Categories: Praveen's Blog

10 Mar 2017

After 21 years, I’m done with my chronic disease. Here’s that story

After 21 years, I'm done with my chronic disease. Here's that story

Just as I turned an adult, I was diagnosed with high blood pressure.

One day, as I ran up the stairs of my engineering college, I had an urge to throw up.

I told my family about it. We soon visited a doctor.

When checked, my BP was high. The doctor promptly put me on a beta-blocker to protect me from heart disease.

That was more than 21 years ago.

Of course, we went through the protocols of ruling out secondary causes.

Years rolled by.

At no point, did we (my doctors, my family or I) think of testing whether I really needed medication. It actually sounds risky to even think of it.

Slowly I knew that my body developed a dependency on the beta-blocker, a class of drugs that block the effect of stress hormones. So that the heart works less harder. When I missed taking it, my body would somehow tell me. Slight discomfort. Irritability.

For the most part, I hid my condition from everyone. Never talking about it. As if it were a shameful thing. May be I thought people would think less of me.

The possibility of overcoming a chronic condition like high blood pressure never occurred to me. Not even once.

It took 17 years before I woke up.

There’s always a wakeup call

During the summer of 2013, I was on a long, difficult trek in Bhutan. While descending back to Gasa Dzong, a town that seemed in a rush to modernize, I noticed that my body was beat up.

My eyes caught a bad infection. Muscles ached. I coughed every five minutes. I was completely exhausted. Somewhat annoyed with my body.

I visited a hospital on my return. After tests, they suggested that I had early onset of asthma. I was prescribed a nebulizer and medications. They also wanted to tinker with my hypertension meds.

As a good patient, I complied. But, while puffing on my nebulizer, I knew something was off. It wasn’t the way I wanted to live.

4 steps that freed my body from high blood pressure

One of my doctors made me think differently about hypertension by saying:

High blood pressure means that your body’s engine revs at a different speed than average. It does not mean that you have some debilitating heart condition.

Open, sometimes longwinded clinical conversations helped me lose unnamed fears and believe in the possibility of a healthier body. It changed my mindset.

The wakeup call after the Bhutan trek made me approach my health issues head-on. However, what actually helped were steps that were already underway.

The Mindfulness Step

I’ve had some form of regular mindfulness practice since 2003. It has made all the difference. It became the foundation for every other step.

As a patient, I inherently understood that there were certain triggers that led to high blood pressure.

Say, it would be something that someone said. I would brood quietly about it for days. The resulting anger or irritation would manifest into physical discomfort, perhaps higher blood pressure.

Meditation helped cut this deadly chain. From accumulation of negative emotions to simply observing and letting go. Now I had a method to regularly drop the baggage I would’ve earlier pointlessly carried.

The resulting awareness also made it easier to take the steps of diet and exercise.

The Physical Step

I began trekking outdoors regularly. The mountains made me curious about the capacity of the human body.

That curiosity helped me make choices that improved my physical strength.

Exercise became a natural part of life. Once I began enjoying it, I could not stop from myself from staying active.

It was a sea-change from the sedentary lifestyle I had led for the first 10 years of my pill-popping, chronic disease journey.

The Diet Step

When we consider the heart together with other vital organs such as stomach, liver, lungs, and kidneys, we understand the body’s correlations better.

When I eat fatty food, my stomach requires the heart to pump more blood because it takes longer to digest. When I don’t eat enough fiber, my intestines require more blood to clean the gut. Liver, our chemical factory, works harder to clean up the toxins we introduce into the body (sometimes in the form of prescription drugs).

These correlations matter but aren’t discussed enough in medical rooms.

Understanding my stomach’s role in blood pressure, helped me change my food habits. Eating in time. More fruits and vegetables. Less processed food. Reducing salt.

The Clinical Step

While I’ve always consulted doctors to keep my body in check, finding the right doctors took a long time. It happened by chance.

Unlike most patients, I had no presenting symptoms that needed a quick fix. What I wanted was a long-term fix for my body.

Finally I found a cardiologist in a different city. I had to fly in for consults.

While he’s highly renowned, he doesn’t fit easily into the modern healthcare fraternity. Believing that less is more, he seems on a mission to moderate the use of medicine.

At 78, he’s as sharp and bright as ever. His clinical wisdom shines in its simplicity:

It’s not what you eat that kills you; it’s what eats you that kills.

He does a meticulous physical exam (eyes, tongue, hands, chest, back, feet, ankles, veins). The act of taking a blood pressure measurement becomes a craft in his hands.

My tapering took 2 years. From 2015 to 2017. Very slow and methodical.

