http://www.telegraphindia.com/1150309/jsp/knowhow/story_7506.jsp

Beat stress

---

Your Health - Dr. Gita Mathai

---

• 

Life in urban India is stressful. Something as simple as commuting means dealing with vehicles crawling along at a snail’s pace. Quite often drivers “loose it.” They honk, shout at each other and sometimes drive recklessly.

“Traffic stress” is a recent phenomenon. It can be uncontrollable anger with illogical actions, called the intermittent explosive disorder. It can manifest itself as a panic-stricken desire to get out of the traffic jam at whatever cost, even if it means going the wrong way and snarling up the traffic further. Both reactions can result in rapid heart rates and sweating.

Exposure to traffic pollution causes a build up of carbon monoxide in the body. This reduces the brain’s oxygen carrying capacity. The higher functions of the brain like logic and decision making are affected. Even personalities can change!
Even in areas without much air pollution, people face stress. By middle school, a child is under parental and peer pressure to perform well. Teenagers are under stress to conform. Adults have pressures of work, finance and family interactions. Life has never been less peaceful!

As soon as stress sets in, alarm bells go off in the hypothalamus area of the brain. It responds instantaneously with nerve and hormonal signals to other areas of the body. The levels of the stress chemicals adrenaline and cortisol escalate. The heart rate rises, sweating occurs and blood sugar levels climb, readying the body for defensive action.
This natural alarm system also communicates with regions of the brain that control mood, motivation and fear. This should be a temporary reaction, say when there is a sudden sound such as firecrackers. If the stress is chronic and there is sustained reaction from the emergency system, the elevated hormone and chemical levels have deleterious effects on the body.

There may be constant anxiety, depression, irritability, anger, insomnia, fatigue, vague chest pains, digestive problems and lack of motivation. Unconsciously, the body may attempt to counter these problems. Smoking or chewing tobacco, alcohol abuse or using “sleeping tablets” may appear to alleviate the stress temporarily. All these have addictive potential and long-term, harmful effects on health. They are not a solution.

The important thing is not to let stress take over your life. Having a conversation about stressors to relatives, friends and colleagues often helps. When problems are voiced out loud, they do not seem so bad.
Medication should be a last resort. Sleeping tablets and anti anxiolytics should be taken only with a prescription and under supervision. Medication should not be continued long-term.

Avoid confrontation and situations precipitating stress. If a relative or colleague constantly raises your blood pressure it is better to avoid them as far as possible.

Eat balanced meals on time. Overindulgence in snacks, fried or fat laden food or chocolates and ice cream is a recipe for disaster. There is an increase in the level of the “feel good” chemicals but the effect is short-lived. As the chemicals (endorphins) are metabolised, their levels fall below normal, causing a release of stress-producing chemicals and hormones.

Leave early for work. This way you might avoid the crowded public transportation system and traffic jams. You might arrive at work more relaxed. If long lines or slow service in restaurants and cafeterias are irritating, consider packing a light lunch and carrying it with you. Studies have shown that a 20-30 minute stroll during the lunch hour goes a long way to reducing workplace stress. (It also boosts energy and reduces drowsiness.)

Exercise religiously for 40 minutes every day, preferably in the open. Fresh air washes out the carbon dioxide from your body, so parks or other unpolluted areas are preferable to air-conditioned gyms.

Yoga is a great stress buster. The simple stretches will keep your body supple and fit. The meditation will calm your brain and help you face life head on.

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

Flu guard

http://www.telegraphindia.com/1150302/jsp/knowhow/story_6392.jsp

---

Your Health - Dr. Gita Mathai

---

• 

Pandemics (diseases that do not recognise geographic or political boundaries) affect people all over the world. There have been pandemics of influenza (the most recent being the swine flu epidemic), measles and plague at various times in history. An epidemic, on the other hand, is said to occur when a large number of people in a given area are affected in a short space of time (two weeks). Common epidemics are colds, conjunctivitis and, the most lethal in recent times, the SARS (Severe Respiratory Distress Syndrome) outbreak. Endemic diseases like malaria simmer constantly in the population in Africa and India, with some people affected all the time.

