|HEALTH TRIBUNE||Wednesday, September 12, 2001, Chandigarh, India|
Thyroid: the ‘‘butterfly’’ gland
Phulbehri: don't be afraid
Pet is part of you
Cocaine and your heart
Rural salvation: profile in self-help
THIS is an inspiring story of a group of 10 small villages and hamlets tucked in the Shivalik foothills, in prosperous Punjab's Ropar district, comprising a population of about 20,000 — Perch, Chhoti Perch, Bari Seonk, Chhoti Seonk, Majri, Singhari Ala, Gura Karauli, Karaondiwala, Baghindi and Nada — names not easy to remember.
Most of these, it seems, have seldom been visited by a person other than a patwari or a tehsildar, let aside a BDO, a DC, anMLA or a Deputy Minister!
Surprisingly, they have no government dispensary, what to say of a primary health centre. The ayurvedic dispensary there has not many medicines, and no regular Ayurvedacharya.
We came to know of the medical step-motherliness when, on the publication of a news item in The Tribune, we went there for organising a medical aid camp during the floods last year.
We were impressed to discover that the sarpanch and the panchayat had guts and the Punjabi rural hoi-polloi had the will to work. They were also lavishly hospitable with tea (made in milk) and rural snacks, never mind the ravages wrought by the floods.
We were moved to offer them a permanent regular Primary Health Care Centre if they could give us a four-room complex for a dispensary, a laboratory, an x-ray and ECG machines and a room for the doctor to see the patients. They were so overwhelmed by this unbelievable offer that they unanimously agreed to build a four-room complex.
The only two available tractors were
commissioned to level the panchayat mound. A senior village mason
volunteered to work as an architect-cum-engineer, the young and the
old together did "kar-seva", panchayat trees were sold off
to raise funds, every household contributed to the common kitty, and,
lo and behold, within a few months, a four-room pucca rural health
care complex came up as a landmark of pride for one and all.
At 8 a.m. on a rainy August morning, there was a loud ring of the call bell, like an alarm. As I came out, expecting a needy patient in distress, to my utter surprise, I saw the sarpanch and his entire panchayat mounted on a tractor trailer combine, all greeting me with a triumphant grin.
"Doctor Sahib, the four-room complex is ready. It is now your turn to fulfil your promise". It sounded like a clarion call and a challenge from the sarpanch. They "conscripted" me to the site, but in a Maruti taxi specially hired for me!
A white structure with a boundary wall (to keep out cattle) stood in contrast to the heaps of cowdung, stagnant open drains and kutcha tracks winding through the narrow lanes into the otherwise vibrant village!
There was a moment of serene silence, due to silence, due to disgust about the development even after half a century of Independence, in this prime state of India. We could not give them even a dispensary!
"Where is the three-phase, 14 KW bijli for the x-ray and paani for the lab?"Iasked. "Surely, you can first start with only the dispensary", suggested a grey old grandma standing by in case no bijli and paani were provided by the sarkar for another six months. Her grassroot wisdom was irrefutable. "Bebe, you are right. We will first start the dispensary service during the first week of September", we promised. With a toothless grin, pleased, she walked her way, giving her blessings.
A few days later, when we went to stock the dispensary we mentioned to Sardar Bhag Singh, the sarpanch, that we would also try to bring a "Bhadra Purush" for the inauguration. But, the very next day he rang up to say that "nobody comes, nor do we want any Bara Saab for the inauguration".Instead, theirJathedar, who always stood by them, would perform the ceremony.
We had already passed around the feelers to our well-known donors, philanthropists and benevolent Senior Citizens for generous contributions.
On the third of September, 2001, after we offered prayers at the gurdwara, Jathedar Ujagar Singh Wadali inaugurated and blessed the dispensary amidst sky-rending echoes of "Bole So Nihal, Sat Sri Akal". Thus opened our 15th healthcare centre.
The most encouraging highlights of the ceremony were generous donations of Rs 1 lakh by Bibi Harpreet Kaur Bhullar, who owns a farm nearby for the x-ray plant, an ECGmachine (Rs 50,000) by Sardar Baljit Singh, Chief Executive of HSBaljit Electric Co. SAS Nagar, and three well qualified doctors who offered to give free service in rotation.
Now, when the Perch Free Health Care Centre has become a living reality, someone in the bijli and paani departments will surely expedite these facilities as well. Hats off to rural patience!
