 Hi Vasanthi. You are on mute. Yes. Hello. Hello everybody. Hi Vasanthi. Very good afternoon. Good afternoon. Okay. So our hospital director is there. Dr. S. G. S. Lakshman is from Manipalas, Karnataka. Right. Yeah. So we will go soon live sharp 4 o'clock and just waiting for a couple of people to join. Sure. We can go live at 4. No problem. Yeah. Yeah. Yes. Sure. Hi ma'am. Hello ma'am. Hello. Yes ma'am you are audible now. Vasanthi. Now you are not audible. Hello Dr. Anjali. Hello Vasanthi. Good to see you. Ma'am just to introduce to you Vasanthi. Vasanthi is our regular anchor for all our webinars across India and international. We do international training programs for doctors, teachers, nurses and she is full time Manipal Hospital I can say anchor both for hosting the shows, for hospital new launch, new campaigns, any wellness initiative and also Vasanthi I want to introduce Ninmalwadan ma'am. She is from the principle of Kalyani school. Ma'am I just want to introduce to you about Vasanthi. Vasanthi is the ex NDTV correspondent and she has worked in all international forums and all and we normally use this type of anchors for hosting our show. Vasanthi it's all yours. Yes. We have about four minutes more. I am also looking forward to starting the program but it's really wonderful. Yes as I don't mentioned I am a journalist and I am also the founder of Pickle jar. We tell stories through podcasts and we are helping Manipal do all their storytelling as well. It's wonderful to meet everybody here. Nice meeting you Vasanthi. Thank you. As soon as I think we get the you know about four o'clock I think on the dot we should be able to start this. I can see people are putting their introductions. Very good. Please keep that coming. Vasanthi when you I think you are going to say that welcome. The first sentence you are going to say then you will do give me the mic for few minutes. That's right. Yes for you ma'am. Yeah so we will have you know a customary Annapan and then I will give it back to you. Sorry customary? Annapan. Two minutes of meditation kind of thing. Ma'am after that you will also address the gathering that we decided. Yeah same thing. I will talk. I will address and then we will stop for two minutes. I will give you all the instructions what to do. Yeah sure. And those with specs take them on etc all those things are. Yeah sure. And I will serve. Yeah ma'am. I will be doing the vote of time. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. I put in the group all in chat this one also in the chat flow plan entire flow plan. Thank you. Yeah. Vasanthi just to introduce to you our hospital directors. One is Dr. Viju Rajan. Hi ma'am. Good afternoon. Hello Dr. Viju. Hi good afternoon. Ma'am Vasanthi is our regular host at all Manipal Hospital's event and also introducing to you Lakshman sir. Sir Lakshman sir. Hi Arun. Good afternoon. Hi Vasanthi. Good afternoon. So hello Lakshman sir. I hope you can recall me Vasanthi. Say hello. Oh yes. Yes of course. Wanted to see you again. Yes Vasanthi just two minutes. Dr. Viju and Lakshman sir. Main two people I want to introduce. One is Madam Anjali Guruja. Ma'am and Nirmal madam. Yeah ma'am. I was just taking a sip of water. Hello. Yeah ma'am last time you had met with you ma'am also. Yes ma'am. Yes. So she is here. So everyone is aware of flow plan at all. Chat four o'clock Vasanthi will host the show. And it is already live on YouTube and we have nearly 200 teachers real heroes already on the stream actually live stream. Yeah. I'll put in my school group also let them join again in case they need a reminder. Sure ma'am no problem. Nirmal ma'am thanks for putting it up on the main show of the group. I know but I didn't see the attendance is so poor. No they'll join in actually. By four ten past four many more will join because I checked with Arun yesterday he said 2000 and many will join on the YouTube. It's a 2000 registered that's nice. So we've achieved something. Yeah and they will join on the YouTube many of them. They will log in on the YouTube. Shall we start. Yes ma'am please start. So so it is that when it strikes four o'clock it's time for all of us to come together into the classroom except that this is a classroom full of teachers educators who already are doing a fantastic job. In imparting learning and I have the privilege of speaking to a community of you about you about your wellness as part of the Manipal hospitals program and webinar today. So as we say in this part of India Namaskara to everybody Namaste Adab and a good evening. My name is Vasanthi Hari Prakash. I'm a television and radio journalist and also the founder editor of pickle jar and we tell stories. We help brands tell stories to fresh forms of content Manipal Hospital is one such entity always doing something so new and so impactful. I would like to spend the next couple of minutes before I start inviting speakers. For those of you who have joined us and I can see the numbers are slowly growing on the right side of my laptop. So I totally encourage you to use the chat box to tell us who you are. What's your name with school which institution. You're joining us from what are you you know what do you do and what would you love to do and please keep using this chat box. Let us put this one hour or so to the best use. I think we are getting a technology is making it possible for us to join from different parts of the country and beyond. So please use the chat box call me Vasanthi and of course continue to engage. Now Manipal hospitals ladies and gentlemen has been the front runner in creating public awareness campaigns for the welfare and benefit of people, not just in India but across the globe. You could say I have been I witness I have also been a part of this. So the endeavor is always to change mindsets, encourage the public how you can adopt a healthy lifestyle. And this at an early stage of your life because it's all easy to sort of go wrong at the beginning and then try to course correct. Instead of that, is it possible to have a change towards adopting a healthy lifestyle, and this will have a lifelong impact. Now, with the same ethos today Manipal has organized a school wellness initiative for teachers in Pune. So all of you who are joining in are from the Pune region. There are those of you from Pune probably are at the moment, in different places but yes, so this healthy nation as we always say is possible with the aim of creating healthy students and you are the ones with that powerful tool. And already, we've had an opportunity to interact with nurses and doctors and army people and media people. And now, when we are speaking to you, a request to you is also that please become and more active part of this Manipal hospitals Manipal education in medical group that is any MG. It's one of India's leading medical research education and healthcare service providers. It manages hospitals, educational institutions, insurance agencies and medical research facilities. I of course have more statistics and as friends from the teaching fraternity, join us we will share more, but today's doctors on the panel and I wish to introduce before I hand the stage over to Dr. We have the consultant cardiologist Dr. Consultant orthopedic Dr. Consultant. Neurology Dr. So, before we move ahead for the welcome address, please join me in welcoming Madame Anjali Gurjar, principal of power public school, Nanded Pune. Namaskar. Namaskar. Wasnti and thank you. Good evening and Namaste everybody. A warm welcome to all of you from Pune Sahodai member schools and also to the elite staff from Manipal hospital group. We are privileged to get an opportunity to hear from the esteemed doctors. You're the best person's dear doctors to understand that the educators health is of utmost importance. All of us teachers, being nation builders, we have to be physically and mentally healthy and happy to deliver to the children. The teaching profession comes in with professional health hazards, lack of time, pollution etc are also the factors. For the information of all you doctors on the panel, the Sahodai is a group of CBSE affiliated school principals working together. Sahodai and Uday, all of us helping each other to sort out our issues and to give value added inputs in the form of training, seminars, competitions etc. I welcome everyone once again and I thank Nirmal ma'am, principal of the Kalyani school for introducing us to Manipal hospitals and to Mr. Arun, the coordinator from Manipal Health. Let us begin with our customary Anna Pan so that we are all focused for the talk. I will give you a set of instructions please follow those, it will just take a minute or two. I request all of you to please sit straight. Those with spectacles please take them out and keep them in a safe place. Close your eyes, feet on the ground, both palms overlapping and placed on your lap. Think of what you are going to hear for the next two hours about your health, where we all need to improve. Let the other thoughts rush in, you cannot prevent them unless you are a practitioner. Be in this state for a minute. Let us all say a prayer. Oh God, help us to gather as much information as possible from today's seminar. Help us to focus and be present mentally and physically in today's seminar. Thank you for giving us various opportunities for self development and self improvement. I request everybody please rub your palms and place them on your eyes very gently. When you feel comfortable, open your eyes with a few blinks. Thank you. Manipal Health, Vasanthi please take over. Such a beautiful practice. You know Dr. Anjali, I was just thinking to myself, why don't we do this to all other things as well. Thank you for giving us this very powerful intent. So I think that to create a sense of focus on what this program is going to be, is definitely going to help our community of people who are listening into us or joined us. Thank you once again. Now to speak about Manipal and the importance of wellness in school, may I invite Dr. Viju Rajan, Hospital Director, Manipal Hospital Paneer. Over to you Dr. Viju. Yes, very good evening and it's wonderful, wonderful actually to see so many people logged in. Thank you Vasanthi and Dr. Anjali. I think it's an amazing initiative and very honestly school health is always associated with students. But I think we've turned this around on its head and we've completely understood that unless and until the school students themselves and their educators are going to be healthy, mindful, exactly like what Dr. Anjali told us, be present now. If we have those kind of anchoring into the world, the students definitely are going to be much, much benefited. I think COVID has completely changed the health landscape, the school landscape as well. And we cannot forget and the contribution of the teachers, me myself being a mother of a, you know, 11th and 12th standard student who went through those two very, very formative years. I mean, I think every year is formative, but I would say, you know, landmaking, landmarking in the sense of completely different isolated, but in a way all the teachers I think were the backbone of having these students come across through these COVID, you know, COVID schoolscape. And I've come out and emerged very strong with different issues we understand and they're all struggling with those kind of issues. And I think unless teachers, educators, school administrators, and I think it's a wonderful fact that we have so many people logged in, that unless they themselves realize the importance of the anchorage that they provide to students and ensure that the team that is actually geared towards providing a safe school atmosphere starts with y'all. So it's very, very, I would not say innovative, but I think we're kind of late in actually having to get this to this level to ensure that teachers, administrators, and you know, all of you educators out there, it's become so highly competitive. Everyone's multitasking with all these videos, zoom calls and everything. Like Dr. Anjali showed us the way we really need to be mindful, be present now, these kind of things will go a long way. The consultants that we have actually here to speak for you and to kind of address all your concerns are things that I think we have not been taken too seriously. We haven't been having the time or the energy to focus towards taking care of our health and we struggle all of us like that with busy schedules, with pressures of school and exams. I think the school education system and the team that has come together to lead all the teachers is doing a wonderful job. And it's just, you can assess the pulse of the requirement or the need of this by the number of people who have logged in. And my only request is, please do take this, not just something that you need to attend or to participate in, but something that you will go back and ensure that you yourself take time out for doing basic health checkups that are required. It's not just a physical health checkup, it's mental well-being, it's peace. And it's also about being holistically satisfied with what you're doing to prevent burnout. I think teacher burnout and burnout in most sections of any profession is very common. So it's essential that we take this seriously. And we're only going to give you small pointers, but I think if we have leadership at the school level like we've seen now, if y'all can ensure that a survey is done, that people really make sure that they participate in taking care of their health in a very focused manner all through the year that will be very essential. So that's all I have to say. Thank you very much for coming together. I think this is beyond your working