Above the age of 65 ??? Even a violent jolt over speed-breaker can lead you to spine fracture.

: Dr Himanshu Tyagi.

Mrs Sudha 73 year old housewife, had a painful lock down period recently due to a fracture in her lower spine.

She suffered this spinal fracture 5 months ago while traveling in a bus which jolted over a speed-breaker.

There are many similar stories where passengers have suffered serious injuries due to flawed speed breaker designs.

Flawed speed-breakers can cause serious injuries in 2 wheeler traveller’s.

Common injuries in 4

1) Lower spine fractures (40%)
2) Neck injuries (30%)
3) Head injuries(25%)
4) Tail bone injury and others (5 %)

Medically speaking injuries due speed-breaker bumps can be life-threatening. 2 wheeler drivers are at a greater risk when it comes to fatal injuries or limb amputation.

Can cause compression fractures in lower spine

Common injuries 2 wheeler-

1) Head injury & Limb injuries. (80%)- without helmet.
2) Limb injuries exclusive -40 %.
3) Spine/chest/pelvic – 40 %

Types based on mode of injury –

1) LAUNCHING IMPACT – Head injury and neck/cervical fracture. (Occurs when passengers bounces and hit the roof of the car).

2) LANDING IMPACT – lower spinal (Lumbar spine) fractures. (Occurs when passengers lands on buttock in flexed spinal position).

Relation between vehicle & injuries –

1) 2 wheelers : skid over flawed speed-breaker. Head injury, limb injuries, cuts, bruises.

2) Car : Jolt over speed-breaker. Head injury, neck injury, lower back fractures.

3) Bus : Landing Impact. Lower back fractures.

4 wheeler’s are comparatively safer as life-threatening injuries are rare even though spinal fractures are common, which may require bed rest up to 2 months or occasionally a surgery.

People at risk for fracture

1) People above the age of 75.
2) Cancer patients.
3) Osteoporosis patient.
4) Passenger at the back seat of car (Launching impact).
5) Tall individual in a car with low head clearance.
6) Passengers at the rear end of bus (Landing impact).
7) Public transport/Bus with poor shock absorbing mechanics.
8) Speeding vehicles (speed about 65km/h is the critical velocity).
9) Not wearing seat belts.

Though as per the official dimensions, a speed-breaker should be at least 3.7 metres wide, should have a radius of curvature (ROC) of 17 metres and height of 10 cm but many a times we see speed-breakers with flawed design in India (Narrow & high speed-breakers)

Official recommendation for Speed limit over a speed breaker is less than 25 km/h in India. However we see people over-speeding on a speed-breaker and getting impact in spine due to the jolt.


Senior consultant Spine surgeon, Delhi NCR.

Ph: +919654095717


Spine surgery: When is it required?

: Dr Himanshu Tyagi

Back or neck pain is undoubtedly the most common reason to visit an orthopedician in today’s era. Low back pain alone accounts for almost 60 % of orthopedic OPD in any given hospital. Normally, low back pain or neck pain respond well to conservative treatment in the form of lifestyle modification, weight loss, posture training and exercises. Occasionally we need to supplement above mentioned measures with medicines (maximum up to 6 weeks).

“Around 97% of the patients respond well to non surgical treatment and only 3% require any sort of surgical intervention.”

Next step for spinal pain management includes well directed physiotherapy (IFT, TENS, Laser, manipulations) or spinal pain injections ( facetal blocks, pain blocks, radio-frequency ablation etc.)

If the problem still isn’t resolved, in such situations surgery becomes a good option.

“Minimum 6 weeks of conservative treatment should be tried before deciding for spine surgery”

Few specific indications to undergo spine surgery includes-

1) Progressive muscle weakness : This is one of the most common and often urgent indication to undergo spine surgery. This happens usually because of a slip disc in neck or lower back region affecting nerve carrying signal from brain to the muscle (through spinal cord). For best surgical result (reversing paralysis) the surgery should be done within 24 hours.

2) Loss of control for urination or bowel : called as ‘cauda-equina syndrome’ , this is usually due to a sudden slip disc in the lower back region affecting the nerves carrying control of urinary bladder, sex and bowel region to the brain. Ideally the surgery should be done within 6 hours of diagnosing the problem.

3) Spinal deformity correction: scoliosis or curved back deformity is a challenging but gratifying surgery. The post surgery results improves not only the cosmetic appearance but also lung function, pain and considerably reduces future risk of paralysis.

4) Severe back or neck pain not responding to conservative treatment: Normally , if the pain is not resolving within 6 to 8 weeks and is affecting the daily activities of a person (like going to office, traveling, sex or social requirements) then going ahead with the surgery becomes a reasonable option.

Severe Pain persisting beyond 6 weeks inspite of treatment calls for surgery.

5) Severe radicular pain in arms or legs : this is mostly because of nerve impingement in the spine either because of a disc protrusion or excessive bone growth or ligament swelling in spine. Severe nerve compression can lead to pain radiating down the arm or leg and can affect activities like normal limb function or even sleep.

6) Neurological Claudication : this is a special condition where compression of the nerves in the lower back can cause stiffness and cramps in legs while walking. This can be a very debilitating condition as the person is not able to stand and walk even to do normal day-to-day activities.

Tightness and cramps in legs during standing or walking.

7) Numbness, Sensory loss or Tingling in any body part : This represents a severe nerve compression leading to functional impairment in nerve’s sensation conduction capacity. If left untreated it may lead to permanent sensory loss or may even progress to paralysis.

