ED

http://www.telegraphindia.com/1140922/jsp/knowhow/story_18858708.jsp#.VCRAs4C1Ybg

An embarrassing disease

Your Health DR GITA MATHAI

Every week this column gets a number of letters from men who have — or think they have — impotence or erectile dysfunction. They are too embarrassed to consult their physicians and the letters invariably end with the request “please answer the question but do not publish my name!” Many men, as they cross the age of 40, avoid exercise, put on weight (particularly around the waist), drink alcohol and use tobacco. This unhealthy lifestyle results in a bouquet of diseases, with diabetes, high blood pressure, unhealthy lipid profiles and heart attacks topping the list. About 40 per cent also suffer from impotence or erectile dysfunction (ED). Proper erectile function requires a complex interplay between brain chemicals, blood follow to the concerned organ, psychological factors and love or desire for the partner. It is not a mechanical response. If erection never occurs, it may be due to low testosterone levels. Testosterone levels are highest in adolescents and young men — usually between 300-1200ng/dL. After the age of 40, testosterone levels decline at the rate of approximately one per cent per year. Tumours in the pituitary called prolactinomas or under functioning thyroid glands can cause hypogonadism and low testosterone levels. If erection occurred initially and then declined in frequency or ceased, the reason may be psychological. But diseases that can interfere with proper functioning need to be ruled out or tackled first. Diabetes affects not only the blood flow but also the pudendal nerves responsible for a sustained erectile response. Some people are unaware that they have “crossed over” and become diabetics. Others are unwilling to accept the illness and do not regulate their intake of food and sugar. Elevated lipids can form plaques, which block vital blood vessels, physically preventing proper erection. Blockage can also occur because of nicotine — inhaled (as cigarettes), chewed or sniffed. Alcohol affects the liver, and that in turn reduces the level of male hormones. It also produces a neuropathy in the vagal nerves. These need to work properly for erection to occur. Surgery or injury to the male reproductive organs can result in ED. Surgery to the prostrate has often been blamed. The prostrate actually does not have a role in erection. The problem can occur because the nerves in the pelvic area may be damaged during surgery. Some prescribed medications such as the SSRI group of antidepressants and some anti-hypertensives can have an adverse effect. It is important not to stop taking these medications without asking your physician for an alternative. ED is treated by specialised urologists called andrologists. They initially screen the patient with blood tests to rule out correctable causes for ED. Blood tests will pick up diabetes, elevated lipids, thyroid malfunctions, liver disease, renal diseases and low testosterone levels. Other specific tests are duplex ultrasound, tests of penile nerve function, nocturnal penile tumescence, biothesiometry, dynamic infusion caverosometry, corpus cavernosometry and magnetic resonance angiography. If all the tests are normal, the reason for the malfunction may be psychological, usually due to stress. Psychotherapy helps. In addition medications, particularly sildenafil (better known as Viagra) and its derivatives, often help. Although these medications are available over the counter (OTC) it is advisable to take them under medical supervision. They are contraindicated in heart conditions and can react adversely with other medication you take. Sildenafil takes 30-60 minutes to work and can be taken once in 24 hours. Ideal body weight (height in meter squared X 23), a healthy lifestyle with 40-60 minutes of running, jogging or cycling a day, yoga or meditation to avoid stress, a good nights sleep, avoiding alcohol and smoking and a stable loving relationship with a significant other will probably avert these embarrassing shortcomings. 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

diabetic neuropathy

http://www.telegraphindia.com/1140915/jsp/knowhow/story_18835166.jsp#.VBbuZ5SSya8 The slow killer

