summer skin lesions

wo baths a day keep bacteria at bay

Your Health DR GITA MATHAI

Come summer and people start suffering from pimples, prickly heat, carbuncles and heat boils. No matter what the advertisements say, no cream, talc or lotion can keep you “cool” and prevent heat-induced skin infections. For that, you need to maintain basic hygiene. Bathe twice a day, preferably with medicated soap. Add 1 teaspoon of sodium bicarbonate to each bucket of water. It is best to shave off facial hair and the armpit area, which can easily develop an infection because of the sweat build up there. It will not clear until all the hair has been removed. Any medication applied will otherwise stick to the hair and not permeate to the pores. The area should also be washed with soap three times a day. Do not apply any powder. Contrary to what the advertisements say, prickly heat powder or talc actually encourages skin infections. Powder combines with sweat to block the pores of the skin. The sebum and sweat builds up behind the blocked pore, providing a nutritious medium for bacteria to grow. If a pimple or furuncle appears, do not pick or press it. Clean the area with medicated soap and apply antibacterial ointment (such as Neosporin or bacitracin) with a cotton bud. Unfortunately, most people are unable to keep their hands off these lesions. They pick and press to remove them or even try to shave the rash off. Medical personnel and beauty parlours also offer cosmetic and “safe” removal of facial blemishes, pimples and acne. There is no such thing. Bacteria belonging to the Staphylococcus family live on the surface of the skin. Usually, they do not cause any harm. However, if a person’s immunity decreases because of debilitating illness or there is an injury, these bacteria can enter the deeper layers of the skin. The bacteria that do this are not necessarily more virulent mutants of theStaphylococcus family. They are opportunistic, taking advantage of the temporary weakness and breach in the body’s defences. Medicated soaps such as Neko damage the outer cell wall of the Staphylococcusbacteria, killing them. So it is a good idea to use such a soap regularly. Apply it on the body with a loofah or towel. The skin of the face is abundantly supplied with blood vessels. These pass through connective tissue and then directly join the veins in the brain. So any time there is a cut on the face, it is relatively easy for bacteria to enter the brain and cause dangerous infections. This is particularly true of a triangular area of the face, which can be demarcated by drawing an imaginary line between the tip of the nose and the angles of the mouth. Even trivial infections in this area can be fatal, earning it the name “dangerous” area. Unfortunately this area is also very injury prone. It can be easily nicked while shaving. The upper lip is hairy (in both sexes) and so retains sweat and dirt. The pores become easily blocked. Young people are often in the habit of actively picking at facial lesions. Even in the absence of active physical interference, infection can set in. Initially there may be just a cold feeling. This will soon be followed by high fever. The area may become red, swollen, hard and painful to touch. The eye on the affected side can become puffed up and half shut. These are dangerous signs and a physician needs to be contacted immediately. Pus accumulating in other parts of the body needs to be drained. In this dangerous area, it needs to be left alone. This is because any interference with the lesion causes the pus to enter the deeper tissues and spread rapidly because of the abundant blood supply. The high content of connective tissue in that area facilitates this spread by holding the veins open. Instead of surgical interference, high doses of antibiotics should be given. Clean the area gently, without pressing down on it. Self-medication with one or two doses of antibiotics for insignificant skin infections makes the friendly skin bacteria resistant and virulent. Infections will recur frequently, spread to other areas of the body and become non-responsive to treatment. So only take antibiotics under medical supervision and always complete the dose the doctor has prescribed. 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

