heart aches

Take care of your heart Your Health DR GITA MATHAI Heart attacks are responsible for 25 per cent of deaths in India. By 2020, 50 per cent of people with heart disease all over the world will be Indians. Unlike in the developed countries where older people are affected, in India the young — many in their early thirties — are cut down by heart attacks. Women were traditionally considered protected by their hormones till menopause but today, the number of “attacks” in premenopausal women is steadily rising. Women tend to have atypical pain with heart attacks. Any symptom is unfortunately taken less seriously than in men. They are also less likely to reach an appropriate hospital in time. This makes them more prone to die during the first attack. Even when women reach for treatment, their ECG and angiogram may not show typical blocks. Their blood vessels are also smaller in size. Earlier, the results of cardiac intervention in women did not do as much good as in men. Now, this problem has been rectified. The instruments and stents are smaller in size and the outcome has improved. Certain visible body changes are associated with an increased risk of developing heart disease. In almost 50 per cent there are small yellowish white lumps called xanthelesmata around the eye or the elbow. The earlobe may have a vertical crease on one or both sides. Obesity is a definite risk factor. The body stature is different in Indians so even relatively thin individuals have a “tummy”, indicating a high waist hip ratio. To determine the waist to hip ratio, use a measuring tape to measure the circumference of your hips at the widest part of your buttocks and your waist at the smaller circumference, usually just above the belly button. Then divide your waist measurement by your hip measurement. Abdominal obesity exists when the waist-hip ratio is above 0.95 for males and above 0.80 for females. The ideal BMI (body mass index) is not 25 (the value internationally) in Indians but 23. The BMI is calculated by measuring the height in metre squared and dividing it by weight in kg. Ideal body weight is, therefore, height in meter squared multiplied by 23. Many Indians carry the “thrifty gene”, a small change in chromosome 3q 27. This helped store fat during seasons of plenty and use it during times of famine. We do not have to face famine situations now —thanks to better availability of food, government distribution and storage facilities — but the gene still works to conserve calories. This predisposes the affected individual to obesity, insulin resistance, diabetes and heart disease. Abnormal lipids with elevated cholesterol, triglycerides and altered ratios in lipoproteins cause deposition of fat plaques in the blood vessels. These may obstruct the blood vessels in the heart, brain or even in the limbs. The blood supply is compromised and heart attacks and strokes are the result. This tendency can also be inherited. The interplay between inherited tendencies and manifestation of disease is a complex one. The expression of the unhealthy genes mentioned above can be modified by the environment (food availability and family habits) and lifestyle. Children have to be taught from a young age to eat 4-6 helpings of fruit and vegetables instead of snacking on high calorie foods like potato chips, cream biscuits, iced cakes and aerated sweetened beverages. Oil consumption should be reduced to half a litre per person a month. Palm oil, coconut oil, butter, ghee and other saturated oils should constitute only seven per cent of the total intake. Refined flour and cereal should be substituted with whole grain products (atta instead of maida, red rice instead of white). Eating should be a focused activity. It should not be combined with distracting activity such as reading or viewing television. This is because the satiety signals from the brain are interfered with. More food will be eaten than required. Eating out is also fraught with danger. The food served may be more than required and unnecessarily oily. Since we are taught from a young age not to waste food, we tend to eat everything ordered even when we are not hungry. Smoking (active and passive) is a definite risk factor, which increases all others. Exercise makes the heart work harder, utilising its maximum capacity. The rhythmic contractions force blood vessels open and improve blood supply. New connections are forged in compromised vessels. Walking briskly for 40 to 60 minutes a day will achieve these benefits and modify many of the detrimental effects of inherited bad genes. “No time” for regular aerobic exercise will result in a lot of time for heart disease. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

