Celebrate “One step forward”

(A happy new year: in true sense)

Source: Nora Schlesinger/Unsplash

What does the New Year’s Eve mean to most of us? Celebrating the arrival of new year with food, drinks, friends, families….right? How about adding some value or meaning to this grand celebration! I mean what’s the point of welcoming new year if we don’t commit any changes for good! What’s the big deal about count down, looking at the dropping ball in Time Square! What’s the significance of sparkling skies with fire works?

Is it just about drinking and eating on the New Year’s Eve and getting sick with nausea and hangovers on the very first day of the year? That cannot be an ideal start to a new year!

A lot of people make some resolutions for new year. What’s your new year resolution? Be sure you are practical or realistic about making any resolution because resolutions are usually broken more often than applied. According to me, the true sense of celebrating new year should be to take One Step Forward towards a healthier and happier life. Because it’s this One step forward that’s gonna not only bring value to our lives but also inspire our children and younger generations to stay committed and healthier.

Here are some of the things you might want to Cut down or Add on, One at a time, so you don’t feel the burden from sudden change.

Cut down….

(Cutting down ONE is just a minimum. If you can, avoid these items for good.)

  • ONE coffee per day
  • ONE cigarette per day
  • ONE day per week of alcohol consumption
  • ONE meal per week of junk food (eat home made food or freshly cooked food from outside)
  • ONE hour per week of screen time
  • ONE plastic use per week (minimize use of bottled water)
  • ONE bad characteristic in your behavior like anger, jealousy, lying, cheating, etc. Trust me all of these are related to bad health.

Add on….

(Adding a minimum of ONE is a suggestion, not a rule. Feel free to add more than one if needed or tolerated)

  • ONE serving of fibrous food (vegetables and fruits) per week in your meal
  • ONE day per week of cooking fresh food at home
  • ONE day per week of physical exercise, if your doctor allows
  • ONE day per week of monitoring your blood pressure
  • ONE reading per day of your blood sugar
  • ONE hour per week of family time
  • ONE dollar per day to your savings (reduces financial stress on a long term)
  • ONE act of gratitude per week (reduces stress, anxiety, depression and other mental disorders)
  • ONE act of charity per year
Source: Michael Fousert/Unsplash

Celebrate the new year with a real meaning!

Don’t just celebrate the new year for name sake or to show off your lavish lifestyle or your grandeur villas or expensive clothes! Celebrate it with a sense of gratitude towards the past year and committing loyalty towards new year with all the good habits.

Feel accomplished for the past year and don’t forget to thank everyone (and even God if you are not atheists) who participated or contributed towards your success. If you haven’t accomplished during the past year, it’s still okay to thank people for challenging you and providing you those valuable feedbacks. And most importantly, commit the new year, about chasing your dreams with solid intent and hard work.

It’s said the “an aimless life is a miserable life”. So on the last day of the year, take a few moments to account for all the goods and bads in your lives and like an accountant, devise a plan for the next year how to reduce items in bad column and increase in good column, just like we try to increase our assets and decrease liabilities every fiscal year. To me, that’s a celebration in true sense. There has to be something special about so many humans getting together on one night- can’t be just superficial celebrations!

Finally, to all my family members, friends and well-wishers, I bow to you for all the good things you have blessed me with and I wish you all health, peace and prosperity.

Happy New Year! Have a blessed 2020 and also decades thereafter! New year, new beginning:

Source: Alexa Presa/Unsplash

Pharmacy benefit manager

(The power of the middle man)

Source: Pepi Stojanovski/Unsplash

To simply put in perspective, PBMs work for insurance companies to manage their drug costs, negotiate with manufacturers for better pricing and placing their drugs on preferred formularies versus others. By doing so, they eventually save money for insurance companies, promote drugs of companies who negotiated “good deals” or rebates and thus, make money from both entities.

This model is so lucrative for PBMs. Think about it. They don’t make drugs, they are not the insurers either but they get to control everything about prescription drugs and make tons of money being the middle man….lol! Caremark, Medco, Optum RX, Prime Therapeutics are some of the giant PBMs who control pretty much the entire country’s prescription business. Most insurances fall into these 4 PBMs.

Source: https://www.buaut.com/single-post/2017/11/27/PBM-industrys-impending-Amazon-threat

Just money

It’s neither doctors, nor patients nor pharmacies- it’s a trio of insurance companies, manufacturers and PBMs that get benefitted for the most part!

Doctors are often unhappy when certain drugs are “not covered”. Some drugs need extensive “prior authorization” process for them to be covered. Some expensive drugs (medications for specialty conditions like oncology, rheumatology, dermatology, multiple sclerosis, etc.) require patients to pay extensive copays. In most cases, pharmacies help them to get copay assistance but sometimes unavailability of copay assistance make these treatments unaffordable. Thus these patients go untreated making doctors look unsuccessful.