All panchayats should emulate Perch. Collective self-help never fails because God helps those who help themselves!
Thyroid: the ‘‘butterfly’’ gland
Thyroid problems are common and affect many people.
What is a thyroid gland?
It is a small, butterfly-shaped gland, just below Adam’s apple. It has a big effect on the way the body works. A healthy thyroid keeps the body working right and keeps you feeling good.
What is the thyroid hormone?: The thyroid gland makes the thyroid hormone — a chemical that carries messages from the thyroid to the rest of the body through the blood stream. It regulates the rate at which every part of the body works. It acts on the heart and the brain. It also acts on the digestive system to control how efficiently you burn calories. It keeps your skin, hair and nails healthy and muscles and nerves in good condition. It can even influence your thinking and feeling.
What happens when a large amount of thyroid hormone is produced?: When a large amount of thyroid hormone is produced, the cells work faster. The common symptoms are shaking, nervousness, palpitation, jitters, irritability, feeling hot, muscle weakness, fatigue, frequent bowel movements, weight loss, hair loss, and eyes looking with a bulge.
What are the problems of too little hormone (hypothyroidism)?: Too little hormone can cause fatigue, a decreased energy level, the feeling of coldness, muscle pain, slowed thinking, constipation, longer or heavier menstrual period, weight gain, dry and brittle skin, hair, and nails, and feeling depressed.
What tests can be done to evaluate thyroid function?: Blood tests measure levels of the thyroid hormone and help confirm whether the thyroid gland is making too much or too little hormone. These tests help in determining what types of thyroid problem you have. A radioactive iodine uptake test measures how well the thyroid absorbs iodine. A small amount of radioactive iodine is given and several hours later a machine similar to an x-ray machine is used to measure the level of radioactive iodine in your thyroid.
How to manage an underactive thyroid? :Thyroid hormone pills are given to treat and return the blood level of the thyroid hormone to normal. The dose may need to be adjusted a few times before the best level is found for you. To maintain your thyroid hormone at the right level you will probably need to take thyroid hormone pills for the rest of your life. The hormone is natural and easily accepted by the body. It generally has no side-effects.
How to control an overactive thyroid? : Several methods are available to treat an overactive thyroid. Medications may slow the production of the thyroid hormone, returning the level of the hormone to normal. If medications do not work, radioactive iodine may be given which kills the thyroid cells. Sometimes the thyroid gland is removed surgically.
Thyroid problems under control: Problems with the thyroid gland are often easy to treat. Once your problems are under control, you can get back to doing the things you like to do. If you have been given the thyroid hormone or other medications, take your pills regularly to help keep your hormone at the right level and your body running smoothly. Regular blood tests confirm that hormone pills or medications are still at a dose that is right for you. See your doctor for regular check ups.
Phulbehri: don't be afraid
Vitiligo (leukoderma, white-spots disease) is a devastating psychological problem that results in low self-esteem and depression. It is a disease comprising progressive hypomelanosis (pigment loss)of the skin. It is often familial and characterised by the total absence of melanocytes (pigment-producing cells) microscopically. The first evidence of a depigmented spot is often traumatic and the patient passes through a major psychogenic shock. Most patients expect quick results, but it is essential for them to understand that melanocytes are slow responders to the treatment, which may have to be continued for months together.
The treatment of vitiligo
The current approach to the treatment of vitiligo is as follows:
1. The first priority in every patient should be to control the activity of the disease. In mild cases, this can be achieved by oral levamisole. Patients having fast-spreading and extensive disease need oral mini-pulse (OMP) therapy with betamethasone and cyclophosphamide.
2. Once the disease has been controlled adequately, repigmentation can be augmented by topical corticosteroids. Placental extract can also be used in the form of intramuscular or intralesional injections. Its topical application followed by sun exposure is also beneficial. The most patent and widely used method for inducing repigmentation is known as PUVA/PUVASOL. It involves the administration of psoralens followed by exposure to ultraviolet rays from the UVlamps (PUVA) or sunlight (PUVASOL).
The residual lesions can then be subjected to the surgical procedures for transplanting melanocytes into the area or camouflaged.
Surgical treatment of vitiligo: Various surgical modalities have brought a revolution as far as the treatment of vitiligo is concerned. Some of the latest innovations are discussed below:
1. Excision: The stable vitiligo patch is excised followed by suturing. It can be performed when the patch is small, especially on the scalp, waist, penile skin and the sides of the face.
