Set a reminder

http://www.telegraphindia.com/1150601/jsp/knowhow/story_23145.jsp

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Your Health - Dr. Gita Mathai

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I receive many letters from patients distressed over infections of chickenpox, typhoid or jaundice. All these infections are preventable with timely immunisation. If only parents did not forget!

For the first two years of a child's life, forgetting the infants or their needs is difficult. Even their immunisations are a priority both in families and by the government and given automatically on time.

The BCG (Bacillus Calmette-Guérin) is used for the prevention of tuberculosis. It does protect against severe and lethal forms of tuberculosis like meningitis. It has a protective effect against leprosy. Hepatitis B vaccine prevents liver infection, which can be life-threatening. The vaccine is free. One dose is given at birth along with BCG. Repeat injections are given a month and then 4-6 months later. The vaccine prevents infection and the development of chronic liver disease like cirrhosis and cancer. This vaccine can be combined from the second dose onwards with HiB - the vaccine against the bacteria H. Infuenzae (this is not the flu vaccine). This protects the child from meningitis, throat and lung infections. Also combined with HiB is "triple" antigen (DPT). This protects against diphtheria, pertussis and tetanus.

Polio has been eradicated from our country (as per government statistics and WHO certification) since May 2014. This has been achieved through an aggressive free immunisation campaign with OPV (Oral Polio Vaccine) or IPV (Injectable Polio Vaccine). IPV is considered superior, but unlike OPV but is not yet free. Even if the doses are given on schedule, all children under the age of five years should attend mass immunisation campaigns.

Influenza (flu) vaccine has to be taken every year in October after the age of six months. Measles vaccine (also free) is given between the ages of 9-12 months.

At this point, immunisation schedules may start to fall by the wayside. The immunisations are no longer every month so parents do forget. Rotavirus causes severe diarrhoea. Breast-fed babies have some degree of immunity. The vaccine is given by mouth in three doses at two, four and six months of age. Varicella vaccine is given soon after the first birthday with a booster at the age of 10. MMR (measles, mumps and rubella) has to be given at 15 months of age with a booster at 4-5 years.

Typhoid is endemic in India. The vaccine is inexpensive and efficient. It is given after the age of two years with a booster every three years. Now even 97 per cent of cervical cancers can be prevented if HPV (Human Papillomavirus) injections are given between the ages of 9-11.

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/1150525/jsp/knowhow/story_21859.jsp

delhi belly

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Your Health - Dr. Gita Mathai

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India is on the move, professionally and for recreation. Vacations for many no longer mean a visit to the grandparents and the native village. Tours, (in India and abroad), timeshares and exotic holidays are becoming common. The speed of air travel means that no corner of the globe is more than 24 hours away.

While travelling, the intestinal tract has to acclimatise itself with a shift in circadian rhythm (where there is a day night shift due to time differences) and the body clock has to reset. The normal viruses and bacteria present in food and water may be the same species as the ones at home but of different subtypes. The commonest ailment this causes is "traveller's diarrhoea".

In order for motion to be considered diarrhoea, it should be more frequent than normal (more than three times a day) and of a consistency less formed than usual. Diarrhoea may be accompanied by fever, vomiting and abdominal pain. There may be tenesmus - a desire to pass motion constantly even when the rectum is empty. If there is blood and mucous in the motion then it is more likely to be dysentery.

The commonest organism causing travellers diarrhoea is the bacteriaE.coli. The infection is usually acquired as a result of eating raw food (fruits and vegetables) or items which are not piping hot, drinking water or using ice cubes contaminated by bacteria. (Purchased bottled water sometimes may not really be as "pure" as advertised.)

The diarrhoea sets in 3-7 days after the initial exposure. There may be low-grade fever, but the usual symptoms are nausea, bloating, urgency and explosive diarrhoea. The disease is usually self-limiting and subsides on its own in another 3-4 days.

Giardia is another common parasite found all over the world. The symptoms are similar but take longer to set in. The discomfort progressively worsens. Eventually it may become a chronic diarrhoea which persists even after returning home.

Various viruses can also cause diarrhoea. Bacteria belonging to the salmonella or shigella group can also lead to diarrhoea though these infections produce fever and blood in the stool. Amoebae cause long-standing diarrhoea without fever but with tenesmus, abdominal pain, blood and mucous. Untreated, it can become chronic. It can also cause cysts in other organs like the liver.

