Save your sanity
YOUR HEALTH
DR GITA MATHAI
A “sick” patient who goes for medical consultation does not always have a physical ailment that can be diagnosed and treated quickly. About 36 per cent of these patients suffers from mental illnesses, and of these 20 per cent has “somatisation” — that is, depression showing up as exhaustion, dizzy spells, intolerance to noise, tingling sensation, pain or insomnia. Their thoughts, emotions and behaviour are affected. They are always “sick”, and this makes it difficult for them to hold down a job or relate to people.
Serious mental illnesses (psychotic disorders) are present in 0.5 per cent of this population. Such people may suffer from schizophrenia, wherein they hear voices inside their head and which command them to do strange things. They may also be paranoid — that is, convinced that everyone (even close friends and family) is determined to harm them. Depression may cause them to become unproductive, addicted to alcohol or drugs, or have suicidal thoughts. Panic and anxiety can be so extreme that he or she is unable to leave home. Maniacal behaviour may cause reckless spending or sexual promiscuity.
Mental illness is a chronic disease, just like diabetes or arthritis. Unfortunately, it is not viewed as such. The patient and his or her family may conceal the illness because they are ashamed of it. They hope it is a passing phase brought about by “bad fate”, religious or moral transgressions, or is a result of witchcraft. If the patient is a catatonic schizophrenic — that is, remains immobile in a bizarre statue-like position for hours or even days — people around may not always understand the situation. Undiagnosed patients may be denied treatment and stigmatised, or even confined, chained or beaten.
Both men and women are prone to mental illness, but the spectrum of disease slightly differs in the sexes. Men are more prone to schizophrenia and women to depression. In addition, women suffer a specific type of depression called post natal depression (PND). This can set in one to six months after the birth of a child and can last weeks or months. During this time, women feel anxious, guilty and suicidal, as they are unable to cope with the baby. Unfortunately, though it is a self-limited treatable condition, it is often ignored. The patients are at times even accused of being “possessed” and treated by quacks.
Centuries ago, Hippocrates postulated that the brain is an organ with particular functions, just like the liver or heart, and that it is prone to disease and malfunction. Scanning techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have demonstrated that he was right. Blood flow to certain areas of the brain and its actual physical size differs in those with mental illnesses.
The heart responds to exercise with an increase in its rate. Similarly, the brain responds to life events with the release of chemical neurotransmitters such as dopamine, serotonin, noradrenaline, gamma-amino butyric acid and acetylcholine. An imbalance, the excess of any chemical, a change in the ratio or relative deficiency leads to gradations of depression, anxiety and schizophrenia.
Mental illnesses tend to run in families and have a genetic basis. Members carry genes that predispose them to neurotransmitter imbalances. The genes manifest themselves if the environmental factors are conducive. Children may be victims of abuse if one or both parents are mentally ill. They may witness alcoholism, other addictions or domestic violence. Discipline may be haphazard and academic performance unstructured and poor. This may predispose them to mental illness in later life.
If an unprovoked person suddenly becomes violent or starts talking gibberish, the diagnosis of mental illness is easy. In the early stages of mental illnesses — when the symptoms may be subtle — or in paranoid schizophrenics (who may be persuasive and appear rational in their delusions), the diagnosis is not so obvious. Conversations and interviews with the patient and relatives and verbal tests eventually lead the psychiatrist to the diagnosis. There are no confirmatory blood or imaging tests. It is a subjective diagnosis that requires expertise and years of training.
Mental illnesses may be difficult to treat, even in the best of hands. Drug combinations and dosages have to be individualised. Medication has to be continued long term. The neurochemicals in the brain take time to change, and hence the response is gradual and not dramatic. Relapses can occur, especially if dosages are missed. Psychotherapy (talking to the patient) and social rehabilitation have to take place simultaneously.
The duration of therapy and pace of improvement is often discouraging. It may make the relatives fall prey to charlatans who promise a “miracle cure”. However, their methods are unscientific and may cause harm. Religious organisations with untrained personnel are not a substitute for psychiatrists or psychotherapists. And last but not the least, marriage does not cure mental illness.
Mental illness can be prevented by —
• Early identification of problem behaviour
• Adequate social support and social networking
• Learning mechanisms for coping with stress
• Effective community care
• Physical fitness plays a positive role. A family that exercises for 40 minutes a day will be physically and mentally healthy.
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
Friday, July 24, 2009
Monday, July 13, 2009
fit to fly
Fit enough to fly
YOUR HEALTH
DR GITA MATHAI
Indians are on the move like never before. Families are scattered all over India and the globe and they travel to stay in touch. Airplanes are safe, despite the high flying altitude, relatively lower partial pressure of oxygen, variable air circulation, low humidity, sustained periods of noise, vibration and turbulence.
The rapid changes that occur during a flight (typically during descent) can give rise to ear pain, a blocked feeling, ringing in the ears, giddiness, hearing loss or even rupture of the eardrum. These complications are more likely if the Eustachian tube (connecting the ear and throat) is blocked by allergy, colds, sinusitis or middle ear infections. Chewing gum and frequent swallowing during descent can help ease the discomfort.
Decongestant nose drops will clear a blocked nose. Air travel should be avoided for 10 days if there has been a recent ear surgery or tonsillectomy.
Women often need to travel during pregnancy — as part of their jobs, because of transfers or simply to head home to have the baby. Air travel during pregnancy is safe and poses no special risks. Mid pregnancy, from the 14th to 28th week, is the safest time. In the case of multiple pregnancy (twins), a history of premature delivery, cervical incompetence, bleeding or increased uterine activity (irritable uterus), flying is inadvisable. If you need to be elsewhere for the delivery, it is better to leave before the 36th week or use an alternative mode of transport.
Most airlines refuse to allow pregnant passengers after the 36th week because of the fear that labour may set in during the flight. It is better to carry certified medical documentation about the expected date of delivery.
During pregnancy,
• the seat belt should be fastened under the abdomen, not across it;
• an aisle seat is preferable to facilitate visits to the toilet;
• try to get out of the seat every 30 minutes and walk a short distance;
• if this is not possible, flex and extend the ankles.
Babies should, preferably, not fly till they are at least seven days old.
There is a 10-day ban on air travel (not prohibited but inadvisable) after a stroke, brain surgery, an epileptic seizure, eye surgery or ear, nose or throat procedures.
Even in normal people abdominal gas increases by 25 per cent during air travel. A three to four week gap is advisable after abdominal surgery even if it is a “keyhole” or laparoscopic surgery as gas is introduced into the abdomen during the procedure. This extra gas can expand and cause the sutures to give way.
A person with congestive cardiac failure (when the heart does not function properly) should be stable for at least 10 days prior to travel.
