|HEALTH TRIBUNE||Wednesday, March 26, 2003, Chandigarh, India|
Some tips for epilepsy management
Stress increases risk of fatal stroke
AYURVEDA AND YOU
Natural bypass called ‘enhanced external
DESPITE the increasing success of conventional medical therapeutic approaches and continued development and improvement of mechanical revascularisation approaches, a significant number of angina and coronary heart disease patients cannot be managed successfully. Also a substantial proportion of these patients do not achieve complete revascularisation even after successful angioplasty/bypass surgery and continue to experience exertional angina or ischemia despite medication. Apart from these factors, the traditional procedures — bypass surgery (CABG) and angioplasty (PTCA) — are expensive and involve a certain degree of risk in the form of iatrogenic morbidity and mortality.
Besides, unfortunately, treatment to clear blockages often results in cell regrowth that can obstruct vessels again. This condition, called re-stenosis, occurs after about 20 to 30 per cent of PTCA procedures. Repeat procedures are non uncommon and re-stenosis rates after repeat PTCA are as high as 50 per cent. With bypass surgery, repeat procedures are sometimes necessary. Six to 10 per cent of CABG procedures are now re-operations. However, re-operative mortality rates are two to three times of those of initial procedure and range from 2 to 3 per cent for second operations and up to 15 per cent for third and subsequent operations. Patients undergoing repeat procedures generally have more advanced coronary artery disease rendering the re-vascularisation process less effective.
EECP or Enhanced External Counter Pulsation is a new form of therapy that may relieve or eliminate angina by increasing blood flow to the heart. This therapy has been approved worldwide by the health authorities, including the Food and Drug Administration, USA, the NHS, England, and of course, China where it is widely practised.
The patient lies down on a padded treatment table. The calves, thighs and hips are tied with cuffs which inflate in a sequential manner from calves upwards, thus "milking" and blood in the reverse direction precisely timed in milliseconds with a sophisticated computer, which increase the blood flow to the heart when it is relaxing and when the blood flow to the coronary arteries is at its peak. The increased blood flow pressure during this phase of the cardiac cycle causes dilatation of the coronary blood vessels, opens and expands the networks of the dormant small blood vessels. These channels can create natural bypasses around the clogged arteries boosting blood supply to the oxygen deprived areas of the heart. The permanent opening of these channels may account for the long lasting benefits of EECP therapy.
Typically, EECP is done as a series of 35 sessions, each lasting one hour. The patient is investigated through standard tests such as treadmill test (TMT), echocardiogram and stress thallium before and after the completion of the sessions to verify the improvement in the status of the patient. It is important to note here that for this treatment, coronary angiogram is not important as with it only the degree of blockage of the main coronary arteries and their branches can be assessed, and it is not suitable for visualising the minute vessels, arterioles and capillaries or for assessing the overall blood flow to a particular region of the heart which is actually more important.
Clinical studies over the past few years have shown that about 75 per cent of the patients treated with a single course of EECP experience a reduction in angina frequency and intensity, and are able to return to a more active lifestyle. The need for anti-anginal medication is reduced or eliminated. The ejection fraction (measure of heart function) shows improvement and so do the TMT and stress thallium scans.
Unlike procedures such as bypass surgery and balloon angioplasty, EECP treatment is administered in outpatient sessions, carries little or no risk and is relatively comfortable and inexpensive.
At present, this treatment is being offered to those patients who have chronic stable angina; who do not receive adequate relief from angina by taking nitrates; who do not qualify as candidates for invasive procedures; who have exhausted invasive treatments without lasting relief of symptoms; who are unwilling to undergo surgery or angioplasty or who want to explore alternatives to bypass surgery or angioplasty. Indeed, it is a viable alternative for those coronary heart disease patients who are not candidates for invasive or surgical interventions by the physician’s or their own choice.
