tackling pain

What a pain! http://www.telegraphindia.com/1141229/jsp/knowhow/story_5590.jsp

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Your Health - Dr. Gita Mathai

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Everyone feels pain at some point in their lives. Unfortunately, there is no machine to objectively assess pain. Physicians have to rely on what the patient says. Sensitivity to pain varies - acute pain may make a person only grit her teeth and wince whereas the same injury can produce "severe, unbearable pain" with weeping and wailing in others.

Pain forces a person to take notice of a body part they had probably taken for granted. This is particularly true of acute pain such as a toothache, sinusitis, appendicitis or urinary tract infection.

Our bodies are plentifully supplied with "nociceptors" in the skin, bones, muscles and internal organs. Noxious stimuli, (either injury or infection) activates them. They release electrical currents and biochemical agents. These travel along the nerves, up the spinal cord and eventually reach certain areas in the brain. The reaction occurs in a flash and the perception of pain is instantaneous.

A number of medications can be used to treat acute pain. Many of these are available OTC (over the counter). Commonly used medication is paracetemol (10 mg /kg/dose in children 500 mg per dose in adults). It can be repeated every four hours. Paracetemol helps with fever as well, so if the aches and pains are due to seasonal flu, there is rapid improvement. It also blocks the areas of the brain that recognise pain. NSAIDs (non steroidal anti inflammatory drugs) like ibuprofen (Brufen) and nalidixic acid relieve pain but do not have much effect on fever. They act by blocking prostaglandin, one of the chemicals responsible for feeling pain. Topical anti-inflammatory medications, particularly those containing capsaicin are very effective. They should be applied lightly over the painful area followed by an ice pack.

Pain is chronic if it lasts for more than six weeks. It may be due to a simple, correctable cause. Wearing flip-flops while walking for long periods of time can cause heel pain. Speaking on a cell phone wedged between your shoulder and ear causes neck pain and headaches. Playing computer games on cell phones also causes neck pain. Frequent texting causes pain in the thumbs. Long-term computer use causes pain in the wrist.

More often chronic pain is due to the various types of arthritis (rheumatoid, osteoarthritis), autoimmune diseases, gout and mechanical problems like a disc prolapse. It needs to be diagnosed correctly so that appropriate treatment can be started. The medications taken may be steroids, opiods or the coxib group of drugs.

The brain has to be retrained in its perception and response to pain. This can be done with a combination of physiotherapy and aerobic exercise. Judiciously used, these interventions help to reduce long-term dependence on pain medication.

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

blue light

http://www.telegraphindia.com/1141215/jsp/knowhow/story_3630.jsp

• Clear bedrooms of electronic clutter and blue light. This includes digital alarm clocks, televisions, computers and cell phones.
•  If a night light is needed, use a red bulb.
•  Do not use in-ear earphones at high volume for long periods of time. Do not give them to children.
•  Do not use cell phones when the charge is dying or for hours at a time or if the signal is weak.
•  Let your fingers do the talking. Texting is safer than calling.
•  Do not let toddlers play with cellphones.

My child" (all of two years) said the mother, "is so smart! She knows how to operate the cell phone. She listens to songs. She even works the TV remote."

Other parents bring their children for consultations, complaining about poor school performance, an inability to recall what has been taught in school or revised at home. On enquiry, they appeared to eat their meals in front of the television and some even do their homework there! The television is never switched off, at least not until the last member of the family finally goes to bed. The problem is compounded if there are olders in the house who do not understand why they need to curtail their television viewing for the sake of the children.

The television emits "blue" light with a wavelength of 475 nm when it is on. During the day, this spectrum stimulates the brain. We remain awake, alert and active. At night, in nature there is no light, so our brains are able to wind down and we sleep. Our brains work in a circadian rhythm, an approximately 24-hour regular sleep-wake pattern.

A chemical called melatonin is secreted in the brain during darkness. It helps us sleep and allows the brain to rejuvenate itself. Any light at night disrupts this process. Blue light is particularly disruptive. It can be from televisions, phone chargers, cell phone messages, computer screens and even low wattage energy efficient lighting. Some studies have shown a link between constant exposure to blue light and cancer, especially that of the breast and prostrate.

Also, the images on television are not really free flowing. They are actually rapidly moving "stop and start" static images. The rapid-fire transmission makes it impossible for our brains to process it making the movement appear fluid. Many brain chemicals get depleted during this process, making the brain tired. Children who watch more than an hour of television a day find concentration and mental recall difficult because of this. They also become irritable, adamant and perform poorly in school.

Where would we be without cellphones? Everyone (even children) have them cradled close to their heads. Cell phones and even cordless phones emit radiation. Although no positive correlation has as yet been made with brain cancer, many advisories advocate no cellphone use before the age of 20, no more than 20 minutes at a time continuous usage and no usage in areas where the signal is weak (the phone emits more radiation as it attempts to connect).

Children under the age of two should be kept away from cell phones. Radiation is emitted up to six inches from the phone even when it is off. They should definitely not be encouraged to use it, play games on it or listen to music. The surface of the cell phone is also highly contaminated with disease-causing bacteria. This can result in respiratory and skin infections.

Earphones can damage our ears and cause progressive hearing loss. This is particularly the case of "in-ear" buds. The over the ear headphones are safer. Special earphones are now made for children. These cannot be used above a certain volume.

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

broken hearts

http://www.telegraphindia.com/1141208/jsp/knowhow/story_2612.jsp

don't break my heart

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Heartbroken is just a word we use but did you know that hearts could really be broken? Till recently, even doctors did not take broken hearts seriously.

