REMEMBERING PROF. V.S. DAVE BY HIS LECTURE ON PARESTHESIA IN THE EXTREMITIES

 

The Neurosurgery Department in King George’s Medical College was always amongst the best teaching units of our Ammeter. It was started by Prof. P.N. Tandon way back in 1961, when just a handful of Neurosurgery teaching units existed in India. Prof. P.N. Tandon later moved to All India Institute of Medical Sciences. As Neurosurgery was a part of the Department of Surgery, its Head of the Department Prof. S.C. Mishra then handpicked Prof. V.S. Dave from Mumbai to run the new Department in K.G.M.C. in 1967. Prof. Dave was the gentlest of souls I ever came across. He was so soft spoken that in my residency days, even in his rounds we, the resident team, could hardly hear him. Only when he had to discuss a finding on the Carotid Angiograms, which we residents used to perform on all head injury patients, could he be heard teaching his residents. He was invariably dressed in white and always wore a starched white apron and was extremely kind to patients and their relatives. Though Neurosurgery those days had very serious patients and was very busy, he and his 2^nd. In Command, Dr. D.K. Chabbra worked tirelessly without looking at watch. His dedication and his diligence were infectious and easily trickled down his team.

Prof. Dave and his team performed all kinds of Cranial and Spinal Surgery. Pitutary surgery, ICP Monitoring, Minimally Invasive Cranial and Spinal Neurosurgery, Brain Tumor Surgery, Spinal Tumor Surgery, Brain and Spinal Trauma Management, Surgery of CV Junction Anomalies, Neuro Vascular Surgery, Micro Neurosurgery, Pediatric Neurosurgery (Meningocele, Encephalocele, Hydrocephalus etc.) were all performed in the Neurosurgery Department. Skull base surgery was his speciality and he excelled in it. You have to appreciate that those were pre CT Scan and pre MRI days and a good clinical examination and a carotid angiogram were the only two means of arriving at a diagnosis.

Prof. Dave used to stay in Rana Pratap Marg near the Botanical Garden and could reach the sick patient’s bedside within 10 minutes of a telephone call. He was always available for everybody. Even when there was an anaesthetic accident in the Ophthalmology OR, a request from his Ophthalmology colleague was enough to find him by his side within minutes. Availability was his hallmark and he was accessible to the junior most member of the resident team. He had a special bond with Dr. D.K. Chabbra and the latter could interpret his gestures and facial expressions and do exactly as the Professor wished. I have introduced you to Prof. D.K. Chabbra in one of my previous blogs: https://surajitbrainwaves.blogspot.com/2020/06/remembering-prof-d-k-chabra-today.html

Prof. Dave’s son Ajay is an ophthalmologist of repute.

 

I have been able to salvage a lecture on Peripheral Neuropathy or Paresthesia in the extremities, which was delivered to our class by Prof. V.S. Dave. 

Paresthesia is the tingling sensation or numbness, or sensation similar to pins and needles, experienced in the extremities – arms and hands or thighs, legs and feet. Often, as pins and needles, it is simply a benign consequence of undue pressure being placed on the body parts in question, such as leaning on one arm or crossing your legs for a long time. It is resolved as quickly as it appears when you remove the offending pressure, causing only mild discomfort, but no pain.  

The very same sensation can occur without any obvious pressure being applied. This paresthesia may be severe, episodic or even chronic (never ending). If this happens and is coupled with other symptoms, like

·        Pain

·        Itchiness

·        Numbness

·        Muscle wasting

then the tingling might be an indication of nerve damage. Such damage is called peripheral neuropathy, affecting nerves that are far away from the brain and spinal cord, usually in the hands and feet.  There are three categories of causation.  

1. Diabetes

Many people who are diabetic, the elderly in particular, suffer from peripheral neuropathy. There are in excess of 100 different types of peripheral neuropathy. In time, the condition worsens when left untreated, resulting in reduced mobility and possibly even disability. The major cause of peripheral neuropathy, in around 30% of cases, is diabetes. Peripheral neuropathy is therefore considered to be the first sign of diabetes. 

Since peripheral neuropathy, the underlying cause of paresthesia, in 30% of cases is a sign of diabetes, it is very important that if your patient has a history of prolonged paresthesia monitor his/her blood sugar levels.   Some common Peripheral Neuropathies in Diabetes are;

·        Peripheral symmetric neuropathy: This affects the feet and hands and is the most common form of neuropathy.

