looking after baby

Baby steps Your Health DR GITA MATHAI New mothers are under a great deal of stress because of lack of support in nuclear families, especially since the traditional caregiver — the grandmother — is more likely to be a working woman these days. The deluge of contradictory advice, paucity of reliable information and lack of a clear road map don’t make things easier. Here are a few things that new mothers should know. During pregnancy walk for a half hour in the morning and evening. The baby’s head is the heaviest part of its body, and walking will help gravity pull it down to the lowest part of the birth canal. It will also strengthen the calf and thigh muscles, making it easier to push out the baby during delivery. Many gyms offer special exercise or yoga classes for pregnancy and childbirth. As the skin stretches over the distended abdomen, the elastic fibres under the skin break and tear. This leaves indelible brown or white marks on the abdomen called stretch marks. To avoid them, apply oil on your tummy, thighs and back everyday from the time your stomach starts to grow. The nipples may develop painful cracks and fissures once the baby starts to feed. Oil (coconut, olive, sesame or a mixture of the three) needs to be applied, left on for 10 minutes and washed off with a delicate body wash. Food and drinks with artificial colours, preservatives and other chemicals should be avoided. Restaurants tend to use ajinomoto (and not just in Chinese food) so home cooked food and fresh juice is best. Avoid alcohol and cigarettes as well as second hand smoke from a spouse or parent. Vapourising mosquito repellents should be avoided. A mosquito net and an electric bat to hit recalcitrant mosquitoes are safe and effective alternatives. It is better to stick to one doctor during the entire pregnancy. Folic acid, iron and calcium supplements are essential. Urinary tract infections are common and need to be treated. Diabetes or hypertension that were pre-existent or developed during pregnancy needs to be controlled. Poor control can mean small babies or sudden death of the baby during pregnancy. Any medication for long term illnesses such as a seizure disorder or a psychiatric illness should be continued. The appropriate consultants should be informed about the pregnancy so that they can change the medication or adjust the dose. If you see a new doctor, mention you’re pregnant. It is best to not travel during early pregnancy. If travel is unavoidable, trains are probably better than planes. If you are planning to have the baby in a different city, be there a month before the anticipated date. Babies are notorious for arriving early and in the middle of the night. Wear loose clothes in natural fibres and flat sandals. Stay away from heels. Put the new born to the breast as soon as possible. Although the first milk secreted appears watery and inadequate, it contains essential immunoglobulin to protect the baby against infections. As the baby sucks more and more milk will be produced. If at this point artificial feeds are introduced, the baby loses interest in sucking. Without the stimulation, breast milk will decrease. Drinking a glass of water before and after feeding keeps the milk flowing adequately. Breastfed babies do not need water until weaning starts. The umbilical cord usually falls off between 7-10 days after birth. It needs to be kept dry and exposed to air till then, so the diaper needs to be tied below the umbilicus. Basin baths should be avoided until the stump is healed. Do not apply soap directly to baby’s skin. Soap up a soft wet towel and use that. Clean and dry the folds in the neck and groin properly. Do not use powder (even baby powder) on children. Talcs contain magnesium trisilicate and may be contaminated with cancer causing asbestos. If inhaled, the fine particles can cause wheezing and lung damage. Application in the groin area in girls has been linked to ovarian cancer. Babies need fresh air and sunshine. They should be taken outside within a week of their birth for limited periods of time. Exposure to crowded places or travel is not advisable until the first three immunisations are complete. 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 email