Around ten years ago, there were a few high profile deaths in young people. They were diagnosed as having died from a "broken heart". Now, a broken heart or stunned myocardium syndrome (also called takotsubo) is a documented condition. It occurs as the response of the heart to sudden, intense emotional stress such as the death of a spouse; rejection at the workplace; acute fear; or uncontrolled anger. These intense emotions can cause immediate breathlessness or strokes. The broken heart can occur simultaneously or a few minutes later.

The sudden surge of uncontrolled emotions causes the release of two chemicals, adrenaline and nor adrenaline. These help the body ready itself for a "fight or flight" reaction. Sometimes, there is an abnormal elevation of these chemicals. This causes the cardiac arteries to narrow, decreasing blood flow to the heart. The adrenaline binds to the heart muscles, causing a large number of calcium ions to enter the cells and skewing the balance among calcium, potassium and sodium. The muscle becomes dysfunctional. The affected areas start to balloon out. The lower-most part of the heart (the apex) has the least blood supply so it is most affected.

The symptoms are similar to a heart attack - chest pain, sweating, giddiness or dizziness, nausea, vomiting, weakness and palpitations. Blood pressure may drop. Heart failure may develop.

The ECG changes are atypical, with imprecise changes in the ST segment and T waves. They are "suspicious of but non conclusive" of myocardial infraction. Blood tests for the enzyme creatine kinase and proteins troponin should be done. These are elevated in a heart attack. In a stunned heart, these results too are inconclusive. The echocardiogram is the clincher. The heart is ballooned out. This change occurs typically at the apex of the heart. It is important to make a distinction between heart attack and takotsubo as the medication is different.

The treatment for takotsubo is mainly supportive. Medication is given to remove fluid from the lungs and prevent clots. Recovery occurs within a few days.

About two per cent of people who were thought to have a heart attack actually had broken hearts. In the case of women, this increases to seven per cent. Women, mainly menopausal ones (60-75 years), have "broken hearts" eight to nine times more often than men. Some people are genetically prone to "broken hearts." Depression plays a role in susceptibility to this condition. Recurrences can occur in 10 per cent of people.

People who are in poor physical condition do not need severe emotional stress to suffer a broken heart. An episode may be precipitated by a minor event like rejection, or even a lecture or talk before an audience.

In order to never develop this condition; it is important to develop metal and physical toughness. Walking for 40-60 minutes a day at a brisk pace exposes the heart to small doses of adrenaline and nor adrenaline in a controlled manner. The heart gets conditioned and is immune to sudden chemical surges. Meditation and yoga provide calmness and the mental strength to cope with good days and bad.

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

contraception

http://www.telegraphindia.com/1141124/jsp/knowhow/story_19078544.jsp Let’s talk of contraception Your Health DR GITA MATHAI Since it is the woman who has to carry a baby for 40 weeks — with its attendant nausea, food fetishes, backache and swollen feet — she should have a right to choose when she wants to have children and how many. This is where prevention of pregnancy or contraception comes in. There are 15 or more methods of contraception available internationally. They are both temporary (for spacing) and permanent. Most require access to clinics and medical personnel. Understanding each method and choosing the correct one requires intelligence and some level of education. Sterilisation (tubal ligation) involves tying off the tubes leading to the uterus. This is a short surgical procedure, which requires only local anaesthesia. Though it is a “permanent” method, it can be reversed with a 40-80 per cent success rate. Men can also have surgical and even “non-scalpel” vasectomy. Reversal is successful in 50 per cent cases. The procedure in men is simpler and less prone to complications. Despite that it is not very popular. The oral contraceptive pill is 99.9 per cent effective if used correctly. A medical check up should be done before starting “the pill” and yearly after that. Fertility returns within 3-5 months of stopping the tablet. Rings impregnated with estrogen and progesterone can be inserted into the vagina. They have to be removed after three weeks and a new ring reinserted a week later. Hormonal patches (Ortho Evra) can be stuck on the skin. They need to be changed every week. Injections of long acting progesterone can be administered every 12 weeks. They may cause some weight gain and irregular bleeding. Implants are small, hormone-impregnated rods that can be inserted beneath the skin under local anaesthesia. They need to be replaced every three years. Intrauterine devices can be inserted into the uterus and left there for periods varying from three to five 10 years. A medical professional needs to insert and remove them. The I-pill or morning after contraceptive is used for unexpected unprotected intercourse. The pill should be taken within 72 hours. Since it contains a high dose of hormones it should be used for emergencies only. It is not suitable for frequent use. Condoms are available for both men and women. They should be used from the beginning to the end of intercourse. Their effectiveness increases if used in combination with spermicides like Today or Durafoam vaginal tablets, Delfen or Volper cream. Diaphragms, cervical caps and sponges can be inserted just before intercourse. They can be combined with spermicidal jelly or foam. Women need to be fitted with a device of the correct size and taught to insert it. It needs to be left in place for at least six hours after intercourse. It is washed, dried and used again. If any of these contraception methods fail, pregnancy can occur, even in breast-feeding mothers or women who have not yet had their periods after childbirth. Abortion is legal in India and can be surgical or medical. There are protocols in place for the use of surgery or tablets for safe abortion. Please do not purchase tablets over the counter or attempt abortion without medical guidance. 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

