The pain of wisdom

The pain of wisdom
By Dr. Gita Mathai

EVERYONE knows that wisdom comes with age and maturity. That is why in all languages and cultures, the belated appearance of the last molar is equated with the accrual of wisdom. In Europe, the word for this tooth is derived from the Latin root "dens sapientiae", meaning "far standing and wise".
Evolution has made our mouths smaller. We have invented implements to externally cut our food into smaller pieces. We do not need to tear at our food as it is mashed, minced and cooked to a comfortable edible texture. The net result is that most people have smaller jaw-bones that can comfortably accommodate 28 teeth. Once the last (third) molars appear, the mouth has 32 teeth. This makes for a very cramped and uncomfortable environment. The last four teeth (that make the total 32) have no space to erupt in nine out of ten people.

Sometimes the last or third molar does not appear it all. These lucky people have "hypodontia" or less than the normal number of teeth. Some unfortunate people have supernumery teeth (more than 32), they have a mouth obviously full of many teeth crowded together.

Wisdom teeth usually erupt around the age of 17-24 years. They actually start to develop by the age of 9-11 years as small sacs inside the jaw, behind the second molar. They then grow and the roots become firmly planted in the jawbone. By the early 20s, the crown of a wisdom tooth begins to emerge from the gum. By the time you hit 40, the roots of the wisdom teeth are solidly planted within the dense bone of the jaw.

All teeth (except the wisdom tooth) have two teeth on either side holding them in place. The last molar has no tooth behind it. Unable to find its way out upwards in a normal position, it may get totally stuck or "impacted". A sac that surrounds the impacted tooth can fill with fluid and enlarge to form a cyst. This enlargement can encroach on the jaw and erode the bone causing permanent damage to the adjacent teeth, jawbone and nerves. Infection can set it with pain and swelling. It can remain as a tumor-like swelling in the jaw.

Signs heralding impending impaction or eruption are pain, tenderness, swelling both inside and outside the jaw, bad breath and difficulty with eating and swallowing. There may or may not be fever. Initial rumbling symptoms tend to progress with shorter and shorter pain-free intervals.

Painkillers and antibiotics (if there is fever) can provide only a certain amount of relief. There are no miracle cures. Hoping for spontaneous recovery is an exercise in futility. The troublesome tooth has to be surgically tackled.

Choose a dental surgeon who speaks kindly and explains the procedure. Lignocaine (local anaesthetic) and a comforting speech go a long way towards easing pain and anxiety. The numb mouth cannot feel the pain as the extraction is done, but often the gut-wrenching crunches made by the implements can be heard.

Once the surgery is over, the worst is yet to come. As the local anaesthetic wears off, the pain kicks in. Ice packs applied to the outside of the cheek help with the pain. Do not be a hero. Take a few days leave and use painkillers liberally. Eat only soft solids and don not chew on the affected side. There may be some oozing of blood, so the mouth may need to be rinsed with slightly salted water.

In Korea, wisdom teeth are called "love teeth" and in Japanese, its name literally means "unknown to the parents".

They all have the right idea. For most young adults the eruption of the third molar occurs when they have just fallen in love or started life on their own, either in a job or marriage. As they handle this major painful, though not life threatening, illness on their own, they truly attain maturity and wisdom.

The writer is a paediatrician with a family practice. She can be contacted at gitamathai@yahoo.com

Aging India

Growing old gracefully

	YOUR HEALTH   DR GITA MATHAI
Nafisa Ali Sodhi, an epitome of graceful ageing

Indians haven't reached the stage of Methuselah (who, the Bible says, lived for 969 years), but our life expectancy has increased from 32 years in 1940 to 65 years in 2000. Seven per cent of the 1.1 billion Indian population is today over the age of 60. We now have better access to health care but can we look forward to fun, health, dignity, economic independence and a peaceful death?

Today children work far away from home, the joint family system is breaking down, and women (traditional care-givers) have joined the work force. The old have to fend for themselves.

They cannot afford to be ill as sickness is expensive. Preventive medicine and maintenance of health is, therefore, a priority.

Good vision and hearing prevent accidents, but unfortunately they are the first senses that fail. After the age of 60, 30 per cent of the people are unable to hear a conversation. Leaning slightly forward and turning to the right side does help initially, but eventually hearing aids may be needed. Eyes too should be checked regularly and defects corrected promptly.

The skin loses its elasticity with age, becoming dry and wrinkled. Itching and scratching cause mechanical injury and secondary bacterial infection. Apply a small quantity of a mixture of 500ml of coconut oil, 500ml of sesame oil and 100ml of olive oil half an hour before bath. Add a teaspoon of coconut oil to the bath water. Use a moisturising soap. Apply body lotion or baby oil after bath.

Despite good care, regular brushing and flossing, the teeth may become discoloured, brittle, and may decay and recede. Visit the dentist at least once a year.

