|HEALTH TRIBUNE||Wednesday, April 23, 2003, Chandigarh, India|
Donít ignore pain in the legs
Managing insomnia successfully
AYURVEDA & YOU
Donít ignore pain in the legs
Many people who find walking painful may believe that it is related to arthritis or is a natural effect of aging. Quite often it is the result of the blockage of the arteries of the leg due to atherosclerosis called peripheral vascular disease (PVD). Atherosclerosis or hardening of the arteries is a gradual process in which cholesterol and scar tissue build up forming a substance called "plaque" that clogs the blood vessels . There may or may not be a superimposed blood clot also. It commonly affects men and women over 50 who often also suffer from heart disease, diabetes, high cholesterol and high blood pressure, and are smokers.
PVD affects about one in 20 people over the age of 50 (about 10 million in the USA). More than half of them have symptoms but initially many dismiss these as related to the normal aging process while only half of those with symptoms get proper diagnosis and treatment. People with early PVD will be asymptomatic at rest, but on walking they will get a crampy pain in their calf muscles , thighs or buttocks. This is known as intermittent claudication. It is usually severe enough to make the person stop walking leading to relief from the pain.
As the blockage progresses the claudication distance reduces so that even a short walk will precipitate the pain. With very severe blockage, the patients may get rest pain in their toes and feet. This pain is relieved when the foot is kept lower than the rest of the body. As this may not always be possible, the pain may disrupt sleep and normal lifestyle. Other symptoms may include numbness, tingling, weakness, burning or aching in the leg. There may be a cooling or colour change along with the shininess of the skin of the legs or feet or loss of hair on the legs. Rarely, there may be no obvious early symptoms. This was seen in an otherwise very active women golfer, who ended up with an amputation as her first symptom was gangrene. With the progression of the disease, there may be ulceration, bluish discoloration and even blackening of the toes or foot (gangrene).
The severity of the blockage can be assessed by a diligent history taking a good clinical examination followed by non-invasive tests. The most common test for PVD is the measurement of blood pressure with a special ultrasound stethoscope and machine at the ankle and its comparison with that at the elbow ó the ankle-brachial index (ABI) . This is a painless and fairly sensitive test which gives some idea about the severity of the disease. It also is useful in following the patientís progress after medication or surgery.
The next test is a duplex ultrasound study of the arteries . In this test an ultrasound wave is used to measure the size of the artery and the quantity of flow in it. For an accurate anatomical imaging magnetic resonance angiography (MRA) a computed tomography (CT) angiography or a peripheral angiogram is performed. In this a radio-opaque dye is injected into the artery and a dynamic X-ray taken to see the flow of the dye and the exact degree and location of the blocks.
If the block is discrete it may be opened with a balloon. If the cause is an acute blood clot it may respond to medicines which dissolve the clot. This means the use of thrombolytics (clot busters) or a minor surgical procedure Ė embolectomy Ė to remove the clot. However, the block is usually of a fibro-atheromatous plaque at the level of the knee in the popliteal artery and may be long and totally choking the vessel. In such patients a peripheral vascular bypass surgery is required . Here a conduit is used to bypass the block by attaching it proximally to a normal artery and distally to the artery beyond the block. In cases where the artery is totally choked and with no lumen, the plaque of cholesterol may need to be removed. This is known as endarterectomy. The conduit used to bypass the block is usually a piece of the patientís own saphenous (leg) vein. However, the results of the vein graft are not optimal as the vein can get kinked when crossing the knee joint and can also develop blocks by cholesterol over time. A useful modification here is to use the patientís own radial artery (artery of the hand) and use it for the area where the knee joint is to be crossed.
The radial artery can be used in the majority of people as we have another big artery in the hand (the ulnar artery) which takes over and a simple test is done to confirm this. The radial artery has been used as a graft during heart bypass surgeries for over seven years now with no compromise to the function of the hand. The procedure is called a "femoro- popliteal bypass using the radial artery". This procedure was developed by the author and has found a place in the Limca Book of World records. The procedure has been demonstrated at various conferences and workshops in India and abroad and is being used successfully by surgeons all over the world.
