Preventing cancer
Your Health
DR GITA MATHAI
A shot in the arm
Cancer conjures up images of mutilating surgery, chemotherapy, radiation, years with doctors and in hospitals, and — most terrible — death. It comes in many avatars and can attack any part of the body. The risk factors for the ailment are many. It has been found to have associations with infections, lifestyle, genetic factors and heredity. If an injection is available to prevent cancer, it is hard to imagine anyone opting not to take it!
Viruses have long been known to cause infections that can progress to cancer. Previously, the association was suspected but not proven. Today, with electron microscopes, DNA sequencing and other advanced techniques, the association between certain viral infections and cancer has been conclusively proven. Of these, two types of cancer — of the cervix and some cancers of the liver — can be prevented with timely immunisation.a
The statistics speak for themselves. Cervical cancer (or cancer of the neck of the uterus) accounts for 25 per cent of all cancers in women. It is commoner than breast cancer (14 per cent). Around 1,30,000 cases are detected annually in India and half of these women eventually succumb to the disease.
Cervical cancer has long been associated with certain risk factors. It is more likely to occur if the woman smokes, does not have a healthy diet with plenty of fruits and vegetables, is exposed to multiple male sexual partners, has her first sexual contact before the age of 17 years, or has multiple pregnancies. A higher incidence is also noted if the woman has other sexually transmitted infections like Chlamydia or infection with HIV.
Recently, the association between infection with HPV (Human Papilloma Virus) and cervical cancer has been conclusively established. More than 95 per cent of the women with cervical cancer have evidence of HPV infection. Although 75 per cent of normal women have evidence of HPV infection, the virus persists and goes on to cause cancer in 5-10 per cent.
There are 130 identified types of HPV. Some cause infection but produce no symptoms like fever or pain, and are harmless. The patient may remain totally unaware of the infection. Other subtypes of HPV may cause warts on the skin. Around 30-40 types of the virus is transmitted through sexual contact. They may produce no symptoms when the infection first occurs. The virus can persist in the surface mucosa of the moist ano-genital areas. It can produce disfiguring warts in these areas. It can extend into the vaginal areas and cervix. Cancerous changes occur 20-30 years after the initial infection, when the woman is in her 40s and 50s.The progression depends on the type of virus and is more likely to occur if the infection occurred with the subtypes 15-20.
Once the association between cervical cancer and HPV was established, the scientific community got to work and produced a vaccine. It has been extensively studied and is now marketed in India by two companies under the trade names “Gardasil” and “Cervarix”. This is a major scientific breakthrough and cervical cancer can now be prevented in future generations of women.
The dosage schedule advised for HPV vaccine is as follows. The first dose is given between nine and 11 years of age. The second dose is administered two months later, and the third six months after that. No booster doses are advised at present. Women who have not been immunised can have the first dose at any time up to the age of 26 years. If they have already been exposed to HPV, the vaccine will only protect them against the strains to which they have not been exposed. Immunisation is not advised in pregnancy but can be given to breast-feeding mothers. Side effects are rare and include fever and rash.
For those of us who are older and have not had access to the vaccine, a screening test called “pap smear” (Papanicolaou test) can be done to detect cervical cancer in its early stages. The test is widely used and is effective. Screening should ideally be done three years after sexual activity has started and then continued every three years after that. Many Indian women do not have access to this test or are unaware of it.
Liver cancer and chronic liver disease can occur in people who develop hepatitis B infection. This too is a viral disease which is spread by contact with infected body fluids (blood transfusions, sexual intercourse). Infection can be prevented by three doses of hepatitis B vaccine. The second dose is given a month after the first and the third six months later.
Men and women should receive immunisation against Hepatitis B. At present, HPV vaccine is advised only for girls. Perhaps we have forgotten that women get the infection from their infected male partners, making a case for non-gender specific universal immunisation of all children.
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, December 28, 2009
Tuesday, December 22, 2009
woman like
Breasts like a woman
Your Health
DR GITA MATHAI
Both men and women have breasts. In women they are well developed while in men they are rudimentary. Yet 60 per cent of men, at some point in their life, develop aesthetically unacceptable “gynaecomastia”, a term which in Greek means “breasts like a woman”.
Male babies may develop enlargement of one or both breasts. Sometimes, the affected breasts may also secrete a watery milk-like secretion. This is normal and occurs because the baby’s breast has been influenced by the mother’s hormones. It disappears if left alone. Pressing it to remove the milk can result in infection and abscess formation.
Thirty to 50 per cent boys in the age group 11 to 14 years suddenly develop breasts. It occurs because during this time the levels of the sex hormones, both estrogen (female hormone) and testosterone (male hormone), start to increase. Testosterone controls male traits such as muscle mass and body hair, while estrogen controls female traits, including the growth of breasts. A perfect ratio has to be maintained, or else it might lead to the development of breasts in boys. In 75 per cent of them, the breasts regress spontaneously within three years.
