tinnitus

https://www.telegraphindia.com/1170605/jsp/knowhow/story_155102.jsp

Phantom noise 

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Your Health - Dr. Gita Mathai

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Noise can be loud and irritating. The good thing about external noise is that it can be shut out. Phantom noises — ringing, buzzing, roaring or hissing — varying in intensity and pitch continuous or intermittent, in one or both ears can only be heard by the affected person. They are called tinnitus and cannot be shut out. Sometimes it feels like an insect is trapped in the ear. The sound is disconcerting, and distracting. It is a common problem. The risk of developing tinnitus is higher in men and in smokers. About 25 per cent people experience it by the age of 70.

Tinnitus may be caused by a variety of reasons. It may be due to age. A type of hearing loss called presbycusis often accompanies it. This may be because the fine hair (cilia) in the inner ear die or are damaged. The bones of the inner ear may be damaged. This is called otosclerosis and may run in families. The nerves may not conduct sounds as efficiently. Atherosclerosis and high blood pressure may also cause tinnitus. It may be something as simple as the ear being blocked by wax.

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Temporary tinnitus can occur with sudden exposure to a blast of loud noise. This may be accompanied by pain in the ear. Continuous long-term exposure can make the damage permanent. This occurs in younger people who continuously blast music from electronic devices.

Changes in the fluid pressure in the inner ear can occur on one side. It can cause a feeling of vertigo and tinnitus. It is episodic and can be accompanied by hearing loss. It usually goes away on its own in a year or two.

The temporomandibular joint is situated at the angle of the jaw next to the ear. Muscles used in chewing, the ligaments of the jaw and nerves transmitting sounds share some common entities with this joint. Pain, swelling, arthritis or dislocations of this joint or an accident, especially if there has been injury to the head as well, can aggravate tinnitus. 

Tumours in the head and neck or the eighth cranial nerve that transmits hearing can cause tinnitus. This can be picked up with CT scans or MRI.

We live in an era where antibiotics are prescribed for the mildest infections. Some of the commonly used antibiotics like erythromycin and gentamicin, and some of the higher ones like vancomycin, polymyxcin and neomycin can affect hearing and cause tinnitus. Diuretics like furosemide (Lasix) and quinine used for malaria can cause similar effects. Aspirin is one of the oldest medications prescribed for pain. In high doses (twelve 300 mg tablets or more) it can cause tinnitus.

Tinnitus is investigated with a hearing tests, CT scans and MRIs. No real cause is usually found. This is depressing for the patient as the continuous sound interferes with sleep and concentration.

Medication does not work well for tinnitus. The irritating sound can be masked with white noise (sounds of waves or rainfall) playing continuously. Hearing aids will help if there is deafness as well.

Some yoga exercises like the triangle pose, camel pose and downward facing dog are found to be beneficial. You can also stimulate the eight nerve by blocking the ears with the forefingers and making an “ooh” sound. Couple this with walking or jogging for 40 minutes a day, light weights and exercises to strengthen the head and neck.

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Dr Mathai is a paediatrician and author of 
Staying Healthy in Modern India. Mail your
questions to yourhealthgm@yahoo.co.in

Bye-bye bellyhttps://www.telegraphindia.com/1170529/jsp/knowhow/story_153930.jsp

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Your Health - Dr. Gita Mathai

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Everyone wants a flat and toned six pack abdomen: the youngster trying to zip up a pair of pants, the middle aged executive trying to hold his stomach in and the mother squeezing herself into a "shaper" and blaming childbirth for her loss of form. No one wants a paunch or potbelly.

You know you have a paunch when you:

• Are no longer able to see your toes when you stand straight

• Swing your arms across your body while walking and not side to side

• Have BMI (body mass index: weight divided by height in meter squared) greater than 27

• A waist circumference more than 35cm (women) or 40cm (men)

• Are able to pinch up more than inch of subcutaneous fat on the back of the arms or abdomen.

The bad news is that after the potbelly, which is aesthetically undesirable but fairly harmless subcutaneous fat, fat starts getting deposited around the organs inside the abdominal cavity as visceral fat. It is a risk factor for diabetes, hypertension, stroke, gall bladder stones, arthritis, some cancers and dementia. The effective area available for breathing decreases as the abdomen pushes up against the chest. This causes sleep apnoea and snoring.