In the case of a heart attack the person should have been stable for three to four weeks.
After pneumonia or chest surgery, a person should wait for three weeks. Even after this time they should be able to walk unassisted for at least 50 metres without becoming breathless.
Anaemia, with haemoglobin count less than 7.5 grams per decilitre, reduces the oxygen carrying capacity of blood. This can get critical during flights.
People with fractures can travel two days after the cast has been applied. In traditional casts air can be trapped between the cast and the leg. As this air expands during the flight, it can compress the limb and cut off blood supply. If a person needs to fly immediately, the doctor needs to be informed beforehand. A bivalved or split cast, which does not trap air, can be applied.
People with mental illness should be well controlled, on medication and preferably have a companion.
Diseases are spread from one country to another by infected travellers. In the recent swine flu epidemic, the spread of the disease could be plotted by tracking the flights out of Mexico (where the epidemic started).
People with open tuberculosis or measles should also defer travel. If a person has an infectious disease, travelling should be postponed until recovery. Infected air keeps circulating in a plane and this will result in the disease spreading.
The economy class has little legroom. The edge of the seat can compress the veins at the bent knee. Together with the forced immobility, blood pools in the legs and the feet swell. This can result in deep vein thrombosis and pulmonary embolism. Sudden unexpected death can occur hours or days after travel.
Generally, try to drink plenty of fluids and balance any alcohol consumed with an equal amount of water. Walk around the airport while waiting. Remember, the most dangerous thing to do is to sit still with your legs crossed.
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
YOUR HEALTH
DR GITA MATHAI
Indians are on the move like never before. Families are scattered all over India and the globe and they travel to stay in touch. Airplanes are safe, despite the high flying altitude, relatively lower partial pressure of oxygen, variable air circulation, low humidity, sustained periods of noise, vibration and turbulence.
The rapid changes that occur during a flight (typically during descent) can give rise to ear pain, a blocked feeling, ringing in the ears, giddiness, hearing loss or even rupture of the eardrum. These complications are more likely if the Eustachian tube (connecting the ear and throat) is blocked by allergy, colds, sinusitis or middle ear infections. Chewing gum and frequent swallowing during descent can help ease the discomfort.
Decongestant nose drops will clear a blocked nose. Air travel should be avoided for 10 days if there has been a recent ear surgery or tonsillectomy.
Women often need to travel during pregnancy — as part of their jobs, because of transfers or simply to head home to have the baby. Air travel during pregnancy is safe and poses no special risks. Mid pregnancy, from the 14th to 28th week, is the safest time. In the case of multiple pregnancy (twins), a history of premature delivery, cervical incompetence, bleeding or increased uterine activity (irritable uterus), flying is inadvisable. If you need to be elsewhere for the delivery, it is better to leave before the 36th week or use an alternative mode of transport.
Most airlines refuse to allow pregnant passengers after the 36th week because of the fear that labour may set in during the flight. It is better to carry certified medical documentation about the expected date of delivery.
During pregnancy,
• the seat belt should be fastened under the abdomen, not across it;
• an aisle seat is preferable to facilitate visits to the toilet;
• try to get out of the seat every 30 minutes and walk a short distance;
• if this is not possible, flex and extend the ankles.
Babies should, preferably, not fly till they are at least seven days old.
There is a 10-day ban on air travel (not prohibited but inadvisable) after a stroke, brain surgery, an epileptic seizure, eye surgery or ear, nose or throat procedures.
Even in normal people abdominal gas increases by 25 per cent during air travel. A three to four week gap is advisable after abdominal surgery even if it is a “keyhole” or laparoscopic surgery as gas is introduced into the abdomen during the procedure. This extra gas can expand and cause the sutures to give way.
A person with congestive cardiac failure (when the heart does not function properly) should be stable for at least 10 days prior to travel.
In the case of a heart attack the person should have been stable for three to four weeks.
After pneumonia or chest surgery, a person should wait for three weeks. Even after this time they should be able to walk unassisted for at least 50 metres without becoming breathless.
Anaemia, with haemoglobin count less than 7.5 grams per decilitre, reduces the oxygen carrying capacity of blood. This can get critical during flights.
People with fractures can travel two days after the cast has been applied. In traditional casts air can be trapped between the cast and the leg. As this air expands during the flight, it can compress the limb and cut off blood supply. If a person needs to fly immediately, the doctor needs to be informed beforehand. A bivalved or split cast, which does not trap air, can be applied.
People with mental illness should be well controlled, on medication and preferably have a companion.
Diseases are spread from one country to another by infected travellers. In the recent swine flu epidemic, the spread of the disease could be plotted by tracking the flights out of Mexico (where the epidemic started).
People with open tuberculosis or measles should also defer travel. If a person has an infectious disease, travelling should be postponed until recovery. Infected air keeps circulating in a plane and this will result in the disease spreading.
The economy class has little legroom. The edge of the seat can compress the veins at the bent knee. Together with the forced immobility, blood pools in the legs and the feet swell. This can result in deep vein thrombosis and pulmonary embolism. Sudden unexpected death can occur hours or days after travel.
Generally, try to drink plenty of fluids and balance any alcohol consumed with an equal amount of water. Walk around the airport while waiting. Remember, the most dangerous thing to do is to sit still with your legs crossed.
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
Monday, June 29, 2009
nail the problem
Nail the problem
Your Health
DR GITA MATHAI
Your fingernails are on public display, visible as you talk, eat and work. If you are a “nail biter”, your obsessive compulsive habit advertises to the world your stressful lifestyle. And bad nails do not sit well with designer clothes.
Nail biting (medical term, onychophagia) is a common habit. It helps relieve stress and cope with excitement and boredom. It is a habit learnt by observation and runs in families. About half of all children aged 10-18 bite their nails. A small number (three per cent), of which more are males, continue this habit into adult life. Nails become disfigured and the nail beds get damaged. This can result in infection. The habit has to be consciously stopped. Difficult? Try painting the nails with a bitter nail polish.
Nails are very strong and are composed of three multicellular layers of tissue sealed together. They can be cut across but not lengthwise. Since they grow daily — about a millimetre a week — most diseases affecting an individual are reflected in visible changes in the nails. Heavy metals and toxins become deposited in the nails and remain there till the nails grow out. Poisoning with lead, thallium and arsenic can be diagnosed this way.
Healthy nails are normally slightly curved upward. The shape changes and nails become spoon shaped in case of iron deficiency anaemia. With the correction of the deficiency, the nails become normal.