autism spectrum disorder

Rain man Your Health DR GITA MATHAI Fifty years ago the “autism spectrum of diseases” was practically unheard of in India. We lived in large joint families where one child or another may have been “difficult”, “hyperactive” (read: naughty), refused to study but eventually did assimilate into society. The rest of the family looked after the physical and financial needs of the person. He was just the uncle who was “weird” and perhaps did no work. The advent of the nuclear family changed this. Today, one in 85 children is diagnosed with autism spectrum disorder. Four out of five such children are boys. Most autistic children are only diagnosed by the age of three. This is when many of them start some sort of structured education and need to interact with their peers and the autistic behaviour becomes evident. There may still be a delay in diagnosis as the severity of the symptoms and the manifestations vary from child to child. The symptoms may be subtle but appear in infancy. The child may not smile, make eye contact, or babble happily. They may resist cuddling and withdraw into themselves. They may show little or no interest in surroundings. The reaction to toys may be bizarre. They may be focused on just a portion of the toy, like the wheel of a toy car, with no desire to see how it works. Some actually lose speech and other milestones they had already developed. The ability to interact with other people may be defective or absent. Their behaviour may be inexplicably disruptive and aggressive. Children need to be evaluated if • They do not smile by the time they are six months old • Do not mimic sounds or facial expressions by nine months • Do not babble by one year • Do speak at all by 16 months • Do not speak two word phrases by 24 months These symptoms are suspicious but not diagnostic. The diagnosis of autism is based on the presence of at least six specific symptoms from the DSM (Diagnostic and Statistical Manual of Mental Disorders). A qualified professional must make the diagnosis as it has major implications for the future of the child. Autism may exist alone or may be part of a wider spectrum of diseases. The child may also have genetic abnormalities, seizure disorders or tuberous sclerosis (multiple tumours in the brain). Once enrolled in school, they have learning difficulties. Though they might repeat what they learn and appear to grasp it quickly, they cannot understand the logic or concept; so they are unable to apply what they learn in daily life. They may be unable to understand certain concepts altogether. Some may be savants with exceptional musical, mathematical or artistic talents. This is easier for parents to accept as they would rather have a child who is a genius and not one with learning disabilities. Families are understandably upset with the diagnosis of autism. Unfortunately the exact reason for autism is not known though there appear to be several contributory genetic and environmental factors. If the families of autistic children are carefully studied, there may be several members with one or another symptom in a mild form. They may lack social skills, be abrupt or rude or have learning disabilities. There may be just a small defect in the genes of each individual and they may be compounded in the child. Modern day additives, pesticides and other pollutants in the environment and in the food eaten during pregnancy are suspected but not proven to play a role. There was a great deal of hype in the media postulating a link between autism and vaccines particularly MMR (measles mumps rubella). This is a disproved hypothesis. Failure to immunise the child places it at risk of contracting serious preventable infectious diseases. Older parents are more likely to have autistic children. There is no miracle drug to cure autism, but coexistent medical conditions should be treated. Careful nurturing and education can integrate many autistic persons into mainstream society. Many children with mild forms when helped do seem to “outgrow” it during their teenage years. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

fat or fit?

Fat or fit?