Sleep becomes less relaxing with early waking up and relative insomnia. Extrinsic factors like a snoring spouse or frequent essential trips to the toilet may compound the problem. Intrinsic factors like reduction in the restful delta rhythm, depression, pain, anxiety and stress can be tackled with exercise, meditation, yoga and prayer instead of getting addicted to sleeping pills.

With age the heart and blood vessels become less efficient even in the absence of obvious diseases. The heart tends to get enlarged and the pumping action decreases. The blood vessels become less pliable and elastic. This can result in the swelling of feet, high blood pressure and heart failure. Restricting salt consumption to 5gm (one teaspoon in 24 hours) and avoiding salty fried food, pickles and chutneys will help alleviate this problem.

The digestive tract also slows down. When this is compounded with a decrease in fibre content of the food and insufficient fluid intake, constipation becomes a problem. The oesophageal sphincter becomes inefficient, allowing acid to regurgitate from the stomach, causing burning and chest pain. Digestive problems are aggravated by smoking, drinking, untimely meals or lying down immediately after food.

Bones weaken with age, arthritis sets in, flexibility is lost and muscle strength reduces. These can lead to pain, falls and fractures. Supplements of calcium (1.2gms/day), walking for 40 minutes a day, and strengthening and flexibility exercises will help.

If you have a chronic disease like diabetes or high blood pressure, regular health checkups are a must.

Men need an annual digital exam of the prostate and a PSA (prostate specific antigen) test to rule out cancer of the prostrate.

Women need a pelvic examination and a PAP smear starting at 35-40 years, repeated every three years.

A breast self examination should be done every month. A screening mammogram at 40 years, and then every two years after that, is needed to detect breast cancer early enough.

Annual haemoglobin, blood sugar, lipid profile, urea, creatinine and thyroid function tests are also needed.

A baseline chest X-ray will help detect tuberculosis, emphysema and cancer.

A baseline ECG should be done around the age of 50 years and then repeated every 2-3 years.

An annual faecal occult blood test helps detect colorectal cancer.

Flexible sigmoidoscopy/colonoscopy at 50 and every 4 years thence is advisable.

Bone densitometry evaluates the risk of osteoporosis. It should be done every 1-2 years after menopause.

Immunisation does not stop in childhood. After the age of 65 years, pneumococcal vaccine will help prevent pneumonia, and "flu" vaccine influenza. Both are debilitating and can be fatal in the elderly.

To age healthily, control your weight, blood pressure and diabetes, eat four to six portions of fruit or vegetables daily, do not smoke, avoid salt, drink alcohol in moderation, walk daily, maintain muscle strength and flexibility with exercise and sleep for six or seven hours a night.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Sex Sells

This column receives many queries about contraception, even if the latest article has nothing to do with sex.

Is this because, despite our exploding population, our push for family planning and our desire to propagate the one child norm, sex education is not yet an integral part of the school curriculum?

Our teenagers have inaccurate, incorrect and inadequate information about sex from folklore, peers, pornography and the internet.

Contraception is not really a licentious 20^th century notion. Nobody ever wanted to reproduce every time they had sex. Egyptian women inserted vaginal tablets made from mildly acidic substances, the French used a hair from a horse's mane and sometimes honey or oil was poured into the vagina soon after intercourse to prevent conception. The Chinese used the first female condoms, a cervical blocking cap made of oiled paper. The first male condoms were made of animal intestine and were used in the 17^th century.

These methods were unpleasant and inefficient, so the science of contraception evolved to produce the more reliable methods that we have today.

Women can prevent pregnancy by abstinence (not having sex at all). Timed intercourse is more popular than abstinence and is considered "natural.". The "safe period" when unprotected intercourse is least likely to result in a pregnancy is carefully calculated. Ovulation (release of the egg) occurs in women on the fourteenth day BEFORE the first day of the next period and that is the period of maximum fertility. Avoiding intercourse five days before and after this date decreases the chances of an unwanted pregnancy. This method can be combined with "coitus interruptus", when ejaculation is controlled and takes place outside the vagina.

Women do not function like machines. Menstrual cycles can suddenly lengthen or shorten, making this an unreliable method. Its efficiency can be increased by watching the consistency of the cervical mucous. This changes from clear and transparent to sticky and opaque in the safe period. The body temperature also rises by 0.5⁰ C during ovulation and this can be measured daily with a thermometer. All these methods require an understanding and compliant male partner. They are more successful in planning pregnancy than preventing it.

Oral contraceptive pills (OCPs) taken by women are safe, popular and reliable provided they are taken as prescribed, at the same time every day. They are combinations of synthetic estrogens and progesterones and are taken for 21 days at a stretch. Then there is a "pill free" interval of 7 days, during which menstruation occurs. Some companies provide a 28 day pack, in which the last 7 tablets are placebos. If a pill is forgotten two should be taken the next day. If there has been two or more pill free days contraception is not assured. The actual formulation of the various hormones in the pills marketed vary. The pill best suited to that particular individual can be prescribed. Pills are contraindicated in those with complicated diabetes, thrombo-embolism, sickle cell disease, cancer of any reproductive organ and undiagnosed vaginal bleeding.

