HEALTH TRIBUNE Wednesday, October 17, Chandigarh, India
 

How to manage sports injuries
Dr Ravinder Chadha
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HERE is a misconception among the general public suffering from injuries regarding first aid measures. Immediately after injury, hot fomentation and analgesic ointments are applied. Such first-aid treatment,, instead of helping, increases the problem by delaying the healing process. Hot fomentation increases the swelling by improving the blood circulation to the injured part.

Scientific insight into major matters of sight
North Zone meet
M
ORE awareness of eye ailments is being brought about in this World Sight Month. The Department of Ophthalmology, Government Medical College Hospital, Chandigarh, is organising the XV Annual Conference of the North Zone Ophthalmological Society on October 20 and 21. Dr O.P. Sharma, a former National Professor, is the Chairman of the Organising Committee and Prof S. Sood, Head of the Department of Ophthalmology is the Organising Secretary of the conference.

  • The elderly’s vision
  • World Menopause Day

TOTAL HEALTH & AYURVEDA
Juvenating jaiphal
Dr R. Vatsyayan, Ayurvedacharya
J
AIPHAL, known as nutmeg in English, Myristica fragrance botanically and Jatiphal in Sanskrit, is the dried kernel of the fruit of a tall and evergreen tree found in southern parts of India. The fruit has a yellowish red covering which, if dried and peeled, is called mace or javitri. Both jaiphal and javitri have been used for centuries in Ayurveda.

Job stress & mental illness

Q&A
Knee pain: close view
Dr Mandeep S. Dhillon

 
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How to manage sports injuries
Dr Ravinder Chadha

THERE is a misconception among the general public suffering from injuries regarding first aid measures. Immediately after injury, hot fomentation and analgesic ointments are applied. Such first-aid treatment,, instead of helping, increases the problem by delaying the healing process. Hot fomentation increases the swelling by improving the blood circulation to the injured part. Once swelling appears, It takes a long time to subside. In case we are able to use certain first-aid measures, which do not allow the swelling to increase at the initial stage, the healing time can be reduced to a great extent.

The aim of this article is to present an overall view of the techniques and strategies of managing injuries and conditions in order to optimise recovery.

Once an injury has occurred, and has been identified as involving soft tissue (contusion, sprain, strain) action must be taken to avoid the worsening of the lesion. Generally, this means restricting the activities to prevent the extension of the lesion and placing the injured part in a comfortable and safe position. It may necessitate the use of a sling, crutches or protective padding, strapping or bracing.

In order to minimise the degree of tissue damage, the associated bleeding and pain, rest should be given to the injured part. Rest is required generally to ensure the lowering of the blood pressure and the consequent leaking from the damaged blood vessels in the injured tissues.

The role of ice is now well accepted in the management of acute soft-tissue injury. Its capacity as a pain reliever and reducer of bleeding and swelling is known. The recommended maximum duration for continuous ice treatment to an acute soft-tissue injury is 15 to 20 minutes. Ice is then replaced for further 20 minutes, after a 20 to 60 minutes' break, depending upon the improvement in the swelling. The reason for limiting the duration of continuous ice application is to reduce the chance of freezing the superficial body fluid and causing an "ice-burn" (frost-bite) injury. Ice should be applied through a moist piece of cloth against the skin to avoid excessive cooling.

The application of an effective compression bandage to an acute soft-tissue injury can give a significant result in the control of the swelling and the minimisation of the congestive phase of the inflammatory response to the injury. Compression assists in a faster re-establishment of normal circulation and lympathatic drainage in the injured area.

Once a compression bandage is applied, it should be monitored to ensure that adequate circulation is maintained distally to the bandage. If the patient is leaving the doctor's care, instructions should be given to loosen and re-apply the bandage, should there be any distal swelling, parasthesia, cyanosis or coldness. Unlike ice, loosen a compression bandage can be used over open wounds (once the wound is suitably dressed) and it can remain on the injury-site throughout the acute inflammatory stage.