Diarrhoea can often be treated without going to the hospital by replacing the fluid lost. ORS (oral rehydration solution) can be used as desired after it is reconstituted. In case ORS sachets are not available, homemade solutions of either half a teaspoon of salt and six level teaspoons of sugar dissolved in one litre of safe water, or lightly-salted rice gruel or even sips of plain water can be used. Bananas also help to reduce the frequency of stool. A tablespoon of home made curd on an empty stomach everyday will help to repopulate the intestines with "good" bacteria that fight infective agents. This works in the same way as the expensive sachets of probiotics with minimal expenditure.

Anti-motility agents like lomotil or imodium (lomofen) can reduce the frequency of stool. They do not have any effect on the organism causing the diarrhoea. They can cause bloating of the abdomen in adults. They are contraindicated in children under four years of age.

Diarrhoea needs to be taken seriously and a physician consulted if it persists for two weeks if the heart rate increases, a headache develops urine volume decreases, becomes dark coloured or is not passed at all confusion and disorientation occur there is fever blood is present there is documented weight loss.

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/1150511/jsp/knowhow/story_19277.jsp

Do not sit still

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Your Health - Dr. Gita Mathai

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All age groups should exercise. The minimum recommended varies (depending on different agencies) from 30-40 minutes a day of aerobic activity, 10 minutes of stair climbing to walking at least 10,000 steps a day. At least 400 calories should be expended with each session of exercise. At least once a week, double that (800-1,000 calories) should ideally be used. Unless you are actually training for a sporting event, the exercise can be spaced out during the day and split into multiple sessions.

Despite assiduously following these recommendations, people are often not as fit as expected.
Sitting still at a desk means your lifestyle is sedentary, even if you go to the gym or run. It negates the effects of the activity that you have put in. It is almost as bad as smoking!

The enforced inactivity may be inadvertent in people because their jobs entail sitting down (IT professionals, bankers, corporate employees) or because television sets have gained a stranglehold on lifestyle. As the inactive lifestyle becomes habitual, it becomes easier to telephone co workers or do a computer chat rather than walk a few steps. Many buildings, flats and even private houses have lifts. Climbing up even one flight of steps becomes unnecessary and tedious. Even children may be encouraged to “sit down and watch television” rather than “run around being a nuisance.”

You not only need to exercise but also try to not be sedentary. It often poses a real challenge. Many fit CEOs internationally use the stairs (if they do not have time to go to the gym) even if it means climbing 14 floors in a hotel!

Sitting slows the metabolism. When we sit, the large skeletal muscles in the legs and back are very still. They do not utilise glucose, as they require very little energy to be still. This is why “fidgety” children do not gain weight, even if they eat more than their sedentary, TV-viewing counterparts.

Food eaten is not efficiently utilised. The blood sugars become elevated. The excess sugar is converted to fat. This accumulates in the blood and then gets deposited in other organs such as the liver (fatty liver) and heart. The blood pressure too starts to rise. The risk for diabetes, heart disease and death is elevated by nearly 100 per cent. In short, excessive sitting has strong associations with becoming obese, developing type 2 diabetes and premature death.

Physical activity throughout the day — even simple standing — increases the levels of the body’s own insulin. At the same time, it lowers the levels of biologically available sex hormones. This has a cascading effect and reduces the incidence of cancers of the uterus, ovary, breast and prostrate. The body’s overall immune system improves. This decreases the number of infections and shortens the time spent with illness. The body’s ability to cope is vastly improved.

Exercise has a plateau effect. Those who exercised a little more than an hour a day every day reduced their chance of premature death by 40 per cent. The reduction in mortality and health benefits did not increase at levels of exercise beyond this. The additional hours at the gym or training added no significant benefit unless they were training for competitions. The chances of injury on the other hand almost quadrupled. Everything has to be done in moderation.

Quick look

• The highest risk of early death is in people who do not exercise at all.
• Those who exercised for at least 150 minutes every week (the bare minimum recommended) reduced their risk of dying by 40 per cent compared with those who never exercised.
• Physical inactivity increased the risk of premature death by 7 per cent
• Frank obesity with a BMI greater than 30 increased the risk by 4 per cent. This statistic is independent of other risk factors like sex, education, smoking and alcohol intake.