Your Health DR GITA MATHAI

Women often ask, “Do I look fat?” If you feel the need to ask that question you probably have a problem! This question seldom worries overweight men, until their physicians point it out or diagnose lifestyle diseases. All of us want to look good but in reality beauty does not lie in the eye of the beholder; the ideal size and shape is a debatable question and can be calculated with numerical formulae. Various parameters are used by insurance companies to assess health and predict longevity, or, in other words, how fit a person is. The most widely used is the body mass index or BMI (weight in kilograms divided by height in metre squared). Based on this simple formula people were classified into: low (18.5 and below), normal (18.5 to 25.0; Asian value is 23), obese level 1 (25.0 to 30.0), obese level 2 (from 30.0 to 35.0), obese level 3 (from 35.0 to 40.0) and obese level 4 (40.0 and above). But the formula has been found to have many defects. It is accurate for men of medium height, but flawed for women. Athletes have increased muscle mass and this increases their BMI. Very tall or short individuals fall outside the normal range even when they are healthy. Medical professionals sometimes measure the waist alone. If it is more than 35in (89cm) for women and more than 40in (102cm) for men, there is an increased risk of lifestyle diseases. The waist:hip ratio (WHR) can also be used. Ideally, it should be 0.7 for women and 0.9 for men. Women in the ideal range have optimal levels of the female hormone estrogen; this makes them less likely to have menstrual irregularities and more likely to be fertile. The likelihood of developing cancers of the uterus and ovary is also reduced. In men too, normal values indicate better fertility and less likelihood of cancer of the testes or prostrate. An ideal WHR makes both sexes less likely to develop lifestyle diseases. Measurements, statistics and appearance are useful as rough guidelines but health actually means being “fit”, that is, having a flexible body, with efficient heart, lungs, bones, muscles and nervous system. A person in the “overweight” or “obese” range according to the formulae above can actually be fit while a “thin” person may be unhealthy. Fitness means: The person should not use tobacco in any form or drink excessively. Blood pressure, lipid profile and sugars should be normal. The person should be able to move all their joints through their entire range of motion painlessly, both actively and passively. Simple tests to measure fitness at age 30 and above: Seated comfortably in a chair, with arms crossed, they should be able to stand up and sit down approximately 12 times in 30 seconds. Should be able to sprint 100 metres in 20 seconds or less Seated cross legged on the floor, should be able to stand up without using any other part of the body for balance, assistance and support. The primary goal should not be “looking good” but “feeling great”. Weight loss is often difficult, especially after the teenage years. It cannot really be simplified into the formula calories eaten minus calories used. People utilise calories at different rates for the same activities. The BMR (basal metabolic rate) at which their bodies perform basic functions necessary to stay alive varies. This is where genetics comes into play. Some people are inherently more efficient at conserving calories and perform the same functions utilising less energy. Physical activity helps the body maintain healthy levels of insulin and blood sugar. This prevents damage to blood vessels and internal organs such as the heart and kidney. Regular exercise blunts obesity’s ill effects even with little or no weight loss. As fitness is achieved, some amount of weight loss is bound to eventually occur. Together, this increases lifespan and reduces the risk of cancers and other serious illnesses by 20-30 per cent. Achieving fitness should be a lifelong goal. It requires aerobic activity (running, jogging, brisk walking, cycling or swimming) for 30-60 minutes a day, core and muscle strengthening exercises, light weights and yoga or other flexibility exercises for 20 minutes a day. No time for exercise? That just means you will have a lot of time for illness later! 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

problems with gas

ull of air

Your Health DR GITA MATHAI

If you have dyspepsia: • Eat meals on time, chewing the food well. • Drink around three litres of water a day. Water dissolves gas. • Do not sleep for at least an hour after eating. • Avoid consuming more than 400ml of milk a day. • If you have a sedentary job, stand up and move at least around your desk every hour. • Walk, run or jog for 40 minutes to an hour a day. The movements will tighten your abdominal muscles preventing distension. The chemicals released by the muscles during exercise help to regulate the nervous system • Do yoga. There are specific exercises for dyspepsia. The meditation will relieve stress and calm your mind. Burping, belching, a painful distended abdomen, a feeling of fullness after eating “just a little” — these uncomfortable symptoms of dyspepsia affect 20 per cent of the population at some point in their lives. Many blame dietary indiscretions — a temporary overindulgence in rich food. Since there is no consistent pattern, the patient ends up avoiding more and more food items with less and less satisfactory results. Dyspepsia is predominantly a clinical diagnosis, made when the symptoms mentioned above have been present for three months or more. Thorough investigations are necessary if these symptoms suddenly appear in a person over 55 years old, there is bloodstained vomiting, intractable pain, difficulty in swallowing or significant weight loss. The symptoms of dyspepsia can also be a side effect of certain pain relieving medicines or steroids. They can even be caused by diabetes, lipid abnormalities, thyroid problems or kidney disease. In women, symptoms may be aggravated pre-menstrually or during pregnancy, precipitated by hormonal changes. Angina (forerunner of a heart attack) can also lead to pain in the upper abdomen pain but it is usually accompanied by sweating and can be picked up on an ECG. If investigations rule out all of the above, get an X-ray, ultrasound and CT scan done. This can be followed by endoscopy, if necessary. Endoscopy allows the doctor to see the lining of the stomach clearly; if there are ulcers, they can be sent for biopsy. Eighty per cent of stomach and duodenal ulcers are caused by bacteria calledHelicobacter pylori. The “azole” group of drugs can treat ulcers. Gallstones may be blamed for the symptoms but they are rarely the cause. About half of the population has gallstones but no symptoms. Removal of the gall bladder usually does not cure the symptoms. The good news is that medical tests for most people with dyspepsia return normal results. The bad news is that they still have a disease, a chronic condition that improves and relapses. So if their condition improves after they have eliminated a certain food from their diet, it makes patients erroneously believe that is what has led to an improvement. Self-imposed dietary restrictions may then result in other health problems. Dyspepsia is caused by a malfunctioning gastrointestinal smooth muscle. The nerves that supply the muscle do not work properly, probably because signals from the brain and chemicals released for their action are faulty. This can be confirmed with motility studies. This investigation is expensive, time consuming and done only in specialised centres. The emptying time of the stomach and forward propulsion of food are aggravated by eating too fast, drinking carbonated beverages and overeating. The discomfort results in pain and belching. As the air is expelled there is some relief. In some people belching is a response to any kind of abdominal discomfort, even when there is no excess air. Not much research has been done on dyspepsia since it is not fatal. Response to treatment is difficult to evaluate. A variety of medications have been tried — the “azole” group of drugs, prokinetics such as domperone and periactin. The response is variable, with some patients responding well and others poorly. Better results are sometimes obtained if they are also put on anti-depressants. The medicines work on the transmitter nerves and have a pain relieving effect as well. 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

