MASTACON stands for the annual event of Maharashtra Indian Medical Association Conference.This year Thane city was the host and was held from 24th Nov to 26th Nov.I had started writing this post on the 27th,and now I am continuing writing after a long gap.It is 8th Dec today.The sessions started with breakfast at 9 am,The presentations were from 9.30 to 1.30.Then a lunch break for an hour.The afternoon sessions were from 2.30 to 5.00.Banquets from 7.00 pm onwards.I had to keep my clinic closed in the morning to hear some topics of interest to me like Diabetes, a workshop on HIV--AIDS ,Abdominal emergencies related to Diabetes.
Apart from the technical discussions,what was interesting was my classmates presenting their lectures.Dr.Vijay Panikkar was my chief attraction on day one.The session was hosted by another of my classmates,Dr.Vijay Neglur.Dr. Panikkar has not changed one bit since the college days.It was so thrilling to see a classmate,with whom we had studied sitting in the same classroom and all the mischiefs,the college elections-he was elected as Cultural Secretary--, standing on the stage to give a talk with all LCD projections and slide presentations. Very mischevious and knowledgable.An authority on Diabetes and a leading practitioner in Dadar Mumbai.He speakes in simple terms and very practical.He always gives day to day experiences and gave an example of a senior couple sitting with drooping faces in front of him,they had come to consult him after visiting ' n ' number of doctors and to see if this one has anything new to offer especially regarding diet.Diabetes is such a thing that no one likes to hear about do's and dont's of diet ,with the complicated calorie calculations which the dieticians give.So after the couple were checked up and after dicussion regarding medicines ,etc was over the dreaded topic of diet came up.The man asked 'what should we eat,looking sideways at his wife and expecting the usual list. Dr Vijay said" Dont worry,eat everything yes everything " surprising the couple. He added jokingly that the look on their faces was as if they had come at a wrong place and the doctor doesn't seem to know anything."Yes everything ' he repeated again" except that eat half of what is normally eaten".The couple were satisfied that the dreaded topic of diet was finished in a few words only.the only caution was regular monitoring of blood sugar.
Dr.Vijay went on to say that senior people on being detected for diabetes are at the mercy of their near and dear ones,who in good faith actually make the life of that person miserable.Each member of the family offers different advise and the poor old man may die due to some cause other than his diabetes.We too follow same principles in treating patients especially seniors who in this fag end of their lives should not be made to suffer psychologically.
More about the MASTACON lectures and the Banquets in coming posts.
Monday, November 27, 2006
Sunday, November 26, 2006
Sunday, November 12, 2006
Control of Lipids
My first technically oriented blog today.
Dyslipidemia is very common in the affluent world.We in India and also most of Asia have an excess of the bad cholesterol [LDL ]as well as an increase in the Triglycerides,due to genetic factors or nowadays due to urbanisation and the ills of modernisation.Both are independant risk factors for cardiac events.Patients being symptom free are unaware of their problems until tested and hence are at the highest risk.Control of lipids is based on trials conducted basically by the western world. Cholesterol is controlled by statins and Triglycerides by fibrates.
Last night I attended a CME on"Newer paradigm in Lipid Management and Antiplatelet Therapy", sponsored by Shreya Life Sciences.The speakers were two eminent intervention cardiologists,Dr D Kumbla and Dr.S Shetty.The role of aspirin and statins were discussed on a more theoretical basis interspersed with few case experiences.It was a sort of revision for me of the various studies conducted worldwide as these topics are regularly presented at various CMEs.
Now for some personal experiences and trials that I have conducted and which was discussed in the Question Answer session conducted at the end. As a family physician,I deal mostly with primary prevention of cardiovascular problems.The patients are usually in midlife or nowadays even in late 30s due to the hectic lifestyles and stress.On routine screening they are usually uncomplicated cases, detected for the first time for impaired fasting sugar or glucose intolerance or dyslipidemia.They may or may not have hypertension,may or may not be overweight or obese.The advise is standardised text book like.Lifestyle modification like diet and exercise,giving up tobacco,control over alcohol, weight reduction and the medicines.
