Wednesday, February 11, 2009

CATARACT SURGERY


Cataract is an opacity in the lens of the eye. The normal lens is transparent and allows light to reach the retina. When it becomes opaque (cataract) light does no reach the retina and the patient is unable to see clearly.

Till date there is no proven cure of cataract. The only available treatment is surgery. And so the method and technique of surgery is of importance. Earlier surgery was done only when the cataract was mature and vision was impaired to the extent that daily activities were hampered. But today no one waits so long. Cataract surgery is done electively. This is possible because of the new techniques and developments in surgery
Past techniques

There was a time when cataract was removed through a 12mm large opening. Now with the latest technology we remove the lens through a small opening of 2.8mm with the help of ultrasonic aspiration technique called phacoemulsification. A foldable intraocular lens is then implanted in the eye.

The success rate is close to 99.5 per cent. The present options in phaco surgery are Standard phaco or the first generation phaco surgery using simpler machines and an incision size of 3.2 mm . This was first conducted in late 1970s. In Cold phaco or the second generation surgery, the incision size reduced to 2.8mm but it was much safer since the amount of heat being delivered to the eye was reduced significantly thus reducing the trauma.

Now there is Microincisional (Mini Keyhole) Cataract Surgery. Introduced by Bausch and Lomb this is a revolutionary technology that enables cataract surgery to be done through the a 1.6 mm to 1.8 mm incision.

A new intraocular lens has been devised which can be inserted through this small incision and gets unfolded inside the eye. This is called a micro intraocular lens (MIL). The advantages of this are quicker surgery (sutureless); faster recovery; minimal post–operative restrictions; better vision quality and astigmatism neutral.

After effects

Most people do not need to wear glasses for distance vision but will need them for reading. This can be avoided if a multi-focal lens is placed in the eye. Then glasses may not be required for most work. A few may require glasses to refine their vision.

About five per cent of people get a thickening of the posterior capsule after the surgery, which is called after cataract. This can be easily dealt with by a laser procedure done as an out patient procedure.

The authors are Chennai-based Ophthalmologists.

Causes

Ageing, UV light, Deficiency in protein and vitamins, Intrauterine Infections leading to congenital cataract, Developmental cataract seen in adolescents, Injury and Systemic factors like diabetes mellitus.

Symptoms

Blurring of images, Double images, Image distortion

FOR HEALTHY HEART


One Sunday morning a 24-year-old executive went to a fitness centre for the first time. After working for half an hour, he complained of pain in the left shoulder. The trainer asked him to continue, as it was his first day.

After about 20 minutes this young executive suffered severe chest pain when he was rushed to hospital. He collapsed and cardiac resuscitation was done. His ECG showed Extensive Heart Attack for which an emergency angioplasty was done and patient survived. After investigations his LPA levels were 130mg.

Hence a word of caution for all fitness freaks. Heart disease and heart attacks have assumed epidemic proportion in India over the past two decades. It is one of the leading causes of death and long-term disability. Based on the evidence, heart diseases will double by 2015 and become the single largest contributor to mortality, accounting for almost one-third of all deaths.
Early manifestation

Not only is the incidence of heart attacks increasing significantly, but the blockage of coronary arteries manifests at least a decade earlier. Every sixth patient with heart attack is below 40 years of age. Young Indians have a five to 10 fold higher rate of heart attacks and deaths as compared to Western population. Indians all over the world have the highest rate of mortality and morbidity for heart attacks whereas the incidence of heart attack have halved in the West during the past 30 years. Irrespective of gender, religion and social class, the high rates of heart attacks in Indians are in sharp contrast to very low rates in other Asians such as Japanese and Chinese.

The most important reason is a combination of nature and nurture — genetic pre-disposition (nature), urbanisation with affluence (nurture). Genetic pre-disposition is reflected by levels of Lipoprotein–A (LPA), which is higher in Indians. Sedentary habits and western lifestyle leads to decreased physical activity, increased consumption of junk food results in obesity, insulin resistance and atherogenic lipid abnormalities. High LP (A), high triglycerides, high levels of bad cholesterol and low levels of good cholesterol predispose heart diseases and heart attacks.
What you can do

Lifestyle modification is of prime importance. One should walk about five kilometres in 45 minutes at least five days a week. Unaccustomed exercises should be avoided. Preventive measures should be undertaken in those with risk factors but without established disease i.e., counselling for tobacco use, early diagnosis and treatment of high blood pressure, diabetes mellitus and dietary measures to treat lipid abnormalities. All these are important in those individuals who have a family history of heart diseases.

The family physician should be trained to recognise signs and symptoms and ECG evidence of heart attacks and institute first aid measures and prompt referral to a hospital where definite therapy can be given.

