Diet and health: The “ill effects” of jackfruit

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Origin of medical myths

Superstitions prevail in Science. At least sometimes.

It is believed that Pythagoras sacrificed an animal to appease god after he succeeded in proving his famous theorem in geometry.

I have heard that some scientists from Indian Space Research Organization chant mantras on the eves of launch of vehicles that carry satellites.

Some of these things may not be superstition in true sense but simply a ritual.

I am not talking of these rituals.

I intend to address the superstitions prevailing in medicine or medical practice rather.

Patients often associate their symptom to a particular event preceding it. For instance, “I got flue because I ate…..”

In India, patients often ask you what food they should avoid. There are conditions where a particular food or ingredient may be desirable or avoidable. Everyone knows what to avoid if you are diabetic or hypertensive. Then there can be food allergies, indigestions. For instance Celiac disease patients need to avoid a protein in wheat called gluten.

A doctor may ask patients to avoid leafy vegetables and other vitamin K rich food materials if some one has a high risk of thrombo-embolic phenomenon which can lead to the formation of clots within the vessels. These patients may still take these food materials but they would have to enhance the dose of anti-coagulant drugs they are taking.

All this is justified and there is Science behind that has been understood.

However, what would you do if a condition does not require any dietary restriction or addition but a patient insists and would not go without such an advice?

I finally advised one such stubborn patient to avoid “Jackfruit pickle especially if old” in a remote and arid area of Gujarat where you actually don’t get Jackfruits at all! Nevertheless, my patient returned happily… fully satisfied! He returned with good post operative vision and attributed it to strict adherence to my advice.

If you see this woman propagating the message that consuming jackfruit affects the visual recovery after a cataract surgery, don’t blame her. It’s me.

As you see the origin of some of the medical myths lies in such pieces of advice we give.

Sorry poor innocent Jackfruit!

Don’t worry; I am going to have you in my dinner tonight.

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Doctor, how long will it take....

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What do you think, how long will it take ....

(A) me to die?

(B) me to turn blind?

(C) my regurgitation to progress from moderate to severe?

Questions like this are almost universal in the minds of patients with chronic illnesses.

Why do they originate and how can one answer them?

They originate because the communication between a doctor and a patient is incomplete. When we doctors tell you the prognosis (i.e. the likely outcome) of a medical scenario, we are talking statistically, which means given a large group of patients, most would tend to behave along the expected lines. But statistic does not predict the fate of an individual in the same group!

This incomplete communication between a doctor and his patient leads to a lot of avoidable anxiety.

Finally to answer all such questions, I use the following illustration:

My hair is 10 percent grey (in reality the grey colour is barely visible!), can you tell me how long it will take it to be 100 percent grey?

You can't predict that.

So why worry?

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Depressed due to illness? Shine like a comet!

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In my previous post, I mentioned a doctor who was misdiagnosed to have leukemia.

A reader might wonder what is so inspiring about this tragic story. There is.

I have seen a comet only twice in my life. Halley’s comet orbits sun every 76 years. It was last seen in 1986. I had seen it with my bare eyes. The other one was the comet Hale-Bopp.

There are moments in life when one doesn’t know what lies ahead. Everyone no matter how fortunate or otherwise he or she is faces such days.

Prior to 1986, the Halley’s comet was seen in 1910. As everyone knows, there are myths about these poor celestial objects.

The world would end!
The life on this planet would cease!

These were some of the myths associated with the Halley’s comet. A report in a Hindi Magazine in 1986 told me that several people gathered together in a mosque in Tehran and committed a mass suicide in 1910! In a similar stand, several people gathered in the basement of a building in Vienna to face a common predicament.

The myths and panic reappeared in 1997, when the comet Hale-Bopp was seen. There were talks of an alien aircraft closely following the comet. A religious cult “Heaven's Gate cult” encouraged people to commit suicide as it would ensure a good “after life”.

So in a way, I like most of us survived one or two major comets!

I wish the doctor I mentioned in my post had opted for a timely second opinion and bounced back to life. However he chose to be eclipsed slowly.

The message: Don’t let any thing eclipse you, try to shine like a comet.

Lisa Ray diagnosed with multiple myeloma is shining. She did so at the Toronto film festival recently.

Best

Happy Alzheimer's day!

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He lived with a disease he never had...

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Year 1986, Gandhi Medical College, Bhopal.

I had just moved in one of the hostels as a second year MBBS student. Located adjacent to the beautiful Upper Lake in Bhopal, it was a lovely place to be in. However those days ragging used to be rampant in medical colleges and most of the time we remained cocooned inside our rooms. One of the largest rooms was occupied by a grand senior who entered the college in 1968 and had still not cleared his MBBS! There was no college regulation that could be invoked to "see off" such perennials.

He had been there for time immemorial: Although unlike another grand old man, he hardly spoke to anyone, we were still a bit scared to be around his room. I saw him exchanging words with only a cook who prepared food in his mess.

