Wednesday, October 29, 2008
Monday, October 27, 2008
Laughter Aerobics
Laughter Aerobics:
Dr. V.P.Nair, MBBS, MRCP, FAMS, FRCPI, FRCPE, FRCGP, FRCP(Lon), FACC
Consultant Cardiologist, Nair Cardiac Medical Centre, Mount Elizabeth Medical Centre # 16-08, Singapore
Conventional Aerobics is gaining popularity worldwide due to its benefits on physical and mental health. I would like to coin a new terminology, the “Laughter Aerobics”.
History: Laughter is usually induced by a joke, a pleasant event or a funny comment. Most jokes are a matter of personal preference and do not necessarily appeal to every one. This led to the novel idea of laughing without the need for a joke in 1995 and resulted in the evolution of more than 2000 laughter clubs around the world in 2007. The pioneers in the field of laughter are. Madan Kataria from Bombay, Lee Berk M Loma Linda University, California,. Michael Miller, V P Nair Singapore and Bennet MP, Indiana state University school of Nursing USA, among many others.
General Benefits: Laughter, whether in the form of chuckle, giggle or belly laugh, enhances muscle relaxation, and abdominal toning. Through reduced stress hormone production such as adrenaline, dopamine and cortisol, that constrict blood vessels and suppress immune activity, laughter stimulates the much-needed immunity activation. By increasing endorphin production, it enables better tolerance to pain and provide a feeling of general well being.
Job Satisfaction: The work-related benefits are improvement in team building, communication skills, efficient conflict management, enhanced morale, job satisfaction, creativity, problem solving ability and resilience and results in increased productivity.
Immunology: Laughter is believed to increase a specific type of white blood cell called natural killer cell, thus helping to raise the much-needed protective antibody level. Our immune system plays a vital role in keeping good health by warding away infections, allergies and cancers. Immunologists have shown that negative emotions such as anxiety, depression or anger weaken the immune system. At least two types of killer cells known as Cytotoxic T – cells and Natural Killer Cells (NKC) are present in our circulation. To attack, cytototoxic T – cells need to recognize a specific antigen, whereas natural killer cells do not need it. Both types contain granules filled with potent chemicals, and both types destroy the enemy, be it a virus or antigen, on contact. The killer binds to the target, aims its weapons, and delivers a burst of lethal chemicals. By increasing immunoglobulin A in the mucus of the nose and respiratory passages, laughter helps to fight against viruses, bacteria and other microorganisms. Many members of the laughter clubs have noticed reduced frequency of colds, sore throat and chest infection
Psychosomatic disorders: The stress and strain of modern living such as the recent credit crunch in October 2008, with a tsunami effect on the stock market worldwide are taking a heavy toll on the human mind and body. Anxiety, depression, nervous breakdowns insomnia and suicide are on the rise. Regular laughter has the power to make people less depressed and less dependent on tranquilizers. The psychological benefits of laughter are reduced stress, anger, and anxiety, increased joy, alertness, positive thinking, optimistic view and mood elevation. Laughter is in essence an economical and easy to practice anti-stress placebo.
High Blood Pressure: In 95% of hypertension, a specific cause cannot be found. However there are many contributory factors for Primary Hypertension such as stress, heredity, obesity, smoking and excessive intake of salt and alcohol. Laughter helps to control blood pressure to a small extent by modifying the stress related hormones.
Heart disease: Laughter therapy strengthens the cardiovascular system Those suffering from heart disease and stabilized on medication will find laughter beneficial, as it improves the blood circulation and oxygen supply to the heart and skeletal muscles. Those who have had heart attacks or have undergone balloon angioplasty, stents or heart bypass surgery will also benefit from laughter. In three consecutive papers by Wittstein IS et al, in the New England Journal of Medicine 2005;352, 539-548 entitled “Neurohormonal features of myocardial stunning due to sudden emotional stress”, Sharkey SW et al , in Circulation 2005;111,472-479 entitled “Acute and reversible cardiomyopathy provoked by stress in women” , Dec G. Williamc in Circulation 2005 ;111, 388-390 entitled “Recognition of the apical ballooning syndrome”, the authors described a condition called “stress Cardiomyopathy”. Moreover the Heart wire of Feb. 2005, published an article entitled, “proof at last –You can die of a broken heart” often misdiagnosed as acute myocardial infarction. All of them agreed that the difference between stress cardiomyopathy and AMI (Acute Myocardial Infarction = Heart attack) is that stress-cardiomyopathy patients recover much more quickly than those who suffer from an AMI. These are patients who were previously healthy but have an acute event triggered by stress such as news of a death, divorce, shock from a surprise party, terrorist attack or an armed robbery. Plasma catecholamine levels at presentation were markedly higher among the stress-induced cardiomyopathy than among those with AMI suggesting a potential cause of the syndrome.