There appears to be a swine flu epidemic in India at present. The virus is an unusually virulent, mutated form of the original H1N1 swine flu virus. It is believed to have combined with the bird flu (avian) virus and other human influenza strains.

The flu season starts around October. It lasts till March. Immunisation is available against flu. It is safe. It can be given after the age of six months to children, adults, pregnant women and senior citizens. Immunity levels rise after two weeks and lasts six to eight months. This means re-vaccination has to be done every year in October. Even if you do get the disease after immunisation, it is likely to be mild and not fatal.

We should also follow basic hygiene techniques like coughing or sneezing only into a handkerchief, or into the crook of the elbow, and washing hands frequently. A face mask is more likely to prevent you from infecting others and not vice versa.

Infectious diseases, both bacterial and viral, can be prevented by timely immunisation. At birth, BCG is given. Even though it does not protect against all tuberculosis it does shield against the more lethal forms like tuberculosis meningitis.

The triple antigen DPT (diphtheria-pertussis-tetanus) vaccine can be combined with OPV (oral polio vaccine) or IPV (injectable polio vaccine), Hib (H. Influenzae, not flu), Hepatitis B, and pneumococcal vaccine. It is given three times in the first year and then boosters (DPT/OPV/IPV alone) are given at the age of one and a half years and five years. Further boosters against diphtheria and tetanus (dT or dual antigen) have to be given at the age of 10 and 16 years.

Rotavirus causes dangerous child diarrhoea. Immunisation can be given after the age of two months.

A measles shot is first given at the age of 10 months. The immunity rapidly wanes. It is combined with mumps and rubella vaccines as MMR. The first dose of MMR is given at 15 months and a booster at 4-5 years. The chicken pox vaccine should be given at 13-15 months of age. A booster can be given at 4-5 years of age.

The hepatitis A vaccine, given as two doses six months apart after the age of 18 months, provides lifetime immunity. After the age of nine children (especially girls) should be immunised against HPV (human papillovirus), responsible for cervical cancer.

Much of the spread of swine flu could have been prevented if Indians had immunised themselves in October 2014. Don't forget to do so in 2015.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in

tired feelings

That tired feeling

---

Your Health - Dr. Gita Mathai

http://www.telegraphindia.com/1150216/jsp/knowhow/story_3515.jsp

---

• 

"I feel tired/weak/lethargic, I cannot work." People of all ages and both sexes often voice this complaint. They ask for tonics, vitamin pills, energy drinks - any sort of "pick me up" that will help them go about their work to efficiently.

Fatigue is incapacitating when it lasts longer than a few days, occurs frequently or is continuous. Sleep in these cases is non-refreshing.

Sometimes our muscles refuse to obey our commands to perform optimally. This is physical fatigue. It occurs because movement causes the gradual build up of a neurotransmitter called serotonin. How fast it accumulates and how tired you feel depends on your age and overall health. A physically fit person, irrespective of age, is able to metabolise and remove serotonin rapidly. They can work "against fatigue," and recovery is rapid.

Sleep is essential for the body to restore itself. Inadequate, disturbed sleep, episodes of snoring or sleep apnoea, leave us in a permanent state of tiredness.

Drinking coffee, smoking, or having glucose or energy drinks provide a temporary boost in energy levels. Once the effect wears off, however, the dip in energy levels is even greater.

Mental fatigue occurs because of alterations in the ratio of neurotransmitters in the RAS (reticulo activation system) in the brain. It may be because of long hours at work, depression or boredom. Overstimulation of the brain can cause rapid depletion of essential neurotransmitters. This is seen with constant television viewing or computer game playing. If the brain does not have a chance to rejuvenate owing to inadequate sleep, this leads to constant fatigue. Mental laziness, in which the brain is not used regularly at least to partial capacity, results in inefficiency in the release and metabolism of neurotransmitters. This also causes long- standing fatigue.

