Where have the family picnics gone,wonder many old-timers. Naturally,because with winter setting in, alongwithwoollens and quilts out of the mothballs,steaming hot coffee, juicy oranges, cakes,and the Yuletide spirit in the air, going fora picnic into a nearby destination with fam-ily and friends always featured in the holi-day calendar.

With the rise of nuclear families and abusy lifestyle to cope with, people todayfind it hard to spend enough quality timewith their children or friends. But the con-cept of picnics as an outing is very muchthere, even if in a different format, assurethe young.

In educational institutions, as well as inmany offices, an outing to nearby places isa common event in winter. "A daylong out-ing releases stress and is a part of compa-ny's policy to grant occasional sops to itsemployees. This way, both work-life bal-ance of the staff and corporate firm'sturnover is well taken care of," says soft-ware techie Pritam Ghosh, 39, from Ben-galuru. Recently his weekend excursionswith a group of his colleagues to provincialChikmagalur, nestled in the lap of forestsand a lofty mountain-range besides the his-torical site of Hampi, are well-etched in hismemory.

What do other city-bred yuppies haveto say about this age-old practice? Tacklinga hectic schedule of exacting deadlines,graveyard shifts, social networking, famil-ial duties, party-hopping, gym-hitting andwhat not - the upwardly-mobile youngsterstoday hardly get free time to unwind andrelax. Often the pubs and nightclubs com-pensate for breaking the monotony where-in they no longer feel the urge to board abus or drive a jeep to cover long stretchesin distant places. Chetan Jadhav, a PR pro-fessional from Mumbai, sometimes joinshis boy-brigade in a bachelor pad and chillsout over drinks, flavoured hookahs, andmidnight refreshments ordered from out-door catering services. "This alternativearrangement comes handy when you can'tgo on a casual leave," he shares. But attimes they do escape from the noisy city life."The weekdays are breathlessly huddled upwith workload, so a respite is a necessity.My friends and I take trips outside Mum-bai in search of a la la land, literally! Wewent to locales like Lonavala, Matheran

hill-station, Goa, Daman only to activateour endorphins. We would take turns to gobehind the wheel driving for over 500 kmsand even organize campfires and tents fora night-stay in the open-air,"

For some, a picnic means an album ofhappiness to cherish for others, it definespure nostalgia. Mass Communicationsundergraduate student Debolina Guhafondly remembers her picnic outing withher batch-mates to Gandhighat along theGanga in Barrackpore, off Kolkata. "Thearea is quite famous as a picnic spot andcan accommodate hundreds of people.Although two thakurs (hired cooks)accompanied us on the trip, we girls hadloads of fun cutting and chopping the veg-etables to help them rustle up a deliciousmeal. The boys were no less enthusiastic.They too chipped in. Rice, roti, potato cur-ry, chicken with gravy, and rasagullasrounded off our sumptuous menu. We saton the grass devouring the food under asunny sky and it was glorious."

Pushpita Mitra, 35, a homemaker, goesback to the 80s to narrate her introductionto picnics as a child. "We went all togetherfrom our para (neighbourhood) club and itwas thrilling to visit a suburban North 24Parganas district for the first time. Thelocation was Banabithi Picnic Garden, aserene area near Duttapukur. Readymadeearthen-ovens and a cool shade of trees allaround had created a comfortable ambi-ence to make merry," she recalls. "Whilemusic, cooking, adda-sessions kept theseniors busy, we kids had a lovely timeexploring the greenery all around the spot.I still can't forget riding on the van rick-shaws, a regular mode of local transport,alongside paddy fields and sugarcane plan-tations in those idyllic rural areas," sheelaborates.