Here I am writing about medicines only in Lipids control.I put the patients on a daily dose of 10mg atorvastatin and 160 mg of fenofibrate for those having both high LDL and Triglycerides..I have noticed that my patients respond extremely well to 10 mg statin and I have never had to titrate the dose or add Ezetimibe.Cardiologist always recomend a combination of statin and Ezetemibe in all CMEs probably because they mostly see post event cases and are on secondary prevention.In the first follow up in 1 to 3 months,on seeing good control, I advise them to take a statin alternate day as on Monday,Wednesday and Friday and a Fibrate on Tuesday,Thursday and Saturday with a holiday on Sunday.Even with this pattern I have seen good control over the past few years followup.The positive thing is a greater patient compliance and better tolerability of the drugs as they have lesser side effects which are mostly general weakness and abdominal pains.I have not seen any case with the side effect of myopathy or rhabdomyolisis with these doses.
This was discussed in yesterday's CME and the cardiologists agreed that though this alternate day dosage is not studied or documented it is alright to have this regime as long as the patients are under regular supervision and followup.
I would like to know if any clinician has treated dyslipidemia in this way and their experiences. I have not been able to document my experiences due to lack of time in our setup of general practise.
Dyslipidemia is very common in the affluent world.We in India and also most of Asia have an excess of the bad cholesterol [LDL ]as well as an increase in the Triglycerides,due to genetic factors or nowadays due to urbanisation and the ills of modernisation.Both are independant risk factors for cardiac events.Patients being symptom free are unaware of their problems until tested and hence are at the highest risk.Control of lipids is based on trials conducted basically by the western world. Cholesterol is controlled by statins and Triglycerides by fibrates.
Last night I attended a CME on"Newer paradigm in Lipid Management and Antiplatelet Therapy", sponsored by Shreya Life Sciences.The speakers were two eminent intervention cardiologists,Dr D Kumbla and Dr.S Shetty.The role of aspirin and statins were discussed on a more theoretical basis interspersed with few case experiences.It was a sort of revision for me of the various studies conducted worldwide as these topics are regularly presented at various CMEs.
Now for some personal experiences and trials that I have conducted and which was discussed in the Question Answer session conducted at the end. As a family physician,I deal mostly with primary prevention of cardiovascular problems.The patients are usually in midlife or nowadays even in late 30s due to the hectic lifestyles and stress.On routine screening they are usually uncomplicated cases, detected for the first time for impaired fasting sugar or glucose intolerance or dyslipidemia.They may or may not have hypertension,may or may not be overweight or obese.The advise is standardised text book like.Lifestyle modification like diet and exercise,giving up tobacco,control over alcohol, weight reduction and the medicines.
Here I am writing about medicines only in Lipids control.I put the patients on a daily dose of 10mg atorvastatin and 160 mg of fenofibrate for those having both high LDL and Triglycerides..I have noticed that my patients respond extremely well to 10 mg statin and I have never had to titrate the dose or add Ezetimibe.Cardiologist always recomend a combination of statin and Ezetemibe in all CMEs probably because they mostly see post event cases and are on secondary prevention.In the first follow up in 1 to 3 months,on seeing good control, I advise them to take a statin alternate day as on Monday,Wednesday and Friday and a Fibrate on Tuesday,Thursday and Saturday with a holiday on Sunday.Even with this pattern I have seen good control over the past few years followup.The positive thing is a greater patient compliance and better tolerability of the drugs as they have lesser side effects which are mostly general weakness and abdominal pains.I have not seen any case with the side effect of myopathy or rhabdomyolisis with these doses.
This was discussed in yesterday's CME and the cardiologists agreed that though this alternate day dosage is not studied or documented it is alright to have this regime as long as the patients are under regular supervision and followup.
I would like to know if any clinician has treated dyslipidemia in this way and their experiences. I have not been able to document my experiences due to lack of time in our setup of general practise.
Tuesday, November 07, 2006
India and World Cricket
What a sight on the TV screen at the end of the final match .The night skyline was lit up with beautiful fire crackers.This match will be remembered for the revival of the matches at the nostalgic Brabourne Stadium, the unexpected showers which interrupted the one sided match,the monotony of an Aussie win absence of any Asian team and the TV presentation which became more worth watching than the cricket itself.India and the expert event managers of the Cricket board held the series in grand style ,with the likes of Mandira Bedi,who made it sure that all stayed glued to the TV and saw the commercials always and Cricket whenever it was interesting.
So we now come to the Title "India and World Cricket".What is India's and the Indian team's contribution.India has been always hospitable to any guests and especially so when there are celebrities.We feel honoured when all praise us in taking utmost care of the cricketers,their travelling,site seeing,lodging,receptions,functions in their honour,etc.This part is very well taken care of.
