killing heat

Summer blues

YOUR HEALTH DR GITA MATHAI

The killing heat” is not just a figure of speech. Every summer, newspapers report deaths from sunstroke, heat and dehydration. This may only be the tip of the iceberg as medical documentation and statistics on illness in India are still unsatisfactory. We really do not know exactly how many people are affected. Human beings are sensitive to outside temperature. To survive, the body has to maintain its internal body temperature at 98.4°F. If it is cold outside, we have to insulate the body by covering ourselves. If it is hot, the temperature has to be brought down. The skin is provided with four million sweat glands distributed all over its surface. As the temperature rises, the brain sends chemical signals to these glands and they start functioning. The body becomes drenched in a film of sweat. As this evaporates, the temperature drops. The volume of water lost in sweat daily is highly variable, ranging from 100 to 8,000 millilitres a day, depending on the outside temperature and the extent of physical activity. Sweat is not pure water. It contains small amounts (0.2 - 1 per cent) of chemicals like sodium (0.9 gram/ litre), potassium (0.2 gram/litre), calcium (0.015 gram/litre), magnesium (0.0013 gram/litre) and other trace elements. When a person moves from a cold climate to a hot climate, adaptive changes, called acclimatisation, occur in their sweating mechanisms, regulating not only the fluid lost but also the chemical content. Summer months are vacation months when people travel to the hills from the plains and vice versa. If you are travelling to a warmer environment, it takes your body a couple of days to adjust to the new temperatures. The maximum rate and quantity of sweat has to increase and it has to become more dilute. This acclimatisation period is the time when people are most vulnerable to the effects of heat. The sweating mechanism is inefficient and immature in children till the age of about four. It does not function well in the elderly, the obese and those with diabetes. The system also breaks down with some of the medications taken for high blood pressure and depression. This subset of the population is, therefore, more vulnerable to the effects of heat. The body’s natural cooling mechanism can fail: • If sweat cannot evaporate because the outside environment is humid. The internal temperature continues to rise even though the body remains bathed in sweat. • When inadequate fluid intake with dehydration prevents adequate sweating. • Due to continuous physically taxing work or exercise in a hot environment without sufficient intake of fluids. Heat exhaustion occurs first. You may get a headache, giddiness, a feeling of weakness, palpitations and painful cramps in the leg muscles. The body temperature rises and may eventually be as high as 104°F. If heat exhaustion is not recognised and treated, this can progress to a heat stroke. The temperature rises even to 105°F. There may be confusion, disorientation, seizures and even death. Unfortunately, children often cannot express the early symptoms of heat exhaustion. The only sign noted by the parents may be the temperature. Fearful of fever, they may cover up the child with inappropriate warm clothing and bed sheets. Thirst may be ignored. This accelerates the progress to a heat stroke. To deal with the summer • Try to stay indoors as much as possible, 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. • Avoid synthetic garments. Wear clothes made of cotton, linen, jute and other natural fibres. • Drink plenty of fluids. Do not wait to feel thirsty. The best liquids are tender coconut water or lightly salted lime juice and buttermilk. • Avoid aerated drinks. They add unnecessary calories. Many of them are hypertonic and will not quench your thirst. • Dehydration and the ill effects of heat are aggravated by caffeinated beverages, whether they are colas, tea or coffee. • nAlcohol has a similar effect. If you suspect heat exhaustion • Immediately move the person to the shade, under the fan or to an air-conditioned or air-cooled place. • Give plenty of fluids, preferably with salt. There are many commercially available oral rehydrating solutions that conform to World Health Organization standards. These sachets can be reconstituted and administered. Most of us live in heat radiating concrete jungles where we have to go out to work in the summer. Frequent power cuts and inadequate voltage make amenities like fans, coolers and air conditioners dysfunctional. In this scenario we have to be careful about the effects of the summer heat, particularly on the vulnerable young and old members of our families. 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