Aerobic Exercise: Fat accumulated in the abdomen, the so called pot belly, finds easy access to the blood stream. A belly laugh is equivalent to “an internal jogging”. This is especially beneficial for those who are unable to perform physical exercise due to arthritis and other disabling conditions. After 15 to 20 minutes of laughter in the morning, one feels fresh the whole day. You tend to inhale more oxygen, stimulate blood circulation and exercise skeletal muscles, similar to the aerobic exercise. Laughter can be compared to magic fingers, which effectively reach the interior of the abdomen and massage the organs, particularly the intestines, which in turn help the bowels to move regularly.
standard
Analgesic properties: Laughter increases endorphin production by the pituitary gland in the brain. Endorphins are natural painkillers and laughter may help to reduce the intensity of pain in arthritis, spondylitis, muscular spasms, migraine and tension headaches.
Stage Performance: Laughter Therapy can be beneficial to singers and actors. Increased lung capacity and exercise of the diaphragm and abdominal muscles will
help to gain better control of speech and voice. In addition, it enhances self-confidence and reduces stage fright.
Rejuvenation: Laughter and Yoga benefit all muscles of the body, including the facial muscles. It tones up the muscles of the face and improves facial expression, making people look more cheerful and attractive. Laughter exercises the abdominal
muscles and helps to improve muscle tone in those with potbellies. .
Sparkling Eyes: Laughter often widens the eyelids and makes the eye look brighter. Chuckling laughter induces the tear glands to produce fresh tears making the eyes wet and shiny. By squeezing the tear ducts and automatically massaging the eye muscles, laughter presents you with sparkling eyes. You will look young and feel good too.
Respiration: Frequent belly laughter empties the lung of more air than it takes resulting in a cleansing effect of the respiratory system .It improves the lung capacity. It also improves the tone of the intercostals and other respiratory muscles.
Personal and Social Aspects: Members of the Laughter Club meet and greet each other regularly as one family. Laughter often breaks the ice making it easier for people to interact and eases the union in uncomfortable and unfamiliar situations. By laughing in a group in a public place, you become more sociable and confident. A pleasant side effect of this is a more positive attitude towards life and a better ability to deal with minor setbacks. Members often conduct seminars and workshops, which in turn helps to remove stage fright and to become good public speakers.
Conclusion: Laughter strengthens the immune system; increases physical and intellectual performance, boosts confidence and improves social skills. Friendship, and camaraderie evolved through laughter can create happy and healthy families, societies, communities and Nations. The negative aspect is that some of the publications are lacking in scientific proof, as they are based on anecdotal evidence However, I believe that “if smile is the gateway to friendship and courtesy, laughter is the open house to good health and happiness”. Moreover it is a cheap, effective, and an easily available commodity. Ideally one should combine laughter aerobics with conventional exercise for maximum benefit. In reality laughter is an energy boosting, brain and body gymnasium. So don’t worry, be happy and keep on laughing. I hope my nomenclature of laughter aerobics is justified
Dr. V P Nair, MD, MRCP, FRCP, FAMS, FACC
Dr. V.P.Nair, MBBS, MRCP, FAMS, FRCPI, FRCPE, FRCGP, FRCP(Lon), FACC
Consultant Cardiologist, Nair Cardiac Medical Centre, Mount Elizabeth Medical Centre # 16-08, Singapore
Conventional Aerobics is gaining popularity worldwide due to its benefits on physical and mental health. I would like to coin a new terminology, the “Laughter Aerobics”.
History: Laughter is usually induced by a joke, a pleasant event or a funny comment. Most jokes are a matter of personal preference and do not necessarily appeal to every one. This led to the novel idea of laughing without the need for a joke in 1995 and resulted in the evolution of more than 2000 laughter clubs around the world in 2007. The pioneers in the field of laughter are. Madan Kataria from Bombay, Lee Berk M Loma Linda University, California,. Michael Miller, V P Nair Singapore and Bennet MP, Indiana state University school of Nursing USA, among many others.