The elevation of the injured part is to reduce the local intravascular pressure and thus the bleeding from the damaged vessels, and to facilitate the draining of any accumulating interstitial fluid towards the central circulation. In the case of lower limb injury, elevation at least ensures protection and rest for the site. Injuries to the shoulder girdle are unaffected by attempts to elevate them due to their proximity to the heart; more distal upper limb injuries (forearm and hand) can be elevated, relative to the elbow; by a sling.

Referring the patient to a hospital should be considered when further investigation, intervention or supervision are required, e.g, when immediate radiological evaluation is necessary, or a person with a head injury needs specialised observation for several hours.

There are many activities which undermine the effectiveness of the ice regime, and the patient should be warned accordingly. These are the application of heat, the ingestion of alcohol (a potent vasodilator and suppressor of common sense) and vigorous body activity. These factors have been combined into an acronym: HARM (heat, alcohol, running, massage). So remember, ice is nice, but don't HARM an injury.

The stage of promotion of healing lasts for 72 hours to six weeks. This phase involves the continual removal of debris from the injury site and the proliferation of fibroblasts. These cells are responsible for the healing of the lesion.

Physiotherapy at this stage is aimed at reducing the congestion (swelling), facilitating the oxygenation and nutrition of the injury-site and restoring the normal movement pattern while minimising further deterioration and avoiding re-inflaming the lesion.

Physiotherapeutic measures which maybe used in the early stages of this healing phase include massage to mobilise the congestion and aid lymphatic drainage, low-dose ultrasound (to facilitate the transfer of ions or fluids across cell membranes), electrical current (for cell membrane permeability and pain relief), electrical muscle stimulation (to aid drainage by changing pressure in the area and stimulating vascular supply), exercise (for increased blood and lymph flow, and reduction of adhesions and atrophy) and instruction to the patient regarding the limitation of activity (to prevent re-inflammation and interruption of the repair process).

In a nutshell, first-aid treatment for injuries should be prompt and precise in order to minimise the recovery period.

Dr Ravinder Chadha was the doctor/physio of the Indian cricket team from 1998 to 2000.
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Scientific insight into major matters of sight

North Zone meet

MORE awareness of eye ailments is being brought about in this World Sight Month. The Department of Ophthalmology, Government Medical College Hospital, Chandigarh, is organising the XV Annual Conference of the North Zone Ophthalmological Society on October 20 and 21. Dr O.P. Sharma, a former National Professor, is the Chairman of the Organising Committee and Prof S. Sood, Head of the Department of Ophthalmology is the Organising Secretary of the conference. According to them, the conference is likely to be attended by more than 400 delegates from Punjab, Haryana, Himachal Pradesh, Jammu and Kashmir, Chandigarh and also Delhi. Mr Suraj Bhan, the Governor of Himachal Pradesh, will inaugurate it.

Dr J.K. Pasricha, President of the All-India Ophthalmological Society and Director of the Karnal Eye Institute, will be the guest of honour.

Prof H.K. Tewari, Chief of the Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi; and Dr P.N. Nagpal, Director Retina Foundation, Ahmedabad (both pioneers in retinal disease management), will participate as guest speakers. In addition, Prof Amod Gupta, Head of the Department of Ophthalmology, PGI, Chandigarh; Dr S. Natarajan (Mumbai); Dr A.K. Grover (New Delhi) and Dr Satish Gupta, Head of the Venu Eye Institute (New Delhi) will shed light on various problems and prospects in their fields.

Prof S. Sood says that during the conference there will be a number of symposia, instruction courses, video-assisted skill transfer courses (VAST) and live surgery sessions. The academic deliberations will be focused on the emerging causes of blindness in the region and on the latest developments in the field of the management of diabetic retinopathy, age-related retinal disease and uveal inflammations. Cataract, the cause of reversible blindness (80%) will be discussed at length. Live phaco surgery sessions will be conducted by Dr Jagat Ram, Additional Professor at the PGI.

