not twins

That sounded logical. I was not sure of the family planning rules, which seemed to change every now and again.
The government frequently said things like, “You will get money if you get sterilized after two children, sometimes “only if both are girls”, sometimes, if you got “sterilized after one child.” I had stopped keeping track. Nothing seemed to deter the ones who wanted more children. Not money or threats.
She kept bringing the first child. His health was poor, he was underweight, his nose dripped constantly and he had a vacant adenoidal stare. He was a wheezer. A week or two after treatment his weight always picked up, his mouth remained closed, the dripping was better, but he then he had diarrhea. Then we would be back to square one. Once the diarrhea recovered, he would start wheezing again.
Once she came and said, ”can you see me out of turn? The taxi is waiting. We have to go for a wedding. He has diarrhea.”
I looked out of my window to see if she was telling the truth. I saw four identically dressed boys of marginally different sizes.
“Who are these ?’ I asked.
“They are mine.” She said.
But there are four----.
She looked sheepish. My husband said you would get angry if we had four boys and I have not had a sterilization. We registered the first and second with the same name.”
I thought of my consternation and bewilderment each time he/ they came with their weights going up and down like a yo-yo. In my records they both had the same name and birth date, but were actually 11 months apart!
I don’t know who I was investigation for eosinophilia, anemia, milk intolerance, adenoids, failure to thrive!!!
“Why? Why?” I asked.
“We want a girl---“
I

gait

https://www.telegraphindia.com/1170821/jsp/knowhow/story_168290.jsp

Talk the walk

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Your Health - Dr. Gita Mathai

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As infants grow, their motor skills develop in a certain set, sequential pattern. They first turn over, then sit, crawl, stand and walk. Some give the crawling stage a miss. Others, very efficient at crawling, may learn to walk later. Most children are mobile by 14-16 months of age.

The first steps of a baby are wide-based, wobbly, short and rapid with the arms outstretched for balance. Like every activity, walking improves with practice. Though falls are frequent, they need not be feared unless they are from a height or down steps.

The adult gait is different. The heel of one leg first touches the ground then the whole foot is placed flat. The heel then rises, the weight is transferred onto the toes. The body swings off the toes with arms swinging in a reciprocal manner. Children start to develop this gait around 18 months and perfect it by the age of eight.

Some children may have a "toe-in" gait, with the toes pointing inwards as they walk. Others may walk with a "toe out" gait. This may run in the family or be due to a cramped position in the uterus. This seldom interferes with running or sports activities. Some children walk on their toes.

As children get older, their posture, muscle power, and control spontaneously improve. The abnormal gait begins to correct itself. In toeing usually improves by the age of three, flat feet by six years, bow legs by 18 months and knock knees by seven years. There is cause for concern if the abnormality is not symmetrical and appears to affect one foot more, if it is accompanied by limping or pain, or if there are mental developmental delays.

Some gaits are definitely abnormal and need to be evaluated. Children may refuse to bear weight on one leg. They may complain of pain or there may be obvious shortening. The legs may swing forwards, remain stiff and spastic, and refuse to bend. The gait may remain wide-based and unstable. Faulty motor coordination due to neurological causes may produce an inordinately clumsy child who has frequent falls.

About 35 per cent of senior citizens have difficulty in walking half a kilometre or climbing one flight of stairs. The gait changes gradually in 60 per cent people; this is obvious in those 80 years or older. There is a reduction in speed of motion, the width and the length of the stride. A greater length of time tends to be spent with both feet on the ground. There is a tendency to remain bent with eyes fixed on the ground. This makes the gait appear cautious and shuffling. Weak hip muscles may make the gait "waddling."

This deterioration is not necessarily a natural consequence of aging, even though physically inactive people lose five per cent of muscle mass every decade. The change in gait may be due to weakness, but medication, diabetes, liver disease, the pain of arthritis, peripheral neuritis can also play a part. An unstable gait can lead to falls, injuries and fractures.

