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| HEALTH & FITNESS |
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Asthmatics
don’t need to restrict physical activity Prostate
enlargement: don’t be afraid of surgery How many
vaccinations are safe for a baby to have at one go? Do you know your
rights as a patient? Quitting smoking Working women
healthier than unemployed ones Consumption and
dependence on alcohol related to genes Ayurveda
& you
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Asthmatics
don’t need to restrict physical activity This is the time when asthma patients should be more careful about their health. Bronchial asthma is many a times a fatal disease, affecting a very large proportion of the population. The current level of asthma control in India falls far short of the universally accepted goals for long-term management. Despite the availability of highly effective asthma therapies, the low level of control is surprising. Patients on regular medical treatment and supervision can surely remain on good control and can have a good quality of life. Seven general goals for long-term asthma management are as follows:
The findings from patients in India in general are falling short of the goals as follows:
The unscheduled visit to doctors due to urgency are much more, whereas the goal calls for no emergency visits and no hospitalisation. The goal calls for minimal need for quick relief medicines. By contrast, in India, 85 per cent patients are using quick relief medicines only. Nearly 86 per cent patients abstain from sports and recreation, 30 per cent miss work and school because of asthma, 78 per cent miss social activities and 88 per cent limit their physical activity whereas an asthma patient, if on proper treatment, need not restrict physical activity and exercise. Most patients do not undergo lung function tests due to many reasons. They feel that because of tests the cost of treatment is unnecessarily increasing. They should realise the gain of scientific treatment. Health care resources are under enormous strain in developing countries like India. But in asthma the picture is gloomy not because of resources but because of poor knowledge, attitude and behaviour of patients and health care providers. The patient’s perception of asthma control is different from what actually it should be. They are unaware of the potential for improvement. They fear inhalers and cortcosteroids, consider it as a last priority to visit the doctor unless there is emergency. They want to stop medicines even if medicines improve their quality of life and cause no side-effects. The cost benefit analysis of treatment is not a consideration at all. The patient alone is not to blame. We doctors ought to update knowledge and put it to patients’ use. We have to communicate with patients better to improve their understanding of the disease and treatment modalities. Drug companies ought to bring down the cost of medicines. The chemists and paramedical staff should also play a positive role in patient education. It is definite that patients’ interest in better understanding their condition and treatment can improve the management scenario of bronchial asthma in India. The writer, a former President of
the Indian Academy of Paediatrics, is an allergy specialist and
pediatrician based at Chandigarh. She was earlier associated with the
PGI.
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Prostate
enlargement: don’t be afraid of surgery "When hair becomes grey and thin, when atheromatous deposits invade the arterial walls, when there has formed a white zone about the cornea, at the same time, ordinarily — I dare say invariably — the prostate increases in volume." (Sir Benjamin Brodie, Surgeon, St George’s Hospital, London). Prostate gland is present in all male animals as well as in human males. It surrounds like a collar around the beginning of urethra — the tube that starts from the bladder and exits at the penis. It has grossly three lobes, two lateral and one median lobe, latter on enlargement projects into the bladder. It is under the influence of two hormones, male (androgenic) and female (estrogenic). Prostate produces serum acid phosphatase. Enlargement of the prostate is of two types: benign (non-cancerous) and cancerous. We will use confine to benign prostate hyperplasia (BPH). Enlargement of prostate occurs in men most often between 60-70 years of age, but Indians suffer at a younger age. It is rare in the Negroes. Frequency of urination is the commonest complaint, more so at night. At times, it makes a patient’s life miserable. The complaints in advanced cases are: Retention of urine — the patient cannot pass urine. Acute retention is painful whereas chronic retention is painless. In fact, the patient greets you with a smile though his bladder is full up to navel. Retention with overflow — the bladder is full and further urine is flowing out, giving the false impression of the patient passing urine freely. Painful urination due to the infection in the bladder. Passing of blood in urine. If still neglected, kidney failure may take place due to back pressure. An examination of the patient is the cornerstone of medical management. Laboratory tests without a good examination are self-defeating. Of special emphasis is the rectal examination with a gloved lubricated finger. The size of the prostate, the presence/absence of its groove and its consistency (elastic/hard feeling) usually are the first and foremost yet most forgotten steps by referring doctors. Many times, it is the urologist who puts a finger into the patient’s anus first! Investigations include the routine urine examination and its culture, blood urea and serum creatinine, plan x-ray of kidneys — ureter — bladder area, trans-rectal ultrasonography, specially for the size and nature of the prostate. An intravenous pyclography (IVP) is essential for management. The patient should play the central role in determining the need of the treatment. There are four options before him. (a) Watchful waiting, (b) medical treatment, (c) minimally invasive treatment, (d) surgical treatment. Watchful waiting is preferred management for patients with mild complaints or those without complication of BPH. They are advised decreasing fluid intake before bed-time. In fact, there should be no fluid intake one hour before going to bed, with moderating the intake of alcohol and caffeine-containing products like coffee. Passing of urine should be every two-three hours. Trans-urethral Resection Prostate (TURP) is the gold standard treatment. About 90 per cent of the patients are undergoing this operation. It is carried out under general/spinal anaesthesia and requires hospitalisation for about four-five days. Removal of the prostate through urinary bladder reserved for the large-sized prostate. TURP in maximally performed with good results in expert hands. Old age is not a curse as surgery today is safe, patient-friendly and affordable. But drugs are helpful at the initial stage when doctors do not advise surgery. The writer, a retired
Major-General, was Director, Medical Services, Western Command,
Chandimandir. He is a practising urologist.
