This pressure can kill
Your Health
DR GITA MATHAI
High blood pressure sneaks up on you like a thief in the night with practically no warning. Symptoms like giddiness, headache, nose bleeds and convulsions occur very late in the disease, when the blood pressure has already spiralled out of control. The only way to ensure early detection is by getting your blood pressure checked every two years, starting when you turn 18.
Blood pressure measurements have two values, an upper or systolic and a lower or diastolic. As long as the upper value is 120 or less and the lower value is 80, you are safe. If it creeps up to 139/89 you are in the pre-hypertension stage, which requires frequent evaluation and perhaps, medication. Once you have reached 140/90 you require treatment to prevent progression and side effects. Blood pressure varies from day to day. At least three values are needed before a diagnosis is made.
Primary hypertension has no known cause. It tends to run in families. Several genes have been identified in its inheritance. A person with a genetic predisposition to hypertension is more likely to develop it if they are also obese and inactive.
Secondary hypertension occurs when there is kidney disease, congenital abnormalities in blood vessels, sometimes during pregnancy or as a side effect of certain medication. The pressure returns to normal if the precipitating factor is removed.
The risk of developing blood pressure increases with age. This is because blood vessels become rigid and less compliant as you age. Obesity increases the risk. It is also more likely to eventually occur in diabetics.
Tobacco (smoked, chewed or snorted) releases certain chemicals into the body. These cause an immediate transient elevation in blood pressure. Over a period of time, the inner lining of the blood vessels become permanently damaged and narrowed, causing a permanent elevation of the blood pressure. Passive inhalation of second hand smoke causes the same effects.
Alcohol increases the heart rate. As it is metabolised, certain chemicals are released that elevate the blood pressure. It also damages the heart, making it more vulnerable to the effects of hypertension.
Salt adds flavour to food but too much of it can cause the body to retain fluid and elevate blood pressure. The requirement is 6gm a day (1 teaspoon = 5gm). Most people take around 9gm a day. Potassium balances salt in the blood, and the requirement is 1.5gm to 2gm a day. It is present in bananas and some nuts. Most people get too little potassium, causing salt to accumulate.
Deficiency of vitamin D affects some kidney enzymes that regulate blood pressure, aggravating hypertension.
High blood pressure can affect children and teenagers too. Most often it is aggravated by obesity, lack of exercise and excessive consumption of high salt snacks.
Uncontrolled hypertension silently damages the body. It can cause the heart to work hard to pump blood against resistance. The heart can become enlarged, weakened and eventually fail. The blood vessels in the body can be damaged and weakened. They may give way, causing a bulge called an aneurysm. This can suddenly rupture. If this occurs in the eyes, it can result in blindness.
Blood supply to the brain can become compromised. Initially this can result in loss of memory, forgetfulness or confusion. It can eventually result in a stroke. Blood vessels to the kidneys can get damaged, causing them to fail.
There is no universal medication for high blood pressure. Some people do well with a single drug. Others require frequent dosing with as many as four or more drugs. The important thing is to remember to take your medication regularly and not skip doses. Fasting, rearranging schedules or switching to alternate medication should not be done without consulting a doctor. Drugs can react with one another. So it is better to stay with a single physician who will be able to monitor your medication and response. Low dose aspirin may be needed to prevent strokes and heart attacks.
Lifestyle changes are necessary to eventually reduce the dosage, number of drugs and the long-term effects of high blood pressure.
lMaintain ideal body weight. This can be calculated by multiplying height in metre squared by 23.
lTry adding more fruits, vegetables and fibre rich food to your diet. Reduce the fat content.
lReduce salt intake to 1.5gm (one-fourth tsp) a day. Remember to take into account the salt in pickles, and ready-to-eat soups and sauces.
lDo not smoke or use tobacco in any form.
lAvoid alcohol. If that is not possible, remember the allowance is 2 drinks a day for men and one for women.
lGet moving. You can reap huge benefits by walking as little as 30 minutes a day. Every step counts!
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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Saturday, April 14, 2012
Thursday, March 29, 2012
diabetes
he other diabetes
Your Health
DR GITA MATHAI
Diabetes, which affects eight to nine per cent of the urban population in India, is perceived to be a lifestyle disease of overweight, sedentary and middle-aged people. These patients do not require insulin injections. In this type of diabetes, the body either loses its sensitivity to insulin (the natural hormone needed to reduce blood sugar) or the pancreas (which produces insulin) fails to produce enough of the stuff. A judicious combination of restricted diet, exercise and tablets are usually enough to keep the sugar level in check and complications at bay.
Few people, however, realise that one per cent of newly diagnosed diabetics are thin and young. They have type 1 diabetes. The disease was previously called juvenile diabetes as sufferers were usually young but now the nomenclature has been changed to “insulin dependent diabetes”. In these patients, the pancreas fails to produce insulin. It can occur at any age, from infancy, childhood, and adolescence to adults, as both genetic factors and environmental triggers are involved. Once it has set in, it cannot be prevented, delayed or cured, it can only be treated.
Type 1 diabetes may be inherited or occur suddenly after an infection. The mumps, Epstein-Barr and coxsackie virus in particular have been implicated. The body itself may also produce antibodies to the islet cells (which produce insulin) in the pancreas, destroying them. A relative deficiency of vitamin D has been linked to an increased risk of type 1 diabetes. Drinking water contaminated with nitrates may also increase the risk. Early weaning (before the recommended 4-6 months) increases the risk. Exclusive breast feeding until the age of one reduces the risk.
Diagnosing insulin dependent diabetes in a child is difficult. There has to be a high index of suspicion on the part of the parent and the doctor. The typical symptoms of increased thirst, frequent urination, a relapse of bedwetting after successful toilet training, voracious appetite and overeating with loss of weight or fatigue may be accepted and dismissed as a “normal” part of childhood. Often the diagnosis is only made by accident or after uncontrolled infections or other complications set in.
Blood tests are needed to confirm the diagnosis. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher, Glycated hemoglobin (A1C) of 6.5 per cent or more, a fasting blood sugar of 126 mg/dL indicates diabetes.
