mouth ulcers

mouthful of pain Your Health DR GITA MATHAI At any given time, 20 per cent of the population is suffering from one or more mouth ulcers (aphthous ulcers). These can develop inside the cheeks, tongue, on the roof of the mouth or the inside of the lips. They may be one or many, small or large. Usually such ulcers are less than 10mm in size and three in number. There may be also be enlarged painful lymph nodes below the jaw. The mucosa in the mouth is abundantly supplied with nerves so mouth ulcers are extremely painful. Contact of hot or spicy food increases the pain so those suffering from mouth ulcers are often unable to eat. Unfortunately, no clear single cause for the ulcers has been identified. Children can develop mouth ulcers due to a viral infection, teething, fungus or an injury. In some adults, ulcers may start after a swollen area in the mouth is inadvertently bitten. Usually, around adolescence, ulcers start to “just appear” several times a year, spontaneously and mysteriously. Women are more likely to suffer from such ulcers. Stress, illness, antibiotic use and general debility may also precipitate mouth ulcers. The viruses implicated in mouth ulcers are Herpes, Coxsackie, Cytomegalovirus and Hepatitis C . The Herpes virus tends to produce multiple ulcers. Adults with herpetic ulcers may be diabetic, immunocompromised, or have cancer. These ulcers respond well to antiviral medication. Fungal infection with candida (monilia) produces a red sore mouth and cheeks with white curd-like patches. If the patches are scrubbed clean, a raw red surface is seen. Children who use feeding bottles usually suffer from such an infection, even if the nipple is apparently sterilised adequately. Those who use pacifiers are even more prone to it. Such a child finds it difficult to swallow and may lose interest in feeding. In adults, monilial infection can occur with uncontrolled diabetes, prolonged antibiotic use, cancer and its treatment. It is one of the markers for HIV infection. Constant trauma to the mucosa of the mouth can also cause ulcers. This may be due to abrasive, poorly aligned dentures or broken irregular teeth with rough and jagged edges. Failure to brush the teeth morning and evening causes build up of hard yellow plaque on the inside of the teeth near the gums. Once this has occurred, vigorous brushing no longer removes the tartar. Bacteria are able to gain a foothold in the crevices resulting in recurrent mouth ulcers with accompanying bad breath. Food, particularly fast food, is often coloured with red or yellow dyes. These are often contaminated, substandard and non-food grade. They can cause contact allergy, damage to the mucosa as well as ulcers. Smoking as well as chewing tobacco, paan, gutka, supari and Pan Parag (all of them are toxic) can damage the lining of the mouth. Continuous use can cause loss of pigmentation (leukplakia), visible as white patches on the inside of the mouth. This condition can be precancerous. It needs a diagnostic biopsy, expert evaluation and follow up. Illnesses like ulcerative colitis and SLE (Systemic lupus erythematosus, a long-term autoimmune disorder) affect the immune system of the body and can produce chronic mouth ulcers. Deficiency of iron, zinc and the B group of vitamins can cause a red sore mouth with a smooth tongue and fissured lips. The mucosa becomes thin and delicate. It is easily traumatised producing ulcers. The response to treatment is difficult to assess as ulcers spontaneously disappear in 2-3 weeks even if untreated and do not scar. Ulcer treatment Sucking on an ice cube before eating numbs the pain. Local anaesthetic ointments dull the pain. Mix equal quantities of antacid and benedryl syrup and swirl it in the mouth several times a day. Steroids (if prescribed) can be applied locally (They will aggravate ulcers due to infections). Ulcers due to the herpes virus respond to a short course of antiviral medication. Any ulcer in the mouth which does not heal after two weeks of treatment needs a biopsy to rule out cancer. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

cigarettes the cancer sticks

In the Sixties and Seventies, puffing on what we now call the cancer stick was considered sophisticated by adults and “cool” by the younger generation. Movie stars, politicians, doctors, academics — they all smoked. My professors in medical college disappeared into the canteen at 10 am every day for a smoke and a coffee.

Forty years have gone by. One professor has developed lung cancer and another has succumbed to it. The world has belatedly woken up to tobacco addiction in its myriad forms (puffs, chews or snuff). The Indian government has passed a few laws but not only is it too little too late, the enforcement too is rather lax.

We know the effects of addictive drugs such as cannabis and heroin. They have been banned. If the tobacco industry had not managed to conceal the dangerous and addictive nature of tobacco for so many years, it too would have joined the list of banned drugs.

Tobacco grows in India, has always been freely available and its use is widespread, often starting in the teenage years. Males tend to smoke cigarettes or beedis while women seem to prefer chewing tobacco, gutka or snuff. Some female addicts begin their day by brushing their teeth with tobacco and then placing a wad of it in a corner of the mouth. Social acceptance has resulted in more young urban women openly smoking.

Tobacco use varies from state to state. In India 30-50 per cent of males and 20-30 per cent of females above the age of 15 use tobacco regularly. Many more, particularly children, are affected by exhaled second hand smoke.

