GENIUS ON THE EDGE

The John Hopkins Hospital

John Hopkins

Johns Hopkins born in 1795, an entrepreneur and philanthropist was one of the richest Americans of his time. In 1889 Johns Hopkins donated this huge hospital and the university to Baltimore and it was to be called The Johns Hopkins Hospital “the greatest gift to mankind”. Dr. Welch was a trustee. Welch had already established himself as a great pathologist. He was a friend of Dr. John. S. Billings who had been librarian of the Surgeon General’s Office and was now chairman of the board of trustees of the Johns Hopkins Hospital.

Welch had suggested to Billings that William Halsted was the right man for the chair of surgery in spite of his recent addiction to Cocaine which he had got over. He was appointed to this prestigious position. Besides Welch there were on the team William Osler now called the father of modern medicine and Kelly a man who had blazed a trail in gynecology. So it was Osler, Welch, Kelly and Halsted who formed the nucleus of this great team, an institution that would break all barriers in medical science. No more did people talk only of Berlin and Vienna but they spoke in the same breath of The Johns Hopkins and the Mayo clinic. American medicine had come into its own.

            

William Halsted

What was William Halsted’s background before he joined the Johns Hopkins in 1889. He ardently believed in the work of Pasteur, Koch and Semmelweis, and Lister’s application of the antiseptic theory and applied it to his work in New York where he had already established himself as a surgeon of repute. In 1882 he was the first surgeon to do a cholecystectomy and that too on his mother. Halsted was also the first to give his own blood to his sister who was dying of postpartum hemorrhage, and this was before Landsteiner had discovered the blood groups. His sister lived, they must have been of the same group or Halsted must have been group ‘O’. He was also the first to device an ingenious method of treating carbon monoxide poisoning. He drew blood from the patient in a citrate solution in an open container and then shook the flask to oxygenate it and injected it back into the patient. His patients lived.

Then tragedy struck Halsted. He had heard of Karl Koller an ophthalmologist’s work on Cocaine- he was removing cataracts painlessly under a local drop of Cocaine in the eye. This was actually suggested to Koller by a paper published by his friend Sigmund Freud, Halsted always the scientist and experimenter began to experiment on himself and some of his pupils. He performed major surgery by using Cocaine as nerve blocks. He also found that he under Cocaine had developed tremendous energy and capacity for work without any fatigue. Then one tragic day as he picked up his knife to operate he found that his hand was shacking. He was shocked, looked around amazed, handed the knife to his assistant and had to be helped out of the theater. That night was the darkest night in William Halsted’s life this great surgeon with a remarkable future had become a physical and mental wreck. Welch who was following Halsted’s career closely and believed that the man had a great future came to his rescue. He institutionalized him, opium was used in small doses to get him off cocaine. But unfortunately he got hooked on to opium so it was from the frying pan into the fire. It took a long time to get this man back to work.

Portrait of 'the big four' at Hopkins - Drs. Welsh, Osler,
Halsted and Kelly from the medical archives of the John
Hopkins Medical Institute.

It was then that he took on the chair of surgery at The Johns Hopkins and accepted Billing’s offer prompted by Welch. This he did with great hesitation for he was not sure of himself. Prior to this he had spent a lot of time while recuperating in Welch’s laboratory where he had ample opportunity to study both anatomy and pathology in the cadaver.  Cocaine had changed his personality and this fast, bold and rather traumatic surgeon became slow and meticulous. He devised new and systematic operations- one of the examples was his work on Cancer of the Breast. Kelly said of him, half in joke, that William Halsted is the only surgeon whose upper incision healed before he has come to the lower part. From Halsted’s cocaine addiction came the three principles of good surgery, reverence for tissue, elimination of dead space, and complete hemostasis.

Halsted fell in love with his theater sister Caroline Hampton and married her. Caroline was a remarkable woman and supported Halsted in his work, she developed an allergy to carbolic and Halsted had the Leyland rubber company make surgical gloves for her, which later became part of the ritual for the exercise of aseptic surgery and every surgeon began to wear sterile rubber gloves. At about this time Johns Hopkins decided to appoint an Urologist under Halsted. By now The Johns Hopkins had become a famed center and hoary professors of surgery applied for the post from all over Europe and America. Osler, Welch, Kelly and Halsted were on the selection committee. During the interview Halsted kept falling asleep and the others would wake him up saying “William this is going to be your decision. Wake up and listen” and Halsted would say “I am listening, I am listening”. At the end of the three days they asked him, “William who is your choice?” Back came the answer like a bolt from the blue. “why who else but young Hugh” the pun was on the word young. The others almost jumped out of their seats and they asked “what does Hugh Young know about uro surgery?” Nothing replied Halsted but what do those old fogies that we have heard know about the subject? “This man has a clean incisive virgin mind you appoint him and you take my word he will blaze a trail and one day Johns Hopkins will be proud of him”... They appointed him, Halsted was right, you open any chapter on genito urinary surgery and Hugh Young has made a contribution. Today he is remembered for his radical perineal prostatectomy for cancer of the prostate.