Patients become victims of this complicated system. They get unpleasant surprises all the time in-spite of paying exorbitant premiums every month. They not only have to deal with complex disease states but also PBM led complications.

And of course, the pharmacies are not spared either. In a lot of cases, pharmacies dispense the drugs bearing a “LOSS”. Yes it’s unbelievable how PBMs force these pharmacies with such loss imposing contracts. It almost looks like pharmacies are at the mercy of PBMs. If pharmacies don’t agree their terms, they are out of network and won’t have any business. The contractual rates and reimbursements are so terrible that pharmacists are not seeing this as a prosperous business anymore. Even chain pharmacies have gotten a big hit from PBMs. The gross profits have gone down to bare minimum, so much so that the companies have stopped giving raises or bonuses to their pharmacists. Lack of transparency regarding rebates and DIR have created issues of mistrust and conflict of interest.

Read the following article from “http://obroncology.com/article/pbms-hatch-a-new-scheme-dir-fees/“

The Need for Transparency with DIR Fees

By Christina Bennett, MS

“Pharmacy benefit managers (PBMs) have found a new way to manipulate pharmacies—specialty pharmacies in particular—for their gain with direct and indirect remuneration (DIR) fees.

The term “conflict of interest” has never really been more justly stated than when it describes the relationship between a PBM and a specialty pharmacy, said Jeff Vacirca, MD, Community Oncology Alliance, CEO, New York Cancer Specialists, in an interview with OBR. “It’s an atrocity,” he told us.”


Legit DIR Fees Have Become Warped

“Normally, after a drug is sold to a patient, PBMs and insurers receive additional compensation, such as manufacturer rebates, that produce a net drug price much lower than the list price. Under Medicare Part D plans, patient co-pays are calculated off the list price of a drug, not the lower net price.

Having co-pays calculated off the list price, which typically is inflated and not transparent, means neither Medicare beneficiaries nor CMS share in any cost-savings. CMS requires all transactions after the point of sale to be reported to CMS; these transactions are called DIR fees. CMS then uses the reported DIR fees to capture the true net price of the drug and calculate accurate payments to Medicare Part D insurers.

However, PBMs have misrepresented DIR fees to their benefit. Several months after a prescription has been dispensed, PBMs are charging fees to the specialty pharmacy that eliminate most, if not all, profit it may incur for dispensing the drug. Retail pharmacies are being hit by these fees as well, but mostly this practice is occurring within specialty pharmacy and with Medicare Part D plans.1,2

“A lot of PBMs own pharmacies, such as CVS Caremark that has its own specialty pharmacy, and they always keep saying, ‘well they’re paying DIR fees too’—but you’re paying them to yourself,” said Eric Dallara, RPh, pharmacist in charge of the dispensing pharmacy at New England Cancer Specialists.

Four national PBMs—Express Scripts, Inc., CVS/Caremark Corp., OptumRx, and Prime Therapeutics—control 80% of the prescription drug market and they each own a specialty pharmacy.1,3-6

Additionally, the four largest Medicare Part D plan sponsors—UnitedHealth Group, Humana, SilverScript (CVS Health), and Express Scripts—own or are affiliated with a PBM.2 Having PBMs and insurers so closely tied together is like taking money from one pocket and putting in another.2

Worse, PBMs do not always label fees as DIR fees; instead they use phrases like “network rebates” or “pharmacy performance payments.”1

Legislations….

Source: Brandon Mowinkel
  • Gag clause prohibitions: Gag clauses are provisions written into contracts between PBMs and pharmacies, prohibiting pharmacists from informing customers when the out-of-pocket (or cash) price for a prescription is lower than the medication’s co-payment, or whether a cheaper alternative is available.
  • Claw back legislation: “Claw back” requirements are provisions written in contracts that force pharmacies to pay back to PBMs and/or health plans the difference between a patient’s copayment and the negotiated drug price, when a patient’s copayment for a drug is greater than the price the PBM or insurer negotiated with the pharmacy. In 2019, SD and NE became two of the most recent states to enact legislation prohibiting co-pay “claw back” contract provisions. To date, at least 22 states have passed some form of “claw back” legislation.
  • Price gouging and price increasing reporting: Prohibiting manufacturers and wholesalers from engaging in “price gouging” which is defined as an unconscionable, excessive, unjustified price increase of an essential off-patent drug.

So, do we need PBMs? Unless PBMs become patient-centric and provide some relief to pharmacists, unless PBMs stop being opaque to their revenue flow, unless PBMs do not cater to one specific entity and avoid conflicts of interests, they WON’T be trusted at all.

