The 6 pack

Six pack abs

	Your Health   DR GITA MATHAI

Gone are the days when a paunch, a plump wife and a couple of well-fed children were signs of success. The "now " generation follows the fashion trends of its idols (the Khan brigade of Aamir, Shah Rukh, Salmaan and a few others in Bollywood) and everyone wants a six pack, or at least a four pack ab. Such ambition is not the prerogative of men alone. Women too want a midriff that can be bared and need not be concealed under voluminous folds of chiffon.

The concept is simple. Just strengthen the abdominal muscles and lose body fat. What could be easier?

The catch lies in putting the equation to action. If your job and personal monetary value rest on your appearance (as with models and movie stars), many hours a day can be dedicated to achieving and maintaining this goal. Personal trainers, physiotherapists, physicians and dieticians can be employed.

For most people, an hour a day is about all they can spare, and the household income will not support the services of additional helpers.

With patience, dedication and will power, a six pack is an achievable objective and the effort is well worth it. Your morale, and physical and mental health will improve. An added bonus — despite your age, heads will turn.

The first step is often the most difficult — to get off the couch, put down the TV remote and start exercising.

When you eventually do get a six pack, the idea is that it should be seen and appreciated. This will not happen if it is hidden under a layer of body fat. Priority one is, therefore, to get rid of that flab. To do this, cardiovascular exercises like running, swimming, cycling, skipping or stair climbing for at least 20 to 30 minutes have to be combined with muscle training. Ideally the cardiovascular exercise should be performed after weight training. Having a light tea or coffee before starting also kick starts the metabolism.

Weight training increases muscle mass, calorie consumption at rest and reduces flab. Around 20 repetitive movements with a light weight (1-5kg) for each group of muscles is usually sufficient. This will not result in huge bulging muscle masses as in body builders.

Abdominal exercises have to be repeated at least every other day to maintain muscle tone. Exercises involve lying on the floor with the knees bent and then trying to touch the knee with the nose, bringing the knee up to touch the nose or moving both together simultaneously to meet in the middle. Start with 20 repetitions and eventually work up to 500 of each exercise set, increasing the number done only once a week. The most efficient abdominal exercise is cycling in the air.

While performing any manoeuvres, protect the neck. Do not attempt to place the fingers behind the head and pull up using arm strength. Place the arm across the chest or else place just the tips of the fingers behind the ears. Also, make the movements smooth and fluid. Jerky jack knife movements can injure the lower back.

Exercise does not really have to be a "no pain, no gain" process. Activities like flexing, stretching, clenching and unclenching the stomach while sitting behind a desk (especially if your job is sedentary) will effortlessly go a long way to achieving a flat stomach.

The abdominal machines advertised on television are really not worth the money. Similar results can be achieved with persistence. Targeting just a specific area of your body and doing exercises only to reduce fat from that particular region does not work. Dieting, exercising and working out have to be combined to get the ideal shape. Space out calories in 3-4 meals instead of missing a meal altogether. Try eating a fruit or drinking a large glass of water before a meal. Both will curb the appetite and offer health benefits as well.

Snacking on high calorie foods is unhealthy and silently adds to the number of calories consumed. Even when the meals actually eaten are small, there is no weight loss and the paunch remains. A written record of the food eaten and exercise done will help to keep a reality check on intake and output.

Many supplements (pills, powders, liquids) are advertised as the magic cure for increasing muscle mass and/or weight loss. They are expensive and the claims misleading. Thyroid tablets (to increase the metabolism) and anabolic steroids (for muscle) or diuretics (to lose water) are dangerous. There are specific appetite suppressant drugs that can be taken under strict medical supervision. Adjuvants will work only if combined with diet and exercise.

Everyone has an opinion on diet, exercise and body sculpting. Listen to these opinions, settle on a routine that works for you, and, remember, working out is like having a job. You cannot "take off" too many days without losing out.

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

The Great Depression

The great depression

	Your Health   DR GITA MATHAI

Feeling down and blue? That's not surprising — the economy is down, jobs are scarce, people are being laid off and the stock market has collapsed. What could be worse?

