Oh my foot!http://www.telegraphindia.com/1160222/jsp/knowhow/story_70544.jsp

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Your Health - Dr. Gita Mathai

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Once we start to walk, (around the age of one) most of us take around 5000 steps a day, even though the recommended number to maintain health is 10,000. This means that each of our two feet, which are comparatively small compared to our body, carries half our body weight around for at least six hours a day. In addition, the feet have to propel us forward, absorb the shocks and jolts of uneven surfaces and help maintain our balance. The force eventually exerted on the feet is actually 50 per cent greater than the body weight.

The foot has 26 small bones and 33 joints - all to each other by 120 muscles, many ligaments and an intertwining web of nerves. There is therefore a great deal of potential for things to go wrong!

Once the feet start to pain, the function of the whole body is affected. But first, it is important to analyse it. Is it a onetime phenomenon due to an acute injury like hitting a door or stepping on a rock, or is it chronic and long lasting? In either case, it is important to localise the area of the pain broadly into toes, forefoot or hind foot.

Footwear can cause and aggravate foot pain if they are ill-fitting and have hard unyielding soles. Feet (specially those of school children) are often squeezed into shoes a size too small, or may flap around in shoes a size too large. Children's feet do grow rapidly and shoes are expensive but buying the correct size will prevent long lasting damage to their feet. Adults may buy shoes that are in fashion. High heels, pointed toes and shoes too narrow for the feet with hard soles can cause corns and callouses. If feet are squeezed into narrow shoes, the front toes can develop arthritis and pain.

Pain in the feet may be due to the wear and tear of age, or part of a medical problem like rheumatoid or osteoarthritis. Obesity may increase the strain on the foot. The weight gain in pregnancy can cause pain in the feet. Diabetes can make the feet numb and cause nerve damage and shooting pains. Spinal problems, weakness and paralysis, cerebral palsy or Parkinson's disease, all of which cause changes in the gait, can alter the alignment of the joints of the foot and result in pain.

If feet pain, soak them in warm salted water for about 10 minutes. Manipulate the feet with your hands to see if the pain is relieved. Practise proper walking posture. Raise and curl the toes several times. Practise picking up a soft object with the foot. Stand up and rock heel to toe.

If the pain persists, an orthopaedic surgeon needs to be consulted. There may be obvious problems in the forefoot, like hammertoes, claw toes, ingrown toe nails, bunions, corns or callouses. It may be due to a metabolic disorder like gout or diabetes. Specific remedial treatment will cure the pain.

Pain in the midfoot is often due to flat foot. This may have been present from childhood or it may appear with increasing age and obesity. Insoles or corrective footwear will help with this.

The heel often hurts because of the Achilles tendon (the large tendon attaching the calf muscle to the heel pulling on it and causing micro fractures. There may be bursitis under the heel bone, or a bony spur may form there.

Any foot pain that does not disappear in a few days with hot soaks and OTC pain relievers requires a medical evaluation.

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

Seizure disorder

http://www.telegraphindia.com/1160208/jsp/knowhow/story_67973.jsp

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Your Health - Dr. Gita Mathai

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Epilepsy is scary to see. In a typical "grand mal" seizure there is uncontrolled flaying of hands and legs, rolled up eyes, a guttural sound, and a chance of the tongue getting bitten. The person usually falls to the ground, bowel and bladder control may be lost and there may be loss of consciousness. The seizure ends with the person waking up in a few minutes, unaware of the occurrence. Small wonder that in ancient times epilepsy was equalled with demon possession!

If you witness such an attack, don't try to hold the victim down. Seizures are usually self-limited. The best thing to do is turn the person to one side, clear the immediate area of sharp objects and remain with the person till the "fugue" or confused state wears off.

All the muscles in our body are controlled by electrical signals originating in our brain. If electrical signals become uncontrolled with rapid firing, the muscles respond with twitches or seizures. Once the "fuse" blows, the movements stop.

Typical "grand-mal" seizures involve the whole body. Partial seizures involve only one half of the brain or sometimes just a small area. There may be sudden repetitive movements in certain voluntary muscle groups. The person may wander off or see, say, hear and do things they have no recollection of later. They may suddenly find themselves in strange surroundings. They may just stare blankly and be unresponsive for a few seconds or suddenly drop to the ground. There may be twitching of a limb or a side of the mouth.

The uncontrolled movements during a seizure can result in injury. A seizure while driving or swimming can be fatal. If a seizure occurs during sleep it can cause SUDEP (sudden unexplained death in epilepsy).

