Consumption of bathroom cleaning acid is one of the most common methods of attempting suicide especially in young girls and most often this does not kill but leaves the patient in a very miserable state of affairs impairing their ability to swallow and subjecting them to multiple hospital visits, endoscopic treatment and quite often surgery. And not all of them will be cured by any of the medical and surgical measures.

Being easily available and cheap , bathroom cleaning acids are one of the commonest sources ingested for suicidal purposes. Accidental ingestion by toddlers and children is not uncommon.

These victims present with severe chest and abdominal pain, vomiting and burning sensation in the mouth which usually settles down in 2 - 3 days. They will then be able to swallow liquids and later solids. The real effect of acid injury to the food pipe will show after about 40-50 days after the incident when swallowing of liquids will also not be possible needing hospitalisation and treatment

The sordid saga will start from then on. Barium x-rays, endoscopic dilatation and often major abdominal surgery will be required to enable the patient to swallow. The involvement of mouth, voice box and upper food pipe makes surgery very difficult with poor outcomes. At times we resort ot silencing the voice box with a permanent tracheostomy to enable eating.

There will be huge drain on the family both emotionally and financially and the worst bit is that no one will have any sympathy to the patient.

Corrosive acid ingestion will not kill a person but will cause considerable damage. One has to be very careful with bathroom acids. these shouldnt be left in the bathroom within the reach of children.

Dr.Patta Radhakrishna MS MCh (GI Surgery)
Senior consultant Surgical Gastroenterologist
Apollo Hospitals, Chennai.

To be effective in treating stress, it’s important to be specific. With the Ayurvedic approach, we always try to target the etiological (causal) factors and then bring that area into balance. But we are careful not to create imbalance in other areas that may produce negative side effects.

Vata, Pitta and Kapha are the three psycho-physiological Ayurvedic principles (called doshas) that govern all the activities of the mind and body. A person enjoys perfect health if these principles are in perfect balance.
Each person’s constitution tends to be dominated by either one or two of these three doshas and very rarely by all three doshas. But whatever one’s constitution is, when a person goes out of balance, Vata destabilizes most easily. Vata is the dosha mainly affected by stress. We can explain this because Vata governs all movements in the body and the nervous system. This includes the in-and-out flow of the breath, the action of our limbs, the circulation of subtle energy in our organism, every current running through a nerve and the mind’s ceaseless flow of thoughts, words, and images. If there is too much movement in body or mind, which happens if stressed, the balance of Vata will be affected and imbalance created.

The nervous system becomes overstimulated with stress, creating an imbalance. Therefore Vata goes easily out of balance. Since dry, rough, airy, fast-moving, and irregularity are the core qualities of Vata, the Ayurvedic approach is to prescribe treatments, activities and foods that provide the opposite qualities: oiliness, grounding, slowness, heaviness, consistency and regularity.

There are three different manifestations of day-to-day stress from the perspective of Ayurveda - mental, emotional, and physical. Each requires different approaches and therapies.
Mental Stress
Mental stress, according to Ayurveda, is caused by an overuse or misuse of the mind. For instance, if you perform intense mental work many hours a day, or if you work long hours on the computer, it can cause an imbalance in Prana Vata, the mind-body operator concerned with brain activity, energy and the mind. The first symptom of Prana Vata imbalance is losing the ability to handle day-to-day stress. As the person becomes more stressed, it impacts mental functions such as dhi, dhriti, and smriti-acquisition, retention, and recall. The person’s mind becomes hyperactive, yet the person loses the ability to make clear decisions, to think positively, to feel enthusiastic, and even to fall asleep at night.
Therapies for mental stress
To address day-to-day mental stress, it is important to begin by managing mental activity. Secondly, you can take measures to pacify Prana Vata, for example, by:
• Favouring Vata-balancing foods, such as sweet, sour, and salty tastes, warm, nourishing, liquid and heavier foods
• Favouring warm milk and other light dairy products
• Performing a full-body warm oil self-massage everyday in the morning before the shower. This is called abhyanga in Ayurveda
• Doing breathing exercises (Pranayama) in the morning and evening
• Having a regular daily routine
• Eating meals at regular times and taking your time when you eat, avoiding eating on the run
• It is important to get plenty of rest, and if you are having trouble falling sleep, avoid stimulants like caffeine and sip on herbal tea instead. Relaxing aromatherapy and meditation can help calm the mind.
Emotional stress
Emotional stress can be caused by a problem in a relationship, the loss of a relative, or any situation that might hurt the heart. Emotional stress shows up as irritability, depression, and emotional instability. It affects sleep in a different way than mental stress - it can cause you to wake up in the night and not be able to go back to sleep.