hours. This is something that maybe should be incorporated into your school working hours so that it becomes part of your routine and lifestyle. Thank you all for participating. Please do give us feedback. Manipal hospitals in Pune is now in Bhaner as well as I have my colleague Lakshmanan on the east side of Pune in Kharradi and we're in Bhaner in the west side. So we've got you covered. So across Pune, if there's anything that you require, we are all there. But I think the essence of today's this thing is preventive help. So I'm sure all of us would take the necessary steps in that direction. Thank you. Thank you, Dr. Viju. So succinctly you have, you know, you put the importance and relevance of what the program is given us the big picture. I would like to also acknowledge those who have introduced themselves. Priya Gaikwad from Sri Sri Ravishankar Vidya Mandir Pune. There is Latika Kolkarni, there's Savita Pawar who has wished us. There's Ganesh Kumble from, you know, Heritage International, Kasar Amboli Pune and other people. So here's a chat box that you see at the bottom of the screen is where you can leave your name and which school you're from. You can also use it to ask questions as our speakers come in one after the other. May I now invite the consultant orthopedics, Dr. Srinakumar Bhaskaran from Manipal Hospital, Skaradi to please present Dr. Srinakumar. Yes. Hi, good evening. Am I audible now? You are, you are. Okay. And at the outset, thank you so much, you know, for having us. I think Dr. Viju had just put it across quite clearly that I'm though an orthopedic surgeon and surgery being my, you know, main profession. So today I'll be talking about ways how you, how we can avoid coming to a surgeon, you know, so we'll be focusing more on the preventive aspect of orthopedic and musculoskeletal issues rather than looking at what surgical treatments are needed once, you know, you need to, once you develop kind of end stage musculoskeletal kind of diseases. So again, once again, thank you so much for having us and like Dr. Anjali mentioned earlier, you know, so having a audience of teachers is both a bit unnerving and at the same time it's a big honor and privilege as well for us, you know, to get to address you all. And I hope on behalf of Manpal Hospital, we'll be able to, you know, clear most of the doubts that you have. And at the same time, like Dr. Viju mentioned, we have you covered any kind of issues at any point you can get back to us. Even today you can use the chat box as an OPD consultation and you know, just as fire away all your questions and we are here to sort them out. So today I'll just share my screen and so it's my screen visible. No. Not yet, doctor. Yeah, sorry. Yes, now we can see it. Okay. So, like I mentioned before, I'm Dr. Sinukumar Bhaskaran and I'm an orthopedic consultant at Manipal Karadi. My main areas of interest being joint replacement and orthopedics. So today I would be focusing more on the orthopedic general orthopedic kind of OPD that we run and what are the common issues that we see in our day to day outpatient practice. And so most of this are you know lifestyle related and actually related to, you know, our daily postures or daily activities that we do. They begin off as small kind of irritations and then later on they become major pathologies and which, you know, then would need, you know, kind of large scale investigations and treatment. So we'll be looking at how we can avoid them. To start off with I'll just run through the common kind of situations that are issues that I see in my OPD routinely. I think the most commonest thing that patients come to us with is, you know, neck pain or the cervical strain, what is called as, you know, usually ligament related problems in the upper back or the neck region. Then we have the very common kind of lower back pains what we call as a lumbar disc or lower back strain kind of issues. Then we have this very new kind of problem that we have seen in the last few years that is it's this guilt consciousness of, you know, our kind of lifestyle where we spend the entire week, you know, sitting at one place and not being very active and then we try to overcompensate towards the weekend by, you know, trying and being active playing a sport and then we end up with certain kind of injuries and that's pretty common as well. And so what we do and how we deal with them is something that I'll be talking about. And then of course the commonest injuries like overuse injuries because of the kind of devices that we are using nowadays, you know, inflammation around your thumb, some, you know, I'll be going into details of that, the carpal tunnel syndrome. You know, these are just problems that can be very easily managed, not something that needs major kind of treatments but just to make you aware of that these kind of conditions exist and how we could, you know, prevent them rather than, you know, looking at treatment of these. I think the biggest change that has happened is our work profile, the way we actually have to, the work profile in the last 20 to 30 years is the kind of work and average person has been doing from the kind of physical kind of activity that he was doing to, as you can see in this picture, you know, it's now mainly sedentary we are sitting in one place we are, you know, sitting in a particular posture, either using a laptop or maybe a phone. And so that's that's had its own advantages like you know when you avoid heavy physical work when you're not lifting things there are certain advantages of that you have prevented other injuries but at the same time then you've commonly seen other kind of issues have and one of the most commonest thing, like I said, problem that the patients come up to us is with a, you know, neck pain or stiffness in the neck so something called as a cervical sprain it's basically the ligaments that hold your neck, the skull to your body, you know, being put under a lot of strain and then because of this happening over and repeatedly these ligaments undergo inflammation and this inflammatory pain then leads to a lot of kind of spasm around your upper back muscles and then patients usually present to us with a lot of stiffness around the neck. So this is something called as a cervical strain. And why this happens is something I'll just try and explain to you. So if you can look in this figure here. So when you're sitting upright and looking straight. You can see the amount of that is the weight of the normal skull when you're sitting straight and looking at an object right ahead of you. But the moment you start bending the same skull which was about 10 to 12 pounds. It increases to almost, you know, five to six times of the weight so if you can see something was about 10 to 12 pounds it's almost 60 pounds when you're bending at 60 degrees or 45 degrees. So if you look at the kind of activities with phone that we normally use it now earlier we used to use phones just for speaking but nowadays the usage of phone is more for you know reading maybe even texting reading and those kind of things and we tend to forget the amount of time we are spending in this very abnormal or unnatural kind of position so if you can see the last extreme right and the image so that is the most common kind of I think posture that we adapt when we are actually really into something we're reading something and spending a lot of time. So you can see the weight of the skull which is around 10 to 12 pounds is now become around 60 pounds. So the same muscle, which is actually designed by nature to just take this particular amount of weight has to take multiple times that same kind of weight so that is the exact reason why these ligaments which you know earlier we never had these problems and that's the reason why these ligaments have started undergoing this kind of chronic inflammation and then you know slowly starting off as pain spasm and in the initial stages it's just that mild irritating pain or stiffness that you get once in a while and these are usually easily treatable you know just medications and some physiotherapy but then if you continue these kind of wrong postures for a long time what happens is I don't know if you could appreciate on the image on the right hand side. So if you look at your spine it is not just a single piece of bone so there are multiple bones that are stacked on top of each other right from the base of your skull till the tip of your spine at the bottom. There are these multiple bones which are stacked on top and stacked on top of each other and in between them there is a small pushing material called as a disc which acts like a shock absorber. And now when you have these strains coming on your cervical spine, or even the lumbar spine for that matter for very long hours what happens is this disc tends to migrate or move from its place and it moves behind and it starts pressing on to your spinal cord and your now this is a serious issue. Now here what you develop is not just neck pain you would also complain of some pain in the shoulder or you might complain of some pain in the arm as well. This is something what is described as a radiculopathy or a neuropathic kind of pain. Now we have progressed from a situation which was earlier just easily treatable with a few medications and physiotherapy maybe rest but now it is something where you might be looking at kind of an intervention like a surgery or maybe a small injection there. So it is the same kind of stress when it's prolonged over a period of time, we end up with these kind of situations. So I mean just to you know again re-trade the postures like on the left hand side as you can see that's the right way how you need to hold up a phone or a book when you're reading the right being the absolutely wrong way like we saw the reason mainly being this increases the weight of your skull and it's the same muscle that has to hold it which was supposed to hold about a 10-12 pound of weight of the human skull and now it has to you know lift about 60 pounds of human skull so that muscle and ligament that's why it undergoes that inflammation. Then secondly coming to our work posture we usually we start off when we are working we sit in a straight kind of position and we are usually very correct and once we tend to get absorbed in our work and we are really concentrating hard we tend to lose you know track of time we tend to lose how we are sitting all our focus is in the work and this is what happens and so again when you're spending hours together in this kind of postures you tend to end up having some kind of damage both in your upper back and in your neck that is the cervical spine as well. In the last few years through us through us a new challenge of the pandemic and as a result of which we had the work from home kind of situation coming up. Though it's opening up right now we still have quite a few you know with the mixed or the hybrid scenario where a lot of people are spending quite a lot of time at home working on the same kind of devices. So usually they don't have the same ergonomic kind of tables at home you tend to work from whatever is available nearby like your sofa or your bed and this has in fact led to sort of worsening the situation the same kind of stressors but they're now much more multiplied as before. So this is just in general talking about the cervical spine and the treatment modalities are usually when we see these patients it is usually just you know muscle relax and sandy inflammatory kind of medications. So when a patient comes to us in the initial stage with this kind of pain or stiffness. We do not recommend exercises. Exercises are mainly for prevention that is something that is very very important that I would like you know if that is even a take home that you could you know get to it today I think that would help because almost each and every one of my patient who has a neck sprain or spasm in the neck. The first thing they try to do is to stretch it and move it around and try and get it free that is something that you should not be doing. You should know if they know about some exercises physiotherapy exercises of the back or the neck they try to, you know, start doing that and this would in fact actually worsen the condition. So in an acute scenario when you have spasm when you have pain, stiffness of the neck, what you have to do is just rest it out. Let nature do its thing, but do not try and stretch it, because you'll worsen the situation. Remember the exercises are for preventing so when you're completely normal. That's when you have to be doing the exercises so that in the future you wouldn't get these situations again, again, kind of the slot of massage kind of treatments being done. So some of them, when you do it at home in a gentle kind of fashion that's okay but there's some of those massages that are done. The so called professional kind of massages we have seen a lot of issues cropping up with that as well so I wouldn't recommend that at all. And always remember when you have a spasm when you have that tightness you cannot move your neck around and your neck is really stiff. But always try and do warm water fermentation rather than rather than using ice packs because an ice pack is going to increase the tightness or the spasm in your muscle more. So always use a warm water fermentation when you have a stiff neck. Okay, and then. So how to correct this again, you know, making sure that you're sitting up straight. So as you can see on this image so when when you're looking straight, you know, again, you're taking care of your cervical spine and at the same time your lower lumbar spine as well. So the best way is to have a chair