Hypertension- simply ignored!

(A ticking time bomb leading to heart attack)

Source: Hush Naidoo/Unsplash

It’s said that “A good heart makes one a better person”.The thought holds true for health too! Heart can be affected by several abnormalities; some genetic and some acquired. One of the most common disease and also the most ignored disease is hypertension or high blood pressure.

First of all, it’s seldom realized by the patient, so he/she won’t even see a doctor till one day, a chest pain or breathlessness or sweating is felt while talking. In the worst case, these symptoms are multiple folds and the person experiences a heart attack.

While there are a few reasons to get a heart attack including emotional and psycho-social factors, hypertension is one of the known ones to cause it. Hypertension is mostly ignored because it’s mostly asymptomatic and even if it’s diagnosed, non-adherence to its treatment is seen in most patients.

In countries like US, where there is so much emphasis on prevention, hypertension is still one of the leading causes of deaths. People are educated but still don’t practice healthy living. Improper life styles, diet, stress and lack of physical exercise contribute to poor heart health and lead to hospitalizations and even deaths! There are a lot of people who keep living under the notion of negligence and that “I am never sick, I always stay healthy and I don’t need any doctor or medicines.” Some say “why should I go to a doctor when I don’t feel anything”. Some go to doctors and get a prescription but are too busy to fill the prescription in a pharmacy. Some fill the prescription but don’t take them. Pharmacies have made it so easy to help patients stay adherent by refill reminders, auto refills, text messages, 90 day fills but eventually, patients will have to assume the responsibility to live longer and healthier.

Staggering stats…

“High Blood Pressure in the United States

  • Having high blood pressure puts you at risk for heart disease and stroke, which are leading causes of death in the United States.1
  • About 75 million American adults (32%) have high blood pressure—that’s 1 in every 3 adults.3
  • About 1 in 3 American adults has prehypertension—blood pressure numbers that are higher than normal—but not yet in the high blood pressure range.3
  • Only about half (54%) of people with high blood pressure have their condition under control.2
  • High blood pressure was a primary or contributing cause of death for more than 410,000 Americans in 2014—that’s more than 1,100 deaths each day.1
  • High blood pressure costs the nation $48.6 billion each year. This total includes the cost of health care services, medications to treat high blood pressure, and missed days of work.”

Source: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm

Stats related to non-adherence

“The patients who didn’t take their medication correctly were also more likely to be admitted to hospital after a stroke. Their risk of hospitalisation was 2.7-fold higher in the second year after being prescribed anti-hypertensive drugs compared to adherent patients, and nearly 1.7-fold higher in the tenth year. In the year in which they admitted to hospital with a stroke, their risk was nearly two-fold higher than the adherent patients.”

Source: https://www.sciencedaily.com/releases/2013/07/130716194917.htm

People often take it so casually because they may not be aware of the consequences. In most cases, one has to take just one pill a day and monitor it 3-4 times a week. That’s it! If we cannot find time to do this bare minimum task to keep us alive, then even god cannot help us. It’s about being responsible to ourselves first…right? I hear from people all the time saying that I am alright and I don’t need any pill…lol! I mean, you might be alright but have you measured your blood pressure? There are non-pharmacological ways too to maintain your blood pressure but the key is to monitor it regularly and keeping a log. In extreme cases of unstable blood pressure, it’s advisable to follow the treatment regimen advised by your doctor.

Risk factors

  • Other Comorbidities like Cardiovascular abnormalities, diabetes, chronic kidney disease, hyperlipidemia.
  • Genetics-family history.
  • Smoking
  • Stressful job

Bottomline: Don’t play with your heart. Follow your doctor’s treatment and be a good, adherent patient.

Source: Dale Carnegie (2010). “How to Stop Worrying and Start Living”, p.187, Simon and Schuster

Medication therapy management (MTM)

Source: fda.gov

How many times a pharmacist interventions prevents a major drug-drug or drug food interactions? I wonder if there were no pharmacists, we would have had some many casualties related to these adverse drug reactions. According to fda’s article, https://www.fda.gov/drugs/drug-interactions-labeling/preventable-adverse-drug-reactions-focus-drug-interactions :

“The Institute of Medicine reported in January of 2000 that from 44,000 to 98,000 deaths occur annually from medical errors.1 Of this total, an estimated 7,000 deaths occur due to ADRs.”

