Neurologist Dr.K. Neeraja Reddy Full Interview|@signaturestudiostv
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Title: Neurologist Dr.K. Neeraja Reddy Full Interview|@signaturestudiostv
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Description: Neurologist Dr.K. Neeraja Reddy Full Interview|@SignatureStudiostv
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Transcript:
(00:00) Today our special guest is Dr. Neeja Reddy, a neurologist; let’s welcome her first. Hello, Neeja garu. Greetings, greetings. You have huge fans on YouTube, not just patients but people who follow your spine care and your way of speaking, and even your sarees! Someone commented : "Madam, you wear a saree only once, if you aren't using them, please give them to us.
(00:27) " So nice, really, having such a following for a doctor is something different; I feel so lucky, I don't know why, but I do. So lucky. Actually, in one of the first comments, some people asked about those doing desk jobs. What are the general neurological problems they face and what precautions should they take? Mainly, software professionals and those in desk jobs tell us their working hours; they work 8 to 10 hours a day, and often if they have clients abroad, they work evening shifts.
(01:02) Night shifts too. Night shifts, those are the timings; starting at 2 PM and stopping at 12 at night. So, their sleep patterns and food timings all change because of these abnormal shifts. They end up eating their night meal after 12, and then they can't fall asleep. If they wake up early the next morning, they don't get enough sleep; so these are somewhat abnormal changes.
(01:29) Another thing I've noticed is that while we also did night shifts in our career, it was fixed, and it all finished before 30. After 30, other health problems arise, it's not very convenient; exactly, so after their 30s too, poor things, they start their jobs at 22 or 20. By the time we used to start, we were already 30.
(01:52) Poor things, at a young age of 22, because of abnormal food and sleep, everything gets damaged, and by the time they hit their 30s, their brain and body both become very aged. Correct. One is sitting positions—keeping the laptop low, or working while lying down ; some people even work from their beds .
(02:13) Because of this abnormal posture, the spine doesn't stay erect, and spondylosis sets in very early. There are people who have even had surgeries at 25 or 26 due to cervical spondylosis . Why? Because of the abnormal posture. Also, they are not doing any diet or exercises at all. We have this feeling that we should exercise after 40, but since they have been sitting since 20, they get these diseases by 40.
(02:40) Degenerative. It happens, so we have no choice but to do it, we must make it a ritual. Follow it properly; I will definitely move for one hour, be it walking or yoga, and avoid eating just anything like burgers or pizzas; we shouldn't do that. We must take a proper balanced diet; our routine dal. Follow a good diet with vegetables; the sitting posture, posture itself tells our age, and we see it change with age; so how we sit is very, very important; when working, one must have a good table and chair; thinking "I'm working
(03:20) from home, I can sit anywhere" is not correct. So, when we are at the office, we take a tea break every few hours, we go out, meet a few people, walk around, and then sit back down. Even if you are working from home, you should have other activities like frequently drinking water, going to the restroom, stepping out, talking to parents, or preparing something in the kitchen.
(03:44) You shouldn't think, "I will relax only after I finish all my work." So, we should start the ritual of a healthy lifestyle from the beginning. That way, even if we are doing a desk job for a long time, we can stay healthy. It feels sad for me to tell 22-year-olds to exercise, and they look at me as if asking, "Are you telling me this at 22?" My son is 16 years old.
(04:10) When I heard his friend got sciatica, Oh! How could they have sciatica at such a young age? True, true. I mean, what could be the problem? I didn't understand. It could be a bit genetic. Their bone structure or disc issues could be genetic. Hmm. We see it now—what should we tell a student going to intermediate who has sciatica? They have to go to a hostel, eat, study, and sit for hours together.
(04:37) It feels sad to tell them to use painkillers. Sciatica drugs all make you sleepy. I have seen many cases, and it is very difficult to suggest surgery to an 18 or 16-year-old. It’s very difficult. We see many cases; it might be genetic or due to their diet from a young age. Sometimes, if there is obesity, it might happen sooner.
(04:59) It is very unfortunate, though very rare. Once it happens at that age, we definitely have to change our lifestyle . In intermediate, they make them sit from morning till night, they aren't used to that. True, true. They have to take breaks in between while they are away from home. I found a very good coach at my gym.
(05:20) Ha ha. He has experimented with a lot of things, like yoga and Pilates. Basically, he is a sportsman. Hmm. So, for those who come with tailbone pain or C3, C4, L4, or L5 problems, he suggests what muscle strengthening exercises would be good, and he personally supervises them using gym equipment and floor exercises.
(05:45) First, tell me every day what your health issue is. Last month, due to continuous long journeys, I got tailbone pain. There is a separate pillow for that, right, which we use for sitting? They said that using that would be enough for three months. Still, when I mentioned it at the gym, he suggested some exercises to strengthen the hip joint muscles so that too much pressure wouldn't be put on it.
(06:09) Believe it or not, the pain that was supposed to take three months to heal went away in a month and a half, and I can sit happily again. Definitely, it's usually called therapy yoga or something similar. Exactly, they must have a good grip on anatomy. Which muscle? Which muscle works where? If I say I can't sit down and get up, then it's this muscle.
(06:26) Correct. If I say I have trouble climbing stairs , then it's this muscle. So, they identify the muscle and focus on it to get great results. If we do it abnormally, sometimes the exercises can even have the opposite effect. Yes, yes. So, a proper therapist is very, very important. Another thing is, as you mentioned earlier, those who work desk jobs for hours at a time.
(06:50) There are some people who, after just a quarter of an hour, get up to do some sit-ups or stretching, and everyone in the office laughs at them. Many people say, "Look at this one, they just sit for 10 minutes and then get up to walk for two minutes, how extra they are." Doctor, what do you tell such people as a doctor? With time, it becomes a routine.
(07:12) They will accept it. Even if we say something when someone around us is fit , deep down, we also have that thought. That we should also do it, so with time , everyone will realize. Instead of being negative, it is better to support that atmosphere from the sidelines. Yes . So, I remember when we were in intermediate, if we got up every half hour or went to the restroom between classes, they would scold us.
(07:36) That you are doing it on purpose. Are you going on purpose? Like, shouldn't we drink water or move around? But I hope they don't do that now; I know everyone knows now that, poor things, they need to go. Awareness has increased a lot. Awareness has increased a lot, meaning there is a lot of health-related information coming in, which has made everyone aware.
(07:56) But at the same time, wrong information is also spreading— "eat this, it will go away,""do this, it will go away." So, both wrong and right information are coming. Yes. So, I tell people many times, you are watching all these videos, but we must think about whether each one applies to our body. Yes. One shouldn't blindly follow just because someone said it.
(08:19) One should question science—what is the reason for this? We need to question and find the answer. True, true, absolutely. My mother says the same thing in the morning, "Oh, these bone pains appear more during the rainy and winter seasons." She says, "I don't have this trouble in summer; I don't have this much pain.
(08:36) " Yes. Why bone pains in winter and rainy seasons? Normally, if someone has arthritis, like rheumatoid arthritis, the joints get a little tighter in the cold. So, in the morning, they go to the stove and put their hands near it, and they feel a bit freer; when placed in cold water, the pain increases.
(08:55) So naturally, when summer comes and the temperature rises, other problems might arise, but these pains subside. Yes. So, for all joint pains, generally, when the temperature is low, the pain is higher. So, with age, they also notice these changes well. At our age, all joints are fine, so we don't notice much of a difference, but as such, the pains increase.
(09:18) However, one doesn't need medication; if you move frequently, the temperature in your body will rise. They keep moving, so that's why they say early in the morning, when you wake up and it's cold, the joints haven't moved yet, so they hurt. As the evening approaches, the pains keep getting relieved. I mean, when talking to many doctors, they told me one thing.
(09:38) One thing is that when going to the dentist, he says that for the last 20 to 25 years, jaw size has been decreasing. Number one, orthopedic specialists are saying that we don't see bones with the same strength as before. Yes. Even people who worked in border security, the Indian Border Security Force, say, "We used to work in such deadly cold, but now there are no people working with that level of dedication, or with such strong physiques.
(10:08) " Even height, people with good height and robust appearances are decreasing; doctors in different sectors and different specializations are all saying this. But who? We generally don't pay attention to it in society, though. When we look at the big, big picture, I've noticed things are becoming quite degenerate, especially in recent times.
(10:30) Regardless of age, are there any cases of people coming to your hospital with these problems at such a young age? True, true. Earlier, we used to see headaches and strokes at a certain age, but that age is shifting. Yes, it's shifting down to the 30s, 20s , and 15s. Most of the rising issues are lifestyle diseases—diabetes, cancer, thyroid—which we bring upon ourselves through an abnormal lifestyle .
(11:03) Once, humans hunted and stayed physically fit. Physical health was important then; whoever was strong was considered superior. It's not like that now; now it's about intellect. We... Are using it more. We are using our brains more. So, who is intelligent now? Strength isn't about being physically strong, but being smart. Correct. Now, even our food is soft, chosen for comfort.
(11:29) If you give a kid a peanut ball to eat, mine won't eat it. If you gave it to me now, I'd laugh, because I ate it when I was young. If I gave it to my daughter now, well ...if we don't put pressure on our bones, they weaken. As evolution progresses, our body and genes know what is needed and what isn't.
(11:51) Wisdom teeth are disappearing because we don't need them; we don't chew as much. The body saves energy by letting go of what's not needed. So, by using our brains more, we are cutting back elsewhere. On the other hand, we are increasing our lifespan. Yes. So, these changes occur. Joint pains and such are all part of the changes we've made.
(12:15) Yes. Kids don't go outside to play actively anymore; they play video games and look at phones. We ourselves tell them to sit and study because it's not the time to play, and exams are coming. Their activity levels drop, and thus, all these diseases are shifting to younger ages.
(12:33) Once, a stroke in a young person meant someone in their 60s, then 50s. Now, it's occurring at much younger ages like 40s and 30s. Yes. Even when we look for a reason, we often don't find one in many people. Many times, we don't even find a cause. So what do we do then? Just like in the old days, we give the same advice: "Eat healthy food and don't take tension.
(12:54) " Science is advancing, and humans are advancing, but physically, we are becoming weaker by the day. Once, people did farm work themselves; now, they get it done. They hire ten people to do the work, yet they are unable to keep up. So, what about those who do the work now? The cost of healthy food has gone up, while unhealthy food has become cheap.
(13:14) Yes. For those working in the fields, they consume too much rice and cut back on vegetables because they are expensive. Even millets have become costly. So, the farmers themselves end up obese despite heavy labor due to a lack of nutritious food. And because of that, they have their own share of problems.
(13:35) Those who can afford it are comfortable now, and those who can afford everything don't strain their bodies. Yes. So they are not well; there is an imbalance, too much or too little. We have to somehow think optimistically that we are living longer compared to before. There was no treatment for many diseases back then.
(13:55) Now treatments have arrived. So we are living long, but the quality of life and health standards are largely decreasing. When I got my daughter vaccinated the other day, I laughed. I mean, I have such a deathly fear of injections even today. I am so afraid that three people have to hold me down to get a blood test.
(14:14) Seeing that, I laughed, thinking, "Oh, they probably think we both are such cowards ." It is very difficult. To get it done, I need about 10 people. I tell everyone, "My daughter is coming for an injection today," and that's it. Even during COVID, for the vaccines, she would fall down and crawl under the bed.
(14:32) I would pull her out from under the bed, saying , "Give it to her, give it to her!" My son, on the other hand, if you hold him tightly, he’s just so small and thin. Holding him is easy. But my daughter, if she resists a little, she can push me away. That's why some help is needed . True, I remember my own experience.
(14:50) Even now, if someone needs to draw my blood, I close my eyes like this, one person has to hold me here, two people have to hold my hands, and the technician complains that they can't find a vein. When they finally find it, they say, "Only air is coming out, nothing else." I get tense thinking, " Oh no, do I have no blood?" Another person nearby says that's not the issue ; the needle just slipped out long ago.
(15:07) When we were studying, we used to take our own blood for some tests. Oh. We just needed a blood sample to put on a slide to observe and learn. So, we had to prick ourselves. In MBBS, there would always be one brave person who would prick themselves, and then everyone would get a drop. I used to wonder, "Should I prick myself or not? Should I?" Poor things, there would always be someone brave enough.
(15:39) I would spend the whole class thinking about whether to do it or not. But now, that fear is completely gone. I mean, after seeing so much... After enduring so many difficult pains, I now tell myself, "Oh, why was I so afraid of injections?" So, I have completely removed that fear. I mean, I have been in the media for several years, right? Guests from 15 or 20 years ago, when I sit them down again to talk about some topic...
(16:08) Hmm. I ask a question, and after talking for five or ten minutes, they ask, "Anjali, what topic are we talking about?" If I say, "Oh, are you forgetting like this? " they say, "You're right, I am forgetting. Why is this happening?" They talk about the topic I asked about just ten minutes ago, and then they suddenly get diverted.
(16:31) They get diverted and start talking about something else. When they ask what the question was, I have to think, "Yes, they are talking about this, what was the question?" and I have to recollect it too. So, this present discussion stays in our working memory—that is, the memory we use right now.
(16:48) So, in working memory, we should do one task at a time. If we are talking about one thing and then think about something else, the working memory's job isn't to store it; it just erases it. So, people say they are multitasking, especially mothers who do ten things; it's not just one, we have something on the stove, tell the maid to do something else, tell the kids something, and do something ourselves.
(17:07) Actually, the brain doesn't do four things at once; it switches; it keeps switching from one task to the next, back and forth. Correct. That flexibility decreases with age. So , we tell many people not to walk while talking on the phone because when your concentration goes to the phone, you don't know what's in front of you; this switching doesn't happen well with age.
(17:29) Multitasking isn't actually efficient; we think we are doing it with ten hands , but we end up lowering the quality of each task. It's better to do one thing at a time; you shouldn't confuse your brain. With age, you shouldn't even attempt that; a common thing people say now is, "I went to the fridge, opened it, but forgot why I came here.
(17:55) " That’s because while going to the fridge, they were thinking about what's on the stove, the kids 'schedule, and their husband's lunch box. When people tell me they are forgetting things, I tell them to slow down, do one thing at a time peacefully, and then move to the next.
(18:16) If it is excessive and comes with age, in some people, it could also be early stages of dementia. Can we identify it early? We can identify it because it changes over time; it progresses and increases. Sometimes, forgetting routes or forgetting the names of people you see very frequently. We also see changes in their personality; maybe someone who never used to socialize now does so excessively.
(18:44) Or, someone who used to be very social becomes an introvert. So, when a person's nature changes, or a patient comes and says, "I am forgetting things a lot." Those around them say, "They say they are forgetting things, but they are also doing all these other things." These things are happening; they never used to visit certain people's houses, but lately, they are going there.
(19:02) They never used to ask anyone for money, but now they are taking money from everyone and spending it excessively. Others will notice these personality changes, and those are what we call red flags. So, if you are forgetting things like keys, it’s risky. If you search for keys, it’s because you keep them in a different place every day, so you will definitely search for them.
(19:21) When you put them down, you are thinking of something else; you aren't concentrating. The mind isn't there. No, forgetting old names can happen. Some people don't remember names; even I don't remember names many times, even the names of people who work for me. Yes. It’s because we didn't pay attention. The focus isn't on the name; the mind is on their problems.
(19:42) Exactly, I remember what their husband does and what their kids do. I just don't remember their name, but I remember all the background information. Exactly. So, that is okay; it is acceptable. Okay. Stress is the most common cause for a decrease in memory. The second is lack of sleep; if you don't sleep well, you won't remember much.
(20:05) So, getting proper sleep, reducing stress, and focusing on one task at a time is more important than multitasking. You might think, viewers, that problems don't just appear out of nowhere. Whether in movies or real life, stories are born from things we see, and I often take questions that people ask me when I'm out, or issues shared by people I know.
(20:29) Like, saying, "I can't sleep, so I'll have a couple of pegs tonight to help me drift off." Starting to drink. Yes. Even after two or three beers or long drinks, people are still sitting up all night without getting any sleep. I see this happening a lot; they fall asleep at 5:30 or 6 in the morning, wake up at 11:30 or 12, and lose half the day to sleep.
(20:53) Then they wake up and think, "Oh no, why is all the work stuck like this?" Then they get anxious and stressed; many people are suffering because they can't break this routine or cycle. So, what would you say to such people? You see, we have a day cycle and a night cycle in our bodies. At night, a hormone called melatonin is produced.
(21:13) Nighttime is meant to be dark . By nighttime, we should eat early and slow down; our digestion also slows down. That's how we drift into sleep. It's a process; the body has a circadian rhythm. It flows according to that rhythm. But we have made many changes to it for our convenience, acting against our bodies. Yes, we use lights, making everything bright at a time when it should be dark at night.
(21:37) Yes. We used to eat before it got dark. But now, we are eating very late. We think, "I want to watch a movie tonight, I'll watch it tonight and sleep tomorrow." We take it for granted that sleep will come eventually. Yes, we actually neglect it a lot. We've done this since childhood. When parents ask me why their kids aren't sleeping at nine, I ask, "Why aren't you sleeping?" and they say, "My kid won't sleep until 12.
(22:08) " It doesn't work like that. If we sleep at nine from the start, turn off the lights, and eat by eight, they will sleep. If you tell them to go to their room while you finish work, watch TV, and use your phone, they won't sleep. It becomes a habit for them. So, we change the subconscious processes happening in our bodies.
(22:31) At first, it starts with, "I have exams, I'll study at night," or "I have work to finish, so I must do it at night." So, we take it for granted. Thinking sleep will come somehow, we change our schedule. Over time, we end up changing our natural rhythm. And it becomes difficult to reset it. We need to slow down by the evening; all processes should slow down.
(22:58) There shouldn't be a rush of calls or tasks at night; if we decide to turn off the lights at nine, we must follow that same schedule every day. We should also cut down on coffee, tea, and excessive water in the evening so we don't have to keep getting up to use the restroom, and our digestion should be mostly complete by the time we go to sleep.
(23:24) So the body needs to go into complete rest , but after abusing it for so many years, we end up destroying it. Hmm. Now, it's common for kids to say, "I studied until 1:00 AM," and we actually feel proud of that. That's it, right? That shouldn't be the way; you should study every day.
