physician watching the documentary about the Olympic archery

 As a physician watching the documentary about the Olympic archery hopeful from India what was very striking to me was the episode where she is examined by a physician and Mumbai and he says that she may be suffering from bicipital tendinitis and administers a steroid injection because she has to go for a competition and cannot afford to wait it out to heal the injury.
What I do not understand was whether the documentary maker did not capture the whole interaction between the physician and the spokesperson and the complete examination details are that the physician simply made the diagnosis after listening to the coach/ trainer more than the spokesperson herself so what kind of a sports doctor is that he is am really unhappy about the whole situation and as I have decided to make this my retirement hobby I'm going to research this to the full extent and see whether it is really bicipital tendinitis which was causing Deepika Kumari's pain in the shoulder when she was drawing the arrow.

villambulu , Dipika kumari ,విల్లంబులు, धनुष और बाण दीपिका कुमारी My interest in Archery. good hobby for retirement

Anatomy of the Shoulder The shoulder is the most mobile joint in the entire body. The shoulder joint is a ball and socket joint that allows movement in all three planes of motion. The major bone structure of the shoulder consists of the clavicle (collarbone), the scapula, the humerus (the top bone of the arm), the vertebrae of the spine, and the rib cage. Many muscles act on the shoulder joint. The muscles can be divided into two categories: the major muscles and the rotator cuff muscles. Five major superficial (close to the surface) muscles act on the shoulder joint resulting in the arm and upper back movement (see figure 5.2). The largest of the


muscles are the muscles of the chest and the large muscles of the back. The muscles Of the chest and back are antagonist muscles; they balance each Other during the archery draw. You need to balance the development Of antagonist muscles. An imbalance in strength between antagonist muscles can cause injury. The three remaining major muscles Of the shoulder are the front, the side, and the back deltoids. These muscles must be developed equally to protect the shoulder joint during the repetition Of the archery draw. The rotator cuff muscles are a group of four small muscles deep in the shoulder joint. Even though these muscles are small, they hold and stabilize the arm when it is extended (e.g., during the movement Of the archery draw). These muscles run between the upper arm and the back. The muscles are small and easily injured through overuse secondary to the improper development and error in training. Rotator Cuff Injuries The most common injury to the shoulder joint is shoulder impingement syndrome. Impingement syndrome is a very painful condition caused by the inflammation 

 Anatomy of the Shoulder The shoulder is the most mobile joint in the entire body. The sho

scapula when the arm or shoulder is moved. If left untreated, chronic bursitis and impingement syndrome can cause debilitating pain. If the archer "works through" the pain, permanent injury can result when the tendons are torn from their bony attachments. Surgery and extensive rehabilitation are required to repair the damage. The initial symptom of impingement syndrome is pain when the arm is held over the head. Untreated impingement syndrome leads to pain when extending the arm forward (e.g„ to shake hands). Pushing motions will also cause pain. Treatment for impingement syndrome starts with rest. A physician should be consulted if the pain persists after an extended (two weeks) period of rest, if the pain has increased, or if the archer has had the pain for more than a rnonth. Pushing movements must be avoided during the healing period. If the damage to the rotator cuff is minor, the physician will prescribe a strength program for the entire shoulder, back, and chest. In addition. exercises specific to rotator cuff development will be added when the muscles have healed. If the damage is severe and involves tearing of the tendons, the only recourse may be surgery. Rotator cuff injury can be prevented by strengthening the rotator cuff muscles, the shoulder, and the chest and back muscles and by following a com- plete flexibility program.


Flexibility Training The final element of a well-balanced fitness program is flexibility. Flexibility exerciæs increase the range Of motion Of the joints, elongate the muscles, provide a warm-up and cool-down Of the body, and decrease the risk Of injury. A stretching program should include a series Of slow stretches Of each body part. Flexibility is especially important for archers. Archery practice usually involves shooting hundreds of arrows over extended periods. Archers spend most Of their training and competi- tion day on their feet, frozen in their archery stance, which causes the muscles to Cool down and shorten. To maintain optimum muscle performance, archers should stretch at least once an hour during competitions and training. A comprehensive stretching program increases the range Of motion Of the joints and is the perfect way to relax the body and mind after a long day of training. A flexible joint has a complete range Of motion (ROM). ROM is defined as the ability Of a joint to move freely in every direction. Joint mobility is limited by the joint structure, the elasticity and strength Of the surrounding muscles, and the connective tissue of the joint. Flexibility training minimizes these factors. Like other aspects of physical conditioning, ROM can be improved with a complete flexibility training program. Warming Up Before performing any stretching activity, warm up the muscles. Your warm- «apula when arm or shoulder is moved. If left untreat«i, and impingement syndrome can cause debilitating pain. If the

oints of Pectoral Girdle: Anatomy of Shoulder Joint, Acromioclavicular Joint and Sternoclavicular Joint

Pectoral Girdle

Pectoral Girdle or Shoulder Girdle connects the free part of the upper limb with the trunk. It consists ofscapula and clavicle on each side. A series of anatomical organization makes the girdle extremely mobile. The mobility of scapula is essential for free movement of upper limb. The clavicle acts as a strut which holds the scapula laterally allowing the upper limb to swing freely from the side of the trunk. 

Pectoral girdle consists of three joints: i) Sternoclavicular joint, ii) Acromioclavicular joint and iii) Glenohumeral joint. The scapula is connected to the clavicle and humerus (bone of the arm) by acromioclavicular and glenohumeral joints respectively. The upper limb and pectoral girdle are connected to the trunk (axial skeleton) only through the sterno-clavicular joint. Scapula does not make any anatomical joint with axial skeleton rather it is connected to the vertebral column and thorax only by the muscles. This connection of scapula with the thorax is sometimes referred as conceptual scapula-thoracic joint orphysiological scapula-thoracic joint. Thus the extremely mobile pectoral girdle is supported and stabilized by the muscles that are attached to the ribs, sternum and vertebrae. 

