Category: Patient Stories

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Adolescents Adults Buddhi Stories Featured Patient Stories

The day we gave back life through saving his liver – Navins story

Humanity is always greater than the problem

Navin at his college, and another picture of him and his mother

The first time I met Navin was as a patient in 2018, he was admitted with Acute Liver Failure. Acute liver failure is described as a loss of liver function that occurs suddenly within days or weeks most commonly in patients who do not have any prior liver disease. As his liver was failing and his family lacked resources, they were scrambling to find competent treatment to prolong his life. The hospital reached out to me and informed me of his dire and progressively deteriorating health.

Before the onset of his disease, Navin was a happy, healthy, and vibrant high schooler living with his mom and brother. They lived in a remote part of Kumbakonam with limited access to good healthcare. His father was no more and they were struggling to find resources to support his treatment.

When I met Navin, many hospitals had certified that his chances of survival were slim to none. I could not stand idle by the sidelines and watch a vibrant young life prematurely end without a fighting chance.

The team at Liverindia set up crowdfunding resources and also undertook his treatment regiment under our wings. We collected over 30 lakhs within a week and utilized our funds for fast-tracking his operation.

In retrospect, as a doctor and an experienced surgeon, I can say that his survival was not guaranteed. However, for Navin, God was gracious. His brother was a perfect tissue match for a liver transplant. We performed a highly complex partial liver transplant and waited for a week for positive indicators on his recovery.

In some cases of Acute Liver Failure, some patients may go through episodes of memory loss (altered cognitive capability and story recall). It is a common sign of hepatic encephalopathy, an added effect due to lowered liver functioning.

Even though he was improving physically, he was unable to read or write for a prolonged period. Liverindia was invested in his care and in getting him wholly healthy again.

Navin with the team at SuVitas

With the residual funds from the transplant, we transferred him to a famous neuro transition and recovery care facility called SuVitas.

“When Naveen was first transferred to SuVitas, it was obvious that he had received excellent life-saving interventions at the hospital and his family were full of hope for his recovery. His journey with us involved crafting a customized and comprehensive care plan that included medical monitoring, skilled nursing care, medical nutrition therapy, and calibrated physiotherapy in an infection-free facility. The team went above and beyond, as they always do for each patient, even to the extent of using psychological interventions for the emotional wellbeing of the family (since they were out of the station in these tough times). From being addled with limited functionality he progressed to be completely independent and being able to even sign his name – Naveen’s recovery remains a memory of pride for all of us at SuVitas.” Dr.Vijay Janagama, Founding Medical Director, SuVitas

Navin stayed there for a month, recuperated, and rejoined his classes but he relapsed and went blank during his last exams.

Following the memory relapse, Navin experienced some mental trauma and depression. Again Liverindia along with the help of Buddhi Clinic took his case to a famous Neuropsychiatrist, Ennapadam Srinivas Krishnamoorthy, a specialist in Epilepsy and Dementia.

From noted Neuropsychiatrist and Founder and Director of Neurokrish, Dr. Ennapadam Srinivas Krishnamoorthy and the team at Buddhi Clinic,

‘Navin came to us at Buddhi Clinic referred by Dr. Karthik Mathivannan, liver transplant surgeon. N had undergone a liver transplant in September 2018 for ALF following which he was comatose for 20 days.

When he came around it was found that he had significant memory complaints and swallowing difficulties, blanked out during exams. The mother reported that he had developed explosive anger episodes. This left him volatile and he cried often. He also had problems with sleeping, speech, and tremors in his upper limbs.

In line with Buddhi Clinic’s good practice, we started with a comprehensive assessment of the patient to thoroughly evaluate him across physical, behavioral, and cognitive domains. Treatment & Rehabilitation: He was inducted into our Buddhi Seva social impact program given his disability and socio-economic status. Based on this comprehensive assessment in both physical and behavioral/cognitive domains, an intensive integrative therapy program was put together in a span of 5 weeks to treat the various post coma sequalae This comprised of 20 hours of CAM treatments including 7 hours of Ayurveda therapy and 13 hours of Naturopathy
therapies which helped him regain focus and improved his memory and behavior. Caregiver counseling was done for his mother to help her cope with his behavioral symptoms and reduce her anxiety.

Outcome: At the end of the therapy program, his attention and memory had improved,especially recall. He was emotionally more stable, with reduced crying spells and agitation. He was able to speak more clearly and with confidence. With significant improvements in both
behavioral and cognitive domains, Navin and his mother were satisfied with the holistic approach of assessments and treatments from the Buddhi Clinic team and by the all-around gains made by the patient post-therapy.’

He recovered fully post this treatment and regained his memory completely. He is now a fully functioning adult and recently graduated college. His story truly highlights the importance of never giving up on hope and why we as Liverindia exist as medical help for the hopeless.