(23:43) What is the point of cramming before exams? If you don't sleep the next day, how will you remember anything? You won't. So, once it’s messed up, you need to reset it, meaning you have to fix the root cause of why it got messed up. Many say, "If I use medicine, I'll get addicted to it ." Well, obviously, the medicine is made to help you sleep on the days you take it; if you stop, you'll return to normal.
(24:07) You should exercise during the day and be tired by night; you should feel sleepy as soon as you see the bed. If we use that same bed to look at our phones, use laptops, and watch TV in the bedroom, we won't get those relaxing vibes when we actually go to sleep. That’s why you should do a task only where it belongs.
(24:23) Nowadays, people even put laptops and phones on the dining table; they don't even know what they are eating. Exactly! The bedroom is only for sleep; it shouldn't be used for anything else. If you can't sleep, you shouldn't sit on the bed and turn on your phone again; that's not right. You should actually get out of that room, read a book or something, and only go back when you feel sleepy again .
(24:44) Some people also say, "Drinking turmeric milk helps me sleep." So, we should keep trying these natural methods. If I go to bed at 12:00 and wake up at 7:00, 8:00, or 9:00 AM, how will I feel sleepy again at night? If you wake up at 9:00 AM, will you feel sleepy at 9:00 PM? You won't, right? Exactly. You have to shift that schedule; you need to push yourself to wake up at 6:00 AM for a few days.
(25:06) Only then will you be tired by the evening. People take naps in the afternoon because they didn't sleep at night. If you nap in the afternoon, you won't feel sleepy at night. Kids usually need naps, but adults don't. By 8:00 or 9:00 PM, your eyes should be heavy; that's when you know you're doing well. Correct, correct.
(25:30) So we have to make an active effort for sleep, but when we look at those preparing for competitive exams, intermediate students, or those focused on their careers... They are the same; many are night owls. Actually, it's not a good habit. Thinking, "I only feel like studying at night," is not right. We need to change that schedule.
(25:53) You can't just change it because you feel like it. Even in hostels, they don't make them study all night; they close things down at night and start again in the morning. Can you really study for 12 to 14 hours a day? If you study beyond that, does it even register? It won't stay in the brain; it won't be retained.
(26:11) Many college kids come to the hospital; poor things, they take time out to visit because their parents bring them saying their headache isn't going away. I really don't understand it. I ask them, "What time do you sleep?" They say 11:30 or 12:00. "What time do you wake up?" They say 5:00 AM. What else can I do to reduce their headaches? You need to have memory too, right? You should be able to remember what you studied.
(26:31) That is why when I ask what you do in class, you say, "I keep dozing off in class." I ask parents, "You should tell them that if they sleep like this in a hostel, their daughter will get marks," and they reply, "But everyone else is studying like that." They say that people don't listen to what we tell them.
(26:48) In my house, when I tell my kids, "No phones or laptops at the dining table," they ask, "Do you think this is a hostel?" Aha. This is a home, right? " If you act like a hostel warden holding a stick, we don't feel like staying at home." And moreover, "How can you be this strict?""Nobody is like this, only you are.
(27:05) ""It's very difficult if you are like this.""Only robots will work for you; no human can stay with you." They tell me all this; my daughter used to give me these lectures too. "Other parents gave laptops and iPads, but you aren't giving any.""We need to chat on WhatsApp with friends, do group calls, all these things.
(27:22) " It is very hard to say no, but you have to be firm. Yes. If they know we are negotiating, they will get the upper hand over us. Exactly, they will climb on our heads and dance. They are very smart negotiators, good lawyers, so to speak. Yes. Cut it off right there and say "no"— "no" means no; this topic is not for discussion.
(27:42) Once I say no, it means no, they won't ask again; just tell them, " This is how I am." Fine. So, proper sleep is very, very important. Every parent must ensure that. It's difficult without looking into that. I tell them by 10 o'clock, even if my kids don't sleep, I lie down beside them; I can't wait, I will sleep. I don't know if they fall asleep or not, but they fall asleep in 10 minutes out of boredom.
(28:05) But parenting has become very difficult , hasn't it? A lot, it wasn't like this once. Yes. They used to be afraid once, they are not afraid now. Yes. They have exposure to social media; they see what's happening outside and compare it to how they are. Yes, yes. So, too much knowledge is not good. Knowledge should come in the right way.
(28:28) Many people get carried away by these shortcuts, saying, "My kid learned all this on the phone." Yes, they feel like they know all the technology at a very young age. That knowledge is useless; it's not useful to us. We should learn how to learn; children must know how to learn through proper channels.
(28:46) Yes. So, just because they learned it somehow doesn't mean it's correct because we have to learn for a lifetime , right? Does it end with schooling? It doesn't, right? We must always learn; we still attend conferences and keep learning new things that come up. So, the process of how to remember what you heard once, they must learn that actively.
(29:07) At the age they are supposed to know, if they say "Do you know about this in Japan? Do you know about this in the US?", why do I need all that? It's of no use to us. We don't even have enough time to look at who we are, what our home is, or what the situation is around us. Everyone is busy discussing things that happened somewhere else.
(29:25) Parenting is very difficult indeed. Very troublesome. Right, if we don't do parenting well, no matter how much we achieve in life, we will suffer in the end. That's it, right? One side is our career, the other side is our personal life. Both happen at the same time; career and kids happen in parallel.
(29:42) Those who balance both are successful. If we do well in our career and neglect our family, everyone will notice that. The loss will be felt very, very much after a certain time. There are things to do, but at the same time, there are responsibilities too. Hmm. So we must balance both. True, especially as women, as working ladies, it is a very, very difficult job, a very tough job, very tough.
(30:12) At such times, men keep moving forward in their careers, while ladies face hurdles after hurdles. It is inevitable . It is true, isn't it? A lady recently wrote an article, suggesting that we cannot be equal because our burdens are more, and our responsibilities are more. True, they don't have as much work as we do.
(30:32) They don't, they don't. Perhaps we took it upon ourselves; it seems to have been ingrained in our blood for generations that we must do everything and handle everything ourselves. That is how it is; a lady nurtures a child. My son is four, and the other day he said, "I don't like girls." I raised him, I gave him life, I feed him, his grandmother plays with him, his sister teaches him, his teacher is a lady—with so many women raising a child, for him to say "I don't like girls"...
(31:03) At that young age, even. Mom. That's when I thought, caring and nurturing is our very nature. Bringing a life into the world and raising them is our main responsibility . Correct. Since there is no recognition for that, we have to do all of this too. We end up doing everything. Exactly. If I sit at home for one day, my daughter asks, "Don't you have any work today?" Again, the fear—if we stay home, people ask, "Don't you have work? " Men don't need that.
(31:34) If I want to move up in my career, we still provide the care, saying, "You go ahead, I will look after the family carefully." Does anyone do that for you? No one will. We can't do otherwise, and no one else can do that work either. Who else can do it but a mother? In nature, it's the same with animals, it's the mother.
(31:51) Absolutely, it is our biology. We are caregivers. A career is something we learned later; we chose it. So, if we want to move forward in that, we only get the opportunity if we do this, and if we don't do this, there is no opportunity. So, looking at working ladies, I see many school teachers; they wake up at four, pack all the lunch boxes, leave by six, and travel because their school is in another town . Yes.
(32:18) They want their kids to study in a good school and live in a good area, so they come back at nine at night and get ready for the next day. It's impossible . Men cannot do that job. Only a mother can do that work. It is a great thing, actually. If this were recognized and they were given the respect they deserve, it would be wonderful. It would be wonderful.
(32:40) Instead, telling them, "Stay home, cook , don't you have work in the kitchen? Close the door," and things like that — By not respecting them and treating them with disrespect, they start seeking their own recognition, thinking , "What am I lacking? Why am I less?" Once triggered by the thought, "I am such a perfect person," the lady starts focusing on her personal development; that is what I feel.
(33:04) In the whole process, the thing we neglect is our health. Exactly. 100%. We don't eat on time, we don't sleep on time. Why? Because in a house with young children, we eat the leftovers. That's it. " Oh, should I put this in the dustbin? Why waste it?"" Let's just eat it," and we put it in our stomach; that's exactly it.
(33:19) Then, about exercise, we think, "Why waste another hour? Doing housework is enough." So, we keep health last. By the time the kids are settled and we are about to retire— Our health has drastically declined. They are fine. Yes, they are fine by that time. I see it when they come into the clinic; the husband walks in very neatly, but the wife walks in all hunched over, and it makes me sad.
(33:43) It makes me very sad too. So, she sacrificed for so many years, and now she can't even enjoy things. There is no recognition for that sacrifice; no one says, "Oh, you poor thing, look at what you’ve become." Hmm. Because our health is our responsibility first and foremost; so, if we think our children, career, and our health are all equally important, only then......
(34:08) can we manage it. If you feed them at eight, don't wait until eleven to eat; if you feed them at eight, you should be done eating by 8:30. Or if they eat first, thinking they can work more if they are strong, they can look after their own health. I’ve realized many times that it takes a lot of patience to feed my son; I only have that patience if I eat first.
(34:25) Exactly, otherwise I get angry and end up scolding him. That’s not it; it's more like, "I will eat first, then you eat." That shouldn't be considered selfishness. It shouldn't be called selfish; that is the truth. The idea that everyone else should eat first—those things will change with time, I’m sure.
(34:48) People used to see sacrifice as something great, but I think those changes will come. What is selfish about taking care of your own health? It is mandatory. We don't need someone to buy us special food, but at the very least, a husband should ask, " Did you eat?"" What did you have?" or "Are you in pain anywhere? Can I support you?" If there is a person who can ask that, that life is blessed.
(35:17) We don't need flowers or diamonds like they show in movies; I think those only happen in movies. That only happens in movies; it doesn't happen in real life for anyone. Even if it really happens, true love isn't about that; it's always about responsibility. Responsibility is the most important part. These are all things that come with wisdom and age.
(35:35) Yes. You don't have these thoughts in your 20s. Yes, slowly, one by one, I am learning. I am beginning to understand what life is. Sometimes I think that compared to getting married at 17 or 18 without knowing anything...... marrying now, when children have matured to around 25 or 28 and have some understanding and mental maturity, might be better.
(36:01) Back then, it felt like life just passed by in a blur, not knowing how we had children or how we raised them. I see it—my daughter is 35 now and I'm still giving her advice, and I think, "Oh, I'm still raising a little child." Exactly. All my friends have children under five or ten; they feel they did it very late.
(36:22) I did it early, and I don't feel bad. At the end of the day, it's an advantage; if you finish early, you have one less thing to worry about, and we’ll have more patience when they settle down. Yes, my daughter is nearly 12 now; I am a young mother to her. Yes, I am an old mother to my son. It’s an advantage for my daughter.
(36:43) Correct. Young parents. Many people—I have seen such changes in those aged 35 to 40; after all, I meet doctors quite regularly. Suddenly, a finger gets cramped, or suddenly a hand starts twitching like this. They often say that suddenly a shoulder starts shivering a lot. Why do you think this happens, and is there really a need to take it that seriously? Muscle twitching, or the occasional muscle flickering, is something many people experience; mine has been twitching since yesterday.
(37:15) They say left eye twitching brings bad luck, but I’ve been thinking about it since yesterday—even while at the clinic, it keeps twitching. It’s natural for some muscles to twitch occasionally. Okay. We should worry only if the muscle is getting damaged. How do we know if it’s damaged? Suppose it’s twitching and that arm starts thinning, indicating muscle atrophy.
(37:43) So, if it twitches consistently and you notice other changes in that area, then we should be concerned. Otherwise, occasional twitching can happen, especially due to lack of sleep or high stress; it’s natural, just like an eye twitch. We should observe other changes—not just the twitching—like losing grip in the hands, numbness, things falling, or the arm getting thinner.
(38:16) Something else should accompany it. Oh. So, if it’s only twitching, there’s no need to worry about it at all. Actually, B12 injections. Yes. I’ve heard that vegetarians really need them; it’s my own experience too . When I went to the doctor due to severe dizziness, they found my B12 was very low, and when asked if I was a vegetarian, I said yes. Uh-huh.
(38:35) You might ask because some food bloggers interviewed me in some videos, and they chose non-veg restaurants. I take it as a medicine. I don’t eat it because I like it. It’s like, I eat one piece and feel relieved, thinking, "Finally, I got my medicine, a calcium tablet, some protein" for my body. That’s how I take it; please remember that.
(38:57) Someone commented the other day, "Madam, you said you are a vegetarian, but you ate chicken in that video," and I replied, "Oh dear, eating for a video is different from eating because you like it." What we eat regularly is what matters, right? So, eating it once in a while doesn’t really count. Yes, when we ask if someone is non-veg or vegetarian, we consider once a year or once every six months as still vegetarian, but we classify weekly consumption as non-vegetarian.
(39:18) If we take it once a week, we still consider ourselves vegetarians in our medical history. So, once we start these B12 injections, how often do we need to get them? Normally, if there is a deficiency. For some, it is not in their diet. Even among non-vegetarians who eat it four times a week, some still have low B12 levels.
(39:42) So, there is plenty of B12 in the diet, but there is still a deficiency. Why is that? They need an intrinsic factor in the stomach for B12 absorption. Okay. So, in those with a deficiency, it won’t get absorbed even if they eat it. It’s quite interesting, so don't assume you have enough B12 just because you're eating it.
(39:59) We see this in non-vegetarians too. If you say, "I am a non-vegetarian and I eat it every other day," you can still get a B12 deficiency. So, if non-vegetarians have low levels too, then injections are mandatory for them. Because even if we give them tablets, it might not work since it's already in their diet.
(40:18) So, when there is a severe deficiency, we administer them regularly. We say to take one daily for about five or six days, then once a week for a month, and after that, continue with once a month. One injection a month; whether you get it from your food or not, or whether your body absorbs it or not, if you continue once a month, you won't have that doubt .
(40:39) Okay, and for vegetarians, since it's not in their diet, we can give oral supplements, and it might work. Even if we prescribe B12 tablets, it will improve if they have the absorption. So when it's very low, I shouldn't delay by giving tablets. If it's quite low, I start with injections, and after regular injections, you can try oral supplements as you don't get it from your diet.
(41:11) Checking once in a while doesn't mean stopping tablets and moving to injectables; for many people, tablets keep it well under control. Many people are told to remember and take it occasionally. Even if I say I eat this or that food, levels often don't increase, so supplements have very high doses. Since we provide high doses, we can be confident that at least some will be absorbed; if there's excess, it will just pass through the urine anyway.
(41:45) There is no major issue with that, so if you say you want to correct it only through food, remember that the deficiency in your body didn't happen overnight; it has been there for a while. We shouldn't wait until our body undergoes permanent changes. Correct. Many people ask if they can start with food and take their time to correct the deficiency.
(42:05) I tell them, sure, try to correct it with food. But meanwhile, we should start the treatment to avoid any damage . Later, you can focus on your diet, and we can check again. Correct. But waiting three or four months to see if food works before checking again is not good, as B12 deficiency can cause changes in that time; I always say it’s good to try through diet.
(42:32) But meanwhile, don't neglect the treatment because we would tell you ourselves if the treatment had side effects. Why would you hesitate to start when there are no side effects? We can go ahead and start. I have never seen you wearing nail polish in any of your videos; is there a reason for that? In our profession, we shouldn't wear it because we touch patients.
(42:57) It might not look professional to them; patients might lack confidence if their doctor wears nail polish. I rarely wear it, and even then, I ensure it's not visible. So, appearance is very important. So, what I mean is, it was my dream. I wanted to be a doctor from as early as I can remember.
(43:26) My mother used to say that when they visited a doctor, I would ask, "Will you put my name under your board outside?""Put up another board for me." So back then, how old was I? Two or three years old! I used to pretend to have everything at home back then. I would catch cockroaches, cut them open, and tell my little brother, who got hurt and was bleeding, "Don't tell anyone, I will treat you myself." He was still very young then.
(43:52) My uncle used to say, "You do all your experiments on him." So, even though I didn't really know what a doctor does, there is this image of a doctor, right? That’s why people say, "I felt better the moment I went there," that image is very important. So, I always wanted to become a good lady doctor.
(44:10) Wearing a saree, putting on an apron, holding a stethoscope; I wanted that. I didn't know what they actually did. You have become exactly what you manifested. Yes, that's why as soon as I finished my degree, the first thing I did was learn how to drape a saree. There was one more part left in my dream. So, I learned to drape it properly, and even when my husband asked if all this was necessary, I said, "No, I have to, it’s my dream.
(44:33) " Because of that, does appearance change the treatment or the knowledge of the treatment? No, it doesn't. It doesn't. Yes, yes. But that is my feeling, if I am pleasant in front of the patient, I am giving them that confidence. Correct. So many times, even without any major treatment, they say, "I feel better after coming to you," that’s all just human connection.
(44:55) This doesn't happen over the phone. Many people call and ask, "I have this issue, what should I do?" No, person-to-person contact is necessary. I get very irritated by phone messages; I don't really look at them because I feel you can't get that feeling of seeing the person over the phone. We have to see them.
(45:15) They must come and see me. I've never been interested in online treatments or phone consultations. Everyone complains , "I sent a message, I called, you didn't reply," but I stay away from that as much as possible. Even though I post videos on YouTube, I don't watch YouTube much. I know. At the end of the day, there are comments, and they are mostly very positive and good.
(45:40) Very much so. But I have my mother read them all. I tell her, "Read them and tell me," because sometimes I can't handle the criticism; that's my nature. If someone says something negative, I cry immediately, thinking, "Why did they say this about me?" So that's the problem I’ve been facing lately. Sometimes people even call me and tell me not to make these videos at all.
(46:04) Why? I don't even have the courage to ask that. Forget about it, just let it be. You shouldn't worry about those things. No matter how much good we do, 90 people won't like it; there will always be 10 people who can't stand your progress, or there are many who get jealous if they aren't as beautiful as you, or if you have a great voice and they don't, they can't handle it; there are many such people.
(46:29) But what is the need to express it? They could just keep it inside, right? Exactly. If you want to be angry, you can just keep it inside. Everyone—even someone as great as Gandhi—didn't he have critics? Everything is there, but... Exactly. I feel like this freedom of speech has become excessive; perhaps it’s all Western culture.
