Save your sanity
YOUR HEALTH
DR GITA MATHAI
A “sick” patient who goes for medical consultation does not always have a physical ailment that can be diagnosed and treated quickly. About 36 per cent of these patients suffers from mental illnesses, and of these 20 per cent has “somatisation” — that is, depression showing up as exhaustion, dizzy spells, intolerance to noise, tingling sensation, pain or insomnia. Their thoughts, emotions and behaviour are affected. They are always “sick”, and this makes it difficult for them to hold down a job or relate to people.
Serious mental illnesses (psychotic disorders) are present in 0.5 per cent of this population. Such people may suffer from schizophrenia, wherein they hear voices inside their head and which command them to do strange things. They may also be paranoid — that is, convinced that everyone (even close friends and family) is determined to harm them. Depression may cause them to become unproductive, addicted to alcohol or drugs, or have suicidal thoughts. Panic and anxiety can be so extreme that he or she is unable to leave home. Maniacal behaviour may cause reckless spending or sexual promiscuity.
Mental illness is a chronic disease, just like diabetes or arthritis. Unfortunately, it is not viewed as such. The patient and his or her family may conceal the illness because they are ashamed of it. They hope it is a passing phase brought about by “bad fate”, religious or moral transgressions, or is a result of witchcraft. If the patient is a catatonic schizophrenic — that is, remains immobile in a bizarre statue-like position for hours or even days — people around may not always understand the situation. Undiagnosed patients may be denied treatment and stigmatised, or even confined, chained or beaten.
Both men and women are prone to mental illness, but the spectrum of disease slightly differs in the sexes. Men are more prone to schizophrenia and women to depression. In addition, women suffer a specific type of depression called post natal depression (PND). This can set in one to six months after the birth of a child and can last weeks or months. During this time, women feel anxious, guilty and suicidal, as they are unable to cope with the baby. Unfortunately, though it is a self-limited treatable condition, it is often ignored. The patients are at times even accused of being “possessed” and treated by quacks.
Centuries ago, Hippocrates postulated that the brain is an organ with particular functions, just like the liver or heart, and that it is prone to disease and malfunction. Scanning techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have demonstrated that he was right. Blood flow to certain areas of the brain and its actual physical size differs in those with mental illnesses.
The heart responds to exercise with an increase in its rate. Similarly, the brain responds to life events with the release of chemical neurotransmitters such as dopamine, serotonin, noradrenaline, gamma-amino butyric acid and acetylcholine. An imbalance, the excess of any chemical, a change in the ratio or relative deficiency leads to gradations of depression, anxiety and schizophrenia.
Mental illnesses tend to run in families and have a genetic basis. Members carry genes that predispose them to neurotransmitter imbalances. The genes manifest themselves if the environmental factors are conducive. Children may be victims of abuse if one or both parents are mentally ill. They may witness alcoholism, other addictions or domestic violence. Discipline may be haphazard and academic performance unstructured and poor. This may predispose them to mental illness in later life.
If an unprovoked person suddenly becomes violent or starts talking gibberish, the diagnosis of mental illness is easy. In the early stages of mental illnesses — when the symptoms may be subtle — or in paranoid schizophrenics (who may be persuasive and appear rational in their delusions), the diagnosis is not so obvious. Conversations and interviews with the patient and relatives and verbal tests eventually lead the psychiatrist to the diagnosis. There are no confirmatory blood or imaging tests. It is a subjective diagnosis that requires expertise and years of training.
Mental illnesses may be difficult to treat, even in the best of hands. Drug combinations and dosages have to be individualised. Medication has to be continued long term. The neurochemicals in the brain take time to change, and hence the response is gradual and not dramatic. Relapses can occur, especially if dosages are missed. Psychotherapy (talking to the patient) and social rehabilitation have to take place simultaneously.
The duration of therapy and pace of improvement is often discouraging. It may make the relatives fall prey to charlatans who promise a “miracle cure”. However, their methods are unscientific and may cause harm. Religious organisations with untrained personnel are not a substitute for psychiatrists or psychotherapists. And last but not the least, marriage does not cure mental illness.
