New mom? Eat right and exercise
Your Health
DR GITA MATHAI
The thought, preparation and expense that go into “the great Indian wedding” are unbelievable. Yet barely have the stars faded from the new bride’s eyes than subtle pressure from parents, in-laws, spouse and well-wishers sets in. Everyone wants to hear the “good news” —a baby on the way. People don’t stop to think if the bride is ready for motherhood. And once the mother-to-be has been coddled through the pregnancy and everyone has oohed and aahed over the little bundle of joy, the excitement and interest fades. The new mother finds that she is totally unprepared for the drastic changes in her life after the birth of a baby. No one told her that she might have a baby that refuses to sleep at night or that she would feel and look like an elephant after childbirth.
A weight gain of between 12 to 14kg during pregnancy is normal and healthy. Many women expect all the extra kilos to disappear immediately after delivery. Actually, around 5kg (the weight of the baby and the placenta) will disappear immediately. The rest should disappear gradually within nine months.
It is very easy to start overeating after childbirth. Visitors arrive laden with delicious tidbits and vociferously advise rest and a high calorie diet to ensure adequate breast milk. In truth, breast-feeding requires only around 750 extra calories. Since brand new moms tend to be sedentary, their caloric intake should be limited to approximately 2,500 calories. Even though many women complain that they continue to “feel like a bloated elephant” after delivery, this is not the correct time to go on a drastic diet. Healthy eating and judicious exercise will ensure a gradual and safe return to pre-pregnancy weight.
Light aerobic exercise or walking can be started around two weeks after delivery, even by a person who did not exercise at all during pregnancy. But it is important not to do too much too soon. A hormone called relaxin, responsible for making the joints loose during pregnancy so that delivery is easy, persists in the body for about six months after delivery. So vigorous exercise should be started only after six months to avoid damaging joints. Walking 15 minutes a day is a good start. Increase the time by 15 minutes every week until you reach an hour. Endorphins released during walking will help to elevate the mood and combat any post partum depression. It will also help to tone the muscles. Exercise does not reduce breast milk production.
Pain in the genital and the caesarian site often comes as a shock. It makes going to the bathroom or even sitting an ordeal. Many are afraid to take medication (with reason) for fear that it might cross over in the breast milk to the newborn baby. Heat or cold applied locally to the area will relieve the pain. You can use an infra red lamp, a hot water bottle, or apply ice. The ice needs to be in a plastic bag or bottle. To prevent infection, always wash the area with water after going to the bathroom.
The skin over the abdomen may show white lines called stretch marks. These may itch. Applying coconut oil for half an hour before a bath helps.
These usually fade over time. If there is a scar (caesarian or episiotomy), it should be left alone until it has healed completely.
The hormones responsible for maintaining the pregnancy drop suddenly after childbirth. This abrupt change can lead to depression, bouts of crying and feelings of inadequacy. These usually last for around two weeks and then subside by themselves. If they last for a month or longer, then postnatal depression may have developed and a physician should be consulted.
The abdominal wall becomes lax during pregnancy. The abdomen itself may appear pendulous. Sits ups with the knees bend and oblique abdominal exercises will help with this. Start with 10 sets twice a day. Aim to reach 50 repetitions morning and evening within four months. You need to continue doing this exercise at least thrice a week.
A few drops of urine may leak out while coughing, sneezing or laughing. It may be difficult to hold the urine for even a limited time if the bladder is full. This is because the pelvic floor muscles become weakened during childbirth, making the sphincters, which control urination, lax. This can occur even if the delivery was by caesarian section.
These humiliating accidents can be tackled by doing “Keegles’s exercises”. Sit on the floor in the namaz position or in the yoga “child’s pose”. Touch the nose to the ground, concentrate on the pelvic muscles and consciously tighten them. Also, try to “stop and start” consciously while passing urine.
New mothers have lost a great deal of blood. The baby needs to be fed frequently so that sleep patterns are disturbed and often inadequate. Tiredness and fatigue are common and normal after childbirth. Try to sleep whenever the baby sleeps. And those colourful iron and calcium supplements need to be continued as long as you are feeding the baby.
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, June 20, 2011
Wednesday, June 15, 2011
help I'm being treated
The caterwauling could be heard in the corridor long before the young adult male was carried in on a plank of wood. His head was lolling from side to side, a red trickle of blood oozed from the corner of his mouth. His checked shirt was discolored and stained.
Evaluation was difficult.
I had to push past an old woman beating her chest and a young one (wife?) throwing herself at his feet and hanging on for dear life.
Haemetemisis perhaps? Whatever. Anyway, emergency treatment had to be given. Perhaps if I started an IV line, pushed in a stomach tube and washed out the stomach with ice water, the bleeding would stop long enough for me to send him to the nearest hospital. The sooner the better. The accompanying crowd can get very nasty if there is a death. I did not really want by premises destroyed or the publicity.
He was conscious, oriented and passive when I inserted the needle.
The stomach tube was another story altogether. He gagged, fought and sat up. Determined to succeed (Robert Bruce – try and try again) I held him down and tried harder.
Suddenly, he pulled out the IV line. (This made blood drip on the floor as well). He pushed me to one side, fell to the floor and clutched my feet.
“Save me!” He shouted.
“ I am trying to, but unless you cooperate what can I do?”
“I want to be saved from you,” he shouted, “you are killing me!”
“Nonsense! I am trying to save your life.”
“Ayoo! I am not vomiting blood. I just swallowed a brick dissolved in water to frighten my family. Let me go. If I stay here any longer, you WILL kill me.”
Gathering his clothes he ran out of the room followed closely by disbelieving relatives.