Twenty per cent of women suffer from a condition called brittle nails — when the nail plate is dry, delaminates (that is, splits into thin layers) and cracks easily. This occurs with iron deficiency anaemia and is aggravated if the hands are frequently immersed in water for prolonged periods. It can be corrected by taking iron supplements and moisturising the nail several times a day. Proprietary moisturisers — many of which are overpriced — are available in the market. A homemade preparation of 50 per cent jojoba oil and 50 per cent aloe vera or a mixture of 500ml coconut oil, 500ml sesame oil and 100ml olive oil can be used. They work just as well.
An exaggeration of the normal nail curvature is called clubbing. It makes the nails resemble a parrot’s curved beak. This is found in people who have emphysema, chronic lung diseases and heart disease. The nails may also be blue because of inadequate oxygenation of the blood.
Fingernails are normally smooth and shiny. They can develop multiple small dents or pits if there is a disease like psoriasis. As the disease is brought under control, the pits disappear.
Yellow nails can be because of diabetes. It can be normal in women who wear dark coloured nail polish for long periods of time. White nails occur in case of liver and kidney disease.
White lines or dots can appear on the nails of otherwise healthy individuals. Usually it is harmless. The dots may have been caused by injury to the nail bed. Since it is visible only after the nail grows out, the injury may have been forgotten and the patch may be a cause of concern. Dots can also appear in people with eczema or in nutritional zinc deficiency. Zinc is present in fish, chicken and whole grains. The daily requirement is 10-15mg. Supplements are freely available in vitamin and mineral capsules. A white line or a dark coloured line can occur as a result of injury to the growing cells in the nail bed. This marks the date of an illness or a course of antibiotics.
Fungal infections can occur in the nail. Then the nail becomes separated from the underlying skin, starts to lift up and a crumbly white substance is seen underneath. Bacterial infections cause the nail to appear green. Diabetes also can cause either of these.
Cutting the nail too close to the skin can introduce infection. Salons offering manicures or pedicures sometimes do not sterilise their instruments properly. Small cuts and nicks during the procedure can introduce infections. Infections can be aggravated by immersion in water. A doctor should be consulted if there is sudden swelling or pain in the nails a day or two after a manicure.
Nails will reflect the underlying illness and this sometimes cannot be camouflaged even with nail polish. To strengthen normal nails, avoid infections and improve their appearance:
• Use rubber gloves when immersing the hands in water.
• Avoid nail biting or picking.
• Apply moisturiser to your nails and cuticles every day.
• File your nails in one direction and round the tip slightly, rather than filing to a point.
• Don’t remove the cuticles or clean too deeply under your nails.
• Don’t dig out ingrown toenails at home using unsterile blades and knives.
• Avoid nail polish removers that contain acetone or formaldehyde.
• Take your own instruments for manicures and pedicures.
• Eat a balanced diet with sufficient protein and vitamins.
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
Your Health
DR GITA MATHAI
Your fingernails are on public display, visible as you talk, eat and work. If you are a “nail biter”, your obsessive compulsive habit advertises to the world your stressful lifestyle. And bad nails do not sit well with designer clothes.
Nail biting (medical term, onychophagia) is a common habit. It helps relieve stress and cope with excitement and boredom. It is a habit learnt by observation and runs in families. About half of all children aged 10-18 bite their nails. A small number (three per cent), of which more are males, continue this habit into adult life. Nails become disfigured and the nail beds get damaged. This can result in infection. The habit has to be consciously stopped. Difficult? Try painting the nails with a bitter nail polish.
Nails are very strong and are composed of three multicellular layers of tissue sealed together. They can be cut across but not lengthwise. Since they grow daily — about a millimetre a week — most diseases affecting an individual are reflected in visible changes in the nails. Heavy metals and toxins become deposited in the nails and remain there till the nails grow out. Poisoning with lead, thallium and arsenic can be diagnosed this way.
Healthy nails are normally slightly curved upward. The shape changes and nails become spoon shaped in case of iron deficiency anaemia. With the correction of the deficiency, the nails become normal.
Twenty per cent of women suffer from a condition called brittle nails — when the nail plate is dry, delaminates (that is, splits into thin layers) and cracks easily. This occurs with iron deficiency anaemia and is aggravated if the hands are frequently immersed in water for prolonged periods. It can be corrected by taking iron supplements and moisturising the nail several times a day. Proprietary moisturisers — many of which are overpriced — are available in the market. A homemade preparation of 50 per cent jojoba oil and 50 per cent aloe vera or a mixture of 500ml coconut oil, 500ml sesame oil and 100ml olive oil can be used. They work just as well.
An exaggeration of the normal nail curvature is called clubbing. It makes the nails resemble a parrot’s curved beak. This is found in people who have emphysema, chronic lung diseases and heart disease. The nails may also be blue because of inadequate oxygenation of the blood.
Fingernails are normally smooth and shiny. They can develop multiple small dents or pits if there is a disease like psoriasis. As the disease is brought under control, the pits disappear.
Yellow nails can be because of diabetes. It can be normal in women who wear dark coloured nail polish for long periods of time. White nails occur in case of liver and kidney disease.
White lines or dots can appear on the nails of otherwise healthy individuals. Usually it is harmless. The dots may have been caused by injury to the nail bed. Since it is visible only after the nail grows out, the injury may have been forgotten and the patch may be a cause of concern. Dots can also appear in people with eczema or in nutritional zinc deficiency. Zinc is present in fish, chicken and whole grains. The daily requirement is 10-15mg. Supplements are freely available in vitamin and mineral capsules. A white line or a dark coloured line can occur as a result of injury to the growing cells in the nail bed. This marks the date of an illness or a course of antibiotics.
Fungal infections can occur in the nail. Then the nail becomes separated from the underlying skin, starts to lift up and a crumbly white substance is seen underneath. Bacterial infections cause the nail to appear green. Diabetes also can cause either of these.
Cutting the nail too close to the skin can introduce infection. Salons offering manicures or pedicures sometimes do not sterilise their instruments properly. Small cuts and nicks during the procedure can introduce infections. Infections can be aggravated by immersion in water. A doctor should be consulted if there is sudden swelling or pain in the nails a day or two after a manicure.
Nails will reflect the underlying illness and this sometimes cannot be camouflaged even with nail polish. To strengthen normal nails, avoid infections and improve their appearance:
• Use rubber gloves when immersing the hands in water.
• Avoid nail biting or picking.
• Apply moisturiser to your nails and cuticles every day.
• File your nails in one direction and round the tip slightly, rather than filing to a point.
• Don’t remove the cuticles or clean too deeply under your nails.
• Don’t dig out ingrown toenails at home using unsterile blades and knives.
• Avoid nail polish removers that contain acetone or formaldehyde.
• Take your own instruments for manicures and pedicures.