letters

Hole in my ear

YOUR HEALTH DR GITA MATHAI

Q: I developed a hole in my eardrum and I think it is due to prolonged use of the mobile phone. I cannot manage without my phone. A: The hole (perforation) in the ear drum is unlikely to have been caused by the use of a mobile phone. Usually it develops as a result of an ear infection (otitis media), an injury with a sharp object or a sudden loud sound near the ear. It needs to be evaluated. You should consult an ear, nose and throat (ENT) surgeon. It may heal and close with antibiotics and the use of ear drops. A long-standing non-healing perforation may require an operation called a tympanoplasty. In any case, why not use the speaker phones option? Tingling feet Q: My 72 years old father, is a diabetic, whose blood sugar is well controlled by oral medications. He has a lot of discomfort in his lower legs and feet. He had consulted a neurologist and after certain tests was found to have neuropathy. Although he was given vitamin combinations he has had no relief. A: Diabetic neuropathy is a nerve disorder that can occur as a complication of diabetes usually if there is poor blood sugar control. It can cause problems with the sensation in the feet. The symptoms are numbness, pain, or tingling in the feet or lower legs. There may be difficulty in walking and balance. The first step is to bring blood sugar levels under control. You could purchase a glucometer and check the sugar level regularly at home. Make sure he always wears well fitting shoes. Walking regularly, taking warm baths, or using elastic stockings may help relieve leg pain. Analgesics, low doses of antidepressants, and some anticonvulsant medication can be prescribed, in addition to vitamins, in severely affected individuals. Potty tot Q: I have a son who is three and half years old. He has been suffering from acute constipation for the last one year. He passes hard stool, with pain. Sometimes small amounts are passed 10-12 times a day. He eats well and his diet includes 1,000ml of milk, which I give in a bottle at night. A: The quantity of milk that you are giving is far in excess of what he requires. He needs only 400ml of milk a day at the very most. It can be split into two 200ml feeds, in the morning and evening, not at night. At three and a half years he is far beyond the stage of feeding bottles. Encourage bowel movement in the morning by making him sit in the toilet at a fixed time even if he does not feel the urge. If the constipation persists a further evaluation with a paediatrician can be done to rule out thyroid deficiency or bowel malfunctions. Worried about AIDs Q: Does a married couple need to have sex with a condom? I want to prevent HIV infection in myself and my wife. I am worried about AIDS. A: If either party has had prior sexual encounters, it is better to use a condom until you check for HIV and hepatitis B. It is better to check again after six months when the window period for HIV infection is over. If you go to a Voluntary Counselling and Testing Centre, the tests are free. Married people need to use condoms as a contraceptive device if they wish to prevent pregnancy, or if one of the parties is HIV or HbAg positive (hepatitis B). Seeking perfect eyesight Q: I want perfect eyesight. What diet should I eat and what can I do? A: Green leafy vegetables like spinach, beetroot, carrot and drumsticks help eyesight because of their vitamin and antioxidant content. Overcooking destroys heat sensitive labile beneficial vitamins of the B group. Steaming or microwave cooking vegetables or eating them raw is, therefore, better. Eating two raw tomatoes a day will give you all the vitamins you need. There are eye exercises in yoga which, done regularly, help to maintain and improve your eyesight. More children Q: I am 41 and my wife is 35. We have an eight-year-old daughter. We decided to try for a son. Despite our best attempts over the last one year, we failed. Although my wife’s periods are irregular, no tests have been done. We have received all kinds of tablets from various doctors. Now we read that some of them have potentially dangerous side effects. A: All medicines have some side effects even if they are aryuvedic, homeopathic or herbal. The tablets used to induce ovulation can be dangerous if given for too many cycles in improper doses. Before proceeding consider • You already have a healthy daughter. • Do you really want another child? •Test yourself — do a semen analysis • Do an ultrasound for your wife to see why the periods are irregular. 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

irritating itches

That irritating itch!

	YOUR HEALTH   DR GITA MATHAI

Eczema is a strange disease. If you have it, the frustrating itching and scratching starts and then just never seems to go away. The number of people with eczema is increasing. One in five now develops it in childhood. Many factors, such as early weaning, chemicals (preservatives and pesticides) in the human diet, perfumes and pollution, have been blamed. The fact is no one really knows the cause of eczema, but we do know that exclusively breast-fed infants are less prone to it.