wheezing

Cease that wheeze Your Health DR GITA MATHAI Sometimes, patients walk in saying, “I have eosinophilia,” or describe a friend or relative who has the complaint. It is difficult to understand what they mean. Do they have wheezing? Or has a blood test revealed a high eosinophil count? Wheezing is a high-pitched whistling sound — with or without chest tightening and discomfort. The sound occurs because the airways in the lung contract so that air is forced out through a narrowed opening. Blowing air into a balloon and then holding its mouth partially open can produce a similar effect. Wheezing occurs for a variety of reasons, such as exposure to inhaled or ingested allergens or viral and bacterial infections. It can also occur when the eosinophil content of the blood increases. Wheezing is equated with asthma — a frightening word. It conjures up visions of an emaciated, permanently incapacitated individual, with breathlessness and a hacking cough. Incidentally, asthma is a term that is not in use any more as the illness has been renamed “reactive airways disease”. People, however, prefer to use eosinophilia in conversation as it is a safe, non-life threatening, benign medical diagnosis to describe all kinds of wheezing. Human blood contains four types of white blood cells (WBCs) — neutrophils, lymphocytes, monocytes and eosinophils. The percentage of eosinophils is usually less than 6 per cent. The total count of eosinophils in 1ml is 500 or less. If the count is greater than this, it is diagnosed as eosinophilia. If the count is 1500 or more then hyper eosinophilia is diagnosed. This is a laboratory diagnosis made after analysing a blood smear. Eosinophils are useful cells, which destroy foreign substances (bacteria, viruses, parasites, tumour cells) marked as dangerous by the immune system. This action of the eosinophils can release chemicals such as histamine, which cause inflammation and can result in wheezing. The eosinophil count can rise for a variety of reasons: • Parasitic infection particularly filaria, hook worm, round worm and pin worm. • Fungal diseases of the skin • Allergy to inhaled compounds, food like seafish or prawns, food colouring (red and yellow) or additives (monosodium glutamate) and even medication. • Eczematous skin lesions that are itchy and weepy • Endocrine disorders • Tumours like ovarian cancer • Blood cancers such as some types of leukaemia and lymphoma • Autoimmune diseases such as ulcerative colitis A high eosinophil count with wheezing can occur in a condition called Tropical Pulmonary Eosinophilia (TPE). It is peculiar to Southeast Asia and India. It occurs because that particular person has an abnormally vigorous immunological response to the parasites Wuchereria bancrofti and Brugia malayi, which cause filaria. Filaria is endemic in India. The filaria parasite is injected into the blood through the bite of an infected mosquito. The victim develops typical filaria with fever, swelling of the limbs and enlarged lymph nodes. The parasite breeds in the lymph nodes and more and more worms are released into the blood stream. Blood vessels in the lung attempt to get rid of these parasites with the help of eosinophils. Some patients react vigorously to the infection, producing a large number of eosinophils. The eosinophil count in the blood rises. Meanwhile, some worms get trapped, die and release allergenic chemicals, precipitating wheezing and coughing. TPE is suspected in patients with a cough, breathlessness and wheezing, which often worsens at night. There may also be fever, loss of appetite and weight loss. Pulmonary function tests show restrictive and obstructive defects. The chest X-ray shows typical changes. Blood tests show a high eosinophil count. The diagnosis is clinched with the demonstration of high serum concentrations of filarial specific antibodies. Although TPE was considered a disease of Asia, increased travel has spread it all over the world. Fortunately, it is an eminently treatable condition. Most patients respond well to a 21-day course of diethylcarbamazine citrate, an inexpensive tablet marketed by a number of drug companies. Mild wheezing may, however, persist for longer in a few people. In any case of wheezing, avoid inhaled allergens such as mosquito repellents (coils, mats, liquid or spray). While waiting for a diagnosis, take steam inhalations morning and evening. Medication is usually prescribed as an inhaler or rotahalor, which will deliver medicine directly to the lungs, produce no side effects and keep you comfortable. Treatment can be initiated after a specific diagnosis is made. Wheezing is just a symptom. All wheezing is not asthma nor is it eosinophilia. It is important to obtain an accurate diagnosis to determine the reason behind it. Specific treatment will provide a cure once the diagnosis is made. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

