Take care of your thyroid

http://www.telegraphindia.com/1160118/jsp/knowhow/story_64332.jsp

---

Your Health - Dr. Gita Mathai

---

The thyroid is a butterfly-shaped gland situated in the front of the neck. It releases hormones that control many functions in the body such as breathing, heart rate, metabolic rate, body temperature, menstrual cycles and the lipid profile (mainly the triglyceride levels). It is under the control of two other glands in the brain, the pituitary and the hypothalamus. A deficiency of thyroid hormones causes weight gain, abnormal menstrual cycles and elevated triglycerides. These changes are usually picked up early both because of the symptoms, the physical changes in the patient and the fact that the thyroid gland is situated in the front of the neck. Changes in the size, texture or the appearance of nodules are visible and palpable.

Thyroid disorders can be diagnosed by doing the thyroid function tests which estimate the level of hormones.

Normal values:

• Serum thyroxine (T4) 4.6-12 ug/dl
• Serum triiodothyronine (T3) 80-180 ng/dl
• Thyroid stimulating hormone (TSH) 0.4-4.2 mcU/mL

Forty two million Indians suffer from thyroid diseases; 80 per cent have low levels of thyroid hormones (hypothyroidism). These individuals benefit from titrated doses of replacement thyroid hormones. The tablets are administered on an empty stomach and the dose is increased every two weeks until it is optimised.

• 

Unregulated usage in unpurified forms (self administered tonics and health supplements for losing weight or gaining height or an appetite) mean that varying amounts of the hormone are being taken. The dosage may even change from day to day. Also, the person may actually have thyroid glands that function normally. Their obesity may be due to an imbalance between caloric intake and expenditure. In this scenario, taking supplements with varying amounts of thyroid hormone can be injurious to health. The pulse rate may go up and there may be heart beat irregularities. It can be fatal.

India has "goitre belts" where iodine deficiency results in an overworked, enlarged thyroid gland and a swelling in the front of the neck. The body cannot store iodine so the daily requirement (adults require 150 micrograms of iodine a day; pregnant and lactating women require 200 micrograms) has to be provided with salt in the food. It is also found naturally in fish and seaweed. The government has tackled this by selling iodised salt in which 30gm of iodine is added per kilo. On an average, 10-15gm of salt is consumed every day, and this provides most people with the required amount of iodine.

Despite this, hypothyroidism can occur if the body produces antibodies to thyroid hormones, a type of autoimmune disease called Hashimoto's thyroiditis, or the gland has been surgically removed. It can also occur with pituitary diseases, or with certain medications like lithium.

The thyroid gland can also go out of control because of excess stimulation from the pituitary gland, or because of cancerous or non-cancerous nodules secreting excess amounts of thyroid hormone. It can be part of Hashimoto's thyroiditis where the body destroys the thyroid hormones produced so that the gland is stimulated to work harder. It can occur owing to painful or painless inflammation of the thyroid gland. It may be due to extraneous administration of iodine or thyroid as part of tonics or health supplements.

A hyperactive thyroid can be treated with medication or radioactive iodine. Anti thyroid medications can be administered for short-term control. Beta blockers slow and regulate the heart rate. Sometimes, hyperfunctioning nodules or even the gland itself may need to be removed.

The thyroid controls almost all functions of the body. Malfuctions may be subclinical and present subtly. It is important to check thyroid functions as part of the master health check up, especially if you are a woman nearing the age of fifty.

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

new year resolutions

Out with the bad

---

http://www.telegraphindia.com/1160111/jsp/knowhow/story_63168.jsp

Your Health - Dr. Gita Mathai

---

Now that all the fanfare that ushered in the new year is over, it is time to introspect. Take a long, hard look at the year ahead - you can make a new beginning, health wise.

Try to quit bad lifestyle habits such as smoking, drinking or overeating. Even if you do not feel the negative effects of "just another" drink, chocolate or cigarette right now, one day the aging body will no longer be able to tolerate the years of abuse. Side effects like hypertension, heart attacks, chronic obstructive pulmonary disease (COPD), and arthritis will suddenly appear to make life miserable.

If you find that quitting smoking cold turkey is impossible, try stopping for one day a week. Increase the abstinence to two days after two weeks. Eventually, you would have stopped smoking for the entire week. The same can be applied to drinking. The cravings will disappear. To make this lifestyle change, it is important that you avoid the company of people who smoke or drink. Otherwise, despite your best intentions, the situation may spiral out of control. The enticing aroma of second hand smoke may make your resolution fly out of the window!

The more public you make your goals, the more likely you are to succeed. You cannot really say "I will control my weight in 2016," and then gorge on cake and ice cream. Your friends are likely to remind you about your resolution, making failure an embarrassment!

