Coffee Beans

I tasted coffee beans for the first time in my life today. All in the name of learning about how caffeine affects our brain. Professor David Presti, who teaches “Drugs and the Brain,” at Cal, brought a whole bag of Peet’s Dark Roast Coffee Beans and passed them around for the class to taste. I’ve never tasted coffee before, let alone coffee beans, so this was a new experience. It was crunchy, kind of over burnt and somewhat bitter to the tongue. But I ate another bean anyway. I can see why folks love it so much. The effect was pretty immediate. I was more awake or maybe the immediate effect was due to the the bitterness.

The aroma, I’m familiar with, with my grandparents and most relatives all habitual coffee drinkers. My parents managed to kick the caffeine habit only recently after suffering the withdrawal symptoms of headache and fatigue. The coffee aroma is one I associate most with my grandparents. My Srinivasan grandpa who lives in Chennai, gets up before everyone else, receives the milk from the milkman, boils the milk and then brews a fresh batch of coffee decoction in a manual coffee filter. I’ve rarely seen grandpa in the kitchen otherwise, he really wants his coffee made the right way I guess. While in Chennai, I  wake up to the smell of coffee (and other things being prepared in the kitchen).  South Indian coffee looks different from the coffee ones sees in the coffee makers in the offices and restaurants here. It’s thicker as it has some chicory as well. Whenever my grandparents have visited the US, they’ve  brought coffee powder with them, as they did not prefer the local US brands. My other late Raghavan grandpa was also a coffee aficionado. He liked his coffee black without any sugar even and it had to be brewed just right. The coffee was not be be put on the stove or microwave directly to warm, rather the decoction had to warmed up in a hot water bath, else the taste would be spoiled.  During one of his visits to the US, he had one of the specialty coffee shop guys give him sample tastes of almost 2 dozen types of coffee beans before he found he kind of liked. My grandma would say that on a train journey, my  grandpa would keep stopping the coffee vendor who walked up and down almost every hour or so and ask for refills. At weddings, the coffee tray makes a regular appearance throughout the day.

Chemically, caffeine is one of the methylated xanthines. It’s an antagonist for the inhibitory neurotransmitter Adenosine. Inhibitory means slowing down of neural activity (or firing them up) while an antagonist is a molecule that blocks the action of the neurotransmitter at the receptor.. When Adenosine binds at the receptors it causes you to be calmer (helps sleep)  in addition to vasodilation or opening up of blood vessels (which allows for more oxygen flow). By blocking adenosine, caffeine causes the stimulating effects that is associated with coffee such as alertness, increased heart rate and increased BP.

One cup of 7 oz coffee or tea contains almost 100 mg of caffeine. But the giant sized drinks sold these days are almost 12oz, so extrapolate the caffeine. Apparently the so called decaf still has 3mg of caffeine. Energy drinks like Rockstar and RedBull have 120mg of caffeine and the tiny 5 Hour Energy Drink has a whopping 200mg.  Students have gone to the ER after a few of those high powered drinks - increased heart rate.  

A side note of interest was the Peet (of Peet’s Coffee) is from Berkeley and started his company in the 1960s. (Peet’s is now owned by a German Company.) Peet even showed the Starbucks guys how to make coffee.

Being Halloween, Prof Presti opened with a picture of a giant pumpkin stuck on top of the spire of the Campanile (Sather Clock Tower) in 2000 as part a Halloween Prank. The pumpkin had a giant “Live” carved into it. Wonder how they managed to get it up there. Apparently it was quite the spectacle till maintenance managed to get it down.

Benzodiazepines Paper - Outline

Hari Srinivasan

Prof David Presti

GSI Carson McNeil

Drugs & the Brain

Homework 5 - Outline for Research Paper

Benzodiazepines

My paper will talk of the unnecessary over-prescription of benzodiazepines without regard to potential long term dependence, side effects and withdrawal issues, especially amongst the intellectual disabilities population and the elderly population.

The study by Oswald et al. (2007) shows for instance that almost 70% of children over age 8, with the Autism Spectrum diagnosis were prescribed some form of psychoactive medication including benzodiazepines. Another study by Kalachnik et al. (2002), suggests that many behavioral symptoms in the intellectual disabilities population could be caused by the Benzodiazepines and be mistaken for other psychiatric behaviors which need to be further treated. The irony is that Benzodiazepines are given to to this population to mitigate those very behavioral symptoms.