Progesterone only pills are also available and can be used in women in whom estrogens are contraindicated. They are taken continuously with no pill free interval.

India has also developed a contraceptive tablet called centchroman which belongs to the SERM (Selective Estrogen Receptor Molecule) group of medications.

OCPs are very safe, can be taken for years, do not increase the risk of cancer or decrease with the chances of a subsequent pregnancy.

Long acting progesterone injections like medroxyprogesterone acetate or norethisterone acetate, can be given every 12 and 8 weeks respectively instead for women who cannot remember to take their tablets.

Alternatively, an IUD (intrauterine device) can be inserted and left in situ to prevent pregnancy for around 3 years.

Condoms, both male and female, if properly used from the beginning to the end of intercourse protect against both pregnancy and STD. Their efficacy is increased if they are combined with a spermicidal cream.

Accidents can occur and people may have sex first and remember contraception afterwards. The government has licensed the use of "emergency contraceptive morning after pills." They are effective if taken within 72 hours.

Abortion is legal in India and medical methods with mifepristone and misoprost can be used up to 49 days.

If the pregnancy is more advanced surgical methods like a suction or dilatation curettage are needed.

Permanent contraception can be achieved by surgical sterilization, a tubectomy in women and vasectomy in men.

Pregnancy can occur if contraception is not used during lactation, with irregular cycles or even if there has been prompt douching.

Responsibility for safe sex, rests with both partners. However, unfortunately it is the women who displays the obvious outward results of an unprotected sexual encounter.

Would men be more careful if they were the ones becoming pregnant?

Dr. Gita Mathai

The writer is a paediatrician with a family practice at Vellore.

If you have any questions on health issues please write to

yourhealthgm@yahoo.co.in

 

Bald is Beautiful

Bald is Beautiful

Miss Tanzania really stood out among the Miss Universe contestants. While others had a head full of hair, she was totally clean shaven. The judges felt that "bald is beautiful," and she managed to make it to the short list of 15 semi-finalists.

Paintings and photographs traditionally depict Indian woman with dark long and lustrous hair. Indian men on the other hand are usually shown with turbans or some other covering for their head. Today, much of this has changed. Women have short hair, and the uncovered heads of many men show receding hairlines and male pattern baldness. Scanty, discolored, prematurely grey or brittle hair causes concern in both sexes. This is a lucrative market and many oils, creams and shampoos are successfully advertised on television and other to rectify theses defects.

Normal hair often responds poorly to theses expensive artificial chemicals. Traditional hair care achieves the same results with much less expense.

• Oil the hair twice a week using the tips of the fingers (not the nails).
  

  • Massage the oil into the scalp. 
    

  • A homemade excellent combination consists of a mixture of 
    

  • ½ kilo coconut oil, 
    

  • ½ kilo sesame oil 
    

  • 100 ml castor oil 
    

  • Add a bunch of curry leaves, a clove and 20 peppercorns and boiled it in this mixture. If darkening of the hair is also required curry leaves, henna leaves or powder, and shoe flower petals (red hibiscus) can be boiled in the oil in addition. 
    

  • Wash the hair without chemicals. Use home made shikakai powder mixed with a soap nut (reeta) solution. All commercial shampoos and most packaged "ready to use" herbal powders have chemical and foaming additives which are likely to damage you hair. Packaged ready made shikakai powder also has chemical additives.
    

  • Crinkling and curling can be safely done at home by plaiting the hair tightly and leaving it overnight. There is no need to use heat treatments and chemical curlers.
    

  • Blow-drying damages hair. If a dryer has to be used, cover the head with a towel and allow the air to heat the towel instead applying it directly to the head. 
    

  • Have split ends trimmed professionally.
    

Lustrous heir needs t be nutured. A diet with 

 

The Truth about Coffee

"Pregnant women should not drink coffee" declared the newspaper article. Coffee consumption was always considered undesirable for children and pregnant women. Now this old wives' tale has been vindicated and proven, based on scientific facts.

The problem with coffee is that it contains caffeine, a xanthine alkaloid that acts as a stimulant in humans. It is not just coffee that contains caffeine. It is also found in tea, carbonated beverages and chocolate. Consumption is legal, universal and unregulated. 90% of the adults use caffeine in some form, making it the world's most widely consumed psychoactive substance.

Coffee contains 40 to 120 mgms of caffeine /120ml , tea 15-30 mgms/120ml, chocolate 3 mgs/30gms and cola drinks 20 to 50 mgms/240ml. An acute overdose of caffeine can occur if more than 3–4 cups of brewed coffee, tea or cola drinks (providing 400 milligrams) is taken in a short time. It causes caffeine intoxication, with restlessness, nervousness, agitation, excitement, insomnia, flushing, urination, muscle twitching, rambling thought processes and speech, irritability and palpitations.

Caffeine ingestion can be fatal if more than 150 to 200 mgm per kilogram (80 to 100 cups of coffee for an average adult ) is taken within a limited time frame. Overdose fatalities can occur in addicted people who snort pure caffeine powder.