which has got a bit of spring action which can decline about 25 degrees backwards. That's the most ideal position because again when you sit straight upright it's going to put a bit of strain on your lower lumbar spine and you know how you can have problems there. So this kind of 25 degree of reclining is the right way of working. The best way of doing that reminding yourself is to put up some kind of an alarm. And you know that would keep reminding you every 45 minutes or an hour that you're sitting the right way, and you're not sitting straight up because what happens over a period of time is once you start sitting straight, you start tending to stoop forward as well after certain, you know, after some time. So again, the prevention. So just to give you an idea of how to maintain this posture is when you're sitting upright, you just have to make sure that your ears are at the same level as of your shoulder when you're looking at it from the side. I know it sounds a bit, you know, difficult or not difficult means in the, I mean, you'll have to check on it repeatedly it sounds a bit, you know, difficult in between your schedule but you have to just like I said not put in those alarms make sure that you're maintaining that position. And, you know, also other very important thing is frequently change positions don't just sit in one position, you know, get up every 45 minutes, half an hour and take a small store just come back. And then of course, even prevention is what's very important is getting getting meeting up a physiotherapist doing this exercises, very, very regularly. So the exercises would be of course, be trained by a physiotherapist and you just need to see it once and they're pretty simple so you can keep doing that. At your home itself. Then coming to the lower back issues or the lumbar spine issues. The commonest problems that you have is again, it's so whenever you talk about lower back we normally talk of severe issues like slib discs or sciatica, you know, those kind of problems but majority of them are the small injuries or, you know, muscle spasms, which usually trouble you but these are, you know, early warning signs that sort of the body of the nature is telling you that if you don't take or intervene at this stage, you could end up having severe disc and kind of, you know, sciatica kind of issues. So again, the common causes of faulty postures sitting for prolonged hours extensive, I mean, mainly kind of road travel. These are issues that you know these are situations that increases these problems. The treatment again here is absolute bed rest when you have lower back pain the best way to treat it is even you can just do that at home is you have to just lie down for 24 to 48 hours. I mean just getting up for your basic needs like having food or going to the bathroom rest of the time just lie down, keeping a pillow under both your knees so that your legs are slightly bent, or you could sleep sideways in a fetal kind of position that is, you know, folding up your hip and knees all the way. So that also releases the pressure on the lower back. And a lot of people go in for treatments like traction that there is clear cut scientific evidence that there is no role of traction in today's world for treating, you know, lower back pain so all you have to do is bed rest and that would take care of it. So medications painkillers muscle relaxants would help if they don't then you have to go and meet a physiotherapist again not for exercises but you meet a physiotherapist for certain modalities what is called as IFT or tense you know where they give small electrical vibrations to the area of your lower back. And then you have to give ultrasonic kind of vibrations there and that takes care of this, you know, severe specimen pain. Again, I'm just repeating that point physiotherapy exercises would be started. Once your pain is completely over because it is purely for preventing these kind of problems. The point I discussed before is that of weekend athletes, you know, so very, very important to understand is that, you know, there is a difference between what is a sprain and a strain so this is basically a sprain as any injury to the ligament well as a strain is an injury to a muscle so I wouldn't go into the degrees of that. So, commonly patients coming to us, you know, so I like I said it's a question of overcompensating the entire week you're, you know, sitting you're being sedentary, there's not much walking around and then suddenly towards the weekend, you know, you feel like it's you know, you know, sort of compensate for what you've not done throughout the week and at the same time you want to, you're inspired by certain sporting activities or sporting heroes and you want to emulate them and you know, we've seen a lot of, you know, patients turn up with, you know, joint kind of ligament injury so the communist joints that get affected are the ankle the knee and the shoulder. So the ankle you have again, you know, normal sprain strains and there are certain major ligaments like ATFL ligament in the knee you have this ACL ligament or there is this cushioning structure in between called as meniscus which you end up damaging. Again, in the shoulder you have something called as a rotator cuff injury, which is again, you know, one of the most important stabilizing muscles of the shoulder and if you usually happens to players who are, you know, throwing a ball or who's a baller or who's doing something like a javelin throw and you can end up tearing that muscle and these are situations, you know, like all the ACL meniscus, ATFL, these are situations where you cannot just treat it normally with, you know, rest and medications, it might need some kind of a surgical intervention. So there are three grades of strength, not every strain or strain would need surgical treatment. Grade one or grade two strains which is minimally or partially kind of damage can be treated very easily with rest medicines. But as you can see a complete dissociation like in a grade three would need some kind of intervention if you don't, you know, if it's a very functional kind of ligament like your ACL ligament or muscle like your biceps muscle if it's torn completely unless you get it to repair it's never going to function again. So that's but it's pretty rare if you look at all the injuries out of that it's just two to three percent of the grade three injuries. Otherwise almost 95% of them are just grade one to grade two injuries so which can be very well managed with rest. So just again running through the conditions in the knee you have the meniscus and the ACL and the rotator cuff in the shoulder and in the ankle there's something called as an ATF, tibial fibula ligament. This is again a very common injury, but usually it's just so what is typically called as an ankle strain and it doesn't need a sporting activity as well. It's sometimes you just walking on an uneven surface or with a high heel kind of shoe, and all you need is your, you know, foot turn inwards and you can sort of damage that ligament. But thankfully these are usually just the grade one screens and they respond very well to conservative kind of treatments, you know, resting it out using ice packs, elevating it and few days of anti-inflammatories and you're good to go then. And the time when you actually decide on meeting a doctor is if this pain doesn't go away at the end of one week or if the swelling is massive around your ankle or if the pain every time you load your foot down and the pain is quite intense and it's been the same for the next two, days for the, for at least about half a week or two, three days, then there's this no doubt about it that you definitely done a bit more damage than the routine regular kind of a grade one screen. So this is the time where you should not then be waiting on it because better get a surgeon or orthopedician to have a look at it. And usually then the treatment is you're given a plaster cast and then you wouldn't have to use a walker so that you're not loading the leg for the next three to four weeks. So almost a month you would be out of action in terms of standing and walking. So, but that's needed as well in some of the great injuries. But it's better to get it checked once from the specialist fractures again fracture is a injury in the bone so you have something called as a simple fracture or a compound fracture. The simple fractures are once in which you know usually the bone is just broken but then there is still a kind of connection between both ends of the bone. But well as a complete displaced compound fracture there is absolutely no connection between the two ends of the bone so you would be confused as to a lot of times you go with a fracture to a doctor and there will be sometimes they would say just put in a plaster and you will be fine. But some of the fractures they would say no you need surgery. So the compound fracture that there is no end to end contact that is the time when you need a surgical kind of intervention for a fracture. But if you have fracture ends of bone they have good contact with each other and all you have to do is put in a plaster. But yeah it's going to take about a good two to three months for it to heal up completely based on the local localization on the type of injury that you had. The treatment for all this you know the ligament injury sprains and you know even the mild kind of fractures are usually ice fermentation bracing medications, some injections and of course if it is like I mentioned if it is, you know, severe then you need surgical intervention. Doctor sorry to interrupt you, I just have the interest of time you know because if, yeah which is why I'm requesting all doctors to keep the presentation short because questions are so many and we have very limited time. Okay, so I'm just yeah I'll just I think conclude with my, I think just last two of these slides, yeah sure I'll do that. So, again, like I mentioned in the start the overuse of the repetition injuries are very commonly seen. It's again this is something called a set you know sign or it is earlier call us a blackberry thumb. It was because of repeated typing with your, you know, thumb you tended to develop inflammation on the base of your thumb and, but this is again very easily treatable with just medications physiotherapy. Finally, you need surgically, you know, kind of treatment that is to release that compass part of the tension of the tendon. And this is something again when you're spending a lot of time in front of a laptop and typing. There's a constant pressure that comes on the base of your wrist and you can get this know that is there just below, which gets inflate and then you can develop this neuropathic kind of pain. And again, there is, you know, mostly just medications and towards the end of course it doesn't respond to any of this we need surgical intervention there. So, prevention is identifying the condition and just, you know, having proper padding or support kind of that, and avoiding these kind of repeated moments so I would like to stop there. And I'm so sorry about overshooting. Yes, Dr. Yeah, you know, we don't actually have time for questions but if you can just answer very succinctly, there have been questions that have come in for, you know, because teachers have long hours of work and they land up standing. Many of them have this bone and knee pain, the arthritis kind of variety but I'm not getting into those details some of which you've already addressed. But there is, you know, this question from from this teacher called Vandana and she says that if I want to remain an active teacher, you know, active person teacher from public school Vandana I want to remain an active teacher with good health. So broadly speaking, yeah, you did mention the specifics. Any one tip that you would leave for all teachers. I think, yeah, I think specific to the teacher profession like you mentioned standing is the biggest risk factor. And when you're standing and working for long, I think the biggest strain, the area that is trained is your lower spine the lumber area. So they have to make sure that they get those breaks every 45 minutes to one hour they're sitting at least down sitting down for about 15 to 20 minutes before they stand. So that is definitely a proven. I mean, cause for having lumber this problems, you can get very close kind of situations that is, you know, Venus kind of dilatations in your lower leg if you're standing for long. These are again very specific conditions, but you should know about them and these are, you know, specific to the profession of teachers, but then to remain active to, you know, continue being healthy. Yeah, it is the basic kind of like for everybody else being active having a good lifestyle, eating, you know, healthy. Those are things that are going to take care of. Thank you so much, Dr. Senu Kumar. Thank you for actually taking time out for our teacher community and putting out so much of, you know, terms and things that they face in their profession. Thank you once again. Thank you so much. I would like to now move on to our next guest and I would also just in the interest of time again request all our guests to keep in mind the question time because that is what will make it very effective for teachers. If you can keep it crisp and concise, I have great pleasure inviting Dr. Bhushan Joshi. Dr. Bhushan Joshi joins us from MH Kali is going to be, he's a consultant on neurology, and let's hear what he has for all of us over to you, Dr. Bhushan. Okay. Thank you. Thank you for opportunity. And it's my great pleasure to take in front of this imminent audience of all teachers who are