Lumps & Bumps

Not a pleasant topic, but things you should know;
Download the PDF (220 KB), as it appears in the print edition.

Lumps & Bumps: Things to consider when you notice a lump on your body
Over the course of a day, we all poke, rub, and scratch. Usually it’s an itch or a sore. Occasionally we notice a lump! What should we do? Rightly, some of us will worry about it and cannot rest until we find out what the lump is. Others will completely ignore it.

Fortunately, the vast majority of lumps and bumps are benign (see box at end) and do not threaten our lives. But some can be dangerous and require immediate medical attention. So which lumps should we worry about? Which lumps and bumps require a doctor’s care, and which ones can be ignored?

We usually discover lumps and bumps about our hands and feet earlier than if they were in our thighs or buttocks, for example. Our hands and feet don’t have as much soft tissue around them, making it easier to notice even small lumps. Our buttocks, thighs and even the upper arms can hide quite a large mass before we notice.
Continue reading “Lumps & Bumps”

Omega-3s and Grilled Salmon: Food for the Heart and Brain

Salmon being marinated with spices for grilling by Arun Shanbhag
Come spring, I can’t wait to fire up the grill and throw some salmon on it. Not only is grilled salmon one of my favorite, salmon is also an excellent source of omega-3 fatty acids. These essential fatty acids improve heart health, have anti-inflammatory properties and as recent research informs, improve brain function. Yaay! Continue reading “Omega-3s and Grilled Salmon: Food for the Heart and Brain”

Yoga for Arthritis

Yoga can provide immense physical benefits for women with arthritis.

For arthritis patients, aerobic exercises, muscle conditioning and increased physical activity can keep you strong and agile, improve heart fitness and reduce your weight. Yoga provides an effective alternative to the traditional strengthening and aerobic exercises, and offers other benefits as well.

While yoga may bring visions of complex body contortions, most yoga classes provide simple, gentle movements that gradually build muscular strength, promote balance and improve flexibility. Its meditative nature soothes and relaxes the mind, and is associated with increased mental alertness and enthusiasm. Scientific studies have shown that practicing yoga is a safe and effective way to increase physical activity, which is strongly recommended for arthritis patients. Yoga does not increase pain or worsen arthritis.

Picture of Padmasana Yoga Pose
Continue reading “Yoga for Arthritis”

PiPi Unbound

Growing up, even a thimble full of these squiggly bits was a treat It still is. I found this in a desi store here. Now I get my stash from Mumbai on every visit. (Chikki was my other treat.)

Continue reading “PiPi Unbound”

Men are from Mars and Women get Arthritis

Why more women suffer from Arthritis by Arun Shanbhag
Biochemistry, Anatomy & Lifestyle Explain Why more Women Suffer from Arthritis.
Titles in bookstores remind us that women think, behave and feel differently than men. Even in health, diseases in women manifest and progress uniquely, and the effectiveness of medications varies. Scientific research informs us that women are also more vulnerable to arthritis. Such differences may be due to hormonal, genetic, biomechanical, and lifestyle differences between genders, contributing to disparities in men and women’s treatments. Understanding these gender-specific differences will help us treat women’s arthritis more effectively.
Continue reading “Men are from Mars and Women get Arthritis”

Repetitive Strain Injury

Cross-posted from Aches & Joints

Repetitive Strain Injury or RSI describes a group of conditions associated with overuse of soft tissues such as muscles, tendons and nerves. RSI causing pain can affect the upper back, arms, hands, wrists, or fingers. Continuous and prolonged use of a computer keyboard, strumming a guitar, or wielding tools on an assembly line, have all been associated with RSI.

Continue reading “Repetitive Strain Injury”

Five Easy Steps to an Exceptionally Long life!

Good genes certainly help in living a long life. But alas, we don’t get to control them. A recent study (Original Article; NYT article) tracked more than 2000 elderly men (ave 72 years) for up to 25 years. Based on those who survived to age 90, the authors identified five factors that we can control.