Bless you! http://www.telegraphindia.com/1141117/jsp/knowhow/story_19048878.jsp#.VG64v4vLe9g Your Health DR GITA MATHAI Winter brings in its wake runny noses, sneezing, itchy eyes and sometimes even wheezing. Is it the flu? Or is it allergic rhinitis (a runny nose caused by allergy)? Distinguishing between the two is sometimes difficult. But remember there is always fever with flu whereas in allergies there is no rise in temperature. Allergies occur because the body reacts to foreign particles — pollen, dust, cockroach dander, birds, cats, dogs or even strong odours like room fresheners, paint and mosquito repellents. As soon as the allergen comes into contact with the lining of the nose, IgE (immunoglobin E) is produced. This attaches itself to mast cells present in the nose. In an attempt to rid the body of the offending compound, the mast cells release histamine and other inflammatory chemicals. These are responsible for the symptoms of allergy. The eyes and nose water, and there may be incessant sneezing. IgE is specific; each type is produced in response to a particular allergen. This is why some people are allergic to cats and others to paint. Some people are not allergic at all as their IgE levels are low. The tendency to have allergies runs in families. Some people are unfortunate and sneeze all year round. They have perennial rhinitis with chronic nasal congestion. Perennial rhinitis increases with age as the nasal mucous membrane progressively becomes thin and dry. Also, constant exposure to irritants like cigarette smoke and air pollution can cause the nasal passages to become irritated, engorged and leak fluid. Estrogens can cause nasal congestion and sneezing. This may be distressing during pregnancy or during certain phases of the menstrual cycle. Synthetic estrogens (in oral contraceptives or hormone replacement therapy) can produce a similar effect. Other medicines like antidepressants, sedatives like alprazolam and blood pressure medications can cause nasal congestion as a side effect. To keep allergies away: • Avoid obvious allergens like cigarette smoke and strong odours • Keep the house dust and mold free • Make sure that pests like cockroaches or bed bugs are eliminated • Wash the nostrils morning and evening using a solution of half a teaspoon of salt and a pinch of baking soda in a cup of water • Spay the nostrils with a non absorbable steroid spray morning and evening • Take steam inhalations Antihistamines are the mainstay of therapy for allergic rhinitis. They dry the secretions so that the symptoms disappear. The older antihistamines like diphenhydramine (benedryl) caused drowsiness, but the newer second generation antihistamines are much better. Leukotriene antagonists like montelukast can be used in combination with antihistamines for added benefits and quicker results. If the symptoms are very severe then it may be possible to identify the allergen. There are centres that specialise in allergy testing. The skin is pricked and exposed to small amounts of suspected allergens. If a bump appears at the site of testing, the test is positive. Desensitisation is attempted by injecting increasing doses of the allergen at specific intervals. A third of the patients benefit to some extent but many require maintenance injections. 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

pelvic pain

http://www.telegraphindia.com/1141103/jsp/knowhow/story_18992189.jsp#.VF3JNjSUea8 Pelvic pain Your Health DR GITA MATHAI Many of us suffer from pelvic pain. Although common, it is a poorly understood disease. At best it may be described as a discomfort somewhere below the umbilicus and above the pubis. It may be constant or intermittent, dull or sharp, and aggravated by sitting or standing for long periods. Lying down usually brings relief. The condition is called chronic if it is present for six months or more. However, such pain should not be confused with dysmenorrhea — the pain that accompanies menstruation — or pregnancy pains. Pelvic pain has many causes. In women, it may be due to a pelvic infection. Organisms such as bacteria, viruses, chlamydia or spirochetes may affect the body. The infection may not have been treated or may have been inadequately treated, resulting in chronicity and adhesions. Endometriosis is another reason. This is a condition where the endometrium, a tissue that forms the inner lining of the uterus, grows outside it — in the pelvis and abdominal cavity. But it behaves as though it were in the uterus and bleeds during the menstrual cycle. As this blood cannot exit the body, it breaks down wherever it is and forms adhesions and scars that distort the pelvic architecture. This can cause severe pain. The cause may also lie in the urinary bladder (cystitis) or in the bladder wall (interstitial cystitis). There is pain if the bladder is full. Sometimes, pelvic pressure or pain is felt if the person suffers from irritable bowel syndrome (IBS). Then there may be uncomfortable or painful bloating, with constipation or diarrhoea. Another reason is pelvic congestion, which is due to enlarged veins. This can be picked up by doppler or ultrasound studies. In men, pelvic pain may be due to urinary tract, bladder or prostrate problems. Urinary tract or acute prostate infections can be identified and treated. Chronic prostatitis is difficult to diagnose and treat. The infecting organisms are tough to identify. Prolonged treatment with antibiotics like quinolones (ciprofloxacin) or Septran may be needed, although the symptoms may persist. A pelvic examination helps identify infections, tumours or an enlarged prostate. There may be trigger areas which when pressed produce the pain. Cultures of urine from samples taken by prostatic massage, from the cervix or vagina may grow bacteria. An ultrasound will estimate the size of the pelvic organs and tumours, if any. If nothing shows up, X-rays and CT scans or MRIs may be done. If all the tests are negative, a laparoscopy may be needed to see into the pelvis. While diagnosis is pending, one may explore other avenues. Sitz baths — sitting in a basin of warm water for 10 minutes two or three times a day — often help. Another technique is alkanisation of the urine with alkalising solutions got from the pharmacy. Or else dissolve a teaspoonful of baking soda (sodium bicarbonate) in a tall glass of warm water (300ml) and drink it at bedtime. Those who have high blood pressure or are on salt-restricted diets cannot do this. The trigger points on the abdomen may be numbed by applying ice packs. Sometimes a local anaesthetic can be injected to provide temporarily relief. The sensation of pain travels through nerves up the spinal cord to the brain. Mild antidepressants like amitriptyline and gabapentin can block these transmissions and relieve the pain. They are especially effective if combined with anti-inflammatory medications like ibuprofen. IBS and food allergies should also be tackled. Sometimes avoiding milk or wheat or both, and tackling abnormal gut motility works. Physical activity reduces pain to an extent. Walking, jogging or running for 40 minutes a day is important. This should be combined with stretching and pelvic exercises. And if there is stress, cut it down with yoga and meditation. 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

