ear aches

A pain in the ear

http://www.telegraphindia.com/1160905/jsp/knowhow/story_106287.jsp

---

Your Health - Dr. Gita Mathai

---

Earaches are what the word describes - a pain in the ear. What the word fails to convey is just how debilitating the attack can be. This is especially true in young children, whose inability to localise the discomfort can lead to prolonged, unexplained crying with fever.

The pain is most often due to a problem in the middle ear (otitis media). This is a small space with three bones (ossicles), the malleus, incus and stapes. The confined space is closed to the outside by the eardrum. Infections cause a build up of secretions (viral) and pus (bacterial), which is unable to escape. This causes excruciating pain. It can press on the ear drum, causing it to bulge. It can eventually burst, discharging the fluid.

The ear, nose and throat are all connected by the Eustachian tube that is situated behind the throat. An infection in any three can cause an earache. Allergies, or viral and bacterial infections can cause the nose to be blocked. In children the inner tonsil (adenoid) may become infected. This can swell, blocking the Eustachian tube.

In bottle-fed infants, milk can enter the Eustachian tube, which is shorter and straighter in infants. This can be caused by the infant sucking too rapidly from the bottle (unlike the breast where the flow is naturally regulated), lying flat while sucking (not at the recommended 45° angle), being put to sleep with a feeding bottle or holding the bottle and feeding themselves.

• 

Once infection sets in, there is fever and severe pain. The eardrum bulges and can be seen by physicians using an "otoscope". The child may be irritable and refuse to eat as any movement of the jaw aggravates the pain. There may even be temporary loss of hearing or balance. If the infection is not treated adequately and in time, it can recur or become chronic. It can even spread to the base of the brain.

The skin of the external ear canal can become infected because of excessive dampness caused by swimming, rain, allergies, eczema, or if the ear canal is damaged by hearing aids, buds, hairpins or even earphones.

The pinna of the external ear can get infected. This occurs in people who participate in contact sports such as wrestling and boxing, if small scratches occur to the ear or if the skin is pulled off. People may also have multiple ear piercings, with some holes being in the cartilage of the ear. Infection and damage can occur, especially if the procedure was unsterile. The infection can spread rapidly and affect the whole ear. It can become a bag of pus. Even if the pus is drained surgically, the ear may become deformed with multiple bumps forming a "cauliflower ear."

To prevent ear infections:

♦ Use a cup and spoon to feed children. If you must use a bottle, prop the child up at 45° angle. Do not use pacifiers.

♦ Yearly immunisation prevents flu, which predisposes children to ear infection. Common bacteria (Haemophilus influenza,
Streptococcus pneumoniae) which cause ear infection in children can also be prevented by immunisation.

♦ Avoid exposure to cigarette smoke. Even second hand smoke on hair and clothes precipitates infection.

♦ Do not damage the ear by placing foreign objects in it.

♦ Dry out the ear canal with a hair drier after swimming.

♦ If flying causes ear ache, use decongestant nose drops before boarding the flight.

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

dengue

http://www.telegraphindia.com/1160822/jsp/knowhow/story_103646.

Banish the bite

---

Your Health - Dr. Gita Mathai

---

• 

Mosquito borne diseases usually arrive with the monsoon. And this year is no exception; there is a resurgence of dengue. And it is we who are to blame. If each citizen took his or her social responsibility seriously, our country would not need to be a marked in red on the WHO maps for dengue!

The disease is spread by the Aedes egypti mosquito, an attractive insect, recognisable by its tiger striped legs (unlike the boring grey of the Culex and Anopheles mosquitoes). It is a friendly insect, which does not stray far from its place of birth. It loves humans and their environment. Unlike the dawn and dusk attacks of other mosquitoes, it bites in the daytime too. It is ferocious when it attacks its prey. One bite is not enough. It either attacks the person repeatedly or bites several human beings in the vicinity. That is why several members of the family can get dengue at the same time.

Four to 10 days after the bite, the affected person suddenly develops a fever. He or she may also suffer from a red rash, headache, pain behind the eyes, in the joints and the abdomen, nausea, vomiting and throat pain. At this stage, it is difficult to distinguish dengue from other fevers.