hysterectomy

Off with the womb

Your Health DR GITA MATHAI

Some women become tired of having a uterus, not because it is the seat of “hysteria” (the ancient Greeks actually believed women became hysterical because they had a hystera, the Greek word for womb or uterus), but for reasons such as severe pain during periods, constant pelvic discomfort or excessive bleeding or even regular periods. Once the uterus is no longer needed to support and nurture a baby, it seems expendable. Surgery seems an attractive option. Hysterectomy (removal of the uterus) is a common surgical procedure. Eight per cent of women in India have had a hysterectomy by the age of 50. There is, however, an urban-rural discrepancy. Almost 20 per cent of urban women have had hysterectomies. Rural women are more conservative and tend not to opt for surgery. Many women have the hysterectomy before menopause, while in their late thirties or forties. The two ovaries situated on either side of the uterus not only produce eggs but also the female hormones which keep a woman’s bones, heart and blood chemistry normal and healthy. During a hysterectomy, the ovaries may or may not be removed. If left behind, with no target organ (uterus), they cease to function within a year or two, even in young women. This causes artificial symptomatic menopause. The sudden withdrawal of female hormones does not give the body time to adjust. There may be hot flushes, night sweats, weakness, depression and insomnia. The bones lose calcium and become osteoporotic. This can lead to fractures, particularly in the vertebrae. As the protective effect of the female hormones disappear, the lipid profile changes and the risk of heart disease increases seven fold. The vagina becomes dry and sex may become painful. The urinary bladder loses part of its supporting wall. It may prolapse into the vagina and urine may be retained. There may be urinary incontinence. Recurrent infections can occur. Similarly the rectum can protrude into the vagina, causing constipation. A hysterectomy is not a risk-free procedure. There may be excessive bleeding during the operation, clots may form in blood vessels and other organs such as the urinary tract or rectum may be inadvertently damaged. The procedure, however, is necessary if there is cancer in the uterus or cervix. Chemotherapy or radiation or both then follows the removal of the organ. Sometimes, the tissue lining the uterus, the endometrium, grows into the adjacent organs such as the ovaries, bladder and even intestines. With each menstrual cycle the tissue grows a little more. It can cause severe pain during periods and interfere with the functioning of the other organs. Initially, hormone therapy should be tried. Hysterectomy should be the last resort. The muscle of the uterus can grow abnormally, producing noncancerous growths called fibroids. These can be single or multiple, small or large. They can exert pressure on surrounding structures like the bladder and rectum. They can cause excessive bleeding or painful periods. Twenty per cent of the women over 35 have fibroids. Many are asymptomatic and are picked up during an ultrasound of the abdomen. Most of symptoms of fibroids can be tackled medically. It is possible to remove large fibroids without a hysterectomy. Fibroids do not develop into cancer. Childbirth stretches the ligaments supporting the uterus. It can start to slip downwards (uterine prolapse) and may even appear outside the body. It may be possible to surgically tighten these ligaments, or hysterectomy may be the only option. Excessive bleeding during periods can usually be controlled by a judicious combination of tablets. A hysterectomy may seem like a good solution to constant unidentifiable pelvic pain, but it may not relieve the symptom and the cure may be worse than the disease. The uterus can be removed thorough a cut in the abdomen, button hole surgery with a laparoscope or through the vagina. In the latter two procedures, there is no abdominal scar. The choice depends on the size of the uterus and whether the surgeon needs to look at the rest of the organs in the pelvis or not. It can be a “total” hysterectomy when the entire organ is removed or partial, if the cervix (lower part of the uterus) is left behind. The piece left behind can become cancerous in later years, so partial hysterectomies are not popular. It takes around six weeks to recover from a hysterectomy. During that time the patient should not lift heavy objects or perform strenuous activity. You can start exercising after six weeks to build up muscle and bone strength. Start walking for 10 minutes in the morning or evening. Gradually increase this to an hour. Muscle strength can be built up with repetitive movements using light weights. 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