tuberculosis

The great deceiver Your Health DR GITA MATHAI TB spreads through the air. Only lung TB is infectious. People with extra-pulmonary TB are not infectious to others Children with TB do not spread it to their contacts TB is curable with adequate treatment and patient compliance Tuberculosis can be described as “the great deceiver,” confounding doctors and patients alike. It appears so slowly and insidiously that the patient is often unable to pinpoint the exact time and date the illness started. The symptoms may be non-specific — a vague feeling of being unwell, tiredness, fatigue, aches and pains, a rise in temperature in the evening, sweating in the night and occasional chills. Symptoms may be present for weeks before the patient or the doctor realises that something is wrong. When we think of TB patients, we visualise an emaciated — possibly poor — person who coughs up blood. This image is, however, far from the truth. Although TB most commonly occurs in the lungs, it can also affect other organs such as lymphnodes, covering of the heart, bones, brain and spinal cord, urinary tract, abdomen, reproductive system and even the eye. Only “open” cases of TB transmit the infection, that is, patients who cough or spit out sputum containing TB bacteria. Anyone who inhales the bacteria may get infected. About 40 per cent of the Indian population carries the TB bacteria but not all of them manifest the disease. Once the person’s resistance is compromised, the disease can flare up. Although the initial infection is in the lung, it can spread via the blood to any organ in the body and produce an infection there. Sometimes, particularly in children or immunodeficient individuals, it can produce an explosive illness — a “military spread” that affects all the organs in the body. TB is more likely in children, those aged between 14 and 20, and the elderly. The risk increases if the person also has cancer and is undergoing treatment for it, has silicosis (an occupational disease affecting people who work in quartz, granite or silica mines) or diabetes, liver or kidney failure, is on steroids or has HIV. Overcrowding, lack of ventilation and using a wood fire increases the risk. Overcrowding means a person with open tuberculosis has a greater chance of infecting family and neighbours. Smoking beedis or cigarettes is an independent risk factor. It has been linked to 50 per cent of TB cases in India. Despite treatment, smokers tend to have a higher mortality. The same is true of alcoholics, particularly if liver function is compromised. Most of the initial exposure to TB occurs in childhood. In an attempt to prevent this, the government administers BCG (Bacilli Calmette-Guerin) immunisation to all children soon after birth. The vaccine does not prevent TB, but it does reduce the severity of the disease, and also prevents TB meningitis (in the brain). Once the disease has been diagnosed, treatment has to be adhered to. Medication has to be taken regularly and systematically for periods ranging from six months to a year. Usually, a combination of three to four drugs is used. Of them, rifampicin has to be taken on an empty stomach to have maximum effect. It can cause sunlight sensitivity so patients must use sunscreen. Ethambutol can cause blurred vision, painful red eyes and red-green colour blindness. Pyridoxine (a B complex vitamin) needs to be concurrently taken to prevent INAH (isoniazide)-induced nerve toxicity. The government provides free TB treatment through primary health care settings and non governmental orgnisations. They usually administer DOTS (Directly Observed Tuberculosis treatment Short course). The drugs are administered under supervision to the patient every alternate day. Some schemes give the patient a week or a month’s treatment in hand. The schemes have drawbacks. The distribution site may be inconveniently located, timings of the centre may be inconvenient for working people, strikes and government holidays may interfere with its efficiency. Many people do not know that anti-TB medication can be purchased from private pharmacies with a prescription. A few weeks after treatment is started, the symptoms disappear and the patient feels better. Unfortunately, at this time many discontinue treatment. Strict adherence to treatment usually results in a cure. Failure to do so can result in relapses or recurrences. These can be expensive, difficult to treat or fatal, as the organism may have developed multi drug resistance. 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

