M. P. Ravindra Nathan

When 91-year-old generally healthy Walter complained of fatigue and occasional dizziness, the children, though concerned, felt, "Dad is getting old, so this has to be expected, right?"

Then one day, he suddenly fainted and had to be taken to the emergency department of our hospital. I was the cardiologist on call. Walter had developed a 'complete heart block' resulting in a slow heart beat. A simple pacemaker cured his condition and all his fatigue and dizziness resolved. "I am not senile after all," he said triumphantly after recovery. A few weeks ago, Walter walked into my office unaided for his check up, seemingly alert and sharp, announcing, "You know, yesterday we celebrated my 98th birthday!" He was gloating over his good health and was grateful for the treatment he received. Yes, he still sports a pacemaker but doesn't take a single medication!

	Yoga teacher Inga Shilling, 76, maintains perfect balance in this Nataraja (Dancing Shiva) pose.

So, what is the moral of this story? Do not accept a decline in one's abilities as simply age-related since there may be bona fide reasons for a person's symptoms. 'Ageism' is not a diagnosis, although there will be some attrition of your faculties as you get older. What is the secret of Walter's longevity? "I was an insurance salesman till I retired about 30 years ago. I had to park my car at one end of the road and then walk the full length selling insurance door to door. So, I never got fat. And I quit smoking long ago before it got me," he said smilingly.

My patient and friend Howard is 90 and plays excellent doubles tennis at our local park. Occasionally, I join him to hit a few balls. A widower, he now dates a lady 15 years younger. He did go through a heart valve replacement a few years ago, but has maintained good health since then. "There is nothing I cannot do that somebody 20 years younger can do," he said proudly.

He observes his dietary restrictions and is active physically and mentally. I have a feeling he too is headed for celebrating his centenary in style. Another person who is aging gracefully is my own yoga teacher, Inga Shilling, now 76 years. At 5 feet, 1 inch, she weighs just 105 pounds and looks quite fit. She went from classical ballet to ice skating at the age of 19 and made it to the top ice shows in the world, skating in Europe, USA and Canada.

She even earned a bronze medal in world professional championship. Now after retirement from professional skating, she continues to be active with walking, skiing, yoga, etc. She takes just a little medicine for high blood pressure and is otherwise healthy. She can do all yoga poses exceptionally well and her power of concentration is outstanding as is obvious in this Nataraja (Dancing Shiva) pose, maintaining perfect balance. A non-smoker, non-drinker, her biological age is at least 10 years less. Yes, biology and metabolism are important as you get older. Again, diet, exercise, absence of overweight and no bad habits seem to be the key factors.

The paradigm for health care seems to be changing, albeit slowly. There is a fundamental need to shift our nation toward a "wellness society" by starting to observe the principles and practices of preventive care and maintenance of wellness.

A few health care institutes collaborating with Congressional health reform committees are kicking off a public campaign, 'Wellness Initiative for the Nation (WIN)' in hopes of creating a "Wellness Trust." The current attitude of "why fix it if it ain't broken?" won't work if you want to prevent illnesses and age gracefully without disability.

Prevention is so much cheaper too, which is one reason doctors advice regular medical checkups. Occasionally, I visit nursing homes, just to see how an elderly patient is doing. And I feel a bit saddened at the enormity of their helplessness. Yes, there are many indignities and infirmities associated with aging. And sooner or later, we all have to age but why bring it on any earlier and why increase the disabilities? By following some of the fundamentals outlined in the previous columns, you can truly enjoy the twilight of your life, may be even add a few more healthy years.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville, lives in Brooksville.

We are in an era of fitness, becoming aware of and looking to take care of our health. In the Indian community, we see chronic diseases such as cardiac problems, blood pressure and diabetes by the late 30s and early 40s in men. Here are some steps to make your life active.

1. Most men lose their muscle mass and muscle strength by late 30s because of inactivity. That should be the starting point. Pick up lightweight dumbbells or bar and begin with 5-10 biceps curls and 5-10 bench presses on a regular basis. Start with 1 set and then 2 and 3. Do not perform more than 4 reps. I can promise you will get your muscle strength back at any age. You also reduce the fat content as you increase the muscle mass. Biceps curls and bench press exercises also are a great activity to do with young kids, especially boys. Of course, teenagers wants big bisects and broad chest and it is a good thing to get the youth into a routine of exercise so they can delay health complications in their life.

