restless legs

Sometimes, legs ache, tingle and develop shooting pins and needles in the night. These uncomfortable sensations cause a person to wake up. If he or she gets up and moves around, or massages the leg, the sensations disappears. Only to reappear when the leg is at rest again.

Sleep is very important. Lack of or disturbed, non-refreshing sleep can occur due to these feelings in one or both legs. The person is then unable to get up in the morning or cope with the day. It also results in fatigue, forgetfulness, depression and irritability. Work, efficiency and academic performance suffer.

This “restless leg syndrome” (RLS), also called Willis-Ekbom Disease, affects almost eight per cent of the population. It is commoner in children and middle-aged adults. More women than men are affected.

It is more common in people with diabetes, peripheral neuritis from any cause, kidney disease and anaemia. It tends to run in families. Some specific gene variants have been associated with RLS. One theory is that the basal ganglia in the brain — responsible for the production of a chemical called dopamine that controls smooth, purposeful muscle activity — do not function efficiently. Low levels of iron in the blood have an adverse effect on the production of dopamine.

RLS can be pecipitated in some people by certain medications, such as antipsychotics, antidepressants, antihistamines and those used to combat nausea and vomiting. In these cases, the RLS is temporary. Stopping the medication relieves the symptoms. RLS sometimes appears during pregnancy and spontaneously disappears around a month after childbirth. Use of alcohol, tobacco in any form (cigarettes, beedis, snuff and chewing tobacco) and caffeine (coffee, tea and cola) aggravate RLS.

Simple measures such as controlling diabetes, correcting electrolyte and mineral imbalances, treating kidney disease and taking iron supplements help. Megavitamin supplements, however, are not beneficial.

Sleeping for seven to nine hours a night as well as waking up and going to bed at fixed times is often beneficial. Symptoms are usually less in the early morning, so getting up later may help with sleep. Taking a bath in hot water at bedtime helps relax the muscles as does gentle stretching exercises. Exercise also releases chemicals from calf muscles which reduce the symptoms. Remember, however, to keep a gap of at least an hour between working out and going to bed so that the body has time to cool down.

RLS can also occur during long flights or if you just sit still for a long time, say binge watching television. If you sit reading on the other hand, symptoms can decrease even if there is no active movement of the legs. A hot water bottle or heating pad helps relieve the pain in some people while ice packs help in others. Sleeping with the legs elevated also relieves symptoms.

If these simple measures do not help, medication may be required. Iron supplements can cause gastric irritation and constipation so take them on a full stomach. Combining iron pills with citrus juices (rich in Vitamin C) increases the absorption. Pain relieving medication is helpful but can be habituating (codine) or addiction (benzodiazepines). Some anti-seizure medications such as gabapentin and pregabalin also work. Treatment has to be individualised.

The good news is that in some people RLS spontaneously disappears, especially if they have implemented beneficial lifestyle changes. The bad news is we still don’t know why RLS occurs.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.

If you have any questions on health issues, please write toyourhealthgm@yahoo.co.in

GERD

Guard from the gut

GERD: symptoms and solution

By Dr Gita Mathai

• Published 27.03.19, 12:09 PM
• Updated 27.03.19, 12:09 PM

• 2 mins read
•  

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Nearly 25% of older Indians suffer from symptoms of gastro-oesophageal reflux disease or GERD.(Shutterstock)

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Many older Indians — nearly 25 per cent of them — suffer from symptoms of gastro-oesophageal reflux disease or GERD. They have a plethora of disconcerting symptoms, some of which may seem unrelated to acid or reflux. They may have a persistent dry cough, sore throat, hoarseness of voice, burping, hiccups, bloating, difficulty swallowing with a choking feeling and a sensation of a something sticking in the throat. Sometimes, it can give rise to agonising chest pain, which can be mistaken for a heart attack. Many such patients wind up in casualty or chest pain units. After a medical evaluation, often expensive, many are told, “It is just stomach pain.”

There is a tight sphincter muscle at the junction of the stomach and the oesophagus. This acts like a valve, keeping the contents of the stomach from flowing back into the oesophagus. There is another such muscle at the intersection of the throat and the oesophagus. If and when food is swallowed, these muscles relax sequentially. They then shut tightly, preventing regurgitation of the food and acidic stomach contents into the oesophagus and mouth.

If the stomach contents regurgitate, the lining of the oesophagus is bathed in acid. It becomes damaged, can form ulcers and repeated damage can even cause cancer.