(46:49) In our culture, we never speak ill of anyone. Yes. But now, I wonder if our culture is becoming Westernized. When I see other videos and look at the comments, oh my, it scares me. Seeing those comments, I'm afraid to look at my own, so I ask my mother if they are good. She says they wrote very well and asks me about the doubts they raised.
(47:08) I just say " okay, okay, okay." Seeing all that negativity in that community, really... It makes me feel very upset. Good thoughts—everything that comes from our body, like sweat, saliva, or urine, has a bad smell. Even on the day we die, we emit a bad smell. The good thing that comes from us is our words. Our words are our beauty.
(47:32) Everything that comes from our mouth is very important. That is the only good thing that comes from our body; everything else is useless. So, if we use them negatively, that's not good either. We should use our voice where necessary, speak up, and criticize, but in a healthy way. Have you been like this since you were young? With such a cute voice, keeping the volume low? My family wonders why I speak so loudly, but at home, they love me this way—with this thin, small voice, calm and peaceful, like Buddha.
(48:13) I've always been an introvert; I spoke very little when I was young. But my profession has...... made me speak. It forced me to. So, from day one, my intention was that awareness must reach people through proper channels. They should take care of their own health. Sometimes, we see patients coming in four days after suddenly losing vision in one eye.
(48:39) When asked what they did for four days, they say, "It's nothing, I thought something just fell in my eye." For us, a sudden loss of vision is an emergency; we need to rush. But poor them, they don't know it's an emergency. Who is to tell them that this is an emergency and that we should immediately see a primary healthcare provider? We don't have that concept here.
(49:03) So, someone has to tell them, and I realized the only way to reach everyone is the phone. Everyone has a phone in their hand. So, there are only a few diseases that make us run to a neurologist. Paralysis. Bleeding in the brain, strokes, vision loss, loss of gait, sudden incontinence —these are some emergencies. If these happen, you must put aside other things like headaches or dizziness and rush for this.
(49:30) You must rush because we have very little time. There is a short time window in which we can set the patient right. You must be able to act within that golden period. Now, many people think, "I've had this headache for 15-20 years ; I've neglected it all these days." If a headache for 15-20 years hasn't harmed you, it won't do anything in the future either.
(49:49) They just need reassurance; what they did was not neglect. They were trying to cope with it in their own way; that is good. So, that is not an emergency. In many cases , managing that headache is in your hands rather than in medicines. But these are emergencies. Thoughts like, "It's nothing, I'll just take a tablet or buy something from the shop" should not happen.
(50:11) Exactly. So, for people to know all this, somebody has to...... communicate. Communicate with them in their regional language. If things come out in English, they can't understand them, right? I have seen this many times lately; people are coming immediately when they suddenly feel numbness on one side.
(50:30) Or rather, why? Because they are now aware. Earlier, they would put themselves in life-threatening situations, but now, awareness has increased. Now, there is a mnemonic called B-FAST in every place. It is put up everywhere , saying if these stroke symptoms appear, go immediately. Usually, the government consciously took this up; these are concepts created to provide stroke awareness.
(50:51) So, we need to ensure we deliver that, the health awareness. Many people now say, "You are scaring us by saying all this, like saying' if you get sudden numbness, go to the doctor 'feels like you are scaring us." But, if we delay, it really becomes a problem, right? Why would it be scaring? Telling you that you will get a shock if you put your finger in the switch is for awareness, it's not about being afraid that you will get a shock.
(51:14) That's not it, is it? It is all about what happens if you do something and what the possibilities are, just for their awareness, not to scare them. Why would anyone do that? Now, our thinking is like, if someone says something, we ask "Why are they saying this, what do they want from me? " The process is also in us, so whatever is said, along with the positive, we look for the hidden meaning behind it.
(51:35) Ah. People look for that, right? So that is where some friction arises. Just now you mentioned what happens if you suddenly lose vision in one eye. Generally, if there is a problem with the eyes, we think we should go to an eye doctor. When we go to an ophthalmologist, they might not have a neurological perspective.
(51:54) Is there a possibility of missing something there? Suppose you come to me, is there a chance of missing something about the eye? What exactly happens? Usually, there are signs. If a patient says, "I suddenly lost vision on one side," a good doctor will immediately say, "This is not my field."" Go to a neurologist.
(52:12) " If you suddenly cannot see out of one eye, the eye doctor first checks if there is bleeding in the eye or any other issue. When they find nothing, they immediately refer you to a neurologist. If vision is decreasing slowly over a long time, like with cataracts, they handle those themselves. But ophthalmologists will understand.
(52:32) Immediately. That this is a neurological emergency. So, if they listen to the history, they will catch it. Correct, correct. If we don't tell the history and just say, "I came to get my eyes checked," then such things might be missed. So, recently a patient came—an educated school teacher—whose vision decreased and returned three times in the last month.
(52:55) Vision decreased, returned, decreased, returned—three times in the last month. So she went to an eye doctor, and he told her to urgently go to a neurologist, so she came to me. So, this happened in the last three months; it is an emergency because at any minute it could turn into a full-blown stroke. The artery going to the eye comes from a main blood vessel in the brain, so if there is a block there, one whole side could be blocked.
(53:23) So, if they say, "Suddenly my vision went out and came back," we immediately do an angio to see where the blocks are . Based on those blocks, we must start treatment immediately. If one thinks, " Nothing happened to me three times, so I'm fine," the fourth time might not be our lucky day. Correct, correct.
(53:41) Perhaps the clot was breaking up on its own, but if it doesn't break the fourth time, what then? If you come then, the disease has already occurred, and it is actually too late for us. It’s not something you can tell from an MRA or just a scan; you need an angiogram. We can do an angiogram within an MRI; that’s the advantage for the brain, it's called an MR Angio.
(54:01) Okay. You can look at the angiogram during the scan itself, you don’t need to inject dye separately like you do for the heart. Once you do an MR Angio, we will understand. So, they went to an eye doctor, and the eye doctor told them immediately. " This isn't my department; go see a neurologist immediately.
(54:17) " So, they were very well educated. But how did she know this was an emergency? So, now she knows; she found out now. So, others should know it too. That’s why I take notes when I come across things like this. I write them down, thinking, "I need to share this, I need to talk about this." My focus is always on educating the people.
(54:38) Exactly, I love the subject of neurology. I realized I have a talent for simplifying the subject so others can understand; it’s a gift I have. So maybe I can help someone. But you have to be able to identify very minute things, right? It’s a typical job for you, actually. The nerves are so small and thin.
(55:00) Sometimes patients forget to mention small symptoms, thinking, "What does this matter?" but that’s exactly what’s important to us in the end. That’s it, isn't it? We call them red flags, so when we see them, we tell them to get scanned immediately, but it’s hard to communicate that to the patient; they say, "I feel fine now, why are you asking for a scan?" It’s to prevent anything further from happening.
(55:26) We don't know what's happening inside the body. But look, scans are also being abused, right? Yes, yes, yes. So, there are faults on both sides. It’s from this side and that side because healthcare is a business now. Yes. It’s not just healthcare; it’s a healthcare business. You have to show profits, go to public markets, IPOs, and all that.
(55:53) Where does that turnover in crores come from? So, you have targets, just like in software. When corporates get involved, this culture has become more of a... A correct business. That’s why the trust from the patient's side has decreased. From the doctor's side, we feel we must first save ourselves. Hmm. Right, even if they do everything for a patient, sometimes they still say the patient died.
(56:23) It can happen. Didn't people like Jayalalithaa die in a hospital? Yes, even with the best treatment, one can pass away. Ever since that movie* Tagore*came out, people keep saying they put dead patients on ventilators. So, because of all this, we have to be defensive and protect ourselves first, explaining things like this.
(56:41) Yes. It’s not as rosy as it used to be. When I wanted to become a doctor, the image of a doctor was different. It was different, yes. The doctor now... It’s very typical. It’s different, it has changed a lot. I doubt those days will ever return. My daughter says she won't be a doctor; she wants to be a lawyer.
(57:04) Oh, that’s even worse. You come home and are still talking on the phone. Haha, does she think lawyers don't talk ? Who knows? It’s just her age, right? As I said, if you ask people in any job , even government employees face extreme stress. There is no job without stress. Phones have increased the stress; I even work on Sundays because calls come in.
(57:30) I feel that way because, in my profession, it's a matter of life and death, so phone calls are important to me. Why are phone calls important to you? Because higher officials call, and if you don't pick up, they will scold you or hit you. It's like that. Yes. So, those phone calls are mandatory; even if they come at midnight, you have to answer them.
(57:47) So, this is how it is now: they work at the office, they work at home, and they work on holidays. The media is the same, dear. A guest might be called at midnight, or they might say, "Look at this thumbnail, Anjali, delete it urgently," and then I have to wake up my editor. That’s exactly what I don’t understand—everyone is under so much stress, poor things.
(58:04) So much stress, really, oh my god. We are getting children accustomed to stress from a young age. Yes, so to be happy...but no, there is fear that something might happen the next minute. So, with time, there are different goals at different stages. "I must do this at this time,""I must do this at this time.
(58:25) " So, with age, these goals change, and we feel we must change how we work outside. True, some people say supplements should actually be taken on an empty stomach, while others say they should be taken only after a meal. But whether it's calcium or B12, most supplements come in higher doses so that they are absorbed regardless of the conditions.
(58:47) Many people feel uncomfortable taking tablets on an empty stomach. There are only a few specific tablets that must be taken on an empty stomach, like thyroid or gas tablets. In cases of Parkinson's, we prescribe things like Syndopa because they work better on an empty stomach. They work. They work well.
(59:04) Iron tablets also work better on an empty stomach, but many people get gastritis because of them. Yes, some supplements cause gastritis. They do cause it; the supplement or its coating can cause it. People can't handle it, and what we need is for them to take it continuously. So, what we see mostly is that if they take them after eating, or perhaps before going to bed—if we set a fixed time, they remember to take them better .
(59:26) If we set it for the afternoon, they usually forget. So, we set convenient dosing for supplements. They remember well at certain times. Since they are busy in the morning, we tell them, "Take it at this time." If they are supposed to take it for 10 days but only take it properly for four days, that’s a problem.
(59:42) Instead, if you take them for 10 days at a time that is comfortable for you, that is good. We specifically mention which tablets are for an empty stomach. If we don't specify, then it's fine to take them comfortably after a meal. One more thing is that many people take everything together. Instead of doing that... Exactly. You should give some gap.
(1:00:03) If you give some gap, whether it's calcium or omega ...why take everything at once, aren't they all supplements anyway? Some vitamins interrupt the absorption of other vitamins, so if taken together , some won't work properly. So, it's better to give some gap and remember to take them.
(1:00:22) It's good to separate them: one after breakfast, one after lunch, and one after dinner. There are pill boxes for people who have multiple pills, so we tell them to use a pill box to remember, especially for older people, because after a while they might wonder, "Did I take it or not?" and end up taking another one. Yes. So, that’s how they should remember.
(1:00:41) By the way, how is your Wednesday saree plan going? It's going well, it's good. On Wednesdays, I wake up at 6:00 and leave home by 6:30 in the morning. I reach there by 8:30. So, earlier I used to return around 7:30. It was almost 12 hours. 12 hours, 12 hours. Previously, I used to reach late, maybe by 9:30 or 10:00, and leave at 10:00 at night, which left me with absolutely...
(1:01:07) No energy left after that. The next day would become difficult. It gets difficult, yes. So, I made some changes like finishing early by 7:00 and getting home by 9:00 so I can sleep at my usual time. I have a migraine triggered by travel. Very good. I get a headache from traveling. Exactly, once my journey starts, my head aches.
(1:01:30) If my people schedule outdoor work, they say, "Yes, come on, keep your migraine meds ready." It also happens with seaside weather and humidity. So, by the time I reach Chirala, the tablet is already kept on the table. It’s unbearable; you really can't do any work with focus. If I think I'll wait until night, it just gets worse.
(1:01:48) If I take one initially, it gets a bit controlled. There's also a sense of happiness when you take a painkiller, thinking, "Yes, it’s subsiding now, I can work." It's true! One can work with a bit of happiness. So, you have a migraine? I thought I was the only one with that ailment.
(1:02:06) It starts with the journey— oh, it's not normal. It’s much worse during travel. Some of my students have migraines, and they commute every day; I feel bad for them. I ask them, "When will your travel end?" They say, "Next is B.Tech," and then they travel again for that. So, travel and migraine are ... What else? What exactly is the problem? Does it shake up, like do your nerves get agitated? It's that movement, like motion sickness; that’s when the vomiting sensation and headache all start.
(1:02:35) If the road is smooth, it's okay. The road we take to Chirala is bumpy, and by the time we reach, I’m exhausted. It's finished. So, for Chirala alone, I take a painkiller that one day; the other days I'm fine, and there's not much trouble. So, I have actually set numbers for myself now, saying I will only see this many.
(1:02:57) Right. Because I can't see beyond that. If the quality isn't there, we don't feel satisfied ourselves. So, if I see 100 people and miss one diagnosis, that one is very important; it shouldn't happen. Many people actually complain. They say, "You aren't seeing us fast, you're slow, you aren't giving appointments.
(1:03:20) " I mean, quality is more important than quantity . The numbers are fixed, and the hours in the day are fixed. Every day, I put my kids on the school bus at 8:30; I get ready by then, feed them, get them ready, and once I send them off, I head to the hospital. I leave the hospital again at 8:30 at night and reach home by 9:00.
(1:03:44) I take a 10-15 minute lunch break and eat breakfast there at the hospital, which is another 10-15 minutes. There are no other breaks; I just go to the restroom once or twice, that's it. Working beyond that is useless, other than making mistakes. Correct, correct. So, this is all I can do. I say, "Kindly bear with me," but even then, some people scold me.
(1:04:06) Some patients come and say, "My husband is scolding me every day." 10 people scold me and leave in the OP every day. You have to listen and let it go, don't take it to heart. It’s true, I have written down some medical terminology. You mentioned in a video that ASL and MND are different; actually, MND is Motor Neuron Disease, which is Anterior Horn Cell disease, or AHC, and MND is related.
(1:04:39) Ah, AHC, is it ? Okay, okay. So, Motor Neuron Disease is a degenerative disease; it means that once it starts, as we age, the body gradually deteriorates, which we call degeneration. In Motor Neuron Disease, our body has separate nerves for sensation and separate nerves for movement. These are peripheral nerves, and there are different nerves for smell and vision as well, so if we want to move a finger, that is the job of motor neurons.
(1:05:09) Okay. Even though we have sensation, the nerves for movement gradually deteriorate one by one. Oh. So, there is no exact reason why this happens. It can be due to some mutations or genetic changes, and rarely it can run in families. Mostly it appears after 40 or 50, but recently , I've seen about 10 people in their twenties.
(1:05:39) At 20 or 25 years old, first, a finger won't move, then the hand, then the other hand, then legs, then speech, swallowing—I can't get up, I can't walk, I can't breathe. So, it keeps progressing like that. With no treatment; there is no treatment for it. Oh my God, then what do you do for such people? Nothing can be done; that’s the saddest part.
(1:06:07) If a 25-year-old boy asks if he should get married or not, we tell him not to, because this will progress. Another thing is that you are aware of all the difficulties you are going through. Brain functioning remains good, you see. In many disorders, our body is damaged or the brain is damaged, so we don't understand, but here, we are aware of everything.
(1:06:25) So, after a stage—five or six years after the disease starts—a ventilator might even be needed. Because there will be no breathing. So at that stage, we ask if they want a ventilator or not , asking, "Do you want this life, or do you not want this life?" So, that decision has to be made. Since you cannot enjoy your life, most people say they don't want a ventilator.
(1:06:50) At one stage, if food doesn't go down, we tell everyone, "Get a PEG tube inserted, at least the food needs to go inside," but they don't agree. Because they say, "If I get it done, will I get better?""Just tell me that," they say. We tell them food will go in. "What is the use of that food if my body is deteriorating?" they ask.
(1:07:08) So, it's a very, very bad disease. There is no treatment anywhere ; they keep going from place to place. We just have to call it fate. That’s it; it can happen any day, to anyone. Correct, correct. When we were studying, we used to think , "I hope I don't get any disease." I mean, among the diseases you know, which one is the worst? Which one do you not want? Someone says, "I hope I don't get (MND).
(1:07:27) " I used to say, "I hope I don't get dementia." Because if I were to lose my memory and behave like a mad person...and you doctors, " It's great to talk about diseases, friends." Today, if you ask "What do you not want?", I’d say, "God, I hope I don't get paralyzed!" Truly, if there are so many incurable diseases just in neurology, they must exist in other fields too, right? We don't know what kind of disease might come on any given day.
(1:07:54) The innocence of people is that they believe if they go to a doctor, they will be cured of everything. Initially, when I started practicing, I used to get angry if a patient spoke in a certain way, but after a point, I stopped feeling that way because I realized they come to us with their own hardships. Yes, they go through so much without knowing.
(1:08:13) And sometimes, we might not be able to help them either. We shouldn't try to think we are great; we aren't great just because we treat patients. When I say "I can't do anything," I mean: "I am useless for your illness, I cannot help." No doctor can help; the treatment doesn't even exist yet. They keep going from place to place, hoping that some scientist will come up with a treatment and they might see some relief. But yes, there is Dr.
(1:08:40) Gokhale, the cardiologist, he is very famous. For almost 10 years, in every interview —the first, second, and third—he says the same thing: "There is nothing we can do." He expresses it by saying, "We can't do anything; we doctors think we can fix everything, but often, it's not in our hands." Sometimes there is a saying: "Despite the treatment, the patient survived.
(1:09:08) " Meaning, sometimes we aren't able to help through our treatment. There can even be cases where the treatment itself causes harm. Correct. So, "masterly inactivity" means you must know when to be inactive; you shouldn't just do something for the sake of doing it. A doctor shouldn't feel superior, because if the same disease hit us...
(1:09:34) Yes. ... there is nothing we could do either. Now, regarding blood pressure, the idea that there is a fixed limit for BP doesn't really hold up anymore. They say it varies from person to person. As for when to start BP medication, we usually say 140/90. Depending on age, it might be a bit higher in elderly people because their blood vessels harden, so 140 or sometimes even 150 is okay for them.