• Eat a balanced diet with sufficient protein and vitamins.
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
Monday, June 22, 2009
why fall?
When old, you’ll fall
Your Health
DR GITA MATHAI
Everyone falls, but this is most frequent at the two extremes of life: under the age of three and over the age of 70. In the interim, people fall less. Even if they slip, they can recover unscathed as their reflexes are better and they can get hold of something and correct themselves. In older people, with less muscle strength and a slower reaction time, falls are complete and dangerous. Seventy per cent of the elderly die as an aftermath of the first fall. Thirty per cent suffer fractures, sprains, head injuries or painful bruising. Sixty per cent of the survivors become “recurrent fallers” with three or more potentially fatal episodes during the next year. Even if recovery is complete, 90 per cent suffer from a psychological fear of falling, leading to fear of movement, loss of independence, poor quality of life and isolation.
Poor vision is a common cause of accidents. Ageing decreases vision. Perception of objects and adaptation to light and darkness are faulty. The eyesight should be checked every year, spectacles purchased and timely cataract surgery performed, if required.
Hearing too is essential for balance and safety. With age, in addition to the loss of hearing that occurs naturally, there may be a build up of hard earwax blocking the ear and affecting balance. Applying a few drops of baby oil to the outer ear canal regularly and not using ear buds (which may accidentally push the wax in) will go a long way to preventing this.
Body weight should be maintained so that the body mass index (BMI) — the weight in kilograms divided by height in metre squared — is 23. If it is less than 20, the chances of a fracture are greater, with no protective pads of fat to cushion the bones. If it is greater than 23, the chances of osteoarthritis and loss of balance are greater.
The elderly tend to walk slowly, stooping at the head and shoulders. Arm swing is decreased and there is more side to side movement. This leads to subtle alterations in the centre of gravity and a tendency towards loss of balance. The propioceptors (sensors that respond to stimuli) also react slowly, contributing to falls. To correct this, practise walking consciously correcting these defects. Also, stand with both legs planted firmly on the ground, close both eyes for a minute, and then balance on one leg with the eyes still shut. This helps in maintaining a sense of balance.
Footwear slips if it is too large, the straps are not firm and the soles are smooth. These defects have to be eliminated.
Bathroom floors can be slippery and treacherous. The tiles should be rough, not glazed and smooth. Handrails should be fixed near the toilet and shower to aid in getting up from the squatting position. Lighting in the bathroom should be bright and the switch near the door.
With ageing come diseases like arthritis, foot deformities, stroke, Parkinson’s and other tremors, epilepsy, dementia and peripheral neuropathy (numbness of the feet). These complicate other long-standing illness like diabetes and hypertension. Multiple diseases require treatment with a “polypharmacy” of drugs. These medications can contribute to giddiness and falls. Drugs for controlling high blood pressure may cause “postural hypotension”, a condition in which the blood pressure is apparently normal and well controlled on lying down but drops on standing. This is because the body does not compensate for the postural change and bring the pressure to normal levels quickly enough. Diabetic medication may cause sugar levels to drop precipitously, causing a loss of consciousness and a fall. Sometimes, elderly patients are placed on antidepressants or sedatives. They may fall off the bed, or, if they wake up suddenly in the night, they may be confused and disoriented.
The following risk factors triple the chances of a fall. Just remember “I hate falling”.
I — Inflammation of joints (or joint deformity)
H — Hypotension (orthostatic blood pressure changes)
A — Auditory and visual abnormalities
T — Tremor (Parkinson’s disease or other causes of tremor)
E — Equilibrium (balance) problem
F — Foot problems
A — Arrhythmia, heart block or valvular disease
L — Leg-length discrepancy
L — Lack of conditioning (generalised weakness)
I — Illness
N — Nutrition (poor; weight loss)
G — Gait disturbance
To estimate you’re chances of a fall, sit on a stool, get up without assistance, walk 10 steps, return to the stool and sit again within 10 seconds. If you can do this, your muscle strength, power and coordination are good and you are not likely to fall.
To prevent falls, exercise aerobically by walking 40 minutes a day. Balance can be improved with regular yoga. Exercise improves muscle and bone strength and dissipates the force of an impact during a fall. It lessens the chance of fracture by 60 per cent.
As the Indian population ages, we have to concentrate on measures to ensure that the elderly are not bed ridden and a burden to their younger caregivers. Be it at 50-60 or 80, age is no bar to exercising.
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
Your Health
DR GITA MATHAI
Everyone falls, but this is most frequent at the two extremes of life: under the age of three and over the age of 70. In the interim, people fall less. Even if they slip, they can recover unscathed as their reflexes are better and they can get hold of something and correct themselves. In older people, with less muscle strength and a slower reaction time, falls are complete and dangerous. Seventy per cent of the elderly die as an aftermath of the first fall. Thirty per cent suffer fractures, sprains, head injuries or painful bruising. Sixty per cent of the survivors become “recurrent fallers” with three or more potentially fatal episodes during the next year. Even if recovery is complete, 90 per cent suffer from a psychological fear of falling, leading to fear of movement, loss of independence, poor quality of life and isolation.
Poor vision is a common cause of accidents. Ageing decreases vision. Perception of objects and adaptation to light and darkness are faulty. The eyesight should be checked every year, spectacles purchased and timely cataract surgery performed, if required.
Hearing too is essential for balance and safety. With age, in addition to the loss of hearing that occurs naturally, there may be a build up of hard earwax blocking the ear and affecting balance. Applying a few drops of baby oil to the outer ear canal regularly and not using ear buds (which may accidentally push the wax in) will go a long way to preventing this.
Body weight should be maintained so that the body mass index (BMI) — the weight in kilograms divided by height in metre squared — is 23. If it is less than 20, the chances of a fracture are greater, with no protective pads of fat to cushion the bones. If it is greater than 23, the chances of osteoarthritis and loss of balance are greater.
The elderly tend to walk slowly, stooping at the head and shoulders. Arm swing is decreased and there is more side to side movement. This leads to subtle alterations in the centre of gravity and a tendency towards loss of balance. The propioceptors (sensors that respond to stimuli) also react slowly, contributing to falls. To correct this, practise walking consciously correcting these defects. Also, stand with both legs planted firmly on the ground, close both eyes for a minute, and then balance on one leg with the eyes still shut. This helps in maintaining a sense of balance.
Footwear slips if it is too large, the straps are not firm and the soles are smooth. These defects have to be eliminated.
Bathroom floors can be slippery and treacherous. The tiles should be rough, not glazed and smooth. Handrails should be fixed near the toilet and shower to aid in getting up from the squatting position. Lighting in the bathroom should be bright and the switch near the door.