Halsted was not only a great surgeon but he was a great teacher of surgery. He collected in his unit at one time men like Harvey Cushing who pioneered neuro surgery, Bloodgood, who made monumental contribution to breast pathology, Foley of Foleys catheter fame, Finney, who did the first pyloroplasty and revolutionized gastric surgery, Mitchell who devised his clips and Hugh Young who pioneered uro surgery and above them all was Osler the father of modern medicine, Welch a great pathologist and Kelly who was a master of gynecological surgery.

In 1918 Halstead recognized that he had like his mother gall stones and that he would require a surgery of which he was a pioneer. One of his assistant Dr. Foley operated on him. The recovery was slow and he was never the same man again. He said to Caroline one day “I can still think, I can read & write and talk. When I can’t do any of these things, it will be time to quit.” Papers on the thyroid, on arteries, aneurysms and cancer poured from his pen. He spoke occasionally at meetings.

On an August morning he quietly told Caroline to phone up the hospital in Baltimore and have a surgeon ready to operate “It is my old enemy again Caroline. Dr. Reid was to operate. “Be sure that the drainage is done through the cystic duct, this might be my last experiment”. There was a faint smile on his face as he went under. A large stone was removed from the common bile duct. In early September Halsted developed Pneumonia. His old friend and mentor Sir William Osler had called Pneumonia “the old man’s friend”. On September the 7^th William Halstead died. A postmortem was conducted according to his request. The cause of death was pneumonia, pleurisy and advanced atherosclerosis. There was no peritonitis, the drainage through the cystic duct had been perfect. William Halstead’s “last experiment” as he called it was a success.

The next day the Baltimore Sun carried an editorial the rest of the page was left blank and this is what it said:-“Because Dr. William S.  Halsted lived, the world is a better, a safer, a happier place in which to be. In his death, not only Baltimore, but civilization everywhere has sustained a heavy loss. He was one of the few men who really did count. Quiet, simple, un-ostentatious except in the medical world, where he towered, a great and dominating figure, the full scope of his genius and the tremendous extent and value of his service to mankind were neither generally known nor generally appreciated. To the Johns Hopkins hospital, the institution to whose reputation and up building he had so enormously contributed, his death is a staggering blow. Along with Osler and Welch he laid the foundation upon which Hopkins so solidly rests today.

                       

I am posting some pictures of these great men all from the Johns Hopkins and all at the same time. I have always been fascinated by this story and would like to share it with you.  

THE INDIA STORY - WHO ARE WE?

Who are We?

The question “who are we?” has intrigued historians, linguists and geneticists as much as it does the common Indian. In the recent years it has become fashionable to debunk scientifically derived theories about the origin of the Indian nation, because there is a new ultra-nationalism about. It’s true we are an ancient people and our nationhood was forged on the mighty anvil of our geography, but our civilization was fused from many cultures and our nationality from diverse races. What we are now is a result of many great migrations. While there seem to have been many migratory waves from the east also, it is the western migrations that mostly shaped our present civilization. These migratory waves continued till well into the modern age and each one seems to have left an indelible mark upon us.

It would be wrong to see these migrations just in terms Islamic conquests as we increasing tend to do. The advent of Islam into India is only a visible marker, for peoples who migrated earlier and even just before the Islamic conquests were also of similar stock. For instance that great Rajput clan, the Sisodia’s are of Scythian origin and historians derive their name from Sassanian. Just as Jat derives from Gatae, Ahir from Avar, Gujar from Khazar, Thakur from Tukharian. The Scythian or Saka tribes were the last pre-Islamic migrants into India. Some entered the plains through the Bolan Pass, and settled in Rajasthan which is why some Rajput, Gujar and Jat clans such as Pawar, Chauhan, Rathi, Sial etc. now claim descent from there, whereas others like Mann, Gill, Bajwa, Bhullar, Sandhu etc. who came via the Khyber Pass claim descent from Afghanistan. 

Some of these clans acquired kingships and were readily granted genealogies by the Brahmin priesthood, who were ever willing to be imaginative as long as their status was assured and for suitable monetary rewards. The agnikula ritual cleansed them of the past and gave them a high place under the Hindu scheme. 

Some of the genealogies given are quite extravagant. Thus the Suryavanshis can claim to have descended from the Sun god, while the Chandravanshis can claim descent from the lunar god, and some claim even more specifically to be Raghuvanshis, the clan of Lord Rama. Not that to be a Scythian is something to be ashamed of. Herodotus reveals that even way back in the 5th century BC, the Scythians had political control over much of Central Asia and even as far as the Gangetic plain. Alexander the Great took a Bactran princess, Roxanne (Rukhshana), as his bride as he had to buy peace with and gain Scythian allies. 

Political maps of India of early periods clearly suggest an Indian polity heavily weighted in the northwestern part of South Asia. Even Emperor Ashoka’s kingdom while centered in Pataliputra (Patna) extended mostly westward, as far as Bamian and Herat now in Afghanistan and hardly into the Deccan and below. This seems to have been so even way back between 2800-2600 BC, when the Indus valley civilization existed. This civilization is estimated to have included over 1500 settlements over an area the size of Western Europe in present day Pakistan and western India. Excavations, not just in Mohenjo Daro, Harappa, Kot Dijian and Dholavira, very clearly suggest that these were Dravidian settlements and were so till about 1600 BC. 

