HEALTH TRIBUNE Wednesday, December 12, 2001, Chandigarh, India
 


CHD: an eminent cardiologist holds out hope 
Prevention is possible I I
Dr. R.P.Sapru

This writer believes that smoking of tobacco should be equated with cyanide except that smoking kills slowly while cyanide has a more dramatic result. Both will ultimately cause death, the example of Winston Churchill notwithstanding.

SEASONAL PROBLEMS
Come winter, come lung infections
Dr S.K. Jindal
T
HE onset of winter heralds the onset of respiratory infections of different kinds. Besides being troublesome, the infections tend to spread from one person to another. None other than William Shakespeare described better the need to control infection when he wrote:

SPOT LIGHT ON MIND
Postpartum blues: a close psychiatric look
Dr Rajeev Gupta
T
HE life of a woman is far more complicated than that of a man. During her reproductive age, month after month she experiences a roller coaster ride of the hormonal changes. Pregnancies and deliveries are unique physiological and psycho-social experiences which fall in the exclusive domain of the female gender.

AYURVEDA & TOTAL HEALTH

Be a good learner

Without having any sense of jealousy, one should always strive to acquire good qualities even from one's rivals. Wisemen consider the entire world as their teacher; it is only the fools who consider it to be their enemy.

Charak Samhita.

A great gift to man from Mother Nature
Dr R. Vatsyayan, Ayurvedacharya
A
MLA is one of the greatest gifts of nature to mankind. Charak and Sushrut have almost left no disease where they haven't mentioned the use of amla in one way or the other. The famous ancient scholar of herbal medicine and applied botany, Pandit Bhavamishra, has written that amla corrects the body metabolism and is a tonic of immense value.

Food allergies and you

 
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CHD: an eminent cardiologist holds out hope 
Prevention is possible II
Dr. R.P.Sapru

This writer believes that smoking of tobacco should be equated with cyanide except that smoking kills slowly while cyanide has a more dramatic result. Both will ultimately cause death, the example of Winston Churchill notwithstanding.

The basic underlying cause of a heart attack is the disease of the coronary arteries, which are the blood vessels that supply blood to the heart muscle.

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Certain circumstances are associated with an increased risk of falling victim to the disease.

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There is strong evidence to suggest that smoking is perhaps the most important risk factor in the case of the rural poor.

The message is loud and clear:"If you do not smoke, do not even try for fun. If you do smoke, give it up completely now, this minute, not later. Educate and persuade your near and dear ones not to smoke. Avoid sitting in the company of others if they smoke." There is a pressing need for people, especially the non-smokers, to raise their voice and condemn the smoking habit as an anti-social activity and demand a smoke-free environment. Tobacco smoke is like a drug that kills, albeit slowly. The macho image is completely false and misleading; on the contrary the tobacco habit decreases libido as well as physical strength! The film and television industry could help greatly by consciously and voluntarily excluding from their portrayals all such scenes as depict the use of tobacco.

The second most important risk factor is high blood pressure. It is believed that almost 15% of people over the age of 30 years have high blood pressure. Even a mild, but persistent, increase in blood pressure is harmful. The upper limit of normal blood pressure in adults of all ages if 130/85 mm of Hg. It does not matter what strategy is used to keep the blood pressure within normal limits; the important thing is that it must remain within normal limits. There are some misconceptions amongst people regarding blood pressure and these need to be clarified.

Firstly, high blood pressure does not lead to any symptom unless, of course, the pressure is very high. Therefore, it is not possible for a person to predict his or her own blood pressure. Secondly, the treatment of high blood pressure (meditation, yoga, exercise or drugs) is effective only as long as the treatment is taken. Once the treatment is stopped, the blood pressure will rise again. The patient, of course, remains unaware since no symptoms are likely to appear when the blood pressure begins to rise again!A false sense of security is, therefore, created unless actual measurements of blood pressure are made. Thirdly, even elderly patients should try to achieve the same range of normal blood pressure unless, of course, they suffer from a neurological problem. Fourthly, currently available drugs are fairly safe and can be taken for many years without the fear of unacceptable side-effects. In case side effects are experienced, the doctor will be able to find a mix of drugs that would suit the patient better; currently, a large number of options are available.

The third important risk factor is diabetes. Like high blood pressure, diabetes also does not produce symptoms except in the advanced stages of the disease. Uncontrolled, or even inadequately controlled, diabetes leads to a gradual but inexorable disease of all the blood vessels of the body especially those in the heart, brain and kidneys. Heart attacks are more common and the outcomes are worse in patients who have diabetes as compared to those who do not have the disease. Adequate control of diabetes, however, achieved, has been demonstrated to reduce the chances of heart attacks and improve the outcomes of the disease. Even the long-term benefits of treatments like bypass surgery or ballooning are greatly increased if diabetes is kept under control as compared to those patients in whom the blood sugar levels are not adequately controlled.

