Overcoming oedema
YOUR HEALTH
DR GITA MATHAI
Swollen feet — medically called oedema — can make life miserable. Shoes and slippers don’t fit — they are tight and uncomfortable and sometimes impossible to put on. The feet feel like dead weights, and walking becomes a Herculean task. It is much easier to simply sit. But inactivity makes the swelling worse, and the sufferer is caught in a vicious cycle of swelling-inactivity-more swelling.
The fluid that accumulates and causes oedema leaks from tiny blood vessels called capillaries. This can occur as a result of increased pressure, damage to the vessels or a fall in the protein concentration of the blood. As soon as the body senses that the capillaries are leaking, compensatory mechanisms come into play and fluid is retained in the body by the kidney. The amount of fluid circulating in the body therefore increases. This, in turn, causes the capillaries to leak more. This fluid from the capillaries leaks into the surrounding tissue, causing the swelling. At least five litres of fluid need to be retained before actual swelling appears.
Feet swell before any other part of the body. This is because the hydrostatic pressure on the blood vessels of the lower limbs are, by virtue of gravity, one metre more than the pressure on the face. Also, when we sit and stand, our feet are at a lower level than the heart and this aggravates the problem.
To demonstrate oedema, press firmly with your forefinger and maintain the pressure for 10 seconds. A persistent dimple like depression indicates the presence of oedema.
However, swollen feet do not always indicate disease. Overweight individuals may develop some amount of swelling at the end of a stationery day. (Fat is fluid at body temperature). This can be normal. The swelling can extend up to the knees.
Salt also causes fluid retention. If you consume a lot of salty snacks and pickles, the kidney is not able to handle the sodium overload and fluid is retained.
Women are more prone to develop oedema than men. The female hormones oestrogen and progesterone cause fluid retention. Women tend to “swell up” during the pre-menstrual period, pregnancy and if they are on hormones, either as oral contraceptive pills or as part of hormone replacement therapy (HRT). This can extend to the hands, making finger rings tight. The face may also appear puffy. This type of oedema disappears spontaneously in a few days once menstruation occurs, the baby is born or the hormones discontinued.
Oedema can be a side effect of prescribed medication like nifedepine, amlodepin and other anti-hypertensives. Medicines for pain belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group can also cause fluid retention. Some like diclofenac may damage the kidneys. If you develop swelling while on medication, consult your doctor.
At times, oedema can be the first sign of a serious underlying medical condition. If the heart is unable to pump blood efficiently, blood can accumulate in the capillaries of the legs, ankles and feet, causing oedema.
The liver regulates the protein content of the blood. It is also responsible for adjusting the hormones and chemicals that regulate the fluid content of the body. The organ can become damaged as a result of alcoholism, hepatitis B infection or other diseases. This injury results in scar formation and is called cirrhosis. Fluid can then accumulate in the legs and abdomen. But two of the causal factors can be prevented — don’t drink excessively and take your hepatitis B immunisations.
Damaged kidneys cannot excrete excess fluid. The oedema then occurs typically around the legs and eyes. Kidney damage can occur for a variety of reasons. Preventable causes are uncontrolled, neglected diabetes and hypertension.
The veins in the leg may be damaged or weak. Sometimes the valves in these veins — which prevent back flow of blood — may be inefficient. Chronic venous insufficiency and varicose veins can result in swelling.
Excess fluid from tissues is cleared by the lymphatic system. These drain into lymph nodes and eventually into the large veins. Infections like filaria can damage the lymphatic system. The nodes can be infiltrated by cancerous deposits. The nodes may have been removed or damaged during surgery. All this can result in swelling. Usually this is present in any one limb and not symmetrically on both sides of the body.