Caffeine stimulates the central nervous system. It makes the person alert, with faster and clearer thought processes, improved focus, coordination, endurance and peak performance especially in sports. It delays but does not eliminate the need for sleep. It takes an hour for caffeine to work and three to four hours for the effects to wear off. If large amounts are consumed over a prolonged period, caffeinism, addiction or dependency can occur. The person exhibits nervousness, irritability, anxiety, tremulousness, muscle twitching, insomnia, headaches, palpitations, peptic ulcers, and gastroesophageal reflux disease (GERD).Tolerance develops quickly, especially among heavy coffee and cola drink consumers. Withdrawal is associated with symptoms like headache, irritability, and an inability to concentrate, which may last for day.

10% of heavy coffee or tea drinkers develop symptoms that mimic organic mental disorders with anxiety agitation and panic attacks. They may be misdiagnosed and unnecessarily medicated. Withholding caffeine would have actually cured them in a few days.

Children should not be given tea and coffee. Most parents are aware of this. Contrary to popular belief, caffeine does not stunt growth in children. It does however stimulate their nervous system. They cannot tolerate more than 45 milligrams of caffeine a day. Children who consume more than this become nervous , jittery, hyperactive, have difficulty concentrating and sleeping and have a rapid heart rate.

Parents sometimes do give their children "cola drinks." Some of the orange or lime and lemony flavoured drinks also contain caffeine. The ingredients should be carefully checked on the beverage label before it is given to the child. Unfortunately regulations in India are not as strict as they are in other countries; the listing may be absent, inaccurate or incomplete.

During the hot summer months drinking caffeine containing beverages to overcome thirst is counterproductive. Caffeine acts a mild diuretic, urine production is increased, thirst is not assuaged and dehydration may be aggravated.

Coffee and tea drinking is not all bad. Caffeine consumption has its plus points. It increases mental alertness and reduces drowsiness, two qualities essential for those on night shift work or driving a vehicle for prolonged periods. It potentiates the action of many painkillers. The onset of action is faster as absorption is rapid and eventual relief is 40% better. Many over-the-counter (OTC) headache, cold, and flu drugs contain caffeine. Coffee and tea drinking is also associated with a reduced risk of developing type 2 diabetes, gallstone disease, rheumatoid arthritis, alcoholic cirrhosis, and Parkinson's disease.

Adults can safely consume two to three cups of coffee daily as it causes no detrimental long-term health consequences in them and may even confer some health benefits.

Menopausal women are more sensitive to caffeine than their menstruating counterparts. It may produce jitteriness and interfere with sleep at lower levels. The traditional tea time consumption may need to be curtailed to ensure a good night's rest.

Women have to careful about their caffeine intake from all sources (not just tea and coffee) if they are pregnant or are planning to have a baby. The best time to stop is around a month before the pregnancy is planned. This abstinence should ideally be continued throughout the pregnancy. The caffeine is harmful because it stimulates the baby's immature metabolism and stresses it. Is also suspected to decrease blood flow to the placenta. This in turn increases the risk of miscarriages and may eventually result in a small underweight baby.

If you enjoy your tea or coffee,

• Start after you are an adult
  
• Restrict yourself to 3-4 cups a day
  
• Avoid additional caffeine in carbonated beverages
  
• Have your last cup at least 6 hours before your bedtime
  
• Avoid both during pregnancy.
  

Dr. Gita Mathai

The writer is a paediatrician with a family practice at Vellore.

If you have any questions on health issues please write to

yourhealthgm@yahoo.co.in

 

Day Time Mosquitoes

Beware the day mosquito

	YOUR HEALTH   DR GITA MATHAI

People living in countries like India, Bangladesh, Myanmar and Sri Lanka, bordering the Indian Ocean and Arabian Sea, have recently been suffering from high fever, red rashes, muscle aches and incapacitating and excruciating joint pain. The disease, chikungunya, has now assumed epidemic proportions. It disregards economic status and affects everyone, from the poor farmer in his hut to the well-heeled businessman in his mansion. Entire families, housing colonies, villages and townships suffer together.

It starts suddenly and as the small joints of the hands and feet are affected the person is unable to walk. It fells a previously healthy person to the ground. Once the fever subsides, the joint pain remains for around 10-15 days in the young, 1-2 months in the middle aged and 3-6 months or even five years in older people. Work comes to a grinding halt as the patient is prostrate with a headache and joint pain.

High fever and joint pain can appear acutely in other infections like dengue, malaria or filaria. Joint pains caused by chikungunya last for months, so that it can be confused with non-infectious diseases like rheumatoid or osteoarthritis. Fortunately these diseases can be ruled out with X-rays and appropriate blood tests.

Chikungunya (meaning 'bent over' in an African tribal language) created confusion among physicians till it was rightly diagnosed during the present epidemic that started in 2006. Significantly, it wasn't the first time that chikungunya was reported in India. In 1971 an epidemic of chikungunya was proven and documented in Calcutta.