·        Autonomic neuropathy: This affects the nerves that control involuntary functions of the body, such as digestion, urination, or heart rate.

·        Proximal neuropathy: This affects the muscles of the hips, thighs, or buttocks and is also known as diabetic amyotrophy.

·        Focal neuropathy: This affects a single nerve, usually in the head, torso, or leg.

 

2. Idiopathic Cause 

In another 30% of cases of peripheral neuropathy, where the cause is not diabetes, no cause can be found, and they are thus labeled ‘idiopathic’. This may be the case more commonly in over the age of 60, and it progresses slowly. Patients often resort to over-the-counter pain medication for mild pain, but for severe pain, judicious use of NSAIDs and anti-depressants are prescribed. Therapeutic footwears can also be acquired which reduce symptoms.   

3. Unrelated causes

The remaining 40% of cases besides diabetic and idiopathic causes of peripheral neuropathy contain a wide variety of unrelated causes. However, the disease is very well-researched, and most of the time it is possible to diagnose the root cause of  paresthesia efficiently.   Besides paresthesia​, other nerve related condition are:

1.      Neuralgia: This is a potent stabbing or burning pain that occurs right along the nerve that has become damaged. It has many possible causes, such as shingles, diabetes, or multiple sclerosis.

2.      Radiculopathy: this is a disease of the spinal nerve roots. It can produce pain, numbness, and weakness at the spine area. 

3.      Carpal Tunnel: a syndrome of the hand’s median nerve, which has become compressed. It is located on your palm.  I have discussed Carpal Tunnel Syndrome in one of my previous blogs: https://surajitbrainwaves.blogspot.com/2022/04/carpel-tunnel-syndrome.html

4.      Mini Stroke (transient ischemic attack): unlike a stroke, which kills brain cells, this ITA, mini-stroke, does not. It does, however, cause similar symptoms to a stroke, and is the result of blood flow to the brain stopping for a period of time. This is considered a medical emergency that may well require urgent attention. I have a blog on Stroke and Mini Stroke: https://surajitbrainwaves.blogspot.com/2022/01/stroke-killer-mini-stroke-warning.html

5.      Spinal Cord Injury: This is a very serious type of injury, which may drastically alter your patient’s life condition and quality. It too will require urgent medical attention.  

6.      Other common causes include, but are not limited, to:

·        Cervical Spondylitis

·        Stroke (urgent)

·        Ulnar Nerve Palsy 

·        Panic Disorder

·        Intracerebral Hemorrhage (urgent) 

·        Guillain-Barre Syndrome (urgent) 

·        Stenosis of spinal canal

·        Spinal Bone Fracture

·        Alcohol Abuse / Alcoholism

·        Frostbite (urgent)

·        Vitamin Deficiency

 

 

Diagnoses

History: In order to be absolutely thorough, you will require a complete medical history of how the paresthesia or neuralgia started. Since medication is often considered a cause of tingling, history of any such medications, or vaccinations would be important. A detailed history of any infections or injuries the patient might have sustained may be vital.  A habit of asking a set of questions may be of help to avoid missing the diagnosis:

·        Numbness or tingling with no obvious cause

·        A pain in the neck, forearm or fingers

·        Unusually frequent urination

·        Numbness in legs which worsens on walking

·        History of a rash

·        History of dizziness, a muscle spasm, or something else unusual.

·        Weakness in limbs interfering with normal mobility

·        History of recent head, neck or back injury

·        Inability to control arms or leg movement

·        Lost bladder or bowel control

·        Feel confused and have lost consciousness for a

·        Speech is slurring

·        Vision is affected

Physical examination: A detailed examination of the patient, not restricting oneself to the effected limb, is vital. Which spinal levels are involved or which peripheral nerve is compressed and where is important to document. Any scar in the anatomical line of a nerve or any local tenderness should ne documented.

Investigations: Blood tests CBC, electrolyte levels, thyroid functions, toxicology screening and nerve conduction studies are required to establish the diagnosis. Perhaps a lumbar puncture and CSF examination may be needed. X-rays and angiograms, may clinch the diagnosis.   

 

Treatment

Treatments will be related to the diagnosis made of the cause of your paresthesia. If the peripheral nerve cells have not died they will regenerate and the patient will return to normal. For diabetes, good blood sugar control can slow down and reduce the progression of diabetic neuropathy. Those who, for example, have a vitamin deficiency can have their diet supplemented with more balance, which will also correct their peripheral neuropathy.    Maintaining an optimal weight by adhering to a regimen of diet and exercises and drastically cutting down alcohol and tobacco consumption will help. .If the cause of tingling is surgical like cervical spondylitis, carpel tunnel syndrome or other compression neuropathies then prompt surgery is indicated before muscle wasting sets in.

