REMOTE CONTROLLED MEDICAL CLINICS OF ARJUN&;ARAN.

INTRODUCTION:-THIS IS A MEDICAL CLINIC WITH ALL SUPER SPECIALITY DOCTORS LOCATED IN CHENNAI TO SERVE THE MEDICAL NEEDS OF NRIS &;ALLIED PERSONS MUCH FASTER THAN THEY CAN GET IN THEIR OWN PLACE&; FOUND TO BE VERY HELPFUL IN ALMOST ALL MEDICAL EMERGENCIES SAFELY &;RELIABLY.ASK OUR CLIENTS &;JOIN.
THIS IS MEANT FOR THOSE WHO DONT HAVE EASY ACCESS TO A WELL QUALIFIED PHYSICIAN IN AN EMERGENCY.EXAMPLE:-A PERSON MAY GET LOOSE WATERY MOTION SEVERAL TIMES AFTER DINNER.THIS IS A SYMPTAMATICALLY CURABLE DISORDER.NO NEED TO GO IN SEARCH OF A DOCTOR AT MIDDLE OF THE NIGHT.USEFUL FOR THOSE WHO LIVE IN 1)INACCESSIBLE AREA 2)LIVE IN REMOTE VILLAGE-LIKE CONDITION WHERE DOCTOR IS AVAILABLE AFTER 30 MILES.3)AT A FAR OFF PLACE FROM WORKING AREA OR RESIDENCE.4)IN A PLACE WHERE PHARMACY IS LOCATED AT A FAR OFF PLACE.5)WHERE MEDICINES CAN NOT BE PROCURED WITHOUT A DOCTOR'S PRESCRIPTION 6)PEOPLE LIVING ABROAD.7)PEOPLE WHO FLY FRQUENTLY8)THOSE WHO DONT HAVE TIME FOR DOCTOR'S APPOINMENT &;WAIT.9)ECONOMICALLY NON-VIABILITY.(MANY DRUGS WITHSAME PHARMACUTICAL FORMULATIONS IN INDIA COSTS UPTO 40 TIMES IN USA) DESIGNED TO MEET THE NEEDS OF NRIS IN ANY COUNTRY &MEDICAL AID REACHES THEM IN MINUTES &SOLUTION OBTAINED FOR PROBLEM IN LESS THAN ONE HOUR

P L A N
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A SET OF 10 -20 MEDICINES SENT FOR VARIOUS COMMON DAY -TODAY AIL MENTS.A BOOKLET CONTAINING INDICATIONS &;DOSAGE GIVEN. MEDICINE TAKEN ONLY AFTER CONSULTING OUR DOCTOR TELEPHONICALLY AT EACH EPISODE.A 4 LINE TELEPHONE FECILITY AVAILABLE ALL THE 24 HRS.A WELL QUALIFIED PROFESSOR CADRE -DOCTOR IS AVAILABLE ON SHIFT DUTY.THIS IS WORLD'S FIRST ORGANISATION OF THIS KIND &;IS PURELY SERVICE ORIENTED.

DRUGS FOR THE FOLLOWING AILMENTS WILL BE SENT IN PLAN "A"
1)FEVER2)PAIN.3)CONSTIPATION +/-ANUS TEAR 4)DIARRHOEA /VOMITING.5)ALL KINDS OF COUGH. 6)PEPTIC ULCER(BURNING BEHIND CHEST BONE) 7)EAR /NOSE/ THROAT AILMENT8)KNOWN ASTHMA 9)BURNING WHILE PASSING URINE.10)ITCHING SENSE AT GROIN, GENITALS ,ANYWHERE.

IN PLAN "B" WE HAVE MANY GYNACOLOGICAL/MENSTRUAL SOLUTION INCLUDING EMERGENCY CONTRACEPTION(NEW CONCEPT)&;ALSO SOLUTIONS FOR MANY CHILD HEALTH PROBLEMS&; SENIOR CITIZENS.

COST OF PACKAGE.
---------------
1)ONE CONSIGNMENT OF MEDICINE IS USUALLY SUFFICIENT FOR ONE YEAR.
2)COST OF MEDICINE -AROUND-USD 12/PACKAGE +POSTAGE EXTRA.
3)SERVICE CHARGE USD.250/YEAR(WORKS OUT TO USD20/MONTHLY)
4)ALL E MAIL,TELEPHONE CONSULTATIONS FREE.
5)NUMBER OF CONSULTATIONS UNLIMITED.
6)works out toUSD7/HEAD FOR A SMALL FAMILY OF 3
CLINIC - DIRECTOR--DR P.SELVARAJ.M.D.,D.C.H.,F.R.S.H.,(LONDON)
PROFESSOR OF PEDIATRICS-RETIRED.
E-MAIL ,TELEPHONE CONSULTATIONS FREE.

