Bent and twisted
Your Health
DR GITA MATHAI
The hunchback of Notre Dame (Quasimodo), immortalised by the novelist Victor Hugo, was so deformed that he never ventured out of the cathedral. He suffered from scoliosis, a condition where his spine was bent “idiopathically” (for no known reason). He was not alone. The condition affects 2-3 per cent of the population. Some illustrious people who have not been spared by scoliosis are Hrithik Roshan, the Malayalam movie star Mohanlal and Eleanor Roosevelt. More girls than boys suffer from it. It is distributed across society, with both the rich and the poor being afflicted. The difference is that the rich can afford treatment while the poor cannot.
Normally, spines are elongated, elegant and mildly S-shaped, rather like a swan’s neck. In people with scoliosis it forms a “C” or an exaggerated “S”. Man stands upright defying gravity. Once the basic support system of the spine is bent, the person faces various problems. The appearance becomes grotesque. Other physical and neurologic problems may also arise.
The deviation in the spine may be so mild that it may remain undetected unless specifically searched for. The mother may merely feel that the child’s spine is not straight because of bad posture. Constant nagging, with the refrain “sit up, stand straight, don’t slouch” may begin. Others may blame scoliosis on food faddism, bad diet, over exertion, or carrying heavy back packs to school. Attempted correction of these variables produces no improvement. Parents don’t regard it as a disease process as the child usually does not have any associated symptoms like fever or pain.
In less than 0.1 per cent of people, scoliosis may actually have a cause. It may appear after an accident. It may also be associated with fever and eventually diagnosed as an infection of the bones of the vertebral column. It may be part of a generalised musculo-skeletal disease, in which case bones, joints and muscles other than those of the spine may be affected.
There is a genetic predisposition to scoliosis and several members of a family may be inexplicably affected over generations. These people do not suffer from any disease which could be responsible for this bent spine. It is idiopathic.
Scoliosis can be present from birth. More often it appears in childhood or adolescence as a painless rib “hump” or a prominent shoulder blade visible under a T-shirt. The uneven appearance may deter the person from wearing tight fitting clothes. The muscles on one side of the spine may develop abnormally. This may result in the shoulder and hip being at different levels on the two sides. The gait then becomes lurching.
In girls, scoliosis may cause one breast to appear unaccountably larger and more prominent than the other. Worried and puzzled parents doctor shop as they search for an answer and a cure.
Mild scoliosis may be detected only if the person is asked to lean forwards. Scoliosis is considered mild when the angle measured by the orthopaedic surgeon is less than 10 degrees. Eighty per cent of the cases in India fall in this category. These people have no symptoms and can lead a normal active life. In some, however, the curvature progresses and the angle gradually increases to 45 degrees or more. Symptoms usually begin to appear at this time. Pressure may be exerted on the contents of the chest. The heart and lungs may get displaced, leading to cardiac problems and breathing difficulties. Teenage girls with asymptomatic but visible scoliosis are distressed by their body image. They may withdraw from contact with peers and become depressed and isolated. In some people, like Quasimodo, the hump is so large that the person appears misshapen and grotesque.
There are several scientifically proven treatment options for scoliosis. Mild cases can be watched. Severe cases need braces, followed by surgery. Bracing techniques have improved greatly. Earlier braces were made of steel. Now they are made of lightweight synthetic materials. Modern braces are of the underarm type, which can be worn under the clothing. This means that the braces are comfortable and well tolerated, increasing compliance. In 75 per cent of the cases progression of the deformity can be prevented.
After the bony growth ceases, corrective surgery can halt the progressive deformity and produce a normal looking spine.
Unfortunately, in India, children with idiopathic scoliosis are not offered corrective therapy. Parents are fearful and reluctant. Naturopathy, massages, ayurveda, stretching, biofeedback, electrical stimulation and bizarre exercises are tried one after another. These have no proven benefit, and some are positively harmful. Poorly performed physical therapy, stretching machines and hot massages used intermittently can even cause neurological damage.
Scoliosis is correctable and treatable. Ignorance and financial constraints prevent many of our young people from accessing corrective braces and surgery. Eventually, like Quasimodo, they have to hide forever from society.
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
Sunday, April 11, 2010
scoliosis
Bent and twisted
Your Health
DR GITA MATHAI
The hunchback of Notre Dame (Quasimodo), immortalised by the novelist Victor Hugo, was so deformed that he never ventured out of the cathedral. He suffered from scoliosis, a condition where his spine was bent "idiopathically" (for no known reason). He was not alone. The condition affects 2-3 per cent of the population. Some illustrious people who have not been spared by scoliosis are Hrithik Roshan, the Malayalam movie star Mohanlal and Eleanor Roosevelt. More girls than boys suffer from it. It is distributed across society, with both the rich and the poor being afflicted. The difference is that the rich can afford treatment while the poor cannot.
Normally, spines are elongated, elegant and mildly S-shaped, rather like a swan's neck. In people with scoliosis it forms a "C" or an exaggerated "S". Man stands upright defying gravity. Once the basic support system of the spine is bent, the person faces various problems. The appearance becomes grotesque. Other physical and neurologic problems may also arise.
The deviation in the spine may be so mild that it may remain undetected unless specifically searched for. The mother may merely feel that the child's spine is not straight because of bad posture. Constant nagging, with the refrain "sit up, stand straight, don't slouch" may begin. Others may blame scoliosis on food faddism, bad diet, over exertion, or carrying heavy back packs to school. Attempted correction of these variables produces no improvement. Parents don't regard it as a disease process as the child usually does not have any associated symptoms like fever or pain.
In less than 0.1 per cent of people, scoliosis may actually have a cause. It may appear after an accident. It may also be associated with fever and eventually diagnosed as an infection of the bones of the vertebral column. It may be part of a generalised musculo-skeletal disease, in which case bones, joints and muscles other than those of the spine may be affected.
There is a genetic predisposition to scoliosis and several members of a family may be inexplicably affected over generations. These people do not suffer from any disease which could be responsible for this bent spine. It is idiopathic.