Five Easy Steps to an Exceptionally Long life:

  1. Abstain from smoking
  2. Weight management
  3. Control blood pressure
  4. Regular exercise, and
  5. Avoid diabetes

Not very surprising! It’s not that those long-lifers got less ill, but they became ill a little later in life, and were better able to deal with the diseases and survive.

Not only did survivors enjoy healthier lifestyles, more than two-thirds described their health as “excellent” or “very good;” and they were mentally with-it! And sadly, smokers had worse physical function coupled with a decrease in mental function as they aged. Don’t expect the tobacco industry to put this in their cool ads! Interestingly, low cholesterol levels and social drinking of alcohol were not associated with increased life span. Even though they studied men, these finding certainly hold for women as well.

So stub out and join me for a run!

BTW, did I mention that survivors in their 90s had a higher incidence of arthritis? This may be partly related to their vigorous activity. So those knee aches may be with me for a while! 😦

Heel Drop – Stretching Calf Muscles

The Heel Drop is another great exercise to stretch the calf muscles, the Achilles tendon, as well as the fascia under the heel. You can do this where ever you see a set of stairs. And it only takes a couple of minutes. One of my favorites before I head out for a run!

Stretching Calf Muscles, Meg Vitter

  • Look for a set of stairs with railings.
  • Hold on to railings for support.
  • Place the ball of your left foot on the edge of a step.
  • Place entire right foot on the step above for stability.
  • Gradually let the heel of your left foot drop, while keeping your leg straight.
  • Feel the stretch in the sole of your left foot, Achilles tendon and calf muscles.
  • Hold this position for 30 seconds.
  • Repeat the stretch three to five times for each leg.
  • You can even repeat this after a run or a workout.

Demonstrated by Meg Vitter of Boston, MA.

Also read:
Treating Heel Pain or Plantar Fasciitis;
Heel and Achilles Tendon Stretch;
Toe Extension;
Precautions to take before starting new exercises

See other exercises at Aches & Joints

© Arun Shanbhag 2008

Foot and Toe Extension

Continues the Heel Pain and Plantar Fasciitis Series.

For most of the day, our feet are bound within stiff shoes and many of the soft tissues within the feet are infrequently used. This is a simple yet very effective exercise to stretch the heel and underlying plantar fascia … and bring life to those toes!

If you have heel pain, perform this stretch as you wake up and place your feet on the floor. This can also be performed while sitting in the office chair or on the couch.

  • Sit on a chair and place your ankle over the opposite knee.
  • Grip toes and gently pull them back towards the knee, while holding the ankle to prevent it from moving.
  • Feel the stretch in the sole of the foot all the way to the heel.
  • Hold the stretch for 30 seconds.
  • Repeat three times for each foot.

See related articles:
Treating Heel Pain or Plantar Fasciitis
Heel and Achilles Tendon Stretch
This article and archives are available at

Heel & Achilles Tendon Stretch

Continuing my Health & Fitness Series, as published in our patient newsletter, Aches & Joints.

Following up on the Heel Pain (Plantar Fasciitis) article from a few weeks earlier, here is the first of a series of exercises that can help recovery from heel pain.

This is a wonderfully effective warm-up before running, going for a walk, or participating in any sports. Or just do this stretch because you want to. This stretches the Achilles tendon as well as the calf muscles. Runners especially need to do stretch these before heading out and after returning from a run too.

You don’t need to go to a health club or gym to do this. Stretch in your office or waiting in the coffee line, or even during a walk in the park.

Enjoy and Share with others. Live well!
heel achilles tendon stretch, Meg Vitter

  • When out for a walk, find a wall to lean against. Even a tree will do.
  • Stand an arms length from the wall.
  • Place the leg to be stretched about 12-18 inches behind you.
  • Keep your toes pointed forward and slightly inward.
  • Bend your arms and gradually lean towards the wall.
  • Make sure your leg is straight and the heel of your back leg is pressed to the floor.
  • Feel the stretch in the calf and heel of the back leg.
  • Hold this position for 30 seconds and return to starting position.
  • Repeat three times for each leg.

Stretches demonstrated by Meg Vitter of Boston, MA.