VACCINES-BIRD"S EYE VIEW/IAP-&AAP

Introduction:These two giant organisations in the world are making the policy decisions on immunisations for children&is formulated by Advisery commitee on immunisation practices on the respective countries.This is a comparative study of observation between Indian academy of pediatrics,&American academy of pediatrics regarding their immunisation policy,meant for elite population & N R I S.For completion sake & for quick reference certain other countries' immunisation are included,as we have lot of NRIS IN THESE COUNTRIES:1)INDIA 2)USA3)AUSTRALIA 4)UK 5) MALAYSIA 6)SINGAPORE.
Immunisation is a global procedure against preventable diseases as per prevalance.World's Eco system is such that mother nature has distributed the organisms in its own way.In the densely populated country like India like every dog has its day,these organisms also had their days &played their part to reduce population explosion.The health measures required to counteract simply sucks the country's finance like leeches.People's co operation is essential in disease eradication.In India people expect all vaccines to be available free,thanks to LION'S &ROTARY CLUBS IN PROVIDING HEPATITIS &POLIO VACCINES RESPECTIVELY.Ignorance is still alive even with educated people. Every parent must feel that they are morally responsible for prevention of disease to their children even if one is poor.Let him beg ,borrow, or ,steal to immunise his child.

I A P IMMUNISATION TIME TABLE:2005--2006.
-------------------------------------------------------

Total doctor's visit-10
diseases covered---10(optional vaccines-3)
Birth
OPV-0
Hep B-1
6 weeks DTPW-I/DTPa-1
OPV-1
HEP B-2
Hib-1
10 weeks DTPW-2/DTPa-2
OPV-2
Hib-2
14 weeks DTPW3/DTPa3
OPV-3
HEP.B-3
Hib-3

9 Months. meascles
15-18 months DTPWB-1/DTPaB-1
OPVB-1
Hib B-1
MMR
2 YEARS Typhoid+

5 years DTPWB-2/DTPaB2

10YEARS Td#/TT
16.YEARS Td#/TT


PREGNANT WEMEN:2 DOSES OF Td#/TT.

Vaccines that can be given after discussion with parents:---

>6 WEEKS----------PNUMOCOCCAL CONJUGATE VACCINE *
>15 months---------Varicella(chicken pox)#.
>18 months---------Hep A +
#<13>13 YRS- 2DOSES.(1-2 MONTHS INTERVAL)

+ 2 doses (6-12 months interval) (hep.A)

*3 primary doses at 6, 10 ,14 weeks followed by booster at 15 months (Pnuemococcal)
New recommendations:2 Doses of MMR.USE of combination vaccines &IPV in private practice.
Observation:one of the countries recomendingBCG.Only country to advice typhoid.No rota virus, or meningococcal vaccine advised.Chiken pox,pneumococcal,&hepatitis A are advised after discussion with parents.T .T FOR PREGNANT women advised .


A A P--JAN 2008. (U S A) AMERICAN ACADEMY OF PEDIATRICS.
--------------------
Hep.B-1--Birth,1mo,2 mo,12-15 mo
Rota virus-1 mo,3 mo,6 mo.
Diph,tetanus, pertusis--2mo,4mo,6mo,15mo.
Hib-2mo,4mo,6mo, 12-15mo
pnuemo--2 mo,4 mo,6 mo,12-15 mo.pnuemo-polisacharide(ppv)--2--6yrs.
Inactivated polio--2 mo,4 mo,12-15mo, 4-6 yrs.
Infuenza- yearly.4-6 yrs for certain high risk group
MMR--12-15 mo, 4-6 yrs
Varicella-12-15mo, 4-6yrs.
Hep A---2 doses.12-15 mo--19-23 mo,
Meningococcus:--recomended for teens &college students.
MCV 4--FOR HIGH RISK group,at 2--6 yrs.
HUMAN PAPPILLOMA VIRUS VACCINE :FOR GIRLS AT AGE 12-13YRS.

IMMUNISATION SHCEDULE --UK.SEP 2006.
------------------------------------------------
3 DAYS.--BCG if TB in family in last 6 months.
Hep.B.if mother is Hbs Ag +ve
2 mo.---DTaP+IPV+Hib+pneumococcal(pcv)
3 mo.---DTaP+IPV+Hib+Meningitis-C
4 MO.--DTaP+IPV+Hib(pediacel)+pneumococcal(prevnar)+meningitis-c(neisvac)

12 mo.--Hib+meningitis-c(menitorix)
13 mo.-MMR+Pnuemococcal
3 -1/2---5 yrs.-dtap+ipv, or,Dtap+ipv(,Repavax)or,Infanrix
MMR(Priorix,or mmr)
13-18yrs.-Td+IPV(TETANUS/DIPHTHERIA/POLIO)
OVER 65&
<65 AT RISK GROUP:-Annual influenza vaccine+one of pnuemococcal.

