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What is the behavioural approach used in ADHD? (ADHD Part -IV)

What is the behavioural approach used for treating ADHD?

The behavioural approach, for instance, is to increase the attention span of the child. In mild to moderate only behavioural management is needed.  It could be in the form of a game, depending on the age of the child. Depending upon the developmental level of the child we give them tasks to improve their attention skill:

Games and Activities

What is the behavioural approach used in ADHD?We prescribe certain games and activities where the child can sit and persist with the task. That will improve the child’s attention span.

At School

What is the behavioural approach used in ADHD?For the classroom instruction, we sometimes give a letter to the teacher suggesting where he should be seated.  The teacher should have proximity to the child. Seat given to the child should not be near the window side, door side or outskirts. The child should be given aisle seat so that he can have eye contact with the teacher. These will help him focus on activities in the classroom. The teacher should be monitoring the child so that his attention doesn’t wander. They should examine the notebooks frequently so that the books are complete. The child should be called his or her name. If he is called by his name, his attention span will persist.

Appreciation and Rewards

What is the behavioural approach used in ADHD?The parents and teachers are instructed to reward the child whenever he behaves well. Usually, his hyperactivity or impulsive behaviour is judged as indiscipline in the school. He is scolded and not much of positive comments are obtained by the child. Parents and teachers are asked to look out for even the smallest good behaviour. He must be praised and rewarded with gifts. He must be given small responsibilities in the class like carrying the books to the staff room so that he feels that he is worthy. In this way, his behaviour is likely to improve.

At home

Medication for ADHD (Attention Deficit Hyperactivity Disorder)Parents are asked to give clear instruction to the boy to keep his shoes, bags and toys in its proper place.  Thus his life will become more structured. Whenever he complies with the parents’ expectation of the kind of behaviour they expect from him he can be rewarded.

Nurturing their Abilities

What is the behavioural approach used in ADHD?When we assess the child we assess their potential. Some of them are good at sports. So encouraging them in sports is part of the behavioural therapy. Some may be good in arts or electronics, so channelizing their ability will help them.

‘Time Out’ Method

What is the behavioural approach used in ADHD?Parents are trained to deal with impulsive behaviour. Sometimes they have to set limits when the child is exceeding certain limits. In very severe situations parents may be asked to keep the child in a room so that anger comes down. It is not a punishment but a principle of ‘time out’.  This principle has to be applied only sometimes.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

How ADHD is diagnosed?(ADHD Part -III)

How ADHD is diagnosed?(ADHD Part -III)

How is ADHD diagnosed?

On a simple physical examination, you will not find anything abnormal. MRI or CT scan will not show any abnormality. If you do a functional brain imaging you may find that these circuits are dysfunctional.

A simple physical examination will not reveal anything abnormal.

Usually, we do not diagnose ADHD when the child is 3 or 4 years unless it is a very severe condition. We wait till the child is 5 or 6, by the time the child will go to school and some external discipline will come.

Who Defines criteria for Diagnosis of ADHD?

Authorities like International Classification of Diseases (ICD) by World Health Organisation (WHO), American Psychiatric Association(APA) and Diagnostic and Statistical Manual of Mental Disorders(DSM) are the world authorities that define criteria for diagnosing ADHD.

What is the process of Diagnosis?

Diagnosis of ADHD is not based on any laboratory test. We do not have a lab test or a scan to Diagnose ADHD. It is based on the history provided by the parents and teachers and the direct observation of the child by a trained professional. It is a clinical diagnosis. Functional brain imagery is available only in research labs.

What is the next step after ADHD is diagnosed?

So once you diagnose ADHD, the next step is to educate the parents and teachers. We take collateral information from teachers also. In our centre, there is a form called ‘teacher’s observation report’ about the child. The teacher fills information about child’s behaviour in school and class. We also ask them to bring their notebook because that may show some careless mistakes which are common in ADHD.