Interestingly,  the older 1983 study by Owen et al. on the use of Benzodiazepines on the intellectual disabilities population reflected my own experiences with Benzodiazepine usage. That is to say, prolonged use does cause dependence and  sudden withdrawal could cause seizures. Other withdrawal symptoms were also included in their study.  Their claim is a 5-15 days withdrawal period but my personal experience and the experiences of families I know seem to stretch the withdrawal time of such medications up to even 6 weeks.

The other major group to whom benzodiazepines were overprescribed were the aging population leading to dependence. The study by Bloom et al (1993) finds that the elderly are unnecessarily  being over prescribed benzodiazepines often due to lack of knowledge by Family Practitioners about their dependence and withdrawal issues.

Benzodiazepines are very effective in the short term. They are so effective that their use is continued to prolong the “good” effects on mood and anxiety.  In the meantime, tolerance builds up as does dependence. It is like caught between caught between scylla and charybdis, can’t live with them, can’t do without them either as other medications are less effective.

I chose the topic of Benzodiazepines as I have been on two of them for a number of years now. A pediatrician in Foster City had first prescribed a sublingual spray version of short acting Lorazepam in 2009 to take the edge of agitation produced by anxiety especially during travel.  Since Lorazepam is highly addictive, it was not to be used on a regular basis. In fact, if it was used over multiple days in a row, its efficacy decreased. In the meantime psychiatrists were playing about with other meds to be taken on a regular basis to handle my behavioral and anxiety issues. The head of pediatric child psychiatry at John Muir Hospital finally decided on Clonazepam, a cousin of Lorazepam. Clonazepam stayed longer in the blood stream and the claim was that my dosage was low enough to not build any kind of dependence. Lorazepam was still to be used as needed address any immediate agitation and anxiety as that was faster acting. It is now 2017 and I am still on Clonazepam and its not working as well anymore as well. In 2015, an attempt was made by the doctor to wean me off. Clonazepam was stopped over a 2 day period and an anti-seizure Trileptal was put in its place. I had a tonic-clonic seizure the day after Clonazepam was stopped. Apparently two days was not enough of a wean off period despite the fact that an anti-seizure med had replaced it. Clonazepam was put back on. A team of Stanford psychiatrics have been trying to wean me off the clonazepam and stabilize my meds since 2015, with limited success.  In the meantime I continue to struggle with fluctuating mood and anxiety issues. It is frustrating that Psychiatry is still such an inexact science.

Works Cited

Bloom, J. A., Frank, J. W., Shafir, M. S., & Martiquet, P. (1993). Potentially undesirable prescribing and drug use among the elderly. Measurable and remediable. Canadian Family Physician, 39, 2337–2345.

Donald P. Oswald and Neil A. Sonenklar. Journal of Child and Adolescent Psychopharmacology. July 2007, 17(3): 348-355. https://doi.org/10.1089/cap.2006.17303

Owen, R.T. & Tyrer, P. Drugs (1983) 25: 385. https://doi.org/10.2165/00003495-1983

----------------------------

Homework #5:  - To be turned in to your Discussion Section GSI during the week of October 30 to November 3, 2017

Write a brief (1-2 paragraphs, single -spaced) summary of your topical essay ideas, including what it is you are writing about and why the topic is interesting to you.  List at least 3 references you are using and briefly indicate what kinds of information you have found in these references.  Use the format for references described on page four of the Topical Essay Guidelines.

Plant Rituals

Hari Srinivasan
Prof David Presti

Psych C19 Drugs & the Brain

(Assignment about 2 Plant Rituals)

Plant Rituals - Brahmi Thailam and Neem

My family has been vegetarian for generations and so are deeply rooted in plant traditions.  I was hard pressed as to which ones to pick. I focus on two of these - Brahmi Thailam and Neem.

Many a  weekend, I’m given a hair oil massage with Brahmi Thailam. Thailam means oil in Ayurveda lingo. A head massage with Brahmi Thailam is a most relaxing experience.

Fingers massage oil into the scalp.