When events over which people feel they have no control occur, or when they are inevitable but unpleasant, people say, "I am depressed." They feel down and out. Depression can be medically diagnosed not merely when changes in outlook and mood negatively affect behaviour, thinking and normal functioning, but only if they have lasted two weeks or longer.

Depression appears to be a nebulous entity, "all in the head", and is often summarily dismissed as just that. In a way it is true, because medically, depression occurs when the neurotransmitters — chemicals responsible for carrying messages in the brain — are unbalanced and out of sync. It can start in childhood, but usually becomes obvious between the ages of 25 and 44. This is a time when the external stresses of life are at their peak. It probably results from a combination of genetic, biochemical, environmental and psychological factors.

The onset of depression appears with the insidious onset of vague sadness, irritability, anxiety, fatigue, loss of energy, altered eating habits with weight gain or loss and decreased concentration. Physical symptoms like headache, digestive symptoms and vague aches and pains may set in. None of these, on investigation, entail identifiable diagnostic abnormalities, nor do they respond to conventional medical treatment. Subconscious attempts by the individual to artificially boost one's mood may manifest as drug or alcohol abuse. It may remain unrecognised by family, peers and society until there's a suicide attempt.

The Greeks had a name for long lasting depression. They called it "dysthymia", a diagnostic term still in use. The symptoms of dysthymia are mild and last from 3-5 years. Affected people are always sad, pessimistic, socially withdrawn and unproductive. Major depression, on the other hand, shows negative mood changes that may be overwhelming. This, if untreated, can last from six months to one and a half years. A combination of stressful situations leads to a type of depression called an "adjustment disorder". Manic-depression or bipolar disorder results in extreme mood swings, alternating between sadness and withdrawal and reckless mood elevation, insomnia, increased libido and grandiose ideas.

All types of depression are more common in women. Hormonal changes in women — pre-menstrual and during menopause and childbirth — directly alter the neurotransmitter ratios in the brain and make them vulnerable to depression. A particular type, called post partum (after childbirth) depression, is peculiar to women.

Depression is not a normal or inevitable part of ageing. Depression can set in with age, as a result of external causes like financial insecurity, illnesses and loss of a spouse, or physical factors like atherosclerotic blood vessels with compromised blood flow to the brain.

Children and adolescents can also develop depression. They feign illness, refuse to go to school, sulk, get into trouble, or are disruptive, negative and irritable.

Depression must be treated before it spirals out of control. Treatment with psychotherapy (talking) and medication leads to 80 per cent recovery and normal productive lives.

Antidepressants must be taken regularly for three to four weeks before the full therapeutic effect appears. The medication should then be continued for the time specified by the doctor, despite apparent improvement, to prevent a relapse.

If you are depressed:

Feelings of tiredness and hopelessness are part of depression and, even though it may be difficult, go to a therapist and begin treatment.

 • Engage in regular physical exercise. The chemicals released during the activity will cross the blood brain barrier and elevate your mood. Physical fitness is a great morale booster.

 • Go to a movie, or visit a friend.

 • Participate in religious, social or cultural activities.

 • Set realistic goals.

 • Large tasks may appear formidable and insurmountable, but can be completed if broken into smaller ones, and then prioritised without guilt.

Try to spend time with other people and speak to a trusted friend or relative. Isolating yourself prevents others from reaching out to you.

It is better to postpone life-altering decisions like marriage, divorce or a job change till the depression lifts.

Mood improves gradually. It does not become elevated overnight, nor is it possible to "snap out" of depression. Improvement is often as insidious as the onset. Sleep patterns revert to normal and appetite becomes normal even before the mood lifts. Positive thinking replaces negative thoughts as the depression starts to respond to treatment.

Those around depressed souls also need to be conscious. They can help by listening to them, providing encouragement and not making demands that may heighten their sense of failure. Any reference to suicide is a red flag — an appeal for help and urgent intervention. It must be taken seriously.

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

Snoring? It is a cinch!

