A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

A stroke changes the life of a person in an instant, making everyday activities like walking, talking, or even holding a cup difficult. But strokes do not always mean these challenges are permanent. Many people recover lost abilities and enhance their lives with timely treatment, proper rehabilitation and continued support.

A stroke occurs when blood stops flowing to the brain or a blood vessel in the brain bursts, cutting off oxygen to brain cells. It can cause weakness or paralysis, speech problems, poor balance, or memory issues, or trouble swallowing, depending on the part of the brain that is affected.

Tips to Support Recovery from Stroke

• Begin rehabilitation immediately after a stroke
• Attend Physiotherapy and speech Therapy sessions regularly
• Take prescribed medications as directed.
• Keep blood pressure, diabetes and cholesterol under control.
• Have a healthy and nutritious diet to restore energy.
• Stay physically active
• Seeking emotional and psychological support

Also read: 100% Blockage At 18, 25% Patients Under 40: On World Heart Day, Cardiologists Reveal An Alarming Heart Attack Pattern

The Treatment Journey:

Timely Medical Care Makes a Big Difference

Patients who reach the hospital within a certain time may be eligible for clot-busting medications or clot removal procedures. These procedures restore blood flow, reduce brain damage and increase the likelihood of faster recovery.

Rehabilitation starts immediately after stroke

Stroke care extends beyond emergency treatment. Rehabilitation begins within 24 hours after a stroke when the patient is medically stable. A team of specialists, including neurologists, physiotherapists, and speech therapists, works together to help the patient regain function, rebuild confidence and return to everyday activities as soon as possible.

Physical Therapy to Rebuild Body Movement and Independence

When a stroke happens, muscles on one side of the body may become weak or paralysed, affecting the patient's strength, balance, coordination, posture, and walking.

Physiotherapy consists of a series of exercises, muscle training and mobility techniques that enhance mobility of the body and improve functional independence. Many patients can perform activities with greater ease with regular rehabilitation.

Also read: Weekend Workouts: Why Sudden Intense Exercise May Put Stress on Your Heart

Enhancing communication and cognitive skills

After a stroke, some patients have problems talking, speaking, swallowing, remembering or concentrating. Speech and language therapy are used to help with communication and safe swallowing, and cognitive rehabilitation is used to support memory, attention, reasoning and problem solving. These therapies assist patients in re-entering the workforce, social circles and independent living more smoothly.

Modern Rehabilitation Methods for Better Recovery

Advances in rehabilitation have expanded the range of therapies available to support stroke recovery.

Techniques like robot-assisted rehabilitation, functional electrical stimulation (FES), virtual reality-based therapy, constraint-induced movement therapy, balance training systems and computer-assisted gait training complement conventional rehabilitation very well. These methods provide repetitive, targeted exercises that promote functional improvement in the brain and body.

Managing Ongoing Challenges

After a stroke, some patients have muscle stiffness (spasticity), chronic pain or trouble walking or moving their hands. They are treated with medications, injections and continued rehabilitation therapy.

Recovery from a stroke is much better with proper rehabilitation. While some regain most of their abilities, others continue to need support, making patience and consistency just as important as medical help. The right care at the right time makes a big difference in rebuilding your life.

By Dr. (Lt Gen) CS Narayanan, VSM, Chairman - Manipal Institute of Neuro Sciences, Manipal Hospital, Dwarka, New Delhi

Heart attacks were largely seen as a disease of older age. But lately cardiologists have been increasingly treating patients in their 20s and 30s, including people who appeared healthy, exercised regularly and had no obvious warning signs.

One of the youngest patients treated by Dr Zakia Khan, Director – Interventional Cardiology, Fortis Hospital, Mumbai, was just 18 years old. Dr. Khan told HealthandMe that the young man was a heavy smoker and developed chest pain, which he initially ignored.

“At such a young age, people often do not think of chest pain as a possible heart problem, which can delay treatment,” Dr Khan said.

Dr Girish B Navasundi, Cardiologist, Apollo Hospitals, Bangalore, also told HealthandMe that he has treated an 18-year-old college student with a 100% blockage in one of his coronary arteries. Dr. Navasundi revealed that the patient smoked and used recreational drugs.

These cases highlight a worrying reality that being young does not make one immune to heart disease. Dr. Aseem R. Srivastava , Chief – Pediatric CTVS & Chief – Adult CTVS , Artemis Hospital, Gurugram told HealthandMe, "The situation is so grim that we are no longer surprised if a man in his 20’s comes to our ER with a heart attack."

On World Heart Day, we spoke to cardiologists about their young heart attack patients, the biggest red flags they saw, and what their advice for young people about maintaining a healthy heart.

Heart Attacks Are On The Rise Among Young People

Smoking remains an important reason, but doctors say it is rarely the only factor. Dr Khan says she commonly sees a combination of various factors. Experts also say that a person can look healthy on the outside while carrying several cardiovascular risk factors underneath.

She said, “Smoking is one of the common risk factors I have seen in younger patients. Along with this, family history of premature coronary artery disease and an unhealthy diet, particularly one high in junk food and trans fats, can significantly increase risk. Some patients may otherwise appear healthy.”

