I have started writing a series for The Dignity Foundation – an organization focused on senior citizens. Here is the first in the series that got published in the September issue of their magazine.

The best gift that we can give ourselves and our families is to live in good health until we leave this planet. As someone with several senior citizen relatives including some near and dear ones, i want to highlight some observations that i have collected about Elder Care.

To my utter shock and dismay, i find 2 broad patterns of behavior from doctors when it comes to treating senior citizens. And I am talking about doctors from reputed hospitals. One pattern is – doctors don’t seem to order basic diagnostic tests that are necessary, possibly under the pretext of saving money or because they have not kept themselves updated about the latest diagnostic tools and techniques. The other pattern is – doctors order surgical procedures aggressively when other treatment options are available.  Let me explain with some pertinent examples.

One of my senior citizen relatives recently started having blurred vision in one of the eyes. The doctor diagnosed it correctly as a damage to the retina due to high blood pressure  and left it at prescribing some medication for hypertension. Another doctor was consulted for a second opinion and that doctor immediately ordered an angiogram and it showed that there were some blocks in the arteries in the heart.  Armed with this information, consulted another opthalmologist, who decided to order an Eye Angiogram. It showed the areas that are damaged in the retina precisely.  I didn’t know such a test was available and i was impressed by the doctor who ordered it. With the results from both the Eye Angiogram and the Heart Angiogram, sufficient information was available to create a proper treatment plan. Why didn’t the first doctor order these tests?

In another instance, we took a senior citizen relative, who was complaining of a painful inflammation in the anal tract, to a reputed hospital. Several specialists got involved and they recommended an emergency surgery to fix the problem. We then took a second opinion from another doctor who simply gave some medication and the inflammation dissappeared in a few days.  I shudder to think what complications could have arisen if the surgery had been done.

There are many such examples i have noted which led me to the conclusion that there are serious issues with elder care in this country. My advice to elders, please try to understand what health condition you have and ask your doctor to explain the diagnosis and the course of treatment. Don’t be afraid to ask questions. If you don’t get convincing answers, go to another doctor.  Do some research on the Internet about the illness and be armed with information so that you can have a meaningful dialogue with your doctor.  Your health is too important to be left to the experts.

Although, it is easy to blame the doctors for these problems, i find that many elders have abysmal awareness about health issues. Many even hold outdated views such as:

- “In my family, there is no history of XYZ illness, so i will never get it”.
- “Oh! I am 70 years old, i am expected to have these problems, right?”

Everyone will agree that early detection of illnesses is critically important in effective cures and in the case of elders, this is even more important.  Here are some basic tips I strongly recommend that all elders follow:

1. Be very aware of your body – how much time you sleep, how many times you pass stools, urine – the consistency, color etc of the stools, urine. Frequently monitor these to make sure there are no dramatic changes in either the frequency or the color/consistency etc.

2. Check your weight atleast once a week and note it down to identify any sudden deviations.

3. Check your blood pressure frequently

4. Once a year do a master health check that includes your eyesight. If that is expensive, talk to your doctor about ordering some basic tests that are inexpensive but help you monitor the critical indicators.

Next month, we will cover how to research health issues on the Internet. Stay tuned.

Updated Apr 23, 2007: Vamsi commented that Apollo Hospitals is also doing this. Thanks Vamsi. See below.

While living in the USA for more than 10 years, i used to often envy the 911 service – emergency response within minutes. It shows how much value is placed on the human life and even animal lives. In fact, once I and Priya Raju were walking around in our neighborhood and we found a cat struggling for its life having been hit by a speeding car. We called the local animal shelter and within 15 minutes, a car had come to pick up the animal, but unfortunately by then the poor thing was dead. Amazing speed of response.

In contrast, you come across so many instances in India, where people are simply left to die because the emergency response is simply too late or no one considerate enough to help out etc. And even if some good samaritan wants to help and takes the victim to the hospital, one would face an endless barrage of bureaucratic procedures by which time the victim maybe beyond help.  You don’t even need to ask what happens to an animal in distress.