Epilepsy is confirmed with tests like the EEG (Electroencephalogram), X-rays, CT, MRI and special brain scans.

About five per cent of children between the ages of six months and five years develop febrile seizures when their temperature rises to 101°F or 38.3°C. The seizures can recur with the next episode of fever, unless the temperature is aggressively brought down with paracetamol and tepid sponging.

Most children outgrow their febrile seizures but about 10 per cent do go on to develop epilepsy, especially if the seizure has lasted for more than 10 minutes or recurred within 24 hours.

Epilepsy is usually "idiopathic" which means that there is no identifiable cause. In some families many members are affected, and around 500 genes have been linked to it. It may be part of the spectrum of other conditions like autism or neurofibrosis. It can be a result of a head injury during birth or in sports or traffic accidents. It may be a sequel of infections of the brain like meningitis or encephalitis. In older adults it may be due to a stroke or a tumour. It can be due to the use of illegal drugs or alcohol. It can be precipitated by low blood sugars or electrolyte disturbances in the blood that occur with vomiting, diarrhoea or heat stroke.

Many medications are available to treat seizures. Usually a single drug is started and after the maximum permissible dose is reached, a second medication is added. It is important to take medications on time and not miss doses while fasting or travelling. Once good control is achieved, epileptics can lead normal productive lives.

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

Tail endhttp://www.telegraphindia.com/1160201/jsp/knowhow/story_66774.jsp

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Your Health - Dr. Gita Mathai

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We humans have evolved biologically so much that we tend to forget that we were once animals and had a tail. That is, till we suddenly develop a pain deep down in the cleft between the buttocks, making it difficult to abruptly shift positions, from sitting to standing or getting up after lying down. This pain is called coccydynia.

That last bone in the vertebral column is called a coccyx. It actually is a vestigial tail, which has shrunk over generations. About 2.7 per cent of patients who see a doctor for "backache" actually had pain in the tailbone. It is more likely to occur in physically active youngsters and adults over the age of 40. Women, with their wide pelvis, are more prone to coccodynia.

The coccyx is prone to injury. Acute dislocations, sprains and fractures can occur. Usually there is a history of having fallen abruptly, on a staircase, the side of the swimming pool or some other hard surface. It can also occur while cycling or rowing. Chronic injury can occur if work or academics involves sitting for prolonged periods on hard surfaces like a wooden bench or a chair without cushions. In women, the coccyx can be injured during childbirth, especially if labour is prolonged. Overweight and obese men and women are more likely to develop problems with the coccyx.

Once coccydynia has been diagnosed, conservative treatment can make the pain disappear in 8-12 weeks. This involves sitting in a basin of hot water (sitz bath) for 10-15 minutes at least twice a day. A donut shaped cushion makes sitting during work easier. Inflatable rubber cushions are available which can be carried around. When seated on chairs or in the toilet, try to lean slightly forwards.

Stretches can be done for that area. The two common ones are the kneeling stretch, when you kneel on one leg keeping the other bent at a right angle. After 30 seconds switch sides. The other stretch involves lying down, bending the knees, crossing the legs at the ankle and then pulling the legs towards you with your arms.

NSAIDs (non-steroidal anti inflammatory drugs) like ibuprofen and pain modulators like amitriptyline can help reduce the discomfort. Even mild constipation can aggravate the pain because of straining. Stool softeners like ipsagol husk should be taken. Physiotherapists can manipulate the coccyx if it has been displaced. Orthopaedic surgeons can give an injection of a local anaesthetic in the coccyx. This numbs the pain, the effect lasts for many months and quite often the pain never returns. If all else fails then the coccyx can be surgically removed. Like the appendix, it is a vestigial structure. Removal has no structural consequences.

Every part of our body (even the coccyx) needs looking after.

• While cycling on a stationery bike or on the road, make sure the cycle seat is soft and comfortable. Special "cycling innerwear" is available with padding and should be used.
   
• Do not run on slippery surfaces like the edges of the swimming pool.
   
• Wear footwear that is rubber soled or has a "grip", not smooth leather.
   
• Maintain ideal body weight. This can be calculated as height in metre squared X 23.
   
• Walk and sit with the correct posture. If you feel you are slouching, stand with both shoulders touching the wall and balance a book on your head.
   
• Do not sit on hard surfaces for prolonged periods of time.
   
• Do the stretches described above.

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

Take care of your thyroid

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

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Your Health - Dr. Gita Mathai

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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.

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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

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

Your Health - Dr. Gita Mathai

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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!

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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

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Your Health - Dr. Gita Mathai

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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

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Your Health - Dr. Gita Mathai

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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.