BE A PERSUASIVE SPEAKER

 

 

Persuasion is undoubtedly an art form, but have you ever wondered about the secrets of the world’s most persuasive speakers? They are usually tasked with steering an audience to accomplish an explicit action, or to get it to convert to a specific assumption or opinion. A persuasive speaker is someone who effectively convinces their audience to believe or act in a certain way. They use arguments, evidence, and emotional appeals to influence the audience's beliefs, attitudes, values, or behaviors. If you can recollect Martin Luther King Jr.’s “I have a dream” speech or Jawaharlal Nehru’s “Tryst with destiny” speech or Hillary Clinton’s “Women’s rights are human rights” speech or Winston Churchill’s “We will fight on the beaches” speech you will at once understand what I am hinting at.  So, what makes these speakers different?

 

1. They always appear confident

Although the confidence might not be there in reality, a persuasive speaker will always give the impression of confidence. This is one of the most imperative parts of being persuasive. Unsureness on the speaker’s part will be picked up on by the audience, so it’s crucial for a persuasive speaker to have a confident demeanor.

 

2. They always reinforce who they are

The introduction of a speaker is usually the thing that sells the message to an audience before a speech even commences. It is the thing that makes the audience eager to listen to what the speaker has to say.

 

3. Their body language is strong

In order to maximize their interface with an audience, a speaker must exhibit strong body language. Consider how much emphasis is now made on visuals in our culture thanks to technologies such as tablet computers, smart televisions, movies, video games and smartphones. We come to expect the same visual strength from the people we consider to be persuasive.

 

4. They make eye contact

Rather than looking out at the audience as a collective, a persuasive speaker will go that extra mile to ensure that they make eye contact with as many individuals as they can during their speech. In fact, people in an audience tend to expect a speaker to make eye contact with them, and this is a great way of building trust.

 

5. They use an emotional punch

Many highly persuasive speakers include a “grabber” right at the start of their presentations. Examples of a grabber are a declaration, symbol, image or other tool that is employed to immediately grab the audience’s attention. Furthermore, persuasive speakers also use emotions to gain attention and elicit a positive response from their audience.

 

6. They always answer “why” questions

Another technique that persuasive speakers use is to answer a “why” question at the very beginning of a presentation, such as “why is it essential to discuss this subject at this point in time?” Posing such a question, then having the ability to answer it clearly is a demonstration of strong and effective communication skills.

 

7. They are passionate about the topic at hand

In order to persuade or convince an audience, a speaker needs to be passionate, or at least convey passion, about the topic at hand. This has an impact on the audience, which will inevitably pick up on the passion, leaving its members with a sense of obligation that they should accept what they are being told for their own good.

 

8. They speak conversationally

A persuasive speaker will always place emphasis on talking conversationally with their audience, as opposed to giving a speech. This creates an honest and trustworthy perception of the speaker in the minds of the audience members. The Indian Prime Minister, Narendra Modi is a brilliant example. He never lectures in rallies, he establishes a dialogue and uses easily understandable language, the language of regular conversation.

 

 9. They build a sense of truth among the audience

The world’s best actors are prized for their ability to completely involve themselves physically, mentally, and emotionally in the role they are playing. Just try to remember Marlin Brando in Godfather or Anupam Kher in Saransh. A persuasive speaker takes on the same role when in the boardroom or at a conference. The more natural the delivery, the more believable the speaker’s message is.

 

10. They will use repetition for emphasis

Recapping certain points a few times throughout the course of a presentation is the perfect way for a speaker to create greater engagement with the audience. This is especially effective when the speaker goes over the points covered in the presentation immediately after it has been given.

 

11. They share their personal experiences

In order to make themselves more relatable, persuasive speakers will share personal experiences when and where they can as they’re giving their presentation. Doing so brings the message to life, makes the presentation pleasant and wins over the hearts and minds of the audience.

What makes a great and iconic speech? There are numerous examples of brilliant orators and speechmakers throughout history, from classical times to the present day. What the best speeches tend to have in common are more than just a solid intellectual argument: they have emotive power, or, for want of a more scholarly word, ‘heart’. Great speeches rouse us to action, or move us to tears – or both.

REMEMBERING PROF. DEVIKA NAG BY HER LECTURE ON NEUROPATHIES

 

Prof. Devika Nag M.D, F.A.A.N, F.I.A.N.Sc. was our teacher of Medicine, in charge of the Department of Neurolgy in King George’s Medical College in Lucknow. She was a very serious academician and a very good teacher, besides being an extremely graceful lady, and a role model for many Georgians.

