leg pain

Treat leg pain with RICE

YOUR HEALTH — ?Dr Gita Mathai Aug 15, 2018 00:00 IST

As we age, one or both of our legs can pain. A slip or fall or even an awkward step can sprain the ankle. It bears half the weight of the upright body but is a relatively weak joint. If the ligaments are strained, swelling and pain occur. If the ligaments are torn, there may be bruising as well. The R.I.C.E. treatment (rest, application of ice every 20 minutes, compression with an elastocrepe bandage and elevation ) for 2-3 days will usually work. Medication such as paracetamol and ibuprofen help relieve the pain. If there is no improvement after three days, a fracture may have occurred.

If you have an active lifestyle, you can develop a sudden severe pain on the inside of the leg called "shin splints". It is more likely to occur if you have flat feet or use footwear unsuitable for activity or if muscles around the bone are overused. They can be relieved with ice packs and elevation of the legs. If shin splints are persistent, a stress fracture (hairline fracture) may have occurred.

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Varicose veins appear as bluish swellings on the legs, usually on both sides and cause a dull, throbbing pain. They occur if valves in the veins are weak, making it difficult for blood to be pumped back into the heart from the legs. They are usually seen in people whose BMI (weight divided by height in metre squared) is greater than 30, in women during pregnancy or in those who sit or stand long hours for work. Wearing compression stockings, exercise and losing weight help.

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Cramps occur as a sharp, unbearable pain, usually in the calf muscle. The muscle becomes tight and forms a hard lump which can be felt under the skin. It can be relieved by stretching and massage. It occurs with dehydration and lack of sodium or calcium. It usually goes away on its own. Recurrent cramps need medical evaluation.

Sciatica is a sharp shooting pain that extends from the lower back down the thigh, usually on one side. It is due to a slipped or herniated vertebral disc impinging on the nerves to the leg. It usually improves with OTC medication and physiotherapy. If it is persistent and incapacitating, surgery may be required.

Peripheral neuropathy may damage nerves in the thighs and feet. They may exhibit pricking or shooting pains that get worse at night. It is usually because of vitamin deficiencies, infections, nerve damage or diabetes. Treatment of the underlying cause is required in addition to specific medication.

If along with the pain in the legs there is swelling, change of colour in the overlying skin, fever, or no improvement after three days, a physician should be consulted.

water requirements

The liquid of life
Your health
Dr Gita Mathai Jun 27, 2018 00:00 IST

Illustration: Suman Choudhury
Water makes up 75 per cent of the body weight of an infant and 55 per cent of an adult. Our body is composed of multiple complex cells which contain enzymes, electrolytes and electrical charges. All these function only in the presence of water. "Fasting unto death" (for political or religious reasons) will take two months if only food is avoided. It will take seven days or less if water is also withheld.

The exact amount of water required for healthy existence has not been accurately studied. Roughly, the amount required varies with age from around 700ml (1 cup=250ml) a day for infants to 3.8 litres (16 cups) for lactating women. Not all this fluid has to come from water.

Infants get much of their fluid requirement from milk. The electrolyte composition of breast milk is ideal for babies. Any tinned formula has to be reconstituted precisely as advised (usually one flat scoop for 30ml of water) Adding more or less powder will cause variations in the electrolyte composition. The sodium content can go up and down (hypo or hypernatremia, respectively), as the infants immature kidneys cannot regulate this effectively. After weaning, water comes from food, juices and, later in life, from tea and coffee.

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The amount of water an adult needs depends on body composition (muscle:fat) outside temperature, humidity and level of activity. A labourer or marathon runner requires more fluids than a sedentary office worker. Before a workout, drink two cups of water to hydrate yourself. An active workout requires one cup of water every 20-30 minutes.

Older people may not be able to regulate their fluid intake relying on thirst alone. They may need to consciously drink water. School and college going youngsters (particularly girls) may suppress their thirst as they do not wish to use the restroom.

High coloured urine does not necessarily mean dehydration. The colour may be due to natural colours or additives in the food.

You can overhydrate by drinking too much water. This results in low sodium or hyponatremia. Headache and fatigue can be followed by muscle spasms or convulsions. Sportspersons can prevent this by adding a pinch of salt to their water or consuming isotonic sports drinks.