Within a few days, the white blood cell and platelet counts drop. The liver enzymes can start to rise. The person starts to develop antibodies to the virus which are are detectable in 50 per cent of patients by days 3-5 after onset of illness, and in 99 per cent by day 10.

Keep dengue away

• As little as 2ml of water is enough for mosquitoes to lay eggs. Check your immediate environment for garbage like old tires, bottle caps, even leaves. • Tanks and ponds should be stocked with small, larva-eating fish like guppies. • Pouring a little kerosene or oil on stagnant water creates a thin film on the surface that prevents larvae from breathing. • Put up mosquito-proofing nets on windows and ventilators. Keep doors shut. Sleep inside mosquito nets. • Application of mosquito repellents on clothing (not skin) is effective for a few hours. Patches (mosquito tattoos) contain pure citronella extract and can be placed on clothing. Equal volumes of vanilla extract and water applied on the skin repels mosquitoes for an hour.

A person usually recovers spontaneously from the first attack of dengue. Immunity develops to that particular strain of virus (there are four strains) and lasts for a lifetime. Unfortunately, if there is a subsequent attack of dengue (a different strain), the body's immune reaction produces a severe response.

Complications are more likely in patients under the age of 12 and over the age of 60 years. The white blood cell and platelet counts drop. This can lead to bleeding from various places. If the bleeding occurs in the brain, it can be fatal. The liver becomes enlarged and the liver enzymes elevated. As more toxins are released into the blood, the blood vessels become permeable. Fluid leaks out of the blood vessels and accumulates in the abdomen and in the lungs. The circulating plasma volume is reduced and shock may develop. Eventually, as organs like the liver, heart and kidney do not get enough blood, they can fail.

There are no antibiotics that cure dengue. Treatment is mainly supportive, to reduce the temperature, (paracetemol 10-15mg/kg per dose every 4-6 hours in children and 500mg in adults). Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided.

Plenty of fluids should be given. In critically ill patients, admission to hospital and IV fluids and transfusions (of platelets) may be required. The exact criteria for platelet transfusion varies, and must be carefully done, as there is inherent risk associated with the transfusion of blood components.

There is as yet no vaccine against dengue. Ridding the house and its surroundings of the Aedes mosquito is the key to controlling dengue. Each individual needs to play a proactive role in this.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in

breast milk

Best for baby

---

Your Health - Dr. Gita Mathai

---

·      

Last week (August 1-7) was breast feeding week, and the entire world was involved in the great “latch on” — a word that best describes the way mammalian babies find their mothers and derive nutrition. Mothers gathered in public places and demonstrated that it was possible to breast feed babies, in public, discreetly and elegantly, and there was nothing “indecent” about it.

Breast feeding, though natural, is a failing art. It needs to be actively promoted, and not just for one week a year.

Breast milk is rich in fat and omega 3 fatty acids. It also contains the fat digesting enzyme lipase, so that all the fat is digested and absorbed. It also contains immunoglobulins (IgA), which protect the child against common viral, bacterial and gastrointestinal diseases. The composition and quantity of milk changes and regulates itself as the child grows older.

All mammals produce milk and the composition for each species is specific. Cow’s milk is best for calves and goat’s milk for kids. Human milk cannot be replicated in a factory, despite best efforts by the infant formula industry. The companies have tried various nutritious additives but it is not the “real thing.”

Manufacturers have tried to base the composition of formula milk on a human mother’s milk, analysed at approximately one to three months postpartum. Still, there are significant differences in the nutrient content of these products. For formula, purified cow’s milk, whey and casein are used as the  protein source, a blend of vegetable oils as the fat source and lactose for carbohydrates. Each manufacturer tries to add different vitamins and minerals to claim superiority over other products. None contain trace elements and immunoglobulins. It does not protect the child against disease. The fats are also not digested well and the stools of formula fed babies are foul smelling.

WHO (World Health Organization) recommends that infants  be exclusively breast fed for the first six months. To do this efficiently, the mother should be given a peaceful environment, an adequate diet and plenty of fluids. Drinking a glass of water before and after feeding ensures adequate flow of milk.

The baby has to search for the nipple, find it and latch on. Placing the nipple against the baby’s cheek can do this. Pushing the nipple into the mouth is counterproductive. The baby should be held at an angle of 45 degrees. Lying down and feeding the  baby is not a good idea.

