ovarian cysts

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http://www.telegraphindia.com/1150706/jsp/knowhow/story_29721.jsp

Your Health - Dr. Gita Mathai

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Around 15 per cent of women all over the world develop ovarian cysts. These may be a "one off" occurrence, recurrent benign follicular cysts that occur with menstruation, part of the polycystic ovarian syndrome (PCOS) or ovarian cancer. About three per cent of cancers in women arise from the ovary.

The ovaries are paired organs situated on either side of the uterus. They are present from birth. They have tiny black speckles, which are the millions of immature eggs. They remain dormant and start to function only at puberty, under the influence of hormones released by the pituitary gland in the brain. One mature egg is released every month from one ovary. The area from which the egg is released usually collapses and seals itself off.

Sometimes, the follicle doesn't rupture properly or seal itself off. The ruptured follicle releases hormones for conception. These accumulate, the follicle keeps growing and forms a corpus luteum cyst. Sometimes it just grows and turns into a follicular cyst. These two types of cysts are harmless and asymptomatic. They are usually discovered incidentally during an ultrasound examination. They disappear by themselves after two or three menstrual cycles.

About 15 per cent of women of child-bearing age have PCOS. They suffer from hormonal imbalances as a result of which multiple immature follicles or cysts form in the ovaries. Menstruation becomes irregular with periods that won't start or won't stop. They also fail to conceive. The diagnosis is confirmed with an ultrasound of the pelvis, which show 12 or more cysts in each ovary.

Such cysts can be treated for 3-6 cycles with oral contraceptive pills. In PCOS they regularise the cycle. Loss of as little as 10 per cent of body weight can result in spontaneous remission of menstrual symptoms. The anti diabetic medication metformin also helps.

Some cysts have no correlation with the menstrual cycle. Of these, dermoid cysts can grow to a large size and contain hair and teeth. Cystadenomas are filled with watery or mucous like material. They can also painlessly grow to a large size before they are noticed. These can become cancerous. The endometrium (lining of the uterus) can grow outside the uterus and attach itself to the ovary, forming a tumour- like mass. This can increase in size with each menstrual cycle.

An ovarian cyst causes symptoms if it is large, visibly distends the abdomen and presses on other organs. It can cause dull lower abdominal pain, dyspareunia (painful intercourse), a desire to urinate frequently or pain during bowel movements.

Once an ovarian cyst is discovered, a pregnancy test needs to be done to see if it is a complication of pregnancy. An ultrasound will help to distinguish between a functional cyst and other types. An ultrasound, CT or MRI scan may be followed by laparoscopic visualisation of the cyst. A blood test called the CA125 is done. Normal values are less than 35 U/mL. Elevated values means that the ovarian cyst has to be further evaluated as it may be malignant.

Once an ovarian cyst is discovered, if there is sudden severe abdominal pain, fever, vomiting, cold clammy skin and sweating, you need to go to a hospital at once.

Ovarian cysts can vary in size from 1cm to 10cm or more. Cysts need to be operated if they are of mixed consistency, larger than 5cm, the CA 125 is elevated or there is a family history of breast or ovarian cancer. Laparoscopic surgery can be done for simple cysts. If there is a suspicion of malignancy, open surgery is preferred.

Pregnancy and breast feeding lessen the chance of ovarian cysts and cancer. Both tubectomy and OCP use for family planning also reduce the risk of ovarian cancer.

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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old age

http://www.telegraphindia.com/1150622/jsp/knowhow/story_26985.jspOld and wise

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Your Health - Dr. Gita Mathai

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Life expectancy in India has now reached 66 years. This is around 10 years less than in China and the US. If you are educated, financially stable, do not have a life threatening infection (septicaemia, brain fever) or a chronic lifestyle illness, are not exposed to physical violence, unregulated traffic and war, you can probably — irrespective of your nationality — expect to live to 85. Living beyond that involves a combination of genetics and lifestyle factors.

Our national policy of retiring at 60 is counterproductive. It hastens aging, illness and death. Retirement should be the start of a second life on your own terms, without the constraints of finances and family responsibilities. Those who live to be a hundred are alike in many respects, even when their race or sex differs.

