Breast cancer

Check your breasts for cancer

YOUR HEALTH   DR GITA MATHAI

Cancer. The word is derived from "crab" and conjures up visions of multiple tentacles insidiously spreading all over the body. Unfortunately, the vision includes undiagnosed, undetected, untreated versions of the dreaded disease. Women in India are prone to cervical (lower end of the uterus) and breast cancer. A vaccine (HPV or human papillovirus vaccine) was recently introduced to reduce the incidence of cancer of the cervix. However, there is no vaccine to prevent breast cancer. One in 22 women in India are projected to be diagnosed with breast cancer in the course of their lifetime. The incidence varies from eight per 1,00,000 women in rural India to 27 per 1,00,000 women in urban areas. Breast cancer is not a disease confined to women; in rare occasions, it can occur in men too. Lumps in the breast can be felt when they are pea sized. The tissue feels different, and is firmer and harder than in the surrounding areas. Later the skin over the lump may be discoloured or thickened (resembling an orange peel). Also, there may be retraction (pulling inward) of the nipple. Many lumps are harmless non-cancerous fibroadenomas. Others are not real lumps but nodular breasts reflecting the hormonal changes that occur during the course of a normal menstrual cycle. All lumps, however, must be taken seriously and evaluated as soon as they appear. Evaluation of a breast lump is usually done with a mammogram or an ultrasound examination. Once the position has been accurately localised, the lump is aspirated with a fine needle. Cells obtained during the procedure are used to diagnose the nature of the lump. Depending on the diagnosis, the breast is operated. This is followed by chemotherapy, radiotherapy, hormone therapy and immunotherapy. Breast cancer can occur at any age, though it is less common under the age of 25 years. The exact mechanism which sets in motion the changes responsible for breast cancer is not known. Certain environmental and genetic factors are associated with an increased risk of breast cancer. • Long years of menstruation with early menarche (less than 12) and late menopause (over 55) • Delayed childbirth • Failure to breast-feed children • Breast or ovarian cancer in first degree relatives • Smoking and drinking alcohol • Obesity • Cancer elsewhere and exposure to radiation • Post menopausal hormone replacement therapy for more than four years. In developed countries, the majority

Assault

Dealing with sexual assault

YOUR HEALTH   DR GITA MATHAI

Self medication can be harmful, consult a doctor when your child is sick We perceive India as a safe, tradition bound country that honours women and loves children. Yet, our cities are becoming famous, even internationally, for molestation and rape. The number of cases reported has increased 700 per cent since Independence. And this is probably only the tip of the iceberg. Shame, family pressures, social stigma, economic vulnerability and lack of knowledge of legal procedures coerce a victim into silence. To make things worse, the victim is often regarded by our inadequately educated, underpaid and insensitive police personnel as the one at "fault". Rape is traditionally considered a crime against women. But times are changing. Horror stories abound about homosexual sexual predators targeting, kidnapping and victimising young boys. The victims range from six-month-olds to 80-year-olds. The perpetuators of rape, however, are almost always male. Around 80 per cent of the crime is committed by someone known to the victim. Often, the abuser is a member of the victim's family or belongs to his or her circle of acquaintances. In such cases, the crime is perpetuated in a known place, in either of their homes or that of a friend, relative or neighbour. Today, children of both sexes are in danger, in exclusive neighbourhoods as well as the slums. Their lack of knowledge, inexperience and trusting nature make them ideal victims. Many of these attacks are not random but well planned by a predator known to the victim. Police complaints are often followed by unwelcome media publicity. There are no "special victim units" in the police force yet, that may be trained to handle such cases with discretion and empathy. The guidelines provided deal mostly with the rape of women. The concept of male or child rape is new and the level of expertise in dealing with this is low. Despite this, if a parent or the victim wishes to prosecute the assailant, a physical medical examination, documentation of the evidence and registration of an FIR (First Information Report) must be done. Even otherwise, a thorough medical examination must be undertaken as soon as possible to treat and record lacerations and injuries, both external and internal. The greatest fear about sexual assault is that of acquiring STDs. The number infected varies between 5 and 10 per cent. Infection depends upon several factors, such as the type of sexual contact, number of assailants, and whether or not they had an STD at the time of the assault. The risk of contracting STDs can be reduced by taking medication as a preventive measure. Immediate and effective treatment options are available for some STDs such as hepatitis B, gonorrhea, syphilis, herpes, chlamydia and trichomonas vaginalis. The regimen recommended is a single injection of ceftriaxone, plus an oral dose of azithromycin, plus either secnidazole, tinidazole or metronidazole. Herpes can be tackled with a five or seven-day course of acyclovir. The risk of acquiring HIV infection is less than 1 per cent. However, it is important for medico-legal reasons to document the HIV status immediately. The test should be repeated after six months and then a year. A 28-day regimen of zidovudine and lamivudine provides post-exposure prophylaxis for HIV and should be started as soon as possible, preferably within 72 hours. Injuries and lacerations require a single booster dose of tetanus toxoid. Hepatitis B can be sexually transmitted. Most children today have received three doses of the vaccine as part of their immunisation schedule and are thus protected against the infection. In that case, only a booster dose needs to be given. If the victim has not been immunised in childhood, immunoglobulin needs to be given. In addition, three doses of the vaccine must be given — immediately after the incident, after a month and after six months. Prophylactic treatment against syphilis is not advised. Instead, a blood test can be done after three months to ascertain if infection has occurred. Counselling, psychiatric evaluation and support are necessary for the victim as well as his or her family to overcome the trauma. To protect children — • Make them learn addresses and phone numbers by heart • Teach them certain body parts are not to be touched • Discourage them from talking to strangers • Do not send them anywhere alone, especially after dark • Escort them to and from school bus stops • Encourage physical fitness and teach them martial arts • Teach them to trust their survival instincts and, if needed, run in the opposite direction as fast as they can, shouting all the way. For adults, the best bet is —   To have peepholes in the front door   Avoid dark and deserted areas   Be physically fit and able to run fast. 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