Your Health DR GITA MATHAI

Most senior citizens in India have diabetes. Unfortunately, many do not take this disease seriously. They cheat on their diet, add “a little sugar” to their tea and miss their daily dose of pills. They coast along, as complications take a long time to set in. Uncontrolled sugars damage the nerves, causing “diabetic neuropathy”. High blood sugars slow down conduction signals in nerves and the blood vessels, which supply essential nutrients to the nerves, are also compromised. Smoking and consumption of alcohol aggravate diabetic neuropathy. The symptoms are many. Tingling, numbness, sudden shooting pains can occur along the peripheral nerves, which supply the limbs. The pain of an injury may not be felt as the sensation in the distal parts of the limbs is affected. So injuries that go unnoticed can lead to an infection and eventual amputation. Muscles become weak and flabby, resulting in loss of power and balance. If the autonomic nervous system is affected, the heart rate can be inappropriately rapid at all times instead of fluctuating with activity. This interferes with the body’s ability to maintain blood pressure. Giddiness may appear or consciousness may be lost on suddenly standing up. The movement of the gastrointestinal tract can be affected. It may become difficult to swallow as the esophagus does not contract properly. The stomach may become lax and distended causing belching, a feeling of fullness, nausea and vomiting. The slow movement of food through the intestine can cause constipation. In others the neuropathy may cause uncontrollable watery diarrhoea, worse at night. Damage to the bladder nerves prevents the person from sensing whether the bladder is full or empty, leading to incontinence. Sex organs can become affected. In men, this can cause impotence and erectile dysfunction. In women vaginal lubrication may decrease and there may be failure to achieve orgasm. The muscles responsible for proper focus in the eyes can malfunction. There is blurring of vision. The treatment of diabetic neuropathy begins with proper control of blood sugars. The blood sugar should be in the target range of 80-130mg dL on an empty stomach and 180mg dL two hours after food. A judicious combination of diet and exercise needs to be followed. Between 1500 -2000 calories can be eaten a day. Avoid processed food, sugar and honey. Walk, jog, cycle or swim for at least 30 minutes a day. Weight training exercises help maintain muscle mass and strength. Twenty to thirty repetitions of standard drills with dumbbells weighing 1-2kg will maintain muscle mass without adding bulk. Blood sugar can be controlled with insulin injections or medications that increase the body’s insulin output. In addition, specific medicine can be taken for the symptoms of neuropathy. The pain of neuropathy responds to external applications of a capsaicin-containing ointment and also to acupuncture. If these do not work, effective drugs are pregabalin and carbamazepine, which belong to the seizure medication group. Antidepressants like amitriptyline, nortriptyline, desipramine and duloxetine are effective in some people. Avoid codeine-based painkillers as they can become addictive. 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

http://www.telegraphindia.com/1140901/jsp/knowhow/story_18785654.jsp#.VAep6YC1Ybg Tackling depression Your Health DR GITA MATHAI Robin Williams was everyone’s favourite funny man yet his death showed that his life was anything but happy. Depression is now a common disease. In fact, India has the largest number of people suffering from depression, a staggering 35 per cent of the population. Depression can result from imbalance in the chemical messengers (neuroreceptors) in the brain. The tendency to develop this can be inherited. Symptoms of depression may set in insidiously. The victim may have ordinary feelings such as sadness, anger, irritability or frustration, which are more than warranted by the occasion. Pleasurable pastimes may cease to be so. There may be a feeling of perpetual tiredness, difficulty with initiating or completing a task. Remembering things and concentrating may be a problem. Depression can result in loss of appetite and weight but in many victims there may also be a pica (craving for inedible things) or food cravings. Indulgence in certain foods such as chocolates can temporarily increase the levels of mood elevating chemicals in the brain. Frequent indulging, in an effect to maintain the euphoria, can result in weight gain. It can also result in the use of alcohol, tobacco products, over the counter (OTC) drugs such as mood elevators or sleeping tablets, illegal drugs such as amphetamines, or hard drugs. In children, the symptoms are subtle. They may cling to the parent or guardian, refuse to go to school, have recurrent aches and pains (such as headaches), not eat food and fail to gain weight as expected. Depressed teenagers avoid social interaction with their peers, lose interest in normal activities, are extra sensitive and eat and sleep too much. Academic performance starts to drop. Psychiatrists classify depression as major or minor, depending on the number of symptoms present. Major depression can continue for a long time if not treated. The person may talk of suicide or make an attempt at it. The first attempt (especially in women) often fails. It should be considered a plea for help and a professional consulted. In women, delivery can precipitate post partum depression. This clears up within a year with medication and family support. Hormonal changes occurring with menstruation can trigger mild to severe depressive symptoms every month. If mild, they are called PMS (premenstrual syndrome) and if severe premenstrual dysphoric disorder (PMDD). Both conditions are aggravated by alcohol use (not a rarity in Indian women anymore), being overweight and lack of exercise. Both can be managed with regular exercise and a reduction in salt (pickles and preserved foods) and caffeine (coffee, tea and cola) intake. Treatment of depression involves a combination of psychotherapy, medication and lifestyle changes. Medication belonging to several chemical groups alone or in combination can be used for treatment. They act by correcting the neurotransmitter imbalances in the brain, which may take a few weeks. A lifestyle change with socialisation helps depression. In may be worthwhile to join groups with similar interests. Exercise has proven benefits. The chemicals released from the large muscles utilised during exercise correct neurotransmitter imbalances in the brain but at least 40 minutes of aerobic activity is required for this. 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

