diarrhoea dos and donts

Diarrhoea dos and don'ts

http://www.telegraphindia.com/1151019/jsp/knowhow/story_48726.jsp

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Your Health - Dr. Gita Mathai

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Thousands of adults and children in India suffer from diarrhoea every day. The disease - caused by bacteria, viruses or parasites - is food or water borne and the result of contamination.

The symptoms of "food poisoning" may set in within 12-24 hours or can be delayed for 7-10 days. The delay sometimes makes the diagnosis difficult as by then people have forgotten what they ate. The severity of symptoms varies from person to person depending on the number of bacteria consumed and the general health and immune status of a person. Young children, the elderly, pregnant women, and anyone whose immunity is low (on steroid medication, cancer treatment or in an immunocompromised state like infection with HIV) is likely to be severely affected.

Contaminating organisms are killed when food is cooked at high temperatures. If the cooking process is too rapid, organisms can survive in the relatively raw middle portions of the food. They can remain dormant there and then start to multiply.

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Contamination with bacteria belonging to the staphylococcus family can occur before, during or after the cooking process. The bacteria release heat stable toxins into the food. The bacteria may die during the cooking process but the toxins are unaffected. They cause the stomach upsets.

A dangerous form of food poisoning called Botulism is caused by toxins released by a bacteria called C. botulinium. The spores of the bacteria contaminate the food, the organisms multiply and release toxins. Later, cooking may kill the organism but the toxin remains. In infants the infection is caused by direct ingestion of spores of the organism in contaminated food, usually unpasteurised milk or honey. In addition to the vomiting and diarrhoea (which may be relatively mild) the nerves are affected. There may be blurred vision, droopy eyes and lethargy. Muscle weakness and respiratory paralysis can set in. Antitoxin has to be administered. The person also needs supportive treatment and respiratory support. The diagnosis may be missed because the incubation period can be long (days).

The usual culprits in causing diarrhoea are salmonella, shigella and E. coli. These bacteria are present in the stools of patients and healthy asymptomatic carriers. Food may be contaminated by the fecal-oral route if hands are not washed properly. Surfaces in contact with raw or cooked food should be washed and wiped regularly and frequently with soapy water. The local mithaiwala should wear disposable gloves when he weighs your sweets and savouries.

Sewage contamination of the water supply can occur because the water and sewage pipes run close to each other. Water should be boiled before it is drunk, or only bottled water should be used. Fresh cut fruits and vegetables are also potent sources of infection. Sometimes, they are also sprinkled with contaminated water in the summer months to preserve their appetising appearance.

Food poisoning produces mild fever, vomiting and profuse watery diarrhoea with mucous or sometimes blood. There may be stomach cramps and tenesmus (a painful desire to unsuccessfully pass motion). As more and more stool is passed, or vomiting makes it impossible to retain fluids, dehydration can set in. The volume of urine becomes scanty or may cease altogether. The temperature may rise.

There is no need to rush to a doctor when diarrhoea sets in. Your gut needs rest to cope with the bacteria and the toxins. Keep yourself hydrated with sips of water or by sucking on ice cubes. Cook kichdi in a pressure cooker with equal quantities of rice and dal. Add salt to taste and then boil again with water till it is a flowing consistency. Take a tablespoon of this mixture every ten minutes and alternate it with water. You can also alternate the kichdi with bites of yellow banana. Once the gut has rested for 24 hours, spontaneous recovery can occur.

Self-medication with single doses of antibiotics, metronidazole or enteroquinone is dangerous and can lead to the emergence of resistant organisms.

Lomotil and loperamide can reduce the frequency of diarrhoea without eliminating the causative organism. Repeated doses should not be taken. It should not be used in children under the age of 10.

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

bursitis

sacs of painhttp://www.telegraphindia.com/1150928/jsp/knowhow/story_44868.jsp

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Your Health - Dr. Gita Mathai

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The human body has around 160 joints, all of which are in motion at some time or another as we sit, stand, walk and work in the office or at home. These joints are surrounded by protective fluid filled sacs called "bursa". The job of the bursa is to prevent friction between the bone, skin, muscles, ligaments and tendons that surround the joints. Constant overuse or infection of the bursa can result in a painful condition called "bursitis".

Painful bursitis can set in if the amount of fluid in the bursa increases. This can be due to constant excessive friction, an infection or trauma. The skin overlying the bursa becomes red, warm and the bursa itself is painful when pressed.

All 160 bursa do not become painful. Only five or six are notorious for causing problems. Bursitis of specific joints is often referred to by common descriptive terms such as "frozen shoulder" or "bricklayer's shoulder", "tennis elbow" or "miner's elbow", "housemaid's or clergyman's knee", "policeman's heel and "tailor's buttocks" (pain at the upper end of the thigh bone). Bursitis of the big toe is referred to as a "bunion".