Remember
• Oedema can be treated if the causal factor is removed
• Reduce weight if the BMI (body mass index or weight divided by height in metre squared ) is more than 23
• Walk, jog or swim for 40 minutes a day
• Try to move the legs every half hour during the day
• Do not add extra salt to food and avoid salty snacks
• Keep the feet elevated
• Use elastocrepe bandages or compression stockings on affected limbs
• Do not consume NSAIDs unnecessarily
• Seek medical advice immediately for filaria
• Use diurectics to get rid of fluid only if prescribed by a doctor
• Control diabetes and hypertension.
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, May 31, 2010
Wednesday, May 19, 2010
colour of the skin
The colour of your skin
Your Health
DR GITA MATHAI
Indians are very conscious of their skin colour. There is great alarm and anxiety if the skin suddenly develops white patches. About 1 per cent of the population is affected by this condition — called leukoderma (white skin) or vitiligo (“streaked calf” in Greek). The patches usually appear between the ages of 12 and 40. The disease affects people in all socio-economic strata. Michael Jackson was affected by it. Other rich and famous sufferers are Amitabh Bachchan and Gautam Singhania, the chairman and managing director of Raymonds.
The sudden loss of pigmentation causes 25 per cent of these people to become obsessed with their skin colour, depressed or even suicidal. Money does not make the disease disappear; it only makes it possible to consult the world’s best dermatologists.
The de-pigmentation often starts on the hands and feet. In the case of Jackson, it first appeared on his hands. This was the reason behind his signature white glove. In others it may start around orifices like the nose, mouth, eyes, umbilicus, genital areas and rectum. The patches may remain stationary, increase in size or spread over the whole body. They are symmetrical on both sides of the body. Some areas may suddenly re-pigment while the white patches continue to spread.
The loss of colour is due to the mutation of one of the genes on chromosome 17. This is usually inherited. The mutations may remain unexpressed and the person may be normal all through life. However, if a family member is affected, the risk of vitiligo developing eventually in another member is increased five-fold. The same gene is responsible for premature greying. Some members may have patches, others may develop grey hair in their twenties while still others may appear perfectly normal. The gene may start to express itself and cause de-pigmentation as a result of a trigger like a stressful event. It may also be precipitated by an injury or constant friction in shoes or clothing.
The mutated gene triggers an autoimmune disorder and the body forms antibodies against melanocytes (pigment producing cells). The latter are thus destroyed. Vitiligo may be associated with other autoimmune disorders which affect organs such as the thyroid, stomach and adrenal glands. It may form part of the spectrum of systemic lupus (an autoimmune disease that affects all the organs in the body, and is thus difficult to diagnose).
Sometimes a white baby is born to a “normal” family. The entire skin, hair and even the eyes lack pigment. This condition is called albinism and the person is referred to as an albino. It occurs because the melanocytes are unable to produce melanin, the colouring pigment. This is also an inherited condition but since the gene is recessive it does not express itself and manifest itself as a “white baby” unless it is inherited from both parents. A person who carries the gene may look normal and not be aware of it. If he or she incidentally marries another carrier, the child can be albino.
The pigment producing melanocytes may be absent from birth in certain areas. This hereditary condition is called piebaldism. It can occur anywhere, and can result in just a white forelock — like in the case of Indira Gandhi.
Owing to the similarity in symptoms, vitiligo is sometimes confused with piebaldism, albinsim or even leprosy. White scars may give rise to a similar appearance. A diagnosis can be reached by a skin biopsy.
It is better to avoid sunlight when vitiligo first appears. As the skin tans, the areas without melanin become obvious. Use an umbrella or apply SF (sunfilter) 30 sunscreen on the exposed areas.
Small patches can be camouflaged with cosmetics. They can also be treated under supervision by applying steroid creams. Constant use of these creams, however, can damage the skin texture.