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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summer RASHES

Summer rashes

http://www.telegraphindia.com/1150504/jsp/knowhow/story_17975.jsp

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Your Health - Dr. Gita Mathai

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Summer means unrelenting sunshine, rising temperatures, power cuts and sweating. The sweat pours down our face and our bodies. It carries dead cells and bacteria with it. These can enter pores in the skin and block them. As more sweat forms, it is unable to escape onto the surface of the skin. It gets trapped and forms bumps (prickly heat) under the skin.

Prickly heat or miliria (as it is scientifically known) can be mild and confined to the surface of the skin. These bumps and blisters are filled with clear fluid. If the sweat glands deeper down are blocked, the little bumps may be red in colour. They can itch and the whole skin may have a pricking feeling.

Prickly heat usually subsides if left alone. Friction from clothing and rubbing and scratching for relief may cause the rash to become secondarily infected. The rashes then look like pustules. There may be fever. The local lymph nodes may be enlarged.

It is possible to control and treat prickly heat at home. Water and soap can be used to wash off dead cells and sweat - and to cool the body. Take a mild, non irritating soap and apply it on a wet face towel or a loofah. Use it to lather the body, do not use the soap directly. Bathe twice a day.

Wear clothes made of cotton or a mixture of 60 per cent cotton and 40 per cent polyester. Wear clothes made of the newer cotton wicking material during exercising. Avoid wearing synthetic clothes as far as possible.

Talcum powder is very popular as a "cure" for prickly heat but contrary to the advertisements on TV, (where miraculous relief occurs in seconds), it actually aggravates prickly heat.

Talc is made up of finely powdered zinc stearate, silicates and perfume additives. The fine particles block the skin pores. Heat causes sweating. The blocked pores cannot release the sweat. It builds up in the sweat glands. This aggravates the prickly heat.

Talc causes other medical problems as well. Inhaling the air-borne particles of talc can cause inflammation and swelling of the airways. Eventually it can cause a type of aspiration pneumonia. Long-term treatment may be needed. Aspiration can be fatal in babies and young children.

And there is no such thing as "baby powder".

IF YOU HAVE PRICKLY HEAT:

•  Stay indoors between 10am and 6pm. Ifyou must go out, wear a cap or carry an umbrella. Stay away from the direct heat of the sun as far as possible.
• Wear loose and airy cotton clothes.
• Do not scratch. Prickly heat causes an overwhelming desire to scratch. The more you scratch the more it will itch.
• Take a mild antihistamine after con sulting your physician.
• Do not apply oil-based creams or ointments. They will only block the pores and aggravate the condition.
• Bathe two or three times a day in tepid water. Add a teaspoon of sodium bicarbonate and a teaspoon of salt to a bucket of water before bathing.
• Use soap containing trichlorhexi- dine (Dial, Neko) or a mild, non-irritating soap.
• Do not apply soap directly to the skin. Use a moist piece of towelling, a herbal scrubber or a loofah.
• Lightly moisturise the itchy skin with baby oil or a water-based aloe vera lotion.
• If prickly heat becomes red or yellow and pustular, changes appearance, or if the temperature rises, consult a doctor immediately.

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

typhoid

Every year, approximately 20 million cases of typhoid fever, and its milder version paratyphoid, occur in World Health Organisation's South East Asia region, which includes India. This results in around a million deaths. The exact Indian statistics are unknown. Although the disease is supposed to be notified to relevant government health authorities when it occurs, this seldom happens. Our illnesses are treated by a plethora of private practitioners of various systems of medicine, with very little networking or government supervision.

This is in stark contrast to the US, which has around 400 cases annually (mostly imported). Even a century ago, the US public health system was very active and backed to the hilt by the police. In 1860, the US had an asymptomatic typhoid carrier nicknamed "typhoid Mary" (actual name: Mary Mallory). She worked in several places as a cook. She did not wash her hands frequently and consequently managed to infect several hundred people and kill 50. She was tracked down and quarantined for more than 20 years till her death. In India, cooks and other labour are unregulated. They do not undergo regular health checkups. Unauthorised food stalls dot the countryside. The servers seldom wear gloves, nor do they wash hands frequently.

Typhoid and paratyphoid bacteria are ingested with contaminated food and water. (Ice cream and cream cakes are notorious). It takes one to three weeks for the symptoms of fatigue, headache, loss of appetite, diarrhoea, a red rash and fever (which starts at around 100°F and then increases to 102°F-104°F) to appear. Complications like intestinal bleeding and perforation occur in the second or third week. (This accounts for the age-old habit of keeping people with fever on a soft and bland diet.)