AUSTRALIAN GOVERNMENT--31 OCT 2007
-----------------------------------------------------
Birth :Hep.B
2 mo :DPT+POLIO+Hib+HepB+pnuemo+rota virus
4 mo. :DPT+POLIO+Hib+Hep .B(Infanrix-Hexa)+Pnuemo(prevnar)+Rota virus(Rotateq)
6 mo :DPT+POLIO(IPV)+Hib+Hep.B+Pnuemococal+Rotavirus.

12mo :MMR+Hib+Hep.B+ Meningococcal-C.
18 mo.VARICELLA.
4 YRS :DPT+POLIO+MMR.
Comments:No,BCG/TYPHOID/H EPATITIS A advised.

M A L A Y S I A 28 FEB 2006
---------------------------------
At birth : B C G

2. mo.---Hep,B+OPV+DPT/DT+Hib

3.mo---Hep.B+opv+DPT/DT+Hib

5.mo.--Hep.B+OPV+DPT/DT+Hib

6.mo.--Meascles.

!2 mo.--MMR

18.mo.--opv+DPT

5-7 yrs.-OPV+DPT+MMR.

12--15yrs--TT+Rubella.
COMMENTS: Hib,/rotavirus/pnuemo/ meningo/Hep A /Influenza/chickenpox are not advised.

SINGAPORE--GOVERNMENT--11-AUG-2007.
-------------------------------------------------
Birth: BCG+Hep.B(FIRST DOSE)

1.mo.--Hep.B (SECOND DOSE)

3.mo.--DPT/DT-- 1st dose.
oral sabin 1st dose

4 .mo-DPT/DT----2nd dose.
oral sabin ---2nd dose.

5.mo.DPT?DT ----3rd dose-----Hep.B. can be combined for patient compliance
oral sabin ----3rd dose.
5-6.mo.--Hep B----3rd dose-if not comb9ned above.

1-2 yrs.----MMR-primary dose.

18. mo.--DPT/DT+ORAL SABIN 1st booster.

6-7yrs--DT+ORAL SABIN-------2nd booster.

11-12 yrs.-DT+ORAL SABIN-----3rd booster.+MMR BOOSTER DOSE.
comments;No Measles/Rubella//Hib/ Pnuemo/meningo/Rota/Influenza/Hep A advised.Using OPV like India.All Other countries using IPV
OBSERVATION & ANALYSIS:
----------------------------------
There is conses of openion for immunising for the following diseases in all the countries.
1) Hepatitis B 2)Polio 3)Diphtheria.4)Tetanus.5)Wooping cough.6)Meascles.7)Mumps.
8)Rubella.
2)Tuberculosis:IAP continues to advice BCG, AS THE DISEASE IS STILL PREVALENT IN INDIA
&also believed to reduce incidence of desseminated TB such as TBM,OR REDUCE THE MORBIDITY IN TBM. Malaysia& singapore continues BCG as INDIA IS NEARBY&there is lot of traveller's movement.Other developed nations stopped BCG as they think the disease has been eradicated, or they believe that TB eradication is better done by other non-vaccine methods like offering better treatment(like surgical removal of the pulmonary liesions wherever
possible)
3)Vaccines for the following disease are advised byIAP,ONLY after discussion with the parents.
a)H.influenza(hib)b)chicken pox.(varilrix for varicella)c)Hepatitis A.d)pnuemococcal vaccine.The reasons are not given.Perhaps it may be due to following causes.a) It is expensive(not available free of cost).b)low incidence of the disease.c)not virulent compared to Hep.B. d)Anaphylaxis &other side effects possible.
4)Following vaccines are advised by AAP ONLY FOR HIGH RISK GROUP.
A) Influenza
B)Hep.A.
C)Meningococcal.
The center for disease control(cdc) in USA from time to time advises adults &kids for influenza shots, whenever there is evidence of a slight epidemic.Recently there was one schoolchild died in USA,&THE AUTHORITIES SAID THAT IT WAS AN ISOLATED CASE,EVEN THOUGH IT IS VACCINE PREVENTABLE DISEASE(T V News.feb 2008 usa)
5)Typhoid is recommended only in india.Does it mean that it has been eradicated world wide?
6)Rota virus vaccine:Advised only by USA& AUSTRALIA.
Mortality is said to be 200-300 per year in USA& all children said to suffer at least once before 5 yrs of age.The occurence of intusseption after vaccine is so negligible that the issue does not seem to merit further discussion.Though in India ROTA VIRUS DIARRHOEA IS PREVALENT.THE MORTALITY RATE HAS COME DOWN.Still the the incidence of diarrhoea &pnumonia are the top two for highest mortality.If pnuemococcal vaccine(prevnar) &rota virus vaccine(rotateq) are used in India,pediatric physicians will have no work!.(Oh! politics,Oh Finance--Thou shall get up?
7)Tetanus Toxoid: in pregnancy(to prevent neonatal tetanus)
Not advised by any country other than India.India can boast almost 100% success in eradicating neonatal tetanus.AAP advises TT/DPT TO ALL CHILDREN.It means tetanus organisms are present in the American soil.Does a pregnant women is immune to tetanus in USA?