Scoliosis can be present from birth. More often it appears in childhood or adolescence as a painless rib "hump" or a prominent shoulder blade visible under a T-shirt. The uneven appearance may deter the person from wearing tight fitting clothes. The muscles on one side of the spine may develop abnormally. This may result in the shoulder and hip being at different levels on the two sides. The gait then becomes lurching.
In girls, scoliosis may cause one breast to appear unaccountably larger and more prominent than the other. Worried and puzzled parents doctor shop as they search for an answer and a cure.
Mild scoliosis may be detected only if the person is asked to lean forwards. Scoliosis is considered mild when the angle measured by the orthopaedic surgeon is less than 10 degrees. Eighty per cent of the cases in India fall in this category. These people have no symptoms and can lead a normal active life. In some, however, the curvature progresses and the angle gradually increases to 45 degrees or more. Symptoms usually begin to appear at this time. Pressure may be exerted on the contents of the chest. The heart and lungs may get displaced, leading to cardiac problems and breathing difficulties. Teenage girls with asymptomatic but visible scoliosis are distressed by their body image. They may withdraw from contact with peers and become depressed and isolated. In some people, like Quasimodo, the hump is so large that the person appears misshapen and grotesque.
There are several scientifically proven treatment options for scoliosis. Mild cases can be watched. Severe cases need braces, followed by surgery. Bracing techniques have improved greatly. Earlier braces were made of steel. Now they are made of lightweight synthetic materials. Modern braces are of the underarm type, which can be worn under the clothing. This means that the braces are comfortable and well tolerated, increasing compliance. In 75 per cent of the cases progression of the deformity can be prevented.
After the bony growth ceases, corrective surgery can halt the progressive deformity and produce a normal looking spine.
Unfortunately, in India, children with idiopathic scoliosis are not offered corrective therapy. Parents are fearful and reluctant. Naturopathy, massages, ayurveda, stretching, biofeedback, electrical stimulation and bizarre exercises are tried one after another. These have no proven benefit, and some are positively harmful. Poorly performed physical therapy, stretching machines and hot massages used intermittently can even cause neurological damage.
Scoliosis is correctable and treatable. Ignorance and financial constraints prevent many of our young people from accessing corrective braces and surgery. Eventually, like Quasimodo, they have to hide forever from society.
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
Monday, March 29, 2010
medical palmistry
our Health
DR GITA MATHAI
Rogue, fraud, charlatan. Words we often use to describe the roadside palmist. Can anyone say what the creases, lines and stars etched on our palms mean? Or if they do mean anything at all?
Some people, it seems, can say much about your life by “reading” your palm.
Welcome to the world of medical palmistry, a branch of science based on documented and proven scientific observations.
A detailed examination of the palm does provide valuable clues to a person’s medical history, lifestyle, diseases and life expectancy. Palms and fingers have characteristic creases, whorls, arches and loops. These are unique in each individual and never identical, even in twins. One of the oldest biometric methods of establishing positive identity is by using fingerprints.
“Palmar creases” form in an unborn baby as it holds its hands tightly clenched during the 12th week. Normally this forms three palmar creases or lines. Any physical, medical or drug-induced injury to the foetus during the first three months is reflected permanently as abnormal palmar creases. This can be picked up on ultrasound examination after the 12th week. If the creases are abnormal, the foetus should be closely monitored for associated abnormalities in the kidney, heart and other organs.
Sometimes the upper two lines fuse to form a single palmar crease or simian line that stretches across the open palm. A single palmar crease can be present in one out of 30 apparently normal people. It is more common in males and is usually present only on one hand. One or both parents of these children may have the abnormal crease on one hand. This is a minor aberration and warrants monitoring as these children may reveal mild abnormalities in other organs in later life. It is also associated with certain chromosomal anomalies, the most common of which is Down’s Syndrome (Trisomy 21).
Not all abnormal palmar creases are hereditary or genetic. Alcoholic women who continue to drink during pregnancy can produce children with “foetal alcohol syndrome” and a single palmar crease.
People with mental illnesses have more open loops and fewer whorls on their finger tips. Those prone to chronic diseases like leprosy and tuberculosis also tend to have only two lines on the palm, with the abnormal line just above the thumb.
Normally, a person has 10 fingers and toes. In one in 1,000 births, there may be extra digits, separate, complete, incomplete or fused. These defects can be associated with other internal congenital malformations, and so a detailed examination must be done for any affected newborn.
Marfans syndrome is a genetic disorder in which the person has “arachnodactyly” or abnormally long fingers like spider legs. This can be diagnosed before birth through ultrasound.
Congenital hypothyroidism, certain renal diseases and some forms of dwarfism are linked with a “tripartiate” hand — where the index, middle and ring fingers are the same length.
Cigarette smokers, people suffering from chronic respiratory ailments, and those with congenital heart disease may have blue nails. Some lung diseases like bronchiectasis, and chronic intestinal diseases may bend the nail like a convex parrot beak, a condition called “clubbing”. Jaundice causes the skin of the palms to turn yellow. Carotenemia produces a similar appearance. It is a harmless condition and is caused by an excess consumption of yellow carotene containing fruits and vegetables.
Hormone levels in the uterus also influences finger length. A person (irrespective of sex) with the index finger shorter than the ring finger will have had more testosterone (male hormone) while in the womb, and a person with an index finger longer than the ring finger will have had more eostrogen (female hormone). Professional women, especially women scientists, tend to have higher levels of testosterone vis-a-vis their oestrogen level, making their brains closer to those of men in general. The converse is true with men working in the fine arts and social sciences.
The position in which we hold our palms is a reflection of the body mass index or BMI (weight in kilogram divided by height in metre squared). A BMI more than 30 is diagnostic of obesity. Such people tend to hold their hands with the thumbs facing backwards as they stand. Overweight people with a BMI between 25 and 30 hold their arms with the thumb facing sideways. People of normal weight with a BMI between 20 and 25 stand with their palms facing forwards.
