Thursday, December 3, 2009
Monday, November 16, 2009
As the world moves towards better health care, the shift in information and right to choice is moving more from the domain of 'The Doctor Says ' to what information is there and to the patient himself. In other words ,the market oriented, client oriented forces in the treatment and approach to medicine has arrived. As the treatment options become more expensive and varied , the market forces are geared towards a more well informed choice. The medical market seems to represent a real test or quality of the 'product' screen as the best outcome is the real test and the real result that will be the bench mark for any treatment.
breast cancer has been to this day a best diagnosis that can be tested as all it's treatment ,choice, from diagnosis to the cosmetic impact is there for the people to monitor and watch. It can be taken as a test also for improving the results, improving the equipment in both diagnostic and treatment purposes.
Tuesday, October 20, 2009
Arming School Children Against Violence...Preparing To Handle Terrorist Threats In Pakistani Schools.
So far, there is no comprehensive policy both at the governmental level or at the school level to address this problem. Both the school administration and the parents will need to device strategies and initiate learning programs to help the children deal with such threats as school bombings and the instillation of fear .The parents need to be aware of the situation confronting their child and be armed and ready with mechanisms of how to deal with these conflict situations.
Lots of web presence is there on how to deal with school violence to which I am giving links but simple instructions on how to deal with such a situation are not there. Here I am writing a few points for both the teachers and the parents to follow in order to be better prepared.
For School Administration and Teachers:
- Make a security plan for the school with a clear objective for evacuation,response in case of attack, fire,threat, devising coordination with local rescue, fire agencies,local councillors, representatives, ambulances, police station , hospital and clinic.
- Prepare a list of parents' contact and keep it handy. Train at least two or three people to start contact. Prioritise tasks to handle response as a list on,two,three...Train people to do the drill regularly.
- Discuss and train parents the response plan with parents at least monthly in a meeting and use email contacts with information regularly to allay their anxiety.
- Regularly do fire drill as an evacuation plan with children.
- Provide reassurance and support to parents and children by appointing a counsellor and or trained person to provide support.
- It is essential that you find out the kind of information your child is getting about violence.Talk to him/her and explain the situation honestly.
- Give assurance and emotional support to address their needs. Do not avoid topics of death and destruction. Give reasonable explanation.
- Allay fears and anxiety by simple examples and avoid showing your own anxiety.
- Prepare them for drills in school.
- Make their daily tasks simple and let them follow a simple routine. Provide a relaxing atmosphere. Engage them in sport, music, painting etc. Limit exposure to tv and violent movies etc.
- Seek professional help if you think you cannot handle and the child is having nightmares, bedwetting, bad grades , bad behviour, shyness, intriversion, avoidance in school and such trauma symptoms.
- Teach them helping skills like simple first aid , what to do if someone fell down and other life saving skills.
- Let them keep a pet if they can ,this teaches them nurturing.
You can find good informaation on these sites; http://www.talkingwithkids.org/
Spread the word of help around for all to benefit.Defeat the fear factor spread by terrorist. Help humanity live healthily.
Monday, August 31, 2009
These are some of the points which should be noted:
- Always keep computer in shared spaces and check history daily. Use good software to block sites(K9) is a good example.
- Be aware of your kids friends and their families and the time and places they spend and meet them in.
- Always talk in an open and friendly manner and never use accusative or deriding language.
- When giving education, use diagrams and make things look scientific.
- In USA abstinence is bieng reported as ineffective, but Pakistani parents and teachers can use this effectively as we have religious and social taboos.Teenage unwanted pregnancy statistics are not known in Pakistan but I as a practicing gynaecologist in a large city have seen a large number of cases most of them of assault on children.It is therefore a must to teach children about sex.
- Prevention of sexually transmitted diseases (STD's) which is also increasing in incidence and is a high cause of infertility in Pakistan should also be taught at an appropriate age. In Pakistan girls also marry young.
- Teach your child in a manner that he /she may have a healthy attitude towards reproductive health.Nowadays a lot of deviant and bad exposure(especially in our society where health education is not given) to sex may risk the emotional and psychological state of a child.
- Prevention of Hepatitis which is endemic in our towns and cities such as Larkana, Hyderabad is essential as this also occurs in unsafe sex and assault.
- Make emotional and psychological aspects of puberty and teenage a part of education. A psychiatrist or psychologist can provide curriculum and topic support.