Some people are born with defective valves. They develop acid reflux at a young age. But GERD occurs mostly in middle-aged people because of obesity, especially those with protruding pot bellies and poor core strength.

GERD is often a clinical diagnosis. It can be confirmed, if required, with X-rays, endoscopy, oesophageal manometry and an ambulatory acid probe test.

Symptoms are aggravated by use of tobacco in any form — smoking, chewing or as snuff. Alcohol also loosens the oesophageal sphincters. Some foods such as citrus fruits, tomatoes, caffeinated cola drinks, raw onions, garlic, coffee, tea and chocolate are also blamed. Foods that cause reflux are idiosyncratic to the individual. Some foods aggravate symptoms in certain people but not in others. This can be determined with a detailed food history. Oily foods take a long time to digest and universally exacerbate symptoms. High-fibre foods like carrots, beetroot, radish, green leafy vegetables, apples, bananas, pears, almonds and walnuts, lentils, chickpeas and beans reduce symptoms. As far as possible, non-processed natural food should be eaten. Processed foods contain chemicals, colouring, flavours and preservatives, which increase acidity.

Symptoms can be reduced by eating 5-6 small, healthy meals a day instead of three large ones, and not sleeping or exercising for at least an hour after eating. The head of the bed can also be raised by six inches to prevent regurgitation.

Weight loss, diet restrictions and lifestyle modifications are not popular with many adults. They prefer to “pop a pill” to solve the problem. Ranitidine, omeprazole and its many acid-suppressing proton pump inhibiting derivatives are easily available in pharmacies without a prescription. Many people are on long-term self-medication with these acid suppressants.

These pills should ideally be taken 30 minutes before a meal once or twice a day. They should be stopped after two weeks. They should not be taken “as and when” in anticipation of a heavy meal or drinking binge. It is a myth that these medications are harmless. Long-term and unregulated use leads to side effects, more and more of which are being discovered every day. As they suppress acid formation, they can lead to micronutrient deficiencies, susceptibility to infections and reduction in bone density leading to fractures. If they are also combined with antacids, there is growing evidence that they can precipitate early onset dementia.

Diet and lifestyle changes can heal ulcers, undo damage already done and reduce the symptoms of GERD. That is the only way to treat it.

• The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.
• If you have any questions on health issues, please write toyourhealthgm@yahoo.co.in

manage pain

Tricks to manage pain

Rhythmically tapping a part of the body that is away from the area of the pain confuses the brain

By Dr Gita Mathai

There is a myth that we use only 10 per cent of our brain, but actually we use most of our brain almost all the time. It functions tirelessly, 24 hours a day, whether we are awake or asleep. It performs complicated sequential actions, some physical (those performed by an expert juggler), some mental (complex mathematics) and coordinates thinking and movement. All activities, conscious and subconscious, performed by humans are under the centralised control of the brain.

With advancing age, brain cells die, leading to loss of function, physical prowess and memory. The good news is that neurogenesis — the formation of new neurons — also occurs. It occurs naturally rapidly in children but reduces in adult life.

It really slows down in older people unless active efforts are made to form and maintain new connections. This can be done by learning new skills — such as dancing, a different language or a musical instrument.

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Adults tend to accelerate the rate of destruction of brain cells with inappropriate lifestyle habits such as smoking, uncontrolled diabetes or hypertension, or working with volatile aromatic compounds such as glue. Of all the lifestyle poisons, controlled alcohol consumption — not more than one “small” drink a day for women and two for men — is the least harmful.

Incidentally, it is possible to control some subconscious brain functions, such as the perception of pain, by tricking the neurons. All of us feel pain at some point of time. If it is an episode of acute pain, it can be tackled with medication but chronic pain is a different story. Arthritis and other painful diseases can take over our lives, preventing efficient functioning. Although pain arises in specific areas of the body, it is processed and felt in the brain. And it is possible to trick the brain into thinking that the pain has disappeared or lessened. Here’s how:

Apply ice for 5-10 minutes to the area of pain. Then rhythmically tap a part of the body that is on the side opposite or away from the area of the pain. The conflicting signals confuse the brain and there is an “override”. The pain reduces in intensity. The dose of painkillers can also gradually be reduced.

Listening to music lessens the perception of pain as the auditory sensory signals override that generated by the pain. Meditation and repeating mantras also helps.

People sometimes have an uncontrollable itch in a part of the body. If there is no discolouration or swelling, it may be a kind of neurogenic itch . That too responds to ice packs, followed by rubbing the opposite side of the body. This manoeuvre is even more efficient if it is done seated in front of a mirror.