“ A miracle!” shouted one of them, “I told you this doctor has lucky hands. She just has to touch you and you will recover.”
Well, a little community goodwill doesn’t hurt , And, in the final analysis, “All’s well that end’s well!”
Evaluation was difficult.
I had to push past an old woman beating her chest and a young one (wife?) throwing herself at his feet and hanging on for dear life.
Haemetemisis perhaps? Whatever. Anyway, emergency treatment had to be given. Perhaps if I started an IV line, pushed in a stomach tube and washed out the stomach with ice water, the bleeding would stop long enough for me to send him to the nearest hospital. The sooner the better. The accompanying crowd can get very nasty if there is a death. I did not really want by premises destroyed or the publicity.
He was conscious, oriented and passive when I inserted the needle.
The stomach tube was another story altogether. He gagged, fought and sat up. Determined to succeed (Robert Bruce – try and try again) I held him down and tried harder.
Suddenly, he pulled out the IV line. (This made blood drip on the floor as well). He pushed me to one side, fell to the floor and clutched my feet.
“Save me!” He shouted.
“ I am trying to, but unless you cooperate what can I do?”
“I want to be saved from you,” he shouted, “you are killing me!”
“Nonsense! I am trying to save your life.”
“Ayoo! I am not vomiting blood. I just swallowed a brick dissolved in water to frighten my family. Let me go. If I stay here any longer, you WILL kill me.”
Gathering his clothes he ran out of the room followed closely by disbelieving relatives.
“ A miracle!” shouted one of them, “I told you this doctor has lucky hands. She just has to touch you and you will recover.”
Well, a little community goodwill doesn’t hurt , And, in the final analysis, “All’s well that end’s well!”
Monday, June 6, 2011
too fat too young
Too fat by far
Your Health
DR GITA MATHAI
It is difficult to convince parents that their child is overweight even if you prove it by measuring the weight in kg and dividing it by the height in metre squared. (The normal value is around 23). Parents are disbelieving even when faced with values higher than 30. Perhaps this is because we tend to equate prosperity with a “well-fed look” and look admiringly at plump parents accompanied by children with pot bellies. Generations of coping with famine, want, the unavailability and unaffordability of food have taken their toll. As the money rolls in, parents abandon their traditional healthy life style and adopt a western approach to food and leisure.
Our tradition of breast-feeding infants provided them with the correct amount of calories for the first six months of life. A “let down” reflex controls the production of milk; as the baby sucks, more milk is produced. This ensures that the baby gets enough for its requirement, and doubles its birth weight by the end of the fifth month and triples it by the end of the first year. A baby that starts life at 2 kg will be normal if it weighs 6 kg on its first birthday. Its appearance will be a stark contrast to the baby that was 4 kg at birth and 12 kg on its first birthday. Both are normal, but cannot be compared as they represent two ends of a normal spectrum.
Unhappy with small but normal babies, parents often supplement breast milk with powdered formula or cow’s milk, a practice that should be avoided as far as possible. There really is no superior or adequate substitute for the “real thing,” that ensures healthy, adequate and normal growth.
Traditional weaning is with home-cooked cereals such rice, ragi and wheat with added milk and sugar. Today parents opt for ready-made sodium-rich, precooked, packaged weaning foods, or “milk biscuits” with disastrous results. These changed child-rearing practices have resulted in an epidemic of childhood obesity: 30 per cent of urban children are obese. Tragically, 70 per cent will go on to become obese adolescents and adults.
With cartoons, television serials, computer games, homework and tuition, children spend more than three hours a day almost motionless. Added to this is snacking on fat-laden packaged food and drinking calorie-high sugar-dense aerated bottled drinks. There is practically no physical activity at all.
Busy parents prefer these sedentary activities as they require minimum parental participation. For activity and sports, parents have to take the children to a place where they can play. There is a shortage of parks and open spaces. Children cannot be left unsupervised as there are the problems of safety, and social crimes like abuse and abduction (This used to be true only for girls but now both sexes are equally in danger).
The problem is compounded by the fact that life in India is very competitive. Only a few sportspeople succeed, but academic excellence ensures “good jobs”. Parents are under the misconception that children who “play” will be too tired to study.
Gradually caloric intake overtakes expenditure and obesity sets in. It also causes many psychological problems. Children develop a negative self image and either withdraw into themselves or become bullies. By the early twenties many are already exhibiting signs of syndrome X or insulin resistance, their blood sugar and lipid profile become abnormal. They develop diabetes, hypertension and heart disease. Girls may develop the polycystic ovarian syndrome (PCOS) with irregular periods and eventually, fertility problems. Indians are genetically prone to these abnormalities.
Studies have shown that children over the age of two need an hour of physical activity a day. This can be a single one-hour session or split into two 30-minute one. Even six 10-minute sessions are effective. It can be running, cycling, playing structured games, skipping or swimming.
Exercise helps children maintain an ideal body weight, feel less stressed and angry, improve concentration in school and sleep well at night. Objective studies using MRI scans demonstrated that exercise in children increases brain activity in the prefrontal cortex of the brain. This is the area associated with cognitive skills, complex thinking, decision making and correct social behaviour. Also the IQ (intelligence quotient) of these children improves by almost four points.
Children all over the world are becoming obese for the same reasons. Parents have a crucial role to play in making children healthy. They should exercise and lead by example. TV viewing should be limited. Oily, ready-to-eat snacks should be avoided.
Other governments (the UK, the US, Japan, China) have woken up to the fact that obese children grow into unhealthy unproductive adults, with medical problems that are a burden on the national exchequer. They have begun to tackle the problem on a war footing. We have not, and this means that India may eventually be a country where the life expectancy starts to fall.