A history of risk of infection and a gradual onset of fever that increases in severity raise the suspicion of typhoid or paratyphoid fever if the symptoms mentioned earlier are present. Infection with typhoid or paratyphoid fever causes very low-grade septicemia. A single blood culture is positive in only half the cases. Bone marrow culture is positive in about 80 per cent of the cases. Stool and urine cultures become positive later.

Popular tests like the Widal test are unreliable. It can be negative in up to 30 per cent of culture-proven cases of typhoid fever. It can give false positive results if the infection is due to other gram negative organisms, or malaria, typhus or medical conditions like liver cirrhosis. Two blood samples taken a week apart showing a rising Widal titer are more reliable. The newer "Typhidot" tests are more accurate, but need to be done a minimum of five days after the onset of the fever. This is to allow antibodies time to develop.

Typhoid can be treated with a wide range of newer antibiotics. Choloromycetin, the antibiotic widely used earlier, is not popular now as it not only has dangerous side effects but many typhoid bacteria are also resistant to it. Treatment should be continued for 10-14 days and not stopped when the patient is symptomatically better.

After apparent recovery, some people harbour typhoid bacteria in their gall bladder, intestines or kidney. They do not have fever, but continue to shed bacteria in their motion and urine. They are a danger to others as they spread the disease far and wide.

Typhoid can be prevented with immunisation. Both injectable and oral forms of vaccine are available and can be taken after the age of two. Vaccination has to be repeated every three years since immunity wanes after that time.

To protect yourself against food borne diseases like typhoid:

• Drink only boiled or bottled water.
• Do not put ice into drinks unless the ice is made from boiled or mineral water.
• If you eat street food, avoid raw fruits and vegetables
• Eat food that has been thoroughly cooked and is steaming hot

Immunise yourself and your family. The vaccine costs less than Rs 500.

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

http://www.telegraphindia.com/1150413/jsp/knowhow/story_14181.jsp

Complete course to cure TB

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Your Health - Dr. Gita Mathai

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March 24 was world tuberculosis (TB) day. Our country has 2.2 million cases of TB out of a global incidence of 8.7 million. The problem in India is compounded by irresponsible individuals who are irregular with treatment or discontinue it. This eventually results in the spread of TB bacteria that are resistant to standard inexpensive medication.

TB is caused by Mycobacterium tuberculosis. It is acquired when a person with lung tuberculosis coughs or spits out bacteria-laden sputum. Once the bacteria is inhaled or ingested, it spreads via blood. It can lodge itself in any organ - lungs, liver, kidney, lymph nodes, gastrointestinal tract, genitourinary tract, nervous system and even the eye. It can cause active infection immediately or remain dormant for a lifetime (latent TB). It can get reactivated, especially if immunity falls owing to other illnesses such as HIV infection, diabetes or cancer.

The symptoms of TB are often vague. There may be low-grade fever (especially in the evenings), sweating, weight loss and a cough, which lasts three weeks or more. There may also be blood-stained sputum or urine, white discharge, diarrhoea, lumps and bumps, enlarged lymph nodes and bony swellings, depending on the organ affected. All these signs and symptoms can occur with other diseases. Lumps may be due to tumour, fever may be due to other infections, and blood-stained sputum can occur in pneumonia, lung abscess or cancer.

If there is blood-stained sputum, it can be examined for TB bacteria. A positive result means that there is TB infection in the lungs. A negative result does not rule it out. The test needs to be repeated at least twice more. TB bacteria from the lungs can be swallowed during sleep. This can be tested by inserting a tube into the stomach and checking the early morning aspirate. Lumps and bumps can be biopsied. The diagnosis may be suspected by the appearance of the affected organs on X-rays or scans.

A skin (Mantoux) test can be done, wherein a small dose of PPD (purified protein derivative) is injected in the skin of the forearm. It is measured 48 to 72 hours later. A negative result does not rule out TB as the test may have been done too early in the disease (before immunity develops), the person may be immuno-compromised or on steroids. Other blood tests are also available like QuantiFERON-TB Gold in-Tube test and T-Spot test. They can also give false positive or negative results.

Once the diagnosis is reached, treatment is started. The duration may be anywhere from six months to one and half years depending on the site (lymph node disease requires shorter treatment whereas that in bone and meninges require longer treatment), the extent of disease, the severity and the response.