Parents and teachers might think that the child is only an indisciplined, overprotected and pampered child.

We collect information from other sources if available.  All those assessments are taken into account and if the assessment satisfies for ADHD, we teach and educate the parents about the problem. And after completing the assessment we talk to the parents. We need to educate the parents. They might think that the child is only indiscipline, overprotected and pampered child.  We talk about options to manage the problem. And see whether he is able to cope with the management procedures.

When do you finally Confirm that a child has ADHD?

We have to check for any medical conditions that are like ADHD. For instance, some may have epilepsy or anaemia. So there has to be a physical examination. The next step is to examine for some conditions that occur with ADHD. For instance dyslexia, a specific learning disorder (SLD) which is known as a learning disorder.

There are two approaches to manage the disorder- behavioural approach and pharmacological approach.

Almost two-thirds of the children with ADHD also have SLD along with it. ADHD is rated as mild, moderate and severe depending on the number of symptoms present and the functional impairment it produces. Mild cases may not require medication. In moderate and severe cases the option of medicine is given to the parents.

What are the procedures to manage the disorder?

After all the assessment we call a section once again with the parents. Education is given to them, explaining the problems and giving them management options.

We teach the parents, give suggestions to the teacher and encourage the child is the behavioural components of ADHD.

There are two approaches for managing the disorder – behavioural approach and pharmacological approach.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

READ MORE…

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

What is the behavioural approach used in ADHD? (ADHD Part -IV)

What is ADHD (Attention Deficit Hyperactivity Disorder)? (ADHD Part -II)

What is ADHD (Attention Deficit Hyperactivity Disorder)?

Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder. Some say that there is no such disorder, which is incorrect. It is a worldwide accepted condition. It is a brain development disorder occurring in about 5 to 7 percent children.

It is a brain development disorder occurring in about 5 % to 7% children.

In certain brain development disorders, the physical features are visible. In Cerebral Palsy and Down Syndrome, for instance, the physical features are evident and hence these are accepted as real disorders. But, when you look at a child with ADHD they may not have any visible physical anomaly. And therefore it is not recognized as a medical condition. The behavioural manifestation of ADHD could be passed on as a naughty behaviour of a normal childhood, or even smartness. In these children there are no physical abnormalities, they have behavioural problems.

What are the mental functions that are affected in ADHD?

Attention deficit

What is ADHD (Attention Deficit Hyperactivity Disorder)?

 

The ability to focus attention is the function of the brain. As far as a school child is concerned he should have approximately 30-40 minutes of attention span.  There should be a coordination of eyes, hands and mind. Brain should be able to focus these functions.  That varies from person to person, but with children with ADHD, attention holding function is very grossly impaired.

What happens is that the child will not be able to persist with the task. In the classroom, he will not be able to pay attention for a long time, and this will affect his academic performance.

Hyperactivity

What is ADHD (Attention Deficit Hyperactivity Disorder)?

Generally, a five or six-year child is able to sit quietly and keep calm when they are engaged with some serious activities. But children with ADHD will not be able to control their action. They will be very fidgety, restless, squirming on the seat and moving around.   In addition to the distractibility, if the student is restless he can disrupt the whole class. The energy might be considered as the smartness of the child; however, it is an illness. It is “Disruptive” overactivity. Normally school going children are active and exuberant. That is not hyperactivity. Disruptive overactivity is called hyperactivity.

In addition to the distractibility, if the student is restless he can disrupt the whole class. The energy might be considered as the smartness of the child; however, it is an illness. It is “Disruptive” overactivity. Normally school going children are active and exuberant. That is not hyperactivity. Disruptive overactivity is called hyperactivity.

Impulsivity

What is ADHD (Attention Deficit Hyperactivity Disorder)?Impulsivity means they are unable to hold their responses. Whenever they are angry they may use bad words. They may be talkative in class and they may find it difficult to wait for their turn in group activities. They may blurt out answers even before questions are finished.  They are unable to hold their emotions. Impulsivity can land them in trouble.