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
It is difficult to convince parents that their child is overweight even if you prove it by measuring the weight in kg and dividing it by the height in metre squared. (The normal value is around 23). Parents are disbelieving even when faced with values higher than 30. Perhaps this is because we tend to equate prosperity with a “well-fed look” and look admiringly at plump parents accompanied by children with pot bellies. Generations of coping with famine, want, the unavailability and unaffordability of food have taken their toll. As the money rolls in, parents abandon their traditional healthy life style and adopt a western approach to food and leisure.
Our tradition of breast-feeding infants provided them with the correct amount of calories for the first six months of life. A “let down” reflex controls the production of milk; as the baby sucks, more milk is produced. This ensures that the baby gets enough for its requirement, and doubles its birth weight by the end of the fifth month and triples it by the end of the first year. A baby that starts life at 2 kg will be normal if it weighs 6 kg on its first birthday. Its appearance will be a stark contrast to the baby that was 4 kg at birth and 12 kg on its first birthday. Both are normal, but cannot be compared as they represent two ends of a normal spectrum.
Unhappy with small but normal babies, parents often supplement breast milk with powdered formula or cow’s milk, a practice that should be avoided as far as possible. There really is no superior or adequate substitute for the “real thing,” that ensures healthy, adequate and normal growth.
Traditional weaning is with home-cooked cereals such rice, ragi and wheat with added milk and sugar. Today parents opt for ready-made sodium-rich, precooked, packaged weaning foods, or “milk biscuits” with disastrous results. These changed child-rearing practices have resulted in an epidemic of childhood obesity: 30 per cent of urban children are obese. Tragically, 70 per cent will go on to become obese adolescents and adults.
With cartoons, television serials, computer games, homework and tuition, children spend more than three hours a day almost motionless. Added to this is snacking on fat-laden packaged food and drinking calorie-high sugar-dense aerated bottled drinks. There is practically no physical activity at all.
Busy parents prefer these sedentary activities as they require minimum parental participation. For activity and sports, parents have to take the children to a place where they can play. There is a shortage of parks and open spaces. Children cannot be left unsupervised as there are the problems of safety, and social crimes like abuse and abduction (This used to be true only for girls but now both sexes are equally in danger).
The problem is compounded by the fact that life in India is very competitive. Only a few sportspeople succeed, but academic excellence ensures “good jobs”. Parents are under the misconception that children who “play” will be too tired to study.
Gradually caloric intake overtakes expenditure and obesity sets in. It also causes many psychological problems. Children develop a negative self image and either withdraw into themselves or become bullies. By the early twenties many are already exhibiting signs of syndrome X or insulin resistance, their blood sugar and lipid profile become abnormal. They develop diabetes, hypertension and heart disease. Girls may develop the polycystic ovarian syndrome (PCOS) with irregular periods and eventually, fertility problems. Indians are genetically prone to these abnormalities.
Studies have shown that children over the age of two need an hour of physical activity a day. This can be a single one-hour session or split into two 30-minute one. Even six 10-minute sessions are effective. It can be running, cycling, playing structured games, skipping or swimming.
Exercise helps children maintain an ideal body weight, feel less stressed and angry, improve concentration in school and sleep well at night. Objective studies using MRI scans demonstrated that exercise in children increases brain activity in the prefrontal cortex of the brain. This is the area associated with cognitive skills, complex thinking, decision making and correct social behaviour. Also the IQ (intelligence quotient) of these children improves by almost four points.
Children all over the world are becoming obese for the same reasons. Parents have a crucial role to play in making children healthy. They should exercise and lead by example. TV viewing should be limited. Oily, ready-to-eat snacks should be avoided.
Other governments (the UK, the US, Japan, China) have woken up to the fact that obese children grow into unhealthy unproductive adults, with medical problems that are a burden on the national exchequer. They have begun to tackle the problem on a war footing. We have not, and this means that India may eventually be a country where the life expectancy starts to fall.
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, May 29, 2011
no talc for prickly heat
rickly heat? Don’t try talc
Your Health
DR GITA MATHAI
A genuine “Indian summer” is upon us now with temperatures all over the country in the high thirties and forties. Earlier, Indians used to wear white cotton clothes in summer but now most prefer to dress in synthetic silks, and polyester fabrics, little realising that those clothes are totally inappropriate in this weather.
Even school children — who are issued uniforms with the material and tailoring regulated by the school — end up wearing thick synthetic clothes when ideally they should wear pure cotton or at least a 60 per cent cotton and 40 per cent polyester mix.
To survive, our bodies need to maintain an average internal temperature of 98.6ºF or 36.6ºC and it uses sweating to regulate the temperature. When the outside temperature is high, the body secretes sweat from glands situated in the layer below the skin. The sweat reaches the surface through coiled tubes and forms a thin film of fluid. As this layer evaporates, the body cools down. Sweating can be excessive when the temperature is high, there is increased physical exertion, there is little or no circulation of air and if the clothes are made of synthetic material that traps the sweat. (Nowadays many sports companies manufacture sports clothes out of special material that “wicks” away the sweat).
If sweat pores get blocked (by dead skin cells, dirt or talcum powder), the trapped sweat forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). These look unsightly but do not really cause any symptoms. Eventually, they turn red (miliria rubra), and evolve into a brown scaly rash which can be confused with pimples, folliculitis or chicken pox.
Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. The forehead is affected if it is covered with a fringe or cap. The upper back and chest, and the arms are other common locations. In adults the rash sometimes appears on the inner thighs or in areas where there are body folds. It is aggravated by friction between the skin and tight fitting non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area.