(1:10:04) But if a pregnant woman comes in, 140 is considered very high; same for children, 140 is very high. It all depends on the age. Also, we look for symptoms. We can see the effects of BP in the eyes, heart, and kidneys. If there are changes in the blood vessels of the eyes...... or changes in the kidneys, or if the heart shows signs of ventricular hypertrophy, it means the organs are being affected by the blood pressure.
(1:10:36) In such cases, we must definitely provide treatment. You might have seen people walking around perfectly fine even with sugar levels at 300. Hmm. While some feel tingling and burning sensations even at 150 or 160. That depends on how their body is; it varies greatly from person to person. Some people live their whole lives with sugar at 400 and feel fine, not even realizing it's that high.
(1:11:03) And sometimes, even those who keep it under good control still develop complications. So, we say there are multiple factors. We don't just look at BP; there could be other unknown factors in their body. We tell them that if parents have diabetes and complications, you will likely get them too.
(1:11:22) Suppose the parents have severe diabetes but are doing perfectly fine; the diabetes you inherit might be the same. So, you might be doing just as well. These are due to other genes in your body—protective genes—so even if you have diabetes, you have protection. Even if you have high BP, you have protection. Many patients say, when I tell them to start medication immediately for a 180 BP reading, "I've had this for 10 or 20 years.
(1:11:42) ""Nothing has happened to me until now, so why are you making me start medicine urgently?" they ask. We don't understand their body's nature, but based on my education, I must prescribe it; I cannot leave it untreated. If I say your BP is high, they say, "It's the same at home, sometimes even 200, but I feel fine.
(1:12:02) " But since every day isn't the same, we tell them to start at least a small tablet. Another thing: kidney patients often have high BP. They are often at 220; those with poor kidney health have a major role in controlling BP, so if it doesn't come under control, we send them to a nephrologist. They are the experts; every kidney patient is often on five or six types of pills to control their blood pressure.
(1:12:34) Okay, okay. So, at a stage, as a neurologist, I manage BP with the knowledge of a physician—since I did my MD before doing my DM. Yes, that's right. I treat BP based on general medicine knowledge, but sometimes if it's complicated and I don't understand, I refer them to a better person—a nephrologist or cardiologist—to find the underlying cause.
(1:13:01) I manage it to a point, but after that, I refer them to other specialties if my experience isn't sufficient. Right, right. Another thing: what is GBS in small children? GBS stands for Guillain-Barré Syndrome ; it affects the nerves, specifically the peripheral nerves outside. Nerves come from the spine to our hands and legs.
(1:13:26) If we get any infection, our body tries to fight it. If a viral infection occurs, like loose motions or a cough, while fighting it, our immune system starts killing our nerves instead of the virus—it attacks our own nervous system. It mistakes it for something else. That’s because the coating of the virus and the coating of our nerves are somewhat similar.
(1:13:52) The body gets confused and its immunity starts killing our nerves, even though the infection subsides. Okay, okay. New symptoms appear day by day. "The first day things slipped from my hands, then I became unsteady, the third day I couldn't get up, and by the fourth day, I couldn't get out of bed.
(1:14:10) " That's how fast it progresses. There were recent outbreaks due to some water contamination; they even reported it in Pune. GBS has been around for a long time, but such a sudden surge of cases is very, very rare. It was like a sudden outbreak from water sources because of an increase in viral infections.
(1:14:30) But GBS is a disease we have been seeing for a long time. The thing is, it’s our own immunity causing the damage, so it's not the virus that's the problem now; we are treating the immune system. We need to lower the immunity entirely, and then the nervous system will recover on its own. It takes a lot of time, but to help recovery, we usually perform a blood exchange for some patients.
(1:14:55) We filter out the entire plasma and infuse different plasma into the body. So, we have to remove all of that. Okay. In some people, there are immunoglobulins; we give them antibodies against the antibodies already in their body. All of this is just to treat the immune system aggressively for five days. After that, we start physiotherapy.
(1:15:17) Recovery might take one month, two months, three months, or even six months for some. Okay, okay. So, this is to ensure the nervous system isn't damaged further, and physiotherapy is for the damage that has already occurred. But you doctors are really great. Watching problems, treating them, and explaining things over and over—we get mentally exhausted.
(1:15:39) Patience is the first trait a doctor must have. Because even if we explain something, they may not understand, so we have to explain it again and again. I have seen some doctors shouting if patients don't listen. They are under a lot of stress, and they have tensions at home too, right? If there is tension at home, who do they take it out on? They take it out on you.
(1:16:04) They haven't eaten. It's lunchtime. That frustration falls on the patient. And they happened to be at the wrong place, at the wrong time, and asked the wrong question. That's it. Because of that question... so, there is one case I remember very well. When I was at NIMHANS, a little boy came in while I was on emergency duty.
(1:16:30) It was night duty, his father was an Uber driver or something. The boy came in because he was just sleeping too much, vomiting, not eating, and had a fever. So, at first, we thought it was GBS. Later, when we checked, there were changes in the brain, so we suspected brainstem encephalitis. So, we take CSF , the fluid from the spine.
(1:16:49) We tested the CSF, couldn't find anything, and started one treatment. He got worse over time, and then his brain swelled. We performed surgery and even took a piece from the brain. Since we couldn't understand what disease it was, we did a brain biopsy; we take a piece from the brain itself.
(1:17:06) In the end, we still couldn't figure out the problem, and even the last specimen didn't show anything. Later, in neurology, we gave him IVIG, plasma exchange, and Rituximab—things related to immunity. We gave him everything, but he didn't respond. Finally, we took all the fluid samples again. Even after taking everything, we found nothing.
(1:17:28) The boy just kept going downhill and passed away within two months. His poor father was there for the first 10 days, but then, to spend money, one has to work, right? Even though NIMHANS is a government hospital, there are nominal charges. For some rare drugs, you have to pay a little, though it is very low compared to outside.
(1:17:49) But still, those nominal charges have to be borne. The poor man had to go to work, and this was his only son, he said. So, they stored his CSF and gave it to me, saying you keep testing this fluid over and over, so I’ll pack it in a sterile container for you. A professor gave it to me, telling me to keep it with me in case I have doubts or need to run a new test.
(1:18:12) So, I still have it with me. It means I always remember him that way . NIMHANS is one of the best institutes in the country and even in Asia. But even after so many professors, assistants, and surgeons examined him, the boy passed away in the end without us ever knowing what it was. Because what we know...
(1:18:35) We still haven't found out. We don't know, we don't know. What we know in science is just the tip of the iceberg. There is still something beyond science. There are many diseases yet to be discovered. So, I keep that with me as a reminder. You are not superior to the patient, and you can't say you are better, because sometimes we might not know anything, even the best of us.
(1:19:04) So, what is this GBS? Can you explain that a bit? It is an autoimmune condition; it’s when our body responds incorrectly to an infection. Okay. Another good thing about this is that it’s not a disease that keeps coming back; it's mostly a one-time thing. It might happen once in a lifetime, but no more than that.
(1:19:26) The most important thing is the treatment. As I said, if we catch it when the very first symptoms appear, it’s treated early. If we catch it when they can’t walk anymore, it’s a late treatment. So, suddenly, rather than just tingling or burning sensations, we lose power in our body; we test all the muscles for strength. Um.
(1:19:48) If his grip has weakened, it means the power has decreased. So, a loss of power is a dangerous sign . So, if I feel like things are slipping from my hands or I can't get up because my legs are failing, that means the loss of power has started, especially after an infection. If that power loss starts, the chances of it being GBS are high.
(1:20:12) We run some tests for it, but proof of GBS doesn't come from tests alone; many things come back normal, and scans often show nothing at all. Okay. We do an NCV test, a nerve test, but it doesn't show anything in the first four or five days. It only picks it up after the condition has progressed a bit.
(1:20:29) So, we shouldn't wait until it gets worse! We don't know after which infection it might occur; it can happen in children, pregnant women, the elderly—it can happen at any age. So, after it occurs, how quickly we treat it is what matters . You asked if we look for the cause— often, we don't.
(1:20:49) Because whatever the reason, the treatment remains the same. We might not find the cause at all. So, we do a few investigations, and if the patient comes on day one, we start the treatment that very same day. But the treatment is very expensive. For GBS, we give IVIG, and it's based on weight. If a child gets it, the cost is lower because they weigh less.
(1:21:10) But for adults weighing 60 or 70 kg, the injections alone can cost 3 to 4 lakhs. So they have to spend it immediately, right? Calf muscle cramps occur, sometimes even in the middle of the night while sleeping. As a sportsman, what I tell people is, if that happens, first get up and walk. Stand up and take a step, it will slowly calm down.
(1:21:31) I will talk about exercises to strengthen the calf muscle. But why do they actually happen? Can we neglect them, or can we recover through exercise? What do you say? Calf muscle cramps are very common, we see this in many people. Dehydration from not drinking enough water is one sign of calf cramps.
(1:21:54) Along with that, there is neuropathy in diabetics, known as diabetic neuropathy , so they can also get cramps. Another thing is certain deficiencies—vitamin D deficiency, or low levels of vitamin E or vitamin D in the body—can also cause cramps when there are such deficiencies. Hmm. So, if anyone comes to us with cramps, the first things I advise are hydration , exercises, and supplements.
(1:22:22) Whether we check or not, many people have deficiencies, so we give them vitamin E and tablets; vitamin D is also low in many people since we don't go out in the sun. That's right. We provide vitamin D. If it doesn't subside after using these, we will investigate further. It's not something to worry about, but they are bothersome and disrupt sleep, right? Very much so.
(1:22:44) So, doing some calf stretches before sleeping. When we use a blanket, we pull it up to our feet, and when we pull it suddenly, they cramp up. Yes, yes. So, pull it up all the way so there are no sudden movements of the feet. In the elderly, they come often without any reason. They can occur without any specific reason too.
(1:23:04) If they don't subside with routine medicines, then we test to see if there is any neuropathy or other issues. Right. Routine investigations are not usually needed for these cramps. Even in the toes and fingers, some cramps occur— some fingers move apart, and some come closer. They can occur due to calcium deficiency, called carpopedal spasms.
(1:23:27) We see this especially in women when calcium levels drop; these cramps occur during the daytime while doing chores, appearing suddenly and then slowly subsiding. Yes. So, that can happen in some women due to calcium deficiency. Okay. So, regularly using calcium supplements after menopause can keep them at bay.
(1:23:48) There are some rare diseases that cause low calcium, like parathyroid gland disorders, but those are very, very rare. So, usually, we start with the first-line treatment. If it doesn't improve, we then investigate rare muscle or calcium-related diseases later on. Recently, I have been hearing one thing very often—fatigue and exhaustion.
(1:24:13) People eat well. Yes. They exercise well, but still, they say they feel very exhausted. Hmm, so can we consider this as a vitamin deficiency? It is possible it could be due to vitamin deficiency or lack of sleep. But there is a disease called Chronic Fatigue Syndrome, where fatigue is the main symptom, lasting beyond three months.
(1:24:36) Okay. They eventually cannot even do exercises. Even a little work causes fatigue, and it feels like having a fever. It is still unknown why this occurs. But in these people, we see blood pressure dropping when standing and some enlargement of glands. Frequent sore throats, frequent fevers, and multiple complaints like body aches —when you look for the cause, you find nothing.
(1:25:04) So, if nothing is found and these symptoms persist for more than three months, we call it Chronic Fatigue Syndrome. Okay. So, we tell those patients to start exercising slowly. Take vitamins because we don't really know why it happens, and there is no specific treatment for it. However, it is important to identify it, because the whole family says you are doing this on purpose.
(1:25:25) They say you are doing it on purpose, yes. So, it is not something you are doing on purpose; if you tell them it is a medical condition, it doesn't matter even if there is no cure. We get that satisfaction. These symptoms didn't come because I thought about them; it's a health problem.
(1:25:43) Many people have this Chronic Fatigue Syndrome, but the family comes and complains, "They are always saying they can't do any work." So, we first check vitamins, and if those are fine, this is a possibility. Some people have aches, aches, and more aches, no appetite, and trouble with urination; they list multiple complaints.
(1:26:04) That is when we say that one person cannot have all these diseases at once. All these diseases don't come together, right? If so many illnesses come together, in neurology, we call it a somatoform disorder. So, I have to give one single reason for all of this. We can't attribute each one to a separate cause, like "this is worn out, ""this is from vitamin deficiency," or "this is from that.
(1:26:25) " Exactly. So, there is one cause: it could sometimes be a symptom of the brain. Meaning, the brain interprets everything happening in the body as pain. The brain is the one that tells us, right? In some people, there is no pain center at all; they don't feel pain in their nerves. We see this in some children from birth; their eyes and fingers get damaged because they keep rubbing them.
(1:26:50) For us, rubbing causes discomfort, but they don't feel the pain. They keep rubbing and rubbing, and their eyes get damaged at a young age. Oh no. They get injured, and their fingers and toes get damaged. This is a disease caused by the absence of pain. Pain is that important to the body. Since our bodies are healthy and we feel pain, we don't touch hot things.
(1:27:10) But for those children, we don't even know what to do ; they don't feel pain, and they end up getting injured everywhere. So, the brain is the one that signals this pain . The hand doesn't say it hurts; the brain says it hurts. So, if someone's body is perfectly fine but the pain doesn't subside, the problem is in their brain.
(1:27:32) The reason for this relates to certain brain hormones and chemicals like serotonin, norepinephrine, and dopamine. Due to changes in these, or a lack of proper hormones in certain pain centers in the brain, these pains can occur. So, in many such cases, we take the help of a psychiatrist. If the pain just won't subside, I need a psychiatrist's help more than a neurologist's.
(1:28:01) But when we ask a patient to go to a psychiatrist, what is the next question they ask? Yes , they cannot accept it. They ask, "Are you saying I am doing this on purpose?" We would say it if we thought they were faking it, but we told them to go to a psychiatrist instead, right? Exactly. So, a neurologist can only treat certain diseases related to the brain.
(1:28:19) Neurologists cannot treat many diseases , so the help of a psychologist or psychiatrist is needed. You see, people often talk about things like "being possessed by a spirit." All these have a psychological basis. But acceptance is very, very low in our society. I recently made a video with a psychiatrist as well.
(1:28:40) People need to know, because 10 percent of patients in a neurology OPD are actually psychiatric patients. They need this help. Yes. But no one is willing to send them. So, there is NIMHANS, which stands for National Institute of Mental Health and Neurological Sciences. Okay. Meaning, psychiatry and neurology work together there, because it's all interconnected.
(1:29:03) They can't actually be separated; if you say I don't have a nerve problem but a psychiatric one, both are related to nerves. Exactly. But we have divided it up as, "I'll handle this, you handle that." So, psychiatrically, depression is something everyone faces. I ask many doctors; even they take antidepressants sometimes, yet those who actually need them don't.
(1:29:29) Because no one is ready to accept it. Correct, correct. So, I often think that in this field, our country is lagging far behind. Just look at other countries. They truly accept it, thinking, "Yes, if I take these tablets, I will recover ," and they believe in it and use them. It means they give a lot of respect to it as a profession.
(1:29:48) Very, very much. Here, psychiatry is often considered a last resort; I wouldn't go to a psychiatrist unless it's an emergency. They won't go. Yes. So, this mental health is a part of neurology. It isn't something one does on purpose. Now, about a patient with depression— I shouldn't mention names.
(1:30:11) Someone who works with me mentioned that a patient had multiple death wishes and later passed away. When there are multiple death wishes and a feeling of wanting to die, it's an emergency. We must act. We think, "Won't they listen if I tell them?" But their brain doesn't listen to anyone at that stage. The feeling of wanting to die, regardless of the hardships, is not something a normal person feels.
(1:30:37) Correct. Well, why didn't they show it to a doctor? They said they thought it was spirit possession. So, we must identify it early. If they attempt suicide for the first time, it's a very big deal; one must see a psychiatrist immediately and start treatment. If not, there's no point in thinking about it later.
(1:30:59) I wondered, do they still not know she is suffering from depression? So, they are saying that for all these years, they thought she was possessed by a spirit, but she is clinically depressed. So that is something we must... Remember. Remember, sudden deaths are happening even in young children, and brain strokes are occurring more frequently with multiple attacks.
(1:31:28) I have seen three cases this year where they collapsed while singing on stage. When I checked their age, they were just 22 or 23. It felt very sad. Were there symptoms before that were neglected, or does it pop up suddenly? Usually, most sudden deaths are heart-related, called cardiac deaths. Rarely, it happens in very young children; we call them crib deaths, where a baby in the cradle dies for no apparent reason.
(1:31:55) There is a disease called SUDEP. It's like an unknown seizure or epilepsy-like condition. In their sleep ...the child is found dead in the morning. It is related to some genes; there are cases in the same family where two children have suddenly died in their sleep before the age of one. So, sometimes it's like a fit or seizure-like disorder.
(1:32:16) In some people, after a certain age, we find that some heart problems were undetected. Mm. Usually, these lifestyle diseases should appear in our 30s and 40s. Yes. I mean, we need time to cause damage to the body, right? Correct. So, if it appears in the 10s or 20s, the first thing we check is whether the organs were formed correctly, meaning there might be some issue with their blood vessel formation.
(1:32:40) There could be. Plus, there might be some problem in their genes as well. So, do these symptoms appear early? Often, in these cases where kids experience sudden cardiac issues, there might be no symptoms, or it's not really an age where they would pay attention to them. Exactly, that's it. So, can they get checked early? It's not really an age to get checked early.
(1:32:59) Even if checked, it might not show up, and we can't get checked specifically for that. We usually just check blood sugar and BP. But they might have this rare problem, a problem that occurs in one out of a court. How do we check for that? We can't. So there could be multiple risk factors, some genetic issue, or something like that.
(1:33:17) If it shows up early with small symptoms, we should feel happy. When it happens like this, there is nothing we can do. So, when it happens suddenly—we recently had an emergency case where a 22- year-old died suddenly. A cardiac death . At that age, you shouldn't have any illness; the body is supposed to be in perfect condition, so you can't even ask if they didn't eat right or anything else.
(1:33:46) But there might be some birth defects. Often, we... Don't know, yeah. We don't know, and we can't search for it beforehand; we can't check everything in everyone, right? Lady, thank you so much for your time. Please forgive me for taking up so much of it; please don't mind. Spending time with you doesn't feel like work at all; I feel so happy.
