Tribute to my teacher

 

You taught us how to hold our pencils steady.           

You taught us how to get our brush strokes right.

From watercolors to oil colors,

From paper to canvas, 

We advanced under your tutelage. 

Always kind, forever caring like my dad. You became a father to us too.

Several summer days were spent camping in your studio attic.

Numerous after-school evenings were spent in your craft hall studio.

You stood beside us as a guiding star as we sketched, painted, sculpted, and carved countless pieces of art. 

Every year on August 15th, when the country celebrated Independence Day, you celebrated our victory in the day-long Jaycees competition. Our school swept medals in all the art categories in all the competitions due to your outstanding commitment and driving force. 

Your talented hands brought life to a blank canvas, your creative mind could make castles from clay, and your intuitive eyes spotted beauty in almost everything. Your flair for the camera gave us long-lasting photo souvenirs from our school days. 

Mastering the perfect circle free-hand made us understand the circle of life, seeing the shades of colors through your lens made us appreciate the different hues of humans, and our perspective on life got an innovative spin under your mentorship.

Kind, compassionate, caring, genuine, gifted, and indeed one-of-a-kind was our drawing Sir. Will miss you tremendously, sir.

ReplyForward

Make America Safe Again!

The lockdown has ended, the businesses have started to re-open their doors. It was a welcoming change to see the empty parking lots fill with cars again. We have revamped the entire office setting, scheduling, etc., educated my staff with the new safety protocols and screening procedures.
Few nervous days went by when we were still learning to breathe, talk with our N 95, and face shield on. With those multiple layering on the face, I felt so distanced from my patients, in addition to the new social distancing norms. The face shields often fogged, giving me a feeling of getting submerged underwater. We could not get enough hand sanitizer bottles in our office, we scrubbed our hands 100 hundred times, enough to make us look like skinless chicken! So it was only natural to get appalled on finding a doctor's office right in the same building break all the rules. As I walked into my office building on a fine morning, to my displeasure, shock, annoyance, etc etc., I found patients waiting right next to each other shoulder-to-shoulder outside a locked office. Thank god they were at least wearing their masks!. When I confronted that physician, he was angry, and in denial! I was talked to as if it was my own battle against the virus, and he was immune to it.
This is the real problem in America and around the world when the people in the leadership position are either being arrogant enough not to follow the safety precautions or they are in absolute denial of a dire situation. I find educated people acting like morons. We seem to have wrong role models and leaders in a crisis situation. Why is America being the most developed in the world topping the chart as number # 1 country with the highest number of cases of COVID-19? The death toll has surpassed 100,000 more than the Vietnam war and the sad part is our first outbreak has not even ended. We still have to face this harsh reality for many many more months until we have a safe vaccine in hand.
Our own neighbor Canada where the outbreak started just about the same time as in the US seem to have done a commendable job of bringing it under control by following strict safety measures, staggered re-opening, keeping the politics out and most importantly listening to their Prime minister who is not ashamed to wear a mask in public. Countries like Singapore,Taiwan having learnt their lessons from SARS had set up an excellent task force to act promptly in any epidemic/pandemic. On the contrary our own task force was dissolved long before the mandatory mask rules were enforced. The warnings from doctors,scientists are being ignored constantly and we are seeing its repercussions every single day. There is no one national policy for the safety mandates, instead every state, even county is acting independently.
America saw people hitting the beaches the past 2 holiday weekends as if this pandemic was long gone. I don't understand what type of wake up call they would need to wake their inner conscience from a deep slumber. While these imbecile party, the most vulnerable are succumbing to this deadly outbreak and the selfless healthcare workers are putting their lives at risk. More than a vaccine or anti-viral we need proper leadership to steer this country in the right direction. The public is constantly getting bombarded with conflicting opinions. The WH and WHO are not thinking alike,that's the issue. When Dr.Fauci is pleading with the public to be compliant with wearing the mask, listen to the expert. Getting a mask alone is not sufficient but wear it correctly matters. Mask is meant to cover the nose and mouth... not the chin or forehead!

All disasters require active participation, ownership by everyone to curb it. The current crisis is the mother of all crises, aren't we supposed to show solidarity at this time at least! This virus has not been partial to anyone, the rich, the poor, the doctors, the celebrities, the millionaires to the homeless...all equally vulnerable. No firearms or missile can protect us, only masks can do it at this time. It has to be a joint effort by everyone to follow the rules to protect themselves and the people around them. Until everyone realizes that we are morally, ethically bound by this new social rules our only hope is holding on to our dear....masks!!

The Crown Virus

Re-incarnated as COVID-19, this novel Coronavirus came into this world,

Armed with keys to enter human cells, squeezing out oxygen,

and triggering a cascade of inflammatory reactions spiraling down

to respiratory failure and death. 

Unlike its predecessors, this strain causing a Tsunami wave of illnesses and death.

From flu-like illness to fatality...its presentation changing like the

designs on the kaleidoscope

Making the best and the brightest Virologist to Pulmonologist puzzled.

It hopped from person to person, transported by respiratory droplets,

and it rested on the fomites to attack its next victim.

From Wuhan, it made its footprints into every part of the world in a matter of weeks.

Distancing us all socially, crushing us economically.

Fear is the only emotion on the human faces now.

No terrorist in our recent history has induced such fear

in humans as this invisible enemy!

We are in a war with a malicious microorganism with dwindling supplies of PPE, losing our own brave soldiers every single day, still figuring out ways to conquer it…

From age-old Chloroquine to mechanical ventilators to plasma transfusion,

we continue to come up with tactics to battle this new beast. 

Until we invent a vaccine or treatment, the only thing we are going to hold onto is....

hope and of course our masks!

Our pandemic world

Memorial weekend signals the start of summer in America. Americans, especially in Northeast like me, get very excited about the thought of putting away those heavy jackets, gloves, and snow boots. The freedom of going out to the beach barefooted and feeling the grains of sand on the toes is priceless. The thought of feeling the warm sun rays on my face while I prune my roses makes me jump up in joy.  Everyone start thinking about summer vacations, picnics, cook-outs, flea markets, etc., etc. People gather in their yards, parks, beaches feeling liberated from the winter blues. Memorial Day parades happen in every town, with streets decorated in blue, white & red theme, marching bands from local schools playing the patriotic songs and excited crowd lining the sidewalks with the flags. This was all before an invisible intruder hit a pause button on our lives. Our freedom, health, finances, happiness all wiped away in an instant by this pandemic of historic proportions.