Some tips for epilepsy management
EPILEPSY is a common clinical problem. It is popularly called "mirgi". This illness comes in the form of attacks, which appear out of the blue. One gets a feeling that something is going to happen with him and starts with jerky movements of one part of the body or whole of the body and may become unconscious and fall down. During such attacks one may bite one’s tongue, cheeks or lips and may start bleeding. At times, one may pass stool and urine soiling one’s clothes. Frothing of the mouth is a common accompanying feature. Some epileptic patients don’t get jerks and may become unconscious only. Others may have only jerks without losing consciousness. There are many other forms of epilepsy also.
I have been regularly treating epileptic patients for more than 25 years. Here are some important observations for the benefit of patients and their families:
1. Epilepsy is often related to a lot of myths, and a veil of ignorance covers the disease. There are many families, which still consider that the illness results because of supernatural forces and "jadu-tonas" done by their enemies. They keep on shuttling from one non-medical agency to another and get only frustration at the end. It is important to realise that epilepsy is a definite disease, for which there is very specific and highly effective treatment.
2. Treatment of epilepsy is adequately taught to all medical graduates. They can handle most cases in their clinical practice. But a small percentage of these patients need specialised help and guidance.
3. Drug therapy is the main treatment of epilepsy. A very small percentage may need surgical treatment. In most cases drug treatment alone is enough.
4. Before the drug treatment is started, patients are subjected to blood tests, x-ray of the skull, E.E.G, CT scan, MRI of the brain, etc (depending upon the case, but your doctor is the best judge). Blood tests and the EEG test may have to be repeated at periodical intervals.
5. The duration of the treatment varies from case to case. As we know, all diabetics are not the same. Similarly, all epileptics do not have similar illness. Patients may have different underlying cause and the pathology of epilepsy. In some cases, one may not find any reason for epilepsy. Some patients may completely recover with one-year treatment only. Others may need treatment for three to five years. A few cases may need life-long treatment.
6. It is a commonly held notion that there is a fixed three-year treatment for epilepsy. It should be very clear that there is nothing like a three-year treatment regimen. There are a number factors like the nature of epilepsy, the frequency of attacks, the response to drug treatment, the family history of epilepsy, the underlying pathology in the brain and the tendency for relapse which may decide the duration. It is a common experience that sometimes those patients who feel well on drug treatment for even more than five years relapse following drug withdrawal.
7. Anti-epileptic drugs should never be stopped without medical advice. Under the wrong perception that the treatment has to be given for a fixed period only, many family members abruptly stop the medicine. Sudden stoppage of the medicine may lead to a condition called status epilepticus, where a patient starts getting a repeated number of jerks without regaining consciousness.
8. Once epileptic attacks are controlled with drug treatment, one can resume normal activity. About driving and swimming one should take advice from the attending doctor.
9. Epileptics should avoid watching TV for prolonged hours. Watching TV for long periods is known to precipitate epileptic fits.
10. Sleep deprivation in the night during social or religious functions or otherwise may also precipitate an attack.
11. Drug treatment has to be taken on a daily basis. No dose should be missed.
12. Marriage is no solution for the disease. Many families erroneously believe that marriage cures epilepsy. Under the false belief that marriage will act as a panacea for the epilepsy, many families abruptly discontinue the treatment of their epileptic daughters a few days before marriage, and once the fits relapse, boy’s parents are completely caught unawares.
13. Some people wrongly believe that epilepsy is a contagious illness and avoid mixing up with them. This is absolutely incorrect.
Epilepsy is like any other disease. There is nothing supernatural about it, and one should take the maximum benefit of the available treatment.
Stress increases risk of fatal stroke
Danish researchers also found that people who said they felt stress on a weekly basis also had a significant increased risk of a fatal stroke compared to those in the least stressed groups. The link could be due to stressed people having other cardiovascular risk factors, such as being smokers, doing less exercise, being heavy drinkers and having high blood pressure. There was no significant effect of stress on non-fatal strokes, a report in BBC said.