The elderly’s vision

The elderly are being given special attention in this World Sight Month. Anyone can contact Brig (Dr) M.L. Kataria’s staff at Lala Lajpat Rai Bhavan in Sector 15, Chandigarh, for guidance.

Dr Kataria says : Among thousands of senior citizens whom we have had the privilege to serve through our several health care centres, there are many in the tenth decade of their glorious life and some of them are still without cataract, hypertension, glaucoma, diabetes or senile retinal degeneration! One of them, at 97 with a BP of 110/70, still stands on his head for five minutes (now reduced to two minutes on my suggestion) to maintain his retinal circulation. He drives his car, purchased more than 50 years ago.

World Menopause Day

October 18 is World Menopause Day and the Indian Menopause Society joins the International Menopause Society to tell women worldwide: ‘‘Have one of the most important discussions of your life today’’.

World Menopause Day calls on every woman of the age of 45 and older to talk to her physician about her individual health history, her risks for diseases, the benefits and risks of the hormone replacement therapy, and steps she can take now to take charge of her health.

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TOTAL HEALTH & AYURVEDA
Juvenating jaiphal
Dr R. Vatsyayan, Ayurvedacharya

Will for life

A man of the world should first and foremost develop a will for life because when life is lost, everything is lost. A healthy person can safeguard it by following a healthy regimen; a sick person by paying proper attention to relieving disorders.

— Charaka Samhita

JAIPHAL, known as nutmeg in English, Myristica fragrance botanically and Jatiphal in Sanskrit, is the dried kernel of the fruit of a tall and evergreen tree found in southern parts of India. The fruit has a yellowish red covering which, if dried and peeled, is called mace or javitri. Both jaiphal and javitri have been used for centuries in Ayurveda.

Pungent, bitter and astringent in taste and light, sharp, hot and unctuous in properties: that is how jaiphal has been described in ayurvedic texts. While aggravating pitta, it calms down vata and kapha. The chemical composition of jaiphal includes volatile oils, protein, starch and minerals. It also contains an aromatic oil and an active principle known as myristicin.

Commonly used in kitchen preparations, jaiphal is digestive, appetiser, aromatic and astringent. Ayurveda attributes various other efficacies to it like anti-inflammatory, anti-diarrhoeal, analgesic and kamottejak and shukrastambhak (sex-stimulant and averting premature ejaculation). Though sedative in high doses, this fruit is considered to be a bitter tonic. Jaiphal is known to have numerous therapeutic effects. It is one of the very useful drugs which helps to control diarrhoea and dysentery, stimulate liver functions and cure chronic nasal discharge, insomnia and headache. Some of its common uses are as under:

Digestive upsets: Take one fourth of a teaspoonful of jaiphal powder with a little jaggery. It will promptly control diarrhoea. Adding a pinch of its powder to peppermint tea or taking it with honey relieves the symptoms of hiccups, gas, nausea and vomiting. It is also a well-known home remedy for recurrent loose motions of infants. After rubbing this nut in water, a paste--like material is obtained and given to children. Joint pains — Medicated sesame oil, prepared with the dried powder of jaiphal, is applied on inflamed and painful joints. Similarly, the application of the watery paste of jaiphal is very effective in the case of headache arising from exposure to cold.

Insomnia — Jaiphal powder is a remedy for sleeplessness. For this purpose, half gram of its powder can be taken mixed with honey. Its paste, in a very minute quantity, can also be given for inducing sleep to infants who cry at night for no apparent reason.

Other uses — Jaiphal is a commonly used ingredient in herbal cosmetics, mouth freshners and complexion promoting packs. In the case of diminished libido, one eighth of a teaspoonful of powdered jaiphal can be taken mixed in a little honey in the evening.