Never in our lifetime have we experienced an outbreak that would put the entire world in a lockdown mode for months. People afraid to even step out of their houses with fear of contracting this terrible infection. Masks becoming an integral part of our outfits and hand sanitizer becoming our shields. We would have never imagined a world where women would care less about their mascara than their masks. Similarly, generous layers of hand sanitizer decorated women's hands than the nail polishes.

With social distancing measures, meet & greet has become a thing of the past. The joy of socializing is take away when we have to stay 6 feet apart, wearing our masks, not sharing a handshake, or a hug.
We all could not think of getting on a crowded subway or rubbing shoulder with a stranger on a flight now. The things we did so casually have become so complicated since this outbreak. The new protocols or safety measures that are imposed on us have changed our lives upside down.
Our world now becoming nearly "Virtual"... from doctor's visit to marriages all done online. It has really opened new avenues for many professions where digitalization did not exist before. I hope that "Work from home" culture persists long after this pandemic vanishes, keeping our roads and air cleaner.

This virus not only gave us emotional and financial stress, but it also taught us to be humble. Its wrath did not spare the rich and the famous. In the medical field, every doctor was scratching their head by the varied presentation of this infection and how to combat it. In a country like the US with a robust infrastructure who would have imagined a short supply of the most basic equipment to protect our health care workers in the frontline? Finally, this microbe has clearly shown us that monetary possession does not mean much, especially during a crisis. How many of us reached for our wallet in the last two months to feel relaxed? On the other hand, people around the world have been engaging in virtual meetings, social media, etc. to stay connected with their loved ones. What really is giving us the strength is our willpower, which is, in turn, powered by our personal relationships. Social distancing has, in fact, brought us closer together emotionally, and this pandemic has clearly shown us the value of human bond over the stock market bond. 

The Corona craziness

Who would have thought the March Madness will mean a different type of madness this year. The excitement of the basketball court, being replaced with an extreme sense of panic in every corner of America. Even the luck of the Irish could not save the St.Patrick's day celebration. The usually crowded pubs, restaurants around this time of the year were left deserted due to the government-mandated curfew in many cities. St.Patrick's day parade, one of the largest celebrations in the world, canceled for the first time ever due to this virulent virus.
A fragile microorganism makes the stock market to plummet, schools to close, and businesses to shut down. Broadway pulled its curtains indefinitely, Hollywood turned off its lights, a record number of flights came to a squealing halt, restaurants turned their chairs upside down.... the entire world in lockdown due to this rapidly spreading pandemic. It makes us all feel so vulnerable. Never in our lifetime have we all witnessed an outbreak of this magnitude. There seem to a shortage of everything from canned food to compassion, respirator to respite, masks to mercy. The Corona induced craziness is unbelievable. People hoarding supplies from the stores as if there is no tomorrow!
I believe that adversities are indeed the litmus tests to differentiate an altruist from egoistic.
During hurricane Sandy, in 2012, strangers from the community gathered to pile sandbags on the beaches, deliver food to the elderly, rescue residents from their flooded basements... a real act of kindness at a time of need. Similarly, the Chennai floods in 2015 not only demarcated the low-lying area of the city but also spotlighted those incredibly selfless people who resurrected the city successfully in a few months. We are now seeing thousands of health-care workers on the frontline who have put their lives at risk to save others. Many working even without proper personal protective gear, their patience, and resilience put to the test. My own friend Anu, an infectious disease specialist, has been an altruist angel being in the eye of the storm and braving it.

The handwashing that we have been emphasizing forever suddenly takes center stage of every conversation, news, and talk shows. The so neglected disinfectants are suddenly getting sold like hotcakes, and the protective gears that stayed on the storage units of the hospitals are being used like water.  This pathogen gave a new face to this world that is the masked face. Handshakes and hugs being substituted by elbow shakes or our good old Namaste! The social distancing putting the already distanced community into social isolation. Corona in Greek means a crown, this virus definitely takes the crown for causing the maximum damage to mankind.
This unseen enemy has induced greater fear and uncertainty than the terrorist attack of 911. Despite the advanced technology and medical science, we all feel so unprotected with our new battle against this pandemic. COVID-19 is an equal opportunity provider.... does not spare anyone, from Tom Hanks to Kevin Durant to Mrs. Trudeau to Aam Adhami, everyone is in its wrath. It makes us all realize that despite one's financial status or fame or title, we all are equal in the eyes of a pathogen and in the face of death.
While the cops were happy with the decline in the incidence of motor vehicle accidents, they were annoyed by the dramatic increase in domestic violence for obvious reasons! China saw not only a record number of Coronavirus infection but also a record number of divorce rates in recent months. Divorce lawyers see gold mines in this crisis while the rest of the working class is running to file for unemployment benefits. Everyone in this world seems to be suffering from some fever or other; if not Corona, then it is Cabin fever. Cabin fever has brought out a lot of hidden talents, we see Smulers, Tik-Toker cropping up every day of this lockdown period. Quarantine taught us the value of companionship, social distancing made us long for the warmth of the human touch and most important of all it taught us the fragility of our existence.
In my own experience, it felt bizarre to screen every patient as a potential COVID-19 infected patient, to wear the N-95 ask that covered 95% of my facial expression and the gloves that concealed that warmth of my touch. Even my staff obsessing with spraying aerosols in every room, wiping off all the surface with loads of disinfectant wipes while saying a prayer or two to oust this microscopic menace. We are all slowly getting used to this new normal.
After a long stressful day, as I hopped into my car, the near-empty parking lots and streets gave me a strange sense of loneliness. The thought of being trapped in a tunnel or navigating through a maze in an unknown land! Just then, I noticed the Daffodils, Tulips popping out with their colorful faces trying to tell me the brighter days are ahead! Life goes on... and we all will live to tell our grandchildren about the pandemic of 2020. 