If you are suffering from fatigue, first figure out if it is due to the lifestyle you have. Nicotine use or medication such as anti histamines, cold and cough tablets or syrups, sleeping pills and anti depressives, can cause fatigue. Too much or too little exercise too can cause tiredness. Stress or depression can also reduce energy levels.

Medical conditions can cause fatigue, but other symptoms are usually present to help make the diagnosis. Tests need to be done to rule out disorders such as anaemia (very common in India), vitamin deficiencies (particularly D3), diabetes, liver diseases (including hepatitis B infection) kidney disease, lung diseases like emphysema and chronic obstructive airways disease, heart failure, thyroid disorders, fatigue from chronic illnesses like auto immune disease or cancer. Obesity also causes tiredness, probably from the effort of carrying around so much weight!

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

period problems

Period problemshttp://www.telegraphindia.com/1150119/jsp/knowhow/story_9008.jsp

---

Your Health - Dr. Gita Mathai

---

• 

What is the actual difference between men and women? Women can produce babies while men cannot. For this, women have a uterus and two ovaries. Although these are present from birth, they start to function at a certain age called "menarche," when menstrual bleeding or the periodic shedding of the lining of the uterus sets in.

The age of menarche varies from nine to 15 years. It depends on genetics, nutrition, environment, physical activity and body weight. Usually the BMI needs to be above 18.5, with around 15-20 per cent body fat, for menarche to occur. It is brought about by the shedding of the thickened uterine lining in response to fluctuation in levels of oestrogen and progesterone hormones. Delayed menarche may occur in families where many members mature late. Investigations may be needed if menarche does not occur after 15-16 years.

The menstrual cycle can vary in length from 21 to 35 days. The cycles may be irregular in the first year after menarche and one or two years before menopause. The bleeding usually last 3-7 days. Total blood lost is 50-60ml and requires the use of one or one and a half packets of sanitary napkins.

At any age, the commonest reason for a missed period is pregnancy. It can occur soon after childbirth and also while breast feeding without menstruation having occurred. Childbirth and breast feeding can delay periods and make them irregular.

PCOS (polycystic ovarian syndrome) occurs in almost 60 per cent women of childbearing age. Cycles are unpredictable. The periods do not appear for months on end unless medication is taken. Once bleeding sets in, it does not stop without treatment.

Athletes, women who exercise rigorously (6-7 hours a day), diet excessively and achieve extreme weight loss can have scanty, infrequent periods. The ovaries can fail gradually at a young age. Periods become scanty and may suddenly stop before the age of 40. Usually no reason can be found and this is termed "primary ovarian failure."

Uterine fibroids, ovarian cysts, endometriosis, pelvic inflammation or cancer can cause irregular, excessive bleeding.

If there has been no menstruation for three months and the pregnancy test is negative, if the flow is excessive, if there is abdominal pain, or it is associated with fever, consult a gynaecologist.

A pelvic examination and an ultrasound scan helps to make a diagnosis. Menstrual irregularities can be a reflection of a problem elsewhere in the body; thyroid function tests may be required and pituitary hormone levels may need to be estimated.

OCP (oral contraceptive pills) or progesterone only pills are usually prescribed to regularise the cycle and reduce bleeding. Correction of any underlying disease with appropriate therapy may control the problem. Surgery may be required for cysts, fibroids and other tumours.

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

Happy New Year

http://www.telegraphindia.com/1150105/jsp/knowhow/story_6661.jsp

---

Your Health - Dr. Gita Mathai

---

• 

New Year is the time for making resolutions. Almost every individual is declaring his or her decision to lose weight, keep diseases such as diabetes under control, reduce stress, exercise, give up cigarettes or alcohol and so on. Everyone is eager to change for the better and happy to believe that bad habits - cultivated over years - will magically disappear.

In reality, fewer than eight per cent of these people will manage to keep their promises for longer than a month. A week has already passed and many may have already forgotten their declarations.