8)POLIO:
Polio-immunisation.AAP advises ,inactivated polio vaccines,which is undoubtedly more effective than oral polio.IAP continues to advise ,oral polio only for various socio economic/ political reasons,while fully acknoledging that IPV IS BETTER..AMONG many causes for our inability to eradicate poilo the use of oral polio itself is considered as one cause.Now IAP advises &recomends IPV may be given by private practitioners, if they desire to do so.The key to global polio eradication,lies in India.UP &Madhya pradesh continues to harbour polio virus.Unless the government machinary is fully geared up there like other statesfor polio eradication it can not be expected that global polio eradication is in the near vicinity.UK advises IPV for 13-18 yr age group also.Theoritically &practically it is found to be good in UK.India should emulate this as it is possible for adults to excrete polio virus,in their excreta.These excreta may infect children ,&this is a worthy point to ponder about&if practiced may yield in polio eradication in India or any other country.
AAP;FURTHER RECOMENDS TO ADOLESCENTS as below:This is not recomended by IAP.ALL VACCINES ADMINISTERED IN CHILDHOOD ARE REPEATED ONCE OR TWICE+pappilloma virus vaccine for girls 11-12 yrs ,if not at 13-18 yrs.USA is the only country to recomennds,pappilloma virus vaccine,meningococcal+pnuemococcal also given
DTP+TDaP+HPV=MCV ARE COMPULSARILY GIVEN AT 11-12 YRS All other vaccines either as a catch up immunisation or certain hige risk group (immune difficiency like status)

F I R S T A I D --FOR CHILDREN

Introduction:

Though this is a first aid home treatment for your kids,some of them are suitable to adults also.PLEASE note that this is not a treatment guide for your child's medical problems,BUT ONLY a first aid management at critical times.All drugs named here should be used only for ONE DOSE ONLY& visit doctor at earliest oppertunity.
If a child gets fever at 10 pm one can not wait till morning.If fever is not controlled he may throw a fit.Or suppose,you are urgently moving with your family from one place to another 300 km,your family member gets a vomiting,diarrhoea,acidity,or abdominal pain discomfort,anxiety,what will you do?Or while at home your child swallows few tablets of adults(like anti-diabetic /blood pressure reducing.)what will you do?So it becomes necessary for all mothers to know certain first aid treatment.It is with this hope the following is written& to be practiced only at a critical situation& non availability of doctor for quick help.

FIRST AID TREATMENT AT HOME:
All drugs,can be given as per this schedule.Dose of any adult tablet for children can be given thus.--New born-1/10,6 months-1/6.,1-3 yrs--1/4.,5 yrs-1/2,.10 yrs-1.,
Syrup;New born-5-9 drops.,6 months-1/2tsp.,1-3 yrs--3/4 tsp.,5 yrs--1-2 tsp.
PLEASE remember the above is for single dose only.consult doctor for subsequent dose.