http://www.telegraphindia.com/1141027/jsp/knowhow/story_18967972.jsp#.VFYA34vLe9g Sleep, sweet sleep Your Health DR GITA MATHAI Good night • Avoid caffeine in any form after 2pm • Do not consume tobacco and alcohol • Walk, jog, run, swim or cycle for 40-60 minutes a day • Stop all exercise three hours before bedtime • Meditate before bedtime • Drink a glass of warm milk before going to bed The amount we sleep and wake is not a random occurrence. It is regulated by complex chemical transmitters in our brain. During the day, activity causes a chemical called adenosine to build up in our body. When it reaches a critical level, there is an overwhelming desire to sleep. If you have not been sleeping enough, you can build up a “sleep debt” with high levels of adenosine, causing lack of concentration, daytime drowsiness and sudden attacks of sleepiness. These may be socially inappropriate or cause life-threatening accidents. In children, lack of sleep produces paradoxical changes with irritability, aggressiveness and hyperactivity. Our spinning world is governed by light and darkness. The changes in the external environment are reflected in our internal biological clock, a bundle of cells in our brains. These respond to darkness by producing a chemical called melatonin, which produces sleep. These cells get confused when the environment has artificial light. The “blue light” produced by televisions, computer monitors and cell phones is particularly harmful. Infants need 16-18 hours of sleep a day. This drops to 9-10 hours in children and 8-9 hours in teenagers. Adults need 7-9 hours of sleep a day. Adequate sleep is needed to keep the brain chemicals in balance. Long standing sleep deprivation causes these neurotransmitters to go haywire. The production of leptin, responsible for appetite suppression, decreases and its opposing enzyme ghrelin increases. Appetite increases, along with a craving for carbohydrates. Eventually people become obese, develop glucose intolerance and may actually become diabetic. Sleep may be disturbed because of concurrent illnesses or social situations. Urinary tract infection or an enlarged prostrate may require frequent visits to the toilet. Infants may require frequent night feeds. The other people sleeping in the room may snore loudly or grind their teeth. Children may suck their thumb. In the silence of the night, these sounds can appear extremely loud. The common sleep disturbances are: • Insomnia with difficulty in falling and staying asleep with early rising and intermittent bouts of wakefulness. • The restless leg syndrome where there is an irresistible urge to move the legs. This can force people to get to up, shake the leg and walk around. • Sleep apnoea where people stop breathing several times during the night • Narcolepsy with excessive daytime sleepiness and uncontrollable episodes of falling asleep during the day. If you feel you have a sleep disorder, correctable causes must be treated first. Any external factors causing a disturbance, like a noisy partner or electronic equipment in the room, must be tackled. Stimulants like caffeine (coffee, tea and cola), should not be drunk after 2pm. Nicotine (cigarettes, snuff and chewing tobacco) stimulate the brain cells so that sleep is disturbed. Alcohol can “knock you out” fast, but the sleep is deep, disturbed, unnatural and arousal occurs within a few hours. Concurrent medical problems like cardiac failure, renal failure and even bronchial asthma can cause sleep to be uncomfortable and disturbed. The pain in arthritis can cause tossing and turning. Mental changes of Alzheimer’s or early onset dementia can cause lack of restful sleep. Depression makes people wake early. They toss and turn restlessly, unable to sleep again, and have their problems reverberate in their brains. Sleep apnoea sufferers have intermittent episodes in the night when they may snore or stop breathing. They wake up as the carbon dioxide concentration builds up. It may occur because the throat muscles relax too much or because the brain fails to send proper signals to the respiratory centre muscles, ordering them to breathe. It can be fatal. Lack of sleep should be investigated. A diary should be maintained of the sleep-wake patterns. Medical conditions should be investigated and treated. There are “sleep laboratories” which observe, test, diagnose and treat sleep disorders accurately. If sleep eludes you, do not lie in bed tossing and turning. Get up and read a book (television is not a good idea) and try not to become anxious and frustrated. 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

breast cancer

http://www.telegraphindia.com/1141013/jsp/knowhow/story_18919489.jsp#.VEIo6im1Ybg