Joints of Pectoral Girdle

Sternoclavicular Joint

Type: Saddle type of synovial joint.

Articulation:

The sternal end of the clavicle articulates with the manubrium sterni and the first costal cartilage.

Capsule: This surrounds the joint and is attached to the margins of the articular surfaces.

Synovial membrane: This lines the inside of capsule and extends to the margins of the cartilage covering the articular surfaces.

Ligaments:

Anterior and Posterior sternoclavicular ligaments reinforce the capsule from the front and behind.  

Interclavicular ligament strengthens the capsule superiorly. It extends from sternal end of one clavicle to the sternal end of the other.

Costoclavicular ligament connects the inferior surface of sternal end of clavicle to the 1^st rib and its costal cartilage.

Articular disc: It is a fibrocartilaginous disc which divides the interior of the joint into two compartments. The peripheral margin of the disc is attached to the interior of the capsule. It is also strongly attached to the superior margin of the articular surface of the clavicle above and to the first costal cartilage below.

Movements:

It is very mobile to allow movements of the pectoral girdle and upper limb. The movements that occur in SC joint are: forward and backward movements and elevation and depression. During full elevation of upper limb the clavicle is raised to approximately a 60⁰ angle.

Muscles producing the movement:

Forward movement: Serratus anterior

Backward movement: trapezius and rhomboids

Elevation: trapezius, sternocleidomastoid, levator scapulae and rhomboids

Depression: pectoralis minor and subclavius

Nerve supply: The supraclavicular nerve and the nerve to the subclavius muscle.

Blood supply: by internal thoracic and suprascapular arteries.

Acromioclavicular Joint

Type: Plane synovial joint

Articulation: lateral end of clavicle articulates with the acromion of the scapula.

Capsule: Capsuleis relatively loose and is attached to the margin of the articular surfaces. From the capsule an incomplete wedge shaped fibrocartilaginous disc projects into the joint cavity from the above.

Ligaments: Superior and inferior acromioclavicular ligaments reinforces the capsule. The integrity of the joint is maintained by the extrinsic ligament called coracoclavicular ligament. It consists of a pair of strong bands that connect the coracoid process of scapula to the clavicle. The coracoclavicular ligament consists of two parts: conoid and trapezoid part.

The conoid ligament is cone shaped with its apex directed downward and attached to the root of the coracoid process and its base to the conoid tubercle on the undersurface of the clavicle. The trapezoid ligament is extends laterally for its attachment from the superior surface of coracoid process to the trapezoid line on the inferior surface of the clavicle. The coracoclavicluar ligament is also responsible for suspending the scapula and free limb from clavicular strut.

Movement: A gliding movement takes place when the scapula rotates or when the clavicle is elevated or depressed. The thoraco-appendicular muscles that attach to and move the scapula cause the acromion to move on the clavicle.

Nerve supply: Supraclavicular, lateral perctoral and axillary nerves

Blood Supply: Suprascapular and thoracoacromial arteries

 

Glenohumeral Joint

Glenohumeral joint is also called shoulder joint.

Type: Ball and Socket synovial joint

Articulation: occurs between the large rounded head of the humerus and a shallow glenoid cavity of the scapula. The articular surfaces are lined by the hyaline cartilage. The shallow glenoid cavity is deepened by a fibrocartilaginous tissue called glenoid labrum. The cavity receives more than a third of humeral head which is held in position by the tonus of the musculotendinous rotator cuff muscles.

Capsule:

The fibrous capsule surrounds the joint and is relatively thin and lax allowing the greater range of movement. Superiorly it is strengthened by the fibrous slips from the rotator cuff muscles. Inferiorly it is relatively weaker and is common site for dislocation of the joint.

 

Attachment of the capsule:

Medially – it is attached to the margin of the glenoid cavity outside the labrum. It also enclosed the origin of long head of biceps brachii.

Laterally – it is attached to anatomical neck of humerus except at two places, a) upper end of bicipital groove to allow the passage of tendon of long head of biceps brachii and b) inferomedially, the line of attachment extends downward for about 1 cm to the surgical neck.

Synovial Membrane: it lines the inside of the capsule and reflects from it onto the glenoid labrum and humerus as far as the articular margin of the head. It forms a tubular sheath around the long tendon of biceps brachii. It passes through the anterior wall of the capsule to form the subscapular bursa beneath the subscapularis muscle.

Ligaments:

Glenohumeral ligament

Coracohumeral ligament

Transverse humeral ligament

Coracoacromial ligament (accessory ligament)

Glenoid labrum

Glenohumeral and coracohumeral ligaments are the thickening of joint capsule that strengthens the anterior and superior aspects of the capsule respectively.

Glenohumeral ligaments are three fibrous bands, evident only on the interior of the joint capsule. The superior, middle and inferior bands of the glenohumeral ligaments are attached medially to the superomedial margin of glenoid cavity and blends with glenoid labrum. Laterally, all three bands radiate and are attached to the upper part of lesser tubercle, lower part of lesser tubercle and lower part of anatomical neck respectively.

The coracohumeral ligament extends from the root of the coracoid process to anatomical neck opposite the greater tubercle of the humerus.

The transverse humeral ligament bridges the gap between the two tubercles and strengthens the capsule.

Coracoacromial ligament is an accessory ligament which along with the inferior aspects of acromion and coroacoid process of scapula forms coracoacromial arch and protects the superior aspect of the joint as it prevents the superior displacement of humeral head. A subacromial bursa intervenes between the arch above and the tendon of supraspinatus and greater tubercle below.

Glenoid labrum:

It is made up of fibrocatilaginous tissue and helps deepening the glenoid cavity. It is attached to the margin of the glenoid cavity except above from where the long head of biceps brachii arises.