Any medical conditions causing gait problems should be targeted and treated. Physical therapy is helpful. During exercise, concentrate on the correct gait sequence: heel strike, flat foot, toe off. You should practise walking in a straight line, toe to heel walking, balance exercises, yoga, and pelvic and leg muscle strengthening. These interventions are effective if they are performed regularly four to five times a week.

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

aging India

Neither tired, Nor retired

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Your Health - Dr. Gita Mathai

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When India gained independence, its population had a life expectancy in the 30s. Today, barring unforeseen events, we can expect to live to our 70s. This transformation has been facilitated by better nutrition, education, hygiene, and immunisation against many diseases.

Unfortunately, our social system has not kept pace with the changing times. Though healthcare is theoretically provided free by the government - and there are government insurance schemes covering admission in private hospitals - it is woefully inadequate. The burden of elder care usually falls on the 30 per cent working adult population. Shrinking nuclear families, women in the workforce and global migration of the educated, has resulted in a dearth of caretakers, leaving the elderly to fend for themselves.

All of us get older, and as we do, oxidative stress damages our cells. The telomeres in our chromosomes grow shorter and suffer mutations. Though these changes occur in everyone, they are greater, and faster, in people who smoke, drink (anything more than the equivalent of a glass of wine a day) or are obese. These factors shorten the lifespan by as much as 10-12 years. By tweaking your lifestyle and making it a healthy one, the sunset years can be comfortable, and hopefully, disease and pain free.

Until the age of 30, nature protects us by making our muscles grow and remain strong. After that fat slowly infiltrates the muscles at the rate of around 5 per cent every 10 years. This accelerates after the age of 70. Muscles begin to sag and lose their strength. Balance is affected and falls can occur. Bones become weak and osteoporotic, resulting in fractures even when the injury is mild.

As you grow older, fatigue sets in easily with a desire for a mid-morning or afternoon nap. This can lead to insomnia and sleep that is not refreshing. Popping sleeping pills regularly is not the answer. Instead, avoiding a siesta can often solve the problem.

In India we retire young at 58 or 60 years. The brain starts to deteriorate rapidly once its synapses and electrical pathways are not used. Five per cent of the brain cells die every day. This is trebled if they are not used or were abused with chemicals, alcohol and nicotine.

Studies show that there is less deterioration in the brains of those who do yoga regularly. So, attend a yoga class, learn the basic movements and practice a minimum of three times a week. Learning poetry or the scriptures by heart also boosts brain cells.

Exercise is important to maintain muscles and prevent age-related deterioration. Weights of 1-2 kg should be held in both hands and movements like that of a school sports drill repeated 20 times. It is worthwhile to go online and see how all groups of muscles can be exercised. Follow this up with eye and breathing exercises. Flexion, core strengthening and balance exercises are also necessary.

Make sure you have adequate carbohydrates and proteins in your diet and 4-6 helpings of fruits and vegetables daily. This will provide protective immunity by boosting flavonoids and antioxidants. A protein shake a day is beneficial too.

Adults also need immunisation. Pneumococcal vaccine should be taken after the age of 65 as well as the Herpes zoster vaccine. A yearly flu shot between September and March is also necessary.

Lifestyle diseases such as diabetes, hypertension and lipid derangements should be kept in control with regular diet and medication. Residences need to made "elder friendly" with bright lighting and railings. Supporting bars should be embedded near the toilet and bathing areas to prevent falls and fractures.

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

eczema

Ditch the itch

https://www.telegraphindia.com/1170717/jsp/knowhow/story_162231.jsp

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Your Health - Dr. Gita Mathai

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Itchy red rashes are irritating. If they appear frequently, they interfere with the quality of life. Around 10 per cent of children and three per cent of adults have periodic flare ups of rashes. This phenomenon is loosely termed eczema and it is assumed that the cause is allergies. Quite often, the symptom runs in families. Some members itch, others sneeze (rhinitis), or wheeze (bronchial asthma). Fortunately, if the symptoms start in infancy, there is hope. The child may outgrow the allergies by the time he or she is 10.

Any part of the body can be affected by eczema but it always starts with uncontrollable itching. A rash may follow. Scratching does not relieve the itch, it only perpetuates it and makes it worse. It may result in secondary infection and crusting. Once the eczema disappears, the area may remain hypo or hyper pigmented for some time.