Left handed or right?

Hope for clumsy clods

Your Health   Dr Gita Mathai

Being left handed does not come in the way of excellence, at least not for batsman Gautam Gambhir Right handed or left? Worldwide, about 90 per cent of the people prefer to use their right hand for doing things. Not surprisingly, life in all cultures is geared to the right-handed individual. Implements like nuts and bolts are difficult to handle for the left-handed. Incidentally, "right" also means "correct". The word "left" is derived from the Anglo-Saxon "lyft" which means "weak" or "useless". Our brains are wired for handedness. During the process of evolution, the centre for language moved to the left hemisphere in the majority of the people. The human brain functions such that the left and dominant hemisphere controls the right side of the body, making the majority (80 per cent) totally right-handed. The dominance does not extend to the use of the hand alone — such people are also are "right sided". Their dominant eye, ear and leg are on the same side of the body. Problems arise in 20 per cent of the population that doesn't have a dominant hemisphere to determine laterality or handedness. Their brains are "cross wired", giving them mixed handedness or laterality, cross dominance, mixed dominance or cross laterality. In short, the right hand may be matched with the left foot or the left hand with the right eye. This leads to confused, crossed signals in the brain when complex tasks are performed. The electrical and chemical signals have to criss-cross the midline before they eventually reach their final destination in the designated area of the brain. Therefore, such individuals are accident prone, and have things around them explode, collapse, catch fire or fall apart. Day-to-day objects are misplaced, and navigation from one place to another (with left to right confusion) — even along familiar roads — becomes a nightmare. These adults evolved from clumsy children, who kept bumping into things and frequently fell down. Their bodies have scars and evidence of healed fractures. Their school projects get "excellent" for imagination and "zero" for execution. Life is difficult for people with mixed laterality. Career choices are affected, with professions like driving or piloting a plane remaining distant dreams. People with mixed laterality alternate hands when writing and legs when kicking. They hold the telephone to the ear opposite to their writing hand. They subconsciously use one hand first and then the other to perform complex tasks. Earlier, such people were considered ambidextrous, but true ambidexterity is almost unknown. The uncertainty also extends to the mental image of their own limbs or body surface. This causes an inability to rapidly execute commands to turn right or left. The march past becomes a formidable hurdle, with everyone doing a "right turn", while the affected individual wanders off in the wrong direction. Hesitation is evident if they are asked to perform complicated tasks with alternating hands initiating the movement. Slowed reactions preclude split second decisions, causing frequent accidents. Also, people with mixed laterality do not perform well in track and field events. Their feet do not alternate quickly enough. Running is slow and uncoordinated. The good news, however, is that they excel in games involving a bat (such as hockey, cricket, tennis, badminton and table tennis). This is because the bat is held across the body on the dominant side. Mixed laterality also has its advantages. The criss-crossing of brain signals uses and strengthens many normally unused brain synapses and pathways. Hence such people are exceptionally talented, creative and artistic. If portraits or photographs of some famous artists — such as Leonardo da Vinci and Rembrandt — are scrutinised, you will see that they may paint with one hand, while tilting the head to the other side and crossing the opposite leg. This demonstrates mixed laterality. To check your laterality, figure out — * Which hand you use to write, pick up objects or dial the telephone * Which leg you use to kick or which is uppermost when your legs are crossed (this remains constant all through life) * If you cannot hear clearly, to which side you tilt your head * The side of your jaw you use to chew (this is also constant unless there is a dental problem) If you have mixed laterality, it is possible to overcome the "defects" and strengthen both sides equally, in a way that it "compensates" for mixed laterality. These exercises, that require 10 repetitions, may be of help — • While walking, clench and unclench your hands, alternating them with the foot you use to step forward (right hand and left foot) • Standing on one leg at a time • Close one eye first and then the other • Close one ear at a time • Doing yogic breathing through one nostril at a time. If a child is "left" handed, that may be the "right" laterality for him or her. Punishment, ridicule or forceful correction messes up the brain connections. Desist from interference, or you might just have sabotaged the emergence of the next Einstein. 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