 

Thus ended Prof. Dave’s lecture on Paresthesia in the extremities. He would gently smile and quietly walk out of the lecture theatre with his Senior Residents and continue with his morning patient rounds. No fuss, no fanfare, always gentle and always held in very high esteem, Prof. Dave was a true Georgian role model. He was the senior most professor of Surgery in our Department but he refused to become the Head of the Department as he felt that would interfere with his true passion of teaching and training Neurosurgery residents and treating Neurosurgery patients. With no CT Scans, no MRIs, no neuroendoscope and with very primitive operating microscope, the Professor could do wonders by his sheer dedication to Neurosurgery and devotion to his professional duties.

FEELING GLOOMY AND DEPRESSED? THIS CAN HELP

 

Depression is a common mental health condition that causes a persistent feeling of sadness and changes in how you think, sleep, eat and act. Most of us see depression as a phenomenon caused mainly by various negative events we have experienced and unfortunate circumstances that make us feel down and gloomy. However, there are a variety of everyday causes of depression that most people ignore and that actually affect the quality of our lives in a significant way. 

Everybody feels gloomy once in a while, and that is normal. But when a gloomy mood lasts for weeks and you feel like doing nothing and you lose pleasure in your normal daily activities, the gloom gradually turns into a depression. The difference between gloom and depression is sometimes difficult, but it is mainly determined by the duration and intensity of the sad feelings.

It can start with feeling down, worrying a lot, lots of negative thoughts, less pleasure and interest in day to day activities and monotony. Left unattended it can result in concentration or memory problems, irritability, disturbance in diet, sleep, easy fatigability and vague physical problems such as headache, stomach ache or muscle pain. A psychotherapist, who is both a patient and now a friend, recently visited me and I tried to probe why is this getting so common amongst the younger folks too, as I felt they are supposed to be the fountainhead of enthusiasm, zeal and zest! 

So, as my friend brought out, if you feel unexplained sadness, are overwhelmed with constant negative thoughts, and have a host of other symptoms that indicate that you may be depressed, it is time to check if you are getting into habits that have an adverse effect on the mind. These are avoidable and so will help you to come out of a depressed mood.

 

1. Excessive use of technology

Smartphones, tablets, televisions, and computers - all of them pass our time pleasantly and allow us to consume information whenever and wherever we wish. However, they may act as a double-edged sword and may encourage symptoms of depression. The emergence of these symptoms was explained by the fact that multitasking, such as watching TV and reading news on a smartphone simultaneously, overloads the brain with too much information to work properly, leading to exhaustion and ultimately depression.

 

2. Poor nutrition

Our dietary habits have a direct impact on our overall health. But while many choose to focus on negative effects such as being overweight, our food also has the power to change our mood completely. In a study published in the British Journal of Psychiatry, participants that ate more processed foods had more symptoms of depression than their counterparts who avoided doing so. Another study found that participants whose diets were low in fish suffered more depression than their counterparts, probably due to lack of omega-3 fatty acids. These acids are commonly associated with regulating levels of serotonin, a neurotransmitter in the brain that affects our mood. 

 

3. Going to sleep late

Sometimes all we want to do at the end of a hard and busy day is to zone out and watch TV, spend time at a restaurant or engage in a favorite hobby. However, this may leave you sluggish and inattentive  next morning, although you spent that ‘me’ time at rest and relaxation. The reason for this is that a severe lack of sleep disrupts the functioning of the brain and significantly harms attention, concentration, and memory. Thus, apart from the sense of exhaustion that will accompany you throughout the day, the great effort to maintain normal functioning will only trigger stronger feelings of frustration and anxiety. 

 

4. Keeping pessimistic company

It is very possible that the negative criticism and comments from the circle of people closest to you come from their genuine desire to provide you with good advice. However, as in many other cases, even negative and pessimistic feelings should be taken at the right dosage. Spending many hours together with a negative person may change our worldview for the worse, make us identify with the negative thoughts of the other person and compare them to many events in our lives. This doesn’t mean you have to write off people who are close to you, just try to talk to them about the fact that negative conversations don’t benefit you, and perhaps you will make them see the world in a much more positive way.  I would always try to surround myself with ‘a circle of geniues’ who are smarter than me and inspire me by their words and deeds.