1)FEVER:101.F is significant.Tepid?ice sponging is enough.In very high fever,ice at axilla,groin soles will be required.Doctor will find cause &treat latter.you may use tab/syrup paracetamol
6 months-1/6tab/1/2 tsp.5yrs-1/2 tab..1 tsp.
2)VOMITING:2-3 vomitings significant Ideal treatment-I V Fluids at hospital.or else, tab domperidol,mixed in honey.No feeds for 8 hrs.If vomiting occurs 2 hrs after tab,,go to hospital as emergency.
3)Jaundice:Dangerous during first 3 days of neonatal life.Admit as emergencyfor other jaundice also go to doctor.Dont trust KEELANELLI leaf extract,or any other siddha ayurveda or other herbal treatments.Jaundice after 15 days can be due to surgical congenital cause,if with clay white stools.Jaundice in an unimmunised child at any age could be due to virus infection.Blood test necessary.
4)Diarrhoea:One loose large watery motion needs admission in hospital.3 such motions is often dangerous,unless iv fluid treatment given.Very risky upto age 2 yrsMaximum death rate in this age group.So any home treatment is not advisible.
May try tab lopramideafter 6 months of age.Diarrhoea should stop within 2 hrs.STOP THE FOLLOWING:a)any oral feed b)milk--mothers,/cow's.c)electrolyte powder.d)sweets. e)tender coconut water.If no associated vomiting may try rice water after 2 hrs of lopramide,in small frequent feeds(100 ml/kg /day)
5)Fits:Signifies ,irritation to brain.Needs immediate admission as emergency.Do not put the child in sitting position..put the child lying,face turned to one side&keep a spoon betweenupper 7lower molar teeth,to avoid tongue bite.SUCK OUT MOUTH SECRETIONS.If conscious you can give one tab of Diazapam,orGardinal,especially if he is already a known case of fits.Dont give keys or iron in the hands because it is unscientific.
6)Febrile fits:Fits occuring only during fever episodes in certain children,aged 6months to 6 yrs.Once fever is controlled,fits usually subsides &never reccurs if continuous tepid/ice sponging alone is sufficiently givenIt is necessary that a doctor should rule out it is not brain infection by clinical/ csf exam..A (30 mg-for 10 kgdose of phenobarb(gardinal)(30 mg for 10 kg ,&60 mg for 20 kg child) may be given.
7)Rigor(chills)Abnormal body temperature meckanism as if thermostate function is out of order,
in the brain..Put on a warmer,or heater fan.cover body with blankets.Apply hot water bottle 1--2 is the best.In 10 mts there will be total relief.If not controlled adeqately,give Tab Avil+ dexamethasone.Take him to hospital if no relief within 1 hour.
8)'stomach' pain: If there is no vomiting or diarrhoea,give antacid tabs-3Wait for 15 mts.If no relief ,tab Raftase/CYCLOPAM,WHICH IS GOOD FOR ALL PAINS,INCLUDING MENSTRUAL
DISORDER DIS MENNORRHOEA,OVULATIONPAIN(pain 15 days after menses) kidney stones(Beralgan-drops-tabs)
9)URETHRITIS (Burning micturition).child cries while passing urine,&puts hands over the genitaia & scratches.children above 5 can clearly communicate.give frequent water&tab pyridium,which imparts a brownish red colour to urine.pain disappears in 30 mts like butter on a frying pan.
10)Ear pain:Otogesic/Otec ac/candidwith local anaesthetic drops..Can take one Paracetamol+brufen.
11)foriegn body Eye: Sudden & continuous irritation of Eye.Go to eye specialist immediately.dont try your own treatment.If at night go to government eye hospital Egmore chennai for 24 hr service.
12)Foriegn body-Nose/Ears.:Go to doctor or childrens hospital egmore chennai(24 hrs)
13)accidental poisoning:Children taking blood pressure/diabetes drugs of elders,or any other poisonous substances.If child is CONSCIOUS only,induce vomiting by giving 100- 200 ml of saturated solution of common salt(put salt more so that there is a deposit at the bottom of the vessel.specific antidote can be given at hos pitalIf child is unconscious take him to hospital in LYING POSITION.
14)CHEST PAIN :(Adults above 40 yrs)Left or rt.sidedor central,with or without sweating or reflected to left shoulder or left jaw;Gelusil 3 tabs +1 tab aspirin150 mg,swallowed.1 tab sorbitrate 5 mg kept under tongue.
15)Burns/scalds:Put ice pack all over affected part.sedate ,if pain is severe. tab diazapam1-2 as per age.(5 mg .tab.)
16)SEVERE ITCHING;IN ANY PART OF THE BODY,OR GENERALISED ALL OVER WITH RASHES,?PATCHY THICKENED SKIN(URTICARIA).THE MORE ONE SCRATCHES THE MORE WILL BE ITCHING SENSE: Take tab AVIL+dexamethasone.Flucort ointment for external use if the affected part is very small.If genaralised go to hospital streight.
17)Breath holding spell :Some young children when they cry end up in compleat breathlessness,at the end of the cry&may turn blue.recovers by itslf.stimulate by cold /hot water on the palms/soles.dont give feeds.some times child may throw a fit due to lack of oxygen to brain.
18)Asthma.Not a sudden problem if taking proper medications.Keep a beclamethasone inhaler & give 1-2 puffs,in addition to usual drugs
19)Difficulty in breathing:Put the child in sitting position&not in lying positionDont give feeds when child is restless,till doctor sees.
20)coughing blood/vomiting blood:Emergency admission in hospital with blood transfusion fecility.dont give feeds.transport in sitting position forcough,&lying for vomiting.
21)Insect bites:Tab Avil+Dexamethasone.
22)sleeplessness;Tab?Syp:Diazapam/phenergan
Phenergan should be available in all homes&kept at height not reachable by kids.Good for:-
irritability,sleeplessness,asthma or any wheezing,allergy, coughs,rashes,vomiting,running nose ,pain any where in the body, any insect bite including scorpion sting.It is like Gold or King among the drugs for kids.
23)child's cry over 1-2 hrs:Depends on age &many other factors.There is no way to stop until the cause is foundNo harm to try phenergan syp.
24)Fall from a height:Effect depends upon height &the anatomical part touching the groundfirst.If there is no obvious external injury &if the child is conscious,but for a short cry of 5-10 mts,nothing much to worry.If child stops crying on its own it is good.If the cry is continuous ,take him to doctor.Let him decide.C-T Scan brain may be required if there is a blunt head injury.
25)Cuts/wounds/lacerations/fractures:Dont take any risk for head injuries.All city govt.hospitals equiped with Neuro centeres,for 24 hr service.
For any obvious fractures,or severe pain+inability to move any part:fold 1-2 pages of News paper as splint&keep it at center of deformed part&bandage along with the folded news paper,for immobilisation.
small cuts, lacerations:Clean it with dettol if possible,or apply sterile gause dressings(available in medical shop).INJ.TETANUS TOXOID CAN BE TAKEN LEISURLY.
Keep a first aid box to contain,dressings &all other medicines mentioned in this article(4 tabs in each variety)
It may be stressed that school children may be put to work for 1-2 hrs a week in a doctors clinic as a hobby or pastime so that he can not only learn how to practice first aid on demand when need arises,but also develope interest to become a doctor in later life that will be not only be useful to him but also to the community.
Keep the telephone numbers of the following written in the calender for ready reference;
Ambulance,nearest medical college hospital,fire,leading private hospitals,nearest doctor's clinic ,,residence,any small hospital for ambulance service only, poison controlcenter,casuality department of any big hospital.