Prickly heat causes itching and a tingling sensation but scratching can cause secondary infection with bacteria. The appearance of the rash then changes and there can be a yellow pus discharge. The person may develop fever. Uninfected prickly heat, however, does not cause fever. Although prickly heat is uncomfortable and unsightly, with a little care it can be easily prevented.
• Stay away from the direct heat of the sun as far as possible
• Wear loose fitting cotton clothes or at least a 60-40 mix of cotton and polyester
• Make sure school uniforms are stitched out of natural materials, preferably thin materials
• Try to ensure that schools have fans and ventilation.
• Do not scratch. The more you scratch, the more it will itch.
• Use a mild dose of antihistamine to control itching.
• Do not apply thick oil-based creams and talc. They will only block the pores further.
• Bathe two or three times a day in tepid water. Add a teaspoon of sodium bicarbonate to a bucket of water before bathing till the prickly heat disappears.
• Use soap containing trichlorhexidine (Dial, Neko) Do not apply soap directly to the skin. Use a moist wash rag, a herbal scrubber or a loofah.
• If prickly heat becomes red and pustular, changes appearance or the temperature rises, consult a doctor immediately.
Contrary to advertisements on television, talc does not soothe, relieve or prevent prickly heat. Talc is made up of finely powdered combinations of ground zinc stearate, and silicates. It blocks the skin pores, increasing the sweat build up and aggravating prickly heat.
Talc causes other medical problems as well. The size of the particles is so small that they can easily be inhaled. The particles can reach the smallest areas of the lung and cause pneumonia, inflammation or swelling of the airways. This can be fatal in babies. If applied to the groin and genital areas, talc can migrate through the vagina, uterus, and fallopian tubes to the ovary. Some scientific studies have found a relationship between the use of talcum powder and cancer of the ovary.
Baby powder is talc based and should not be used. Nappy rash is different from prickly heat and the treatment is different too.
If you get prickly heat, bathe two to three times a day. Use plain calamine lotion (not creams and ointment) to relieve the itching. If secondary infection has occurred, consult a doctor.
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 genuine “Indian summer” is upon us now with temperatures all over the country in the high thirties and forties. Earlier, Indians used to wear white cotton clothes in summer but now most prefer to dress in synthetic silks, and polyester fabrics, little realising that those clothes are totally inappropriate in this weather.
Even school children — who are issued uniforms with the material and tailoring regulated by the school — end up wearing thick synthetic clothes when ideally they should wear pure cotton or at least a 60 per cent cotton and 40 per cent polyester mix.
To survive, our bodies need to maintain an average internal temperature of 98.6ºF or 36.6ºC and it uses sweating to regulate the temperature. When the outside temperature is high, the body secretes sweat from glands situated in the layer below the skin. The sweat reaches the surface through coiled tubes and forms a thin film of fluid. As this layer evaporates, the body cools down. Sweating can be excessive when the temperature is high, there is increased physical exertion, there is little or no circulation of air and if the clothes are made of synthetic material that traps the sweat. (Nowadays many sports companies manufacture sports clothes out of special material that “wicks” away the sweat).
If sweat pores get blocked (by dead skin cells, dirt or talcum powder), the trapped sweat forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). These look unsightly but do not really cause any symptoms. Eventually, they turn red (miliria rubra), and evolve into a brown scaly rash which can be confused with pimples, folliculitis or chicken pox.
Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. The forehead is affected if it is covered with a fringe or cap. The upper back and chest, and the arms are other common locations. In adults the rash sometimes appears on the inner thighs or in areas where there are body folds. It is aggravated by friction between the skin and tight fitting non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area.
Prickly heat causes itching and a tingling sensation but scratching can cause secondary infection with bacteria. The appearance of the rash then changes and there can be a yellow pus discharge. The person may develop fever. Uninfected prickly heat, however, does not cause fever. Although prickly heat is uncomfortable and unsightly, with a little care it can be easily prevented.
• Stay away from the direct heat of the sun as far as possible
• Wear loose fitting cotton clothes or at least a 60-40 mix of cotton and polyester
• Make sure school uniforms are stitched out of natural materials, preferably thin materials
• Try to ensure that schools have fans and ventilation.
• Do not scratch. The more you scratch, the more it will itch.
• Use a mild dose of antihistamine to control itching.
• Do not apply thick oil-based creams and talc. They will only block the pores further.
• Bathe two or three times a day in tepid water. Add a teaspoon of sodium bicarbonate to a bucket of water before bathing till the prickly heat disappears.
• Use soap containing trichlorhexidine (Dial, Neko) Do not apply soap directly to the skin. Use a moist wash rag, a herbal scrubber or a loofah.
• If prickly heat becomes red and pustular, changes appearance or the temperature rises, consult a doctor immediately.
Contrary to advertisements on television, talc does not soothe, relieve or prevent prickly heat. Talc is made up of finely powdered combinations of ground zinc stearate, and silicates. It blocks the skin pores, increasing the sweat build up and aggravating prickly heat.
Talc causes other medical problems as well. The size of the particles is so small that they can easily be inhaled. The particles can reach the smallest areas of the lung and cause pneumonia, inflammation or swelling of the airways. This can be fatal in babies. If applied to the groin and genital areas, talc can migrate through the vagina, uterus, and fallopian tubes to the ovary. Some scientific studies have found a relationship between the use of talcum powder and cancer of the ovary.
Baby powder is talc based and should not be used. Nappy rash is different from prickly heat and the treatment is different too.
If you get prickly heat, bathe two to three times a day. Use plain calamine lotion (not creams and ointment) to relieve the itching. If secondary infection has occurred, consult a doctor.