There are more than 4,000 chemicals in tobacco, most of which are harmful. The main constituent is nicotine, which immediately makes the heart beat faster and pushes up the blood pressure. It crosses over into the brain where it affects certain chemicals. There is a pleasurable feeling of relaxation and reduction of tension and stress. As the nicotine is cleared from the blood stream, the tension and stress return, producing a craving for “another fix”. As the body enzymes become more efficient at removing this poison, the cravings return at shorter intervals. The consumption of tobacco perceptibly increases. Other harmful chemicals in tobacco are ammonia, acetone, cadmium, vinyl chloride, naphthalene and carbon monoxide. In short, imagine eating or inhaling smoke from a burning concoction of paper, moth balls, old batteries, toilet cleaner and nail polish remover!

Smoking causes long term changes in the lung tissue. Their function and air exchange is compromised with perpetual breathlessness, chronic obstructive airways disease and emphysema. Smoking or inhaling second hand smoke causes 90 per cent of lung cancers. It is responsible for 1.4 million deaths annually worldwide.

The chemicals in tobacco affect every organ in the body. Cancers can occur in the oral cavity, pharynx, larynx, oesophagus, pancreas, stomach, urinary tract, and blood (acute myeloid leukaemia).

Even if cancer does not develop, the teeth become yellow, plaque ridden, loosened from the sockets and may eventually fall out. Conversation becomes difficult because of halitosis (bad breath). The bones weaken, leading to early osteoporosis. The body metabolism changes, precipitating glucose intolerance and eventually diabetes. Atherosclerotic plaques build up in the blood vessels, leading to heart disease, paralysis, stroke and vascular disease. Blocks develop in the peripheral blood vessels. Walking becomes painful. Numbness, burning and tingling in the limbs interferes with sleep.

The IQ (intelligence quotient) falls with tobacco use and cognitive skills decline. This places users at risk for early dementia and Alzheimer’s.

Women who use tobacco tend to be less fertile, have smaller babies, weaker bones and reach menopause two to three years earlier. They also tend to have small babies who may develop Attention deficit -hyperactivity disorder (ADHD). They may have supernumery or less than five digits. Fingers and toes may be stuck together.

Tobacco use shortens the life span considerably. The death rate from related causes is 60 per cent higher in both sexes between the ages of 30 and 70.

The bad news is that addiction gets established within a year. By that time, the brain receptors change. The craving for nicotine may be present lifelong.

The good news is that you can stop and reverse many harmful body changes. No matter what your age, it’s high time you said bye to that stick.

Time to stop

• You can do it on your own—the mind is a very powerful tool.
• Set a date and stick to it.
• Avoid areas and friends who use tobacco.
• The government as well as private organisations run programmes to help de-addiction.
• Cravings can be reduced with nicotine patches and aversion produced by some medication.
• Regular aerobic exercise (running, walking, swimming or cycling), and yoga, improve fitness and lung capacity and reverse the negative effects.

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

hair loss and gain

Hair today, gone tomorrow

Your Health DR GITA MATHAI

Everyone would like a full head of hair, and, when it begins to fall at an alarming rate, anxiety and consternation set in. Hair loss appears to be a common problem, and its treatment a lucrative business, if the number of advertisements for oils, shampoos and revitalising products are to be believed. Hair growth and loss has its own natural cycle. Scalp hair grows about half an inch a month during a long growing phase that lasts from two to six years. This is followed by a resting phase that lasts two to three months. At the end of the resting stage, the hair is shed. Losing 75-100 hairs a day is normal. At any given time, 10 per cent of hair is in the resting and 80-90 per cent in the growing phase. After hair is shed, a new hair grows from the same follicle, starting the cycle once more. As people age, their rate of hair growth slows. Some of the hair follicles die and the number of follicles shows a gradual decline. If the loss is greater than 150 hairs per day, there is a pathological process affecting the normal hair renewal process. This needs medical evaluation. The affected person alone may be sensitive to his or her hair loss. It may be within the normal spectrum and may not be taken seriously by the doctor. Also, 50 per cent of hair needs to fall before it becomes obvious to the doctor. Hair loss may be due to dietary factors with sub-clinical malnutrition. This may be the result of fad or crash diets, with an accompanying deficiency of proteins, vitamins and minerals, particularly iron and zinc. Hormonal imbalances cause increased hair loss, with the hair also becoming thin, brittle and lacklustre. The hormonal balance can go awry because of malfunction of any of the endocrine glands. Thyroid hormones are notorious for this. Androgens (male hormones) cause male pattern baldness. If a women has excess androgens for any reason, she tends to become bald. The female to male hormone ratio can be altered as part of the natural changes at menarche, pregnancy, lactation and menopause. The predisposition to lose hair after a certain age is genetically transmitted in families. It usually affects males, but females can also start going bald. Hair loss can occur in well-defined, circular patches. Expert evaluation is required to rule out conditions likealopecia areata. Local treatment can initially reverse the process. One it progresses to alopecia totalis (loss of all hair) treatment is not very successful. Hair loss may be may be due to “hair pulling” or trichotillomania where people, particularly children, twist and pull out their own hair, eyebrows, or lashes. It is a habit precipitated by psychological and social stress. There is spontaneous improvement with psychiatric help if the stress factors are removed. Chemotherapy causes reversible hair loss. Radiation injury and surgical scars cause permanent hair loss. Medical treatments are available to reverse hair loss. Applications of minoxidil solution (two per cent in women and 5 per cent in men) to the scalp twice a day results in improvement in about six months. Once the application is discontinued, the new hair falls out within a few weeks. Finasteride, when taken regularly, blocks the formation of the active male hormones in the hair follicle and causes hair growth in men. It cannot be used in women. Hair transplantation is a plastic surgery procedure which can be used in men and women and provides permanent hair replacement. It involves moving hair from donor sites to recipient sites with simultaneous removal of the bald skin. For proper care and maintenance of normal hair a few tips need to be followed. • Mix half kg coconut oil, half kg sesame oil and 100ml castor oil. Boil the mixture after adding a bunch of curry leaves, a clove and 20 peppercorns. If you need to darken the hair, mix in henna leaves or powder and petals of red hibiscus. Massage this oil into the hair twice a week using the tips of fingers (not nails). Vigorous massage may break the hair at the roots • Use only half a teaspoon shampoo to wash hair. Apply shampoo on the hair shaft and not the scalp.  • Blow-drying damages hair. If a dryer has to be used, cover the head with a towel and allow the air to heat the towel instead of applying it directly to the hair • Heat and chemical treatments for curling or straightening hair eventually damage it. Crinkling and curling can be safely done at home by plaiting wet hair tightly and leaving it overnight Dr Gita Mathai is a paediatrician with a family practice at Vellore. Question