Transdermal absorption of Brahmi

Neurotransmitters observe as they flow

Neural Communication, dendrites grow

Brahmi Thailam is a widely used  Ayurveda Oil to improve the functioning of the brain and nervous system. The main ingredients of Brahmi Thailam are Bacopa monnieri and Emblica officinalis (Amla). Bacopa monnieri is a nootropic herb and is thought to directly impact cognition and memory while reducing anxiety. In addition to being an antioxidant it is also thought to promote  dendrite growth and thus neural connections.  It can’t really be ingested orally as it can cause nausea. The other ingredient Alma, is a widely used plant and is used in many forms. I found the fruit is sour and tart to taste. It is widely used in cooking (dried or pickled) and common in most  hair oil preparations sold in India. Amla  is high in Vitamin C and is believed to help in longevity and promoting hair growth as well as neural function.

Ayurveda doshas, underlying physiological energies

Vata  brain, nervous system

Pitha  bile, digestive system and more

Kapha wind, respiratory and circulatory

Balance of doshas is the goal.

I’ve had a personal love affair with Ayurveda oils after my few summers of Ayurveda treatment in in Kerala, South India. Most of my knowledge and love of Ayurveda comes from what I learnt during that time. The Shirodhara (warm Ayurveda oil is slowly dribbled on the forehead for a full hour) and Kizhi (warm bundles of oil soaked herbs are applied on the body) treatments were deeply relaxing for the body, and for that duration at least the mind and thoughts would be in tranquility. That is saying something, for my mind seems to be ever in an excitatory state with my hyperactivity and other autism challenges. I long for the calm meditative state that an Ayurveda treatment brings. Alas, the effect is but temporary for me. The days of intense Ayurveda treatments in the land of coconut trees and elephants maybe in the past but the ritual that has continued on is the hair oil massages. The strong tang of the ayurveda oil wafts all over the room and I feel I am back in Kerala again. I soak in the oil anywhere from 10 mins to half an hour before taking a shower.

Kerala,

Swaying Coconut trees, Elephants, Houseboats

Gentle backwaters meet the Arabian Sea

Ayurveda Central, deemed Danvantri

A specific set of herbs is boiled with either Sesame Oil or Coconut Oil as a base to make Ayurveda oils. The Ayurveda hospital in Kerala where I’d received treatment had its own manufacturing wing. There was one oil there which took 100 days to prepare over a slow wood fire. They believed in  old style preparation- wood instead of gas fires as the latter could destroy the property of the concoction. Coconut oil is thought to be a more effective base by many of the Ayurveda doctors. But Coconut Oil becomes rancid within a few months while Sesame Oil can have a shelf life of upto 10 years so is preferred. Kerala is kind of like the Ayurveda central of India as there is where Ayurveda originated and is most practised, even amongst regular families with the knowledge passed down from generation to generation.

As winter approaches here, my oil massages become less frequent as they cool the body and that is asking to catch a cold in cold weather. I just look forward to them when the weather warms up again.

Another interesting tradition is the use of Neem. (Azadirachta indica, Margosa or Indian Lilac).  It is supposedly the ultimate anti-bacterial. I brush my teeth every night with Neem powder. Actually, I sprinkle a little bit of Neem powder on top of the toothpaste. It tastes slightly bitter but one gets used to the taste. In the olden days, folks did not have toothbrushes or toothpaste so they chewed away at a twig of the neem tree each morning, which basically cleaned their teeth. My grandma mentioned that it has now made a comeback in modern India with local vegetable vendors selling fresh neem twigs. My grandma even got me some but I found it sensorily hard to sustain chewing the twig - it literally is like chewing on the end of a pencil - a woody taste. However, the twigs have to be fresh when they are still soft, which makes bringing them into the US difficult as they dry out. So the substitute  has been a sprinkle of Neem.

Neem Neem, the village Pharmacy

Central gathering place, shade and cool air

Treetop to root, how I use thee

The neem tree was often called the village pharmacy as it had so many beneficial qualities and can be used from treetop to root. The Neem tree was usually found in the central village square. My other grandma (who has a large Neem tree in her front yard) tells me that neem leaves are used to treat chickenpox even today. Neem has been found to have many medicinal  properties -  anti-inflammation, anti-ulcer, anti-fungal, antioxidant, anti-bacterial, anti-mutagenic, anti-viral, anti-carcinogen and a powerful immunomodulator. It is thought to be a powerful medicine for the GI tract. I was on Neem supplements a few years back to help with GI inflammation. At my home,  the dried Neem inflorescence is often toasted in sesame oil and sprinkled on food items like our digestive drink called Rasam, which I’ve learnt to make. It lends a lovely flavor though it can be a little bitter.