Dr Srivastava explained that most often they have a strong family history of heart disease. And very often, youngsters make this genetic predisposition worse by smoking (tobacco). He also said that recurring pattern in patient with heart attack/coronary artery disease is tobacco use. He said, "The most common denominator is usually smoking or tobacco use."

He advises, "Please understand - genetic predisposition is modifiable only little bit but our lifestyle and habits are completely modifiable. And we can greatly reduce the risk by simple changes to our habits."

He also said that even if someone eats healthy, exercises, and maintains a healthy sleep schedule, they will always be at high cardiovascular risk if they smoke.

Dr Navasundi says many young patients appear well and may even report having no symptoms. But several lifestyle factors can contribute to risk.

“Most of them have four lifestyle factors in the form of stress at work, smoking, improper sleep, lack of physical exercise as some of the precipitating factors for heart attack. Also at least one third of them have had abnormally high cholesterol, blood sugar or blood pressure,” he said.

Also read: Inflammation May Be Quietly Changing Your Heart: Study Finds 43% Higher Risk Of Heart Attack & Stroke

Symptoms May Not Look Like A Heart Attack

According to the doctors, one of the biggest problems among younger people is that they don't recognise their symptoms as a cardiac problem. Chest pain is a common symptom, but young patients may dismiss it as acidity, gas, indigestion or even muscle pain.

“Many young people describe it as acidity, gas or indigestion and do not take it seriously. Some ignore the discomfort altogether, assuming it will settle on its own. This can delay medical attention,” Dr Khan said.

Dr Navasundi has seen an even wider range of symptoms. “Common symptoms that they’ve had is uneasiness in the chest, centre of the chest, in the form of burning or choking or as pain, gas, not able to burp or tightness in the chest. Some of the people have had slightly unusual symptoms such as pain only in the left arm or both arms or upper back without having pain in the front of the chest.”

Other patients, he said, have reported excessive tiredness, jaw pain, a sensation of something being stuck in the throat, or a feeling of gas and not being able to burp.

The problem is compounded by the misguided belief that heart attacks happen to older people. Young adults may therefore wait for symptoms to become severe before seeking help, which may lead to preventable fatalities.

Also read: Your Heart After A Cardiac Event: What Recovery Really Looks Like

Sometimes It Could Be Genetic

The experts also say that not every young heart-attack patient may arrive with an obvious lifestyle explanation. Dr Navasundi says some patients have clotting disorders, familial hypercholesterolaemia or a strong family history of premature heart disease.

“Some young people truly have unconventional risk factors like clotting disorders, familial hypercholesterolaemia, that means very high cholesterol from a very young age, and a strong family history of premature heart disease even when these people have a very disciplined lifestyle including eating very healthy, exercising very well, sleeping well. In spite of that, their genetic make-up, the gene and family history make them more vulnerable.”

Dr Khan similarly emphasises that family history can be a warning sign even when someone feels completely healthy.

“A person may feel completely healthy but still carry an inherited tendency towards cardiovascular risk. Knowing your family history can help you identify the need for earlier screening and lifestyle changes.”

Dr. Srivastava gave examples of genetically-induced heart attacks in a 9-year-old and an 11-year-old who had familial hyper cholesterolemia (in which her cholesterol level was very high) and kawasaki disease (in which antibodies form against a virus that attack the coronary arteries) respectively.

Also read: How To Reduce Heart Disease Risk Naturally: Diet, Exercise & Lifestyle Tips

Can You Be Fit And Still Be At Risk?

Regular exercise is beneficial for heart health, but doctors caution against treating gym habit as proof that the cardiovascular system is healthy. Exercising everyday is not enough to believe that your heart is completely healthy.

“Going to the gym does not automatically mean that a person has no cardiovascular risk. People can overlook smoking, family history, high cholesterol, blood pressure, or an unhealthy diet. Fitness should not be judged only by how much one can exercise,” Dr Khan said.

This is noteworthy for young adults who exercise intensely but do not know their blood pressure, blood sugar, or cholesterol levels. Dr Khan recommends a baseline health assessment with a family history of early heart disease or other risk factors before undertaking very intense training.

Also read: Stopping Ozempic, Wegovy, Mounjaro Linked To 22% Higher Heart Attack, Stroke Risk: Study

If You Are Going To Engage In Intense Exercise...

Dr Navasundi recommends that healthy young adults who are planning to begin intense gym training, marathon running or strenuous recreational activities undergo a comprehensive cardiovascular and lung-function test after consultation with a cardiologist.

Dr. Khan said, “A baseline health check is important, especially for someone with a family history or other risk factors. Blood pressure, blood sugar and cholesterol should be assessed, and any symptoms should not be ignored. It is better to understand your cardiovascular risk before starting very intense training.”

Depending on the person, a cardiologist may recommend tests like an ECG, echocardiogram, stress treadmill test, lipid profile, blood sugar and other investigations. In people with a strong family history of premature disease, further testing may sometimes be considered.