Jaiphal should only be taken in the prescribed dosage and that too not for a prolonged period. Its average daily dose is up to one gram. An overdose can produce toxic symptoms like severe acidity, nausea, giddiness and hallucinations. Javitri has properties similar to that of jaiphal but it is more of a carminative than anti-diarrhoeal. The ancient ayurvedic scholar, Sharangadhar, has written about Jatiphaladi Churna and Jatiphaladi Vati — the two classic medicines which contain jaiphal as their main ingredient.

Dr R. Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana. He has been nominated as a technical member of the Punjab Government's Medicinal Plant Board. (Phones - 423500, 431500; e-mail - sanjivni@satyam.net.in)
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Job stress & mental illness

WHAT is job stress? Job stress can be defined as the harmful physical and emotional response that occurs when the requirements of the job do not match the capabilities, resources, or needs of the worker. Stressful working conditions may interfere with an employee’s ability to work safely, contributing to work injuries and illnesses. In the workplace, the most highly ranked and frequently reported organisational stressors are potential job loss, technological advances and ineffective top management. At the work unit level, work overload, poor supervision and inadequate training are the top-ranking factors.

— “Mental Health and Work” (WFMH and WHO)

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Q&A
Knee pain: close view
Dr Mandeep S. Dhillon

Why do the knees pain?
The knee joint is a major weight-bearing joint which is not freely mobile in all planes. It is somewhat like a hinge joint with most of the motion in one plane. Due to this, it is prone to strains and injury in young adults; arthritis and degeneration are the common cause of pain in the elderly. Pain associated with swelling may indicate a severe problem, even an infection, which needs a specialist's opinion.

What is the cause of knee pain in young adults?
The commonest cause of knee pain in youngsters is injury (sporting or otherwise) where some part of the cartilage, usually the meniscus, which is a washer-like structure, is torn. Sometimes the ligaments may be injured and there is a serious problem. In young girls, a more common cause is malalignment of the knee-cap, with more wear on one side, which causes pain during squatting or the use of stairs. In the elderly, the wear of the joint surface leads to arthritis, which causes pain with almost all types of activity and significantly hinders day-to-day life.

What are the treatment options available?
An accurate diagnosis, some medication and rest are helpful in acute pain. An exercise regime which strengthens the muscles and helps realign the knee-cap, is beneficial in the young population. Some cases may need arthroscopy, which is extremely beneficial. Most cases will do well with these measures, and physiotherapy in the form of heat application and strengthening exercises is the most important aspect of the treatment protocol. In the elderly, the treatment consists of initial rest and gradual rehabilitation with more possibility of surgery for the correction of alignment, arthroscopy or even joint replacement.

What is arthroscopy?
Arthroscopy is the use of fiber optics to look inside the knee through a keyhole incision; this also allows the correction of most painful conditions, ranging from cartilage tears, ligament injuries, removal of loose pieces and even the smoothening out of some roughened surfaces caused by arthritis. The procedure is minor and needs minimal or no hospitalisation.

When is joint replacement needed and is it successful?
Joint replacement is needed in the elderly when the joint surfaces have worn away to the bone. This is a very successful surgery as is evidenced by lakhs of patients worldwide. However, it is preferably done late in life, when the patients' activity level is reduced and the primary aim is pain relief and enhanced mobility. Some motion restrictions like inability to squat and sit cross-legged are inevitable but most cases with painful knees are unable to do this anyway. The quality of life is significantly improved and age is no bar for this surgery. It is rather costly, though!

What about the newer forms of non-operative treatment for the elderly?
Certain dietary supplement like Glusoamine and Chondroitin, which are available off the shelf, are helpful in the early stages of osteoarthritis with specific indications. Injections of "artificial synovial fluid", which could potentially aid joint lubrication, have also come into the market but the relief is temporary and the patient may ultimately need surgery.

Dr Dhillon is Associate Professor of Orthopaedic Surgery at the PGI, Chandigarh. His article on "Flat feet and knock knees" will appear subsequently.
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