prostate problems

The prostrate, present in the pelvis area of males since birth, starts to grow at puberty and increases in size all through life - from 15cc to 30cc. If it becomes bigger, the man is said to have BPH (benign prostatic hypertrophy). Hormones such as testosterone, dihydrotestosterone (DHT), and estrogen are responsible for the growth of the prostrate. The enlarged prostrate (BPH) causes symptoms in some men but not in others. The reason for this discrepancy is not known.

In men, the urethra through which urine leaves the body actually passes through the prostrate. This means that as BPH occurs, it causes problems in 60-80 per cent of men. This usually starts from the age of 50. By the time they are 85, 90 per cent men have symptoms.

Initially, there may be difficulty in initiating urination, a delay during which, despite efforts to empty the bladder, the urine stream just refuses to start. There may be a sense of incomplete evacuation, a feeling that some urine is still present in the bladder. Straining to expel this urine results in further blockage with the prostrate acting as a stop valve. The increased effort may result in hypertrophy of the bladder musculature. Urine may get infected. It may be forced backwards into the kidney, which can eventually get damaged. There may be sudden acute retention of urine, with a painful enlarged and full bladder that cannot be emptied.

Similar symptoms can occur with inflammation or infection of the prostrate, or a combination of both. Acute infection can follow a urinary tract infection. Unlike in BPH, there is also fever, pelvic pain and dysuria. Cure requires around two weeks of treatment with antibiotics. If the treatment is incomplete, acute complications like a prostrate abscess can occur. If the infection still persists in a low-grade form for three months or more, it is called "chronic prostatitis". In this situation antibiotics need to be given for one to one and a half months to eradicate the infection. Long-term suppressive therapy may be required in some men.

BPH is frightening because, although it does not increase the risk of prostrate cancer, the symptoms are the same. Evaluation of BPH includes a digital rectal evaluation of the prostrate and an ultrasound examination. Blood tests can be done to estimate the level of PSA (prostrate specific antigen). Earlier this test was done as part of the "master health check up" for men. It was considered a standard test to estimate the risk of developing prostrate cancer. It is now found to be unreliable and non-specific. It only reduces the risk of dying of prostrate cancer by 21 per cent. It resulted in many biopsies in normal men. It should be reserved for men at high risk.

The risk of developing cancer of the prostrate increases after the age of 50. It is also two and a half times greater in men with a father or brother who had prostrate cancer, especially if they were diagnosed before 60 years. Some older men (almost 80 per cent) never realise they have prostrate cancer. It remains as a slow-growing, non-invasive encapsulated tumour causing no symptoms. In younger men (under 50), however, it is an aggressive tumour that spreads rapidly even outside the prostrate.

live to be a 100

Live to be a 100

http://www.telegraphindia.com/1150824/jsp/knowhow/story_38713.jsp

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Your Health - Dr. Gita Mathai

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Living to be a 100 years old is a very real possibility in the near future. After all, now there are sprightly 80 year olds running businesses, managing their finances and living independently (with a little help from friends and relatives)!

Health is the key to a long and happy life. The effort to achieve and maintain health has to start when you are young, before disease sets in.

A great deal of research has gone into understanding aging, as the world's population is getting older. In one study, senior citizens were divided into three groups. The first group did an hour of aerobic activity (such as running, jogging, walking or cycling) a day combined with weight training with weights of 1-2 kilos. The second group did only flexing and stretching exercises. The third continued with their usual sedentary life. After a period of six months, the first group was found to not only have gained muscle but also developed a positive outlook on life and become mentally sharper. There was no noticeable difference in groups two and three. Uniformly though, they had lost muscle mass and "slowed down" mentally and physically.

After research and several studies, 10,000 steps a day was declared a magic figure to maintain health. It works out to about five miles a day. Most people actually walk only 3,500 steps a day. The new smartphones, some watches and pedometers are able to track daily activity accurately. The other way is to get up every hour and walk for a minute. This can be added to, or alternated with, stair climbing - a 1,000 calorie per hour activity. Swimming, walking, jogging and running use about 300 calories per hour depending on the intensity, the distance covered and the speed.