A ticking time bomb

Your Health DR GITA MATHAI

The figures are disturbing. One in 30 urban women and one in 60 rural women in India develop breast cancer by the age of 70. This difference in incidence may be real, or because rural women (out of fear, socioeconomic reasons or ignorance), do not come forward for treatment. Breast cancer develops silently and painlessly. A lump that is “just there” may be ignored. By the time action is taken, it may be really large or have spread to adjacent lymph nodes or disseminated via the blood stream to various other organs like the lungs, liver or bones. There is a great deal of scientific research on breast cancer. This makes it one of the more treatable cancers. The downside is that even though technically the person is cured, the cancer can recur elsewhere — in the same breast, at the scar site or metastasise (spread) to a distant organ even 10-15 years later. Once diagnosed, even if treatment is taken and completed, the disease remains a ticking time bomb. Regular follow up is required. Breast cancer is more likely to develop if: Menstruation began before the age of 12 and menopause after the age of 54 The woman has no more than one child Child birth occured after the age of 30 The woman has a high fat diet BMI (weight divided by height in metre squared) is more than 30. The woman has no aerobic exercise. Some families are more prone to breast cancer. Many of the first-degree relatives (mother, aunts, grandmother, sisters) have breast cancer. These families carry genes and mutations that make them 60-80 per cent more prone to developing the disease. The commonly known genes are the BRCA1 and the BRCA2. The BRCA2 gene is associated with bilateral disease. Men who carry this gene can develop breast cancer. Other less-known genes are also associated with breast cancer. Breast self examination familiarises women with the shape, size and texture of their breasts. It helps them to pick up subtle changes, which may require further investigation. It should be done every month 5-7 days after the periods. Breast cancer can be present in the milk ducts alone. It then causes unilateral discharge of milky fluid or a brown or blood stained discharge. The nipple may get pulled inwards so that its shape is distorted. Bilateral milky discharge is more likely to be non cancerous. It can be due to thyroid deficiency, pituitary disease, fibrocystic changes in the breasts or the side effect of certain motility medications like perinorm or domperidone. The cancer may be in the lobules of the breast. The lump may be clearly felt. The skin overlying it may change in appearance, causing it to have an orange peel (peau de orange) appearance. Once a lump or cancer is suspected, the following may be done: Ultra sound scanning (for screening) Mammogram PET scan MRI Lumpectomy (removal of the tumour) and pathology studies Fine needle aspiration cytology Sentinel node biopsy to see if it has spread. Cancer always starts in a single cell whose multiplication is rapid and uncontrolled. As long as it remains localised, it is called “cancer in situ” or non-invasive cancer. As it grows, it becomes invasive. Some cancers grow fast in the presence of estrogen. They are called ER (estrogen receptor) positive cancer. Aggressive spread of the cancer and a tendency to recurrence occur in women who carry the HER2 gene. If the cancer type is known it is possible to specifically target the estrogen receptors and the HER2 gene. Previously, the entire breast with cancer, the regional lymph nodes and the muscles of the anterior chest wall were removed. Now just the lump is removed, leaving a healthy tissue margin. Sometimes the tumour is shrunk before surgery with radiation or chemotherapy. Carriers of the BRAC2 gene have a four per cent chance of a recurrence in the opposite breast. Some women opt for prophylactic removal of the normal breast. This is an informed choice and not a necessity. Surgery can always be done later if cancer crops up. Personal preventive methods: Breast-feed children to the age of one Maintain ideal body weight Avoid fat-laden food Exercise for an hour a day Perform breast self-examinations regularly to detect changes early 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

balance and coordination http://www.telegraphindia.com/1141006/jsp/knowhow/story_18896719.jsp#.VDPDbmeSya8

Balancing act

Your Health DR GITA MATHAI

In the womb, we float around like fish. Once born, we have to learn to sit, crawl, stand up, walk with one foot always touching the ground and run with both feet off the ground. Later we progress to activities that need even more balance, such as riding a bicycle or playing structured games. These skills are lost in reverse as we age. We acquire balance as our nerves mature. We develop a complex interplay of nervous activity with smooth, rapid connections established between the eyes, the vestibular (balance) apparatus in the ears, muscles, bones, peripheral nerves and brain. Constant use and practice hones these pathways. If the centre of gravity shifts and falls outside the base of support (the feet if we are standing or buttocks if we are sitting), we tilt and fall. After the age of two, children are able to correct this easily, automatically widening their feet and legs. As age advances, adults slowly lose this ability. Loss of balance and falls spike sharply after the age of 65. In addition to balance, we require coordination — the ability to perform smooth, accurate, controlled movements, visualising and gauging the distance and the strength required for the action. The graceful strokes of a tennis player or the movements of a basketball team are evidence of this. One of the commonest causes of loss of balance and coordination in older people is lack of exercise. Disuse makes muscles flabby. They are no longer able to support the body and reaction time is slowed. Weak muscles do not respond rapidly or appropriately. Low levels of calcium, with or without vitamin D3 deficiency, is common in older adults. This not only makes muscles flabby but also sends them into spasms. A sudden cramp can cause loss of balance. Substance abuse, particularly alcohol, disturbs the internal equilibrium. When a person who has imbibed a little loses his balance, he are usually able to correct himself . Once he has drunk too much, he “passes out” and lies wherever and however he has fallen. The same holds true of people who have taken recreational drugs like marijuana. Even excess of coffee has a similar effect! If a person who has taken a sleeping pill is woken up suddenly, he can be disoriented. If he tries to stand up, he can lose his balance and fall, particularly if the room is dark, as the eyes are unable to compensate. This is why many physicians are reluctant to prescribe sleeping pills for older adults. Vitamin B 12 deficiency causes a glove and stocking type of loss of sensation in the hands and feet. As the person cannot accurately gauge or feel the position of his feet, there can be loss of balance. Aerobic exercises such as walking, jogging, running, cycling and swimming is recommended for 40 minutes a day to maintain health. In addition, solving puzzles such as sudoku or learning poetry is recommended to keep neurons alive and active. Additional exercises for balance should be done for 10 minutes. Any movements that are repetitive and involve rapid transition from one hand or leg to another is good for maintaining balance and coordination. FIT AND FINE • Pretend to sit on a chair. Hold the pose for 20 seconds. Repeat twenty times • Lift one leg (hold a chair if necessary) till the hip is flexed to 90 degrees. Hold for a count of 20. Repeat with the other leg. Do 20 repetitions • Get down on hands and knees. Stretch a leg out and the opposite hand. Hold for a count of 20. Repeat with the other leg. Do 20 repetitions • Cycle in the air touching the opposite knee with the elbow. Do 50 repetitions • If there is a ladder, place it flat on the ground. Run or walk through the rungs forwards and backwards 5-6 times • There are several yoga poses that help with balance, like the tree, eagle or warrior pose. It is better to go to a yoga class and learn from an instructor 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