The new social norm

The new social norm

When I was growing up in the 80's-90's friendship meant so much. Our lives revolved around our social circle. There was great excitement in making new friends. We even made pen pals through letter chains from far away cities. When emails, social media was a far-fetched thought, we managed to keep in touch with near and far ones through letters. The blue color folded inland letter carried every emotion from love, heartbreaks, marriage proposals to casual chitchats. Technology has revolutionized the way we communicate with each other. I'm not sure if it is good or bad.
Facebook, more than a decade ago, was the go-to social media from teens to seniors alike. Now we have Instagram, Snapchat, and whatnot. The kids unable to tolerate the postings of their parents quickly moved out of FB and found their hub on Instagram, Snapchat. FB branded its platform in terminologies like "like," "friends." In the FB world, the word "Friend" got a new meaning. He/She may be a person whom you have never met or set eyes on, like your sister-in-law's friend's son's ex-girlfriend! For many FB friend's lists grew in 100's to 1000's enough to make them believe that they can challenge Rajini in popularity. Moms and dads got carried away with the thought of sharing their glories with their so-called FB friends. Friendship also got a new measure in the FB world .... the number of likes! People found instant gratification in sharing their mundane moments that got the much-expected reaction in the number of likes. The privacy factor was quickly tossed into the trash bin. There is no limit to what people could post on FB.
Another breakthrough a few years back was WhatsApp. It was a dream come true to carry those international chitchats initially through text, then came audio and video calls that too all for free! Groups cropped up in WA from mommy's to alumni to professional groups. The life span varied from a few days to a few years.  The shortest one I was ever on lasted 5 days. Group dynamics change too, the admin who is the creator of the group might vanish into thin air, and the most active member might be the one who no one knows in real life. Members can be categorized as the incessant chatters, the attention mongers, the smart heads, the life-givers, the trouble makers, etc. Some people in WA are forever asleep, while a few are always in a meeting, while some roam around with dying cellphone battery all the time! Some manage to be silent spectators but still will not let go of the membership status. Some get their adrenaline rush by actively sharing their lives moments while others post controversial topics and get in trouble. Chat groups are supposed to mimic living room chitchats, but except that the person sitting next to you on your living room couch will most likely respond to you, but in WA chat rooms, there are no courtesy, decorum or even rules. People choose to ignore when they want to or actively choose to respond when it is convenient. The purpose/agenda of the group changes too, one group which was started for travel ended up being a political battleground with candidates running for election from a professional organization on each other' s throat to win the election.
We all live in a different era now, and it is required to embrace these societal changes. It keeps the community together on the surface, whether it strengthens the bonds is a million-dollar question. The happiness that a simple handwritten postcard brought is still missing in the technologically advanced instant messages delivered by our fancy gadgets. 

Holidays are about giving...not gaining. Holiday survival guide to tip the scale in your favor!

The holiday season is a wonderful time of the year when we all come together with family and friends. As the weather gets frightful, we all find warmth in the company of our loved ones. Getting together always revolves around food. Every holiday has been associated with its signature food from time immemorial. It may be music to every foodie's ear but not for a person watching their waistline. Here are a few suggestions to survive this holiday without adding extra pounds:

• Game Plan - Have a set plan for the holiday parties, whether you are hosting or attending. Plan ahead about what to eat and what to avoid. Allocate your calorie quota for the party, but make sure you do not go overboard on the alcoholic beverages and dessert. Drinking a warm drink like hot tea or even a cup of warm water will improve satiety. Fill your plate with salads and vegetables. Take a dessert plate for the main course; in that way, you consume fewer carbohydrates, fat. If you have a sweet tooth, go for that apple pie or creme brulee without feeling that you deprived yourself of the pleasure of the holiday meal but stop with one serving the size of a custard cup or a ramekin. 
• Assertiveness - Never be afraid to say "NO." You can politely decline the food that you don't want to indulge in without being obligated to eat. If your aunt Karen tries to push her freshly baked butter cookies on you, you should be assertive and not be shy about explaining your weight loss goals. 
• Partner - Having a weight loss partner will make this journey towards your goal painless, especially during the challenging times. Exchanging tips, healthy holiday recipes, and even ways to handle the foodies in your life can be more meaningful if you share it with someone with a similar ideology. 
• Diet - Maintain your caloric intake as close to normal as possible. It can be very challenging with holiday parties, travel, guests, etc. As long as you are mindful of what you eat, you will not fall off the wagon. 
• Exercise - If going to the gym is not possible, aim for 10,000 steps/day. Another option to burn off the calories from that cheesecake is by getting on the dance floor. A pair of dancing feet on the dancing floor for half-hour can help you burn 200-400 calories.
• Sleep - We are all creatures of habit. So once our routine is disrupted, a good night's sleep may be challenging to squeeze in during the holidays. Always make sure you get at least 7 hours of sleep/night. If you are too tired during the day, taking a power nap for 30 minutes can help recharge your body.
• The day-after - Tighten your belt the day after the party, don't eat the left-overs, clear all the pies/pastries from your refrigerator, write down your new goals and plan. Get right back into the routine with the excitement of setting the right foot forward from the New Year.

             Wishing you all a very joyous holiday season. 

Eggless,Meatless,Milkless.....what does it mean?

                                                                   
With the buzz now for various weight-loss diets, the Vegan diet is very much on the spotlight. Vegans constitute about 2% of the US population but continue to be a growing number.
What's a Vegan diet? A vegetarian diet that excludes all animal-based food. That means no meat, no fish and no dairy products. Vegetables, fruits, beans, legumes instead become the staple.
What are the health benefits of a Vegan/Vegetarian diet? Studies have shown that dietary fibers, folate, antioxidants in fruits, vegetables and whole grains decreases the risk of hypertension, diabetes, colon cancer, and obesity. The risk is further decreased slightly among vegans.
What are the harmful effects of a Vegan diet? A diet that is mainly plant-based is deficient in Vitamin B12, Vitamin D, Protein, Calcium, and Iron. Vitamin B12 deficiency is very common among Vegan. Vitamin B12 deficiency may manifest as fatigue, anemia or as neurological problems. Vitamin D is essential for bone health so is Calcium. Bone pain, bony deformities, brittle bones maybe some of the symptoms of Vitamin D deficiency. A diet low in protein will not provide enough nutrition for building the muscle mass. A decrease in the muscle mass will not only decrease your muscle strength/endurance but also decrease your metabolic rate. Iron deficiency presents itself as anemia or hair loss. Hence it is highly recommended that vegans take Vitamin B12, Vitamin D, and Calcium supplements. Always consult with your physician before starting any supplement.
Is Vegan same as Vegetarian diet? No. A vegan diet is even more restricted than a Vegetarian diet since dairy products are eliminated as well. Among vegetarians, there are pesco- vegetarians, ovo-lacto-vegetarians, and vegans.

