Wednesday, August 4, 1999

Stretching for health
By Bob Anderson
TODAY millions of people are discovering the benefits of movement. Everywhere you look they are out walking, jogging, running, playing tennis or recquetball, cycling or swimming. What do they hope to accomplish? Why this relatively sudden interest in physical fitness?

The cutting edge of modern medicine Herb and cataract
LONDON: St John's Wort, a herb often billed as a natural alternative to the anti-depressant Prozac, could cause cataracts if people taking it are exposed to bright light and sunshine, the new scientist magazine said.

High blood pressure: fact & fiction
by Dr G.D. Thapar

HIGH blood pressure or by hypertension is a common health problem after the age of forty. Like diabetes, it is a serious risk factor for many diseases, yet it can be easily treated and controlled. With proper control it is absolutely possible to prevent its harmful effects and ensure good quality of life and longevity.

What is normal blood pressure?

Generally, 140/90 is considered to be the upper limit of normal blood pressure at the age of 40. The upper figure is called systolic pressure and the lower figure diastolic pressure. As age advances somewhat higher figures may be accepted as normal. There are fairly wide variations from person to person and in the same person from time to time. After all, it is not a fixed figure like the length of a finger. Physical work, exercise, fevers, emotions, sexual intercourse temporarily raise it; in winter months it is higher than in summer. Considering the variables, it is best to depend upon readings taken early in the morning before breakfast, after resting for 15 minutes.

At this point I wish to dispel fears harboured by some persons who are young and normal, and have low readings like 110/70 or even lower. These are perfectly normal readings. Low blood pressure need cause anxiety only if there is a sudden fall of blood pressure; then there is a cause for it, such as a drug, a heart attack of bleeding somewhere. A habitually low blood pressure in an otherwise normal person, on the other hand, is a blessing.

Why does blood pressure rise?

There are certain diseases, e.g, kidney diseases, which raise the blood pressure, but in the vast majority (over 90 per cent) of cases no identifiable cause can be found. These cases are called 'essential hypertension'. Most of the discussion that follows relates to these cases.

How blood pressure rises

The smallest peripheral arterial blood vessels become constricted and narrowed; this raises the blood pressure all over the arterial tree, just like the rise of pressure of water if you constrict the end of a rubber hosepipe connected to a water tap. Why the arterial constriction takes place, nobody knows for certain, though theories abound. However, certain factors like tension, hurry, working against time, emotional disturbances and perturbations do aggravate hypertension. Mild but chronic urinary tract infections are also known to raise the blood pressure.

Harm done by high BP

By itself hypertension produces few symptoms, may be sometimes heaviness of head. This is why it has been termed as 'silent killer'. It is not uncommon for physicians to see patients with as high a pressure as 240/130 and the patient not feeling anything wrong with himself, unless some complication like a heart problem or stroke occurs as a consequence of the very high pressure. It is therefore very wrong to try to judge the level of blood pressure by one's feelings. There is no other way except to check the reading with a blood pressure instrument, preferably mercurial.

Blood flowing in the arteries at a high pressure year after year damages the walls of the major arteries of the heart, kidneys, brain, etc. The high pressure forces the cholesterol contained in the blood into the arterial wall. It thus facilitates the formation of fatty deposits (atheroma) on the walls of the arteries. These deposits cause obstruction to the flow of blood in the affected arteries and are the cause of heart attacks and strokes (Chapters 13-15). The high pressure also causes degeneration of the delicate arteries of the eyes and kidneys, thereby damaging those organs. The damage once done to blood vessels cannot be undone.

High pressure in the arteries compels the heart to contract with greater force to overcome the high pressure. The work of the heart is thereby increased. In course of time its mass and size increases, but there is a limit to which the heart can adapt to the high pressure. Eventually, blood pressure remaining untreated, the heart fails in its function as a pump.

The above effects of hypertension are long term chronic effects. However, if blood pressure suddenly shoots up to very high levels, above 200 mm systolic, there is immediate danger of bursting of an artery, e.g, in the brain, or the heart may be unable to cope with this sudden rise of pressure and may fail in its function.

What is to be done ?

You would have guessed by now that if the person has to be helped, the proper time to start the control of pressure is right at its onset. In our present state of knowledge there is no treatment available which can radically cure the disease. The aim of the treatment is, therefore, to reduce the blood pressure to near normal levels and keep it at that level, so that the adverse effects of hypertension are prevented from occurring. Being a lifelong disease the treatment has to be lifelong. Lowering the blood pressure for a few months is of no value.

If you have high blood pressure, you would be well-advised to keep it under control with the help of your physician, though you may otherwise be feeling normal. Once complications of the disease appear, the treatment becomes more complicated, more expensive and less effective.

Examination and investigation

The physician will examine you, may be more than once, and assess the level of your blood pressure, the condition of your heart, kidneys, eyes and other body organs. He may order certain investigations which may include an ECG, urine examination, urine culture, X-ray of the chest for heart size, etc. He may look into your eyes with an ophthalmoscope to check on the health of the arteries which are directly visible inside the eyes. Urine examination and culture is necessary because sometimes low grade chronic infection of the urinary tract keeps the blood pressure high, and treatment of this infection may itself bring down the blood pressure substantially.