 

5. Spending too much time in a busy and overcrowded environment

Life in the center of the city has many advantages such as proximity to many restaurants, public transportation availability, various public facilities, vibrant nightlife, many employment opportunities and more. However, the speed and noise of life that characterizes large cities may also create a great deal of mental stress, manifested in symptoms of anxiety and depression. So, despite your great love for these areas, try to spend a little more time in public parks and gardens close to your home where you can connect to nature and enjoy some peace and quiet. Give your five senses a drill to complete

1.      See 5colours in nature for 5 seconds each

2.      Smell 4 fragrances in nature for 5 seconds each

3.      Hear 3 sounds in nature for 5 seconds each

4.      Touch 2 textures in nature for 5 seconds each

5.      Taste 1 object in nature for 5 seconds

This is my prescription for combating the fast pace city life induced depression.

 

6. Isolating yourself for a long time

After a busy day of chores, it is only natural that we feel the need to isolate ourselves and get the peace and quiet we craved throughout the day. There are many benefits of having a little quality time with ourselves because it allows us to solve problems more efficiently and process the vast amount of information we were exposed to throughout the day. Nevertheless, it is recommended that this habit not be overdone, and spending quality time with children, family and friends still remains the best relaxant and anti-depressant. As part of our coping with the challenges of everyday life, it is important that we strengthen our existing friendships and create new relationships that will enable us to share and express our feelings. Being alone is surely benefician but being lonely is not. To read my blog, please click: https://surajitbrainwaves.blogspot.com/2023/04/being-alone-and-being-lonly-are-two.html

 

7. Inaction is dangerous

Although we all like to be idle in front of the TV screen from time to time, we also want to know how to set some boundaries and challenge ourselves in a variety of tasks and hobbies. Doing different tasks, even those that don’t interest us, gives us a sense of meaning, distracts us from negative thoughts, and improves our mood significantly. Even having a strict and consistent exercise regimen is an excellent anti-depressant, due to the various chemicals, such as endorphins, released in our brains which promote a sense of calm and tranquility.

 

 8. Not enough daylight exposure

This is something I experienced while working in the U.K. Long stretch of cold, damp and cloudy days, with no trace of the sun, are most depressing. Our busy lives can often have us sitting in front of a screen for hours together, sometimes without even having a short outdoor break. Not experiencing bright daylight can bring the gloomy mood that overcomes you out of nowhere. Apart from our natural need to get some fresh air and clear our head, sun exposure accelerates the production of serotonin, a neurotransmitter in the brain that plays a central role in emotional regulation. In addition, daylight stimulates the production of vitamin D essential to brain health that allows us to stay sharp and logical.

 

9. Taking various medications

Just as physical side effects like nausea, vomiting and cramps, many drugs have psychological side effects too. Thus, drugs such as oral contraceptives, and anti-epileptic drugs may have associated symptoms of depression and anxiety. Corticosteroids may conversely give a sense of wellbeing, as do the mood elevators.

 

10. Poor posture

Our posture conveys what we feel, and shows whether we are self-confident, scared, sad and so on. Our posture has a direct effect on us emotionally; people who walked with their backs bent, shoulders slumped forward and a slightly bowed head, often look and feel depressed and, one walking straight looks happy and confident. Yes, looks can be deceptive, and the guy with slumped shoulder may turn out to be happier, but mostly that is not the case. Our bodies seldom fail to tell what the brain is feeling.

 

11. Monotony

This is exactly what precipitates middle age crisis. We end up executing the same daily routine days, week and months together and this monotony leads to depression. We start wondering whether this grind is truly worth it. And if this effort of our’s goes unappreciated, it further accentuates depression. So doing newer things, deviating from the routine, expanding our horizons and going out of comfort zone brings new thrill to life.

 

Depression is much more serious a problem than what we have tried to describe, and one must never hesitate to seek professional opinion regarding its management. Failing to do so may affect the health and wellbeing of not only the sufferer but also his / her loved ones.

HOW CAN INDIA DEVELOP WITHOUT WOMEN IN WORKFORCE

 

As the President of G 20, one of the most remarkable commitments India made was to promote women led development. This, in the entire developing world, will ensure women empowerment. As countries that have embraced gender diversity in decision making have witnessed better economic and financial performance, this is vital for India if we aim to become a developed country by the year 2047. Though we knew it all along IMF's Geeta Gopinath emphasized it once again that India's economic aspirations can't be met without healthier women labour force participation. According to a research conducted by Azim Premji University in 2023 only 17% of urban women are in paid workforce and the situation in the rural hinterland is far worse.