Breast milk is always available on demand, it is sterile and at the right temperature. Our Indian clothes, with dupattas and sari pallus make breast feeding discreet.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in·    

http://www.telegraphindia.com/1160815/jsp/knowhow/story_102445.jsp

frozen shoulder

Frozen shoulder? Just roll it

http://www.telegraphindia.com/1160725/jsp/knowhow/story_98489.jsp

---

Your Health - Dr. Gita Mathai

---

The shoulders are joints with a wide range of motion. That helps us painlessly perform a variety of tasks such as combing hair, applying soap to the back or hooking undergarments. If the movements of the shoulder are restricted due to pain, life becomes difficult.

This may occur because the joint is strained from overexertion, the tendons of the muscles surrounding the joint are inflamed, the joint itself may be unstable and dislocated, or because of neck problems. Most often though, no real disease process can explain the pain and it is called a "frozen shoulder."

Women between 50 and 60 years of age are prone to developing frozen shoulders, especially if they also suffer from hypothyroidism or diabetes. It affects the non-dominant shoulder and is seldom bilateral, but the pain restricts even the simplest two-handed tasks. Men can also develop "frozen shoulders", but it is milder and less common.

A frozen shoulder usually starts as lack of free movement in a normal shoulder joint, with no recollection of overuse or injury. The pain then comes in fits and starts, tends to be worse at night, and interferes with sleep, as turning from side to side produces discomfort. This stage lasts for around three to four months.

Later, during the sticking or freezing phase, all movements are restricted by pain. The shoulder is held fixed to prevent involuntary movement. Subconsciously, use of the affected arm reduces. The muscles around the joint get wasted due to disuse. The rounded contour of the shoulder changes and becomes flattened. Just as suddenly as it starts, it spontaneously, inexplicably improves.

The entire cycle takes around 30 months. In seven per cent of sufferers, it does not fully resolve, and pain and functional disability remain for many years.

• 

A frozen shoulder is usually diagnosed clinically. The normal procedure is to get X-rays, CT and MRI scans done. However, X-rays may only reveal thinning of the bone due to disuse.

Once the shoulder has become relatively immobile, treatment is essentially symptomatic. During the initial painful stages, treatment is directed at relief. The patient has to determine the limit of activity or exercise, pushing their limits a little further each day. All pain free activities are allowed and all painful activities curtailed.

At home, external application of a capsaicin gel followed by ice offers relief. Professional physiotherapy, with alternating heat and cold therapy, passive movements, low load, prolonged stretches and strengthening exercises are helpful. Physiotherapy provides greater benefit when it is combined with intracapsular steroid injections. Non-steroidal anti-inflammatory drugs (NSAIDs) supplemented with other analgesics may be helpful. Long-term use of these drugs is not advised, as it is detrimental to the kidneys.

If functional disability persists despite physiotherapy and medication for six months, an orthopaedic surgeon can perform manipulation of the joint under anaesthesia. Arthroscopic (surgical) release of the capsule can also be done.

It is better to be patient and manage the symptoms rather than go in for surgery immediately as most people recover spontaneously.

Anyone can develop a frozen shoulder. This makes preventive measures a practical necessity to prevent pain and disability occurring.

Yoga has exercises that prevent frozen shoulder from developing if started young, performed regularly and continued lifelong. Shoulder rolls, arm elevations, arm rotations, the plank pose and a complete suryanamaskar all help to maintain the integrity, position and health of the shoulder joint.

The Chinese Tai-Chi exercises confer similar benefits.

These traditional exercises can be combined with biceps curls, triceps curls and lateral lifts using small one or two kilo "baby" dumbbells.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

blisters and boils

Bubble trouble

http://www.telegraphindia.com/1160718/jsp/knowhow/story_97197.jsp

---

Your Health - Dr. Gita Mathai

---

• 

A blister is a very superficial lesion, which occurs when the surface layer of the skin gets separated from the deeper layers. Fluid or blood can accumulate in this space. This raises the surface of the skin. A small, translucent or blood-filled bump forms, which may or may not be painful. Blisters can occur singly, in clusters or all over the body.

Single blisters occur on the feet - if shoes are tight or ill fitting - or the hands, if repetitive movements are performed with tools. Exposure to extreme temperatures (both freezing and boiling) can cause a blister.