For senior citizens, reliving the erst-while picnic expeditions is like walkingdown the memory lane. Namita Sen, 65,returns to her teenage days when she wouldtravel from her tea-estate in the Dooarsarea of North Bengal. "Going for a picnicwith a group of factory babus (clerics andofficers), tea garden labourers and theirfamilies was quite an adventure in wintrydays. How I miss that call of the wild ! Thesmart resorts, tourist lodges and hotelswere yet to come up then. For us, logs offirewood, vehicle-borne grocery and rawitems, the large ladles and enormous uten-sils ensured we would enjoy a good meal inthe open." From Santalabari to the sleepyRaidak forest where they had spotted tigerpugmarks along the river- bank to Goru-mara's wilderness at the foothills of Teraiand the gurgling Diana river, the memo-ries of picnics in the wild have stayed withher as if in a picture postcard travelogue."Post marriage, I had to settle down inKolkata and could instantly feel the differ-ence after being stuck in a match-box exis-tence in concrete cubicles," she rues.

A social angle can also be espied in thistraditional habit of community engage-ment. "An annual picnic by the year-endfor local clubs and communities offers awonderful opportunity to indulge in socialbonding and interaction. It also encour-ages a healthy exchange about cultural cus-toms and exchanging pleasantries withyour neighbors, which is otherwise not pos-sible on a day-to-day basis, thanks to ourfast-paced mechanical existence," com-ments Gurgaon-based retired air-forceofficer Sudhir Basu. "We still try and followthis convention and get set for a whistle-stop junket in order to recharge ourexhausted batteries," he shares. (TWF)

SUNDAY, JANUARY 31, 2016 (PAGE-4)

LIFESTYLE

HEALTHLINES

Dr Rohit Lahori

Pain is "an unpleasant sensory and emotionalexperience associated with actual or potentialtissue damage, or described in terms of suchdamage.

Pain can be reported in absence of any tissue damage orany likely patho-physiologicalcause. If person regard their expe-rience as pain……it should beaccepted as pain. Pain alters thequality of life more than anyother health-related problem.It interferes with sleep, mobili-ty, nutrition, thought, sexualactivity, emotional well-being,creativity, and self-actualization.Surprisingly, even though pain issuch an important obstacle to com-fort, it is one of the least understood,most undertreated and often-dis-counted problems of healthcareproviders and their clients.

Types of PainACUTE PAIN These

are Recent pains .Alsocalled PhysiologicalPain, they arise mostlyfrom bones,muscles(Nociceptive)or Viscera .The pain istypically well localized,constant, and often withan aching or throbbingquality .Pain is either Symp-tom of a disease or disease process initself .Treatment of diseases cures pain& it is self-limiting e g fracture of bone,muscle sprain .Post-operative pains

CHRONIC PAIN (NonmalignantPain) Duration of pain is more than 1month, some accept it as 3 months.They are also called Pathological Painand are associated with Nerve pain(Neuropathic). It is a disease itself, adisease of nervous system, difficult totreat & sustaining in nature e g lowback pain radiating to lower limb,orneck and shoulder pain radiating toarms, Post herpatic Neuralgia,Trigeminal Neuralgia, carpal tunnel syn-drome, diabetic peripheral neuropathy (wide-spread nerve damage) or any other neuropathy

Chronic Malignant or cancer pain Malignant, cancerouschronic pain may be due to tumor progression, invasive pro-cedures, infection, toxicities of treatment, and physical limita-tions. Such pain may be felt at the tumor site or some distancefrom it. Since patients with cancer may experience both chron-ic and acute pain, healthcare providers need to investigateimmediately any new pain in these clients.

ASSESSMENT OF PAINOn a scale of 0 to 10, with 0 representing no pain, how much

pain would you say you are experiencing?Management of painsPatient knows his pain better than any one else and it is his

experience that holds the key to make a plan to treat it. Each

person and his pains are unique. The treatment depends uponfollowing factors

.The cause ,intensity, duration ,provocative and relivingfactors

WHO has developed a step ladder for pain managementwhich include acute, chronic and cancer pains

NSAIDS :- These are the group of pain relieving drugs,These drugs also reduce swelling (Inflammation). They are useful in acute painful conditions for a short duration as they havecause lot of side effects .Paractmol is only one of the safestNSAID and can be prescribed for longer period