Archeologists have concluded that during this period Harappa, despite the seeming lack of an army, was one of the largest and most powerful economic and political centers in the region (see Scientific American, July 2003). Archeologists also believe that the decline of this civilization coincided with the shifting of the course of the Ghaggar-Hakra River (Saraswathi), then a major river of the Indus Valley. The collapse of the agricultural economy largely due to this, led to the overcrowding of cities like Mohenjo Daro and Harappa leading to civic disorder. Thus when the Aryans made their appearance around 1500 BC these cities were ready to fall. By 1000 BC a new and distinctive ideology and language began to emerge in this region. The Vedic period had arrived.

Quiet clearly, both, the Aryans and Dravidians were migrant races that traveled eastwards in search of pastures for their cattle and fertile land for agriculture. This is where we run into ideological problems with the ultra-nationalist and conservative Hindu gerontocracy that, like Gagabhatt did for Shivaji, are foisting a new genealogy upon our nation. The word out now is that we, Indians of today, are an indigenous people. Nothing can be further from the truth. 

The only indigenous people in India are the Adivasis, who Nihar Ranjan Ray described as “the original autochthonous people of India.” The rest, be they Dravidian or Aryan, Hindu or Muslim, Rajput or Jat, are migrants with as much or as little claim as the European settlers in the new world have to be known as Americans. It is true that the colonizing people in the Americas have managed to forge a distinct new identity, just as the European Jew has managed to become the modern Israeli, and the world acknowledges them as that, but to believe them to be an indigenous people would be akin to the patently bogus Afrikaner claim to be an indigenous African people.

There are scientific ways to discover who we are? The recent advances in genetics have made it possible to draw linkages between peoples of different regions. Studies here in India have not only confirmed that Nihar Ranjan Ray was right when he said that the Adivasi of Central India was the only real native of this country.  

A study by Dr. Michael Bamshad MD, geneticist at the University of Utah published in the June 2001 of Genome Research explicitly states that the ancestors of modern upper caste Indian populations are genetically more similar to Europeans and lower caste populations are more similar to Asians. Another recent study conducted by Andhra University scientists (BB Rao, M Naidu, BVR Prasad and others) has found the southern Indian to be quite distinct to the northern Indian, in terms of genetic make up at least. That stands to reason considering that the varna composition in South India which is weighted overwhelmingly in favor of the lower castes is very different than that of North India which has a more even spread of caste density.

Despite the divergent trails of genetic markers, Aryans and Dravidians may not be that far removed from each other. Linguists have for long been agreed that “English, Dutch, German, and Russian are each branches of the vast Indo-European language family, which includes Germanic, Slavic, Celtic, Baltic, Indo-Iranian and other languages, -- all descendants of more ancient languages like Greek, Latin and Sanskrit. Digging down another level, linguists have reconstructed an earlier language from which the latter were derived. They call it proto-Indo-European, or PIE for short.” 

Dr. Alexis Manaster Ramer of Wayne State University, USA digs even deeper and finds common roots between PIE and two other language groups: Uralic, which includes Finnish, Estonian and Hungarian; and Altaic that includes Turkish and Mongolian. All these three groups, Dr. Ramer argues, find their roots in an older language called Nostratic. If he is right then all Indian languages, Sanskritic or Dravidian are descended from Nostratic, spoken about 12000 years ago.

Dr. Vitaly Shevoroshkin at the Institute of Linguistics at Moscow, and another Russian scholar, Dr. Aaron Dogopolsky now at the University of Haifa, did pioneering work in establishing the Nostratic language in the 1960’s, and this today is the inspiration to younger linguists like Ramer. Incidentally the word “Nostratic” means “our language”. 

This study of language is really the study of the evolution of the human race after the advent of the anatomically modern human being, a relatively recent 120,000 years ago. Language, as linguists see it, is more just the heard word and the spoken for we can even communicate with gestures and signs. According to Dr. Derek Bickerton of the University of Hawaii, “the essence of language is words and syntax, each generated by a combinational system in the brain.”

Dr.Asko Parpola, a prominent Finnish scholar raises a fundamental question as to whether Sanskrit is a Dravidian language and advances enough evidence to suggest that is just what it is. Dr. Malathi J. Shendge, a well-regarded Indologist is of the same opinion and elaborated on her research leading to this conclusion recently in a series of lectures at the India International Centre. Another Indian scholar, Gopi Nathan, has recently published a paper on the similarities of words and syntax between the Dravidian languages, Tamil, Telugu, Malayalam, Kannada and Tulu, and the Finno-Ugrian languages such as Finnish, Hungarian, Estonian and Lapp languages. Gopi Nathan concedes that while the modern versions of these Dravidian languages are considerably influenced by Sanskrit words, the old writings “do not contain a single Sanskrit word.” On the other hand, he argues, a number of Dravidian “loanwords” appear in the Rig Veda. 

Not only Sanskrit but languages like Latin and Greek too have a number of loanwords from Dravidian. For instance, the proto-Dravidian word for rice, arici is similar to oryza in Latin and Greek, and ginger is inciver in Tamil while it is ingwer in German, zinziberis in Greek. This lends much credence to the theory that the original Dravidians were of Mediterranean and Armenoid stock, who in 4th millennium BC and settled in the Indus Valley to create one of the four early Old World state-cultures along with Mesopotamia, Egypt, and China’s Yellow River civilization. The continued presence of a Dravidian language, Brahui, in Pakistan’s Baluchistan province still spoken by more than half a million people, further suggests that the Dravidians moved eastwards and southwards under Aryan pressure. The struggle between these two ancient races is captured vividly in the mythology of the ages which depicts a great struggle between the light skinned devas and the dark skinned asuras. 

