Sep 26, 2010
Scene I: Circa 1945. Popular Dr. Shetty was much in demand from morning to evening and, at times, even at night. So it was on a particular Friday. After a day’s full engagement at the home-attached clinic, and sick calls, the good doctor called it a day and went to sleep at 8 p.m.- as was common in those pre- electricity days. Then came two messengers pleading for the doctor’s visit to attend on a patient in the Loretto area, up the steep ascend from the doctor’s residence in suburb of Bantwal town. Not the one to say “no”, the doctor set out on his bicycle which was only useful for the descending homeward return journey. His family waited for the doctor to return and by 11 p.m., a small party set out to check out the doctor’s progress (no phones – leave alone mobiles). When they had traveled one km, with their dim lantern, and naked flames from lighted bundles of dry palm fronds, they came upon a cycle fallen on the mud track. Nearby lay the doctor--dead.
Close by the spot, where the SVS College has since come up, was a wooded Nagabana -the grove hosting cobras. The news spread like wild fire that the doctor has died of Bhootada Pett—Devil’s Slap. In those days many such sudden deaths were ascribed to Bhootada Pett.
Scene 2: Circa 2005. Manipal. There is an awareness programme on heart diseases. An eminent cardiologist takes the podium, adjusts the mike and starts his learned discourse. He collapses and dies on the spot. The verdict: massive heart attack
Like Bhootada Pett, heart attack is a broad popular description covering a number of heart-related fatal attacks. As we mark World Heart Day on September 26, there are programmes galore on educating people on taking care of their hearts. There is an obsession about heart diseases, the ways to prevent them and calls for change of lifestyle. There are alarming signals about the diseases of the heart on account of obesity and wrong lifestyle.
“A man’s first care should be to avoid the reproach of his own heart”. This injunction by Joseph Addison, English writer (1672 – 1719) needs to be recalled when we celebrate another World Heart Day. The marking of the last Sunday of September as World Heart Day annually was initiated by the World Health Organisation (WHO) in 2000. It sets the theme for highlighting and creating awareness for each year’s celebration. It was physical activity in the first year followed by women’s heart diseases and children’s heart diseases. This year the theme is “Wellness in the Workplace”.
Obesity and overweight
As Dr.H. Prabhakar, MD, DM, Chief Interventional Cardiologist at Fr. Muller Medical College Hospital, Mangalore, pointed out during an interview on the subject, over-weight and obesity are main causes of increased risk of heart diseases and heart attacks. Dr. Prabhakar explained that overweight and obesity manifest in two forms wherein the excess body fat takes the shape of apple or pear. In the apple syndrome, the excess body fat is stored or accumulated in the abdomen (central obesity – in stomach or waist area). Pear shaped figures tend to gain weight around the hips and buttocks. Apple shapes have an increased risk of heart disease and call for extra care to maintain health. Dr. Prabhakar cautioned that in some cases apple shaped person may have normal weight or even less – because the rest of the body may be lean – but still have the risk factor.
There are some accepted norms of measuring obesity and overweight factors. Here is how. Measure your waist above your navel. If you are over 37 inches for a man and over 32 inches for a woman you are considered at risk. Over 40 inches for men and 35 inches for women means you are at still higher risk.
Symtoms
The reproaches of the heart of Addison’s quote above, or symptoms of heart disease, are breathlessness when walking, fatigue during routine activities, chest discomfort and breathing discomfort. There could be family history of heart diseases. These symptoms call for timely diagnosis and treatment, including the non-intrusive angioplasty procedure or open heart surgery, on case to case basis.
Beyond obesity as a risk factor in heart diseases, presently there is great concern about narrowing of arteries making women more prone to coronary artery diseases (CAD). According to Dr Johnson George (lotushearthospital@yahoo.com), CAD in Indian women gets less attention than CAD in Indian males. He says that the incidence of CAD has increased phenomenally in the last five decades across the world. As per WHO, by 2010, about 60% of the world’s cardiac patients could be of Indian origin. Among admissions to most coronary care units, 38 to 40 % are women. In the last decade, there has been a 300% increase in CAD cases in women of 30 to 70 years.
According to Dr. George, there are two sets of risks – controllable and uncontrollable. The age at which the disease develops and a strong family history are uncontrollable factors. In women, the post-menopausal period is fraught with risk as the protective influence of oestrogen is lost. Hence, at least by middle age, Indian women must watch out for controllable risks like obesity, high blood pressure, sedentary lifestyle and smoking.
The subject has many dimensions and awareness of the subject is prelude to preventive and corrective action. Hospitals in Mangalore and elsewhere are having programmes to enhance public awareness coinciding with World Heart Day. As in the past, there may be lectures and exhibitions on various aspects of heart diseases, with charts, models, video shows and animations. Interested persons are advised to track newspapers for announcements of these by medical colleges and hospitals on days preceding World Heart Day.
In the midst all these, I will queer the pitch and talk of hearts in different contexts.
Tryst with Heart
The first tryst of today’s school children with the heart comes in the cute story of the monkey and the crocodile. The male crocodile swims to the lake edge every day and helps itself to fruits plucked from the tree by a male monkey. They develop a great bond of friendship. The crocodile takes some fruit for its wife, who lives in the depth of the lake and minds their children. Before long the wife crocodile develops a desire to eat the heart of the monkey. With heavy heart, the male crocodile manages to lure the monkey to come with it on the pretext of meeting its wife.
Benjamin Franklin says: “The heart of the fool is in his mouth, but the mouth of the wise man is in his heart” It happens that the crocodile could not control its mouth and half ways to its under-water residence, it confesses about the craving of its wife for the monkey’s heart. Collecting its wits quickly and remaining unfazed, the monkey explains that it has left its heart behind on the tree and would gladly bring it along if the crocodile would take it back to shore of the lake. Once on the shore, the monkey quickly scampered up the tree and never got close to the treacherous crocodile.
There ends the Kindergarten story. But, with the benefit of age and hindsight, there seems to be more to the story than meets the eye. Could it be possible that the female crocodile was bored with its husband and wanted to have some romantic affairs with the shore-based male monkey? It could have been a plot for meeting of hearts rather than eating of heart.
Writers on Heart
The heart has been at the heart of writings of poets and philosophers. Starting with the Bible, we have Evangelist (one of the writers of the New Testament of the Bible) John saying: “Let not your heart be troubled.” And Evangelist Mathew says: “Where your treasure is, there will be your heart also.” Chew on these hearty quotations.
“Only the heart without stain knows perfect ease.”- Goethe
Two chambers hath the heart,
There dwelling
Live Joy and Pain apart.
-Newmann
“He hath a heart as sound as a bell and is a clapper, for what his heart thinks his tongue speaks. - Shakespeare in Much Ado About Nothing.
There is another day in the year marked for the heart – February 14 – now made famous by the moral policing brigades favoured with pink chaddies. It is Valentine Day - when young hearts are supposed to conquer their chosen ones with Cupid’s arrow. For them, Thomas Gay has a promise:
If the heart of a man is depressed with cares
The mist is dispelled when a woman appears.
John B. Monteiro, author and journalist, is editor of his website www.welcometoreason.com (Interactive Cerebral Challenger).
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