The next risk factor is the level of fats in the blood, commonly measured as cholesterol. It is now established that the total cholesterol level in the blood should be less than 200 mg/ 100 ml. Even more importantly, the amount of the so-called "bad cholesterol"(LDL-cholesterol) should not exceed 100 mg/100 ml. Mention is often made of the protection that may be afforded by adequate levels of the so-called "good cholesterol"(HDL-cholesterol). Research has shown that one of the possible reasons for the proneness of Indians (in common with other south Asians) to heart attacks is the low levels of HDL- cholesterol in the blood due to genetic mechanisms. The level of total cholesterol in the blood has nothing to do with body weight. Even persons with a lean body build can have elevated cholesterol! However, the tendency for elevated cholesterol does run in families. While eating rich food, excessive fats, animal products, etc, will contribute to increased levels of cholesterol in the blood, it is not uncommon to find elevated levels of cholesterol even in persons who may not be in the habit of consuming such foods.

Before the reader jumps to the conclusion that it is of no use to avoid the kind of rich foods mentioned above, it is important to appreciate that the correct interpretation of this apparent paradox is that persons with elevated cholesterol levels in spite of good food habits would have shown even higher cholesterol levels if their food habits were to change for the worse! Therefore, there are no two opinions about the need to cultivate good food habits for all, children and grown ups, as well as those with disease and those without.

The earlier in life children learn the need for good food habits the better. What that means is that ghee, hydrogenated oils and butter should not be used at all. It is regrettable that Amul has put out a vigorous ad campaign to encourage the use of butter. The advertisement may promote business; it will most certainly not promote good health. Only cholesterol-free margarine could be considered, not butter. A mix of some of the vegetable oils (e.g. corn oil with mustard or groundnut oil) is perhaps the best available option. Increased consumption of fiber in the form of green vegetables, fruit or whole-wheat atta should be encouraged. Egg yolk is particularly rich in cholesterol. While there is no harm in consuming egg white, the yolk should be avoided. Of the meat preparations fish and white meat are superior to red meat, though vegetarian food is superior to both options! In the last few years very effective and reasonably safe drug has become available for the control of high cholesterol levels in the blood. However, these should be taken only under medical supervision. It must, however, be realised that while the drugs lower blood cholesterol levels, they do not cure the cause of the abnormality. Hence blood cholesterol will rise again if and when the drugs are stopped. Therefore, treatment, in most instances, will have to be life long.

Regular exercise is quite helpful in many ways. It reduces the risk of heart attacks by helping to achieve better control of blood pressure, diabetes and blood cholesterol; perhaps also in some other more subtle ways. Additional benefits include better physical fitness and a more positive attitude to life. Those who can should make it a regular habit. A brisk walk everyday for 30 to 45 minutes is sufficient. Bicycling is superior. A socio-cultural shift that would encourage the habit of cycling to work could work wonders for the health and safety of the individual, the national economy as well as the environment! Instead of being considered infra dig, cycling to work should be lauded as a positive contribution towards the well-being of all. Designers of future cities should provide covered cycle paths for the people. Even in existing cities and towns, future development should provide for such a positive attitudinal shift. Long distances could be covered by a mixed mode of transport such as a train or a bus and the bicycle. The hackles that are likely to be raised at this seemingly audacious suggestion will melt away on cool reflection. The objection is in our perception and not based on facts. Long-term economic benefits will recover the investment costs. Consider also the saving in time, for the time saved on the morning walk will compensate for the additional time spent in bicycling! The idea is not entirely novel; some countries have already started experimenting on just these lines. We could anticipate the coming revolution or wait till vents overtake us!

Overweight individuals are more prone to high blood pressure and diabetes. Scientific research over the past few years suggests that people with a paunch belly are in particular susceptible to heart disease! Somehow this physical form reflects the genetic proneness amongst Indians referred to earlier. There are persuasive arguments which indicate that people should strive to maintain an ideal body weight. There is good evidence to suggest that some persons are more prone to gain weight than others. Therefore, it is no use to compare one's food intake with that of others, even members of the same family. I like to suggest that body weight is like a bank balance; it will grow if the credit is greater than the debit, and shrink if the debit is greater than the credit! A clear fact that needs to be understood is that persons who eat more than their individual requirement will gain in weight and vice versa. There is no need to follow any specific diet schedule. The best policy is to invest in a weighing machine and weigh oneself daily, bare body, after the morning bath. If you are losing weight at the rate of an average of a kilogram in one or two weeks your dietary intake is satisfactory; if not, you are eating more than what your body needs! Persons on a dieting schedule tend to miss out on vitamins. Therefore they should take vitamin supplements. Institutionalised weight control businesses offer just these simple facts in an attractive package, of course, with a suitable price tag.

