Nail the problem
Your Health
DR GITA MATHAI
Your fingernails are on public display, visible as you talk, eat and work. If you are a “nail biter”, your obsessive compulsive habit advertises to the world your stressful lifestyle. And bad nails do not sit well with designer clothes.
Nail biting (medical term, onychophagia) is a common habit. It helps relieve stress and cope with excitement and boredom. It is a habit learnt by observation and runs in families. About half of all children aged 10-18 bite their nails. A small number (three per cent), of which more are males, continue this habit into adult life. Nails become disfigured and the nail beds get damaged. This can result in infection. The habit has to be consciously stopped. Difficult? Try painting the nails with a bitter nail polish.
Nails are very strong and are composed of three multicellular layers of tissue sealed together. They can be cut across but not lengthwise. Since they grow daily — about a millimetre a week — most diseases affecting an individual are reflected in visible changes in the nails. Heavy metals and toxins become deposited in the nails and remain there till the nails grow out. Poisoning with lead, thallium and arsenic can be diagnosed this way.
Healthy nails are normally slightly curved upward. The shape changes and nails become spoon shaped in case of iron deficiency anaemia. With the correction of the deficiency, the nails become normal.
Twenty per cent of women suffer from a condition called brittle nails — when the nail plate is dry, delaminates (that is, splits into thin layers) and cracks easily. This occurs with iron deficiency anaemia and is aggravated if the hands are frequently immersed in water for prolonged periods. It can be corrected by taking iron supplements and moisturising the nail several times a day. Proprietary moisturisers — many of which are overpriced — are available in the market. A homemade preparation of 50 per cent jojoba oil and 50 per cent aloe vera or a mixture of 500ml coconut oil, 500ml sesame oil and 100ml olive oil can be used. They work just as well.
An exaggeration of the normal nail curvature is called clubbing. It makes the nails resemble a parrot’s curved beak. This is found in people who have emphysema, chronic lung diseases and heart disease. The nails may also be blue because of inadequate oxygenation of the blood.
Fingernails are normally smooth and shiny. They can develop multiple small dents or pits if there is a disease like psoriasis. As the disease is brought under control, the pits disappear.
Yellow nails can be because of diabetes. It can be normal in women who wear dark coloured nail polish for long periods of time. White nails occur in case of liver and kidney disease.
White lines or dots can appear on the nails of otherwise healthy individuals. Usually it is harmless. The dots may have been caused by injury to the nail bed. Since it is visible only after the nail grows out, the injury may have been forgotten and the patch may be a cause of concern. Dots can also appear in people with eczema or in nutritional zinc deficiency. Zinc is present in fish, chicken and whole grains. The daily requirement is 10-15mg. Supplements are freely available in vitamin and mineral capsules. A white line or a dark coloured line can occur as a result of injury to the growing cells in the nail bed. This marks the date of an illness or a course of antibiotics.
Fungal infections can occur in the nail. Then the nail becomes separated from the underlying skin, starts to lift up and a crumbly white substance is seen underneath. Bacterial infections cause the nail to appear green. Diabetes also can cause either of these.
Cutting the nail too close to the skin can introduce infection. Salons offering manicures or pedicures sometimes do not sterilise their instruments properly. Small cuts and nicks during the procedure can introduce infections. Infections can be aggravated by immersion in water. A doctor should be consulted if there is sudden swelling or pain in the nails a day or two after a manicure.
Nails will reflect the underlying illness and this sometimes cannot be camouflaged even with nail polish. To strengthen normal nails, avoid infections and improve their appearance:
• Use rubber gloves when immersing the hands in water.
• Avoid nail biting or picking.
• Apply moisturiser to your nails and cuticles every day.
• File your nails in one direction and round the tip slightly, rather than filing to a point.
• Don’t remove the cuticles or clean too deeply under your nails.
• Don’t dig out ingrown toenails at home using unsterile blades and knives.
• Avoid nail polish removers that contain acetone or formaldehyde.
• Take your own instruments for manicures and pedicures.
• Eat a balanced diet with sufficient protein and vitamins.
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
Monday, June 29, 2009
Monday, June 22, 2009
why fall?
