Help, I can’t breathe…
Your Health
DR GITA MATHAI
More and more people today are complaining thus, be it summer, monsoon or winter. And it’s not surprising ; the global incidence of asthma is steadily rising. In India, between 5 and 25 per cent of the population is affected. The wide variation is because statistics are difficult to come by. There is very little unbiased documentation about the true incidence of asthma using instruments and lung function tests.
Asthma — now called reactive airways disease — tends to run in families prone to allergy. Some members wheeze, some sneeze while others may have itchy, red skin lesions. Wheezing may be present all the year round with varying degrees of severity. Attacks may also come and go, precipitated by cigarette smoke, chemicals in the air (mosquito repellents, room fresheners), infections (particularly viral), medication (aspirin, ibubrufen) or food additives (dyes, preservatives), with symptom-free intervals.
Air enters the body through the main air vessels — the bronchi, which branch out into the lungs as bronchioles. If they are irritated, they secrete mucous which narrows them. In normal people, the bronchioles relax when this occurs so a slight cough expels the obstructing plugs of mucous. In allergic people, the bronchioles constrict further, trapping the mucous and causing a feeling of suffocation.
Symptoms usually start with a tight feeling around the chest and a cough. But there is no sputum, the cough is ineffective and fails to relieve the feeling of breathlessness and suffocation. More severe, hacking and ineffective cough then sets in.
Doctors do not like to tell a patient or a parent that there is “wheezing” — the latter tend to equate it with asthma and fear chronic lifetime debility. Others confuse it with tuberculosis or primary complex. Neither is true. Wheezing is treatable and the person can lead a normal life.
The mainstay of treatment is bronchodilators, which open up the narrowed bronchi. If a direct delivery system is used, the drug goes straight into the lungs. Nebulisers, inhalers and rotahalors are freely available and efficient. Nebulisers require electricity to work and are not portable. Inhalers and rotahalors can be carried around. Inhalers, unlike rotahalors, require a certain amount of breathing co-ordination to be affective. In young children and the elderly, they become efficient only when combined with a spacer and facemask.
For an acute attack, salbutamol is usually sufficient. If there are repeated attacks, interfering with sleep at night, long-term treatment is needed. There are long-acting medications like salmeterol. When delivered to the lungs, it opens up the airways. This must be combined with a steroid like fluticosone. It prevents the local inflammatory reaction, decreases mucous secretion and helps keep the airways open.
Tablets and syrups do work eventually to control wheezing. They need to reach the stomach, get absorbed, reach the blood and eventually the lungs. They are more likely to produce side effects like nausea, vomiting and tremors. The onset of action is also slow.
Some lifestyle modifications may help to control the disease. Obesity contributes to the severity and frequency of attacks. The “pot belly” reduces the capacity of the lungs, as it tends to push them upwards. The BMI (body mass index) — weight divided by the height in metre squared — must be as close to 23 as possible.
Aerobic exercises like fast walking, jogging, swimming, skipping or stair climbing improve lung function and capacity.
Avoid known allergens that are likely to precipitate attacks. It may be airborne chemicals, like those in mosquito mats, coils and liquids. These should not be used anywhere in the house, as the smoke tends to permeate easily. Some allergens may be present in food or medication. If an attack seems to be precipitated by ingestion of a particular substance, it’s better to avoid it than search for a cure. Desensitisation is offered in some clinics but it’s a laborious and expensive process.
Stop smoking and as far as possible stay away from smokers.
People with reactive airways have poor breathing technique. This can be improved with exercises taught by physiotherapists and yoga teachers. Videos are available on the Internet. Proper breathing techniques go a long way towards improving lung capacity and reducing the duration, frequency and severity of attacks.
Hand-held devices called spirometers are available to measure the amount of air you breathe in and out. These are inexpensive. By documenting the readings daily, it is possible to anticipate an attack and take prophylactic action.
