The Mandala Metaphor

Mrs. Prakash was becoming increasingly concerned about a cascade of health problems during the last decade. She was sixty years old, retired and wealthy. In spite of eating the most nutritious food available and exercising every day, she had developed Diabetes when she was 48 years. A few years later, she developed high blood pressure and had high cholesterol levels. Mrs. Prakash was following appropriate schedule for testing and monitoring and was also taking her medicines on time. When she was 59, she required a stent for a blockage in one of the arteries to her heart. Last week, she had been discharged from the hospital for a hip fracture when she slipped while climbing down stairs.

Mrs. Prakash’s questions were - “I am doing everything right. Why are all these problems happening to me? Why me? Will these happen again? What can I do to start again on a clean slate and prevent them forever?”

At this point, dear reader, allow me to make a detour. Join me as I enter a Buddhist Monastery. The main hall is laden with a carpet of silence. A number of monks are hard at work. For last three months, they have been using more than a dozen containers of coloured sand to make a large, circle-like design on the floor. With the help of this sand, they are now putting the final touches to one of the most intricate designs of colours we have ever seen. This design, occupying almost the entire floor of the large hall, has taken over three hundred hours of hard work, meticulousness and attention to fine detailing. The result is stunning. This design is Mandala and this particular example is that of a Sand Mandala. Beautiful. Wondrous.

For a few moments, let us, dear reader, join the monks as they step back to reflect on their work, an amazing moment that is frozen in time.

After the pause, the monks start again, doing something even more amazing. They proceed to dismantle the Mandala, which they had so painstakingly created. Collecting the coloured sand into containers, in their own calm manner, the monks form a line to carry these containers to the river. Having deposited the sand into the river, they gently walk back to the monastery, and almost immediately begin work on the next Mandala.

What is the message behind this seemingly futile exercise? Well, it is not a futile activity, but an exercise in endurance. An exercise that helps endure the ephemeral nature of life. Like the Mandala created again and again, circle of life and its ups and downs must go on.

If Mrs. Prakash had joined us on this visit to the Vanishing Mandala (as this activity is popularly called), she would, no doubt, have realized the answer to her question. There can never be a clean slate. This is especially true in matters of health. Despite advances in medical care, we are still centuries away from attaining eternal fitness or immortality. We will age. Illnesses will come and we must endure. Again and again. With advances in health, we can prevent/delay the frequency of illnesses and also ensure a quicker recovery. But a completely clean slate? Difficult.

This difficulty is especially true for illnesses like Diabetes, which is associated with many issues such as eye problems, kidney disease, foot injury, infection and heart diseases. To an extent, many of these problems and their prevention and treatment have been regularly covered in the annals of our Diabetes Health magazine.

One aspect of Diabetes, often overlooked, is that of bone health of people with Diabetes. We cover this topic in this issue of Diabetes Health. Just like the Mandala, which is created then dismantled only to be born again, our bones are living and dynamic and constantly recreated in our body.

To make the skeleton stronger, our bones have a process that is called remodelling. Like the intricate designs laid down for the sand Mandala, certain cells called osteoblasts lay down new bone. Later this new bone vanishes, because other bone cells called osteoclasts remove the new bone- only to free up space for new bone to be formed again. This cycle of bone loss and bone formation occurs continuously in our bodies, even as I write this and you read this. This cycle makes the bone stronger and stronger, just as the practice of the vanishing Mandala helps to become stronger in terms of mental endurance and dealing with loss.

In Diabetes and in several other diseases, there are problems in the way bone is removed and new bone is formed. When new bone is removed faster than it is formed, bones can fracture. A classic site of the fracture is the hip bone and this occurs in post menopausal women, and this usually happens after a minor fall at home. This event could well explain the aforementioned hip fracture suffered by Mrs. Prakash. Finally kidney diseases, vitamin D deficiency as well as some medications prescribed in people with Diabetes can impair bone health.

We discuss all these aspects on our cover story of bone health on Diabetes. In addition to that we also take a 360 degree view of all aspects of Diabetes in this issue of Diabetes Health. So that even as your bones go from strength to strength, the correct knowledge about Diabetes will simultaneously help you with your health.

Happy reading!