 

Why are women important at workplace?

When a group of researchers Ratna Sahai, Benedict Clements and Huy Nguyen sampled the number of women in parliament of120 countries they witnessed that their higher share and senior positions ensured higher spending on health and education. Social outcomes like Infant Mortality Rate and Maternal Mortality Rate came down. Nobel laureate Esther Doflo, working in Indian villages found that female leadership in villages positively influenced the aspirations of impressionable adolescent girls and broke gender stereotypes.

 

Banks in India have witnessed that higher number of women in managerial positions resulted in lower Non Productive Assets, (NPAs), loan default and improved their financial stability. Researchers have found that having even a single woman in the board of a NSE listed company resulted in lower debt equity ratio and higher profitability. 

 

Despite these overwhelming evidences of the benefits of including women in the work force, only a dismal number of them are included. Our government keeps on reminding us that we are the fifth largest economy but what it does not say is we are there despite a only 18% contribution from our female work force. Can you imagine where we would have been had we not languished at 129th position in the gender gap ladder which has only 146 countries? Women employment and economic prosperity of a nation are closely related. If half the population is dismally represented in the workforce of a nation then it has no hope to thrive and prosper.

 

What are they doing with their education?

Right from school leaving exams we see the girls performing better than the boys at every step - higher pass percentage, higher marks, and in more numbers among the toppers. Then why is this educational superiority not being represented in the workforce? Why their labour force participation is is only 32.7% (25.6 crores or 256 million)! What are they doing with their education? The conservatives would say that they are building the future India in their homes, but that is being done even by working mothers! So, the obvious answer is that they are not getting their due share of opportunities. They cannot keep on doing unpaid and unsung jobs in homes and fields and waste their talents and skills (see the India Today pie chart).

 

Even after 77 years of Independence they comprise only 14% of Lok Sabha, 15.2% of Rajya Sabha, 8% of Union ministers, 14% of sitting High Court judges and 4% of Supreme Court judges. Only around 11% of IAS officers are women. So if this is their representation in the decision making stratosphere is it at all surprising that only 5-8% of central government jobs and 25-30% of state governments jobs are with women? If they are smart enough to treat the diseased and the infirm, if they are intelligent enough to send satellites to the space and beyond, if they are creative enough to produce award winning films and literature surely they must be good enough for a larger share of government jobs!

 

If the society could not address this gender discrimination in 77 years it is time to do so by legislative means. Reserving 30% of parliamentary seats are not enough, this should extend to government jobs and it should be nothing less than 50%. The private sector, the administration and the judiciary too should be encouraged to do the same. More women in the system will make it safer for women. When they start contributing to their fullest ability, our success in nation building as well as economy is assured.

Two Road-bumps

It turns out that women in our country encounter two road-bumps in their path to employment success - marriage and childbirth. So, are women in developed countries and even in the developing Asian Tiger nations not getting married or having children? How come they can cope with it and our ladies can't? The problem lies in our mindset and in our societal structure.

 

We were hoping that education would empower women to ride smoothly over the marriage road-bump with greater household bargaining power. We were also expecting that more educated husbands would be less conservative in social attitude and be a more active parent and homemaker. But except in a very small section, mostly professionals, this has not happened. Parents are still bringing up their sons and daughters differently and that is giving them a wrong start.

Sadly India has not seen women in workforce rise at anywhere near the pace of their rise in education. Their window of employment opportunity and economic freedom is fleetingly small - from ending education to getting married and then their talent and education is never being used for nation building. For far too long the society has indoctrinated them with the notion that their family is the brick by which this nation will be built and their job is to take good care of the family, the vital unit of the nation. This cannot be their sole responsibility and a much active role in nation building awaits them.

 

Why are women not in workforce in India?

Higher levels if harassment, threats, violence, patriarchal norms and societal stereotypes keep women out of workforce. Even in village panchayats which have women heads, the decisions are often taken by male family members. Only 42% of women in the latest PLFS survey work as against 79% of men. Unpaid household duties consume most of their time. After marriage and particularly after childbirth, their numbers reduce drastically in workforces and only a few end up reaching senior positions. If the mother-in-law is a working lady then the daughter-in-law faces less resistance at home to work.

