“I “ declared the woman , “have diabetes. I have had it for the last 10 years”. I checked her blood sugar value. It was 430.
“Your sugar is very high!” I said.
She smiled smugly. “It has never been below 400”.
“These other values are also high. You seem to have diabetes , high blood pressure and high cholesterol.”
“I don’t know about all that doctor. I ate biriyani before coming. That is why my weight and cholesterol are is high. I always become tense before seeing a doctor.”
I decided to give her the benefit of the doubt. “Do you take any tablets for the diabetes?”
“Yes,” she said , “sometimes, when I feel the sugar is high or I have drunk a Coke.”
I protested, “you cannot control your sugars based on feelings! Nor can you drink Coke.”
I could see she was not convinced. But she was willing to try. I gave her a diabetic diet sheet and asked her to follow it. “You also have to walk for an hour a day for the medications to work.”
“Can I walk up and down my hallway? “ She asked.
To me, that did not seem very practical. After all how long could a hallway be? There was the additional problem of interruptions, telephone calls, family members, the milk man-----.
“No” I said firmly, “you have to walk outside the house.”
She returned a week later. The sugar value had gone upto 500. She had put on weight as well. She had adhered to the diet. She said,” doctor it is not possible to eat all that you gave me. With my regular food as well, I am not able to eat all that.”
“The diet”, I said “is all that you get to eat. It is not in addition to what you already eat.”
Live and learn. The next 5 patients received detailed instructions on diet. It was “instead of” and not “in addition to.”
She came a week later. The sugars were still high and we were fast approaching the 100 kilo mark. In desperation I sent for her husband. Pot belied, obese with curry stains on the front of his shirt. I guess the large size of his paunch prevented him from eating his food without dripping it!
“Your wife urgently needs to exercise. She cannot go out to walk and there seems to be no park nearby. I want you to get her a treadmill or a cross trainer.”
He looked at me. “Shall I fire the servants?” we seemed to be talking at cross purposes.
“Why?” I asked.
“If she washes all the clothes and cleans the house—is that not enough?”
“No “ I said “it is not.” I had visions of trying to tackle the resultant back ache, painful knees and fungal infections of the fingers.
A month later she was brought in a state of collapse. The sugar was 63, but she was as fat as ever.
“What happened?”
I asked.
“Well,” said the husband , “today is the day she fasts.”
I had a bad feeling. “Did she take her medication?”
“Oh yes. I make sure she never misses a single dose.”
The next half hour was spent trying to explain that she should not fast. Even is she does, she should not take her medication as well. They were like recalcitrant children. . They found ways around every situation. They had an answer for everything. Within days the sugar was back to 430.
“Does she eat only 2 chappatis for dinner?”
“Yes “ he said “look.”
They were the biggest chapattis I had seen, the size of a thali meals plate.
“Does she use the treadmill?”
“Yes doctor,” it is a convenient shape and size to hang our undergarments.”
I don’t know why and how but she managed to maintain her weight (97 kg) and her sugar (330-450) for the next five years. Last I heard she was going to Mumbai to look after her grand children.
Maybe there is a lesson in this. Ideal body weight, controlled sugars and blood pressure—these are all myths. How you live and when you die – it is in the stars.
Sunday, December 11, 2011
Friday, December 9, 2011
tired?
Tired? Check your thyroid
Your Health
DR GITA MATHAI
Body temperature and weight, heart rate, skin texture, muscle and bone function, reproduction, bowel movements, sleep patterns and mental acuity are all controlled by a master computer in the brain — the pituitary gland, which sends its signals to a small gland in the neck called the thyroid. The 10-30gm gland cannot be felt by hand and its presence is unnoticed until it begins to malfunction.
One out of 4,000 children is born either without the thyroid or with one which functions sub optimally. Within a few months, parents notice that the child fails to grow as fast as his or her peers, does not feed satisfactorily, becomes constipated, has dry skin and a tongue that protrudes like that of a lizard. What is worse, mental development too is slower.
It is essential that the symptoms are recognised early on and a correct diagnosis reached because if such children do not get early and appropriate treatment they suffer physical and mental retardation.
In fact, thyroid problems can be diagnosed at birth by testing the cord blood TSH (thyroid stimulating hormone) level. This is routinely done in many hospitals. If the value is higher than normal (more than 20), the child is evaluated and treatment with thyroid hormones is started in time.
In adults, a thyroid that has been functioning normally can start malfunctioning (usually a drop in the production of thyroid hormones). This problem affects about 100 million Indians. The average age of such patients is 50 years, a majority of whom are women.
The initial symptoms are so vague that they are easy to miss — a tendency to put on weight, periods being heavier than normal, skin becoming dry, nails and hair brittle, constipation, muscle aches, lethargy and depression.
Such symptoms are often ignored and untreated. A feeling of “being tired all the time” is easy to dismiss. These symptoms can be mistaken for a normal part of perimenopause or depression or “the empty nest” syndrome. Patients may unsuccessfully try to counter the problems with nutritional supplements and multivitamin capsules. As the symptoms progress, the gland gets over-stimulated by the pituitary in an attempt to produce the required amount of hormone. It responds by increasing in size. A swelling called a goitre may then appear in the front of the neck.
At an advanced stage, the disease can be potentially fatal. As the symptoms progress, body temperature eventually drops, breathing decreases and depression and inactivity set in. The person may cease to respond, slip into a coma and die.
The body requires iodine to manufacture thyroid hormones. Adults require 150 micrograms of iodine a day. Pregnant and lactating women require 200 micrograms. Since the body cannot store iodine, it has to be taken every day. This iodine comes directly or indirectly from plants, fish and seaweed. Sea water does not contain sufficient iodine.
The amount of iodine obtained from the diet is insufficient in most cases. The government has asked salt manufacturers to fortify salt with iodine. Usually 30gm is added per kilo. Although the potency decreases with moisture, storage and cooking, usually 10-15gm of salt is consumed every day, and this provides most people with sufficient iodine.
Iodine deficiency is not the only cause of thyroid malfunction. The gland may be absent since birth, removed during surgery or destroyed by radiation. Some medications like lithium may interfere with hormone production. Stimulation of the gland may be insufficient because of pituitary disease.
The only way to treat thyroid hormone deficiency is through replacement therapy. The tablet has to be taken every day on an empty stomach first thing in the morning, otherwise it is not absorbed. The dosage has to be titrated for each patient as the response varies. Tablets should not be discontinued without a doctor’s advice. Usually, patients have to keep taking the pills all their life.
Thyroid hormones increase the BMR (basal metabolic rate). The heart rate increases, there is sweating, fine tremors and weight loss. Inappropriate administration can be dangerous. Many unscrupulous non ISI (Indian Standards Institute) pharmaceutical companies add iodine or thyroid hormone to their multimineral polyvitamin formulations. Sometimes they use thyroid gland extract from other animals as then the formulation can be labelled a “natural” product. Such supplements decrease fatigue and increase the appetite. Parents are happy as the child seems to eat more. Eventually, however side effects may appear. The natural function of the gland is suppressed. When the “tonic” is stopped, hypothyroidism sets in.
Remember:
Always use iodised salt
Read the fine print on any nutritional supplement, health drink or tonic that you and your family may have be taking
Do thyroid function tests as part of your master health check up
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
Body temperature and weight, heart rate, skin texture, muscle and bone function, reproduction, bowel movements, sleep patterns and mental acuity are all controlled by a master computer in the brain — the pituitary gland, which sends its signals to a small gland in the neck called the thyroid. The 10-30gm gland cannot be felt by hand and its presence is unnoticed until it begins to malfunction.
One out of 4,000 children is born either without the thyroid or with one which functions sub optimally. Within a few months, parents notice that the child fails to grow as fast as his or her peers, does not feed satisfactorily, becomes constipated, has dry skin and a tongue that protrudes like that of a lizard. What is worse, mental development too is slower.
It is essential that the symptoms are recognised early on and a correct diagnosis reached because if such children do not get early and appropriate treatment they suffer physical and mental retardation.
In fact, thyroid problems can be diagnosed at birth by testing the cord blood TSH (thyroid stimulating hormone) level. This is routinely done in many hospitals. If the value is higher than normal (more than 20), the child is evaluated and treatment with thyroid hormones is started in time.
In adults, a thyroid that has been functioning normally can start malfunctioning (usually a drop in the production of thyroid hormones). This problem affects about 100 million Indians. The average age of such patients is 50 years, a majority of whom are women.
The initial symptoms are so vague that they are easy to miss — a tendency to put on weight, periods being heavier than normal, skin becoming dry, nails and hair brittle, constipation, muscle aches, lethargy and depression.
Such symptoms are often ignored and untreated. A feeling of “being tired all the time” is easy to dismiss. These symptoms can be mistaken for a normal part of perimenopause or depression or “the empty nest” syndrome. Patients may unsuccessfully try to counter the problems with nutritional supplements and multivitamin capsules. As the symptoms progress, the gland gets over-stimulated by the pituitary in an attempt to produce the required amount of hormone. It responds by increasing in size. A swelling called a goitre may then appear in the front of the neck.
At an advanced stage, the disease can be potentially fatal. As the symptoms progress, body temperature eventually drops, breathing decreases and depression and inactivity set in. The person may cease to respond, slip into a coma and die.
The body requires iodine to manufacture thyroid hormones. Adults require 150 micrograms of iodine a day. Pregnant and lactating women require 200 micrograms. Since the body cannot store iodine, it has to be taken every day. This iodine comes directly or indirectly from plants, fish and seaweed. Sea water does not contain sufficient iodine.
The amount of iodine obtained from the diet is insufficient in most cases. The government has asked salt manufacturers to fortify salt with iodine. Usually 30gm is added per kilo. Although the potency decreases with moisture, storage and cooking, usually 10-15gm of salt is consumed every day, and this provides most people with sufficient iodine.
Iodine deficiency is not the only cause of thyroid malfunction. The gland may be absent since birth, removed during surgery or destroyed by radiation. Some medications like lithium may interfere with hormone production. Stimulation of the gland may be insufficient because of pituitary disease.
The only way to treat thyroid hormone deficiency is through replacement therapy. The tablet has to be taken every day on an empty stomach first thing in the morning, otherwise it is not absorbed. The dosage has to be titrated for each patient as the response varies. Tablets should not be discontinued without a doctor’s advice. Usually, patients have to keep taking the pills all their life.
Thyroid hormones increase the BMR (basal metabolic rate). The heart rate increases, there is sweating, fine tremors and weight loss. Inappropriate administration can be dangerous. Many unscrupulous non ISI (Indian Standards Institute) pharmaceutical companies add iodine or thyroid hormone to their multimineral polyvitamin formulations. Sometimes they use thyroid gland extract from other animals as then the formulation can be labelled a “natural” product. Such supplements decrease fatigue and increase the appetite. Parents are happy as the child seems to eat more. Eventually, however side effects may appear. The natural function of the gland is suppressed. When the “tonic” is stopped, hypothyroidism sets in.
Remember:
Always use iodised salt
Read the fine print on any nutritional supplement, health drink or tonic that you and your family may have be taking
Do thyroid function tests as part of your master health check up
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, December 1, 2011
first aid
ox of help
YOUR HEALTH
DR GITA MATHAI
Cuts, bruises, electrical shocks, insect bites, earache — everyone has faced an acute medical emergency at some time in their life, often at night when neither helpful neighbours nor transportation is easily available. Emergencies seem to have a knack of occurring only at night or during a bandh when professional help is just not available.
The first step to tackling emergencies successfully is to fabricate a first aid box and keep it in an easy-to-find place, which incidentally, should be out of the reach of children.
The box should contain:
• a pair of scissors,
• a writing pad and pen,
• a torch (that works),
• copies of medical insurance papers or cash less cards,
• contact address and phone number of hospitals where such treatment is available,
• a roll of gauze bandage,
• a roll of cotton,
• some band aid strips,
• a tube of pain relieving ointment,
• an antiseptic ointment like povidone-iodine,
• an antibiotic ointment (bacitracin, polymixcin),
• eye drops, nose drops and analgesic ear drops
• Medications such as tablets of aspirin, paracetemol (for adults and children), an antispasmodic, and anti histamines like chlorpheniramine maleate (Avil) or diphendydramine (Benedryl), and an antacid liquid.
Chest pain always causes panic — in the sufferer and in family members — with visions of sudden death. Remember, in a heart attack the pain is present for 15 minutes or longer. It radiates up the neck, down the arm, moves to the back and is associated with sweating, fainting and pallor. There is no localised area of tenderness. If your pain ticks all these boxes, get medical help urgently. Before heading to the hospital, however, taking a tablet of aspirin (325mg) may save your life like it has saved that of innumerable others.
A toothache can often start in the middle of the night. Sucking on an ice cube may help. Also, take a painkiller like aspirin or paracetamol and contact a dentist as soon as possible.
Electrical short circuits, fires and shocks are other common emergencies. Always switch off the electricity mains first. Use a non-conducting material such as a wooden spoon or plastic stick to separate the person from the live wire. Do not touch the person with your bare hands. Although the actual burn caused by an electric shock appears small, the damage can extend deep into the body. It can cause the heart to stop beating. Violent jerking can cause dislocations and fractures.
Burns and scalds are very common. If a person is on fire, roll them on the ground or wrap them in a heavy sheet to smother the fire. Hold the affected area under cold water or apply a cold compress. Placing ice directly on the burnt area is not advisable as can cause frostbite. If there is a blister, wipe it and the area around it with a solution of povidone iodine to sterilise it. Then poke it in three areas, taking care to keep the overlying skin intact. This makes the skin collapse on the blister and the area is no longer raw. Apply an antibiotic ointment and cover it with a gauze bandage.
Fainting is usually harmless. First, position the person on their back. Elevate the legs above the head with cushions or anything else available. If the person is in the sitting position, place the head between the knees. People faint because of a sudden decrease in blood flowing to the brain. By elevating the legs above the head, the venous return is increased, rectifying this problem.
Anything can precipitate an allergic reaction, pollen, chemicals in the air, dust, latex from gloves or shoes, or additives and colouring agents in food. There may be itching, the throat may swell, lips may become red and swollen and there may be difficulty in breathing. Mild reactions can be treated with oral tablets of an antihistamine such as chlorpheniramine (Avil) or diphenhydramine (Bendryl). Difficulty in breathing or swelling of the throat is an emergency and the person should be rushed to hospital.
If an insect has entered the ear, place the ear against a bright light. The insect may fly out. Otherwise, pour a little paraffin oil or baby oil into the ear. The insect will float up. Do not attempt to pry the insect loose with an ear bud as you may damage the ear.
A blocked nose may not be an emergency but it is very uncomfortable. Tilt the head back, put a couple of drops of a nasal drop into each nostril and then take a steam inhalation. This will clear up both an allergic block or one due to a cold. If there is a foreign body in the nose, try to blow it out gently while closing the opposite nostril. Do not suck in air as it will move the object upwards.
You can usually stop a nose bleed by using decongestant nose drops and then pinching the nostrils together. Frequent nosebleeds require evaluation.
Injury around the eye causes discolouration — a “black eye”. This is usually not serious. It will subside spontaneously with a cold compress. Bilateral black eyes may be due to head injury and is a dangerous sign. A foreign body in the eye can cause damage to the cornea. Immediately wash the eye with running water and apply antibiotic eye drops.
Learning basic first aid will bring peace of mind and, maybe, even help you save a 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
Cuts, bruises, electrical shocks, insect bites, earache — everyone has faced an acute medical emergency at some time in their life, often at night when neither helpful neighbours nor transportation is easily available. Emergencies seem to have a knack of occurring only at night or during a bandh when professional help is just not available.
The first step to tackling emergencies successfully is to fabricate a first aid box and keep it in an easy-to-find place, which incidentally, should be out of the reach of children.
The box should contain:
• a pair of scissors,
• a writing pad and pen,
• a torch (that works),
• copies of medical insurance papers or cash less cards,
• contact address and phone number of hospitals where such treatment is available,
• a roll of gauze bandage,
• a roll of cotton,
• some band aid strips,
• a tube of pain relieving ointment,
• an antiseptic ointment like povidone-iodine,
• an antibiotic ointment (bacitracin, polymixcin),
• eye drops, nose drops and analgesic ear drops
• Medications such as tablets of aspirin, paracetemol (for adults and children), an antispasmodic, and anti histamines like chlorpheniramine maleate (Avil) or diphendydramine (Benedryl), and an antacid liquid.
Chest pain always causes panic — in the sufferer and in family members — with visions of sudden death. Remember, in a heart attack the pain is present for 15 minutes or longer. It radiates up the neck, down the arm, moves to the back and is associated with sweating, fainting and pallor. There is no localised area of tenderness. If your pain ticks all these boxes, get medical help urgently. Before heading to the hospital, however, taking a tablet of aspirin (325mg) may save your life like it has saved that of innumerable others.
A toothache can often start in the middle of the night. Sucking on an ice cube may help. Also, take a painkiller like aspirin or paracetamol and contact a dentist as soon as possible.
Electrical short circuits, fires and shocks are other common emergencies. Always switch off the electricity mains first. Use a non-conducting material such as a wooden spoon or plastic stick to separate the person from the live wire. Do not touch the person with your bare hands. Although the actual burn caused by an electric shock appears small, the damage can extend deep into the body. It can cause the heart to stop beating. Violent jerking can cause dislocations and fractures.