 

Prof. Devika Nag lost her father, who was in Army, at young age and later her only younger sister (at UK) due to Subarachnoid Haemorrhage due to ruptured aneurysm. She took good care of her mother till she passed away few years ago. As a child she was keen to become a writer but as destiny desired, she appeared in Premedical test on advice of her mother and topped it. She did MBBS & MD (Medicine) from KGMC and won dozens of awards and medals. Her batch was very bright and gave the Alma mater teachers like Prof. T.C. Goel, Prof. Chandrawati, Prof. A.K. Wahklu and Prof. Indu Wakhlu. She was later trained in Neurology at Boston and other USA & UK institutions.

 

She headed the newly developed Department of Neurology and the department made tremendous progress in all fields, patient care, teaching and research under her leadership. Her consistent efforts led to the start of DM Neurology program in the year 1981, first in state of UP. Prof. Nag served as the Head of the Department from 1977 to 1999 and was a very popular teacher. She later became Professor Emeritus, and served the Department and the speciality in innumerable ways.

 

Neurology and Neurotoxicology were her principal areas of interest and in 1994 the National Academy of Medical Sciences decorated her with their prestigious membership. She served as President of various associations to name a few: Indian Academy of Neurosciences, Neurological Society of India, Indian Academy of Neurology and Indian Epilepsy Association. Her students went on to head various Neorology departments all over the India and even ended up heading their respective institutions as Principals.

She was very punctual, meticulous record keeper, a strict disciplinarian but very soft at heart. Interest of patient was of paramount importance to her. She even declined the offer of becoming the Principal of King George’s Medical College knowing that she will get less time for patient care. She used to take detailed history of all her patients and  perform a proper thorough examination every time. She would take regular evening rounds on Tuesday, the day of her OPD & emergency. This would avoid missing any impending emergency in her newly admitted patients. She was so considerate that she brought home made breakfast for residents sometime when she knew the hostel mess was closed for some reason. She is still serving her patients with devotion even today at Dr KP Singh Memorial (Mayo) hospital at Gomtinagar, Lucknow.

 

There is no better way of remembering a teacher than by remembering what she taught us. This is a one her lectures, on the difficult topic on Neuropathies, which she delivered to our class.

 

The term Neuropathy is short for 'peripheral neuropathy'. It relates to nerve damage suffered by the peripheral nervous system, which is in charge of our nerves outside the brain and spinal cord.   

Causes

Neuropathy is a complication that can be caused by a number of various conditions:

·        Physical trauma

·        Repetitive injury

·        Infections

·        Metabolic diseases

·        Exposure to toxins and some drugs

All these can all lead to peripheral neuropathy. 

 

Signs and symptoms of neuropathy

Neuropathy usually starts as a tingling or burning sensation at our extremities, such as fingers and toes. There is also a loss of sensation at the edge of the nerves that patients have reported feeling like they are wearing a thin stocking or glove on their hands. They can say that the feel pins and needles or ants crawling on their feet. The precise symptoms differ from patient to patient based on the types of nerves affected and how they choose to express themselves.

There are three types of nerves that may be affected by neuropathy, namely sensory, motor and autonomic.

Sensory nerves: Sensory nerves are responsible for collecting sensory information for the body, such as touch, temperature, pain, pressure and vibrations. Neuropathy of the sensory nerves can be expressed as:

·        Spreading numbness and tingling in hands and/or feet (which can spread to the arms and legs)

·        Burning, sharp or electric-like pain

·        Extreme sensitivity to touch

·        Problems with coordination

Motor nerves: Motor nerves are the nerves responsible for activating our muscles and control movements. The involvement of motor nerves present as:

·        Muscle weakness

·        Paralysis

Autonomic nerves: Autonomic nerves are responsible for autonomic functions of the body, such as regulating digestion, heat and blood pressure. Their involvement can present as:

·        Intolerance to heat

·        Problems with digestion, bladder and bowel control

·        Dizziness - brought about by problems with blood pressure.

 

A common cause of neuropathy is Diabetes

Among diabetics, about 50% have minimal neuropathy presenting in some form or the other. They often won't notice the symptoms, and it will stay on a very low level. For the other 50%, however, the symptoms will be unavoidable.

Pain is the most common complaint, usually a 'prickling', 'stabbing' or 'burning' pain, that happens mostly at night. This, along with a numbness that feels as if the limb is 'asleep' - occurs predominantly in the toes, feet and legs. A proper history of the patient’s past illness is mandatory, lest we miss diabetes. Today we end up treating these neuropathy patients with drugs like anti-depressants, anti-convulsants, steroid and cortisone injections, lidocaine and pain killers. These are powerful drugs that address the painful sensations for short and long term relief. However, they have a host of side-effects and must be administered very carefully. Some medical practitioners recommend electrical stimulation of the pain area and of the spine. A lot of research is going on in this area, but progress has been very slow from the medical and drug industry so far.  