Treatment for insulin dependent diabetes requires a judicious combination of diet, exercise and insulin. The diet should be nutritious with plenty of fresh fruits and vegetables. The total calories required depends on the age and level of physical activity. Blood sugar levels should be checked three times a day (with a glucometer) before meals so that the quantity of food eaten can be adjusted. Some young people do well if food is split into six mini meals instead of three big ones. Control is often difficult for parents when the children are fussy eaters.
Unfortunately there is no oral medication or miracle drug as yet which can replace insulin. So insulin has to be given as injections — often several times a day — depending on blood sugar values and the quantity of food about to be eaten. It becomes difficult for parents when the child refuses to eat after the calculated dose of insulin has been given, or the child vomits. Flexibility in the diet and dosage of insulin has to be maintained.
Low blood sugar can be dangerous. It can cause sweating, shivering, hunger, giddiness, tiredness, headache, irritability, palpitations, tremors, sweating, convulsions and loss of consciousness. Some form of sugar should be given as soon as such symptoms occur. Affected children need to always carry sweets. Blood sugar can become low at night and cause sweating and morning headache.
In the absence of insulin, even when blood sugar levels are high, cells are unable to process the sugar and face starvation. The body begins to break down fat stores. This leads to a dangerous condition called ketoacidosis. There may be nausea, vomiting, abdominal pain, a fruity odour and eventually loss of consciousness or seizures.
Uncontrolled high blood sugar can over the years cause complications in the eyes, heart, kidney, skin, and nerves. Infections become difficult to control and wounds may not heal. In later life, dementia and Alzheimer’s can set in.
If the sugars are controlled with diet, exercise and insulin, patients can lead normal lives and have standard life expectancy.
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
Diabetes, which affects eight to nine per cent of the urban population in India, is perceived to be a lifestyle disease of overweight, sedentary and middle-aged people. These patients do not require insulin injections. In this type of diabetes, the body either loses its sensitivity to insulin (the natural hormone needed to reduce blood sugar) or the pancreas (which produces insulin) fails to produce enough of the stuff. A judicious combination of restricted diet, exercise and tablets are usually enough to keep the sugar level in check and complications at bay.
Few people, however, realise that one per cent of newly diagnosed diabetics are thin and young. They have type 1 diabetes. The disease was previously called juvenile diabetes as sufferers were usually young but now the nomenclature has been changed to “insulin dependent diabetes”. In these patients, the pancreas fails to produce insulin. It can occur at any age, from infancy, childhood, and adolescence to adults, as both genetic factors and environmental triggers are involved. Once it has set in, it cannot be prevented, delayed or cured, it can only be treated.
Type 1 diabetes may be inherited or occur suddenly after an infection. The mumps, Epstein-Barr and coxsackie virus in particular have been implicated. The body itself may also produce antibodies to the islet cells (which produce insulin) in the pancreas, destroying them. A relative deficiency of vitamin D has been linked to an increased risk of type 1 diabetes. Drinking water contaminated with nitrates may also increase the risk. Early weaning (before the recommended 4-6 months) increases the risk. Exclusive breast feeding until the age of one reduces the risk.
Diagnosing insulin dependent diabetes in a child is difficult. There has to be a high index of suspicion on the part of the parent and the doctor. The typical symptoms of increased thirst, frequent urination, a relapse of bedwetting after successful toilet training, voracious appetite and overeating with loss of weight or fatigue may be accepted and dismissed as a “normal” part of childhood. Often the diagnosis is only made by accident or after uncontrolled infections or other complications set in.
Blood tests are needed to confirm the diagnosis. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher, Glycated hemoglobin (A1C) of 6.5 per cent or more, a fasting blood sugar of 126 mg/dL indicates diabetes.
Treatment for insulin dependent diabetes requires a judicious combination of diet, exercise and insulin. The diet should be nutritious with plenty of fresh fruits and vegetables. The total calories required depends on the age and level of physical activity. Blood sugar levels should be checked three times a day (with a glucometer) before meals so that the quantity of food eaten can be adjusted. Some young people do well if food is split into six mini meals instead of three big ones. Control is often difficult for parents when the children are fussy eaters.
Unfortunately there is no oral medication or miracle drug as yet which can replace insulin. So insulin has to be given as injections — often several times a day — depending on blood sugar values and the quantity of food about to be eaten. It becomes difficult for parents when the child refuses to eat after the calculated dose of insulin has been given, or the child vomits. Flexibility in the diet and dosage of insulin has to be maintained.
Low blood sugar can be dangerous. It can cause sweating, shivering, hunger, giddiness, tiredness, headache, irritability, palpitations, tremors, sweating, convulsions and loss of consciousness. Some form of sugar should be given as soon as such symptoms occur. Affected children need to always carry sweets. Blood sugar can become low at night and cause sweating and morning headache.
In the absence of insulin, even when blood sugar levels are high, cells are unable to process the sugar and face starvation. The body begins to break down fat stores. This leads to a dangerous condition called ketoacidosis. There may be nausea, vomiting, abdominal pain, a fruity odour and eventually loss of consciousness or seizures.
Uncontrolled high blood sugar can over the years cause complications in the eyes, heart, kidney, skin, and nerves. Infections become difficult to control and wounds may not heal. In later life, dementia and Alzheimer’s can set in.
If the sugars are controlled with diet, exercise and insulin, patients can lead normal lives and have standard life expectancy.
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, March 19, 2012
move it
Let’s move it
Your Health
DR GITA MATHAI
Whenever exercise is mentioned, “I don’t have time,” is the common refrain across all age groups — from school students to teenagers to housewives to working professionals and even retirees. Twenty-four hours do not seem to be enough to work, study, eat, sleep and squeeze in TV viewing, which is given priority over exercise. The saying “no time for exercise, a lot of time for illness” has not yet hit home.
How much exercise do we need? The ideal is one hour of aerobic activity — such as running, jogging, cycling or swimming — every day, the minimum is 30 minutes three days a week. You can even split the 30 minutes into two or three segments. And this still seems an impossible target for many.
