How to Get the Best Medical care. A guide for t

2. HOW TO GET THE BEST MEDICAL
CARE – FOR LESS !
Dr Aniruddha Malpani, MD
Dr Anjali Malpani, MD
www.thebestmedicalcare.com

3. Preface
Effective health care depends on self-care.
Ivan Illich.
Whenever someone falls sick, they hope to get the best medical care from their
doctor. In a perfect world you'd have the perfect doctor who would have plenty of
time, infinite wisdom, low fees, be totally honest yet compassionate, have a
conveniently located clinic and understand your emotional as well as medical
problems – in short, one who treats you as a VIP !
Since it's unlikely you are going to find this doctor, you're going to have to take
active charge of your own medical care ! Medicine, as both a science and art,
often requires choices and there are no "right" answers - you need to make your
own decisions - after all, it's your life !
While you obviously have a vital interest in treatment decisions and outcomes ,
unfortunately you lack the medical knowledge and skill to be able to decide
alone. This is where the concept of a team , which consists of you and your
doctor , is so important. Your role on the medical team is multifaceted -
remember that you need to wear many hats when you are a patient !
Medical Information Researcher: The more knowledgeable you are about your
problem and its treatment, the better are your chances of getting the right
treatment. Educate yourself - you need to become an informed participant in
your medical care in order to ask the right questions and to participate in making
decisions about your treatment.
Medical Team Manager: You will have to find, evaluate, select, hire - and
sometimes fire - members of your medical team. As an enlightened patient, you
need to remember that you are the one in charge of your body !
Treatment Decision Maker: You will have to decide which treatment to choose.
Sometimes the choices are straightforward , but sometimes they can be very
confusing. A good doctor will offer you all the options and help you to decide - but
it is finally your right (and responsibility ! ) to select which is right for you. You
cannot afford to leave everything upto God - or upto the doctor either !

4. Medical Record Keeper. You must keep all your records - this can be very
helpful if you need to change doctors or get a second opinion.
Financial Manager: Medical treatment can be very expensive these days - and
you must be aware of the costs involved . Many patients are hesitant to talk to
their doctor about money matters - but this reluctance can prove to be very
expensive !
Communicator: It is important that you be open and honest with your doctor. Ask
questions, listen to the answers and take notes. Remember, the only stupid
question is the one you don't ask - so don't hesitate to ask ! And if you don't
understand, the fault is not yours - it just means your doctor is not explaining
well!
This book will help you during your medical journey – right from choosing your
doctor; making the best use of his expertise; researching your options;
understanding medical jargon; to taking care of yourself in hospital and during
surgery. It answers all your common questions about medical care, medical tests
and medicines – right from birth to death, so you can get the best medical care
for yourself – and for your family !
All the information in the world will never replace a personal conversation with
your own doctor. But it can be a starting point in helping you to take control over
your own medical situation ; to find the doctor who can best treat it; to have
effective conversations with that doctor; and to help you to be a partner in your
treatment. A VIP patient is a very well Informed Patient - and that's the best kind
of patient to be if you want to get VIP care !
Dr Aniruddha Malpani, MD
Dr Anjali Malpani, MD
Medical Director
HELP - Health Education Library for People
Om Chambers
Kemps Corner
Bombay 400 036.
India
Email: malpani@vsnl.com

5. Contents
Preface
I Your Health And How To Keep It
Chapter 1 Going Beyond An Apple a Day: How to Remain Healthy
Chapter 2 Health Headlines: Making Sense of Medical Stories in the News
Chapter 3 How You Can Give Your Baby a Head Start in Life
Chapter 4 Medical Care for Your Offspring: No Child’s Play
Chapter 5 Growing Old, But Keeping Fit
Chapter 6 Caregiving: Taking Care of Elders
Chapter 7 Learning to Live well with a chronic illness
Chapter 8 Self-Care: Handling Common Medical Problems at Home
Chapter 9 How to Keep Fit While Travelling
Chapter 10 How Not to Get ‘Quacked’
Chapter 11 Alternative Medicine: Exploring Your Options
Chapter 12 The Healthy Community: One for All, All for One
II You and Your Doctor
Chapter 13 Looking for Dr Right
Chapter 14 How to Make the Most of Your Doctor
Chapter 15 How to Talk Intelligently to Your Doctor
Chapter 16 How to Use the Telephone Wisely
Chapter 17 Making Friends with the Clinic Staff

6. Chapter 18 A Second Opinion: A Prime Necessity
Chapter 19 Specialist: A Class Apart
Chapter 20 The Ideal Doctor's Code of Practice
III Becoming An Empowered Patient:
Making the Doctor-Patient Partnership Work
Chapter 21 The Responsibilities of a Patient: Quite a Load!
Chapter 22 Your Rights as a Patient
Chapter 23 Your Medical Records: Vital Statistics
Chapter 24 Beware of Medical Care!
Chapter 25 Checking up the Medical Check-up
Chapter 26 Medspeak: Making Sense of Medical Jargon
Chapter 27 Support Groups: Self-Help Is the Best Help
Chapter 28 Sources of Information: How to Research Your Medical Problem
Chapter 29 New Technology in Medicine: Handle with Care
Chapter 30 How to Prevent ‘Testitis’
Chapter 31 Making Decisions about Treatment
Chapter 32 Medical Insurance
Chapter 33 Healthy, Wealthy and Wise: How to Balance the Medical Budget
Chapter 34 Informed Consent: A Crucial Factor
Chapter 35 How to Complain Effectively: The Legal Options
IV You And Your Medicines
Chapter 36 Medicines : Boon or Bane?
Chapter 37 Over-the-Counter Drugs: How to Use them Wisely

7. Chapter 38 Coping with Side-Effects
Chapter 39 Preventing Medication Errors: A Vital Precaution
Chapter 40 ‘Prescription’ for a Healthy Medicine Cabinet
V A User-Friendly Guide to the Hospital
Chapter 41 On the Way to the Operation Theatre: What You Should Ask Your
Doctor Before Undergoing Surgery
Chapter 42 The Kinder Cut: Surgery Made Easy
Chapter 43 The Importance of Emergency care
Chapter 44 How to Make a Hospital Hospitable
Chapter 45 Intensive Care or Insensitive Care?
Chapter 46 Death with Dignity
VI Appendixes
Appendix 1 Your Personal Health History
Appendix 2 Key Questions to Ask Your Doctor
Appendix 3 Detailed Information About Your Medical Problem : Delivered at
Your Doorstep

8. Chapter 1
Going Beyond An Apple a Day: How to Remain
Healthy
Those who think they have no time for exercise will sooner or later have to
find time for illness.
Edward Stanley
An ounce of prevention is worth a pound of cure is a cliché, but very true,
nevertheless ! All said and done, no matter how efficient medical technology is,
and no matter how competent your doctor is, the best course would be to adopt
such a lifestyle that you never need to see a doctor in the first place !
Unfortunately, we have become increasingly dependent upon technology,
with the result that we have lost sight of the sagacity of the ages; which was so
designed that human beings could live in harmony with nature, and use nature’s
healing powers and the body’s intrinsic wisdom to remain well. Fortunately,
preventive health and wellness have once again become fashionable ideas for
the 1990s — after all, the best medicine is prevention!
Do we really need a doctor to keep us healthy ? The dismal fact is that most
doctors know a lot about treating ailments, but they know precious little about
how to remain healthy ! (Unfortunately, medical colleges do not teach doctors
how to specialize in keeping people healthy !) In fact, since doctors are so used
to treating patients who are ill, many of them really wouldn’t be of much use in
teaching you how to remain healthy! Fortunately, you do have a remarkable
teacher, who can help you to remain healthy — the wisdom of your own body !
Many people are now realizing the value of going back to nature. None of the
steps involved in such a process is difficult, complex or expensive, but you need
a firm resolve to implement them. Fortunately, India can boast of a rich tradition
of folklore and wisdom ( including yoga and ayurveda) to fall back on, and we
should tap this resource before we lose it entirely. All sensible doctors realize
that healing finally occurs from within, and thus we can make beneficial use of

9. the innate wisdom of the body to remain healthy ! Traditional wisdom recognizes
that it is the body which heals itself; in other words, the power to cure a disease
lies within the body itself and not in the hands of the doctor.
A majority of people will admit that they have fallen victim to several bad
habits. However, most of us are still not willing to change, and that’s odd,
because most people still believe that being healthy is far more important than
having lots is money or driving a fabulous car. So why don’t we change ?
One reason is that we feel it’s too much trouble to hoist ourselves out of our
comfortable ruts, in which we are deeply entrenched. This is especially true
when we’re under stress. Unhealthy behavior proves easier and more convenient
than doing what we know is right !
One factor which galvanizes many people to get serious about living healthily is
confronting a serious illness, either afflicting them, or a friend or a relative. This
realization usually acts like a kick in the pants, and makes them reform quickly!
Many patients, after having been through the rigours of a heart attack, for
example, are so thankful to be alive that they’re very willing to make serious
changes in lifestyle. However, a smart person learns from others, and you don’t
have to wait for an agonizing incident to jumpstart a change in your life!
The most important question is: How do you get started? For one, start out by
trying to make small changes before going in for big ones. Also, begin by
adopting a new behaviour pattern rather than giving up an old one, because the
former is easier. For example, it’s hard to stop smoking, but it’s pretty easy to
add fruit to your diet every day. If you’re successful in introducing small changes,
the resulting benefit will motivate you to undertake the required big changes.
Do things that make you feel good instantly, such as spending more time with
understanding friends. If they let you talk out your problems and are warm and
caring, even if they aren’t in the best shape themselves, such a sympathetic
attitude will reduce your stress and make it easier for you to follow other healthy
strategies.
Prayer, worship and belief in God are an important part of life for many people,
and spiritual beliefs and practices can actually enhance your health and well-
being as well.
Keeping a pet is also a beneficial activity, and has been shown to improve life
expectancy according to many studies.
It would be worthwhile to be realistic and specific when setting goals for
yourself – don’t try to run a marathon if so you’re out of shape that you cannot
even walk one kilometre! Start by promising yourself to walk for five minutes
every day; then increase the duration gradually each week.
If you find yourself gobbling sweets or junk food at certain times of the day, try
to figure out what triggers the desire. If you find that you keep on munching
chips while watching TV, put a bowl of fruit next to you instead; or else don’t