Always use the nebuliser, inhaler or rotahalor as directed. Sometimes a single dose at night may prevent lung damage and keep the lung capacity at a satisfactory level.
Monday, February 28, 2011
Monday, February 14, 2011
control BP live longer
Lower your BP, live longer
Your Health
DR GITA MATHAI
In western countries, the number of people affected by high blood pressure (BP) or hypertension is decreasing. In India, however, the figure is creeping up, albeit marginally (2-3 per cent). This is worrying because, untreated, hypertension may result in complications like a heart attack, heart or kidney failure, tearing of the blood vessels and loss of vision. It can also cause subtle loss of memory and the ability to think clearly.
BP indicates the force with which the heart pumps blood against the blood vessel. It has two values — an upper or systolic and a lower or diastolic. Values of 120/80 are normal, while 139/89 indicates pre-hypertension and 140/90 or above hypertension. With age, the blood vessels tend to harden, decreasing their pliability. This causes a peculiar type of hypertension where only the upper value is high. About 70 per cent of the population over the age of 60 has this type of systolic hypertension. BP should be measured every two years after the age of 20 and yearly after 40.
The risk of hypertension increases with age, obesity, a family history of high BP, kidney diseases, diabetes, endocrine diseases, smoking, alcohol consumption, medications like corticosteroids, birth control pills or those for losing weight. Narrow abnormally placed blood vessels present from birth can also lead to high BP. If no cause can be detected, it’s called “essential hypertension” and requires medication to prevent complications. Even isolated systolic hypertension requires treatment.
BP is linked to salt intake. A high salt intake results in elevated BP. The effect is even more pronounced in people (around 20 per cent of the population) who are “salt sensitive”.
The recommended salt intake for a normal person is 5gm or 1 teaspoon a day. But the “hidden salt” must also be considered. All food and even drinking water contains varying amounts of natural salt. Sodium (a component of salt) is added to food products in the form of monosodium glutamate, sodium nitrite, sodium saccharin, baking soda (sodium bicarbonate) or sodium benzoate. These are ingredients in condiments and seasonings like tomato sauce, soy sauce and pickles. Processed meats such as bacon, sausage and ham, and fast foods like burgers and pizzas are high in sodium content.
Medications belonging to groups such as diuretics, alpha blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers and rennin inhibitors are available to control blood pressure. The pharmaceutical industry also introduces “new and improved” drugs in the market with monotonous regularity. Control remains unsatisfactory in many patients who are then dosed with two or more anti hypertensives. The older, long-acting diuretics, surprisingly, remain one of the most effective medications, either as an adjuvant to existing medicine or alone.
Better control of BP with lower doses of medication can often be achieved if the person is willing to make certain lifestyle changes. Weight needs to be ideal. As weight increases, so does the pressure on your artery walls. To calculate your ideal body weight, multiply your height in meter squared by 23.
Inactive people have a faster heart rate, forcing the heart to work harder for longer periods of time. Aerobic exercise like walking, jogging, swimming or running needs to be done daily. It should be started at the age of around six with 20 minutes of running. Gradually this should be increased to an hour by the age of 18 years.
Smoking (even second-hand smoke), using snuff or chewing tobacco releases chemicals into the body which damage the blood vessels, making them narrow and thus increasing the BP.
Salt makes the body retain fluid, which in turn increases the BP. Limit your intake to 5gm a day. Sodium can be balanced by potassium found in fresh fruits and vegetables. Eat four to six helpings of this a day.
Vitamin D obtained through the diet and by exposure to sunlight affects the levels of a BP-regulating enzyme in the kidneys. Inadequate levels can indirectly elevate the BP.
Heavy drinking can cause permanent heart damage. Even two or three drinks in a single sitting can cause the release of chemicals that temporarily elevate the BP.
Stress can elevate the BP. It needs to tackled with meditation and yoga. Chronic diseases like diabetes, high cholesterol, kidney disease and sleep apnoea need to be controlled as they contribute to the risk of high BP.