Emotional stress disturbs Sadhaka Pitta, the mind-body operator concerned with the emotions and functioning of the heart.
Therapies for emotional stress
To balance emotional stress, you need to favour Pitta-pacifying foods and routine, such as:
• Favouring Pitta-pacifying foods such as the sweet, bitter and astringent tastes.
• Eating lots of sweet juicy fruits
• Drinking a cup of warm milk with cooling rose petal preserve or a pinch of fennel and cardamom before bed
• Cooking with Pitta-pacifying spices such as cardamom, coriander, cilantro (fresh coriander), fennel, and mint
• Going to bed before 10:00 p.m
• Taking regular breaks and time out avoiding overworking or trying to be an over achiever and Mr or Mrs Perfect. Moderation, don’t overwork.
• Keep cool. Avoid hot temperatures and food. Favour cool foods and drinks. Sweet, bitter and astringent tastes. Cool means at room temperature but not fridge or freezer temperature.
• Reduce spicy, pungent, sour, salty tastes and hot, oily foods.
• Allow for leisure time.
• Regular mealtimes, especially lunch at noon.
• Abhyanga (Ayurvedic oil massage) with cooling oil such as coconut.

All Pitta products: drink Pitta tea and season meals with Pitta churna (powder), practice cooling aromatherapy with Pitta aroma oil e.g. mint, sandalwood.
Physical stress
Physical stress is caused by misuse or overuse of the body, such as exercising too much or working for extended periods at a job that is physically taxing. This can cause a person to experience physical fatigue, along with mental fogginess, difficulty in concentrating, and dullness of the mind.

Excessive physical strain causes three sub-doshas to go out of balance: Shleshaka Kapha, the subdosha concerned with lubrication of the joints and moisture balance in the skin, Vyana Vata, which governs the circulation, nerve impulses and the sense of touch, and Tarpaka Kapha, which governs the neuro humors.
Another reason for physical stress can be too little exercise, which results in a sluggish digestion and the formation of ama, the digestive impurities that clog the channels. In either type of physical fatigue, the process of regenerating cells slows down, and thus the cells themselves become physically tired.
Therapies for physical stress
The solution is to balance Vata and to support Kapha to make the body more stable and nurturing, for example, by:
• Getting adequate rest and moderate exercise
• Taking breaks and time out
• Following a Vata-Kapha pacifying diet (like warm meals, not to light nor to heavy or oily, see your Ayurvedic practitioner for more particular information)
• Eating regularly and avoiding to eat on the run
• Performing the full-body warm oil self massage everyday

Dumping syndrome refers to a group of GI and vasomotor symptoms that occurs following ingestion of a meal post gastric surgeries. Alterations of gastric anatomy by surgery including resection or bypass of the pylorus and interference with gastric innervation effects the rate of gastric emptying.The accomodation and cyclic contractility of the stomach in response to distention are abolished after partial gastrectomy allowing immediate dumping of gastric contents into the jejunum.
There are two types of dumping. Early dumping which occurs as a result of rapid emptying of sugars or CHO from the gastric pouch (post gastric bypass) into the small intestine which causes the release of hormone (gut peptides) that effects the B.P, heartrate, skin flushing & intestinal transit.
The symptoms occur 30-60min after eating and can last upto an hour. Sweating, flushing lightheadedness, tachycardia, palpitations, desire to lie down, epigastric fullness, nausea, vomiting, diarrhea, cramping and active audible bowel sounds are seen.
Late dumping which occurs 1-3 hours after a meal is related to increased insulin with subsequent reactive hypoglycemia. Symptoms include sweating shakiness, loss of concentration, hunger fainting or passing out. Severe dumping can lead to malnutrition .
The diagnosis is primarily made by obtaining a history of the presence of classic symptoms related to food intake. Dietary compliance with avoidance of refined sugars, high glycemic carbohydrates or other food associated with the syndrome would be the primary treatment. Late dumping that persists may be treated with small amount of sugar about an hour after a meal. Medications such as sandostatin or octreotide may be helpful. May need surgical management where it cannot be managed medically.