health supplements

Supplements are not healthy Your Health DR GITA MATHAI The health supplement industry is an unregulated goldmine worth crores of rupees. It capitalises on people afraid of illness, doctors, surgery and the side effects of allopathic medication. They swallow supplements — labelled dietary, nutritional, health, sports and body-building — in an effort to tackle diseases. Advertisements and coaches also con youngsters into taking such supplements to improve performance. The athletes do not realise the dangers of this “doping” and are convinced that the supplements are what they claim to be — products obtained from natural sources that are free of chemicals and side effects. There are many plant products that really have medicinal properties. From ancient times the fox glove plant, the cinchona bark, ma hung and extracts from many other plants have been used to treat diseases. Today, the active ingredients in these plant products have been identified. They are now extracted specifically, or chemically synthesised in factories. This purified form makes dosing easier and helps tackle side effects. Drug interactions are also known and can be predicted. Health supplements often use the same substance used in allopathic medicines. A widely advertised “herbal tonic” for sexual dysfunction contains high concentrations of thiosildenafil, which is a precursor of sildenafil citrate or Viagra. The obesity epidemic has led to a huge market for easy weight loss solutions. One of which is natural herbal weight loss “shakes” that claim to help you lose weight without dieting or exercising. Consumers do lose weight but some became jittery and develop sweating and tremors. Almost all regain the lost weight once the expensive supplements were discontinued. A chemical analysis of the product showed that it contained plant alkaloids with high concentrations of ephedrine, thyroxin and caffeine. These increase the metabolism rate and produce these side effects when ingested by people who do not need them. Body builders use protein supplements — usually whey, casein, soy protein and cysteine — to bulk up. Often the supplement contains male hormones such as testosterone or androgens. Sometimes they contain prohormones — precursors to hormones that are converted to testosterone in the body. Testosterone derivatives may help you develop a six pack quickly but long term use is associated with dangerous side effects such as changes in liver and kidney function, sterility, precipitation of diabetes, aggression and even frank psychosis. In fact, the perception that body builders need a lot of protein is wrong. While normal persons need 0.8g protein / kg / day, body builders need 0.90g / kg / day, those undergoing strength training need 1.4-1.8g / kg / day and endurance athletes 1.2-1.4 g / kg / day. Excess dietary protein supplements can lead to obesity, dehydration, increase in liver enzymes and kidney problems. Nutritional requirements should primarily be met naturally through the diet. Certain diets, however, are inadequate because of dietary restrictions due to disease or religious beliefs (see box). Natural food is superior to supplements because it contains trace minerals and anti oxidants that are needed for proper functioning of enzymes and to fight disease. Before you take a supplement, check the label. That food supplement you drink is enriched with minerals, vitamins and calcium and if you take the same in pill form too, you may overdose. Similarly if you are on medication, that herbal tonic may contain the same ingredients in a more natural form, resulting in toxicity and side effects. You may not be able to glean all this information from the salesperson. Also, check the expiry date. If there isn’t any, do not buy it. Also, think whether the supplements are worth the price you pay. You may get the same benefits just by tweaking your diet. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