Apart from above mentioned common reasons , few other indications which may require a spine surgery includes spinal fractures , spinal tumour removal, infections in spine and certain metabolic conditions.

“Minimally invasive surgery is going to be the future of spine surgery , as it requires a much smaller incision, less blood loss, faster recovery ,less pain to the patient and reduced Hospital stay”

Scared to visit Hospital during COVID? Here’s your guide to managing common orthopedic problems at home.

Key highlights – 

  1. Your first aid guide for managing arthritis muscular pains, and minor injuries.
  2. Common tips for managing orthopedic injuries/sprain effectively at home.
  3. Understanding when is it important to visit a doctor. 

It’s an open secret now that fewer people are willing to visit hospitals in view of the ongoing corona pandemic.  People are trying to manage small ailments/semi emergencies at home, but trying to avoid hospitals as far as possible. 

As a result, those who don’t have access to doctor’s advice (over phone) are turning to Google, relatives and friends for advice during emergency hours. The suggestions given by them are often misleading, based purely on their past experience or social media knowledge.

Up to 70% reduction in OPD patients

Mrs Smriti (name changed) unfortunately fell into the same trap, when she made her 81 year old mother to perform few back exercises based on her friend’s suggestion. Soon after the exercises her pain increased, forcing her to get hospitalized. 

“Patients are often seen delaying critical treatments in fear of catching the virus.”

Here are few tips to manage common orthopedic problems at home-

For Injury or Trauma – 

1) Ice compression – Do not apply ice directly on the skin. Wrap it in a towel and then apply it. (10 minutes, 3 times a day).

2) Keep the injured body part elevated (this reduces swelling).

3) Give rest to the injured part. 

4) Keep compression or pressure over the injured area.

5) Provide support – crepe bandage, splint or pressure bandage for the first 48 hours.

“It’s wrong to avoid going to the hospital and rather take chances at home,” 

For knee arthritis – 

1) Avoid squatting, climbing stairs, sitting cross-legged and using Indian type of toilet seat.

2) Do regular hot compression twice daily (10 minutes each).

3) Be regular in quadriceps – hamstring strengthening exercises. (click on the link below for exercises)


Acute back pain/spasm – 

1) Complete rest (in posture as shown below).

2) Avoid bending forward or lifting heavy weight.

3) Hot compression. (10 minutes, 3 times a day). 

4) Avoid any form of exercises during acute painful conditions.

5) Visit a doctor immediately if weakness, numbness or tingling in the leg.

6) Use pain relieving sprays (alcohol based/counter irritants) for local application over back.

7) For instruction regarding ‘Dos & Donts’ for back pain. Click here – https://youtu.be/xq-xcjsu9kc

Proper sleeping posture for
back pain patients

“There are many ways to consult a doctor – Video consultation, private clinic visit and online Medicare portals, are top few” 

For Cuts/wounds – 

1) Apply pressure and stop bleeding.

2) Clean the wound with running water to remove dirt and lose dead tissue. 

3) Clean the wound with Dettol or betadine liquid and apply a dressing of betadine ointment. 

4) Dressing should be of sterile gauze or clean cloth only. Avoid putting cotton over the wound directly.

5) Consider for tetanus/infection/gas gangrene prophylaxis /treatment if the injury is inflicted by a grossly contaminated object. 

Chronic neck pain –

1) Maintain good posture (especially while working on laptop and sleeping).

Proper sitting posture

2) Be regular in neck exercises.

3) Do intermittent stretching (every 30 minutes), if working on the laptop for long hours. 

4) Hot compression over sore muscles at night. (10 minutes, using a warm water bag)

5) For video regarding chronic neck pain instructions, click here 👇


When to visit a doctor (red flag signs) – 

1) Numbness, tingling in a limb or body part.

2) Pain out of proportion to the intensity of the injury.

3) Swelling or pain not subsiding within 48 hours.

4) Difficulty or inability to control urine or bladder. 

5) Visible/gross deformity in limb post-injury.

6) Open wounds or bleeding tissues.

7) Inability to move a body part

8) Severe swelling over the area.

9) Discoloration or limb turning pale.

Common orthopedic problems can be effectively managed at home to a major extent. But visiting a hospital is a must when situation gets serious (Red flag signs).  It is important to understand when and where to go if required. Online medical consultation and Video consultations are growing in India to tackle the situation. Before heading towards hospital it is always wise to contact your doctor through Video-consultation and take his opinion.

Disclaimer: The tips and suggestions given in this article are for general information purposes only. These should not be taken as professional medical advice. Please visit your doctor for any specific query related to medical matters. 

Lockdown Corollary –  Weight gain and Arthritis.

: Dr Himanshu Tyagi

I have put on some weight during this lockdown” – this is probably one of the most commonly heard statements of 2020. And the very next declaration would be “My knees have started hurting lately”.

As per one study, almost one-third of the population has put on weight during the last 4 months. This fact seems to be more exemplified in our urban upper-class population,where the incidence is as high as 70%. This weight gain has led to an exponential upsurge in the cases of knee pain, back pain, arthritis and bone pains.

The ‘Big 5’ reasons for this sudden increase in the Orthopaedic problems post lockdown are –

1) Weight gain.

2) Sedentary lifestyle.

3) Lack of exercise

4) Poor posture

5)  Vitamin D deficiency due to less sunlight exposure.

“The most common complaint is knee pain, followed by back pain and closely contested by neck pain at the 3rd spot.”

Most common pain – Knee pain

Other contributing factors behind these pains are –

1) ‘Work from home’ culture – long sittings in front of laptop or computer especially in poor posture has contributed immensely to these pains.