This guy was not always like this. "Legends" circulated about him. He had topped the first professional examination of the MBBS amidst a group of 140 students.

Then came the biggest blow of his life. He was (mis)diagnosed to have leukaemia!

Years passed by. There was no counselling available for him.

He awaited what we call death in vain for years, untill one fine day, he was declared not to have leukaemia at all!

However life had changed irreversibly for him. I believe he had been a drug addict.

A year after I graduated, he also finally managed to get his degree.

Dr. D.L Aren was an MBBS in around 1991 or 1992. He soon perished not because of leukemia but a generalized debilitation as a consequence of his addictions and alcoholism.

A beautiful life came to its end after a miserable journey.

Dr. Aren lived with a disease he never had, but ironically met his freedom from illness in his untimely death. I normally change the names of the subjects in my posts, but call it whatever, this as a delayed obituary to a man who would otherwise be a great doctor, but for a medical error.

Block A where he lived is now a girls' hostel.

The garden is there, but the "selfish giant" of O. Henry who unintentionally prevented us (kids) from playing there is not there.

You are missed Dr. Aren!

Manish

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(Please read my epilogue to be posted separately in a subsequent post.)

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One of their kind

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While Mr. George Abraham, the founder of WBCC, himself fancied being a fast bowler like Dennis Lillee, here is another man.

Born In Zimbabwe, Dean Du Plessis is blind since childhood: He reportedly had retinal tumors which I believe to have been retinoblastoma.

This chap uses the stump microphone and his accentuated hearing to occupy his seat in the commentator box. He has covered test matches, one day internationals and even 20 20 matches!

Aren't they one of their kind?

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Look, who is playing cricket!

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I had an opportunity to meet George in 1998 at Venu Eye Institute. Senior consultant Dr. Anil Tara had introduced us. He called him George, so did I. I saw him, while he heard me.

As I learnt much later, Mr. George Abraham had founded the World Blind Cricket Council (WBCC) and was the man behind the world cup for the blind. His visual status was a result of complication of meningitis that had affected his optic nerves.

I was subsequently assigned the task of screening a bunch of young cricketers from seven countries. They all had varying degree of visual handicap; some were completely blind.

In my ophthalmic career, I have come across all kind of people with disabilities and also normal people feigning a disability. Examination these players was a different ball game. Their disability had to be graded so that an appropriate mix of these guys could be included in a nation's team.

A guy from New Zea Land was a tough nut. He had retinitis pigmentosa - so the disability as such was beyond doubt. However the decision to designate him as an individual with highest grade of disability was tough and required knowledge about his visual acuity as well as field of vision. After much consideration, I gave him a benefit of doubt and he was regarded a player with higher degree of deficit. I followed the news of the world cup with an extra interest: What if the Kiwis had an extra advantage with this player. Final was played between South Africa and Pakistan and I was a relieved person.

Mr Abraham is reported to be working on Indian Blind Cricket league. My good wishes to him and the players.

With my chronic ailment, should I really marry…? Why not?

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That is what my answer to the question asked by my patient is.

To my mind Rahul should be more open, if not overtly looking to hunt a partner. He has every opportunity to share the nature of his illness to his prospective spouse whether she comes a natural way or through an arrangement as is the case in India for most.

How should he do it?

He should do this in an open straightforward manner without sounding either guilty or insecure about the future of his relationship. Even people without an ailment have heart breaks. His potential spouses should have a right to approve, choose, or discard him. A person contemplating marriage to some one like Rahul, should give enough time to self so that one doesn’t marry out of “pity”.

Similarly, Rahul should prepare himself for a negative response. Remember, his potential spouse had that right even if he had not had the medical problem… Her right needs to be respected.

I have heard of people concealing their status even those who are carrying HIV virus or have full blown AIDS! for the sake of marriage. Their spouses, whom they infect in due course have been abandoned after they pass away. Not only this, the stigma of AIDS, takes its toll as well. There are reports where a wife has been held responsible for the disease, even though she contracted it through her deceased husband.

Message to Rahul:

Open up…
Look for a potential mate…
Share honestly…
Don’t feel rejected! Every human has a personal dignity, so in true sense, a human rejection is simply a subjective perception.
If a proposal is turned down, it saved at least two lives….
And finally even without the ailment, your marriage could fall apart…
So be happy.

Every single person can be married any moment.
But every married person can’t be single so quickly!

A single person’s life is better than that of a person in a wrong relationship.

Looking forward to your marriage invitation, Rahul …!

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Doctor, with my chronic ailment, should I really marry…?

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Rahul (name changed) is 27, a tall, handsome guy with hazel colored iris pigment. Self employed and runs a placement agency. He was a juvenile glaucoma patient who had been operated for intractable glaucoma when he was only 9 year old. He says, his visual status (which is significantly reduced in terms of the visual field), is known only to two persons: his doctor (that happened to be this blogger) and himself. His family obviously knows about his ailment; however to everyone else he is a crazy guy who owns a bike, has access to his father’s car but for reasons best known to him, avoids driving either of them.