Source: https://liverindia.in/

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Adults COVID-19 Featured Patient Stories

Raja Mohan Rides Again!

The Buddhi Clinic team first met Raja Mohan a Southern Railway employee, then in service, in early 2019. He was referred to us for rehabilitation following a stroke that had left him bed bound, paralysed and unable to care for himself. Over three months, with our then “new” brand of integrated care, #trimed, Raja Mohan made an amazing recovery, becoming completely independent and ambulant once again. So much so, that his integrative medicine rehabilitation case study was covered in Doctor #Vikatan a popular Tamil language magazine. Raja Mohan went on to rejoin work in the Southern Railway Booking Office, would walk a couple of kilometres every day to catch the bus to work, and resumed a generally active lifestyle. With multiple co-morbidities, Chronic Obstructive Pulmonary Disease (COPD), Hypertension, Diabetes, High Cholesterol levels, and Mild Cognitive Impairment (post Stroke), he remained active, followed up with all his medical specialists regularly, thanks to his loving wife, fulfilled his many roles as husband, father, sibling, uncle to his large extended family of 26 people occupying a block of apartments in Chennai, and worked till his retirement from the Railway in 2019.

Earlier this year, Rajmohan was wheeled back into Buddhi Clinic by his distraught wife. Affected by #Covid-19 he had been in hospital for two weeks, before being discharged. Wheel-chair bound, confused and disoriented, he was uncommunicative, vacant and unable to care for himself, being incontinent of urine, needing feeding by hand and assistance for all activities of daily living. In normal circumstances we would have advised admission to hospital for #delirium management and #rehabilitation. In these troubled times of a second wave, neither were hospital beds available, nor would his condition be considered a priority. Thus began our #home care protocol for #Covid-19 delirium rehabilitation with his wife and extended family assisting his recovery.

At intake the following symptoms were targeted for rehabilitation.

  • Poor sitting and standing balance
  • Difficulty in walking
  • Mild weakness of lt upper and lower limbs-4
  • Slurred speech
  • Poor food intake
  • Dyspnea on exertion
  • Mild tremors in both hands

Medication was substantive and included neuropsychiatric, pulmonology, Diabetology and medical prescriptions, in total a list of about 16 different formulations including some combination drugs. The neuropsychiatric drugs included sodium valproate (for seizure prevention and behavioural control, continued from hospital), donepezil (for cognitive dysfunction, piracetam, citicholine and ginseng. No other psychotropic drugs were prescribed to manage delirium as there were no problem behaviours.

We commence care on 16th April 2021 with our physical therapist (Mobility Lab), tDCS technician (Brain Mapping Lab – Neuromodulation) and Complimentary & Alternative Medicine technician (CAM Lab) delivering 10 sessions of care each at home.

LabTreatment Provided
Mobility LabElectrotherapy, exercise therapy, gait training & manual therapy
CAM LabFocal abhyangam and reflexology
NeuromodulationtDCS- delerim protocol

With each lab tech visiting Raja Mohan two to three times weekly (as the ongoing lockdown would permit) Rajamohan made a slow and steady recovery. Indeed when reviewed by our founder Dr. Ennapadam S Krishnamoorthy on 10th May 2021 (about 3 weeks on) the clinical notes were “Has made good recovery from post Covid delirium- in home based rehab from Buddhi Clinic. Is ambulant, responds appropriately. Continues to have slowed cognition, mild tremors, some dryness of skin in the feet etc.

At our end of “first therapy cycle” case conference the outcomes were recorded as follows.

SymptomPre-therapy VAS*End Therapy VAS*Inference
Mobility62Much Improved
Sleep62Much Improved
Pain62Much Improved
Metabolism62Much Improved
Speech64Some Improvement

Raja Mohan is no longer confused or disoriented. He is completely independent in all activities of daily life, moves about freely and safely, walking with a broad based but stable gait, and responds appropriately to all questions, with some delay and slowness, but with clarity. Indeed, his wife’s comment was “you have given him a third life”, she having witnessed the devastation of neurological insult twice in the span of eight years, first a stroke and now Covid-19 delirium. From the medical perspective we learn that Covid-19 can cause delirium which is treatable, this being our third success story. From the humanistic perspective we understand the importance of faith, hope and family in rehabilitation and care.

Raja Mohan rides again and in doing so he validates for us the importance of our Buddhi Clinic’ integrated care model in #neuropsychiatry.

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Adults Featured Patient Stories

From heaven’s door to the emerald isle!

An “I Found TriMed” Story

Mr. P from Sri Lanka was brought to our attention, by another patient of ours Mr. A, who had benefitted greatly from our therapy. Four months earlier, Mr. P, a successful trader, had found himself developing abnormal sensations in his hands and legs, followed insidiously by progressive weakness. He went on to develop, over a month, problems with swallowing, speech and a host of other brain functions. As the family was concerned about his progressive illness, he was shifted to a major Chennai hospital. There he was diagnosed to have an acute inflammatory disorder of the brain, Acute Disseminating Encephalomyelitis (ADEM). After a fortnight in hospital during which time he received high dose intravenous steroids and a host of life saving procedures, Mr. P was discharged to home care and physiotherapy. A fortnight later, when the family found progress lacking, the TRIMED team was called in.