actually one of the noblest profile profession amongst amongst all I'll say most noble profession and the topic given to me stress management understanding stress and stress management. So stress or let us understand what is stress stress is any sudden change in physical, emotional or psychological environment leading to strain. So what is this environment, the environments we divide into internal and external environment internal environment is your health and external environment is the environment in which we work we study we play we live in. So that is external and internal environment. Stress is not just an emotion. There are anatomical basis there are structures in our system, which control stress. So main structure which controls our stress is in brain we call that thing center of stress is hippocampus hippocampus is an area of a brain, which which controls all of our emotion, particularly including stress. Forget just not stress all other emotions. So it's a in short or in simple words we call that reward and punishment center. So what are we are doing and what are our emotions are are actually generated by this reward and punishment center. Then it controls our different glands pituitary is one of them. We are aware of pituitary adrenal gland is second gland. These are the two main glands which releases certain hormones which which creates appropriate change in our system leading to feeling of either happiness or sadness or some stress. So when when anyone is stressed, the main hormone release are corticosteroids adrenal corticosteroids will not go in detail of that but what are those hormones are they they lead to the leading increase in our heart rate blood pressure and increasing the speed of circulation of the blood increase in urine production so and plus negative emotions like sadness and anxiety. So if what happens if we consistently stimulate this hormone then that leads to a permanent change in our system leading to many neurological condition. So as a simple example in view of considering time also I'm just going to discuss one common neurological condition which is associated with this stress. So migraine is this commonest example migraine must almost everyone must have heard about this condition migraine is a condition in which patient gets headache headache is the most common example of that. This migraine symptom headache is the most common symptom of migraine and most common cause or trigger of migraine is stress. So all all how this stress affects migraine stress physical stress if you're fasting fasting can trigger our patients suffering with migraine and he or she is fasting that can trigger the migraine. And prolonged fasting change in certain change in timing of the food so being in a teaching profession say sometimes you're very busy food timings cannot be followed breakfast lunch and dinner three meals are compulsory to minimize our stress intermittent fasting and those sort of methods are usually stressful for body so three meals are recommended. If food is missed that triggers migraine so physical stress triggers migraine certain sleep deprivation if your patient or any individual is not able to sleep for more than six at least six hours at night. If they're sleeping less than six hours in night that lead to increase production of this stressful hormones corticosteroid hormones so this sleep deprivation triggers migraine sleep deprivation is also independent respect for many cardiovascular condition rather it has been proven if you're sleeping consistently less than six hours it is as bad as smoking 10 cigarettes a day. So physical stress leading to this many bad effects on our system. Second emotional stress sudden tension for patient or for individual is going to emotional stress say exam or sudden financial stress or time limit or task given to be fulfilled in particular time. These deadlines this kind of emotional stress also triggers migraine it causes increasing blood flow to patient brain leading to that typical throbbing type of headache and along with medication when I'm trying to treat my patient of migraine the most important concept is stress management. So I asked my patients to keep their food timings regular breakfast lunch dinner should be on time six to seven hours of night time sleep and regular exercises. So if you handle patient stress and give him certain medication the response and results are long lasting and persistent. If I ignore the stress factor then only medication may not work completely and patient may not get adequate results. So this is simple example as I have selected migraine because it's commonly known but the point here I want to convey is stress management if I ignore stress any neurological condition will not respond to medication alone. So few tips regarding how to manage our stress. So as I said stress is produced by certain hormones so happiness is also produced by certain hormones and reward and punishment center punishment part was stress and reward and happiness part is again situated in the hippocampus. So for stress production there are only two or three hormone but for happiness there are four hormones most these are these common is four hormones are serotonin oxytocin endorphins and epinephrine. So these four hormones how to generate those hormones serotonin is called as the calming hormone oxytocin is called as the fill of hormone. Then endorphins are called as energetic hormones and how to generate these hormones. So let us understand one by one. The last one was dopamine. Dopamine is called as fill good hormone. So we'll start with dopamine fill good hormone. Dopamine is usually released when you are doing certain activities like which will give you happiness for example performing certain hobby listening to music watching movie playing a game of badminton with your friend or in your club or drawing painting. So these activities stimulate production of dopamine which causes fill good or happiness. So by doing this if we are going through stress at least take out 20-30 minutes to inculcate any hobby try and learn new things and do it meticulously that that job will help you to control your stress. So second hormone I was talking about endorphins. Endorphins are released when you are exercising. When you are cardiovascular exercises particularly when your heart rate causes crosses 100 and you experience sweating that is the level of exercise I am talking about. When we do this type of exercise our brain releases endorphins. Endorphins give us feeling of strength feeling of internal strongness. Then that prevents us from getting stress and that prevents us from experiencing the sad emotions associated with any minor illness. So endorphins are also called as happy hormones how to release them just 20 minutes of cardiovascular exercises at least 4 days a week. Now serotonin. Serotonin is the calming hormone doing spiritual activities yoga or meditation sitting in front of the place of worship and just meditating staying calm at least 10 minutes of calmness or meditation has proven to increase the serotonin concentration to almost double than the baseline. So doing all these activities helps us to reproduce this serotonin. And we can experience calmness and we can manage our stress. If you are doing and the last hormone happy hormone I will talk about is oxytocin. Oxytocin is the loving hormone. Go sit with your friends, laugh, crack a joke, cuddling, hugging your kid or your pet or socializing. These are the activities where our brain enjoys them by releasing oxytocin. So meeting with your summer is meeting with your friend, enjoying playing a game or inculcating any hobby and enjoying that hobby exercising, meditating. So you can you can give at least say one hour in your water busy schedule and regularly to either of these activities which will release these happy hormones and which will in long term tackle the bad effects of the stressful hormones and in terms it will reduce bad effect happening on your system. So that is all on my side. Thank you. Thank you, Dr. Bhushan. I have a few couple of questions for you. I'll keep them quick in the interest of time is you know and I'm also clubbing a few questions it may not necessarily be in your department nevertheless just to put them out is migraine related to coffin cold or acidity that's one one question. Also this profession which, as we mentioned has long standing hours of most teachers say that they suffer from throat pain which is which is, which they don't recover from heel pain that cervical pain and this kind of a stiff back. So, as a neurologist, how do you address these. Yeah, first one question regarding trigger about migraine. I mean they say that anything under sun including sun can trigger migraine this this this but these triggers are individual specific. So, if you're suffering with recurrent migraines then you have to note down any particular factor which which you did differently on that day. Suppose drinking coffee, for example, and if consistently that is the factor or correlation you're observing then that is the trigger for that individual patient. And then I will suggest or I suggest my patient to avoid only that particular thing. If you Google the things which can trigger migraine as I said there are many plenty anything can trigger it. So, suppose as in the last example coffee is triggering migraine for that individual it may not trigger my migraine and he is triggering my migraine it may not trigger your migraine. So, you have to identify and you have to give time maintain the particular diary how frequently you are getting what any particular object you have done differently thing you have done differently on that day and that that is how you can identify your migraine. Regarding the long-standing pain I mean the pain resulting from speaking loud and standing for long period of time. And Dr. Seenu sir I address that part but see I just mentioned about the endorphins. Endorphins see if my patient is suffering with a long disease even after disease is gone cured for example we'll say dengue. Dengue is cured let's say normal fever is gone but that fatigue persists so that fatigue is also result of this chronic illness. Endorphins help us in fighting that illness and I just discuss about that how to naturally produce endorphins is 20 minutes of vigorous cardiovascular exercises at least 3 days a week. If you do that you will I mean within 10-15 days start noticing that this chronic pains which are not specific because of say any particular bone injury you will get rid of those pains. I think that's a very helpful tip. Thank you Dr. Bhushan Joshi. Thanks to our teachers. Please keep using the chat box in fact one of the questions is for Dr. Seenu Kumar if you can please put this answer in the chat box also Dr. Seenu. If at all you are still online and can you know or if you are attending to a patient of course we understand but this message for Dr. Seenu Kumar was like my name is Vanitha from Dwarka school Mahalungi Chakan. I have a heel pain in one leg since a year it's very painful what is the reason of this pain and what is the treatment that's what she has asked. So please do put it out in the chat box whatever you wish to answer that. I would now like to request Dr. Asmita Dongre consultant OBG gynecology and obstetrics because there are so many issues that women in particular face and women teachers among them. Let's hear what Dr. Asmita has to say and then if there's time we can have questions for her as well. Dr. Asmita. Good afternoon everyone. I'm Dr. Asmita Dongre and consultant obstetrician and gynecologist in Manipal Hospital. Today I'm going to share some information about PCOS or PCOD. It's one of the most common terminologies used nowadays. So PCOS stands for polycystic ovarian syndrome. So it is very common for one in 10 women have PCOS. It is a common condition where hormonal imbalance causes irregular periods which means ovaries do not release the eggs regularly. Excess of androgens which may increase the facial hair and polycystic ovaries seen on sonography where ovaries look like they are enlarged and they contains multiple fluid fill sacs at the outer edge of the ovary. If you have at least two of these features then you may be diagnosed as a case of PCOS for which you need to get some blood tests done and an ultrasound. Symptoms can vary from woman to woman and some women might experience mild or fewer symptoms whereas some may be severely affected. So let us understand what is PCOS. So all of us know that the female reproductive tract consists of uterus, then cervix, vagina, two fallopian tubes and ovaries. These ovaries contain egg bank which is stored in fluid filled follicles. So the pituitary gland which is located at the base of the brain directly regulates the function of these ovaries. The pituitary gland secretes follicle stimulating hormone that is FSH and luteinizing hormone that is LH to regulate the function of ovaries. So each month when the pituitary releases FSH and LH it stimulates the ovary to grow follicles and make the follicles mature. So as these eggs are maturing it secretes estrogen and the estrogen actually makes the egg bigger and once it reaches at certain level the pituitary cell signal for LH to increase. Which helps in releasing the egg, mature egg from the follicle. This process is called as ovulation. Now once the ovulation has happened this free egg again travels from the ovary to the fallopian tube and it awaits here for fertilization. So suppose if fertilization does not happen then this egg gets dissolved and the inner lining of the womb is shed in the menstrual cycle. So if you have PCOS then your pituitary may be releasing