When attention deficit, hyperactivity and impulsivity combine that produces this syndrome called ADHD.

What can be the reason for ADHD?

The exact reason cannot be pointed out. The genetic factor could be a reason for ADHD. Many parents say that the father also was hyperactive in his childhood, but in those days, no one realized that it was ADHD. Nobody is sure why it happens in some children.

Nobody is sure why it happens in some children. Basically, there could be some genetic influences.

Basically, there could be some genetic influences. It could be some infection or toxins that the mother carried when she was pregnant. Many a time we are unable to pinpoint that this is the cause, but these are the possibility. Scientific research has shown that the circuits in the brain that control the motor activity – brain circuits which control the impulsive reactions – these circuits are dysfunctional.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

READ MORE…

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

How ADHD is diagnosed?(ADHD Part -III)

What is the behavioural approach used in ADHD? (ADHD Part -IV)

Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? (ADHD Part -I)

Do you know ADHD occurs in about 5% to 7% children? If a child behaves a little different from others, then teachers recommend them to be taken to the psychiatric counsellors. The counsellor might diagonise the disorder as ADHD (Attention Deficit Hyperactivity Disorder).

There are many concerns among parents: Whether we should take the child for a counselling section? If the counsellor says that the child has to take medicine, then do we really have to follow the advice? Is Medication for ADHD (Attention Deficit Hyperactivity Disorder) child necessary? Will there be any side-effects of the medication? Will the child be branded as mentally unfit, if he goes for the counselling sections?

I had a discussion with Dr. Varghese Punnoose, an MD in Psychiarty regarding ADHD (Attention Deficit Hyperactivity Disorder) and its medication. He discussed every aspect of the disorder from the symptoms to the medication and the misunderstandings. Dr. Punnoose is specilaised in Child Psychiatry.  He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala. 

Read on to know more about Medication for children with ADHD………..

When do you prescribe medicine for children with ADHD?

In moderate to severe ADHD, we give the option of medication to the parents. Medications are not prescribed on the first day that the child comes to us. The medication is suggested only after two or three sitting. After a complete assessment, if the child needs medication, the parents have to take the decision. The child is a minor by legal terms and they cannot take a decision on their own. And we do not force our decision. We give a recommendation of medication as an evidence-based scientific option. Medications available in India are mainly two types – Methylphenidate, a stimulant group of medication and Atomoxetine.

What are the concerns parents have regarding the medications?

Many a times parents are apprehensive about the medicines that the doctor prescribes for hyperactivity. They are doubtful that the medicines are sedatives which will damage the child’s brain or make him dull and sleepy. Or the child may develop some addiction or dependence on medication.

These are much-distorted facts which are being propagated partly from ignorance and partly from some vested interest.

These are much-distorted facts which are being propagated partly from ignorance and partly from some vested interest. These medicines are specifically developed by scientific authorities with evidence for their efficacy as well as safety. They are used all over the world. Methylphenidate is available in the last thirty/forty years. Atomoxetine is available for the past 10-15 years.

Is there any benefit of the medication?

They will not cure ADHD, but they will correct some of the symptoms of ADHD. 70% of the children will improve attention span. The child will be able to hold attention for a long time.  They can bring down hyperactivity not by sedating but by bringing down the extra overactivity. The brain gets a better control of motor activity.

Most of the side effects are not serious, that is why these medicines are approved for paediatric treatment.

There is no sedation or tranquillizing. The brain gets more ability to control the impulses. So the attention span improves that translates to improvement in academic functions. Hyperactivity and impulsivity in reduced. That translates to improvement in behaviour. 60%-70% children get benefitted from medication.

Will the medications cause any side effects?

Of course, they produce side-effects. But no major side effects like brain damage or addiction. Most of the side effects are not serious, that is why they are approved for paediatric treatment.