2. Next step is one extra walk. I understand that folks normally work long hours. However, take a 1-mile walk (about 2,300 steps) alone after dinner or with the family. I think it is a calm way to catch with the family's day. Walk every single day.

3. Then make an actual commitment. Go to a gym. Get on an elliptical for 30 minutes. Then perform serious strength exercise. Work on your biceps, chest, hamstrings and quadriceps. You will clearly see the difference in weight loss and how you feel during the day. Your days will be much energetic. Yes, there will be cramping of muscles and pain after a vigorous exercise but you will overcome it as you work out on a regular basis.

4. At last, work on belly fat. That takes long cardio exercises and 100 sit-ups and crunches a day. You can see your abs at any age. Guaranteed.

Diet. Give up one unhealthy food item and substitute one healthy item every week in your diet.

For example:

Week 1: Give up a bowl of ice-cream that you are in a habit to have at bed time. Substitute with a glass of skim milk or a small ball of berry-plain yogurt. Fat-free frozen yogurt is a good substitute.

Week 2: Give up an extra pickle, papad or any type of salty and oily side dish. Replace with a cucumber or any vegetable. You also can substitute the salty and oily side dish with a vegetable or dry-fruit raita (yogurt with nuts or vegetables).

Week 3: Replace that glass of alcohol with your favorite juice. Begin with pineapple or pomegranate juice. Chilled lemonade would be good too.

Week 4: Hard one! Give up one carbohydrate item. You either should eat rice or a wheat item. Not both. This is tough for many people, including me sometimes because we are used to eating heavily carbohydrate dinner. I would say alter rice and wheat item (roti, bhakhri, puri, etc.) every other day. A good replacement is vegetables such as lettuce, cucumber, tomatoes, boiled potatoes, carrots, etc.

Achut Mashruwala of Fitness Guru Inc. can be reached at (813) 857-5103 or e-mail [email protected]

	Payal Patel

There comes a time in every toddler's life when parents feel it is the right time to start potty training. Therefore, many parents come prepared with a slew of questions about the right time for their child and how to proceed so as not to instill a fear of toilet training.

First, you have to assess whether your child is ready to toilet train or not. This is evident by the child demonstrating the ability to understand what pee-pee, poo-poo, potty or whatever term is used. The readiness is usually demonstrated at 15-18 months of age. Most children are ready by the time they are 2 years old to proceed to be completely trained and most children can be trained by the time they are 3 years old.

A child has to be able to understand what the toilet is for, and this can be learned by watching older siblings or parents using the potty. Also, a child signifies readiness to train when he or she can tell the difference between a dry and wet diaper and shows interest in changing so they are dry. Many children actually are able to tell you when they are about to wet their diaper or when they have to stool as well.

To help your child, read toilet-training books so they understand what they will have to do soon. Let them play with older children who are toilet trained so they see that it will be OK when they use the toilet. Teach them how the toilet works. Be positive and supportive of their trial and errors, and don't get frustrated, which they will be able to sense.

The best way to start training your child is by praising them when they are able to tell you if they want to pee pee or poop. Do not scold or punish them if they hesitate; instead, be patient and try to make it fun. Buy a potty seat together and let the child know why you are doing it. Let them feel like they are in control by purchasing the seat, bringing it home and then experimenting with it.

Let them sit on it with their clothes to get a feel of what it will be when they are ready. Praise them for doing it. Talk about a plan where action will entitle them to a reward such as stickers, or healthy treats such as raisins, crackers, etc. Practice first when you notice your child either saying pee pee or has signs they want to void or stool, and lead him to the potty. Encourage him to take his diaper off and sit on the potty. Try to make it comfortable by either holding a favorite stuffed animal, a toy or even reading their favorite book.

If they are able to do it, praise and reward him appropriately. If it does not go as planned, reassure your child that it's OK and to try again next time.

Your child may continue to have accidents during the day, which is perfectly normal. Let he or she know its OK and mommy or daddy is not mad, and that he/she will get it eventually. Once the child consistently uses the toilet, you can use pull-ups to encourage and give them a sense they are a big boy or girl. If your child refuses to train, stop training, until a few months later, or when they feel ready.

Dr. Payal Patel is a board-certified pediatrician at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz. For information, call (813) 948-2679.