Once you start gaining weight, the area where fat is deposited is genetically determined. Hips and thighs usually increase in size first, followed by the paunch. In some unfortunate individuals, any increase in weight first shows up on the belly. The abdominal contents are held in place by muscles. These get stretched during pregnancy. The "core muscles", the entire group of muscles between the chest bone and hip bone, have to be strengthened for good posture and a flat abdomen. Weak abdomen and core muscles contribute to the protruding belly.

Very rarely, the sudden appearance of a paunch may be due to accumulation of fluid in the abdomen or a tumour. It is worth visiting a physician if the change has occurred within a short span of time.

There is no food supplement, medication or miracle exercise to get rid of just the paunch. Without overall weight loss, crunches will only strengthen your muscles, not get rid of the paunch. Also during the weight loss process, weight from other areas such as the cheeks, neck and arms may go before it makes a dent in the paunch.

Men require around 2,500 calories a day and women 2,000. A person with a sedentary lifestyle needs only 1,800-2,000 calories. If you can maintain a caloric deficit of 500 calories a day, it will result in weight loss.

Weight loss diets succeed when they are close to your normal food habits. Reduce intake of snacks, fat, aerated beverages, and refined carbohydrates. Serve all the food on the plate and estimate the calorie content. Do not have a second helping no matter how tasty the food is.

Dieting needs to be combined with exercise to prevent loss of muscle mass. If you have the time then try an hour of brisk walking, jogging, cycling or swimming at least five days a week. If there is no time, you could do 10 minutes of HIIT (High Intensity Interval Training) or stair climbing. Remember to run up the stairs but walk down. Climbing them two at a time is also a good idea. Exercises using light weights, crunches and core strengthening are essential and beneficial.

Losing a paunch and keeping it off is a lifetime commitment.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

dizziness

Dizzy? First feel easy 

https://www.telegraphindia.com/1170515/jsp/knowhow/story_151568.jsp

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Your Health - Dr. Gita Mathai

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People sometimes complain about light-headedness, giddiness or dizziness. They use the terms interchangeably, confusing the physician. Does the person feel like fainting? Is the room spinning around? Is it a feeling of nausea?

It is light-headedness if the person feels he or she may faint but the surroundings do not spin. It can occur if meals have been delayed, or if the person stands up too quickly after lying down. It may be due to allergies, fever, vomiting or diarrhoea (dehydration), anxiety and stress, (especially if accompanied by hyperventilation), alcohol, tobacco and illegal recreational drugs. It may even be due to medicines prescribed for other ailments. The light-headedness usually goes away on its own and is not serious. Rarely, light-headedness may be due to excessive blood loss because of heavy menstrual bleeding, acute trauma or continuous, silent loss of small quantities of blood from the gastrointestinal tract. Defects in the conducting system of the heart or certain medication can also cause irregular heartbeats and light-headedness.

In cases of dizziness, not only does the person feel unsteady but there is also a false sense of the environment spinning. This is also called vertigo. In order to maintain balance, the brain receives signals from the balance apparatus in the inner ear, eyes, the skin, bones and joints. When these signals are not in sync and are conflicting, vertigo occurs. The most common cause is benign paroxysmal positional vertigo,(BPPV). This is due to crystalline calcium deposits in the fluid of the inner ear (otoliths) moving abnormally and affecting balance. This occurs in older people, is intermittent and sometimes just disappears on its own. In Meniere's disease, the vertigo is accompanied by progressive loss of hearing and a ringing sound in the ear. Migraines can also cause vertigo as can infections of the inner ear or malfunction of the vestibular nerve that supplies the ear. Head injuries can cause acute vertigo. Blood supply to the base of the brain can be compromised by build up of cholesterol plaques, causing giddiness. If vertigo is accompanied by neurological symptoms such as weakness or loss of speech, it may a transient ischaemic attack. This can herald a stroke.

Often these symptoms are dismissed as symptoms of "low blood pressure". Normal blood pressure varies between 140/90 and 90/60. When blood pressure falls below this, the brain does not get enough oxygen. This can cause light-headedness and fainting.