belly troubles diarrhoea and dysentry

Delhi belly Your Health DR GITA MATHAI I receive many letters from people who complain of having “dysentery” or “always” having “diarrhoea”, which stops them from functioning effectively in their jobs or studies. The terms diarrhoea and dysentery are freely interchanged, leading to confusion in the minds of patient and physician. Diarrhoea occurs when the consistency and frequency of the bowel movement changes. It becomes either watery or frequent (usually more than three times a day) or both. Dysentery occurs when there is blood and mucous in the stool. Our intestines are full of good bacteria. These colonise the bowel and produce essential vitamins of the B group as well as vitamin K. They also kill disease-causing bacteria ingested with food. Antibiotics, prescribed for various infections, kill these good bacteria too. So harmful bacteria can gain a foothold, leading to diarrhoea. This accounts for the mild tummy upset that may follow a course of antibiotics. Infective diarrhoea can be viral, bacterial or parasitic. Organisms are ingested with every meal. The acid in the stomach, the first line of defence, destroys these. Acidity in the stomach is reduced by antacids and medications such as ranitidine, omeprazole and pantaprazole. Large numbers of disease-causing bacteria in contaminated food can overwhelm even normal stomach defences. Bacterial overgrowth can also occur in food if it is left outside and reheated and used the next day. A very common form of this occurs if leftover rice is eaten the next day. Even if it is fried, the bacterial toxins withstand the heating process. In victims of diarrhoea, rehydration is important. You can use commercial ORS (oral rehydrating solution), tender coconut water, salted lime juice, buttermilk or a watery mixture of rice and dal. Make an estimate of the amount of fluid lost and replenish it. If diarrhoea continues for more than three days, or if urine output decreases, consult a physician immediately. Anti motility agents such as lomotil and lomofen do not cure diarrhoea. They merely reduce the movement of the intestine so that the frequency becomes less. They are contraindicated in children under the age of five. They do not work in dysentery. Viral diarrhoeas do not respond to antibiotics. They subside on their own. Bacterial and parasitic diarrhoeas can be treated with specific medications. Make sure to complete the course, otherwise the organism becomes resistant, causing diarrhoea to recur after 2-3 days. Dysentery means that there is blood and mucous in the stool. It is usually caused by an infecting organism (such as bacteria and amoebae) invading the large intestine. There may by paroxysms of pain and fever. The full course of medication should be followed. “Probiotic” capsules are often prescribed to restore intestinal flora to its original state. They are expensive and of dubious efficacy. A similar effect can be obtained by swallowing one tablespoonful of home-made curd early in the morning on an empty stomach. Curd is not a true probiotic but contains sufficient lactobabillus and other bacteria to repopulate the intestine. Taking zinc supplements also reduces the duration and frequency of diarrhoea. If diarrhoea or dysentery persists for two weeks, it is classified as chronic and needs to be re-evaluated by a physician. It may be an ordinary or exotic infection that has been missed in the preliminary round of investigations. Also, not all diarrhoeas, or dysentery-like diseases, are due to infections. Mucous may appear as a part of IBS (idiopathic bowel syndrome). Blood may appear in diverticulosis of the large intestine or if there are polyps present. In children milk allergy or lactose intolerance can read as recurrent diarrhoea or dysentery. Haemorrhoids (piles) or a fissure can be the reason for blood in the stool. On very rare occasions, cancer of the large intestine can also be the reason for blood in the stool. Cholera, typhoid (which can also cause diarrhoea) and rotavirus infections are preventable by timely immunisation. The cholera vaccine is now given by mouth in two doses and the typhoid as an injection repeated every three years. Rotavirus is likely to affect children and can be fatal. The vaccine is administered orally and is best given before the age of six months as two doses a month apart. Diarrhoea falls just behind respiratory illness in frequency and mortality. One of the reasons is that 50 per cent of 1.2 billion Indians lack toilets and defecate in the open, perpetuating the cycle of diarrhoeal illness. Tourists and travellers to India expect and dread the onset of diarrhoea. In the long term, improvements in sanitation, safe water supply, regulated food safety and community awareness of preventive measures will go a long way towards reducing the frequency of diarrhoeal diseases. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