Rahul is not alone. Many glaucoma patients are forced to lead a restrained life due to visual field restrictions. As I said in a previous post, some countries even have legislation that (rightly) prohibits them from driving.

Unaware of his actual visual status, his parents are behind him. They feel it’s high time he “settles down” with a suitable bride.

Around a year ago, he sought my views about this. Marriage in India, unlike in most western countries are arranged, unless someone falls in love, in which case there may still be a lot of family drama because of multiple differences in caste, religion, region, language and financial differences.

Nevertheless, the question Rahul has raised, I believe must be shared by many others irrespective of which part of the world they live in. A patient with a chronic disease, physical limitation more often than not relives these restrictive factors and puts up a lot of anxiety not directly linked to the ailment itself.

So Rahul discussed his reasons for avoiding a marriage:

“I don’t have a girl friend, whom I could marry. (He probably closed the doors for a relationship because of the potential impact she would have to bear!). Even if I had, I wouldn’t want to ruin the life of someone I loved. My parents are pressing me to tie the knot, but the question is why should I marry and cheat a person I have never known….” he says.

Effectively, he has ruled out marrying someone he could have been in love with as well as others whom he wouldn’t be in with.

What do you say to this question?

I would post my answer shortly.

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Can herbal drugs evolve to be integrated into modern medicine?

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This is the story of a wounded soldier named Hussein Khan. Critically injured, down with high grade fever and thirsty, he decided to drink dirty water from a pond. The water was too bitter, but since his thirst was unquenched, he decided to have a mouthful of it “one last time”, or so he thought.

Hours passed and he woke up again. The fever was gone. A new dawn looked ahead!

This water was no magic water. It turned out that the bitterness was due to the bark of trees of cinchona that were abundant in the region. Quinine is derived from the same bark. Effectively, the soldier had survived malaria in a war torn endemic zone! Quinine the first effective anti-malarial drug is seldom used now but its analogues such as chloroquine are.

Quinine is not the only drug of herbal origin used in modern medicine. Digitalis derived from fox glove, atropine derived from atropa belladonna are some other examples of drugs that had herbal origin, but thanks to modern research, they are now seen as “allopathic drugs”. From anti malarials to anti malignancy drugs and immunomodulators, one can cite many examples.

All these wonder drugs are not free from side effects in either crude or refined form as any student of pharmacology would tell you. It’s just the difference between the right dose and wrong. Digitalis used in cardiac ailment is also known to offset the rhythm of the heart! Quinidine an isomer of quinine has serious cardiac toxicity as well as ocular toxicity that is shared by its synthetic analogue, chloroquine. Cyclosporine, an immuno-
modulator is used by renal transplant recipients, but is known to be a nephrotoxic drug itself.

So the notion, that only ‘modern drugs” have side effects and others are free needs to be readdressed. Only a placebo would be free from side effects, but it would have no desired effect as well!

Having said this I would like to address a discussion begun by a fellow Ophthalmologist as a comment on my previous post: What about the potential therapeutic effect of a herbal drug that someone prescribes for viral hepatitis, in Maharashtra, India? I would say, if the observation is correct, someone needs to design a study to see if any substance present in its extract indeed has an anti viral property!

But until such substantiation is there, the herbal drug is at best only a “potential” or “candidate” drug.

A proper research on such drugs is in every one’s interests, especially the patients who squander a lot of money on alternative medicine. According to my personal estimation, the money spent on irrational treatment (including irrelevant use of proven drugs) outweighs that spent on real drugs judiciously.

So the mantra remains: Know about medicines, explore the credentials of a doctor. Its your body, don’t use it as a test tube.

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Short cuts in medical research: a fallout

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Few years ago, I hospital in Noida, UP, India had a press release about a "new procedure" that rejuvenated a diseased heart. The approach was based on use of "gene therapy" and employed delivering a gene to the heart so that new blood vessels could "sprout out" in place of the diseased ones that were blocked. This was kind of a medical first in India.

An alternative to this procedure would be a coronary angioplasty surgery, whereby a graft would be inserted to resume blood circulation to a diseased heart.

Soon again the hospital was in lime light again albeit for wrong reasons this time. The procedure was not pretested either on animals or in a pilot study. I am sure research groups across the world would have been working on the same line, but did not pursue it so speedily as did this group.

As a result of gene therapy primarily targeted on heart, there was sprouting of blood vessels in the retina of these patients, a process know as "neovascularization" to medical retina experts and ophthalmologists. Clinically it was like eliciting a diabetic retinopathy in those without diabetes!

Such a scenario could have been averted if the desire to be among the pioneers could be curbed.

What is a patient supposed to do if the research itself has proprietary or academic interests?

I seek views of readers and hope to answer through a subsequent post.

Manish

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