2) Excessive household work during the lockdown, due to unavailability of maids/domestic help.

3) Poor dietary habits during the lockdown. Deficiency of nutrients like protein, zinc, omega fatty acids &  lipoic acids can lead to early fatigability and muscle pains.

4) Inadequate sleep or poor sleep routine: Affects the metabolism negatively and can lead to reducing muscle endurance and fibromyalgia.

Snacking – Biggest contributor to obesity

Medically speaking, in the last four months, we have seen a lot of new patients coming to the OPD with complaints of –

1) Osteoarthritis – More common in females above the age group of 55 years.

2) Bone painsYoung females with concomitant vitamin D deficiency.

3) Slip disc /Sciatica/Back pain: middle-age professionals working on the laptops for long hours (work from home).

4) Neck pain/Shoulder/Upper back pain: due to poor posture while reading books, watching TV,  working on phone or sleeping.

COVID -19  pandemic forced us into lockdown and social isolation, which in addition to orthopaedic pains also gave rise to various mental problems like demotivation, loneliness and depression which ultimately affects the body’s healing power against osteoarthritis and bone pains.

“The lockdown was particularly brutal on our female working professionals, as they had to manage both the fronts almost single-handedly.”

Even today, Due to Corona scare,  people are afraid to go out for a walk or to exercise in the open, which only adds to weight gain and muscle weakness. The situation is only made worse by government prohibition on the functioning of gyms, swimming pools and fitness centres.

The way out –

1) Following a minimum 30-minute daily schedule for exercise,  relaxation or yoga of any form.

2) Focus on strength training and weight-bearing exercises in addition to stretching and flexibility exercises.

3) Enrol for an online Fitness training session or yoga class or Zumba class.

4) Follow a strict sleeping routine. Hit the bed on time and get out of the bed every morning before 7 AM. Proper sleep allows healing of sore muscles and inflamed joints.

5)  Diet – avoid food items which are rich in carbohydrates, oil, sweets or saturated fats.

6)Avoid aerated drinks or high energy drinks like Cola or workout drinks.

7) Avoid self-administration of painkillers as it may lead to gastritis, internal bleeding, kidney and liver issues in the long run. (Consult your doctor)

8) If you are not comfortable visiting a hospital go for a telemedicine consultation through video call or online consultation with the Orthopaedic expert.

9) Give due emphasis on maintaining proper posture while working on a laptop/ computer during work from home.

10) Since this corona crisis is nowhere near its end, buying a  treadmill or home exercising cycle is not at all a bad option.

11) Taking a dietitian consultation for healthy and supervised nutritional assistance is also a good option.

Eat Healthy

2020 may have proved a challenging year in many ways (economic, business, professional) but taking care of your health is of paramount importance.

“Just take care of your health, everything else would fall in place…..eventually.”

About the Author –

Dr Himanshu Tyagi is a senior consultant Orthopaedic surgeon practicing in Delhi.

Ph- 9654095717


Online classes causing spine pains & eye problems in children.

: Dr Himanshu Tyagi /Dr Meghana sahasrabuddhe

7-year-old Yasharth has been suffering from back and neck pain for the last three weeks. He is a student of class 3, studying in a reputed school. Since the lockdown was announced on March 22nd this year, his entire education has shifted to online mode now. As a result, he has been having 5 to 6 hours of online classes daily since almost the last 2 and half months.

This recent onset neck and back pain are primarily due to poor sitting posture during the online classes & lack of exercises these days.

Poor posture can lead to back pain in children

The situation is even worse for those students who are not having proper laptops or desktops available to them and are somehow managing to use mobile phones for online classes.

As per the data available, Internet connectivity is less than 50% in urban settlements and less than 20% in the rural population till date. Talking about high-speed internet (to support good quality video calls)it is still less than 8% even in urban settlements.

Online class on cell phone is bad for both neck and eyes.

Medically speaking,  sitting in a bad posture for long hours is taking a toll on these young children leading to muscle fatigue, spasm, strain and postural pains.

Nowadays both back & neck pain are becoming common.

These virtual schools are not only causing problems related to orthopedics but also causing eye-related problems in children like eyestrain, headache, watering, dryness, refractive errors and dryness leading to frequent eye rubbing.  These ophthalmic problems are primarily due to infrequent blinking and constant focusing on mobile/laptop during online classes. Another contributing factor here could be excessive TV viewing because of the lockdown.

Red eye/watery eyes – after 3-4 hours of classes

An indirect effect of these virtual classrooms is on the mental health of the children as well. This fact is well exemplified by the suicide of schoolgirl in Kerala who could not attend online classes because of the unavailability of mobile with high-speed internet.

The Mental health-related issues include irritability, loss of concentration, behavioural changes like an argument, refusal, defiance, opposition and withdrawal.

Don’t ignore an irritable child

Karnataka has already imposed a ban on virtual classrooms for children under grade 5 and Gujarat is also moving towards the same direction (a PIL is under consideration in the Gujarat High Court for banning online education for children under the age of 6 years).

The possible solutions –

Neck/back pain –

# Encourage children to use only study table or dining table during classes and make sure that they maintain a good posture throughout the class. (back well supported, no slouching, arms supported on the armrest)

Always prefer class on table & chair

# Do not allow children to sit on the sofa or lie down in bed during classes. (Unsupported spine for long hours can lead to pain).

Sitting on sofa during class should be discouraged.

# Encourage them to play or do physical activities inside the house so that they maintain healthy muscle strength to support the spine.

