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