Children too are at risk from as early as six or eight years if they are obese, inactive and eat high sodium snacks. These lifestyle changes, therefore, need to be initiated from a young age.
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
In western countries, the number of people affected by high blood pressure (BP) or hypertension is decreasing. In India, however, the figure is creeping up, albeit marginally (2-3 per cent). This is worrying because, untreated, hypertension may result in complications like a heart attack, heart or kidney failure, tearing of the blood vessels and loss of vision. It can also cause subtle loss of memory and the ability to think clearly.
BP indicates the force with which the heart pumps blood against the blood vessel. It has two values — an upper or systolic and a lower or diastolic. Values of 120/80 are normal, while 139/89 indicates pre-hypertension and 140/90 or above hypertension. With age, the blood vessels tend to harden, decreasing their pliability. This causes a peculiar type of hypertension where only the upper value is high. About 70 per cent of the population over the age of 60 has this type of systolic hypertension. BP should be measured every two years after the age of 20 and yearly after 40.
The risk of hypertension increases with age, obesity, a family history of high BP, kidney diseases, diabetes, endocrine diseases, smoking, alcohol consumption, medications like corticosteroids, birth control pills or those for losing weight. Narrow abnormally placed blood vessels present from birth can also lead to high BP. If no cause can be detected, it’s called “essential hypertension” and requires medication to prevent complications. Even isolated systolic hypertension requires treatment.
BP is linked to salt intake. A high salt intake results in elevated BP. The effect is even more pronounced in people (around 20 per cent of the population) who are “salt sensitive”.
The recommended salt intake for a normal person is 5gm or 1 teaspoon a day. But the “hidden salt” must also be considered. All food and even drinking water contains varying amounts of natural salt. Sodium (a component of salt) is added to food products in the form of monosodium glutamate, sodium nitrite, sodium saccharin, baking soda (sodium bicarbonate) or sodium benzoate. These are ingredients in condiments and seasonings like tomato sauce, soy sauce and pickles. Processed meats such as bacon, sausage and ham, and fast foods like burgers and pizzas are high in sodium content.
Medications belonging to groups such as diuretics, alpha blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers and rennin inhibitors are available to control blood pressure. The pharmaceutical industry also introduces “new and improved” drugs in the market with monotonous regularity. Control remains unsatisfactory in many patients who are then dosed with two or more anti hypertensives. The older, long-acting diuretics, surprisingly, remain one of the most effective medications, either as an adjuvant to existing medicine or alone.
Better control of BP with lower doses of medication can often be achieved if the person is willing to make certain lifestyle changes. Weight needs to be ideal. As weight increases, so does the pressure on your artery walls. To calculate your ideal body weight, multiply your height in meter squared by 23.
Inactive people have a faster heart rate, forcing the heart to work harder for longer periods of time. Aerobic exercise like walking, jogging, swimming or running needs to be done daily. It should be started at the age of around six with 20 minutes of running. Gradually this should be increased to an hour by the age of 18 years.
Smoking (even second-hand smoke), using snuff or chewing tobacco releases chemicals into the body which damage the blood vessels, making them narrow and thus increasing the BP.
Salt makes the body retain fluid, which in turn increases the BP. Limit your intake to 5gm a day. Sodium can be balanced by potassium found in fresh fruits and vegetables. Eat four to six helpings of this a day.
Vitamin D obtained through the diet and by exposure to sunlight affects the levels of a BP-regulating enzyme in the kidneys. Inadequate levels can indirectly elevate the BP.
Heavy drinking can cause permanent heart damage. Even two or three drinks in a single sitting can cause the release of chemicals that temporarily elevate the BP.
Stress can elevate the BP. It needs to tackled with meditation and yoga. Chronic diseases like diabetes, high cholesterol, kidney disease and sleep apnoea need to be controlled as they contribute to the risk of high BP.