So, remember, your palms will reveal a lot about your health, but only if you go to a medical palmist.
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
DR GITA MATHAI
Rogue, fraud, charlatan. Words we often use to describe the roadside palmist. Can anyone say what the creases, lines and stars etched on our palms mean? Or if they do mean anything at all?
Some people, it seems, can say much about your life by “reading” your palm.
Welcome to the world of medical palmistry, a branch of science based on documented and proven scientific observations.
A detailed examination of the palm does provide valuable clues to a person’s medical history, lifestyle, diseases and life expectancy. Palms and fingers have characteristic creases, whorls, arches and loops. These are unique in each individual and never identical, even in twins. One of the oldest biometric methods of establishing positive identity is by using fingerprints.
“Palmar creases” form in an unborn baby as it holds its hands tightly clenched during the 12th week. Normally this forms three palmar creases or lines. Any physical, medical or drug-induced injury to the foetus during the first three months is reflected permanently as abnormal palmar creases. This can be picked up on ultrasound examination after the 12th week. If the creases are abnormal, the foetus should be closely monitored for associated abnormalities in the kidney, heart and other organs.
Sometimes the upper two lines fuse to form a single palmar crease or simian line that stretches across the open palm. A single palmar crease can be present in one out of 30 apparently normal people. It is more common in males and is usually present only on one hand. One or both parents of these children may have the abnormal crease on one hand. This is a minor aberration and warrants monitoring as these children may reveal mild abnormalities in other organs in later life. It is also associated with certain chromosomal anomalies, the most common of which is Down’s Syndrome (Trisomy 21).
Not all abnormal palmar creases are hereditary or genetic. Alcoholic women who continue to drink during pregnancy can produce children with “foetal alcohol syndrome” and a single palmar crease.
People with mental illnesses have more open loops and fewer whorls on their finger tips. Those prone to chronic diseases like leprosy and tuberculosis also tend to have only two lines on the palm, with the abnormal line just above the thumb.
Normally, a person has 10 fingers and toes. In one in 1,000 births, there may be extra digits, separate, complete, incomplete or fused. These defects can be associated with other internal congenital malformations, and so a detailed examination must be done for any affected newborn.
Marfans syndrome is a genetic disorder in which the person has “arachnodactyly” or abnormally long fingers like spider legs. This can be diagnosed before birth through ultrasound.
Congenital hypothyroidism, certain renal diseases and some forms of dwarfism are linked with a “tripartiate” hand — where the index, middle and ring fingers are the same length.
Cigarette smokers, people suffering from chronic respiratory ailments, and those with congenital heart disease may have blue nails. Some lung diseases like bronchiectasis, and chronic intestinal diseases may bend the nail like a convex parrot beak, a condition called “clubbing”. Jaundice causes the skin of the palms to turn yellow. Carotenemia produces a similar appearance. It is a harmless condition and is caused by an excess consumption of yellow carotene containing fruits and vegetables.
Hormone levels in the uterus also influences finger length. A person (irrespective of sex) with the index finger shorter than the ring finger will have had more testosterone (male hormone) while in the womb, and a person with an index finger longer than the ring finger will have had more eostrogen (female hormone). Professional women, especially women scientists, tend to have higher levels of testosterone vis-a-vis their oestrogen level, making their brains closer to those of men in general. The converse is true with men working in the fine arts and social sciences.
The position in which we hold our palms is a reflection of the body mass index or BMI (weight in kilogram divided by height in metre squared). A BMI more than 30 is diagnostic of obesity. Such people tend to hold their hands with the thumbs facing backwards as they stand. Overweight people with a BMI between 25 and 30 hold their arms with the thumb facing sideways. People of normal weight with a BMI between 20 and 25 stand with their palms facing forwards.
So, remember, your palms will reveal a lot about your health, but only if you go to a medical palmist.
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
Saturday, March 20, 2010
Can't get the words out
Stutter and stammer
Your Health
DR GITA MATHAI
“Honey should be applied to a baby’s tongue soon after birth. The child then goes on to develop sweet speech with no stammering.”
This was the practice a century ago. Medically, the honey did nothing to prevent stammering. But if it was contaminated with bacteria, it did cause fatal botulinium poisoning with flaccid paralysis in a significant percentage of children.
Around 10 million people in India stammer. The speech disorder affects 3-5 per cent of children, of which one per cent continues to stammer into adult life. About 80 per cent of the affected children are boys, and first-born males are more likely to be affected. Around 65 per cent of them have a family history of stammering. In most cases, it is the father who stammers or has rapid staccato speech.
Speech is a complex process. A person decides what he or she wants to say, and electro chemical signals are triggered in the brain’s speech area. These signals have to reach the muscle groups in the pharynx, larynx and tongue. If the speed of the thought and the release of the chemicals are not perfectly co-ordinated, stammering occurs. Words or syllables are repeated or prolonged, speech suddenly stops and no sound emerges. The speech becomes blocked in spasms, resulting in repetitive sounds or no sound at all. Even in normal people, emotions can trigger such a condition. In those who stammer, anxiety anticipation of stammering, and embarrassment can trigger tics and spasms of the facial muscles as well.
Children start to stammer before the age of five. It may first become evident when they start school. Many recover spontaneously, while others require treatment. If the stammering continues beyond the age of seven, it is likely to persist into adult life.
Many famous people like Winston Churchill stammered. It didn’t prevent them from scaling great heights. In most cases, however, the sufferer fails to achieve his or her potential. Such people fail in job interviews and viva voce presentations, as stress worsens the stammer. Society often pokes fun at these individuals. In films too comedians are often shown to stammer. As a result, these otherwise intelligent and sensitive people become withdrawn and isolated.
When in contact with a person who stammers:
• Try not to show your embarrassment or look away. Do not reassure them just wait patiently and they will complete what they want to say
• Do not try to complete their sentences for them
• Maintain eye contact
• Many of those who stammer find answering the phone an ordeal. So if the phone rings and there is silence, wait till the person is able to speak.