Now the Indian teams contribution.Well they participated in it whole heartedly,as though taking part in some celebrations.The ICC President has aptly said that India has the money but where is the cricket ? People fail to understand that India has just to participate.We are there to generate revenue for the individuals,the Board,the local Associations,the Sponsors.Cricket has been reduced to an event,no seriousness,no answerability as far as the Indian team is concerned.
What makes the other countries tick ? Not only cricket but other sports as well . Year after year as India performs miserably,the postmortems go on till the next event . Talking about cricket why is the selection made on past performances and past glories ? Is it wrong to drop a senior non performing player and take a young promising one,who is curently in great form ? I feel other countries especially Australia have developed their habit of winning because of merit and nothing else . Money corrupts absolutely, as shown by our players . I get the feeling that they spend more time in shoots than in the nets . My suggestion is that the Board should collect the lollies on their behalf and release the money as per their performances . No play no money . It looks so stupid seeing them dancing around and making faces in the ads that crop up when actually wickets are tumbling down or the bowlers are getting slaughtered . Don't they themselves feel ashamed or are they busy counting their lollies as criticism mounts and they turn a blind eye and deaf ears ?
The only heartening thing is the Midas Touch !! No country on this planet will criticise India's performance . They know and we also know India has to just participate and the money flows . ICC has made a great turnaround thanks to Indian Administrators . All the boards and the clubs reap a golden harvest as India participates . People forget the scores ,the losses,the humiliation that the spectators and not the players feel, we only remember the performance in the advertisements not on the field. Lavish praises will always be for the rival teams.
Hence forth my resolution is to see the game ,as a game we know, when other teams play and see it as a performance when India plays,as it looks like excellent acting when they stare at the bat,or shake their head,or limp or droop their head,or have a sorrowful face when returning to the pavilion . With this in mind it will not be necessary for me to write on this topic again.Blogging is great.So nice and relieved I feel on purging my mind of a pent up frustration on India and World Cricket.
So we now come to the Title "India and World Cricket".What is India's and the Indian team's contribution.India has been always hospitable to any guests and especially so when there are celebrities.We feel honoured when all praise us in taking utmost care of the cricketers,their travelling,site seeing,lodging,receptions,functions in their honour,etc.This part is very well taken care of.
Now the Indian teams contribution.Well they participated in it whole heartedly,as though taking part in some celebrations.The ICC President has aptly said that India has the money but where is the cricket ? People fail to understand that India has just to participate.We are there to generate revenue for the individuals,the Board,the local Associations,the Sponsors.Cricket has been reduced to an event,no seriousness,no answerability as far as the Indian team is concerned.
What makes the other countries tick ? Not only cricket but other sports as well . Year after year as India performs miserably,the postmortems go on till the next event . Talking about cricket why is the selection made on past performances and past glories ? Is it wrong to drop a senior non performing player and take a young promising one,who is curently in great form ? I feel other countries especially Australia have developed their habit of winning because of merit and nothing else . Money corrupts absolutely, as shown by our players . I get the feeling that they spend more time in shoots than in the nets . My suggestion is that the Board should collect the lollies on their behalf and release the money as per their performances . No play no money . It looks so stupid seeing them dancing around and making faces in the ads that crop up when actually wickets are tumbling down or the bowlers are getting slaughtered . Don't they themselves feel ashamed or are they busy counting their lollies as criticism mounts and they turn a blind eye and deaf ears ?
The only heartening thing is the Midas Touch !! No country on this planet will criticise India's performance . They know and we also know India has to just participate and the money flows . ICC has made a great turnaround thanks to Indian Administrators . All the boards and the clubs reap a golden harvest as India participates . People forget the scores ,the losses,the humiliation that the spectators and not the players feel, we only remember the performance in the advertisements not on the field. Lavish praises will always be for the rival teams.
Hence forth my resolution is to see the game ,as a game we know, when other teams play and see it as a performance when India plays,as it looks like excellent acting when they stare at the bat,or shake their head,or limp or droop their head,or have a sorrowful face when returning to the pavilion . With this in mind it will not be necessary for me to write on this topic again.Blogging is great.So nice and relieved I feel on purging my mind of a pent up frustration on India and World Cricket.
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