From 5mg to 2.5mg for almost a year and a half. Normal.

Then to a quarter for 4 months. Normal.

Then to nothing.

Remember these two things

On my last visit, before he sent me away with no prescription, he casually told me to remember two things.

Continue doing a little bit of yoga or exercise every day.

Then the cardiologist said something that’s hard to forget. Words I’d never heard in a clinical setting.

Do some good for someone else every day. I can’t tell you exactly why it’s linked to keeping blood pressure in control but it is.


Originally featured in LinkedIn Pulse Healthcare, by Praveen Suthrum, President & Co-Founder, NextServices

09 Jan 2017

Upgrading/Moderating: Two Evolving Views of Healthcare

Upgrading/Moderating: Two Evolving Views of Healthcare

As I reflect on what I learnt in 2016, I see two somewhat conflicting world-views of health: upgrading and moderating.

One promotes upgrading the human body much like software. In this case, our biological processes can be considered as algorithms that can be improved upon. The other view calls for moderating our dependence on medicine by influencing elements surrounding health, such as food and environment.

Let’s consider both views.

Upgrading the human body

I first heard this phrase from Yuval Noah Harari whose work has deeply influenced me this past year.

Even though the underlying goal of medicine has been about sickness, the industry is increasingly moving towards upgrading the human body. For example, Testosterone therapy doesn’t cure any debilitating illness but still comes under the purview of medicine.

An upgrade we’ve taken for granted is how we manage chronic conditions, such as hypertension and diabetes.

At a more complex level, longevity companies (such as Calico and Human Longevity, Inc.) aim to upgrade us by fixing genes that result in disease.

Our expectations from medicine are evolving from  fixing sickness to  managing conditions to  upgrading the human body.

Much like how we regard smartphones as a necessity today, people will begin to expect upgraded bodies as a new norm. Productivity-enhancing drugs (lookup nootropics popular among Silicon Valley geeks), implantable chips, mind-calming substances (cited as a titanic tool in Tim Ferris’ new book Tools of Titans), genetic modifications and even nanobots that traverse our bloodstream could be part of the new deal.

Through such upgrades, we are expected to become better versions of ourselves – perhaps like Bradley Cooper in the movie Limitless.

via Peaknootropics

Moderating Medicine

Upgrading seems to have exciting benefits. I could continue gorging on pizza, even as I wait for the industry to upgrade me. Win-win, as they say.

Are we missing something?

The last 50 years of pharmaceutical evolution has shown that quick-fix upgrades invariably have downsides too. I know because of a tiny hypertension drug that I consumed for 20 years. It changed my physiology in a way that I can’t clearly describe.

I became acutely aware of my dependence on the beta-blocker when I started tapering-off from 5mg/day to 2.5mg/day under the guidance of a well-regarded cardiologist about a year ago. During first several weeks of tapering, I experienced withdrawal symptoms – irritability, flutter in the chest, sleeplessness and mood swings even while my readings showed normal.

Last November (one year later), my cardiologist tapered it further from 2.5mg to 1.25mg. I experienced similar withdrawals but for a shorter duration. After a meticulous physical exam, he had sniggered, “Even while standing, your BP is 120/80!”

Latest blood pressure guidelines suggest that I may never have had hypertension to begin with (140/90 is the new norm). It’s disorienting to know that I upgraded to fix a bug that never really existed. [Read 4 Disturbing Trends in Healthcare for more details].

But tapering-off is hard work. It requires you to exercise, eat right and in time, meditate, sleep well and skip fun things like binge-drinking into the night.

Wouldn’t you much rather upgrade?

Upgrade or moderate?

Even if driverless cars could examine our health soon, it’s not all that clear if our advances will upgrade our bodies cleanly without introducing new bugs that require new fixes.

The modern grocery store gave us convenience but deeply altered what we eat. We now have easy access to a fiber-less, fatty-sugary-salty diet that was unthinkable just a few generations ago.

New lifestyles have led to new diseases prompting us to look for better upgrades. We are stuck in a loop – perhaps to the point of no return. Yuval Noah Harari supposes that our ongoing upgrades will evolve homo sapiens into an altogether newer species that could only be part-human. Ahem.

I guess we must find the balance between these worlds of upgrading and moderating. In it are hidden opportunities to think about healthcare differently.

How much do we upgrade and buy into new problems? How much do we moderate and work towards better health?

As a wise-one once said, it’s all in our hands.


My notes from earlier years: 2016201520142013.

Industry notes:

Originally featured in LinkedIn Pulse Healthcare, by Praveen Suthrum, President & Co-Founder, NextServices