When old, you’ll fall
Your Health
DR GITA MATHAI
Everyone falls, but this is most frequent at the two extremes of life: under the age of three and over the age of 70. In the interim, people fall less. Even if they slip, they can recover unscathed as their reflexes are better and they can get hold of something and correct themselves. In older people, with less muscle strength and a slower reaction time, falls are complete and dangerous. Seventy per cent of the elderly die as an aftermath of the first fall. Thirty per cent suffer fractures, sprains, head injuries or painful bruising. Sixty per cent of the survivors become “recurrent fallers” with three or more potentially fatal episodes during the next year. Even if recovery is complete, 90 per cent suffer from a psychological fear of falling, leading to fear of movement, loss of independence, poor quality of life and isolation.
Poor vision is a common cause of accidents. Ageing decreases vision. Perception of objects and adaptation to light and darkness are faulty. The eyesight should be checked every year, spectacles purchased and timely cataract surgery performed, if required.
Hearing too is essential for balance and safety. With age, in addition to the loss of hearing that occurs naturally, there may be a build up of hard earwax blocking the ear and affecting balance. Applying a few drops of baby oil to the outer ear canal regularly and not using ear buds (which may accidentally push the wax in) will go a long way to preventing this.
Body weight should be maintained so that the body mass index (BMI) — the weight in kilograms divided by height in metre squared — is 23. If it is less than 20, the chances of a fracture are greater, with no protective pads of fat to cushion the bones. If it is greater than 23, the chances of osteoarthritis and loss of balance are greater.
The elderly tend to walk slowly, stooping at the head and shoulders. Arm swing is decreased and there is more side to side movement. This leads to subtle alterations in the centre of gravity and a tendency towards loss of balance. The propioceptors (sensors that respond to stimuli) also react slowly, contributing to falls. To correct this, practise walking consciously correcting these defects. Also, stand with both legs planted firmly on the ground, close both eyes for a minute, and then balance on one leg with the eyes still shut. This helps in maintaining a sense of balance.
Footwear slips if it is too large, the straps are not firm and the soles are smooth. These defects have to be eliminated.
Bathroom floors can be slippery and treacherous. The tiles should be rough, not glazed and smooth. Handrails should be fixed near the toilet and shower to aid in getting up from the squatting position. Lighting in the bathroom should be bright and the switch near the door.
With ageing come diseases like arthritis, foot deformities, stroke, Parkinson’s and other tremors, epilepsy, dementia and peripheral neuropathy (numbness of the feet). These complicate other long-standing illness like diabetes and hypertension. Multiple diseases require treatment with a “polypharmacy” of drugs. These medications can contribute to giddiness and falls. Drugs for controlling high blood pressure may cause “postural hypotension”, a condition in which the blood pressure is apparently normal and well controlled on lying down but drops on standing. This is because the body does not compensate for the postural change and bring the pressure to normal levels quickly enough. Diabetic medication may cause sugar levels to drop precipitously, causing a loss of consciousness and a fall. Sometimes, elderly patients are placed on antidepressants or sedatives. They may fall off the bed, or, if they wake up suddenly in the night, they may be confused and disoriented.
The following risk factors triple the chances of a fall. Just remember “I hate falling”.
I — Inflammation of joints (or joint deformity)
H — Hypotension (orthostatic blood pressure changes)
A — Auditory and visual abnormalities
T — Tremor (Parkinson’s disease or other causes of tremor)
E — Equilibrium (balance) problem
F — Foot problems
A — Arrhythmia, heart block or valvular disease
L — Leg-length discrepancy
L — Lack of conditioning (generalised weakness)
I — Illness
N — Nutrition (poor; weight loss)
G — Gait disturbance
To estimate you’re chances of a fall, sit on a stool, get up without assistance, walk 10 steps, return to the stool and sit again within 10 seconds. If you can do this, your muscle strength, power and coordination are good and you are not likely to fall.
To prevent falls, exercise aerobically by walking 40 minutes a day. Balance can be improved with regular yoga. Exercise improves muscle and bone strength and dissipates the force of an impact during a fall. It lessens the chance of fracture by 60 per cent.