Government is very strict about approving medicines for paediatric cases. These two molecules have passed all the tests, and they are time-tested.

Loss of sleep

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childThe possible adverse effects that we come across are if we give methylphenidate as a night time dose. The medicine will interfere with sleep. Usually, they are given as daytime dose – one in the morning or one in the afternoon.

Loss of appetite

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childThe second problem is that they may produce loss of appetite and weight loss. In some children, it may produce anorexia, loss of appetite. But again it is for a limited period. After a few weeks, they will get out of it.

Growth retardation

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childThere were apprehensions that use of Methylphenidate could result in growth retardation. But long-term follow-up studies have not demonstrated any significant growth retardation in children on Methylphenidate. However, height monitoring is recommended.

What is the consequence if the medication is withdrawn?

If at all the parents are worried, then there is no problem in withdrawing the medicines or discontinuing the treatment. Very rarely some children may develop liver dysfunction or some other issues for which the children are carefully monitored. But practically we do not come across such issues.

How long to continue medication?

There is no clear-cut answer because we cannot prescribe the medicines are not like a course of antibiotics for the infection. This is a system dysfunction which varies from child to child.

Initially, the children are monitored weekly, then monthly, then once in three months, once in six months. And if the attention span in improving and ADHD score is coming down and the child is able to manage without medication, then the child may not require medication.

If you discontinue, the only thing is that some advantage that you would get from the medication.

In most of the cases, children are diagnosed with ADHD when they are in fourth standard, fifth standard or sixth standard. And they may continue medication up to ninth, tenth or eleventh also. That varies from person to person. There is no worsening.

Sometimes parents are apprehensive that if they stop the medication then thinks will become worse. Nothing like that happens. Only thing is that some advantage that you would get from the medication will not be there if you discontinue.

Why there are some apprehensions regarding the medications?

There are apprehensions about methylphenidate, the stimulant group of medications. Methylphenidate can be abused by adults that is why there is a lot of restriction on prescription. Only a qualified psychiatrist can prescribe this medication. Because of the restriction, parents are worried that this is a very dangerous component. The abuse potential in the paediatric case is nil. This has been used for the past three or four decades.

Atomoxetine does not have such restriction for the prescription. Deciding which medication to give for the child is a clinical decision. There are conditions where we prefer methylphenidate and there are conditions where we prefer atomoxetine.

Is it compulsory to take Medication for ADHD (Attention Deficit Hyperactivity Disorder) child?

We always tell the parents that medication is not the only thing; it is part of the whole package. The main emphasis is on educating the parents and teachers and encouraging the child. All are involved to improve the behaviour of the child. In moderate to severe cases medications are used so as to take away the biochemical block. If the medication is taken then the behavioural therapy becomes more effective. But if the parents are unwilling then they are not forced to take medications.

What about suicidal behaviour due to Medication?

Suicidal behaviour is not related to ADHD. Impulsive behaviour may lead on to impulsive self-injurious behaviour. However, there are no such reports in India. Whenever there is such reporting it will be put to stringent examination by authorities like The Food and Drug Administration (FDA), of the United States of America. And if at all there is the slightest suspicion of such kind of a problem they will immediately order to suspend/ban the product.

If at all there is the slightest suspicion of such kind of a problem authorities like FDI will immediately order to suspend/ban the product.

The first common cause of death in adolescence is accidents, the second is suicide. For an adolescent to commit suicide there can be a large number of factors.  If the child was on a medication when he committed suicide then that has to put for scientific scrutiny. None of the studies so far have shown such results, if in case there were any issues stringent measures would be taken. So far no instructions have come. In India, approval is there only for atomoxetine and Methylphenidate.

How long will the medicine remain the system after the medication is withdrawn?

It will be there in the blood for maximum two days. It is not going to be permanently deposited in the system.

Should medication continue in adulthood?

