dizziness

Dizzy? First feel easy 

https://www.telegraphindia.com/1170515/jsp/knowhow/story_151568.jsp

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Your Health - Dr. Gita Mathai

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People sometimes complain about light-headedness, giddiness or dizziness. They use the terms interchangeably, confusing the physician. Does the person feel like fainting? Is the room spinning around? Is it a feeling of nausea?

It is light-headedness if the person feels he or she may faint but the surroundings do not spin. It can occur if meals have been delayed, or if the person stands up too quickly after lying down. It may be due to allergies, fever, vomiting or diarrhoea (dehydration), anxiety and stress, (especially if accompanied by hyperventilation), alcohol, tobacco and illegal recreational drugs. It may even be due to medicines prescribed for other ailments. The light-headedness usually goes away on its own and is not serious. Rarely, light-headedness may be due to excessive blood loss because of heavy menstrual bleeding, acute trauma or continuous, silent loss of small quantities of blood from the gastrointestinal tract. Defects in the conducting system of the heart or certain medication can also cause irregular heartbeats and light-headedness.

In cases of dizziness, not only does the person feel unsteady but there is also a false sense of the environment spinning. This is also called vertigo. In order to maintain balance, the brain receives signals from the balance apparatus in the inner ear, eyes, the skin, bones and joints. When these signals are not in sync and are conflicting, vertigo occurs. The most common cause is benign paroxysmal positional vertigo,(BPPV). This is due to crystalline calcium deposits in the fluid of the inner ear (otoliths) moving abnormally and affecting balance. This occurs in older people, is intermittent and sometimes just disappears on its own. In Meniere's disease, the vertigo is accompanied by progressive loss of hearing and a ringing sound in the ear. Migraines can also cause vertigo as can infections of the inner ear or malfunction of the vestibular nerve that supplies the ear. Head injuries can cause acute vertigo. Blood supply to the base of the brain can be compromised by build up of cholesterol plaques, causing giddiness. If vertigo is accompanied by neurological symptoms such as weakness or loss of speech, it may a transient ischaemic attack. This can herald a stroke.

Often these symptoms are dismissed as symptoms of "low blood pressure". Normal blood pressure varies between 140/90 and 90/60. When blood pressure falls below this, the brain does not get enough oxygen. This can cause light-headedness and fainting.

It can also be a normal response to standing up suddenly after lying down. This is because the brain does not respond rapidly enough to changes in posture. It can occur in soldiers after standing for a long period of time as this causes pooling of blood in the lower limbs. It can also occur with increasing age, pregnancy, heat exhaustion, low blood sugar, hypothyroidism and abnormal heart rhythms and as a side effect of diuretics or blood pressure medication.

It is important to investigate giddiness, dizziness and light-headedness to determine the cause of the symptom. This may involve an ENT evaluation, ECG and blood tests.

Dizziness, light-headedness and vertigo usually subside over time once the precipitating factors have been corrected.

KEEP A STEADY HEAD

• Take medication
• You can lose your balance and fall, so walk slowly. Use a cane if needed
• Lie down as soon as you feel giddy. Keep your eyes closed
• Keep the house and bathroom well lit to minimise chances of a fall
• Avoid driving
• Avoid caffeine (coffee, tea, cola), salty food, alcohol and tobacco
• Drink plenty of fluids
• Exercise regularly and do postural, balance and neck exercises at least three days a week

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

screening infants

Born well, now be well

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Your Health - Dr. Gita Mathai

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The infant (and under-five) mortality rate in India has seen an impressive decline, from about 80 per 1,000 live births in 1991 to 35 in 2016. The main contributors to this decline are West Bengal, Tamil Nadu, Kerala, Punjab and Himachal Pradesh. These are also the states that have enthusiastically adopted the small family norm. This enables parents to avail good antenatal care, safe delivery and immunisations to prevent death from common childhood infections.

Now, it is time to worry about other diseases that affect the mortality and quality of life of these children. These are mainly haemoglobinopathies (haemoglobin disorders), bleeding disorders, inborn errors of metabolism, endocrinopathies, and congenital deafness. Many of these diseases are inherited. One or more parents may carry the gene, which may not be expressed in the parent. Relatives may be affected, or else have mild forms of the disease. In some cases, it is a sporadic mutation and the child is the only one exhibiting the problem.

Congenital hearing loss can be tested by the newborn hearing screening test (NBST). Though seven per cent of newborns have hearing loss, this test is usually not done. When the child is three months to a year old, parents realise that he or she does not respond to sounds. The impact of hearing loss is less if it is treated before the child starts to speak.

Sometimes children are born with ambiguous external genitalia but they may not be brought for treatment till they are older. It is usually due to congenital adrenal hyperplasia (CAH). If the disease is severe then other symptoms such as diarrhoea, vomiting, dehydration, low blood sugar levels and shock can produce a life-threatening medical emergency.

There are other defects for which children are screened at birth in developed countries. These require collecting blood on a filter paper from a heel prick, amniotic fluid, buccal smear, skin or hair, within 24-48 hours of birth. The disorders that can be detected are phenylkentonuria (PKU), congenital hypothyroidism, haemoglobin disorders such as sickle cell disease, the thalassaemia group of diseases, galactosaemia, tyrosinaemia and other biochemical diseases, cystic fibrosis and so on. The cost of the test varies from Rs 2,500 to Rs 10,000, depending on the number of diseases screened for. That depends on prevalence in that area, family history, marriages between close blood relatives and medical advice.

Congenital hypothyroidism requires immediate treatment with medication so that the child may have normal physical and mental development. PKU, tyrosinaemia and galactosaemia need immediate alterations in the diet to prevent brain, eye, heart and kidney damage. Haemoglobin disorders require constant monitoring, transfusions, and specialised management.

Newborn screening and early intervention can vastly improve the quality of life as well as development of children. Make sure you get the relevant tests done as early as possible. After all, it is always better to know the enemy you are fighting.