Chikungunya is an arbo virus infection transmitted by the bite of the Aedes mosquito, a small, innocuous insect with an attractive striped body. As the mosquito is a daytime biter which is "domesticated", entire families can be affected within a few days of each other. This is because, unlike the Culex and Anopheles mosquito species, which bite at dawn and dusk, the Aedes mosquito bites in broad daylight. It loves civilisation, and thrives and breeds prolifically in the new urban environment with open water storage, poor sewage disposal, and inadequate uncovered drains. It is a hardy survivor which requires only in a few millilitres of water to breed in, a quantity that easily accumulates in old tyres, upturned bottle caps and flower vases. It can also survive in luggage, clothes, cars, trains and planes and then be inadvertently carried by tourists from one place to another. The Indian epidemic has now spread to Italy and other countries in Europe. There is a reservoir of infection as the virus survives in warm blooded vertebrates like monkeys, rodents and birds.

Treatment for chikungunya is not very satisfactory. NSAIDs (nonsteroidal anti-inflammatory drugs) and paracetemol can be used for pain and fever. New studies have shown that 250mg of chloroquine (a drug used for malaria) once a day reduces joint pain. Patients become very frustrated as the response is slow and unpredictable. This makes them "doctor shop" and opt for non-conventional therapy. This can result in misdiagnosis and inappropriate treatment and may be dangerous.

There is no vaccine to prevent chikungunya. The only effective method is to prevent the mosquito bites. Since the bites occur in the daytime, mosquito nets are not effective. Keeping an affected individual in a net for 24 hours a day prevents the disease spreading to others in the house. The breeding of the mosquito should be prevented by eliminating breeding grounds.

As you walk, turn over bottles caps and coconut shells so that rainwater doesn't accumulate and stagnate. Straighten sagging canvas and plastic coverings periodically.

 Empty air conditioning and cooler trays. Alternatively, put a handful of salt into the tray so that mosquitoes cannot breed.

 Do not place trays under potted plants. Empty pots and vases regularly.

 Fix mosquito mesh on open tanks and wells.

 Windows and doors can be "mosquito proofed" using inexpensive plastic mesh.

 BTI (bacillus thurin giensis israelensis) is a naturally occurring bacterium that kills immature mosquito larvae. It is available with the government malaria control division. The substance is nontoxic to humans and can be dumped in stagnant brackish or slowly flowing water.

 There are some hardy mosquito larva eating ornamental fish, like Gambusia and Poecilia (guppy), which can be added to public ponds, canals and sewers.

 Coils, liquid repellents and mosquito mats are better avoided. They should not be used in places where there are children below the age of six months. They can cause respiratory allergy, and lead to wheezing and sneezing in susceptible individuals.

 Many mosquitoes are now resistant to DDT and other commonly used insecticides so that they survive and reproduce despite regular spraying by government and private agencies. Spraying the environment with insecticides causes the development of "pesticide resistance" in mosquitoes and respiratory allergies in susceptible individuals. It is eventually counterproductive.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Identical Ears

 

Ears Years and Hears

 

Terrorists and other unsocial elements are caught even though they radically alter their physical facial characteristics. They have plastic surgery, change their hair colour, grow moustaches and shave beards. Yet they are recognized irrefutably before their fingerprints are taken. This is because although cosmetic surgery can drastically alter physical characteristics, they do not change the shape of their ears.

 

Ears, like finger and palm prints, and dental records, provide an irrefutable biometric method of identification. This is the rational for identification photographs requesting the subject to present three-quarters of their face to the camera. Police photographs also ask for full face and profile.

 

Faces change as age advances. Our ears composed of firm cartilage defy age, do not change in shape, but continue to grow through out life instead. This is why some wizened senior citizens appear to have disproportionately large ears.

 

Our brain has a mental picture of our outer ear or pinna. These function as ear trumpets protruding from the head on either side of the body. They collect sound which are eventually interpreted as meaningful sounds. Alteration in the shape of the pinna confuses the hearing centre in the brain. Hearing functions below par until the brain reorients itself.

 

Ears are formed in utero from a series of cell "folds" which fuse together in a complicated predestined sequence to give ears their shape and unique individuality.. Sometimes the fusion does not occur fully and a tiny aperture is visible in the front of the ear called a pre auricular sinus. This can remain throughout life without causing any discomfort. In some, it gets blocked with water, soap, dust and other debris. It then becomes secondarily infected, painful swollen and red, and requires surgery and antibiotics.

 

Improper fusion can leave small mobile skin tags in the front of the ear. They are not manifestations of "good luck" and require cosmetic surgery.

 

In India ear lobes are pierced, sometimes for both sexes, at an early age. It is often a social function and may be accompanied by tonsuring. The ceremony may have a religious significance, and conducted in places of worship or by pujaris.

 

The instruments used for both procedures are may not be clean or sterile and the experienced elder not medically qualified. The gold needle heated used traditionally for the piercing may or may not be fully sterilized. It may have been used for many years on generations of children.