ED

http://www.telegraphindia.com/1140922/jsp/knowhow/story_18858708.jsp#.VCRAs4C1Ybg

An embarrassing disease

Your Health DR GITA MATHAI

Every week this column gets a number of letters from men who have — or think they have — impotence or erectile dysfunction. They are too embarrassed to consult their physicians and the letters invariably end with the request “please answer the question but do not publish my name!” Many men, as they cross the age of 40, avoid exercise, put on weight (particularly around the waist), drink alcohol and use tobacco. This unhealthy lifestyle results in a bouquet of diseases, with diabetes, high blood pressure, unhealthy lipid profiles and heart attacks topping the list. About 40 per cent also suffer from impotence or erectile dysfunction (ED). Proper erectile function requires a complex interplay between brain chemicals, blood follow to the concerned organ, psychological factors and love or desire for the partner. It is not a mechanical response. If erection never occurs, it may be due to low testosterone levels. Testosterone levels are highest in adolescents and young men — usually between 300-1200ng/dL. After the age of 40, testosterone levels decline at the rate of approximately one per cent per year. Tumours in the pituitary called prolactinomas or under functioning thyroid glands can cause hypogonadism and low testosterone levels. If erection occurred initially and then declined in frequency or ceased, the reason may be psychological. But diseases that can interfere with proper functioning need to be ruled out or tackled first. Diabetes affects not only the blood flow but also the pudendal nerves responsible for a sustained erectile response. Some people are unaware that they have “crossed over” and become diabetics. Others are unwilling to accept the illness and do not regulate their intake of food and sugar. Elevated lipids can form plaques, which block vital blood vessels, physically preventing proper erection. Blockage can also occur because of nicotine — inhaled (as cigarettes), chewed or sniffed. Alcohol affects the liver, and that in turn reduces the level of male hormones. It also produces a neuropathy in the vagal nerves. These need to work properly for erection to occur. Surgery or injury to the male reproductive organs can result in ED. Surgery to the prostrate has often been blamed. The prostrate actually does not have a role in erection. The problem can occur because the nerves in the pelvic area may be damaged during surgery. Some prescribed medications such as the SSRI group of antidepressants and some anti-hypertensives can have an adverse effect. It is important not to stop taking these medications without asking your physician for an alternative. ED is treated by specialised urologists called andrologists. They initially screen the patient with blood tests to rule out correctable causes for ED. Blood tests will pick up diabetes, elevated lipids, thyroid malfunctions, liver disease, renal diseases and low testosterone levels. Other specific tests are duplex ultrasound, tests of penile nerve function, nocturnal penile tumescence, biothesiometry, dynamic infusion caverosometry, corpus cavernosometry and magnetic resonance angiography. If all the tests are normal, the reason for the malfunction may be psychological, usually due to stress. Psychotherapy helps. In addition medications, particularly sildenafil (better known as Viagra) and its derivatives, often help. Although these medications are available over the counter (OTC) it is advisable to take them under medical supervision. They are contraindicated in heart conditions and can react adversely with other medication you take. Sildenafil takes 30-60 minutes to work and can be taken once in 24 hours. Ideal body weight (height in meter squared X 23), a healthy lifestyle with 40-60 minutes of running, jogging or cycling a day, yoga or meditation to avoid stress, a good nights sleep, avoiding alcohol and smoking and a stable loving relationship with a significant other will probably avert these embarrassing shortcomings. 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

diabetic neuropathy

http://www.telegraphindia.com/1140915/jsp/knowhow/story_18835166.jsp#.VBbuZ5SSya8 The slow killer