Drug treatment

Many effective drugs, singly or in combination, are now available — Diuretics (e.g, Lasix, Dytide), Betablocking drugs (e.g, Inderal, Atenolol), Methyl dopa (Aldomet), Hydrallazine, Calcium channel blockers (e.g, Nifedipine), to name but a few. Your physician will choose the drug or combination of drugs most suitable for you. Periodical checks by your physician are essential to keep the blood pressure under good control, not high nor too low. He will also keep an eye on early signs of any complication.

It must be mentioned that the drugs for hypertension cannot be treated light-heartedly like popcorn. They have to be taken under the guidance of your physician. Sometimes side-effects can occur, the common ones being depression with Serpasil, frightening dreams with Inderal, drowsiness with Aldomet, general weakness with diuretics. Some drugs cause loss of libodo and sexual potency. If you experience any of these effects, report to your physician; he will suitably modify the treatment. With the introduction or more and more new and effective drugs it is now possible to control blood pressure without undesirable side-effects.

Physiological measures

Keeping one's cool, not working against time, not being too time-bound, avoiding hurry, and a regular schedule of meals, rest, exercise and sleep as well as stopping to smoke can go a long way in lowering your blood pressure and reducing the need for anti-hypertensive drugs. Meditation may also help towards this end; its technique should be learnt in one of the many centres which have sprung up in recent times in most of the towns across the country and abroad.

It has been found that high consumption of common salt (sodium chloride) raises the blood pressure, and so does lack of potassium. Potassium is present in many vegetables and fruits, particularly citrus and bananas. Hypertensive persons should reduce their salt intake to say one-third of their usual consumption. They should not stop it altogether, because this can be harmful in summer months when there is considerable loss of salt by way of sweat, or when diuretics are administered which dispose off the salt from the body. They should eat plenty of vegetables and fruits, particularly oranges, kinu and bananas. Vegetarian diet is ideal for hypertensives, though the non-vegetarian items of food need not be entirely excluded. To reduce salt intake it is suggested that use of chillies and spices should be kept to the minimum; they need more salt for taste. Indian pickles (achars) and chutneys are also rich in salt and should be taken sparingly.

Concluding, it must be stressed that hypertension is a serious risk factor, especially for the heart and brain, it has few or no symptoms and therefore has been aptly termed as the 'silent killer'. Proper treatment and control under the care of your physician is imperative, and has to be lifelong. The rewards of such control are a good quality of life and longevity.

Dr G.D. Thapar is an internationally known clinician, writer and medical administrator. He is based in Ambala Cantt.

Stretching for health
By Bob Anderson

TODAY millions of people are discovering the benefits of movement. Everywhere you look they are out walking, jogging, running, playing tennis or recquetball, cycling or swimming. What do they hope to accomplish? Why this relatively sudden interest in physical fitness?

We are discovering that active people lead fuller lives. They have more stamina, resist illness, and stay trim. They have more self-confidence, are less depressed, and often, even late in life, are still working energetically at new projects.

In recent years, medical research has shown that a great deal of ill health is directly related to lack of physical activity. Awareness of this fact, along with fuller knowledge of health care, is changing lifestyles. The current enthusiasm for movement is not a fad. We now realise that the only way to prevent the diseases of inactivity is to remain active — not for a month, or a year, but for a lifetime.

Our ancestors, did not have the problems that go with a sedentary life; they had to work hard to survive. They stayed strong and healthy through continuous, vigorous outdoor work: chopping, digging, tilling, planting, hunting, and all their other daily activities. But with the advent of the Industrial Revolution, machines began to do the work once done by hand. As people became less active, they began to lose strength and the instinct for natural movement.

Machines have obviously made life easier, but they have also created serious problems. Instead of walking, we drive; rather than climb stairs; we use elevators; while once we were almost continuously active, we now spend much of our lives sitting. Without daily physical exertion, our bodies become storehouses of unreleased tensions. With no natural outlets for our tensions, our muscles become weak and tight, and we lose touch with our physical nature, with life's energies.

But times are changing. The 1990's have brought us a critical awareness of the necessity for a healthy life. We have found that health is something we can control, that we can prevent poor health and disease. We are no longer content to sit and stagnate. Now, we are moving, rediscovering the joys of an active, healthy life. What's more, we can resume a more healthy and rewarding existence at any age.

The body's capacity for recovery is phenomenal. For example, a surgeon makes an incision, removes or corrects the problem, then sews you back up. At this point, the body takes over and heals itself. Nature finishes the surgeon's job. All of us have this seemingly miraculous capacity for regaining health, whether it be from something as drastic as surgery, or from poor physical condition caused by lack of activity and bad diet.

What does stretching have to do with all this? It is the important link between the sedentary life and the active life. It keeps the muscles supple, prepares you for movement, and helps you make the daily transition from inactivity to vigorous activity without undue strain. It is especially important if you run, cycle, play tennis or engage in other strenuous exercises, because activities like these promote tightness and inflexibility. Stretching before and after you work out will keep you flexible and help prevent common injuries such as shin splints or Achilles tendinitus from running, and sore shoulders or elbows from tennis.