Opioids these are medications that relieve pain. Theyreduce the intensity of pain signals reaching the brain and

affect those brain areas controlling emotion,which dimin-shes the effects of painful stimulus.eg oxycodone. codine,morphine etc. they are more commonly used in moder-

ate to intense pain along with Cancer painsThe commonest side effects aredependancy, constipation, respirato-

ry depression and sedationAdjuvant pain medicationsthey are not typically used for

pain but may be helpful forits management. There is

a long list of these drugswhich include

AntidepressantsThey help in treat-ment of pain asso-ciated withdepression,they

work by increasingthe levels of certain

chemicals(norepineph-rine,serotonin) at nerve

endings. These drugs improvethe quality of life

Anti seizure medications are help-ful for for nerve related painMuscle relaxants are used in pain manage-

ment , there use is limited for short period.Calcium channel blockers are the group of

drugs used in chronic pain treatmentBOTULINUM TOXIN

BOTULINUM TOXIN TYPE A -knowncommercially as Botox is used to treat musclespasticity associated with many diseases.

Presently the drug is being used in the treat-ment ofchronic migraine headache

INTERVENTIONAL PROCEDURESInterventional pain managment is a subspecialty of pain

management, devoted to the use of invasive technique to diag-nose and treat pain . They interrupt the flow of pain signalsalong the specfic neural pathway thus confirms the diagnosis.certain drugs eg local anesthetics and local steroids are usedto decrease the swellings of specfic nerves and nerve roots thusby decreasing the swelling and irritation of nerves, pain istreated. Radiofrequency procedures are done to treat the backpain by abilating certain nerves. Newer concepts eg Ozonoly-sis , Platlet rich plasma,Prolotheraphy are being used in inter-vention pain managment .

(The author is a Specialist in Pain Management)

Management of pain

The tradition of going forpicnics in winter with familyand friends has remainedpopular even though indifferent formats, findsPramita Bose

Bollywood has seen many films that have been based onsports like cricket, hockey, football etc. In the recent times,there was the Priyanka Chopra starrer biopic MARY KOM thatbrought the game of boxing in the public eye and gave it the(due) credit it deserved. This week's release SAALA KHADOOStoo takes an inside look in the world of boxing. Will the filmdeliver a knockout punch at the box-office or will it hang itsgloves, let's analyse.

The film starts off with the introduction of Adi Tomar akaAdi (R. Madhavan), who, by profession, happens to be a coachof the girls' boxing team. Courtesy the dirty politics (whereinhe is falsely accused of sexual harassment), he gets transferredto Chennai. Adi is now on a lookout for a girl who has the muchrequired passion for the sport and fire in her belly. And hissearch ends in the most unlikely person for the job Madhi (Riti-ka Singh), who, despite being a fisherwoman by profession, isa born talent in boxing and she idolises Mohammad Ali. Afterhaving agreed to pay Rs. 500 per day towards her training, Aditakes her under his wing. On the other hand, Madhi's elder sis-ter Lakshmi aka Laks (Mumtaz Sorcar) also happens to be aboxer wanting to get into police department so that she cantake care of the family. Seeing Adi's closeness and confidencein Madhi, Laks plays a dirty game with her own sister, thisresulting in Madhi's ouster from an important match.Unaware of the real reason for Madhi's dismal performance,Adi gets wild on her at her poor performance and throws heraway from his life and training. Situations then take a U-turnwhich leads to the imprisonment of Madhi who also escapesfrom being a prey of chief selector's desires. What action ofMadhi leads her to be jailed, who is the person who tries totake advantage of her, does Adi ever get to coach his oncefavourite student Madhi all over again, what ultimately hap-pens to Adi and Madhi is what forms the rest of the story.