SAVE YOUR KIDNEYS


The twin bean-like organ located on either side of the spine is better known as the biochemist of the body. The kidneys filter about 200 litres of fluid every 24 hours and return it to the blood stream. Approximately 1.5-2 litres is eliminated from the body in the form of urine, and the rest is retained. The production of urine involves highly complex steps of excretion and re-absorption, which is necessary to maintain a stable balance of body chemicals.

Kidneys perform crucial functions, which affect all parts of the body. But the kidneys are also vulnerable to a range of problems from a minor urinary tract infection to progressive kidney failure. Advances over the past three decades have improved the ability to diagnose and treat those who suffer from kidney disorders.

Kidney diseases usually affect both kidneys. If the kidney’s ability to remove and regulate water and chemicals is seriously damaged, waste products and excess fluids build-up, causing severe swelling and symptoms of kidney failure.
Different kinds

The different types of kidney diseases are characterised as Hereditary, which can be transmitted to both males and females and generally produce clinical symptoms from teenage years to adulthood; Congenital, which usually involves some malformation of the genitourinary tract leading to obstruction; Acquired, also known as nephritis or inflammation. The most common is "glomerulonephritis".

Kidney failures are not always permanent. Some get better after treatment. With acute kidney failure, dialysis may be needed until the kidneys get better. In Chronic or End Stage Kidney Failure, there is no improvement and dialysis is a must for the rest of the patient’s life. If the patient is in a fit condition, kidney transplant can be one treatment option.

Unfortunately, many kidney diseases are still of unknown cause. Some can be successfully treated while others progress to advanced kidney failure, or End Stage Renal Diseases (E.S.R.D) requiring dialysis and/or transplantation.

Dialysis is performed routinely on persons who suffer from acute or chronic renal failure, or who have ESRD. It involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used for individuals who have been exposed to or ingested toxic substances to prevent renal failure.
Treatment

Haemodialysis removes waste products from the blood by passing it out of the body, through a filtering system (dialyser) and returning it, cleaned, to the body. While in the filtering system, the blood flows through tubes made of membranes that allows the waste products (which are much smaller than the blood cells) to pass out. The waste products pass through the membrane into a dialysis solution (dialysate), then out of the machine. The clean blood is returned safely to the body. This cycle is repeated throughout the dialysis session. It takes about four hours to complete a session and it needs to be done thrice a week.

In Peritoneal Dialysis, instead of being cleaned by an artificial membrane outside the body, the blood is cleaned inside the body, through the Peritoneum (a thin membrane that surrounds the outside of the organs in the abdomen).The peritoneum allows waste products to pass through it and is very rich in small blood vessels. By running a dialysis fluid into the peritoneal cavity through a tube called Catheter, and then out again, waste can be filtered from the blood.
Two types

There are two types of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis or CAPD is done without machines. The patient can do it himself, usually four or five times a day at home or at work, while continuing with regular life. Automated Peritoneal Dialysis or APD is a more refined version. In this the dialysate solution is changed by a machine, at night, while the patient is asleep.

In both cases, the patient can travel, as the bags can be delivered to the visiting areas. In APD the small size of the machine makes it easy to travel.

Kidney transplant or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. There are two sources of kidney donors: Living and Deceased. But before opting for transplant one should thoroughly consult his doctor and get a physical examination done.

The writer is a Consultant Nephrologist based in New Delhi.
Warning signs

Burning or difficulty during urination

An increase in frequency of urination, nocturnal

Passage of bloody urine

Puffiness around eyes

Swelling of hands and feet

Pain in back just below ribs

High blood pressure

FOOD FOR YOUR MOOD


There is a deadline at work, you feel the pressure mounting and you haven’t had much sleep. You feel tired, petulant and anxious. You reach for that bag of chips or packet of biscuits as you try and figure out your presentation. You haven’t had lunch so you are ravenous. You finish that bag of chips and the biscuits and a bottle of some sweet syrupy drink. Why are you still hungry?

You go home in the evening and as you work at your laptop you pile up your plate with, you’re not sure what exactly, something greasy and filling. You mindlessly shovel food into your mouth as you try and focus.

Late into the night you eat a big bowl of ice cream as you watch the late night news, while another part of your brain tries to fathom the final touches to your presentation. By the time you get to bed at 2.00 a.m. you are exhausted, disconcerted and strangely, still hungry. Does this sound familiar?

Here’s another scenario. You’re feeling depressed and sad. You try to appease your senses with chocolate; as you keep eating, you seem to feel better, and the gratification of that creamy chocolate helps, temporarily.

An hour later, you reach for a piece of fresh cream cake; somehow it doesn’t seem to stop with a piece. Before you know it, the entire cake is over. Does this sound familiar too?
Connections

Is there a connection between Mood and Food? Apparently, yes.

All too often we find that our longings for food, especially ‘unhealthy’ food, happen to concur with the most vulnerable periods in our life. During emotional low points, we discover ourselves unconsciously seeking solace in food.

