bad breath

To banish bad breath

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Your Health - Dr. Gita Mathai

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Bad breath makes us self-conscious. About 25 per cent of the population feel that they have bad breath, when actually they don't. Another 10 per cent really have foul breath but fail to recognise it. It is an embarrassing problem and even close family members will seldom tell you that you have it. To check, cup your palms, hold it over your mouth and nose, breathe out and then smell your breath. You will get a fairly clear idea of the odour.

Most of the time, bad breath originates in the mouth. There may be untreated cavities. There may be food stuck in between the teeth. Bacteria feast on this food, breaking it down and releasing gases. Plaque may have formed between gums and teeth. This causes gum infection. Sometimes, if the gums are pressed, pus can be seen. Coffee and alcohol also cause overgrowth of mouth bacteria.

Brush teeth twice a day, morning and evening. Rinse your mouth well after every meal. A mouthwash can also be swirled around in the mouth for 30 seconds after every meal. Try to drink 2-3 litres of water in summer. Water cleanses the mouth and washes out food debris and bacteria.

Food containing spices, onions or garlic can produce halitosis even after the mouth is rinsed and teeth brushed. These condiments contain sulphides, which are released as they are digested. The sulphides are absorbed into the blood stream and released in the breath.

Gastrointestinal reflux disease (GERD) can cause belching and foul smelling breath. Diabetic ketoacidosis produces a fruity odour. Kidney and liver disease can cause a smell like ammonia. Intestinal obstruction causes the breath to smell like faeces. Now there are theories that various types of cancer release characteristic odours.

Sinusitis, post-nasal drip, blocked nose with mouth breathing, tonsillitis and adenoids cause bad breath. Lung infections like bronchitis, lung abscesses, bronchiectasis all result in halitosis, as toxins released by the bacteria in the lungs are breathed out.

Tobacco use destroys teeth and causes bad breath. It does not matter if the tobacco is chewed, smoked or used as snuff.

Sometimes children are put to sleep with a milk bottle in their mouth. This results in dental caries, a coated tongue and foul breath (bottle mouth). They may have sinusitis or adenoids. Children sometimes place objects like erasers, twigs, crayons or toys in the nose. Once the object is stuck there, there is a discharge and a foul smell. They child may not remember placing the object there or may deny it.

If correcting your oral hygiene does not get rid of bad breath:

• Consult a dentist to ensure nothing is wrong with your teeth and gums.

• See a physician to rule out GERD, diabetes, liver and kidney disease.

• Consult an ENT surgeon to rule out nasopharyngeal problems.

• Maintain a food diary to see if any particular item causes the odour.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

summer heat

Keep your cool in summer

https://www.telegraphindia.com/1170417/jsp/knowhow/story_146630.jsp

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Your Health - Dr. Gita Mathai

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We are going to have a long, hot, dry summer, with above average temperatures and no rain. A few deaths from heat stroke have already been reported.

Our body organs function best at an internal temperature of 98.4°F. If the body temperature rises above this, the brain immediately sends chemical signals to the four million sweat glands all over the body. They secrete sweat, which covers the body in a thin film. As this evaporates, body temperature drops.

Sweating is not effective in cooling down children under the age of four as their sweat glands are immature. The process is inefficient in the elderly, in obese individuals and those with diabetes or on certain medications such as anti-depressants and anti-hypertensives. You require water to sweat so dehydration can reduce the amount of sweat formed. This is particularly true in athletes. Clothes made of synthetic fibres also trap the sweat next to the body, making it lose its cooling ability. If there is more than 60 per cent humidity in the atmosphere, sweat cannot evaporate.

If sweat fails to cool the body down, heat exhaustion sets in, with symptoms of weakness, headache, giddiness, palpitations and painful cramps. If this is not recognised, the body’s core temperature continues to rise and can reach as high as 105°F. This can result in confusion, disorientation, seizures and even death.

To prevent heat stroke, in summer, try to stay indoors as much as possible, preferably going out only before sunrise and after sunset. Confine exercising outdoors to the same time. Even swimming in the hot sun can lead to heat exhaustion and stroke.

The key to hydration is to drink plenty of fluids even before you feel thirsty. The best liquids are tender coconut water, lightly salted limejuice and buttermilk. Aerated cola drinks may feel good but are actually hypertonic. They aggravate dehydration. The ill effects of heat are also intensified by tea, coffee and alcohol. 