Dehydration is more dangerous. Concentration becomes poor, reaction time is increased, learning, memory, and retention are poor, and there may be mood swings. As dehydration progresses, organs can shut down, resulting in death.

Women should be conscious of their fluid intake during pregnancy as dehydration, especially in the last trimester, can precipitate urinary tract infections and premature labour. After delivery, good hydration means there is adequate breast milk for the baby.

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 to yourhealthgm@yahoo.co.in

memory

Aids to memory

YOUR HEALTH - DR GITA MATHAI Apr 18, 2018 00:00 IST

Forgetfulness is a terrible thing. In children, it leads to poor grades. In older people, it leads to mislaid keys and forgotten appointments.

Now, scientists have found the basis of memory, using fancy contrast scans. As new information was processed, they could observe new synapses being formed between the neurons. Repetition made these connections stronger.

These days, both adults and children watch a great deal of television. The objects on TV appear to move because of the unrealistically rapid pace at which they are projected. "Reading" these images overworks the synapses and depletes brain chemicals. As little as an hour of TV a day negatively impacts the processing and retention of information. In young children, it raises the chances of developing attention deficit disorder by 10 per cent.

These neurochemicals are reformed during sleep. Adults and children do not sleep the required 7 and 10 hours respectively at night. A gradual deficit builds up, making remembering difficult.

Just like the body needs physical exercise to stay fit, the brain needs intellectual stimulation. It also requires healthy food, such as fruits and vegetables. Smoking has a negative effect while alcohol, in quantities greater than 30ml a day for women and 60ml for men, can permanently shrink brain cells.

Stress depletes brain chemicals and prevents them from reforming. Music, yoga, prayer, meditation or even just taking 20 deep breathes at a time, three or four times a day, are effective for destressing.

Recall and retention become more efficient if things are written down and then repeated loudly. This is because the brain is then stimulated in all three directions - graphics, audio and visual. Also, break down complicated tasks into simple steps which can be focussed on one at a time. Written notes are a great aid to memory.

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 to yourhealthgm@yahoo.co.in

memory

tired

Tired? Blame the T cells

YOUR HEALTH - DR. GITA MATHAI Mar 21, 2018 00:00 IST

20

Illustration: Suman Choudhury

Have you been feeling tired, lethargic, short on energy and unable to complete daily chores? While these complaints are common in all age groups, they are more likely in older people, especially women. The tiredness can also is expressed as daytime drowsiness.

That inexplicable tiredness should not be dismissed out of hand. It is not a natural part of ageing and though fatigue may be a component of a psychiatric illness such as depression, this should not be presumed to be the case without ruling out a plethora of medical problems.

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In a small percentage of people - between 40 and 60 years of age and predominantly female - a mild flu can leave a debilitating fatigue which lasts for months. Despite investigations, no cause can be found. Till recently medical personnel did not take this seriously but now it has been identified as "chronic fatigue syndrome". A diagnosis is made if the condition has persisted for six months or longer. Exertion aggravates the symptoms, sleep is not refreshing despite long hours in bed, multiple muscles and joints pain but without redness or swelling. The head aches and a few lymph nodes may be enlarged.

The symptoms are now believed to be caused by an immune system malfunction, often following a trivial viral infection. The blood levels of cytokines are high, and the T cells needed to fight off infection function abnormally.

Treatment has to be individualised. Medications to treat pain, anxiety and depression, a healthy diet, vitamin supplements and sleep intervention are all helpful. Exercise has to be graded. "Pushing the limits" week by week, a little at a time, can help with the fatigue. Recovery is slow and may take a year or so. The important thing is to break up big jobs into little doable tasks, and to persist with the treatment.

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 to yourhealthgm@yahoo.co.in

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candida infection

Decoding candida

Your Health

Dr Gita Mathai Feb 14, 2018 00:00 IST

The commonest fungus that affects humans belongs to the candida species. That is why the infection is called candida or thrush.

We are usually resistant to a thrush infection because of our natural immunity. Babies, the elderly and people whose immunity is compromised by HIV infection, cancer or treatment with steroids are unable to withstand the infection.

The spores thrive in the mouth, vagina, penis, and in the sweaty folds of the body - in the armpits, under the folds of the breast, in the groin and diaper areas of babies. They can grow rapidly, causing the area to become inflamed, red, scaly and itchy.