aging gracefully

Old isn’t always gold Your Health DR GITA MATHAI The Indian population (1.27 billion at present) is projected to overtake that of China in another 10 years, with more births and steadily climbing life expectancy (65 years at present). Between 2000 and 2050, the total population will increase by around 60 per cent but the number of senior citizens (that is, people above the age of 60) will increase by a mind boggling 360 per cent. At that time, they will comprise 20 per cent of the total population. This group is likely to be “feminised” as women tend to outlive men. Also, 70 per cent of the women in that age group would have lost their husbands, whereas only 30 per cent of the men would have lost their wives. Some of these men may remarry, but the majority of women remain single. Many of these old men and women lose their independence and liberty. They are told (often out of kindness) to take rest, relax, watch television and not venture out on to unsafe roads. They may lose control of their resources and suffer neglect or abuse, even though the government has declared that any Indian citizen over the age of 60 is entitled to maintenance from their children. That is all very well in theory but newspapers are inundated with horror stories of abuse, neglect, starvation and even murder. It is a fact that our health deteriorates as we age. “Slowing down” seems a normal process with decline in cognitive skills, muscle strength, and endurance. Finally, the elderly become dependent on caregivers physically and financially. We cannot totally halt this process but it can be slowed down if unhealthy and dangerous behaviour and habits are curtailed while we are still young and fit. Smoking is one of the biggest offenders. It is responsible for bone loss, breathing difficulties, early dementia, heart failure and cancer. No one really likes to look after a wheezy, breathless elder who can barely move around the house. It is a habit that needs to be stopped (not reduced) as soon as possible. Drinking is a double-edged sword, especially as you get older. The drinkers argue that moderate drinking, that is, one drink a day for women or two drinks a day for men, (one drink means 12 fluid ounces of beer, five fluid ounces of wine and 1.5 fluid ounces of 80 per cent proof spirits) has health benefits. It has been credited with a reduction in the risk of getting a heart attack or stroke. It may prevent formation of gallstones and delay diabetes. It may be of benefit in older adults who already have high cholesterol or are at risk for heart disease. Doctors, on the other hand, feel that drinking does not have positive effects for everyone. It can lead to addiction and abuse. Long-term drinking can damage the heart, liver, brain and nervous system. It can lead to personality change. Since the jury is still out, if you do drink do so in moderation and have a day off a week. If you don’t drink, please don’t start. A balanced diet goes a long way towards preserving health. Proteins, fats and carbohydrates should be eaten with four helpings of fruits and vegetables a day. This will keep muscles and bones healthy, prevent constipation, and provide roughage, fibre, vitamins, trace elements and disease fighting anti-oxidants. Regular habits, with at least seven hours of sleep, keeps the brain functioning like a well-oiled machine and gives it enough time to recuperate. As the messages travel again and again through the same internal circuits, the transmission and execution become efficient. The unused areas of the brain tend to atrophy. To prevent this from happening, they need stimulation. Learning a new skill like chess, dancing or music can do this. This may not be possible if a person is house bound and unable to attend a class or a social group. Religious books are usually always available in the house. Committing parts of it to memory and then trying to recall it or learning poetry are excellent ways to stimulate the brain. Crossword puzzles and Sudoku also accomplish this, but then again books need to be provided. The benefits of physical exercise are immeasurable. Regular aerobic activity such as walking, running, jogging, swimming for an hour a day builds muscle and bone strength. This in turn helps balance and that prevents falls and fractures. It also prevents cognitive decline. We owe it to our children to give up unhealthy lifestyles and become physically and mentally fit. That way, we are unlikely to become elderly burdens financially and emotionally. 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