Physicians in India and Egypt documented vitiligo as early as 1,500 BC. They treated it by applying and administering extracts of the fruit, seeds and leaves of two plants — Psoralea coryifolia Linnaues and Ammi majus Linnaeus. Even today, isolates of these plants are successfully used topically and orally. Synthetic compounds are also available. They act by increasing sensitivity to light and augmenting pigmentation in the affected areas (photochemotherapy) . Treatment usually involves exposure to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation. Phototherapy (without light-sensitising chemicals) can also be used. Sunburn is a common complication.
Surgical treatment can be tried by using skin grafts from pigmented areas. The success rate varies between 65 and 90 per cent. If the de-pigmented areas are extensive, some patients bleach the remaining dark portions of the skin to achieve a universal white colour.
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 very conscious of their skin colour. There is great alarm and anxiety if the skin suddenly develops white patches. About 1 per cent of the population is affected by this condition — called leukoderma (white skin) or vitiligo (“streaked calf” in Greek). The patches usually appear between the ages of 12 and 40. The disease affects people in all socio-economic strata. Michael Jackson was affected by it. Other rich and famous sufferers are Amitabh Bachchan and Gautam Singhania, the chairman and managing director of Raymonds.
The sudden loss of pigmentation causes 25 per cent of these people to become obsessed with their skin colour, depressed or even suicidal. Money does not make the disease disappear; it only makes it possible to consult the world’s best dermatologists.
The de-pigmentation often starts on the hands and feet. In the case of Jackson, it first appeared on his hands. This was the reason behind his signature white glove. In others it may start around orifices like the nose, mouth, eyes, umbilicus, genital areas and rectum. The patches may remain stationary, increase in size or spread over the whole body. They are symmetrical on both sides of the body. Some areas may suddenly re-pigment while the white patches continue to spread.
The loss of colour is due to the mutation of one of the genes on chromosome 17. This is usually inherited. The mutations may remain unexpressed and the person may be normal all through life. However, if a family member is affected, the risk of vitiligo developing eventually in another member is increased five-fold. The same gene is responsible for premature greying. Some members may have patches, others may develop grey hair in their twenties while still others may appear perfectly normal. The gene may start to express itself and cause de-pigmentation as a result of a trigger like a stressful event. It may also be precipitated by an injury or constant friction in shoes or clothing.
The mutated gene triggers an autoimmune disorder and the body forms antibodies against melanocytes (pigment producing cells). The latter are thus destroyed. Vitiligo may be associated with other autoimmune disorders which affect organs such as the thyroid, stomach and adrenal glands. It may form part of the spectrum of systemic lupus (an autoimmune disease that affects all the organs in the body, and is thus difficult to diagnose).
Sometimes a white baby is born to a “normal” family. The entire skin, hair and even the eyes lack pigment. This condition is called albinism and the person is referred to as an albino. It occurs because the melanocytes are unable to produce melanin, the colouring pigment. This is also an inherited condition but since the gene is recessive it does not express itself and manifest itself as a “white baby” unless it is inherited from both parents. A person who carries the gene may look normal and not be aware of it. If he or she incidentally marries another carrier, the child can be albino.
The pigment producing melanocytes may be absent from birth in certain areas. This hereditary condition is called piebaldism. It can occur anywhere, and can result in just a white forelock — like in the case of Indira Gandhi.
Owing to the similarity in symptoms, vitiligo is sometimes confused with piebaldism, albinsim or even leprosy. White scars may give rise to a similar appearance. A diagnosis can be reached by a skin biopsy.
It is better to avoid sunlight when vitiligo first appears. As the skin tans, the areas without melanin become obvious. Use an umbrella or apply SF (sunfilter) 30 sunscreen on the exposed areas.
Small patches can be camouflaged with cosmetics. They can also be treated under supervision by applying steroid creams. Constant use of these creams, however, can damage the skin texture.
Physicians in India and Egypt documented vitiligo as early as 1,500 BC. They treated it by applying and administering extracts of the fruit, seeds and leaves of two plants — Psoralea coryifolia Linnaues and Ammi majus Linnaeus. Even today, isolates of these plants are successfully used topically and orally. Synthetic compounds are also available. They act by increasing sensitivity to light and augmenting pigmentation in the affected areas (photochemotherapy) . Treatment usually involves exposure to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation. Phototherapy (without light-sensitising chemicals) can also be used. Sunburn is a common complication.