humble tomato

Red blobs of goodness Your Health DR GITA MATHAI “Can you prescribe a good vitamin tonic or tablet?” This is an oft-repeated request from patients. Vitamins are perceived to be a panacea for most illnesses, including listlessness, tiredness, failure to thrive as well as aches and pains. There may be some truth to this as vitamins and trace minerals are needed in small quantities (not mega doses) for survival. They maintain the integrity of the various cells and systems in the body. They are ingredients of enzyme systems that keep the body functioning efficiently. Vitamin supplements, however, are a far cry from the natural product. Some tablets or tonics pack mega doses, most lack one or the other vital ingredient. Some combinations may actually be harmful. There really is no need to go for artificial substitutes when we have the real thing — tomatoes. A single helping (150gm or one cup) of tomatoes is just 20 calories, with seven per cent fibre. It fills you up but does not contribute to weight gain. The fibre prevents constipation. More important, tomatoes contain all the essential vitamin groups — both fat soluble (A, D, E and K) and water soluble (C and B) — in an easy to digest form. It is also contains folate, a vitamin essential for pregnant mothers to prevent abnormalities in the brain and spine of the foetus. Folate also prevents anaemia and damage to the nerves. Tomatoes contain the trace minerals magnesium, phosphorus, chromium and copper, which are necessary to keep the body enzymes functioning efficiently. Chromium, for example, helps keep diabetes under control. In addition, tomatoes contain lycophene — a carotenoid that is a powerful natural antioxidant, which is not destroyed by cooking. This means it is present in tomato sauces, soups and purees as well. It prevents damage to the heart muscle from naturally produced toxic free radicals. These free radicals are responsible for much of the damage to blood vessels. They also have a role in the development of cancer. By binding free radicals, lycophene has a protective, anti-cancer effect, particularly against cancer of prostate, breast and skin. The brain and nervous system degenerate with age. There is forgetfulness, clumsiness, loss of balance and decline in reason and cognitive skills. A daily helping of tomatoes will retard this process and may produce improvement in memory. If you want to improve your child’s memory, instead of “memory capsules”, feed them a helping of tomato salad, homemade tomato soup, sauce or juice daily. An unexpected bonus will be that the damage caused to your child’s skin by the sun will also be repaired. Not only are tomatoes good for skin but also hair — it improves texture and prevents hair loss. The high vitamin A content of tomatoes protects against night blindness and helps prevent macular degeneration, a cause of blindness in older people. Tomatoes also have high concentrations of natural anti-inflammatory agents that help fight pain, especially chronic pain like in arthritis. A few studies have shown that tomato seeds contain a chemical called oxalate, which can combine with calcium (diet or supplements) and precipitate in the urine as kidney stones in susceptible people. If you have a family history of stones, it is better to remove the seeds. Or, drink lemon juice. The citric acid in the lime prevents the oxalate from precipitating. Tomato farmers often use chemical fertilisers. These chemicals and other pollutants from the soil can leach into tomatoes. An allergic reaction with itching, rashes, abdominal pain or bloating may occur in susceptible individuals. To prevent this, grow your own tomatoes in crates or pots. 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