Researchers from the Department of
Neurology at Bispebjerg Hospital and the Institute of Preventive
Medicine in Copenhagen, Denmark, used data from the Copenhagen City
Heart Study on 5,600 men and 6,970 women from 1981 to 1983. People
were asked how often they felt stressed and how stressed they felt.
Stress was defined as the sensation of tension, nervousness,
impatience, anxiety or sleeplessness. People were followed for 13
years, the report added. In that period, 929 had a first stroke, 22
per cent of which were fatal within 28 days. Of the 716 people who
reported high stress, 59 had strokes, 18 of which were fatal. ANI
AYURVEDA AND YOU
OILY, sharp, hot, light, fleshy-smelling, spreading and liquid; that is how pitta, the second body humor, has been described in ayurveda. A combination of fire and water elements, it controls all types of energy in the body and mind. An array of complex physiological functions like digestion, metabolism and hormonal system also fall under the realm of pitta. Besides regulating the normal temperature of the body, "pitta" helps in blood formation and generates natural urges like hunger and thirst. It also provides complexion to skin, maintains vision and supports mental phenomena like intellectual comprehension, conviction, courage and valour.
"Pitta prakriti" denotes a person overwhelmingly reflecting the qualities of "pitta" humor. They are medium-built persons with moderately developed physique and have warm and moist skin which is prone to moles and freckles. "Pitta" persons usually have moderate, fine and soft hair but also have a tendency to get premature graying of them or even becoming bald. Their appetite is strong and sharp whereas profuse sweating and a strong body odor is their another characteristic feature. Usually, their speech is argumentative and convincing.
With a sharp and clear memory, "pitta" people are courageous, competitive, intelligent, penetrating and critical. They easily tend towards fiery emotions like irritability and anger but are also articulate, self-righteous and possess a strong will helping to make them good warriors, guides and leaders. Persons with "pitta" dominant character more often choose power, fame and influence as their aim in life. Most of the time they are helpful to friends but unforgiving to opponents. Ayurveda believes that due to "rajasic guna" these qualities can incline towards aggressiveness, pride and impulsiveness whereas if "tamasic guna" supercedes, it can pervert them to the negative realm of destruction, hate, vindictiveness, crime and violence.
Persons with dominant "pitta" qualities are usually prone to the diseases reflecting typical features of "pitta" as a body humor. With an excessive urge for food and thirst, they are susceptible to digestive upsets like hyperacidity and diarhoea. They feel very uncomfortable in hot and humid climate and are more prone to get diseases like rashes, boils, acne, pigmentation disorders and other problems associated with skin. Burning micturation, raised uric acid, stomatitis, ulcers, hemorrhagic tendencies and metabolic disorders are some of the other diseases which more often affect them. "Pitta" women tend to get profuse menstruation, which may be accompanied by loose bowels and mild cramps.
While discussing dietary planning and lifestyle guidelines, ayurveda advises that "pitta" persons should always choose food items which are cool and soothing in effect. Eatables with more of sweet, bitter and astringent tastes rather than ones having sour, salty and pungent taste should make a place in their diet. They should also avoid too much of fried, over-cooked and spicy food. Rice, wheat and barley among the grains, pomegranate, mango, melons, fresh coconut juice and apple from among the fruits and cardamom, mint and coriander are the spices best suited for "pitta" people. They are also advised to take less of red meat, dry fruits and nuts and should also cut the consumption of tea, coffee and alcohol.
The ideal environment for a "pitta" individual is cool and dry. Early morning exercise, swimming and taking cold shower help them to remain fresh . Excessive intake of water is their necessity and to satiate strong appetite, "pitta" people are advised to eat at regular intervals. Sandal, rose and khus are some of the sharbats which have a cooling and cleansing effect on their system. Since anger and animosity are the main negative psychological traits of a "pitta" personality, such people are best advised to adopt poise and peace in their temperament.
The writer is a senior ayurvedic
consultant based at Ludhiana. Phones - 2423500, 2431500. E mail -