Keen students of health-related information may have found mention of quite a few other risk factors for heart disease but these are more subtle and perhaps not quite as important as those mentioned above. One of these relates to the need for folic acid supplementation, a harmless vitamin that may be particularly beneficial for Indians. More work on the subject is awaited before a firm statement can be made one way or the other. The regular use of aspirin (Colsprin etc) is a very effective measure for persons who have manifest coronary artery disease. The advantage of regular aspirin intake by persons who do not have manifest heart disease is still questionable. Even this common drug is not without its share of side-effects, so regular use should only be under medical supervision.

Since the Second World War there has been a 30% decline in death rates from coronary artery disease in the USA. Much of this change is attributed to heightened awareness about the benefits of risk factor control that has been translated into effective action. On the contrary, in our country, the frequency of the disease as well as death rates from it have been on the increase! The message clearly is that coronary artery disease can be prevented, or the outcomes of the disease improved, if a concerted effort is made to control the risk factors. The evidence is compelling, implementation requires an attitudinal change in society that encourages positive preventive measures for better health and a longer and more fruitful life. Appropriate peer pressure will go a long way to achieve this. Everyone should contribute to this collective effort. (Concluded)

Dr Sapru, a former Head of the Department of Cardiology at the PGI, Chandigarh is the Medical Director of INSCOL, Sector 34, in the same city.

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SEASONAL PROBLEMS
Come winter, come lung infections
Dr S.K. Jindal

THE onset of winter heralds the onset of respiratory infections of different kinds. Besides being troublesome, the infections tend to spread from one person to another. None other than William Shakespeare described better the need to control infection when he wrote:

Pursue him to his house and pluck him thence,

lest his infection being of catching nature,

spread further (Coriolanus)

Upper respiratory tract infections, grouped together as upper respiratory catarrh (URC) or common cold, are common during the change of seasons. Factually speaking, common cold is only one of the several different infections of the upper respiratory tract which consist of those of the nose, mouth, throat and their contents such as the tonsils, pharynx and larynx. These organs are generally involved together although individual afflictions may also occur. Infectious conditions such as rhinitis, tonsillitis, pharyngitis, laryngitis or tracheitis can constitute one or different forms of a URC "itis" denotes the inflammation of tissues in medical terminology.

The acute onset of symptoms of cough, the running nose, sore throat and/or throat clearing, fever, general prostration, weakness and fatigue indicate the presence of a viral URC. It is mostly self-limiting and only symptomatic treatment suffices. Bacterial infections and the presence of purulent secretions necessitate the use of antibiotics. The decision should be made by the doctor since an inappropriate use of drugs, especially the antibiotics, can cause more problems without doing any good.

These are the lower respiratory tract infections i.e. bronchitis and pneumonias, which require more urgent attention. Not infrequently, the upper respiratory infection may spread and extend downwards to involve the lower respiratory tract. This may, however, happen only if the infection is severe to start with or the person who is infected is immunosuppressed (weak in his defence against the microorganisms). Both bronchitis and pneumonia frequently involve the otherwise healthy individuals.

Bronchitis may occur de novo in an individual following a sudden exposure to cold, smoke or other inhalational chemicals and fumes. It may also complicate the otherwise stable course of a patient with chronic bronchitis or bronchial asthma. Patients with chronic respiratory diseases in particular need to be careful due the onset of winter.

Besides the change in temperature, the winter season is notoriously dangerous because of air-pollution. The dust and smoke particles in the air condense and coalesce; the hydrocarbon present in the air from vehicular and industrial exhausts get oxidised dur to the sunlight. The combination of smoke and the winter fog gets the nomenclature "smog" a real danger. Several episodes of smog in the late nineties and early fifties in Europe and the USA were labelled as "epidemics" because of their widespread nature. Smog is dangerous by itself but much more so by predisposing one to respiratory infections.

Pneumonia is the real prototype of lung infection. It represents the inflammation of the lung cells or pneumocytes and should, therefore, be called pneumonitis. Pneumonias are classified variously depending on the cause (infectious, chemical or toxic), the setting (e.g. community or hospital-acquired), the host (immunosuppressed) and the agent (pneumococcal, klebsiella, fungal, viral etc.). While community-acquired pneumonias are more common, the others are more serious and more likely to be seen at the referral hospitals and tertiary care centres.