abnormally high LH. As a result of which these follicles are not growing the way they should grow or the ovulation is not happening at all. So that is the cause of anovilatory periods and infertility. So in PCOS what happens is that some of the follicles may not dissolve and they actually are seen in the ultrasound like this sitting at the outer edge of the ovary like a fluid filled tiny sacs. That's why it is called as a poly that is multiple cysts like that is cystic ovary. Actually there is nothing like a big cyst or something like that. These are the follicles which do not dissolve or may not ovulate at all. So PCOS is also considered as like related to high level of insulin. All of us know insulin is the hormone which regulates the blood sugar in our body. So what happens is that in PCOS your body is not responding to the insulin in your own body and what happens is sugar levels are rising. So the more sugar level is rising the body is producing more insulin and this phenomenon is called as insulin resistance. So because of this insulin resistance it causes weight gain, irregular period and fertility problem. In addition to this high insulin levels can lead to androgen axis by which I mean male hormone. So that causes increased hair growth over face, back, buttocks or chest. So I know this figure is bit complex but here I can show you that pituitary, citrus, FSH and LH this stimulate the follicular growth. And once they start growing estrogen level is rising here in the middle of the cycle. Once the estrogen has reached certain level the LH surge is happening and here you can see ovulation has happened. So this axis or this rhythm is disturbed in PCOS. That's why we say PCOS is a condition where it is hormonal imbalance and the exact cause is not known. These are the biochemical abnormalities or hormonal abnormalities which we can talk about. The why it happens in one person that reason is not really known. It has seen that it runs in the families. So as we know like what is PCOS let's go and understand that how to manage it. So as I told you that it presents with irregular periods or no periods at all sometimes. Difficulty in getting pregnant because irregular ovulation or no ovulation happening at all. Excessive hair growth over face, back, buttocks and chest, weight gain, oily skin and acne. Also studies have shown that it is associated with increased risk of type 2 diabetes and lettuce and high cholesterol levels in later life. So managing PCOS it is important that we follow healthy lifestyle. So it is the mainstay of the treatment of PCOS. So we have to aim that our body mass index is between 19 to 25 and to gain that body mass index, normal body mass index. We need to eat healthy, do regular exercises and follow healthy dietary habits. So losing weight is very important in PCOS. Studies say that even if we lose 5% of the weight the symptoms can become much, much better. So in choosing diet it is important that we choose high protein meals and low carbohydrate meals. By which I mean choosing proteins like chicken, fish, egg and if you're vegetarian then tofu, soya food you can choose. And low carbohydrate is that cutting down to sugar, then salt, coffee and choosing like ground bread or wholemeal grains and cereals you can choose. Also having fruits and vegetables it is important because it has antioxidants which play role in preventing the free radical damage. So choosing healthy diet is extremely important in treatment of PCOS. Also medicines are available to treat the symptoms which includes if someone has irregular periods you will be offered birth control pills to regularize your periods. If there is problems with excessive hair on face then anti androgen medications can be taken to rectify that. Also as I told you that insulin resistance is one of the factors which causes PCOS, diabetes medicines are also being prescribed. And the women who are looking for fertility problems, we prescribe fertility medications, we try to regularize the cycle, we give medications so that you ovulate and you conceive a baby. In case if it fails then there are certain simple procedures, surgical procedures which includes laparoscopic ovarian drilling which plays an important role in inducing ovulation. So actually I have kept my presentation very crisp so my message is educate yourself like by which I mean that we need to understand our body, we need to understand that we should have normal body mass index and we all teachers mothers and you know you must be seeing all the girls in the school. So faulty diet is a big thing now, eating preserved food, a lot of pizza, pasta, all major things people are eating and not regularly exercising. So educate yourself by which like I mean whatever you are eating, how much you are exercising that is very important. Empower yourself that is motivate yourself to eat healthy and do regular exercises and definitely then we will be able to end the PCOS. So I hope that I was able to give you bird's eye view of PCOS and if you have any questions please feel free to ask or post in chat box as well. Thank you. This was so you know succinct at the same time it was so useful Dr. Asmita. Thank you. Thank you for yeah it's it's good that you kept the you know presentation size just so that you can interact a little bit more please have any more questions for Dr. Asmita you could certainly place them in the chat box. But one thing which had come up you know there were many questions which came in even at the entry stage we're not able to include all of them because of want of time. But I can see that there are about 500 people participating so thanks to the teacher community for coming out in such large numbers. So there is you know what is the one factor Dr. Asmita that why we know the sedentary lifestyle changes you also said that people are eating you know Mehta and Anilthi but at the same time the realities of life for a woman particularly let's say ages of 20 to 40 that you know sometimes you're a working woman you're you just don't have the time for self care. And but that's also the most important time of a woman's life you know it's a reproductive phase you're raising a family and children. So, given this kind of work challenges and reality of not being able to make the best of things. Have you come across a good case studies in your among your patient that were young and was still able to do things to prevent things like PCOS. The first and foremost is you know you have to control your weight. That is the most important thing the half of the job is done if your body mass index is normal. And to control that you know you have to have healthy choices while you eat. That is the most important thing all these things you know you require medications or what you need treatment that comes very later. But if you know if you're getting hold of your body mass index you're downloading apps and checking. Then it is quite possible that we will be able to avoid you know full blown PCOS. It is not going to run anywhere if you have a PCOS then you have PCOS it is not going to run anywhere it's like diabetes. You have to cope up with PCOS change your lifestyle and keep it under control and that is quite possible. Weight management and of course there are things now let's say like yoga and other forms of people can look for. And just to add you know healthy mind you know actually it comes the first it is healthy body and then it is healthy mind. I believe because it's all biochemical thing mind is the you know so it's all biochemistry. So it is very important that we all are following our daughters it does everybody should follow healthy diet and exercise that's a must. True doctor Swasman is what houses a swasheri ultimately now we have a question by Shubhada Londe who says how acne and excessive hair growth can be controlled at the age of 20. In the case of PCOS. Okay so for acne first of all skin routine is very important like because these girls are in such a age group where they're very active going out and everything. When it is oily skin acne is going to happen so skin routine following you know like cleaning your face at least twice daily and making sure that you know when you eat. Average awarding coffee chocolates like awarding sugar that is another thing and there are certain medications like I told anti androgens which can be given and reduce the facial hair and it can partly help in acne as well. If acne are like you know getting infected or you know there's any purse formation then you might have to see dermatologist as well. Before I invite Dr. Kavita Verma one last question is that yes in what's the age group of is it only a young woman's issue like you know there are teachers who are let's say on the verge of retirement or this thing. So tell us give us a sense of what about the menopausal women do they also face PCOS what's the kind of cut off. Unlikely unlikely this is mainly you know it starts from early teens till the you know you can say 4548 or something as we as women become premenopausal perimenopausal it will not like it will not affect them much. Right so so as in in the case of the senior teachers who are there the women teachers or this thing any any also tip for for a healthy life life from gynecology and this thing that you would like to leave. If senior teachers are there and you know so we are thinking about perimenopausal things you know so it again the same thing applies to them eating healthy diet regular exercise in the form of yoga or walking is also fine for them. In addition to that some meditation pranayam is important because again it's a shutdown of ovary so a lot of changes happens mood swings are there hot flushes are there and this is the time when women are you know going through hormonal shift and kids are in teenage so actually sometimes there is nobody to listen to them nobody to vent out. So they should I believe in that they should have a common group where they are venting out their feelings from doctor point of view regular exercise meditation dietary calcium dietary vitamin D3 if it if at all diet is not giving enough then supplement should be taken and I think that is all. Thank you so much Dr. Smita. Okay, thank you. Nice meeting you. Thanks. I have questions who from anonymous attendees people who are feeling more comfortable to put their identity in secret but also ask questions we will probably have the money pile team reaching out to you doctor to direct those questions and they can probably answered by email. Thank you. My pleasure. Thank you. One such question relates to another doctor. This attendee teacher wants to know how can this be he'll spawn below arthritis fibromyalgia. She's been suffering from a range of ailments starting with cervical spondylosis and she has given many of these ailments that she's been suffering from the past 15 to 18 years I'm sure the money pile team will reach it to the respective doctors. I would like to invite Dr. Kavita Verma who will after after we heard so much about PCOS it was literally like an education. Dr. Kavita we look forward to hearing from you on the big C that's something which which even today is is a dread for mankind when it comes to women and cancer. So, I would like to pass the session now over to you. Dr. Kavita. Yeah, I hope I'm audible. Yeah. Thank you so much for having me. It's indeed very humbling to be talking to a group of teachers, you know, who are the backbone of a conscious, enlightened and civilized society. I have been given the topic of breast cancer. Are you able to see the screen? Are you able to see the screen? I don't. Yes, yes, yes. But I'm not sure if it is. Can you can you just change the. I think it's still the old screen that that is coming up doctor can you please. Yeah, maybe maybe a refresh would help at this point of time. Meanwhile, I'd also like to request all the teachers we are now 500 strong here. Please post your questions for Dr. Kavita Verma she she is addressing one of the most important issues just to do with breast cancer doctor would you like to now try sharing again. Let me try it. Just give me a minute. No, not yet doctor yet. Yes, one minute. I would like to use this time by the time Dr. Kavita Verma. Fine. Not yet. Not yet. Doctor, I will let you know the moment I see the screen up if at all. Yeah, I'll just try to get something. Amrita Moolay from Pawar Public School. There is Shubharta Londe there is also. Anjali Vishal there is, you know, it's it's wonderful to hear from all of you from GK Gurukul. There is Vandana Vanita Gargote Nirmala Sundaram, who's asked about how to keep joints healthy. There is Asavari Dharma, who has asked about heal pain because of continuous standing. There are people who have used the chat box to post their various queries. Amrita Chaudhary also Rupa Gogate Darshanapuri. It's wonderful to have so many of you. Bhargavi Devaram from Deputy Patil Dhyan Shanti School. Rina Pilevar from Gothari Kondin Thakola Maharashtra Kalpana Singh, Bria Gekwad also Pratima Thakur Latika Kulkarni and Ganesh Kamble. Thank you for joining us and you do see the chat box at the bottom. There are of course doctors who are here with us. They have shared so much and Dr. Kavita Verma will be joining us soon as soon as it sorted the technical issue at her end. Dhruv Rajan from Deepali Rajan from RMD Chinchwar Pune. Welcome all the teachers who are here with us. We are very happy because like every speaker has said, it's definitely a special community. And Manipal Hospital has great delight in designing this and I as a host. My name is Vasanthi Hari Prakash. So please put your questions on the chat box. Dr. Kavita, were you able to sort out the issue at your