 

"Blow into the didgeridoo" said the article in the February 4th issue of the BMJ (British Medical Journal) with a photograph of a middle aged man blowing into a strange wind instrument. Studies had proven that people who played this instrument for 25 minutes a day not only snored less, there was also a decrease in their sleep apnoea episodes.

 

Snoring is seldom heard by the perpetuator (who often vehemently denies the accusation). It is a complaint voiced by long suffering family members sharing the same living space.

 

A few years ago, snorers were not taken seriously and were the butt of unkind jokes. All that changed now, and snoring is considered a serious medical disorder. It has been found to be a forerunner to dangerous obstructive sleep apnoea. These are repeated episodes of cessation of breathing occurring during deep REM (rapid eye movement) sleep in the night. The diagnosis is confirmed if 15 or more episodes occur during the course of an hour. The person does not waken when this occurs. Instead the start and stop pattern of breathing leads to exacerbation of hypertension leading to heart attacks and sudden death, usually at night. `

 

Obstructive sleep apnoea is suspected if there is :

Loud snoring

Day time drowsiness

Choking at night

Morning headache

 

It is possible to distinguish between normal drowsiness, tiredness, simple snoring and dangerous sleep apnoea using an "Epworth" sleepiness scale.

Grade answers to pertinent questions with :

0 for never dozing

1 slight chances

2 moderate chances

3 high chances.

 

Add the score with answers to the questions:

Would you drop off to sleep

While watching TV

Sitting in a meeting

Riding in a car continuously for an hour

Lying down in the after noon

Sitting quietly after lunch

In a car at a traffic light

 

A score of 1-9 is normal

12-16 severe obstructive sleep apnoea

 

 

 

 

More and more Indians suffer from obstructive sleep apnoea, placing them in danger of sudden death. This is because our lifestyles have changed. India is moving up globally at a fast pace.

 

The boom in our economy has come at a price. MNCs employ our MBAs and other graduates at unimaginable salary scales. In private family owned businesses and in the public sector employees have to produce results. We have also acquired the diseases associated with this new lifestyle, Stressed out executives are unable to lead a regular life. They seldom have the time to exercise. Travel upsets their circadian rhythms and they do not to sleep well. Eventually, they tend to fall asleep in important meetings, or while driving. All this cuts into their productivity and the sharp cutting edge thinking process of their brains.

 

To cater to the requirements of this subset of patients "sleep labs" have sprung up in the major metros. For a fancy price, they will analyze your sleep patterns and diagnose either simple snoring or sleep apnoea.

 

A fortunate 30 % have correctable causes. Surgical removal of enlarged tonsils, adenoids, nasal polyps or correction of a nasal deformity removes mechanical obstructions to breathing. Others are in the habit of drinking alcohol or taking medications like sedatives and tranquillizers. All these depress the respiratory centre in the brain.

The remaining 70% will have some improvement if they loose weight. A BMI (Wt in kg / ht in m2) more than 30 needs regular dieting and exercise. Till the ideal weight is achieved CPAP(continuous positive pressure ventilation) through a nasal mask prevents the oxygen saturation from falling below danger levels.

 

Many anti snoring devices like a T-shirt with a tennis ball sewn in the back, especially designed pillows, neck braces and tongue depressors are advertised. Their efficiency is debateable and anecdotal.

 

Turning the snoring person to one side also helps.

 

Until the didgeridoo study sufferers were not really offered viable options. Now simply practising blowing into this instrument for 25-30 minutes a day has produced tremendous documented improvement. This can be done while travelling to and from work.

 

It is possible to substitute the didgeridoo with a football bladder available in sports shops, or an inexpensive bamboo flute sold on the streets. If the flute is used it makes sense to block the openings so that a loud irritating sound is not produced.

 

A simple solution to a complex dangerous and irritating problem!

 

Attention cat lovers

People are cat lovers, dog lovers, bird fanciers, or those who hate all pets.

 

Dogs are leashed, confined and controlled. Cats may be collared but they are never leashed or chained. They roam free, nimbly climb stairs, and reach high ledges.