monsoon fevers

That feverish feeling Your Health DR GITA MATHAI The monsoon may be over but it has left behind the rash of mysterious illnesses it brought with it. All across the country, people are still suffering from high fever, rashes and head and body ache — but the causes are different. There have been deaths from dengue, encephalitis (brain fever) and malaria. While not fatal, chickungunya, influenza, jaundice and typhoid too are making their presence felt. If someone you know “feels sick and feverish”, don’t panic. Get a digital thermometer and check the temperature. Body temperature varies, depending on age, physical activity and time of day. An early morning temperature higher than 37.2°C (>98.9°F) or a late afternoon temperature higher than 37.7°C (>99.9°F) is considered fever. There has been an upsurge in the number of dengue cases this year with reports of fatalities. Four distinct types of viruses cause dengue. So just because you had it once doesn’t mean you are immune. Dengue starts with high fever, red rash, headache, painful blood shot eyes, and severe backache. The fever subsides on its own after 3-4 days, only to return with a vengeance a few days later. The dangerous dengue haemorrhagic fever is caused by two or more sequential infections of different types. The fever is followed by bleeding, falling blood pressure, circulatory collapse and shock. The diagnosis of dengue is confirmed by enzyme linked immunoassay (Elisa) and haemagglutination blood tests. There is no specific treatment or immunisation. Symptomatic treatment with paracetamol helps. If there is bleeding or a falling platelet count, blood transfusions may be required. Malaria sets in with headache, high temperature and diarrhoea. The fever returns every alternate or third day with shivering and sweating. It is diagnosed by checking blood smears. Medication is curative. It is important that treatment be given as soon as possible. Chickungunya sets in suddenly with high fever, red rashes, muscle aches and excruciating pain in the small joints of the hands and feet. Once the fever subsides, the joint pain remains for around 10-15 days in the young, 1-2 months in the middle-aged and 3-6 months or even up to five years in older people. There is no specific curative treatment. Colds occur several times a year, usually when the weather changes. It causes a runny nose, cough, headache, chills, fever and body ache. Influenza or “flu” starts with fever (102-104°F) and symptoms similar to the common cold except in a more severe form. Encephalitis means high fever that may cause seizures or loss of consciousness. The monsoons cause flooding in urban areas. Water stagnates and sometimes the water supply gets contaminated. This leads to diarrhoea, dysentery and hepatitis. In addition, the rodents who get flushed out of their habitat can spread leptospirosis. This is characterised by high fever, severe headache, chills, muscle aches, and vomitting. It may include jaundice, red eyes, abdominal pain, diarrhoea, and rash. There is a lot of overlap between the symptoms of these illnesses. So blood tests are required for an accurate diagnosis. Influenza, typhoid and hepatitis A can be prevented with immunisation. The influenza vaccine has to be taken every year, usually in November. The typhoid vaccine has to be repeated every three years. The hepatitis A vaccine is administered in two doses six months apart for lifetime immunity. Immunisation is also available for Jap B encephalitis. Dengue, malaria, chickungunya and viral encephalitis spread through mosquito bites. Breeding of mosquitoes should be prevented. Mosquito repellent gels, especially ones containing lemon grass oil, are fairly efficient. It is better to apply it to clothes than on skin. Don’t use them on children younger than a year or on pregnant women. • As you walk, turn over discarded tyres, bottle caps and coconut shells so that water does not stagnate inside • Put a handful of salt into air conditioning and cooler trays so that mosquitoes cannot breed • Do not place trays under potted plants. Empty pots and vases regularly • Fix mosquito meshes on open tanks, wells, and doors and windows • Ornamental fish that eat mosquito larvae, such as Gabusia and Poecili (guppy) should be added to public ponds, canals and sewers • Sleep inside a mosquito net to prevent bites. Wear full-sleeved shirts, full pants and covered shoes for the same reason 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

