The truth about pandemics
Your Health
DR GITA MATHAI
We are reeling under a surfeit of breaking news and scientific expert opinions about the swine flu pandemic. However, we need to remain focused and evaluate the statistics. The World Health Organization (WHO) says that there are approximately 1.2 million cases worldwide and around 1,000 deaths. In India, the fatalities are still in the double digits.
In contrast, tuberculosis (TB) causes 4,00,000 deaths in India annually. In fact, it is the leading cause of death in the economically productive 15 to 45 age group. However, TB can be easily diagnosed and cured with proper medication.
Around 450 out of 1,00,000 healthy young women die during childbirth. This is in contrast to China where the figure has fallen to 50. The WHO report states that the problem is magnified because the poor get inadequate care, while the rich demand and pay for caesarians and other non essential interventions.
Nineteen-year-old Saina Nehwal made headlines when she developed chicken pox a couple of weeks before the August 10 world badminton finals. She is part of the 95 per cent of the world population that develops chicken pox at some time in the course of their lives. It is an extremely contagious infection which is not taken seriously, as it usually results in innocuous disease. It can, however, turn dangerous and cause complications like brain fever, blindness, pneumonia and sterility in 10 per cent of those affected. If it occurs in childhood, it usually passes off with about a month’s absence from school. But if it occurs at a crucial stage in life like during your college finals or a public exam, it can cause much misery. The fact is such harassment is totally avoidable. The disease is preventable with a single dose of Varicella vaccine, which has to be administered after the age of one.
Pneumococcal disease causes pneumonia, brain fever, ear infection, sinusitis and bronchitis. The infection is common and results in 1.6 million deaths every year. Of this, one million are children. The death toll can be eliminated with timely immunisation in childhood. Infective jaundice because of hepatitis A and B can also be prevented with immunisation. Hepatitis A is considered harmless and exposure inevitable in India. Although the number of fatalities is negligible, it causes morbidity, with a feeling of “weakness”, lack of energy and ill health that persists for months. Hepatitis B is more dangerous. It can result in liver damage, chronic disease, cancer and even death. Again, both infections are preventable with immunisation.
Rubella or German measles is another disease that is preventable through vaccination. If acquired during pregnancy, the affliction can result in a stillbirth or a mentally retarded child with multiple defects requiring a lifetime of care. There are more vaccine preventable diseases such as measles, brain fever (caused by H. Influenzae or the meningococcal bacteria), typhoid, rotor virus diarrhoea, polio and even cervical cancer (caused by the Human Papillovirus infection).
Why then are we so focused on the swine flu epidemic? Flu has been around for centuries. Confirmed pandemics have been occurring with devastating regularity after 1918. The viruses responsible have a reservoir in birds and animals from where they mutate and transmigrate into humans. Since pigs share many genes with humans, the transition is this particular pandemic is very efficient. The rapid spread of the virus is helped by the lack of sunshine during the monsoon and in winter. It cannot survive long when exposed to our tropical sun, so in India the pandemic may be time bound.
It is difficult to differentiate the symptoms of regular flu from that of swine flu. Both start with fever, body ache, headache, sore throat, nasal stuffiness and cough. There may be diarrhoea or vomiting. The symptoms are more severe with swine flu. Most healthy people recover spontaneously from either. Those at risk are children under five, old people above 65, pregnant women and those with underlying medical conditions such as cancer, diabetes or heart disease.
Vaccines are available, but they have to be “upgraded” and “restructured” each time there is a new epidemic, as the genetic nature of the virus changes. The WHO anticipates that a vaccine to protect us against this pandemic will be available by October or November. But will there be enough vaccine to cover the entire world (or even Indian) population at risk?
The diagnosis is confirmed by tests done on nasal and throat swabs or nasal aspirates. Blood tests can be done but they take five days and involve taking two different samples. Treatment too is available in government hospitals. The drug Tamiflu (oseltamivir) is administered once diagnosis is confirmed.
The likelihood of infection is reduced by:
• Washing hands with soap several times a day, especially after handling money
• Cleaning surfaces like doorknobs with disinfectant
• Using a face mask
• Covering the face while coughing or sneezing
• Not spitting.