Our body requires a certain amount of energy to stay alive even if we sleep all day. This can be calculated as the weight in kilos multiplied by 2.2 multiplied by 11. It works out to around 1,500 calories for a 60-kilo adult. 1,500 calories a day is a "restricted diet." It is barely enough to enjoy a good meal or indulge even occasionally in tasty, high calorie snacks. To be able to eat more and enjoy it, you need to increase activity. Then the calories utilised in the activity can be added to the total daily consumption.

Every decade the metabolic rate falls by five per cent in men and three per cent in women. Muscles atrophy and become insidiously replaced by fat if they are not used, and with increasing age. Muscle, even at rest, consumes more energy than fat. This lowers the metabolic rate. It also reduces strength and affects balance. Weight training needs to be done. A litre bottle can be filled with water and held in each hand and the traditional school drill should be done using this. This consists of five up and down and side-to-side movements with the arms. Gradually work up to twenty repetitions of each circuit.

Mental activity like puzzles, Sudoku and learning verses by heart alone will not keep the brain sharp, it will only marginally delay the onset of Alzheimer's and dementia. It has to be combined with an hour of physical activity a day, preferably outdoors in the sunshine. Even walking up and down a portico or around a block of flats is all right.

The effect of an hour's effort today and everyday will make a hundred fold difference in a lifetime. The other fact - you are never too old to start.

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

foti and tofi

http://www.telegraphindia.com/1150817/jsp/knowhow/story_37515.jsp

Fat outside, thin inside

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Your Health - Dr. Gita Mathai

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Human beings do not roll off a factory line like cars, identical in appearance. They vary in shape and size. They may be classified in the case of women as pears, apples or bananas or as upside down triangles, upright triangles, hour glasses, diamonds, rectangles or the number 8. These classifications are self-explanatory.

Males are classified as ectomorphs (very thin), endomorps (medium) or mesomorphs (positively obese). The athletic mesomorph is most attractive to women.

Our body type is genetic. Less than 15 per cent of the population is blessed with their perceived ideal body type. The other 85 per cent are unhappy with their shape and want to change it. Most are unsuccessful. Changing body shape requires great effort.

For years the gold standard for health was the BMI (body mass index), the weight in kilograms divided by the height in meters squared. For Indian adults the ideal BMI is now 23. If you have a BMI of 30 or more, you are obese. The fallacy is that some fit individuals like sumo wrestlers and kabbadi players have a high BMI. They are not obese - just fit and muscular. So many people fell outside the spectrum that total body fat became the new mantra for measuring health. No one should have more than 25 per cent body fat.

Total fat content of the body is not easy to measure. It requires an MRI scan. When heavy weight sumo wrestlers were checked during studies, they were found to have most of their fat deposited under the skin. They had little or no visceral fat. In short, they were FOTIs (fat outside thin inside). This was in sharp contrast to many thin individuals and size zero women who were TOFIs (thin outside fat inside).

In everyone, including FOTIs and TOFIs, extra fat gets deposited around the abdominal organs as visceral fat. This precipitates lifestyle diseases like hypertension and diabetes. The extra fat in the body acts as an independent organ. It releases chemicals and hormones. These alter mood, reduce lucid and deductive thinking and prevent restful sleep. It also increases the propensity to develop cancer. It changes the reproductive hormonal profile leading to lower fertility - and even sterility - in men and women.

People cannot change their body type - but they can work with it. This requires a controlled diet as well as exercise. For it to be effective, you should exercise non-stop for at least 40 minutes a day.

As people get older, their weight slowly climbs. This is because the metabolism slows down. Increasing the exercise and marginally reducing the food can circumvent this.

Quick look

• You may be born with an unattractive shape but you CAN work with what you have
• FOTI is healthier than TOFI
• Everyone should exercise for at least 40 minutes every day

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

Your Health - Dr. Gita Mathai

http://www.telegraphindia.com/1150803/jsp/knowhow/story_35024.jsp

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A "stroke" is exactly what the word conjures up in the mind - a sudden catastrophic physical event because of a deficiency in blood supply to the brain. The brain cells begin to die when deprived of blood. This leads to a loss of function of the body parts controlled by those parts of the brain.