Burns and scalds are very common. If a person is on fire, roll them on the ground or wrap them in a heavy sheet to smother the fire. Hold the affected area under cold water or apply a cold compress. Placing ice directly on the burnt area is not advisable as can cause frostbite. If there is a blister, wipe it and the area around it with a solution of povidone iodine to sterilise it. Then poke it in three areas, taking care to keep the overlying skin intact. This makes the skin collapse on the blister and the area is no longer raw. Apply an antibiotic ointment and cover it with a gauze bandage.
Fainting is usually harmless. First, position the person on their back. Elevate the legs above the head with cushions or anything else available. If the person is in the sitting position, place the head between the knees. People faint because of a sudden decrease in blood flowing to the brain. By elevating the legs above the head, the venous return is increased, rectifying this problem.
Anything can precipitate an allergic reaction, pollen, chemicals in the air, dust, latex from gloves or shoes, or additives and colouring agents in food. There may be itching, the throat may swell, lips may become red and swollen and there may be difficulty in breathing. Mild reactions can be treated with oral tablets of an antihistamine such as chlorpheniramine (Avil) or diphenhydramine (Bendryl). Difficulty in breathing or swelling of the throat is an emergency and the person should be rushed to hospital.
If an insect has entered the ear, place the ear against a bright light. The insect may fly out. Otherwise, pour a little paraffin oil or baby oil into the ear. The insect will float up. Do not attempt to pry the insect loose with an ear bud as you may damage the ear.
A blocked nose may not be an emergency but it is very uncomfortable. Tilt the head back, put a couple of drops of a nasal drop into each nostril and then take a steam inhalation. This will clear up both an allergic block or one due to a cold. If there is a foreign body in the nose, try to blow it out gently while closing the opposite nostril. Do not suck in air as it will move the object upwards.
You can usually stop a nose bleed by using decongestant nose drops and then pinching the nostrils together. Frequent nosebleeds require evaluation.
Injury around the eye causes discolouration — a “black eye”. This is usually not serious. It will subside spontaneously with a cold compress. Bilateral black eyes may be due to head injury and is a dangerous sign. A foreign body in the eye can cause damage to the cornea. Immediately wash the eye with running water and apply antibiotic eye drops.
Learning basic first aid will bring peace of mind and, maybe, even help you save a 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, November 15, 2011
bony spurs
Feel it in your bones
Your Health
DR GITA MATHAI
When babies are born, they have about 350 bones. Many of these eventually fuse and adults are left with 208 bones. Locomotion and movement are possible because the bones form joints, which “articulate” with each other. Carpenters have taken a leaf out of God’s book and based the joints in their trade on this. Like us, they too have metal and plastic sliding, hinged and ball and socket joints. Just like in mechanical joints, in human joints too mechanical failure, slipping and degeneration can occur with age, overuse, lack of proper lubrication and misalignment.
Unlike carpentry joints, human joints are protected from injury by muscles and tendons. Wear and tear and overuse can cause microscopic tears in these. Calcium gets deposited in the tears, forming bony projections called spurs, which are meant to actually protect the joint.
The symptoms caused by spurs depend on their location. Spurs are usually too deep to be felt. They can be asymptomatic and be discovered accidently in an X-ray taken for some other reason. But they can cause discomfort if they press on nerves.
One of the commonest locations for spurs is the heel. If you feel a severe shooting pain, especially while placing the foot on the ground first thing in the morning, be sure it is a spur. It affects 10 per cent of the population at some point in their life.
Spurs are common in women, especially if you have gained weight. It is yet another symptom brought on by the “middle aged spread”. Feet have to bear the weight of the entire body, and an increase in weight tends to increase the pressure on the heels. Other factors that can bring on a spur are a faulty gait with the foot turned too far inwards or prolonged use of footwear with hard unyielding soles.
Heel pain and spurs can also occur if the calf muscle becomes tight and contracted. These muscles are attached to the heel. If they are not adequately stretched before and after exercise, they can pull on the heel, causing pain.
The heel is attached to the front of the foot by thick tissue called plantar fascia. Shortening or injury of this fascia can also cause strain on the back of the heel and result in spurs.
In the neck vertebrae, spur formation can press on nerves, leading to dizziness and giddiness, especially with a change in posture. It can press on the oesophagus, causing difficulty in swallowing.
Further down in the lumbar vertebra, osteophytes can press on the nerves going to the leg. They can cause pain, weakness in the legs, loss of sensation and difficulty in sitting and squatting.
Osteoarthritic changes in the fingers cause spurs to develop. The fingers appear disfigured and knotted. The range of movement is restricted. Sudden incapacitating shooting pains can also develop.
The shoulder needs to move in a full circle. Spurs restrict this so that the hand can be lifted only to 90 degrees. Combing hair and dressing become difficult.
Spur formation and degenerative changes are not a disease of old people alone. They can form in athletes and people who exercise. It tends to occur when proper stretching techniques before and after exercise are not followed.
Sometimes the extra bone formed breaks off and enters the joint space. It can suddenly make the joint painfully stuck and “locked” in an awkward position.
Symptomatic spurs require treatment. In 95 per cent of cases, simple remedial measures are sufficient and the pain disappears in six months. Ice packs alternating with hot compresses relieve pain rapidly. This may need to be combined with physiotherapy. Active and passive exercises to improve the range of motion and strengthen the muscles around the joint are essential for quick improvement. Shock wave therapy using ultrasound is also very effective.
A short course of NSAIDs (non steroidal anti inflammatory agents) will help to relieve pain in the acute phase. They should not be taken for longer than two weeks continuously as they have side effects.
Corticosteroid can be injected into the joints. The relief is significant and may last four to six months. But it can cause further degeneration of the joint if given too frequently.
Loose bodies that get stuck have to be surgically removed. Endoscopic minimally invasive surgery means hospital stay is minimal. Surgery is also indicated if there is compression on a nerve, resulting in wasting and weakness in addition to pain.
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
Gita Mathai
Your Health
DR GITA MATHAI
When babies are born, they have about 350 bones. Many of these eventually fuse and adults are left with 208 bones. Locomotion and movement are possible because the bones form joints, which “articulate” with each other. Carpenters have taken a leaf out of God’s book and based the joints in their trade on this. Like us, they too have metal and plastic sliding, hinged and ball and socket joints. Just like in mechanical joints, in human joints too mechanical failure, slipping and degeneration can occur with age, overuse, lack of proper lubrication and misalignment.
Unlike carpentry joints, human joints are protected from injury by muscles and tendons. Wear and tear and overuse can cause microscopic tears in these. Calcium gets deposited in the tears, forming bony projections called spurs, which are meant to actually protect the joint.
The symptoms caused by spurs depend on their location. Spurs are usually too deep to be felt. They can be asymptomatic and be discovered accidently in an X-ray taken for some other reason. But they can cause discomfort if they press on nerves.
One of the commonest locations for spurs is the heel. If you feel a severe shooting pain, especially while placing the foot on the ground first thing in the morning, be sure it is a spur. It affects 10 per cent of the population at some point in their life.
Spurs are common in women, especially if you have gained weight. It is yet another symptom brought on by the “middle aged spread”. Feet have to bear the weight of the entire body, and an increase in weight tends to increase the pressure on the heels. Other factors that can bring on a spur are a faulty gait with the foot turned too far inwards or prolonged use of footwear with hard unyielding soles.
Heel pain and spurs can also occur if the calf muscle becomes tight and contracted. These muscles are attached to the heel. If they are not adequately stretched before and after exercise, they can pull on the heel, causing pain.
The heel is attached to the front of the foot by thick tissue called plantar fascia. Shortening or injury of this fascia can also cause strain on the back of the heel and result in spurs.
In the neck vertebrae, spur formation can press on nerves, leading to dizziness and giddiness, especially with a change in posture. It can press on the oesophagus, causing difficulty in swallowing.
Further down in the lumbar vertebra, osteophytes can press on the nerves going to the leg. They can cause pain, weakness in the legs, loss of sensation and difficulty in sitting and squatting.
Osteoarthritic changes in the fingers cause spurs to develop. The fingers appear disfigured and knotted. The range of movement is restricted. Sudden incapacitating shooting pains can also develop.
The shoulder needs to move in a full circle. Spurs restrict this so that the hand can be lifted only to 90 degrees. Combing hair and dressing become difficult.
Spur formation and degenerative changes are not a disease of old people alone. They can form in athletes and people who exercise. It tends to occur when proper stretching techniques before and after exercise are not followed.
Sometimes the extra bone formed breaks off and enters the joint space. It can suddenly make the joint painfully stuck and “locked” in an awkward position.
Symptomatic spurs require treatment. In 95 per cent of cases, simple remedial measures are sufficient and the pain disappears in six months. Ice packs alternating with hot compresses relieve pain rapidly. This may need to be combined with physiotherapy. Active and passive exercises to improve the range of motion and strengthen the muscles around the joint are essential for quick improvement. Shock wave therapy using ultrasound is also very effective.
A short course of NSAIDs (non steroidal anti inflammatory agents) will help to relieve pain in the acute phase. They should not be taken for longer than two weeks continuously as they have side effects.
Corticosteroid can be injected into the joints. The relief is significant and may last four to six months. But it can cause further degeneration of the joint if given too frequently.
Loose bodies that get stuck have to be surgically removed. Endoscopic minimally invasive surgery means hospital stay is minimal. Surgery is also indicated if there is compression on a nerve, resulting in wasting and weakness in addition to pain.
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
Gita Mathai
Friday, November 4, 2011
memories
Why you forget
Why you forget
Your Health
DR GITA MATHAI
No matter which stage of life you are in, memory lapses will be a cause of consternation; for the young it will affect their marks, for professionals it will mean missed appointments and for the elderly the fear that it may signal Alzheimer’s or dementia. A rule of thumb is that if you are more concerned about it than the people around you, it probably isn’t serious.
Memory starts in the brain with the encoding of data. The brain scans inputs much like a computer and files it away for retrieval at a later date. This process requires chemical reactions in the brain with enzymes, vitamins and essential minerals.
Schools in India emphasise rote learning so our brains become efficient at retention and immediate recall. But often parents complain that whatever is learnt the previous day is forgotten the next morning.
These children have to be tested for anaemia, lead poisoning, thyroid functions and learning disabilities. Their eyesight and hearing need to be checked. If all is normal, the social environment should be investigated. Most often the problem is in the parenting.
Part of the problem may be that children’s lives are very full. The competitive environment makes parents enrol them in tutorial schools. At home television viewing (especially while eating) may further cut into their time. Even if they do not watch TV and only the adults do, the set is often left on permanently, creating a “white noise”. The rapidly flashing images and noise depletes chemicals in the brain. The same thing happens with electronic games on phones, computers or hand-held devices. Much of the information gathered in school and in the tutorials is not encoded properly and is lost for later recall. The areas of the brain responsible for original thought are not stimulated and do not develop to their potential.
Children need adequate sleep to function at their peak scholastically. This is because chemicals in the brain regenerate during “rest time”. Although the number of hours that a child sleeps is very individual, preteen children need around 10 hours and teenagers about eight. While sleep deprived adults become grouchy and bad tempered, children may become hyperactive and unreasonable, with delayed response time. Attentiveness, particularly in school and to homework, may be unsatisfactory. Short-term memory may decrease. Memory improves with physical exercise — an hour of activity replenishes brain chemicals.
Instead of correcting these factors, parents purchase expensive herbal products and health supplements to improve performance. But unless the home environment is corrected, there will be no improvement.
In adults, some memory loss as you age is inevitable. People are afraid they have Alzheimer’s or dementia when they forget things like names or where they left their keys. In these serious disorders you are more likely to forget how to use the key rather than where you left it.
Normal forgetfulness is aggravated by anxiety, stress and depression. Addiction to alcohol, tobacco products or recreational drugs also produces detrimental changes in brain function. Memory becomes poor if there is uncontrolled diabetes, lung, kidney or liver diseases, vitamin B12 or thiamine deficiency. It, therefore, becomes important to maintain your health and prevent and control diseases, as you grow older.
People who eat too much are at risk of lifestyle diseases, which increases their risk for strokes. These destroy small areas in the brain, causing brain ageing and memory loss. Small changes in lifestyle can slow down brain ageing — enough mental activity, physical fitness, stress reduction and a healthy diet. Also, many people miss out on the necessary amount of antioxidants as they do not eat the required 4-6 helpings a day of fruits and vegetables.
Children and adults need a healthy diet, regular and adequate exercise, social interaction and intellectual stimulation to develop a good memory and maintain it. If all else fails, you can always make notes and lists to remind yourself.
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
Why you forget
Your Health
DR GITA MATHAI
No matter which stage of life you are in, memory lapses will be a cause of consternation; for the young it will affect their marks, for professionals it will mean missed appointments and for the elderly the fear that it may signal Alzheimer’s or dementia. A rule of thumb is that if you are more concerned about it than the people around you, it probably isn’t serious.
Memory starts in the brain with the encoding of data. The brain scans inputs much like a computer and files it away for retrieval at a later date. This process requires chemical reactions in the brain with enzymes, vitamins and essential minerals.
Schools in India emphasise rote learning so our brains become efficient at retention and immediate recall. But often parents complain that whatever is learnt the previous day is forgotten the next morning.
These children have to be tested for anaemia, lead poisoning, thyroid functions and learning disabilities. Their eyesight and hearing need to be checked. If all is normal, the social environment should be investigated. Most often the problem is in the parenting.
Part of the problem may be that children’s lives are very full. The competitive environment makes parents enrol them in tutorial schools. At home television viewing (especially while eating) may further cut into their time. Even if they do not watch TV and only the adults do, the set is often left on permanently, creating a “white noise”. The rapidly flashing images and noise depletes chemicals in the brain. The same thing happens with electronic games on phones, computers or hand-held devices. Much of the information gathered in school and in the tutorials is not encoded properly and is lost for later recall. The areas of the brain responsible for original thought are not stimulated and do not develop to their potential.
Children need adequate sleep to function at their peak scholastically. This is because chemicals in the brain regenerate during “rest time”. Although the number of hours that a child sleeps is very individual, preteen children need around 10 hours and teenagers about eight. While sleep deprived adults become grouchy and bad tempered, children may become hyperactive and unreasonable, with delayed response time. Attentiveness, particularly in school and to homework, may be unsatisfactory. Short-term memory may decrease. Memory improves with physical exercise — an hour of activity replenishes brain chemicals.
Instead of correcting these factors, parents purchase expensive herbal products and health supplements to improve performance. But unless the home environment is corrected, there will be no improvement.
In adults, some memory loss as you age is inevitable. People are afraid they have Alzheimer’s or dementia when they forget things like names or where they left their keys. In these serious disorders you are more likely to forget how to use the key rather than where you left it.
Normal forgetfulness is aggravated by anxiety, stress and depression. Addiction to alcohol, tobacco products or recreational drugs also produces detrimental changes in brain function. Memory becomes poor if there is uncontrolled diabetes, lung, kidney or liver diseases, vitamin B12 or thiamine deficiency. It, therefore, becomes important to maintain your health and prevent and control diseases, as you grow older.
People who eat too much are at risk of lifestyle diseases, which increases their risk for strokes. These destroy small areas in the brain, causing brain ageing and memory loss. Small changes in lifestyle can slow down brain ageing — enough mental activity, physical fitness, stress reduction and a healthy diet. Also, many people miss out on the necessary amount of antioxidants as they do not eat the required 4-6 helpings a day of fruits and vegetables.
Children and adults need a healthy diet, regular and adequate exercise, social interaction and intellectual stimulation to develop a good memory and maintain it. If all else fails, you can always make notes and lists to remind yourself.
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, October 25, 2011
panacea for all illnesses
An aspirin a day keeps the doc away
Your Health
DR GITA MATHAI
No one likes to be ill, and once the inevitable occurs, one does not want to swallow a large number of multicoloured tablets of all shapes and sizes.
Can you not reduce the number of tablets? I am sure if I take all these I will suffer side effects! Can I not alter the disease process with diet alone? Can I switch to a different system of medicine?
Common queries that busy physicians seldom address patiently.
Anyone who does not wish to have a chronic disease (and swallow tablets for the rest of his or her life) has to take care of his or her health from an early age.
Today, lifestyle diseases such as obesity, diabetes, hypertension and heart disease are rampant. Unfortunately, these diseases usually occur in combination. One of the diseases, say hypertension or diabetes, may start alone as a result of obesity and abnormal lipid profiles, which are often due to inactivity and an improper diet. Then there is a cascading effect — obesity leads to an abnormal lipid profile to diabetes or hypertension to heart disease.
So a person ends up taking tablets several times a day to keep the sugar under control, the blood pressure within limits and the lipids in check. Add a B complex and calcium supplement and you are looking at around 5-6 tablets a day.
The pharmaceutical industry has been working overtime to make life easier for such patients. They have come up with fixed drug combinations so that patients can take one tablet instead of two or three. The idea is good but combination medicines often fail to live up to their potential. This is because the dosage ratios are fixed; so too much or too little of one or more of the medications may be taken. Drugs that need to be taken before and after food may also be inappropriately administered. Sometimes combinations are irrational, with two antagonistic drugs being combined. Occasionally, both medications compete for the same site in the intestine for absorption so that eventually neither works! In fact, if you are prescribed combination tablets, ask your doctor if it is possible to take the tablets individually.