Your Health DR GITA MATHAI

Most senior citizens in India have diabetes. Unfortunately, many do not take this disease seriously. They cheat on their diet, add “a little sugar” to their tea and miss their daily dose of pills. They coast along, as complications take a long time to set in. Uncontrolled sugars damage the nerves, causing “diabetic neuropathy”. High blood sugars slow down conduction signals in nerves and the blood vessels, which supply essential nutrients to the nerves, are also compromised. Smoking and consumption of alcohol aggravate diabetic neuropathy. The symptoms are many. Tingling, numbness, sudden shooting pains can occur along the peripheral nerves, which supply the limbs. The pain of an injury may not be felt as the sensation in the distal parts of the limbs is affected. So injuries that go unnoticed can lead to an infection and eventual amputation. Muscles become weak and flabby, resulting in loss of power and balance. If the autonomic nervous system is affected, the heart rate can be inappropriately rapid at all times instead of fluctuating with activity. This interferes with the body’s ability to maintain blood pressure. Giddiness may appear or consciousness may be lost on suddenly standing up. The movement of the gastrointestinal tract can be affected. It may become difficult to swallow as the esophagus does not contract properly. The stomach may become lax and distended causing belching, a feeling of fullness, nausea and vomiting. The slow movement of food through the intestine can cause constipation. In others the neuropathy may cause uncontrollable watery diarrhoea, worse at night. Damage to the bladder nerves prevents the person from sensing whether the bladder is full or empty, leading to incontinence. Sex organs can become affected. In men, this can cause impotence and erectile dysfunction. In women vaginal lubrication may decrease and there may be failure to achieve orgasm. The muscles responsible for proper focus in the eyes can malfunction. There is blurring of vision. The treatment of diabetic neuropathy begins with proper control of blood sugars. The blood sugar should be in the target range of 80-130mg dL on an empty stomach and 180mg dL two hours after food. A judicious combination of diet and exercise needs to be followed. Between 1500 -2000 calories can be eaten a day. Avoid processed food, sugar and honey. Walk, jog, cycle or swim for at least 30 minutes a day. Weight training exercises help maintain muscle mass and strength. Twenty to thirty repetitions of standard drills with dumbbells weighing 1-2kg will maintain muscle mass without adding bulk. Blood sugar can be controlled with insulin injections or medications that increase the body’s insulin output. In addition, specific medicine can be taken for the symptoms of neuropathy. The pain of neuropathy responds to external applications of a capsaicin-containing ointment and also to acupuncture. If these do not work, effective drugs are pregabalin and carbamazepine, which belong to the seizure medication group. Antidepressants like amitriptyline, nortriptyline, desipramine and duloxetine are effective in some people. Avoid codeine-based painkillers as they can become addictive. 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

http://www.telegraphindia.com/1140901/jsp/knowhow/story_18785654.jsp#.VAep6YC1Ybg Tackling depression Your Health DR GITA MATHAI Robin Williams was everyone’s favourite funny man yet his death showed that his life was anything but happy. Depression is now a common disease. In fact, India has the largest number of people suffering from depression, a staggering 35 per cent of the population. Depression can result from imbalance in the chemical messengers (neuroreceptors) in the brain. The tendency to develop this can be inherited. Symptoms of depression may set in insidiously. The victim may have ordinary feelings such as sadness, anger, irritability or frustration, which are more than warranted by the occasion. Pleasurable pastimes may cease to be so. There may be a feeling of perpetual tiredness, difficulty with initiating or completing a task. Remembering things and concentrating may be a problem. Depression can result in loss of appetite and weight but in many victims there may also be a pica (craving for inedible things) or food cravings. Indulgence in certain foods such as chocolates can temporarily increase the levels of mood elevating chemicals in the brain. Frequent indulging, in an effect to maintain the euphoria, can result in weight gain. It can also result in the use of alcohol, tobacco products, over the counter (OTC) drugs such as mood elevators or sleeping tablets, illegal drugs such as amphetamines, or hard drugs. In children, the symptoms are subtle. They may cling to the parent or guardian, refuse to go to school, have recurrent aches and pains (such as headaches), not eat food and fail to gain weight as expected. Depressed teenagers avoid social interaction with their peers, lose interest in normal activities, are extra sensitive and eat and sleep too much. Academic performance starts to drop. Psychiatrists classify depression as major or minor, depending on the number of symptoms present. Major depression can continue for a long time if not treated. The person may talk of suicide or make an attempt at it. The first attempt (especially in women) often fails. It should be considered a plea for help and a professional consulted. In women, delivery can precipitate post partum depression. This clears up within a year with medication and family support. Hormonal changes occurring with menstruation can trigger mild to severe depressive symptoms every month. If mild, they are called PMS (premenstrual syndrome) and if severe premenstrual dysphoric disorder (PMDD). Both conditions are aggravated by alcohol use (not a rarity in Indian women anymore), being overweight and lack of exercise. Both can be managed with regular exercise and a reduction in salt (pickles and preserved foods) and caffeine (coffee, tea and cola) intake. Treatment of depression involves a combination of psychotherapy, medication and lifestyle changes. Medication belonging to several chemical groups alone or in combination can be used for treatment. They act by correcting the neurotransmitter imbalances in the brain, which may take a few weeks. A lifestyle change with socialisation helps depression. In may be worthwhile to join groups with similar interests. Exercise has proven benefits. The chemicals released from the large muscles utilised during exercise correct neurotransmitter imbalances in the brain but at least 40 minutes of aerobic activity is required for this. 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

knee pains

Take care of your knees • Obesity puts strain on the knees. Maintain a BMI (weight divided by height in metre squared) between 23 and 25 • Do exercises to strengthen the knees. These exercises are available on the Internet, are part of yoga and can be taught by a physiotherapist • Always warm up before and cool down after exercise • If you have knee pain, shift to non-weight bearing exercises such as swimming or water aerobics

The knees are one of the larger joints in the body, supporting its entire weight. It is a hinge joint, like that of a door, capable only of moving forwards and backwards. Attempts to force a door to move sideways or push it open in the wrong direction will result in the door “coming off its hinges.” A similar problem occurs when the knee is forced to move in the wrong direction.

The knee joint is composed of three bones, the lower end of the femur and the upper ends of the tibia and fibula, articulating with one another. The raw bones do not grate against each other. They are separated by a “joint space” filled with synovial fluid, lined with articulating cartilage and separated by little washers called meniscii. There are ligaments inside the joint holding it in place. Considering the size of the knee joint, these ligaments are woefully inadequate. In the front of the knee is the kneecap or patella.

The knee undergoes constant wear and tear. Our daily activities involve walking and climbing stairs as well as exercising. In a lifetime, the knee joint functions over and above its capacity!