dandruff

Flaky, itchy and embarrassing

Your Health DR GITA MATHAI

Poor hygiene is not to blame Dandruff affects 90 per cent of the population at some time in their lives. It itches uncontrollably and produces an ungroomed appearance, with unsightly white flakes on the hair and clothing. Even newborn babies may develop a greasy, flaky scalp called "cradle cap". This, fortunately, disappears within a few months. Our skin is in a continuous process of renovation. It grows outwards, then dies and is shed. Normally, this is a well-regulated orderly process which takes a little more than 20 days and goes unobserved. In people with dandruff, the process is uncoordinated. The cycle completes itself rapidly in a week or less. Thus there is excessive shedding. The dead cells then cluster together and are visible as clumps or flakes of white material. Although dandruff is not infectious, it is associated with an organism called Malassezia (formerly called pityrosporum). This is a fat-eating, yeast-like fungus that feeds on the sebum secreted by hair follicles. It is present on the scalps of normal healthy individuals without causing problems. At certain times, overgrowth of Malassezia occurs, resulting in irritation and increased skin cell turn over. A large number of dead skin cells are then formed. As these cells fall off, the natural oil from the scalp makes them stick together. This makes the cells white and visible. The sudden overgrowth is caused by a change in the biochemical environment of the scalp. This may be precipitated by the natural hormonal fluctuations of adolescence or aggravated in adult life by stress, illness, neurological disorders and diseases of the immune system. It is a misconception that poor hair hygiene causes dandruff. Actually, excessive use of soaps and shampoos can damage the sensitive skin of the scalp. Dandruff may be confused with other dermatological conditions with a similar appearance, like psoariasis or seborrhic dermatitis. The diagnosis has to be confirmed before treatment is initiated. Treatment has to be individualised. As dandruff is chronic, treatment may have to be continued lifelong. • Mild forms can be controlled with daily cleansing using a gentle shampoo. This reduces oiliness and the build up of dead cells. Baby shampoos can be used as they are mild. • If there has been poor response to the above, one of the various anti-dandruff shampoos sold over the counter can be tried. These contain a range of active ingredients like zinc pyrithione, coal tar, salicylic acid or selenium sulphide. Trial and error will help to determine the most suitable shampoo. Some of these might leave the scalp dry. A conditioner or a non-greasy hair oil can be massaged on the scalp after shampooing. • After cleansing, the hair can be rinsed with a mug of water in which an aspirin tablet has been dissolved. • Ketoconazole shampoos contain a broad-spectrum anti-fungal agent. They may work even when other shampoos have failed. • Dandruff treatment is filled with folklore and word-of-mouth home remedies. Some natural shampoos containing henna, tulasi and neem are effective for some people. In others, if the product is contaminated there may be an allergic reaction. Use one of these shampoos daily until the dandruff is controlled. After that, use it two or three times a week. Sometimes, alternating shampoos of two or three different groups is more effective. The shampoo may have to be left on the scalp for a few minutes to give the active ingredients time to act before it is rinsed. The instructions on the container must be strictly followed. It is better to consult a dermatologist if the dandruff does not improve after a month of self-care. More aggressive treatment with steroid lotions may be required. The risk of persistent dandruff can be reduced by – • Eating a healthy diet with adequate proteins, vitamins and minerals, particularly iron, zinc and calcium • Reducing stress • Adequate exercise, preferably outdoor as sunlight reduces dandruff • Shampooing the hair regularly • Avoiding chemicals like hair sprays, styling gels, mousses and hair waxes Dandruff does not cause or aggravate baldness and hair loss. It is harmless and can be tackled with a little time and effort. Dr Gita Mathai is a paediatrician with a family practice at Vellore. If you have any questions on health issues, please write toyourhealthgm@yahoo.co.in