 

Aware that dog bites can cause rabies and death, people, if bitten, immediately seek medical advice and treatment. Cats and dogs belong to the same mammalian species and are branches of the same family tree. Public awareness about the dangers of cat bite is minimal. Pet cats are hardly ever immunized. Their owners do not take bites or scratches (accidental or intentional) very seriously.

 

A domesticated and docile cat can revert to its "wild ways" and "tom-cat" on certain days. Cats (even well fed ones) occasionally attack, kill and eat other animals. They are territorial and can ferociously defend their perceived living space from other cats. These battles leave them injured, wounded and scarred. They can acquire rabies during these forays, because of the close contact with other infected cats or dogs. After infection, cats can also harbour the dreaded rabies virus and may become asymptomatic carriers. Unlike dogs, cats rarely exhibit the classic form of rabies and become furious biters. Instead, they tend to develop the passive form, remain silent and withdrawn but infective, until they die.

 

Domesticated cattle often harbour cysts of the organism known as "Toxoplasma gondii". Cats eat the raw carcasses or placenta of these animals even if they are well cared for. Cats then acquire the infection but remain asymptomatic. They shed the potentially infective oocytes of the organism into the environment. Floors of houses or any other surface on which infected cats sit and groom themselves become contaminated. Oocytes remain in the dormant form for years until they are accidentally swallowed.

 

Children are particularly susceptible both because of their age and their propensity to touch contaminated surfaces and then their mouths. Almost 4% of the adult population has had asymptomatic infection with demonstrable antibody level.

 

This infection is dangerous if acquired in pregnancy as they can transmit the infection (via the placenta) to the foetus. It can affect the developing brain producing a small head, retardation blindness and deafness.

 

The Egyptian royal family (pharaohs) eventually became extinct after many members died young or were born deformed with small microcephalic heads. Many suffered from seizures. These are classical symptoms of Toxoplasma gondii infection. Historians now theorize that part of the problem was caused by their propensity to live with cats. Cats were worshiped in ancient Egypt and reared by the royal family. Killing a cat was a serious offence punishable by death.

 

Almost 75% of cats carry pasteurella bacteria in their mouths and can these contaminate bites. Unless wounds are cleaned thoroughly with hydrogen peroxide solution followed by an antibiotic ointment (Neosporin, Bacitracin) antibiotics may be required.

 

Fleas and ticks live on cats until they are manually removed by the owner. These fleas can jump on to other convenient warm-blooded hosts (man). This causes itchy red lesions. These can be mistaken and treated as a frustratingly recurrent eczema which remains unresponsive to treatment. The fleas also harbour the bartonella species of bacteria and this can cause "cat scratch disease" with fever body ache and enlarged lymph nodes.

 

Cats have diarrhoea caused by the same viruses and bacteria as humans. Their excreta contaminate the environment and may dry unnoticed in areas of the house transmitting the infection.

 

Tonsillitis in humans and cats is caused by identical group of streptococcal bacteria. The disease is mild in cats but can be severe, persistent, recurrent and unresponsive to treatment in children and immunocompromised adults.

 

Panic occurred among many cat owners when they read that the H. pylori bacteria implicated in stomach ulcers and cancer is found in cats and can spread from them to humans. H. pylori is a familial infection commoner in cat rearing families.

 

Mycobacteria (TB group) species, typical and atypical can cause disease in cats and be transmitted to humans. This is likely to occur in immunodeficient (HIV) individuals or in young children.

 

Small pox has been eradicated in the world, but cow pox is still present and transmitted by cats. It can cause fever and rash with a similar confounding appearance in humans particularly children.

 

Diseases caused by cats are serious in children, pregnant women and immunocopromised (HIV, cancer) adults. The diagnosis may be missed as patients, unaware of the serious implications, fail to mention feline contacts to the treating physician.

 

Attention "cat lovers",

Immunize your cat, yourself and your family

Treat all illness in the cat promptly

Do not allow cats to sit on areas used for food preparation

Do not feed cats from your plate

Wash hands after contact with cats

Swab the house with a disinfectant solution

 

Better safe than sorry.