doping kids

Foul play Your Health DR GITA MATHAI “This is my son,” said the man, as he walked into my clinic, “He is a district level sprinter. He is to compete at the state interschool athletics meet. Can you give me a certificate saying he is 16 years old? “Don’t you have a birth certificate?” I asked. “Yes,” said the man, “According to that he has completed 19 and will have to compete in another age division”. “Is he 19 years old?” “Yes” confessed the father, “he started school late. Also his coach feels that he is underweight and his muscles are not well developed. He gets tired easily. So he wants him to take these vitamins and supplements.” He produced a plastic bag that contained a mini pharmacy: capsules with vitamins and minerals in mega doses, pills containing anabolic steroids and testosterone, a jar of a “food supplement” with high doses of amino acids and creatine and even injections of long-acting testosterone. Apparently the entire team, including the girls, were on these supplements and injections! Athletes have to practice day in and out for years to build up stamina and muscle to excel in their chosen sport. There are no short-cuts. Some of our young athletes are naturally talented and are spotted by coaches at the school level. Others have parents who pay for coaches and training. After all, if you can compete in a sport at the national level, it will guarantee you a place at college (even with lower marks) and a job under the “sports quota”. In India, the focus is on academics since it is thought to be the only thing that will help a child get a good job. Many parents feel that sports are a waste of time and money. After all, how many Dhonis or Milkha Singhs does the country produce? This means that many talented children do not achieve their potential in sports. So with no access to (or interest from) the talented, coaches look for shortcuts to produce national level athletes. One way is to fudge the age. A 19-year-old always has a good chance of performing better than a 14-year-old. The other is doping. Last year, the International Association of Athletics Federation caught 52 Indians doping. Even more frightening, in last year’s National Schools Championship, 11 student athletes were caught doping. Often the athlete and the parents are ignorant about what is there in the health supplement prescribed by the coach. Creatine powder is one of the things widely used by coaches as it is believed to speed up recovery and increase muscle mass and strength. Since creatine occurs in the body naturally, it is thought to be harmless but the truth is very different. Consuming creatine leads to weight gain and irreparable kidney damage. Steroids and steroid precursors (usually medications ending with “abol”) and DHEA (d ehydroepiandrosterone, a hormone) are misused to better performance. They, however, also cause pimples, damage the heart and liver, precipitate diabetes and high blood pressure and cause short stature by interfering with bone growth. Girls can also develop a deep voice and become hairy and sterile. No one can progress in the chosen field (even if it is only lifting weight in the local gym) without putting in hard work. If you take dangerous supplements as a shortcut to success, you will either be caught or the dangerous side effects will quickly cut short your career and perhaps even your life. If parents and athletes knew what exactly they were consuming in their “health supplements” and what the long-term effects were, most of them would probably decide not to take this “short-cut” and choose to work hard. An athlete’s diet needs to have adequate calories and proteins. The calorific requirement can be roughly calculated by multiplying the ideal weight in pounds by 13. Then add the calories expended in the sport. Running is 350-500 calories an hour, swimming 550-600 and weightlifting 450-500 calories. Depending on the intensity of the training, these calories can be added to the daily requirement. Infants require about 10gm of protein, teenage boys 50gm, girls 46gm, adult males 55gm and women 45gm a day. Meat, fish, eggs, nuts and dairy products are good and healthy sources. Sports is about developing personality, dedication and discipline in children. It is not about winning by any means, fair or foul. It is about instilling ethics, not chasing short-term gains by a devious route at the cost of future health. 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