In countries like US, the practice of pharmacy is so much organized and clinical allowing pharmacists to be integral part of healthcare, helping clinicians with preventing duplication of therapy, drug interactions, promoting patient education and adherence. In countries where pharmacy practice is not so much regulated and clinical, the number of deaths due to drug interactions are significantly higher. In a big country like India, where pharmacies are just treated like “commodity stores”, doctors are too busy to even look at patients’ files, poor patients are pretty much on their own. Can you imagine, how these elderly patients deal with 20 different medications from several doctors? Not surprised, I have witnessed issues like duplication, drug interactions and suboptimal treatment with my own mother who lives in India. I have to intervene periodically so my mom can live longer. Because systems are not integrated, absence of electronic health records and reporting, there is not much data available indicating casualties due to ADRs in India.

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Source: Getty images

If a patient who suffers from conditions diabetes , hypertension, hyperlipidemia finds out that he/she is diagnosed with cancer, then guess what, the person can be completely devastated. And complicate that with the age factor. How does this patient manage his/her medications? How does he/she coordinate with different doctors? How does she make sure that the different medications do not interact with each other? How can she stay adherent to all of her medications? Patients like these need help with managing their medications. So please consult your pharmacist and ask for a comprehensive medication review.

Even third-parties have realized how important it is to help their members with their medications to prevent hospitalizations, ER visits and deaths. That’s why, they reimburse pharmacists for MTM services to save themselves millions and billions!

Source: medicalexecutivepost.com

Medication adherence and health care costs

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/#!po=0.862069

As per the article by Aurel O Luga and Maura J McGuire: “Between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the US annually, representing 3% to 10% of total US health care costs.7,38While there is substantial information relating nonadherence to poor patient outcomes, relatively few high quality studies report the impact on costs. The cost of nonadherence is generally determined by using administrative data to evaluate health care costs in populations of patients who are adherent compared to costs of populations of patients who are nonadherent. Systematic reviews of adherence note that differences in design, cost definitions, and included diagnosis (International Classification of Diseases [ICD]-9) groups, have varying levels of attributable-cost and make comparison of outcomes challenging. Over the last decade, the impact of adherence has been evaluated in association with numerous illnesses, including cardiovascular, pulmonary, gastrointestinal, metabolic, infectious, and psychiatric diseases. Representative findings are presented in our review, including summaries of systematic reviews when available.”

Source: National Cancer Institute/ Unsplash

Just by taking your medications regularly on schedule properly prevents exacerbations and hospitalizations. There are a lot of creative ways that you can improve your adherence: setting up alarms, using some handy apps, use of pill boxes, use of auto refills, etc.

Bottomline: Talk to your pharmacist today and see how he/she can help your live longer and healthier.

Modern food and cancer

Everything starts with your food- be careful!

Source: Unsplash

Interestingly, my last blog talked about nutrition needed to fight cancer. Today, I want to discuss certain foods or the way certain foods are made, as causes of cancer! Ultimately, anything we ingest does affect our bodies- one way or the other!

A lot of foods or rather “junk food” that we eat nowadays lack the basic nutrients like fiber and vitamins. They may have more appeal but studies have associated these with several diseases including cancer. But our fast lives have given ourselves an excuse of not cooking at home and indulging in bad habits. Corporate pressure, competition and tendency to extract more and more from ourselves: these habits have tired and stressed us so much that we don’t care to prioritize on eating healthy food. After dealing with day to day cat and mouse race, we are so overwhelmed that “we don’t have time to cook”. We would rather bring home some junk food or order food at the convenience of our smart phones and sofa couches.

Statistics have shown that 1 out of 3 Americans eat fast food every day. Fast food has been associated with increased evidence of obesity, cardiovascular conditions and diabetes. Obesity is a big risk factor to develop cancer.

Genetically modified foods

These foods are derived from plants which are genetically modified to withstand weather extremities, to develop resistance to pests and make them stronger to adapt to other adversities. Although there are no conclusive studies, but there are a lot of concerns whether these foods cause cancer or not! But then I also wonder that some drugs too, after decades, are found to cause detrimental effects which are not known in the beginning. Vioxx, for example, a very useful drug for arthritis and pain, was later found to cause stroke. A recent example is sudden recalls of Valsartan, Losartan, Ranitidine because they all have traces of impurity called NDMA, which is a carcinogen. So who knows, a decade later, these genetically modified foods may be found to cause something that hasn’t been found yet! Scary, isn’t it?

I wonder why are plants genetically modified! Isn’t natural way of producing crops enough for the expanding population? Or do we consume more than needed? Or is it the corporate greed to produce foods all around the year even if it may not be the right season to grow a crop?

Processed foods or “junk food”

Source: Unsplash

The more fresh the food is, the healthier it is. It has become too difficult for families to make fresh food every day. So preserved foods have been the norm these days! The various preservatives used can accumulate if these are consumed every day. Nitrates and nitrites, used as preservatives have been found as carcinogens. Additives like colors, flavors and sweeteners might make the food tastier and more attractive. But studies have shown association with mass consumption of these foods and cancer, particularly breast cancer, leukemias and even brain cancer. Besides, over consumption of processed foods may lead to obesity, cardiovascular, diabetes and metabolic disorders which all become risk factors for cancer, particularly obesity.