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
Thursday, August 27, 2009
Thursday, August 13, 2009
pain killers
Pain and painkillers
YOUR HEALTH
DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick
Michael Jackson lived and died under the arc lights. Speculation attributes his sudden death to addiction to painkillers, disastrously fuelled by the purchasing power of his millions. He could buy schedule H drugs — which are available on prescription only — and pay for their expert administration.
Pain is universal and accounts for half the medical consultations worldwide. Since everyone wants instant relief, painkillers — also called analgesics — are the most commonly prescribed and purchased medications. They belong to several chemical groups and act by dulling unbearable pain. They do not, however, cure the disease that is the root of the problem.
This means that if the actual disease is not tackled, the pain is likely to reappear when the medication wears off. This leaves patients dissatisfied and they tend to shop around for doctors.
Pain is handled by several specialists such as neurologists, surgeons, rheumatologists, general physicians, anesthetists and dentists. A patient can have several prescriptions with unidentifiable “trade names” instead of chemical names.
In an attempt to obtain relief, he or she may take several medications together. Others may dispense with the medical profession altogether and purchase analgesics over the counter (OTC) from the friendly neighbourhood pharmacy.
In such a scenario, the quantity of drug consumed and dosage intervals are no longer scientific or within safe limits. About 25 per cent of patients overdoses and 56 per cent experiences side effects — by either taking more than the recommended dose, or taking it at intervals so short that the medication is not adequately metabolised in the body.
Gradually, the body may become so used to the painkillers that habituation sets in. The medications no longer provide relief. Higher and more frequent doses are needed until, eventually, toxic levels are reached.
Today, there are millions of people from all socio-economic strata, around the world, who have unknowingly become addicted to painkillers. They are unaware of the potentially dangerous and lethal side effects of these “harmless” medications.
Pain is defined medically as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage.” It is a natural protective defence, which prevents bodily harm. Unfortunately, pain is not a tangible or measurable entity. It is as severe as the sufferer says it is.
Although pain is subjective, the degree of pain and tolerance to it are influenced greatly by social, cultural and religious factors. Egyptian queens delivered in “birthing” chairs in full view of the entire court, without any analgesic or anaesthetic, and not one of them changed their expression. It certainly was not because they were impervious to pain!
Most of the time, pain has a sudden, acute onset at a specific location in the body and is dull, burning, throbbing or stabbing. The cause — which may be an infection or injury — can usually be identified. The pain generally disappears quickly either with no treatment at all, or with simple measures such as hot or cold compresses and analgesics.
Problems set in when the pain becomes chronic, and occurs day after day, evolving into a disease entity which seems impossible to bear or cure. Around 20 to 30 per cent of the world’s population suffers from chronic pain. The commonest causes of chronic pain are low backache, arthritis, migraine and nerve pains.
If you are suffering from chronic pain,
Ask your doctor for a diagnosis
Make sure you are not receiving habit-forming or dangerous medications
Check if your social or family problems are aggravating the symptoms
Do not take more than the amount prescribed or change the frequency
Liniments and ointments may provide relief. They need to be combined with icepacks and moist heat
Vibration can be applied by rubbing with the hand or with a machine operated by a physiotherapist. It stimulates nerve endings and the chemicals released interfere with those causing pain and block them
Acupuncture uses needles to stimulate certain nerves. It is believed to release beneficial chemicals which block those causing pain
Graded exercises and physiotherapy help by gradually strengthening the muscles overlying painful joints
Nutritional supplements like curcumin (found in turmeric), glucosamine, chondroitin (found in cartilage) and omega-3 fatty acids (found in fish) can be added to the medication. They may help even though there is no clear-cut scientific evidence that they are beneficial.
When nothing seems to work, intravenous medication and anaesthesia can be used. This should be reserved for severe pain as occurs in cancer or after surgery. This can be dangerous and should not be administered on request.
The response to pain is a conditioned reflex. Tolerance increases with physical fitness. Exercise causes the release of chemicals from the large muscles of the body which help to withstand pain. Exercise regularly for a healthy, pain-free life.