However, you can take some simple steps to ensure this does not happen. One, resolutions must be reinforced on the smart phone, computer or written in a diary. Also, they are more likely to succeed if family or friends keep an eye out for success or failure. But most important, resolutions have to be realistic, thought out and well-planned.

I will lose weight

A good decision by itself but more likely to succeed if interspersed with: "I am going to lose 2kg a month and reach my ideal body weight by 2016." Ideal body weight is calculated by multiplying the height in metre squared by 23. Weight must be taken weekly (not every day), and a daily diary maintained of all the food, fruits, snacks and beverages consumed. Calories in Indian foods can be read off the packaging or found on the Internet. A calorie deficit of 3,500 leads to a weight loss of 2.2kg. Avoiding sweets, snacks and cola drinks is important.

I will quit smoking, alcohol

You need the help and support of family and friends, and a confessional visit to a physician. You need to set a date and probably quit cold turkey. It will be hard, so give a yourself a week to overcome cravings, tremors and sleeplessness. It will be worth it.

I will exercise

An hour of aerobic activity keeps you physically fit as well as delaying the onset of diabetes, hypertension and heart disease. It even reduces the incidence of cancer, Alzheimer's, dementia and other degenerative diseases. It prevents loss of essential muscle mass, and improves posture and balance. Most activity burns between 300 and 400 calories an hour depending on the intensity. Stair climbing is excellent as it burns about 1,000 calories an hour. Remember that aerobic activity must be combined with stretches to prevent damage to muscles. Even if you cheat on the stretches before exercise, the ones after should not be missed.

About 10,000 steps a day is the minimum amount you must walk. This can be measured with a small device called a pedometer strapped to your waist.

If you spend much of your time sitting, improve fitness by standing as much as possible. The height of your worktable can be altered for this. Otherwise slouching, stooping or craning the neck will produce other aches and pains.

You can use an exercise cycle while watching TV. Otherwise, just stand and watch and tell your children to do the same.

Consistency is the key. Try to exercise every day. Then you will probably manage 5-6 days a week. If you plan an off day, unexpected impediments will further reduce the frequency. If you miss three days in a row, much of the muscle conditioning is lost. It is almost like starting from the beginning!

I will reduce stress

The 21st century is full of stress - at home, in the workplace, regarding finances and family members. Much of this cannot be removed. But stress can be tackled, so that it does not cause insomnia or precipitate diseases like high blood pressure. Regular yoga and meditation will help you reach a state where these pinpricks of life are no longer relevant in the larger scheme of things.

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

---

BharatMatrimony - the gateway to happy marriages. Register 

tackling pain

What a pain! http://www.telegraphindia.com/1141229/jsp/knowhow/story_5590.jsp

---

Your Health - Dr. Gita Mathai

---

• 

Everyone feels pain at some point in their lives. Unfortunately, there is no machine to objectively assess pain. Physicians have to rely on what the patient says. Sensitivity to pain varies - acute pain may make a person only grit her teeth and wince whereas the same injury can produce "severe, unbearable pain" with weeping and wailing in others.

Pain forces a person to take notice of a body part they had probably taken for granted. This is particularly true of acute pain such as a toothache, sinusitis, appendicitis or urinary tract infection.

Our bodies are plentifully supplied with "nociceptors" in the skin, bones, muscles and internal organs. Noxious stimuli, (either injury or infection) activates them. They release electrical currents and biochemical agents. These travel along the nerves, up the spinal cord and eventually reach certain areas in the brain. The reaction occurs in a flash and the perception of pain is instantaneous.

A number of medications can be used to treat acute pain. Many of these are available OTC (over the counter). Commonly used medication is paracetemol (10 mg /kg/dose in children 500 mg per dose in adults). It can be repeated every four hours. Paracetemol helps with fever as well, so if the aches and pains are due to seasonal flu, there is rapid improvement. It also blocks the areas of the brain that recognise pain. NSAIDs (non steroidal anti inflammatory drugs) like ibuprofen (Brufen) and nalidixic acid relieve pain but do not have much effect on fever. They act by blocking prostaglandin, one of the chemicals responsible for feeling pain. Topical anti-inflammatory medications, particularly those containing capsaicin are very effective. They should be applied lightly over the painful area followed by an ice pack.

