Wednesday, December 29, 1999

• Nail care

How to revive the apparently dead
By Dr G.D. Thapar
A heart attack is a dangerous condition, and the greatest danger is that of the occurrence of a cardiac arrest (sudden stoppage of heart action). If this happens, there is no heart beat and, therefore, no pulse.

Drugging & dooming
By Dr Rajeev Gupta
Thousands of innocent young lives are mercilessly crushed during their budding state by the cruel effects of various drugs and addictive substances. Unfortunately, most of these addicts are young students and unemployed rural and urban boys.

Nailing the problems of nails
The troubles range from disease to fungus
infections to wear and tear

Lustrous colours to suit any occasion. Exotic shades like rich blues, greens and black for those well-manicured nails.... Cosmetic manufacturers make you believe that your nails have only cosmetic value. That they are mere ornamentations to make your hands look more beautiful. But nails are not just the best instruments to scratch when you itch. They enhance fine touch, protect fingers and toes, and improve your tactile sensitivity. In their protective role, nails bear the brunt of our daily activities.

Most nail problems masquerade as cosmetic problems and we tend to ignore them. But, a naked fingernail can provide physicians with clues to underlying health problems. The skin under nails should be a healthy pink. Pale or whitish nails suggest anaemia. Bluish nails, due to insufficient oxygen in the blood, may signal poisoning, heart failure, or chronic lung disease.

So, warns the Reader's Digest Family Medical Adviser and the European Touch Company, USA, if you notice that your nails are turning colours (like white, yellow or brown) and are getting thick, brittle or flaky, it's time to do something about them. Some common ailments and causes are explained below:

Onycholysis (flaking nails):

Sign: The top layers of nails may separate and start to flake off if they are exposed to too much soap or detergent and water.

Cause: A trauma or thyroid disorder, anaemia or psoriasis may also be the cause.

Treatment: Carefully trim away the separated nail. If flaking occurs, wear plastic gloves when washing dishes or clothes. And massage nail cream into the nail base every day.

Brittle nail syndrome

Sign: Extremely thin or peeling nails that do not grow very far past the end of the nail bed.

Cause: Weak nails that easily crack or break are caused by general ill health or a protein deficiency in the diet. Or, by advancing age or extreme dryness.

Treatment: Nail strengtheners and hardeners will protect brittle nails, but polish removers weaken them. If you have brittle nails, apply subsequent coats of treatment over the previous ones, rather than removing them everyday. Rub in a nail cream every morning and night for dryness. Increase intake of lean meat, fish, fresh fruit and vegetables.

Contact dermatitis

Sign: Symptoms include itching, redness, and dryness. Can be confused for psoriasis or onychomycosis (fungal infection).

Cause: This is a reaction in the nail to contact with either irritants or allergens, such as monomers, adhesives, or primers.

Treatment: Discontinue use of the irritating or allergenic material. Refer to dermatologist if it is unclear what is causing the problem

Onychauxis

Sign: Overgrowth of the nail with an extreme thickening and curving of the nail plate.

Cause: This is a rare congenital defect. May be caused by internal disease as well.

Treatment: Refer to a dermatologist. Mild cases can be buffed.

Koilonychia (spoon nails)

Sign: A rippled deformed nail plate that appears shaped like a spoon (the nail curls upward) and is white or opaque. The index, ring and middle fingers are the most affected.

Cause: By age, tumours, anaemia, hypothyroidism or chronic infection.

Treatment: Treat the infected nails very gently as the nail plate will be fragile.

Paronychia

Sign: This is an inflammation of the fold of skin at the margin of a nail. Acute pain with pus under the nail is a symptom. It often results in inflammation, pus, and pain in and around the cuticle.

Cause: Common among people whose hands are continually in water, or with habit biting.

Treatment: Keep your hands dry, and refer to a physician. Avoid prolonged wet-work and injury to the hands. Wearing gloves during wet work helps prevention.

Haemorrhage (black/bruised nails)

Sign: A heavy blow on the nail — or jamming it in a door — can cause bleeding under the nail which eventually turns black.