If a good quality vein and radial artery is not available, eg if it has already been used in a previous heart bypass operation, then as a last resort a synthetic tube of Gore Tex can be used. However, this is fairly expensive and the results are not as good as with the patientís own artery or vein. The optimal procedure depends on a number of factors, including the patientís overall health, the location of the affected artery and the size and cause of the blockage.
Any patient with PVD must be checked for the presence of vascular disease in the other organs of the body, especially the heart and the brain, as the basic disease process ó atherosclerosis ó is a generalised one. Quite often these patients have severe heart disease also in the form of blockage of the heart arteries which might have been overlooked as the patient was not performing much physical activity due to his PVD. Such patients may require a combined procedure to clear both the heart and leg arteries. The risk of stroke is also higher in a patient with PVD.
How can PVD be prevented?
In the early stages the use of dietary modifications ó basically, a low fat vegetarian diet , weight reduction (if overweight), graded exercise, along with the use of blood thinners, vessel dilators and cholesterol reducing drugs (statins) ó helps to prevent the progression of the blockage and encourages the development of collaterals. Regular exercise is the most consistently effective treatment for PVD. Exercise programmes include simple walking regimens, leg exercises and treadmill exercises under expert supervision three or four times a week.
Avoidance of smoking and all other former of tobacco use is mandatory if a permanent solution is to be got.
In diabetes the risk of narrowing of the arteries by a build-up of fat and cholesterol (atherosclerosis) is much more than in non-diabetics. The patient must inspect his feet between toes and pressure areas using a mirror regularly. He must wash his feet daily with soap and lukewarm water. He must avoid tight-fitting shoes and very hot water, hot water bottles or chemicals (to treat corns) on the feet.
Thus, simple measures should be taken from an early stage in life to prevent a crippling and even life-threatening condition from developing.
Managing insomnia successfully
Insomnia is a common ailment. During uninterrupted sleep, a young adult drifts through four progressively deeper stages of non-rapid eye-movement associated with slow wave activity on the electro-encephalogram (EEG or brain wave tracing). After about 90 minutes the first episode of rapid eye-movement sleep (REM sleep) is entered, when muscle relaxation takes place and dreaming occurs.
Sleep and wakefulness are goverened by two systems: an arousal system and a sleep system. For sleep to occur, the arousal system must subside and allow sleep to take over. Insomniacs may have an overactive arousal system, heightened by tension or such other factors.
* Insomnia may be triggered by body sickness like pains, breathing disorders, some kidney and thyroid problems, restless legs or leg jerks, diabetes, an enlarged prostate during old age and incipient heart failure.
* The natural process of aging with its diminished sleep efficiency.
* Disturbing problems at the work place or at home or the worry of an upcoming test.
* A digestive tract rumbling from too little or too much food or cold extremities and exertion too close to bed-time.
* Addiction to alcohol, intoxicants or drugs, coffee, tea, etc.
* Factors such as bereavement, divorce, etc, resulting in the fear of the future and the sense of helplessness and hopelessness. There is nervous breakdown and negative conditioning when fear of insomnia can become its own self-fulfilling prophecy.
* Irregular sleeping and waking time, as in the case of air-hostesses and those who work in shifts, disturb the sleep mechanism.
Homoeopathic treatment of insomnia affords cure through a judicious prescription of medicines based on the characteristic symptoms of individual patients. But it is always better to consult an experienced physician.
* Resort to a natural diet of fresh fruit and vegetables. Avoid consuming heavily spiced food, meat, etc. A cup of hot water or a tumbler of hot milk before going to bed is useful.
* Ensure regular sleeping and waking time. This sets the bodyís sleep/ wake clock on a definite pattern.
* Adopt relaxing activity before going to bed. This includes reading a good book, watching a pleasant episode on TV or discussing pleasantries with family members.
* Brisk walking and a light exercise of the neck and back muscles are good for sleep.
* Take a hot bath before retiring.
* A correct, positive attitude towards life along with equanimity proves to be a good tonic for a full nightís sleep.
* Get rid of all the worries. Write down worries and what you will do about them the next day. Stop thinking about anything but sleep while getting into bed.