Tobacco smoking is the other major cause of bronchitis. Chronic bronchitis is almost always associated with smoking. Acute bronchitis, on the other hand, results from acute, heavy exposures to dust and smoke. In children, passive smoking on exposure to smoke from parents is an important factor for predisposition to respiratory infection.

The clinical picture of pneumonia is known since 4th to 5th century BC when Hippocrates vividly described..... "when pneumonia is at its height.....It is bad if he had dyspnoea.... and if sweat comes out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales and the violence of the disease". Typically, there is fever and cough which may be accompanied with chest pain, rigors, chills and sweating. Sputum production is nil or insignificant but may increase with time if complications occur. It should be clearly remembered that pneumonia can go on to develop pus formation in the lungs, the pleural cavity and even elsewhere in the body.

An individual needs to be careful to prevent the occurrence of respiratory infection. The avoidance of exposure to cold is important. Warm clothing should be used for outdoor activities. Early morning walks should preferably be avoided especially by people with pre-existing lung and/or other systemic diseases.

Similarly, it is important to stay away from dust and smoke as much as possible. General civic rules should be practised and coughing, spitting and nose blowing should not be done in the presence of others. Infection is not easy to prevent. When it does occur, early medical advice may help prevent further problems. A trouble is better nipped in the bud than allowed to grow.

Dr S.K. Jindal is Professor and Head of the Department of Pulmonary Medicine, PGI, Chandigarh.

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SPOT LIGHT ON MIND
Postpartum blues: a close psychiatric look
Dr Rajeev Gupta

THE life of a woman is far more complicated than that of a man. During her reproductive age, month after month she experiences a roller coaster ride of the hormonal changes. Pregnancies and deliveries are unique physiological and psycho-social experiences which fall in the exclusive domain of the female gender.

It is well established that during pregnancy and in the postpartum period, a woman is prone to a variety of serious medical and emotional problems. Though such problems have been described long back in ayurvedic texts and Hippocrates, the Greek physician, gave a detailed description of such problems in 700 BC, even today it is highly unfortunate that a major part of such sufferings remains unidentified and untreated. Millions of women suffer in silence in our country. The victims and their families should be motivated and encouraged to seek timely medical and psycho-social help and get themselves back on the path of recovery.

Common psychiatric problems:

1. Postpartum stress: These are called transitory mood disorders. The common symptoms occurring in the first week following delivery are frequent crying, poor sleep, irritability and mood changes. These may continue for a few weeks. More than 50 per cent women have these blues. Maternal blues are more common after the first delivery. The clinical state does not need any treatment.

2. The common depressive syndrome: It is more debilitating than the blues. The woman may have the feeling of severe sadness, tearfulness, and the perception of guilt, inadequacy, anxiety, irritability and fatigue. If these go untreated, the situation can be prolonged and may play havoc with the life of the patient.

3. Postpartum psychosis or puerperal psychosis: It is relatively an uncommon disorder occurring after child birth. Its symptoms are confusion, agitation, alteration in moods, the feeling of hopelessness, suspiciousness, auditory hallucinations (hearing voices), rapid speech, an occasional hilarious mood and hyperacidity. These symptoms need immediate psychiatric attention.

4. Postpartum post-traumatic stress syndrome: In some women, childbirth may mean caeasarian birth, the death of an infant, the birth of a female child etc. These are quite traumatic and trigger postpartum illnesses.

The following factors predispose a woman to various postpartum problems:

1. Hormonal changes: During the postpartum period, there is a sharp drop in the levels of hormones like estrogen and progesterone. The levels of prolactin, another hormone, fall immediately after the delivery and rise in the first week after child birth. In some studies postpartum problems are found to be more in such women as do not breastfeed their babies.

2. Personality variables: Psychological factors play an important role in postpartum psychiatric disorders. Some women suffer from deep feelings of inadequacy regarding child-bearing. Many working women suffer from the role conflicts between their job roll and their role as a mother. Those women who have low self-esteem are more prone to developing such problems. In our country women giving repeated births to female children are bound to become victims of the low-esteem syndrome. They also become targets of family and social ridicule and neglect.

3. Demographic variables: Females belonging to low socio-economic status and having low psycho-social support become more vulnerable to these psychological problems. Malnutrition and vitamin deficiencies can also add to one's proneness to such sufferings.

4. Obstetric variables: It is commonly observed that young mothers, having a traumatic obstetric experience, are more prone to developing postpartum problems. The mood changes are more marked in patients following caesarian section.