The loss of blood supply may be because a blood vessel leaks, bursts, or becomes blocked. If there is a disruption in the right side of the brain, it affects the left side of the body and vice versa. The centre for speech is situated on the left side, so if the stroke has affected the left half of the brain, the person will have paralysis or weakness on the right side of the body and be unable to speak as well.

A person who is developing a stroke may suddenly have slurred speech and be unable to comprehend instructions. There may be loss of vision in one eye. There may be weakness or total loss of strength in one half of the face, the arms or the legs. The weakness may cause the patient to lose his balance and fall down. There may be a headache, giddiness, loss of consciousness or even a seizure.

If the block is not complete, the person may appear to recover rapidly. Within 24 hours it is almost as though the stroke never occurred. This often means that the person and relatives do not take the symptoms seriously. These episodes are called TIA (transient ischemic attack). It is followed by a full-blown stroke in the next 24 to 72 hours in 40 per cent of cases.

The risk of having a stroke increases with age, going up exponentially after 55 years. It is commoner in men. Women are more likely to have a stroke if they are on hormone replacement therapy. Pregnancy increases the likelihood of blood clots. Emboli may occur during childbirth. In both sexes, the risk factors for strokes are obesity, physical inactivity, smoking, use of tobacco products or high alcohol consumption. Diseases like high blood pressure, diabetes and elevated lipids can increase the risk of a stroke. Irregular and rapid heart beats can occur as a result of hyperthyroidism, as an aftermath of rheumatic heart disease, heart attacks or because of congenital abnormalities of the heart. This can cause clots to form in the heart itself, which can move to various parts of the body.

The disabilities resulting from a stroke can be temporary or permanent. There may be weakness or loss of movement to one side of the body, making walking, eating and self-care difficult. Speech may be slurred or impossible. There may be loss of memory for recent events. Words may be elusive even with clarity in the thought process. This makes communication difficult. The paralysed parts of the body may have strange sensations or paradoxical pain. Judgment, rational thought and reasoning may be affected.

A stroke is a medical emergency. Prompt treatment and follow up management helps to minimise deaths and complications.

Aspirin prevents blood from clotting further. A tablet of aspirin dissolved in 100ml of water is the emergency treatment for a stroke resulting from a clot. Clot busting drugs like TPA (tissue plasminogen activator) can be given intravenously. Administration should be a maximum of 3-4 hours after the event to be effective. Clots may be removed surgically, stents can be inserted into narrowed arteries and bulging blood vessels clipped.

Rehabilitation with physiotherapy and occupational therapy needs to be started as early as possible.

Rewiring of the brain is possible with training of the nerve cells. This way, other areas of the brain take over some lost functions and the surviving brain cells can be efficiently and optimally utilised.

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

stop suicide

Stop suicide

http://www.telegraphindia.com/1150727/jsp/knowhow/story_33764.jsp

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Your Health - Dr. Gita Mathai

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A physician friend was fascinated by a WHO statement that India had the largest number of suicides when there seemed no statistics available to ratify this claim. As he started looking for facts, he found that in his district there were hardly any suicides, just 11 per 1,00,000 people. Then he stumbled upon the actual problem. No one wants it on record that a family member committed suicide, to which a religious and social stigma is attached. So the sympathetic administration often puts the cause of death as "other". In reality, the suicide rate in India is closer to 58 per 1,00,000 people.

Both men and women attempt suicide - about four times more women than men are likely to attempt it but men are more likely to succeed in their first attempt. The decision to commit suicide may be due to financial problems, stress, a major psychiatric illness such as depression, bipolar disorder or schizophrenia, an incurable medical condition like cancer or an autoimmune disease or, in the case of the aged, a desire to stop being a financial burden to the family.

