Leisure, Lifestyle & Wellness
Pain Responds to Exercise and Not Rest!
Is it possible to get rid of pain without a pain-killer pill and no rest? 
Take this as a case report, if you are one of those conventional scientists, or as my personal saga, if you are an ordinary man like me. The conventional wisdom in medicine is that when you are injured, even if you are able to move about, you are asked to take rest lest the healing should take a longer time than needed. This was believed to hold for other illnesses also, say, a heart attack. The latter ended when General Eisenhower had a heart attack at the end of the third year of his presidency. For his doctors, Sam Levine and Paul Dudley White, it was a big dilemma. The General was a very popular president and had a sure chance of re-election for a second term. A year or so earlier, Nobel Laureate Bernard Lown had published the chair treatment idea after a heart attack  which involved putting heart patients on a chair, against the prevailing orthodoxy of complete bed rest.
The president’s doctors took a very bold stand—that he should not only be mobilised early through chair treatment but also should run for the second term. History is a great teacher; he did very well, got his second term and went on to live for many more years. Early mobilisation after a heart attack and heart surgery became a mantra, since then. What of other injuries? We still do not have clear guidelines and doctors take the safer route for themselves by asking patients to take rest after any injury.  
I had a freak accident at the Bengaluru airport a couple of weeks ago. I was, as usual, sitting and looking at my emails when the announcement of my flight came on the public address system. I got up from my seat in that small cubicle where the chair and the table are so close to each other that there is hardly any leg space. 
The aisle was on my left and in the aisle was a granite table. My left leg could easily get out of the cubicle while my right leg was still inside the small leg space. In my hurry, I didn’t realise that and tried to move on. Naturally, I was thrown forward on the left side—my head hitting the granite table and also my left forearm. Providentially, instead of my forehead hitting the hard granite table my chin hit it so hard that I had a big bump there along with a painful swelling of the left forearm in the middle.
Eventually, when my right leg came out, my right knee fell and hit the leg of the granite table, giving me a big swelling and severe pain the right knee joint. People started rushing to help me but I told them not to do any such thing and I got up with difficulty myself and made my way slowly to the flight. In retrospect, I do not know how I made it. I must have been a sight for the Gods and the co-passengers. Sitting in the plane was difficult but it was just 25 minutes to Chennai where I was headed. 
I had no handbags and walked slowly, without help, to the luggage carousel. The Jet Airways boys helped me to pick up my bag and I walked out of the terminal using my trolley bag as a crutch. I had to go to our research centre for a meeting and seeing patients which I did with some difficulty, but the pain and the swelling were slowly getting worse.
We have a Varma Kalai specialist in our team, Suresh, who is very good. He came in the evening when I had finished my day’s work. He worked on me so well for nearly an hour and half with his special oils and intelligent use of the pressure points (102 in all) and I was a lot better at the end. The pain was 50% but the Varma point pressures were too painful to bear when applied. I was not sure if I would be able to sleep with all the pain. However, all went well and I had a good night’s rest. The next morning, as usual, I went for a walk with some difficulty but did not cut down my walk time; I had my full quota. I went back to work as usual and did whole day’s work going up and down the stairs to see patients and to attend meetings. In the evening, Suresh had another go at me; this time, it was more painful than before. My pain disappeared almost 90% and I could walk freely. All the swelling had gone but I could not fully bend my right knee to sit in vajra asana.
The following day, I was in Mangalore for my father’s death anniversary celebrations. During the puja there, I had to sit on the floor and get up at least 20 times. That took a toll on my back muscles that had to contract abnormally while sitting down with one knee almost disabled. The back started hurting so much that it was unbearable; but I went on as usual and went to Udupi and many other places by car in the following two days before leaving for Delhi with the backache in full intensity. I had a very busy schedule in Delhi and had to go back via Chennai where I had a lecture at IIT Chennai. My friend, Suresh, had two sittings with me and my backache has almost come down 99%.
A week later, I was in Delhi and was able to do all asanas normally as well as take my usual one-hour walk. I am writing this note at the India International Centre, Delhi, with all my pain gone for good (I suppose, touch wood!). In essence, I did not take a single pain-killer pill and had no rest at all after the accident. My experience tells me that it would have taken much longer for the pain to disappear, if I had taken rest after the accident. I am wondering if early mobilisation is a good idea in post-accident periods also. Will the concerned people listen and do a larger study acceptable to conventional thinkers? Interestingly, there is now a rethink on our conventional reductionist large cohort studies most of which have not delivered the goods. Even the journal Science advocates one-for-one study in place of large cohort studies. This is a one-on-one study, if you like. I did not have to take any informed consent from the patient, as I was the patient myself.
Knowledge advances, wrote Karl Popper, “Not by repeating known things but by refuting false dogmas.” How very true! Disease, rest and recovery need a fresh look to see if we should change for the better. Having said all that, I do not want the layman, a novice in the field, to decide what exercise or rest that he needs with any pain as s/he will not be able to assess what brought on the pain in the first place. If you have your family doctor and discuss the details with him, he will guide you. If you try on your own and come to grief, do not blame me.
“Exercise is done against one’s wishes and maintained only because the alternative is worse.”— George  A  Sheehan