Eczema appears as red, itchy, dry and flaky skin, with or without small pustules. A few months of constant itching may make the skin permanently rough, thick and hyperpigmented.

The classification of eczema is not very clear. It can be due to atopy (tendency to develop allergy), allergic contact, infantile seborrhoea (dandruff-like condition of the head that occurs in infants) or varicose veins.

Atopic eczema is the commonest form. It usually occurs in childhood as an itchy rash distributed on the head and scalp, neck, inside of elbows, behind the knees and on the buttocks. It has a hereditary component and runs in families.

Infants can develop an eczema variant called cradle cap — with a greasy, itchy flaky scalp. This can extend to the eyebrows, face and the trunk. Although the condition is self limiting and harmless, the physical appearance can be distressing to the family.

Irritant contact eczema can be distinguished from the atopic form by the typical distribution and family history. It occurs as an immediate or delayed reaction to contact with an allergen. It may be nickel in the safety pins used on clothes, fashion jewellery containing unacceptable metals or colouring, plants in the garden or chemicals in the workplace. Makeup or face powder can cause an idiosyncratic reaction. Sometimes the contact eczema may be photosensitive and flare up only when the skin is exposed to sunlight. Eczema caused by a specific chemical or disease process can be cured if the underlying factor is removed.

Bacterial, viral or fungal infection of the skin, or infestations with skin parasites like scabies or body lice can cause secondary itching and eczema. Poor blood circulation to the legs as a result of varicose veins can lead to itching and discolouration, particularly near the ankles. These forms are totally curable and tend to disappear forever when the infection is treated or the blood circulation is improved.

Unfortunately most varieties of eczema do not fall into the curable category. They recur time and again, and sometimes become self perpetuating as scratching and picking the skin becomes a habit.

Dry skin aggravates eczema. Therefore it pays to keep the skin moist and oiled. Coconut oil can be applied to the skin half an hour before a bath. A teaspoon can also be added to the bath water. Mild and non-perfumed soaps should be used. The body should not be scrubbed with a loofah. The skin should be patted dry, and not wiped. After the bath a non-greasy oil or lotion can be applied.

There are several baby oils, aloe vera preparations, ceramide (a natural oil in the skin) and vaseline-based creams available in the market. If it says "non greasy" it means that it is unlikely to stain your clothes. Traditional oils, like coconut, stain the clothes and that is why they need to be applied before a bath.

Salt water reduces eczema. People who immerse themselves regularly in the sea improve gradually over a period of time.

Detergents are widely used to wash clothes. Most contain chemicals like sodium lauryl sulphate, which remain behind in the clothes in small quantities. They can penetrate the skin when sweating occurs, aggravating eczema. Commercially available "hypoallergic" or "doctor tested and recommended" detergents have unsubstantiated claims and have not been proven safer. Since clothes have to be washed and kept clean, it is preferable to use non-allergic soaps made from neem oil. They are marketed in India by the government run chain of khadi stores.

Eczema disappears when steroid creams are applied. These should be used under medical supervision for a short period, till the symptoms subside. After that antihistamines (to control itching) and moisturisers should be continued. Patients, unfortunately, purchase and apply the ointments themselves. Prolonged use of topical corticosteroids causes side effects like thinning of the skin and secondary bacterial or fungal infection. Small quantities of the more potent steroid creams can become absorbed in the body through the skin. If they are inadvertently applied to the eye, cataracts and glaucoma can result.

Specific pinprick allergy testing can be done to identify allergens. Without this, drastic potentially harmful changes should not be made to the diet (particularly a child's) presuming that the eczema is precipitated by allergies to milk, fish or certain vegetables.