- Give adequate information to the children about rape and sexual abuse. This has become very common both in school population and in families. Many children travel in buses, vans , and with drivers. Many children go to places with friends where they may suffer by friends and other persons. Only if they recognise the extent of assault or are aware of what is happening can they prevent and seek help. Always give your child your number on the speed dial. I have seen fainting people after injury bieng helped after using speed dial number.Boys should also be made aware of recognising abuse and made to report in confidence to parents and teachers. Brushing this issue aside as is bieng done by both parents and teachers in Pakistan will only make this issue graver as the statistics are markedly increasing.
- Read about these topics and make your own notes. compare with others like teachers or other parents.some sites are; Web MD.com/children's health. www.kidsgrowth.com www.asharstd.org/teens/teens-overview.cfu
Friday, June 26, 2009
This addiction is damaging both for the teenager and the family.
In Pakistan as there is little support both in medical community and at the governmental level and because drug trade and mafia is operating freely and with a masive vengeance in urban areas, this problem has multiplied manifold.
There are many signs and symptoms of drug abuse which parents need to be aware of and recognise in order to seek earlier help and solution to the problem.
If your child is skipping school both in your information or without your information.
If he or she is unusually sleepy and avoids interaction with you.
If you find small or large sums of money missing or some jewellery missing frequently.
If your child often goes to pillow parties and other late night outings especially and avoids bieng with you on coming home.
If your child is losing grades, avoids normal social interactions.
If medicines are missing from cabinet.
If your child frequents area doctor or says he wants to visit frequently without apparent disease.
In Pakistan, drugs are freely prescribed by millions of quacks all over the cities.
There are other signs such as lack of grooming,unhygeinic appearance, anger outbursts.
The parents should try and take the child as soon as possible to a proper psychiatrist first as he or she maybe able to rule out diseases such as depression or diagnose these concomittant with drug/substance abuse.
Friday, June 19, 2009
Wednesday, June 17, 2009
Often we tend to find ways to cope with situations only in a reactionary way. A boss may criticise and we instead of seeing and rectifying the deficiency or fault react. This further worsens our stress level and hampers positive thinking.
Many of our relationships also suffer due to negative thinking and often we may get into a vicious cycle and damage a perfectly good relationship.
Nowadays there are many known,tried and tested therapies such as yoga,meditation, prayer, music,guided imagery, excercise ,cognitive behaviour therapy which help convert negative thinking into positive ones. Cognitive Behaviour Therapy can be taken with a counsellor or it can be practicised at home once you learn the techniques. Web Md is a good source of learning these techniques. Positive thinking is key to behaviour change be it for leaving smoking,drug habit, anger management, stress management or dealing with depression and other diseases.Weight loss program also gains immensly from learning positive thinking.
I once improved greatly in my repeated negative thoughts about people taunting( Tana in Urdu) by reading Anthony Robbins and practicing the techniques in the book.This happened some 15 years back and my learned behaviour has improved so much that now not a single thought comes in mind that I convert it into positive thinking. Previously I used to be ruled by that negative thought and it was very stressful!
CBT can be done with a counsellor or can be done at home.The change can make you realise the negative thoughts . You can then learn to review these thoughts and then learn to remove them and replace with positive thoughts.Mind relaxation techniques also enhance positive thoughts and behaviour modification.The one thing I have learned most in my positive behaviour modification role , be it with teenagers, children or adults, is that when you tell the other person you care and trust them does the positive change starts to occur. So if you are doing this for yourself, start by saying to yourself the following things;
- I trust myself to change my negative thinking or thoughts to positive thinking or thoughts.
- I trust myself to acknowledge my negative thoughts after recognising them.
- I trust and promise myself to change my negative behaviour to positive behaviour by dismissing negative thoughts immediately and replacing them with positive thoughts immediately.
- I trust and promise myself to improve my behaviour by helping myself by understanding the ngative behaviours such as smoking, violence, anger,cursing or other abuse,and immediately stopping them with the help of a psychiatrist, a doctor, a counsellor some other person or even myself.
- if myself then I will read extensively and repeat the behaviuor modification excercises.
- I trust myself to learn time management and spend my liesure time in positive activities such as sport, teaching, helping
Wednesday, May 20, 2009
Autism is genetic ,also environmental causes have been implicated. other than the recent vaccine issue the causes are not very important from management or treatment perspective.
