HEALTH & FITNESS

Senior citizens’ lifestyle problems
Dr (Brig retd) M.L. Kataria

There was an alarming press report referring to the WHO some time ago that lifestyle ailments were likely to cost India more than $ 2.5 billion in the coming couple of decades. What are these ailments and which age groups are vulnerable to them?

Knee arthritis — myths and realities
Dr Ravinder Chadha

Patients suffering from knee arthritis are always in a fix regarding the treatment (medication, aerobic activity, exercises, etc) to be undertaken or undergoing knee replacement surgery. Knee arthritis is one of the most common forms of arthritis in our country.

Teething troubles: The best time to brush
Dr H.S. Chawla

“When should I brush?” is a common query directed at me. Patients, friends and acquaintances want to know whether they should brush in the morning, evening or at night and, secondly, before or after meals.

Health Notes

  • Now a simple test to detect kids with swallowing disorder

  • Key protein linked to pancreatic cancer growth identified

  • Vascular drug improves learning and memory in rats

 

 

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Senior citizens’ lifestyle problems
Dr (Brig retd) M.L. Kataria

There was an alarming press report referring to the WHO some time ago that lifestyle ailments were likely to cost India more than $ 2.5 billion in the coming couple of decades. What are these ailments and which age groups are vulnerable to them?

Here are some health-related questions often asked by senior citizens:

Question: I am 65 and a diabetic. What is the usual life-span for a diabetic and the recommended lifestyle?

Answer: With controlled blood sugar levels and a regulated lifestyle, I know diabetics at 85, 90 and above.

Q: What are the acceptable blood sugar levels?

A: The fasting blood sugar level should be around 100 mgm% and the post-paradial levels 11/2 to 2 hrs after prescribed meal should not exceed 140 mgm

Q: How to maintain these blood sugar levels?

A: In a normal person insulin secreted by the pancreas, a massive gland in the abdomen, controls the blood sugar levels. There is an autonomous reciprocity between the quantum of carbohydrate diet ingested and the insulin secretion. A diabetic is an insulinaenic. Therefore, the pancreatic gland has to be flogged by drugs to produce more insulin to cope with the metabolism of carbohydrates to yield energy for the body.

Q: For general knowledge, could you please mention some of these drugs?

A: There is a plethora of drugs in the market to control diabetes. Commonly used drugs are Metformins, Glybendarnides, Gliclazides and Pyciglitazones prescribed singly or in combination, besides the injectable insulin. As over-dose may lead to fatal hypoglycaemia, these drugs should be used under medical advice.

Q: Can diabetes be controlled without drugs?

A: Yes, mild diabetics can maintain blood sugar levels within normal limits by diet control and regular exercise. A low carbohydrate diet and exercise can reduce the drug dosage even in an advanced diabetic. Alcohol seems to worsen the blood sugar levels.

Q: In brief, what should be a diabetic’s lifestyle?

A: Low carbohydrate diet, preferably vegetarian, with a lot of fibre, regular exercise, almost abstinence, with minimum drug dosage and a monthly/quarterly blood sugar monitoring. A diabetic should have his own Glucometer.

Q: I am 70 plus, a case of high blood pressure, on Indral 25 mg. daily for the last 10 years. Many drugs for blood pressure have flooded the market. I am interested in knowing about them. Should I give up Indral and change over to any of the latest drugs?

A: All the drugs for BP belong to the basic groups of beta-blockers, calcium channel blockers, angiotensin, converting enzyme blockers, vasodialators, diuretics, etc. Multinational pharmaceutical companies have given them various names. These are used singly or in combination by doctors to control blood pressure. If Indral has so far kept your BP under control without any side-effect, it should not be changed.

Q: What are the normal limits of BP?

A: Blood pressure is not the same during 24 hours. There are diurnal variations. As an average, it should be around 120/80 (mmof mercury) preferably 110.70, but not more than 140/90, at any time.

Q: What is the recommended lifestyle for a person with confirmed hypertension?

A: A low salt and fat diet, with regular exercise, normal limits of weight, a bi-annual check on lipidogram, renal function testes, an ECG and, above all, a stress-free equanimity of an easy-going mind.

Q: I am 80 and cannot enjoy a dream-free sleep. I often wake up at 2 or 3 a.m. and have to take a half or full tablet of diazopan. What should be my lifestyle to enjoy dream-free sound sleep and no diazopan?