In order to reduce loss of crops from weeds and increased productivity, crops have been treated with excessive amounts of pesticides. All of these pesticides are nothing but CARCINOGENS! This practice is another example of human greed. Studies have shown that excessive pesticides are not only harmful to humans but also adversely affect the fertility of soil. The good bacteria in the soil needed for organic growth of crops are killed by these pesticides!

Limit consumption of sodas and coffee! Let me save this discussion for another day because I can write pages on this issue…..lol!

Meat

Source: http://www.sutterhealth.org

In general, any food that has more saturated and trans fatty acids is harmful. Red meat (beef, pork and lamb) is an example of such food. Some of the other meat/chicken items that should not be consumed in excess are chicken nuggets, bacon, corned beef, duck. All these have long chain hydrocarbons, more saturated and trans fat which cause cardiovascular problems, diabetes and obesity which is a huge risk factor for cancer. Colon cancer is associated with too much consumption of red meat.

“People who eat 50 grams of processed meat a day have a 1.18 times higher risk of cancer than those who don’t eat meat. Contrast that to smokers, who have a 20 times higher risk of developing cancer than nonsmokers. This is a far greater danger than the 18 percent increased risk for cancer associated with processed meats,” Dr. Toni Brayer (M.D., an internist with the Sutter Pacific Medical Foundation) says. We all agree that smoking is worse than eating meat but the point conveyed here is “people eating processed meats have 18% higher risk than those who don’t eat meat at all”.

Over-cooking is bad

Over cooking not only denatures proteins, vitamins and other useful nutrients, but also produces acrylamide, a carcinogen. Read more at:

https://www.nhs.uk/news/cancer/overcooked-food-and-cancer/:

“A common chemical caused by frying, roasting or grilling can double the risk of cancer in women,” The Daily Telegraph reported today. The story warns that acrylamide, a chemical contained in cooked foods including bread, coffee and breakfast cereals, and meat and potatoes that have been fried, baked, roasted, grilled or barbecued, has been directly linked to the incidence of ovarian and womb cancer.”

Moral of the story

  • Practice moderation- consuming too much of anything is harmful. Drinking too much water is also harmful….yes it’s true. We must set a limit for everything in and around us!
  • Avoid genetically modified foods. Read the labels for “Non GMO”. If possible, buy organic foods. Yes they are expensive but not as expensive as compared to acquiring dreadful diseases.
  • Avoid over-cooking
  • Avoid red meat and chicken nuggets
  • Wash fruits and vegetables gently with water to remove pesticides and dirt. Do not eat anything before washing.
  • Do not rely on junk food on a regular basis. Home made food is always fresh and healthier!

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Cancer and Nutrition

Source: Unsplash

Cancer- a word that can not only change a patient’s life but can also be devastating on the family. Cancer and it’s treatment can be overwhelming for patients and their families. According to http://www.cancer.gov, Cancer and it’s treatments can alter taste, smell, appetite and the ability to eat enough food or absorb the nutrients.

Without proper nutrition, the ability of a patient to fight cancer can substantially weaken. It’s like sending a malnourished soldier to a war. Even if this soldier has sofisticated weapons, he can’t operate them if he is not nourished well. Proper nutrition provides the immunity required for immuno-compromised cancer patients to fight cancer.

Malnutrition can cause the patient to be weak, tired, and unable to fight infection or finish cancer treatment. Malnutrition may be made worse if the cancer grows or spreads. Eating the right amount of protein and calories is important for healing, fighting infection, and having enough energy.

This video belongs to a foundation called “Cuddles foundation” from India. Had I not seen a program about them on TV a couple days ago, I would have probably not written this blog today. What an amazing job they do! They help children with the nourishment needed to fight cancer and also support families who cannot afford food in the course of running out of money for treatments.

Family support and love- much needed nutrition

Source: Unspash

Support from family can bring all the positivity in a patient. This positivity can really make a huge difference. The willingness to live longer makes patient’s chemos work. And then proper nutrition supports the treatment. In general, vegetables and fruits provide antioxidants and phytochemicals. Consumption of certain vegetables and fruits is linked to reduced risk of cancer. Some beans and nuts are also useful to prevent certain types of cancers including colorectal cancer. Flaxseed, olive oil and garlic are some other good nutrients to consider. Processed meat and overcooked food are not good. And let’s not forget dehydration which is caused by all oral chemo drugs like Capecitabine, Abiraterone, Everolimus and a lot of other drugs. So hydration is a key consideration for these patients besides other nutrients.