When we first met Mr. P he was bedridden, needing assistance for all activities of daily living; being fed by a Ryle’s tube, unable to speak, communicate, even indicate his needs. We were very concerned about his health and longevity. A brief admission in our affiliate hospital showed metabolic disturbances, probably a consequence of poor intake, needing immediate correction, as well as (in endoscopy by our discerning ENT consultant) significant oedema (swelling) of the laryngeal structures. He was stabilised in hospital over 5 days and discharged back to home care by the TRIMED team. We started our work with home based rehabilitation using a combination of Ayurveda therapies, mud therapy, physiotherapy, acupuncture, nutritional management and motivational counselling. In a week Mr. P was being mobilised from his bed to a wheelchair and was able to come to the TRIMED centre in his neighbourhood for intensive therapy. He was acknowledging his caregivers and attempting to communicate. In two weeks he started to stand with support and was able to swallow small quantities of blended food. He was able to speak a few words in a low voice. At the end of three weeks Mr. P was able to walk with assistance, eat most foods given to him; speak well enough to be clearly understood, eat normal meals and enjoy watching TV.

Four weeks on, from the time he found TRIMED, Mr. P boarded a flight back to Sri Lanka. He came to Chennai in a stretcher and boarded a hospital ambulance, acutely ill. Six weeks on, he walked through Chennai airport to board his aircraft. We are sure he will continue to practice the TRIMED way, our one hour program combining hatha yoga, progressive muscle relaxation and ergonomic exercises. His wife, besides herself with joy, has pinned an inspirational message on our centre’s notice board.

No doubt Mr. P needed and benefited from acute medical care, which saved his life. But it was our rich TRIMED blend of modern medicine with ancient medical traditions that got him back on his feet, delivering care beyond cure. Mr. P’s journey to Heaven’s Door and his triumphant return to the Emerald Isle, is our continued well-spring of inspiration at TRIMED

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Adults Featured Patient Stories

What lies beneath the beautiful mind?

On John Nash and his Schizophrenia- published in Deccan Chronicle

The famous mathematician John Nash is a prime example, the film, A Beautiful Mind, bringing to engaging life the tumults that affect a person with schizophrenia. For the mind is a construct, not a physical entity. Modern medicine sees the mind as software and the brain as hardware. Millions of neurons, linked by chemicals (neurotransmitters) that establish pathways and communicate through them, form it. But when there is major mental illness, such as schizophrenia, this neurochemical system breaks down and there follows a disintegration of thought processes and reasoning.

What lies beneath?

The person so afflicted suffers from a degeneration of the neurotransmitter systems, of dopamine, serotonin and acetylcholine in particular, which serve like chemical messengers of the brain. They are molecular substances that can affect mood, appetite, anxiety, sleep and other parameters. Schizophrenia causes  atrophy of critical brain structures, such as the hippocampus, which is the storehouse of memory and a device for comparing  emotion. The person is likely to have grown up in an environment that offered limited opportunities for emotional expression or development. He or she also has an inherent over-sensitivity, a tendency to misperceive environmental events and is likely to over-react. It is important though, from a social perspective, for them to be educated, employed and to marry.

Symptoms

Mood swings, happiness or sadness that is out of proportion to the circumstances; hallucinations, seeing or hearing things; beliefs that have no basis in reality or delusions, making assumptions where none are warranted; emotional dyscontrol (anger, laughter, crying, inappropriately); sleep and appetite disturbances; lifestyle issues — these are some of the common symptoms. More severely affected people show a disintegration of language and communication, with stilted speech, odd behaviours and inappropriate gesturing.

Treatment

The advent of chlorpromazine in the middle of the last century signalled the advent of a biological ‘mind cure’, and ever since, many psychotropic drugs have emerged that can help restore normal mental functioning and been found to be quite safe and effective. However, drugs are not without side effects and are by no means universally effective, a proportion of people failing to respond to various permutations and combinations. Further, while drugs control symptoms — even banish them — they do not restore normal functioning or the quality of life on their own. The affected person needs to relearn lost emotional, social and pragmatic skills, regain confidence to engage in social intercourse, learn once again to pay attention, concentrate and commit to memory; indeed function as an integrated whole, in family, at work and in society.

A comprehensive programme of psychological therapy for the person and the family is therefore essential. Occupational therapy to regain lost skills and focus; physical therapy, including exercise, to manage attendant physical symptoms and regain bodily fitness; yoga and meditation to manage anxiety, restore calm and enhance well being, are all helpful.