A: Most worldy-wise elderly persons have an anxiety neurosis due to domestic, financial social and physical problems, resulting in insomnia or sleeplessness. Enlarged prostate, osteoporosis, multi-joint pains, high BP, muscular convulsions and many more must be isolated and treated. A lifestyle of gradual withdrawal and detachment from financial ambitions, social and domestic obligations should ease the mind. Diazopan is too strong a sedative. All sleeping pills, as a rule, should be avoided. They give addiction and have side-effects over the long run. If required occasionally, Alprazolenes in fractional doses of 0.25 to 0.50 mgm may be taken for insomnia, but not as a regular habit.


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Knee arthritis — myths and realities
Dr Ravinder Chadha

Patients suffering from knee arthritis are always in a fix regarding the treatment (medication, aerobic activity, exercises, etc) to be undertaken or undergoing knee replacement surgery. Knee arthritis is one of the most common forms of arthritis in our country.

The causes are varied vis-a-vis degeneration, injury, rheumatoid arthritis, obesity, genetic, etc. Most common symptom is pain experienced on the inner side of the knee. To avoid pain while walking, the patient tries to move the knees outwards resulting in bow-leg deformity.

Osteoarthritis can be effectively treated using various modalities, including activity modification, anti-inflammation medication, knee support, injections and, as a last resort, total knee replacement.

Various myths, which are widely believed, need to be reassessed.

l Bed rest helps knee arthritis as it decreases the load on the knee. The truth, on the contrary, is prolonged bed rest facilitates degeneration and also leads to an increase in weight. In fact, such individuals are truly benefited by undertaking aerobic activity — walking, cycling, etc. Walking (preferably on a soft surface) not only slows the progression of arthritis but also helps relieve pain. However, such patients should avoid high-impact sports, kneeling, squatting, sitting on low chair, etc.

l Obesity does not affect arthritis: The fact is one kilogram of excess weight exerts 3-5 per cent extra load on the knee joint. Obese individuals should be encouraged to lose weight so as to relieve load on the knees.

l Exercise renders arthritis more painful: The truth is that exercises undertaken for the muscles which control the knee joint, especially quadriceps muscles (in front of the thigh), if done effectively, reduce pain considerably and enhance the range of motion too.

l Uncertain role of drugs like glucosamine, chondroitin sulfate and diacerein: These medications, if taken regularly, may, in fact reduce pain and inflammation and regenerate cartilage. These are beneficial in the initial stages of arthritis. If no results are obtained within three months these medications should be stopped.

l Cortisone injections are potentially harmful: These injections are usually indicated in cases of acute pain and when there is no relief through medication. Steroids act as anti-inflammatory drugs, reducing pain although they are not curative in action. However, they should be restricted to a maximum of three a year and with a gap of three months between two injections.

l Pain medication should be avoided: These medications, when used in limit, facilitate pain relief and stiffness. However, long-term indiscriminate use can cause gastric ulcer and also affect kidneys, etc. Judicious, intermittent use can avoid long term complications.

l Cracking sounds imply arthritis: Not really so. Cracking sounds are due to the gliding of bones on one another. Cracking sounds without pain or swelling carry little significance.

l Hyaluronic acid injections are not of much use: The fact is that these injections are extremely effective in early arthritis and prior bone-to-bone contact. The damaged cartilage lacks the ability to produce the lubricating fluid rendering the joint dry, stiff and painful. The hyaluronic acid injection alleviates the symptoms of pain and stiffness by cushioning of the knee joints.

l Sports persons/ defence personnel are more prone to arthritis: The truth is that over-usage can cause joint injury and may make the joint more prone to arthritis. However, defence personnel and sports persons undertaking a high level of aerobic activity may not be easy candidates for knee arthritis as the muscles and ligaments surrounding the knees are strong enough to absorb the shock.

l Knee replacement surgery is the only option for arthritis: The fact is that knee replacement surgery is the last resort. This should be undertaken when symptoms are not relieved by medication, exercises, etc, and pain/ stiffness is persistent at all times.

The writer runs a pain management clinic in Chandigarh. e-mail-chadha_r 2003@yahoo.co.in. 


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Teething troubles: The best time to brush
Dr H.S. Chawla

“When should I brush?” is a common query directed at me. Patients, friends and acquaintances want to know whether they should brush in the morning, evening or at night and, secondly, before or after meals.

Generally, one brushes to remove food particles from the teeth. Some of you brush to keep the teeth white and sparkling — which contributes immensely to an overall smart appearance — and others to avoid bad breath. Children brush because their parents tell them to.

