Tuesday, July 28, 2015

stop suicide

Stop suicide

http://www.telegraphindia.com/1150727/jsp/knowhow/story_33764.jsp
Dr. Gita MathaiYour Health - Dr. Gita Mathai

A physician friend was fascinated by a WHO statement that India had the largest number of suicides when there seemed no statistics available to ratify this claim. As he started looking for facts, he found that in his district there were hardly any suicides, just 11 per 1,00,000 people. Then he stumbled upon the actual problem. No one wants it on record that a family member committed suicide, to which a religious and social stigma is attached. So the sympathetic administration often puts the cause of death as "other". In reality, the suicide rate in India is closer to 58 per 1,00,000 people.
Both men and women attempt suicide - about four times more women than men are likely to attempt it but men are more likely to succeed in their first attempt. The decision to commit suicide may be due to financial problems, stress, a major psychiatric illness such as depression, bipolar disorder or schizophrenia, an incurable medical condition like cancer or an autoimmune disease or, in the case of the aged, a desire to stop being a financial burden to the family.
Suicidal tendencies can suddenly pop into the minds of people who abuse alcohol, sleeping tablets or are on psychiatric medication. The tendency is aggravated if there has been a death in the family, financial forfeiture or loss of a job. Smoking and tobacco use also increase the risk of suicide. The exact mechanism by which the tobacco alters the brain chemistry is not known.
Gamblers become depressed when they suffer financial losses, especially if they have gambled with family money, lost property or savings. Gambling is a surreptitious way of getting an "endorphin high." It is an addiction and finally more money has to be gambled frequently to achieve the same effect. The rebound "down" is when the suicide occurs.
Whole families commit suicide in India. The parents kill the children and then themselves. This is most often associated with financial losses. Chit fund losses are particularly notorious for this outcome.
Teenagers and young adults cannot cope with rejection and failure in academics, the work place or relationships. While studying survivors of a suicide attempt, researchers found that it takes an average of 10 minutes from the thought to the act. Also regret sets in, according to survivors, but it is too little, too late.
Teenage and young adult suicides often occur in clusters around the time of the board exams or when results of professional courses are announced. Parents are often oblivious that their children are stressed and depressed.
Laughter has great anti depressant value. Children laugh 100-150 times a day. Adults laugh 10 times a day and elders 4-5 times. The incidence of depression also creeps up.
If a person threatens or attempts suicide, it is an urgent appeal for help. The person should be referred to a psychiatrist who will evaluate him or her for risk, depression and requirement for medication. A combination of antidepressants and psychotherapy works best.
Suicide prevention is everyone's responsibility. For confidential helplines (for India) log on to suicide.org.
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

Thursday, July 16, 2015

blood clots


http://www.telegraphindia.com/1150713/jsp/knowhow/story_31142.jsp

Of clots


Dr. Gita MathaiYour Health - Dr. Gita Mathai

Every now and again an unexpected "young death" makes the news - a celebrity, more often than not, who died a few hours, days or weeks after a long flight. Though this has been labelled the "economy class syndrome," it affects first and business class passengers as well. It is due to a blood clot that formed in stationery legs, broke free and then blocked blood supply to a vital organ like the heart, lungs or brain.
To remain alive, blood has to flow ceaselessly through our blood vessels. The heart pumps it through the arteries, and it returns to the heart via the veins. The total volume of blood circulating in an adult is between 4.7 and 5 litres. If there is a block or a break in the vessels, the blood supply either drains away or stops. Both can result in death.
Blood remains fluid as long as there is no impediment to its flow. If there is an irregularity or break in the vessel wall, one of its components called platelets collect there. A cascading reaction involving many proteins (clotting factors) occurs and a clot forms. The clot keeps extending until anticlotting factors (also present in the blood) come into play. The clot is contained. After it has served its purpose, it is broken down and absorbed.
Clots form during injuries and fractures. These are "good" clots that prevent the body from bleeding to death. Blood clots may also form if a woman is obese or pregnant. This is due to a combination of factors like physical impediment to the free flow of blood and hormonal imbalances. An excess of estrogens aggravates clotting. If activity is suddenly decreased with prolonged bed rest owing to illnesses or paralysis, stasis in the blood vessels can cause a clot. Cancers can cause blood clots, particularly blood cancers. Smoking is an independent risk factor for clots. Elevated lipids cause "fat plaques" to form along the blood vessels. This makes their lining irregular. Sensing this, platelets aggregate there and form clots. The blood can carry these clots to different parts of the body, producing symptoms and complications. Irregular heart beats can cause clots to form in the heart and then be transmitted elsewhere.
Once a clot forms, there may be warmth, redness, swelling and pain. It may cause a stroke or a heart attack. If it lodges itself in the lungs, it can cause acute breathlessness and death. Sometimes the blood vessel gets slowly blocked by an enlarging clot. This often occurs in the arms and legs. There may be pallor, tingling numbness, reduced hair growth and thin, delicate skin.
Doppler and other imaging tests can confirm the presence of a clot. Blood tests can be done if clots are found in young people to confirm a hypercoaguable state (which happens because of a genetic defect).
Clots can be removed by surgical intervention or treated with medication in the form of injections (initially) and then tablets. Treatment often has to be lifelong. Pregnant women with hypercoaguable states can carry the baby successfully to term with appropriate anti coagulation 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