Largely untapped also, are the secrets ancient medical traditions hold, with potential to enhance physical and mental well being, Shirodhara in Ayurveda and Hydrotherapy from naturopathy, being classic examples.

Reintegrating the mind is thus a task for a multidisciplinary team,  guided by a qualified mental health professional, and such an approach, with well defined goals, can go a long way in helping the patient.

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Adolescents Adults Children Elders Featured Patient Stories

A traditional touch alongside an allopath

#Trimedtherapy.com our #innovative #healthcare #enterprise featured in the #start-up files of the Times of India recently- a story by Pushpa Narayan.

After practicing medicine for seven years in India, London returned neuropsychiatrist Dr Ennapadam S Krishnamoorthy understood that while Indians had total trust in modern medicine their heart was often in traditional systems. If an Ayurvedic medicine would work or if a series of yoga sessions seemed to help, they would rather go for that. Like most allopaths, Dr Krishnamoorthy , was initially dismissive but soon realized that he should investigate the science behind “alternative medicine.”

After some years of diligent research and efforts, he launched a small clinic called Trimed, as a pilot, near his house in Sri Nagar Colony in 2009. With seed money from family and friends, Trimed sought to weave allopathy with Ayurveda, yoga, naturopathy and Pilates.

The first task for the integrated medical therapy centre was drawing up treatment protocols that integrate diverse genre whose practitioners have typically worked in silos – with each being mostly dismissive of the other. “In most such integrated centers, we realized that treatment was mostly left to patients’ choice. Many times patients aren’t guided through choices. Ours was a clinic and we decided that treatment protocols will be decided by the doctor,” said Dr Krishnamoorthy , one of the founders of Trimed. For nearly 40 conditions including pain, disability and mental health issues the team has standardized treatment practices.

Patients coming to Trimed meet an allopathic practitioner first, but they are also evaluated by at least four other specialists including a physiotherapist, naturopath, Ayurveda practitioner and a psychologist. The specialists then discuss the treatment plan for each case sheet.”Sometimes treatment plans take more than two hours to formulate,” said Dr Rema Raghu, an epidemiologist/ lifestyle physician, who is one of the core members. The aim is to bridge the limitations of allopathy with the wisdom in traditional medicine. “We made a conscious choice that all medicines prescribed will be only allopathic. Massages and therapy from other traditional streams are integrated with modern medicine. But with every case it is important to offer holistic care,” she adds.

The cloud-based electronic medical records of each patient stored at the hospital showed substantial progress in most patients. For instance, a 92-year-old a wheelchair bound patient walked out of the hospital after 15 days of intensive therapy and young IT professional was taken off the bench and put on projects after he was able to control mood disorders. Soon, Trimed, with its mobile therapy unit -an ambulance converted to therapy centre -extended services to home-care. “When people come to us they realize that almost everyone in the family needs holistic medical management,” said Gayathri Krishnamoorthy, a core administrator at Trimed. The centre, which was exclusively for medical management, is now expanding to offer rejuvenation therapy.

The company received funding of $300,000 from an Indian businessman living abroad. It is planning to start another centre in Coimbatore. “When I first heard about it I was impressed about the holistic approach concept. In fact some members in my family tried and benefited from it. I don’t think such centres should mushroom all over, but I certainly believe they have a place,” said A Vellayan, executive chairman, Murugappa Group, who has invested in his individual capacity.

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Adults Elders Featured Patient Stories

Food for the ageing brain…

The prevention of dementia assumes great significance, especially as we exist in an era of chronic and lifestyle diseases. Indeed, the role of hypertension, obesity, lipidemias (high cholesterol) and diabetes (the HOLD construct) as causative factors of chronic and lifestyle diseases including dementia has assumed great significance in the last decade. The American Dietetic Association has opined that food and nutrition play an important role in maintaining one’s health. It is also well known that sub-clinical deficiency in essential nutrients and nutrition-related disorders can lead to loss of memory and other cognitive functions.

Poor performance in memory tests has been shown to be associated with low levels of a range of nutritional factors:

  • Vit B12 (with elevated homocysteine)
  • plasma lycopene
  • a-carotene, total carotene, b-carotene
  • b-cryptoxanthin
  • a-tocopherol etc. 

Supplementation: 

There is growing evidence that vitamin supplementation has a significant role to play in lowering the risk of dementia. Evidence for vit C, E, B12 and folic acid being given, as supplementation in higher doses, is particularly strong. However, the benefit seems most when supplementation is introduced in people who need it (with low vitamin levels) than in those who do not. These findings and allied research have also resulted in the US FDA recommending folic acid fortification of foods for the elderly, for example flour and bread. It is important to remember that high vitamin levels due to inappropriate supplementation can also be problematic and the taking of supplements should therefore be done with medical supervision.