With the tremendous number of people exercising now, the need for correct information is vital. Stretching is easy, but when it is done incorrectly, it can actually do more harm than good. For this reason it is essential to understand the right techniques.

Stretching feels good when done correctly. You do not have to push limits or attempt to go further each day. It should not be a personal contest to see how far you can stretch. Stretching should be tailored to your particular muscular structure, flexibility, and varying tension levels. The key is regularity and relaxation. The object is to reduce muscular tension, thereby promoting freer movement — not to concentrate on attaining extreme flexibility, which often leads to overstretching and injury.

We can learn a lot by observing animals. Watch a cat or a dog. They instinctively know how to stretch. They do so spontaneously, never overstretching, continually and naturally tuning up muscles they will have to use.

Stretching is not stressful. It is peaceful, relaxing and non-competitive. The subtle, invigorating feelings of stretching allow you to get in touch with your muscles. It is completely adjustable to the individual. You do not have to conform to any unyielding discipline; stretching gives you the freedom to be yourself and enjoy being yourself.

Anyone can be fit, with the right approach. You don't need to be a great athlete. But you do need to take its slowly, especially in the beginning. Give your body and mind time to adjust to the stresses of physical activity. Start easy and be regular. There is no way to get into shape in a day.

When you are stretching regularly and exercising frequently, you will learn to enjoy movement. Remember, each one of us is a unique physical and mental being with our own comfortable and enjoyable rhythms. We are all different in strength, endurance, flexibility and temperament. If you learn about your body and its needs, you will be able to develop your own personal potential and gradually build a foundation of fitness that will last a lifetime.

For further information, read “Stretch Yourself for Health and Fitness” (UBSPD, New Delhi) by the writer.

The cutting edge of modern medicine Herb and cataract

LONDON: St John's Wort, a herb often billed as a natural alternative to the anti-depressant Prozac, could cause cataracts if people taking it are exposed to bright light and sunshine, the new scientist magazine said.

A story by Ms Joan Roberts and researchers at Fordham University in New York showed that hypericin, the active ingredient in the herb, reacts with ultraviolet light to produce chemicals in the body called free radicals that damage cells.

"If this product is consumed, one should avoid exposure to bright light to prevent damage to the eye", the magazine quoted Ms Roberts as saying. — Reuter

Breakthrough by Lasik laser

Lasik laser surgery is the “safest and most modern procedure for removal of spectacles”: it has been claimed by a specialist. The accuracy of this procedure is dependent mainly on two things (i) excimer laser and (ii) Microkeratomes. Till recently, the available excimer lasers had a drawback. They could not correct all types of refractive errors fully and accurately. These limitations were mainly in pure cylindrical numbers, plus numbers of combinations of the two.

The excimer laser available now is a real breakthrough in technology. This is the first ever LB scan machine in India. It has been widely acclaimed in Australia and the USA.

This machine can very accurately correct all possible types of refractive errors (except presbyopia). This is not possible in other currently available scanners in the country, says Dr Jagmohan Sardana, head of the Lasik Laser Centre, Rajouri Garden, New Delhi. The claim needs professional verification.

More details can be obtained from Dr Sardana. — Cynthia, K.

ABCI: mutated gene

TORONTO: A mutated gene that raises bad cholesterol levels and causes heart disease could eventually provide breakthrough therapies to battle the illness, Canadian researchers have said.

A mutated gene called ABCI has been found in patients lacking proper levels of protective cholesterol called HDL cholesterol. The gene, which appears in specific diseases, is the main cause of low levels of HDL cholesterol, researchers believe.

This good cholesterol protects blood vessels from obstruction by transferring amounts of LDL, or dangerous cholesterol, to the liver for excretion.

"There's potential for a therapy that acts on these (mutated) genes to moderate them, to influence them to raise HDL levels in humans," Dr Michael Hayden, principal investigator in the study said yesterday from Vancouver.- Reuters.

Isolate, but don't condemn

NEW DELHI: Isolation, say doctors, is a healthy way to prevent the spread of deadly communicable diseases. But in India, more often than not, this translates into ostracisation of the afflicted.

Notwithstanding the fact that many a disease like leprosy, dengue and rabies are curable, myths and social stigmas associated with them still spell doom for a person suffering from them.

Hundreds of such patients are daily refused treatment for want of proper diagnostic and other facilities, support staff and even the taboos attached to these diseases, experts say, advocating a more "humane" approach to them.

Five years ago, Surat witnessed a mass exodus after the outbreak of plague and virtually the whole of the city was "isolated" to prevent its spread.

Recently two rabies patients are reported to have died in the rabies cell of a speciality hospital locked behind bars, with even the support staff not ready to help them.

"The problem stems from myths and misconceptions associated with infectious diseases over the centuries -- they were thought as more of a curse of God than as the doing of a virus or other carriers," says Dr Jeevan Prakash, Chief Medical Officer, Safdarjung Hospital.

"It is all a question of changing the mindset of the people... The public attitude has to be more of acceptance," says Dr Arvind Taneja, a specialist in infectious diseases. — PTI