“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
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