Diet:

There is mounting evidence that the Mediterranean diet, which includes a high consumption of olive oil and fish — and hence elevated intakes of monounsaturated fatty acids and v–3 polyunsaturated fatty acids — is protective against age-related cognitive decline. This maybe partly due to the antioxidant compounds in olive oil (tocopherols and polyphenols) and in part to the role of fatty acids in maintaining the structural integrity of nerve membranes. 

Red Wine:

There is no doubt that red wine consumed in moderation has been shown to be beneficial to health and well-being; reducing bad cholesterol, preventing blood clots and protecting the heart. In part this has been attributed to the constituents of red wine, which include procyanidins, a class of flavonoids found in plants, fruits and cocoa beans.

Plant Formulations:

It has long been known that certain plant formulations have pro-cognitive properties and may enhance memory function. Many of these are the subject of active research today, Brahmi (Bacopa Monnieri), Tulsi (Basil), Ashwagandha (Withania Somnifera) for example. Curcumin, an active ingredient of turmeric, is also the subject of worldwide research. Among the fruits the pomegranate and walnut are thought to have pro-cognitive properties. While a variety of plants and plant formulations are under study, the jury is still out with regard to their specific benefits. The evidence for over-the-counter plant formulations is, therefore, not yet existent, notwithstanding their many claims.

Lifestyle & Attitude:

The jury is still out as to whether it is the aforementioned constituent factors that render protection, or indeed whether the overall Mediterranean lifestyle — physical activity, healthy food, abundant sunshine, meals eaten at a leisurely pace with plenty of socialisation — is responsible for the health, well being and good levels of memory/ cognitive function in that population. For example, therefore, red wine consumed in moderate quantities may be good for you, but only when it’s accompanied by such a “healthy” lifestyle & attitude.

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Adults Alzhimers Featured Memory Problems Patient Stories

Of menopause & memory

A is a generally healthy and active woman professional of about 48 summers. I know her socially, well, and was curious when she sought an urgent appointment to see me professionally. “I am losing my memory doc”, was A’s first statement as she walked into my office. Probing further I found A was complaining of much more that absent mindedness. Word finding difficulties, struggling with routine skills like driving, becoming disoriented on arriving in a hitherto familiar location, not precisely remembering why she was there anyway, the list seemed endless. “Am I getting Alzheimer’s doc” was her genuine concern, expressed more than once as our interview progressed. 

Different Strokes

I asked her about her general health- whether she had any of the four key lifestyle risk factors which predispose to memory loss: Hypertension, Obesity, Lipid (high cholesterol) or Diabetes. While she did not have high blood pressure, blood sugar or cholesterol, she had been overweight until 2 years ago when she went ahead and elected to have bariatric surgery abroad. Following this she has lost considerable weight and had been on a rather severe diet that was recommended for about 18 months after. “I am slowly resuming a normal diet, but the quantities I eat remain small”, said A. On questioning she reported normal thyroid function, no lupus or other such inflammatory condition, both of which can also predispose to memory problems in younger people. Her heart and kidneys had been declared “fit and well” by her physician, during her last master health evaluation. What about your monthly periods, I demurred? “Menopause finally set in doc, about 2 years ago”, said A. When did the memory problems start, I wondered? A thought for a few moments before responding; “about the same time as my periods started tapering off” she responded. A clarified to leading questions that she was not under any significant emotional stress, nor were there any stressful life events in recent times. Indeed, with both children off to college and her husband having come into considerable wealth recently, A felt life could not be better, especially as they now had the time, resources and freedom to travel, something they both enjoyed. I asked her about neurological events or symptoms during her lifetime: head injury, seizures, fainting episodes, strokes, to all of which she replied in the negative. 

On physical evaluation A was completely well and there were no signs of concern. On the bedside evaluation of memory and cognition, though, I found A struggled a little with tasks of attention (focus), recent memory (recall) & executive function (ability to perform tasks in sequence), resulting in her working memory being somewhat affected. She did manage to remember and perform most tasks: however, she was a little less efficient and speedy than I expected her to be, considering that she was a smart & efficient professional. The obligatory brain scan (as a measure of safety) was normal, but her blood tests revealed that she was deficient in vitamin B12 (an outcome of her dietary restrictions following bariatric surgery) with elevated homocysteine, a brain chemical that is associated with memory problems. I concluded therefore that A had two reversible causes of memory impairment: vitamin B12 deficiency & menopause. 

