fingernails and toenails

Nailed it

YOUR HEATH DR GITA MATHAI

When you are young, fingernails and toenails give no trouble at all. (They may just be a bit dirty). With advancing age, however, they become brittle, hard, fall off or develop infections and become painful. Suddenly, you are forced to notice your nails! Healthy nails are usually smooth and light pink in colour. Blue nails occur when there is a lack of oxygen in the blood (heart and lung disease). Nails can turn black in vitamin B12 deficiency. A horizontal depression or discoloration can develop across the nail due to illness, antibiotics or chemotherapy. The line becomes prominent as the nail grows out and then gradually disappears. Nails may grow brittle if there is anaemia and can also become spoon shaped. The opposite, a bulged out, parrot-beak like club-shaped nail is seen in chronic obstructive airways disease. Splitting and fraying are associated with hypothyroidism and psoriasis. When trimming your toenails: Briefly soak your foot in warm water to soften the nail. Use a clean, sharp nail trimmer. Trim toenails straight across the top. Do not taper or round the corners or trim too short. Do not pick or tear at the nails. Fingernails grow faster than toenails. The rate of growth depends on health, heredity and sex. Growth slows during illness and with increasing age, but at the same time, the nails become tougher. They are then more difficult to trim. In prehistoric times people had to bite their nails to trim them but today it is a social no-no. Biting in itself is harmless but it can cause secondary bacterial infection of the skin around the nail. It can cause and perpetuate worm infestation. It can transmit flu viruses acquired from contaminated surfaces directly to the mouth. Bitten down nails may work against you in job interviews. It is a habit that is arises out of lack of impulse control, and is perpetuated by stress. Most important, a close examination of the nails can reveal other disease processes such as iron deficiency (anaemia), vitamin B12 deficiency, diabetes, kidney and liver disease and even infection of the heart valves (endocarditis). In older people (particularly those who have high blood sugar) an infected ingrown toenail (usually the big toe) is a common problem. This occurs when toenails are trimmed too short, blades or knives are used instead of nail cutters or if the edges of the nails are picked and torn. If there is no diabetes, an ingrown toenail can be treated at home by soaking it in warm salted water for 10 minutes and placing a cotton ball soaked in antibiotic ointment under it. Nails are also prone to fungal infections. This destroys the nails and gives it an “eaten away” appearance. Topical ointments are not very effective. Medicines have to be taken orally until the infection resolves and a healthy nail grows out. This takes anywhere from three to six months. Medical conditions like psoariasis may mimic fungal infection. A proper diagnosis is essential before embarking on treatment. In our climate, slippers or open-toed sandals are better than shoes. If shoes have to be worn, they should fit properly. Shoes that you wear every day should have plenty of room around the toes so that nails do not hit the end of the shoe. They should also not be too loose as your feet will slide forward while walking or running and hit the end damaging the nails. 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

exercise for children

Teach kids to stay fit

Your Health DR GITA MATHAI

Summer vacations have started. Earlier children would “go to the grandparent’s village” for a month of playing in the fresh air and sunshine. It was a welcome annual ritual, an antidote to the structured drudgery of school days. This is no more the case. Now grandparents too live in towns or cities where there are few playgrounds. The heat makes everyone lethargic; summer sports coaching is available but inaccessible to the majority of children. The stress on academic excellence often means that from a young age children are sent to coaching classes during the holidays. Parents say “my son /daughter plays everyday.” They mean computer games, video games or running around in the house or apartment complex. Others bemoan the number of hours spent watching television. This is often coupled with unhealthy snacking -- packaged foods washed down with sweetened aerated drinks. Naturally the children gain weight. But, the weight gain is unhealthy and the child is over and above the recommended weight for age. The formula (age +3)X5 = ideal body weight in pounds. This divided by 2.2 gives the weight in kilograms. Alternatively the height in metre squared multiplied by 23 provides an approximate value of the ideal body weight. The extra fat is usually deposited in the abdomen producing an unsightly paunch. The accompanying fat thighs mean the children look knock kneed and have an ungainly waddling gait. An hour is the minimum recommended amount of exercise required for physical and mental health of children. Today, the majority of children and adolescents do not get the required one hour of aerobic activity (running, swimming or cycling) a day either during school days or during the holidays. Their muscles are often weak and flabby. As sunlight exposure is minimal, their bones too lack strength, predisposing them to calcium deficiency and osteomalacia in adult life. Studies have shown that around 70-80 per cent of children and adolescents in India are vitamin D deficient despite our abundant sunshine. Obesity and vitamin D deficiency are two of the factors that predispose to the development of diabetes. The lifestyle and habits that result in progression to diabetes are established in childhood. One out of five Indians is either frankly diabetic, prediabetic or has gestational diabetes (diabetes during pregnancy). Many of these people are unaware that they have a problem. They go about their daily activities without any symptoms at all. Some may feel tired, notice extra hunger or thirst, have frequent visits to the toilet, lose weight, or develop urinary tract infections, boils, skin lesions that do not heal, fungal infections on the skin or vagina or urinary tract infections. It is important to recognise a predisposition to develop diabetes. Children who are inactive and obese grow into adults who are the same. They learn by observation. They watch sedentary adults (often their role models) in the family, snacking and watching television assiduously. During adolescence, boys may develop breasts and a paunch. This makes them self-conscious and often undermines their self-confidence. In girls, hormonal imbalances develop. The periods become irregular. Attractive girls grow into teenagers with pimples, a hairy face and scanty hair on the head. Urgent action is needed now, when parents and children have time and energy and are not under the stress of examinations. • Search for a government sports complex near your home. These are well run and provide training in a variety of sports. Even if they do not express an interest and show a reluctance to go, eventually interaction with athletic peers will cultivate a competitive spirit and interest in the sport. • If nothing is available, get up at 5AM, wake up the children and ask them to run/walk outside the house for 40 minutes. The traffic is usually not heavy at that time but supervision is needed. You cannot really sit in the house and tell children “go and run.” • Appropriate footwear is needed. Shoes and socks need to be provided. Running in slippers and sandals is not advisable as it predisposes to injuries of the foot. • Flexibility and core strength is important. This prevents injuries and backache, arthritis and knee pain in adult life. Yoga can be learnt and practiced at home. Martial arts training is also a good alternative. Especially for girls, it provides flexibility, confidence and personal security. Although you may have a strong family history of diabetes, and you may eventually succumb to your genes, regular exercise, and maintenance of a healthy lifestyle and ideal body weight with good muscle mass will go a long way in delaying the onset of the inevitable. It is never too late to start, even if you are technically past your childhood. 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