praying hands

Reading the hand Your Health DR GITA MATHAI Praying Hands (see pic) is a famous pen-and-ink drawing by Albrecht Dürer. A close look at the drawing makes several medical assumptions possible.  The person is middle-aged or older.  The hands have been used to manual labour.  The person is diabetic or will shortly become so. Diabetes produces changes in the structure of the hands so that when they are folded, as in prayer, a small gap is visible between the two little fingers. As people walk, they unconsciously move their arms. Watch to see the position of the thumb. If it is rotated inwards, the person has a body mass index (BMI) over 29 and is already obese or heading there. The creases and lines on our palms, formed when the foetus is 12 weeks old, are genetically determined. Normally, three lines are formed. If there are only two lines (single palmar crease), the child must be followed up for Down’s syndrome, or other genetic abnormalities. It is rare for normal people to have a single palmar crease but some do have it only on one palm, a trait shared by many in the family. Some people are prone to chronic infectious diseases such as tuberculosis. They too tend to have only two lines but their single abnormal line is situated just above the thumb. Hormone levels in the uterus influence finger length. A person (irrespective of sex) whose index finger is shorter than the ring finger will have had more testosterone (male hormone) in the womb and a person with an index finger longer than the ring finger will have had more estrogen (female hormone). The difference in the lengths can as little as two or three per cent but is important. Professional women and female scientists tend to have higher levels of testosterone relative to their oestrogen level, while the converse is true of men in the fine arts and social sciences. Marfan’s syndrome is a genetic disease in which the person has abnormally long fingers (arachnodactly), like that of a spider. Congenital hypothyroidism, certain renal diseases and some forms of dwarfism are associated with a tripartiate hand where the index, middle and ring fingers are of the same length. Palmar creases, tripartate hands and archnodactly can be picked up on ultrasound examination after the 12th week. All of five fingers are essential for the hand to function properly. The thumb is the most important as it helps us to grasp something securely. If there are extra fingers, they need to be surgically removed. They may be associated with internal organ abnormalities, particularly of the kidney. The tips of the fingers have loops and whorls, some closed and circular, others open ended. No two individuals have identical fingerprints. Strangely, people with mental illnesses have more open loops and fewer whorls. Smokers have yellowish brown nails. In chronic respiratory ailments or congenital heart disease, nails bulge with a convex parrot beak appearance and are blue in colour. The skin of the palm may be yellow. Jaundice causes this. It can also occur because of excessive consumption of yellow vegetables and fruits. Hard labour can make the fingers gnarled and knotted; housework, which involves dealing with harsh detergents, makes the skin rough. Office work makes the hands soft and smooth. Regular manicures keep the hands looking good. The occupation and financial status of a person can be determined by looking at the hands. Fingers may get fixed in the flex position with sudden painful release, the “trigger finger”. The tissues of the hand may get thickened, causing them to contract. These conditions need to be seen by an orthopaedic surgeon. Osteoarthritis sets in with age and is commoner in women. The fingers become painful and work becomes difficult. This is a localised condition and other body systems are not affected. Rheumatoid arthritis occurs in younger people. The joint deformities give the fingers a spindle shaped appearance. This disease can affect other organs as well. Treatment is long drawn and includes medication, physiotherapy and regular exercise. Most joint pains, whatever the cause, respond well to immersion in hot salted water and underwater exercises. Involuntary shaking movements called tremors can be first seen in the hands and may be associated with tingling. Sometimes these are familial and harmless. Tremors can also be the result of too much coffee, medication induced or the manifestation of a neurological disease like Parkinson’s. Tremors need to be evaluated by a physician. Hands reveal a great deal if observed carefully. No wonder palmistry is a successful profession! 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