Almost 60 percent of the symptoms may continue. Whether medication is to be continued in adulthood is a very controversial topic. In our centre, we do not generally encourage medication for the adult. We leave it as an option for children and adolescents.

Why controversies regarding ADHD?

Controversies happen because of overdiagnosis of ADHD. From certain reviews, I find that overdiagnosis is done in certain provinces in the United States. From there the movement has come that children are being medicated unnecessarily. The overdiagnosis issue is not an issue in India. Here the issue in underdiagnosis.

Why there are advocacies against medications for ADHD?

There should be some advocacy to protect the right of the citizen. Children need protection. Advocacy is good because there will be checks and balances. The opposite result happens when deserving children, who should get the advantage of medication, are denied medication because of the stir.

Medication for ADHD (Attention Deficit Hyperactivity Disorder) childDr. Varghese Punnoose specilaised in Child Psychiatry. He is an MBBS and MD in Psychiatry from Government Medical College. He is currently  Professor and Head of Department at Government Medical College, Kottayam, Kerala.

He authored a book ‘Manorogangal’, in malayalam, about Pshycatric disorders. There is one chapter on ADHD also. 

READ MORE…

What is ADHD (Attention Deficit Hyperactivity Disorder)?

How ADHD is diagnosed?(ADHD Part -III)

What is the behavioural approach used in ADHD? (ADHD Part -IV)

3 New year resolutions for people with arthritis

Every year we take new year resolution to give up a bad habit or to begin a good  one. This years theme for World Arthritis Day on October 12th was “It is in your hand, take action” to live life to the fullest. Most of the people with arthritis, whom I know, put in lots of efforts so that they can keep in pace with the demands of the world and live life like normal human being. The excruciating pain, fatigue and disability are some of the hindrance for a arthritis patient. Some succumb to the condition, while other turn all the obstacles into opportunity. If those suffering from arthritis take some new year resolutions to improve their lifestyle then they too can live their life to the fullest.

Arthritis is becoming quite common in Delhi, especially after the yearly outbreaks of Chikungunya virus.  People experience joint pain and difficulty to walk even a few months after they had Chikkungunya. Now a days, if you stagger, people inquire if you were suffering from Chikkungunya.

There is lot of commonality between Chikkungunya and Arthritis pain, and in some cases Arthritis pain and deformation are triggered after a Chikungunya attack.  People of any age can get arthritis, but if you take some precautions you can avoid worsening of the  condition. If you chart out a healthy lifestyle pattern for yourself, some of the damages get repaired and you can enjoy a normal lifestyle.

Most of the arthritis patients I meet have come up with their own creative methods to mitigate the pain. Some rely on allopathic medicines, others on Ayurveda and some on herbal remedies. They now know which food causes pain and which one relieves pain.

On this New Year, those suffering from arthritis should take the New year resolutions to live life to the fullest. Here are a few, new year resolutions, ideas based on the experience of those arthritis patients who have overcome all odds by following a healthy lifestyle:

Eat the right Food

Preferably follow a vegetarian diet, which is easier to digest. Some fishes are good, but egg and meat are better not to be consumed regularly. Have lots of water especially on an empty stomach.

And sometimes it is good to fast. Most religions have fasting period in the religious calendar. If you follow the fasting with discipline that will help relieve the pain. If you have never fasted in your life, then consult a doctor before fasting. Arthritis is an auto-immune disease where the body cells are attacking one another. Experts say that  during fasting period the body cells get time to relax and repair.

Walking and Exercise

Of all the medicines, walking is the best prescription for arthritis. Some say that they walk instead of driving or riding a scooter. But that is not enough. Every day you must walk atleast 20 minutes, as part of fitness regime. Consult your doctor to find out how much time is recommended for your walking and exercise. Also find out if you are permitted to Jog. Walking is the best medicine for arthritis. If you walk atleast 5 days a week, you can maintain a healthy lifestyle. When you feel pain, doing exercise will mitigate the pain.

