making babies

Making a baby

Your Health DR GITA MATHAI

ON YOUR PART....  Make sure your immunisations against rubella (R-vac) and Hepatitis B are complete and up to date  Take folic acid supplements (5mg a day ) to ensure proper development of the nervous system in the foetus  Reduce stress, by taking up yoga, meditation or Tai chi  Exercise for an hour a day even if both the husband and wife are of ideal body weight At any given time, 12 per cent of married couples in India are trying unsuccessfully to have children. A majority of them have had arranged marriages. The pressure on the couple (especially the woman) to procreate is tremendous. If they haven’t conceived within 4- 6 months of marriage, many can be found in doctors’ offices, anxious and depressed. A couple is considered relatively infertile only if they have been married at least a year, the woman menstruates regularly, the man has a normal sperm count, they have had regular and frequent intercourse during this period and still haven’t conceived. This automatically excludes couples who are together only every fortnight or once a month. Women ovulate only once in 28 days (if they have regular cycles). Once the egg leaves the ovary, it survives for 12-24 hours. After ejaculation, sperms survive for 3-5 days. This means that there is a very small window in a month when pregnancy is possible. Work, travel, illness, social and religious functions all make it very possible for the “fertile period” to be missed completely. A person can have intercourse only on weekends for months on end and still manage to miss the “fertile days”. It is possible to approximately calculate fertile days (the egg is released 14 days before the next period) and make sure they are not missed. The downside is that women do not function like machines and the length of their menstrual cycles can vary. There are many specialised fertility centres all over India, which offer expensive and high tech solutions, intrauterine insemination (IUI) and IVF (in vitro fertilisation) being two that are much advertised. Before attending one of these centres and embarking on an expensive journey, there are a few simple interventions that can be tried. Check the BMI (body mass index) of both the husband and wife. Women with a BMI of 35 were found to be 25 per cent less likely to achieve a spontaneous pregnancy. If the BMI goes up to 40, the chances fall to below 40 per cent, despite regular menstruation. If the BMI is more than 25 in either partner, then the first thing to do is get it down with strict diet and exercise. Even before the weight begins to drop, the chemicals released by the body during regular and consistent exercise improves chances of conception by 50 per cent. Men with a BMI of 30 or more are also relatively infertile. Both partners need to stop smoking or using tobacco in any form and stop consuming alcohol. A physician needs to be consulted without waiting for the mandatory year if you are an older couple (more than 35), if the woman’s periods are irregular, painful, there is endometriosis or symptoms of pelvic infection. In men, a visit to the doctor is recommended if there is a history of having been treated for diseases such as gonorrhea, prostate or cancer, or surgery for varicocele, hernia or hydrocele. If reasons for infertility are analysed, in 33 per cent of the cases the woman has a problem, in 33 per cent it is the male and in 33 per cent no cause can be identified. Men may not have children because their sperm count is low, the sperms are abnormal, there are ejaculation problems, over exposure to chemicals or heat in the workplace has harmed sperm, or as a side effect of hernia, hydrocele or varicocele, sexually transmitted diseases or previous cancer treatment. Women’s infertility may stem from ovulation problems, polycystic ovaries, hormonal problems (thyroid, prolactin), abnormalities in the shape of the uterus or cervix, blocked fallopian tubes, endometriosis or premature menopause. Evaluation for causes of infertility need to be done on a step-by-step basis after a complete physical check up by a doctor. Once a specific diagnosis is arrived, interventions can be suggested. Tests and treatment take time and can be expensive and uncomfortable. Even after a particular line of treatment is suggested and followed it takes a whole month (one menstrual cycle) before there is even a suspicion that the treatment may have been successful. Switching doctors and clinics every few months because of anecdotes about success or turning to different systems of medicine will not ensure success. Instead, there will only be duplication of tests and procedures as each doctor attempts to give you a baby. Even in the best of hands success rates all over the world have not crossed 50 per cent. Do not let that depress you. Some couples eventually become pregnant after they have actually “given up” on treatment. Also, there are other options available today like adoption and surrogacy. 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.