 

Natural solutions to neuropathy 

If your patient is suffering from Diabetic neuropathy then you must advice the following:

·        Give up smoking

·        Cut down on alcohol consumption or give it up altogether

·        Maintain a healthy weight

·        Exercise

·        Wear clothing that causes less irritation, such as cotton, covering the sensitive areas with wound dressing or cling film and using cold packs. 

·        Stress relief is also a big help when it comes to neuropathy, and so relaxation techniques such as yoga, and meditation will come in handy.

 

Vitamin therapy

Clinical studies have shown that certain supplements can have a cumulative effect on the symptoms and causes of neuropathy.

1.      Vitamins B1, B2, B6 and B12 Vitamin B deficiency is one of the major causes of neuropathy, and also one of the best natural solutions.

2.      Vitamin B1, usually in its common form of thiamine is helpful. 

3.      Recent natural medications have reverted to using benfotiamine, which has been found to be significantly more effective (almost 3 times) in delivering vitamin B than thiamine.

4.      Stabilized R-Alpha Lipoic Acid (R-ALA) This powerful antioxidant is one of the few, rare materials that can pass through the brain's blood/brain barrier to enter the brain and go directly where it is needed the most.  Most importantly, it has a specific effect on the nerves that eases the pain and numbness associated with neuropathy, and promotes better blood flow and oxygen to the nerves. Recent studies have reported that just by using the R-ALA alone, orally, symptoms of neuropathy were reduced.

Neuropathy support formulas These days, it is common for those suffering from neuropathy to take both medical and vitamin therapies, combining short-term treatment with the cumulative effects of correct nutrition.  The best formulas include vitamins B1, B2 and B12, as well as Vitamin D, R-ALA and materials that relax your nervous system, avoiding over-stimulation.  diabetes patients, this would be a good way to perhaps prevent the onset of neuropathic symptoms.

 

Friends, this was a lecture delivered in 1978-79. Many new things have happened in the field of Neuropathies since then and this field has been much enriched by recent advances. From emerging therapies leveraging stem cells and gene editing to holistic approaches encompassing mind-body techniques and nutritional interventions, the landscape of neuropathy management is rapidly evolving, but the foundation that was laid down by Prof. Devika Nag in our MBBS days has only helped us to understand these recent advances, and not get overwhelmed by them. I have to thank my batch-mate, Prof. Atul Agarwal, who is a retired professor of Neurology from the Department Madam Devika Nag chaired, and an eminent neurologist and epilepsy expert of our country, to help me with this blog.

CASTE CENSUS – SCOPE AND CHALLENGES

 

Now that the story is old and dust has settled over it, it is worth revisiting the issue of caste census with a cool head. One may think that talking about caste in modern day India could re-legitimize, reinforce and reestablish an institution that progress and modernity has rendered irrelevant and the Constitution has made illegal, but honestly, have we ever left it behind as we progressed?

 

Caste is a living reality in India, among all religions and in all states.Yes, Muslims in India too are divided along caste likes. They are stratified into three main castes. At the top of the pyramid are the Ashrafs (literally, the ‘nobles’, who trace their ancestry to inhabitants of the Arab peninsula or Central Asia or are converts from Hindu upper castes), Ajlafs (literally, the ‘commoners’, who are said to be converted from Hindu low castes) and Arzals (literally, the ‘despicable’, who are said to be Dalit converts). Even among Christians, after conversion from Hinduism the stigma of caste stick with them and Dalits become Dalit Christians and cannot marry Syrian Christians in Kerala. Similarly in Tamilnadu Christian Nadar would enter into a marital alliance with a Hindu Nadar but never with a Christian of another caste!

 

There are villages after villages which don't cast their vote but simply vote for their caste. We live with caste all the time. So many family names are caste identifiers. We still are uneasy with inter-caste marriages. Members of subaltern caste still suffer discrimination in villages and at work, even across seven seas. Caste based social oppression, though illegal, is overtly or covertly practiced. 

 

The irony of not knowing the caste numbers is profound. This caste invisibility has produced strange paradox, we debate about reservations from the streets to the parliament without knowing the real distribution of the disadvantaged. We deploy caste neutral tools in deeply stratified society, and well meaning government policies miss their mark because we are unaware of the real numbers.

 

 

Why is a caste census necessary?

So, why do we want to again scratch the old festering caste wound which our society carries? This is a necessary surgery, which can no longer be ignored, lest it turns cancerous. Critics fear that caste counting may harden identities or fuel populist demands of increasing the reservation quota. Such concerns are not without merit, but fear of its misuse cannot justify a National statistical blindness. What the government does to address these problems will depend upon its political statecraft and many such political time bombs, kept safely in the cupboard for many years, have been defused in the past by the present government. 