Children too are at risk from as early as six or eight years if they are obese, inactive and eat high sodium snacks. These lifestyle changes, therefore, need to be initiated from a young age.
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, February 10, 2011
facts about the nose
Nose job
YOUR HEALTH
DR GITA MATHAI
To most people a nose is just an organ in the centre of our face. It may be straight and aquiline (enhancing perceptions of classical beauty), snub or button-shaped, flat or crooked. Some of us do not like the way our nose is structured and try to change its appearance. Elderly relatives may pull a baby’s nose several times a day in an attempt to make it grow longer. Others may grab a wallet and head to the nearest plastic surgeon for a “nose job” (rhinoplasy).
Whatever the shape, the nose warms and humidifies the air that enters our body. It is lined with fine hair that prevents dust from going into the lungs. This acts as a first line of defence against viral and bacterial infections. On contact with an organism or a noxious chemical, it secretes fluid that washes out the offending material (causing a dripping nose).
Sometimes violent sneezing is triggered which expels these substances far away from the body.
Until the age of 18 years, the nose grows and changes in shape and size. As we get older, the nasal cartilage loses its elasticity. This causes the tip of the nose to lengthen and droop. This makes the nose appear larger in older people.
The nose enables us to smell. This helps us identify substances and distinguish between pleasant harmless odours and noxious harmful ones. Like other animals, man once had a keenly developed sense of smell. This helped him identify potentially dangerous animals as well as warring strangers from other regions and tribes. We adults have lost this ability with evolution. However, smell is the best developed of all the five senses in a baby. Infants can distinguish between their mothers, other lactating women and strangers.
The sense of smell contributes to the taste of our food. People suffering from anosmia, or loss of the sense of smell, do not find food palatable. This causes them to lose weight. Anosmia may be a temporary phenomenon when the nose is blocked as a result of a cold. It may occur when the “smell centre” in the brain is damaged, or if the person has Parkinson’s disease. Attempts to relieve a blocked nose with repeated use of nasal sprays can damage the lining of the nose sufficiently to cause a permanent loss of smell.
Some people tend to pick their noses using their fingers. This is an unsavoury, socially unacceptable habit. It may also result in damage to the lining of the nose and bleeding. Constant trauma to the nostrils can cause infection of the hair follicles in the nose. This can result in fever, swelling and pus formation.
A pierced nose is perceived to enhance the beauty of a woman. It is a common practice in India from ancient times and was believed to ease the pains of childbirth. The area that should be pierced is just below the cartilage. If the nose cartilage is accidentally pierced instead, serious complications like bleeding, infection and permanent deformity can occur. Even otherwise, infection, redness, swelling and scar formation may occur.
The jewellery used may cause problems. It may come loose and be accidentally swallowed. The back of the stud can become embedded in the skin, or nose rings can get caught in clothing and violently pulled out. Also, once you have pierced your nose, even if you change your mind and decide against jewellery, there will always be a little hole.
About 60 per cent of people experience nose bleed (epistaxis) at some time in their lives. It occurs most often under the age of 10 and over the age of 60 years. This is usually due to a local problem in the nose like a cold, nose picking, a foreign body, irritants like cigarette smoke, or an injury. Less often it may be due to a systemic disease like high blood pressure or clotting disorders like haemophilia. It can also occur owing to blood thinning medicines such as aspirin, clopidogrel, heparin or warfarin. The patient may have purchased medicines over the counter, or may be taking non-allopathic drugs and may be unaware of their side effects.
Most nosebleeds can be tackled at home:
Make the person sit up. This prevents blood from filling up in the throat and choking the person
Pinch the nostrils firmly and maintain steady pressure for 10 minutes
Instill a decongestant nasal spray containing oxymetazoline (Nasivion or Otrivin).
Most nosebleeds are harmless. Very rarely, they can be fatal. You need to seek medical help if the bleeding has lasted for more than 20 minutes, or if it followed a fall, a blow to the head or an accident.