Last week i was on the road and i was immensely delighted to watch an advertisement on the airport TV network for what seemed like a 911 service in India from an organization called EMRI.

During the weekend, i checked EMRI’s website and sure enough it is India’s answer to the 911 service. It is currently operational only in the state of Andhra Pradesh and within the year that it has been in operation, it has helped save over 8,506 lives and responded to over 4.75 million calls. If you reside in Andhra Pradesh, you are lucky, and you can find help in an emergency by dialing 108. The agency coordinates with the medical, police and fire departments and dispatches help on an emergency basis.

Interestingly this EMRI organization has been funded by Satyam Computers, one of the key software service providers in India. Satyam’s corporate social responsibility initiative is admirable. Kudos to Satyam for funding such a great service.  Hope EMRI spreads its service quickly to all the states of India.

Flashback:

I had written about my experience at BSNL a while ago and in general about how in India we let the customer drive our workflows. This naked workflow problem is everywhere in India not just in government agencies. If you think about the 911 service, the innovation is mainly around the eliminating the need for the customer to figure out who to call, where to go etc. Hope the 108 service inspires others to cure the naked workflow problem.

Apollo Hospitals: 

Excerpt from Apollo’s website:

The National Network of Emergency Services is operational across 9 cities in the country (Chennai, Hyderabad, Delhi, Ahmedabad, Kolkata, Pune, Bilaspur, Kakinada and Bangalore). The system comprises 22 emergency rooms, 60 ambulances and over 500 personnel. The network is expanding rapidly and is expected to cover all the major towns and cities in the country by the end of 2006.

Notice that it still says “..2006″. I guess Apollo has forgotten to update its website. Hopefully, they have not abandoned their program to expand it to the entire country! BTW if you reside in one of them 9 cities you can call 1066 to get emergency help. The problem i see is that Apollo’s service doesn’t cover fire, police and other emergency services which the EMRI service covers.  May I ask why EMRI and Apollo pool their considerable resources and expand their services faster to all locations instead of having 2 competing emergency networks?

1. In what is potentially a breakthrough Researchers convert heat to electricity using organic molecules, that could lead to a new energy source. This employs the well-known Seebeck Effect. 2. TIME carried an interesting article on the web 2.0 gift economy. <Via Nick Carr> 3. In the animal watching department, check out Portia Labiata – a spider that does strategy. We typically associate strategy with large-brained animals including ourselves, but this tiny spider which has an even tinier brain is a master of strategy. Another bastion of unique human capability – strategy has fallen. 4. In the neuroscience department, researchers have found that amensiacs are unable to imagine the future. Till now, we associate amnesia with the memories of the past. 5. Priya Raju picked out “Thank you for Smoking” – a satire involving a lobbyist for the big tobacco companies – a part that Aaron Eckhart plays to perfection. This is a must see movie.

Priya Raju digs deep into her fear of cockroaches and comes up with some surprising possibilities. As for me, I am not afraid of cockroaches but I am afraid of creepy-crawly insects like spiders.
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I’m terrified of roaches. I can’t see even a single grown roach or its picture, without freaking out. And I have plenty of company. Blattiphobia - the paralyzing fear of roaches – is something that millions of us suffer thru.
It seems ridiculous to me that any human being would be afraid of something as insignificant as a roach: most specimens are just 2 inches long. They are neither poisonous nor are they terrifying. Surely, I must be able to explain why I’m afraid of roaches. After all, everything has a reason.

It is true that roaches bite – they’ll even eat human skin. In fact, it will eat any edible organic matter that doesn’t move. Since they are nocturnal, the bigger roaches may nip your ears or your scalp. But unless you are a child, your skin just isn’t tender enough to suffer damages from a roach bite.

Most people who are afraid of roaches aren’t exactly worrying about their bite. Mosquitoes bite too, but when was the last time you saw anyone screaming their head off in mortal fear of skeeters?