Gestational diabetes mellitus

Not all sugary

	Your Health   DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick

Shock was writ all over her face and her husband's. "How can I have diabetes," asked the young woman. "When I saw the result of the blood sugar test, I thought it was a mistake. No one in my family has diabetes!" Well, that may be true, but it is also a fact that 2 per cent of the Indian population has diabetes and 15 per cent of pregnant women have abnormal blood glucose values.

Despite the epidemic of diabetes in our young urban adults, statistics about the exact prevalence of the disease in pregnancy are difficult to obtain. Many pregnant women are not tested. In centres offering antenatal care, the presence or absence of "sugar" in the urine — an unreliable test at best — is used to diagnose diabetes.

Blood should be tested as part of routine antenatal care. A fasting glucose level of more than 126mg/dL or 7mmols/L in pregnancy is considered abnormal. A blood sample can also be drawn one hour after ingesting 50g of glucose. A normal value is less than 140mg/dL or 7.8mmols/L. If it is higher, it needs to be followed by a three-hour OGTT (oral glucose tolerance test) with a 100g glucose load. A positive diagnosis is made if the fasting value is 105mg/dl, the one-hour value 190 mg/dL, the two-hour value 165mg/dL and the three-hour value 145 mg/dL or more.

Some of the women with these values are diabetics who are asymptomatic and unaware of their condition. Others have relative insulin insufficiency, or MODY (maturity onset diabetes of the young), and are already on oral diabetic medications. Women with polycystic ovarian syndrome may be on the oral diabetic drug metformin. They may become overtly diabetic during pregnancy.

Others with abnormal blood sugar levels have gestational diabetes mellitus (GDM), a peculiar type of glucose intolerance which first appears during pregnancy in an otherwise normal woman. It can occur at any time during the pregnancy, though it is more likely to occur after 24 weeks. The exact reason for gestational diabetes is not known.

Women at risk are those who

* Have a family history of diabetes,

* Have a BMI (body mass index — that is, weight in kilogram divided by height in metre squared) of more than 30,

* Are older than 25,

* Have previously had large babies (more than 4kg) or still births.

The glucose in the mother's blood crosses over via the placenta to the baby. The excess sugar supplied makes the baby grow rapidly. The baby's pancreas starts to work overtime to lower the sugar to normal by secreting insulin. The excess calories are stored as fat. This gives rise to a large baby (macrosomia) weighing more than 4kg. This in itself increases mortality by 50 per cent. The size may cause the baby to get stuck in the birth canal. Forceful extraction can result in fractures of the collarbone or paralysis of the nerves to the arm. After birth, the baby's pancreas continues to produce high levels of insulin as it is acclimatised to do so. This may cause the blood sugar levels in the baby to drop precipitously. The baby may then have seizures. In addition, it may develop other problems such as low blood levels of calcium and magnesium. Many babies also die (that is, are still born) while others (up to 50 per cent) may have breathing difficulties.

About 33 per cent may have polycythemia (excess blood) and 16 per cent develop jaundice at birth or soon after.

Mothers with GDM are also prone to develop other complications during the pregnancy such as hypertension. Almost 60 per cent of these women develop GDM in subsequent pregnancies, particularly if there has been maternal weight gain between the two pregnancies. Around 35 per cent will go on to develop diabetes in the next 15 years. The blood sugar in mothers with GDM should be well controlled to prevent complications in her as well as the baby. Diet regulation is needed to keep the sugars under control. Since not all women with GDM are obese, the diet has to be adjusted in accordance with the mother's BMI. The diet should consist of 40 per cent carbohydrate, 20 per cent protein and 40 per cent fat.