 

 

People are cat lovers, dog lovers, bird fanciers, or those who hate all pets.

 

Dogs are leashed, confined and controlled. Cats may be collared but they are never leashed or chained. They roam free, nimbly climb stairs, and reach high ledges.

 

Aware that dog bites can cause rabies and death, people, if bitten, immediately seek medical advice and treatment. Cats and dogs belong to the same mammalian species and are branches of the same family tree. Public awareness about the dangers of cat bite is minimal. Pet cats are hardly ever immunized. Their owners do not take bites or scratches (accidental or intentional) very seriously.

 

A domesticated and docile cat can revert to its "wild ways" and "tom-cat" on certain days. Cats (even well fed ones) occasionally attack, kill and eat other animals. They are territorial and can ferociously defend their perceived living space from other cats. These battles leave them injured, wounded and scarred. They can acquire rabies during these forays, because of the close contact with other infected cats or dogs. After infection, cats can also harbour the dreaded rabies virus and may become asymptomatic carriers. Unlike dogs, cats rarely exhibit the classic form of rabies and become furious biters. Instead, they tend to develop the passive form, remain silent and withdrawn but infective, until they die.

 

Domesticated cattle often harbour cysts of the organism known as "Toxoplasma gondii". Cats eat the raw carcasses or placenta of these animals even if they are well cared for. Cats then acquire the infection but remain asymptomatic. They shed the potentially infective oocytes of the organism into the environment. Floors of houses or any other surface on which infected cats sit and groom themselves become contaminated. Oocytes remain in the dormant form for years until they are accidentally swallowed.

 

Children are particularly susceptible both because of their age and their propensity to touch contaminated surfaces and then their mouths. Almost 4% of the adult population has had asymptomatic infection with demonstrable antibody level.

 

This infection is dangerous if acquired in pregnancy as they can transmit the infection (via the placenta) to the foetus. It can affect the developing brain producing a small head, retardation blindness and deafness.

 

The Egyptian royal family (pharaohs) eventually became extinct after many members died young or were born deformed with small microcephalic heads. Many suffered from seizures. These are classical symptoms of Toxoplasma gondii infection. Historians now theorize that part of the problem was caused by their propensity to live with cats. Cats were worshiped in ancient Egypt and reared by the royal family. Killing a cat was a serious offence punishable by death.

 

Almost 75% of cats carry pasteurella bacteria in their mouths and can these contaminate bites. Unless wounds are cleaned thoroughly with hydrogen peroxide solution followed by an antibiotic ointment (Neosporin, Bacitracin) antibiotics may be required.

 

Fleas and ticks live on cats until they are manually removed by the owner. These fleas can jump on to other convenient warm-blooded hosts (man). This causes itchy red lesions. These can be mistaken and treated as a frustratingly recurrent eczema which remains unresponsive to treatment. The fleas also harbour the bartonella species of bacteria and this can cause "cat scratch disease" with fever body ache and enlarged lymph nodes.

 

Cats have diarrhoea caused by the same viruses and bacteria as humans. Their excreta contaminate the environment and may dry unnoticed in areas of the house transmitting the infection.

 

Tonsillitis in humans and cats is caused by identical group of streptococcal bacteria. The disease is mild in cats but can be severe, persistent, recurrent and unresponsive to treatment in children and immunocompromised adults.

 

Panic occurred among many cat owners when they read that the H. pylori bacteria implicated in stomach ulcers and cancer is found in cats and can spread from them to humans. H. pylori is a familial infection commoner in cat rearing families.

 

Mycobacteria (TB group) species, typical and atypical can cause disease in cats and be transmitted to humans. This is likely to occur in immunodeficient (HIV) individuals or in young children.

 

Small pox has been eradicated in the world, but cow pox is still present and transmitted by cats. It can cause fever and rash with a similar confounding appearance in humans particularly children.

 

Diseases caused by cats are serious in children, pregnant women and immunocopromised (HIV, cancer) adults. The diagnosis may be missed as patients, unaware of the serious implications, fail to mention feline contacts to the treating physician.