Stammering is not due to tongue-tie, so surgery does not help. Since it is aggravated by stress, and the affected individuals appear distressed, antiaxiolytic medications like alpraxolam and valium, tranquillisers and antidepressants were initially tried. But they were not very useful. In short, there is no magic pill to cure stammering.
If a child’s stammer lasts more than six months, causes psychological problems in school, or continues beyond the age of five, it needs to be evaluated.
Children cannot voluntarily control stammering. Ridicule, asking him or her to speak slowly, or forcing him or her to repeat the words wont help. The only way parents can help is by providing a relaxed and supportive environment where the child is allowed to speak without feeling self-conscious.
Speech therapists can work with people who stammer, and by using a variety of techniques, can improve the speech. They can also help improve communication skills and create self awareness and confidence. Newer auditory feedback devices and computer assisted speech training can also be tried out. Many people do not have access to speech therapists and are forced to handle their child’s stammering as best they can.
A person may stammer while talking but not while singing. Asking him or her to formulate thoughts in the mind and then speak in a singsong way often helps. Speaking slowly, syllable by syllable instead of complete words, gets rid of the repetitive “th th th” sounds. Asking the person to follow the speech of the therapist or parent also helps. Sometimes using a gesture as the stammer sets in takes the concentration away from the speech and the stammer disappears.
Universal tips
• Sing the words
• Visualise the words in your head first
• Take a deep breath before speaking
• Speak slowly and break up the words into smaller components
• Speaking loudly or in a whisper makes stammering less obvious
If your child stammers, encourage him or her to do physical activity. This gives confidence which helps the anxiety and depression caused by stammering. Yoga calms the mind and corrects faulty breathing. It also improves speech in those who stammer.
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
Your Health
DR GITA MATHAI
“Honey should be applied to a baby’s tongue soon after birth. The child then goes on to develop sweet speech with no stammering.”
This was the practice a century ago. Medically, the honey did nothing to prevent stammering. But if it was contaminated with bacteria, it did cause fatal botulinium poisoning with flaccid paralysis in a significant percentage of children.
Around 10 million people in India stammer. The speech disorder affects 3-5 per cent of children, of which one per cent continues to stammer into adult life. About 80 per cent of the affected children are boys, and first-born males are more likely to be affected. Around 65 per cent of them have a family history of stammering. In most cases, it is the father who stammers or has rapid staccato speech.
Speech is a complex process. A person decides what he or she wants to say, and electro chemical signals are triggered in the brain’s speech area. These signals have to reach the muscle groups in the pharynx, larynx and tongue. If the speed of the thought and the release of the chemicals are not perfectly co-ordinated, stammering occurs. Words or syllables are repeated or prolonged, speech suddenly stops and no sound emerges. The speech becomes blocked in spasms, resulting in repetitive sounds or no sound at all. Even in normal people, emotions can trigger such a condition. In those who stammer, anxiety anticipation of stammering, and embarrassment can trigger tics and spasms of the facial muscles as well.
Children start to stammer before the age of five. It may first become evident when they start school. Many recover spontaneously, while others require treatment. If the stammering continues beyond the age of seven, it is likely to persist into adult life.
Many famous people like Winston Churchill stammered. It didn’t prevent them from scaling great heights. In most cases, however, the sufferer fails to achieve his or her potential. Such people fail in job interviews and viva voce presentations, as stress worsens the stammer. Society often pokes fun at these individuals. In films too comedians are often shown to stammer. As a result, these otherwise intelligent and sensitive people become withdrawn and isolated.
When in contact with a person who stammers:
• Try not to show your embarrassment or look away. Do not reassure them just wait patiently and they will complete what they want to say
• Do not try to complete their sentences for them
• Maintain eye contact
• Many of those who stammer find answering the phone an ordeal. So if the phone rings and there is silence, wait till the person is able to speak.
Stammering is not due to tongue-tie, so surgery does not help. Since it is aggravated by stress, and the affected individuals appear distressed, antiaxiolytic medications like alpraxolam and valium, tranquillisers and antidepressants were initially tried. But they were not very useful. In short, there is no magic pill to cure stammering.
If a child’s stammer lasts more than six months, causes psychological problems in school, or continues beyond the age of five, it needs to be evaluated.
Children cannot voluntarily control stammering. Ridicule, asking him or her to speak slowly, or forcing him or her to repeat the words wont help. The only way parents can help is by providing a relaxed and supportive environment where the child is allowed to speak without feeling self-conscious.
Speech therapists can work with people who stammer, and by using a variety of techniques, can improve the speech. They can also help improve communication skills and create self awareness and confidence. Newer auditory feedback devices and computer assisted speech training can also be tried out. Many people do not have access to speech therapists and are forced to handle their child’s stammering as best they can.
A person may stammer while talking but not while singing. Asking him or her to formulate thoughts in the mind and then speak in a singsong way often helps. Speaking slowly, syllable by syllable instead of complete words, gets rid of the repetitive “th th th” sounds. Asking the person to follow the speech of the therapist or parent also helps. Sometimes using a gesture as the stammer sets in takes the concentration away from the speech and the stammer disappears.
Universal tips
• Sing the words
• Visualise the words in your head first
• Take a deep breath before speaking
• Speak slowly and break up the words into smaller components
• Speaking loudly or in a whisper makes stammering less obvious
If your child stammers, encourage him or her to do physical activity. This gives confidence which helps the anxiety and depression caused by stammering. Yoga calms the mind and corrects faulty breathing. It also improves speech in those who stammer.
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
Tuesday, March 9, 2010
i can't breathe
Hunger for air
YOUR HEALTH
DR GITA MATHAI
“I can’t breathe,” said the woman, panic stricken and one hand clutched at her chest. Her forehead was lined with sweat and fear of death etched on her face. Breathing, after all, is essential for life.
We take breathing or respiration for granted. It is an involuntary, autonomous and automatic reflex that is present from birth to death. We can consciously take deep or shallow breaths, but we cannot stop breathing at will. In short, you cannot commit suicide by voluntarily ceasing to breathe.