aches and pains

Pop a pill to kill pain

Your Health DR GITA MATHAI

Pain is something that everyone has felt at some time in his or her life. That unpleasant sensation is usually caused by an injury, which leads to release of chemicals that the local nerves pick up. They are then carried by the nervous system to the brain. Pain is protective. It signals danger, and alerts the body to try and avoid the stimulus that leads to it. Acute pain is usually due to an injury, infection or trauma. It lasts only as long as the condition is present. It responds to medication and treatment. Chronic pain on the other hand persists for weeks, months, even years. It may follow an attack of acute pain, (fracture, surgery), persist because of an untreated condition (sinusitis, ear or tooth infections) or incurable disease (arthritis, cancer). Some people may also suffer pain for a long time despite there being no history of injury or any sign of damage. Even doctors and clinical tests may be unable to find out its cause. Headache, backache, leg pain, sharp electric nerve pains and other chronic pains are commoner in older adults and women. Four to five per cent of the adult global population suffers from pain. It is the commonest reason for medical consultations across all specialties, as the patient picks and chooses consultants, depending on their perception of the diagnosis (back ache — orthopedics, headache — neurologist). Patients in constant pain lose manhours at work, are unable to concentrate, feel depressed and lethargic and suffer from insomnia. Their efficiency and productivity are affected. They feel that their lives are out of control. Pain is of several types, superficial, deep, visceral, spasmodic or neuropathic. It is treated with a group of drugs called analgesics. Many are available OTC (over the counter) and do not require a doctor’s prescription. Some are even advertised. Patients often self medicate with inappropriate analgesics in inadequate or excessive dosage but you have to remember that the same medication does not work for all pain. It is best to consult a doctor who can make an educated choice of medication. More than 60 per cent of the patients who approached doctors for pain relief improved, and had fewer side effects compared to the less than 40 per cent of those who treated themselves. Treatment for pain starts with the lowest dose of the mildest agent and the analgesics should gradually be increased step by step. Once the maximum dose is reached, another group can be added or the medication changed. The safest drugs are paracetemol, salicylates and NSAIDs (non-steroidal anti-inflammatory agents). For best results, the prescribed dose and the time between each dose should be followed meticulously. Do not supplement prescribed painkillers with OTC drugs or herbal preparations as all of them may actually contain the same ingredients. Then the total dosage may unknowingly exceed the safety limits and produce dangerous side effects. All these drugs can cause gastric irritation and prolong bleeding time. Long term use can result in aggravation of ulcers, liver and kidney toxicity. Hearing loss can occur subtly and be gradually progressive. The next group of drugs is the COX inhibitors. Various derivatives are available but across the board, they have been associated with deleterious effects on the heart. Opioid derivatives like tramadol, codeine and morphine are effective but can be addictive. The traditional analgesics may not work satisfactorily for “nerve pain”. To be effective and reduce the stimulus to the nerves, they may have to be combined with medications traditionally considered antidepressants or anticonvulsants. All painkillers (even aspirin and paracetemol) can be habituating, with higher doses gradually required to produce the same effect. They can be addictive as well. Before starting medication try a few simple remedies. Chronic pain (particularly arthritis and back pain) responds to topical applications of ointments containing capsaicin, ibuprofen, diclofenac or menthol. These need to be gently applied over the affected site every four hours, followed by an ice pack. Yoga, acupressure, Tai chi and meditation are traditional but effective methods to reduce pain perception. Physiotherapy helps with mobility and pain relief. Bio-feedback techniques can be used to alter pain perception and trick the body into feeling that the pain has disappeared. Exercising regularly — walking, jogging, running, cycling or swimming — teaches the body discipline and enables it to work through pain and fatigue. It has also been proven that exercise can prevent many of the diseases responsible for chronic 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

heart aches

Take care of your heart Your Health DR GITA MATHAI Heart attacks are responsible for 25 per cent of deaths in India. By 2020, 50 per cent of people with heart disease all over the world will be Indians. Unlike in the developed countries where older people are affected, in India the young — many in their early thirties — are cut down by heart attacks. Women were traditionally considered protected by their hormones till menopause but today, the number of “attacks” in premenopausal women is steadily rising. Women tend to have atypical pain with heart attacks. Any symptom is unfortunately taken less seriously than in men. They are also less likely to reach an appropriate hospital in time. This makes them more prone to die during the first attack. Even when women reach for treatment, their ECG and angiogram may not show typical blocks. Their blood vessels are also smaller in size. Earlier, the results of cardiac intervention in women did not do as much good as in men. Now, this problem has been rectified. The instruments and stents are smaller in size and the outcome has improved. Certain visible body changes are associated with an increased risk of developing heart disease. In almost 50 per cent there are small yellowish white lumps called xanthelesmata around the eye or the elbow. The earlobe may have a vertical crease on one or both sides. Obesity is a definite risk factor. The body stature is different in Indians so even relatively thin individuals have a “tummy”, indicating a high waist hip ratio. To determine the waist to hip ratio, use a measuring tape to measure the circumference of your hips at the widest part of your buttocks and your waist at the smaller circumference, usually just above the belly button. Then divide your waist measurement by your hip measurement. Abdominal obesity exists when the waist-hip ratio is above 0.95 for males and above 0.80 for females. The ideal BMI (body mass index) is not 25 (the value internationally) in Indians but 23. The BMI is calculated by measuring the height in metre squared and dividing it by weight in kg. Ideal body weight is, therefore, height in meter squared multiplied by 23. Many Indians carry the “thrifty gene”, a small change in chromosome 3q 27. This helped store fat during seasons of plenty and use it during times of famine. We do not have to face famine situations now —thanks to better availability of food, government distribution and storage facilities — but the gene still works to conserve calories. This predisposes the affected individual to obesity, insulin resistance, diabetes and heart disease. Abnormal lipids with elevated cholesterol, triglycerides and altered ratios in lipoproteins cause deposition of fat plaques in the blood vessels. These may obstruct the blood vessels in the heart, brain or even in the limbs. The blood supply is compromised and heart attacks and strokes are the result. This tendency can also be inherited. The interplay between inherited tendencies and manifestation of disease is a complex one. The expression of the unhealthy genes mentioned above can be modified by the environment (food availability and family habits) and lifestyle. Children have to be taught from a young age to eat 4-6 helpings of fruit and vegetables instead of snacking on high calorie foods like potato chips, cream biscuits, iced cakes and aerated sweetened beverages. Oil consumption should be reduced to half a litre per person a month. Palm oil, coconut oil, butter, ghee and other saturated oils should constitute only seven per cent of the total intake. Refined flour and cereal should be substituted with whole grain products (atta instead of maida, red rice instead of white). Eating should be a focused activity. It should not be combined with distracting activity such as reading or viewing television. This is because the satiety signals from the brain are interfered with. More food will be eaten than required. Eating out is also fraught with danger. The food served may be more than required and unnecessarily oily. Since we are taught from a young age not to waste food, we tend to eat everything ordered even when we are not hungry. Smoking (active and passive) is a definite risk factor, which increases all others. Exercise makes the heart work harder, utilising its maximum capacity. The rhythmic contractions force blood vessels open and improve blood supply. New connections are forged in compromised vessels. Walking briskly for 40 to 60 minutes a day will achieve these benefits and modify many of the detrimental effects of inherited bad genes. “No time” for regular aerobic exercise will result in a lot of time for heart disease. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