The difficulties Pakistani parents face are manifold;
They do not recognise the autism symptoms earlier as there is no awareness about these disorders even in doctors. If the child presents with different presentations and loss of verbal skills ,they may think it as shyness, indiscipline etc. Due to the social and religious dogmatic milue of our society there is no effort on the part of even medical personnel to make people aware of this problem and provide help and care including educating the parents or family.
As in USA , Pakistan also now faces a large burden of disease with children with autism and related disorders.People need to understand these disorders.
Autism and autism like disorders consist of a spectrum in which are included Rett's, Asperger's syndromes, non-specific autism like disorders, etc.the difficulty faced by parents is that in case not earlier detected, th child may not be put in school,or may become aschool dropout due to failure to integrate.
If symptoms such as difficulty in social interactions such as eye contact, conversation,abnormal verbal exchange,inappropriate emotional response, repetetive actions and interest in games etc are causing concern , the parents need to seek help !
The good news is that if the child is given interventional treatment such as cognitive, behavioural and special educational treatment he may recover. Now according to a new study children with higher IQ's may eventually become fully functional. The best part about this study is that it gives hope to parents of children with these disorders.
In Pakistan there is a dire need for people to be made aware of these disorders and be given help and treatment facilities.
Sunday, March 29, 2009
Always dissociate your relationship and try to look at her/his disease in a cool and scientific manner.
Whenever a crises situation starts always contact a professional for guidance, help.
Keep important telephone numbers handy; on the fridge ,with the keys hanger or easily accessable place.
Place all important information about patient, drugs treatment ,dosage, emergency help measures in easily accessable place and keep copy in office, with friends or other family members.
Always take into confidence about the condition of the patient, the treatment,physician, other help information, a close friend or relative, so that in case of emergency, they maybe able to help.
Always keep the nearest hospital/ emergency telephone,contact person address handy.
Always take time out for your own self and find some entertainment to lighten up.
Take time out for other children and family members.
Always take psychologist help to train yourself to manage situations like anger,stress,etc.
Many a times your own depression or other mental disorder may exacerbate or come to limelight during a crises.Seek professional help immediately. Do not postpone or decide to face things on your own. This is just like a car when it needs servicing or oil has to be given the service. you cant give water to a car and presume it will function. You have to be fit yourself when the child needs more care from you.
Also see that your spouse or partner also does not need professional help. Sometimes both parents also need psychiatric help.
Always take into guided confidence about your child's treatment and care options, information, the school management.Try to softly and cooly provide them enough information so that they may help and not panic if a need arises.
In Pakistan, the bigger ,the more famous the schools are the less likely they are to understand or help the child . So try and put your child in a school where they may be less stressed and find more happy environment.
Do not be judgemental and do not discuss or argue infront of the child. Always remove him or her if any one is bitching or bieng judgemental.
Try and read a smuch as possible and go on internet , see u tube and read health articles as much as possible to understand the disorder.
Find support groups, if not available locally, create one yourself. You will be surprised how many children suffer from mental disorders.
Last but not least try to find inner peace in yourself through prayer and charity. You will be surprised how much spirituality helps in healing.
Monday, March 9, 2009
Drop by drop an ocean make, start your effort NOW!
Saturday, February 7, 2009
Friday, January 30, 2009
- Go ahead shop for doctors,good ones too.
- Read maximum about the disorder but do not make the diagnosis yourself,you may be surprised by the diagnosis given by the expert.
- Always start treatment under doctor's care, stick to appointments, never stop treatment on your own, report any symptoms that are new to the doctor.
- Go for cognitive behavioural therapy,this will help you to learn skills,make resources and indulge in hobbies like painting to focus and improve your cognitive health.
- In case of menstrual mood changes go ahead with treatment with SSRI's under doctor's care for short term. It helps.Help ateenager or adolescent understand his/her disorder.
- Give support to others,it has been seen that nurturing fosters speeding up of healing.
Wednesday, January 28, 2009
Tuesday, January 20, 2009
Friday, January 9, 2009
Here are some points to note:
- If you feel sad,irritable or angry frequently,look for professional help from the psychiatrist,clinical psychologist,other support groups.
- Get regular excercise,every day,even for shorter periods.