Breast enlargement in boys may persist because of hypogonadism (inadequate development of the male sex organs). This may be genetic — in people whose genetic profile is XXY instead of XY, owing to the failure of the testes to develop at all, or a result of artificial removal of the testes (castration). It may occur in adults as a result of kidney and thyroid diseases. Liver damage can also result in low testosterone levels and enlarged breasts.
Enzymes belonging to the cytochrome P450 group, found in fat tissue, convert testosterones to estrogens. As the fat tissue increases gynaecomastia can occur. Weight loss and exercises, like the bench press and push-ups, can correct this type of breast enlargement along with overall weight reduction.
These enzymes can be affected by medications for ulcers, anti psychotic drugs, sedatives, diuretics and some antibiotics. Long-term use of medications belonging to these groups can cause gynaecomastia. Several illicit drugs are available on the streets today. Some, such as the amphetamines, are touted as a “safe” adjuvant to long hours of studying as they prevent drowsiness. But long-term use of these not only damages the psyche but also promotes breast development.
“Nutritional supplements” are used by many bodybuilders. Many do not contain all the ingredients listed. Some are sold secretly “under the counter” or via the Internet. Many preparations are not legal or may have expired. They may not conform to safety standards. Moreover, they may contain steroids. Sometimes, they contain creatinine, natural ingredients found in the human body. However, they may be dangerous to health, and cause enlarged and sometimes lumpy breasts.
There is no short cut to a “Mr World” physique. At least two hours of workout is needed with a healthy high-protein, low-fat diet.
Gynaecomastia is not always harmless. It needs to be reviewed with all previous medical documents, and investigated with blood tests and scans. Very rarely, gynaecomastia confined to one side may be due to cancer.
Diagnosis and treatment of the underlying cause of gynaecomastia may lead to improvement. Changing the offending medication, avoiding alcohol and exercising regularly may be all that is required. Some medications which are anti estrogen, or testosterone derivatives can sometimes be used on a short-term basis under medical supervision. These medications are for treating other diseases and are not universally approved for the treatment of gynaecomastia.
Medical treatment or “waiting and watching” can be tried for two to three years. After that, the breast tissue tends to harden and then surgery is the only alternative. There are several options — liposuction, gland excision, skin sculpture, reduction mammoplasty or a combination of these techniques. Reduction surgery is a cosmetic procedure and is usually performed by plastic surgeons.
In 25 per cent of men with persistent gynaecomastia, there is no correctable cause, nor is the condition dangerous. If they do not wish to have surgery or try medications and just wish to live with the condition, the breasts can often be compressed. An elastic girdle worn by women around their abdomens can be used and works quite well. Or else, a loose thick shirt may be sufficient to hide the offending bulges.
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
Both men and women have breasts. In women they are well developed while in men they are rudimentary. Yet 60 per cent of men, at some point in their life, develop aesthetically unacceptable “gynaecomastia”, a term which in Greek means “breasts like a woman”.
Male babies may develop enlargement of one or both breasts. Sometimes, the affected breasts may also secrete a watery milk-like secretion. This is normal and occurs because the baby’s breast has been influenced by the mother’s hormones. It disappears if left alone. Pressing it to remove the milk can result in infection and abscess formation.
Thirty to 50 per cent boys in the age group 11 to 14 years suddenly develop breasts. It occurs because during this time the levels of the sex hormones, both estrogen (female hormone) and testosterone (male hormone), start to increase. Testosterone controls male traits such as muscle mass and body hair, while estrogen controls female traits, including the growth of breasts. A perfect ratio has to be maintained, or else it might lead to the development of breasts in boys. In 75 per cent of them, the breasts regress spontaneously within three years.
Breast enlargement in boys may persist because of hypogonadism (inadequate development of the male sex organs). This may be genetic — in people whose genetic profile is XXY instead of XY, owing to the failure of the testes to develop at all, or a result of artificial removal of the testes (castration). It may occur in adults as a result of kidney and thyroid diseases. Liver damage can also result in low testosterone levels and enlarged breasts.
Enzymes belonging to the cytochrome P450 group, found in fat tissue, convert testosterones to estrogens. As the fat tissue increases gynaecomastia can occur. Weight loss and exercises, like the bench press and push-ups, can correct this type of breast enlargement along with overall weight reduction.