Meditation and Spirituality

Mental and spiritual well being is a crucial aspect of arthritis. The condition aggravates when one is mentally disturbed. Hence you should spend atleast an hour every day for Meditation. You must find the inner peace and the soul connect. Many patients with RA positive,and some even chronically bed ridden, claim to have been miraculously cured because of their belief in God. Some doctors recommend meditation  for an hour daily. Being at peace with oneself and avoiding stress helps in coping with arthritis.

 

 

Visit to an old age home

The population of the elderly is increasing, and so is the number of Old Age Homes. Recently I met Stanley Johnson who runs John’s Daycare and Boarding for Senior Citizens, where elders stay, who suffer from various Geriatric ailments. On a holiday I decided to visit John’s Home, in Aya Nagar, Delhi, to know more about how an old age home works and to meet the elderly. I visited the home with my family, assuming that the kids will have a new experience rather than visiting some tourist destinations.

In the lush green lawns, of the quiet haven, of John’s Senior Citizens Home, the elderly Aunts and Uncles were sitting on the benches and enjoying the cool breeze and evening sunlight. Inside the home, there was pin drop silence, and a handsome Uncle was sitting in the reception, busily scribbling something in a note book.

Mr. Stanley said that the Uncle got mentally disturbed after he suffered a huge loss in business. After coming to John’s Old Age Home he was put on medication, and now he has recovered. He does not speak much but reads voraciously, and he is also the library in-charge.

Apart from the neatly and hygienically kept rooms, which are provided to the elders, there are also common recreation and dining areas. The clean and odorless surrounding of the Old Age Home is different from the rooms of elderly at our homes, which will usually smell of medicines and human waste. “The ultimate goal of our institution”, says Mr. Stanley, “is to ensure that the elders who are with us are happy and live with dignity in a safe clean environment.”

Stanley says that the care required by the elderly are of three different types: Some are fully depended so they require complete assistance in all their activities (Dependent Ageing), some are partially depended (Assisted Ageing) and other can manage their daily routines on their own (Active Ageing). “Some normal problems of the elders are loneliness due to loss of the spouse, weak eye sight, disability in walking and another movement, self-denial, loss of Memory, paralysis, Dementia, Alzheimer, Parkinson, Blood Pressure, Diabetic, Cardiac problems and Bed sores.”

We met some of the elders, and the aunties talked more and socialized. Some of them were wealthy, some abandoned and others suffered cruelty and treachery from their relatives. Because of their willingness to talk and share their feelings, I made a video which is shared below.

The elders are given round the clock individual attention by care givers, Nursing Staff, Supervisors etc. every senior is served in a different manner as per the need of the inmate, For Eg: Arthritics patient is dealt in the softest manner of lifting and placing for food /toilet habits.   Many of the elders here are affected by dementia, Alzheimer’s,  partially paralyzed, physically handicapped,  completely bedridden or suffering from loss of memory, sight and with a negative attitude to the life.

Dementia or Alzheimer’s require full-time nursing as the patients lose their memory and they are to be treated like new born babies. The care takers require a lot of patience and training to attend to an Alzheimer patients needs. John’s Home is known for the care they give to such patients.  A 78-year-old Aunty, a Keralite, who is there for the past eight years, thinks that she has come there only a few days ago. She claims she is from a Royal family in Kerala.  Stanley says “There was a mentally imbalanced upset aunty who now gets an audience to hear her sad stories and sings beautifully for the school children who visit her often”.

The Nonagenarian, Aunty, stole our heart. She is 99 and will be celebrating her 100th Birthday very soon. She is a vivacious and elegant lady who was a teacher in Nainital and Dehradun in her hey days. She is never satisfied with the care she receives/received anywhere, and she demands more care. Care for here means – someone to listen to her endlessly. She is been at Johns home for the past many months and surely enjoys her stay there. At the ripe old age, she was punctually out in the lawn after tea for her evening walk, accompanied by her attendee.