end? In case you, I think Sonal Pandey and Shikha Sharma, those questions are also coming in. We're also going to take a look at Dr. Kavita in case she's ready to present now. Okay, am I seen for the presentation? Yes, very clearly seen and heard Dr. Kavita. So I think there's some glitch here and I'm sorry about that. No problem. I will just start talking about the topic of breast cancer. I am Dr. Kavita Verma, a consultant surgeon at Manipal Hospital, Baneer. And well, talking about breast cancer, a very ominous thing to hear about. Why are we so concerned about breast cancer? According to the study by GlobalCon, every four minutes a woman is diagnosed with breast cancer. You know, that's alarmingly how high this is moving. About 178 new cases are diagnosed every year and this we are talking about in India. For some time earlier, it was cervical cancer which was amongst one of the cancers most common in Indian women. But breast cancer has overtaken that and the current trends point to a higher proportion occurring in younger women. Now this is very alarming and younger women who are, you know, in the reproductive age group who have a very long life ahead to live and they suffering from cancer like this is very distressing emotionally, physically, in all manners. Now before I go in and start talking about breast cancer, I would like to mention one thing here that if there is any problem related to the breast that any of the women notice, please do not, you know, conclude that you have breast cancer. Benign breast diseases account for almost 80% of the breast pathology. So not everything that is presenting in the breast is cancer. Benign breast conditions are practically a universal phenomenon amongst all women and very, very few benign breast diseases have an ability to turn cancerous. So, you know, not everything in the breast is cancer. Since today I will be talking about breast cancer, I won't go into the non-cancerous part of the breast diseases. Now what are the risks and who are the women who are at risk of developing breast cancer? Age, now women over the age of 50 are at a higher risk than women who are less than 50. Those who have a family history, those with genetic mutations, those who have a prolonged exposure to the estrogen hormone as in early monarchy and the late menopause. That is, they start having their periods at the age of 10 or 12 and the menopause, they do not stop having their cycles till they are say about 55 to 56 years of age. Any radiation to the chest or the breast that has been received in childhood or in early adolescence, like it happens with case of Hodgkin's lymphoma where radiation is given to the chest. Now these women are at high risk of developing breast cancer. An exposure to certain drugs, especially one drug which was used in the early 60s and 70s for treating miscarriages, DES that has a high propensity for, you know, women developing breast cancer. Now these factors that I spoke of, they, it's something which you cannot control, but the risk factors that can change really, which are in your hands, that is physical activity. Now if you see in all the talks of all the colleagues who have spoken before me, we all stress on being physically active, you know, being physically active has shown to reduce the risk of breast cancer. HRT, that is hormone supplements for women who are suffering from menopause, certain oral contraceptive pills. Again, I would like to mention certain oral contraceptive pills do have a high risk of, patients on OCPs have a high risk, but as soon as these pills are stopped, the risk does reduce. The reproductive history, now women who are Nully Paras who have, who conceived for the first time later, at an later age, these are the women who are at higher risk of developing breast cancer. Smoking, alcohol, red meat, these are next in line. Now what are the symptoms of breast cancer? The most common symptom of breast cancer is a painless lump in the breast or in the armpit. There is disfigurement or there is retraction of the nipple that is deploying or puckering of the skin that happens. There could be nipple discharge and most often this nipple discharge is bloody. So what do you do, you know, how do we evaluate somebody who has any of these symptoms? Now any pathology in the breast, there are three components to assess it or to diagnose it. They are clinical examination, a radiological examination and a pathological examination in that order. Meaning you go and visit your surgeon when you suspect that there is something wrong in the breast. So that is the part of the clinical examination. Once your surgeon has examined you, then they would suggest an appropriate radiological examination. Now the components of radiological examination include a breast ultrasound which is also called as sonomamo. Then there is mammography and then we have MRI breast. The indications for MRI breast are very, very minimal. So I will not touch upon that. Coming to breast ultrasound. Now breast ultrasound is the best modality especially in younger women who have dense breasts. I would like to stress mammography is not the investigation of choice in younger women. It is breast ultrasound which gives higher information to us in younger women regarding the breast related problems. It also helps in distinguishing cysts from solid lesions. Cysts means fluid filled lumps and solid lesions. Mammography cannot give us this difference between a cyst and a solid lesion. Now mammography, the sensitivity of this investigation increases with age and hence this is used as a screening tool in the elderly or in the high risk population. That is women who do not have any breast related problems should start going in for a mammography which is an annual feature after the age of 50 if they do not fall in the high risk category. If they are in the higher risk category then there are other better modalities or mammography in younger women in a subset only. So once we are done with the radiological then comes the pathological examination which is what is actually going to give us the diagnosis. So the components of that would be a needle test or a true cut biopsy and women who have just a nipple discharge that is also examined. So at the end of all of this we have a diagnosis of whether or not the lesion is cancerous. So once you have been detected that finally you have made a diagnosis that this is breast cancer we next need to stage the breast cancer. So the investigation that we need in staging is called as a PET scan. This is a kind of a CT scan which is slightly different from the conventional CT. It's called a PET CT that helps to tell us whether the cancer has spread out of the breast that is at the lungs, the liver, the brain, whether these are involved or not. So a PET scan is done for that. So once we have the PET scan then we come to the staging of breast cancer. The stages of breast cancer would be stage 1, 2, 3 and 4. Stage 1 is called as the early breast cancer when it's a small tumor usually less than 2 cm which is restricted to the breast. Stage 2 is when they are larger tumors and they involve the nodes. Stage 3 is called as a locally advanced breast cancer that is the cancer or the lump involves the part of the skin or the chest wall. This is called a locally advanced breast cancer and stage 4 would be a metastatic disease that is a cancer which has spread to the other organs. So once the stage has been, we know the diagnosis, we know the stage then comes the treatment. Treatment for breast cancer, it's not always only a single therapy for breast cancer. Treatment of breast cancer is multimodal that is it involves surgery, chemotherapy, hormonal therapy and radiation therapy not necessarily in that order. Depending on the stage, it can be surgery first followed by chemo and radiation or it could be chemotherapy followed by surgery and radiation. So depending upon the stage and the hormonal status of the tumor, the treatment is decided but it is never ever a single modality. It is a multimodal treatment. Breast cancer treatment is a multimodal treatment. So to conclude, not all breast related issues are cancerous. 80% of the diseases of the breast are benign. So if you notice any lump or a discharge, please do not panic. Do not jump to a conclusion that you have cancer. Do visit a surgeon and in the same breath I would like to say do not ignore symptoms that just because there is no pain, there is a lump and there is no pain, do not ignore it. And early diagnosis of breast cancer is the key to survival. So diagnosing cancer early will definitely improve survival. Breast cancer if detected early is curable. So with this, I conclude my talk. I'm sorry for the glitch. If there are any questions, I'll be happy to answer. Dr. Kavita, what a clear sort of structured understanding you gave of breast cancer. We all think that we hear so much about it that we know it in some sense, but you know when you actually put out very clearly the kind of cancers and so many other details, it really was helpful. I would like to thank you. There are a few questions. So I'm going to try and club them in the interest of time. There is Bilkis Dharmadhamnaykar who asks, is there any problem if double breast is there? That is extra fat from underarms. So is that like risk prone? There is also a question by an anonymous attendee teacher who asks, what case should be taken if there's a tendency to create fibroids in the body? There are two more questions after this, Dr. See the first question I would like to mention here. The teacher probably is talking about what we call as an accessory breast. Accessory breast means an extra breast tissue. It could be a full blown breast with nipple and areola or it could be a rudimentary breast tissue. Now the breast develops from what we call as a milk line which extends from the armpit lower down into the abdomen and it's only in the center of that milk line that you know the breasts tend to develop. So you can have this rudimentary breast tissue anywhere along the milk line and the most common is in the armpit or in the axilla. Now having an accessory breast or a rudimentary breast or an extra breast does not increase the risk of breast cancer in any way. So this is a benign thing. It really does not require any specific attention unless it's cosmetically disfiguring and you are not prone to cancer because of that. So that answers the first question. The second one regarding fibroids. Well, it's actually a fibrocadenoma when we are talking about the breast. The most common non-cancerous lump in the breast is called as fibroadenoma. Fibroids are usually in the uterus. In the breast it is a fibroadenoma. Fibroadenomas are common. They can be single. They can be multiple. It's either one breast which is involved or it could be both the breasts which are involved. Fibroadenomas are definitely benign. They are not known to turn cancerous. So the risk of developing cancer in a fibroadenoma is 0.3%. Okay. So before concluding that a lump is fibroadenoma, it needs to be evaluated. That is very important. So you go through that triple assessment. Yes, I think that's a very important point. One is, of course, what does it look like as you feel something which is like a lump and then you begin to conclude it plays on your mind. So the point Dr. Kavita is making is to also have it assessed properly by the doctor. Quickly to the next question. She says breast as well as tightness in the breast and sometimes that is worrying. To distinguish between the pain or a thing that probably she feels before her periods and the pain that probably could be cancerous, Dr. if you wish to answer. Okay. Now breast pain is called as nostalgia in clinical terms. Now nostalgia are of two types. One is cyclical and one is non-cyclical. Cyclical is very typically related to the menstrual cycle. This pain tends to start after 14 or 15 days of the cycle and the progesterone levels in the body increase. There tends to be some kind of a swelling in the breast and then women can have pain in the breast. Okay. And once they start menstruating, once they have their periods, the progesterone levels dip and then the breast swelling reduces, the pain reduces. So this pain is cyclical. It comes and it goes. So pain which is vaccine and vending is not a cancerous pain. Right. Right. Breast cancer in 80 to 90% of the patients is not associated with pain. So it's a painless lump which is usually a cancer. Pain. Very few cases of breast cancer actually are associated with pain. Doctor, the last two questions. One is Krishma who wants to know what she in January, she was diagnosed with cyst in the breast and it was cured as well, but it continues to pain. She wants to ask about that. There is also Sri Rajendra who wants to know, you know, this kind of information that has to be, that can be given to students in schools because you know, if there are young girls, even boys I think who need to know about this because there are women in the family. The first question, sorry, could you repeat that? I didn't get that. So the question. The breast cyst. Yes. Okay. Now see breast cyst meaning the lump. And the pain she is facing despite the cure. Okay. Now see this pain, pain necessarily need not be cyst. The cyclical pain that I was talking about associated with cysts or lumps. It's more of a lumpiness, a feeling of a lump in the breast, but there is no lump in the breast. So, you know, you need to actually evaluate it, get an ultrasound done, because an ultrasound will tell you whether you have a cyst or you do not have a cyst. Now cyst again, let me tell you cysts are generally painless unless they are because of some kind of an injury or