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

fishy facts

Eat fish, be fit YOUR HEALTH DR GITA MATHAI With age, who would not prefer to avoid poor eyesight, cognitive decline, dementia, cancer, diabetes, or death from a sudden heart attack? People would also prefer to have strong bones resistant to fracture and be looked after by healthy children. The Inuits of Greenland (Eskimos), the Alaskans and the Japanese seem to enjoy all these benefits. Scientific research has zeroed in on the one thing these populations have in common: their staple diet protein was obtained from fish. The benefits came from the relatively higher consumption of omega-3 fatty acids, found in fish. Omega-3 fatty acids are a heterogeneous group of long-chain polyunsaturated fatty acids — the “essential fatty acids” (EFAs) composed of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). The recommended intake of ALA is 1.5 grams a day and DHA 0.5-1.0gm a day. EFAs are essential for the healthy development and functioning of the brain. They make up 20 per cent of the brain’s dry weight. The human body cannot synthesise EFAs. They have to be obtained from dietary sources. Vegetarians get their quota of EFA in the form of omega-6 fatty acids from whole grains, sprouts, flaxseeds, soyabeans, walnuts, leafy green vegetables and legumes like beans. But this is slightly different in chemical composition from the omega-3 fatty acids found in fish. The benefits of eating fish begin to appear when 60gm of fish are taken at least once a week. The benefits plateau if the consumption is more. Combined with soya nuggets, nuts and legumes, when both omega-3 and omega-6 fatty acids are obtained, the benefits increase. The optimal ratio for maximal health benefits is 4:1 (omega-6:omega-3). Fish are also an excellent source of protein. A hundred grams of cooked fish provide 20gm of protein, which is a third of the daily requirement. Fish protein, which is of high quality, is lower in fat content than mutton or chicken, and contains minerals like iron, zinc and calcium. In pregnant women, seafood provides DHA which decreases the chances of preterm birth, improves visual acuity and helps optimise the development of the nervous system in the unborn child. During lactation, it reduces the incidence of post partum depression and provides DHA to the baby. We have polluted our earth and the seabeds are contaminated with mercury. This liquid metal is present in fish too. Excess exposure to mercury can harm the development of the nervous system of a baby. Pregnant and lactating mothers should, therefore, limit their intake of fish to 400gm a week. Not everyone can eat fish. While some are vegetarians, others may be allergic. Or fish may just not be available. The pharmaceutical industry markets supplements of cod liver oil, fish oil and omega-3 fatty acid as capsules and tonics. These, along with other lipid lowering medicines like statins, can be taken to potentiate (enhance) their effect. DHA has also been added to health drinks and to fortified infant formulae. The claim is that the benefits are provided without the toxins, to improve outcome in heart disease, lower blood pressure, optimise lipid levels, reduce inflammation and improve immunity. The claim extends to helping in chronic diseases like diabetes, epilepsy and rheumatoid arthritis, fighting depression, relieving asthma, preventing eczema and producing intelligent children with good visual acuity. Capsulated EFAs are processed and bottled basically for convenience and commercial advantage. The purity, strength or safety of the products and their effects may vary. Product labels therefore must be read carefully. Prescribed medication should not be discontinued in favour of these supplements. People who are allergic to fish or nuts should exercise caution if they are planning to take these products. Omega-3 fatty acids should be used only as an adjunct and not as a substitute for a healthy diet and regular exercise. Their actions in the prevention of cardiovascular disease are still controversial. Their superiority to current drugs is also disputed. Despite all the hype about these capsules and supplements, studies have not yet conclusively proven that they are superior to natural sources of EFAs. The superiority of breast milk is undisputed and it remains the best for the baby. An overdose of these supplements can be dangerous, as it can produce vitamin D toxicity, bleeding, diarrhoea and leg cramps. This can also potentiate the effects of diabetic medications and insulin, causing blood sugar levels to drop. Fish do make a difference. Research has proved that even if you don’t eat fish, keeping an aquarium reduces stress and blood pressure, helps in Alzheimer’s and calms hyperactive children with attention deficit disorder. It does not even have to be a real aquarium. Watching a virtual one, a DVD with moving fish or even having a screen saver with fish has equal benefits at home and in the work place. There is a clear medical benefit to association with fish, whether you are a “fish eater” or a “fish watcher”. 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

queries

Do antacids help?