Classification of dietary patterns *

Dietary Pattern	Definition	Beef	Poultry/Fish	Dairy/Eggs
Non-vegetarian	Eat red meat, poultry, fish, milk, and eggs more than once a week
Semi-vegetarian	Eat red meat, poultry, and fish less than once per week and more than once per month
Vegetarian
Pesco-	Eat fish, milk, and eggs but no red meat nor poultry
Lacto-Ovo	Eat eggs, milk, or both but no red meat, fish, nor poultry
Vegan	Eat no red meat, fish, poultry, dairy, and eggs

* Adapted from Gary E. Fraser [15].

What is a Vegan's substitute for meat?
Beans, soy, lentils, nuts, quinoa are the main source of protein for vegans. Meaty texture or taste is often mimicked by the use of eggplant or mushroom. Similarly, vegan/veggie burger made from beans, tofu is available in the grocery stores as well as in select vegan-friendly restaurants.
Meat substitutes for Vegans are :

Food	Serving size	Grams of protein
soybeans	1 cup	29
peanut butter	2 tablespoon	8
lentils	1 cup	18
beans, such as chickpeas, black beans, and kidney beans	1 cup	15
tofu, firm	4 ounces	11
quinoa	1 cup	8

What's a Vegan's substitute for dairy products?
There are non-dairy milk, cheese, butter, etc are available in the market. They are made from nuts like almond, cashew, and soy.

What's a Vegan substitute for eggs?
Flax seeds and chia seeds are used as an egg substitute for baking. Commercially available yeast is also used for baking instead of egg.

Where do the Vegans get their supply of Omega-3 fatty acids?
Since Omega 3 fatty acids are mainly found in fish/seafood a Vegan diet may not provide the required supply of essential fatty acid which is very important for many bodily functions. Flaxseed, Chia seeds, Walnuts, Soybean oil, Canola oil are few plant sources of Omega 3 fatty acids.

What should be in a Vegan's pantry?
Absolute "must-have": Lentils, black beans, soybeans, red kidney beans, nuts, tofu, rice, quinoa, yeast, vegetable stock or broth, soybean/canola/olive oil.

What are the best Vegan websites/apps?
Happy Cow, americanvegan.org, chooseveg.com are few helpful online resources for vegan recipes to restaurants.

"Veganism" as they call it, is a way of living that excludes the use of animal-based products not only for nutrition but for clothing, cosmetics, etc. On the compassionate ground, Veganism does stop the butchering of animals to put food on our table. It also curbs the exploitation of innocent animals by humans for our selfish needs. There are good alternative food sources that we get from the earth. In my opinion, it is wrong to say that all foods from an animal source are unhealthy since the nutritional benefits of dairy products, fish, etc cannot be discounted. So whether you are pesco-vegetarian, semi-vegetarian or a vegan choose your plate prudently to maintain good health.

Reference: National Institute of health

Ghosts from the past

They came alone, they came in pairs and a few in the same bunch as in the past
Some looked taller, some heavier but all definitely older
Few reminisced with friends in sentimental talks while some laughed with their partners in crime from the past.
Some put on an air and some simple with no flair
Few shared their ups and downs with their peers, while some flew high propelled by their own ego.
Many found solace in the reunion while a few seemed untouched by the bond from the past.
The toppers, the last benchers, the athletes, the artists, the nightingales, the ballerinas all wearing the same title... "The Alumni."
Some awestruck by the power of the human connections and some over the materialistic acquisitions.
Be it a ghost or an angel from the past, it has had an impact!
Time changes everything, but one thing that will remain untouched is the warmth of a genuine friendship.
Until the next time, let us share, laugh, live, cherish, and savor every moment together!. 

Hidden facts in your food

As the cold air gives way to brisk air perfused with the fragrance of the freshly bloomed flowers, as the bright green leaves start spurting out from the trees and as the squirrels, birds, and bees dash out from nowhere, we know that spring has sprung. What does that mean? Allergy season has arrived.
We all are aware of the seasonal allergies with itchy, watery eyes, runny nose, and the sniffles triggered by the environmental allergens. Do you know that hidden allergens in your diet can trigger an inflammatory response in your body leading to weight gain?

Food intolerance or food sensitivity is a hot topic in the field of medicine now. It is quite different from food allergies. While an allergic reaction to food can vary from a mild rash to a life-threatening anaphylactic reaction, symptoms of food intolerance often times are subtle. Food intolerance/sensitivity can cause vague symptoms like fatigue, indigestion, weight gain, etc. Thus making the diagnosis very challenging.

If you are struggling to lose weight in spite of a strict calorie restricted diet, exercise then talk to your doctor about food intolerance. A person can be intolerant to any food or even to food additives, coloring agents, and preservatives. If you are not sure, getting a blood test done for food sensitivity will be very useful. Avoid processed food. The preservatives and additives in those foods may be the culprit in triggering food sensitivity. Also, keep away from Genetically Modified foods which alter your immune response by providing unnatural food and toxins. They are not nutritionally balanced either. Eliminating the food that you are sensitive to will help with controlling your cravings for food thus paving a path for weight loss.
If you are yo-yo dieter with rapid fluctuation in your weight, it is time to think about food sensitivity.
Once you know the trigger, it is vital to eliminate it from your diet for a minimum of 6 months to make your body forget it and to re-introduce it slowly after 6 months. This way you are giving your immune system a second chance to handle the same food in a different way. Rotation diet has been validated for food sensitive individuals. It is avoiding the same food not more than every 4 days in order to prevent the development of food intolerance.
The immune system can go haywire due to stress, unhealthy diet, lack of sleep, etc, thus causing a skewed response to food. Maintaining a healthy immune system with a daily supply of Vitamin B complex, Vitamin C, good night sleep, exercise, and meditation can mitigate this abnormal response to food.

What you need to know & do :

• Think outside the box -If your symptoms do not fit in any typical medical diagnosis or if you are caught in the vicious cycle of weight loss and weight gain, it is time to consider food intolerance.
• Do not mix up - Food allergy is very different from food intolerance.
• The litmus test - Simple avoidance can pin the diagnosis for many with Gluten or Lactose intolerance. Most of the patients do require the help of blood testing to find out the foods they are intolerant to.
• The 3"R" remedy - Remove, Rotate and Re-introduce. Remove the food that you are intolerant to from your diet strictly, rotate your food on a 4 days cycle and re-introduce the food that you are sensitive to after 6 months. 

         Stay healthy and enjoy life!

          Dr.Aparna Chandra

Caution with Carbs!