These enzymes can be affected by medications for ulcers, anti psychotic drugs, sedatives, diuretics and some antibiotics. Long-term use of medications belonging to these groups can cause gynaecomastia. Several illicit drugs are available on the streets today. Some, such as the amphetamines, are touted as a “safe” adjuvant to long hours of studying as they prevent drowsiness. But long-term use of these not only damages the psyche but also promotes breast development.
“Nutritional supplements” are used by many bodybuilders. Many do not contain all the ingredients listed. Some are sold secretly “under the counter” or via the Internet. Many preparations are not legal or may have expired. They may not conform to safety standards. Moreover, they may contain steroids. Sometimes, they contain creatinine, natural ingredients found in the human body. However, they may be dangerous to health, and cause enlarged and sometimes lumpy breasts.
There is no short cut to a “Mr World” physique. At least two hours of workout is needed with a healthy high-protein, low-fat diet.
Gynaecomastia is not always harmless. It needs to be reviewed with all previous medical documents, and investigated with blood tests and scans. Very rarely, gynaecomastia confined to one side may be due to cancer.
Diagnosis and treatment of the underlying cause of gynaecomastia may lead to improvement. Changing the offending medication, avoiding alcohol and exercising regularly may be all that is required. Some medications which are anti estrogen, or testosterone derivatives can sometimes be used on a short-term basis under medical supervision. These medications are for treating other diseases and are not universally approved for the treatment of gynaecomastia.
Medical treatment or “waiting and watching” can be tried for two to three years. After that, the breast tissue tends to harden and then surgery is the only alternative. There are several options — liposuction, gland excision, skin sculpture, reduction mammoplasty or a combination of these techniques. Reduction surgery is a cosmetic procedure and is usually performed by plastic surgeons.
In 25 per cent of men with persistent gynaecomastia, there is no correctable cause, nor is the condition dangerous. If they do not wish to have surgery or try medications and just wish to live with the condition, the breasts can often be compressed. An elastic girdle worn by women around their abdomens can be used and works quite well. Or else, a loose thick shirt may be sufficient to hide the offending bulges.
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
Saturday, December 5, 2009
leg cramps
A painful night visitor
Your Health
DR GITA MATHAI
It is not unusual to get a sudden spasm or cramp in a muscle, causing excruciating pain and a temporary inability to move. The condition, however, has an unusual colloquial name in the US and the UK — charley horse. This may be because the pain resembles the kick of a horse. The ailment is not confined to Western nations or horse riders. It affects 70 per cent of people over the age of 50 and 50 per cent of women during pregnancy.
These leg cramps usually last less than a minute — though it may seem much longer as the pain is severe — but the contraction may take several minutes to subside. It may leave a residual dull ache. It can occur once — as a never-to-be-forgotten single incidence — or several times a month, or disturb the person’s sleep night after night.
Although any muscle can go into such cramps, it commonly occurs in bigger muscles that cross two joints, like the hamstrings and quadriceps which cross the knee and hip or calf muscles which cross the ankle and the knee. It can occur in the fingers and toes as well.
The exact reason for cramps is not known. Older people, especially post menopausal obese women, and smokers are more prone to them. Improper footwear while exercising aggravates the problem. Medications — such as statins (for high cholesterol), some drugs for high blood pressure, diuretics and steroids — may cause cramps. People of all ages can develop cramps, especially if they change their mode of exercise and suddenly increase its intensity, type and duration.
Cramps are a result of electrolyte imbalance in the body. This causes defective functioning of the muscle-nerve reflex arc. It is rather like traffic lights going out of sync and causing a jam. The electrolytes involved are sodium, potassium, magnesium, iron, zinc and calcium. Cramps occur if the ratio among these minerals changes. Proper functioning of the reflex arcs also requires biochemical reactions in the body, mediated by enzymes. The latter are affected by diseases like diabetes and malfunctioning of the thyroid gland. Deficiencies in the B group of vitamins, alcohol consumption, excessive caffeine intake and smoking also affect the enzymes.
If you have several attacks of leg cramps a month, consult your doctor. You need to tackle treatable conditions and change medication that may be aggravating it. If the cramps are due to pregnancy, they usually disappear once the baby is born.
If all the tests are normal, you may try a few simple measures:
* Try eating three to four helpings of fresh fruit and raw vegetables every day. It will correct any potassium and vitamin B deficiency.
* Eat a handful of nuts. It will take care of your requirements of magnesium and zinc.
* If you are anaemic, take iron and folic acid supplements.
* Most people do not get enough calcium from their diet and this needs to be supplemented. Around 1,200 mg of calcium needs to be taken daily, preferably at bedtime.
* Keep yourself well hydrated. Drink at least three litres of water a day and at least 250 ml before going to bed.
* Finish all your exercise at least an hour before bedtime.
* Soak the legs in warm water for 10 minutes before bedtime, and place a pillow at the end of the bed so that you sleep with your feet propped up.