infection. So most of the cysts are painless. Pain and cysts, they are two different things. So you need to know whether the pain is because of the cyst or the pain is independent of the cyst. So this needs an evaluation. So you're directed off to your cyst, but the pain persists. So probably the pain was not because of the cyst. The pain is something else. Or there is a residual cyst. Yeah. Yeah, I know we are running short of time, still a lot of questions coming in, one of whom says, you know, lesions in arms and on diagnosis, she got to know it's lipoma, can it turn to cancer later. So if you can just quickly touch upon education and schools regarding breast cancer on this topic. Okay, well, see when we are talking about school children, I think many of them are fairly well aware nowadays that breast cancer is an entity because someone or the other in their family would have probably suffered from breast cancer. So breast cancer, one thing that you need to know is it has to be picked up early. So how do women come to know that, you know, they have breast cancer. So something called as a breast self examination. Now this is not very relevant for school children or girls who are 16 or 18. The question of breast self examination would come in when the breasts are fully developed. So usually after the age of 18, 20, fully developed breast, breast self examination in women is very important to pick up anything abnormal in the breast. You know, either the shape, the skin or some abnormal discharge from the nipples. So breast self examination is something that girls or women can focus on. And secondly, if you hear or feel that there's something wrong with the breast, don't be, what should I say, afraid of upfront seeking help. Or don't try to say that everything that is happening is probably just a part of the growth or puberty. So anything abnormal rather than, you know, googling things and talking to friends, talking to family, consult a doctor, consult a surgeon. So you know exactly what is the problem. And if someone you know in your family suffering from breast cancer, it's not the end of life. You know, it's a curable disease. No matter what the stage, we can always attempt to cure. Very clearly put, very, you know, well answered. I'd request you to stay back. Even after your talk, Dr. Kavita, in case there are more questions coming in, I will make sure that, you know, on the chat box, if you could answer them as well. So Dr. Kavita Verma, we'd like to thank you on behalf of Manipal hospitals and of course, all the teacher community to have answered and given so much clarity on this. Thank you, my pleasure. We now move on to Dr. Dhananjay Zuchi because cardiovascular diseases, CVD, those three alphabets when they put together are something which really are so important given so much of our urban lifestyle is causing it, but I will leave it to the expert to speak about this. Dr. Dhananjay, it's over to you. Thank you. Good evening. Yes, doctor. Yes, I will start the presentation. May I please start it? I know that there would be a lot of questions regarding heart attack, cardiac arrest, health tips, how to, you know, curb stress. So these are some of the questions that must be ringing in your mind. We have a lot of teachers who deal with this or with their family members. So please use the chat box. You see the Q&A box on the bottom of your screen. You can type in your name, your school name as well as a question and what you have, you know, even regarding CPR. Dr. Dhananjay, if you could spend a few minutes because that is something which students need to be very much trained in and if you can shed light, it's over to you, Dr. Dhananjay. Let's start, but how do I speak then? I can. Just give me two minutes. Yeah, that's the same. Yeah, sir, he is not able to present. Just give me two minutes. Not a problem at all. Meanwhile, we are taking this time to introduce more questions. If our other doctors can please answer via the chat box Pratibha Vadekar who says, good afternoon, ma'am. I have a stiff back mostly at night. I can't sleep the whole night. Sometimes I find it difficult to bear the pain and is there a solution to this? There's one question which will be for Dr. Dhananjay himself. Gayatri Rao from Dhruv Global School who says, what care should be taken by teachers to ensure that their stress levels don't affect their daily work by which he means both personal as well as professional because this is something which a lot of teachers face as part of their work and it would be great to have answers regarding this. Also, even as Dr. Dhananjay's team tries to rectify whatever the glitch that they are facing, I'd like to take this opportunity to inform all our learned teacher audience about Manipal Hospital's network, some statistics for you all to think about which is almost 4.5 million patients are treated annually, the second largest hospital group in India and in your own region in Pune, Bhaner and Karidhi. There are important Manipal hospitals, so please do take full opportunity to make use of this facility. There are cath labs and CCU beds, cardiologists, ambulances and then there are patients being treated from around 100 plus countries. In fact, I was invited to anchor a program which had international patients who had found success and who had found a cure for whatever they were suffering from. So even in terms of India regionally, locally, nationally and internationally, this is a hospital group that is out to create more awareness about health issues. So please do make use of that. You could tell your friends as well. There is Kavita Deshmukh who says that her age is 32 and for the last two years she's been suffering from continuing hands pain in particular directions. Can I get a solution? So Kavita, if you could slightly elaborate when you say hands, are you talking about the arms, are you talking about fingers or a forearm, the wrist and is that like something which we call the repetitive usage because of, let's say, writing or because of texting, what kind of pain are you talking about? Because I understand, as a journalist, I've seen so many of the teacher community who have had to step up their work during the post-pandemic time taking digital classes, helping students cope, that has meant extra work hours. So please feel free to tell us what is it that the health issues that you've been facing, what is it that you observed, has it become more after the lockdown or did the lockdown give you some kind of time to put some, you know, exercises for yourself? Looks like Dr. Dananjay, if you are able to present, there's also Aditya Lalit who would like to know what are the activities we can follow to be stress-free in day-to-day life. So, Shivani Kare who wants to know but says that there's a slight audio problem, I hope that is sorted out. Meanwhile, there are, yes, so in terms of, you know, questions you can put them in the chat box and somebody from the Manipal team will get back to you. Also, the doctors team, can you please send the PPT to ArunChakri at gmail.com. Dr. Dananjay, if you can please hear me. If you can colleague, if your colleague can send your presentation to this email ID, ArunChakravarti from Manipal Hospitals. The email ID is ArunChakri, A-R-U-N, C-H-A-K-R-I at gmail.com. ArunChakri at gmail.com. The other email ID being ArunChakravarti, Arun.Chakravarti at ManipalHospitals.com. So, if you do that, then probably the PPT can be played from his end. You can focus on your talk. The last option being, even without the presentation, just like how Dr. Varma did before you, you can please probably go ahead and tell us and talk about CVD. That's Cardiovascular Diseases. Hello, good evening. I'm unable to have the presentation. So, we'll just talk about how can we know our risk, sorry for the glitch. No problems. So, how can we know our risk of heart disease and then how can we prevent it? So, as we know in the modern world, cardiovascular disease has become quite common and the incidence is quite high. So, there are a number of risk factors that predispose us to the risk of heart disease. Now, there are some modifiable and some unmodifiable. Our age, so as our age increases, our risk of having a heart problem increases. But unfortunately, there's nothing that we can do to prevent, to escape from this risk. Males, gender, males inherently have a more greater risk of heart problems as compared to females. However, after menopause, the risk in female also increases of having any heart problem. Race, ethnicity have their own risk and family history increases our risk of having heart problems. So, these problems which are the age, our sex, race, ethnicity and family history, these increase our risk of having heart problems. But unfortunately, there is nothing that we can do to decrease the risk that occurs from these problems. So, these are basically our non-modifiable factors. But at the same time, if we know that we have these factors within us, then we can definitely be more aware and concentrate on the factors which are modifiable. So, the modifiable factors are number one being the cholesterol. So, we know that cholesterol, there are two types of cholesterol. LDL cholesterol is the bad cholesterol and HDL is a good cholesterol. Generally, we try to keep the HDL which is a good cholesterol above 40 in males. And in females, we try to, the recommended value is above 50. Total cholesterol should be less than 200. This is the number one risk factor. The number two is diabetes. We should keep our blood sugars under control. In case we don't have diabetes, then it's best that we monitor ourselves regularly and prevent ourselves from becoming a diabetes. Diabetes goes through stages as a normal blood sugar levels, then we have pre-diabetes and then we get into diabetes. So, if we are able to catch ourselves early in the earlier phases, we may prevent ourselves from this risk factor. The third way, hypertension. So, hypertension also attracts from the early childhood days, then through the middle-aged days and then into the elder population. The recommended cut-off for blood pressure is 140 which is the above, which is the systolic blood pressure and 90 mm of mercury for the lower one, which we call as the diastolic blood pressure. When far blood pressure is between 130 to 140 and between 80 to 90, then we should be aware that okay, yes, we are in the pre-hypertensive range. And once when it crosses above 140 and above 90, then we consider it as a patient of hypertension and we advise medicines along with all the other lifestyle modifications. So, in general, it's this that the increased cholesterol levels, sugar levels and blood pressure levels that we need to keep under control. Apart from that, we have obesity. Reducing our weight helps us. In general, it has a pleotrophic benefits. It improves our blood pressure control. It improves the blood cholesterol levels, the sugar levels and also our risk of heart disease. Other dietary habits like, not the dietary, other habits like smoking. Smoking is considered as a major cardiovascular risk factor. So, quitting smoke is highly recommended for any heart-friendly activity. Regular physical activity for around 30 minutes per day for five days a week is what is recommended by the guidelines. Even if we do a more strenuous workout, we can do it for 15 minutes per day for around three days a week. That's a more rigorous exercise. Otherwise, routinely a moderate intensity exercise for around 30 minutes per day for five days a week is what we generally recommend. Dr. Dhananjay, may I use this opportunity to ask you questions that have been coming in? Some of them have been anonymous. Some of them have put this out. You have banished your address of your question yourself. Thank you for that. Teachers deal with a lot of issues, particularly in the new age form of teaching. Like some places, of course, I moved on from online, but at the same time, realistically, you're handling a huge class. There are students. It's a challenge not to lose one's temper. Now, all this translates somewhere, day after day, there's incremental buildup in the stress. So essentially even anger management, that is something which is very crucial for teachers along with the fact that they have to cope with so much of pressure themselves, whether it's in terms of evaluating the answer sheets and, of course, filling up those documents that the school needs them to. So this is the end besides their own family life. What are the tips that you would like to offer, doctor, whether in terms of anger management or in this balance? For anger management and it's more often, more of what we can call as an emotional stability. What I would like to recommend is number one, to have a very good sleep habit. So if you are able to have a good sleep about six to eight hours per day, this helps us in reducing, helps us to provide more of emotional stability and the mental stress factor, which in itself contributes to many disease problems, including all the heart problems, hypertension, diabetes. So that component can be taken care of by a good adequate sleep. Apart from that, there are stress management techniques, which are like meditation. Meditation and yoga have been proven scientifically to help in for a good cardiovascular health. Even regular physical activity reduces, helps us, is shown to have an effect on a good mental health. Doctor, I would like to next ask you about CPR because there are countries where this is so much part of the curriculum, the fact that you can be as a common person equipped to save a life. Would you like to shed light on CPR itself? What teachers can keep in mind and how this can be