrum of disorders in which the difficulty to adapt to the world and be able to take care of oneself varies from mild to severe. Rudraesh is severely autistic since it took 12 years for him to get toilet trained and hygiene conscious. Since his elder brother is normal, his mother feels the reason for his autism is the undue emotional stress she had while she was pregnant with him.

The exact cause of autism still eludes mankind. Researchers are trying to find possible associations which lead to autism. A strong belief is that MMR vaccine (Measles, Mumps and Rubella) predisposes a child to autism. Indiscriminate use of antibiotics during pregnancy and infancy is also suspected to increase the chances of autism. It appears that autism runs in families since many extended families have more than one child affected by it.

Rudraesh has the good fortune of having a dedicated and caring mother and a father who is earning well. She has painstakingly ensured that he picks up basic survival skills and his father spares no expense in getting best possible assistance in the form of special schooling and occupational therapy. Their dream is that Rudraesh can earn a living for himself and be self-sustained. It’s a challenging dream but with the hard work that both parents are putting in, it looks like a reality albeit in distant future.

The second story is that of Madhav, 5. Madhav’smom was heartbroken when the paediatrician diagnosed him to be a mildly autistic child. Initially, she thought her son was mentally retarded. Unlike mentally retarded children, autistic children usually are gifted e.g a few of them have a drawing and painting talent and some are excellent with numbers. Remember Dustin Hoffman’s character in the epic movie Rainman?

Hoffman played an autistic adult who won his brother millions in the casino because of his mathematical gift of predicting permutations in the card deck. Madhav is a mild case because he was able to do a lot of other activities which kids his age did except that he didn’t know his name was Madhav, something a normal 8 months old definitely knows. He wouldn’t respond when his name was called out. Since his autistic trait was diagnosed in time and his parents took help from a good team of therapists who treat children with developmental delays, at age 4 years he is now at par with other normal children. The therapy involves multiple innovative ways of stimulating the child’s brain to grow and learn and catch up.

To summarize, autistic individuals need a lot of support and patience from the society so that their troubles can be minimized.Occupational and behaviour therapy specialists along with parents of these children make a lot of efforts to help them learn to integrate with the world around them and we as mature citizens also need to support them by being non-judgemental and understanding.