wheezing

Cease that wheeze Your Health DR GITA MATHAI Sometimes, patients walk in saying, “I have eosinophilia,” or describe a friend or relative who has the complaint. It is difficult to understand what they mean. Do they have wheezing? Or has a blood test revealed a high eosinophil count? Wheezing is a high-pitched whistling sound — with or without chest tightening and discomfort. The sound occurs because the airways in the lung contract so that air is forced out through a narrowed opening. Blowing air into a balloon and then holding its mouth partially open can produce a similar effect. Wheezing occurs for a variety of reasons, such as exposure to inhaled or ingested allergens or viral and bacterial infections. It can also occur when the eosinophil content of the blood increases. Wheezing is equated with asthma — a frightening word. It conjures up visions of an emaciated, permanently incapacitated individual, with breathlessness and a hacking cough. Incidentally, asthma is a term that is not in use any more as the illness has been renamed “reactive airways disease”. People, however, prefer to use eosinophilia in conversation as it is a safe, non-life threatening, benign medical diagnosis to describe all kinds of wheezing. Human blood contains four types of white blood cells (WBCs) — neutrophils, lymphocytes, monocytes and eosinophils. The percentage of eosinophils is usually less than 6 per cent. The total count of eosinophils in 1ml is 500 or less. If the count is greater than this, it is diagnosed as eosinophilia. If the count is 1500 or more then hyper eosinophilia is diagnosed. This is a laboratory diagnosis made after analysing a blood smear. Eosinophils are useful cells, which destroy foreign substances (bacteria, viruses, parasites, tumour cells) marked as dangerous by the immune system. This action of the eosinophils can release chemicals such as histamine, which cause inflammation and can result in wheezing. The eosinophil count can rise for a variety of reasons: • Parasitic infection particularly filaria, hook worm, round worm and pin worm. • Fungal diseases of the skin • Allergy to inhaled compounds, food like seafish or prawns, food colouring (red and yellow) or additives (monosodium glutamate) and even medication. • Eczematous skin lesions that are itchy and weepy • Endocrine disorders • Tumours like ovarian cancer • Blood cancers such as some types of leukaemia and lymphoma • Autoimmune diseases such as ulcerative colitis A high eosinophil count with wheezing can occur in a condition called Tropical Pulmonary Eosinophilia (TPE). It is peculiar to Southeast Asia and India. It occurs because that particular person has an abnormally vigorous immunological response to the parasites Wuchereria bancrofti and Brugia malayi, which cause filaria. Filaria is endemic in India. The filaria parasite is injected into the blood through the bite of an infected mosquito. The victim develops typical filaria with fever, swelling of the limbs and enlarged lymph nodes. The parasite breeds in the lymph nodes and more and more worms are released into the blood stream. Blood vessels in the lung attempt to get rid of these parasites with the help of eosinophils. Some patients react vigorously to the infection, producing a large number of eosinophils. The eosinophil count in the blood rises. Meanwhile, some worms get trapped, die and release allergenic chemicals, precipitating wheezing and coughing. TPE is suspected in patients with a cough, breathlessness and wheezing, which often worsens at night. There may also be fever, loss of appetite and weight loss. Pulmonary function tests show restrictive and obstructive defects. The chest X-ray shows typical changes. Blood tests show a high eosinophil count. The diagnosis is clinched with the demonstration of high serum concentrations of filarial specific antibodies. Although TPE was considered a disease of Asia, increased travel has spread it all over the world. Fortunately, it is an eminently treatable condition. Most patients respond well to a 21-day course of diethylcarbamazine citrate, an inexpensive tablet marketed by a number of drug companies. Mild wheezing may, however, persist for longer in a few people. In any case of wheezing, avoid inhaled allergens such as mosquito repellents (coils, mats, liquid or spray). While waiting for a diagnosis, take steam inhalations morning and evening. Medication is usually prescribed as an inhaler or rotahalor, which will deliver medicine directly to the lungs, produce no side effects and keep you comfortable. Treatment can be initiated after a specific diagnosis is made. Wheezing is just a symptom. All wheezing is not asthma nor is it eosinophilia. It is important to obtain an accurate diagnosis to determine the reason behind it. Specific treatment will provide a cure once the diagnosis is made. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