The combination tablets are a response to people’s demand for a “magic bullet”, a single medication that at a low dose, with a wide margin of safety, and few or no side effects, will cure all their ailments. Actually centuries ago, ancient cultures like that of the Indians, the American Indians, the Chinese, the Egyptians and the Greeks did have something like a magic bullet. Medicine men or healers brewed infusions or teas with the petals of a flowering plant — the Spiraea ulmaria — which relieved pain caused by injury, toothache, headache, and arthritis. Hippocrates even successfully administered it to ease the pain of childbirth. Eventually, about a hundred years ago, Felix Hoffmann, a chemist working for Bayer, synthesised the active ingredient in Spiraea ulmaria — salicylic acid. And that has evolved into the aspirin we use today.
Aspirin reduces pain, fever and headaches. It can be used to prevent clotting of blood, which helps prevent strokes, heart attacks and miscarriage. Aspirin also retards the onset and progress of Alzheimer’s and dementia. And it has been shown to reduce the incidence of many types of adenocarcinomas, especially that of the colon. That does make it magic but aspirin can’t cure a lifestyle disease. An aspirin a day, however, can keep lifestyle diseases away.
The other thing that can prevent them is maintaining ideal body weight, which is calculated by measuring the body mass index or BMI (weight in kilograms divided by height in meter squared). Values up to 24 are normal, 25-29 is defined as overweight, 30-34 obese and anything above that as extremely obese.
A person’s weight starts the upward climb because of an imbalance between food intake and physical activity. Environmental factors are important as both these factors are strongly influenced by habits learnt in childhood. Families that enjoy excessive amounts of calorie-dense food with refined sugars and oil and inadequate amounts (less than the recommended 400mg) of pulses, vegetables and fruits tend to have overweight children who grow up to be obese. To avoid addiction to high-calorie foods, stock fruits and vegetables as snacks. Have plain water instead of carbonated drinks and pack home-cooked food for school lunches instead of the packaged variety.
In addition, exercise is essential. It conditions the body, improves immunity, and delays, and sometimes prevents, the onset of lifestyle diseases and some cancers. Adults require an hour of aerobic activity (walking, jogging, running or swimming) followed by 20 minutes of flexion, core strengthening or yoga a day.
In short, a balanced diet, exercise and 75mg of aspirin a day should keep you healthy!
Before popping an aspirin, however, remember that it is contraindicated in children, people with bleeding disorders and those with gastric or duodenal ulcer. Aspirin is available without a prescription but please check with your doctor before you start taking it.
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
No one likes to be ill, and once the inevitable occurs, one does not want to swallow a large number of multicoloured tablets of all shapes and sizes.
Can you not reduce the number of tablets? I am sure if I take all these I will suffer side effects! Can I not alter the disease process with diet alone? Can I switch to a different system of medicine?
Common queries that busy physicians seldom address patiently.
Anyone who does not wish to have a chronic disease (and swallow tablets for the rest of his or her life) has to take care of his or her health from an early age.
Today, lifestyle diseases such as obesity, diabetes, hypertension and heart disease are rampant. Unfortunately, these diseases usually occur in combination. One of the diseases, say hypertension or diabetes, may start alone as a result of obesity and abnormal lipid profiles, which are often due to inactivity and an improper diet. Then there is a cascading effect — obesity leads to an abnormal lipid profile to diabetes or hypertension to heart disease.
So a person ends up taking tablets several times a day to keep the sugar under control, the blood pressure within limits and the lipids in check. Add a B complex and calcium supplement and you are looking at around 5-6 tablets a day.
The pharmaceutical industry has been working overtime to make life easier for such patients. They have come up with fixed drug combinations so that patients can take one tablet instead of two or three. The idea is good but combination medicines often fail to live up to their potential. This is because the dosage ratios are fixed; so too much or too little of one or more of the medications may be taken. Drugs that need to be taken before and after food may also be inappropriately administered. Sometimes combinations are irrational, with two antagonistic drugs being combined. Occasionally, both medications compete for the same site in the intestine for absorption so that eventually neither works! In fact, if you are prescribed combination tablets, ask your doctor if it is possible to take the tablets individually.
The combination tablets are a response to people’s demand for a “magic bullet”, a single medication that at a low dose, with a wide margin of safety, and few or no side effects, will cure all their ailments. Actually centuries ago, ancient cultures like that of the Indians, the American Indians, the Chinese, the Egyptians and the Greeks did have something like a magic bullet. Medicine men or healers brewed infusions or teas with the petals of a flowering plant — the Spiraea ulmaria — which relieved pain caused by injury, toothache, headache, and arthritis. Hippocrates even successfully administered it to ease the pain of childbirth. Eventually, about a hundred years ago, Felix Hoffmann, a chemist working for Bayer, synthesised the active ingredient in Spiraea ulmaria — salicylic acid. And that has evolved into the aspirin we use today.
Aspirin reduces pain, fever and headaches. It can be used to prevent clotting of blood, which helps prevent strokes, heart attacks and miscarriage. Aspirin also retards the onset and progress of Alzheimer’s and dementia. And it has been shown to reduce the incidence of many types of adenocarcinomas, especially that of the colon. That does make it magic but aspirin can’t cure a lifestyle disease. An aspirin a day, however, can keep lifestyle diseases away.
The other thing that can prevent them is maintaining ideal body weight, which is calculated by measuring the body mass index or BMI (weight in kilograms divided by height in meter squared). Values up to 24 are normal, 25-29 is defined as overweight, 30-34 obese and anything above that as extremely obese.
A person’s weight starts the upward climb because of an imbalance between food intake and physical activity. Environmental factors are important as both these factors are strongly influenced by habits learnt in childhood. Families that enjoy excessive amounts of calorie-dense food with refined sugars and oil and inadequate amounts (less than the recommended 400mg) of pulses, vegetables and fruits tend to have overweight children who grow up to be obese. To avoid addiction to high-calorie foods, stock fruits and vegetables as snacks. Have plain water instead of carbonated drinks and pack home-cooked food for school lunches instead of the packaged variety.
In addition, exercise is essential. It conditions the body, improves immunity, and delays, and sometimes prevents, the onset of lifestyle diseases and some cancers. Adults require an hour of aerobic activity (walking, jogging, running or swimming) followed by 20 minutes of flexion, core strengthening or yoga a day.
In short, a balanced diet, exercise and 75mg of aspirin a day should keep you healthy!
Before popping an aspirin, however, remember that it is contraindicated in children, people with bleeding disorders and those with gastric or duodenal ulcer. Aspirin is available without a prescription but please check with your doctor before you start taking it.
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, October 10, 2011
schizophrenia
Let’s talk about schizophrenia
Your Health
DR GITA MATHAI
People sometimes change inexplicably in their late teens – they behave bizarrely, argue unnecessarily with everyone, imagine events, become suspicious or withdraw into a shell. This is actually a disease called schizophrenia and these forms are classic, delusional, paranoid and catanonic. The word itself means "split mind " in Greek as it was confused with a multiple personality disorder by earlier physicians. Today, these two illnesses are classified separately.
Schizophrenia is a serious mental illness that is likely to affect one in 100 men and women (0.5-0.7 per cent respectively). It strikes people usually in their late teens and twenties. It is rare for schizophrenia to set in after the age of 40 and children are rarely diagnosed with it. They can, however, go on to develop it as adults if they have some other mental illness such as autism.
The onset of schizophrenia is so gradual that it mostly goes unrecognised and untreated, especially in developing countries with inadequate healthcare. In addition, people baulk at the idea of admitting they or a loved one is suffering from schizophrenia though no one has a problem saying they have an incurable chronic illness like diabetes or hypertension.
Schizophrenic patients may be delusional or hallucinate — that is see and hear things that are not real. Their speech may be disconnected, dressing and behaviour may be socially inappropriate and they may cry and laugh for no reason at all. Sometimes the person may be “catatonic” or unresponsive to any external stimulus.
Unreasonable behaviour and a quarrelsome nature may affect relations with friends, family and colleagues. The person may be unable to keep a job. Insomnia and morning drowsiness affect efficiency. The appetite may be poor.
The diagnosis of schizophrenia is difficult as the symptoms evolve gradually over a period of months or years. It is often difficult to pinpoint the exact date at which the changes were noticeable. The symptoms should be present for a month for schizophrenia to be suspected and remain for six months for the diagnosis to be established. The patient or a caretaker can report the symptoms. They should be substantiated by evaluation by a qualified medical professional.
PET scans also do not strictly conform to normal parameters. The brains in schizophrenics have smaller temporal and frontal lobes. The levels and ratios of certain brain chemicals like serotonin, dopamine and glutamine are altered.
The exact reason for these behaviour altering brain changes is not known. However, seven per cent of persons with schizophrenia have a family member who suffers from a similar disease. Many have been born to mothers who suffered several viral illnesses during pregnancy. Environmental factors also play a role — the incidence of the disease increases in persons who are financially insecure or from dysfunctional families with a history of childhood abuse.
Schizophrenics tend to gain weight because their lifestyle is sedentary. Patients also have a predilection for addiction — to tobacco products, alcohol and drugs like cannabis. They are often unwilling to check the addictions to control lifestyle diseases like diabetes or hypertension. Also, they do not adhere to diet modifications or medications needed to keep their disease in check; so this shortens lifespan. They eventually die 10-15 years earlier than their peers. They are also 15 per cent more likely to commit suicide.
Gone are the days when schizophrenics were locked up, immersed in cold baths or given electrical shock therapy. Today there are a plethora of drugs that can be used singly or in combination to control the symptoms of schizophrenia and help the person function fairly normally. These drugs act by correcting the enzyme and chemical imbalances in the brain. Response to medication may be slow and this may be frustrating for the patient as well as caregivers but medication can be increased only gradually to optimal levels. Drugs, combinations and dosages have to be individualised and vary from person to person.
The side effects of medication are weight gain, menstrual irregularities and drowsiness. Some people become very stiff and have abnormal smacking movements or grimaces but doctors are able to tackle this with other medications.
Rehabilitation is important. Once the symptoms are controlled, patients can function in society and even hold down jobs. They need to be trained to handle money and in personal care and hygiene. Medication needs to be continued even when the symptoms have disappeared. The involvement of the whole family helps as the person is then more likely to follow medical treatment and less likely to relapse.
People often ask for a “miracle drug” — a single tablet to treat all diseases. The only universal ingredient to improve health in all diseases (even mental problems) is physical exercise. So go take a walk.
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
People sometimes change inexplicably in their late teens – they behave bizarrely, argue unnecessarily with everyone, imagine events, become suspicious or withdraw into a shell. This is actually a disease called schizophrenia and these forms are classic, delusional, paranoid and catanonic. The word itself means "split mind " in Greek as it was confused with a multiple personality disorder by earlier physicians. Today, these two illnesses are classified separately.
Schizophrenia is a serious mental illness that is likely to affect one in 100 men and women (0.5-0.7 per cent respectively). It strikes people usually in their late teens and twenties. It is rare for schizophrenia to set in after the age of 40 and children are rarely diagnosed with it. They can, however, go on to develop it as adults if they have some other mental illness such as autism.
The onset of schizophrenia is so gradual that it mostly goes unrecognised and untreated, especially in developing countries with inadequate healthcare. In addition, people baulk at the idea of admitting they or a loved one is suffering from schizophrenia though no one has a problem saying they have an incurable chronic illness like diabetes or hypertension.
Schizophrenic patients may be delusional or hallucinate — that is see and hear things that are not real. Their speech may be disconnected, dressing and behaviour may be socially inappropriate and they may cry and laugh for no reason at all. Sometimes the person may be “catatonic” or unresponsive to any external stimulus.
Unreasonable behaviour and a quarrelsome nature may affect relations with friends, family and colleagues. The person may be unable to keep a job. Insomnia and morning drowsiness affect efficiency. The appetite may be poor.
The diagnosis of schizophrenia is difficult as the symptoms evolve gradually over a period of months or years. It is often difficult to pinpoint the exact date at which the changes were noticeable. The symptoms should be present for a month for schizophrenia to be suspected and remain for six months for the diagnosis to be established. The patient or a caretaker can report the symptoms. They should be substantiated by evaluation by a qualified medical professional.
PET scans also do not strictly conform to normal parameters. The brains in schizophrenics have smaller temporal and frontal lobes. The levels and ratios of certain brain chemicals like serotonin, dopamine and glutamine are altered.
The exact reason for these behaviour altering brain changes is not known. However, seven per cent of persons with schizophrenia have a family member who suffers from a similar disease. Many have been born to mothers who suffered several viral illnesses during pregnancy. Environmental factors also play a role — the incidence of the disease increases in persons who are financially insecure or from dysfunctional families with a history of childhood abuse.
Schizophrenics tend to gain weight because their lifestyle is sedentary. Patients also have a predilection for addiction — to tobacco products, alcohol and drugs like cannabis. They are often unwilling to check the addictions to control lifestyle diseases like diabetes or hypertension. Also, they do not adhere to diet modifications or medications needed to keep their disease in check; so this shortens lifespan. They eventually die 10-15 years earlier than their peers. They are also 15 per cent more likely to commit suicide.
Gone are the days when schizophrenics were locked up, immersed in cold baths or given electrical shock therapy. Today there are a plethora of drugs that can be used singly or in combination to control the symptoms of schizophrenia and help the person function fairly normally. These drugs act by correcting the enzyme and chemical imbalances in the brain. Response to medication may be slow and this may be frustrating for the patient as well as caregivers but medication can be increased only gradually to optimal levels. Drugs, combinations and dosages have to be individualised and vary from person to person.
The side effects of medication are weight gain, menstrual irregularities and drowsiness. Some people become very stiff and have abnormal smacking movements or grimaces but doctors are able to tackle this with other medications.
Rehabilitation is important. Once the symptoms are controlled, patients can function in society and even hold down jobs. They need to be trained to handle money and in personal care and hygiene. Medication needs to be continued even when the symptoms have disappeared. The involvement of the whole family helps as the person is then more likely to follow medical treatment and less likely to relapse.
People often ask for a “miracle drug” — a single tablet to treat all diseases. The only universal ingredient to improve health in all diseases (even mental problems) is physical exercise. So go take a walk.
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, October 6, 2011
heralding diabetes
A herald of diabetes
Your Health
DR GITA MATHAI
The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.
The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.
Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.
An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.
The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.
Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.
Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.
If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.
There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:
• If it is due to medication or health supplements, stop taking them.
• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).
• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.
• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.
• Evening primrose oil or fish oil supplements may help.
• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.
• Fairness creams do not help.
• Surgical dermal abrasion can be done.
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
The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.
The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.
Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.
An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.
The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.
Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.
Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.
If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.
There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:
• If it is due to medication or health supplements, stop taking them.
• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).
• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.
• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.
• Evening primrose oil or fish oil supplements may help.
• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.
• Fairness creams do not help.
• Surgical dermal abrasion can be done.
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, September 21, 2011
how hysterical
Ill? How hysterical
Your Health
DR GITA MATHAI
Some illnesses defy scientific explanation. One such has symptoms ranging from blindness to deafness to paralysis to seizures. The attacks are inconsistent and erratic, they tend to come and go. Patients are usually taken to the friendly neighbourhood physician (unexplained symptoms account for up to 40 per cent of primary care consultations) who can usually reach no medical diagnosis despite repeated visits. Patients then typically proceed to specialised tertiary care hospitals to have a battery of expensive diagnostic tests done. Even there, eventually, four per cent of illnesses remain scientifically unexplained.
These illnesses, however, are not lifestyle diseases specific to the modern age. Patients with inexplicable symptoms were present even during the time of Socrates. Greek physicians noticed that women were more likely have such symptoms. So they decided that the uterus was the root cause of all these illnesses and labelled them hysteria from the Greek word hysterus for uterus.
Hysteria has myriad manifestations. One such manifestation is called “possession” and is found all over the world. The person’s body appears to have been taken over by spirits or a demon. The voice changes and he or she may harm themselves or others. They may suddenly have the strength of 10 people. Their actions are bizarre and often frightening.
Another is “somatisation” in which various body parts develop “diseases”. There may be peppery hot sensations, loss of feeling and numbness or actual paralysis. Sometimes food may appear to stick in the throat. There are hundreds of symptoms that can be attributed to hysteria, but the symptoms overlap with some very real illnesses. Hysteria, therefore, becomes a diagnosis by exclusion.
Another symptom of hysteria — seizures — can also occur because of epilepsy, brain tumours, brain fever or even high fever in children. Some seizures may be atypical, with staring spells or repetitive twitches. Hysterical seizures can usually be distinguished as they do not fit any of these patterns. Instead, they represent what the patient thinks seizures should look like.
Today, hysterical symptoms are attributed to the brain’s attempt to protect the person from stress. It may be for gain, such as staying home from a hated job or to avoid a social requirement. It may also be to control a third person like a parent or spouse.
Recently, scientific brain scans were done on patients diagnosed with hysteria. As the person attempted to move the apparently paralysed hand, the motor cortex that controls movement did not light up. Instead, brain activity was confined to the temporal and frontal lobes, which control emotion. The person thought they she was paralysed and the brain supported her belief.
Nobody likes to be labelled hysterical. And no one wants to hear that their symptoms have no scientific basis. So a host of inoffensive synonyms for “hysteria” have appeared in medical parlance such as functional, nonorganic, psychogenic and the favourite “medically unexplained” disease. Clinicians tend to use these bland terms to retain their patients and stop doctor hopping.
A chunk of hysteria patients also visit native healers, exorcists and mediums for treatment. Some of them have excellent rates of cure. They may beat the patients, douse them with water or burn them. Some of the rituals have, in fact, ended in the death of the patient.