(1:34:05) Thank you. Thank you so much, viewers. Just like the last episode, if you have any doubts this time, please comment in the comment section below. I will definitely get them clarified by Ma'am in the next episode. Thank you, Ma'am. Thank you so much. Thank you.
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Transcript:
(00:00) Today our special guest is Dr. Neeja Reddy, a neurologist; let’s welcome her first. Hello, Neeja garu. Greetings, greetings. You have huge fans on YouTube, not just patients but people who follow your spine care and your way of speaking, and even your sarees! Someone commented : "Madam, you wear a saree only once, if you aren't using them, please give them to us.
(00:27) " So nice, really, having such a following for a doctor is something different; I feel so lucky, I don't know why, but I do. So lucky. Actually, in one of the first comments, some people asked about those doing desk jobs. What are the general neurological problems they face and what precautions should they take? Mainly, software professionals and those in desk jobs tell us their working hours; they work 8 to 10 hours a day, and often if they have clients abroad, they work evening shifts.
(01:02) Night shifts too. Night shifts, those are the timings; starting at 2 PM and stopping at 12 at night. So, their sleep patterns and food timings all change because of these abnormal shifts. They end up eating their night meal after 12, and then they can't fall asleep. If they wake up early the next morning, they don't get enough sleep; so these are somewhat abnormal changes.
(01:29) Another thing I've noticed is that while we also did night shifts in our career, it was fixed, and it all finished before 30. After 30, other health problems arise, it's not very convenient; exactly, so after their 30s too, poor things, they start their jobs at 22 or 20. By the time we used to start, we were already 30.
(01:52) Poor things, at a young age of 22, because of abnormal food and sleep, everything gets damaged, and by the time they hit their 30s, their brain and body both become very aged. Correct. One is sitting positions—keeping the laptop low, or working while lying down ; some people even work from their beds .
(02:13) Because of this abnormal posture, the spine doesn't stay erect, and spondylosis sets in very early. There are people who have even had surgeries at 25 or 26 due to cervical spondylosis . Why? Because of the abnormal posture. Also, they are not doing any diet or exercises at all. We have this feeling that we should exercise after 40, but since they have been sitting since 20, they get these diseases by 40.
(02:40) Degenerative. It happens, so we have no choice but to do it, we must make it a ritual. Follow it properly; I will definitely move for one hour, be it walking or yoga, and avoid eating just anything like burgers or pizzas; we shouldn't do that. We must take a proper balanced diet; our routine dal. Follow a good diet with vegetables; the sitting posture, posture itself tells our age, and we see it change with age; so how we sit is very, very important; when working, one must have a good table and chair; thinking "I'm working
(03:20) from home, I can sit anywhere" is not correct. So, when we are at the office, we take a tea break every few hours, we go out, meet a few people, walk around, and then sit back down. Even if you are working from home, you should have other activities like frequently drinking water, going to the restroom, stepping out, talking to parents, or preparing something in the kitchen.
(03:44) You shouldn't think, "I will relax only after I finish all my work." So, we should start the ritual of a healthy lifestyle from the beginning. That way, even if we are doing a desk job for a long time, we can stay healthy. It feels sad for me to tell 22-year-olds to exercise, and they look at me as if asking, "Are you telling me this at 22?" My son is 16 years old.
(04:10) When I heard his friend got sciatica, Oh! How could they have sciatica at such a young age? True, true. I mean, what could be the problem? I didn't understand. It could be a bit genetic. Their bone structure or disc issues could be genetic. Hmm. We see it now—what should we tell a student going to intermediate who has sciatica? They have to go to a hostel, eat, study, and sit for hours together.
(04:37) It feels sad to tell them to use painkillers. Sciatica drugs all make you sleepy. I have seen many cases, and it is very difficult to suggest surgery to an 18 or 16-year-old. It’s very difficult. We see many cases; it might be genetic or due to their diet from a young age. Sometimes, if there is obesity, it might happen sooner.
(04:59) It is very unfortunate, though very rare. Once it happens at that age, we definitely have to change our lifestyle . In intermediate, they make them sit from morning till night, they aren't used to that. True, true. They have to take breaks in between while they are away from home. I found a very good coach at my gym.
(05:20) Ha ha. He has experimented with a lot of things, like yoga and Pilates. Basically, he is a sportsman. Hmm. So, for those who come with tailbone pain or C3, C4, L4, or L5 problems, he suggests what muscle strengthening exercises would be good, and he personally supervises them using gym equipment and floor exercises.
(05:45) First, tell me every day what your health issue is. Last month, due to continuous long journeys, I got tailbone pain. There is a separate pillow for that, right, which we use for sitting? They said that using that would be enough for three months. Still, when I mentioned it at the gym, he suggested some exercises to strengthen the hip joint muscles so that too much pressure wouldn't be put on it.
(06:09) Believe it or not, the pain that was supposed to take three months to heal went away in a month and a half, and I can sit happily again. Definitely, it's usually called therapy yoga or something similar. Exactly, they must have a good grip on anatomy. Which muscle? Which muscle works where? If I say I can't sit down and get up, then it's this muscle.
(06:26) Correct. If I say I have trouble climbing stairs , then it's this muscle. So, they identify the muscle and focus on it to get great results. If we do it abnormally, sometimes the exercises can even have the opposite effect. Yes, yes. So, a proper therapist is very, very important. Another thing is, as you mentioned earlier, those who work desk jobs for hours at a time.
(06:50) There are some people who, after just a quarter of an hour, get up to do some sit-ups or stretching, and everyone in the office laughs at them. Many people say, "Look at this one, they just sit for 10 minutes and then get up to walk for two minutes, how extra they are." Doctor, what do you tell such people as a doctor? With time, it becomes a routine.
(07:12) They will accept it. Even if we say something when someone around us is fit , deep down, we also have that thought. That we should also do it, so with time , everyone will realize. Instead of being negative, it is better to support that atmosphere from the sidelines. Yes . So, I remember when we were in intermediate, if we got up every half hour or went to the restroom between classes, they would scold us.
(07:36) That you are doing it on purpose. Are you going on purpose? Like, shouldn't we drink water or move around? But I hope they don't do that now; I know everyone knows now that, poor things, they need to go. Awareness has increased a lot. Awareness has increased a lot, meaning there is a lot of health-related information coming in, which has made everyone aware.
(07:56) But at the same time, wrong information is also spreading— "eat this, it will go away,""do this, it will go away." So, both wrong and right information are coming. Yes. So, I tell people many times, you are watching all these videos, but we must think about whether each one applies to our body. Yes. One shouldn't blindly follow just because someone said it.
(08:19) One should question science—what is the reason for this? We need to question and find the answer. True, true, absolutely. My mother says the same thing in the morning, "Oh, these bone pains appear more during the rainy and winter seasons." She says, "I don't have this trouble in summer; I don't have this much pain.
(08:36) " Yes. Why bone pains in winter and rainy seasons? Normally, if someone has arthritis, like rheumatoid arthritis, the joints get a little tighter in the cold. So, in the morning, they go to the stove and put their hands near it, and they feel a bit freer; when placed in cold water, the pain increases.
(08:55) So naturally, when summer comes and the temperature rises, other problems might arise, but these pains subside. Yes. So, for all joint pains, generally, when the temperature is low, the pain is higher. So, with age, they also notice these changes well. At our age, all joints are fine, so we don't notice much of a difference, but as such, the pains increase.
(09:18) However, one doesn't need medication; if you move frequently, the temperature in your body will rise. They keep moving, so that's why they say early in the morning, when you wake up and it's cold, the joints haven't moved yet, so they hurt. As the evening approaches, the pains keep getting relieved. I mean, when talking to many doctors, they told me one thing.
(09:38) One thing is that when going to the dentist, he says that for the last 20 to 25 years, jaw size has been decreasing. Number one, orthopedic specialists are saying that we don't see bones with the same strength as before. Yes. Even people who worked in border security, the Indian Border Security Force, say, "We used to work in such deadly cold, but now there are no people working with that level of dedication, or with such strong physiques.
(10:08) " Even height, people with good height and robust appearances are decreasing; doctors in different sectors and different specializations are all saying this. But who? We generally don't pay attention to it in society, though. When we look at the big, big picture, I've noticed things are becoming quite degenerate, especially in recent times.
(10:30) Regardless of age, are there any cases of people coming to your hospital with these problems at such a young age? True, true. Earlier, we used to see headaches and strokes at a certain age, but that age is shifting. Yes, it's shifting down to the 30s, 20s , and 15s. Most of the rising issues are lifestyle diseases—diabetes, cancer, thyroid—which we bring upon ourselves through an abnormal lifestyle .
(11:03) Once, humans hunted and stayed physically fit. Physical health was important then; whoever was strong was considered superior. It's not like that now; now it's about intellect. We... Are using it more. We are using our brains more. So, who is intelligent now? Strength isn't about being physically strong, but being smart. Correct. Now, even our food is soft, chosen for comfort.
(11:29) If you give a kid a peanut ball to eat, mine won't eat it. If you gave it to me now, I'd laugh, because I ate it when I was young. If I gave it to my daughter now, well ...if we don't put pressure on our bones, they weaken. As evolution progresses, our body and genes know what is needed and what isn't.
(11:51) Wisdom teeth are disappearing because we don't need them; we don't chew as much. The body saves energy by letting go of what's not needed. So, by using our brains more, we are cutting back elsewhere. On the other hand, we are increasing our lifespan. Yes. So, these changes occur. Joint pains and such are all part of the changes we've made.
(12:15) Yes. Kids don't go outside to play actively anymore; they play video games and look at phones. We ourselves tell them to sit and study because it's not the time to play, and exams are coming. Their activity levels drop, and thus, all these diseases are shifting to younger ages.
(12:33) Once, a stroke in a young person meant someone in their 60s, then 50s. Now, it's occurring at much younger ages like 40s and 30s. Yes. Even when we look for a reason, we often don't find one in many people. Many times, we don't even find a cause. So what do we do then? Just like in the old days, we give the same advice: "Eat healthy food and don't take tension.
(12:54) " Science is advancing, and humans are advancing, but physically, we are becoming weaker by the day. Once, people did farm work themselves; now, they get it done. They hire ten people to do the work, yet they are unable to keep up. So, what about those who do the work now? The cost of healthy food has gone up, while unhealthy food has become cheap.
(13:14) Yes. For those working in the fields, they consume too much rice and cut back on vegetables because they are expensive. Even millets have become costly. So, the farmers themselves end up obese despite heavy labor due to a lack of nutritious food. And because of that, they have their own share of problems.
(13:35) Those who can afford it are comfortable now, and those who can afford everything don't strain their bodies. Yes. So they are not well; there is an imbalance, too much or too little. We have to somehow think optimistically that we are living longer compared to before. There was no treatment for many diseases back then.
(13:55) Now treatments have arrived. So we are living long, but the quality of life and health standards are largely decreasing. When I got my daughter vaccinated the other day, I laughed. I mean, I have such a deathly fear of injections even today. I am so afraid that three people have to hold me down to get a blood test.
(14:14) Seeing that, I laughed, thinking, "Oh, they probably think we both are such cowards ." It is very difficult. To get it done, I need about 10 people. I tell everyone, "My daughter is coming for an injection today," and that's it. Even during COVID, for the vaccines, she would fall down and crawl under the bed.
(14:32) I would pull her out from under the bed, saying , "Give it to her, give it to her!" My son, on the other hand, if you hold him tightly, he’s just so small and thin. Holding him is easy. But my daughter, if she resists a little, she can push me away. That's why some help is needed . True, I remember my own experience.
(14:50) Even now, if someone needs to draw my blood, I close my eyes like this, one person has to hold me here, two people have to hold my hands, and the technician complains that they can't find a vein. When they finally find it, they say, "Only air is coming out, nothing else." I get tense thinking, " Oh no, do I have no blood?" Another person nearby says that's not the issue ; the needle just slipped out long ago.
(15:07) When we were studying, we used to take our own blood for some tests. Oh. We just needed a blood sample to put on a slide to observe and learn. So, we had to prick ourselves. In MBBS, there would always be one brave person who would prick themselves, and then everyone would get a drop. I used to wonder, "Should I prick myself or not? Should I?" Poor things, there would always be someone brave enough.
(15:39) I would spend the whole class thinking about whether to do it or not. But now, that fear is completely gone. I mean, after seeing so much... After enduring so many difficult pains, I now tell myself, "Oh, why was I so afraid of injections?" So, I have completely removed that fear. I mean, I have been in the media for several years, right? Guests from 15 or 20 years ago, when I sit them down again to talk about some topic...
(16:08) Hmm. I ask a question, and after talking for five or ten minutes, they ask, "Anjali, what topic are we talking about?" If I say, "Oh, are you forgetting like this? " they say, "You're right, I am forgetting. Why is this happening?" They talk about the topic I asked about just ten minutes ago, and then they suddenly get diverted.
(16:31) They get diverted and start talking about something else. When they ask what the question was, I have to think, "Yes, they are talking about this, what was the question?" and I have to recollect it too. So, this present discussion stays in our working memory—that is, the memory we use right now.
(16:48) So, in working memory, we should do one task at a time. If we are talking about one thing and then think about something else, the working memory's job isn't to store it; it just erases it. So, people say they are multitasking, especially mothers who do ten things; it's not just one, we have something on the stove, tell the maid to do something else, tell the kids something, and do something ourselves.
(17:07) Actually, the brain doesn't do four things at once; it switches; it keeps switching from one task to the next, back and forth. Correct. That flexibility decreases with age. So , we tell many people not to walk while talking on the phone because when your concentration goes to the phone, you don't know what's in front of you; this switching doesn't happen well with age.
(17:29) Multitasking isn't actually efficient; we think we are doing it with ten hands , but we end up lowering the quality of each task. It's better to do one thing at a time; you shouldn't confuse your brain. With age, you shouldn't even attempt that; a common thing people say now is, "I went to the fridge, opened it, but forgot why I came here.
(17:55) " That’s because while going to the fridge, they were thinking about what's on the stove, the kids 'schedule, and their husband's lunch box. When people tell me they are forgetting things, I tell them to slow down, do one thing at a time peacefully, and then move to the next.
(18:16) If it is excessive and comes with age, in some people, it could also be early stages of dementia. Can we identify it early? We can identify it because it changes over time; it progresses and increases. Sometimes, forgetting routes or forgetting the names of people you see very frequently. We also see changes in their personality; maybe someone who never used to socialize now does so excessively.
(18:44) Or, someone who used to be very social becomes an introvert. So, when a person's nature changes, or a patient comes and says, "I am forgetting things a lot." Those around them say, "They say they are forgetting things, but they are also doing all these other things." These things are happening; they never used to visit certain people's houses, but lately, they are going there.
(19:02) They never used to ask anyone for money, but now they are taking money from everyone and spending it excessively. Others will notice these personality changes, and those are what we call red flags. So, if you are forgetting things like keys, it’s risky. If you search for keys, it’s because you keep them in a different place every day, so you will definitely search for them.
(19:21) When you put them down, you are thinking of something else; you aren't concentrating. The mind isn't there. No, forgetting old names can happen. Some people don't remember names; even I don't remember names many times, even the names of people who work for me. Yes. It’s because we didn't pay attention. The focus isn't on the name; the mind is on their problems.
(19:42) Exactly, I remember what their husband does and what their kids do. I just don't remember their name, but I remember all the background information. Exactly. So, that is okay; it is acceptable. Okay. Stress is the most common cause for a decrease in memory. The second is lack of sleep; if you don't sleep well, you won't remember much.
(20:05) So, getting proper sleep, reducing stress, and focusing on one task at a time is more important than multitasking. You might think, viewers, that problems don't just appear out of nowhere. Whether in movies or real life, stories are born from things we see, and I often take questions that people ask me when I'm out, or issues shared by people I know.
(20:29) Like, saying, "I can't sleep, so I'll have a couple of pegs tonight to help me drift off." Starting to drink. Yes. Even after two or three beers or long drinks, people are still sitting up all night without getting any sleep. I see this happening a lot; they fall asleep at 5:30 or 6 in the morning, wake up at 11:30 or 12, and lose half the day to sleep.
(20:53) Then they wake up and think, "Oh no, why is all the work stuck like this?" Then they get anxious and stressed; many people are suffering because they can't break this routine or cycle. So, what would you say to such people? You see, we have a day cycle and a night cycle in our bodies. At night, a hormone called melatonin is produced.
(21:13) Nighttime is meant to be dark . By nighttime, we should eat early and slow down; our digestion also slows down. That's how we drift into sleep. It's a process; the body has a circadian rhythm. It flows according to that rhythm. But we have made many changes to it for our convenience, acting against our bodies. Yes, we use lights, making everything bright at a time when it should be dark at night.
(21:37) Yes. We used to eat before it got dark. But now, we are eating very late. We think, "I want to watch a movie tonight, I'll watch it tonight and sleep tomorrow." We take it for granted that sleep will come eventually. Yes, we actually neglect it a lot. We've done this since childhood. When parents ask me why their kids aren't sleeping at nine, I ask, "Why aren't you sleeping?" and they say, "My kid won't sleep until 12.
(22:08) " It doesn't work like that. If we sleep at nine from the start, turn off the lights, and eat by eight, they will sleep. If you tell them to go to their room while you finish work, watch TV, and use your phone, they won't sleep. It becomes a habit for them. So, we change the subconscious processes happening in our bodies.
(22:31) At first, it starts with, "I have exams, I'll study at night," or "I have work to finish, so I must do it at night." So, we take it for granted. Thinking sleep will come somehow, we change our schedule. Over time, we end up changing our natural rhythm. And it becomes difficult to reset it. We need to slow down by the evening; all processes should slow down.
(22:58) There shouldn't be a rush of calls or tasks at night; if we decide to turn off the lights at nine, we must follow that same schedule every day. We should also cut down on coffee, tea, and excessive water in the evening so we don't have to keep getting up to use the restroom, and our digestion should be mostly complete by the time we go to sleep.
(23:24) So the body needs to go into complete rest , but after abusing it for so many years, we end up destroying it. Hmm. Now, it's common for kids to say, "I studied until 1:00 AM," and we actually feel proud of that. That's it, right? That shouldn't be the way; you should study every day.
(23:43) What is the point of cramming before exams? If you don't sleep the next day, how will you remember anything? You won't. So, once it’s messed up, you need to reset it, meaning you have to fix the root cause of why it got messed up. Many say, "If I use medicine, I'll get addicted to it ." Well, obviously, the medicine is made to help you sleep on the days you take it; if you stop, you'll return to normal.