Movements at shoulder joint:

The shoulder joint has greater mobility. (Its stability has been compromised at the cost of the mobility as compared to hip joint which has greater stability but has limited range of movements). The freedom of movement is mainly due to the thin and lax capsule and the large size of humeral head compared to the receiving socket provided by the glenoid cavity. The glenohumeral joint produces movements around three axes and permits flexion-extension, adduction-abduction, medial-lateral rotation and circumduction.

Flexion and Extension:

Flexion and extension take place right angle to the plane of the body of scapula around an axis that passes through the humeral head and center of glenoid cavity. Flexion moves the arm forward and medially and is about 90⁰. Extension moves the arm backward and laterally and is about 45⁰.

Adduction-abduction:

Abduction and adduction take place parallel to the plane of the body of scapula around an axis which passes through the head of humerus and is parallel to the glenoid cavity. The abduction carries the arm laterally and adduction medially. During adduction the arm can be swung 45⁰ across the front of the chest.

Mechanism of Abduction:

Abduction of the arm is accomplished by movement at shoulder joint as well as by the rotation of scapula at conceptual scapula-thoracic joint. The abduction is initiated for the first 15⁰ by supraspinatus muscle which also holds the head of the humerus against the glenoid cavity. The later action then allows deltoid to take over and complete the further abduction. The limb can be elevated by 180⁰ during abduction. Except for the first 30 degree of abduction which occur due to movement at shoulder joint only, in every 15⁰elevation, 10⁰ occurs at shoulder joint and 5⁰ by rotation of scapula at conceptual scapula-thoracic joint in the ration of 2:1. When the arm is abducted to 90⁰, the further elevation is prevented as the articular surface is exhausted and the greater tubercle impinges on the lateral edge of acromion. The further elevation is then accomplished by the lateral rotation of humerus by 180⁰ which brings the greater tubercle posteriorly thus providing more articular surface to continue elevation. From 120⁰-180⁰, the abduction is accomplished by the rotating the scapula.  

Medial and lateral rotations:

The plane producing these movements is a vertical axis passing through center of the humeral head to the center of the capitulum. In a semi-flexed elbow, the medial rotation at shoulder joint carries the hand medially and lateral rotation moves the hand laterally.

Circumduction:

It is a combination of above mentioned movements so that the lower end of the humerus defines the base of the core and the humeral head forms apex of the cone.

Muscles producing the movements at shoulder joint:

Flexion: Anterior fibers of Deltoid, Pectoralis Major and Coracobrachialis (weak flexor)

Extension: Posterior fibers of Deltoid, Latissimus Dorsi and Teres Major

Abduction: Supraspinatus (initial 15⁰) and Deltoid

Adduction: Pectoralis Major, Latissimus Dorsi, Teres Major and Subscapularis

Medial Rotation: Subscapularis, Latissimus dorsi, Teres Major, Pectoralis Major, Anterior Fibers of Deltoid

Lateral Rotation: Infraspinatus, Teres Minor and Posterior Fibers of Deltoid

Factors stabilizing the shoulder joint:

As noted earlier, the shoulder joint is relatively weaker joint owing to its thin and lax joint capsule, greater mobility and shallow glenoid fossa to receive larger head of the humerus.

Rotator cuff: The tendons of small muscles namely subscapularis, supraspinatus, Infraspinatus and teres minor on their way to insertion on humerus flatten and blend with each other and with the fibrous capsule of shoulder joint. The tone of these muscles support and strengthen the shoulder joint from the front, above and from the behind.

Glenoid labrum: this fibrocartilaginous tissue deepens the glenoid cavity.

Glenohumeral and Coracohumeral ligaments support the joint from anterior and superior aspects respectively.

The coracoacromial arch prevents the upwards displacement of the joint. Similarly, the tendon of long head of biceps brachii also holds the head of the humerus in position during abduction. Similarly, the downward displacement of humerus during abduction is prevented by the long head of triceps brachii.

Blood Supply:

Anterior circumflex humeral artery, branch of third part of axillary artery

Posterior circumflex humeral artery, branch of third of axillary artery

Branches of suprascapular artery, branch of thyrocervical trunk of subclavian artery or directly from subclavian artery

Nerve Supply:

Axillary nerve and suprascapular nerve

REFERENCES:

Following resources are used while preparing this post (readers are strongly recommended to go through them for more details):

Gray's Anatomy

K. L. Moore's Clinically Oriented Anatomy

R. Snell's Clinical Anatomy

In 1932 Klopsteg
"The archery files include correspondence and related materials, published articles, and speech manuscripts. A substantial folder of correspondence with Erle Stanley Gardner concerns their mutual interest in archery. Also of interest are four folders of correspondence with A.J. Costner, a pioneer in the resurgence of archery who also worked with the Pima Indians. Clippings also are included here. Several pertain to "Little Joe," the secret bow-pistol Klopsteg designed during World War II (Box 6, Folder 3; Box 9, Folder 3)."
Earl Hoyt
pope
 Erle Stanley Gardner 

A.J. Costner

VITAMIN DAILY RECOMMENDATION

DAILYRECOMMENDED DIETARYALLOWANCE (RDA) FOR ADULTS VITAMIN

 BEST FOOD SOURCES
  ROLEIN HEALTH MALES 19+ FEMALES 19+
SYMPTOMS OF DEFICIENCY
SYMPTOMS OF EXCESS FAT-SOLUBLE VITAMINS
Vitamin A
 (from retinols in animal products or beta-carotene in plant foods) Retinols: Liver; salmon and other coldwater fish; egg yolks; fortified milk and dairy products. Betacarotene: Orange and yellow fruits and vegetables, such as carrots, squash, and cantaloupes; leafy green vegetables. Prevents night blindness; needed for growth and cell development; maintains healthy skin, hair, and nails, as well as gums, glands, bones, and teeth; may help prevent lung cancer. 900 mcg 700 mcg Night blindness; stunted growth in children; dry skin and eyes; increased susceptibility to infection. Headaches and blurred vision; fatigue; bone and joint pain; appetite loss and diarrhea; dry, cracked skin, rashes, and itchiness; hair loss. Can cause birth defects if taken in high doses before and during early pregnancy.