So now doctors have come up with a workout that takes only 20 minutes. High intensity interval training (HIIT) is suitable for all age groups and is beneficial for heart patients and those with hypertension. However, check with your physician before you start this regime.
HIIT involves achieving 90 per cent of your target heart rate (220-age). The exercises are running, walking, jumping jacks, stair climbing, skipping, or toe tapping. You exercise vigorously for 30 seconds, followed by 30 seconds of rest, repeated 10 times. You need to work up to one minute followed by a minute of rest. This 20-minute workout gives the same benefits as the hour-long run or walk.
Regular physical activity promotes health, prevents disease and helps reduce stress. It keeps students alert and active, despite fatigue. It also retards cognitive decline, memory loss and dementia in older people so annual medical costs are much reduced.
Inactivity eventually results in obesity, which causes relative infertility, arthritis, precipitates diabetes, elevates blood sugar values in those already diabetic, results in hypertension, heart disease, and abnormal lipid profiles. It is also linked to the development of certain cancers like that of the colon.
The chronic medical conditions associated with physical inactivity are expensive. Diagnostic tests, doctor’s consultations and medicines cost money. Workdays are lost as a result of illness. People may not realise their full potential as they are unable to work to their full capacity, limited by the pain of arthritis or the side effects of medications. Enforced premature retirement or untimely death cuts short the earning potential.
As we honour our women achievers this month, we should remember that women find it more difficult to be physically active. The constraints may be social, cultural or environmental. They require greater encouragement and motivation. And the biggest benefit (a reduction in illness and medical costs) is seen in women over 55 who are encouraged to be physically active.
Another thing physical activity improves is balance, which is important to prevent falls and expensive treatment for fractures. Weight bearing aerobic activity is essential for normal skeletal development in childhood and adolescence. It is needed to maintain peak bone mass in young adults. The decline in bone mass that occurs in older people can be slowed and averted with exercise. Conservative estimates say that in India 20 per cent of women over 55 and 15 per cent of men have decreased bone density. Medications (vitamin D supplements, alendronate and calcium) for this group are expensive and usually have to be added to medicines for diabetes, hypertension, lipids and heart disease and the cost increases with every new budget.
“I cannot sleep,” is a common complaint in older people. It may be due to many factors including depression. Many are on antidepressants, anxiolytics or sleeping pills, often in increasing dosages as habituation sets in. Exercise obviates the necessity for these medications.
All you really need to get started is a good pair of sports shoes (costing Rs 600 to Rs 10,000) a pair of socks (Rs100-150) and 20-60 minutes of your time, depending on whether you are going in for traditional exercise or HIIT. People spend far more to buy a car! Yet regular exercise will be far more cost effective in the long run.
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
Whenever exercise is mentioned, “I don’t have time,” is the common refrain across all age groups — from school students to teenagers to housewives to working professionals and even retirees. Twenty-four hours do not seem to be enough to work, study, eat, sleep and squeeze in TV viewing, which is given priority over exercise. The saying “no time for exercise, a lot of time for illness” has not yet hit home.
How much exercise do we need? The ideal is one hour of aerobic activity — such as running, jogging, cycling or swimming — every day, the minimum is 30 minutes three days a week. You can even split the 30 minutes into two or three segments. And this still seems an impossible target for many.
So now doctors have come up with a workout that takes only 20 minutes. High intensity interval training (HIIT) is suitable for all age groups and is beneficial for heart patients and those with hypertension. However, check with your physician before you start this regime.
HIIT involves achieving 90 per cent of your target heart rate (220-age). The exercises are running, walking, jumping jacks, stair climbing, skipping, or toe tapping. You exercise vigorously for 30 seconds, followed by 30 seconds of rest, repeated 10 times. You need to work up to one minute followed by a minute of rest. This 20-minute workout gives the same benefits as the hour-long run or walk.
Regular physical activity promotes health, prevents disease and helps reduce stress. It keeps students alert and active, despite fatigue. It also retards cognitive decline, memory loss and dementia in older people so annual medical costs are much reduced.
Inactivity eventually results in obesity, which causes relative infertility, arthritis, precipitates diabetes, elevates blood sugar values in those already diabetic, results in hypertension, heart disease, and abnormal lipid profiles. It is also linked to the development of certain cancers like that of the colon.
The chronic medical conditions associated with physical inactivity are expensive. Diagnostic tests, doctor’s consultations and medicines cost money. Workdays are lost as a result of illness. People may not realise their full potential as they are unable to work to their full capacity, limited by the pain of arthritis or the side effects of medications. Enforced premature retirement or untimely death cuts short the earning potential.
As we honour our women achievers this month, we should remember that women find it more difficult to be physically active. The constraints may be social, cultural or environmental. They require greater encouragement and motivation. And the biggest benefit (a reduction in illness and medical costs) is seen in women over 55 who are encouraged to be physically active.
Another thing physical activity improves is balance, which is important to prevent falls and expensive treatment for fractures. Weight bearing aerobic activity is essential for normal skeletal development in childhood and adolescence. It is needed to maintain peak bone mass in young adults. The decline in bone mass that occurs in older people can be slowed and averted with exercise. Conservative estimates say that in India 20 per cent of women over 55 and 15 per cent of men have decreased bone density. Medications (vitamin D supplements, alendronate and calcium) for this group are expensive and usually have to be added to medicines for diabetes, hypertension, lipids and heart disease and the cost increases with every new budget.
“I cannot sleep,” is a common complaint in older people. It may be due to many factors including depression. Many are on antidepressants, anxiolytics or sleeping pills, often in increasing dosages as habituation sets in. Exercise obviates the necessity for these medications.
All you really need to get started is a good pair of sports shoes (costing Rs 600 to Rs 10,000) a pair of socks (Rs100-150) and 20-60 minutes of your time, depending on whether you are going in for traditional exercise or HIIT. People spend far more to buy a car! Yet regular exercise will be far more cost effective in the long run.