Also read: Preeclampsia May End With Pregnancy. Your Heart Risk May Not

Cardiologists Reveal An Alarming Heart Attack Pattern

Dr Navasundi says the biggest change he has observed over his three-decade career is the age at which heart attacks are occurring and the severity of disease in some young patients.

He said, “Compared to my early career I see much younger patients right from the age of 20 onwards having heart attacks and much larger number of heart attack patients. Patients are younger these days. At least 25% of my heart attack patients are less than 40 years of age and close to about 40% of our heart attack patients are less than 50 years of age.”

He also says he is seeing recurrent heart attacks in young people, multiple blockages and, in some patients in their 30s, three-vessel disease. He added, “Many young people are having severe damage during the very first heart attack compared to people in earlier years.”

Dr. Khan said that young cases are showing much earlier than they expected. She said, “I have been seeing this trend of heart attacks occurring in younger patients, sometimes nearly a decade earlier than what we traditionally expected, for the past 10 to 15 years. The increasing presence of risk factors such as smoking and unhealthy dietary habits in younger people is concerning.”

Dr. Srivastava pointed towards another alarming pattern in which doctors increasingly started cases of coronary heart disease among women.

He said, "We used to consider that young females are protected from having a heart attack (coronary artery disease) because of their hormones but we are seeing more and more young females come to us with coronary artery disease and is placing a question mark on our age old understanding."

Three Things Young Adults Should Not Ignore

Dr Khan has three simple messages for people in their 20s and 30s: “First, age does not completely protect you from heart disease. Second, never dismiss chest discomfort as acidity without considering other possibilities. Third, know your family history and get a baseline health check, particularly if you smoke, have risk factors or are planning intense exercise.”

Dr Srivastava said, "1. TOBACCO kills, 2. ⁠QUIT tobacco, 3. ⁠Stop Smoking. And of course- be careful if you have family history of a heart disease, exercise, eat healthy and watch your blood sugar."

Dr Navasundi urges young adults to know their numbers, including blood pressure, heart rate, blood sugar and cholesterol, rather than simply being told that their results are “normal” or “abnormal”.

His final message is that heart health should not become a concern only after a cardiac event. He added, “So live with sense of vulnerability and responsibility to prevent heart disease in your early life. Know your family history, know your numbers.”

Waking up at night can make it difficult to fall back asleep, especially when the mind becomes alert and starts racing. Neuroscientist Andrew Huberman has suggested a simple eye-movement routine that he says may help people drift back to sleep. But does it actually work?

How Does Andrew Huberman’s Sleep Trick Work?

The routine is performed with the eyes closed:

• Slowly move the eyes to one side, then the other, followed by up and down.

• Trace a circle with the eyes, first counterclockwise and then clockwise.

• Point the eyes toward the nose and take a long exhale.

Huberman suggests repeating the sequence two to three times.

His theory is that the movements may interact with brain circuits involved in tracking the body's position, including pathways involving the eyes, brainstem and cerebellum.

Also read: Struggling With Sleep? Neurologist Shares 3 Simple Tips For Better Sleep Health

Sleep Experts Say The Idea Is Unproven

Shelby Harris, a psychologist and board-certified sleep expert, says there are reasonable grounds to try it, Women's World magazine reported.

“I think it’s a very reasonable thing to try. It’s free, low effort, carries essentially no risk and has solid reasons it could help,” Harris was quoted as saying.

She notes that sleep tends to become more fragmented with age.

“Sleep naturally becomes more fragmented with age, with less time in deep sleep and more time in the lighter stages where it’s easy to wake up,” Harris said.

Hormonal changes with age can also contribute to more fragile sleep in women. But a plausible explanation does not mean the technique has been proven.

Michael Grandner, a clinical psychologist and sleep researcher at the University of Arizona, told Inc.com that eye movements, balance signals, the brainstem and cerebellum all contribute to how the brain tracks the body's position in space.

However, he said he is “not aware of studies that have directly tested that chain of events, or clinical trials showing that this particular eye-movement exercise reliably shortens sleep onset.”

Brant Hasler, co-director of the Behavioral Sleep Medicine Training Program at the University of Pittsburgh School of Medicine, added that the technique does not resemble a validated behavioral sleep intervention.

A Relaxing Technique Not A Treatment

According to Grandner, the exercise may be better understood as a relaxation or focused-attention technique.

He said he would place it “closer to a relaxation, focused-attention, or mindfulness exercise than to an established treatment for insomnia.”

The repetitive movements could give the mind something neutral to focus on instead of worrying, planning for the next day or checking whether sleep has returned.

Further, Hasler said bedtime activities can be useful when they occupy the mind without becoming stimulating. The eye exercise could work in that way, he said, “regardless of any additional effects via proprioception.”

The slow breathing paired with the exercise may also help with relaxation.

It Could Backfire If You Try Too Hard

Hasler said expectancy effects could explain some positive experiences with the technique. Grandner also cautioned against repeatedly checking whether the trick is working.

If the exercise becomes another task to perform perfectly, “it could become another form of sleep effort, which can actually perpetuate insomnia,” he said.