First things first. One has to simply give it to the film'sdirector Sudha Kongara Prasad for bringing out a film that issimply a class apart. While she has already made films in theSouth (ANDHRA ANDAGADU, DROHI), SAALA KHADOOSmarks her directorial debut in Bollywood. In addition toSAALA KHADOOS, she has also directed the Tamil versionof the film IRUDHI SUTTRU, which has a different tone andcontent from the Hindi version. Besides directing the film,Sudha Kongara Prasad is also the writer of SAALAKHADOOS. And she excels superlatively in both the depart-ments. Her stint of being an assistant director to filmmakerMani Ratnam for nearly seven years seems to have paid richdividend and it shows in the film in the form of a tight and

crisp screenplay. Director Sudha Kongara deserves distinc-tion marks. This one's straight from the heart. Full marks toher for convincingly depicting a story of an underdog girl andher coach fighting against all the odds as they race towardsvictory. In addition to this, she has not only highlighted uponthe existing (dirty) politics in the sports of boxing, but also thesorry plight of the players who represent India on an interna-tional level. While the film's narrative is fast and doesn't lagat any place, the sad part is that the film's dialogues lack themuch needed 'punch'.

As far as the performances are concerned, it is the film'slead stars R. Madhavan and debutante Ritika Singh who car-ry the film on their shoulders right from the start to the end.R. Madhavan delivers an extraordinary and extremely realis-tic performance. His hard work and dedication shows in everystep of his performance. Right from attaining the perfectlytoned body to his impeccable control over his emotions, R.Madhavan comes a clean winner. His chemistry with Ritikahas to be seen to be believed. As far as Ritika Singh is con-cerned, she is definitely a revelation and a find of Bollywood.She is not just a firebrand, but also surely a name to watch outfor. Despite being a debutante, she doesn't show any signs ofnervousness. Her being a real life martial arts expert hashelped her immensely while delivering such flawless perform-ance. Do not miss the nail biting finale. While Nasar and ZakirHussain are first rate, Mumtaz Sorcar and also the couple whoplay Ritika's parents are extremely endearing and believable,which adds to the film's narrative. Every character in the filmshines in his own right.

The film's music (Santhosh Narayanan) is limited to oneromantic song, which is decent. The background music (San-thosh Narayanan) is good. While the film's cinematography(Sivakumar Vijayan) is average and could have been better,the film's editing (Sathish Suriya) is watertight and crisp. Aspecial word of mention to the film's boxing scenes, which havebeen done by the Hollywood stunt choreographer Tom Del-mar (whose works can be seen in films like ALIENS, JAMESBOND FILMS, SNATCH, STAR WARS II).

A special word of mention to R. Madhavan and Raju Hiranifor having backed a film like SAALA KHADOOS as producers.

On the whole, SAALA KHADOOS is an euphoric and elec-trifying film with amazing performances from the lead cast. Itis definitely engaging, and inspiring. It truly deserves an ova-tion and is worth your time and money. SAALA KHADOOSdelivers a solid punch. Winner!

Courtesy http://www.bollywoodhungama.com.

MOVIE-REVIEW

Dr. T. S. Kler

Studies have shown that 60 % of all cardiac deaths are dueto Sudden Cardiac Arrest occurring due to tachyarrhythmiasand this is one of the leading causes of death globally. It isestimated that more than 3 million people die yearly from SCA,with a survival rate of less than 1%.

Sudden cardiac arrest occurs most frequently in adults intheir mid-40s to mid-50s, and affects men twice as often as itdoes women. The most common cause of sudden cardiacdeath is coronary artery disease.

When SCA strikes, and often without any warning or symp-toms, it requires immediate action for survival. Survival canbe as high as 90 percent if treatment is initiated within thefirst five minutes after sudden cardiac arrest. The rate decreas-es by about 10 percent each minute longer. While CPR cankeep some blood flowing to your heart and brain for a shorttime, the most effective way to treat sudden cardiac arrest andrestore heart’s normal rhythm is by defibrillation. The Amer-ican Heart Association recommends defibrillation within 3 to5 minutes of arrest, or sooner, for suddencardiac arrests occurring outside the hos-pital.