As the Indian population ages, we have to concentrate on measures to ensure that the elderly are not bed ridden and a burden to their younger caregivers. Be it at 50-60 or 80, age is no bar to exercising.
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
Your Health
DR GITA MATHAI
Everyone falls, but this is most frequent at the two extremes of life: under the age of three and over the age of 70. In the interim, people fall less. Even if they slip, they can recover unscathed as their reflexes are better and they can get hold of something and correct themselves. In older people, with less muscle strength and a slower reaction time, falls are complete and dangerous. Seventy per cent of the elderly die as an aftermath of the first fall. Thirty per cent suffer fractures, sprains, head injuries or painful bruising. Sixty per cent of the survivors become “recurrent fallers” with three or more potentially fatal episodes during the next year. Even if recovery is complete, 90 per cent suffer from a psychological fear of falling, leading to fear of movement, loss of independence, poor quality of life and isolation.
Poor vision is a common cause of accidents. Ageing decreases vision. Perception of objects and adaptation to light and darkness are faulty. The eyesight should be checked every year, spectacles purchased and timely cataract surgery performed, if required.
Hearing too is essential for balance and safety. With age, in addition to the loss of hearing that occurs naturally, there may be a build up of hard earwax blocking the ear and affecting balance. Applying a few drops of baby oil to the outer ear canal regularly and not using ear buds (which may accidentally push the wax in) will go a long way to preventing this.
Body weight should be maintained so that the body mass index (BMI) — the weight in kilograms divided by height in metre squared — is 23. If it is less than 20, the chances of a fracture are greater, with no protective pads of fat to cushion the bones. If it is greater than 23, the chances of osteoarthritis and loss of balance are greater.
The elderly tend to walk slowly, stooping at the head and shoulders. Arm swing is decreased and there is more side to side movement. This leads to subtle alterations in the centre of gravity and a tendency towards loss of balance. The propioceptors (sensors that respond to stimuli) also react slowly, contributing to falls. To correct this, practise walking consciously correcting these defects. Also, stand with both legs planted firmly on the ground, close both eyes for a minute, and then balance on one leg with the eyes still shut. This helps in maintaining a sense of balance.
Footwear slips if it is too large, the straps are not firm and the soles are smooth. These defects have to be eliminated.
Bathroom floors can be slippery and treacherous. The tiles should be rough, not glazed and smooth. Handrails should be fixed near the toilet and shower to aid in getting up from the squatting position. Lighting in the bathroom should be bright and the switch near the door.
With ageing come diseases like arthritis, foot deformities, stroke, Parkinson’s and other tremors, epilepsy, dementia and peripheral neuropathy (numbness of the feet). These complicate other long-standing illness like diabetes and hypertension. Multiple diseases require treatment with a “polypharmacy” of drugs. These medications can contribute to giddiness and falls. Drugs for controlling high blood pressure may cause “postural hypotension”, a condition in which the blood pressure is apparently normal and well controlled on lying down but drops on standing. This is because the body does not compensate for the postural change and bring the pressure to normal levels quickly enough. Diabetic medication may cause sugar levels to drop precipitously, causing a loss of consciousness and a fall. Sometimes, elderly patients are placed on antidepressants or sedatives. They may fall off the bed, or, if they wake up suddenly in the night, they may be confused and disoriented.
The following risk factors triple the chances of a fall. Just remember “I hate falling”.
I — Inflammation of joints (or joint deformity)
H — Hypotension (orthostatic blood pressure changes)
A — Auditory and visual abnormalities
T — Tremor (Parkinson’s disease or other causes of tremor)
E — Equilibrium (balance) problem
F — Foot problems
A — Arrhythmia, heart block or valvular disease
L — Leg-length discrepancy
L — Lack of conditioning (generalised weakness)
I — Illness
N — Nutrition (poor; weight loss)
G — Gait disturbance
To estimate you’re chances of a fall, sit on a stool, get up without assistance, walk 10 steps, return to the stool and sit again within 10 seconds. If you can do this, your muscle strength, power and coordination are good and you are not likely to fall.