(24:07) You should exercise during the day and be tired by night; you should feel sleepy as soon as you see the bed. If we use that same bed to look at our phones, use laptops, and watch TV in the bedroom, we won't get those relaxing vibes when we actually go to sleep. That’s why you should do a task only where it belongs.
(24:23) Nowadays, people even put laptops and phones on the dining table; they don't even know what they are eating. Exactly! The bedroom is only for sleep; it shouldn't be used for anything else. If you can't sleep, you shouldn't sit on the bed and turn on your phone again; that's not right. You should actually get out of that room, read a book or something, and only go back when you feel sleepy again .
(24:44) Some people also say, "Drinking turmeric milk helps me sleep." So, we should keep trying these natural methods. If I go to bed at 12:00 and wake up at 7:00, 8:00, or 9:00 AM, how will I feel sleepy again at night? If you wake up at 9:00 AM, will you feel sleepy at 9:00 PM? You won't, right? Exactly. You have to shift that schedule; you need to push yourself to wake up at 6:00 AM for a few days.
(25:06) Only then will you be tired by the evening. People take naps in the afternoon because they didn't sleep at night. If you nap in the afternoon, you won't feel sleepy at night. Kids usually need naps, but adults don't. By 8:00 or 9:00 PM, your eyes should be heavy; that's when you know you're doing well. Correct, correct.
(25:30) So we have to make an active effort for sleep, but when we look at those preparing for competitive exams, intermediate students, or those focused on their careers... They are the same; many are night owls. Actually, it's not a good habit. Thinking, "I only feel like studying at night," is not right. We need to change that schedule.
(25:53) You can't just change it because you feel like it. Even in hostels, they don't make them study all night; they close things down at night and start again in the morning. Can you really study for 12 to 14 hours a day? If you study beyond that, does it even register? It won't stay in the brain; it won't be retained.
(26:11) Many college kids come to the hospital; poor things, they take time out to visit because their parents bring them saying their headache isn't going away. I really don't understand it. I ask them, "What time do you sleep?" They say 11:30 or 12:00. "What time do you wake up?" They say 5:00 AM. What else can I do to reduce their headaches? You need to have memory too, right? You should be able to remember what you studied.
(26:31) That is why when I ask what you do in class, you say, "I keep dozing off in class." I ask parents, "You should tell them that if they sleep like this in a hostel, their daughter will get marks," and they reply, "But everyone else is studying like that." They say that people don't listen to what we tell them.
(26:48) In my house, when I tell my kids, "No phones or laptops at the dining table," they ask, "Do you think this is a hostel?" Aha. This is a home, right? " If you act like a hostel warden holding a stick, we don't feel like staying at home." And moreover, "How can you be this strict?""Nobody is like this, only you are.
(27:05) ""It's very difficult if you are like this.""Only robots will work for you; no human can stay with you." They tell me all this; my daughter used to give me these lectures too. "Other parents gave laptops and iPads, but you aren't giving any.""We need to chat on WhatsApp with friends, do group calls, all these things.
(27:22) " It is very hard to say no, but you have to be firm. Yes. If they know we are negotiating, they will get the upper hand over us. Exactly, they will climb on our heads and dance. They are very smart negotiators, good lawyers, so to speak. Yes. Cut it off right there and say "no"— "no" means no; this topic is not for discussion.
(27:42) Once I say no, it means no, they won't ask again; just tell them, " This is how I am." Fine. So, proper sleep is very, very important. Every parent must ensure that. It's difficult without looking into that. I tell them by 10 o'clock, even if my kids don't sleep, I lie down beside them; I can't wait, I will sleep. I don't know if they fall asleep or not, but they fall asleep in 10 minutes out of boredom.
(28:05) But parenting has become very difficult , hasn't it? A lot, it wasn't like this once. Yes. They used to be afraid once, they are not afraid now. Yes. They have exposure to social media; they see what's happening outside and compare it to how they are. Yes, yes. So, too much knowledge is not good. Knowledge should come in the right way.
(28:28) Many people get carried away by these shortcuts, saying, "My kid learned all this on the phone." Yes, they feel like they know all the technology at a very young age. That knowledge is useless; it's not useful to us. We should learn how to learn; children must know how to learn through proper channels.
(28:46) Yes. So, just because they learned it somehow doesn't mean it's correct because we have to learn for a lifetime , right? Does it end with schooling? It doesn't, right? We must always learn; we still attend conferences and keep learning new things that come up. So, the process of how to remember what you heard once, they must learn that actively.
(29:07) At the age they are supposed to know, if they say "Do you know about this in Japan? Do you know about this in the US?", why do I need all that? It's of no use to us. We don't even have enough time to look at who we are, what our home is, or what the situation is around us. Everyone is busy discussing things that happened somewhere else.
(29:25) Parenting is very difficult indeed. Very troublesome. Right, if we don't do parenting well, no matter how much we achieve in life, we will suffer in the end. That's it, right? One side is our career, the other side is our personal life. Both happen at the same time; career and kids happen in parallel.
(29:42) Those who balance both are successful. If we do well in our career and neglect our family, everyone will notice that. The loss will be felt very, very much after a certain time. There are things to do, but at the same time, there are responsibilities too. Hmm. So we must balance both. True, especially as women, as working ladies, it is a very, very difficult job, a very tough job, very tough.
(30:12) At such times, men keep moving forward in their careers, while ladies face hurdles after hurdles. It is inevitable . It is true, isn't it? A lady recently wrote an article, suggesting that we cannot be equal because our burdens are more, and our responsibilities are more. True, they don't have as much work as we do.
(30:32) They don't, they don't. Perhaps we took it upon ourselves; it seems to have been ingrained in our blood for generations that we must do everything and handle everything ourselves. That is how it is; a lady nurtures a child. My son is four, and the other day he said, "I don't like girls." I raised him, I gave him life, I feed him, his grandmother plays with him, his sister teaches him, his teacher is a lady—with so many women raising a child, for him to say "I don't like girls"...
(31:03) At that young age, even. Mom. That's when I thought, caring and nurturing is our very nature. Bringing a life into the world and raising them is our main responsibility . Correct. Since there is no recognition for that, we have to do all of this too. We end up doing everything. Exactly. If I sit at home for one day, my daughter asks, "Don't you have any work today?" Again, the fear—if we stay home, people ask, "Don't you have work? " Men don't need that.
(31:34) If I want to move up in my career, we still provide the care, saying, "You go ahead, I will look after the family carefully." Does anyone do that for you? No one will. We can't do otherwise, and no one else can do that work either. Who else can do it but a mother? In nature, it's the same with animals, it's the mother.
(31:51) Absolutely, it is our biology. We are caregivers. A career is something we learned later; we chose it. So, if we want to move forward in that, we only get the opportunity if we do this, and if we don't do this, there is no opportunity. So, looking at working ladies, I see many school teachers; they wake up at four, pack all the lunch boxes, leave by six, and travel because their school is in another town . Yes.
(32:18) They want their kids to study in a good school and live in a good area, so they come back at nine at night and get ready for the next day. It's impossible . Men cannot do that job. Only a mother can do that work. It is a great thing, actually. If this were recognized and they were given the respect they deserve, it would be wonderful. It would be wonderful.
(32:40) Instead, telling them, "Stay home, cook , don't you have work in the kitchen? Close the door," and things like that — By not respecting them and treating them with disrespect, they start seeking their own recognition, thinking , "What am I lacking? Why am I less?" Once triggered by the thought, "I am such a perfect person," the lady starts focusing on her personal development; that is what I feel.
(33:04) In the whole process, the thing we neglect is our health. Exactly. 100%. We don't eat on time, we don't sleep on time. Why? Because in a house with young children, we eat the leftovers. That's it. " Oh, should I put this in the dustbin? Why waste it?"" Let's just eat it," and we put it in our stomach; that's exactly it.
(33:19) Then, about exercise, we think, "Why waste another hour? Doing housework is enough." So, we keep health last. By the time the kids are settled and we are about to retire— Our health has drastically declined. They are fine. Yes, they are fine by that time. I see it when they come into the clinic; the husband walks in very neatly, but the wife walks in all hunched over, and it makes me sad.
(33:43) It makes me very sad too. So, she sacrificed for so many years, and now she can't even enjoy things. There is no recognition for that sacrifice; no one says, "Oh, you poor thing, look at what you’ve become." Hmm. Because our health is our responsibility first and foremost; so, if we think our children, career, and our health are all equally important, only then......
(34:08) can we manage it. If you feed them at eight, don't wait until eleven to eat; if you feed them at eight, you should be done eating by 8:30. Or if they eat first, thinking they can work more if they are strong, they can look after their own health. I’ve realized many times that it takes a lot of patience to feed my son; I only have that patience if I eat first.
(34:25) Exactly, otherwise I get angry and end up scolding him. That’s not it; it's more like, "I will eat first, then you eat." That shouldn't be considered selfishness. It shouldn't be called selfish; that is the truth. The idea that everyone else should eat first—those things will change with time, I’m sure.
(34:48) People used to see sacrifice as something great, but I think those changes will come. What is selfish about taking care of your own health? It is mandatory. We don't need someone to buy us special food, but at the very least, a husband should ask, " Did you eat?"" What did you have?" or "Are you in pain anywhere? Can I support you?" If there is a person who can ask that, that life is blessed.
(35:17) We don't need flowers or diamonds like they show in movies; I think those only happen in movies. That only happens in movies; it doesn't happen in real life for anyone. Even if it really happens, true love isn't about that; it's always about responsibility. Responsibility is the most important part. These are all things that come with wisdom and age.
(35:35) Yes. You don't have these thoughts in your 20s. Yes, slowly, one by one, I am learning. I am beginning to understand what life is. Sometimes I think that compared to getting married at 17 or 18 without knowing anything...... marrying now, when children have matured to around 25 or 28 and have some understanding and mental maturity, might be better.
(36:01) Back then, it felt like life just passed by in a blur, not knowing how we had children or how we raised them. I see it—my daughter is 35 now and I'm still giving her advice, and I think, "Oh, I'm still raising a little child." Exactly. All my friends have children under five or ten; they feel they did it very late.
(36:22) I did it early, and I don't feel bad. At the end of the day, it's an advantage; if you finish early, you have one less thing to worry about, and we’ll have more patience when they settle down. Yes, my daughter is nearly 12 now; I am a young mother to her. Yes, I am an old mother to my son. It’s an advantage for my daughter.
(36:43) Correct. Young parents. Many people—I have seen such changes in those aged 35 to 40; after all, I meet doctors quite regularly. Suddenly, a finger gets cramped, or suddenly a hand starts twitching like this. They often say that suddenly a shoulder starts shivering a lot. Why do you think this happens, and is there really a need to take it that seriously? Muscle twitching, or the occasional muscle flickering, is something many people experience; mine has been twitching since yesterday.
(37:15) They say left eye twitching brings bad luck, but I’ve been thinking about it since yesterday—even while at the clinic, it keeps twitching. It’s natural for some muscles to twitch occasionally. Okay. We should worry only if the muscle is getting damaged. How do we know if it’s damaged? Suppose it’s twitching and that arm starts thinning, indicating muscle atrophy.
(37:43) So, if it twitches consistently and you notice other changes in that area, then we should be concerned. Otherwise, occasional twitching can happen, especially due to lack of sleep or high stress; it’s natural, just like an eye twitch. We should observe other changes—not just the twitching—like losing grip in the hands, numbness, things falling, or the arm getting thinner.
(38:16) Something else should accompany it. Oh. So, if it’s only twitching, there’s no need to worry about it at all. Actually, B12 injections. Yes. I’ve heard that vegetarians really need them; it’s my own experience too . When I went to the doctor due to severe dizziness, they found my B12 was very low, and when asked if I was a vegetarian, I said yes. Uh-huh.
(38:35) You might ask because some food bloggers interviewed me in some videos, and they chose non-veg restaurants. I take it as a medicine. I don’t eat it because I like it. It’s like, I eat one piece and feel relieved, thinking, "Finally, I got my medicine, a calcium tablet, some protein" for my body. That’s how I take it; please remember that.
(38:57) Someone commented the other day, "Madam, you said you are a vegetarian, but you ate chicken in that video," and I replied, "Oh dear, eating for a video is different from eating because you like it." What we eat regularly is what matters, right? So, eating it once in a while doesn’t really count. Yes, when we ask if someone is non-veg or vegetarian, we consider once a year or once every six months as still vegetarian, but we classify weekly consumption as non-vegetarian.
(39:18) If we take it once a week, we still consider ourselves vegetarians in our medical history. So, once we start these B12 injections, how often do we need to get them? Normally, if there is a deficiency. For some, it is not in their diet. Even among non-vegetarians who eat it four times a week, some still have low B12 levels.
(39:42) So, there is plenty of B12 in the diet, but there is still a deficiency. Why is that? They need an intrinsic factor in the stomach for B12 absorption. Okay. So, in those with a deficiency, it won’t get absorbed even if they eat it. It’s quite interesting, so don't assume you have enough B12 just because you're eating it.
(39:59) We see this in non-vegetarians too. If you say, "I am a non-vegetarian and I eat it every other day," you can still get a B12 deficiency. So, if non-vegetarians have low levels too, then injections are mandatory for them. Because even if we give them tablets, it might not work since it's already in their diet.
(40:18) So, when there is a severe deficiency, we administer them regularly. We say to take one daily for about five or six days, then once a week for a month, and after that, continue with once a month. One injection a month; whether you get it from your food or not, or whether your body absorbs it or not, if you continue once a month, you won't have that doubt .
(40:39) Okay, and for vegetarians, since it's not in their diet, we can give oral supplements, and it might work. Even if we prescribe B12 tablets, it will improve if they have the absorption. So when it's very low, I shouldn't delay by giving tablets. If it's quite low, I start with injections, and after regular injections, you can try oral supplements as you don't get it from your diet.
(41:11) Checking once in a while doesn't mean stopping tablets and moving to injectables; for many people, tablets keep it well under control. Many people are told to remember and take it occasionally. Even if I say I eat this or that food, levels often don't increase, so supplements have very high doses. Since we provide high doses, we can be confident that at least some will be absorbed; if there's excess, it will just pass through the urine anyway.
(41:45) There is no major issue with that, so if you say you want to correct it only through food, remember that the deficiency in your body didn't happen overnight; it has been there for a while. We shouldn't wait until our body undergoes permanent changes. Correct. Many people ask if they can start with food and take their time to correct the deficiency.
(42:05) I tell them, sure, try to correct it with food. But meanwhile, we should start the treatment to avoid any damage . Later, you can focus on your diet, and we can check again. Correct. But waiting three or four months to see if food works before checking again is not good, as B12 deficiency can cause changes in that time; I always say it’s good to try through diet.
(42:32) But meanwhile, don't neglect the treatment because we would tell you ourselves if the treatment had side effects. Why would you hesitate to start when there are no side effects? We can go ahead and start. I have never seen you wearing nail polish in any of your videos; is there a reason for that? In our profession, we shouldn't wear it because we touch patients.
(42:57) It might not look professional to them; patients might lack confidence if their doctor wears nail polish. I rarely wear it, and even then, I ensure it's not visible. So, appearance is very important. So, what I mean is, it was my dream. I wanted to be a doctor from as early as I can remember.
(43:26) My mother used to say that when they visited a doctor, I would ask, "Will you put my name under your board outside?""Put up another board for me." So back then, how old was I? Two or three years old! I used to pretend to have everything at home back then. I would catch cockroaches, cut them open, and tell my little brother, who got hurt and was bleeding, "Don't tell anyone, I will treat you myself." He was still very young then.
(43:52) My uncle used to say, "You do all your experiments on him." So, even though I didn't really know what a doctor does, there is this image of a doctor, right? That’s why people say, "I felt better the moment I went there," that image is very important. So, I always wanted to become a good lady doctor.
(44:10) Wearing a saree, putting on an apron, holding a stethoscope; I wanted that. I didn't know what they actually did. You have become exactly what you manifested. Yes, that's why as soon as I finished my degree, the first thing I did was learn how to drape a saree. There was one more part left in my dream. So, I learned to drape it properly, and even when my husband asked if all this was necessary, I said, "No, I have to, it’s my dream.
(44:33) " Because of that, does appearance change the treatment or the knowledge of the treatment? No, it doesn't. It doesn't. Yes, yes. But that is my feeling, if I am pleasant in front of the patient, I am giving them that confidence. Correct. So many times, even without any major treatment, they say, "I feel better after coming to you," that’s all just human connection.
(44:55) This doesn't happen over the phone. Many people call and ask, "I have this issue, what should I do?" No, person-to-person contact is necessary. I get very irritated by phone messages; I don't really look at them because I feel you can't get that feeling of seeing the person over the phone. We have to see them.
(45:15) They must come and see me. I've never been interested in online treatments or phone consultations. Everyone complains , "I sent a message, I called, you didn't reply," but I stay away from that as much as possible. Even though I post videos on YouTube, I don't watch YouTube much. I know. At the end of the day, there are comments, and they are mostly very positive and good.
(45:40) Very much so. But I have my mother read them all. I tell her, "Read them and tell me," because sometimes I can't handle the criticism; that's my nature. If someone says something negative, I cry immediately, thinking, "Why did they say this about me?" So that's the problem I’ve been facing lately. Sometimes people even call me and tell me not to make these videos at all.
(46:04) Why? I don't even have the courage to ask that. Forget about it, just let it be. You shouldn't worry about those things. No matter how much good we do, 90 people won't like it; there will always be 10 people who can't stand your progress, or there are many who get jealous if they aren't as beautiful as you, or if you have a great voice and they don't, they can't handle it; there are many such people.
(46:29) But what is the need to express it? They could just keep it inside, right? Exactly. If you want to be angry, you can just keep it inside. Everyone—even someone as great as Gandhi—didn't he have critics? Everything is there, but... Exactly. I feel like this freedom of speech has become excessive; perhaps it’s all Western culture.
(46:49) In our culture, we never speak ill of anyone. Yes. But now, I wonder if our culture is becoming Westernized. When I see other videos and look at the comments, oh my, it scares me. Seeing those comments, I'm afraid to look at my own, so I ask my mother if they are good. She says they wrote very well and asks me about the doubts they raised.