NORI (National Oncolcogy Research Institute) has detailed some important facts about methionine, Vitamin K, ketogenic diet, Selenium and other nutrients. “There are two core elements of the NORI protocol which are a methionine restricted diet and the creation of oxidative stress. A methionine restricted diet is intended to slow cancer progression and weaken cancer cells. Oxidative stress is a powerful mechanism to trigger apoptosis selectively in cancer cells. This idea is contrary to the belief that antioxidants are beneficial for cancer treatment. Current studies show that antioxidants help the survival of cancer cells.”

Read more at: https://nutritionaloncology.net/nori-protocol?gclid=EAIaIQobChMIh5qX4YOV5gIVS9bACh2-aQNYEAAYAiAAEgKr8_D_BwE

To summarize: consult a nutritionist and have a good nutrition plan to help fight cancer. Above all, a healthy support, good nutrition, some aerobic exercise and a positive mind can cure all the cancers of life! A negative mindset is self-destructive anyways and doesn’t need any cancer to kill oneself. Feel free to submit your queries and questions and we will do our best to provide you the answers.

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Happy and Healthy Thanksgiving!

What a festival is Thanksgiving! If we think about our lives, how we got here and how we will get where we want, there are so many people we owe “Thank you”!

I want to take this opportunity to thank my family, friends, professors, mentors , peers, subordinates and of course, my blog-followers. Without these people, I wouldn’t be what I am today. I find myself so fortunate to be blessed to have these people in and around my life. And of course, thanks to that Almighty, that conferred the humbleness to me to follow the wisdom of these great people.

Gratitude and health

Source: ggsc.berkeley.edu

There is an excellent study published by Harvard University about correlation of gratitude and good health. How being thankful or grateful leads to better health?

“The word gratitude is derived from the Latin word gratia, which means grace, graciousness, or gratefulness (depending on the context). In some ways gratitude encompasses all of these meanings. Gratitude is a thankful appreciation for what an individual receives, whether tangible or intangible. With gratitude, people acknowledge the goodness in their lives. In the process, people usually recognize that the source of that goodness lies at least partially outside themselves. As a result, gratitude also helps people connect to something larger than themselves as individuals — whether to other people, nature, or a higher power.”

“Two psychologists, Dr. Robert A. Emmons of the University of California, Davis, and Dr. Michael E. McCullough of the University of Miami, have done much of the research on gratitude. In one study, they asked all participants to write a few sentences each week, focusing on particular topics. One group wrote about things they were grateful for that had occurred during the week. A second group wrote lol about daily irritations or things that had displeased them, and the third wrote about events that had affected them (with no emphasis on them being positive or negative). After 10 weeks, those who wrote about gratitude were more optimistic and felt better about their lives. Surprisingly, they also exercised more and had fewer visits to physicians than those who focused on sources of aggravation.”

Read more:

https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier

The article clearly illustrates the work of some researchers who established through their studies that people expressing gratitude are very positive in life and thus healthier. Sometimes I feel like science is just a testimony to common sense. Saying thank you is something that we were all taught by our parents, grand parents, teachers and our gurus. By expressing gratitude, one is not only making other feel great but also making oneself look generous and greater. There is no bigger reward than a plain “Thank you”.

Be thankful, happy and healthy

So my dear friends, if you feel like you have never got anything from anyone, I am afraid to say that you are wrong. Life is a journey and the success to reach its destination depends on a lot of factors including people. So it is so impossible to lead a successful life without people or their interventions. Bottom line: We all owe a Thank you to someone if not everyone. On this auspicious holiday, let’s thank everyone that we think are a vital part of our lives. Let’s leave our egos aside and bow to those people who changed our lives and made us positive. Let’s at least thank to that Almighty for keeping us healthy and happy!

Have a great weekend friends! And Thank you for reading and following “Over the Counter” blogs. Please feel free to subscribe for FREE for any advice on any health related issues at:

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Counseling points for Diabetes management

People with diabetes need a lot of discipline in terms of diet, exercise and adherence to their medications. Not having a good balance of any one of these can complicate the disease and may lead to severe consequences. So as a healthcare provider and a certified diabetes education, I present the following tips helpful for caregivers:

  • Type 1 Diabetics must test blood sugar at least 3 times per day in addition to testing before meals for insulin dosage determination as directed by your physician. First reading must be fasting (right after you wake up), the other 2 or 3 readings (postprandial) must be taken 2 hours after breakfast, lunch and/or dinner.
  • Continuous glucose monitoring or CGM is recommended in most cases of diabetes 1, especially kids. This set of devices measure sugar throughout the day and can alert the patient or parents if blood glucose goes beyond the set range. Most insurances cover them and most patients get copay assistance from manufacturers. Talk to your doctor for a prescription. Ask your pharmacist about copays. Dexcom for example, is growing popularity simply because of its ease of use and once daily calibration requirement.
  • Type 2 Diabetics must test blood at least 1-2 times per day. Fasting and one post-prandial.
  • People on insulin pump or severe cases of juvenile diabetes must test more frequently as directed by your doctor. These are ideal cases for CGM.
  • Keep a log of your blood sugar readings. Use “Daily blood glucose monitoring” function in Glucocious app to email your results to yourself or your doctor.
  • Know your A1C value. It is important to test A1C every 3, 6 or 12 months depending on the severity of the condition.
  • Always carry Glucagon Kit with you, especially school going kids or juveniles.
  • Keep glucose tablets or other form of immediate sugar in your pocket as a rescue in case you feel dizziness, palpitations, sweating, headache or have other symptoms of hypoglycemia.
  • You should eat smaller meals but can eat more frequently. Make sure your meals are consistent every day.
  • Please record any discrepancies in your diet or physical activity in the blood sugar log.For example: If you ate a Pizza today, write it down on the log sheet. Or if you ate an ice cream after dinner, document it. It is important to note these irregularities so your doctor can relate the significantly different glucose readings to these diet changes.
  • Scientific studies have proven that brisk walking is one of the top most calorie burning exercise besides sprinting. Brisk walking for 15-20 minues per day will help you control your diabetes on a long run.
    Please note that people with heart disease, respiratory disease, chest pain and shortness of breath must be cautious while exercising. Do not continue if symptoms present.
  • Measure ketones in urine. Do not exercise if ketones are high. Learn more about Ketoacidosis in Glucocious app or any good diabetes literature.
  • It is very important to be adherent to your medications daily on time. Missing a single dose can shoot up the blood sugar and may even become life-threatening.
  • It may be harder to control your blood sugar during times of stress, illness or infection. Make a note of abnormal readings in your log about your illness so your doctor can understand the reason.
  • Ask your doctor if you are or going to be pregnant or breastfeeding. Benefits/risks need to be evaluated with your doctor. Avoid alcohol in diabetes.
  • It is very important to consult a cardiologist, nephrologist, podiatrist, ophthalmologist and a nutritionist to prevent any complications from diabetes. Ulcers in feet or other extremities have led to amputations. Damages in retina have led to blindness. Kidney failure is also a big concern for uncontrolled blood sugar.
  • Prevent conditions like FLU, Pneumonia, Tetanus, Diphtheria, Whooping cough, Shingles, etc by getting these vaccines from your pharmacist or doctors. All of these vaccines are covered by your insurances in countries like US. These vaccines are considered as part wellness visits. I hope there could be similar awareness in India where providers are not very proactive in immunization.
  • Learn proper injection techniques from your pharmacist. Check CONSULT A PHARMACIST section in Glucocious app.

Is diabetes an Inflammatory condition?

Source: Getty images

Diabetes is such a widespread disease and is talked about so much everyday and everywhere. And still, I see patients on a daily basis who don’t take it seriously. Diabetes should be dealt with a lot of discipline . I am not gonna describe what diabetes is, what the symptoms are, keto acidosis, etc, etc. All of this info is available in a lot of published literature, books or online. What I want to talk about, is Diabetes type 2 and Inflammation! Yes, diabetes type 2 is also an inflammatory disease.

Diabetes type 2 is a condition where insulin resistance develops because of inflammatory conditions. This inflammation is in turn linked to obesity. According to a study, metabolic disorders range from a spectrum of undernourished to overnourished conditions. Undernourished people get susceptible to infections due to low immunity. Whereas over nourishment can lead to obesity which in turn can lead to inflammatory response, insulin resistance, diabetes, atherosclerosis and many more. Other factors like sedentary life style and mental stress can also lead to obesity.

People with chronic inflammatory diseases like rheumatoid arthritis, psoriasis, hepatitis C or other conditions may have more susceptibility towards developing diabetes type 2. These conditions combined with obesity and stress can all stimulate cytokines, macrophages and other inflammatory mediators which can inhibit Insulin sensitivity of insulin receptors. Cancer is another condition which is linked to development of diabetes type 2.

More on inflammation: https://pharmacist4u.info/what-is-inflammation/

Your diabetes coach- Glucocious app

Glucocious is an app that highlights the importance of moderating inflammation. Use of supplements like Omega-3, foods rich in omega-3 like “mung beans” and other anti-inflammatory supplements is detailed in this app. The app mentions some anti-oxidants that also play an important role in controlling inflammation. The app also provides handy consultation from a homeopath for managing diabetes and other chronic conditions. Glucocious helps you keep track of your numbers with the blood pressure- blood sugar log tracker.