Breathing difficulty is a perception. Some people may have fairly severe lung restriction, but be able to continue their normal activities. Others may feel breathless with the slightest unaccustomed exertion. This is more likely to occur if the person is unfit, obese and unaccustomed to exercise. A sudden “panic attack” owing to an external factor can be “breath stopping”. High altitudes and high temperature can also cause similar problems.
Breathing difficulty can occur suddenly because of a foreign body like a peanut which has got lodged in the food pipe. This then becomes a medical emergency. Immediately stand behind the person, make a fist with both hands and exert a sudden forceful upward thrust in the stomach area below the chest bone (sternum). This is called a “Heimlich maneuver” and it has saved many lives.
Mucous secretions — watery in case of viral infections and allergy, and thick and viscous in case of secondary bacterial infection — can clog the nasal passages and bronchi. Some of these secretions can drip backwards into the throat, causing a post nasal drip with a sense of suffocation.
The nasal passages can be cleared with nose drops. It is important to use saline nasal drops. This is commercially manufactured by many companies. It needs to be used every two hours. Nasal drops containing chemicals may provide faster relief. But as the effect wears off, they may cause “rebound congestion” with worse blockage. Long-term frequent usage of chemical nose drops may cause habituation, wherein the body stops responding to the medication. If the nasal block is due to an allergy, prescribed locally acting steroid nasal sprays are very effective.
The bronchi can narrow in response to exposure to ingested allergens like peanuts and food colour, or inhaled ones like cigarette or wood smoke, room fresheners and mosquito repellents. This is called reactive airways disease or asthma.
Smokers may have damaged their lungs structure permanently, causing a disease called COAD (chronic obstructive airways disease). This sets in around 20-30 years after the first puff. It attacks people in their 40s and 50s. They become breathless with exertion and sometimes even at rest. Some require continuous artificial oxygen supply.
Initially — that is, before damage sets in — airway constriction is reversible. Inhalers or rotahalers deliver relief producing bronchodilating medication directly to the bronchi. The respite is immediate and sustained if the medication is “puffed” as prescribed. Direct delivery systems make medication more effective and are less likely to cause side effects.
The rate of breathing increases during pregnancy because of the oxygen demand of the baby. Moreover, pregnancy causes the uterus to enlarge which pushes the abdominal contents upwards. This may cause a feeling of inadequacy while breathing. This is self-limited and disappears with delivery.
Congenital heart disease, heart failure and myocarditis (disease of the heart muscles) can cause difficulty in breathing and a feeling of air hunger. This is because a failing heart provides inefficient circulation of blood and insufficient oxygenation to the tissues of the body. The blood carrying capacity of the body itself may be compromised because of anaemia. Specific medication for the diseases will help with the problem.
Breathlessness needs to be evaluated if:
The difficulty occurred suddenly for no apparent reason
• It was accompanied by chest discomfort, pain or pressure
• It comes with a slight exertion or at rest
• There is an inability to lie down flat and sleep
• It is accompanied by fever
• There is pressure, fullness or a squeezing pain in the chest.
Good breathing techniques require the co-ordinated use of intercostals (groups of muscles that run between the ribs, and help form and move the chest wall), diaphragm and stomach muscles. As the breath goes in, the intercostals and stomach expand and the latter moves outwards. And as we breathe out, the chest contracts, the diaphragm moves up and the stomach moves in. Breathing is a natural response and occurs normally and naturally in children. As age advances, we tend to lose the ability to breathe efficiently.
Long hours at work seated in a sloppy posture, obesity or an inactive life without the mandatory one hour of aerobic activity (running, swimming, jogging or cycling) results in inefficient and inadequate breathing, even in a normal individual.
Place a hand on your abdomen, stand in front of a mirror and breathe in and out to check if your breathing is correct. Consciously correct deficiencies and practise breathing exercises (yoga pranayam) for a healthier tomorrow.
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
YOUR HEALTH
DR GITA MATHAI
“I can’t breathe,” said the woman, panic stricken and one hand clutched at her chest. Her forehead was lined with sweat and fear of death etched on her face. Breathing, after all, is essential for life.
We take breathing or respiration for granted. It is an involuntary, autonomous and automatic reflex that is present from birth to death. We can consciously take deep or shallow breaths, but we cannot stop breathing at will. In short, you cannot commit suicide by voluntarily ceasing to breathe.
Breathing difficulty is a perception. Some people may have fairly severe lung restriction, but be able to continue their normal activities. Others may feel breathless with the slightest unaccustomed exertion. This is more likely to occur if the person is unfit, obese and unaccustomed to exercise. A sudden “panic attack” owing to an external factor can be “breath stopping”. High altitudes and high temperature can also cause similar problems.
Breathing difficulty can occur suddenly because of a foreign body like a peanut which has got lodged in the food pipe. This then becomes a medical emergency. Immediately stand behind the person, make a fist with both hands and exert a sudden forceful upward thrust in the stomach area below the chest bone (sternum). This is called a “Heimlich maneuver” and it has saved many lives.
Mucous secretions — watery in case of viral infections and allergy, and thick and viscous in case of secondary bacterial infection — can clog the nasal passages and bronchi. Some of these secretions can drip backwards into the throat, causing a post nasal drip with a sense of suffocation.
The nasal passages can be cleared with nose drops. It is important to use saline nasal drops. This is commercially manufactured by many companies. It needs to be used every two hours. Nasal drops containing chemicals may provide faster relief. But as the effect wears off, they may cause “rebound congestion” with worse blockage. Long-term frequent usage of chemical nose drops may cause habituation, wherein the body stops responding to the medication. If the nasal block is due to an allergy, prescribed locally acting steroid nasal sprays are very effective.
The bronchi can narrow in response to exposure to ingested allergens like peanuts and food colour, or inhaled ones like cigarette or wood smoke, room fresheners and mosquito repellents. This is called reactive airways disease or asthma.