palpitations

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Straight from the heart Your Health DR GITA MATHAI Palpitations need to be taken seriously and evaluated if: More than six abnormal beats occur in a minute or if they are perceived to be clustered in groups of three There is underlying diabetes or hypertension There is a concomitant loss of consciousness There is chest pain radiating to the arm and neck or unusual sweating Even if they are not that frequent, if the palpitations affect your lifestyle, they need to be tackled Our heart functions just like a fan, telephone, refrigerator or the other numerous silently efficient machines around us. It is only when such machines make a noise or stop altogether that they impinge on our consciousness. Similarly, as long as our heart — which is responsible for maintaining all the vital organs essential for life — keeps beating efficiently at a rate of 60-100 beats a minute (in adults), we are not aware of its silent, steady and rhythmic function. Sometimes, it misses a beat, races ahead or produces uncomfortable, unexpected, thumps in our chest. This is when it encroaches on our consciousness. If you lie on your left side and concentrate, you can feel the heart beat. This is normal. The unexpected thumps or palpitations may be accompanied by chest pain, giddiness, sweating or fainting. These symptoms may be a one time occurrence or they may recur with frightening regularity. Although heartbeat irregularities occur to everyone at some point, if it becomes a recurring phenomenon it is a cause for concern. Women, particularly between the ages of 18-65, tend to experience such symptoms more frequently than men. A perceptible increased thumping of the heart can also be normal. About 10-15 per cent cases of palpitations fall into this category. Such palpitations can occur during or soon after vigorous exercise. The heart’s response may also produce a choking feeling, particularly if the person is not used to exercise. With fever, the racing pulse may produce uncomfortable feelings in the chest. In pregnant women, blood volume increases and there is a similar response. Caffeine in coffee and tea increases the heart rate and can produce irregularities. Tolerance to caffeine varies, is idiosyncratic and not necessarily dose dependent. Some people become jittery, and develop an increased heart rate with a single cup. (This is particularly true of children). Others may consume 6-8 cups of coffee or tea without a problem. Many aerated beverages and cola drinks contain caffeine in varying concentrations. Some “sports” drinks have caffeine. “Energy” beverages may contain other chemicals in addition, which in synergy can cause dangerous increases in the heart rate. Nicotine (cigarettes, beedis, chewing tobacco and snuff) can cause irregularities, missed beats and even heart attacks. Certain medications such as diet pills, thyroid replacement therapy (particularly an overdose), salbutamol (to treat bronchial asthma) or pseudoephedrine (allergy medication) can have a similar effect. Heart palpitations may not be a symptom of underlying disease. In 30 per cent cases the cause may be psychosomatic — a physical manifestation of psychological stress. The palpitations may have been precipitated by anxiety, anger, a frightening episode on television or a near-death experience. In 45 per cent of cases, the palpitations have a proven cause. They may be due to anaemia, high blood pressure, diabetes, abnormal heart valves, heart disease, thyroid malfunction or electrolyte imbalance. To evaluate palpitations a complete physical examination is done to rule out anaemia, thyroid disease, electrolyte imbalance, fever and other causes not related to the heart. Then a 12 lead ECG (electrocardiogram) is done. This may be completely normal, particularly if the palpitations occur suddenly and unexpectedly. They cannot be produced on demand for the ECG. To overcome this problem, the behaviour of the heart can be recorded for 24 hours by wearing a portable Holter monitor. A diary can also be kept to physically record times and dates. The heart structure and size can be evaluated with a chest X-ray and an echocardiogram. Any underlying undesirable habit (smoking or drinking) or any disease precipitating the palpitation needs to be tackled first for any medication or intervention to succeed. Simultaneously, drugs may be administered to keep the heart rate within the normal range. In 15 per cent of people, no diagnosis is reached for the palpitations. All blood tests and other parameters are found to be normal. The rapid abnormal beats may have been caused by anger, tension and anxiety. Walking an hour a day, meditation, yoga, music and Tai chi can help you to cope with life without palpitations or dependence on “calming medications” or “sleeping pills.” 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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to operate or not

o operate or not to operate DR GITA MATHAI Fit individuals withstand surgery better. They are also less likely to require surgery for hip, spine and knee problems. To attain this:  Walk briskly for an hour a day every day Do flexion and core strengthening exercises Maintain ideal body weight Almost all of us will have to undergo some sort of surgical procedure at some point in our lives. Most of us (even doctors) are scared of surgery and face it with trepidation. Surgery is unavoidable in cases of severe trauma caused by an accident, acute appendicitis, badly broken bones, acute abdominal emergency and Caesarean sections. Many cases are not life threatening, and the surgery can be postponed to a time and date convenient to the surgeon, the patient and family members. This respite can be effectively utilised to seek a second opinion (preferably from a teaching institution) to see if the surgery really is essential. Also, a physician can be consulted to see if medical treatment is a viable option. Procedures like hip and knee replacement, spinal surgery for back problems and hysterectomy have become common. Before going under the knife, check if a combination of weight loss, physiotherapy, medication or hormonal treatment can do away with the need for surgery. Bypass surgery for blocked heart arteries has become commonplace. Today, interventional cardiologists can clear many of these blocks and place stents (angioplasty) at less expense. Earlier, all surgeries meant that patients were opened up and required prolonged hospitalisation to deal with the extreme pain and to heal properly — post operative complications led to deaths, too. Nowadays, many surgeries can be done through “minimally invasive” techniques. Laparoscopy is one such procedure where doctors insert two tubes through small openings. One of the tubes has a small camera which projects the view of the area on screens inside the operation theatre. That helps doctors manoeuvre the tiny scalpel in the other tube. Many surgeons specialise in laparoscopic surgery. Blood loss in such surgeries is minimal and hospital stay is very much reduced. Laser cutting knives and robotic extensions have made surgeons more efficient and reduced patient suffering. If you need an “elective” surgery as opposed to an “emergency” procedure, you can usually delay it for a month or two while you prepare yourself mentally, physically and emotionally. Postponing it any longer may be counter productive as the disease may progress. If you are a fit 70 something, opting for a knee or hip replacement may make the rest of your life pain free. (Now that life expectancy has increased). If you delay the surgery for too long, you may become incapacitated, medically unfit or complications may set in. Pain and immobility may make your life difficult and you may become a burden to your caregivers. While you wait for surgery, control blood sugar and improve nutrition and exercise to better your muscles, heart and lungs. All this will speed up healing. If you are a smoker, tell your surgeon and try to quit at last two weeks before the procedure. Smokers take longer to recover from anaesthesia, require more time on the ventilator, wound healing is delayed and scar tissue is more likely to form. Regular alcohol consumption results in relative resistance to anaesthesia and higher doses of sedation and painkillers may be required. All allergies and intolerance to medication should be documented and the surgeon and anaesthetist informed. A list of medication for other illnesses such as diabetes, hypertension, asthma or heart disease should be prepared and handed over. Herbal, ayurvedhic or homeopathic medication should be discontinued five to seven days before surgery. Even if they are taken for general health or an unrelated condition and classified as “harmless”, they can interfere with blood clotting and medication for sedation. Anxiety about the surgery, fear of anaesthesia, thoughts about death may cause insomnia, hypertension and palpitations in the days prior to surgery. Surgery is now a safe procedure and techniques are very advanced. If reassurances do not alleviate anxiety, yoga and meditation may help. Alternative medicines or massages do not serve as a substitute for surgery once it has been fixed and deemed to be essential. They can only help the body cope, but do not serve as a substitute. 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