Whatever be its origins, it seems clear that the Sanskrit that emerged out of the Aryan Dravidian fusion was the language of a light skinned elite and was replaced by Persian, another Indo-European language of another light skinned elite. In northern India, these languages of the elites combined with regional dialects to produce a patois called Hindawi or Urdu. 

Santosh Kumar Khare on the origin of Hindi in “Truth about Language in India” (EPW, December 14, 2002) writes: “the notion of Hindi and Urdu as two distinct languages crystallized at Fort William College in the first half of the 19th century.” He adds: “their linguistic and literary repertoires were built up accordingly, Urdu borrowing from Persian/Arabic and Hindi from Sanskrit.” They came to represent the narrow competing interests of emergent middle class urban Hindu and Muslim/Kayastha groups. But the real sting is in the conclusion that “modern Hindi (or Khari boli) was an artificial construct of the East India Company which, while preserving the grammar and diction of Urdu, cleansed it of ‘foreign and rustic’ words and substituted them with Sanskrit synonyms.” 

That’s makes for some interesting irony for the RSS, the foremost protagonist of Hindi today, takes great pleasure in deriding English speakers in India as "Macaulay's children."

Mohan Guruswamy

WE ARE PEAS OF THE SAME POD

Human migration - routes and dates

According to palaeontology our species is an African one: Africa is where we first evolved, and this is because the earliest fossils of recognizably modern Homo sapiens appear in the fossil record at Omo Kibish in Ethiopia, around 200,000 years ago. Although earlier fossils may be found over the coming years, this is our best understanding of when and approximately where we originated.

According to the genetic and paleontological record, we only started to leave Africa between 60,000 and 70,000 years ago. What set this in motion is uncertain, but we think it has something to do with major climatic shifts that were happening around that time—a sudden cooling in the Earth’s climate driven by the onset of one of the worst parts of the last Ice Age. This cold snap would have made life difficult for our African ancestors and the genetic evidence points to a sharp reduction in population size around this time. In fact, the human population likely dropped to fewer than 10,000. We were holding on by a thread.

Once the climate started to improve, after 70,000 years ago, we came back from this near-extinction event. The population expanded, and some intrepid explorers ventured beyond Africa. The earliest people to colonize the Eurasian landmass likely did so across the Bab-al-Mandab Strait separating present-day Yemen from Djibouti. These early beachcombers expanded rapidly along the coast to India, and reached Southeast Asia and Australia by 50,000 years ago. The first great foray of our species beyond Africa had led us all the way across the globe.

Slightly later, a little after 50,000 years ago, a second group appears to have set out on an inland trek, leaving behind the certainties of life in the tropics to head out into the Middle East and southern Central Asia. From these base camps, they were poised to colonize the northern latitudes of Asia, Europe, and beyond.

Around 20,000 years ago a small group of these Asian hunters headed into the face of the storm, entering the East Asian Arctic during the Last Glacial Maximum. At this time the great ice sheets covering the far north had literally sucked up much of the Earth’s moisture in their vast expanses of white wasteland, dropping sea levels by more than 300 feet. This exposed a land bridge that connected the Old World to the New, joining Asia to the Americas. In crossing it, the hunters had made the final great leap of the human journey. By 15,000 years ago they had penetrated the land south of the ice, and within 1,000 years they had made it all the way to the tip of South America. Some may have even made the journey by sea.

In paleoanthropology, the recent African origin of modern humans, also called the "Out of Africa" theory (OOA), recent single-origin hypothesis (RSOH), replacement hypothesis, or recent African origin model (RAO). When humans first ventured out of Africa some 60,000 years ago, they left genetic footprints still visible today. By mapping the appearance and frequency of genetic markers in modern peoples, we create a picture of when and where ancient humans moved around the world. These great migrations eventually led the descendants of a small group of Africans to occupy even the farthest reaches of the Earth.

The Out of Africa theory is not unfounded and anecdotal. Evidence supporting the Out of Africa model are:

·         the oldest known fossils of Homo sapiens are African

·         fossil evidence indicates that modern humans quickly replaced earlier humans in Europe and western Asia.

·         all living people show little genetic diversity. This is interpreted as being the result of a relatively recent replacement of earlier, more diverse populations.

·         a variety of different DNA studies on modern humans all suggest a recent common ancestry from a small gene pool. Most of these point to Africa as the origin of this population

·         DNA from contemporary humans can be used to produce maps of human movement throughout the world and show how long an indigenous population has lived in an area. These indicate modern human origins in Africa.

·         analysis of the Neanderthal genome and comparisons with modern humans does support the view that the vast majority of genes of non-Africans came with the spread of modern humans that originated in Africa and then spread throughout the world.