Cause: Haematomas, beneath the toenails, are especially common if your lifestyle is active as in sportsmen. They are caused by the toes repeatedly rubbing against the shoe. If the bleeding is extensive, the nail may eventually fall off.

Treatment: A haematoma may indicate a fractured bone, especially after an injury. If the injury is very painful, the nail may have to be removed surgically. Mild cases may be treated by taking special care to avoid further pain or damage.

Hang (split) nails

Sign: Small tears or splits in the nail plate or surrounding tissue.

Cause: The splits, or hang nails, are painful and can become infected. If untreated, they may tear and become raw, painful, and subject to infection. Usually the result of nail-biting, they may also be caused by dry skin or injury. If your hands are frequently immersed in water, the outer skin layer may split away from the cuticle. Overuse or nail polish remover may also cause splitting.

Treatment: Hang nails can be snipped off with sharp nail scissors. Treat with an antiseptic, if the affected area is small. Badly damaged areas should be referred to a dermatologist. To prevent them from occurring, the skin should be kept flexible by nightly applications of cold cream.

Onycophagy (nail biting)

Sign: Damaged nails may appear ridged, cracked or broken.

Cause: This condition is often the result of nervous habits, including picking at, playing with, or stroking the nails. In both adults and children, nail biting is a common habit. Excessive nail-biting results in very weak nails and, in extreme cases, damaged fingers caused by chewing the nail down to the quick — the sensitive skin beneath the nail.

Treatment: There is no guaranteed cure for nail-biting. Frequent manicures help, especially when nails are filed very short. Find something that occupies your hands when they are idle — a creative hobby such as building models, painting, knitting or sewing.

Onychogryphosis (claw nail)

Sign: Claw nails are those with extreme thickening, twisting, or inward curving of the nail.

Cause: Often caused by an injury.

Treatment: Refer to a dermatologist. Mild cases may be treated.

Beau's lines (corrugations)

Sign: Often indicated by furrows or wavy horizontal lines across the nails. The furrows may split open causing pain, and an infection could occur if dirt enters the split.

Cause: May result from infectious diseases, pregnancy, heart disease, emotional shock, injury, a major surgery or alcoholism.

Treatment: Mild cases may be treated carefully by gently buffing to help smooth out furrows. Refer more severe cases to a dermatologist. New growth gets rid of the problem.

Leukonychia (white spots)

Sign: The little white flecks that occur in the nail.

Cause: Sometimes the result of a minor injury, such as a damaged cuticle. On some people, they appear spontaneously.

Treatment: Spots will grow out as the nail grows and will not affect a manicure or pedicure. No need for treatment.

Onychomycosis (fungal infection)

Sign: This common infection can affect the finger and toe nails. Depending on the type of fungus, your nail may turn yellow, gray, brown or black. Often, the nail becomes thick and brittle, and cracks or separates from its bed. Your surrounding skin may become red, itchy or swollen. As the fungus grows, foul-smelling, moist debris can be seen. Pressure from a thickened nail or the build up of debris may make the toe painful.

Cause: It can develop on your nail or its outer edge, when your nails are continually exposed to a warm, moist environment or chemical.

Treatment: Although common, it's one of the most difficult infections to treat. Once an infection occurs, it can persist indefinitely if not treated. Refer to a dermatologist, as treatment is best begun at the early stages of infection. The accumulation of debris under the nail plate may lead to an ingrown nail, or to a more serious bacterial infection that can spread beyond the foot.

Psoriasis

Sign: The nail may lose its normal lusture and appear discoloured. Gross thickening of the nail is another feature. Sometimes complicated by onycholysis (flaking nails) and thickening of the nail bed, psoriatic nails are scaly or pitted, and they can have debris collected under them. Severe cases can result in the nail plate completely crumbling. The space beneath may then become infected, causing discolouration. Rashes would often be present on the fingers, toes and elsewhere on the body.

Cause: Can result from the excessive use of nail hardeners containing formaldehyde.

Treatment: Psoriasis of the nails is a serious condition, and should be referred to a dermatologist.