 

But the disproportionate burden of work they carry at home prevent them from taking up regular jobs for which they are no less qualified. If a large proportion of their time is spent on tending for the family, making endless cups of tea, cooking hot snacks and real mega meals comprising of two sabjis, fish, egg or chicken, daal, raita, pickle, chutney, papadams, chaas, ghee jaggery, rice and hot phulkas served straight from oven to the plate, then where is the time left for a proper and productive job? How can she make her contribution to nation building? As if that was not enough, the son's homework, the daughter's dance classes, and overlooking the work of the gardener, the household bai, the safai karmchari, the washerwomen, the driver are all her duties. It seems the system is so designed in order to keep her entangled in non productive work 24x7 and idolize her homemaker status in the most futile way.

 

Unsafe work environment also keep women away from work. Unfavourable working hours, improper lighting, unsafe resting space, and unkind and irresponsible colleagues make them subjects of workplace harassment. Her social status is not a security as was witnessed in the rape and murder of the female doctor in Kolkata’s R.G. Kar Medical College recently. Considering the rape of a trainee doctor in a renowned medical institution of one of the busiest metropolitan city of our country, is it difficult to understand why so few women venture out to work? Can you imagine how many chains and hurdles the poor doctor had to break through to be on night duty? As if her assault and murder was not enough the patriarchy spoke through the Principal of the institution when he said the victim was irresponsible! Rape is the most heinous crime and are the worst fault lines in our civilization and if it goes unpunished how many girls will dare to come out and work?

 

Economists are stumped

Over nearly two decades, India's female labor participation rate looks like a steady downward curve, from 32% in 2005, to 19% in 2021 – the most recent year for which statistics are available. As India develops, women are dropping out of its workforce – in record numbers. This is happening among rich and poor women, in urban and rural areas – across social class, religion and age groups. In fact, it's happening even among poor rural women – who might need a paycheck the most. Economists cite six factors that may help explain this economic mystery: prosperity, education, social norms, safety concerns, problems with statistical measurement and a lack of decent and productive employment.

1.      Prosperity: As household incomes rise, women are dropping out of India's workforce simply because they can afford to. Many no longer have to do back-breaking tasks in agriculture or other manual labor. Women move in and out of employment, depending on their family's needs, working only when it becomes difficult to survive on single income of the husband alone.

2.      Education: They are staying longer in schools and colleges and so are counted out of work for that period of time, when compared to the previous generation. This skews the work force data mostly just for women in their teens and early twenties but doesn't explain what's happening across all age groups

3.      Social Norms: Indians still have conservative ideas about a woman's role in the family. We have discussed this extensively, how they are prioritizing unpaid household labor over profession.

4.     Safety concerns: A massive wave of migration out of India's countryside has unintended consequences for women. Often it's a solo male worker who migrates first, leaving women and children in their ancestral village – where the wife effectively becomes a single parent. She has less flexibility to seek paid work outside the home. When women do migrate to urban areas, they often have safety concerns. They may not know their neighbors as well as they did in their ancestral villages. And if they get jobs, they may have to commute long distances, or at night – on public transit that's often unreliable and unsafe. Violence against women is exacerbated by privatization. Take Uber, for example! It's not an affordable option for a majority of workers, but is it safe every time?

5.      Statistics may not tell the truth: Women not working dose not always mean that women are not earning. They are often replacing the lack of income with economic activities,  which are generally not counted as work – like collecting firewood, working in the agricultural sector, taking care of cattle, making milk products, pickle and papadam.

6.     Lack of decent employment: This is an issue about the ability, or lack thereof , of an economy to create decent, productive employment that's appropriate and accessible for women. She has to take care of her family and then find time for work. So, her choice of suitable work gets limited. Weak labor laws don't help. India has no national minimum wage or law governing overtime and so they easily get exploited and leave the workforce.

So this may be one of India's biggest challenges, as its population grows. Not only to create jobs for all of its workers, but to create the conditions that'll allow its female workers to take them. They constitute 49% of our population. You cannot ignore them and progress.

TRAVEL TIPS FOR SENIORS

 

My MBBS batch mates taking a dip in the Gangesin our 40th reunion!

 

Travelling the world is my passion and a huge learning experience for me. My policy has always been that traveling is fun, and let it be just that. Plan it well, but don’t get obsessed by your plans and disheartened by minor irritants. Enjoy them, as they become your travel stories to tell. I have missed flights, missed baggage, lost boarding pass (when they were printed on paper), misplaced wallet, sprained my ankle, ordered horribly wrong food, been duped by travel agents but I regret none of them. My advice to you is be careful and avoid the major glitches and be sure to start planning for the next holiday as soon as you are back home from one.