To prevent falls, exercise aerobically by walking 40 minutes a day. Balance can be improved with regular yoga. Exercise improves muscle and bone strength and dissipates the force of an impact during a fall. It lessens the chance of fracture by 60 per cent.
As the Indian population ages, we have to concentrate on measures to ensure that the elderly are not bed ridden and a burden to their younger caregivers. Be it at 50-60 or 80, age is no bar to exercising.
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
Wednesday, June 3, 2009
typhoid
Watch out for typhoid
Your Health
DR GITA MATHAI
Sanitation has never been an election issue. No political party has promised us cleaner cities or a healthier environment. Even after more than 60 years of independence the infrastructure cannot keep pace with the haphazard growth of cities. Slums have sprouted everywhere, garbage is piled up and sewage pipes are often clogged, open, aged or leaking. In many towns and villages the drainage is left open, or there is no sewage disposal at all. People still use open spaces for their ablutions.
Sewage contaminates our water supply. Epidemics of water borne diseases like typhoid (caused by the salmonella species of bacteria) occur during the rainy season. India has a very high incidence of typhoid, a fact mentioned prominently on travel advisories for tourists from other countries.
After the bacterium enters the body, there is an incubation period of 10-14 days, after which there is a feeling of malaise, followed by high spiking fever. In fair skinned individuals a red rash can be seen over the trunk and abdomen. The patient loses appetite. There may be abdominal pain and diarrhoea. In most fevers the heart rate increases approximately by 10 beats for every degree rise in temperature. There is a paradoxical effect in typhoid — slow pulse rate in the presence of high fever. The tongue is coated and white, with a central clear area like a streak of red. Lymph nodes, the liver and spleen become enlarged and can be felt.
Typhoid can be confirmed with blood tests. Some are non-specific but add to the index of suspicion. Unlike in the cases of other fevers, in typhoid the white blood cell count drops instead of rising. Laboratories often do a typhoid test called a “Widal test”. This is a non-specific test and can be positive in a variety of fevers. It is inconclusive if a single value is taken. For the diagnosis to be accurate a rising — doubling or tripling — of the titer (measurement of the amount of antibody in an organism) after a week has to be ascertained by two blood tests a week apart. No patient is really going to wait that long without treatment! The organism will grow in blood, stool and urine cultures. This also takes at least 48 hours.
There are newer more specific instant “card tests” for typhoid. When blood from the patient is placed on the card a positive result shows up as a red dot or a stripe.
If undiagnosed and untreated, typhoid complications set in during the third week. Infection can spread to the brain, lungs, bones and cause fatal complications like perforation in the intestines.
Untreated, fatality can be as high as 30 per cent. Relapses occur in 10 per cent of the people and 1-4 per cent go on to become chronic carriers of the bacteria. The organism gains a foothold in the gall bladder and remains there for the rest of the person’s life. Carriers remain apparently healthy but continue to excrete the bacteria in their stool. They are responsible for the spread of the disease.
In the 1900s an epidemic of typhoid in New York was traced to a healthy carrier, a cook called Mary. This resulted in the nickname “typhoid Mary”, a term used even today. “Typhoid Mary” now has actually become a generic term for a carrier of any dangerous disease, who is a health hazard because of a refusal to take appropriate precautions. It has also come into use as a term for a person who spreads computer viruses and malicious software.
Typhoid bacteria are killed by a variety of antibiotics. The older, more toxic drugs like chloromycetin are now seldom used and have been replaced by quinolones, cephalosporins and other groups of antibiotics with less side effects. Seven to ten days of treatment may be required. The duration of treatment, the intervals between doses and the quantity of drug given have to be adequate. Otherwise the organism becomes resistant to the medication.
Frequently, based on suspicion alone, any prolonged high spiking fever is labelled “typhoid”. Without confirmatory tests, the problem gets compounded.
Another problem is that often people discontinue medication once they feel better. Sometimes, impatient as the response and improvement are slower than anticipated, they “doctor shop” and switch medication. Medical shops also get into the act and dispense an illogical, inadequate, incomplete cocktail of antibiotics and other fever medication over the counter.
All this adds to drug resistance on the part of the organism, a failure to respond, spread of the disease and development of a carrier state.