The Menopause Effect

The World Health Organization defines the perimenopause as the time immediately preceding the menopause, beginning with endocrine, biologic, and clinical changes, and ending a year after the final menstrual period. The Study of Women’s Health Across the Nation (SWAN) published in the American Journal of Epidemiology (2000) showed that of 12425 women aged 45-55 years across sociodemographic categories who participated, between 31 and 44 % of perimenopausal women, endorsed forgetfulness. Overall perimenopausal women were 1.4 times more likely than premenopausal women to be forgetful, this finding not being just due to emotional stress. Indeed, there is considerable research today to show that in the year after the final menstrual period, women do demonstrate deficits in attention, working memory, visual & verbal memory and motor speed. Interestingly, studies like the “Harvard Study of Moods & Cycles” show that in the perimenopausal period, women are twice as likely to be depressed, and while this is not related to negative life events, it is associated with vasomotor symptoms (hot flushes). This links up with the theory that the brain hormone cortisol (which exercises an influence on the reproductive hormones) may be associated with both memory and mood; that higher cortisol levels and/or greater cortisol reactivity may be the biological link between hot flashes, depressive or anxiety symptoms and perimenopausal decrements in memory. Indeed, research has shown that young women have lower reactivity to cortisol than older (perimenopausal) women. This of course brings up the inevitable question, which A asked me “doc, should I be on Hormone Replacement Therapy”? HRT has been both praised and vilified (like many medical procedures) in equal measure. The summary evidence suggests that HRT commenced during the perimenopausal period has the potential to help symptoms of mood, anxiety and perhaps importantly, memory. However, HRT started outside these time periods does not appear to have a similarly beneficial effect, indeed may even be detrimental. 

Prevention & Cure

I had identified in A, apart from menopausal transition, a reversible cause of memory impairment, vit B12 deficiency with elevated homocysteine; which has an impact on memory and makes one vulnerable to having strokes. Other reasons why middle aged individuals like A have problems with memory include depression, infections, inflammations and metabolic (including thyroid) problems (all reversible); cancer, strokes & brain tumours (potentially reversible, at least in part); and  brain degeneration (non- reversible but can be slowed, partly arrested). It is for this reason that people with memory complaints in middle life like A, need to be thoroughly evaluated for a range of causes. A did go through such an evaluation before we concluded that her problems were due to menopausal transition and B12 deficiency, both of which we proceeded to address. We recommended to her, all those things that can help a person stave off memory loss (and indeed lifestyle disease): a healthy and predictable life, an antioxidant rich diet, adequate rest and sleep; regular aerobic exercise (walking, jogging, gymming); yoga, pilates or tai chi as mind-body interventions; moderation in all that one does, including and especially social consumption of alcohol. Turmeric is today in advanced trials and extra virgin coconut oil in early phase trials as a memory protecting agent. The former is adequately present in Indian diets generally; the latter easy to add, admixed with rice etc. We recommended both to A. 

We learnt from her too, as we do from all patients; the links between mood, memory & menopause, preventive health and the importance of holistic evaluation and care. All memory loss is not dementia and women like A in menopausal transition would do well to consider and address that aspect of their health.

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Adults Featured Patient Stories

The four legged stool

Mr. A is one of our “happy stories”. One who has been helped by the four legged stool: self-motivation, a supportive family, a supportive boss and adherence to the therapeutic relationship with the Neurokrish-Trimed team. He found and stayed with TRIMED and in him we find the raison d’être for our professional existence. 

When we first met Mr. A 8 years ago, he was doing his Masters in a prestigious American university. Rather devastatingly for him and his family he was diagnosed with Paranoid Schizophrenia, which had in the previous year impacted severely on his life and academic performance. Confused by his hallucinations and delusions, fearful for his safety and struggling to live alone, Mr. A was brought back to Chennai by his family. We treated his acute illness with psychotropic drugs, relaxation exercises, individual and family counselling and nutritional counselling (for his obesity, in part a consequence of his drug treatment). Within a month, Mr. A was able to return to his university and continue his course. He did of course have a few stable paranoid ideas and occasional mood swings.

Mr. A managed to stay on in university and graduate with a Master’s degree with ample family support. He progressed to secure a suitable technical position in a major multi-national computer manufacturing firm. Here, he was fortunate to be placed under a humane and empathetic boss. Over the past 8 years he has continued to visit Chennai annually for a course of multi-disciplinary therapy with our team. He also remains on fortnightly-monthly skype sessions with our clinical psychologist. He has had periodic exacerbations of mood changes with racing thoughts and paranoid ideas. He has wondered about the intentions of his fellow employees and become agitated in his interactions with them. He has had to take time off work to go and stay with his sister, in another part of the US, for a few days. He has on occasion, especially close to major life events (exams, role transfers) needed his parents to travel to the US and stay with him.

However, thanks to his own efforts, his uniquely supportive parents and sibling, a very supportive boss and mentor at work, and (in our belief) TRIMED therapy, he has managed not only to keep his symptoms under control, but to hold on to a job and climb the ranks at work. Back in India for his review and booster therapy sessions, Mr. A reported that his symptoms have almost remitted over the last year. This, despite his move to a new job at another respected multinational technology major. He is proud to share his weight loss efforts and to seek TRIMED’s assistance in meeting these goals. He has been diligent about his medicines, and has practiced the TRIMED way (relaxation, yoga and ergonomics) diligently, through the past year.