C H I L D H O O D --O B E S I T Y .

Introduction:4- 5 decades backPediatricians were more conserned,with malnutrition(Kwashiorkor,Marasmus) management.Thoough it was essentially disorder of poverty, ignorance & illiteracy also played their parts..Now doctors very often see during examination of school children about 10% sufferining frim Obesity,&another 10% with overweight. This shows that there is no poverty now&litracy has done no contribution to stop Obesity in children. Ignorance level continues to be same.There seems to be little awareness about child's obesity & its attendant complications. For all disease &disorders prevention is the best. If diagnosed earlier,it is easily controllable &manageable.

Is your child chubby or obese?
1)what is obesity?Is it same like overweight?
Over weight means more weight for a perticular height.Obesity meansbeing more fatty +over weight,&is calculated as per Body Mass Index.
BMI=WEIGHT IN KG/HEIGHT IN SQUARE METERS.
2) WHAT ARE THE COMPLICATIONS OF OBESITY?
a)difficulty in breathing while walking ,or at rest.
b)difficulty in walking.
c)short life expectancy
d)diabetes mellitus-type II
e) heart disease.
f)cancer
g)depression
h)stress urinary incontinence
i)lower quality of life.
j)high blood pressure
k)high blood cholesterol
l)sleep apnoea(cessation of breathingwhile sleeping)
J)G E R D
K)osteo arthritis.
l)joint pain.
m)female reproductive health disorder.
3)How does BMI helps?.
Yes it does in many ways.There is a graph available(similar to road to health chart)with which a person's bmi CAN BE ASSESSED READILYby plotting height & weight to find out if a given person,belongs to following catagory for clinical assessment/treatment.
BMI-less than 17.5=malnutrition(anorexia nervosa)
BMI18.5--25 =optimal(normal)
BMIless than 18.5 =under weight.
BMI more than 25 =over weight
BMI more than 30 =obesity.
(All the above are applicable to children only)
4)Is it connected to endocrine problems?
Yes. The following endocrine disorders could be the cause for obesity.
a)Thyroid(blood test for T3 ,T4,TSH.)
b)PITUITARY.(BLOOD HORMONE ASSAY)
c)LIPID DISORDER.(BLOOD LIPID PROFILE--CHOLESTROL ANALYSIS)
d)CUSHING'S SYNDROME.(ADRENAL GLAND-HYPER FUNCTION)-HORMONE ASSAY
5)When do we suspect endocrine problem when a child is obese?