Vitamin D (calciferol)
 Fortified milk; fortified soy and rice beverages; butter; egg yolks; fatty fish; fishliver oils. Necessary for calcium absorption; helps build and maintain strong 15 mcg (20 mcg after 15 mcg (20 mcg after age 70) Weak bones, leading to rickets in children and osteomalacia Headaches, loss of appetite, diarrhea, and possible calcium deposits in Also made by the body when exposed to the sun. bones and teeth. age 70) in adults. heart, blood vessels, and kidneys.

Vitamin E (tocopherols) Eggs, vegetable oils, margarine, and mayonnaise; nuts and seeds; fortified cereals. Protects fatty acids; maintains muscles and red blood cells; important antioxidant. 15 mg 15 mg Unknown in humans. Excessive bleeding, especially when taken with aspirin and other anticlotting drugs.

Vitamin K Spinach, broccoli, and other green leafy vegetables; liver. Essential for proper blood clotting. 120 mcg* 90 mcg* Excessive bleeding; easy bruising. May interfere with anti-clotting drugs; possible jaundice.

WATER-SOLUBLE VITAMINS
Biotin
Egg yolks; soybeans; whole grains; nuts, and yeast. Energy metabolism. 30 mcg* 30 mcg* Scaly skin; hair loss; depression; elevated blood cholesterol levels. Apparently none. Folate (folic acid, folacin) Liver; yeast; spinach and other leafy green vegetables; asparagus; orange juice; fortified Needed to make DNA, RNA, and red blood cells, and to synthesize certain amino acids. Important for women to have 400 mcg 400 mcg Abnormal red blood cells and impaired cell division; anemia; weight loss and intestinal May inhibit absorption of phenytoin, causing seizures in those with epilepsy taking this drug; large flour; avocados; legumes. sufficient folate before and after pregnancy to prevent birth defects. upsets; deficiency may cause birth defects. doses may inhibit zinc absorption.
 Riboflavin (vitamin B2) Fortified and enriched cereals and grains; lean meat and poultry; milk and other dairy products; fortified soy and rice beverages; raw mushrooms. Essential for energy metabolism; aids adrenal function; supports normal vision and healthy skin 1.3 mg 1.1 mg Vision problems and light sensitivity; mouth and nose sores; swallowing problems. Generally none, but may interfere with cancer chemotherapy. Depression Thiamine (vitamin B1) Pork; legumes; nuts and seeds; fortified cereals; and grains. Energy metabolism; helps maintain normal digestion, appetite, and proper nerve function. 1.2 mg 1.1 mg (1.5 mg after age 50) and mood swings; loss of appetite and nausea; muscle cramps. In extreme cases, muscle wasting and beriberi.

Niacin (vitamin B3, nicotinic acid, nicotinamide)
 Lean meats, poultry, and seafood; milk; eggs; legumes; fortified breads and cereals. Needed to metabolize energy; promotes normal growth. Large doses lower cholesterol. 16 mg 14 mg Diarrhea and mouth sores; pellagra (in extreme cases). Hot flashes; liver damage; elevated blood sugar and uric acid. Pantothenic acid (vitamin B5) Almost all foods. Aids in energy metabolism; normalizing blood sugar levels; and synthesizing antibodies, cholesterol, hemoglobin, and some hormones. 5 mg* 5 mg* Unknown in humans. Very high doses may cause diarrhea and edema.



Deficiency of other B vitamins.
 Vitamin B6 (pyridoxine, pyridoxamine, pyridoxal) Meat, fish, and poultry; grains and cereals; bananas; green leafy vegetables, potatoes, and soybeans. Promotes protein metabolism; metabolism of carbohydrates and release of energy; proper nerve function; synthesis of red blood cells. 1.3 mg (1.7 mg after age 50) 1.3 mg (1.5 mg after age 50) Depression and confusion; itchy, scaling skin; smooth, red tongue; weight loss. Sensory nerve deterioration.

 Vitamin B12 (cobalamins) All animal products. Needed to make red blood cells, DNA, RNA, and myelin (for nerve fibers). 2.4 mcg 2.4 mcg Pernicious anemia; nerve problems and weakness; smooth or sore tongue. Apparently none. Vitamin C (ascorbic acid) Citrus fruits and juices; melons and berries; peppers, broccoli, potatoes; and many other fruits and vegetables. Strengthens blood vessel walls; promotes wound healing; and iron absorption; helps prevent atherosclerosis; supports immunity; key antioxidant. 90 mg 75 mg Loose teeth; bleeding gums; bruises; loss of appetite; dry skin; poor healing. In extreme cases, scurvy and internal hemorrhages. Diarrhea; kidney stones; urinary-tract irritation; iron buildup; bone loss. Below are the Institute of Medicine’s recommendations for daily mineral intake. The amounts may vary for pregnant and lactating women. MINERAL
 DAILY RECOMMENDATIONS
  DAILYRECOMMENDED DIETARY ALLOWANCE(RDA) FOR ADULTS MINERAL
 BEST FOOD SOURCES
ROLEIN HEALTH MALES 19+ FEMALES 19+ DAILY TOLERABLE UPPER INTAKE LEVELS (UL) FOR ADULTS OVER 19

  MACROMINERALS Calcium Milk and milk products; fortified soy and rice beverages; canned sardines and salmon (including bones); dark green vegetables; tofu. Builds strong bones and teeth; vital to muscle and nerve function, blood clotting, and metabolism; helps regulate blood pressure. 1,000 mg* 19– 50 years; 1,200 mg* 51+ 1,000 mg* 19– 50 years; 1,200 mg* 51+ 2,500 mg Magnesium Leafy green vegetables; legumes and whole grain cereals and breads; meats, poultry, fish, and eggs; nuts. Stimulates bone growth; necessary for muscle and nerve function and metabolism; supports immunity. 400 mg 19–30 years; 420 mg 31+ 310 mg 19–30 years; 320 mg 31+ 350 mg** Phosphorus Meat, poultry, fish, egg yolks; legumes; dairy Helps maintains strong bones and teeth; component of some enzymes; 700 mg 700 mg 4,000 mg products. essential for proper metabolism.