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
Saturday, March 10, 2012
constipation
ruit a day keeps constipation away
Your Health
DR GITA MATHAI
“If you don’t clear your bowels every morning,” explained the grandmother, “the poisons from the stool will get absorbed in your blood.” She paused dramatically for effect. “That is what is happening to me.”
Now that statement is not strictly true. If you are constipated, the rectum continues to absorb water from the stool, making it hard. It can then become impacted (stuck) and cause painful excoriations and fissures at the anal opening. No toxins, however, are released into the blood stream.
There is no real "normal" for bowel movements; it varies from person to person. Fewer than three movements a week, however, may indicate constipation and more than three a day diarrhoea. Only about 50 per cent of the population regularly clears its bowels every morning.
Pooping has both voluntary and involuntary components. As faecal matter enters the rectum, it causes it to stretch. Nerves from the rectum carry the message to the brain. The anal sphincters relax, the abdominal and pelvic muscles contract. This increases the pressure and the motion is forced out. If the signal is ignored, the signal ceases. The motion remains in the rectum. If the signal is consistently ignored, the motion becomes hard and then gets impacted or stuck.
The stool should be well formed, sausage shaped, brown and passed painlessly. If there is a sudden change in the frequency, consistency and colour of the stool, if it is mixed with blood or mucous, if diarrhoea suddenly begins to alternate with constipation or there is significant weight loss, there is reason to be concerned. Consult a doctor at once.
Sudden acute constipation is also a worrisome symptom. It may signify a serious medical illness like an obstructive tumour. Constipation also requires an immediate assessment if it is accompanied by pain, vomiting and abdominal pain.
Chronic constipation occurs over a period of months. It is always caused by the slow movement of the stool through the colon. This may be due to hormonal imbalances, particularly deficiency of the thyroid hormone. It may be due to medicines like painkillers (codeine), cough medication, antidepressants, antacids that contain aluminium and even laxatives. Laxatives can be habit forming. The dosage has to be gradually increased for the same benefit. The intestinal nerves and musculature may cease to respond, aggravating the problem. If constipation is due to abuse, side effects or misuse of medication, the constipation disappears when the offending medication is discontinued.
Fibre is required to provide bulk to the stool. Many diets are deficient, particularly in people who consume mainly refined flour (maida) and do not eat the recommended 4-5 helpings of fruits and vegetables. (Juices do not count as the dietary fibre is strained out.). This results in constipation.
The pelvic floor musculature has to function efficiently to push out the stool. The nerves may be inefficient as a result of old age, uncontrolled diabetes or some other neuropathy. This can result in inertia of the large intestine. The nerves and muscles may be damaged as a result of repeated childbirth or surgery. Both colonic inertia and pelvic floor dysfunction can cause constipation.
If the medical evaluation for constipation does not reveal any specific treatable cause, some non specific modifications of diet, life style and simple medications can help. The goal of treatment is to achieve one bowel movement every two to three days without straining.
8 Increase you physical activity. A sedentary lifestyle slows all the muscles in the body, including abdominal and pelvic muscles.
8Modify your diet to include 4-5 helpings of food and vegetables a day. Drink enough water (not juices, colas, tea or coffee).
8Try to sit on the toilet at a specific time every day. Your body will eventually get the message.
8Women are more prone to constipation during the premenstrual phase and pregnancy. They need to increase their intake of dietary fibre at this time.
8Ipsagol husk dissolved in water increases the bulk of the stool and is safe and effective.
8Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.
Herbal laxatives are marketed as “natural products”. Many of them contain senna and other stimulant plant-based laxatives in unregulated quantities. They should not be used without medical advice.
Mineral oils like paraffin act as lubricants. Long term use results in a deficiency of fat-soluble vitamins.
Hyperosmolar laxatives like sorbitol or lactulose, saline laxatives and stool softeners are efficient, unabsorbed and fairly safe.
Your body may take time to respond to these simple measures. Patience and persistence are required to make the treatment programme successful.
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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Your Health
DR GITA MATHAI
“If you don’t clear your bowels every morning,” explained the grandmother, “the poisons from the stool will get absorbed in your blood.” She paused dramatically for effect. “That is what is happening to me.”
Now that statement is not strictly true. If you are constipated, the rectum continues to absorb water from the stool, making it hard. It can then become impacted (stuck) and cause painful excoriations and fissures at the anal opening. No toxins, however, are released into the blood stream.
There is no real "normal" for bowel movements; it varies from person to person. Fewer than three movements a week, however, may indicate constipation and more than three a day diarrhoea. Only about 50 per cent of the population regularly clears its bowels every morning.
Pooping has both voluntary and involuntary components. As faecal matter enters the rectum, it causes it to stretch. Nerves from the rectum carry the message to the brain. The anal sphincters relax, the abdominal and pelvic muscles contract. This increases the pressure and the motion is forced out. If the signal is ignored, the signal ceases. The motion remains in the rectum. If the signal is consistently ignored, the motion becomes hard and then gets impacted or stuck.
The stool should be well formed, sausage shaped, brown and passed painlessly. If there is a sudden change in the frequency, consistency and colour of the stool, if it is mixed with blood or mucous, if diarrhoea suddenly begins to alternate with constipation or there is significant weight loss, there is reason to be concerned. Consult a doctor at once.
Sudden acute constipation is also a worrisome symptom. It may signify a serious medical illness like an obstructive tumour. Constipation also requires an immediate assessment if it is accompanied by pain, vomiting and abdominal pain.
Chronic constipation occurs over a period of months. It is always caused by the slow movement of the stool through the colon. This may be due to hormonal imbalances, particularly deficiency of the thyroid hormone. It may be due to medicines like painkillers (codeine), cough medication, antidepressants, antacids that contain aluminium and even laxatives. Laxatives can be habit forming. The dosage has to be gradually increased for the same benefit. The intestinal nerves and musculature may cease to respond, aggravating the problem. If constipation is due to abuse, side effects or misuse of medication, the constipation disappears when the offending medication is discontinued.