YOUR HEALTH DR GITA MATHAI

Q: Whenever I take any antibiotics or painkillers I develop severe gastric irritation, with belching, burning and pain. Can I take antacids to prevent this? A: Painkillers usually belong to the “aspirin” family, or are paracetamol or are NSAIDs (non-steroidal anti-inflammatory agents). All of them can cause gastric irritation to varying degrees. The same is true of some antibiotics also. Using an antacid decreases the availability of the medication as many of them interact with the antacid in the stomach. Instead, you can add omeprazole, pantoprazole or ranitidine to the prescription. You can speak to your physician for specific advice and dosage schedules. Try smiling Q: At 50 years of age I find I have a sad and depressed look as I have bags on the cheek and my whole face sags. It affects my mood when I look in the mirror. A: Sagging of the skin (jowls) occurs owing to the loss of subcutaneous elastic tissue with age. The skin is not held taut. Gravity then causes the cheeks to sag. You have to be very conscious of this. Instead of developing a grumpy expression, try smiling. This will pull up your cheek muscles and the skin overlying them. You can also apply oil every morning and massage your cheeks upwards. This will give you slow improvement. If nothing works, and you are really mentally affected by this, several plastic surgery techniques are available. Alternatively, you can always try Botox. Grandma’s bladder Q: My 82-year-old grandmother suffers from recurrent urinary tract infections. Cultures of the urine repeatedly grow significant numbers of bacteria. The doctors advised an ultrasound (USG) and it indicated significant residual urine — around 190cc. What can we do? A: Residual urine means that her bladder is not emptying properly. Urine is left behind in significant amounts after she has passed urine. This occurs because of a weakness of the pelvic muscles as a result of previous childbirth, age and the loss of protective female hormones after menopause. Urine is a good culture medium for bacteria to gain a foothold and thrive. As long as this problem persists and urine remains in the bladder, infections will recur. You also need to check if she has any additional risk factors like diabetes. Appropriate antibiotic treatment has to be given in the correct dosage for the recommended schedule for the infection to clear. Sometimes a small night dose of antibiotic has to be continued prophylactically for a few months. Ask your grandmother to lean backwards instead of forwards while passing urine. That will help to empty the bladder more. In addition, yoga or Keegle’s exercises can be done to strengthen the pelvic muscles. Exercise, please Q: I have been a naturopath and yoga teacher for 30 years. Many diseases, infirmities, injuries and the effects of ageing can be delayed or prevented by practising this scientific ancient exercise form. Recovery from illness is also faster. I find most of my patients very resistant to the idea of exercise. They have a thousand irrelevant excuses to put off to “tomorrow” a schedule to start being physically active. Needless to say, tomorrow never comes! A: People are looking for a “quick fix ”, an instant solution or a miracle drug that’ll cure all their ailments with the least effort. Unfortunately the body has to be maintained and nurtured like any other piece of functioning ageing machinery. Studies show that 60 minutes of aerobic activity and 10 minutes of stretching will go a long way in maintaining health. For those who cannot spare that amount of time at one stretch, it can be split into 10 or 20 minute segments. The eventual benefits are immeasurable. On the pill for 15 years Q: I am 45 years old and have been on an oral contraceptive pill (OCP) for 15 years. How will I know if I have reached menopause? After all, the pill produces withdrawal bleeding every month. A: When you actually reach menopause there will be no withdrawal bleeding after the tablets are stopped. If this occurs for three months you have probably reached menopause. It is safer to continue the pills for a year more. If you stop the pill you should use some other form of contraception like condoms for a year. Excruciating pain Q: I was pregnant a year ago. On scan the baby was found to have Down’s syndrome. I underwent a termination of the pregnancy. Now I have lower abdominal pain all the time. Sometimes it is so severe that I have to double up. What can I do? A: Since this pain has appeared after the abortion, you could take an ultrasound of the pelvis and do a urine examination. This will help to determine if there is an infection or any other reason for the pain. Armed with these reports you could go to a gynaecologist for specific advice and treatment. 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

cNo baby blues

	Your Health   DR GITA MATHAI

It's difficult to believe but true that despite our 1.2 billion population, many of our young adults have difficulty in producing children. They may be called "sterile, infertile or sub fertile". But before a couple is labelled "infertile", they should have had at least 12 months of regular contraception-free intercourse.