The India story

From what is Ethiopia today the initial migrants traveled north and crossed into the Arabian Peninsula. Early archeological evidence of H. sapiens fossils outside Africa was discovered in the prehistoric caves of Qafzeh and Skhul, in present-day Israel. New mass-spectrometric techniques have dated these fossils to ~80–106 kya (kya is 1000 years ago – a unit of time in Astronomy, Geology and Paleontology). Some traveled further north into central Asia, which became the staging ground for migrations into Serbia and Europe.

The Indian subcontinent-comprising India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and Myanmar–became one of the first geographical regions of the world to be populated by H. sapiens . One group from the Arabian Peninsula took the coastal route through India, Myanmar, and Malaysia to Australia. Studies conducted by the National Geographic Society's Genographic Project in 2007 and 2013 found that people living in a village near Madurai in South India carried the same rare genetic markers as some Australian aborigines and people living in Africa . The findings showed a link between the three continents and confirmed that the people in Australia and India with this genetic marker were likely descendants of the original coastal migrants from Africa.

The migration through India was interrupted about 75 kya by the eruption of Mount Toba in Sumatra, Indonesia, which is recorded as one of the largest volcanic eruptions in this planet's history, resulting in an extended nuclear winter and ice age. Michael Petraglia and his team of archeologists discovered stone tools at Jwalapuram in Andhra Pradesh, South India, above and below a thick layer of ash from the Toba eruption. These tools match those used in Africa from the same period and suggested the presence of modern humans in India at the time of the Toba event. These were the ancestors of our Adivasis perhaps.  After warming of the climate, new migrations out of Africa from ~50 kya populated India with large numbers of humans who later became known as Dravidians.

The Aryans arrived in north India somewhere from Iran and southern Russia at around 1500 BC. Some people believe India’s earliest inhabitants were the Dravidians of Harappa and Mohenjodaro. According to the Aryan Invasion Theory promoted by the erstwhile British rulers of India, these Dravidians were driven away South by the mighty Aryans who migrated from Central Asia during the 2nd millennium BCE. Several school students all over India still continue to learn about the Aryan Invasion Theory, but now we know that what they’re learning is not actually be true. Had the Aryans migrated into India, we would expect some evidence of different tools, weapons, objects of daily use, pottery style and art forms, but that’s not the case.

There is evidence that strongly suggests that the Aryan invasion never happened. However, there is no evidence to support this 19th century theory which was propagated by Indologists like Max Muller. The theory was deliberately misused by colonial powers to divide the North and South, and upper and lower castes. Swami Vivekananda also questioned the myth of the Aryan invasion. “There is not one word in our scriptures, not one to prove that the Aryans ever came from anywhere outside India … the whole of India is Aryan, nothing else,” Swamiji had said.

So today when we designate some people as immigrants we are simply showing our ignorance of the history of our human race. Our appearance, culture, traditions, language, food, drink, dress and behaviour might differ, we may belong to different nations, religions, caste and creed, our slant of the eyes, sharpness of the nose and colour of the skin may differ, our Gods whom we worship may differ but genetically it is absolutely beyond doubt that we are cut from the same cloth. This may be a very disturbing to those who believe in their self declared supremacy but only this is fact and all the rest is fiction.

STRETCH MARKS – OFTEN THE PRICE OF HAPPINESS

Stretch marks are often the price the mother ends up paying for her bundle of joy and so I refuse to refer to them as unsightly, but they are a common and often temporary problem. They pose no long-term health risks, and treatment is normally intended to improve the self-image of the mother who has her hands full anyway!

These white and purple scars, known as stretch marks, affect almost 90% of women after pregnancy. The greater degrees of skin stretching in obese women with larger babies like the diabetic mothers make them more prone to stretch marks. Age-related changes in skin collagen and connective tissue that affect the likelihood of tearing make the elderly mothers more prone to these marks.

But pregnancy is not the only reason of stretch marks, abdomen is not the only place which has these blemishes and females are not the only sex that is having them! They can also occur in men and teenagers who rapidly lose weight. 

Why do stretch marks appear?

Stretch marks develop when the top layer of the skin expands or contracts faster than the layer beneath. These changes cause the connective tissues, such as collagen and elastin fibers, to break and leave the dermis scarred. As the body grows, the connecting fibers in the dermis slowly stretch to accommodate slow growth. However, rapid growth leads to sudden stretching. This causes the dermis to tear, allowing deeper layers of skin to show through.

They are more likely to develop and become more severe where there are high levels of circulating cortisone, or when cortisone is applied to the skin. Cortisol, the stress hormone produced by the adrenal glands, is converted into cortisone. This weakens elastic fibers in the skin.

Stretch marks on an athlete

Stretch marks are seen not only women after pregnancy but also:

- Teenagers that grew suddenly
- Athletes who are very physically active
- Bodybuilders who gain and lose weight
- People on steroids
- People who have lost weight rapidly
- People who have put on weight rapidly
- Women who have had breast enlargement surgery
- Individuals with thick skin
- People with hormonal failure
- People suffering from Cushing's disease or Marfan syndrome. 

 Types of stretch marks:

Most stretch marks have a veiny or branched pattern, exposing the areas where the skin has thinned, and tissues have been damaged. Before stretch marks begin to emerge, the skin can appear thin and pink. It may also feel irritated or itchy. The marks initially develop as wrinkly, raised streaks that can be red, purple, pink, reddish-brown or dark brown, depending on skin color. These are called Striae rubra. The streaks eventually fade and flatten and tend to change to a silvery color over time and settle as thin, white scars called striae alba. Stretch marks may gradually become less noticeable, but this can often take years.