Stanley says “Once there was an unhappy Grand Father who doubted and complained about everyone in his own home.  He was made the Supervisor of the floor and he had no complaints as he saw himself as a captain and is very happy and felt that this home was better placed than his previous home”.

The vision of John’s home is to ensure that the solace provided by them helps every elder staying at the home forget their past sorrows and live joyfully with a smiling face. Their future goal is to have their own home along with a Geriatric division giving Age care facilities to accommodate at least hundred Senior citizens.

“At John’s, we have been constantly working as a team on spreading awareness about the need to uplift senior citizens and help them thru their disabilities as age catches by and thus working on the human cause of uplifting social awareness. Taking our endeavors forward, this year we have crossed boundaries, serving the society is great Pleasure. Our life is incomplete till we add meaning to it.”

John’s Old Age Home provides social services to the community, especially the underprivileged by organizing medical camps in coordination with different hospitals at our center on timely intervals.

When asked why and how your team decided for serving the Seniors he explained that amongst our members there was a feeling that we could have done much more for our parents who have left this universe and that prompted us to do something and dedicate our remaining time, energy and money for caring for elders. The similar kind of feeling is shared by every child with aging parents – even after taking care of them at home, or give them complete medical attention, after their death, children ask the same question ‘Did I do as much as I should have done’. Whatever may be the reason for being sent to such homes, Old age homes like John’s Home provide complete care, attention, and love, which gives happiness to the elders in their old age.

Mission of John’s Old Age Home

  • Encourage each and every one to share and gain!
  • Generating awareness for a disease free society is our moral and ethical responsibility.
  • We always tend to impart education on preventive aspects of healthcare along with suggestive measures to build a healthy environment leading to a healthy society.
  • Our work is a way of telling the people among whom we operate that we care. Responsibility towards our community remains an integral part of most of our endeavors.

How can We help in the care of the Elderly?

  • As a Coherent community let us bring about the cultural leap of helping people. Helping someone is equivalent to praying to God.
  • Let us all come together to help and support people for their better and healthy life.
  • Everybody should be as encouraged to volunteer their time and skills and enjoy the experience of giving back to the community in which they work.

Good news about rheumatoid arthritis

Two years back I spent a month in an ayurveda hospital to recuperate from the side-effects of an accident. While lying in the hospital I saw many patients of different age groups suffering from various forms of arthritis. Since I was undergoing ayurveda massage the only activity  I could do was to browse the net on my little mobile phone.

I read many online articles by medical practitioners and patients about the causes, symptoms and treatments for arthritis. There were many stories by arthritis patients about how they lived with the condition. Just like when you read the symptoms of any mental disease and you feel like you too got the mental disease, after reading about the symptoms of various forms of arthritis I felt I got one or all forms of arthritis. After reading the life stories of some arthritis patients, I imagined myself with a walking stick after few years. Then the doctor advised me to stop reading.

After returning to Delhi, I met rheumatoid arthritis (RA) patients surviving on pain Killers and they felt doomed.  One even described arthritis as a ‘dirty disease’. The online articles about arthritis and the experience of the patients in Delhi were similar. They all felt the same way;

  • There is not cure for arthritis
  • One day you are going to be bed bound
  • The doctors only prescribe pain killer, which has side-effect

And so I concluded that there is no use in taking medicines for arthritis, and all you can do is learn to live with arthritis.

After two years when I went to Kerala last month, I met a few young rheumatoid arthritis patients in their early thirties who were mostly detected with the disease only after they fell paralysed. I found positivity in their and their care takers attitudes. The patients lead a normal life while still continuing with the medical treatment. Rewinding memories to my days in the hospital I remember meeting patients and hearing stories of recovery and how Ayurveda helped them stays active.