 

Attention "cat lovers",

Immunize your cat, yourself and your family

Treat all illness in the cat promptly

Do not allow cats to sit on areas used for food preparation

Do not feed cats from your plate

Wash hands after contact with cats

Swab the house with a disinfectant solution

 

Better safe than sorry.

 

 

The pain of wisdom

The pain of wisdom
By Dr. Gita Mathai

EVERYONE knows that wisdom comes with age and maturity. That is why in all languages and cultures, the belated appearance of the last molar is equated with the accrual of wisdom. In Europe, the word for this tooth is derived from the Latin root "dens sapientiae", meaning "far standing and wise".
Evolution has made our mouths smaller. We have invented implements to externally cut our food into smaller pieces. We do not need to tear at our food as it is mashed, minced and cooked to a comfortable edible texture. The net result is that most people have smaller jaw-bones that can comfortably accommodate 28 teeth. Once the last (third) molars appear, the mouth has 32 teeth. This makes for a very cramped and uncomfortable environment. The last four teeth (that make the total 32) have no space to erupt in nine out of ten people.

Sometimes the last or third molar does not appear it all. These lucky people have "hypodontia" or less than the normal number of teeth. Some unfortunate people have supernumery teeth (more than 32), they have a mouth obviously full of many teeth crowded together.

Wisdom teeth usually erupt around the age of 17-24 years. They actually start to develop by the age of 9-11 years as small sacs inside the jaw, behind the second molar. They then grow and the roots become firmly planted in the jawbone. By the early 20s, the crown of a wisdom tooth begins to emerge from the gum. By the time you hit 40, the roots of the wisdom teeth are solidly planted within the dense bone of the jaw.

All teeth (except the wisdom tooth) have two teeth on either side holding them in place. The last molar has no tooth behind it. Unable to find its way out upwards in a normal position, it may get totally stuck or "impacted". A sac that surrounds the impacted tooth can fill with fluid and enlarge to form a cyst. This enlargement can encroach on the jaw and erode the bone causing permanent damage to the adjacent teeth, jawbone and nerves. Infection can set it with pain and swelling. It can remain as a tumor-like swelling in the jaw.

Signs heralding impending impaction or eruption are pain, tenderness, swelling both inside and outside the jaw, bad breath and difficulty with eating and swallowing. There may or may not be fever. Initial rumbling symptoms tend to progress with shorter and shorter pain-free intervals.

Painkillers and antibiotics (if there is fever) can provide only a certain amount of relief. There are no miracle cures. Hoping for spontaneous recovery is an exercise in futility. The troublesome tooth has to be surgically tackled.

Choose a dental surgeon who speaks kindly and explains the procedure. Lignocaine (local anaesthetic) and a comforting speech go a long way towards easing pain and anxiety. The numb mouth cannot feel the pain as the extraction is done, but often the gut-wrenching crunches made by the implements can be heard.

Once the surgery is over, the worst is yet to come. As the local anaesthetic wears off, the pain kicks in. Ice packs applied to the outside of the cheek help with the pain. Do not be a hero. Take a few days leave and use painkillers liberally. Eat only soft solids and don not chew on the affected side. There may be some oozing of blood, so the mouth may need to be rinsed with slightly salted water.

In Korea, wisdom teeth are called "love teeth" and in Japanese, its name literally means "unknown to the parents".

They all have the right idea. For most young adults the eruption of the third molar occurs when they have just fallen in love or started life on their own, either in a job or marriage. As they handle this major painful, though not life threatening, illness on their own, they truly attain maturity and wisdom.

The writer is a paediatrician with a family practice. She can be contacted at gitamathai@yahoo.com

Aging India

Growing old gracefully

	YOUR HEALTH   DR GITA MATHAI
Nafisa Ali Sodhi, an epitome of graceful ageing

Indians haven't reached the stage of Methuselah (who, the Bible says, lived for 969 years), but our life expectancy has increased from 32 years in 1940 to 65 years in 2000. Seven per cent of the 1.1 billion Indian population is today over the age of 60. We now have better access to health care but can we look forward to fun, health, dignity, economic independence and a peaceful death?