Worldwide, infertility affects 7-10 per cent of the population. Although women actually produce the babies, if the reasons for the infertility are investigated the woman is at fault in a third of the cases; in a third it is the man and in the remainder either both are responsible or no real cause can be found.

Before embarking on a planned pregnancy, the woman should have had immunisations for measles, mumps rubella (MMR) and hepatitis B (3 doses). She should also start folic acid supplements (5mg/day). Children born with physical or mental defects because these basic facts were forgotten are a human tragedy. Both partners need to keep their body mass index (BMI, or weight in kilograms divided by height in metre squared) at around 23 and be physically active for around 40 minutes a day. They also need to treat any existing underlying disease like diabetes, high blood pressure or thyroid problems.

Studies show that caffeine (found in tea, coffee and cola drinks) affects fertility. Women who drink alcohol can produce babies with "foetal alcohol syndrome". It also reduces the sperm count in men. Smoking affects the quality of the sperms and inhaled passive smoke is bad for the growing baby. Sperm counts may be reduced by inhaling hazardous chemicals in the work place or by working in high temperatures.

Women ovulate cyclically and the egg is released 14 days before the next period. For a woman to conceive, intercourse must take place around this time and the sperm count must be optimal. Initially, if a menstrual calendar is maintained, the fertile days can be calculated. A semen analysis for sperm count is a non-invasive simple test. Also, after intercourse lie down, don't douche, and avoid lubricants and cleansing agents.

If these simple methods fail in a couple where the woman menstruates regularly and the man has a normal sperm count, a visit to a reproductive medical unit is warranted. Further investigations to establish the patency of the tubes and quality of the sperm may be needed. Depending on the problem, medication or surgical correction of a specific defect may be needed.

Conservative medical treatments are usually tried for periods varying from 6 months to a year. If they fail, assisted reproductive technology (ART) techniques are started.

In IUI (intrauterine insemination) the woman is scanned during her most fertile period to determine ovulation. Healthy treated sperms from her partner are then inserted into the uterus. The technique is used when the sperm count is low, the motility unsatisfactory or if donor sperm is being used.

In GIFT (gamete intra-fallopian transfer), eggs and sperms are collected, mixed and then placed in the woman's fallopian tube. Fertilisation takes place naturally in the body.

In IVF (in vitro fertilisation) the eggs are harvested and fertilised with sperm in the laboratory. The resulting embryos are then placed in the uterus. This is used in cases where the fallopian tubes are blocked, the fertility unexplained or when several attempts with the other forms of ART have failed. It can result in multiple pregnancies. Some clinics offer "natural cycle IVF". This involves collecting and fertilising the one egg released during the normal monthly cycle. It avoids the side effects of fertility drugs and multiple pregnancies are less likely.

In ICSI (intracytoplasmic sperm injection) a single sperm is injected into the centre of an egg. This is used when the male partner has a very low sperm count or if other problems with the sperm have been identified.

Donor eggs from other women can be used if the woman has no eggs of her own, or if she is over 40 and the eggs are of poor quality. Sperm from donors can be used if the husband has a low count (oligospermia) or no sperms (azoospermia). Surrogate mothers can be hired to carry the baby to term.

There is no right time to seek medical help, but if sexual intercourse at least three times a week without contraception for a year has been unsuccessful, it is probably time for proactive action. If, however, the woman has periods at intervals less than 21 days or more than 90 days, the flow is unpredictable (if it starts it does not stop and if it stops it does not start) or if there has been pelvic infection in the past, an evaluation should be done at the earliest. In men, if the testes are not felt in the scrotum, or there is a hydrocoele (swelling) or a past prostate infection, investigation and treatment should be started sooner.