cold sores

Cold sores decoded Your Health DR GITA MATHAI Fever, infections (particularly bronchitis and pneumonia), stress, excessive exposure to sunlight or even menstruation can sometimes lead to the appearance of “fever blisters” or “cold sores”. These are multiple, transparent blisters grouped together — filled with a clear fluid — that are situated near the margins of the lips, the nose or the cheeks. They appear without warning and disappear in much the same way in around two weeks. These lesions are due to infection by one of the Herpes group of viruses. The various members of the Herpes family that can cause infections such as chicken pox, herpes zoster and an STD (sexually transmitted disease). The one causing the fever blister is usually the Herpes Simplex Virus (HSV) type 1 but can also be type 2. Exposure to the virus starts from birth. The rate of infection increases from 0 per cent at birth to 30 per cent by age 30, 50 per cent by age 50 and 90 per cent by the age of 70. Exposure does not necessarily result in blisters. The virus is capable of remaining dormant till the immune system is sufficiently weakened for it to manifest. There is tingling and mild discomfort 2-3 days before the lesions erupt. Children (under five years) may have fever, headache, dizziness and nausea. Although the blisters have not yet appeared, the person can still spread the infection. Soon, the affected area becomes a mild red. Tiny, pimple-like swellings filled with a clear fluid erupt. These usually appear in clusters on the lip itself, the border of the lips, the chin or nose. The blisters then burst and release a clear fluid. This fluid is highly contagious. The blisters then crust over and form scabs, which fall off. The scabs too contain potentially infective viruses. In children (under five) the infection may start in the mouth. Initially there is redness, followed by the appearance of multiple blisters. These rapidly break down and can coalesce, forming multiple painful shallow ulcers. Swallowing becomes painful so the child may refuse to eat or drink. It may be difficult to even swallow saliva. As a result the child drools. The neck may be swollen with enlarged and painful lymph nodes. The unfortunate reality is that the virus never entirely leaves the body once it enters. It establishes permanent residence in one of the branches of the trigeminal nerve, which supplies various areas of the face. In 20 per cent of the people, the virus remains latent in the body and does not resurface. In the majority there are one to three recurrences in a year. Some unfortunate individuals have up to 12 attacks a year. The cold sores usually clear up by themselves within two weeks if left alone. A doctor needs to be consulted if the lesions are still present after a couple of weeks. This may occur if the initial diagnosis is not be correct or secondary infection has occurred. Treatment is most effective if started in the early stages when the tingling occurs but the blisters have not yet appeared. Unless people have frequent attacks, they do not realise that this is the prelude to an attack. Applying creams containing one per cent lemon extract, zinc oxide or the anti viral “cyclovir” group of compounds twice or thrice a day will reduce the symptoms, and speed healing by a day or two. In young children, people with deficient immunity and the elderly, doctors may start anti-viral tablets to speed up the healing process. Cold sores are highly infectious. They are also itchy, pricking and irritating. It is difficult to not touch, scratch or pick at the scabs once they form. The virus then transfers to the hands and gets deposited on any surface it comes into contact with. It survives on tables, walls or clothes for many weeks. The virus can also be transferred through utensils or shared food. Any person who touches these contaminated surfaces and then their face, nose, lips or mouth can develop the infection. Children who place their infected fingers in their mouth develop infection there. It can also be transferred from feeding bottles, pacifiers and toys. Any blisters which recur days, months or years later are equally infectious. One of the best ways to prevent infection is not to touch the infected area, to wash hands frequently, and not share utensils or food. Once the primary infection has occurred, it is difficult to predict or prevent recurrences. 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