As we get older or tolerance for the unexpected unfortunately decreases. We want everything planned to perfection, but experience has taught me that perfect travel plan is a utopian dream, one that is never fulfilled. Yes, I will always advise you not to make major mistakes to ruin your holidays and I have written a blog on this subject:

https://surajitbrainwaves.blogspot.com/2019/10/dont-ruin-your-holiday.html

Another blog, which again comes from my experience, is travel tips for all age groups.

https://surajitbrainwaves.blogspot.com/2017/09/travel-tips-for-all-traveland-tourism.html

Travelling can be an exhilarating and fulfilling experience, but it also presents unique challenges, particularly for seniors, and this blog is all about travel tips to seniors. Surely, the tips to all age group hold true for seniors as well, but they are special, and also especially vulnerable.

 

Long trips, unexpected schedule changes, and unfamiliar environments can lead to added stress if not carefully planned. While younger travelers often adapt quickly, older adults may require additional precautions to ensure their journeys are safe, comfortable, and enjoyable. Fortunately, with some thoughtful preparation and effective strategies, seniors can travel with confidence. So, here are some practical tips to help senior travelers stay organized and make the most of their trips.

 

1. Keep medications easily accessible

Managing medications while traveling is a top priority. Seniors should always keep at least a few days’ worth of prescriptions in their carry-on bags. This ensures they won’t miss a dose if their checked luggage is delayed or lost. Liquid medications may require special clearance at airport security, so getting a doctor’s note in advance can help avoid unnecessary trouble. Having a list of medications, dosages, and doctor contact information is also useful in case of emergencies, especially when visiting another country where replacement prescriptions might be difficult to obtain. Additionally, seniors should consider carrying a small pill organizer to keep medications organized. If they have complex medication schedules, setting reminders on a phone or a travel alarm can be helpful. Pharmacies in some locations may not have equivalent substitutes, so carrying a sufficient supply for the entire trip is always a wise decision.

 

2. Stay active to prevent discomfort

Sitting for extended periods during flights, car rides, or train journeys can cause stiffness, discomfort, and even serious health risks such as deep vein thrombosis (DVT). Know all about DVT in my blog: https://surajitbrainwaves.blogspot.com/2024/06/deep-vein-thrombosis.html

Booking an aisle seat is always useful. It allows for easy movement, making it easier to get up and stretch regularly, and also go to the washroom without disturbing co-passengers. For road trips, it’s important to schedule breaks every couple of hours to walk around and loosen up. Simple leg exercises, even while seated, can improve circulation and reduce the risk of complications.

Hydration also plays a key role in preventing stiffness and fatigue. Seniors should drink plenty of water to stay hydrated and avoid excessive caffeine or alcohol, which can contribute to dehydration.

Wearing compression socks may further help in reducing the risk of blood clots during long journeys.

 

3. Prepare for airport security checks

Airports can be stressful, especially with strict security measures. Seniors with medical devices such as pacemakers, artificial joints, or prosthetics may set off metal detectors, which can lead to additional screening. Having a physician’s letter or medical identification card can help clarify any concerns at security checkpoints. Knowing the security protocol and procedures ahead of time can also ease anxiety and make the process smoother. To make security checks more efficient, wearing slip-on shoes and avoiding excessive metal in clothing or accessories can save time. Arriving early at the airport ensures there’s no rush, allowing seniors to go through screenings at a comfortable pace.

 

4. Choose destinations wisely

Not all travel destinations are equally accessible for seniors. Some locations have limited healthcare facilities, rough terrain, or inadequate public transportation. Before finalizing a trip, it’s important to research the area to determine whether it suits the senior traveler’s needs. Kailash Mansarovar trek is for the youngsters as the air is thin at higher altitudes and seniors staying at sea levels or plains may find breathing very difficult if they are not used to such altitudes.

Seniors should check if their accommodations have elevators, ramps, and other accessibility options. They should also consider how easy it will be to get medical help in case of an emergency.

Weather conditions should also be taken into account. Extreme heat, high altitudes, or harsh winters may present additional challenges. Seniors should choose destinations that they can comfortably explore without straining themselves.

 

5. Pack light and use luggage wisely

Heavy suitcases can make travel unnecessarily difficult. Seniors should pack only what they need and use rolling luggage for convenience. If a trip involves multiple stops, having a smaller carry-on bag with essentials like toiletries, a change of clothes and important documents can reduce the need to haul large suitcases frequently. Seeking assistance from hotel staff or using airport luggage services can help prevent strain and injury. Packing cubes and vacuum-seal bags can maximize space and keep belongings organized. Choosing wrinkle-resistant and versatile clothing minimizes the need for excessive outfits, making packing more efficient.