Overall, striking a good balance in nutrition, regular physical exercise, education on diabetes, knowing your numbers, use of anti-inflammatory supplements and regular check up with your doctor are some of the good habits that will prevent obesity, stress and inflammation. Controlling inflammation will prevent diabetes type 2 and a lot of other inflammatory conditions.

Mental disorders- a wake up call!

It’s okay to talk about it- please don’t gossip!

Source: Mental disorder- Wikipedia

Back in the days, a person mumbling to himself or herself or depressed or schizophrenic or even having bed-wetting (nocturnal enuresis) problem used to become a subject of gossip or sympathy. And that person had to deal with embarrassment on a day to day life. Several other psychiatric problems like anxiety, bipolar disorder, GAD etc were never taken seriously. This is back in the days when there wasn’t enough research, diagnostic tools or awareness. What’s shameful is the fact that it’s still a STIGMA in certain societies! That makes me wonder about the uneducated behavior of the otherwise educated societies.

A personal s..t…t…tory!

Source: huffpost.com

Are you serious? I am so happy to see this that there is a day called “International Stuttering Awareness Day”. I wish people were aware when I was in high school and in my speech on Mother’s Day, I went berserk with my speech: “All mothers are g…o…o…o..o…d mothers”. And my friends who were also competitors broke out into thunderous laugh. I saw them blow out their laughs and I almost had tears in my eyes but I had to finish the speech. Later I found 2 friends in freshman year of college who were also stutterers and for the first time, I felt better that there are people like me. I am eager to get their reactions after they read this blog.

A piece from psychcentral.com: “The idea that stuttering is a brain disorder in the same category as schizophrenia and bipolar disorder is very controversial,” says Gerald Maguire, M.D., assistant clinical professor and director of residency training in the department of psychiatry at the University of California at Irvine. , a stutterer. In fact, there has been a push to recategorize stuttering as something other than psychiatric. “Some feel it attaches a stigma to a disorder that’s already very misunderstood by most,” Maguire said.

Some stats….

1 in 5 U.S. adults experience mental illness each year

1 in 5 Indians May suffer from depression in their lifetime. Due to the stigma associated with mental illness, a lack of awareness, and limited access to professional help, only 10-12% of these sufferers will seek help. (Source: https://www.weforum.org/agenda/2018/04/5-charts-that-reveal-how-india-sees-mental-health/)


1 in 25 U.S. adults experience serious mental illness each year

1 out of 8 emergency department visits are due to mental illness or substance abuse

Suicidal rates are 4 times in Lesbian, gays and bisexual individuals.


Suicide is the 2nd leading cause of death among people aged 10-34

Read more on: https://www.nami.org/learn-more/mental-health-by-the-numbers

These are some mind-blowing stats and facts. Please take mental disorders seriously before they become ominous and threatening.

Ripple effect

As mentioned in the article from National Alliance on Mental Illness, people with mental disorders can have:

  • Increased risk of cardiovascular and metabolic disorders
  • Substance abuse disorder
  • Higher rate of unemployment
  • High school students dropping out
  • Suicide in youths

Celebrities vow to reduce stigma

Source: zedge.net

It’s so cool when Virat Kohli backed up Glenn Maxwell’s decision to take a break from his job on grounds of mental health issues. What Glenn did is remarkable….Kohli says. That he didn’t hide from the world and why should he! Glen wants to take care of his health issue and then come back stronger! Read this link:

https://www.indiatoday.in/sports/cricket/story/virat-kohli-mental-health-glenn-maxwell-break-2014-england-tour-1618452-2019-11-13

A top Bollywood actress, Deepika Padukone runs a foundation called “The Live Love Laugh Foundation” that aims to create awareness of mental illness and reduce the stigma associated with it, with a particular focus on stress, anxiety and depression.

To summarize….

Mental disorders are on the rise. Why do you think the suicidal tendencies keep going up since 2001? Is it due to the pressure created by corporates to perform more and more? Is it due to schools demanding more and more from students? Is is due to the peer pressure of societies? Or is it the due to loneliness or self-centered culture that prohibits people to interact with people?

A few questions to answer to get solutions to improve our mental status. Are we mentally fit to live in this world with ever growing expectations? How can we prevent tragedies where mentally unstable people take on arms and claim lives? Can we take steps to spread awareness so people with mental disorders can come forward to get help? Modern research and studies have proven that counseling helps. Medications may be added to supplement counseling to help treat the mental disorders.

Please show vigilance, empathy and support to cure mental illnesses.

https://www.nami.org/Blogs/NAMI-Blog/November-2019/Things-Not-to-Say-to-a-Parent-of-a-Child-with-Ment