Pregnant women do not really "have to eat for two". The calorie requirements are

*35kcal/kg/ 24hour for a woman of normal weight (BMI 25).

* 24kcal/kg/ 24hour for overweight women (BMI 25-30).

* 12 to 15 kcal/kg/24hour for morbidly obese women (BMI 30-40).

* 40kcal/kg/24hour for underweight women (BMI less than 25).

A combination of diet control and aerobic exercise such as brisk walking for 45 minutes every day usually keeps the blood sugars normal. If the sugars remain high, insulin therapy may have to be started. Many of the oral diabetic medications cross the placenta and cause hypoglycaemia in the baby. Some of them are, however, used under supervision.

Unlike other forms of diabetes, which are permanent, GDM disappears after delivery. It, however, acts as a warning. Exercise for 45 minutes or more a day, reduce your weight and maintain your BMI at 23. That way, diabetes may not plague you in your later years.

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

swine flu pandemic

The truth about pandemics

Your Health
DR GITA MATHAI

We are reeling under a surfeit of breaking news and scientific expert opinions about the swine flu pandemic. However, we need to remain focused and evaluate the statistics. The World Health Organization (WHO) says that there are approximately 1.2 million cases worldwide and around 1,000 deaths. In India, the fatalities are still in the double digits.

In contrast, tuberculosis (TB) causes 4,00,000 deaths in India annually. In fact, it is the leading cause of death in the economically productive 15 to 45 age group. However, TB can be easily diagnosed and cured with proper medication.

Around 450 out of 1,00,000 healthy young women die during childbirth. This is in contrast to China where the figure has fallen to 50. The WHO report states that the problem is magnified because the poor get inadequate care, while the rich demand and pay for caesarians and other non essential interventions.

Nineteen-year-old Saina Nehwal made headlines when she developed chicken pox a couple of weeks before the August 10 world badminton finals. She is part of the 95 per cent of the world population that develops chicken pox at some time in the course of their lives. It is an extremely contagious infection which is not taken seriously, as it usually results in innocuous disease. It can, however, turn dangerous and cause complications like brain fever, blindness, pneumonia and sterility in 10 per cent of those affected. If it occurs in childhood, it usually passes off with about a month’s absence from school. But if it occurs at a crucial stage in life like during your college finals or a public exam, it can cause much misery. The fact is such harassment is totally avoidable. The disease is preventable with a single dose of Varicella vaccine, which has to be administered after the age of one.

Pneumococcal disease causes pneumonia, brain fever, ear infection, sinusitis and bronchitis. The infection is common and results in 1.6 million deaths every year. Of this, one million are children. The death toll can be eliminated with timely immunisation in childhood. Infective jaundice because of hepatitis A and B can also be prevented with immunisation. Hepatitis A is considered harmless and exposure inevitable in India. Although the number of fatalities is negligible, it causes morbidity, with a feeling of “weakness”, lack of energy and ill health that persists for months. Hepatitis B is more dangerous. It can result in liver damage, chronic disease, cancer and even death. Again, both infections are preventable with immunisation.

Rubella or German measles is another disease that is preventable through vaccination. If acquired during pregnancy, the affliction can result in a stillbirth or a mentally retarded child with multiple defects requiring a lifetime of care. There are more vaccine preventable diseases such as measles, brain fever (caused by H. Influenzae or the meningococcal bacteria), typhoid, rotor virus diarrhoea, polio and even cervical cancer (caused by the Human Papillovirus infection).

Why then are we so focused on the swine flu epidemic? Flu has been around for centuries. Confirmed pandemics have been occurring with devastating regularity after 1918. The viruses responsible have a reservoir in birds and animals from where they mutate and transmigrate into humans. Since pigs share many genes with humans, the transition is this particular pandemic is very efficient. The rapid spread of the virus is helped by the lack of sunshine during the monsoon and in winter. It cannot survive long when exposed to our tropical sun, so in India the pandemic may be time bound.

It is difficult to differentiate the symptoms of regular flu from that of swine flu. Both start with fever, body ache, headache, sore throat, nasal stuffiness and cough. There may be diarrhoea or vomiting. The symptoms are more severe with swine flu. Most healthy people recover spontaneously from either. Those at risk are children under five, old people above 65, pregnant women and those with underlying medical conditions such as cancer, diabetes or heart disease.