A person suffering from heat exhaustion should be moved to a shaded spot or indoors under a fan or to an air-conditioned room. He or she should be given plenty of fluids, preferably with salt added. The body should be sponged with tepid water and ice packs placed on the armpits, groin and temples.

Summer is also the season for profuse sweating and prickly heat. Sweat pores can become blocked by dead skin cells, dirt or talcum powder. As the sweat tries to escape, it forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). Eventually, they turn red (miliria rubra), become itchy, and evolve into a brown scaly rash.

Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. Common areas are the forehead, the upper back, chest, arms and inner thighs — in areas where there are body folds and poor air circulation. It is aggravated by friction between the skin and tight-fitting, non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area. This can become secondarily infected with bacteria or candida.

To prevent prickly heat, bathe twice a day after adding a teaspoon of baking soda to a bucket of water. Do not apply soap directly on the skin but use a loofah. Even though advertising portrays prickly heat talc as a soothing option, it will only block the pores further and aggravate the condition. So do not use prickly heat talc, or any other talc, to get relief from prickly heat.

Dr Mathai is a paediatrician. Mail your questions to yourhealthgm@yahoo.co.in

young heart attacks

Young at heart attacked

https://www.telegraphindia.com/1170410/jsp/knowhow/story_145446.jsp

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Your Health - Dr. Gita Mathai

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Heart attacks are accepted as part and parcel of aging, with men over 45 and women over 55 aware that any chest pain they feel may signal an attack. Now, however, the scenario in India is changing. Heart attacks are occurring in men in their twenties and thirties. Since many are unaware that they are at risk, they fail to recognise the symptoms and get help in time. Therefore, 25 per cent of these first attacks unfortunately turn fatal.

The most common symptom of a heart attack is crushing chest pain which can radiate to the neck, jaw, arm or back. It may be accompanied by nausea, vomiting, pallor, dizziness, sweating and an inability to stand. The heartbeat and pulse may be irregular. It can be mistaken for acid dyspepsia, GERD (gastro-esophageal reflux disease), pain in the chest wall, pleural infection, gall bladder disease or eso- phageal spasm.

If a person is suspected of having a heart attack, an ECG (electro cardiogram) is done, which usually shows characteristic changes. Blood tests for cardiac enzymes and blood troponin show elevated levels if the cardiac muscles are damaged. A chest X-ray can be taken to estimate the size of the heart. An echocardiogram delineates the damaged and non-functioning areas of the heart. Cardiac catheterisation is used to visualise the blocked arteries. This helps to determine whether the blocks can be treated by placing stents into the arteries or if a bypass surgery is needed. After recovery, heart function can be evaluated with a treadmill test, cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).

India was an agrarian society where villagers laboured hard in the fields from sunrise till sunset. People developed preventable infectious diseases and died young. Now, education has changed their lifestyle. Many villagers have migrated to cities. Tobacco use is rampant. Exercise is minimal. Food habits have changed, with precooked, high fat, fast food being consumed as the norm. The consumption of fresh fruits and vegetables is minimal.

Many apparently healthy, young, adult males lead sedentary lifestyles. They work long hours and do night duty in an attempt to succeed in their profession. Though many offices have gyms, they are underutilised due to lack of awareness and time, and fatigue. Their weight gradually creeps up. They deposit fat around the stomach. In no time at all, their waist measures more than the ideal 32 inches and the BMI (weight divided by height in meter squared) is more than 25.

Food habits are often bad, with irregular eating times and dependency on oily fried snacks and trans fat filled fast food. Chronic lack of sleeps causes the blood pressure to go up. All this may precipitate diabetes and cause a deranged lipid profile. These abnormalities may be missed as no check ups are done. Many young men decide to have their first check up at 40 when it may already be too late.

Many are smokers, which adds substantially to the risk. Other precipitating factors are sudden emotions as while watching sports, excessive alcohol consumption, heavy fatty meals or sudden unaccustomed physical effort.

To prevent sudden death from a heart attack, the habit of aerobic exercise should be inculcated in children from first grade itself. This should be continued into adult life and in the work place. If you cannot spare an hour, or the recommended 150 minutes a week, run quickly up the stairs and down again slowly for 10 minutes a day. Avoid smoking and excessive binge drinking. Pay attention to your diet and consume 4-6 helpings of fresh fruits and vegetables daily.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in