With ageing come diseases like arthritis, foot deformities, stroke, Parkinson’s and other tremors, epilepsy, dementia and peripheral neuropathy (numbness of the feet). These complicate other long-standing illness like diabetes and hypertension. Multiple diseases require treatment with a “polypharmacy” of drugs. These medications can contribute to giddiness and falls. Drugs for controlling high blood pressure may cause “postural hypotension”, a condition in which the blood pressure is apparently normal and well controlled on lying down but drops on standing. This is because the body does not compensate for the postural change and bring the pressure to normal levels quickly enough. Diabetic medication may cause sugar levels to drop precipitously, causing a loss of consciousness and a fall. Sometimes, elderly patients are placed on antidepressants or sedatives. They may fall off the bed, or, if they wake up suddenly in the night, they may be confused and disoriented.
The following risk factors triple the chances of a fall. Just remember “I hate falling”.
I — Inflammation of joints (or joint deformity)
H — Hypotension (orthostatic blood pressure changes)
A — Auditory and visual abnormalities
T — Tremor (Parkinson’s disease or other causes of tremor)
E — Equilibrium (balance) problem
F — Foot problems
A — Arrhythmia, heart block or valvular disease
L — Leg-length discrepancy
L — Lack of conditioning (generalised weakness)
I — Illness
N — Nutrition (poor; weight loss)
G — Gait disturbance
To estimate you’re chances of a fall, sit on a stool, get up without assistance, walk 10 steps, return to the stool and sit again within 10 seconds. If you can do this, your muscle strength, power and coordination are good and you are not likely to fall.
To prevent falls, exercise aerobically by walking 40 minutes a day. Balance can be improved with regular yoga. Exercise improves muscle and bone strength and dissipates the force of an impact during a fall. It lessens the chance of fracture by 60 per cent.
As the Indian population ages, we have to concentrate on measures to ensure that the elderly are not bed ridden and a burden to their younger caregivers. Be it at 50-60 or 80, age is no bar to exercising.
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
Wednesday, June 3, 2009
typhoid
Watch out for typhoid
Your Health
DR GITA MATHAI
Sanitation has never been an election issue. No political party has promised us cleaner cities or a healthier environment. Even after more than 60 years of independence the infrastructure cannot keep pace with the haphazard growth of cities. Slums have sprouted everywhere, garbage is piled up and sewage pipes are often clogged, open, aged or leaking. In many towns and villages the drainage is left open, or there is no sewage disposal at all. People still use open spaces for their ablutions.
Sewage contaminates our water supply. Epidemics of water borne diseases like typhoid (caused by the salmonella species of bacteria) occur during the rainy season. India has a very high incidence of typhoid, a fact mentioned prominently on travel advisories for tourists from other countries.
After the bacterium enters the body, there is an incubation period of 10-14 days, after which there is a feeling of malaise, followed by high spiking fever. In fair skinned individuals a red rash can be seen over the trunk and abdomen. The patient loses appetite. There may be abdominal pain and diarrhoea. In most fevers the heart rate increases approximately by 10 beats for every degree rise in temperature. There is a paradoxical effect in typhoid — slow pulse rate in the presence of high fever. The tongue is coated and white, with a central clear area like a streak of red. Lymph nodes, the liver and spleen become enlarged and can be felt.
Typhoid can be confirmed with blood tests. Some are non-specific but add to the index of suspicion. Unlike in the cases of other fevers, in typhoid the white blood cell count drops instead of rising. Laboratories often do a typhoid test called a “Widal test”. This is a non-specific test and can be positive in a variety of fevers. It is inconclusive if a single value is taken. For the diagnosis to be accurate a rising — doubling or tripling — of the titer (measurement of the amount of antibody in an organism) after a week has to be ascertained by two blood tests a week apart. No patient is really going to wait that long without treatment! The organism will grow in blood, stool and urine cultures. This also takes at least 48 hours.
There are newer more specific instant “card tests” for typhoid. When blood from the patient is placed on the card a positive result shows up as a red dot or a stripe.
If undiagnosed and untreated, typhoid complications set in during the third week. Infection can spread to the brain, lungs, bones and cause fatal complications like perforation in the intestines.
Untreated, fatality can be as high as 30 per cent. Relapses occur in 10 per cent of the people and 1-4 per cent go on to become chronic carriers of the bacteria. The organism gains a foothold in the gall bladder and remains there for the rest of the person’s life. Carriers remain apparently healthy but continue to excrete the bacteria in their stool. They are responsible for the spread of the disease.
In the 1900s an epidemic of typhoid in New York was traced to a healthy carrier, a cook called Mary. This resulted in the nickname “typhoid Mary”, a term used even today. “Typhoid Mary” now has actually become a generic term for a carrier of any dangerous disease, who is a health hazard because of a refusal to take appropriate precautions. It has also come into use as a term for a person who spreads computer viruses and malicious software.
Typhoid bacteria are killed by a variety of antibiotics. The older, more toxic drugs like chloromycetin are now seldom used and have been replaced by quinolones, cephalosporins and other groups of antibiotics with less side effects. Seven to ten days of treatment may be required. The duration of treatment, the intervals between doses and the quantity of drug given have to be adequate. Otherwise the organism becomes resistant to the medication.
Frequently, based on suspicion alone, any prolonged high spiking fever is labelled “typhoid”. Without confirmatory tests, the problem gets compounded.
Another problem is that often people discontinue medication once they feel better. Sometimes, impatient as the response and improvement are slower than anticipated, they “doctor shop” and switch medication. Medical shops also get into the act and dispense an illogical, inadequate, incomplete cocktail of antibiotics and other fever medication over the counter.
All this adds to drug resistance on the part of the organism, a failure to respond, spread of the disease and development of a carrier state.
With immunisation typhoid is preventable. The injection (a single shot) can be given after the age of two with a booster dose every three years. The oral vaccine consists of three capsules, to be taken once a day for three days. Protection lasts for two years.
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
Your Health
DR GITA MATHAI
Sanitation has never been an election issue. No political party has promised us cleaner cities or a healthier environment. Even after more than 60 years of independence the infrastructure cannot keep pace with the haphazard growth of cities. Slums have sprouted everywhere, garbage is piled up and sewage pipes are often clogged, open, aged or leaking. In many towns and villages the drainage is left open, or there is no sewage disposal at all. People still use open spaces for their ablutions.
Sewage contaminates our water supply. Epidemics of water borne diseases like typhoid (caused by the salmonella species of bacteria) occur during the rainy season. India has a very high incidence of typhoid, a fact mentioned prominently on travel advisories for tourists from other countries.