saving lives in emergencies

Saving lives in emergencies YOUR HEALTH DR GITA MATHAI A few days ago while driving, my grandson suddenly shouted, “Stop, stop! Look at all the blood on the road.” I pulled up to the side, and saw a dazed, 75-year-old man fast losing consciousness. A motorbike had knocked him down and sped away. There was a gaping hole in the side of his leg and he was exsanguinating rapidly from a cut artery. We had no first aid equipment but we ripped off his shirt and applied sufficient pressure to reduce the bleeding till we got him to hospital. Most of the bystanders did nothing while a few clicked snaps on their cell phones. India has only one per cent of the world’s motor vehicles but accounts for six per cent of global road traffic accident (RTA) deaths. Over 1,20,000 people die on the roads every year (one every two minutes), and a majority of them is pedestrians. Twenty per cent of the accidents are the result of alcohol consumption. The majority of the workforce in India is males under 45. This means that the greatest number of deaths also occur in this age group. Of those who survive, most are bedridden or confined to a wheel chair. Usually, they are the sole bread earners for their families. Stop and take charge as people are looking for leadership. Check if the person is bleeding. Apply pressure over the site to stop the bleeding. Get the person to the nearest hospital. Maintaining heartbeat and breathing is very important. If necessary, perform cardio-pulmonary resuscitation (CPR). Learn it as 15 per cent of people will have the opportunity to perform CPR sometime in their lives. Basic resuscitation can be remembered as ABC. A. Clear the airway because if it is blocked with blood, mucous, a foreign body (bones, nuts) or water, air cannot enter. Then perform the Heimlich manoeuvre. Stand behind the person and wrap your arms around the waist. Make a fist and place the thumb side of your fist against the victim’s upper abdomen, below the ribcage and above the navel. Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage; confine the force of the thrust to your hands. Repeat until the object is expelled. If the victim is pregnant or obese, it is difficult to wrap the arms all the way around. Then stand behind the victim, move your arms up into the victims armpits, and make a fist in the centre of the chest, over the sternum, before proceeding with swift inward movements. If the person is unconscious or unable to stand, place the victim on his or her back. Kneel astride the victim’s hips. Place one hand on top of the other. Place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel. Use your body weight to press into the upper abdomen with a quick upward thrust. Repeat until the object is expelled B. Once the airway is clear, listen and look for breathing by watching for the rise and fall of the abdomen. If the person is not breathing Pinch the victim’s nostrils firmly Place your mouth over the victim’s mouth Blow air in forcefully at the rate of one breath per second. If the mouth is full of vomited material or blood, administering chest compressions alone will help. C. Circulation has to be maintained. If there is no heart beat: Place the heel of one hand over the lower half of the sternum. Place the heel of the second hand on top of the first. Keep the arms straight. Rhythmically depress the sternum 2-5cm at the rate of 100 compressions a minute. In children use the thumbs one on top of the other and press down only 1-2 cm. It is easier if two people work in tandem, with 15 chest compressions to two breaths (15:2) ratio. There is a so called “golden hour,” the first hour after trauma, when the person has the best chance of survival provided he reaches the emergency department of a hospital geared to deal with accidents. By following these steps, you too might 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

thirst and rehydration

Beat the heat, correctly DR GITA MATHAI Summer is here in full force and advertisements for fizzy drinks, colas, sports drinks, beer (surrogate advertising) and even plain glucose have started flooding prime time television. They claim to quench your thirst, give a much needed energy boost and improve flagging sports performance. Everyone needs adequate fluid and electrolytes in summer, to replace the visible amounts lost as sweat and the unseen lost as evaporation from the body. In hot and humid climates, the fluid loss may go unnoticed till the body signals dehydration with thirst, a parched mouth, headache, nausea and muscle cramps. Urine may become scanty and darker. If these symptoms are ignored, dehydration can proceed to heat exhaustion or heat stroke, with the temperature rising to 104°F or more, dry flushed skin with no sweating, delirium, loss of consciousness and even seizures and death. Healthy adults recognise the symptoms of thirst and proceed to drink water. Those over 65 may not recognise the symptoms or ignore them. They may also be more vulnerable if they are on medication like beta blockers or anti depressants. These affect the body’s ability to stay hydrated. Infants are unable to express themselves when they are thirsty. They also lose more fluid as their exposed body surface is greater than in adults. Some, though not all, may stick out their tongue in a serpentine movement if they are thirsty. Parents and caregivers need to recognise their need and offer fluids at frequent intervals. A child that is not thirsty will refuse the fluid. School going children may become engrossed in play and ignore thirst. They need to carry at least a litre of water with them to school. Even while playing in the compound, they should carry water. Fluids that are “isotonic” and contain water and electrolytes in the correct proportions replenish body fluids. Many advertised fruit drinks, colas and reconstituted powders are “hypertonic”. The body loses fluid from its cells into the stomach as it tries to make them isotonic and utilisable. Thirst is aggravated instead of being quenched. Sugar or plain glucose is often added to drinks. Since the body requires glucose for metabolism, this should in theory provide the body with an instant energy boost and quench thirst. If the drink is isotonic (some sports drinks are), the extra glucose will provide a temporary energy boost. After an hour, in some people there is a rebound effect with increased thirst, fatigue and drowsiness. The instant calories also prevent the body from efficiently breaking down its fat stores, negating the effect of exercise on weight loss. Although ice water may appear refreshing, the body has to expend energy to bring the water to room temperature before it is absorbed. Fluid at room temperature is absorbed faster. Fluids should be drunk before thirst sets in so that you never become dehydrated. Adult men need around three litres of water a day and women around 2.5. Children need 100ml/kg until they are 10kg. Over 20kg they need 1,000ml (1 litre) plus 50 ml/kg. This is the baseline requirement. Activity requires additional fluid; adults need 300ml for every 20 minutes and children 200ml. Fluid needs do not stop when the activity is over. Around 500-600ml needs to be drunk after activity. A mouthful of liquid for an adult is roughly 30ml and a child’s 15ml. If you are rarely thirsty and pass around 1.5 litres of urine a day, your hydration is probably adequate. Plain water is best for rehydration. Lightly salted butter milk, lime juice or coconut water are also effective. Ready mix drinks and sports drinks should be either avoided (unless you are an endurance athlete) or used judiciously. If a person has heat exhaustion: nBring them indoors to a shady place and switch on the fan Give them fluids Place ice in the armpits and groin Swab them with a towel soaked in water at room temperature. Allow the water to evaporate 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