I could go on about other plant rituals, but alas this assignment only calls for two.

Plant Rituals

Plant Rituals - Brahmi Thailam and Neem

(Assignment about 2 Plant Rituals for Prof David Presti's, Drugs and the Brain Class at Cal)

My family has been vegetarian for generations and so are deeply rooted in plant traditions.  I was hard pressed as to which ones to pick. I focus on two of these - Brahmi Thailam and Neem.

Many a  weekend, I’m given a hair oil massage with Brahmi Thailam. Thailam means oil in Ayurveda lingo. A head massage with Brahmi Thailam is a most relaxing experience.

Fingers massage oil into the scalp.

Transdermal absorption of Brahmi

Neurotransmitters observe as they flow

Neural Communication, dendrites grow

Brahmi Thailam is a widely used  Ayurveda Oil to improve the functioning of the brain and nervous system. The main ingredients of Brahmi Thailam are Bacopa monnieri and Emblica officinalis (Amla). Bacopa monnieri is a nootropic herb and is thought to directly impact cognition and memory while reducing anxiety. In addition to being an antioxidant it is also thought to promote  dendrite growth and thus neural connections.  It can’t really be ingested orally as it can cause nausea. The other ingredient Alma, is a widely used plant and is used in many forms. I found the fruit is sour and tart to taste. It is widely used in cooking (dried or pickled) and common in most  hair oil preparations sold in India. Amla  is high in Vitamin C and is believed to help in longevity and promoting hair growth as well as neural function.

Ayurveda doshas, underlying physiological energies

Vata  brain, nervous system

Pitha  bile, digestive system and more

Kapha wind, respiratory and circulatory

Balance of doshas is the goal.

I’ve had a personal love affair with Ayurveda oils after my few summers of Ayurveda treatment in in Kerala, South India. Most of my knowledge and love of Ayurveda comes from what I learnt during that time. The Shirodhara (warm Ayurveda oil is slowly dribbled on the forehead for a full hour) and Kizhi (warm bundles of oil soaked herbs are applied on the body) treatments were deeply relaxing for the body, and for that duration at least the mind and thoughts would be in tranquility. That is saying something, for my mind seems to be ever in an excitatory state with my hyperactivity and other autism challenges. I long for the calm meditative state that an Ayurveda treatment brings. Alas, the effect is but temporary for me. The days of intense Ayurveda treatments in the land of coconut trees and elephants maybe in the past but the ritual that has continued on is the hair oil massages. The strong tang of the ayurveda oil wafts all over the room and I feel I am back in Kerala again. I soak in the oil anywhere from 10 mins to half an hour before taking a shower.

Kerala,

Swaying Coconut trees, Elephants, Houseboats

Gentle backwaters meet the Arabian Sea

Ayurveda Central, deemed Danvantri

A specific set of herbs is boiled with either Sesame Oil or Coconut Oil as a base to make Ayurveda oils. The Ayurveda hospital in Kerala where I’d received treatment had its own manufacturing wing. There was one oil there which took 100 days to prepare over a slow wood fire. They believed in  old style preparation- wood instead of gas fires as the latter could destroy the property of the concoction. Coconut oil is thought to be a more effective base by many of the Ayurveda doctors. But Coconut Oil becomes rancid within a few months while Sesame Oil can have a shelf life of upto 10 years so is preferred. Kerala is kind of like the Ayurveda central of India as there is where Ayurveda originated and is most practised, even amongst regular families with the knowledge passed down from generation to generation.

As winter approaches here, my oil massages become less frequent as they cool the body and that is asking to catch a cold in cold weather. I just look forward to them when the weather warms up again.

Another interesting tradition is the use of Neem. (Azadirachta indica, Margosa or Indian Lilac).  It is supposedly the ultimate anti-bacterial. I brush my teeth every night with Neem powder. Actually, I sprinkle a little bit of Neem powder on top of the toothpaste. It tastes slightly bitter but one gets used to the taste. In the olden days, folks did not have toothbrushes or toothpaste so they chewed away at a twig of the neem tree each morning, which basically cleaned their teeth. My grandma mentioned that it has now made a comeback in modern India with local vegetable vendors selling fresh neem twigs. My grandma even got me some but I found it sensorily hard to sustain chewing the twig - it literally is like chewing on the end of a pencil - a woody taste. However, the twigs have to be fresh when they are still soft, which makes bringing them into the US difficult as they dry out. So the substitute  has been a sprinkle of Neem.