Mental illness can be prevented by —
• Early identification of problem behaviour
• Adequate social support and social networking
• Learning mechanisms for coping with stress
• Effective community care
• Physical fitness plays a positive role. A family that exercises for 40 minutes a day will be physically and mentally healthy.
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
Friday, July 24, 2009
Monday, July 13, 2009
fit to fly
Fit enough to fly
YOUR HEALTH
DR GITA MATHAI
Indians are on the move like never before. Families are scattered all over India and the globe and they travel to stay in touch. Airplanes are safe, despite the high flying altitude, relatively lower partial pressure of oxygen, variable air circulation, low humidity, sustained periods of noise, vibration and turbulence.
The rapid changes that occur during a flight (typically during descent) can give rise to ear pain, a blocked feeling, ringing in the ears, giddiness, hearing loss or even rupture of the eardrum. These complications are more likely if the Eustachian tube (connecting the ear and throat) is blocked by allergy, colds, sinusitis or middle ear infections. Chewing gum and frequent swallowing during descent can help ease the discomfort.
Decongestant nose drops will clear a blocked nose. Air travel should be avoided for 10 days if there has been a recent ear surgery or tonsillectomy.
Women often need to travel during pregnancy — as part of their jobs, because of transfers or simply to head home to have the baby. Air travel during pregnancy is safe and poses no special risks. Mid pregnancy, from the 14th to 28th week, is the safest time. In the case of multiple pregnancy (twins), a history of premature delivery, cervical incompetence, bleeding or increased uterine activity (irritable uterus), flying is inadvisable. If you need to be elsewhere for the delivery, it is better to leave before the 36th week or use an alternative mode of transport.
Most airlines refuse to allow pregnant passengers after the 36th week because of the fear that labour may set in during the flight. It is better to carry certified medical documentation about the expected date of delivery.
During pregnancy,
• the seat belt should be fastened under the abdomen, not across it;
• an aisle seat is preferable to facilitate visits to the toilet;
• try to get out of the seat every 30 minutes and walk a short distance;
• if this is not possible, flex and extend the ankles.
Babies should, preferably, not fly till they are at least seven days old.
There is a 10-day ban on air travel (not prohibited but inadvisable) after a stroke, brain surgery, an epileptic seizure, eye surgery or ear, nose or throat procedures.
Even in normal people abdominal gas increases by 25 per cent during air travel. A three to four week gap is advisable after abdominal surgery even if it is a “keyhole” or laparoscopic surgery as gas is introduced into the abdomen during the procedure. This extra gas can expand and cause the sutures to give way.
A person with congestive cardiac failure (when the heart does not function properly) should be stable for at least 10 days prior to travel.
In the case of a heart attack the person should have been stable for three to four weeks.
After pneumonia or chest surgery, a person should wait for three weeks. Even after this time they should be able to walk unassisted for at least 50 metres without becoming breathless.
Anaemia, with haemoglobin count less than 7.5 grams per decilitre, reduces the oxygen carrying capacity of blood. This can get critical during flights.
People with fractures can travel two days after the cast has been applied. In traditional casts air can be trapped between the cast and the leg. As this air expands during the flight, it can compress the limb and cut off blood supply. If a person needs to fly immediately, the doctor needs to be informed beforehand. A bivalved or split cast, which does not trap air, can be applied.
People with mental illness should be well controlled, on medication and preferably have a companion.
Diseases are spread from one country to another by infected travellers. In the recent swine flu epidemic, the spread of the disease could be plotted by tracking the flights out of Mexico (where the epidemic started).
People with open tuberculosis or measles should also defer travel. If a person has an infectious disease, travelling should be postponed until recovery. Infected air keeps circulating in a plane and this will result in the disease spreading.
The economy class has little legroom. The edge of the seat can compress the veins at the bent knee. Together with the forced immobility, blood pools in the legs and the feet swell. This can result in deep vein thrombosis and pulmonary embolism. Sudden unexpected death can occur hours or days after travel.