10. watch TV. It’s very important not to let temporary setbacks obstruct your overall
progress. We are all normally prone to relapse; just don’t treat it as a
monumental problem. Promise yourself that you’ll start again and get back on
track right away.
It’s simple to live healthily — and it’s not expensive either ! There are only
seven major ingredients in a plan for good health:
1. Exercise: Work up to a regular aerobic ( endurance) exercise programme
2. Diet and nutrition: Everything in moderation – and cut down on the fat.
3. Weight Control: Maintain a healthy weight, avoid gaining and losing it.
4. No smoking: Consider smoking as enemy number one.
5. Alcohol moderation: Abstinence would be ideal.
6. Avoiding injury: Use your common sense (for example, by using seat belts,
or opting only for safe sex).
7. Disease prevention: This can be achieved through periodic check-ups,
immunizations and health risk appraisals.
Your future health is largely determined by what you do at present; your lifestyle
and dietary habits will determine how much time you’ll spend in hospitals and
how rapidly you’ll age. Techniques have been developed for estimating
mathematically your future health risks. These techniques are collectively termed
‘health risk appraisal’ or ‘health assessment’. Here, you have to fill a
questionnaire about your lifestyle and health habits and your responses are
computed to evaluate the likelihood of your developing major medical problems,
such as heart disease and cancer. These techniques are an important part of
comprehensive health education programmes, and can help you shape your own
personal health maintenance regimen. Remember that a health risk assessment
is virtually useless unless it motivates you to change your behaviour. You should
constantly remind yourself that you can reduce your health risks by changing
your lifestyle!
Any person on the street knows that to live longer you need to eat properly,
exercise regularly and reduce stress to the extent possible! What you need to do
is to get off your backside and start doing what you know will help you feel better
and lead a longer and healthier life. Just do it, like the Nike ads exhort! Teach
your children as well, so that our next generation can look forward to a healthier
future !

11. Chapter 2
Health Headlines: Making Sense of Medical Stories in
the News
It’s all story telling, you know. That’s what journalism is all about.
Tom Brokaw
All of us rely on the media (TV, radio, newspapers, magazines) to remain
updated with the latest news. While making sense of the share prices in the
financial section is straightforward, how does one interpret or understand the
medical stories?
We are now awash in a flood of health information, and barely a day goes by
without a report of a spectacular new cure for a formerly incurable illness.
However, many people find themselves increasingly frustrated in the face of the
media barrage of confusing and contradictory health advice. One day, drinking
alcohol is bad for your health; the next day it is reported to help prevent heart
disease. One day, margarine is healthier than butter; the next day it's not. One
day fish prevents heart disease, then it doesn't! You may be exasperated enough
to ask: Why can't researchers get their facts right the first time? And how are you
supposed to make sense of what you read, if the experts themselves can't make
up their minds?
In order to maintain a balanced perspective, it's important to remember that
news, by its very definition, implies something new and unusual. This is why
medical stories in the media often seem to be at loggerheads with what common
sense tells us. After all, the hundredth study showing a relationship between high
cholesterol and heart disease is hardly news, but the one study that shows that
eating fat helps prevent heart disease is likely to become a headline — no matter
how flawed it may be! The media is often guilty of oversimplifying or exaggerating
results. Moreover, headline writers may focus on an angle that gives a distorted
impression, which often means that facts are sacrificed at the altar of readability
or circulation figures.
Many reasons can be attributed to the somewhat shoddy standard of
reporting in the lay press with respect to medical matters. Editors crave for stuff
which is ‘new’ and doctors and hospitals are only to happy to tom-tom their latest
gadgets and gizmos. Reporters are often not specialized enough to understand
the medical technical background. Often, they do not do their homework
properly, which results in misreporting, which is, unfortunately, a common

12. occurrence in India. It is a sad fact that although most newspapers and
magazines have a battery of expert financial reporters, few have full-time
knowledgeable health medical reporters.
The outcome of the foregoing drawbacks is that patients are often confused
and are not sure how the latest advances apply to them. They often flood their
doctor’s clinics with ‘false alarms’. As a result, the media loses credibility, so that
they often end up performing a disservice to patients and their doctors. Because
the public is eager, for any scrap of medical news, the media often reports
individual studies out of context, as if each study could stand alone. However,
single studies rarely yield a simple ‘yes’ or ‘no’ answer to a medical question.
One ought to realize that scientific discovery is a process that often takes years
to unfold. In a sense, medical researchers are weaving a large tapestry that will
eventually tell a complex story when one stands back to look at the whole
picture. An individual medical study can only contribute a small strand to the
overall fabric. While the findings of individual studies may even seem to
contradict one another, evidence accumulates gradually from scores of such
studies. A coherent picture emerges slowly over time, and only then can we
make definitive recommendations.
One way of solving the problem arising due to misleading, inaccurate or
piecemeal reporting on the medical front would be for newspapers or magazines
to appoint medical doctors as consultants on their editorial panel, who can be
used as a sounding board to assess the reliability and validity of a medical story.
Also, as the media realizes the importance of health stories, hopefully, we will
soon have full-time reporters who specialize in covering health stories
exclusively. Till then, what can you do to separate the wheat from the chaff ?
First of all, identify the source. Does the information come from a reputed
publication (such as The Lancet) or a leading medical professional organisation
(such as the American Heart Association)? Not that such identification can
guarantee its reliability or trustworthiness either, but it helps to know that the
information is coming from a respected and respectable source. At the other
extreme of unreliability is information from a commercial source, or from an
Internet newsgroup!
Second, look beyond the statistics. When reports hurl at you statistics like ‘a 30
per cent increase’ or phrases such as ‘a 50 per cent higher risk ,’ take a closer
look at the exact numbers. Many of us get ‘turned off’ by numbers, but this
attitude can prove dangerous: you need to ask yourself what the numbers really
mean and how they apply to you? Benjamin Disraeli once remarked that there
are three kinds of lies: lies, damned lies and statistics. Remember that statistical
methods are simply tools, and they can produce blatantly wrong conclusions
unless sensibly used. One common way in which statistics can be misleading
pertains to reporting of relative and absolute risk. A headline that screams ‘X

13. Doubles the Risk of Y’ is way off target if your chance of contracting ‘Y’ is one in
a million to begin with. Doubling the risk of ‘Y’ only makes it two in a million! The
relative risk (doubled) is nothing to worry about if the absolute risk (an increase
from one to two in a million) is tiny.
Third, scrutinize the results. Does this information reveal a direct cause-
and-effect relation between two factors? Or is it merely an association? For
example, someone could argue there’s an association between matches and
lung cancer because matches light the tobacco that causes lung cancer. But
common sense would tell you that lighted matches don’t cause lung cancer.
Typically, years of consecutive studies are required to prove a cause-and-effect
relation and the results of one study usually don’t provide enough proof. If just
one medical study has documented an unusual or peculiar finding, and if the
results have never been replicated by any other study, then this situation
suggests that the study is not reliable!
None of us wants to become a medical researcher, but it does help to
know a little bit about the various types of medical research as well as their limits.
Basically, medical studies can belong to three categories:
(1) Laboratory experiments; (2) epidemiological research; and
(3) clinical trials.
Laboratory experiments can be carried out in test tubes or on animals
such as mice, rabbits or guinea pigs. Results obtained from animal trials should
never be applied directly to humans for several reasons. For starters, of course,
people are not lab animals. Also, mice and other small creatures are not naturally
subject to many of the common ailments that afflict humans; therefore, scientists
have to alter them genetically or physiologically to create animal ‘models’ for
human diseases. The results of such studies are interesting and useful to
scientists, and often pave the way for important advances, but they don’t tell
doctors which medicines to prescribe for people.
In epidemiological research; scientists closely study a large group of
people and then collate their findings. Next, they extrapolate these findings to the
general population . Because such a study is observational, it is a fairly useful
method to uncover possible risk factors but it can never actually prove a cause-
and-effect relation, because the interactions between humans and the
environment are extremely complex.
In contrast to epidemiological studies, which scrutinize the complexity of real-
life cases, clinical trials provide a systematic way of testing the effects of one
particular factor, such as a drug, under tightly controlled circumstances. Clinical
trials, which are experiments performed on people, are thus the most reliable of
the three categories, because they compare two carefully controlled groups of
people. However, remember that these trials have their own limitations as well.

14. Often, the process of reading the original research study in a medical journal
can be an intimidating task. However, editorials in the journal help place things in
proper perspective. Also, review articles can help provide a broad overview of the
research and its importance. Consumer health magazines also help demystify
some of the research by providing understandable commentary.
One important safeguard against imperfect or flawed scientific reporting is
peer review; i.e., scientists scrutinize each other's work in advance. Almost all
well-respected scientific journals rely on peer review to select papers for
publication. Any study that has not undergone peer review should be regarded
with the utmost scepticism. For example, one should be wary of findings
announced at a press conference that are not accompanied by publication in a
journal or by a presentation at a scientific forum. At the same time, it's also true
that peer review is no guarantee by itself that a study is reliable. For example,
expert reviewers have no way of knowing if an investigator has falsified the data
in an article. And even if a study is well-designed and scientifically valid, it may
have absolutely no relevance to most people.
The next crucial question is: how do you apply what you have learnt? Let's
imagine for a moment that you've read a report about a new clinical trial and all
the signs appear encouraging: its results confirm conclusions drawn from similar
trials and the experts seem to agree that it has been well designed and has
generated valid information. Now comes the difficult part: how can you use these
new findings to improve your own health?
Initially, ask some basic questions: How likely am I to get this disease in the
first place? Were the symptoms of the participants in the study at all similar to
mine? Because perspective on depth is so often missing from news reports,
some people focus on the latest details at the expense of the big picture. You
should ideally follow the dictum: Be quick to question, but slow to change.
Moreover, if the ‘new’ information is in conflict with ‘conventional wisdom’, you
should regard it warily. Trying to heed all the advice all the time can prove
overwhelming and disconcerting. You should evaluate your individual risk profile,
based
On your lifestyle and family history, and then make appropriate changes that
will give you the highest returns for your effort.
If a news report raises nagging doubts in your mind about your treatment ,
diet or lifestyle, make it a point to ask your doctor whether or not the report
applies to you. However, most of the time you simply need to rely on your
common sense. After all, it's rather silly to worry about having missed one's daily
quota of beta- carotene supplement while smoking the twentieth cigarette of the
day !