Vaccines are available, but they have to be “upgraded” and “restructured” each time there is a new epidemic, as the genetic nature of the virus changes. The WHO anticipates that a vaccine to protect us against this pandemic will be available by October or November. But will there be enough vaccine to cover the entire world (or even Indian) population at risk?

The diagnosis is confirmed by tests done on nasal and throat swabs or nasal aspirates. Blood tests can be done but they take five days and involve taking two different samples. Treatment too is available in government hospitals. The drug Tamiflu (oseltamivir) is administered once diagnosis is confirmed.

The likelihood of infection is reduced by:

• Washing hands with soap several times a day, especially after handling money

• Cleaning surfaces like doorknobs with disinfectant

• Using a face mask

• Covering the face while coughing or sneezing

• Not spitting.

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

pain killers

Pain and painkillers
YOUR HEALTH
DR GITA MATHAI

Self medication can be harmful, consult a doctor when your child is sick
Michael Jackson lived and died under the arc lights. Speculation attributes his sudden death to addiction to painkillers, disastrously fuelled by the purchasing power of his millions. He could buy schedule H drugs — which are available on prescription only — and pay for their expert administration.

Pain is universal and accounts for half the medical consultations worldwide. Since everyone wants instant relief, painkillers — also called analgesics — are the most commonly prescribed and purchased medications. They belong to several chemical groups and act by dulling unbearable pain. They do not, however, cure the disease that is the root of the problem.

This means that if the actual disease is not tackled, the pain is likely to reappear when the medication wears off. This leaves patients dissatisfied and they tend to shop around for doctors.

Pain is handled by several specialists such as neurologists, surgeons, rheumatologists, general physicians, anesthetists and dentists. A patient can have several prescriptions with unidentifiable “trade names” instead of chemical names.

In an attempt to obtain relief, he or she may take several medications together. Others may dispense with the medical profession altogether and purchase analgesics over the counter (OTC) from the friendly neighbourhood pharmacy.

In such a scenario, the quantity of drug consumed and dosage intervals are no longer scientific or within safe limits. About 25 per cent of patients overdoses and 56 per cent experiences side effects — by either taking more than the recommended dose, or taking it at intervals so short that the medication is not adequately metabolised in the body.

Gradually, the body may become so used to the painkillers that habituation sets in. The medications no longer provide relief. Higher and more frequent doses are needed until, eventually, toxic levels are reached.

Today, there are millions of people from all socio-economic strata, around the world, who have unknowingly become addicted to painkillers. They are unaware of the potentially dangerous and lethal side effects of these “harmless” medications.

Pain is defined medically as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage.” It is a natural protective defence, which prevents bodily harm. Unfortunately, pain is not a tangible or measurable entity. It is as severe as the sufferer says it is.

Although pain is subjective, the degree of pain and tolerance to it are influenced greatly by social, cultural and religious factors. Egyptian queens delivered in “birthing” chairs in full view of the entire court, without any analgesic or anaesthetic, and not one of them changed their expression. It certainly was not because they were impervious to pain!

Most of the time, pain has a sudden, acute onset at a specific location in the body and is dull, burning, throbbing or stabbing. The cause — which may be an infection or injury — can usually be identified. The pain generally disappears quickly either with no treatment at all, or with simple measures such as hot or cold compresses and analgesics.

Problems set in when the pain becomes chronic, and occurs day after day, evolving into a disease entity which seems impossible to bear or cure. Around 20 to 30 per cent of the world’s population suffers from chronic pain. The commonest causes of chronic pain are low backache, arthritis, migraine and nerve pains.

If you are suffering from chronic pain,

Ask your doctor for a diagnosis

Make sure you are not receiving habit-forming or dangerous medications

Check if your social or family problems are aggravating the symptoms

Do not take more than the amount prescribed or change the frequency

Liniments and ointments may provide relief. They need to be combined with icepacks and moist heat

Vibration can be applied by rubbing with the hand or with a machine operated by a physiotherapist. It stimulates nerve endings and the chemicals released interfere with those causing pain and block them

Acupuncture uses needles to stimulate certain nerves. It is believed to release beneficial chemicals which block those causing pain

Graded exercises and physiotherapy help by gradually strengthening the muscles overlying painful joints

Nutritional supplements like curcumin (found in turmeric), glucosamine, chondroitin (found in cartilage) and omega-3 fatty acids (found in fish) can be added to the medication. They may help even though there is no clear-cut scientific evidence that they are beneficial.