General Benefits: Laughter, whether in the form of chuckle, giggle or belly laugh, enhances muscle relaxation, and abdominal toning. Through reduced stress hormone production such as adrenaline, dopamine and cortisol, that constrict blood vessels and suppress immune activity, laughter stimulates the much-needed immunity activation. By increasing endorphin production, it enables better tolerance to pain and provide a feeling of general well being.
Job Satisfaction: The work-related benefits are improvement in team building, communication skills, efficient conflict management, enhanced morale, job satisfaction, creativity, problem solving ability and resilience and results in increased productivity.
Immunology: Laughter is believed to increase a specific type of white blood cell called natural killer cell, thus helping to raise the much-needed protective antibody level. Our immune system plays a vital role in keeping good health by warding away infections, allergies and cancers. Immunologists have shown that negative emotions such as anxiety, depression or anger weaken the immune system. At least two types of killer cells known as Cytotoxic T – cells and Natural Killer Cells (NKC) are present in our circulation. To attack, cytototoxic T – cells need to recognize a specific antigen, whereas natural killer cells do not need it. Both types contain granules filled with potent chemicals, and both types destroy the enemy, be it a virus or antigen, on contact. The killer binds to the target, aims its weapons, and delivers a burst of lethal chemicals. By increasing immunoglobulin A in the mucus of the nose and respiratory passages, laughter helps to fight against viruses, bacteria and other microorganisms. Many members of the laughter clubs have noticed reduced frequency of colds, sore throat and chest infection
Psychosomatic disorders: The stress and strain of modern living such as the recent credit crunch in October 2008, with a tsunami effect on the stock market worldwide are taking a heavy toll on the human mind and body. Anxiety, depression, nervous breakdowns insomnia and suicide are on the rise. Regular laughter has the power to make people less depressed and less dependent on tranquilizers. The psychological benefits of laughter are reduced stress, anger, and anxiety, increased joy, alertness, positive thinking, optimistic view and mood elevation. Laughter is in essence an economical and easy to practice anti-stress placebo.
High Blood Pressure: In 95% of hypertension, a specific cause cannot be found. However there are many contributory factors for Primary Hypertension such as stress, heredity, obesity, smoking and excessive intake of salt and alcohol. Laughter helps to control blood pressure to a small extent by modifying the stress related hormones.
Heart disease: Laughter therapy strengthens the cardiovascular system Those suffering from heart disease and stabilized on medication will find laughter beneficial, as it improves the blood circulation and oxygen supply to the heart and skeletal muscles. Those who have had heart attacks or have undergone balloon angioplasty, stents or heart bypass surgery will also benefit from laughter. In three consecutive papers by Wittstein IS et al, in the New England Journal of Medicine 2005;352, 539-548 entitled “Neurohormonal features of myocardial stunning due to sudden emotional stress”, Sharkey SW et al , in Circulation 2005;111,472-479 entitled “Acute and reversible cardiomyopathy provoked by stress in women” , Dec G. Williamc in Circulation 2005 ;111, 388-390 entitled “Recognition of the apical ballooning syndrome”, the authors described a condition called “stress Cardiomyopathy”. Moreover the Heart wire of Feb. 2005, published an article entitled, “proof at last –You can die of a broken heart” often misdiagnosed as acute myocardial infarction. All of them agreed that the difference between stress cardiomyopathy and AMI (Acute Myocardial Infarction = Heart attack) is that stress-cardiomyopathy patients recover much more quickly than those who suffer from an AMI. These are patients who were previously healthy but have an acute event triggered by stress such as news of a death, divorce, shock from a surprise party, terrorist attack or an armed robbery. Plasma catecholamine levels at presentation were markedly higher among the stress-induced cardiomyopathy than among those with AMI suggesting a potential cause of the syndrome.
Aerobic Exercise: Fat accumulated in the abdomen, the so called pot belly, finds easy access to the blood stream. A belly laugh is equivalent to “an internal jogging”. This is especially beneficial for those who are unable to perform physical exercise due to arthritis and other disabling conditions. After 15 to 20 minutes of laughter in the morning, one feels fresh the whole day. You tend to inhale more oxygen, stimulate blood circulation and exercise skeletal muscles, similar to the aerobic exercise. Laughter can be compared to magic fingers, which effectively reach the interior of the abdomen and massage the organs, particularly the intestines, which in turn help the bowels to move regularly.
standard
Analgesic properties: Laughter increases endorphin production by the pituitary gland in the brain. Endorphins are natural painkillers and laughter may help to reduce the intensity of pain in arthritis, spondylitis, muscular spasms, migraine and tension headaches.