Bursitis is precipitated in particular joints like the shoulder if it is used for repetitive movement like lifting a weighted object over the head, swimming, playing a bat and ball game like cricket, golf, tennis or badminton, In the elbow, activity with a flexed hand such as playing tennis, wringing clothes or even leaning on the elbow for long periods while sitting at a desk is likely to cause the problem. Prolonged sitting - particularly on a hard, uncushioned surface - causes pain at the point of contact. In short, sitting on a hard wooden surface leaning forward on a table can cause elbow and buttock pain.

The risk of developing bursitis increases with age, aggravating occupations or hobbies which involve repetitive use of the same joints. It is also more likely with other diseases like gout and diabetes.

When bursitis sets in, the joint suddenly feels itchy or stiff, is painful to touch or on movement and looks swollen.

Home treatment is often effective and can be summarised by the word PRICE (protection, rest, ice compression and elevation)

Apply ice. It reduces the swelling and inflammation, reduces muscle spasm and numbs pain. Alternate with moist heat.

Protect the joint from further strain with elastocrepe bandages, a wrist support, a shoulder brace, elbow guard or knee cap. These are available in medical stores.

If the pain is in the heel, wear soft cushioned footwear and do not walk barefoot.

Take mild painkillers like aspirin, or NSAIDs (non-steroidal anti-inflammatory agents) like Ibuprofen or just paracetemol.

You can usually wait for 10 days to two week before consulting a physician, unless the pain is accompanied by fever, there is redness or a rash, the area has a bluish discoloration like a bruise or there is a sharp pain on movement that brings all activity to a stand still.

It is often difficult to make an accurate diagnosis clinically. X-rays are helpful, but usually CT scans and MRIs are needed to be sure. Blood tests need to be done to rule out infection (the white blood cell count will be high), uric acid levels for gout, blood sugars for diabetes, and rheumatoid factor, C Reactive Protein etc for other types of arthritis.

In addition to specific treatment for underlying diseases, physicians usually recommend physiotherapy. If all else fails, injections into the bursa, or surgical decompression or removal of the bursa itself may be done.

To prevent bursitis

• Maintain ideal body weight
• Do flexion, stretching and strengthening exercises regularly, particularly if you play a sport.
• As soon as pain develops, rest the joint for a day or two to give it time to recover.

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

that itchy feeling

That irritating itch

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Your Health - Dr. Gita Mathai

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Just like in the environment, fungi grow on our bodies in dark and moist. They usually have no effect on us but if they breach the skin or the mucous membranes in the mouth, anus, vagina, penis, and, in obese people in the skin folds in the axilla, the thighs and under the breast (in infants the diaper area), the resulting infection is called thrush, monilia or candida. The infection causes an intense desire to itch and scratch.

Candida in the mouth appears as curdy white patches. They appear to be stuck to the inside of the mouth.

In infants and young children, oral thrush is common. In breast-fed infants infection can occur spontaneously if the mother is on antibiotics. It can also occur if her hormonal profile changes and estrogen levels increase (hormone tablets). The infection can then pass back and forth between the mother and infant. It occurs more often in children who are on the bottle or suck pacifiers. Infants who are born preterm or underweight are also more prone to infection.

Vitamin B deficiency causes a red raspberry tongue, which burns and is very sensitive to hot and spicy food. This occurs in the elderly as their diet is often inadequate. It can also occur with antibiotic treatment as along with the bad bacteria the medication knocks off the "good bacteria" in the gut that synthesise vitamin B in our bodies.

People who use inhalers, rotacaps and nebulizers often do not rinse out the mouth after using them. The particles of medication can stick to the mouth and eventually monilia infection can occur.

Vulvo-vaginal candidiasis can occur in women of all ages. It is precipitated by antibiotic use. It can occur with urinary tract infections.

Men can develop candida on the tip of the penis or in the skin fold there. This is more likely to occur with diabetes. Although technically it is not a sexually transmitted disease, it can be passed back and forth between partners.

In overweight individuals, sweat accumulates in skin folds in the thigh, and under the breasts. This reacts with soap, providing a moist fertile area for monilia to thrive.

Monilia will disappear on its own once the precipitating factor is removed. (The diabetes controlled, the hormones corrected, the urinary tract infection treated, vitamin deficiency and diet corrected, bottle feeding stopped, pacifier thrown away, smoking stopped).

If you have monilia, consult a physician who can treat the precipitating cause. External applications of clotrimazole lotion to the mouth, cream to other parts of the body and pessaries for vulvo-vaginal candidiasis will usually get rid of the infection. Clotrimazole powder is available and can be used for the armpit and chest area. Sometimes the creams are combined with steroids. Although they appear to clear up the infection in record time, recurrences will occur as steroids provide a fertile ground for bacteria growth.

Bacteria of the lactobacillus family help to colonise the gut and vagina with friendly bacteria and prevent overgrowth of monilia and other fungi. A tablespoon of home-made curd on an empty stomach every day will usually do the trick.

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

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

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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