— Courtesy: Insight (1999)

Nail care

Here are some basic steps, from Consumer Reports on Health, to ensure the health of your nails:

* Protect your nails from water. Wear cotton-lined rubber gloves when doing household chores such as washing dishes.

* Immediately after exposure to water, apply a moisturising lotion to your hands and feet. Keep your nails dry and clean.

* Avoid wearing footwear that is very tight. Wear shoes (preferably of leather) that allow your feet to breathe. And stick to your own shoes.

* If your feet perspire excessively, change socks more often. Also, consider using an antifungal foot spray or powder on your feet and inside your shoes.

* Wear gloves during activities that might harm your nails.

* Keep your nails short to prevent breakage. Before trimming, soak them in water for a few minutes. They will be less brittle under the clipper. File in only one direction — not back and forth, which can create splits. Apply moisturiser afterwards.

* Don't pick or poke around your nails. A minor cut or tear in the skin beside your nail becomes an entry point for infectious organisms.

* Don't pick at hangnails. That can break the skin and invite infection. Clip hangnails off close to the skin with cuticle scissors.

* Avoid nail-polish removers that contain acetone, which may dry nails. Look for ones that contain acetate instead. And use remover as less as possible.

* If you get your nails done professionally, make sure that sterile instruments are used. And ask the manicurist to be gentle on your cuticles.

* Be sceptical of products that claim to nourish or condition nails. They can't — no matter what vitamins, minerals or proteins are added — because nails, like hair, are dead tissue.

* Don't walk barefoot in public places like parks, hotel lobbies, and near swimming pools.

How to revive the apparently dead
By Dr G.D. Thapar

A heart attack is a dangerous condition, and the greatest danger is that of the occurrence of a cardiac arrest (sudden stoppage of heart action). If this happens, there is no heart beat and, therefore, no pulse.

Why is a cardiac arrest so dangerous? All supply of blood to the body is cut off. No organ can live without oxygen for any length of time, and least of all the brain. Within four minutes of such a happening the brain tissue starts dying.

Even if the heart starts beating again later, the damage to the brain has been more or less done, depending upon the time the heart had remained at a standstill.

In a few minutes, vital centres fail and the respiration also stops, making the job of resuscitation more difficult and uncertain.

Under these circumstances, if something has to be done, there are only three and a half minutes available in which to revive the heart. In such a short time no doctor can possibly reach the patient unless he happens to be available on the spot. Whosoever is on the spot is the only one who can save the patient provided he knows what exactly needs to be done.

Recognition of a cardiac arrest: The first and foremost thing is that persons on the spot should be able to recognise that a cardiac arrest has taken place before they can take any action. A middle-aged or older person, with or without a previous history of heart disease, may suddenly stop talking and become unconscious. His head droops, he becomes greyish blue, and there may be convulsions as in epilepsy. You will find no pulse and, on putting your ear to his chest, you will hear no heart beat. Such an event is, most likely a cardiac arrest, which demands the most urgent action — every second is precious. Apart from a heart attack, the other common conditions which can cause a cardiac arrest are electrocution, drowning and suffocation.

How to revive a patient of a cardiac arrest?

Remember, you have only three and a half minutes to revive him.

Shout for help; somebody else should be telephoning for the doctor and the ambulance.

Don't panic; be bold.

Immediately, give a sharp firm thump with your fist on the front of the patient's chest in the middle. Don't be afraid of injuring the patient or breaking a bone. There is no injury greater than a cardiac arrest. The heart may start beating again after the thump. In that case, the pulse will return, his face will twitch, he may give out a cry, his colour may return to normal and he may open his eyes. He may be confused for a few minutes and then start talking normally. If this does not happen, repeat the procedure twice. If still the pulse does not return, lay him on a hard surface such as the floor immediately and start external cardiac massage.

Lay the patient on a hard surface (floor, hard bed, etc) with the face up.

Place the palm of your left hand flat on the lower part of the breast bone just above the pit of the stomach.

Place the heel of the right hand on the heel of the left hand.