# keep their diet rich in calcium and Vitamin D by including milk, cheese, paneer, yoghurt, Soybeans & calcium-fortified orange juice, oatmeal, and cereals.

# The mobile or laptop screen should be kept at the child’s eye level, so that he/she doesn’t have to bend his/her neck down. (This is the most damaging posture for neck)

Screen should be at the eye level

# There should be a break every 20 minutes in class during which children should be encouraged to do stretching and play around.

# Schools should be advised to have a compulsory yoga or dance class every day to have a minimum amount of physical activity/ fitness in the curriculum for the day.

Yoga or exercises period – most important.

Eye strain/irritation –

1) Children should be encouraged to sit relaxed with eyes closed in between classes and blink eyes frequently during classes.

Give rest to eyes in between

2) Cell phones/ laptops should be kept at least one arm’s distance away from the face.

3) TV viewing should be restricted for kids as it would increase the total screen time on a given day (class +TV). Also, kids should be asked to look 20 feet away in between, to relax eye muscles.

Avoid prolonged TV watching

4) Lubricating eye drops or teardrops should be used (after consulting ophthalmologist) if the child is complaining of red-eye or irritation or watering from the eyes.

Consult ophthalmologist before administering any eye drop.

5) If the child frequently complains of headache post classes or during the day, parents should consult ophthalmologist in view of slipping eyesight (need for spectacles).

6) Children should sit in a well-illuminated room with laptop/ mobile screen not very bright (illumination) and should avoid frequent eye rubbing.

7) Always prefer laptop, desktop or  iPad in comparison to mobile phones for classes (bigger screen is better)

Bigger the screen…..better for eyes

Mental/Emotional support –

1) Since virtual classrooms mean no real friend to interact and share the feeling. Be a friend to them.

2) Children are becoming silent spectators and sometimes victims of all the stress and tension going in the house due to lockdown/Covid-19. Understand them well.

2) Don’t try to recreate school at home. It’s not possible……and also not required.

Do not vent out your anger/frustration on children.

3) Encourage them to talk to their friends over phone or video call. Have virtual birthday celebrations for them.

4) Speak up and give your feedback to your child’s school about the length of classes, teaching methodology, breaks and comfort of your child during the class.

Parents should give feedback to the teachers

5) Children below the age of five years should not have any class longer than 30 minutes at a stretch.

6)  Parents should be encouraged to spend time with kids, especially if it’s a nuclear family. Best is to have a dedicated time for kids & family.

It is high time we take care of our kids now. Education is important but not at the expense of their eyes, spine or mental health.

About the Authors –

1) Dr Himanshu Tyagi : Senior Orthopaedic Surgeon, Delhi

2) Dr Meghana sahasrabuddhe: Senior Ophthalmologist, Mumbai.

For more queries or details, visit Dr Himanshu Tyagi @ –


Or call – +919654095717

Fake corona treatment circulated over social media doing more damage than Covid-19 itself. – Dr Himanshu Tyagi

Mr. Gopal Rai (name changed), 74-year-old resident of Delhi was rushed to the emergency department of a hospital with complaints of palpitations and restlessness. Upon investigation, he was found to have cardiac arrhythmia (abnormal heart contractions) due to hydroxychloroquine ingestion.  Apparently, he self-medicated himself with this drug after reading about it on Facebook.

No proven benefit, but definitely harsh on heart.

In a similar incidence, 24 years old Rajat (name changed) was attended by emergency doctor due to severe gastritis secondary to consuming garlic -onion paste in vinegar thrice daily with hot water.

Fortunately, both Mr Gopal Rai and Rajat survived, but with a take-home message –  “Fact check is important before applying any of the social media circulated COVID -19 treatment“.

“The person in the video looked like some senior doctor. The video looked very genuine and the treatment he suggested claimed to have 100% effectiveness against covid” said Rajat after getting discharged from the hospital.

With COVID crisis proving out to be an unfathomable predicament to all, fake treatment information over social media is attracting too many eyeballs.

If the reports are to be believed, the fake news circulation over 4 major social media platforms (Facebook, WhatsApp, YouTube & Instagram) ranges from 55-60% when it comes to covid-19 treatment.

The problem is not about circulation only, but due to blind experimentation of these treatment methods, people are landing into serious health issues now. The primary example here is imprudent self-medication of antimalarial drug hydroxychloroquine for COVID treatment based on few unconfirmed trials widely circulated over WhatsApp. Latest in this regard is a steroid named dexamethasone, which is doing rounds on facebook these days. Unsupervised and injudicious self-administration of this steroid can lead to increased blood sugar, muscle damage, swelling in legs, irritability and wound healing problems.

With social media now turning into a hub of fraudulent news related to COVID treatment,  in the past four months we have seen many WhatsApp messages endorsing the use of garlic, onion, vinegar, rasam, exotic herbs, cardamom, ginger to even gold powder without any scientific basis behind them.

Now a days, people are often seen taking overdose of zinc, Vitamin C, vitamin B, Vitamin D  and Calcium tablets based on some fake messages circulated over WhatsApp groups. These supplements are good for generalized health and immunity but to circulate them over social media as a cure for COVID-19 is still wrong.

Cases are even reported where people have even tried taking antiviral medicines and high-end antibiotics like Azithromycin without any medical consultation based on some video seen over Facebook.

Fake prescription in the name of Sir Ganga Ram Hospital

Half knowledge is more dangerous than no knowledge,  this fact is well exemplified by the incidence which happened in Arizona (USA),  where a person confused hydroxychloroquine with chloroquine phosphate and paid the price for ingesting the  tablet meant for clearing the fish tank in lieu of hydroxychloroquine.