Ganesh Johnson

6 months ago

Dear Dr. Hegde, you are SPOT ON!

I have had similar experiences of pain management.

Here's an example of last few days. About 10 days ago, may be due to incorrect posture while travelling/driving, or some extra strain on account of swimming, my lower left back (which has been vulnerable always) muscles started complaining; the pain started getting worse and would not subside even after a night's sleep. Bending became painful. But as is my experience I went for a triathalon (cycling/walking/running) set of exercises for 2 hours yesterday evening; the pain had subsided quite a bit after that. As of now the pain is manageable; and i would be further exercising to reduce and eliminate this episode of back pain.

Again, zero pain killers. In fact I am really afraid of pain killers, after having seen an elderly aunt of mine destroying herself over the last 20 years due to being habituated to pain killers (which were prescribed to her by her allopathic doctor son-in-law by the way).

So I totally agree with you!

States' rising debt, non-plan spending worries central bank
Kolkata : Non-productive expenditure of state governments remain a cause for worry and their growing liabilities need redressal, even though there has been some improvement in this regard, the Reserve Bank of India (RBI) has said in a report.
"The rising trend in the committed expenditure to gross state domestic product ratio in recent years is a cause for concern," the central bank said in its latest report on state finances, calling for steps to step up the output.
Committed expenditure includes interest payment, pensions and administrative services and is set to rise further upon the implementation of the 7th Central Pay Commission recommendations, which may also have a cascading impact on the salaries and pension burdens on states, the RBI said.
Such expenditure is a major fiscal drain on states and inhibit money for development purposes.
The report said one solution is for states to expand faster than the rate at which such expenses are growing. "Capital outlay must go up significantly. But states are not able to step it up dramatically," Ajitava Raychaudhuri, economist at Jadavpur University, told IANS.
According to the report, states in general raised the average capital outlay to their output by 0.6 percentage points after implementing the steps under fiscal responsibility and budget management from 1.8 percent to 2.4 percent.
"But this is not a significant increase," Raychaudhuri said.
The report said aggregate capital expenditure of states remained almost stagnant over the years as a proportion to the state output. The banking regulator also said states do not sacrifice growth-inducing expenditures within the overall framework of fiscal consolidation.
"Every state has its own comparative advantage. Each state should identify and develop them via its own resources or public-private partnership. This will create more assets and ensure future flow of income," Dipankar Dasgupta, economist at Indian Statistical Institute told IANS.
He said tourism was one such area for West Bengal to create productive assets.
Economists said unless states increase their income, they will continue to rely on borrowings and that again will be used to retire old debt. As a result, debt burden only grows without any sign of increases in the states' gross domestic product or incomes.
"Governance is deteriorating. There is lack of accountability in the system. Someone must oversee states for their unproductive expenditure. Most financing decisions are for political gains," former professor of Delhi School of Economics B.L Pandit told IANS.
"Capital expenditure has multiplier effect on growth. But states are unable to increase it enough to push growth to a higher level. Majority of borrowed money is spent neither efficiently nor on productive purposes. So the debt burden of the states has not reduced much," Pandit added.
The central bank said outstanding liabilities of state governments have experienced double-digit expansion since 2012-13, with steady increase in public debt. "The increase in market borrowings of state governments since 2008-09 entails large repayment obligations from 2017-18 onward."
As on end-March 2016, the outstanding liabilities of West Bengal, for example, stood at Rs.3,088 billion, while for Maharashtra it was Rs.3,793.6 billion. For Uttar Pradesh, it was Rs.3,274.7 billion, Tamil Nadu Rs.2,352.6 billion and Gujarat Rs.2,292.8 billion.
Nonetheless, West Bengal's debt as percentage of its output improved to 35.5 percent in 2015 from 41.9 percent in 2011. As a non-special category state, it is the worst. For Punjab, the ratio improved to 32.4 percent from 33.1 percent, and for Kerala to 28.5 percent from 31.8 percent.
At the same time, the report said the fiscal health of states deteriorated in 2013-14 with their consolidated revenues turning into deficit after three years. It further weakened in 2014-15, as gross fiscal deficit and primary deficit also increased as proportions to state output.
But the central bank had a ray of hope. "The overall fiscal performance of states is expected to improve with the revenue account turning back to surplus. Such improvement, if sustained, would reduce the debt burden of states."
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.