Also read:
Treating Heel Pain or Plantar Fasciitis
Precautions to Take Before Starting New Exercises
Article archives are available at

Treating Heel Pain or Plantar Fasciitis

I had previously published this article in our patient newsletter Aches & Joints.

If you are a runner, you probably worried about Plantar Fasciitis. Early in the summer when researching this article, I got a mild case of heel pain that left me distraught. My training for the Boston Half Marathon (Oct 7th 2007) was guarded and I am still tentative with my heel. But doing all the exercises linked at the end, I am good to go. Continue reading “Treating Heel Pain or Plantar Fasciitis”

Almond Pista Milk

Last year on my return from the Kailash Manasarovar yatra, I had a severe case of acid reflux which was affecting my throat and vocal chords. Apparently, eating foods cooked in an unknown quality of oils and lying in sleeping bags (without pillow) can cause this. Of course, my intense running also brings up stomach acid and aggravates it. In addition to medications and other dietary changes, my doctor recommended that I stop drinking coffee! I could not imagine starting my day without a double shot of espresso. But I loved running more. So for several months I drank green tea in the mornings (and yawned at my desk). I came upon Masala Milk Mix in the grocery store and loved its refreshing taste. My mother noted that it was easy to make the powder at home and that got me started on grinding my own Badam Pista Milk Mix.

Now, I start my day with a warm cup of Badam Pista Dudh. I still drink about half a cup of coffee after lunch. My acidity problems have been essentially resolved and I feel great.

Easy to make.
Continue reading “Almond Pista Milk”

Man Who Moved a Mountain

Every morning, for 22 long years, a frail, diminutive man, barefoot and clad in a loin cloth, would trudge two kilometres to a hillock of solid rock and chip away at it with a hammer and chisel. Bemused onlookers thought he had lost his mind, and he was an object of great fun for village urchins. But the women of the village, young and old, admired him, for his was a labour of love.

Dasrath Manjhi was trying to clear this mountain so a road could be built leading to the nearby village with a hospital. His wife had died because he couldn’t get her to the hospital in time. This was a memorial to his wife.

Read the story from Outlook India: here

Introducing Aches & Joints: A health blog

Subscribe and stay abreast of the latest in Orthopaedic knowledge, with exercise tips to keep you healthy and moving. And all this while blogging! Really! Not Kidding!

While there is no dearth of blogs on travel (guilty), photography (guilty), food (guilty) and other less than ennobling interests (guilty, again), there is a severe paucity of good health care related information.

With my Orthopaedic knowledge base, I started a work-related Newsletter with a mission to, “distill, interpret and translate the latest orthopaedic knowledge for the general reader.” Its appropriately called, Aches & Joints.

For accurate information, we recruited Orthopaedic Surgeons at the front lines of clinical medicine, to contribute on the latest topics of interest. We recruited certified trainers to demonstrate exercises to overcome our aches and keep us going.

For a reputable founding based on oversight and peer-review, we brought together an Editorial Board. After everyone’s blessings, we published the first issue in early May (2007). These were placed in our Orthopaedic Clinical Waiting areas. The Newsletter has been a big hit, and is flying off the racks. Sidebar – About 60,000 patients visit our busy clinics each year!

Here is a sneak preview of a blog I developed, populated by articles from the Newsletter: Aches & Joints We will announce this to our patients in about 2 weeks when we release the second issue of A&J. It is still called “beta” as I plan on tweaking the overall design. Check out the features and exercises. Leave comments and let me know what you think of the articles and the style.

Yoga: For the everyday stress of life

The Financial Times (London) reports that yoga is gaining acceptance beyond India's middle class. The physical and mental benefits of yoga are no longer exclusive to the well off, but are now being enjoyed by the aam janta.

Ashok Leyland has included yoga in the training curriculum for truck drivers, helping them better cope with the stress of driving on India's roads. Also makes for safer driving for the rest of us.

According to the FT, the Indian Armed Services offers yoga training to soldiers posted at high altitudes in the mountains of Kashmir and naval officers who man submarines.

The Army’s 10-year research program concluded “that soldiers who did yoga along with conventional physical training showed better physiological responses than those receiving only routine training. Participants with yoga training maintained stability under stress and quickly returned to an equilibrium state.”