knee pains

Take care of your knees • Obesity puts strain on the knees. Maintain a BMI (weight divided by height in metre squared) between 23 and 25 • Do exercises to strengthen the knees. These exercises are available on the Internet, are part of yoga and can be taught by a physiotherapist • Always warm up before and cool down after exercise • If you have knee pain, shift to non-weight bearing exercises such as swimming or water aerobics

The knees are one of the larger joints in the body, supporting its entire weight. It is a hinge joint, like that of a door, capable only of moving forwards and backwards. Attempts to force a door to move sideways or push it open in the wrong direction will result in the door “coming off its hinges.” A similar problem occurs when the knee is forced to move in the wrong direction.

The knee joint is composed of three bones, the lower end of the femur and the upper ends of the tibia and fibula, articulating with one another. The raw bones do not grate against each other. They are separated by a “joint space” filled with synovial fluid, lined with articulating cartilage and separated by little washers called meniscii. There are ligaments inside the joint holding it in place. Considering the size of the knee joint, these ligaments are woefully inadequate. In the front of the knee is the kneecap or patella.

The knee undergoes constant wear and tear. Our daily activities involve walking and climbing stairs as well as exercising. In a lifetime, the knee joint functions over and above its capacity!

Pain in the joint can be acute and occurs owing to injury, infection, or age-(or overuse) related degeneration. The cartilage breaks down, exposing parts of the bone underneath. The raw nerves are exposed and this becomes very painful. Bits of broken cartilage can get trapped in the joint. When that occurs, movement can result is sudden pain and the joint can get locked.

Dislocations and injuries are more common in the young — basketball and football are notorious for causing knee injuries. This is because there are sudden abrupt changes in the direction of movement, which may be against the normal anatomical direction of movement. The player may land awkwardly or fall, bruising and injuring the joint.

The two knees support the weight of the entire body between them. The bones are physically capable of supporting only a certain amount of weight. Obesity causes the knees to degenerate rapidly. Depending on gait and posture, one side may wear out faster than the other. This may result in a bow-legged appearance. Walking is extremely painful and the gait may be crab like. The entire joint may be swollen and painful. Or, the pain may be localised on one side. At times, instead of the whole joint, the area under the patella gets worn down and irregular. As that rubs against the bones underneath, there is terrible pain with movement.

Children seldom develop knee pain without injury or a fracture. Boys can develop pain as part of certain inherited congenital syndromes or birth defects in the knee. The patella may also get dislocated. This is more common in teenage girls.

Infections, acute trauma and fractures result in swollen, warm and tender joints. Arthritis, especially rheumatoid or osteoarthritis, can produce a similar picture. Infection always produces fever. Gout usually affects the big toe but can present itself as a painful knee joint. It may be worth checking uric acid levels.