The exact cause of eczema is not known. One theory is that because the skin is unduly sensitive, it cannot perform its barrier function efficiently. Rough clothing, detergents, soap, sweating, exposure to cold temperatures, pollen, animal dander, nickel in fashion jewellery, colouring in food, face powder, perfume, makeup, exposure to sunlight and even mental stress can cause a flare up. Sometimes eczema is not due to an allergy but is an itchy infestation of the skin like scabies. This causes symptoms that persist till the scabies is treated and cured. Varicose veins cause stagnation of blood in the lower limbs. This can also cause eczema till the veins are treated.

Traditionally, we give babies an oil massage before their bath. Usually we use coconut oil. It penetrates the skin and efficiently moisturises it. A mixture of 250ml coconut oil, 250ml sesame oil and 100ml paraffin, castor or olive oil is an even better moisturiser. Oiling the whole body for 15 minutes everyday (also in adults) and then bathing with a mild soap will help prevent eczema. Adding a teaspoon of salt and soda bicarbonate (baking soda) to the bathwater also helps. Applying coconut oil after a bath is counter productive as it attracts ants which bite, causing itching and scratching.

Most detergents contain chemicals such as sodium lauryl sulphate, which remain behind in small quantities in the clothes despite rinsing well. They penetrate the skin when sweating occurs, aggravating eczema. Commercially available "hypoallergic" or "doctor tested and recommended" detergents have not been ratified or proven to be safer. It is preferable to use non-allergic soaps made from neem oil. They are marketed in India by the government-run chain of Khadi stores.

Treatment of eczema is an ongoing process that involves enjoying remissions and tackling sudden exacerbations. Known allergens should be consciously avoided. The skin should be moisturised regularly before a bath and after, when it is still damp. Non-staining preparations like paraffin oil and ointments with paraffin wax are efficient and inexpensive. Low dose one per cent steroid creams can be applied for short durations if moisturisation is not enough.

The itch, scratch, itch cycle has to be broken. Application of cold compresses to the itchy area reduces the desire to scratch. Antihistamines will reduce the itch. The newer non-sedating anti-histamines can be taken during the day too.

Adults (except pregnant women) and children over the age of two who do not respond to the above measures can be treated with prescription creams containing immunomodulators like pimecrolimus or tacrolimeus. These potentially increase your cancer risk with long-term use. So be careful of that.

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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dieting Blues

Dieting Blues

I have been trying to loose weight (rather unsuccessfully ) after the birth (37 years ago) of my second child. (He often says  I blame everything on him)!

My friend and classmate in medical college is an expert on weight loss. She set up a very successful clinic. She is in great demand and She motivates her dieters, and allows them  no excuses at all. The regimen does not require any exercise, so it is very popular. The diet is totally carbohydrate free with just protein and fat. There are raw green leafy vegetables too. After some time  you feel like a mutant herbivore. You also begin to chew the leaves you are allowed to eat in a desultory fashion. It keeps your mind off food. The diet works, and,  even though your dreams are full of biriyani, parottas and dal makhani, the weight just melts off.

Keeping the kilos  off is quite another matter. After a year or two, when chewing cud is not a viable option, and pongal vadai irresistible, it just creeps back on again. Also there is the unsightly sagging in the areas of weight loss, usually the arms, the face , the sundry other regions covered with skin. The areas from which the fat has disappeared leaves long streaks, ugly discoloured pink or white visible stretch marks.

Another classmate looked very slim and trim. At the alumni reunion she was a source of great envy. Her stomach was flat her arms toned.

“What exactly is your secret?” I asked. The rest of the women (many of whom had paunches that led from the front) listened with interest.

“I eat only every alternate day,” she replied. There was a shocked silence.

On the other days, “I only drink water. Since I work, I do not really notice the lack of food.”

She added , “ I also use the cross trainer for an hour on the days I don’t fast.”