Sometimes these fake news and advertisements are circulated on purpose. The intention being, to scare people and drive them towards buying expensive products like face mask, sanitizers disinfectants,  personal protection equipment/ kits and virus killing fabrics over cheap and easily available similar products.

Unfortunately,  people fall into the trap and out of fear they succumb into buying online fake or  unapproved products against Covid seen on social media.

Sometimes unintentionally we become ‘a partner in the crime’ by forwarding an ‘authentic sounding’ but fake message without checking the facts. Though the intention is pure here but we end up being a part of this fraudulent message chain.

To fight this situation,  several countries like Hungary, Bulgaria & Algeria have brought out strict laws against those spreading fake news over social media. The penalty ranges from monetary punishment to even jail term.

Unfortunately, today we are caught up between the pandemic of corona and epidemic of fake news. Social media is flooded with abridged and manipulated  screenshots of news anchors and popular celebrities endorsing unapproved ‘corona prevention pills’ to Ayurvedic treatment like cow urine to homemade remedies.

Also there is a rampant sale of fake masks, sanitizers and  pulse oximeter (for measuring the blood oxygen level) through online and home delivery portals due to public panic.

People often recklessly forward the messages from one WhatsApp group to another without even testing the authenticity of the treatment recommended. With more than 160 million active users of WhatsApp in India,  any false news can spread like a forest fire.

Medically, it is far more important to be aware of the side effects of any medicine/ayurvedic product before trying it. Most of these deceitful videos/ advertisements on facebook/whatssap claim 100% cure rate, no adverse effect and based on research by USA/UK/Japan.

India also is now coming harsh on those spreading false claim and unnecessary panic. This fact recently got enforced by the arrest of a man who was sourcing out forged messages about a possible Covid hotspot within the office campus of a famous news channel.

Let us all pledge together not to be part of this fraudulent message chain. Let’s stop being unscrupulous and halt the transformation of Facebook into ‘Fakebook’ .There is no 100% approved treatment for corona till now. Let us accept this fact and just stick to basic measures to avoid infection like use of  mask, social distancing, frequent hand washing and maintaining general hygiene.

As a vigilant Indian let’s not get fooled by fake Covid treatment over social media. Let’s be careful about what we believe and what we transmit.

Check before you forward

Best would be to do a ‘fact check’ on WhatsApp corona virus information hub or subscribe to WHO (World Health Organisation) medical updates or visit ICMR (Indian Council of Medical Research ) website or UCSF fact check website or at least give a call to your family doctor before trying any remedy against Covid-19.

With Unemployment and Covid-19 on a rising trend in India…..it’s time to take care of your health & thought process. : Dr Himanshu Tyagi

Are we reaching a tipping point here ?  Corona pandemic is coming harsh on india with it’s different faces like lockdown, economic slump and now unemployment.   With no approved corona virus vaccine or drug therapy to stop this pandemic so far, it’s time to introspect and decide what we can do best in the present situation. Corona is not only hitting us hard on healthcare front but also on economy and it’s far reaching implication.

Examples are many, but announcements like 25%  job cuts by both Ola & Uber show us a glimpse of the gloomy future ahead. Unemployment was almost  9% in march and but now it has gone up to approximately 25% as per latest statement by  Centre for Monitoring of Indian Economy (CMIE).  Surprisingly,  Urban unemployment picking up faster than rural unemployment in current reports.

With unemployment rates escalating sky high even for countries like US and Britain, India will be no exception in coming times. With GDP falling to 3.1 % in FY 2020, It is worth noticing here that the ‘salaried class’ is the worst hit , as it is most difficult for a full time salaried employee to quickly get another reasonable job with comparable salary (The New Urban dilemma).

Today, what it looks like is that covid-19 is  going to stay with us for a long time or at least for a near future. As per the recent medical developments, we are at least six months away from any concrete vaccine or cure which can halt this pandemic. Currently the world does not know what is the best way out and this fact is well exemplified by the fact that world leaders and WHO are moving from hydroxychloroquine to Azithromycin to anti-viral medicines to vaccine without any success.

We can hope time and again that someday a miracle medicine or vaccine would fall into our lap and the entire situation across the world would come back to normalcy within no time. However,  pragmatism tells us that now is the time to learn to live with Corona,  sick businesses, unemployment and salary cuts.

Though the Indian government has already announced a package of 20 lakh crore to revamp Indian economy, but we all know that is going to be too little for a country with population close to 130 crores and majority unemployment expected in unorganized sector.

Slump has worst hit industries are aviation, travel, tourism manufacturing and hotel .This situation is not going to improve soon as Indian economy by large will always have a far reaching reflection of the global economy.

It goes without saying here that the stress of salary cut, unemployment or sick business can lead to insomnia, elevated blood pressure, raised sugar levels, headaches, irritability, impotency and what not. Thus it is important here not to allow this stress to get over you.

Thus it’s time now to concentrate on your mental and physical health and make sure that in spite of all adversities we come out strong at the end of this pandemic and survive its economic implications.

Few steps in this direction can be –

1) Understand the fact that this is a temporary situation and it will change within few months.

2) Focus on survival for next 6-9 months rather than chasing goals or making career plans.

3) It is most logical to focus right now on just securing a job or business even at the face of a salary cut or low income.

4) It’s high time to concentrate on your health. Set fitness goals, keep a healthy diet and be regular in your efforts. Remember that health is your most useful asset.