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, May 15, 2011
rabies
Animal bites
Your Health
DR GITA MATHAI
Dogs are man’s best friends. They may be street dogs, available for free, or expensive pedigreed animals. People from all walks of life have them at home. But dogs are also responsible for 90 per cent of rabies cases. India has around 30,000 reported deaths from this disease every year. The exact number, however, could be much higher as many cases are not diagnosed or reported.
Rabies is caused by a virus. Once it enters the body through a bite or lick from an infected animal, it travels silently along the nerves till it reaches the brain. This means that after an asymptomatic period — which can range from two weeks to two years — the person begins to experience symptoms. Initially, these are non-specific and may be mistaken for flu. There may be fever, headache and body pain. Later, there may be slight or partial paralysis with weakness of the limbs, anxiety, insomnia, confusion, agitation, terror and hallucinations. The throat muscles eventually become paralysed, making both speech and swallowing painful and later impossible. The person panics when presented with liquids to drink and cannot quench his or her thirst as the muscles go into painful spasms. Death usually occurs within two to 10 days.
It is difficult to suspect or diagnose rabies unless the person mentions the animal bite and also exhibits the classical symptoms of rabies. There is a fluorescent antibody test to demonstrate the presence of a viral antigen to confirm the diagnosis but it is available in very few centres.
Other animals like cats, monkeys, bats, rodents as well as horses and cattle too can transmit rabies. Unaware of this, in case of a bite by any of these animals, many people just apply an antiseptic solution and do not take it seriously. Human to human transmission of rabies does not occur unless a corneal or some other organ transplant has occurred from an infected donor.
House pets — dogs or cats — need to be immunised. Vaccines are available in government veterinary hospitals and private clinics. Booster injections have to be given every year as long as the animal lives. This is often not done, particularly as the animal gets older.
Children often play with stray animals. They are prone to attack but such bites are less likely to be reported. Even if it is a pet animal, a bite or scratch should be taken seriously. The pet’s immunisation may be incomplete or they may be asymptomatic carriers of the rabies virus. Also, there is a silent reservoir of infection from wild animals, which may have attacked the pet and run away unnoticed.
If scratched or bitten, the bruise must first be cleaned thoroughly with soap and water. Soap kills the viruses in the wound. Iodine — either tincture iodine or povidone (Betadine) — should then be applied. The wound should be left open. Suturing should be avoided as a closed environment allows further multiplication of the viruses.
A bite is graded according to its severity. A course of injections (immunoglobins and anti-rabies vaccine) should be started immediately. Prior to the advent of the human diploid cell and other newer vaccines, anti-rabies was injected in the abdomen around the navel. This regimen had many side effects, of which pain was the least sinister and most tolerable! In addition, bites require tetanus prophylaxis and antibiotic cover against aerobic and anaerobic bacteria, which may have infected the wound from the teeth.
A number of pharmaceutical companies market the newer vaccines. The dosage schedule is printed on the package insert and should be meticulously followed. Post-exposure prophylaxis is usually given on days 0, 3, 5, 7, 14 and 28. The injections should be administered intramuscularly in the shoulder and not the buttocks. That’s because the high fat content of the buttocks interferes with antibody production.
Pre-exposure prophylaxis (before the bite) consists of three injections on days 0, 7 and 28 with a booster every five years. It must be taken by all owners of pet dogs or cats, veterinary surgeons, laboratory workers and travellers, especially if they are going to pass through endemic areas where appropriate treatment for animal bites may not be readily available. If your children have a penchant for playing with animals, it makes sense to immunise them too.
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
Dogs are man’s best friends. They may be street dogs, available for free, or expensive pedigreed animals. People from all walks of life have them at home. But dogs are also responsible for 90 per cent of rabies cases. India has around 30,000 reported deaths from this disease every year. The exact number, however, could be much higher as many cases are not diagnosed or reported.
Rabies is caused by a virus. Once it enters the body through a bite or lick from an infected animal, it travels silently along the nerves till it reaches the brain. This means that after an asymptomatic period — which can range from two weeks to two years — the person begins to experience symptoms. Initially, these are non-specific and may be mistaken for flu. There may be fever, headache and body pain. Later, there may be slight or partial paralysis with weakness of the limbs, anxiety, insomnia, confusion, agitation, terror and hallucinations. The throat muscles eventually become paralysed, making both speech and swallowing painful and later impossible. The person panics when presented with liquids to drink and cannot quench his or her thirst as the muscles go into painful spasms. Death usually occurs within two to 10 days.
It is difficult to suspect or diagnose rabies unless the person mentions the animal bite and also exhibits the classical symptoms of rabies. There is a fluorescent antibody test to demonstrate the presence of a viral antigen to confirm the diagnosis but it is available in very few centres.
Other animals like cats, monkeys, bats, rodents as well as horses and cattle too can transmit rabies. Unaware of this, in case of a bite by any of these animals, many people just apply an antiseptic solution and do not take it seriously. Human to human transmission of rabies does not occur unless a corneal or some other organ transplant has occurred from an infected donor.
House pets — dogs or cats — need to be immunised. Vaccines are available in government veterinary hospitals and private clinics. Booster injections have to be given every year as long as the animal lives. This is often not done, particularly as the animal gets older.
Children often play with stray animals. They are prone to attack but such bites are less likely to be reported. Even if it is a pet animal, a bite or scratch should be taken seriously. The pet’s immunisation may be incomplete or they may be asymptomatic carriers of the rabies virus. Also, there is a silent reservoir of infection from wild animals, which may have attacked the pet and run away unnoticed.
If scratched or bitten, the bruise must first be cleaned thoroughly with soap and water. Soap kills the viruses in the wound. Iodine — either tincture iodine or povidone (Betadine) — should then be applied. The wound should be left open. Suturing should be avoided as a closed environment allows further multiplication of the viruses.