* If you wake up in the night, relax in the bed and let sleep return. Try reading a good book, listening to music or pursuing some quiet activity until you are sleepy again.
* Tranquilisers to induce sleep should be avoided since they are habit-forming.
In a broader context, arthritis refers to various types of inflammation of the joints. But when we talk about rheumatoid arthritis (RA), it is the one having the potential to cause serious disorders in the joints besides affecting other systems of the body. Though the earlier ayurvedic literature gives only a passing reference of this disease, it was the later-day treatise like the Madhavanidanam which, while discussing it in detail, named it as "amavata". Forming a significant part of medical practice in India and abroad, rheumatoid arthritis continues to be one of the most complex diseases affecting mankind.
Whereas the modern medicine overwhelmingly, if not conclusively, finds rheumatoid arthritis to be an auto-immune disorder, ayurveda believes "ama" to be its main causative factor. The word "ama" in ayurvedic parlance denotes unripe, stagnated or partially digested food which is unwholesome for the body. Ayurveda considers weak digestive fire (mandagni) and wrong diet as a major causative factor of many diseases, and "ama" as a general term includes dietary impurities and toxins produced as a result of faulty digestion. Nowadays the consumption of unsuitable and incompatible food substances is also believed to be an important factor for RA in genetically susceptible individuals.
Apart from the dietary reasons, ayurveda also refers to some other factors which in their own way are responsible for the formation of "ama" in the body. They include infections and swelling, lack of exercise or opting for over-exercise especially after taking heavy and oily food, suppression of natural body urges, living in damp and squalid environments and confronting severe psychological upheavals like stress, anxiety and depression. Some of these known and many unknown reasons help to generate "ama".
Ayurvedic texts discuss certain signs and symptoms which are known to appear before the actual occurrence of rheumatoid arthritis. These mild premonitory signs like the loss of appetite, lethargy, malaise, body ache and weakness of the limbs usually pass unnoticed. Actually this is the stage when "ama" has not settled down in the joints. The fully acute or the flare-up phase of the disease begins with severe and excruciating pain in the small and big joints of the body accompanied by their swelling and stiffness. The most common joints to be affected are of fingers of hands which may give spindle-like appearance. More often, this pain and stiffness follow a symmetrical pattern which is more pronounced in the morning. It also lasts a brief period of rest during the daytime.
Though symptoms of rheumatoid arthritis differ from person to person, depending upon the intervention of "vata", "pitta" and "kapha" separately or in combination with each other, the disease turns into a complex one. Along with severe pain and swelling of the joints, which the ancient experts have likened to that of many scorpion bites, the patient may complain of feverishness, lethargy, general rundown, lack of drive and loss of appetite. These symptoms get aggravated due to many other reasons like cloudy weather or rainy season, the onset of winter, constipation and mental stress.
Snoring linked to headaches
WASHINGTON: Are you suffering from splitting headaches very often? Well, snoring could be the culprit. A new study, published in Neurology, the scientific journal of the American Academy of Neurology, has found a link between snoring and chronic daily headaches.
The researchers examined the snoring habits of people with chronic daily headaches and people with occasional headaches. People with chronic daily headaches suffered at least 15 headaches per month. Occasional headache was defined as two to 104 headaches per year. ANI
New laser eye surgery
WASHINGTON: A joint team of physicists and ophthalmologists at the University of Michigan has developed a new bladeless laser surgical method, which may help reduce complications and improve overall results of the popular Lasik eye surgery.
According to a recent study of 208 procedures in 108 patients, femtosecond lasers can make clean, high-precision cuts in the human cornea that offer superior reliability and fewer complications than cuts made with mechanical devices now used in most LASIK procedures. ANI
WASHINGTON: Cancer cells can trigger changes in their immediate surroundings that promote self-preservation and resistance to chemotherapy.
Collagen VI, a protein produced by ovarian cancer cells, appears to help these cells alter their microenvironment so that they are more resistant to chemotherapeutic drugs commonly used to treat the disease, according to investigators at the National Institute on Aging (NIA) Intramural Research Program. ANI