After the bacterium enters the body, there is an incubation period of 10-14 days, after which there is a feeling of malaise, followed by high spiking fever. In fair skinned individuals a red rash can be seen over the trunk and abdomen. The patient loses appetite. There may be abdominal pain and diarrhoea. In most fevers the heart rate increases approximately by 10 beats for every degree rise in temperature. There is a paradoxical effect in typhoid — slow pulse rate in the presence of high fever. The tongue is coated and white, with a central clear area like a streak of red. Lymph nodes, the liver and spleen become enlarged and can be felt.
Typhoid can be confirmed with blood tests. Some are non-specific but add to the index of suspicion. Unlike in the cases of other fevers, in typhoid the white blood cell count drops instead of rising. Laboratories often do a typhoid test called a “Widal test”. This is a non-specific test and can be positive in a variety of fevers. It is inconclusive if a single value is taken. For the diagnosis to be accurate a rising — doubling or tripling — of the titer (measurement of the amount of antibody in an organism) after a week has to be ascertained by two blood tests a week apart. No patient is really going to wait that long without treatment! The organism will grow in blood, stool and urine cultures. This also takes at least 48 hours.
There are newer more specific instant “card tests” for typhoid. When blood from the patient is placed on the card a positive result shows up as a red dot or a stripe.
If undiagnosed and untreated, typhoid complications set in during the third week. Infection can spread to the brain, lungs, bones and cause fatal complications like perforation in the intestines.
Untreated, fatality can be as high as 30 per cent. Relapses occur in 10 per cent of the people and 1-4 per cent go on to become chronic carriers of the bacteria. The organism gains a foothold in the gall bladder and remains there for the rest of the person’s life. Carriers remain apparently healthy but continue to excrete the bacteria in their stool. They are responsible for the spread of the disease.
In the 1900s an epidemic of typhoid in New York was traced to a healthy carrier, a cook called Mary. This resulted in the nickname “typhoid Mary”, a term used even today. “Typhoid Mary” now has actually become a generic term for a carrier of any dangerous disease, who is a health hazard because of a refusal to take appropriate precautions. It has also come into use as a term for a person who spreads computer viruses and malicious software.
Typhoid bacteria are killed by a variety of antibiotics. The older, more toxic drugs like chloromycetin are now seldom used and have been replaced by quinolones, cephalosporins and other groups of antibiotics with less side effects. Seven to ten days of treatment may be required. The duration of treatment, the intervals between doses and the quantity of drug given have to be adequate. Otherwise the organism becomes resistant to the medication.
Frequently, based on suspicion alone, any prolonged high spiking fever is labelled “typhoid”. Without confirmatory tests, the problem gets compounded.
Another problem is that often people discontinue medication once they feel better. Sometimes, impatient as the response and improvement are slower than anticipated, they “doctor shop” and switch medication. Medical shops also get into the act and dispense an illogical, inadequate, incomplete cocktail of antibiotics and other fever medication over the counter.
All this adds to drug resistance on the part of the organism, a failure to respond, spread of the disease and development of a carrier state.
With immunisation typhoid is preventable. The injection (a single shot) can be given after the age of two with a booster dose every three years. The oral vaccine consists of three capsules, to be taken once a day for three days. Protection lasts for two years.
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
Wednesday, May 27, 2009
school days
Back to school
YOUR HEALTH DR GITA MATHAI
It is that time of year again. Stressed out parents are standing in serpentine queues in front of book, shoe and clothing stores as they attempt to cope financially, emotionally and physically with the dawn of another school year. The transition from “Cartoon Network” holidays to “tuition filled” school days is traumatic. Without adequate and timely preparation, stress levels in parents and children can skyrocket.
There is usually a whole month before a new session starts. So take some steps at least a week before school begins.
Establish a routine. Wake the child up at 6 am and encourage 20 minutes of aerobic physical activity. Running up and down on the road in front of the house will wake up all “sleepy heads”, ensuring that they are “alive and kicking” for the rest of the day. This also sharpens the intellect, improves memory, boosts academic performance, instils discipline and reduces stress.
Unfortunately many schools do not have structured compulsory PT or games periods, especially in the higher “examgoing classes”. Games periods, usually scheduled only twice a week, are often usurped for “annual day” practices or to complete the academic syllabi.
Get the immunisation card verified. Even the most meticulous parent can get caught out with an incomplete immunisation card in these days of “package immunisation deals”. The schedule is complex with combined shots, varying intervals between doses and boosters that finally finish in the 16th year.
Many ailments acquired in school — like jaundice, typhoid, chicken pox, measles, German measles and mumps — are preventable with timely and adequate immunisation. This reduces the number of “lost” school days. Jaundice (hepatitis A and B together) requires five injections. Typhoid boosters have to be given every three years. The newer pneumococcal vaccine protects against pneumonia and repeated ear infections. The meningococcal vaccine prevents a type of brain fever. Influenza vaccine too is available.
Organise teeth, eye and ear checkups. Visual defects and hearing are correctable impediments to academic excellence. It may be a simple blocked ear as a result of wax build up or something more sinister. Poor eyesight, uncorrected with the proper prescription glasses, may result in difficulty in reading alphabets, numbers and copying from the board.
The school bag should be a backpack with padded straps that fit well on both shoulders. The weight of the school bag should not be more than 10 per cent of the total weight of the child. Greater weight alters the centre of gravity, which can cause loss of balance and also result in accidents.
School uniform material should not be of more than 40 per cent polyester (the rest being cotton). This is suitable for our climatic conditions. Undergarments and socks should be made of pure cotton and washed daily. Sweaty socks, “air dried” and worn again, can cause fungal infections of the feet. Shoes should be made out of natural material like leather or cloth. Damaged, torn, worn out, ill-fitting (too large or small) shoes can damage growing feet irreparably.
Transportation to and from school should be safe. Packing 20 or more children into a vehicle (other than a bus) is not a pleasant, safe or advisable way to commute.
Television viewing should be restricted to two to three hours (a movie) on Saturdays. Watching 2-3 hours of cartoons and other mind numbing channels on a daily basis can result in academic underachievement.
These apart, ensure that the child eats a balanced breakfast. Milk (200ml) is not a substitute and should be given after breakfast. If the child refuses to eat, 1 ounce (30gm) of cooked ragi (or finger millet), with milk and sugar added, can be given as a substitute.
A preferably home cooked nutritious snack, like carrot halwa, peanut barfi, kesari, bhajis, samosas and bondas, should be given at “breaks”. Carbohydrate-overloaded, salted, preservative-laden packaged eats or “instant” snacks should be avoided.
Many children attend tuition straight after school. A banana and another snack should be eaten after school is over and before this grind starts. A tired, hungry child will find it difficult to concentrate. Also, a child needs approximately 1.5 litres of water for a school day.