In the mouth and vagina, thrush is visible as curdy white patches that cannot be scraped off. It makes the foreskin of the penis inflamed and cracked. There may be a foul odour. Scratching causes the organism to be deposited under the nails and transported to other areas.

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Prolonged sucking on pacifiers and bottle nipples can cause micro trauma to the mucous membrane of the mouth in babies, enabling candida to get a foothold. If the infant is on antibiotics, the protective microbes in the mouth can get suppressed, causing an overgrowth of candida. The infection can occur in breast-fed infants also and may be passed back and forth from nipple to mouth.

Diapers can promote the overgrowth of candida. The diaper area may be covered with red splotches or be scaly. It can occur because the baby is left in the soiled diaper too long or the baby or mother is on antibiotics.

Local applications of anti-fungal solutions or creams are usually all that is required for the infection to clear up.

Natural probiotics (like a tablespoon of curd) on an empty stomach in the morning will help to repopulate the body with good bacteria and prevent overgrowth of fungus.

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 to yourhealthgm@yahoo.co.in

feeding children

To feed or not to feed

Your Health

Dr Gita Mathai Jan 31, 2018 00:00 IST

The human race varies in shape and size, unlike articles manufactured on a conveyor belt. As people look around, they worry about this difference in weight. Parents are perturbed by thin children, and want them to gain weight. Actually, both ends of the spectrum — very thin and very fat (BMI over 30 or under 18.5) — can face health problems and need help.

Obesity, which once seemed a problem of developed countries, has arrived with a bang in India. We are now home to 3.7 per cent of obese men (around 9.8 million) and 5.3 per cent (around 20 million) of obese women in the world. India also has 40 per cent of the global underweight population. About 42 per cent of our children below the age of 5 are thin. 
Being over or underweight is not just an aesthetic problem — obesity is associated with lifestyle diseases such as diabetes, hypertension, arthritis, stroke and an increase in the incidence of many cancers.

Being “thin” may result in stunted growth in children as well as failure to attain their full physical and mental potential. In underweight people all age groups, essential nutrients like amino acids, vitamins and minerals may be deficient. This may produce inadequate muscle mass, weak osteoporotic bones and anaemia. The immune system may not function efficiently so that frequent infections are common. Underweight women are more likely to suffer miscarriages during the first three months of pregnancy. Children carried to term are likely to be underweight and anaemic.

A low BMI can be normal in a person genetically predisposed to be thin. It can occur with infections such as tuberculosis, cancer, untreated diabetes, an overactive thyroid gland, gastrointestinal and liver disease.

People can also have emaciation, an extreme form of  low weight with a gaunt appearance, loss of subcutaneous fat and lack of energy. It is caused by severe calorie restriction. The starvation may be due to poverty, infestations with intestinal parasites, malignancy and infections. It can be due to psychiatric illness or eating disorders like anorexia nervosa.

Parents worry about children who look thinner than their peers. Babies should ideally double their birth weight at the end of the fifth month and triple it by the first birthday. A child who was 2.5kg at birth should be 7.5kg on their first birthday. One who was 3.5kg at birth will be 10.5kg. Although both are normal, one child will appear bigger than the other. After the first birthday, 2-3 kilos are gained a year till puberty, when there is a growth spurt. Weight gain depends on the appetite, which in turn is controlled by a centre in the brain.

Most of the time, children spontaneously regulate their appetite and instinctively know how much food should be consumed. This mechanism fails if there is force feeding, if the child is a finicky eater who does not like the food, or if there is stress and conflict while eating. Allergy to milk or other food may cause stomach pain and refusal to feed. There may be undiagnosed gastrointestinal reflux.

The value of exercise cannot be underestimated. At any age, 60 minutes of continuous physical activity will help to control weight, working off the excess calories in the obese and increasing the appetite in the underweight. 

EAT RIGHT 

•  By the age of two, children should be eating the same things as the rest of the family

•  Meals should be eaten at fixed times

•  Food should be eaten at one place, the dining table, and not all over the house or in front of the television

•  Force feeding, scolding and beating should be avoided to reduce stress

•  Children require six meals a day as their stomach size is small

•  Avoid more than 400ml of milk per day

•  Avoid sugar-laden snacks

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 to yourhealthgm@yahoo.co.in