Smokers may have damaged their lungs structure permanently, causing a disease called COAD (chronic obstructive airways disease). This sets in around 20-30 years after the first puff. It attacks people in their 40s and 50s. They become breathless with exertion and sometimes even at rest. Some require continuous artificial oxygen supply.
Initially — that is, before damage sets in — airway constriction is reversible. Inhalers or rotahalers deliver relief producing bronchodilating medication directly to the bronchi. The respite is immediate and sustained if the medication is “puffed” as prescribed. Direct delivery systems make medication more effective and are less likely to cause side effects.
The rate of breathing increases during pregnancy because of the oxygen demand of the baby. Moreover, pregnancy causes the uterus to enlarge which pushes the abdominal contents upwards. This may cause a feeling of inadequacy while breathing. This is self-limited and disappears with delivery.
Congenital heart disease, heart failure and myocarditis (disease of the heart muscles) can cause difficulty in breathing and a feeling of air hunger. This is because a failing heart provides inefficient circulation of blood and insufficient oxygenation to the tissues of the body. The blood carrying capacity of the body itself may be compromised because of anaemia. Specific medication for the diseases will help with the problem.
Breathlessness needs to be evaluated if:
The difficulty occurred suddenly for no apparent reason
• It was accompanied by chest discomfort, pain or pressure
• It comes with a slight exertion or at rest
• There is an inability to lie down flat and sleep
• It is accompanied by fever
• There is pressure, fullness or a squeezing pain in the chest.
Good breathing techniques require the co-ordinated use of intercostals (groups of muscles that run between the ribs, and help form and move the chest wall), diaphragm and stomach muscles. As the breath goes in, the intercostals and stomach expand and the latter moves outwards. And as we breathe out, the chest contracts, the diaphragm moves up and the stomach moves in. Breathing is a natural response and occurs normally and naturally in children. As age advances, we tend to lose the ability to breathe efficiently.
Long hours at work seated in a sloppy posture, obesity or an inactive life without the mandatory one hour of aerobic activity (running, swimming, jogging or cycling) results in inefficient and inadequate breathing, even in a normal individual.
Place a hand on your abdomen, stand in front of a mirror and breathe in and out to check if your breathing is correct. Consciously correct deficiencies and practise breathing exercises (yoga pranayam) for a healthier tomorrow.
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
Saturday, February 20, 2010
belly bulges
Belly bulges
Your Health
________________________________________DR GITA MATHAI
A protruding belly button is commoner in boys and may run in families
Everyone would love an eight pack abdomen, but for some it may remain just a dream. Their abdominal wall has unsightly bulges and protuberances, which may be a well rounded paunch or even hernia.
Some children have a protruding navel or belly button, which is noticed soon after the remnant of the umbilical cord falls off. When the baby cries or strains, the tummy bulges at the umbilicus. The swelling is called an umbilical hernia. It is commoner in boys. It may run in families and be associated with other diseases like thyroid deficiency or inborn errors of metabolism.
The foetus receives its nutrition through umbilical blood vessels that are attached to the navel. The abdominal muscles also fuse at that point. There is an area of weakness there which can cause a defect in the abdominal wall muscles. The intestines may protrude through this. Usually, the intestines can be pushed back when the child is quiet and lying down.
By the age of three or four years, the abdominal musculature develops and the hernia disappears on its own. It usually does not cause any symptoms till that time. If the skin over the hernia changes colour, or if the child starts to cry incessantly, consult a doctor. It may mean the intestine has got trapped in the hernia and its blood supply is being compromised, strangling the bowel.
Strapping the bulging belly button with plaster, tying it with a bandage or fixing a coin over it won’t help. On the contrary, it may be harmful as a piece of intestine may get caught in the bandage and stop the blood supply. This then becomes a medical emergency. If the hernia persists after the age of three, it needs to be surgically repaired.
Hernias can also suddenly appear near the umbilicus in adults. This “paraumbilical hernia” is situated just above the navel and occurs through a weakness in the abdominal wall muscles. It may be due to pregnancy, obesity or poor abdominal muscle tone. It may also appear if fluid accumulates in the abdomen as a result of kidney or liver disease. The hernia may contain fat or intestines.
Paraumbilical hernias that appear during pregnancy may disappear on their own. In others, they need to be surgically corrected, even if they are painless. Bits of bowel or other intestinal content can suddenly become trapped in them, precipitating an emergency. There is a band of fibrous tissue connecting and holding together the musculature of the two halves of the abdomen. If this is weak and separates out, it may cause a condition called “divarication of the rectus abdominus”. It is common in obesity. The affected area is usually long and stretches over the abdomen from the umbilicus to the rib cage. As the defect is large, the intestine does not become trapped inside. If there is no umbilical hernia, it can be left alone. Surgical repair is a variation of a “tummy tuck” and is done purely for cosmetic reasons.
If there is a small defect in the linea alba (fibrous structure running down the midline of the abdomen), a ping-pong ball sized bulge can occur at the spot. This is called an “epigastric hernia”. It needs to corrected.
About 75 per cent of hernias occur lower down in the groin area and are called “inguinal hernias”. They are commoner in men. They can extend from the lower part of the abdomen to the scrotum in men and to the labia in women. They are caused by a congenital defect in the abdominal wall. Some men push the contents of the hernia back into the abdomen and then use a “surgical truss” to hold it there.
The surgical treatment of hernias has changed over the years. Traditional techniques involved opening the abdomen and suturing the muscle layers. Hospital stays were prolonged and recovery slow. Now, laparoscopic repairs can be done, reducing the hospital stay to two or three days. Fine sterile surgical mesh can be used to cover the defect. The hernia is then less likely to recur as there is no tension on the layers of the abdominal muscles.
Some hernias can’t be prevented. Congenital abdominal wall defects are less likely to manifest as hernias if
• The BMI (body weight divided by height in metre squared) is 23
• Core strengthening exercises (oblique sit ups, plank position) are done daily
• Lifting heavy weights is avoided
• Weight-lifting exercises are done after proper training and conditioning.