5) Check your thought process, be positive, keep away from negative people and negative influence. (Also…..Sometimes cutting watssap/Facebook can prove to be really helpful)

6) Cherish this time with your family members and interact with them as often as possible. Remember…they need you as much as you need them in this hour.

7) Pick up a hobby like painting or guitar or singing or any other activity which gives you a chance to be creative and enjoy at the same time. (Researchers has proved that learning a new trait or engagement in recreational activities lowers the stress levels and boosts immunity.)

8) Try focusing on the larger picture of life which includes your family, friends, health and purpose of your life (Not ‘Aim’ of your life).

9) Accept the fact that worrying about the future is not going to make it any better. Be pragmatic about the situation and set the future goals practically.

10) It’s high time to get enrolled in any self help session or training or education program for which you never had time earlier.  Join any weekend or online course which interests you and adds to your CV/expertise.

11) Maintain your cool, avoid getting involved in confrontations or indulged into conflicts over petty issues. (A battle avoided is a battle won).

12) Avoid the temptation of chasing the future. Don’t try to keep a track of every movement movement around (professionally). ‘Too much’ knowledge can be sometimes ‘too little helpful’.

13) It is a golden period for making new relations and rejuvenating the old ones (friends,relatives, professional, cultural &emotional). Catching up old college & school friends over a beer might be a good idea.

14) Embrace the change. Take life as it comes. Life may have given  you a different ‘question paper’ this time….but marks are awarded for ‘attempting’ this time….

15) Prioritise your time and effort. Everyone in your life expects your share of time and attention during this period.

16) Maintain your confidence and  be hopeful  for a brighter future because tough times don’t last, but tough people do.

Author’s recommendations –

This article is specifically useful for those who are between the ages of 30 & 55 ( ambitious, career oriented, high fliers, focused and with go-getter attitude).

Lockdown leading to Joint pains in women due to excessive household work.

Doctor I have a severe pain in my back and right shoulder since last 25 days, please advise me some strong painkiller as I cannot afford to take rest at this point” said Mrs Sangeeta, 46 year old working women having 2  kids and a husband.

This is not just the story of Mrs Sangeeta but many other women who are presently trying to strike a balance between their professional life, household work, kids and spouse.

Women- The multitasker

As per Mrs Sushila Mehta 39 year old executive working in a IT company “I am working almost 8 to 9 hours daily for my office work (work from home) , in between  I am doing cooking for my family, arranging online classes for my kids plus cleaning my home. Though my husband is trying to extend a helping hand to me but he is also too busy  with his office work at times”

Due to lockdown, maids are presently unavailable to help the ladies with household domestic work. This is particularly making the situation worst for working women who are now working extra hard to balance their office work, family life plus the household work.

Three categories of women worst affected are –

1) Women working professionally (work from home) and also managing the family during lockdown.

2) Women with small kids, parents/in-laws and husband at home.

3) women above 45 years of age with pre-existing health issues like arthritis or diabetes, living with unmarried kids, husband and old parents.

It is now 56 days since the lockdown was announced by the government of India. Though this lockdown was essential in the interest of public health but now many women are approaching doctors with complains of knee pain, shoulder pain, back pain and vague muscular pains due to excessive work.

Lockdown 4.0

Cleaning the house requires activities like brooming, mopping, dusting on regular basis with other activities like washing & ironing the clothes done frequently. This list is a never ending one, as it also involves daily activities like cooking, washing utensils and getting vegetables and essential items from outside. Before lockdown maids were available to the house ladies for help in most of above mentioned activities.

In the present scenario, even though husbands are trying their very best to help out their wives, but still a lot of physical labour falls onto the shoulders of  ‘The lady of house’ especially when it comes to cooking and cleaning.  Thus, our ladies are finding it difficult to stay at their best with all this pressure and physical exertion.

We are together in this……

Activities like brooming, washing the clothes and mopping puts a lot of pressure on the knees, lower back, shoulder, elbow and forearm region. Due to repeated strains the muscles of the lower back and shoulder starts getting fatigued. Over a period of time if the activities are continued, it results into actual muscle injuries or pain syndromes.

This situation is particularly severe for ladies with kids less than 10 years of age and husband also working from home, as young kids require more help and attention from mother. Also since the schools are closed and children are already going through a mental turmoil, they require greater attention and support at this moment and they look towards their mother for extra help.

Mom…..I need help

These pains and aches are temporary to start with and get relieved by rest initially. However as more and more days are passing in the lockdown, these aches specially  related to lower back and shoulder are taking a more permanent shape, not getting relieved by rest and requiring frank orthopaedic opinion for their management.

Majority of time the orthopedician prescribes them analgesics and anti-inflammatory with advice of rest for few days. However rest is not an option here for these hardworking females as invariably they choose their family and home above their own health.

Multiple Aches

It is seen that almost 20% of the females coming to orthopedician complain of shoulder, elbow and wrist pain, 60% of the females  complain of only back pain and  around 30% complain of both back and knee pain.

The way out  –

1) Prioritise your activities. Give importance to what is urgent & important over desirable and non urgent.

2) Don’t go for perfection in every activity, stop when adequate level of standard is reached.

3) Don’t bend down from your back but fold your knees and sit down whenever trying to clean the floor.

4) Use vacuum cleaner with long attachments for dusting the house twice a week instead of cloth for daily dusting (which requires repeated shoulder movements).