Recurrent nosebleeds with no identifiable or correctable cause need to be tackled by an ENT surgeon.
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
To most people a nose is just an organ in the centre of our face. It may be straight and aquiline (enhancing perceptions of classical beauty), snub or button-shaped, flat or crooked. Some of us do not like the way our nose is structured and try to change its appearance. Elderly relatives may pull a baby’s nose several times a day in an attempt to make it grow longer. Others may grab a wallet and head to the nearest plastic surgeon for a “nose job” (rhinoplasy).
Whatever the shape, the nose warms and humidifies the air that enters our body. It is lined with fine hair that prevents dust from going into the lungs. This acts as a first line of defence against viral and bacterial infections. On contact with an organism or a noxious chemical, it secretes fluid that washes out the offending material (causing a dripping nose).
Sometimes violent sneezing is triggered which expels these substances far away from the body.
Until the age of 18 years, the nose grows and changes in shape and size. As we get older, the nasal cartilage loses its elasticity. This causes the tip of the nose to lengthen and droop. This makes the nose appear larger in older people.
The nose enables us to smell. This helps us identify substances and distinguish between pleasant harmless odours and noxious harmful ones. Like other animals, man once had a keenly developed sense of smell. This helped him identify potentially dangerous animals as well as warring strangers from other regions and tribes. We adults have lost this ability with evolution. However, smell is the best developed of all the five senses in a baby. Infants can distinguish between their mothers, other lactating women and strangers.
The sense of smell contributes to the taste of our food. People suffering from anosmia, or loss of the sense of smell, do not find food palatable. This causes them to lose weight. Anosmia may be a temporary phenomenon when the nose is blocked as a result of a cold. It may occur when the “smell centre” in the brain is damaged, or if the person has Parkinson’s disease. Attempts to relieve a blocked nose with repeated use of nasal sprays can damage the lining of the nose sufficiently to cause a permanent loss of smell.
Some people tend to pick their noses using their fingers. This is an unsavoury, socially unacceptable habit. It may also result in damage to the lining of the nose and bleeding. Constant trauma to the nostrils can cause infection of the hair follicles in the nose. This can result in fever, swelling and pus formation.
A pierced nose is perceived to enhance the beauty of a woman. It is a common practice in India from ancient times and was believed to ease the pains of childbirth. The area that should be pierced is just below the cartilage. If the nose cartilage is accidentally pierced instead, serious complications like bleeding, infection and permanent deformity can occur. Even otherwise, infection, redness, swelling and scar formation may occur.
The jewellery used may cause problems. It may come loose and be accidentally swallowed. The back of the stud can become embedded in the skin, or nose rings can get caught in clothing and violently pulled out. Also, once you have pierced your nose, even if you change your mind and decide against jewellery, there will always be a little hole.
About 60 per cent of people experience nose bleed (epistaxis) at some time in their lives. It occurs most often under the age of 10 and over the age of 60 years. This is usually due to a local problem in the nose like a cold, nose picking, a foreign body, irritants like cigarette smoke, or an injury. Less often it may be due to a systemic disease like high blood pressure or clotting disorders like haemophilia. It can also occur owing to blood thinning medicines such as aspirin, clopidogrel, heparin or warfarin. The patient may have purchased medicines over the counter, or may be taking non-allopathic drugs and may be unaware of their side effects.
Most nosebleeds can be tackled at home:
Make the person sit up. This prevents blood from filling up in the throat and choking the person
Pinch the nostrils firmly and maintain steady pressure for 10 minutes
Instill a decongestant nasal spray containing oxymetazoline (Nasivion or Otrivin).
Most nosebleeds are harmless. Very rarely, they can be fatal. You need to seek medical help if the bleeding has lasted for more than 20 minutes, or if it followed a fall, a blow to the head or an accident.
Recurrent nosebleeds with no identifiable or correctable cause need to be tackled by an ENT surgeon.
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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