 

This will be the first caste census of independent India. The main opposition party avoided it like plague in the 65 years it ruled for it was unsure about the consequences. Their model of 'caste blind development ' failed to curb inequalities and Garibi hatao remained a slogan.  But it succeeded in ensuring caste is deeply entrenched in the political system. They feared that caste enumeration would mobilize political realignment and consolidation of depressed caste communities into electorally powerful vote bank, whose aspirations were left unmet. This caste census will be the first step towards understanding the composition of our society and a giant leap towards evidence based inclusive governance. 

 

The results will have to be implemented with care, clarity and purpose, without bothering about the seismic changes it might usher. For decades our planning and development has moved ahead with a critical blind spot. We were all along chasing parameters like GDP but ignoring such an important factor like caste, which continues to decide access to education, employment, healthcare, housing and delivery of justice!

 

 

How will caste census help?

After every census we are able to interpret data under headings like age, gender, geography, language, but not caste! Why did we continue with this huge umbra region in our national understanding? The caste census will offer an opportunity to correct this misalignment. We will know how our society is truly composed, not only their population size, but their social and economic conditions. This caste census will not be about reinforcing identity but about identifying structural inequalities.

 

Caste enumeration is not about division, it is about design. It will help designing a fairer system, target our interventions more accurately and create more inclusive India. Cast census is not about looking backwards but it is about moving forward with a clear and just plan, with wisdom and with eyes wide open. The numbers we gather today will shape the justice we deliver tomorrow. 

 

Expect a seismic change

Political parties, both in government and in opposition, may be out for a rude shock not only in relative numerical strength of a particular caste in a given region but today's leaders may realize that their caste following is much less than they had projected and anticipated so far! Data could reveal presumed armies of caste supporters to be much smaller or much larger than the leaders and followers had assumed. This could lead to a scramble of realignment within and across parties. Who knows whether the Congress President and leader of the opposition will still enjoy the presumed caste dominance in Gulberga, Karnataka after the caste census!

 

Even more significant political fallout of caste census may be the loss of luster of caste and religion in politics and the predominance of performance, decision making and good governance! After all, caste leaders like Sri Lalu Prasad in Bihar and Sri Mulayam Singh in U.P did precious nothing to improve the conditions of their caste and everything to enrich their own families! Armed with caste census, with detailed knowledge of not only their numbers but their education, employment, health, housing and financial status, will there not be a revolt within these family ruled regional parties? After all, this is the true empowerment of the subaltern groups. Raw data from this census will verify or negate the notion that whether mobilization in the name of caste, or for that matter religion, brings deliverance and prosperity.

 

 

The logistical challenge

The logistical challenge of census in India is formidable but including caste will multiply the challenge manifold. Well designed questionnaire to know not only their numbers but their living conditions, their educational qualifications, their employment status, their housing, banking and credit facilities, their position in society and their delivery of justice is a must. The task will be a technical nightmare. 

 

You may be thinking of caste amomh Hindus as 4 varnas- Brahmin,  Khatriya, Vaishya and Shudra. But each varna has multiple castes or jatis and each caste has multitudes of sub-castes or upjatis. There are more than 3000 jatis in India and countless upjatis. Borders between these castes and sub-castes are petty porous for opportunists to slide in and out to get maximum benefits in government schemes and reservations. Add to this the parliament approved EWS or extremely weaker section category and the oft repeated agitation in almost every state for inclusion in OBC category. As if that was not enough, we have the Muslim Dalits, the Christian Dalits, and the Muslim OBC (Pasmandas), once counted in the census do they too get qualified for affirmative actins like reservation? And now you have an idea how gigantic a problem awaits our political system. 

 

 

Caste is not just a part of our past for most Indians, it is a crucial dimension of our present. If we want caste to matter less tomorrow, we must now understand how much it matters today, and draw a baseline. To pretend that caste has become irrelevant is like ignoring the elephant in the room. To exclude caste from the census is to continue policy making in the dark. To include it, thoughtfully and responsibly is to shine long overdue light in this dark corner and solve the problem of delivering education, employment, healthcare, housing, banking, trade and delivery of justice purposefully. It is the real road to last mile delivery.

 

REMEMBERING PROF. K.M. SINGH BY HIS LECTURE ON BENIGN HYPERPLASIA OF PROSTATE

 

 

Prof. K.M. Singh was a Reader in the Department of Surgery, in King George’s Medical College when we were doing our MBBS. He always wore white clothes and a starched apron and was responsible for the teaching of undergraduate students along with Prof. T.C. Goel. He was always smiling and very helpful and was easily approachable. We could go inside his room with any problem and he was always keen to help. He lived in New Hyderabad, almost 3 Km from our Institution and was extremely punctual. His classes were very methodical and they were very easy to follow. For those who found English difficult to grasp, he would translate in Hindi and repeat the subject again and again till the last person had understood the point. This quality made him very popular with the students.