(47:08) I just say " okay, okay, okay." Seeing all that negativity in that community, really... It makes me feel very upset. Good thoughts—everything that comes from our body, like sweat, saliva, or urine, has a bad smell. Even on the day we die, we emit a bad smell. The good thing that comes from us is our words. Our words are our beauty.
(47:32) Everything that comes from our mouth is very important. That is the only good thing that comes from our body; everything else is useless. So, if we use them negatively, that's not good either. We should use our voice where necessary, speak up, and criticize, but in a healthy way. Have you been like this since you were young? With such a cute voice, keeping the volume low? My family wonders why I speak so loudly, but at home, they love me this way—with this thin, small voice, calm and peaceful, like Buddha.
(48:13) I've always been an introvert; I spoke very little when I was young. But my profession has...... made me speak. It forced me to. So, from day one, my intention was that awareness must reach people through proper channels. They should take care of their own health. Sometimes, we see patients coming in four days after suddenly losing vision in one eye.
(48:39) When asked what they did for four days, they say, "It's nothing, I thought something just fell in my eye." For us, a sudden loss of vision is an emergency; we need to rush. But poor them, they don't know it's an emergency. Who is to tell them that this is an emergency and that we should immediately see a primary healthcare provider? We don't have that concept here.
(49:03) So, someone has to tell them, and I realized the only way to reach everyone is the phone. Everyone has a phone in their hand. So, there are only a few diseases that make us run to a neurologist. Paralysis. Bleeding in the brain, strokes, vision loss, loss of gait, sudden incontinence —these are some emergencies. If these happen, you must put aside other things like headaches or dizziness and rush for this.
(49:30) You must rush because we have very little time. There is a short time window in which we can set the patient right. You must be able to act within that golden period. Now, many people think, "I've had this headache for 15-20 years ; I've neglected it all these days." If a headache for 15-20 years hasn't harmed you, it won't do anything in the future either.
(49:49) They just need reassurance; what they did was not neglect. They were trying to cope with it in their own way; that is good. So, that is not an emergency. In many cases , managing that headache is in your hands rather than in medicines. But these are emergencies. Thoughts like, "It's nothing, I'll just take a tablet or buy something from the shop" should not happen.
(50:11) Exactly. So, for people to know all this, somebody has to...... communicate. Communicate with them in their regional language. If things come out in English, they can't understand them, right? I have seen this many times lately; people are coming immediately when they suddenly feel numbness on one side.
(50:30) Or rather, why? Because they are now aware. Earlier, they would put themselves in life-threatening situations, but now, awareness has increased. Now, there is a mnemonic called B-FAST in every place. It is put up everywhere , saying if these stroke symptoms appear, go immediately. Usually, the government consciously took this up; these are concepts created to provide stroke awareness.
(50:51) So, we need to ensure we deliver that, the health awareness. Many people now say, "You are scaring us by saying all this, like saying' if you get sudden numbness, go to the doctor 'feels like you are scaring us." But, if we delay, it really becomes a problem, right? Why would it be scaring? Telling you that you will get a shock if you put your finger in the switch is for awareness, it's not about being afraid that you will get a shock.
(51:14) That's not it, is it? It is all about what happens if you do something and what the possibilities are, just for their awareness, not to scare them. Why would anyone do that? Now, our thinking is like, if someone says something, we ask "Why are they saying this, what do they want from me? " The process is also in us, so whatever is said, along with the positive, we look for the hidden meaning behind it.
(51:35) Ah. People look for that, right? So that is where some friction arises. Just now you mentioned what happens if you suddenly lose vision in one eye. Generally, if there is a problem with the eyes, we think we should go to an eye doctor. When we go to an ophthalmologist, they might not have a neurological perspective.
(51:54) Is there a possibility of missing something there? Suppose you come to me, is there a chance of missing something about the eye? What exactly happens? Usually, there are signs. If a patient says, "I suddenly lost vision on one side," a good doctor will immediately say, "This is not my field."" Go to a neurologist.
(52:12) " If you suddenly cannot see out of one eye, the eye doctor first checks if there is bleeding in the eye or any other issue. When they find nothing, they immediately refer you to a neurologist. If vision is decreasing slowly over a long time, like with cataracts, they handle those themselves. But ophthalmologists will understand.
(52:32) Immediately. That this is a neurological emergency. So, if they listen to the history, they will catch it. Correct, correct. If we don't tell the history and just say, "I came to get my eyes checked," then such things might be missed. So, recently a patient came—an educated school teacher—whose vision decreased and returned three times in the last month.
(52:55) Vision decreased, returned, decreased, returned—three times in the last month. So she went to an eye doctor, and he told her to urgently go to a neurologist, so she came to me. So, this happened in the last three months; it is an emergency because at any minute it could turn into a full-blown stroke. The artery going to the eye comes from a main blood vessel in the brain, so if there is a block there, one whole side could be blocked.
(53:23) So, if they say, "Suddenly my vision went out and came back," we immediately do an angio to see where the blocks are . Based on those blocks, we must start treatment immediately. If one thinks, " Nothing happened to me three times, so I'm fine," the fourth time might not be our lucky day. Correct, correct.
(53:41) Perhaps the clot was breaking up on its own, but if it doesn't break the fourth time, what then? If you come then, the disease has already occurred, and it is actually too late for us. It’s not something you can tell from an MRA or just a scan; you need an angiogram. We can do an angiogram within an MRI; that’s the advantage for the brain, it's called an MR Angio.
(54:01) Okay. You can look at the angiogram during the scan itself, you don’t need to inject dye separately like you do for the heart. Once you do an MR Angio, we will understand. So, they went to an eye doctor, and the eye doctor told them immediately. " This isn't my department; go see a neurologist immediately.
(54:17) " So, they were very well educated. But how did she know this was an emergency? So, now she knows; she found out now. So, others should know it too. That’s why I take notes when I come across things like this. I write them down, thinking, "I need to share this, I need to talk about this." My focus is always on educating the people.
(54:38) Exactly, I love the subject of neurology. I realized I have a talent for simplifying the subject so others can understand; it’s a gift I have. So maybe I can help someone. But you have to be able to identify very minute things, right? It’s a typical job for you, actually. The nerves are so small and thin.
(55:00) Sometimes patients forget to mention small symptoms, thinking, "What does this matter?" but that’s exactly what’s important to us in the end. That’s it, isn't it? We call them red flags, so when we see them, we tell them to get scanned immediately, but it’s hard to communicate that to the patient; they say, "I feel fine now, why are you asking for a scan?" It’s to prevent anything further from happening.
(55:26) We don't know what's happening inside the body. But look, scans are also being abused, right? Yes, yes, yes. So, there are faults on both sides. It’s from this side and that side because healthcare is a business now. Yes. It’s not just healthcare; it’s a healthcare business. You have to show profits, go to public markets, IPOs, and all that.
(55:53) Where does that turnover in crores come from? So, you have targets, just like in software. When corporates get involved, this culture has become more of a... A correct business. That’s why the trust from the patient's side has decreased. From the doctor's side, we feel we must first save ourselves. Hmm. Right, even if they do everything for a patient, sometimes they still say the patient died.
(56:23) It can happen. Didn't people like Jayalalithaa die in a hospital? Yes, even with the best treatment, one can pass away. Ever since that movie* Tagore*came out, people keep saying they put dead patients on ventilators. So, because of all this, we have to be defensive and protect ourselves first, explaining things like this.
(56:41) Yes. It’s not as rosy as it used to be. When I wanted to become a doctor, the image of a doctor was different. It was different, yes. The doctor now... It’s very typical. It’s different, it has changed a lot. I doubt those days will ever return. My daughter says she won't be a doctor; she wants to be a lawyer.
(57:04) Oh, that’s even worse. You come home and are still talking on the phone. Haha, does she think lawyers don't talk ? Who knows? It’s just her age, right? As I said, if you ask people in any job , even government employees face extreme stress. There is no job without stress. Phones have increased the stress; I even work on Sundays because calls come in.
(57:30) I feel that way because, in my profession, it's a matter of life and death, so phone calls are important to me. Why are phone calls important to you? Because higher officials call, and if you don't pick up, they will scold you or hit you. It's like that. Yes. So, those phone calls are mandatory; even if they come at midnight, you have to answer them.
(57:47) So, this is how it is now: they work at the office, they work at home, and they work on holidays. The media is the same, dear. A guest might be called at midnight, or they might say, "Look at this thumbnail, Anjali, delete it urgently," and then I have to wake up my editor. That’s exactly what I don’t understand—everyone is under so much stress, poor things.
(58:04) So much stress, really, oh my god. We are getting children accustomed to stress from a young age. Yes, so to be happy...but no, there is fear that something might happen the next minute. So, with time, there are different goals at different stages. "I must do this at this time,""I must do this at this time.
(58:25) " So, with age, these goals change, and we feel we must change how we work outside. True, some people say supplements should actually be taken on an empty stomach, while others say they should be taken only after a meal. But whether it's calcium or B12, most supplements come in higher doses so that they are absorbed regardless of the conditions.
(58:47) Many people feel uncomfortable taking tablets on an empty stomach. There are only a few specific tablets that must be taken on an empty stomach, like thyroid or gas tablets. In cases of Parkinson's, we prescribe things like Syndopa because they work better on an empty stomach. They work. They work well.
(59:04) Iron tablets also work better on an empty stomach, but many people get gastritis because of them. Yes, some supplements cause gastritis. They do cause it; the supplement or its coating can cause it. People can't handle it, and what we need is for them to take it continuously. So, what we see mostly is that if they take them after eating, or perhaps before going to bed—if we set a fixed time, they remember to take them better .
(59:26) If we set it for the afternoon, they usually forget. So, we set convenient dosing for supplements. They remember well at certain times. Since they are busy in the morning, we tell them, "Take it at this time." If they are supposed to take it for 10 days but only take it properly for four days, that’s a problem.
(59:42) Instead, if you take them for 10 days at a time that is comfortable for you, that is good. We specifically mention which tablets are for an empty stomach. If we don't specify, then it's fine to take them comfortably after a meal. One more thing is that many people take everything together. Instead of doing that... Exactly. You should give some gap.
(1:00:03) If you give some gap, whether it's calcium or omega ...why take everything at once, aren't they all supplements anyway? Some vitamins interrupt the absorption of other vitamins, so if taken together , some won't work properly. So, it's better to give some gap and remember to take them.
(1:00:22) It's good to separate them: one after breakfast, one after lunch, and one after dinner. There are pill boxes for people who have multiple pills, so we tell them to use a pill box to remember, especially for older people, because after a while they might wonder, "Did I take it or not?" and end up taking another one. Yes. So, that’s how they should remember.
(1:00:41) By the way, how is your Wednesday saree plan going? It's going well, it's good. On Wednesdays, I wake up at 6:00 and leave home by 6:30 in the morning. I reach there by 8:30. So, earlier I used to return around 7:30. It was almost 12 hours. 12 hours, 12 hours. Previously, I used to reach late, maybe by 9:30 or 10:00, and leave at 10:00 at night, which left me with absolutely...
(1:01:07) No energy left after that. The next day would become difficult. It gets difficult, yes. So, I made some changes like finishing early by 7:00 and getting home by 9:00 so I can sleep at my usual time. I have a migraine triggered by travel. Very good. I get a headache from traveling. Exactly, once my journey starts, my head aches.
(1:01:30) If my people schedule outdoor work, they say, "Yes, come on, keep your migraine meds ready." It also happens with seaside weather and humidity. So, by the time I reach Chirala, the tablet is already kept on the table. It’s unbearable; you really can't do any work with focus. If I think I'll wait until night, it just gets worse.
(1:01:48) If I take one initially, it gets a bit controlled. There's also a sense of happiness when you take a painkiller, thinking, "Yes, it’s subsiding now, I can work." It's true! One can work with a bit of happiness. So, you have a migraine? I thought I was the only one with that ailment.
(1:02:06) It starts with the journey— oh, it's not normal. It’s much worse during travel. Some of my students have migraines, and they commute every day; I feel bad for them. I ask them, "When will your travel end?" They say, "Next is B.Tech," and then they travel again for that. So, travel and migraine are ... What else? What exactly is the problem? Does it shake up, like do your nerves get agitated? It's that movement, like motion sickness; that’s when the vomiting sensation and headache all start.
(1:02:35) If the road is smooth, it's okay. The road we take to Chirala is bumpy, and by the time we reach, I’m exhausted. It's finished. So, for Chirala alone, I take a painkiller that one day; the other days I'm fine, and there's not much trouble. So, I have actually set numbers for myself now, saying I will only see this many.
(1:02:57) Right. Because I can't see beyond that. If the quality isn't there, we don't feel satisfied ourselves. So, if I see 100 people and miss one diagnosis, that one is very important; it shouldn't happen. Many people actually complain. They say, "You aren't seeing us fast, you're slow, you aren't giving appointments.
(1:03:20) " I mean, quality is more important than quantity . The numbers are fixed, and the hours in the day are fixed. Every day, I put my kids on the school bus at 8:30; I get ready by then, feed them, get them ready, and once I send them off, I head to the hospital. I leave the hospital again at 8:30 at night and reach home by 9:00.
(1:03:44) I take a 10-15 minute lunch break and eat breakfast there at the hospital, which is another 10-15 minutes. There are no other breaks; I just go to the restroom once or twice, that's it. Working beyond that is useless, other than making mistakes. Correct, correct. So, this is all I can do. I say, "Kindly bear with me," but even then, some people scold me.
(1:04:06) Some patients come and say, "My husband is scolding me every day." 10 people scold me and leave in the OP every day. You have to listen and let it go, don't take it to heart. It’s true, I have written down some medical terminology. You mentioned in a video that ASL and MND are different; actually, MND is Motor Neuron Disease, which is Anterior Horn Cell disease, or AHC, and MND is related.
(1:04:39) Ah, AHC, is it ? Okay, okay. So, Motor Neuron Disease is a degenerative disease; it means that once it starts, as we age, the body gradually deteriorates, which we call degeneration. In Motor Neuron Disease, our body has separate nerves for sensation and separate nerves for movement. These are peripheral nerves, and there are different nerves for smell and vision as well, so if we want to move a finger, that is the job of motor neurons.
(1:05:09) Okay. Even though we have sensation, the nerves for movement gradually deteriorate one by one. Oh. So, there is no exact reason why this happens. It can be due to some mutations or genetic changes, and rarely it can run in families. Mostly it appears after 40 or 50, but recently , I've seen about 10 people in their twenties.
(1:05:39) At 20 or 25 years old, first, a finger won't move, then the hand, then the other hand, then legs, then speech, swallowing—I can't get up, I can't walk, I can't breathe. So, it keeps progressing like that. With no treatment; there is no treatment for it. Oh my God, then what do you do for such people? Nothing can be done; that’s the saddest part.
(1:06:07) If a 25-year-old boy asks if he should get married or not, we tell him not to, because this will progress. Another thing is that you are aware of all the difficulties you are going through. Brain functioning remains good, you see. In many disorders, our body is damaged or the brain is damaged, so we don't understand, but here, we are aware of everything.
(1:06:25) So, after a stage—five or six years after the disease starts—a ventilator might even be needed. Because there will be no breathing. So at that stage, we ask if they want a ventilator or not , asking, "Do you want this life, or do you not want this life?" So, that decision has to be made. Since you cannot enjoy your life, most people say they don't want a ventilator.
(1:06:50) At one stage, if food doesn't go down, we tell everyone, "Get a PEG tube inserted, at least the food needs to go inside," but they don't agree. Because they say, "If I get it done, will I get better?""Just tell me that," they say. We tell them food will go in. "What is the use of that food if my body is deteriorating?" they ask.
(1:07:08) So, it's a very, very bad disease. There is no treatment anywhere ; they keep going from place to place. We just have to call it fate. That’s it; it can happen any day, to anyone. Correct, correct. When we were studying, we used to think , "I hope I don't get any disease." I mean, among the diseases you know, which one is the worst? Which one do you not want? Someone says, "I hope I don't get (MND).
(1:07:27) " I used to say, "I hope I don't get dementia." Because if I were to lose my memory and behave like a mad person...and you doctors, " It's great to talk about diseases, friends." Today, if you ask "What do you not want?", I’d say, "God, I hope I don't get paralyzed!" Truly, if there are so many incurable diseases just in neurology, they must exist in other fields too, right? We don't know what kind of disease might come on any given day.
(1:07:54) The innocence of people is that they believe if they go to a doctor, they will be cured of everything. Initially, when I started practicing, I used to get angry if a patient spoke in a certain way, but after a point, I stopped feeling that way because I realized they come to us with their own hardships. Yes, they go through so much without knowing.
(1:08:13) And sometimes, we might not be able to help them either. We shouldn't try to think we are great; we aren't great just because we treat patients. When I say "I can't do anything," I mean: "I am useless for your illness, I cannot help." No doctor can help; the treatment doesn't even exist yet. They keep going from place to place, hoping that some scientist will come up with a treatment and they might see some relief. But yes, there is Dr.
(1:08:40) Gokhale, the cardiologist, he is very famous. For almost 10 years, in every interview —the first, second, and third—he says the same thing: "There is nothing we can do." He expresses it by saying, "We can't do anything; we doctors think we can fix everything, but often, it's not in our hands." Sometimes there is a saying: "Despite the treatment, the patient survived.
(1:09:08) " Meaning, sometimes we aren't able to help through our treatment. There can even be cases where the treatment itself causes harm. Correct. So, "masterly inactivity" means you must know when to be inactive; you shouldn't just do something for the sake of doing it. A doctor shouldn't feel superior, because if the same disease hit us...
(1:09:34) Yes. ... there is nothing we could do either. Now, regarding blood pressure, the idea that there is a fixed limit for BP doesn't really hold up anymore. They say it varies from person to person. As for when to start BP medication, we usually say 140/90. Depending on age, it might be a bit higher in elderly people because their blood vessels harden, so 140 or sometimes even 150 is okay for them.
(1:10:04) But if a pregnant woman comes in, 140 is considered very high; same for children, 140 is very high. It all depends on the age. Also, we look for symptoms. We can see the effects of BP in the eyes, heart, and kidneys. If there are changes in the blood vessels of the eyes...... or changes in the kidneys, or if the heart shows signs of ventricular hypertrophy, it means the organs are being affected by the blood pressure.
