The Pursuit of Wellness

credit: UND

When Mr. R the CEO of a very large enterprise first walked into TRIMED it was for non-specific aches and fatigue, no doubt the result of his highly pressured lifestyle. After a course of treatment, while he reported an improvement in his general well-being, he also shared with us his valuable impressions and insights, about how our therapeutic process could improve to address “relatively well” clients like him-self. Indeed, his frank feedback resulted in our implementing no fewer than 3 key therapeutic process developments in TRIMED. When Mr. R contacted us a few months later, seeking an urgent consultation on Sunday, it was with a whole new set of complaints. He had developed severe and unpredictable giddiness of three weeks duration, which had incapacitated him to such an extent that he had stopped working for over 10 days. Predictably Mr. R had seen specialists of every description: ENT, orthopedics, neurology, all of whom had cleared him after extensive investigations of having a serious problem, leading (much to his dismay) to his family doctor suggesting he see a psychiatrist for mental stress. Fed up with his many medical interactions, Mr. R decided to come back to TRIMED, this time with “significant’ medical symptoms; not merely for wellness, but seeking a cure.

When we re-examined Mr. R we noted three key factors.
a. Cervical spondylosis and resultant severe cervical spasm
b. Postural vertigo that came on suddenly when he moved or changed posture
c. Accompanying acute anxiety and phobia about falling that understandably accompanied the aforementioned symptoms.

Mr. R was started on a TRIMED program to address the aforementioned key factors. A combination of massage, physiotherapy (posture and balance exercises and instrumental therapy to reduce cervical spasm) and Relaxation techniques were delivered sequentially to him in our TRIMED center over 2 weeks. He did of course receive suitable allopathic medication for these new symptoms.

In a week Mr. R was feeling much better, started to travel to his office and spend a couple of hours there, bringing work home. In two weeks he stopped experiencing his giddiness episodes and was well enough for prolonged periods of time, to return to measured daily duties. A month on, he was back in his CEO saddle, multitasking, travelling extensively, managing crises in multifarious forms. Two things have changed however: Mr. R has become more measured in his approach to his work life balance. He is also regular with his practice of the TRIMED Way. Mr. R still drops into TRIMED religiously for an hour long weekly session with his favorite therapist; his way of “staying well”. Mr. R found TRIMED and together with us has made the journey from Illness to Wellness, like so many others before and after him.

The Man Behind the Dementia Mask !!

When the TRIMED team first encountered Mr. R aged 61 years, he was curled up on his bed in a fetal position, doubly incontinent (for both urine and faeces), barely taking in a few sips of liquid and a few mouthfuls of food each day. He was mute and had last communicated with the family in a meaningful way about 4 months earlier. According to the family he had been suffering from memory loss for over 3 years and had experienced considerable worsening in his clinical condition in recent times. His wife of 35 years was beside herself with anxiety at his declining health. It was his son, visiting from the US, moved by the plight of his beloved father, who found TRIMED.

At TRIMED Mr. R was first put through a “360* Assessment”- a measure of his TRUE HEALTH, in which our family physician, ayurved, naturopath & yoga doctor, physical therapist, clinical psychologist and nutritionist evaluated him. A detailed blood profile, brain imaging, electrophysiological tests and expert neuropsychiatry opinion from the Neurokrish team, completed our work up, revealing surprisingly few bodily aberrations that we proceeded to correct. He was started on suitable allopathic drug treatment for his condition, including anti-dementia drugs and vitamin supplements. Mr. R was inducted into TRIMED’s disease management program for dementia and over 3 weeks received nutritional therapy, ayurveda treatments, reflexology, physical exercises & mobilisation, and motivation enhancement training. Drawing him out of his cocoon in a few days, the TRIMED team soon had him up and about, taking part in his therapeutic program with increasing interest, eating well and sleeping normally. Caregiver education about dementia was effectively delivered and cognitive retraining instituted, reminiscence therapy being a particular forte among our counselling psychologists.

Today, 6 weeks on, Mr. R strode into our TRIMED centre confidently for his review appointment. With a beaming smile he greeted us appropriately with a “namaste”. He continues to have recent (and some remote) memory disturbances and to confabulate (make up) his replies. However his social behaviour and interactions are appropriate, he recognises his family members and addresses them suitably, is eating, sleeping and exercising well. Indeed he even follows “the TRIMED way” our one hour exercise protocol, with a bit of prompting. Mr. R’s son is leaving for the USA this week, a happy man. He found TRIMED for his father, and in his father TRIMED found “the man behind the Dementia mask”.

We at TRIMED are inspired every day, by people like Mr. R, their families, and the power of “modern healthcare with ancient wisdom”.

A Story Of Recovery From Brain Haemorrhage

Mr. M a farmer from an area near Chennai was first admitted in a prominent Chennai hospital with brain haemorrhage. After a two week stay in ICU he was transferred to a rehab centre. The stroke had left him confused, disoriented and apathetic with slurred speech and a weak left half of the body. Over 1 month intensive physio at the rehab centre resulted in his being more alert and able to sit up but not stand or walk. At this stage, his employer, a satisfied TRIMED customer, requested us to examine him and take him up for therapy.

Mr. M’s first visit to our Teynampet centre was in a wheel chair. While alert and oriented, he was depressed and apathetic, lacked confidence, and remained severely impaired in his activities, despite daily physiotherapy. At TRIMED Mr. M was started on whole body ayurvedic massage, acupuncture, yoga therapy, goal oriented physiotherapy, specifically gait training and psychological therapy (relaxation training and motivation enhancement). Almost miraculously, on the fourth day of therapy, Mr. M started to take a few steps with support and expressed a desire to get well. Today, after 3 weeks of TRIMED THERAPY, Mr. M is able to walk around with support, even going around the centre building with his family member assisting him. He has regained independence in all his sitting activities of daily living and is now being trained on safe transfers- bed-chair-toilet, in preparation to returning home. Needless to say Mr. M, his family, employer and treating physician, are all delighted with his progress, once thought to be unimaginable.