Have realistic expectations from your child. Each child is different, with talents and interests that are individual. There is no point in trying to fit all children (even siblings) into the same common mould. Failure to perceive this causes stress and depression in parents and children alike. Before berating and blaming a child for academic underachievement, reflect and introspect.
Attend all parents-teacher meetings regularly. The regular physical presence of concerned parents prevents bullying, ragging, victimisation and favouritism. Volunteer to help with annual days, plays and sports days. Teachers will remember your actions and your child will benefit.
School days should be remembered as “fun days” and not fear and tension filled “bamboo stick” days!
YOUR HEALTH DR GITA MATHAI
It is that time of year again. Stressed out parents are standing in serpentine queues in front of book, shoe and clothing stores as they attempt to cope financially, emotionally and physically with the dawn of another school year. The transition from “Cartoon Network” holidays to “tuition filled” school days is traumatic. Without adequate and timely preparation, stress levels in parents and children can skyrocket.
There is usually a whole month before a new session starts. So take some steps at least a week before school begins.
Establish a routine. Wake the child up at 6 am and encourage 20 minutes of aerobic physical activity. Running up and down on the road in front of the house will wake up all “sleepy heads”, ensuring that they are “alive and kicking” for the rest of the day. This also sharpens the intellect, improves memory, boosts academic performance, instils discipline and reduces stress.
Unfortunately many schools do not have structured compulsory PT or games periods, especially in the higher “examgoing classes”. Games periods, usually scheduled only twice a week, are often usurped for “annual day” practices or to complete the academic syllabi.
Get the immunisation card verified. Even the most meticulous parent can get caught out with an incomplete immunisation card in these days of “package immunisation deals”. The schedule is complex with combined shots, varying intervals between doses and boosters that finally finish in the 16th year.
Many ailments acquired in school — like jaundice, typhoid, chicken pox, measles, German measles and mumps — are preventable with timely and adequate immunisation. This reduces the number of “lost” school days. Jaundice (hepatitis A and B together) requires five injections. Typhoid boosters have to be given every three years. The newer pneumococcal vaccine protects against pneumonia and repeated ear infections. The meningococcal vaccine prevents a type of brain fever. Influenza vaccine too is available.
Organise teeth, eye and ear checkups. Visual defects and hearing are correctable impediments to academic excellence. It may be a simple blocked ear as a result of wax build up or something more sinister. Poor eyesight, uncorrected with the proper prescription glasses, may result in difficulty in reading alphabets, numbers and copying from the board.
The school bag should be a backpack with padded straps that fit well on both shoulders. The weight of the school bag should not be more than 10 per cent of the total weight of the child. Greater weight alters the centre of gravity, which can cause loss of balance and also result in accidents.
School uniform material should not be of more than 40 per cent polyester (the rest being cotton). This is suitable for our climatic conditions. Undergarments and socks should be made of pure cotton and washed daily. Sweaty socks, “air dried” and worn again, can cause fungal infections of the feet. Shoes should be made out of natural material like leather or cloth. Damaged, torn, worn out, ill-fitting (too large or small) shoes can damage growing feet irreparably.
Transportation to and from school should be safe. Packing 20 or more children into a vehicle (other than a bus) is not a pleasant, safe or advisable way to commute.
Television viewing should be restricted to two to three hours (a movie) on Saturdays. Watching 2-3 hours of cartoons and other mind numbing channels on a daily basis can result in academic underachievement.
These apart, ensure that the child eats a balanced breakfast. Milk (200ml) is not a substitute and should be given after breakfast. If the child refuses to eat, 1 ounce (30gm) of cooked ragi (or finger millet), with milk and sugar added, can be given as a substitute.
A preferably home cooked nutritious snack, like carrot halwa, peanut barfi, kesari, bhajis, samosas and bondas, should be given at “breaks”. Carbohydrate-overloaded, salted, preservative-laden packaged eats or “instant” snacks should be avoided.
Many children attend tuition straight after school. A banana and another snack should be eaten after school is over and before this grind starts. A tired, hungry child will find it difficult to concentrate. Also, a child needs approximately 1.5 litres of water for a school day.
Have realistic expectations from your child. Each child is different, with talents and interests that are individual. There is no point in trying to fit all children (even siblings) into the same common mould. Failure to perceive this causes stress and depression in parents and children alike. Before berating and blaming a child for academic underachievement, reflect and introspect.
Attend all parents-teacher meetings regularly. The regular physical presence of concerned parents prevents bullying, ragging, victimisation and favouritism. Volunteer to help with annual days, plays and sports days. Teachers will remember your actions and your child will benefit.
School days should be remembered as “fun days” and not fear and tension filled “bamboo stick” days!
Wednesday, May 13, 2009
pandemic
Rest is best
Your Health
DR GITA MATHAI
It is the wrong time of year for “flu” (influenza), but the World Health Organization (WHO) has issued a warning that we are on the verge of a swine flu pandemic. This is serious news indeed because the WHO does not like to cause unnecessary panic. Its gradation of influenza varies from phase 1 where the infection is present and circulating only in animals like birds and pigs, to phase 6, the highest level,where the virus has spread to another geographic region and its transmission is increased and sustained. With the scare posed at phase 5 — where a pandemic is imminent — its fears seem justified as the H1N1 virus that causes swine flu has been identified in Mexico, the US, Canada, the Netherlands, Israel, the UK, Denmark, Germany and Spain.
Influenza pandemics occur with devastating regularity. The first wave of Spanish flu occurred in 1918, affected 50 per cent of the world’s population and killed 50 million people. Asian flu in 1957 killed one million and Hong Kong flu in 1968 another one million. The seasonal flu epidemics kill around half a million people a year. In contrast, only 25 million deaths are attributable to HIV and AIDS worldwide.
Flu starts like a common cold, with symptoms like fatigue, fever, headache, runny nose, watery red eyes and muscle pains that set in one or two days after contact with another infected individual. It spreads from one person to another by direct transmission. As an infected person coughs, sneezes or spits, the virus particles are transmitted in the air. The inhaled droplet particles are 0.5 to 5 µm in diameter. A single particle can cause an infection. Each cough or sneeze expels 40,000 droplets into the environment. These can also get deposited on surfaces, contaminating walls, doors, paper, coins and other surfaces. They can be transmitted through unwashed hands from one person to another. High ambient temperatures and ultraviolet radiation kill the viruses rapidly in 5-15 minutes. However, if the virus is expelled enveloped in mucous discharge, it can survive for up to 48 hours. Crowding, with close contact, lack of ventilation and low temperatures in winter facilitate the spread of influenza.