Saturday, July 11, 2015

ovarian cysts


Dr. Gita Mathaihttp://www.telegraphindia.com/1150706/jsp/knowhow/story_29721.jsp



Your Health - Dr. Gita Mathai

Around 15 per cent of women all over the world develop ovarian cysts. These may be a "one off" occurrence, recurrent benign follicular cysts that occur with menstruation, part of the polycystic ovarian syndrome (PCOS) or ovarian cancer. About three per cent of cancers in women arise from the ovary.
The ovaries are paired organs situated on either side of the uterus. They are present from birth. They have tiny black speckles, which are the millions of immature eggs. They remain dormant and start to function only at puberty, under the influence of hormones released by the pituitary gland in the brain. One mature egg is released every month from one ovary. The area from which the egg is released usually collapses and seals itself off.
Sometimes, the follicle doesn't rupture properly or seal itself off. The ruptured follicle releases hormones for conception. These accumulate, the follicle keeps growing and forms a corpus luteum cyst. Sometimes it just grows and turns into a follicular cyst. These two types of cysts are harmless and asymptomatic. They are usually discovered incidentally during an ultrasound examination. They disappear by themselves after two or three menstrual cycles.
About 15 per cent of women of child-bearing age have PCOS. They suffer from hormonal imbalances as a result of which multiple immature follicles or cysts form in the ovaries. Menstruation becomes irregular with periods that won't start or won't stop. They also fail to conceive. The diagnosis is confirmed with an ultrasound of the pelvis, which show 12 or more cysts in each ovary.
Such cysts can be treated for 3-6 cycles with oral contraceptive pills. In PCOS they regularise the cycle. Loss of as little as 10 per cent of body weight can result in spontaneous remission of menstrual symptoms. The anti diabetic medication metformin also helps.
Some cysts have no correlation with the menstrual cycle. Of these, dermoid cysts can grow to a large size and contain hair and teeth. Cystadenomas are filled with watery or mucous like material. They can also painlessly grow to a large size before they are noticed. These can become cancerous. The endometrium (lining of the uterus) can grow outside the uterus and attach itself to the ovary, forming a tumour- like mass. This can increase in size with each menstrual cycle.
An ovarian cyst causes symptoms if it is large, visibly distends the abdomen and presses on other organs. It can cause dull lower abdominal pain, dyspareunia (painful intercourse), a desire to urinate frequently or pain during bowel movements.
Once an ovarian cyst is discovered, a pregnancy test needs to be done to see if it is a complication of pregnancy. An ultrasound will help to distinguish between a functional cyst and other types. An ultrasound, CT or MRI scan may be followed by laparoscopic visualisation of the cyst. A blood test called the CA125 is done. Normal values are less than 35 U/mL. Elevated values means that the ovarian cyst has to be further evaluated as it may be malignant.
Once an ovarian cyst is discovered, if there is sudden severe abdominal pain, fever, vomiting, cold clammy skin and sweating, you need to go to a hospital at once.
Ovarian cysts can vary in size from 1cm to 10cm or more. Cysts need to be operated if they are of mixed consistency, larger than 5cm, the CA 125 is elevated or there is a family history of breast or ovarian cancer. Laparoscopic surgery can be done for simple cysts. If there is a suspicion of malignancy, open surgery is preferred.
Pregnancy and breast feeding lessen the chance of ovarian cysts and cancer. Both tubectomy and OCP use for family planning also reduce the risk of ovarian cancer.
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