Fortunately, though hysteria has have not changed much through the centuries, the medical profession’s understanding of it has. Instead of beating, burning and trial by fire, medical and scientific therapy is available today. Basically, hysteria is a cry for help, often by people trapped in a “no win” situation from which there is no escape.
Many of the symptoms disappear with psychotherapy. Attention seeking symptoms, like sudden blindness or loud inappropriate belching, respond if the appropriate amount of attention is given, or when the person realises that the end no longer justifies the means. Depression, which can precipitate hysteria, responds to medication.
Segments of the population are said to be suffering from collective or mass hysteria when several people have the same symptoms — like nausea, headache, muscle weakness, rash or seizures — at the same time. One person may complain of light-headedness at a social function and the symptom may spread like wild fire. A majority of those present may be affected. There is no rational scientific reason for these occurrences. They usually peter out gradually.
Hysteria may also not be confined to illnesses. It may involve seeing aliens or God. Quite often it involves attacks on persons believed to have a “black tongue” or an “evil eye”. A crowd can be whipped up to a frenzy with devastating and often fatal consequences.
When you develop a worrisome symptom, listen to your doctor. Ask for a rational explanation. If none is forthcoming, look within. In society, before you act and blindly follow the crowd, remember you have a brain, pause and THINK.
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
Some illnesses defy scientific explanation. One such has symptoms ranging from blindness to deafness to paralysis to seizures. The attacks are inconsistent and erratic, they tend to come and go. Patients are usually taken to the friendly neighbourhood physician (unexplained symptoms account for up to 40 per cent of primary care consultations) who can usually reach no medical diagnosis despite repeated visits. Patients then typically proceed to specialised tertiary care hospitals to have a battery of expensive diagnostic tests done. Even there, eventually, four per cent of illnesses remain scientifically unexplained.
These illnesses, however, are not lifestyle diseases specific to the modern age. Patients with inexplicable symptoms were present even during the time of Socrates. Greek physicians noticed that women were more likely have such symptoms. So they decided that the uterus was the root cause of all these illnesses and labelled them hysteria from the Greek word hysterus for uterus.
Hysteria has myriad manifestations. One such manifestation is called “possession” and is found all over the world. The person’s body appears to have been taken over by spirits or a demon. The voice changes and he or she may harm themselves or others. They may suddenly have the strength of 10 people. Their actions are bizarre and often frightening.
Another is “somatisation” in which various body parts develop “diseases”. There may be peppery hot sensations, loss of feeling and numbness or actual paralysis. Sometimes food may appear to stick in the throat. There are hundreds of symptoms that can be attributed to hysteria, but the symptoms overlap with some very real illnesses. Hysteria, therefore, becomes a diagnosis by exclusion.
Another symptom of hysteria — seizures — can also occur because of epilepsy, brain tumours, brain fever or even high fever in children. Some seizures may be atypical, with staring spells or repetitive twitches. Hysterical seizures can usually be distinguished as they do not fit any of these patterns. Instead, they represent what the patient thinks seizures should look like.
Today, hysterical symptoms are attributed to the brain’s attempt to protect the person from stress. It may be for gain, such as staying home from a hated job or to avoid a social requirement. It may also be to control a third person like a parent or spouse.
Recently, scientific brain scans were done on patients diagnosed with hysteria. As the person attempted to move the apparently paralysed hand, the motor cortex that controls movement did not light up. Instead, brain activity was confined to the temporal and frontal lobes, which control emotion. The person thought they she was paralysed and the brain supported her belief.
Nobody likes to be labelled hysterical. And no one wants to hear that their symptoms have no scientific basis. So a host of inoffensive synonyms for “hysteria” have appeared in medical parlance such as functional, nonorganic, psychogenic and the favourite “medically unexplained” disease. Clinicians tend to use these bland terms to retain their patients and stop doctor hopping.
A chunk of hysteria patients also visit native healers, exorcists and mediums for treatment. Some of them have excellent rates of cure. They may beat the patients, douse them with water or burn them. Some of the rituals have, in fact, ended in the death of the patient.
Fortunately, though hysteria has have not changed much through the centuries, the medical profession’s understanding of it has. Instead of beating, burning and trial by fire, medical and scientific therapy is available today. Basically, hysteria is a cry for help, often by people trapped in a “no win” situation from which there is no escape.
Many of the symptoms disappear with psychotherapy. Attention seeking symptoms, like sudden blindness or loud inappropriate belching, respond if the appropriate amount of attention is given, or when the person realises that the end no longer justifies the means. Depression, which can precipitate hysteria, responds to medication.
Segments of the population are said to be suffering from collective or mass hysteria when several people have the same symptoms — like nausea, headache, muscle weakness, rash or seizures — at the same time. One person may complain of light-headedness at a social function and the symptom may spread like wild fire. A majority of those present may be affected. There is no rational scientific reason for these occurrences. They usually peter out gradually.
Hysteria may also not be confined to illnesses. It may involve seeing aliens or God. Quite often it involves attacks on persons believed to have a “black tongue” or an “evil eye”. A crowd can be whipped up to a frenzy with devastating and often fatal consequences.
When you develop a worrisome symptom, listen to your doctor. Ask for a rational explanation. If none is forthcoming, look within. In society, before you act and blindly follow the crowd, remember you have a brain, pause and THINK.
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, September 12, 2011
paunches and other problems
Aerobics, to lose that paunch
Your Health
DR GITA MATHAI
“I want to lose my paunch,” announced the young woman, “It looks ugly when I wear jeans.”
A common complaint and certainly not a new one. A number of people want a miracle cure for their arms, thighs, belly, double chin — the list of problem areas is endless. Some catchy names have been made up for excess fat that can accumulate in the most inconvenient places. A paunch that spills over a tight salwar or jeans is called muffin top while a substantial round paunch that dictates where you wear your trousers is called a beer belly and the rolls of fat around your torso are called love handles. There’s of course nothing to love about any of these cutely named body parts and all of us would love to get rid of them, but without much effort.
There are advertisements galore pushing machines, diets and “body wraps” that claim to offer a miracle cure for problem areas but it would be a miracle if any of them actually work. It is just not possible to reduce fat from one particular spot, without overall weight reduction. To get rid of that paunch or those baggy upper arms, you’ll have to reach your ideal body weight first.
Whether you look fat or thin depends on height, weight and body habitus, that is, whether you are an endomorph, mesomorph and ectomorph. Being “fat” is not in the eye of the beholder. It is a measurable entity and anyone whose weight is 10 per cent more than it should be is categorised as fat.
How do you find out your ideal body weight? On life insurance charts, for one. If you are an athlete, your height cubed in inches divided by 1906 will give your ideal body weight. If your body mass index (BMI) is 23, then your body weight is ideal. You can find your BMI by dividing your weight in kg by your height in metres squared. The value should be 23; less than that is bad, but more is worse. If maths isn’t your strong point, measure your waist. You have nothing to worry about if your waist is less than 37 inches if you are a man and 32 inches if you are a woman.
But if your waist measures more than that you have a paunch, which means you have fat deposits around the organs in the abdomen and in the liver. This tends to occur with inactivity, is commoner in men and with increasing age. Abdominal fat increases the risk for diabetes, hypertension, heart disease and cancer.
The first step towards a washboard abdomen is achieving ideal body weight. Food eaten (calories consumed) minus exercise (calories expended) determines eventual weight gain or loss. To lose weight, you need to eat 20 calories /kg / day, to maintain your present weight 30 calories / kg/ day and to increase your weight you need 40 calories / kg / day. Pregnant and breast feeding women need 30-35 calories / kg / day.
A reduction of 1,600 calories a day results in the loss of 1kg. A sustainable weight-reducing diet provides about 1,200 calories a day. A diet containing 800 calories a day (or fasting) may ensure initial rapid weight loss but cannot be maintained long term.
Exercise is of two kinds. Aerobic exercise, which includes swimming, dancing, cycling, jogging, running, stair climbing and skipping, uses between 200 and 400 calories an hour, depending on the intensity and the distance. Anaerobic exercise consists of weight or resistance training and yoga.
An hour of aerobic exercise a day results in significant loss of abdominal fat. The liver is able to work more efficiently. Insulin resistance drops and blood sugar levels improve. Many young people, however, prefer to do only weight training at the gym, concentrating on the muscles that they want to improve — like the abdomen or biceps — under the guidance of a “trainer”. Such people increase their lean muscle mass and also lose a little subcutaneous fat. Their body becomes more efficient at burning calories, but their stamina and resistance power do not improve.
Also, an hour of aerobic activity burns 70 per cent more calories than weight training. Also, the chemicals released by the muscles elevate mood and reduce stress. The heart becomes conditioned and fit. Immunity improves. Best of all, aerobic activity has proven to reduce the risk of developing lung, colon, breast, prostate and endometrial cancer.
So, whatever your age, start exercising. For best results, combine an hour of aerobic exercise with a half-hour of anaerobic activity. And say goodbye to all that extra fat.
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
“I want to lose my paunch,” announced the young woman, “It looks ugly when I wear jeans.”
A common complaint and certainly not a new one. A number of people want a miracle cure for their arms, thighs, belly, double chin — the list of problem areas is endless. Some catchy names have been made up for excess fat that can accumulate in the most inconvenient places. A paunch that spills over a tight salwar or jeans is called muffin top while a substantial round paunch that dictates where you wear your trousers is called a beer belly and the rolls of fat around your torso are called love handles. There’s of course nothing to love about any of these cutely named body parts and all of us would love to get rid of them, but without much effort.
There are advertisements galore pushing machines, diets and “body wraps” that claim to offer a miracle cure for problem areas but it would be a miracle if any of them actually work. It is just not possible to reduce fat from one particular spot, without overall weight reduction. To get rid of that paunch or those baggy upper arms, you’ll have to reach your ideal body weight first.
Whether you look fat or thin depends on height, weight and body habitus, that is, whether you are an endomorph, mesomorph and ectomorph. Being “fat” is not in the eye of the beholder. It is a measurable entity and anyone whose weight is 10 per cent more than it should be is categorised as fat.
How do you find out your ideal body weight? On life insurance charts, for one. If you are an athlete, your height cubed in inches divided by 1906 will give your ideal body weight. If your body mass index (BMI) is 23, then your body weight is ideal. You can find your BMI by dividing your weight in kg by your height in metres squared. The value should be 23; less than that is bad, but more is worse. If maths isn’t your strong point, measure your waist. You have nothing to worry about if your waist is less than 37 inches if you are a man and 32 inches if you are a woman.
But if your waist measures more than that you have a paunch, which means you have fat deposits around the organs in the abdomen and in the liver. This tends to occur with inactivity, is commoner in men and with increasing age. Abdominal fat increases the risk for diabetes, hypertension, heart disease and cancer.
The first step towards a washboard abdomen is achieving ideal body weight. Food eaten (calories consumed) minus exercise (calories expended) determines eventual weight gain or loss. To lose weight, you need to eat 20 calories /kg / day, to maintain your present weight 30 calories / kg/ day and to increase your weight you need 40 calories / kg / day. Pregnant and breast feeding women need 30-35 calories / kg / day.
A reduction of 1,600 calories a day results in the loss of 1kg. A sustainable weight-reducing diet provides about 1,200 calories a day. A diet containing 800 calories a day (or fasting) may ensure initial rapid weight loss but cannot be maintained long term.
Exercise is of two kinds. Aerobic exercise, which includes swimming, dancing, cycling, jogging, running, stair climbing and skipping, uses between 200 and 400 calories an hour, depending on the intensity and the distance. Anaerobic exercise consists of weight or resistance training and yoga.
An hour of aerobic exercise a day results in significant loss of abdominal fat. The liver is able to work more efficiently. Insulin resistance drops and blood sugar levels improve. Many young people, however, prefer to do only weight training at the gym, concentrating on the muscles that they want to improve — like the abdomen or biceps — under the guidance of a “trainer”. Such people increase their lean muscle mass and also lose a little subcutaneous fat. Their body becomes more efficient at burning calories, but their stamina and resistance power do not improve.
Also, an hour of aerobic activity burns 70 per cent more calories than weight training. Also, the chemicals released by the muscles elevate mood and reduce stress. The heart becomes conditioned and fit. Immunity improves. Best of all, aerobic activity has proven to reduce the risk of developing lung, colon, breast, prostate and endometrial cancer.
So, whatever your age, start exercising. For best results, combine an hour of aerobic exercise with a half-hour of anaerobic activity. And say goodbye to all that extra fat.
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, September 1, 2011
delhi belly
Delhi belly
Your Health
DR GITA MATHAI
Keep diarrhoea away
• Always wash hands with soap or a hand sanitizer before eating
• Drink water that has been boiled for 5 minutes, purified through a machine or bought as “mineral water” from a reputed company
• If that is not available, add a drop of tincture iodine or a pinch or turmeric to the water
The monsoons may bring a good harvest but the stagnant rainwater, overflowing drains and flooded roads also play havoc with our health. Flooding leads to back flow in sewage drains and drinking water can become contaminated. This results in outbreaks of diarrhoea, dysentery and, occasionally, cholera epidemics.
Diarrhoea is defined as stools that are more frequent, bulkier or more watery than usual. It occurs either because a damaged intestine does not absorb fluid from the food or secretes excess fluid. If blood and mucous is present in the stool as well, then it is called dysentery. Other incidental symptoms are fever, vomiting or stomach pain.
Viruses, bacteria and parasites damage the lining of the intestines. There is “intestinal hurry” as food is rushed through it before the liquid portion can be fully absorbed.
In weddings and other functions, diarrhoea can affect a number of people, and is referred to as food poisoning. This is caused by heat stable intestine damaging toxins released by the bacteria which initially contaminated the food. Subsequent cooking destroys the bacteria, but not the toxin.
Usually diarrhoea (even infective ones) subsides on its own, without specific treatment, in 3 to 7 days. If it lasts two weeks or longer, it needs to be investigated. The diagnosis requires a detailed history, stool and blood tests and sometimes endoscopy studies.
Common causes for such diarrhoea are alcohol, coffee, tea and allergy to food, particularly the oil used, or the preservatives or colouring added. Some people are intolerant to milk and if “a little extra” is consumed, it results in diarrhoea. Even if you did not have milk intolerance in childhood, it can occur later in life. Also, the blood supply to the intestines may be inefficient because of a hernia, prior surgery, radiation treatment, diabetes or an abnormal lipid profile and this can lead to diarrhoea.
Antibiotics can also kill the friendly bacteria in the gut that help in digestion and absorption. This results in antibiotic diarrhoea. Antacids containing magnesium, painkillers and cholesterol-lowering statin group of drugs are other offenders. Sometimes people take laxatives (allopathy or homeopathy) and this can also result in chronic diarrhoea.
Painful but non-infectious diarrhoea may occur as a result of a poorly understood condition called the irritable bowel syndrome. Coeliac disease (where the person is intolerant to wheat and wheat products) responds only to a strict diet. Cancer of the intestine can result in constipation alternating with diarrhoea.
Acute diarrhoea can result in dehydration as fluids are lost from the body faster than they are replaced. It makes the person drowsy, irritable, lethargic and giddy with cold and clammy hands and feet and sunken eyes. Urine may not be passed for 6-8 hours. Dehydration is dangerous. If it is not corrected, it can lead to kidney failure and even death.
Dehydration can be prevented by taking small frequent sips of water alternating with rice gruel, watery khichdi (combination of equal quantities of rice and dal) and banana. This replaces the electrolytes lost. Commercially available ORS (oral rehydration solution) sachets can also be reconstituted and used. Tea, coffee, fruit juices and fizzy drinks are best avoided.
Loperamide and Lomotil can be used to reduce intestinal motility and stop the diarrhoea. They do not treat the disease, only its symptoms. They can cause intestinal bloating and should not be used in children or in older patients.
Antibiotics do not work in viral diarrhoea or in food poisoning. They should not be used unless there is an identified bacteria causing the diarrhoea. Single doses should not be purchased from medical shops without a prescription and taken indiscriminately, as it results in the development of resistant bacteria.
Immunisation is available to prevent diarrhoea due to the rotavirus (for children), cholera, seasonal flu and typhoid.
A doctor should be consulted if there is dehydration, the diarrhoea has persisted for more than three days, there is fever, blood and mucous in the stool, or if it follows treatment with antibiotics.
Probiotics sold as sachets and tablets have gained popularity. They are advertised widely and are reputed to check antibiotic induced and other diarrhoeas. They are “good bacteria” which normally populate the intestine and prevent overgrowth of disease producing bacteria. Potent probiotics are found in freshly prepared home-made curd. A spoon of curd every morning can prevent overgrowth of diarrhoea producing organisms.
Breast-fed babies are less likely to develop diarrhoea. This is because human milk contains white blood cells that kill germs. It also contains immunoglobulin (IgA) which gives the baby’s intestines a protective coating and prevents infections and allergies.
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
Keep diarrhoea away
• Always wash hands with soap or a hand sanitizer before eating
• Drink water that has been boiled for 5 minutes, purified through a machine or bought as “mineral water” from a reputed company
• If that is not available, add a drop of tincture iodine or a pinch or turmeric to the water
The monsoons may bring a good harvest but the stagnant rainwater, overflowing drains and flooded roads also play havoc with our health. Flooding leads to back flow in sewage drains and drinking water can become contaminated. This results in outbreaks of diarrhoea, dysentery and, occasionally, cholera epidemics.