Fibre is required to provide bulk to the stool. Many diets are deficient, particularly in people who consume mainly refined flour (maida) and do not eat the recommended 4-5 helpings of fruits and vegetables. (Juices do not count as the dietary fibre is strained out.). This results in constipation.
The pelvic floor musculature has to function efficiently to push out the stool. The nerves may be inefficient as a result of old age, uncontrolled diabetes or some other neuropathy. This can result in inertia of the large intestine. The nerves and muscles may be damaged as a result of repeated childbirth or surgery. Both colonic inertia and pelvic floor dysfunction can cause constipation.
If the medical evaluation for constipation does not reveal any specific treatable cause, some non specific modifications of diet, life style and simple medications can help. The goal of treatment is to achieve one bowel movement every two to three days without straining.
8 Increase you physical activity. A sedentary lifestyle slows all the muscles in the body, including abdominal and pelvic muscles.
8Modify your diet to include 4-5 helpings of food and vegetables a day. Drink enough water (not juices, colas, tea or coffee).
8Try to sit on the toilet at a specific time every day. Your body will eventually get the message.
8Women are more prone to constipation during the premenstrual phase and pregnancy. They need to increase their intake of dietary fibre at this time.
8Ipsagol husk dissolved in water increases the bulk of the stool and is safe and effective.
8Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.
Herbal laxatives are marketed as “natural products”. Many of them contain senna and other stimulant plant-based laxatives in unregulated quantities. They should not be used without medical advice.
Mineral oils like paraffin act as lubricants. Long term use results in a deficiency of fat-soluble vitamins.
Hyperosmolar laxatives like sorbitol or lactulose, saline laxatives and stool softeners are efficient, unabsorbed and fairly safe.
Your body may take time to respond to these simple measures. Patience and persistence are required to make the treatment programme successful.
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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Tuesday, February 28, 2012
sciatica
Oh my aching back
Your Health
DR GITA MATHAI
Absenteeism is a global phenomenon and, statistically, illnesses that cannot be verified, such as a cold, headache or backache (sciatica), are the commonest ailments. Seventy per cent of the adult population suffers from backache (the terms backache and sciatica are often used interchangeably) at some point in their lives. The quantum of pain cannot be objectively measured. Most of the time, the pain is not incapacitating and the discomfort clears up on its own in a day or two with or without treatment. The person returns to work, only to have the symptoms flare up again months or years later.
The sciatic nerve is one of the thickest nerves in the body. It functions as an expressway conveying electrical signals from the brain through the spinal cord to the legs. It becomes irritated and painful if there is an impediment at any point along its path. This may be due to an injury (accident), disc problem, spasm of the muscles near the exit point of the nerve or a narrowing of the spinal column. The pain may start in the back, but then can radiate a to any point along the path of the nerve. It may be felt in the buttocks, thighs, along the back of the calf and right up to the toes. There may be tingling, numbness or a feeling like an electric shock. In severe cases the foot or leg muscles may become weak and walking could become difficult. In severe cases, control over bladder and bowel movements may be lost.
Sciatica can occur at any time after the twenties. It is precipitated by weight gain, diabetes and a sedentary lifestyle.
The pain can be tackled by cold compresses (ice) applied several times a day over the affected part. After a few days, this can be alternated with hot fomentations. Topical applications of pain relieving gels followed by cold and hot compresses often offer a great deal of relief. Over the counter (OTC) painkillers such as paracetemol, naproxen or ibubrufen help but remember, do not take more than the recommended dose to prevent toxicity. Stronger analgesics have no proven value. Painkillers are, however, not a permanent or long-term solution. If you still require them after two weeks, consult a doctor.
After the pain has subsided a little (usually in a day or two), an exercise regimen should be started. Prolonged bed rest used to be recommended but it has now been found to have no real benefit. On the contrary, it may be detrimental because it weakens the spinal muscles that help to hold the backbone in place.
Walking, cycling and swimming are ideal. Wear well-cushioned shoes and start slowly. Then build up to 40-60 minutes a day. The endorphins released from your muscles during exercise will reduce any residual inflammation and promote healing.
Add calf and hamstring stretches and “core strengthening” exercises to your daily routine — such as squats, push-ups and many yoga poses. This, along with 3-6 suryanamaskars a day will help prevent a recurrence of the problem. Try to get back to your normal level of activity within a month.
To prevent recurrences, avoid stretching to reach objects, twisting and turning. Do not sit in one position for more than 30 minutes. If your work requires you to do this, make sure the table and chair are of the correct height. If you need to lift a heavy object or even a toddler, bend at the knees to crouch down and then lift. Do not leap out of bed. Turn to one side, lower your legs to the floor and then get up. Look in a mirror and see if your posture is good with a ramrod straight back. Control diabetes. If your BMI (body mass index, weight divided by height in metre squared) is more than 23-25 try a regimen of diet and exercise to lose weight.
You need to consult a doctor immediately if:
• The symptoms occur after an accident
• The onset is acute and accompanied by weakness of a leg or foot
• There is loss of bladder or bowel control
• There is no relief after two weeks
Doctors may do investigations like X-rays, CT scans or MRI scans. They may advice medication, physiotherapy and graded exercise.
Some patients require steroid injections into the affected area. This reduces inflammation and provides short-term symptom relief. It is not a permanent solution. Surgery may be eventually required to remove a bulging disc or a growth responsible for the pain.
Sciatica may be precipitated by many factors. There is no universal treatment or miracle cure. What worked for someone else may not necessarily work for you. It is important to listen to your body and to your physician.
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
Absenteeism is a global phenomenon and, statistically, illnesses that cannot be verified, such as a cold, headache or backache (sciatica), are the commonest ailments. Seventy per cent of the adult population suffers from backache (the terms backache and sciatica are often used interchangeably) at some point in their lives. The quantum of pain cannot be objectively measured. Most of the time, the pain is not incapacitating and the discomfort clears up on its own in a day or two with or without treatment. The person returns to work, only to have the symptoms flare up again months or years later.