MICROMINERALS Chromium Brewer’s yeast, whole grain products; liver; cheese; chicken; mushrooms; molasses; shellfish; legumes; nuts; prunes. Works with insulin to metabolize glucose. 35 mcg* 19–50 years; 30 mcg* 51+ 25 mcg* 19–50 years; 20 mcg* 51+ Not established Copper Liver, meat, shellfish; legumes; nuts and seeds; prunes; whole grains. Promotes iron absorption; essential to red blood cells, connective tissue, nerve fibers, and skin pigment. Component of several enzymes. 900 mcg 900 mcg 10,000 mcg Fluoride Fluoridated water; tea. Helps maintain strong bones and teeth. 4 mg* 3 mg* 10 mg Iodine Iodized salt, seafood, foods grown in iodinerich soil. Necessary to make thyroid hormones. 150 mcg 150 mcg 1,100 mcg Liver, meat, seafood; eggs; legumes; Needed to produce hemoglobin, 18 mg 19–50 Iron fortified cereals; dried fruits; whole grains; leafy greens; nuts and seeds. which transports oxygen throughout the body. 8 mg years; 8 mg 51+ 45 mg Manganese Tea; nuts and seeds; legumes; bran; leafy greens; whole grains; egg yolks. Component of many enzymes needed for metabolism; necessary for bone and tendon formation. 2.3 mg* 1.8 mg* 11 mg Molybdenum Liver and other organ meats; dark green leafy vegetables; whole grain products, legumes, nuts. Component of enzymes needed for metabolism; instrumental in iron storage. 45 mcg 45 mcg 2,000 mcg Selenium Brazil nuts and other nuts; fish, seafood; whole grain products; onions, garlic, mushrooms; brown rice; organ meats. Antioxidant that works to protect cell membranes from oxidative damage. 55 mcg 55 mcg 400 mcg Zinc Oysters, meat, poultry; yogurt, milk, eggs; wheat germ; nuts; legumes. Instrumental in metabolic action of enzymes; essential for growth and reproduction; supports immune function. 11 mg 8 mg 40 mg With sodium, 2,300 mg* 19- 2,300 mg* 19- Chloride Table salt; seafood; milk, eggs, meat. maintains fluid balance and normal cell functions. 50 years ; 2,000 mg* 50- 70 years; 1,800 mg* 71+ 50 years ; 2,000 mg* 50- 70 years; 1,800 mg* 71+ 3,600 mg Potassium Avocados, bananas, citrus and dried fruits; legumes and many vegetables; whole grain products; dairy products. Along with sodium, helps to maintain fluid balance; promotes proper metabolism and muscle function. 4,700 mg 4,700 mg Not established Sodium Table salt; dairy products; seafood; seasonings; most processed foods. With potassium, regulates the body’s fluid balance; promotes proper muscle and nerve function. 1,500 mg* 19- 50 years; 1,300 mg* 50-70 years; 1,200mg* 71+ 1,500 mg* 19- 50 years; 1,300 mg* 50-70 years; 1,200mg* 71+ 2,300 mg *These values represent daily Adequate Intake (AI). These tables presents daily Recommended Dietary Allowances (RDAs), except where there is an asterisk. The RDAs are set to meet the known needs of practically all healthy people. The term Adequate Intake is used rather than RDA when scientific evidence is insufficient to estimate an average requirement. **The UL for magnesium represents intake from a pharmacological agent only and does not include intake from food and water. Source: Institute of Medicine, Food and Nutrition Board. National Academy Press, Washington, D. C

కొత్తిమీర నిలువ పచ్చడి

కొత్తిమీర నిలువ పచ్చడి

కావలసిన సామాగ్రి

1.కొత్తిమీర  250 gm/ గ్రా
2.చింతపండు 125 gm/ గ్రా
3.ఎండు మిర్చి  50  gm/ గ్రా
4.శనగ పప్పు   1/4 కప్
5.మినపప్పు  1/8 కప్
6.ధనియా  1/4 కప్
7.జీలకఱ్ఱ  1/8 కప్
8. ఉప్పు  100   gm/ గ్రా
9. పసుపు 1/2 టీ . స్పూ
10. బెల్లం  1/8 కప్
 తాలింపు గింజలు

3.ఎండు మిర్చి  50  gm/ గ్రా
4.శనగ పప్పు   1/4 కప్
5.మినపప్పు  1/8 కప్
6.ధనియా  1/4 కప్
7.జీలకఱ్ఱ  1/8 కప్
 వీటిని  ఒక చెం చా నూనె తో   లేదా పొడిగా/డ్రై రోస్ట్  (వేయించి )
ఒక మిక్సి లో  పోడి  చేసి పక్కనపెట్టుకొని
కొత్తిమీర లో కాడలు లేకుండా చేసి తరవాత సన్నగా తురిమి
బాండిలో నూనె వేసి  కొత్తిమీరలో  నీరు పోయి  డ్రై గా అయ్యేవరకు వేయించాలి
తరవాత  చింతపండు ,పసుపు, ఉప్పు వేయించిన  కొత్తిమీరను  పైన  పొడిచేసి న  మిశ్రమం తో  (  బెల్లం  మిక్సీలో వేసి  రుబ్బి  ఒక బాండిలో వేసి తాలింపు కలిపి  ఒక జాడీలోకి తీసుకుంటే   ఒక వరం రోజులు నిలువ ఉంటుంది
 గాలి తగలకుండా  ఫ్రిజ్ లో ఉంచితే  ఇంకా ఎక్కువకా రోజుల వరకు  నిలువ  ఉంటుంది

the secret to a healthy diet ! you have to earn every calorie you eat.!