15. Chapter 3
How You Can Give Your Baby a
Head Start in Life
Take care to be born well.
George Bernard Shaw
We are all familiar with the adage: ‘Be good to your baby before it is
born’. This aphorism serves to emphasis the importance of medical care during
pregnancy (known as antenatal care). However, in reality, the best time to start
taking care of your unborn baby is even before you conceive! Such care is called
pre-pregnancy or pre-conception care.
Why is this care so important? Remember, that the foetal organs are actively
developing during first 12 weeks of pregnancy (this crucial period is called
‘organogenesis’.) The embryo is highly susceptible to external insults during this
time, so that any damage can lead to crippling birth defects.
The beauty about pre-pregnancy care is that it is so simple: all that is
involved is visiting your doctor before you are planning to get pregnant, rather
than after you've missed your menstrual period! The doctor normally undertakes
the following procedures: (1) takes a medical history; (2) carries out a physical
examination; and (3) performs some simple laboratory tests. These procedures
are inexpensive and easy to conduct and signify examples of preventive
medicine at its best!
Pre-pregnancy care also leads to other benefits. For instance, it allows the
doctor (duly assisted by you) to identify problems and rectify them. If, on the
other hand, these problems were to be spotted only after you became pregnant,
detailed testing can become very difficult, because the very presence of the
delicate embryo, can impede testing. The harsh reality is that not all problems
are preventable, but you can, nevertheless, increase your chances of having a
healthy baby by identifying the risks you face and trying to eliminate them, if
possible. After all, most doctors go in for a battery of tests before performing
major surgery, to make sure that the patient is healthy enough to withstand the
stress generated by the operation and the anesthesia. Pregnancy can also stress
the body, and it is important to screen the woman for potential problems before
she embarks on one of the most important journeys she will ever make!
The most important precaution to be taken is to ensure a regular intake of
a vitamin called folic acid. Folic acid greatly reduces the chances of your baby
being born with spina bifida (a developmental anomaly affecting the spinal cord)
or anencephaly (without a brain) if taken before you become pregnant and during

16. the first six weeks of pregnancy. This vitamin is now routinely prescribed in many
countries in the West to prevent many birth defects.
Most women are aware of the importance of regular medical care during
pregnancy and you should plan to register with a reliable obstetrician as soon as
you find out that you are pregnant. This ensuing pre-natal care will then simply
be an extension of your pre-pregnancy care. While modern obstetric care can
ensure that pregnancy and childbirth are very safe for both mother and baby,
unfortunately, today doctors have ‘medicalized’ pregnancy to such an extent that
what is otherwise a normal event has been converted to one which needs
rigorous and frequent medical assistance.
Every mother naturally wants a normal baby, and technology can be very
useful in reassuring her that all is well. However, it's easy to misuse technology.
One particularly disturbing trend stems from the fact that many obstetricians
nowadays overuse medical technology; such overuse can often prove
detrimental to both the mother and the baby. Common tests which are misused
include: blood tests for TORCH (Toxoplasmosis, Rubella, Cytomegalovirus;
Herpes) infections; ultrasound scans; and foetal monitoring. Another area of
misuse relates to the tests available for screening the baby for a possible birth
defect. Many doctors routinely subject their patients to a ‘triple test’ during the
pregnancy to screen for birth defects. While this is an easy test (it’s a simple
blood test which measures the levels of 3 hormones in the blood) to carry out
unfortunately, it has still not been standardized for Indian women. Such a
drawback leads to a large number of tests yielding abnormal results, even though
the babies are completely normal. An ‘abnormal’ result creates a lot of anxiety -
and then the doctor needs to perform a battery of other tests to confirm that the
baby is, in fact, normal to reassure the mother. The second tier of tests can be
expensive, and risky as well, because some of them can cause the mother to
miscarry. Thus, it is not uncommon for a mother to lose a healthy baby because
of a test which was not really required in the first place!
The foetal monitoring procedure has also been overused over the past few
years. While this procedure was initially designed to serve as a tool to monitor
the well-being of the foetus and to help reduce the need for medical intervention,
today it is often used to justify an LSCS (Caesarean section) in order to forcibly
take out a baby ‘in foetal distress’! A much simpler alternative would be to opt for
‘kick counts’, a procedure in which the mother simply keeps track of how often
her baby moves in a given time period — a baby which moves actively is sure to
be healthy!
Antenatal classes conducted by medical or paramedical professionals can be
very helpful. Here, you not only to learn a lot about pregnancy and childbirth, but
also you get an opportunity to interact with other women in various stages of their

17. pregnancy. The friendships developed during this period can be very supportive
and helpful!
Despite tremendous advances in medical science, labour and childbirth are
still events which many women dread. Moreover, the rituals associated with
childbirth in hospitals have unfortunately been designed for the doctor's
convenience, rather than the patients'! In this context, the harmful practises
include: forced induction of labour; routine use of enemas and intravenous drips,
foetal monitoring, making the patient lie down (rather than allowing her to walk
about) — it's a long list! Don't let the hospital/clinic staff patronize you — you
need to assert your rights! It's very useful to draw up a birth plan (which includes
things you will allow and those you won't ) and make sure your doctor agrees
with the procedures. The presence of a doula (birth assistant) has been proven
to be you very helpful for women in labour. Also, should encourage your husband
to participate in this adventure as actively as possible !
Yet another minus point pertains to the application of anaesthesia for pain
relief, which has become the norm nowadays. We have mindlessly aped this
Western ‘advance’, much to the detriment of both the mother and the child. While
techniques for pain relief a valuable resource, can be they should be used only
when absolutely necessary.
We are witnessing a virtual epidemic of Ceasarean sections today. Whereas
a CS once used to be the method of last resort to deliver the baby, it has at
present, tragically, become the norm in some hospitals, accounting for 50 per
cent of all births. The reason, of course, is obvious: a CS is financially much
more lucrative to the doctor than a normal delivery. As a senior obstetrician wryly
put it: ‘The only indication for a normal delivery today seems to be if a patient
delivers before the doctor reaches the hospital!’
The alarming spurt in CS has taken on the dimensions of a major scandal
today, which needs to be tackled actively. What steps can you take if you don't
want to end up as another statistic? It would be a prudent idea to find out the
rates your doctor charges for a CS and for a normal birth. You can also ask him
what proportion of his patients successfully delivers normally. Other patients in
the clinic, as well as the hospital nursing staff, can prove to be valuable sources
of information, which you should effectively tap to alert you to a “knife-happy”
obstetrician, from whom you need to stay away!
A significant recent development is that many women in the West are turning
back to natural childbirth once again, often either at home or what are known as
‘birthing centres’. In other words, they would like to keep as far away from a
hospital as possible! Despite the fact many doctors scare women into believing
that the hospital is the safest place to deliver a baby, recent international studies
have shown that the home is often much safer and much more congenial for
normal births. For example, Holland, where over 60 per cent of births occur at

18. home, under the supervision of midwives, can justifiably boast of having one of
the world's lowest neonatal mortality rates! The midwifery model seeks to remind
women that childbirth is a natural process for healthy women and women need
to learn (or rather, relearn!) to trust their bodies!
There are several ‘dos’ and ‘don'ts during labour and birth; for instance:
• Do walk around.
• Do learn to manage your labour pains without resorting to unnecessary
medication.
• Do ask to hold your baby as soon after birth as possible, so that you start
immediate bonding.
• Do ask that your baby be allowed to remain with you.
• Do leave hospital as soon as possible (in 2-3 days).
• Do have your husband with you.
• Do have a doula (birth assistant) with you .
• Do use pain relief medications very sparingly.
On the other hand:
• Don't take an enema.
• Don't lie in bed constantly.
• Don't allow an episiotomy (i.e., surgical incision into the perineum and
vagina).
• Don't allow the doctor or other medical staff to cut the umbilical cord, until it
stops pulsating.
• Don't allow them to start an IV drip, routinely.
• Don't allow them to take your baby away.
• Don't allow them to give the baby top feeds (i.e., food other than mother’s
milk).
The last point needs a little elucidation. While everyone knows that breast milk is
best for baby, unfortunately, many mothers still persist in giving their babies
manufactured products. Why not give your baby ‘the real thing’, rather than a
substitute ? It's a shame that most women who would never dream of wearing
imitation jewellery don't mind feeding their babies an imitation substitute!
TIPS FOR A HEALTHY PREGNANCY

19. The following pointers would prove useful during your pregnancy.
1. Learn as much as possible about the wonderful ways in which your body is
changing and about how your baby is growing. Talk to your mother, your
friends, and other women about pregnancy, labour and birth. Attend
pregnancy-related classes, read the relevant books, and watch videos about
normal pregnancy and childbirth.
2. Eat a well-balanced diet and drink lots of water.
3. Avoid substances that may be dangerous for you and your baby such as
cigarettes, alcohol and street drugs.
Do not take any medications, even over-the-counter varieties, unless you
have discussed them with your doctor and taken his approval.
4. Remain active! Continue with the exercise programmes that you were
following before you became pregnant, modified, if needed, according to the
recommendations of your doctor. If you were not exercising at all before
becoming pregnant, consider going in for walking or swimming. Start with
short periods of exercise, and gradually increase the amount of time.
5. Get plenty of rest. Listen to your body to determine if you need short breaks
during the day as well as to determine how many hours of sleep you need
at night.
6. Talk to your baby and enjoy your growing bond with him. Research now
shows that babies can react to the sense of touch as early as ten weeks of
pregnancy! A little later, they can react to light, your voice, music, and other
sounds.
7. Try to minimize the stress in your life by practising stress management
techniques such as slow and deep breathing, yoga and relaxing various
muscle groups when you feel stressed.
8. Plan your baby's birth. For most women, the process is normal, natural, and
healthy.
9. Enjoy this special time in your life! Your husband and, your family and
friends can help you make the most of this wonderful transition. Have
confidence in your body's ability to grow, nourish, and give birth to this baby
just as women have done for centuries.
10. During pregnancy, many women are highly motivated to remain as healthy
as possible, so that they can give their baby the best start in life. Pregnancy
is an excellent opportunity to develop good health habits; you can use these
habits to keep yourself healthy for the rest of your life!