Emotional eating however can disrupt our well meaning efforts at weight loss and healthy eating. This leads to a tailspin of weight gain, self recrimination, and plummeting self-confidence, leading to further despair and over eating.

First, we need to understand that nearly all unhealthy eating is motivated by something we’re not always aware of on a conscious level. It is most often the result of unconstructive thoughts, beliefs and attitudes that may be lurking just below our conscious awareness.

This negative thinking is invariably the product of negative programming that we might have assimilated in childhood from parents, teachers, etc. We may have learnt early to soothe unpleasant feeling of a tumultuous childhood for instance with a candy bar, or parents may have used food as a reward for ‘good behaviour’.

The positive sensations that were associated with the food involved may often need to be re-experienced in adulthood whenever one is anxious or unhappy. Major life stressors — such as death of a loved one, unemployment, ill health, divorce, day to day set backs such as bad weather and unwelcome changes in your normal routine can trigger emotions that encourage overeating.

But why do negative emotions lead to overeating? Some foods have seemingly addictive qualities. For example, when you eat beguiling foods, such as chocolate, your body releases trace amounts of mood-enhancing hormones. Eating it may make you feel better, if only momentarily.
Distraction

Food can also be a distraction. If you’re concerned about an imminent event or rethinking an earlier conflict, eating comfort foods may distract you. But the distraction is short-lived. While you are eating, your thoughts may focus on the satisfying taste of your comfort food. Unfortunately, when you’re done overeating, your attention returns to your worries, and you may now bear the additional burden of guilt about overeating.

As you might have realised, "will power" alone is an ineffective tool to address this problem, since our unconscious motivations are much more powerful and persistent than our conscious desire to eat healthy, exercise and so on.

The only valid and permanent solution to our unhealthy eating habits is to get to the heart of the problem, analyse and eliminate the toxic thinking pattern that created our bad habits in the first place. This may require some amount of counselling and a deeper understanding of the issues at hand.

Happy occasions also call for celebration with food as our society is immersed in experimenting with gastronomic pleasures at any pretext possible. So it doesn’t help your resolve to eat healthy when inundated with an array of pleasures for the palate. If on such an occasion, you are stressed, anxious or unhappy, needless to say, the problem is compounded.

Of course, it’s very important to be armed with a healthy diet plan and a well-structured exercise programme that you can sustain. But neither of these things alone can bring about real and lasting weight loss if our own subconscious mind and concealed thoughts are still destroying us.

The writer is a Practising Obgyn, Fitness and Lifestyle Consultant,

NAFC (USA) and Director, TFL Fitness Studio, Chennai. E-mail: drsheela@tflinc.net
How to stop this futile cycle

Learn to recognise real hunger. Studies have found that the body is sometimes unable to distinguish true hunger from just stress or even thirst. (The next time you think you are hungry, drink a glass of water, wait a while and see if you are still experiencing hunger.)

Identify the triggers that lead you to overeat. Maintaining a ‘food journal’ for a week or two is an excellent way of recording your food intake, satiety levels and correlated mood. You may find to your surprise that there is a very definite association between that stressful meeting you need to attend and your reaching for the nearest ‘comfort food’, or your tendency to overeat at lunch when you have had a showdown with the kids or your spouse.

Identify the thoughts and feelings you normally experience before your gluttonous enterprise and those that justify your indulgences.

The best way to circumvent the downward spiral of overeating, self-loathing and then further overeating is to avoid keeping those sinful temptations near at hand. Instead, stock up on healthier options, so if real hunger strikes you are not left feeling frustrated.

Exercise regularly. It has been found repeatedly that exercise acts as a stress reliever. Modalities like Yoga and meditation go a long way in managing stress. Any form of low to moderate intensity cardiovascular activity like a walk or a swim will help relieve stress. Find your favourite mode of exercise and use it to get you through the tough times instead of using food as a way out.

Get adequate sleep. Sleep deprivation has been shown to confuse the body into misreading the body’s signals of fatigue as hunger.

Make a habit of ‘mindful eating’. Taking 10 minutes off for your meal will enable you to focus completely on the food and enjoy it, rather than consuming hundreds of calories without actually registering it.

Find other outlets for your stress. Taking a walk, talking to a friend, watching a movie, pursuing a hobby can all substitute as distractions instead of food during susceptible times.

See a therapist. If after your attempts to gain control of the situation you find there is no progress, it may be time to see a therapist to delve a little deeper into the psychological aspect of the problem.

Upheavals are part and parcel of life. Learning to use the right resources to deal with unpleasant feelings is an important part of staying healthy. If you intend to make meaningful changes in your diet, weight and lifestyle, understanding yourself a little better will go a long way in preventing self sabotage and regret.