going for gold

Striking gold

YOUR HEALTH DR GITA MATHAI

AS GOOD AS GOLD: Vijender Singh Citius, Altius, Fortius” goes the Olympic motto in Latin. Translated, it means “Swifter, Higher, Stronger.” That is what every Olympic athlete strives for — to be the best. His or her single-minded dedication, tremendous personal sacrifice and discipline are to be admired and emulated. It is not easy to drive your body to its limits. Great athletes need the right genetic makeup, body proportions and physique. They can then be moulded for the job. Michael Phelps is 6 feet 4 inches tall, but has proportionately shorter legs attached to a long trunk, with giant size 14 feet that look and function like fins. Kip Keino, the Kenyan marathon runner, is only 5 feet 8 inches tall but has thin, long runner’s legs and a short torso. In short, aspiring athletes need the correct genes and a supportive family and government. A genetically apt form and physique is wasted without the right training, nutrition, mental discipline and financial support. This does not mean that we ordinary people cannot exercise and strive to be healthy. The human body has striated or voluntary muscles which function on demand. These muscles are either “fast-twitch” (white) muscles or “slow-twitch” (red) muscles. The white muscles contract rapidly and tire easily. They are good for sprinting. The red fibres are best for endurance sports as they have increased muscle power and are twice as efficient. With training it is possible to develop a particular muscle type, but a choice has to be made between speed and endurance. This is why a tall, strong, muscular and powerful human with more red muscle cannot move swiftly or manoeuvre as efficiently as a small, lean person with more white muscle. Animals show this distinction in evolution. The cheetah has tremendous sprinting speed over short distances, but the horse has far greater stamina and endurance. Once a particular muscle type has been trained, it is possible to excel in related events that have similar energy requirements. The same people will do well in the 100m and 400m sprints, the 110m hurdle and the long jump, but not in the 5000m event which requires more stamina. Tremendous torso strength is required to throw a shot put, hammer or javelin. These events require stocky athletes who may not be able to move fast and do well in sprints or jumps. Everyone (particularly all Indians) should prioritise staying fit and exercising to the limit of his or her endurance. This means exercising one hour a day and trying to achieve the target heart rate (80 per cent of 220 minus age). This habit needs to be started young. Unfortunately, many school going children today are obese with a Body Mass Index (weight in kg divided by height in metre squared) greater than 25. However, it is never too late to start. Despite age, infirmity and illness, the body when trained and pushed is capable of miracles. To start exercising, set a realistic primary fitness goal, and prioritise it as daily, monthly and lifetime goals. Decide if the exercise is to remain healthy, lose weight, contour the figure, improve cardiovascular status, control blood sugars, normalise blood pressure, for anti anxiety and anti depressant effects, to help work through fatigue or to compete in sports. The effort put in and the training will be different in each case. Targets will never be achieved without setting goals and if there is a tendency to procrastinate. Regular exercise should include a 15-minute warm-up, a one-hour workout and a 10-minute cool-down phase to prevent muscle injury. For the warm-up, do one or two pull-ups, spot jogging, skipping, push-ups and short stepping in place, gradually increasing the pace till sweating starts. Finish the warm-up with stretches. Slowly move the muscles, tendons and ligaments to increase flexibility. Stretch the Achilles tendon. Lunge from side to side and front to back. For each workout, pick and target a specific area that needs improvement. Decide ahead and fix a rotating timetable so that all the major muscle groups are exercised. Muscles accumulate lactic acid during high intensity exercise. This needs to be removed during a 10-minute cool down process that involves walking and stretching. Regular and judicious exercise can delay the onset of diabetes or hypertension by 10-15 years. It also increases breathing capacity and reduces the frequency of wheezing attacks in asthmatics. Body weight remains under control. Bones, muscles and joints stay flexible, reducing the pain of arthritis. Physically active people have better coping skills and are less likely to succumb to anxiety or depression. The feel good factor makes life pleasurable. The sense of achievement boosts morale. This in turn reduces illnesses, medication, the number of visits to the physician and hospitalisations. As you start your exercise programme, remember each year of exercise adds approximately a year of life. 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