20. Chapter 4
Medical Care for Your Offspring:
No Child’s Play
A smart mother often makes a better diagnosis than a
poor doctor.
August Bier
Nowadays, many mothers prefer to select a children’s doctor (pediatrician)
even before childbirth, in order to ensure that he is around when the child is born!
Your pediatrician plays an important role in making sure that your baby remains
healthy in the first year of his life, and will provide routine baby care, by
examining your baby every few weeks, to make sure he is growing well and has
taken his immunization shots on schedule.
As your child grows older, it is a good idea to continue with the same
pediatrician, with whom you can get in touch in case any worries assail you.
There are going to be numerous occasions when uncertainties and anxieties grip
you, especially if it’s your first baby, and having a doctor who is familiar with your
child can be very reassuring when he develops a fever or a cough.
Nevertheless, remember to trust your own common sense and instinct. As a
mother, you are final expert as far your baby is concerned and you are much
more likely to be able to sense when your child is ill (or when he is getting better)
than a doctor. The trouble today is that many of us have become so dependent
upon the doctor that we do not heed our own gut feelings.
Most children dread going to the doctor with good reason; after all, most of us
still associate the doctor with painful jabs and awful tasting medicines! When you
are on the lookout for a pediatrician, remember that a good doctor can do a lot to
put your child at ease. A pediatrician should be unhurried and be willing to spend
plenty of time with you and your child (and often it is the mother who needs
reassurance more than the child needs treatment!). A good doctor will talk and
play with your infant or toddler when he is on your lap, before he even attempts
to conduct an examination. After all, your baby is reluctant to leave the comfort of
your arms, and will regard the examining table with puzzlement and fear.
Therefore, many doctors will examine your baby when he feels safe and secure
in your lap. They also give out lollipops and speak to kids in baby talk to calm
them down. A good doctor will always approach kids in such a manner that he is
on the same eye level as the little patient, rather than standing over the child.
Another strategy many doctors adopt is to let children play an active role in
the examination. Whether it's looking into mummy's ears or listening to daddy's

21. heart, being proactive allows them to understand they're at the doctor's clinic for
help, not to get hurt. Some pediatricians even keep toy doctor kits on hand,
complete with bandages and plastic stethoscopes. Others give away stickers ‘for
being such a brave little girl’ at the end of a visit! Distractions such as toys are
very helpful, and many pediatricians remark an entire corner in the waiting room
for children’s rattles, minibeads and building blocks, so that they feel more at
home!
The unknown probably holds the biggest fear for most children. A lot of kids
associate going to the doctor with a needle. A good doctor should be able to
reassure the child (only when it is completely true , of course ! ) that there are
not going to be any 'ouches' or anything that hurts.
You can find out what it is that makes your child most relaxed by simply
asking. For example, if he says he needs his favorite stuffed toy to make him feel
brave, then bringing it to the doctor's office would be an enormous help.
Remember that in the long run, your child's positive attitude toward his health can
start with happy experiences at the doctor's.
Sometimes, your child may be sick enough to need hospitalization.
Remember that hospitalization can be a scary experience even for adults, so that
it's likely to be even worse for children. If you think about it from a child's
perspective, a stay at a hospital can be scary and confusing! "Is the stretcher
going to stretch me?" "Is the IV like the plant that covers up buildings? "Some of
your child's misunderstandings might seem humorous, but they probably indicate
serious anxiety about entering the hospital. Children commonly wonder: Will it
hurt? Will mom or dad be with me? Will I get better? Is it my fault? When can I go
home? Why don't my friends have to go to the hospital? For many children, a
hospital stay often represents their first night in an unfamiliar setting, away from
the comfortable surroundings of home.
Before arriving at the hospital, talk with your child about what to expect and
why hospitalization is necessary. Be confident , honest and serene. Accurate
information — given in a way that child a can understand — is the best way to
reassure and calm your child. If you tell him that a procedure will not hurt and
then it does, you stand to lose credibility and he may not trust you again. It is
unfortunately a fact of life that medical procedures can be painful. However, they
are often necessary in order to help your child recover, and if your child can be
reassured so that he cooperates in his care (rather than fights it), this can help to
improve the care he receives, that would lead to optimum benefit as a result of
for their medical care.
Parents who remain calm help their children feel calm. If you don't know what
is happening with regard your child's care, ask a doctor or nurse to explain the
details to you. Remember that families are members of the health-care team, and
that you, as a parent, are the expert on your child !

22. Try to understand your child's feelings — put yourself in his shoes! Younger
children might need reassurance that hospitalization is not a form of punishment
for something they did. It's not uncommon for children to act younger than their
age (such as by wetting the bed or sucking their thumbs) before, during or after a
hospital stay. Your child fears are often age – specific, and toddlers don't worry
on this count; most children return to normal very soon. Worry about being
separated from parents; school-going children are more concerned about being
different from their peers, while teenagers have a greater need for privacy and
independence.
Admission to the hospital early in the morning, immediately before the
planned procedure or surgery, is common, but this step affords little time for a
child to adjust to the new environment. Ask the authorities if your child can visit
the hospital a day or two before scheduled surgery to help him understand what
will happen. All children should be told ahead of time what to expect, but very
young children may not possess a clear concept of time, such as tomorrow or
next week, so that a review of what is going to happen, just before it occurs, can
help children overcome their fears.
Children often demonstrate their understanding of the world through the
medium of play. You may get an opportunity to reassure your child if you observe
misconceptions about the hospital in his play. Many progressive hospitals offer
children a playroom, so that they can relax, even when they are in hospital.
Some hospitals even allow them to tour a ‘mock’ operation theatre; and wear
nurses' uniforms and doctors’ masks, so that they are more comfortable in a
hospital setting. After hospitalization, play can be a very beneficial way for young
children to make sense of their experiences. Reading aloud children's stories
about hospitals before and after your child's stay also can be helpful.
Most hospitals encourage parents or close relatives to stay overnight with
their child. A parent or family member can provide security in the unfamiliar and
somewhat disorienting world of the hospital. Stay with younger children,
especially, as much as possible. If you need to leave, it is best to be factual with
your child about where you will be, why you need to go, and when you plan to
return.
Remember that you can help doctors and nurses do their job more
competently by observing and reporting your child's symptoms accurately. It
helps to prepare in advance by writing down your questions and observations.
A child in hospital can feel comforted if you bring along a few treasures such
as favourite dolls, stuffed animals, security blankets or family pictures. These
items provide a connection to home. School homework may not be a ‘treasure,’
but if your child is able to work on class assignments at the hospital, the process
can ease the transition back to school.

23. Hospitalized children are usually gripped by three main fears: (1) fear of pain;
(2) fear of the unknown; and (3) fear of separation. While hospital personnel and
the child's immediate family can help dispel the first two fears, visitors can help
allay the fear of separation. For older children and, especially for teenagers, visits
from their friends can be really important because, at that age, peers may be as
important as family. Request visitors to behave the way they normally do with the
child – there is no need for them to change their behavior just because he is in
hospital. Don't discuss the child's situation with other adults in front of the child as
if he or she weren't present — either include the child in the conversation, or go
and talk elsewhere.
Although a hospital stay can be frightening, well-prepared children often show
remarkable courage. Remember that children are very resilient, and can bounce
back to health rapidly!

24. Chapter 5
Growing Old, But Keeping Fit
Growing old is a bad habit which a busy man has no time to form.
Andre Maurois.
Most people are scared, indeed, terrified of old age because they feel that
aging is characterized by a progressive loss of essential body functions that they
have learnt to take for granted over the years; for instance, loss of vision,
hearing, teeth, memory, intelligence, sexual drive, muscle strength and vigour.
However, it needs to be emphasized that you can become old healthily;
remember that old age does not necessarily mean progressive deterioration or
susceptibility to a plethora of ailments!
The best way to live to a ripe old age entails possessing the right genes. In
other words, if your parents and grandparents have led long lives, you are likely
to do so too! However, the fact remains that while you cannot choose your
parents, you can, nevertheless, increase the chances of your growing old
healthily!
Despite the advertised claims to the contrary, there is no fountain of youth or
magic potion that can prevent the process of aging. And no one has still
answered the key question: why do we grow old? According to a popular theory,
free radicals damage cells, tissues and organs progressively and as we age the
body’s ability to neutralize such damages wanes.
In this context, it is useful to bear in mind that anti-oxidants are natural
substances that fight these harmful free radicals. Some recent studies have
indicated that anti-oxidants may help prevent heart disease, some cancers,
cataracts, and other ailments that are more common among older people.
Among the antioxidants available in food are vitamins C and E and beta-carotene
which is why most experts recommend five servings of fruits and vegetables a
day.
Presently, research is being conducted to test the anti-aging effects of
human growth hormones, DHEA (Dehydroepiandrosterone), and other
hormones, such as testosterone and estrogen. However, it’s too early to
ascertain whether or not any of these hormones will be effective. The fact
remains that there is still no known drug, pill, or treatment that has been proven
to reverse the aging process or to extend life. However, the good news is that
there is solid evidence to prove that adopting a healthy lifestyle can both
lengthen and improve the quality of an individual’s later years.