There is a theory that such phobias represent genuine fears that helped our ancestors at some point or another. If that is the case, the fear should be much more prevalent than it is today. Plus, I see no earthly benefits for our ancestors: If a fear of pythons has been passed that way, it might be meaningful. I can hardly imagine 12 feet long, human-eating roaches ruling the terrestrial environment in the late Pleistocene.

It has been observed that a considerable segment of the people with roach phobia may also fear other creepy-crawlies such as snakes, spiders, lizards, scorpions, worms etc. So, some people argue that roach phobia is a displaced fear of these other creatures. Yes and No: I fail to see how one can mistake a roach for a snake or a scorpion. The rest: I think there’s a connection – more on that later.

It is true that scorpions have a segmented body like roaches. Well, if you want to see the resemblance, turn an obliging roach backwards to see its ugly arthropod body. When I was a child of 5, I called the adults to the foyer – with true old world hospitality – to welcome a visitor. My mom came in, with the cook in tow. My mom took one look at the “guest” & froze: ambling along the foyer was a huge scorpion. Evidently, it was pleased with the reception & was inspecting its new quarters with enthusiasm. Our cook let out a piercing howl, dropped the griddle on the scorpion in fright & sent it on a one-way trip to join its Maker.

What I’m saying is this: I have a healthy fear of scorpions, born out of respect for its sting. But that’s about it: No dread, no scanning the horizon for some sign of the oppressor, no inborn fear. So, I don’t see the connection here either.

How can anyone transfer their fear of snakes onto roaches? There is absolutely no resemblance. I read that a genus of roaches – Gromphadorhina – hiss like snakes. This hissing is loud enough to scare dogs. But, our common, garden variety roaches are mute – so, there is no mistaking a roach for a snake!

Some people argue that Fear Conditioning is the cause. This is defined as a synthetic fear that we develop on a neutral object, when we repeatedly see it while in a state of fear. I once saw a TV program of a woman scared of feathers. It was very painful to watch an otherwise normal woman, become hysterical at the sight of a single feather. People might develop it – say, for instance – if they had a cruel care-taker/guardian/parent who beat them up while wearing feather boas.

This again is far-fetched in the case of roach phobias. If something scary happened in one’s childhood, it might create a synthetic fear of something of considerable size – like a teddy bear, a cabbage patch doll or roller skates. A roach is just too small & insignificant to be noticed.

We can stop right here, shrug our shoulders & observe that phobias are irrational; so, trying to find a reason for them is futile: Or not. Perhaps if I try to explain my phobia in words, it will help. Here we go:

Roaches are the epitome of ugliness. They have the most nauseating color combination in the entire animal kingdom – a dirty brown body with a yellow band near the neck. Their antennae are like limp hair – they have none of the cuteness of the bristly whiskers of a cat. Their legs are the stuff of nightmares – they have built-in spikes. When I was a child, a roach got into my T-shirt & waltzed all over my back, till my mom came to my rescue. My neck prickles when I think of how their legs felt on my skin.

Their mobility is their worst trait – I can only utter primordial screams when they move in their characteristic erratic fashion. They can flatten their body like pancakes & slither into the smallest of cracks. They will almost always run in the least expected direction. And boy, can they fly.

Just read the above blurb: It doesn’t describe fear, but that’s what I set out to do. If I wanted to explain why I’m afraid of tigers – for instance – I’ll say, “becoz they might eat me, stupid”. You can’t argue with that logic.

My blurb may not describe fear – but it describes another very basic emotion: DISGUST.

But Fear and Disgust are distinctly different emotions. There are considerable differences in the neural pathways for these feelings. There are distinct facial expressions associated with both of them. The Amygdala makes us aware of our fears, while the Insula processes disgust.

One can argue that most stimuli create a mixture of emotions in us. So, could the roach trigger both fear & disgust in me? Possibly – but we still can’t get away from the fact that I haven’t used a single word in my blurb that expresses fear.