When nothing seems to work, intravenous medication and anaesthesia can be used. This should be reserved for severe pain as occurs in cancer or after surgery. This can be dangerous and should not be administered on request.

The response to pain is a conditioned reflex. Tolerance increases with physical fitness. Exercise causes the release of chemicals from the large muscles of the body which help to withstand pain. Exercise regularly for a healthy, pain-free life.

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

ouc my aching back

Ouch, my back!

Your Health
DR GITA MATHAI

Regular exercise helps overcome backache
Lumbago or backache affects 80 per cent of the population at some time in their lives and 50 per cent of the working population every year. It accounts for 20 per cent of medical consultations. The resultant loss of working days has enormous economic implications.

Why do we have backaches? As man evolved, he gradually became two-legged from four-legged. This change occurred at a price. The lower back bones (vertebrae) have to bear the weight of the ones above and cope with the additional effect of gravitational pull. This makes them prone to strain, misalignment and dislocation. Also, vertebrae are separated by water filled gelatinous discs held in place by ligaments and muscles.

With age, the discs become brittle and less flexible. They can bulge out, get displaced or dislocated and impinge on nearby structures. Nerves to the legs and arms come out of the little spaces between the vertebrae. This means that any misalignment presses on the nerves and causes pain.

Backaches cannot be attributed to any particular reason in 98 per cent of the people. X-rays are rarely useful in the evaluation of those with acute-onset low back pain. About 75 per cent will show non-specific, inconclusive, age-related changes. Magnetic resonance imaging (MRI) or computed tomography (CT) studies are more likely to reveal a diagnosis.

There might be a history of trauma, an area of weakness, loss of sensation, persistent fever, intractable pain, weight loss, an underlying cancer or it might be a side-effect of corticosteroid medication.

Conservative management should be tried for four to six weeks before proceeding for tests. Some things should be kept in mind —

• Backaches require bed rest. This means lying down for two-three days. However, rest for longer periods may weaken the back muscles further. Rest in the “sitting” position can worsen disc pain as it raises intradiscal pressures.

• Painkillers like paracetamol and non-steroidal anti-inflammatory agents (NSAIDs) should be used. Narcotics should be avoided as they are habit forming.

• Superficial heat, ultrasound, cold packs and massage can relieve pain

• The usefulness of lumbar traction is questionable.

Our changing lifestyles also increase the propensity to develop backaches. School children begin to complain of backache and shoulder pain around the time they attend middle school. Very rarely is it due to an actual back pathology. A heavy school bag, asymmetrically balanced on one sagging shoulder, with an accompanying water bottle, skews the centre of gravity and causes muscle and ligament strain. Moreover, school hours are long and involve prolonged seating. And the furniture is also often not ergonomically designed. The height of the seat may be improper or back support inadequate. At home too, homework may be done sprawled on the floor or across a sofa, with no attention paid to posture.

Women are at particular risk. Fashionable footwear (block heels, stilettos, platforms) shifts the centre of gravity. Balance then requires abnormal adjustments on part of the spine. Pregnancy exaggerates the normal shallow “S” bend (lordosis) of the lumbar spine. Hormonal laxity allows the alignment to “slip”. The resultant backache sometimes persists through life.

Sedentary individuals develop backache if they lift weights. This is because their unconditioned muscles and ligaments cannot respond efficiently to the sudden physical stress.

Weight gain too places additional stress on the spine, with each extra kilo resembling a permanently attached knapsack, to be carried during all waking hours.

As age advances, the water content of the intervertebral discs naturally decreases, causing shrinkage, fragility and decreased pliability. This in itself causes older people to “pull” their backs and injure themselves. Bones too become weaker as their calcium content decreases with increasing age.

Backaches can be prevented with a little care, effort and attention to correctable reversible factors, like posture, footwear and furniture.

The school bag should not be more than 10 per cent of the weight of the child. It should have padded straps and be placed over both shoulders. Any other weights like a water bottle (a litre of water weighs a kilo) should be consciously alternated between the two shoulders.

Seating and lighting arrangements at schools and at home should be reviewed and improved. At all ages, any weight carried should be alternated between the two arms.

Children under the age of 16 years should not wear heels. Footwear should be supportive, well designed, comfortable, practical and without heels.

A conscious effort should be made to shed excess weight and maintain the BMI (body mass index, which is weight in kilogram divided by height in metre squared) below 25.

Calcium supplements should be taken regularly.

Back exercises should be started early and continued through life. They can be learnt from yoga instructors, physiotherapists, books or television. If done regularly, back injury and pain may never occur.

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