Generally, try to drink plenty of fluids and balance any alcohol consumed with an equal amount of water. Walk around the airport while waiting. Remember, the most dangerous thing to do is to sit still with your legs crossed.
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
Indians are on the move like never before. Families are scattered all over India and the globe and they travel to stay in touch. Airplanes are safe, despite the high flying altitude, relatively lower partial pressure of oxygen, variable air circulation, low humidity, sustained periods of noise, vibration and turbulence.
The rapid changes that occur during a flight (typically during descent) can give rise to ear pain, a blocked feeling, ringing in the ears, giddiness, hearing loss or even rupture of the eardrum. These complications are more likely if the Eustachian tube (connecting the ear and throat) is blocked by allergy, colds, sinusitis or middle ear infections. Chewing gum and frequent swallowing during descent can help ease the discomfort.
Decongestant nose drops will clear a blocked nose. Air travel should be avoided for 10 days if there has been a recent ear surgery or tonsillectomy.
Women often need to travel during pregnancy — as part of their jobs, because of transfers or simply to head home to have the baby. Air travel during pregnancy is safe and poses no special risks. Mid pregnancy, from the 14th to 28th week, is the safest time. In the case of multiple pregnancy (twins), a history of premature delivery, cervical incompetence, bleeding or increased uterine activity (irritable uterus), flying is inadvisable. If you need to be elsewhere for the delivery, it is better to leave before the 36th week or use an alternative mode of transport.
Most airlines refuse to allow pregnant passengers after the 36th week because of the fear that labour may set in during the flight. It is better to carry certified medical documentation about the expected date of delivery.
During pregnancy,
• the seat belt should be fastened under the abdomen, not across it;
• an aisle seat is preferable to facilitate visits to the toilet;
• try to get out of the seat every 30 minutes and walk a short distance;
• if this is not possible, flex and extend the ankles.
Babies should, preferably, not fly till they are at least seven days old.
There is a 10-day ban on air travel (not prohibited but inadvisable) after a stroke, brain surgery, an epileptic seizure, eye surgery or ear, nose or throat procedures.
Even in normal people abdominal gas increases by 25 per cent during air travel. A three to four week gap is advisable after abdominal surgery even if it is a “keyhole” or laparoscopic surgery as gas is introduced into the abdomen during the procedure. This extra gas can expand and cause the sutures to give way.
A person with congestive cardiac failure (when the heart does not function properly) should be stable for at least 10 days prior to travel.
In the case of a heart attack the person should have been stable for three to four weeks.
After pneumonia or chest surgery, a person should wait for three weeks. Even after this time they should be able to walk unassisted for at least 50 metres without becoming breathless.
Anaemia, with haemoglobin count less than 7.5 grams per decilitre, reduces the oxygen carrying capacity of blood. This can get critical during flights.
People with fractures can travel two days after the cast has been applied. In traditional casts air can be trapped between the cast and the leg. As this air expands during the flight, it can compress the limb and cut off blood supply. If a person needs to fly immediately, the doctor needs to be informed beforehand. A bivalved or split cast, which does not trap air, can be applied.
People with mental illness should be well controlled, on medication and preferably have a companion.
Diseases are spread from one country to another by infected travellers. In the recent swine flu epidemic, the spread of the disease could be plotted by tracking the flights out of Mexico (where the epidemic started).
People with open tuberculosis or measles should also defer travel. If a person has an infectious disease, travelling should be postponed until recovery. Infected air keeps circulating in a plane and this will result in the disease spreading.
The economy class has little legroom. The edge of the seat can compress the veins at the bent knee. Together with the forced immobility, blood pools in the legs and the feet swell. This can result in deep vein thrombosis and pulmonary embolism. Sudden unexpected death can occur hours or days after travel.
Generally, try to drink plenty of fluids and balance any alcohol consumed with an equal amount of water. Walk around the airport while waiting. Remember, the most dangerous thing to do is to sit still with your legs crossed.
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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