It can also be a normal response to standing up suddenly after lying down. This is because the brain does not respond rapidly enough to changes in posture. It can occur in soldiers after standing for a long period of time as this causes pooling of blood in the lower limbs. It can also occur with increasing age, pregnancy, heat exhaustion, low blood sugar, hypothyroidism and abnormal heart rhythms and as a side effect of diuretics or blood pressure medication.

It is important to investigate giddiness, dizziness and light-headedness to determine the cause of the symptom. This may involve an ENT evaluation, ECG and blood tests.

Dizziness, light-headedness and vertigo usually subside over time once the precipitating factors have been corrected.

KEEP A STEADY HEAD

• Take medication
• You can lose your balance and fall, so walk slowly. Use a cane if needed
• Lie down as soon as you feel giddy. Keep your eyes closed
• Keep the house and bathroom well lit to minimise chances of a fall
• Avoid driving
• Avoid caffeine (coffee, tea, cola), salty food, alcohol and tobacco
• Drink plenty of fluids
• Exercise regularly and do postural, balance and neck exercises at least three days a week

Dr Mathai is a paediatrician and author of StayingHealthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

screening infants

Born well, now be well

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Your Health - Dr. Gita Mathai

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The infant (and under-five) mortality rate in India has seen an impressive decline, from about 80 per 1,000 live births in 1991 to 35 in 2016. The main contributors to this decline are West Bengal, Tamil Nadu, Kerala, Punjab and Himachal Pradesh. These are also the states that have enthusiastically adopted the small family norm. This enables parents to avail good antenatal care, safe delivery and immunisations to prevent death from common childhood infections.

Now, it is time to worry about other diseases that affect the mortality and quality of life of these children. These are mainly haemoglobinopathies (haemoglobin disorders), bleeding disorders, inborn errors of metabolism, endocrinopathies, and congenital deafness. Many of these diseases are inherited. One or more parents may carry the gene, which may not be expressed in the parent. Relatives may be affected, or else have mild forms of the disease. In some cases, it is a sporadic mutation and the child is the only one exhibiting the problem.

Congenital hearing loss can be tested by the newborn hearing screening test (NBST). Though seven per cent of newborns have hearing loss, this test is usually not done. When the child is three months to a year old, parents realise that he or she does not respond to sounds. The impact of hearing loss is less if it is treated before the child starts to speak.

Sometimes children are born with ambiguous external genitalia but they may not be brought for treatment till they are older. It is usually due to congenital adrenal hyperplasia (CAH). If the disease is severe then other symptoms such as diarrhoea, vomiting, dehydration, low blood sugar levels and shock can produce a life-threatening medical emergency.

There are other defects for which children are screened at birth in developed countries. These require collecting blood on a filter paper from a heel prick, amniotic fluid, buccal smear, skin or hair, within 24-48 hours of birth. The disorders that can be detected are phenylkentonuria (PKU), congenital hypothyroidism, haemoglobin disorders such as sickle cell disease, the thalassaemia group of diseases, galactosaemia, tyrosinaemia and other biochemical diseases, cystic fibrosis and so on. The cost of the test varies from Rs 2,500 to Rs 10,000, depending on the number of diseases screened for. That depends on prevalence in that area, family history, marriages between close blood relatives and medical advice.

Congenital hypothyroidism requires immediate treatment with medication so that the child may have normal physical and mental development. PKU, tyrosinaemia and galactosaemia need immediate alterations in the diet to prevent brain, eye, heart and kidney damage. Haemoglobin disorders require constant monitoring, transfusions, and specialised management.

Newborn screening and early intervention can vastly improve the quality of life as well as development of children. Make sure you get the relevant tests done as early as possible. After all, it is always better to know the enemy you are fighting.

bad breath

To banish bad breath

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Your Health - Dr. Gita Mathai

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Bad breath makes us self-conscious. About 25 per cent of the population feel that they have bad breath, when actually they don't. Another 10 per cent really have foul breath but fail to recognise it. It is an embarrassing problem and even close family members will seldom tell you that you have it. To check, cup your palms, hold it over your mouth and nose, breathe out and then smell your breath. You will get a fairly clear idea of the odour.