• 

Occasional relapses are common and to be expected. Instead of obsessing over them, think ahead and avoid unfavourable situations so that relapses are less likely to occur. Try to find something to do immediately (like eating a peppermint) to negate the desire when the craving for a cigarette pops up.

There is nothing as satisfying as rewarding yourself. Don't wait for the end of 2016 to do that. If a fortnight goes by without a relapse, reward yourself with a movie or shopping, not a cigarette or a drink!

When it comes to weight loss, it is important to set realistic and achievable goals. One kilo a month works out to 12 kilos a year. It is an achievable target. Five kilos a month is possible but difficult and more likely to result in failure and depression.

If you need to stop three habits, like smoking, drinking and nail biting, it is better to work on them one at a time. Give yourself four months to rid yourself of each habit. That way, you would have got rid of all three by the end of 2016.

Relapses occur most often in the first two months of attempted change. If you can sustain your resolutions till June, consider the battle won. Statistics show that once half the year is over, the old habits die and the new ones become ingrained. There is a positive lifestyle change.

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

Fight typhoid

http://www.telegraphindia.com/1151130/jsp/knowhow/story_55762.jsp

---

Your Health - Dr. Gita Mathai

---

• 

Several infectious diseases such as small pox and polio have been eliminated in India through universal immunisation. Typhoid, which has practically disappeared from industrialised countries, is however endemic in the country. Around 20-25 million people worldwide are affected every year by typhoid and of these around 2,00,000 die. The major burden of typhoid is in India, Pakistan and Bangladesh.

Bacteria belonging to the Salmonella family cause typhoid and its two milder variants of paratyphoid fever. The bacteria are excreted in the stools and urine of infected individuals. Some people (carriers) continue to excrete the organism even after treatment of the disease and apparent recovery. The environment gets contaminated as the bacteria leach into the soil, and eventually enter water and food. The bacteria can survive for weeks as they wait for a host. They survive only in humans.

Defecating in the open is unhealthy and aesthetically repulsive but it is an accepted part of life in India. Our towns and cities also contribute to the problem. They often have open drainage. Untreated sewage (almost 80 per cent of the total generation) is pumped into lakes and rivers. The bacteria seep into the ground and leach into groundwater and drinking supplies.

Once the typhoid bacteria enter the body, symptoms occur after an incubation period of a week or two. During this time the bacteria slowly multiply, invade the intestine and circulate in the blood. They reach the liver, kidney and bone marrow. They then re-enter the blood stream, causing symptoms like tiredness, high fever (103°F, 39.5°C), a mild red rash, abdominal pain and diarrhoea.

Blood counts in typhoid are non-specific. In the early and late stages of the disease the bacteria can be grown in cultures of blood (70 per cent) and stool or bone marrow (90 per cent). There are a number of blood tests. The most commonly used is the Widal test. This is a very non-specific test. A single high value is inconclusive. It confirms typhoid if a repeat test shows a rising titer. There are also “card” tests for typhoid similar to the ones used for pregnancy tests.

Treatment with oral antibiotics needs to be continued for 10-14 days. Supportive therapy in the form of a bland diet, tepid sponging and paracetemol helps. Despite adequate treatment and apparent cure, 3-5 per cent of the infected individuals remain asymptomatic carriers. Those with kidney or gall bladder stones are more likely to become carriers. Removal of the stones or the gall bladder helps recovery.

Good sanitation and proper sewage disposal is the key to the prevention of typhoid. In most of India this does not occur. Nor has the toilet construction scheme been successful.

Single shot vaccines are available for typhoid. They can be given after the age of two. Boosters have to be given every three years. Oral vaccines are also available. They can be given after the age of five. They are not as effective as the injections.

To protect against typhoid:

♦ Drink water that is boiled, bottled or purified.
♦ Do not eat raw vegetables or fruits washed in untreated water
♦ If you eat outside, make sure the food is piping hot.
♦ Immunise yourself and your family. The vaccine is not expensive.
♦ Try to mobilise local government for action on sewage and sanitation.

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

backaches

My aching back

http://www.telegraphindia.com/1151109/jsp/knowhow/story_52112.jsp

---

Your Health - Dr. Gita Mathai

---

• 

One of the commonest problems for which patients consult doctors is back pain. It can occur at all ages but there is a spurt of patients in their thirties and forties because of the weight gain in middle age, the large abdomen of pregnancy and the gradual weakness and degeneration of under-exercised back muscles. We were meant to walk on all four limbs like other animals but we chose to defy the laws of gravity and stand upright. This places a great deal of strain on the bones (vertebrae) of the lower back.