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
Self medication can be harmful, consult a doctor when your child is sick
Michael Jackson lived and died under the arc lights. Speculation attributes his sudden death to addiction to painkillers, disastrously fuelled by the purchasing power of his millions. He could buy schedule H drugs — which are available on prescription only — and pay for their expert administration.
Pain is universal and accounts for half the medical consultations worldwide. Since everyone wants instant relief, painkillers — also called analgesics — are the most commonly prescribed and purchased medications. They belong to several chemical groups and act by dulling unbearable pain. They do not, however, cure the disease that is the root of the problem.
This means that if the actual disease is not tackled, the pain is likely to reappear when the medication wears off. This leaves patients dissatisfied and they tend to shop around for doctors.
Pain is handled by several specialists such as neurologists, surgeons, rheumatologists, general physicians, anesthetists and dentists. A patient can have several prescriptions with unidentifiable “trade names” instead of chemical names.
In an attempt to obtain relief, he or she may take several medications together. Others may dispense with the medical profession altogether and purchase analgesics over the counter (OTC) from the friendly neighbourhood pharmacy.
In such a scenario, the quantity of drug consumed and dosage intervals are no longer scientific or within safe limits. About 25 per cent of patients overdoses and 56 per cent experiences side effects — by either taking more than the recommended dose, or taking it at intervals so short that the medication is not adequately metabolised in the body.
Gradually, the body may become so used to the painkillers that habituation sets in. The medications no longer provide relief. Higher and more frequent doses are needed until, eventually, toxic levels are reached.
Today, there are millions of people from all socio-economic strata, around the world, who have unknowingly become addicted to painkillers. They are unaware of the potentially dangerous and lethal side effects of these “harmless” medications.
Pain is defined medically as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage.” It is a natural protective defence, which prevents bodily harm. Unfortunately, pain is not a tangible or measurable entity. It is as severe as the sufferer says it is.
Although pain is subjective, the degree of pain and tolerance to it are influenced greatly by social, cultural and religious factors. Egyptian queens delivered in “birthing” chairs in full view of the entire court, without any analgesic or anaesthetic, and not one of them changed their expression. It certainly was not because they were impervious to pain!
Most of the time, pain has a sudden, acute onset at a specific location in the body and is dull, burning, throbbing or stabbing. The cause — which may be an infection or injury — can usually be identified. The pain generally disappears quickly either with no treatment at all, or with simple measures such as hot or cold compresses and analgesics.
Problems set in when the pain becomes chronic, and occurs day after day, evolving into a disease entity which seems impossible to bear or cure. Around 20 to 30 per cent of the world’s population suffers from chronic pain. The commonest causes of chronic pain are low backache, arthritis, migraine and nerve pains.
If you are suffering from chronic pain,
Ask your doctor for a diagnosis
Make sure you are not receiving habit-forming or dangerous medications
Check if your social or family problems are aggravating the symptoms
Do not take more than the amount prescribed or change the frequency
Liniments and ointments may provide relief. They need to be combined with icepacks and moist heat
Vibration can be applied by rubbing with the hand or with a machine operated by a physiotherapist. It stimulates nerve endings and the chemicals released interfere with those causing pain and block them
Acupuncture uses needles to stimulate certain nerves. It is believed to release beneficial chemicals which block those causing pain
Graded exercises and physiotherapy help by gradually strengthening the muscles overlying painful joints
Nutritional supplements like curcumin (found in turmeric), glucosamine, chondroitin (found in cartilage) and omega-3 fatty acids (found in fish) can be added to the medication. They may help even though there is no clear-cut scientific evidence that they are beneficial.
When nothing seems to work, intravenous medication and anaesthesia can be used. This should be reserved for severe pain as occurs in cancer or after surgery. This can be dangerous and should not be administered on request.
The response to pain is a conditioned reflex. Tolerance increases with physical fitness. Exercise causes the release of chemicals from the large muscles of the body which help to withstand pain. Exercise regularly for a healthy, pain-free life.
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
Tuesday, August 4, 2009
ouc my aching back
Ouch, my back!