Aphim is a vish-dravya.
Guna – sukshma, ruksha
Ras – tikta kashay
Vipak – katu
Veerya – ushna
Prabhav – maadak
Doshagnata – kaphavaatshaamak, pittaprakopak
Overdose – ojakshay and tadjanya vaatprakop- pralapadi lakshanas and mrutyu.
Dose - 1/4 to 1 gunja. (in less dose – uttejak. In large doses – avasaadak)
Kalpa – ahiphenasav, nidroday vati, karpur ras, dugdha vati etc.
Aphim shuddhi - Firstly dissolve in water, filter it and boil it on low- flame. After that give 21 bhavanas of ardrak swaras to dried aphim. By this aphim get shudhdh but vishatava does not vanish.
Chemical composition of Aphim –
There are 29 active principles in aphim, mainly morphin, codeine, thebaine and narcotine .

Rogaghnata –
1) As it is vyavaayi-vikasi-maadak and ushna in guna, acts well as vedana-sthaapak, nidrajanan and akshepaghna. Useful in udarshool, ashmari-shool, grudhrasi-shool, parshwa-shool. Useful in Nidranaash. As it is akshepaghna so useful in Apasmaar, apatantrak, kampavaat, dhanusthambh, kuchala-vishbadha.
2) Useful in ati-lala-straav. Aamashayshoth, pakvatisaar, vaatatisaar, vishuchika-prarambhik avastha.
3) Hrudbalya. Raktastambhak, hrudayksheenatajanya shwaas, hrudshool.
4) Shwasankendre avasaadak. Kaphanashak , shwasaghna, vaat-kaphaja kaas, phuphphusavaran-shoth, peenas
5) Purushatva-ghatak. But shukrastambhan is there due to aphim. So in shighra-patan it is useful

Absorption and Excretion –
Amashaye – mand-shoshan
Antra – shighra – shoshan
90% of aphim is excreted by mutra and remaining 10% through purish, sthanya, amashaygat ras and sweda.
Generally within 6 hours, aphim is excreted from body. 75% of aphim is excreted within 24 hours through mutra.
Aphim – where should not be given ? –
1)phuphphusavaran-shoth
2)chhinna-shwaas
3)mastishkavaran-shoth
4)jwar and ati-shramjanya mastishkagat raktastraav
5)Serious vrukka vikruti specially uremia
6)In baal rugna and vrudhdha rugna
7)Generally addiction of aphim is seen if given for long time in jeerna-vyadhi

Lakshana of aphim-vish-badha -
1)tandra
2)nidra
3)sanyaas
4)avasaad
5)shwasavarodh
6)mrutyu

Firstly netra-tarakaa (pupils) sankuchan (pin pointed) is seen. But before few minutes of death they are dilated. Generally avasaad is seen in 4-6 hours and death is seen in 6-12 hours.
Death by aphim is not so painful. On the contrary, patient of phim death doen not know that he is dying.
Upachaar for aphim-vish-baadha –
1)shodhan - arishta(ritha)- jal or sarshap sidhha jal for vaman. Stomach wash till clean water returns.
2)antidotes of aphim – Ritha, Hing, Amalaki, Erand, Karpaas, Dronapushpi, Ghrut, Tejapatra, Nimb, Patha
Take care - the patient should not sleep till aphim vish-badha vanishes.

Bariatric surgery denotes surgical operations on the stomach to drastically reduce its size and capacity in an attempt reduce body weight in patients who are morbidly obese.

Obesity has become an important medical problem in India now. Over weight is a phenomenon which is on the rise . Childhood obesity seen in affluent classes evetually leads on to adult obesity. It is now not uncommomn to see plump and overweight children in every classroom in convent schools. This phenomenon is due to overeating and eating all the wrong foods. Quite often this is due to parental pressure to eat well and these children are generally force fed.

There are many medical conditions which develop in obese individuals like diabetes, hypertension, osteo-arthritis, breathing problems , sleep apnoea, snoring.

There is no medical treatment for obesity. Diet restriction is the main stay and curtailing the volume of food intake definitely reduces weight. But then to maintain a lower weight for longer times is often difficult. Physical exercise on a daily basis benefits obese patients immensely.

Definitive treatment for morbid obesity is surgery. There are many operations for obesity but the commonest ones are the gastric bypass and sleeve resection of stomach. Effectively these operations reduce the capacity of the stomach drastically thereby curtailing the volume of food intake leading on to reasonable weight loss.

So please get your height and weight checked and you'll know whether you are overweight. If you are obese - then do something about it - today.


Dr.Patta Radhakrishna MS MCh
Con surgical gastroenterologist & Lap surgeon
Apollo Hospitals, Chennai.