(1:10:36) In such cases, we must definitely provide treatment. You might have seen people walking around perfectly fine even with sugar levels at 300. Hmm. While some feel tingling and burning sensations even at 150 or 160. That depends on how their body is; it varies greatly from person to person. Some people live their whole lives with sugar at 400 and feel fine, not even realizing it's that high.
(1:11:03) And sometimes, even those who keep it under good control still develop complications. So, we say there are multiple factors. We don't just look at BP; there could be other unknown factors in their body. We tell them that if parents have diabetes and complications, you will likely get them too.
(1:11:22) Suppose the parents have severe diabetes but are doing perfectly fine; the diabetes you inherit might be the same. So, you might be doing just as well. These are due to other genes in your body—protective genes—so even if you have diabetes, you have protection. Even if you have high BP, you have protection. Many patients say, when I tell them to start medication immediately for a 180 BP reading, "I've had this for 10 or 20 years.
(1:11:42) ""Nothing has happened to me until now, so why are you making me start medicine urgently?" they ask. We don't understand their body's nature, but based on my education, I must prescribe it; I cannot leave it untreated. If I say your BP is high, they say, "It's the same at home, sometimes even 200, but I feel fine.
(1:12:02) " But since every day isn't the same, we tell them to start at least a small tablet. Another thing: kidney patients often have high BP. They are often at 220; those with poor kidney health have a major role in controlling BP, so if it doesn't come under control, we send them to a nephrologist. They are the experts; every kidney patient is often on five or six types of pills to control their blood pressure.
(1:12:34) Okay, okay. So, at a stage, as a neurologist, I manage BP with the knowledge of a physician—since I did my MD before doing my DM. Yes, that's right. I treat BP based on general medicine knowledge, but sometimes if it's complicated and I don't understand, I refer them to a better person—a nephrologist or cardiologist—to find the underlying cause.
(1:13:01) I manage it to a point, but after that, I refer them to other specialties if my experience isn't sufficient. Right, right. Another thing: what is GBS in small children? GBS stands for Guillain-Barré Syndrome ; it affects the nerves, specifically the peripheral nerves outside. Nerves come from the spine to our hands and legs.
(1:13:26) If we get any infection, our body tries to fight it. If a viral infection occurs, like loose motions or a cough, while fighting it, our immune system starts killing our nerves instead of the virus—it attacks our own nervous system. It mistakes it for something else. That’s because the coating of the virus and the coating of our nerves are somewhat similar.
(1:13:52) The body gets confused and its immunity starts killing our nerves, even though the infection subsides. Okay, okay. New symptoms appear day by day. "The first day things slipped from my hands, then I became unsteady, the third day I couldn't get up, and by the fourth day, I couldn't get out of bed.
(1:14:10) " That's how fast it progresses. There were recent outbreaks due to some water contamination; they even reported it in Pune. GBS has been around for a long time, but such a sudden surge of cases is very, very rare. It was like a sudden outbreak from water sources because of an increase in viral infections.
(1:14:30) But GBS is a disease we have been seeing for a long time. The thing is, it’s our own immunity causing the damage, so it's not the virus that's the problem now; we are treating the immune system. We need to lower the immunity entirely, and then the nervous system will recover on its own. It takes a lot of time, but to help recovery, we usually perform a blood exchange for some patients.
(1:14:55) We filter out the entire plasma and infuse different plasma into the body. So, we have to remove all of that. Okay. In some people, there are immunoglobulins; we give them antibodies against the antibodies already in their body. All of this is just to treat the immune system aggressively for five days. After that, we start physiotherapy.
(1:15:17) Recovery might take one month, two months, three months, or even six months for some. Okay, okay. So, this is to ensure the nervous system isn't damaged further, and physiotherapy is for the damage that has already occurred. But you doctors are really great. Watching problems, treating them, and explaining things over and over—we get mentally exhausted.
(1:15:39) Patience is the first trait a doctor must have. Because even if we explain something, they may not understand, so we have to explain it again and again. I have seen some doctors shouting if patients don't listen. They are under a lot of stress, and they have tensions at home too, right? If there is tension at home, who do they take it out on? They take it out on you.
(1:16:04) They haven't eaten. It's lunchtime. That frustration falls on the patient. And they happened to be at the wrong place, at the wrong time, and asked the wrong question. That's it. Because of that question... so, there is one case I remember very well. When I was at NIMHANS, a little boy came in while I was on emergency duty.
(1:16:30) It was night duty, his father was an Uber driver or something. The boy came in because he was just sleeping too much, vomiting, not eating, and had a fever. So, at first, we thought it was GBS. Later, when we checked, there were changes in the brain, so we suspected brainstem encephalitis. So, we take CSF , the fluid from the spine.
(1:16:49) We tested the CSF, couldn't find anything, and started one treatment. He got worse over time, and then his brain swelled. We performed surgery and even took a piece from the brain. Since we couldn't understand what disease it was, we did a brain biopsy; we take a piece from the brain itself.
(1:17:06) In the end, we still couldn't figure out the problem, and even the last specimen didn't show anything. Later, in neurology, we gave him IVIG, plasma exchange, and Rituximab—things related to immunity. We gave him everything, but he didn't respond. Finally, we took all the fluid samples again. Even after taking everything, we found nothing.
(1:17:28) The boy just kept going downhill and passed away within two months. His poor father was there for the first 10 days, but then, to spend money, one has to work, right? Even though NIMHANS is a government hospital, there are nominal charges. For some rare drugs, you have to pay a little, though it is very low compared to outside.
(1:17:49) But still, those nominal charges have to be borne. The poor man had to go to work, and this was his only son, he said. So, they stored his CSF and gave it to me, saying you keep testing this fluid over and over, so I’ll pack it in a sterile container for you. A professor gave it to me, telling me to keep it with me in case I have doubts or need to run a new test.
(1:18:12) So, I still have it with me. It means I always remember him that way . NIMHANS is one of the best institutes in the country and even in Asia. But even after so many professors, assistants, and surgeons examined him, the boy passed away in the end without us ever knowing what it was. Because what we know...
(1:18:35) We still haven't found out. We don't know, we don't know. What we know in science is just the tip of the iceberg. There is still something beyond science. There are many diseases yet to be discovered. So, I keep that with me as a reminder. You are not superior to the patient, and you can't say you are better, because sometimes we might not know anything, even the best of us.
(1:19:04) So, what is this GBS? Can you explain that a bit? It is an autoimmune condition; it’s when our body responds incorrectly to an infection. Okay. Another good thing about this is that it’s not a disease that keeps coming back; it's mostly a one-time thing. It might happen once in a lifetime, but no more than that.
(1:19:26) The most important thing is the treatment. As I said, if we catch it when the very first symptoms appear, it’s treated early. If we catch it when they can’t walk anymore, it’s a late treatment. So, suddenly, rather than just tingling or burning sensations, we lose power in our body; we test all the muscles for strength. Um.
(1:19:48) If his grip has weakened, it means the power has decreased. So, a loss of power is a dangerous sign . So, if I feel like things are slipping from my hands or I can't get up because my legs are failing, that means the loss of power has started, especially after an infection. If that power loss starts, the chances of it being GBS are high.
(1:20:12) We run some tests for it, but proof of GBS doesn't come from tests alone; many things come back normal, and scans often show nothing at all. Okay. We do an NCV test, a nerve test, but it doesn't show anything in the first four or five days. It only picks it up after the condition has progressed a bit.
(1:20:29) So, we shouldn't wait until it gets worse! We don't know after which infection it might occur; it can happen in children, pregnant women, the elderly—it can happen at any age. So, after it occurs, how quickly we treat it is what matters . You asked if we look for the cause— often, we don't.
(1:20:49) Because whatever the reason, the treatment remains the same. We might not find the cause at all. So, we do a few investigations, and if the patient comes on day one, we start the treatment that very same day. But the treatment is very expensive. For GBS, we give IVIG, and it's based on weight. If a child gets it, the cost is lower because they weigh less.
(1:21:10) But for adults weighing 60 or 70 kg, the injections alone can cost 3 to 4 lakhs. So they have to spend it immediately, right? Calf muscle cramps occur, sometimes even in the middle of the night while sleeping. As a sportsman, what I tell people is, if that happens, first get up and walk. Stand up and take a step, it will slowly calm down.
(1:21:31) I will talk about exercises to strengthen the calf muscle. But why do they actually happen? Can we neglect them, or can we recover through exercise? What do you say? Calf muscle cramps are very common, we see this in many people. Dehydration from not drinking enough water is one sign of calf cramps.
(1:21:54) Along with that, there is neuropathy in diabetics, known as diabetic neuropathy , so they can also get cramps. Another thing is certain deficiencies—vitamin D deficiency, or low levels of vitamin E or vitamin D in the body—can also cause cramps when there are such deficiencies. Hmm. So, if anyone comes to us with cramps, the first things I advise are hydration , exercises, and supplements.
(1:22:22) Whether we check or not, many people have deficiencies, so we give them vitamin E and tablets; vitamin D is also low in many people since we don't go out in the sun. That's right. We provide vitamin D. If it doesn't subside after using these, we will investigate further. It's not something to worry about, but they are bothersome and disrupt sleep, right? Very much so.
(1:22:44) So, doing some calf stretches before sleeping. When we use a blanket, we pull it up to our feet, and when we pull it suddenly, they cramp up. Yes, yes. So, pull it up all the way so there are no sudden movements of the feet. In the elderly, they come often without any reason. They can occur without any specific reason too.
(1:23:04) If they don't subside with routine medicines, then we test to see if there is any neuropathy or other issues. Right. Routine investigations are not usually needed for these cramps. Even in the toes and fingers, some cramps occur— some fingers move apart, and some come closer. They can occur due to calcium deficiency, called carpopedal spasms.
(1:23:27) We see this especially in women when calcium levels drop; these cramps occur during the daytime while doing chores, appearing suddenly and then slowly subsiding. Yes. So, that can happen in some women due to calcium deficiency. Okay. So, regularly using calcium supplements after menopause can keep them at bay.
(1:23:48) There are some rare diseases that cause low calcium, like parathyroid gland disorders, but those are very, very rare. So, usually, we start with the first-line treatment. If it doesn't improve, we then investigate rare muscle or calcium-related diseases later on. Recently, I have been hearing one thing very often—fatigue and exhaustion.
(1:24:13) People eat well. Yes. They exercise well, but still, they say they feel very exhausted. Hmm, so can we consider this as a vitamin deficiency? It is possible it could be due to vitamin deficiency or lack of sleep. But there is a disease called Chronic Fatigue Syndrome, where fatigue is the main symptom, lasting beyond three months.
(1:24:36) Okay. They eventually cannot even do exercises. Even a little work causes fatigue, and it feels like having a fever. It is still unknown why this occurs. But in these people, we see blood pressure dropping when standing and some enlargement of glands. Frequent sore throats, frequent fevers, and multiple complaints like body aches —when you look for the cause, you find nothing.
(1:25:04) So, if nothing is found and these symptoms persist for more than three months, we call it Chronic Fatigue Syndrome. Okay. So, we tell those patients to start exercising slowly. Take vitamins because we don't really know why it happens, and there is no specific treatment for it. However, it is important to identify it, because the whole family says you are doing this on purpose.
(1:25:25) They say you are doing it on purpose, yes. So, it is not something you are doing on purpose; if you tell them it is a medical condition, it doesn't matter even if there is no cure. We get that satisfaction. These symptoms didn't come because I thought about them; it's a health problem.
(1:25:43) Many people have this Chronic Fatigue Syndrome, but the family comes and complains, "They are always saying they can't do any work." So, we first check vitamins, and if those are fine, this is a possibility. Some people have aches, aches, and more aches, no appetite, and trouble with urination; they list multiple complaints.
(1:26:04) That is when we say that one person cannot have all these diseases at once. All these diseases don't come together, right? If so many illnesses come together, in neurology, we call it a somatoform disorder. So, I have to give one single reason for all of this. We can't attribute each one to a separate cause, like "this is worn out, ""this is from vitamin deficiency," or "this is from that.
(1:26:25) " Exactly. So, there is one cause: it could sometimes be a symptom of the brain. Meaning, the brain interprets everything happening in the body as pain. The brain is the one that tells us, right? In some people, there is no pain center at all; they don't feel pain in their nerves. We see this in some children from birth; their eyes and fingers get damaged because they keep rubbing them.
(1:26:50) For us, rubbing causes discomfort, but they don't feel the pain. They keep rubbing and rubbing, and their eyes get damaged at a young age. Oh no. They get injured, and their fingers and toes get damaged. This is a disease caused by the absence of pain. Pain is that important to the body. Since our bodies are healthy and we feel pain, we don't touch hot things.
(1:27:10) But for those children, we don't even know what to do ; they don't feel pain, and they end up getting injured everywhere. So, the brain is the one that signals this pain . The hand doesn't say it hurts; the brain says it hurts. So, if someone's body is perfectly fine but the pain doesn't subside, the problem is in their brain.
(1:27:32) The reason for this relates to certain brain hormones and chemicals like serotonin, norepinephrine, and dopamine. Due to changes in these, or a lack of proper hormones in certain pain centers in the brain, these pains can occur. So, in many such cases, we take the help of a psychiatrist. If the pain just won't subside, I need a psychiatrist's help more than a neurologist's.
(1:28:01) But when we ask a patient to go to a psychiatrist, what is the next question they ask? Yes , they cannot accept it. They ask, "Are you saying I am doing this on purpose?" We would say it if we thought they were faking it, but we told them to go to a psychiatrist instead, right? Exactly. So, a neurologist can only treat certain diseases related to the brain.
(1:28:19) Neurologists cannot treat many diseases , so the help of a psychologist or psychiatrist is needed. You see, people often talk about things like "being possessed by a spirit." All these have a psychological basis. But acceptance is very, very low in our society. I recently made a video with a psychiatrist as well.
(1:28:40) People need to know, because 10 percent of patients in a neurology OPD are actually psychiatric patients. They need this help. Yes. But no one is willing to send them. So, there is NIMHANS, which stands for National Institute of Mental Health and Neurological Sciences. Okay. Meaning, psychiatry and neurology work together there, because it's all interconnected.
(1:29:03) They can't actually be separated; if you say I don't have a nerve problem but a psychiatric one, both are related to nerves. Exactly. But we have divided it up as, "I'll handle this, you handle that." So, psychiatrically, depression is something everyone faces. I ask many doctors; even they take antidepressants sometimes, yet those who actually need them don't.
(1:29:29) Because no one is ready to accept it. Correct, correct. So, I often think that in this field, our country is lagging far behind. Just look at other countries. They truly accept it, thinking, "Yes, if I take these tablets, I will recover ," and they believe in it and use them. It means they give a lot of respect to it as a profession.
(1:29:48) Very, very much. Here, psychiatry is often considered a last resort; I wouldn't go to a psychiatrist unless it's an emergency. They won't go. Yes. So, this mental health is a part of neurology. It isn't something one does on purpose. Now, about a patient with depression— I shouldn't mention names.
(1:30:11) Someone who works with me mentioned that a patient had multiple death wishes and later passed away. When there are multiple death wishes and a feeling of wanting to die, it's an emergency. We must act. We think, "Won't they listen if I tell them?" But their brain doesn't listen to anyone at that stage. The feeling of wanting to die, regardless of the hardships, is not something a normal person feels.
(1:30:37) Correct. Well, why didn't they show it to a doctor? They said they thought it was spirit possession. So, we must identify it early. If they attempt suicide for the first time, it's a very big deal; one must see a psychiatrist immediately and start treatment. If not, there's no point in thinking about it later.
(1:30:59) I wondered, do they still not know she is suffering from depression? So, they are saying that for all these years, they thought she was possessed by a spirit, but she is clinically depressed. So that is something we must... Remember. Remember, sudden deaths are happening even in young children, and brain strokes are occurring more frequently with multiple attacks.
(1:31:28) I have seen three cases this year where they collapsed while singing on stage. When I checked their age, they were just 22 or 23. It felt very sad. Were there symptoms before that were neglected, or does it pop up suddenly? Usually, most sudden deaths are heart-related, called cardiac deaths. Rarely, it happens in very young children; we call them crib deaths, where a baby in the cradle dies for no apparent reason.
(1:31:55) There is a disease called SUDEP. It's like an unknown seizure or epilepsy-like condition. In their sleep ...the child is found dead in the morning. It is related to some genes; there are cases in the same family where two children have suddenly died in their sleep before the age of one. So, sometimes it's like a fit or seizure-like disorder.
(1:32:16) In some people, after a certain age, we find that some heart problems were undetected. Mm. Usually, these lifestyle diseases should appear in our 30s and 40s. Yes. I mean, we need time to cause damage to the body, right? Correct. So, if it appears in the 10s or 20s, the first thing we check is whether the organs were formed correctly, meaning there might be some issue with their blood vessel formation.
(1:32:40) There could be. Plus, there might be some problem in their genes as well. So, do these symptoms appear early? Often, in these cases where kids experience sudden cardiac issues, there might be no symptoms, or it's not really an age where they would pay attention to them. Exactly, that's it. So, can they get checked early? It's not really an age to get checked early.
(1:32:59) Even if checked, it might not show up, and we can't get checked specifically for that. We usually just check blood sugar and BP. But they might have this rare problem, a problem that occurs in one out of a court. How do we check for that? We can't. So there could be multiple risk factors, some genetic issue, or something like that.
(1:33:17) If it shows up early with small symptoms, we should feel happy. When it happens like this, there is nothing we can do. So, when it happens suddenly—we recently had an emergency case where a 22- year-old died suddenly. A cardiac death . At that age, you shouldn't have any illness; the body is supposed to be in perfect condition, so you can't even ask if they didn't eat right or anything else.
(1:33:46) But there might be some birth defects. Often, we... Don't know, yeah. We don't know, and we can't search for it beforehand; we can't check everything in everyone, right? Lady, thank you so much for your time. Please forgive me for taking up so much of it; please don't mind. Spending time with you doesn't feel like work at all; I feel so happy.
(1:34:05) Thank you. Thank you so much, viewers. Just like the last episode, if you have any doubts this time, please comment in the comment section below. I will definitely get them clarified by Ma'am in the next episode. Thank you, Ma'am. Thank you so much. Thank you.
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