hysterectomy

Off with the womb

Your Health DR GITA MATHAI

Some women become tired of having a uterus, not because it is the seat of “hysteria” (the ancient Greeks actually believed women became hysterical because they had a hystera, the Greek word for womb or uterus), but for reasons such as severe pain during periods, constant pelvic discomfort or excessive bleeding or even regular periods. Once the uterus is no longer needed to support and nurture a baby, it seems expendable. Surgery seems an attractive option. Hysterectomy (removal of the uterus) is a common surgical procedure. Eight per cent of women in India have had a hysterectomy by the age of 50. There is, however, an urban-rural discrepancy. Almost 20 per cent of urban women have had hysterectomies. Rural women are more conservative and tend not to opt for surgery. Many women have the hysterectomy before menopause, while in their late thirties or forties. The two ovaries situated on either side of the uterus not only produce eggs but also the female hormones which keep a woman’s bones, heart and blood chemistry normal and healthy. During a hysterectomy, the ovaries may or may not be removed. If left behind, with no target organ (uterus), they cease to function within a year or two, even in young women. This causes artificial symptomatic menopause. The sudden withdrawal of female hormones does not give the body time to adjust. There may be hot flushes, night sweats, weakness, depression and insomnia. The bones lose calcium and become osteoporotic. This can lead to fractures, particularly in the vertebrae. As the protective effect of the female hormones disappear, the lipid profile changes and the risk of heart disease increases seven fold. The vagina becomes dry and sex may become painful. The urinary bladder loses part of its supporting wall. It may prolapse into the vagina and urine may be retained. There may be urinary incontinence. Recurrent infections can occur. Similarly the rectum can protrude into the vagina, causing constipation. A hysterectomy is not a risk-free procedure. There may be excessive bleeding during the operation, clots may form in blood vessels and other organs such as the urinary tract or rectum may be inadvertently damaged. The procedure, however, is necessary if there is cancer in the uterus or cervix. Chemotherapy or radiation or both then follows the removal of the organ. Sometimes, the tissue lining the uterus, the endometrium, grows into the adjacent organs such as the ovaries, bladder and even intestines. With each menstrual cycle the tissue grows a little more. It can cause severe pain during periods and interfere with the functioning of the other organs. Initially, hormone therapy should be tried. Hysterectomy should be the last resort. The muscle of the uterus can grow abnormally, producing noncancerous growths called fibroids. These can be single or multiple, small or large. They can exert pressure on surrounding structures like the bladder and rectum. They can cause excessive bleeding or painful periods. Twenty per cent of the women over 35 have fibroids. Many are asymptomatic and are picked up during an ultrasound of the abdomen. Most of symptoms of fibroids can be tackled medically. It is possible to remove large fibroids without a hysterectomy. Fibroids do not develop into cancer. Childbirth stretches the ligaments supporting the uterus. It can start to slip downwards (uterine prolapse) and may even appear outside the body. It may be possible to surgically tighten these ligaments, or hysterectomy may be the only option. Excessive bleeding during periods can usually be controlled by a judicious combination of tablets. A hysterectomy may seem like a good solution to constant unidentifiable pelvic pain, but it may not relieve the symptom and the cure may be worse than the disease. The uterus can be removed thorough a cut in the abdomen, button hole surgery with a laparoscope or through the vagina. In the latter two procedures, there is no abdominal scar. The choice depends on the size of the uterus and whether the surgeon needs to look at the rest of the organs in the pelvis or not. It can be a “total” hysterectomy when the entire organ is removed or partial, if the cervix (lower part of the uterus) is left behind. The piece left behind can become cancerous in later years, so partial hysterectomies are not popular. It takes around six weeks to recover from a hysterectomy. During that time the patient should not lift heavy objects or perform strenuous activity. You can start exercising after six weeks to build up muscle and bone strength. Start walking for 10 minutes in the morning or evening. Gradually increase this to an hour. Muscle strength can be built up with repetitive movements using light weights. 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

health supplements

Supplements are not healthy Your Health DR GITA MATHAI The health supplement industry is an unregulated goldmine worth crores of rupees. It capitalises on people afraid of illness, doctors, surgery and the side effects of allopathic medication. They swallow supplements — labelled dietary, nutritional, health, sports and body-building — in an effort to tackle diseases. Advertisements and coaches also con youngsters into taking such supplements to improve performance. The athletes do not realise the dangers of this “doping” and are convinced that the supplements are what they claim to be — products obtained from natural sources that are free of chemicals and side effects. There are many plant products that really have medicinal properties. From ancient times the fox glove plant, the cinchona bark, ma hung and extracts from many other plants have been used to treat diseases. Today, the active ingredients in these plant products have been identified. They are now extracted specifically, or chemically synthesised in factories. This purified form makes dosing easier and helps tackle side effects. Drug interactions are also known and can be predicted. Health supplements often use the same substance used in allopathic medicines. A widely advertised “herbal tonic” for sexual dysfunction contains high concentrations of thiosildenafil, which is a precursor of sildenafil citrate or Viagra. The obesity epidemic has led to a huge market for easy weight loss solutions. One of which is natural herbal weight loss “shakes” that claim to help you lose weight without dieting or exercising. Consumers do lose weight but some became jittery and develop sweating and tremors. Almost all regain the lost weight once the expensive supplements were discontinued. A chemical analysis of the product showed that it contained plant alkaloids with high concentrations of ephedrine, thyroxin and caffeine. These increase the metabolism rate and produce these side effects when ingested by people who do not need them. Body builders use protein supplements — usually whey, casein, soy protein and cysteine — to bulk up. Often the supplement contains male hormones such as testosterone or androgens. Sometimes they contain prohormones — precursors to hormones that are converted to testosterone in the body. Testosterone derivatives may help you develop a six pack quickly but long term use is associated with dangerous side effects such as changes in liver and kidney function, sterility, precipitation of diabetes, aggression and even frank psychosis. In fact, the perception that body builders need a lot of protein is wrong. While normal persons need 0.8g protein / kg / day, body builders need 0.90g / kg / day, those undergoing strength training need 1.4-1.8g / kg / day and endurance athletes 1.2-1.4 g / kg / day. Excess dietary protein supplements can lead to obesity, dehydration, increase in liver enzymes and kidney problems. Nutritional requirements should primarily be met naturally through the diet. Certain diets, however, are inadequate because of dietary restrictions due to disease or religious beliefs (see box). Natural food is superior to supplements because it contains trace minerals and anti oxidants that are needed for proper functioning of enzymes and to fight disease. Before you take a supplement, check the label. That food supplement you drink is enriched with minerals, vitamins and calcium and if you take the same in pill form too, you may overdose. Similarly if you are on medication, that herbal tonic may contain the same ingredients in a more natural form, resulting in toxicity and side effects. You may not be able to glean all this information from the salesperson. Also, check the expiry date. If there isn’t any, do not buy it. Also, think whether the supplements are worth the price you pay. You may get the same benefits just by tweaking your diet. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