body odor

Body odour? No sweat

Your Health DR GITA MATHAI

Tips to fight body odour ● Bathe twice a day using a loofah and a medicated soap ● Remove hair in the underarm and groin areas ● Use a deodorant spray after bathing ● Wear cotton clothes and change them daily ● Use sweat wicking garments while exercising ● Wear cotton or sweat wicking socks ● Wear leather or canvas shoes ● Give your shoes and slippers time to dry by wearing a pair only once in 24 hours Sweating is a very individual phenomenon. It is difficult to categorise the amount a person sweats as normal or excessive. Some people and families perceptibly sweat more (and smell). Also, increased sweating is normal in hot weather, with exercise or extreme emotions like fear or anger. Sweat is a clear fluid secreted by two types of glands. The eccrine glands are situated all over the body. They open directly on to the skin. They secrete a clear and odourless sweat composed of water, electrolytes and a little urea. The apocrine sweat glands develop at puberty. They are situated in the hairy areas of the body, the scalp, armpits and groin. They open into the hair follicles. The sweat mixes with the fatty secretions in the hair follicles. This provides a good medium for the overgrowth of bacteria, which are normally present on the skin. The bacteria breakdown the “fatty” portion of the sweat, causing body odour. (Children do not smell even if they sweat because they lack apocrine glands). Everyone has a distinctive body odour. It is influenced by diet (especially garlic and onions). It becomes distinctive in certain diseases. In diabetes, the body smells fruity, in liver disease, particularly cirrhosis, and in renal failure there is a musty odour. Lung abscesses smell like apple blossoms. Non healing ulcers smell like rotting compost. Schizophrenics have a distinct odour in their sweat owing to a chemical called trans-3-methylhexanoic acid. Some people sweat excessively, in quantities far greater than needed to cool their bodies. This is a condition is known as “hyperhidrosis”. It usually affects the palms, soles and underarms. It becomes a social embarrassment as such people have wet and smelly clothes, cold clammy hands, are unable to write or hold a pen, and feet which slip out of foot wear or smell bad, especially if they wear socks. The constant dampness may cause the nails (both fingers and toes) to develop fungal infections, which are difficult to eradicate. Bacterial infection may occur on the hair follicles or the area between the toes. The armpits may be wet and foul smelling. Focal hyperhidrosis affects only the palms and soles and is usually an exaggerated response to emotions. It may be inherited. In generalised hyperhidrosis, sweating affects the whole body. It can be normal or occur unexpectedly at different times of the day or week during the peri-menopausal period when the female hormone levels fluctuate. It can occur during certain infections like malaria or tuberculosis. It can be precipitated by low blood sugars. It can be one of the symptoms of an overactive thyroid gland. The ingestion of medication like aspirin, paracetemol or even caffeine found in tea, coffee or aerated beverages can precipitate an attack. It may also be the first sign of a heart attack. Hyperhidrosis can be tackled with antiperspirants containing aluminium chloride. This should be applied to the armpits, palms and soles at night after washing and drying the area. They should be washed off in the morning. They work well in mild cases. Antiperspirants are different from deodorants, which contain perfume to mask body odour. The label on the container should be read carefully. A group of drugs called “anticholinergics” reduce sweating. They are effective but can react with other medications and cause side effects like dryness of the mouth, blurred vision, constipation, retention of urine, dizziness and loss of taste. Dermatologists do a procedure called “iontophoresis”. The body is immersed in water and a low electric current is passed using a battery-operated device. Initially, daily therapy is required, but eventually maintenance treatment once in 10-15 days is all that is needed. Injections of botulinium toxin (Botox) have become very popular. They act by blocking the nerves. They need to be given by a qualified cosmetic surgeon. Inexpert administration can cause side effects like weakness of the muscles. The action is not permanent but lasts around 4-6 months. Sweat glands can be surgically removed from troublesome areas like the armpits. If the problem is more widespread, the nerves carrying the messages to the sweat glands can be cut with an endoscope. This is specialised surgery and should be reserved for severe cases. Excessive sweating may only be part of the problem. People are usually more concerned about the unpleasant body odour it causes. 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