If a child at any age upto 12 has any or many of thefollowing clinical problems it is a fitting case to be reffered to a pediatric endocrinologist:
a)polycystic overy.(scan -abdomen)
b)high cholestrol blood(blood lipid profile)
c)high blood pressure.
d)BP+abnormal potassium(serum electrolytes)
e)unusual stretch marks anywhere in the skin.
f)weight gain centered around abdomen+thin extrimities.
g)weight gain with aesy bruising.
h)weight gain without adequate food
i)irregular menses+ or _ abnormal hair growthj
j)if left untreated may have pregnancy related complications in adult life.

6)what is the treatment?
Find out &treat the cause.Every text book says diet +exercise.Any experienced physician over 40 yrs of service will agree upon only one treatment:50-70% weight lossoccurs only on BARIATRIC SURGERY.Diet &excercise are useless in todays concept,if obesity is labelled.
7)Is it preventable? When does it become identifiable?
To a great extant it is preventable if the root cause is diagnosed early.Like ,vaccine preventable diseases parents must take suitable steps to identify early&prevent obesity by appropriate means.
Few recommended steps:
a)well baby?well child health check ups--yearly once.
b)systamatic plotting of road to health chart,upto 12 years.
c)Alteration in eating habits must be watched(whether over eating too much NV items)
Auther's true relevent story.:
10 yr old female child weighing 80 kgs.On questioning about diet history, she said she will go to her fathers restaurent daily after school hours &eat fried chicken legs-6 pieces .Now the readers can tell the treatment.
d)once obesity is confirmed--surgery is the answer.

About S M O K I N G.

ALSO WRITTEN FOR THE PARENTS of adolescent boys.Typically starts only in the adolescent age.Very few start after age 25.Majotity start after seeing a cinema where the villain often smokes..some think that they may look smarter &more presentable before girls.The fact is girls hate smoking.One elderly man told once,"If you want to start smoking,drinking etc start after 25.You will know the hazards &drawbacks behind it."One of the quick addiction forming habit.The drug Nicotine from tobaccostimulates the body to secrete more steroides which gives a false sense of strength,&a sense of well being.
plus points: nil.
Minus points:
1)prohibited in the office& public places.
2)poeple dislike this pungent odour.
3)Individual's reputation usually under estimated.
4)Damages the whole of respiratory pathway including lungs
5)Important cause of cancer.
6)Can cause blood vessel disease,blocking the blood flow to fingers &toes,resulting in the death &dissappearence of fingers &toes(Reynaurd's disease)
7)Considered an important cause of heart attck.
8)Causes sluggish bood flow to brain,due to increased bood viscosity.
9)Robs your putse.
10)May distract attentionwhile driving
11)Can cause fire accident in the car or house or any where
How to get rid of the habit?
Those who want to smoke or already smoking should do the following test&then decide whether to smoke or not.
Test:Take good puff of cigerette smoke ,hold the breath for a while&blow it over a paper or a hand kerchief close to mouth & see the effect.You will find a surprise.There will be hole in the paper or cloth .After seeing this let them decide.If one resorts to smoke after this test,it is short of commiting suicide--a psychological abberation.One wise man told"Cigerett is one ,with a fire at one end & a fool's mouth at the other"
Treatment:Same way like any de-addiction procedure with a qualified doctor.Best is careful supervision in the young age by parents& nip it in the bud itself.