A bite is graded according to its severity. A course of injections (immunoglobins and anti-rabies vaccine) should be started immediately. Prior to the advent of the human diploid cell and other newer vaccines, anti-rabies was injected in the abdomen around the navel. This regimen had many side effects, of which pain was the least sinister and most tolerable! In addition, bites require tetanus prophylaxis and antibiotic cover against aerobic and anaerobic bacteria, which may have infected the wound from the teeth.
A number of pharmaceutical companies market the newer vaccines. The dosage schedule is printed on the package insert and should be meticulously followed. Post-exposure prophylaxis is usually given on days 0, 3, 5, 7, 14 and 28. The injections should be administered intramuscularly in the shoulder and not the buttocks. That’s because the high fat content of the buttocks interferes with antibody production.
Pre-exposure prophylaxis (before the bite) consists of three injections on days 0, 7 and 28 with a booster every five years. It must be taken by all owners of pet dogs or cats, veterinary surgeons, laboratory workers and travellers, especially if they are going to pass through endemic areas where appropriate treatment for animal bites may not be readily available. If your children have a penchant for playing with animals, it makes sense to immunise them too.
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, April 19, 2011
kha anna
Fast track to healthy living
Your Health
DR GITA MATHAI
Anna Hazare during his fast in New Delhi
Fasting is common in India. Hindus fast on certain days of the week, Jains after six in the evening, Muslims during the month of Ramadan and Christians during Lent. Politicians and activists have traditionally used it as a means to an end.
Some fasts involve total avoidance of all food and water. In some others, food is avoided at specific times of the day. Yet others restrict the type of food. Fasting is different from involuntary starvation due to famine or illness. Voluntary fasting isn’t advisable for people under 15, over 70, pregnant women, people involved in outdoor or heavy labour, and those suffering from illnesses. Some medicines dangerously accelerate the biochemical effects of fasting.
Any food that we eat is digested and broken down into its components — glucose, fatty acids and amino acids. Glucose is the body’s main source of energy and is required by all tissues. When the body is deprived of food, any excess glucose stored in the body is accessed and utilised to get energy. Once these stores are depleted, the body starts to break down fat and use it. This is around 7 per cent of the body weight of males and 10 per cent in females. When is used up, there is an intense craving for food. If this is still not enough, the muscles in the body start to get metabolised. The person develops a wasted and emaciated appearance.
Deprived of food and water, a healthy adult can survive about 10-12 days. With water, survival can extend to 50-60 days. Children and the elderly succumb more rapidly. Women and obese individuals (both sexes) are able to withstand starvation better as they have more body fat reserves. Extremes of temperature (heat or cold) accelerate the ill effects of starvation.
Stopping food and water abruptly causes changes of “acute starvation” in the body within 24 hours. Thirst and hunger pains set in. The mouth gets parched, the saliva thickens and the urine is high coloured and scanty. After 48 hours, the voice becomes feeble, the pulse weakens, the temperature drops and dehydration sets in. As the days pass by, the blood pressure and temperature drop, the hair and nails become brittle, the eyes sink and the pupils dilate. Constipation is usual, but diarrhoea may occur. The intellect can remain clear and unclouded, but delirium and convulsions may precede death.
The medical complications associated with prolonged fasting are electrolyte imbalances, cardiac arrhythmia and kidney failure. Death can occur if fasting is pursued to the point of complete starvation.
Some medical tests have to be done upon “fasting” or on an “empty stomach”. There is often ambiguity and confusion between these two terms. Medically, fasting usually means an overnight fast of eight to 12 hours. That’s because metabolic adjustments occur in the body during fasting. The normal values of the results of some tests like lipid profile and sugar tests are standardised for fasting conditions. “On an empty stomach” typically means three to five hours after a meal, when the meal has left the stomach and digestion is complete.
Extended, intermittent, regular fasting has been recommended from the ancient times to preserve health. Today we know fasting improves the blood lipid profile and reduces total cholesterol. Research done on human volunteers at the US National Institute on Aging suggests that fasting every alternate day offers major health benefits. The cumulative calorific restriction reduces the risk of cancer, cardiovascular diseases, diabetes, insulin resistance and immune disorders. It also actually slows the aging process, and seems to have the potential to increase the life span. People do tend to lose weight with alternate day fasting, but on the negative side they tend to be irritable on the fasting day. Also, repeated fasts can result in the body going into a “conserve mode” and the metabolism slowing down to conserve energy. There will be no weight loss despite repeated intermittent fasting.
It is possible to “starve in the midst of plenty”. This occurs in diabetics who are unable to utilise the food they eat. In some others, the food may be unhealthy (just fat and sugar) and lacking essential proteins, vitamins and minerals.
Teenagers may resort to excessive fasting to prevent obesity. This can result in mental changes and anorexia nervosa.
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
Anna Hazare during his fast in New Delhi
Fasting is common in India. Hindus fast on certain days of the week, Jains after six in the evening, Muslims during the month of Ramadan and Christians during Lent. Politicians and activists have traditionally used it as a means to an end.
Some fasts involve total avoidance of all food and water. In some others, food is avoided at specific times of the day. Yet others restrict the type of food. Fasting is different from involuntary starvation due to famine or illness. Voluntary fasting isn’t advisable for people under 15, over 70, pregnant women, people involved in outdoor or heavy labour, and those suffering from illnesses. Some medicines dangerously accelerate the biochemical effects of fasting.