Today children work far away from home, the joint family system is breaking down, and women (traditional care-givers) have joined the work force. The old have to fend for themselves.

They cannot afford to be ill as sickness is expensive. Preventive medicine and maintenance of health is, therefore, a priority.

Good vision and hearing prevent accidents, but unfortunately they are the first senses that fail. After the age of 60, 30 per cent of the people are unable to hear a conversation. Leaning slightly forward and turning to the right side does help initially, but eventually hearing aids may be needed. Eyes too should be checked regularly and defects corrected promptly.

The skin loses its elasticity with age, becoming dry and wrinkled. Itching and scratching cause mechanical injury and secondary bacterial infection. Apply a small quantity of a mixture of 500ml of coconut oil, 500ml of sesame oil and 100ml of olive oil half an hour before bath. Add a teaspoon of coconut oil to the bath water. Use a moisturising soap. Apply body lotion or baby oil after bath.

Despite good care, regular brushing and flossing, the teeth may become discoloured, brittle, and may decay and recede. Visit the dentist at least once a year.

Sleep becomes less relaxing with early waking up and relative insomnia. Extrinsic factors like a snoring spouse or frequent essential trips to the toilet may compound the problem. Intrinsic factors like reduction in the restful delta rhythm, depression, pain, anxiety and stress can be tackled with exercise, meditation, yoga and prayer instead of getting addicted to sleeping pills.

With age the heart and blood vessels become less efficient even in the absence of obvious diseases. The heart tends to get enlarged and the pumping action decreases. The blood vessels become less pliable and elastic. This can result in the swelling of feet, high blood pressure and heart failure. Restricting salt consumption to 5gm (one teaspoon in 24 hours) and avoiding salty fried food, pickles and chutneys will help alleviate this problem.

The digestive tract also slows down. When this is compounded with a decrease in fibre content of the food and insufficient fluid intake, constipation becomes a problem. The oesophageal sphincter becomes inefficient, allowing acid to regurgitate from the stomach, causing burning and chest pain. Digestive problems are aggravated by smoking, drinking, untimely meals or lying down immediately after food.

Bones weaken with age, arthritis sets in, flexibility is lost and muscle strength reduces. These can lead to pain, falls and fractures. Supplements of calcium (1.2gms/day), walking for 40 minutes a day, and strengthening and flexibility exercises will help.

If you have a chronic disease like diabetes or high blood pressure, regular health checkups are a must.

Men need an annual digital exam of the prostate and a PSA (prostate specific antigen) test to rule out cancer of the prostrate.

Women need a pelvic examination and a PAP smear starting at 35-40 years, repeated every three years.

A breast self examination should be done every month. A screening mammogram at 40 years, and then every two years after that, is needed to detect breast cancer early enough.

Annual haemoglobin, blood sugar, lipid profile, urea, creatinine and thyroid function tests are also needed.

A baseline chest X-ray will help detect tuberculosis, emphysema and cancer.

A baseline ECG should be done around the age of 50 years and then repeated every 2-3 years.

An annual faecal occult blood test helps detect colorectal cancer.

Flexible sigmoidoscopy/colonoscopy at 50 and every 4 years thence is advisable.

Bone densitometry evaluates the risk of osteoporosis. It should be done every 1-2 years after menopause.

Immunisation does not stop in childhood. After the age of 65 years, pneumococcal vaccine will help prevent pneumonia, and "flu" vaccine influenza. Both are debilitating and can be fatal in the elderly.

To age healthily, control your weight, blood pressure and diabetes, eat four to six portions of fruit or vegetables daily, do not smoke, avoid salt, drink alcohol in moderation, walk daily, maintain muscle strength and flexibility with exercise and sleep for six or seven hours a night.

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

Sex Sells

This column receives many queries about contraception, even if the latest article has nothing to do with sex.