The common dental diseases — dental caries and gum diseases — are caused by bacteria in the mouth. Bacteria live in every mouth, on the teeth and the upper surface of the tongue. Bacterial aggregation on teeth is called dental plaque. The difference between a disease-free mouth and one with disease is that the former has lower concentration of bacteria whereas the latter has more.

Bacterial action upon food produces acid. The acid is formed almost immediately upon eating. The acidity of the dental plaque increases (in scientific terminology, the pH of dental plaque decreases). Acid erodes tooth enamel (the outer hard layer of the tooth). Many attacks like this on enamel produce cavities in the teeth.

Therefore, the main aim of cleaning your teeth should be to remove dental plaque and reduce bacterial concentration. This keeps teeth free from cavities and gum-disease. When this happens, all other objectives of cleaning the teeth are automatically achieved. Here are various options regarding timing:

Brushing immediately after meals

There are many nooks and corners in the mouth where bacteria can live and multiply. Because of the tight contact between one tooth and the other, it is practically impossible to get rid of all these bacteria. The acid forms and starts eroding tooth enamel almost immediately upon eating. It takes about 30 minutes for the acidity of the plaque to return to normal.

Thus, brushing right after eating is not at all advised, as the acid produced has already begun the process of eroding enamel. If you brush promptly after a meal, you rub off part of the dissolved minerals of the enamel.

When you brush after meals, you should wait for at least an hour to give time for the acidity of plaque to decrease. It will set the environment for re-mineralisation.

Brushing before meals

Most people normally brush their teeth in the morning before breakfast. That is beneficial, as you have reduced the number of bacteria before exposing them to food. The amount of acid production is expected to be less, and so would be the damage to the teeth.

You get an additional benefit if you use fluoride tooth paste, as the fluoride gets incorporated into the enamel and makes it strong and resistant to the effect of acid. (Fluoride converts the hydroxy-apatite of enamel to calcium fluor-apatite).

Brushing before dinner

Similarly, based on the above concept, brushing before dinner, indeed, is more beneficial than post-dinner brushing. However, it is essential to get rid of the food particles sticking in the oral cavity after dinner. To achieve this, inter-dental cleaning along with a little bit of brushing is also needed before retiring to sleep. Otherwise, thanks to the decrease of salivary secretions while we sleep, and the mouth remaining closed for a prolonged period, an ideal environment is created for bacteria to multiply.

Brushing at any time of the day

Thorough brushing at any time of the day is more beneficial than half-hearted brushing at selected times. It involves brushing without tooth paste for 5-7 minutes and spitting out each time as the mouth becomes filled with spit, followed by brushing with tooth paste. Interdental cleaning with dental floss (or with inter-dental brush) is then carried out. Brush once again with tooth paste.

Thorough brushing whenever you have the time is preferred over half-hearted brushing before or after meals. If you do not spend time on brushing, you are just removing bacteria from one segment of your teeth and re-settling them on another. Brushing before meals is more beneficial than after meals. Brushing immediately after meals should be avoided.

The writer is Head, Dental Department, The Apollo Clinic, Chandigarh, and Permanent Visiting Professor, The University of Leeds, UK. Email: chawlahs@gmail.com


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Health Notes
Now a simple test to detect kids with swallowing disorder

Washington: American scientists say that a simple screening test to swallow three ounces of water can help determine whether or not a child has the swallowing disorder oropharyngeal dysphagia.

Oropharyngeal dysphagia is caused by abnormalities of muscles, nerves, or structures of the oral cavity, pharynx, and upper esophageal sphincter.

Writing in Otolaryngology - Head and Neck Surgery, the researchers revealed that their study issued a three-part challenge to 56 children with suspected oropharyngeal dysphagia. — ANI

Key protein linked to pancreatic cancer growth identified

Washington: Researchers at Stanford University School of Medicine have identified a protein that plays an important role in pancreatic cancer growth.

In a study on mice, they found that blocking the expression of the protein connective tissue growth factor (CTGF), also known as CCN2, slowed or prevented tumour growth and made cultured cancer cells vulnerable to the conditions of low oxygen that occur in solid tumours.

“This research clearly shows that inhibiting the protein inhibits the tumour’s ability to grow,” said cancer biologist Amato Giaccia.— ANI

Vascular drug improves learning and memory in rats

Washington: Arizona researchers have revealed that a drug, which is used to treat vascular problems in brain, can effectively improve learning and memory.

The drug known as Fasudil, which has been used for more than 10 years to treat vascular problems in the brain, often helping with recovery from stroke, has been found to improve cognition in middle age rats.

However, further studies are required to prove its efficacy in humans. — ANI


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