25. TIPS FOR HEALTHY AGING
The following points should be borne in mind:
1. Ensure a balanced diet, including five helpings of fruits and vegetables a day.
2. Exercise regularly. However, check with your doctor before starting an
exercise programme.
3. Go in for regular health check-ups.
4. Don’t ever smoke. If you have picked up the habit, it’s never too late to stop.
5. Practice safety habits at home to prevent falls and fractures. Always wear
your seatbelt while driving a vehicle.
6. Stay in touch with family and friends. Remain active through work and play
and interact regularly with other members of the community.
7. If you drink alcohol, moderation is the keyword. Let someone else drive the
vehicle after each of your drinking bouts!
8. Adopt and maintain a positive attitude towards life. Do things that make you
happy.
Since it's extremely difficult to change the habits of a lifetime overnight, it would
be highly beneficial to develop good habits right from childhood. Such habits are
likely to pay you rich dividends in the future, so that you can be playing golf while
your contemporaries are ailing in hospital beds!
Fortunately, aging doesn't have to be a downhill slides and gaining adequate
knowledge about changing body patterns over time can help you age the healthy
way. Older people have the reputation of being more mature, experienced and
thoughtful. Whether or not you become wiser as you grow older, you are likely to
become farsighted for sure ! Farsightedness ( presbyopia ) is a change in vision
that's a normal part of aging. Presbyopia is caused by a gradual hardening of the
eye's lens, which impairs your ability to see up close. Your optometrist may
recommend a pair of non-prescription reading glasses or prescribe bifocals for
you.
Staying active is a terrific way to stave off the negative effects of aging
because it helps your body maintain, improve and even repair itself. Physical
activity increases flexibility, lowers blood pressure, strengthens bones, slows
down the process of osteoporosis, and promotes weight loss. The remarkable
aspect about getting fit is that it's never too late to start. Fifteen to 30 minutes of
exercise, with a warm-up and a cool-down, three or four times a week, would be
ideal. Remember to start out slowly, exercising for about five to ten minutes twice
a week, and gradually build up to a higher level of activity. Choose an activity that
you'll enjoy, and try to get a friend to accompany you. Brisk walking, swimming

26. and yoga are just a few of the options. Before starting your regular exercise
regimen, please check with your doctor about possible complications or risks.
Ensuring a healthy diet pattern is also very important. Middle-aged individuals
need to increase their intake of certain vitamins, such as D and B6, while also
simultaneously reducing the number of calories they consume. Bodily changes
caused by aging, combined with reduced physical activity, could lead to a
situation when you may gain weight more easily in your 50s than you did in your
younger years. Be that as it may, that excess weight contributes to health
problems more often in older people, including diabetes, heart disease and high
blood pressure.
Contrary to popular opinion, most senior citizens want to enjoy active, and
satisfying sex lives. The natural process of aging does entail physical changes
that can sometimes adversely affect sexual intimacy and your capabilities during
intercourse. Women may experience discomfort during sex because their vagina
becomes drier and more fragile. As they get older, men often notice differences
in their erection patterns, and it may take them longer to achieve an erection and
to sustain it. Also, the erection may not be as firm or as large as during their
younger years. Anxiety and depression, which often accompany a chronic illness
can also interfere with your libido.
A strong support system is an important aspect of good health, and seniors
can benefit greatly by being socially active. Community organisations, clubs and
religious places such as churches and temples are ideal meeting points for
elderly people to socialize and to make friends.
Continue to remain productive, whatever be your field of activity; this is good
for your self-esteem. Even if you have retired from your job, you can contribute
your time and skills in many ways: for example, by volunteering for social service
organisations; or teaching part-time in any educational institution. You could also
learn new skills (such as a painting or becoming computer literate). The ultimate
objective is to keep your brain active !
The twilight years are also likely to lead to an unfortunate increase in
illnesses, accompanied by the additional burden of unwelcome medical bills and
the fear of dying and death. As the body ages, biological systems start failing
gradually, and one starts developing an assortment of medical problems.
Consequently, older patients often have special health care needs. It is not
uncommon for many older patients to suffer from multiple medical complications:
for example, diabetes, hypertension and ischaemic heart disease often go hand
in hand. Such a situation also means that they will need to be subjected to
multiple medications; and perhaps consult many different doctors as well! Thus,
while their care pattern becomes more complex, it also becomes more
fragmented! In fact, geriatric medicine has attained the status of a specialty in its

27. own right in many parts of the world, in order to take care of the medical needs of
an aging population.
Most old people face a lot of difficulty in taking care of their own needs,
because of persistent problems such as deteriorating hearing, failing vision, and
decreasing memory. Many of them tend to be afraid of becoming dependent on
others as they lose control over their bodily functions. Others dread becoming
disabled and being confined to a wheelchair or bed. Instances of abuse and
neglect of old people are becoming increasingly prevalent, as the joint family
structure is breaking down in urban India. As a result, homes for the aged are
becoming increasingly popular in India, so that older people can live together and
support each other, when their own families are no longer willing to do so.
Remember that illness and aging need not go hand in hand. If you take good
care of your body in the ‘morning’, it will take good care of you in the ‘evening’ of
your life.

28. Chapter 6
Caregiving: Taking Care of Elders
We need to learn to take as good care of our parents in their second childhood as
they took of us in our parents in their second childhood as they took of us in our
first childhood.
Thanks to the rapid advances in the field of medicine, more and more people
live to a ripe old age, it is increasingly likely that you will be taking care of older
relatives at home. While this has always been a traditional practice in the joint
Indian family, caregiving can prove to be quite a burden in the modern Indian
city. Caregiving refers to a wide range of involvement — everything, from
checking in on your relatives every day at their places of residence to providing
round-the-clock care for your parents in your own home.
Entering into a caregiving relationship offers a valuable chance to reconnect
with someone for whom you care deeply. But as this person ages and becomes
more infirm and demanding with each passing day the relationship can become
increasingly stressful and, at times, acrimonious. Also, ambivalent or unhappy
feelings from the past can re-emerge and cause pain and bitterness, unless you
work through them positively.
If you’re trying to shoulder the burden all alone, the frustrations may
overwhelm you. An amicable situation can turn sour and, in some cases,
mistreatment or abuse of the older person could be the tragic result. As
testimony to this disquieting but indisputable reality, the media is reporting more
and more cases of abuse and neglect of the elderly in India. Many parents have
even been forced to commit suicide when they have got fed up of the ill-
treatment they have received.
To sidestep an unpleasant situation and to ensure that you handle caregiving
as successfully as possible, you should go in for a little thought, education and
preplanning.
To start with, hold a family session when your parents are well. Talk about the
future, and what they would like you to do for them in case they fall stick. Involve
your brothers and sisters in the discussion and hold it in a positive atmosphere.
Although talking about old age and impending debility can be uncomfortable, and
disconcerting, this could be the most positive approach in the long run. Consider
covering the following areas:

29. 1. Division of labour: Decide who will do what — in an unambiguous manner —
when your parents need help. If one relative lives close by and decides to be
the primary caregiver, it’s crucial that the other siblings play a supportive role.
One should also find answers to the following important queries: Who will give
the primary caregiver a break when he or she needs it? Who will help
financially? Who will lend a sympathetic ear when the primary caregiver feels
overwhelmed?
2. Money: To plan for the years ahead, you should know your parents’ financial
resources. Such information helps you avoid the pitfalls of arranging for your
parents to live beyond or below their means. If you’re the main caregiver,
decide well ahead of time if you want financial compensation for your efforts.
This attitude might seem very commercial , but may actually help in the long
run!
3. Insurance: Make sure your parents have taken adequate medical insurance
to cover their medical expenses.
4. Living will: This document puts into writing what medical measures your
family member does and doesn’t want to be taken in the event of a terminal
illness or condition.
5. Power of attorney: This legal document allows a designated person to make
specified legal and financial decisions if your parent or elderly relative
becomes unable to manage his or her affairs.
Try to make your caregiving relationship as positive as possible, while, at the
same time, being realistic. The relationship you had with your parent as a child
doesn’t disappear, and if you had a friendly, easygoing rapport with your mother
or father when you were younger, it’s likely to continue. However, if the
relationship was subject to stresses, they may re-emerge. Also remember that
prominent personality traits tend to become exaggerated as both of you grow
older.
Caring for an older adult is very different from caring for a child. With the
passage of time older persons become more dependent on others, not less. On
some days, the experience may feel like an emotional roller-coaster ride: you
quickly move from pity and guilt to love and on to anger and frustration.
The following suggestions can help make you a better and more considerate
caregiver:
1. Encourage independence: If it takes your father 10 minutes to button his
shirt, so be it. The ‘I’ll-do-it-for-you’ attitude leads to work overload (for you)
as well as increasing dependence and low self-esteem on the older person’s
part.

30. 2. Set limits: A highly dependent parent can be demanding. You should know
your limits and learn how to refuse requests politely but firmly. You could say:
‘No, I’m too tired to go to the store today. We’ll go tomorrow.’ A failure on this
count can lead to resentment and a feeling of being ill-treated on the part of
the caregiver.
3. Make time for fun: Break the routine occasionally by inviting friends and other
family members over to watch a funny movie or play cards. A little laughter
and a bit of socialising can lift everyone’s spirits.
4. Encourage your parents to remain active: Also, motivate them to take part in
community activities so that they have additional sources of support, and are
not totally dependent on you.
5. Share the care: When your friends or relatives offer to help, accept it gladly
and gratefully.
6. Take a break: This aspect is critical. You could risk your own health if you
persevere for long periods without a break. Get someone to fill in for you as
often and as long as needed.
7. Cancel guilt trips: You’re bound to experience anger and frustration, but don’t
let these feelings make you feel guilty, they are normal. Your parents most
probably felt the same way about you when you used to give them a hard
time as a child !
8. Stay active: Even though you may feel limited as far as time and freedom are
concerned, do your best to keep your interests in a club or hobby alive. These
activities will continue to enrich your life when your caregiving responsibilities
are over.
Being a caregiver does not mean that you have to give up your own rights!
The following are included in a Caregiver’s Bill of Rights, as formulated by Dr.
Virginia Flagg. A caregiver has the right to:
1. Honest communication with the patient, his/her friends, family, and other
caregivers.
2. Express opinions and suggestions when appropriate.
3. Expect the patient to make as many decisions and put affairs in order as
much as possible.
4. Make reasonable requests of the patient.
5. Take care of his/her own needs without guilt.
6. Express emotions in front of the patient.
7. Acknowledge his/her limitations and obtain assistance from outside
resources.
8. Continue maintaining relationships and activities outside the caregiving
role.

31. 9. Not take responsibility for decisions and actions made by the patient.
With pragmatic planning, acquiring help from others and adhering to a
commitment to devote time to yourself, you can emerge as a successful and
happy caregiver. And don’t forget that you’ll be setting an example for your
children, so that when it’s time for them to take care of you when you become
old, they’ll do a good job too !