Blattiphobes show all the classic responses to disgust: Nausea, Avoidance & Sensitivity. In other words:

• Nausea AKA Food Rejection – We are rejecting the roach as food. EWWW! Enough said.

• Disease Avoidance – By running away, we are avoiding them like the plague. Roaches have the repulsive habit of eating & shitting in the same place. If you leave food open, just throw it in the trash. Chances are, the roach has decorated your food with its pee. Did I mention that the GI tract of roaches has all the disease-carrying germs in the neighborhood? This is because they eat anything. Their feces will have representative samples from all the germs in their gut.

• Sensitivity AKA Contamination Prevention – We are trying to ensure that the stupid roach doesn’t get into our mouths. If that happens, we would have to vomit till we don’t have any innards.

Let’s consider this: Insula takes some time to respond. Amygdala responds almost instantaneously. This indicates that our brain needs some time to process the disgust-relevant image – unlike fear.

There is a theory that the fear of roaches is hereditary. Neither of my parents are afraid of roaches, but I have several aunts & cousins (all on my father’s side) who’ll shriek & bring the house down if they saw a roach. But statistically, there is no proof that this fear is passed on from generation to generation.

But something else is passed on: Sensitivity to Disgust. Whether it is passed on genetically or thru social conditioning – we don’t know yet. I would argue that it is a combination of both.

It is well known that roaches are carriers of disease. So, if someone has a heightened sense of disgust, they’ll try their best to avoid roaches – or, spiders, rats, worms & lizards. All of them have or had a reputation of spreaders of disease. Or, they look plainly repulsive.

It is interesting to note that most other phobias are a symptom of an anxious personality: While Heightened Disgust manifests itself as phobia of small animals.

Tail Piece

I’m offering this as corroborating evidence. My brother has a phobia for lizards. We – me, my brother & our father – also have Migraines, Motion Sickness & Vertigo. In short, ailments which make us very nauseous – perhaps this proves that we have a tendency to be disgusted: Since nausea is an essential element of disgust.

I read that Migraine sufferers have low levels of Serotonin. Lowered levels of this neurotransmitter result in obsessive or compulsive behavior. My father is painfully methodical in everything. My brother is compulsively clean. I obsess about every little detail in anything I do. In short, none of us are easily satisfied. Classic symptom of low Serotonin, I think.

So, here is what I wonder. Do people with low serotonin levels have phobias of creepy-crawlies? Will my Blattiphobia be cured temporarily if I get a Serotonin injection? It would certainly be interesting to try it out.
References:

1. http://www.bio.umass.edu/biology/kunkel/cockroach_faq.html
2. http://www.open2.net/healthliving/body_mind/fear_and_loathing_p.html
3. http://mentalhealth.about.com/library/sci/0203/bleww203.htm
4. http://www.psyeta.org/sa/sa2.1/davey.html

Priya Raju is on a roll here. Here is her second post.

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When it comes to working out, I’m one of the laziest people in the world. No exaggeration: If this kind of laziness became a formal discipline, I’ll pass out summa cum laude. My husband Sukumar is an industrious guy. He at times complains of difficulties in dropping off to sleep at night. That is one problem I never have.

For the past 2 decades, I’ve been struggling with my migraines. It just grew & grew every year, like a human child. If my math is any good, it is 21 years old & it has probably just graduated from college. It is alive & kicking – and I’m in deep shit.

My doctor now wants me to start a mild to moderate exercise plan. Whenever I have my regular checkup, she asks me if I’ve started working out. I promptly tell her that I’m “waiting for X”: X being some lame-ass excuse that I concocted specially for her. Where exercise is concerned, I’m a procrastinator too. I practice it like an art form. It takes a lot of ingenuity to rationalize delays & actually feel good about it.