Diarrhoea is defined as stools that are more frequent, bulkier or more watery than usual. It occurs either because a damaged intestine does not absorb fluid from the food or secretes excess fluid. If blood and mucous is present in the stool as well, then it is called dysentery. Other incidental symptoms are fever, vomiting or stomach pain.
Viruses, bacteria and parasites damage the lining of the intestines. There is “intestinal hurry” as food is rushed through it before the liquid portion can be fully absorbed.
In weddings and other functions, diarrhoea can affect a number of people, and is referred to as food poisoning. This is caused by heat stable intestine damaging toxins released by the bacteria which initially contaminated the food. Subsequent cooking destroys the bacteria, but not the toxin.
Usually diarrhoea (even infective ones) subsides on its own, without specific treatment, in 3 to 7 days. If it lasts two weeks or longer, it needs to be investigated. The diagnosis requires a detailed history, stool and blood tests and sometimes endoscopy studies.
Common causes for such diarrhoea are alcohol, coffee, tea and allergy to food, particularly the oil used, or the preservatives or colouring added. Some people are intolerant to milk and if “a little extra” is consumed, it results in diarrhoea. Even if you did not have milk intolerance in childhood, it can occur later in life. Also, the blood supply to the intestines may be inefficient because of a hernia, prior surgery, radiation treatment, diabetes or an abnormal lipid profile and this can lead to diarrhoea.
Antibiotics can also kill the friendly bacteria in the gut that help in digestion and absorption. This results in antibiotic diarrhoea. Antacids containing magnesium, painkillers and cholesterol-lowering statin group of drugs are other offenders. Sometimes people take laxatives (allopathy or homeopathy) and this can also result in chronic diarrhoea.
Painful but non-infectious diarrhoea may occur as a result of a poorly understood condition called the irritable bowel syndrome. Coeliac disease (where the person is intolerant to wheat and wheat products) responds only to a strict diet. Cancer of the intestine can result in constipation alternating with diarrhoea.
Acute diarrhoea can result in dehydration as fluids are lost from the body faster than they are replaced. It makes the person drowsy, irritable, lethargic and giddy with cold and clammy hands and feet and sunken eyes. Urine may not be passed for 6-8 hours. Dehydration is dangerous. If it is not corrected, it can lead to kidney failure and even death.
Dehydration can be prevented by taking small frequent sips of water alternating with rice gruel, watery khichdi (combination of equal quantities of rice and dal) and banana. This replaces the electrolytes lost. Commercially available ORS (oral rehydration solution) sachets can also be reconstituted and used. Tea, coffee, fruit juices and fizzy drinks are best avoided.
Loperamide and Lomotil can be used to reduce intestinal motility and stop the diarrhoea. They do not treat the disease, only its symptoms. They can cause intestinal bloating and should not be used in children or in older patients.
Antibiotics do not work in viral diarrhoea or in food poisoning. They should not be used unless there is an identified bacteria causing the diarrhoea. Single doses should not be purchased from medical shops without a prescription and taken indiscriminately, as it results in the development of resistant bacteria.
Immunisation is available to prevent diarrhoea due to the rotavirus (for children), cholera, seasonal flu and typhoid.
A doctor should be consulted if there is dehydration, the diarrhoea has persisted for more than three days, there is fever, blood and mucous in the stool, or if it follows treatment with antibiotics.
Probiotics sold as sachets and tablets have gained popularity. They are advertised widely and are reputed to check antibiotic induced and other diarrhoeas. They are “good bacteria” which normally populate the intestine and prevent overgrowth of disease producing bacteria. Potent probiotics are found in freshly prepared home-made curd. A spoon of curd every morning can prevent overgrowth of diarrhoea producing organisms.
Breast-fed babies are less likely to develop diarrhoea. This is because human milk contains white blood cells that kill germs. It also contains immunoglobulin (IgA) which gives the baby’s intestines a protective coating and prevents infections and allergies.
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, August 22, 2011
strokes
Brain attack
Your Health
DR GITA MATHAI
Keep your brain healthy by doing the crossword everyday
An elderly person’s worst nightmare is suffering a stroke. It conjures up visions of being confined to bed with the inability to move or speak and, worst of all, loss of bowel and bladder control. A cerebral stroke occurs when blood supply to a part of the brain stops for any reason. Though strokes can occur at any age, they are more common after 65 years. With the increase in life expectancy in India, the incidence of stroke has doubled from 175 to 350 per 1,00,000.
Although it is uncommon for strokes to occur in young people, it can happen in youngsters born with a malformed blood vessel in the brain, brain tumours or those who suffer severe dehydration. Also, at any age, irregular heartbeats can lead to small clots in the brain called emboli, which can block vessels. The chances of having a stroke increase in those above 65 years if they have diabetes, hypertension, obesity, elevated blood lipids (cholesterol and triglycerides), are smokers, take more than 60ml of alcohol a day and do not have an active life.
Pregnant women can also suffer a stroke because of an increase in clotting tendency . In fact, the number of such women having a stroke has increased internationally. This upsurge has been blamed on older age at first pregnancy, an inactive life prior to and during pregnancy and obesity.
The manifestations of a stroke are giddiness, weakness or paralysis of muscle groups, blurring of vision, inability to speak or loss of consciousness. This is followed by paralysis of a limb, or a side of the body. A stroke occurs when blood supply to an area of the brain is cut off, either as a result of a block or a bleed.
Usually, there are a few warning TIA (transient ischaemic attacks) before a stroke or cerebral attack. There can be sudden blurring of vision, inability to speak or weakness of a limb. These signs are due to spasm of a diseased vessel in the brain or to small amounts of blood leaking. Many people do not take these symptoms seriously since recovery is spontaneous and complete. But appropriate preventive treatment at this point can prevent a full-blown stroke.
In the absence of treatment, TIAs are soon followed by the real thing — a stroke. The devastation caused by it depends on the extent of damage to the brain. This in turn depends on the site and size of the block or leak. Thirty three percent of stroke victims recover, 33 per cent have permanent disability and another 33 per cent die. Cerebral stroke is responsible for 1.2 per cent of the recorded deaths in India.
The most common effect is paralysis of a part of the face or one side of the body. Muscles in the throat and mouth lose co-ordination, making it difficult for the person to swallow and talk. Speech may become slurred and distorted. If the speech centre in the brain is affected the person may understand everything that is said but be unable to reply. Memory loss may make recollection of present events a blur. Quite often though past memories are intact. A person may also lose the ability to make judgements, reason and understand concepts. This makes them appear unnecessarily stubborn. A strange numbness or pricking sensations may occur in the paralysed limb. Since all these effects are because of damage to the brain, they are difficult to treat with medication.
All injuries heal given time and treatment, the brain is no exception. It is capable of rewiring itself so that lost skills are regained to an extent. A person who is predominantly right handed can learn to write with his left hand. Physiotherapy makes the paralysed muscles flexible and stronger. Since a few muscle spindles may be still active, they can be retrained to enlarge and take over the function of the paralysed muscles. The bladder can be trained to empty itself every 3-4 hours. By speaking slowly and using simple sentences, it is often possible to be understood. The brain can be stimulated with puzzles and poetry to enable faster healing.
Better still, try to prevent a stroke.
• Keep diabetes and hypertension in control.
• Take medications to reduce lipid levels.
• Take aspirin and clopidogrel, usually prescribed to diabetics and those with high pressure, regularly to prevent a stroke.
• Walk, swim or cycle for at least 30 minutes a day.
• Stimulate yourself intellectually by learning new skills and doing puzzles.
When it comes to brain circuits, the correct mantra is “use it or lose it!”
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
Sunday, August 14, 2011
hear hear
Hear, hear
Your Health
DR GITA MATHAI
The ears are one of our five sense organs but most of us take very little care of them. And a lot of us are gradually losing our hearing owing to neglect, misuse and wilful damage. The inability to hear properly and the consequent misinterpretation of what is heard can lead to misunderstandings with friends and social isolation. It can also be dangerous, as motor horns, bells, sirens and even warnings shouted may be missed.
Some babies are born deaf as an isolated defect or part of a complex plethora of congenital defects and syndromes. Sometimes the mother contracts measles, mumps or chicken pox during the first few months of pregnancy and deafness occurs in the baby as a result.
Hearing should be checked soon after birth. Some babies can hear, but develop post-lingual (after speech develops) hearing loss. Minor hearing loss can begin by age 20, with difficulty in hearing whispers and soft speech. By the time one reaches 65, 30 per cent have significant hearing loss while 50 per cent are quite deaf by the time they cross 75. Age related gradual degenerative deafness is called presbycusis.
The ear consists of the outer ear, middle ear and inner ear. Sound waves enter through the outer ear and cause vibrations at the eardrum. Three small bones of the middle ear amplify these vibrations as they pass to the inner ear, which contains a fluid-filled snail shaped structure called cochlea. Sound waves make the tiny hairs attached to the nerve cells in the cochlea move in different directions. This transforms the sound waves into electrical signals that are transmitted to the brain.
Continuous exposure to loud sound can damage the fine hair on the nerve cells, leading to progressive loss of hearing. This can be occupational in people who work with loud machinery. It is becoming common in teenagers who use “in ear” earphones to listen to loud music prolonged periods. Even soft piano music should not be listened to for more than two hours at a stretch.
Difficulty in hearing can also occur because of the external ear canal being blocked with wax. This can also lead to severe ear ache. It can be tackled with wax dissolving eardrops. A physician can clean it out. Ear buds tend to push hard wax further inwards, blocking the canal further. Pins and other sharp objects should never be inserted into the ear as they can damage the eardrum.
The middle ear is prone to viral and bacterial infections. Fluid and pus can collect, causing temporary hearing loss. Viral infections are unavoidable but immunisation is available against H. Influenzae and pneumococcus, the two common bacteria that cause ear infections in childhood. These injections are not part of the free national immunisation schedule; they are classified as “optional” vaccines and have to be paid for.
If left untreated, middle ear infections can result in hearing loss. The infection can spread outwards damaging the eardrum or inwards causing brain fever and meningitis. It can also damage the nerves conducting sounds to the brain.
Childhood infections such as measles, mumps and chicken pox could cause deafness as a complication. This too is preventable with immunisation. Vaccinations for all these diseases should be completed by the age of two.
Hearing loss can develop because of a defect either in the conduction pathways or in the nerve cells. It can also be a side effect of medication such as chloroquine, quinine and aspirin as well as antibiotics like gentamicin and kanamycin.
A sudden blow to the head, or a poke with a sharp object can also rupture the eardrum. Sudden loud noises can have the same effect. In war zones, there are “epidemics” of deafness where large numbers of the population cannot hear. Children are particularly vulnerable.
Once hearing loss has set in it should be evaluated professionally to assess the severity, whether one or both ears are affected and if it is reversible and curable.
Small holes in the eardrum can heal spontaneously or with medication. Larger holes require surgical repair, with skin grafts. In permanent hearing loss, a hearing aid should be considered, particularly in older individuals. Hearing aids vary in price, size and usability. The individual has to be fitted with the aid that suits him best. Cochlear implant surgery is also an effective but expensive solution.
Tips to preserve hearing:
• If occupational exposure to loud noise is inevitable, use ear mufflers.
• Turn TV and music volumes down.
• Do not place foreign objects in the ear.
• Children should be immunised against measles, mumps, German measles, chicken pox, H. influenza and pneumococcus.
• Women should complete their immunisation schedule before marriage.
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
The ears are one of our five sense organs but most of us take very little care of them. And a lot of us are gradually losing our hearing owing to neglect, misuse and wilful damage. The inability to hear properly and the consequent misinterpretation of what is heard can lead to misunderstandings with friends and social isolation. It can also be dangerous, as motor horns, bells, sirens and even warnings shouted may be missed.
Some babies are born deaf as an isolated defect or part of a complex plethora of congenital defects and syndromes. Sometimes the mother contracts measles, mumps or chicken pox during the first few months of pregnancy and deafness occurs in the baby as a result.
Hearing should be checked soon after birth. Some babies can hear, but develop post-lingual (after speech develops) hearing loss. Minor hearing loss can begin by age 20, with difficulty in hearing whispers and soft speech. By the time one reaches 65, 30 per cent have significant hearing loss while 50 per cent are quite deaf by the time they cross 75. Age related gradual degenerative deafness is called presbycusis.
The ear consists of the outer ear, middle ear and inner ear. Sound waves enter through the outer ear and cause vibrations at the eardrum. Three small bones of the middle ear amplify these vibrations as they pass to the inner ear, which contains a fluid-filled snail shaped structure called cochlea. Sound waves make the tiny hairs attached to the nerve cells in the cochlea move in different directions. This transforms the sound waves into electrical signals that are transmitted to the brain.
Continuous exposure to loud sound can damage the fine hair on the nerve cells, leading to progressive loss of hearing. This can be occupational in people who work with loud machinery. It is becoming common in teenagers who use “in ear” earphones to listen to loud music prolonged periods. Even soft piano music should not be listened to for more than two hours at a stretch.
Difficulty in hearing can also occur because of the external ear canal being blocked with wax. This can also lead to severe ear ache. It can be tackled with wax dissolving eardrops. A physician can clean it out. Ear buds tend to push hard wax further inwards, blocking the canal further. Pins and other sharp objects should never be inserted into the ear as they can damage the eardrum.
The middle ear is prone to viral and bacterial infections. Fluid and pus can collect, causing temporary hearing loss. Viral infections are unavoidable but immunisation is available against H. Influenzae and pneumococcus, the two common bacteria that cause ear infections in childhood. These injections are not part of the free national immunisation schedule; they are classified as “optional” vaccines and have to be paid for.
If left untreated, middle ear infections can result in hearing loss. The infection can spread outwards damaging the eardrum or inwards causing brain fever and meningitis. It can also damage the nerves conducting sounds to the brain.
Childhood infections such as measles, mumps and chicken pox could cause deafness as a complication. This too is preventable with immunisation. Vaccinations for all these diseases should be completed by the age of two.
Hearing loss can develop because of a defect either in the conduction pathways or in the nerve cells. It can also be a side effect of medication such as chloroquine, quinine and aspirin as well as antibiotics like gentamicin and kanamycin.
A sudden blow to the head, or a poke with a sharp object can also rupture the eardrum. Sudden loud noises can have the same effect. In war zones, there are “epidemics” of deafness where large numbers of the population cannot hear. Children are particularly vulnerable.
Once hearing loss has set in it should be evaluated professionally to assess the severity, whether one or both ears are affected and if it is reversible and curable.
Small holes in the eardrum can heal spontaneously or with medication. Larger holes require surgical repair, with skin grafts. In permanent hearing loss, a hearing aid should be considered, particularly in older individuals. Hearing aids vary in price, size and usability. The individual has to be fitted with the aid that suits him best. Cochlear implant surgery is also an effective but expensive solution.
Tips to preserve hearing:
• If occupational exposure to loud noise is inevitable, use ear mufflers.
• Turn TV and music volumes down.
• Do not place foreign objects in the ear.
• Children should be immunised against measles, mumps, German measles, chicken pox, H. influenza and pneumococcus.
• Women should complete their immunisation schedule before marriage.
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, July 20, 2011
calcium needed
Calcium every day keeps fractures away
Your Health
DR GITA MATHAI
Debility, illness and loss of independence are assumed to be an inevitable part of ageing. In a society like ours, where there are no health benefits and minimal social security, old age can be frightening. Unfortunately, young people do not realise that if they take remedial action, some of the incapacitating changes of ageing like osteoporosis are preventable.
Osteoporosis occurs because of calcium deficiency — the bones became fragile and brittle. This means that the slightest trauma can lead to a fracture. In India, the incidence of osteoporosis is high and, with our ageing population, it will only climb.
Patients do not realise that anything is wrong until the first fracture. The trauma that caused the break need not be severe; a trivial fall may be sufficient. The commonest sites are the wrist and the hip. Treatment usually requires setting the bone surgically and screwing it into place. Healing is a long-drawn-out and painful process. Fear of surgery may lead people to native bonesetters, who set fractures with bandages and egg whites. But these ancient treatments are not successful in osteoporosis, especially when the fracture occurs in a deep-seated bone like the hip.
Apart from fractures, early signs of osteoporosis are a decrease in height as the spinal vertebrae grind into each other. This also results in a stooped appearance with a “dowager’s hump”.
The only way to avoid osteoporosis is to have enough calcium, which is necessary not only for healthy bones but also for the proper functioning of cells and enzymes. If there isn’t enough calcium in the blood, the body gets it from the bones. If this calcium is not replaced, the bones become increasingly fragile. Bones are built up in childhood, adolescence and the early twenties. So it should be ensured that the body gets enough calcium during this period. The final strength of the bones is determined by genes but diet and lifestyle can modify this.
The body gets calcium from dairy products such as milk and cheese (processed as well as cottage). Other calcium-rich foods are sardines, custard apples and green leafy vegetables. To absorb dietary calcium, the body also needs 400 IU of vitamin D, 400mg of magnesium and 110 micrograms of vitamin K. The skin can synthesise sufficient vitamin D from sunlight but the problem is that most people either work indoors or use sunscreen and umbrellas. The other source of vitamins is green leafy vegetables. However, the requisite amounts of these vitamins are usually not available in a normal diet. Therefore, you need calcium supplements, most of which contain additional vitamins and minerals to aid absorption.