Initially, a combination of four first line drugs - Isoniazid, Rifampicin, Pyrazinamide, Ethambutol - and sometimes Streptomycin is used. After some months, the number of drugs (not the dosage) is reduced. Rifampicin needs to be taken on an empty stomach. It can colour the urine and sweat reddish-yellow.

These drugs can be purchased with prescriptions but free treatment is also provided by the government. Patients can opt for whatever suits them personally and financially.

Treatment is complicated by the fact that the bacteria multiplies slowly. If the drug dosage is inadequate or irregular, the bacteria becomes resistant and thrives even with continued administration of medication. Drug-resistant bacteria then develop which have to be treated with expensive second line medication. These unresponsive bacteria can spread in the community.

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

10,000 steps a day keep diabetes away

http://www.telegraphindia.com/1150330/jsp/knowhow/story_11485.jsp

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Your Health - Dr. Gita Mathai

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India has around 70 million diabetics and the number is increasing every day. The disease occurs when the body is not able to keep blood sugar in the normal range. Diabetes is suspected if the blood glucose level is 126 milligrams per decilitre (mg/dL) after an overnight fast, non-fasting glucose level (random) is greater than 200 mg/dL or glucose level is greater than 200 mg/dL two hours after a meal.

The level of glucose in blood is maintained in the normal range by a hormone called insulin, produced by islet cells in the pancreas. Diabetes occurs when there is an absence or relative lack of insulin or if there is peripheral resistance to its action. An absolute lack of insulin occurs if the islet cells are absent or destroyed. This means that insulin has to be externally supplied as injections. A relative lack of insulin is more common; 95 per cent of diabetics fall in this category.

Diabetes is more likely to occur with increasing age; 45 was considered a magic number, with a dramatic increase in the incidence of diabetes after this age. This may be due to a propensity to "settle into prosperous middle age" at this time with an increasingly sedentary lifestyle and over eating.

Resistance to the action of insulin occurs with an increase in the number and size of fat cells. To diagnose obesity, the BMI (weight divided by height in metres squared) should be less than 30, the waist circumference less than 40 inches in men and 34.5 in women, the waist:hip ratio less than 0.9 for men and 0.85 for women.

The tendency to obesity sets in at a young age. Many children do not have the compulsory hour of physical activity daily. Computer games and television occupy their time instead. Weight climbs up and many are frankly obese by the time they are teenagers. As a result of this, diabetes increasingly occurs in adolescents and young adults in their twenties and early thirties as MODY (Maturity Onset Diabetes of the Young).

If one parent has type 2 diabetes, the risk of the offspring getting diabetes is 1 in 7. A mother with type 2 diabetes is more likely to pass it on to her offspring than a father. If both parents are diabetic, the chances of the child eventually developing the disease is 50 per cent.

The environment in which the child grows up can explain much of this. Diabetes is more likely to manifest itself if the family is sedentary, obese and overeats, with unhealthy food habits and a propensity for fat-laden processed or fast food. Mothers usually influence food habits a great deal more than fathers.

High blood pressure is linked to diabetes. A person with one disease often gets the other within a few years. Dyslipidemia - with elevated lipids and an abnormal lipid profile - also increases the risk of diabetes. All the three are linked and this group of biochemical abnormalities is called the "metabolic syndrome X." Unless steps are taken to correct these biochemical abnormalities, diabetes can eventually occur.

Women with PCOS (polycystic ovarian syndrome) often have all the abnormalities of metabolic syndrome X. They also have insulin resistance and obesity. Unless intervention (diet, exercise, metformin) occurs, 50 per cent go on to develop diabetes.

Pregnancy can precipitate a type of diabetes called "gestational diabetes" in a predisposed individual. The sugars usually return to normal values after the delivery. Diabetes may develop a few years later if obesity occurs.

Diet plays a very important role in the control of diabetes. Calories have to be restricted to 1500 or 1800 a day, depending on the level of exercise. Foods have a glycaemic index or GI, which measures how a carbohydrate-containing food raises blood glucose. Food is ranked on the GI scale from 0-100. The glycaemic index of a particular food can be found on the Internet. Food with a high GI raises blood glucose more than food with a medium or low GI. Foods with a low GI include legumes, all non-starchy vegetables, sweet potatoes, most fruit, long grained brown or red rice, and whole grain rotis.

To control diabetes and delay its onset, combine diet with exercise for an hour a day, either at a single go or split into two sessions, or cover 10,000 steps a day.

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