Stretch marks associated with pregnancy are called striae gravidarum.

Stretch marks at sites other than abdomen are also called striae, striae distensae (SD), or striae atrophicans

Where do we see stretch marks?

While mostly it is the striae gravidarum that are commonly encountered but stretch marks are also seen on the breast, hips, flanks, buttocks and thighs. The skin covering the breasts is thinner than it is in many other parts of the body, making it more vulnerable to fine tears. Hormonal events, including pregnancy and puberty, cause the breast tissues to expand quickly. Breast surgeries often change the shape of the breast suddenly, forcing the skin to adjust quickly and increasing the risk of new scaring. Hips, flanks and thighs show striae usually after massive weight loss.

Treatment:

Creams, gels, lotions, and cosmetic surgery have all been proposed as treatments for stretch marks, although there is little medical evidence to support the effectiveness of such treatments. So far current treatments are particularly limited in their ability to deliver long-lasting improvements for all skin types.

Stretch marks often fade over time and become unnoticeable. For women who develop stretch marks in pregnancy, these usually become less noticeable around 6 to 12 months after giving birth. Makeup can be used to conceal stretch marks on more exposed areas of the body while they are more pronounced.

Many popular products that claim to get rid of stretch marks are just a marketing trick or myth. If you want to prevent stretch marks, these products do work well, but they do not help get rid of already existing scars. Some tips to bear in mind:

- Special creams and lotions are just moisturizing creams and lotions, which cannot eliminate stretch marks from the skin.
- Cosmetic products containing tretinoin (vitamin A that works against pimples), collagen and hyaluronic acid won't help you get rid of stretch marks despite their properties of active substances.
- Oils like coconut, almond, olive and those with vitamin E, shea oil, and others, won't erase stretch marks even if you massage the skin regularly.
- Medicinal herbs like aloe can't remove scars, even if the wisest representatives of traditional medicine promise it will. Ingredients like coffee, honey, and sugar body scrubs or peels can help simply because these products are scrubs. They remove the upper layer of scars and slowly make your stretch marks look more like healthy skin so that they become less visible.

Reliable professional methods:

The fight against stretch marks using modern technology too has not met with perfect satisfaction. Below are some recommendations: 

Peeling: Scrubs are made of smooth natural components; peeling procedures imply the effect of aggressive chemical substances. Local anesthesia is usually used. 

Microdermabrasion: This is a rather painful procedure as it removes several layers of the epidermis with the help of aluminum oxide crystals. This method is supposed to force newer and younger skin to grow faster.

Laser: Laser therapy is a new and effective method against stretch marks. As well as microdermabrasion devices, it removes skin and affects deeper layers too. There are instances when laser is performed under general anesthesia. One of the advantages of laser therapy is that it is not all that expensive and there's a low chance of having any adverse reactions. 

Plastic surgery: Sometimes people turn to this method of removing the damaged skin by a tummy tuck or abdominoplasty. This reduces the area of skin afflicted with stretch marks ant stretches out the remaining abdominal skin to make it look smoother. 

Mesotherapy: A number of useful substances such as hyaluronic acid and vitamins are included in the mesotherapy injections. It's especially suitable to prevent stretch marks and it's more effective than creams and lotions containing the same substances. 

A creative solution: Today you can cover your scars with tattoos. But the success rate will depend on your skin, the ink and the tattoo artist's experience and style.  Think twice before doing so if stretch marks are new and still purple. In this case, it is better to wait as your tattoo can get damaged or ink can fall out. Women should also not get a tattoo while breastfeeding. For tattooing it is recommended to wait at least 1 year and only when the family is complete. 

MONSOON TRAVEL PLANS - LOVE THEM

I am of the firm opinion that when it comes to travelling, there is no such thing as bad weather, only a bad choice of clothing and bad attitude. If you love walking in the rain monsoon is a great time for travelling. Otherwise why would you gleefully accept the notoriously unpredictable London rains but frown when it pours in Kolkata?  Cold rains and heavy winds in Vancouver, Melbourne, Chicago and Wellington send chills right down to the bones of my tropically tuned body. Mumbai, Shillong, Chennai, Nainital and Mount Abu are any day more friendly……….only if we take care of a couple of things. It’s all about setting the right expectations and making the best of the situation.

The Indian monsoon has disadvantages of a paucity of infrastructure, which is still developing, but it also many benefits: the lush greenery, less tourist crowds and much lower prices for accommodation and other services, to name a few. However, we can’t predict the weather and every monsoon is different. One year it could rain cats and dogs and in the next year India suffers from droughts. So do embrace whatever may come and make the best of it in India.

Travelling during the monsoon is a very exotic concept to those travelers coming from more moderate climate zones. It can come in any form – from constant drizzle to short but heavy rainfalls to tropical storms and gales to a heavy deluge. But India is a big country with multiple climate zones and therefore the monsoon can develop differently in various regions. At places like Lucknow there is usually a drizzle or the one shower for a couple of minutes as you get in South-East Asia. But it often rains for days and it rains heavily in the tropical areas of the west coast and in the north of India. The cities have an almost non-existent drainage system and the streets flood quickly. And on top of it there is the humidity, your constant travel companion. Clothes don’t dry for hours to days and the heat feels more discomforting. But if you are travelling to a hot country were you not expecting this? It’s all about the attitude when you travel during the Indian monsoon. 