breathing

A breath of fresh air

Your Health DR GITA MATHAI

Work your lungs Stand straight with feet shoulder width apart. Take a deep breath for a count of 20, allow air to fill your chest, and then push out your abdomen. Hold it for a count of 20. Breathe out, pushing in your stomach and forcing your diaphragm upwards. Do this for a count of 40. Repeat 20 times Life starts with a baby’s first breath and ends with the last one. We breathe without being conscious of it. It is an autonomous reflex that is so deeply embedded in the brain that it is not possible to commit suicide by holding your breath. Shortness of breath occurs when we become conscious of our breathing and it is no longer automatic. We feel it is insufficient, or that the “air” is not enough. It can occur for many reasons. It may be just a subjective perception; anxiety may make you take short, sharp, ineffective breaths or attention-seeking individuals may have conscious intermittent sighing respiration, which induces anxiety in care givers and bystanders. The respiratory rate can be measured by counting the number of breaths for a full minute. It is 30-60 per minute in babies. It then gradually falls to 12-20 per minute in adults. The rate increases with illness, in anxiety, fear or with exercise. It decreases (8-18/min) and becomes imperceptible and shallow while sleeping. During breathing, air enters through the nose and reaches the lungs through a system of pipes and airways. The lungs have multiple alveoli or sacs where oxygen from the air enters the body and carbon dioxide (a waste product) leaves the body. The lungs expand when air is breathed in. This occurs because the rib cage moves out, the diaphragm (a muscle that separates the chest from the abdomen) moves down and the stomach moves out. With age, the rib cage becomes fixed and the muscles that move it weak. Breathing becomes laboured, inefficient and difficult. Obesity causes mechanical problems. The rib cage and stomach do not move efficiently so the lung capacity is reduced. Fat deposits around the neck can cause obstruction and snoring while sleeping. Difficulty in breathing may be due to problems in the nose itself. It may be blocked with an allergy or a viral infection, there may be obstructive polyps, the septum may be deviated to one side or the sinuses that drain through the nose may be infected. Allergies can be due to dust, paint, cement, cockroaches, house mites, incense sticks, aerosol sprays or vapourising mosquito repellents. Avoiding the allergen may cure the nose block. If this is not possible, tackle it with nasal drops and sprays. Medicated sprays tend to be habit forming and cause rebound congestion. This means they become less effective and have to be used more frequently. It is better to use saline drops or a locally acting steroid like fluticasone. Steam inhalations also help. Antihistamines dry nasal secretions. A deviated septum may require surgical correction. Enlarged tonsils and adenoids can cause mechanical block and snoring in children. Hyperactive airways can constrict and collapse when there is infection, an allergy or exposure to more or less the same allergens that cause nose blocks. This results in a wheezing sound. Breathing becomes laboured and a fear of “asthma” sets in. This constriction can be effectively tackled by direct delivery of medication to the lungs. Nebulizers, spacers, inhalers and rotahalors do this efficiently and effectively. Since these deliver the medication directly to the target organ (lung), the side effects are minimal. Before these systems were developed, only tablets and syrups were available. They had to get absorbed from the intestines and then be carried by the blood to the lungs. This took a long time and the medication also produced side effects. Heart, liver and kidney disease or failure causes fluid build up in the body. The feet and abdomen become swollen and fluid accumulates in the lungs, making breathing difficult. This fluid has to be medically removed for breathlessness to improve. Even though breathing is a reflex, we need to make sure the apparatus functions efficiently. Aerobic exercises such as running, jogging, swimming, cycling and brisk walking increase the oxygen requirements of the body. Breathing becomes rapid and all the muscles need to function to their maximum capacity. Exercising for an hour most days a week keeps our breathing apparatus working in tip-top condition. There are breathing exercises in yoga, Tai Chi and in the martial arts. If performed regularly, they increase lung capacity. These are worth practising every day so that age-induced changes do not reduce respiratory capacity. These exercises complement aerobic 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