1. In 1985  Boyd Eaton and MELVIN KONNER wrote a paper titled “Paleolithic Nutrition: A Consideration of Its Nature and Current Implications,” which appeared in The New England Journal of Medicine.
2. Our ancestors ate meat, fish and plant foods from the wild, but in what proportions? compiled data from 20th-century studies of what recent hunter-gatherers ate and tried to come up with a composite picture.
3. Whatever the ratio, our theory was that early humans who made it past the gauntlet of childhood microbes—which led to very high infant mortality and low life expectancy on average—would be much less likely to suffer the plagues of modern life: diabetes, heart disease, stroke, cancer.
4. Anthropologists estimated that their diet was 70% plant foods—a surprise to those who thought of ancestral humans as hunters first.
5. One fascinating new finding is that within the last few thousand years Eskimos evolved genes for enzymes to process the fatty acids in Arctic fish. ( go eat that blubber  you  stupid Atkins  and  VEERmachaneni Ramakrishna )
6. Our ancestors ate meat, fish and plant foods from the wild, but in what proportions? 
7. How do we know that we haven’t adapted to the average American diet? Because Twinkies and sodas have been around too short a time for evolution to deal with them.
8. In a 2014 paper in the Journal of Human Evolution, Amanda Henry and her colleagues found that even our Neanderthal cousins ate barley broth along with their steaks.
9. We reasoned that if other animals have certain diets that are natural to them—pet lovers will recognize this idea—then humans might, too.
10. Once thought of as extreme carnivores, Neanderthals were actually diet opportunists, just like our own direct ancestors.
11. We’d be wise to limit salt and saturated fat, which our ancestors’ prey had little of, and fiber and omega-three fatty acids seem to be good.
12. Our ancestors’ watchword was to eat while you can, the more calories the better—which didn’t do much harm when you had to earn every calorie and the spectrum of foods was healthier.
13. We still think that a mismatch between the lifestyle to which our genes are adapted and current habits helps to explain these new epidemics.
14. the “paleo diet” faddists urge their disciples to keep all carbs to a palm-size mound a day.
15. In 1985 scientists believed that few genetic changes had occurred since we were all hunting and gathering, say 10,000 years ago.
16. All of these strategies—low-carb paleo diets, too—seem to be compatible with life and health.
17. Anthropologists know that people obsess about diet.

Protein not just the bodybuilder

1. Animal protein (with the exception of gelatin) provides all nine essential amino acids in the proportions required by the body and is therefore referred to as complete, or high-quality, protein.
2. Plant Protein In contrast, plant proteins (with the exception of soy) lack one or more of the essential amino acids.
3. DNA (deoxyribonucleic acid), the genetic material that is found in the nucleus of each body cell, provides the blueprint for how amino acids are arranged to form individual proteins.
4. Keratin, still another type of protein, is used by the body to make hair and nails.
5. Connective tissue made from protein forms the matrix of bones.
6. Just as the letters in the alphabet are joined to make words, so too are amino acids arranged in an almost infinite number of different ways to form the more than 50,000 different proteins in the body.(proteomics,is the  study of  protein structure in detail)
7. The human body requires 20 different amino acids to build all the proteins it needs.
8. With the exception of oils and pure sugar, all foods contain at least some protein, but its quality varies according to the amino acids it provides.
9. Animal Protein Proteins are made of amino acids.Of these, 11 can be made in the body, but the other nine referred to as essential amino acids, must come from the diet.
10. How Proteins Harm and Heal Protein is the quintessential nutrient that every cell in the human body requires for growth or repair.
11. By combining a grain with a legume, you can obtain the complete range of amino acids.
12. Interestingly, many cuisines include classic combinations that do just that. For example, Refried beans and corn tortillas of Mexico • Rice and dahl of India • Tofu, rice, and vegetable combinations in Asian cuisine • Chickpeas and bulgur wheat in Middle Eastern dishes 
13. They simply need to make sure that they eat foods with the right combination of amino acids.
14. This essential amino acid is plentiful in dried beans and other legumes, which are deficient in methionine.
15. For example, grains are high in the essential amino acid methionine, but they lack lysine.
16. With so many essential functions linked to the protein, you might assume that it should make up the bulk of your diet, but this is not the case.
17. Healthy adults only need 0.36 g per lb (0.8 g per kg) of body weight of protein every day, though if you exercise regularly, you may need more.
18. Thus, a person weighing 154 lbs (70 kg) requires 56 g of protein per day—the amount in a 3-oz serving of chicken.

Is Fat really a dietary evil?