Suicidal tendencies can suddenly pop into the minds of people who abuse alcohol, sleeping tablets or are on psychiatric medication. The tendency is aggravated if there has been a death in the family, financial forfeiture or loss of a job. Smoking and tobacco use also increase the risk of suicide. The exact mechanism by which the tobacco alters the brain chemistry is not known.

Gamblers become depressed when they suffer financial losses, especially if they have gambled with family money, lost property or savings. Gambling is a surreptitious way of getting an "endorphin high." It is an addiction and finally more money has to be gambled frequently to achieve the same effect. The rebound "down" is when the suicide occurs.

Whole families commit suicide in India. The parents kill the children and then themselves. This is most often associated with financial losses. Chit fund losses are particularly notorious for this outcome.

Teenagers and young adults cannot cope with rejection and failure in academics, the work place or relationships. While studying survivors of a suicide attempt, researchers found that it takes an average of 10 minutes from the thought to the act. Also regret sets in, according to survivors, but it is too little, too late.

Teenage and young adult suicides often occur in clusters around the time of the board exams or when results of professional courses are announced. Parents are often oblivious that their children are stressed and depressed.

Laughter has great anti depressant value. Children laugh 100-150 times a day. Adults laugh 10 times a day and elders 4-5 times. The incidence of depression also creeps up.

If a person threatens or attempts suicide, it is an urgent appeal for help. The person should be referred to a psychiatrist who will evaluate him or her for risk, depression and requirement for medication. A combination of antidepressants and psychotherapy works best.

Suicide prevention is everyone's responsibility. For confidential helplines (for India) log on to suicide.org.

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

blood clots

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Of clots

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Your Health - Dr. Gita Mathai

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Every now and again an unexpected "young death" makes the news - a celebrity, more often than not, who died a few hours, days or weeks after a long flight. Though this has been labelled the "economy class syndrome," it affects first and business class passengers as well. It is due to a blood clot that formed in stationery legs, broke free and then blocked blood supply to a vital organ like the heart, lungs or brain.

To remain alive, blood has to flow ceaselessly through our blood vessels. The heart pumps it through the arteries, and it returns to the heart via the veins. The total volume of blood circulating in an adult is between 4.7 and 5 litres. If there is a block or a break in the vessels, the blood supply either drains away or stops. Both can result in death.

Blood remains fluid as long as there is no impediment to its flow. If there is an irregularity or break in the vessel wall, one of its components called platelets collect there. A cascading reaction involving many proteins (clotting factors) occurs and a clot forms. The clot keeps extending until anticlotting factors (also present in the blood) come into play. The clot is contained. After it has served its purpose, it is broken down and absorbed.

Clots form during injuries and fractures. These are "good" clots that prevent the body from bleeding to death. Blood clots may also form if a woman is obese or pregnant. This is due to a combination of factors like physical impediment to the free flow of blood and hormonal imbalances. An excess of estrogens aggravates clotting. If activity is suddenly decreased with prolonged bed rest owing to illnesses or paralysis, stasis in the blood vessels can cause a clot. Cancers can cause blood clots, particularly blood cancers. Smoking is an independent risk factor for clots. Elevated lipids cause "fat plaques" to form along the blood vessels. This makes their lining irregular. Sensing this, platelets aggregate there and form clots. The blood can carry these clots to different parts of the body, producing symptoms and complications. Irregular heart beats can cause clots to form in the heart and then be transmitted elsewhere.

Once a clot forms, there may be warmth, redness, swelling and pain. It may cause a stroke or a heart attack. If it lodges itself in the lungs, it can cause acute breathlessness and death. Sometimes the blood vessel gets slowly blocked by an enlarging clot. This often occurs in the arms and legs. There may be pallor, tingling numbness, reduced hair growth and thin, delicate skin.

Doppler and other imaging tests can confirm the presence of a clot. Blood tests can be done if clots are found in young people to confirm a hypercoaguable state (which happens because of a genetic defect).

Clots can be removed by surgical intervention or treated with medication in the form of injections (initially) and then tablets. Treatment often has to be lifelong. Pregnant women with hypercoaguable states can carry the baby successfully to term with appropriate anti coagulation 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

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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