Your Health
DR GITA MATHAI
Regular exercise helps overcome backache
Lumbago or backache affects 80 per cent of the population at some time in their lives and 50 per cent of the working population every year. It accounts for 20 per cent of medical consultations. The resultant loss of working days has enormous economic implications.
Why do we have backaches? As man evolved, he gradually became two-legged from four-legged. This change occurred at a price. The lower back bones (vertebrae) have to bear the weight of the ones above and cope with the additional effect of gravitational pull. This makes them prone to strain, misalignment and dislocation. Also, vertebrae are separated by water filled gelatinous discs held in place by ligaments and muscles.
With age, the discs become brittle and less flexible. They can bulge out, get displaced or dislocated and impinge on nearby structures. Nerves to the legs and arms come out of the little spaces between the vertebrae. This means that any misalignment presses on the nerves and causes pain.
Backaches cannot be attributed to any particular reason in 98 per cent of the people. X-rays are rarely useful in the evaluation of those with acute-onset low back pain. About 75 per cent will show non-specific, inconclusive, age-related changes. Magnetic resonance imaging (MRI) or computed tomography (CT) studies are more likely to reveal a diagnosis.
There might be a history of trauma, an area of weakness, loss of sensation, persistent fever, intractable pain, weight loss, an underlying cancer or it might be a side-effect of corticosteroid medication.
Conservative management should be tried for four to six weeks before proceeding for tests. Some things should be kept in mind —
• Backaches require bed rest. This means lying down for two-three days. However, rest for longer periods may weaken the back muscles further. Rest in the “sitting” position can worsen disc pain as it raises intradiscal pressures.
• Painkillers like paracetamol and non-steroidal anti-inflammatory agents (NSAIDs) should be used. Narcotics should be avoided as they are habit forming.
• Superficial heat, ultrasound, cold packs and massage can relieve pain
• The usefulness of lumbar traction is questionable.
Our changing lifestyles also increase the propensity to develop backaches. School children begin to complain of backache and shoulder pain around the time they attend middle school. Very rarely is it due to an actual back pathology. A heavy school bag, asymmetrically balanced on one sagging shoulder, with an accompanying water bottle, skews the centre of gravity and causes muscle and ligament strain. Moreover, school hours are long and involve prolonged seating. And the furniture is also often not ergonomically designed. The height of the seat may be improper or back support inadequate. At home too, homework may be done sprawled on the floor or across a sofa, with no attention paid to posture.
Women are at particular risk. Fashionable footwear (block heels, stilettos, platforms) shifts the centre of gravity. Balance then requires abnormal adjustments on part of the spine. Pregnancy exaggerates the normal shallow “S” bend (lordosis) of the lumbar spine. Hormonal laxity allows the alignment to “slip”. The resultant backache sometimes persists through life.
Sedentary individuals develop backache if they lift weights. This is because their unconditioned muscles and ligaments cannot respond efficiently to the sudden physical stress.
Weight gain too places additional stress on the spine, with each extra kilo resembling a permanently attached knapsack, to be carried during all waking hours.
As age advances, the water content of the intervertebral discs naturally decreases, causing shrinkage, fragility and decreased pliability. This in itself causes older people to “pull” their backs and injure themselves. Bones too become weaker as their calcium content decreases with increasing age.
Backaches can be prevented with a little care, effort and attention to correctable reversible factors, like posture, footwear and furniture.
The school bag should not be more than 10 per cent of the weight of the child. It should have padded straps and be placed over both shoulders. Any other weights like a water bottle (a litre of water weighs a kilo) should be consciously alternated between the two shoulders.
Seating and lighting arrangements at schools and at home should be reviewed and improved. At all ages, any weight carried should be alternated between the two arms.
Children under the age of 16 years should not wear heels. Footwear should be supportive, well designed, comfortable, practical and without heels.
A conscious effort should be made to shed excess weight and maintain the BMI (body mass index, which is weight in kilogram divided by height in metre squared) below 25.
Calcium supplements should be taken regularly.
Back exercises should be started early and continued through life. They can be learnt from yoga instructors, physiotherapists, books or television. If done regularly, back injury and pain may never occur.