They do nothing to excess: they may have the occasional drink or cigar, but these habits that have taken over their lives. They avoid “killers” like chewing tobacco, snuff, gutka or betel leaves. They eat well, but only till they are three-fourths full. They have 8-10 helpings of fruit and vegetables a day. Their carbohydrates tend to be fibre filled. They stick to water and fresh juice and avoid carbonated beverages. They eat fish and chicken, but their consumption of dairy foods and red meat is comparatively less.

Teeth should be brushed twice a day and flossing should be done regularly too. The mouth should be thoroughly rinsed after eating.

Longevity requires a positive attitude to life. Companionship extends the life span. It can be found with a spouse, friends or family. Having a social life is important. Religion and meditation provide comfort, hope and mental recuperation.

Centenarians remain intellectually active, keeping abreast with the times. Solving puzzles, doing Sudoku, crosswords or scrabble has benefits. Just solving one puzzle a week is enough to keep the brain stimulated and active.

Health requires both mental and physical activity. This does not necessarily mean going to the gym or running a marathon. It can be 15-minute bursts of activity interspersed throughout the day, or standing and walking instead of sitting.

Brain cells recuperate during sleep. This should be natural and stress-free. This means no sleeping pills and waking up without alarms.

Pollution destroys brain cells. People who live in the countryside have longer and healthier lives. Pollution can be transported to the place of residence though, (even in the countryside) particularly if you or people around you smoke, use wood fires, agarbattis or vapourising mosquito repellents. It can be reduced by having indoor plants even in cities.

Remember you have only one life. Do the work you like, if necessary switch jobs (or wait till retirement) to find the work you love. That way, you will be happier, more efficient and successful and it will contribute to a long, full and contented 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

toxic food

http://www.telegraphindia.com/1150615/jsp/knowhow/story_25776.jsp

The food we eat

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Your Health - Dr. Gita Mathai

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A particular brand of instant noodles was recently banned for containing higher than permissible levels of lead and MSG (monosodium glutamate). But why are higher levels of lead and ajinomoto or MSG bad for health?

Lead is a non biodegradable heavy metal, naturally present in the soil, which the human body cannot eliminate efficiently. Adverse health effects are seen when the blood levels are as little as 10 µg/dL in children and 40 µg/dL in adults. Lead interferes with the oxygen carrying capacity of blood by causing anaemia. If there is a coexisting deficiency of iron, zinc or calcium, the absorption and ill effects of lead increase.

In children, the IQ reduces, the attention span is short and hearing may be affected. Fatigue may set in. Physical growth is stunted. Later in life kidney damage and hypertension may occur.

Until recently, our petrol was not "unleaded." This meant that we breathed in lead contaminated fumes every day. Much of the paint used commercially and domestically is still lead based. The idols sold during festivals are often painted with lead based paints, as are inexpensive toys. Electronic waste and batteries are indiscriminately dumped. Small-scale industries and soldering units use lead.

The dumping of lead-based products into the environment lets lead seep into the soil. It then contaminates the ground water (which we all drink) leading to a slow build up of this poison in our body.

MSG, or its more primitive form glutamic acid, has been around for centuries as a taste enhancer. It is naturally present in foods such as tomatoes and mushrooms. No definite link has been established between this compound and cancer. It can cause allergies though. Some reactions may be mild, such as flushing and a headache. Others like palpitations, increased heart rate, chest pain and wheezing can be severe and require hospitalisation.

The food we eat every day is laden with toxins. Cooked dishes may have artificial colours like tartarazine, allura red or food yellow added to enhance their appearance. Small quantities of these can cause food intolerance and allergies. Children who consume large quantities of these colours in beverages, sauces, jams, pastries and biscuits can become hyperactive.

Fruits and vegetables are shipped out from farms before they ripen because of logistics (ripe fruits are fragile and have a short shelf-life). Farmers tend to use high doses of pesticide during transportation to protect the crop. These pesticides affect the brain, breathing and can cause cancer. After the fruits reach the market, a chemicals such as calcium carbide, ethephon and oxytocin are used to hasten the ripening process. Calcium carbide is contaminated with carcinogenic chemicals like arsenic and phosphorus hydride. Ethephon gas is safer but as it is expensive farmers tend to dip fruits into impure and dangerous solutions of the product instead of using the gas. Oxytocin is a hormone and a neurotransmitter that can affect the brain.

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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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