5) Always use floor mops with long handles so that you don’t have to  bend over to clean. (Save your back)

Use floor mops with long handles

6) Avoid wearing white or light colour clothes which require a separate cleaning through wringing movement of arm (leads to elbow and wrist pain). Wear clothes which can be washed in a washing machine without manual effort.

7) Clean utensils in small loads rather than washing all utensils at the end of day. (Saves your hand muscles from getting fatigued)

8) Take help of all family members based on their age, capacity and convenience.

9)Instead of going for traditional brooming, go for broom with long handles so that it can be done in standing position.

10) Don’t go for extensive dusting of curtains or carpet, leave them for the post lockdown period when the help is available.

11) If you are getting back pain, knee pain or shoulder pain avoid stranous activities for more than 30 minutes in one stretch.

12) Take care of your sore muscles by doing hot fomentation and simple muscle stretching exercises after your work.

Regular stretching exercises are important

13) Try to get minimum 8 hours of sleep as adequate sleep is important for proper healing and regeneration of muscles.

Get minimum 8 hours of sleep

14) If you are a working woman and have to sit for long hours for computer work, best would be to take a break every 30 or 45 minutes do some stretching exercises and change your posture.

Take a break from laptop work every 30-45 minutes

15) It is always advisable to get into the practice of 15 minutes exercise program, which includes exercises for lower back, knees and neck muscles.

16) Ironing of cloths should be done on iron board or dining table of adequate height  only, so that the person need not to bend forward while ironing the clothes. Also  it is desirable that clothes requiring minimal or no ironing should be worn to save the effort.

Height of the iron board should be sufficient

It is important for all of us to take care of each other during this challenging period. It is imperative that we act before these pains transform into something more prominent. By adopting to few simple modifications in our daily life we can improve our health in big way. Let us stand together during this lockdown to take care of our  ladies.

Excessive cell phone use during lockdown leading to neurological and orthopaedic issues in elderly and children :  Dr Himanshu Tyagi

2020 has been a year of rare challenges. We have seen an unprecedented diseases like Covid-19  and an unheard measure like lockdown. This situation is particularly dreaded on our elderly population and children, not only in terms of infection susceptibility but also when it comes to adjusting with the lockdown. Medically today we are faced with the different challenge where spectrum of new diseases are coming upfront because of the lockdown. At the forefront of this disease spectrum are conditions associated with increased cellphone use, specially in our elderly Indian population and children.

Cellphone – Master or slave ?

In the recent past there has been a lot of emphasis on mental health and behavioral changes secondary to home confinement because of lockdown.

Mental stress is touching everyone’s life

Now as we are nearing the end of lockdown, we are seeing a sudden upsurge in the incidences of a number of physical ailments making it clear that If the lockdown era belonged to mental ailments,  post lockdown era will belong to physical ailments.

Many of these physical ailments are a result of excessive cellphone use during this lockdown period, which can be very well concluded from the fact that average daily mobile use increased by almost 4 to 6 times in elderly and 2 to 4 times in age group below the age of 18 years.

Glimpse of cellphone dependency

Also as per the internet service providers the daily usage of internet increased by 4 fold in rural areas and up to 6 times in urban settlements.

But this excessive cellphone use has come with its own implications on health. The health problems because of excessive mobile use can be broadly classified into two categories orthopaedic & neurological.

Few of the most common Orthopaedic ailments which have taken a center stage in last 2 months due to excessive mobile use are –

1) Neck text syndrome :
Neck pain, slip disc and nerve pain radiating down the arm . This is the most common condition because of cell phone use. This is due to continuous forward bend position of neck during typing or using the mobile which increases the pressure on the the intervertebral disc and causes impingement on the nerve.

Pressure on intervertebral disc increases with neck bending

2) Smartphone thumb (base of thumb arthritis):   This is due to do excessive use of thumb during scrolling and typing on mobile. This condition particularly affects the thumb of dominant hand and most commonly seen in elderly population above age of 70 years.

Smartphone thumb

3) Dequerveins tenosynovitis : Wrist tendon swelling & inflammation due to holding the phone for long hours in steady position.  

4) Carpal tunnel syndrome : Nerve compression at the wrist due to long continuous holding of mobile in awkward position. Specially seen in elderly females.

5) Tennis elbow : pain over the outer aspect of elbow due to fatigued long muscles of arm while holding the mobile in one position. Specially seen in elderly females.

Tennis elbow and Student’s elbow

6) Mid back or upper back pain due to poor sitting posture (continuous forward bend posture). Specially seen in children below the age of 10 an elderly about the age of 70. Commonly associated if mobile use is more than 4 hours a day. Seen commonly in adolescents with poor muscle strength or lack of exercise. Often associated with Vitamin D deficiency and lack of exercise.

Bad posture can lead to back pain

7) Chronic fatigue syndrome of upper back & shoulder (clinically known as Trapezitis). Seen in elderly population due to prolonged holding of mobile in unsupported position, like holding the mobile when lying in bed.

8) Student’s elbow or olecranon bursitis : Swelling and pain over elbows due to holding the cellphone for long hours while entire body weight is supported over elbow (as while sitting over table or desk) Seen in  children below the age of 18 may become painful as well.

Talking about the top neurological problems due to excessive cellphone usage are –

1) Irritability, poor concentration and aggressiveness: This is specifically seen in adolescents who are spending long hours playing online games which requires quick reflexes or are competition oriented.

2) Headache – Due to excessive tension in eye muscle while focusing on mobile screen, specially if  placed closer than 10 inches. A lot of adolescence are facing this problem these days.

3) Eye strain – Common in children. Specially in those children who are watching or playing games in cellphone for more than 1 hour uninterrupted. This can become a serious problem and may even affect the eye sight early in life.