Postpartum problems are more common following the birth of the first baby and when there are very short intervals between pregnancies.

Management: It is important to know that doctors and the paramedical staff attending to such patients should be sensitive towards the appearance of psychological and behavioural changes after delivery. Fortunately, the problems show a very good response to drugs like anti-anxiety, anti-depression, and anti-psychotic drugs. These medicines have to be used on the basis of the symptomatology and clinical profile of the given case. Severe cases, that turn violent and aggressive or suicidal, may need inpatient care. Such patients require good emotional support and care.

The families of the patients should be cautious since in subsequent deliveries the risk of the re-emergence of the problems increases. It is important for women to be prepared and motivated for the delivery. Delivery is one of the most important milestones in a woman's life. So love, affection and care can make a lot of difference in coming out of the psychological and physical pain of the delivery and some of the negativity associated with it.

The author is a consultant psychiatrist and de-addiction specialist at MANAS Psychology and De-addiction Centre, TagoreNagar, Ludhiana (Ph: 472822 and 472899.)

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A great gift to man from Mother Nature
Dr R. Vatsyayan, Ayurvedacharya

AMLA is one of the greatest gifts of nature to mankind. Charak and Sushrut have almost left no disease where they haven't mentioned the use of amla in one way or the other. The famous ancient scholar of herbal medicine and applied botany, Pandit Bhavamishra, has written that amla corrects the body metabolism and is a tonic of immense value.

The wide spectrum of the actions of amla on the human body shows it as a rejuvenator of unparalleled status. Being a rich natural source of vitamin C, it raises immunity and helps us fight day-to-day wear and tear of the body. It is an excellent antipyretic, antioxidant, astringent, laxative, diuretic, aphrodisiac, antacid and haemostatic. It also acts as a booster for physiological systems of the body.

Amla is used in fever, anemia, hyperacidity, peptic ulcer and diseases of the urinary and genital tract. It is also a drug of choice in a number of other ailments such as epistaxis, dysfunctional uterine bleeding, leucorrhoea, menopausal syndrome, general emaciation, hair and eye problems, jaundice, oedema, cough and asthma. Besides all this, it is a very good general tonic.

Since time immemorial, amla continues to be used as a household remedy in a number of conditions. Here are some easy tips to gain its medicinal benefits:

Hyperacidity: In acute or chronic acidity, simply taking, twice a day, one gram of the powder of dry amla and a little sugar with milk or water gives magical relief. In more severe cases of acid peptic disease or ulcer one can add 250 mg of Kamadhudha Rasa (mukta yukta) with it. This also helps one in healing the ulcers.

Bleeding piles: Being an effective haemostatic agent, the juice of fresh amla, if taken with 250 mg of giloy satva (extract of Tinosporia cordifolia), is an effective remedy for bleeding piles and non-specific epistaxis.

Burning micturation: Taking 500 mg of turmeric powder with two or three teaspoonsfull of amla juice diluted in a glass of water proves effective in the case of burning sensation after passing urine. It also allays the stubborn and recurring infections of the urinary tract.

As a hair tonic: All traditional recipes for promoting hair growth and preventing premature greying include amla as the chief ingredient. Dried pieces of amla are soaked in water overnight and used as the last rinse while washing the hair. This filtered water is also used to wash the eyes to prevent or treat allergic conjunctivitis. Amla-enriched oils and shampoos are very popular aids for hair care.

Amalaki Rasayana: Take half a kg of dry amla powder and stir it in the fresh juice of amla fruits for 21 days. When dried, it becomes a fortified form of amla. This formulation known as Amalaki Rasayana finds mention in many ancient ayurvedic texts. It acts as a good antioxidant and also as an adjunct in many chronic and wasting diseases. As a tonic, it can be taken (half to one gm a day) with milk throughout the year.

Apart from Triphala Churna and Dhatri Loh, Chyavanprash and Brahma Rasayana are other famous and classic ayurvedic medicines which contain amla as their main ingredient. Amla also serves well in various other forms as murabba, pickle, jam and chutney. (Next week: Corriander: from kitchen shelf to medicine table.)

Dr R. Vatsyayan is an ayurvedic consultant based at the Sanjivani Ayurvedic Centre, Ludhiana. (Phones: 423500 and 431500; E-mail- sanjivni@satyam.net.in).

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Food allergies and you

Food allergies pose very serious health-related problems in a relatively small section of the population, says Gauri V. Singh, a Jalandhar-based dietician. The majority of the people are not aware of these and their ill-effects particularly when these are caused by a major food group, making meal planning and balancing nutrition a daunting task even for nutrition experts and educated persons.

(Details next week)

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