Most of the time, bad breath originates in the mouth. There may be untreated cavities. There may be food stuck in between the teeth. Bacteria feast on this food, breaking it down and releasing gases. Plaque may have formed between gums and teeth. This causes gum infection. Sometimes, if the gums are pressed, pus can be seen. Coffee and alcohol also cause overgrowth of mouth bacteria.

Brush teeth twice a day, morning and evening. Rinse your mouth well after every meal. A mouthwash can also be swirled around in the mouth for 30 seconds after every meal. Try to drink 2-3 litres of water in summer. Water cleanses the mouth and washes out food debris and bacteria.

Food containing spices, onions or garlic can produce halitosis even after the mouth is rinsed and teeth brushed. These condiments contain sulphides, which are released as they are digested. The sulphides are absorbed into the blood stream and released in the breath.

Gastrointestinal reflux disease (GERD) can cause belching and foul smelling breath. Diabetic ketoacidosis produces a fruity odour. Kidney and liver disease can cause a smell like ammonia. Intestinal obstruction causes the breath to smell like faeces. Now there are theories that various types of cancer release characteristic odours.

Sinusitis, post-nasal drip, blocked nose with mouth breathing, tonsillitis and adenoids cause bad breath. Lung infections like bronchitis, lung abscesses, bronchiectasis all result in halitosis, as toxins released by the bacteria in the lungs are breathed out.

Tobacco use destroys teeth and causes bad breath. It does not matter if the tobacco is chewed, smoked or used as snuff.

Sometimes children are put to sleep with a milk bottle in their mouth. This results in dental caries, a coated tongue and foul breath (bottle mouth). They may have sinusitis or adenoids. Children sometimes place objects like erasers, twigs, crayons or toys in the nose. Once the object is stuck there, there is a discharge and a foul smell. They child may not remember placing the object there or may deny it.

If correcting your oral hygiene does not get rid of bad breath:

• Consult a dentist to ensure nothing is wrong with your teeth and gums.

• See a physician to rule out GERD, diabetes, liver and kidney disease.

• Consult an ENT surgeon to rule out nasopharyngeal problems.

• Maintain a food diary to see if any particular item causes the odour.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

summer heat

Keep your cool in summer

https://www.telegraphindia.com/1170417/jsp/knowhow/story_146630.jsp

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Your Health - Dr. Gita Mathai

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We are going to have a long, hot, dry summer, with above average temperatures and no rain. A few deaths from heat stroke have already been reported.

Our body organs function best at an internal temperature of 98.4°F. If the body temperature rises above this, the brain immediately sends chemical signals to the four million sweat glands all over the body. They secrete sweat, which covers the body in a thin film. As this evaporates, body temperature drops.

Sweating is not effective in cooling down children under the age of four as their sweat glands are immature. The process is inefficient in the elderly, in obese individuals and those with diabetes or on certain medications such as anti-depressants and anti-hypertensives. You require water to sweat so dehydration can reduce the amount of sweat formed. This is particularly true in athletes. Clothes made of synthetic fibres also trap the sweat next to the body, making it lose its cooling ability. If there is more than 60 per cent humidity in the atmosphere, sweat cannot evaporate.

If sweat fails to cool the body down, heat exhaustion sets in, with symptoms of weakness, headache, giddiness, palpitations and painful cramps. If this is not recognised, the body’s core temperature continues to rise and can reach as high as 105°F. This can result in confusion, disorientation, seizures and even death.

To prevent heat stroke, in summer, try to stay indoors as much as possible, preferably going out only before sunrise and after sunset. Confine exercising outdoors to the same time. Even swimming in the hot sun can lead to heat exhaustion and stroke.

The key to hydration is to drink plenty of fluids even before you feel thirsty. The best liquids are tender coconut water, lightly salted limejuice and buttermilk. Aerated cola drinks may feel good but are actually hypertonic. They aggravate dehydration. The ill effects of heat are also intensified by tea, coffee and alcohol. 

A person suffering from heat exhaustion should be moved to a shaded spot or indoors under a fan or to an air-conditioned room. He or she should be given plenty of fluids, preferably with salt added. The body should be sponged with tepid water and ice packs placed on the armpits, groin and temples.