Does your palate crave for a piece of scrumptious cake with creamy rich chocolate filling after dinner? Do you feel that once you take the first bite of that sugar-loaded piece of heaven that your willpower to say "no" flies out of the window? You are not alone....join the club of millions of people inflicted with sugar addiction. Here are some facts about the most talked about macro-nutrient:
Basic Facts about Carbohydrates:
Carbohydrates are one of the macro-nutrients that are broken down to glucose to provide energy for bodily functions. They are divided into simple, complex carbohydrates and fibers. Simple Carbohydrates are sugars like glucose, fructose, and sucrose, whereas complex carbohydrates are starches that are made up of many sugar molecules, joined together. Fibers are the carbohydrates found in plant-source only.
Functional Facts about Carbohydrates:
1. Natural Vs Added - Carbohydrates that are found naturally in the foods like fructose in fruits or lactose in dairy products are a good source of carbohydrates than added sugars found in sweetened beverages, desserts, and other processed foods.
2. Go with the colors - Green colored kale, orange colored carrots, and red kidney beans not only add color to your plate but also provide you with a healthy source of carbohydrates.
3. Wipe off the whites - Say "no" to the refined carbohydrates found in the white food like white bread, potato, and sugar. Refined carbohydrates get absorbed quickly increasing the sugar level in the body. As Johny rightly said "Eating Sugar, No Papa"!
4. Interpreting the labels - Beware..sugar can go by different names like sucrose, high fructose corn syrup, molasses, agave nectar, fructose sweetener, dextrose etc. Paying attention to these added sugars on the food label will help you to make a healthy decision. Higher the position on the label, larger is the quantity of it in that particular food.
5. Fit in Fiber - Fiber usually comes from the plant source and are not absorbed by the body. Hence they do not increase the sugar levels. Chose your fiber source from legumes, peas, apples and green beans. Daily quota of 25-30 grams of fiber from natural plant-source is essential to maintain digestive health, improve satiety and decrease cholesterol level. The easiest way to get 25-30 grams of fiber/day is to start with whole grain cereal like oatmeal, eat at least 1 whole fruit/day, snack on raw vegetables and substitute meat with legumes, white rice with brown rice or quinoa and white pasta with whole grain pasta.
6. Advice on Artificial sweeteners - Sugar-free may not be completely sugar/carb free. There are 6 FDA approved sugar substitutes in the US. These artificial sweeteners are 100 times sweeter than sugar and must be used in very small amounts only. In my opinion, natural sweeteners like agave or honey are preferable to artificial sweetener.
7. Diabetic diet - If you have diabetes, it is advisable to consult with a Dietitian or Diabetic educator to learn about carb counting and to customize your meal plan.
8. Curbing the cravings - Avoid taking that tempting first bite, if you indulge in one it will soon push you into an avalanche of carb indulgence. Space meals equally during the day so that there is no rapid fluctuation in sugar level, low sugar level itself will cause the cravings. Fool your body with natural sugars in fruits instead of added sugars. A bowl of blueberries or strawberries with a dollop of fat-free whipped cream may satisfy your sweet tooth as good as a bowl of ice cream! Anytime chose water to quench your thirst over sugar-sweetened beverage or soda.
9. Zero-in on the diet -There is nothing called Zero-Carb diet since all foods have some amount of carbohydrate. Instead of avoiding carbs completely, I recommend choosing the right type of carbs found in legumes, fruits, vegetables, dairy, and whole grains.

Carbohydrates are the main source of energy to our body. We all need it for survival. It is not all that bad as it has been portrayed in recent years if it is from right, natural source. So make your choice of carbs wisely, consume in smaller portions, combine it with other macro-nutrients like unsaturated fat and protein, most importantly stay away from the added sugars.

Heart Healthy

As January comes to an end, the excitement of the New Year wanes slowly, we find ourselves struggling with the reality of keeping up with the new commitments and most importantly those resolutions that we made a month ago on New Year's day. Next month is going to be easy since we already have an idea on how to put our resolution into action effectively. The motto for the month of February should be "Focus on your heart". What better month than February to pay attention to the heart. With Valentine's day just around the corner, love is in the air and where does this love emanate from? The Heart of course!
This four-chambered vital organ in the chest that beats rhythmically, pumps blood and love with every beat. It beats more than 3 million times in one's lifetime supplying every cell in the body with the much-needed oxygen for survival. February is Heart Health month for a reason. Heart diseases are the leading cause of death for both men and women around the world. Raising awareness about the preventable causes of heart disease and steps that should be taken to protect the heart will go a long way in improving a person's health and life expectancy.

Here are a few heart-healthy tips:
1. Screening for silent killers: Know your Blood Pressure, Cholesterol, and Blood Sugar numbers. Yearly wellness exams shed light on the silent killers like Hypertension, Hyperlipidemia which will otherwise go unnoticed until a catastrophic event occurs.
2. Weigh in on your weight:  Maintain an ideal weight. If you are overweight, set a goal to bring it to the ideal weight. If you are already there, make sure you maintain it.
3. Say No to Nicotine: Quit smoking! Even second-hand smoking increases the risk of heart disease. According to the CDC, it is estimated that second-hand smoke caused nearly 34,000 heart disease deaths each year from 2005 to 2009 among adult nonsmokers in the United States. If you are a smoker, do your heart and the hearts of your loved ones a favor by putting out your puffing habit for good.

4. Limit the Liquor: Drinking in moderation is helpful to your heart. Health benefits of red wine are well known and well studied. Men should drink no more than 2 glasses/day and women no more than 1 glass/day.

5. Food for Heart: Go low on the salt. Too much salt increases blood pressure and risk of heart disease. Avoid Trans-fat labeled as "Partially hydrogenated oils". Even though Trans-fat was banned by FDA small amount may still be present in the cookie, cake, pizza, and frozen food. Saturated fat found in butter, cream, red meat etc. are also harmful to the heart. Eat plenty of fresh fruits, vegetables, low-fat dairy, whole grains and less of processed food. Add nuts and seeds to your diet at least  4-5 times/week.
6. FIT(T) for Fitness: Get up and move! Start with small steps and aim for 10,000 steps/day. An exercise recommendation that focuses on the following points will be highly beneficial for wellness:
The Frequency of exercise, Intensity of exercise, Type of exercise and Timing. Check with your doctor before starting any exercise regime and get professional help from an exercise therapist or personal trainer when needed.

Take care of your heart and it will take care of you until...the last beat!