1. Fat is a dietary evil—or so you may have heard.
2. Here are several sources of good-for-you fats: • Olive and canola oils • Nuts, especially walnuts • Seeds, especially flaxseeds • Fatty fish, such as salmon • Avocados Omega-3 fats help steady heart rhythm, lower artery-clogging triglycerides, cool chronic inflammation in the arteries, prevent blood clotting, and produce a modest drop in blood pressure, all of which cut your risk of a heart attack or stroke.
3. (Some researchers believe that the type of saturated fat in coconut oil increases good HDL cholesterol as well as bad LDL cholesterol, so it’s been touted as more of a good fat in recent years.) Unsaturated Fats In general, unsaturated fats are healthier than saturated fats; they either lower blood cholesterol or have no effect on it, and may also help lower blood sugar and blood pressure.
4. Trans fats are found in: • Partially hydrogenated vegetable oils • Some margarines • Crackers • Cookies • Commercially fried foods Hydrogenation makes polyunsaturated vegetable oils act like saturated fats: They raise LDL cholesterol levels.
5. A diet high in saturated fats can raise blood cholesterol levels, one of the leading risk factors for heart disease.
6. Monounsaturated fats (sometimes called MUFAs) improve blood cholesterol levels and may benefit insulin levels, thus lowering your risk of heart disease and type 2 diabetes.
7. Some fats, like those found in fish and olive oil, actually lower your risk of heart disease and can even help you stick to a weight loss plan.
8. Omega-3 fats are found in fatty fish such as salmon, mackerel, herring, and sardines, as well as flaxseed, walnut, and canola oils and some newer products such as omega-3-rich eggs.
9. Fats supply the fatty acids that are essential for numerous chemical processes, including growth and development in children, the production of sex hormones and prostaglandins, the formation and function of cell membranes, and the transport of other molecules into and out of cells.
10. Experts recommend that no more than 10% of your daily calories come from saturated fat, especially animal fats.
11. In addition, many commercially produced foods are made with trans fats, which are rarely found in nature.
12. QUICK TIP: Get healthy fats Knowing what foods have good fats can help the next time you’re at the grocery.
13. Fats fall into two main categories: saturated and unsaturated.
14. While there are a variety of opinions on the optimal ratio of omega-3 to omega-6, experts agree that we tend to eat far more omega-6 fats than we need and too few omega-3s.
15. Saturated Fats Saturated fats generally come from animal sources, but there are some plant sources as well.
16. Trans Fats Trans fats are created when a vegetable oil undergoes hydrogenation, a process that lengthens foods’ shelf life.
17. Unsaturated fats fall into two main categories: monounsaturated and polyunsaturated.
18. Most saturated fats are solid at room temperature.
19. FAT FACTS • All fats contain the same number of calories by weight; that is, about 250 calories per ounce, or 9 calories per gram.
20. Not only are fats a more concentrated source of calories than carbs or protein, but studies indicate that the body more readily stores fats.
21. Omega-6 fats, on the other hand, increase inflammation if you consume too much.
22. Most unsaturated fats are liquid at room temperature and solid or semisolid under refrigeration.
23. Thus, nutritionists recommend that you consume as few trans fats as possible.
24. Polyunsaturated fats, in turn, are divided into omega-3 and omega-6 fats.
25. As with carbohydrates, the type of fats we eat is more important than the total amount.
26. Fats add flavor and a smooth, pleasing texture to foods.
27. Fats also stimulate the intestine to release cholecystokinin, a hormone that suppresses the appetite and signals us to stop eating.
28. Finally, fats are needed for the transport and absorption of the fat-soluble vitamins A, D, E, and K.
29. Because they take longer to digest, fats let us feel full even after the proteins and carbohydrates have left our stomach.
30. Findings from 30 large studies conducted around the world show that people who consume just 1 or 2 servings of omega-3-rich fish per week lower their risk of a fatal heart attack by an average of 36%

How Carbohydrates Harm and Heal

Old School
Fewer carbs is healthier.

 New Wisdom
Choosing the healthiest carbohydrates, especially whole grains, is more important to your wellbeing.

1. Instead, look for a fiber content of at least 3 g per serving and for the first ingredient to be a whole grain such as: • Brown rice • Bran • Bulgur • Kasha • Oats • Quinoa • Rye • Whole wheat In addition to unprocessed grains, get plenty of legumes, beans, and raw or slightly cooked vegetables and fruits.
2. When shopping for whole grains, don’t be fooled by deceptive label claims such as “made with wheat flour” or “seven grain.” Or by white flour breads topped with a sprinkling of oats or colored brown with molasses.
3. Starches and fiber are naturally found in most grains and vegetables and some fruits, which also provide essential nutrients such as B vitamins, iron, and other minerals.
4. On the other hand, choosing refined grains such as white bread, sugary cereal, white rice, or white pasta can boost your heart attack risk by up to 30%.
5. The refining process removes fiber and many essential nutrients, making refined grains too easy to digest and thus flooding the body with too much glucose.
6. But both are important to good health; while starches provide glucose for energy, dietary fiber promotes colon function and may help prevent some types of cancer, heart attacks, and other diseases.
7. American and Canadian guidelines, for example, urge people to make sure that whole grains account for at least half of all grain foods.
8. New Wisdom Choosing the healthiest carbohydrates, especially whole grains, is more important to your wellbeing.
9. At least seven major studies show that women and men who eat more whole grains have 20 to 30% less heart disease.
10. And in a 2010 study of more than 13,000 adults, those who ate the most servings of whole grains had lower body weight.
11. Unprocessed whole grains are the best source.
12. And refined grains are associated with insulin resistance and high blood pressure.
13. Complex carbohydrates are made of complex chains of sugars and can be classified as starches or fiber.
14. Our digestive system can metabolize most starches but lacks the enzymes needed to break down most fiber.

“Let thy food be thy medicine and thy medicine be thy food.”

“Let thy food be thy medicine and thy medicine be thy food.” This advice is as true today as it was more than 2,000 years ago when Hippocrates, the famous Greek physician, coined the phrase. But exactly what foods should you be eating to keep the doctor away? The answer is more complex than you might think. How each food affects you depends on how much of it you eat, when you eat it, and what you eat it with. In addition, how the food is grown, stored, and cooked can make a big difference, as can medications you’re taking.