 

During our residency days, posting in his unit was most sought after because of two reasons – he would see to it that surgery was fairly distributed amongst residents and he had started doing cystoscopy and trans urethral resection of prostate for benign hyperplasia of prostate (BHP) and urinary bladder tumours (BT). The urinary bladder endoscopy was newly introduced in the department and only Prof. Harish Chandra and Prof. K.M. Singh were performing it and all residents were keen to learn the skill.

 

An outstanding quality of Prof. K.M. Singh was his respect for his seniors and colleagues. During my residency days, when I was a resident in Prof. R.P. Sahi’s unit, one day I saw Prof. K.M. Singh waiting outside Prof. Sahi’s outpatient clinic, where he was teaching undergraduates. When I asked him that should I inform Prof. Sahi that he is waiting outside he, most vehemently, said no, and waited for the next 45 minutes patiently. Any other staff member of his seniority could have excused himself and barged in, but for Prof. K.M. Singh that was simply unthinkable. His respect for his seniors was only matched by his love for his students. These enviable qualities and his professional skills took him to the post of Head of the Department of Surgery and eventually the Principal of King George’s Medical College.

 

Prof. K.M. Singh had h huge collection of surgical instruments, X. rays and pathology specimens in his room and they were routinely used for undergraduate teaching. I was one of the few residents who could borrow them for my evening ward teaching of students and next day he would always ask how the class went.

 

After returning from my overseas training I started practicing in Mahanagar. My new clinic was bang opposite Mahanagar Nursing Home and Prof. K.M. Singh would operate his private patients in that hospital. He always wondered why I spent all the money in buying a clinic when I could easily practice from his chamber in the morning when he was in the Medical College. On countless occasions he would send a ward boy to call me to assist him in his surgeries. One day when I referred a patient of acute appendicitis to him he got really angry “Why can’t you operate on appendicitis?” he enquired. I told him that I will only do Plastic Surgery but he was not convinced. “You cannot refuse to operate when you can, it sends wrong message to the society”. He made me operate on that patient that evening and never entered the OT. He later shifted to a bigger and better hospital but his affection for me never waned and he referred all his plastic surgery cases to me.

 

This is an undergraduate lesson on Benign Hyperplasia Prostate that was taught to our class by Prof. K.M. Singh.

Epidemiology

BPH is common with incidence increasing with advancing age. Whilst rare before the age of 40, it affects 30-40% of men older than 50. It is seen in around 90% of men aged 90. Men of African origin are more commonly affected.

Aetiology

The aetiology of BPH is poorly understood. BPH is common with increasing age. It is a hormone-dependent process involving testosterone and dihydrotestosterone production. A failure of normal apoptosis and abnormal epithelial and stromal proliferation have been implicated. This proliferation occurs primarily in the transition zone of the prostate, this leads to restriction of the prostatic urethra and urinary flow.

Clinical features

Features tend to be those of increased urinary frequency, nocturia and incomplete emptying.

• Urinary frequency
• Nocturia
• Incomplete emptying
• Decreased urinary flow
• Dribbling
• Hesitancy
• Retention (acute or chronic)

This condition can cause bothersome problems including frequent urination at night, as well as difficulty completely emptying the bladder, and the urgent need to urinate at inconvenient times. BPH triggers noticeable problems in a third of men in their 60s and nearly half of those in their 80s. In the case of men with milder symptoms, BPH may not interfere with their daily lives much, but if it gets distressing and interferes with quality of life then surgery may be required.

Irritative symptoms (problems with bladder function) include:

• Frequent urination during the day or night
• Strong and sudden urge to urinate, sometimes with involuntary leaking of urine
• Obstructive symptoms (problems with the flow of urine) include:
• Difficulty starting urination
• Straining to urinate
• Incomplete bladder emptying
• Weak or intermittent urine stream
• Dribbling after urination.

Patho-physiology

The prostate gland may begin to grow larger over time in many men. The urethra passes right through the prostate, so it doesn't take much prostate growth to make urination difficult. It is usually the median lobe which obstructs the flow of urine. As the bladder works against the restriction, its muscular walls begin to thicken which can cause problems like the need for more frequent visits to the bathroom and difficulty fully emptying the bladder.

Examination

Digital rectal examination

This is a key component of the examination and allows for assessment of the rough size of the prostate. Irregular enlargement should raise concerns and further investigation for cancer. Evidence of reduced anal tone may be indicative of neurogenic causes of lower urinary track symptoms.

Investigations

Investigations are targeted at confirming the diagnosis, excluding malignancy and accessing for complications.