Is this because, despite our exploding population, our push for family planning and our desire to propagate the one child norm, sex education is not yet an integral part of the school curriculum?

Our teenagers have inaccurate, incorrect and inadequate information about sex from folklore, peers, pornography and the internet.

Contraception is not really a licentious 20^th century notion. Nobody ever wanted to reproduce every time they had sex. Egyptian women inserted vaginal tablets made from mildly acidic substances, the French used a hair from a horse's mane and sometimes honey or oil was poured into the vagina soon after intercourse to prevent conception. The Chinese used the first female condoms, a cervical blocking cap made of oiled paper. The first male condoms were made of animal intestine and were used in the 17^th century.

These methods were unpleasant and inefficient, so the science of contraception evolved to produce the more reliable methods that we have today.

Women can prevent pregnancy by abstinence (not having sex at all). Timed intercourse is more popular than abstinence and is considered "natural.". The "safe period" when unprotected intercourse is least likely to result in a pregnancy is carefully calculated. Ovulation (release of the egg) occurs in women on the fourteenth day BEFORE the first day of the next period and that is the period of maximum fertility. Avoiding intercourse five days before and after this date decreases the chances of an unwanted pregnancy. This method can be combined with "coitus interruptus", when ejaculation is controlled and takes place outside the vagina.

Women do not function like machines. Menstrual cycles can suddenly lengthen or shorten, making this an unreliable method. Its efficiency can be increased by watching the consistency of the cervical mucous. This changes from clear and transparent to sticky and opaque in the safe period. The body temperature also rises by 0.5⁰ C during ovulation and this can be measured daily with a thermometer. All these methods require an understanding and compliant male partner. They are more successful in planning pregnancy than preventing it.

Oral contraceptive pills (OCPs) taken by women are safe, popular and reliable provided they are taken as prescribed, at the same time every day. They are combinations of synthetic estrogens and progesterones and are taken for 21 days at a stretch. Then there is a "pill free" interval of 7 days, during which menstruation occurs. Some companies provide a 28 day pack, in which the last 7 tablets are placebos. If a pill is forgotten two should be taken the next day. If there has been two or more pill free days contraception is not assured. The actual formulation of the various hormones in the pills marketed vary. The pill best suited to that particular individual can be prescribed. Pills are contraindicated in those with complicated diabetes, thrombo-embolism, sickle cell disease, cancer of any reproductive organ and undiagnosed vaginal bleeding.

Progesterone only pills are also available and can be used in women in whom estrogens are contraindicated. They are taken continuously with no pill free interval.

India has also developed a contraceptive tablet called centchroman which belongs to the SERM (Selective Estrogen Receptor Molecule) group of medications.

OCPs are very safe, can be taken for years, do not increase the risk of cancer or decrease with the chances of a subsequent pregnancy.

Long acting progesterone injections like medroxyprogesterone acetate or norethisterone acetate, can be given every 12 and 8 weeks respectively instead for women who cannot remember to take their tablets.

Alternatively, an IUD (intrauterine device) can be inserted and left in situ to prevent pregnancy for around 3 years.

Condoms, both male and female, if properly used from the beginning to the end of intercourse protect against both pregnancy and STD. Their efficacy is increased if they are combined with a spermicidal cream.

Accidents can occur and people may have sex first and remember contraception afterwards. The government has licensed the use of "emergency contraceptive morning after pills." They are effective if taken within 72 hours.

Abortion is legal in India and medical methods with mifepristone and misoprost can be used up to 49 days.

If the pregnancy is more advanced surgical methods like a suction or dilatation curettage are needed.

Permanent contraception can be achieved by surgical sterilization, a tubectomy in women and vasectomy in men.

Pregnancy can occur if contraception is not used during lactation, with irregular cycles or even if there has been prompt douching.

Responsibility for safe sex, rests with both partners. However, unfortunately it is the women who displays the obvious outward results of an unprotected sexual encounter.

Would men be more careful if they were the ones becoming pregnant?

Dr. Gita Mathai

The writer is a paediatrician with a family practice at Vellore.

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