Mr. M is only one of many stroke patients who have made marvellous recoveries in our TRIMED THERAPY program, learning to overcome their disability. Indeed, they inspire TRIMED in its quest for excellence.

One Too Many – Tips to Tackle Multi-Medical Conditions.

Healthcare in the 21 Century has woken up to a new challenge — multi-morbidity. The presence of two or more chronic medical conditions in an individual is referred to as multimorbidity. Examples include dementia and stroke, diabetes and ischemic heart disease, hypertension and chronic kidney disease.

Multimorbidity mostly affects the middle aged and the elderly. Surveys in India have shown that over a third of all elders in India suffer from one or more chronic medical conditions. As chronic medical conditions co-occur, they lead to a cumulative burden of medical disability. Multimorbidity is most prevalent in these individuals.

Multimorbidity has significant impact on the person, family and society — in terms of healthcare costs, higher risk of hospital admissions and earlier death, poor quality of life and increased burden on the care-takers as well.

Where should we intervene?
Experts feel that interventions for multimorbidity must be primary care and community based and not confined to the specialist setting. Yet most patients with more than one chronic medical disease consult multiple specialist settings. In India where the family physician has gone out of vogue, people turn to various specialists. There is a need for integration of care, and this must begin with the family medical practitioner.

When should we intervene?
Interventions for patients with multimorbidity are needed urgently and without delay. Those interventions can be situated in primary medical care, and extend to specialist care settings. Healthcare professionals across settings, the family and society, should also be involved.

How should we intervene?

  • Interventions for multimorbidity are manifold.
  • Patient-centred: Education, support, self-management.
  • Financial: Targeting healthcare providers to reach specific targets.
  • Regulatory: National regulations designed to alter healthcare delivery and alter specific outcomes.
  • Organisational: Case management and coordination, allocation of tasks to specific members, addition of members to the team.

Best practice model in India

Our model of assessment and care for multimorbidity and chronic medical disability, developed for neuropsychiatric conditions, subsequently expanded to all medical conditions was adjudged a best practice model in the ‘World Health Report of the WHO, 2012’. In this model, both assessment and care are accomplished by an interdisciplinary team, care being rehabilitative and palliative, involving both modern and traditional medical systems, with focus on quality of life. Importantly, in the Indian context, care has to be centred in the family and community. Indeed, a series of editorials on multimorbidity in the British Medical Journal, have in recent times highlighted the need for a comprehensive approach and innovations.

Originally Published in The Hindu on 1 February 2014

Author can be reached at: Dr. Ennapadam S Krishnamoorthy

Never Mind

Caregiving can be taxing when your child suffers from a neuro-developmental disorder. But, don’t lose hope. Dr. Ennapadam S Krishnamoorthy

Children with neuro-developmental disorders (NDD) suffer from these core symptoms: learning disability, childhood epilepsy, cerebral palsy, mental retardation, attention deficit and hyperactivity disorder, autistic spectrum disorder …

What is neuro-developmental disorder?

Conditions that follow abnormal brain development and impact on motor (strength, dexterity, coordination); cognitive (intelligence, learning, aptitude); or emotional and behavioural (mood swings, temper tantrums, socialisation issues etc.) function.

Why NDD?

While some have NDD imprinted in their biological code (through genetic, hormonal, and other neurobiological factors), for many the causes lie in critical stages of development — during pregnancy, trauma, drugs, alcohol, smoking, infections, malnutrition etc. Factors affecting the child include birth trauma, infection and neonatal compromise (asphyxia, jaundice, accidents or abuse, infections, malnutrition).

Who is at risk?

The majority of NDD may be deemed to be multi-factorial, i.e. more than one genetic/ biological abnormality being responsible, with strong contributions from environmental events. In general, having a parent with a neuro-psychiatric or developmental condition may double the risk. Parental consanguinity also increases the risk.

When to suspect NDD?

Moderate to severe problems manifest early. Typically they are slow-learners in school, who find academic progress challenging.

Why should we take action early?

Children who do not receive support are likely to feel stigmatised and lose their confidence. The paediatrician should be the first port of call. The class teacher may also have valuable inputs. When either the paediatrician or the class teacher (or both) suspect a problem, more specialised inputs become necessary. Consultations include:

Learning and intelligence: clinical psychologist

Motor weakness/other brain disorders (like epilepsy): neurologist assisted by the occupational therapist

Behaviour: psychiatrist assisted by a counsellor

Language development: ENT doctor supported by speech and language therapists.

In many instances, comprehensive assessment requires a team approach. Depending on the problem, a range of laboratory tests may be required, from brain scans, EEG/ electrophysiological tests to blood and urine tests, including hormonal assays.

How should I progress once diagnosed?

The paediatrician should be your primary support. The child’s school needs to be kept in the loop. Identify a team of professionals; be consistent in your interactions and regular in follow up. Make sustainable plans and set realistic goals. Don’t focus only on the disability; your child may also have special interests and abilities. Focus on them too. Don’t be preoccupied with academic results; focus on overall development.

Care-giving is challenging and tiring; share the challenge as a family. Develop your own support networks with other parents and keep your spirit up. It’s a long road, but rest assured, there is light at the end of the tunnel.

Originally Published in The Hindu on 1 December 2013