Paving a new path

As 2018 comes to an end, as many others I have been pondering on the journey that I embarked this year. The journey of life enriches every soul with different emotions, it takes us up and down the roller coaster ride.When I stood at the starting point on January 1st, little did I know that the friends whom I considered as my pillar of support were indeed the road blocks. So I decided to clear those road blocks to pave my way for a productive year. As I continued my expedition alone, I found great solace in the silence around me. I started to enjoy the little things in life that I had long forgotten being caught in the cobweb of relationships.The soft touch of morning breeze or fragrance of the flowers in my garden or beauty of sunset ...all seem so much pleasurable to see,smell and feel wholeheartedly. The clarity in my vision and mind improved so did my resilience,soon I found myself discovering greater destination on this road. I started covering longer distance, enduring uphill roads to find my destination...a place filled with happiness and tranquility.
Just when I was basking in my moments of success, I found myself being engulfed in a wildfire from the "Dark Web" called Facebook .The fire that initially started as a spark to ignite my spirit soon started to burn my soul. I looked around to find many victims of this wildfire who lost their money,friends,peace of mind and mostly importantly their privacy. I was determined to extinguish it around myself which was not difficult at all. My phone and my mind was no longer cluttered with notifications about irrelevant posts or overwhelming birthday reminders or unlikable "likes"!
I have lived and formed strong friendships in pre-Facebook era and was very confident that my bond with my real friends will always stay strong,so I let go off the Facebook friends ( should we even give those acquaintances the "Friend" title?)
After the smoke from the Facebook fire cleared,the scenery around me had already changed to different shades of yellow and the air turned to crisp cold signaling the arrival of autumn. The days were getting shorter and I was afraid that I will lose my way in the dark, winding road ahead of me. I was almost close to my finish-line and was determined to make it.Then came my guardian angel in a black and tan furry bundle whose warm body and lively spirit brightened my dark gloomy days. My four legged loyal pal guided me through the path ahead, her vigilance warded off all the dangers in my way. I walked confidently knowing that I'm being protected by my paw clad pal.
By the time I saw the first snowstorm of the winter,I was experienced in walking, jogging as well as hiking in all weather conditions. The coating of white brought peace and tranquility to my mind at the same time reminded me to be cautious of the slippery path if I don't pay attention. So I slowed down and walked steadily with my mind focused only on my target. On the way I stopped by the fire build with love by my caring family and true friends to warm my body and soul. It was Christmas eve and I was almost there! There was one sharp turn which I maneuvered it by preparing my body and mind with physical as well mental exercise. I was tempted to look back but my gut feeling told me to look ahead and  move on until I reach my destination....the New Year. I finally reached the finish line...it was a picturesque place as I had imagined with relentless parade of  silvery waves to the shore telling me never to give up and the golden yellow sun rising on the horizon sending message of hope and a new beginning. I felt gratified with the lessons that this path had taught me and I'm looking forward to start another exciting expedition in the upcoming year.

New Year...New Beginning

As we put away the Christmas decorations,clear the last piece of chocolate, throw away the left-overs from the holiday party, we realize that it is already New Year. A New Year signals a new beginning. A fresh start with renewed energy to overcome our challenges, a new chance to accomplish our dreams.
Once the calendar resets to January 1st, we suddenly feel an overwhelming urge to reset our bodies to the healthiest version possible. We jot down the list of things to achieve in the new year. Weight loss being the top most priority this year again for many, we are excited at the same time overwhelmed to navigate our way through the maze of diet plans,supplements and medicines.
Here are some quick tips to reach your optimum weight this year and also to keep it off :
1. Set realistic goals. Write down your goal weight, most importantly set a date especially if you have any upcoming event. The weight did not come on overnight so do not expect it to come down easily either.
2. Track your weight weekly on the same scale in the morning without clothes and maintain a log.
3. Focus on eating healthy. Allot time for smart grocery shopping, meal planning and preparation. This will go a long way not only in weight loss but also in improving your energy level,saving you money and time. If time is in short supply,make use of the food delivery services that caters to health conscious consumers with fresh ingredients and recipes delivered right to your doorstep.
4. Exercise can be fun. Sweating it off on the treadmill is not the only way to burn calories. Choose any physical activity that you enjoy doing, be it gardening or walking the dog but maintain a regime.
5. Make use of technology. Apps like MyFitness Pal, Fitbit makes tracking easier right from the palm of your hand.
6. Clear your mind of all conflicts. Emotional instability can lead to binge eating, insomnia, depression and weight gain.
7. Partner with a pal. Having a weight loss partner can be both motivating and supportive. Friendly competition like "Biggest Loser" among girlfriends, family members or colleagues can give you the best outcome.

Let this year be the one to tip the scale in your favor. Good luck.

Obesity Care Week

 

As America's waistline increases so do the medical conditions and healthcare costs associated with the disease state causing this expanding phenomenon...Obesity. Obesity, unlike other disease conditions, was not recognized as a disease until a few years back. A medical condition that is the root cause of about 230 diseases was buried under social stigmatization, body shaming, prejudice, and most importantly misconception even among medical providers. 

About 33% of Americans are obese, the percentage of children affected by overweight has increased from 15% to 32% in the past 30 years. If we do not take action now, it is predicted that about 50% of adults will be obese by 2030. Obesity is not just a national problem but a global one. According to WHO, the prevalence of obesity nearly tripled between 1975 and 2016 worldwide.
 . What does it really mean? This means that time to take action is now! 

Take the NOCW Pledge

National Obesity Care Week (NOCW) is going to be observed September 15th-21st to raise awareness, to provide educational tools, to remove bias and to give access to health care.

Here is what you can do :

• Schedule a wellness exam with your Primary Care Provider. A wellness exam is always a good time to start the dialogue about your weight issue.
• Have a set goal weight, weight loss plan, and most importantly realistic expectation.
• Track your caloric intake. There are many smartphone apps that are user-friendly and free.
• Have a calorie-conscious eating plan. Find out the calorie content of every food before you place it in your mouth.
• Follow smart grocery shopping tips. Never go to the grocery store hungry, shop only in the periphery of the store that has the fresh produce and stays away from the free samples.
• Incorporate physical activity and fitness into your routine.
• If you follow all the above steps but still struggle with your weight, consult a professional. There are physicians certified to treat obesity called Bariatric Physician for medical weight loss options. Bariatric surgery may be suitable for patients who are morbidly obese and/or those patients who failed medical treatment. Dietitians/nutritionist, a health coach can provide additional help.
• Talk to your health insurance company and your employer about coverage for weight loss treatment be it Rx medications or surgery. There are a few health insurance companies with good plans for unlimited preventive service coverage whereas with some plan "obesity" is an exclusion.
• Do not blame yourself. Poor self-esteem, depression, anxiety, substance abuse are closely linked to obesity and have a poor outcome. Never be a silent spectator for weight bias..speak up!
• Beware of those fad diets and over-the-counter diet pills. 