Any food that we eat is digested and broken down into its components — glucose, fatty acids and amino acids. Glucose is the body’s main source of energy and is required by all tissues. When the body is deprived of food, any excess glucose stored in the body is accessed and utilised to get energy. Once these stores are depleted, the body starts to break down fat and use it. This is around 7 per cent of the body weight of males and 10 per cent in females. When is used up, there is an intense craving for food. If this is still not enough, the muscles in the body start to get metabolised. The person develops a wasted and emaciated appearance.
Deprived of food and water, a healthy adult can survive about 10-12 days. With water, survival can extend to 50-60 days. Children and the elderly succumb more rapidly. Women and obese individuals (both sexes) are able to withstand starvation better as they have more body fat reserves. Extremes of temperature (heat or cold) accelerate the ill effects of starvation.
Stopping food and water abruptly causes changes of “acute starvation” in the body within 24 hours. Thirst and hunger pains set in. The mouth gets parched, the saliva thickens and the urine is high coloured and scanty. After 48 hours, the voice becomes feeble, the pulse weakens, the temperature drops and dehydration sets in. As the days pass by, the blood pressure and temperature drop, the hair and nails become brittle, the eyes sink and the pupils dilate. Constipation is usual, but diarrhoea may occur. The intellect can remain clear and unclouded, but delirium and convulsions may precede death.
The medical complications associated with prolonged fasting are electrolyte imbalances, cardiac arrhythmia and kidney failure. Death can occur if fasting is pursued to the point of complete starvation.
Some medical tests have to be done upon “fasting” or on an “empty stomach”. There is often ambiguity and confusion between these two terms. Medically, fasting usually means an overnight fast of eight to 12 hours. That’s because metabolic adjustments occur in the body during fasting. The normal values of the results of some tests like lipid profile and sugar tests are standardised for fasting conditions. “On an empty stomach” typically means three to five hours after a meal, when the meal has left the stomach and digestion is complete.
Extended, intermittent, regular fasting has been recommended from the ancient times to preserve health. Today we know fasting improves the blood lipid profile and reduces total cholesterol. Research done on human volunteers at the US National Institute on Aging suggests that fasting every alternate day offers major health benefits. The cumulative calorific restriction reduces the risk of cancer, cardiovascular diseases, diabetes, insulin resistance and immune disorders. It also actually slows the aging process, and seems to have the potential to increase the life span. People do tend to lose weight with alternate day fasting, but on the negative side they tend to be irritable on the fasting day. Also, repeated fasts can result in the body going into a “conserve mode” and the metabolism slowing down to conserve energy. There will be no weight loss despite repeated intermittent fasting.
It is possible to “starve in the midst of plenty”. This occurs in diabetics who are unable to utilise the food they eat. In some others, the food may be unhealthy (just fat and sugar) and lacking essential proteins, vitamins and minerals.
Teenagers may resort to excessive fasting to prevent obesity. This can result in mental changes and anorexia nervosa.
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, April 12, 2011
PS its PMS
It’s PMS, stupid
Your Health
DR GITA MATHAI
Women are often maligned and labelled as “unreasonable, unrealistic, illogical and hysterical”, even when their statements are reasonable and logical. “Blame it on the hormones” is the usual explanation from a male-dominated society. Physicians (mostly male) in the 19th century, unaware of hormone levels, concluded that somehow all this behaviour was connected to the presence of a uterus (from the Greek word hystera which means womb). They sometimes recommended hysterectomy to remove the root cause of these problems and render these women “normal”.
Unfortunately, some surgeons today, too, subscribe to this view. Women in the reproductive age are advised a hysterectomy to remove the uterus, once it has finished its reproductive function, to relieve them of all their physical and psychological symptoms.
Yet 15 per cent of women suffer from unreasonable anger, excessive sensitivity, paranoid thoughts, anxiety, depression, uncontrollable crying spells, and bizarre food cravings during the pre-menstrual period. In 0.4 per cent, the symptoms may be severe enough to be labelled psychotic. These symptoms are called pre-menstrual syndrome (PMS). They are not because of the presence of the uterus, but are attributed to the body’s response to normal changes in the hormonal (oestrogen and progesterone) ratios during the course of a menstrual cycle.
In PMS sufferers, there’s a lack of perfect synchronisation in the hormone levels, both at the pituitary-hypothalamic level in the brain and at the level of the ovaries (not uterus). Surges and dips cause changes in the biochemical neurotransmitters (serotonin) and precipitate the depressed “low feeling”. Attempts to alleviate the depression and push up neurotransmitter levels lead to food cravings and binge eating.
The mental changes can be disruptive to the family and in the workplace. By the time the distraught family persuades the woman to seek medical help, the onset of menstruation has restored the woman’s Jekyll-and-Hyde personality to normal. Unfortunately, the menstrual cycle and mood swings repeat themselves month after month.
PMS is commoner between the ages of 30 and 45. This led to the erroneous belief that it was in some way connected with approaching menopause. This isn’t true. However, this is the time when women experience the maximum stress in both their family life and career. They often fail to cope with the combination of stress and hormonal imbalances.
Some physical changes can be produced as a result of the hormones. Fluid retention can result in a measurable weight gain (1-2kg). This can make clothes tighter. There may be backache, joint pain, breast tenderness and palpitations.
Treatment becomes imperative when the mood swings make women depressed and suicidal, or psychotic and murderous. (Most murderesses committed their crime during their pre-menstrual phase). Also, job efficiency and interpersonal relationships may be affected because of tiredness, fatigue, sensitivity and ill temper.