Blisters can cause throbbing pain because of pressure. The clear liquid or blood that accumulates inside remains uninfected as long as the skin over the blister is intact. Care should be taken to make sure the skin does not break. The protective skin should not be pricked. If you don't disturb it, a blister will usually disappear on its own within a few days. Antibiotic treatment is not required.

Before wearing a new pair of shoes or using tools, take a bar of soap (traditionally, Lifebuoy is used) and rub it on the dry skin. It prevents blisters forming due to friction. Sports people or those in the NCC or military can also wear thick socks.

Bites of bed bugs, scabies mites, mosquitoes and spiders can also cause blisters. These tend to itch. Scratching can lead to the skin breaking, which in turn can cause a secondary infection. In the case of a spider bite, there is a clear blister in the centre surrounded by a red area. It tends to burn, not itch. After a few days, the area in the centre becomes black and the skin sloughs off.

A herpes virus infection also leads to blisters. Multiple blisters, usually on the face, occur and recur in clusters in the same area with the Herpes simplex infection. They are precipitated by other unrelated, incidental infections such as a flu or fever. Their appearance is preceded by a pricking sensation. They last a few days and then disappear spontaneously, only to reappear with the next infection.

Herpes genitalis, a sexually transmitted infection, produces blisters in the genital area. These are extremely painful. The first infection needs to be aggressively treated with antivirals. Despite this, the virus continues to live in the nerve roots in the pelvic area. The ulcers recur painfully every few months. Eventually, the attacks become less frequent and then cease altogether.

Herpes zoster occurs several years after a childhood attack of chicken pox. It causes painful blisters along the distribution of a single nerve. The pain and the blisters take around 10 days to disappear. Although the attacks do not recur, the pain can persist for months or years as "post herpetic neuralgia." The initial attack can be shortened with antiviral medication and the pain lessened with medication. A vaccine is in the pipeline for the prevention of Herpes zoster.

The herpes virus also causes chicken pox. A few days after fever, a rash appears and blisters begin to break out all over the body. They are painless and will subside harmlessly if left alone (not scratched). Attacks occur as epidemics particularly in schools. The disease is contagious from before the appearance of the rash till the blisters have scabbed and fallen off. The duration and severity of the attack can be reduced with antiviral medication. The Varicella vaccine can be administered after the age of one and again at the age of 10 years to prevent chicken pox.

The Coxsackie virus produces highly infectious "hand, foot and mouth'' disease, with blisters in these areas, particularly in young children. It disappears on its own in 7-10 days with no treatment.

So if you have blisters, make sure you don't scratch or burst them and visit the doctor only if they are painful.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in

aloe vera

A magic pill? http://www.telegraphindia.com/1160613/jsp/knowhow/story_90821.jsp

---

Your Health - Dr. Gita Mathai

---

People are always searching for a magic pill that will miraculously cure all their diseases. Aloe vera is the latest candidate. The aloe vera plant has been around for centuries but it is only now that it is being touted as a panacea for all diseases, with anti-aging and rejuvenating properties. Ointments, cosmetics, drinks, tablets and extracts of aloe vera are all available OTC (over the counter).

Aloe vera is the name of a family of cactus-like plants with fleshy green leaves lined with spikes. Both the milk (latex), extracted from under the skin of the leaf, and its juice, obtained by splitting the fleshy leaf, contains a variety of anti-bacterial and anti-viral chemicals. It has long been used in traditional medicine but now it is being used in allopathic medicines as well.

• 

Applying 30 per cent aloe gel twice daily to the skin alleviates diaper rash, sunburn, dry skin, the allergic rashes, scabies and superficial burns. For haemorrhoids and anal fissures, try 0.5 per cent spray dried and powdered aloe juice ointment. To be effective, the application has to be combined with sitz baths three times daily, a diet with sufficient fibre and supplements of ispaghula husk, for three weeks. The severity of dandruff and seborrhoeic dermatitis can be reduced by using shampoos with 80-85 per cent aloe vera daily, for at least six months. Aloe vera toothpaste reduces the build up of dental plaque if used three times a day for a month. Gels reduce the pain, severity and duration of mouth ulcers.

