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