I started yoga about a month ago and it has definitely helped me better control my emotions and take things in stride. Of course, while I don't have to deal with road rage, or the stress of keeping our borders safe, dealing with the PC at work and e-mails is plenty stressful.

Yoga should be made mandatory in all schools, if it isn't already! As a bonus, it could get kids off their gameboys, inculcate healthy lifestyles, and tackle weight gain and its associated pathologies of heart disease and diabetes!


First Book! First Look!

This was five years in the making! Lots of ups and downs! There were times I thought it would never see the light of day. But my co-editors were always there to pick me up, dust my knees and pat my shoulder. “You can do it!” M always reminded me. And so I persevered, and finally it is here.

When I saw the package from the Publisher, it was actually anticlimactic. Yes! I was glad to finally hold the tome. But it represented the culmination, the end of one project; and an opportunity to focus on another. I celebrate the confidence I gained, from assembling nearly 30 leading groups from around the world to contribute. The confidence of bringing such an undertaking to completion. I celebrate the friendships I nurtured, the friends I did not let down. A time to celebrate the long journey ahead, time to energize myself for the next push.

I don't expect you to rush out and buy a copy. It's expensive! At 783 pages, it will weigh your bag down considerably, but will look impressive on your book shelf. If you are trying to impress your boyfriend/girlfriend, this can certainly be an ice-breaker. If you are considering curling up with this book and a blanket, well … I strongly recommend against it. The first page will put you to sleep and the book falling on our face can hurt you! I suggest propping it up on a heavy table and resting your chin on a pillow. A particularly safe posture, especially when falling asleep is assured. There is no plot really, and the characters are lifeless. The writing is esoteric and dense. Very few pictures and importantly, there is no sex! So, there you go! Ask your doctor or a engineering/medical school library to get a copy!

Find more details at this random site.

High Cholesterol: The curse of doing well!

A couple of friends have recently had their blood cholesterol levels tested. To aid in deciphering the numbers, I am including a link to the guidelines developed by the US's National Institutes of Health. It is well written and gives guidance on how to interpret the results.

Click here to start a heart healthy lifestyle
The 6-page PDF guide will address the following:

  • What do the cholesterol numbers mean?
  • What affects cholesterol levels?
  • Includes a brief questionnaire to determine your risk of developing heart disease, or getting a heart attack.
  • Treating high cholesterol.
  • Therapeutic lifestyle changes to lower cholesterol.

    More Background

    Per guidelines, if you are over the age of 20, you need to get your blood cholesterol tested every five years. If you are over 30, make it every 2 years! Ask your doctor for a “Lipid Profile” (or cholesterol profile, or lipoprotein profile). In the US, just ask your primary care physician. In India I was told, most hospitals and clinics offer this service. It only requires a simple fasting blood draw. You should not have eaten any food or drinks 10-12 hours before the blood is taken. In most instances, this is not a problem. After an early, normal dinner, get the blood drawn first thing in the morning. You should get your results within a day.

    There appears to be a big discrepancy in the way the lipid profile results are interpreted. There is also confusion regarding what should be the optimal levels of the various types of cholesterol. The interpretation of the results, and the 'advise' given by doctors varies, depending upon the skill of the doctor, and how well he or she is up to date on the latest health guidelines.

    The United States' National Institutes of Health (NIH) is the leader in driving all basic science and clinical research, and develops various guidelines for all health related concerns. Thus the NIH is the “go-to” place for the most up to date health information.

    The NIH's National Heart, Lung and Blood Institute (NHLBI) manages all cardiovascular research. And the NHLBI develops the guidelines for blood cholesterol levels. The NHLBI's guidelines are in-turn adopted by the various non-governmental doctors groups and organizations such as the American Heart Association. If your doctor is a member of this or other such organization, or reads any of their literature, then he or she is made aware of the latest updates. Please don't go by 'average' population data. It only informs how a group of people (by city, country, gender, disease, etc) are doing, and not what you should be aiming for.

    A long way of saying: Follow the NHLBI Guidelines

    It is a handy guide. Read it and keep it with your medical records – so you know where to look for it the next time you have a blood test. And, share it with your friends.