 I decided to try it. To motivate myself further, I went to work without carrying any breakfast or lunch with me. I took black coffee and lime water (not lime juice). By 11:30 AM I started to see double. The patient’s face split into two halves sideways and then joined again. I once saw a movie about a schizophrenic lady. The credits had her face split into two halves which sporadically joined together. My stomach let out loud audible rumbles.   I send my staff out to buy curd rice.

That was the  end of the fasting!

After my Achilles tendon tear, this year, the orthopedic surgeon warned me.

“You are going to be in bed for three months. Even with a normal diet, you will gain weight. Your leg won’t be able to take it. You have a high chance of re-rupture.”

Visions of this purgatory (cast and bed rest) haunted  me.

I cut my food intake in half.

I lost 7 kilos in three months. The physicians were not happy.

“No one can diet like this. We need to do a whole body PET scan to rule out occult malignancy.”

My protests fell on deaf ears.

The good news? The scan was normal!

scars

https://www.telegraphindia.com/1170626/jsp/knowhow/story_158677.jsp

Scars will fade

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Your Health - Dr. Gita Mathai

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The skin covers our body, like a well-fitted, elastic garment. It does not normally have any cuts or breaks. If the skin suffers an injury, just like material which is torn and darned, an obvious blemish forms. It may be due to a fall, surgery, trauma, burns or just boils or pimples. This is a scar.

Initially, damage causes bleeding, followed by the formation of a blood clot. This dries, and then new granulation tissue forms over the wound. Then a scab forms which may itch. New skin forms over the wound. This is smaller in size than the original skin so the edges of the wound pull together. Over the next two to three years, the scar may fade completely.

While scar tissue has the same composition as skin, it is inferior in quality and often, of a different colour or texture. It also does not have hair follicles or sweat glands, unlike skin.

Unsightly scarring can occur even with mild trauma, especially if the injury has occurred where the skin is taut, if the person is young or if there is a familial tendency to develop severe scars.

Acne causes severe scarring in one per cent of the population. It may appear as pits or waves. Since 90 per cent people suffer from acne at some stage, it is a severe cosmetic and social problem. Scars are less if acne is treated as soon as it develops. Pricking or squeezing the pimples can lead to secondary infection and severe scaring. Also, if there is no improvement after a couple of months of home treatment (wash the face twice a day with mild cleansers and apply OTC anti-acne medication), a dermatologist should be consulted.

Burns, (water, chemical or electrical) can extend deep into muscles and even bones. As they heal, the edges of the skin pull together causing disfigurement. They produce contracted scars. If scarring occurs over joints, mobility can be affected.

Some scars are "hypertrophic". Although they appear to rise above the wound, they do not extend beyond its boundaries. They do not pain or itch but can be disfiguring.

Scars which extend beyond the margins of the wound, are red or brown in colour and are itchy or painful are called Keloid scars. It can be due to acne trauma, ear piercing or surgery. They can grow slowly over months or years. They are cosmetically unappealing and the symptoms can be very troublesome.

To prevent scar formation, as soon as injury occurs, stop any bleeding by applying pressure. Then clean the wound with soap. Topical antibiotic creams reduce the risk of infection. Clean bandages should be placed on the wound. These should be changed as soon as they become soiled. Gaping wounds need suturing.

Scars tend to fade over time. So it is best to wait a year before opting for aggressive treatment. Advertised OTC creams to treat scars are usually not very effective. Dermatologists and surgeons can offer a variety of options like skin grafts, dermabrasion, chemical peels, laser surgery, skin grafts or filling the scars with collagen.

Applying an ice pack for 20 minutes, several times a day, can relieve the symptoms of mild keloids. The keloids should be moisturised. Steroid creams and oral antihistamines can relieve the itching. Mix a teaspoon of baking soda with three teaspoons of hydrogen peroxide and apply it to the keloid. Keep it on for 15-20 minutes and then wash it off. Do it three times a day to see results.

Non responsive symptomatic keloids require specialised treatment with steroid injections, silicone gel sheets, laser treatment and cryotherapy (freezing), or as a last resort, radiation.

Most scars usually fade away, but it takes time.

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

tinnitus

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

Phantom noise 

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Your Health - Dr. Gita Mathai

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

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

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

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

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

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

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

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

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

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

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