Calcium supplements are best absorbed if taken after meals in 500mg doses several times a day. Other minerals such as iron and zinc interfere with calcium absorption. Even though many people need supplements of all these elements, they have to be given separately or at least 12 hours apart. A common mistake is to try and combine all these ingredients into one giant biologically ineffective capsule or tablet.
The other thing that can interfere with calcium absorption is too much protein, caffeine (coffee and cola) or alcohol in the diet. There is a demonstrated difference between the bone density of people who drink colas every day and those who drink it once a month.
Osteoporosis can also occur as a side effect of medication like corticosteroids (called secondary osteoporosis). These are prescribed for ailments such as arthritis or asthma and patients are sometimes not aware that they have been given steroids on a long-term basis. Sometimes, it is part of the unlabeled medication dispensed by practitioners of alternative medicine.
Some antacids contain aluminium, which acts as “bone poison” and interferes with the incorporation of calcium into the bones, increasing the risk of osteoporosis. Thyroid disorders or malfunctioning parathyroid glands can also increase the risk of developing the disease. Lactose (milk) intolerance results in an inadequate intake of milk and dairy products with subsequent calcium deficiency.
It is never too late to contain osteoporosis. Physical activity helps bones retain and even gain density all through life. Effective exercises are running, jogging, skipping, stair-climbing, tennis and badminton. Exercise also improves muscle strength and coordination so that falls and injuries are less. One should exercise for an hour every day, all through life. Although exercise at any age is a boon to health, to build bone strength one needs to be regular and consistent.
Daily calcium requirement
• 1-3 yr: 700mg
• 4-8 yr: 1,000mg
• 10-20 yr: 1,300mg
• 20-70 yr: 1,000mg
• Women over 50: 1,200mg
• Men over 71: 1,200mg
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
Debility, illness and loss of independence are assumed to be an inevitable part of ageing. In a society like ours, where there are no health benefits and minimal social security, old age can be frightening. Unfortunately, young people do not realise that if they take remedial action, some of the incapacitating changes of ageing like osteoporosis are preventable.
Osteoporosis occurs because of calcium deficiency — the bones became fragile and brittle. This means that the slightest trauma can lead to a fracture. In India, the incidence of osteoporosis is high and, with our ageing population, it will only climb.
Patients do not realise that anything is wrong until the first fracture. The trauma that caused the break need not be severe; a trivial fall may be sufficient. The commonest sites are the wrist and the hip. Treatment usually requires setting the bone surgically and screwing it into place. Healing is a long-drawn-out and painful process. Fear of surgery may lead people to native bonesetters, who set fractures with bandages and egg whites. But these ancient treatments are not successful in osteoporosis, especially when the fracture occurs in a deep-seated bone like the hip.
Apart from fractures, early signs of osteoporosis are a decrease in height as the spinal vertebrae grind into each other. This also results in a stooped appearance with a “dowager’s hump”.
The only way to avoid osteoporosis is to have enough calcium, which is necessary not only for healthy bones but also for the proper functioning of cells and enzymes. If there isn’t enough calcium in the blood, the body gets it from the bones. If this calcium is not replaced, the bones become increasingly fragile. Bones are built up in childhood, adolescence and the early twenties. So it should be ensured that the body gets enough calcium during this period. The final strength of the bones is determined by genes but diet and lifestyle can modify this.
The body gets calcium from dairy products such as milk and cheese (processed as well as cottage). Other calcium-rich foods are sardines, custard apples and green leafy vegetables. To absorb dietary calcium, the body also needs 400 IU of vitamin D, 400mg of magnesium and 110 micrograms of vitamin K. The skin can synthesise sufficient vitamin D from sunlight but the problem is that most people either work indoors or use sunscreen and umbrellas. The other source of vitamins is green leafy vegetables. However, the requisite amounts of these vitamins are usually not available in a normal diet. Therefore, you need calcium supplements, most of which contain additional vitamins and minerals to aid absorption.
Calcium supplements are best absorbed if taken after meals in 500mg doses several times a day. Other minerals such as iron and zinc interfere with calcium absorption. Even though many people need supplements of all these elements, they have to be given separately or at least 12 hours apart. A common mistake is to try and combine all these ingredients into one giant biologically ineffective capsule or tablet.
The other thing that can interfere with calcium absorption is too much protein, caffeine (coffee and cola) or alcohol in the diet. There is a demonstrated difference between the bone density of people who drink colas every day and those who drink it once a month.
Osteoporosis can also occur as a side effect of medication like corticosteroids (called secondary osteoporosis). These are prescribed for ailments such as arthritis or asthma and patients are sometimes not aware that they have been given steroids on a long-term basis. Sometimes, it is part of the unlabeled medication dispensed by practitioners of alternative medicine.
Some antacids contain aluminium, which acts as “bone poison” and interferes with the incorporation of calcium into the bones, increasing the risk of osteoporosis. Thyroid disorders or malfunctioning parathyroid glands can also increase the risk of developing the disease. Lactose (milk) intolerance results in an inadequate intake of milk and dairy products with subsequent calcium deficiency.
It is never too late to contain osteoporosis. Physical activity helps bones retain and even gain density all through life. Effective exercises are running, jogging, skipping, stair-climbing, tennis and badminton. Exercise also improves muscle strength and coordination so that falls and injuries are less. One should exercise for an hour every day, all through life. Although exercise at any age is a boon to health, to build bone strength one needs to be regular and consistent.
Daily calcium requirement
• 1-3 yr: 700mg
• 4-8 yr: 1,000mg
• 10-20 yr: 1,300mg
• 20-70 yr: 1,000mg
• Women over 50: 1,200mg
• Men over 71: 1,200mg
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 27, 2011
going grey
Colour grey
Your Health
DR GITA MATHAI
As we grow older several changes take place in our body, some visible, others not so visible. The most obvious one is the hair — and moustache in the case of men — turning grey from jet black. Unfortunately, nowadays it is not just senior citizens who are greying but also those in their twenties or early thirties. Twenty years ago, 18 per cent of adults under the age of 30 had started to grey. According to a recent report, that figure is now close to 32 per cent. Hair care brands have come up with a new mnemonic for grey haired over stressed twenty something — GHOSTS. The first grey hair stresses out GHOSTS even more as the current job market prizes youth — or at least looking youthful — over experience.
The age at which one starts to grey is determined genetically. At that age the hair cells stop producing the colouring pigment melanin. This makes the shaft of the hair transparent. Light reflects off it, giving it its white appearance. Not all hairs stop producing melanin simultaneously. The mixed white and normal black makes the hair appear grey.
People who are exposed constantly to pollution and UV rays can get grey hair even before their genetically determined age to grey. The poisonous chemicals in tobacco kill the melanocytes, making smokers go grey before their non-smoking peers. Deficiency of vitamin B12 can also cause premature greying, as can a a peculiar type of anaemia called pernicious anaemia. Thyroid malfunction can also turn hair grey.
Grey hair has been cosmetically unacceptable for centuries. People used all kinds of natural dyes such as henna, indigo, walnut, curry leaves, gooseberries, tea, coffee, hibiscus flowers and arecanut either alone or in combination to colour grey hair. These natural products are used even today. Most, if used consistently, produce a dark brown colour. They are popular as they are inexpensive, can be applied at home, and are considered safe. But some people are allergic to even herbal products.
Hair can also be dyed with commercially available colouring agents. Temporary colours last a single wash. They can be funky colours like pink, blue or green but dark hair will not take these unless it is bleached first. Repeated use of these dyes without proper conditioning can, however, make hair brittle and lustreless.
Permanent hair colouring is the one usually used to disguise grey hair. It is a two-step process. First the hair is lightened using an agent like hydrogen peroxide or ammonia. Then the dye is applied and fixed. The colouring lasts until the hair grows out. This can be anything between 4 to 6 weeks.
Some people are allergic to hair dyes. Redness, itching, burning or skin rashes can occur either immediately or within 48 hours. To prevent this, before applying a dye for the first time, or switching brands, do a patch test. Take a small quantity of dye and apply it to the skin [usually on the inside of the elbow] for a day to see if there is any reaction. Sometimes a person can turn allergic to a product that they have been using safely for many years.
If hair is being coloured at home, it is important to follow the instructions on the package implicitly. Before using the dye, apply Vaseline to the hairline and ears. This will prevent the skin from staining. Always use gloves to apply the colour. Leave it on the hair for the time specified. Then wash it off with water. Apply a conditioner and leave it on for 7-9 minutes. Shampoo the next day.
Most shampoos (particularly the anti-dandruff ones) are harsh and unsuitable for regular use on coloured hair. Special colour safe shampoos and conditioners should be used to preserve the health of hair and minimise fading.
Hair that has been damaged by excessive and improper exposure to chemicals becomes dry, rough and fragile. The only solution is to stop using chemicals and cut off the damaged bit.
Hair colour should also not be used to darken facial hair because its texture is different and also because using traditional hair dyes so close to the nose can be distressing because of the odour of ammonia and other chemicals. The best thing to use is a range of colouring products labelled “just for men”.
How to delay greying:
Avoid stress
Don’t smoke
Avoid too much exposure to ultraviolet rays
Exercise regularly
Eat at least 4-5 helpings of fruit and vegetables a day.
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
As we grow older several changes take place in our body, some visible, others not so visible. The most obvious one is the hair — and moustache in the case of men — turning grey from jet black. Unfortunately, nowadays it is not just senior citizens who are greying but also those in their twenties or early thirties. Twenty years ago, 18 per cent of adults under the age of 30 had started to grey. According to a recent report, that figure is now close to 32 per cent. Hair care brands have come up with a new mnemonic for grey haired over stressed twenty something — GHOSTS. The first grey hair stresses out GHOSTS even more as the current job market prizes youth — or at least looking youthful — over experience.
The age at which one starts to grey is determined genetically. At that age the hair cells stop producing the colouring pigment melanin. This makes the shaft of the hair transparent. Light reflects off it, giving it its white appearance. Not all hairs stop producing melanin simultaneously. The mixed white and normal black makes the hair appear grey.
People who are exposed constantly to pollution and UV rays can get grey hair even before their genetically determined age to grey. The poisonous chemicals in tobacco kill the melanocytes, making smokers go grey before their non-smoking peers. Deficiency of vitamin B12 can also cause premature greying, as can a a peculiar type of anaemia called pernicious anaemia. Thyroid malfunction can also turn hair grey.
Grey hair has been cosmetically unacceptable for centuries. People used all kinds of natural dyes such as henna, indigo, walnut, curry leaves, gooseberries, tea, coffee, hibiscus flowers and arecanut either alone or in combination to colour grey hair. These natural products are used even today. Most, if used consistently, produce a dark brown colour. They are popular as they are inexpensive, can be applied at home, and are considered safe. But some people are allergic to even herbal products.
Hair can also be dyed with commercially available colouring agents. Temporary colours last a single wash. They can be funky colours like pink, blue or green but dark hair will not take these unless it is bleached first. Repeated use of these dyes without proper conditioning can, however, make hair brittle and lustreless.
Permanent hair colouring is the one usually used to disguise grey hair. It is a two-step process. First the hair is lightened using an agent like hydrogen peroxide or ammonia. Then the dye is applied and fixed. The colouring lasts until the hair grows out. This can be anything between 4 to 6 weeks.
Some people are allergic to hair dyes. Redness, itching, burning or skin rashes can occur either immediately or within 48 hours. To prevent this, before applying a dye for the first time, or switching brands, do a patch test. Take a small quantity of dye and apply it to the skin [usually on the inside of the elbow] for a day to see if there is any reaction. Sometimes a person can turn allergic to a product that they have been using safely for many years.
If hair is being coloured at home, it is important to follow the instructions on the package implicitly. Before using the dye, apply Vaseline to the hairline and ears. This will prevent the skin from staining. Always use gloves to apply the colour. Leave it on the hair for the time specified. Then wash it off with water. Apply a conditioner and leave it on for 7-9 minutes. Shampoo the next day.
Most shampoos (particularly the anti-dandruff ones) are harsh and unsuitable for regular use on coloured hair. Special colour safe shampoos and conditioners should be used to preserve the health of hair and minimise fading.
Hair that has been damaged by excessive and improper exposure to chemicals becomes dry, rough and fragile. The only solution is to stop using chemicals and cut off the damaged bit.
Hair colour should also not be used to darken facial hair because its texture is different and also because using traditional hair dyes so close to the nose can be distressing because of the odour of ammonia and other chemicals. The best thing to use is a range of colouring products labelled “just for men”.
How to delay greying:
Avoid stress
Don’t smoke
Avoid too much exposure to ultraviolet rays
Exercise regularly
Eat at least 4-5 helpings of fruit and vegetables a day.
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 20, 2011
new mom
New mom? Eat right and exercise
Your Health
DR GITA MATHAI
The thought, preparation and expense that go into “the great Indian wedding” are unbelievable. Yet barely have the stars faded from the new bride’s eyes than subtle pressure from parents, in-laws, spouse and well-wishers sets in. Everyone wants to hear the “good news” —a baby on the way. People don’t stop to think if the bride is ready for motherhood. And once the mother-to-be has been coddled through the pregnancy and everyone has oohed and aahed over the little bundle of joy, the excitement and interest fades. The new mother finds that she is totally unprepared for the drastic changes in her life after the birth of a baby. No one told her that she might have a baby that refuses to sleep at night or that she would feel and look like an elephant after childbirth.
A weight gain of between 12 to 14kg during pregnancy is normal and healthy. Many women expect all the extra kilos to disappear immediately after delivery. Actually, around 5kg (the weight of the baby and the placenta) will disappear immediately. The rest should disappear gradually within nine months.
It is very easy to start overeating after childbirth. Visitors arrive laden with delicious tidbits and vociferously advise rest and a high calorie diet to ensure adequate breast milk. In truth, breast-feeding requires only around 750 extra calories. Since brand new moms tend to be sedentary, their caloric intake should be limited to approximately 2,500 calories. Even though many women complain that they continue to “feel like a bloated elephant” after delivery, this is not the correct time to go on a drastic diet. Healthy eating and judicious exercise will ensure a gradual and safe return to pre-pregnancy weight.
Light aerobic exercise or walking can be started around two weeks after delivery, even by a person who did not exercise at all during pregnancy. But it is important not to do too much too soon. A hormone called relaxin, responsible for making the joints loose during pregnancy so that delivery is easy, persists in the body for about six months after delivery. So vigorous exercise should be started only after six months to avoid damaging joints. Walking 15 minutes a day is a good start. Increase the time by 15 minutes every week until you reach an hour. Endorphins released during walking will help to elevate the mood and combat any post partum depression. It will also help to tone the muscles. Exercise does not reduce breast milk production.
Pain in the genital and the caesarian site often comes as a shock. It makes going to the bathroom or even sitting an ordeal. Many are afraid to take medication (with reason) for fear that it might cross over in the breast milk to the newborn baby. Heat or cold applied locally to the area will relieve the pain. You can use an infra red lamp, a hot water bottle, or apply ice. The ice needs to be in a plastic bag or bottle. To prevent infection, always wash the area with water after going to the bathroom.
The skin over the abdomen may show white lines called stretch marks. These may itch. Applying coconut oil for half an hour before a bath helps.
These usually fade over time. If there is a scar (caesarian or episiotomy), it should be left alone until it has healed completely.
The hormones responsible for maintaining the pregnancy drop suddenly after childbirth. This abrupt change can lead to depression, bouts of crying and feelings of inadequacy. These usually last for around two weeks and then subside by themselves. If they last for a month or longer, then postnatal depression may have developed and a physician should be consulted.
The abdominal wall becomes lax during pregnancy. The abdomen itself may appear pendulous. Sits ups with the knees bend and oblique abdominal exercises will help with this. Start with 10 sets twice a day. Aim to reach 50 repetitions morning and evening within four months. You need to continue doing this exercise at least thrice a week.
A few drops of urine may leak out while coughing, sneezing or laughing. It may be difficult to hold the urine for even a limited time if the bladder is full. This is because the pelvic floor muscles become weakened during childbirth, making the sphincters, which control urination, lax. This can occur even if the delivery was by caesarian section.
These humiliating accidents can be tackled by doing “Keegles’s exercises”. Sit on the floor in the namaz position or in the yoga “child’s pose”. Touch the nose to the ground, concentrate on the pelvic muscles and consciously tighten them. Also, try to “stop and start” consciously while passing urine.
New mothers have lost a great deal of blood. The baby needs to be fed frequently so that sleep patterns are disturbed and often inadequate. Tiredness and fatigue are common and normal after childbirth. Try to sleep whenever the baby sleeps. And those colourful iron and calcium supplements need to be continued as long as you are feeding the baby.
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
The thought, preparation and expense that go into “the great Indian wedding” are unbelievable. Yet barely have the stars faded from the new bride’s eyes than subtle pressure from parents, in-laws, spouse and well-wishers sets in. Everyone wants to hear the “good news” —a baby on the way. People don’t stop to think if the bride is ready for motherhood. And once the mother-to-be has been coddled through the pregnancy and everyone has oohed and aahed over the little bundle of joy, the excitement and interest fades. The new mother finds that she is totally unprepared for the drastic changes in her life after the birth of a baby. No one told her that she might have a baby that refuses to sleep at night or that she would feel and look like an elephant after childbirth.
A weight gain of between 12 to 14kg during pregnancy is normal and healthy. Many women expect all the extra kilos to disappear immediately after delivery. Actually, around 5kg (the weight of the baby and the placenta) will disappear immediately. The rest should disappear gradually within nine months.