With a sudden firm thrust, press the patient's chest down and then release the pressure.

Wait for one second (say to yourself: one hundred and one; the time taken in saying these words is one second).

Repeat the procedure of depressing and releasing the chest once every second, i.e 60 times per minute. The maximum rate achieved should not exceed 100 per minute.

Resist the temptation to increase the rate; it is self-defeating.

Continue till you are successful or the doctor arrives and takes over.

If the patient has stopped breathing, respiration has also failed. In that case, in addition to cardiac massage, give mouth-to-mouth breathing.

Continue the external cardiac massage.

Extend the patient's neck backwards.

After every four or five compressions of the chest, give one breath to the patient. Inhale deeply yourself; place your mouth on the mouth of the patient. With his nose closed with your fingers, exhale deeply into his mouth; you will find his chest expanding.

Repeat the procedure after every four or five compressions of cardiac massage, i.e, about 15 times per minute.

Continue till the doctor arrives or the patient is revived.

If someone else is available, let him take turns with you.

When the doctor arrives, he will take over. After revival, the patient will be assessed for further treatment in a hospital.

It is important that you carefully learn and practise the above-mentioned procedure and teach it to everyone around you. Who knows who will need it and when? It may be you yourself!

Drugging & dooming
By Dr Rajeev Gupta

Thousands of innocent young lives are mercilessly crushed during their budding state by the cruel effects of various drugs and addictive substances. Unfortunately, most of these addicts are young students and unemployed rural and urban boys.

Enter any psychiatric ward in Punjab. More than one third admissions of male patients are because of drug addiction. The virus is afflicting our population fast. The figures are frightening.

Common cough syrups, narcotic pain-killers like proxyvon, anti-diarrhoeal drugs like lomotil, cannabis preparations (bhang, ganja, charas), injections of Morphine, Fortwin and Avil, tablets of Charysomas and many other drugs have become fancy items for the Punjabi youth.

Smack is becoming another killer in Amritsar and other border towns.

The menace is spreading menacingly to other areas also. In my own clinical experience of treating addiction cases, I find smack as one of the worst kinds of addiction.

All addictive drugs are very strong and, when used regularly, they damage the brain cells. Those who are addicted to them tend to become aggressive, violent and emotionally callous. They become restless and suspicious also.

When money is not given to them, they threaten their parents, brothers and sisters with dire consequences. I come across a number of addicts who physically harm the members of their families. Feeling completely helpless, the parents don't know how to react and handle them. Recently, a 21-year-old addict was brought to my clinic. He used to slash his forearm when money was denied to him. His parents always surrendered and gave him money for drugs.

Our youth is getting hooked to alcohol also. Even women are getting addicted to it. The number of people affected by alcohol liver diseases is really alarming. Hospital statistics show that most of the addicts are using more than one drug. Their personality is getting distorted. They discontinue their studies. They stop doing productive work. They become a nuisance for their families and society. When parents shut their doors on them, they start snatching chains and purses on the roads. They lift scooters and cars and gradually enter the world of crime.

Many addicts finally end up becoming petty couriers and live a life of slavery and infinite misery.

Who is responsible for such a pitiable state? You can't blame one single person or an authority. All of us will have to share the burden. Parents have no time for their children these days and they themselves are mesmerised by the "Viagra effect." They appear to be gripped by the glare of their newly acquired western culture.

We often say that society has degenerated. It is absolutely wrong. It is not society alone. All of us have deteriorated. The desire to gain materialistic benefits has made us lose our cherished values.

Can you blame a chemist who dispenses dangerous drugs without any prescription? He is allured by the premium on these drugs. Can you blame the drug authorities whose job is to monitor the sale of drugs? They religiously pay their monthly visit to such shops for motives other than keeping a close watch. Can you blame the health authorities who are themselves deeply involved in various scams? Can you take the help of the police so that drugs do not reach your son or daughter?

Can you blame the present educational system which is making senseless robots out of students. One does not know what to do. There is a complete administrative, moral and social failure. Today is the time to become vigilant and alert. Tomorrow may be too late for many amongst us.