Pain is chronic if it lasts for more than six weeks. It may be due to a simple, correctable cause. Wearing flip-flops while walking for long periods of time can cause heel pain. Speaking on a cell phone wedged between your shoulder and ear causes neck pain and headaches. Playing computer games on cell phones also causes neck pain. Frequent texting causes pain in the thumbs. Long-term computer use causes pain in the wrist.

More often chronic pain is due to the various types of arthritis (rheumatoid, osteoarthritis), autoimmune diseases, gout and mechanical problems like a disc prolapse. It needs to be diagnosed correctly so that appropriate treatment can be started. The medications taken may be steroids, opiods or the coxib group of drugs.

The brain has to be retrained in its perception and response to pain. This can be done with a combination of physiotherapy and aerobic exercise. Judiciously used, these interventions help to reduce long-term dependence on pain medication.

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

blue light

http://www.telegraphindia.com/1141215/jsp/knowhow/story_3630.jsp

• Clear bedrooms of electronic clutter and blue light. This includes digital alarm clocks, televisions, computers and cell phones.
•  If a night light is needed, use a red bulb.
•  Do not use in-ear earphones at high volume for long periods of time. Do not give them to children.
•  Do not use cell phones when the charge is dying or for hours at a time or if the signal is weak.
•  Let your fingers do the talking. Texting is safer than calling.
•  Do not let toddlers play with cellphones.

My child" (all of two years) said the mother, "is so smart! She knows how to operate the cell phone. She listens to songs. She even works the TV remote."

Other parents bring their children for consultations, complaining about poor school performance, an inability to recall what has been taught in school or revised at home. On enquiry, they appeared to eat their meals in front of the television and some even do their homework there! The television is never switched off, at least not until the last member of the family finally goes to bed. The problem is compounded if there are olders in the house who do not understand why they need to curtail their television viewing for the sake of the children.

The television emits "blue" light with a wavelength of 475 nm when it is on. During the day, this spectrum stimulates the brain. We remain awake, alert and active. At night, in nature there is no light, so our brains are able to wind down and we sleep. Our brains work in a circadian rhythm, an approximately 24-hour regular sleep-wake pattern.

A chemical called melatonin is secreted in the brain during darkness. It helps us sleep and allows the brain to rejuvenate itself. Any light at night disrupts this process. Blue light is particularly disruptive. It can be from televisions, phone chargers, cell phone messages, computer screens and even low wattage energy efficient lighting. Some studies have shown a link between constant exposure to blue light and cancer, especially that of the breast and prostrate.

Also, the images on television are not really free flowing. They are actually rapidly moving "stop and start" static images. The rapid-fire transmission makes it impossible for our brains to process it making the movement appear fluid. Many brain chemicals get depleted during this process, making the brain tired. Children who watch more than an hour of television a day find concentration and mental recall difficult because of this. They also become irritable, adamant and perform poorly in school.

Where would we be without cellphones? Everyone (even children) have them cradled close to their heads. Cell phones and even cordless phones emit radiation. Although no positive correlation has as yet been made with brain cancer, many advisories advocate no cellphone use before the age of 20, no more than 20 minutes at a time continuous usage and no usage in areas where the signal is weak (the phone emits more radiation as it attempts to connect).

Children under the age of two should be kept away from cell phones. Radiation is emitted up to six inches from the phone even when it is off. They should definitely not be encouraged to use it, play games on it or listen to music. The surface of the cell phone is also highly contaminated with disease-causing bacteria. This can result in respiratory and skin infections.

Earphones can damage our ears and cause progressive hearing loss. This is particularly the case of "in-ear" buds. The over the ear headphones are safer. Special earphones are now made for children. These cannot be used above a certain volume.

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