 

6. Be cautious with public Wi-Fi

Many seniors rely on free Wi-Fi to stay in touch with family and friends while traveling, but unsecured networks can expose them to security risks. It’s best to avoid checking sensitive accounts, such as online banking, while connected to public networks. If internet access is needed, verifying the official Wi-Fi connection with hotel or café staff is a safer option. For added protection, using a virtual private network (VPN) can help secure personal information. Carrying a portable hotspot or using mobile data for important tasks can provide a more secure way to access the internet. Seniors should also enable two-factor authentication on important accounts before traveling.

 

7. Carry copies of important documents

Losing passports, tickets, or identification can create major setbacks. Keeping extra copies of these documents in phone or as hard copy can help speed up replacements if anything goes missing. Seniors should carry both physical and digital copies of their travel documents. Scanning documents and storing them in a secure email account or cloud service ensures that they can be retrieved if needed. Having emergency contact information and addresses written down can be helpful in situations where electronic devices fail or get lost. A small travel pouch for organizing documents can make access easier.

 

8. Ask about senior travel discounts

Many airlines, hotels, and attractions offer discounts for older travelers, but they don’t always advertise them. Carrying an ID or passport can help secure these savings. Seniors should also ask about special rates when booking flights, transportation, or accommodations. Travel organizations like Make My Trip and Yatra.com often have exclusive deals that can make trips more affordable. Booking in advance and checking for bundle deals may offer additional savings. Signing up for airline loyalty programs can also provide benefits such as priority boarding or extra baggage allowances.

 

9. Consider travel insurance

Unexpected health issues or travel disruptions can be costly, making travel insurance a smart investment. Many standard health insurance plans do not cover medical expenses abroad, so seniors should look for policies that include emergency care and evacuation coverage. Insurance can also protect against trip cancelations, lost baggage, or unexpected delays, offering peace of mind throughout the journey. Reviewing the fine print of policies ensures that seniors get the coverage they need. Choosing plans with 24/7 assistance services can be helpful in case of medical or logistical emergencies.

 

10. Consult a doctor before traveling

A pre-trip medical check-up can help ensure that seniors are fit for travel. Any chronic conditions, recent surgeries, or necessary vaccinations should be discussed with a doctor. If traveling to a country with potential health risks, seniors should be informed about recommended immunizations and any precautions they should take during their stay. Doctors may also provide advice on managing jet lag, dietary restrictions, and adapting to different time zones. If you are going to trek then let your doctor reassure you that you will be safe in that altitude. Carrying an updated health summary can help medical professionals abroad in case of emergencies.

 

11. Travel off season

I love travelling off-season. With good protective clothing and plenty of me time in the tourist attractions, National Parks and art galleries you are bound to see something most tourists never will. The locals have more time for you to share their stories and off-season has its own culinary delights that await you! You have the freedom to change your schedule on a whim and not suffer the consequence of paying more for a bus ticket or a hotel room. I have in the past written about the joy of off-season travel. Please click: 

https://surajitbrainwaves.blogspot.com/2022/08/the-joy-of-off-season-travel.html

 

12. Don’t rush

Instead of a busy travel schedule with Expedia or Sita Travels, plan your own trip at a leisurely pace. Go to a place and stay there for some time to enjoy its physical beauty, its culture and its cuisine. Rush-rush trips are not for seniors. If you love to drive and are comfortable driving on the right side of the road then only rent a car. Otherwise use public transport and eat where locals do. Spend time with the locals even if you don’t understand their language. A judicious combination of English and hand signs usually does the trick. You can also use your phone’s language translation software like Google Translate to  communicate and locals invariably help. Remember ‘smile’ is the universal key that opens all locks in this world.

 

Every trip I take, whether in India or overseas, I enjoy, I experience and I learn. I started travelling in my teens. My taste of travel, purpose of travel, my choice of destination and my modality of travel has changed. Low cost 3 tier sleeper coaches in Indian Railways and Aeroflot air tickets with long stops in Moscow were once my choice, because that is what I could afford, but I have no regrets. I enjoyed them too. Today I can sacrifice economy for comfort and pamper myself with an occasional spa experience, which once was a useless luxury. But the quotient of enjoyment is certainly not related to the amount of money spent. It is all about the state of mind.