belly troubles diarrhoea and dysentry

Delhi belly Your Health DR GITA MATHAI I receive many letters from people who complain of having “dysentery” or “always” having “diarrhoea”, which stops them from functioning effectively in their jobs or studies. The terms diarrhoea and dysentery are freely interchanged, leading to confusion in the minds of patient and physician. Diarrhoea occurs when the consistency and frequency of the bowel movement changes. It becomes either watery or frequent (usually more than three times a day) or both. Dysentery occurs when there is blood and mucous in the stool. Our intestines are full of good bacteria. These colonise the bowel and produce essential vitamins of the B group as well as vitamin K. They also kill disease-causing bacteria ingested with food. Antibiotics, prescribed for various infections, kill these good bacteria too. So harmful bacteria can gain a foothold, leading to diarrhoea. This accounts for the mild tummy upset that may follow a course of antibiotics. Infective diarrhoea can be viral, bacterial or parasitic. Organisms are ingested with every meal. The acid in the stomach, the first line of defence, destroys these. Acidity in the stomach is reduced by antacids and medications such as ranitidine, omeprazole and pantaprazole. Large numbers of disease-causing bacteria in contaminated food can overwhelm even normal stomach defences. Bacterial overgrowth can also occur in food if it is left outside and reheated and used the next day. A very common form of this occurs if leftover rice is eaten the next day. Even if it is fried, the bacterial toxins withstand the heating process. In victims of diarrhoea, rehydration is important. You can use commercial ORS (oral rehydrating solution), tender coconut water, salted lime juice, buttermilk or a watery mixture of rice and dal. Make an estimate of the amount of fluid lost and replenish it. If diarrhoea continues for more than three days, or if urine output decreases, consult a physician immediately. Anti motility agents such as lomotil and lomofen do not cure diarrhoea. They merely reduce the movement of the intestine so that the frequency becomes less. They are contraindicated in children under the age of five. They do not work in dysentery. Viral diarrhoeas do not respond to antibiotics. They subside on their own. Bacterial and parasitic diarrhoeas can be treated with specific medications. Make sure to complete the course, otherwise the organism becomes resistant, causing diarrhoea to recur after 2-3 days. Dysentery means that there is blood and mucous in the stool. It is usually caused by an infecting organism (such as bacteria and amoebae) invading the large intestine. There may by paroxysms of pain and fever. The full course of medication should be followed. “Probiotic” capsules are often prescribed to restore intestinal flora to its original state. They are expensive and of dubious efficacy. A similar effect can be obtained by swallowing one tablespoonful of home-made curd early in the morning on an empty stomach. Curd is not a true probiotic but contains sufficient lactobabillus and other bacteria to repopulate the intestine. Taking zinc supplements also reduces the duration and frequency of diarrhoea. If diarrhoea or dysentery persists for two weeks, it is classified as chronic and needs to be re-evaluated by a physician. It may be an ordinary or exotic infection that has been missed in the preliminary round of investigations. Also, not all diarrhoeas, or dysentery-like diseases, are due to infections. Mucous may appear as a part of IBS (idiopathic bowel syndrome). Blood may appear in diverticulosis of the large intestine or if there are polyps present. In children milk allergy or lactose intolerance can read as recurrent diarrhoea or dysentery. Haemorrhoids (piles) or a fissure can be the reason for blood in the stool. On very rare occasions, cancer of the large intestine can also be the reason for blood in the stool. Cholera, typhoid (which can also cause diarrhoea) and rotavirus infections are preventable by timely immunisation. The cholera vaccine is now given by mouth in two doses and the typhoid as an injection repeated every three years. Rotavirus is likely to affect children and can be fatal. The vaccine is administered orally and is best given before the age of six months as two doses a month apart. Diarrhoea falls just behind respiratory illness in frequency and mortality. One of the reasons is that 50 per cent of 1.2 billion Indians lack toilets and defecate in the open, perpetuating the cycle of diarrhoeal illness. Tourists and travellers to India expect and dread the onset of diarrhoea. In the long term, improvements in sanitation, safe water supply, regulated food safety and community awareness of preventive measures will go a long way towards reducing the frequency of diarrhoeal diseases. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services