Insomnia — the inability to fall asleep and stay asleep — is the plague of the 21st century. It aggravates a plethora of diseases, such as diabetes and hypertension, and contributes to weight gain. In addition to exercising in the evening (only until 7pm), going to bed at the same time every day in a darkened room with no plugged-in electronic devices and drinking a glass of warm milk before bed, you could try the 4-7-8 method.

Place the tip of the tongue behind the two front teeth, exhale completely through the mouth while making a sound for a count of eight. Inhale through the nose for a count of four and then hold your breath for a count of seven.Repeat three times. This works miracles, without the aid of addictive sleeping medication. Sweet dreams!

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.

If you have any questions on health issues please write to yourhealthgm@yahoo.co.in

travellers diarrhoea

Travelling? Take precautions for traveller's bug

Unfortunately, 40-60 per cent of travellers are prone to sundry infections

By Dr Gita Mathai

• Published 21.11.18, 1:51 AM
• Updated 21.11.18, 1:51 AM

• 2 mins read
•  

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Viruses from the enterovirus and rotavirus family, bacteria, especially E.coli and protozoa-like giardia can cause traveller's diarrhoeaImage: Wikimedia Commons

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The holiday season has started and elaborate plans are being made for pilgrimages, trips to holiday resorts and visits to exotic locations. Unfortunately, 40-60 per cent of travellers will be exposed to disease-causing “bugs”, which result in sundry infections. Of these, 'traveller's diarrhoea' is the most common and incapacitating. It forces sightseeing and travel to be put on hold, as the search for a toilet becomes a priority.

The diarrhoea usually sets in within two to seven days of travel. It is watery and may be associated with other symptoms like nausea, vomiting, abdominal pain and urgency. The good news is that it is self-limiting. It usually subsides within two or three days with or without treatment. One of the critical features of the traveller’s diarrhoea is that local hosts are immune to it. Their intestines have developed resistance over the years to the offending organism.

Viruses belonging to the enterovirus and rotavirus family, bacteria (especially E.coli) and protozoa-like giardia can all cause traveller's diarrhoea. In 70 per cent of the patients, no one agent has been found to be responsible. There is therefore no universal cause and no common cure.

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Although the disease is self-limiting and usually subsides on its own, it is essential to prevent complications like dehydration. Fluids, such as correctly reconstituted, commercially available packets of ORS (oral rehydration solution), homemade ORS (1 litre of water, 1/2 tsp salt and 6 level tsp of sugar), salted rice gruel, khichdi, bananas, lightly salted buttermilk and lime juice with sugar and salt can be consumed for hydration. Alcoholic drinks and caffeinated, carbonated beverages are not recommended. It is also best to avoid milk. Keep in mind that rehydration will not reduce the frequency or quantity of the stool. It will only prevent complications.

The frequency of diarrhoea can be reduced with anti-motility agents such as loperamide (imodium). More than 4-8 tablets should not be used as it can cause dizziness and bloating. These tablets are not advised for children under six years of age. Antibiotics are not routinely prescribed, as often the diarrhoea is due to viruses or protozoa which do not respond to these medications. Also, inappropriate antibiotic treatment does not reduce the frequency and duration of diarrhoea. It is only likely to produce side effects like monilial overgrowth and resistant organisms. Superinfection with some of these organisms can be life-threatening. If the diarrhoea persists for seven days or more, antibiotics may be required with a medical consultation. A short three-day course is usually sufficient. Taking random antibiotics before travel to prevent diarrhoea will also not work.

If the diarrhoea persists for 10 days or more after travel, it needs to be investigated. If it is associated with belching, bloating and large unformed stools, it may be due to giardia. If there is blood and mucous, organisms like shigella or cryptococcus may be responsible. If the diarrhoea persists a month or more, and no infectious agent can be found, it may be due to a non-infectious cause or a complication that has set in, such as IBS (inflammatory bowel disease) or milk allergy.

Here are precautions you can take to reduce the likelihood of diarrhoea —

• Drink only boiling hot tea or coffee. Avoid juice as ice used in it may not be sterile.
• Drink bottled water or water that has been boiled for three minutes. Even teeth have to be brushed with bottled water in some countries.
• Avoid cut fruits and vegetables such as in salads.
• Some diarrhoeas due to rotavirus, cholera and typhoid can be avoided with timely immunisation.