* Some stretches done morning and evening prevent cramps. Stand on the floor with your feet apart. Stretch your hands up over your head and rise up on to your toes. Holding this position, rock backwards and forwards on your feet for a minute.
* Always warm up and cool down before and after exercise.
* The stretches done as a part of yoga prevent cramps.
If you develop spasms despite all this, immediately try to push the foot upwards. Massage the affected leg and apply moist heat. Sometimes, stretching the unaffected leg helps.
Leg cramps occur specifically at night. That is what distinguishes them from pain that is due to nerve disorders or damage, slipped discs or blocked blood vessels which reduce blood circulation to the legs. These diseases cause pain all the time, day and night.
“Restless legs” are different from leg cramps. This is a peculiar condition where both the legs develop pins and needles and sometimes a creeping pain several times during the night. It wakes up the person, and relief can be obtained only by moving the leg or standing up. Sleep is disturbed and inadequate. This needs to be evaluated by a doctor and treated with medication.
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
It is not unusual to get a sudden spasm or cramp in a muscle, causing excruciating pain and a temporary inability to move. The condition, however, has an unusual colloquial name in the US and the UK — charley horse. This may be because the pain resembles the kick of a horse. The ailment is not confined to Western nations or horse riders. It affects 70 per cent of people over the age of 50 and 50 per cent of women during pregnancy.
These leg cramps usually last less than a minute — though it may seem much longer as the pain is severe — but the contraction may take several minutes to subside. It may leave a residual dull ache. It can occur once — as a never-to-be-forgotten single incidence — or several times a month, or disturb the person’s sleep night after night.
Although any muscle can go into such cramps, it commonly occurs in bigger muscles that cross two joints, like the hamstrings and quadriceps which cross the knee and hip or calf muscles which cross the ankle and the knee. It can occur in the fingers and toes as well.
The exact reason for cramps is not known. Older people, especially post menopausal obese women, and smokers are more prone to them. Improper footwear while exercising aggravates the problem. Medications — such as statins (for high cholesterol), some drugs for high blood pressure, diuretics and steroids — may cause cramps. People of all ages can develop cramps, especially if they change their mode of exercise and suddenly increase its intensity, type and duration.
Cramps are a result of electrolyte imbalance in the body. This causes defective functioning of the muscle-nerve reflex arc. It is rather like traffic lights going out of sync and causing a jam. The electrolytes involved are sodium, potassium, magnesium, iron, zinc and calcium. Cramps occur if the ratio among these minerals changes. Proper functioning of the reflex arcs also requires biochemical reactions in the body, mediated by enzymes. The latter are affected by diseases like diabetes and malfunctioning of the thyroid gland. Deficiencies in the B group of vitamins, alcohol consumption, excessive caffeine intake and smoking also affect the enzymes.
If you have several attacks of leg cramps a month, consult your doctor. You need to tackle treatable conditions and change medication that may be aggravating it. If the cramps are due to pregnancy, they usually disappear once the baby is born.
If all the tests are normal, you may try a few simple measures:
* Try eating three to four helpings of fresh fruit and raw vegetables every day. It will correct any potassium and vitamin B deficiency.
* Eat a handful of nuts. It will take care of your requirements of magnesium and zinc.
* If you are anaemic, take iron and folic acid supplements.
* Most people do not get enough calcium from their diet and this needs to be supplemented. Around 1,200 mg of calcium needs to be taken daily, preferably at bedtime.
* Keep yourself well hydrated. Drink at least three litres of water a day and at least 250 ml before going to bed.
* Finish all your exercise at least an hour before bedtime.
* Soak the legs in warm water for 10 minutes before bedtime, and place a pillow at the end of the bed so that you sleep with your feet propped up.
* Some stretches done morning and evening prevent cramps. Stand on the floor with your feet apart. Stretch your hands up over your head and rise up on to your toes. Holding this position, rock backwards and forwards on your feet for a minute.
* Always warm up and cool down before and after exercise.
* The stretches done as a part of yoga prevent cramps.
If you develop spasms despite all this, immediately try to push the foot upwards. Massage the affected leg and apply moist heat. Sometimes, stretching the unaffected leg helps.
Leg cramps occur specifically at night. That is what distinguishes them from pain that is due to nerve disorders or damage, slipped discs or blocked blood vessels which reduce blood circulation to the legs. These diseases cause pain all the time, day and night.
“Restless legs” are different from leg cramps. This is a peculiar condition where both the legs develop pins and needles and sometimes a creeping pain several times during the night. It wakes up the person, and relief can be obtained only by moving the leg or standing up. Sleep is disturbed and inadequate. This needs to be evaluated by a doctor and treated with medication.
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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