Neem Neem, the village Pharmacy

Central gathering place, shade and cool air

Treetop to root, how I use thee

The neem tree was often called the village pharmacy as it had so many beneficial qualities and can be used from treetop to root. The Neem tree was usually found in the central village square. My other grandma (who has a large Neem tree in her front yard) tells me that neem leaves are used to treat chickenpox even today. Neem has been found to have many medicinal  properties -  anti-inflammation, anti-ulcer, anti-fungal, antioxidant, anti-bacterial, anti-mutagenic, anti-viral, anti-carcinogen and a powerful immunomodulator. It is thought to be a powerful medicine for the GI tract. I was on Neem supplements a few years back to help with GI inflammation. At my home,  the dried Neem inflorescence is often toasted in sesame oil and sprinkled on food items like our digestive drink called Rasam, which I’ve learnt to make. It lends a lovely flavor though it can be a little bitter.

I could go on about other plant rituals, but alas this assignment only calls for two.

We Embrace, Accept CA

I was the Guest of Honor at the talent show of the newly formed non-profit for special needs individuals, We Embrace Accept CA. Accept CA was formed with a view to bridge the gap between the neurotypical experience and the special needs population.

It was an impressive set of performances from some quite "extra-ordinarly" special needs individuals. I was especially impressed by the bicycling skills of my 19 year old friend Athish who has CP. Most typical individuals take skills like biking for granted,  a skill that is easily mastered in childhood and then automated by the body. The act of biking actually involves all kinds of coordination, balance and motor skills. Athish has been learning to ride a bike only the last few months and was able to bike around the stage with little assistance all by himself. Bravo Athish! Athish's parents, Meena Kalyanasundaram and her husband Som are very old family friends of my folks and founders of Accept CA.

I also loved the Stand Up Comedy by 16 year old Riley Ross. This joke of autists taking phrases literally was definitely the best. His mom had told him his birthday was just around the corner and he walked around the block looking for it. He asked why his mom could not just have said that his birthday was the next week.  Young Aarnav has some lovely calendar skills - ask him any date in any years and within some 30-40 seconds, he comes back with the day of the week. He even throws in whether that year was a leap year or not.  Many of the kids performing have some pretty severe challenges, nevertheless they joyfully showcased  their Bollywood skills in the Happy Feet performance.

The Vatsalyam Bharatanatyam performance by co-founder Seena, was a poignant dance-drama portrayal of a mother's expectations and transformation. She expects  a typical child. the joy and fun activities she would have with that child. Instead she is bewildered with a child with  all kinds of issues that she was unprepared for. The dance interpretation of the transformation was quite riveting, especially the eye expressions.  She goes from devastation, grief and hurt to trying to pick up the pieces and fighting for her child. The sadness never quite goes up but it gets buried deeper along the way. I can totally understand as I have observed my mom (and Dad) go through many of these emotions. And these emotions are an ongoing process as disability continually brings with it periods of setbacks and new challenges at every stage of life which are very discouraging, yet they have to find the courage to move ahead.  I'd written a poem few years back, You Never Gave Up on Me.to appreciate not just my mom but all the mom's and caretakers.

I only stayed till intermission unfortunately. The mood-vagaries of my own disability caught up with me, causing a sudden bout of anxiety. It was just better for me to leave at that point. I was sad to have missed the rest of the event but I'm sure it was superb.

I know my journey has been an inspiration to many parents and given them lot of hope for their kids. A decade ago, no one would have thought that my someone with my significant level of challenges would make it to a world-class and top university such as UC Berkeley. Meena Aunty asked me to present a powerpoint of my journey plus any thoughts I had to share. The slides follow in next post

My family has known Athish and his parents Meena and Som since he was a baby and I’ve observed Athish’s progress over the years. Though we don’t communicate openly due to our respective sets of challenges, I could not be prouder to call him my friend. What a wonderful idea to start Accept CA.

Thanks Meena Aunty for having me there and honoring me as well by making me Guest of Honor.