In the mountains landslides aren’t uncommon. Transport, especially buses and trains can be delayed due to heavy fog and rains even air traffic can be disturbed. Almost all national parks in India are shut from June to beginning of October and tiger and other safaris won’t be possible. But Mother Nature is most generous and is dressed in her best outfit. The tree tops are all lost in the clouds and the mountain tops far away are still shining in glorious sunlight! The nature comes to life, dry brown grasslands and forests become lush and green, the farmers welcome the season with full productivity and lakes and rivers as well as waterfalls fill up and become stronger than ever.

 During monsoons it’s a great pleasure to walk through the lush hills and pass the freshly filled lakes and rivers and enjoy what makes the tropics so interesting and unique. Wayanad, Munnar and Thekkady are such places but also the Dudhsagar Waterfall Hike in Goa. Ooty in Tamil Nadu is very popular amongst domestic tourists to flee the heat of the cities.

Even the run of the mill metro cities look surprisingly different and if you have spent some time negotiating the Mumbai traffic during the monsoons you will at once understanding what I am hinting at. Forget the flooded roads and the occasional potholes if you can and look at the classical architectural marvel the city has to offer, all washed clean and shining after a good downpour. Look at their amazing reflections on the flooded roads and get ready to capture the best of the city in your camera for memories!

 Many tourists avoid India in the monsoon which means that you have a lot of sights to yourself. That makes it easier to connect to locals and experience more authenticity. The typical tourist scams appear at a minimum and all together you just don’t feel like one in a thousand travelers while you stroll the lanes and monuments of ancient India.

Furthermore, it is the best time for budget-conscious backpackers who like to keep their expenses to a minimum but don’t want to miss out on some comfort. Many hotels offer their rooms for much less, often even for half the costs than in the main season. You can stay at boutique hotels or luxury resorts for low prices. A good accommodation is a must in the Indian monsoon time as you might spend some time indoors when a particular strong downpour hits the city.

But in order to be a monsoon tourist you have to prepare yourself beforehand. These are a few useful tips.

1.      Always carry an umbrella with firm stretchers--otherwise you'll find yourself clinging to an upturned umbrella when the torrential showers hit. Better would be a raincoat with a cap. A thin rain jacket with breathable material is essential as well as thin light clothes that dry quickly. Pack clothes that cover your skin entirely as the sun can be quite harsh when she shines through the clouds. Sometimes a rain jacket might feel to warm so also pack an umbrella.

2.    Though plastic is banned in many Indian cities but during rains they are invaluable to protect your phones, laptops, watches, or anything that is dear to you.

3.    Footwear should be water-proof and so sturdy sneakers, rain boots, or shoes that come with rubber soles are advisable. Flip Flops aren’t the best option as you just flip the dirt against your legs while walking. But any sandals made of lasting rubber and with a back strap to hold the shoes to your feet are a good idea. Not only will that decrease your chances of falling and breaking your teeth, it will also save your expensive footwear from being ruined in the rain and mud.

4.      Keep a change in a plastic or water-proof bag. There will be many occasions when even the best of the umbrellas and rain-coats will not be able to keep you from the windy rain; it is wiser to keep a change of clothes handy. Also, don't forget a pair of dry socks!

5.      Be careful with your choice of food. Avoid the street food and go for the freshly cooked hotel or restaurant food and stick to fruits in between meals. Chai and pakoras are popular rain snacks but if not straight from the stove, they may be difficult to digest.

6.      Beware of potholes and open manholes and don’t ask me how! These hell-holes become twice as dangerous in the pouring rain and you cannot see them. So follow the local guy who is walking in front of you and pray that he knows where the potholes are, but be ready to pull him out if he starts disappearing in front of you. This is Monsoon Symbiosis!

7.      Be very careful while driving. Long drives along the Marine Drive and along Shaheed Path undoubtedly top the things-to-do-during-Mumbai and Lucknow monsoon list. But with water all over the place and rain hitting down on your windshield relentlessly, you've got to be a tad more careful behind the wheel, or on your bike. The overflowing gutters and dirt mixed with rainwater create risks of skidding for drivers here. Keeping your vehicles well-maintained is one away to get around it, apart from putting the wipers and headlights to their utmost use.

8.      Carry some medicines – Ciprofloxacin, Metronidazole and Paracetamol for some stomach upset and flu. Drink safe water either from your hotel or securely bottled ones.

So do not let the monsoon dampen your travel plans. When you were a child did you not enjoy the rainy days? So, it is not the rain but the attitude! Some walk in the rain and enjoy and some get wet and frown. Make the best use of this lean tourist season from June to September. After a hot summer the monsoon rains inject an amazing amount of vigor into the local people, and it's common to see children running about, dancing in the rain, and playing games. Even the adults join in because it's so refreshing. Be like the locals – hope for the best and be prepared for the worst!

MIRROR OR BILLBOARD….WHICH IS MORE BEAUTIFUL?