part of school's curriculum? It's a very good thing to have CPR as a school curriculum because CPR basically addresses the time gap that is required between the problem that has occurred in a patient and the time till a healthcare provider approaches him. Sorry doctor, can you, for those who don't know what CPR is, can you just also explain in quick words? CPR is the full form is cardiopulmonary resuscitation. Whenever anybody is in a collapsed state, it indirectly means that his circulation, C is for circulation, means the blood flowing within the body. Pulmonary is the lungs, which is the air flowing out from a body into the lungs. So basically these are the two vital systems that maintain life. The air going in and out and the blood going throughout the body. So we consider them that when a person is collapsed, so these systems have been stopped. So CPR basically means that we artificially start these systems by our manual efforts, by manual chest compressions and by giving some air into the patient's oral cavity. So CPR basically is cardiopulmonary resuscitation. We start giving chest compressions with our hands. We give it at a rate of around 100 to 120 times per minute. So this helps in maintaining circulation throughout the body, which is normally the function of our heart. And for the pulmonary, we start giving, we start blowing air within the mouth of the patient. And this is done at a ratio of around 3 is to 1. So after every three compressions, we once blow air into the mouth. This actually will take care of the function, which is the lungs, which are lungs normally do. I would request our teacher, colleagues, friends to also look up CPR. There are lots of videos on YouTube because this is such an important aspect. But Dr. Dhananjay, I certainly give us a segue and an introduction into that. Dr., some more questions coming in. I'd like to club them. This comes from Preeti Singh from Pawar Public School. She says I'm very much fit and fine physically and mentally. Can you please suggest how often we have to go for regular checkup? By which I think she means that it's not something which is so alarming, then should you still have a regular checkup and how often? So in generally, there is nothing significant within the family and we are not having any habit like smoking, which increases our risk. Up to 40 years of age, we do not recommend a routine checkup. So after this is for the western data, it's for the western country. For our population, we may consider it a decade earlier, say around from 30 years. Right. So for us, we recommend it after 30. Right. Thank you, doctor. So Vibha Davi from Cambridge International School, Pune, how can LDL be reduced effectively without medications? It can be done by reducing the oil intake in our diet. The oil which we recommend is the olive oil and all the other oil except palm oil and coconut oil. Remaining all the other oil is fine and apart from that, even her regular exercise will lower the cholesterol levels. Vibha Davi again who wants to know, can you help me distinguish between gastric pain in the chest and any abnormality? It's a wonderful question that she's asked because a lot of times, doctor people either tend to mistake gastric pain for chest pain or ignore a real chest pain thinking it could be gastric pain. How do you distinguish? So cardiac pain usually is related to our exertional activity. So when we physically exert ourselves, we are walking or we are running, at that time if a pain occurs, then it's more likely to be a cardiac pain. Gastric pain on the other hand will occur when we are seated while at rest and if we lie down maybe the reflux, it increases. So going from a standing or sitting to a supine posture the chances of the pain increases, pain having increases if it's a gastric pain. And definitely a relation with exertion is a cardiac pain. That's helpful doctor. Sonali Ghatpande who says we get advice frequently to change oil. I think she has put on doctors but sometimes even these ads this is a healthy heart oil, you get so many things in the media she wants to know Sonali G about how to go about this. How do you suddenly shift from one oil to another? How do you know that this is the right oil? For example, I have personally heard about rice bran oil doctor. Is it really as good as people think some people say it is and what her question has been? The oil that we discourage to have is palm oil and coconut oil but remaining from these oils the other oils are in general not discouraged. So the extra virgin olive oil is one of the most recommended oils and apart from that safflower oil, soya bean oil mustard oil, all these oils can be used. The thing that we is recommended we can rotate either we can use one oil for one week and then shift to another oil for the next week or even mixing of oils is you know advised. Doctor, the early symptoms is what Meenal Kapoor would like to know early symptom of any cardiovascular disease. Early symptoms so if we have a regular exercise in our daily routine it is quite easy to pick it up early. So for example when the problem occurs in our heart when the blockages start which is the most common problem so it will generally manifest only after a prolonged physical exertion. So if we have in a routine in a daily routine say a walk like around 3-4 km so at the end of 3 km we will start experiencing that problem and then it slowly progresses. So if we have a good exercise in our schedule we can pick up heart problems early. Doctor, two more questions I know we are almost nearing end of time but Jyoti Kale who says problem of low BP among teachers seems to be very common is there any connection between long hours of talking and low BP and how do you address this? Low BP as such BP if it is low we consider it to be significant only if it is causing any problem a problem in the mean if it is affecting the circulation in all our body so it can either manifest if you are having low BP at the same time if you are having confusion or if our hands are cold or or we are feeling dizzy so then that low BP is significant otherwise some people inherently have low BP that is more of related to our body mass index so if our BMI body mass index or if our body surface area is less than the average population then it is quite probable that we can have a low blood pressure which is not significant blood pressure coming less than 90 by 60 is called as low blood pressure anything above 90 the lower upper one is not a low blood pressure and anything above 60 for the lower one is also not a low blood pressure and you don't really see any connection between long hours of talking as Jyoti ji thinks and low BP that can if the long hours of talking has been associated with dehydration we are not we have been dehydrated during that entire period then it can lead to low BP how much ghee can be consumed in a day and which one cow or buffalo is better because you mentioned oils so Jyoti Joshi this teacher wants to know ghee in general is less recommended as compared to oils and yeah but on occasion once or twice a week it's good to mix it with oil the cow ghee would be better rather than buffalo ghee cow ghee would be better than buffalo ghee alright that helps I know Pratibha Wadekar you've had a question regarding a stiff back at night I can't sleep the whole night she said I don't know if Dr. Dhananjay can particularly address that but we would really like the Manipal team to post it to Dr. Sinu and then get the response across to this teacher but meanwhile I would like to anyway any final tips Dr. Wadekar sometimes there are people who say it started with a back ache and then they realise it's much more than that any closing comments on this Dr. Dhananjay back ache is not a specific symptom of the heart but it can be one of the less common representations of heart problem so the thing that can give us a clue of our back ache is that if there is a relation with exertion as we have already pointed out so anything that is related to exertion should raise our suspicion of heart problems and then if we have other can you explain that doctor exertion in simple terms what should she look out for when she is physically exerting herself if she is you know started walking and if she is doing a brisk walk or jogging if at that time her back pain is increasing in intensity and when she stops doing this if the back pain gets relieved then it can be considered that we should rule out heart problem right I hope Mr. Pratibha that you got your answers Dr. Dhananjay despite not having your presentation plays it turned out to be such an engaging session where you gave us so many answers that will definitely help our teacher community I would like to thank you for your time and for your guidance thank you well we are come to the absolute end of this show however we have Mr. Lakshmanan here he is the medical director of Manipal hospitals in that region so it's wonderful to have you Mr. Lakshmanan please it's over to you and your words for all of us good evening Vasanthi and first of all I would like to thank Sagodya school members and the office bearers for giving us this opportunity and also I would like to thank the consultants both from Bhaner and Karadi in disseminating the information the core health problems that is being faced by the teachers community as such and we would like to thank and there is a standard phrase like prevention is better than cure so Manipal as such has a lot of wellness programs especially the health check programs especially well women health check programs which we have so as well as some unavoidable circumstances if there is any emergency that is happening for the members of the Sagodya school members or their family members so we want to engage both in the prevention aspect as well as in case of any exigency through your privilege membership card kind of an arrangement regarding that we will discuss with Dr. Anjali and the office bearers of Sagodya school and we are very happy to associate in this school members and that is all from my end Vasanthi Thank you so much for putting that out and indeed people should avail of this facility and the teacher community is listening they have joined us in large numbers today so thank you Mr. Lakshmanan for that note it is now time for me to invite Nirmal madam to propose a vote of thanks Namaste everybody from the Sagodya school complex Pune I would like to thank the Manipal hospital authorities organizing to webinar this webinar coordinated by Dr. Arun from Manipal hospital under the guidance of their director Dr. Viju Rajan I would also like to the panelists Dr. Dhananjay, Dr. Srinu, Dr. Asmi, Dr. Kavita Dr. Bhushan Joshi for sharing their knowledge and thinking about the teaching fraternity as students and thank you Vasanthi ma'am for being the hope and being the compare for today I am sure that today's webinar has helped many teachers and principals and has answered some of our doubts in future Manipal hospital authorities are planning to office such as for students and God bless the participants and the organizers and may I request the director Dr. Ji to please answer all the questions chat box and send it to us over the mail so that we can pass it on to all of their teaching fraternity in Pune and about the card what you are spoken we will speak in details and might be in one of the meetings we can pass the cards to all of them. Thank you very much. Namaste. Have a good evening. Thank you Madam Adirmal. As she said there are still questions coming in the chat box I am seeing people who are saying that I am having a high BP it's it's kind of 165 400 taking regular medicine but still what do you do what should I do and again heartbeat rate be related to genetics and then my mother's heart rate is always less than 72 so all these questions are telling us something there are doctors who are still online there are some doctors who ever had to drop off because they have had patients to attend but it just says that the teacher you know teachers who have joined us are just as vulnerable as any other group and I am really glad that Manipal hospitals is doing the special targeted awareness program because teachers are so special you are very special to us so like Vandana Angne has said that all the speakers were really very good it was such an informative session and then there are people who are continuing to speak about their neck pain their migraine their heart stress diseases their fears and concerns and therefore as madam Nirmal was saying please continue to post your questions here and the Manipal team I think is also would like to place on record a special thanks to Anjali madam and Nirmal ma'am for their unconditional support Arun Dr Arun is letting me know it's been a pleasure for me Vasanthi Hari Prakash to be with you all to understand what is it that is of prime concern to this very very special group of people the sabko dhanivad sabko namaskar it's time for all of us to part here but there is a there is social media there are other things and as I always say good people should stay together and connected let's build an empowered India let's all do very good things let this be the beginning of more a check out to happen on that note thank you once again namaskar thank you very much once again Vasanthi sure Vasanthi the questions are continuing to come Arun and Anjali I am seeing them in the chat box yes it's great and I think people can see each other's names and these days it's so easy to stay in touch via whatever social media that you plan to choose there are also the doctors here who have taken time off until we meet next time in another program absolutely look forward namaskar once again