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
Your Health
________________________________________DR GITA MATHAI
A protruding belly button is commoner in boys and may run in families
Everyone would love an eight pack abdomen, but for some it may remain just a dream. Their abdominal wall has unsightly bulges and protuberances, which may be a well rounded paunch or even hernia.
Some children have a protruding navel or belly button, which is noticed soon after the remnant of the umbilical cord falls off. When the baby cries or strains, the tummy bulges at the umbilicus. The swelling is called an umbilical hernia. It is commoner in boys. It may run in families and be associated with other diseases like thyroid deficiency or inborn errors of metabolism.
The foetus receives its nutrition through umbilical blood vessels that are attached to the navel. The abdominal muscles also fuse at that point. There is an area of weakness there which can cause a defect in the abdominal wall muscles. The intestines may protrude through this. Usually, the intestines can be pushed back when the child is quiet and lying down.
By the age of three or four years, the abdominal musculature develops and the hernia disappears on its own. It usually does not cause any symptoms till that time. If the skin over the hernia changes colour, or if the child starts to cry incessantly, consult a doctor. It may mean the intestine has got trapped in the hernia and its blood supply is being compromised, strangling the bowel.
Strapping the bulging belly button with plaster, tying it with a bandage or fixing a coin over it won’t help. On the contrary, it may be harmful as a piece of intestine may get caught in the bandage and stop the blood supply. This then becomes a medical emergency. If the hernia persists after the age of three, it needs to be surgically repaired.
Hernias can also suddenly appear near the umbilicus in adults. This “paraumbilical hernia” is situated just above the navel and occurs through a weakness in the abdominal wall muscles. It may be due to pregnancy, obesity or poor abdominal muscle tone. It may also appear if fluid accumulates in the abdomen as a result of kidney or liver disease. The hernia may contain fat or intestines.
Paraumbilical hernias that appear during pregnancy may disappear on their own. In others, they need to be surgically corrected, even if they are painless. Bits of bowel or other intestinal content can suddenly become trapped in them, precipitating an emergency. There is a band of fibrous tissue connecting and holding together the musculature of the two halves of the abdomen. If this is weak and separates out, it may cause a condition called “divarication of the rectus abdominus”. It is common in obesity. The affected area is usually long and stretches over the abdomen from the umbilicus to the rib cage. As the defect is large, the intestine does not become trapped inside. If there is no umbilical hernia, it can be left alone. Surgical repair is a variation of a “tummy tuck” and is done purely for cosmetic reasons.
If there is a small defect in the linea alba (fibrous structure running down the midline of the abdomen), a ping-pong ball sized bulge can occur at the spot. This is called an “epigastric hernia”. It needs to corrected.
About 75 per cent of hernias occur lower down in the groin area and are called “inguinal hernias”. They are commoner in men. They can extend from the lower part of the abdomen to the scrotum in men and to the labia in women. They are caused by a congenital defect in the abdominal wall. Some men push the contents of the hernia back into the abdomen and then use a “surgical truss” to hold it there.
The surgical treatment of hernias has changed over the years. Traditional techniques involved opening the abdomen and suturing the muscle layers. Hospital stays were prolonged and recovery slow. Now, laparoscopic repairs can be done, reducing the hospital stay to two or three days. Fine sterile surgical mesh can be used to cover the defect. The hernia is then less likely to recur as there is no tension on the layers of the abdominal muscles.
Some hernias can’t be prevented. Congenital abdominal wall defects are less likely to manifest as hernias if
• The BMI (body weight divided by height in metre squared) is 23
• Core strengthening exercises (oblique sit ups, plank position) are done daily
• Lifting heavy weights is avoided
• Weight-lifting exercises are done after proper training and conditioning.
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
Saturday, February 13, 2010
fair and lovely
All’s not fair
Your Health
DR GITA MATHAI
PRIDE OR PREJUDICE? Beauty lies in a healthy, glowing skin and confident personality
Remember those TV commercials in which a dark complexioned girl found it impossible to get a suitable boy until she used a fairness cream? The ads continue, only with a slight difference: finding a groom has given way to finding a career path — as an airhostess, a sports anchor or beauty queen. The fair factor remains, as is engraved in our psyche. And it’s not just women who are being sent the unfair message; men too are told they must use fairness creams to win a girl or shine in their career.
Most people have a bias for fair skin. They consider it more attractive and subconsciously place it higher on the socio-economic scale. Newspapers are replete with matrimonial ads for “fair and beautiful” women.
Skin colour is genetically determined — it depends on the skin colour of both the parents. If one parent is dark and the other fair, the child is more likely to be dark. Dark skin contains more melanin, a pigment that gives skin its colour and protects against sunburn and skin cancer. This means dark skin is superior for adaptation and survival in the process of evolution.
People do various things to appear fair. Those who can spare only a few minutes apply a liberal coat of talcum powder before stepping out. The powder may be slightly yellow (as it may be mixed with sandalwood or turmeric), pink (calamine or some other colouring agent) or white, giving the person a ghostly, unnatural shade. Perfume and other additives in the talcum may cause allergy, itching, rash or sunlight sensitivity, leading to unsightly blotchy skin with dark and light patches.
Beauty parlours offer “skin peeling” face packs. They strip the superficial tanned and pigmented layers of the skin. Stripping does make a person appear 10 to 20 per cent fairer, but only temporarily. Once the skin grows back, the original colour returns. Stripping should not be done on a regular basis as it damages the skin. Also, it should never be done if there are pimples or cuts.
Manufacturers of fairness creams claim they do not use any harmful ingredients. As a rule, they must mention all the components on the packaging. The list, however, is often incomplete. Moreover, the percentage of each component is seldom stated. Companies hide behind the façade of it being a “trade secret”.
Most fairness creams contain sunscreen to prevent tanning. This is usually harmless. Some may have a bleaching agent, the concentration of which should not be more than 3-4 per cent. Higher concentrations may cause severe reactions with irritation, itching, blistering and severe pain.