It is very easy to start overeating after childbirth. Visitors arrive laden with delicious tidbits and vociferously advise rest and a high calorie diet to ensure adequate breast milk. In truth, breast-feeding requires only around 750 extra calories. Since brand new moms tend to be sedentary, their caloric intake should be limited to approximately 2,500 calories. Even though many women complain that they continue to “feel like a bloated elephant” after delivery, this is not the correct time to go on a drastic diet. Healthy eating and judicious exercise will ensure a gradual and safe return to pre-pregnancy weight.
Light aerobic exercise or walking can be started around two weeks after delivery, even by a person who did not exercise at all during pregnancy. But it is important not to do too much too soon. A hormone called relaxin, responsible for making the joints loose during pregnancy so that delivery is easy, persists in the body for about six months after delivery. So vigorous exercise should be started only after six months to avoid damaging joints. Walking 15 minutes a day is a good start. Increase the time by 15 minutes every week until you reach an hour. Endorphins released during walking will help to elevate the mood and combat any post partum depression. It will also help to tone the muscles. Exercise does not reduce breast milk production.
Pain in the genital and the caesarian site often comes as a shock. It makes going to the bathroom or even sitting an ordeal. Many are afraid to take medication (with reason) for fear that it might cross over in the breast milk to the newborn baby. Heat or cold applied locally to the area will relieve the pain. You can use an infra red lamp, a hot water bottle, or apply ice. The ice needs to be in a plastic bag or bottle. To prevent infection, always wash the area with water after going to the bathroom.
The skin over the abdomen may show white lines called stretch marks. These may itch. Applying coconut oil for half an hour before a bath helps.
These usually fade over time. If there is a scar (caesarian or episiotomy), it should be left alone until it has healed completely.
The hormones responsible for maintaining the pregnancy drop suddenly after childbirth. This abrupt change can lead to depression, bouts of crying and feelings of inadequacy. These usually last for around two weeks and then subside by themselves. If they last for a month or longer, then postnatal depression may have developed and a physician should be consulted.
The abdominal wall becomes lax during pregnancy. The abdomen itself may appear pendulous. Sits ups with the knees bend and oblique abdominal exercises will help with this. Start with 10 sets twice a day. Aim to reach 50 repetitions morning and evening within four months. You need to continue doing this exercise at least thrice a week.
A few drops of urine may leak out while coughing, sneezing or laughing. It may be difficult to hold the urine for even a limited time if the bladder is full. This is because the pelvic floor muscles become weakened during childbirth, making the sphincters, which control urination, lax. This can occur even if the delivery was by caesarian section.
These humiliating accidents can be tackled by doing “Keegles’s exercises”. Sit on the floor in the namaz position or in the yoga “child’s pose”. Touch the nose to the ground, concentrate on the pelvic muscles and consciously tighten them. Also, try to “stop and start” consciously while passing urine.
New mothers have lost a great deal of blood. The baby needs to be fed frequently so that sleep patterns are disturbed and often inadequate. Tiredness and fatigue are common and normal after childbirth. Try to sleep whenever the baby sleeps. And those colourful iron and calcium supplements need to be continued as long as you are feeding the baby.
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 15, 2011
help I'm being treated
The caterwauling could be heard in the corridor long before the young adult male was carried in on a plank of wood. His head was lolling from side to side, a red trickle of blood oozed from the corner of his mouth. His checked shirt was discolored and stained.
Evaluation was difficult.
I had to push past an old woman beating her chest and a young one (wife?) throwing herself at his feet and hanging on for dear life.
Haemetemisis perhaps? Whatever. Anyway, emergency treatment had to be given. Perhaps if I started an IV line, pushed in a stomach tube and washed out the stomach with ice water, the bleeding would stop long enough for me to send him to the nearest hospital. The sooner the better. The accompanying crowd can get very nasty if there is a death. I did not really want by premises destroyed or the publicity.
He was conscious, oriented and passive when I inserted the needle.
The stomach tube was another story altogether. He gagged, fought and sat up. Determined to succeed (Robert Bruce – try and try again) I held him down and tried harder.
Suddenly, he pulled out the IV line. (This made blood drip on the floor as well). He pushed me to one side, fell to the floor and clutched my feet.
“Save me!” He shouted.
“ I am trying to, but unless you cooperate what can I do?”
“I want to be saved from you,” he shouted, “you are killing me!”
“Nonsense! I am trying to save your life.”
“Ayoo! I am not vomiting blood. I just swallowed a brick dissolved in water to frighten my family. Let me go. If I stay here any longer, you WILL kill me.”
Gathering his clothes he ran out of the room followed closely by disbelieving relatives.
“ A miracle!” shouted one of them, “I told you this doctor has lucky hands. She just has to touch you and you will recover.”
Well, a little community goodwill doesn’t hurt , And, in the final analysis, “All’s well that end’s well!”
Evaluation was difficult.
I had to push past an old woman beating her chest and a young one (wife?) throwing herself at his feet and hanging on for dear life.
Haemetemisis perhaps? Whatever. Anyway, emergency treatment had to be given. Perhaps if I started an IV line, pushed in a stomach tube and washed out the stomach with ice water, the bleeding would stop long enough for me to send him to the nearest hospital. The sooner the better. The accompanying crowd can get very nasty if there is a death. I did not really want by premises destroyed or the publicity.
He was conscious, oriented and passive when I inserted the needle.
The stomach tube was another story altogether. He gagged, fought and sat up. Determined to succeed (Robert Bruce – try and try again) I held him down and tried harder.
Suddenly, he pulled out the IV line. (This made blood drip on the floor as well). He pushed me to one side, fell to the floor and clutched my feet.
“Save me!” He shouted.
“ I am trying to, but unless you cooperate what can I do?”
“I want to be saved from you,” he shouted, “you are killing me!”
“Nonsense! I am trying to save your life.”
“Ayoo! I am not vomiting blood. I just swallowed a brick dissolved in water to frighten my family. Let me go. If I stay here any longer, you WILL kill me.”
Gathering his clothes he ran out of the room followed closely by disbelieving relatives.
“ A miracle!” shouted one of them, “I told you this doctor has lucky hands. She just has to touch you and you will recover.”
Well, a little community goodwill doesn’t hurt , And, in the final analysis, “All’s well that end’s well!”
Monday, June 6, 2011
too fat too young
Too fat by far
Your Health
DR GITA MATHAI
It is difficult to convince parents that their child is overweight even if you prove it by measuring the weight in kg and dividing it by the height in metre squared. (The normal value is around 23). Parents are disbelieving even when faced with values higher than 30. Perhaps this is because we tend to equate prosperity with a “well-fed look” and look admiringly at plump parents accompanied by children with pot bellies. Generations of coping with famine, want, the unavailability and unaffordability of food have taken their toll. As the money rolls in, parents abandon their traditional healthy life style and adopt a western approach to food and leisure.
Our tradition of breast-feeding infants provided them with the correct amount of calories for the first six months of life. A “let down” reflex controls the production of milk; as the baby sucks, more milk is produced. This ensures that the baby gets enough for its requirement, and doubles its birth weight by the end of the fifth month and triples it by the end of the first year. A baby that starts life at 2 kg will be normal if it weighs 6 kg on its first birthday. Its appearance will be a stark contrast to the baby that was 4 kg at birth and 12 kg on its first birthday. Both are normal, but cannot be compared as they represent two ends of a normal spectrum.
Unhappy with small but normal babies, parents often supplement breast milk with powdered formula or cow’s milk, a practice that should be avoided as far as possible. There really is no superior or adequate substitute for the “real thing,” that ensures healthy, adequate and normal growth.
Traditional weaning is with home-cooked cereals such rice, ragi and wheat with added milk and sugar. Today parents opt for ready-made sodium-rich, precooked, packaged weaning foods, or “milk biscuits” with disastrous results. These changed child-rearing practices have resulted in an epidemic of childhood obesity: 30 per cent of urban children are obese. Tragically, 70 per cent will go on to become obese adolescents and adults.
With cartoons, television serials, computer games, homework and tuition, children spend more than three hours a day almost motionless. Added to this is snacking on fat-laden packaged food and drinking calorie-high sugar-dense aerated bottled drinks. There is practically no physical activity at all.
Busy parents prefer these sedentary activities as they require minimum parental participation. For activity and sports, parents have to take the children to a place where they can play. There is a shortage of parks and open spaces. Children cannot be left unsupervised as there are the problems of safety, and social crimes like abuse and abduction (This used to be true only for girls but now both sexes are equally in danger).
The problem is compounded by the fact that life in India is very competitive. Only a few sportspeople succeed, but academic excellence ensures “good jobs”. Parents are under the misconception that children who “play” will be too tired to study.
Gradually caloric intake overtakes expenditure and obesity sets in. It also causes many psychological problems. Children develop a negative self image and either withdraw into themselves or become bullies. By the early twenties many are already exhibiting signs of syndrome X or insulin resistance, their blood sugar and lipid profile become abnormal. They develop diabetes, hypertension and heart disease. Girls may develop the polycystic ovarian syndrome (PCOS) with irregular periods and eventually, fertility problems. Indians are genetically prone to these abnormalities.
Studies have shown that children over the age of two need an hour of physical activity a day. This can be a single one-hour session or split into two 30-minute one. Even six 10-minute sessions are effective. It can be running, cycling, playing structured games, skipping or swimming.
Exercise helps children maintain an ideal body weight, feel less stressed and angry, improve concentration in school and sleep well at night. Objective studies using MRI scans demonstrated that exercise in children increases brain activity in the prefrontal cortex of the brain. This is the area associated with cognitive skills, complex thinking, decision making and correct social behaviour. Also the IQ (intelligence quotient) of these children improves by almost four points.
Children all over the world are becoming obese for the same reasons. Parents have a crucial role to play in making children healthy. They should exercise and lead by example. TV viewing should be limited. Oily, ready-to-eat snacks should be avoided.
Other governments (the UK, the US, Japan, China) have woken up to the fact that obese children grow into unhealthy unproductive adults, with medical problems that are a burden on the national exchequer. They have begun to tackle the problem on a war footing. We have not, and this means that India may eventually be a country where the life expectancy starts to fall.
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 difficult to convince parents that their child is overweight even if you prove it by measuring the weight in kg and dividing it by the height in metre squared. (The normal value is around 23). Parents are disbelieving even when faced with values higher than 30. Perhaps this is because we tend to equate prosperity with a “well-fed look” and look admiringly at plump parents accompanied by children with pot bellies. Generations of coping with famine, want, the unavailability and unaffordability of food have taken their toll. As the money rolls in, parents abandon their traditional healthy life style and adopt a western approach to food and leisure.
Our tradition of breast-feeding infants provided them with the correct amount of calories for the first six months of life. A “let down” reflex controls the production of milk; as the baby sucks, more milk is produced. This ensures that the baby gets enough for its requirement, and doubles its birth weight by the end of the fifth month and triples it by the end of the first year. A baby that starts life at 2 kg will be normal if it weighs 6 kg on its first birthday. Its appearance will be a stark contrast to the baby that was 4 kg at birth and 12 kg on its first birthday. Both are normal, but cannot be compared as they represent two ends of a normal spectrum.
Unhappy with small but normal babies, parents often supplement breast milk with powdered formula or cow’s milk, a practice that should be avoided as far as possible. There really is no superior or adequate substitute for the “real thing,” that ensures healthy, adequate and normal growth.
Traditional weaning is with home-cooked cereals such rice, ragi and wheat with added milk and sugar. Today parents opt for ready-made sodium-rich, precooked, packaged weaning foods, or “milk biscuits” with disastrous results. These changed child-rearing practices have resulted in an epidemic of childhood obesity: 30 per cent of urban children are obese. Tragically, 70 per cent will go on to become obese adolescents and adults.
With cartoons, television serials, computer games, homework and tuition, children spend more than three hours a day almost motionless. Added to this is snacking on fat-laden packaged food and drinking calorie-high sugar-dense aerated bottled drinks. There is practically no physical activity at all.
Busy parents prefer these sedentary activities as they require minimum parental participation. For activity and sports, parents have to take the children to a place where they can play. There is a shortage of parks and open spaces. Children cannot be left unsupervised as there are the problems of safety, and social crimes like abuse and abduction (This used to be true only for girls but now both sexes are equally in danger).
The problem is compounded by the fact that life in India is very competitive. Only a few sportspeople succeed, but academic excellence ensures “good jobs”. Parents are under the misconception that children who “play” will be too tired to study.
Gradually caloric intake overtakes expenditure and obesity sets in. It also causes many psychological problems. Children develop a negative self image and either withdraw into themselves or become bullies. By the early twenties many are already exhibiting signs of syndrome X or insulin resistance, their blood sugar and lipid profile become abnormal. They develop diabetes, hypertension and heart disease. Girls may develop the polycystic ovarian syndrome (PCOS) with irregular periods and eventually, fertility problems. Indians are genetically prone to these abnormalities.
Studies have shown that children over the age of two need an hour of physical activity a day. This can be a single one-hour session or split into two 30-minute one. Even six 10-minute sessions are effective. It can be running, cycling, playing structured games, skipping or swimming.
Exercise helps children maintain an ideal body weight, feel less stressed and angry, improve concentration in school and sleep well at night. Objective studies using MRI scans demonstrated that exercise in children increases brain activity in the prefrontal cortex of the brain. This is the area associated with cognitive skills, complex thinking, decision making and correct social behaviour. Also the IQ (intelligence quotient) of these children improves by almost four points.
Children all over the world are becoming obese for the same reasons. Parents have a crucial role to play in making children healthy. They should exercise and lead by example. TV viewing should be limited. Oily, ready-to-eat snacks should be avoided.
Other governments (the UK, the US, Japan, China) have woken up to the fact that obese children grow into unhealthy unproductive adults, with medical problems that are a burden on the national exchequer. They have begun to tackle the problem on a war footing. We have not, and this means that India may eventually be a country where the life expectancy starts to fall.
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
Sunday, May 29, 2011
no talc for prickly heat
rickly heat? Don’t try talc
Your Health
DR GITA MATHAI
A genuine “Indian summer” is upon us now with temperatures all over the country in the high thirties and forties. Earlier, Indians used to wear white cotton clothes in summer but now most prefer to dress in synthetic silks, and polyester fabrics, little realising that those clothes are totally inappropriate in this weather.
Even school children — who are issued uniforms with the material and tailoring regulated by the school — end up wearing thick synthetic clothes when ideally they should wear pure cotton or at least a 60 per cent cotton and 40 per cent polyester mix.
To survive, our bodies need to maintain an average internal temperature of 98.6ºF or 36.6ºC and it uses sweating to regulate the temperature. When the outside temperature is high, the body secretes sweat from glands situated in the layer below the skin. The sweat reaches the surface through coiled tubes and forms a thin film of fluid. As this layer evaporates, the body cools down. Sweating can be excessive when the temperature is high, there is increased physical exertion, there is little or no circulation of air and if the clothes are made of synthetic material that traps the sweat. (Nowadays many sports companies manufacture sports clothes out of special material that “wicks” away the sweat).
If sweat pores get blocked (by dead skin cells, dirt or talcum powder), the trapped sweat forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). These look unsightly but do not really cause any symptoms. Eventually, they turn red (miliria rubra), and evolve into a brown scaly rash which can be confused with pimples, folliculitis or chicken pox.
Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. The forehead is affected if it is covered with a fringe or cap. The upper back and chest, and the arms are other common locations. In adults the rash sometimes appears on the inner thighs or in areas where there are body folds. It is aggravated by friction between the skin and tight fitting non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area.
Prickly heat causes itching and a tingling sensation but scratching can cause secondary infection with bacteria. The appearance of the rash then changes and there can be a yellow pus discharge. The person may develop fever. Uninfected prickly heat, however, does not cause fever. Although prickly heat is uncomfortable and unsightly, with a little care it can be easily prevented.
• Stay away from the direct heat of the sun as far as possible
• Wear loose fitting cotton clothes or at least a 60-40 mix of cotton and polyester
• Make sure school uniforms are stitched out of natural materials, preferably thin materials
• Try to ensure that schools have fans and ventilation.
• Do not scratch. The more you scratch, the more it will itch.
• Use a mild dose of antihistamine to control itching.
• Do not apply thick oil-based creams and talc. They will only block the pores further.
• Bathe two or three times a day in tepid water. Add a teaspoon of sodium bicarbonate to a bucket of water before bathing till the prickly heat disappears.
• Use soap containing trichlorhexidine (Dial, Neko) Do not apply soap directly to the skin. Use a moist wash rag, a herbal scrubber or a loofah.
• If prickly heat becomes red and pustular, changes appearance or the temperature rises, consult a doctor immediately.
Contrary to advertisements on television, talc does not soothe, relieve or prevent prickly heat. Talc is made up of finely powdered combinations of ground zinc stearate, and silicates. It blocks the skin pores, increasing the sweat build up and aggravating prickly heat.
Talc causes other medical problems as well. The size of the particles is so small that they can easily be inhaled. The particles can reach the smallest areas of the lung and cause pneumonia, inflammation or swelling of the airways. This can be fatal in babies. If applied to the groin and genital areas, talc can migrate through the vagina, uterus, and fallopian tubes to the ovary. Some scientific studies have found a relationship between the use of talcum powder and cancer of the ovary.
Baby powder is talc based and should not be used. Nappy rash is different from prickly heat and the treatment is different too.
If you get prickly heat, bathe two to three times a day. Use plain calamine lotion (not creams and ointment) to relieve the itching. If secondary infection has occurred, consult a doctor.