Diesel, petrol cabs go off roads, owners warn of suicides
New Delhi : The Supreme Court's ban on plying of diesel and petrol driven taxis in Delhi took effect on Sunday, with three taxi owners warning this might lead to suicides in frustration.
Cab operators termed the apex court's decision tyrannical, saying if the decision was not changed then it will lead many of them to commit suicide. Over 27,000 taxis run on diesel alone in Delhi.
The cab operators told IANS that they had decided to launch a protest after mutual consultations. They claimed that almost half the taxis were run on diesel in the national capital.
"I have cancelled 17 bookings since morning as most of my taxis are run on diesel. I have only five taxis run by CNG. We do not understand why the court and Government come up with such decisions?" S. Kumar, owner of Kumar Taxi Services in central Delhi, told IANS. 
He said the apex court decision of Saturday will lead many taxi operators to commit suicide as they won't be able to pay their car instalments now.
"How do we pay our monthly instalments to banks for the loans taken to buy taxis? Does not the government realize that diesel cars can't be converted into CNG?"
The Supreme Court on Saturday refused to give more time to taxi operators to switch to the cleaner compressed natural gas (CNG). The deadline for the change, which had been extended twice, was Saturday.
Another transporter, who did not wished to be named, told IANS: "The order would have at least made sense if it was applicable to diesel taxis after their ongoing permit got over. That would have at least given some time to the operators to arrange for alternate taxis. But now we are all ruined."
According to the Delhi transport department, about 60,000 taxis are registered in the city. Of them, 27,000 run on diesel.
Some taxi operators believe the court ruling will mainly affect cab aggregators Ola and Uber.
"The decision is not applicable to taxis with All India Tourist Permit. This is going to be a setback for Ola and Uber who have a large number of taxis run on diesel," Raman of Kamal Taxi Service told IANS.
"The authorities should not be surprised if taxi owners and drivers commit suicide in sheer frustration," Raman added.
Pritpal Singh, a taxi owner in south Delhi, that even taxis with all-India permits often plied within the capital when there was no business for journeys outside. "So even they will be hit. We don't know what to do."
On Sunday, with taxis plying on petrol and diesel staying off the roads, commuters switched over to the limited number of CNG-driven yellow-top taxis and auto-rickshaws. The problem is expected to peak on Monday.
"I called two taxi companies but declined to take my booking citing lack of CNG cabs. Finally I took an auto-rickshaw to reach Noida Sector 15," Sangeeta Johari, a stock broker, told IANS.
Piyush, working with a NGO, told IANS that he waited for two hours to get his taxi booked.
"I was initially told there are no cabs. Later, they said a taxi will be available but in two hours. I had no option and to wait," he said.
This is the second blow to Uber and Ola in Delhi. The Delhi government has declared that it will not let them charge "surge pricing".
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.


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