not twins

That sounded logical. I was not sure of the family planning rules, which seemed to change every now and again.
The government frequently said things like, “You will get money if you get sterilized after two children, sometimes “only if both are girls”, sometimes, if you got “sterilized after one child.” I had stopped keeping track. Nothing seemed to deter the ones who wanted more children. Not money or threats.
She kept bringing the first child. His health was poor, he was underweight, his nose dripped constantly and he had a vacant adenoidal stare. He was a wheezer. A week or two after treatment his weight always picked up, his mouth remained closed, the dripping was better, but he then he had diarrhea. Then we would be back to square one. Once the diarrhea recovered, he would start wheezing again.
Once she came and said, ”can you see me out of turn? The taxi is waiting. We have to go for a wedding. He has diarrhea.”
I looked out of my window to see if she was telling the truth. I saw four identically dressed boys of marginally different sizes.
“Who are these ?’ I asked.
“They are mine.” She said.
But there are four----.
She looked sheepish. My husband said you would get angry if we had four boys and I have not had a sterilization. We registered the first and second with the same name.”
I thought of my consternation and bewilderment each time he/ they came with their weights going up and down like a yo-yo. In my records they both had the same name and birth date, but were actually 11 months apart!
I don’t know who I was investigation for eosinophilia, anemia, milk intolerance, adenoids, failure to thrive!!!
“Why? Why?” I asked.
“We want a girl---“
I

gait

https://www.telegraphindia.com/1170821/jsp/knowhow/story_168290.jsp

Talk the walk

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Your Health - Dr. Gita Mathai

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As infants grow, their motor skills develop in a certain set, sequential pattern. They first turn over, then sit, crawl, stand and walk. Some give the crawling stage a miss. Others, very efficient at crawling, may learn to walk later. Most children are mobile by 14-16 months of age.

The first steps of a baby are wide-based, wobbly, short and rapid with the arms outstretched for balance. Like every activity, walking improves with practice. Though falls are frequent, they need not be feared unless they are from a height or down steps.

The adult gait is different. The heel of one leg first touches the ground then the whole foot is placed flat. The heel then rises, the weight is transferred onto the toes. The body swings off the toes with arms swinging in a reciprocal manner. Children start to develop this gait around 18 months and perfect it by the age of eight.

Some children may have a "toe-in" gait, with the toes pointing inwards as they walk. Others may walk with a "toe out" gait. This may run in the family or be due to a cramped position in the uterus. This seldom interferes with running or sports activities. Some children walk on their toes.

As children get older, their posture, muscle power, and control spontaneously improve. The abnormal gait begins to correct itself. In toeing usually improves by the age of three, flat feet by six years, bow legs by 18 months and knock knees by seven years. There is cause for concern if the abnormality is not symmetrical and appears to affect one foot more, if it is accompanied by limping or pain, or if there are mental developmental delays.

Some gaits are definitely abnormal and need to be evaluated. Children may refuse to bear weight on one leg. They may complain of pain or there may be obvious shortening. The legs may swing forwards, remain stiff and spastic, and refuse to bend. The gait may remain wide-based and unstable. Faulty motor coordination due to neurological causes may produce an inordinately clumsy child who has frequent falls.

About 35 per cent of senior citizens have difficulty in walking half a kilometre or climbing one flight of stairs. The gait changes gradually in 60 per cent people; this is obvious in those 80 years or older. There is a reduction in speed of motion, the width and the length of the stride. A greater length of time tends to be spent with both feet on the ground. There is a tendency to remain bent with eyes fixed on the ground. This makes the gait appear cautious and shuffling. Weak hip muscles may make the gait "waddling."

This deterioration is not necessarily a natural consequence of aging, even though physically inactive people lose five per cent of muscle mass every decade. The change in gait may be due to weakness, but medication, diabetes, liver disease, the pain of arthritis, peripheral neuritis can also play a part. An unstable gait can lead to falls, injuries and fractures.

Any medical conditions causing gait problems should be targeted and treated. Physical therapy is helpful. During exercise, concentrate on the correct gait sequence: heel strike, flat foot, toe off. You should practise walking in a straight line, toe to heel walking, balance exercises, yoga, and pelvic and leg muscle strengthening. These interventions are effective if they are performed regularly four to five times a week.

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

aging India

Neither tired, Nor retired

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Your Health - Dr. Gita Mathai

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When India gained independence, its population had a life expectancy in the 30s. Today, barring unforeseen events, we can expect to live to our 70s. This transformation has been facilitated by better nutrition, education, hygiene, and immunisation against many diseases.

Unfortunately, our social system has not kept pace with the changing times. Though healthcare is theoretically provided free by the government - and there are government insurance schemes covering admission in private hospitals - it is woefully inadequate. The burden of elder care usually falls on the 30 per cent working adult population. Shrinking nuclear families, women in the workforce and global migration of the educated, has resulted in a dearth of caretakers, leaving the elderly to fend for themselves.

All of us get older, and as we do, oxidative stress damages our cells. The telomeres in our chromosomes grow shorter and suffer mutations. Though these changes occur in everyone, they are greater, and faster, in people who smoke, drink (anything more than the equivalent of a glass of wine a day) or are obese. These factors shorten the lifespan by as much as 10-12 years. By tweaking your lifestyle and making it a healthy one, the sunset years can be comfortable, and hopefully, disease and pain free.

Until the age of 30, nature protects us by making our muscles grow and remain strong. After that fat slowly infiltrates the muscles at the rate of around 5 per cent every 10 years. This accelerates after the age of 70. Muscles begin to sag and lose their strength. Balance is affected and falls can occur. Bones become weak and osteoporotic, resulting in fractures even when the injury is mild.

As you grow older, fatigue sets in easily with a desire for a mid-morning or afternoon nap. This can lead to insomnia and sleep that is not refreshing. Popping sleeping pills regularly is not the answer. Instead, avoiding a siesta can often solve the problem.

In India we retire young at 58 or 60 years. The brain starts to deteriorate rapidly once its synapses and electrical pathways are not used. Five per cent of the brain cells die every day. This is trebled if they are not used or were abused with chemicals, alcohol and nicotine.

Studies show that there is less deterioration in the brains of those who do yoga regularly. So, attend a yoga class, learn the basic movements and practice a minimum of three times a week. Learning poetry or the scriptures by heart also boosts brain cells.

Exercise is important to maintain muscles and prevent age-related deterioration. Weights of 1-2 kg should be held in both hands and movements like that of a school sports drill repeated 20 times. It is worthwhile to go online and see how all groups of muscles can be exercised. Follow this up with eye and breathing exercises. Flexion, core strengthening and balance exercises are also necessary.

Make sure you have adequate carbohydrates and proteins in your diet and 4-6 helpings of fruits and vegetables daily. This will provide protective immunity by boosting flavonoids and antioxidants. A protein shake a day is beneficial too.

Adults also need immunisation. Pneumococcal vaccine should be taken after the age of 65 as well as the Herpes zoster vaccine. A yearly flu shot between September and March is also necessary.

Lifestyle diseases such as diabetes, hypertension and lipid derangements should be kept in control with regular diet and medication. Residences need to made "elder friendly" with bright lighting and railings. Supporting bars should be embedded near the toilet and bathing areas to prevent falls and fractures.

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