I saw some videos of interviews by ayurveda and allopathic doctors in Kerala who claim that if arthritis is detected at an early stage, the disease can be cured and that in the last two decades many medicines have been discovered to cure arthritis.  What I understand is that the people in Kerala approach arthritis not as a deadly disease but as a lifestyle disease like diabetes or cholesterol, which can be kept in control. There is no fear or phobia about the disease.

Delhi and the western countries, from where most of the articles on arthritis originates, are developed place, where people lead a fast life and so they follow only the allopathy treatment. Kerala is the land of Ayurveda, where even the Keralite diaspora living in different parts of the world rely on Ayurveda for many ailments – especially medications post delivery.  Nowadays some keralite patients combine ayurveda and allopathy, or allopathy and homeopathy etc.

  • Maybe there is a difference in the way Keralites deal with pain and deformity.
  • Maybe the lifestyle in Kerala helps them deal with the disease is a better manner.
  • Maybe the authors of articles online are those with acute arthritis.

I could sense that the approach to arthritis was different in both part of the world, so an interaction between patients on two sides of the globe will provide new hope for arthritis patients.

For a healthy adulthood parents must ensure kids get enough Nutrition for growth

Mother has a 75 year old helper called Bhavani Amma. I remember Bhavani Amma for her peculiar diet, or ‘strict diet’, that baffles everyone. Before telling about her diet I would like to explain her background.

Bhavani Amma spent her childhood on the shores of backwaters in Allappuzha which is famous for the paddy fields and fresh fish. She grew up on a diet of nature fresh rice and fresh-caught fish curry. In her twenties she was married off and she came to settle in our part of Allappuzha . Fish caught from the backwaters, rivers and sea reaches our village only after 8 to 10 hour. Bhawani Amma is choosy, she eats only fresh-caught fish with soft bones. Which means most of the days she had frugal diet. Bhawani Amma doesn’t consume chicken and in case non-veg is cooked in her home, she will survive on tea, from a nearby tea-shop, (chaya-vellam as we call in Kerala prepared from 1 portion milk and 2 portion water) for the next two days.

She has a concave stomach hollow like a shallow frying pan. My mother used to worry that Bhawani Ammani will one day starve to death because of her stubborn diet.

Last year Bhawani Amma slipped and fell; and as it is common among elderly we thought she was going to be bed-ridden for the rest of her life. To our surprise the doctor said that she had a minor injury and she will recover soon because of all the calcium she had accumulated in her younger days.

Bhawani Amma’s story compels me to believe that whatever we do in growing period keeps us healthy and sharper in our adulthood and old age. A doctor once said that after the age of 40 if you suddenly start having milk that would not benefit you in any form. And all of a sudden if you start jogging after the age of 40 that would not benefit you. Your diet and fitness regimen should be inculcated in the childhood.

Born during the time when the environment was unpolluted, nature provided Bhawani Amma, from a poor family, with all the nutrition for growth. In today’s world even the fish and vegetables are polluted. So we do not have the uncontaminated natural source to accumulate all the healthy nutrients. Hence we need to depend on food supplements to provide necessary vitamins, proteins and minerals during the growing period. One such popular and easy source of nutrient intake is by malt-based milk drinks.

Parents are doubtful whether milk health drinks are good for the children. Nowadays as we do not have the natural sources to provide proteins, vitamins and minerals to our kids, giving them malt-based hot milk drinks helps provide some nutrition for growth. Studies by consumer organizations show that malt-based milk drinks contains vitamins, minerals, calcium and protein; either all or majority of the nutrients. Children grow up within the blink of an eye and they should not be denied the essential nutrition for growth.

A mother of a 20 yr old girl now wonders whether her daughter did not grow taller because she did not give milk drinks. So instead of ruminating over ‘to give or not to give’ malt-based milk drinks to kids, better start giving them a hot glass of milk drink everyday. Since Consumer studies do not show any side effects of having milk drinks let the kids have milk drink and accumulate some nutrients.