metabolic syndrome X

Not sweet

YOUR HEALTH / DR GITA MATHAI

Diabetes has reached epidemic proportions in India. Exact figures are difficult to come by but screening studies place the numbers at between 10 and 20 per cent of the total population. These, of course, are only the people with frank diabetes. It does not take into account pre-diabetics, those with mildly elevated sugars who may eventually become full-blown diabetics. Nor does it consider the gestational diabetics — pregnant women who are diabetic during pregnancy but may recover completely after delivery. Unfortunately, diabetes affects systems all over the body, particularly if it is undiagnosed or uncontrolled. In the brain, it may lead to strokes or an earlier onset of cognitive decline, with memory loss and unreasonable behaviour. The eyes can develop cataract, muscles can become weak and the blood pressure can rise. In the heart it can lead to myopathy, blocked vessels or heart attacks. The kidneys can begin to malfunction and the nerves develop neuropathy with tingling numbness and weakness. Many diabetics remain undiagnosed as they have limited access to medical care or have not got themselves evaluated . Others have more faith in alternate systems of medicine. Many of these systems emphasise a “symptom based” approach to diagnosis and treatment. Individual symptoms such as weakness, frequent urination or loss of weight are treated. The main disease (diabetes) remains undiagnosed. Although diabetes is a dangerous disease, evolution has not wiped out the genes responsible for it. This is because it was originally a survival mechanism . Before large-scale storage of food was available, people (particularly women) needed to store food as fat in their bodies to tide them over in lean times (famines). People with the ability to do this were more likely to survive and pass on the genes to their offspring. People prone to diabetes have a similar metabolism that can efficiently convert food to fat and store it. Now that food is plentiful, these genes have become detrimental. They cause the metabolic syndrome X and this eventually leads to diabetes. The International Diabetes Federation has defined “the metabolic syndrome X” as the presence of central obesity — a waist-:hip ratio greater than 0.90 in males and 0.85 in females, or BMI 30 kg/m 2 . (The waist hip ratio can be measured in inches or centimetres by measuring the narrowest part of the waist and the widest part of the hip. The BMI is the weight in kg divided by the height in meter squared.) In addition, any two of the following should be present: Triglycerides more than 150mg/dL HDL cholesterol 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females. A blood pressure reading of 135/85 or higher A fasting blood sugar value more than 100 mg/dL To avoid diabetes, the total calories consumed should not exceed that which is required by the body. The number of calories we need is based on our body weight, level of activity and the thermic effect of food (TEF) or the calories required to digest the food that we eat. About 60-70 per cent of the calories we eat goes towards supporting life. To find calorific requirement in males multiply body weight in pounds by 10 and then add double the body weight. In adult females multiply the body weight by 10, add the body weight. (1 pound = 2.2.kg) In addition calories are burnt during physical activity. This can be added to the above value. The TEF is a flat 10 per cent of the total calories consumed. So eat sensibly and exercise for an hour daily. 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

violent children

Violent child

DR GITA MATHAI

The media seem to be overflowing with tales of violence. There are stories on robbery, kidnapping, rape and murder. While such crimes have become more visible now, the truth is that they have always been around. What is worrying is the rise in violent crimes committed by children and adolescents all over the world, not just in India. The middle class and the rich of this country like to think that such crimes are only committed by the economically disadvantaged and that “their children” are safe in “good” private schools. Nothing could be farther from the truth. The wealthy are just better at concealing the incidents, hushing them up and paying off the victims. Now, however, that is no longer the case. Under increased media glare, the crimes get exposed even if the criminal is rich, well connected or a juvenile. Children are becoming violent because of several factors. Often, both parents work so there is no one to keep an eye on the children when they return from school. Most are left to the care of uneducated domestic helps. (The old loyal breed of ayahs is now practically non-existent). They may be sent to “tuitions”, but they have no hobbies, do not read much and even when they play with friends they are unsupervised. The television is often used as a babysitter. Children watch two to three hours of TV a day unsupervised. Many of the serials and movies have adult content with sex, violence, stereotyping of women and lawlessness. They glorify a violent solution to everyday problems and often portray it as the only alternative. Authority is downplayed. Success needs to be achieved at any cost. The actors are seldom injured. Even when sustaining trauma or death, they mysteriously reappear in other episodes or different serials. The lines between the virtual and real world become blurred in the child’s mind. Blood and gore appear commonplace. The child becomes insensitised to violence and ceases to feel empathy for the victim. They may even begin to identify with the “villain”. Unfortunately, violence eventually ceases to horrify. It seems an ideal way to solve problems. The lines between right and wrong become blurred and the end appears to justify the means. Children as young as three or four may exhibit violent behaviour. Sometimes, the preschool may not report it. Even if it does, parents do not take it seriously. They blame the school, or feel that the child will grow out of it. A child in danger of developing violent behaviour has certain characteristics. He or she is impulsive, demanding, physically aggressive and throws temper tantrums if thwarted. He or she may destroy property and be cruel to animals. Violent behaviour is more likely to develop in children if there is marital discord, alcoholism or domestic violence. The child sees violence as a solution to problems and imitates elders. Also, alcohol may be available in the house, leading to experimentation, especially in older children. In these situations the lines between a genetic predisposition to violence and environmental factors like upbringing become blurred. If a child shows violent behaviour, excessive punishment or expulsion is not the solution, though it may keep other members of the school safe. The child needs evaluation and counselling. If the problem is alcoholism, marital discord and violence in the home, the parents need counselling and treatment. This may be difficult as they as adults have developed this pattern of behaviour with callous disregard for the consequences on their family or society. It is very important to spend time with children and monitor their movies, television programmes and computer games. It is important to not allow certain programmes or games, even if there is peer pressure and the oft-repeated complaint, “everyone else gets to watch it”. Limiting television viewing has other positive fallouts. Children have more time to study, read, play sports and pursue hobbies. Structured physical activity such as a game or sport and regular exercise helps to vent frustration and anger in a healthy fashion. Interest in sports means the child is likely to spend time outdoors. He or she is more likely to avoid cigarettes, alcohol and drugs. He or she also develops a sense of self- worth. They do not need to boost this with bullying or violence. As parents and caregivers, we can only lead by example. That means we too must give up violent programmes, exercise regularly and learn to peacefully co-exist with our families, neighbours and society. 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