- Take time out for the activity you enjoy like reading,listening to music,playing,or any other hobby.
- If you dont have a hobby go out once a week to meet a friend,the movies,or along walk.
- Recognise stress and take steps to manage it.(learn techniques for stress management including yoga,meditation etc.)
- Learn time management;divide tasks you need to do;prioritize them according to urgency,taking time out for oneself everyday is also essential.
- Also take care of your personal life like job,finances,other responsibilities.Remember looking good is part of the game.Unless you look your best the person you are looking after will not be happy,so take care of your hair,nails,dressing up and overall carry a cheerful expression.sulking and pouting will not help anyone.Smile and see yourself!
- Do not ignore other important relationships,learn to give time and attention to them also.Keep your emotions in context.
- Learn to acknowledge and understand your limitations.Do not try to give more than you canor you will face a burn out.Remember if you are well then only can you take care of someone else.Keep everything in perspective.
- Learn to empower the person you are helping.For example if a person has Parkinson's disease,help him to learn to be independant,by giving him support and tools.Empowerment needs the tasks to be made simplee,achievable in sequences for example;
- Divide tasks like eating food:getting plate, spoon out,putting food on table,putting food on plate,eating slowly and steadily,putting plates away etc.
- Provide enough modifications and tools for the patients to achieve their objectives,simple things like plate guards,special spoons as in case of parkinson's.
- Do not try to be perfect.Allow for mistakes.Better still,learn to laugh at mistakes.A good sense of humour can take you past the greatest of obstacles.
- Respect the person's independance,self respect and personality.Do not become a mother,father or school marm.Learn to let others live with dignity.
- Give the person taken care of some sense of achievement like looking after a pet or a plant. There is evidence that nurturing helps in cure.
- Always give tasks which the person may achieve.Identify their abilities.You cannot ask a person with Parkinsonism to wash the car!
- Always make sure that the person achieves his tasks by not taking too much risks.Give friendly and safe tools and objects.
in the end,it has to be emphasised that the object of the whole excercise of caregiving is almost spiritual,ethereal,but we as humans have to keep in mind our limitations in order to achieve this higher goal.Be proactive,be optimistic,have a good sense of humour.Keep smiling!
Monday, January 5, 2009
Signs to watch for are:
- Decreased interest in friends and activities(like going out to play,attending family get togethers,meeting friends and relatives.)
- Difficulty in getting up on time to go to school or college.
- Lack of interest in school or college activities.
- Difficulty in concentrating on school/college work or in household tasks.Unkempt look(dishevelled hair,not brushing teeth,untidy dress code.)
- Frequent complaints of tiredness and boredom.
- Unexplained aches and pains.
- Either insomnia or oversleeping.
- Trouble getting along with others(may get into fights due to increased irritability.)
- Hypersensitivity to rejection or failure.
- Emotional outbursts such as weeping,anger,shouting.
- Reckless behaviour as in driving a car, alcohol or drug abuse.
- Self abuse or injury.
- Suicidal talk or expression.
- Social withdrawal.(this increases with level of depression.)
- Fall in grades and achievements.
For general information depression is of different kinds like major,dysthymia,seasonal affective disorder,atypical.For the parent or care giver it is important that they recognise the symptoms and seek help.There are several criteria for coming to a diagnosis but they are recognised by trained health personnel. For example DSM IV TR for major depression in adolescents.
Causes and links have been not well defined but hereditary,disbalance of nuerotransmitters,such as serotonin,noreepinephrine and dopamine have been known to cause the symptoms.In children and adolescents a strong link between stressful life events and manifestation of depression seems likely.
Other conditions may co-exist like ADHD,eating disorders,personality disorders substance abuse,anxiety disorders ,oppositional defiant disorders etc.
These and other diseases may be only identified by the physicianIn our society it is considered a stigma to go to a mental health professional so the role of a general practitioner as the final carer is very important.He should refer patient for final diagnosis and treatment and then keep on treating the patient with cooperation.
The out look for treated patients is good. Learning to live with depression is a very long and tedious effort but if optimism is adopted then life can be good.Treatment is now very advanced and easily available but it has to be taken seriously and under good guidance.Never listen to sad anecdotal stories of failure .Always see the silver lining.The new health paradigm is adopting a healthy lifestyle,be it eating,treatment,excercise or therapy.