cancer the crab that kills

The crab that kills

Your Health DR GITA MATHAI

Cancer is not a new disease. The word cancer is derived from karkinos, Greek for crab. Worldwide, 13 per cent of deaths can be directly or indirectly attributed to cancer. The apparent increase in numbers is due to the population explosion, increased longevity, improved diagnoses and better communication. Everyone knows someone who has cancer. In developed countries, cancer is picked up early because of awareness and subsidised screening programmes. Treatment is effective and a large number of people survive. This is not the case in our country. Here, cancer is diagnosed late because of fear, ignorance or lack of facilities. In the coming decade, 70 per cent of cancer deaths worldwide will occur in developing countries. There are more than 100 types of cancer with different symptoms. The patient may notice the presence of a swelling. The abdomen may get swollen. Lymph nodes may enlarge and appear in various parts of the body. The diagnosis is difficult when the symptoms are vague, like chronic fatigue, weight loss, hoarseness of the voice, difficulty in swallowing or breathing or non-specific muscle and joint pains. All cancers are due to mutations in the genes and damage in the chromosomal structure of the body. These alterations in cell structure allow them to grow rapidly with no regulation. Normally, tumour suppressor genes prevent this abnormal growth. Genetic damage is corrected by inherent repair genes. Cancer sets in when these genes are either damaged or dysfunctional. Genes may be defective from birth. If this is balanced by a normal gene, the person may not get cancer. In others, the abnormal gene may cause cells to grow at a certain age. The cancer then manifests itself. Many members of a family may carry the gene and eventually develop cancer. If the defect is in a particular gene they will all have the same type of cancer, such as breast cancer. If it is in the tumour suppressor gene or repair genes, the affected members will have different kinds of cancer. Not all people who have a defective gene will develop cancer. The environment and lifestyle also play a part in it. Genetic mutations may occur as a result of chronic inflammation or viral infections (Human Papilloma Virus, Hepatitis B virus, Epstein-Barr virus.). It can occur as a result of imbalanced hormones, excessive exposure to ultraviolet light or prolonged contact with or intake of cancer causing chemicals. Although cancer can occur at any age, the risk increases with age and the incidence rises sharply after 65. Other risk factors are unhealthy habits such as tobacco (chewing, snuff, smoking) use, being exposed to second-hand cigarette smoke and having more than two drinks a day (in men; one in women). Consumption of food additives such as sodium monoglutamate, preservatives and some food colours is dangerous. Exposure to chemicals like benzene or working with asbestos are risk factors. Cancer is diagnosed by a comprehensive physical examination, followed by appropriate blood tests, X-rays, scans and biopsies of suspicious lesions. There is no universal test for cancer. Accurate and early diagnosis usually results in successful treatment. The tumour may be surgically removed. This may be followed by radiation and chemotherapy. Pain, infection and other complications may require adjuvant palliative care. Some cancers require stem cell treatment. In others, biological therapy is used whereby the body is taught to recognise and attack cancer cells. Alternative medicine has not been proven to have an effective cure for cancer. But yoga, hypnosis, acupuncture, acupressure or massage can help the patient cope with it. 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