 

Children are susceptible to tetanus and hepatitis B. Piercing should therefore preferably be done only after immunization with the three doses of triple antigen and hepatitis B have been completed.

 

The ear lobe is very soft and the needle goes through easily. A restless child may move suddenly so that the two ear lobes are unfortunately asymmetrically pierced. The position should therefore be clearly marked with indelible ink prior to piercing after the ear is wiped with spirit or the antiseptic poviodine iodine.

 

There are several advantages to early piercing. The young child is less likely to develop keloids (unsightly hyper pigmented protrusions) at the site of the piercing. Once there is a tendency for the skin to form keloids, all successive pokes will be affected.

 

Adolescents and older individuals pierce the cartilage of their ears in several places and have numerous earrings in each ear. The piecing unfortunately is performed by friends, relatives and unqualified enthusiasts, often using a sewing needle and thread. This often causes infection of the cartilage of the ear. If untreated it form a bag of pus. The entire ear can then be destroyed forming an unsightly "cauliflower ear" identical to the ones seen in injured boxers.

 

The ear and the kidney develop at the same time (around the 12th week ) in utero. An insult in the form of an illness, prescribed medication or recreational drugs in the mother can affect both at the same time. The ear, unlike the kidney, can be clearly seen.

If the ear is abnormal the kidney should be evaluated. The hearing should also be checked.

 

Ears may be rotated abnormally, asymmetrically located and have extra creases and folds. All these abnormalities are genetic markers and warrant a careful search for other abnormalities.

 

In normal ears, a straight line drawn from the outer edge of the eye should pass through the upper 1/3 of the ear. Low set are seen in Down's syndrome (Mongolism) and some other congenital conditions.

 

Protruding (elephant ears) are normal, run in families, and can be corrected by plastic surgery.

 

A crease sometimes appears in both ear lobes. Called the "ear lobe sign" in medical parlance, it is associated with elevated lipids and cholesterol. Both ears turn black as age advances in persons with alkaptinuria or homocystinuria. In uncontrolled gout, "tophi" get deposited on the earlobes and are diagnostic markers for the disease.

 

Look closely at ears, you might pick up what your doctor missed!

 

 

 

Gita Mathai @yourhealthgmyahoo.co.in

 

        

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A salute to our Sun

A salute to the sun

Mankind knows that that the sun is the centre of the universe and that it sustains life, but sometimes, the ancient civilizations were a little confused: Did the sun go around the earth? Or was it the other way around? They (Chinese, Aztecs, Greeks, Romans and Indians) all respected the sun and had elaborate rituals to appease its mighty power. Many of these movements were later incorporated into exercise forms, performed early in the morning, clad in scanty clothing, as the first rays of the sun appeared on the horizon.

 

The sun emits light with varying spectra. The ultraviolet rays UVB (ultra violet band) stimulates the production of vitamin D. These rays are maximal at sunrise and sunset when the sunlight hits the body at an angle, and not when the sun is directly over head as it is at noon. The beneficial rays are also filtered out by window panes, clouds, fog and smog. This is why exercise is best performed outdoors at these times.

 

As sunlight falls on the skin, it helps the body to manufacture vitamin D. In 30 minutes, around 3000 IU of Vitamin D is formed and absorbed into the body. Vitamin D is essential for calcium to enter our bones. It prevents rickets in children and osteoporosis and osteomalacia in adults. Most people require only five minutes of exposure to obtain their daily requirements of this important vitamin.

 

Many people take artificially manufactured supplements of Vitamin D or capsules of natural cod liver oil to prevent deficiency. These rarely contain more than 90 IU (International Units) even though children require 200 IU and adult 400 IU/day.

 

 

Sunlight affects the pineal gland in the brain and exposure reduces the formation and release of a hormone called melatonin. Increase in melatonin levels leads to depression. That is why the "blues" set in (even in tropical countries) during winter when the days are shorter, or during the dark cloudy monsoon days. Post-natal depression too is aggravated in women confined indoors in dark rooms after child birth.

 

Regular and longer exposure to sunlight elevates the mood naturally. People who walk or jog outdoors in daylight regularly have a more positive approach to life, less stress and better coping capabilities. Roman gladiators were exposed to the sun regularly as part of their training. The trainers discovered that this toughened them mentally, and enlarged and strengthened the muscles giving them an edge over their opponents.

 

Fretful children who are sleep poorly build up fatigue and tension in their hapless parents. These children sleep longer and more soundly if they are exposed to sunlight between 12 noon and 4 pm in a veranda or some other shaded area.

 

Sometimes babies are jaundiced after birth. Whatever the cause, exposure of the affected unclothed baby to sunlight (UVB) early in the morning for 10 minutes daily brings down the jaundice. In severe cases, (in intensive care facilities and nurseries), infants are exposed to artificial UVB lights for longer periods to produce the same effect.

 

The incidence of certain cancers, like that of the breast, prostate, reproductive organs and colon are increased in individuals who are not regularly exposed to the sun.