Continuous use of cellphone can lead to red and watery eyes

4) Irregular sleep pattern :  (surprisingly this is affecting elderly & children equally). Often elders of the house are found these days spending a lot of late night hours over watssap or Facebook.

Disturbed sleep pattern

5) Harmful effect of cell phone radiation on our brain and nervous system.

Of all the above mentioned medical issues most common are ‘neck text syndrome’  and ‘smartphone thumb’  in elderly (above the age of 65).

In children most common are aggressiveness, behavioural change, irritability, mid back pain and poor sleep pattern.

The way out of all above mentioned medical problems is through judicious use of mobile phone and self control by both elderly and adolescents.

Few steps in this direction should include –

1) Use of mobile should be restricted to maximum 20 minutes in a single stretch.

2) Maximum 1.5 hours in a day (keep alarms in cellphone to remind you and warn you). Few apps are also available which tell you about your daily mobile use.

3) Proper neck posture while talking on phone. (Try to to bring up your mobile phone to the level of your neck rather than bending the neck down)

4) Support your elbow and wrist well while working on mobile to reduce the strain over shoulder & neck muscle .

5) Type shorter texts, use abbreviations frequently.

6) Using autocorrect decreases the amount of typing to be done.

7) Use ‘Speech to text’ apps if you want to type a long message.

8)  Always use both your hands while using your phone.

9) Perform wrist and finger stretching regularly.

10) Use Bluetooth hands free while talking on phone.

11) frequent washing of eyes (specially children).

12) Meditation (specially for children)

13) Make it a rule not to use your mobile after 10 p.m. and before 8:00 a.m.

The battle against covid-19 crisis is still far from over, however if we are determined not to complicate the present situation by adding other health problems to covid-19, let’s decide that we will be using our cell phones judicially in future.

India: Final Wake Up Call…….

With situation in Mumbai becoming desperate now and the CM of Maharashtra trying to get additional help by calling in private practioners (doctors of all specialities) to stride over Covid-19 situation which is filling the available ICU beds fast, one can make out that the nightmare is becoming a reality now.

This is the first glimpse of coming future and Maharashtra is just a beginning. Though the  Maharashtra CM is acting fast here and trying to arrange additional ICU beds and hospitals under the defence and railway quota for general public as well, clearly shows that he is getting ready for all possible worst outcome.

This move of calling the private practitioners for help during the Covid emergency was not a totally unforeseen events but one has to be careful about the health of these doctors as well since the number of Corona positive doctors, nurses & paramedical staff in India has escalated to 548 within no time.

Soon a  similar condition like Mumbai can be anticipated in states like Gujarat, Bengal, Delhi and many more if decisive steps not taken.

If we wish to take lessons from our experience in Maharashtra,  let us then quickly act upon getting all doctors (private & public)  together and defining their role based on their speciality and expertise through a well chalked out plan, just in case we hit the threshold point where the number of positive patients overflow the existing government Medical system.

This doctors database collection and planning cannot be left to eleventh hour and must be done today by all state governments. Also it should not be a forced decision binding to all doctors but should be a conscious decision to be taken by doctor’s bodies taking into account their own safety, family responsibilities, place of service, medical expertise and suitable remuneration for the service.

It is important to understand here that we will be able to fight corona only if our these warriers (doctors) are safe, and they will be able to give in their 200% only if they have suitable safety measures for themselves.

Italy has already lost more than 100 doctors in this battle and Britain has seen maximum civilian casualties in Europe so far. If we compare India’s situation with both these countries,  we very well know here that we are standing on a slippery ground, since our medical infrastructure stands nowhere in comparison to both these countries and our population load is tremendous.

The US President has already called this crisis worse than Pearl harbour attack in 1941, in terms of casualties chaos and implications. US is a country with far better medical facilities for a population about one-fourth compared to India, spread over a land area of almost four times compare to our’s.

If we want to win this battle, now is the time when we should be ready with a well chalked out plan about how to use best our viable and non viable resources to maximum benefit. We need to be ready with –

1) Our doctor’s complete database including their age, expertise, experience, sub speciality, additional trainings (emergency or basic/advanced life support training course) and leadership role in past or present situations.

2) We should have a plan ready with us for worst situation,  where under the leadership of physicians, ICU experts or emergency care professionals we should have a team of  doctors from other speciality (like opthalmology, orthopaedic, surgery etc) in supporting roles but with proper coordination.

3) The roles and duties of various medical professionals should be decided taking into consideration there present location,  travel time and family requirements.

4) all the hospitals within a single state (private, public, defence, railway, PSU, port trust, etc) should prepare for patients and open their doors to general population under the leadership of state health department.

5) Redistribution of resources like medicines,  personal protection kits, ventilator, ambu bags and emergency beds should be done based on population density, healthcare resources and rural or urban areas.

6) Government should try to fast track the distribution of ventilators/Ambu bags and emergency care medicines to designated centres from manufacturing companies (like Maruti or other manufacturers).

It is most important to understand here that, at this hour if we fail to co-ordinate, redistribute and use our resources well, we will surpass all previous records in terms of body counts.

In this difficult hour, we also pray to the Lord to give us the strength and wisdom to put up a commendable fight against this virus and to help us,  by breaking a cure for this deadly virus soon (Italy and Israel are claiming encouraging test results for their vaccine and antibodies respectively).

We also hope that before the situation gets worst, we should have a cure in our hands and a vaccine in our lap to prevent its further spread.

The reality
We are all together in this