Mr. A is one of our “happy stories”. One who has been helped by the four legged stool: self-motivation, a supportive family, a supportive boss and adherence to the therapeutic relationship with the Neurokrish-Trimed team. He found and stayed with TRIMED and in him we find the raison d’être for our professional existence.

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Adults Buddhi Stories Epilepsy & Seizures Featured Memory Problems Patient Stories

Rare illness, caught on time

Rare illness, caught on time
Rare illness, caught on time

Seizures, memory loss, aggression: symptoms that left a television news editor unfit to work. Until a providential diagnosis helped him make a remarkable recovery.

When R, a television news editor in his 40s, came to us a couple of years ago, he was suffering from seizures, poor short-term memory, mood swings, irritability, suspiciousness and aggression. Although he had a great track record at work, his condition had left him unfit to return to his job at a well-known television company. We found that his symptoms were provoked by limbic encephalitis, an antibody syndrome where the body’s immune system attacks rather than defends it. Apart from repeated seizures, the condition, which affects parts of the brain that control memory and emotion (the temporal lobes), had left him with a set of neurobehavioral symptoms.

While treating him for this, a timely visit from Oxford by Angela Vincent, a world renowned expert on antibody syndromes, in 2014, helped us diagnose R with a second, hitherto undiagnosed — and rare — antibody-mediated syndrome called NMDAR 1. We gave him a second course of intravenous steroids (the first having been given during initial presentation) following this discovery, and saw a distinct improvement in his memory and behaviour.

Evaluating R in some detail, we found he had severe deficits in cognition, with very poor ability to remember any new information. Indeed, he took quite a while to even become familiar with our team that was meeting him each day.

Our integrative rehabilitation programme for him was, therefore, focused on memory retraining and behavioural management, but included shirodhara (an Ayurveda treatment with brain-behaviour focus), acupressure, reflexology and physiotherapy. He was also given a combination of drugs to control seizures, enhance memory and modulate behaviour.

Counselling the family, helping them understand his predicament — that his symptoms were not deliberate or put on but an outcome of brain injury — was also part of the treatment. Working with his employer, who was concerned about R’s inability to do even some simple crucial functions, and prescribing a time-frame for our continued efforts, was also essential, helping R retain his job. Indeed, his immediate boss, a popular media personality, visited the centre to discuss R’s condition.

R’s recovery over two years was stormy. Seizure clusters, poorly controlled (pre-existing) diabetes, and an extraordinary reaction to a drug prescribed for seizures resulted in three emergency hospital admissions.

Also, R had great difficulty in accepting changes at home, such as his wife taking on decision-making and financial management roles. Paranoia and disturbed sleep taxed him and his interpersonal relationships greatly. At work, a change in the software platform magnified R’s difficulties. No longer could he work on auto-pilot; skills learnt over two decades were suddenly obsolete.

Supported by a caregiving trinity — family, employer and medical team — working in tandem, R managed to overcome these multifaceted problems.

Two years on, the transformation in R is remarkable. He is seizure-free, composed, communicates clearly, manages well at work having learnt to use the new software platform effectively, and enjoys a close trusting relationship with his family. He still has some residual memory and cognitive dysfunction and attends our centre for weekly cognitive retraining sessions. He continues to take some medication to control seizures and improve his memory.

This father of two, the sole breadwinner of a young family, managed to retain his job and win back his life because of a providential and timely diagnosis.

Categories
Adults Buddhi Stories Featured Patient Stories Unexplained Medical Symptoms

What’s up, doc?

Whats Up Doc
Whats Up Doc

When symptoms defy explanation, an interdisciplinary approach works best.

When I first met Mrs. A, the wife of a practising physician, she had been clinically symptomatic for over two years. Her main complaints were an uncontrolled appetite (she was eating every two hours and in large quantities), weight gain (over 10 kilograms), irritable bowels (she was visiting the loo every two hours as well), vague aches and pains, fatigue and excessive sleep. She had consulted an army of specialists of every conceivable description, undergone (often repeatedly) a battery of investigations, no specific abnormalities being identified and consequently no diagnosis having been made.

Each person who saw her had given her a diagnosis: the gastroenterologist called it “irritable bowel syndrome”, the orthopaedic surgeon “fibromyalgia” and psychiatrist “atypical depression”. None of these diagnosis or treatments thereof had resulted in symptom reduction. Mrs. A was thus at her wits end when we met, desperate for a diagnosis and a cure.

Mrs. A is one of many people who suffer from a distinctly peculiar condition: unexplained medical symptoms. Clinical studies have shown that over 30 per cent of people attending out-patient clinics and emergency rooms have medical symptoms without ostensible cause. Indeed, a plethora of examinations and investigations done in these individuals fail to reveal any specific clinical abnormality, or diagnostic entity.