 

The sun is a good anti septic. Before the modern antibiotic era, fresh air and sunshine were used heal wounds and to treat tuberculosis.

 

Bed bugs can be eliminated by regular exposure of mattresses and linen to sunlight. This avoids human exposure to toxic chemical pesticides.

 

In resource limited settings, where fuel is scarce and expensive, families often consume contaminated water without boiling it. This causes diarrhoea eventually leading to chronic ill health and malnutrition. Exposure of the water to sunlight in transparent plastic drums for an hour significantly reduces the bacterial load and the incidence of diarrhoeal diseases.

 

Beneficial sunlight enters our body through our eyes. It has a profound effect on hormones, reproduction and our natural internal circadian (sleep) rhythm. The amount allowed inside is naturally adjusted (without sunglasses) by the pupils and according to the colour of our eyes. In Scandinavian countries where the sunlight is less the eyes are light coloured allowing in more light, while the converse is true closer to the equator.

 

The ill effects of exposure to sunlight and the danger of developing skin cancer have been widely publicized. Skin cancer usually develops as a result of inappropriate exposure to excessive sunlight, usually around mid-day in lightly pigmented individuals. Too much of anything is bad, and the same is true of the sun.

 

The sun is a boundless source of energy and health. We need to expose ourselves to its slanting rays regularly in the morning or evening, to keep our moods elevated, our muscles strong, our circadian rhythms intact and our body cancer free. It helps to start the day with the "suryanamaskar," our very own traditional Indian salute to the sun.

 

Dr. Gita Mathai

The writer is a paediatrician with a family practice at Vellore.

If you have any questions on health issues please write to

yourhealthgm@yahoo.co.in

 

 

 

 

 

Psychopaths

The killings and other horrific acts perpetuated in Nithari, Noida, have been in the news for quite some time. A married man with grown up children, apparently aided and abetted by his domestic help, raped, murdered and eviscerated around 40 children. The motive of the two, however, is still unclear. How on earth could any civilised human do so vile a deed? Were they cannibals? Or paedophiles with a lucrative donor organ trade as a sideline? However, the most plausible explanation is that two people with antisocial personality disorder (ASPD) drifted into a relationship that was mutually beneficial, psychologically and financially. ASPD in varying degrees of severity is common in about three per cent of the total male and one per cent of the total female populations. US prison statistics indicate that 20 per cent of the long-term inmates suffer from this disorder. If chronic criminal offenders are studied, between 30 and 80 per cent would fit this profile. A person with ASPD is Corrupt. Such individuals exhibit the following traits — C — cannot follow the law O — obligations ignored R — remorselessness R — recklessness U — underhandedness P — planning deficit T — temper There are no specific tests to identify this disorder. The diagnosis is made after the age of 18 if at least three of the above symptoms have been present from the age of 15 years. The diagnosis is based on clinical interviews, self-rating personality surveys, and ratings from co-workers and family. Colour brain scans, as used while interrogating the accused from Noida, can also be used. These scans are based on the observations made by scientists while studying normal, healthy volunteers. It has been seen that varying emotions make different areas of the brain light up. Video clips of happy and neutral faces were shown to normal individuals and those diagnosed with ASPD. Both groups showed increased activity in the same areas of the brain. However, in ASPD sufferers, the response was less and slower, indicating emotional blunting. When fearful, frightening photographs were shown, healthy volunteers showed marked agitation but the response was minimal in those with ASPD. This has led researchers to conclude that though ASPD sufferers have intact neural and biochemical pathways to process emotions, the response is blunted and of low intensity. Unable to biochemically process emotional signals, people with ASPD fail to recognise facial and other signals of distress and pain. They feel no sympathy or empathy and can proceed deliberately with horrific acts of violence. Such people stride forward boldly where others fear to tread, as they are unable to plan for the future or foresee negative consequences of their actions. They make excellent mercenaries as they have no loyalty except to themselves, are indifferent to the possibility of physical pain or punishment, and show no fear when threatened. The ASPD-affected may survive and succeed due to their ability to take risks. They attract others with similar personalities. They may then band together (this is what probably happened in Noida) to form criminal gangs capable of unimaginable cruelty and violence towards the weaker members of society. The tendency to developing ASPD can be suspected in children who exhibit three warning signs, the MacDonald Triad of prolonged bedwetting, cruelty to animals and pyromania (sense of loneliness, followed by rage). During the teenage years, these individuals show a persistent disregard for the feelings and rights of others, poor academic performance, recklessness, depression and a tendency for addiction and substance abuse. When investigated, results indicate a family history of male members with milder versions of this disorder. The fathers tend to be abusive violent drug addicts or alcoholics. The mothers, too, are undemonstrative, showing little or no affection towards the children. The home environment with this combination as parents is unsatisfactory, with inadequate random inconsistent discipline and vague behavioural boundaries. In adoption studies, it was found that genes played a role in the inheritance of this personality disorder. However, the disorder was fully expressed only in those who also grew up in unsatisfactory home environments, with inadequate nurturing before five years of age. Although some people with ASPD do become successful but cruel dictators, most eventually end up in prison. In others, drug or alcohol abuse controls their lives. Treatment, with psychotherapy or medication, is difficult and not very successful. ASPD can be prevented to some extent With nurturing during the first five years of life, from caring individuals if the parents are unavailable Satisfactory parenting with consistent reasonable and logical discipline which is not harsh and arbitrary Starting psychiatric counselling in childhood if pyromania or cruelty to animals is noticed Paying attention to academic performance in the teenage years Watching for signs of drug addiction or crime in teens Not arranging a marriage for an alcoholic or drug addict in the hope that matrimony and family responsibility will provide a miraculous cure. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

