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embarrassed to consult their physicians and the letters invariably end with the request “please answer the question but do not publish my name!”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