32. Chapter 7
Learning to Live well with a
Chronic illness
Illness is the night side of life.
Sontag
In some ways, living with chronic illness is very much like being trapped in a
maze - you’re never quite certain what lies ahead of you; so, it’s easy to lose
your perspective. You wander the same path over and over again - totally lost
and bewildered. You appear to be alone with no one to show you the way out.
There are many questions, but few answers. Which is the most effective
treatment ? Who are the best doctors ? What options can be utilized so that
the way out can be found ? You need to find your own path, and confronting
your illness is a process that must be worked through . This process takes time
and effort. If you live with a chronic condition, how you view the path you’re on
and decide to manage your day-to-day situations can greatly affect your quality
of your life.
Acute vs. Chronic
Most people are familiar with acute illness, such as appendicitis, typhoid fever or
pneumonia, which comes on suddenly and often has an identifiable cause.
Generally, such an illness is treatable. Often the individual regains normal
health, and usually does not remain sick very long.
On the other hand, a chronic illness often begins gradually and may have
several causes. Also, rarely is a chronic illness cured, and it usually persists for
an indefinite period of time. Diabetes, heart disease and arthritis are examples of
chronic illness.
Many factors can affect the course of a chronic illness, including heredity,
lifestyle (e.g., stress, diet, exercise) and even environment. As a result, it’s
difficult to predict how you may feel from one day to another.
Restoring a sense of control
Many factors can affect the course of a chronic illness, including heredity,
lifestyle (e.g., stress, diet, exercise) and even environment. As a result, it’s
difficult to predict how you may feel from one day to another.

33. The process of living well despite suffering from a chronic illness begins
with understanding your illness. What you know about your condition can make a
vast difference to how you approach each day. You can start by collecting
information about our illness – and remember that there is a wealth of information
out there ! (See Chapter 28).
Another useful information tool both for you and your doctor is a medical
diary. In this diary, keep track of your visits to the doctor, noting down
meticulously when and why. In addition, maintain a list of treatments undertaken,
along with the following details: side effects; copies of your test results; and a
record of symptoms, their severity and possible triggers. This diary will not only
serve as a useful record of your illness, but will also provide your doctor with
valuable diagnostic clues, which may help him to tailoring your treatment
appropriately. Many people also find that the very act of recording their feelings
and emotions in a different section of the diary can be therapeutic as well, as it
allows them to ventilate your feelings!
Attitude by itself cannot cure a chronic illness, but cultivating a positive
outlook and learning self-management techniques can make it much easier to
live with. No matter what the ailment, confidence and determination will help you
to maximize your health.
Living well with a chronic illness often involves making important lifestyle
adjustments. One of the first decisions to be taken is to consider how you should
pace yourself. Adopting a moderate pace, maintaining a regular schedule and
getting adequate rest and exercise can help you in managing your illness more
effectively. Be wary of overextending yourself. Learn how to say “no.” It’s
especially important to pace yourself properly on days when you feel energetic
and may be tempted to overdo things.
Other precautions or adjustments include the following :
ν Taking medications regularly : Follow your doctor’s instructions carefully
on how and when to take your medications. Stay in close contact with your
doctor, especially when you start taking a new medicine, so that you can
let him know how your symptoms are affected ; and what side effects you
experience.
ν Eating properly : Depending on your illness, you may need to avoid some
types of food and incorporate others in your diet. In addition, consult your
doctor about determining a healthful weight and ways to achieve that
objective.

34. ν Exercising regularly : Appropriate exercise, as prescribed by your doctor,
is a vital tool in managing chronic illness. Regular exercise can improve
your strength and energy levels, as well as self-confidence. Such activity
can also play a role in lessening the anxiety and depression, which is
often associated with a chronic illness.
Emotional ups and downs
Living with chronic illness can give rise to a roller-coaster of emotions. There are
several ways in which you can help even out the ups and downs:
ν Maintain normal daily activities as best as you can.
ν Stay in touch with friends and family.
ν Continue to pursue the hobbies you enjoy without overexerting yourself.
If your illness impairs your ability to perform activities that you enjoy, check with
your doctor about possible ways to get around the obstacles. Keep in mind that
your physical health can directly impact your mental health. Men may feel guilty
about not being able to work, perform sexually, or provide for the family, while
women may feel guilty about not being able to care for children or the husband.
Negative emotions such as denial, anger and frustration are not uncommon
when you learn life has dealt you something painful and unexpected. In addition,
many chronic illness are associated with an increased risk of depression. Such a
state of affairs does not mean a ‘failure to cope’ but may indicate a disruption in
the body’s neurochemistry. Such as disruption can be rectified by appropriate
medical treatment.
At times, you may need more “tools” to deal with these negative emotions.
Professionals, such as psychotherapists or psychologists, can help you put
things in perspective. They can also teach you coping skills, including relaxation
techniques, that may be helpful. Sometimes, a support group is the best answer.
Again. your doctor is the ideal person to suggest the best course in your specific
case.
Living with someone who’s chronically ill
Nowadays, with longer life expectancy, chances are greater than ever that
you will need to help in caring for someone who’s chronically ill. Remember that
chronic illness affects whole families as well as the patient, especially if the
illness is terminal. Family members may find themselves in unfamiliar or

35. undesired roles, and providing 24-hour nursing care can prove to be a major
burden. They can become isolated from social networks as they struggle to care
for a sick loved one. Stress can break down close relationships, and a patient’s
inability to take care of himself often causes guilt, shame or irritation.
Indian society expects the spouse and children of the chronically ill to
always be patient, kind, supportive and understanding – a tall order indeed!
Interestingly, researchers have found that a spouse’s attitude affects the
suffering of someone with a chronic illness. When the spouse is supportive, it is
easier for the sufferer to be positive and optimistic. By contrast, those with critical
spouses are more likely to feel hopelessly victimized by their illness. A families’
efforts to downplay the severity of an illness is likely to make the sick member
worse, whereas openness, acceptance, and compassion have a positive effect.
Here are some aspects on which you can focus as a caregiver to help make your
role more manageable:
ν Accept the reality that the chronic illness may not go away.
ν Focus on the signs of well-being – such as activities and the person’s
feelings rather than on just physical health.
ν Be readily available and listen, emphasizing positive changes.
ν Get involved together in productive, fun-filled activities to distract the
patient from the illness.
ν Encourage independence while maintaining as “normal” a family life as
possible.
ν Take care of yourself, and seek help when needed. Look for
organizations that offer support for caregivers.
If you are a victim of a chronic illness, there’s no denying the fact that it
affects your life adversely. But how much you allow it to determine the quality of
your life depends, to some extent, on the way you choose to live one day to the
next. It’s true that a chronic illness does not ‘go away’, but you can learn to cope
with it and lead satisfying and a happy life!

36. Chapter 8
Self-Care: Handling Common
Medical Problems at Home
The aim of medicine is to prevent disease and prolong
life; the ideal of medicine is to eliminate the need of
a physician.
William Mayo
Not every medical problem that affects you should make you rush to your
doctor. After all, most medical problems are minor and self-limited, and experts
estimate that more than 80 per cent of them can be safely managed at home.
You should constantly remember that your body possesses remarkable healing
powers, and given enough time and tender loving care, it can ‘repair’ most
ailments on its own! Home remedies, many of which have stood the test of time,
have proved to be effective and helpful. Simple measures such as massage and
compresses are helpful as well – use to learn them judiciously!
Here are some practical and useful steps you can use in order to take
care of common problems which affect most of us at some point of time or the
other. These are based on guidelines suggested by the American Institute for
preventive medicine.
Note: When your symptoms fall under the “Call your Doctor “ heading,
you should do just that: call your doctor for with. State the problem precisely and
you can get relevant instructions. When your symptoms fall under the “Get
Immediate Care For” heading, you should get help fast – the situation may be a
medical emergency!
COLDS
Symptoms:
Sneezing, runny or stuffy nose, sore throat, dry cough, low-grade fever.
Self-Care Measures
- Take adequate rest if you have a fever.
- Drink lots of liquids.
- Take an over- the –counter medicine (paracetamol and/ or aspirin) for
relieving pain and/or fever.

37. - Use salt water drops for nasal decongestion. The procedure is as follows:
Dissolve half a teaspoon of salt in one cup of warm water and put three to
four drops into each nostril several times a day, using a clean medicine
dropper.
- Use a vaporizer or a humidifier, if possible.
- Eat hot and spicy foods, which help in draining the mucus.
Call Your Doctor for
- Quick breathing, troubled breathing or wheezing
- A feeling of weakness or with loss of energy along with delirium
- A bad earache or swollen, painful neck glands
- Fever lasting more than three to four days or over 102° F.
- A sore throat that looks red or has white spots.
- A cough that brings up sputum of any color.
- Pain or swelling over your sinuses.
COUGHS
Cough can be of two kinds: a dry cough, or one that brings up sputum
( productive)
Self-Care Measures
For coughs that bring up sputum:
- Drink plenty of liquids.
- Use a vaporizer.
- Take a shower.
- Take an over-the –counter cough medicine that contains guaiphenisen.
For coughs that are dry:
- Drink plenty of liquids, essentially hot beverages such as tea, milk or soup.
- Suck on cough lozenges.
- Take an over-the-counter cough medicine that contains dextromethorphan.
Call Your Doctor For

38. - A cough that has started suddenly and lasts for one hour or more without
stopping
- A cough afflicting a baby or small child that sounds like a whoop or seal’s
bark (high pitched like a whistle), and if the baby or child develops a fever of
102° F or higher.
- Weight loss (for no apparent reason), feeling tired, and sweating a lot at night.
- Wheezing, shortness of breath, rapid breathing, and swelling of the abdomen,
legs, and ankles.
- A cough with sputum of any colour.
- A cough lasting for more than two weeks.
Get Immediate Care for
- Very hard time breathing or if lips become purple.
- Chest pain that spreads to the neck, arm, or jaw.
- Fainting.
- Coughing up blood.
Diarrhea
Watery, loose bowel movements passed many times a day.
Measures for Self-Care
- Drink plenty of liquids; for example, lime juice, lassi (whipped up curds or
buttermilk with salt or sugar), fruit juice and soft drinks (after releasing the
fizz).
- Try an over-the-counter medication, such as Imodium or Lomotil, if your
condition does not improve even after 12 hours. You may need to take a
tablet after each bowel movement.
- Once the diarrhea has subsided, you can eat small amounts of soft foods,
such as cooked potatoes, yogurt (curds) and rice.
- If a small child (less than three years old) has diarrhoea, then start him on
oral rehydration therapy. You can use rice kanji, the ORS solution available at
the chemist’s, or make it up at home yourself (by adding eight teaspoons of
sugar and a half a teaspoon of salt to a litre of water). Continue breastfeeding
(or his regular food) – don’t starve him!
Call Your Doctor for