With immunisation typhoid is preventable. The injection (a single shot) can be given after the age of two with a booster dose every three years. The oral vaccine consists of three capsules, to be taken once a day for three days. Protection lasts for two years.
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
Your Health
DR GITA MATHAI
Sanitation has never been an election issue. No political party has promised us cleaner cities or a healthier environment. Even after more than 60 years of independence the infrastructure cannot keep pace with the haphazard growth of cities. Slums have sprouted everywhere, garbage is piled up and sewage pipes are often clogged, open, aged or leaking. In many towns and villages the drainage is left open, or there is no sewage disposal at all. People still use open spaces for their ablutions.
Sewage contaminates our water supply. Epidemics of water borne diseases like typhoid (caused by the salmonella species of bacteria) occur during the rainy season. India has a very high incidence of typhoid, a fact mentioned prominently on travel advisories for tourists from other countries.
After the bacterium enters the body, there is an incubation period of 10-14 days, after which there is a feeling of malaise, followed by high spiking fever. In fair skinned individuals a red rash can be seen over the trunk and abdomen. The patient loses appetite. There may be abdominal pain and diarrhoea. In most fevers the heart rate increases approximately by 10 beats for every degree rise in temperature. There is a paradoxical effect in typhoid — slow pulse rate in the presence of high fever. The tongue is coated and white, with a central clear area like a streak of red. Lymph nodes, the liver and spleen become enlarged and can be felt.
Typhoid can be confirmed with blood tests. Some are non-specific but add to the index of suspicion. Unlike in the cases of other fevers, in typhoid the white blood cell count drops instead of rising. Laboratories often do a typhoid test called a “Widal test”. This is a non-specific test and can be positive in a variety of fevers. It is inconclusive if a single value is taken. For the diagnosis to be accurate a rising — doubling or tripling — of the titer (measurement of the amount of antibody in an organism) after a week has to be ascertained by two blood tests a week apart. No patient is really going to wait that long without treatment! The organism will grow in blood, stool and urine cultures. This also takes at least 48 hours.
There are newer more specific instant “card tests” for typhoid. When blood from the patient is placed on the card a positive result shows up as a red dot or a stripe.
If undiagnosed and untreated, typhoid complications set in during the third week. Infection can spread to the brain, lungs, bones and cause fatal complications like perforation in the intestines.
Untreated, fatality can be as high as 30 per cent. Relapses occur in 10 per cent of the people and 1-4 per cent go on to become chronic carriers of the bacteria. The organism gains a foothold in the gall bladder and remains there for the rest of the person’s life. Carriers remain apparently healthy but continue to excrete the bacteria in their stool. They are responsible for the spread of the disease.
In the 1900s an epidemic of typhoid in New York was traced to a healthy carrier, a cook called Mary. This resulted in the nickname “typhoid Mary”, a term used even today. “Typhoid Mary” now has actually become a generic term for a carrier of any dangerous disease, who is a health hazard because of a refusal to take appropriate precautions. It has also come into use as a term for a person who spreads computer viruses and malicious software.
Typhoid bacteria are killed by a variety of antibiotics. The older, more toxic drugs like chloromycetin are now seldom used and have been replaced by quinolones, cephalosporins and other groups of antibiotics with less side effects. Seven to ten days of treatment may be required. The duration of treatment, the intervals between doses and the quantity of drug given have to be adequate. Otherwise the organism becomes resistant to the medication.
Frequently, based on suspicion alone, any prolonged high spiking fever is labelled “typhoid”. Without confirmatory tests, the problem gets compounded.
Another problem is that often people discontinue medication once they feel better. Sometimes, impatient as the response and improvement are slower than anticipated, they “doctor shop” and switch medication. Medical shops also get into the act and dispense an illogical, inadequate, incomplete cocktail of antibiotics and other fever medication over the counter.
All this adds to drug resistance on the part of the organism, a failure to respond, spread of the disease and development of a carrier state.
With immunisation typhoid is preventable. The injection (a single shot) can be given after the age of two with a booster dose every three years. The oral vaccine consists of three capsules, to be taken once a day for three days. Protection lasts for two years.
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
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