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

Jaundice

Top of Form Royal disease YOUR HEALTH   DR GITA MATHAI Jaundice, icterus, hepatitis." These three terms are interchanged by people to describe what they believe is a single common affliction, a disease that causes the skin and eyes to turn yellow. The word "jaundice" is actually a corrupted anglicised version of the French jaune coined in the 19th century by French physicians to describe what they thought was a single disease entity. Unaware of cause or cure, the discolouration was also called the morbus regius (the regal disease), with the belief that only the touch of a king could cure it. Times have now changed and medicine has become evidence based. Tests can be done if a person becomes "jaundiced" to evaluate the "when, where and why". Once the cause is removed, the disease will disappear. The yellow colour is due to a pigment called bilirubin, normally produced in the spleen and liver when old red blood cells are broken down. The pigment is then metabolised in the liver and excreted. The level of bilirubin is usually 0.3 to 1.9mg/dl (milligrams per decilitre). The human eye can discern the yellow colour imparted by bilirubin when the level is three times or more than the normal 3mg/dl in the blood. Infectious diseases can interfere with the ability of the liver cells to metabolise bilirubin. The most common infections are viral, commonly caused by the hepatitis group of viruses. There are several of these — some are transmitted through contaminated food or water, others through unprotected sex or unsterile injections. Jaundice owing to viral hepatitis A is the commonest form of jaundice in young people. It is usually a mild self-limited disease that recovers spontaneously in one or two months. No specific treatment is required. Hepatitis B, C or E can be more severe, relapsing, fatal or chronic. Out of this group, hepatitis A and B are preventable. Vaccination against hepatitis B is offered in a 3-dose schedule before the age of one year (it can be given later to anyone who missed it). Hepatitis A vaccine is given after the age of two years as a 2-dose schedule. Protection is almost 100 per cent. Other infections caused by the herpes group of viruses, leptospirosis, cytomegalovirus, malaria or even severe bacterial sepsis can also cause jaundice. These diseases are not preventable by immunisation. Jaundice is not always due to an infection. If for any reason the number of red blood cells destroyed is greater than normal, the liver is unable to cope with the overload of pigment and the person becomes jaundiced. This occurs in some hereditary blood disorders like thalassaemia, and sickle cell disease, or a hereditary metabolic defect like G6PD deficiency. Sometimes, the liver cells themselves are defective and unable to cope with even the normal amount of bilirubin produced in the body. This occurs in certain inherited conditions like the Dubin-Johnson or the Gilbert syndrome. Several members of a family are affected, the jaundice is mild and fluctuating and it is not fatal. Medications can be toxic to the liver and cause jaundice. Common examples are an overdose of paracetamol or even oestrogens. Alcohol is a direct toxin, poisonous to the liver cells. Consumption on a regular basis over many years can damage the liver and can result in jaundice. Even when the bilirubin is adequately metabolised and produced in normal quantities, jaundice can occur, if the drainage ducts are blocked by stones, strictures and primary or secondary cancer deposits. Sixty per cent of newborns can develop a "physiological" or normal self-limited jaundice. There is a rapid cell turnover in newborns and they produce bilirubin at a rate of 6 to 8 mg per kg per day, (more than twice the production rate in adults). The immature liver cells are initially unable to cope but the bilirubin production and level typically decline to the adult level within 10 to 14 days. Sometimes the jaundice is due to a mother-baby blood group incompatibility. The mother forms antibodies to the infant's blood. This too is self limited and treatable. The sudden appearance of jaundice in any age group should not be self diagnosed, ignored, treated with diet restrictions or herbs without a diagnosis. After consultations with a physician, appropriate blood and urine tests and, if necessary, scans or a laproscopy should be done to arrive at a diagnosis. Eighty per cent of the jaundice in young adults is due to hepatitis A. As this disease is self-limited, quackery and miracle cures (like the touch of the king, amulets and bracelets) abound and appear successful. Secondary jaundice recovers once the causative factor is removed. Abstaining from alcohol and discontinuing offending drugs may reverse jaundice. If a correctable obstruction is seen on scanning or a laparoscopy, surgical treatment provides relief. The tragedy of jaundice is that ignorance and superstition stand in the way. Some treatable and curable forms of jaundice are not diagnosed or tackled till it is too late. 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   Bottom of Form