39. - Diarrhea that has lasted 48 hours or more.
- Diarrhea which entails bowel movements more than eight times a day in an
infant or a chronically ill person.
- Diarrhea that has started only after taking medication (s).
Get Immediate Care for
- Dehydration (symptoms: passing very little or no urine, being very thirsty and
lightheaded, dry skin that doesn’t spring back after being pinched, sunken
eyes, and disorientation).
- Severe abdominal or rectal pain or blood in the stool.
Fever
Elevated body temperature, usually over 100° F (by way of mouth) or over 101° F
(by way of rectum).
Measures for Self-Care
- Consume plenty of fluids.
- Take a sponge bath with warm water.
- Take an over-the-counter medicine (paracetamol) to reduce the fever.
- Don’t wear too many clothes or cover yourself with too many blankets.
Call Your Doctor for
- Fever that is accompanied by: ear pain; sore throat; vomiting; diarrhea;
abdominal pain; burning urinary pain, skin rashes or skin that has turned red
and swollen or developed areas of pus.
- Fever that occurs in a baby less than six months old.
Get Immediate Care for
- Fever that occurs with rapid heartbeat, confusion, disorientation and loss of
consciousness.
- Fever with stiff neck, headache, lethargy, nausea and vomiting.
- Fever accompanied by lightheadedness and shortness of breath

40. Headaches
- Tension headache: Pain or pressure in scalp, temples or back of the head;
and tightness in neck and shoulders.
- Sinus headache: Pain behind the forehead and eyes; sinus congestion; and
fever.
- Migraine headache: Severe throbbing pain which usually starts on one side of
the head and may lead to nausea, vomiting; dizziness, increased sensitivity to
light and noise and problems with vision, such as blind spots or flashing
lights.
Measures for Self-care
- Take an over-the-counter medicine for reducing the pain as soon as possible.
Don’t wait for the pain to become worse!
- Rest in a quiet, dark room with your eyes closed.
- Massage the base of your head with your thumbs.
- Take a warm bath or shower.
- Place a cold or warm washcloth, whichever feels better, over the area that
aches. Or else, place an ice pack on the back or the top of the head.
- Try to relax. Meditation and yoga can help.
Call Your Doctor for
- Headaches that occur at the same time of day, week, or mouth.
- A headache that starts after taking a newly prescribed medicine or an over-
the-counter medicine.
Get Immediate Care for
- A serious head injury or loss of consciousness.
- A headache accompanied by pain in one eye, blurred vision, double vision,
slurring of speech, mental confusion, personality change, or difficulty in
moving arms or legs.
- A headache along with a stiff neck, fever, lethargy nausea and vomiting.
Heartburn
Symptoms

41. Pain or a burning in the chest after eating and/or after bending over or lying
down. Also, belching and a burning feeling in the throat.
Measures for Self-Care
- Sit straight while eating. Sit up, stand up or walk after you have eaten. Don’t
lie down!
- If heartburn bothers you at night, raise the head of the bed by 6 inches.
- Shed some kilos if are overweight.
- Don’t wear tight-fitting clothes.
- Eat small quantities. Limit your intake of alcohol.
- Limit the consumption of foods and beverages that contain gas, such as
potatoes and such as soft drinks.
- Don’t eat or drink anything two to three hours before bedtime.
- Antacids, such as Tums, can help relieve heartburn.
- Don’t smoke at all.
- If you have to take medicines such as aspirin, ibuprofen, naproxen sodium, or
medicines for arthritis, take them along with food.
Call your doctor for
- Stools that are tar-like and black in colours.
- Pain that goes through to your back or gripping pain in the upper abdomen.
- Difficulty in swallowing.
- Heartburn that occurs frequently.
Get Immediate Care for
- Heartburn accompanied by a tightness or pain in the chest which spreads to
the neck, jaw, or arm; a feeling of discomfort in the chest with sweating or
shortness of breath, nausea and/or vomiting or uneven pulse or heartbeart.
- Heartburn leading to vomiting blood or what looks like coffee grounds.
Low Back Pain
Symptoms
• Back pain can be sharp, dull, acute, or chronic.

42. Measures for Self-Care
- Take an over-the-counter medicine for relieving the pain, if needed.
- For the first 48 hours, apply a cold pack to the pain-afflicted area. Do this for
five to ten minutes at a time, several times a day.
- After 48 hours, apply heat (e.g., hot water bottle, hot shower), several times a
day.
- Continue your regular activities to the extent possible. Rest your back if you
must, but don’t remain in bed for more than 2 to 3 days, even if your back
hurts a lot.
Call Your Doctor for
- Pain that spreads down the legs and below the knee.
- Pain that is very intense, or has lasted five days or more.
- Increased pain when you move, cough, sneeze, lift something, or strain.
- Loss of control over bladder or bowel.
- Sensation of pain, burning, or itching when you pass urine, or if urine turns
bloody or cloudy.
- Fever or vomiting.
Get Immediate Care for
- Any serious injury affecting the neck, spine, or back.
- The onset of pain being sudden and starting with a “cracking” sound.
- Back pain accompanied by difficulty in breathing and lightheadedness.
Sore Throats
Symptoms
• Mild to severe throat pain, with or without swollen neck glands. The inside of
the throat and/or tonsils could turn bright red or could be marked by white
spots.

43. Measures for Self-Care
- Mix one-fourth teaspoon of salt in half a cup of warm water. Gargle every few
hours with this mixture, preparing it afresh each time.
- Drink plenty of warm liquids, such as tea and soup.
- Don’t smoke at all.
- Avoid eating spicy or hot foods.
- Suck on a medicated lozenge frequently.
- Take an over-the-counter medicine for relieving the pain and/or fever.
Call Your Doctor for
- Sore throat that occurs along with: fever; swollen, enlarged neck glands;
headache; chest, or ear pain; bad breath; skin rashes; abdominal pain;
vomiting; or discharge of dark urine.
- The back of the throat turning very red or developing white spots.
- A mild sore throat that lasts for more than two weeks.
Get Immediate Care for
- Extreme difficulty while breathing or if the lips turn purple.
- Inability to swallow your own saliva.
Vomiting
Measures for Self-Care
- Don’t eat solid foods; don’t drink milk.
- Drink only clear liquids (such as clear soups or coconut water). Take small
sips; i.e., drink only one to two ounces at a time. Suck on ice chips if nothing
else will stay down.
- After you stop vomiting, continue with clear liquids. Gradually return to regular
diet, but wait about 8 hours from the last time you vomited to eat solid foods.
Start with foods that are easy to digest.
- Don’t smoke, don’t drink alcohol, and don’t take aspirin.
Call Your Doctor for

44. - Very severe stomach pain, which lasts for more than two hours.
- Yellow looking skin or if the whites or the eyes appear yellow.
- Vomiting which lasts for more than 12 hours (two to six hours for a small
child) without subsiding.
Get Immediate Care for
- Vomiting caused by a serious head injury.
- Vomiting accompanied a stiff neck, fever, headache, and lethargy.
- Vomiting which is black or bloody.
- Dehydration (symptoms: very little or no urine, extreme thirst; and
lightheadedness; dry skin that doesn’t spring back after being pinched;
sunken eyes; and confusion).
Vomiting occurring after a mild blow or injury to the head.
Sprains
A sprain is an injury that causes a stretch or a tear in a ligament. Ligaments are
strong bands of tissue that connect bones at the joint. Sprains may be classified
as mild, moderate, or severe.
Measures for Self-Care
The general rule for treating sprains is R-I-C-E:
R for rest. Rest the joint! Avoid activities that cause pain. If you have
an ankle sprain or knee sprain you may need crutches.
I for ice. Apply ice and cool the injury to avoid swelling and
every 3 to 4 hours. Do this for 2 to 3 days or until the swelling goes
away. The ice will help to numb the pain.
C for compression. Tie an elastic crepe bandage around the injured
joint to reduce the swelling and inflammation.
E for elevation. The injured part should be elevated so that gravity
helps the circulatory system to reduce the swelling.
You can also take pain-killers to reduce the pain.
Call Your Doctor For

45. Symptoms of a severe sprain.
If a mild sprain persists longer than 2 weeks.
Pain, swelling or bruising worsens despite treatment.
Get Immediate Care for
Inability to move the limb or joint.
Chapter 9
How to Keep Fit While Travelling
Men travel faster now, but I do not know if they go to better things.
Willa Cather
Even healthy people may find that travelling can precipitate illness. Differences
in food, climate and schedule, in addition to the possible stress of travel can
make you more susceptible to illness. Here are some tips to help you stay
healthy when you travel.
BEFORE THE TRIP
First of all, plan ahead. Get your medical and dental checkups done before your
trip, so that any problems can be detected, and to relevant medicines can be
taken along. Find out what your health insurance company will pay for if you
need to consult a doctor while you're away. In case you are travelling abroad,
you may need to obtain a special health insurance policy called an Overseas
Mediclaim Insurance Policy. Carry adequate quantities of your regular medicines
in their original containers, along with extra prescriptions for them. It would also
be a good idea to carry a doctor's note, listing your medical diagnoses and the
medicines you need to take. If you are going abroad, get this translated into local
language (for example, French or German), if possible. Carry a spare pair of
spectacles and an extra set of contact lenses, if needed. If you have medical
disorders such as diabetes or epilepsy, wearing a medical information bracelet
can provide life-saving information in an emergency in a foreign country.
Prepare and pack a simple first-aid kit in your suitcase. This kit should
contain the following items:
• Your prescription medicines, in their original containers.