There has been a significant advancement in the field of obesity medicine, so there is hope. As we see more medications in the market as well as more in the pipeline, there is definitely a surge of optimism. Also groups like Obesity Medicine Association, the STOP obesity alliance are constantly interacting with law-makers in Capitol Hill to bring about a positive change in healthcare, research, and education. So, this week, let's all join hands and take a pledge to spread the word about obesity, focus on healthy behavior, help those in need gain access to healthcare and remove weight bias. Together, we can tip the scale in our favor!

Body Mass IndexIs it Reliable Indicator of Obesity

Body Mass IndexIs it Reliable Indicator of Obesity

Cyberspace slandering

" Pen is mightier than sword" that's the old saying, nowadays " Social media is more powerful than any nuclear weapon. Disgruntled patients often resort to cyberspace to get the steam off. We as physicians do not have the luxury of time to follow their posts, blogs or bursts of tweets. The cause of dissatisfaction may range from long wait time to lack of Wifi in the waiting room. What gives them the right to lash out on us when we don't have an opportunity to defend ourselves?Seldom does a satisfied patient run home to give a 5 star rating for us. If patients treat medical office like hospitality service then we should not be asked to write off their copays or deductibles. Fallacious review online will tarnish an otherwise impeccable reputation of a committed physician. If only we get a chance to tweet about our temperamental patients or post a review about our abusive patients,I'm sure they will think twice about putting baseless accusation online.
        There were many instances in my office recently of patients threatening us openly about posting bad reviews in social media... the reason always seem to be with a statement for services provided. Their reluctance to pay or their lack of understanding of the insurance coverage gets twisted into a take of vulnerable patients caught in the hands of professional predators. Now where would I blog,report or post this?!Patients are now abusing this powerful tool in their palm to exploit, extort and defame us.
While I understand that every individual has the freedom of speech in this country, no one should be given the freedom of abusive speech. If medical offices are going to put in the same platform as pizzeria, then patient must be ready to keep their wallet out as soon as they step in. How often do they get to leave a pizzeria with a slice of pizza for free ?!   I feel that we all must join hands in curbing this culture of social media slandering of doctors. We can’t let anyone stain our white coat online with their dirty digital finger prints.
 Responding to your negative review is key. This ensures that you are taking every comment/review seriously. Short, crisp and assertive response always makes the best impression.
Secondly, one can try contacting Google, Yelp directly and flag it as abusive but it may or may not work.
If that doesn’t work, some physicians have penned their views to the patient asking them politely to delete those derogatory reviews. Finally, if Google gives you the run around, patients turns a deaf ear the last resort is to seek Legal services for a defamatory lawsuit. After all your reputation is worth it!

How I achieve work-life balance as a physician

When I set my eyes on stethoscope and my mind on white coat, the warnings about personal life was endless. "It is a 24/7 job. Think about becoming a professor with lots of vacation time" said my dad. "Be prepared to miss parties, holidays and family functions" said my mom. More skeptical comments poured in from many others that made me a little edgy. We physicians have a stereotypical image of work mongers with no reprieve. White coat workers dealing with disease and death. It is an irony that we as health care professional who give lectures to our patients about eating right, sleeping tight, are the ones who are often running from offices to hospitals missing many meals and spending sleepless nights.

I, like many others juggle with personal and professional responsibilities. Planning, preparing and most importantly unwinding has helped me keep those adrenaline rush under control.
➤Prudent Planning: Being a typical "Type A" personality I have always planned my days well ahead. I usually go through my week's schedule on Sunday to give me an idea on how to prepare myself for both personal and professional demands. If there is any conflicts I try to fix it then and there.
➤Practical preparation: Putting the planning to action requires a lot of co-ordination and time management. I pack lunch, set clothes for my kids and myself the night before so that we waste little time in the morning searching for a pair of socks or belt. I have a set schedule for dinner during the week days that is simple and easy to follow. I finish most of the chores like laundry, grocery shopping during the weekend so that weekday evenings are spent entirely with kids.
➤Modus operandi: Most important change I did with my work schedule is to start early and finish early. This way I not only waste time in traffic but also give my patient the flexibility of scheduling their doctor's visit before they hit work. I keep my office hours strictly for patient care and try to get as much work as possible while at office. We have a office policy of not allowing lunches from any salesperson. I limit my interaction with drug reps to a quick hello and signature at the waiting room. All my staff members are encouraged to communicate with me through our EHR messaging system. Monthly face to face meeting with my staff gives me the dedicated time to discuss about their concerns and come up with a plan . I also log in every night to check labs, send messages and do Rx refills which saves me tremendous amount of time during the work day. I allot specific to-do list for my staff so that work flow is streamlined. I keep one day a week as an administrative day when my staff catch up with those lengthy phone calls with insurance companies or carry out those ever frustrating "PA" process while I do my nursing home rounds.

➤Power naps: Do not underestimate the "Power of power naps". I have always been a big advocate of power naps and cannot stress enough how much it has helped me to be very productive in the evening. Since I come home with my boys I do get ( rather make) time for a quick 20 minute nap that seem to revitalize me.The rest of the evening until their bed time is exclusively for my children which is as fulfilling to me as my white coat job.

➤ I have a discovered a few ways to unwind after work which is both relaxing as well as purposeful like cooking, gardening. I not only get my quota of physical activity but also get my chores done. Another new hobby I very much enjoy is blogging. My personal blog covers a wide range of topics from real life events to abstract narrative which helps me connect with friends with all walks of lives.On the other hand I maintain my grounds in the field of medicine through my health blog that constantly pushes me to be up-to-date.

➤Splendid Saturdays: Most of us would prefer a golf course to an examination room on Saturdays.Meeting friends will make more sense on Saturdays than meeting the "Meaningful use criteria"! I beg to differ.  I have a short but a packed schedule on Saturdays which has helped my practice tremendously. Working on Saturdays has been very fulfilling to me for many reasons, less traffic on the street, empty parking spaces, gratified patients and laid back atmosphere. By the time my family finishes their brunch, I'm home for some quality family time.