Surgical treatment can be tried by using skin grafts from pigmented areas. The success rate varies between 65 and 90 per cent. If the de-pigmented areas are extensive, some patients bleach the remaining dark portions of the skin to achieve a universal white colour.
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, May 10, 2010
marked for life
Moles birthmarks and angel kisses
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Mikhail Gorbachev is easily identified in photographs by a distinctive large red mark on his head. The patch is actually a birthmark — a capillary naevus — which is present from birth. One in 10 children has birthmarks on his or her body.
These marks have fascinated people down the ages. In the 16th and 17th centuries, there developed a branch of astrology called moleoscopy. Specialists interpreted the “occult significance” of birthmarks and their “effect” on one’s character and destiny. The positions of the moles were linked with astrological signs. Hippocrates, the father of medicine, wrote a treatise on the link between birthmarks and health. He had the right idea. Health is a strong determinant of the future. We now know that the birthmarks are a coincidence.
Birthmarks that are red in colour are called strawberry marks, angel kisses or stork bites. They are usually present on the eyelids, forehead or nape of the neck. They may be flat or appear slightly raised or bumpy. They are caused by an overgrowth of the small blood vessels (capillaries). They are not hereditary or cancerous and usually disappear without treatment by the age of two.
Gorbachev’s large red naevus is called a port wine stain. Such marks too are present at birth, but are much larger, do not cross the midline and unlike strawberry marks do not fade with age. Sometimes they may be associated with seizures and glaucoma in later life.
Dark slate grey or bluish marks can be present over the areas of the buttocks or back in 80 per cent of Indian babies. These are called “mongoloid spots” and to the untrained eye can be mistaken for bruises. They occur because melanocytes (pigment producing cells in the skin) get caught in the deeper layers of the skin during the development process. The marks may last till adolescence.
Café au lait spots are so called because they are a shade of brown that looks like milky coffee. They may be present at birth or appear in early childhood. If they are very large, or four or more are present, the child may be carrying the gene for neurofibromatosis. This is a condition where multiple painless bumps appear all over the face and body in adult life.
Birthmarks that are large (the size of a fist), black and sometimes hairy are called congenital naevi. They have to be watched carefully as 10 per cent can turn cancerous.
Older children may develop pigmented areas on the skin called moles. These are also called beauty marks. Marilyn Monroe and Madhubala had attractive facial moles. In the last century, moles were a fashion statement for both men and women.
A real mole is an area of skin where there is an increase in the number of melanocytes which then form a cluster. They can be flat or raised. Some may have hair growing in it. The number present increases with age and most adults have 20-40 moles. They also increase during times of hormonal change like adolescence and pregnancy. They can darken when exposed to sunlight. Some fade away with age.
Moles rarely can become cancerous. The danger signals are —
* If the mole suddenly appears after the age of 20 and seems to be increasing in size
* If the diameter is larger than the end of a pencil
* If it suddenly changes in colour
* If it itches, oozes or bleeds.
A dermatologist can remove a mole which shows any of these signs and send it for testing. Removal of a cancerous mole in the early stages is curative.
Not all pigmentations on the skin are moles. They may be “lentigenes” or brown spots that appear on the face and hands in older people, especially after exposure to sunlight. They resemble freckles. They are harmless and can be prevented by avoiding the sun.
Black spots may appear on the chest and back as people get older. They look like blobs of dirt stuck on the skin, but cannot be picked off. These are barnacles or seborrheic keratosis. The condition may run in families. They occur because keratin, a strong natural protein normally formed in the skin, increases and forms circular whorls. They are harmless and can be left alone. Some may be cosmetically disfiguring. Others may get caught in clothing and become irritated, red and start bleeding. These can be removed by a dermatologist.