While application of aloe vera is quite effective, eating it is more problematic. For one, effects of the consumption of aloe vera extracts have not been extensively studied. The scientific evidence is confusing. Much of the evidence is anecdotal. Children below the age of 12 as well as pregnant and lactating mothers should not consume aloe vera.

Aloe vera juice, if taken in doses of 5-15ml twice a day, lowers blood sugar. To lower lipids, take 10-20ml of aloe daily. This also decreases your hunger so you eat less. The problem is that aloe vera increases the effectiveness of diabetes medication, so blood sugar levels may dip dangerously.

Chemicals called anthraquinone glycosides, present in aloe vera, act as a laxative. The recommended dose is 0.04-0.17 grams of dried juice. If consumed in higher than recommended doses, or in the non-decolourised form, there can be abdominal pain, cramps and diarrhoea. The liver can get damaged. Consumption of the whole leaf extract is can cause cancer in animals.

For heart disease, take a 120 ml dose of a solution containing 1,200 mg of aloe vera. It increases the effectiveness of any cardiac drug, so it can result in arrhythmias.

So think deeply and work out all ramifications before you decide to take aloe vera as a herbal supplement.

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

cystitis

Your Health - Dr. Gita Mathai

http://www.telegraphindia.com/1160606/jsp/knowhow/story_89487.jsp

---

• 

Sometimes, without warning, people (mainly women) develop a burning sensation while urinating and a heaviness in the lower abdomen. They have to run to the toilet frequently but pass small quantities of high coloured or blood stained urine. They may or may not have fever. The agony is apparently indescribable! In children, the symptoms may be subtle - with vomiting or sudden loss of bladder control.

These are the classical symptoms of cystitis, the medical term for inflammation of the urinary bladder. Cystitis is usually due to a bacterial infection. It is annoying and debilitating, and can become a serious problem if the infection ascends from the bladder to the kidneys.

All cystitis is not due to infection. It may be a complication of another illness, such as catheterisation or radiation treatment for cancer. It may be due to allergy to feminine hygiene sprays, harsh soap or some other chemicals used on the private parts.

Women are more prone to UTIs than men. Around 85 per cent of medical consultations by women are for UTI or related symptoms. By the age of 30, 30 per cent of women and in a lifetime, 50 per cent will experience at least one episode of UTI. Young men are 30 times less prone to infection than women. The disparity is due to the shorter length of the female urethra, its proximity to the anus, and hormonal changes that occur with pregnancy and menopause.

A thorough examination should be done if UTI is suspected. This includes a general check up and a pelvic examination. In men, an enlarged prostate can cause an impediment to the free flow of urine. In women it can be fibroids or some other growth in the uterus and ovaries. In both sexes, stones in the urinary tract (kidney, ureter, bladder) can be responsible for obstruction. People who are catheterised, have diabetes, are on steroids or are immune-compromised are prone to UTI. These conditions need to be treated for the UTI to respond to treatment.

In addition, the urine needs to be examined and cultured so that the choice of antibiotics is appropriate. Pelvic ultrasound scans, X-rays, CT scans and MRIs may be needed. Sometimes the inside of the bladder may need to be visualised using a scope.

Most UTIs are caused by a bacteria called Escherichia coli. It has little protrusions called pili with which it attaches itself firmly to the bladder wall. Initially, E.coli were responsive to treatment. Taking mild antibiotics for only three days was sufficient to cure it. Now stronger antibiotics may need to be used as the organism has become resilient and resistant. The duration of therapy also has to be seven or 14 days. It is important to follow your physician's advice about the choice of antibiotic and the length of treatment. A medicine that worked for one individual may not be suitable for another. Even if UTIs are recurrent, self-treatment with OTC (over the counter) drugs should be avoided.

Drinking cranberry juice regularly has shown some benefit in UTI. This is because it contains active natural chemicals like condensed tannins and proanthocyanidins, which prevent E.coli and other bacteria from attaching themselves to the bladder wall.

To prevent UTI

♦ Drink 2.5 -3 litres of water a day depending on the climate and the level of physical activity. Do not wait for thirst to develop.

♦ Lean backwards (women) while passing urine.

♦ Clean the area after passing motion from front to back. This is very important in children.

♦ Pass urine before and after intercourse.

♦ Gently wash the skin in the genital area with a mild soap. Do not use perfumes and sprays.
 

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in