<!– D(["mb","Then, something happened: Retail Therapy back-fired. What started out as a routine shopping trip for clothes, goaded me to act. In plain English, I was 9 pounds heavier. I shuddered when I looked at my butt in the fitting room mirrors – it looked like a pumpkin in full bloom (or whatever it is pumpkins do – I\\\'m no botanist).\n

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Vanity gets you when reality doesn\\\'t. So, I\\\'ve started working out these days. But what about eating healthy?

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I\\\'ve decided to cut down on junk food: easier said than done. India is the diabetes capital of the world – get this: All the assorted sweet shops & bakeries in \nIndia contribute a whopping 50% of the retail sector. Or so I read.

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India feels a lot like the US of the 1950s. The newly affluent middle class is focused on living as well as possible within their means. So, \nIndia is the land of hedonistic pleasures now & gourmandizing is a star attraction. Adi Shankara & all other sages who preached contentment would be stirring in their graves. Well, Hindus are cremated, so they probably don\\\'t have a grave – but you get my point. \n

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Not that I blame my fellow Indians. Poor blokes never had money till now & most people don\\\'t care terribly for contentment. Let\\\'s be Dionysian for a change: Enough of namby-pamby Apollonian tastes & traits. Nietzsche used the phrases "Dionysian" & "Apollonian" to describe artistic impulses, but I think it also holds well to describe one\\\'s attitude to life.\n",1] ); //–>Then, something happened: Retail Therapy back-fired. What started out as a routine shopping trip for clothes, goaded me to act. In plain English, I was 9 pounds heavier. I shuddered when I looked at my butt in the fitting room mirrors – it looked like a pumpkin in full bloom (or whatever it is pumpkins do – I’m no botanist).

Vanity gets you when reality doesn’t. So, I’ve started working out these days. But what about eating healthy?

I’ve decided to cut down on junk food: easier said than done. India is the diabetes capital of the world – get this: All the assorted sweet shops & bakeries in India contribute a whopping 50% of the retail sector. Or so I read.

India feels a lot like the US of the 1950s. The newly affluent middle class is focused on living as well as possible within their means. So, India is the land of hedonistic pleasures now & gourmandizing is a star attraction. Adi Shankara & all other sages who preached contentment would be stirring in their graves. Well, Hindus are cremated, so they probably don’t have a grave – but you get my point.

Not that I blame my fellow Indians. Poor blokes never had money till now & most people don’t care terribly for contentment. Let’s be Dionysian for a change: Enough of namby-pamby Apollonian tastes & traits. Nietzsche used the phrases “Dionysian” & “Apollonian” to describe artistic impulses, but I think it also holds well to describe one’s attitude to life. <!– D(["mb","

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Coming back to my point – I want to eat healthy stuff, but that\\\'s not easy. I\\\'d really like to stay away from trans-fat laden, instant artery hardeners that are - sadly these days - the only items that taste good in \nIndia. Most restaurants just don\\\'t have healthy & edible stuff on their menus.

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An example - I took the tremendous risk of ordering Minestrone soup in a local restaurant. My advice: Press it on someone you want to murder – buying soup for somebody you hate is not illegal & you get the job done in under $2. I was served an orange colored goop on which mystery vegetables had been cruelly mutilated. I chickened out & ordered some fried heart-choker. \n

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All I\\\'m saying is, it won\\\'t be easy to work out regularly & eat healthy. But, I\\\'m going to try.

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Coming back to my point – I want to eat healthy stuff, but that’s not easy. I’d really like to stay away from trans-fat laden, instant artery hardeners that are – sadly these days – the only items that taste good in India. Most restaurants just don’t have healthy & edible stuff on their menus.

An example – I took the tremendous risk of ordering Minestrone soup in a local restaurant. My advice: Press it on someone you want to murder – buying soup for somebody you hate is not illegal & you get the job done in under $2. I was served an orange colored goop on which mystery vegetables had been cruelly mutilated. I chickened out & ordered some fried heart-choker.

All I’m saying is, it won’t be easy to work out regularly & eat healthy. But, I’m going to try.