I am of the firm opinion that ‘Appearance’ today is the last bastion of discrimination that we are yet to conquer. Conventional wisdom holds that beauty is in the eye of the beholder, but most beholders tend to agree on what is beautiful. A number of researchers have independently found that, when people are asked to rate an individual's attractiveness, their responses are quite consistent, even across race, sex, age, class and cultural background. Facial symmetry and unblemished skin are universally admired. Men get a bump for height, women are favoured if they have hourglass figures, and racial minorities get points for light skin colour.

Some of us will even go to great lengths, spending a lot of money to indulge in Cosmetic surgeries, trying to fit societal expectations. And it is not that the affluent and the rich in show business are going for these surgeries, middle class too is requiring these procedures to get married or to keep their jobs. Yes, performance matters but if somebody is both a good performer and good looking, his/her chances of promotion in jobs or eligibility in the market of arranged marriages is certainly enhanced. Appearance-related bias also exacerbates disadvantages based on gender, race, ethnicity, age, sexual orientation and class. Prevailing beauty standards penalize people who lack the time and money to invest in their appearance. And weight discrimination, in particular, imposes special problems of unwanted stares, unkind jokes and unnecessary harassment.

History:

The history of atrocities on the not so beautiful is not all that subtle. The ancient Romans would throw the babies born with Cleft Lip off a cliff! In the 19th century, many American cities banned public appearances by "unsightly" individuals. A Chicago ordinance was typical: "Any person who is diseased, maimed, mutilated, or in any way deformed, so as to be an unsightly or disgusting subject . . . shall not . . . expose himself to public view, under the penalty of a fine of $1 for each offense." Though we are far more civilized today but we have not stopped judging people by their looks.

The perfect body syndrome:

While the opinion of others can be ignored with courage, I think all of us, men and women, have looked in the mirror at one point in our lives and thought how much happier we’d be if our stomachs were flatter, noses straighter, and if our wrinkles would just disappear. We all have moments when we aren’t satisfied with our external appearance, and all these moments do is put us in a bad mood or make us try to create change in our lives that we don’t really want to stick to. Useless this journey to the "perfect body" really is bothering you, and will help you begin your journey toward acceptance and self-love I do not advice cosmetic surgery to my patients.

Let us break the myth of the ‘perfect body’ and move towards the goal of ‘perfect you’. Let us understand a few very basic points:

1.       The so called standards of beauty – are they real?

Through propaganda the world media has built a glittering ideal of what perfect men and women should look like. Advertisements, billboards, and celebrities who set fashion trends, whose sole purpose is to dictate to all of us what is beautiful and what is not, are actually selling products and ideas. But most of their indicators of beauty are inconsistent with sane reality. Why? Because there is no such thing as a "perfect body", and trying to determine one is a very superficial and unattainable idea. Perfect health, I can understand, but perfect body shape, perfect skin tone, perfect smile do not only vary from time to time and place to place but need not stick to a stereotype at all. It is this variety which makes us all different and beautiful. And even real-life models don’t look the way they do in pictures, as most ads are heavily Photoshopped.

The beauty industry thrives on our insecurity. Their posters tell us that we may not be good enough and their product will make us as beautiful as their models. Their goal is to make you feel uncomfortable in your body to increase sales, whether it's weight loss solutions, trendy clothing or makeup.

2.       Those parts of your body that you hate are also yours

A receding hairline or a protruding belly can deprive us of pleasures of living a full life because of a feeling of guilt that rises within us. But are all people with scanty hairs on their crown and a few extra pounds on their belly failures? More often they carry them with aplomb and they have learned to love them and thereby themselves. Accepting and internalizing the fact that there are some parts of your body you don’t like about your body is the first step towards a more positive attitude towards your outward appearance. The next obvious step is if possible do something about it – diet, exercise, gym anything….but do not sulk.

Just as you accept your friends or partners despite their negative qualities (there is no perfect person), you have to accept yourself with the knowledge that there are some parts of you that you would prefer to change, but you can live with them, and keep on trying to improve.

3.       We all have our bad days.

On days when you look in the mirror and see nothing positive in your appearance, you need to remind yourself that you are looking at a person who is loved by parents, a spouse, friends, and children if. In addition, remember that every small wrinkle attests to the wisdom that you’ve gained over the years, and every scar attests to the tremendous power you have. Then ask yourself some serious questions – have you been too busy? Have you slept well? Have you eaten well? Are you tired? These are important questions because your outward appearance often reflects your energy and health, rather than the fact that you are more or less attractive.

4.       The mirror does not show your fourth dimension

When you look at yourself in the mirror, you see only your outward appearance, but there are other things in you that make you who you are. You have thoughts, beliefs, hopes, dreams, and emotions that are much more powerful than your external appearance, even when it comes to how people who do not know you see you. Your appearance may create a very quick first impression, but people will eventually judge you by your character, even after a short 5-minute conversation.

If you feel beautiful you will be beautiful, and this is the only truth! Beauty is not only in your appearance but also in the self-confidence you have. People who convey confidence are much more attractive than people who try to hide, and this confidence can only be built through the story that you tell about yourself. So remember, if you are telling a happy story, you are far more beautiful than that dumb model on the billboard. Beauty is not in the eyes of the beholder……it lies deep inside you!