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How
many vaccinations are safe for a baby Believe it or not, a baby has the theoretical capacity to tolerate 10,000 vaccines at any one time. This is, no doubt, news to the campaigners who have been arguing that the government's proposed new five-in-one jab could, at least according to the Daily Mail, overload a young baby's immune system while increasing the danger of autism and other brain disorders. The new vaccine, Pediacel, is a replacement for DTwP, a vaccine that protects against diphtheria, tetanus, whooping cough and Hib (an infection that can lead to meningitis). Pediacel will, in addition to these, incorporate protection for polio. Vaccines work by introducing the body to various antigens - foreign objects that stimulate it to make antibodies, which then fight them. Antigens can come in many forms: bacteria, viruses, proteins, toxins or even transplanted organs. Vaccines normally contain some form of the disease being protected against. Whether or not multiple vaccines overwhelm an infant's immune system was the subject of a study published in the journal Paediatrics in January 2002 by Paul Offit of the Children's Hospital of Philadelphia. He came to the 10,000 vaccine figure by first working out how much antibody would be required to fight a particular antigen. Assuming that there are about 100 antigens in every vaccine, and calculating the amount of time it would take a baby's immune system to manufacture enough antibodies for each, Offit was able to work out the baby's theoretical capacity. Opponents are not convinced. "The reasons we've always had concerns over multiple vaccines is ... that safety studies in the UK have never been long enough or effective enough," says Jackie Fletcher, a spokeswoman for the parent support group Jabs. "With the single vaccines, because they have been around and in popular use for 40 years, we've got safety track records that are proven." But Helen Bradford, a researcher at
the Institute of Child Health, says the new vaccine is much safer.
"This is actually a really good development," she says. —
The Guardian
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Do you
know your rights as a patient? Have you been examined by the doctor who is actually going to operate on you? Is the doctor who has examined you going to perform the operation himself or is he going to call someone from somewhere? Insist on having a detailed discussion with the surgeon who is actually going to perform the operation. This discussion must be held at least a day prior to the operation. Talk to your surgeon about the following points:
Find out if your surgeon will be able to examine you at least once a day after the operation for as long as you are in hospital. If there is a complication after the operation, will the surgeon be available to handle it himself, or will he tackle it only on the phone? Is the surgeon well qualified, well equipped and well experienced to handle all the usual complications of the operation? Does the hospital have the necessary manpower and equipment to handle all complications that may arise after the operation? Approximately what will be the total expenditure involved, including all tests, the doctor’s fee, medicines, stay in hospital, etc? At the time of discharge: Insist on getting a discharge card/discharge slip. Insist on getting all test reports in original, especially if you have paid for them. Insist on getting the original test report of the tissue/organ removed from your body. Insist that your surgeon examines you at least once after about a month of the operation. The writer is an Amritsar-based
urologist.