Newer technologies in past few yearshave emerged as device therapy forarrhythmias- ICDs and device therapy forheart failure -Cardiac ResynchronisationTherapy - CRT).

Implantable Cardioverter Defibrilla-tors (ICD) – an emergency room in thechest

An implantable cardioverter-defibrillator (ICD) is a specialized devicedesigned to directly treatcardiac tach-yarrhythmias. ICDs have revolutionizedthe treatment of patients at risk for sud-den cardiac death due to ventricular tach-yarrhythmia.

(Doctors quote)Patients at high riskfor sudden cardiac arrest:- Post heart-attack patients with low pumping func-tion (EF <35%)- Additional risk factors such as NSVTs(non-sustained ventricular tachycardia), PVCs (prematureventricular contraction) and syncope / presyncope increasethe risk of SCA in post MI patients and can be assessed throughecho and ECG testsAn (ICD) is designed to monitoryour heartrhythm 24 hours a day. If your heart isbeating too fast or irreg-ularly, the device will first sendsmall painless electrical sig-nals to correct your heartrate. If the fast heart rate continues,the defibrillator willdeliver a shock to restore your heart to anormal rate.The ICD is like an emergency room in the chestpreventing sudden cardiac death due to fast rates.Novel pro-gramming algorithms that reduce administration of unneces-sary shocks and allows for remote monitoring, so that thepatient is managed from his home reducing his hospital vis-its, has brought a new ray of hope amongst heart patients.

Recently cardiac devices industry has yielded an interest-ing innovation with regard to pacemakers and ICDs which hasincreased its use in clinical practice phenomenally. Thesedevices are embedded with new technology that allows for full-body MRI scans among patients with these devices. It is esti-mated that as many as 63 % of patients will need an MRI with-in 10 years of receiving a device. Furthermore, 85 percent ofall pacemaker patients have one or more comorbidities, mak-

ing comprehensive multi-specialty care, including access toMRI, important in today’s environment. Until the availabili-ty of MR-Conditional pacemaker and ICD systems, patientswith devices have been contraindicated from receiving MRIscans because of potential interactions between the MRI anddevice function, which in turn affects the diagnosis and treat-ment.

The SureScan® technology is anapproved technologyresulting in a growing number of implantable cardiac devicesthat are approved for use in an MRI (magnetic resonanceimaging) environment.

Cardiac Resynchronization Therapy – resynchronize theheart and improve quality of life

Heart failure in India has been conservatively estimated toaffect up to 4.6 million people, with up to 1.8 million new diag-noses made each year. Heart failure is a progressive diseaseassociated with symptoms such as breathlessness, frequenturination, systemic and pulmonary edema requiring frequenthospitalisations to decompensate, all severely affecting thequality of life. Also repeated heart failure hospitalisations are

associated with increased mortality. Cardiac resynchronisation therapy (CRT) is a way of treat-

ing heart failure; this device uses tiny electrical pulses to bothventricles (lower chambers) of the heart to make them beattogether again in a more synchronised pattern.

Latest addition in cardiac devices for heart failure patientsis a cardiac resynchronisation device which coordinates theleft and right ventricular contractions and improves theheart’s pumping efficiency. Infactthe latest AdaptivCRT®algorithm, is the only algorithm demonstrated to improveheart failure patients’ response to the therapy and reduce therisk of atrial fibrillation (as compared to conventional biven-tricular therapy). This device automatically adapts to patient’sneeds, continuously optimizes therapy, improves responserate and reduces heart failure hospitalizations.

While technology innovation is generating newer and bet-ter devices &improving clinical outcomes in cardiac patients,it is quintessential to create awareness amongst the massesabout the disease progression and risks and enable them tomake informed decisions about choosing the right treatmentat the right time to enjoy a healthy&quality rich lifestyle.

(The author is executive Director Cardiac Sciences Fortis Escorts heart Okhla New

Delhi)

Medical inventions that save lives

Let's go for a picnic