Backache can be due to congenital defects in the structure of the spine such as scoliosis (bent backbone) or spina bifida (absence of the supporting spinous processes). Usually though, the person remembers a sudden "give" in the back while lifting an object or a fall. In older persons with osteoporotic bones, the injury may be so trivial as to pass unnoticed till the pain sets in. Sometimes backache is part of a generalised disease process like ankylosing spondylitis, psoriasis or inflammatory bowel disease. It can also be due to problems in the kidney, ovary or uterus.

The person usually complains of persistent pain, stiffness and difficulty in standing and movement. The pain can be anywhere from the neck to the buttocks, but is usually nearer the lower back. This is called lumbago. The pain may remain fixed in that area or radiate down one or both legs, when it is called sciatica. (These are just descriptive terms and not a diagnosis).

Pain in the lower back can be treated at home with the application of a capsaicin containing gel, followed by alternating cold and hot fomentations. This can be repeated several times a day. Mild analgesics like paracetemol or ibuprofen can also be taken. Bed rest does not really help. It may delay long-term recovery by weakening supporting muscles further.

You need to see a doctor if the pain lasts for more than two weeks, interferes with sleep at night, there is weakness in either leg, fever, bowel and bladder functions are affected or cancer has been diagnosed or treated in the past.

A complete examination and blood work is required, including evaluation of the vitamin D3 status. X-rays can reveal gross abnormalities, but usually CT and MRI scans are also needed to make a definitive diagnosis.

If there is an underlying disease, that needs to be tackled and treated. Otherwise, physiotherapy involving applications of heat, ultrasound and electrical stimulation is usually recommended. Once the pain is better, exercises to improve posture, increase flexibility and strengthen back and abdominal muscles are taught. It is imperative to do them regularly as otherwise the benefits accrued disappear rapidly.

Usually, most patients improve within a month or two.

To prevent backache:

• Exercise regularly by jogging, walking or swimming.
• Do “core strengthening” exercises for your back so that the muscles hold your bones firmly in place.
• Do flexion exercises like yoga or pilates.
• Keep your weight in the desired range for your height. To calculate this multiply your height in metre squared by 23.
• Stand erect. Teach children correct posture. If your work involves standing for long periods of time keep a stool under one foot and alternate legs every 10-15 minutes.
• Use ergonomically designed chairs, of the correct height with back supports.

origins of obesity

Not so cute http://www.telegraphindia.com/1151026/jsp/knowhow/story_49582.jsp

---

Your Health - Dr. Gita Mathai

---

• 

All over the world, parents love chubby babies with their potbellies and plump dimpled thighs. Unfortunately, these children grow into overweight teenagers and adults. What was considered "cute" in childhood becomes not only a subject of ridicule but also a health risk.

Sometimes, whether a person will be obese or not is decided even before they are born. The mother's weight gain reflects on the baby's birth weight. Infants who are underweight or overweight at birth tend to grow into obese adults. Women who smoke, use tobacco products or inhale second hand smoke tend to have small babies. Pregnant women with gestational diabetes produce large babies. Both groups grow into obese adults.

Exclusive breastfeeding for the first six month of life protects against adult obesity. Many parents feel their breast milk is not enough and they resort to "top up" feeds with cow's milk or formula. This results in formula-fed infants being fatter and apparently growing faster.

Breastfeeding lowers plasma insulin levels and decreases both fat storage and the development of excessive fat cells. Also, breastfeeding is on demand. Parents who use formula often overfeed their children.

Weaning should be delayed till the age of six months. If this is not possible, then at least till four months are completed. As far as possible, weaning foods should be home cooked. Cereals, fruits and vegetables are ideal. Packaged infant foods are calorie dense, and often have too much sugar and sodium. Artificially sweetened fruit juices should also be avoided.

Infants need to sleep at least 12 hours. Lack of adequate sleep in infancy leads to obesity in later life.

The motor milestones of obese children are delayed as they are unable to lift themselves up to sit, crawl, stand and walk. This further aggravates the obesity and prevents proper development of bones and muscles.

Once they reach adolescence, they may develop pre-diabetes, bone and joint problems and sleep apnoea. This leads to daytime drowsiness and poor academic performance. Eventually they are at risk for heart disease, diabetes, hypertension and also many types of cancer, including cancer of the breast, colon, uterus, gall bladder, multiple myeloma and Hodgkin's lymphoma.

Even if genetics, prenatal development and early life are against you, and it is "all your mother's fault", it is never too early or too late to start rectifying mistakes. Everyone (all ages) needs at around seven to eight hours sleep, an hour of exercise and a sensible and healthy diet.

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

diarrhoea dos and donts

Diarrhoea dos and don'ts

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

---

Your Health - Dr. Gita Mathai

---

• 

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.

• 

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

---

Your Health - Dr. Gita Mathai

---

• 

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