The sciatic nerve is one of the thickest nerves in the body. It functions as an expressway conveying electrical signals from the brain through the spinal cord to the legs. It becomes irritated and painful if there is an impediment at any point along its path. This may be due to an injury (accident), disc problem, spasm of the muscles near the exit point of the nerve or a narrowing of the spinal column. The pain may start in the back, but then can radiate a to any point along the path of the nerve. It may be felt in the buttocks, thighs, along the back of the calf and right up to the toes. There may be tingling, numbness or a feeling like an electric shock. In severe cases the foot or leg muscles may become weak and walking could become difficult. In severe cases, control over bladder and bowel movements may be lost.
Sciatica can occur at any time after the twenties. It is precipitated by weight gain, diabetes and a sedentary lifestyle.
The pain can be tackled by cold compresses (ice) applied several times a day over the affected part. After a few days, this can be alternated with hot fomentations. Topical applications of pain relieving gels followed by cold and hot compresses often offer a great deal of relief. Over the counter (OTC) painkillers such as paracetemol, naproxen or ibubrufen help but remember, do not take more than the recommended dose to prevent toxicity. Stronger analgesics have no proven value. Painkillers are, however, not a permanent or long-term solution. If you still require them after two weeks, consult a doctor.
After the pain has subsided a little (usually in a day or two), an exercise regimen should be started. Prolonged bed rest used to be recommended but it has now been found to have no real benefit. On the contrary, it may be detrimental because it weakens the spinal muscles that help to hold the backbone in place.
Walking, cycling and swimming are ideal. Wear well-cushioned shoes and start slowly. Then build up to 40-60 minutes a day. The endorphins released from your muscles during exercise will reduce any residual inflammation and promote healing.
Add calf and hamstring stretches and “core strengthening” exercises to your daily routine — such as squats, push-ups and many yoga poses. This, along with 3-6 suryanamaskars a day will help prevent a recurrence of the problem. Try to get back to your normal level of activity within a month.
To prevent recurrences, avoid stretching to reach objects, twisting and turning. Do not sit in one position for more than 30 minutes. If your work requires you to do this, make sure the table and chair are of the correct height. If you need to lift a heavy object or even a toddler, bend at the knees to crouch down and then lift. Do not leap out of bed. Turn to one side, lower your legs to the floor and then get up. Look in a mirror and see if your posture is good with a ramrod straight back. Control diabetes. If your BMI (body mass index, weight divided by height in metre squared) is more than 23-25 try a regimen of diet and exercise to lose weight.
You need to consult a doctor immediately if:
• The symptoms occur after an accident
• The onset is acute and accompanied by weakness of a leg or foot
• There is loss of bladder or bowel control
• There is no relief after two weeks
Doctors may do investigations like X-rays, CT scans or MRI scans. They may advice medication, physiotherapy and graded exercise.
Some patients require steroid injections into the affected area. This reduces inflammation and provides short-term symptom relief. It is not a permanent solution. Surgery may be eventually required to remove a bulging disc or a growth responsible for the pain.
Sciatica may be precipitated by many factors. There is no universal treatment or miracle cure. What worked for someone else may not necessarily work for you. It is important to listen to your body and to your physician.
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
Tuesday, February 7, 2012
moving makes me sick
On the move and sick of it
YOUR HEALTH
DR GITA MATHAI
Indians love to travel. We travel to attend family events, on pilgrimages and to holiday in exotic spots. Yet, for 25 per cent of the population, travelling is not a pleasure but an exhausting saga of attacks of kinetosis (a fancy medical word for motion sickness). The giddiness, fatigue, nausea and vomiting (all or any of the symptoms) that characterise kinetosis also affect 45 per cent of daily commuters and a staggering 60 per cent of student aircrews. Travelling by plane, ship, or car (especially along winding roads) is torture for those affected by motion sickness.
Kinetosis can also affect people who watch movies or TV programmes on large screens, play computer or video games for prolonged periods, deal with virtual reality or ride roller-coasters and giant wheels.
What causes this exhausting illness? The inner ear has a vestibular apparatus that detects movement. Its input is validated by sensory input from the eyes and from the brain’s perception of the position of the body and limbs. The input becomes discordant when the body is still but the eyes perceive movement, as in a train, with 3D games, virtual reality and large screens. Motion sickness is caused by movement that is felt but not seen or seen but not felt. The brain gets confused, as it cannot reconcile the sensory inputs. It decides that a hallucinogenic toxin has entered the body and causes violent contractions of the stomach to expel the “poison”.
Motion sickness is more likely in 2-12 year old children, particularly if they are fed a heavy breakfast before a long commute to school. Infants (under two years) are immune. Women are more likely to have motion sickness if they are pregnant, menstruating, or on hormone therapy. The anxiety brought on by the thought of motion sickness is likely to precipitate an attack.
If the nausea is tolerated long enough, motion sickness may go away. This, however, cannot be guaranteed and is not a viable option.
Most victims of motion sickness prefer to take medication before going on a journey. Such pills should be swallowed at least an hour before travel to give them sufficient time to act. A wide range of centrally acting medicines like Dramamine, Avomine or Stugeron can be used. Sedation is a side effect and must be anticipated. The usual anti emetics like metachlopromide (Perinorm) Domperone or Ondesterone do not work in motion sickness. It is advisable to contact your physician and obtain a prescription for the drug that suits you best. The dosage in children has to be calculated on a mg/kg basis and is not based on age.
Certain simple precautions can help you cope:
Be aware of situations that tend to trigger symptoms and avoid them.
Optimise seating position while travelling. Sit in the front seat of a car or bus, or over the wing of an aircraft. Keep your head still. Try to focus on a distant stationary object.
Do not eat a heavy meal, drink caffeinated beverages, alcohol or eat chocolate or sweets before travel. Chewing gum does help.
Eating ginger helps some people.
Some odours like mint or lime may reduce nausea. Other smells like cigarette smoke may aggravate it.
Acupressure has proven to be useful in motion sickness. Steady pressure over the K-9 point located on both hands in the middle phalanx of the fourth (ring) finger stops the nausea. You can also try the P6 acupressure point located on the inside of the wrist, three finger widths up the arm. Repeat the pressure on both wrists.
