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
Wednesday, September 21, 2011
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
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