Shuttling between doctors, hospitals and diagnostic facilities, they often remain clueless about the real cause of their symptoms. Over time they develop a cynicism about the healthcare environment and proceed to explore alternative options. Meanwhile, healthcare professionals also become cynical toward such individuals, labelling them “neurotic”, “anxious”, “hysterical” and other potentially disparaging terms.

A famous study by Dr. Eliot Slater — an eminent psychiatrist in the National Hospital for Neurology, Queen Square, London — followed up over a decade, all those diagnosed with “hysteria” in this pre-eminent institution and showed that a very large proportion (about half) went on to develop “real” medical illnesses. The results of that medical study published many years ago, warned physicians about the dangers of writing off unexplained medical symptoms as being “hysterical” or “in the mind”.

A repeat study in the same hospital in the 1990s, under the guidance of Prof. Maria Ron, an eminent neuropsychiatrist, showed that the rate of erroneous labelling as “non-organic” had fallen to about 10 per cent, aided no doubt by advances in medical technology. It must be noted however, that mis-diagnosis as “non-organic” or “in the mind” continues to occur even in pre-eminent medical institutions staffed by experts with access to best medical technology. Having said that, a number of people with unexplained medical symptoms do have “non-organic” causality.

So why do people have unexplained medical symptoms? A proportion, perhaps, have a genuine medical cause or complaint that has remained undetected. Examples include inflammatory, infectious and metabolic conditions, and rare forms of cancer that may take time to manifest their full avatar. A proportion may have true hysteria — deep psychological trauma that is finding its outlet in physical symptomatology with secondary gain being the attention derived thereof.

A proportion may be addicted to the hospital environment — “Munchausen’s” hospital addiction syndrome — leading them to repeatedly seek contact and reassurance from healthcare professionals. A proportion may have health-related anxiety and engage in so called “abnormal illness behaviour”, with their reactions being out of proportion to the symptoms they are experiencing. A proportion may be engaging in conscious malingering, presenting a medical symptom in order to avoid a social problem, for example, an arrest or a court appearance.

In all people with unexplained medical symptoms, the bogey of an “organic” cause that has hitherto gone undetected, needs to be kept in mind. Repeated and detailed history-taking and clinical examinations are necessary, as is a close and empathetic follow up, with neither the physician nor the patient’s family succumbing to the proverbial “crying wolf” syndrome. In patients in whom an organic cause has been excluded beyond reasonable doubt, hysteria, somatisation (multiple physical symptoms without a physical cause), Munchausen’s syndrome, Abnormal Illness Behaviour and malingering may all be considered and form part of a psychological continuum.

What varies across this continuum is the level of conscious awareness, considered low (hence unconscious) in hysteria and somatisation, and high (hence conscious, deliberate and wilful projection of symptoms) in malingering. What varies also is the motive or intent; preference for the hospital environment in Munchausen’s syndrome, avoidance of a social problem in malingering, or indeed the more fuzzy and less easy to diagnose “secondary gain” of hysteria and somatisation. In all these instances, an empathetic approach, with deep understanding of the client’s background (developmental, familial, social, occupational and marital) is necessary, as is a strong therapeutic relationship rooted in mutual respect and trust.

All the above seem a tall order when demanded from a solitary physician doing her/his best with the constraints of time and resources. Patients with unexplained medical symptoms do well when managed by an interdisciplinary team. Such a team usually is lead by an astute clinically focussed physician, supported by nurse practitioners, physical therapists, psychological therapists and counsellors, nutritionists, and other caregiving professionals.

In the emerging space of integrative medicine, physicians from a host of alternative disciplines like Naturopathy & Yoga, Ayurveda, Homeopathy, Acupuncture etc. participate in care delivery. For the person with unexplained medical symptoms interdisciplinary care provides the opportunity to both understand and manage various symptoms, physical and psychological, better. Learning to live with what cannot be cured, maintaining one’s activities of daily living and quality of life often become reasonable and acceptable goals.

Mrs. A was diagnosed by an interdisciplinary team, after a detailed evaluation, to have clinically significant autonomic dysfunction, a difficult to diagnose problem with myriad physical and psychological manifestations. Combined with this was an element of “Abnormal Illness Behaviour”. Her medical management was suitably augmented to address these complaints and she committed herself to a care program that integrated physical, psychological and nutritional therapy with ayurvedic treatments, mud therapy and yoga therapy.

Over a span of three months her symptoms improved considerably: normalization of appetite, regulated bowel movements, improved energy and enhanced activities of daily living and considerably reduced health related anxiety. Her success story underlines the challenges of interpreting unexplained maladies, the crucial role of personalised clinical medicine, the need for interdisciplinary care for chronic medical conditions, and for our intellectual glasnost as a society towards the wealth of clinical wisdom that resides in our ancient medical traditions.

As Hans Berger, the inventor of the Electroencephalogram (EEG) an instrument that studies brain waves, said, “A machine can replace neither common sense nor intelligence”.