46. • Medicines for diarrhoea and an upset stomach. Obtain from your doctor a
prescription for an antibiotic you can take in case you are struck by diarrhoea.
Ensure that you have packed medicines such as loperamide and antacids.
• Cough and cold medicines, such as pseudoephedrine tablets and cough
syrups.
• Pain-relieving medicines, such as acetaminophen, ibuprofen and aspirin.
• Decongestants and antihistamines for treating allergies. Go in for the
varieties that don’t cause sleepiness or drowsiness.
• Antibiotic ointments, adhesive bandages and hydrocortisone cream.
• Medicines for preventing motion sickness, such as dimenhydrinate and an
anti-nausea drug such as promethazine.
• Scissores, tweezers, nail clippers, pocket knife, thermometer, torch and
mirror.
If you are travelling abroad, remember that medicines can be very expensive
in the West! Also, many medicines are available only on prescription, which
means you will need to spend additional money on a doctor’s consultation.
Therefore, it’s far more prudent and much less expensive to carry all your
medicines with you! If you are travelling with children or elders, you will need to
take extra supplies to be able to meet their needs as well.
WHILE YOU’RE TRAVELING
The first precaution: Eat carefully! Traveler's diarrhoea can easily ruin a holiday!
Steaming-hot, well-cooked food is usually the safest. Avoid eating foods from
street vendors, unpasteurised dairy products, and raw or uncooked seafood.
Peel the fruits yourself. Drink water only from commercially sealed bottles or
else go in for carbonated beverages. Avoid using ice. Brush your teeth with
bottled water.
If you're going to a place where you could face an increased risk of
mosquito-borne diseases, protect yourself well. Insect repellents that contain
DEET(N, N-diethyl-metatoluamide) work the best. If possible, wear permethrin-
coated clothing and use nets while you sleep.
Sunburn can be hazard if you plan to spend a lot of time in the hot sun.
Use a sun block with a sun protection factor (SPF) greater than 15 and reapply
this lotion after swimming or sweating.
If you are going trekking in the mountains, you should be aware of the risk
of developing acute mountain sickness, which is caused by a lack of oxygen
when travelling to higher elevations. This form of sickness usually occurs at an
altitude: headache, fatigue, shortness of breath, nausea, poor appetite and

47. inability to sleep. It can be prevented by gradually ascending over several days
to give your body a chance to acclimatize to the higher altitudes.
Jet lag is a major bane for air travellers. Adjusting to a new time zone can
take up to a week and the more time zones you cross, the longer the adjustment
period. Symptoms include daytime fatigue, nighttime insomnia, headache and
disorientation. Lengthy travel may upset your circadian rhythm which controls
various body cycles, including the production of a hormone involved in sleep
patterns (melatonin). One strategy to prevent jet-lag is to change your sleep time
closer to the new time zone over a period of several days; adjust go-to-bed and
get-up times appropriately, so that you will be only slightly out of sync when you
arrive at your destination.
Being forced to sit for long periods in an uncomfortable airplane seat just
adds to your woes (unless you are flying executive class!). Simple tips to help
you cope with the travails of intercontinental flight are as follows:
• Try to get good night’s sleep just prior to departure.
• The dry air in aircraft causes dehydration. Therefore, drink plenty of fluids
(non-alcoholic only!) to counter water loss. Water is better than coffee, tea or
fruit juices. Alcohol is not only useless in combating dehydration, but also
brings about a markedly greater intoxicating effect when consumed in the
rarefield atmosphere of an airliner than it does at ground level.
• Blindfolds, earplugs, neck rests and blow-up pillows are all used in helping
you get quality sleep while flying.
• Get as much exercise as you can in the plane; for instance, by walking up
and down the aisle, standing for spells and performing small twisting and
stretching exercises in your seat. All of these help reduce discomfort,
especially the swelling of legs and feet. If possible, get off the plane at
stopovers, and perform some exercises or take a walk.
Motion sickness can pose a major problem for some people, especially on a
ship, or on long car journeys. There are many effective products available to
prevent and treat this problem (including prescription drugs such as
cinnarizine and promethazine) and you should start taking them at least one
hour before starting your journey. Recent studies have shown that ginger
root may be as effective as drug treatment, and is associated with fewer side-
effects.
AFTER YOUR TRIP

48. In case you do fall ill during your trip, or after you come back, don’t forget to let
your doctor know about your journey, as this information can help him in making
the correct diagnosis.

49. Chapter 9
How Not to Get “Quacked”
He who asks is a fool for five minutes, but he who does
not ask remains a fool forever.
Chinese proverb
All of us would like to become younger, sexier and thinner, and to live longer!
Given these universal needs, it is hardly surprising that quackery flourishes all
over the world. ‘Quackery’ is derived from the word quacksalver (a throwback to
the days when travelling salesmen would boast about the healing powers of their
salves). Since quacks quack, quackery’s paramount characteristic is hype and
promotion rather than simply fraud, greed, or misinformation — though these
qualities often go hand in hand !
Much quackery is involved in informing people that something is bad for them
(such as food additives) and selling a substitute (such as ‘organic’ or ‘natural’
food). Quackery is also involved in misleading advertising of dietary
supplements, homoeopathic products, ayurvedic medicines and some non-
prescription drugs. In many such instances no individual ‘quack’ is involved —
just deception by manufacturers and their advertising agencies.
Remember that quackery is not an all-or-nothing phenomenon. Some
products can be useful for some purposes, but worthless for others. For example,
vitamin B∧12 shots can be life-saving in cases of pernicious anemia, but giving
them to ‘pep you up’ is a form of medical fraud. Similarly, while certain ayurvedic
herbs can be very useful, often the mass-manufactured ayurvedic medicines
available in chemists’ shops are completely useless, because they do not contain
what they are supposed to! While there is no doubt that homoeopathic medicines
can be helpful, the concept of a standard homoeopathic remedy for common
illnesses such as headaches and colds flouts a basic homoeopathic principle,
which states that remedies need to be tailor made for a particular person and
only a skilled homoeopathic physician can identify the required medicines
properly.
Unproven methods are not necessarily quackery. Those consistent with
scientific concepts may be considered to be experimental, but legitimate
practitioners do not go around promoting unproven procedures in the
marketplace. Instead, they engage in responsible, properly designed research
studies to prove or disprove their claims. Methods not compatible with
established scientific concepts should be classified as nonsensical or disproven

50. rather than experimental: for example, ‘fish cure’ for asthma which draws huge
crowds to Hyderabad.
Quackery can harm individuals in many ways. First, is the loss of a
tremendous amount of money which patients invest in pursuing this treatment,
and many unscrupulous practitioners can bleed patients and their relatives dry —
a little at a time. (There is an old saying: “The highwayman demands ‘your
money OR your life’, but quacks demand “your money AND your life!”) Also,
many of the quack therapies can cause direct harm. It is a common
misconception that ‘natural medicines’ have no harmful side- effects — but
anything which can have an effect, by definition, also has the potential to cause
harmful effects (after all, the desired effects of a medicine are what we call its
therapeutic action and undesirable effects are labeled ‘side-effects’!). The indirect
harm they cause can also be enormous: for example, patients may pursue
‘alternative medicine’ for treating their cancers and may deprive themselves of
the opportunity of getting effective state-of-the-art medical treatment.
Quackery flourishes even in the USA where people are much more
sophisticated, and the US Food and Drug Administration (FDA) provides effective
policing. Therefore, it is hardly surprising that in India this menace is rampant,
and there are far more quacks than regular medical practitioners. Faith healing,
for example, is an integral part of Indian traditions, especially in villages where
educated priests take advantage of people’s ignorance and blind faith.
Many of us believe that we are far more sophisticated than the illiterate
villager, and are above falling prey to quacks, but we need to realise that modern
health quacks are supersalesmen, who play on fear and cater to hope. Who
amongst us has not clipped at least one ad or bought at least one product which
promises to either make you grow more hair, make you a better lover, remove
your wrinkles, make you lose flab, or improve your memory? While the cold
scientific fact remains that there is not a single effective way of fulfilling the
aforementioned claims, the fact that ads for these products are so prevalent
obviously means they have a ready audience and are pulling in the bucks for
their manufacturers!
How can you save yourself from being quacked? Here are some useful
pointers by Dr. Stephen Barrett from his Quackwatch Web site (at
http://www.quackwatch.com.)
1. Forget about ‘secret cures’. True scientists share their knowledge as part of
the process of scientific development. Quacks often keep their methods
secret to prevent others from decisively demonstrating that they don’t work.
No one who actually discovered a cure would have reason to keep it secret. If
a method works — specially for a serious disease — the discoverer would

51. gain enormous fame, fortune and personal satisfaction by sharing the
discovery with others.
2. Remember that quackery often garbs itself in a cloak of pseudo-scientific
respectability and its promoters often use scientific terms and quote (or
misquote) from scientific references. Be equally wary of pseudo-medical
jargon. Instead of offering to treat your disease, some quacks will promise to
‘detoxify’ your body, ‘balance’ its chemistry, release its ‘nerve energy’ or ‘bring
it in harmony with nature’. The use of concepts that are impossible to
measure or quantify enables success to be claimed even though nothing has
actually been accomplished.
3. Ignore any practitioner who says that most diseases are caused by faulty
nutrition or can be remedied by taking supplements. Although some diseases
are related to diet, most are not. Moreover, in most cases where diet actually
is a factor in a person’s health problem, the solution is not to take vitamins but
to alter the diet.
4. Be wary of catchy anecdotes and testimonials. If someone claims to have
been helped by an unorthodox remedy there is often a rational explanation.
Most single episodes of disease which affect patients lead to recovery with
the passage of time, and most chronic ailments (such as arthritis and
psoriasis) are marked by symptom-free periods. Many people who give
testimonials about recovery from cancer have undergone effective treatment
as well as unorthodox treatment, but give credit to the latter. Some
testimonials, of course, are complete fabrications!
5. Be skeptical of any product which claims to be effective against a wide range
of unrelated diseases, particularly serious diseases. There is no such thing as
a panacea or ‘cure-all’.
6. Ignore appeals to your vanity. One of quackery’s most powerful appeals is the
suggestion to ‘think for yourself’ instead of following the collective wisdom of
the scientific community. A similar appeal is the idea that although a remedy
has not been proven to work for other people, it still might work for you.
Remember that all humans have the same anatomy and physiology, and
scientific rules apply to all of us.
7. Don’t let desperation cloud your judgement! If you feel that your doctor isn’t
doing enough to help you, or if you have been told that your condition is
incurable and don’t wish to accept this fate without a struggle, don’t stray from
scientific health care in a desperate attempt to find a solution. Instead,
discuss your feelings with your doctor and consider a consultation with a
recognized expert.
The best way you can protect yourself from being taken for a ride, is to make
sure you are well informed about your own body. The ‘take-home message’ is
simple: if it sounds too good to be true, it probably isn’t !