Wristbands that apply continuous pressure to these areas are available commercially. Magnetic bracelets have anecdotally been known to help some people. It is better to try non medical interventions before opting for sedative medication.
The good news is that these pressure points also work in the morning sickness of pregnancy. The bad news is that once you have motion sickness, it can return to torment you at any age, even after a long, symptom-free interval. It has to be factored in when choosing a career — becoming an airline pilot, astronaut or sailor may not be a logical choice.
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 love to travel. We travel to attend family events, on pilgrimages and to holiday in exotic spots. Yet, for 25 per cent of the population, travelling is not a pleasure but an exhausting saga of attacks of kinetosis (a fancy medical word for motion sickness). The giddiness, fatigue, nausea and vomiting (all or any of the symptoms) that characterise kinetosis also affect 45 per cent of daily commuters and a staggering 60 per cent of student aircrews. Travelling by plane, ship, or car (especially along winding roads) is torture for those affected by motion sickness.
Kinetosis can also affect people who watch movies or TV programmes on large screens, play computer or video games for prolonged periods, deal with virtual reality or ride roller-coasters and giant wheels.
What causes this exhausting illness? The inner ear has a vestibular apparatus that detects movement. Its input is validated by sensory input from the eyes and from the brain’s perception of the position of the body and limbs. The input becomes discordant when the body is still but the eyes perceive movement, as in a train, with 3D games, virtual reality and large screens. Motion sickness is caused by movement that is felt but not seen or seen but not felt. The brain gets confused, as it cannot reconcile the sensory inputs. It decides that a hallucinogenic toxin has entered the body and causes violent contractions of the stomach to expel the “poison”.
Motion sickness is more likely in 2-12 year old children, particularly if they are fed a heavy breakfast before a long commute to school. Infants (under two years) are immune. Women are more likely to have motion sickness if they are pregnant, menstruating, or on hormone therapy. The anxiety brought on by the thought of motion sickness is likely to precipitate an attack.
If the nausea is tolerated long enough, motion sickness may go away. This, however, cannot be guaranteed and is not a viable option.
Most victims of motion sickness prefer to take medication before going on a journey. Such pills should be swallowed at least an hour before travel to give them sufficient time to act. A wide range of centrally acting medicines like Dramamine, Avomine or Stugeron can be used. Sedation is a side effect and must be anticipated. The usual anti emetics like metachlopromide (Perinorm) Domperone or Ondesterone do not work in motion sickness. It is advisable to contact your physician and obtain a prescription for the drug that suits you best. The dosage in children has to be calculated on a mg/kg basis and is not based on age.
Certain simple precautions can help you cope:
Be aware of situations that tend to trigger symptoms and avoid them.
Optimise seating position while travelling. Sit in the front seat of a car or bus, or over the wing of an aircraft. Keep your head still. Try to focus on a distant stationary object.
Do not eat a heavy meal, drink caffeinated beverages, alcohol or eat chocolate or sweets before travel. Chewing gum does help.
Eating ginger helps some people.
Some odours like mint or lime may reduce nausea. Other smells like cigarette smoke may aggravate it.
Acupressure has proven to be useful in motion sickness. Steady pressure over the K-9 point located on both hands in the middle phalanx of the fourth (ring) finger stops the nausea. You can also try the P6 acupressure point located on the inside of the wrist, three finger widths up the arm. Repeat the pressure on both wrists.
Wristbands that apply continuous pressure to these areas are available commercially. Magnetic bracelets have anecdotally been known to help some people. It is better to try non medical interventions before opting for sedative medication.
The good news is that these pressure points also work in the morning sickness of pregnancy. The bad news is that once you have motion sickness, it can return to torment you at any age, even after a long, symptom-free interval. It has to be factored in when choosing a career — becoming an airline pilot, astronaut or sailor may not be a logical choice.
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, January 25, 2012
growing old in India
Staying healthy in old age
Your Health
DR GITA MATHAI
India is a young country. Thirty per cent of its population is below the age of 30 and seven per cent over the age of 60. In this scenario, writing about old age may seem inappropriate as it apparently affects only a minority!
This, however, is a fallacy, as the burden of caring for the seven per cent — financially, physically and emotionally — falls on the rest of the population.
Parents grow old, children often live far away and the elders refuse to move in with the next generation as they wish to retain their independence. Responsibility can no longer be relegated to relatives or neighbours. Visits to your parents are a good time to check if they are being able to cope.
Physical appearance provides invaluable clues. Parents should appear clean and well groomed. Failure to bathe, brush teeth or wear clean clothes indicates an inability to keep up with daily routine. This may be due to physical weakness, dementia or just depression.
Adults usually have a fixed routine. If you carefully watch the way parents do things around the house, you might find inexplicable illogical changes in the routine. The house may be dirty and housework neglected. Also, they may be absent-minded, like leaving things on the stove and forgetting about them. These are danger signals indicating that care is required.
Make sure the lighting in the house is bright, especially in hallways and bathrooms. Narrow staircases and slippery front steps are also difficult to navigate. Banisters are essential. Supporting bars need to be embedded near the toilet and bathing areas. Otherwise the chances of accidental falls and fractures are greater.
Good nutrition is essential for immunity (to prevent diseases) and muscle mass (for strength to prevent falls). To monitor nutrition, keep an eye on the weight, the quality of skin, hair and nails. Older adults may suffer from malnutrition even when they can financially afford an adequate diet. They may be unable to shop for the materials required. Cooking may be troublesome, time consuming or they may be physically unable to do it. Medications, illness or a recent hospitalisation may dull taste and reduce the appetite. Diet restrictions (on salt, sugar, oil, fluid and spice) owing to diseases may make the food unappetising and inadvertently limit intake. Social isolation and depression can also lead to people eating less.
If necessary, meals (at least once a day) can be delivered from outside.