Urinary

Routine and Microscopic examination of urine is advised. Under the microscope we look for casts, RBCs and pus cells.

Blood

• General Blood Picture
• Blood urea and Serum Creatininr
• Blood Sugar – fasting and post prandial
• LFTs (Alkaline Phosphtase may be elevated in prostatic cancer with bony metastasis)

Additional investigations

Depending on the differentials and certainty of diagnosis, there are many other investigations that may be ordered. These include voiding cysto-urethrogram, urethrocystoscopy and urodynamics (e.g. filling cystometry and pressure-flow studies).

Management

Management is aimed at reducing symptoms and preventing complications (e.g. urinary retention and infection).

Conservative, medical and surgical methods may be used to treat BPH.

Conservative

Consider watchful waiting in those with mild disease and symptoms. Surgery has complications that may be avoided or delayed. In certain circumstances, when patient is not fit for surgery, a long-term catheter (changed every 3 months) is used for management.

Fluid restriction: Patients are advised to restrict the volume of fluids they drink and when they drink to prevent bothersome bathroom visits. Advise them not to drink fluids before driving, traveling or attending events where finding a bathroom will be difficult. Also, ask them to avoid caffeine and alcoholic beverages after dinner or within two hours of bedtime.

Bladder habits : Ask your patients to change the time and manner in which they empty their bladder to reduce symptoms or make them less disruptive.

• Caution them not to hold it in for too long.
• Ask them to empty your bladder when they first get the urge to do so. 
• When out in public, ask them to go to the bathroom and try to urinate when they get the chance, even if they don't feel the need.
• They should take your time when urinating, emptying their bladder as much as possible.
• After each time they urinate, they should try again right away. 
• They should try urethral milking, this will prevent post-void dribbling. 
• Teach them to gently squeeze the base of the penis after urinating and work their way outward to force urine out of the urethra.

Medical

Treatment of urinary track infection – but this may be virtually impossible if the prostate is causing outflow obstruction. Stagnant urine has a tendency to get infected.

Surgical

Transurethral Resection of the Prostate (TURP): is a new procedure in which a resectoscope is used to resect obstructing tissue. There are a number of complications that can occur. Retrograde ejaculation (up to 75%), urinary infection, need for urinary catheter are all relatively common. Occasionally clot retention, urinary incontinence, urethral stricture and erectile dysfunction may occur. A rare but serious early complication is TURP syndrome.

Open prostatectomy: tends to be reserved for very large prostates (> 80-100ml) following discussion of more conservative options. No ejaculate can be produced following prostatectomy and most experience symptoms of urinary urgency, frequency and nocturia. Erectile dysfunction may occur. Prostatic tissue remains and cancer can still occur.

Treatment of Urinary retention

Urinary retention may complicate BPH

Acute retention

Men presenting with acute urinary retention require catheterization. Ensure you evaluate for infection and renal impairment that may complicate urinary retention.

Patients require urological review and work-up (particularly if they do not have an existing diagnosis). Typically on the first occasion, a patient may be catheterized. Recurrent retention typically indicates a need for surgical intervention.

Chronic retention

Men with chronic retention should be catheterized particularly where there is renal impairment or hydronephrosis. Often surgery will be advised, though intermittent self-catheterization or a long-term catheter can be used to tide over a critical phase.

 

That is how Prof. K.M. Singh’s lecture on BHP ended. Those were the days when there were no Ultrasound and MRI, no Uroflowmetry, no drugs like alpha blockers, 5-alpha reductase inhibitors, or tadalafil, which can relax the bladder neck and prostate, shrink the prostate, or improve the urinary flow and those were the days when suprapubic open prostatectomy was commonly done. Under these circumstances when I look at my class notes, I can only wonder how conclusive our undergraduate teaching was and how much effort our teachers like Prof. K.M. Singh took to teach us.

ARE YOU A DIABETIC? LET ME HELP.

 

 

Being diagnosed with Type II diabetes can feel like the end of the world, but it also marks the beginning of a journey towards better health and well-being. And, it's very common these days, so don't panic! Understanding and managing this chronic condition is essential to living a fulfilling life. Outstanding sportspersons like Waseem Akram, Craig  Cummins, Billy Jean King, Alexander Zeverev and Sophie Devine are all diabetic and have achieved the pinnacle of their sporting career despite that. The first steps you take after diagnosis set the foundation for effective blood sugar control, reduced complications, and improved quality of life. From adopting a balanced diet to a brisk walking schedule, to monitoring your glucose levels, each action plays a crucial role.

This blog is for guiding you through those initial, vital steps, and for empowering you to take control confidently and proactively. Embrace this opportunity to learn, adapt, and thrive on your path to managing Type II diabetes successfully.