2. Dermabrasion: It involves the mechanism of the migration of melanocytes from the undamaged portion of the hair follicle walls. These melanocytes repigment the new epithelium.
3. Micro-pigmentation (tattooing): Permanent camouflage by different shades of iron oxide serves the purpose of hiding a stable vitiligo patch. The sites preferred for tattooing are lips, eyebrows, hands, fingers, feet and toes. In fact, any part of the body (including elbows, knees, breasts and penis) can be treated by micropigmentation when the patient is psychologically in need of a dramatic response.
4. Punch grafting: This procedure carried out under local anaesthesia consists of taking thin, punch-skin autografts with biopsy punches from normal pigmented donor skin and individually grafting them in the appropriately punched out chambers at the recipient stable vitiligo site.
5. Thin Thiersch graft (split thickness skin graft): It consists of obtaining the epidermis and part of the dermis from one area of the body (normal donor site) and transferring it to another area of the body (vitiliginous recipient site) where it is taken up.
6. Epidermal grafting by suction blistering: Autologous epidermal grafting with the suction blister technique is a novel therapeutic modality for the treatment of stable vitiliginous patch. The graft is obtained by applying negative pressure to the skin surface with the help of a suction device, causing separation at the dermoepidermal junction. This is then grafted on the denuded recipient area.
7. Repigmentation with cultured melanocytes: Vitiligo not responding to the medical line of treatment indicates that the melanocyte reservoir is no more available in these areas and its repopulation is needed. This can be achieved by cell suspensions of autologous cultured melanocytes. Now it is possible not only to grow the melanocytes in artificial culture media but also transplant them in depigmentary disorder. The technique gives no scarring and there is perfect matching in stable vitiligo.
Surgery is a relatively new concept in vitiligo. Future advancement with the use of hair follicular melanocytes and genetic cloning will solve some of the current problems and only that will:
"Clear up the clouded vision.
Clear out the foggy mind.
The clouds are always passing.
And each is silver-lined."
Pet is part of you
WHAT you do for your pet is less important than what you do to it. You take pride in your status, discussing your ability to acquire and maintain it. But do you care adequately for it?Perhaps, you don't — mostly because you are not sufficiently educated to do so. The first- ever seminar of its kind on "Canine Health-care" held in Chandigarh on Sunday last taught you much through the Get Well Pet Care Services, a subsidiary of the Get Well Dog Clinic. The venue was Hotel G.K. International.
The educational programme for the members of "File Green", a membership group of Get Well Dog Clinic's pet-owners, for instance, told you that your health was protected if you took good care of the health of your pet which had "a personality of its own".
First aid was discussed by experts. So were diet and exercise. You had a chance to interact with the experts and the industry — Sarabhai-Zydus, Pfizer-Zydus, Pfizer-Growmed and Pet Shoppe, Sector 10, Chandigarh, the sponsors for the event.
The delegates and the listeners included medical scientists of the stature of Dr S.D. Deodhar, militarymen like General Rajendra Nath, spiritual persons like Mrs Sukarma Sundra and senior mediamen and women.
Dr Arun Atrey's lecture mentioned the 1.5 million-strong population of pedigreed dogs, called all dogs precious like Yudhishthira's friend and Dr V.K. Sobti explained the surgical aspects of pet-care.
With Dr C.B. Singh's organising ability, erudition and eloquence, nothing under or over the skin remained hidden. "God and Dog were spelt with the same letters", was the final impression. — K.P.S
Cocaine and your heart
Q Do you know that you should avoid cocaine for your heart's sake?
A Listen to Dr H.S. Wasir:
Cocaine is an alkaloid derived from the coca bush that grows in South America. Mostly consumed by inhalation or nasal snuff, it is an addictive agent falling in the category of stimulants like amphetamine but much more powerful in small amounts. It is specially harmful for the heart — the basic mechanism being the excess outpouring of catecholeamines (vasopressor substances) into the blood stream that result in heart damage through the following ways:
1. An increase in the frequency and force of heart-beating, thereby increasing the oxygen requirement by the heart and if it is happening frequently the heart muscle gets tired and weak. Ultimately, it fails to eject the blood proportionate to the needs of the body.
2. Irregularity in pulse beat and palpitations often occur in the cocaine-users. It keeps the person awake, but not necessarily attentive and vigilant.