1. Let us cut through all the confusion about whether or not pesticides, additives, and genetically modified foods are really harmful or not, and find out when it’s really worth spending more on organic grapes or free range chicken
2. “Let thy food be thy medicine and thy medicine be thy food.” This advice is as true today as it was more than 2,000 years ago when Hippocrates, the famous Greek physician, coined the phrase.
3. In addition, how the food you eat is grown, stored, and cooked can make a big difference, as can medications you’re taking.
4. Get the real deal on what types of fat are good or bad for you, whether low-carb diets really work, and which vitamins and minerals you need more of.
5. But exactly what foods should you be eating to keep the doctor away? The answer is more complex than you might think.
6. And if you’re on a blood thinner such as heparin or warfarin, don’t eat too much, as it can interfere with the medication.
7. let us tackle the controversial subject of food safety.
8. But be careful to wash spinach thoroughly to reduce the likelihood of E.
9. Despite all of these variables, the basics of good nutrition don’t have to be hard to follow.
10. How each food affects you depends on how much of it you eat, when you eat it, and what you eat it with.

Keyword highlighting:

• To help your body absorb the iron, calcium, and other minerals in spinach, 
• it’s best to pair spinach with other foods rich in vitamin C.
• This section will first give you an overview of the substances in our foods that are actually doing all the work—the carbohydrates that give us energy, the vitamins that keep your brain and body functioning, the antioxidants that fight disease, and much more.
• For instance, cooking spinach helps your body to absorb the antioxidants lutein and zeaxanthin, which can prevent age-related macular degeneration.
• We cut through all the white noise about whether or not pesticides, additives, and genetically modified foods are really harmful or not, and tell you when it’s really worth spending more on organic grapes or grass-fed beef.
• “Let thy food be thy medicine and thy medicine be thy food.” This advice is as true today as it was more than 2,000 years ago when Hippocrates, the famous Greek physician, coined the phrase.
• In addition, how the food is grown, stored, and cooked can make a big difference, as can medications you’re taking.
• Here we’ll give you the real deal on what types of fat are good or bad for you, whether low-carb diets really work, and which vitamins and minerals you need more of.
• But exactly what foods should you be eating to keep the doctor away? The answer is more complex than you might think.
• And if you’re on a blood thinner such as heparin or warfarin, don’t eat too much, as it can interfere with the medication.
• Next we tackle the controversial subject of food safety.
• But be careful to wash spinach thoroughly to reduce the likelihood of E.
• Despite all of these variables, the basics of good nutrition don’t have to be hard to follow.
• How each food affects you depends on how much of it you eat, when you eat it, and what you eat it with.
• excerpted from  2013 edition of Foods That Harm, Foods That Heal.

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Learning is no longer scheduled for or measured by “Butt in the seat time"

In 1979 when I entered the Osmania Medical College as a greenhorn medical student, I found  the  teaching to be  no different  than what I was taught  by my teachers  in high school.

The only difference was instead of thin light text books there were massive tomes which used to give good exercise to our arms and backs. The same old time tested “Practicals” which had absolutely no relevance to the actual practice of medicine were conducted by the tutors of the preclinical subjects.I still cannot fathom, why I had to find out the side and muscle attachments of a scaphoid bone or the humerus, thrown like dice on the table by the Anatomy “external” even today.

Main emphasis was on studying retaining facts and regurgitating them without any modification on the asking of the examiner. There was no logic or rationale to anything which was taught. After coming to clinicals, at least few of my teachers taught me some rudiments of, what real doctoring is like. People  knew all about esoteric syndrome found only in the Ashkenazim Jews  but had no clue to treat a child with fever or relieve an old man’s urinary obstruction. In fact at the end  of the  final year if  I was faced with someone having a medical emergency probably I would have either fainted then and there or ran away.

People  who  were  savvy with the  way  world works  and  had  natural inborn  people’s skills  were no where in the  top of the  graduating  class. But  20 years later  quite a few  of the  toppers  were  real failures  or remained  mediocre  where as theses  guys  with the  soft  skills  rose to the  top.

With the  advent  of the   digital revolution, Internet and ready use of Google by many patients,  we in the  medical world are facing a different  world now.  Which is going to become even more complex and challenging in the future .

There is an urgent  need for a paradigm  shift in  teaching of Medicine 

1.     Learning is no longer scheduled for or measured by “Butt in the seat time"

2.      Educators need to be mindful of evaluating students on learning outcomes and assessing the impact of e-learning.

3.     Understanding and learning the essentials of E-Learning is necessary for both new and experienced educators. They must learn how to use e-leaning tools to facilitate learning and integrate them into courses and programs.

4.     To meet the needs of these learners, educational institutions have to make significant investments in learning infrastructure such as classrooms equipped with videoconferencing and learner response systems, simulation centers with high-fidelity human patient simulators, as well as ubiquitous wireless access and online learning course management systems.

5.     As increasing numbers of the “net-generation” enter Medical schools and the Health workforce, faculty and staff educators are challenged to provide educational experiences for learners who are savvy users of e-learning technologies.

6.     E-learning requires systems level planning for acquiring resources such as hardware and software, identifying stakeholders, developing the support team, and orienting learners and educators.

7.     today’s medical educators are likely to find themselves teaching in these “high-tech” classrooms and having clinical experiences in agencies where using e-learning is the norm, not all are prepared to do so.

8.     Define e-learning, explain the theoretical underpinnings of learning with technology a design process to create an optimal learning environment. (39)

9.     Learners may retrieve reading materials from electronic book readers and access information from smartphones, and often choose to enroll in online educational programs because they are accessible and convenient.

10.  Strategic planning will be required for all administrators and e-learning coordinators charged with leading the planning, implementing, and evaluating of the e-learning enterprise.

11.  Learners relate to educators and each other through social networking Web sites and text messaging.

12.  How to teach in Web-supported courses, use technology in the curriculum, and develop and manage clinical simulations.

13.   Concepts of continuous quality improvement are  to be threaded throughout the learning  experience