Flu is usually a mild disease from which patients recover spontaneously. Serious illness, complications like secondary bacterial pneumonia and death can occur in the very young and the elderly (extremes of life), pregnant women, those with HIV or heart disease, and in smokers.
The diagnosis is mainly clinical, based on the characteristic signs and symptoms during an epidemic. Rapid diagnostic tests and viral cultures are available and can confirm the diagnosis with an accuracy of 75-90 per cent.
The virus causing influenza is a RNA virus — a virus that has ribonucleic acid as its genetic material — with five genera (family subdivisions). The commonest disease causing ones belong to A, B and C. They are given names like H1N1, H5N1, depending on the human antibody response. These viruses live in birds and animals like pigs. They can suddenly mutate and become virulent enough to cause disease in humans. Since the human population hasn’t been exposed to this new form of the virus, it doesn’t have any immunity. The disease then spreads rapidly in the susceptible population, causing a pandemic.
Outbreaks of influenza usually occur in winter. Since winter occurs at different times in the northern and southern hemispheres, there are two major epidemics a year. In addition, in the tropics an epidemic also occurs during the rainy season. These are the times when usually there is less sunlight and people tend to crowd together indoors. Air travel among regions and hemispheres has blurred these typical occurrences.
To contain an epidemic
Wash your hands with soap after visiting a sick person. Wash your hands several times a day, especially after handling money.
Clean surfaces like door knobs with a disinfectant.
Use a face mask.
Cover the face while coughing or sneezing.
Avoid spitting.
Immunisation is available against the influenza virus. The WHO tries to predict the strain that is likely to cause an infection that year and passes on this information to the pharmaceutical companies. They then have around six months to develop the vaccine. It is 75 per cent effective in preventing influenza.
In people who develop it after immunisation, the disease is less severe and runs a shorter course with reduced complications. The injectable vaccine is available in India. It is recommended for the young, the elderly, the diabetics and those with heart disease. A nasal spray vaccine is available in other countries.
If you are unfortunate enough to contract flu, stay at home and rest. Recovery will be faster and you will not be spreading the virus to the general public. Take paracetamol for the fever, aches and pains. Generally aspirin and other salicylic acid preparations should be avoided. Though they are generally safe medication, they can cause dreaded complications if given with flu. Specific antiviral medication like oseltamivir (Tamiflu) can be taken under medical supervision for prophylaxis and also to reduce the duration and severity of the illness.
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
Top
Your Health
DR GITA MATHAI
It is the wrong time of year for “flu” (influenza), but the World Health Organization (WHO) has issued a warning that we are on the verge of a swine flu pandemic. This is serious news indeed because the WHO does not like to cause unnecessary panic. Its gradation of influenza varies from phase 1 where the infection is present and circulating only in animals like birds and pigs, to phase 6, the highest level,where the virus has spread to another geographic region and its transmission is increased and sustained. With the scare posed at phase 5 — where a pandemic is imminent — its fears seem justified as the H1N1 virus that causes swine flu has been identified in Mexico, the US, Canada, the Netherlands, Israel, the UK, Denmark, Germany and Spain.
Influenza pandemics occur with devastating regularity. The first wave of Spanish flu occurred in 1918, affected 50 per cent of the world’s population and killed 50 million people. Asian flu in 1957 killed one million and Hong Kong flu in 1968 another one million. The seasonal flu epidemics kill around half a million people a year. In contrast, only 25 million deaths are attributable to HIV and AIDS worldwide.
Flu starts like a common cold, with symptoms like fatigue, fever, headache, runny nose, watery red eyes and muscle pains that set in one or two days after contact with another infected individual. It spreads from one person to another by direct transmission. As an infected person coughs, sneezes or spits, the virus particles are transmitted in the air. The inhaled droplet particles are 0.5 to 5 µm in diameter. A single particle can cause an infection. Each cough or sneeze expels 40,000 droplets into the environment. These can also get deposited on surfaces, contaminating walls, doors, paper, coins and other surfaces. They can be transmitted through unwashed hands from one person to another. High ambient temperatures and ultraviolet radiation kill the viruses rapidly in 5-15 minutes. However, if the virus is expelled enveloped in mucous discharge, it can survive for up to 48 hours. Crowding, with close contact, lack of ventilation and low temperatures in winter facilitate the spread of influenza.
Flu is usually a mild disease from which patients recover spontaneously. Serious illness, complications like secondary bacterial pneumonia and death can occur in the very young and the elderly (extremes of life), pregnant women, those with HIV or heart disease, and in smokers.
The diagnosis is mainly clinical, based on the characteristic signs and symptoms during an epidemic. Rapid diagnostic tests and viral cultures are available and can confirm the diagnosis with an accuracy of 75-90 per cent.
The virus causing influenza is a RNA virus — a virus that has ribonucleic acid as its genetic material — with five genera (family subdivisions). The commonest disease causing ones belong to A, B and C. They are given names like H1N1, H5N1, depending on the human antibody response. These viruses live in birds and animals like pigs. They can suddenly mutate and become virulent enough to cause disease in humans. Since the human population hasn’t been exposed to this new form of the virus, it doesn’t have any immunity. The disease then spreads rapidly in the susceptible population, causing a pandemic.
Outbreaks of influenza usually occur in winter. Since winter occurs at different times in the northern and southern hemispheres, there are two major epidemics a year. In addition, in the tropics an epidemic also occurs during the rainy season. These are the times when usually there is less sunlight and people tend to crowd together indoors. Air travel among regions and hemispheres has blurred these typical occurrences.
To contain an epidemic
Wash your hands with soap after visiting a sick person. Wash your hands several times a day, especially after handling money.
Clean surfaces like door knobs with a disinfectant.
Use a face mask.
Cover the face while coughing or sneezing.
Avoid spitting.
Immunisation is available against the influenza virus. The WHO tries to predict the strain that is likely to cause an infection that year and passes on this information to the pharmaceutical companies. They then have around six months to develop the vaccine. It is 75 per cent effective in preventing influenza.
In people who develop it after immunisation, the disease is less severe and runs a shorter course with reduced complications. The injectable vaccine is available in India. It is recommended for the young, the elderly, the diabetics and those with heart disease. A nasal spray vaccine is available in other countries.
If you are unfortunate enough to contract flu, stay at home and rest. Recovery will be faster and you will not be spreading the virus to the general public. Take paracetamol for the fever, aches and pains. Generally aspirin and other salicylic acid preparations should be avoided. Though they are generally safe medication, they can cause dreaded complications if given with flu. Specific antiviral medication like oseltamivir (Tamiflu) can be taken under medical supervision for prophylaxis and also to reduce the duration and severity of the illness.
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
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