Pain in the joint can be acute and occurs owing to injury, infection, or age-(or overuse) related degeneration. The cartilage breaks down, exposing parts of the bone underneath. The raw nerves are exposed and this becomes very painful. Bits of broken cartilage can get trapped in the joint. When that occurs, movement can result is sudden pain and the joint can get locked.

Dislocations and injuries are more common in the young — basketball and football are notorious for causing knee injuries. This is because there are sudden abrupt changes in the direction of movement, which may be against the normal anatomical direction of movement. The player may land awkwardly or fall, bruising and injuring the joint.

The two knees support the weight of the entire body between them. The bones are physically capable of supporting only a certain amount of weight. Obesity causes the knees to degenerate rapidly. Depending on gait and posture, one side may wear out faster than the other. This may result in a bow-legged appearance. Walking is extremely painful and the gait may be crab like. The entire joint may be swollen and painful. Or, the pain may be localised on one side. At times, instead of the whole joint, the area under the patella gets worn down and irregular. As that rubs against the bones underneath, there is terrible pain with movement.

Children seldom develop knee pain without injury or a fracture. Boys can develop pain as part of certain inherited congenital syndromes or birth defects in the knee. The patella may also get dislocated. This is more common in teenage girls.

Infections, acute trauma and fractures result in swollen, warm and tender joints. Arthritis, especially rheumatoid or osteoarthritis, can produce a similar picture. Infection always produces fever. Gout usually affects the big toe but can present itself as a painful knee joint. It may be worth checking uric acid levels.

going for gold

Striking gold

YOUR HEALTH DR GITA MATHAI

AS GOOD AS GOLD: Vijender Singh Citius, Altius, Fortius” goes the Olympic motto in Latin. Translated, it means “Swifter, Higher, Stronger.” That is what every Olympic athlete strives for — to be the best. His or her single-minded dedication, tremendous personal sacrifice and discipline are to be admired and emulated. It is not easy to drive your body to its limits. Great athletes need the right genetic makeup, body proportions and physique. They can then be moulded for the job. Michael Phelps is 6 feet 4 inches tall, but has proportionately shorter legs attached to a long trunk, with giant size 14 feet that look and function like fins. Kip Keino, the Kenyan marathon runner, is only 5 feet 8 inches tall but has thin, long runner’s legs and a short torso. In short, aspiring athletes need the correct genes and a supportive family and government. A genetically apt form and physique is wasted without the right training, nutrition, mental discipline and financial support. This does not mean that we ordinary people cannot exercise and strive to be healthy. The human body has striated or voluntary muscles which function on demand. These muscles are either “fast-twitch” (white) muscles or “slow-twitch” (red) muscles. The white muscles contract rapidly and tire easily. They are good for sprinting. The red fibres are best for endurance sports as they have increased muscle power and are twice as efficient. With training it is possible to develop a particular muscle type, but a choice has to be made between speed and endurance. This is why a tall, strong, muscular and powerful human with more red muscle cannot move swiftly or manoeuvre as efficiently as a small, lean person with more white muscle. Animals show this distinction in evolution. The cheetah has tremendous sprinting speed over short distances, but the horse has far greater stamina and endurance. Once a particular muscle type has been trained, it is possible to excel in related events that have similar energy requirements. The same people will do well in the 100m and 400m sprints, the 110m hurdle and the long jump, but not in the 5000m event which requires more stamina. Tremendous torso strength is required to throw a shot put, hammer or javelin. These events require stocky athletes who may not be able to move fast and do well in sprints or jumps. Everyone (particularly all Indians) should prioritise staying fit and exercising to the limit of his or her endurance. This means exercising one hour a day and trying to achieve the target heart rate (80 per cent of 220 minus age). This habit needs to be started young. Unfortunately, many school going children today are obese with a Body Mass Index (weight in kg divided by height in metre squared) greater than 25. However, it is never too late to start. Despite age, infirmity and illness, the body when trained and pushed is capable of miracles. To start exercising, set a realistic primary fitness goal, and prioritise it as daily, monthly and lifetime goals. Decide if the exercise is to remain healthy, lose weight, contour the figure, improve cardiovascular status, control blood sugars, normalise blood pressure, for anti anxiety and anti depressant effects, to help work through fatigue or to compete in sports. The effort put in and the training will be different in each case. Targets will never be achieved without setting goals and if there is a tendency to procrastinate. Regular exercise should include a 15-minute warm-up, a one-hour workout and a 10-minute cool-down phase to prevent muscle injury. For the warm-up, do one or two pull-ups, spot jogging, skipping, push-ups and short stepping in place, gradually increasing the pace till sweating starts. Finish the warm-up with stretches. Slowly move the muscles, tendons and ligaments to increase flexibility. Stretch the Achilles tendon. Lunge from side to side and front to back. For each workout, pick and target a specific area that needs improvement. Decide ahead and fix a rotating timetable so that all the major muscle groups are exercised. Muscles accumulate lactic acid during high intensity exercise. This needs to be removed during a 10-minute cool down process that involves walking and stretching. Regular and judicious exercise can delay the onset of diabetes or hypertension by 10-15 years. It also increases breathing capacity and reduces the frequency of wheezing attacks in asthmatics. Body weight remains under control. Bones, muscles and joints stay flexible, reducing the pain of arthritis. Physically active people have better coping skills and are less likely to succumb to anxiety or depression. The feel good factor makes life pleasurable. The sense of achievement boosts morale. This in turn reduces illnesses, medication, the number of visits to the physician and hospitalisations. As you start your exercise programme, remember each year of exercise adds approximately a year of 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