Stage Performance: Laughter Therapy can be beneficial to singers and actors. Increased lung capacity and exercise of the diaphragm and abdominal muscles will
help to gain better control of speech and voice. In addition, it enhances self-confidence and reduces stage fright.
Rejuvenation: Laughter and Yoga benefit all muscles of the body, including the facial muscles. It tones up the muscles of the face and improves facial expression, making people look more cheerful and attractive. Laughter exercises the abdominal
muscles and helps to improve muscle tone in those with potbellies. .
Sparkling Eyes: Laughter often widens the eyelids and makes the eye look brighter. Chuckling laughter induces the tear glands to produce fresh tears making the eyes wet and shiny. By squeezing the tear ducts and automatically massaging the eye muscles, laughter presents you with sparkling eyes. You will look young and feel good too.
Respiration: Frequent belly laughter empties the lung of more air than it takes resulting in a cleansing effect of the respiratory system .It improves the lung capacity. It also improves the tone of the intercostals and other respiratory muscles.
Personal and Social Aspects: Members of the Laughter Club meet and greet each other regularly as one family. Laughter often breaks the ice making it easier for people to interact and eases the union in uncomfortable and unfamiliar situations. By laughing in a group in a public place, you become more sociable and confident. A pleasant side effect of this is a more positive attitude towards life and a better ability to deal with minor setbacks. Members often conduct seminars and workshops, which in turn helps to remove stage fright and to become good public speakers.
Conclusion: Laughter strengthens the immune system; increases physical and intellectual performance, boosts confidence and improves social skills. Friendship, and camaraderie evolved through laughter can create happy and healthy families, societies, communities and Nations. The negative aspect is that some of the publications are lacking in scientific proof, as they are based on anecdotal evidence However, I believe that “if smile is the gateway to friendship and courtesy, laughter is the open house to good health and happiness”. Moreover it is a cheap, effective, and an easily available commodity. Ideally one should combine laughter aerobics with conventional exercise for maximum benefit. In reality laughter is an energy boosting, brain and body gymnasium. So don’t worry, be happy and keep on laughing. I hope my nomenclature of laughter aerobics is justified
Dr. V P Nair, MD, MRCP, FRCP, FAMS, FACC
Tuesday, October 21, 2008
Heart Attack, Angioplasty and Stenting
Heart Facts and Heartening Trends
“Longer the Belt Line, shorter the Life Line”-Dr V P Nair
Dr. V.P. Nair, MBBS, MRCP (UK), MRCP (Ireland), FRCGP (UK), FRCP (Edinburgh) FRCP (Ireland) FAMS (Cardiology, S`pore) FICA (USA) FACC (USA) FRCP (London)
Consultant Interventional Cardiologist, Mount Elizabeth Medical Centre, Singapore
Heart attack due to Coronary Artery Disease (CAD) is the number one killer in the world.
The recognized risk factors for coronary heart disease are, tobacco smoking, high blood pressure, dyslipidemia, high levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL), diabetes, advancing age, male gender, obesity, family history of heart disease, sedentary life style, chronic stress and in some cases elevated blood homocystine levels.
Basic investigations for the detection of coronary artery disease include history and physical examination, Electrocardiography (ECG), blood tests, urine analysis and chest X-Ray. Special tests such as Treadmill exercise stress test, Echocardiography, 24 hour ECG Holter monitoring, MIBI scan, stress echo, multi-directional computerized tomography – MDCT also known as multi slice CT (MSCT) including coronary calcium score, magnetic resonance imaging or MRI of the heart, and the gold standard Coronary Angiogram are necessary as and when indicated.
Blocked arteries can be treated with medications, bypass surgery, ballooning (angioplasty) or stenting. Newer medications, off pump Coronary Artery Bypass Graft and modern Drug Eluting Stents have revolutionized treatment of coronary artery disease and improved quality of life. The current players in the well-documented drug eluting stents in Singapore are Cordis Cypher Sirolimus drug –eluting stent (Cipher Select, Cypherselect plus) and Boston Scientific Taxus Paclitaxel drug-eluting stents (express, liberte). The other drug eluting stents available are Medtronic`s Endeavour, Abbott`s Zomaxx, Guidant`s Xience everolimus, Concor`s Co Star with a bio reabsorbable polymer, and the endothelial progenior coated Genous stent. The only caveat is that two anti-platelet medications such as aspirin and clopidogril (Plavix) should be continued for six months to one year and often for life following the stent implantation. This can be a real problem when a major surgery is required in the future due to the potential of bleeding due to the usage of the antiplatelet medications. In such a situation, you should always consult the expert. You have to be very careful and adhere strictly with life style modifications such as low fat, low sugar, low salt diet, and regular exercise. You should also continue taking the other relevant medications.