About A L C O H O L

"It provokes the desire, but takes away the performance"--WILLIAM SHAKESPERE.
If a person starts ttaking the habit of drinking alcohol ,in the adolescent age ,he is most likely to be come an addict.If he tastes it around 25yrs of age he could have controle over it.This philosophy is mostly truewith all bad habits.DRUGS like opium alkaloides ,once started ,that is the beginning as well as end & other norcotics once started will get awy only at one place--the graveyard .This is written for the parents of adolecent boys.
Alcohol-plus points.:(only in moderate quantity)
1)It increases appetite.
2)Gives a pleasurable sensation.
3)Gives a good sleep.
4)Provokes sexual desire.
Alcohol--minus points.
1)stomach&bowel ulcer.(constant severe stomach pain-unbearable)
2)Leather bottle stomach or beer drinkers stomach(stomach functions drastically drops down)
3)Liver cirrhosis(multiple scar tissue formation,leading to reduced function.
4)Increased blood pressure(never comes down)
5)Altered behaviour pattern.
6)Inability to do office work.
7)Inability to maintain good posture.
8)Early Diabetes,or aggravation of exhisting diabetes.
9)Tremor of fongers &hands.
10)Gives a false sense of belief,&false self confidence.May result in bad driving,leading to accidents or fighting with a person stronger than him,or commit a serious crime.After blood alcohol level comes down they realise that they were in a false world.
11)Addiction forming drug:After a certain stage (variable from person to person),he feels that he can not be without it.IF HE DOES SO ,HE WILL DEVELOPE,sleeplessness,subjective sensation of heart beats,fits,jitteriness tremors,psychological depression muscle crampsabdominal pain, suicidal tendency,etc, etc.Once he developes drug dependencyif alcohol is withdrwan,he will pose an unmanageblehome situation&suffer from Delerium tremons.The habit should be nipped in the bud itself by the parents or other responsible persons.If mother knows that there is an element of suspision in the boy"s behaviour ,she should not hide it from her husband.
12)Steals your money purse.
How to prevent alcoholism?
There are many ways.
Use of drugs;1)There is a drug called ANTABUSE.If taken 30 mts before alcohol,he will develope severe vomiting after alcohol consumption,that it leaves a wretched feeling &hatred towards alcohol.
2)Use of other sedative drugs by doctors,in the place of alcohol&slowly taper down &stop that drug.
3)Hypnotism:(brain washing)Psychological approach to make him accept to give up alcohol,by councelling.
4)After developing chronic alcoholism addiction is the rule.The one & only & the best wayis preventionEvery alcoholic should realise that he is going to be a potential addict,&he is going to develope,high BP diabetes,&liver damage.So HE SHOULD DEVELOPE A MODERATE habit
in the begining years of drinking itself.There are many who drink only on saterdays ,sundays for decades & nothinh bad happened to them.Their way of drinking is usually differentfrom many others .They take about 30 ml 200 ml of water &drink over a period of 45-60 mts,&not more than 2 drinksThey dont drink for the sake of" KICKS" It is meant for pleasure or elated mood,not for kicks.No morning or after noon drinkiong.No late night drinking.No drinking in the bar excapt at residence.No drinking with a group.Drinking should be done in a style,like "Hold the bottle by the neck,&hold a woman by the waist"These are some of the ways by which a man can avoid being a druncard,or an addict.

ELOCUTION-GUIDE TO CHILDREN(PARENTS)

Children should participate in extra curricular activities like elocution contests,as it will give them self confidence.&a subjective assessment of themselves, for a healthy psychological state. This is written with the hope that parents might take this hint to help their children.


They should guide children continuously & encourage them.Parents, teachers, or well wishers must be in charge as a coach at all times.The following points must be physically checked while preparing a child for a competition.

• Must talk boldly. This is very important because if the child is scared before the audience he will forget what to speak. The best way to get rid of fear complex is, to tell him that all the spectators in front are fools &that the child alone is intelligent.BETTER the child is taught to look into a mirror &say within his "heart" in his private room thus:"All those in front of me are fools".So the child when gets on stage speakers like this mentally before opening the mouth for a talk.
• Must have several rehearsals.
• Body language essential as per contents of speech.
• VOICE MUST BE AUDIBLE &LOUD.No harm if the volume of sound is more than average.Child can speak 2-3 sentences &ask the audience whether they can hear.Beware the mick may fail due to electricity failure.
• contents of speech:For example if the subject is related to the topic"THE TRUTH",speak about Harichandra a Hindu mythological hero or if it is "SACRIFICE", PEOPLE WHO MADE THE HIGHEST SACRIFICE BY NAME IS ESSENTIAL,LIKE VEERAPANDIA KATTABOMMAN
• VOC, OR NEHRU FAMILY,should be mentioned.The child who uses the name of the best & famous personalities who are known for heroism,or valor alone wins the contest.
• Better not to see the paper while talking.But under certain circumstances can look into the points.
• Better to mix some humor in the form of a short story for people to laugh,&clap hands.
• Address the stage as RESPECTFUL TEACHERS,BROTHERS & SISTER
• SOME GESTURES,TO START WITH, AS IF THIS STAGE IS NOTHING FOR YOU,BY RUBBING YOUR FACE NECK ears ON ONE SIDE&LOOKING UP
• IF YOU FORGET BY CHANCE,THE NEXT POINT OF YOUR SPEECH,take out your hand kerchief & clean your face to recollect the forgotten point. not too fast. Let the audience hear each &every sentence of yours.
• Add one or two quotations if possible.Books available for this purpose can be referred to.
• RECORD THE SPEECH IN A TAPE RECORDER,&REPLAY.MAKE necessary corrections.
• Can start with a relevant "Thirukkural", first,&translate it into English. Continue other points latter.
• Have a high level of confidence.you will not miss points.
• A coach is necessary,be it a teacher, or parent.
• It should be stressed, that winning the prize is not the motto,but the spirit of participation is important,so that if the child does not win the contest ,he should not feel discouraged &loose his heart .This should be strongly advised before hand ,well in advance.
• Some children may feel guilty as if they have made a big mistake.Tell them that failures are stepping stones to success.