body odour? don't sweat

Front Page > KnowHOW > Story Share on emailShare on printShare on facebookShare on twitterMore Sharing Services Body odour? No sweat Your Health DR GITA MATHAI Tips to fight body odour ● Bathe twice a day using a loofah and a medicated soap ● Remove hair in the underarm and groin areas ● Use a deodorant spray after bathing ● Wear cotton clothes and change them daily ● Use sweat wicking garments while exercising ● Wear cotton or sweat wicking socks ● Wear leather or canvas shoes ● Give your shoes and slippers time to dry by wearing a pair only once in 24 hours Sweating is a very individual phenomenon. It is difficult to categorise the amount a person sweats as normal or excessive. Some people and families perceptibly sweat more (and smell). Also, increased sweating is normal in hot weather, with exercise or extreme emotions like fear or anger. Sweat is a clear fluid secreted by two types of glands. The eccrine glands are situated all over the body. They open directly on to the skin. They secrete a clear and odourless sweat composed of water, electrolytes and a little urea. The apocrine sweat glands develop at puberty. They are situated in the hairy areas of the body, the scalp, armpits and groin. They open into the hair follicles. The sweat mixes with the fatty secretions in the hair follicles. This provides a good medium for the overgrowth of bacteria, which are normally present on the skin. The bacteria breakdown the “fatty” portion of the sweat, causing body odour. (Children do not smell even if they sweat because they lack apocrine glands). Everyone has a distinctive body odour. It is influenced by diet (especially garlic and onions). It becomes distinctive in certain diseases. In diabetes, the body smells fruity, in liver disease, particularly cirrhosis, and in renal failure there is a musty odour. Lung abscesses smell like apple blossoms. Non healing ulcers smell like rotting compost. Schizophrenics have a distinct odour in their sweat owing to a chemical called trans-3-methylhexanoic acid. Some people sweat excessively, in quantities far greater than needed to cool their bodies. This is a condition is known as “hyperhidrosis”. It usually affects the palms, soles and underarms. It becomes a social embarrassment as such people have wet and smelly clothes, cold clammy hands, are unable to write or hold a pen, and feet which slip out of foot wear or smell bad, especially if they wear socks. The constant dampness may cause the nails (both fingers and toes) to develop fungal infections, which are difficult to eradicate. Bacterial infection may occur on the hair follicles or the area between the toes. The armpits may be wet and foul smelling. Focal hyperhidrosis affects only the palms and soles and is usually an exaggerated response to emotions. It may be inherited. In generalised hyperhidrosis, sweating affects the whole body. It can be normal or occur unexpectedly at different times of the day or week during the peri-menopausal period when the female hormone levels fluctuate. It can occur during certain infections like malaria or tuberculosis. It can be precipitated by low blood sugars. It can be one of the symptoms of an overactive thyroid gland. The ingestion of medication like aspirin, paracetemol or even caffeine found in tea, coffee or aerated beverages can precipitate an attack. It may also be the first sign of a heart attack. Hyperhidrosis can be tackled with antiperspirants containing aluminium chloride. This should be applied to the armpits, palms and soles at night after washing and drying the area. They should be washed off in the morning. They work well in mild cases. Antiperspirants are different from deodorants, which contain perfume to mask body odour. The label on the container should be read carefully. A group of drugs called “anticholinergics” reduce sweating. They are effective but can react with other medications and cause side effects like dryness of the mouth, blurred vision, constipation, retention of urine, dizziness and loss of taste. Dermatologists do a procedure called “iontophoresis”. The body is immersed in water and a low electric current is passed using a battery-operated device. Initially, daily therapy is required, but eventually maintenance treatment once in 10-15 days is all that is needed. Injections of botulinium toxin (Botox) have become very popular. They act by blocking the nerves. They need to be given by a qualified cosmetic surgeon. Inexpert administration can cause side effects like weakness of the muscles. The action is not permanent but lasts around 4-6 months. Sweat glands can be surgically removed from troublesome areas like the armpits. If the problem is more widespread, the nerves carrying the messages to the sweat glands can be cut with an endoscope. This is specialised surgery and should be reserved for severe cases. Excessive sweating may only be part of the problem. People are usually more concerned about the unpleasant body odour it causes. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services