free radicals

http://www.telegraphindia.com/1140811/jsp/knowhow/story_18707974.jsp#.U_AbooCSx2A Radical changes Your Health DR GITA MATHAI No one wants to grow old. The body constantly battles against this process. Free radicals are responsible for the changes and shortening of the DNA in our cells, which in turn causes the visible changes of ageing. Free radicals are compounds created when a molecule in our body gains or loses an electron, rendering it unstable. The commonest free radicals are known as ROS (reactive oxygen species). Apart from damaging the DNA, excess free radicals body can harm protein structure and cell membrane. This results in diseases such as arthritis, vasculitis, glomerulonephritis, lupus erythematous, adult respiratory diseases syndrome, emphysema, hemochromatosis, gastric ulcers, hypertension, atherosclerosis, cancer, Parkinson’s disease, Alzheimer’s disease and obesity. Particularly, ROS can fragment atherosclerotic plaques, spreading them all over the body, causing heart attacks and strokes. Atherosclerotic plaques are fatty deposits on the walls of blood vessels that make them narrow. Production of free radicals increases with infection, inflammation and during exercise. It increases exponentially with exposure to environmental pollutants, cigarette smoke, radiation and solvents. Antioxidants act as scavengers, removing the destroyed or fragmented DNA caused by free radicals. These days they are being prescribed as the panacea of all ills. Conditions ranging from poor immunity, male infertility, heart attacks, diabetes, cancer to even ageing are said to benefit from antioxidant supplements. Antioxidants occur in a variety of foods, especially coloured (red, yellow, green, purple) fruits and vegetables. They are not heat stable, so it is better to eat the fruits or vegetables raw. People who eat 4-6 helpings of fruits and vegetables a day have a lower incidence of cancer and live longer. On the other hand, they tend to be health conscious, exercise, have healthier lifestyles and are conscious of body weight. A large amount of ROP is released during exercise. So taking antioxidant supplements should decrease recovery time. A number of studies have demonstrated that this is not the case. Ironically, taking antioxidant supplements actually slows down recovery. Patients with cancer are often advised to take supplements of megavitamins and antioxidants. They may actually be detrimental. High doses of betacarotene increases the risk of lung cancer in smokers. Vitamin E can increase the risk of prostate cancer and high doses of vitamin C the risk of bladder cancer. High-dose supplements of antioxidants are linked to worse cancer outcomes, especially in smokers. Instead of antioxidants, • Invest in a pair of gym shoes • Walk, jog or run 40 minutes a day. • Eat 4-6 helpings of fresh fruit and vegetables a day • Do not smoke or spend time around smokers 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

free radicals

http://www.telegraphindia.com/1140811/jsp/knowhow/story_18707974.jsp#.U-ls5oCSx2A

Radical changes

Your Health DR GITA MATHAI

No one wants to grow old. The body constantly battles against this process. Free radicals are responsible for the changes and shortening of the DNA in our cells, which in turn causes the visible changes of ageing. Free radicals are compounds created when a molecule in our body gains or loses an electron, rendering it unstable. The commonest free radicals are known as ROS (reactive oxygen species). Apart from damaging the DNA, excess free radicals body can harm protein structure and cell membrane. This results in diseases such as arthritis, vasculitis, glomerulonephritis, lupus erythematous, adult respiratory diseases syndrome, emphysema, hemochromatosis, gastric ulcers, hypertension, atherosclerosis, cancer, Parkinson’s disease, Alzheimer’s disease and obesity. Particularly, ROS can fragment atherosclerotic plaques, spreading them all over the body, causing heart attacks and strokes. Atherosclerotic plaques are fatty deposits on the walls of blood vessels that make them narrow. Production of free radicals increases with infection, inflammation and during exercise. It increases exponentially with exposure to environmental pollutants, cigarette smoke, radiation and solvents. Antioxidants act as scavengers, removing the destroyed or fragmented DNA caused by free radicals. These days they are being prescribed as the panacea of all ills. Conditions ranging from poor immunity, male infertility, heart attacks, diabetes, cancer to even ageing are said to benefit from antioxidant supplements. Antioxidants occur in a variety of foods, especially coloured (red, yellow, green, purple) fruits and vegetables. They are not heat stable, so it is better to eat the fruits or vegetables raw. People who eat 4-6 helpings of fruits and vegetables a day have a lower incidence of cancer and live longer. On the other hand, they tend to be health conscious, exercise, have healthier lifestyles and are conscious of body weight. A large amount of ROP is released during exercise. So taking antioxidant supplements should decrease recovery time. A number of studies have demonstrated that this is not the case. Ironically, taking antioxidant supplements actually slows down recovery. Patients with cancer are often advised to take supplements of megavitamins and antioxidants. They may actually be detrimental. High doses of betacarotene increases the risk of lung cancer in smokers. Vitamin E can increase the risk of prostate cancer and high doses of vitamin C the risk of bladder cancer. High-dose supplements of antioxidants are linked to worse cancer outcomes, especially in smokers. Instead of antioxidants, • Invest in a pair of gym shoes • Walk, jog or run 40 minutes a day. • Eat 4-6 helpings of fresh fruit and vegetables a day • Do not smoke or spend time around smokers 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