Around 20 per cent of skin pigmentation can be reversed by applying 2 per cent hydroquinolone alone or in combination with 0.05-0.1 per cent tretinoin. Fairness creams often contain these chemicals.
What many people don’t know is that they may cause paradoxical sunlight sensitivity with sunburn if the skin is exposed to sunlight after application. Higher concentrations of these chemicals are dangerous and have been shown to cause cancer and birth defects in mice. They are banned in some countries.
If the cream contains steroids, it will cause thinness and atrophy of the skin. If used for prolonged periods, sufficient quantities can get absorbed and produce side effects like weight gain and facial hair.
“Natural herbal” products too are not 100 per cent safe. They contain refined plant extracts which may cause allergy.
Ayurvedic fairness creams contain heavy metals like mercury. These can get absorbed and accumulate in the deeper layers, causing liver and kidney damage.
The fairness industry in India is worth around Rs 1,400 crore. Advertisements often assert that people can become several shades fairer in four to six weeks. But they do not state how long the change lasts.
Any change in skin colour achieved with creams is not permanent. The superficial layers of the skin may change to a lighter shade. Actually, thousands of these cells are shed every day. It’s the deeper layers that contain the genetically determined quantities of melanin. As they grow out in three or four weeks, the dark colour returns. This means the products have to be used continuously, which may lead to side effects.
The safest products are probably the homemade ones. Make a mixture of 500 ml of coconut oil, 500 ml of sesame oil and 100 ml of olive oil. Apply a small quantity 10 minutes before a bath.
Homemade face packs can be made by mixing curd, honey and lemon juice. The lactic acid in the curd and citric acid in the lime act as mild bleaching agents, while the honey soothes the skin.
Before falling prey to an elusive dream, remember that regular exercise and a healthy, balanced diet will give you a glowing skin, toned body and a confident personality. This surely is worth more than just “fair” skin.
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
Your Health
DR GITA MATHAI
PRIDE OR PREJUDICE? Beauty lies in a healthy, glowing skin and confident personality
Remember those TV commercials in which a dark complexioned girl found it impossible to get a suitable boy until she used a fairness cream? The ads continue, only with a slight difference: finding a groom has given way to finding a career path — as an airhostess, a sports anchor or beauty queen. The fair factor remains, as is engraved in our psyche. And it’s not just women who are being sent the unfair message; men too are told they must use fairness creams to win a girl or shine in their career.
Most people have a bias for fair skin. They consider it more attractive and subconsciously place it higher on the socio-economic scale. Newspapers are replete with matrimonial ads for “fair and beautiful” women.
Skin colour is genetically determined — it depends on the skin colour of both the parents. If one parent is dark and the other fair, the child is more likely to be dark. Dark skin contains more melanin, a pigment that gives skin its colour and protects against sunburn and skin cancer. This means dark skin is superior for adaptation and survival in the process of evolution.
People do various things to appear fair. Those who can spare only a few minutes apply a liberal coat of talcum powder before stepping out. The powder may be slightly yellow (as it may be mixed with sandalwood or turmeric), pink (calamine or some other colouring agent) or white, giving the person a ghostly, unnatural shade. Perfume and other additives in the talcum may cause allergy, itching, rash or sunlight sensitivity, leading to unsightly blotchy skin with dark and light patches.
Beauty parlours offer “skin peeling” face packs. They strip the superficial tanned and pigmented layers of the skin. Stripping does make a person appear 10 to 20 per cent fairer, but only temporarily. Once the skin grows back, the original colour returns. Stripping should not be done on a regular basis as it damages the skin. Also, it should never be done if there are pimples or cuts.
Manufacturers of fairness creams claim they do not use any harmful ingredients. As a rule, they must mention all the components on the packaging. The list, however, is often incomplete. Moreover, the percentage of each component is seldom stated. Companies hide behind the façade of it being a “trade secret”.
Most fairness creams contain sunscreen to prevent tanning. This is usually harmless. Some may have a bleaching agent, the concentration of which should not be more than 3-4 per cent. Higher concentrations may cause severe reactions with irritation, itching, blistering and severe pain.
Around 20 per cent of skin pigmentation can be reversed by applying 2 per cent hydroquinolone alone or in combination with 0.05-0.1 per cent tretinoin. Fairness creams often contain these chemicals.
What many people don’t know is that they may cause paradoxical sunlight sensitivity with sunburn if the skin is exposed to sunlight after application. Higher concentrations of these chemicals are dangerous and have been shown to cause cancer and birth defects in mice. They are banned in some countries.
If the cream contains steroids, it will cause thinness and atrophy of the skin. If used for prolonged periods, sufficient quantities can get absorbed and produce side effects like weight gain and facial hair.
“Natural herbal” products too are not 100 per cent safe. They contain refined plant extracts which may cause allergy.
Ayurvedic fairness creams contain heavy metals like mercury. These can get absorbed and accumulate in the deeper layers, causing liver and kidney damage.
The fairness industry in India is worth around Rs 1,400 crore. Advertisements often assert that people can become several shades fairer in four to six weeks. But they do not state how long the change lasts.
Any change in skin colour achieved with creams is not permanent. The superficial layers of the skin may change to a lighter shade. Actually, thousands of these cells are shed every day. It’s the deeper layers that contain the genetically determined quantities of melanin. As they grow out in three or four weeks, the dark colour returns. This means the products have to be used continuously, which may lead to side effects.
The safest products are probably the homemade ones. Make a mixture of 500 ml of coconut oil, 500 ml of sesame oil and 100 ml of olive oil. Apply a small quantity 10 minutes before a bath.
Homemade face packs can be made by mixing curd, honey and lemon juice. The lactic acid in the curd and citric acid in the lime act as mild bleaching agents, while the honey soothes the skin.
Before falling prey to an elusive dream, remember that regular exercise and a healthy, balanced diet will give you a glowing skin, toned body and a confident personality. This surely is worth more than just “fair” skin.
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
Subscribe to:
Posts (Atom)