 

Introduction

Understanding Type II Diabetes

Type II diabetes is a chronic condition characterized by the body's ineffective use of insulin, leading to elevated blood sugar levels. Unlike Type I diabetes, it often develops gradually and is commonly associated with lifestyle factors such as diet, physical inactivity, and obesity. Understanding this condition is crucial as it impacts numerous body systems and can lead to complications if not managed in time.

The Importance of Early Management

Early management of Type II diabetes is vital to prevent complications like heart disease, nerve damage, and kidney problems. Taking immediate steps—such as adopting a balanced diet rich in whole grains and vegetables, initiating regular physical activity, and monitoring blood sugar levels—can significantly improve health outcomes. For example, incorporating a 30-minute daily walk or consulting a doctor  or dietitian to create a personalized meal plan are practical measures to start with. Early engagement with healthcare professionals empowers patients to control their condition effectively, improving quality of life.

 

Understanding Your Diagnosis

What Type II Diabetes Means

Type II Diabetes is a chronic condition where the body either resists the effects of insulin or doesn't produce enough insulin to maintain normal glucose levels. Unlike Type I Diabetes, it often develops over time and is largely influenced by lifestyle factors. Understanding this is crucial, as managing blood sugar involves both medication and lifestyle adjustments.

Common Symptoms and Risks

Symptoms often include increased thirst, frequent urination, fatigue, and blurred vision. If left unmanaged, risks include heart disease, nerve damage, and kidney issues. Recognizing symptoms early allows for timely intervention. For instance, if you notice excessive thirst or unexplained weight loss, consult your healthcare provider promptly.

There are many misconceptions about Type II Diabetes, such as it being caused solely by eating sugar or that insulin is the only treatment. In reality, a balanced diet, regular exercise, and sometimes oral medications are key to management. For example, incorporating daily walks can improve insulin sensitivity. Educate yourself to separate myths from facts to make informed health decisions.

Watching for Low Blood Sugar

Hypoglycemia (low blood sugar) can occur, especially when on medications. Watch for: Shakiness, Sweating, Confusion, Dizziness and nausea. Keep glucose biscuits, toffees or a small juice box with you just in case.

 

Consulting Healthcare Professionals

Choosing the Right Healthcare Providers

Start with your general practitioner, who can confirm the diagnosis and refer you as needed. An endocrinologist can offer specialized care, and a registered dietitian can help with a tailored eating plan. Choose professionals with experience treating diabetes and with whom you feel comfortable communicating.

Important Tests and Screenings

Diabetic affects certain target organs – heart, kidneys, and eyes. By doing these screening tests we repeatedly test these target organs and see if they are being harmed by diabetes. This is called target organ survey. Expect the following in your first round of evaluations:

·        Blood Sugar 11 hours fasting and 90 minutes PP

·        HbA1c test (measures average blood sugar over 2–3 months)

·        Kidney function tests

·        Blood pressure monitoring

·        Serum Lipid profile

·        Eye – fundus examination

·        Chest X. Ray

·        Foot examination to detect early complications

These form the baseline for your ongoing care plan. Regular investigations that monitor your target organs – heart, kidneys and eyes, when they return normal is not a waste of money, it is a guarantee and a reassurance of the fact that you are doing well.

Setting Up Regular Follow-Ups: 

Initially, follow-up visits every 3 months are common to check your numbers and adjust your plan. Set reminders and don’t skip these—small changes in test results can be a cue to prevent bigger issues later.

Selecting the Right Doctor or Specialist

Choosing the appropriate healthcare provider is crucial after a Type II diabetes diagnosis. Start by consulting your primary care physician, who can manage your condition and refer you to specialists if necessary. An endocrinologist specializes in diabetes and hormonal disorders and can offer advanced care for complex cases.

Initial Medical Tests and Assessments

Your healthcare provider will order several tests to understand your condition better. Common assessments include HbA1c testing to measure average blood glucose over the past two to three months, kidney function tests, cholesterol levels, and blood pressure monitoring. Eye exams and foot checks are also important to identify complications early. These tests form the baseline for your treatment and help personalize your management plan.

Setting Up Follow-up Appointments

Regular follow-up appointments are essential to monitor your progress and adjust treatment as needed. Initially, you may need visits every three months to evaluate your blood sugar control and overall health. Discuss scheduling with your doctor and set reminders to keep appointments. Consistent communication helps in timely identification of issues, ensuring better long-term management of your diabetes.