    Live long and prosper!

Sunday Cuisine: A berry beautiful meal!

Its July and the peak season for fruits at the local farm stall – berries in particular. Blueberries are my favorite, with raspberries, cherries and strawberries close behind. Theres something about blueberries. Bluish-black tinged, tiny, no seeds, tangy and barely sweet, and my tongue turns blue! When I wrap handfuls in a napkin and toss in my bag, they don't get squishy either.

Many recipes call for smothering the blueberries in pancakes, choking them in muffins, preserving them in jam, pickling them in a lemony cheese tart, freezing them, whipping them in a smoothie, or covering them in chocolate. I ask, why this obsession with messing up something so delicious to start with? I love my blueberries just plain – no recipes needed, thank you!

And if taste doesn't convince you, they have the highest anti-oxidant activity which protects from the detrimental effects of aging (I should know), prevents cancer and heart disease!

After a satisfying run, my dinner on Sunday was a bowl full of blueberries, a handful of cherries, papayas and a strawberry-mango lassi, which you needed to spoon out. Burp! Aaaaah! Life!

Notes: Unwashed blueberries shot in natural light of the setting sun, with my Olympus C4040

What apples were they?

From my previous post on apples.

The apples shown were (from left): Royal Gala, Golden Delicious, Granny Smith, Braeburn, Fuji and Red Delicious.

As many of you promised, grab a few apples (or any other fruit) on your next outing to the grocery store. They are so much better than the junk snacks the MNCs want us to eat.

An Apple (or two) a day!

I love to eat apples. They are juicy, crunchy, delicious and filling. And they are nutritionally loaded! A convenient snack whenever I want. I carry a couple in my bag everyday to work. I eat them at my desk, walking to the train, waiting for a meeting, or even in a lecture. Wet and wipe clean, and bite into it! Crunch! Crunch! Some varieties are so juicy that as you bite, you have to suck the juice as well, or it runs down the side of your mouth.

I eat about 8-10 apples each week. Thus I select a wide variety at the grocery stores. Red Delicious are probably my favorite – sweet, juicy and crunchy. As they over ripen they tend to crumble without a crunch and that is a big NO. Braeburns are probably my next favorite. They are a little smaller and great as a second apple of the day. I need to be in a certain mood to munch on the extra crunchy and sour Granny Smiths. If I cut one at home, I sprinkle a little salt on it and it reminds me of 'kairi' with salt outside the school. Royal Gala seems a nice mix of the crunchiness of the Granny Smith and the sweetness of the Red Delicious. Fuji apples are very similar in taste, crunchiness and sweetness to the Braeburns, but a tad less juicy. The Golden Delicious are probably my least favorite, They seem to have aspects I dislike in all the others – they crumble, less sweet, less juicy, not sour – just middle of the road. But I still eat them regularly for variety – to build character I say! What about Macintosh's? Well, there is only so much character a guy can have.

Here are a few apples from this weekend. Can you match the names to the apples shown. There is only one of each. Give it a shot! Better still, pick up a few during your next stop at the grocery store.

Answers here
Crunch! Crunch!

Health and Dioxins

It is well know that dioxins are carcinogens, ie cause cancer. But where do they intersect our lives?

Plastic Water Bottles: Don't freeze your plastic water bottles with water as this releases dioxin from the plastic into the water.

Heating food in the microwave using plastic containers. The combination of fat, high heat and plastics releases dioxin into the food and ultimately into the body. Instead, use glassware, or ceramics for heating food.

Instant meals, soups, etc, should be removed from the container and heated in glassware.

Leftovers in foam containers are the worst. The dioxin released was the reason fast food restaurants moved to cardboard. But restaurants still give leftovers in foam containers and we tend to microwave the whole container. Ever since reading this info I caught myself doing it on more than one occasion.

Saran wrap placed over foods as they are microwaved with the high heat, actually drips toxins (mixed in with the condensate) onto the food. Remove plastic wrap and cover with glass dish or paper napkin.

Live long and healthy … so you can eat great foods and be happy!

info compiled from friends and newsletters!

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