3. An acute and sudden rise in blood pressure also occurs due to cocaine and in a person who is already suffering from high blood pressure; it may result in stroke and heart failure.
4. Cocaine is turning out to be a common cause of chest pain in young people in the West. This pain simulates a heart attack and angina and is associated in many cases with abnormal ECG just like in a patient with a typical heart attack. These patients need treatment like any other patient with a heart attack.
In a large number of such persons with a heart attack due to cocaine, the blood vessels that supply oxygenated blood to the heart (coronary arteries) do not show any structural blocks. The heart attacks and anginal chest pain due to cocaine's use occur due to the severe temporary narrowing of the coronary arteries (coronary spasm) resulting in a sudden decrease in the blood flow to the heart this causing heart muscle damage. Apart from this damaging effect in otherwise normal hearts, cocaine also aggravates the atherosclortic process (hardening and narrowing of coronary arteries), the usual common cause of heart attacks. Cocaine's use may thus be the cause of sudden cardiac death in some persons specially in young age groups that do not have enough collateral blood vessels as reserve bylanes to supply blood to the heart muscle in the emergency of a sudden block in one of the major arteries.
5. Frequently occurring disturbances in the blood coronary supply to the heart and the direct harmful effect of catecho-leamines (due to cocaine) on the heart muscle result in congestive heart failure and death.
In view of these harmful effects of cocaine on heart and blood pressure and the emerging trend of young people falling prey to this addictive habit, it is high time we made our people aware of this dangerous trend so that we could be saved from the havoc these addictive agents have caused in many countries of the world.
Dr Wasir is the Chief Cardiologist and
Medical Adviser to Batra Hospital and Medical Research Centre, New
Delhi. He was Professor of Cardiology, and Head of the Department at
the AIIMS, New Delhi, for many years.
is an ordinary-looking tall shrub that sometimes grows to the height
of a small tree. Known as gandharva hasta in Sanskrit and ricinus
communis botanically, the plants are usually seen growing wild near
habitations and wasteland. But these are also cultivated as a
commercial crop. Though the oil of erand which is known as castor oil
is largely used as medicine, the leaves and the root of the plant also
possess curative properties.
One of the foremost herbs to treat vata disorders, erand has been mentioned in almost all the ancient ayurvedic texts. It has been described as sweet and pungent in taste but hot, sharp and heavy in effect. The seed of the plant, which yield the oil contain alkaloid ricinine and toxalbumine ricin. All over the world, castor oil is commonly used as a safe purgative.
The oil has anti-inflammatory, analgesic and carminative properties. However, in Ayurveda, it is best known for its anti-rheumatic action. It is also used in a number of diseases like the Sciatica-Lumbago Syndrome, paralysis, Parkinson's disease, constipation and many skin problems. Here are a few tips indicating its common use in different diseases:
Rheumatism: The use of castor oil forms the basic treatment of rheumatoid arthritis in ayurveda. In its early stage taking 10 to 20 ml of castor oil and two grams of the powder of dry ginger with a cup of warm milk daily for a fortnight at bedtime reduces inflammation besides the early morning stiffness of the joints which is a characteristic feature of the diseases.
Chronic backache and sciatica: The kheer of erand seeds, after boiling them in milk, is a famous household remedy for the Sciatica-Lumbago Syndrome. The same recipe is given to patients of other vata diseases like hemiplegia and Parkinson's disease.
Constipation: Varying in dose from patient to patient, castor oil is a simple and harmless purgative. Usually, 20 to 60 ml of it can be taken at bedtime with lukewarm milk. Castor oil works faster if it is taken during daytime.
Skin diseases: Castor oil and its leaves are used in many poultices which are applied over inflammed conditions of joints, boils and the enlargement of lymphnodes. Its application is also beneficial if it is done on the cracked skin of the feet.
Since erand is a drug of choice in the treatment of rheumatoid arthritis, there are various ayurvedic medicines containing castor oil and the bark of the erand root. Sinhanad Guggul, Rasna Saptak Qwath, Erandpak and Brihad Saindhvadi Tailam are a few famous classic medicines.
Caution: An overdose of castor oil may cause nausea, vomiting and griping in the abdomen whereas its habitual use results in rebound constipation. Castor oil should also be used with care in pregnant women.
Dr Vatsyayan is an ayurvedic consultant
based at Sanjivani Ayurvedic Centre, Ludhiana. (Phones: 423500 and
431500; E-mail-sanjivni @satyam. net. in)