Using sophisticated MRI and other parameters after s a long –term study of 2,744 people with a median age of 45, a group of cardiologists led by Dr. James de Lemos at the University of Texas Southwestern Medical Centre in Dallas USA reported in the prestigious American College of Cardiology on 14 August 2007, that there is a direct relationship between waist size and early indications of heart disease, regardless of patient’s overall weight. I am very delighted at this new scientific statement, as way back in 1992 the Straits Times news paper in Singapore quoted me with my statement of 1992 that apple shaped tummy, the so called pot belly is not appropriate, as fat accumulated in the abdomen can easily find access to the blood stream, whereas fat deposited in the bullocks, the so-called pear bottom has no such access and is comparatively safe. As such, “longer the belt line shorter the life line”(Dr V P Nair 1992). So Let us keep our belt Line within the normal range by diet control and regular exercise.
I invite your comments
Dr V P Nair
“Longer the Belt Line, shorter the Life Line”-Dr V P Nair
Dr. V.P. Nair, MBBS, MRCP (UK), MRCP (Ireland), FRCGP (UK), FRCP (Edinburgh) FRCP (Ireland) FAMS (Cardiology, S`pore) FICA (USA) FACC (USA) FRCP (London)
Consultant Interventional Cardiologist, Mount Elizabeth Medical Centre, Singapore
Heart attack due to Coronary Artery Disease (CAD) is the number one killer in the world.
The recognized risk factors for coronary heart disease are, tobacco smoking, high blood pressure, dyslipidemia, high levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL), diabetes, advancing age, male gender, obesity, family history of heart disease, sedentary life style, chronic stress and in some cases elevated blood homocystine levels.
Basic investigations for the detection of coronary artery disease include history and physical examination, Electrocardiography (ECG), blood tests, urine analysis and chest X-Ray. Special tests such as Treadmill exercise stress test, Echocardiography, 24 hour ECG Holter monitoring, MIBI scan, stress echo, multi-directional computerized tomography – MDCT also known as multi slice CT (MSCT) including coronary calcium score, magnetic resonance imaging or MRI of the heart, and the gold standard Coronary Angiogram are necessary as and when indicated.
Blocked arteries can be treated with medications, bypass surgery, ballooning (angioplasty) or stenting. Newer medications, off pump Coronary Artery Bypass Graft and modern Drug Eluting Stents have revolutionized treatment of coronary artery disease and improved quality of life. The current players in the well-documented drug eluting stents in Singapore are Cordis Cypher Sirolimus drug –eluting stent (Cipher Select, Cypherselect plus) and Boston Scientific Taxus Paclitaxel drug-eluting stents (express, liberte). The other drug eluting stents available are Medtronic`s Endeavour, Abbott`s Zomaxx, Guidant`s Xience everolimus, Concor`s Co Star with a bio reabsorbable polymer, and the endothelial progenior coated Genous stent. The only caveat is that two anti-platelet medications such as aspirin and clopidogril (Plavix) should be continued for six months to one year and often for life following the stent implantation. This can be a real problem when a major surgery is required in the future due to the potential of bleeding due to the usage of the antiplatelet medications. In such a situation, you should always consult the expert. You have to be very careful and adhere strictly with life style modifications such as low fat, low sugar, low salt diet, and regular exercise. You should also continue taking the other relevant medications.
Using sophisticated MRI and other parameters after s a long –term study of 2,744 people with a median age of 45, a group of cardiologists led by Dr. James de Lemos at the University of Texas Southwestern Medical Centre in Dallas USA reported in the prestigious American College of Cardiology on 14 August 2007, that there is a direct relationship between waist size and early indications of heart disease, regardless of patient’s overall weight. I am very delighted at this new scientific statement, as way back in 1992 the Straits Times news paper in Singapore quoted me with my statement of 1992 that apple shaped tummy, the so called pot belly is not appropriate, as fat accumulated in the abdomen can easily find access to the blood stream, whereas fat deposited in the bullocks, the so-called pear bottom has no such access and is comparatively safe. As such, “longer the belt line shorter the life line”(Dr V P Nair 1992). So Let us keep our belt Line within the normal range by diet control and regular exercise.
I invite your comments
Dr V P Nair
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