How do we find balance between a personal and professional life? Some would even ask is there a perfect balance ? The answer is in our hands. Physicians belong to the society of high achievers. We have always pushed us to go beyond what it is expected from us. So it is only natural that we continue set our goals higher. There is nothing wrong in aiming big and working hard but not at the cost one's piece of mind. Of late physician burnout has increased exponentially, suicide rate and sudden cardiac death continue to raise among us. We need to fix it,before this Stress syndrome sucks out the life from us.

Being in this noble profession has opened my eyes to the world. I learnt that key to happiness is being yourself, to pursue your heart's desire. The simple joys of life cannot be measured in dollar amount. I get up every morning eager to put on my white coat knowing that I can make a difference in someone's life and I come home with same enthusiasm knowing that I'm going to have personally gratifying time with my loved ones. 

Color blind

It was heart breaking to hear about the killing of a young Indian man in Kansas last week. A senseless act of violence brought the life of a 32 year old loving husband, a caring brother and adorable son to an abrupt end. His American dream turning into a nightmare! Until that day I have always felt safe in American soil. My brown skin, unpronounceable Indian name or my desi accent did not alienate me from others. I felt a part of the multicultural American fabric as many other immigrants. This incident wiped off all securities in my mind in an instant!The country that welcomed immigrants from all over the world with open arms is now closing its doors. Shall I say is made to close its doors! Fear swept across the Indian diaspora as we look for an answer. What shall we tell our children? How do we prepare ourselves from these racist attacks? Crippling fear, overwhelming sadness and above all precarious future are the dark clouds above of our heads.  As law abiding Americans we all take pride in everything American irrespective of the color of our skin, country of origin or religious affiliation.
 Martin Luther King's famous speech says " I have a  dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character". It is about time to create a color blind society. We all need to unite under one common goal of protecting human life. Human life, irrespective of race, religion, etc is precious and we all can do our part in spreading the message of seeing every human being as our own, to feel their pain and appreciate their differences. 

The realm of relationship

Let's admit it, we all have felt jealous of someone at some point or other. May be he/she is better looking, endowed with great skills or just the type who outsmarts everyone. Recent article in a local newspaper titled " Friends you don't want your partner to meet"triggered a series of interesting discussions that led me to ponder on these lines. Feeling of jealously when in a relationship as much as it reflects one's insecurity it also reflects one's love for their partner. There is that hidden pleasure in knowing that our significant other is feeling jealous and within limits being possessive also means that boundless love for someone special. That love that you don't want it to share it with anyone else!
 
One of my friend from college days had a super possessive boyfriend who would go to her college and punch her seniors for merely ragging her. May be they flirted a little in the name of ragging! We used to tease her saying  " He has sign on your back - My property, no trespassing allowed strictly!" It is okay if done within limits like many other things but that special person in your life should not feel suffocated. Feeling of suffocation even with love can be detrimental to a relationship.

Another very interesting category is your "Ex" who is your friend currently. That category is too complicated for many partners to digest even if one swears that they have erased any such feeling. This reminds me of the award winning malayalum movie called "Olangal". In that movie the hero Amul Palekar brings in a child home,telling his wife Ambika that the little girl is the daughter of his friend who had died in an accident. Ambika showers her motherly love on that girl until one day she finds out that the child was in fact her husband's love child from another women. All hell breaks loose from then on...If someone cannot accept a child think about an adult. It will be a topic that would be best avoided for known reasons. The society does not give any "Ex" a second chance to put the differences and animosity behind, even if that person is willing. There are outlier to the garden variety group of "ex" who are able to filter that hatred for each other, untangle the relationship web, turn a deaf ear to the gossip mongers....and maintain a blissful relationship with their ex-partners.

Ladies often feel intimidated by that "Super hot" friend who steals everyone's attention and would possibly steal their man too. If you are teenager that attractive friend of yours could be a threat as boys usually carry their hearts in their pocket... and would easily lose it to a good looking dame! The more they know about our insecurities more will be the drooling episodes. As we grow up we realize( I mean both the genders) that beauty is skin deep and we need more than a pretty face to establish a long lasting relationship.

Everyone is quite cautious about that flirtatious group of men and women. Boy! I hate them like many others. Their agenda is to create havoc in a serious relationship and nothing else. In one of our hospital parties I witnessed one such act. This young male doctor Sanjay had his eyes on his female colleague Anjali and he made sure that he announced it to the world that evening! Anjali was getting introduced to a senior physician in the hospital Dr.Singh and poor Dr.Singh happened to hold her hand a little longer than the usual brief hand shake. Our Casanova walks into the middle of that formal introduction and puts his hand around her. He did not stop there...he went ahead to the chief " Take your hands off of her, I know about you oldies too well". Everyone in that group had their mouth open...he gave this sermon with his hands firmly placed on her hip !! The entire evening he followed her everywhere and flirted to his heart's content. so much so that, some even thought that he was Anjali's husband. Now did Sanjay has any serious feelings for Anjali, to my knowledge "no" but he is that carefree Casanova whom you would never introduce to your partner!

Next group of people are the "Smartie pants" type. They think that they know it all and make sure that they rub it on everyone else. They are out spoken, loud and do not think twice about bragging about themselves. They impress people in the first meeting and make everyone around them feel like "nobody". A good friend of mine has this natural instinct of showing off her knowledge, materialistic possession, her awards from kindergarten to Medical college on her very first encounter. She can talk hours about treating a common cold and make every non medical person in the room open their mouth wide in an awe and every medical person roll their eyes and walk away. These self proclaimed Nobel laureate can be very annoying and it can also damage a fragile self -esteem. They are harmless, annoyance who can trigger small fights in a relationship but nothing more!

That secret admirer of yours...can be exciting, daunting and often perplexing. That gut feeling that he/she likes you but can't be sure. Very tricky group to deal with since we do not know for sure where we stand. Should I introduce him/her to my significant other? What if he/she drops the "admiration bomb" in front of my possessive partner?  What if  he/she acts indifferently out of jealously ? There lot more questions that would come to one's mind in dealing with these puzzling persona.

Good relationship as such is very difficult to establish. I feel that there is some super natural power to bring like-minded people together..." Rab ne bana di jodi" Out of the thousands of eyes we see there is one pair that strikes a chord. And out of the hundreds we have spoken to, there is one voice that speaks our heart's language. If you have that person in your life, cherish every moment with your loved one and do not worry about whom you partner gets introduced to.