The skin, especially in older overweight women, can form tags — small flaps of tissue that hang off the skin. These are not painful or dangerous. If they get snagged frequently on jewellery or clothing, they can be easily removed.
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
Mikhail Gorbachev is easily identified in photographs by a distinctive large red mark on his head. The patch is actually a birthmark — a capillary naevus — which is present from birth. One in 10 children has birthmarks on his or her body.
These marks have fascinated people down the ages. In the 16th and 17th centuries, there developed a branch of astrology called moleoscopy. Specialists interpreted the “occult significance” of birthmarks and their “effect” on one’s character and destiny. The positions of the moles were linked with astrological signs. Hippocrates, the father of medicine, wrote a treatise on the link between birthmarks and health. He had the right idea. Health is a strong determinant of the future. We now know that the birthmarks are a coincidence.
Birthmarks that are red in colour are called strawberry marks, angel kisses or stork bites. They are usually present on the eyelids, forehead or nape of the neck. They may be flat or appear slightly raised or bumpy. They are caused by an overgrowth of the small blood vessels (capillaries). They are not hereditary or cancerous and usually disappear without treatment by the age of two.
Gorbachev’s large red naevus is called a port wine stain. Such marks too are present at birth, but are much larger, do not cross the midline and unlike strawberry marks do not fade with age. Sometimes they may be associated with seizures and glaucoma in later life.
Dark slate grey or bluish marks can be present over the areas of the buttocks or back in 80 per cent of Indian babies. These are called “mongoloid spots” and to the untrained eye can be mistaken for bruises. They occur because melanocytes (pigment producing cells in the skin) get caught in the deeper layers of the skin during the development process. The marks may last till adolescence.
Café au lait spots are so called because they are a shade of brown that looks like milky coffee. They may be present at birth or appear in early childhood. If they are very large, or four or more are present, the child may be carrying the gene for neurofibromatosis. This is a condition where multiple painless bumps appear all over the face and body in adult life.
Birthmarks that are large (the size of a fist), black and sometimes hairy are called congenital naevi. They have to be watched carefully as 10 per cent can turn cancerous.
Older children may develop pigmented areas on the skin called moles. These are also called beauty marks. Marilyn Monroe and Madhubala had attractive facial moles. In the last century, moles were a fashion statement for both men and women.
A real mole is an area of skin where there is an increase in the number of melanocytes which then form a cluster. They can be flat or raised. Some may have hair growing in it. The number present increases with age and most adults have 20-40 moles. They also increase during times of hormonal change like adolescence and pregnancy. They can darken when exposed to sunlight. Some fade away with age.
Moles rarely can become cancerous. The danger signals are —
* If the mole suddenly appears after the age of 20 and seems to be increasing in size
* If the diameter is larger than the end of a pencil
* If it suddenly changes in colour
* If it itches, oozes or bleeds.
A dermatologist can remove a mole which shows any of these signs and send it for testing. Removal of a cancerous mole in the early stages is curative.
Not all pigmentations on the skin are moles. They may be “lentigenes” or brown spots that appear on the face and hands in older people, especially after exposure to sunlight. They resemble freckles. They are harmless and can be prevented by avoiding the sun.
Black spots may appear on the chest and back as people get older. They look like blobs of dirt stuck on the skin, but cannot be picked off. These are barnacles or seborrheic keratosis. The condition may run in families. They occur because keratin, a strong natural protein normally formed in the skin, increases and forms circular whorls. They are harmless and can be left alone. Some may be cosmetically disfiguring. Others may get caught in clothing and become irritated, red and start bleeding. These can be removed by a dermatologist.
The skin, especially in older overweight women, can form tags — small flaps of tissue that hang off the skin. These are not painful or dangerous. If they get snagged frequently on jewellery or clothing, they can be easily removed.
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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