We all have memory lapses and these are greater and more frequent with increasing age. Glasses and keys may be constantly misplaced. Memory loss is abnormal if it extends to names of close relatives (children, grandchildren, nieces and nephews), the way to the neighbourhood shop or dosages of regular medications. At that point, medical evaluation is required.
Lifestyle and chronic diseases occur with ageing. It is important that all medical details and prescriptions be neatly filed chronologically. This should then be placed in an accessible place. Medical check ups and visits to the doctor should be scheduled regularly. Medical containers should be neatly labelled. If tablets are in strips, the person should be able to distinguish one medicine from another. Some look very alike (calcium tablets and metformin) and it is possible to make disastrous, life-threatening mistakes.
Hearing and eyesight should be checked regularly and timely corrective measures taken. Hearing loss and partial loss of eyesight leads to dependency and feelings of social isolation. Cataract surgery and hearing aids (if required) often are lifesavers.
Sleep disturbances are common in older adults. In some it may be because of Alzheimer’s, when the sleep-wake cycle is disturbed , leading to daytime drowsiness and night-time restlessness. In many it may be because of medications, snoring (obstructive sleep apnea) or restless legs or just depression.
Good sleep can be promoted with
Exposure to a few hours of bright sunlight in the morning
Not taking caffeine (tea or coffee) after 1pm.
Adjusting medication with the help of the doctor so that any tablets with a stimulatory effect are taken in the morning.
Avoid sleeping tablets as they are habit forming and cause confusion.
Daytime sleep should be avoided at all costs. No one can sleep for more than 6-7 hours a day. If this quota is used up during the day, night sleep will be affected.
Medically treat any diseases that might interfere with restful sleep.
At the age of 60, elders need a dose of pneumococcal vaccine to prevent the development of silent and often fatal pneumococcal pneumonia.
Physical activity for at least an hour a day should be encouraged. Walking will help with appetite, lifestyle diseases, balance co-ordination, depression, dementia and sleep disturbances. It will also entail some social activity as they will meet other walkers.
A little extra effort will pay off in the long run to make old age hassle free for everyone, both the elderly and the young adult.
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
India is a young country. Thirty per cent of its population is below the age of 30 and seven per cent over the age of 60. In this scenario, writing about old age may seem inappropriate as it apparently affects only a minority!
This, however, is a fallacy, as the burden of caring for the seven per cent — financially, physically and emotionally — falls on the rest of the population.
Parents grow old, children often live far away and the elders refuse to move in with the next generation as they wish to retain their independence. Responsibility can no longer be relegated to relatives or neighbours. Visits to your parents are a good time to check if they are being able to cope.
Physical appearance provides invaluable clues. Parents should appear clean and well groomed. Failure to bathe, brush teeth or wear clean clothes indicates an inability to keep up with daily routine. This may be due to physical weakness, dementia or just depression.
Adults usually have a fixed routine. If you carefully watch the way parents do things around the house, you might find inexplicable illogical changes in the routine. The house may be dirty and housework neglected. Also, they may be absent-minded, like leaving things on the stove and forgetting about them. These are danger signals indicating that care is required.
Make sure the lighting in the house is bright, especially in hallways and bathrooms. Narrow staircases and slippery front steps are also difficult to navigate. Banisters are essential. Supporting bars need to be embedded near the toilet and bathing areas. Otherwise the chances of accidental falls and fractures are greater.
Good nutrition is essential for immunity (to prevent diseases) and muscle mass (for strength to prevent falls). To monitor nutrition, keep an eye on the weight, the quality of skin, hair and nails. Older adults may suffer from malnutrition even when they can financially afford an adequate diet. They may be unable to shop for the materials required. Cooking may be troublesome, time consuming or they may be physically unable to do it. Medications, illness or a recent hospitalisation may dull taste and reduce the appetite. Diet restrictions (on salt, sugar, oil, fluid and spice) owing to diseases may make the food unappetising and inadvertently limit intake. Social isolation and depression can also lead to people eating less.
If necessary, meals (at least once a day) can be delivered from outside.
We all have memory lapses and these are greater and more frequent with increasing age. Glasses and keys may be constantly misplaced. Memory loss is abnormal if it extends to names of close relatives (children, grandchildren, nieces and nephews), the way to the neighbourhood shop or dosages of regular medications. At that point, medical evaluation is required.
Lifestyle and chronic diseases occur with ageing. It is important that all medical details and prescriptions be neatly filed chronologically. This should then be placed in an accessible place. Medical check ups and visits to the doctor should be scheduled regularly. Medical containers should be neatly labelled. If tablets are in strips, the person should be able to distinguish one medicine from another. Some look very alike (calcium tablets and metformin) and it is possible to make disastrous, life-threatening mistakes.
Hearing and eyesight should be checked regularly and timely corrective measures taken. Hearing loss and partial loss of eyesight leads to dependency and feelings of social isolation. Cataract surgery and hearing aids (if required) often are lifesavers.
Sleep disturbances are common in older adults. In some it may be because of Alzheimer’s, when the sleep-wake cycle is disturbed , leading to daytime drowsiness and night-time restlessness. In many it may be because of medications, snoring (obstructive sleep apnea) or restless legs or just depression.
Good sleep can be promoted with
Exposure to a few hours of bright sunlight in the morning
Not taking caffeine (tea or coffee) after 1pm.
Adjusting medication with the help of the doctor so that any tablets with a stimulatory effect are taken in the morning.
Avoid sleeping tablets as they are habit forming and cause confusion.
Daytime sleep should be avoided at all costs. No one can sleep for more than 6-7 hours a day. If this quota is used up during the day, night sleep will be affected.
Medically treat any diseases that might interfere with restful sleep.
At the age of 60, elders need a dose of pneumococcal vaccine to prevent the development of silent and often fatal pneumococcal pneumonia.
Physical activity for at least an hour a day should be encouraged. Walking will help with appetite, lifestyle diseases, balance co-ordination, depression, dementia and sleep disturbances. It will also entail some social activity as they will meet other walkers.
A little extra effort will pay off in the long run to make old age hassle free for everyone, both the elderly and the young adult.
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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