It is difficult to convince women with PMS that they need help, especially since they are normal for around 20 days in a month. Also, the sensitivity varies from woman to woman. Some with mild forms may be acutely conscious of their problem, while others with severe degrees of PMS may rationalise their behaviour. To avoid PMS,
Try to maintain a body mass index (weight divided by height in metre squared) as close to 23 as possible
Instead of three large meals, eat six small meals at regular three-hour intervals. Add at least six helpings of fresh fruits and vegetables, one with each meal. These are high in fibre and beneficial antioxidants. Fibres delay digestion and absorption, helping to maintain a steady blood glucose level with no depression-inducing dips
Reduce the salt intake in cooked food to one teaspoon a day
Avoid fried, salted snacks and chocolate
Reduce the use of caffeine by cutting down on carbonated colas, tea and coffee
Do regular aerobic exercise such as an hour of walking, jogging, cycling, climbing stairs or swimming to reduce stress. Exercise improves blood circulation and reduces bloating and fatigue. It produces a sense of well being. It boosts the body’s natural production of endorphins, which acts as a mood elevator
Daily supplements of vitamins and minerals may be administered to relieve some PMS symptoms. A multivitamin capsule with B6 (100 mcg), B complex, vitamin E (400 IU) and vitamin C (100mg) and calcium (1,000mg) supplementation is beneficial
Capsules of evening primrose oil, oral contraceptive pills, low dose diuretic therapy, mild antidepressants and tranquilisers have been tried and have anecdotally helped some sufferers.
PMS tends to run in families. This may be because the hormone ratios are inherited, leading to similar behaviour. This becomes more likely because of a comparable lifestyle, with improper diet and inadequate physical activity.
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
Women are often maligned and labelled as “unreasonable, unrealistic, illogical and hysterical”, even when their statements are reasonable and logical. “Blame it on the hormones” is the usual explanation from a male-dominated society. Physicians (mostly male) in the 19th century, unaware of hormone levels, concluded that somehow all this behaviour was connected to the presence of a uterus (from the Greek word hystera which means womb). They sometimes recommended hysterectomy to remove the root cause of these problems and render these women “normal”.
Unfortunately, some surgeons today, too, subscribe to this view. Women in the reproductive age are advised a hysterectomy to remove the uterus, once it has finished its reproductive function, to relieve them of all their physical and psychological symptoms.
Yet 15 per cent of women suffer from unreasonable anger, excessive sensitivity, paranoid thoughts, anxiety, depression, uncontrollable crying spells, and bizarre food cravings during the pre-menstrual period. In 0.4 per cent, the symptoms may be severe enough to be labelled psychotic. These symptoms are called pre-menstrual syndrome (PMS). They are not because of the presence of the uterus, but are attributed to the body’s response to normal changes in the hormonal (oestrogen and progesterone) ratios during the course of a menstrual cycle.
In PMS sufferers, there’s a lack of perfect synchronisation in the hormone levels, both at the pituitary-hypothalamic level in the brain and at the level of the ovaries (not uterus). Surges and dips cause changes in the biochemical neurotransmitters (serotonin) and precipitate the depressed “low feeling”. Attempts to alleviate the depression and push up neurotransmitter levels lead to food cravings and binge eating.
The mental changes can be disruptive to the family and in the workplace. By the time the distraught family persuades the woman to seek medical help, the onset of menstruation has restored the woman’s Jekyll-and-Hyde personality to normal. Unfortunately, the menstrual cycle and mood swings repeat themselves month after month.
PMS is commoner between the ages of 30 and 45. This led to the erroneous belief that it was in some way connected with approaching menopause. This isn’t true. However, this is the time when women experience the maximum stress in both their family life and career. They often fail to cope with the combination of stress and hormonal imbalances.
Some physical changes can be produced as a result of the hormones. Fluid retention can result in a measurable weight gain (1-2kg). This can make clothes tighter. There may be backache, joint pain, breast tenderness and palpitations.
Treatment becomes imperative when the mood swings make women depressed and suicidal, or psychotic and murderous. (Most murderesses committed their crime during their pre-menstrual phase). Also, job efficiency and interpersonal relationships may be affected because of tiredness, fatigue, sensitivity and ill temper.
It is difficult to convince women with PMS that they need help, especially since they are normal for around 20 days in a month. Also, the sensitivity varies from woman to woman. Some with mild forms may be acutely conscious of their problem, while others with severe degrees of PMS may rationalise their behaviour. To avoid PMS,
Try to maintain a body mass index (weight divided by height in metre squared) as close to 23 as possible
Instead of three large meals, eat six small meals at regular three-hour intervals. Add at least six helpings of fresh fruits and vegetables, one with each meal. These are high in fibre and beneficial antioxidants. Fibres delay digestion and absorption, helping to maintain a steady blood glucose level with no depression-inducing dips
Reduce the salt intake in cooked food to one teaspoon a day
Avoid fried, salted snacks and chocolate
Reduce the use of caffeine by cutting down on carbonated colas, tea and coffee
Do regular aerobic exercise such as an hour of walking, jogging, cycling, climbing stairs or swimming to reduce stress. Exercise improves blood circulation and reduces bloating and fatigue. It produces a sense of well being. It boosts the body’s natural production of endorphins, which acts as a mood elevator
Daily supplements of vitamins and minerals may be administered to relieve some PMS symptoms. A multivitamin capsule with B6 (100 mcg), B complex, vitamin E (400 IU) and vitamin C (100mg) and calcium (1,000mg) supplementation is beneficial
Capsules of evening primrose oil, oral contraceptive pills, low dose diuretic therapy, mild antidepressants and tranquilisers have been tried and have anecdotally helped some sufferers.
PMS tends to run in families. This may be because the hormone ratios are inherited, leading to similar behaviour. This becomes more likely because of a comparable lifestyle, with improper diet and inadequate physical activity.
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
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