 

 

 

 

 

Happy New Year

Tipple time

	Your Health   DR GITA MATHAI

The economy may be slowing down and the job market may be dicey, but it's the season to be jolly and everyone seems to be celebrating.

Almost everyone uninhibitedly imbibes at parties, as alcohol flows freely. With a variety of small pegs (30ml) or large pegs (60ml) offered, it makes sense for a person who is not a regular drinker to stick to a single glass of wine or beer, and then make it last all evening. Beverages vary in their alcohol content and in the swiftness of their action.

This is because alcohol easily enters cell membranes and all the tissues in the body. Most importantly, it unobtrusively depresses the central nervous system. It suppresses social inhibitions and affects the higher brain functions. A quiet friend may be suddenly transformed into a joking, laughing, party animal. The effect depends on not only how much was drunk but when and by whom.

Control is the key to social drinking. Salty snacks served along with alcohol enhance thirst and subtly increase consumption. After the initial feeling of relaxation and good cheer, excessive drinking can cause a blurring of vision and co-ordination problems. Unfortunately vomiting can occur and may be followed by loss of consciousness. Fluid and food from the stomach may be aspirated into the lungs. This can lead to death, an unfortunate tragic end to a happy outing. Bets may be placed or an individual may be egged on by peers to consume more and more. Continuous uninhibited consumption can lead to alcohol poisoning and death. A blood alcohol concentration of 0.45 per cent will kill 50 per cent of the people.

The same high requires more and more alcohol in regular drinkers. This is because of habituation. The exact amount required for dangerous side effects varies from person to person. The effects of alcohol can also be slowed by eating a heavy meal prior to the drinks as the absorption is delayed (one reason to eat those delicious starters). Also, if you must drink, it is better to be a man. Women become intoxicated with much less alcohol as they constitutionally have more fat and less muscle in their bodies.

Rash driving "under the influence" is common. Reaction time is slowed, making essential split second decisions difficult. Blissfully unaware, convinced of vehicle control, the drunk may speed, take unnecessary risks, or drive poorly, leading to fatal or incapacitating motor vehicle accidents.

After a drink or two, desire rears its head. Inhibitions may be sufficiently lowered for consensual, casual sex between consenting, unprepared, unprotected partners. In the cold sober light of day, the scenario changes and accusations of rape or betrayal rear their heads. Such sex can result in sexually transmitted diseases like chlamydia, herpes, gonorrhoea, hepatitis B or C or an unwanted, unplanned pregnancy.

Date rape is a very real danger today. Rape is not gender specific or confined to women. Men too can be raped, with adverse psychological and health consequences. In 40 per cent of rape cases, the perpetuator and victim are casual acquaintances, friends, colleagues, classmates or neighbours.

A bouquet of date rape drugs — tasteless, odourless, fast acting chemicals — are available, like diazepam (Valium), lorazepam, the newer flunitrazepam (Rohypnol or roofies) hallucinogenic drugs, street drugs, GHB (gamma hydroxybutyric acid) and Ketamine. Many unscrupulous antisocial elements know how to procure and use these to secretly spike alcoholic drinks, cola beverages or food, especially in dark surroundings like those found in bars and discos. The person suffers a short term memory loss, cannot recall the event or the perpetuators, and can be photographed in compromising situations. Robbery or blackmail then becomes an additional motive.

Unplanned, unprotected, casual, sexual encounters can result in unfortunate consequences like a pregnancy. Anxious days waiting for the results of a pregnancy test can now be avoided by using the i-pill for emergency contraception. It can be purchased over the counter and is effective if taken within 72 hours of intercourse. It should be taken after food. If vomiting occurs within three hours, the dose should be repeated as soon as possible. The i-Pill is meant for emergency contraception only and not for use on a regular basis. It is not an abortificant and will not terminate an established pregnancy.

Memory loss makes the victim disoriented and the recollection of the details hazy. Fear of society, guilt and social stigma make many victims hide crimes that occur while under the influence, wittingly or otherwise, of alcohol or drugs.

Avoid problems, and not parties. Remember, sensible partying requires a "designated driver" — a person who will not drink at all at that particular party, keep an eye out for friends, recognise dangers and then drive everyone safely home. A good time with no regrets can be had by all.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in