Summer is also the season for profuse sweating and prickly heat. Sweat pores can become blocked by dead skin cells, dirt or talcum powder. As the sweat tries to escape, it forms tiny clear bumps below the surface of the skin called miliria crystalline (prickly heat). Eventually, they turn red (miliria rubra), become itchy, and evolve into a brown scaly rash.

Prickly heat usually appears in covered areas where sweat cannot evaporate easily or the pores are blocked. Common areas are the forehead, the upper back, chest, arms and inner thighs — in areas where there are body folds and poor air circulation. It is aggravated by friction between the skin and tight-fitting, non-absorbent synthetic clothing. The continuous rubbing can lead to the skin eventually peeling off, leaving a raw red area. This can become secondarily infected with bacteria or candida.

To prevent prickly heat, bathe twice a day after adding a teaspoon of baking soda to a bucket of water. Do not apply soap directly on the skin but use a loofah. Even though advertising portrays prickly heat talc as a soothing option, it will only block the pores further and aggravate the condition. So do not use prickly heat talc, or any other talc, to get relief from prickly heat.

Dr Mathai is a paediatrician. Mail your questions to yourhealthgm@yahoo.co.in

young heart attacks

Young at heart attacked

https://www.telegraphindia.com/1170410/jsp/knowhow/story_145446.jsp

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Your Health - Dr. Gita Mathai

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Heart attacks are accepted as part and parcel of aging, with men over 45 and women over 55 aware that any chest pain they feel may signal an attack. Now, however, the scenario in India is changing. Heart attacks are occurring in men in their twenties and thirties. Since many are unaware that they are at risk, they fail to recognise the symptoms and get help in time. Therefore, 25 per cent of these first attacks unfortunately turn fatal.

The most common symptom of a heart attack is crushing chest pain which can radiate to the neck, jaw, arm or back. It may be accompanied by nausea, vomiting, pallor, dizziness, sweating and an inability to stand. The heartbeat and pulse may be irregular. It can be mistaken for acid dyspepsia, GERD (gastro-esophageal reflux disease), pain in the chest wall, pleural infection, gall bladder disease or eso- phageal spasm.

If a person is suspected of having a heart attack, an ECG (electro cardiogram) is done, which usually shows characteristic changes. Blood tests for cardiac enzymes and blood troponin show elevated levels if the cardiac muscles are damaged. A chest X-ray can be taken to estimate the size of the heart. An echocardiogram delineates the damaged and non-functioning areas of the heart. Cardiac catheterisation is used to visualise the blocked arteries. This helps to determine whether the blocks can be treated by placing stents into the arteries or if a bypass surgery is needed. After recovery, heart function can be evaluated with a treadmill test, cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).

India was an agrarian society where villagers laboured hard in the fields from sunrise till sunset. People developed preventable infectious diseases and died young. Now, education has changed their lifestyle. Many villagers have migrated to cities. Tobacco use is rampant. Exercise is minimal. Food habits have changed, with precooked, high fat, fast food being consumed as the norm. The consumption of fresh fruits and vegetables is minimal.

Many apparently healthy, young, adult males lead sedentary lifestyles. They work long hours and do night duty in an attempt to succeed in their profession. Though many offices have gyms, they are underutilised due to lack of awareness and time, and fatigue. Their weight gradually creeps up. They deposit fat around the stomach. In no time at all, their waist measures more than the ideal 32 inches and the BMI (weight divided by height in meter squared) is more than 25.

Food habits are often bad, with irregular eating times and dependency on oily fried snacks and trans fat filled fast food. Chronic lack of sleeps causes the blood pressure to go up. All this may precipitate diabetes and cause a deranged lipid profile. These abnormalities may be missed as no check ups are done. Many young men decide to have their first check up at 40 when it may already be too late.

Many are smokers, which adds substantially to the risk. Other precipitating factors are sudden emotions as while watching sports, excessive alcohol consumption, heavy fatty meals or sudden unaccustomed physical effort.

To prevent sudden death from a heart attack, the habit of aerobic exercise should be inculcated in children from first grade itself. This should be continued into adult life and in the work place. If you cannot spare an hour, or the recommended 150 minutes a week, run quickly up the stairs and down again slowly for 10 minutes a day. Avoid smoking and excessive binge drinking. Pay attention to your diet and consume 4-6 helpings of fresh fruits and vegetables daily.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in