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
A genuine “Indian summer” is upon us now with temperatures all over the country in the high thirties and forties. Earlier, Indians used to wear white cotton clothes in summer but now most prefer to dress in synthetic silks, and polyester fabrics, little realising that those clothes are totally inappropriate in this weather.
Even school children — who are issued uniforms with the material and tailoring regulated by the school — end up wearing thick synthetic clothes when ideally they should wear pure cotton or at least a 60 per cent cotton and 40 per cent polyester mix.
To survive, our bodies need to maintain an average internal temperature of 98.6ºF or 36.6ºC and it uses sweating to regulate the temperature. When the outside temperature is high, the body secretes sweat from glands situated in the layer below the skin. The sweat reaches the surface through coiled tubes and forms a thin film of fluid. As this layer evaporates, the body cools down. Sweating can be excessive when the temperature is high, there is increased physical exertion, there is little or no circulation of air and if the clothes are made of synthetic material that traps the sweat. (Nowadays many sports companies manufacture sports clothes out of special material that “wicks” away the sweat).
If sweat pores get blocked (by dead skin cells, dirt or talcum powder), the trapped sweat forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). These look unsightly but do not really cause any symptoms. Eventually, they turn red (miliria rubra), and evolve into a brown scaly rash which can be confused with pimples, folliculitis or chicken pox.
Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. The forehead is affected if it is covered with a fringe or cap. The upper back and chest, and the arms are other common locations. In adults the rash sometimes appears on the inner thighs or in areas where there are body folds. It is aggravated by friction between the skin and tight fitting non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area.
Prickly heat causes itching and a tingling sensation but scratching can cause secondary infection with bacteria. The appearance of the rash then changes and there can be a yellow pus discharge. The person may develop fever. Uninfected prickly heat, however, does not cause fever. Although prickly heat is uncomfortable and unsightly, with a little care it can be easily prevented.
• Stay away from the direct heat of the sun as far as possible
• Wear loose fitting cotton clothes or at least a 60-40 mix of cotton and polyester
• Make sure school uniforms are stitched out of natural materials, preferably thin materials
• Try to ensure that schools have fans and ventilation.
• Do not scratch. The more you scratch, the more it will itch.
• Use a mild dose of antihistamine to control itching.
• Do not apply thick oil-based creams and talc. They will only block the pores further.
• Bathe two or three times a day in tepid water. Add a teaspoon of sodium bicarbonate to a bucket of water before bathing till the prickly heat disappears.
• Use soap containing trichlorhexidine (Dial, Neko) Do not apply soap directly to the skin. Use a moist wash rag, a herbal scrubber or a loofah.
• If prickly heat becomes red and pustular, changes appearance or the temperature rises, consult a doctor immediately.
Contrary to advertisements on television, talc does not soothe, relieve or prevent prickly heat. Talc is made up of finely powdered combinations of ground zinc stearate, and silicates. It blocks the skin pores, increasing the sweat build up and aggravating prickly heat.
Talc causes other medical problems as well. The size of the particles is so small that they can easily be inhaled. The particles can reach the smallest areas of the lung and cause pneumonia, inflammation or swelling of the airways. This can be fatal in babies. If applied to the groin and genital areas, talc can migrate through the vagina, uterus, and fallopian tubes to the ovary. Some scientific studies have found a relationship between the use of talcum powder and cancer of the ovary.
Baby powder is talc based and should not be used. Nappy rash is different from prickly heat and the treatment is different too.
If you get prickly heat, bathe two to three times a day. Use plain calamine lotion (not creams and ointment) to relieve the itching. If secondary infection has occurred, consult a doctor.
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
Sunday, May 15, 2011
rabies
Animal bites
Your Health
DR GITA MATHAI
Dogs are man’s best friends. They may be street dogs, available for free, or expensive pedigreed animals. People from all walks of life have them at home. But dogs are also responsible for 90 per cent of rabies cases. India has around 30,000 reported deaths from this disease every year. The exact number, however, could be much higher as many cases are not diagnosed or reported.
Rabies is caused by a virus. Once it enters the body through a bite or lick from an infected animal, it travels silently along the nerves till it reaches the brain. This means that after an asymptomatic period — which can range from two weeks to two years — the person begins to experience symptoms. Initially, these are non-specific and may be mistaken for flu. There may be fever, headache and body pain. Later, there may be slight or partial paralysis with weakness of the limbs, anxiety, insomnia, confusion, agitation, terror and hallucinations. The throat muscles eventually become paralysed, making both speech and swallowing painful and later impossible. The person panics when presented with liquids to drink and cannot quench his or her thirst as the muscles go into painful spasms. Death usually occurs within two to 10 days.
It is difficult to suspect or diagnose rabies unless the person mentions the animal bite and also exhibits the classical symptoms of rabies. There is a fluorescent antibody test to demonstrate the presence of a viral antigen to confirm the diagnosis but it is available in very few centres.
Other animals like cats, monkeys, bats, rodents as well as horses and cattle too can transmit rabies. Unaware of this, in case of a bite by any of these animals, many people just apply an antiseptic solution and do not take it seriously. Human to human transmission of rabies does not occur unless a corneal or some other organ transplant has occurred from an infected donor.
House pets — dogs or cats — need to be immunised. Vaccines are available in government veterinary hospitals and private clinics. Booster injections have to be given every year as long as the animal lives. This is often not done, particularly as the animal gets older.
Children often play with stray animals. They are prone to attack but such bites are less likely to be reported. Even if it is a pet animal, a bite or scratch should be taken seriously. The pet’s immunisation may be incomplete or they may be asymptomatic carriers of the rabies virus. Also, there is a silent reservoir of infection from wild animals, which may have attacked the pet and run away unnoticed.
If scratched or bitten, the bruise must first be cleaned thoroughly with soap and water. Soap kills the viruses in the wound. Iodine — either tincture iodine or povidone (Betadine) — should then be applied. The wound should be left open. Suturing should be avoided as a closed environment allows further multiplication of the viruses.
A bite is graded according to its severity. A course of injections (immunoglobins and anti-rabies vaccine) should be started immediately. Prior to the advent of the human diploid cell and other newer vaccines, anti-rabies was injected in the abdomen around the navel. This regimen had many side effects, of which pain was the least sinister and most tolerable! In addition, bites require tetanus prophylaxis and antibiotic cover against aerobic and anaerobic bacteria, which may have infected the wound from the teeth.
A number of pharmaceutical companies market the newer vaccines. The dosage schedule is printed on the package insert and should be meticulously followed. Post-exposure prophylaxis is usually given on days 0, 3, 5, 7, 14 and 28. The injections should be administered intramuscularly in the shoulder and not the buttocks. That’s because the high fat content of the buttocks interferes with antibody production.
Pre-exposure prophylaxis (before the bite) consists of three injections on days 0, 7 and 28 with a booster every five years. It must be taken by all owners of pet dogs or cats, veterinary surgeons, laboratory workers and travellers, especially if they are going to pass through endemic areas where appropriate treatment for animal bites may not be readily available. If your children have a penchant for playing with animals, it makes sense to immunise them too.
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
Dogs are man’s best friends. They may be street dogs, available for free, or expensive pedigreed animals. People from all walks of life have them at home. But dogs are also responsible for 90 per cent of rabies cases. India has around 30,000 reported deaths from this disease every year. The exact number, however, could be much higher as many cases are not diagnosed or reported.
Rabies is caused by a virus. Once it enters the body through a bite or lick from an infected animal, it travels silently along the nerves till it reaches the brain. This means that after an asymptomatic period — which can range from two weeks to two years — the person begins to experience symptoms. Initially, these are non-specific and may be mistaken for flu. There may be fever, headache and body pain. Later, there may be slight or partial paralysis with weakness of the limbs, anxiety, insomnia, confusion, agitation, terror and hallucinations. The throat muscles eventually become paralysed, making both speech and swallowing painful and later impossible. The person panics when presented with liquids to drink and cannot quench his or her thirst as the muscles go into painful spasms. Death usually occurs within two to 10 days.
It is difficult to suspect or diagnose rabies unless the person mentions the animal bite and also exhibits the classical symptoms of rabies. There is a fluorescent antibody test to demonstrate the presence of a viral antigen to confirm the diagnosis but it is available in very few centres.
Other animals like cats, monkeys, bats, rodents as well as horses and cattle too can transmit rabies. Unaware of this, in case of a bite by any of these animals, many people just apply an antiseptic solution and do not take it seriously. Human to human transmission of rabies does not occur unless a corneal or some other organ transplant has occurred from an infected donor.
House pets — dogs or cats — need to be immunised. Vaccines are available in government veterinary hospitals and private clinics. Booster injections have to be given every year as long as the animal lives. This is often not done, particularly as the animal gets older.
Children often play with stray animals. They are prone to attack but such bites are less likely to be reported. Even if it is a pet animal, a bite or scratch should be taken seriously. The pet’s immunisation may be incomplete or they may be asymptomatic carriers of the rabies virus. Also, there is a silent reservoir of infection from wild animals, which may have attacked the pet and run away unnoticed.
If scratched or bitten, the bruise must first be cleaned thoroughly with soap and water. Soap kills the viruses in the wound. Iodine — either tincture iodine or povidone (Betadine) — should then be applied. The wound should be left open. Suturing should be avoided as a closed environment allows further multiplication of the viruses.
A bite is graded according to its severity. A course of injections (immunoglobins and anti-rabies vaccine) should be started immediately. Prior to the advent of the human diploid cell and other newer vaccines, anti-rabies was injected in the abdomen around the navel. This regimen had many side effects, of which pain was the least sinister and most tolerable! In addition, bites require tetanus prophylaxis and antibiotic cover against aerobic and anaerobic bacteria, which may have infected the wound from the teeth.
A number of pharmaceutical companies market the newer vaccines. The dosage schedule is printed on the package insert and should be meticulously followed. Post-exposure prophylaxis is usually given on days 0, 3, 5, 7, 14 and 28. The injections should be administered intramuscularly in the shoulder and not the buttocks. That’s because the high fat content of the buttocks interferes with antibody production.
Pre-exposure prophylaxis (before the bite) consists of three injections on days 0, 7 and 28 with a booster every five years. It must be taken by all owners of pet dogs or cats, veterinary surgeons, laboratory workers and travellers, especially if they are going to pass through endemic areas where appropriate treatment for animal bites may not be readily available. If your children have a penchant for playing with animals, it makes sense to immunise them too.
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, April 19, 2011
kha anna
Fast track to healthy living
Your Health
DR GITA MATHAI
Anna Hazare during his fast in New Delhi
Fasting is common in India. Hindus fast on certain days of the week, Jains after six in the evening, Muslims during the month of Ramadan and Christians during Lent. Politicians and activists have traditionally used it as a means to an end.
Some fasts involve total avoidance of all food and water. In some others, food is avoided at specific times of the day. Yet others restrict the type of food. Fasting is different from involuntary starvation due to famine or illness. Voluntary fasting isn’t advisable for people under 15, over 70, pregnant women, people involved in outdoor or heavy labour, and those suffering from illnesses. Some medicines dangerously accelerate the biochemical effects of fasting.
Any food that we eat is digested and broken down into its components — glucose, fatty acids and amino acids. Glucose is the body’s main source of energy and is required by all tissues. When the body is deprived of food, any excess glucose stored in the body is accessed and utilised to get energy. Once these stores are depleted, the body starts to break down fat and use it. This is around 7 per cent of the body weight of males and 10 per cent in females. When is used up, there is an intense craving for food. If this is still not enough, the muscles in the body start to get metabolised. The person develops a wasted and emaciated appearance.
Deprived of food and water, a healthy adult can survive about 10-12 days. With water, survival can extend to 50-60 days. Children and the elderly succumb more rapidly. Women and obese individuals (both sexes) are able to withstand starvation better as they have more body fat reserves. Extremes of temperature (heat or cold) accelerate the ill effects of starvation.
Stopping food and water abruptly causes changes of “acute starvation” in the body within 24 hours. Thirst and hunger pains set in. The mouth gets parched, the saliva thickens and the urine is high coloured and scanty. After 48 hours, the voice becomes feeble, the pulse weakens, the temperature drops and dehydration sets in. As the days pass by, the blood pressure and temperature drop, the hair and nails become brittle, the eyes sink and the pupils dilate. Constipation is usual, but diarrhoea may occur. The intellect can remain clear and unclouded, but delirium and convulsions may precede death.
The medical complications associated with prolonged fasting are electrolyte imbalances, cardiac arrhythmia and kidney failure. Death can occur if fasting is pursued to the point of complete starvation.
Some medical tests have to be done upon “fasting” or on an “empty stomach”. There is often ambiguity and confusion between these two terms. Medically, fasting usually means an overnight fast of eight to 12 hours. That’s because metabolic adjustments occur in the body during fasting. The normal values of the results of some tests like lipid profile and sugar tests are standardised for fasting conditions. “On an empty stomach” typically means three to five hours after a meal, when the meal has left the stomach and digestion is complete.
Extended, intermittent, regular fasting has been recommended from the ancient times to preserve health. Today we know fasting improves the blood lipid profile and reduces total cholesterol. Research done on human volunteers at the US National Institute on Aging suggests that fasting every alternate day offers major health benefits. The cumulative calorific restriction reduces the risk of cancer, cardiovascular diseases, diabetes, insulin resistance and immune disorders. It also actually slows the aging process, and seems to have the potential to increase the life span. People do tend to lose weight with alternate day fasting, but on the negative side they tend to be irritable on the fasting day. Also, repeated fasts can result in the body going into a “conserve mode” and the metabolism slowing down to conserve energy. There will be no weight loss despite repeated intermittent fasting.
It is possible to “starve in the midst of plenty”. This occurs in diabetics who are unable to utilise the food they eat. In some others, the food may be unhealthy (just fat and sugar) and lacking essential proteins, vitamins and minerals.
Teenagers may resort to excessive fasting to prevent obesity. This can result in mental changes and anorexia nervosa.
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
Anna Hazare during his fast in New Delhi
Fasting is common in India. Hindus fast on certain days of the week, Jains after six in the evening, Muslims during the month of Ramadan and Christians during Lent. Politicians and activists have traditionally used it as a means to an end.
Some fasts involve total avoidance of all food and water. In some others, food is avoided at specific times of the day. Yet others restrict the type of food. Fasting is different from involuntary starvation due to famine or illness. Voluntary fasting isn’t advisable for people under 15, over 70, pregnant women, people involved in outdoor or heavy labour, and those suffering from illnesses. Some medicines dangerously accelerate the biochemical effects of fasting.
Any food that we eat is digested and broken down into its components — glucose, fatty acids and amino acids. Glucose is the body’s main source of energy and is required by all tissues. When the body is deprived of food, any excess glucose stored in the body is accessed and utilised to get energy. Once these stores are depleted, the body starts to break down fat and use it. This is around 7 per cent of the body weight of males and 10 per cent in females. When is used up, there is an intense craving for food. If this is still not enough, the muscles in the body start to get metabolised. The person develops a wasted and emaciated appearance.
Deprived of food and water, a healthy adult can survive about 10-12 days. With water, survival can extend to 50-60 days. Children and the elderly succumb more rapidly. Women and obese individuals (both sexes) are able to withstand starvation better as they have more body fat reserves. Extremes of temperature (heat or cold) accelerate the ill effects of starvation.
Stopping food and water abruptly causes changes of “acute starvation” in the body within 24 hours. Thirst and hunger pains set in. The mouth gets parched, the saliva thickens and the urine is high coloured and scanty. After 48 hours, the voice becomes feeble, the pulse weakens, the temperature drops and dehydration sets in. As the days pass by, the blood pressure and temperature drop, the hair and nails become brittle, the eyes sink and the pupils dilate. Constipation is usual, but diarrhoea may occur. The intellect can remain clear and unclouded, but delirium and convulsions may precede death.
The medical complications associated with prolonged fasting are electrolyte imbalances, cardiac arrhythmia and kidney failure. Death can occur if fasting is pursued to the point of complete starvation.
Some medical tests have to be done upon “fasting” or on an “empty stomach”. There is often ambiguity and confusion between these two terms. Medically, fasting usually means an overnight fast of eight to 12 hours. That’s because metabolic adjustments occur in the body during fasting. The normal values of the results of some tests like lipid profile and sugar tests are standardised for fasting conditions. “On an empty stomach” typically means three to five hours after a meal, when the meal has left the stomach and digestion is complete.
Extended, intermittent, regular fasting has been recommended from the ancient times to preserve health. Today we know fasting improves the blood lipid profile and reduces total cholesterol. Research done on human volunteers at the US National Institute on Aging suggests that fasting every alternate day offers major health benefits. The cumulative calorific restriction reduces the risk of cancer, cardiovascular diseases, diabetes, insulin resistance and immune disorders. It also actually slows the aging process, and seems to have the potential to increase the life span. People do tend to lose weight with alternate day fasting, but on the negative side they tend to be irritable on the fasting day. Also, repeated fasts can result in the body going into a “conserve mode” and the metabolism slowing down to conserve energy. There will be no weight loss despite repeated intermittent fasting.
It is possible to “starve in the midst of plenty”. This occurs in diabetics who are unable to utilise the food they eat. In some others, the food may be unhealthy (just fat and sugar) and lacking essential proteins, vitamins and minerals.
Teenagers may resort to excessive fasting to prevent obesity. This can result in mental changes and anorexia nervosa.
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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