 

Lifestyle Modifications

Declare you are a diabetic

This should be the first thing you should tell your doctor, if he is a new one. No matter why you are visiting him/her, for a fractured bone, or chest pain or diminishing vision or dizziness, the first thing your doctor must know is that you are a diabetic and the second thing he/she should know is your latest Blood Sugar levels – both fasting and PP and your HbA1c levels. If you hide your diabetic status the doctor stops thinking about a host of diseases that are much common in diabetics, and your diagnosis may be delayed. You can be a controlled diabetic or an un-controled diabetic, but once a diabetic, you always remain a diabetic. 

Adopting a Diabetes-friendly Diet

Eating a balanced, diabetes-friendly diet is crucial to managing blood sugar levels. Focus on incorporating whole grains, lean proteins, and plenty of vegetables into your meals. Limit intake of sugary foods, refined carbohydrates, and saturated fats. For example, replace white bread with whole grain options and opt for grilled chicken instead of fried foods. Monitoring portion sizes can also help maintain stable glucose levels. Try to build meals around: Whole grains (e.g., oats, brown rice, quinoa) Lean proteins (e.g., chicken, fish, tofu) Fresh vegetables and legumes.

Remember, fat is more harmful than sugar as it offers twice the number of calories to your body per gram (Sugar 4.5calories and fat 9 calories). So, when you look at you food, think "If I put this on a newspaper will it leave an oil / grease stain?" If the answer is 'yes', then that food is not for you. 

Incorporating Physical Activity

Regular physical activity improves insulin sensitivity and aids weight management. Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, swimming, or cycling. Starting with just 10-15 minute sessions and gradually increasing duration can make exercise more manageable. Additionally, incorporating strength training exercises twice a week can further support blood sugar control.

Managing Stress and Mental Health

Stress can negatively impact blood sugar levels, so managing mental health is important. Techniques such as mindfulness meditation, deep breathing exercises, and yoga can reduce stress. Seeking support from healthcare professionals or support groups may also be beneficial. Establishing a consistent sleep schedule and practicing relaxation before bedtime can improve overall well-being and diabetes management.

 

Medication and Monitoring

Understanding Prescribed Medications

After a Type II diabetes diagnosis, it is crucial to understand any medications prescribed by your healthcare provider. Common medications include metformin, which helps control blood sugar levels by improving insulin sensitivity. Be sure to follow the dosage instructions carefully and discuss any side effects or concerns with your doctor. Keeping a medication diary or using a pill organizer can help ensure you take your medications consistently.

Remember, the same drug every day will only control you if you consume the same number of calories and spend the same number of calories every day. You cannot be irregular with your diet and exercise and expect the drug to do wonders. So changing your attitude and bringing discipline in your life is more important than changing your doctor. 

Blood Sugar Monitoring Techniques

Regular blood sugar monitoring helps you and your healthcare team understand how well your treatment plan is working. Use a blood glucose meter to check your levels, typically before meals and at bedtime. Record your readings in a logbook or smartphone app to track patterns. Your doctor might also recommend continuous glucose monitoring (CGM) devices for more detailed information.

Recognizing and Managing Hypoglycemia

Hypoglycemia, or low blood sugar, can occur if medications lower your glucose too much. Learn to recognize symptoms such as sweating, shakiness, confusion, and dizziness. If you experience these signs, quickly consume fast-acting carbohydrates like glucose biscuits or powder, fruit juice, or regular soda. Always carry a source of sugar with you, and inform family and friends about how to assist you in managing hypoglycemic episodes.

 

Building a Support System

Informing Family and Friends

Sharing your Type II diabetes diagnosis with family and friends is a crucial first step to building a robust support system. Open communication allows your loved ones to understand your needs, provide encouragement, and assist you in managing your condition. For example, involve them in meal planning or remind them of your blood sugar monitoring schedule. Being transparent helps reduce feelings of isolation and fosters a supportive environment.

Joining Diabetes Support Groups

Support groups offer a space to connect with others facing similar challenges, share experiences, and learn practical coping strategies. Whether in-person or virtual, attending regular meetings can enhance your motivation to adhere to treatment plans. Look for local community centers or hospitals that host diabetes groups, or consider online forums if you prefer flexibility and anonymity.

Utilizing Online Resources and Tools

Leveraging online resources such as mobile apps for blood sugar tracking, educational websites, and meal planning tools can empower you to take control of your health. Many apps offer reminders to take medication and log physical activity, helping to maintain consistency. Additionally, reputable diabetes education websites provide up-to-date information and practical tips, which can complement advice from your healthcare provider.

 

Taking the first steps after a Type II diabetes diagnosis is crucial for managing your health effectively. Embrace lifestyle changes, adhere to medication, monitor blood sugar levels, and seek support from healthcare professionals. Remember, proactive management empowers you to live a healthy, fulfilling life. Diabetes is not the end of the road, and it is so prevalent these days that there are many support groups and organizations ready to help you on your journey to a healthier existence.