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
Regular exercise helps overcome backache
Lumbago or backache affects 80 per cent of the population at some time in their lives and 50 per cent of the working population every year. It accounts for 20 per cent of medical consultations. The resultant loss of working days has enormous economic implications.
Why do we have backaches? As man evolved, he gradually became two-legged from four-legged. This change occurred at a price. The lower back bones (vertebrae) have to bear the weight of the ones above and cope with the additional effect of gravitational pull. This makes them prone to strain, misalignment and dislocation. Also, vertebrae are separated by water filled gelatinous discs held in place by ligaments and muscles.
With age, the discs become brittle and less flexible. They can bulge out, get displaced or dislocated and impinge on nearby structures. Nerves to the legs and arms come out of the little spaces between the vertebrae. This means that any misalignment presses on the nerves and causes pain.
Backaches cannot be attributed to any particular reason in 98 per cent of the people. X-rays are rarely useful in the evaluation of those with acute-onset low back pain. About 75 per cent will show non-specific, inconclusive, age-related changes. Magnetic resonance imaging (MRI) or computed tomography (CT) studies are more likely to reveal a diagnosis.
There might be a history of trauma, an area of weakness, loss of sensation, persistent fever, intractable pain, weight loss, an underlying cancer or it might be a side-effect of corticosteroid medication.
Conservative management should be tried for four to six weeks before proceeding for tests. Some things should be kept in mind —
• Backaches require bed rest. This means lying down for two-three days. However, rest for longer periods may weaken the back muscles further. Rest in the “sitting” position can worsen disc pain as it raises intradiscal pressures.
• Painkillers like paracetamol and non-steroidal anti-inflammatory agents (NSAIDs) should be used. Narcotics should be avoided as they are habit forming.
• Superficial heat, ultrasound, cold packs and massage can relieve pain
• The usefulness of lumbar traction is questionable.
Our changing lifestyles also increase the propensity to develop backaches. School children begin to complain of backache and shoulder pain around the time they attend middle school. Very rarely is it due to an actual back pathology. A heavy school bag, asymmetrically balanced on one sagging shoulder, with an accompanying water bottle, skews the centre of gravity and causes muscle and ligament strain. Moreover, school hours are long and involve prolonged seating. And the furniture is also often not ergonomically designed. The height of the seat may be improper or back support inadequate. At home too, homework may be done sprawled on the floor or across a sofa, with no attention paid to posture.
Women are at particular risk. Fashionable footwear (block heels, stilettos, platforms) shifts the centre of gravity. Balance then requires abnormal adjustments on part of the spine. Pregnancy exaggerates the normal shallow “S” bend (lordosis) of the lumbar spine. Hormonal laxity allows the alignment to “slip”. The resultant backache sometimes persists through life.
Sedentary individuals develop backache if they lift weights. This is because their unconditioned muscles and ligaments cannot respond efficiently to the sudden physical stress.
Weight gain too places additional stress on the spine, with each extra kilo resembling a permanently attached knapsack, to be carried during all waking hours.
As age advances, the water content of the intervertebral discs naturally decreases, causing shrinkage, fragility and decreased pliability. This in itself causes older people to “pull” their backs and injure themselves. Bones too become weaker as their calcium content decreases with increasing age.
Backaches can be prevented with a little care, effort and attention to correctable reversible factors, like posture, footwear and furniture.
The school bag should not be more than 10 per cent of the weight of the child. It should have padded straps and be placed over both shoulders. Any other weights like a water bottle (a litre of water weighs a kilo) should be consciously alternated between the two shoulders.
Seating and lighting arrangements at schools and at home should be reviewed and improved. At all ages, any weight carried should be alternated between the two arms.
Children under the age of 16 years should not wear heels. Footwear should be supportive, well designed, comfortable, practical and without heels.
A conscious effort should be made to shed excess weight and maintain the BMI (body mass index, which is weight in kilogram divided by height in metre squared) below 25.
Calcium supplements should be taken regularly.
Back exercises should be started early and continued through life. They can be learnt from yoga instructors, physiotherapists, books or television. If done regularly, back injury and pain may never occur.
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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