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Washington: American researchers have revealed that Nicotine Replacement Therapy (NRT) works better for men than women, indicating perhaps, why men find it easier to quit smoking than their female counterparts. Conducted at Texas A and M University and published in Consulting and Clinical Psychology Journal by the American Psychological Association (APA), the study states that in the long term, women using NRT find it harder than men to quit smoking. A research team led by Antonio
Cepeda-Benito found that NRT worked better than any placebo and was
about as helpful to men and women after six months. But its
effectiveness declined for both sexes as the follow-up periods grew
longer. — ANI
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Working women healthier than unemployed ones Washington: Working women who are doubly burdened by the pressure of household obligations and performing well on their jobs outside home, are healthier than those who are unemployed, says a research by the University of Pennsylvania’s Department of Sociology. According to sociologist Jason Schnittker, the most important factor in increasing women’s health is an increase in their employment rates. Schnittker’s research results indicate that more women are working and that more women are working longer hours. Furthermore, women are combining full-time work with raising a young child. The gender gap in wages, however, continues to affect gender differences in health. Schnittker hypothesizes that working women might have poor health in comparison to others because they are underpaid. What the present results suggest is
that the health benefits may be derived from the income. This is not
something scholars have focused on in the past, but it is important
and should not be neglected. — ANI
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Consumption
and dependence on alcohol Sydney: A new research has revealed that variation in long-term average alcohol intake and dependence on it are almost entirely due to genetic differences, but the causes of susceptibility to the two may be different. Some genes affect both alcohol intake and dependence while others affect only dependence. "Alcohol consumption is about how much a person drinks at some particular time, whereas alcohol dependence is more about the effects that alcohol has, or has had, on a person, their behaviour, their neurophysiology, and their relationships with other people," explained John B. Whitfield, the author of the study. "We have known for some years that there are genetic influences on the risk of alcohol dependence, but it has been challenging to separate out the extent of influence of a person’s genes from the influence of their childhood environment," said Kate Conigrave, associate professor and staff specialist at Royal Prince Alfred Hospital in Sydney. According to the research, published
in the Journal of Alcoholism: Clinical and Experimental Research,
problems related to alcohol are not only confined to dependent
drinkers. Many alcohol-related problems like road trauma and high
blood pressure occur in those who are drinking above recommended
limits, but are still in control of their drinking. — ANI
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Ayurveda
& you Ayurveda views that most of the diseases arise from poor or wrong functioning of the digestive system. Though food is a heterogeneous substance, it is made homogeneous to the body at different stages of the digestion — breaking, absorption and assimilation. The factors responsible for these activities, whether they are in the digestive tract or in the tissue cells, are known as "agnis". Ancient scholars have written that it is the proper functioning of the digestive fire or the "jatharagni" which is central to good health. Proper digestion and nourishment promotes adequate energy and strong resistance to disease. To the contrary, undigested or improperly digested food becomes like a pathogen in the body, breeding toxins and upsetting the immune system. If we give due attention to feed and nourish ourselves, it is equally important for us to take care of the digestive system and give it the power to adequately extract and utilise the nourishment. Digestive fire has four states in ayurveda: high, low, variable and balanced. The first one is a condition which is marked by excessive appetite, where a person digests even large quantities of frequent meals. The second one, called low digestive fire or "mandagni", denotes a situation when it is difficult to digest or metabolise even a small quantity of otherwise easily digestible food. The variable digestive fire is an erratic state where it sometimes helps the process of complete digestion and at other times produces unsavoury symptoms like distension, colic, constipation and even loose motions. Ayurveda lays great emphasis on achieving a state where all the body systems are supported by a balanced digestion. Called "samagni’, it is the equilibrated state of the complete digestive process which is marked with normal and regular appetite that is constant and is easily satisfied with normal and natural foods. In other words, it ensures complete digestion of food ingested at the proper time without any irregularity. Digestion occurs in three stages. The first stage is dominated by "kapha" with alkaline secretions in the mouth and the stomach. Any abnormality here can produce symptoms of nausea, salivation and lack of desire for food. The second stage is dominated by "pitta" with acid secretions in the duodenum and small intestine. Hyper acidity and burning sensation are the result of the vitiation of the digestive process here. With the formation of stool in the large intestine, "vata" dominates the third phase. Symptoms of gas and constipation or erratic bowel pattern arise if digestion is faulty at this stage. Improper digestion results in the accumulation of undigested and toxic food mass. It is indicated when the stools are not properly formed, breath is unpleasant, appetite is abnormal, a coating appears on the tongue and there is a feeling of heaviness in the body. Even a person who has no immediate disease problem should keep a watch on his digestion, making sure that digestive impurities do not occur. Ayurveda believes that it is not only easy to stop the disease process at its origin but in treating all the diseases we also must consider first the state of the digestive system. The writer is a Ludhiana-based
ayurvedic consultant.
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